Hematology&nbsp;&nbsp;&nbsp;

How would you manage a patient with history of follicular lymphoma treated with Bendamustine-Rituximab who now has a new FDG avid lesion that is biopsy proven CD30 positive CD20 negative DLBCL?

Does discovery of clonal hematopoiesis on liquid biopsy for solid tumors change your treatment approach in terms of which chemotherapy to offer for the solid tumor?

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...

Would you re-challenge a patient with refractory multiple myeloma with carfilzomib who responded well but developed grade 3 heart failure and subsequently recovered the EF upon holding carfilzomib?

If you do recommend resuming carfilzomib, what dose and frequency would you use?

Do you routinely check for copper deficiency as part of workup for bicytopenia with leukopenia/anemia or pancytopenia?

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

What's the optimal management of stage IA nodal ATLL in a young fit patient?

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

How would you approach a patient with vitreoretinal lymphoma without CNS or systemic involvement?

What would be your RT volumes and dose?

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...

Does cytoreductive therapy in high risk PV reduce thrombotic events because of better normalization of blood counts as compared to phlebotomy, or through some other mechanism?

Are there any circumstances where you consider repeating CT Angiogram Chest after 3-6 months of anticoagulation for pulmonary embolism?

Is prophylactic anticoagulation indicated in patients with frequent ulcerative colitis flares?

If so, what agent(s) do you prefer?

What factors do you look at while deciding between a daratumumab-based quadruplet induction versus standard triplet induction such as VRd for newly diagnosed MM?

For hypogammaglobulinemia as a complication of successful treatment, do you empirically start prophylaxis with either 400 mg/kg monthly for IVIG or 100 mg/kg weekly for subcutaneous immune globulin?

Do you recommend work up for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?

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

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 manage HIT in a patient with high bleeding risk?

e.g. in the setting of using prophylactic heparin in the past but now requiring therapeutic anticoagulation

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...

How do you diagnose sickle hepatopathy?

What is your approach to a patient who has an ischemic stroke while on clopidogrel despite strict compliance and normal results on clopidogrel response assay?

What is your standard workup and treatment for an incidentally-noted splanchnic vein thrombosis?

What is your duration of anticoagulation?

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?

What is your approach to a patient with positive antiphospholipid antibodies who otherwise do not meet clinical criteria for APS?

What if the patient is triple-positive or has continued seropositivity on repeat lab testing? What is the appropriate interval of monitoring and does ...

How would you approach early stage unfavorable classical Hodgkin lymphoma with metabolic CR apart from a single residual positive node after 6 cycles of ABVD?

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

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...

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?

Do you always initiate hypercoagulable work up in a patient with recurrent stroke?

If so, what would you consider ordering?

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?

In your practice, do you usually check MMA and B12 simultaneously or start with B12 levels and check MMA only if indeterminate?

Do you send an antiphospholipid antibody panel routinely for all patients with an unprovoked thrombus?

For young patients with smoldering multiple myeloma who wish to be treated with lenalidomide, how do you go about harvesting their cells for an autologous transplant?

Insurance won't pay for harvesting if the transplant is not done within a year.

Do you recommend COVID vaccination in patients with antiphospholipid antibody positivity or other prothrombotic states not on anti-coagulation?

What factors do you take into account for recommending venetoclax/obtinutuzumab vs BTK inhibitors vs chemotherapy in front line therapy for CLL?

Are there specific clinical, patient, or disease factors you focus on?

Would you extrapolate results from ELEVATE-RR study to favor use of acalabrutinib as first-line therapy in treatment-naive CLL?

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

Do you find ELEVATE-RR data and study design compelling to start preferentially using acalabrutinib over ibrutinib?

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...

Do you routinely offer fungal prophylaxis for patients on BTK inhibitors?

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

What is your approach to CLL in patients with atrial fibrillation and/or on anticoagulation?

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...

Given results of the ELEVATE-RR study, would you consider use of acalabrutinib in all patients with previously treated CLL, or restrict it to certain patient populations?

Such as patients with specific underlying cardiovascular risk factors or other medical comorbidities?

How would you manage a patient with acquired von Willebrand disease who requires DAPT for arterial disease?

In the absence of symptoms would you still treat high risk myelofibrosis if transplant ineligible?

Is leukocytosis and thrombocytosis alone an indication for treatment?

How do you approach the initial dosing of carfilzomib for patients with relapsed multiple myeloma?

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

Would you treat iron deficiency in post PV myelofibrosis if anemia is the predominant concern?

How have you been counseling patients with sickle cell regarding a 3rd COVID vaccine?

In a patient with progressive thrombocytosis but negative MPN mutations on peripheral blood, what are your diagnostic and treatment recommendations?

Do you ever recheck JAK2/CALR/MPL/BCR-ABL? Would you recommend a bone marrow biopsy? Is cytoreductive therapy indicated?

When do you check for EPOR gene mutations in your workup for erythrocytosis, and if found, how do you manage it?

Is there a role for aspirin or hydroxyurea? Do you perform phlebotomy, and if so, what goals?

For frail patients with cardiac co-morbidities and relapsed CLL with high cytogenetic risk, what are some considerations for using continuous acalabrutinib over fixed duration therapies such as venetoclax/rituximab?

How do you diagnose MDS in a patient with equivocal morphological findings?

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 you routinely offer a bisphosphonate or denosumab to multiple myeloma patients without skeletal lesions?

Recommendations in guidelines are discordant (ASCO vs NCCN vs UptoDate).

What hematologic conditions are contraindications for a COVID vaccine?

How would you manage a patient with type 1 cryoglobulinemia secondary to MGUS?

What if the patient is no longer responding to steroids?

Would you use aspirin 81 mg for VTE prophylaxis in patients on adjuvant tamoxifen/SERMs?

Is there data that it actually helps ?

Do you consider low-dose aspirin for primary thromboprophylaxis in patients with high-risk antiphospholipid antibody profiles?

While low-dose aspirin for primary thrombosis prevention in aPL without APS is not typically recommended outside cardiovascular prevention guidelines ...

How do you counsel patients referred for abnormal light chain ratio when individual light chains are in normal range?

What is your preferred maintenance strategy for high risk multiple myeloma?

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 a CLL patient who experienced severe infusion reactions with rituximab and has exhausted all other options?

Is it safe to challenge with other CD20 monoclonal antibodies such as obinutuzumab?

What is the anticoagulation recommendation for a chronic DVT?

How would you approach a young person with JAK2 V617F positive essential thrombocytosis with otherwise low risk features?

Would you get bone marrow biopsy periodically? Would your approach change based off specific age or platelet count?

Would you routinely use G-CSF prophylaxis in a CMML patient for decitabine-related neutropenia?

In the rare setting of enoxaparin injection-induced abdominal wall hematoma in patients requiring long-term anticoagulation, what is your timeline for restarting anticoagulation?

Would appreciate expert opinion on when to reimage and when to restart anticoagulation depending on findings.

Would you require pre-RT dental evaluation and clearance for a patient who is being treated with ISRT to Waldeyer's ring/BOT area to 30 - 36Gy?

Should patients with active multiple myeloma and other gammopathies be routinely vaccinated against herpes zoster?

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

What is the role, if any, for next generation sequencing testing in patients with suspected MPN who test negative for commonly identified mutations such as JAK2, CALR, MPL, and BCR-ABL?

How would you manage symptomatic iron deficiency in patients with PV on frequent phlebotomies?

Is this a reason to start hydrea? Would you give oral iron after adequate control on hydrea?

How would you manage a patient with JAK2-positive PV who is not responding to hydroxyurea or IFN-alpha for cytoreduction?

This is in the setting of a patient who is now on ruxolitinib with rising leukocytosis and thrombocytosis, but cannot be on aspirin due to recent blee...

Do you recommend anticoagulation for a splenic infarct in patients with myelofibrosis and splenomegaly?

What is the maximum pRBC volume you can transfuse when performing a manual exchange transfusion in an adult-sized patient with sickle cell disease?

Do you discontinue anti-hormonal therapy if a high-risk ER+ HER2- localized breast cancer patient develops blood clots on anti-hormonal therapy?

How would you approach a patient who is intolerant of AI and develops thrombosis while on SERM?

What would you recommend for a stage I follicular lymphoma of the bone?

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

How do you approach treatment of vasculitis in a sickle cell disease patient?

There are multiple difficulties that could be seen: steroids can precipitate a sickle cell crisis, vasculitis and sickle cell can produce similar clin...

Would you offer RT to a patient with a stage I low grade follicular lymphoma in the groin/upper thigh (7 cm) s/p complete excision with negative margins?

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

How often should you repeat iron testing in patients with hemochromatosis, not on phlebotomy?

Patient with ferritin level <1000 ng/mL and no evidence of end-organ damage

How soon after a VTE would you feel comfortable with a patient undergoing an elective surgery?

While there are many factors involving:- type (DVT vs PE, unprovoked vs provoked) and severity of venous thromboembolism (VTE) size- duration of antic...

How do you counsel patients with newly diagnosed transplant-ineligible multiple myeloma on the expectations of treatment in terms of disease control, duration of therapy, monitoring and follow up?

How do you approach an isolated T-cell gene arrangement found in the setting of persistent hypereosinophilia?

If all work-up including peripheral flow, bone marrow biopsy, PET-CT returns negative, what additional management (if any) would be recommended?

What level of 24h urine M protein do you consider to define active myeloma in a patient with renal insufficiency, proteinuria and monoclonal gammopathy?

When do you start treatment in this case?

What would be your preferred second line treatment for a frail elderly patient progressing on Rd?

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 ...

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...

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 ...

Would you offer a complement inhibitor to a minimally symptomatic PNH patient with mild non-transfusion dependent hemolytic anemia?

What is your perioperative approach to holding and restarting hydroxyurea in patients with essential thrombocythemia?

Are there any special considerations when evaluating patients with non-malignant hematologic or immunodeficiency disorders for allogeneic transplant?

Are there major differences in standard conditioning and/or GVHD prophylaxis regimens utilized? Does the non-relapse mortality different significantl...

What regimen would you recommend for a younger, fit, transplant eligible patient with relapsed IDH1 positive AML?

With what agents can you replace PPIs if they cause thrombocytopenia?

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?

Should platelet transfusions be considered for anti-platelet agent reversal in patients with major bleeding?

Should assessing for a MTHFR mutation be part of the thrombophilia evaluation in a patient presenting with a thrombus?

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?

Can you use other iron formulations if a patient develops Stevens-Johnson Syndrome with ferumoxytol?

For a patient with MM progressing on a daratumumab-based regimen, is it preferable to entirely switch drug class or is another monoclonal antibody such as isatuximab an acceptable next step?

How do you determine when to use a maintenance regimen vs continuous 3-drug regimen in a transplant-ineligible MM patient after response to first line therapy?

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

What clinical factors impact your upfront treatment decisions in transplant-ineligible MM?

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

How often do you follow ferritin and organ iron-deposition in a patient who has known hereditary hemochromatosis, but no current evidence of iron overload?

e.g. a genetic mutation picked up through a family member

Is there any role for iron chelation in a patient with iatrogenic transfusion-induced iron overload such as in patients with end-stage kidney or liver disease?

Does transplant eligibility make a difference for management?

What is your preferred first line treatment regimen for patients with untreated transplant-ineligible MM?

Do you opt for VRd, DaraRD, CyBorD or another regimen? How would this change for a patient with high risk cytogenetics?

When, if ever, would you choose a two-drug regimen instead of three drug regimen first line in patients with transplant-ineligible Myeloma?

What factors besides disease progression would lead you to de-intensify or change MM therapy for a patient with ongoing response?

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

How do you manage testosterone replacement therapy-induced erythrocytosis?

Do you recommend therapeutic phlebotomy to a certain Hct goal? Any strong evidence for thromboembolic risk related to erythrocytosis or if this is mit...

Do you routinely obtain bone marrow biopsy in newly diagnosed autoimmune hemolytic anemia when working up potential underlying etiologies?

What is the optimal initial therapy and management of Erdheim-Chester disease without actionable mutations such as BRAF or MAPK-ERK pathway alterations?

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.

How does evidence of cerebral amyloid angiopathy/microbleeds affect choices for secondary stroke prevention in patients with a history of ischemic stroke and atrial fibrillation?

How do you approach secondary stroke prevention for patients with ischemic stroke, atrial fibrillation, and signs of cerebral amyloid angiopathy/micro...

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 do you advise a patient with VTE on indefinite anticoagulants regarding the Ad26.COV2.S Johnson & Johnson/Janssen COVID vaccine?

When do you consider re-treatment with lenalidomide in later line therapy for relapsed multiple myeloma?

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

How do you counsel patients on the risk of thromboembolic complications with use of immunotherapy in NSCLC?

Given recent data in Blood (Moik et al, 2021), and the potentially overlapping risks with other clinical factors associated with NSCLC. Will you alte...

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

How do you approach evaluation of pulmonary vein thrombosis?

Is there any difference between anticoagulants in this clinical context (e.g. anti-Xa inhibitors vs warfarin vs LMWH)?

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 often do you monitor thiamine levels in a myelofibrosis patient taking fedratinib?

What further genetic testing would you perform on a pediatric patient with cyclic neutropenia who is negative for the most common associated mutations?

With a strong family history

Do you recommend the use of dexamethasone and anakinra as upfront treatment in a pediatric patient with secondary HLH (nonrheumatic) who is too ill to tolerate etoposide?

This type of etoposide sparing therapy has been previously described in a case series at https://pubmed.ncbi.nlm.nih.gov/32725881/

How do you approach the treatment of drug-induced thrombotic microangiopathy?

When do you consider initiating eculizumab?

Do you consider splenic response as adequate to judge efficacy of JAK2 inhibitors in myeloproliferative disorders?

What is the transfusion management of a sickle cell patient during pregnancy?

What are your target goals during transfusion, either prophylactically or during acute complication? Does your management change between vaginal deliv...

Is there a role for anti-fibrinolytic agents in patients with hyperfibrinolytic disseminated intravascular coagulation?

The use of anti-fibrinolytics is typically contraindicated in DIC, but does it have benefit in DIC states characterized by hyperfibrinolysis?

Is there a role for frontline combination therapy with a hypomethylating agent plus venetoclax for high risk MDS?

Would you consider allogeneic stem cell transplant for a newly diagnosed patient with favorable risk AML who had residual disease after initial therapy that included the need for re-induction?

Is there an absolute IgM level, in an asymptomatic patient on surveillance that initiation of therapy would be considered for Waldenstrom's macroglobulinemia?

Does the rate of progression of IgM influence your decision?

Would you recommend use of ESA for anemia of kidney disease in the setting of metastatic solid tumor malignancy?

What is your approach to platelet transfusion in heparin induced thrombocytopenia?

Does having a concurrent consumptive process e.g. DIC change your management?

Is there a risk of increased side effects with combined radiation and ibrutinib therapy?

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...

How would you manage an incidental catheter-related thrombosis in a functioning dialysis catheter?

- Dialysis catheter used for hemodialysis- RIJ thrombus in dialysis catheter was incidentally found- Patient asymptomatic with no prior history of VTE...

In patients with autoimmune cytopenias, is there any reservation for COVID vaccination?

While benefits outweigh known harms and limited data, do you worry about vaccination in patients with a history of or active autoimmune cytopenias (e....

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?

How would you evaluate a patient with an isolated high RBC count but with a normal hemoglobin and hematocrit?

Would you consider this type of patient as having polycythemia?

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

How do you approach transfusing a patient with sickle cell disease who has a history of hyperhemolysis?

Do you offer maintenance rituximab in transplant ineligible patients with mantle cell lymphoma?

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

When (if ever) do you check for anti-platelet antibodies for workup of thrombocytopenia?

Do you offer iron supplementation to a patient with iron studies that are normal (including normal ferritin) except for low iron saturation?

What is the potential differential diagnoses for low iron saturation?

In patients with a history of HIT, how do you counsel them on the use of the AstraZeneca vaccine given reports of unusual thrombosis and association with PF4/heparin antibodies?

AstraZeneca may cause PF4 antibodies leading to vaccine-induced prothrombotic immune thrombocytopenia (VIPIT).

What additional testing, if any, should be performed for an adolescent patient with heavy menstrual bleeding and a negative von Willebrand disease evaluation?

How do you counsel patients on JAK inhibitors about the risk of venous thromboembolism, MACE, and cancer?

Would you consider use of upfront BV plus nivolumab to treat Hodgkin Lymphoma in elderly patients unable to receive standard chemotherapy?

Are there other regimens you employ for patients unsuitable for standard chemotherapy?

Do you check pertussis serologies when sending labs for antiphospholipid syndrome?

How do you treat a low-grade B-cell lymphoma with plasmacytic differentiation (Waldenstrom's) confined to the CNS?

How would you approach treatment of a bulky stage II DLBCL in a patient >80 with a contraindication to anthracyclines but otherwise good performance status?

In a patient with breakthrough VTE on rivaroxaban, would you switch to apixaban or an agent with a different mechanism of action?

Assuming the patient is a candidate for all anticoagulation options (no mechanical valve, antiphospholipid syndrome, patient-specific contraindication...

Would you consider adding midostaurin to azacitadine in elderly patients with newly diagnosed AML with FLT3-ITD mutations in the frontline setting?

How do you approach therapy for a fit adult with relapsed AML with CNS involvement after allogeneic stem cell transplantation?

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

What would be the ideal patient to receive selinexor-based therapy over other options for penta-refractory multiple myeloma?

Excluding clinical trials

Is there a role for phlebotomy in secondary polycythemia?

Aside from addressing the underlying case, is there a role for phlebotomy in secondary polycythemia such as in COPD or post-renal transplant erythrocy...

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 workup do you perform to evaluate for underlying triggers/associated conditions in a pediatric patient with autoimmune hemolytic anemia?

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...

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?

How would you manage a patient with antiphospholipid syndrome in the setting of severe steroid-refractory thrombocytopenia?

Especially in a triple-positive patient with an acute ischemic stroke who may have urgency for anticoagulation with high bleeding risk and severe thro...

How do you risk stratify complex karyotype in newly diagnosed multiple myeloma in the absence of specific high-risk cytogenetic abnormalities?

Would you initiate chemoimmunotherapy (e.g. RCHOP) in a symptomatic patient with DLBCL who tested positive for COVID19?

How would you manage a stage IE DLBCL of the stomach, non-germinal center type by IHC, and Ki-67 of 70%, but negative for double/triple hit by FISH?

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

Would you ever consider prophylactic anticoagulation in patients with CKD requiring ESA therapy?

While the CKD population is at high thrombotic and bleeding risk, would you consider anticoagulating a patient prophylactically if they had a history ...

How do you treat refractory cold agglutinin disease?

The patient who has not responded to steroids, rituximab/bendamustine, and splenectomy?

Is there a role for prophylactic tranexamic acid in patients with hematologic malignancy with chemotherapy-induced thrombocytopenia?

Would you recommend stem cell transplant or gene therapy for a patient with CML and sickle cell disease currently on imatinib with worsening anemia?

What is the best way to monitor intraoperative heparin use in a patient with factor XII deficiency?

In a patient with severe factor XII deficiency with a baseline prolonged PTT, what is the best method to monitor their ACT or heparin levels when on c...

Does your treatment approach for NK/T cell lymphoma of the nasal cavity differ depending on the volume and extent of disease?

How do you approach systemic therapy options? What are your recommended volumes?

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?

How do you approach patients with a history of lymphoma in remission who are in need of immunosuppressive (e.g. TNF blockers, 6MP) or other therapies (e.g. JAK inhibitors) for autoimmune disease that have been linked with the development of lymphoma?

How do you approach the treatment of ITP in a pregnant patient who did not respond to prednisone?

Would you consider high-dose dexamethasone (deliberating adverse effects of antenatal steroids) or move to next-line therapies?

How can healthcare providers better serve as allies of the sickle cell community?

Has your medical practice taken any steps either in community outreach or within the clinic to show support for this medically vulnerable population, ...

How do you decide between CPX-351 and HMA + Venetoclax in treating transplant eligible AML-MRC?

What could explain discordant iron studies?

For a patient with low ferritin, but high TSAT?

How do you workup erythrocytosis with a normal or elevated serum erythropoietin?

When would you recommend using a DOAC in a pediatric patient with VTE?

Do you generally reduce DOAC dosing for extended anticoagulation in patients with first unprovoked VTE?

Ref: EINSTEIN-CHOICE and AMPLIFY-EXT Would you approach this differently in patients with inherited thrombophilias?

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

Do you account for the effect of coffee on platelet aggregation studies?

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

When are you recommending bone marrow transplant recipients receive the SARS-CoV-2 vaccine?

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

Why are autoantibodies not often detected on monoclonal gammopathy assays (SPEP/IFE, quantitiative immunoglobulins)?

For example, in cold agglutinin disease or AIHA, antibodies can be detected via DAT, but are often not observed on assays for monoclonal gammopathies.

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

How would you manage a patient with Stage IVB DLBCL with refractory disease in the retroperitoneum and spleen after 6 cycles of RCHOP?

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?&...

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?

What is your preferred oral iron formulation and dosing for treatment of iron deficiency anemia?

Are most places administering oral iron as once daily or every other day dosing due to upregulation of hepicidin receptors following oral iron adminis...

Is there an equivalent test for serum viscosity in sickle cell disease?

How many years of oral antibiotics prophylaxis do you recommend for a teenager with hereditary spherocytosis post-splenectomy?

There is no uniform guideline in the literature. AAP recommends until 5 years old or 1-year post-splenectomy. Some for 5 years post-splectomy.

Is there a role for G-CSF treatment for SLE patients with persistent neutropenia?

Do you routinely refer young patients with iron deficiency anemia for GI evaluation?

In low-risk patients (age < 40) or patients with very obvious causes of blood loss or iron deficiency (menorrhagia, pregnancy), do you routinely pe...

How do you approach unresectable or borderline resectable symptomatic nasal/paranasal Rosai-Dorfman disease?

Are there effective therapy options that do not include steroids?

Would you offer rituximab maintenance for 2 years after a successful response to induction in a patient with splenic marginal zone lymphoma?

When do you consider splenectomy? Is there a role for splenic radiation in non-surgical candidates?

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?

Is there any benefit in continuing VRd instead of VR as maintenance therapy in transplant ineligible multiple myeloma?

In which patients with atypical HUS would you consider eculizumab discontinuation?

Given the high cost of eculizumab, are there patient characteristics that inform which patients, if any, should be on indefinite therapy versus a time...

How do you manage a delayed hemolytic transfusion reaction in a patient with sickle cell disease?

How do you manage an uncomplicated DHTFR versus a hyperhemolysis?

How would you approach a patient presenting with pancytopenia and splenomegaly whose bone marrow biopsy is morphologically normal but has a positive Philadelphia chromosome in bone marrow as well as peripheral blood?

When do you utilize lenalidomide in patients with MDS without del(5q)?

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?

What is your threshold for pursuing bone marrow biopsy in a lupus patient with cytopenias?

For incidentally found stage I indolent non-Hodgkin's lymphoma in young patients, which subtypes would more strongly warrant a consideration for curative-intent radiation?

For instance, if the tissue came back SLL, Waldenstrom's, follicular lymphoma, or even nodular lymphocyte-predominant Hodgkin lymphoma, would any or a...

How do you approach the management of a patient with symptomatic iron deficiency anemia who is intolerant of iron?

Such as a patient who cannot tolerate oral iron and has had a anaphylaxis to intravenous iron

What is the target ferritin level for patients with hereditary hemochromatosis and signs of end-organ damage?

For example, a patient with hypogonadism unless it matters which organ is involved. Are other markers of iron storage useful in guiding therapy?

How do you approach anticoagulation in patients with catastrophic antiphospholipid syndrome and thrombocytopenia?

Do you recommend long term anticoagulation for all patients with first time unprovoked VTE?

When would you consider splenectomy or other immunosuppressive/cytotoxic therapy for steroid-refractory warm autoimmune hemolytic anemia?

For example, in a patient who is steroid-refractory, requiring regular transfusion, and has not had response to rituximab after several weeks.

Would you consider just treating radiographic residual disease (as opposed to all original sites of disease involvement, per ILROG guidelines) in a patient with bulky early-stage Hodgkin's lymphoma of the mediastinum?

For example, in a young patient where standard fields would be very large and you want to minimize toxicity

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

Would you consider splenectomy for an early stage l/ll primary splenic diffuse large B cell lymphoma followed by R-CHOP?

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

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

Would you offer treatment for asymptomatic CLL with WBC of ~300k or greater, high risk cytogenetics, or doubling time of 6-12 months?

What are your indications for pursuing a rheumatologic workup in a pediatric patient with ITP?

If so, what additional testing do you send?

How would you manage a patient with PV or ET who is experiencing breakthrough thrombosis?

For example, a patient on cytoreductive therapy and aspirin BID, but suffers an arterial event, or a patient who is already on therapeutic anticoagula...

Would you add chemotherapy to a TKI in treating an elderly patient with de novo CML blast crisis?

When would you perform a thrombophilia workup in a pediatric patient presenting with VTE?

Should venous thrombosis in a patient with Behcet syndrome be treated with both immunosuppression and anticoagulation?

How would you manage OCPs in a patient who develops a VTE while on treatment?

In a patient with a medical or personal indication to induce oligomenorrhea/amenorrhea, how would you manage OCP therapy if a patient develops a VTE d...

Would you place an IVC filter in a patient with an acute PE and an absolute contraindication for anticoagulation, but negative imaging for proximal DVT?

How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?

Is there a role for anti-neutrophil antibody testing in the workup of neutropenia?

If autoimmune neutropenia already suspected, is this test informative or unnecessary?

Do hemoglobin S levels always correlate with SCD phenotype?

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

How do you decide between blinatumomab or traditional chemotherapy in combination with TKI for upfront treatment of adult patients with Ph + ALL?

Is there currently a role for adding venetoclax to a hypomethylating agent (HMA) after failure of single-agent HMA therapy in MDS?

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...

What is your approach for treating transplant-ineligible patients with relapsed blastic plasmacytoid dendritic cell neoplasm (BPDCN) who have progressed on tagraxofusp?

How do you decide to transition a patient with stable PNH on eculizumab to extended half-life ravulizumab?

What is your approach to VTE prophylaxis following hematopoietic stem cell transplant?

What would be your choice of therapy in a fit patient with relapsed CLL previously treated with bendamustine and rituximab who does not want BTK inhibitor therapy?

Relapsed disease occurred 3.5 years after initial treatment

How do you approach diagnosing a patient with Iron Refractory Iron Deficiency Anemia (IRIDA)?

Do you go straight to TMPRSS2 genetic testing or what other lab testing (e.g. hepcidin) could be helpful?

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...

How would you manage CML first-line second generation TKI with a best response of MMR 4, but now with a loss of MMR with more than one log response loss but still in complete cytogenetic remission and mutation panel negative?

What is your preferred frontline treatment for CLL in young patients < 50 years old?

What would be your choice for re-induction in a young patient with FLT3+ refractory AML after 7+3 induction therapy with no FLT3 mutation on the day 14 marrow?

Are there patients who can forgo anticoagulation with asymptomatic, incidentally discovered subsegmental pulmonary embolism?

If there are a low-risk patients who can be monitored, how would you do so? If unprovoked, would you consider stopping anticoagulation?

How would you manage acquired von Willebrand syndrome secondary to a myeloproliferative neoplasm in a patient who is already on anticoagulation?

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

What is the optimal VTE prophylaxis for hospitalized patients with COVID-19?

Should we use a different dose in critically ill patients in the ICU? When should we consider intermediate-dose anticoagulation?

What is the optimal management of a patient with refractory TTP who has had poor response to plasma exchange, steroids, rituximab, especially when caplacizumab is unavailable?

How would you treat a de novo CLL with WBC of 1,000,000 and no overt signs of leukostasis?

Is there any role for post chemotherapy (R CHOP x 6) radiation therapy after a splenectomy for a stage IE diffuse large B-cell lymphoma involving only the spleen?

What if it is a young patient?

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?

What would you recommend for a patient with bilateral conjunctival MALT (without systemic disease)?

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...

How would you treat a stage IE diffuse large B-cell lymphoma of the adrenal gland in an elderly patient who is not a candidate for systemic therapy?

What CTV margins do you use for indolent advanced stage lymphoma treated with palliative radiation alone?

Would you forgo consolidation radiotherapy for a patient with stage 1EA diffuse large B cell lymphoma of the stomach who presented with a perforated ulcer?

What dose do you use to palliate multiple myeloma in a vertebral body?

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...

5 Answers available

Would you consider holding treatment with hypomethylating agents and venetoclax in elderly with AML who achieve CR and MRD?

Do you routinely prophylactically anticoagulate patients undergoing systemic chemotherapy outside of the perioperative period?

How do you approach treatment in a patient with a solitary plasmacytoma with minimal marrow involvement (< 10% clonal plasma cells)?

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...

In sickle cell patients with continued pain crises despite hydroxyurea, how do we sequence the use of newer agents?

While L-glutamine has minimal side effects and would likely be added after hydrea, how do you decide between the use of voxelotor and crizanlizumab?

How would you treat an adult patient with T-cell lymphoblastic lymphoma with FGFR1 rearrangement and co-exisiting myeloproliferative neoplasm?

For a patient with previously relapsed TTP but in clinical remission, what is the role of rituximab in treating asymptomatic ADAMTS13 deficiency to prevent relapse?

Rituximab has entered the treatment algorithm in the first-line setting for the initial treatment of TTP. However, in remission, the role of adjuvant ...

What is the role of RT for a patient with double-hit DLBCL and a single site of relapse who can no longer tolerate chemotherapy?

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

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

How often do you utilize soluble transferrin receptor or hepcidin testing in the diagnosis of ambiguous iron deficiency, such as with concomitant anemia of chronic disease?

Does recent iron intake affect the iron panel, and if so, do you often order fasting labs in practice?

Would you anticoagulate a patient with an isolated arterial thrombosis in the setting of an inherited thrombophilia?

Does your opinion change based on the specific underlying inherited thrombophilia? The original case was a central retinal artery occlusion in a patie...

How do you evaluate an isolated prolonged aPTT in patients?

Especially in a patient without hemophilia or thrombosis history?

What therapy do you usually choose in patients with previously treated follicular lymphoma who experience early relapse (< 2 years)?

How do you manage bruising in patients on ibrutinib?

How do you approach CNS prophylaxis in double-hit lymphoma patients?

Do you only give intrathecal chemotherapy or systemic therapy?

What maintenance treatment would you recommend for Ph positive ALL following Hyper-CVAD, transplant eligible or ineligible?

What is the role of radiation in a patient with stage IV DLBCL with bilateral testicular involvement?

Under what circumstances do you consider double autologous stem cell transplants for patients with multiple myeloma?

Do you rebiopsy grade 1-2 follicular lymphoma if SUV is high by PET?

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

Would you start a patient with sickle cell disease and COVID-19 on prophylactic anticoagulation?

Would you recommend anticoagulation for patients with partial false lumen thrombosis in type B aortic dissection?

Would you offer this routinely or only if specific complications arise, such as distal emboli?

Do you offer enasidenib with azacitadine in AML with an IDH2 mutation for patients ineligible for intensive induction chemotherapy?

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

Are there any special considerations for treating CML in the very elderly, greater than 85 years old?

When would you consider transplant for a patient with a bone marrow failure syndrome (FA, DC, etc.)?

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 do you manage thrombocytopenia when radiating the spleen?

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

Is there a role for ruxolitinib in essential thrombocythemia?

In patients who are intolerant to hydroxyurea, anagrelide and interferon

When do you get a bone marrow biopsy for likely essential thrombocytosis?

Is there any benefit to getting it prior to starting cytoreduction?

What frontline therapy would you offer for a patient who is elderly or unfit for standard induction therapy with both IDH-2 and FLT-3 ITD mutations?

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?

Do you recommend that children with sickle cell disease refrain from returning to school during the COVID-19 pandemic?

How do you adjust the dose of Ibrutinib in hepatic dysfunction, particularly if disease related?

Would you consider adding Enasidinib to frontline combination therapy with HMA and Venetoclax in a patient with newly diagnosed AML with IDH2 mutation that is >75 or unfit for standard induction therapy?

Do you use bevacizumab in patients with history of VTE (DVT/PE) who are stable on anticoagulation?

Would it make a difference if the VTE diagnosis occurs during bevacizumab therapy or whether it preceded the cancer diagnosis?

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?

How would you approach re-irradiation to a localized DLBCL of the lower extremity?

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

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

How do you approach the treatment of patients with an e14a3 (b3a3) BCR-ABL fusion in chronic phase CML?

How would you treat DLBCL of the terminal ileum in an otherwise healthy patient?

How would you manage a patient with severe aplastic anemia and a large PNH clone?

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 would you evaluate a pediatric patient referred to rule out cancer due to an isolated significantly elevated vitamin B12 level?

Assuming CBC w/ different and complete metabolic panel are within normal limits, what (if any) further evaluation or management is needed?

Do you offer adjuvant chemoimmunotherapy after IFRT for Stage I to II low grade follicular lymphoma?

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

When during ALL induction therapy are you checking for MRD?

Do you hold maintenance lenalidomide or bortezomib for a patient who needs a surgery?

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

What's your preferred management for a newly diagnosed chronic phase CML with concurrent thrombocytopenia?

How long after discontinuation of TKI (for complete remission) would you feel it is safe for a patient with CML to consider pregnancy?

Would you choose a different anti-CD20 antibody in early relapsed (< 6 months) DLBCL treated with rituximab?

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

What dose and fractionation do you use to palliate mycosis fungoides lesions?

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 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?

Would you stop hydroxyurea for thrombocytosis in a prostate patient receiving radiation?

What is your preferred induction regimen for primary CNS lymphoma in a young patient?

Do you ever discontinue ibrutinib in patients with CLL who have a good response?

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

What factors do you consider when choosing between a 1st and 2nd generation TKI in a newly diagnosed CML patient?

How long would you wait after a cycle of IT MTX to treat a spinal lesion causing cord compression in a patient with stage IV DLBCL?

Do you prefer hyper-CVAD or the CALGB 9111 protocol for high intensity remission induction treatment in Ph-negative ALL patients?

The NCCN recommends both regimens.

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...

Would you consider giving ESA for anemia secondary to chronic kidney disease in a patient with follicular lymphoma in remission and on rituximab maintenance?

How do you decide on the modality of consolidative treatment after a CR in primary CNS lymphoma patients treated with a high-dose methotrexate regimen?

How do you decide between WBRT, maintenance chemotherapy, or stem cell transplantation?

Would you stop current immunosuppressive therapy or delay starting immunosuppressive therapy in a patient with aplastic anemia who has been infected with COVID-19?

Would you recommend anticoagulation prophylaxis for a pediatric patient admitted with COVID-19?

Are patients with bleeding disorders receiving plasma-derived products at increased risk of acquiring COVID-19?

Should patients with bleeding disorders increase their home supplies of clotting factors foreseeing a possible shortage of product availability due to COVID-19?

How would you manage a patient with sickle cell disease who is infected with COVID-19?

How do you assess whether an early-stage Hodgkin's patient is unfavorable?

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

Would you give CNS prophylaxis to a patient with Waldeyer's ring diffuse large B cell lymphoma if it is not triple or double hit ?

Risk of CNS relapse in a reported series is less than 5%.

How would you approach primary CNS lymphoma in an elderly patient over 80 years old?

How does your approach differ when managing a "triple hit" versus a "double hit" or "double expressor" lymphoma?

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

Are there any alternative, hypofractionated RT courses for patients with DLBCL that can be used during the COVID-19 pandemic?

Do you include gemtuzumab ozogamicin for any of your newly diagnosed AML patients who are candidates for 7+3 induction chemotherapy?

Or do you consider addition of this agent in the re-induction setting for refractory disease?

Can acalabrutinib be used in patients who failed ibrutinib in relapsed/refractory mantle cell lymphoma?

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...

What is your recommendations for vaccines to prevent shingles in CLL patients?

When do you use post chemotherapy XRT in advanced (stage 3 and 4) large B cell lymphoma who obtain CR by PET scan and what dose?

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

Would you consider using daratumumab in the first line setting for non-transplant eligible multiple myeloma?

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...

5 Answers available

What is your approach to a patient with systemic AL amyloidosis who has achieved a hematologic response but not an organ response with CyBorD?

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

How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?

What is your approach to treating newly diagnosed plasma cell leukemia?

Do you perform biomarker-based screening for AL amyloidosis in patients with newly diagnosed MGUS?

If so, what is your approach to laboratory and clinical testing?

When do you consider cytoreduction in patients with Essential Thrombocytosis?

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...

How do you approach the workup and initial treatment of systemic AL amyloidosis?

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...

Why do we immediately perform CNS staging with a LP at diagnosis of ALL when the risk of seeding is highest with a high lymphoblast count?

How long do you treat recurrent classical Hodgkin lymphoma with brentuximab/nivolumab if the patient does not want to proceed to BMT?

How would you manage a patient with minimal residual disease (<1% of CD25 positive cells) six months after completing therapy with 2-CDA for Hairy Cell Leukemia?

What dosing schedule of cladribine do you use for newly diagnosed hairy cell leukemia in need of treatment?

Can a rituxumab biosimilar be used for a high grade lymphoma?

How do you manage patients who develop de novo or recurrent skin cancers (SCC or BCC) while on lenalidomide?

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

What is the preferred approach for giving high dose methotrexate in double or triple hit lymphomas being treated with dA-EPOCH-R?

What volumes do you treat for ISRT for extranodal DLBCL?

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...

Do you consider discontinuing brentuximab in stage III-IV classical Hodgkin lymphoma patients on AVD+brentuximab who have a good response to 2 cycles?

(ie Deuvelle criteria 1-3) Is it appropriate to discontinue brentuximab like you would with bleomycin?

Would you offer consolidative RT to a patient with early stage, non-bulky, high-grade non-Hodgkin's lymphoma of the orbit after 6 cycles of RCHOP + IT chemotherapy?

How do you approach maintenance therapy for relapsed follicular lymphoma?

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

How do you manage DLBCL in patients with previous anthracycline exposure?

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

What would be your choice for treatment for an HIV positive patient with no detectable viral load with CD20 negative and CD30 positive DLBCL?

What is your approach in a transplant-eligible patient with relapsed classical Hodgkin lymphoma who has an area of refractory disease after salvage chemotherapy?

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

Would you offer maintenance lenalidomide or rituximab in a patient with DLBCL transformed from a marginal zone lymphoma in a young, fit patient?

Would you offer next-line systemic therapy to a patient with LGL leukemia with chronic severe neutropenia, who has had treatment failure with methotrexate, cyclophosphamide, cyclosporine, and danazol?

If the patient has not experienced significant infectious complications? If so, what agent?

Would you recommend scrotal RT in a patient with stage IV primary testicular lymphoma with CNS involvement after CR to RCHOP and MTX?

What dose and volume would you treat in a patient with diffuse large B-cell lymphoma confined to the stomach after complete response to R-CHOP?

How would your dose and/or volume change if the patient refuses chemotherapy?

Do you alter your management of Stage I-II DLBCL if it's double or triple hit?

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

Do you ever start with lower than standard doses of TKIs when initiating treatment for chronic phase CML?

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

What positions and immobilization strategies do you use to minimize breast and heart dose when treating axillary and mediastinal nodes in young women with large breasts who require consolidative radiation (ISRT) for Hodgkins lympoma?

Any experience treating patients prone with openings for both breasts, no minimize breast overlap with axilla and mediastinum?

Would you recommend consolidative radiation therapy to an isolated frontal dural MALT lymphoma after complete response to chemotherapy?

Do you recommend lenalidomide for high risk smoldering multiple myeloma?

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...

How do you treat a composite NHL of various subtypes?

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

What dosing regimen of carfilzomib do you use in the front line setting for high risk transplant-eligible multiple myeloma?

In a patient with Waldenstrom's macroglobulinemia doing well and feeling better on ibrutinib & rituximab, but with a rising IgM, do you switch treatment or continue?

Can we ever observe newly diagnosed chronic phase CML patients and not immediately start them on therapy?

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

Are you de-escalating treatment for favorable risk Stage I-II DLBCL patients to 4 cycles of R- CHOP with 2 additional rituximab cycles?

Have you changed your practice based off the FLYER trial presented at ASH 2018?

What is the role of consolidative RT to initially bulky sites (>8cm) in a patient with stage III triple hit lymphoma who has tolerated only 4 cycles of DA-EPOCH-R?

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 approach treatment of DLBCL in a patient on hemodialysis?

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

What dose and fractionation would you recommend for a localized primary bone marginal zone lymphoma?

The patient has no bone marrow involvement.

Is there a role at this time for chemo-immunotherapy in the upfront treatment of classic Hodgkin lymphoma?

Although not approved, for example, are you every using AVD-nivolumab?

What is your preferred maintenance therapy in young, fit patients with de novo plasma cell leukemia who achieve complete response after autologous stem cell transplantation?

When treating DLBCL with induction therapy with R-CHOP, if after 2 cycles, you have a mixed response on PET, would you consider that treatment failure or would you continue R-CHOP?

How would you treat an elderly fit patient with stage IE DLBCL (single skin lesion)?

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...

What is your first line treatment of choice for advanced (stage IIIA) follicular lymphoma, histologic grade 1-2 in an otherwise young healthy patient in 2019?

Assuming the patient has an indication for treatment.

How would you manage a CML patient with a T315I mutation that developed severe abdominal pain requiring hospitalization after starting ponatinib 45 mg?

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

For patients who have exceptionally long responses to HMA with high risk MDS or AML and not candidate for more aggressive therapy/transplant, do you consider treatment holidays or spacing out doses into longer intervals?

How do you treat a gastric plasmacytoma which is not amenable to radiation?

For a patient with relapsed FLT3 positive AML on HMA and venetoclax, is there ever a role for the addition of midostaurin to the treatment regimen to improve response rate?

With the recent FDA approvals of Venetoclax and Glasdegib in AML, is one generally preferred over the other for elderly and/or unfit patients in combination with a hypomethylating agent/low-dose cytarabine?

In a newly diagnosed elderly patient with AML who harbors an IDH1 mutation, would you treat with upfront with ivosidenib or would you proceed with venetoclax and HMA as your first line treatment?

Is a very rapidly rising WBC count ever an indication for the upfront treatment of CLL?

Assuming there are no other indications at the moment.

What is your approach for bulky stage I primary mediastinal B-cell lymphoma in a patient with a positive post-chemotherapy PET-CT (residual mass and Deauville 5)?

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

Do you use absolute WBC count or doubling time to determine whether to start treatment for early stage CLL?

Would this affect your decision regardless of the stage and symptoms?

What is your approach to the decision to use CPX-351 or standard 7+3 for de novo AML?

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

What is your preferred TKI and dosing for AYAs or adult patients with Ph+ ALL?

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

Which imaging modalities and schedule do you use to follow stage I-II follicular lymphoma that was treated with radiotherapy alone?

Would you offer chestwall RT after capsultectomy+explant for an implant-related ALCL?

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...

For inpatient treatment of lymphoma and ALL, can rituximab be delayed?

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...

What would you recommend for a stage I diffuse large B cell lymphoma (IPI 0-1) involving a single lymph node that is completely removed with an excisional biopsy?

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...

How do you approach front line treatment for TP53 mutated mantle cell lymphoma?

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

What is the role (if any) for Rituximab in a patient with CD20+, Philadelphia chromosome positive ALL?

What would be the preferred chemotherapy regimen in elderly patients with advanced stage classical Hodgkin Lymphoma and contraindication to doxorubicin and bleomycin?

What factors do you consider when interpreting post treatment PET Deauville scores for patients treated with chemotherapy for classical Hodgkin Lymphoma?

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

What dose/fractionation do you like to use for palliation of bulky LAD from CLL/SLL?

When do you offer consolidative tandem autologous stem cell transplantation for high-risk multiple myeloma?

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

How do you approach CNS prophylaxis in patients with DLBCL?

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

What is the role of salvage radiation therapy in patients with locally recurrent Hodgkin lymphoma after an autologous stem cell transplant?

Should consolidation autologous stem cell transplant be considered for de novo follicular lymphoma transformation to DLBCL after achieving a PR with R-CHOP x 6 cycles, if residual disease showed original indolent follicular lymphoma?

For an otherwise healthy individual, what would be your front line choice for de novo Richter’s transformation?

Pathology is clear this is not a concurrent DLBCL and is indeed transformed CLL

Would using Obinutuzumab and Venetoclax second line after Bendamutine and Rituximab be a reasonable option for a patient with IGHV-unmutated CLL?

When would you add daratumumab to a PI/IMiD/dex backbone for first-line treatment of transplant-eligible multiple myeloma?

Are the early results of CASSIOPEIA (Abst 8003) from ASCO 2019 practice changing?

How do you dose midostaurin in patients with AML who need azole antifungal prophylaxis?

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

How much later after starting a hypomethylating agent in an elderly patient with AML being treated in the upfront setting can venetoclax be started (can it be added after 2 or 3 cycles of HMA)?

Can post op RT be omitted in a surgically repaired pathological fracture site in multiple myeloma if the patient will receive systemic therapy?

How do you incorporate CAR-T cell therapy in the second line setting for DLBCL patients who are eligible for consolidative autologous transplant?

Does the result of their salvage chemotherapy and whether PR or CR is acheived affect your decision?

Do you make diagnostic lumbar puncture part of routine work up for newly diagnosed AML if patient is asymptomatic?

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

Why are hypomethylating agents as single agents not approved yet by FDA for treatment of AML (technically off-label)?

How would you treat low grade follicular lymphoma with diffuse epidural involvement? Would you give intratheracal or high dose systemic methotrexate in addition to systemic chemoimmunotherapy?

How would you approach treatment in an older (>65), but fit patient with intermediate-risk AML, but with MRD persistence after induction with 7+3?

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?

How would you manage a patient with a MALT lymphoma (H. Pylori negative) found incidentally in the surgical specimen at the time of sleeve gastrectomy?

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...

What stage is bilateral orbital/conjunctival NHL (limited only to the bilateral orbit/conjunctiva)?

How early have you been able to detect a response with CAR-T in patients with relapsed DLBCL?

With recent measles outbreaks occurring in the US, would you consider offering multiple myeloma patients s/p ASCT on maintenance treatment vaccination, or an alternate means of immunity?

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

What are the factors that convince you to not immediately treat mantle cell lymphoma and to follow a course of "active surveillance"?

Is there a specific Ki67 percentage? P53-negativity?

How do you manage classical early stage Hodgkin lymphoma patients when an ESR is not checked as part of their workup?

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...

How long after high-dose IV methothrexate for chemo-refractory CNS lymphoma do you wait before giving brain radiation?

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

How would you manage a patient with primary CNS lymphoma who is not a candidate for high-dose methotrexate?

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...

What is your preferred chemotherapy regimen for a fit younger patient with mantle cell lymphoma?

What recommendations do you make regarding the use of biologics for uncontrolled Crohn's disease in patient's who have a history of DLBCL that developed while on infliximab and azathioprine and whose lymphoma is essentially cured?

I have received inquiry from a patient's gastroenterologist regarding use of Entyvio or Stelara in such a situation.

Would detection of an adverse cytogenetic marker such as dup(1q) alone in the setting of MGUS satisfy criteria for a diagnosis of multiple myeloma?

Do you routinely order double-hit assessment in cutaneous DLBCL ?

How would you treat a patient with a refractory primary splenic marginal zone lymphoma with symptomatic splenomegaly (20 cm) and a mild pancytopenia?

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

In staging Hodgkin's lymphoma, would you identify a PET+ bony focus as disease when there are no associated bone changes on CT and a biopsy was not obtained?

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

In transplant-eligible, fit patients with multiple myeloma who have an inadequate response to front-line therapy, what regimen would you choose for second-line?

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

What volume and dose would you use for a Stage I MALT lymphoma of the lung?

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

In transplant-eligible, fit patients with primary refractory myeloma, what is the optimal timing for stem cell collection?

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...

With new data now available for use of brentuximab in ALK positive, CD30 anaplastic large cell lymphoma, what is your first line regimen?

What CTV margins should be used with early stage favorable Hodgkin's Lymphoma in the illiac chain if they had a complete response on PET after 2 cycles of ABVD?

Should prechemo PET positive disease from bowel or other structures be carved out?

In a patient with high risk acute promyelocytic leukemia, when do you consider ATRA+ATO with GO vs ATRA+ATO with idarubicin?

How do you approach fit patients with quickly relapsed Hodgkin lymphoma (disease-free interval less than or equal to one year) after 6 cycles of ABVD and radiation therapy?

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)?

What is your preferred first-line therapy for a patient with standard risk multiple myeloma?

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

Will you offer Ibrutinib and Rituximab for untreated patients with CLL without a 17p deletion?

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...

Is there a role for assessing measurable/minimal residual disease (MRD) in multiple myeloma at this time?

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

Do you recommend using DIBH for young adults with Hodgkin lymphoma who require mediastinal RT?

Which regimen do you prefer for patients with newly diagnosed DLBCL that are not candidates for doxorubicin secondary to low ejection fraction?

Do you use etoposide-based regimens such as R-CEPP? How about substitution with liposomal doxorubicin?

In which patients with early-stage favorable Hodgkin's lymphoma, if any, would you consider omitting consolidation RT after ABVD chemotherapy?

What is your standard dose for total skin irradiation in a mycosis fungoides patient?

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

How would you manage a primary dural low-grade lymphoma?

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

When do you choose to give CyBorD over RVd in a newly diagnosed myeloma patient?

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

What is your approach to choosing a conditioning regimen for allogeneic transplant in AML?

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

How do you approach incidentally diagnosed mantle cell lymphoma found on a routine screening colonoscopy?

How do you approach the treatment of hairy cell leukemia with inadequate response to front line therapy?

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...

How would you treat a younger patient with relapsed mantle cell lymphoma after treatment with hyperCVAD?

How about if disease is found in the CSF?

What is your general approach to post-allogeneic HSCT maintenance therapy for AML?

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

How do you utilize lenalidomide maintenance in non-transplant eligible myeloma?

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

What is your approach to CMV prophylaxis in the post-allogeneic stem cell transplant setting?

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

What is your alternative first line approach to follicular lymphoma that requires treatment if initial treatment with BR leads to significant neutropenia despite G-CSF?

Would you consider switching regimens?

How would you treat an elderly, transplant-ineligible patient with recurrent DLBCL?

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

What is your approach to treating limited stage DLBCL of the colon?

Does isolated del(5q) have the same prognostic implications for post-PV secondary myelofibrosis as it does in MDS?

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

What is the role for maintenance lenalidomide in elderly patients with DLBCL?

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

Would you offer scrotal radiation to a patient with a stage IIE bilateral testicular DLBCL treated with a bilateral orchiectomy and chemotherapy?

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...

What is your preferred treatment to ameliorate bone pain from G-CSF?

Do you routinely add eight extra rituximab doses to six cycles of R-CHOP in elderly patients with DLBCL treated with miniR-CHOP as done in SMARTE-R-CHOP-14 trial ?

What is your preferred first line treatment for patients with high risk MDS who are not candidates for transplant?

What is an appropriate dose for definitive radiation of a stage IE EBV+ polymorphic B-cell lymphoproliferative disorder?

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...

Would you use alternative management in a chronic phase CML with a 3 way translocation between chromosome 9, 22 and 7?

Does anything need to be done if hyperlymphocytosis (i.e. ALC > 300K) develops in a CLL patient just starting ibrutinib?

If you decide to discontinue TKI after prolonged molecular remission in CML, how often would you follow the BCR/ABL after discontinuation?

How would you treat an older patient with newly diagnosed B-ALL and significant cardiac and neurological co-morbidities?

What is your preferred approach to therapy in transplant ineligible multiple myeloma initially treated with CyBorD owing to acute renal failure, after achieving a VGPR (+IFE alone) with continued mild-moderate renal impairment?

Would you change to an alternative triplet therapy, or switch to maintenance therapy? Are there variations in depth of response short of CR that woul...

Does CD5 positivity by itself in DLBCL pose a high risk of CNS recurrence and necessitate CNS prophylaxis?

In classical hodgkin's lymphoma patients with a postive PET after 2 cycles, are you routinely transitioning to escalated BEACOPP?

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...

What are some preferred steroid sparing regimens for untreated multiple myeloma patients who have type 1 diabetes mellitus?

What is your experience with liposomal-encapsulated daunorubicin and cytarabine (CPX-351) for first line treatment of therapy-related AML or AML with myelodysplasia-related changes in elderly patients?

Do you have experience administering these agents in the outpatient setting?

Do you have a preferred strategy for front line induction therapy in DLBCL patients who have asymptomatic depressed ejection fraction and thus concern about anthracycline dosing?

Is there a situation where you would use a purine analogue in combination with rituximab for the frontline line treatment of normal variant Hairy Cell Leukemia?

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 ?

What is your approach to treating relapsed subcutaneous panniculitis-like T-cell lymphoma?

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...

What is the best strategy after initial treatment with hypomethylating agents for high grade myelodysplatic syndromes, mainly for responders who became transfusion independent?

Do we continue the hypomethylating agent indefinitely?

Do you routinely do imaging on patients to look for intrathoracic or abdominal lymphadenopathy in newly diagnosed patients with CLL?

How do you approach treating a patient with IgM-AL amyloidosis?

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...

How are you making the diagnosis of chronic lymphocytic leukemia transforming to prolymphocytic leukemia?

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

What is your preferred approach to the treatment of transplant ineligible multiple myeloma that has been treated with a triplet regimen and reached a plateau phase?

Would you observe until progression or would you place the patient on maintenance?

What is the best dose to treat splenomegaly with pancytonenia in the setting of myelofibrosis?

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

What are your radiotherapy recommendations for a unilateral primary intraocular large B-cell lymphoma following high-dose methotrexate and rituximab?

What factors influence your choice to treat as well as dose and target?

How would you approach a patient with smoldering myeloma that has a quickly rising and very high M-spike (6 g/dL range)?

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

Would you treat a patient with definitive local XRT without systemic therapy if he/she presents with pathology showing a PTCL NOS from a small (1.5 cm) lesion of the skin of the chin?

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...

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

What is an appropriate dose for nodular lymphocyte predominant, stage 1 Hodgkin lymphoma following nodal excision?

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...

How do you approach previously treated grade 1 follicular lymphoma now with transformation to a large cell lymphoma?

What chemotherapy regimen would you recommend for a patient with symptomatic cutaneous B cell lymphoma?

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...

Would you use Ibrutinib plus Venetoclax as second line therapy in relapsed/refractory mantle cell lymphoma?

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...

Do you give 3 or 4 cycles of HiDAC during consolidation for good/intermediate-risk AML without an available allotransplant donor?

How do you choose between 3 and 4?

How would you approach a completely resected DLBCL of the appendix if PET scan and bone marrow biopsy suggest no other disease?

Would you consolidate marginal zone lymphoma transformed to a high grade B-cell lymphoma with a stem cell transplant?

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 ...

How do you approach small lymphocytic lymphoma that does not have a leukemic phase. Do you follow treatment guidelines for indolent lymphoma or CLL?

How do you get 17p testing on someone with only lymphadenopathy

For multiple myeloma, is 8 Gy in 1 fraction an appropriate palliative dose, although this histology was excluded from trials examining a single fraction?

What dose of radiotherapy do you use for low volume Castleman's disease?

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

How do you manage patients with primary refractory Hodgkin lymphoma?

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...

Do you think there will be a role for duvelisib in the treatment of relapsed/refractory chronic lymphocytic leukemia?

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

When do you combine hypomethylating agents with venetoclax or gemtuzumab ozogamicin in elderly patients with AML who are ineligible for intensive chemotherapy?

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...

How would you approach a Follicular grade 1-2 NHL found on a terminal ileum biopsy with otherwise negative EGD and colonoscopy and contrast enhanced CT scan?

Would you consider resection? Or maybe anti-CD20 monoclonal antibody?

What is your threshold for transfusing platelets in an asymptomatic patient after autologous stem cell transplant?

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 ...

Would you consider aggressive presentation of multiple squamous cell carcinomas of the skin an indication for treatment of CLL?

In the absence of any other classic CLL indications for treatment.

Do you have any concerns about enhanced radiation toxicity with any of the novel agents used to treat multiple myeloma?

How do you treat a young woman of child bearing age group diagnosed with primary CNS lymphoma?

The CALGB regimen is quite complicated.

How do you follow patients after radiation treatment for orbital MALT lymphoma?

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...

What growth factor would you use with A+AVD, if any at all?

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

How would you treat a diffuse CNS myeloid sarcoma (aka chloroma/granulocytic sarcoma) without evidence of blood or bone marrow involvement?

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...

When treating a patient with multiple myeloma with bortezomib, how do you decide between subcutaneous vs intravenous dosing?

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

What would you choose as a first line therapy for a patient with CLL who is asymptomatic with Rai Stage 4 with bulky adenopathy and organomegaly?

Would it change your management if patient if IgVH mutated?

What is your approach to treating early stage EBV-positive diffuse large B-cell lymphoma of the elderly after a CR to systemic therapy?

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...

How would you treat a fit, newly diagnosed, high-risk multiple myeloma patient with multiple poor risk factors and circulating plasma cells?

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

Do you prefer a chemo-radiation combination or chemotherapy followed by sequential radiation approach for early stage NK/T-cell lymphoma?

When do you consider re-starting treatment for a patient with relapsed myeloma?

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

For Hodgkin lymphoma patients with initial splenic involvement, do you ever include the pre-chemotherapy involved spleen as part of your consolidative ISRT treatment after a CR?

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 ...

How do you choose among regimens for relapsed refractory myeloma?

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

For a MALT of the eyelid, do you treat the entire conjunctiva reflection as well, or just the eyelid?

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...

How do you choose between azacitidine and decitabine when deciding to treat a patient with MDS with a hypomethylating agent?

How would you qualify and treat a patient with neutropenia, anemia, and abnormal NK cell population with normal trilineage marrow maturation?

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

Can RT to non-bulky sites be omitted in an early stage (stage I or II) classical Hodgkin's lymphoma case with a CR by PET/CT?

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?

Is a CLL FISH panel sufficient to aid in treatment decisions in CLL or is p53 sequence analysis also needed?

How do you approach the development of an LGL clone in a NHL patient actively getting therapy?

What is your approach to a patient with an advanced stage diffuse large B-cell lymphoma treated with chemotherapy alone (with a PET CR) who then develops an isolated CNS relapse?

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

What is your preferred dosing and schedule for interferon in pregnant CML patients?

Given the sensitivity and prognostic value of the serum free light chain ratio for light chain multiple myeloma, do you continue to check urine studies?

In multiple myeloma patients on bortezomib and dexamethasone, who develop HZV reactivation while on HZV prophylaxis, do you stop bortezomib/dexamethasone permanently?

Is venetoclax expected to be useful in patients with refractory CLL/SLL who do not have Del(17p)?

How would you treat stage 3 lymphocyte-predominant Hodgkin Lymphoma that is CD20 negative ?

Are there any indications on advanced stage Hodgkins disease that one might consider stopping the bleomycin after first two cycles?

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

For elderly patients who cannot tolerate chemotherapy, is radiation alone an option for a stage IA favorable classical Hodgkin lymphoma?

What dose and volumes would you use?

For primary CNS lymphoma, when do you refer for whole brain radiation therapy (WBRT)?

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...

For multiple myeloma patients with vertebral lesions requiring palliative radiation (e.g. 20-30 Gy in 10fx), do you treat concurrently with modern systemic myeloma agents such as lenalidomide and bortezomib?

Which systemic agents would you recommend holding during RT?

For male patients in chronic phase CML on a TKI and not yet in a MMR, is there a preferred amount of time spent in a MMR before discontinuing TKI therapy to conceive or bank sperm ?

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...

What is the preferred regimen for testicular lymphoma with de novo symptomatic CNS involvement and systemic disease at the time of presentation ?

If a patient with myeloma develops a symptomatic DVT or PE while on an immunomodulatory drug such as lenalidomide, would you stop the IMiD?

Would you ever give another IMiD?

How do you manage rituximab-induced neutropenia?

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

What is the role of radiation treatment of stage IA ALK negative anaplastic large cell lymphoma?

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

What is your approach to the upfront treatment of anaplastic large cell lymphoma, ALK positive, with low IPI score in a young person?

With the advent of many new agents, any thought to initial therapy different from CHOP or CHOEP?

How would you approach a chronic phase CML patient who is responding to second generation TKI but not yet in molecular remission and is now pregnant?

What dose/fractionation schedule should be used for adjuvant RT after surgical decompression of a spinal cord compression from multiple myeloma osseous lesions?

What is the optimal regimen for advanced stage Nodular Lymphocyte Predominant Hodgkin Lymphoma?

For early stage indolent NHL (low grade follicular, MALT) involving midline structures of the head and neck (ie base of tongue, soft palate) how do you apply the concepts of ISRT?

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...

How do you manage the development of neuropathy in patients receiving bortezomib for multiple myeloma?

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

Does rituximab + lenalidomide have a role in advanced follicular lymphoma?

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

How do you manage a patient who has developed a symptomatic pleural effusion while on dasatinib?

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

Has the combination of daratumumab, bortezomib, and dexamethasone been tried for the treatment of plasma cell leukemia?

When starting a patient on a tyrosine kinase inhibitor for chronic phase CML, which drug do you choose upfront?

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

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...

Do you use anti-microbial prophylaxis when you prescribe ibrutinib?

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

Should we continue to offer consolidative radiation for early stage, non-bulky Hodgkin's disease for individuals who have had a complete response (Deauville 1 or 2) after chemotherapy by PET?

How have the results of the UK RAPID study (Radford et al NEJM 2015) changed your practice?

Is there any data to support to use of Brentuximab in the up-front setting in the treatment of Hodgkin lymphomas?

After induction therapy for acute promyelocytic leukemia with arsenic trioxide and ATRA, at what point do you start consolidation?

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

Do you choose to include or omit growth factor support in the treatment of Hodgkins lymphoma?

When determining treatment approach to newly-diagnosed follicular lymphoma (e.g. watchful waiting vs chemotherapy), do you take the intensity of the SUV measurements on PET into account?

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

What is your preferred approach to a patient with newly diagnosed primary mediastinal B-cell lymphoma in the upfront setting?

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

Does radiation improve bone health and allow for healing of a pathological fracture in a patient with multiple myeloma refusing surgery?

What is the best evidence to support or refute this?

How would you define your radiation treatment volume for a primary diffuse large B-cell lymphoma of the L4 vertebral body that had a complete response to chemotherapy?

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...

For patients with stage 1A-E extra nodal marginal zone lymphoma that has been completely excised, would you still consider radiation?

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

For CLL patients with high-risk cytogenetics on ibrutinib who develop a cardiac event such as an MI, would you continue ibrutinib?

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

How would you treat a young man with refractory AML after HIDAC induction who developed cerebellar toxicity to HIDAC and previously received doxorubicin (300 mg/m2) for lymphoma?

What re-induction regimen without cytarabine or an anthracycline is likely to be most effective?

Which chemotherapy regimen would you choose for a female adolescent with favorable prognosis stage I-II Classical Hodgkin lymphoma, assuming the patient prefers not to do IFRT if the initial PET response is good?

0 Answers available

How would you manage a localized low grade follicular lymphoma diagnosed shortly after a patient had a CR to an aggressive treatment regimen for DLBCL?

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

Is it appropriate to treat a Stage IE DLBCL of the cervix with close followup if a CR is achieved after 4 cycles of R-CHOP followed by a hysterectomy omitting RT?

Is surgery an adequate treatment for Stage IE DLBCL of the cervix?

What is the best treatment management of low grade early stage follicular lymphoma of the mesentery?

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

What is the recommended initial treatment for spinal cord compression due to non-Hodgkin lymphoma (e.g. diffuse large B-cell lymphoma)?

When treating with radiation therapy, what dose-fractionation do you typically utilize?

Should FISH studies be repeated when CLL patients under active surveillance have progressive disease warranting treatment?

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

When treating a patient with classic early stage diffuse large B-cell lymphoma (Stage I/II), when is it appropriate for patients to receive 3 versus 6 cycles of R-CHOP chemotherapy when the treatment is followed by ISRT?

The NCCN guidelines recommend all patients receive 3 cycles RCHOP followed by ISRT unless they have bulky disease greater than 7.5 cm. However, are th...

Do you routinely offer consolidation RT to sites of previous bulky disease in stage III and IV Hodgkin's lymphoma who have a complete metabolic response on restaging PET/CT following 6 cycles of ABVD?

In what situations would you feel comfortable omitting RT to bulky disease in stage III/IV Hodgkin's lymphoma?

Is there any data on an effective RT regimen (dose/fractionation) for inducing an abscopal effect using a PD-1 inhibitor in refractory Hodgkin's lymphoma?

How would you treat Classic Hodgkin's lymphoma when the nodal sites are non-contiguous?

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

Given the improved ability to spare heart, kidney and liver, should IMRT be the standard of care for gastric MALT lymphoma (despite the low dose needed to effectively treat these patients)?

If so, what data should be presented to insurance companies to cover the cost?

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

What dose do you recommend?

Would you irradiate all borderline suspicious lymph node regions on PET/CT in stage IIA nodular lymphocyte predominant Hodgkin's lymphoma treated with ISRT alone?

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

Should whole brain radiation therapy and orbital radiation therapy be administered in situations of ocular B-cell lymphoma recurrence 2 years after primary CNS lymphoma treated with intrathecal methotrexate and no prior cranial irradiation?

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...

What are your current recommendations for treatment of symptomatic splenomegaly in the setting of myelofibrosis when splenectomy is not an option?

Is there a preferred low dose splenic irradiation regimine?

What is the best management of a lacrimal gland MALToma?

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

Is there a role for radiation therapy after chemotherapy for localized anaplastic large cell lymphoma?

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

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?

What is the role of radiation consolidation after chemotherapy for residual splenic involvement in follicular lymphoma?

What dose do you feel comfortable treating the entire circumference of an extremity to before you are concerned about chronic toxicity?

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 treating with total body irradiation, how should the lung blocks be drawn and what dose should the lung receive?

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

Is there a role for consolidation radiation in a patient with stage I low grade follicular lymphoma treated with chemotherapy?

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...

In Stage I-II primary mediastinal B-cell lymphoma (PMBL), bulky or non-bulky, is post-chemotherapy radiotherapy still standard in patients with a complete response to CHOP-R chemotherapy?

What is the best radiation dose to treat primary cutaneous B cell lymphoma?

Specifically for marginal zone or follicle center?

What is the best treatment volume and dose for a marginal zone orbital lymphoma?

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

What is the appropriate treatment for marginal zone lymphoma of the parotid following surgery?

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

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

What is the treatment volume for primary breast lymphoma?

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...

In treating early stage follicular lymphoma with RT, do you approach grade 3 disease any differently than grade 1-2?

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

What is the appropriate RT dose for an advanced stage follicular lymphoma?

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

Is IMRT preferred over 3D conformal RT for lymphoma of the head and neck?

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

Can you observe low grade follicular lymphoma if the involved node(s) have been surgically removed?

Is it time to start incorporating involved site irradiation for all lymphomas?

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

What is the appropriate dose of radiation for a primary osseous non-Hodgkin's lymphoma?

Specifically, for a diffuse large B cell lymphoma of the femur?

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.

What is the difference between involved node and involved site irradiation?