I left this on SA board

[biopearl]

PTCAs unbridled optimism IS warranted. Here's why. The "changing landscape" is actually changing in our favor. I depart for a moment: I am drinking an extraordinary red so what follows will be flight of ideas. Here are the changes. 1. J and J abandons talaco. 2. The remaining J and J drug for MDS does not get into bone marrow (!!!). 3. Roche abandons its MF drug (I read that recently somewhere). 4. Imetelstat is still on J and J's list after three years. 5. The 4.7/9.4 mg/kg decision was made after only three months of therapy. 6. The 4.7 group must have give some signal to allow for this decision, I am guessing an early separation of Kaplan Meir curves or 7. Some objective measure: I am guessing a molecular marker (FDA loves these). 8. OS data is apparent! We have certainly exceeded 14 months. 9. Consider a mechanistic possibility: In MDS (and MF) Imetelstat targets the malignant clone directly. The MDS competition, while improving transfusion independence works further "downstream" by encouraging red cell production like erythropoetin but to my understanding (please correct me here) there is no effect on the malignant close itself thus the potential to effect disease modification (e.g. progression to AML) is nil. 10. No other drug has been associated with reversal of bone marrow fibrosis. 11. The combination of venetoclax and Imetelstat in lab animals is astounding. 12. Imetelstat gets into the bone marrow--that's where the action is. When Scarlett said changing landscape I freaked out. Now I see the landscape changing all right, but in our favor. Here's to PCTA, may his optimism reign. Regards, to all. Hello Newmantelo. Back to this extraordinary red. bp

[Fishermangents]

Nice post, BP. I share your vision. The things you mention are simple and solid, derived from what we actually know from various publications and telco's.

Btw: ESA's only boost red cell production for a while. Or never, because still a large portion of MF and MDS patients don't respond to ESA's (such as EPO) at all. Even if an MF patient produces sufficiently EPO himself, it won't help the red cell production. I am highly interest in the question whether imet can actually reduce the MDS disease burden, like it obviously is capable of in MF and ET patients. I haven't read a lot about that, only that IMerge is replicating the Mayo pilot results regarding safety and efficacy (see Geron January 2017 Corporate Presentation).

[biopearl]

Fish, its not impossible that we might see early evidence for disease modification (CR/PR) in MDS but I have no idea if bone marrow samples were obtained to look. Probably surrogates will be used for this. Await abstract(s) with interest. bp