Myeloma and Amyloid Oncologist, Asst Professor of Medicine@hackensackUMC. Local guide NYC restaurants. Ravenclaw. Tweets are my own
Hackensack, NJ
Joined August 2009
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Cartitude 4 dara R/R pts=19 mos median pfs. Cart 1, median pfs at 3 yrs, all dara R/R, cart1 accrual reflected pts enrolled in a later line, survived long enough to receive it reflecting a more indolent disease. Selection bias ?
Harsh Parmar MD retweeted
New Research: Primum non nocere: a critical analysis of early intervention clinical trials in smoldering multiple myeloma frontiersin.org/articles/10.… #FrontiersIn #Oncology
I propose a principle. Kaplan Meier reliability heuristic. The core rule: If majority of censoring occurs prior to 67% events, the data is immature and needs more followup before jumping to conclusions. Below this event fraction, sample size is too small to anchor the curves well
A rough bullsh*t detector when p values look amazing. For HRs look for CI. If upper 95th/lower 95th bound CI ratio is <2 = strong finding. 2-3=ok. 3-4=‘wobbly’ HR. >4 = useless
Harsh Parmar MD retweeted
PR after induction - "Go on" to ASCT OR "Hold on" for VGPR and then do ASCT. A dilemma which many of us face in practice. Our analysis from my previous workplace which answers this important question @ishbtish @IndMyAcGp @DrPMPGI @UdayYanamandra @IsbmtU
Harsh Parmar MD retweeted
I like this approach. Depositing light chains is toxic, and the treatment of AL should be considered a quasi-emergency! Almost like renal failure in MM.
#everydaymatters
Harsh Parmar MD retweeted
Important clinical pearl from @Ron_Witteles! In cardiac AL, I check FLCs q-weekly in the first couple of months, and switch treatment if I sense plateau. “Every day matters” for the component of toxic cardiomyopathy from circulating FLCs.
Congrats to the authors, but 2 critical points: 1) There’s no role for PYP scan in setting of + monoclonal protein. 2) “Promptly diagnosing” does not mean 1-2 months from time of suspicion. When #AL #amyloidosis is in the differential, it’s a near-emergency — every day matters.
Talquetamab dysguesia and xerostomia. Try this-
Pilocarpine 2.5mg BID (upto 4 times a day) - can help
Harsh Parmar MD retweeted
Went to pick up a prescription at the pharmacy and with my prescription card it was $467…. Cash price $63.40. Our healthcare and insurance system, and the Pharmacy benefit managers have created the biggest fraud machine I’ve ever seen.
6 prior LOTs. Anti-bcma cart failed (carvykti)-progressed x 2 months.Progressedx2 cycles of talq. Salvage Mel with a strong response, ‘consolidation’ elra x 1 and now on ‘maintenance’ selinexor (100mg weekly) thalidomide 400, in CR. No nausea, no fatigue. *Every* therapy matters
MM in >=4 LOT misbehaves a lot. Multiple pts on TCE or post cart even if not meeting progression by dFLC but consistent iFLC trend increment with end organ damage (mostly skeletal events).Perhaps the LC or m-spike criteria need adjustment allowing change of Rx before these events
70 + F with RRMM 4 prior lines, triple ref. Bcma sensitive, diagnosed with stage IIb melanoma on adjuvant pembro since 7/2024 planned x 1 yr. Concerned about cart with LD w flu/cy or benda ld (interrupt w adjuvant therapy efficacy), data for TCEs w CPI(?)
I have used anti-bcma therapy AFTER anti-gprc5d therapy more frequently these days; I see no issues with compromised responses even if done sequentially. (TCEs) for the most part. Any data presented for this?
Waldenstrom/LPL defines disease progression biochemically as a 25% increment in IgM from best response but no minimum threshold considered in terms of an absolute value increase ? I know most of us go by clinical symptoms regardless
AL question- post treatment initiation (eg.post asct) once uiFLC>iFLC,are we considering heme progression across the mathematical line to consider 50% increment to include negative difference and subsequent positive difference once iFLC>uiFLC? I think we should be
Any experience with CAR-T in AL for pts with profound dysautonomia? Supine SBP 170s, drops to 80s while standing, already on midodrine, fludrocortisone for hypotension (trial of pyridostigmine??)
About 30% of my pts achieve biochem CR with some of the bridging therapies (TCEs or HD mel) with the goal of CAR. (Most 4th LOT). Bridge administered post apheresis. I am opting to wait and monitor closely until progression (can preserve CARs upto 6 months). Any thoughts?