Hematologic Malignancies&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?

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

For patients with Stage IIIB or IV HD flowing Bv-AVEPC with initial large mediastinal adenopathy, how can we avoid ISRT?

Per the NCCN guideline for HR HD, if treated per OEPA-COPDAC, you can omit ISRT. This patient received treatment per AHOD1331, which recommends ISRT f...

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 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 would you approach post-operative VTE prophylaxis for renal transplant in patients with a prior history of provoked VTE?

Are there specific guidelines for managing this patient population?

For patients diagnosed with T-cell lymphoblastic lymphoma with CNS involvement (CSF), what is your approach to the typical schedule for IT chemotherapy?

Would you change therapy for a CML patient in hematologic remission on imatinib found with positive qualitative BCR-ABL1 for the p230 protein?

qPCR for BCR/ABL was negative. FISH remained positive.

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...

How do you incorporate blinatumomab into therapy for a pediatric or AYA patient with isolated CNS relapse of B-ALL, if at all?

When would you use proximal complement inhibitors like pegcetacoplan over terminal complement inhibitors for initial treatment of paroxysmal nocturnal hemoglobinuria?

Have you used oral vancomycin as prophylaxis for C difficile infection in patients admitted for allogeneic hematopoietic cell transplant?

Are you including Bortezomib as standard of care in the upfront treatment of T lymphoblastic-lymphoma?

How do you approach delivering ISRT to nodular lymphocyte predominant Hodgkin Lymphoma that has responded on FDG-PET/CT after chemotherapy?

Does the stage at diagnosis affect your decision?

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

Does the use of A+AVD versus ABVD affect your decision for consolidation RT for bulky Hodgkin lymphoma?

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 antibiotic, antifungal and antiviral prophylaxis you give post CAR-T therapy, and what is the duration?

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 address logistic barriers related to blinatumomab when treating relapsed B-ALL?

For example, if patients are unable to receive continuous infusion from home health agencies, or if prolonged hospitalization is cost-prohibitive.&nbs...

How do you manage severe hypertriglyceridemia in the adolescent & young adult population receiving chemotherapy for ALL, in the absence of complications related to hypertriglyceridemia?

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?

Does the presence of asparaginase antibodies on Granger Genetics testing indicate need to switch asparaginase formulations?

In what situations do you use G-CSF for patients undergoing allogeneic HSCT to facilitate engraftment?

How does graft source, conditioning regimen, and indication for transplant affect your decision regarding G-CSF?

For AML patients, when do you stop antiinfective agents?

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

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

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?

For pediatric patients with localized diffuse large B-cell lymphoma being treated per COG ANHL 1131 in group B, do you feel it is necessary to complete all lumbar punctures with IT therapy?

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?

What are your top takeaways from ASH 2023?

7 Answers available

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

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

8 Answers available

For a pediatric patient with B-ALL who requires surgery during maintenance, what therapy modifications do you recommend to allow for optimal healing and minimal treatment disruption?

For a pediatric patient with B-ALL who needs elective surgery during maintenance, what are potential treatment options during the month recommended fo...

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

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

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

What is the role of radiation therapy in recurrent Rosai-Dorfman disease after surgical resection, which manifests as many cutaneous lesions on the arms and buttocks?

Does the fact that the patient is on methotrexate alter your choice?

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

Would you consider post-BMT maintenance therapy for patients with Ph-like ALL with a JAK2 mutation?

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?

Based on recently published data from COG ANHL12P1, how will you use crizotinib in pediatric and AYA patients with ALK+ anaplastic large cell lymphoma?

How would the risk of VTE associated with crizotinib affect your decision? Should we consider using crizotinib in combination with brentuximab?

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?

Do you routinely use G-CSF post-allogeneic transplant for non-haploidentical transplants?

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

Can Hodgkin-like PTLD be treated with Rituximab and weaning of immunosuppression, or is Hodgkin-directed chemotherapy necessary for cure?

Do you check asparaginase levels for all patients receiving receiving E. coli-derived products, or only in certain clinical situations?

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

What is your approach to treating a young adult with severe aplastic anemia unresponsive to steroids and TPO-mimetics?

What would your next line therapy be? If the patient had no matched related or unrelated donors, would you consider haploidentical transplant?

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

Presuming there are no matched unrelated donors.

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?

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

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?

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?

Do you typically see peripheral neuropathy in patients with castleman syndrome?

What are your top takeaways from ASH 2022?

8 Answers available

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

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?

What is the treatment of choice for mixed phenotype ALL?

What are the differences in approach to B lymphoid/myeloid and T lymphoid/myeloid MPAL?

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?

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

What is the role of PD-1 inhibitors in relapsed B-cell ALL?

What is the role of PD-1 inhibitors after CAR-T infusion, either as maintenance therapy or in the setting of relapsed disease?

Is there a role for IL2-receptor antagonists and TNF-alpha inhibitors in cytokine release syndrome as a complication of CAR-T or immunotherapy?

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.

When using daratumumab in the setting of post-transplant red cell aplasia or post-transplant immune-mediated cytopenias, do you hold the drug for certain ANC parameters?

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”?

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?

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

Which, if any, young/fit intermediate-risk AML patients would you not offer allogeneic transplant to in MRD- CR1?

How do you define bulky disease for Hodgkin's lymphoma which is outside the mediastinum?

Do you use a cutoff of 10 cm? Do you measure the size of the largest node or measure the largest conglomerate or measure the total length of the entir...

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...

What criteria is needed in relapsed/refractory B-cell ALL to choose CAR-T therapy over conventional stem cell transplant as destination therapy?

When would you consider additional testing for NUDT15 and other polymorphisms related to 6-MP/6-TG metabolism, if not guided by a study protocol?

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

What is your approach to pediatric or AYA patients with B-cell ALL who relapse after CD-19 CAR-T?

How do you approach IVIG replacement for pediatric patients with low IgG during treatment for hematologic malignancies?

Do you routinely check IgG levels during therapy, if not indicated by a study protocol?

Do you routinely offer antiviral prophylaxis for patients receiving chemoimmunotherapy?

If so, what regimen do you utilize?

Does R-CHOP provide durable remission in low-risk pediatric Burkitt or Burkitt-like lymphoma?

How do you interpret a Deauville score of 3 on PET when performing mid-treatment assessments in patients with Hodgkin lymphoma?

Are there situations in which a Deauville 3 would cause you to escalate therapy?

How would you treat a pediatric or AYA patient with Ph-like ALL with induction failure?

When would you consider an umbilical cord blood transplant over a haploidentical transplant with post-transplant cyclophosphamide, or using a desensitization protocol for high donor-specific antibodies?

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 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?

Is there a role for radiation therapy in the treatment of a lymphoproliferative disorder involving the orbit?

If so, what dose and fractionation would you recommend?

What is the typical time course of cytopenias after CAR-T therapy, and how do you treat them?

What is your escalation strategy for chronic GvHD?

How does belumosudil now fit in your approach to steroid refractory chronic graft-versus-host disease?

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?

When is a lumbar puncture indicated in a lymphoma staging work up for a pediatric or AYA patient?

Is an LP only recommended in the setting of particular subtypes of lymphoma or symptoms of CNS disease?

What is the role of upfront addition of an ALK inhibitor in an ALK positive mature B Cell lymphoma in an AYA patient?

What is the preferred treatment regimen for an adolescent or young adult patient with treatment-related AML?

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?

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

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?

What is the preferred regimen for AYA patients with T-Cell Lymphoblastic Lymphoma?

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

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...

What is the current opinion on G-CSF usage for AML patients during induction and consolidation phases of treatment?

It used to be a contraindication for G-CSF use for AML patients, but currently, several protocols include it to decrease neutropenic duration.

Should a teenager diagnosed with CML in blast crisis go to transplant once MRD is negative?

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?

Would you recommend hematopoietic stem cell transplant for AYAs with Ph-like ALL?

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?

What is your approach for salvage therapy in a patient with Relapsed/Refractory Primary Mediastinal B-Cell Lymphoma that has received a Rituximab-containing upfront regimen?

Is dexrazoxane recommended for cardioprotection in AYA patients with Hodgkin lymphoma who are receiving anthracyclines as part of their upfront therapy?

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 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?

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

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

How do you choose between blinatumomab and CAR-T cell therapy for relapsed or refractory pre B- ALL?

How do you incorporate next gen sequencing results into your management of pediatric patients with B-ALL who have not been transplanted?

With the new COG leukemia studies, it is difficult to interpret these results in the context of their clinical status and conventional MRD

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?

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?

When during ALL induction therapy are you checking for MRD?

Would you recommend prophylactic cranial irradiation (PCI) for a teenager with a T cell acute lymphoblastic leukemia in remission?

If so, what dose would you recommend?

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 have preferred regimens for young patients (<30 y/o) with early stage DLBCL?

Guidelines indicate RCHOPx3 +RT as category I and RCHOP x 6 below that; long term f/u for SWOG 8736 showed similar PFS and OS. Do you have and approac...

When would you consider treating a testicular relapse with definitive radiation in a child with ALL?

What is the risk of breast cancer that you quote to young women with early stage Hodgkin's lymphoma receiving involved field/site radiation therapy?

We often see young women with favorable, early stage disease in the mediastinum who have had a complete response to chemotherapy. With current smaller...

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

What dose do you recommend?

How would you treat a pediatric patient with Stage IVB Hodkin lymphoma who still has persistent PET+ disease after dose-escalated chemotherapy?

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...

Do you omit consolidative RT in pediatric patients with intermediate risk, non-bulky Hodgkin lymphoma who have a rapid early response to chemotherapy?

Are the results of AHOD0031 practice changing?

Is it acceptable to treat pediatric Hodgkin's lymphoma with an involved nodal field outside the setting of a clinical trial?

Is it preferable to simulate pediatric Hodgkin's lymphoma patients with arms up or akimbo?

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.