Tiffany (Lin) Lucas Profile picture
Dec 12, 2022 9 tweets 6 min read Read on X
And then he took from chapter 1 and applied it to chapter 2 - found that he could assess for mixed chimerism using restriction length polymorphism. And then.. time to find a job! And he wanted to bring it in to the clinic, so... #ASH22 6/n
Always love showing photos of the researchers earlier in their careers! So then he was able to establish a mouse a model of graft rejection. And tried in vivo cytokine injection to increase graft - tried lots of them, some toxic, some didn't work. 7/n #ASH22 Image
Then tried donor NK cell depletion and CD4 and CD8 depletion -- but then tried L-leucyl-L-leucine methyl ester that worked but.. it couldn't be made in GMP - what a let down for a researcher, but real life. Thanks for sharing this roller coaster. #ASH22 8/n
Look at all the Blazar publications in those years -- and then found rapamycin -- not all of them working but giving them more information. #ASH22 9/n Image
Now we have this list of T cell costimulatory and co-inhibitory signals -- and you look at the sum total of the positive and negative signals to decide which cells respond, how long it lasts, etc! This is complex! #ASH22 10/n Image
Look at the time from the original findings published to the final approval - #abatacept got FDA approval in 2021. Way to continue along. #ASH22 11/n Image
Then thinking about Treg:T cell ratio was used. Was able to go from 200 fold expression to 13000 fold! But then the immune response was not sustained after infusion so then found orthogonal IL-2 ameliorates this. #ASH22 12/n Image
Four GVHD drugs are now FDA approved. CTAL4-Ig, ibrutinib for chronic GVHD, belumosudil (ton increase Tregs) and ruxolitinib for a and cGVHD! #ASH22 13/n
If any #ASH22 #ASHtrainees wonder why we want you to have a SOC for your fellowship project -- look at these many people listed including research mentors but also clinical physicians, trainees and postdocs. You HAVE to remember this is a team sport. Love it! 14/14 ImageImageImage

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More from @DrTiffanyL

Dec 13, 2022
Two oral abstracts on the #STELLAR study (Sickle Cell Transplant Evaluation of Long-term and Late Effects Registry) presented by Dr. Sobenna George (hi!) and Dr. Lillian Meacham #ASH22 1/n
What's the problem? You can get DOR = diminished ovarian reserve or POI = primary ovarian insufficiency (early menopause). This is SUCH a good explanation!! #ASH22 2/n ImageImage
Small numbers but such great data, 30 females and 18 males, about 4-6 years post therapy (myeloablative transplants (mostly matched sib) and one each with gene tx) #ASH22 3/n
Read 7 tweets
Dec 13, 2022
How many patients are on disease modifying treatments for #SCD - data from 2014-2021 presented by Dr. Terri Newman. @ash22 1/n
We're talking about #Hydroxyurea and in 2017, expanded use of #HU as well as L-glutamine and then in 2019 #voxelotor and #crizanlizumab. #ASH22 2/n
They looked at 5022 patients with Rx of DMTs. Those on DMTs were surprisingly mostly in the 18-45 group (the box is wrong on the screenshot) and mostly male and had more VOCs. #ASH22 3/n Image
Read 5 tweets
Dec 13, 2022
Management of pregnant women with #SCD in high income countries with Dr. Eugene Oteng-Ntim (with the cutest intro from Dr. Eugenia Asare). Writing down the #pearls here so I can share with my patients for their future and so I can advocate for them. #ASH22 1/n
As we know, more low/not detectable AMH levels in women with #SCD. Know that preimplantation diagnosis and successful transfer is possible with data to support that. And many want #NIPT secondary to fear of amnio or CVS, which can be done. (w/ @Nonacus) #ASH22 2/n
What risks are we talking about in sickle cell disease and pregnancy? 1/4 of the patients in their cohort required transfusion during pregnancy and RR of preeclampsia is 2.43 and 3x risk of SGA, 4x risk of stillbirth. #ASH22 3/n
Read 5 tweets
Dec 13, 2022
Dr. Mark Fleming talking about pathology vs molecular testing in MDS. He first reminds us the difference of childhood MDS from adult MDS -- and these WHO guidelines, childhood MDS is only classified into these two subtypes. #ASH22 1/n Image
The issue is that the "dysplasia" definition has been defined by the cytogenetic abnormalities and genotypes of adult MDS so the criteria for blast %age, extent of dysplasia -- but does this apply?? #ASH22 2/n
MDS in pediatric patients is more normo or hypocellular than hypercellular. There is not ringed sideroblasts in persons <30 and he also reminds us that there are a number of baseline dysplasias in germline BMF pts that are mistaken for MDS! #ASH22 3/n
Read 7 tweets
Dec 13, 2022
#ASH22 Bone marrow failure syndromes: diagnostic principles in 2022. Starting with Sara Lewis, a genetic counselor in hematology. Follow this tweet for more. 1/n
Sara reminds us that she feels patients think more about their family history as they see her draw the pedigree. Time for me to start doing this! #phodocs #ASH22 #pearl 2/n
Here are the options for diagnostic workup - genetic tests can be done from somatic genes or germline! #ASH22 3/n
Read 6 tweets
Dec 13, 2022
@bhwords Dr. Beverley Hunt presenting on #COVID19 and #thrombosis. She wants to chronologically review the battles we have fought! #ASH22 1/n
@bhwords This story (clinical presentation) -- a reminder of the patients from the front lines in the beginning and what some docs went through! #COVID19 #ASH22 2/n Image
@bhwords #COVID19 is the 'perfect suit for VTE' ... inflammation, sticky blood, vessel wall changes. The amazingly high levels of fibrinogen (14g/L! (normal is 2-4g/L)) D-dimers reported on a log scale because of the significant increase. #ASH22 3/n
Read 12 tweets

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