Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Would you consider CAR-T therapy without autologous transplant in a patient with multiple myeloma whose best response to induction therapy is a partial response?
Excellent question that will be even more pressing in ~2024 (maybe earlier!) as we get more data and possibly more FDA/insurance approvals here. For now, the only way to get second-line CAR-T for inadequate response to frontline induction is on a clinical trial - and several such single-arm trials a...
How do you approach treatment for a patient with hypoplastic MDS who is not eligible for transplant?
I believe it is reasonable to try immunosuppressive therapy particularly if the patient is positive for HLA-DR15. I would treat such a patient with triple immunosuppressive therapy with horse ATG, cyclosporine, and eltrombopag (de Latour et al., PMID 34986284) if they are HLA-DR15 positive. If they ...
Do you avoid using tafasitamab in germinal center subtype diffuse large B-cell lymphoma?
I don’t! I think the rationale behind the question is that tafasitamab has to be given with lenalidomide which has been shown to be more efficacious in non-GCB DLBCL. The rationale of combining lenalidomide with tafasitamab has more to do with expansion of NK cells to augment tafasitamab-mediated an...
To what extent does the degree of thrombocytopenia correlate with the severity of cirrhosis?
The degree of thrombocytopenia in cirrhosis is dependent on multiple factors. Decreased production of thrombopoietin by the liver. This can usually be overcome by the administration of a TPO-receptor agonist IF an increase in count is needed for a procedure and there is at least a week to prepare. ...
In a patient with multiple myeloma on lenalidomide who develops COVID-19 and is going to receive Paxlovid treatment, would you stop lenalidomide for the duration of Paxlovid treatment?
I would stop lenalidomide until symptoms are resolved or Paxlovid is complete (whichever comes first). Same goes for any anti-myeloma therapy.
How long after starting anticoagulation would you remove an IVC filter in a patient with a DVT presenting with stroke and PFO which is now closed?
This can be a complex scenario. The first question to ponder: if the patient could receive anticoagulation (a/c), why was the filter placed? Let us assume that there was a short period of time from the initial presentation of stroke, during which anticoagulation was contraindicated and there was a l...
Do you recommend hydroxyurea in patients with sickle cell disease with hereditary persistence of fetal hemoglobin who have recurrent vaso-occlusive crises requiring hospital admission?
It’s complicated. Patients with sickle cell-HPFH that is due to deletion of the beta-globin gene usually have 30% HbF spread nearly evenly among their red cells (pancellular), and as a result, have almost normal hematology and rarely have sickle vasoocclusive events. They do not require treatment. (...
Is there any benefit to transplant patients with Ph+ ALL who have achieved MRD-negativity?
First, some semantics: Asking if there is a "benefit to transplant" may imply there are randomized controlled trials addressing this question, but none to my knowledge have been performed. The last "donor-no donor" trials done in adults with ALL in first remission largely occurred in the pre-TKI era...
What salvage chemotherapy, if any, would you recommend for a patient with primary refractory DLBCL who progressed after two cycles of R-CHOP?
Primary progressive DLBCL is certainly clinically challenging. After biopsy confirms the diagnosis, how best to proceed depends on many factors including burden of disease, tempo of disease, and patient characteristics. ZUMA-7 establishes axi-cel as superior to the standard approach of platinum-base...
Would you give antithrombin concentrate for surgical VTE prophylaxis in case of congenital AT deficiency?
There is no role for routine antithrombin (AT) infusions. In selected situations, during high risk e.g. periods surgery or labor and delivery, etc when anticoagulants are interrupted, AT replenishment is reasonable.