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Rahul Banerjee, MD, FACP Profile picture
@RahulBanerjeeMD
Jun 7, 2023 • 11 tweets • 11 min read • Read on X
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1/ My time-to-tweet interval re: #ASCO23 myeloma abstracts is longer than my time-to-toci with CAR-T, but finally off 🏥 service and excited to tweet about a few #MMsm gems!

My research focuses on ⬇️ AEs, ⬇️ time tox, & improved workflows. Here are a few that stood out to me:
2/ @bhemato et al, CARTITUDE-4 (cilta-cel in #MMsm 1-3 prior lines).

Beyond dramatic PFS benefit, worth 🔨 home that CAR-T "one & done" (visits become ≤1x per month) vs DPd/VPd [even stronger DKd] always ≥1x visit/month.

Time tox advantage to CAR-T!

meetings.asco.org/abstracts-pres… Image
3/ @adamssperling et al, PHE885 rapidly manufactured CAR-T with ⬇️ T-cell exhaustion.

Bridging before #MMsm CAR-T unlikely to ≥PR but likely to worsen cytopenias.

⬇️ vein-to-vein time to ~2 weeks: less bridging, happier bone marrow, happier patients!

meetings.asco.org/abstracts-pres… Image
4/ @AjayNookaMD et al, KPd maintenance for high-risk #MMsm

Ideally Kyprolis will be q2wk and #downwithdex in RRMM (cc @jmikhaelmd), but pom less temperamental than len in CKD plus (?) ⬇️ risk of SPMs... so I'm all in!

Why else I love this abstract 👇
Image
5/ Y Cohen et al, RedirecTT-1 of tec/tal in #MMsm.

bsAbs targeting BCMA and GPRC5D at once. Infxns manageable. Look at these responses & duration in EMD!

P.S. Doubly impressive because authors were EMD purists, i.e. only soft-tissue = "extra"medullary.

meetings.asco.org/abstracts-pres… Image
6/ @DholariaMD et al, TRIMM-2 of talq + dara.

"Flogging T cells to attack B-lineage cells" is a crude description of BCMA bsAb given weekly until #MMsm PD.

In grand multiverse, a BCMA-free combo exists: def lower infection rates than I'd have expected!

meetings.asco.org/abstracts-pres… Image
7/ Switching to posters: @RoswellPark study of T-cell phenotype before & after 6-month physical activity intervention.

Great way to shed some pounds, but more importantly shed PD-L1 & TIGIT! Exhausted T cells may contribute to functional high risk #MMsm.

meetings.asco.org/abstracts-pres… Image
8/ @Radhika_Bansl @YiLinMDPhD outpatient teclistamab in #MMsm using day hospital and RPM #cellphonesandcelltherapies

98% of 155 tec doses safely given as outpt 🤯

⬇️ costs of care, ⬇️ monster 10-day LOS, happier patients (no 🛌 better than one's own!)

meetings.asco.org/abstracts-pres… Image
9/ @KimmelCancerCtr retrospective analysis of time to Zometa in new Dx #MMsm.

Definitely some confounders, e.g. pre-existing access to dentist probably = ⬆️ SES.

But maybe we - myself included! - are overemphasizing need for dental 'clearance' in all...

meetings.asco.org/abstracts-pres… Image
10/ van de Donk et al with PPx toci before teclistamab in #MMsm.

Any-grade CRS less than half of MajesTEC-1, similar to #ASH23 oral with cevostamab by Trudel & colleagues. ⬇️ CRS = ⬇️ time in hospital!

Now if only we can get a subQ version of toci...

meetings.asco.org/abstracts-pres… Image
11/ @AhlstromJenny et al: @HealthTree survey of 325 pts.

Although my research interests are ⬇️ AEs / time tox, our #MMsm pts bravely willing to put up with a LOT if it'll help.

Bottom two 👇 less "trade-offable": fin tox & caregiver research important!

meetings.asco.org/abstracts-pres… Image

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More from @RahulBanerjeeMD

Rahul Banerjee, MD, FACP Profile picture
Jan 11
1/ 🚨 Now open-access in @BloodAdvances:

The "Doctor, can CAR-T therapy cause cancer?" question in clinic

In past 2 months, updated FDA info re: T-cell malignancies after CAR-T and MDS after cilta-cel in #MMsm.

How do we contextualize to our patients?

ashpublications.org/bloodadvances/…
Image
2/ We suggest a 3-part framework to discuss this with our #leusm #lymsm #MMsm patients as shown below:

1️⃣ The benefits of CAR-T outweigh the risks
2️⃣ A causal association possible, but confounders exist
3️⃣ Active cancers generally a bigger threat than a potential cancer later Image
3/ Point 1: Benefits of CAR-T (⬆️ PFS, ⬆️ QOL, in some cases ⬆️ OS) outweigh risks.

Excellent partner read (came out yesterday!) by @BLLPHD et al 👇🏼

By any metric, T-cell malignancy risk <0.1%:
 - 20 out of >30K treated
 - 3 out of 11K in CIBMTR data

nature.com/articles/s4159…


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Read 9 tweets
Rahul Banerjee, MD, FACP Profile picture
Dec 23, 2023
1/ The FDA has been keeping us busy! Now an update to the cilta-cel CAR-T label in describing 10 cases of second blood cancers in patients treated on CARTITUDE-1.

Note that in CARTITUDE-1, median time since #MMsm Dx 5.9 yrs. 99% len exposed, 90% prior ASCT.

A few thoughts 🧵: Image
2/ We know that ASCT +/- len raise #MMsm patients' risks of 2nd malignancies.

In IFM 2005-02, SPM/year rate was over twice as high with len maintenance (albeit still rare).

Key point: All CARTITUDE-1 recipients had other risk factors for MDS/AML.

nejm.org/doi/full/10.10…
3/ Don't forget "immortal time bias" - pts can only get 2nd malignancies if #MMsm is controlled enough and they are alive.

In MAMMOTH (albeit not quite the same), median survival only 8.6 months.

In FDA statement, time to MDS/AML was >1yr since CAR-T.

nature.com/articles/s4137…
Read 6 tweets
Rahul Banerjee, MD, FACP Profile picture
Nov 11, 2023
1/ So excited to see this out!


In myeloma, trials continue to use 2x weekly bortezomib because of a belief that standard of care (SOC) is only based on older trials.

In reality, the SOC is how typical physicians would approach #MMsm care - so we asked!nature.com/articles/s4140…

Image
2/ Compared to twice-weekly subQ bortezomib in #MMsm, once-weekly dosing has:
- Comparable efficacy
- Less neuropathy
- Less time toxicity from unnecessary clinic visits

#ASH23 will feature @FiekeHoff (@GKaurMD's mentee)'s tour de force oral presentation with Flatiron data 👏 Image
3/ Thanks to 217 physicians from 38 countries and 6 continents (38% community-based and 29% LMIC-based) 🙏

Physicians order once-weekly bortezomib for 95% of their #MMsm pts.

Outside of acute cast nephropathy (rarely trial-eligible), vast majorities support 1x weekly dosing.


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Read 5 tweets
Rahul Banerjee, MD, FACP Profile picture
Mar 20, 2023
1/ Question for #MMsm hive mind 🙏

For patients with functional high-risk myeloma (e.g., relapse ≤18 mo of 1st-line Tx), any good summary of data for functional high-risk vs high-risk FISH vs both?

Summarizing what I found so far, but I know I must be missing a few studies! Image
2/ In KarMMa-2 Cohort A from #ASH22 by @szusmani @DrKrinaPatel et al, 37 patients with #MMsm enrolled in early ide-cel trial for functional high-risk.

Of n=22 with evaluable FISH (I wish it were a little higher), 45% didn't have any high-risk features.

ashpublications.org/blood/article/… Image
3/ In #ASH21 RWE #MMsm database analysis by @kansagraMD et al, 1719 pts analyzed inc. hypodiploid as high-risk 🐠

Thanks Ankit for this awesome work! Am I analyzing abstract correctly to say that 73% of functional high-risk pts had standard FISH? 🤯

ashpublications.org/blood/article/… Image
Read 4 tweets
Rahul Banerjee, MD, FACP Profile picture
Apr 3, 2020
(1/20) Just finished leading a conference about #COVID19 and hematology. >50% of my citations were preprints, so that got me thinking: why write my own preprint when I can just do a tweetorial? So here goes: 🎺🥁[fanfare] COVID-19 for the HEME CONSULT fellow or attending. Image
(2/20) This is a saga about #COVID19 and non-malignant hematology* in three chapters:
1) COVID-19 and lymphocytes
2) COVID-19 and platelets
3) COVID-19 and RBCs

* Or should I say, “classical hematology.” Image
(3/20) For #COVID19 and lymphocytes: Lymphopenia is bad, and lymphocyte % (on diff) starting <20% ➡️5% over time is even worse. Mehh methods but good commentary, spelled out in this excellent tweetorial by @Leo_ReapDO
Read 21 tweets

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