Discover and read the best of Twitter Threads about #ASH21
Most recents (18)
1/ Question for #MMsm hive mind 🙏
For patients with functional high-risk myeloma (e.g., relapse ≤18 mo of 1st-line Tx), any good summary of data for functional high-risk vs high-risk FISH vs both?
Summarizing what I found so far, but I know I must be missing a few studies!
For patients with functional high-risk myeloma (e.g., relapse ≤18 mo of 1st-line Tx), any good summary of data for functional high-risk vs high-risk FISH vs both?
Summarizing what I found so far, but I know I must be missing a few studies!
2/ In KarMMa-2 Cohort A from #ASH22 by @szusmani @DrKrinaPatel et al, 37 patients with #MMsm enrolled in early ide-cel trial for functional high-risk.
Of n=22 with evaluable FISH (I wish it were a little higher), 45% didn't have any high-risk features.
ashpublications.org/blood/article/…
Of n=22 with evaluable FISH (I wish it were a little higher), 45% didn't have any high-risk features.
ashpublications.org/blood/article/…
3/ In #ASH21 RWE #MMsm database analysis by @kansagraMD et al, 1719 pts analyzed inc. hypodiploid as high-risk 🐠
Thanks Ankit for this awesome work! Am I analyzing abstract correctly to say that 73% of functional high-risk pts had standard FISH? 🤯
ashpublications.org/blood/article/…
Thanks Ankit for this awesome work! Am I analyzing abstract correctly to say that 73% of functional high-risk pts had standard FISH? 🤯
ashpublications.org/blood/article/…
🚥 #leukemia #ASH21 🛎️ Last call for poster #️5️ 〰️ Graaph-2014 study ➕ adding Nelarabine to chemo for #ALL pts 🔹 #OncTwitter w/ @LoriMuffly & @LuskinMarlise 🔸#CME from @BonumCe 🔗bit.ly/3FIOane 🔸Supported by edu grant Jazz Pharma twitter.com/i/broadcasts/1…
2/🟠Get your 🆓 #CME
CME ℹ️👉 bit.ly/3FIOane
#MedTwitter #OncTwitter #leusm
✔️What are your credentials❓
CME ℹ️👉 bit.ly/3FIOane
#MedTwitter #OncTwitter #leusm
✔️What are your credentials❓
3/ 🏆#CME credit provided by @IntegrityCE
🤝In partnership w/ @BonumCe
⏱️ Please answer! ⏱️
🟢 PRE-polls before 💬
🔴POST-polls after 💬
🟠or🔗 bit.ly/3FIOane for #CME ℹ️
👇CME info 👇
🤝In partnership w/ @BonumCe
⏱️ Please answer! ⏱️
🟢 PRE-polls before 💬
🔴POST-polls after 💬
🟠or🔗 bit.ly/3FIOane for #CME ℹ️
👇CME info 👇
Myeloma FAQs for patients & clinicians. Please add additional questions.
1) Do you still recommend autologous stem cell transplant?
Yes. But for standard risk patients, delaying transplant is an option & gives similar survival (#ASH21 below). Look forward to #ASCO22 plenary.
1) Do you still recommend autologous stem cell transplant?
Yes. But for standard risk patients, delaying transplant is an option & gives similar survival (#ASH21 below). Look forward to #ASCO22 plenary.
2) What regimen do use for initial therapy?
VRd for most. Dara plus VRd for young high risk patients as pre transplant induction.
DRd is an alternative to VRd; but you need Dara plus Revlimid for many years. With VRd after 6-8 months it's only Revlimid. onlinelibrary.wiley.com/doi/abs/10.100…
VRd for most. Dara plus VRd for young high risk patients as pre transplant induction.
DRd is an alternative to VRd; but you need Dara plus Revlimid for many years. With VRd after 6-8 months it's only Revlimid. onlinelibrary.wiley.com/doi/abs/10.100…
3) What do you use for maintenance therapy?
Lenalidomide alone for standard risk. Lenalidomide plus bortezomib for high risk.
Lenalidomide alone for standard risk. Lenalidomide plus bortezomib for high risk.
🎄tweetorial
Is MGUS more common in patients with osteoporosis? Do patients with MGUS have lower bone density? Should patients with osteoporosis be screened for MGUS? Or patients with MGUS screened for osteoporosis? What does the data (and guidelines) say?
🧵
#mmsm #medtwitter
Is MGUS more common in patients with osteoporosis? Do patients with MGUS have lower bone density? Should patients with osteoporosis be screened for MGUS? Or patients with MGUS screened for osteoporosis? What does the data (and guidelines) say?
🧵
#mmsm #medtwitter
We know from work done by the gurus of myeloma- that fractures are more common in patients with mgus than general population
But are fractures because of decreased done density or existing osteoporosis? We didn’t know.
pubmed.ncbi.nlm.nih.gov/14753733/
But are fractures because of decreased done density or existing osteoporosis? We didn’t know.
pubmed.ncbi.nlm.nih.gov/14753733/
More work from the Mayo Group did also show that patients with MGUS had a slightly higher risk of osteoporosis, but you can see- the RR was 1.2 with 95% CI of 1.0-1.4.
pubmed.ncbi.nlm.nih.gov/19648385/
pubmed.ncbi.nlm.nih.gov/19648385/
I loved all the best of #ASH21 threads this year, but in this thread I highlight 5 deeply flawed marketing advertisements (studies) that should not change practice.
#mmsm 🧵
#mmsm 🧵
I will start by saying that it is very hard to criticize studies without offending people, so I apologize sincerely and it is my intention only to call out what I perceive as flawed. I may be wrong, and many of these authors have done more than I ever will for myeloma
1:
bit.ly/3GTkXGt
We had chance to universally give dara upon progression to control arm in newly diagnosed MM in 3 different trials. But we didn’t. And now we shouldn’t just create a modeled scenario with so many assumptions and say it’s better to give dara up front
bit.ly/3GTkXGt
We had chance to universally give dara upon progression to control arm in newly diagnosed MM in 3 different trials. But we didn’t. And now we shouldn’t just create a modeled scenario with so many assumptions and say it’s better to give dara up front
I confess that after #ASH21 I likely will use more quads.
but it isnt because Isa-RVD vs RVD showed ⬆️1 timept MRD🙄- or that GRIFFIN (DRVD vs RVD) showed signal for PFS benefit.
Read on for a 🧵on uncertainty, equipoise, decision making as an oncologist
@AaronGoodman33
#mmsm
but it isnt because Isa-RVD vs RVD showed ⬆️1 timept MRD🙄- or that GRIFFIN (DRVD vs RVD) showed signal for PFS benefit.
Read on for a 🧵on uncertainty, equipoise, decision making as an oncologist
@AaronGoodman33
#mmsm
Before we delve in, there are two facts that the evidence seems to indicate:
Fact 1:
-MRD is undoubtedly prognostic, those that achieve (and sustain) MRD neg tend to have better outcomes than those who dont achieve and sustain MRD neg.
Fact 1:
-MRD is undoubtedly prognostic, those that achieve (and sustain) MRD neg tend to have better outcomes than those who dont achieve and sustain MRD neg.
Fact 2:
Youd be neglecting the history of myeloma literature, if you looked back and didnt notice that interventions to deepen response (and achieve MRD negativity) havent always translated to increased overall survival, if those interventions were given later in disease course.
Youd be neglecting the history of myeloma literature, if you looked back and didnt notice that interventions to deepen response (and achieve MRD negativity) havent always translated to increased overall survival, if those interventions were given later in disease course.
So #twitterx doesn't throw me in Twitter jail, here are 10 #ASH21 abstracts...as HARRY POTTER characters.
I couldn't decide if I should rank based on "impactful" or "practice changing", so these are some that I think everyone should *read carefully*, and I tried to make it fun!
I couldn't decide if I should rank based on "impactful" or "practice changing", so these are some that I think everyone should *read carefully*, and I tried to make it fun!
1. POLARIX = Severus Snape ash.confex.com/ash/2021/webpr… Why? Because of how controversial this is, and also this is a well done study. Should we change practice based on a drug without an OS or QOL benefit? I argue no. Nagini, kill. #lymsm
2. GRAAPH-2014 Study = Dudley Dursley ash.confex.com/ash/2021/webpr… Removing HiDAC from chemo in Ph+ ALL worsened outcomes. A cautionary tale that we can’t get greedy and we need RCT data like this as we “de-intensify” regimens in ALL with novel therapies like blin, TKIs, etc. #leusm
Clinical trials:
See one
Do one
Teach one
Without leading a trial it's hard for you to realize how hard it is to do one and you may end up throwing stones at investigators trying to do their best. #ASH21
See one
Do one
Teach one
Without leading a trial it's hard for you to realize how hard it is to do one and you may end up throwing stones at investigators trying to do their best. #ASH21
See this thread on how many people control the design of a trial. Most of this thread applies also to investigator initiated non randomized trials also. #ASH21
When you have this brilliant idea on how a trial should have been designed, in many cases the PI is also brilliant enough to know the same but they often had to make the hard choice of putting their foot down and not have a trial at all or compromise.
#ASH21
#ASH21
1/12 Tweetorial on initial therapy in older adults with #AML at #ASH21. We presented on CPX-351 vs ven/aza. There was no difference in OS. HR 0.88 with 95%CI crossing 1. OS at 2yrs 28% both arms and median OS 13 vs 11 mos tinyurl.com/2p95bn78. #leusm
2/12 We looked at 656 patients at Penn and across the nation with Flatiron. Ven/aza patients were older, more likely to be treated in community rather than academic centers and more had de novo AML.
3/12 There was no difference in OS among univariate subgroups and no difference after: unadjusted, multivariate Cox (MVC), restriction to CPX-351 eligible patients only, multiple imputation (MI) and MVC, and MI & inverse probability of treatment weighting.
Besides my Top 5 picks in myeloma at #ASH21 listed below the 3 most important findings being presented in myeloma this year are:
1) A variety of bispecifics showing high single agent activity
2) CAR-T efficacy
3) PFS improvement with Dara-VRd in GRIFFIN
#ASH21VR
1) A variety of bispecifics showing high single agent activity
2) CAR-T efficacy
3) PFS improvement with Dara-VRd in GRIFFIN
#ASH21VR
Bispecifics and CART single agent activity is more than double of the single agent activity seen with existing drugs. Slide from @TomBmt133 #ASH21
Cilta-cel efficacy presented by @TomBmt133 is also outstanding and well summarized in this tweet by @ninashah33 #ASH21
Recs for using free light chains (FLC) in practice. #ASH21
1) We get a lot of consults for abnormal FLC ratios /levels. If FLCs are the only abnormality, you don't need to do much unless involved/uninvolved ratio is >8.
Don't chase minor abnormalities.
ashpublications.org/blood/article/…
1) We get a lot of consults for abnormal FLC ratios /levels. If FLCs are the only abnormality, you don't need to do much unless involved/uninvolved ratio is >8.
Don't chase minor abnormalities.
ashpublications.org/blood/article/…
2/ If there is clinical concern for light chain process like amyloid or if there is intact immunoglobulin M spike, u can do more. But uncomplicated FLC ratio <8 is almost never going to be high risk SMM. #ASH21
Light chain MGUS with FLC ratio <8 is managed like low risk MGUS.
Light chain MGUS with FLC ratio <8 is managed like low risk MGUS.
3/ When we first established the normal FLC range it was a new test and the consequences of abnormal value was not known. A very strict cut off was used. We know now that the normal ratio is affected by age and creatinine. @sykristinsson #ASH21 ash.confex.com/ash/2021/webpr…
Few prelim thoughts on this trial (from quick read)
#ASH21
1. It is not a 'second line' trial, it is a trial in the worst subset of second line pts & cannot extrapolate beyond
Primary refractory & relapse <12 mo
(TBH, a lot of people doing this already)
#ASH21
1. It is not a 'second line' trial, it is a trial in the worst subset of second line pts & cannot extrapolate beyond
Primary refractory & relapse <12 mo
(TBH, a lot of people doing this already)
As such, it should not generalize to relapse > 12 months
2. That said, for those included, axi-cel seems preferable to chemo then auto; I am not surprised this is true in the most chemo insensitive biology. But a few more thoughts
2. That said, for those included, axi-cel seems preferable to chemo then auto; I am not surprised this is true in the most chemo insensitive biology. But a few more thoughts
3. This is Wrong, you are not supposed to do this 👇👇
Standard practice is to take these pts to CAR-T if needed in the control arm; thus, you must compare routine, upfront CAR-T to using CAR-T as salvage when indicated and standard of care.
And you don't adjust for it
Standard practice is to take these pts to CAR-T if needed in the control arm; thus, you must compare routine, upfront CAR-T to using CAR-T as salvage when indicated and standard of care.
And you don't adjust for it
#ASH21 Oral abstract:Ciltacabtagene Autoleucel for Triple-Class Exposed MM:Adjusted Comparisons of CARTITUDE-1 Patient Outcomes Versus Therapies from Real-World Clinical Practice from the LocoMMotion Prospective Study #mmsm 🧵
➡️ash.confex.com/ash/2021/webpr…
🛑some important issues👇
➡️ash.confex.com/ash/2021/webpr…
🛑some important issues👇
#ASH21 #mmsm
➡️Cilta Cel is effective in difficult to ttt pts, this is not the aim of the discussion
➡️In this abstract,authors compared a prospectively matched triple class ref MM pts who received diff ttt vs Cilta cel
➡️ what did they find? 👇 (Cilta Cel better) but wait🛑
➡️Cilta Cel is effective in difficult to ttt pts, this is not the aim of the discussion
➡️In this abstract,authors compared a prospectively matched triple class ref MM pts who received diff ttt vs Cilta cel
➡️ what did they find? 👇 (Cilta Cel better) but wait🛑
➡️Read results 👇
1️⃣countries:only 9% RWCP in US vs. 100% of pts who got Cilta Cel in CARTITUDE-1 were in US (16 Center) ➡️study compared pts across the ocean with diff access to ttt🙈
2️⃣>90 ttt options😅
3️⃣2 of the most frequently used regimens were doublet 🙈Kd (~14%),Pd (11%)
1️⃣countries:only 9% RWCP in US vs. 100% of pts who got Cilta Cel in CARTITUDE-1 were in US (16 Center) ➡️study compared pts across the ocean with diff access to ttt🙈
2️⃣>90 ttt options😅
3️⃣2 of the most frequently used regimens were doublet 🙈Kd (~14%),Pd (11%)
1/For this #ASH21 'Best of Abstracts' selection, I asked my @sloan_kettering #mmsm service team members for top 5 abstracts in different categories. Please follow the thread below for the #ASH21_MSKMM selections:
2/Top 5 Basic/Translational
-ash.confex.com/ash/2021/webpr…
- ash.confex.com/ash/2021/webpr…
- ash.confex.com/ash/2021/webpr…
- ash.confex.com/ash/2021/webpr…
-ash.confex.com/ash/2021/webpr…
- ash.confex.com/ash/2021/webpr…
- ash.confex.com/ash/2021/webpr…
- ash.confex.com/ash/2021/webpr…
$NVS R&D day slides
novartis.com/sites/novartis…
$SAN $SNY Vaccine day slides from yesterday
Part 1
sanofi.com/-/media/Projec…
Part 2
sanofi.com/-/media/Projec…
novartis.com/sites/novartis…
$SAN $SNY Vaccine day slides from yesterday
Part 1
sanofi.com/-/media/Projec…
Part 2
sanofi.com/-/media/Projec…
$NVS featured multi-b$ products
$NVS Strategy to 2026
main approvals by mkt potential & current "strength of evidence"
earlier stage pipe in pharmaceuticals & oncology
main approvals by mkt potential & current "strength of evidence"
earlier stage pipe in pharmaceuticals & oncology
Here are my Top 10 #ASH21
@ASH_hematology myeloma abstracts.
Links to the full abstract. As in the past, I focus on scientific innovation and clinical high-impact studies.
@SylvesterCancer #mmsm @mtmdphd
Thread with countdown
👇
@ASH_hematology myeloma abstracts.
Links to the full abstract. As in the past, I focus on scientific innovation and clinical high-impact studies.
@SylvesterCancer #mmsm @mtmdphd
Thread with countdown
👇
1) Prevalence of Smoldering Multiple Myeloma: Results from the Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) Study. ash.confex.com/ash/2021/webpr…
A game changer for the field, addressing the role of population screening.
#ASH21 @SylvesterCancer #mmsm @mtmdphd
A game changer for the field, addressing the role of population screening.
#ASH21 @SylvesterCancer #mmsm @mtmdphd
2) Monoclonal Gammopathy of Undetermined Significance and COVID-19: Results from the Population-Based Iceland Screens Treats or Prevents Multiple Myeloma Study (iStopMM). ash.confex.com/ash/2021/webpr… Highly important information for individuals diagnosed with MGUS. #ASH21
Here are my Top 5 #ASH21 @ASH_hematology myeloma abstracts. #ASH21VR
Links to the full abstract. As in the past, I left out studies where similar results were already presented or published before. Top 5 based on new data, clinical impact & methodology
Thread with countdown👇
Links to the full abstract. As in the past, I left out studies where similar results were already presented or published before. Top 5 based on new data, clinical impact & methodology
Thread with countdown👇
#5 Outcome of patients with refractory myeloma treated with bispecific antibodies.
64 patients. Median 7 prior regimens. 58% response rate. Importantly median survival 18 months — brings hope. @tarekmd91 @JoshuaRichterMD @MountSinaiNYC #ASH21 #ASH21VR ash.confex.com/ash/2021/webpr…
64 patients. Median 7 prior regimens. 58% response rate. Importantly median survival 18 months — brings hope. @tarekmd91 @JoshuaRichterMD @MountSinaiNYC #ASH21 #ASH21VR ash.confex.com/ash/2021/webpr…
#4 Prevalence of smoldering myeloma (SMM) in the general population.
75,000 person RCT iStopMM estimates prevalence at 0.5% of population age >=40 #ASH21 #ASH21VR @SigrunThorstei1 @sykristinsson @DrOlaLandgren @TBSsteharding @BrianDurieMD @MalinHultcrantz ash.confex.com/ash/2021/webpr…
75,000 person RCT iStopMM estimates prevalence at 0.5% of population age >=40 #ASH21 #ASH21VR @SigrunThorstei1 @sykristinsson @DrOlaLandgren @TBSsteharding @BrianDurieMD @MalinHultcrantz ash.confex.com/ash/2021/webpr…
Interrupting the #Omicron coverage flooding your feed for some under-the-radar ASH abstracts to which I'm looking forward. Collectively, these aren't the "stock moving" headliners that will get broader attention, but are sleepers with important & far-reaching implications (1/24)
In the non-viral delivery world, first HSC-tropic LNP data in NHPs from $BEAM, showing up to ~19% "transduction" at doses up to 1mg/kg. Recall, we've seen directionally similar efficacy data from $NTLA, but doses were not disclosed (2/24)
ash.confex.com/ash/2021/webpr…
ash.confex.com/ash/2021/webpr…
Bone marrow is likely the next frontier for LNPs, and is looking increasingly tractable with cell-selective activity afforded by lineage-specific gene expression (eg BCL11a). Potency needs to improve, but BM-directed LNP could truly be an end-game of sorts for SCD / B-thal (3/24)
