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30 Nov, 7 tweets, 10 min read
Here are my Top 5 #ASH21 @ASH_hematology myeloma abstracts. #ASH21VR
Links to the full abstract. As in the past, I left out studies where similar results were already presented or published before. Top 5 based on new data, clinical impact & methodology

Thread with countdown👇
#5 Outcome of patients with refractory myeloma treated with bispecific antibodies.
64 patients. Median 7 prior regimens. 58% response rate. Importantly median survival 18 months — brings hope. @tarekmd91 @JoshuaRichterMD @MountSinaiNYC #ASH21 #ASH21VR ash.confex.com/ash/2021/webpr…
#4 Prevalence of smoldering myeloma (SMM) in the general population.
75,000 person RCT iStopMM estimates prevalence at 0.5% of population age >=40 #ASH21 #ASH21VR @SigrunThorstei1 @sykristinsson @DrOlaLandgren @TBSsteharding @BrianDurieMD @MalinHultcrantz ash.confex.com/ash/2021/webpr… Image
#3 Prevalence of MGUS in high risk populations (African American or family history) age >=40 years. PROMISE MGB Biobank study of 2960 people. Prevalence of MGUS was high at 10%. @HabibElKhoury @IreneGhobrial @DanaFarber #ASH21 #ASH21VR ash.confex.com/ash/2021/webpr… Image
#2 Identification of an MGUS like phenotype on flow cytometry in a study of over 5000 patients. Patients with MM who had MGUS like residual phenotype have excellent survival, even without CR. @LeireBurgos @BrunoPaiva_UNAV @mvmateos #ASH21 #ASH21VR ash.confex.com/ash/2021/webpr…
#1 iStopMM RCT shows prevalence of MGUS in age >=40 is 5%. Importantly early results show that screening detects significantly higher number of people with MM, SMM. #ASH21 #ASH21VR @sykristinsson @SigrunThorstei1 @ThorvardurL @TBSsteharding @BrianDurieMD ash.confex.com/ash/2021/webpr… Image
For top picks from previous years see thread.

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More from @VincentRK

Vincent Rajkumar Profile picture
2 Dec
Thread on financial conflict of interest.

1/My 2018 Dollars for Docs: $0

This was enormously difficult & is not sustainable. Coz if you lead trials some small amount gets invariably reported.

$0 is possible only for people who don't lead therapeutic trials. #MedTwitter Image
2/ I had to go through all kinds of contortions to get to $0, including taking my name off many papers even though I was an investigator. Ride separately from other investigators to meetings. Avoid drinking even bottled water in long meetings to get zero dollars reported.
3/So we have a problem. If you want experts with zero $ conflicts you will end up with people who don't lead clinical trials.

The $ amounts reported do not mean that investigators are enriching themselves: it can be meetings, being authors on papers. Actual cost to do the trial
Read 19 tweets
Vincent Rajkumar Profile picture
1 Dec
FDA advisory panel votes in favor of EUA for molnupiravir for treatment of COVID. @Merck

Molnupiravir is a pill taken twice a day for 5 days starting within 5 days from onset of symptoms. @Merck Image
The main issue with this drug is that in the interim analysis there was a 50% reduction in risk of hospitalization and death. In full analysis the benefit narrowed to 30%.

Is a 30% decrease in risk of severe Covid good enough? Yes in my opinion.
Next up, Pfizer's antiviral pill.
Read 4 tweets
Vincent Rajkumar Profile picture
30 Nov
People are counting waves differently. Some say we are in our 5th wave.

We are a big country so as a wave spreads it looks like 2 waves, but it's one wave sequentially in 2 places.

Initial 2 peaks is first wave Apr-Sep 20.
2nd wave Nov 20-May 21.
3rd wave is the current one. Image
Easier to appreciate when you look at deaths because with cases, numbers over time have been affected by test availability.

So looking at deaths, the first two peaks are one wave, affecting separate parts of the country as COVID spread initially. We are now in end of 3rd wave. Image
When you look at individual states easier to appreciate 3 waves. New York and Texas below. ImageImage
Read 4 tweets
Vincent Rajkumar Profile picture
28 Nov
I was just thinking of flying to see family. #OmicronVariant threatens plans because we have no idea what countries and airlines will do at the last minute.

The last thing you want is to be stuck for days in a quarantine hotel.
Like what happened to passengers on these two flights.
Airline websites give a lot of unhelpful disclaimers: "We have no idea what the rules may be. Requirements may change at last minute." Right.

Can we not have a worldwide consensus policy requirements for air travel that will be enough for Covid and any new variant?
Read 4 tweets
Vincent Rajkumar Profile picture
23 Nov
People are rightly confused how is it that we have another wave when 60% or more are vaccinated, & 40-50% of the population has probably had COVID.
Where is immunity?

Thread.

1/ How strong and durable immunity is following infection or vaccination depends on many factors.
2/ The strength and durability of the immune response depends on the nature of the antigen, how it is presented to the immune system, number of exposures, etc.

3/ With Covid we also got a bad deal: A new serious virus that we were not immune to, that spreads easily, & mutates.
4/ The immune response is more durable with repeated exposure: generation of a true secondary immune response. microbiologynotes.com/differences-be…

With natural infection sometimes one infection is long enough to trigger a durable secondary response. Sometimes its not, & you are susceptible.
Read 15 tweets
Vincent Rajkumar Profile picture
21 Nov
Just like anti vaccine folks found Gibraltar, another place they keep pointing to is Vermont, the most highly vaccinated state.

Best for people know the facts.

1) No state has done as well as Vermont in this pandemic: fewest lives lost. They know what they are doing.
2) Vermont is the best vaccinated state and vaccinations have kept deaths low. Since June 1 by which data everyone had an opportunity to be vaccinated, deaths have continued to stay low in Vermont. But have increased in many less well vaccinated states.
3) Even Vermont is not as well vaccinated as it should be. So 72% while #1 in the US is lower than many countries. There are vulnerable people and unvaccinated people, so with delta cases will occur.
Read 9 tweets

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