Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you offer bridging radiation before or after leukapheresis?
We believe the ideal time for bridging radiotherapy is after leukapheresis but before CAR T-cell infusion to avoid a negative impact on T-cell collection. However, the clinical situation has to be considered, and if a symptomatic presentation necessitates urgent treatment before leukapheresis, treat...
Would you offer bridging radiation before or after leukapheresis?
We believe the ideal time for bridging radiotherapy is after leukapheresis but before CAR T-cell infusion to avoid a negative impact on T-cell collection. However, the clinical situation has to be considered, and if a symptomatic presentation necessitates urgent treatment before leukapheresis, treat...
How would you approach BCMA-directed therapy in a patient with myeloma and renal failure on dialysis?
The short answer: Very carefully. Lots of anecdotes and theoretical fears out there, but very little real data to guide us as of July 2023 as I write this. The largest experience with BCMA CAR-T with CKD is this TCT abstract by Sidana and colleagues that I don't think has been published yet:Sidana e...
What induction regimen do you choose for high risk newly diagnosed multiple myeloma in light of the recent high risk focused studies?
Two things are clear from the slew of high-risk enrichment studies and subgroup analyses that have been done. In the age of upfront quadruplet therapy with an anti-CD38 monoclonal antibody, outcomes for patients with one high-risk cytogenetic abnormality are very good, even in the absence of prolong...
What induction regimen do you choose for high risk newly diagnosed multiple myeloma in light of the recent high risk focused studies?
Two things are clear from the slew of high-risk enrichment studies and subgroup analyses that have been done. In the age of upfront quadruplet therapy with an anti-CD38 monoclonal antibody, outcomes for patients with one high-risk cytogenetic abnormality are very good, even in the absence of prolong...
Do you routinely prescribe PPI prophylaxis for myeloma patients who will be on low-dose aspirin and weekly dexamethasone?
Depends on the dose of weekly dexamethasone. If 40 mg weekly, would use PPI. If given along with cyclophosphamide as CyBorD, would use PPI regardless of dose of dex; if symptomatic gastritis on aspirin or dex, will use PPI even with lower doses of dex.
Do you routinely prescribe PPI prophylaxis for myeloma patients who will be on low-dose aspirin and weekly dexamethasone?
Depends on the dose of weekly dexamethasone. If 40 mg weekly, would use PPI. If given along with cyclophosphamide as CyBorD, would use PPI regardless of dose of dex; if symptomatic gastritis on aspirin or dex, will use PPI even with lower doses of dex.
For otherwise transplant-eligible patients with myeloma, given developments of bispecifics and CAR-T, what is your age cutoff for consolidative autologous transplant?
For any lawyers reading this, there is no upper age cutoff for consideration of transplantation. For the physicians and other healthcare providers reading this, it's much more nuanced. As the question poster alluded to, this isn't 2010 and we have many more treatment options available. I have many p...
For otherwise transplant-eligible patients with myeloma, given developments of bispecifics and CAR-T, what is your age cutoff for consolidative autologous transplant?
For any lawyers reading this, there is no upper age cutoff for consideration of transplantation. For the physicians and other healthcare providers reading this, it's much more nuanced. As the question poster alluded to, this isn't 2010 and we have many more treatment options available. I have many p...
In a young female with severe osteoporosis due to congenital estrogen deficiency, can estrogen be prescribed if genetic testing for congenital disorders reveals a heterozygous Factor V Leiden mutation?
First of all, I don't think testing for inherited thrombophilia is warranted in a patient with no personal or family history of thrombosis. Given the multigenic nature of thrombophilia and our limited ability to test for it, it's difficult if not impossible to determine an individual's risk of throm...