Bernie Marini

Clinical Pharmacist Specialist #Heme #Leukemia. @UMichPharmacy Dad. Girls Hockey & Lacrosse Coach. Views my own

[Bernie Marini @Berninini]

🔑 for those discussing or presenting results at @ASH_hematology! This also applies to us TWEETING about results #ASH25
- Present a balanced appraisal - remember, we are caregivers and scientists, not cheerleaders
- do not minimize toxicities or QOL!
https://t.co/fLJYnPZrKR

[Bishal Gyawali, MD, PhD, FASCO @oncology_bg]

I don't practice myeloma but this is a very meaningful de-escalation trial with immediate global implications. This should set an example for the why and the how of de-escalation trials in oncology.
I was very impressed not just with the results but also with the methodology. This was not designed to show non-inferiority of fixed-duration over indefinite therapy but was appropriately designed to show superiority of indefinite over fixed-duration. As it should be. https://t.co/NEzaswuODs

Congratulations to the investigators, as well as to patients and health care systems.

[WolverHeme @WolverHeme]

⚽🩸 CHECKING OFFSIDE…

A leukemia cell has crossed the diagnostic line.

This week on WolverHeme Happy Hour, Dr. Dale Bixby joins us in the VAR booth for:

“VAR Review with Dr. Bixby: Reversing the Call on MPAL”

https://t.co/ZHabm1g616

[Eddie Cliff @Eddie_Cliff]

👀 @NatureMedicine retracts first time-of-day immunotherapy RCT - equipoise remains! https://t.co/x11n6EA69O

[James Davis, PharmD, BCOP @thisisJamesD]

➡️ Last year we published use of #pocketdex in patients on teclistamab.
🧠 🤓 Now hot off the press as a full manuscript, see how dex for low-grade CRS is safe and effective with talquetamab

https://t.co/H8ODIQ08Xl

[WolverHeme @WolverHeme]

The hottest take in myeloma right now:

☠️ “Cilta-cell is dead.”

With bispecifics delivering impressive results has CAR-T lost its crown?

We brought in @ManniMD1 for a discussion that every myeloma clinician should hear.

🎧 Listen here: https://t.co/emTP22tNgw

[Bernie Marini @Berninini]

@JMaakaron Yup! We used to not know what to do for these pts, so we tried HD MTX prophy, hoping it would ⬇️ CNS relapse. But maybe we were wrong.

Gotta make clinical judgements with data we have, esp when there isn’t going to be an RCT! Another good editorial 👉 https://t.co/T5z2Fy9K92

[Bernie Marini @Berninini]

A really well done analysis (n=1923!). In ultra high risk pts, no benefit to HD MTX in preventing cns relapse. Authors did a good job w/propensity score analysis for possible confounders

This practice comes with serious risks & patient burden, and it doesn’t seem to help.

[Papa Heme @Papa_Heme]

It’s about time we remove CNS ppx in DLBCL from the NCCN guidelines.

High-Dose Methotrexate as CNS Prophylaxis in Ultra High-Risk Large B-Cell Lymphoma: An International Multicenter Analysis | Journal of Clinical Oncology https://t.co/cWhKcpvIzh

[Bernie Marini @Berninini]

@JMaakaron 😂 there’s a great companion editorial to this! Check it out man! Lots of good reading on the topic!

[Rodrigo Lastra del Prado @DrRodrigoLastra]

Common Sense Oncology in Iberoamerican Context:

Registration free:

https://t.co/TNM77btKbi

[Ajay Major, MD, MBA @majorajay]

Does HD-MTX ppx reduce CNS relapse even in ultra-high-risk LBCL? #lymsm
- >1900 pts, all CNS-IPI 5-6; testicular, renal/adrenal, breast; ≥3 EN sites
- 3-yr CNS relapse: 9.3% (no HD-MTX) v 8.1% (HD-MTX), adjusted HR 1.13 [0.82, 1.57]
- no diff in isolated CNS relapse: 5.9% v 5.7%
- no diff in relapse rates for any high-risk subtypes
- DHL/THL not included
End of HD-MTX ppx, although DHL/THL is still a question. cc @tobyeyre82 @mattwilson2287
https://t.co/80zAeJmlXo

[Bernie Marini @Berninini]

@cvigilgonzales @LeukDocJZ @DrMarcosdelima @beatalleukemia @bcutd_research I think it would imply it’s NOT non-inferior… but could be driven by small sample size (hence the wide CI), or genomic differences between cohorts (eg NPM1/IDH)

[Bernie Marini @Berninini]

This is a REALLY great outline of the data in the cilta-cel vs. bispecific in the 2nd line MM treatment debate!

[Al Garfall @AlGarfall]

@Eddie_Cliff @NatRevClinOncol @rajshekharucms @ManniMD1 @DianaNrco Nice commentary. I mostly agree as I outlined in this friendly exchange with @Rfonsi1: https://t.co/vvUvMqtMxF
Cilta-cel still has a role after bsAb or before in pts who prefer it and fully understand risk. There are still many data gaps.

[Eddie Cliff @Eddie_Cliff]

🚨 Hot off the press @NatRevClinOncol

In the wake of MajesTEC-9 presented at #ASCO26, we ask the provocative question: does cilta-cel have a future in myeloma?

https://t.co/ddjP5Xx4BC

What do you think?

#mmsm #myeloma #CARTcells @rajshekharucms @ManniMD1 @AlGarfall

[Bishal Gyawali, MD, PhD, FASCO @oncology_bg]

Hot off the press. Published just now in @NatRevClinOncol led by @OncologyBGLab current fellow @JavierDavidBen2 with past fellow @lateuwen !

https://t.co/NpHcI8vg6P

We dissect the RECITE trial and conclude that the excitement re romiplostim for chemo induced thrombocytopenia misses the point- we are supposed to treat patients, not platelets.

[Bernie Marini @Berninini]

@JMaakaron @WolverHeme @Papa_Heme @FeeneyTate @ajperissinotti I’m guessing Joe didn’t listen to the episode or read the paper. Must have missed that quote 😂

It’s a tongue in cheek title about biases and beliefs that we ALL have in medicine, and we go through our own :)

Read the paper, it’s pretty cool
https://t.co/jbfQxVuUhk

[Bernie Marini @Berninini]

@DrChrisWillner @WolverHeme @Papa_Heme @FeeneyTate @ajperissinotti Haha that’s a great one!

[Papa Heme @Papa_Heme]

Been a while since I did a podcast. Fun times as always with WolverHeme

[WolverHeme @WolverHeme]

Check out our latest episode "Cult-Like Thinking in BMT" with @Papa_Heme @FeeneyTate @ajperissinotti @Berninini! Comment below 👇what "cult-like" practices you've seen in medicine! https://t.co/x1JXzfSnfA

[Papa Heme @Papa_Heme]

I know running clinical trials is tough but that doesn’t mean us clinicians have to accept the results as the new standard if we find the results not applicable to our current practice.

[Bernie Marini @Berninini]

Young clinicians don’t need to make critical appraisal their primary academic focus, but it is a skill every clinician MUST learn as early as possible. No trial is perfect but understanding the implications of imperfections is 🔑.

And remember - critique trials, not people!

[Vincent Rajkumar @VincentRK]

I know some have become experts at clinical appraisal and clinical trial critique. It’s important to have this dialogue and it helps physicians and patients understand the drawbacks of a given trial. But my advise to young investigators is to best not to make it your primary academic output.

Secondly, when critiquing it’s also worthwhile remembering that the investigators of trials may also fully aware of the issues but there are many barriers and often we have to choose between not doing a trial at all versus compromising. Perfect trials are not common; we can usually find some fault with almost all trials. So we must strive to avoid rudeness and condescension.

Third, try if possible to lead a clinical trial or at least get engaged with someone who leads trials and get a feel for the various stakeholders who have veto power during trial design, and more importantly the various competing priorities for what the trial seeks to accomplish, it will be easier to understand why a specific control arm was chosen, or a why a specific endpoint was chosen, even though you may think they are the wrong ones.