🔥Today in @AnnalsofIM: We show Axi-cel & Liso-cel are NOT COST-EFFECTIVE in our decision analysis of second-line CAR-T therapies for Diffuse Large B-Cell Lymphoma, and calculate the economic impact to be >$6.8 billion over 5 years!

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acpjournals.org/doi/10.7326/M2…
2/📉Only 20-30% with relapsed/refractory DLBCL achieve durable remissions with standard-of-care second-line salvage chemoimmunotherapy with autologous stem cell transplantation (ASCT). Novel CAR-T therapies improve survival over ASCT but cost >$400k/infusion! #lymsm #TcellRx

Some current Hematologic diagnostic & management dilemmas of Adenovirus #JNJ & #AstraZeneca #VITT:
1⃣VITT seems to behave like autoimmune (Type 2) HIT rather than non-immune (Type 1) HIT (more common).
(Greinacher et al, @JTHjournal, 2017)
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#MedTwitter #HemeTwitter #COVID19 2⃣High enough doses of heparin or LWMH can outcompete these PF4-polyanion complexes for binding sites & reduce platelet aggregation (similar to HIT).
➡️BUT, we can't yet tell where/if there's a consistent dose breakeven point at which aggregation⬇️
(Schultz et al, @NEJM, 2021)
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#JNJ Vaccine Cerebral Venous Sinus Thrombosis Surveillance🧵after @CDCgov #ACIP (for now ...):
1⃣Watch for symptoms like headache, aphasia, paresis, papilledema, seizure, mental status changes
2⃣High-risk groups *seem* to be young women (~20-50), 6-20 days after #JNJ vaccine

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https://twitter.com/amarkelkar/status/1382428822268694535

3⃣True #CVST event rate is TBD (as is the true background rate)
4⃣PF4 IgG ELISA in all patients for screening (#publichealth reporting) & management (avoiding heparin if positive)
5⃣Consider IV steroids & IVIg for thrombocytopenia
#HemeTwitter
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The @CDCgov Advisory Committee on Immunization Practices (ACIP) emergency meeting on the #JNJ vaccine is ongoing. Currently, they're reviewing known data on 8 cases of thrombotic thrombocytopenia. Follow this thread for updates. 1/ #COVID19 #MedTwitter ustream.tv/channel/VWBXKB… This was the initial @US_FDA announcement yesterday describing the #COVID19Vaccine #JNJ hold. In summary, 6 post-market cases of cerebral venous thrombosis reported as of yesterday (in ~6.8 million doses delivered) prior to the hold.

Apparently, I was a much keener observer when I was a student ... or at least took more meticulous notes. From those notes comes a #parasitology story told by a professor during my medical school days. His inflection is lost, but the story remains LEGENDARY! #MedStudentTwitter 1/ As a PhD student, I was on a very small stipend and my supervisor said to me, 'I'll give you $400 if you could be a definitive host for some saginata for me.'

I thought, 'Yeah, no problem.'

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Excited to share our (@BlakeJodian @kartc @hmaddd28 @BobbieLMcKee @chris_cogle) paper on #COVID19 #VaccineHesitancy in patients with #Cancer & caregivers, & impact of an educational #Webinar in Healthcare (@MDPIOpenAccess)! A #tweetorial... #MedTwitter 1/ mdpi.com/1041036 -Pre-pandemic rising #VaccineHesitency (#PublicHealth threat by @WHO in 2019)
-April 2020, Fisher et al (@AnnalsofIM) reported ~57% of 991 reported the intention to receive a #COVID19Vaccine (⬆️since then)
-Limited data on successful interventions to combat #vaccine hesitancy
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#Hahnemann is a cautionary tale of for-profit companies plundering a #SafetyNetHospital for a land deal. After speaking with several former physician trainees and the Internal Medicine PD @DaveAizenberg. The stories were disheartening. We must do better. #HahnemannStories 1/ #Hahnemann #tweetorial-In all the talk of policy changes and corporate malfeasance, the personal impact cannot be undersold. One story that needs to be shared is that of Erika Correa (permission given to share her experience). #HahnemannStories #medtwitter #MembersMoveMedicine 2/

A brief #tweetorial for those curious as to why I spend countless hours on a non-specialty medical organization. The basic premise of the @AmerMedicalAssn House of Delegates is actually simple. #healthpolicy #publichealth #MembersMoveMedicine 1/ It’s a representative democratic body consisting of members of societies from the US states and subspecialties of medicine, convening twice a year as the @AmerMedicalAssn House of Delegates (HoD). The majority of each meeting is spent deliberating policy proposals. #AMAmtg 2/