This is a peripheral smear from yesterdayโs overnight Hematology call. WBC count of 290K!
Can you guess the diagnosis?
And a classic clinical phenotype associated with this?
@HemOncFellows
@MayoHemeOnc
Delighted to share my academic promotion to Assistant Professor in Medicine and Oncology. Final year of fellowship off to a great start!
Thank you
@myelomaMD
@MyelomaDrKapoor
@jonaspaludo
for the support and mentorship!
Now just need to fit these in the tiny cubicle ๐
We have put a man on the moon but somehow we are still not doing a good job at figuring out how to let our patients sleep at night in the hospital! A small concerted effort can go a long way for the well being of our patients.
Incredibly fortunate to be part of the amazing
@MayoHemeOnc
group, with a very proud tradition of prior hem/onc fellowship recipients of the Mayo Brothers Award!
@JithmaA
@OncDocBock
! And as always thankful to
@MayoCancerCare
for funding our research!
Congratulations Dr. Zanwar on many recent accomplishments!! Dr. Zanwar was recently awarded the Mayo Brothers Distinguished Fellowship Award in addition to obtaining a Hematology Small Grant and Merit Award. We are amazed by all you do!
@ZanwarSaurabh
Congratulations
@JithmaA
for receiving the Mayo Brothers Distinguished Fellow Award! Fantastic recognition for an amazing human being and physician! Many more accolades to follow.
@MayoHemeOnc
Almost hitting a deer on the drive to the airport and then walking into the most seamless (read empty) security experience has to be the most Minnesota way to depart for a meeting!
#ASH23
I donโt think I have ever ordered this much potassium in my life than I have in the past 4 weeks on the BMT service! But boy does it feel good when the WBC count goes from 0.1 to 0.2 for the first time!!
#smallwins
#MedTwitter
Delighted to share that I have been promoted to an academic rank of โInstructor in Medicineโ ๐ฌ๐ฌ
Now thatโs an exciting start to fellowship
@MayoHemeOnc
#medtwitter
I have a love-hate relationship with virtual options for scientific meetings. While it comes with not being able to meet longtime friends and mentors, the snuggles from your 4 month old definitely make up for it.
PC: wife who would (rightly) disown me if I travelled
#IMS2022
Ever since the kiddo came along, meetings have been bittersweet! Thank you to my brilliant and ever so accommodating wife (who refuses to join this platform) to help me be here and still not far off for lullaby time!
#ASH23
Takeaways from day 1 of career development retreat:
1. Success seen on podiums doesnโt show the past failures
2. Work toward what fills your cup
3. Back yourself
4. A grant getting rejected is a failure only if not resubmitted
@MayoHemeOnc
@NarjustDumaMD
@mpdrc
@DavidSteensma
Saw a patient today on one of the most toxic myelosuppresive chemotherapies known to mankind, who runs 6 miles a day and has a hemoglobin of 8.2!!
When I proposed cutting back a little, he said he did cut back from 12 mi to 6 mi!
The human spirit never ceases to amaze me.
Delighted to share that our work in Triple Class Refractory Multiple Myeloma was selected for an ASH Abstract Achievement Award! Much more work needed in this rapidly evolving field.
โฆ
@MayoMyeloma
โฉ โฆ
@myelomaMD
โฉ โฆ
@MayoHemeOnc
โฉ โฆโฉ
Steps in brewing a cappuccino with a newborn:
1. Grind coffee
2. Change a diaper or two
3. Brew coffee
4. Feed-burp cycle
5. Froth the milk (only take the foam-we like it dry)
6. Hymn her to sleep
7. Drink the already cold but satisfying cappuccino
Then restart the 2 hour loop!
I finally changed my Starbucks name from the generic โSamโ to my actual name today! After a few trial and errors and some sign language use, my regular caffeine providers now know how to pronounce my name!
Feels like I accomplished something ๐
Check out our latest publication discussing the disease heterogeneity, prognostication and personalisation of therapy in multiple myeloma.
Thank you
@myelomaMD
@MayoHemeOnc
@MayoMN_IMRES
for the opportunity!
AL amyloidosis can be challenging to diagnose. Here we review the clinical presentation, diagnostic testing and prognostication of AL Amyloidosis.
๐๐ผ
@MorieGertz
and Dr.Muchtar for the mentorship! โฆ
@JNCCN
โฉ โฆ
@MayoAmyloid
โฉ โฆ
@MayoCancerCare
โฉ
Our latest publication looking at the rapidly emerging problem of triple class refractory myeloma. Here we describe:
โ Cytogenetic evolution
โ Prognostic markers
โ Outcomes
โฆ
@myelomaMD
โฉโฆโฉ โฆโฆ
@MatthewHoMD
โฉ โฆโฆโฆโฆ
@MayoHemeOnc
โฉ
I will never be able to understand why our patients are not able to know the cost of their care before getting the bill! It is saddening to hear the struggle they have to go through to battle it out with these financial strains on top of fighting such tough diseases.
Came across this paper while looking up a regimen for a patient I am caring for. Such a refreshingly honest conclusion! Please donโt sugarcoat ineffective treatments that donโt benefit the patients. Kudos to the authors!
Check out our publication describing a cryptic presentation of spontaneous tumor lysis.
We also present an algorithm for TLS management.
Nice read for internal medicine, Pulm/Crit and Hem/Onc trainees alike.
@MatthewHoMD
@AjHematology
@MayoHemeOnc
Made breakfast (rare occurrence). Worked out (even rarer). Watched some Champions League football. Played some Coldplay. Read a manuscript and revised another. And yet itโs just 3 pm. Day before the fellowship match is turning out to be a long one!
#MedTwitter
#NRMP
#relativity
This picture from my awesome ID rotation showed up in my reminders today! The first vial of penicillin manufactured in the US!! Who else but the legendary Dr. Walt Wilson to share this piece of history with us!
If you want to create a horror movie for physicians, just title it โPrior Authorizationโ.
โPeer to Peerโ a close second place.
All the fancy new hem/onc drugs will make it to the credit reels.
Day 2 of Career Development Retreat:
1. Community Oncology: Find your fit. Negotiate work/life balance> $$
2. Advances need Advocacy
3. No PhD โ No lab research
4. Collaboration is key. Get different skill sets together.
@IreneGhobrial
@GregNowakowski
@AlanRosmarinMD
@MayoHemeOnc
Our paper looking at BRAF fusions as rare drivers of disease in histiocytic disorders. They are enriched in xanthogranulomas and likely respond to MEK inhibition.
โฆ
@JithmaA
โฉ โฆ
@aravindranmd
โฉ โฆโฆ
@BloodCancerJnl
โฉ โฆโฆ
@GauravGoyalMD
โฉ
Our recent paper demonstrating immune paresis to be an independent risk factor for severe COVID19 in patients with MGUS. Point prevalence for COVID19 was low at 3% but 1 in 4 had severe COVID-19 โฆ
@MatthewHoMD
โฉ โฆ
@myelomaMD
โฉ โฆ
@VincentRK
โฉ
Why do I love my fellowship:
@rleonferre
gave an amazing 1:1 education session on triple negative breast cancer over zoomโฆduring a time he was supposed to be away!
@MayoHemeOnc
If you are at the poster session tonight at
#ASH23
, come find us at Poster 3030 as we discuss our data on prognostication in Waldenstrom Macroglobulinemia.
And kudos
@ASH_hematology
for printing and hanging the poster!! Such a nice initiative!
How cool is it when your friends and colleaguesโ work gets mentioned during the morning didactics!
Last week was
@arjunlakshmanMD
โs work in myeloma and this week was
@StevenHwangMD
โs work in HIT!
Looking forward to the next three years of awesomeness!
@MayoHemeOnc
Waldenstrom Macroglobulinemia is an intriguing disease with an increasingly personalised therapy. We cover the latest in WM in this review.
โฆ
@JithmaA
โฉ โฆ
@MayoCancerCare
โฉ โฆ
@MayoHemeOnc
โฉ
Do you get paranoid if you donโt get any pages on a home call?
Test paged myself, bugged my colleague
@JithmaA
to make sure I pulled the right pager.
Doesnโt help if you demonstrate such behaviours when your wife is a psychiatrist.
#MedTwitter
Another riveting twitter spaces discussion by leaders in the field on immune therapies in MM and Covid-19
@VincentRK
@NoopurRajeMD
@szusmani
. Contd use Evusheld, additional boosters seemingly the key. Curious to see the duration of protection from additional boosters.
#IMS2022
And thatโs a wrap to a fulfilling week. So many inspiring stories and amazing science. Such detailed feedback on grant proposals! Didnโt ever imagine we would labs (wet and dry) in a hotel! Thank you
@AACR
@rosslevinemd
@christine_lovly
for the wonderful opportunity ๐๐ผ
#AACRMBCO
So true. My Mom just recovered from COVID-19 last month and now Dad got diagnosed and admitted. It is really difficult to not be able to travel but thankful they are able to get good care. Cannot imagine what people without support systems are going through.
As COVID rips through India, the nearly 100,000 doctors of Indian origin who are in the US feel both helpless & determined to help at the same time.
Most of us have close family in India. Every few hours we get calls about some friend or relative who's very ill with COVID.
Six years is too long of time to meet
@AnantRamaswamy
! The best senior we could have hoped for in training ! So glad to see all your amazing work in improving the care for patients with hepatobiliary malignancies.
@TataMemorial
Come check out our posters in Hall A this morning at
#ASCO23
:
Board
#14
: Extramedullary myeloma (EMM) treatment outcomes, including with CAR-T and bispecifics
Board
#35
: Predictors for development of EMM and itโs prognostic impact.
@MayoHemeOnc
@MayoCancerCare
@MayoMyeloma
#mmsm
Absolutely love this! To be able to do collaborative research in such busy clinical practices is a feat to be lauded! So great to see so many friends and colleagues in one picture!
So true. Attended my First ASH meeting in 2015 when I was a trainee in India!
@TataMemorial
provided a generous grant but the overhead was still about two months of rent in Mumbai ๐
Honestly it was the jet lag that I couldnโt live with. Yawned my way through the whole meeting!
A lot of awesome hematologists from a lot of LMIC cannot afford to go to
#ASH23
or any major conference for that matter ๐ญ
It's not just the registration cost, but also the travel and stay that's prohibitively expensive ๐ญ
Attending it virtually is a great idea !
#MedTwitter
CNS involvement by lymphoplasmacytic lymphoma, aka Bing Neel Syndrome, is a rare complication. We describe our experience in this publication and suggest an algorithm for diagnosis and Rx
๐งต
@MayoMyeloma
@MyelomaDrKapoor
@JithmaA
Free link:
What counts as high risk MM?
-t(4;14) is heterogenous with impact determined by breakpoint location
-Del17p allelic burden (10/20/55) still debated
-No t(14;16) in R2-ISS
All this while many centres without access to PC enriched FISH!
Thoughts?
@bdermanmd
@AjayNookaMD
#IMS2022
If one doesnโt already exist, we need a โThank your Pathologistโ day! So fortunate to be able to regularly chew the brains of our amazing Pathologists!
@MayoHemeOnc
@MayoClinicPath
Excellent discussion at
#IMS2022
on incorporating frailty assessment in determining optimal treatment. Frailty indices are prognostic but are they practically applicable in busy clinics? As
@MorieGertz
puts it โScience vs Practiceโ. โEyeballโ test still the prevalent practice
Check out our recent paper in British Journal of Haematology looking at predictors of disease progression and outcomes of Smoldering/Asymptomatic Waldenstrom Macroglobulienmia
@JithmaA
@MyelomaDrKapoor
@myelomaMD
@MayoLymphoma
I have started and finished 3 different medical training programs since the last time United won at Anfield in the league! And if we lose this Sunday, it will likely be four. Thank you for the scars
@ManUtd
!
#MUFC
#LIVMUN
Same day same journal
Me: This case report is never getting accepted. Why am I doing this!?
Journal: favourable review
Also me: This other paper has really interesting data. Will definitely get in.
Journal: Nah. Reject without revisions.
Moral: donโt presume
#MedTwitter
Me: Your lung cancer is progressing and second line Rx is docetaxel. Response rate of 10-15% with substantial toxicities.
Patient: Iโll take it (no questions asked)
Me: you should consider getting the Covid19 shot. It is highly efficacious and safe.
Patient: Nope.
๐คท๐ฝ
Excellent session on disease monitoring in myeloma at
#IMS22
hosted by
@VincentRK
@myelomaMD
@szusmani
How big of a microscope do we need for MRD(10^5 vs10^6)? Best imaging technique? When to act for an expanding subclone?
Lots of intriguing questions needing prospective study
Very elderly (โฅ75 years) patients with Waldenstrom Macroglobulinemia continue to do worse compared to the age, sex and calendar-year matched general US population. Higher prevalence of poor prognostic markers also noted in the very elderly.
@JithmaA
Itโs ASH time of the year! Look forward to some exciting science and seek some inspiration.
Excited to present our data on the impact of pre-ASCT immune composition and risk of tMN and MM outcomes (thanks
@Taxkourel
@MayoMyeloma
)
#ASH23
๐งต
Chalk talk time! Medicine morning reports are always fun. We discussed tumor lysis syndrome yesterday.
And yes, I have the handwriting of a 3 year old!
#MedTwitter
Excellent talk yesterday by the amazing
@ADispenzieri
and
@awechalekar
on the heels of
#ASH23
on diagnosis and management of AL Amyloidosis! So much good info on supportive care as well!
Why is it so hard to unsubscribe from paper journals๐คท๐ฝ
Unsubscribed the print version through my account. Didnโt work.
Emailed customer support. Didnโt work.
Ended up moving during this and didnโt update my address with the journal.
Still get them faithfully!
#MedTwitter
Do you have a test that you always order and it never provides you the answer for whatโs going on with your patient?๐ค
For me it has to be TSH.
#MedTwitter
@AaronGoodman33
Haha. Classic Dr. House scenarios. Clarkson Syndrome. The eyes donโt see what the mind doesnโt know. We reported one such clinical scenario
Never have I ever seen such medically complex patients before my preanesthetic medical evaluation clinic rotation! ๐ฅ
And I have cared for patients undergoing allogenic transplants before!
@davidharmonMD
@GColbensonMD
@TheEKGGuy
#medtwitter
So we had to get 6 PET-CTs in the last 4 weeks on an inpatient Medicine service! And yes, all were indicted.
Needless to say, it has been an absolutely fascinating month of diagnostic medicine!
#MedTwitter
Evidence based cardiology โ
Patient centered medicine โ
Reminiscing the life and career of Diego Maradona post roundsโ
Thatโs a wrap on another wonderful week on the Cardiology floors with the one and only Dr. Brenes Salazar!
@CardioGeriatric
@SammyPistiolis
@TheEKGGuy
Myeloma drugs โ Dosing and schedule
What I do in practice
#MedTwitter
1. Dex: 40 mg once a week age <70; 20 mg if age >70 or frail
Stop Dex at around one year if good response.
Days 1-4, 8, 15, 22 schedule for 1st cycle only in cast nephropathy; or VDT-PACE type regimen
Such a pleasure to chat with the one and only
@marklewismd
!! Few more grey hair compared to the portrait hanging in the
@MayoHemeOnc
graduates but all the wisdom that comes with it ๐
#ASCO23
Check out our recent publication: Bendamustine-Rituximab demonstrates superior outcomes (ORR,PFS) among frontline non-BTK therapy options for Waldenstrom Macroglobulinemia irrespective of MYD88 status.
@ASCO
Elections-stellar candidates out there.
I'm honored to be nominated for the Board of Directors (International Member).
I hope to serve ASCO in this role to promote access to affordable high-quality cancer care-everywhere
has more about the candidates
Phenomenal thread! Goes to show the effort that goes into the studies that we criticise (read eviscerate) in our journal clubs. Provides some context into some of the less explainable inclusions/exclusions in the protocols. Next time, please go a little gentle on the authors! ๐
So, you want to lead a randomized trial?
I ran a poll: How many people have near veto power over the approval & design of an investigator initiated oncology randomized trial? Only 23% guessed right.
Answer: >50!
@RielyMD
@mtmdphd
Here are the steps to do an RCT? Thread 1/
@MatthewHoMD
@KirtanPatolia
@ASanchez_PS
Good ones
@MatthewHoMD
I ll start with an onc bias:
Necrolytic migratory erythema: glucagonoma
Eyes have so many of these. Not always 100% but close:
KF Rings-Wilson disease
Lisch nodules: NF1
Dislocated lens: Marfan (up and out) homocystinuria (down and in).
Tec + Tal with an 85% ORR in R/R extramedullary myeloma! Needs longer FU and safety data but dual bispecific combination seems feasible and exciting!
Check out our experience in Extramedullary myeloma and Immune effector therapies:
#ASCO23
#mmsm
@nihardesai7
In short, With a lot of difficulty ๐ฌ
The exams and repeating training is the easy part. Tougher part is to get interviews for residency because you are โolderโ. Kept hearing phrases โYOG is ancientโ, โretraining never worksโ etc.
Highly recommended if truly passionate.
Diving straight from the 1 month Hematology Consult service rotation into
#IMS23
week!
Virtual immersion again this year and
@RahulBanerjeeMD
โs posts are as close to the in person experience Iโll get.
Exclusively Greek food takeout this week in spirit of the meeting๐