Hematologic Malignancies   

Questions discussed in this category



Ropeginterferon is now a preferred therapy for Polycythemia Vera (PV) as per a recent update to the NCCN guidelines.

If a patient had a high dose of radiation to the spleen (10 Gy over 5 fractions) over a year ago but with increasing splenomegaly now, would you consi...

Patient in their 60s with TP53 mutation by NGS, treated 12 years ago with FCR, then at first relapse 2 years ago started ibrutinib. Bone marrow biopsy...

Most would argue that gain(1q) in combination with another high-risk feature constitutes ultra-high-risk multiple myeloma, and most would argue (with ...

The OS benefit with Zometa was seen only in patients with myeloma bone disease achieving less than or equal to a partial response. SRE risk reduction ...

For many clinical trials, a screening bone marrow biopsy is necessary to get a new baseline. Do you do the same in real-world practice?

Previous questions have focused on the newly diagnosed setting and choice of bisphosphonate versus denosumab. IMWG guidelines do recommend resuming zo...

Given pelvic RT is likely to induce ovarian dysfunction/menopause, would you consider systemic options?

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

What does it add beyond a serum electrophoresis or light chain testing? Are there certain types of patients where monitoring immunoglobulins is parti...

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

What field design and dosing is most appropriate? Would you use ISRT or a more extended field? 

Patient developed atrial fibrillation on Ibrutinib, severe fatigue and intolerance to Zanubrutinib and a maculopapular rash (grade 2) on Acalabrutinib

If yes, would you go with Zidovudine monotherapy versus combining with interferon-alpha? And what would be the preferred dose and duration? 

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...

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

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

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

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

Transplant is not part of the trial but is the standard outside of the trial. A041501 is a phase III trial to evaluate the efficacy of the addition of...

For example, how do you address tendency to "over-order" these tests in patients with common aches/pains but no structural abnormalities on advanced i...

Please assume that IVIG is fine (as it is for many Jehovah's Witness patients, since IgG is often not considered a blood product per se).

Would you consider this de novo DLBCL (unable to assess for clonality)? How would you handle prior anthracycline exposure? 

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

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

Given CPX-351 was given to elderly patients ages 60-75 with a lower dose (60 mg/m2) Daunorubicin, can one generalize from this study to younger adults...

Would you transplant a patient over the age of 70 with newly diagnosed myeloma? Does the risk category impact your decision?

Would you follow an algorithm such as the one proposed by Hall et al., PMID 29940062?How do you decide between intrathecal chemotherapy vs systemic th...

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

Initial tumor size:18 cm. Partial response was achieved after cycle 2 and cycle 6 of chemotherapy. Complete response (Deauville 2, size: 6 cm) was ach...

E.g., for a patient with myeloma, s/p induction therapy, and high-dose chemotherapy, followed by autologous rescue with inappropriate antibody respons...

Is the therapeutic purpose of the proteasome inhibitor to maximize total dosage per week or number of infusions per week?

Work-up was performed for isolated anemia which resolved to >11 g/dl after the reversible cause was treated.

Would your management be different in node + vs. node - patients? What would be your radiation volume and dose?

Are you concerned about cases where radiation has to be started urgently before leukapheresis?

In a patient who relapsed following 2nd line transplant, how do you select CAR-T vs bispecifics vs non-T-cell-mediated therapies as outlined in NCCN? ...

Do you speak to different expectations re: ability to achieve PR/CR and/or how this will impact ability to get to later therapies for a patient with p...

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

If the mesentery is widely involved with small lesions would this change your management? What if the patient was symptomatic? 

If there are light chain deposits on the kidney, is that conclusive of MGRS?

What influences your decision to proceed with palliative vs. definitive, and standard vs. hypofractionation dosing regimens?

Triplet v. Quadruplet? Do you opt for VRd, DaraRD, CyBorD, Dara-RVd or another regimen?  How would this change for a patient with high risk cyt...

This question seems quite specific but happens quite often. Multi-drug chemotherapy runs the risk of profound cytopenias and infections, while bispeci...

Are there characteristics which could help identify whether a follicular lymphoma might behave more indolently vs aggressively and inform treatment se...

How many cycles of systemic therapy is recommended? is XRT needed and what XRT dose is recommended?

How frequently and what type of testing/sample are you performing MRD assessment? Does your approach differ between transplant-eligible and transplan...

Are you more inclined to use non cytotoxic regimens such as R2 or PI3K inhibitors?

Do you utilize rituximab or any other specific management strategies?

What XRT dose do you use? Does the location of the disease (e.g., mediastinum) affect your decision when taking toxicity into account? would you offer...

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

Would you prefer CAR-T or bi-specific or neither? If CAR-T, how do you approach lymphodepletion? 

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

Several patients with inability to access oral cyclophosphamide or lenalidomide, have attempted assistance and grants to no avail.

Given recent retrospective study showing potential lack of benefit with bortezomib-based maintenance therapy (Bumma et al., PMID 37021929).High-risk a...

Which PI and at what dosing intervals? Dexamethasone or not? Emory has now published data with VRd consolidation as well as KPd consolidation, while ...

Do next generation sequencing results influence diagnostic and therapeutic decisions for patients with MDS?

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?

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

Assuming there is clear laboratory and/or imaging evidence of disease progression, and assuming FISH data is already available from a prior biopsy, do...

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

Patient with stable disease on maintenance therapy with lenalidomide and dexamethasone

240-300 mg/m2 prior exposure. How would your management change in young fit/older individuals with comorbidities? Would you obtain interval TTE during...

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...

Do you worry about their marrow reserve and response to neulasta in terms of lymphocytosis and decreased ANC response?

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

E.g. in a patient with tenuous cardiac function, would starting treatment several weeks earlier potentially improve outcomes?

The patient has also acquired mutations in BCR-ABL, namely p.Met244Val, (c.730A>G); 3.7%, which may confer resistance, and p.Phe359Cys, (c.1076T>...

This is an adult patient that is status-post orchiectomy and R-CHOP now requiring prophylactic contralateral testicular radiation. Would you recommend...

Good performance score, 7 cm in size, CSF cytology is negative, MRI complete spine is negative. Would you consider any additional systemic therapy mod...

Elderly patient with large fungating necrotic breast mass positive for high grade BCL and a solitary hypermetabolic ipsilateral axillary node. Medical...

Would you continue ibrutinib even if they are placed on anti-platelet therapy such as clopidogrel or ticagrelor? When do you switch to an altern...

Do you incorporate PEG-asparaginase or brentuximab vedotin (for CD30-expressing malignant cells) into anthracycline-based induction regimens? Do you c...

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...

It is understood that the trial's experience was to keep on treatment indefinitely until progression or unacceptable toxicity. We are asking about rea...

How would your choice of therapy differ (if at all) for high vs low risk disease? Would the specific anti-platelet agents used influence your choice ...

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

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

Does your treatment approach differ from Waldenstrom's Macroglobulinemia? Does the presence/absence of a MYD88 L265P and/or CXCR4 mutation change you...

If tolerated through Cycle #1, how aggressively do you try to titrate the selinexor dose up toward 100mg weekly or 80mg twice-weekly? And does your a...

How do you generally think about sequencing treatment among available options? Would your choice be affected by a patient's eligibility for transplan...

Do you have a certain immunoglobulin level which you would use to determine this?

If so, how do you incorporate GCSF into treatment of these patients?

When would you treat the entire orbit versus partial orbit? One patient has medial rectus involvement and another has only conjunctival involvement. I...

What VAF burden would be considered significant prognostically or for treatment decisions?

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

Are there particular indications you use for RT? i.e. multiply recurrent, refractory to other therapies, near critical structures, unresectable (or re...

How much weight do you give to a hgb/hct threshold versus symptoms?

Are there agents (eg. bendamustine) or modalities to avoid? Does washout times prior to collection vary between modalities?

Please specify your approach in elective and emergency surgical situations

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

E.g. a patient with monoclonal protein with mild light chain ratio elevation. Do we need to get a BM biopsy in all such patients?

In this case, the patient had received daratumumab/lenalidomide/dexamethasone as part of a cooperative group trial. Would you say that the patient had...

Other than in the setting of disease progression or significant treatment-related adverse event?

Does your answer change based on clinical or molecular risk factors, and if so how? Does your answer change if MRD status after induction is unknown?

Infection is not part of the criteria for starting treatment both in UpToDate and in NCCN guidelines. 

How do you determine whether to add intrathecal chemotherapy in patients with +CSF? Would your approach change for primary vs secondary CNS lymphoma?

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

Would you treat as bulky or non-bulky? Is ISRT indicated? Biopsy was performed because there was concern for soft tissue sarcoma. 

How do you assess if a patient may be a candidate for CAR-T cell therapy?

When is this discussed? What are the common/less common toxicities you advise patients on? Are there best practices for coordination with referring on...

Given the results of ZUMA-7, TRANSFORM, and BELINDA - how does this inform your current practice? What are the currently approved indications for CAR-...

Does the safety profile impact your choice significantly? Does your first choice vary by disease histology?

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...

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...

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...

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...

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

What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice? ...

Does a progressing kappa/lambda ratio > 100 at any point in time warrant treatment, or does one wait to treat patients in the setting of a slowly i...

Peripheral blood flow shows prominent NK cell population but marrow aspiration/bx shows normocellular marrow with trilineage hematopoiesis. 

Frailty Index per Palumbo et al. PMID 25628469Is it practical to apply in clinics? Have you made decision changes based on it?

Venetoclax has demonstrated efficacy in patients harboring t(11;14) mutations but is not FDA approved for MM. Can you expand on what situations you ma...

i.e. treatment-refractory PV, prior to progression to PMF or AML

Are the early results of CASSIOPEIA (Abst 8003) from ASCO 2019 practice changing? What about the GRIFFIN results in 2020?

Do you modify the aspirin dose based off the lenalidomide dose? Do you ever use higher dose aspirin in lieu of an anticoagulant? The NCCN guidelines s...

Would 5000 cGy ISRT be appropriate?  Would you include the entire maxilla to 3000 cGy and cone down or just treat the post incisional biopsy site...

For example: shorten IMiD duration each cycle, add scheduled G-CSF, add antibacterial prophylaxis, etc.

If the plasmacytoma was originally limited to the femoral neck, is it necessary to cover the entire femur out of concern for marrow space involvement?

CAR-T (any specific preference of product?) vs bispecific antibodies vs any other specific agents not previously utilized?

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...

In situations when we are waiting for insurance clearance or due to other logistical reasons. 

Plasmacytoma of 6th rib s/p resection. Negative multiple myeloma work-up.

Would the presence of JAK2 versus CALR versus MPL influence this decision? What if there are other risk factors for cardiovascular disease?

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

After 3-4 cycles of RVD, would you automatically take the patient to transplant if he has achieved at least a partial response, or is there any benefi...

NCCN only recommends palliative ISRT for non-transplant eligible patients with refractory/relapsed DLBCL

Patient in mid-30s with no major medical history presented with isolated left neck swelling. Incisional biopsy w/ HTLV1/2 associated ATLL, Ki67 of >...

Can you expand on this by sharing exactly what this routine workup should include? What additional tests outside of evaluating for POEMS and amyloidos...

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

Would you move straight to second-line systemic therapy or first attempt consolidative ISRT/boost, or employ both? Assume node is biopsy-proven. 

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

Does this data change your preferred first line treatment regimens when considering other options such as mAb combos, cytotoxic chemotherapy?

Is the non-inferiority margin of 1.429 sufficient, how was this selected? Is the open label (rather than blinded) study design of any concern? Is th...

Can experts comment on fungal pneumonia risk with individual BTK inhibitors as seen in ELEVATE-RR and whether this impacts their management decisions?

Do you feel comfortable with BTK inhibitors in these patients? In ELEVATE-RR patients on a/c were excluded, and rate of atrial fibrillation in the ac...

In the case of subtle single lineage dysplasia with normal cytogenetics, do you routinely perform NGS testing for CHIP-type clonal mutations? Do you ...

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

If the patient has received RCHOPx3 and the post treatment PET is negative, what would your management be?

If yes would you delay initiation of antineoplastic therapy to allow time for the vaccine to start acting?

Would your recommendation change based on grade and/or location (weight-bearing vs non weight-bearing bone)? 

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

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?

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

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?

Should systemic therapy or ISRT be utilized?   Is there a risk for intrabdominal spread with perforation? If the ulcer is repaired by simple...

Would you consider ISRT after 3 cycles of RCHOP, omit radiation and proceed to surgery after 6 cycles of RCHOP, or do something else?

Specifically, would you consolidate initially bulky sites or allow patient to proceed to next line systemic therapy / transplant? 

How is this impacted by patient features, cytogenetics/disease biology, depth of response, or other factors? What would compel you to continue 3 drugs...

How do you factor in patient age, frailty, patients with underlying organ dysfunction, or other clinical features? Do you still consider CyBorD or R...

In your experience, do certain regimens have more cumulative toxicity, financial impact, or patient convenience factors?

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

The patient was started immediately on chemotherapy due to gastric bleed and scrotal irradiation is planned.

Are there scenarios where you would use a higher dose of lenalidomide in a novel doublet or triplet (eg. relapse on lenalidomide maintenance)?

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

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...

When would you consider utilizing autologous SCT in those with a PR or SD? Is there a potential role for BCMA-directed CAR-T or bispecific therapy in...

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 ...

How do you distinguish this entity from other plasma cell disorders (eg. MGUS, MM, etc.)?   Review of literature suggests that most of these pa...

Are there any subsets of patients that you're more inclined to offer maintenance?

The patient in question has Stage IIIA DLBCL with a CR after 6 cycles R-CHOP. When would you treat the involved tonsil?

PET/CT negative for any other sites of metastatic disease. Focal activity noted on PET (postop changes?). CSF negative. Bone marrow biopsy negative. 2...

What regimens would you consider combining it with? Any specific combinations to avoid or special considerations?

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

Is Ommaya placement with CNS-directed therapy preferred to intrathecal or cranial irradiation? How do you interweave this therapy with systemic therap...

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

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 recommendation change based on whether the patient has one or multiple lesions? 

Would you use R-CHOP or a more intensive chemotherapy regimen?  Would you consolidate with radiation therapy after 3 cycles or use systemic thera...

The current NCCN guideline version 2.2021 is a little confusing. On page HODG-2,  the clinical staging/risk classification did not include ESR, b...

Does your recommendation differ between autologous and allogeneic transplants? Does your recommendation differ in allogeneic transplant recipients wh...

Would you offer refractory doses (40-50 Gy) to the RPnodes and send for splenectomy? Or would you offer refractory doses to both RP nodes and spleen?&...

Patient was previously well controlled on methotrexate, which was discontinued during cancer treatment.

Does your management change based on the type of end-organ involvement at the time of diagnosis? Are there any reports of CNS involvement with non-se...

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

Do you use specific tools or take into account certain factors when considering treatment options for older adults?

Are there particular mutations (eg SF3B1) or syndromes (eg MDS/MPN overlaps such as MDS/MPN-RS-T) where you are more apt to using lenalidomide?

For example, in a patient treated with multiple systemic therapies over ~10 years, would it be reasonable to use radiation to a single asymptomatic si...

If so, what is your time threshold for when you'll start PCP prophylaxis--when you anticipate steroid courses greater than 1 week? 1 month? 3 months?&...

An otherwise healthy patient with spleen only diffuse large B cell lymphoma with mild spleenomegaly, Spleenectomy plus Rchop or Rchop plus RT? 

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...

Bulky adenopathy compressed bilateral ureters, CrCl < 30, post stent placement, but renal function has plateaued

Individuals with MPNs may be at higher risk for thrombosis and be placed on antiplatelet therapy or even anticoagulation because of prior thrombosis. ...

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

In this scenario, is systemic treatment better given bilateral involvement? In a patient who has already had cataract surgery and is not at risk for c...

 Does your dose recommendation change if a patient has cord compression or has undergone surgery? There is a range of doses in the ILROG guidelin...

Is there any data justifying the use of systemic therapy over localized therapy (e.g. radiation or surgery) in this situation prior to a progression e...

Do you only give intrathecal chemotherapy or systemic therapy?

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

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

At what point would you recommend transfusion? At what point would you stop radiation?

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

The patient received R-EPOCH followed by consolidative RT (36 Gy in 18 fractions) approximately one year ago and was subsequently salvaged with RICE.

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?

There seems to be a wide variety of palliative doses used in clinical practice (8 Gy x 1, 2 Gy x2, and 20 Gy in 10 fx).  Do you have a preferred ...

Would your approach change based on the type of reaction (eg. Stevens-Johnson syndrome vs DRESS)? How would you address maintenance (if any) post-tra...

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...

The unfavorable risk factors for stage I-II Classic Hodgkin's Lymphoma differ depending on the cooperative group (GHSG, EORTC, NCCN), which criteria d...

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

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...

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...

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...

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

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

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?

The patient is not a transplant candidate due to multiple co-morbidities. Some of the sites in question have had a complete response and other have ha...

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...

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.

If the breast was previously radiated 15 years ago, would that change your decision?  If there was residual lymphoma on cytology of a chronic se...

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...

Would you recommend RCHOP x 3-6 or RCHOP x 3 + ISRT?  If you end up doing ISRT, would your target be any different than the principles that guide...

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...

Is your scoring based on SUV uptake vs the subjective interpretation of the radiologist? How do you go about reconciling Deauville scoring when there ...

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

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?

Repeat EGD and additional biopsies of the stomach were all negative for MALT lymphoma and H. Pylori. A CT of the C/A/P was done showing no evidence of...

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

For example, would you go ahead with 20 Gy of ISRT if medical oncology has already treated a stage I-IIA patient with 2 cycles of ABVD meeting all oth...

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

In a patient who absolutely cannot receive chemotherapy due to impaired performance status, what dose would you use for WBRT and what dose would you u...

Prior trials of systemic therapy including alkylating agents and rituximab have failed and the patient is medically inoperable with no history of Hepa...

The staging bone marrow biopsy was negative. The staging manual simply states "bone involvement is identified using appropriate imaging studies."...

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

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

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

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?

Do you generally always boost the scalp and/or soles even if those sites are not involved with disease?  

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?

The patient had a bilateral orchiectomy (pathology demonstrated no invasion of the tunica) followed by R-CHOP x 6 and IT Mtx with a PET CR in a para-a...

The patient is a 75 yo immunocompetent man who has a history of inverted papilloma of the sinuses and presented with a new lesion in the right maxilla...

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...

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

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

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

The patient does have significant weight loss, drenching night sweats, but no evidence of other involved sites on PET, thorough skin exam, and has nor...

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

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

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

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

Do you follow treatment guidelines for indolent lymphoma or CLL? How do you get 17p testing on someone with only lymphadenopathy?

I have a patient with low volume disease of Castleman's disease with cervical lymphadenopathy and tonsillar hyperplasia that is suspicious but not bio...

If a patient has an increase in PET avidity between the PET/CT done after 2 cycles of ABVD and after completion of chemo, how would you proceed? Would...

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 ...

Does your follow-up differ depending on the dose you used (e.g. boom boom vs. 24 Gy)?  Do you routinely image?  If so, do you use MRI or PET...

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?

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?

If the patient had a CR by PET/CT after 2 cycles of ABVD and received 6 cycles of ABVD would you recommended consolidating only the bulky disease and ...

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

What technique do you use (IMRT vs direct electrons w bolus)?  The ILROG paper on extranodal NHL says "For tumors confined to the conjunctiva or...

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?

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

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...

For example: would you treat the entire Waldeyer's ring?  For a stage II patient who also has cervical lymph node involvement on one side, do you...

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?

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

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?

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

Would you include one vertebral body above and below the involved vertebral body? Is IMRT appropriate in order to reduce dose to small bowel? What oth...

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

If a patient had recently completed R-EPOCH x 6 cycles, would you change your dose for a low grade follicular lymphoma?

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

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

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

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

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

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

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

In drawing the lung blocks approximately 1 cm in from the chest wall, diaphragm and mediastinum, should the blocks stop underneath the clavicle o...

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

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

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

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

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

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

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

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


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