Imp. paper by @VincentRK 𝑒𝑡 𝑎𝑙 on mode of progression in a 𝐦𝐨𝐝𝐞𝐫𝐧 𝐜𝐨𝐡𝐨𝐫𝐭 of patients with smoldering #myeloma!

Helpful for initial discussion in patients with 𝐇𝐢𝐠𝐡-𝐑𝐢𝐬𝐤 𝐒𝐌𝐌 re. clinical trials vs active surveillance vs Len

1/4 tinyurl.com/4w4bmzen
🔑finding: 23/71 pts. (~𝟑𝟐%) with HR-SMM progressed to clinically significant MDEs (Bone Disease/Hypercalcemia/Renal Failure) at a median f/u of ~4 years!

In other words, >2/3rd of patients with HR-SMM did 𝐧𝐨𝐭 have clinically significant MDEs at progression!

2/4

Our study on outcomes with Dara-VCD in AL #Amyloidosis outside of clinical trials: What did we learn beyond ANDROMEDA?
@columbiacancer @CAMPamyloidosis
@SLentzsch @MurielFinkel @MathewMaurer @DivayaB 1. Hopefully, the days are gone when ~30% of pts with stage IIIa and ~60-70% of stage IIIb would unfortunately die by 1 year! We show that early mortality has ⬇️ed (can't explain solely by early diagnosis since >65% of our cohort were stage IIIa/b and median NT-proBNP of ~3300)

Phase III GMMG ReLApsE Trial #ASH23: Is it the last nail in the coffin of salvage auto-transplant in relapsed #MultipleMyeloma?

Lets unpack in this short 🧵 (also, an important teaching point on prognostic vs predictive marker!)

tinyurl.com/2s36byjf The prevailing dogma regarding salvage ASCT in #Myeloma is to offer to pts who had prolonged remission after ASCT1 (typically >3 yrs).

The assumption is that a long remission after ASCT1 would 𝐩𝐫𝐞𝐝𝐢𝐜𝐭 for⬆️benefit from ASCT2 over std therapies!

Enter ReLapse Trial!

Few thoughts on CANOVA trial (Ven-Dex vs Pom-Dex in t[11;14]). I do think that venetoclax still has a role in t(11;14) plasma cell disorders, but these results add nuance to my interpretation of venetoclax data and how I will use it. First, PFS numerically higher with Ven but not statistically significant is disappointing!

But one thing to note here is the differential censoring (something I have learnt from @VPrasadMDMPH to always pay attention to in PFS curves):
7% (Ven) vs 20% (Pom) at 10 mo.

With high-risk #MultipleMyeloma being a challenging entity to manage despite new drugs, the 𝐆𝐌𝐌𝐆-𝐂𝐎𝐍𝐂𝐄𝐏𝐓 𝐬𝐭𝐮𝐝𝐲 #IMS23 @JCO_ASCO is an imp. addition! 🧵on the key takeaways and what can we learn (with focus on ASCT-Eligible pts)
tinyurl.com/2rumue4e First, lets look at the regimen for transplant-eligible pts:
Isa-KRD x 6 ➡️Auto-Transplant (90% single auto) ➡️Isa-KRD x 4 ➡️Isa-KR x ≈2 years

👏🏽for allowing 1 cycle of therapy prior to enrollment & oligo-/non-secretory disease!

Important paper by IMWG on management of patients with 𝐌𝐲𝐞𝐥𝐨𝐦𝐚 𝐂𝐚𝐬𝐭 𝐍𝐞𝐩𝐡𝐫𝐨𝐩𝐚𝐭𝐡𝐲! A🧵on imp. clinical pearls in this paper and how to apply in daily clinical practice:
https://t.co/Zna40yvbaYtinyurl.com/5xk8ec26
We commonly get consulted by other specialties when M-protein or increased serum FLC ratio is discovered during workup of kidney injury.

This table provides a great framework on how to approach these situations!

Although a negative trial, the recently published Vorinostat-Len (VR) vs Len (R) analysis of Myeloma XI RCT had some important learning points🧵#mmsm @profghjackson @DrGarethMorgan1
tinyurl.com/ysxu446k 1. Drugs with high symptomatic toxicities are 𝒏𝒐𝒕 good for maintenance therapy. IMO, drugs like selinexor and belantamab mafadotin are perhaps in the same league and unlikely to be successful in maintenance setting. 2x greater risk of Rx discontinuation in Vorinostat arm!!

Ten #ASH20 #MultipleMyeloma abstracts that I think will most inform my clinical practice [𝑻𝒉𝒓𝒆𝒂𝒅] #1/11 #mmsm 1. Another trial [𝑭𝑶𝑹𝑻𝑬] shows meaningful PFS benefit with early ASCT [after KRD], irrespective of cytogenetic risk. (Despite similar early MRD-negative rates in both arms) tinyurl.com/y4re2gpw #mmsm 2/11