Study of blood, the blood-forming organs, and blood diseases
POPULARITY
34 episodes with hematologic
8 episodes with hematologic
4 episodes with hematologic
4 episodes with hematologic
4 episodes with hematologic
4 episodes with hematologic
3 episodes with hematologic
4 episodes with hematologic
4 episodes with hematologic
Join Howard and Janeen Arbuckle for this discussion of pediatric and adolescent gynecology essentials. Pediatric and adolescent gynecology is a newer discipline bringing specialized care to young women with unique gynecologic needs, with a focus on counseling, education, and age-appropriate interventions. • Abnormal uterine bleeding in adolescents is rarely caused by structural problems (unlike in adults) and typically relates to immaturity of the hypothalamic-pituitary-ovarian axis• Hematologic workup should be considered for adolescents with heavy menstrual bleeding as this may be the first time their clotting system is challenged• Hormonal therapies are safe to use once menarche has occurred, with no impact on bone growth• Long-acting reversible contraceptives offer superior pregnancy prevention (1 in 10,000 for implants vs 8 in 100 for typical pill use) but require thoughtful counseling• Private interviews with adolescent patients create trust while preparing them for independent healthcare navigation• Tranexamic acid is effective for heavy menstrual bleeding in adolescents but pill size and frequency can limit compliance• Most ovarian cysts in adolescents represent normal physiologic function and rarely require intervention• Preservation of reproductive organs should be prioritized in adolescent surgery, including leaving ovaries after torsion when possible• Vaginal bleeding in pre-pubertal girls requires assessment for secondary sexual characteristics to distinguish precocious puberty from other causes00:00:00 Introduction to Pediatric Gynecology00:07:20 Abnormal Uterine Bleeding in Adolescents00:19:36 Contraception Choices for Young Patients00:29:40 Managing Difficult Patient-Parent Conversations00:38:04 Pelvic Pain and Endometriosis00:46:58 Adnexal Pathology and Ovarian Issues00:50:51 Congenital Anomalies and Vaginal BleedingFollow us on Instagram @thinkingaboutobgyn.
CME credits: 0.50 Valid until: 28-02-2026 Claim your CME credit at https://reachmd.com/programs/cme/diagnosis-and-treatment-of-systemic-mastocytosis-with-an-associated-hematologic-neoplasm/32715/ The identification of KIT D816V mutation as a key driver for the expansion and accumulation of neoplastic mast cells in systemic mastocytosis (SM) has significantly improved the diagnosis, subclassification, and management of SM. Moreover, the advent of novel targeted therapies has dramatically changed the treatment landscape. However, challenges persist for community clinicians due to the low prevalence of SM and its vague and wide spectrum of clinical features. Expanded knowledge of the recommended pathology and laboratory evaluation for the diagnosis and subclassification of the disease is needed to shorten delays in diagnosis and delivery of optimal care. Tune in and find out more about the management of SM and the latest clinical evidence and guideline recommendations for the use of tyrosine kinase inhibitors (TKIs) and learn about the role played by pathologists in the identification and diagnosis of SM, which ultimately guides treatment selection.
Commentary by Dr. Jian'an Wang
Shira Dinner, MD, Northwestern University, Chicago, IL and Tom Martin, MD, University of California San Francisco, San Francisco, CA Recorded on September 9, 2024 Join us for this special episode, recorded at the Twelfth Annual Meeting of the Society of Hematologic Oncology in Houston, TX! Guest host and conference attendee, Lauren Berger, Senior Director of Professional Education and Engagement at The Leukemia & Lymphoma Society, speaks with Dr. Shira Dinner, from Northwestern University, and Dr. Tom Martin, from University of California San Francisco, about their insights and key takeaways from the conference. Learn more by tuning in here! Shira Dinner, MD Associate Professor Robert H. Lurie Comprehensive Cancer Center Northwestern University Chicago, IL Tom Martin, MDClinical Professor of Medicine, Division of Hematology/Oncology Director, Clinical Research, Hematologic Malignancies Program Co-Leader, Cancer Immunology and Immunotherapy Associate Director, Myeloma Program University of California San Francisco San Francisco, CA
In today's VETgirl podcast, we discuss a study by Dohany et al. assessing phenobarbital-induced hematologic changes in 69 cats. As we know, phenobarbital is a widely prescribed anti-epileptic medication used in veterinary medicine. But how aware are you of the cytopenias that can be associated with chronic phenobarbital administration?
Ximena Jordan-Bruno, MD, University of Pennsylvania, Philadelphia, PA Recorded on June 4, 2024 Ximena Jordan-Bruno, MD Assistant Professor, Division of Hematology/Oncology University of Pennsylvania Philadelphia, PA Join us for this fascinating episode, where Dr. Ximena Jordan-Bruno from the University of Pennsylvania explores hereditary myeloid and hematologic disorders, covering their classifications, mutations, and related germline predisposition syndromes. Learn about key clinical features, diagnostic approaches, the role of genetic counseling, and future research directions. Tune in today for valuable updates to enhance your understanding and practice!
At the 2024 European Hematology Association (EHA) Congress, CancerNetwork® spoke with a variety of experts in the hematologic oncology space about optimizing outcomes across different patient populations and subgroups based on updated research they presented at the meeting. Manali Kamdar, MD, an associate professor of medicine-hematology and clinical director of Lymphoma Services at the University of Colorado Anschutz Medical Campus, in Colorado, spoke about data from the phase 1 TRANSCEND NHL 001 trial (NCT02631044) supporting the use of lisocabtagene maraleucel (liso-cel; Breyanzi) in earlier lines of therapy for patients with relapsed/refractory mantle cell lymphoma (MCL).1 Specifically, Kamdar highlighted how research should continue to focus on the potential utility of liso-cel in MCL subgroups such as those with TP53 mutations or blastoid morphology. Additionally, she stated that liso-cel may need to be further tested in earlier lines of therapy for patients with diffuse large B-cell lymphoma, including those with double-hit lymphoma. Michael R. Grunwald, MD, chief of the Leukemia Division and director of the Transplantation and Cellular Therapy Program at Atrium Health's Levine Cancer Institute, in North Carolina, discussed findings from the Prospective Observational Study of Patients With Polycythemia Vera (PV) in US Clinical Practices Trial (REVEAL) exploring risk factors for disease progression in patients with polycythemia vera (PV).2 According to Grunwald, a history of thromboembolic events, elevated white blood cell counts, and higher variant allele frequencies may contribute to a patient's likelihood of experiencing progression to myelofibrosis or acute myeloid leukemia (AML). Additionally, he highlighted ongoing research into the potential molecular factors that may prognosticate disease transformation in PV among a small cohort of patients enrolled on the REVEAL trial.3 Harry P. Erba, MD, PhD, a professor of medicine in the Division of Hematologic Malignancies and Cellular Therapy and the director of the Leukemia Program and Phase I Development in Hematologic Malignancies at Duke Cancer Institute, in North Carolina, discussed the clinical implications of data from the phase 3 QuANTUM-First study (NCT02668653).4 Specifically, findings demonstrated that continuation therapy with quizartinib (Vanflyta) elicited a more pronounced survival benefit vs placebo in patients with newly diagnosed FLT3-ITD–positive AML who did not undergo allogeneic hematopoietic stem cell transplant (allo-HSCT). However, Erba noted that survival outcomes were not significantly different in the quizartinib and placebo arms among patients who received allo-HSCT. References 1. Palomba ML, Siddiqi T, Gordon LI, et al. Subgroup analyses in patients with R/R MCL treated with lisocabtagene maraleucel by prior lines of therapy and response to Bruton tyrosine kinase inhibitor from the TRANSCEND NHL 001 MCL cohort. Presented at the European Hematology Association (EHA) 2024 Congress; Madrid, Spain; June 13-16, 2024. P1126. 2. Grunwald M, Zwicker J, Gerds A, et al. A real-world evaluation of risk factors for disease progression in patients with polycythemia vera (PV) enrolled in REVEAL. Presented at the 2024 European Hematology Association (EHA) Congress; June 13-16, 2024; Madrid, Spain. Abstract P1047. 3. Crowgey E, Timmers C, Xue Z, et al. Analysis of molecular mechanisms and predictive biomarkers of disease transformation in polycythemia vera. Presented at the 2024 European Hematology Association (EHA) Congress; June 13-16, 2024; Madrid, Spain. Abstract S217. 4. Sekeres MA, Erba H, Montesinos P, et al. QuANTUM-First: efficacy in newly diagnosed patients with FMS-like tyrosine kinase 3-internal tandem duplication–positive (FLT3-ITD+) acute myeloid leukemia (AML) who received continuation therapy. Presented at the 2024 European Hematology Association (EHA) Congress; June 13-16, 2024; Madrid, Spain. Abstract S142.
Welcome to this Hematology Round Up from #EHA24WE have focused on on Hematologic malignancies with abstracts presented on June 15nd, 2024The first presentation was abstract s100 This Phase 3 study results of isatuximab, bortezomib, lenalidomide, and dexamethasone (Isa-VRd) versus VRd for transplant-ineligible patients with newly diagnosed multiple myeloma (IMROZ) . Presented by Dr. FaconThis trial presentation had a concomitant publication on the @NEJMat #ASCO24 last weekhttps://lnkd.in/d2dRh6HpThe Second presentation was abstract S101THE LANDSCAPE OF TP53 MUTATIONS AND THEIR PROGNOSTIC IMPACT IN CHRONIC LYMPHOCYTIC LEUKEMIAhttps://lnkd.in/dYg6DqPTThe Next presentation was abstract S102FIRST RESULTS OF THE APOLLO TRIAL: A RANDOMIZED PHASE III STUDY TO COMPARE ATO COMBINED WITH ATRA VERSUS STANDARD AIDA REGIMEN FOR PATIENTS WITH NEWLY DIAGNOSED, HIGH-RISK ACUTE PROMYELOCYTIC LEUKEMIAhttps://lnkd.in/d2ZM6Z4QThe Next presentation is abstract S103ASCIMINIB (ASC) PROVIDES SUPERIOR EFFICACY AND EXCELLENT SAFETY AND TOLERABILITY VS TYROSINE KINASE INHIBITORS (TKI) IN NEWLY DIAGNOSED CHRONIC MYELOID LEUKEMIA (CML) IN THE PIVOTAL ASC4FIRST STUDYhttps://lnkd.in/dxiets8mOur final Presentation is Late breaking abstract 3438GLOFITAMAB PLUS GEMCITABINE AND OXALIPLATIN (GLOFIT-GEMOX) FOR RELAPSED/REFRACTORY (R/R) DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL): RESULTS OF A GLOBAL RANDOMIZED PHASE III TRIAL (STARGLO)https://lnkd.in/dMWxnyF4Thank you for your attention and enjoy #EHA24Disclosure: This Hematology Round Up was supported by Sanofi
Dear Colleagues,Welcome to this Hematology Round Up from hashtag#ASCO24 . WE have focused on Hematologic malignancies with 3 presentations which were presented on June 2nd, 2024The first presentation was the Phase 3 study results of isatuximab, bortezomib, lenalidomide, and dexamethasone (Isa-VRd) versus VRd for transplant-ineligible patients with newly diagnosed multiple myeloma (IMROZ) . Presented by Dr. FaconThis trial presentation came with a concomitant publication on the New England Journal of Medicine (NEJM).https://lnkd.in/d2dRh6HpThe Second Presentation was the Phase 3 randomized BENEFIT study of isatuximab (Isa) plus lenalidomide and dexamethasone (Rd) with bortezomib versus isard in patients with newly diagnosed transplant ineligible multiple myeloma (NDMM TI). Presented by Dr. LeleuThis trial presentation came with a concomitant publication on Nature Medicinehttps://lnkd.in/dSjVvk7XThe final presentation was Daratumumab (DARA) + bortezomib/lenalidomide/dexamethasone (VRd) in transplant-eligible (TE) patients (pts) with newly diagnosed multiple myeloma (NDMM): Analysis of minimal residual disease (MRD) in the PERSEUS trial. Presented by Dr Rodriguez-OteroDr. Landgren discussed how quadruple therapies showed higher rates of minimal residual disease (MRD) and longer progression-free survival compared to triplets, regardless of age and transplant eligibility, potentially making them a new standard of care for newly diagnosed Multiple Myeloma.He emphasized the importance of minimal residual disease as an endpoint in newly diagnosed multiple myeloma, suggesting that having it as an early endpoint for accelerated approval could give patients faster access to new therapies. However, he also highlighted that bortezomib increases the rate of peripheral neuropathy.Dr. Landgren pointed out that CD38 monoclonal antibodies narrow the gap between transplant-eligible, younger, and fit patients, and transplant-ineligible, older, and less fit patients with multiple myeloma.Thank you for your attention and enjoy ASCODisclosure: This Hematology Round Up was supported by Sanofi
CME credits: 1.00 Valid until: 19-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/gastrointestinal-and-hematologic-teaes-related-to-adc-therapy-in-gynecologic-cancers/18172/ "Mastering the AEs of ADCs to Unlock Their Full Potential in Breast, Lung, and Gynecologic Cancer” is a multiepisodic CME series that delves into the treatment-emergent adverse events related to antibody-drug conjugates. Join expert faculty as they assess these toxicities and provide guidance on the optimal management of these side effects. On April 5, 2024, the FDA granted accelerated approval to fam-trastuzumab deruxtecan-nxki (Enhertu, Daiichi Sankyo, Inc.) for adult patients with unresectable or metastatic HER2-positive (IHC3+) solid tumors who have received prior systemic treatment and have no satisfactory alternative treatment options. . To learn more about this approval, please visit: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-fam-trastuzumab-deruxtecan-nxki-unresectable-or-metastatic-her2
CME credits: 1.00 Valid until: 19-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/adc-related-hematologic-adverse-events/18169/ "Mastering the AEs of ADCs to Unlock Their Full Potential in Breast, Lung, and Gynecologic Cancer” is a multiepisodic CME series that delves into the treatment-emergent adverse events related to antibody-drug conjugates. Join expert faculty as they assess these toxicities and provide guidance on the optimal management of these side effects. On April 5, 2024, the FDA granted accelerated approval to fam-trastuzumab deruxtecan-nxki (Enhertu, Daiichi Sankyo, Inc.) for adult patients with unresectable or metastatic HER2-positive (IHC3+) solid tumors who have received prior systemic treatment and have no satisfactory alternative treatment options. . To learn more about this approval, please visit: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-fam-trastuzumab-deruxtecan-nxki-unresectable-or-metastatic-her2
CME credits: 1.00 Valid until: 19-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/hematologic-adverse-events-with-adcs-in-breast-cancer-optimal-management-strategies/18165/ "Mastering the AEs of ADCs to Unlock Their Full Potential in Breast, Lung, and Gynecologic Cancer” is a multiepisodic CME series that delves into the treatment-emergent adverse events related to antibody-drug conjugates. Join expert faculty as they assess these toxicities and provide guidance on the optimal management of these side effects. On April 5, 2024, the FDA granted accelerated approval to fam-trastuzumab deruxtecan-nxki (Enhertu, Daiichi Sankyo, Inc.) for adult patients with unresectable or metastatic HER2-positive (IHC3+) solid tumors who have received prior systemic treatment and have no satisfactory alternative treatment options. . To learn more about this approval, please visit: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-grants-accelerated-approval-fam-trastuzumab-deruxtecan-nxki-unresectable-or-metastatic-her2
In this episode we discuss the management of newly diagnosed AL amyloidosis with Dr. Angela Dispenzieri from the Mayo Clinic. Here are the key articles discussed:1. Optimal use of tissue biopsy in AL amyloidosis: https://pubmed.ncbi.nlm.nih.gov/28271734/ 2. Mayo 2004 staging: https://pubmed.ncbi.nlm.nih.gov/15365071/ 3. Mayo 2012 staging: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675680/ 4. Renal staging: https://pubmed.ncbi.nlm.nih.gov/25115890/ 5. Hematologic and cardiac response criteria in AL amyloidosis: https://pubmed.ncbi.nlm.nih.gov/23091105/ 6. ANDROMEDA Trial: Dara-VCD vs VCD in newly diagnosed AL amyloidosis: https://pubmed.ncbi.nlm.nih.gov/34192431/ 7. How I Treat AL Amyloidosis: https://pubmed.ncbi.nlm.nih.gov/34517412/ 8. Venetoclax in AL amyloidosis (largest retrospective study till date): https://pubmed.ncbi.nlm.nih.gov/33431806/
Kathy Ford is the Chief Operating Officer (COO) at Kura Oncology. She has over 30 years experience in biopharmaceuticals. She is equally passionate about the work she does bringing treatment to cancer patients and as a mom and grandmother. Kathy earned her R.N. from Massachusetts General Hospital School of Nursing and her B.S.N. from Fitchburg State College.What do we talk about in this episode?Kathy's journey from nursing, being a stay at home mom, and back into the job market and into executive management in biopharmaceuticals.The changes she has seen for women in medicine and STEM fields over the past several decades.The importance of family in her life. Grandmotherhood is her greatest joy!Her passion for working for a company working to treat and cure cancer.The importance of women, especially in higher positions, using their voice to support other women.What does a COO do?Music used in the podcast: Higher Up, Silverman Sound StudioYou can support my podcast on Patreon here: https://patreon.com/user?u=72701887ResourcesHematologic cancers begin in blood-forming tissue, such as the bone marrow, or in the cells of the immune system. Examples of hematologic cancer include leukemia, lymphoma, and multiple myeloma. It's also referred to as blood cancer. (https://www.summitcancercenters.com/cancers-we-treat/hematologic-cancer/#:~:text=Hematologic%20cancers%20begin%20in%20blood,referred%20to%20as%20blood%20cancer.)Some 37% of active physicians in the U.S. were women in 2021, up from about 36% in 2019, and about 47% of residents and fellows were women, according to the AAMC report.Large gender pay gaps still exist, however. A 2021 report from the Rand Corporation published in Health Affairs found female physicians earn $2 million less than men over the course of their career, with the largest gaps in male-dominated specialties. (https://www.healthcaredive.com/news/AAMC-us-physician-workforce-women-specialties/640621/#:~:text=Some%2037%25%20of%20active%20physicians,according%20to%20the%20AAMC%20report.)
Featuring perspectives from Dr Nicole Lamanna and Dr William G Wierda, including the following topics: Introduction: Mentoring Fellows (0:00) Case: A woman in her mid 50s with multiple cardiovascular comorbidities and relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL) receives bendamustine/rituximab induction followed by venetoclax/rituximab consolidation in a clinical trial — Spencer Henick Bachow, MD (11:47) Case: A man in his late 70s with relapsed del(11q) CLL develops atrial fibrillation while receiving ibrutinib — Warren S Brenner, MD (18:15) Case: A man in his early 70s with CLL develops rash and bruising while receiving ibrutinib — Gigi Chen, MD (27:02) Case: A man in his late 80s with CLL receives acalabrutinib as initial therapy and experiences thrombocytopenia — Kapisthalam (KS) Kumar, MD (31:42) Case: A woman in her mid 80s with relapsed CLL (TP53 mutation) discontinues ibrutinib due to bruising — Dr Brenner (40:08) Case: A man in his early 80s with R/R mantle cell lymphoma discontinues ibrutinib due to bleeding risks after a traumatic head injury — Dr Bachow (49:01) Case: A man in his late 50s with CLL and response to acalabrutinib develops worsening myalgias a year later — Eric H Lee, MD, PhD (58:36) CME information and select publications
“It's really important to look at where your target is and what the toxicities are associated with hitting that target. Make sure you include that thinking when you're talking about bispecifics,” ONS member Rowena (Moe) Schwartz, PharmD, BCOP, professor of pharmacy practice at the James L. Winkle College of Pharmacy at the University of Cincinnati in Ohio, told Jaime Weimer, MSN, RN, AGCNS-BS, AOCNS®, manager of oncology nursing practice at ONS, during a discussion about the use of bispecific monoclonal antibodies in hematologic cancers and solid tumors. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD), which may be applied to the treatment ILNA category, by listening to the full recording and completing an evaluation at myoutcomes.ons.org by September 1, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to bispecific monoclonal antibodies in hematologic cancers and solid tumors. Episode Notes Complete this evaluation for free NCPD. ONS Voice drug reference sheets and FDA announcements about bispecific anticancer therapies ONS resources for cytokine release syndrome Oncology Nursing Podcast Episode 176: Oncologic Emergencies 101: Cytokine Release Syndrome Clinical Journal of Oncology Nursing article: STAT: Cytokine Release Syndrome Clinical Practice Resource Clinical Practice Video Huddle Card™ Cancer article: The BiTE (Bispecific T-Cell Engager) Platform: Development and Future Potential of a Targeted Immuno-Oncology Therapy Across Tumor Types Pharmaceutics article: Bispecific Antibodies in Cancer Immunotherapy: A Novel Response to an Old Question U.S. Food and Drug Administration label search for package inserts To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “When we talk about bispecifics, we need to really pay attention to both the target on the cancer and the target for T-cell engaging, because that impacts both efficacy but also toxicity.” TS 4:20 “If you really look deep into the clinical trials, often the patients that are receiving these agents in clinical trials have had more than the required three or four lines of treatment. They may have had five or more lines of treatment. So it's really important to kind of look at where it sits right now, knowing, of course, that that's an evolving target.” TS 7:13 “One of the things I think can be missed, at times, is the fact that you need to consider the toxicities associated with your target on the cancer cell.” TS 10:06 “In terms of mitigating risk, there's been two major ways that have been done. One is a step-up dose schedule, and so one of the key things I would say: If you're not familiar with an agent that you're going to be administering, it's really important to review the entire step-up scheme because it's different for each agent. In some cases, patients need to be admitted to the hospital for the entire step-up strategy. Other times it's just the first dose. So it's really important to look at that.” TS 11:58 “I think we're going to get to the point where our teaching strategy is going to have to be somewhat tailored to the agent we're giving. So, how the drug is given during the step-up, what the subsequent cycling is going to be, whether it's going to be a Q21-day cycle or a weekly dosing administration or every-two-week administration after a certain point. So, I think some understanding of what to expect going forward because these are drugs that are given continually in most situations and so it's important for people to know what to expect.” TS 14:25 “I think we're going to see bispecifics that perhaps engage other aspects of the immune system besides CD3. In fact, those are in clinical trials. And I do believe that we're going to see these more and more developed for cancers beyond the hematologic malignancies. There's a lot of work being done at looking at targets that we know are helpful targets in certain cancers. And I think we'll see more drugs approved beyond the myeloma and the lymphoma and the leukemia space.” TS 20:42
In this episode, Dr. Zanotti discusses the management of acute-on-chronic liver failure (ACLF) in the ICU. He is joined by Dr. Nanchal, a practicing critical care physician with an interest in liver disease. He is a Professor in the Division of Pulmonary and Critical Care Medicine, at the Medical College of Wisconsin, in Milwaukee. Dr. Nanchal is also the lead author of the Society of Critical Care Medicine's Guideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU. Additional Resources Executive Summary for Guideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Neurology, Peri-transplant Medicine, Infectious Disease, and Gastroenterology Considerations: https://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=2023&issue=05000&article=00010&type=Fulltext Guideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Neurology, Peri-transplant Medicine, Infectious Disease, and Gastroenterology Considerations: https://journals.lww.com/ccmjournal/pages/articleviewer.aspx?year=2023&issue=05000&article=00011&type=Fulltext Guideline for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Cardiovascular, Endocrine, Hematologic, Pulmonary, and Renal Considerations: https://journals.lww.com/ccmjournal/Fulltext/2020/03000/Guidelines_for_the_Management_of_Adult_Acute_and.29.aspx Previous Episodes of Critical Matters on the Topic of Acute-on-Chronic Liver Failure: https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=953807698 https://soundphysicians.com/podcast-episode/?podcast_id=342&track_id=965563996 Books Mentioned in this Episode: Noise: A Flaw in Human Judgement. By Daniel Kahneman, et al: https://bit.ly/3sqfRin Seven Brief Lessons on Physics. By Carlo Rovelli: https://bit.ly/45jv82N Anaximander: And the Birth of Science. By Carlo Rovelli: https://bit.ly/3sqgqbZ
Understanding Your Complete Blood Count: Hematologic Cancers | On Call with the Prairie Doc® | May 11, 2023 | Prairie Doc® host Dr. Andrew Ellsworth is joined by Dr. Xavier Andrade Gonzalez from Avera.
“When someone is faced with a cancer diagnosis, you want to really try to work to make that patient an active part of their care team. Understand that there are things out of their control, but there are also things that are within their control. You can teach them how to manage fatigue associated with anemia, or how to prevent falls. These are the things you can do to prevent infection; these are the nutrition things you should focus on to help you feel your best,” ONS member Kimberly Miller, BSN, RN, BMTCN®, transplant case manager at Nebraska Medicine in Omaha, and member of the Metro Omaha ONS Chapter, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS, during a conversation about nursing management of cancer-related hematologic complications. This episode is part of a series about cancer symptom management basics. The others are linked in the episode notes. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below. Music Credit: “Fireflies and Stardust” by Kevin MacLeod Licensed under Creative Commons by Attribution 3.0 Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by April 21, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation. Learning outcome: The learner will report an increase in knowledge related to hematologic complications. Episode Notes Complete this evaluation for free NCPD. Previous Oncology Nursing Podcast episodes on cancer symptom management basics Additional Oncology Nursing Podcast episodes: Episode 181: Oncologic Emergencies 101: Febrile Neutropenia Episode 196: Oncologic Emergencies 101: Bleeding and Thrombosis Episode 220: Oncologic Emergencies 101: Febrile Neutropenia and Sepsis Episode 234: Oncologic Emergencies 101: Thrombotic Thrombocytopenia Purpura ONS book: Cancer Basics (third edition) ONS course: Cancer Basics ONS Symptom Interventions for Prevention of Bleeding American Cancer Society patient education handouts: Low Red Blood Cell Counts (Anemia) Low Platelet Count (Bleeding) Low White Blood Cell Counts (Neutropenia) American Society of Clinical Oncology Answers fact sheets Centers for Disease Control and Prevention patient education on neutropenia Leukemia and Lymphoma Society patient education To discuss the information in this episode with other oncology nurses, visit the ONS Communities. To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org. Highlights From Today's Episode “The biggest complication is infection. You do not have the ability to present with the normal signs and symptoms of infection. You're not going to have redness and swelling and drainage. You're going to have more fever, hypertension, dysuria, shortness of breath, or cough.” Timestamp (TS) 07:22 “Some patients get really nervous if their blood counts get to a certain point. I find that we just try to explain to them, ‘We're watching your labs very frequently, we see you several times a week, these are the complications that can happen,' and talk them through the rationale for not giving a lot of maybe not necessary transfusions.” TS 15:15 “In general, the guidelines are if you expect a patient to have severe prolonged neutropenia, lasting greater than seven days, then you would want to consider giving them an antibiotic to help prevent neutropenic fever. . . . A high-risk patient would benefit from that.” TS 17:23 “Myelosuppression can delay chemotherapy, so patients who are getting treatment for their cancer may experience delays in their next cycle, they may have dose reduction, they may have to discontinue that chemotherapy if they have severe myelosuppression. That could affect their outcomes as far as their cancer treatment goes. Patients who are anemic—if you are fatigued and your legs feel heavy and you feel dizzy when you get up and you fall and your platelets are low as well, that leads to an increased risk of bleeding, and really a decrease in quality of life.” TS 23:30 “Myelosuppresion and cancer treatment in general does carry other toxicities besides the physical: emotional, mental, financial, and social.” TS 25:33 “For a patient with cancer, from diagnosis on, there's a lot that they can't control. When you're faced with that diagnosis, you want to really try to work to make that patient an active part of their care team. So, I think it's important to talk with a patient—understand that there are things out of their control, but there are things that are within their control. You can teach them how to manage fatigue associated with anemia or how to prevent falls. These are the things you can do to prevent infection; these are the nutrition things you should focus on to help you feel your best. Anything that you can let the patient have control over because their life has just changed dramatically.” TS 29:03 “Oncology nurses are wonderful at looking at the patient as a whole person. Keep in mind that there are financial toxicities as well as physical, emotional, and mental. So, it might create a bigger team of people that need to step in and help the patient find the resources that they need to be successful. Also, don't forget about the caregivers.” TS 33:47
Howie and Harlan are joined by Megan Ranney, who will become the dean of the newly independent Yale School of Public Health later this year. Harlan reflects on the research that is helping us understand aging at a cellular level; Howie discusses a new study that he co-authored which examines the costs that make it harder for many mothers to breastfeed. Links: “Accelerated Epigenetic Aging Is Associated with Multiple Cardiometabolic, Hematologic, and Renal Abnormalities: A Project Baseline Health Substudy” Outlive by Peter Attia with Bill Gifford “Megan Ranney named dean of Yale School of Public Health” “Yale School of Public Health to become self-supporting, independent school” Megan Ranney: “To prevent gun injury, build better research” Megan Ranney: “We need more research on guns. Here are 5 questions we can answer.” Howard Forman: “No such thing as a free lunch: The direct marginal costs of breastfeeding” Learn more about the MBA for Executives program at Yale SOM. Email Howie and Harlan comments or questions.
Howie and Harlan are joined by Megan Ranney, who will become the dean of the newly independent Yale School of Public Health later this year. Harlan reflects on the research that is helping us understand aging at a cellular level; Howie discusses a new study that he co-authored which examines the costs that make it harder for many mothers to breastfeed. Links: “Accelerated Epigenetic Aging Is Associated with Multiple Cardiometabolic, Hematologic, and Renal Abnormalities: A Project Baseline Health Substudy” Outlive by Peter Attia with Bill Gifford “Megan Ranney named dean of Yale School of Public Health” “Yale School of Public Health to become self-supporting, independent school” Megan Ranney: “To prevent gun injury, build better research” Megan Ranney: “We need more research on guns. Here are 5 questions we can answer.” Howard Forman: “No such thing as a free lunch: The direct marginal costs of breastfeeding” Learn more about the MBA for Executives program at Yale SOM. Email Howie and Harlan comments or questions.
In this bonus episode Associate Editor, Dr. Mario Cazzola discusses the review series on Germline predisposition to hematologic malignancies with authors, Dr. Lucy Godley, Dr. Anna Brown, and Dr. Dennis Hickstein.
Mike Goldstein is a fourth year medical student in the Uniform Services University School of Medicine, and he plans to go into Obstetrics and Gynecology. Mike was the recipient of both the Gibbons award for medical students to attend the armed forces district annual meeting for American Congress of Obstetricians and Gynecologists, and the Chairman's award for the top manuscript at the annual conference. In this episode, Mike provides insights on shoulder dystocia, the risks to mom and baby, and the maneuvers to relieve it. *Mike Goldstein is also the creator of the logo for this podcast! Coaching offerSupport the showConnect with Kelly Hof at kellyhof.comMedical Disclaimer:This podcast is intended as a safe space for women to share their birth experiences. It is not intended to provide medical advice. Each woman's medical course of action is individual and may not appropriately transfer to another similar situation. Please speak to your medical provider before making any medical decisions. Additionally, it is important to keep in mind that evidence based practice evolves as our knowledge of science improves. To the best of my ability I will attempt to present the most current ACOG and AWHONN recommendations at the time the podcast is recorded, but that may not necessarily reflect the best practices at the time the podcast is heard. Additionally, guests sharing their stories have the right to autonomy in their medical decisions, and may share their choice to go against current practice recommendations. I intend to hold space for people to share their decisions. I will attempt to share the current recommendations so that my audience is informed, but it is up to each individual to choose what is best for them.
Dr Kirk Barber is very happy to have Dr Julie Powell on the podcast for a difficult but important conversation, children and cancer. They discuss the article she co-authored in the July-August 2022 issue of the Journal of Cutaneous Medicine and Surgery. It's titled: "Pediatric Cutaneous Hematologic Disorders: Cutaneous Lymphoma and Leukemia Cutis—Experience of a Tertiary-Care Pediatric Institution and Review of the Literature."Dr Julie Powell is a clinical professor in both pediatrics and dermatology at the University of Montreal. And she practices at the Ste. Justine University Health Centre. She is also a past president of the Canadian Dermatology Association. For more on the work of the Canadian Dermatology Association, please visit our website at dermatology.ca JCMS Author Interviews is produced by the CDA and David McGuffin of Explore Podcast Productions in Ottawa. Our theme music was composed by Lee Rosevere.
Exclusive content and support: https://www.patreon.com/theemttutor The EMT student will have an understanding of diabetes, sickle cell disease, clotting disorders, and the complications associated with each. EMT students should be able to understand the characteristics of type 1 and type 2 diabetes and be able to list the appropriate steps for assessment and prehospital treatment of diabetic emergencies. Students should also be able to discuss hematologic emergencies, and describe sickle cell disease, hemophilia, thrombophilia, and deep vein thrombosis. Knowledge Domains Describe the anatomy and physiology of the endocrine system and its main function in the body and discuss the role of glucose as a major source of energy for the body as well as its relationship to insulin. Define the terms diabetes mellitus, hyperglycemia, and hypoglycemia and understand the differences between hypo and hyperglycemia to include the signs and symptoms of both. Understand the interventions for providing emergency medical care to both a conscious and unconscious patient with an altered mental status and a history of diabetes who is having symptomatic hyperglycemia or hypoglycemia. Identify the steps the EMT should follow when conducting a primary and secondary assessment of a patient with an altered mental status who is a suspected of having diabetes. Know the indications, and contraindications for giving oral glucose to a patient with a decreased level of consciousness who has a history of diabetes. Know the composition and functions of blood as well as describing the pathophysiology of sickle cell disease, complications, and management of sickle cell disease. Describe two types of blood clotting disorders, and the risk factors, characteristics, and management of each. --- Send in a voice message: https://anchor.fm/thepublicsafetyguru/message
Hematologic cancer patients have the benefit of many new oral medications to manage their conditions; however, those medications may create or worsen cardiovascular comorbidities. Nurse Practitioners Courtney Estes (Cardio-Oncology Program) and Ellen Lazarre (Hematology Oncology Division) discuss the balancing act of managing risks while attacking cancer, which is only possible with an interdisciplinary team. They discuss the most common cardiovascular comorbidities (e.g., AFib, hypertension) and alternative treatments that may address them without interfering with effective cancer treatments.
Saad Z. Usmani, MD, MBA, FACP, Memorial Sloan Kettering Cancer Center, New York, NY Recorded on September 30, 2022 Join us for this special episode, recorded live from the Tenth Annual Meeting of the Society of Hematologic Oncology in Houston, TX! Guest host and conference attendee, Lauren Berger, Senior Director of Professional Education and Engagement at The Leukemia & Lymphoma Society, speaks with Dr. Saad Usmani, from Memorial Sloan Kettering Cancer Center, about his insights into the progress in immunotherapies in blood cancers shared at the conference. Not able to attend SOHO? Learn more about what was shared at the conference by tuning in here!
Featuring perspectives from Drs Ajai Chari, Ian Flinn, Nikhil Munshi and Laurie Sehn, including the following topics: Part 1: Case Presentations and Clinical Decision-Making (0:00) Case: A man in his early 70s with diffuse large B-cell lymphoma (DLBCL) arising from follicular lymphoma — Ian W Flinn, MD, PhD (3:46) Case: A man in his late 50s with nongerminal center B-cell-like subtype DLBCL — Laurie H Sehn, MD, MPH (15:57) Case: CAR-T therapy during the pandemic — Nikhil C Munshi, MD (22:16) Case: Anti-BCMC bispecific in triple-class and penta-drug refractory disease — Ajai Chari, MD (33:54) CAR-T therapy for non-Hodgkin lymphoma — Dr Flinn (37:09) Bispecifics for non-Hodgkin lymphoma — Dr Sehn (51:48) CAR-T therapy for multiple myeloma — Dr Munshi (1:13:23) Bispecifics for multiple myeloma — Dr Chari (1:26:14) CME information and select publications
Proceedings from an educational event held in partnership with the 2022 Pan Pacific Lymphoma Conference, featuring perspectives from Drs Ajai Chari, Ian Flinn, Nikhil Munshi and Laurie Sehn, moderated by Dr Neil Love.
Featuring an interview with Dr Loretta Nastoupil, including the following topics: Impact of COVID-19 on the management of follicular lymphoma (FL) (0:00) Case: A woman in her late 50s with Grade IIIA symptomatic FL (3:48) Case: A man in his early 70s with low-grade FL and asymptomatic adenopathy 6 years after a complete response (8:21) Case: A patient with heavily pretreated relapsed/refractory FL who received copanlisib followed by CAR (chimeric antigen receptor) T-cell therapy (14:56) Case: A woman in her early 50s with refractory FL who received mosunetuzumab (18:06) Novel treatment strategies for FL and considerations for the future (23:28) CME information and select publications
Featuring a slide presentation and related discussion from Dr Loretta Nastoupil, including the following topics: Current and emerging therapies for patients with follicular lymphoma (FL) (0:00) CAR (chimeric antigen receptor) T-cell therapy for patients with FL (10:34) Efficacy and tolerability of bispecific antibodies for patients with FL (19:6) CME information and select publications
Dr. Janhavi Athale is a Critical Care physician and Hematologist/Oncologist at Mayo Clinic in Phoenix, Arizona. She presents a lecture on important "Hematologic and Oncologic Emergencies" as part of the DC5 lecture series.
On this week's episode of Fast Facts - Perio Edition, Katrina Sanders, wraps up the series on Periodontitis as a Manifestation of Systemic Disease, finishing by educating us on hematologic disorders! Quotes: “Now, we know hematologic diseases are disorders of the blood or can be disorders of blood forming organs and this affects millions of Americans.” “When we take a look at some of these different types of diseases, we are looking at things like blood cell cancers, hematologic diseases, including rare genetic disorders, anemias, conditions that can be related to HIV, sickle cell disease, or even in some cases, complications affiliated with chemotherapy or transfusions.” “Recent studies that have demonstrated that bacteria like Porphomonas gingivalis does govern aspects of osteoclast differentiation, meaning that the way that our own cells, our own bone cells, are able to break down bone is readily influenced by the presence of this Gram Negative anaerobic bacteria.” Resources: DentistRX: https://www.dentistrx.com More Fast Facts: https://www.ataleoftwohygienists.com/fast-facts/ Katrina Sanders Website: https://www.katrinasanders.com Katrina Sanders Instagram: https://www.instagram.com/thedentalwinegenist/ Papapanou, P. N., Sanz, M., Buduneli, N., Dietrich, T., Feres, M., Fine, D. H., ... & Tonetti, M. S. (2018). Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, Demirel K, de Sanctis M, Ercoli C, Fan J, Geurs NC, Hughes FJ, Jin L, Kantarci A, Lalla E, Madianos PN, Matthews D, McGuire MK, Mills MP, Preshaw PM, Reynolds MA, Sculean A, Susin C, West NX, Yamazaki K. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018 Jun;89 Suppl 1:S237-S248. doi: 10.1002/JPER.17-0733. PMID: 29926943. Botelho, J., Machado, V. & Mendes, J.J. Periodontal Health and Blood Disorders. Curr Oral Health Rep 8, 107–116 (2021). https://doi.org/10.1007/s40496-021-00301-w
On this week's episode of Fast Facts - Perio Edition, Katrina Sanders, wraps up the series on Periodontitis as a Manifestation of Systemic Disease, finishing by educating us on hematologic disorders! Quotes: “Now, we know hematologic diseases are disorders of the blood or can be disorders of blood forming organs and this affects millions of Americans.” “When we take a look at some of these different types of diseases, we are looking at things like blood cell cancers, hematologic diseases, including rare genetic disorders, anemias, conditions that can be related to HIV, sickle cell disease, or even in some cases, complications affiliated with chemotherapy or transfusions.” “Recent studies that have demonstrated that bacteria like Porphomonas gingivalis does govern aspects of osteoclast differentiation, meaning that the way that our own cells, our own bone cells, are able to break down bone is readily influenced by the presence of this Gram Negative anaerobic bacteria.” Resources: DentistRX: https://www.dentistrx.com More Fast Facts: https://www.ataleoftwohygienists.com/fast-facts/ Katrina Sanders Website: https://www.katrinasanders.com Katrina Sanders Instagram: https://www.instagram.com/thedentalwinegenist/ Papapanou, P. N., Sanz, M., Buduneli, N., Dietrich, T., Feres, M., Fine, D. H., ... & Tonetti, M. S. (2018). Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, Demirel K, de Sanctis M, Ercoli C, Fan J, Geurs NC, Hughes FJ, Jin L, Kantarci A, Lalla E, Madianos PN, Matthews D, McGuire MK, Mills MP, Preshaw PM, Reynolds MA, Sculean A, Susin C, West NX, Yamazaki K. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018 Jun;89 Suppl 1:S237-S248. doi: 10.1002/JPER.17-0733. PMID: 29926943. Botelho, J., Machado, V. & Mendes, J.J. Periodontal Health and Blood Disorders. Curr Oral Health Rep 8, 107–116 (2021). https://doi.org/10.1007/s40496-021-00301-w
Featuring slide presentations and related discussion from Drs Andrew Evens, Ian Flinn and Gilles Salles, including the following topics: Follicular Lymphoma — Andrew Evens, DO, MSc (0:00) Mantle Cell Lymphoma — Ian Flinn, MD, PhD (36:39) Diffuse Large B-Cell Lymphoma — Gilles Salles, MD, PhD (1:03:37) CME information and select publications
Featuring slide presentations and related discussion from Drs Courtney DiNardo, Daniel Pollyea, David Sallman and Eunice Wang, including the following topics: Treatment Options for Patients with Newly Diagnosed Acute Myeloid Leukemia (AML) without Targetable Mutations — Daniel A Pollyea, MD, MS (0:00) Optimal Management of AML with Targetable Mutations — Courtney D DiNardo, MD, MSCE (28:03) Other Currently Available and Investigation Treatment Strategies for AML — Eunice S Wang, MD (49:37) Current and Future Therapeutic Approaches for Patients with Myelodysplastic Syndromes (MDS) — David Sallman, MD (1:28:55) CME information and select publications
Featuring case presentations from Drs Courtney DiNardo, Daniel Pollyea, David Sallman and Eunice Wang, including the following topics: Case: A woman in her mid-80s with newly diagnosed acute myeloid leukemia (AML) — Daniel A Pollyea, MD, MS (0:00) Case: A man in his early 70s with AML and a complex monosomal karyotype — Dr Pollyea (4:02) Case: A woman in her mid-70s with newly diagnosed AML with trisomy 21 and AXLS1 and RUNX1 mutations — Dr Pollyea (5:22) Case: A woman in her late 70s with AML and a FLT3-ITD mutation — Courtney D DiNardo, MD, MSCE (7:41) Case: A man in his late 70s with AML and diploid cytogenetics — Dr DiNardo (11:46) Case: A man in his mid-60s with secondary AML and DNMT3A and FLT3-ITD mutations — Eunice S Wang, MD (17:33) Case: A woman in her late 60s with lower-risk myelodysplastic syndrome (MDS) — David Sallman, MD (25:55) Case: A man in his late 70s with high-risk MDS — Dr Sallman (29:26) CME information and select publications
Episode 76: Eating Disorders. The malaria vaccine is announced by Dr Parker, eating disorders such as anorexia and bulimia are briefly discussed by Sophia, Jeffrey and Dr Arreaza. Introduction: Introducing the malaria vaccine (RTS,S)Written by Hector Arreaza, MD; read by Tana Parker, MD. Today is November 26, 2021.Malaria is a devastating disease that continues to kill thousands of people every year around the world. Since the year 2000, there have been 1.5 billion cases of malaria and 7.6 million deaths. In 2019, there were 229 million new cases, and 409,000 deaths, mostly children under 5 years of age.Effective vaccines for many protozoal diseases are available for animals (for example, the vaccine against toxoplasmosis in sheep, babesiosis in cows, and more.) However, vaccines for protozoal disease in humans had not been widely available … until now. The RTS,S is a vaccine against malaria approved by the European Medicines Agency in July 2015 for babies at risk, and it was rolled out in pilot projects in Malawi, Ghana and Kenya in 2019. In October 2021, the World Health Organization announced the recommendation of this anti-malaria vaccine. The trade name of this vaccine is Mosquirix®. The vaccination is recommended for children in sub-Saharan Africa and other regions with moderate to high transmission of Plasmodium falciparum, which is considered the deadliest parasite in humans. The approved vaccine has shown low to moderate efficacy, preventing about 30% of severe malaria after 4 doses in children younger than five years old. Implementation of vaccination is not free from challenges, and it should be executed not as the solution for the disease, but as part of the solution, along with other efforts such as mosquito control, effective health care, and more.RTS,S is an add-on to continue the fight against malaria worldwide. Hopefully we can lighten the heavy burden of malaria for more than 87 countries that suffer the severe consequences of poor control of this devastating disease. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. ___________________________Eating Disorders. Written by Sophia Dhillon, MS3, Jeffrey Nguyen, MS3. Discussion with Hector Arreaza, MD. This is not intended to be a comprehensive lecture on eating disorders. This episode is intended to give you basic information, hoping to motivate you keep learning about it. Let's start talking about eating disorders today, specifically anorexia nervosa and bulimia nervosa. What is an eating disorder? An eating disorder is a disturbance of eating that interferes with health. As a reminder, health is “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.” So, an eating disorder, in a wide context, is any eating pattern that is out of what is considered “normal”, and that variation in feeding causes health problems. But in general, when we talk about eating disorders in medicine, we refer to anorexia nervosa and bulimia nervosa, but it includes also avoidant/restrictive food intake disorder, binge eating disorder, night eating disorder, pica, and rumination disorder. ANOREXIAIn general, anorexia is characterized by immoderate food restriction, inappropriate eating habits or rituals, obsession with having a thin figure or an irrational fear of weight gain as well as distorted body self-perception. There are 2 main subtypes of anorexia: restricting type vs binge-eating/purging type. Tell us the difference between anorexia restrictive type and binge eating-purging type.Anorexia, restrictive type is when weight loss is achieved by diet, fasting and/or excessive exercise, meanwhile the binge-eating/purging type entails eating binges followed by self-induced vomiting and/or using laxatives, enemas or diuretics. These patients will have intense fear of gaining weight or becoming fat. They will have a distorted perception of body weight and shape or denial of the medical seriousness of one's low body weight.Anorexia nervosa is different than avoidant/restrictive food intake disorder. In anorexia, you have an altered perception of your body (“I'm fat”), but in avoidant/restrictive food intake disorder, your perception of your body weight and shape is not abnormal. “I'm skinny, and I'm OK with that.” This is new information for me. I thought anorexia was present always when a patient refused to eat, whether you liked your body or not.Why do people develop eating disorders? There are so many reasons why people develop eating disorders. First, it can be psychological due to low self-esteem, feelings of inadequacy or failure, feeling of being out of control, response to change (i. e. puberty) or response to stress. Second, it can be due to interpersonal issues like having trouble with family and personal relationships, difficult expressing emotions or feelings, or even history of being teased based on size or weight. Lastly, it is the social and cultural norms that we grow up in. There are cultural pressures that glorify thinness and place value on obtaining the perfect body, narrow definitions of beauty that include women and men of specific body weights and shapes. Sometimes there is no reason. Some people just get obsessed with their weight and perceive themselves as “fat”. Effect of anorexia on different parts of the bodySince these patients are scared of gaining weight, how does it affect the entire body?Anorexia can affect multiple systems in our body. Just to name a few symptoms that it can manifest as: amenorrhea, infertility, constipation, dizziness, hypothermia, bradycardia, hypotension, dry skin and even hair loss. Starvation induces protein and fat catabolism that leads to loss of cellular volume and atrophy of the heart, brain, liver, intestines, kidneys, and muscles. Cardiac: It can decrease cardiac mass, decrease cardiac chamber volumes, cause myocardial fibrosis and pericardial effusion. These manifestations are reversible if the patient gains weight. Functionally, it can cause bradycardia due to increased parasympathetic activity, hypotension, decreased heart rate variability and QT prolongation on ECG. Lungs: shortness of breath due to weakened and wasting of the respiratory muscles, pneumothorax and aspiration pneumonia. GI system: it leads to gastroparesis with bloating, constipation, severe pancreatitis and mild transaminitis. Hematologic: anemia, leukopenia and thrombocytopenia. Skin manifestations include dry/scaly skin, hair loss, acne, hyperpigmentation and acrocyanosis. You can also find lanugo, which is a very thin, light colored hair on the face and body. It is thought that the lanugo is an adaptation from the body to keep it warm. Lanugo is common in patients with anorexia nervosa or other causes of malnourishment. That's why wearing coats in warm weather can be a silent sign of anorexia. Other subtle signs include social withdrawal, fidgeting (to burn calories), and always “eating” in private. It is important to remember that all these manifestation that Jeffrey mentioned are not present with intermittent fasting because intermittent fasting is an intermittent restriction of food, the nutritional needs are met during the “feasting” periods after “fasting”. Some may argue that intermittent fasting may promote eating disorders, but I believe intermittent fasting is just an effective treatment for obesity.Treatment plan for anorexiaThere are several treatment options for these patients. We can refer them to nutritional rehabilitation where they can supervise meals. We can refer them to psychotherapy, such as cognitive behavioral therapy or motivational interviewing. There is also a drug called Olanzapine for this condition. Sometimes, patients may need admission to the hospital. I learned recently that UCLA has an Eating Disorder Program which includes inpatient services. Some centers are very specialized and include family therapy and group therapy. Listeners, you can continue to research about anorexia, it's is fascinating. The prevalence of anorexia in the US is estimated to be 0.6%[3]. BULIMIABy definition, bulimia nervosa is when a person binge eats and then uses certain behaviors to prevent weight gain. These behaviors may include self-induced vomiting, using laxatives or diuretics, exercising excessively, or fasting and having a restrictive diet. Signs and symptoms to look forA physical examination is key. On physical presentation, these people usually can have overweight or obesity. That's the main difference with anorexia. Anorexia: skinny people, bulimia: normal weight, overweight or obesity. Regardless of their weight, these patients are malnourished. They may lack some essential nutrients causing serious health consequences. That's why nutrition cannot be assessed by BMI only. Common signs they will present with will include tachycardia, hypotension (systolic blood pressure below 90), dry skin, and hair loss. If the person uses self-induced vomiting to prevent weight gain, they may have erosion of the dental enamel from all the acid that comes up when they vomit. There may also be scarring or calluses on the dorsum side of the hand from all the acid too. Their parotid glands, that are located on the side of the jaws will also be swollen, causing a sign known as chipmunk face of bulimia.From talking to this person and getting a detailed history, we will learn of the symptoms bulimia nervosa can cause. This will include lethargy and fatigue, irregular menstrual periods in a female, abdominal pain and bloating, and constipationThis disorder really does take a toll on the body. There's plenty of complications that come with it as well. Let's try to break it down by system. GI system has the most complications: esophageal tears from the vomiting called Mallory-Weiss syndrome, which will present with bloody vomits, a loss of gag reflex, esophageal dysmotility, abdominal pain and bloating, GERD, diarrhea and malabsorption of nutrients, fatty stools known as steatorrhea, colonic dysmotility leading to constipation, irritable bowel syndrome, rectal prolapse, and pancreatitis. Cardiac: serious complication is ipeac-induced myopathy, let's spend a little time on this. Ipecac is a syrup that someone with bulimia nervosa may use to make themselves vomit. If a person uses this syrup frequently or for a long amount of time, there is a component called emetine will accumulate in muscle, including cardiac muscle. If a person uses ipecac chronically, it can be detected in the urine for up to 60 days. This will damage the heart muscles or myocardium and lead to cardiomyopathy. It will present with symptoms such as chest pain, shortness of breath, hypotension, tachycardia or bradycardia, T wave abnormalities on ECG, conduction delays, arrythmias, pericardial effusions, and even congestive heart failure. Cardiomyopathy may be irreversible. Renal system: dehydration, hypokalemia, hypochloremia, hyponatremia, and metabolic alkalosis. This could happen in patient who use diuretics as a purging mechanism. Endocrine system: Electrolytes and hormones imbalance. The endocrine system primarily impacts the reproductive and skeletal systems. Among 82 women treated for bulimia nervosa, menstrual irregularities were present in 45 percent at pretreatment and in 31 percent at 12-month follow-up. These irregularities may look like spotty or very light menstrual cycles. Cycles may be very erratic or completely absent. Skeletal system: osteopenia and osteoporosis are common with bulimia nervosa. Osteopenia means weaker and more brittle bones. Osteoporosis is more serious than osteopenia and can more easily result in fractures.The diagnosis of bulimia nervosa can usually be made clinically. And after the diagnosis with bulimia nervosa, the first step in helping them is always getting a full lab work up to see what systems to the body have been impacted. Treatment options include nutritional counseling, behavioral therapy, and even medications. If a person needs help connecting with someone that can help with this disorder, there are organizations that they can contact which will connect them with proper resources in their area. Organizations include the Academy for Eating Disorders and the National Eating Disorders Association. Bulimia nervosa is more prevalent in females than males in all age groups. In the US, adult prevalence is 1.0% and adolescent prevalence is 0.9%, with the median age of onset of 18 years. After comparing different age groups, we have seen the prevalence of bulimia nervosa has increased over time. Conclusion: Anorexia nervosa and bulimia nervosa are eating disorders that can have consequences on the health of our patients. We should know the difference between these two diseases and know the resources available in our community to assist these patients. The diagnosis may be done clinically, but you will need to order labs or imaging for a full assessment. Eating disorders are an example of the direct effect a mental illness can have in the body. In the specific case, anorexia and bulimia cause malnutrition. The treatment of these diseases requires a multidisciplinary team to treat the patient and the family as well.____________________________Conclusion: Now we conclude our episode number 76 “Eating Disorders.” We started this episode with exciting news about the new malaria vaccine, a step forward on our fight against malaria. Sophia, Jeffrey, and Dr Arreaza presented an interesting overview about anorexia and bulimia. They taught us that if a patient perceives him or herself as “fat”, but they are actually underweight, they may have anorexia. Patients with bulimia tend to have normal or above normal BMI but have periods of binging and purging. Be aware of these conditions while assessing your patients' nutritional status and treat appropriately or refer as needed. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Tana Parker, Sophia Dhillon, and Jeffrey Nguyen. Audio edition: Suraj Amrutia. See you next week! _____________________References: Malaria's Impact Worldwide, Centers for Disease Control and Prevention, https://www.cdc.gov/malaria/malaria_worldwide/impact.html, accessed on November 15, 2021. Constitution of the World Health Organization, Basic Documents, Forty-fifth edition, Supplement, October 2006, accessed on Aug 26, 2021. Accessed on November 15, 2021. https://www.who.int/governance/eb/who_constitution_en.pdf. 12 Secret Signs of Anorexia, CBS News, August 12, 2010, https://www.cbsnews.com/pictures/12-secret-signs-of-anorexia/3/. Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Feb 1;61(3):348-58. doi: 10.1016/j.biopsych.2006.03.040. Epub 2006 Jul 3. Erratum in: Biol Psychiatry. 2012 Jul 15;72(2):164. PMID: 16815322; PMCID: PMC1892232. https://pubmed.ncbi.nlm.nih.gov/16815322/. Mitchell, James E, MD; and Christie Zunker, PhD, CPH, CHES, Bulimia nervosa and binge eating disorder in adults: Medical complications and their management, UpToDate, October 2021. https://www.uptodate.com/contents/bulimia-nervosa-and-binge-eating-disorder-in-adults-medical-complications-and-their-management?search=Bulimia%20nervosa%20and%20binge%20eating%20disorder%20in%20adults:%20Medical%20complications%20and%20their%20management&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Yager, Joel, MD, Eating disorders: Overview of epidemiology, clinical features, and diagnosis, UpToDate, October 2021. https://www.uptodate.com/contents/eating-disorders-overview-of-epidemiology-clinical-features-and-diagnosis?search=Eating%20disorders:%20Overview%20of%20epidemiology,%20clinical%20features,%20and%20diagnosis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Yager, Joel, MD, Eating disorders: Overview of prevention and treatment, UpToDate, October 2021. https://www.uptodate.com/contents/eating-disorders-overview-of-prevention-and-treatment?search=Eating%20disorders:%20Overview%20of%20prevention%20and%20treatment&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
An interview with Dr. Loretta Nastoupil from MD Anderson Cancer Center, author on “Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update.” She discusses the identification, evaluation, and management of hematologic toxicities in patients receiving ICPis, including hemolytic anemia among others in Part 10 of this 13-part series. For more information visit www.asco.org/supportive-care-guidelines TRANSCRIPT [MUSIC PLAYING] SPEAKER: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. BRITTANY HARVEY: Hello, and welcome to the ASCO Guidelines podcast series brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at ASCO.org/podcasts. My name is Brittany Harvey. And today, we're continuing our series on the management of immune-related adverse events. I am joined by Dr. Loretta Nastoupil from the University of Texas M.D. Anderson Cancer Center in Houston, Texas, author on Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy, ASCO Guideline Update, and Management of Immune-Related Adverse Events in Patients Treated With Chimeric Antigen Receptor T-Cell Therapy ASCO Guideline. And today, we're focusing on hematologic toxicities in patients treated with immune-checkpoint inhibitor therapy. Thank you for being here, Dr. Nastoupil. LORETTA NASTOUPIL: Thanks, Brittany. I'm happy to be here. BRITTANY HARVEY: Great. Then first I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guidelines in the Journal of Clinical Oncology. Dr. Nastoupil, do you have any relevant disclosures that are related to these guidelines? LORETTA NASTOUPIL: Yes, Brittany. So I have received honorarium for participation in advisory boards from the following companies, including BMS/Celgene, Genentech, Janssen, Novartis, Merck, MorphoSys TG Therapeutics, and Takeda. And I've also received research funding support from BMS/Celgene, Gilead Kite, Genentech, Janssen, Novartis and Takeda. BRITTANY HARVEY: I thank you for those disclosures. Then let's get into what we're here today to talk about. So what are the immune-related hematologic toxicities addressed in this guideline? LORETTA NASTOUPIL: So it's important to recognize that hematologic toxicities that are immune-related as a result of immune therapy are infrequent occurrences. So it's important to recognize when they do occur and some of the unique workups given that they are so infrequent. So probably one of the most common is hemolytic anemia. It's important to recognize that these are cancer patients. And they may have multiple reasons for the development of acute or new onset anemia, but recognizing if they're on either checkpoint inhibitors or immune therapies, it's important to recognize that it might be spurred on as a result of immune-mediated anemia. We advise in terms of history and workup to consider whether or not they've been exposed to new drugs, whether or not they've had a recent insect or snakebite exposure. The recommended workup includes a CBC with also a peripheral blood smear to look for evidence of hemolysis or macroketosis. In addition, other hemolytic anemia workup includes evaluation for LDH, haptoglobin, reticulocyte count, bilirubin, and free hemoglobin. Other potential diagnoses on the differential include DIC, so a panel, including coags, PT, INR, and PTT, exploring autoimmune serologies, PNH screening, evaluation for infection such as viral or bacterial causes of hemolysis, and also consideration for bone marrow failure syndrome, including evaluation for potentially reversible causes, such as B12, folate, copper, parvovirus, iron, thyroid, infection, et cetera. G6PD level is helpful in the evaluation, as well as exploration as I mentioned of potentially new drugs that might be linked, including ribavirin, rifampin, dapsone, interferon, some of the antibiotics, such as cephalosporins, penicillins, NSAIDs, ciprofloxacin, for instance, et cetera. So as part of the workup, if we have excluded alternative causes and we think that the immune-checkpoint inhibitor might be the underlying cause of the autoimmune hemolytic anemia, then generally we will continue unless they have grade 2 or higher toxicity, which is generally a hemoglobin less than 10. In which case, we would recommend to hold the immune-checkpoint inhibitor, again, with significant anemia. So those with grade 2 or higher, you might consider initiating corticosteroids, including 1.5 to 1 milligram per kilogram per day until improvement. For grade 3 or higher-- so this is more severe anemia So hemoglobin is less than 8. Generally, we're recommending permanent discontinuation of the checkpoint inhibitor and potentially higher doses, including up to 2 milligrams per kilogram per day of prednisone or corticosteroid equivalent to speed up the recovery. In regards to transfusion requirements or consideration, we are suggesting you evaluate or consider your local or regional guidelines. We generally do not transfuse for a target hemoglobin greater than seven to eight. And we also recommend supplementation with folic acid. BRITTANY HARVEY: Great. And then beyond those recommendations for hemolytic anemia, what are the key recommendations for identification, evaluation, and management of acquired thrombotic thrombocytopenia purpura? LORETTA NASTOUPIL: Sure. So fortunately, TTP is quite rare, but, again, something that is worth exploring. Some of the challenges are in the clinical syndrome. And that it can mimic some of the other toxicities that are covered in other sections, particularly the neurotoxicity section. But essentially, for patients who have pretty dramatic change in platelet count, again, they may have additional clinical sequelae such as neurologic toxicity or adverse events. It's important to recognize that TTP might be an underlying cause, again, for patients who are on immune-checkpoint inhibitors. This is where a hematology consult early in the clinical course would be particularly of importance to recognize it and potentially to minimize offending agents. Drug exposure is always important, because many of these patients might have other drugs, in addition to their immune-checkpoint inhibitors, such as chemotherapy, sirolimus, tacrolimus, antibiotics et cetera. And so exploring offending agents is important. An ADAMTS13 level, an inhibitor titer, would be important to send if you're considering TTP, in addition to evaluating the peripheral smear, and the hemolytic anemia workup, as I just mentioned, including LDH, haptoglobin and reticulocyte count. Exploring infectious etiology, including CMV titers or serology, would be particularly helpful, an additional clinical evaluation, such as brain imaging with CT or MRI, echocardiogram, and EKG would be of help. For all grades of TTP, again, even with a clinical suspicion for the diagnosis, in addition to hematology consult, we recommend stabilizing the patient. That might require care in an acute care setting, making sure that they have adequate organ function and that this is stabilized. For grade 1 or higher, we recommend holding the immune-checkpoint inhibitor. And you might consider, again, initiation of corticosteroids with 0.5 to 1 milligram per kilogram per day of prednisone or an equivalent. For grade 3 or higher, we would, again, in addition to holding the checkpoint inhibitor and in conjunction with your hematology colleagues, you might initiate a therapeutic plasma exchange. Again, in accordance with existing guidelines, you may consider higher doses of steroids, including methylprednisolone 1 gram IV daily for three days. You could consider some additional supportive agents, such as rituximab or pembrolizumab if the ADAMTS13 level is less than 10 or less than 10% of normal and an inhibitor or elevated ADAMTS13 IgG has been detected. BRITTANY HARVEY: I appreciate you going through the details for TTP. So then, additionally, this guideline addresses aplastic anemia. So what are the key recommendations for identification, evaluation, and management of aplastic anemia? LORETTA NASTOUPIL: Yeah. So fortunately, again, these are quite rare situations. So with aplastic anemia, similar to what we've discussed in terms of workup of anemia, globally, it's important to explore potentially causes of, again, bone marrow failure syndrome. And aplastic anemia is one of those such causes. Exploration of a bone marrow biopsy in conjunction, again, with your hematology consult would be critically important, and exploring potentially reversible causes, again, such as deficiencies and important nutrients, viral etiologies, in addition to parvovirus, CMV, HHV-6 is important to consider and rule out. But I think the end of the day, a bone marrow biopsy and aspirate is going to be the most helpful assessment to ensure that aplastic anemia has been considered and worked up. In regards to management of aplastic anemia, we're going to hold the immune-checkpoint inhibitor. You may need to provide additional support such as growth factors. And close follow-up, I think is the most critical aspect of this. Sometimes we initiate patients on corticosteroids. We hold the checkpoint inhibitor. And then we may monitor them less frequently. Oftentimes, these patients with high malignancies are going to need to be followed very closely, sometimes weekly or multiple times a week. So in regards to management of aplastic anemia that might be immune mediated as a result of immune-checkpoint inhibitors and in conjunction with your hematology and colleagues, consideration of management might include administration of horse ATG and cyclosporine, but again transfusion support, growth factor support, even consideration for HLA typing and evaluation first. Stem cell transplantation might be appropriate, particularly for a young patient with minimal comorbidities. For grade 3 or higher, in addition to these considerations, we're going to hold the checkpoint inhibitor and monitor weekly for improvement. If no response, you might consider repeating immune suppression with Rabbit ATG plus cyclosporine or cyclophosphamide. And for refractory patients, consider eltrombopag plus best supportive care. BRITTANY HARVEY: Great. Thank you. Those are important notes on the management of aplastic anemia. So then, additionally, what are the key recommendations for the identification, evaluation, and management of lymphopenia? LORETTA NASTOUPIL: Yeah. I think one of the challenges with lymphopenia, it's common for patients who've had cancer-directed therapy, particularly things like chemotherapy. And so understanding whether or not this is a new onset after exposure to checkpoint inhibitors is one of the critical aspects, in addition to considering alternative causes. But for patients in which we do think the lymphopenia is a result of the immune-checkpoint inhibitor, we're not generally advising discontinuation or holding of the immune-checkpoint inhibitor, but it is important to consider best supportive measures, including whether or not patients might benefit from monitoring for reactivation of certain viral etiologies, including CMV and HHV-6, for instance, in addition to potential consideration for prophylactic strategies, such as PJP prophylaxis. Also, zoster reactivation might be something that these patients might indeed be at risk for. So as opposed to holding your checkpoint inhibitor and initiating things like corticosteroids, if we have excluded alternative causes and think lymphopenia is a result of the immune-checkpoint inhibitor or as immune mediated, ensuring that they are receiving best supportive care to mitigate some of their toxicity that may result as the result of the lymphopenia. BRITTANY HARVEY: Understood. And it's important to note for clinicians that management is different from a lot of the management of the other hematologic toxicities. So then the last hematologic toxicity that was addressed in this guideline was acquired hemophilia A. So what are those key recommendations? LORETTA NASTOUPIL: Acquired hemophilia A, again, fortunately is very rare and uncommon, but this is one situation where engagement of a hematologist, who is an expert in management of hemophilia, will be critical. So that would potentially be step one. In terms of laboratory assessment, that would be helpful, in addition to your CBC, where you're assessing things like platelet count, coagulation workup, including fibrinogen, PT, PTT, INR, that would be informative. Patients with acquired hemophilia A will likely have a prolonged activated PTT with a normal PT. So that might be one of the clues. Imaging would be helpful to ensure the patients don't have any signs of spontaneous bleeding or hematoma basis, such as MRI, CT, or ultrasound, if particularly they have any localizing symptoms. Medication review to look for alternative causes would always be helpful. And determination of the Bethesda unit level of inhibitor would be critical. In regards to management, we would hold the checkpoint inhibitor, initiate corticosteroids, transfusion support as indicated, and you want to treat the underlying acquired hemophilia with conjunction of a hematologist. For grade 2 or higher, this may require factor replacement. And the choice is usually based on the Bethesda unit of the titer. Administration of prednisone, in addition to rituximab 375 milligrams per meter squared weekly for four weeks or cyclophosphamide dosed at 1 to 2 milligrams per kilogram per day may be patient specific. And, again, that decision should be made in conjunction with your hematology consult. Prednisone, rituximab, and cyclophosphamide should be given for a minimum of five weeks. And factors should be prescribed to increase the level, particularly during bleeding episodes. And, again, the choice of the factor is based on the presence or absence of an inhibitor. For grade 3 or higher, we advise to permanently discontinue the immune-checkpoint inhibitor. These patients generally will be admitted for stabilization. They do require factor replacement. Bypassing agents may also be required, including factor VII. Caution should be taken in elderly patients and those with coronary artery disease. Corticosteroids, rituximab, and cyclophosphamide should also be considered, transfusion support, if they're having active bleeding. And if worsening or no improvement, you could consider adding cyclosporine or immune suppression to try and stabilize these patients. Again, acquired hemophilia A requires special clinical and laboratory expertise. This would require consult and potentially even transfer to a specialized center, and consultation with a hemophilia center should be initiated as soon as this is considered or confirmed. BRITTANY HARVEY: That's a great summary of these recommendations. The expert panel and you clearly put in a lot of work into these recommendations. So then in your view, how will these recommendations for the management of hematologic toxicities impact both clinicians and patients? LORETTA NASTOUPIL: I think the most important thing are disseminating this information. I think ASCO plays a critical role in helping clinicians first recognize some of the toxicities that are different from what we have traditionally seen with chemotherapy and may have different management strategies. So guidelines, such as this, are critically helpful. Podcasts, such as this, are incredibly helpful to get the information out, recognizing that all of us authors are more than willing to provide additional guidance and are willing to be contacted in this situation where someone's facing one of these unique and rare toxicities and would like some additional guidance in terms of further management. Hematologic toxicities are sometimes hard to distinguish or maybe potentially hard to recognize, given many of these patients may have been on prior chemotherapy agents, and anemia or thrombocytopenia may not be unusual, but recognizing if it's new or more severe than what has been seen previously and that, at least, consideration of an immune-mediated hematologic toxicity, be considered, because the management might be unique. And so I hope that we've outlined today some of the hematologic toxicities that are rare that may be seen with immune therapy and some of the strategies to work up alternative diagnoses and management if it is indeed immune-mediated toxicity. BRITTANY HARVEY: Definitely. And I really appreciate you going through these rare but very important toxicities. So thank you for your work on these guidelines and for taking the time to speak with me today, Dr. Nastoupil. LORETTA NASTOUPIL: Thanks, Brittany. BRITTANY HARVEY: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. Stay tuned for additional episodes on the management of immune-related adverse events. To read the full guideline, go to www.ASCO.org/supportive care guidlines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe so you never miss an episode. [MUSIC PLAYING]
Critical illness occurs frequently after a new diagnosis of hematologic malignancy and has high associated mortality. Baseline characteristics at diagnosis can help identify those patients at the highest risk of critical illness. Original article: https://doi.org/10.1007/s00134-021-06502-2 (Critical illness in patients with hematologic malignancy: a population-based cohort study) Speakers: Bruno L. FERREYRO. Interdepartmental Division of Critical Care Medicine, University of Toronto (CA). Laveena MUNSHI. Interdepartmental Division of Critical Care Medicine, University of Toronto (CA). Gaetano SCARAMUZZO. Department of Translational medicine, University of Ferrara (IT).
Featuring perspectives from Drs Jeff Sharman, Mitchell Smith and Philip Thompson, including the following topics: Evidence-Based Therapy for Patients with Treatment-Naïve Chronic Lymphocytic Leukemia — Mitchell R Smith, MD, PhD (0:00) Considerations in the Selection of Treatment for Special Patient Populations; Management of Adverse Events with BTK and Bcl-2 Inhibitors — Jeff Sharman, MD (35:02) Selection and Sequencing of Treatment for Relapsed/Refractory Disease; Novel Investigational Agents and Strategies — Philip A Thompson, MB, BS (1:04:47) CME information and select publications
Featuring perspectives from Drs Andrew Evens, Ian Flinn and Gilles Salles, including the following topics: Introduction (0:00) Follicular Lymphoma (FL) (1:40) Case: A man in his early 70s with relapsed/refractory (R/R) FL — Andrew M Evens, DO, MSc (6:47) Case: A woman in her late 60s with R/R FL and an EZH2 mutation — Ian W Flinn, MD, PhD (15:00) Mantle Cell Lymphoma (MCL) (21:40) Case: A man in his early 70s with MCL — Dr Flinn (28:51) Case: A woman in her late 60s with MCL who received a Bruton tyrosine kinase inhibitor and received chimeric antigen receptor (CAR) T-cell therapy — Dr Evens (33:18) Case: A man in his early 60s with R/R MCL — Dr Flinn (36:04) Diffuse Large B-Cell Lymphoma (DLBCL) (37:41) Case: A man in his early 80s with R/R DLBCL — Dr Flinn (43:53) Case: A woman in her late 70s with DLBCL — Gilles Salles, MD, PhD (46:46) Case: A man in his late 20s with R/R DLBCL treated with CAR T-cell therapy — Dr Salles (51:00) CME information and select publications
Featuring perspectives from Drs Jeff Sharman, Mitchell Smith and Philip Thompson, including the following topics: Treatment of CLL in 2021 Introduction (0:00) First-line therapy for a younger and fit patient with CLL (11:52) Case: A man in his mid-60s with IGHV-unmutated CLL — Mitchell R Smith, MD, PhD (16:20) Case: A man in his mid-30s with IGHV-unmutated CLL — Philip A Thompson, MD, BS (20:24) Case: A woman in her late 60s with IGHV-mutated, trisomy 12, TP53 wild-type CLL — Jeff Sharman, MD (25:11) First-line therapy for older and frail patients with CLL (26:55) Case: A man in his early 70s with IGHV-unmutated CLL — Dr Thompson (31:04) First-line therapy for patients with high-risk CLL (33:37) Choice of Bruton tyrosine kinase (BTK) inhibitor for the treatment of CLL (36:02) Prevention and management of COVID-19 in patients with CLL (43:21) Future Treatment of CLL Future role of BTK inhibitors combined with venetoclax in the management of CLL (48:33) Future role of pirtobrutinib (LOXO-305) in the management of CLL (52:22) Case: A woman in her late 60s with multiregimen-relapsed CLL — Dr Sharman (55:10) Case: A woman in her mid-50s with multiregimen-relapsed CLL — Dr Thompson (57:32) CME information and select publications
Featuring perspectives from Drs Courtney DiNardo, Daniel Pollyea, David Sallman and Eunice Wang, including the following topics: Introduction (0:00) Prologue: A Personal Reflection on Acute Myeloid Leukemia (AML) (1:01) Case: A woman in her mid-80s with newly diagnosed AML — Daniel A Pollyea, MD, MS (8:28) Up-Front Treatment of AML in Patients Who Are Not Eligible for Intensive Therapy (11:54) Case: A man in his early 70s with AML and a complex monosomal karyotype — Dr Pollyea (24:32) Management of AML with Targetable Mutations (33:14) Case: A woman in her late 70s with AML and a FLT3-ITD mutation — Courtney D DiNardo, MD, MSCE (40:04) Case: A man in his late 70s with AML and diploid cytogenetics — Dr DiNardo (48:41) Other Currently Available and Investigational Treatment Strategies for AML (51:57) Case: A man in his mid-60s with secondary AML and DNMT3A and FLT3-ITD mutations — Eunice S Wang, MD (54:50) Case: A woman in her late 50s with leukemia cutis — Dr Wang (1:06:25) Case: A woman in her late 60s with lower-risk myelodysplastic syndrome (MDS) — David Sallman, MD (1:09:20) Case: A man in his late 70s with high-risk MDS — Dr Sallman (1:15:37) Case: A man in his mid-80s with high-risk MDS — Dr Sallman (1:22:27) CME information and select publications
A special audio program developed from a series of webinars held in conjunction with the 2021 ASCO Annual Meeting. Featuring perspectives from Drs Caron Jacobson, David G Maloney and Nikhil C Munshi.
Welcome to the next episode of The Reveal where we take you inside the mind of a test-taker to deconstruct and connect the dots of a board-style question so you can become a better student, transform how you learn, and excel not only on high-stakes exams, but also in your general medical knowledge. Let's get read more... The post Try This Challenging Board Review Question About Hematologic Disorders appeared first on RoshReview.com.
Hematologic Disorders in Pregnancy with guest Dr. Kelsey Martin May 19, 2019 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095
Hematologic Disorders in Pregnancy with guest Dr. Kelsey Martin May 19, 2019 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095
Question: A nurse is teaching a patient about self-care at home after he has experienced an anaphylactic reaction to shellfish. For future reference for the patient, after exposure to shellfish, in order to best manage an allergic reaction and prevent anaphylactic shock, the nurse should counsel the patient to do what as an initial intervention? […] The post QOD 78: Prevention of Anaphylactic Shock (Hematologic/Immunology/Health Promotion and Maintenance) appeared first on NURSING.com.
© 2020-2025 Ivy Podcast Discovery LLC
