Hematology findings in COVID-19 at admission (Guan NEJM):
-lymphocytopenia (<1500) in 83.2%
-thrombocytopenia in 36.2%,
-leukopenia in 33.7%.
Lymphocytopenia correlates w/ disease severity
I highly recommend viewing Thursdays MGH grand rounds on COVID
Observation from a program director currently reading through hundreds of applications:
you guys are killing me with the AI-generated personal statements.
I am grateful for the academic oncologists willing to refer their patients to another center for an appropriate clinical trial. This is unfortunately uncommon. It takes a village to study rare diseases and we must do this to move forward.
Before we run out of PPE, we should check serologies on all health care workers. Those who have already been exposed and have robust Ab responses but are no longer shedding virus can take over COVID care.
Italian physician Roberto Stella died - he continued caring for
#COVID19
patients after running out of personal protective equipment, saying “We have run out of masks. But we don't stop. We are careful and we go on.” 1/
Tip from a Heme/Onc Fellowship Program Director
If you spent 1+ years as a hospitalist, I will ask: "What did you do to leave your hospital better than when you found it?"
QI projects, Med student teaching, mentorship, moving forward a research project are all acceptable answers
With a little foresight, the vacant
@The_BMC
E Newton pavilion (w it’s 50+ ICU beds) could be made into the Boston COVID-19 hospital. Think of how this would help triage and isolation.
@marty_walsh
@MassGovernor
@KateWalshCEO
I’ve started using fabricated aphorisms to my point. Today I told a patient “It’s like my dad always said: make sure you buy a plunger before you need a plunger.” My father definitely never said that.
Can we all agree CDAs should NOT be needed just get a look at the schema and inclusion criteria of a pharma-sponsored trial?
Involving a hospital lawyer just to look at basic trial information that should already be publicly available is an enormous waste of resources.
Every leukemia survivor owes their life to this extraordinary man. Pioneer of platelet transfusions and multi-agent chemotherapy. The reason our wards are no longer ‘abbatoirs’ is because of his work.
Looking forward to visiting
@The_BMC
tomorrow w/
@SecAzar
to learn more about the compassionate natal care & support given to mothers & babies w/ NAS.
#BeBest
You would think for a $730 registration and $375 membership fee
@ASH_hematology
could just let us watch the education spotlight videos from
#ASH22
at our leisure.
I don’t know who needs to hear this (
@SWOG
) but if you write a protocol that requires holding therapy for low ANC it makes it impossible to treat Duffy (a- b-) aka benign ethnic neutropenia patients. Result: black patients don’t go on trial or are taken off trial. Fix it.
I can’t even tell you guys how much I love these
@BUHemeOncFellows
. They got through this year with their shoulder to shoulder with their heads down but their eyes on the future. So proud.
Its time for my yearly
#ASH18
Summary!
Drug A + Drug B has better PFS and more toxicity than drug B alone.
Too early to see OS benefit but there probably is none.
Dinner and Drinks by makers of Drug A at 8pm tonight at fancy restaurant C.
Stop by the booth for free crap!
I was following someone for an IgG lambda MGUS for a few years before I noticed they were on Benlysta (belimumab) for SLE- a chimeric IgG lambda monoclonal. Not MGUS.
The lesson is:
Biologics don’t always appear on med list and aren’t obvious from their brand name.
@AspiringERMD
Life is long. How you feel at this moment will not be how you always feel; your struggles in 10 years will be much different. Find something (even if it is very small) each day that helps you believe you are doing meaningful work (which you are).
What’s funny about academic medicine is that you’ll be doing your job and then when you are starting on service they will be like “here is a whole other job in addition to your job.”
25-50% of healthy people of african ancestry have ANC<1500
The term ‘Benign Ethnic Neutropenia’ implies non-whiteness is itself a disease.
Create a .phrase for “typical neutrophil count w Fy(a-b-) status”
@LaurenMerzMD
@AchebeMaureen
Why do hospitals still have shared rooms? You can’t choose the lighting or the room temperature. Listening to your roommates TV, phone conversations, snoring and beeping IV is not healing. We pretend to value privacy but ignore this egregious violation.
Today I learned there is a drug called Imlifidase that completely degrades IgG for ~7 days. This could be used to temporize A LOT of problems in hematology.
@jeanfrancis72
One of the
@BUHemeOncFellows
has an agreement with the man who hands out masks in the
@The_BMC
lobby to notify him by text whenever the morning Starbucks line shortens. Genius.
I ate a donut today from the nurses station even though I knew it was a bad idea. It wasn’t even good. I Can’t believe that’s how I’m going down. Idiot.
#COVIDONUT
The worst time to round on a patient is after they have poured the milk on their rice crispies but before they had a chance to eat them. Our team managed to hit this sweet spot in >50% of our service today.
Not all AL Amyloidosis should get dara-CyBorD.
Rituxan is the cornerstone of tx for Waldenstroms Associated AL. You often need to look hard to find the LPL clone. BTK inhibs unexpectedly toxic in AL.
Here is the
@BU_Amyloidosis
experience.
My strategy for this morning’s video conference:
1. Use a Mandalorian coffee mug to establish dominance
2. Rather than agree w a colleague, say “this is the way”
3. Proclaim “I have spoken” after every statement.
International friends Help me get promoted!
My faculty review committee tells me I need to give more international talks but that virtual talks will count.
Invite me to talk at your grand rounds!
I am best at talking about AL amyloidosis and Adult T Cell lymphoma leukemia.
Misspelling amyloid is no big deal. Misdiagnosing
#amyloid
, on the other hand, can be deadly.
#spellingbee
@Amyloidosis_BU
•Ratio of MM pts to AL pts is 5:1.
•renal biopsy for nephrotic syndrome has amyloid in 13%
•10% of bilat carpal tunnel pts
Green flags in fellowship applications.
Competitive programs have space to interview <10% of applicants so anything you want us to know needs to be conveyed in the application itself-- you can't wait for the interview to make a case for 'fit'.
Applying for Heme/onc fellowship?
Consider our four year program w
@BUgeriatrics
results in triple board eligibility.
It is designed to create leaders in the growing field of geriatric oncology.
@RZChipMD
@MayaAbdallah_MD
Hematologist: Hi! You've been diagnosed with smoldering multiple myeloma. Would you prefer to be over-treated or under-treated?
Patient: Ummm. Neither?
Hematologist: Great! Over-treatment it is. MRD here we come!
Benefit of Vyxeos in secondary AML comes almost entirely from subgroup w DNTM3A and TET2 mutations. Didn’t help at all for TP53mut. Ven/aza inferior in TP53 Mut vs wt although good CR rate in poor risk cytogenetics w p53wt. Data from
@ColemanLindsley
&
@DanPollyea
#ASH22
Excited that
@The_BMC
was selected to be a part of this project. It is a first step towards improving outcomes in Duffy null persons.
#DANC
@LaurenMerzMD
24 health & hospital systems have been selected to participate in the Absolute Neutrophil Count (ANC) by Duffy Status Project, supported by
@DorisDukeFdn
, which will redefine ANC reference ranges by Duffy status & address a critical health equity concern.
Hemophagocytosis is a common finding in lymph nodes and spleen on
#COVID
autopsies. These findings would often boost pre-mortem H-core into range consistent with HLH. Full preprint here: .
@DitaGratzinger
@joshmcgoo
1. Time alone w the patient is the greatest gift you can give a student.
2. You don’t need to try to teach with every breath. When you’re pinched for time make a single teaching point and then move on.
3. Show them that you enjoy and take pride in your work.
The 2023
@ASH_hematology
guideline recommends thrombophilia testing for patients w/ pregnancy or contraceptive induced VTE and indefinite AC for those who test +.
I wasn't testing or giving extended AC for clearly provoked events.
@MiddeldorpS
@connors_md
@NTConnell
We wrote this trial after growing tired of watching ATLL patients die. There were no front line studies available at the time. This shows that long term survival is possible. Early Brentuximab inclusion (even if CD30 negative) and PROMPT alloSCT critical. Still enrolling!
Heme/Onc Fellow applicants:
@The_BMC
has a unique 4 yr geriatric oncology program that leads to triple board eligibility. Graduates are doing amazing things.
In ERAS as a separate app; it pulls from a smaller pool of applicants
@RZChipMD
@drjessigold
@sairarahman
@choo_ek
I was at an auction once where you could hire a bugler for several hours to play a fanfare whenever you entered a room or successfully printed an after visit summary.
Not that we need another thing to worry about, but I haven’t seen a new lymphoma referral in weeks. They’re not making their way through the system. Not good.
Dear ABIM,
I do not order or interpret as many oxygen dissociation tests as you seem to think I should. Thanks for a fun day!
Sincerely,
A hematologist who will hopefully remain board certified.
Several common eligibility criteria are really just surrogates for age exclusion. Does your trial REALLY need a GFR > 60? Clinical trials demographics should be representative. Thx to
@sharon_inouye
@paula_span
for the reality check.
Cassini study results as late breaking ASH abstract. Rivaroxaban effective for reducing cancer associated thrombosis in high risk patients while on threatment. Great work by
@aakonc
To everyone’s credit, this study (SWOG S1803) has been amended to accommodate appropriate dosing for the >50% of african American patients who are Duffy null.
Another day another black patient unable to enroll on
@SWOG
S1803 (DRAMMATIC) because of their Duffy Null status. Minorities deserve fair representation on clinical trials.
@DoctorAKrishnan
@vsanchorawala
All elective procedures, stem cell transplants where timing isn’t critical, etc should be all postponed ASAP. Honestly the BEST thing that can happen is that months from now everyone will say we overreacted and hurt the hospital bottom line. That would be lovely.
I’ve Discussed this w many of the most knowledgeable Lymphoma docs in the US and literally nobody agrees w
@nccn
guidelines to give escalated BEACOPP for PET2+ patients. This guideline needs revisiting.
I tried this metaphor in conference for
@BUHemeOncFellows
but nobody understood. I will therefore be including
@TomBrady
meme interpretation in my match selection criteria for next year.
#TB12
> 40% of black pts experience skin pigment changes on Revlimid. Changes occur early, are slow to resolve and can be distressing.
This was underappreciated because pivotal trials done almost exclusively in white pts.
@dhughesPharmD
@vsanchorawala
In 9 years at my hospital, the only IT change that made my life better was when they increased my email storage quota. Everything else just resulted in more clicking to satisfy an administrator.
I strongly consider any fellowship candidate w a black belt for an interview because they would be useful in case there is a rumble with another program at the hematology meeting.
Message from
@MorieGertz
at
#ISA2018
:
If you’re a cardiologist, nephrologist or oncologist and haven’t Diagnosed
#Amyloidosis
, you aren’t doing a good job.
•Ratio of MM pts to AL pts is 5:1.
•renal biopsy for nephrotic syndrome amyloid in 13%
•median 3 MDs seen before dx
While we usually shrug it off as insignificant, the loss of the Y chromosome (mLOY) in men is associated with a much higher cancer mortality, CV mortality and all cause mortality than those without it.
Possible association with ATTR amyloidosis.
@BU_Amyloidosis
Sickle cell trait is frequently blamed as a cause of death for black people who die while in custody. Thank you to
@laforgia_
@jenvalentino
for exposing this charade.
#Hemetwitter
has your back.
Accumulating data on sequencing of bispecific Abs and CAR-T. Summary: Still getting good responses, lower CR rates and lower DOR. Dont use same product. Good idea to switch antigens, be mindful of T cell exhaustion.
#ASH23
@OBGaYN
NOBODY CARES WHAT THEIR DOCTORS STEP 1 SCORES WERE. Missing an entire year of medical school to cram for the boards is an absurd decision. Learn it, test it, forget it is a lousy educational strategy if the real goal is to be a good doctor.
Planning to write this protocol as a small ph2
@The_BMC
this weekend. Does anyone have any thoughts or advice? Anyone know of something similar in existence? Any advice for getting an expedited IND? Thanks!
A Hickman catheter signifies a serious problem has occurred. New AML. Stem cell transplant. Access for dialysis. Yet it’s placement allows the work of healing to begin. I’m grateful to Dr Hickman for making my job possible.
@skohoro
One secret to a sustainable academic career is to have enough roles that nobody ever knows where you are ‘supposed to be’ at a given moment. People assume I’m doing something important when I’m not in my office, which I am, but it often involves coaching a little league game.
For some reason we expect that the intelligent, talented people are also the kind people. In reality, these qualities exist on independent axes. Understanding this saves me some disappointment.
David Seldin has an ongoing presence in many lives through his scientific work and mentorship. Would that he were here to see our progress in
#amyloidosis
.
@Amyloidosis_BU
@The_BMC
There is no evidence to support therapeutic anticoagulation w/o overt thrombosis in COVID-19 DIC. Not sure why AC for pts above an arbitrary d-dimer threshold is showing up in hospital protocols.
@connors_md
@DrYukselUrun
FAQ on COVID-19 coagulopathy.
This is NOT a joke:
Q: What do you get when you treat a patient who has ATTR + MGUS with plasma cell tx?
A: Progressive ATTR + side effects from plasma cell therapy.
Need TTR typing on all af/am pts and LC MS/MS in ambiguous cases.