Al Garfall

Oncologist @PennMedicine @PennCancer specializing in multiple myeloma and cellular immunotherapy.

[Al Garfall @AlGarfall]

@RahulBanerjeeMD @awechalekar @JanakiramMurali @FDA Also dramatically decreases quality of life for the coordinators, which is bad in itself and also leads to higher turnover and overall much less efficient clinical research.

[Michael Jain @MichaelDJain]

In @BloodAdvances we report on 56 patients with secondary MDS after CAR T cell therapy compared to @Ramikomrokji database of patients with tMN after auto transplant or standard chemo/XRT 🧵

https://t.co/K1Kipy0bhq

[Stanford University @Stanford]

The most important briefings of the day.

Karl Deisseroth, professor of bioengineering and of psychiatry and behavioral sciences, shares the news of his Nobel Prize with his kids.

[Suzanne Lentzsch, MD, PhD @SLentzsch]

@awechalekar @AlexionPharma @Amyloidosis_ARC @ISA_Amyloidosis Anselamimab was approved in Japan as Amylpave for systemic k-AL on Sept 16th in Japan!

[Tanya Bondar @_TanyaBondar_]

Free to read via the Myeloma Collection link during #IMS26 (though Sunday):
https://t.co/awsiupHxVN
@AlGarfall

[Raj Chakraborty @rajshekharucms]

Incredible 2-year PFS with Ramantamig in a ~95% CD38-refractory and 100% triple-class exposed population! These results are substantially superior compared to single-agent BCMA BsAbs and BCMA or GPRC5D CAR Ts in similar population. Based on these results, its plausible that we will see a near-flat PFS curve with Ram in Trilogy-5!
#IMS26
@AlGarfall @MileHighMyeloma

[Al Garfall @AlGarfall]

@JanakiramMurali This is interesting. Similar findings from Maus lab just published: https://t.co/MiCqXt4aRp

Though @MatthewHoMD et al found functional differences between cilta and ide when expressed under same promoter: https://t.co/aUg3bofd0B

[Al Garfall @AlGarfall]

@RahulBanerjeeMD @HiraSMian @mtmdphd @SniperGangDon1 @VincentRK @NoopurRajeMD Thanks, Rahul. We have been stopping IVIG based on IgG trend, and it’s more a wean than an abrupt stop since endogenous IgG returns gradually and on variable time course. Anecdotally, most pts still need some out to 12m. We will have data on this from LimiTec.

[Mike Thompson, MD, PhD, FASCO @mtmdphd]

Measles, rubella, and mumps titers post chemotherapy plus autologous stem cell transplant in multiple myeloma patients [Nov 25, 2021] Mariano Arribas et al. @Rfonsi1 @AjHematology https://t.co/DHKdQ8mXll #mmsm #bmtsm #IDonc HT @RahulBanerjeeMD

[Raj Chakraborty @rajshekharucms]

Such an exciting milestone for another groundbreaking RCT in newly diagnosed #myeloma from @CoMMitTrials testing time-limited BsAb therapy to improve outcomes in MRD-positive and de-escalating ASCT in MRD-negative patients after Quad induction! Grateful for the small role we got to play in it @columbiacancer!

[Hira Mian @HiraSMian]

Anticd38 are absolutely pivotal in myeloma, the question of how long to use it still remains open, there likely is a sweet spot, glad our trial @CDNCancerTrials @AnnetteHay1 will try to address this @MyelomaCanada

[Myeloma Society @Myeloma_Society]

Expert perspectives. Real-world insights. A must-attend session at #IMS26 ➡️https://t.co/jCVLKjHI0B

[Al Garfall @AlGarfall]

@NBahlis @RahulBanerjeeMD @BloodPortfolio @paurotero @AjaiChari @mvmateos @AnnaSureda5 @DholariaMD @DoctorAKrishnan Are your data on lower antigen escape with tec/tal + anti-CD38 from late-line or early-line patients?

[Al Garfall @AlGarfall]

@NBahlis @RahulBanerjeeMD @BloodPortfolio @paurotero @AjaiChari @mvmateos @AnnaSureda5 @DholariaMD @DoctorAKrishnan Totally open to this possibility, but...
Tec+dara in dara-R: ORR 67%, ≥CR 40%, 12M DOR 70%
Tec mono in Tec-1: ORR 63%, ≥CR 46%, 12M DOR 70%

[Bruce Levine, Ph.D. 🇺🇦🥼🔬🧬🧪💉 @BLLPHD]

🚨NEW @BloodPortfolio Why do some CLL-derived CAR T-cell products fail even when they still produce inflammatory cytokines? @jh_noll et al (link in reply) identifies immunosenescence, not exhaustion alone.
-Senescence and Senescence Associate Secretory Phenotype (SASP) programs were detectable before infusion, intensified during manufacturing in susceptible products, and tracked with weak in vivo CAR T-cell expansion and inferior survival.
- Repeated CD19 stimulation exposed a proliferative ceiling, while p53-high products lost cytotoxic reserve. Poor response was also associated with costimulatory loss and reduced TCR diversity.
- Ibrutinib attenuated senescence-associated features and SASP output and improved proliferative fitness. The broader message: starting T-cell fitness is measurable and potentially modifiable.
#immunology #immunotherapy #immunosenescence #TCell #CARTCell #CLL

[Philadelphia Phillies @Phillies]

WALK-OFF SCHWARBOMB OVER THE BATTER'S EYE!!!!!!

[Andrew Portuguese, MD @AJPortuguese]

🧵 Myeloma community: CMS is considering an important change to Medicare coverage for autologous stem cell transplant (ASCT). Comments are needed.

CMS proposal + comment submission:
https://t.co/XcXRWiNErA

@RahulBanerjeeMD @AlGarfall @End_myeloma @SurbhiSidanaMD @DrKrinaPatel

[Al Garfall @AlGarfall]

@HiraSMian @VincentRK Though it pains me to say, the more I dig into the ENDURANCE results (non-adherence, under-enrollment, and low event count), I feel it does not settle the question for patients who are tolerating longer term Len. If sustained MRD neg, other data support stopping though.

[Al Garfall @AlGarfall]

Our experience (N=4, or 1.5% of our pts) with neuralgic amyotrophy leading to arm/shoulder weakness/pain after cilta-cel for #mmsm; improvement with steroids but persistent symptoms in most.
https://t.co/Md8Cg3Sit3

[Hira Mian @HiraSMian]

De-escalation in MM: Tough questions—but we now have the tools and drugs to do this in select pts. Here we review existing evidence and offer practical guidance for designing the next wave of de-escalation trials @End_myeloma @Mohty_EBMT @AlGarfall @VincentRK