#HOjournalclub Transcript
Healthcare social media transcript of the #HOjournalclub hashtag.
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See #HOjournalclub Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | HOJournalClub @HOJournalClub Welcome to our fall #HOJournalclub ! Q1 coming up in 5 minutes. Let’s get started with introductions https://t.co/LlFPzNxaPU |
 | Devika Das, MD, MSHQS @DevikaDasMD @HOJournalClub Devika Das - Med Onc faculty at UAB #HOJournalclub ! |
 | Liza Henry McDonald @DocLHenry @HOJournalClub Hi all! Liza from Loyola in Chicago. I'm a solid tumor oncologist but excited to learn more about #BPDCN and Tagraxofusp. #hojournalclub |
 | Shonali Midha, M.D. @ShoMidha @HOJournalClub Shonali - Fellow from @MoffittNews #HOJournalClub |
| HOJournalClub @HOJournalClub While we wait for introductions,please help us out by filling out this short ( anonymous ) survey about your experience with this journal club ! #HOJournalclub https://t.co/dA3UQCr0RA |
| Liza Henry McDonald @DocLHenry RT @HOJournalClub: Welcome to our fall #HOJournalclub ! Q1 coming up in 5 minutes. Let’s get started with introductions https://t.co/LlFPzNxaPU |
 | Aaron Gerds MD, MS @AaronGerds .@HOJournalClub’s ready to go! I’m Hematology faculty at @ClevelandClinic Happy to discuss this paper by @doctorpemm. #HOJournalclub |
 | Martina Murphy, MD @DrMMurphy @HOJournalClub Hi! Martina from @UFMedicine - looking forward to learning about a disease I'd never heard of before! #HOJournalClub |
 | Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub Hi there - @amarkelkar here! I'm a 2nd year Heme/Onc Fellow at UF in Gainesville, FL! Glad to join in again (as I cook dinner). #HOJournalClub |
| HOJournalClub @HOJournalClub . #HOJournalclub https://t.co/E8qKTbCx6j |
| Martina Murphy, MD @DrMMurphy @HOJournalClub We'd be so appreciative of your input while we try and maximize #HOJournalClub for all. Less than 10 questions! |
 | Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi Hematopathologist/molecular pathologist at @MDAndersonNews joining #HOJournalclub and eager to discuss the #BPDCN paper @doctorpemm @lane_andy |
| HOJournalClub @HOJournalClub Let’s get started as folks trickle in with Q1 for tonight - remember to use A1 with response and the hashtag #Hojournalclub https://t.co/7qpjzrrLwm |
 | Loyola Heme/Onc @LoyolaOnc Come join us heme/onc fellows! Chat underway now! #hojournalclub |
| Liza Henry McDonald @DocLHenry @HOJournalClub A1: open label non-randomized study. Total 47 pts with #BPDCN (32 1st line Rx, 15 w/ prior Rx.) Several stages with a safety run in, into expansion, and then 'pivotal' testing. #hojournalclub |
| Devika Das, MD, MSHQS @DevikaDasMD @HOJournalClub A1 Highlights - includes PS 2 #HOJournalclub https://t.co/JT5jLINfMM |
| Aaron Gerds MD, MS @AaronGerds A1: the key here is " a median duration of follow-up of 19 months (range, 1 to 42).” #HOJournalclub |
| Shonali Midha, M.D. @ShoMidha @HOJournalClub A1: Non-randomized, multi-stage (dose-escalation/safety/efficacy) trial of treatment-naive (32) and previously treated (15) BPDCN patients. Given mOS of pts with BPDCN is poor (8-14 mos), median follow-up of 19 is adequate, however would appreciate further evals #HOJournalClub |
 | Natasha Dhawan, MD @NatashaDhawanMD @HOJournalClub Hi everyone - I'm Natasha, current #HPM fellow, hopeful heme/onc fellow next year :) #HOJournalClub |
| Natasha Dhawan, MD @NatashaDhawanMD @amarkelkar @HOJournalClub I hear ya, trying to work on my fellow talk simultaneously. #HOJournalclub |
| HOJournalClub @HOJournalClub Moving on to Q2 - comment on the results and proposed outcomes #HOJournalclub https://t.co/b0X4IzeSXj |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub A1. This was a nonrandomized, multistage, open-label, multicenter clinical trial of tagraxofusp monotherapy. Both previously treated and untreated patients with BPDCN were included. The follow-up time seemed appropriate since median relapse time is ~9 months. #HOJournalClub |
| HOJournalClub @HOJournalClub . #HOJournalclub |
| HOJournalClub @HOJournalClub RT @amarkelkar: @HOJournalClub A1. This was a nonrandomized, multistage, open-label, multicenter clinical trial of tagraxofusp monotherapy. Both previously treated and untreated patients with BPDCN were included. The follow-up time seemed appropriate since median relapse time is ~9 months. #HOJournalClub |
 | Ashley Love Sumrall, MD, FACP, FASCO @AshleySumrallMD @DocLHenry @HOJournalClub Following along. 👋🏻 from this neuro-onc/ med onc from @LevineCancer in Charlotte. #HOjournalclub |
| HOJournalClub @HOJournalClub A1 #HOJournalclub |
| HOJournalClub @HOJournalClub RT @HOJournalClub: Moving on to Q2 - comment on the results and proposed outcomes #HOJournalclub https://t.co/b0X4IzeSXj |
| Martina Murphy, MD @DrMMurphy @HOJournalClub A1 bonus: extra credit points for anyone who can accurately pronounce the drug and say it 3 times fast! ;) #HOJournalClub |
| Aaron Gerds MD, MS @AaronGerds Is 19 months adequate? the group also reported on a retrospective cohort as a “comparator arms” Median survival there was 24 months 🤔#HOJournalClub @HOJournalClub |
| Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi RT @DrMMurphy: @HOJournalClub A1 bonus: @HOJournalClub A1 bonus: extra credit points for anyone who can accurately pronounce the drug and say it 3 times fast! ;) #HOJournalClub |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub But to be honest, I didn't quite appreciate the reasoning for the multistage design or the statistical tools used to group patients who were assigned to different stages back together in the analysis ... #HOJournalClub https://t.co/2OKe40pOhE |
| Devika Das, MD, MSHQS @DevikaDasMD @HOJournalClub A2 #HOJournalclub https://t.co/AgG8ZE3lhK |
| HOJournalClub @HOJournalClub RT @amarkelkar: @HOJournalClub But to be honest, I didn't quite appreciate the reasoning for the multistage design or the statistical tools used to group patients who were assigned to different stages back together in the analysis ... #HOJournalClub https://t.co/2OKe40pOhE |
| Liza Henry McDonald @DocLHenry @Mansourgergi @HOJournalClub A2: I thought the endpt of CR or Clinical CR was interesting. Novel since there were not previously described response criteria in this rare disease. #hojournalclub |
 | Nishi Shah @sisodoc @HOJournalClub A2. Study outcomes- primary: combined rate of complete response and clinical complete response. This study also evaluated overall response rate #HOjournalclub |
| HOJournalClub @HOJournalClub #HOJournalclub |
| Aaron Gerds MD, MS @AaronGerds @DrMMurphy @HOJournalClub I can’t! That is why I always call is SL-401 😀 #HOJournalclub |
| Shonali Midha, M.D. @ShoMidha @HOJournalClub A2: Combined CR and clinical CR in 13 evaluated (pivotal phase) was 54% (met PE) and 72% (met PE) in the 29 treatment-naive pts. ORR 67% in 15 previously treated. #HOJournalClub |
| Natasha Dhawan, MD @NatashaDhawanMD @HOJournalClub A1: Don't think time for follow-up of 19 months was adequate, given the medial survival was 24 months. #HOJournalClub |
| Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi @DocLHenry @Mansourgergi @HOJournalClub How do you FU #BPDCN at @LoyolaChicago? Calling @KMirza @LoyolaHemePath curious to know... #HOJournalclub |
| Liza Henry McDonald @DocLHenry @HOJournalClub A2: good response rates generally. CR+CCR of 54%-72% in the st3/st2 pts. For Rx naive pts (n=29) 45% were bridged to transplant. #hojournalclub |
| Natasha Dhawan, MD @NatashaDhawanMD I heard that's a requirement to graduate from fellowship. #HOJournalClub |
| Aaron Gerds MD, MS @AaronGerds @DocLHenry @Mansourgergi @HOJournalClub "For this scenario, we established a novel outcome of clinical complete response, which was validated as a measure of clinical benefit.” However, there was no mention of how it was built. Is a mention that it was validated by correlating response with survival. #HOJournalclub |
| HOJournalClub @HOJournalClub Great discussion so far !! Q3 -Any specific comments on the adverse events in this study ? #HOJOurnalclub https://t.co/Dk2EQirTMm |
| Liza Henry McDonald @DocLHenry @AaronGerds @amarkelkar @HOJournalClub That's helpful! Do you think part of this is necessity due to #rarecancer? #hojournalclub |
| Martina Murphy, MD @DrMMurphy @NatashaDhawanMD Yep! Definitely in the latest iteration of ACGME requirements for Heme/Onc trainees! ;) #HOJournalClub |
 | Taylor Lab UM @TaylorJ_MD @DevikaDasMD @HOJournalClub If I remember correctly from the patient characteristics table all the patients actually treated were PS 0 or 1, am I right? #HOJournalClub |
| Aaron Gerds MD, MS @AaronGerds A2: as a point of reference for response, CR with AML/ALL-like regimens around 80%-90%, with NHL-like regimens w40%-50% in historical cohorts. #HOJournalclub @HOJournalClub |
| Devika Das, MD, MSHQS @DevikaDasMD @HOJournalClub A3 Particularly interested in knowing more about the capillary leak syndrome and some real life experiences ? #HOJournalclub https://t.co/6SpFXkQ9mK |
| HOJournalClub @HOJournalClub RT @AaronGerds: A2: A2: as a point of reference for response, CR with AML/ALL-like regimens around 80%-90%, with NHL-like regimens w40%-50% in historical cohorts. #HOJournalclub @HOJournalClub |
 | Mansour Gergi MD @Mansourgergi @HOJournalClub A3 Definetly some significant toxicity esp with the capillary leak sydrome but it seems that could be avoided with good selection of patients and albumin IV. But again this a rare disease with no significant treatment up until this study so benefit still > risk #hojournalclub |
| HOJournalClub @HOJournalClub . #HOJournalclub |
| Aaron Gerds MD, MS @AaronGerds @TaylorJ_MD @DevikaDasMD @HOJournalClub You are correct! key point. must consider performance status when picking therapy, especially with the perceived toxicity of intensive treatments. #HOJournalclub |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub A2. Of 13 stage 3 previously untreated patients combined complete response and clinical complete response was 54% (95% CI, 25-81%). In the 29 patient not previously treated getting the 12 μg/kg higher dose, the combined response was 72% (95% CI, 53-87). #HOJournalClub |
| Liza Henry McDonald @DocLHenry @HOJournalClub A3: SAEs were many. Nearly 80% grade 3+. But seems on par with induction for other acute leukemias? The capillary leak syndrome was interesting. Kind of harkens to our HDIL2 Rx days (speaking as an #RCC doc!) #hojournalclub |
| Taylor Lab UM @TaylorJ_MD @AaronGerds @HOJournalClub I think the primary outcome of the Tagraxofusp study was response rate. I agree we need longer follow-up to evaluate survival endpoints. For fit patients who can tolerate intensive induction chemotherapy and transplant we really don’t know if it’s better #HOJournalClub |
| Liza Henry McDonald @DocLHenry @HOJournalClub A3: what do you guys think about the pt deaths? Will this be a case where more time and experience helps us control for the severe toxicities? #hojournalclub |
| Aaron Gerds MD, MS @AaronGerds @HOJournalClub NB: There was a lot of capillary leak syndrome #HOJournalclub |
| HOJournalClub @HOJournalClub RT @AaronGerds: @HOJournalClub NB: @HOJournalClub NB: There was a lot of capillary leak syndrome #HOJournalclub |
| Liza Henry McDonald @DocLHenry Great takeaway #hojournalclub |
| HOJournalClub @HOJournalClub RT @TaylorJ_MD: @AaronGerds @HOJournalClub I think the primary outcome of the Tagraxofusp study was response rate. I agree we need longer follow-up to evaluate survival endpoints. For fit patients who can tolerate intensive induction chemotherapy and transplant we really don’t know if it’s better #HOJournalClub |
| Mansour Gergi MD @Mansourgergi @AaronGerds @HOJournalClub Can we extrapolate to the CRS experience with CAR T cells. We know it will happen but we learn how to manage it and treat through the side effects to improve outcomes #HOJournalClub |
| HOJournalClub @HOJournalClub Now for Q4 - How does this impact your practice ? Have you seen any #BPCDN cases yet ? Is the data applicable to your patient population ? #HOJournalclub https://t.co/NjJQbeaTck |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub A2. ORR in this 29-patient untreated group was 90%, with 45% going on to SCT. Survival rates in the 13-patient stage 3 group was 59% at 18 months and 52% at 24 months and seemed to have a long tail. The jumping between these two groups was less helpful ... #HOJournalClub |
| Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi RT @HOJournalClub: Now for Q4 - How does this impact your practice ? Have you seen any #BPCDN cases yet ? Is the data applicable to your patient population ? #HOJournalclub https://t.co/NjJQbeaTck |
| HOJournalClub @HOJournalClub . #HOjournalclub |
| Natasha Dhawan, MD @NatashaDhawanMD @HOJournalClub A3: Most imp AE was capillary leak syndrome --> death. A significant # of other AEs were related to hepatic injury. Given the lack of alt therapies for BPDCN (other than HSCT) I'd argue benefits > risks, esp for older pts who wouldn't be eligible for transplant. #HOJournalClub |
| Shonali Midha, M.D. @ShoMidha @HOJournalClub A3: AST/ALT elevations, thrombocytopenia, Capillary leak syndrome; while cardiac function and baseline albumin added to screening, CLS continued to lead to another death without mention of change in pre-emptive measures #HOJournalClub |
| HOJournalClub @HOJournalClub RT @ShoMidha: @HOJournalClub A3: @HOJournalClub A3: AST/ALT elevations, thrombocytopenia, Capillary leak syndrome; while cardiac function and baseline albumin added to screening, CLS continued to lead to another death without mention of change in pre-emptive measures #HOJournalClub |
| HOJournalClub @HOJournalClub RT @NatashaDhawanMD: @HOJournalClub A3: @HOJournalClub A3: Most imp AE was capillary leak syndrome --> death. A significant # of other AEs were related to hepatic injury. Given the lack of alt therapies for BPDCN (other than HSCT) I'd argue benefits > risks, esp for older pts who wouldn't be eligible for transplant. #HOJournalClub |
| Mansour Gergi MD @Mansourgergi @HOJournalClub A4 Never heard about it till this journal club but good to know the best available option in case ever encountered #HOJournalClub |
| HOJournalClub @HOJournalClub . #HOJournalclub |
| HOJournalClub @HOJournalClub RT @Mansourgergi: @HOJournalClub A4 Never heard about it till this journal club but good to know the best available option in case ever encountered #HOJournalClub |
| HOJournalClub @HOJournalClub RT @amarkelkar: @HOJournalClub A2. ORR in this 29-patient untreated group was 90%, with 45% going on to SCT. Survival rates in the 13-patient stage 3 group was 59% at 18 months and 52% at 24 months and seemed to have a long tail. The jumping between these two groups was less helpful ... #HOJournalClub |
| HOJournalClub @HOJournalClub RT @Mansourgergi: @AaronGerds @HOJournalClub Can we extrapolate to the CRS experience with CAR T cells. We know it will happen but we learn how to manage it and treat through the side effects to improve outcomes #HOJournalClub |
| Aaron Gerds MD, MS @AaronGerds @HOJournalClub According to the manufacture’s website “the first, and only” drug approved. The FDA label is open. Should it be first line? Second line? what patients? #HOJournalclub |
 | Megan Murray Dupuis, MD, PhD @MissMeganEl @HOJournalClub #HOJournalClub |
| Liza Henry McDonald @DocLHenry @HOJournalClub A4: I'm a #GU oncologist so I sure hope it won't impact my practice! 😂 But I feel more prepped to help my #hematology colleagues care for these pts. I think it's exciting to see #noveltherapeutics with this CD123 directed toxin. I'm assuming more will follow. #hojournalclub |
| Taylor Lab UM @TaylorJ_MD @AaronGerds @DevikaDasMD @HOJournalClub Agree. MSKCC was not part of the trial and the first few patients we treated after FDA approval was a steep learning curve for handling capillary leak. It might be appropriate to have patients treated at experienced centers who are seeing at least 3-5 cases/year #HOJournalClub |
| Devika Das, MD, MSHQS @DevikaDasMD @HOJournalClub A4 Saw 1 prior patient as a trainee who was treated with an AML regimen- approved for ages 2 and above !!! 🚨 comments ? ##HOJournalclub https://t.co/whY5PbOGqr |
| Liza Henry McDonald @DocLHenry @AaronGerds @HOJournalClub @DevikaDasMD I was going to ask if this was given inpatient. Again, like HD IL2 once we learned how to manage the toxicity and make appropriate adjustments the toxicity was better controlled. #hojournalclub |
| HOJournalClub @HOJournalClub RT @TaylorJ_MD: @AaronGerds @DevikaDasMD @HOJournalClub Agree. MSKCC was not part of the trial and the first few patients we treated after FDA approval was a steep learning curve for handling capillary leak. It might be appropriate to have patients treated at experienced centers who are seeing at least 3-5 cases/year #HOJournalClub |
| Shonali Midha, M.D. @ShoMidha @HOJournalClub A4: Had one prior patient with BPDCN s/p alloHSCT for MDS in the past with skin involvement (no CNS involvement); would def have considered treatment as bridge to alloHSCT (or in her case DLI) #HOJournalClub |
| HOJournalClub @HOJournalClub RT @DocLHenry: @AaronGerds @HOJournalClub @DevikaDasMD I was going to ask if this was given inpatient. Again, like HD IL2 once we learned how to manage the toxicity and make appropriate adjustments the toxicity was better controlled. #hojournalclub |
| Natasha Dhawan, MD @NatashaDhawanMD @HOJournalClub A4: As others have said, I didn't know of this cancer before this article -- so good job on the choice! I'd be interested in seeing how #BPCDN responds to a BCL2 inhibitor. #HOJournalClub |
| HOJournalClub @HOJournalClub RT @AaronGerds: @HOJournalClub According to the manufacture’s website “the first, and only” drug approved. The FDA label is open. Should it be first line? Second line? what patients? #HOJournalclub |
| HOJournalClub @HOJournalClub RT @NatashaDhawanMD: @HOJournalClub A4: @HOJournalClub A4: As others have said, I didn't know of this cancer before this article -- so good job on the choice! I'd be interested in seeing how #BPCDN responds to a BCL2 inhibitor. #HOJournalClub |
| Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi RT @NatashaDhawanMD: @HOJournalClub A4: @HOJournalClub A4: As others have said, I didn't know of this cancer before this article -- so good job on the choice! I'd be interested in seeing how #BPCDN responds to a BCL2 inhibitor. #HOJournalClub |
| Martina Murphy, MD @DrMMurphy @DevikaDasMD @HOJournalClub CLS is a serious problem in terms of an AE to be managed. Know well-studied (i.e. beyond case studies) effective treatments for acute events beyond supportive care. #HOJournalClub |
| HOJournalClub @HOJournalClub RT @DrMMurphy: @DevikaDasMD @HOJournalClub CLS is a serious problem in terms of an AE to be managed. Know well-studied (i.e. beyond case studies) effective treatments for acute events beyond supportive care. #HOJournalClub |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub A3. ~1/2 the patients experienced a serious adverse event (23/47), with 3 treatment-related deaths. Capillary leak syndrome stood out, occurring in 9 patients. Cytopenias occurred less than I expected, but hepatotoxicities were more common. #HOJournalClub |
| Nishi Shah @sisodoc @HOJournalClub I have not seen any cases so far of BPCDN. But it is good to know that this treatment is available for it. Overall the concept of this targeted therapy is pretty important and we need to be aware of its adverse effects #HOJournalClub |
| Liza Henry McDonald @DocLHenry @ShoMidha @HOJournalClub I thought it was interesting to observe that these older pts were able to get to transplant. PS was already pretty good in this study population but clearly with uncontrolled leukemia there window for transplant would o/w be short. #hojournalclub |
| HOJournalClub @HOJournalClub #HOJournalclub |
| Megan Murray Dupuis, MD, PhD @MissMeganEl @HOJournalClub A4. Tagraxofusp definitely practice changing for #BPDCN patients. Important to treat at a center where docs know what they’re doing, but this is the best option out there by far. I’ve gotten to successfully see multiple patients treated with this drug. #HOJournalClub |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub They pointed out "decrease in albumin ... appeared to be the most consistent predictor of capillary leak syndrome" which is not surprising, but makes me wonder if there was some tool that could further predict these patients to allow for earlier intervention. #HOJournalClub |
| Aaron Gerds MD, MS @AaronGerds @HOJournalClub A4 - the big cost question. Without a RCT will never know if this is better than induction chemo. That is the challenge of incorporating it into treatment algorithms. Especially when thinking of cost! #HOJournalclub |
| HOJournalClub @HOJournalClub RT @amarkelkar: @HOJournalClub They pointed out "decrease in albumin ... appeared to be the most consistent predictor of capillary leak syndrome" which is not surprising, but makes me wonder if there was some tool that could further predict these patients to allow for earlier intervention. #HOJournalClub |
| HOJournalClub @HOJournalClub RT @MissMeganEl: @HOJournalClub A4. Tagraxofusp definitely practice changing for #BPDCN patients. Important to treat at a center where docs know what they’re doing, but this is the best option out there by far. I’ve gotten to successfully see multiple patients treated with this drug. #HOJournalClub |
| Liza Henry McDonald @DocLHenry @AaronGerds @HOJournalClub It seemed like first line as transplant bridge was the kind of ideal arrangement. With this disease, do you often get multiple chances? How do you weigh this drug vs a traditional cytotoxic chemo induction? #hojournalclub |
| Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi RT @MissMeganEl: @HOJournalClub A4. Tagraxofusp definitely practice changing for #BPDCN patients. Important to treat at a center where docs know what they’re doing, but this is the best option out there by far. I’ve gotten to successfully see multiple patients treated with this drug. #HOJournalClub |
| Liza Henry McDonald @DocLHenry RT @AaronGerds: @HOJournalClub A4 - the big cost question. Without a RCT will never know if this is better than induction chemo. That is the challenge of incorporating it into treatment algorithms. Especially when thinking of cost! #HOJournalclub |
| Taylor Lab UM @TaylorJ_MD @HOJournalClub A4- Given the rarity it will likely not affect practice for most but I think a good lesson of how to do drug development in rare cancers. Also the drug is being developed in #AML so may be more widely used in the future #HOJournalClub |
| Martina Murphy, MD @DrMMurphy @amarkelkar @HOJournalClub Would be helpful to predict because, as I mentioned before, no great treatments for acute capillary leak and they can be rapidly fatal :( #HOJournalClub |
| HOJournalClub @HOJournalClub RT @TaylorJ_MD: @HOJournalClub A4- Given the rarity it will likely not affect practice for most but I think a good lesson of how to do drug development in rare cancers. Also the drug is being developed in #AML so may be more widely used in the future #HOJournalClub |
| Aaron Gerds MD, MS @AaronGerds The response rates for SL-401 in the relapse setting after induction chemo (IC) was better than expected. So will give a better shot at that second chance. But if historical CR rates for IC are about the same, is it a better 1st line bridge? #HOJournalclub |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub A4. I have yet to see a patient with #BPCDN but this would definitely be a consideration first-line as a bridge to transplant, given that most of the longer-term combined CR patients eventually got a transplant. #HOJournalClub |
| HOJournalClub @HOJournalClub . #HOJournalclub |
| HOJournalClub @HOJournalClub Also thought this was a helpful paper providing modern cohort of #BPDCN cases to help gauge outcomes. #hojournalclub https://t.co/UcV8MLep00 |
| Aaron Gerds MD, MS @AaronGerds @TaylorJ_MD @HOJournalClub Absolutely true! #HOJournalclub |
| Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi @TaylorJ_MD @HOJournalClub May not affect practice widely but hopefully will affect individual patient outcomes #HOJournalclub |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub A4. I am curious to know how those two non-transplant patients with combined CR >1 year (seen in the swimmer plot) fared in terms of AEs and longer-term remission ... #HOJournalClub https://t.co/jY1iNSRxDX |
| Megan Murray Dupuis, MD, PhD @MissMeganEl @HOJournalClub A5. What should we do once patients relapse, esp after HSCT? Rechallenge with tagraxofusp? Give Venetoclax based therapies? #HOJournalClub |
| HOJournalClub @HOJournalClub RT @AaronGerds: The response rates for SL-401 in the relapse setting after induction chemo (IC) was better than expected. So will give a better shot at that second chance. But if historical CR rates for IC are about the same, is it a better 1st line bridge? #HOJournalclub |
| Taylor Lab UM @TaylorJ_MD @AaronGerds Great question! #HOJournalClub |
| Liza Henry McDonald @DocLHenry @HOJournalClub A5: I was also curious aboutnhow this potentially changes the landscape for transplant. At least one pt (maybe 2?) seemed durable response w/o #BMT? Will we start to see pts who could maybe avoid? #hojournalclub https://t.co/jTFCrlBuv4 |
| Aaron Gerds MD, MS @AaronGerds @HOJournalClub Yes a helpful paper. Here is also another paper that looks at HCT outcomes as well. #HOJournalclub https://t.co/TRff72kqN4 |
| HOJournalClub @HOJournalClub RT @DocLHenry: @HOJournalClub A5: @HOJournalClub A5: I was also curious aboutnhow this potentially changes the landscape for transplant. At least one pt (maybe 2?) seemed durable response w/o #BMT? Will we start to see pts who could maybe avoid? #hojournalclub https://t.co/jTFCrlBuv4 |
| HOJournalClub @HOJournalClub RT @MissMeganEl: @HOJournalClub A5. What should we do once patients relapse, esp after HSCT? Rechallenge with tagraxofusp? Give Venetoclax based therapies? #HOJournalClub |
| HOJournalClub @HOJournalClub RT @AaronGerds: @HOJournalClub Yes a helpful paper. Here is also another paper that looks at HCT outcomes as well. #HOJournalclub https://t.co/TRff72kqN4 |
| HOJournalClub @HOJournalClub . @AaronGerds ? |
| Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi @DevikaDasMD @HOJournalClub Not Yo rain on your parade but remember sometime CD56 can be negative in #BPDCN and that’s the most common scenario we see is misdiagnosed #Hemepath #HOJournalclub |
| Aaron Gerds MD, MS @AaronGerds @DevikaDasMD @HOJournalClub That is a great one! #HOJournalclub |
| Liza Henry McDonald @DocLHenry @TaylorJ_MD @AaronGerds Interesting. So perhaps IC and if nonresponse move to Tagrax to take another run at CR...? 🤔 #HOjournalclub |
| Natasha Dhawan, MD @NatashaDhawanMD @DevikaDasMD @HOJournalClub Excellent find! Thanks @DevikaDasMD #HOJournalClub |
| HOJournalClub @HOJournalClub RT @sanamloghavi: @DevikaDasMD @HOJournalClub Not Yo rain on your parade but remember sometime CD56 can be negative in #BPDCN and that’s the most common scenario we see is misdiagnosed #Hemepath #HOJournalclub |
| Shonali Midha, M.D. @ShoMidha @HOJournalClub A5: Extended follow-up, identify determinants/risk factors to developing capillary leak, assess response in those with CNS involvement, compare as 1st line to typical leukemia protocols. Esp interested to see response with venetoclax/tagaraxofusp combination. #HOJournalClub |
| Aaron Gerds MD, MS @AaronGerds @DocLHenry @HOJournalClub I think we need to learn more about this disease and why those two had such a durable response. That is certainly an pleasantly unexpected outcome! #HOJournalclub |
 | Mehrnoosh Tashakori, MD PhD @TashakoriM RT @sanamloghavi: The latest #BPDCN #Tagraxofusp paper by @doctorpemm , @lane_andy @DrHKantarjian and others in @NEJM is the subject of discussion at #HOJournalclub tonight!! Tune in.... @LeukemiaMDA #leusm #hemepath |
| Taylor Lab UM @TaylorJ_MD @sanamloghavi @HOJournalClub Can you comment on if the drug has changed pathologic practice? Or maybe just the awareness of #BPDCN overall has changed how you workup diseases to rule out BPDCN? #HOJournalClub |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub A5. Did rates of GVHD in the tagraxofusp patients who got allogenic transplants differ from those with other bridging regimens? How long did some of these treatment-related AEs last? #HOJournalClub |
| Devika Das, MD, MSHQS @DevikaDasMD RT @sanamloghavi: @DevikaDasMD @HOJournalClub Not Yo rain on your parade but remember sometime CD56 can be negative in #BPDCN and that’s the most common scenario we see is misdiagnosed #Hemepath #HOJournalclub |
| HOJournalClub @HOJournalClub RT @amarkelkar: @HOJournalClub A5. Did rates of GVHD in the tagraxofusp patients who got allogenic transplants differ from those with other bridging regimens? How long did some of these treatment-related AEs last? #HOJournalClub |
| HOJournalClub @HOJournalClub RT @TaylorJ_MD: @sanamloghavi @HOJournalClub Can you comment on if the drug has changed pathologic practice? Or maybe just the awareness of #BPDCN overall has changed how you workup diseases to rule out BPDCN? #HOJournalClub |
| HOJournalClub @HOJournalClub RT @AaronGerds: @DocLHenry @HOJournalClub I think we need to learn more about this disease and why those two had such a durable response. That is certainly an pleasantly unexpected outcome! #HOJournalclub |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub A5. Having not seen a #BPDCN case before, do all patients have confirmed IL3RA overexpression or should this be a pre-requisite before receiving this potentially toxic treatment? #HOJournalClub |
| Aaron Gerds MD, MS @AaronGerds @amarkelkar @HOJournalClub HCT is still key. I think the 1st line therapy is still up for debate. No doubt this is better than any second-line chemo (eg AML inception chemotherapy after ALL-like induction chemotherapy or vice versa). #HOJournalclub |
| Liza Henry McDonald @DocLHenry @amarkelkar @HOJournalClub Oooh yes good question. @AaronGerds @TaylorJ_MD @sanamloghavi are you aware? #hojournalclub |
| Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi @TaylorJ_MD @HOJournalClub I think this paper has definitely raised awareness in the #Hemepath community of this rare disease. The drug per se has not changed our practice. We are doing MRD flow on #BPDCN patients on the trial. I don’t think many places are outside of large cancer centers. #HOJournalclub |
| HOJournalClub @HOJournalClub Bonus question : Any thoughts on the cost and or payer coverage ? Is this drug available and covered in Europe and Asia ? #HOJournalclub |
| HOJournalClub @HOJournalClub RT @sanamloghavi: @TaylorJ_MD @HOJournalClub I think this paper has definitely raised awareness in the #Hemepath community of this rare disease. The drug per se has not changed our practice. We are doing MRD flow on #BPDCN patients on the trial. I don’t think many places are outside of large cancer centers. #HOJournalclub |
| HOJournalClub @HOJournalClub RT @AaronGerds: @HOJournalClub A4 - the big cost question. Without a RCT will never know if this is better than induction chemo. That is the challenge of incorporating it into treatment algorithms. Especially when thinking of cost! #HOJournalclub |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub A5. Can tagraxofusp be used or reused in patients who relapse after transplant? Has the IL3RA status been reassessed in cases that relapsed? #HOJournalClub |
| Taylor Lab UM @TaylorJ_MD @AaronGerds @DocLHenry @HOJournalClub There have been reports of durable remissions to chemotherapy without transplant, especially in “Skin-only” disease. Wish I had the reference on me. #HOJournalClub |
| HOJournalClub @HOJournalClub RT @TaylorJ_MD: @AaronGerds @DocLHenry @HOJournalClub There have been reports of durable remissions to chemotherapy without transplant, especially in “Skin-only” disease. Wish I had the reference on me. #HOJournalClub |
| HOJournalClub @HOJournalClub RT @amarkelkar: @HOJournalClub A5. Can tagraxofusp be used or reused in patients who relapse after transplant? Has the IL3RA status been reassessed in cases that relapsed? #HOJournalClub |
| Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi @TaylorJ_MD @HOJournalClub But I want to emphasize its important to be aware of the phenotypic variations. They don’t always read the books in terms of phenotype. Keep #BPDCN in your differential when you see a CD123 pos neoplasm #HOJournalclub #hemepath |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub A5. And what were the results of the venetoclax in patients with BPDCN trial? Given the differing targets, could these therapies be staggered for patients who relapse? #HOJournalClub |
| HOJournalClub @HOJournalClub RT @sanamloghavi: @TaylorJ_MD @HOJournalClub But I want to emphasize its important to be aware of the phenotypic variations. They don’t always read the books in terms of phenotype. Keep #BPDCN in your differential when you see a CD123 pos neoplasm #HOJournalclub #hemepath |
| Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi RT @TaylorJ_MD: @AaronGerds @DocLHenry @HOJournalClub There have been reports of durable remissions to chemotherapy without transplant, especially in “Skin-only” disease. Wish I had the reference on me. #HOJournalClub |
| Aaron Gerds MD, MS @AaronGerds @DocLHenry @amarkelkar @HOJournalClub @TaylorJ_MD @sanamloghavi No reports yet on this. The challenge of doing studies in a rare disease! Since it it is a drug-antibody conjugate (although not calicheamicin like gemtuzumab), would also be interested in liver toxicity after HCT (ie VOD-SOS). #HOJournalclub |
| Aaron Gerds MD, MS @AaronGerds RT @sanamloghavi: @TaylorJ_MD @HOJournalClub But I want to emphasize its important to be aware of the phenotypic variations. They don’t always read the books in terms of phenotype. Keep #BPDCN in your differential when you see a CD123 pos neoplasm #HOJournalclub #hemepath |
| Taylor Lab UM @TaylorJ_MD @amarkelkar @HOJournalClub On all #BPDCN at presentation. Loss of CD123 was not a mechanism of escape/relapse but I would still double-check if re-treating after relapse. #HOJournalClub |
| Taylor Lab UM @TaylorJ_MD @HOJournalClub A5- Outcomes with auto vs allo-transplant. I think the jury is still out whether auto-SCT is as good as allo! #HOJournalClub |
| Liza Henry McDonald @DocLHenry @HOJournalClub A5: one more Q-- will CAR-Ts play a role here some day? Since the expression of CD123 seems to be a ubiquitous marker in #BPDCN? #hojournalclub |
| Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi RT @TaylorJ_MD: @amarkelkar @HOJournalClub On all #BPDCN at presentation. Loss of CD123 was not a mechanism of escape/relapse but I would still double-check if re-treating after relapse. #HOJournalClub |
| Aaron Gerds MD, MS @AaronGerds @HOJournalClub Given as an inpatient, the cost is a challenge since it will blow up the DRG! Drugs like tagraxofusp and Vyxeos (cpx-351) are a real challenge from a program standpoint. #HOJournalclub |
| HOJournalClub @HOJournalClub The response to this #HOJournalclub has been phenomenal ! Save the date for next month’s #bcsm themed JC *Also please fill this short survey before you leave 🙏🏽 https://t.co/dA3UQCr0RA https://t.co/mm2HlXCvg5 |
| Amar Kelkar, MD, MPH, FACP @amarkelkar I've already learned far more in one hour of #HOJournalClub about Blastic plasmacytoid dendritic-cell neoplasm (#BPDCN) than I had through training so far. It's rare, but highly aggressive and I hoping we'll continue to get more tools to combat it. Thanks @AaronGerds! |
| HOJournalClub @HOJournalClub For our followers in other times zones and countries - Feel free to continue to post responses !!! #HOJournalclub |
| Amar Kelkar, MD, MPH, FACP @amarkelkar RT @TaylorJ_MD: @amarkelkar @HOJournalClub On all #BPDCN at presentation. Loss of CD123 was not a mechanism of escape/relapse but I would still double-check if re-treating after relapse. #HOJournalClub |
| Aaron Gerds MD, MS @AaronGerds @DocLHenry @HOJournalClub That would not be much of a stretch! Actually some anti-CD123 CAR T-cells are in development for AML, but would be effective for #BPDCN too! #HOJournalclub |
| Taylor Lab UM @TaylorJ_MD @DocLHenry @amarkelkar @HOJournalClub @AaronGerds @sanamloghavi I’m not aware of GVHD rates after Tagaxofusp. We did report rates seen with other types of induction for BPDCN, which were overall low. #HOJournalClub |
| Liza Henry McDonald @DocLHenry RT @HOJournalClub: For our followers in other times zones and countries - Feel free to continue to post responses !!! #HOJournalclub |
| Amar Kelkar, MD, MPH, FACP @amarkelkar RT @AaronGerds: @HOJournalClub A4 - the big cost question. Without a RCT will never know if this is better than induction chemo. That is the challenge of incorporating it into treatment algorithms. Especially when thinking of cost! #HOJournalclub |
| Aaron Gerds MD, MS @AaronGerds @amarkelkar Awesome sauce! 😜 (yes I went there). #HOJournalclub |
| Liza Henry McDonald @DocLHenry The power of #somedocs #medtwitter #meded #oncmeded 💪 #hojournalclub FTW! |
| Aaron Gerds MD, MS @AaronGerds @HOJournalClub Thanks so much everyone, this has been fantastic! #HOJournalclub |
| HOJournalClub @HOJournalClub . #value #financialtoxicity #HOJournalclub |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @AaronGerds @HOJournalClub At our hospital, I've only seen Vyxeos given outpatient for that reason. I wonder if we'll see the same for tagraxofusp ... #HOJournalClub |
| HOJournalClub @HOJournalClub Thank you to our fabulous guest discussant @AaronGerds and all other participants for this very educational #HOJournalclub ! |
| Natasha Dhawan, MD @NatashaDhawanMD @amarkelkar @AaronGerds #HOjournalclub https://t.co/Er7vRllL1u |
| HOJournalClub @HOJournalClub RT @amarkelkar: I've already learned far more in one hour of #HOJournalClub about Blastic plasmacytoid dendritic-cell neoplasm (#BPDCN) than I had through training so far. It's rare, but highly aggressive and I hoping we'll continue to get more tools to combat it. Thanks @AaronGerds! |
| Megan Murray Dupuis, MD, PhD @MissMeganEl @sisodoc @HOJournalClub Mechanism of CLS occurs because of diphtheria toxin mediated effects on vascular endothelial cells - causes intercellular gaps btwn endothelium and they pull apart! #HOJournalClub |
| HOJournalClub @HOJournalClub RT @MissMeganEl: @sisodoc @HOJournalClub Mechanism of CLS occurs because of diphtheria toxin mediated effects on vascular endothelial cells - causes intercellular gaps btwn endothelium and they pull apart! #HOJournalClub |
| Amar Kelkar, MD, MPH, FACP @amarkelkar @HOJournalClub Stemline Therapeutics is likely riding the orphan drug/orphan disease train and associated pricing patterns, but per @ncdhhs "The maximum reimbursement rate per unit is: $26.38" so I'm sure this is going to need further remediation before it becomes more prevalent #HOJournalClub |
| Sanam Loghavi, MD صنم لغوی 🔬🧬 @sanamloghavi RT @amarkelkar: I've already learned far more in one hour of #HOJournalClub about Blastic plasmacytoid dendritic-cell neoplasm (#BPDCN) than I had through training so far. It's rare, but highly aggressive and I hoping we'll continue to get more tools to combat it. Thanks @AaronGerds! |
| HOJournalClub @HOJournalClub RT @amarkelkar: @HOJournalClub Stemline Therapeutics is likely riding the orphan drug/orphan disease train and associated pricing patterns, but per @ncdhhs "The maximum reimbursement rate per unit is: $26.38" so I'm sure this is going to need further remediation before it becomes more prevalent #HOJournalClub |
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