I was born in Oregon and raised in Iowa, where I cultivated my initial interest in science and medicine. I completed my undergraduate degree and medical school at the University of Iowa before heading to Stanford University for my internal medicine residency and oncology fellowship training. I chose this field to try my best in assisting patients during times of great need, and working to understand what is of greatest importance to them as they navigate their unique journey of cancer care. My clinical focus is in the care of patients with lymphoma and other hematologic cancers. My scholarly interests include better understanding the efficacy cancer therapeutics, improving patients' experience as the proceed through treatment, and promoting strength in medical education.

Honors & Awards

  • Stanford Hematology and Oncology Fellowship Humanism Award, Stanford University School of Medicine, Divisions of Hematology and Oncology (2020)
  • Timothy F. Beckett, Jr. Award for Best Clinical Teaching by a Medicine Fellow, Stanford University School of Medicine, Department of Internal Medicine (2018)
  • Award for Best Clinical Teaching by a Medicine Resident, Stanford University School of Medicine, Department of Internal Medicine (2017)
  • Charles Dorsey Armstrong Award for Clinical Excellence in Patient Care, Stanford University School of Medicine, Department of Internal Medicine (2017)
  • Julian Wolfsohn Award for Outstanding Performance in Internal Medicine, Stanford University School of Medicine, Department of Internal Medicine (2017)
  • Medical Student Education Award, Stanford University School of Medicine (2015)
  • William R. Wilson Award for Outstanding Performance in Internal Medicine by a Senior Medical Student, Carver College of Medicine, University of Iowa (2014)

Boards, Advisory Committees, Professional Organizations

  • Member, American Society of Clinical Oncology (2017 - Present)
  • Member, American Society of Hematology (2016 - Present)
  • Member, American College of Physicians (2014 - Present)

Professional Education

  • Fellowship, Stanford University, Hematology and Oncology (2020)
  • Residency, Stanford University, Internal Medicine (2017)
  • MD, Carver College of Medicine, University of Iowa (2014)
  • BS, University of Iowa, Biomedical Engineering (2010)

All Publications

  • Clinical characteristics, treatment patterns, and outcomes of cytotoxic cutaneous T-cell lymphomas. American journal of hematology Mou, E., Fernandez-Pol, S., Li, S., Rieger, K. E., Novoa, R., Suarez, C. J., Wieland, R., Weng, W., Kim, Y. H., Khodadoust, M. S. 2024

    View details for DOI 10.1002/ajh.27266

    View details for PubMedID 38391088

  • Sezary syndrome initially presenting as pityriasis rubra pilaris: Clinicopathologic study of 3 cases. JAAD case reports Alsawas, M., Alzayadneh, E., Mou, E., Liu, V. 2024; 44: 101-106

    View details for DOI 10.1016/j.jdcr.2023.12.003

    View details for PubMedID 38357556

    View details for PubMedCentralID PMC10864165

  • Molecular techniques drive cutting edge advancements in management of cutaneous T cell lymphoma FRONTIERS IN IMMUNOLOGY Lefebvre, M. N., Borcherding, N., Reis, R. J., Mou, E., Liu, V., Jabbari, A. 2023; 14: 1228563


    Cutaneous 5T cell lymphoma (CTCL), characterized by malignant T cells infiltrating the skin with potential for dissemination, remains a challenging disease to diagnose and treat due to disease heterogeneity, treatment resistance, and lack of effective and standardized diagnostic and prognostic clinical tools. Currently, diagnosis of CTCL practically relies on clinical presentation, histopathology, and immunohistochemistry. These methods are collectively fraught with limitations in sensitivity and specificity. Fortunately, recent advances in flow cytometry, polymerase chain reaction, high throughput sequencing, and other molecular techniques have shown promise in improving diagnosis and treatment of CTCL. Examples of these advances include T cell receptor clonotyping via sequencing to detect CTCL earlier in the disease course and single-cell RNA sequencing to identify gene expression patterns that commonly drive CTCL pathogenesis. Experience with these techniques has afforded novel insights which may translate into enhanced diagnostic and therapeutic approaches for CTCL.

    View details for DOI 10.3389/fimmu.2023.1228563

    View details for Web of Science ID 001057291900001

    View details for PubMedID 37654486

    View details for PubMedCentralID PMC10465366

  • Small volume biopsy diagnostic yield at initial diagnosis versus recurrence/transformation of follicular lymphoma: Aretrospective Cyto-Heme Interinstitutional Collaborative study. Cancer cytopathology Fitzpatrick, M. J., Sundaram, V., Ly, A., Abramson, J. S., Balassanian, R., Cheung, M. C., Cook, S. L., Falchi, L., Frank, A. K., Gupta, S., Hasserjian, R. P., Lin, O., Long, S. R., Menke, J. R., Mou, E., Reed, D. R., Ruiz-Cordero, R., Volaric, A. K., Wang, L., Wen, K. W., Xie, Y., Zadeh, S. L., Gratzinger, D. 2022


    BACKGROUND: Few studies have evaluated diagnostic yield of small volume biopsies (SVB) for the diagnosis and management of follicular lymphoma (FL).METHODS: The authors performed a multi-institutional retrospective analysis of SVBs including fine-needle aspiration (FNA) and needle core biopsy (NCB) for initial FL diagnosis and suspected recurrence or transformation of FL. A total of 676 workups beginning with SVB were assessed for the mean number of biopsies per workup, the proportion of workups requiring multiple biopsies, and the proportion with a complete diagnosis including grade, on initial biopsy.RESULTS: Compared to workups performed for question transformation/recurrence, those done for initial FL diagnosis were significantly more likely to require multiple biopsies (p<.01), had a higher mean number of biopsies per workup (1.7 vs. 1.1, absolute standardized difference=1.1), and a lower complete diagnosis rate at initial biopsy (39% vs. 56%). At initial FL diagnosis, NCB +/- FNA was associated with fewer biopsies per workup compared to FNA +/- CB (1.2 vs. 1.9), fewer workups requiring multiple biopsies (23% vs. 83%), and a higher complete diagnosis rate (71% vs. 18%). In contrast, during assessment for transformation/recurrence, NCB and FNA showed a similar mean number of biopsies per workup (1.2 vs. 1.2) and few workups required multiple biopsies (6% vs. 19%).CONCLUSIONS: SVB at initial FL diagnosis often required additional biopsies to establish a complete diagnosis. In contrast, when assessing for transformed/recurrent FL, additional biopsies were generally not obtained regardless of SVB type, suggesting that in these clinical settings SVB may be sufficient for clinical decision-making.

    View details for DOI 10.1002/cncy.22676

    View details for PubMedID 36573933

  • Diagnostic Discrepancies in Small-volume Biopsy for the Initial Diagnosis, Recurrence, and Transformation of Follicular Lymphoma: A Multi-Institutional Collaborative Study. The American journal of surgical pathology Volaric, A. K., Lin, O., Balassanian, R., Cook, S., Falchi, L., Fitzpatrick, M. J., Frank, A. K., Gupta, S., Hasserjian, R. P., Long, S., Ly, A., Menke, J. R., Mou, E., Natkunam, Y., Reed, D. R., Ruiz-Cordero, R., Wang, L., Wen, K. W., Xie, Y., Zadeh, S. L., Gratzinger, D. 2022


    Small-volume biopsies (SVBs) including fine-needle aspiration (FNA), cell block, and needle core biopsies (NCB) are increasingly utilized to diagnose and guide the clinical management of lymphoma. We established a multi-institutional interdisciplinary collaboration of cytopathologists, hematopathologists, and oncologists focused on the role of SVB in the management of patients with follicular lymphoma (FL). To assess the performance characteristics of SVB in this setting, we evaluated all consecutive SVBs performed for clinical indications of initial diagnosis, recurrence, or transformation of FL over a 5-year period and focused on the 182 that had at least one subsequent biopsy within 3 months as part of the same clinical work-up. The most common outcome of a subsequent biopsy as part of the same clinical work-up was a more specific diagnosis usually assigning the pathologic grade (111/182, 61%), followed by a complete agreement with the SVB (24/182, 13%), and change from nondiagnostic on initial biopsy to diagnostic on subsequent biopsy (21/182, 12%). A minority resulted in a diagnostic change from benign to lymphoma (17/182, 9%), a change in FL grade (5/182, 3%), or change in the lymphoma diagnostic category (4/182, 2%). There were no cases where an initial diagnosis of lymphoma was overturned. The distribution of discrepancies was similar across initial SVB types (FNA, FNA + cell block, NCB with or without FNA). Tissue limitations were noted in a minority of cases (53/182, 29%) and were enriched among initially nondiagnostic biopsies (16/21, 76%). Flow cytometry immunophenotyping was performed in the majority of cases both at the first and last biopsy (147/182, 81%). SVB can be a powerful method to detect FL in various clinical indications, with discrepant cases mostly resulting from a refinement in the initial diagnosis.

    View details for DOI 10.1097/PAS.0000000000001985

    View details for PubMedID 36537240

  • The Advanced-Stage Hodgkin Lymphoma International Prognostic Index: Development and Validation of a Clinical Prediction Model From the HoLISTIC Consortium. Journal of clinical oncology : official journal of the American Society of Clinical Oncology Rodday, A. M., Parsons, S. K., Upshaw, J. N., Friedberg, J. W., Gallamini, A., Hawkes, E., Hodgson, D., Johnson, P., Link, B. K., Mou, E., Savage, K. J., Zinzani, P. L., Maurer, M., Evens, A. M. 2022: JCO2202473


    The International Prognostic Score (IPS) has been used in classic Hodgkin lymphoma (cHL) for 25 years. However, analyses have documented suboptimal performance of the IPS among contemporarily treated patients. Harnessing multisource individual patient data from the Hodgkin Lymphoma International Study for Individual Care consortium, we developed and validated a modern clinical prediction model.Model development via Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis guidelines was performed on 4,022 patients with newly diagnosed advanced-stage adult cHL from eight international phase III clinical trials, conducted from 1996 to 2014. External validation was performed on 1,431 contemporaneously treated patients from four real-world cHL registries. To consider association over a full range of continuous variables, we evaluated piecewise linear splines for potential nonlinear relationships. Five-year progression-free survival (PFS) and overall survival (OS) were estimated using Cox proportional hazard models.The median age in the development cohort was 33 (18-65) years; nodular sclerosis was the most common histology. Kaplan-Meier estimators were 0.77 for 5-year PFS and 0.92 for 5-year OS. Significant predictor variables included age, sex, stage, bulk, absolute lymphocyte count, hemoglobin, and albumin, with slight variation for PFS versus OS. Moreover, age and absolute lymphocyte count yielded nonlinear relationships with outcomes. Optimism-corrected c-statistics in the development model for 5-year PFS and OS were 0.590 and 0.720, respectively. There was good discrimination and calibration in external validation and consistent performance in internal-external validation. Compared with the IPS, there was superior discrimination for OS and enhanced calibration for PFS and OS.We rigorously developed and externally validated a clinical prediction model in > 5,000 patients with advanced-stage cHL. Furthermore, we identified several novel nonlinear relationships and improved the prediction of patient outcomes. An online calculator was created for individualized point-of-care use.

    View details for DOI 10.1200/JCO.22.02473

    View details for PubMedID 36495588

  • Integrating Novel Agents into the Treatment of Advanced Mycosis Fungoides and Sézary Syndrome. Blood Khodadoust, M. S., Mou, E., Kim, Y. H. 2022


    Agents targeting the unique biology of mycosis fungoides and Sézary syndrome are quickly being incorporated into clinical management. With these new therapies, we are now capable of inducing more durable responses and even complete remissions in advanced disease, outcomes which were exceedingly rare with prior therapies. Yet, even this new generation of therapies typically produces objective responses in only a minority of patients. As our therapeutic options increase, we are now challenged with selecting treatments from a growing list of options. To gain the full benefit of these novel agents, we must develop strategies to match treatments to the patients most likely to benefit from them. Here, we consider both the current approaches to treatment selection based on clinical features and the future of molecular biomarker-guided therapy for patients with this heterogeneous disease.

    View details for DOI 10.1182/blood.2020008241

    View details for PubMedID 36379025

  • Increasing tissue requirements in lymphoma trials may exclude patients with high risk disease or worse prognosis. Blood advances Desai, S. H., Mwangi, R., Ng, W. L., King, R. L., Maurer, M. J., Cerhan, J. R., Feldman, A., Farooq, U., Mou, E., Habermann, T. M., Thompson, C. A., Wang, Y., Witzig, T. E., Nowakowski, G. S. 2022


    Enhanced understanding of molecular heterogeneity of diffuse large B cell lymphoma (DLBCL) has opened doors to clinical trials evaluating novel agents with subtype-specific activity. It is an emerging question whether core needle biopsies (CNB) can adequately meet increasing tissue requirements of these clinical trials. This can potentially lead to selective enrollment of patients who can undergo excisional biopsy. It is also important to know whether patients who can undergo extensive diagnostic work up differ in their disease characteristics and outcomes from patients who can't. In this observational study, we describe characteristics, outcomes and adequacy of diagnostic tissue in patients with newly diagnosed DLBCL and primary mediastinal large B cell lymphoma who undergo EB versus CNB. Out of 1061 patients, 532 (49.8%) underwent EB and 529 (50.1%) underwent CNB. Significantly higher proportion of patients with CNB had advanced stage, IPI>=3 and inadequate tissue for molecular analyses. Patients with CNB had significantly worse 5-year event free survival (EFS, 67.6% vs 56.9%, HR 0.76 (CI95: 0.6-0.9, p<0.001) and 5-year overall survival (OS, 76.4% vs 69.2%, HR 0.8 (CI95: 0.6-0.9), p<0.001). Thus, patients who undergo CNB have poor risk features, have inferior outcomes on frontline chemoimmunotherapy, are more likely to have inadequate tissue for molecular analyses and might not be able to meet tissue requirements of biomarker-driven clinical trials. Thus, increasing tissue requirements of biomarker driven clinical trials may result in exclusion of high risk DLBCL pts who need novel agents.

    View details for DOI 10.1182/bloodadvances.2022007569

    View details for PubMedID 36170803

  • Sequential Pembrolizumab and AVD is Highly Effective at any PD-L1 Expression Level in Untreated Hodgkin Lymphoma. Blood advances Allen, P. B., Lu, X., Chen, Q., Kane, K. L., Chmiel, J. S., Barnea Slonim, L., Sukhanova, M., Savas, H., Evens, A. M., Advani, R., Pro, B., Karmali, R., Palmer, B., Bayer, R., Eisner, R. M., Mou, E., Dillehay, G., Gordon, L. I., Winter, J. N. 2022


    In a multicenter, phase II investigator-initiated trial of sequential pembrolizumab and AVD, nearly two-thirds of patients with untreated unfavorable or advanced stage classic Hodgkin Lymphoma (cHL) achieved PET-defined complete or near complete metabolic responses (CMR) following 3 doses of pembrolizumab monotherapy. Furthermore, all achieved CMR following 2 cycles of AVD chemotherapy and 100% of patients were alive without relapse at the time of initial publication. We now report long-term follow-up, including 3-year OS and planned correlative analyses. Thirty patients received single agent pembrolizumab every 3 weeks x 3, followed by AVD chemotherapy for 4-6 cycles depending on stage and bulk. PET/CT scan was performed after pembrolizumab monotherapy, 2 cycles of AVD, and at the end of therapy. Baseline biopsy samples were analyzed for genomic alterations of chromosome 9p24.1 and PD-1 pathway markers by immunohistochemistry. At a median follow up of 33.1 months (range, 26.0-43.0), PFS and OS remain 100%. All patients had genomic alterations in 9p24.1 and were positive for PD-L1 by immunohistochemistry. There was no relationship between response to single agent pembrolizumumab measured by decline in metabolic tumor volume and 9p24.1 alterations or PD-1 pathway H-scores. With additional follow-up, sequential pembrolizumab and AVD remains highly effective. The high response rates observed at all PD-ligand levels suggest that even low levels of PD ligand expression are sufficient for response to PD-1 blockade in untreated cHL. An international phase II trial (NCT05008224) to confirm these findings is ongoing.

    View details for DOI 10.1182/bloodadvances.2022008116

    View details for PubMedID 36083129

  • Global Cytopathology-Hematopathology Practice Trends. American journal of clinical pathology Zadeh, S. L., Balassanian, R., Cheung, M. C., Falchi, L., Hasserjian, R., Lin, O., Long, S. R., Menke, J. R., Mou, E., Natkunam, Y., Ruiz-Cordero, R., Volaric, A. K., Wang, L., Wen, K. W., Gratzinger, D. 2021


    OBJECTIVES: Small-volume biopsy-fine-needle aspiration biopsy (FNAB) with or without core biopsy-is in increasing use in diagnosis and management of lymphoma patients. Our objective was to survey the current practice in small-volume biopsy diagnosis of lymphoma, focusing on the interaction among hematopathologists and cytopathologists and the integration of FNAB, core biopsy, and flow cytometry studies at sign-out.METHODS: This study used a cross-sectional survey design employing the RedCap database distributed via nine pathology professional society email listservs. The survey consisted of 25 multiple-choice questions and several free text fields. In total, 128 pathologists participated.RESULTS: Most respondents indicated that FNAB specimens in which lymphoma is a diagnostic consideration (FNAB-L) are seen daily or weekly (68/116; 58.6%). However, most institutions have separate hematopathology and cytopathology services (72/116; 62.1%) with inconsistent communication. When communication occurred, respondents were frequently inclined to reconsider their original diagnoses. Barriers identified included lack of communication, inadequate access to diagnostic studies, no formal subspecialty training, and various opinions regarding FNAB in diagnosing lymphoma.CONCLUSIONS: This survey showed that FNAB-L specimens are common, with a lack of uniformity in how complementary fine-needle aspiration and core biopsy specimens or flow immunophenotyping results are shared across hematopathology and cytopathology services.

    View details for DOI 10.1093/ajcp/aqab111

    View details for PubMedID 34508545

  • Multicenter analysis of geriatric fitness and real-world outcomes in older patients with classical Hodgkin lymphoma. Blood advances Orellana-Noia, V. M., Isaac, K., Malecek, M., Bartlett, N. L., Voorhees, T. J., Grover, N. S., Hwang, S. R., Bennani, N. N., Hu, R., Hill, B. T., Mou, E., Advani, R., Carter, J., David, K. A., Ballard, H. J., Svoboda, J., Churnetski, M. C., Magarelli, G., Feldman, T., Cohen, J. B., Evens, A. M., Portell, C. 2021


    We performed a multicenter retrospective analysis across 10 US academic medical centers (2010 - 2018) to evaluate current treatment patterns and outcomes in patients age ≥60 with classical Hodgkin lymphoma (cHL). Among 244 eligible patients, median age was 68, 63% had advanced stage (III/IV), 14% had ECOG performance status (PS) 2-4, and 12% had documented loss of ≥1 activity of daily living (ADLs). Medical comorbidities were assessed by the Cumulative Illness Rating Scale - Geriatric (CIRS-G), where n=44 (18%) had total scores ≥10. Using multivariable Cox models, only ADL loss predicted shorter progression-free (PFS; HR 2.13, p=0.007) and overall survival (OS; HR=2.52, P=0.02). Most patients (n=203, 83%) received conventional chemotherapy regimens, including ABVD (56%), AVD (14%), and AVD with brentuximab vedotin (BV; 9%). Compared to alternative therapies, conventional regimens significantly improved PFS (HR 0.46, P=0.0007) and OS (HR 0.31, p=0.0003). Survival was similar following conventional chemotherapy in those ages 60-69 vs ≥70: PFS HR 0.88, p=0.63; OS HR 0.73, p=0.55. Early treatment discontinuation due to toxicity was more common with CIRS-G ≥10 (28 vs 12%, p=0.016) or documented geriatric syndrome (28 vs 13%, p=0.02). A competing risk analysis demonstrated improved disease-related survival with conventional therapy (HR 0.29, p=0.02) and higher mortality from causes other than disease or treatment in those with high CIRS-G or geriatric syndromes. These data suggest conventional chemotherapy regimens be considered standard of care in fit older patients with cHL, and highlights the importance of geriatric assessments in defining fitness for cHL therapy going forward.

    View details for DOI 10.1182/bloodadvances.2021004645

    View details for PubMedID 34448831

  • Impact of initial biopsy type on the time to final diagnostic biopsy in patients with follicular lymphoma and suspected histologic transformation. Leukemia & lymphoma Mou, E., Falchi, L., Sundaram, V., Abramson, J. S., Balassanian, R., Beygi, S., Fitzpatrick, M. J., Frank, A. K., Gupta, S., Lin, O., Long, S. R., Menke, J. R., Reed, D. R., Ruiz-Cordero, R., Volaric, A. K., Xie, Y., Wang, L., Wen, K. W., Zadeh, S. L., Natkunam, Y., Cheung, M. C., Gratzinger, D., Cyto-Heme Institutional Collaborative (CHIC) consortium 2021: 1-9


    Diagnosis of histologic transformation (HT) of follicular lymphoma (FL) requires tissue biopsy. While surgical biopsy represents the gold standard, less invasive procedures such as fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) are frequently performed. In this retrospective multi-institutional study including 269 patients with FL and suspected HT, the median time from initial clinical suspicion to final diagnostic biopsy was similar whether the workup began with FNAB, CNB, or surgical biopsy (4, 9, and 6days, respectively; p=.27), despite more subsequent biopsies performed following initial FNAB. Periprocedural complications were uniformly minimal. Biopsy-proven HT was more common in the initial surgery group and in workups including positron emission tomography/computed tomography (PET/CT). Our findings, derived from US academic centers with specialized procedural and pathology expertise, suggest that FNAB, CNB, and surgical biopsy are all viable initial diagnostic procedures that can inform clinical decision-making in select FL patients with suspected HT.

    View details for DOI 10.1080/10428194.2021.1941936

    View details for PubMedID 34176413

  • A randomized study of a best practice alert for platelet transfusions. Vox sanguinis Murphy, C., Mou, E., Pang, E., Shieh, L., Hom, J., Shah, N. 2021


    BACKGROUND AND OBJECTIVES: Inappropriate platelet transfusions represent an opportunity for improvements in patient care. Use of a best practice alert (BPA) as clinical decision support (CDS) for red cell transfusions has successfully reduced unnecessary red blood cell (RBC) transfusions in prior studies. We studied the impact of a platelet transfusion BPA with visibility randomized by patient chart.MATERIALS AND METHODS: A BPA was built to introduce CDS at the time of platelet ordering in the electronic health record. Alert visibility was randomized at the patient encounter level. BPA eligible platelet transfusions for patients with both visible and non-visible alerts were recorded along with reasons given for override of the BPA. Focused interviews were performed with providers who interacted with the BPA to assess its impact on their decision making.RESULTS: Over a 9-month study period, 446 patient charts were randomized. The visible alert group used 25.3% fewer BPA eligible platelets. Mean monthly usage of platelets eligible for BPA display was 65.7 for the control group and 49.1 for the visible alert group (p=0.07). BPA-eligible platelets used per inpatient day at risk per month were not significantly different between groups (2.4 vs. 2.1, p=0.53).CONCLUSION: It is feasible to study CDS via chart-based randomization. A platelet BPA reduced total platelets used over the study period and may have resulted in $151,069 in yearly savings, although there were no differences when adjusted for inpatient days at risk. During interviews, providers offered additional workflow insights allowing further improvement of CDS for platelet transfusions.

    View details for DOI 10.1111/vox.13132

    View details for PubMedID 34081800

  • Hodgkin Lymphoma Williams Hematology, 10th ed. Spinner, M., Mou, E., Advani, R. McGraw-Hill. 2021
  • Pembrolizumab followed by AVD in untreated early unfavorable and advanced stage classical Hodgkin lymphoma. Blood Allen, P. B., Savas, H. n., Evens, A. M., Advani, R. n., Palmer, B. n., Pro, B. n., Karmali, R. n., Mou, E. n., Bearden, J. n., Dillehay, G. n., Bayer, R. n., Eisner, R. M., Chmiel, J. S., O'Shea, K. L., Gordon, L. I., Winter, J. N. 2020


    Pembrolizumab, a humanized IgG4 monoclonal antibody targeting programmed death-1 protein, has demonstrated efficacy in relapsed/refractory classical Hodgkin lymphoma (cHL). To assess the complete metabolic response (CMR) rate and safety of pembrolizumab monotherapy in newly diagnosed cHL, we conducted a multicenter, single-arm, phase II investigator-initiated trial of sequential pembrolizumab and doxorubicin, vinblastine, and dacarbazine (AVD) chemotherapy. Patients > 18 years of age with untreated early unfavorable or advanced stage disease were eligible for treatment. Thirty patients with either early unfavorable (n=12) or advanced (n=18) stage cHL were treated with 3 cycles of pembrolizumab monotherapy followed by AVD for 4-6 cycles depending on stage and bulk. Twelve had either large mediastinal masses and/or bulky disease (>10 cm). Following pembrolizumab monotherapy, 11 patients (37%) demonstrated CMR's, and an additional 7 of 28 (25%) patients with quantifiable positron emission tomography/computed tomography scanning (PET-CT) had >90% reductions in metabolic tumor volume. All patients achieved CMR following 2 cycles of AVD and maintained their responses at end of treatment. With a median follow-up of 22.5 months (range: 14.2-30.6) there have been no changes in therapy, progressions, or deaths. No patients received consolidation radiotherapy, including those with bulky disease. Therapy was well-tolerated. The most common immune-related adverse events were grade 1 rash (n=6), and grade 2 infusion reactions (n=4). One patient had a reversible grade 4 transaminitis and a second had a reversible Bell's palsy. Brief pembrolizumab monotherapy followed by AVD proved both highly effective and safe in newly diagnosed cHL patients including those with bulky disease. This trial was registered at as #NCT03226249.

    View details for DOI 10.1182/blood.2020007400

    View details for PubMedID 32992341

  • Long-Term Outcomes of Patients with Early-Stage Non-Bulky Hodgkin Lymphoma Treated with Combined Modality Therapy on the Stanford V Trials (The G4 and G5 Studies). International journal of radiation oncology, biology, physics Mou, E. n., Advani, R. H., von Eyben, R. n., Rosenberg, S. A., Hoppe, R. T. 2020


    Combined modality therapy (CMT) is standard therapy for early-stage Hodgkin lymphoma (ESHL). We previously reported excellent outcomes with the abbreviated Stanford V regimen. Herein we report updated results with median follow-up >10 years on survival, therapy-related late effects, and impact of disease risk factors on patient outcomes.The XXXXXX and YYYYYY studies enrolled patients with stage I-IIA non-bulky ESHL. Patients received eight weeks of Stanford V chemotherapy followed by 30 Gy modified involved-field radiotherapy (mIFRT) (XXXXXX) or Stanford V-C + 20 Gy mIFRT (YYYYYY). Patients were categorized as favorable or unfavorable risk per German Hodgkin Study Group (GHSG) criteria and outcomes between groups compared.129 patients were enrolled (68 favorable and 61 unfavorable risk). In the XXXXXX study (n = 87), at median follow-up of 19.7 years, 5-, 10-, and 15-year PFS and OS were 95.4%/97.7%, 91.8%/96.5%, and 91.8%/95.3%, respectively. In the YYYYYY study (n = 42), at median follow-up of 13.5 years, the 5-, 10-, and 15-year PFS and OS were 92.9%/100%, 92.9%/100%, and 88.4%/91.9%, respectively. PFS (p = 0.86) and OS (p = 0.86) were not significantly different between studies. There were also no significant differences between studies in patients with favorable or unfavorable risk for PFS (F: p = 0.53; U: p = 0.96), OS (F: p = 0.99; U: p = 0.78), secondary malignancies (F: p = .74; U: p = 1.0), and cardiovascular complications (F: no cases; U: p = 1.0).The XXXXXX and YYYYYY studies achieve high rates of durable remission. 20 versus 30 Gy mIFRT and cyclophosphamide substituted for mechlorethamine did not compromise nodal control, PFS, or OS in both favorable and unfavorable risk disease. These results support the efficacy of CMT in early-stage disease and lower-dose radiotherapy in patients with favorable and non-bulky unfavorable ESHL.

    View details for DOI 10.1016/j.ijrobp.2020.12.039

    View details for PubMedID 33385495

  • Thrombophilia testing in the inpatient setting: impact of an educational intervention. BMC medical informatics and decision making Kwang, H. n., Mou, E. n., Richman, I. n., Kumar, A. n., Berube, C. n., Kaimal, R. n., Ahuja, N. n., Harman, S. n., Johnson, T. n., Shah, N. n., Witteles, R. n., Harrington, R. n., Shieh, L. n., Hom, J. n. 2019; 19 (1): 167


    Thrombophilia testing is frequently ordered in the inpatient setting despite its limited impact on clinical decision-making and unreliable results in the setting of acute thrombosis or ongoing anticoagulation. We sought to determine the effect of an educational intervention in reducing inappropriate thrombophilia testing for hospitalized patients.During the 2014 academic year, we implemented an educational intervention with a phase implementation design for Internal Medicine interns at Stanford University Hospital. The educational session covering epidemiology, appropriate thrombophilia evaluation and clinical rationale behind these recommendations. Their ordering behavior was compared with a contemporaneous control (non-medicine and private services) and a historical control (interns from prior academic year). From the analyzed data, we determined the proportion of inappropriate thrombophilia testing of each group. Logistic generalized estimating equations were used to estimate odds ratios for inappropriate thrombophilia testing associated with the intervention.Of 2151 orders included, 934 were deemed inappropriate (43.4%). The two intervention groups placed 147 orders. A pooled analysis of ordering practices by intervention groups revealed a trend toward reduction of inappropriate ordering (p = 0.053). By the end of the study, the intervention groups had significantly lower rates of inappropriate testing compared to historical or contemporaneous controls.A brief educational intervention was associated with a trend toward reduction in inappropriate thrombophilia testing. These findings suggest that focused education on thrombophilia testing can positively impact inpatient ordering practices.

    View details for DOI 10.1186/s12911-019-0889-6

    View details for PubMedID 31429747

  • An Electronic Best Practice Alert Based on Choosing Wisely Guidelines Reduces Thrombophilia Testing in the Outpatient Setting JOURNAL OF GENERAL INTERNAL MEDICINE Jun, T., Kwang, H., Mou, E., Berube, C., Bentley, J., Shieh, L., Hom, J. 2019; 34 (1): 29-30
  • The Power of Trust JAMA ONCOLOGY Mou, E., Schapira, L., Kunz, P. 2018; 4 (9): 1173–74
  • Magnitude of Potentially Inappropriate Thrombophilia Testing in the Inpatient Hospital Setting. Journal of hospital medicine Mou, E. n., Kwang, H. n., Hom, J. n., Shieh, L. n., Kumar, A. n., Richman, I. n., Berube, C. n. 2017; 12 (9): 735–38


    Laboratory costs of thrombophilia testing exceed an estimated $650 million (in US dollars) annually. Quantifying the prevalence and financial impact of potentially inappropriate testing in the inpatient hospital setting represents an integral component of the effort to reduce healthcare expenditures. We conducted a retrospective analysis of our electronic medical record to evaluate 2 years' worth of inpatient thrombophilia testing measured against preformulated appropriateness criteria. Cost data were obtained from the Centers for Medicare and Medicaid Services 2016 Clinical Laboratory Fee Schedule. Of the 1817 orders analyzed, 777 (42.7%) were potentially inappropriate, with an associated cost of $40,422. The tests most frequently inappropriately ordered were Factor V Leiden, prothrombin gene mutation, protein C and S activity levels, antithrombin activity levels, and the lupus anticoagulant. Potentially inappropriate thrombophilia testing is common and costly. These data demonstrate a need for institution-wide changes in order to reduce unnecessary expenditures and improve patient care.

    View details for PubMedID 28914278