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Vincent Rajkumar Profile picture
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30 May, 4 tweets, 2 min read
What a difference a month makes. India in Feb, March, April, and May.

What exponential spread of COVID looks like: 10k to 400k in 4 months. ImageImageImageImage
As I watch cases rise in Scotland, Taiwan, Malaysia, Columbia, Chile, Suriname, Dominican Republic, Portugal: Worried about how quickly things can change. We need vaccinations to speed up dramatically. More vaccine producers. More tech transfer.

And 2 doses for all coz of B1.617
In India cases are decreasing as almost every state is in lockdown. But with 97% or the population not fully vaccinated, I worry about the next wave if restrictions are relaxed without maintaining adequate precautions and speeding up vaccination. Image
Also I wish I could preview how the pics will look when I post them. Or be able to edit. Sorry about the way the pics are cropped in the tweet.

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More from @VincentRK

Vincent Rajkumar Profile picture
31 May
Here are my Top 5 #ASCO21 @ASCO myeloma abstracts. #ASCO21VR
I’ve listed them with links to the full abstract. @mtmdphd @Rfonsi1 @MayoMyeloma @chadinabhan @Mohty_EBMT @BldCancerDoc @szusmani @NBahlis @NoopurRajeMD @profghjackson @contirena1 @DusetzinaS
Thread for countdown👇
#5 Daratumumab, bortezomib, lenalidomide, cyclophosphamide and dexamethasone (Dara-CVRd) for ultra high risk MM and plasma cell leukemia. A modern alternative to VDT-PACE. 94% response rate. @profghjackson @MyelomaUK #ASCO21VR #ASCO21
meetinglibrary.asco.org/record/195431/…
#4 Financial difficulty in patients with multiple myeloma. 20% of patients reported financial difficulties in 1 year. Glad this is being studied. I do think this is an underestimate. @ALLIANCE_org @theNCI @contirena1 #ASCO21VR #ASCO21
meetinglibrary.asco.org/record/195456/…
Read 9 tweets
Vincent Rajkumar Profile picture
29 May
US Vaccine Progress

~60% of eligible population (166 million of ~280 million age >12) have had at least 1 dose of COVID vaccine

To reach herd immunity:
100 million more to go. (80% threshold)
(60 million if we consider recovery from COVID as immune)

What can disrupt the math?
Factors that affect the math and goals:

1) Extent of protection from current vaccines in immunocompromised individuals and very elderly. Neutralizing antibody levels can be a biomarker that helps predict extent of protection from vaccination. See thread.
2) Extent of protection from current vaccines against the B.1.617 variants. Thankfully data so far indicate that current vaccines are highly protective against symptomatic disease from B.1.617 variant. See thread. 👇
Read 7 tweets
Vincent Rajkumar Profile picture
29 May
Everyday I hear about someone very young in India, in the best of health, dying or critically ill with COVID. In many, the clinical course is one of rapid progression.

Added to what's going on in the UK, makes me nervous about B.1.617 variants.

Get vaccinated. That does work.
Ask anyone in India, and most will know of someone like this. It's real.
In some one can blame lack of resources or steroid related complications. But in most it's pretty significant lung damage due to COVID.

#GetVaccinated
Read 7 tweets
Vincent Rajkumar Profile picture
28 May
Important to realize that we use steroids like dexamethasone as anticancer drugs (for myeloma) to kill the same cells that make antibodies & help us fight infection.

They are not antivirals. They are anti immune system. They help the COVID virus if given early or inappropriately
When treating the cancer multiple myeloma, we have found that giving high doses of dexamethasone cause more deaths than low doses. More steroids is NOT better. Less is more. @TheLancetOncol thelancet.com/journals/lanon…
Dexamethasone and other steroids will make any kind of fever disappear and make people feel better, but behind the scenes they cause harm when used incorrectly.

We found all kinds of side effects are higher with higher dose of dexamethasone. From blood clots to infections.
Read 8 tweets
Vincent Rajkumar Profile picture
27 May
Evidence that current vaccines protect against B1.617 variants seen in India. #VaccinesWork

1/ Although 7 fold more resistant to neutralizing antibodies from convalescent or Pfizer/Moderna vaccinated people, ALL vaccinated sera still able to neutralize. biorxiv.org/content/10.110…
2/ UK study: 88% efficacy with Pfizer, & 60% with AZ against symptomatic COVID. This is only slightly lower than original RCTs of these vaccines, & when compared to B.1.1.7. in this study.

Likely much more efficacy against severe COVID.

Link to preprint: khub.net/documents/1359…
3/ Full vaccinated healthcare workers in India seem to be protected from severe COVID and deaths to a high degree. There are definitely some reports of loss of life in fully vaccinated, but I think these are rare. See thread.
Read 7 tweets
Vincent Rajkumar Profile picture
26 May
How and why I treat high risk smoldering multiple myeloma (SMM). Thread.

1/ Based on the progression risk curve over time, and genomic analysis, SMM is now considered a heterogenous clinical entity in which 50% of patients have premalignancy and 50% asymptomatic malignancy.
2/ These two groups can be considered as high risk SMM (asymptomatic malignancy) and intermediate/low risk SMM (premalignancy).

We are specifically concerned about high risk SMM, defined as 50% risk of progression to myeloma over 2 years.
3/ Patients with high risk SMM can be identified by the Mayo 2018 criteria: Also called the 20-2-20 criteria.

BMPC >20%
M spike >2
FLC Ratio >20

Any 2 of the 3 risk factors is considered high risk SMM. @MayoMyeloma @MayoCancerCare @myelomaMD
Read 13 tweets

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