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Al-Ola A Abdallah MD (USMIRC)

@Abdallah81MD

Mar 13

🧵 High-Risk Myeloma Maintenance

1️⃣🧬 Maintenance Strategies in High-Risk Multiple Myeloma (HRMM)
New multicenter analysis from the USMIRC collaborative compares lenalidomide (R) vs bortezomib + lenalidomide (VR) maintenance after ASCT.

Key question:
👉 Does intensifying maintenance improve outcomes in HRMM?
#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @Larvol @US_HMC @MedwatchKate @OncoAlert

2️⃣ Background
📊 HRMM remains a major challenge despite modern induction + ASCT.

High-risk cytogenetics (per IMWG):
⚠️ del(17p)
⚠️ t(4;14)
⚠️ t(14;16) / t(14;20)
⚠️ +1q gain/amplification
⚠️ Double- or triple-hit disease

Standard maintenance = lenalidomide, but outcomes remain inferior in HRMM.

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @Larvol @US_HMC @MedwatchKate @OncoAlert

3️⃣ Study Design
🔬 USMIRC multicenter retrospective study

👥 97 HRMM patients
• R maintenance: 68
• VR maintenance: 29

Maintenance initiated within 180 days post-ASCT
📅 Study period: 2009–2024

Median age: ~60 yrs

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @Larvol @US_HMC @MedwatchKate @OncoAlert

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Al-Ola A Abdallah MD (USMIRC)

@Abdallah81MD

Mar 7

Teclistamab in RRMM with Renal Impairment Real-world data from the USMIRC multi-institutional study 🧵

1️⃣🧬 (n=195) shows that teclistamab remains safe and effective even in patients with significant renal dysfunction (CrCl <40 mL/min) — a population excluded from the original MAJESTEC-1 trial.
#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

2️⃣ Mechanism Refresher 🔬
Teclistamab = BCMA × CD3 bispecific antibody

➡️ Targets BCMA on myeloma cells
➡️ Engages CD3 on T cells
➡️ Activates cytotoxic response (perforin + granzymes)

Result: T-cell–mediated myeloma cell killing.

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

3️⃣ Study Design 📊
Multi-institutional USMIRC real-world analysis

• 195 RRMM patients
• 17% with renal impairment (CrCl <40 mL/min)
• Median age ~70
• Similar disease characteristics across groups
• Standard step-up dosing → 1.5 mg/kg weekly

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

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Al-Ola A Abdallah MD (USMIRC)

@Abdallah81MD

Feb 25

Guess how much it costs to publish a paper in any Heme/Onc Journal? 🧵

Answer in post 3!!

1/ 🌍📚 New study in JCO Oncology Advances explores the global landscape of open-access publishing in hematology/oncology — and the equity gaps are hard to ignore.

#mmsm #Myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

2/ 🔎 Study design
• Cross-sectional analysis of 534 journals
• Data from Scopus + Clarivate
• Examined APCs, impact factor (IF), geography, and income level

#mmsm #Myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

3/ 💰 Major finding: APCs vary dramatically by region
• 🇺🇸 North America: $3,519 (highest)
• 🇪🇺 Europe/Central Asia: $2,874
• 🌏 East Asia/Pacific: $1,680
• 🌎 Latin America/Caribbean: $0 (lowest)
➡️ P < .001

#mmsm #Myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @MedwatchKate @Larvol

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Al-Ola A Abdallah MD (USMIRC)

@Abdallah81MD

Jan 30

🚨Out now by @AlmaHabibMD published at USMIRC special edition @CurrentOncology

🧵BCMA CAR-T in RRMM pts w/ Renal Impairment (RI)
What happens when CrCl <45 mL/min? Real-world data answer an important gap

1/🧬 Background
• Renal impairment (RI) is common in MM (cast nephropathy, ↑ FLC)
• Pivotal CAR-T trials largely excluded RI pts
• ~10–15% of RRMM pts are trial-ineligible due to kidney dysfunction

➡️ Real-world question: Can BCMA CAR-T still work safely?

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @Larvol @MedicalwatchHQ @MedwatchKate

📊 Study Design
• Multicenter retrospective (2021–2024)
• N = 223 RRMM pts
• RI = CrCl <45 mL/min (n=25, 11%)
• Compared to normal renal function (n=198)

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @Larvol @MedicalwatchHQ @MedwatchKate

👥 Who were the RI patients?
• Older (median 67 yrs)
• More often African American (36% vs 15%)
• More advanced disease (R-ISS III: 53% vs 20%)
• Same prior lines (median 6)
• Mostly received ide-cel (84%)
• ❌ No dialysis at infusion

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @OncoAlert @Larvol @MedicalwatchHQ @MedwatchKate

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Al-Ola A Abdallah MD (USMIRC)

@Abdallah81MD

Jan 18

🧵 Immune Effector Cell–Associated HLH-like Syndrome (IEC-HS) in CAR-T & TCE-treated myeloma and B-cell malignancies
Insights from a large FAERS pharmacovigilance study 👇

1️⃣ IEC-HS is rare but deadly ⚠️
Among >23,000 AE reports, IEC-HS occurred in 1.6%, yet mortality was >60%.
This is not “just CRS”—it’s a distinct, life-threatening hyperinflammatory syndrome 🔥
#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @Larvol @MedwatchKate @OncoAlert

2️⃣ Who reports it most?
Absolute numbers are highest with axi-cel and tisa-cel—but raw counts mislead.
Utilization ≠ risk. We need signal detection, not anecdotes 📊

3️⃣ Disproportionality analysis (2024 data) reveals:
🔺 tisa-cel → ROR 2.2
🔺 cilta-cel → ROR 2.24
⚖️ axi-cel → no disproportionate signal (ROR ~1)
🔽 teclistamab → lower reporting (ROR 0.43)

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @Larvol @MedwatchKate @OncoAlert

4️⃣ In Myeloma:
• Cilta-cel had the highest IEC-HS burden among BCMA CAR-T
• TCEs showed fewer cases, but teclistamab IEC-HS carried ~60% mortality 💀
Low frequency ≠ low danger.

#mmsm #myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @Larvol @MedwatchKate @OncoAlert

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Al-Ola A Abdallah MD (USMIRC)

@Abdallah81MD

Jan 5

🧵Outcomes of pPCL Diagnosed Using the IMWG 2021 Consensus Definition: Retrospective Multicenter #USMIRC Analysis

1️⃣ pPCL in 2025: still ultra–high risk 🧬🔥
New multicenter data using IMWG 2021 criteria (≥5% circulating plasma cells) confirms: prognosis remains poor—but modern transplant strategies matter.
#mmsm #Myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @MedwatchKate @OncoAlert @Larvol

2️⃣ Study snapshot 🧪
📊 67 pts | 2010–2023 | 3 academic centers
• Median age: 64
• High-risk cytogenetics: 60%
• EMD: 24%
• 25% met new pPCL criteria only (5–20% CPC)

#mmsm #Myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @MedwatchKate @OncoAlert @Larvol

3️⃣ Induction in the real world 💉
Most common regimens:
• PACE-based: 43%
• CyBorD: 27%
• VRd: 15%
ORR after induction: 67%

#mmsm #Myeloma #MedEd #MedTwitter #USMIRC @USMIRCNEWS @US_HMC @MedwatchKate @OncoAlert @Larvol

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