Estefania Gauto Mariotti, MD

BMT/plasma cell dyscrasias advanced fellowship. My views are my own.

[Hamza Hashmi @hhashmi87]

#LLMGreatDebates
Will CAR T/BsAb replace ASCT for Multiple Myeloma?
Great debate by @szusmani and Jonathan Kaufman
#MMSM #LLMGreatDebates

[The New York Times @nytimes]

From @TheAthleticFC: Paraguay achieved one of the greatest upsets of recent World Cup history to defeat Germany in a penalty shootout. Germany had never lost a World Cup shootout.

Germany: ❌ ✅ ✅ ❌ ✅ ❌
Paraguay: ✅ ✅ ✅ ❌ ❌ ✅
https://t.co/U3nNYLHzex

[Robert Z. Orlowski @Myeloma_Doc]

#Myeloma Paper of the Day: A secondary analysis of CIBMTR data finds functional high-risk phenotype (progression within 12-24 months of front-line induction + ASCT) predicts poor survival in multiple myeloma independent of front-line treatment: https://t.co/ErdLMLPYHm. #mmsm

[Samer Al Hadidi, MD,MS,FACP @HadidiSamer]

ANDROMEDA final analysis #mmsm

🛑Still, ~25% of D-VCd patients relapse and need more therapy
🛑 1/3 of pts of D-VCd didn’t achieve heme CR
🛑 do we really need maintenance at in pts with heme CR (EMILIA trial ongoing: 6 vs 18 cycles daratumumab)
✅ Patients achieving cardiac CR: HR for death 0.05 (95% CI 0.01–0.19)👇
The OS curve for cardiac CR patients is essentially flat — nearly no deaths over 6 years

[Samer Al Hadidi, MD,MS,FACP @HadidiSamer]

ANDROMEDA final analysis #mmsm

✅early death in AL amyloidosis is driven by cardiac failure in patients who don't achieve rapid deep hematologic response (time is money)

This is where BCMA based therapies (mainly BCMA BsAb) will be a game changer IMO

End 🧵

[Samer Al Hadidi, MD,MS,FACP @HadidiSamer]

ANDROMEDA final analysis #mmsm

Early mortality

✅Deaths within 30 days of last study treatment: 11% D-VCd vs 7% VCd : higher in D-VCd arm but mostly unrelated to treatment (16/22 D-VCd and 12/14 VCd deaths were treatment-unrelated)
🛑 23 VCd deaths in months 6–12 vs 6 D-VCd deaths (the window where rapid response matters most)
✅The majority of early deaths in both arms occurred in patients with cardiac involvement at baseline (reflecting the disease itself rather than treatment toxicity)
✅Total deaths overall: 46 (24%) D-VCd vs 66 (34%) VCd

🛑This trial excluded Mayo stage IIIB patients

[Al-Ola A Abdallah MD (USMIRC) @Abdallah81MD]

1/ 🧵 ANDROMEDA final analysis is practice-changing for newly diagnosed AL amyloidosis.

IMPORTANT tweets: 3/4 and 6 for clinicians who treats Amyloidosis

D-VCd = daratumumab + bortezomib/cyclophosphamide/dexamethasone.

With 61.4 months median follow-up, D-VCd improved depth of response, organ recovery, MOD-PFS, and OS. 🔥
#USMIRC #MedEd #medtwitter #mmsm #myeloma @USMIRCNEWS @US_HMC @MedwatchKate @Larvol @OncoAlert

[International Myeloma Foundation @IMFmyeloma]

"Why not replace stem cell transplant entirely with CAR-T therapy?" Dr. Joe breaks it down. Drop your questions below and bookmark this video for later.

#AskTheIMF #mmsm @Bethfaiman @jmikhaelmd

[Estefania Gauto Mariotti, MD @stefigm]

Excellent work @Kennethjclim

[Hamza Hashmi @hhashmi87]

This paper is a great read and addresses an area of uncertainty in #Myeloma

Should we consider treating SBPmm with HR CG (del17p, 1q) like Myeloma? @Rfonsi1 @RahulBanerjeeMD @VincentRK @brandon_imber

A multi-center study of progression-risk and outcomes in solitary bone plasmacytoma with and without marrow involvement https://t.co/mmUVex5KW7

[American College of Cardiology @ACCinTouch]

🆕 ACC/AHA Guideline on the Management of Dyslipidemia offers a comprehensive “one-stop shop” for addressing the evaluation, management & monitoring of individuals w/ dyslipidemias.

Read the full guideline in #JACC: https://t.co/rhUKNIRRL4 #cvLipids #ClinicalGuidelines

[American College of Cardiology @ACCinTouch]

Cardiac #amyloidosis occurs when an abnormal protein called amyloid builds up in the 🫀. As a result, the 🫀 becomes thick, & doesn't fill or pump well.

Explore #CardioSmart hub for resources to help guide discussions w/ patients: https://t.co/xRrJym2GMC

#AmyloidosisAwareness

[Vincent Rajkumar @VincentRK]

This changes how we approach first relapse.

In Dara sensitive patients: Tec-Dara or Cilta-cel are the top two choices.

If Dara refractory: Bispecifics alone or Cilta-cel are the main options.

CART and Bispecifics both need close monitoring and specialized care and certain requirements. So for some patients, we may still use triplets.

[Oncology Brothers @OncBrothers]

Teclistamab + Daratumumab now @US_FDA ✅ in 2L+ myeloma based off MajesTEC3:

- ⬆️ PFS HR: 0.17
- ⬆️ OS HR: 0.46
- AEs: CRS (Majority Gr1), Infections
- IVIG should be used upfront
- New SoC (along with CAR-T)

#OncTwitter #HemeTwitter #mmsm @OncUpdates @End_myeloma 👏👏

[Multiple Myeloma Hub @MM_Hub]

New publication 📝 Results from a pooled analysis, published in @BloodPortfolio, demonstrated slower MRD clearance in patients with t(11;14)+ NDMM treated with QUAD induction + ASCT, yet comparable sustained MRD− and superior 4-year PFS vs patients with t(11;14)− NDMM.

Learn more: https://t.co/GBNQcjpnfP

#mmsm #myeloma #MultipleMyeloma #MedNews #MedEd

[UHN Plus @UHN_Plus]

🇪🇸‼️ | EXCELENTES NOTICIAS — El doctor español Mariano Barbacid, quien logró eliminar el cáncer de páncreas en ratones sin efectos secundarios, alcanzó la meta de financiamiento privado necesaria para avanzar hacia ensayos en humanos. El hito marca un impulso decisivo para una de las líneas de investigación más prometedoras contra uno de los cánceres más letales.

[Estefania Gauto Mariotti, MD @stefigm]

A targeted combination therapy achieves effective pancreatic cancer regression and prevents tumor resistance - PubMed https://t.co/eVgRyC9dAO

[Vincent Rajkumar @VincentRK]

My annual #ASH25 algorithms are delayed because I’m still wrapping my head around some of the new data like Tec-3!

But here is the first one.
How I treat Smoldering Myeloma.

[Vincent Rajkumar @VincentRK]

Just out! AQUILA data in smoldering myeloma by IMWG 2020 SMM risk groups.
#ASH25 @PlasmaCellPete

Daratumumab is FDA and EMA approved for high risk smoldering myeloma

See the difference in 5 year rate of progression to Active Myeloma: Dara versus Observation

[Rahul Banerjee, MD, FACP @RahulBanerjeeMD]

#ASH25 saying it louder for everyone in the back!

If you are starting a bsAb in #MMsm (especially BCMA), don’t wait for patient to die or IgG to drop. Start IgRT now!

Newest case in point: excellent IFM 2021-01 trial. Only 14% Gr3+ infxns despite older pts & CD38 pair!

[Rahul Banerjee, MD, FACP @RahulBanerjeeMD]

#ASH25 further proof, as @End_myeloma has pointed out, that sustained MRD neg is more important than one-time MRD... also 🐠 findings matter.

@stefigm @End_myeloma and more will be presenting at this session on Saturday 4pm... #sridevarakonda and I co-moderating. Come!