Key Clinical Message: Methotrexate‐induced leukoencephalopathy is to be considered as a potential etiology in any patient presenting with stroke‐like symptoms after receiving methotrexate. One of our cases suggests that the method of administration of the methotrexate can be IV or intrathecal and still results in leukoencephalopathy.

Code status discussions form an important part of advance care planning (ACP) as it enables physicians to respect the patient’s wishes for end-of-life care. However, in some cases, code status discussions can be challenging causing the physician to go against the patient’s wishes and the code of medical ethics. This is especially true in an emergency setting. In this paper, we will discuss three cases of advanced cancer patients, where code status discussions posed challenges to healthcare providers.

Central venous catheters raise the risk of catheter‐related thrombosis (CRT) in patients with cancer, typically affecting the upper extremity. Management of CRT involves catheter removal and anticoagulation. However, robust evidence is lacking on the optimal timing of anticoagulation relative to catheter removal. Our goal is to provide a better understanding of the factors that increase the risk of recurrent venous thromboembolism (VTE) in these patients. We conducted a retrospective chart review of all consecutive patients with cancer in our hospital affected by CRT between January 1, 2015, and December 31, 2017. We measured recurrence of VTE as thrombosis in any vascular bed or pulmonary embolism, for up to 2 years after diagnosis. Logistic and competing risk regression analyses were used to determine the association between different clinical factors and any VTE recurrence in patients with cancer and CRT. Of the 257 individuals meeting the inclusion criteria, 80.2% had their catheter removed; of these, 50.5% did not receive anticoagulation before the removal. Patients who did not receive anticoagulation before the removal had increased 3‐month and 1‐year risks of recurrent VTE (odds ratio, 5.07 [95% confidence interval [CI], 1.53–23.18]; and hazard ratio, 3.47 [95% CI, 1.34–9.01]), respectively. Our study supports the use of anticoagulants before catheter removal in patients with CRT. Randomized clinical trials are recommended to establish stronger evidence pertaining to the long‐term risk of VTE recurrence and the effect of catheter reinsertion.

Immune checkpoint inhibitors (ICIs) targeting CTLA-4, PD-1, and PD-L1 have transformed cancer therapy but may trigger rare, sometimes fatal hematologic immune-related adverse events (irAEs). The most frequent hematologic irAEs are anemia, thrombocytopenia, and pancytopenia, which occur more often with CTLA-4 inhibitors and in patients receiving combination therapy. Risk is heightened when ICIs are combined with chemotherapy or radiation. Common symptoms include fatigue, abnormal bleeding, easy bruising, and recurrent infections. Diagnosis relies on laboratory studies, histologic evaluation, and review of medication history. Management typically involves ICI discontinuation and immunosuppression with corticosteroids or rituximab; adjunctive options include IVIG, transfusions, or plasmapheresis depending on severity. Research is also exploring cytokines such as IL-2, IL-7, and IL-15 for ICI-related lymphopenia. Current evidence is drawn mainly from case reports and small series, highlighting the need for larger studies to clarify incidence, mechanisms, and optimal management. Recent pharmacovigilance and outcomes data confirm these events remain rare and can present late, underscoring the need for long-term surveillance and robust monitoring systems [Fletcher K and Johnson DB 2024; Durbin SM et al. 2025; Yang Y. et al. 2024; Han X. et al. 2025].

Incidental venous thromboembolism (VTE) is common in cancer patients and identifying factors associated with these events can improve the management plan. We studied the characteristics of concomitant deep vein thrombosis (C-DVT) in cancer patients presenting with unsuspected pulmonary embolism (PE) and the association of C-DVT with VTE recurrence and survival outcomes. Patients presenting to our emergency department with confirmed unsuspected/incidental PE between 1 January 2006 and 1 January 2016, were identified. Radiologic reports were reviewed to confirm the presence or absence of C-DVT. Logistic regression analyses and cox regression modeling were used to determine the effect of C-DVT on VTE recurrence and survival outcomes. Of 904 eligible patients, 189 (20.9%) had C-DVT. Patients with C-DVT had twice the odds of developing VTE recurrence (odds ratio 2.07, 95% confidence interval 1.21–3.48, p = 0.007). The mortality rates among C-DVT were significantly higher than in patients without. C-DVT was associated with reduced overall survival in patients with unsuspected PE (hazard ratio 1.33, 95% confidence interval 1.09–1.63, p = 0.005). In conclusion, C-DVT in cancer patients who present with unsuspected PE is common and is associated with an increased risk of VTE recurrence and poor short- and long-term survival. Identifying other venous thrombi in cancer patients presenting with unsuspected PE is recommended and can guide the management plan. For patients with isolated incidental subsegmental pulmonary embolism and concomitant deep vein thrombosis, initiating anticoagulants if no contraindications exist is recommended.

Characteristics of cancer patients with COVID-19 in a cancer hospital Demis N. Lipe, Ahmed Elsayem, Maria T. Cruz-Carreras, Jomol Thomas, Adianes Feliciano, Jenny Ren, Susan M. Gaeta, Eva Rajha, Elisabet Manasanch, Ed Kheder, Patricia Brock, Cielito Reyes-Gibby