Daniel Peters

Azacytidine, our fantastic hypomethylating agent, used for treatment of MDS and AML, was discovered in 1964, and then fell into oblivion. Almost 40 years later it was FDA approved as the first effective MDS treatment. A 🧵about an unusual revival:

Really enjoyed putting this review together! The 💊Menin Inhibitor💊 field is evolving so quickly we had to rewrite half the 📝 2/2 all the updates the occurred 💡from submission ➡️ proof! Whew!😅

Divergent disease names, criteria, and even diagnoses (e.g., AML vs. MDS). It's time to end the division! This paper outlines a clear path forward: bridging gaps through evidence-based consensus to rally around the next WHO edition (WHO6). link.springer.com/article/10.118…

One of my favorite things to write with two colleagues from whom I’ve learned a great deal. @MSKCancerCenter ashpublications.org/blood/article/…

Amazing to be a leukemia MD in this day & age. This is the timeline of new💊approvals in AML that I get to show our @MCG_AUG Heme/Onc fellows. The last decade has sure been exciting. What's next? #leusm #MedEd

“If you have an ASXL1 mutation and smoke you have an increased risk of blood cancer” For too long we’ve known too little about 🩸 cancer risk. We need to do better to DETECT and PREEMPT AML/MDS. Thanks @beatalleukemia for this great talk! #leusm

At the 3rd Annual Perri Symposium @UNC_Lineberger today and it’s been fantastic. Thoughtful talks on de-intensifying 1L AML tx, optimizing FLT3-mut dz 🧬, TP53 biology, and where menin inhibitors are headed 💊. Unlike AML triplets, year 3 is unquestionably the best. @LeukDocJZ

Wishing @jorgecortesmd all the best as he heads to Birmingham. 🎉 I’m genuinely grateful for your leadership at @GACancerCenter, and even in the short time I’ve known you I’ve learned a lot from your example & mentorship. 🎓@ONealCancerUAB is getting an outstanding leader. ⭐️

Hot off the press-> New @BloodCancerUtd Beat AML Analysis @BloodAdvances analyzing clinical outcomes of NPM1m or KMT2Ar AML in pts >60 y/o. This is an important historical reference prior to use of Menin inhibitors. @beatalleukemia @UNC_Lineberger ashpublications.org/bloodadvances/…

🧬 Why Cyclophosphamide (PTCy) is given on D+3 (±D+4) — NOT D+2 post allo-SCT 🧵 Thread (mechanism-based, guideline-driven): 🕒 Day 0 = graft infusion ➡️ Donor T cells enter host ➡️ Antigen recognition starts but most alloreactive T cells are NOT yet dividing 🔄 Day +1 to +2 ❌ Alloreactive T cells still in early activation phase ❌ Many NOT in S-phase ❌ Cyclophosphamide would MISS key pathogenic clones 🧪 Cyclophosphamide = cell-cycle dependent cytotoxicity ➡️ Kills rapidly dividing T cells ➡️ Needs cells in active DNA synthesis 📈 Peak alloreactive T-cell proliferation = Day +3 ✅ Pathogenic GVHD-causing T cells enter rapid cycling ✅ Maximum susceptibility to cyclophosphamide 🎯 Day +3 (± Day +4) = SWEET SPOT 🔥 Deletes alloreactive donor T cells 🛡️ Preserves: •🧫 Hematopoietic stem cells (↑ ALDH expression) •🧑‍⚕️ Regulatory T cells (ALDH-high, slower cycling) •🦠 Pathogen-specific memory T cells ❌ Why NOT Day +2? ⚠️ Too early ⚠️ Incomplete deletion of alloreactive clones ⚠️ → Higher risk of acute GVHD ❌ Why NOT later (D+5 or beyond)? ⚠️ Alloreactive T cells exit peak proliferation ⚠️ Less cyclophosphamide sensitivity ⚠️ Loss of selectivity → ↑ GVHD, ↑ toxicity ⚖️ Clinical balance achieved at D+3: ✔️ GVHD prevention ✔️ Engraftment preserved ✔️ GVL effect maintained ✔️ Immune reconstitution spared 📌 Bottom line: 🧠 PTCy timing is biologically timed to T-cell kinetics — not arbitrary ⏱️ D+3 targets the enemy when it’s most vulnerable #PTCy #AlloSCT #GVHD #BMT #TransplantImmunology #Hematology #KFSHRC #SOHO_KSA #ESH_Emirates_Hematology_Society

This is important🚨 in #AML. Think we will (and already are) going to see similar themes in 🧬NPM1m AML treated with lower intensity therapy (💊AZA/VEN). #leusm #bmtsm. Awesome work. 👏🏻

Giralt 👨‍🍳 for DLI (MUD) 🩸Donor apheresis = 10-12M cells. 1-2M per bag. 🤏Start low: 0.5-1M CD3/kg, then go up next dose ⏱️Give q3-4 months. Closely monitor GVHD 🥼Based on EBMT (expert cons. only) MAY give 5M CD3/kg cell doses in future

A: HMA-“based" 💊 with DLI. Why "based"? ⚠️Open Q: Does VEN kill/impact the new lymphocytes? ❔What DLI dose do others consider? Great Q.

Great Rapid Fire Session of Experts @ASTCT #Tandem26 72y 👴 Relapsed 9mo post-HCT ➡️salvaged to CRi w/ HMA/Ven. No GVHD. Now what? 🤔 Expert answers 👇 M.Sorror S.Geralt A.Artz

@BKRagonMD 🙏When you’re too 🤏💰 to pay for 💎, you get really good at 😀

@DPetersMD 👏🏻to your 🔥 use of emojis in consolidating all of this important data!!

What I learned as 🌱BMT doc D+1: Donor 🔍 in the 🧪PTCy Era 💡Know ALL (MUD/Haplo/MMUD) donor ops upfront NOT stepwise 💡DSA >3-5k MFI =⚠️ ⚖️ 6/8 MMUD≈7/8≈8/8 (GRFS) ❔Best allele mismatch MMUD🤷‍♂️ 👶>🧬 🔹Age 18-30 is 👑 🔹Young MMUD>Old MUD?(⬇️ rlps) #Tandem26 #bmtsm

Fantastic work by our superstar 🌟@MCG_AUG med students 🎓📚 presenting two great posters at #Tandem26. @GACancerCenter @YennyMo64128602

1st #Tandem26 ✈️ for me! 5 min into the abstract 📖 found this 🖼️ worth 1000 words 👀👇 ⭐️ 1y GRFS: 75% v 54% (p=0.012) 🚫 Gr3-4 aGVHD: 0.00% in Orca-T 🐳 arm Impressive signal in patients who need RIC regimens‼️Game-changer for expanding access...if affordable 🤔#bmtsm #leusm