#amyloidosisJC Transcript
Healthcare social media transcript of the #amyloidosisJC hashtag.
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See #amyloidosisJC Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Dr. Jeffrey Zonder @Amyloid_Planet RT @rajshekharucms: Looking forward to #amyloidosisjc tomorrow on outcomes of bortezomib-based frontline treatment in AL #amyloidosis @Amyloid_Planet @vsanchorawala @AlfredChung11 @EdwardLibby13 |
| Dr. Jeffrey Zonder @Amyloid_Planet RT @malignantheme: Tune in to next #amyloidosisjc on Nov'24'2019 2019 @ 9 PM EST. “A prospective observational study of 915 patients with systemic AL amyloidosis treated with upfront bortezomib.” Blood 2019 Moderators: @alfredchung11 @Amyloid_Planet @EdwardLibby13 |
 | Suresh Balasubramanian @malignantheme RT @rajshekharucms: Looking forward to #amyloidosisjc tomorrow on outcomes of bortezomib-based frontline treatment in AL #amyloidosis @Amyloid_Planet @vsanchorawala @AlfredChung11 @EdwardLibby13 |
| Dr. Jeffrey Zonder @Amyloid_Planet About an hour and a half until tonight’s #amyloidosisjc discussing upfront rx of AL #amyloidosis w bortezomib-based regimens. Link to ref: https://t.co/2qqwJSjpbD |
| Dr. Jeffrey Zonder @Amyloid_Planet RT @AlfredChung11: REMINDER-please join us tomorrow Nov 24 2019 @ 9PM EST to discuss Manwani et al “A prospective observational study of 915 patients with systemic AL amyloidosis treated with upfront bortezomib.” Blood 2019 #amyloidosisJC |
 | Alfred Chung @AlfredChung11 RT @Amyloid_Planet: About an hour and a half until tonight’s #amyloidosisjc discussing upfront rx of AL #amyloidosis w bortezomib-based regimens. Link to ref: https://t.co/2qqwJSjpbD |
| Dr. Jeffrey Zonder @Amyloid_Planet just under 10 minutes until #amyloidosisjc! join and hear about current up-front non-transplant therapy of AL #amyloidosis |
 | silva pregja @silvapregja RT @malignantheme: Tune in to next #amyloidosisjc on Nov'24'2019 2019 @ 9 PM EST. “A prospective observational study of 915 patients with systemic AL amyloidosis treated with upfront bortezomib.” Blood 2019 Moderators: @alfredchung11 @Amyloid_Planet @EdwardLibby13 |
 | Sascha Tuchman @stuchman1 RT @Amyloid_Planet: just under 10 minutes until #amyloidosisjc! join and hear about current up-front non-transplant therapy of AL #amyloidosis |
| Alfred Chung @AlfredChung11 Special shout-out to Dr. Cohen (@olivercohen19), who was a co-author on the paper (last week’s JC moderator/travel grant awardee) #amyloidosisJC |
| Alfred Chung @AlfredChung11 Hello everyone. Today we will be discussing Manwani et al. “A prospective observational study of 915 patients with systemic AL amyloidosis treated with upfront bortezomib.” Blood 2019. #amyloidosisJC |
| Alfred Chung @AlfredChung11 @olivercohen19 Here’s a link to the article: https://t.co/oq6roQ2b3T #amyloidosisJC |
| Dr. Jeffrey Zonder @Amyloid_Planet RT @AlfredChung11: Hello everyone. Today we will be discussing Manwani et al. “A prospective observational study of 915 patients with systemic AL amyloidosis treated with upfront bortezomib.” Blood 2019. #amyloidosisJC |
| Suresh Balasubramanian @malignantheme Suresh Kumar Balasubramanian from Wayne State University. Looking forward for an exciting discussion! COI: none #amyloidosisjc @Amyloid_Planet @AlfredChung11 @EdwardLibby13 |
| Alfred Chung @AlfredChung11 For everyone joining us, please introduce yourselves and state any conflicts of interests. I’ll start- Alfred Chung, heme-onc fellow at Stanford, no conflicts of interest! #amyloidosisJC |
| Dr. Jeffrey Zonder @Amyloid_Planet Welcome to tonight’s #amyloidosisjc. I’m Jeffrey Zonder, leader of the #myeloma and #amyloidosis MDT @karmanoscancer in Detroit, MI. For my COI please refer to https://t.co/myWHYQYT8p. Everybody please introduce yourself when you join in, and let us know whether there are any COI |
 | Ximena Jordan Bruno @XimeJordan RT @AlfredChung11: Hello everyone. Today we will be discussing Manwani et al. “A prospective observational study of 915 patients with systemic AL amyloidosis treated with upfront bortezomib.” Blood 2019. #amyloidosisJC |
 | Edward Libby @EdwardLibby13 #amyloidosisjc Happy to be present as well. No COI |
| Dr. Jeffrey Zonder @Amyloid_Planet also, everyone please remember to use the #amyloidosisjc hashtag so we can track all your tweets! thank you @AlfredChung11 for leading tonight's discussion! |
| Sascha Tuchman @stuchman1 Sascha Tuchman, director of the myeloma + amyloid program at @UNC_Lineberger. Relevant COI: consulting for Alnylam (manufactures patisiran), prior research support from Prothena #amyloidosisjc |
| Alfred Chung @AlfredChung11 I will present a series of tweets first highlighting some background -> methods ->results then some key take-home points that I think are important. I will then post some points for discussion. Encourage everyone to participate at any time! #amyloidosisJC |
 | Vijendra Singh @vijsinghmd Vijendra Singh, Second year fellow @karmanoscancer detroit. No COI. #amyloidosisjc |
 | Raj Chakraborty @rajshekharucms Raj Chakraborty, Heme/Onc fellow @ClevelandClinic Excited for today's #amyloidosisjc |
 | omar @omaralbanyan Omar Albanyan. Hematology oncology fellow @karmanoscancer #amyloidosisjc |
| Sascha Tuchman @stuchman1 RT @AlfredChung11: Hello everyone. Today we will be discussing Manwani et al. “A prospective observational study of 915 patients with systemic AL amyloidosis treated with upfront bortezomib.” Blood 2019. #amyloidosisJC |
| Alfred Chung @AlfredChung11 Background: AL amyloidosis involves the deposition of abnormally folded immunoglobulin light chains into various organs. The source of light chains is most commonly a plasma cell neoplasm, thus treatment involves targeting plasma cell clone. #amyloidosisJC |
| Alfred Chung @AlfredChung11 Currently, the main upfront treatment options include high dose melphalan autologous transplant or combination chemotherapy, most commonly bortezomib-based regimens. #amyloidosisJC |
| Alfred Chung @AlfredChung11 The activity of bortezomib in AL amyloidosis was reported by Kastritis et al (J Clin Oncol 2010; 28(6):1031-1037) in their multicenter retrospect. study, demonstrating a heme response rate of 81% in previously untreated and 68% in pretreated patients. #amyloidosisJC |
| Dr. Jeffrey Zonder @Amyloid_Planet anyone can participate - don't be shy with Qs or comments. #amyloidosisjc |
| Alfred Chung @AlfredChung11 Subsequently, several early retrospective studies looked at the combination of cyclophosphamide, bortezomib, and dexamethasone- otherwise known as CyBorD, noting very high response rates >80% and CR rates of 42-71% in the UK and Mayo group respectively #amyloidosisJC |
 | Susan Bal @SusanBal9 #amyloidosisjc Susan Bal from UAB, no COI |
| Dr. Jeffrey Zonder @Amyloid_Planet RT @AlfredChung11: The activity of bortezomib in AL amyloidosis was reported by Kastritis et al (J Clin Oncol 2010; 28(6):1031-1037) in their multicenter retrospect. study, demonstrating a heme response rate of 81% in previously untreated and 68% in pretreated patients. #amyloidosisJC |
 | Hamza Hassan @Hamza_HassanMD Hamza pgy3 IM resident #amyloidosisjc |
 | Gareth Morgan @wittyremarkhere Hi, I'm Gareth Morgan, a basic scientist at Boston University Amyloidosis Center. No relevant COI #amyloidosisjc |
| Alfred Chung @AlfredChung11 These findings have led to CyBorD being a frontline treatment for patients who are non-transplant candidates or as induction before autologous transplant #amyloidosisJC |
| Alfred Chung @AlfredChung11 Links to ref articles: https://t.co/gjhZ5EOBKN https://t.co/sHPGxkYeYk #amyloidosisJC |
| Alfred Chung @AlfredChung11 https://t.co/cEHQMeRiKj #amyloidosisJC |
 | Andrew Kin @Karmanos_DrAKin Andrew Kin, myeloma & amyloid faculty at Karmanos with @Amyloid_Planet . No relevant COI. #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet RT @AlfredChung11: https://t.co/cEHQMeRiKj #amyloidosisJC |
| Alfred Chung @AlfredChung11 Prior to this publication, the largest study of upfront CyBorD was by Palladini et al. (Blood 2015; 126(5):612-615), a multicenter European study of 230 patients treated with CyBorD upfront. #amyloidosisJC |
 | Andrew Staron @a_staron Hi, Andrew Staron, hem/onc fellow from @BUHemeOncFellow joining the discussion #amyloidosisJC |
 | Holly Lee @hollyleeYJ Hello, Holly Lee - heme fellow from Calgary, Canada, no COI #amyloidosisJC |
| Alfred Chung @AlfredChung11 Unlike the prior smaller studies, the observed heme response rate was only 60% with 23% CR rate. 5-year OS was 55% and median time to second-line therapy or death was 13 months. #amyloidosisJC |
| Alfred Chung @AlfredChung11 Patients with high cardiac stage (Stage IIIB) had significantly poorer outcomes, with median OS of 7 months and heme CR rate of only 14% #amyloidosisJC |
| Alfred Chung @AlfredChung11 This brings us to today’s paper. This was a prospective observational study of newly diagnosed AL amyloidosis treated with bortezomib-based regimen from 2/2010 -8/2017 conducted by UK National Amyloidosis Centre. #amyloidosisJC |
| Alfred Chung @AlfredChung11 Pt were treated locally, but seen at 3-months after start of Tx and then q6 months at the study center, where data was collected and analyzed. Heme response was assessed at 6 months and organ responses at 12 and 24 months. #amyloidosisJC |
| Alfred Chung @AlfredChung11 International amyloidosis consensus criteria was used to define organ involvement/response as well as heme-responses. The low-dFLC response criteria was used for presenting dFLC 20-50 mg/L for response assessment. #amyloidosisJC |
| Vijendra Singh @vijsinghmd @AlfredChung11 poor survival make sense, but why low heme CR rate ? #amyloidosisjc |
 | Vaishali Sanchorawala @vsanchorawala Vaishali Sanchorawala from @BU_Amyloidosis #amyloidosisjc |
| Alfred Chung @AlfredChung11 A ‘stringent dFLC response’ was defined as a dFLC <10 mg/L at 6 month time point. One of the goals of the paper was to explore the outcomes associated with achieving this level of response. #amyloidosisJC |
| Dr. Jeffrey Zonder @Amyloid_Planet Q for those participating in #amyloidosisJC tonight: is CyBorD your initial rx of choice in stage 3b pts w #amyloidosis, or do you prefer different regimen? |
| Alfred Chung @AlfredChung11 TNT was defined as time from first-line therapy to beginning of second-line therapy. Patients that died without having progressed to 2nd line therapy were excluded from analysis of TNT – this is important to note and is different than in the Palladini paper #amyloidosisJC |
| Alfred Chung @AlfredChung11 Decisions for second-line treatment was decided by a multidisciplinary team. It seems the authors use TNT as a surrogate for PFS, since many patients are treated with second-line therapy prior to meeting formal criteria for progression. #amyloidosisJC |
| Dr. Jeffrey Zonder @Amyloid_Planet in many cases, failure to even get in 1-2 cycles of therapy to permit a response assessment. median OS 4-7 mos in various pubs. #amyloidosisjc |
| Suresh Balasubramanian @malignantheme @Amyloid_Planet we prefer CyBorD @Amyloid_Planet #amyloidosisjc |
| Andrew Staron @a_staron @AlfredChung11 Was this dFLC-based more stringent response validated previously? #amyloidosisjc |
| Edward Libby @EdwardLibby13 #amyloidosisjc My choice would be CyBorD with a 50% reduction in the dexamethasone dose. I often start the bortezomib at a reduced dose as well e.g. 1 mg/m2 |
| Sascha Tuchman @stuchman1 @Amyloid_Planet Classic "responders do better than non-responders." Death = non-response for analytical purposes, so early death -> low CR rate. #amyloidosisjc |
| Raj Chakraborty @rajshekharucms @AlfredChung11 Important point; also, with high early mortality [>30%!], it is important to consider response rates in the intention-to-treat population IMO #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet interest in this endpoint in part from papers looking at outcomes in #amyloidosis pts with “unmeasurable” baseline dFLC. Link to a paper from Pavia grp @paomilani https://t.co/MuitDYyn0T #amyloidosisJC |
| Raj Chakraborty @rajshekharucms RT @stuchman1: @Amyloid_Planet Classic "responders do better than non-responders." Death = non-response for analytical purposes, so early death -> low CR rate. #amyloidosisjc |
| Vijendra Singh @vijsinghmd @stuchman1 @Amyloid_Planet got it. Thanks, @stuchman1 #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet see my prior comment re: Pavia data. there have also been papers about low baseline LCs in AL #amyloidosis from German grp, Chinese grp, and @MayoAmyloid. Here is a link to the latter, which also suggests value of stringent dFLC #amyloidosisJC https://t.co/cWgIVdmyOG |
 | Tran @tranbryannguyen RT @Amyloid_Planet: in many cases, failure to even get in 1-2 cycles of therapy to permit a response assessment. median OS 4-7 mos in various pubs. #amyloidosisjc |
| Sascha Tuchman @stuchman1 @DrSinghvij @Amyloid_Planet This phenomenon is actually a fascinating topic and carries the name "immortality bias." It's a huge issue in oncology trials in particular. #amyloidosisjc |
| Suresh Balasubramanian @malignantheme @EdwardLibby13 We start with 1.3 mg/m2. Can you please enlighten us with your thoughts on 1mg/m2 on CyBorD, though i have seen that dose in VTD-PACE phase 2 studies. #amyloidosisjc |
| Susan Bal @SusanBal9 What are the practice patterns for Stage 3A in hem CR after Cycle#3? #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet @mpianko This paper from @Mayo Amyloid demonstrates that even within a single practice grp, indications for initiating next Rx can vary: https://t.co/NIAVEc0lwz #amyloidosisJC |
| Vaishali Sanchorawala @vsanchorawala @a_staron @AlfredChung11 Validated by multiple groups, including us. #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet RT @stuchman1: @DrSinghvij @Amyloid_Planet This phenomenon is actually a fascinating topic and carries the name "immortality bias." It's a huge issue in oncology trials in particular. #amyloidosisjc |
| Tran @tranbryannguyen RT @AlfredChung11: @olivercohen19 Here’s a link to the article: @olivercohen19 Here’s a link to the article: https://t.co/oq6roQ2b3T #amyloidosisJC |
| Dr. Jeffrey Zonder @Amyloid_Planet validated in patients with low baseline dFLC, not all pts, yes? #amyloidosisjc |
 | Sam Rubinstein @rubinstein_md @Amyloid_Planet We use CyBorD for the majority of patients #amyloidosisjc |
| Alfred Chung @AlfredChung11 Results: 915 patients were included. 71% had cardiac involvement, 68% renal involvement. 51% of patients had Mayo 2004 Stage III disease (14% Stage IIIB). 95% patients received CyBorD. See table #amyloidosisJC https://t.co/nNaCwmL6se |
| Raj Chakraborty @rajshekharucms @Amyloid_Planet We start with CyBorD, but if <VGPR after 2-3 cycles and patient is transplant-ineligible, add daratumumab [as a single agent or in combination] #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet RT @rajshekharucms: @Amyloid_Planet We start with CyBorD, but if <VGPR after 2-3 cycles and patient is transplant-ineligible, add daratumumab [as a single agent or in combination] #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet @rajshekharucms soon, dara may be part of induction.DARA-CyBorD as initial rx of AL #amyloidosis showed very high ORR as reported at ASCO 2019. Publication in process. #amyloidosisjc |
| Alfred Chung @AlfredChung11 Results: 819 pts assessable for heme response (ITT): 25% CR, 20%VGPR, 16% PR, 4% low-dFLC PR, 35% NR (including 207 deaths=25%). For Mayo Stage III: 23% CR, 19% VGPR, 11% PR, 1% low-DFLC PR, and 46% NR (39% deaths). #amyloidosisJC |
| omar @omaralbanyan What is you though about excluding patient presented with dFLC <20 from response assessments? #amyloidosisjc |
| Andrew Staron @a_staron @AlfredChung11 Wow, there was a patient with a NT-proBNP of 93,776 #amyloidosisjc |
 | Matthew Pianko, MD @mpianko Can I ask about practice patterns for use of doxycycline in amyloidosis? Reserved for stage III or higher, or do you use it in all groups? #amyloidosisjc |
 | Naresh Bumma @NB191186 RT @Amyloid_Planet: @rajshekharucms soon, dara may be part of induction.DARA-CyBorD as initial rx of AL #amyloidosis showed very high ORR as reported at ASCO 2019. Publication in process. #amyloidosisjc |
| Alfred Chung @AlfredChung11 Survival – median follow-up 23 months (32 months for living patients). Median OS was 72 months. 289 patients (31.6%) died without 2nd line therapy. Of remaining 626, median TNT was not reached and 55% had not progressed to further treatment at 7 years. See curves #amyloidosisJC https://t.co/NOnrnubw2X |
| Dr. Jeffrey Zonder @Amyloid_Planet you know what I'm enjoying most about tonight's #amyloidosisjc? half the participants are prior Untangling #Amyloidosis travel grant awardees and/or judges, and/or speakers. |
| Dr. Jeffrey Zonder @Amyloid_Planet necessary, as no prior data to include such patients. #amyloidosisjc |
| Sascha Tuchman @stuchman1 @omaralbanyan Excludes a good-risk patient population, so makes the study population look worse. But understandable to some degree, since you can't do standard response assessment. #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet Here’s a link to a summary re the safety run-in data on DARA-CyBorD. https://t.co/jxfQJkmZBt #amyloidosisJC |
| silva pregja @silvapregja RT @Amyloid_Planet: you know what I'm enjoying most about tonight's #amyloidosisjc? half the participants are prior Untangling #Amyloidosis travel grant awardees and/or judges, and/or speakers. |
| Alfred Chung @AlfredChung11 Survival- Higher Mayo Stage was associated with worse survival with median OS Stage IIIB being 4 months. Deeper responses associated with longer median TNT. See curves #amyloidosisJC https://t.co/xGKY8jPrMZ |
| Raj Chakraborty @rajshekharucms @AlfredChung11 Although follow-up is limited compared to some of the #bmt studies, I think the median OS is impressive in this transplant-ineligible population..thoughts??@Amyloid_Planet @vsanchorawala #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet at our center, in absence of cardiac response, we'd continue induction Rx for total of ~6 cycles and stop. #amyloidosisJC |
| Alfred Chung @AlfredChung11 Of patients considered transplant-eligible, median OS and TNT not reached. 5-year OS was 78% and 71% had not progressed to next-line therapy. #amyloidosisJC |
| Alfred Chung @AlfredChung11 Stringent dFLC response: defined as <10 mg/L at 6 months. 30% of evaluable patients were able to reach this response criteria (table). Presenting dFLC did not impact achievement of response (33% of stringent dFLC responders had initial dFLC >200 mg/L). #amyloidosisJC https://t.co/O8kfh1z17h |
| Edward Libby @EdwardLibby13 #amyloidosisjc I follow the same treatment plan for CR patients that Dr.Zonder describes. |
| Sascha Tuchman @stuchman1 @Amyloid_Planet What does that mean? In presence of cardiac response do you keep going? Stop sooner? We typically go 6 cycles or until max response, whichever is longer. #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet @mpianko honestly, variable. often wait to see how an #amyloidosis pt tolerates CyBorD alone prior to considering adding doxycycline. #amyloidosisjc |
| Alfred Chung @AlfredChung11 There was significant improvement in OS and TNT for stringent dFLC response compared to lesser responses. This included significant difference in OS between CR patients with stringent response vs. w/o as well as VGPR with stringent vs w/o. See figures. #amyloidosisJC |
| Dr. Jeffrey Zonder @Amyloid_Planet @mpianko given tonight's paper is from London grp, the survival numbers for advanced cardiac pts in this paper probably reflect concurrent doxycycline use #amyloidosisjc |
| Raj Chakraborty @rajshekharucms @AlfredChung11 Interestingly, 5-year post-transplant OS in the CIBMTR paper by @adsouza_md @JCO_ASCO was similar at 77% in the 2007-2012 cohort #amyloidosisjc https://t.co/7jIGuRNGq6 |
| Andrew Staron @a_staron @rajshekharucms @AlfredChung11 @Amyloid_Planet @vsanchorawala Survival curve steepest in first 6-months, and there after more gradual. Not surprising for AL amyloidosis. #amyloidosisjc |
| Vaishali Sanchorawala @vsanchorawala @rajshekharucms @AlfredChung11 @Amyloid_Planet Agree with you! #amyloidosisjc |
| Gareth Morgan @wittyremarkhere @a_staron @AlfredChung11 High because of renal failure, presumably? #amyloidosisjc |
| Alfred Chung @AlfredChung11 Organ responses at 12 months according to 6 month heme response. Those who achieved CR, especially CR with stringent dFLC, had best organ response rates at 12 month (59% cardiac response, 22% renal response, 45% liver response). See Table #amyloidosisJC https://t.co/cuV5f0etqB |
| Dr. Jeffrey Zonder @Amyloid_Planet agree. seems impressive - except for stage 3b pts. #amyloidosisJC |
| Sascha Tuchman @stuchman1 @AlfredChung11 Again I call our attention to immortality bias. Pts who achieved stringent dFLC resp had to live long enough to achieve it, so it's already a better risk pt group. (Trainees - landmark analysis is the way to look at impact of response on survival). #amyloidosisjc |
| Alfred Chung @AlfredChung11 Toxicity: see table. Sensory neuropathy 21% Gr 1-2, 1.3% Gr 3-4. Lethargy 55.7% Gr 1-2, 6.5% Gr3-4. #amyloidosisJC https://t.co/HpHvYBZb2x |
| Edward Libby @EdwardLibby13 #amyloidosisjc The extent of organ response may take 3 -36 months to see. So I treat for 6 months and hope patients will have an organ response. Of course if the light chains are not falling significantly by 2-3 months I change treatment. |
| Dr. Jeffrey Zonder @Amyloid_Planet I mean in absence of cardiac response, ASCT remains a non-starter, and we carry on w CyBorD as you describe without subsequent maintenance. #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet RT @AlfredChung11: Stringent dFLC response: Stringent dFLC response: defined as <10 mg/L at 6 months. 30% of evaluable patients were able to reach this response criteria (table). Presenting dFLC did not impact achievement of response (33% of stringent dFLC responders had initial dFLC >200 mg/L). #amyloidosisJC https://t.co/O8kfh1z17h |
| Sascha Tuchman @stuchman1 @Amyloid_Planet Ah - agree. Same here. #amyloidosisjc |
| Andrew Staron @a_staron @wittyremarkhere @AlfredChung11 Presumably. NT-proBNP more affected by reduction in GFR than plasma BNP. #amyloidosisjc |
| Edward Libby @EdwardLibby13 #amyloidosisjc no maintenance |
| Sascha Tuchman @stuchman1 @NB191186 @EdwardLibby13 @Amyloid_Planet @mpianko No maintenance. No data for it in AL alone. If they have myeloma too, we do it. #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet not generally w bortezomib. The options we use which tend to be used continuously are Dara (especially) and IMiDs - do others use BTZ maintenance? any diffenrece in how u use BTZ vs IXA in AL #amyloidosis? #amyloidosisjc |
| Gareth Morgan @wittyremarkhere @AlfredChung11 Is there a correlation between toxicity/tolerability/adverse events and disease stage? Either in this study or more generally? #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet wish AS A RULE studies would break apart Gr 1 and Gr 2 neuropathy rather than lumping. very different implications for a patient #amyloidosisjc |
| Andrew Staron @a_staron @AlfredChung11 I'm surprised by the renal response rate among those with hemCR. Lower than what I expected. #amyloidosisjc |
| Sam Rubinstein @rubinstein_md @Amyloid_Planet Agree. Especially in Nashville. G2 neuropathy can be devastating for a guitarist. #amyloidosisjc |
| Raj Chakraborty @rajshekharucms RT @rubinstein_md: @Amyloid_Planet Agree. Especially in Nashville. G2 neuropathy can be devastating for a guitarist. #amyloidosisjc |
| Sam Rubinstein @rubinstein_md @a_staron @AlfredChung11 At least anecdotally, we have seen several renal responders 18 mo out or longer. May be survivorship bias, but I wonder if 12 mo is not enough follow up for this. What do others think? #amyloidosisjc |
| Alfred Chung @AlfredChung11 Key Points: I believe this paper highlights several important points. (1) Some patients can have quite durable responses to CyBorD (55% of surviving patients not progressing at 7 years). #amyloidosisJC |
| Alfred Chung @AlfredChung11 (2) Deeper dFLC responses ("stringent dFLC") appear to be associated with better outcomes, even with patients classified as VGPR or CR previously #amyloidosisJC |
| Alfred Chung @AlfredChung11 (3) Patients with Mayo 2004 Stage IIIB disease continue to have poor outcomes despite CyBorD with 40% of Stage III patients dying within 6 months of dx #amyloidosisJC. |
| Vaishali Sanchorawala @vsanchorawala @a_staron @AlfredChung11 Renal responses deeper with SCT than non-SCT regimens. #amyloidosisjc |
| Sascha Tuchman @stuchman1 RT @Amyloid_Planet: wish AS A RULE studies would break apart Gr 1 and Gr 2 neuropathy rather than lumping. very different implications for a patient #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet Compared to 2013 report from same grp where almost NO pts got BTZ combos, med OS for stage IIIa pts is better now (36 mos vs 17 mos) https://t.co/PkcgwYpFwJ IIIb pts do exactly as badly as previously. #amyloidosisJC |
| Sascha Tuchman @stuchman1 @rubinstein_md especially since you're an outcomes researcher, I appreciate your attention to very real concrete quality of life issues such as ability to shred. (I play guitar myself, albeit poorly ;) #amyloidosisjc |
| Alfred Chung @AlfredChung11 Discussion Point(1): What are your thoughts on the TNT endpoint? I understand that PFS is not able to be evaluated if pts treated before ISA progression criteria, but excluding patients that die likely inflates median TNT. #amyloidosisJC |
| Dr. Jeffrey Zonder @Amyloid_Planet @AlfredChung11 not "likely"....it absolutely without question does. #amyloidosisjc |
| Raj Chakraborty @rajshekharucms @AlfredChung11 Unfortunate that early mortality remains high in patients with advanced cardiac disease. Reminds me of this editorial by @MorieGertz https://t.co/usXXkRtJe2 #amyloidosisjc |
| Raj Chakraborty @rajshekharucms RT @vsanchorawala: @a_staron @AlfredChung11 Renal responses deeper with SCT than non-SCT regimens. #amyloidosisjc |
| Alfred Chung @AlfredChung11 Discussion Point (2): The authors posit that these results with CyBorD rival those seen with upfront ASCT (PFS 2-4 years). What are your thoughts on this? With emerging evidence of efficacy of daratumumab in subsq line setting – does this challenge role of ASCT? #amyloidosisJC |
| Sascha Tuchman @stuchman1 @rajshekharucms @AlfredChung11 @MorieGertz Unfortunately this is classic AL. Patients either die early due to cardiac involvement, or they survive long enough to achieve heme response and live for years. Key is reducing early cardiac death. Cue Caelum...! #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet still need the elusive RCT of best 2019 (2020) non-ASCT rx vs ASCT in AL #amyloidosis (maybe more than ever) #amyloidosisjc |
| Alfred Chung @AlfredChung11 Discussion Point (3): What were the second-line treatments given? Did any patients get autoSCT subsequently? This would be helpful to note #amyloidosisJC |
| Holly Lee @hollyleeYJ @vsanchorawala @a_staron @AlfredChung11 Does SCT improve rates of achieving stringent dFLC (or MRD neg) compared to non-SCT regimens? Has this been studied? #amyloidosisJC |
| Alfred Chung @AlfredChung11 Discussion Point (4): Outcomes were improved with dFLC < 10 mg/L- “stringent dFLC response”. Should response assessments be modified to account for this? Should we target a stringent dFLC response (eg. Switch or add therapies if patients do not achieve this)? #amyloidosisJC |
| Raj Chakraborty @rajshekharucms RT @stuchman1: @rajshekharucms @AlfredChung11 @MorieGertz Unfortunately this is classic AL. Patients either die early due to cardiac involvement, or they survive long enough to achieve heme response and live for years. Key is reducing early cardiac death. Cue Caelum...! #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet availability of 2nd line anti0CD38 moAb rx would be important to know in order to compare series. #amyloidosisjc |
| Vaishali Sanchorawala @vsanchorawala @holly_dlduwls @a_staron @AlfredChung11 Submitting an abstract for ISA. @a_staron #amyloidosisjc |
| Vaishali Sanchorawala @vsanchorawala @AlfredChung11 Controversial results #amyloidosisjc |
| Gareth Morgan @wittyremarkhere @AlfredChung11 One wrinkle: the availability of second-line treatments (especially len in the UK) varied over the study time period. Might that have influenced TNT more than it would affect PFS? #amyloidosisJC |
| Dr. Jeffrey Zonder @Amyloid_Planet we're at the end of our hour - last thought? great job tonight @AlfredChung11 - one of the best #amyloidosisjc discussions yet |
| Dr. Jeffrey Zonder @Amyloid_Planet @wittyremarkhere @AlfredChung11 an analysis according to either second-line therapy or year of diagnosis would answer this #amyloidosisjc |
| Vaishali Sanchorawala @vsanchorawala @AlfredChung11 Results from Pavia different than these results #amyloidosisjc |
| Alfred Chung @AlfredChung11 In conclusion, this study demonstrates that CyBorD is associated with high overall response rate 65%, favorable time-to-next treatment among those achieving deep responses, and improved outcomes for those achieving “stringent dFLC” < 10 mg/L. #amyloidosisJC |
| Alfred Chung @AlfredChung11 It will be interesting to see the final results of the ANDROMEDA study and what the effects of adding daratumumab to CyBorD will have on outcomes. #amyloidosisJC |
| Dr. Jeffrey Zonder @Amyloid_Planet @AlfredChung11 this seems like a better (moe intuitive) approach. #amyloidosisjc |
| Dr. Jeffrey Zonder @Amyloid_Planet @vsanchorawala @AlfredChung11 yes, and the patients in tonight's paper had a very high % of adv cardiac patients. i puzzled over this too. #amyloidosisjc |
| Sam Rubinstein @rubinstein_md @AlfredChung11 This for me is a huge question. Not clear if stringent dFLC response is simply prognostic or something we should target #amyloidosisjc |
| Alfred Chung @AlfredChung11 Thank you all for participating and for the lively discussion! #amyloidosisJC |
| Suresh Balasubramanian @malignantheme RT @AlfredChung11: In conclusion, this study demonstrates that CyBorD is associated with high overall response rate 65%, favorable time-to-next treatment among those achieving deep responses, and improved outcomes for those achieving “stringent dFLC” < 10 mg/L. #amyloidosisJC |
| Dr. Jeffrey Zonder @Amyloid_Planet thank YOU @AlfredChung11 - transcript of tonight's discussion will be posted @ https://t.co/myWHYQYT8p in next 24 hours. goodnight enryone! thanks for lively discussion. #amyloidosisjc |
| Sascha Tuchman @stuchman1 Pleasure as always. Thanks @alfredchung11 for leading a very informative discussion Have a good night, everyone. #amyloidosisjc |
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