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Vincent Rajkumar Profile picture
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19 Mar, 5 tweets, 3 min read
Paradigm shifts in multiple myeloma.

1/ Change in diagnostic criteria. MDE not CRAB. @TheLancetOncol
2/ Treatment of high risk SMM. Early preventive therapy with Len or Len/dex significantly delays end organ damage in high risk SMM. @SagarLonialMD @mvmateos
3/ Role of Transplant.
Early versus Delayed Transplant. Similar overall survival at 8 years means selected patients with standard risk myeloma can opt to delay transplant if feasible.
4/ MRD directed therapy.
Unresolved. But many ongoing phase 3 trials. Hopeful.
5/ Screening high risk groups.
Screening must be considered in populations at very high risk: African Americans with one affected relative; and all others with 2 affected relatives. @nature nature.com/articles/d4158…

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More from @VincentRK

Vincent Rajkumar Profile picture
20 Mar
Real world data from Israel on Pfizer BNT COVID vaccine.
Population of 1.6 million with 1.2 million vaccinated.

Per test model:
-91.2% efficacy in preventing all infections.
-99.3% efficacy in preventing symptomatic infections.

#GetVaccinated medrxiv.org/content/10.110…
There was a decrease in efficacy noted in people with advanced age (80+), Type 2 diabetes, COPD, and immunosuppression.

However, efficacy was still very good in these groups. And the best way to protect them is for everyone around them to also get vaccinated.
This is incredibly good data. In medicine real world studies seldom give results as good as the randomized trials.

With 99.3 overall protection against symptomatic COVID, it doesn't get any better.
Read 4 tweets
Vincent Rajkumar Profile picture
19 Mar
Astra Zeneca COVID vaccine update.

1/ Out of ~20 million people who received this vaccine, 16 have developed cerebral venous sinus thrombosis in EU/UK. @EMA_News

Germany 7
Italy 3
Norway 2
Spain 1
UK 3

In addition, 2 cases were reported from India.
2/ There were also 7 cases of DIC.

3/ All of the EU /UK events were in people less than 55.

4/ 9 deaths.

ema.europa.eu/en/news/covid-…
5/ The rate of DIC and cerebral venous thrombosis appear higher than expected baseline.

6/ Since these adverse events are very rare, the risks of COVID high, & the high efficacy of the vaccine, the @EMA_News recommended that the benefits of the vaccine outweighed the risks.
Read 4 tweets
Vincent Rajkumar Profile picture
18 Mar
COVID and thrombosis.

There's concern about 11 people who developed central venous thrombosis following COVID vaccine.

But what about COVID itself?
A brief summary:

1/ COVID has been associated with central venous sinus thrombosis. Singapore 2 cases. ncbi.nlm.nih.gov/pmc/articles/P…
2/ France 2 cases. pubmed.ncbi.nlm.nih.gov/33725828/
3/ Egypt 2 cases. pubmed.ncbi.nlm.nih.gov/33520667/
Read 5 tweets
Vincent Rajkumar Profile picture
18 Mar
>2000 COVID deaths a day in the EU. Lots more seriously ill. Astra Zeneca vaccine (& all other approved vaccines) are 100% effective in preventing hospitalization & deaths.

The potential risk reported is a rare form of blood clots in 11 out of 17 million vaccinated.
This is how good the vaccines are in preventing this worst pandemic of all time. 👇👇
The risk benefit equation hugely favors vaccination. I'm glad the @EMA_News recommended to resume vaccinations. wsj.com/articles/astra…
Read 4 tweets
Vincent Rajkumar Profile picture
18 Mar
Sometime depth of expertise makes you so blind, you miss the big picture.
Depth of expertise and critical appraisal are different skill sets. Not every expert has both.
Depth of expertise and make the right risk benefit judgment calls are also different skill sets. Not every expert has both.
Read 4 tweets
Vincent Rajkumar Profile picture
17 Mar
This report that has me somewhat concerned about vaccine escape by a variant. Most previous reports were neutralizing antibody studies. These are clinical results.

Astra Zeneca vaccine was only 10% effective against the B.1.351 variant in South Africa. nejm.org/doi/full/10.10…
Among 39 mild to moderate cases with this variant, 20 occurred in placebo group and 19 in vaccine group. Means: No protection seen.

I'm still optimistic that there will be protection against severe disease and deaths.
There were no severe cases of COVID in this study. No hospitalizations or deaths. It's a small study (n=2021).

Time will tell. Even more reason to consider vaccinations from a global standpoint. Because leaving parts of the world unvaccinated is self defeating.
Read 4 tweets

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