Discover and read the best of Twitter Threads about #leusm

Most recents (24)

In May 2019, Dr. @rschilsky & I co-chaired the #AAADV19 Workshop Plenary Session "Decentralized #ClinicalTrials: The Future is Now." An incredible group of panelists from academia, industry, govt, & patient #advocacy 👇discussed the rationale, challenges, & opportunities of DCTs. Image
No one knew yet that the #COVID19 #pandemic was just around the corner. In Mar 2020, FDA released a guidance on conduct of #clinicaltrials during the pandemic: fda.gov/media/136238/d…, & colleagues wrote about the impact on #OncTwitter trials: ncbi.nlm.nih.gov/pmc/articles/P…. /2
FDA has now released a draft guidance on decentralized #clinicaltrials for drugs, biological products, & devices covering #telehealth, remote assessments, consent, shipping of IP, & more: fda.gov/media/167696/d…. #MedTwitter #regulatory #drugdevelopment Image
Read 5 tweets
A #hemepath case to show why a myeloid FISH panel alone is not sufficient for AML Dx/prognosis
This monocytic AML had no evidence of del(7q) on FISH but had del(7)(q32) in 19/20 metaphases on karyotype
But Why?? #leusm 1/3
Because the @AbbottNews VYSIS D7S486/ CEP7 FISH PROBE KIT used in our FISH probes hybridize to centromere of ch. 7 (to detect monosomy 7)
& 7q31 region of the long arm of ch.7… so it does not detect a deletion telomeric to 7q31 (in this case 7q32)… why do we care? #hemepath 2/3
Interestingly, ELN 2022 only considers monosomy 7 (not del7q) as adverse-risk.. bit.ly/3h2QGwQ
 
But this is debatable as they also recommend classifying del7q as myelodysplasia-related and many studies show del7q is ass/w poor prognosis 3/3 #hemepath
Read 3 tweets
🧵🧵
1/18
We at HCC are so proud of our team and participating centers. 6 abstracts of our collective work have been accepted for #ASH22. If you wish to be a part of this movement either as an individual or as a participating institution, do visit us at hemecancer.org/membership.php
2/18
#2976 Prognostic Factors and Outcomes of Adolescent and Adult Burkitt Lymphoma and Leukemia from a Low-Middle Income Country: An Experience from Hematology Cancer Consortium
ash.confex.com/ash/2022/webpr…
Read 21 tweets
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
1⃣ classic Hodgkin's lymphoma
🩸Reed-Sternberg cell👇
🩸Most common: Nodular sclerosis 👇(fibrosis)
🩸Usually:CD30+, CD15+, weak PAX5 +. CD20-, CD45-
🩸9p24.1 alteration
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
2⃣ Nodular lymphocyte-predominant Hodgkin lymphoma
🩸popcorn cell (from germinal center B-cell)👇
🩸CD20+ (different than cHL),Rituxan used in ttt
🩸can transform(DLBCL)
Blood smears @ASH_hematology 🧵Heme boards
🩸Malignant Hematopoietic Neoplasms🩸
#mmsm #lymsm #leusm #bmtsm
3⃣ Follicular lymphoma
🩸Bone marrow with small lymphocytes👇
🩸CD20+,CD10+,BCL6+,BCL2+,CD5-
🩸t(14;18) in up to 90% of cases
Read 22 tweets
On the inpatient leukemia service for the next 2 weeks, time to start sharing daily articles!

Day 1: our experience with inotuzumab re-treatment in Ph-negative B-ALL @jalbanmd @AyaOncologist #leusm

pubmed.ncbi.nlm.nih.gov/36240471/ Image
@jalbanmd @AyaOncologist Day 2: efficacy of FLT3 and IDH1/2 inhibitors in AML prev tx w/ venetoclax #leusm
-ORR of 18% for entire cohort; ORR of 30% for pt treated w/ gilteritinib
- median OS of 4.2 months

sciencedirect.com/science/articl… Image
@jalbanmd @AyaOncologist Day 3: hyperleukocytosis in AML
- 779 pt with WBC > 50K at presentation, leukostasis in 27% & leukapheresis used in 15%
- mOS was 12.6 months for entire cohort
- leukapheresis did not appear to impact 30d mortality

pubmed.ncbi.nlm.nih.gov/32132655/ Image
Read 14 tweets
Long awaited study (at least for me) on maintenance after hematopoietic cell transplant (BMT) for patients with TP53 acute myeloid leukemia (AML) or myeloid dysplastic syndrome (MDS) @JCO_ASCO ascopubs.org/doi/full/10.12…
Congrats to all !
It's a tricky one. A🧵#leusm #bmtsm #mdssm
Prologue: TP53 mutation is present in ~15-20% and is associated with a poor prognosis in AML and MDS, even in patients who undergo BMT. acsjournals.onlinelibrary.wiley.com/doi/10.1002/cn… Image
Eprenetapopt is a prodrug, small-molecule p53 reactivator, converted into an active moiety, 2-methylene quinuclidine-3-one, stabilizing p53 and targets cellular redox balance to increase oxidative stress & induce cell death.
Read 14 tweets
#Medtwitter friends: I've been having a blast on the BMT service with @c_j_gibson and planning next week's #bmtsm #leusm teaching theme:

📰 Why we do what we do in allogeneic transplantation for myeloid malignancies: Classic/Pivotal trials/papers.

Any you'd add/swap out?
1⃣ Chemo vs. Auto vs. Allo in AML

Cassileth PA et al. Chemotherapy compared with autologous or allogeneic bone marrow transplantation in the management of acute myeloid leukemia in first remission. NEJM 1998

nejm.org/doi/full/10.10…
2⃣ Donors - Related vs. Unrelated

Gupta V et al. Comparable survival after HLA-well-matched unrelated or matched sibling donor transplantation for acute myeloid leukemia in first remission with unfavorable cytogenetics at diagnosis. Blood. 2010

ashpublications.org/blood/article/…
Read 10 tweets
🧵Our latest in @BloodJournal
@coleman_lindsley @c_j_gibson @DanaFarberNews

Older patients with AML undergoing HCT have high rates of relapse & non-relapse mortality

We investigated how outcomes relate to both baseline characteristics and molecular MRD

tinyurl.com/4bn76ham
2. @DrChrisHourigan and others have shown that AML pts with mutations at remission (molecular MRD) have more relapse➡️ inferior survival after HCT, especially if receiving reduced intensity conditioning.
tinyurl.com/23rrbjte Image
3. We wondered:

1⃣ Is prognostic impact of MRD the same for patients age ≥ 60 (underrepresented in RCTs)?

2⃣ Is mutation persistence related to features present at diagnosis?
Read 12 tweets
🚥 #leukemia #ASH21 🛎️ Last call for poster #️5️ 〰️ Graaph-2014 study ➕ adding Nelarabine to chemo for #ALL pts 🔹 #OncTwitter w/ @LoriMuffly & @LuskinMarlise 🔸#CME from @BonumCe 🔗bit.ly/3FIOane 🔸Supported by edu grant Jazz Pharma twitter.com/i/broadcasts/1…
2/🟠Get your 🆓 #CME
CME ℹ️👉 bit.ly/3FIOane

#MedTwitter #OncTwitter #leusm
✔️What are your credentials❓
3/ 🏆#CME credit provided by @IntegrityCE
🤝In partnership w/ @BonumCe

⏱️ Please answer! ⏱️
🟢 PRE-polls before 💬
🔴POST-polls after 💬
🟠or🔗 bit.ly/3FIOane for #CME ℹ️

👇CME info 👇 Image
Read 17 tweets
Its double preprint time! After 5+ years of planning and hard work, @bowman_rl and @andrewdunbar_md’s amazing work is ready to share with all of you on @biorxiv! First one biorxiv.org/content/10.110…
And second one here! biorxiv.org/content/10.110…
Boom!
Read 18 tweets
The many faces of plasma cell neoplasm, diagnostic challenges of the great imitator in #hemepath ➡️bit.ly/3B3jMC1 with @ljmedeirosMD & @ShiminHuMDPhD #mmsm #lymsm #pathtwitter #leusm
1) The small cell variant (mimicking B-cell lymphoma, particularly mantle cell lymphoma➡️CyclinD1 positive) #hemepath #pathtwitter
2) Cleaved cell variant (mimicking follicular lymphoma) #hemepath #pathtwitter
Read 13 tweets
The story of 1 day in the life of a #hematopathologist… I’m too exhausted to make a fancy educational thread but here are some amazing 🔬 pics for your viewing pleasure. I diagnosed all cases in one day 🤯 only at @MDAndersonNews Happy almost weekend people 🥂 #hemepath 🧵 1/n
Myeloproliferative neoplasm w/ concurrent BCR::ABL1 and JAK2 V617F ..the megekaryocyte morphology is clue to something beyond CML #mpnsm #PathOutPic 2/
BPDCN with perfect so-called “hand mirror” (red) and “pearl necklace” (black) morphology #BPDCN #PathOutPic 3/
Read 11 tweets
Happy to share our latest paper w/ @SibaElHussein as lead author, out today in @BMTjournal ⚡️Acquired WT1 mutations contribute to relapse of NPM1mut AML following allogeneic hematopoietic stem cell transplant  rdcu.be/cEuxv #hemepath #leukemia #hemepathMDA Image
WT1 mutations are present in ~7% of de novo AML, are typically Lof mutation involving exons 7-9 of the gene. They frequently (~15%) co-occur w/ NPM1mut & have detrimental impact in this setting, shown by @AkEisfeld and colleagues in  bit.ly/3eWQtXw @LeukemiaJnl Image
We studies a cohort of de novo NPM1-mut AML. 7% had concurrent WT1 mutations at baseline.  22% (15/67) relapsed; 4 (27%) with newly acquired Lof WT1-mut. Illustrated by @furudateken Image
Read 10 tweets
So #twitterx doesn't throw me in Twitter jail, here are 10 #ASH21 abstracts...as HARRY POTTER characters.

I couldn't decide if I should rank based on "impactful" or "practice changing", so these are some that I think everyone should *read carefully*, and I tried to make it fun!
1. POLARIX = Severus Snape ash.confex.com/ash/2021/webpr… Why? Because of how controversial this is, and also this is a well done study. Should we change practice based on a drug without an OS or QOL benefit? I argue no. Nagini, kill. #lymsm
2. GRAAPH-2014 Study = Dudley Dursley ash.confex.com/ash/2021/webpr… Removing HiDAC from chemo in Ph+ ALL worsened outcomes. A cautionary tale that we can’t get greedy and we need RCT data like this as we “de-intensify” regimens in ALL with novel therapies like blin, TKIs, etc. #leusm
Read 12 tweets
1/12 Tweetorial on initial therapy in older adults with #AML at #ASH21. We presented on CPX-351 vs ven/aza. There was no difference in OS. HR 0.88 with 95%CI crossing 1. OS at 2yrs 28% both arms and median OS 13 vs 11 mos tinyurl.com/2p95bn78. #leusm ImageImage
2/12 We looked at 656 patients at Penn and across the nation with Flatiron. Ven/aza patients were older, more likely to be treated in community rather than academic centers and more had de novo AML. Image
3/12 There was no difference in OS among univariate subgroups and no difference after: unadjusted, multivariate Cox (MVC), restriction to CPX-351 eligible patients only, multiple imputation (MI) and MVC, and MI & inverse probability of treatment weighting. ImageImageImage
Read 13 tweets
Delighted to share our latest paper in #JCO, in which we suggest an MRD growth model of CLL, including new data from the CLL14 study (Ven-Obi vs Clb-Obi). #leusm #GCLLSG @ASCO_pubs

bit.ly/2ZyAVEZ

Some results in a quick 🧵 1/n
1.) We used NGS-based MRD quantification of >2,000 PB samples to devise a non-linear mixed effects model for outlining MRD growth after tx. There was wide heterogeneity in MRD growth trajectories that was dependent on various clinical, serological and genetic characteristics.
2.) Notably, one of the most important determinant of MRD growth was actually the choice of therapy: Patients who received Ven-Obi had a signif longer MRD doubling time and time to MRD conversion than pts who received chemo with Clb-Obi.
Read 10 tweets
#tweetorial 🧵
🚩Metabolism and Acute Myeloid Leukemia
(1/23)
➡️📈🔎Increased attention over the last decade on the metabolic perturbations in AML
➡️Potential therapeutic implications – with ‘druggable’ targets Image
(2/23)
➡️🗒️📌Summary of recent concepts
🔊IT IS ALL HAPPENING IN THE MITOCHONDRIA
👉📈🏹Increase potential of targeting the mitochondria
👉🦀Anti-cancer agents specifically targeting cancer cell mitochondria are referred to as 'mitocans'
(3/23)
➡️Metabolic adaptions of AML cells
AML is a 🦀cancer derived from the myeloid lineage of blood🩸cells, characterized by overproduction of malignant cells. Image
Read 26 tweets
#tweetorial 🧵
➡️Ph-like ALL / BCR-ABL1-like ALL

👉A provisional entity in the 2016 World Health Organization classification of acute leukemia 🩸🩸
👉Gene expression 🧬signature similar to Ph-positive ALL but lacks the BCR-ABL1 translocation
@NancyArthurPhD
➡️Originally defined by gene expression 🧬profiling in 2009 by 2 groups
👉Children's Oncology Group (COG) and St. Jude Children's Research Hospital (referred to as Ph-like ALL) 👉Dutch Childhood Oncology Group (referred to as BCR-ABL1-like ALL) – DCOG/COALL
👉The differences in the approaches are outlined in the figure; more on the gene expression 🧬 signatures and diagnostic conundrums later!
Read 41 tweets
"VEXAS SYNDROME", a multidisciplinary team of researchers @genome_gov have identified this new disorder:
(1/8)
➡️Monogenic adult-onset autoinflammatory disease affecting males ♂️👨‍👦 Image
(2/8)
➡️Caused by a mutation in the UBA1 gene 🧬 that encodes major E1 enzyme that initiates ubiquitylation
➡️Suggests postzygotic somatic mutation may be a more frequent cause of human disease👨
➡️Patients develop inflammatory symptoms🔥and hematological abnormalities🩸👇
(3/8)
🔥🔥INFLAMMATORY SYMPTOMS
👉Fatigue 😫
👉Recurrent fever 🤒🌡️
👉Lung infiltrates 🫁
👉Skin lesions🔴
👉Ear chondritis👂
👉and vasculitis
Read 10 tweets
Vandaag wordt voor de vijfde keer de internationale ‘AML World Awareness Day’ gehouden om aandacht te vragen voor acute myeloïde leukemie (#AML), een zeldzame vorm van bloedkanker. #NKRdata #leusm #leukemia #bloodcancer #KnowAML @IKNL @KNOW_AML @HematonNL (1/16)
AML treft momenteel ruim 750 patiënten per jaar in Nederland (zie figuur). Op basis van de internationale
RARECARE-definitie voor zeldzame kanker is AML een zeldzame kankersoort #NKRdata #leusm #bloodcancer #KnowAML @IKNL @KNOW_AML (2/16)
Volgens de RARECARE-definitie is een kankersoort zeldzaam als het minder dan zes nieuwe gevallen per 100.000 personen per jaar treft. Voor Nederland betekent dit dat een kankersoort zeldzaam is als er minder dan 1.021 nieuwe diagnoses per jaar zijn. (3/16)
Read 17 tweets
🩸Roundup of Myeloid Malignancies/BMT papers, starting w/ something I care a lot about:

1/ Poor Survival & Differential Impact of Genetic Features of Black Patients w/ #AML #leusm

Bhatnagar et al, Cancer Discovery
pubmed.ncbi.nlm.nih.gov/33277314/

We got work to do ya'll 😰 ✊🏾
2/ pubmed.ncbi.nlm.nih.gov/33664234/

Salvage use of venetoclax-based therapy for relapsed AML post allogeneic hematopoietic cell transplantation

Joshi et. al, Blood Cancer Journal
3/
Post-Transplant Cyclophosphamide (PTCy) is Associated with Increased Cytomegalovirus Infection: A CIBMTR Analysis

Goldsmith et al, Blood
pubmed.ncbi.nlm.nih.gov/33657221/
Read 9 tweets
Looking forward to #ASH2019 in less than two weeks! Read the thread below for a list of 10 abstracts that I think offer new practice-changing insights, particularly for community oncologists . #leusm #mmsm
(1/10) Daratumumab Plus Bortezomib, Melphalan, and Prednisone Versus Bortezomib, Melphalan, and Prednisone in Patients with Transplant-Ineligible Newly Diagnosed Multiple Myeloma: Overall Survival in Alcyone
Abstract: ash.confex.com/ash/2019/webpr…
(2/10) Dara-KRd Induction, Autologous Transplantation and Post-Transplant, Response-Adapted, Measurable Residual Disease-Based Dara-Krd Consolidation in Patients with Newly Diagnosed Multiple Myeloma
Abstract: ash.confex.com/ash/2019/webpr…
Read 11 tweets
PART 3! If you’re not sold on moderately intensive chemo, outcomes with HMA +/- ven also rival outcomes with CPX-351 in sAML. One could argue the control group in the CPX-351 paper should have been hypomethylating agent-based regimens!
CR/CRi rates with 10-d decitabine are consistently >50%, irrespective of sAML, age, and cytogenetics. Median OS in Blum, PNAS 2010 ~13 months. pnas.org/content/107/16… Image
Whether venetoclax adds anything to this remains to be seen. In the phase I/II study of HMA+ven, CR/CRi in elderly sAML was 67%, median OS NR. Wait for the phase III before you make any conclusions #oncstewardship #anothertweetorial? ncbi.nlm.nih.gov/pubmed/30361262
Read 7 tweets
#Tweetorial Just finished 4 weeks on the leukemia service at @UCCancerCenter. We saw a number of patients present with a new diagnosis of acute leukemia and hyperleukocytosis, our index of concern for the development of leukostasis was dependent on if they had AML or ALL.
In 1982 Lichtman et al wrote about hyperleukocytic leukemias. The leukocrit (packed WBC volume) was described in AML, ALL, and CLL. Due to the larger mean cell volume of myeloblasts, a higher leukocrit was observed in AML compared to ALL and CLL.
The pathophysiology of leukostasis is thought to be driven in part by blood viscosity. A higher leukocrit and hematocrit correlates with a higher blood viscosity.
Read 11 tweets

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