Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Have you encountered acute kidney injury after starting eltrombopag for aplastic anemia as part of triple immunosuppressive regimen with ATG and cyclosporine?
No, I have not. Of course, cyclosporine is intrinsically nephrotoxic and is the likely candidate. Sometimes, ATG will result in renal issues as well although less frequently.
How do you approach post-transplant maintenance for patients with high-risk myeloma?
I'm migrating the discussion from another thread ("Top Takeaways from ASCO 2023") here, mainly because the premise of this question is based on new data about KPd maintenance in high-risk patients presented by Dr. Nooka and colleagues as an oral presentation this past ASCO 2023.@Dr. First Last's ins...
Do you routinely use G-CSF post-allogeneic transplant for non-haploidentical transplants?
Yes, we do. Although when we do reduced intensity transplants, we delay until after methotrexate is complete. Often counts recovery before the GCSF starts.
What is your approach to evaluating a patient with known rheumatologic disease and elevated free kappa:lambda ratio, but no evidence of monoclonal immunoglobulins?
The information given is a bit sketchy. But assuming a bone marrow biopsy has been done and there is no evidence of malignancy, I would adopt a watch-and-wait approach. If no bone marrow has been done, I would keep an eye on the appropriate blood tests and in collaboration with a hematologist do a b...
Would you offer a bone marrow biopsy to the patient with normal CBC and low MDS-associated mutation burden found on NGS?
Generally speaking, we don't perform NGS sequencing for MDS-associated somatic mutations in individuals with normal blood counts. However, the issue does arise when cancer patients undergo blood-based sequencing for other reasons, for example. And, in the future, we may see more mutation testing in ...
How do you manage me anticoagulation in a patient with May Thurner Syndrome, who does not have history of thrombosis, and becomes pregnant?
Watch dimers, if neg, no anticoagulation; if positive, anticoagulation.
How would you work up an elevated copper level without cytopenias in a patient with history of bariatric surgery not on supplements or using copper utensils?
Would make sure they are not on supplements as these are often recommended post bariatric surgery. Otherwise, not sure of a connection with bariatric surgery. Would check ceruloplasmin level to rule out Wilson's disease. A low copper level is more likely and can cause leucopenia and sideroblastic an...
What post-auto maintenance therapy do you recommend for patients with high-risk multiple myeloma?
This is tough. You want each particular risk group to correspond to a maintenance treatment that is likely to benefit the patient - not too much nor too little. The definition of high risk has changed from one single characteristic or one cytogenetic abnormality to a more additive model such as the ...
How do you manage recurrent hemodialysis filter clotting in an in-center ESKD patient with heparin-induced thrombocytopenia?
I have actually not faced this situation recently. something that may be tried though: flush the lines more frequently with saline, giving patients dose of eliquis orally prior to treatment, other anticoagulant?
How do you manage severe hypertriglyceridemia in the adolescent & young adult population receiving chemotherapy for ALL, in the absence of complications related to hypertriglyceridemia?
Not sure what the adults do but in the pediatric/AYA population, I stop the drugs most likely to cause this - often a combination of steroids and asparaginase, consult one of our cardiologists who has a major interest in hyperlipidemia and in the asymptomatic patient, he almost always cautions again...