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Screening for myeloma/MGUS. Thread #medtwitter

1/ General screening of asymptomatic persons is not recommended. iStopMM is a randomized trial to determine role of screening, and also the role of more close follow up to enable early detection clinicaltrials.gov/ct2/show/NCT03… @IMFmyeloma
2/ I now recommend screening to detect high risk smoldering myeloma in persons with 2 or more first degree relatives with myeloma, & in blacks with one or more affected relative. One time screening at age 50-60, or 10 yrs before age of diagnosis of myeloma in relative @neuherman
3/ Whenever we want to look for myeloma / AL amyloidosis due to clinical suspicion, or to screen high risk individuals, the tests to do are: serum protein electrophoresis, serum immunofixation, & serum free light chain assay. @MayoMyeloma @MayoProceedings mayoclinicproceedings.org/article/S0025-…
4/ These tests will only show presence or absence of M protein. They don’t diagnose disease per se. By far, The most common reason for presence of M protein is MGUS. MGUS does not need treatment. ashpublications.org/blood/article-… @MayoClinic @BloodJournal
There are many other diseases to consider if clinically appropriate, when a monoclonal protein is detected. These disorders should be diagnosed based on strict criteria. #myelomaVR @TheLancetOncol thelancet.com/journals/lanon…
@sykristinsson I tagged you in the first tweet of this thread. And I think it got deleted inadvertently when I copy pasted the trial link. Sorry! This is your landmark study. Visionary.
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More from @VincentRK see all

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Vincent Rajkumar
@VincentRK
𝗧𝗼𝗽 𝟭𝟬 𝗺𝘆𝗲𝗹𝗼𝗺𝗮 𝗽𝗮𝗽𝗲𝗿𝘀 𝗼𝗳 𝘁𝗵𝗲 𝘆𝗲𝗮𝗿

2019 was a great year for myeloma. I’ve listed my Top 10 with links to the paper. #MyelomaVR @mtmdphd @Rfonsi1 @grpetersen1 @NorthTxMSG @Mohty_EBMT @SagarLonialMD
Thread/ Countdown below! 👇
#𝟭𝟬 𝗣𝗩𝗱 (𝗢𝗣𝗧𝗜𝗠𝗜𝗦𝗦𝗠)
PVd is a useful regimen with 11 months PFD in relapsed myeloma. @TheLancetOncol @thanosdimop thelancet.com/journals/lanon…
#𝟵 𝗠𝘆𝗲𝗹𝗼𝗺𝗮 𝗫𝗜
Intensification to get deeper response after induction does not improve survival. Important coz we see some centers delay transplant trying to get deeper response. We recommend ASCT after 3-4 cycles. @profghjackson @TheLancetHaem thelancet.com/journals/lanha…
Read 17 tweets
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Vincent Rajkumar
@VincentRK
𝗦𝗲𝗹𝗲𝗰𝘁𝗲𝗱 𝗔𝗹𝗴𝗼𝗿𝗶𝘁𝗵𝗺𝘀 𝗳𝗿𝗼𝗺 #ASH19 #ASH19VR @ASH_hematology
Thread

1/ Myeloma @VincentRK
2/ Myelofibrosis @AaronGerds
3/ Low risk myelodysplastic syndrome (MDS) @MikkaelSekeres
Read 7 tweets
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Vincent Rajkumar
@VincentRK
A common question I get at #ASH19 from researchers:
Why Twitter?

A single tweet commenting on a paper is like an editorial— but with greater impact.

I’m also more aware of publications in & outside of my field.

I interact and get feedback and competing ideas from colleagues
Additional thoughts below 👇
Here is one from @EricTopol
Read 5 tweets

Related threads

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Ashutosh Mishra🇮🇳
@ashutosh147
#Thread
#ForgottenHistoryHeroes
The year was 1555.Portuguese colonial power was at its peak in the 1500’s.They destroyed Zamorins of Calicut.Defeated the Sultan of Bijapur.Took away Daman from the Sultan of Gujarat, Established a colony in Mylapore, Captured Bombay
1/n
 @TIinExile
@TIinExile #Thread
#ForgottenHistoryHeroes
..and made Goa as their headquarters. And while they were at it, pretty much unchallenged, they even ruined the ancient Kapaleeswarar Temple to build a Church over it.
Their next target, the super profitable port of Mangalore.
2/n
 @TIinExile
@TIinExile #Thread
#ForgottenHistoryHeroes

Their only bad luck, just 14 kms south of Mangalore was the small settlement of Ullal - ruled then by a feisty 30 year old woman - RANI ABBAKKA CHOWTA.
Initially, they took her lightly and sent a few boats and soldiers to capture
3/n
 @TIinExile
Read 20 tweets
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CCC
@theCCCuk
#Thread - Agriculture and forestry may be small sectors of the UK economy but they have an important role in delivering the UK’s Net Zero target. #NetZero will not be met without changes in how we use our land. (1/11)
The CCC’s previous work has shown it is possible to reduce land-based emissions of greenhouse gases while contributing to other strategic priorities for land such as climate change adaptation, food production and biodiversity. (2/11)
There is an urgent need for a new approach to land use UK-wide and the legislative opportunities for real change are here. Taking action now will create net benefits for the UK and ensure our land is more resilient to the changing climate. (3/11)
Read 11 tweets
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Briana Ruíz Christophers
@BriChristophers
#MedTwitter has been discussing “Take Two Aspirin + Call Me By My Pronouns,” an op-ed claiming social justice is taking time from sci ed + decreasing the quality of #MedEd.

So here’s my take:
“Take Two Aspirin + Read a Curriculum”
THREAD.

#MedTwitter #SoMeDocs #DoubleDocs
As always, I start threads with my POV: #LatinasInMedicine #DoubleDocs student in year 2 of #medschool. I have interests in both #MedEd + #HealthJustice. I am about to finish my term as diversity rep on our med student govt. I care a lot about advocacy.
Let’s take a moment to learn about the author: Stanley Goldfarb is a nephrologist, *former* assoc dean of curriculum at UPenn Med. He graduated from med school in 1969. Ffolks who studied at UPenn have brought up negative experiences with Dr. Goldfarb.
Read 55 tweets
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Steven Chen
@DrStevenTChen
I remember a surgeon I worked with in med school. She asked me to do something pre-op (without instructions), and after I did what I thought was correct, she started yelling at me for doing it wrong. Then she loudly announced to the OR how stupid I was.

#thread #medtwitter
1/
She literally pointed at me, and laughed with the chief, IN MY FACE. This was 11 yrs ago, and I still remember the moment like it was yesterday. I was livid, but didn’t feel comfortable saying anything.

I entered med school planning on a career in surgery, but changed paths.
2/
While this certainly wasn’t the only reason I ended up in IM/Derm, it helped cement my decision to NOT pursue surgery.

To people who say, “that’s just how surgeons communicate,” or that I just need a thicker skin, I refuse to believe that belittling others is ever okay.
3/
Read 4 tweets
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Roxana Daneshjou, MD/PhD
@RoxanaDaneshjou
I completed medical school 4 years ago. So I would like to discuss how learning cultural competency and advocating for social justice are VERY relevant to my career. And I'm a dermatologist and aspiring physician scientist. THREAD #medtwitter #MedEd
First, this article erroneously assumes we no longer get basic science training. I assure you, we received plenty of basic science classes. I did have to memorize the Krebs cycle, after all. Learning cultural competency and advocacy did not replace basic science. #meded
1) Climate change is very relevant to healthcare. In #dermatology, endemic illnesses have expanded their geographic areas as the climate has changed. See @MishaRosenbach et al: ncbi.nlm.nih.gov/pubmed/27742170
Read 11 tweets
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Briana Ruíz Christophers
@BriChristophers
Alright, I have some thoughts on this op-ed, esp how tradition + legacy are often used as a distraction tactic from diversity/inclusion.

Buckle up for A THREAD.

#MedTwitter #SoMeDocs #DoubleDocs #DiverseDoubleDocs #MedStudentTwitter #WomenInMedicine #DiversityInMedicine
As always I start my thread by recognizing my own position in this conversation: I am a (proud) Latina woman training to be a physician-scientist. I hold a lot of privilege having attended an Ivy League institution for undergrad and currently training as a #DoubleDocs at another.
My own alma mater #PrincetonU has been recently grappling with its own (problematic) history by taking active steps to diversify iconography + naming around campus. I am proud to say that this is in part due to a meeting I co-hosted as co-president of PLA in combo with other orgs
Read 36 tweets

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