Hematology

Lymphoma   

Questions discussed in this category



How does age play a role in this decision?  If you do intensify therapy, how do you explain the negative results of CALGB/Alliance 50303?

Do you only give intrathecal chemotherapy or systemic therapy?

What are the scenarios in which a rebiopsy is warranted for follicular lymphoma?

TROG 99.03 showed nearly 20% improved PFS at 10 years with chemoimmunotherapy despite 31/75 patients assigned R-CVP vs 44/75 assigned CVP without ritu...

Is there a preference for obinutuzumab over rituximab in early relapsed DLBCL, or in primary refractory disease?

At what age would you treat an early stage hodgkins lymphoma patient with ABVD + RT (adult treatment) vs OEPA x 2 or AV-PC x 3 (pediatric paradigm)?&n...

Given the rarity of DLBCL with MYC/BCL2/BCL6 rearrangements, do you approach this disease differently than DLBCL with MYC/BCL2 or BCL6 rearrangement, ...

Do the potential late effects offset any benefit of mediastinal XRT in a young patient with bulky disease?

Do these events mandate discontinuation of lenalidomide therapy or switching to a different agent? Can appropriate therapy for these skin cancers be r...

For a stage IAE DLBCL (in this case, of the oral cavity) that was completely excised, s/p R-CHOP, is the ISRT target volume just the preop volume plus...

Specifically, do you consider repeating maintenance therapy after second line therapy if a patient had already received 2 years of maintenance rituxim...

If a young and otherwise healthy patient with normal echocardiogram and no other cardiac risk factors needs treatment for DLBCL, but has previously re...

Specifically, do you utilize 3 cycles of chemo with ISRT or 6 cycles? Do you use R-EPOCH or R-CHOP in these cases?

e.g. mixed indolent/aggressive NHL, mixed NHL/HL? Is there a definitive way to discern composite from transformation? NCCN does not list recommendatio...

How would you handle high risk features (eg double hit) with the limitations of dialysis?

Would you give 3 cycles of RCHOP followed by consolidative IFRT or 6 cycles of R-mini CHOP? Is there a role for 3 cycles of R-mini CHOP followed by IF...

Would your recommendations change if the mass were significantly smaller, say 1-2 cm, and was completely excised with negative margins?  

Given nationwide shortage in Vinblastine, several of my patients under active therapy are facing delays in their therapies. Is it appropriate to subst...

Some specific questions: Would you recommend repeat biopsy to confirm residual disease? How would your recommendations vary if the patient had pre...

I.e., Can day 2 Rituximab (RCHOP) or day 6 Rituximab (DA-EPOCH, Hyper CVAD) be given? Or should only Day 1 Rituximab be used with chemoimmunotherapy i...

Since some prior studies (eg. Eskelund et al. Blood 2017 130:1903-10.) have shown intensive chemoimmunotherapy does not overcome the ad...

Since ECHELON-1 trial showed an improvement in PFS (but not OS), are there any situations where you would replace bleomycin with brentuximab...

Would you follow an algorithm such as the one proposed by Hall et al? How do you decide between intrathecal chemotherapy vs systemic therapy with HD-...

If they are symptomatic do you relax that time interval? Do you ever consider partial brain radiation instead of whole brain to minimize neurotoxicity...

Would you use a similar dose and fractionation as gastric MALT (30Gy in 1.5 Gy fractions)?

Would the site of disease relapse play a role in your decision (i.e. isolated lymph node recurrence versus failure at primary site of disease)?

Shanafelt et al. recently presented results from the phase III E1912 study at ASH 2018. Will you still utilize FCR as first-line or now use Ritux...

Would you consider observation following surgical resection with negative margins? Would you recommend WBRT and/or ISRT? What would be your preferred ...

Would you treat differently for de novo disease vs disease arising from large cell transformation of an indolent NHL?

Does their candidacy for autologous HSCT affect your decision to use maintenance lenalidomide?

Does the more recent data regarding the continued utility of brentuximab vedotin and the utility of PD-1 inhibitors factor in to your reasoning at all...

Does it differ from the treatment of other relapsed peripheral T-cell lymphomas? Are there any clinical trials or case series focused on SPTCL? Is t...

Given the rarity of this diagnosis (5-7% of all AL amyloidosis cases), and the prognostic and clinical differences when compared to non IgM-AL am...

Would you use 10 Gy in 1 Gy per fraction as mentioned in a litterature review in Pubmed?

In the case of an excised groin node with no residual disease and no chemotherapy in a young adult patient, how large should the fields be? Is it requ...

Assuming that the involved area is too widespread for RT. Would you try single agent rituximab first? Or obinutuzumab? What if rituximab alone gave on...

The recent NEJM phase II trial http://www.nejm.org/doi/full/10.1056/NEJMoa1715519?query=featured_home looked at a small cohort of 24 patients and show...

the MZL was untreated in the past prior to transformation. Do these patients have a higher risk of recurrence post CR as opposed to patients with de ...

If filgrastim, how many days would you give? Pegfilgrastim is often not covered by payers if given less than 14 days before chemotherapy.  

If the patient cannot tolerate methotrexate or further chemotherapy, how effective is radiation therapy (e.g. WBRT) in rendering the patient disease-f...

Specifically I am thinking if a PET scan shows complete response, would it be reasonable to stop bleomycin and continue AVD?

My experience has been that patients can be neurologically devastated years out from WBRT. In Medical Oncology practice at my institution, we do not r...

PET/CT/bone marrow biopsy negative for evidence of distant disease. Following 4 cycles of combination chemotherapy with no evidence of progressive dis...

Although bendamustine + rituximab is a standard option for advanced follicular lymphoma when treatment is required, does the regimen rituximab + lenal...

If so, do you use antivirals and/or antibiotics? Does it matter if the patient has mantle cell lymphoma, CLL, or Waldenstrom's macroglobulinemia?

Specifically, is there still a role for dd RCHOP followed by ICE, or do you recommend DA-R-EPOCH for all patients?

NCCN guidelines suggest XRT as standard of care for this stage of disease. However, occasionally patients have their tumors completely excised when un...

With the field moving more toward ISRT/ INRT, and conformal radiation, would you generate separate PTV for initial nodal involvements that are within ...

When nodal regions not amenable to biopsy but are enlarged without significant SUV uptake, should they be treated as involed and recieve RT?

After ABVE-PC X4 and Ifos/vinorelbine x 2 per AHOD 0831 (and is unable to have these sites biopsied), what dose would you treat to and what volume wou...

When radiation therapy is utilized, what should the radiation therapy treatment fields include and what imaging studies should be completed to assist ...

If so, should involved site radiation thearpy (ISRT) or involved field radiation therapy (IFRT) be used for the radiation therapy treatment fields? Wo...

When the disease (in this case, lymphoma) involves almost all of the entire muscle compartment of the distal lower extremity, what is a safe dose? I'm...

If a patient with stage I, low grade follicular lymphoma achieves a complete response after rituxan and treanda is there any role for consolidative ra...

Is it necessary to treat the whole orbit or is conformal treatment ok? 

After a nerve sparing parotidectomy, would you offer postoperative radiotherapy? If so, what volume and dose? Would it change your management if the p...

In a patient with Stage IE DLBCL, is your treatment volume postchemo ISRT or whole breast? Would you consolidate if a lumpectomy was performed prior t...

Would you prescribe to a higher dose? Treat with wider margins? Encourage the use of systemic therapy?

Hoskin et al (Lancet Oncology 2014) suggest 24Gy/12fx is more effect RT dose compared to 4Gy.

Is there a benefit to IMRT when we treat to relatively low doses (as compared to squamous cell cancers of the head and neck)?

Or is it more appropriate for certain sites/stages/histologies?

It seems that with the arms up, you get better lung blocking but with arms akimbo, you might have a lower dose to the humeral head. 


Papers discussed in this category


Int. J. Radiat. Oncol. Biol. Phys., 2011-07-15

International journal of radiation oncology, biology, physics, 2014-07-15

International journal of radiation oncology, biology, physics, 2014-05-01

Lancet Oncol., 2014-04-01

J. Clin. Oncol., 2014-04-10

J. Clin. Oncol., 2013-11-10

Oncology (Williston Park, N.Y.), 2012-12

N. Engl. J. Med., 2010-08-12

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-11-10

Practical radiation oncology, 2015

International journal of radiation oncology, biology, physics, 2015-05-01

J. Clin. Oncol., 2015-09-10

International journal of radiation oncology, biology, physics, 2015-05-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-09-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-07-20

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-08-10

J Clin Oncol, 2010 Oct 10

J. Natl. Cancer Inst., 2011 Oct 21

The Lancet. Oncology, 2016-08

J. Clin. Oncol., 2010 May 03

Blood, 2016-10-13

The Lancet. Oncology, 2014-11

The New England journal of medicine, 2016-06-23

Blood, 2013-12-19

Cancer, 2004-05-15

N. Engl. J. Med., 2018-01-25

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2002-12-15

Lancet, 2009 Sep 18

Leukemia & lymphoma, 2014-04

The New England journal of medicine, 2017-12-28

Avicenna J Med, 2017 Jul-Sep

J. Clin. Oncol.,

Lancet (London, England), 2018-02-17

British journal of haematology, 2017-11

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2010-04-10

Leukemia & lymphoma, 2017-04

Cancer, 2010-08-15

J. Clin. Oncol., 2018 Jul 05

Lancet (London, England), 2019-01-19

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-03-10

J. Clin. Oncol., 2009 Oct 05

Ann. Oncol.,

Cancer Res., 2010 Feb 02

Dig Liver Dis, 2013 Jun 28

Am. J. Clin. Oncol.,

Radiother Oncol, 2011 Jun 12

Int. J. Radiat. Oncol. Biol. Phys., 2012 Mar 13

Blood, 2018 Sep 04

Blood, 2017-02-02

The Lancet. Haematology, 2016-05

The Lancet. Haematology, 2017-11

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-05-20

Blood, 2018-03-15

Neuro-oncology, 2009-04

Lancet Haematol, 2015 Jun 03

Annals of oncology : official journal of the European Society for Medical Oncology, 2011-02

Haematologica, 2016 Jun 16

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-07-10

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2018-06

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-05-10

Haematologica, 2017 Sep 21

British journal of haematology, 2015-12

Blood Adv,

The Lancet. Oncology, 2014-03

The New England journal of medicine, 2012-05-10

Leukemia, 2019-01

Blood, 2017 Aug 3

J. Clin. Oncol., 2019 Sep 10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-02-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-11-01

Haematologica, 2020

Nature, 2019-03

Blood, 2018 May 02

Leukemia & lymphoma, 2017-12

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2003-01-01

Int. J. Radiat. Oncol. Biol. Phys., 2012 Jul 24