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Anand Patel Profile picture
@Anand_88_Patel
Oct 24, 2022 • 14 tweets • 16 min read • Read on X
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On the inpatient leukemia service for the next 2 weeks, time to start sharing daily articles!

Day 1: our experience with inotuzumab re-treatment in Ph-negative B-ALL @jalbanmd @AyaOncologist #leusm

pubmed.ncbi.nlm.nih.gov/36240471/ Image
@jalbanmd @AyaOncologist Day 2: efficacy of FLT3 and IDH1/2 inhibitors in AML prev tx w/ venetoclax #leusm
-ORR of 18% for entire cohort; ORR of 30% for pt treated w/ gilteritinib
- median OS of 4.2 months

sciencedirect.com/science/articl… Image
@jalbanmd @AyaOncologist Day 3: hyperleukocytosis in AML
- 779 pt with WBC > 50K at presentation, leukostasis in 27% & leukapheresis used in 15%
- mOS was 12.6 months for entire cohort
- leukapheresis did not appear to impact 30d mortality

pubmed.ncbi.nlm.nih.gov/32132655/ Image
@jalbanmd @AyaOncologist Day 4: a very nice review on the management of T-ALL #leusm

journals.lww.com/co-oncology/Fu… Image
Day 5: availability of ATRA at hospitals for APL #leusm

-only 31% of queried hospitals had ATRA in stock

pubmed.ncbi.nlm.nih.gov/34404029/ Image
Day 6: secondary malignancies after lenalidomide

Day 7: an excellent review about inherited susceptibility to heme malignancies by @RoloffGreg @michaelwd & Dr Godley

ascopubs.org/doi/full/10.12… ImageImageImageImage
@RoloffGreg @michaelwd Day 8: early PEG-asparaginase discontinuation for pts with ALL treated on 10403 #leusm
- of 176 pt that achieved CR and went onto delayed intensification 32% d/c'ed PEG early
- lower OS in early d/c patients but not statistically significant

ashpublications.org/bloodadvances/… Image
@RoloffGreg @michaelwd Day 9: a review on all things C diff colitis!

link.springer.com/article/10.100… Image
@RoloffGreg @michaelwd Day 10: prophylactic TXA in heme malignancies
-pt randomized to TXA or placebo arm once plt < 50K and received TXA or placebo once plt < 30K
-no significant difference in WHO Grade ≥2 bleeding

ashpublications.org/blood/article/… Image
@RoloffGreg @michaelwd Day 11: Ven + Aza in R/R MDS #mdssm
- 44pt treated, CR 7% & marrow CR 32%
- 36% w/ transfusion independence for RBCs and/or plt
- median OS 12.6 months

onlinelibrary.wiley.com/doi/10.1002/aj… Image
@RoloffGreg @michaelwd Day 12: considerations in accelerated/blast-phase CML by @GabyHobbs @joanhowMD

ashpublications.org/hematology/art… Image
@RoloffGreg @michaelwd @GabyHobbs @joanhowMD Day 13: lots to learn about transverse myelitis!

sciencedirect.com/science/articl… ImageImage
@RoloffGreg @michaelwd @GabyHobbs @joanhowMD And day 14! Our recent review on newly diagnosed AML @mariamtn89 #leusm

pubmed.ncbi.nlm.nih.gov/36223559/ Image

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More from @Anand_88_Patel

Anand Patel Profile picture
May 9, 2020
A couple weeks ago I was caring for a patient on the heme-onc service that developed progressive L-sided neck/face swelling over 3-4 hours! He ended up having suppurative parotitis, a diagnosis I have not seen very much in practice. Here are some takeaways #MedTwitter
Risk fxrs for suppurative parotitis include poor PO intake, poor dentition/recent dental work, oropharyngeal malignancies, & intubation (all via impaired stimulation/drainage of salivary ducts). The most common offending bugs are Staph Aureus & anaerobes (pubmed.ncbi.nlm.nih.gov/12544218/)
Both US and CT can be used as imaging modalities in the workup of suppurative parotitis. US can identify a potential obstructing stone more easily while CT is more sensitive for ruling out an abscess. Another diagnostic hint is elevated amylase w/ normal lipase
Read 7 tweets
Anand Patel Profile picture
Apr 12, 2020
Let's talk about cytopenias in cirrhosis. Many patients with cirrhosis will have at least one cytopenia (sometimes pancytopenia) attributable to their liver disease, let's talk about some of the mechanisms! #medtwitter #hemetwitter
First up, thrombocytopenia! The potential mechanisms are laid out in the image below (aasldpubs.onlinelibrary.wiley.com/doi/full/10.10…):
- decreased thrombopoietin production
- sequestration
- alcohol/viral causes suppressing marrow
- peripheral destruction
Next up, anemia! The ddx should include the causes we think of in all anemia patients (nutritional, GI losses, hemolysis etc...) but what are some liver-specific etiologies? Spur-cell anemia (ashpublications.org/blood/article/…) typically only reverses w/ transplant
Read 8 tweets
Anand Patel Profile picture
Mar 25, 2020
An awesome discussion from the @CPSolvers and Drs. Gandhi and Bressman! Here are some thoughts about the pivot point of the case... #SpoilerAlert
Drs. Gotlib and Reiter put an an excellent review discussing myeloid neoplasms with hypereosinophilia (ashpublications.org/blood/article-…), these are some of the salient points for all IM folks to take away
The first is knowing that the terms hypereosinophilia and hypereosinophilic syndrome (HES) carry specific meaning! HES meets the definition for hypereosinophilia + there is organ damage 2/2 hypereosinophilia
Read 5 tweets
Anand Patel Profile picture
Feb 21, 2020
Saw a patient in clinic w/ (likely) refractory ITP and luckily there was an excellent @BloodJournal article by Miltiadous and colleagues published earlier this month! I want to highlight some of the main learning points I took away #medtwitter #hemetwitter ashpublications.org/blood/article/…
# 1: Make sure that the patient truly has primary, refractory ITP! If a patient is not responding as expected with primary ITP-directed therapies, it bears consideration to do a more extensive workup looking for alternative diagnoses ImageImage
#2: If a patient is not responding as expected to treatment for ITP, have a low threshold to pursue a bone marrow biopsy. A number of bone marrow failure states can present with isolated thrombocytopenia Image
Read 6 tweets
Anand Patel Profile picture
Oct 23, 2019
Check out my @hdx case from today: a 62-yo man with chest pain! Thanks to @AnandJag1 for the edits. Below you will find some teaching points about this case #SpoilerAlert #Medtwitter
As part of our patient's PMH, he reported facial nerve palsy. Here is a slide with some teaching points about Bell's Palsy including the differential diagnosis to consider (Eviston et al, 2015) Image
Our patient gets imaging in the case that shows cavitary lung lesions. A brief ddx for cavitary lung lesions is below (Gadkowski et al, 2008) Image
Read 4 tweets
Anand Patel Profile picture
Oct 15, 2019
Hi #MedTwitter, let's talk about the workup of polycythemia and making a diagnosis of polycythemia vera (PV) vs. secondary polycythemia! #mpnsm #tweetorial @MedTweetorials
Based on the WHO guidelines, the following values constitute polycythemia:
In men: Hgb >16.5g/dL or Hct > 49%
In women: Hgb > 16 or Hct > 48%

Polycythemia should be confirmed by a subsequent CBC. Below is an image of the ddx of polycythemia (Keohane et al 2013) Image
Our patient's polycythemia has been confirmed! What to do next? Make sure to ask questions related to hyperviscosity (eg chest pain, dyspnea, headache, vision changes, confusion), thrombosis/bleeding hx, and PV-related symptoms (pruritus after baths, erythromelalgia, B-symptoms)
Read 11 tweets

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