It’s MajesTEC-1,2,3,4,5,7,9… but I call it #MagicTec ✨🧬
An easier way to remember the journey:
🔹 Magic 1
Advanced / heavily pretreated disease
🔹 Magic 3
1st+ relapse, non-Dara refractory
(teclistamab + Dara moving earlier)
🔹 Magic 4
Maintenance after transplant
🔹 Magic 5 & 7
Frontline myeloma
• transplant-eligible
• transplant-ineligible
🔹 Magic 9
Dara-exposed / refractory early relapse strategy
What is amazing is not just the speed… but the roadmap itself.
The studies are progressively moving BCMA bispecific therapy:
late line → early relapse → maintenance → frontline
One scientific question at a time.
One indication at a time.
But accumulating very, very fast. ⚡
#MultipleMyeloma ##Bispecifics #HemeTwitter
What's a D-dimer?
Fibrinogen = 3 domains = central E + 2 D
Thrombin cleaves fibrino-peptides (A,B) in E
= Fibrin monomers
With fibrin-peptides A + B gone monomers can polymerize
Fibrin monomers polymerize = Fibrin polymers
FXIIIa crosslinks D in polymers = (D-D)E-(DD)E... = cross linked fibrin->clot stabilized and leaves behind some (d-D) = D-dimer!
PFS is not always OS.
One of the biggest misconceptions in oncology is assuming that delaying progression automatically means patients live longer.
Many strategies consistently improve:
• PFS
• depth of response
• MRD negativity
…but OS often barely moves.
Examples:
• Upfront vs delayed AutoSCT
• Lenalidomide maintenance
• HD melphalan intensification
• Many maintenance strategies in lymphoma
Why?
Because:
• crossover therapies matter
• salvage therapies work
• toxicity matters
• resistant clones survive
• biology evolves
A longer remission is meaningful.
But it is not always a longer life.
The critical question is no longer:
“Did the curve separate?”
The question is:
“What happened to OS?”
#MultipleMyeloma #lymphoma #CART #Hemtwitter
Dr. Fun + G
Differential diagnoses for for an isolated At prolonged PTT with no bleeding!🩸
Lupus anticoagulant
Factor 12 deficiency
HMWK deficiency
Prekallikrein deficiency
Heparin contamination
Workup =
1:1 mix
If corrects check factors for XII etc
Lupus anticoagulant won’t correct
We recently discussed t(11;14), t(4;14), and t(14;16).
Today—let’s simplify what matters most at the bedside:
👉 t(11;14) = “Leaky myeloma” 💧
👉 t(14;16) = “Sticky myeloma” 🧲
Yes… leaky vs sticky.
💧 t(11;14) — LEAKY
• CD56 negative → no adhesion
• Cells don’t stay in marrow → spill into blood
• PB involvement, EMD more common
🧠 Think:
No glue → no home → they wander
🎯 Biology: BCL-2 dependent
→ Target the protein (venetoclax)
🧲 t(14;16) — STICKY
• MAF → adhesion molecules + IL-6 signaling
• Early disease: locked in marrow niche
• Protected, hidden, therapy-resistant
🧠 Think:
Glued in place… safe for now
💥 Then evolution happens:
→ Lose niche dependence
→ Break out → aggressive EMD
🎯 The big difference:
• t(11;14) → escapes early
• t(14;16) → escapes late… and worse
⚡ Clinical translation:
• Leaky → target the vulnerability (BCL-2)
• Sticky → disrupt the environment + multi-agent therapy
🧠 If you remember one thing:
💧 If it leaks → shut the valve
🧲 If it sticks → break the niche
✍️ Dr Fun + G
#myeloma #hemetwitter
1/@haiderwarraich gives #grandrounds “Arc of the Heart”
Arc 1:volatile life expectancy 1540-1800 & life span doubled in 1900s, post WW2 rise CVD & ⬇️ 💀 from scientific advances or public health & prevention @NEJM@PittHealthSci
@CAPUFE hay un perrito corriendo en sentido contrario al tráfico en el kilómetro 73-72 en sentido Querétaro- CdMexico en la autopista 57D. Puede ocasionar un accidente.
Bispecifics in R/R LBCL @BloodPortfolio:
- 245 pts, 64% epcor, 60% prior CAR
- mPFS 2.5 mos (!!!): 2.3 epcor, 3.8 glofi
- mOS 7.8 mos overall (in MV model, glofi = better OS)
- worse PFS/OS if trial ineligible & w/i 90 d of CAR
Outcomes not great. #lymsm
https://t.co/kE16kLV4jo
This might be a little difficult for some!
65 yr old, male, 9 months after a 10/10 MUD for AML, presents with new onset pancytopenia 🤷🏽♂️
Full donor chimerism
No evidence of disease relapse on BM
Peripheral blood shows 👇🏽
What do you see?
Diagnosis?
Management?
#MedTwitter
Ph 1b/2 trial of Aza-Ven-Magro in newly-diagnosed high-risk and R/R #AML: Clinical data & correlative analysis, published in @CCR_AACR
https://t.co/Vyw3qSx7zz
Unfortunately, the neg Ph3 ENHANCE trials terminates research w/ Magrolimab and likely anti-CD47 Rx in AML for now