I'm not a virologist or vaccinologist. I'm addressing this issue as someone whose career has been focused on plasma cells, the cells that make antibodies, for over 20 years. 👇
1) When first exposed to an antigen, virus or vaccine, the immune system produces a primary immune response. On exposure to same antigen again, it produces a better, bigger, and more durable secondary response. Basic immunology. microbiologynotes.com/differences-be…
Sometimes the first infection gives a long enough exposure to the antigen to stimulate the secondary response. Sometimes it's not. Depends on the virus and duration of infection.
So even if someone had COVID, it's better to get the vaccine also to ensure a better, durable secondary immune response. More IgG producing cells, more long lived memory cells.
Given the rate of reinfections we are seeing, it is worrying that COVID doesn't seem to produce an enduring immune response in everyone.
It's possible that 2 vaccine doses given too close to each other may also not produce a durable secondary response. (Why some need boosters).
2) If someone has not yet had Covid, then between getting immunity from the vaccine versus virus, even if the virus induced response is for argument sake better, it is much more risky to acquire immunity that way. It is far safer to get it through a vaccine.
3) Testing for antibodies and then deciding who to vaccinate and who not to is not realistic when we have 70 million eligible left to vaccinate in the US.
4) The virus is also mutating. The more infections we have, the more risk of mutants. Hence the push for vaccinations.
5) There are side effects with the vaccines as there are with any medicine. But truly serious ones are very rare compared to risk of COVID related complications or death. 215 million people have been vaccinated in the US. 3.75 billion people in the world: Almost half the world.
6) There will always be people who doubt the efficacy of vaccines because they hear someone got severe Covid despite vaccines and therefore why bother. Actually vaccines reduce your risk of severe Covid by 90%. They work: Randomized trials and Real world data.
More here on clarifying doubts about vaccine efficacy.
AQUILA trial for high risk smoldering myeloma published in @NEJM today.
@thanosdimop
Personally for me, it is a huge milestone along 25 years of work that started in 1998. #ASH24 #ASH24VR
This story below may help those interested in a clinical trialist career. 1/
In 1998, as a fellow @MayoClinic I was keen to determine if early intervention delayed progression and improved survival in SMM. #ASH24
In 1999, with the help of Tom Witzig, I led a small phase II trial of thalidomide for SMM. @LeukemiaJnl 2/
I was then so fortunate to examine the natural history of SMM, with the legendary Bob Kyle. Honored to be last author on @NEJM paper that also provided data that most progressions occur in the first 5 years of diagnosis.
The start of the concept of high risk vs low risk SMM. 3/
FDA approval doesn’t necessarily mean standard of care.
Thread.
1/
For example FDA approved Dara VMP for frontline therapy in myeloma in 2018.
Literally no one used the regimen in the US.
Literally no one felt the regimen was standard of care in the US.
Before or after approval!
Why?
FDA adjudicates a sponsors submission on whether a given drug/regimen has met the burden of proving safety and efficacy.
Standard of care in clinical practice is a different standard: judgment of risk/benefit of available alternatives, and assessment of trial design/end points.
Cure is a simple word. But there is confusion when it comes to cancer. What cure is in cancer, and what we should aspire for?
When can we say that a given type of cancer is curable?
Thread
1/
There is a difference between when we can say a particular cancer is a curable type versus whether individual patients with a given cancer can be considered potentially cured.
They are not the same.
2/
To call a cancer curable we must be able to treat the cancer for a finite duration, stop all therapy, and know that a certain % of patients will never relapse
Early stage solid tumors, Hodgkin lymphoma, DLBCL, ALL, AML are curable. Real cure. The definition of curable cancer
3/
The 4 big myeloma randomized trials to watch out for @ASCO #ASCO24
1. Isa-VRd vs Isa-Rd newly diagnosed
2.Isa-VRd vs VRd (IMROZ)
3.DREAMM8 Bela-Pd vs Pd
4.Ven Dex vs Pom Dex (Canova)
See thread for why they are important.
1) The Triplet vs Quad trials with will define role of quads in elderly patients with newly diagnosed myeloma. They also provide frontline phase III data with Isatuximab— and a choice between Dara and Isa. For some patients Isa will be more cost effective. @Myeloma_Doc #ASCO24
2) Belantamab will make a comeback.
Corneal toxicity is low with reduced frequency dosing. The drug works very well. And in many patients with refractory myeloma belantamab may be safer and easier to do than bispecifics. We need options. #ASCO24
2/ Even though CART (cilta-cel) is approved for first relapse we are NOT including it in our main algorithm. Reserved only for special circumstances in this population. We have a long track record with standard triplets, and we are concerned about CART side effects.
3/ The current approach for second or higher relapse continues to define 3 specific types of Triple Class refractory. This makes it easier for clinicians to consider options.