Malignant hematologist, Boston VA @BUMedicine. Hem/Onc MD via @The_BMC, @BrownUniversity. Interested in lymphoma, immunology, and coffee 🤙
Boston, MA
Joined March 2021
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It’s a great joy to share (and teach) what’s exciting about hematology!
Here are my go-to threads 🧵 for blood cancer fundamentals 👇
Nice to see 3-year TRANSCEND FL update!
In 3L+ FL, liso-cel had ORR 97%, CR 94%, 3-y PFS 68%, OS 86%- with durable benefit even in high-risk groups.
I especially like this table from the commentary 👇
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Full article here - ashpublications.org/blood/ar…
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Big congrats to @michaelwangmd, @MarekTrnenyDr on the SYMPATICO update 👏
Can we use a chemo-free approach upfront in MCL?
78 pts with untreated MCL received ibrutinib + venetoclax x2y → ibrutinib until progression
My quick thoughts👇
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My takeaways:
Ibrutinib + venetoclax clearly has frontline activity in MCL without chemotherapy
BUT-
BOVen and TRIANGLE (forgive the sin of cross-trial comparison!) report better response rates and PFS in TP53m MCL
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For full text: ashpublications.org/blood/ar…
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A great take from @LymphClinician on the frontMIND trial-
In addition to traditional toxicity measures, Tafa-R2-CHOP adds time toxicity *and* financial toxicity
ashpublications.org/thehemat…
Fun fact! What chemotherapy comes from this plant?
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ALT https://commons.wikimedia.org/wiki/File%3ACatharanthus_roseus_%28Pink_Madagascar_Periwinkle%29.jpg
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Vincristine! from Madagascar periwinkle 🌸
Binds tubulin -> disrupts microtubules -> metaphase arrest -> death
Periwinkle tea was a folk medicine for diabetes- when tested in rats, didn’t lower glucose but DID cause severe bone marrow suppression😅
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That led to the discovery of vinblastine, while vincristine was independently isolated from the same plant.
Vinblastine and vincristine are both vinca alkaloids derived from the Madagascar periwinkle!
Can read more here: pubmed.ncbi.nlm.nih.gov/3912…
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This is interesting! Especially as we’re weighing tec +/- dara in 2L- how much bang for our buck are we really getting with dara *re*treatment? 🤔
Negative studies don't get enough attention, but are just as important. DKd vs Kd in patients with prior dara: LYNX study: Leukemia & Lymphoma: Vol 66, No 14 tandfonline.com/doi/full/10.…
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Very striking-
At first relapse of LBCL, curative-intent therapy (autoSCT or CART) was planned in 65%, but only *half* ultimately received 👇
nature.com/articles/s41408-0…
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Nice to see subQ isatuximab approved!
*But* reminds me of this study👇 from @majorajay- subQ forms (this was for BsAbs) didn’t lead to the time convenience I would have expected
Surprising finding: actual BsAb treatment visit duration was fairly similar across SC and IV BsAb products (~4–6 hrs/visit).
Better convenience of SQ formulations doesn't really pan out once you include labs, premeds, clinician visit, and waiting room time.
Also: “chair time” alone clearly underestimates treatment burden. #lymsm
Really cool to see patient-reported outcomes like this! 👇 from CLL13/GAIA
Ven/Obi improved QoL faster than ven/obi/ibrutinib. Adding BTKi led to ⬆️⬆️ treatment-related symptoms
ashpublications.org/blood/ar…
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Picture this:
A patient presents with hemolysis, and you find this on the smear 👇
Which organ is to blame? 🤔
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