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/…
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

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.

nejm.org/doi/full/10.10…

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…

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 👏

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…

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! 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/…

(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. (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.”