Vein-to-vein ≤1 mo (only 20% of 25 pts even needed bridging), 100% ORR, 100% MRD-neg when checked.
Small n, but this drug is headed places!
8/ #ASH25 Abstract 96: ALC cutoffs to predict MNTs with cilta-cel in #MMsm (Hosoya et al)
Despite no pubs yet, ALC 3K has rocketed into practice based on abstracts. Here:
- ALC 2500 if ≥2x rise also predictive
- Confirmed that ALC reflects CAR T-cells
Best treatment: ????
9/ #ASH25 Abstract 698: Tal-tec deep dive specifically into visceral EMD (@szusmani et al):
ORR 78% in all-comers, including ORR 66% in pts with >50 cm^3 worth of EMD by PET.
12-month DOR 61%. May truly beat CAR-T therapy in #MMsm pts with EMD, even if very high EMD burden!
10/ #ASH25 Abstract 720: 1st-line CRS Tx with dex in #MMsm bsAbs (McElwee @thisisJamesD et al)
"Pocket dex": equal efficacy, way cheaper / simpler than toci, albeit >1 dose more likely.
This makes outpt bsAb SUD *way* easier for pts.
As I now say:
#Downwithdex
#ExceptforCRS !
11/ #ASH25 and finally, a supportive care abstract!
Abstract 1038 by Terpos et al: Retrospective analysis of denosumab in pts with eGFR < 30 (where hypocalcemia quite risky despite tangible benefits of bone-modifying agents in #MMsm).
60 mg Q4W (not 120 mg) may be sweet spot!
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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
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
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 🧵:
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.
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…
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 👏
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.
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.
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!
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.