Six weeks of anyhing will get tiresome near the end, doubly so if it involves taking a 6am train and not getting back home until 7. Combined inpatient/outpatient juggling twice a week didn’t help either, and neither did the high turnover1. Still, as inpatient rotations go, this one was reasonably busy—enough for me to learn quite a bit, but never overwhelming. More importantly, the attendings were awesome, the cases interesting, co-workers friendly, etc.
As the slide set I’ve linked to above shows, lymphoma are tricky in that many are either curable or indolent enough to be kept at bay until something else gets to the patient; but when it’s bad—and with current technology we can’t with certainty say which ones those are at diagnosis, though we’re getting there—it can be catastrophic. Thankfully, those cases are rare.
Though most chemotherapy I was ordering was EPOCH-R or, for NCI’s new primary CNS lymphoma protocol, TEDDI-R, there were several patients with non-hematological malignancies getting IL-15. If you hadn’t heard of this particular interleukin being used for treatment before, it’s becuse the results of the first-in-humans phase I trial done by NCI have just been published in JCO. The maximal tolerated dose was somewhat low when administered as an intravenous bolus, so the patients are now getting it either as a 12-day continuous infusion, or a subcutaneous injection. I’d rather not steal Dr. Conlon’s thunder—or break any government regulations—by writing how these patients did. Just keep an eye for a follow-up paper. And maybe a tumor board presentation from me in the next few months.
I am sure a medical transcriber somewhere is cursing under his or her breath every time they hear my nasal baritone—the last time I had dictated so many discharge summaries was during my intern year. ↩