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Vincent Rajkumar Profile picture
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7 Dec, 4 tweets, 2 min read
Daily COVID deaths in the US have just reached the same level as in April. Back then we can say we were caught unawares. Now we can’t.

A massive human tragedy. ig.ft.com/coronavirus-ch…
I don’t think you want to look at the same figure for daily new cases. It’s not only depressing. But terrifying.
Or the raw numbers.
So when you wake up in the morning and hear Australia is agonizing about 2 overseas travelers who slipped quarantine and we have almost 200,000 new cases that day— it gets you.

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Vincent Rajkumar Profile picture
7 Dec
#ASH20 IFM 2009 trial results presented by @PerrotAurore

On intent to treat basis early and delayed stem cell transplantation led to identical overall survival at 8 years. Timely given the pandemic situation. See thread on what these results mean. #ASH20VR @ASH_hematology ImageImage
Important to note that higher PFS,better MRD- with early transplant, and the fact that not everyone who was randomized to delayed transplant did not manage to affect the probability of staying alive at 8 years one bit. #ASH20

2/
Nevertheless, I still recommend early transplant for most eligible patients for reasons discussed in this thread.
Read 6 tweets
Vincent Rajkumar Profile picture
5 Dec
@sumanthraman @EricTopol This is a great question. I’ll try my best to answer.
1) First is that the question also applies to Europe which is doing just as bad as the US. So why are USA and Europe doing worse than more crowded and much poorer countries?
@sumanthraman @EricTopol 2) I think one of the most likely factors is that there must be some form of pre-existing cross reactive immunity which is helping keep the disease severity low. So more asymptomatic cases, and fewer hospitalizations and deaths. I did a thread on this a while back.
@sumanthraman @EricTopol 3) The second factor is certain favorable demographics in countries like India: age distribution (lower median age), and lower prevalence of obesity. A lot of severe COVID is associated with these two factors.
Read 7 tweets
Vincent Rajkumar Profile picture
4 Dec
Here are selected abstracts from @MayoClinic @MayoCancerCare being presented at #ASH20

1. CyTOF and TNA seq studies reveal major defects in the cellular tumor immune microenvironment with refractory myeloma. ash.confex.com/ash/2020/webpr… @Taxkourel @myelomaMD @MayoMyeloma
2. Lab studies using salicylates to augment anti tumor effects of selinexor. #ASH20 ash.confex.com/ash/2020/webpr… @JithmaA
3. In patients needing Auto transplant for relapsed DLBCL, interestingly the GCB type had poorer outcome compared to non GCB. #ASH20 ash.confex.com/ash/2020/webpr… @MadihaIqbal13
Read 13 tweets
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
3 Dec
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.
Read 4 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

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