Podcasts about Rituximab

David Tuller returns to TWiV to discuss RFK Jr. and the trashing of American public health, rituximab and ME/CFS, The Sick Times, the Cochrane Mess, a Norwegian Long Covid trial, effort preference and more. Host: Vincent Racaniello Guest: David Tuller Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Become a patron of TWiV! Links for this episode MicrobeTV Discord Server David Tuller writes at virology blog CFS, a long tangled tale (virology blog) The Sick Times Norwegian Long COVID trial (virology blog) Cochrane mess (virology blog) Timestamps by Jolene. Thanks! Intro music is by Ronald Jenkees Send your virology questions and comments to twiv@microbe.tv Content on TWiV should not be taken as medical advice.

This episode of Integrative Cancer Solutions with Dr. Karlfeldt. is joined by Steve Becker as he shares his personal cancer journey, which began with awareness of his family history after his father died from colon cancer. Steve discovered a fermented soybean beverage called Halen 951 through a book about someone who successfully treated testicular cancer. After visiting the company in Seattle, Steve became a distributor and began sharing the product with others, including his friend Sherry who was battling stage four breast cancer and experienced remission after using the product. Steve later faced his own cancer battle when he was diagnosed with chronic lymphocytic leukemia (CLL) that progressed to a rare and aggressive form of lymphoma. He opted for a less aggressive chemotherapy protocol (Rituximab and Bendamustine) while simultaneously using Halen 951, which he credits with helping him tolerate the treatment better than other patients. Steve explains that the nitrogenated fermented soy product works by penetrating cancer cell walls and destroying them, while also reducing side effects from traditional treatments. Following his treatment, Steve maintains his health through regular blood work, toxicology tests, and a holistic approach including diet, exercise, and various therapies like mistletoe, IV infusions, and sauna sessions. Despite later being diagnosed with Parkinson's disease, Steve remains committed to finding and sharing effective health solutions, expressing gratitude for the opportunity to help others battling cancer and other health challenges through his story and experiences.Steve Becker discovered Halen 951, a fermented soybean beverage, after reading about someone who successfully treated testicular cancer with it, which led him to become a distributor of the product.Steve's friend Sherry achieved remission from stage four breast cancer after using Halen 951, experiencing an initial increase in her cancer marker before it decreased as the product helped transport cancer cells out of her body.The nitrogenated properties of Halen 951 reportedly penetrate cancer cell walls and destroy them while also helping reduce side effects from traditional chemotherapy and radiation treatments.When facing his own diagnosis of aggressive lymphoma, Steve combined a less damaging chemotherapy protocol with Halen 951, which he credits with helping him tolerate treatment better than other patients.Steve maintains his health through a comprehensive approach including regular blood work, toxicology tests, diet, exercise, and alternative therapies like mistletoe, IV infusions, and sauna sessions despite later developing Parkinson's disease.----Grab my book A Better Way to Treat Cancer: A Comprehensive Guide to Understanding, Preventing and Most Effectively Treating Our Biggest Health Threat - https://www.amazon.com/dp/B0CM1KKD9X?ref_=pe_3052080_397514860 Unleashing 10X Power: A Revolutionary Approach to Conquering Cancerhttps://store.thekarlfeldtcenter.com/products/unleashing-10x-power-Price: $24.99-100% Off Discount Code: CANCERPODCAST1Healing Within: Unraveling the Emotional Roots of Cancerhttps://store.thekarlfeldtcenter.com/products/healing-within-Price: $24.99-100% Off Discount Code: CANCERPODCAST2----Integrative Cancer Solutions was created to instill hope and empowerment. Other people have been where you are right now and have already done the research for you. Listen to their stories and journeys and apply what they learned to achieve similar outcomes as they have, cancer remission and an even more fullness of life than before the diagnosis. Guests will discuss what therapies, supplements, and practitioners they relied on to beat cancer. Once diagnosed, time is of the essence. This podcast will dramatically reduce your learning curve as you search for your own solution to cancer. To learn more about the cutting-edge integrative cancer therapies Dr. Karlfeldt offer at his center, please visit www.TheKarlfeldtCenter.com

The May 2025 recall features four previously posted episodes on myasthenia gravis. The first episode has Dr. Fredrik Piehl discussing rituximab for new-onset generalized MG. In the second episode, Dr. Vera Bril explores the potential use of immunoglobulin as a corticosteroid-sparing agent in MG patients. The third episode features Dr. Ali A. Habib discussing trends in hospital admissions and in-hospital mortality for adult MG patients. The series concludes with Dr. Jennifer Morganroth addressing the increase in thymectomy procedures post-MGTX trial, disparities in access to these surgeries among different demographic groups, and the rise of minimally invasive surgical techniques. Podcast links: Efficacy and Safety of Rituximab for New-Onset Generalized Myasthenia Gravis  Corticosteroid-Sparing Effects of Immunoglobulin in Myasthenia Gravis Hospitalizations and Mortality from MG Hospitalizations and Mortality From Myasthenia Gravis Trends and Disparities in the Utilization of Thymectomy for MG in the US Article links: Efficacy and Safety of Rituximab for New-Onset Generalized Myasthenia Gravis Randomized Double-Blind Placebo-Controlled Trial of the Corticosteroid-Sparing Effects of Immunoglobulin in Myasthenia Gravis Hospitalizations and Mortality From Myasthenia Gravis Trends and Disparities in the Utilization of Thymectomy for Myasthenia Gravis in the United States Disclosures can be found at Neurology.org.

Dr Michael Northend (University College London Hospitals NHS Foundation Trust, and Cancer Research UK & UCL Cancer Trials Centre, London, UK) joins us to discuss the long-term results of a randomised, phase 3 trial on early rituximab monotherapy versus watchful waiting for advanced stage, asymptomatic, low tumour burden follicular lymphoma.Read the full article:https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(25)00034-1/fulltext?dgcid=buzzsprout_icw_podcast_28-04-25_lanhaeContinue this conversation on social!Follow us today at...https://thelancet.bsky.social/https://instagram.com/thelancetgrouphttps://facebook.com/thelancetmedicaljournalhttps://linkedIn.com/company/the-lancethttps://youtube.com/thelancettv

The Filtered Fragments (OG Filtrate)Joel TopfJennie LinSwapnil HiremathSpecial Guest Brad Rovin GN God and second author from The Ohio StateKoyal Jain GN Specialist from UNCAlfred Kim Rheumatologist from Washington UniversityEditing bySimon Topf and Nayan AroraThe Kidney Connection written and performed by by Tim YauShow NotesJoel's monologue One of the most surprising facts of nephrology is that despite conventional wisdom that lupus nephritis is an antibody mediated disease, that over a decade ago, the LUNAR investigtors were unable to find a significant benefit when rituximab was added to conventional therapy. And this was after the equally negative phase 2 trial of rituximab, EXPLORER.In fact, despite this finding rituximab has been able to burough its way into treatment of many nephrologists and rheumatologists as well as the KDIGO guidelines where it is suggested for patients with persistent disease activity or inadequate response to initial standard-of-care therapy.This long conflict is now coming to an end. Obinutuzumab, a newer, better monoclonal antibody targeting the same CD20 that we grew to love with rituximab, but it has a number of advantages.One. It is humanized antibody rather than a chimeric mouse-human antibodyTwo. It's cytotoxicity is not complement dependent an particular advantage if you want to deploy it ina disease where hypocomplementemia is a disease characteristicThree, and most importantly, it causes stronger and deeper b-cell depletion than rituximab. Better B-cell depletion in the blood and tissue.And this brings us to tonight's topic, we had already seen the phase two results of obinutuzumab which, unlike EXPLORER, were positive, we will look at the phase three regency trial. This makes the third novel lupus nephritis drug in the last 4 years. We continue to remake glomerular nephritis.LUNAR: Efficacy and safety of rituximab in patients with active proliferative lupus nephritis: the Lupus Nephritis Assessment with Rituximab study PubmedEXPLORER: Efficacy and safety of rituximab in moderately-to-severely active systemic lupus erythematosus: the randomized, double-blind, phase II/III systemic lupus erythematosus evaluation of rituximab trial PubmedREGENCY: Efficacy and Safety of Obinutuzumab in Active Lupus Nephritis NEJM | NephJCNOBILITY: B-cell depletion with obinutuzumab for the treatment of proliferative lupus nephritis: a randomised, double-blind, placebo-controlled trial Annals of Rheumatic DiseaseComparison of intravenous and subcutaneous exposure supporting dose selection of subcutaneous belimumab systemic lupus erythematosus Phase 3 program PubMed CentralClass 5 lupus nephritis is slow to respond Long-term Use of Voclosporin in Patients with Class V Lupus Nephritis: Results from the AURORA 2 Continuation Study ACR Meeting abstractTubular SecretionsSwap: Young Adult novel I Must Betray You by Ruta Sepetys (Amazon)Koyal: Taekwondo (Wikipedia)Jennie: these unprecedented times Trump NYT: Administration Freezes $1 Billion for Cornell and $790 Million for Northwestern, Officials SayAl: Acquired PodcastBrad: The Feather Thief by Kirk Wallace Johnson (Amazon)Joel: Paradise on Hulu (Wikipedia)

During the 66th American Society of Hematology (ASH) Meeting and Exposition, the Lymphoma Hub was pleased to speak to Stefano Luminari, University of Modena and Reggio Emilia, Modena, IT. We asked about the latest updates from the inMIND trial of tafasitamab plus lenalidomide and rituximab for R/R FL. In this interview, Luminari shares data from the phase III inMIND (NCT04680052) trial of patients with relapsed/refractory follicular lymphoma treated with tafasitamab in combination with lenalidomide and rituximab. Luminari covers key outcomes, highlighting promising efficacy and safety data. He concludes that the data are encouraging and supports using this combination for patients with relapsed/refractory follicular lymphoma in the second-line setting.This educational resource is independently supported by Incyte. All content is developed by SES in collaboration with an expert steering committee; funders are allowed no influence on the content of this resource. Hosted on Acast. See acast.com/privacy for more information.

 In this podcast Dr Rob Lown, Consultant Haematologist at University Hospital Southampton talks to Lymphoma Action's Anne Hook about the monoclonal antibody rituximab. Dr Lown explains what rituximab is and how it works to treat lymphoma, both as part of a chemotherapy regimen and as maintenance therapy. Dr Lown describes why ritixumab was considered a ‘game changer' in the treatment of B-cell lymphomas, and who may be given it as part of their treatment. Side effects of rituximab, the challenges of  long-term treatment, biosimilars and newer antibodies such as Obinutuzumab are also discussed. Lymphoma Voices is a series of podcasts for people living with lymphoma, and their family and friends. In each podcast, we are in conversation with an expert in their field, or someone who has been personally affected by lymphoma, who shares their thoughts and experiences. Lymphoma Action is the only charity in the UK dedicated to supporting people affected by lymphoma. We are here to make sure that everyone affected by the condition receives the best possible information, support, treatment and care. Our services include a Freephone helpline, support group network, Buddy Service, medical information, conferences for those affected by lymphoma, and education and training for healthcare professionals. We would like to thank all of our incredible supporters whose generous donations enable us to offer all our essential support services free of charge. As an organisation we do not receive any government or NHS funding and so every penny received is truly valued. From everyone at Lymphoma Action and on behalf of those affected by lymphoma, thank you. For further information visit: www.lymphoma-action.org.uk

Dipping into the archives (technology issues with new computer) to re-release the Foundations of OncoPharm episode on rituximab. Where did that 375 mg/m2 dose come from anyway?

Welcome to another episode of the Oncology Brothers podcast! In this episode, hosts Drs. Rahul and Rohit Gosain are joined by Dr. Pallawi Torka from Memorial Sloan Kettering Cancer Center to discuss the latest highlights from ASH 2024, focusing on key studies in lymphoma. In this episode, we dive into: •⁠  ⁠POLARIX Study: An update on the POLARIX trial, exploring the use of Polatuzumab in frontline diffuse large B-cell lymphoma (DLBCL) and its impact on progression-free survival (PFS). •⁠  ⁠inMIND Study: A look at the promising results of the inMIND study, which evaluates the combination of Tafasitamab with Lenalidomide and Rituximab in the second-line setting for follicular lymphoma. •⁠  ⁠Triangle Study: Insights into the evolving role of transplant in mantle cell lymphoma and the implications of BTK inhibitors in treatment. •⁠  ⁠ENRICH Study: Discussion on the potential of Ibrutinib combined with Rituximab in the first-line setting and its comparison to traditional chemoimmunotherapy. Join us as we unpack these practice-changing studies, discuss their implications for clinical practice, and share insights on managing side effects associated with new therapies. Follow us on social media: •⁠  ⁠X/Twitter: https://twitter.com/oncbrothers •⁠  ⁠Instagram: https://www.instagram.com/oncbrothers Don't forget to like, subscribe, and hit the notification bell for more updates on the latest in oncology research and practice! #OncologyBrothers #ASH2024 #Lymphoma #CancerResearch #Podcast

Join Dr. Anna Wolska and Dr. Jordan Roberts, a pediatric rheumatologist, as they explore the use of Rituximab in treating childhood-onset systemic lupus erythematosus (SLE). They discuss key factors for healthcare providers when prescribing Rituximab to children and adolescents, especially for severe cases like lupus nephritis and CNS involvement. Dr. Roberts presents recent research on Rituximab's safety, highlighting increased infection risks and the need for targeted prevention strategies. Tune in for expert insights on the latest advancements, challenges, and future directions in pediatric lupus treatment.   Read the paper published in LSM - https://doi.org/10.1136/lupus-2024-001210

In this episode, we discussed the top abstracts in lymphoma and CLL presented at the ASH 2024 annual meeting in San Diego with Dr. David A Russler-Germain from Washington University. Here are the key abstracts we discussed: 1. 3 RCTs in Mantle Cell Lymphoma: a) Update on TRIANGLE: https://ash.confex.com/ash/2024/webprogram/Paper200735.htmlb) ENRICT Trial (Continuous Ibrutinib-Rituximab vs CIT [R-CHOP or BR]): https://ash.confex.com/ash/2024/webprogram/Paper199710.htmlc) ECOG-ACRIN EA4151 Trial (Auto-HCT vs Rituximab maintenance alone in patients with undetectable MRD after induction): https://ash.confex.com/ash/2024/webprogram/Paper212973.html2. DLBCL: a) Update on POLARIX Trial: https://ash.confex.com/ash/2024/webprogram/Paper197938.htmlb) Predictive Value of Cell-of-Origin Subtype By Hans Algorithm in DLBCL Patients Receiving Polatuzumab Vedotin: https://ash.confex.com/ash/2024/webprogram/Paper202153.htmlc) COALITION trial: https://ash.confex.com/ash/2024/webprogram/Paper204930.html3. Follicular Lymphoma: a) Phase 3 inMIND trial (Tafasitamab + R2 vs Placebo + R2): https://ash.confex.com/ash/2024/webprogram/Paper212970.htmlb) Loncastuximab tesirine with rituximab in patients with R/R FL: https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(24)00345-4/abstract4. CLL: a) AMPLIFY Trial (Fixed-Duration Acalabrutinib Plus Venetoclax with or without Obinutuzumab Versus Chemoimmunotherapy in 1st line CLL): https://ash.confex.com/ash/2024/webprogram/Paper200701.html5. Hodgkin Lymphoma: a) Pembrolizumab Maintenance Instead of Auto-HCT for R/R HL: https://ash.confex.com/ash/2024/webprogram/Paper202537.html

(Actualidad Médica 28 - Parte 2) Recomendaciones 2021 para el manejo de vasculitis ANCA del colegio americano de reumatología y la vasculitis foundation PARTE 2Hoy completaremos la revisión de las recomendaciones de manejo 2021 para vasculitis ANCA del colegio americano de reumatología y la vasculitis foundation, nos queda por revisar la sección de Granulomatosis eosinofílica con vasculitis.ENLACE AL ARTÍCULO: ENLACE: https://bit.ly/actualidadmédica28Te invitamos a que participes en la sección de comentarios.¿Qué quieres escuchar? ¿Cuáles son tus temas de interés?Síguenos en www.reumatimes.com, donde podrás encontrar cubrimientos de congresos de reumatología y resúmenes de actualidad en la especialidad. Encuéntranos en YouTube como ReumaTimes Y Facebook como Reumatologia.Online o ReumaTimes, en Instagram como dr.sebastianherrera o ReumaTimes, y en X (antes Twitter) como @Reuma_Online_ o @ReumaTimes. Estamos también en TikTok como @Reuma_Times.Síguenos en www.reumatimes.comTambién puedes encontrarnos en: Twitter: https://twitter.com/Reuma_Online_ Facebook: https://www.facebook.com/reumatologiaonline/ Instagram: https://www.instagram.com/dr.sebastianherrera/ Spreaker: https://www.spreaker.com/user/11390404 Spotify: https://spoti.fi/3DILwLP

(Actualidad Médica 28 - Parte 1) Las vasculitis asociadas a ANCA incluyen la granulomatosis con poliangeitis, la poliangeitis microscópica y la granulomatosis eosinofílica con poliangeitis. Estas afectan vasos de pequeño y mediano tamaño y se caracterizan por compromiso de órganos multisistémico. Las estrategias de tratamiento actuales han mejorado de forma sustancial el pronóstico de estas enfermedades. Desafortunadamente, los tratamientos disponibles se pueden asociar a eventos adversos. Se hacen necesarias recomendaciones de manejo.ENLACE AL ARTÍCULO: ENLACE: https://bit.ly/actualidadmédica28Te invitamos a que participes en la sección de comentarios.¿Qué quieres escuchar? ¿Cuáles son tus temas de interés?Síguenos en www.reumatimes.com, donde podrás encontrar cubrimientos de congresos de reumatología y resúmenes de actualidad en la especialidad. Encuéntranos en YouTube como ReumaTimes Y Facebook como Reumatologia.Online o ReumaTimes, en Instagram como dr.sebastianherrera o ReumaTimes, y en X (antes Twitter) como @Reuma_Online_ o @ReumaTimes. Estamos también en TikTok como @Reuma_Times.Síguenos en www.reumatimes.comTambién puedes encontrarnos en: Twitter: https://twitter.com/Reuma_Online_ Facebook: https://www.facebook.com/reumatologiaonline/ Instagram: https://www.instagram.com/dr.sebastianherrera/ Spreaker: https://www.spreaker.com/user/11390404 Spotify: https://spoti.fi/3DILwLP

When should we choose rituximab over cyclophosphamide? What role can avacopan play as an adjunct therapy? When is plasma exchange a viable option? How can we effectively navigate steroid tapering? These are just a few of the critical questions we'll explore with our next guest, Dr. Tanaz Kermani, founder and director of the Vasculitis Program at UCLA, a dedicated clinician and active researcher. Join us as we delve into these topics and address the challenges of diagnosing and managing patients with vasculitis. 

In this episode, Jonathan is joined by John H. Stone, Professor of Medicine at Harvard Medical School and The Edward A. Fox Chair in Medicine at Massachusetts General Hospital.  Stone discusses his groundbreaking work in systemic vasculitis, including granulomatosis with polyangiitis and ANCA-associated vasculitis. He also shares insights into the emerging field of IgG4-related disease and the exciting possibility of the first approved therapy for this condition. Alongside, he delves into his efforts to minimise glucocorticoid toxicity and his work through the IgG4ward! Foundation.   Timestamps: (00:30) – Introduction (04:00) – Stone's journey into rheumatology (07:28) – WEGET trial (10:30) – Developments in IgG4-related disease and the path to therapy approval (15:52) – Key advancements in the treatment of granulomatosis with polyangiitis (18:04) – Glucocorticoid toxicity and the Glucocorticoid Toxicity Index (GTI) (20:34) – The IgG4ward! Foundation (23:48) – Two Pearls and a Myth (26:45) – Stone's three wishes for rheumatology

Erfahre mehr über B-Zell-Depletionen, wie Ocrevus, Kesimpta, Bonspri, Mabthera, Rituxan und Briumvi, für aktive RRMS & SPMS und frühe PPMS. Du kannst den vollständigen Beitrag auf meinem Blog nachlesen: https://ms-perspektive.de/274-b-zell-depletion B-Zell-Depletions-Therapien wie Ocrelizumab (Ocrevus), Ofatumumab (Kesimpta, Bonspri), Rituximab (Mabthera, Rituxan) und Ublituximab (Briumvi) sind zu wichtigen Instrumenten bei der Behandlung von Multipler Sklerose (MS) geworden. Diese Behandlungen zielen speziell auf B-Zellen ab, eine Art von Immunzellen, die am Entzündungsprozess von MS beteiligt sind, und reduzieren diese. B-Zell-Therapien gelten als einige der spezifischsten und wirksamsten verlaufsmodifizierenden Therapien, die heute verfügbar sind, und bieten einen maßgeschneiderten Ansatz zur Verringerung der Krankheitsaktivität und des Fortschreitens der MS. In diesem Beitrag geht es darum, wie diese Therapien innerhalb der MS-Behandlungsoptionen eingeordnet werden und was ihr Zulassungsstatus und ihre Wirksamkeit für verschiedene Patientengruppen bedeuten. Bitte beachte, dass ich hier nur einen Überblick geben kann. Deine Neurologin und MS-Schwester sollten dich ausführlich über die richtige Therapie für dich beraten. Sie kennen deinen allgemeinen Gesundheitszustand und du solltest auch über deine Ziele, Wünsche, Ängste und Vorlieben sprechen, damit diese berücksichtigt werden können. Inhaltsverzeichnis Allgemeine Informationen Wie werden B-Zell-Depletionen - Ocrelizumab (Ocrevus), Ofatumumab (Kesimpta, Bonspri), Rituximab (Mabthera, Rituxan), Ublituximab (Briumvi) in den Immuntherapien eingeordnet? Wofür sind B-Zell-Depletionen - Ocrelizumab (Ocrevus), Ofatumumab (Kesimpta, Bonspri), Rituximab (Mabthera, Rituxan), Ublituximab (Briumvi) zugelassen? Wie sieht die Situation für spezielle Patientengruppen aus? Wer sollte Ocrelizumab (Ocrevus), Ofatumumab (Kesimpta, Bonspri), Rituximab (Mabthera, Rituxan), Ublituximab (Briumvi) vermeiden? Wie wirken Ocrelizumab (Ocrevus), Ofatumumab (Kesimpta, Bonspri), Rituximab (Mabthera, Rituxan) und Ublituximab (Briumvi)? Wie wird es eingenommen? Wie wirksam sind Ocrelizumab (Ocrevus), Ofatumumab (Kesimpta, Bonspri), Rituximab (Mabthera, Rituxan), Ublituximab (Briumvi)? Risiken und Nebenwirkungen von Ocrelizumab (Ocrevus), Ofatumumab (Kesimpta, Bonspri), Rituximab (Mabthera, Rituxan), Ublituximab (Briumvi) Impfungen Quellen Schlussbemerkung Quellen Für die Erstellung des Inhalts habe ich folgende Quellen verwendet: Vorlesung über pädiatrische Multiple Sklerose von Prof. Dr. Jutta Gärtner im Rahmen des Masterstudiengangs Multiple-Sklerose-Management Vorlesung über B-Zell-depletierende Therapien von Prof. Dr. Xavier Montalban im Rahmen des Masterstudiengangs Multiple-Sklerose-Management Qualitätshandbuch der KKNMS zu Ocrelizumab (Ocrevus), Ofatumumab (Kesimpta, Bonspri), Ublituximab (Briumvi) MS-Selfie-Infokarten von Prof. Dr. Gavin Giovannoni Deutschsprachiges Multiple Sklerose und Kinderwunschregister (DMSKW) Deutsche DECIMS-Informationen zu Ocrelizumab --- Vielleicht möchtest du auch einen Blick auf die Beiträge zu den anderen Immuntherapien werfen: #256: Dimethylfumarat (Tecfidera) und Diroximelfumarat (Vumerity) #258: Glatirameracetat (Copaxone, Brabio) #261: Interferon-beta (Avonex, Betaferon, Extavia, Plegridy, Rebif) #264: Teriflunomid (Aubagio) #266: Natalizumab (Tysabri, Tyruko)  #268: S1P-Modulatoren – Fingolimod (Gilenya), Ozanimod (Zeposia), Ponesimod (Ponvory), Siponimod (Mayzent) #270: Alemtuzumab (Lemtrada, Campath) bei hochaktiver Multipler Sklerose #272: Cladribin (Mavenclad, Leustatin, Litak) bei hochaktiver MS Bis bald und mach das Beste aus Deinem Leben, Nele Mehr Informationen und positive Gedanken erhältst Du in meinem kostenlosen Newsletter. Hier findest Du eine Übersicht zu allen bisherigen Podcastfolgen.

In this week's episode we'll discuss the safety and efficacy of pirtobrutinib with or without rituximab in relapsed/refractory CLL; learn more about erythroid 5ALA synthesis disorders and their conditional synthetic lethal dependency on pyridoxine; and discuss how targeting PKC alpha alleviates iron overload in diabetes and hemochromatosis through the inhibition of ferroportin.Featured Articles:Fixed-duration pirtobrutinib plus venetoclax with or without rituximab in relapsed/refractory CLL: Phase 1b BRUIN trialMurine models of erythroid 5ALA synthesis disorders and their conditional synthetic lethal dependency on pyridoxineTargeting PKCα alleviates iron overload in diabetes and hemochromatosis through the inhibition of ferroportin

In this podcast episode, Farrukh Awan, MD, Jeremy S. Abramson, MD, MMSc, and Shuo Ma, MD, PhD, discuss real-world patient cases and how to align current clinical practice with the NCCN guidelines for CLL/SLL, including:Prognostic variables when deciding between regimensRole of MRD in CLLResults from the phase II CAPTIVATE trialChoosing among the available covalent BTK inhibitorsPreferred partner anti-CD20 antibody in CLL/SLLRole of the noncovalent BTK inhibitor, pirtobrutinib, in CLL/SLLUse of CAR T-cell therapy in CLL/SLLPresenters:Farrukh Awan, MDProfessor of Internal MedicineDirector of Lymphoid Malignancies ProgramHarold C. Simmons Comprehensive Cancer CenterUniversity of Texas Southwestern Medical CenterDallas, TexasJeremy S. Abramson, MD, MMScDirector, Center for LymphomaMassachusetts General HospitalAssociate Professor of MedicineHarvard Medical SchoolBoston, MassachusettsShuo Ma, MD, PhDProfessor of MedicineDivision of Hematology-OncologyDepartment of MedicineRobert H. Lurie Comprehensive Cancer CenterNorthwestern University Feinberg School of MedicineChicago, IllinoisContent based on an online CME program supported by educational grants from BeiGene; Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC; and Lilly, and an independent medical education grant from AbbVie.Link to full program:https://bit.ly/3LzA2As

In this episode, Danielle M. Brander, MD; Deborah Stephens, DO; and Brian Hill, MD, PhD, discuss key aspects of the NCCN CLL guidelines and share strategies for applying these recommendations in your clinical practice to optimize treatment and outcomes. The greater discussion addresses:Optimal selection of therapy for treatment-naive CLL, including second-generation covalent BTK inhibitorsConsiderations in therapy selection for previously treated CLLNovel strategies for treating CLL Presenters:Danielle M. Brander, MDAssistant Professor of MedicineDivision of Hematologic Malignancies and Cellular TherapyDuke Cancer InstituteDurham, North CarolinaBrian Hill, MD, PhDDirector, Lymphoid Malignancies ProgramStaff Physician, Department of Hematology and Medical OncologyTaussig Cancer InstituteCleveland ClinicCleveland, OhioDeborah Stephens, DOAssociate ProfessorDirector of the CLL ProgramLineberger Comprehensive Cancer CenterUniversity of North CarolinaChapel Hill, North CarolinaContent based on a live and online CME program supported by educational grants from AstraZeneca; BeiGene, Ltd.; and Lilly.Link to full program including downloadable slides: https://bit.ly/49YxtSq

This “MOGcast” edition of the “Ask the Expert” podcast series is a collaborative episode titled, “MOGcast 2: Understanding Cortical Encephalitis.” Dr. Eoin Flanagan and Dr. Cristina Valencia Sanchez joined Julia Lefelar of The MOG Project and Dr. GG deFiebre of SRNA to discuss cortical encephalitis, its symptoms, and the connection to MOG antibody disease (MOGAD) [00:04:21]. Audience members asked about the distinction between ADEM and cerebral cortical encephalitis, their treatments, diagnostic methods, and long-term impacts [00:35:34]. Dr. Flanagan and Dr. Sanchez agreed that the preventive treatment approach remains similar regardless of the MOGAD phenotype [00:40:36]. The discussion touched on recent studies on the diagnostic utility of MOG antibody testing in cerebrospinal fluid, and ongoing research on treatments, including clinical trials for developing FDA-approved medications for MOGAD [00:43:05]. Dr. Flanagan and Dr. Sanchez addressed community questions on fulminant cortical involvement cases [00:50:00], the long-term effects of Rituximab treatment [00:51:23], anxiety attacks and mood swings in ADEM [00:53:34], and treatment decisions based on antibody levels [00:54:49]. Eoin Flanagan, MB, BCh is a Professor of Neurology and Consultant in the departments of Neurology and Laboratory Medicine and Pathology at the Mayo Clinic (Rochester, MN). He completed his medical school training at University College Dublin in Ireland in 2005. He did a medical residency in Ireland and then completed neurology residency, fellowships in neuroimmunology and a masters in clinical and translational science at Mayo Clinic (Rochester, MN). He works in the Autoimmune Neurology and Multiple Sclerosis Clinics and the Neuroimmunology Laboratory at the Mayo Clinic. His clinical expertise and research are focused on inflammatory myelopathies and their imaging patterns, myelin oligodendrocyte glycoprotein (MOG) antibody associated disorder, neuromyelitis optica spectrum disorders, autoimmune encephalitis, paraneoplastic neurologic disorders, and multiple sclerosis. He is principal investigator on an NIH RO1 grant studying MOG antibody associated disorder. Cristina Valencia Sanchez, MD, PhD is an Assistant Professor of Neurology and Senior Associate Consultant in the Department of Neurology at the Mayo Clinic (Phoenix, AZ). She completed her medical school training and PhD in Neuroscience at the Universidad Complutense de Madrid. She did a Neurology residency in the Hospital Universitario Clinico San Carlos and then completed Neurology residency and fellowships in ARZ Multiple Sclerosis and RST Autoimmune Neurology at the Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, in Arizona and Minnesota. The research interests of Dr. Valencia Sanchez focus on autoimmune disorders involving the central nervous system. These include neuromyelitis optica spectrum disorders, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), autoimmune encephalitis, and paraneoplastic neurological syndromes. She is particularly interested in the neurological complications of immune checkpoint inhibitor cancer immunotherapy. The clinical trials that she leads at Mayo Clinic in Arizona are among the first studies that may lead to approval of new targeted therapies for MOGAD and autoimmune encephalitis. Additionally, Dr. Valencia Sanchez's clinical research allows for increased recognition of autoimmune neurological disorders. Also, her work is helping to avoid misdiagnosing autoimmune encephalitis in the clinical setting. Her research leads to earlier diagnosis and appropriate treatment to ultimately improve patient outcomes.

Traemos la ReumaGuardia con el cubrimiento de las publicaciones más relevantes de la reumatología en marzo de 2024.Te invitamos a que participes en la sección de comentarios. ¿Qué quieres escuchar? ¿Cuáles son tus temas de interés? Síguenos en www.reumatimes.com, donde podrás encontrar cubrimientos de congresos de reumatología y resúmenes de actualidad en la especialidad. Encuéntranos en YouTube Y Facebook como Reumatologia.Online o ReumaTimes, en Instagram como dr.sebastianherrera o ReumaTimes, y en X (antes Twitter) como @Reuma_Online_ o @ReumaTimes. Estamos también en tiktok como @Reuma_Times.   Los esperamos con información concisa y de utilidad en un próximo podcast

Dr. Shuvro Roy and Dr. Annette Langer-Gould discuss the effective dose of rituximab and other B-cell depleting therapies in patients with multiple sclerosis, as well as important comorbidities to prevent infection risks. Show reference: https://www.neurology.org/doi/10.1212/NXI.0000000000200211 

Dr. Shuvro Roy talks with Dr. Annette Langer-Gould about the effective dose of rituximab and other B-cell depleting therapies in patients with multiple sclerosis, as well as important comorbidities to prevent infection risks. Read the related article in Neurology: Neuroimmunology and Neuroinflammation.  Disclosures can be found at Neurology.org.

Jo Cheah chats with clinical pharmacologist Richard Day about off-label prescribing. Ric explains why off-label prescribing occurs, the barriers to getting new indications added to a drug's approved label, and the potential risks of off-label prescribing without sufficient evidence. Read the full article by Richard Day in Australian Prescriber.

In a paradigm-shifting discovery, researchers uncovered that B cells, not T cells, wield significant influence on orchestrating neurological damage in MS. Join UCSF Professor Dr. Stephen Hauser as he shares the remarkable odyssey from hurdles to triumphs of developing B cell monoclonal antibody treatment for multiple sclerosis.  Disease impact, safety concerns and personalization of MS treatment of these medications including Ocrevus (ocrelizumab), Kesimpta (ofatumumab) and Briumvi (ublituximab) are highlighted.  Brain-penetrant BTK inhibitor therapies that may offer more direct targeting of B cells within the central nervous system, potentially unlocking new possibilities in treating progressive forms of MS. Professor Heinz Wiendl explores the connection between Epstein-Barr virus infection of B cells and the initiation and progression of MS including trials investigating strategies to target EBV-infected B cells. Pioneering approaches like CAR-T therapy and brain shuttle techniques provide optimism for the next generation of MS treatment. Barry Singer MD, Director of The MS Center for Innovations in Care, interviews:  Stephen Hauser MD, Professor of Neurology at the University of California, San Francisco (UCSF) and Director of the UCSF Weill Institute for Neurosciences Heinz Wiendl MD, Professor of Neurology and Chair of the Department of Neurology at the University Hospital of Muenster in Germany

In this episode, we review the hottest updates in lymphoma from the American Society of Hematology 2023 meeting with Dr Toby Eyre, a consultant haematologist at the University of Oxford in the UK. Here are the abstracts that were discussed: Mantle Cell Lymphoma 1. BOVen trial-A Multicenter Phase 2 Trial of Zanubrutinib, Obinutuzumab, and Venetoclax in Patients with Treatment-Naïve, TP53-Mutant Mantle Cell Lymphoma https://ash.confex.com/ash/2023/webprogram/Paper180069.html 2. SYMPATICO Trial: Ibrutinib Combined with Venetoclax in Patients with Relapsed/Refractory Mantle Cell Lymphoma (Late Breaking Abstract)  https://ash.confex.com/ash/2023/webprogram/Paper191921.html Chronic Lymphocytic Leukemia 1. FLAIR trial: Chronic Lymphocytic Leukemia Therapy Guided by Measurable Residual Disease Link for simultaneous NEJM publication: https://www.nejm.org/doi/10.1056/NEJMoa2310063 2. Ibrutinib retreatment in Phase 2 CAPTIVATE study: https://ash.confex.com/ash/2023/webprogram/Paper187128.html Hodgkin Lymphoma 1. S1826 outcomes in older adults:  https://ash.confex.com/ash/2023/webprogram/Paper180114.html Diffuse Large B-cell Lymphoma 1. Smart STOP study: Lenalidomide, Tafasitamab, Rituximab, and Acalabrutinib Alone and with Combination Chemotherapy for the Treatment of Newly Diagnosed Diffuse Large B-Cell Lymphoma https://ash.confex.com/ash/2023/webprogram/Paper180381.html 2. Mosunetuzumab and Polatuzumab Vedotin Demonstrates Preliminary Efficacy in Elderly Unfit/Frail Patients with Previously Untreated Diffuse Large B-Cell Lymphoma https://ash.confex.com/ash/2023/webprogram/Paper177588.html

The Filtrate:Joel TopfSwapnil HiremathSophia AmbrusoAC GomezJosh WaitzmanJennie LinNayan AroraThe CurbsidersMatt F. Watto (@DoctorWatto)Paul Nelson Williams, America's primary care physician (@PaulNWilliamz)With Special Guest:JD Foster (@KidneyVet)Sayed Tabatabai (@TheRealDoctorT) Nephrologist in Austin and the author of These Vital SignsMichelle Rheault (@rheault_m) Chief of Pediatric Nephrology at the University of Minnesota and lead author of the DUPLEX TrialEditor:Joel TopfShow Notes:Lily toxicity in the cat (PubMed)Surgeons perform kidney transplants in cats amid rising demand for advanced pet care (ABC News)Treatment of ibuprofen toxicity with serial charcoal hemoperfusion and hemodialysis in a dog (PubMed)Nephrology in Veterinary Medicine (Kidney 360)Star Wars Society of San Antonio (FaceBook)These Vital Signs (Amazon)Dr Tabatabai read a short story called The Handholder, here is the original tweet thread for that story (ThreadReader)The pearl not the patient (PubMed)Late Braking and High Impact Clinical Trial press releaseMENTOR, Rituximab or Cyclosporine in the Treatment of Membranous Nephropathy, was in 2019 not 2017 (NEJM)KALM-1, A Phase 3 Trial of Difelikefalin in Hemodialysis Patients with Pruritus, was in 2019 not 2017 (NEJM)Sophie's number one pick: Efficacy and safety of sparsentan versus irbesartan in patients with IgA nephropathy (PROTECT): 2-year results from a randomised, active-controlled, phase 3 trial (Lancet)Patients in the sparsentan group had a slower rate of eGFR decline than those in the irbesartan group. eGFR chronic 2-year slope (weeks 6–110) was −2·7 mL/min per 1·73 m2 per year versus −3·8 mL/min per 1·73 m2 per year (difference 1·1 mL/min per 1·73 m2per year, 95% CI 0·1 to 2·1; p=0·037); total 2-year slope (day 1–week 110) was −2·9 mL/min per 1·73 m2 per year versus −3·9 mL/min per 1·73 m2 per year (difference 1·0 mL/min per 1·73 m2 per year, 95% CI −0·03 to 1·94; p=0·058).Clinical Trial Considerations in Developing Treatments for Early Stages of Common, Chronic Kidney Diseases: A Scientific Workshop Cosponsored by the National Kidney Foundation and the US Food and Drug Administration (AJKD)AC Gomez's Pick: MDR-101-MLK Update: Operational Immune Tolerance Achieved in Living Related HLA-Matched Kidney Transplant Recipients (ASN-Online.org) Josh's Pick: A Phase 2 Trial of Sibeprenlimab in Patients with IgA Nephropathy (NEJM)Nayan's Pick: The EnAKT LKD Cluster Randomized Clinical Trial (JAMA Internal Medicine) The Freely Filtered simultaneous release (NephJC)Freely Filtered is now a verb. Swap's Pick: Strategies for the Management of Atrial Fibrillation in PatiEnts Receiving Dialysis (SAFE-D) (ASN-Online.org)Joel's Pick: AYAME Study: Randomized, Double-Blind, Placebo-Controlled Phase 3 Study of Bardoxolone Methyl in Diabetic Kidney Disease (DKD) Patients (ASN-Online.org)Reata is a no-show to the 2012 ASN Kidney Week (PBFluids)Michelle's Pick: Sparsentan versus Irbesartan in Focal Segmental Glomerulosclerosis. The DUPLEX Study (NEJM)DUET: A Phase 2 Study Evaluating the Efficacy and Safety of Sparsentan in Patients with FSGS (PubMed)

In this week's episode, we discuss the findings from a phase 2 study of lenalinomide plus rituximab in elderly frail patients with DLBCL, learn more about platelet GP6-mediated neutrophil recruitment in early stages of acute lung injury, and discuss a newly identified isoform of the tyrosine kinase AXL, termed AXL3, in mantle cell lymphoma.

Rituximab is an intravenous product that reduces B lymphocytes. It can help improve strength in patients with myasthenia gravis and multi-focal motor neuropathy, neuromuscular diseases that are caused by circulating antibodies made by B lymphocytes. In this podcast we examine the possible use of rituximab to treat patients with ALS

Dr. Rae Bacharach discusses the paper, "Rituximab vs Ocrelizumab in Relapsing-Remitting Multiple Sclerosis". Show references: https://jamanetwork.com/journals/jamaneurology/article-abstract/2806000

El Dr. Miguel Mesa nos trae la ReumaGuardia con el cubrimiento de las publicaciones más relevantes de la reumatología en junio de 2023.

If you've been diagnosed with any form of ANCA Vasculitis someone has probably talked to you about Rituximab/Rituxin. Today I talk about my process in the first year of being sick and getting three rounds of Rituximab as well as the consequences of being on high doses of prednisone.   Please don't forget to click that subscibe button whereever you listen to the podcast and do me a HUGE favor and leave a review! These two things help others find the podcast, find our community, and feel a little less alone in their journey through life with chronic illness!   Join us on Instagram: https://www.instagram.com/teamvasculitis Join the Email List: https://teamvasculitis.com/team-vasculitis-email

This presentation discusses key findings in immunotherapies from the investigator's laboratory as well as those that have shaped the landscape of both human and canine cancers. The information focuses on EGFR and HER2 based immunotherapies, including osteosarcoma, hemangiosarcoma and other cancer types in canine patients. Mechanisms of tumor growth and therapy will also be topics of discussions. --- UCLA (B.A.), Univ Notre Dame (M.S.), University of Oklahoma Health Sciences Center (Ph.D.), Yale University School of Medicine (Professor of Medicine). Dr. Mamula's interests are in investigating the early events of inflammatory mediated changes in the proteome that intersect with cellular metabolism and with breaking immune tolerance to self proteins. These studies have been applied to the development of novel immune-therapeutic approaches in for antitumor vaccines in EGFR/HER2 expressing cancers, including breast cancer and colon cancer. In particular, the work has evolved to clinical trials in companion canine populations. Overall, it is the goal of Dr. Mamula's laboratory to understand the mechanisms that may shift the balance of the cellular proteome toward the initiation of anti-self immune responses. In addition, seminal work from the Mamula lab elucidated the proteomics and biochemical forms of autoantigens capable of breaking immunologic tolerance to intracellular autoantigens in type I diabetes (T1D) and in systemic lupus erythematosus (SLE). Simply put, Dr. Mamula examines post translational protein modifications that alter cellular biology and immunity. Recent studies have identified early protein modifications of pancreatic beta cells that are sentinels of early disease and dysfunction of glucose metabolism and insulin release (Nature Comm. 2022). Finally, studies from the Mamula laboratory first demonstrated the ability of B lymphocytes to present autoantigens in the triggering of T cell autoimmunity and in the phenomenon of epitope spreading in lupus autoimmunity, work that contributed to the rationale of B cell mediated therapeutics (Rituximab and Belumimab) in SLE. Dr. Mamula has 113 publications and has mentored over 30 pre-and postdoctoral students and investigators, many of whom have acquired faculty positions as independent investigators at major medical schools, universities, and pharmaceutical industries. --- What We Do at MIB Agents: PROGRAMS: End-of-Life MISSIONS Gamer Agents Agent Writers Prayer Agents Healing Hearts - Bereaved Parent and Sibling Support Ambassador Agents - Peer Support Warrior Mail Young Adult Survivorship Support Group EDUCATION for physicians, researchers and families: OsteoBites, weekly webinar & podcast with thought leaders and innovators in Osteosarcoma MIB Book: Osteosarcoma: From our Families to Yours RESEARCH: Annual MIB FACTOR Research Conference Funding multiple $100,000 and $50,000 grants annually for OS research MIB Testing & Research Directory The Osteosarcoma Project partner with Broad Institute of MIT and Harvard ... Kids are still dying with 40+ year old treatments. Help us MakeItBetter. https://www.mibagents.org​ Help support MIB Agents, Donate here https://give-usa.keela.co/embed/YAipuSaWxHPJP7RCJ SUBSCRIBE for all the Osteosarcoma Intel

On this episode, Jonathan is joined by Noel Morgan, Professor of Endocrine Pharmacology, University of Exeter, UK. The pair discuss Morgan's extensive research in diabetes, including his research on islet biology and signalling mechanisms regulating pro-inflammatory and anti-inflammatory processes in β-cells in Type 1 diabetes. They further discuss areas of research that excite and frustrate him, how we can change beliefs and behaviours associated with diabetes, and the future of diabetes research.   Use the following timestamps to navigate the topics discussed in this episode:   (00:00)-Introduction (02:00)-Morgan's origin story (03:30)-Experiences from Nashville, USA (06:00)-Islet biology (08:00)-Insulin secretion control (12:25)-Aetiology and differences between Type 1 and Type 2 diabetes (15:10)-The largest collection of rare pancreas samples in the world (17:50)-Different ‘types' of Type 1 diabetes (20:15)-Pro-insulin (22:35)-To B or not to B? (24:35)-Rituximab (26:00)-Dorothy Hodgkin Lecture (28:00)-The global obesity epidemic and changing behaviour (31:45)-The war on obesity (33:40)-A longer, unhealthy life? (34:45)-Exciting topics and immunotherapy (36:50)-Three wishes

In this episode, we discuss the management of newly diagnosed DLBCL with Dr. Pallawi Torka. We also have a few bonus ASH22 updates on DLBCL. Links to articles and abstracts discussed in the episode are as follows: 1. A comprehensive review article on DLBCL:https://pubmed.ncbi.nlm.nih.gov/33657296/ 2. RCT testing CHOP vs Three Intensive Regimens in DLBCL:https://www.nejm.org/doi/full/10.1056/nejm199304083281404  3. RCT testing R-CHOP vs CHOP in DLBCL in older adults:https://www.nejm.org/doi/full/10.1056/nejmoa011795  4. RCT testing R-CHOP vs CHOP in young (MINT):https://pubmed.ncbi.nlm.nih.gov/21940214/  5. PHOENIX trial: R-CHOP +/- Ibrutinib:https://pubmed.ncbi.nlm.nih.gov/30901302/ 6. R-CHOP +/- Lenalidomide (ECOG-ACRIN E1412):https://pubmed.ncbi.nlm.nih.gov/33555941/  7. R-CHOP vs Pola-R-CHP (POLARIX Trial):https://www.nejm.org/doi/full/10.1056/NEJMoa2115304 8. Comparison of 3 IPI scores in DLBCL:https://ashpublications.org/blood/article/135/23/2041/452696 9. RCT testing R-CHOP vs Dose-Adjusted R-EPOCH (CALGB 50303):https://ascopubs.org/doi/full/10.1200/JCO.18.01994 10. Timing of CNS Prophylaxis in DLBCL:https://pubmed.ncbi.nlm.nih.gov/34995350/ 11. RCT testing R-CHOP vs R-CHOP + Bortezomib (REMoDL-B):https://pubmed.ncbi.nlm.nih.gov/30948276/ 12. Interim PET in DLBCL? https://ashpublications.org/bloodadvances/article/5/9/2375/475850 13. RCTs in Limited Stage DLBCL: CHOP x 8 vs CHOP x 3 + XRT (S8736):https://ascopubs.org/doi/10.1200/JCO.2015.65.4582 CHOP x 4 + Rituximab x 6 vs R-CHOP x 6 (FLYER):https://pubmed.ncbi.nlm.nih.gov/31868632/ PET-adapted therapy with R-CHOP (S1001):https://pubmed.ncbi.nlm.nih.gov/32658627/ 14.   ASH 2022 updates:REMoDL-B update: https://ashpublications.org/blood/article/140/Supplement%201/1770/493225 Glofitamab update: https://ashpublications.org/blood/article/140/Supplement%201/1062/491024 Epcoritamab update: https://ashpublications.org/blood/article/140/Supplement%201/9443/488543

Join us for this episode where the co-hosts, Tiffany and Leila, share their personal journeys of being diagnosed with AiArthritis diseases. Tune in to hear how their journey of being diagnosed and misdiagnosed and the lessons they learned throughout the process.    We also delve into the exciting new resource tool developed by AiArthritis, which helps patients navigate the process of seeking a diagnosis, understanding symptoms, and asking the right questions of their doctors. Plus, we invite other patients to share their stories and provide insights for those just starting their Auto + inflammatory arthritis journey. Join us for an informative and uplifting conversation on Auto + inflammatory arthritis diseases.    If you would like to share your story, insights or recommendations to help improve our new tool, please fill out the Google form on www.aiarthritis.org/diseases Episode Highlights:  Leila and Tiffany share their different stories of being diagnosed with their diseases  Importance of resources for auto + arthritis diseases for patients to compare their symptoms to and hear other patients stories How to best be supported on the journey of discovering what your disease may be when you show first signs of symptoms  What questions are recommended to ask your doctor when searching for a diagnosis List of different symptoms you may experience with auto or arthritis diseases Best advice for patients seeking AiArthritis diagnosis  Links Mentioned:    Come share your stories for the new AiArthritis Ebook : The Good, The Bad & The Ugly : AiArthritis.org/gbu   Tiffany is the CEO at International Foundation for AiArthritis and uses her professional expertise in mind-mapping and problem solving to help others, like her, who live with AiArthritis diseases work in unison to identify and solve unresolved community issues.   Connect with Tiffany: Facebook: @TiffanyAiArthritis Twitter: @TiffWRobertson LinkedIn: @TiffanyWestrichRobertson   Leila is the Health Education and Engagement Manager at AiArthritis. She manages the AiArthritis Voices Program. At 8 years old, she was diagnosed with immune thrombocytopenia (low platelet count). She spent a lot of time in the hospital trying different infusions and therapies; including prednisone - yuck! Rituximab ended up being the biologic that saved her life. From that experience, she knew that she wanted to be able to help people just like all the healthcare workers at UCSF helped her through that difficult time   Connect with Leila:     Instagram: @lupuslifestyle.lei      LinkedIn: www.linkedin.com/in/leila-lagandaon       Facebook: @leilaaiarthritis      YouTube: LupusLifestyle.Lei      TikTok: @lupuslifestyle.lei     Donate to Support the Show: https://www.aiarthritis.org/donate    Sign up for our Monthly AiArthritis Voices 360 Talk Show newsletter! HERE   AiArthritis Voices 360 is produced by the International Foundation for Autoimmune and Autoinflammatory Arthritis. Visit us on the web at www.aiarthritis.org/talkshow. Find us on Twitter, Instagram, TikTok, or Facebook (@IFAiArthritis) or email us (podcast@aiarthritis.org).  Be sure to check out our top-rated show on Feedspot! 

Diffuse Large B-Cell Lymphoma or DLBCL is the most common type of lymphoma. Much progress has been made in treatment of the disease lately, particularly with emergence of CAR T-cell therapy, but not all patients are benefiting from it. This episode of Cancer Topics features Drs. Loretta Nastoupil and Chijioke Nze exploring treatment approaches for two cases of refractory DLBCL: a 60-year-old man with no comorbidities (1:30) and a 39-year-old woman with HIV (18:35). The guests also discuss improving patient access to CAR T-cell therapy and managing its toxicities (10:35), as well as emerging therapies for DLBCL (14:30). To learn more about management of refractory DLBCL, check out the ASCO course linked bellow. Guest Disclosures:Loretta Nastoupil, MD: Honoraria – Gilead Sciences, Novartis, Bayer, Janssen Oncology, TG Therapeutics, Bristol-Myers Squibb, ADC Therapeuitcs, Morphosys, Epizyme, Genmab, Takeda, Genentech/Roche; Research Funding – Janssen Biotech, Celgene, Genentech/Roche, Epizyme, Novartis, IgM Biosciences, Caribou Biosciences, Gilead Sciences, Allogene Therapeutics, Takeda Chijioke Nze, MD, MPH: No Relationships to Disclose Resources: ASCO Course: Second-line Therapy for Relapsed/Refractory Diffuse Large B-cell Lymphoma (Free to Full and Allied ASCO Members) ASCO Podcast: Cancer Topics - New Therapies for Lymphoma (Part 1) ASCO Guideline: Management of Immune-Related Adverse Events in Patients Treated With Chimeric Antigen Receptor (CAR) T-Cell Therapy ASCO Article: Navigating the Evolving Treatment Landscape of Diffuse Large B-Cell Lymphoma If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org.  TRANSCRIPT The disclosures for guests on this podcast can be found in the show notes. Dr. Loretta Nastoupil: So, I do have optimism that as we have more and more treatment options entering into the treatment landscape, we'll have fewer patients that are experiencing a refractory disease, and potentially succumbing to the lymphoma. Hello, my name is Dr. Loretta Nastoupil, I'm an Associate Professor and Deputy Chair of the Department of Lymphoma and Myeloma, at the University of Texas MD Anderson Cancer Center. Welcome to this ASCO Education podcast episode. It's my pleasure to welcome Dr. Chijioke Nze. Dr. Chijioke Nze: Hello, everyone. I'm Dr. Chijioke Nze, a Hematology/Oncology fellow at MD Anderson, I'll be co-hosting this episode with Dr. Nastoupil. Dr. Loretta Nastoupil: We've seen notable advances in diffuse large B-cell lymphoma research lately, with novel treatments including CAR T-cell therapy, offering the prospect of long-term remission for some patients, yet many patients are not even receiving second-line or later therapy, and even fewer are treated beyond the second line. How do you approach a patient with refractory diffuse large B-cell lymphoma? In today's episode, we'll explore strategies for management of refractory diffuse large B-cell lymphoma through two patient cases. So, Dr. Nze, walk us through our first case. Dr. Chijioke Nze: Our first case is Frank. Frank is 60 years old and has no comorbidities. He presented with severe back pain in September 2021, and was evaluated locally. He had a CT scan that showed retroperitoneal mass, prompting further evaluation. He had a biopsy of the left retroperitoneal mass in November 2021, which was consistent with diffuse large B-cell, germinal center B-cell of phenotype Ki-67 of 90%. He had a subsequent PET-CT scan, which showed a large conglomerate, and invasive left retroperitoneal hypermetabolic mass with satellite nodularity and contiguous bulky retroperitoneal adenopathy. He had bulky, FDG-avid metastatic retrocrural and intrathoracic adenopathy as well. He was treated with R-CHOP for six cycles, and at the end, achieved complete remission. He had a PET-CT a year later that showed new and worsening intensely FDG-avid abdominal adenopathy. This was new from a PET scan he'd had in January 2022 of the same year. He had a biopsy of this retroperitoneal adenopathy, which was consistent with relapsed diffuse large B-cell germinal center phenotype, also Ki-67 of 90%. Locally, he was treated with ICE, times five cycles, and had a follow-up CT scan at the end, which showed persistent bulky nodal disease with periaortic regional nodes with double 5, consistent with persistent disease. He also was found to have new and more conspicuous nodes in other areas as well. He presented for his first visit at MD Anderson in September 2022. Dr. Nastoupil, when you see a patient like this coming into your clinic, what's your typical approach? Dr. Loretta Nastoupil: For a diffuse large B-cell lymphoma, we are always hoping for cure with frontline rituximab, containing anthracycline-based chemotherapy. And so, it's always a gross disappointment when patients experience relapse. The timing of that relapse right now informs our current approach. And the reason I mention that, is because there have been three large randomized studies conducted and reported out just in the last year demonstrating that CAR T-cell therapy is the preferred option for patients who experience either primary refractory disease, or relapse within 12 months. And that is because they resulted in better outcomes than standard salvage-based chemotherapy and high-dose therapy autotransplant in the setting of chemosensitive disease. I have to acknowledge, of the three studies that were done, two were positive trials, so that's why currently, we have axi-cel or Axicabtagene ciloleucel, or Lisocabtagene maraleucel, and not tisa-cel or Tisagenlecleucel, as CAR T-cell therapy options. And again, that's because two of the three studies were positive trials. Now, the challenge is why would we have two positive studies in one negative trial? There are a lot of caveats to how those studies were conducted, but I think one of the biggest important lessons to be gained is that if you're going to consider CAR T for these high-risk patients, you want to do it as soon as possible, because that delay from identifying CAR T as a preferred option to actually infusing cells in a disease-- in a case particularly like this, where patients may have bulky, aggressively-behaving disease - that prolonged time may actually have an impact on outcomes. Dr. Chijioke Nze: Excellent. Thank you. So, you've mentioned he had an early relapse. How would you define early relapse in this patient population? Dr. Loretta Nastoupil: Thinking back to how we've been approaching diffuse large B-cell lymphoma over the last two decades, the PARMA study, which was done prior to Rituximab, suggested that for patients who had chemosensitive disease to a platinum-based salvage chemotherapy, which generally, was at least a partial response on CT, if they went on to high-dose therapy autologous stem cell transplant, 50-60% of those patients could anticipate cure. Whereas for the folks who continued on salvage chemotherapy, 10-20% of those patients had favorable outcome. So, we generally do try salvage-based chemotherapy, and for patients with chemosensitive disease, go on to high-dose therapy autotransplant. However, in the modern era where we've approached patients who've had rituximab as part of their frontline therapy, at least two studies - the ORCHARD study, and the CORAL study suggested that only 20% of patients who relapse in the post-rituximab era, particularly within 12 months, were successfully salvaged with platinum-based chemotherapy and high-dose therapy autologous stem cell transplant. Now, fortunately for patients who fail salvage, we have had CAR T-cell therapy as an option based off of three pivotal phase II studies, demonstrating about 40% of patients could anticipate a cure with CAR T-cell therapy. So, it only made sense to try and move that therapy up into second line, and the preferred population was those that had progressed within 12 months of frontline rituximab and anthracycline-based chemo. Now, to qualify for those studies, patients had to be considered fit for the control arm, which was salvage and auto transplant. Nonetheless, I do think for a patient like this, who's 60, without any other significant comorbidities, whose biggest challenge to longevity of life is his aggressive lymphoma, CAR T-cell therapy should be considered as soon as possible for this patient. Dr. Chijioke Nze: Is there still a role for high-dose therapy and autologous transplant in the new era, given the efficacy shown with CAR T-cell therapy? Dr. Loretta Nastoupil: I think there is. And the reason why I say that is, the trials that were done really did focus on the highest-risk patients, which were those with primary refractory disease or those who progress within 12 months of frontline. Now, there are patients that will have later relapse. And so, I do think for those patients, particularly those who are young and otherwise fit, should be approached first with a platinum-based salvage chemotherapy, in the setting of chemosensitive disease, proceed onto high-dose therapy and autologous stem cell transplant. Now, what do we do for those patients who have a late relapse but are otherwise older, or who have comorbidities that would make them suboptimal candidates for the high-dose therapy preceding stem cell transplant? I have a couple other options for those patients - so, there was a trial done with liso-cel for patients who were otherwise older, or not fit for intensive therapy. It's a single-arm phase II without a randomized comparison, but also demonstrated that liso-cel in second-line, later relapsed patients who are not fit for intensive therapy, resulted in comparable outcomes to what we would anticipate on that third-line or later setting. We also have other non-CAR T-cell therapy options, such as tafasitamab, which is a naked CD19 antibody, which has been combined with lenalidomide in the L-MIND study, again, for patients without primary refractory disease and who would not be appropriate candidates for intensive therapy. So, I do think we have alternative options, it's just when we look at the totality of the data right now, my conclusion is that CAR T-cell therapy, particularly for high-risk patients, is the most likely chance to result in cure. Dr. Chijioke Nze: Excellent. In a patient who we are considering CAR T-cell therapy, what are some of the short-term and long-term consequences, or toxicities that we should worry about? Dr. Loretta Nastoupil: One of the challenges right now with CAR T, and why it's still only available in specialized centers, is the acute toxicity, which is really a derivative of its mechanism of action. We take patients' own T-cells, we use a viral vector to introduce extracellular receptor, but also a co-stimulatory molecule. So, once these cells engage their antigen, sort of prime to react to that, and that can lead to pretty rapid T-cell expansion, release of cytokines, recruitment of other inflammatory cells to that tumor bed, and as a result, a large portion of patients can anticipate to experience cytokine release syndrome, which again, is the result of the activation of these T-cells, the expansion and the recruitment of other inflammatory cells. Fortunately, for most patients, this results in fever alone that can be managed with supportive measures. Occasionally, they'll have concomitant hypoxia or hypotension, and unfortunately, few patients will have significant or severe toxicity. The other toxicity that's less easily manageable or less predictable is the neurotoxicity that can vary according to patient-specific characteristics, such as age, and the amount of tumor burden, their performance status going into CAR, but even more importantly, the construct that's utilized, with highest rates of neurotoxicity associated with axi-cel. Again, likely speaking to its construct and the CD28 costimulatory domain that is unique to axi-cel. As a result of these acute toxicities, patients are required to stay within two hours of their treating center for the first four weeks, and they're also discouraged from operating heavy machinery, such as driving, for the first eight weeks following CAR T. So, I do you think this creates some barriers to access to this therapy, particularly the patients that are treated in community settings that may reside long distances from these certified CAR centers. Dr. Chijioke Nze: So, you mentioned that obviously, given the specialized care needed for the CAR T therapy, that they're kind of localized in certain sites. What are some of these issues with access that you're noticing both in the logistics of giving CAR T, and also in patient access? Dr. Loretta Nastoupil: I'm hoping we're going to address one of those issues right now, which is, education and awareness, because we've had these three randomized studies, and two being positive readouts just in the last year. It's important to get the message out that CAR T-cell therapy for high-risk early relapsed refractory large cell lymphoma patients can result in a significant improvement in event-free survival and progression-free survival over the standard of care. And so, being aware that this therapy can result in more favorable outcomes is step one. Step two is, we have to ensure that there are minimal barriers to getting those patients into these treating centers as quickly as possible. So, recognizing who delivers the care - is it your traditional stem cell transplant physician? Is it a lymphoma doctor? What centers are certified? Some of these issues can be addressed with quick internet searches. So, for instance, in our center, we have a 1-800 number for anyone who's interested in CAR T-cell therapy that connects them directly to a CAR T coordinator who can help them understand do they meet the FDA-approved indication? Would they be interested in seeking consult? And we try and prioritize getting those patients in the door as soon as possible since time likely does have an impact on outcomes. And then, partnering with our community oncologist - you're going to be the primary oncologist for these patients leading up to CAR, and then after that four-week window, when we're keeping the patients in close proximity to our centers, we often send them back. And so, making sure that they're comfortable knowing what potential late toxicities to be on the lookout for, which include B-cell aplasia and risk for infection, or prolonged cytopenias, beyond just lymphopenia. And so again, there's a need for education and partnering with our community sites to make sure that there is successful handoff of these patients back after they've completed the monitoring for the acute toxicity. And then, really trying to explore opportunities to utilize some of the better tolerated CAR T, such as liso-cel, in your non-traditional academic centers. Those that are equipped to handle phase I studies or stem cell transplant, for instance, may not be affiliated with the university. So, I think those are all types of strategies that could be employed to try and improve access for patients. Dr. Chijioke Nze: And then, you mentioned the liso-cel, but in some of the toxicities, are there ways of predicting which patients will do better or worse? Are there ways to reduce toxicities? And is there any hope for things such as outpatient administration of CAR T? Dr. Loretta Nastoupil: So, my answer today may improve over time as we get larger numbers and more experience, but what we currently understand is that the patient performance status, their degree of tumor, how quickly that tumor is increasing, LDH and some inflammatory markers such as CRP or ferritin pretreatment can provide some insight into a higher risk of toxicity. And then obviously, the construct that's utilized. Again, axi-cel has higher rates of neurotoxicity. All will have some form of cytokine release syndrome, generally speaking, but rates of grade three or higher are quite infrequent, particularly with liso-cel and tisa-cel. So, it's multifactorial. That then raises the question, can we do anything to alter those modifiable risk factors? Can we reduce the disease burden? Can we improve the performance status? Can we do anything to reduce the inflammatory markers pre-treatment? And so, those are strategies that are being discussed, and I think in general, as we get more effective therapies that enter into the treatment landscape, it's probably some of the best ways to try and reduce some of those risk factors. Dr. Chijioke Nze: Rounding that up, are there any exciting developments or things to look out for, for exciting therapies in the relapse setting? Dr. Loretta Nastoupil: A couple of things beyond CAR T that I think we should all be aware of and anticipate to be in our toolkit relatively soon; probably, one of the most exciting, is the development of the bispecific antibodies. So, another challenge with CAR T is the requirement to collect these patients' own T-cells and send them off to a central manufacturing site, and the turnaround time can be anywhere from 3-4 weeks. And again, in a situation where you have an aggressive disease, that can be a long time to wait. And so, is there any treatments that are more readily available, that again, will be effective at reducing disease burden? And so, by specifics kind of fit those unmet needs to some extent - you have essentially two heads; one head is going to bind the endogenous T-cells that eliminates the need to leukapherese these patients and manufacture, and then the other head is going to generally engage CD20, which we know is an effective targeted antigen, particularly in B-cell lymphomas. And there are a number that are under development. We saw preliminary phase II data with glofitamab, epcoritamab, as well as combination strategies with mosunetuzumab. So, I do have optimism that the bispecific antibodies will potentially enter into the treatment landscape. I anticipate they'll probably be used first post-CAR T, but will likely move their way into earlier lines of therapy. I've already mentioned tafasitamab in combination with lenalidomide, which is an effective non-chemotherapy option. We have antibody-drug conjugates, such as Loncastuximab, which is a CD19 antibody-drug conjugate. It's essentially targeted delivery of chemotherapy, and it looks to have a pretty promising activity as a single agent in that third-line or later space, and then polatuzumab, which is a CD79b antibody drug conjugate, in the relapse setting has been combined with bendamustine and rituximab, but also demonstrated significant improvement in the frontline setting in the POLARIS study where vincristine was replaced with polatuzumab. So, I do have optimism that as we have more and more treatment options entering into the treatment landscape, we'll have fewer patients that are experiencing refractory disease, and potentially succumbing to the lymphoma. Dr. Chijioke Nze: And then, one additional question: How do you approach a patient who is not quite as fit, in thinking about what their options are for later-line therapies? You already mentioned some of these, but which of those would you prioritize in this setting? Dr. Loretta Nastoupil: Again, as we get more experience, we develop skills that help us sort of navigate all these different options. In my practice, if I'm even considering CAR T, I'm going to delay bendamustine until after I've collected those cells. I think that's one caveat that-- we do get nervous about the quality of those autologous CAR Ts if they're generated in someone who's had recent exposure to bendamustine. So, that may help me sequence that later on. We have questions right now about what's the optimal sequencing of CD19-directed therapy because we have several options beyond just CAR T-- As I mentioned, we have Lonca, we've got tafasitamab and lenalidomide. Currently, we don't have prospective data that really informs that question, and there's a number of research studies underway to try and help us understand if there is a preferred sequence, or even if it matters how we handle CD19 targeting. For my older, frailer patients where I'm really worried, they're not going to be able to tolerate something like liso-cel, or they're not going to be able to have that caregiver, and they're uncomfortable relocating to an area where CAR T might be available, my general approach right now is to consider tafasitamab and lenalidomide first in that relapse setting, followed by either Lonca or Pola-BR. Selinexor is another option. It's an oral agent, though again, in my opinion, if we look at the totality of the data, may be less effective than the other options. So, I might reserve that as a last option for someone, again, with relapsed/refractory large cell. Dr. Chijioke Nze: Excellent. Thank you. This has been very helpful. Dr. Loretta Nastoupil: All right. So, Dr. Nze, now I'm going to turn the table and ask you some questions. I'm going to change this up a little bit - she's now a 39-year-old female. She has significant comorbidities. She has HIV, and again, large cell lymphoma. So, let me walk you through her case, and then we'll discuss some of the challenges, again, in a very different scenario, albeit a similar disease. So, our female is, I mentioned 39, pre-existing HIV, she's treated frontline with six cycles of R-CHOP and intrathecal methotrexate for CNS prophylaxis. Because of her comorbidities, again, not well controlled HIV, she also has a poor functional status at the time of relapse. This was a couple years ago, and CAR T was not an option in second line, though she is someone who had a relapse that was beyond 12 months. So, for her second-line approach, because of her comorbidities, she actually receives rituximab in combination with high-dose cytarabine, dexamethasone, and oxaliplatin for three cycles, and actually achieves a chemosensitive disease and is referred to our stem cell transplant colleagues. Unfortunately, at that time, due to comorbidities, she was deemed not to be an appropriate candidate for high-dose therapy, and she's been monitored for signs of relapse. Despite being in the minority, she actually does not have a recurrence of her lymphoma but has a number of other, again, challenges in regards to her comorbidity, including multiple infections, resulting in recurrent hospitalizations. And so, it's always been a challenge for me in being intimately involved in her case, deciding when she's presenting, how alarmed to be about recurrent lymphoma versus infection, and how I might approach her in the setting of relapsed large cell lymphoma. So, what role does prior type and response to therapy play in treatment selection at your next line of treatment? Dr. Chijioke Nze: I think in this patient, it sounds like she got one adequate therapy on and the initial presentation with R-CHOP, and then with IT chemotherapy as well. She looked like she had a good response. I think the fact that she achieved a complete response and the duration of her response, lets me know that she likely has chemosensitive disease. This, in turn, helps me to pick what to do next. As you mentioned previously, we know how efficacious the CAR T therapy is, but in someone like her who had a long duration, trying salvage therapy and proceeding to autologous transplant might make sense. I'd be interested in your thoughts. Dr. Loretta Nastoupil: Yeah, I agree. And I think part of the challenge, particularly when we're facing patients with HIV, they're often excluded from prospective studies. And so, we're often in a scenario where we may not have the wealth of data to inform our treatment decision. But I do think in general, comorbidities play a major role-- we're navigating treatment options. Because again, traditionally, we've used intensive chemotherapy as our mainstay of treatment, and there are clear criteria that patients generally should meet that help us predict how likely they are to have significant or severe toxicity from high-dose therapy. And this is a prime example of even though she was young, her comorbidity made her a poor candidate for intensive therapy. I think the other sort of non-clinical factors that we sometimes take into consideration, because CAR T was approved off of single-arm phase II studies, again, none of which would've included someone like her, because of her HIV status, how do we extrapolate-- for instance, if she had relapsed in that third-line space, and suggesting that she did not have significant infection or other significant comorbidities, do we have experience to proceed with an autologous CAR in that setting? So, again, there've been a few cases where we have case reports where people have reported on their standard of care outcomes, particularly with CAR T in patients with active HIV disease, but one of the concerns I have in these scenarios is very selected. If you have active infection, that can make the acute toxicity with CAR significantly worse. And so again, we're trying to navigate a sort of limited data zone to try and help her and choose the right therapy. Again, you've met this patient with me, you helped care for her for some time, and you have a unique experience of also practicing in a county hospital where comorbidities, particularly, like HIV, can be much more common. What is your perception regarding barriers to accessing CAR T as it pertains to social factors, clinical factors, and again, this is a case that highlights some of those issues. Dr. Chijioke Nze: You mentioned at first that she had uncontrolled HIV. So, I think which, one, speaks to her treatment reference of her non-malignancy-related diseases, and trying to get that under control would be one of the first things I could think about. Thinking about how her care is managed and what kind of support she has are very important for us to think about as well. The other thing that's very important is, a lot of patients who we're seeing in the community may not have access to such specialized centers such as MD Anderson, where patients do have access to clinical trials and CAR T therapy. So, patients who are unlike her, who might qualify, may not actually be able to get these therapies as well. Part of the reason is, it can be insurance status, which is what we see in a lot of our patients. So, a barrier to get into the door. And then too barriers, lack of social support can be a big issue as well. And then there's also a big push in the community to improve the trust and awareness of these novel therapies, as you've mentioned. So, in a lot of the community practice, some of the community practitioners may not be comfortable with these, and a lot of the patients may not have heard of these new technologies, and also want to defer trying new therapies before having other people try new therapies before they consider them themselves. I think all these things present specific significant barriers to patients in the community. One, their ability to adhere to care, two, their insurance and their ability to get care and the financial toxicities associated with that. And then third, really understanding the options that are available. Dr. Loretta Nastoupil: And again, just to try and illustrate a couple other points. You know, we use a case here, which is a real case, with significant comorbidities such as HIV, which again, is something that is not frequently encountered, and will have a large impact on treatment selection. What if I just told you this patient has comorbidities, but she has moderate type-2 diabetes, and as a result, she has mild renal insufficiency, ejection fraction is actually adequate, would you have done anything different in this case? Dr. Chijioke Nze: No. I think in this particular case, I do think the fact that she did have a good response for a long duration of time, and did seem to have chemosensitive disease, I would probably still have tried a salvage therapy and autologous transplant in this patient. In the event that she was refractory, or had early relapse, and in that case, I would consider her to not be chemosensitive and would definitely have sought some more active therapies such as CAR T cell therapy through available products. Dr. Loretta Nastoupil: And then one last question for you: What if we just changed her age and we made her 79, but no other significant comorbidities, how would that have impacted your approach? Dr. Chijioke Nze: I'm going to turn that one over to you, I'm not exactly sure how I would treat with older patient with the same disease. Dr. Loretta Nastoupil: That's fair. So, if you have an older patient who has a late relapse, but not necessarily someone you would consider appropriate for salvage chemotherapy and high-dose therapy, then I think tafasitamab and lenalidomide would be probably my first choice in that setting, just based off of the L-MIND study. Dr. Chijioke Nze: Thank you, Dr. Nastoupil, for a great discussion of the management of diffuse large B-cell lymphoma. And thank you to all our listeners. We appreciate you tuning in to this episode of the ASCO Educational podcast.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy, should not be construed as an ASCO endorsement.

Battling cancer takes place in many parts of the world and our next guest has led initiatives to do just that. In Part One of this Oncology, Etc. Podcast episode, Dr. Richard Sullivan, Professor of Cancer and Global Health at King's College London, shares with us his intriguing life trajectory, encompassing a childhood in various parts of the world, aspirations for a veterinary career that turned to basic science, medicine, health policy (4:27), and even a long-term stint with the British Army Intelligence (12:22). Dr. Sullivan, who served as Director of Cancer Research UK for nearly a decade also discusses traits he looks for in a cancer investigator (19:21), and how to be happy (21:16)! Guest Disclosures Dr. Richard Sullivan: Honoraria – Pfizer; Consulting or Advisory Role – Pfizer Dr. David Johnson: Consulting or Advisory Role – Merck, Pfizer, Aileron Therapeutics, Boston University Dr. Patrick Loehrer: Research Funding – Novartis, Lilly Foundation, Taiho Pharmaceutical If you liked this episode, please follow. To explore other episodes, as well as courses visit https://education.asco.org. Contact us at education@asco.org. TRANSCRIPT  Pat Loehrer: Hi, I'm Pat Loehrer. I'm director of the Center of Global Oncology and Health Equity at Indiana University Cancer Center.   Dave Johnson: And I'm Dave Johnson at UT Southwestern in Dallas, Texas.   Pat Loehrer: And this is Oncology, Etc. Dave, what book have you read this last month?   Dave Johnson: I have one I wanted to recommend to you. It's very interesting. It's by Steven Johnson, not of the syndrome fame. It's entitled Extra Life: A Short History of Living Longer. You may have heard of this because PBS made a special documentary about this particular book. But in it, Johnson talks about the remarkable increase in human lifespan, especially over the 20th century, and the various factors that contributed to increased years of life from on average in the United States of about 48-49 in 1900 to just about 80 in the year 2000. So that beats anything in the history of mankind before.   And he has a chapter about each of the factors that contribute to this, and some of which I think we all recognize. Things like antibiotics playing a role, but some of the things that I hadn't thought about were improved drug regulation and the development of randomized controlled trials, which all of us have participated in. How important that is.   He also talked about, at least in the United States, the importance of automotive safety. And I'm sure some of us on this podcast are old enough to remember cars that did not have safety belts and certainly not other safety maneuvers that have really improved lifespan in that regard. So I found it a fascinating book. I think our listeners who are interested in medical history would also enjoy this text.   Pat Loehrer: Did he mention this podcast?   Dave Johnson: No, actually it wasn't mentioned, and I thought that was a tremendous oversight. So, I've sent him a letter and recommended that he add it.   Pat Loehrer: We may not live longer, but it just seems like we're living longer. When you listen to this podcast, time stands still.   Pat Loehrer: Well, it's my real great pleasure to introduce our interviewee today, Richard Sullivan. I met Richard several years ago through the late Professor Peter Boyle in Leon, and it's one of the greatest highlights of my life to be able to know Richard.   Professor Richard Sullivan's Research Group studies health systems and particularly chronic disease policy and the impact of conflict on health. He's a professor of cancer and Global Health at King's College in London and director of the Institute of Cancer Policy and Co-director of Conflict and Health Research Group. As well as holding a number of visiting chairs, Richard is an NCD advisor to the WHO, a civil military advisor to the Save the Children Foundation, and a member of the National Cancer Grid of India. His research focuses on global cancer policy and planning and health system strengthening, particularly in conflict ecosystems. He's principal investigative research programs ranging from automated radiotherapy planning for low resource settings to the use of augmented or virtual reality for cancer surgery through the political economy to build affordable equitable cancer control plans around the world.   Richard has led more Lancet Oncology commissions than anyone else. In fact, Lancet is talking about calling it the Sullivan Commissions. He's led five Lancet Oncology commissions and worked on four others. He's currently co-leading the Lancet Oncology Commission on the Future of Cancer Research in Europe and Cancer Care and Conflict in the conflict systems. His research teams have had major programs in capacity building in conflict regions across the Middle East and North Africa. He's done studies on the basic packages of health services in Afghanistan and worked in Pakistan, Syria, and the Democratic Republic of Congo. He's been a member of the British Army, intelligence and security, and in that capacity he's worked many years in biosecurity and counterterrorism issues. I think in some ways, this is the most interesting man in the world, and it's our pleasure today to have Richard join us. Richard, thank you for coming.   Richard Sullivan: Pat, Dave, you're really too kind. Marvelous to be with you. Thank you for the invitation.   Pat Loehrer: Can you tell us a little about your upbringing and early life before you became Dr. James Bond?   Richard Sullivan: I'm not sure that's anywhere close to the truth, sadly. But, yeah, I have had a very interesting, eclectic life. I was born in Aden just on the cusp of where the British Aden Protectorate met a country which actually no longer exists, the People's Democratic Republic of Yemen. Because after the British left Aden, essentially the East Germans, and what was then the Soviet Union took over southern Yemen. So I was born in a very unusual part of the world, which sadly, since then has just deteriorated. I spent many years of my life with my parents, who were in the diplomatic service and doing other things, wandering around the globe, mainly in the Middle East and East Africa. We spent quite a lot of time, strangely enough, we washed up on the shores in the USA once as well. Dayton, Ohio, and eventually-   Pat Loehrer:  Not to interrupt you, Richard, there are no shores in Dayton, Ohio. So just correct you there.   Richard Sullivan: That is so true. My memory - cornfields everywhere. I had a wonderful dog then, that's how I remember it so well. And I didn't really come back to the UK until, oh, gosh, I was nearly 10-11 years old. So, coming back to the UK was actually a bit of a culture shock for me. And then relatively classical in terms of the UK, sort of minor public school and then into medical school. In the old days when it was in the 80's. I had a fabulous childhood, going all over the place, seeing lots of things, being exposed to lots of different cultures. I think it remained with me all my life. I never really feel a foreigner in a foreign land. That's nice. That's really unique and it's been marvelous being able to tie in the passion for global health with my upbringing as well. So, yeah, I had a wonderful childhood.   Dave Johnson: Would you mind expanding on your medical training, Richard? Tell us a little bit about that.   Richard Sullivan: Yeah, so when I, when I went to medical school in the UK, we were still running the old system. And by the old system, I mean, you know, these small medical schools with entries of, you know, 70, 80 individuals, particularly in London, you had that St. Mary's Hospital Medical School, which is where I went, Charing Cross, Guy's, St. Thomas', and they were all individual medical schools. Now, most of these now have merged together into these super medical schools. But certainly when I went to medical school, I'll be absolutely honest with you, I wanted to be a vet to begin with, but actually discovered I wasn't bright enough to be a vet. It was harder to become a vet than it was to become a doctor. In my day going into medicine, and people listening to this, or some people who understand the A level system in the UK will recognize if you're offered a BCD, that's quite low grades to get into medical school. So I went to Mary's, to be absolutely honest with you, because I heard that they took people that played rugby, and I came from a rugby-playing school. And sure enough, 90% of the interview was based on my rugby prowess, and that was St. Mary's Hospital Medical School. So it was wonderful.   And we'd already had people going there who were big rugby players. And again, it was, I remember thinking to myself, am I making the right decision here? But it was interesting, as soon as I went into medical school, I realized that was the life for me. I had done myself a favor by not going into veterinary science, which I would have been awful at. We had six years of very, very intensive pre-medicine, the classical medical rotations, and then that movement into the old schools of pre registration house officers, registrar jobs. We were quite an early stage. I kind of slightly went off-piste and started doing more academic work. Interestingly, most of my academic early days academic work was not in health policy and research. It was actually in very hard core cell signaling. So my doctorate was in biochemistry, and we worked on small GTPases, calcium-sensing proteins.   There were some really extraordinary heady days, and I'm talking here about the early nineties and the mid-nineties of tremendous discovery, real innovation. I was at UCL at the time, but mixing and matching that up with a sort of surgical training, and again, surgical training in those days was pretty classical. You went into your general surgery, then sort of specialized. It was really, really interesting but it was full on. I mean, you spent your entire life working. Morning to night so these were the days of 100 hours week rotations. You were doing one in twos, one in threes. That's every other night and every other weekend on call. It was incredibly intense, but there was a lot more diversity and plasticity in those days. You could dip in and out of medicine because of the way you were chosen and how you were recruited. So it suited my personality because I liked moving around and doing different things and that sort of took me through, really until the late 1990s.   Pat Loehrer: You became a urologist, right?   Richard Sullivan: That's right. Exactly. So I trained up until the late 1990s, it was all pretty standard, I would say. And then I decided I was bored and moved into the pharmaceutical industry and I went to work in for Merck Damstadt at the time, which was relatively small. I was going to say family owned, but it was quite family-owned pharmaceutical company that was just moving into oncology. And because I'd done the background in cell signaling and cell signaling was really the backbone of the new era of targeted therapies, this seemed like a great move. To be absolutely blunt with you, I didn't last very long, less than a couple of years, I think, mainly because I just found the whole environment way too constraining. But what it did provide me with was a springboard to meet the wonderful late Gordon McVie, who I met at a conference. And he said to me, ‘You're absolutely wasting your time and life by staying in the pharmaceutical industry. Why don't you come out, get an academic job at University College London and become my head of clinical programs?” - for what was then the Cancer Research Campaign. This Cancer Research Campaign and the Imperial Cancer Research Fund were the forerunners of Cancer Research UK. So, you know, this was an offer that was too good to be true.   So I jumped ship immediately, went back into academic life and joined CRC. And really the next ten years was this extraordinary blossoming of the merger of CRC with the Imperial College Research Fund, the creation of Cancer Research UK, and that was Paul Nurse, and obviously Gordon and me, bringing that all together. And it was the heady days of that resurgence of cancer, the importance of cancer care and research in the UK. And coupled with that, of course, it was the blossoming of my interest, really then into the global health aspects of cancer, which really, Gordon, people like you mentioned already, the late, wonderful Peter Boyle, all those individuals were already engaged in and they were the ones that really kind of catapulted me into a more international scene.   Dave Johnson: Did you know Dr. McVie before you met him at this conference, or was it just a chance encounter?   Richard Sullivan: No, he actually met me via John Mendelson, because John had picked up a paper I'd been writing on basically the very early versions of Rituximab that we were working on and we were looking for pharmacodynamic endpoints. And of course, one of the things I noticed with the patients is they were getting all these skin rashes on their faces, and I thought, that's terrific. Just seemed to be the skin rashes seemed to be together with those individuals that had better responses. And I remember writing this paper for Signal, which was a kind of relatively minor journal, and I think it was John Mendelson who picked it up and must have mentioned something to Gordon. Gordon hunted me out down at a particular conference, said, "How on earth do you know about this, that you're not anything more than a surgeon?" He was absolutely right about, goodness sake, what do you know about pharmacodynamic endpoints, and I kind of had to sort of confess that I've gone kind of slightly off-piste by doing biochemistry and cells signaling and working with these extraordinary people. And that's how I essentially met Gordon. He was very good for spotting slightly unusual, eclectic human beings.   Pat Loehrer: I'm very curious about the intersection of your work and how you got into the British Army and Intelligence with medicine and how that even may continue even today. So explain that story, that part of your life a little bit to us.   Richard Sullivan: Yeah, it was very early on, as I went into medical school, one of the key concerns was making money. I looked around for ways of doing something interesting to make money, and most of the jobs on offer were bar jobs, et cetera. Then I thought, what about the Territorial Army, which, in the early days of the 1980s, was, and still is, a very large component of the UK Armed Forces. So I actually joined the Royal Army Medical Corps, as you would expect for someone going into medicine. I thought, okay, I'll join the Royal Army Medical Corps, and I was a combat Medical Training Technician, et cetera. So I went along, signed up, and I think I was about three months into training when I was at a place called Kew Barracks and some chap came up to me and handed me a little bit of paper. It said "Intelligence Security Group" and gave a phone number. He said, "This is more your line of work. Why don't you give them a ring?"   It was interesting because, in those early days, they were looking for analysts who could work on lots of different areas. In those days, most of the work was domestic.. Of course, there was counterterrorism with Northern Ireland, but there was also the Soviet Union, and the fallout from the Warsaw Pact, so they were still actively recruiting into that area. There are lots of details I can't talk about, but it was relatively, to begin with, quite hard work and low level. It was a lot of learning foreign equipment recognition. It was what we consider to be standard combat intelligence. But the more time you spend in it, the more interesting it gets.   One of the areas they were looking to recruit into, which I didn't realize at the time but only later, was bioweapons and biosecurity. They needed people who understood biotechnology and the language of science, and who could be taught the language of infectious disease on top of that. That is quite a difficult combination to find. It's very easy to teach people trade craft and intelligence, it's very hard to teach them subject matter expertise. And they were really missing people who specialized in that area.   It was interesting because it was still a relatively open domain. There was still a lot of work going on in the counterterrorism front with biological weapons, and a lot around the Verification of the Biological Weapons and Toxin Convention. And it was an interesting, and I'd almost say parallel life. But your medical knowledge and the scientific knowledge I had already gained and was gaining was what was being looked for. So that was very early on and it has expanded over the years. More and more now we talk about health security and intelligence so that goes beyond what you would consider classic medical intelligence or Armed Forces - this is more about putting together the disciplines of intelligence with the securitized issues of, for example Ebola. That is a classic example. The big outbreaks in West Africa, the DRC, these are sort of the classic security intelligence issues - even COVID 19 for example - and mostly around the world, what we've seen is the intelligence apparatus taking front and center in that, whether you're looking at states like South Korea, et cetera. So I've moved more into that, and we do a lot of work and research into this as well. So we look at, particularly now, how to improve human intelligence in this area, the pros and cons of signal intelligence collection. And we go as far as to kind of ask sort of deep ethical and moral issues, for example, about how far should these sorts of apparatus of state be applied to public good issues like health. Because at the end of the day, when you're talking about the armed forces security sector, their primary job is for defense of the realm. So applying them in other areas obviously comes with a whole load of moral and ethical challenges. So, yes, it's been a fascinating journey, which, as I said, it extends all the way back to the late 1980s. It's been both complementary and different.   Dave Johnson: So, Richard, there's so many things in your resume that warrant exploration, but you served as Clinical Director of Cancer Research UK for nearly a decade. What was that experience like, and what accomplishment are you most proud of?   Richard Sullivan: It was an enormous privilege. In your life, you always look at some jobs and you think, “How lucky I was to be there at that time with those people.” I think, first of all, enormous respect for the people that ran both Cancer Research Campaign, Imperial Cancer Research Fund – I mean, Paul Nurse and Gordon McVeigh, Richard Treisman – I mean, some extraordinary people who were leading both of these charities. And so to be there at that moment when they both came together, but more importantly as well, they had this most amazing global network of literally the illuminati of cancer research, spanning from basic science all the way through to epidemiology, public health, health systems. And in those days, of course, those individuals would come on site visits to the UK to look at the different units and evaluate them. So you can imagine when you're bringing those sorts of individuals across, you get a chance to go out with them, go drinking, talk to them, learn about their research, and also learn about the extraordinary breadth of research that was there in the UK. So you're condensing almost a lifetime's worth of learning into a few years. It was an absolute privilege to have been able to serve the community like that.   What I'm most proud of? Gosh, I like to think I suspect that most proud of trying to help a lot of the fellows get through to where they were going to actually get the most out of their careers. When I look back, there are lots and lots of names of people who started at a very early stage with funding from Cancer Research Campaign or the Imperial College Research Fund, who are now very, very senior professors and global research leaders. And I like to think that we did a little bit to help them along that way and also help to support individual research programs actually reach their full potential. Because I think research management and planning is often overlooked. People think of this as very transactional – it's not transactional. It's an incredibly important, serious discipline. It requires very careful handling to get the very best out of your research ecosystem. You've really, really got to get under the skin and really have a clear view of how you're going to help people. So I think that's what I'm most proud of – is the individuals who made it all the way through and now these great leaders out there.   But it was also, let's be honest, it was halcyon days. Great innovations, great discoveries, new networks growing, incredible expansion of funding in the UK, in Europe, in the USA. They were very, very good days. And it was, as I said, it was a real privilege to be there almost at the center for nearly a decade.   Dave Johnson: Let me follow up on that, if I may, just for a moment. You have had such an incredible influence. What characteristics do you think are most desired in a cancer investigator? What sorts of things do you look for, especially when you're thinking about funding someone?   Richard Sullivan: Creativity. I think creativity is really important. We talk about the word innovation a lot, and it's an interesting engineering term, but creativity is that spark that you can see it in people, the way they talk about what they're doing. They have this really creative approach. And with that, I think you have to have the passion. Research careers are long and difficult, and I'd probably suggest there's probably more downs than there are ups, and you have to have that passion for it. And I think along with that passion is the belief in what you're doing – that first of all, you have that belief that actually drives you forward, that what you know you're doing is good work, and that you're really dedicated to it. But obviously, hand on heart, when you're looking at researchers, it's that passion and that creativity.   I think it's a brave person to judge how any person's career or program is going to go. I don't think any of us are prophets. Even in our own land. We might be able to see slightly into the future, but there are so many elements that make up  “success”. It's funny when I look back and I think those who've been successful, it's people who've also been generally happy in their lives. They've found their careers in whatever shape or form, fulfilling, and they've generally been happy human beings, and they've managed to create a life around research which has given them meaning.   Pat Loehrer: Richard, you have reinvented yourself a number of times – this transition of going from like a basic scientist, a surgeon, moving into public policy and global policy. Tell me a little bit about the journey that's been in terms of academics. How do you learn? What were the transition points in each of these things to get you now to be, as I mentioned before, kind of the key person for Lancet's commissions to somebody who was a rugby player?   Richard Sullivan: I suppose if you're being mean, you say, he clearly gets bored easily. But it's not that. Actually, I'm not very instrumental about life either. I mean, there are many people you will meet who have got their lives and strategies mapped out. They know they're going to do X next year, Y the following year. And for me, it's never been like that. For me, it's that excitement, that creativity of working on new and interesting things, but also knowing when you've run out of road in a particular area, where it no longer gets you out of bed in the morning, where you no longer feel happy, where you no longer feel you're contributing. All of us talking today have the great privilege of having choice about our lives, about what direction our lives should take. And it's not a privilege one should squander lightly because many people do not have choices about their lives. It's all about chance. And having that choice to be able to move into different areas is really important because I said you can stick in the same thing because you think you have to. And you can become an unhappy, miserable human being. And that makes you a miserable researcher to be around. It makes you a terrible doctor. Probably makes you a terrible person, actually, generally, if you're having a miserable life.   So finding new things, that really you're passionate about how you do it, there's no shortcut in this. It's hard work. Readily admit I went back to law school of economics, retaught myself lots of things. There are no shortcuts for. Deciding if you're going to a new area is learning, learning, practice, practice, practice, and just doing the hard work. I think that's an ethos that was probably drilled into us quite early anyway in medical school, because that's how you approach medicine. That's how you approach science when I was growing up. And it was that idea of humility that you can never have enough learning, you will always learn off other people. That's probably what drove me and how I've managed to change and as I say, who knows what the future is? I don't know. Maybe one day I'll think about doing a bit of poetry.   Dave Johnson: Your comments about happiness and work resonate with Pat and me. I think we both feel like humor is really important for happiness and career success. And, you know, Osler once said, “The master word of medicine is work.” You can't get around that. It is what it is. And I think you just reaffirmed that.   Well, this concludes part one of our interview with Richard Sullivan, professor of Cancer and Global Health at King's College, London and director of the King's Institute of Cancer Policy and co-director of the Conflict and Health Research Group. In the second part of this episode, Professor Sullivan will speak about the progress of global health, especially in conflict areas, and the need for young people to enter into the world of oncology and oncology research.   Thank you to all of our listeners for tuning into Oncology, Etc. This is an ASCO educational podcast where we will talk about just about anything and everything. So if you have an idea for a topic or a guest you would like us to interview, please email us at education@asco.org. Thank you again for listening.  Thank you for listening to the ASCO Education podcast. To stay up to date with the latest episodes, please click subscribe. Let us know what you think by leaving a review. For more information, visit the Comprehensive Education Center at education ASCO.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity or therapy should not be construed as an ASCO endorsement.  

Stiff person syndrome (SPS) is a relatively rare neurologic disorder that often causes disabling muscle spasms. After Celine Dion recently announced she was diagnosed with SPS it has received significant attention in the news. What do you need to know to answer your patients' questions about this syndrome and to potentially identify it yourself? Today we'll talk about the common symptoms, diagnostic tests, and treatments used for SPS. Celine Dion's Instagram Posthttps://www.instagram.com/reel/Cl5xJY1AjAO/?utm_source=ig_web_copy_linkStiff-Person Syndromehttps://practicalneurology.com/articles/2020-sept/stiff-person-syndromeStiff-Person Syndrome: A Treatment Update and New Directionshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7793517/Long-term effectiveness of IVIg Maintenance Therapy in 36 patientshttps://nn.neurology.org/content/9/5/e200011Evaluation of Treatment Outcomes in Patients with Stiff Person Syndrome with Rituximab vs. Standard of Carehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524563/ Find me on Twitter @Drkentris (https://twitter.com/DrKentris) Email me at theneurotransmitterspodcast@gmail.com https://linktr.ee/DrKentris The views expressed do not necessarily represent those of any associated organizations. The information in this podcast is for educational and informational purposes only and does not represent specific medical/health advice. Please consult with an appropriate health care professional for any medical/health advice.

In this week's podcast, Neurology Today's editor-in-chief discusses why MS specialists advocate for rituximab for MS, how food security may relate to cognition, and a novel in utero therapy for Pompe diseasea.

Dr. Fredrik Piehl discusses his paper, "Efficacy and Safety of Rituximab for New-Onset Generalized Myasthenia Gravis". Show references: https://jamanetwork.com/journals/jamaneurology/fullarticle/2796552 This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

Dr. Gordon Smith talks with Dr. Fredrik Piehl, about the use of rituximab for new-onset generalized myasthenia gravis. Read the full article on JAMA Neurology. This podcast is sponsored by argenx. Visit www.vyvgarthcp.com for more information.

Excellent overview of Castleman Disease: https://ashpublications.org/blood/article/135/16/1353/452573/Overview-of-Castleman-diseaseInternational consensus guideline for treatment of Idiopathic Multicentric Castleman Disease (iMCD): https://ashpublications.org/blood/article/132/20/2115/39506/International-evidence-based-consensus-treatmentSomatic alterations in Castleman Disease: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9624446/https://www.nature.com/articles/s41375-018-0323-6Rituximab + Liposomal Doxorubicin in HHV8-positive MCD: https://ashpublications.org/blood/article/124/24/3544/33494/Rituximab-plus-liposomal-doxorubicin-in-HIVRCT on Siltuximab for MCD: https://pubmed.ncbi.nlm.nih.gov/25042199/Long-term data on Siltuximab in MCD: https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(19)30257-1/fulltext

Key papers discussed in the show: 1.     Pediatric regimen for older adolescents and young adults with ALL: CALGB 10403 https://ashpublications.org/blood/article/133/14/1548/260519/A-pediatric-regimen-for-older-adolescents-and2.     Dose intensification of daunorubicin and cytarabine during treatment of adult acute lymphoblastic leukemia: C19802 https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.276173.     Rituximab in B-ALL https://www.nejm.org/doi/full/10.1056/NEJMoa16050854.     A Phase II Trial of Blinatumomab Followed by POMP Maintenance in Older Patients with Newly Diagnosed Philadelphia Chromosome–Negative B-Cell Acute Lymphoblastic Leukemia: SWOG 1318 https://ascopubs.org/doi/abs/10.1200/JCO.21.017665.     Blinatumomab for MRD in adults with B-ALL https://ashpublications.org/blood/article/131/14/1522/36655/Blinatumomab-for-minimal-residual-disease-in6.     Ph-like ALL https://www.nejm.org/doi/10.1056/NEJMoa1403088

In this week's episode discuss the efficacy of rivaroxaban as antithrombotic prophylaxis after laparoscopic surgery for colorectal cancer, learn more about the association between genomic variants and survival outcomes after hematopoietic cell transplantation in severe aplastic anemia, and discuss the long-term safety and efficacy of fixed-duration venetoclax plus rituximab in relapsed/refractory CLL.

In this week's episode, we discuss the "ACR's 2022 Guideline Summary for Vaccinations in Patients with Rheumatic and Musculoskeletal Diseases" with lead author Dr. Anne Bass, Attending Physician in the Division of Rheumatology at Hospital for Special Surgery and a Professor of Clinical Medicine at Weill Cornell Medicine. During our conversation we consider the importance of guidelines for vaccines, the impact certain drugs like rituximab and methotrexate have on vaccinations, cover some vaccine highlights within the guidelines, how these guidelines can aid in navigation with insurance companies and much, much more. 

This week we welcome Dr. Alfred Kim to our show as we discuss B-Cell depleting therapies and how patients on these drugs may be more susceptible to COVID-19. During which, Dr. Kim takes us back to the beginning of the pandemic and how he and his patients initially managed the rituximab infusions, how and why people on this drug may be at increased risk of severe disease, the importance of vaccinations, and why they may not work for this patient population. Finally, we finish with Dr. Kim sharing with us important information on how to mitigate the risk of COVID-19 among people taking b-cell depleting therapies, now that there are new therapies for COVID-19 pre-exposure prophylaxis.  

Episode 2 of The Sediment has Drs. Stella Shin and Sudha M hosting a wonderful conversation with Dr. Linda Hua, Dr. Elizabeth Spiwak Dr. Patricia Seo-Mayer and Dr. Andrew South . We discuss Racism and Becoming a JEDI warrior, how to be better at asking the right questions - be it about the mechanistics of hypertension, food insecurity or the use of Rituximab in nephrotic syndrome! Our panelists offer tips and advice on how to change our practice based on what we learnt at ASPN22 today! Editor: Dr. Sudha Garimella.

Major Points Covered: In Part 1 of our Heme Path series, we break down the logistics and applications of flow cytometry.Take aways: 1. Cancer = cells that clone themselves uncontrollably due to mutations.2. Purpose of flow cytometry is to assess phenotype of the cell by characterizing cell surface markers (CD markers for example). For blood cells, this is called the “immunophenotype”.3. Testing requires live cells in suspension and can't be fixed. Remember to keep all lymph node biopsies in suspension when sending for flow cytometry. 4. Flow tells us that if cells share the same abnormal expression of cell surface markers, they are clonal and therefore raise concern for cancer. 5. Flow tells us if cells have specific cell surface markers that we can target for treatment. For example, expression of CD20 can be targeted by the drug Rituximab. 6. If a clone is identified at diagnosis, flow cytometry can be used to sift through thousands of cells to see if a single clone with the original abnormal phenotype is left over. This is called minimal residual disease (MRD) testing and is a great way to monitor response to treatment and identify if any tiny amount of cancer is left over. 7. There are a variety of indications to send flow cytometry but the bottom line to remember is that we are trying to find an abnormal clonal population of cells. You may not see anything abnormal in the peripheral blood because those cells are living in the bone marrow. 8. Blasts reported on the CBC w/ diff is done based on visual inspection of morphology by a hematology lab scientist or pathologist; but can only confirm if it is truly a blast with flow cytometry. 9. Always send bone marrow biopsy aspirate samples for flow cytometry. 10. We use flow cytometry as one piece of the larger puzzle to prove clonality and make a diagnosis. Other uses are for determination of targeted treatments based on cell surface markers and to identify any amount of residual disease (MRD testing by flow cytometry).References:https://ashpublications.org/blood/article/111/8/3941/24550/Flow-cytometric-immunophenotyping-for-hematologic - ASH review article on use of flow cytometry to diagnose heme malignancies. https://onlinelibrary.wiley.com/doi/10.1002/cyto.b.20365 - Bethesda International Consensus Guidlines for Flow Cytometry in 2006https://www.bloodresearch.or.kr/journal/view.html?uid=2357&vmd=Full& - Minimal residual disease testing in ALL as an example of another clinical use of flow cytometry http://www.cyto.purdue.edu/archive/flowcyt/research/pdfs/encyclopedia_2004.pdf - Good article explaining the complexities of the flow cytometry technique Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

The Respiratory Tract and RA with Drs. Sparks, McDermott and Kronzer Guselkumab Use Improves Anemia in Treatment of PsA: Dr. Robert Chao Ultra Low Doses of Rituximab in RA: Dr. Eric Dein and Nathan den Broeder Uveitis and Prevalence of Psoriasis in axSpA: Dr. Robert Chao