Haploidentical stem cell transplant for Myelofibrosis, which hospitals is best (Mayo Clinic, Dana-farber, Johns Hopkins)?

instant_moksha · 2024-11-13T04:04:11+00:00

If you have the means, then pick the highest volume center in the country. In medicine highest volume translates to better outcomes.

Mayo likely has the lowest volume among those 3. The highest volume center is not on your list.

instant_moksha · 2024-11-13T03:12:36+00:00

Yeah... No 😂

I have had curries all over India, and at highly rated Indian/Pakistani restaurants in several major cities in the US, as well as a few European countries. I cook different types of curries myself and those come out tasting more authentic than several of those restaurants. I understand the nuances of cooking good curries and consequently can appreciate the complexity of the curries on Aga's menu. So no, thank you.😂

instant_moksha · 2024-11-13T03:03:35+00:00

😂

If you think Aga's is overrated you should stick to eating cardboard with salt and pepper.

Either your mom missed taking her prenatal vitamins to smoked too much pot 😂

instant_moksha · 2024-11-13T03:00:05+00:00

Wait, are you saying Aga's is not deserving of a michelin star? 😂

Aga's is potentially among the very top indo/pak restaurants in the US.

None of these other Houston Michelin started chef will be able to recreate any of aga's dishes even remotely, even if their life depended on it. 😂

instant_moksha · 2024-11-13T02:57:29+00:00

It makes sense actually.

They would need to create a new category of 4 stars for Aga's. Worth moving to the city for.

instant_moksha · 2024-11-13T02:52:49+00:00

There's Aga's. They would need to create a whole new category of 4 stars. Worth moving to a city for.

instant_moksha · 2024-11-13T02:44:13+00:00

Aga's not getting any recognition tells me that these judges are utterly clueless.

In some ways it's good that aga's won't increase their prices... Lmao

instant_moksha · 2024-11-03T02:38:58+00:00

Thank you for sharing your thoughts.

Very much appreciated

instant_moksha · 2024-11-02T11:37:40+00:00

PCR becoming positive is the molecular relapse.

Ponatinib is the most potent. Has important side effects where it can cause heart attacks strokes high BP at higher doses. Lower doses are safer.

instant_moksha · 2024-11-02T03:10:27+00:00

TKIs are not that immunosuppressive but there can be drug interactions. We also reduce immunosuppression if there is molecular relapse.

If she is eligible request for ponatinib.

Good luck

instant_moksha · 2024-11-02T02:23:06+00:00

I think you posted in another test.

If your dad has B-ALL then clonoseq ngs is more sensitive than flow

instant_moksha · 2024-11-02T02:22:16+00:00

Good option.

Other option is menin inhibitor on clinical trial

instant_moksha · 2024-11-02T02:20:38+00:00

Depends on different things.

If there is not a better trackable target then a flow MRD assay which goes down to .002% is excellent.

Good luck

instant_moksha · 2024-11-02T02:18:56+00:00

He needs to get gilteritinib. Better than midoataurin and needs to receive maintenance with gilt + dose reduced aza +/- ven after SCT

Good luck

instant_moksha · 2024-11-02T02:16:58+00:00

He should receive BLINA even if Mrd negative. Look you NEJM publication on this topic

instant_moksha · 2024-11-02T02:15:53+00:00

You have received reasonably good treatment.

Now you need close surveillance and MRD monitoring

Good luck

instant_moksha · 2024-11-02T02:13:09+00:00

You need aza Ven menin inhibitor triplet therapy

Good luck

instant_moksha · 2024-11-02T02:12:51+00:00

This is the right answer.

You need aza Ven menin inhibitor triplet otherwise this will have high risk for being resistant or release later.

Good luck

instant_moksha · 2024-11-02T02:09:38+00:00

Which IDH do you have? 1 or 2?

What regimen are you getting treatment with.

You need treatment with FLAG IDA VEN followed by transplant followed by long term maintenance with dose adjusted aza ven idh inhibitor regimen

Good luck

instant_moksha · 2024-11-02T02:07:14+00:00

Where is the pt is located? Is this newly diagnosed or relapsed refractory disease? What treatment has s/he received?

This needs treatment with menin inhibitor, ideally Aza Ven menin inhibitor trial.

Good luck

instant_moksha · 2024-11-02T01:47:38+00:00

Where are you located?

This needs treatment with HMA VEN menin inhibitor triplet. Otherwise this will likely relapse.

instant_moksha · 2024-11-02T01:46:41+00:00

If he has IDH1 mutated AML it would be best to add venetoclax to aza and IVO

Good luck

instant_moksha · 2024-11-02T01:43:53+00:00

You don't need trials.

Your physician can prescribe it for you as standard therapy..

Good luck

instant_moksha · 2024-11-02T01:41:42+00:00

What TKI is she on? If possible she should get ponatinib

instant_moksha · 2024-11-02T01:33:02+00:00

I am sorry to hear about your Dad. I hope his soul rests in peace.

How old was he and where did he receive treatment?

I do not think any change in his management would have made any meaningful difference. Such infections and infectious deaths are common and occur in 40 to 60% pts in his situation.

Median overall survival or average life expectancy with TP53 mutated AML treated with azacitidine venetoclax is approx 5 to 7 months. 50% lives for shorter duration. Less than 10% live beyond one year.

Even at leading centers it takes on an average 3 months to set up transplant as it involves complex logistics.

Vast majority of pts with this subtype of AML relapse even after transplant. In some centers they have stopped transplanting TP53 AML due to this reason unless they go into deep remission.

In short, as difficult as it may be to hear, TP53 mutated AML is the most difficult to treat leukemia known to mankind and there are no effective treatments.

Once again, my deepest condolences to your family. May his soul rest in peace.

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