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Vincent Rajkumar Profile picture
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3 Dec, 4 tweets, 2 min read
Follow and search #ASH20VR for my commentaries (&critiques) on important myeloma related abstracts during #ASH20.

I have used these personal hashtags selectively to avoid information overload. Check #ASH19VR for last years picks. @MyelomaTeacher @NorthTxMSG @grpetersen1
I started doing personal hashtags at meetings a few years ago for my own selfish reasons. It has worked out great for me. And I’m hoping it’s useful for others.
I tweet a lot at ASH and other Hematology/oncology meetings but won’t add my personal hashtag unless I feel like it’s something very important that I would want to look up in the future.
For other meetings see below.

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More from @VincentRK

Vincent Rajkumar Profile picture
3 Dec
One of the most common questions myeloma patients ask me is: Should I get a stem cell transplant, and if so when should I do it?

The update of the IFM trial at #ASH20 addresses this question. ash.confex.com/ash/2020/webpr… #ASH20VR

Thread 👇
1) Should eligible patients do a transplant: Yes

Two RCTs show an Overall Survival benefit of transplant over chemo alone.

2) Does timing early vs delayed matter?

4 RCTs (including IFM 2009) show similar overall survival regardless of when transplant is done (early vs delayed)
The IFM 2009 results show identical overall survival ~60% at 8 years with early or delayed transplant, even though not everyone who is in the delayed transplant group even gets to a transplant. But there are important caveats.
Read 7 tweets
Vincent Rajkumar Profile picture
1 Dec
Should we screen for myeloma in high risk individuals?

For Blacks with one or more affected first-degree relatives, & all others with 2 or more affected first-degree relatives — Yes.

I’ve come to this conclusion after considering pros & cons. @nature nature.com/articles/d4158…
If you are going to offer screening, I suggest only a one-time year at age 50 and older, or 10 years before diagnosis in first degree relative.

Test: SPEP, Serum IFE, and Serum FLC. We are not screening for MGUS, but for evidence suggestive of high risk SMM or MM.
This recommendation affects a small number of people who are at high risk of developing SMM or MM. For all others, including general population, wait till results of iSTOP MM RCT, and other studies such as PROMISE. @sykristinsson @IreneGhobrial
Read 4 tweets
Vincent Rajkumar Profile picture
23 Nov
3 for 3!

@AstraZeneca @UniofOxford vaccine highly effective against COVID. Lower cost, easier storage & transport. This is also the vaccine that @SerumInstIndia is manufacturing: means great news for India. @nramind @rameshlaus @sumanthraman @DrEricDing nytimes.com/live/2020/11/2…
This comes on the heels of great results from @pfizer and @moderna_tx

With the pandemic affecting the whole world, we need all the vaccines we can get. I’m very pleased with the efficacy. I wouldn’t worry about 70% versus 95%. Efficacy is efficacy. @singersrinivas @ShirleySetia
The @UniofOxford @AstraZeneca vaccine is an adenovirus vector vaccine. See mechanism of action and doses reserved by country. @business @PSampathkumarMD 👇
Read 7 tweets
Vincent Rajkumar Profile picture
13 Nov
Here are my Top 5 #ASH20 @ASH_hematology myeloma abstracts. #ASH20VR
I’ve listed them with links to the full abstract. @mtmdphd @Rfonsi1 @MayoMyeloma @NorthTxMSG @Mohty_EBMT @BldCancerDoc @szusmani @ninashah33 @profghjackson @Phari @PerrotAurore @mvmateos
Thread for countdown👇
#5 Allogeneic off-the-shelf CAR-T therapy for myeloma. First in human results with Anti BCMA ALLO-647 shows clinical activity in myeloma.
5 of 15 responses. #ASH20 #ASH20VR @sloan_kettering @Phari @AllogeneTx ash.confex.com/ash/2020/webpr…
#4 Identification of a potential mechanism for frequent relapses after CAR-T therapy for myeloma: Bi allelic loss of BCMA locus at 16p. Important work. #ASH20 #ASH20VR @DanaFarber @NoopurRajeMD

ash.confex.com/ash/2020/webpr…
Read 8 tweets
Vincent Rajkumar Profile picture
13 Nov
Whether it is masks or meds consider 𝙬𝙝𝙖𝙩 𝙞𝙛 𝙬𝙚 𝙖𝙧𝙚 𝙧𝙞𝙜𝙝𝙩, as well as𝙬𝙝𝙖𝙩 𝙞𝙛 𝙬𝙚 𝙖𝙧𝙚 𝙬𝙧𝙤𝙣𝙜

For benign interventions (eg., masks for COVID) if we say masks work & they don’t, consequence is small. If we say they don’t when they truly do, it’s tragic
For any intervention we have to always consider the consequences of a Type I error relative to the consequences of a Type 2 error.

For many medicines, the consequences of a Type 1 error in terms of toxicity, harm, & cost usually outweighs those of a Type II error. We need RCTs.
Sometimes there are interventions where consequences of erroneously concluding something is effective when it is not (Type I error) is small compared to concluding it’s not effective when it actually is (Type II error). Eg., hand washing to prevent COVID. Masks are like that.
Read 4 tweets
Vincent Rajkumar Profile picture
11 Nov
COVID thoughts

I’m happy that we rapidly found stuff that works:
-Masks
-Proning
-Dexamethasone
-Monoclonal antibodies
-Upcoming vaccine

I’m disappointed about the many mistakes:
-Lack of a comprehensive strategy
-Mixed messages
-Politicization of masks
-PPE shortage
As a result of our success we have lowered the number of deaths. But the daily death toll is unacceptably high: ~1000 per day. How can we possibly lower it when the number of new cases is skyrocketing? ImageImage
If you compare to Europe, you could come to the conclusion that nothing matters. It’s just the way COVID is. But we have to ask, have they made the same mistakes as us? ImageImage
Read 7 tweets

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