Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Which patients with acute promyelocytic leukemia do you consider maintenance after completing consolidation?
Before we address the role of maintenance in APL, several principles are important to note. First, APL is now a highly curable disease with contemporary therapeutic strategies. Second, we now divide patients into low-risk and high-risk based solely on the presenting WBC (< or =10,000/uL vs >10,000/u...
How do you advise patients with sickle cell disease on contraception?
According to both the "ASH Pocket Guidelines" and the National Heart Lung and Blood Guidelines for health maintenance in Women with sickle cell disease, progestin only and barrier methods of contraception are the preferred recommendations for contraception. Combined hormonal agents can be considered...
How do you approach the management of GVHD prophylaxis in the setting of severe infection?
GVHD prophylaxis the 1st ~ 3 months after alloSCT is paramount and immunosuppression withdrawal might cause GVHD which can in turn exacerbate or cause infection given the need of corticosteroids to control it. Having said that, case-by-case management is important. As an example, alloSCT using a PTC...
Would you consider thrombophilia testing in a pregnant patient with VTE?
I would not check antiphospholipid antibodies in a pregnant woman with thrombosis unless she had a history of autoimmune disease or other concerning findings. However, if it were checked, I would make sure that it is a true positive. DOACs often cause a false positive LAC. I have had patients with f...
How do you titrate hydroxyurea in the management of myeloproliferative neoplasms?
It certainly depends on the situation, but for most patients, the default is to start at 500 mg PO daily and make adjustments every 1 to 2 weeks based on the counts to get to the therapeutic targets.
Would you consider clearing a patient with essential thrombocytosis for a kidney donation?
For brevity, I am assuming that the patient is already medically approved for surgery and organ donation, and I will focus on the clinical significance of the essential thrombocytosis (ET) with regard to both. I am also going to assume that the patient actually has ET, and not masked polycythemia ve...
How would you approach a young patient with a history of APLS and VTE, desiring hormone replacement therapy after oophorectomy?
I think the answer is not straightforward. What APLAs are positive and what was/is the titer? Were there other risk factors at the time of the clot (smoking, oral contraceptives, etc...) My general recommendation would be to avoid estrogens in patients with APLAs. I can imagine a scenario where the ...
How would you approach management of bleeding risk and factor VIII replacement in a patient with severe hemophilia A undergoing stem cell transplant?
Same way as anyone with severe hemophilia: Prophy with QOD factor or weekly hemlibra Extra correction for procedures, trauma, or bleeding
How would you treat a patient with chronic phase CML who could not tolerate nilotinib due to G4 thrombocytopenia despite sequential dose reductions?
It depends on various other factors such as the current response and the doses used. I generally work on trying to get the patients to tolerate treatment first and then focus on response. I have used doses of nilotinib as low as 50 mg daily in some patients; this may make the thrombocytopenia more m...
What are your top takeaways from ASH 2022?
1. Late Breaking Abstract (LBA-1): Consolidation Therapy with Blinatumomab Improves Overall Survival in Newly Diagnosed Adult Patients with B-Lineage Acute Lymphoblastic Leukemia in Measurable Residual Disease Negative Remission: Results from the ECOG-ACRIN E1910 Randomized Phase III National Cooper...