Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Why are autoantibodies not often detected on monoclonal gammopathy assays (SPEP/IFE, quantitiative immunoglobulins)?
Autoantibodies do not cause a false positive M protein. Even though autoantibodies may target a specific antigen, they are polyclonal. Rarely, a very high rheumatoid factor titer can produce a broad-based (polyclonal) peak in the electrophoretic pattern. UpToDate
Is there an equivalent test for serum viscosity in sickle cell disease?
I would not typically order serum viscosity outside of the setting of paraproteinemia. In that setting, I still think serum viscosity is useful, especially as opposed to plasma viscosity, which might be elevated in a sickle cell patient due to the acute phase reactant fibrinogen. It is true also th...
Do you recommend anticoagulation for a splenic infarct in patients with myelofibrosis and splenomegaly?
I generally do not recommend anticoagulation for a splenic infarct in patients with MF and splenomegaly. The situations where I would anticoagulate: ff they have a splanchic vein thrombosis, or clear evidence of embolic disease (i.e., other areas affected in addition to the spleen). However, general...
How would you time COVID-19 vaccination with someone on R-CHOP chemotherapy?
It is really hard to time COVID vaccine while on chemo. Although ideal time would be as far away from chemo as possible (3-6 months) or 6 weeks before chemo starts, that is not practical in someone getting q 3 week R-CHOP. I would recommend giving it when available and if possible, time it on a diff...
How would you approach older patients who are not fit or frail with stage 1 favorable classical Hodgkin lymphoma?
The change in therapy for early stage HL from RT alone to chemotherapy usually with low dose consolidation RT was not because of lack of effectiveness of RT but rather because of concern for long term complications. HL cause specific survival for early stage disease treated with RT alone or combined...
When are you recommending bone marrow transplant recipients receive the SARS-CoV-2 vaccine?
The CIBMTR and EBMT data indicate a 20-30% mortality in transplant patients. Risk factors are age >50, male, and <12 months from HSCT. Unfortunately, the complexity of immunological recovery after transplant makes inferring the likelihood of response to a new vaccine formulation impossible. In gener...
What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?
There are a number of resources available to guide clinicians on these decisions. I recommend the COVID-19 Resources webpage curated by the American Society of Hematology (COI, I'm the editor of that website). https://www.hematology.org/covid-19 This website includes guidance on immunizations in the...
What is the best way to monitor intraoperative heparin use in a patient with factor XII deficiency?
Generally, the baseline ACT may or may not be prolonged, so one should be obtained pre-operatively. The surest way to monitor is with the heparin anti-Xa assay.
How can healthcare providers better serve as allies of the sickle cell community?
Yes, the medical community should absolutely advocate for our patients with sickle cell disease (SCD). The vast majority of Americans with SCD are of African or Hispanic descent, and the overlay of racial inequality and healthcare disparities negatively impact their health outcomes (1-5). In additio...
How do you approach patients with a history of lymphoma in remission who are in need of immunosuppressive (e.g. TNF blockers, 6MP) or other therapies (e.g. JAK inhibitors) for autoimmune disease that have been linked with the development of lymphoma?
Dierickx et al., PMID 26384356. Yes, you can resume immunosuppression (IS) safely. If rituximab can be used for auto immune disease treatment that would be perfect.The prior treatment for lymphoma if it included rituximab would have taken care of the b cell reservoir.If high risk for recurrence of l...