Timothy Schmidt, MD

***COMMIT Publication Alert*** British Journal of Haematology | Wiley Online Library onlinelibrary.wiley.com/doi/10.1111/bj…

ASH has released new Clinical Practice Guidelines on the diagnosis of light chain (AL) amyloidosis, a rare and life-threatening bone marrow disorder. The guidelines present 12 evidence-based recommendations designed to help clinicians improve diagnosis. ow.ly/OMEV50Y4S71

#Myeloma Paper of the Day: American Society of Hematology (ASH) 2026 guidelines on diagnosis of light chain/AL #amyloidosis emphasizing serum & urine immunofixation, serum free light chains, and surrogate biopsies (both bone marrow and fat pad): pubmed.ncbi.nlm.nih.gov/41592868/. #mmsm

💣 Important Shift in Cytopenia Grading: CTCAE v6.0 Update If you are a PI running #Hematology or #Oncology trials, note these key changes in the new CTCAE v6.0 vs v5.0: 📉 General Trend: "Downgrading" of severity. Many counts that were previously Grade 3/4 are now lower grades. 🧪 Neutrophils: Grade 1 Gone: ANC 1000–1500 is now Grade 1 (was G2). The old Grade 1 (1500–LLN) is no longer graded. Stricter G4: threshold drops from <500 to <100/mm³. 🩸 Platelets (Thrombocytopenia): Wider G3: Now covers 10k–50k (previously 25k–50k). Stricter G4: threshold drops from <25k to <10k/mm³. v6.0 also adds "transfusion indicated" to Grade 3 and "urgent intervention indicated" to Grade 4 criteria. Overall, IMO these new thresholds align better with clinical practice. #ClinicalTrials #MedEd #OncTwitter #DrugSafety

All CoMMit active trials and past research is now in one place. Learn more about and support our work. commitmyelomatrials.org

@RahulBanerjeeMD @BrJHaem @SonjaZweegman 💯! Can't remember the last time I prescribed 3 or 4mg caps of pomalidomide. 2mg works very well, nice to see data to support this practice!

Nice work (and visual abstract!) @BrJHaem by Seefat #nielsvandedonk @SonjaZweegman et al. PK & PD with ∆ pom dosing in myeloma #MMsm. Pom 2mg QD = pom 4mg QD in terms of Ikaros/Aiolos knockdown. Pom Q2D not as effective here. Pom 2mg 21/28 days my go-to for many, e.g. KPd!

@bdermanmd Thanks for sharing this! I have been using DOACs for patients with K/imid combos and high risk for thrombosis (prior VTE, recent surgery, immobility), but not most who get DaraVRd. Have been thinking about switching, and this data is probably enough to make DOAC the standard!

One recommendation I make over and over is to use a prophylactic DOAC instead of aspirin in newly diagnosed myeloma. Just choose a DOAC [they are getting much more affordable!]! *⃣Risk scores lack validation for choosing VTE ppx. 😀The BENEFIT trial shows 6-month incidence of VTE was 0.8% in patients receiving ppx DOAC vs 5.6% with ppx heparin, and 9.8% in patients receiving aspirin. pubmed.ncbi.nlm.nih.gov/40523501/

Great turnout, engaging discussions, all for a fantastic cause!

Real-world data provide a CARbon copy for ide-cel #mmsm #bmtsm @TMSchmidtMD @BloodPortfolio ashpublications.org/blood/article/…

It was a pleasure to review the @CIBMTR analysis of ide-cel for @BloodPortfolio and for the invitation to write a commentary. Great data generated by @SurbhiSidanaMD et al confirming the safety and efficacy of ide-cel for myeloma in a real world setting. authors.elsevier.com/a/1lPab1UYwr0b7

@psharmaMD @BijoyTelivala @OncBrothers @RahulBanerjeeMD @VincentRK @HadidiSamer @rajshekharucms As of today, I am actually just doing FISH and karyotype to be honest. Definitely need to incorporate NGS soon. But as @rajshekharucms mentioned, it's challenging to get a sequencing panel that is available, covered and gives you interpretable and complete info.

@TMSchmidtMD @BijoyTelivala @OncBrothers @RahulBanerjeeMD @VincentRK @HadidiSamer What platform do you use for risk stratification btw? Most community and academic centers still use FISH. Is there a best commercially available MM sequencing (NGS) for risk stratification purpose? @VincentRK @rajshekharucms

Can some one please share the new response criteria and guidelines ( especially definitions of high risk MM ) Thank you in advance @OncBrothers @RahulBanerjeeMD

@BijoyTelivala @OncBrothers @RahulBanerjeeMD @VincentRK @HadidiSamer There's always more nuance than what can go into the summary statement of a guideline. There will be many circumstances where the application of a guideline is tricky. I think the point is that if you have someone with standard risk cyto but is ISS-3, don't discount that.

@TMSchmidtMD @OncBrothers @RahulBanerjeeMD @VincentRK @HadidiSamer I ask is because we made light chain ration > 100 a MM defining event many yrs ago Now more and more data that by itself it is no Eg- 82 yr old with creat 1.2 but weighs 45 kg. His GFR is low but many wont call him CKD. Now his beta comes back at 5.6. Is he high risk?

@BijoyTelivala @OncBrothers @RahulBanerjeeMD @VincentRK @HadidiSamer Hmm. I don't think I've ever really looked into that before. In reviewing the citations for the ISS paper, most of the prior literature actually suggested a B2M cutoff of 6 mg/L. I'd have to assume 5.5 was determined in the regression analysis, but I don't know.

@TMSchmidtMD @OncBrothers @RahulBanerjeeMD @VincentRK @HadidiSamer I do understand that beta is prognostic I am curious more about how come a value of 5.5 was choosen

@BijoyTelivala @OncBrothers @RahulBanerjeeMD @VincentRK @HadidiSamer References: ISS table, Greipp, et al 2005 ascopubs.org/doi/10.1200/JC… R2-ISS = D'Agostino, et al, 2022 doi.org/10.1200/JCO.21…

@BijoyTelivala @OncBrothers @RahulBanerjeeMD @VincentRK @HadidiSamer B2M is a marker of disease burden. It is highly prognostic, even accounting for cytogenetics. See table from ISS paper (even B2M 3.5 is strongly prognostic) and impact of ISS3 in the R2-ISS. But it is renally cleared, so among patients with CKD it is artificially elevated

Cartitude-1 LTFU data is very exciting. Unprecedented results! But I think we need to be extremely cautious calling this a cure or functional cure. For me, cure in MM is when I can look a patient in their eyes and tell them they don't need to return to clinic. Not there yet.

@End_myeloma Perhaps early bispecifics will be the best way to go to achieve MRD-negativity post-transplant, as we are investigating in MASTER-2. And perhaps we can see this even FASTER using bispecifics immediately after induction, instead of transplant😉 @AimazAfrough @schadeh @bhemato

MIDAS (👏). Of 24% patients POS at 10-6 after induction in arm A, only 8% became NEG without transplant, vs. 13%/27% with transplant. OR of 1.86 in favor of Transplant. Let's find better alternatives to transplant. Premature to dismiss it. #MMSM

#Myeloma Paper of the Day: Comparison of standard-of-care Ide-cel and Cilta-cel in relapsed/refractory myeloma finds Cilta associated w/ higher likelihood of grade ≥3 CRS, SPMs, and delayed neurotox, but better treatment responses, PFS, and OS: pubmed.ncbi.nlm.nih.gov/39965175/. #mmsm

@HagenPatrick81 @bdermanmd 👆💯 Off trial, I tend to think this is myeloma-like biology, more likely to relapse early without ASCT. But I don't rush into transplant if hCR. Wait for as much organ response as possible to reduce toxicity of ASCT.

@bdermanmd Put them on s2213! The SWOG trial evaluating the role of transplant. We don't know the optimal endpoint in AL... CR sounds great but data is clear that mrd negativity in the BM by NGF or NGS and in the peripheral blood by mass spec leads to improved outcomes across the board.

How do you approach patients with AL amyloidosis with high plasmacytosis in the bone marrow (ex. 35%) but no other evidence of myeloma?