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Vincent Rajkumar Profile picture
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Dec 16 • 4 tweets • 4 min read
10 years ago JesusSanMiguel GiampaoloMerlini and I laid out our vision for redefining myeloma. A paradigm change. @NatRevClinOncol @DianaNrco nature.com/articles/nrcli… #ASH22 Image
The revised IMWG criteria redefining myeloma and related disorders was published in 2014 in @TheLancetOncol — and is now the most cited paper in the field. thelancet.com/journals/lanon…
We also have made significant progress in early detection and therapy of smoldering multiple myeloma as outlined here. @BloodCancerJnl nature.com/articles/s4140…
The next step for me is to classify myeloma into distinct entities based on the underlying primary cytogenetic type: a vision @myelomaMD and I outlined in The Multiple Myelomas. @NatRevClinOncol nature.com/articles/s4157…

A vision originally articulated by @Rfonsi1 Image

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More from @VincentRK

Vincent Rajkumar Profile picture
Dec 14
I just attended one of the biggest cancer meetings in the world. #ASH22 @ASH_hematology

For my followers here is a snapshot of the incredible progress happening with cancer treatment. It’s good. Thread.
1/ There is a revolution in cancer therapy that uses the power of our own immune system to fight cancer cells:

CAR-T cells
Bispecific antibodies

Both these approaches have already produced spectacular results in many cancers and we are just starting.
2/ CAR-T cells: take your own immune system cells out, engineer them to target a specific cancer, and then put them back in the body to go kill the cancer cells. A few CAR-T products have already been FDA approved. Many more to come. my.clevelandclinic.org/health/treatme… Image
Read 13 tweets
Vincent Rajkumar Profile picture
Dec 10
Updated Myeloma Treatment Algorithms presented at @IMFmyeloma @CCO_Education symposium today at #ASH22

1. Newly diagnosed transplant ineligible. Either VRd or DRd is OK. Maintenance varies by risk stratification.
2. Newly Diagnosed myeloma transplant eligible. #ASH22

Early transplant preferred. But for selected standard risk patients depending on preference, delayed is also OK. Maintenance varies by risk stratification.
3. First relapse. The approach depends on refractoriness to Len and CD38moAB. For CD38 Moab either Daratumumab or Isatuximab are OK. Depends on cost and availability. #ASH22
Read 7 tweets
Vincent Rajkumar Profile picture
Dec 8
At #ASH22 my colleague @myelomaMD will present the initial results of the ASCENT trial, aka the 2nd Cure trial to test the hypothesis whether myeloma can be cured if highly active combination therapy is given early at the smoldering myeloma stage. ash.confex.com/ash/2022/webpr… Image
Updated results from the 1st Cure trial, GEM-CESAR led by @mvmateos is also being presented at #ASH22

ash.confex.com/ash/2022/webpr…
These trials are part of a planned series of trials investigating whether the incurability of myeloma is related to the fact that we have traditionally started effective therapy only after the disease has spread and mutated to the point where it is no longer curable.
Read 9 tweets
Vincent Rajkumar Profile picture
Dec 7
Just in time for #ASH22

The IMWG updated diagnostic criteria for myeloma & related disorders has just become the most cited myeloma paper ever. @TheLancetOncol #MedTwitter thelancet.com/journals/lanon…

I was honored to lead this effort for the IMWG. A thread on the main changes.
1/
2/ The paradigm shifting change was including 3 biomarkers that were associated with 80% or greater probability of progression within 2 years as myeloma defining events on top of CRAB.

>100 myeloma experts gave input for the paper. #ASH22 #MedTwitter Image
3/ We simultaneously updated the diagnostic criteria for related plasma cell disorders including MGUS, SMM, and solitary plasmacytoma. Image
Read 13 tweets
Vincent Rajkumar Profile picture
Dec 5
Ahead of #ASH22 here are my updated algorithms for current treatment of myeloma. ImageImageImageImage
Algorithm for second or higher relapse: Any of the first relapse regimens which contains at least 2 drugs the patient is not refractory to.

For refractory myeloma see below. Image
It’s a complicated landscape and I have tried to make it simple for practicing clinicians.

There are changes compared to prior years. @mtmdphd @Mohty_EBMT #MedTwitter Image
Read 5 tweets
Vincent Rajkumar Profile picture
Dec 3
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…
Read 8 tweets

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