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Vincent Rajkumar Profile picture
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12 Aug, 6 tweets, 4 min read
Three articles in the last few days in Blood Cancer Journal #BCJ showing reduced immune responses to COVID vaccines in patients with blood cancers.

1) Myeloma: especially patients on daratumumab and belantamab. nature.com/articles/s4140…
Chronic lymphocytic leukemia. Especially patients on BTK inhibitors (Eg., ibrutinib)nature.com/articles/s4140…
Reduced immune responses in hematologic malignancies. Only half the patients appear to generate sufficient immune protection. Especially if on B cell targeting treatments. #BCJ @BloodCancerJnl @Mohty_EBMT nature.com/articles/s4140…
All articles are open access at nature.com/BCJ @BloodCancerJnl
In light of this, FDA approval of booster mRNA dose is very much appreciated.
Data on how a booster dose helps. @NEJM nejm.org/doi/full/10.10…

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Vincent Rajkumar Profile picture
13 Aug
FDA authorizes booster dose of COVID mRNA vaccine for people who received solid organ transplants and others with similar immunocompromised status.

reuters.com/world/middle-e…
The FDA booster dose authorization does not apply to people who are not immunocompromised.

They don't give wording to preclude J&J recipients who are severely immunocompromised from receiving the booster as far as I can tell. fda.gov/news-events/pr…
This is a good decision that helps severely immunocompromised patients. I believe myeloma patients & those with other B cell malignancies receiving monoclonal antibodies against the immune system are similarly immunocompromised as patients receiving solid organ transplants.
Read 4 tweets
Vincent Rajkumar Profile picture
12 Aug
Just reading the 2017 @ASCO @ASCO_pubs guideline on bone modifying agents for metastatic breast cancer highlights the limits of consensus opinions: No agreement on which of the 3 drugs to use, or whether zoledronic acid should be given every 12 weeks or every 3-4 weeks.
That's kind of strange because denosumab costs 20 times more than the other two. That would have been an easy call for me. But it's listed first.

It looks like two groups could not agree with zoledronic acid should be given every 12 weeks or every 3-4 weeks so they put in both.
I stumbled on this as I'm reviewing a paper today. And it ties into the thread I posted yesterday.
Read 4 tweets
Vincent Rajkumar Profile picture
12 Aug
FDA to authorize booster mRNA vaccine shot for transplant and similar immunocompromised patients. I fully support this decision.

nytimes.com/2021/08/11/us/…
I hope physicians have sufficient latitude in determining which patients need the booster. After all we are the ones who know the patients.

I hope we can give an mRNA booster even if first vaccine was J&J.
Next up:

We need full FDA approval of mRNA vaccines. It's urgent.
Read 4 tweets
Vincent Rajkumar Profile picture
11 Aug
If you have smoldering multiple myeloma, a type of blood disorder, you could see 4 experts and come away with 4 different options:

1) No treatment
2) Mild treatment with 1 drug
3) Cancer like treatment with 3 drugs
4) Aggressive treatment including bone marrow transplant
Of course truth is that one of the treatment options is right. But how is a patient to decide which option will provide the best quality and quantity of life? Which expert to trust?

For each patient there is one right answer and the truth is not necessarily in the middle.
The point is that complex medical problems, whether it is smoldering myeloma, or cancer, or COVID have a lot of variables that need to be considered to make the right call.

Some experts make the right call because they have the ability assess all variables. Some do so by luck.
Read 7 tweets
Vincent Rajkumar Profile picture
11 Aug
COVID vaccines are working extremely well in preventing severe disease and deaths. Deaths are much lower relative to cases in post vaccination waves.

Do not miss the forest for the trees. ImageImage
I didn't make this endpoint about severe disease post hoc. Not changing goalposts. This is how I have always felt. Vaccines will protect especially against severe disease.
The immune response is strengthened and made more durable by each exposure to same antigen. And over time you develop immunity that protects you against severe disease, even if you remain susceptible to mild disease.
Read 5 tweets
Vincent Rajkumar Profile picture
10 Aug
A huge mistake that cannot be rectified. Bewildering that the CDC did not anticipate the need for a robust vaccine card. apnews.com/article/corona…
Lots of people have written about this months ago. @ddiamond
I wish I could post the type of vaccine card India, a country with far less resources issues that my parents got.
Read 4 tweets

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