The Fellow on Call: The Heme/Onc Podcast

We bring back our prior pharmacology discussion because it’s so incredibly important for the conversations that are on the horizon over the next few weeks. In this continuation of our myeloma series, we begin our discussion about treatment options for multiple myeloma, focusing first on pharmacology. We are so thrilled to have a special guest, Kathryn Maples, PharmD, BCOP who is a clinical pharmacy specialist in Multiple Myeloma at the Winship Cancer Institute of Emory Healthcare in Atlanta, Georgia!Content:- What are common drugs we use in "triplet regimens"? "quadruple therapy"? - What considerations must we take into account when prescribing commonly used medications in myeloma? - How should we counsel our patients? - What about supportive care?- How and when do we make dose adjustments? - This episode is SO eye-opening about the "behind the scenes" of myeloma care that physicians do not seeWant to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

Explore the evolving management strategies for smoldering multiple myeloma (SMM) and its higher-risk features. Delve into landmark studies revealing the nuances of this disease's natural history. Learn about the hot debate on whether early treatment or observation is more beneficial. Discover insights from trials like QUIREDEX and AQUILA, highlighting the effectiveness of lenalidomide and daratumumab. Plus, hear about personalized surveillance strategies to empower patient decision-making.

Dive into the intriguing world of plasma cell dyscrasias! This discussion unpacks the nuances between MGUS and smoldering myeloma, from risk assessment to monitoring strategies. Learn how free light chains play a role in interpreting results and why a 24-hour urine protein test is crucial. Get insights on the criteria for diagnosing smoldering myeloma, including the SLIM-CRAB metrics. Plus, discover the significant 20-year progression risks of these conditions and the importance of cytogenetic testing in predicting outcomes.

Delve into the fascinating world of plasma cell dyscrasias! The conversation kicks off with the biology of plasma cells, touching on the role of immunoglobulins. Explore why SPEP referrals are common and the significance of monitoring monoclonal proteins. Learn about MGUS, its prevalence, and associated risks. Discover when a bone marrow biopsy is necessary and the effectiveness of modern imaging techniques. The hosts outline essential testing protocols to navigate this complex landscape!

Dive into the latest advancements in treating relapsed/refractory follicular lymphoma with a focus on cellular therapies like CAR T and bispecific antibodies. Discover how these therapies are manufactured and administered, plus insights into patient selection criteria. Learn about the distinct effects of cytokine release syndrome and neurotoxicity, along with detailed trial results and safety profiles. The conversation also highlights practical considerations for clinicians and the real-world application of these cutting-edge treatments.

The discussion dives into relapsed/refractory follicular lymphoma and explores non-cellular therapy options. It highlights the use of rituximab maintenance therapy and its impact on patient surveillance. The hosts analyze treatment choices for low-burden relapses, comparing lenalidomide combined with rituximab and traditional chemotherapy. Key insights include the importance of POD24 in prognosis and the clinical role of oral tazemetostat. The episode wraps up with a sneak peek into future discussions on bispecifics and CAR-T therapies.

This discussion dives deep into front-line therapies for follicular lymphoma. It unpacks management strategies for both localized and diffuse disease, assessing treatment options for symptomatic versus asymptomatic patients. The impact of rituximab therapy is evaluated, with insights from the PRIMA trial. The conversation also highlights the evolving understanding of lymphoma classifications and the role of personalized care in improving patient outcomes. Historical studies shape today's decisions, making it a compelling exploration of treatment approaches.

Explore the challenges of managing follicular lymphoma as the hosts discuss accurate biopsy techniques and the importance of tissue sampling. Discover the nuances of diagnosing various lymphoma types, particularly focusing on CD10 positivity. Delve into the classification of follicular lymphoma subtypes, including rare variants and their treatment implications. The discussion also highlights the significance of imaging techniques like PET-CT scans and effective staging systems that are critical for tailored treatment strategies.

Delve into the management of antiphospholipid antibody syndrome with insights on anticoagulants. Discover if a higher INR is indeed better for warfarin and explore the role of Direct Oral Anticoagulants. The hosts debate the optimal timing for APLS testing—don't miss their lively back-and-forth! A recent trial sheds light on transitioning patients from warfarin to rivaroxaban, scrutinizing its findings. Plus, learn about the comparative effects of apixaban and warfarin in this complex treatment landscape.

This week, the focus is on antiphospholipid antibody syndrome and its connection to venous thromboembolism. The hosts discuss the complexities of diagnosis, including the significance of specific antibody tests and the common pitfalls of false positives. A real-life case study highlights the clinical criteria necessary for accurate assessment and management. Listeners gain insights into the evolution of the syndrome's understanding and the implications for effective patient care, especially in pregnancy.