Ross Firestone
@RossFirestone
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Heme/Onc fellow @MSKCancerCenter | IM @DOMSinaiNYC | MD/PhD @einstein_mstp | he/him
Joined April 2023
RT @FrancescoMaura4: It was fun to work with @RossFirestone in writing this editorial for @BloodPortfolio #Blood "More than myeloma: the tr….
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RT @aksimhal: 1/ 🚨New research alert! 🚨Our study in @BloodCancerJnl shows that high WEE1 expression is an independent predictor of poor sur….
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RT @BloodJournal: Therapy–mediated BCMA expression loss after belantamab or anti-BCMA chimeric antigen receptor T cells underlies teclistam….
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Thanks to the investigators and to our patients for help with this work! 7/7.
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We also found that, at times of active disease, low or undetectable levels of soluble BCMA reported on expression loss, offering a noninvasive method to test BCMA expression in clinical practice settings 6/7
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This has implications for BCMA-directed therapy sequencing, especially following the results of the DREAMM-7 and DREAMM-8 trials, as belantamab may become more frequently used in earlier lines of treatment 5/7.
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Interestingly, prolonged exposure to belantamab wasn't necessary for antigen loss, as we observed it after only 2 months of therapy in one case 4/7.
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BCMA expression loss in MM had not previously been reported after belantamab treatment, which we found to be due to biallelic loss of the BCMA gene, TNFRSF17 3/7.
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We found that loss of BCMA expression can (rarely) be seen after BCMA CAR T cell or belantamab mafodotin treatment and limits future response to BCMA-directed CAR T cells and bispecifics. It can be detected by IHC before therapy selection 2/7
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Our work with @szusmani and @DavidJChungMD at @MSKCancerCenter looking at antigen escape with BCMA-targeting therapies in #MMSM patients is now out in @BloodJournal 1/7.
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We also can't ignore that remote healthcare utilization is part of the patient experience. Portal messages and phone calls, while not as burdensome as in-person visits, are important signals of patient unease. #rUHI 6/6.
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Conclusion: We need to do a better job preparing patients for the expected complications of BsAb and CAR T therapies (both major and minor) to avoid unnecessary healthcare interactions and improve QoL, while still keeping patients safe. 5/6.
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Notably, unscheduled interactions rarely altered treatments plans, and patients almost always went home from in-person visits without care escalation. 4/6.
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Remote and in-person healthcare utilization was higher in BsAb patients, seemingly due to an increased incidence of low-risk infections (URIs, etc). 3/6
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In this study we looked at unscheduled healthcare interactions in MM patients receiving CAR T or BsAbs, with a focus on remote interactions. We found that healthcare utilization was high, even in patients responding well to treatment. 2/6
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Excited to see our manuscript on healthcare utilization in CAR T and bispecifics patients with #MMSM in press! This work was spearheaded by Anna Howard RN and @isabelconcepci MSN FNP-C. 1/6.
ashpublications.org
Key PointsPatients with MM receiving BsAbs or CAR T-cell therapies require frequent UHIs.BsAb patients had more frequent unscheduled health care interactio
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Lots of work still to do (stay tuned!) but these findings, along with work from other groups, show that immune status may be critical for response to bispecifics like Tec  6/6.
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Exploratory results show that peripheral blood T cell profiles favoring CD8 effectors over Tregs were associated with response to treatment 5/6
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When looking at non-responders, we saw very few patients with loss of BCMA expression, even in patients with prior exposure to BCMA-targeting therapy 4/6
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