Creating Valuable Education for the Hematology/Oncology Fellow With Ronak Mistry, DO, and Vivek Patel, MD

This podcast episode was recorded live by Oncology Data Advisor and ConveyMED at the 2022 ASH Annual Meeting in New Orleans.

Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, we're at the ASH Annual Meeting, and I'm here with Ronak Mistry and Vivek Patel. Thank you both so much for being here.

Ronak Mistry, DO: It's a pleasure to be here, and thank you so much for inviting us.

Vivek Patel, MD: Yes, thanks for having us.

Oncology Data Advisor: Absolutely. So, would you like to introduce yourselves and talk about a little bit what you do and about your podcast?

Dr. Mistry: So, as you said, my name is Ronak Mistry. I'm a second-year fellow, and we are the creators and hosts for The Fellow on Call, which is an educational hematology/oncology (heme/onc) podcast that we created and launched in January of 2022. It's solely dedicated to providing trainees who are physicians, advanced practice providers (APPs), and pharmacy colleagues, with information about the fundamentals of hematology and oncology. It's just been fantastic for us to be on this journey. I think what makes us unique is that essentially, right now, it is a for-trainee, by-trainee model. It's been very well received, so again, we're just super stoked to be a part of this.

Dr. Patel: I think the second part of it is that as we transition on—we're not going to be trainees forever—we are still keeping in mind what content is needed for the trainee. We're also keeping in mind what's needed for the community doctor who may not have been keeping up with all the data that we are exposed to as fellows, constantly, day-in and day-out. We build our episodes on that. It's an asynchronous learning platform where each episode builds on the next, up to the point where we're really getting the nitty-gritty data and expert opinions, and we're really giving everybody the nuanced discussions that they need.

Oncology Data Advisor: That's awesome. So, I'd like to hear about your experience here at ASH. Are you going to be presenting anything?

Dr. Patel: I'll start with this one, and then I'll hand it off to Ronak because his is at tomorrow's forum. I had an oral presentation yesterday. So, my project was looking at the predictors and outcomes of immune effector cell–associated neurotoxicity syndrome (ICANS), which is an adverse event in chimeric antigen receptor (CAR) T-cell therapy. Before our study, we did a retrospective study that included eight US medical centers. There are really very little data on what the predictors are for ICANS and what the long-term survival outcomes are for patients who do develop ICANS.

In our study, what we found was that patients who got ICANS actually didn't have worse survival, which is really important to know. Then the second important thing was that these patients received steroids. If you develop this syndrome, the treatment is steroids, and it didn't affect their progression-free survival or the efficacy of the CAR T-cell therapy. So, that was an interesting finding we saw. The last thing I want to say is that we had a fair number of patients with active central nervous system (CNS) disease at the time of CAR T-cell therapy. We found that even if you had active CNS disease at the time, many of those patients did not develop ICANS. It really suggested, "Hey, CAR T-cell therapy should be used even in patients with CNS disease."

Looking at ICANS, the outcomes actually seem fine. We should treat through it. One of the issues that we found is that right now, it's very difficult to predict who's going to get ICANS. As we think about moving CAR T-cell therapy into the outpatient setting, that's going to be a critical question—identifying the pathophysiology, the pathogenesis, and the risk factors pre-infusion. We looked at some models and really found that, right now, we just have a lot more work to do.

Oncology Data Advisor: That's great. Congrats on a great presentation.

Dr. Patel: Thanks.

Dr. Mistry: He did a fantastic job. So, I have a poster tomorrow looking at the financial aspects of using the chromogenic factor X assay, which is used for assessment of adequate anticoagulation in patients with high thrombotic risk states, and looking at the finances surrounding the involvement of a hematologist in that decision making. Ultimately, our data suggested that having a hematologist in these complex anticoagulation decisions is beneficial. Even though there's an added cost of having a consultant involved, there really wasn't a big difference in terms of lengths of stay between the patient populations.

But what's really interesting—and albeit we have a small cohort of patients that we're looking at—is that the cost range associated with the patients in the hospital who a hematologist was working with is drastically, substantially, different than when a hematologist was not, suggesting that these patients are more complex. Yet their lengths of stay are no different, and the cost was actually not that different. All this is to say, you should have a hematologist on board for these complex decisions.

In addition to being here to present a poster, I'm also a member of the ASH Trainee Council. It's been really fun to be here with some of my colleagues from across the country. I am one of 12 who are on our council from around the country. We represent the voice of trainees at ASH, and we help plan a lot of the ASH trainee events. In addition to doing things like this and presenting data and going to sessions myself, we're also doing a lot of stuff behind the scenes to help our trainees get the most out of this opportunity.

Oncology Data Advisor: That's awesome. I'd love to hear about this perspective of attending ASH as a fellow. What do you think is the importance of being here?

Dr. Patel: I think there are a lot of important things about being here. One of the things is that you finally have, as a fellow, the ability to understand what's going on. That sounds weird, but you have a lot more context. By going to the sessions, you're actually learning a lot about where the field is heading, getting ideas for research that you can come up with, with your mentors, and also building a network of mentors that's even outside your institution. One of the key things that exists in hematology and oncology is that mentorship outside of your institution is also critically important. Collaborative efforts are critically important. This is where you start to forge some of those connections and start to meet people.

Dr. Mistry: I 100% agree. In addition to great learning, I also commented to a mentor who I met again yesterday after a few years, just how much more I know now than when I was here as a resident. It just makes the conference that much more exciting. I'm running around from place to place all day, but I don't mind it because it's for good measure.

But really, truly, I think from a fellow perspective, the opportunity just to meet people is huge. There are people who I met at my first ASH conference in 2019 who I've kept in touch with over the last few years. Some of them were critical in helping me get a fellowship spot when that time came, and now they're willing to help me take that next step in my career. Maybe I'm biased because I'm on the Trainee Council, but I will say that I think that ASH has created an environment that's really conducive to forming those relationships for trainees, and they create opportunities to do that. Certainly, as a fellow, being able to take part in all of that and use those opportunities is wonderful.

Oncology Data Advisor: Awesome, absolutely. It's definitely exciting. Well, thank you both so much for being here. It was really great talking with you.

Dr. Mistry: Once again, thanks so much for the invitation. We really appreciate it.

Dr. Patel: Yes, thanks for having us.

Thank you for listening to this podcast, recorded live at the 2022 ASH Annual Meeting by Oncology Data Advisor and ConveyMED. For more expert perspectives on the latest in cancer research and treatment, be sure to subscribe to the podcast at conveymed.io and OncData.com. Don't forget to follow us on social media for news, exclusive interviews, and more.

About Dr. Mistry and Dr. Patel

Ronak Mistry, DO, and Vivek Patel, MD, are both Clinical Fellows in the Division of Hematology/Oncology at Vanderbilt University Medical Center in Nashville, Tennessee. They are Co-Founders and Hosts, along with Dr. Dan Hausrath, of The Fellow on Call, an educational podcast geared towards hematology/oncology fellows.

For More Information

Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.