Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is the optimal treatment for a fit, elderly patient with NGC diffuse large B cell lymphoma that recurred about 1 year after dose-attenuated R-CHOP?
There are a number of appropriate options to consider depending on the specifics of the case. Could the patient be eligible for axi-cel? 2L CAR-T is appropriate for fit elderly patients so long as they fit eligibility for CAR-T and have access, and axi-cel is approved for early relapse/refractory pa...
How would you manage someone with antithrombin deficiency who has recurrent VTE on a DOAC?
There are no large scale controlled studies demonstrating outcomes of use of oral direct-acting anticoagulants (DOACs) in patients with hereditary thrombophilia. One can find published case reports demonstrating success, but the 'failures' likely do not get published. The general approach would be t...
How do you manage a patient with a history of high-risk leukemia who has increasing loss of donor chimerism in the post-transplant setting in the absence of disease relapse?
Decline in donor chimerism is not very common in pediatric patients who underwent myeloablative conditioning regimen for hematologic malignancy, and if chimerism is initially 100% and subsequently falls, it usually represents a relapse of underlying leukemia, or a new malignancy. I always obtain lin...
How do you interpret elevations in antiphospholipid antibodies that are lower than Sapporo criteria?
I would refer to the following article that provides the most up-to-date definitions (including the definitions for low-level antibodies) and risk stratification tools including APL-S and GAPSS that are developed for people with autoimmune conditions. The article also discusses the levels of evidenc...
How would you treat gray zone lymphoma which initially achieved a CR after 2 cycles of DA-R-EPOCH, but end-of-treatment PET demonstrates progression with new sites of biopsy-proven disease?
While admittedly the (non randomized) data comes from HL, would consider pembro-GDP vs BV/nivo with the plan to go to auto.
How does the presence of concurrent infections or wound issues affect your choice and timing of induction in patients with AML or MDS with excess blasts?
Many patients are diagnosed with AML or MDS with excess blasts after presenting with acute infections. In these circumstances, early recognition and initiation of broad spectrum antibiotics to prevent sepsis is essential. We typically delay induction chemotherapy until the infection is under control...
Would you recommend allogeneic stem cell transplantation for consolidation in a patient with follicular lymphoma who relapsed within 13 months of initial chemo-immunotherapy?
Updated answer - 9/18/23 The role for allogeneic stem cell transplantation in follicular lymphoma has become increasingly narrow as the therapeutic armamentarium has expanded. In the current state, even for early-relapsing patients, it would generally not be an early consideration; such patients are...
What is the benefit of cytoreduction with Hydroxyurea for patients with newly diagnosed chronic phase CML with a WBC count >100 prior to the initiation of a TKI?
For newly diagnosed patients with CML, there is no benefit to using hydroxyurea before TKI. Using HU oftentimes ends up causing cytopenias and it then makes it challenging to keep patients on their TKI when it is started. There are some scenarios where it is reasonable to use- if you don’t yet know ...
What are your top takeaways in Hematologic Malignancies from ASCO 2022?
Each year the American Society of Oncology Annual Meeting offers new or updated information that has the potential to change how we care for our patients. Here I highlight three hematology studies that are highly impactful, and which were rightfully highlighted at ASCO 2022. They serve to reinforce ...
In patients with CML on imatinib and newly diagnosed breast cancer now requiring radiation therapy, should we hold imatinib?
I recommend continuing imatinib through the radiation. The time of imatinib is rather short and stopping poses a risk of CML coming back with the fact that molecular remission is iffy. Kanti Rai