Discover and read the best of Twitter Threads about #ASH22
Most recents (24)
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/…
1/As promised & after reading $CRSP latest Q4 2022 #financial #report here is my impression regarding @CRISPRTX latest corporate status. I have focused only on the main issues that I found to be the most interesting & relevant. #CRISPR #BioTech #FinTwit #Genomics #GeneEditing 🧵
2/IMO the most significant corporate event in Q4 was $CRSP announcement that regulatory Exa-cel submissions of both #SickleCell & #BetaThalassemia validated in the #EU & #UK & that the @US_FDA BLA submission is on track by the end of Q1 ‘23 - possibly reaching the #markets in ‘23
3/Exa-cel/CTX001 - the key program in $CRSP portfolio, is an #autologous Ex-Vivo #CRISPR/#Cas9 #GeneEditing therapy aimed for patients suffering from #TDT or severe #SCD. The latest readout for both programs was phenomenal with 42/44 TDT & 31/31(!) demonstrated remarkable results
#mmsm How do I treat smoldering myeloma?
Observation
How do I treat “high risk” smoldering myeloma?
Observation
Why don’t I enroll on most clinical trials of smoldering myeloma?
Because they assume that treatment (active control arm) is beneficial
🧵
Observation
How do I treat “high risk” smoldering myeloma?
Observation
Why don’t I enroll on most clinical trials of smoldering myeloma?
Because they assume that treatment (active control arm) is beneficial
🧵
In clinic, my consultation for smoldering myeloma takes a long time to go over details.
Patient must have completed comprehensive workup including advanced imaging
I yet to have a patient telling me they want a treatment after discussion
Patients appreciate uncertainty
Patient must have completed comprehensive workup including advanced imaging
I yet to have a patient telling me they want a treatment after discussion
Patients appreciate uncertainty
Since we treat many patients, I see many smoldering myeloma pts who already started ttt because of oncologist thinking they will help pts and that some in the field are pushing hard to make this “standard of care”, which is not
Few observations👇
Few observations👇
Bispecific antibodies, infections & myeloma: a 🧵
Myeloma patients are at high risk of infections
An antibody that drags T-cells to attack plasma cells probably impacts immunity - but we don't know for sure yet
ascopubs.org/doi/full/10.12… @JCO_ASCO @ManniMD1 @akesselheim
#mmsm
Myeloma patients are at high risk of infections
An antibody that drags T-cells to attack plasma cells probably impacts immunity - but we don't know for sure yet
ascopubs.org/doi/full/10.12… @JCO_ASCO @ManniMD1 @akesselheim
#mmsm
We compiled infection rates across myeloma bispecific trials, updated to include #ASH22 data
The majority of patients across trials developed infections, w 20-45% developing grade 3 infections & some deaths from infection ⬇️
Note the frequency of neutropenia & hypogam
The majority of patients across trials developed infections, w 20-45% developing grade 3 infections & some deaths from infection ⬇️
Note the frequency of neutropenia & hypogam
Of course, in single-arm trials, we cannot know whether these events are caused by the patients' multiply-relapsed myeloma (known to cause significant immunosuppression), previous lines of treatment, or trial drug/s, or the extent to which each factor contributes
At @ASH_hematology #ASH22 highlights I am being told some transplanters are refusing to do #AlloHSCT for otherwise eligible #AMLSm younger pts in CR because of bialleic #TP53 +MRD, I don’t think this is acceptable. Counsel on poor outcomes but there is a tail at end of OS curve
Even if it 10%. I anecdotally had few pts who lived for years post transplant going in with TP53 bialleic complex type & MRD+ CR. I don’t think you should deprive pt only possibly of cure just to try to eradicate pre-allo MRD which often does not occur with any pre-transplant tx
Give MAC & throw in early maintenance & hope GVL effect kicks in before relapse. We have to be humble about how we council using data. Encourage trials of novel agents, counsel patients honestly, if older pt who can’t get MAC then maybe discourage transplant not in younger pt
Today, JAMA Oncology's lead article shows that ppl with #hematologic #cancers are among the most vulnerable to COVID infections/hospitalizations.
Thank you to those who went against the grain to mask at the #ASH2022 #ASH22 hematology conference.
jamanetwork.com/journals/jamao…
Thank you to those who went against the grain to mask at the #ASH2022 #ASH22 hematology conference.
jamanetwork.com/journals/jamao…
I will post a thread on our invited editorial later today.
Here is our editorial with suggested solutions:
10 years ago JesusSanMiguel GiampaoloMerlini and I laid out our vision for redefining myeloma. A paradigm change. @NatRevClinOncol @DianaNrco nature.com/articles/nrcli… #ASH22
The revised IMWG criteria redefining myeloma and related disorders was published in 2014 in @TheLancetOncol — and is now the most cited paper in the field. thelancet.com/journals/lanon…
We also have made significant progress in early detection and therapy of smoldering multiple myeloma as outlined here. @BloodCancerJnl nature.com/articles/s4140…
I just attended one of the biggest cancer meetings in the world. #ASH22 @ASH_hematology
For my followers here is a snapshot of the incredible progress happening with cancer treatment. It’s good. Thread.
For my followers here is a snapshot of the incredible progress happening with cancer treatment. It’s good. Thread.
1/ There is a revolution in cancer therapy that uses the power of our own immune system to fight cancer cells:
CAR-T cells
Bispecific antibodies
Both these approaches have already produced spectacular results in many cancers and we are just starting.
CAR-T cells
Bispecific antibodies
Both these approaches have already produced spectacular results in many cancers and we are just starting.
2/ CAR-T cells: take your own immune system cells out, engineer them to target a specific cancer, and then put them back in the body to go kill the cancer cells. A few CAR-T products have already been FDA approved. Many more to come. my.clevelandclinic.org/health/treatme…
The perfect photo to sum up 5 days of bone marrow transplant & blood cancer docs conference #ASH22 👇
Not a mask in sight, packed indoor setting
Multiply this x10000
It's time to end the charade
Stop virtue signalling
Abolish masking in hospitals
sensiblemed.substack.com/p/its-past-tim…
Not a mask in sight, packed indoor setting
Multiply this x10000
It's time to end the charade
Stop virtue signalling
Abolish masking in hospitals
sensiblemed.substack.com/p/its-past-tim…
These docs work on allogenic & autologous bone marrow transplant. They are 100% correct for not wearing a mask. It is illogical and nonsensical to wear masks after vaccination.
It had no good RCT data pre-vax
Post vax it is a delusion
Covid will infect ~all people
Vax & done
It had no good RCT data pre-vax
Post vax it is a delusion
Covid will infect ~all people
Vax & done
We have a crisis of poor thinking
Poor thinking is what led to bivalent booster being approved in children with no credible data
Poor thinking is omnipresent in COVID19 policy online
In real life, sanity and humanity win
Poor thinking is what led to bivalent booster being approved in children with no credible data
Poor thinking is omnipresent in COVID19 policy online
In real life, sanity and humanity win
今年はニューオリンズ(ルイジアナ州)で開催
市中心部ホテルはほぼ貸切(左下:会場のConvention Center)
メイン会場約8000席で講演によっては席がなくなるので,参加者一万人弱？🤔
他にも中規模の口演やポスター発表あり,ここらへんは日本と変わらないですね
市中心部ホテルはほぼ貸切(左下:会場のConvention Center)
メイン会場約8000席で講演によっては席がなくなるので,参加者一万人弱？🤔
他にも中規模の口演やポスター発表あり,ここらへんは日本と変わらないですね
グッズ販売
Around the clock Hematology→『24時間 働こう🩸』というメッセージ😭
... 大丈夫です✌️😎
ジムで鍛えつつ講演聴けます💪
疲れたら,仮眠しながら講演聴けます😴
Around the clock Hematology→『24時間 働こう🩸』というメッセージ😭
... 大丈夫です✌️😎
ジムで鍛えつつ講演聴けます💪
疲れたら,仮眠しながら講演聴けます😴
Two oral abstracts on the #STELLAR study (Sickle Cell Transplant Evaluation of Long-term and Late Effects Registry) presented by Dr. Sobenna George (hi!) and Dr. Lillian Meacham #ASH22 1/n
What's the problem? You can get DOR = diminished ovarian reserve or POI = primary ovarian insufficiency (early menopause). This is SUCH a good explanation!! #ASH22 2/n
Small numbers but such great data, 30 females and 18 males, about 4-6 years post therapy (myeloablative transplants (mostly matched sib) and one each with gene tx) #ASH22 3/n
How many patients are on disease modifying treatments for #SCD - data from 2014-2021 presented by Dr. Terri Newman. @ash22 1/n
We're talking about #Hydroxyurea and in 2017, expanded use of #HU as well as L-glutamine and then in 2019 #voxelotor and #crizanlizumab. #ASH22 2/n
They looked at 5022 patients with Rx of DMTs. Those on DMTs were surprisingly mostly in the 18-45 group (the box is wrong on the screenshot) and mostly male and had more VOCs. #ASH22 3/n
Management of pregnant women with #SCD in high income countries with Dr. Eugene Oteng-Ntim (with the cutest intro from Dr. Eugenia Asare). Writing down the #pearls here so I can share with my patients for their future and so I can advocate for them. #ASH22 1/n
As we know, more low/not detectable AMH levels in women with #SCD. Know that preimplantation diagnosis and successful transfer is possible with data to support that. And many want #NIPT secondary to fear of amnio or CVS, which can be done. (w/ @Nonacus) #ASH22 2/n
What risks are we talking about in sickle cell disease and pregnancy? 1/4 of the patients in their cohort required transfusion during pregnancy and RR of preeclampsia is 2.43 and 3x risk of SGA, 4x risk of stillbirth. #ASH22 3/n
This will be the BEST THING you read in a long time👇
An East Coast Infectious Disease Doc & Prof analyzes why no one wants to go into ID even AFTER A PANDEMIC
The analysis is damning. Fauci, Covid zealotry, virtue signaling, and so much more!!
WOW!
vinayprasadmdmph.substack.com/p/why-no-one-w…
An East Coast Infectious Disease Doc & Prof analyzes why no one wants to go into ID even AFTER A PANDEMIC
The analysis is damning. Fauci, Covid zealotry, virtue signaling, and so much more!!
WOW!
vinayprasadmdmph.substack.com/p/why-no-one-w…
Some ID docs boycott Emily Oster. How sad is it that you can't even talk to people who were pro-school opening?
#1 they were right, & you were wrong
#2 you are an adult who can't have an adult conversation.
To me this is intensely pathetic, but increasingly common
#1 they were right, & you were wrong
#2 you are an adult who can't have an adult conversation.
To me this is intensely pathetic, but increasingly common
ID docs are making statues of Fauci, but honesty means you have to acknowledge that he was 100% wrong about schools & he went on TV and said thing that harmed a generation of poor kids
ID docs need to be honest about Fauci, who is a flawed man, like all men, clutching power
ID docs need to be honest about Fauci, who is a flawed man, like all men, clutching power
Dr. Mark Fleming talking about pathology vs molecular testing in MDS. He first reminds us the difference of childhood MDS from adult MDS -- and these WHO guidelines, childhood MDS is only classified into these two subtypes. #ASH22 1/n
The issue is that the "dysplasia" definition has been defined by the cytogenetic abnormalities and genotypes of adult MDS so the criteria for blast %age, extent of dysplasia -- but does this apply?? #ASH22 2/n
MDS in pediatric patients is more normo or hypocellular than hypercellular. There is not ringed sideroblasts in persons <30 and he also reminds us that there are a number of baseline dysplasias in germline BMF pts that are mistaken for MDS! #ASH22 3/n
#ASH22 Bone marrow failure syndromes: diagnostic principles in 2022. Starting with Sara Lewis, a genetic counselor in hematology. Follow this tweet for more. 1/n
Sara reminds us that she feels patients think more about their family history as they see her draw the pedigree. Time for me to start doing this! #phodocs #ASH22 #pearl 2/n
Here are the options for diagnostic workup - genetic tests can be done from somatic genes or germline! #ASH22 3/n
@bhwords Dr. Beverley Hunt presenting on #COVID19 and #thrombosis. She wants to chronologically review the battles we have fought! #ASH22 1/n
@MiddeldorpS starting with a big thank you :) Great job starting off with these #ASH22 difficulties. 1/n
@MiddeldorpS #ALIFE2 study of low molecular weight heparin vs standard pregnancy care RCT for recurrent miscarriage (2+) and inherited thrombophilia - 41 centers in 5 countries! #ASH22 2/n
@MiddeldorpS Intervention was once daily LMWH until delivery. Intent to treat analysis so required 324 randomized evaluable women. They screened more than 10k women for inherited thrombophilia to get these 326 women! Amazing amount of work. #ASH22 3/n
1/@GraphiteBio presented preclinical results supporting the use of a single-#cell #RNA #sequencing method to assess #gene correction outcomes in #patients treated with nulabeglogene autogedtemcel (nula-cel) - GPH-101. #BioTech #CRISPR #GeneEditing #Genomics $GRPH #ASH22
2/GPH101 (nula-cel) is a #CRISPR #Cas9 #GeneEditing autologous #stem #cell-based #therapy in clinical development aimed to treat #SickleCellDisease. GPH101 is designed to directly correct the underlying mutation, thereby decreasing HbS production & restoring HbA expression #ASH22
3 $GRPH gene correction platform involves editing hematopoietic #stem cells found in the #bonemarrow that develop into various types of #blood #cells. Since red blood cells lose their genomic DNA during maturation-tracking #GeneEditing in mature cells via sequencing is impossible
When I took on leadership of the #CHIP clinic @DanaFarber @DanaFarberNews, I was #bookedandbusy lots of #CHIP & #CCUS had been diagnosed since we rolled out our clinical NGS panel in 2014/15. But the uncertainty (the “indeterminate potential”) was disquieting.
Imagine someone hands you a grenade & says: don’t worry most don't explode. But some do. But most explosions don't kill you. But some do. We don’t know which grenade you have. Oh, and you must hold it forever
That's a hematologists diagnosing CHIP/CCUS, precursors to #MDS & #AML
That's a hematologists diagnosing CHIP/CCUS, precursors to #MDS & #AML
In truth, we're not totally compass-less. @jaiswalmdphd noted the association between high RDW & progression to myeloid neoplasm (MN) in early work.
Luca Malcovati & others noted risk was genotype specific: splicing factor mutations are higher risk than DNMT3A mutations
Luca Malcovati & others noted risk was genotype specific: splicing factor mutations are higher risk than DNMT3A mutations
@redcell_doc Sickle cell DISEASE has a unique reason for thromboembolism -- PE predominance - in situ or embolism from legs? Unclear still. But we know #SCT patients have higher D-dimer levels so maybe there's a hint for more in trait patients. #ASH22 2/n
@redcell_doc so, why not look into this diverse and high powered cohort? Did you know 80% of 23andme people consent to research cohort (caveat 90% of this cohort is from the United States)! #ASH22 3/n
Now back to learn about sickle cell trait #SCT from Faeben Wossenseged, BS. Their participants were mostly female. Retinopathy and hematuria seen in their results! 1/n
Amazing database available and they found 2.45% sickle cell trait carriers - reminds them we need to figure out how to do better #SCT carrier screening and know better how to counsel about this entity. #ASH22 2/2
Q: What about confounders for the SCT data (like for the retinopathy? A: something they are definitely looking to do in the future! (psst, we definitely want to know!) #ASH22
@SharonSavageMD presenting on #DyskeratosisCongenita #DC update. Starting a pt presentation with a de novo TINF2 variant. #ASH22 1/n
@SharonSavageMD She mentions her GI bleeding (as well as other findings) -- something I have seen in #DC. What we know - females do better than male (due to X-linked disease) #ASH22 2/n
@SharonSavageMD Squamous cell carcinoma and AML and MDS rates are high as we know in all these bone marrow failures -- and transplant accelerates this. #ASH22 3/n
#Voxelotor #SCD real world outcomes Q&A -- Q: what about concurrent HU vs not? A: we have thatdata, will get to it! 1/n
Q: what about stroke? A: it's mostly in pediatrics, and dataset is limited so REALLY important, but not from this data just yet. Here are his conclusions. 2/n
Q: improved outcomes here especially with VOC.. can we normalize against # of visits since pandemic may impact this? A: great point! Q: What about decreased ACS? A: No we haven't analyzed ACS but we have to have a # of rates to analyze it. 3/n
