Mario Tapia

Hematology/Bone Marrow Transplant #BMT. Opinions are my own.

[Henry C Fung| MM, lymphoma, leukemia & CART @HenrychihangFu1]

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

[Papa Heme @Papa_Heme]

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!

[Henry C Fung| MM, lymphoma, leukemia & CART @HenrychihangFu1]

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

[Papa Heme @Papa_Heme]

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

[Dr Rupam Manna MD @DrRupamOncology]

📊 **T-ALL / T-LBL at a Glance** – High-Yield Guide to T-Cell Acute Lymphoblastic Leukemia/Lymphoma!

WHO/ICC classification • Molecular pathogenesis (NOTCH1, TAL1, HOXA, JAK/STAT & more) • Risk stratification • Pediatric-inspired intensive therapy • Nelarabine, Venetoclax, JAKi • CNS prophylaxis • Allo-HSCT indications • Prognosis pearls

Aggressive but highly curable with modern care!

Curated by Dr Rupam Manna MD
Medical Oncologist

#Oncology #Hematology #TALL #TCellALL #Leukemia #MedEd #OncoTwitter #CancerCare

[William Aird @WilliamAird4]

1/2

HEMATOLOGY feels impossibly broad… until you realize most problems start in just 4 compartments:

🩸 red cells
⚪ white cells
🟣 platelets
💧 plasma

[Abdullatif Abdullah | Lab 👨‍🔬🔬🧪 @Abdullatif_Lab]

Hematology Calculations

• HCT : Hematocrit
• HGB : Hemoglobin

#SLLE
✍️ Abdullatif Abdullah👨‍🔬🔬🧪
https://t.co/iY122hdgsl

[Henry C Fung| MM, lymphoma, leukemia & CART @HenrychihangFu1]

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

[Oren Gottfried, MD @OGdukeneurosurg]

Arterial tree

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

How I manage patients with unexplained cytopenia [Apr 10, 2025] Malcovati & Cazzola @BloodPortfolio https://t.co/bfCmp1AJ4R #camoldx #PrecisionMedicine

[Ritu Thamman MD @iamritu]

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

[Mario Tapia @marioherooftime]

@NeilAndersonE @Diezmartinez Ah

[Manual Of Medicine @ManualOMedicine]

@AB_drmd Anticoagulants and Fibrinolytics – Summary
https://t.co/0fYnb8Nkns

[Mario Tapia @marioherooftime]

@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.

[Nico Gagelmann @NicoGagelmann]

Let's learn hematology in 2025🩸

Day 30: targeted therapies in CLL

[Anas Nasir @BloodScientist]

Doing a manual differential count in CLL.

[Ajay Major, MD, MBA @majorajay]

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

[𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 MD, DM @nihardesai89]

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

[Ross Prager @ross_prager]

Here are 5 strategies to improve your diagnostic reasoning 👇

A 🧵

[Hagop Kantarjian,MD @DrHKantarjian]

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