Medical Oncology

Hematologic Malignancies   

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?

Can results from emerging AML data be extrapolated to high risk MDS populations? Is there data to guide the choice of continuing the HMA in combinati...

Does the absence of an OS benefit in the AG221-AML-005 presented at ASCO 2020 deter you from this strategy?

Is it at neutrophil recovery, at documentation of CR on bone marrow biopsy, or is there a different point in time?

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...

For example, for joing replacement surgery? Do you hold the revlimid for certain about of time before and after?

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

For instance, would you discontinue when there is resolution of adenopathy and normalization of counts? If so, do you overlap ibrutinib with other the...

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?

To me, the recent NEJM study is flawed in that the control arm did not have maintenance treatment while the experimental arm used maintenance Dar...

Would you proceed to autologous transplant, or switch to an alternate regimen (eg. daratumumab-based) first? Would the type or degree of organ involv...

In a patient with no evidence of bleeding, do you use a platelet cutoff? Do you utilize genomic testing (eg CALR, MPL, JAK2, etc.) to decide on cytore...

Once a tissue biopsy has confirmed light chain amyloid, what additional tests do you perform as part of a standard workup? In whom should treatment b...

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

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...

Would you still proceed to high-dose therapy and autologous SCT? Would you incorporate radiation pre- or post- transplant? Or offer additional salvag...

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

For instance, do you ever start with dasatinib 50 mg daily?  Are there any titration schedules that you follow?

Given the PFS benefit seen in the most recent ECOG-ACRIN, and the prior study of Rd showing an OS benefit, is your practice to put any high-risk SMM p...

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

if so, are there specific cytogenetic, molecular, clinical, or hematologic factors that you take into consideration?

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...

Thrombosis was ruled out and no etiology was found.  Would you start ponatinib back at a lower dose, transition to omacetaxine or begin transplan...

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...

Do you await molecular and cytogenetic results prior to initiating therapy, or does age and function status primarily drive your choice?

NCCN does not list any preferences for the TKIs in their guidelines.

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...

For example - Would you offer tandem transplantation in a young, fit patient in a CR after first transplant, but with MRD detectable?

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-...

FDA package insert lists posaconazole as strong cyp3A4 inhibitor and states to consider other therapies.

Does presenting total white blood cell count affect your decision? Does myeloid subtype affect your decision? 

How might your decision change if the patient had a suitable 10/10 donor? How about if the patient had a targetable molecular mutation such as IDH2?

Although the MMR vaccine is contraindicated in immunosuppressed patients on anticancer treatment according to CDC/ACIP and IDSA guidelines, data on sa...

Given the recent results presented from the Griffin trial, would you choose a daratumumab-based regimen (eg. D-VRd) over other salvage options (V...

We know the longer we expose patients to lenalidomide, the harder collection will be. Would you collect now or switch to an alternative regimen to ach...

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)?

Has the recent data presented at ASH affected your choice of regimen? Would your choice differ between transplant-eligible and transplant-ineligible ...

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 MRD assessments affect your clinical decision making for MM patients outside of a clinical trial?

Specifically, what regimen would you choose in a patient with new renal failure but not requiring dialysis?

What factors influence your decision (patient/disease characteristics, additional agents added to induction chemotherapy, CR1 or later, etc)?

If a patient obtains a PR or less to front line cladribine, what factors help you chose between a second course of cladribine, an alternative pur...

When is it warranted to utilize targeted therapies for known mutations (eg. midostaurin or an alternative TKI for FLT3 mutations, ivosidenib for ...

Does the choice of initial induction regimen affect your decision for when to employ lenalidomide maintenance? Are there situations where you would c...

Are you routinely using letermovir as CMV prophylaxis in high-risk patients? Any special considerations with its use versus other antiviral agents? ...

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

Given the rarity of this in MF, is it still predictive of response to lenalidomide therapy?

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...

Could one make a case for addition of Rituxinab frontline to increase the chances of a complete remission and even maybe achieve MRD-negative status ?

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...

Technically, you can have up to 55% of larger cells circulating and still be called CLL.

Once you decide to begin treatment, any special precautions you would use for protein levels starting that high.

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 ...

Specifically, in patients that had progression or developed toxicity on ibrutinib? Idelalisib is very toxic and venetoclax a labor-intensive drug to g...

Even though Venetoclax is not FDA-approved yet, assuming you can get it off label? 1. Gemtuzumab: What dose/schedule and which HMA? 2. Venetoclax: W...

My practice had always been to transfuse for plts < 10, but the recent ASCO guideline change suggests  that in the post-autoSCT setting it is ...

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

The patient has no medical problems and no history of leukemia/MDS. Biopsy of the filum terminale and arachnoid confirmed a myeloid sarcoma and MRI sh...

Subq has been shown to have lower risk of neuropathy. Is there any reason to use weekly IV still?

This is a recently described entity with poor prognosis, so even with a CR after RCHOPx6 cycles, is your bias to push for ISRT due to EBV being poor p...

In a patient with multiple poor risk features including TP53 mutation, 1q amplification, stage III, and circulating plasma cells, would you consider a...

For example, how significant does the M protein have to increase for you to begin a conversation about new therapy?

Specifically, to you lean towards elotuzumab or a daratumumab-based regimen?

Peripheral blood Flow shows prominent NK cell population but marrow aspiration/bx shows normocellular marrow with trilineage hematopoeisis.  &nb...

If a patient will receive a total of 4 cycles ABVD and has a CR by PET/CT after cycle 2, can RT be omitted to non-bulky sites to avoid toxicity?

Would you change your radiation therapy treatment dose or volume if you needed to treat a chloroma? If a patient had a separate cancer (e.g. skin canc...

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...

Drug information indicates a patient may need 3-4 months off TKI. This seems like a long time off drug. Would a MMR of a certain duration make it less...

Specifically when given as a single agent. Any role for G-CSF?

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

At what point is the neuropathy a contraindication to further bortezomib therapy?

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

Specifically, can you rechallenge after the effusion has resolved (e.g. therapeutic thoracentesis)? If so, how long do you wait to rechallenge (especi...

Imatinib, or a second-generation TKI? Are there specific factors that make you choose one over the other?

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, do you just wait for count recovery? Do you check for morphologic or molecular remission at all during this time?

Do you re-challenge them?  If so, what pre-medications do you give?  Do you dose reduce the cytarabine? Or do you switch another regimen?

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...

Would you continue ibrutinib even if they are placed on anti-platelet therapy such as clopidogrel or ticagrelor?

What is the utility of repeating FISH studies to evaluate for clonal evolution if FISH studies were done at diagnosis?  

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...


Papers discussed in this category


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

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

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

The New England journal of medicine, 2013-04-11

Cancer, 2004-08-15

Br. J. Haematol., 2003-11-01

Br. J. Haematol., 1998-08-01

Cancer, 1990-11-15

Radiother Oncol, 1990-01-01

The New England journal of medicine, 2010-06-17

Blood, 2014-01-23

The New England journal of medicine, 2010-06-17

The New England journal of medicine, 2015-12-17

Medical and pediatric oncology, 1981

JAMA, 2013-04-03

Haematologica, 2016-12-01

Clin Pharmacokinet, 2012-12-01

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

Blood, 2016-12-22

N. Engl. J. Med., 2015-04-23

Leuk. Lymphoma, 2007-09-01

The New England journal of medicine, 2015-08-13

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

British journal of haematology, 2004-04

Blood,

Blood,

Br. J. Haematol., 2017 Nov 21

American journal of hematology, 2016-05

Blood, 2018-06-21

Nature, 2019-06

Leukemia, 2019-02

The Lancet. Oncology, 2009-03

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2002-05-15

Cancer, 2011-06-15

American journal of hematology, 2009-09

Cancer, 2010-08-15

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

Lancet, 2009 Sep 18

Blood, 2013-11-14

J. Clin. Oncol., 2016 Jan 25

Leukemia, 2016-02

The Lancet. Oncology, 2018-02

The Lancet. Oncology, 2010-01

The New England journal of medicine, 2014-09-04

The New England journal of medicine, 2019-05-30

Lancet (London, England), 2017-02-04

The New England journal of medicine, 2018-02-08

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The Lancet. Haematology, 2018-01

Blood, 2014-05-22

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

British journal of haematology, 2017-11

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

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Cancer Res., 2010 Feb 02

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Blood, 2017-02-02

The Lancet. Haematology, 2016-05

The Lancet. Haematology, 2017-11

Blood, 2016 Mar 21

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

N. Engl. J. Med.,

Blood, 2018-03-15

Cancer, 2015-12-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-08-01

Neuro-oncology, 2009-04

Lancet Haematol, 2015 Jun 03

Radiother Oncol, 2011 Jun 12

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

Haematologica, 2016 Jun 16

The New England journal of medicine, 2017-08-03

Lancet, 2012 Apr 05

Haematologica, 2018 Aug 03

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

Leukemia, 2014-03

Cancer, 2014-12-01

Blood, 2019-04-04

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

American journal of hematology, 2018-08

Am. J. Hematol., 2019 Nov 19

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

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N. Engl. J. Med.,

Nature medicine, 2015-02

Clin Lymphoma Myeloma Leuk, 2017 Jun 21

The New England journal of medicine, 2007-01-25

Haematologica, 2020

Nature, 2019-03

Blood, 2018 May 02

Blood, 2016-07-28

Blood advances, 2016-12-27

Cancer, 2016-10

Blood, 2017-08-31

Biol. Blood Marrow Transplant., 2019 Aug 22

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

Leukemia, 2016-04

Blood,

Blood, 2016 Dec 27

Blood, 2018 Apr 5

N Engl J Med,