#amyloidosisJC Transcript

Healthcare social media transcript of the #amyloidosisJC hashtag.
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Dr. Jeffrey Zonder @Amyloid_Planet
RT @rajshekharucms: Looking forward to #amyloidosisjc tomorrow on outcomes of bortezomib-based frontline treatment in AL #amyloidosis @Amyl
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…
Suresh @malignantheme
RT @rajshekharucms: Looking forward to #amyloidosisjc tomorrow on outcomes of bortezomib-based frontline treatment in AL #amyloidosis @Amyl
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 91…
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 reg…
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…
Sascha Tuchman @stuchman1
RT @Amyloid_Planet: just under 10 minutes until #amyloidosisjc! join and hear about current up-front non-transplant therapy of AL #amyloido
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
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
@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 syste…
Suresh @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 syste…
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!
Naresh Bumma @NB191186
Naresh Bumma- myeloma and amyloidosis doc at OSU @OSUCCC_James no pertinent COI #amyloidosisjc
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 @DrSinghvij
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 syste…
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 th…
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
AStaron @a_staron
Hi, Andrew Staron, hem/onc fellow from @BUHemeOncFellow joining the discussion #amyloidosisJC
Holly Lee @holly_dlduwls
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
Naresh Bumma @NB191186
RT @AlfredChung11: Patients with high cardiac stage (Stage IIIB) had significantly poorer outcomes, with median OS of 7 months and heme CR…
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
Vijendra Singh @DrSinghvij
@AlfredChung11 poor survival make sense, but why low heme CR rate ? #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
V 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
Naresh Bumma @NB191186
@Amyloid_Planet outside of clinical trial and in fit patients, CyBorD is my regimen of choice #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 @malignantheme
@Amyloid_Planet we prefer CyBorD @Amyloid_Planet #amyloidosisjc
AStaron @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 d…
Vijendra Singh @DrSinghvij
@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 B. Nguyen @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 vario…
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 @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
V 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…
Tran B. Nguyen @tranbryannguyen
RT @AlfredChung11: @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 daratumum…
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
AStaron @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 a…
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
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
AStaron @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
V 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
Naresh Bumma @NB191186
Agree. Making the case for speedy and accurate diagnosis..
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: defined as <10 mg/L at 6 months. 30% of evaluable patients were able to reach this response cri…
Sascha Tuchman @stuchman1
@Amyloid_Planet Ah - agree. Same here. #amyloidosisjc
AStaron @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
AStaron @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.
V 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…
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 @holly_dlduwls
@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 invol…
Dr. Jeffrey Zonder @Amyloid_Planet
availability of 2nd line anti0CD38 moAb rx would be important to know in order to compare series. #amyloidosisjc
V Sanchorawala @vsanchorawala
@holly_dlduwls @a_staron @AlfredChung11 Submitting an abstract for ISA. @a_staron #amyloidosisjc
V 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
V 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 @malignantheme
RT @AlfredChung11: In conclusion, this study demonstrates that CyBorD is associated with high overall response rate 65%, favorable time-to-…
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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