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Rafael Fonseca MD πŸ‡ΊπŸ‡ΈπŸœπŸ‡²πŸ‡½ Profile picture
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Aug 27 β€’ 4 tweets β€’ 4 min read
Joan Blade presenting Ph3 Bu-MEL vs MEL
#IMS2022 #mmsm
VOD IN 4 PTS.

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Rafael Fonseca MD πŸ‡ΊπŸ‡ΈπŸœπŸ‡²πŸ‡½ Profile picture

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More from @Rfonsi1

Rafael Fonseca MD πŸ‡ΊπŸ‡ΈπŸœπŸ‡²πŸ‡½ Profile picture
Aug 28
I think we cure some MM patients (I know controversial) and some thoughts on how to get there with current therapies
1/x
With median OS over 13 years for standard risk (Emory ASCO 2022) minimizing ENDURING toxicity is critical. Particularly peripheral neuropathy - bortezomib-induced.
2/x
Accordingly, I use KRD as the backbone. The data for QUADs is compelling, so I try to get coverage for Daratumumab-KRD. At this moment the MASTER trial has the best MRD- rates. Daratumumab-VRD is fine too.
3/x Image
Read 17 tweets
Rafael Fonseca MD πŸ‡ΊπŸ‡ΈπŸœπŸ‡²πŸ‡½ Profile picture
Mar 27, 2021
A very quick primer for patients on what CART cells are and why we are so excited for this new approval for myeloma.
#mmsm
CART cells are created by taking the patients won T cells and training them to latch on to the target cells, in this case, myeloma cells via genetic engineering. T cells are bullies and if they latch to something they attack!
The cells are collected from the peripheral blood and sent to a facility where they are trained. They are later shipped back and infused into the person. The hope is they get going, expand and attack the myeloma cells.
Read 8 tweets
Rafael Fonseca MD πŸ‡ΊπŸ‡ΈπŸœπŸ‡²πŸ‡½ Profile picture
Dec 12, 2020
LBA-1 Driver Mutation Acquisition in Utero and Childhood Followed By Lifelong Clonal Evolution Underlie Myeloproliferative Neoplasms.
When do mutations in MPN start? Can we do genetic archeology?
Great study by @jyoti_nangalia
ash.confex.com/ash/2020/webpr…
#ASH2020 #ASH20RF #mmsm 1/x
I have always wondered about this in myeloma (MM). We now know that all MM patients have the preceding stage of MGUS. Studies were done in the US Army with stored blood samples (thousands) found *ALL* patients with MM had prior MGUS.
2/x
 ncbi.nlm.nih.gov/pmc/articles/P…
So if all MM patients had preexisting MGUS, for how long has the MGUS existed? Mathematical modeling predicts decades. In this paper from @MayoClinic >10 yrs.
@VincentRK
3/x
 mayoclinicproceedings.org/article/S0025-…
Read 19 tweets
Rafael Fonseca MD πŸ‡ΊπŸ‡ΈπŸœπŸ‡²πŸ‡½ Profile picture
Dec 11, 2020
Safety and Efficacy of CTX001 in Patients with Transfusion-Dependent Ξ²-Thalassemia and Sickle Cell Disease: Early Results from the Climb THAL-111 and Climb SCD-121 Studies of Autologous CRISPR-CAS9–Modified CD34+ Hematopoietic Stem and Progenitor Cells
A big deal!

#ASH20RF
Patients with B-thal and sickle cell disease who required transfusions were eligible. They collected autologous stem cells, and via CRISPER edited BCL11A, increasing fetal hemoglobin (HbF) production. Patients had myeloablation with busulfan, and cells were infused back.
A small study (n=7). The time to median neutrophil engraftment was 32 and for platelets 37. All patients demonstrated increases in Hb & HbF. some transfusion free over 15 months. ImageImage
Read 5 tweets
Rafael Fonseca MD πŸ‡ΊπŸ‡ΈπŸœπŸ‡²πŸ‡½ Profile picture
Jul 21, 2020
Great thread. The empirical data is consistent. If the prevailing hypotheses hold true then there is a lower likelihood of a big second wave. Focal hotspots possible but big flares not as much. It seems that at 15-25% local hot spots β€œburn out.”
#COVID19
1/4
 @boriquagato
The London data suggest it was too late to do anything once the virus reached a critical point.

No agency possible. It will be interesting to hear narratives later.

Links to threads I have posted on this topic. We can only hope this to be true and not too soon.
2/4
Another thread
3/4
Read 4 tweets
Rafael Fonseca MD πŸ‡ΊπŸ‡ΈπŸœπŸ‡²πŸ‡½ Profile picture
Jul 19, 2020
Mounting evidence- not all are susceptible to COVID-19?
Seeing more studies showing cross-reactivity in T cells protecting against SAR-CoV-2. It seems increasingly likely that some cross-protection occurs. Most of these studies have focused on T cell reactivity.
1/x
 #COVID19
This nature paper shows that T cells from patients who recovered from SARS in 2003 have cross-reactivity against SARS-CoV-2. This is superbly interesting. Why not other coronaviruses?

2/x
 #COVID19
β€œSurprisingly, we also frequently detected SARS-CoV-2 specific T cells in individuals with no history of SARS (sic the 2003 version), COVID-19 or contact with SARS/COVID-19 patients (n=37).”
nature.com/articles/s4158…
3/x
 #COVID19
Read 14 tweets

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