Waldenstrom/LPL defines disease progression biochemically as a 25% increment in IgM from best response but no minimum threshold considered in terms of an absolute value increase ? I know most of us go by clinical symptoms regardless

@sghmd Not unpopular

@ClaudiaBocchini @PhysInHistory I have ! Wanted to re watch it but cannot find it anymore

@RahulBanerjeeMD I struggle with the corollary as well. They have infections but IgG is over 400(barely), or made to stop once the IgG is over 400.

AL question- post treatment initiation (asct) once uiFLC>iFLC,are we considering heme progression across the mathematical line to consider 50% increment to include negative difference and subsequent positive difference once iFLC>uiFLC? I think we should be

@CoffeeBlackMD While a short term obvious benefit at an individual level is implicated, what would be the consequence of such a policy in the long run? Federal deficit exponentially worse? US credit rating significantly downgraded? Loss of purchasing power parity from enhanced inflation?

@Drjhoffmanmiami @MorphologyAmigo @DrAkhilX @nihardesai89 @BijoyTelivala @PriyaSriRajah Or paget’s disease, fibrodysplasia?

@HadidiSamer Are you still using TT regimen for induction and/or tandem (?). We use tandem for HR, without maintenance we are seeing a median PFS/TTNT of 53 months

Any experience with CAR-T in AL for pts with profound dysautonomia? Supine SBP 170s, drops to 80s while standing, already on midodrine, fludrocortisone for hypotension (trial of pyridostigmine??)

@HiraSMian Yes if LTR, usually get a 40-50% remission duration(of first ASCT) mileage with salvage

@allisonoconn Wait till he finds out there is an outpatient schedule after finishing inpatient rounds

@AaronGoodman33 Pray thee tell, wherefore when the heart doth seize with STEMI's grip or CAD's dire disease, no mortal soul doth make great haste to seek a naturopath’s counsel of herb and leek?

@Taxkourel @RahulBanerjeeMD @JoshuaRichterMD @GKaurMD @andrew02114 @OmarNadeemMD @DrOlaLandgren @JKaufmanMD @DrKrinaPatel I do the opposite, (if robust), capture response and then de-escalate

@ZanwarSaurabh @AlGarfall Agree with Saurabh, I use this viewpoint frequently

@PhysInHistory It is dead and alive (?)

About 30% of my pts achieve biochem CR with some of the bridging therapies (TCEs or HD mel) with the goal of CAR. (Most 4th LOT). Bridge administered post apheresis. I am opting to wait and monitor closely until progression (can preserve CARs upto 6 months). Any thoughts?

@NephRodby @bdermanmd @LouisWilliamsMD @rajshekharucms @TWhittier_RUSH Thank you ! We see this in reality with high MM tumor burden. Interesting, I did not know the IgAs have a negative charge. Are these states associated with intravascular volume expansion (to balance viscosity)? If so, does diuresis help?

@DrNeilStone Vinca alkaloid chemotherapy drugs are natural

@LouisWilliamsMD @bdermanmd @rajshekharucms I thought with hypergammaglobulinemia the serum anion gap drops as the immunoglobs are cationic. I am trying to understand this myself ! Not sure if volume consequences are a cause or an effect. Practically speaking- should we be diuresing these pts at all?

@bdermanmd @rajshekharucms Do we truly think it is pseudohypona (as we all conventionally have) ? Or the renal attempt to balance the excessive positive charge (from IgG) in blood by natriuresis. Volume contraction results in an increase of the net positive charge. Volume excess can drop it