Hematologist | BP São Paulo, Brazil Myeloma · Amyloidosis · Cell Therapy · Clinical Research Sharing data that matters
Sao Paulo, Brasil
Joined March 2013
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Daratumumab and infections: IPD meta-analysis of 6 RCTs (N=2989). Grade ≥3 infections 29% vs 20%; adjusted OR 1.47 by 3 months, then risk plateaus. Yet <20% with severe respiratory infection got IgG replacement. Front-load prophylaxis. #mmsm doi.org/10.1111/bjh.70882
Ara-C collected more CD34+ than cyclophosphamide (12.6 vs 7.7 x10^6/kg, p=0.005) in a retrospective MM cohort (n=66, no plerixafor). Question: is chemo-mobilisation still needed, or is G-CSF +/- plerixafor enough? #mmsm doi.org/10.3389/fonc.2026.19…
Finland real-world MM (n=1,733): 31% of non-transplant pts died before 2L vs 5% of transplanted. Risks: age >75, comorbidity, ISS/R-ISS. Early deaths: progressive MM and infections. Need for tolerable, effective 1L. doi.org/10.2340/1651-226X.20… #mmsm
AL amyloidosis on dialysis: does treating the clone still matter? In 362 pts, median survival after dialysis start was 40 mo. Reaching CR/VGPR: 63.8 vs 42 mo with PR or less (retrospective). Deep hematologic response matters even in ESRD. doi.org/10.1002/ajh.70532 #mmsm
Real-world MM in Finland (n=1733, 2013-2022): 31% of non-transplant pts died before 2L vs 5% of transplanted. Risk: age >75, comorbidity, ISS/R-ISS. Infections and MM drove early deaths: frontline must be effective and tolerable. doi.org/10.2340/1651-226X.20… #mmsm
JSH-MM-15 post hoc (n=482; 27% t(11;14)+): PFS similar to high-risk MM, OS intermediate, and lower deep responses that did not track with survival. CD20-/CD56- tumors had worse OS. Hypothesis-generating; needs validation. doi.org/10.1111/cas.70564 #mmsm
Can tumor biology predict who becomes MRD-negative after Isa-KRd in newly diagnosed MM? In 423 tumor samples (MIDAS), MRD-neg rates differed by gene-expression subtype; a multiomic model reached AUC 0.77. Promising, not yet actionable. doi.org/10.1038/s41591-026-0… #mmsm
1/3 The IFM published unified 2026 first-line recommendations for NDMM, covering transplant-eligible and transplant-ineligible patients in one framework. Anti-CD38-VRd quadruplets are now standard of care for transplant-eligible patients. doi.org/10.1016/j.clml.2026.… #mmsm
2/3 TE: dara-VRd or isa-VRd (PERSEUS, GMMG-HD7), ASCT, optional consolidation, dara-len maintenance. TI: DRd backbone (MAIA); fit pts may add bortezomib (IMROZ, CEPHEUS, BENEFIT); frail pts: DR without dex (IFM2017-03). #mmsm
3/3 Modeling projects median PFS ~205 mo (dara-VRd, PERSEUS model) and ~100 mo (CEPHEUS model), supporting a functional cure concept. These are projections. MRD, NGS high-risk and CAR-T/BsAb trials are discussed. doi.org/10.1016/j.clml.2026.… #mmsm
Review of high-risk MM in the CAR-T/bispecific era: cilta-cel and selected bispecifics retain activity in high-risk cytogenetics, but EMD and PCL still show inferior responses and short PFS. Biology-informed prospective studies are needed. doi.org/10.3389/fonc.2026.19… #mmsm
DREAMM-3 final analysis: belantamab mono vs Pd, n=325. PFS 11.2 vs 7.0 mo, HR 0.87 (0.64-1.18); OS HR 0.98 (0.73-1.30). Descriptive only; primary PFS endpoint was not met. Median DOR 25.3 vs 9.9 mo. doi.org/10.1038/s41408-026-0… #mmsm
Non-relapse mortality with BsAbs: SR/meta-analysis + FAERS. Teclistamab showed the highest ICANS and more grade ≥3 infections, with non-negligible NRM in both methods. Infection management and NRM as a standard endpoint are needed. doi.org/10.1002/hon.70268 #mmsm
EMA CHMP backs talquetamab + daratumumab ± pomalidomide for RRMM after ≥1 prior line (opinion, not yet EC approval). MonumenTAL-3: 24-mo PFS 81.3% Tal-DP, 77.6% Tal-D vs 51.2% DPd; HR 0.28/0.33. Interim OS also favored Tal arms. doi.org/10.1056/NEJMoa260465… #mmsm
Kidney transplant in MM is no longer a blanket contraindication. This review favors ≥VGPR, ideally MRD negativity, with timing by cytogenetic risk and remission durability. Evidence is retrospective and small cohorts. doi.org/10.1093/ckj/sfag335 #mmsm
Melphalan dosing by BSA ignores PK variability. In 148 MM pts after ASCT, higher exposure: better 24-mo PFS (60% vs 44%) and day-100 MRD negativity, but more grade ≥3 toxicity. No OS difference. Supports PK-guided dosing trials. doi.org/10.1016/j.jtct.2026.… #mmsm
BCMA sequencing in early R/R MM: prior BsAb seems to compromise CAR-T efficacy, while BsAbs largely keep activity after CAR-T. In Brazil, access barriers often decide the sequence before biology does. Review: doi.org/10.1111/ejh.70328 #mmsm #MM
Cardiac amyloidosis, TriNetX PS-matched cohort: ACEi/ARB/ARNi linked to lower mortality (HR 0.64), in AL (HR 0.57) but not ATTR (HR 0.78, p=0.122). More AKI, hyperkalemia, hospitalization. Retrospective. doi.org/10.1016/j.cpcardiol.… #mmsm #amyloidosis
NMA of 4 phase 3 trials (n=2,174) in early relapsed MM: tec-dara ranked first for PFS under fixed effects, but once heterogeneity was admitted, all contrasts crossed 1 (vs cilta-cel HR 0.62, 0.21-1.81). No proven efficacy hierarchy. doi.org/10.1186/s13045-026-0… #mmsm #MM
MAIA, 64.5-mo follow-up: D-Rd kept its OS benefit in non-frail pts (HR 0.53, 95% CI 0.37-0.76). In frail pts, HR 0.79 (0.58-1.06), favorable but not significant. PFS and MRD-neg rates better with D-Rd in all subgroups. doi.org/10.1038/s41375-026-0… #mmsm #MM
