Myeloma Paper of the Day, August 26th, Suggested by Robert Orlowski (@Myeloma_Doc) @RossFirestone @DrOlaLandgren @szusmani @LesokhinMD https://t.co/y0GurL2CIo #OncoDaily #Oncology #Cancer #Health #Medicine #MedTwitter #MedEd #MedOnc #MedNews #MM #Myeloma @CancerWorldmag

#Myeloma Paper of the Day: Immune-MRD status informs tumor-MRD outcome prognostication in myeloma pts on Len maintenance; T cell profiles enriched w/ activated cytotoxic effectors predict early relapse & quiescent/naïve T-cells predicting remission: https://t.co/SRc8quQNts. #mmsm

It was fun to work with @RossFirestone in writing this editorial for @BloodPortfolio #Blood "More than myeloma: the trouble with “normal” plasma cells", on the recent article from @nickbolli @matteoclaudio84 https://t.co/f7vtz1Dn8W @MSKCancerCenter @MSK_DeptOfMed #mmsm

1/ 🚨New research alert! 🚨Our study in @BloodCancerJnl shows that high WEE1 expression is an independent predictor of poor survival in multiple myeloma (MM), with @RossFirestone, @MalinHultcrantz, @LarryNortonMD, @szusmani, and the rest of the @MSKCancerCenter team! 🧵👇

Therapy–mediated BCMA expression loss after belantamab or anti-BCMA chimeric antigen receptor T cells underlies teclistamab failure in RRMM. https://t.co/F4EnveJMjm #lymphoidneoplasia #immunobiologyandimmunotherapy #multiplemyeloma

Thanks to the investigators and to our patients for help with this work! 7/7

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

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

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

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

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

Our work with @szusmani and @DavidJChungMD at @MSKCancerCenter looking at antigen escape with BCMA-targeting therapies in #MMSM patients is now out in @BloodJournal https://t.co/GCMzIIJoDh 1/7

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

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

Notably, unscheduled interactions rarely altered treatments plans, and patients almost always went home from in-person visits without care escalation. 4/6

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

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

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. https://t.co/AZNTGE2ksd 1/6

Link to paper here! https://t.co/7YwpQnQvcP

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