https://xitter.cf/t.co/ZI0sU4f13q Clinical Pharmacist Specialist #Heme #Leukemia. @UMichPharmacy Dad. Girls Hockey & Lacrosse Coach. Views my own

Joined November 2010
🔑 for those discussing or presenting results at @ASH_hematology! This also applies to us TWEETING about results #ASH25 - Present a balanced appraisal - remember, we are caregivers and scientists, not cheerleaders - do not minimize toxicities or QOL! sciencedirect.com/science/ar…
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Bernie Marini retweeted
New WolverHeme Happy Hour!!!!🎙️ @Berninini & @ajperissinotti are joined by @thisisJamesD, @drrx4L, @Papa_Heme, Jon Weiss to tackle frontline DLBCL: we critically appraise frontMIND and intertwine POLARIX, and EPCORE-DLBCL2. What’s ready to change practice? open.spotify.com/episode/2zX…
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Absolutely need to commend the authors for leading such a magnificent effort! Congratulations to everyone but few caveats here: 1. OS didn't move. HR 0.82 (0.52 to 1.28), 37 deaths against 41, curves overlapping past 20 months. 2. The remission gap narrows as the bar rises: ORR +26 points, CRc +25, CR-or-CRh +14, CR alone +7 (56% vs 49%, overlapping CIs). MRD negativity landed at 71% vs 74%. Most of the extra responses were CRh and CRi, remissions without count recovery. 3. Screening removed the genotypes chemotherapy handles best. CBF, FLT3, and NPM1 under 60 were excluded, 78 of 366 patients failed screening on molecular criteria alone, and the cohort came out 72% adverse-risk. Lu et al (ashpublications.org/blood/ar…) ran the comparison without those exclusions and found EFS and OS equal. 4. Aza-ven was not gentler on the marrow. Febrile neutropenia 57% vs 63%, with neutropenia and leukopenia running higher in the aza-ven arm. 5. One EFS definition (main endpoint of the study), two treatments with different room to maneuver. Unblinded investigators judged "persistent disease prompting therapy change," and aza-ven pts could keep cycling while deriving benefit. 7+3 patients got one permitted reinduction, used by 8.1%, then came off trial as an event.
We are entering a new frontier in AML ➡️The Paradigm study now out in @NEJM showing improved EFS in younger non-fav. risk AML Tx with Aza/Ven vs. Intensive chemo. Huge congrats to Amir Fathi & all authors for this incredibly important study & milestone. nejm.org/doi/full/10.1056/NE…
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I don't practice myeloma but this is a very meaningful de-escalation trial with immediate global implications. This should set an example for the why and the how of de-escalation trials in oncology. I was very impressed not just with the results but also with the methodology. This was not designed to show non-inferiority of fixed-duration over indefinite therapy but was appropriately designed to show superiority of indefinite over fixed-duration. As it should be. academic.oup.com/jnci/advanc… Congratulations to the investigators, as well as to patients and health care systems.
Just out!! In @NEJM - Our randomized trial in myeloma (ENDURANCE trial) shows limited duration of lenalidomide maintenance is just as good as indefinite therapy, with less side effects!!! @eaonc @theNCI Implications are HUGE. This is a drug we spends billions on each year: -Less side effects -Less second cancers -Similar overall survival -Less cost @myelomaMD @Myeloma_Doc @SagarLonialMD National NCI funded trial led by @eaonc and joined by @ALLIANCE_org & @SWOG nejm.org/doi/full/10.1056/NE…
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Bernie Marini retweeted
⚽🩸 CHECKING OFFSIDE… A leukemia cell has crossed the diagnostic line. This week on WolverHeme Happy Hour, Dr. Dale Bixby joins us in the VAR booth for: “VAR Review with Dr. Bixby: Reversing the Call on MPAL” open.spotify.com/episode/2lc…
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➡️ Last year we published use of #pocketdex in patients on teclistamab. 🧠 🤓 Now hot off the press as a full manuscript, see how dex for low-grade CRS is safe and effective with talquetamab onlinelibrary.wiley.com/doi/…
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Bernie Marini retweeted
The hottest take in myeloma right now: ☠️ “Cilta-cell is dead.” With bispecifics delivering impressive results has CAR-T lost its crown? We brought in @ManniMD1 for a discussion that every myeloma clinician should hear. 🎧 Listen here: open.spotify.com/episode/6bu…
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Bernie Marini retweeted
Does HD-MTX ppx reduce CNS relapse even in ultra-high-risk LBCL? #lymsm - >1900 pts, all CNS-IPI 5-6; testicular, renal/adrenal, breast; ≥3 EN sites - 3-yr CNS relapse: 9.3% (no HD-MTX) v 8.1% (HD-MTX), adjusted HR 1.13 [0.82, 1.57] - no diff in isolated CNS relapse: 5.9% v 5.7% - no diff in relapse rates for any high-risk subtypes - DHL/THL not included End of HD-MTX ppx, although DHL/THL is still a question. cc @tobyeyre82 @mattwilson2287 ascopubs.org/doi/10.1200/JCO…
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A really well done analysis (n=1923!). In ultra high risk pts, no benefit to HD MTX in preventing cns relapse. Authors did a good job w/propensity score analysis for possible confounders This practice comes with serious risks & patient burden, and it doesn’t seem to help.
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This is a REALLY great outline of the data in the cilta-cel vs. bispecific in the 2nd line MM treatment debate!
Nice commentary. I mostly agree as I outlined in this friendly exchange with @Rfonsi1: rafaelfonseca.substack.com/p… Cilta-cel still has a role after bsAb or before in pts who prefer it and fully understand risk. There are still many data gaps.
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Bernie Marini retweeted
🚨 Hot off the press @NatRevClinOncol In the wake of MajesTEC-9 presented at #ASCO26, we ask the provocative question: does cilta-cel have a future in myeloma? nature.com/articles/s41571-0… What do you think? #mmsm #myeloma #CARTcells @rajshekharucms @ManniMD1 @AlGarfall
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Hot off the press. Published just now in @NatRevClinOncol led by @OncologyBGLab current fellow @JavierDavidBen2 with past fellow @lateuwen ! nature.com/articles/s41571-0… We dissect the RECITE trial and conclude that the excitement re romiplostim for chemo induced thrombocytopenia misses the point- we are supposed to treat patients, not platelets.
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Bernie Marini retweeted
Been a while since I did a podcast. Fun times as always with WolverHeme
Check out our latest episode "Cult-Like Thinking in BMT" with @Papa_Heme @FeeneyTate @ajperissinotti @Berninini! Comment below 👇what "cult-like" practices you've seen in medicine! open.spotify.com/episode/2S2…
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Bernie Marini retweeted
Check out our latest episode "Cult-Like Thinking in BMT" with @Papa_Heme @FeeneyTate @ajperissinotti @Berninini! Comment below 👇what "cult-like" practices you've seen in medicine! open.spotify.com/episode/2S2…
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Bernie Marini retweeted
I know running clinical trials is tough but that doesn’t mean us clinicians have to accept the results as the new standard if we find the results not applicable to our current practice.
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Young clinicians don’t need to make critical appraisal their primary academic focus, but it is a skill every clinician MUST learn as early as possible. No trial is perfect but understanding the implications of imperfections is 🔑. And remember - critique trials, not people!
Replying to @VincentRK
I know some have become experts at clinical appraisal and clinical trial critique. It’s important to have this dialogue and it helps physicians and patients understand the drawbacks of a given trial. But my advise to young investigators is to best not to make it your primary academic output. Secondly, when critiquing it’s also worthwhile remembering that the investigators of trials may also fully aware of the issues but there are many barriers and often we have to choose between not doing a trial at all versus compromising. Perfect trials are not common; we can usually find some fault with almost all trials. So we must strive to avoid rudeness and condescension. Third, try if possible to lead a clinical trial or at least get engaged with someone who leads trials and get a feel for the various stakeholders who have veto power during trial design, and more importantly the various competing priorities for what the trial seeks to accomplish, it will be easier to understand why a specific control arm was chosen, or a why a specific endpoint was chosen, even though you may think they are the wrong ones.
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