Marshall Winget, PharmD

@UsuarezMD How do you approach a patient with CNS involvement and a performance status that is suboptimal for R-CODOX-M/R-IVAC or R-HyperCVAD?

Burkitt Lymphoma 2025.

Cytopenias following CAR-T are often prolonged and challenging to manage. Whether growth factor support offers benefit or causes harm in this setting remains a question. G-CSF may or may not help here, it doesn’t seem to harm patients in our cohort. sciencedirect.com/science/articl…

🚫💉 End of chemo in mantle is here ? ENRICH trial (Lancet 2025) 👥 397 untreated MCL (≥60 yrs) 💊 Ibrutinib + Rituximab (IR) vs 💉Immunochemotherapy (R-CHOP / R-Benda) 📊 Primary endpoint: PFS • IR > Chemo — HR 0.69 (0.52–0.90), p = 0.0034 • 🔹 vs R-CHOP HR 0.37 (0.22–0.62) • 🔹 vs R-Benda HR 0.91 (0.66–1.25) 🕰️ Median PFS 65.3 mo vs 42.4 mo ⚰️ OS: HR 0.87 (NS) 🩸 Grade ≥3 AEs ≈ 67% (balanced) ❤️ Atrial fibrillation 7% in IR arm 💡 Takeaway: Chemo-free Ibrutinib + Rituximab delivers superior PFS vs R-CHOP in older MCL — marking a new frontline option. 📖 Lewis et al. The Lancet. 2025. DOI: 🔗doi.org/10.1016/S0140-… #OncoTwitter #Lymphoma #MCL #Haematology @OncoAlert @eha_hematology @myESMO @ASCO @TheLancetOncol

🧵 EHA 2025 Clinical Practice Guidelines for Large B-Cell Lymphoma (LBCL) 1️⃣ Diagnosis & Baseline 🧬 🔹 Biopsy (excisional preferred) 🔹 PET-CT for staging 🔹 IPI & CNS-IPI mandatory 🔹 Molecular: MYC, BCL2/BCL6 (DH/TH) ➡️ poor prognosis 🔹 Baseline MRI/CSF if CNS risk #LBCL #EHA25 ⸻ 2️⃣ 1L LBCL – Stage I/II, 0 risk factor, <80y 💉 R-CHOP ×4 cycles (≤60y non-bulky) 💉 Bulky ≥7.5cm ➡️ R-CHOP ×6 🧪 Interim PET for bulky/older 📸 EOT FDG-PET mandatory #DLBCL #hemonc ⸻ 3️⃣ 1L LBCL – 1 risk factor (<80y) 💉 R-CHOP ×6 cycles [IA] 📸 EOT PET mandatory ⚠️ RT generally not indicated if CMR achieved #LBCL #NCCN ⸻ 4️⃣ 1L LBCL – ≥2 risk factors (<80y) 💉 Pola-R-CHP ×6 [IB] 💉 R-CHOP ×6 if Pola not available 📸 EOT PET ⚠️ RT only if PET-positive residual site #DLBCL #POLARIX ⸻ 5️⃣ Special groups 🧠 High CNS risk ➡️ HD-MTX (≥3 g/m² ×2) after CMR 💥 DH/TH LBCL ➡️ DA-EPOCH-R, R-CHOEP-14, R-CODOX-M/IVAC 🫁 PMBCL ➡️ DA-EPOCH-R or R-CHOP14, omit mediastinal RT if CMR ⚽ PTL ➡️ R-CHOP ×6 + contralateral RT + CNS prophylaxis 🧴 IVLBCL ➡️ R-CHOP ×6 + CNS prophylaxis 👴 ≥80y ➡️ R-miniCHOP ×6 ❤️ Cardiac dysfunction ➡️ R-CEOP, R-GCVP, R-COMP, R-GEMOX #hemonc ⸻ 6️⃣ 2L LBCL – R/R 🔍 Biopsy recommended ⏱ <12m relapse/refractory ➡️ CAR-T (Axi-cel, Liso-cel) [IA] ⏱ >12m relapse ➡️ salvage chemo (R-DHAP, R-ICE, R-GDP, R-ESHAP) ➡️ HDT/ASCT if CR/PR 🚫 Not transplant/CAR-T ➡️ Glofitamab+GemOx, Pola-BR, clinical trial, BSC #CARTcell #LBCL ⸻ 7️⃣ 3L+ LBCL 💉 CAR-T if not given before 💉 Bispecific Abs (Glofit, Epcor, Odro) 💉 Tafasitamab-LEN 💉 Loncastuximab tesirine 💉 Pola-BR 🎯 Clinical trials encouraged #RRLymphoma ⸻ 8️⃣ Response Assessment 📸 Interim PET (iPET2/4) – ΔSUVmax >70% = favorable 📸 EOT PET: DS 1-3 = CMR ✅ ⚠️ DS 4-5 ➡️ biopsy / repeat PET (8–12wks) #PETCT #DLBCL ⸻ 9️⃣ Supportive Care 🌿 🧪 G-CSF primary prophylaxis (>60y or intensive tx) 🦠 Anti-infective prophylaxis (HSV/VZV, PCP, vaccines) 💊 Pre-phase steroids improve PS 🦴 Assess osteoporosis risk, Vit D/bisphosphonates 🫀 Cardiac monitoring if anthracyclines #HemoncSupport ⸻ 🔟 Key outcomes ✅ POLARIX: Pola-R-CHP improved 2-y PFS +6.5% vs R-CHOP ✅ CAR-T (ZUMA-7, TRANSFORM): superior to ASCT in early relapse ✅ Glofitamab+GemOx: OS 25.5m vs 12.9m with R-GemOx #ASH24 #EHA25 ⸻ 📌 Exam Pearl (MCQ) 📝 Q: Best 2L option for primary refractory DLBCL fit for intensive therapy? A) R-ICE + ASCT B) Pola-BR C) CAR-T (Axi-cel/Liso-cel) ✅ D) R-GDP Ans: C. CAR-T is standard for refractory/<12m relapse ⸻ 📌 OSCE Example 🎭 Scenario: 68y male, Stage IV DLBCL, relapse 9m post-R-CHOP, ECOG 1. ➡️ Plan: CAR-T (axi-cel/liso-cel). Discuss bridging chemo + infection prophylaxis before infusion.

BREAKING: The FDA's ODAC has voted 8 to 1 against the applicability of the STARGLO trial findings for US patients with relapsed/refractory #DLBCL. This decision impacts the use of glofitamab (Columvi) with GemOx. #lymsm hubs.li/Q03nmsc90

WOW- practice changing MCL trial showing no benefit of autoHCT in uMRD MCL in first remission. Bravo ECOG team. @timfenske #ASH24

An excellent explanation of the differences in mechanism between TCR and CAR-T.

Tarlatamab with anti-PD-L1 as 1L maintenance in ES-SCLC (DeLLphi-303) No DLTs, no fatal TRAEs 9-month OS: 89%!! Impressive results. #WCLC24

A new study published in @NatureMedicine found that vedolizumab reduces lower-GI #aGvHD 📝 More news: gvhdhub.com #GvHD #MedNews #MedEd

‼️Today is #WorldLungCancerDay. It’s an “ERA OF #HOPE” for #Patients with #LungCancer. We celebrate the great progress, but we still have a long way to go. We will keep advancing #CancerResearch & #CancerCare. We will keep the fight FOR and WITH our fearless patients. #LCSM

I moved to this country pursuing my dream of becoming a pharmacist. Last week, I graduated from UNC with Honors and Distinction. My journey has not been easy but I'm grateful for everyone who's helped me along the way! Consider supporting me one last time through @PharmGradWish.

I am so grateful for @PharmGradWish making my transition from pharmacy student to pharmacist easier! Thank you for any and all support! #TwitteRx #PharmGradWishlist amazon.com/hz/wishlist/ls…

#Axatilimab is a humanized monoclonal antibody that inhibits CSF-1R signaling and restrains macrophage development Colony-stimulating factor 1 receptor–dependent macrophages are important for cGVHD development and worsening #ASH23

If you are interested in ID, working with a great team, and having fun in Nashville, consider attending one of our open house sessions! As an alumni of this program, I have nothing but good things to say!

Happy Women Pharmacists Day to all of my incredible women pharmacist colleagues! #WomenPharmacistDay @ASHPOfficial

What do we do with SGLT2i when the eGFR goes south of 25❓ 🚨 keep it going ‼️ Subgroup analysis of DAPA-HF & DELIVER with eGFR < 25 showed that dapagliflozin 👉🏼 ⬇️ rates of CV outcomes 👉🏼 safe ✅ when compared w placebo #ESCCongress #CardioTwitter #MedTwitter 🔗 jacc.org/doi/10.1016/j.…

@jatis_rx Congrats Andy! Excited to give it a read.

Fortunate to have some amazing research mentors during residency! Excited to see this project from PGY1 get to the finish line.

2018 - Interning in Dr.McCurdy’s med chem lab at @UFPharmacy. Deciding between PharmD & PhD. Though I chose PharmD, the culture in his lab was so welcoming that I came back in 2019 and interned again. 2023 - reunited at @AACPharmacy Meeting. Full circle moment #PharmEd23

Yesterday at #PharmEd23, Paula Paseiro presented a poster on test-optional admission policies and Isabel Cheng, Amanda Savage and the @PhrmAlliance team led a special podium presentation on their vaccine champion curriculum! @AACPharmacy

@bvantassell I’ll be at Vanderbilt University Medical Center!

@WingetMarshall Congrats! Where will you be for residency?

As I begin residency tomorrow, this was nice to set the stage and provide perspective on how to progress through this stage of training!