Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How would you manage a patient with CML in chronic phase with a significant cardiac history, such as heart failure with reduced ejection fraction or arrhythmia?
The management of a patient with Chronic Myeloid Leukemia (CML) in the chronic phase who also has a significant cardiac history, such as heart failure with reduced ejection fraction (HFrEF) or arrhythmia, involves a multidisciplinary approach that includes both hematologic and cardiac care (cardio-o...
What is your ferritin threshold to prescribe iron to female adolescent athletes who have symptomatic iron deficiency without anemia?
Since ferritin should be truly reflective of iron levels as we should not expect elevated hepcidin levels in a young athlete. There, I would use 30 ng/mL which has a 98% specificity and 92% sensitivity for absent marrow hemosiderin. Also, since there is expected ongoing iron loss (0.6 mg/L of sweat ...
Would you anticoagulate a patient with an asymptomatic gonadal vein thrombosis on CT scan, found on surveillance imaging for colorectal cancer?
This is an area for which there are very limited reports (case reports/series) and certainly no small or large prospective studies. My bias is to initiate anticoagulation. It would be very important to look for an underlying malignancy or other explanation for the thrombus.
Would you consider radiation therapy before chemotherapy in a patient with stage I-II high-grade B-cell lymphoma presenting with a large necrotic skin lesion?
I would add that it is important to have a reasonable overall plan with Heme-Onc agreed upon to increase the likelihood of a successful outcome. Ideally, chemotherapy is administered first. This allows "consolidation" RT to be customized based on response. For example, a lower dose is utilized in a ...
Is there a role for rituximab in refractory HIT?
If the patient has continued thrombosis/thrombocytopenia after the withdrawal of heparin, the patient could be considered to have autoimmune HIT as described in this excellent article by Warkentin, PMID 37959386.There are case reports of the use of rituximab for refractory HIT. Batra et al., ASH Abs...
In a patient with APS and obesity during pregnancy when switched to LMWH, do you cap the dose of dalteparin as per manufacturers labeling at 18,000U per day or do you use weight based dosing?
Hi @Dr. First Last, We use enoxaparin in our institution, but the general principle that we follow is that we do not cap LMWH dose at a set threshold. I am assuming that you're referring to thromboprophylaxis and not the management of a VTE in the past 6 months. We monitor anti-Xa levels in obese p...
Do the level of positive lupus anticoagulant titers correlate with the risk of VTE?
The lupus anticoagulant test is either positive or negative. It’s not reported out at a titer. The test needs a two-step confirmation, the first being the addition of mixed plasma to rule out a factor deficiency and the second confirmation being the addition of phospholipids and showing normalizatio...
What is the role of CNS prophylaxis in a healthy patient in their 60s with a large DLBCL of the cranium/dura with brain parenchymal invasion?
In general, the role of CNS prophylaxis designed to prevent CNS progression in aggressive B-cell lymphomas is controversial given that it has known toxicities (infections, cytopenias) without good data to support. We still do it at our institution for patients with biologically high-risk tumors, but...
Would you give transdermal hormone replacement therapy to a woman with remote history of provoked pulmonary embolism?
There is good evidence that transdermal HRT does not pose the same risks as oral HRT (Morris and Talaulikar, PMID 36573625). ASA or DOAC prophylaxis is likely not indicated.
Can a patient with MDS have ring sideroblasts in the absence of mutation such as SF3B1?
Yes, < 50% of MDS RS have SF3B1 mutation by NGS. Malcovati et al., PMID 32347921