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Vincent Rajkumar Profile picture
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Oct 28 • 4 tweets • 2 min read
Now that we have BCMA directed CAR-Ts (ide-cel, cilta cel), ADC (belantamab), & bispecific (teclistamab) how do we approach refractory myeloma?👇

For triple class refractory, its either alkylator based or BCMA directed therapy. For penta class refractory, some options promising.
One possible future option besides bispecifics targeting something besides BCMA (cevostamab and talquetamab) is GPRC5D targeted CART therapy. nejm.org/doi/full/10.10…
Here is a slide with current active myeloma treatments and their mechanism of action. #MedTwitter @MayoMyeloma
For more information on treatment of myeloma see @BloodCancerJnl review. -#OpenAccess nature.com/articles/s4140…

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More from @VincentRK

Vincent Rajkumar Profile picture
Oct 27
At @eaonc Group meeting.

We are discussing current and planned phase III trials in our myeloma committee. @myelomaMD @nsc_natalie @NorthTxMSG @mtmdphd @SagarLonialMD

3 key ongoing trials 👇 Image
Thanks @mtmdphd for posting the schemas.
Here’s the smoldering myeloma trial schema.
Read 4 tweets
Vincent Rajkumar Profile picture
Oct 25
Teclistamab granted accelerated approval for relapsed refractory myeloma in the US, for patients who have received at least 4 prior lines of therapy. This is an important new option for myeloma. fda.gov/drugs/resource…

1/
Teclistamab is a first in class novel bispecific antibody targeting BCMA antigen on myeloma cells. Data supporting its approval was published earlier in @NEJM by
@szusmani @TomBmt133 @mvmateos @SurbhiSidanaMD et al.
2/
The FDA approval follows a similar approval by the European Commission a few days ago.
3/
Read 9 tweets
Vincent Rajkumar Profile picture
Oct 23
There will be a joint FDA/International Myeloma Society workshop on drug development in myeloma. Nov 8-9.

Myeloma has been at the forefront of advances in cancer therapy. Register if interested. Over 1000 have already registered. @US_FDA @Myeloma_Society fda.gov/drugs/news-eve…
If you have interest in how we wrestle with competing issues, trial designs, endpoints, and the type of difficult decisions that are made in drug development balancing the needs of the patient, efficacy, safety, etc this workshop will be educational.
The topics discussed will be relevant to all cancers and so those who are in other related fields of oncology will also find the workshop helpful.
Read 4 tweets
Vincent Rajkumar Profile picture
Oct 11
Monoclonal Gammopathy of Undetermined Significance (MGUS).

Present in ~5% of all people age 50+

Therefore something all clinicians should know about. Brief summary.

#medtwitter @ESHaematology

1/
MGUS shows up on a serum protein electrophoresis (PEL) as a spike. See figure. The spike is called an M spike.

It can be typed on immunofixation (IFE) to determine if it’s IgG or IgM or IgA; kappa or lambda. See below.
2/
MGUS was a term coined by Dr. Kyle.

He called It MGUS because prior to that it was called benign monoclonal gammopathy. Since he found a 1% per year risk of progression to myeloma he felt it the word “benign” may not capture the clinical implications adequately.
2/
Read 22 tweets
Vincent Rajkumar Profile picture
Oct 11
What is the best treatment for newly diagnosed myeloma in transplant ineligible patients?

VRd or DRd?
There’s a lot to learn beyond myeloma by studying this question. #medtwitter @ESHaematology

1/
Both triplets VRd and DRd are excellent and well tolerated. Both have beaten lenalidomide/dexamethasone (Rd) in randomized trials.

One adds bortezomib to Rd —-> (VRd regimen)
2/
One adds daratumumab to Rd —-> (DRd regimen)

3/
Read 16 tweets
Vincent Rajkumar Profile picture
Oct 9
COVID Vaccines estimated to have saved nearly 20 million lives worldwide in just one year (Dec 2020-Dec 2021).

@TheLancetInfDis thelancet.com/journals/lanin…
Without COVID vaccines, life today would have been unthinkable. I’m thankful.
Talk to your doctors. Don’t be misled by people who promote anti vax messages. They do not have your best interest at heart.
Read 4 tweets

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