Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Do you recommend continuous antibiotic prophylaxis for patients on complement inhibitors such as eculizumab?
This is an extremely important and timely question. There simply isn’t enough data or firm guidelines on this leading to different practices. The reality is that there have been a number of meningococcal breakthrough infections in those vaccinated against meningococcal disease. Complement therapies ...
How would you approach cytopenias 5 weeks after initial dosing in a young patient with MDS treated with Azacitadine as a bridge to transplant?
Bridging with HMA to transplant in MDS patients is a common practice although it did not show improved outcomes. You will definitely have to r/o other potential causes of pancytopenia (i.e., infections, etc). I would repeat a BM A/Bx to make sure that blasts are not increasing (< 20% and preferably ...
For a patient who has core binding factor AML but also a small FLT3-ITD mutation detected, do you proceed with allo transplant or only HiDAC consolidation after achieving CR from induction chemotherapy?
My CBF patients with FLT3-ITD who have achieved CR1 following induction have done quite well with high dose cytarabine consolidation and I cannot recall any of them who have required transplant. Historically, I have managed my CBF-AML patients with FLT3-ITD the same as those without FLT3-ITD since t...
How would treat a patient with good performance status with PTCL-NOS found to have leptomeningeal disease during treatment course with CHOEP?
I haven’t combined CHOEP with high dose methotrexate before! I have treated a patient with HIV-associated B-cell lymphoma with R-EPOCH and high dose methotrexate at D15 successfully with growth factor support. For patients with PTCL-NOS and leptomeningeal involvement at presentation, I would likely ...
How would you manage anti-platelet therapy in patients presenting with ischemic stroke and have a history of von Willebrand disease?
I follow the ASH ISTH NHF WFH 2021 guidelines, recommendation 3: "In patients with VWD and cardiovascular disease who require treatment with antiplatelet agents or anticoagulant therapy, the panel suggests giving the necessary antiplatelet or anticoagulant therapy over no treatment (conditional reco...
Do you treat secondary erythrocytosis caused by SGLT2 inhibitor?
I have seen this once, and stopped the SGLT2 inhibitor, and recommended they identify an alternative strategy to treat his DM. It seemed to help overall.
How do you choose bridging therapy prior to CAR-T leukapheresis?
There is a lack of uniform clarity around terminology here. To avoid confusion, I prefer using "debulking" for treatment that is administered prior to T-cell apheresis, and "bridging" for treatment administered after apheresis to bridge the patient during manufacture to maintain disease control prio...
Do you use GCSF for a patient with MDS with excess blasts and neutropenia?
It really depends on what you are trying to achieve: If the goal is to get the patient to a curative allogeneic transplant, then the answer is no. If the goal is to get an elderly frail patient to break fever and leave the hospital to spend some quality time with family, then the answer is yes!
How do you work up a young patient with increasing ferritin and normal TSAT without infectious, inflammatory, or liver disorders?
This is a tough one. If the ferritin is increasing and the TSAT is normal and there is no evidence of hemochromatosis, the ONLY possible explanation is some underlying morbidity, inflammatory, rheumatologic, malignant, or infectious is present. In pediatrics, HLH (hemophagocytic lymphohistiocytosi...
What is the treatment of choice for mixed phenotype ALL?
These are difficult to treat. The limited available data suggest that an ALL–like regimen followed by HSCT may be recommended. If no response is achieved, you could try a myeloid-like strategy. For T/Myeloid, combining asparaginase with AML therapy (FA + PEG or Capizzi II) could be an option. The sp...