Podcasts about smoldering

Welcome to The Times of Israel's Daily Briefing, your 20-minute audio update on what's happening in Israel, the Middle East and the Jewish world. Military correspondent Emanuel Fabian joins host Amanda Borschel-Dan for today's episode. Iran fired a volley of missiles at northern Israel Sunday night, catapulting the region back to the cusp of all-out war after two months of a shaky ceasefire, with Israel initially vowing to respond before US President Donald Trump attempted to limit the fallout and keep truce negotiations with Tehran on track. Israel responded overnight and we're recording on Monday morning. We roll back time and give the background and context for the IDF's strikes on Beirut -- ostensibly Iran's trigger for sending some dozen ballistic missiles to Israel last night. Fabian fills us in on a massive subterranean bunker that Hezbollah -- with Iran's help -- carved into a mountain near the iconic Beaufort Castle that sits close to the border with Israel. We learn there are more such sites in southern Israel that the IDF has not yet reached. Hours before the renewed Iran strikes, an Arab Israeli terrorist opened fire in several locations in a shooting spree in central Israel on Sunday, killing an IDF reservist who served as a civil defense squad member, and wounding five other people, before he was shot dead by security forces. Fabian gives us a recap. And finally, we close the program with a look inside news that broke late last week: For the first time, a female combat soldier completed training in the Israeli military’s Sayeret Matkal commando unit. What does this mean for the elite unit? Check out The Times of Israel's ongoing liveblog for more updates. For further reading: Iran fires missiles at Israel for first time in two months; Trump tells Netanyahu not to retaliate IDF strikes Beirut’s Dahiyeh after Hezbollah fires rockets at northern Israel Israeli man killed, five hurt in central Israel terror shooting spree by Arab Israeli In first, female IDF combat soldier completes training for elite Sayeret Matkal unit Subscribe to The Times of Israel Daily Briefing on Apple Podcasts, Spotify, YouTube, or wherever you get your podcasts. This episode was produced by Ari Schlacht.See omnystudio.com/listener for privacy information.

Despite multiple attempts by Israel to quell the fighting in Gaza and decapitate their leadership, Hamas continues a guerilla-style resistance. The IDF now fights on three active fronts, Lebanon, Iran, and Gaza. But it's perhaps the forgotten war in Gaza that could resume major hostilities if left unchecked. Bill speaks with FDD Research Analyst Samuel Ben-Ur about next steps in Gaza. Was Trump's Board of Peace a false window for both combatants to regroup? And, what may trigger a flare up in this long battle spurred by October 7th?

This week, we kick off the first of our myeloma capstone roundtable discussions with two experts who treat myeloma every single day. We welcome back Dr. Manni Mohyuddin from the Huntsman Cancer Institute at the University of Utah, and introduce a new friend of the show, Dr. Adeel Khan from UT Southwestern. In part one, we tackle two highly practical topics: the AQUILA trial and its real-world implications for smoldering myeloma management, and how to approach frontline therapy in the older myeloma patient.In this week's show notes, we summarize the key thoughts about how our experts think about approach to their patients. Stay tuned for part 2 of this discussion next week! Content:- How do our experts approach the management of smoldering multiple myeloma in light of the AQUILA study - What is our experts' approach to older patients with newly diagnosed multiple myeloma ** Want to review the show notes for this episode and others? Check out our website. Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Youtube

Dr. Monty Pal speaks with internationally acclaimed hematologists Dr. Vincent Rajkumar and Dr. Saad Usmani about the AQUILA trial in high-risk smoldering multiple myeloma, as well as advances in CAR-T and other evolving treatment strategies in the myeloma space. TRANSCRIPT Dr. Monty Pal: Hello everyone and welcome to the ASCO Daily News Podcast. I'm your host, Monty Pal. I'm a medical oncologist, underline medical oncologist, a professor, and vice chair of academic affairs at the City of Hope Comprehensive Cancer Center in Los Angeles. You're going to understand why I underlined "medical oncologist" there. I'm actually on the line today with two amazing hematologists. Today, we're going to actually explore treatments for high-risk smoldering multiple myeloma following the FDA's approval last year of daratumumab for the first-ever treatment of this indication. Now, this is based on the AQUILA trial, and this represents a huge shift in our traditional watch-and-wait approach to active disease interception. We're going to consider whether this landmark trial published in The New England Journal translates to day-to-day practice. I think it does, and we'll certainly make an argument for that. And I'm so fortunate today to have two internationally acclaimed experts here in the conversation: Dr. Vincent Rajkumar, senior author on the manuscript, and Dr. Saad Usmani, also an expert in his own right in myeloma. Dr. Rajkumar is the lead investigator of the AQUILA study. He's a professor of medicine and consultant in the divisions of hematology and hematopathology at the Mayo Clinic in Rochester, Minnesota. He actually chairs the Myeloma, Amyloidosis, Dysproteinemia Program. He is also editor-in-chief of the Blood Cancer Journal. Dr. Usmani, he and I actually go way, way back. We actually did the AACR Molecular Biology in Clinical Oncology course, I want to say in 2006, so this is our 20-year anniversary, Saad. He's the chief of the myeloma service at the MSK Cancer Center and a professor of medicine at the Weill Cornell Medical College in New York.  Saad, Vincent, welcome. Dr. Saad Usmani: Thank you so much for having me, Monty. Dr. Vincent Rajkumar: Yeah, thanks, Monty. A pleasure to be here. Dr. Monty Pal: Thanks. And just a quick note for our listeners, all of our disclosures are available in the transcript of this episode. First off, Saad, did I get that right? Was it 2006 when we did that course together? Dr. Saad Usmani: Yeah, 20 years. We are coming up to our 20-year anniversary. It's remarkable to have seen our careers move the way they have, Monty. Dr. Monty Pal: Oh my gosh. And for all the fellows who are on the line, that AACR Molecular Biology and Clinical Oncology course, it's sometimes overlooked. Wonderful primer on translational science. Okay, now we're going to get to the heart of the matter here, the AQUILA trial. So this was a study, Vincent, that you led. I wonder if you'd walk us through the primary endpoints in the study. What are we looking at in the AQUILA trial specifically? Dr. Vincent Rajkumar: Thanks so much. Again, as you mentioned, smoldering multiple myeloma has just been a condition that we watch and wait. And the first thing that I want to clarify here is that the AQUILA trial is looking at only a subset of smoldering multiple myeloma. That is the high-risk smoldering multiple myeloma. It was defined the way high-risk smoldering myeloma was defined at the time the trial was designed. It randomized 390 patients. One arm got daratumumab single agent in an attempt to delay progression to active myeloma and possibly prolong survival. And the other arm was the traditional observation. The primary endpoint, therefore, was time to active multiple myeloma. Other endpoints included time to when patients needed to start therapy for active multiple myeloma, which can vary based on physician judgment, and overall survival. Of course, response rate, complete response rate, and others were also endpoints. Dr. Monty Pal: That's interesting. And you know, I wanted you to riff a little bit on this definition of high-risk smoldering myeloma. Can you tell our audience how that's sort of evolved over the years? Dr. Vincent Rajkumar: Yes. I mean, if you step back, monoclonal gammopathy of undetermined significance has only a 1% per year risk of progression. Smoldering multiple myeloma, all comers have a 10% per year risk of progression. And over the years, trials have been done in the whole population, and then more recently, we felt we should really focus on the people with high-risk smoldering, defined as a 50-50 risk of progression in 2 years. That's like a 25% per year risk of progression in the first 2 years, which is a very high risk for the patient and something that would justify prophylactic intervention. And that definition initially was based on just high levels of monoclonal protein like more than 3 grams, the IgA subtype of myeloma, the suppression of uninvolved immunoglobulins. Others have used bone marrow flow cytometry markers, cytogenetics. Those combinations of factors were available at the time the AQUILA trial was designed, and a select combination was used. Later on, we found that we could match almost all of that in a very simple risk stratification using just the percentage of bone marrow plasma cells, the level of the M-spike, and the free light chain ratio, all three of which are available to all patients with smoldering at the time of diagnosis. So you don't need any special testing. So more than 20% plasma cells, more than 20 for the light chain ratio, and more than 2 grams for the M-spike. If someone has any two of the three, that is high-risk smoldering multiple myeloma according to the IMWG, but that definition, of course, came in 2020 after the AQUILA trial completed accrual. Dr. Monty Pal: That's interesting because this sort of flips the traditional paradigm where biomarkers get more and more complex as time goes on. Am I right in saying this sort of simplifies things a little bit? It uses standard laboratory or clinical parameters to gauge this category? Dr. Vincent Rajkumar: Absolutely. People were using suppression of uninvolved immunoglobulins, and those levels are not standardized, often vary by race. Also, the other aspect was the abnormal plasma cells on flow cytometry. Again, labs define it differently. So this makes it much more simple. But the IMWG also did a separate exploratory cohort within that paper where we added cytogenetics and we added scoring systems to improve on this further. So it simplified it for regular clinical practice and for like trials. But if you have a patient in front of you, the IMWG paper also has more complex scoring systems where you can take more than 20; 21 is more than 20, so is 51. And so, you can use the actual numbers that a patient has, additional variables like cytogenetics, and get a more refined estimate of what is the true risk of progression. Dr. Monty Pal: That's really helpful. Now, you told us about the primary endpoints, you've helped us define high-risk smoldering myeloma. Can you give us a sense of the top-line results from AQUILA? Dr. Vincent Rajkumar: Yes, I think the most important one was the primary endpoint, time to multiple myeloma, was at 5 years, the progression-free survival was 63% in the daratumumab arm compared to 41% in the observation arm. So, you know, approximately 60% of patients in the observation arm had already progressed by 5 years. And that number was about 40% for the daratumumab arm. We also looked at time to starting myeloma therapy, which is clinically actually quite meaningful because, you know, myeloma therapy means patients get a quadruplet for induction, they get stem cell transplant, they get endless maintenance, they get ongoing therapy virtually for the entire duration. So, preventing the need for myeloma therapy is in and of itself, I think, a major endpoint. And that at 3 years, 40% of people in the observation arm required full myeloma therapy compared to only 20% in the daratumumab arm. So there's a significant reduction in the risk of developing active myeloma as well as the need for myeloma therapy by using a time-limited 3 years of daratumumab single agent. Dr. Monty Pal: Perfect summary of the results. And maybe, Saad, I'm going to bring you into the conversation now. How does this sort of influence your day-to-day practice for smoldering myeloma? Is this something that you've incorporated for that high-risk subset? Dr. Saad Usmani: Thank you, Monty, and I agree. I think that's a really nice summary from Vincent. This study is very important for several reasons. It's actually the third clinical trial that has demonstrated that patients who are in the high-risk smoldering myeloma category benefit from an early intervention that delays the progression to active myeloma or to end-organ damage. And so having a nuanced discussion with our patients in the clinic becomes very important. Having this discussion around as an option becomes very important. And like Vincent said, when we look at that high-risk smoldering myeloma patient population, someone who has 22, 23% plasma cells versus, you know, 45, 50, you know, it's going to be a different discussion each time. But I think it's a very important first step. And I think this sets up the stage for us to design clinical trials where we can ask other questions on what would be better than daratumumab alone in terms of delaying progression in these patients. The other thing that I do want to highlight, and Vincent touched upon this a little bit, that the treatment in this clinical trial was for a fixed duration of treatment. So it was not forever treatment. This is maybe something that Vincent, you can even comment on a little bit more because the question we get after having this discussion is, "Okay, what do we do with patients who are going to be progressing to active myeloma?" Whether we can utilize anti-CD38 therapies for those. So Vincent, I would love your take on this too. Dr. Vincent Rajkumar: Yeah, I think, you know, the main philosophical change for me was previously, the thing was 'don't treat', and now for high-risk smoldering multiple myeloma, the question is, is daratumumab the best treatment or can we do something better? And those trials are thankfully ongoing. One of them has already completed accrual, isatuximab-len-dex versus len-dex. And another one is ongoing in ECOG, almost close to finishing accrual. And in the future, we'll be trying to see if we can use early intervention to even cure and prevent progression altogether.  So we are in this phase where we have one approved regimen, one approved drug, and we are not sure whether we can improve on that. The question is, "is a myeloma-like therapy better than monotherapy" would be the next question, and then what would we do further beyond that? In this context, whenever we have patients like this, one of the questions that comes up, as Saad mentioned, is how does this affect newly diagnosed myeloma therapy if somebody has been treated for smoldering and things like that? How will they be considered for clinical trials? Would they be considered as relapse myeloma or still newly diagnosed myeloma? And those are important discussions for clinical trialists to keep in mind, but I think for clinical practice, your duty is to the patient in front of you. If they have high-risk smoldering myeloma and there's data that there's treatments that can delay progression significantly, delay the need for myeloma therapy significantly, that's the highest priority. We'll cross that bridge.   There are so few patients going on clinical trials right now that if such a patient were to later on progress and wants to enter in a newly diagnosed myeloma trial later, years later, we can figure that out later. I feel like the most important discussion is what to do for that patient today. I still prefer a clinical trial if one was available. If one was not available, I'd prefer early intervention, but have an informed discussion with the patient because some of them may wish to delay therapy still. Some of them may have very borderline numbers that you want to watch them closely. Some of them may be having other comorbidities that prevent need for therapy. Some of them maybe have had the smoldering for a long time and you already know it's stable. So a lot of factors go in, and I think it's not a one-size-fits-all. Dr. Monty Pal: This is a terrific discussion, and you know, it sort of segues into maybe a question around biology. And this is something I was going to get to a little bit later, but Saad, I'm glad you brought it up. I'll liken it to the only thing I know, which is kidney cancer. So, you know, in kidney cancer, we use checkpoint inhibitors as adjuvant therapy. And there's this question of whether or not it breeds some resistance in the localized setting to ultimately what the patient might potentially be exposed to in the metastatic setting. Tell me your thoughts on this, Vincent, then maybe Saad separately. If you treat a patient with daratumumab in this high-risk smoldering setting, could it theoretically sort of limit options in the refractory setting now that we have regimens like DRBD that are kind of being utilized, or daratumumab with teclistamab? Vincent, I'll throw that to you first. Dr. Vincent Rajkumar: This is a great question, and it's usually asked when we've done the lenalidomide trials actually. We try to put the question back. If that was your concern, how would you actually solve it? Is it really biology that's going to answer that? Or is it a randomized trial? So the experiment has been done three times now where early intervention has been given. And if there was some detriment because of that, that would be reflected in the overall survival. In all three trials, there's no such detriment seen. In the first lenalidomide-dex trial, there was an improvement in overall survival. In the AQUILA trial again, the confidence interval doesn't cross one, and patients had better long-term survival on AQUILA, but certainly not less. We've also examined PFS2 data, and that doesn't seem to be affected. So yes, there is a theoretical concern, and that concern cannot be allayed for new treatments which we have not even tried, like tec-dara, and whether that effect would be there or not. But so far, I don't see it. And I think the onus is on proof of that in order to prevent people from getting early therapy. Dr. Monty Pal: Yeah. Saad, your thoughts on that? And before you jump in, I'll mention, we're kind of taking the same approach in kidney cancer, we're trying to really do studies to see whether or not, you know, immunotherapy rechallenge in these contexts, you know, really lends any substantial benefit. So far, the results have been interesting. I don't think we have enough numbers as yet to capture the impact of adjuvant therapy as it translates to metastatic, but I see so many similarities between the scenarios that you're facing in myeloma and what we're facing in RCC. Saad, your thoughts? Dr. Saad Usmani: Thanks, Monty. I'll go back to something that Vincent alluded to a few minutes ago about the way that we risk-stratify patients within smoldering myeloma. Right now, we are relying more on a disease burden-based stratification looking at the percentage of plasma cells in the bone marrow, the monoclonal protein, as well as the involved light chain versus the uninvolved light chain ratio. However, there are efforts underway to actually incorporate genomics into that schema and try to refine that definition of high-risk smoldering. And there have been two papers that came out in the latter half of last year. In fact. Dr. Rajkumar and I are co-senior authors on one effort where we can identify genomic myeloma in patients in precursor conditions. One of the key things that came out of that effort was that within the high-risk smoldering myeloma category, about 90% of the patients are genomically myeloma. So this whole debate of whether we need to intervene for those patients, I think, you know, we have sufficient biologic evidence that yes, we need to intervene for those patients.  I think that the next real step, like Vincent stated, is how do we intervene in those patients? And those clinical trials kind of are ongoing. We will probably need to have more validation of those genomic models being incorporated, but that's what I see in the future. I wouldn't be concerned for the patients being seen today with that query about the disease biology evolving because if I'm seeing a patient today in March of the first quarter of 2026 and offering them monotherapy daratumumab in their high-risk smoldering situation for the next 3 years and then they progress to myeloma after another couple of years, we are talking about what would be the treatment options for them in 2031, 2032. So I think the field is moving so fast, we have a lot of novel therapies coming into that frontline setting rapidly, so our options at that time would be very different. So, you know, I just wanted to kind of set up the stage for saying, you know, our tools are getting better in delineating which patients will need that intervention. And then eventually, I think, you know, we'll have much better options for newly diagnosed myeloma patients at the time when they need it in the future. Dr. Monty Pal: Just absolutely brilliant, absolutely brilliant. I love that summary. I think that you're absolutely right in saying that, you know, you've got to think about what you're going to do for that patient sort of in the moment, what's going to optimize their outcome and agree that the landscape is evolving very rapidly.  I'd be remiss, Saad, if I didn't ask you about something that I've been following in terms of your career trajectory. You've developed quite a reputation for your leadership in trials looking at CAR T-cell therapies for myeloma. Can you give us a sense of where that stands in broad terms? Dr. Saad Usmani: Certainly, Monty. I think the CAR Ts have slowly made their way from late relapse to early relapse. And now we have clinical trials that have completed accrual in the frontline setting comparing them to standard-of-care treatment for both older myeloma patients or transplant-ineligible patients, as well as younger transplant-eligible patients where we're actually trying to replace transplants with BCMA-directed CAR T-cell therapies. The nuance there would be we want to equal or better the survival outcomes that we've accomplished without compromising on the safety side of things for patients. Those therapies are moving into earlier lines. And more excitingly, you know, that's just the first wave of CARs. The next wave of CAR technology is coming, and it's going to be in vivo CARs where we may not need lymphodepleting chemotherapy, we may not even need as stringent regulatory nuances that we do for cellular therapies today. So, you know, I think the field is moving rapidly, and it's going to be a very interesting landscape to see over the next 5 to 6 years. Dr. Monty Pal: Yeah, you know, it's so interesting. I know in the solid tumor space, we're trying to replicate the success that you've had with CAR T and bispecifics, and I do see some light at the end of the tunnel. I'm seeing some really promising agents being developed, but clearly, we have so much to learn from our colleagues in hematology. Well, I have to tell you, this has just been a phenomenal conversation. Vincent, congratulations on your leadership of the AQUILA trial. Clearly, a big paradigm shift in the field. Saad, thank you for offering your expert insights and really giving us also a glimpse at the future of myeloma. Really appreciate having you both on the podcast today. Dr. Vincent Rajkumar: Thank you, Monty. Dr. Saad Usmani: Thank you so much. Dr. Monty Pal: And thank you so much to our listeners for your time today. Finally, if you value the insights that you hear from the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: 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. Follow today's speakers:      Dr. Monty Pal    @montypal   Dr. Vincent Rajkumar @VincentRK Dr. Saad Z. Usmani @szusmani   Follow ASCO on social media:           ASCO on X     ASCO on Bluesky          ASCO on Facebook           ASCO on LinkedIn           Disclosures:        Dr. Monty Pal:      Speakers' Bureau: MJH Life Sciences, IntrisiQ, Peerview      Research Funding (Inst.): Exelixis, Merck, Osel, Genentech, Crispr Therapeutics, Adicet Bio, ArsenalBio, Xencor, Miyarsian Pharmaceutical    Travel, Accommodations, Expenses: Crispr Therapeutics, Ipsen, Exelixis    Dr. Vincent Rajkumar: Honoraria: Research to Practice, Medscape Patents, Royalties, Other Intellectual Property: Authorship Royalties from Up To Date Dr. Saad Usmani: Consulting or Advisory Role: Janssen Oncology, GlaxoSmithKline, Abbvie, Bristol-Myers Squibb/Celgene, Regeneron, AstraZeneca, Sanofi Research Funding: Janssen Oncology, Bristol-Myers Squibb, K36 Therapeutics, Abbvie, Regeneron  

A young mother’s journey unfolds steeped in heartache and tragedy. Also, check our new true crime podcast, For My Man, on the Urban One Podcast Network https://www.urban1podcasts.com/for-my-man-true-crime Music Credits: John B. Lund/Shadowed/Courtesy of www.epidemicsound.com Anna Dager/Suspension/Courtesy of www.epidemicsound.com Jo Wandrini/The Arctic/Courtesy of www.epidemicsound.comSee omnystudio.com/listener for privacy information.

Dans cet épisode, je lève le voile sur une étape clé de la maladie : la forme secondairement progressive de la SEP. Je vous explique pourquoi le handicap peut s'aggraver de façon plus continue, indépendamment des poussées, notamment à cause du phénomène de "Smoldering MS", cette neuroinflammation à bas bruit qui travaille dans l'ombre. On discute ensemble de la difficulté du diagnostic, de l'importance cruciale d'une équipe pluridisciplinaire pour vous entourer, mais aussi des réels espoirs portés par les nouvelles molécules de demain !MAT-FR-2600106-01/26 Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.

In this episode of the Oncology Brothers podcast, we dived into the recent FDA approval of daratumumab for high-risk smoldering myeloma, based on the groundbreaking AQUILA study. We were joined by Dr. Vincent Rajkumar, a world-renowned myeloma specialist, who provided valuable insights into the complexities of smoldering myeloma, its risk stratification, and the implications of early intervention. Key topics discussed included: • The definition and classification of smoldering myeloma • The design and findings of the AQUILA trial • The significance of time to progression and overall survival in treatment • The risk-benefit analysis of daratumumab therapy, including potential side effects • Future directions in myeloma treatment and ongoing research Join us for an informative discussion as we bridge the gap between academic research and community practice, helping healthcare professionals and patients navigate the evolving landscape of myeloma treatment. Follow us on social media: •⁠  ⁠X/Twitter: https://twitter.com/oncbrothers •⁠  ⁠Instagram: https://www.instagram.com/oncbrothers •⁠  Website: https://oncbrothers.com/ Don't forget to like, subscribe, and check out our other episodes for more insights on treatment algorithms, conference highlights, and FDA approvals!

You have to literally disobey an order in California to be held in contempt. But federal courts are a little more touchy-feely: they will find a contempt for violating the “spirit” of their orders. Tim and Jeff compare the Ninth Circuit's contempt finding against Apple in the Epic Games dispute, and a state litigant who got around a visitation-time order but without violating the letter of the order, so no contempt.Meanwhile, a CEQA plaintiff that won at the Court of Appeal—only to be reversed by emergency legislation and the Supreme Court—learned the hard way that "prevailing" on the law as written means nothing if the Legislature rewrites the rules mid-case.Key points:Contempt requires literal violation in California, not just bad faith. But in federal court, violating the “spirit” of an order is contempt.Legislative abrogation torpedoed $1.2M in CEQA fees: Plaintiffs in Make UC a Good Neighbor v. Regents won significant CEQA victories establishing that crowd noise and alternative locations must be analyzed—then watched the Legislature pass emergency legislation abrogating both holdings. After the Supreme Court reversed, the Court of Appeal denied nearly $1.2 million in private attorney general fees, calling the prior opinion "smoldering ruins, not citable precedent." The court held plaintiffs weren't "successful parties" because they failed to halt the project, even though they vindicated principles under the law as it existed when filed.Ninth Circuit discovery ruling survives en banc review: The court declined to rehear the Trump administration's challenge to a discovery order requiring production of federal reorganization and layoff plans, rejecting executive privilege claims without requiring plaintiffs to show bad faith. Judge Bumatay's dissent warned of a "binding dicta trap" where the panel's comments on what qualifies as deliberative could become binding precedent.California Supreme Court limits Public Records Act obligations: Superior Courts can issue declaratory relief even after documents are produced if the dispute is likely to recur, but the Public Records Act does not impose a statutory duty to preserve documents a public agency identifies as exempt.

In this year's season premiere, I return to my series on the myths and legends of the Indiana Jones franchise, this time examining the ideas underpinning the recent video game, Indiana Jones and the Great Circle, leading me to all kinds of claims about ancient landmarks aligning and their origin in the concept of ley lines. Check out ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠the show merch⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠, perfect for gifts!  ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Pledge support on Patreon to get an ad-free feed with exclusive episodes!⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Check out my novel, Manuscript Found!⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Direct all advertising inquiries to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠advertising@airwavemedia.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠. Visit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.airwavemedia.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ to find other high-quality podcasts! Some music in this episode was licensed under a Blue Dot Sessions blanket license at the time of publication. Tracks include "Cicle DR Valga," "JoDon," "Access Road 442," "Game Lands," "Aloscape 2," and "Vellum and Steel." Additional music, including "Remedy for Melancholy," "Smoldering," "Sentinel," "daemones," and "Cold War Echo," by Kai Engel, licensed under Creative Commons (CC BY 4.0) Learn more about your ad choices. Visit megaphone.fm/adchoices

ABOUT SILVERDALE BAPTIST CHURCH Silverdale exists to lead people into an authentic relationship with Christ so they will worship God, grow in their faith, and serve the Lord in our community and world. Silverdale's Lead Pastor is Tony Walliser. FIND US ONLINE Website http://silverdalebc.comYouTube: https://www.youtube.com/silverdalebcInstagram https://www.instagram.com/silverdalebcFacebook: https://www.facebook.com/silverdalebc

The Planescape Torment podcast from Duckfeed.tv with art by Drew Weing and music by Gwen StaticIn this episode we watch someone burn alive.Other Segments:Cutter's Dark for Berks: AbishaiManual of the Planes: Primes

The way that we think about smoldering multiple myeloma (SMM) has continued to see evolution in the plasma cell dyscrasia space. If this diagnosis portends a higher risk of developing multiple myeloma, how should we manage patients to prevent possible end-organ damage? Is it a one-size-fits-all approach or are there some patients who are higher risk for progression than others? We cover this and so much more in this new episode! This episode is brought to you by PrimumContent:- What is smoldering multiple myeloma (SMM)?- What are higher risk features of SMM? - What are landmark studies in SMM? - To treat or not to treat? ** This episode is brought to you by Primum: http://primum.co/fellows** Want to review the show notes for this episode and others? Check out our website. Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Youtube

Send us a textGenesis 15 is the moment God locks in the future for Abram. When a deep, terrifying darkness falls, Abram witnesses the ancient, solemn ritual of the Covenant of the Pieces. Discover the meaning of the smoking pot and flaming torch that pass between the animal sacrifice, securing God's land promise not based on Abram's effort, but solely on God's unbreakable commitment. This chapter also contains the shocking prophecy of his descendants' 400 years of captivity. Fire, blood, and a guaranteed future.Contact us at-Email-wildwomeninchrist@gmail.comInstagram-@wildwomeninchristFacebook-Wild Women in ChristThanks for listening!!!

In today's episode, we continue our myeloma series, this time we'll delve deeper into the spectrum of plasma cell dyscrasias, including defining MGUS, discussing surveillance of MGUS, defining smoldering myeloma (SM). We are slowly inching our discussion towards the diagnosis of Multiple myeloma (MM)!Content:- Defining MGUS- Discussing risk of progression of MGUS to MM- How to interpret free light chains in renal failure- How do we monitor MGUS patients?- When do we do additional testing in MGUS?- What is smoldering myeloma?- What are myeloma defining events?- How do we risk stratify SM patients?- How do we monitor SM patients? Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesThis episode has been sponsored by Primum. To sign up for a free account, check out: tfoc.primum.co ** Want to review the show notes for this episode and others? Check out our website: Love what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Youtube

PREVIEW Pacific Palisades Fire Controversy: State Orders Firefighters to Stand Down Jeff Bliss A fire in Pacific Palisades became a major disaster after a previously burned, smoldering area was allowed to reignite. Video evidence reportedly shows a state worker ordering the LA Fire Department to leave the scene and not extinguish the smoldering underbrush. The stated reason for the order was to protect endangered plants. This response, involving state regulations, is described as "unbelievable foolishness."

NOTE: For Ad-Free Episodes, 100+hrs of Bonus Content and More - Visit our Patreon at https://www.patreon.com/thewheelweavespodcastFind us on our Instagram, Twitter, YouTube & Website, and join the conversation on Discord!In this episode Dani and Brett dicuss Chapter 8 of A Memory of Light!!!We would like to thank and welcome Kele Woodruff, madita michl, and Gandalfred Dumbledore to The Wheel Weaves Patreon Team! Thank you so much for your support!!We would also like to thank Elina Fishel, Tara Pokorney, Ryan Lafond, Gabby Young, and FeeFyFiona for renewing their annual pledges! Thank you so much for your support!!We would like to acknowledge and thank our Executive Producers Brandy and Aaron Kirkwood, Sean McGuire, Janes, LightBlindedFool, Deyvis Ferreira, Green Man, Margaret, Big C, Bennett Williamson, Hannah Green, Noralia, Geof Searles, Erik Reed, Greysin Ishara, Helena Jacobsen, Matthew Mendoza, Cyndi, Sims, Patrick Wallbankk, Manethraen, Andrew Scarponi, and Mr. Boddy's Body!The Wheel Weaves is hosted and edited by Dani and Brett, produced by Dani and Brett with Passionsocks, Cody Fouts, Mozyme, Jamie Young, Jared Berg, Rikky Morrisette, Matt Truss, Antoine Benoit, Ashlee Bradley, MKM, Magen, Colby T, Gabby Young, Ricat, Chris G., Sarah Creech, Saverio Bartolini, Mag621, William Johnson, and Soccerphiles Canada; with music by Audionautix.Check out our partner - the Spoiler-Free Wiki - Spliki.com - Your main first time reader, Spoiler-Free WoT information source!Don't forget to leave us that 5 star review if you enjoy the show for a chance to win exclusive merchandise!Check out https://www.thewheelweavespodcast.com for everything The Wheel Weaves!Become a supporter of this podcast: https://www.spreaker.com/podcast/the-wheel-weaves-podcast-a-wheel-of-time-podcast--5482260/support.

Was this fire preventable?See omnystudio.com/listener for privacy information.

Tessa Thompson is solid in "Hedda,” the Amazon Prime reimagining of Ibsen's classic tragedy "Hedda Gabler." Writer/director Nia DaCosta has changed the setting and added lesbian and racial components that Ibsen probably never would have imagined. While not all of DaCosta's changes work and purists may balk, “Hedda” is a mostly effective update that remains true of Ibsen's themes concerning the dangers of greed, passion and ambition. The animated horror comedy "Stitch Head" is aimed squarely at the kindergarten crowd. It's about the monstrous creations of a mad scientist who are more scared of humans than vice versa. “Stitch Head” is reasonably well animated, but the weak storyline blunts its overall appeal. The devastating Netflix documentary "The Perfect Neighbor" is both enlightening and heartbreaking. Told mostly through footage from police body cams, it depicts the events leading up to a tragic and utterly senseless murder. It's sharply edited and skillfully executed. Smoldering racism and convoluted gun laws are exposed in “The Perfect Neighbor, a thoughtful, disturbing and timely social document. Ethan Hawke gives an impressive performance in Richard Linklater's melancholy “Blue Moon,” a talky drama about famed Broadway lyricist Lorenz Hart whose alcoholism and emotional troubles ruined his successful collaboration with composer Richard Rodgers. The whole movie takes place at Broadway's famed Sardi's restaurant, when Hart's life seemed to unravel on the opening night of Rodgers' biggest hit “Oklahoma!” with his new partner, Oscar Hammerstein. “Blue Moon” is a creative bit of speculation that will appeal mostly to fans of musical theater.

Drs Joseph Mikhael and Peter Voorhees discuss considerations for treating smoldering multiple myeloma, including recent studies and shared decision-making. Relevant disclosures can be found with the episode show notes on Medscape https://www.medscape.com/viewarticle/1002716. The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Observation or Treatment for Smoldering Multiple Myeloma? A Systematic Review and Meta-Analysis of Randomized Controlled Studies https://pubmed.ncbi.nlm.nih.gov/40419473/ Monoclonal Gammopathy of Undetermined Significance https://www.ncbi.nlm.nih.gov/books/NBK507880/ From Criteria to Clinic: How Updated Slim CRAB Criteria Influence Multiple Myeloma Diagnostic Activity https://ascopubs.org/doi/pdf/10.1200/JCO.2024.42.16_suppl.7556 International Myeloma Working Group Risk Stratification Model for Smoldering Multiple Myeloma (SMM) https://pubmed.ncbi.nlm.nih.gov/33067414/ Daratumumab or Active Monitoring for High-Risk Smoldering Multiple Myeloma https://pubmed.ncbi.nlm.nih.gov/39652675/ Lenalidomide-Dexamethasone Versus Observation in High-Risk Smoldering Myeloma After 12 Years of Median Follow-Up Time: A Randomized, Open-Label Study https://pubmed.ncbi.nlm.nih.gov/36067617/ Long-Term Outcome With Lenalidomide and Dexamethasone Therapy for Newly Diagnosed Multiple Myeloma https://pubmed.ncbi.nlm.nih.gov/23648667/ CD38-Directed Therapies for Management of Multiple Myeloma https://pubmed.ncbi.nlm.nih.gov/34235096/ Fixed Duration Therapy With Daratumumab, Carfilzomib, Lenalidomide and Dexamethasone for High Risk Smoldering Multiple Myeloma – Results of the Ascent Trial https://ashpublications.org/blood/article/140/Supplement%201/1830/492739/Fixed-Duration-Therapy-with-Daratumumab Curative Strategy for High-Risk Smoldering Myeloma: Carfilzomib, Lenalidomide, and Dexamethasone (Krd) Followed by Transplant, Krd Consolidation, and Rd Maintenance https://pubmed.ncbi.nlm.nih.gov/39038268/ Early Safety and Efficacy of CAR-T Cell Therapy in Precursor Myeloma: Results of the CAR-PRISM Study Using Ciltacabtagene Autoleucel in High-Risk Smoldering Myeloma https://ashpublications.org/blood/article/144/Supplement%201/1027/531466/Early-Safety-and-Efficacy-of-CAR-T-Cell-Therapy-in

Turning Tides: Algeria will discuss the history of the colonization and subsequent battles which plagued Algeria. The second episode, Smoldering Embers, will cover the period from 1872 to 1954, in which WWI and WWII greatly contribute to the rise in the Algerian nationalist movement.If you'd like to donate or sponsor the podcast, our PayPal is @TurningTidesPodcast1, or you can donate to us through our Buy Me a Coffee link: buymeacoffee.com/theturningtidespodcast. Thank you for your support!Produced by Melissa Marie Brown and Joseph Pascone in affiliation with AntiKs Entertainment.Researched and written by Joseph PasconeEdited and revised by Melissa Marie BrownIntro and Outro created by Melissa Marie Brown and Joseph Pascone using Motion ArrayWebsite: https://theturningtidespodcast.weebly.com/IG/YouTube/Threads/Facebook: @theturningtidespodcastBluesky/Mastodon: @turningtidespodEmail: theturningtidespodcast@gmail.comIG/YouTube/Facebook/Threads/TikTok/Bluesky/Mastodon: @antiksentEmail: antiksent@gmail.comEpisode 2 Sources:1. French Invasion: Algerian Resistance (1830 - 1871), by S.E. Al-Djazairi2. The Algerian War of Liberation, 1954 - 1962, Myths and Lies, by S.E. Al-Djazairi3. A Short History of Algeria, by Lina De Marco4. Commander of the Faithful: The Life and Times of Emir Abd el-Kader: A Story of True Jihad, by John W. Kiser5. The History of Algeria: From Berbers to Independence, by Fatima Linda Haddad6. A Savage War of Peace: Algeria, 1954 - 1962, by Alistair Horne7. https://www.wineenthusiast.com/culture/wine/algeria-wine-history-africa/?srsltid=AfmBOoqKYNVCKsjGg-huHFX4PNKdXHQkVeaegIKLSsD4LQtFcpcsCTVM8. https://www.lemonde.fr/culture/article/2022/01/18/l-algerie-sous-vichy-sur-arte-revient-sur-la-strategie-petainiste-pour-diviser-les-juifs-et-les-musulmans-d-algerie_6110013_3246.html9. https://www.marxists.org/reference/archive/mao/works/1937/guerrilla-warfare/10. Wikipedia

In this episode of The HemOnc Pulse, host Melissa speaks with Omar Nadeem, MD, Senior Physician at Dana-Farber Cancer Institute and Assistant Professor of Medicine at Harvard Medical School, about emerging genomic insights in smoldering multiple myeloma. The discussion focuses on recent research showing how molecular profiling can improve understanding of disease progression and refine risk stratification beyond traditional clinical models. Dr. Nadeem highlights how genomic data may help distinguish patients with smoldering myeloma who are at higher risk of progression from those likely to remain stable, offering the potential to guide more personalized treatment decisions. The conversation also explores the evolving landscape of precursor plasma cell disorders and the role of immunotherapy, including CAR T-cell therapy, in clinical management.      

A couple who hired house sitters discovered they were actually professional thieves. The city of Vernon, in southeast Los Angeles County, was named the most burglarized city in California by Safewise, while an apartment shooting in Sun Valley left three teenagers injured and the suspect remains at large. Officials continue to monitor the Palisades Fire, which has been smoldering for seven days—fires can persist underground for months, even under snow. A man shared a disturbing account of a ride with an Uber driver now accused of starting the blaze. The show wrapped with Gary & Shannon joining Tim Conway Jr. for a skit parodying a man using Ted Bundy–style tactics. 

Beaten & Burned: A son reports his mom as missing...only for cops to later find her burned body, including a charred spine, in a backyard fire pit. A boyfriend shoots a mom of 3 dead...in front of her kids - then livestreams her lifeless body online. Plus, a lawsuit exposes the naked truth at a Cali resort! Jennifer Gould reports. See omnystudio.com/listener for privacy information.

Send us a textA roaring fire feels timeless, but the way we move heat and smoke has changed dramatically—from open hearths that once filled rooms with fumes to thoughtfully engineered systems that keep warmth in and hazards out. We explore how castles got away with walk-in fireboxes, why Count Rumford's angled design still matters, and how Benjamin Franklin's stove reinvented efficiency by keeping more heat where you need it.We also get practical about safety. You'll hear why clay flue liners became a turning point, how the late adoption of refractory mortar left older chimneys vulnerable, and what today's repair options look like—from one-piece stainless liners to in-place relining systems. We break down the hidden risks inside manufactured chases, where a small misalignment can leak heat into wood framing and quietly prime a structure fire. And we draw a hard line between chimney fires fueled by creosote and full-on house fires caused by heat escaping the flue path.If you burn wood, the big lesson is simple: avoid “low and slow.” Smoldering fires invite creosote, and creosote can burn near 2,000°F, cracking tiles and opening pathways to nearby framing. We share real-world tips for hot, efficient burns, using stovepipe thermometers, caring for catalytic combustors, scheduling chimney sweeps, and understanding the basic anatomy of your system—firebox, damper, smoke chamber, and flue—so you can spot trouble early. Subscribe for more smart home know-how, share this with someone who loves their fireplace, and leave a review with your best fire-safety habit—we'll feature our favorites next time.Support the showTo learn more about Habitation Investigation, the Three-time Winner of the Best Home Inspection Company in the Midwest Plus the Winner of Consumer Choice Award for Columbus Ohio visit Home Inspection Columbus Ohio - Habitation Investigation (homeinspectionsinohio.com) NBC4 news segments: The importance of home inspections, and what to look for | NBC4 WCMH-TV Advice from experts: Don't skip the home inspection | NBC4 WCMH-TV OSU student's mysterious symptoms end up tied to apartment's air quality | NBC4 WCMH-TV How to save money by winterizing your home | NBC4 WCMH-TV Continuing Education for Ohio Agents Scheduled classes Continuing Education for Ohio Agents Course lis...

Welcome to Tales from the Waystone; Summer Reading Program - Starter Villain; And You'll Know Him by the Trail of Smoldering Hotel Rooms In His Wake, where we will be going over chapters 17-20 of John Scalzi's comedic sci-fi novel Starter Villain. There will continue to be talking dolphins. For Apple Podcast listeners, please consider rating the show and leaving us a review! It'll help us be seen by more people! We have a Patreon! Patreon.com/waystonepod! Also!!! Join our Discord! Phoenix is probably going nuts with boredom because they gave themselves 6+ weeks off from editing and won't be able to be very active for a while! Come over and chat! https://discord.gg/ebDBWfrU9V Thing of the Week: Blue Prince

Already, the group finds themselves with a busy day in Osthamana, with an even busier night ahead. Between family, and friends, and not-a-dates to go on there is much to do... Music in this episode is: "Suonatore di Liuto" by Kevin MacLeod, Licensed under Creative Commons: By Attribution 4.0 License, Incompetech; "Long Note Two" by Kevin MacLeod, Licensed under Creative Commons: By Attribution 4.0 License, Incompetech; "Twilight" by Tyler and Noah Rich, Licensed under Creative Commons: By Attribution 4.0 License, Monumental Studios; "Gates" by Sergey Cherimisinov, Licensed under Creative Commons: Attibution-NonCommercial 4.0 International, Free Music Archives; "Innkeeper" by Tyler and Noah Rich, Licensed under Creative Commons: By Attribution 4.0 License, Monumental Studios; "River Fire" by Kevin MacLeod, Licensed under Creative Commons: By Attribution 4.0 License, Incompetech; "Existing" by Tyler and Noah Rich, Licensed under Creative Commons: By Attribution 4.0 License, Monumental Studios; "Virtutes Instrumenti" by Kevin MacLeod, Licensed under Creative Commons: By Attribution 4.0 License, Incompetech; "Long Note One" by Kevin MacLeod, Licensed under Creative Commons: By Attribution 4.0 License, Incompetech; "Forsaken Sanctum" by Tyler and Noah Rich, Licensed under Creative Commons: By Attribution 4.0 License, Monumental Studios; "Back To Home" by Sergey Cherimisinov, Licensed under Creative Commons: Attibution-NonCommercial 4.0 International, Free Music Archives; "Smoldering" by Kai Engel, Licensed under Creative Commons: Attibution-NonCommercial 4.0 International, Free Music Archives;     Sound Effects by Epidemic Sound, Mixkit and Pixabay

Welcome to Tide Talk!Ryan and Matt talk RIFC's 1-0 home USL Championship win over Indy Eleven, share your thoughts and MORE!Up The Tide!https://linktr.ee/tidetalkri

Men. Emotions. Eros. Need I say more?

Caregiving often hides what I call smoldering rage—resentment that simmers quietly until a fresh crisis ignites it like a wildfire. In this week's Hope for the Caregiver radio show, I open with a monologue about those hidden embers, drawing from Montana's fire season to show how caregivers can confront resentment and apply God's grace before it consumes us. The program closes with a hymn every caregiver needs: “Be Still, My Soul.” Gracie's a cappella performance of this timeless hymn reminds us that God's faithfulness steadies us when caregiving feels unbearable and that the daily grind of service is, in fact, holy work. This episode also features excerpts from my conversation with author and fellow caregiver Jess Ronne, whose story of loss, resilience, and faith offers a powerful reminder that we're not alone in this journey.

AP correspondent Charles de Ledesma reports a blistering heatwave is gripping southwest France, sending thermometers soaring to 43 degrees Celsius - nearly 110 degrees Fahrenheit.

Figuring out if your multiple sclerosis is changing from the relapsing remitting to the secondary progressive stage can be murky. Signs of progression are discussed like slower walking and worsening memory. The underlying reasons for progression are revealed including nervous system injury, remyelination failure, chronic inflammation and aging. Practical ways to improve progressive symptoms are shared. Successful trials for disease-modifying therapy for secondary progressive multiple sclerosis (SPMS) are highlighted. Tolebrutinib, under expedited review by the FDA, has been shown to slow down progression in SPMS patients by targeting cells in the central nervous system causing chronic inflammation. Introducing our new co-host Jamie Holloman MD from The MS Center for Innovations in Care!  Dr. Holloman completed in neurology residency at Washington University, followed by a 3-year fellowship at the Cleveland Clinic.  He interviews: Christopher Laganke MD, Founder of the Joanne P. LaGanke MS Center, Cullman, Alabama Barry Singer MD, Director of The MS Center for Innovations in Care, Missouri Baptist Medical Center, St. Louis    

The party concludes its horrifying, desperate battle against the macaroni oozes.WebsiteDiscordTwitterPathfinder Second Edition and the Kingmaker Adventure Path are published by Paizo."Take the Lead" and other featured music were composed by Kevin MacLeod and licensed under Creative Commons by: Attribution 4.0 License.All ambiances were composed by Michael Ghelfi Studios.The Zero Check are committed to providing an inclusive and respectful experience to all listeners, but we also recognize and acknowledge that we are limited by our individual frames of reference. If we misstep, please let us know. Email all feedback to feedback@zerocheckpodcast.com.Thank you for listening to The Zero Check. Send us a text

Jason takes a break from our study of Acts to bring us the message: "Bruised Reeds Smoldering Wicks". If you are struggling with faith, bring what you have to God, and ask for help, so that he can repair your faith.

Faced with a seemingly unwinnable fight and the option to flee, Sirio must decide whether to hold firm with his party.WebsiteDiscordTwitterPathfinder Second Edition and the Kingmaker Adventure Path are published by Paizo."Take the Lead" and other featured music were composed by Kevin MacLeod and licensed under Creative Commons by: Attribution 4.0 License.All ambiances were composed by Michael Ghelfi Studios.The Zero Check are committed to providing an inclusive and respectful experience to all listeners, but we also recognize and acknowledge that we are limited by our individual frames of reference. If we misstep, please let us know. Email all feedback to feedback@zerocheckpodcast.com.Thank you for listening to The Zero Check. Send us a text

Hawk gives his insight on the Browns drafting Shedeur Sanders, Mike Ryan previews Pat Riley's exit press conference and Roy tells us where he was when his neighbor's house set on fire. Learn more about your ad choices. Visit podcastchoices.com/adchoices

r prorevenge where Old Balls Got Handed to Him You abandoned me, so I won't dance with you Real Estate Agent tested me after an international flight I guess It's a "penny" revenge Smoldering butts Keep your rat hands off my popsicle. You want me to sing? I'll sing I'm wrong because you have a higher position? Get smacked. I tried to help us! Bank Customer stymied... I stole his ashes out of spite Hosted on Acast. See acast.com/privacy for more information.

The LoG return home to Downton Abbey for a Springtime surprise. Mary is knee deep in her new boyfriend drama, juggling Charles Blake and Tony Gillingham. Mr. Bates goes for a day trip. Can Cora plan the bazaar without Robert? To support the LoG on Patreon visit: https://www.patreon.com/lordsofgrantham To buy LoG Merchandise visit: https://www.teepublic.com/user/lords-of-grantham-podcast

On Open Line CHATT, Dr. Michael Rydelnik answers questions about verses from Isaiah 42; are they Messianic descriptions of Jesus leading up to Isaiah chapter 53? Michael also addresses questions about women who served at the tabernacle, about the festival in John chapter 7, and about when Jesus said that there will be a time when all who are in their graves will hear His voice and come out. 'What exactly does that mean, and when will that occur?'Donate to Moody Radio: http://moodyradio.org/donateto/morningshow/wmbwSee omnystudio.com/listener for privacy information.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/DWJ865. CME credit will be available until April 2, 2026.BTK Inhibition as an MS Treatment Strategy: Targeting Smoldering Neuroinflammation In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/DWJ865. CME credit will be available until April 2, 2026.BTK Inhibition as an MS Treatment Strategy: Targeting Smoldering Neuroinflammation In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/DWJ865. CME credit will be available until April 2, 2026.BTK Inhibition as an MS Treatment Strategy: Targeting Smoldering Neuroinflammation In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Sanofi.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME information, and to apply for credit, please visit us at PeerView.com/DWJ865. CME credit will be available until April 2, 2026.BTK Inhibition as an MS Treatment Strategy: Targeting Smoldering Neuroinflammation In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Sanofi.Disclosure information is available at the beginning of the video presentation.

Returning to the show, Drs. Vincent Rajkumar and Aaron Goodman engage in a dynamic debate over the evolving landscape of smoldering multiple myeloma, focusing on the highly anticipated study recently co-authored by Dr. Rajkumar and published in The New England Journal of Medicine after being presented at ASH 2024. They dissect the study's findings, which highlight the impact of early intervention with daratumumab in delaying disease progression for patients classified as high-risk. The discussion explores the nuances of smoldering myeloma classification, the controversy surrounding risk stratification, and the historical context of prior studies that failed to change clinical practice. With their expert insights, Drs. Rajkumar and Goodman break down the implications of this research, questioning whether it truly shifts the standard of care and what it means for future treatment approaches. View the NEJM publication. https://www.nejm.org/doi/abs/10.1056/NEJMoa2409029 Check out Chadi's website for all Healthcare Unfiltered episodes and other content. www.chadinabhan.com/ Watch all Healthcare Unfiltered episodes on YouTube. www.youtube.com/channel/UCjiJPTpIJdIiukcq0UaMFsA

This special episode of RealTalk MS is sponsored by Sanofi.  By now, you may have come across the term smoldering MS and wondered what it means. An international panel of MS experts has published a consensus statement on the definition, biology, and clinical implications of smoldering MS. Joining me is the lead author of that paper, Dr. Antonio Scalfari. Dr. Antonio Scalfari has a research background in multiple sclerosis and neuro-inflammatory conditions. From 2003 to 2006, he was a clinical fellow in the neurology department of Oxford University. In 2011, Dr. Scalfari obtained his PhD in neuro-epidemiology at Imperial College London, where he was then a post-doctorate research fellow from 2011 to 2013. Since 2006, Dr. Scalfari has been working at the London North West Healthcare NHS Trust, and in 2013, he started working at the multiple sclerosis unit at Imperial College Healthcare NHS Trust. In 2017, Dr. Scalfari was appointed as a substantive consultant neurologist. Along with other consultants, he manages the multiple sclerosis and neuro-inflammatory diseases service at Charing Cross and St Mary's hospitals and is a general neurologist at London North West Healthcare NHS Trust. Sanofi convened the meetings and paid for medical writing assistance, but the authors worked independently to develop and draft the consensus statement. While Dr. Scalfari has been compensated by Sanofi, his views and opinions are his own and do not necessarily reflect those of Sanofi.

Episode 184: Multiple Myeloma BasicsSub-Interns and future Drs. Di Tran and Jessica Avila explain the symptoms, work up and treatment of multiple myeloma. Written by Di Tran, MSIV, Ross University School of Medicine; Xiyuan Yang, MSIV, American University of the Caribbean. Comments by Jessica Avila, MSIV, American University of the Caribbean. Edits by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Di: Hi everyone, this is Di Tran, 4th year medical student from Ross university.  It's a pleasure to be back.  To be honest, this project is a part of teamwork of two medical students, myself and another 4th year, her name is XiYuan.  She came from the AUC. Unfortunately, due to personal matters she was unable to make it to the recording today which makes me feel really sad. Jessica: My name is Jessica Avila, MSIV, American University of the Caribbean.Di: The topic we will present today is Multiple Myeloma. Multiple myeloma is typically a rare disease and it's actually a type of blood cancer that affects plasma cells in the bone marrow.Jessica: Let's start with a case: A 66-year-old male comes to his family doctor for an annual health checkup. He is not in any acute distress but he reports that he has been feeling tired and weaker than usual for the last 3 months. He also noticed that he tends to bruise easily. He has a history of arthritis and chronic joint pain, but he thinks his back pain has gotten worse in the last couple of months. Upon checking his lab values, his family doctor found that he has a calcium level of 10.8 and a creatinine level of 1.2, which has increased from his baseline. Given all that information, what do you think his family doctor is suspecting? And what kind of tests she can order for further evaluation?Di: Those symptoms sound awfully familiar – are we talking about the CRAB? You know, the diagnostic criteria for Multiple Myeloma.Jessica: Exactly! Those are called “myeloma-defining events.” Do you remember what those are?Di: CRAB criteria comes in 4 flavors.  It's HYPERCALCEMIA with >1mg/dL, RENAL INSUFFICIENCY with serum creatinine >2mg/dL, ANEMIA with hemoglobin value 10% plasma cells, PLUS any one or more of the CRAB features, we can make the official diagnosis of multiple myeloma. Di:  Before we go deeper, let's back up a little bit and do a little background.  So, what do we know about the immunoglobulins, also known as antibodies? Back from years of studying from medical school, we know that the plasma cells are the ones that producing the antibodies that help fight infections.  There  are various kinds that come with various functions.  Each antibody is made up of 2 heavy chains and 2 light chains.  For heavy chains, we have A, D, E, G, M and for light chains we have Kappa and Lambda.Jessica: Usually, the 5 possible types of immunoglobulins for heavy chains would be written as IgG, IgA, IgD, IgE, and IgM.  And the most common type in the bloodstream is nonetheless the IgG. Di: What is multiple myeloma? In myeloma, all the abnormal plasma cells make the same type of antibody, the monoclonal antibody.  The cause of myeloma is unknown, but there are lots of studies and evidence that show a number of potential etiologies, including viral, genetic, and exposure to toxic chemicals, especially the Agent Orange, which is a chemical used as herbicide and defoliant. It was used as a chemical warfare by the U.S. military during the Vietnam War from 1961 to 1971.Jessica: We need to order some specific blood tests to see if there is elevated monoclonal proteins in the blood or urine. So, to begin with we'll need to take a very thorough history and physical exam. Next, we'll do labs, such as CBC, basic metabolic panel, calcium, serum beta-2 microglobulin, LDH, total protein, and some not so common tests: serum protein electrophoresis (SPEP), immunofixation of blood or urine (IFE), quantitative immunoglobulins (QIg), serum free light chain assay, and serum heavy/light chain ratio assay.If any of the results is abnormal, we should consider referring our patient to an oncologist.Di: Interesting! I read that Multiple Myeloma symptoms vary in different patients.  In fact, about 10-20% of patients with newly diagnosed myeloma do not have any symptoms at all.   Otherwise, classic symptomatic presentations are weakness, fatigue, increased bruising under the skin, reduced urine output, weakened bones that is likely prone to fractures, etc. And if multiple myeloma is highly suspected, a Bone Marrow biopsy should be done with testing for flow cytometry and fluorescent in situ hybridization (FISH). Actually, if any of the “Biomarkers of malignancy (SLIM)” is met we can also diagnose multiple myeloma even without the CRAB criteria. Jessica: The diagnosis is made if one or more of the following is found: >= 60% of clonal plasma cells on bone marrow biopsy, > 1 lytic bone lesion on MRI that is at least 5mm in size, or a biopsy confirmed plasmacytoma. Di: Imaging comes in at the final step especially if we able to find one or more sites of osteolytic bone destruction > 5mm on an MRI scan.Jessica: What if the bone marrow biopsy returns > 10% of monoclonal plasma cells, but our patient doesn't have either the CRAB or the Biomarker criteria? Di: That's actually a very good question, since Multiple Myeloma is part of a spectrum of plasma cell disorders. That's when smoldering myeloma comes into play. It is a precursor of active multiple myeloma. Smoldering myeloma is further categorized as high-risk or low-risk based on specific criteria.A less severe form is called Monoclonal Gammopathy of Undetermined Significance, or simply MGUS, with < 10% bone marrow involvement. Those are diagnoses we give once we rule out actual multiple myeloma, which are defined by the amount of M-protein in the serum.Jessica:  When to get started on treatment? Multiple Myeloma is on a spectrum of plasma cells proliferative disorders, starting from MGUS to Smoldering Myeloma, to Multiple Myeloma and to  Plasma Cell Leukemia.  Close supervision/active watching is enough for MGUS and low risk Smoldering Myeloma. But once it has progressed to high-risk smoldering myeloma or to active Multiple Myeloma, chemotherapy is usually required. Some situations may require emergent treatment to improve renal function, reduce hypercalcemia, and to prevent potential infections.Di: As of 2024, treatment of Multiple Myeloma comprises the Standard-of-Care approved by the FDA. In fact, the quadruple therapy is a combination of 4 different class of drugs that include a monoclonal antibody, a proteasome inhibitor, an immunomodulatory drug, and a steroid. Jessica: They are Darzalex (daratumumab), Velcade (bortezomib), Revlimid (lenalidomide) and dexamethasone.  Other treatment plans for Multiple Myeloma include chemotherapy, immunotherapy, radiation therapy (for plasmacytomas) and stem cell transplants. The patient will also be on prophylaxis acyclovir and Bactrim while on chemotherapy. Sometimes anticoagulants are also considered because the chemo increases the risk of venous thromboembolic events.Di: Although the disease is incurable, but with the advancing of novel therapies and clinical trials patients with multiple myeloma are able to live longer.  Problem is the majority of patients diagnosed with Multiple Myeloma are older adults (>65), the risk of falling is adding to multiple complications of the disease itself, such as bone density loss, pain, neurological compromises, distress and weakness.  Palliative care may come in help at any point in time throughout the course of treatment but is most often needed at the very end of the course. Jessica, can you give us a conclusion for this episode?Jessica: Multiple Myeloma may not be the most common cancer, but we have to be aware of the symptoms and keep it in our differential diagnosis for patients with bone pain, easy bruising, persistent severe headaches, unexplained renal dysfunction, and remember the CRAB: HyperCalcemia, Renal impairment, Anemia and Bone lesions.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:International Myeloma Foundation. (n.d.). International Myeloma Working Group (IMWG) criteria for the diagnosis of multiple myeloma. https://www.myeloma.org/international-myeloma-working-group-imwg-criteria-diagnosis-multiple-myeloma Laubach, J. P. (2024, August 28). Patient education: Multiple myeloma symptoms, diagnosis, and staging (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/multiple-myeloma-symptoms-diagnosis-and-staging-beyond-the-basics.University of California San Francisco. (n.d.). About multiple myeloma. UCSF Helen Diller Family Comprehensive Cancer Center. https://cancer.ucsf.edu/research/multiple-myeloma/about Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/.

Patreon preview. Unlock full episode at https://www.patreon.com/stavvysworld Tommy McNamara joins the pod to discuss growing up in Chicago, his midwestern family's love of diet soda, the ice cream of the future, going to church hammered, beautiful bible verses about donkeys and horses, getting trash talked by an opposing coach as a young tennis player, and much more. Tommy and Stav help callers including a guy who caught his girl texting with an ex, and a man whose girl is extremely jealous after he lost a bunch of weight. Watch Tommy McNamara's special SMOLDERING out now: https://www.youtube.com/watch?v=ViNPDchxUe4 Follow Tommy McNamara on social media: https://www.instagram.com/tommymcnam https://twitter.com/TommyMcNam Wanna be part of the show? Call 904-800-STAV and leave a voicemail to get advice!

Video version here: https://www.youtube.com/live/21w4W7DSLWU Talking holding the Stanley Cup, Caddying for an NHL legend and some other caddy stories, the reason NOW I want Trump to win, Opie and Anthony hanging with Dice and how much fun that was, watched Dark Side of Comedy featuring Chris Farley, Andrew Dice Clay and Artie Lange, looking at putting a radio show together like an artist looking at a empty canvas, Rob Reiner will do WHAT if Trump is elected and more! #funnypodcast #comedypodcast #hamptons #longisland #beachlife #opieandanthonySee omnystudio.com/listener for privacy information.

Roz shields her eyes for the arrival of supernova writer, comedian, actor and co-host of Double Threat, Julie Klausner! Smoldering beneath bangs and huge sunglasses, the two discuss reincarnation, thoughtographer Ted Serios, and why Julie won't stay in old hotels anymore. Want to share YOUR paranormal experience on the podcast? Email your *short* stories to GhostedByRoz@gmail.com and maybe Roz will read it out loud on the show... or even call you! Be sure to follow the show @GhostedByRoz on Instagram. Support this podcast by shopping our latest sponsor deals and promotions at this link: https://bit.ly/3WwYCsr Learn more about your ad choices. Visit megaphone.fm/adchoices

In South Carolina, authorities find an elderly couple dead in a home with an astonishing temperature. The government of China proposes regulations on children and gaming. In Hinds county, Mississippi, investigators discover more than 200 people were buried anonymously, with no attempt to contact their families. All this and more in this week's strange news segment.They don't want you to read our book.: https://static.macmillan.com/static/fib/stuff-you-should-read/See omnystudio.com/listener for privacy information.