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Dec 3 • 8 tweets • 10 min read
Here are my Top 5 #ASH22 @ASH_hematology myeloma abstracts. #ASH22VR
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 Not everyone with MGUS diagnosis needs a marrow. Choosing wisely. The iStopMM trial provides a model that limits unnecessary bone marrow biopsies. #ASH22 #ASH22VR @sykristinsson @eliaseythorsson @SaemundurMD @SigrunThorstei1 ash.confex.com/ash/2022/webpr…
#4 Defining duration of maintenance therapy. Brilliant analysis of Myeloma XI trial. Benefit persists for 3 yrs. But 4-5 yrs after starting maintenance, benefit diminishes. Lot more insights. #ASH22 #ASH22VR @_DrCP @profghjackson @profBigG @DrGarethMorgan1 ash.confex.com/ash/2022/webpr…
#3 Understanding mechanisms of resistance to BCMA CAR-T therapy. Single cell analysis shows initial resistance is not driven by dysfunctional immune system but baseline features of the myeloma cells themselves. #ASH22 #ASH22VR #NikhilMunshi @DanaFarber ash.confex.com/ash/2022/webpr…
#2 Elranatamab, BCMA targeted bispecific in refractory myeloma. Numerous bispecific abstracts being presented. I picked this this coz it shows 54% response in patients with prior BCMA therapy. #ASH22 #ASH22VR @NoopurRajeMD @LesokhinMD @NBahlis @Ccostello7 ash.confex.com/ash/2022/webpr…
#1 Randomized trial in frail patients showing that u can omit dexamethasone from frontline therapy. Congrats IFM for doing an RCT in frail patients. Congrats for testing a Dex free regimen in an RCT #ASH22 #ASH22VR #SalomonManier #ThierryFacon @Mohty_EBMT ash.confex.com/ash/2022/webpr…
I will be posting a discussion on YouTube later. I will be live tweeting from #ASH22 @ASH_hematology during the meeting highlighting focusing on selected new and important studies.

Follow if interested. #ASH22VR
For Top 5 picks from prior ASH meetings see thread from last year. Has links to prior years also. #ASH22

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More from @VincentRK

Vincent Rajkumar Profile picture
Dec 3
The COVID story of the last 3 years. Cases versus Deaths. ImageImage
All countries eventually abandoned the precautions that helped them control COVID. Which led to massive spike in cases especially with more transmissible omicron variants.

But a huge number of lives were saved by controlling COVID until the public was well vaccinated.
The idea that everyone will get COVID eventually and precautions to prevent spread of COVID didn’t matter is wrong.

Controlling COVID until after the public is well vaccinated did save a huge number of lives. Lives saved largely remained lives saved.
Read 5 tweets
Vincent Rajkumar Profile picture
Nov 30
Smoldering myeloma is NOT a premalignancy. It is not analogous to a polyp.

Its a heterogenous entity in which some patients have malignancy & some have premalignancy. We use biomarkers to identify patients most likely to have malignancy. @BloodCancerJnl nature.com/articles/s4140…
This is a complicated topic. And I have more often encountered the problem of a little knowledge is a dangerous thing with this topic than any other in my field. There are a lot of references in this thread.

I don’t make recommendations without thinking hard about pros and cons
More references and rationale in this thread on how I treat smoldering myeloma. #MedTwitter
@SagarLonialMD @mvmateos @myelomaMD
Read 5 tweets
Vincent Rajkumar Profile picture
Nov 28
One of the hardest questions I face as a cancer doctor is: “Doc, how long do I have to live?”

The easy way out is to say I don’t know. But that doesn’t help.

I always give an estimate so patients can plan their lives. Often it is much better than what they fear #MedTwitter

1/
This requires:

- Knowledge of current data to estimate prognosis specific for the patient based on their age, co-morbidities, as well as the stage & biology of the cancer.

- To clearly communicate it: the meaning of median survival and the odds of long term survival.
2/
I’ve found the easiest way to communicate concept of median survival is to say “50% of people in your situation will live longer than x number of years.”

Median survival info is not enough. Patients often want to know long term odds: the probability of 10 or 20 year survival.
3/
Read 7 tweets
Vincent Rajkumar Profile picture
Nov 23
$3.5 million for one shot of one drug.

We are a rich country — but this is unsustainable.

cbsnews.com/amp/news/fda-a…
Novel treatments like this are being developed for almost every serious disease.

Serious diseases are common. Cancer for example.

Can we really afford this long term? We need value based pricing. Medicare Negotiation at launch. @ASlavitt
We have a system where Pharma can name it’s price. They are pushing the limits with each new drug.

The inflation reduction act allows negotiation only after 7-11 years. So companies will now frontload and set a higher price at start to make up. We need more reforms.
Read 4 tweets
Vincent Rajkumar Profile picture
Nov 23
Re Belantamab withdrawal from market. @GSKUS #Myeloma

An unfortunate casualty of:

1) Wrong dose and schedule
2) Wrong trial design for phase III — going against an active control is high risk.
3) Wrong price at launch — drained support from MDs
I don’t know why we push the dose to the max. Clinical benefit is efficacy and safety. Efficacy is not enough. Safety is critical. And anything to do with eye is not going to be treated lightly by regulators.
It is getting complicated to find the right control arm in myeloma. Building an experimental arm that can go with low risk against an active treatment is not easy.

This is FOCUS trial repeated again. Unfortunate.
Read 7 tweets
Vincent Rajkumar Profile picture
Nov 18
1) Explain this: The life-saving leukemia drug imatinib costs only $480 per year at @costplusdrugs @mcuban

Instead of the $100,000+ retail price. How? Why?

thelancet.com/journals/lanha… #MedTwitter Image
2) How is this even possible?

Important article by @DrHKantarjian et al @MDAndersonNews @TheLancetHaem explains the how and why. thelancet.com/journals/lanha… #CostVR
3) Imatinib is a life saving drug for chronic myeloid leukemia. The poster child for successful targeted cancer treatment. It was introduced in 2001 at $32000 per year.

Price rose to >$100,000 by 2012. Lesson 1: Price of old drugs in USA increase markedly for no apparent reason
Read 12 tweets

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