Pediatric Hematology/Oncology&nbsp;&nbsp;&nbsp;

Given the data from SWOG 1826 suggesting that Nivo-AVD is likely the preferred regimen for advanced Hodgkin lymphoma patients, are there scenarios where BV-AVD may still be preferred?

Is your standard of care for newly diagnosed advanced classical Hodgkin now nivolumab-AVD based on SWOG 1826?

What is your surveillance protocol for patients with common variable immunodeficiency receiving chronic IVIG therapy?

Is there a target IgG level to aim for? What should hematologists be aware of in monitoring these patients?

For patients with newly diagnosed brain metastases without a history of seizure activity, do you routinely start anti-seizure medication?

If so, how long do you continue medication and when do you discontinue? Does treatment with surgical resection versus radiation alone change your mana...

How do different inflammatory markers like CRP and ferritin contribute differently, if at all, to the monitoring of CART neurotoxicity?

Can defibrotide be given safely for VOD in patients with refractory thrombocytopenia to platelet transfusions?

Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?

What is the utility of granulocyte infusions in patients with neutropenia and severe infection?

Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?

What are the treatment options for relapsed T-ALL in a patient who was nonadherent with AALL and hyper-CVAD regimens?

Is there a role for nelarabine and venetoclax in this setting?

How do you counsel sickle cell patients on the use of G-CSF to treat neutropenia from other causes, like malignancy?

Do you discuss the risk of sickle cell crises with G-CSF? What about for patients with sickle cell trait?

What is the expected timeframe for the development of radiation myelitis and therapies that have helped with neurologic symptoms?

How do you differentiate demoralization from depression during cancer treatment?

Should I treat a patient who doesn't know she has cancer?

My patient’s family has asked that I don’t tell her that she has metastatic cancer because it will devastate her. I am planning on palliat...

How do you counsel patients with locally advanced malignancies who have ECOG 3-4?

How do you advise patients who strongly desire chemotherapy?

How often do you monitor AML patients after transplant for recurrence?

What is your preferred graft source and conditioning regimen in a patient with Fanconi anemia and AML undergoing stem cell transplant?

Is there a role for non-myeloablative regimens?

How do you approach a young patient with metastatic poorly differentiated thyroid cancer with rhabdoid/non-anaplastic features?

What infections should we rule out in patients who develop diarrhea on immunotherapy?

Chemotherapy is associated with acquiring C diff colitis. Does immunotherapy share that same risk and necessitate ruling out infection prior to anti-d...

How would you manage a patient less than 40 years old with an incidentally found LGG, IDH mutated, 1p19q intact, s/p STR?

Would you offer radiation and chemotherapy, vorasidenib, or observation?

How would you treat suspected secondary HLH in patients whom etoposide is contraindicated?

No clear inciting etiology found. Would you consider dexamethasone +/- cytokine blockade (IL-1, IL-6, or IFN-g)? What do you think about the data for...

Is it appropriate to substitute vincristine for vinblastine in ABVD for systemic therapy of Hodgkins lymphoma?

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

Does your evaluation of a young person with spontaneous upper extremity DVT vary as compared to lower extremity DVT?

Do you do additional workup for venous obstruction or any other different testing/evaluation?

Do you use direct oral anticoagulants to treat port-a-cath related VTE in patients with an active malignancy?

Do social or economic factors (i.e., relative cost of acquiring LMWH, the patient being injection averse) affect your decision to use DOACs? Do you s...

How do you prescribe a steroid taper for radiation and checkpoint inhibitor related pneumonitis?

I've seen a handful of fatal radiation pneumonitis associated with rapid steroid tapers by the non-treating physicians. How do you recommend prescribi...

How do you approach patients with lymph node positive osteosarcoma of the extremities for neoadjuvant chemotherapy?

What parameters would you use to monitor and interpret iron levels in a hemochromatosis patient where ferritin is unreliable due to underlying chronic inflammation?

How would your recommendation change if the patient has H63 homozygous mutation?

What is your strategy for optimizing hydroxyurea dosage in patients with symptomatic sickle cell disease, particularly for genotypes HbSS and HbS/Beta thal?

What is your target Hgb/Hct for women who are pregnant and have sickle cell disease in whom you are doing scheduled transfusions?

What approach do you use when treating adult diffuse gliomas with H3-G34 mutations, now classified into their own category under the 2021 glioma guidelines?

Do you treat this similarly to IDH-Wildtype GBM with the STUPP regimen? Is there any role of less-intensive paradigms, such as 59.4 Gy/33 fx?

How would you approach patients with primary cardiac sarcomas for adjuvant systemic treatment?

How do we approach patients with rare tumors given the paucity of data?

What are magic mouthwash alternatives that you would recommend?

There was a recall on viscous lidocaine and many of our patients cannot find it. What would you recommend as alternatives?

9 Answers available

Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?

How do you manage patients blood pressures while on anti-angiogenic TKIs?

Do you insist on ambulatory/home blood pressures to rule in/out white coat hypertension? Does your practice have a system to log patients' BPs to supp...

How do you manage steroid-refractory acute GVHD following allogeneic transplant?

What criteria do you use to define steroid-refractory disease? Does your management different by organ system involved - GI vs skin vs other?

What, if any, cardioprotective measures beyond dexrazoxane may be used to minimize cardiac risk during or after chemo- or radio-therapy?

Are there other measures, pharmocologic or adjunctive, that can be used or are under investigation to mitigate cardiotoxicity related to chemo- or rad...

Would you offer intensive CNS prophylaxis to Ph negative B-ALL patients who have possible mandibular nerve involvement on MRI face?

The patient presented with a numb chin, more to the right of his face; an MRI did report mandibular nerve opacity, which is non-specific per neuro-rad...

How do you monitor risk of erythrocytosis from testosterone use for female to male transgender patients?

What is your preferred conditioning regimen for fit patients with high-risk MDS undergoing MUD allogeneic stem cell transplantation?

How do you choose between RIC compared to MAC? Is there evidence for one over the other in an otherwise healthy, young patient? Do you include hypome...

How do you approach autologous stem cell transplant in T-cell lymphomas/PTCL after induction chemotherapy with achievement of CR1?

NCCN says "consider autologous HCT" while retrospective data seems to support SCT in most histologies like AITL

What is your current approach to maintenance therapy in FLT3-mutant AML post allogeneic HCT?

Have you changed your practice given BMT-CTN 1506/Morpho results? Would you utilize maintenance therapy in patients who achieve MRD- remission?

How do you approach treatment of sub-total resected ZFTA fusion ependymoma after radiation therapy in a young adult?

Do you recommend adjuvant chemotherapy after radiation treatment?

What is your approach to working up diarrhea in an immunocompromised patient?

How do you approach a young patient with undifferentiated pleomorphic sarcoma of the upper extremity who developed ifosfamide-induced nephrotoxicity after two cycles of adjuvant AIM chemotherapy?

Would you consider stopping therapy versus doxorubicin + dacarbazine/doxorubicin alone versus alternative chemotherapy ?

What special considerations do you take when treating cancer patients with severe intellectual disabilities?

Have you been able to deliver standard of care treatment?

For AML patients, when do you stop antiinfective agents?

At the time of count recovery or do you continue it throughout induction and consolidation?

What systemic therapy would you offer a patient with metastatic melanoma who is BRAF WT and developed metastases while on adjuvant nivolumab?

Would you treat with AZA + venetoclax to achieve CR2 before proceeding to allogeneic stem cell transplant in a young, fit patient with favorable risk AML who relapsed within a year after 7+3 and HIDAC consolidation?

NGS results are pending

Do you recommend preloading with IV magnesium to decrease the risk of cisplatin nephrotoxicity?

What is your practice regarding giving G-CSF to patients with ALL during initial induction?

The patient was recently diagnosed with pre-B ALL and is on day 10 of CALGB 10403. He is expectedly neutropenic as he received daunorubicin and vincri...

How would you manage a young patient with HL who develops HF (EF < 30%) after 4 cycles of A+AVD who obtained a PET2 CR?

How do you approach melanoma patients with a positive sentinel node with extra-nodal extension for definitive surgical management?

Is completing nodal dissection warranted for surgical management?

What is your preferred formulation of parenteral iron?

There are various formulations of intravenous iron; each with varying costs, test dose requirement, elemental dose, and number or time of infusions ne...

Would you extend the duration of anticoagulation in patients with a provoked DVT, but evidence of residual clot at 3 months?

While follow up ultrasound is not usually recommended in provoked DVT, it often is done either for other reasons or by other physicians. Would this in...

How do you approach and manage anorexia and appetite loss in people with advanced cancer?

How do you counsel patients and caregivers? Do you prescribe medications (''appetite stimulants'') with the goal to improve appetite even if they do n...

How would you treat a patient with Hodgkin lymphoma who has an isolated relapse within the CNS?

Can CAR T cell therapy be considered for heart transplant recipients with concurrent lymphoproliferative disorders?

What factors do you use when selecting which NGS platform to use for sequencing solid tumors?

For instance, do you factor availability of RNAseq, inclusion of normal blood controls, and QNS rates into your decision?

What are your top takeaways from ASH 2023?

7 Answers available

In a patient with recurrent fibrolamellar HCC a year after upfront resection (previously refused adjuvant therapy) with a solitary abdominal mass, would you offer neoadjuvant therapy to assess response?

Or offer resection followed by adjuvant therapy?

Do you adjust chemotherapy dose if >=10% change in calculated dose, weight, BSA, or if any of these three parameters are met?

Practice varies among oncologists and institutions

How soon after CAR T-cell therapy can salvage radiation be delivered?

How would you approach breast cancer screening in an adolescent patient with a CDH1 mutation?

What is your approach to cancer patients who inquire about alternative or complementary treatments?

8 Answers available

What is your strategy for breakthrough chemotherapy induced N&V in patients receiving highly emetogenic chemotherapy and already received a NK-1 antagonist, 5-HT3 antagonist, dexamethasone, and olanzapine?

What is your strategy for managing immunosuppression in patients with a kidney transplant who develop metastatic cancer?

Is there a concern for the potential of future congenital malformations in offspring when preservation of eggs and sperm is done AFTER cyclophosphamide treatment given that it is an alkylating agent?

Which patients with relapsed/refractory NHL are appropriate for pre-CAR-T bridging radiation therapy?

What is the ideal period to wait until curative surgery for patients with acute pulmonary embolism and solid malignancy?

Specifically, asymptomatic subsegmental PE diagnosed within a month from planned bilateral mastectomy for breast cancer.

What is the preferred treatment for a patient with an EBV+ monomorphic PTLD (DLBCL) not currently on immunosuppressive therapy?

How do you manage incidentally identified pituitary lesions on brain imaging?

What workup do you typically recommend?

How do you approach evaluation and management of arthralgia in a patient after CAR-T cell therapy?

How would you treat a stage IIIB recurrent seminoma with early recurrence following first-line treatment with VIP?

How would you manage a patient with radiation pneumonitis who remains symptomatic on steroids?

What surveillance plan would you recommend for stage IV melanoma patients who achieve a CR or stable PR response with immunotherapy?

Do you recommend continued PCR testing in a CML patient who underwent allogeneic stem cell transplantation with an identical match about 20 years ago?

Would you use a myeloablative or reduced intensity conditioning regiment for a pediatric or AYA patient who does not recover their counts after treatment for AML, but remains disease free?

Would you test for bone marrow failure syndromes before beginning the conditioning regimen?

How do you approach the management of GVHD prophylaxis in the setting of severe infection?

How do you approach a patient with newly diagnosed high-grade osteosarcoma who received maximum cumulative dose of doxorubicin for a soft tissue sarcoma 10 years earlier?

How do you integrate surgery in treatment of recurrent tenosynovial giant cell tumors (TGCT) when using Pexidartinib?

Do you recommend sperm banking for males prior to undergoing radiation?

Is it necessary to delay the start of radiation therapy for males planning on sperm banking for fertility preservation?

What surveillance imaging do you obtain for stage III melanoma patients after completing systemic adjuvant therapy?

How would you adjust the steroid dose for steroid-induced psychosis in a patient being treated for secondary HLH with the HLH-94 protocol?

What are common indications for ordering NGS of peripheral blood?

Would a negative NGS eliminate the possibility of MDS? Is bone marrow biopsy indicated in a patient with pancytopenia with a negative NGS panel?

Is there evidence to support or argue against intermittent fasting for cancer patients?

Why do we use dexamethasone for CNS edema and prednisone for pneumonitis?

Is this an artifact of what agent prior clinical trials used or something to do with the mechanism of action (i.e., less mineralocorticoid effect of d...

How do you approach very treatment-refractory ITP?

Such as the case in which a patient is unresponsive to steroids, IVIG, TPO-agonist, rituximab, splenectomy, and even fostamitinib.

For patients on immune checkpoint inhibitors presenting with chest pain, dyspnea, fatigue, and troponin elevation, would you recommend early initiation of high dose steroids for empiric treatment of ICI myocarditis while pursuing workup with coronary angiogram, echocardiogram, and/or cardiac MRI, or wait until alternative etiologies have been ruled out?

How do you manage severe cytarabine syndrome in AML patients, manifesting as severe hypotension, fevers, rash, and myalgias?

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?

For patients with incidental findings of venous thromboembolism during workup of a treatable malignancy, how do you approach discontinuation after the treatment is complete?

Would you consider low dose indefinite anticoagulation in any scenario? Any difference in approach between hematological malignancy and solid tum...

How do you approach diagnosis and treatment of HLH/MAS following CAR T-cell therapy?

How is this entity distinct from other secondary HLH entities?

What is the role of local control +/- whole lung irradiation in a patient with relapsed/refractory Ewing sarcoma to the hilum plus multiple lung nodules?

Patient initially achieved CR with VAC-IE with resolution of presumed lung mets and 100% necrosis in LLE primary tumor on BKA. Then was NED again afte...

Would you consider a cycle of EP in a patient with good risk stage IIIB seminoma on BEP but with bleomycin omitted for cycle 3?

Bleomycin omitted due to asymptomatic decline in DLCO

What are best practices for oncologists during the national platinum shortage?

Please specify how your institution is allocating resources now or will be soon.

13 Answers available

What is your surveillance approach for outpatient monitoring of ICI myocarditis?

(i.e. frequency of serial BNP, troponin, cMRI)

Given recent studies investigating ICI myocarditis biomarkers such as Temra CD8+ cells, is there now a growing selection of clinical biomarkers, besides BNP and troponin, being measured routinely in ICI myocarditis cases?

When would you consider tapering glucocorticoids in a patient with ICI-associated myocarditis?

Do you routinely recommend loratadine for pegfilgrastim pain?

How do you mitigate 6-MP-induced GI toxicity in pediatric and AYA patients with leukemia?

What scenario would prophylactic Tocilizumab be considered to prevent Ipilimumab+Nivolumab (immunotherapy) induced toxicity in malignant melanoma?

Would you give doxorubicin and cisplatin for localized chondroblastic osteosarcoma in a patient with prior childhood anthracycline exposure and resultant cardiomyopathy with EF 50%?

What are some alternatives to dexamethasone for brain edema in patients who are allergic, have an intolerance, or refuse the medication?

Would you use a matched sibling donor with a germline heterozygous BRCA1 mutation for stem cell transplant?

Presuming there are no matched unrelated donors.

When do you refer AYA patients with newly diagnosed severe aplastic anemia for transplant?

Would you give a trial of IST first or immediately refer for SCT if the patient has matched siblings?

What is your response to the question, "Is this terminal?"

How do you "have the talk" in a way that is straightforward without emotionally crushing the patient?

8 Answers available

How would you treat an essential-like tremor secondary to tumor (e.g. glioma)?

Is your approach different than that to a primary essential tremor?

For T cell ALL treated in CR (without transplant), how often do you do BM biopsies as part of surveillance, and for how long?

What would you want community oncologists to know when following these patients? Are there any other special issues to follow especially in AYA?

How do you decide between RPLND vs. chemotherapy in patients with Stage IIA mixed germ cell tumor as primary treatment?

When patients develop headaches from luspatercept, do they tend to improve over time?

How can oncologists be more collaborative with palliative care physicians?

How can these interactions be improved?

Would you consider TPO mimetics for chemotherapy induced thrombocytopenia that persists despite dose reductions?

How do you clearly communicate to parents that the main purpose of a phase I trial is to find the best dose of a new drug with the fewest side effects rather than treating the patient's cancer?

There is evidence that parents do not adequately understand the purpose of phase I pediatric cancer trials (Cousino et al., PMID 23071225).

Do you recommend starting an antiplatelet for primary prophylaxis in post splenectomy thrombocytosis given there is some increased risk of venous thrombosis?

If so, what platelet count threshold would you use? Would age impact your decision? Would you do a bone marrow to rule out primary MPD in adults if th...

What is the optimal age at which a patient with sickle cell disease should undergo allogeneic stem cell transplant?

Would you recommend adding a TKI to a pediatric regimen for a AYA B-ALL patient with IKZF1 mutation?

Should high-dose methotrexate be used in the treatment of AYA patients with osteosarcoma?

How would you approach a sarcoma that was initially diagnosed as UPS of the distal femur with groin lymph node spread, resected, and found to have an EWSR1-FLI1 fusion diagnostic of Ewing's on NGS?

What is your treatment approach for a pediatric patient with uterine embryonal rhabdomyosarcoma found after removal of a prolapsing uterine mass, with no evidence of distant metastasis on imaging?

In a patient with HR B ALL and severe pancreatitis due to peg-asparaginase, how do you assess the impact of peg discontinuation on risk of relapse?

For patients not on study, would you consider replacing missed doses of peg with a non-asparaginase based chemotherapy?

Do you switch from imatinib to another TKI in patients with chronic phase CML who develop renal insufficiency?

There are conflicting reports whether it contributes to renal insufficiency. If you do switch, what is your preferred TKI in this scenario?

When treating patients with immune checkpoint inhibitors, do you routinely check markers of endocrinopathies such as TSH/ACTH, or only when a patient has symptoms?

If so, how often do you check these labs?

What are your top takeaways from ASH 2022?

8 Answers available

How do you approach hormone replacement therapy for premenopausal patients following pelvic radiation therapy?

How is your approach different from or similar to those who undergo surgical menopause?

Do you do prophylactic LP/IT chemotherapy in high risk APML prior to starting consolidation?

How would you work up a mildly neutropenic patient (ANC >800) with family history of neutropenia and personal history of occasional mouth sore?

What are indications to order gene mutation studies (e.g. ELANE) and how would it help the patient?

What chemotherapy regimen would you use for a testicular cancer patient in need of BEPx3 but unable to use platinum based chemotherapy regimen due to cochlear implants?

How do you manage prophylactic antimicrobial medications in patients who undergo ATG/cyclosporine/eltrombopag induction for severe aplastic anemia?

What would you recommend within the first year after ATG and thereafter if still maintained on cyclosporine?

What is your approach to BK hemorrhagic cystitis not responding to cidofovir?

Which patients with acute promyelocytic leukemia do you consider maintenance after completing consolidation?

How do you discern whether elevated liver enzymes are from immunotherapy versus chemotherapy when a patient is on combination chemo/immunotherapy?

What would your next line treatment be for a patient previously treated with repeat resection, craniospinal irradiation, and initial cisplatin/vincristine/CCNU with medulloblastoma?

What would be your next treatment for a young adult patient with medulloblastoma refractory to repeat resection, craniospinal irradiation, and initial...

Which chemo regimen, if any, would you use as adjuvant treatment in a young patient with primary malignant thyroid teratoma?

Would surgical margins, evidence of angiolymphatic spread, number of lymph nodes removed during surgery inform your decision?

Should post-transplant cyclophosphamide be utilized for all matched unrelated donor peripheral blood stem cell transplants for hematologic malignancy?

If not, how do you choose GVHD prophylaxis regimen? Is there a preference?

What is your approach to adjuvant treatment for stage IA small cell carcinoma of the ovary, hypercalcemic type, after fertility sparing surgical staging?

How would you approach cytopenias 5 weeks after initial dosing in a young patient with MDS treated with Azacitadine as a bridge to transplant?

E.g. would you dose-reduce or continue at same dose? Baseline ANC was in the normal range

When do you refer patients for germline testing when somatic tumor testing is negative for actionable mutations?

How reliable is somatic testing to detect an underlying germline predisposition?

Is cross reactivity low enough to try cisplatin as an alternative for patients who experience hypersensitivity reaction to carboplatin?

Is skin testing advised prior to trialing alternative?

How would you approach an early stage II unfavorable Hodgkins lymphoma following 6 cycles ABVD with persistent Deauville 5 with negative biopsy?

iPET2 and iPET4 showed Deauville 5 response. CT biopsy after 4 cycles was negative. Patient is currently scheduled for 2 additional cycles of ABVD.

How would you treat a locally-recurrent extraosseous (pulmonary) Ewing sarcoma?

Ewing sarcoma of the right lung, status post bi-lobectomy and adjuvant VDC/IE, with recurrence 6 years in the right lung only. He has reached a cumula...

What is your approach in a fit patient, advanced stage, bulky classical Hodgkin lymphoma who has decreased disease burden in areas but a persistent, hypermetabolic (Deauville 5) anterior mediastinal mass following two cycles of AAVD?

What are your recommendations for a male patient who was recently started on imatinib and wants to conceive?

What is your institutional approach to a restrictive “neutropenic diet”?

How would you work up and manage persistent lymphopenia in an asymptomatic patient?

ALC<200

What is the benefit of cytoreduction with Hydroxyurea for patients with newly diagnosed chronic phase CML with a WBC count >100 prior to the initiation of a TKI?

How do you manage AEDs in patients with malignant brain tumors?

Do you ever add prophylactic Keppra (levetiracetam) for glioblastoma patients without a seizure history based on data such as this study (nature.com) ...

What is your first line of therapy for refractory Hodgkin lymphoma in an AYA patient?

How do you manage a patient with a history of high-risk leukemia who has increasing loss of donor chimerism in the post-transplant setting in the absence of disease relapse?

How does graft function play into your decision making? How do you utilize post allogeneic transplant chimerism in clinical practice? Do you obta...

At what platelet count would you feel comfortable dosing aspirin 81 mg for coronary artery disease in a patient with ITP?

Presuming strong indication for ASA - eg history of NSTEMI

How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?

Is there any benefit to transplant patients with Ph+ ALL who have achieved MRD-negativity?

How do you manage insomnia in cancer patients that is refractory to traditional sleep aides?

In patients who continue to have insomnia despite diphenhydramine, benzos, and trazodone, are there other evidence based treatments that are helpful?

How do you manage real-time release of pathology and radiology results to oncology patients following enaction of the CURES act?

Do you routinely offer antiviral prophylaxis for patients receiving chemoimmunotherapy?

If so, what regimen do you utilize?

In a patient with stage 1 mixed germ cell tumor who cleared tumor markers post-orchiectomy but with subsequent rise to borderline abnormal within 6 weeks, would you treat with 3 cycles BEP as for S1 disease?

If serum markers were normal, how strongly do you consider 1 cycle of BEP for embryonal predominant pathology?

How do you manage patients with chemotherapy-induced paronychia?

For a young male with Stage III intermediate risk NSGCT with active 1 ppd smoking history but normal PFTs and DLCO results, would you still consider use of BEP x 4?

VIP can be considered, but given complex psychosocial issues and limited community cancer treatment resources, this question is being asked.

Are there best practices or data regarding the use of open notes among oncology patients?

What is the impact among patients and providers? Has your documentation been adjusted now that patients can readily review?

How do you approach heparin management in patients who have suprathetherapeutic Xa levels on minimal heparin?

Do you treat stage 1 non-seminoma differently if there is a component of embryonal carcinoma?

Do you routinely check Pulmonary function testing prior to each cycle of BEP for young patients with testicular cancer with no pulmonary risk factors?

NCCN guidelines state check at baseline and then as clinically indicated. Some other sources state, can check prior to each cycle of BEP? What ...

How do you incorporate denosumab into the surgical management of giant cell tumor of bone?

Does the degree of resectability affect your management?

Do you recommend routine use of Evusheld for pre-exposure prophylaxis for patients on immunosuppression?

Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?

How do you manage drug-induced thrombocytopenia when the implicated drug is essential?

e.g. DITP from eptifibatide after a cardiac intervention

For treatment of ITP, what would you add to dexamethasone to achieve the fastest recovery in a patient waiting for a procedure?

IVIG, TPO, or other agents?

How do you approach therapy for a patient with stage IIIA NSGCT who received 4 cycles of EP followed by RPLND which revealed residual mixed teratoma and embryonal carcinoma?

Given persistent embryonal histology on RPLND, do you favor observation or TIP/VIP? What do you use to guide your decision?

What features help distinguish thyroid myopathy from immune checkpoint inhibitor-associated myopathy?

Would you change chemotherapy to VIP in a young patient with stage IIIB intermediate risk non-seminomatous germ cell tumor with borderline DLCO after one cycle of BEP?

How would you treat a young patient with classical intermediate-risk Hodgkin lymphoma who has an underlying DNA repair-deficiency disorder, such as congenital mismatch repair disorder or ataxia telangiectasia?

How does your treatment approach vary depending on the underlying predisposition?

How do you approach relapsed idiopathic HLH?

How will you use Pola-R-CHP in the frontline treatment of DLBCL?

Given the POLARIX study data presented at ASH 2021, will this replace R-CHOP as the standard of care therapy in your practice? If not, how will y...

What are contraindications for growth factors in patients with hematologic malignancies?

Do you routinely check platelet counts after COVID-19 vaccines in patients with chronic ITP?

How do you manage a patient with superficial venous thrombosis with close proximity (<3 cm) to deep veins and an inherited thrombophilia ?

Would you offer indefinite anticoagulation if the event is unprovoked and the patient has low bleeding risk?

Is there experience/reports of using voxelotor in sickle cell patients who are Jehovah Witnesses with few crises but who have fatigue and/or dyspnea?

Also is there value in using voxelotor for the purpose of reducing hemolysis, and if so what parameters do you use to determine when to initiate voxel...

What is your preferred approach for patients with anti-phospholipid syndrome with recurrent thrombosis on coumadin and LMWH?

How would you approach moderate neutropenia (ANC < 1000) in a solid organ transplant recipient?

Is there a particular sequence you would adjust contributing antirejection or antimicrobial medications? Is the use of G-CSF appropriate and at what c...

What is the role of hydroxyurea in variant sickle cell genotypes?

Hydroxyurea is demonstrated to reduce complications and improve long-term outcomes in severe genotypes HbSS and sickle beta0 thalassemia. What clinica...

In what circumstances would you give G-CSF to a patient with severe neutropenia and HLH?

How do you approach conversations regarding discontinuation of transfusions in patients with advanced hematologic malignancies who are otherwise appropriate for hospice?

Are there other supportive care interventions that would otherwise be covered by hospice?

Do you utilize D-dimer to inform anticoagulation duration in the treatment of VTE?

Provoked or unprovoked VTE: Do you use D-Dimer (or even repeat imaging to reassess residual clot) in any capacity to guide anticoagulation duration? E...

How would you manage VTE in a patient with bleeding disorder such as hemophilia?

Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?

How long should patients treated with frontline therapy for Hodgkin lymphoma wait before attempting to conceive a child?

Do your recommendations differ between those who receive ABVD and escalated BEACOPP? Do you recommend consultation with fertility specialists for all...

What regimen would you offer a young patient with T-cell ALL who recurred a short time after allo-transplant and was initially treated with CALGB10403?

Especially with the current drug shortage of nelarabine.

Would you start TKI therapy in a patient with new diagnosis of T-ALL without BCR-ABL gene rearrangement on FISH but found to have very low level p190 transcript on RT-PCR?

How do you approach management of sickle cell patients who mistrust Western medicine and prefer naturopathic therapies?

While building a trusting patient-physician relationship, what therapies could be discussed that may be aligned with naturopathic medicine? (i.e. L-gl...

How would you manage asymptomatic brain metastases from testicular non-seminomatous germ cell tumor with a choriocarcinomatous component?

In which patients with oncologic or hematologic disorders are you recommending a 3rd dose of mRNA COVID vaccine?

How do you approach treatment of a glioblastoma in pregnancy?

Do you use premedications (acetaminophen, diphenhydramine) before pRBC and plt transfusions to prevent febrile nonhemolytic transfusion reactions and allergic reactions?

Does manipulation of blood products (leukoreduction, irradiated) affect your approach? There is growing evidence that routine premedication (at least ...

What is the utility of immunotherapy in management of malignant peripheral nerve sheath tumors?

In particular, is there any data on the efficacy of Ipilimumab/Nivolumab?

Under what circumstances would you consider anticoagulation in a young female patient with persistently elevated factor XI activity?

While this is a known risk factor for venous [Meijers et al NEJM 2000] and potentially arterial [Yang et al, Am J Clin Pathol 2006] thrombosis, it is ...

How would you optimally manage a patient with a MDS/MPN overlap syndrome who has both transfusion-dependent anemia and marked thrombocytosis?

Would this change with someone who has a history of thrombosis (e.g. DVT/PE, MI, CVA)? Would this change with someone who is more fit vs more frail?

Do you think there is any compelling data to support giving brentuximab as frontline therapy for pediatric patients with Hodgkin lymphoma?

Results of AHOD1331 are not yet known, but adults have started using Brentuximab upfront for high risk patients

How would you approach immunosuppression for patients with severe aplastic anemia who are not transplant or ATG candidates?

Such as patients who are frail, elderly, renally impaired? Would you consider sirolimus over cyclosporine or tacrolimus for safer nephrotoxicity prof...

How long do you continue caplacizumab in relapsed refractory TTP?

How often do you monitor ADAMTS-13 levels off therapy?

Are there any reasons to consider a prolonged course of steroids with taper over a shorter course of pulsed steroids in the treatment of ITP?

For example, do we prefer one regimen over the other in patients with a bleeding history or who have relapsed after a lengthy remission?

What strategies have you found to be most effective in engaging PCPs in a primary-care or shared-care model of survivorship for pediatric and AYA patients who will receive ongoing care in their communities away from their primary oncology treatment site?

In follow up to @Jacqueline Casillas presentation at ASCO 2021 regarding models of survivorship care delivery for AYA patients.

With new data showing similar outcomes of mismatched unrelated donor and haploidentical related donor allogeneic transplants using post transplant cyclophosphamide, how does one decide which donor is optimal?

If given both options, which donor would one prefer: haploidentical related donor or 7/8 mismatched unrelated donor using post transplant cyclophospha...

How is pediatric and young adult primary bone lymphoma risk stratified?

NCCN guideline V4.2021 DLBCL page BCEL-3 states stage I-II, bulky >= 7.5cm should be treated with 6 cycles of RCHOP, but most bone lymphoma studies...

Would you consider bone marrow transplant in a pediatric patient with recurrent HLH with no identified exogenous trigger or HLH-associated mutation?

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How would you approach chronic isolated severe non-cyclic neutropenia with negative bone marrow and rheumatologic work-up?

Is there a role for empiric antibiotics if there is history of opportunistic infection?

How do you manage cancer treatment-related cognitive change or "chemo brain?"

Are there any effective non-pharm or pharm interventions?

What dose of PEG-asparaginase do you recommend for teens with high BMI treated on a pediatric ALL regimen?

Would you plan straight pediatric dosing using 2500 Units/m2 or a cap of 3750 Units as used in some adult ALL regimens due to excess liver/pancreas to...

How would you treat an advanced stage small-cell carcinoma of the ovary, hypercalcemic type? (SCCOHT)?

s/p optimal debulking. If this was an early-stage cancer would it change your adjuvant therapy recommendations?

What treatment regimen would you recommend for young adults with platinum refractory relapsed germ cell tumors?

How do you approach the use of low-dose aspirin for primary prevention in non-pregnant patients with SLE and positive aPL antibodies, without clinical criteria for APS?

Do you follow the 2019 EULAR Guidelines that SLE patients with asymptomatic, positive aPL should be on low-dose ASA?

Should targeted therapies such as Brentuximab or Crizotinib be used in the upfront management of anaplastic large cell lymphoma in a pediatric or AYA patient?

What is the role of targeted therapy in relapsed/refractory ALK+ anaplastic large cell lymphoma?

Would you use ALK inhibitors such as crizotinib based on recent phase II data? Are there any research efforts to combine ALK inhibitors with current ...

What is the preferred treatment approach for an AYA patient with intermediate to high risk Hodgkin lymphoma: The pediatric approach (ABVE-PC +/- radiation) or the adult approach (ABVD with possible escalation to BEACOPP)?

When can defibrotide be discontinued before the 21-day treatment course is completed in a pediatric patient with SOS?

Do you always treat with the full 21-day treatment course, or can defibrotide be stopped if certain criteria are met sooner?

How do you choose your systemic treatment for primary mediastinal grey zone lymphomas?

Do you prefer a cHL chemotherapy backbone or PMBL chemotherapy backbone?

Should patients receive thrombophilia testing in the setting of a provoked VTE secondary to hormonal therapy/OCPs?

While thrombophilia testing is not routinely recommended prior to starting OCPs, how about after the development of a VTE?

Can an AYA patient with newly diagnosed AML safely sperm bank after starting cytoreduction with hydroxyurea or cytarabine?

Would you offer immunotherapy for recurrent metastatic Ewing sarcoma if the tumor is MSI high or has high TMB?

What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?

Is a patient with secondary myeloid sarcoma a candidate for hematopoietic stem cell transplant?

How would you time COVID-19 vaccination with someone on R-CHOP chemotherapy?

How do you determine when to give a second CAR-T cell infusion to a pediatric or young adult patient with relapsed/refractory ALL?

How would you approach the treatment of patients with von Willebrand disease or hemophilia A previously managed with intranasal DDAVP during the recall?

During the Stimate recall, how are we performing DDAVP challenges for newly diagnosed hemophilia A or von Willebrand disease?

For AYA patients with early-stage Hodgkin's lymphoma being treated with ABVD, how many cycles of chemotherapy do you administer, and when can radiation be avoided?

Have the RAPID or CALGB 5064 studies changed your treatment approach?

How do you counsel patients who are candidates for a clinical trial regarding their options?

Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?

When should a gallium-dotatate scan be incorporated into the initial evaluation of a patient with a carcinoid tumor of the appendix?

What are your thoughts on adding mycophenolate to steroids in the first line treatment of ITP based on the results of the FLIGHT trial?

Presented at ASH: FLIGHT trial

How would you treat an adolescent or young adult with newly diagnosed hepatosplenic T-cell lymphoma?

How do you approach a patient with multiply relapsed germ cell tumor with rising tumor markers but no obvious site of disease?

If standard of care BEP chemo, tandem transplant, and radiation to primary site have been done previously.

For which rituximab infusion reaction symptoms do you consider it safe to re-challenge in the office with adjusted rates and pre-medications?

Do hemoglobin S levels always correlate with SCD phenotype?

What is the lowest level you have seen with uncomplicated or complicated crises?

Do you re-test patients who test positive for COVID-19 during or prior to starting cancer treatment?

There are mixed recommendations about re-testing vs simply waiting for a quarantine period prior to resuming therapy.

How do you manage a young patient with mediastinal nonseminomatous germ cell tumor that has relapsed after primary treatment with four cycles of VIP?

How do you manage VTE in the setting of persistent severe thrombocytopenia?

Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?

Is there any role for direct oral anticoagulants in the treatment of antiphospholipid syndrome?

What if this was "triple-negative" antiphospholipid syndrome?

At what level of bone marrow disease would you agree to proceed with transplant for a patient with refractory AML?

I have heard <20% MRD. What about proceeding if patient is hypoplastic after chemotherapy?

How do you approach the pharmacologic management of cancer-related fatigue?

After optimizing symptoms and reversible factors, and attempting cognitive-behavioral interventions and exercise, do you recommend pharmacologic agent...

How would you approach therapy for a young, fit patient with alveolar rhabdomyosarcoma involving the anterior nasal vault/sinuses in the absence of available clinical trials?

Presented with mass projecting into right/left anterior ethmoid complex

How would you treat a young patient with symptomatic Rosai-Dorfman disease who has recurrent, life-threatening pericardial and pleural effusions?

CT scans show omental and pelvic disease.

How would you approach treatment in an otherwise young, fit patient with transformed AML currently in remission with a plan for transplant and was found to have an invasive fungal infection not amenable to resection upon recovery from induction?

Would you consider “bridging” therapy with something like an HMA?

How would you approach langerhans cell histiocytosis involving a single bone site after resection?

During induction therapy for acute leukemia, when do you decide to discontinue the antimicrobial prophylaxis?

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

What are the options of induction treatment of young AML patients who are on CRRT, continuous renal replacement therapy ?

For pre-menopausal female patients who present with acute leukemia in need of urgent anti-neoplastic therapy, what is your preferred approach in effort to preserve fertility?

Does acute leukemia sub-type affect your decision?

How do you choose first or second-line systemic therapy for fibrolamellar hepatocellular carcinoma?

What are there most evidence-based options?

How do you approach the decision of whether and when to initiate therapy in patients who remain COVID-19 positive >2 weeks after infection but are asymptomatic from the virus?

E.g. a patient with progression of their primary cancer but still is testing COVID19+ over a month after infection?

When during ALL induction therapy are you checking for MRD?

Should we be utilizing prophylactic G-CSF in our patients with intermediate risk of febrile neutropenia due to the COVID-19 pandemic?

Are you placing more weight on patient risk factors such as age >65 or co-morbidities?

How do you counsel patients and caregivers regarding management of cancer-associated cachexia?

What advice do you give regarding dietary practices, feeding tubes / parenteral nutrition, and pharmacotherapy specifically for cachexia?

Is there a Mednet app?

What is your approach to unresectable metastatic rhabdomyosarcoma transformed from an embryonal cell germ cell tumor?

Should treatment be based on current histology (rhabdomyosarcoma) or origin (germ cell)?

Would you hold rituximab for newly diagnosed B-cell lymphoma if the patient is COVID-19 positive?

What if the patient has a history of confirmed COVID-19 but has since recovered?

What treatment would you offer a young pregnant woman with a symptomatic midline low grade glioma?

Discussion of treatment options for midline low-grade glioma causing life-altering symptoms in a pregnant patient to avoid teratogenicity.

How do you determine whether to treat a young adult with stage IA Hodgkin Lymphoma with the adult or pediatric treatment paradigm?

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...

Do you offer fertility preservation to patients prior to CAR-T therapy?

Do you limit it to post-pubertal patients? Do you offer it only if they will proceed with bone marrow transplantation after CAR-T?

How do you treat a patient with a history of clinical stage IIb cN2, mixed germ cell embryonal carcinoma treated with BEP and RPLND five years ago, who now has signet ring cell adenocarcinoma with abdominal carcinomatosis with an unknown primary?

GI work up negative. NGS cancer type and isochromosome 12p ordered and pending. Pathology at RPLND was negative for cancer.

In what situations do you utilize G-CSF in germ cell tumors or Hodgkin lymphoma patients receiving bleomycin?

There are conflicting reports of increased incidence of bleomycin-induced lung toxicity with G-CSF.

How do you decide the right time to transition to hospice?

Obviously, patient and caregiver preferences are paramount. But, what factors do you consider? Does expanded hospice (e.g., Medicare Care Choices) inf...

What chemotherapy would you recommend for a patient with Ewing Sarcoma who has relapsed after being initially treated with vincristine/doxorubicin/ifosfamide?

Are you altering your use of immune checkpoint inhibitors given the risk of immune-related pneumonitis and the COVID-19 outbreak?

How should you manage a COVID-19 infected/suspected patient who is receiving chemotherapy and cannot interrupt or delay their cancer treatment?

In light of promising results of hydroxychloroquine in COVID-19, should we consider using it prophylactically in cancer patients, especially if immunocompromised?

Acknowledging that there is no time for good trials yet in this setting

How should you manage a coronavirus infected/suspected patient who is receiving radiotherapy and cannot interrupt or delay their cancer treatment?

How would you approach a patient who is receiving chemoRT but has confirmed COVID-19 with minor symptoms, as breaking treatment for 2 weeks quarantine...

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Should I wear gloves during a routine physical exam on an asymptomatic patient with no risk factors for COVID-19?

Is there any consensus or guidance on how to manage germ cell tumor patients in the COVID-19 era?

How does the management of nasopharyngeal cancer in kids/young adults differ from adult patients?

-The data on induction for adult H&N ca has been mixed (excluded NPX) but recent data suggest a benefit for adult NPX. -Given that this is standa...

Do you routinely use tumor lysis prophylaxis when starting chemotherapy for germ cell tumors?

How do you assess risk of tumor lysis syndrome, and is hydration sufficient or should hypouricemic agents be used as well?

Is it unusual to have isolated LDH elevation and normal HCG and AFP in non-seminomatous germ cell tumor (embryonal carcinoma)?

In a patient s/p orchiectomy and with pelvic lymphadenopathy, would you consider lymph node biopsy to confirm involvement by non-seminomatous germ cel...

What is the standard of care (if any) for pediatric desmoplastic round cell tumor?

Is there a role for immunotherapy outside of trial setting?

How do you present the trade off between a small chance of a sustained response for a new drug at the expense of potential worsening quality of life?

How do you manage a patient with a history of non-seminomatous germ cell tumor who has a rising AFP after primary chemotherapy without any imaging evidence of recurrence?

Given the non-specific nature of AFP and its elevation in various benign conditions, is there an AFP cutoff level or change over time for which you wo...

For high risk, stage I, non-seminomatous testicular germ cell tumors, are there particular circumstances under which RPLND is clearly preferred over chemotherapy or surveillance?

Is any amount of teratoma or PNET an indication for surgery?

When would you consider testicular RT prior to TBI for BMT?

What dose do you recommend?