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Managing Acute Leukemias and Lymphomas When Patients Stay Local With Dipti Patel-Donnelly, MD

At the recent American Society of Hematology (ASH) Annual Meeting, Dr. Dipti Patel-Donnelly, a Medical Oncology at Virginia Cancer Specialists, hosted a session highlighting how to optimize management when patients with hematologic malignancies stay local. In this podcast episode, Dr. Patel-Donnelly sits down with Oncology Data Advisor to discuss her session, share some of her pearls of wisdom, and the importance of understanding this crucial topic.  

Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, we're here live at the ASH Annual Meeting, and I'm joined by Dr. Dipti Patel-Donnelly. Thank you so much for coming on today.

Dipti Patel-Donnelly, MD: Thank you for having me. It's a pleasure.

Oncology Data Advisor: To start off, would you like to introduce yourself and share what your work focuses on?

Dr. Patel-Donnelly: Yes, my name is Dipti Patel-Donnelly. I am a Medical Oncologist. I work at a cancer center called Virginia Cancer Specialists in Northern Virginia. I focus on hematologic malignancies.

Oncology Data Advisor: Awesome. So, today we're talking about the presentation, Acute Leukemias and Complicated Lymphomas: Pearls to Optimize Management When Patients Stay Local. To start off, would you like to give us a brief overview of the presentation and tell us a little bit about it?

Dr. Patel-Donnelly: I'm Session Chair of a session that is highlighting hematologic malignancies in the community, and my talk particularly is about acute leukemias and complicated lymphomas. They tend to be challenging when they present in the local setting—in the local emergency room (ER). It is usually in a crisis mode—acute leukemia with a high white-count, complicated lymphomas in the setting of sepsis, kidney function abnormalities—and they need to be diagnosed quickly and they need to be treated quickly.

There's a discomfort sometimes with these complicated cases because they don't present very often, so the average hematologist and oncologist may not see them as often as, say, a breast cancer, colon cancer, or lung cancer. Because of the fact that they're less familiar with them and the fact that the intensity of the treatments and the presentations can make people uncomfortable, what we're trying to do is create an algorithm or treatment management locally so that not all of these patients then get shuttled over to the academic center. If they do need an academic center, we are still going to be the frontlines in terms of diagnosis and treatment. That's often a very important aspect that needs to be managed early.

Oncology Data Advisor: Great, thanks for explaining that. In your presentation, part of the title is "when patients stay local." What is meant by this?

Dr. Patel-Donnelly: So, again, complicated lymphomas and leukemias, because they present in a crisis setting, often, if you're unfamiliar with it, will just get transferred to an academic center—so a larger institution probably, farther away from wherever their own setting is. When we say they stay local, we mean in the community oncology setting. So, they're closer to their own support systems, they're closer to family, there's less likelihood of needing to take time off work. So, from a financial barrier standpoint, it improves that, and, again, if we can do a similar outcome to what patients get in the academic setting, then we all win.

Oncology Data Advisor: Absolutely. Would you like to share some of the pearls from the session?

Dr. Patel-Donnelly: Yes. I think that there's always a role for community oncologists and there's always a role for academic oncologists, but what I think we are finding over the last 20 years is there's an increased diversification of what a community oncology practice is. What I'd like to say is that not only do we have medical oncologists, we have radiation oncologists, surgical subspecialists like orthopedic oncology, breast oncology, and then we also have what we call ancillary support systems. So, we have palliative care doctors, social workers, nutritionists, and all of these are meant to work as a team.

I think what we are doing slowly is we're increasing the diversification of what can happen in a local center, and therefore we are also increasing our footprint in clinical trials, because if you have a disease-specific doctor, say a leukemia doctor or a breast cancer doctor, then he or she is going to be much more vested and knowledgeable about that one little area. Then certainly, enrolling patients or opening clinical trials in that arena increases, which then ultimately means accessing cases to patients that are local.

So, as we diversify, maybe we can do more things locally; we will always need our academic partners. I mean, when we have physicians that are subspecializing in leukemia at an academic center, they're going to have a much deeper depth of knowledge, research skills, et cetera, with that. I think the best management that we can have is what I would call a co-management strategy where we have the local oncologist with a great deal of expertise, but a deeper level of expertise from an academic partner. Again, if we're both working together on the same problem in slightly different ways, the patient benefits the most. There may be times where we have to cross the bridge and say, "This is a time where you have to go see an academic physician," or "This is a time that you can come back." I think it's more of a continuum as opposed to a binary process.

Oncology Data Advisor: Wonderful. Well, this is amazing to hear about, so thank you so much for stopping by today to talk about this.

Dr. Patel-Donnelly: Well, thank you for having me. Appreciate it.

About Dr. Patel-Donnelly

Dipti Patel-Donnelly, MD, is an Assistant Professor of Oncology at Johns Hopkins University and a Medical Oncologist at Virginia Cancer Specialists in Northern Virginia. Dr. Patel-Donnelly research interest and specialty surrounds hematologic malignancies such as leukemia, lymphoma, and multiple myeloma. She is an active participant in clinical research, as well as participating in sessions where she advocates for optimized management and novel treatment options for hematologic malignancies.

For More Information

Patel-Donnelly, D (2023). Acute leukemias and complicated lymphomas: pearls to optimize management when patients stay local. Presented at: 2023 American Society of Hematology. Available at: https://ash.confex.com/ash/2023/webprogram/Paper172194.html

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


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