Myeloma is a curable malignancy
#mmsm
Yes it is curable
The cure rate is not ideal (not all/most patients are cured)- there is still work to be done to improve
We estimate that one out of three patients with standard risk myeloma (vast majority of cases) are cured
🧵
#MedTwitter
Hungry macrophage👇(can see in macrophage activation syndromes/HLH/Infections/etc)
It already ate:
➡️red cells
➡️platelets
➡️monocytes
➡️neutrophils
➡️lymphocyte
⭐️The result is pancytopenia
Little Rock, Arkansas just got hit by a major tornado. Many people lost their homes and damage is still to be estimated
We are safe and blessed, thank you for all who reached out
Please keep all people here in your thoughts and prayers
#MedTwitter
#AcademicTwitter
observation on authorship and number of patients enrolled per author/country🧵
Will use this recent paper as example 👇
Assigning authorship maybe a complex process and depend on many other variables but it is interesting to notice the following:
It is an honor to win the
@GoHealio
Health Equity Disruptive Innovator Award for 2023
@ASCO
#ASCO23
#mmsm
#MedTwitter
Such a privilege to be recognized, thank you for the nomination and the award. It is a true honor
The goal is equitable healthcare for all
Grateful for the
@Myeloma_Society
for receiving young investigator award
#mmsm
#IMS23
on the work of secondary malignancies in long term transplant patients
#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
🧵
#mmsm
Despite the fact that Elranatamab data seem to be better than Teclistimab data, both were single-arm studies that cannot be compared. I made a summary 👇
We need less frequent/finite dosing in a trial setting (Elran had less dosing in a trial setting not per investigator👇)
This is an updated results data of BCMA CAR-T and BCMA BsAb with updated data from recent presentations/publications based on few requests I got
#mmsm
✅Updated data for Elranatamab looks great
✅In areas with equal access to CAR-T: no role for ide cel
✅Excellent BsAb data
How I Treat AL Amyloidosis
@BloodJournal
|
@ASH_hematology
#MMsm
➡️ Nice practical review,summary tables&suggested treatment algorithms with 5 cases
➡️Link:
🛑 it is amazing how science is advancing.Doxycycline study mentioned👇 just reported as negative
#mmsm
Pleased to announce that I will be presenting an oral presentation
@Myeloma_Society
#IMS23
@UAMSMyeloma
@uamscancer
and I will receive IMS young investigator award for exemplary abstract
Our group will present 2 oral abstracts, looking forward for a productive meeting
#ASH21
How to access the "educational book" online chapters?
@ASH_hematology
1⃣Go to program➡️sessions
2⃣Use filter:education and days
3⃣You will have a list,choose one
4⃣Scroll down until you see same name of presentation in red (small box)
5⃣See recording&PDF link(circle)
Unfortunately high publication fees affect academia negatively
Only researchers/institutions/Pharma who can pay such high amounts can publish.
Trainees, researchers with no financial support suffer more.
@inas_md
& me wrote:
#AcademicTwitter
Published at
@NEJM
. VIALE-A trial. Combination of AZA and Venetoclax resulted in ~5 months improvement in OS in elderly patients ineligible for intensive chemotherapy. Dr DiNardo et al
@LeukemiaMDA
🩸Heme boards🩸CAR-T made easy🧵
➡️Approved products/indications
1⃣Tisagenlecleucel (Kymriah): Refractory/Relapsed(>=2L) B-ALL (up to age 25yrs) & R/R Large B cell lymphoma(>=2L)
2⃣ Axicabtagene Ciloleucel (Yescarta):R/R Large B cell lymphoma(>=2L)& R/R follicular lymphoma(>=2L)
An excellent review article
@NEJM
on autoimmune hemolytic anemia
➡️ Link:
➡️ 3 figures/tables to summarise the topic 👇
➡️ High yield for heme boards 🩸
#MedTwitter
#hematology
Check out our
#ASH22
abstract
#mmsm
Clinical Outcome of pts with Relapsed Refractory MM Listed for BCMA Directed Commercial CAR T
➡️
🛑Cumulative incidence of receiving CAR-T at 12 mo from listing:29% LOW
🛑About a third of pts died waiting for CAR-T
Check our paper
Characteristics of Post-hoc Subgroup Analyses of Oncology Clinical Trials: A Systematic Review
#mmsm
#OncTwitter
➡️
Led by a great team of students in 🇯🇴: Jawad, Marah, Muntaser, Nada and Yazan
Relevant as we approach
#ASH23
🧵
#mmsm
How to counsel patients about Cilta Cel using the data from
CARTITUDE-4 and FDA ODAC meeting for earlier use
With data of Cilta cel and Ide cel, assuming having access to both for a given patient, I will personally chose Cilta cel (I explained this before)
🧵
#mmsm
Our first issue of the
@japacademy
journal is out. Check out my short paper on primary plasma cell leukaemia 👇
Lots of efforts in this project 🇯🇴🇺🇸, articles covering wide variety of medical sub-specialities
Here I provide screen shots of important slides (IMO) presented
@ASH_hematology
➡️ASH Hematology Board Review series. Excellent resource,great presenters and tremendous efforts
#ASHTrainee
👏👏
🧵review those slides prior to the exam🧵
#MedTwitter
@HemOncFellows
Benign heme 1/2
#ASH22
@ASH_hematology
Zanubrutinib vs. Ibrutinib (R/R CLL/SLL): ALPINE Phase 3 Study
Interesting!
zanubrutinib has now proven superiority to ibrutinib in both ORR and PFS in pts with R/R CLL/SLL
A thread about academic moderation
#MedTwitter
While many may not realize this but there is ongoing fear/avoidance from new graduates to join academia in the field of hematology and medical oncology due to excessive trespassing of personal/family time
We can/should do better
🧵
Dinner with Bart Barlogie while discussing myeloma history and advances, academia, cure and life.
Lots of wisdom
Stay tuned for some good future things to come
#mmsm
Check our
@UAMSMyeloma
new paper
@NatureComms
@Nature
Bispecific BCMA/CD24 CAR-T cells control multiple myeloma growth
#mmsm
➡️
BCMA-CD24-CAR-T can effectively target bulk MM tumor cells&reduce numbers of minimal residual MM cells&modulate microenvironment
Just at the right time
#ASH23
Check our recent paper
@jcan_policy
#mmsm
Use of Subjective Minimizing Language at Hematology and Oncology Conferences: A Systematic Review
➡️
When you read abstracts and go to presentation watch out for this phenomena
🧵
Check out our work published today
@JAMANetworkOpen
: Geographic and Racial Disparities in Access to Chimeric Antigen Receptor–T Cells and Bispecific Antibodies Trials for Multiple Myeloma
#mmsm
#disparities
Published while in
#IMS2022
Got my copy of Hematology where I contributed to a chapter on marginal zone lymphoma before my interest differentiated into plasma cells
#mmsm
, a great resource to add to my library before disappearance of books in the near future
My top 7
#ASCO24
abstracts to watch for
#mmsm
Will have more details on those once presented/published- those are initial thoughts that may evolve according to more data
There are more interesting data will highlight during the meeting
@ASCO
🧵
#ASH23
#mmsm
LBA
PERSEUS study
Dara-RVD vs RVD transplant eligible pts
Notice relatively only 1 out of 5 are high risk pts
Age is young at 59-61 (median)
1 out of 4 pts >65 yrs
GMMG-HD6: Elotuzumab-RVD vs. RVD in newly diagnosed MM
#mmsm
@TheLancetHaem
@EliasKarlMai
Elotuzumab resulted in no benefit👇
➡️
IMO, Elotuzumab has no role in myeloma, even in relapsed refractory disease. Congrats for authors publishing -ve study
Congratulations for all who submitted abstracts
@ASCO
annual meeting
⭐️Celebrate your hard work regardless of the results
⭐️If it does not work this time, it will work in the future
⭐️Take it to the next level and get your work published (be a finisher)
#MedTwitter
@HemOncFellows
Check our recent paper: Weight loss and dysgeusia in relapsed/refractory MM patients treated with talquetamab
#mmsm
➡️
✅Dysgeusia persisted in 15% of pts
✅pts lost 6% of their weight during ttt, weight loss persisted in~half of pts post-discontinuation
A very good review article about osteoporosis, relevant in patients with myeloma
#mmsm
@AnnalsofIM
Osteoporosis | Annals of Internal Medicine
➡️
A Nice summary table of pharmacological intervention 👇
#mmsm
Treating smoldering multiple myeloma (asymptomatic disease) with CAR-T therapy using any commercially approved product while pts with advanced/refractory multiple myeloma die waiting for CAR-T slot is unethical and should not be celebrated. Pts deserve better.
Myeloma is a field where we argue MM pts(actual cancer) don't require auto transplant while at same time we treat smoldering MM (an asymptomatic disease-may never progress to cancer) with a triplet regimen&auto transplant
Make this make sense
#mmsm
#ASH22
#ASCO21
#mmsm
Relapsed Multiple Myeloma: Does One Size Fit All?
@ninashah33
➡️ Dr Nina Shah is a great speaker, highly recommended lecture
➡️ Developments are great, there are too many products, cost is a major issue
➡️Summary tables👇including differences between approaches
Looking forward for
#ASH21
@ASH_hematology
and happy to announce that I have one submission accepted as oral presentation & another one as poster. Moreover I am honored to be part of the ASH Poster walk this year to highlight some of the excellent work
#mmsm
@UAMSMyeloma
Editorial
@FDAOncology
@NEJM
#mmsm
✅22 cases out of 27,000, 14 with data
✅T-cell lymphoma,T-cell large granular lymphocytosis,peripheral T-cell lymphoma,cutaneous T-cell lymphoma
🛑3 cases with genetic info,CAR transgene detected in malignant clone
➡️
#mmsm
#ASCO24
Educational talk on high risk /ultra high risk
@myelomaMD
Nice summary slide 👇
One problem we have is the varying definition of high risk we showed before
Myeloma is a field where we argue MM ttt cost is too much while at same time we treat smoldering MM (an asymptomatic disease-may never progress to cancer) with ~1 million $ 2yr-regimen (only drug cost) in a single arm study measuring short term response
Make this make sense
#mmsm
👇This is a major issue in academia
Junior faculty suffer targeting, marginalisation&attacks
Role models lead by good examples not by no. of NEJM publications
Delete this article&do not amplify intimidating articles targeting junior faculty
Academia has enough problems
This article broke my heart and reminded me of all the toxicity in academia. I never have condoned any harsh speech against anyone, but I do have reason to believe I am being referred to in this article. I will highlight some themes in this important 🧵
#ASH23
#mmsm
KarMMa-3 updated analysis
Despite improved PFS with earlier use of Ide-Cel, OS was not different
Unfortunate we don't have a tail for PFS with Ide-cel and unfortunate that OS is not better (per ITT, many pts died before product)
Will use of CAR-T earlier be better?
#ASH23
#mmsm
Oral myeloma
@RahulBanerjeeMD
Decreasing the dose of Dex does not seem to affect outcomes negatively
In clinic the lower the dose, the better to avoid AEs for patients and improve QoL IMO
Check out our viewpoint: Treatment Options for Relapsed and Refractory Multiple Myeloma: A Luxury or a Challenge? via
@JAMAOnc
part of
@JAMANetwork
#mmsm
➡️ we think
@NCCN
guidelines in Myeloma need to be re-visited due to multiple shortcomings 🧵
#mmsm
#mmsm
1/2
Things that need to stop in myeloma field
🛑weekly/daily conferences by same speakers
🛑multiple oral presentations by senior faculty
🛑review articles written by medical writers&stamped by name/s of “KOL”
🛑a “KOL”lecturing on benefits of a drug he/she takes >50k/yr
It is nice to see everyone sharing their top choices of
#ASCO21
top abstracts
@ASCO
,but let’s all agree:
⭐️ Kudos for all trainees who submitted and/or will be presenting their work 👏👏
#ASCOtrainee
⭐️Constructive feedback is needed and we should all strive to provide it
Fellowship ✔️ completed
A long road of medical school, residency, faculty job in Internal Medicine, school of public health/biostatistics and heme/onc fellowship is coming to the end
➡️ I am thankful for my family, friends, colleagues and mentors for support and guidance.
Heme boards- Iron resistant iron deficiency anemia (IRIDA)
⭐️Mutation:TMPRSS6 gene⬆️hepcidin synthesis➡️impairs Fe absorption
⭐️Q:IDA not responsive to oral Fe
🪧low iron&tsat
🪧low normal ferritin
🪧smear👇IDA
⭐️R/O:H.pylori/autoimmune gastritis,celiac disease
⭐️ttt:IV iron