🩸Roundup of Myeloid Malignancies/BMT papers, starting w/ something I care a lot about:

1/ Poor Survival & Differential Impact of Genetic Features of Black Patients w/ #AML #leusm

Bhatnagar et al, Cancer Discovery
pubmed.ncbi.nlm.nih.gov/33277314/

We got work to do ya'll 😰 ✊🏾
2/ pubmed.ncbi.nlm.nih.gov/33664234/

Salvage use of venetoclax-based therapy for relapsed AML post allogeneic hematopoietic cell transplantation

Joshi et. al, Blood Cancer Journal
3/
Post-Transplant Cyclophosphamide (PTCy) is Associated with Increased Cytomegalovirus Infection: A CIBMTR Analysis

Goldsmith et al, Blood
pubmed.ncbi.nlm.nih.gov/33657221/
4/ Midostaurin reduces relapse in FLT3-mutant AML: the Alliance CALGB 10603/RATIFY trial

Larson et al Leukemia
pubmed.ncbi.nlm.nih.gov/33654204/

"Analyses were inconclusive in quantifying the impact of the maintenance phase on the overall outcome. In summary, midostaurin reduces the CIR"
5/ The prognosis and durable clearance of RAS mutations in patients with acute myeloid leukemia receiving induction chemotherapy

Ball et al, American Journal of Hematology
pubmed.ncbi.nlm.nih.gov/33650111/
6/ Identification of leukemic and pre-leukemic stem cells by clonal tracking from single-cell transcriptomics

Velten et al, Nature Communications
pubmed.ncbi.nlm.nih.gov/33649320/
7/ A Ph3 trial of azacitidine vs. a semi-intensive fludarabine & cytarabine schedule in older pts w/ untreated AML

Vives et al, Cancer
pubmed.ncbi.nlm.nih.gov/33626197/

FLUGA = more remissions after 3 cycles, but 1y OS superior w/ AZA...long-term outcomes disappointing: 3y OS, 10% vs 5%)
8/ MRD is complicated fam

pubmed.ncbi.nlm.nih.gov/33618432/

"Post-remission CH in the setting of NPM1mut clearance is common and may result in immunophenotypic changes in myeloid progenitors. It is important to not misinterpret these cells as AML measurable residual disease (MRD)."
9/ "Maintenance with lenalidomide showed no apparent effect on relapse probability in 88 patients randomly assigned for this part of the study."

Löwenberg et al, Blood Adv
pubmed.ncbi.nlm.nih.gov/33616652/

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More from @haematognomist

15 Jun 20
1/8 Day 1 of intern year orientation. The nerves & excitement are real

A tweetorial of tweetorials - resources that may be helpful for our first days on the job! We are all in this together 👊🏾

First up:
Calling consults like a pro: @VarunPhadke2
Read 8 tweets
18 May 20
1/n Inspired by RLR: @rabihmgeha & @DxRxEdu...
HLH - @haematognomist & @HannahRAbrams

Two rising interns interested in🩸Heme-Onc & 📚MedEd

Teaching pearls from @NEJM CPC published 6/6/13
Dx spoilers below! @MedTweetorials
2/n First a PR:

Middle age man w/ PMHx HBV infection p/w chronic fevers and progressive weakness, found to have painful asymmetric mixed motor & sensory distal multiple mononeuropathy and nerve biopsy showing active vasculitis diagnosed with...
3/n DDx for mixed motor & sensory multiple mononeuropathy is broad!
▪️Hereditary
▪️Diabetes
▪️Vasculitis
▪️Infections (leprosy, lyme, syphilis, CMV, HIV)
▪️Neoplastic infiltration: (most commonly lymphomatous)
▪️Sarcoid, amyloid

Pt had S4...infiltration of heart & nerves?
Read 9 tweets
8 May 20
@CPSolvers #VMR inspired me to fill gaps in knowledge re: sterile pyuria (adapted from @NEJM article cited in phenomenal thread 👇🏾)
@MedTweetorials

First: what is pyuria?
▪️≥ 10 WBC/mm3
▪️≥ 3 WBC/hpf
▪️pos gram's stain (unspun urine)
▪️Urinary dipstick pos for leuk esterase
"Sterile pyuria is the persistent finding of white cells in the urine in the absence of bacteria"

And it is super common!
"13.9% of women and 2.6% of men are affected"

🤯 The DDx is waaaaay broader than I suspected, so let's take it by category
1/ STI
▪️Gonorrhea, Chlamydia, Mycoplasma
▪️HSV-2, Herpes Zoster
▪️HPV
▪️"In one study, among 104 patients with untreated HIV infection, 13% had pyuria"

Other viruses that do *not* typically have pyuria: adenovirus, BK, CMV --> sometimes cause hemorrhagic cystitis
Read 8 tweets
18 Feb 20
1/ Welcome to the next installment of @NEJM #CPS summaries!

For full case: bit.ly/2SWTDiq
@MedTweetorials

40yo F w/ hx of treated immature teratoma & HBV infection p/w chronic, progressive diffuse pain and weight loss

Me when I get to share clinical pearls 👇🏾
2/ 🌟Initial DDx 🌟
#medstudenttwitter: I often find it tempting to jump straight into listing possible Dx.

Often have to remind myself to be systematic. For this patient:

Up next: how does the PMHx ("background") affect our analysis of this presentation ("foreground")
3/ 📚 History:
Teratoma: tx w/ 4 cycles of bleomycin, etoposide & cisplatin → TAH-BSO

HBV: tx w/ tenofovir

Immigrated from Vietnam 20 years ago

🧠Clinical reasoning: when evaluating "background" I ask myself 3 questions 👇🏾
Read 10 tweets
4 Jan 20
1/ Clinical #Pearls and summary of @NEJM #CPS:
"A Chilly Fever"
For full case: bit.ly/37Co43k

A young man presents in March w/ 1 week of fevers, shaking chills & severe headaches which peaked at night & defervescence by morning.
2/ My initial approach to fever is as follows, and is adapted from Penn frameworks: med.upenn.edu/frameworks/fev…

#PEARL1: I always try to remember the importance of assessing:
1. Host: immunosuppressed?
2. Exposures: work, sexual, travel, animals, IVDU, food/water
3/ He recently traveled to Cape Cod + trip to Uganda 2 years earlier w/ appropriate vaccinations and adherence to malaria ppx. This impacts the DDx:

⬆️ Tickborne infection:
- Lyme disease
- Anaplasmosis
- Babesiosis

#Medtwitter, which infections do you a/w travel to Uganda?
Read 11 tweets
27 Dec 19
1/x Summarized #pearls from @NEJM CPS from 3/5/15. Diagnosis will be spoiled at the end! For full case: nejm.org/doi/full/10.10…

Patient presented with pruritus. An initial approach involves asking:

1. Is the process dermatologic?
2. Is the process due to a systemic illness?
2/x Patient was found to have acute kidney injury, making uremia a likely cause of the pruritus.

Initial approach to AKI involves:
1. Pre-renal
2. Intra-renal
3. Post-renal

Framework from @runthelistpod, also from Penn Frameworks: med.upenn.edu/frameworks/acu…
3/x
Patient had a FENa > 12%, fatty casts, no dysmorphic cells and 24h protein of 22g. This + hypoalbuminemia + edema → nephrotic syndrome.

Imagine of fatty casts: images.app.goo.gl/VjQZBhTSBjfb5z…

@CPSolvers schema for intrarenal AKI: clinicalproblemsolving.com/dx-schema-intr…
Read 10 tweets

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