Discover and read the best of Twitter Threads about #Goodman_heme
Most recents (6)
The 4 most important blood smears for USMLE/IM boards and for life
A short tweetorial
#MedEd
#Goodman_heme
Fevers, AMS, hemolytic anemia, thrombocytopenia = TTP= ADAMTS13 deficiency = Rx plasmapheresis
Smear with schistocytes + thrombocytopenia
A short tweetorial
#MedEd
#Goodman_heme
Fevers, AMS, hemolytic anemia, thrombocytopenia = TTP= ADAMTS13 deficiency = Rx plasmapheresis
Smear with schistocytes + thrombocytopenia
25 yo with bleeding, thrombocytopenia, low fibrinogen = APL = t(15;17) = Rx ATRA
Smear with large promyelocytes with granules, blasts with Auer rods, schistocytes can be present from DIC
Smear with large promyelocytes with granules, blasts with Auer rods, schistocytes can be present from DIC
50 yo asymptomatic with neutrophilic leukocytosis, basophilia, mild splenomegaly = CML = t(9;22) = Rx imatinib
Smear with leukocytosis rare blasts, myelocytes, sets, mature PMNs, basophils. Note WBCs many different shapes and sizes unlike acute leukemia.
Smear with leukocytosis rare blasts, myelocytes, sets, mature PMNs, basophils. Note WBCs many different shapes and sizes unlike acute leukemia.
All FDA Antibody Drug Conjugates Heme Malig
Tweetorial
#Goodman_heme
Antibody+Linker+Chemo/toxin
MOA
FDA approvals (trial)
tox (last tweet)
Gemtuzumab ozogamicin
anti-CD33+calicheamicin (DNA breaker)
Frontline AML+7+3 (ALFA,AML15)
Pediatric induction (AAML0531)
RR AML mono-Rx
Tweetorial
#Goodman_heme
Antibody+Linker+Chemo/toxin
MOA
FDA approvals (trial)
tox (last tweet)
Gemtuzumab ozogamicin
anti-CD33+calicheamicin (DNA breaker)
Frontline AML+7+3 (ALFA,AML15)
Pediatric induction (AAML0531)
RR AML mono-Rx
Brentuximab vedotin
anti-CD30+MMAE (microtubule polym inh)
Frontline HL BV+AVD (ECHELON 1, no OS)
RR HL BV mono-Rx
High risk HL post-ASCT maint (AETHERA,I don't rec)
Frontline CD30+ PTCL BV+CHP (ECHELON2, +OS)
RR systemic anaplastic large cell lymphoma
RR CTCL/cALCL (ALCANZA)
anti-CD30+MMAE (microtubule polym inh)
Frontline HL BV+AVD (ECHELON 1, no OS)
RR HL BV mono-Rx
High risk HL post-ASCT maint (AETHERA,I don't rec)
Frontline CD30+ PTCL BV+CHP (ECHELON2, +OS)
RR systemic anaplastic large cell lymphoma
RR CTCL/cALCL (ALCANZA)
Inotuzumab ozogamicin
anti-CD22+MMAE (+calicheamicin (DNA breaker)
RR B-ALL mono-Rx (INO-VATE, +OS)
Belantamab mafodotin
anti-BCMA+MMAF (microtubule poly inh)
RR multiple myeloma mono-RX (DREAMM-2)
anti-CD22+MMAE (+calicheamicin (DNA breaker)
RR B-ALL mono-Rx (INO-VATE, +OS)
Belantamab mafodotin
anti-BCMA+MMAF (microtubule poly inh)
RR multiple myeloma mono-RX (DREAMM-2)
Cold Blood (short Tweetorial)
#Goodman_heme
3 confusing diseases
1. Cold agglutinin disease
2. Cryoglobulinemia
3. Paroxysmal cold hemoglobinuria
Two of these disease are seen often on both the heme consult service and boards.
#Goodman_heme
3 confusing diseases
1. Cold agglutinin disease
2. Cryoglobulinemia
3. Paroxysmal cold hemoglobinuria
Two of these disease are seen often on both the heme consult service and boards.
Cold Agglutinin Disease
Hemolytic anemia precipitated by cold
Monoclonal IgM binds RBCs (I antigen), agglutination, and fixes complement in cold->hemolysis
DAT+ for C3 and - for IgG
Associated with IgM gammopathies/LPL
Polyclonal form after Mycoplasma infection
Rx = Rituximab
Hemolytic anemia precipitated by cold
Monoclonal IgM binds RBCs (I antigen), agglutination, and fixes complement in cold->hemolysis
DAT+ for C3 and - for IgG
Associated with IgM gammopathies/LPL
Polyclonal form after Mycoplasma infection
Rx = Rituximab
Cryoglobulinemia = precipitate at cold temp
I:
MPGN, palpable purpura
Monoclonal IgG/IgM
LPL, MGUS, myeloma, CLL
II:
Meltzer's triad = palpable purpura, arthralgias, weakness
Mononeuritis multiplex
Monoclonal IgM + polyclonal IgG
HCV, HIV
III:
Polyclonal IgM+IgG
Autoimmune dz
I:
MPGN, palpable purpura
Monoclonal IgG/IgM
LPL, MGUS, myeloma, CLL
II:
Meltzer's triad = palpable purpura, arthralgias, weakness
Mononeuritis multiplex
Monoclonal IgM + polyclonal IgG
HCV, HIV
III:
Polyclonal IgM+IgG
Autoimmune dz
Early stage DLBCL Tweetorial of all key trials from a presentation I just gave
#Goodman_heme
See last slide/Tweet for my conclusions
SWOG 8736:
>18 years
Bulk (>10 cm) allowed
CHOPx 3+IFRT vs. CHOP x 3 +IFRT
OS⬆️with IFRT but no difference in OS with extended f/u
18 year f/u
#Goodman_heme
See last slide/Tweet for my conclusions
SWOG 8736:
>18 years
Bulk (>10 cm) allowed
CHOPx 3+IFRT vs. CHOP x 3 +IFRT
OS⬆️with IFRT but no difference in OS with extended f/u
18 year f/u
ECOG 1484
>16 years
Bulk (>10 cm) allowed
CHOP x 8 if CR (by CT) randomized to IFRT vs observation
DFS improved with IFRT
No difference in OS
>16 years
Bulk (>10 cm) allowed
CHOP x 8 if CR (by CT) randomized to IFRT vs observation
DFS improved with IFRT
No difference in OS
GELA/LNH 93-1
No adverse risk factors on aaIPI
Age <60 years
Bulk (> 10 cm) allowed
ACVBP x 3 vs CHOP x 3 + IFRT
EFS and OS improved with chemo alone
Very young favorable group but chemo alone works!
No adverse risk factors on aaIPI
Age <60 years
Bulk (> 10 cm) allowed
ACVBP x 3 vs CHOP x 3 + IFRT
EFS and OS improved with chemo alone
Very young favorable group but chemo alone works!
High Dose Methotrexate - Tweetorial
#Goodman_Heme
Players
MTX (>500 mg/m2)
Leucovorin (folinic acid)
Sodium bicarbonate
Glucarpidase (hopefully not!)
How we make thymidylate (dTMP)
FH2+NADH = FH4 via dihydrofolate reductase (DHFR)
dUMP+FH4 = dTMP via thymidylate synthase (TS)
#Goodman_Heme
Players
MTX (>500 mg/m2)
Leucovorin (folinic acid)
Sodium bicarbonate
Glucarpidase (hopefully not!)
How we make thymidylate (dTMP)
FH2+NADH = FH4 via dihydrofolate reductase (DHFR)
dUMP+FH4 = dTMP via thymidylate synthase (TS)
MOA of MTX
1. Enters cells via reduced folate carried
2. Polyglutamated (MTX-PG)
3. MTX-PG binds DHFR 1,000 fold greater than FA
4. Competitively inhibits conversion of FH2->FH4 via DHFR
5. No FH4 (dUMP+FH4 = dTMP)
6. No dTMP
7. Stops DNA synthesis
8. Cell dies
1. Enters cells via reduced folate carried
2. Polyglutamated (MTX-PG)
3. MTX-PG binds DHFR 1,000 fold greater than FA
4. Competitively inhibits conversion of FH2->FH4 via DHFR
5. No FH4 (dUMP+FH4 = dTMP)
6. No dTMP
7. Stops DNA synthesis
8. Cell dies
High dose MTX disrupts the blood brain barrier (BBB) and is able to penetrate the CNS.
But high dose MTX causes severe/fatal toxicity =
Nephrotoxicity
Myelosupression
Mucositis
Diarrhea
Hepatitis
How do we prevent these toxicities while still treating the CNS???
But high dose MTX causes severe/fatal toxicity =
Nephrotoxicity
Myelosupression
Mucositis
Diarrhea
Hepatitis
How do we prevent these toxicities while still treating the CNS???
I had a 1 hour Zoom meeting so I thought I go big
(Tweetorial 1/10)
#Goodman_heme
t(8;14) = MYC-IgH = BL
t(2;8) = IgK-MYC = BL
t(8;22) = MYC-IgH = BL
t(14;18) = IgH-BCL2 = FL
t(2;18) = IgK-BCL2 = FL
t(18;22) = BLC2-IgL = FL
t(11;14) = CCND1-IgH = MCL
(Tweetorial 1/10)
#Goodman_heme
t(8;14) = MYC-IgH = BL
t(2;8) = IgK-MYC = BL
t(8;22) = MYC-IgH = BL
t(14;18) = IgH-BCL2 = FL
t(2;18) = IgK-BCL2 = FL
t(18;22) = BLC2-IgL = FL
t(11;14) = CCND1-IgH = MCL
t(11;18) = API2-MALT1 = MZL H. pylori-
t(2;5) = NPM1-ALK = ALCL ALK+
t(6;7) = DUSP22-FRAH7H = ALCL ALK-
iso7q = HSTCL
inv(14) = t(14;14) = MTCP1 = T-PLL
t(X;14) = TCL1 = T-PLL
del(11q) = ATM = CLL (intermediate)
del(13q) = RB1 = CLL (good)
+12 = CLL (good)
t(2;5) = NPM1-ALK = ALCL ALK+
t(6;7) = DUSP22-FRAH7H = ALCL ALK-
iso7q = HSTCL
inv(14) = t(14;14) = MTCP1 = T-PLL
t(X;14) = TCL1 = T-PLL
del(11q) = ATM = CLL (intermediate)
del(13q) = RB1 = CLL (good)
+12 = CLL (good)
9p24.1 amp = PDL1/PDL2/JAK2 = Hodgkin
t(11;14) = CCND1-IgH = Myeloma (standard risk), AL amyloid, plasma cell leukemia
Trisomies 3,5,7,9,11,15,19,21 (odd chromosomes) = Myeloma (standard risk)
t(6;14) = CCND3-IgH = Myeloma (standard risk)
t(11;14) = CCND1-IgH = Myeloma (standard risk), AL amyloid, plasma cell leukemia
Trisomies 3,5,7,9,11,15,19,21 (odd chromosomes) = Myeloma (standard risk)
t(6;14) = CCND3-IgH = Myeloma (standard risk)
