Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach for treating transplant-ineligible patients with relapsed blastic plasmacytoid dendritic cell neoplasm (BPDCN) who have progressed on tagraxofusp?
First, I would have to wonder why the patient is not transplant-eligible. A lot of times we say this, but evaluation at the transplant center might find a patient is eligible for a nonablative approach. Second, I would strongly recommend the patient enter a clinical trial. The mustang biotech bpdcn ...
What is the preferred immunosuppressive modality for patients with an acquired factor 8 inhibitor?
Classic steroids. If no response in a month, would consider cyclophosphamide. A variety of immunosuppressive agents have been used. In Chapel Hill, they use rituximab, but a fair number of patients have relapses and older groups get infections. I typically use rituximab last.
How do you evaluate an isolated prolonged aPTT in patients?
This is a common problem. First, if possible, find out if there has been a normal PTT in the past which usually eliminates inherited deficiencies. Second, take a bleeding and clotting history including family history, presence of known liver disease, and any medications. Sometimes it is not recogniz...
How do you manage VTE in the setting of persistent severe thrombocytopenia?
The thrombosis versus bleeding risk ratio should be weighed. The risk of VTE recurrence or propagation is highest in the first 30 days and we know that thrombocytopenia does not attenuate this risk. Providers should favor anticoagulation. In the case of cancer-associated thrombosis and chemotherapy-...
How would you approach moderate neutropenia (ANC < 1000) in a solid organ transplant recipient?
There are limited data addressing the safety and efficacy of G-CSF in the solid-organ post-transplantation setting. Most case series report no increase in graft rejection with G-CSF treatment, although this question is not rigorously answered. Most cases of neutropenia in the post solid-organ transp...
Are there any situations you would recommend prophylactic anticoagulation for a patient with Factor V heterozygosity?
In short, no. Thrombotic risk is a complex variable with many contributing components. The presence of a single FVL allele, while it appears to increase the risk somewhat, is not sufficiently predictive of overall risk to provide a basis for administering prophylactic anticoagulation in a clinical s...
How often do you utilize soluble transferrin receptor or hepcidin testing in the diagnosis of ambiguous iron deficiency, such as with concomitant anemia of chronic disease?
Almost never. While the soluble transferrin receptor and serum hepcidin levels may provide useful information, their lack of ready availability and costs makes them inconvenient and inefficient as a standard. There is no evidence extant that either offers an advantage to the TSAT. All of this is a m...
What is your approach to a patient with positive antiphospholipid antibodies who otherwise do not meet clinical criteria for APS?
As antiphospholipid antibodies constitute a diagnostic criterion of SLE, such patients may need to be evaluated and monitored long term for both SLE and APS.
Is there a role for radiation therapy in the treatment of a lymphoproliferative disorder involving the orbit?
The great majority of lymphoproliferative disorders of the orbit turn out to be NHL when subjected to sophisticated pathologic evaluation, but even those which are considered benign lymphoid hyperplasia (LH) are often and successfully treated with radiotherapy. The dose of RT for low-grade lymphoma ...
How do you approach treatment in a patient with a solitary plasmacytoma with minimal marrow involvement (< 10% clonal plasma cells)?
Solitary plasmacytoma with minimal bone marrow involvement is a confusing entity as even the name seems somewhat contradictory--it is indicating there is a solitary lesion but at the same time indicating that there is systemic involvement (i.e., bone marrow involvement by clonal plasma cells). It is...