Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
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...
Do you repeat images in patients with venous thrombosis to inform decision about duration of anticoagulation?
The short answer is "no". I do reimage many people near the end of the 3-6 months of treatment, but it doesn't really change my mind about duration of treatment in most instances. I use repeat imaging to help me understand how much of the clot resolved and thus, determine what their new baseline is....
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...
Is there any role in continuing apixaban in a patient with occlusion of the right internal jugular vein with chronic postthrombotic change to prevent a recurrent DVT?
Yes