Miheer Pujara

Heme/onc fellow at UMN. Hospitalist, in remission. Every day is a school day.

[Miheer Pujara @mihematology]

How I teach #anemia

There are many anemia frameworks out there, this is just how I keep all of the possibilities organized in my brain

Feedback welcome #hemesm

[Miheer Pujara @mihematology]

“The push for publication leads young scholars astray,” Pioneer co-founder Matthew Jaskol said. “The message is that looking like a champion is more important than training to be a great athlete.”

https://t.co/jr7VSfUZ0y

[Miheer Pujara @mihematology]

@jmaakaron @mcuban @costplusdrugs Oh wow that’s incredible considering how many insurance companies limit things as essential as ondansetron to 9 pills! @guptaarjun90

https://t.co/FXi10zgZ2q

[Miheer Pujara @mihematology]

Been meaning to go through @mcuban’s @costplusdrugs to see what might be useful in heme/onc, there are quite a few!

The one time I’ve used it so far was seamless, just sent an e-script like any other pharmacy in Epic (after making an account on https://t.co/sGx93LxXUn)

[Prashanth Francis, MD PhD @liverazzi]

@cdmukasa I think this every time I work with undergrads and med students. I think older generations think Millenials are the full labor pains, but we're just Braxton Hicks.

[Miheer Pujara @mihematology]

@jmaakaron Kinda feels like complexity is the goal – the more middlemen you can add and then vertically integrate, the more opportunities there are to siphon money from the system

A hydra with too few heads is scary in this case too, is it so much to ask for a competitive amount of heads?!

[Miheer Pujara @mihematology]

“Historically, the United States has relied nearly entirely on market competition to control prices and promote quality in health care. Yet health care markets haven’t been healthy for some time.”

https://t.co/r7CqJx69FA

[Miheer Pujara @mihematology]

@bradcollins53 Seems like that’s just the reality of the current profit motive in healthcare, the “innovation” that sticks is the kind that maximizes profits!

I appreciate that this article highlights regulatory interventions that shift the profit motive e.g. global budgets

[Miheer Pujara @mihematology]

“Having exposure to the real world… serves as a guide to learning and discovery—what the Greeks refer to as pathemata mathemata (or learning through pain)…

This degree of skin in the game is most palpable by clinicians who spend most of their time seeing patients”

@THilalMD

[The Lancet Haematology @TheLancetHaem]

"The needle would move forward more efficiently when academic medicine equally recognises... clinicians... who dedicate their careers to honing their skills and... impart their wisdom onto the next generation of physicians"

Art of Medicine by @THilalMD
https://t.co/Q5QiL4l9cf

[Miheer Pujara @mihematology]

@DrLizBrem @calliecoombsmd @ASkarbnik @DrMDavids Just a couple examples, it looks like the trials were written to include most CD20+ malignancies and some include CLL, but only certain cohorts have been published/presented so far. I assume that means we’ll see them eventually?

[Miheer Pujara @mihematology]

@BrownHospMed @bradcollins53 “Pimping isn’t a contact sport” - Dr. Mel Anderson

[Miheer Pujara @mihematology]

@DrReddyGI @drjerber @ginorthshore @DrHarryThomas @PerelmansPearls @DrBrianAFrank @GI_Pearls What happens to practices that sell to private equity

[Ajay Major, MD, MBA @majorajay]

@mihematology There are some compelling data for mosun monotherapy in frontline elderly/frail DLBCL as well. #lymsm

https://t.co/9VQFm6Cdgm

[Miheer Pujara @mihematology]

Summary:
BiTEs are active in R/R lymphoma and myeloma, though as monotherapy may only fill the spaces around CAR-T

But I’m excited to see long term durability data and what role they may serve in combination or consolidation therapy!

🧵(7/7)

(*tables are not ITT CAR-T data)

[Miheer Pujara @mihematology]

I put together a talk on bispecific T cell engagers in lymphoma and myeloma for @UMNHOT grand rounds last week

Here’s a quick overview of the four phase 2 BiTE trials published in 2022 including:

• Glofitamab
• Epcoritamab
• Mosunetuzumab
• Teclistamab

🧵(1/7)

[Miheer Pujara @mihematology]

Teclistamab, a BCMAxCD3 BiTE, was studied in a mostly penta-drug exposed population and also had rapid, deep responses with similar CRS/ICANS

But rates of infection, even grade 3-4 infections, were higher than in the CD20xCD3 BiTE trials

🧵(6/7)