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Manni Mohyuddin

@ManniMD1

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Cancer doctor with interest in myeloma, supportive care, end of life, cost-effective/evidence-based care and med-ed. Views own.

Salt Lake City, UT
Joined June 2020
Don't wanna be here? Send us removal request.
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@ManniMD1
Manni Mohyuddin
@ManniMD1
3 years
For those that just followed me: I tweet about plasma cell disorders. I feel strongly about end-of-life, medical education and calling out what I feel is wrong (such as bad control arms, hype etc) I write educational 🧵occasionally- compiled here👇 #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
3 years
So as a junior myeloma faculty, I see a lot of consults for MGUS. Heres a tweetorial on how to interpret light chain values in the setting of kidney disease, as light chains are often checked to look for plasma cell disorders when patients have CKD. 🧵 #mmsm #MedTwitter
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
Just out in @JAMAInternalMed , we highlight a mechanism to detect selection bias/confounding in observational studies by looking at Kaplan Meier curves. If the curves separate implausibly early, the findings are too good to be true! @VPrasadMDMPH
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
Ever wondered about the staging of myeloma? Why is it so confusing? Why are there three stages (as opposed to 4)? How many staging systems are there? What all contributes to risk? Heres a 🧵 that goes over the past, present and future of myeloma staging. Read on! #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
4 months
Ten important observations about myeloma and its precursors that I often discuss with patients and teach to trainees in my clinic. An educational thread 🧵 #mmsm 1/
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@ManniMD1
Manni Mohyuddin
@ManniMD1
10 months
A very common consult that hematologists get is for MGUS in the setting of neuropathy. Are they associated? What diagnosis can explain the association? What workup needs to be ordered? In this thread, we do a deep-dive on this important topic/outline management. #mmsm 🧵 1/
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
I am not a key opinion leader, and I do not take any money from pharma. It is likely my opinion is irrelevant, but I thought I would offer the unfiltered truth about major pharma companies that make #mmsm drugs in a humorous and authentic way. Free consulting in this 🧵
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
When you meet your hematology soulmate for the first time after publishing 12 papers together @AaronGoodman33 #ASH22
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
The first randomized trial of CAR-T in multiple myeloma. Ide-cel versus a choice of five regimens for relapsed multiple myeloma! Lots to learn and process from this trial- so let us get started with this deep-dive 🧵 #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
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 🧵
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Hematologic Oncology News | Blood Cancers Today

Blood Cancers Today provides hematologists and oncologists with news, education, and information relevant to their patients and practices, featuring exclusive expert interviews.

bloodcancerstoday.com
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@ManniMD1
Manni Mohyuddin
@ManniMD1
8 months
How to treat myeloma after #ASH23 -don’t treat high risk smoldering -do quads for transplant eligible (but no cd38 maintenance afterwards) -don’t do quads or carfilzomib in newly diagnosed frail/older patients -don’t do a salvage auto no matter how good the first auto was
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
I am excited to be on the @ASH_hematology News Daily editorial board, and will be covering/attending the meeting this year. In this 🧵, I will highlight the top 10 myeloma abstracts that most influence my thought and practice from the #ASH22 meeting! #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
After ending two weeks on the BMT inpatient service, here is a 🧵 on my favorite BMT CTN trials that I teach to every new fellow/PA/NP/pharmacist/trainee on rounds. I love these trials, and look forward to the ongoing ones! (CAVEAT-trials simplified for purpose of 🧵) #bmtsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
Prophylactic anticoagulation and risk of DVT in myeloma- a 🧵 on the evidence, a few case vignettes, and some guidance (based on VERY imperfect evidence). Read on. #mmsm #medtwitter
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
As 2022 wraps up, it is time for a🧵 that highlights 10 pivotal trials that informed my practice and thinking in 2022. These are articles published in 2022 (although initial results/online pub maybe earlier)- abstracts from meetings covered elsewhere. Myeloma 2022 Recap 👇 #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
8 months
How I treat new myeloma: ⭐️Fit/stnd-risk/wants transplant:DRVd>Auto>Len maint ⭐️Fit/stnd-risk/🚫transplant:DRVd(6-8c)>Len (or dara+len) ⭐️Fit/high-risk:DRVD>Auto>Len or Len+K if accepts opportunity cost for small benefit ⭐️Neuropathy:Use K (not V) ⭐️Older/non-fit: DRd #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
The carfilzomib (K) versus bortezomib (V) saga for newly diagnosed myeloma. An educational, historical and philosophical thread. #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
11 months
A reason why the free light chain ratio of >100 was chosen as a myeloma defining event because limited data suggested a 80% risk of progression to myeloma with end-organ damage in 2 years. But is that true? A really important from Mayo Clinic showed otherwise. 🧵 #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
Two AML questions I struggled with in fellowship answered succinctly in one of my fav trials of #ASH22 DAUNODOUBLE: ⭐️90mg dauno no better than 60 ⭐️Second induction leads to no better survival in those responding well to first #ASH22 @AaronGoodman33
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
If you are a clinician rotating through the hematology clinic and seeing patients with plasma cell dyscrasias, here are 10 applications/calculators that will be of much help to you in your clinic! I have links to each app, and also why I use them. #mmsm 🧵 1/
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@ManniMD1
Manni Mohyuddin
@ManniMD1
6 months
To patients my advice: It is unlikely any one diet will change the trajectory of cancer. Eat healthy. Eat what makes you happy. You are going through a tough time, this is not the time to impose stringent restrictions on yourself. Feel no guilt for what you've ate in the past
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
In honor of myeloma action month, heres a tweetorial on diagnosis of various plasma cell dyscrasias. It is a long interactive one with polls, so be prepared. It is geared towards trainees, oncologists who don't see a lot of myeloma, and other medicine specialties. 🧵 #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
Why is it that an INDUSTRY written analysis of cost-effectiveness (that shows that axi-cel as second line therapy is cost-effective) gets chosen as a late-breaking abstract, while a rigorously conducted INDEPENDENT analysis (that shows opposite) gets a poster? #bmtsm #Tandem22
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@ManniMD1
Manni Mohyuddin
@ManniMD1
3 months
During #ASCO24 we should spare a moment to be thankful to the patients in poorer countries that participate in randomized trials (and often receive subpar therapies on bad control arms), so that more drug options can be approved in the US and other richer countries. 🤷🏽‍♂️
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@ManniMD1
Manni Mohyuddin
@ManniMD1
5 months
One of the most practice changing studies in the field of plasma cell dyscrasias is now published as a manuscript. Great work @iStopMM This model predicts likelihood of finding more than 10% plasma cells, and prevents many from getting a bone marrow!
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 months
A critical appraisal of the long-term follow-up of CASSIOPEIA trial, daratumumab maintenance, and maintenance in general. An educational thread. 1/🧵 #mmsm Non-paywalled link to pub:
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
How I view PFS and OS and discuss it to patients- Using myeloma as an example with references. An educational thread! /1 #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
8 months
There is a lot of progress that happens every year in myeloma. Learnt a lot in 2023, from both negative and positive trials, and am thankful for the progress. In this🧵, I will highlight 🔟 important myeloma publications from 2023 that shaped my thinking and practice. #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
If you have time to read one article today- read this editorial by Dr Booth on the state of clinical trials in hematological malignancies. These findings are concerning and should be a wake up call for us #mmsm @oncology_bg @AaronGoodman33 @VPrasadMDMPH
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
The PROMISE study is a monumental step forward in understanding precursor conditions to myeloma, but there are a lot of complex themes this study raises up that deserves a full tweetorial. Dedicated to trainees, patients and docs/pharmacists who don't lot of myeloma #mmsm 🧵
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@ManniMD1
Manni Mohyuddin
@ManniMD1
10 months
I say this with the kindest intentions. Regardless of what you think of Vinay (who has always been kind to me in my interactions w him) or your views on COVID If you think such a letter is a good idea, I recommend you read,"The Coddling of the American Mind" by Greg Lukianoff
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@ManniMD1
Manni Mohyuddin
@ManniMD1
3 years
So, the FORTE trial was recently published. This is a great trial, and there are many important lessons/concepts/questions that arise from this, which I wanted to highlight in this 🧵 #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
The correct answer to this question was smoldering myeloma. Time for an educational 🧵for trainees/health care folks of all specialties about how we diagnose myeloma! What are CRAB criteria? How is anemia defined? (Key to this Q) Whats the deal with "SLiM" criteria? #mmsm
@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
EDUCATIONAL POLL 65 yr old female referred for anemia. Hb 11.5. M protein of 1.8, kappa light chain 600 (ratio=30). Bone marrow with 30% monoclonal plasma cells. Other anemia workup unrevealing. Kidney function normal. Myeloma MRI neg for bone/marrow lesions. What is diagnosis?
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 months
Suggested approach to 1st relapse of myeloma post #ASCO24 Its suddenly more complicated-and bispecifics will change this too. Bela based triplets >> Dara/Bort/Dex, but CD38+Carfil/Dex still great. Safety of cilta-cel remains in Q, hard to broadly recommend for now. #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
3 months
Your periodic reminder that writing a paper about disparity does not fix a disparity, and doesnt help anyone, if problem is well known already, and you offer no novel insights to address it. Time spent writing such a paper is better spent volunteering or basically anything else
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@ManniMD1
Manni Mohyuddin
@ManniMD1
9 months
List of top 10 plasma cell dyscrasia #ASH23 abstracts. List may reflect positive/negative studies, but all have influenced thinking. I will summarize each study with teaching point. If you are wondering if there are any practice changing myeloma studies- IMO answer is NO. 🧵
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@ManniMD1
Manni Mohyuddin
@ManniMD1
10 months
Kudos to @iStopMM ⭐️EVAL OF LIGHT CHAIN MGUS A free light chain ratio of less than 3.15 has 92% sensitivity, 100% specificity for predicting PRESENCE of monoclonal plasma cells in bone marrow. If FLC ratio less than 3.15- reassure and omit bone marrow biopsy!! #ASH23 #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
3 years
I wanted to write a thread on maintenance in high-risk myeloma, since its such a complex minefield of data. I write this for myself, trainees and other cancer doctors. I also intend to pay homage to some of the myeloma giants along the way. Read on! #mmsm 🧵
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@ManniMD1
Manni Mohyuddin
@ManniMD1
7 months
Usually never tweet about COVID, but Recently saw a NYT article about Paxlovid. That referred to this pre-print about paxlovid reducing mortality. Look at that curve for mortality with immediate separation- no way paxlovid can save lives this quick-this is residual confounding
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@ManniMD1
Manni Mohyuddin
@ManniMD1
16 days
NEJM is the best journal in our field. I did expect a more nuanced editorial and was a little disappointed to see this. Belantamab is indeed defying expectations and turning out to be better than expected. However.... ⭐️The fact that quality of life was not reported as being
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 months
A suggested approach to newly diagnosed myeloma (induction and use of transplant). This incorporates data presented recently at #ASCO24 . As with any schema, some nuance is lost. #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
My approach to transplant for myeloma (some nuance lost): Young stnrd-risk who prioritizes PFS: Upfront auto Young stnrd-risk who doesn't prioritize PFS: Defer Young high-risk: Upfront auto Older high-risk: Transplant only if mel200 can be given Older standard risk: No auto #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
7 months
This practice-changing gem of a study has changed my practice already! Multiple patients this week were told their labs are now considered normal, and they do not require any further visits to the cancer center! YAY! #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
I sincerely plead to my endocrinology colleagues to stop checking SPEP and light chains routinely as part of low bone density evaluations. Plasma cell disorders do not lead to lower bone marrow density. This practice leads to much anxiety and wasteful referrals. #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
8 months
In case this needs to be told again. Carfilzomib is NOT better than bortezomib for newly diagnosed myeloma. It has flunked twice in head to head randomized attempts. And observational studies cant answer a question better than two large randomized trials. #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
The first investigator initiated randomized trial that I am a principal investigator on is now open to enrollment! Yay Using budesonide to reduce diarrhea during auto-transplant in pts with myeloma, as well as robust QOL assessment during auto! Brief 🧵
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@ManniMD1
Manni Mohyuddin
@ManniMD1
6 months
Belantamab/bortezomib/dexa (BVd) had a much better PFS than dara/bortezomib/dex (DVd) in a Phase 3 trial. What are we to make of this result? Lets analyze this in detail! An educational thread on appraisal, and my thoughts on how this may affect my practice/thinking. #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
Heres a thread about cilta-cel, about the importance of intention-to-treat analysis, about ethics and access. It comes from a place of immense personal angst that I feel about the long waiting lists and the patients who die waiting to get this drug. Read on. #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
I vote progression free survival be abbreviated as PF$ rather than PFS to highlight the 💵 that pharma makes by having an easier endpoint, as well as recognize the financial toxicity patients incur in this pursuit. @VPrasadMDMPH @AaronGoodman33 @MyelomaAmateur @oncology_bg
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@ManniMD1
Manni Mohyuddin
@ManniMD1
17 days
Happy to see this piece on @AaronGoodman33 in @TheLancetHaem . A well deserved accolade. Greatness isn’t defined by the n of papers/trials you have, but by taking good care of pts, and being a great husband/father/friend. And that’s what Aaron is!
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@ManniMD1
Manni Mohyuddin
@ManniMD1
7 months
The most important aspect of being an oncologist is communicating effectively. If you have cancer, you deserve an oncologist that understands and speaks your language. I always feel something is missing when I have to use an interpreter, and that my patient deserved better!
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
This RCT of antibiotic de-escalation has such good themes on clinical trial interpretation, sample size nuances, intent to treat versus per protocol, secondary endpoints. So MUCH to learn for trainees. After discussing this at rounds on BMT, I think its worth a 🧵! #bmtsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
What a brilliant essay in @TheLancetOncol by some of the best minds in critical appraisal today. The shortcomings of the monarchE trial noted here apply to many of the oncology trials today. I highly recommend this read. @oncology_bg
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@ManniMD1
Manni Mohyuddin
@ManniMD1
6 months
Repeat after me: Subsequent therapies do not CONFOUND overall survival. Appropriate subsequent therapies should be given! Any analysis that adjusts for them is meaningless (you want your results to apply to a world where subsequent treatment is given!)
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@ManniMD1
Manni Mohyuddin
@ManniMD1
9 months
Just out in @JAMANetworkOpen , we analyze use of terms that minimize toxicity in myeloma trials. Thanks to a stellar team led by @mimi_najjar , with @rajshekharucms @Eddie_Cliff @DavidSteensma @AaronGoodman33 @HadidiSamer @MyelomaAmateur #mmsm 🧵1/
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 months
Sadly, many randomized studies have been done for dietary interventions in people with cancer, and the larger/adequately powered ones usually show no benefit. I am not advocating for processed food- and healthier foods will lead to less cancer in the general population. But if
@DrSuneelDhand
Suneel Dhand MD
@DrSuneelDhand
2 months
Imagine being an oncologist (cancer specialist) and meeting a newly diagnosed cancer patient, and not even spending 30 SECONDS talking to them about resetting their metabolism by eliminating processed foods and minimizing sugars. That’s OVER 95 PERCENT of all modern day
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@ManniMD1
Manni Mohyuddin
@ManniMD1
6 months
The Q of whether dietary interventions help people with cancer is very imp. RCTs are the gold standard for evaluating interventions. What do RCTs of dietary interventions in cancer tell us? We eval in this systematic review of all dietary RCTs 1/🧵
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Dietary interventions in cancer: a systematic review of all randomized controlled trials - PubMed

Most RCTs of dietary interventions in cancer are small and measure nonclinical endpoints. Although only a small number of large RCTs have been conducted to date, these trials have not shown an...

pubmed.ncbi.nlm.nih.gov
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
Our piece in Lancet Haematology on advocating for patients on control arm of trials. They are a disadvantaged population, and this is a disparity. But advocating for them isn't the mainstream narrative. Lets change that. @csoncol @AaronGoodman33
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
The single MOST important study presented at #ASH22 that can impact SO many patients. Please don’t routinely order SPEP/light chains in patients with autoimmune diseases. Such an honor to take a picture with @ingigerdursv by her incredible poster @sykristinsson @iStopMM #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
5 months
My current approach to first relapse of myeloma. (Obviously, lots of nuance is lost in this slide, and this may change with availability of newer therapies for early relapse) #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
8 months
Inspired by a recent discussion on twitter/X about a trial- here’s a thread about the importance of intent to treat analysis, and the caveats/shortcomings of per-protocol or analysis per “compliance/adherence”. Buckle yourself up for an educational 🧵
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@ManniMD1
Manni Mohyuddin
@ManniMD1
4 months
For all its perils, social media has its benefits. My path crossing with @AaronGoodman33 is a beautiful example. It’s led to an amazing friendship, many collabs (and a prospective trial together), and most recently our piece in @NatRevClinOncol
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Manni Mohyuddin
@ManniMD1
1 year
If I had time, I would do systematic review of all Vit D trials in cancer. As opposed to usual paper ending which says "further research is needed"- the ending of this would say: "Further research/funding should be discouraged given lack of benefit in existing literature" 😀🤷‍♂️
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
Our work on how patients perceive cure in myeloma: -they prioritize being off treatment and account for toxicity of treatment more than we do when we think of cure - they remain unaware of terms such as functional cure #mmsm #asco22
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
An educational 🧵on looking beyond just response rates in a single arm Phase II trial and learning from the story of cilta-cel in CARTIFAN. This trial has many golden lessons on critical appraisal/global disparity, and this🧵is for trainees/fellows/pharmacists #mmsm 1/
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@ManniMD1
Manni Mohyuddin
@ManniMD1
9 months
Pharma conducted cost-effectiveness studies are marketing, not science. These studies shouldn't be given a platform at #ASH23 . Case in point: Mosunetuzumab more cost-effective than CAR when done by ind. group But when KITE (maker of axi-cel) does study-opposite results.
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@ManniMD1
Manni Mohyuddin
@ManniMD1
4 months
An excellent review article with insightful case-based management on how to approach thromboprophylaxis in myeloma! @rajshekharucms Non paywalled link: #MMSM
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
Ixazomib is NOT a substitute for other proteasome inhibitors. It is not any less toxic, just because it is oral. It has failed MULTIPLE trials. It should rarely, if ever, be used. Don't let a tweetorial, or a talk by someone paid by Takeda convince you otherwise. #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
Out in @TheLancetHaem - what >1500 pts think a "cure" in #mmsm is -Pts prioritize being off therapy. -Treatment toxicity matters to them -They are unaware of terms such as "functional cure" We should prioritize trials of limited duration tx. #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
3 years
3 truths about MRD in #mmsm 1) MRD is prognostic 2) We do not know “yet” that altering treatment to achieve MRD negativity makes people live longer or better 3)Every single MRD meta-analysis compares good biology responders to bad biology non responders and is hence flawed.
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
Financial toxicity is a pervasive phenomenon that is poorly assessed. Our paper in @BloodCancerJnl aims to characterize this. Credit to an all-star team for doing this. I hope we can move forward from identifying the problem to alleviating it. #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
This trial is as good as it gets ⭐️⭐️⭐️⭐️⭐️ ✅Patient centered supportive care trial ✅Inexpensive medication ✅Conducted in a LMIC ✅Clinically relevant endpoint ✅ Randomized/double-blinded study ✅Potential to immediately change practice Kudos!
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Randomized Double-Blind Placebo-Controlled Study of Olanzapine for Chemotherapy-Related Anorexia in...

PURPOSE Anorexia occurs in 30%-80% of patients with advanced malignancies, which may be worsened with chemotherapy. This trial assessed the efficacy of olanzapine in stimulating appetite and improv...

ascopubs.org
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
Cilta-cel for early relapsed myeloma. A deep dive-thread where we analyze this trial in incredible detail, all the nuances and subtleties. Critical appraisal in patient/trainee friendly langauge. Link to paper: #mmsm #ASCO23
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Cilta-cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma | NEJM

Ciltacabtagene autoleucel (cilta-cel), a B-cell maturation antigen (BCMA)–directed CAR T-cell therapy, is effective in heavily pretreated patients with relapsed or refractory multiple myeloma. We i...

www.nejm.org
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@ManniMD1
Manni Mohyuddin
@ManniMD1
9 months
If you’re a trainee and interested in meeting me at #ASH23 , please reach out via DM (especially if IMG!) I’d love to meet and offer support in whatever capacity I can! I can’t have a research project for each one of you, but happy to help/mentor in any other way possible
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
I find the word "humbled" when sharing accomplishments on twitter problematic. Either you are humbled, in which case one shouldnt share on social media and draw more attention Or you aren't humbled. You are proud, you are thankful etc. Which is OK. Just be real. My 2 cents.
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@ManniMD1
Manni Mohyuddin
@ManniMD1
7 months
What an excellent pragmatic trial done in a LMIC (India)- truly an inspiration for future trials- with results that are applicable globally. I use olanzapine quite liberally during auto-transplant for nausea ppx, and will use lower doses now.
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Low-dose versus standard-dose olanzapine with triple antiemetic therapy for prevention of highly...

Our findings suggest that olanzapine 2·5 mg is non-inferior to 10·0 mg in antiemetic efficacy and results in reduced occurrence of daytime somnolence among patients receiving highly emetic chemothe...

www.thelancet.com
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@ManniMD1
Manni Mohyuddin
@ManniMD1
9 months
Bispecifics in the real-world: What do we know so far, and what lessons can we learn? An educational thread compiling all the real-world data we have for teclistamab in myeloma so far, including that presented at #ASH23 . #mmsm 🧵 1/
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@ManniMD1
Manni Mohyuddin
@ManniMD1
26 days
The GEM-CESAR trial of a super aggressive approach to SMM (KRD>Transplant>KR>Len) just got published. The results are a stunning verdict against early intervention in SMM, despite the way the results are potrayed. Here is a peer review and critical appraisal of this #mmsm 🧵
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
The definition of myeloma changed in 2014 because it was thought the SLiM criteria imparted a 80% risk of progression to MM within 2 years. This critically important NEW study shows that the contemporary risk of progression for SLiM is MUCH lower #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
7 months
Our trial of surveillance incorporating DW-whole body MRI q6 mo for high-risk smoldering myeloma is active. This is a multi-center effort that aims to define natural history of SMM, and show that close surveillance can prevent morbidity while keeping people off treatment 🧵
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@ManniMD1
Manni Mohyuddin
@ManniMD1
5 months
From 2013-2022 pharma paid 12 billion dollars to US physicians. That’s mind boggling. Insane. That’s how silence is bought, the minds of physicians influenced, and ultimately patient care/prescribing patterns influenced.
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Industry Payments to US Physicians by Specialty and Product Type

This study examines the distribution of payments within and across specialties and the medical products associated with the largest total payments.

jamanetwork.com
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@ManniMD1
Manni Mohyuddin
@ManniMD1
4 months
The FDA just approved cilta-cel for early relapse in myeloma (1 prior line of therapy, including PI and IMiD, and refractory to lenalidomide). My thoughts on the approval of cilta-cel for early relapse in myeloma. An educational thread: #mmsm 1/
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
So good! Must read for all trainees interested in oncology. @AaronGoodman33
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
I am often asked about the activity of myeloma drugs of the same class when a previous drug of same class has been used before (for example isa after dara, pom after len etc) This brief educational thread will provide examples and references that will answer this Q #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
Just out in @NatRevClinOncol - we highlight situations in multiple myeloma where PFS is not the best answer to the questions that trials seek to investigate. We suggest solutions and alternatives. Kudos to @Eddie_Cliff - what a delight to work with #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
11 months
Blind adherence to guidelines and diagnostic criteria: For pts without CRAB Light chain ratio 99: you have smoldering myeloma, let’s give you len for two years Light chain ratio 101: you have myeloma, let’s give you quad, transplant and indefinite treatment for life! 🤦🏽‍♂️😡
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@ManniMD1
Manni Mohyuddin
@ManniMD1
6 months
Read this paper carefully. Then read it again. It will open your mind up about censoring in ways you prob have never thought about. A true gem. Must read for all. Numerous myeloma trials (belantamab!) susceptible to this! #mmsm @VPrasadMDMPH
Equal censoring but still informative: When the reasons for censoring differ between treatment arms

In randomized controlled trials, informative censoring has been described as a potential bias, mainly affecting time-to-event composite endpoints, like progression-free survival (PFS). It is usually...

www.ejcancer.com
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@ManniMD1
Manni Mohyuddin
@ManniMD1
5 months
As a myeloma doc on a ski lift, surely this doesn’t mean what I think it means? 🤯 #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
8 months
10/97 people who got cilta-cel in CARTITUDE-1 got myeloid cancers. This is much higher than background rate attributable to transplant. Ppl living longer with bispecifics too- but not seen with that. Randomized trials will tell. Trial in smoldering myeloma needs to stop now!
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
So this was a long 🧵 but my heart aches today at the toxicity of academia, the stifling of critical speech, the unfair assumptions made, and how it is easier to just like and share an article rather than ponder over how it makes junior investigators and trainees feel (end)
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
This is a list of journals I have submitted to over the last few years, hopefully will be of help to other hematology investigators/trainees trying to get their work published! Feel free to let me know what I am missing/should add. #mmsm #lymsm #leusm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
3 years
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
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@ManniMD1
Manni Mohyuddin
@ManniMD1
3 years
Great read by @VPrasadMDMPH - the FDA truly is broken and a shame for us. I wish the future was brighter.
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Opinion | The FDA Is Failing the American People

The agency's recent decision to approve aducanumab offers more evidence of a broken system

www.medpagetoday.com
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@ManniMD1
Manni Mohyuddin
@ManniMD1
4 years
This is brilliant work- my favorite read of 2021 so far, should make us all pause about the current direction of oncology trials and recalibrate our priorities as PIs, editors, reviewers and global citizens @oncology_bg @VPrasadMDMPH @AaronGoodman33
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An Analysis of Contemporary Oncology Randomized Clinical Trials

This cohort study describes the design, results, and publication of all oncology randomized clinical trials published globally to examine the extent to which trials reflect the global cancer burden...

jamanetwork.com
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
✅60 mile ride ✅ Highest fund raising team Kudos to the myeloma team at the @huntsmancancer sportsfest! #mmsm (Now time to round on the service!!)
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 years
How do patients with smoldering myeloma progress? Is it fracture appearing suddenly without corresponding lesions first seen on serial imaging? Is it sudden renal failure? An excellent study from Germany in which patients were prospectively observed provides insight A 🧵 #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
2 months
I wish this was not controversial: If a trial 1. Enrolls in the US 2. Has explicit intention to seek regulatory approval in the US 3. Has control arm below US standard It is unethical- even if control arm is above local standard in poorer countries this trial enrolls in.
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@ManniMD1
Manni Mohyuddin
@ManniMD1
23 days
Maybe one day we will find out that CAR-Ts are better than bispecifics in a RCT. But the curve of such a trial will not look like this. Such a dramatic early separation points to confounding-bispecs given to sicker pts who need urgent treatment, or who are frail. #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
As the junior attending who sees most MGUS diagnosed at our institution- I see first hand the mental angst this diagnosis gives people. We shouldn’t advocate screening without careful impact of the repercussion of over -medicalizing society and whether people live longer. #mmsm
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@ManniMD1
Manni Mohyuddin
@ManniMD1
1 year
What a fascinating case report- A patient with AML and MGUS undergoes allo transplant, AML cured. MGUS untouched, goes on to become myeloma in the future, and patient then undergoes an autologous transplant for the myeloma! 🤯 #mmsm
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