Hi ,

Welcome back to the Oncology Insights Newsletter which fosters your continuous growth in oncology pharmacy practice

Last time you learned about a fun analogy to remember the types of statistical errors, MRD testing in myeloma, and drama surrounding generic paclitaxel's approval back in the day

This week you'll learn about watchful waiting, hyperviscosity syndrome, and a time warp to avoid

Have a great week!

Kelley

🧠 IPS (Insight, Pearl, Sundry)

Insight

In follicular lymphoma, the GELF criteria (Groupe d’Etude des Lymphomes Folliculaires) is used to categorize patients that need immediate treatment versus those that could pursue watchful waiting

Watchful waiting is when we closely monitor a patient and do not administer therapy unless new symptoms appear or baseline symptoms worsen

We use it when the risks of treatment are greater than the benefits and it is the standard of care in those not meeting GELF criteria (which relate to a high burden of disease)

As many as 1/3 of patients who qualify for watchful waiting may never need treatment - by taking this approach, those patients are saved from the financial and toxic effects of treatment

It might seem like watchful waiting is the “riskier” move, but this strategy doesn’t change overall survival compared to those that got earlier treatment

Pearl

Like a “perfect storm”, Waldenstrom Macroglobulinemia (WM) is an unusual, rare hematologic malignancy that is a cross between lymphoma and multiple myeloma

This storm generates an overproduction of the largest immunoglobulin, IgM, which causes the patient's blood to thicken, called hyperviscosity

Essentially, this overproduction of IgM is causing a traffic problem in the blood, triggering the normal 6 lane highway to come to a crawl

Hyperviscosity Syndrome (HVS) is an oncologic emergency that presents with neurological symptoms, visual changes, and mucosal bleeding

Patients with HVS can often be dehydrated and anemic, but they should not be treated with a blood transfusion because it can increase serum viscosity and worsen symptoms

Fluids are the best initial management, along with plasmapheresis for short term definitive therapy to reverse symptoms. Long term definitive treatment of HVS involves treatment of the underlying WM.

💡 A pearl to keep in your back pocket

If the IgM is >/=4000, we should NOT give rituximab, a common treatment for WM (since B cells are involved in the pathophysiology). This drug can actually cause a tumor flare when levels are this high which can increase hyperviscosity symptoms.

Sundry

Look around 👀

You likely see some people talking about interesting things they want to do in their careers and others who are actually doing interesting things

The difference? Some people take action and others don’t.

Have you noticed that time seems to move faster as you get older? It’s freakishly easy to let a few, or even many, years slip by without doing the things you say you want to do.

This is the trap of becoming comfortable. You find a rhythm that works and you lean into it more and more until you’re in so deep it takes a gigantic effort to swim out.

Stop letting time slip by you like there is an endless supply of it - there are no “perfect” moments, there is only right now

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