Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How common are nasal telangiectasia in patients with systemic sclerosis?
Telangiectasias, particularly “matted’’ ones are often seen in patients with Systemic sclerosis (SSc), both limited and diffuse cutaneous. They can also be seen in patients with MCTD, UCTD with SSc features, Lupus or Dermatomyositis (often periungual). In SSc, they are most commonly on the face and ...
How do you manage me anticoagulation in a patient with May Thurner Syndrome, who does not have history of thrombosis, and becomes pregnant?
Watch dimers, if neg, no anticoagulation; if positive, anticoagulation.
How would you work up an elevated copper level without cytopenias in a patient with history of bariatric surgery not on supplements or using copper utensils?
Would make sure they are not on supplements as these are often recommended post bariatric surgery. Otherwise, not sure of a connection with bariatric surgery. Would check ceruloplasmin level to rule out Wilson's disease. A low copper level is more likely and can cause leucopenia and sideroblastic an...
What post-auto maintenance therapy do you recommend for patients with high-risk multiple myeloma?
This is tough. You want each particular risk group to correspond to a maintenance treatment that is likely to benefit the patient - not too much nor too little. The definition of high risk has changed from one single characteristic or one cytogenetic abnormality to a more additive model such as the ...
How do you manage recurrent hemodialysis filter clotting in an in-center ESKD patient with heparin-induced thrombocytopenia?
I have actually not faced this situation recently. something that may be tried though: flush the lines more frequently with saline, giving patients dose of eliquis orally prior to treatment, other anticoagulant?
How do you manage severe hypertriglyceridemia in the adolescent & young adult population receiving chemotherapy for ALL, in the absence of complications related to hypertriglyceridemia?
Not sure what the adults do but in the pediatric/AYA population, I stop the drugs most likely to cause this - often a combination of steroids and asparaginase, consult one of our cardiologists who has a major interest in hyperlipidemia and in the asymptomatic patient, he almost always cautions again...
How would you treat a patient who received 2 cycles of R-CHOP for DLBCL who was subsequently diagnosed with follicular lymphoma?
It looks like the patient has t-FL. More information is needed: what prompted the biopsy after 2 cycles of R-CHOP? Is his disease progressing after 2 cycles of R-CHOP?
In a patient with a history of HIT, how would you reintroduce Heparin?
When patients with even remote histories of HIT are re-exposed to heparin, there is a very high risk of heparin-PF4 antibody seroconversion (Warkentin and Anderson, PMID 27114458). I have seen two patients who suffered a fatal relapse of HIT (e.g., case one in Kodityal et al., PMID 12890149). Bivali...
Would you offer BM biopsy as the next step for progressive thrombocytosis when peripheral blood is negative for JAK2, CALR, and MPL mutations for MPN diagnosis?
Yes, definitely. Always need bone marrow morphology to diagnose MPNs. Triple-negative ET or PMF comprises 5-10% of all ET and PMF and lacks the 3 canonical driver mutations, i.e., in the JAK2, CALR, and MPL genes.
How accurate of an indicator is reticulocyte hemoglobin equivalent for iron deficiency?
I am not sure that question is answerable right now. I can tell you if I had an autoanalyzer with a RET-He, I would use it to determine who needs iron and who does not using a value of 30.7 as the cutoff for iron deficiency and 28.5 to determine the likelihood of responsiveness to iron [remember tha...