Questions discussed in this category

In which situations or patient populations do you find this useful? How is it sterilized?

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...

Does this hold true when the patient has significant inflammation? 

Despite distinguishing between the three MPNs, results may not change management.  There is controversy over whether to follow WHO criteria for d...

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

Is there utility when classic inflammatory markers (ESR,CRP) or disease specific markers (C3, C4, dsDNA) do not correlate with patients disease activi...

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

Should some patients get 325 mg instead of 81mg at least for a certain amount of time, such as patients in the acute phase of ischemic stroke or patie...

Are there specific safety or efficacy benefits associated with prolonged infusion times in this population?

Estimating blood loss from hemoptysis is not always reliable. The bleeding may be due to the PE itself. Is anticoagulation with any degree of hemoptys...

Is a BM biopsy a must when there is skin involvement? If tryptase level is mildly elevated but less than 20 would you recommend a BM biopsy?

The ASH 2020 guidelines have "recommended that adults with HbSS or HbSβ0 thalassemia be screened at least once for silent cerebral infarcts even ...

What is the ferritin target that you would aim for? What would be your approach for a ferritin >500? When do you order an MRI liver for iron quanti...

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

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

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

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

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

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

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

In the setting of requiring anticoagulation for atrial fibrillation and bioprosthetic valve, but also having severe vitamin K deficiency, would you st...

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

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

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

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

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

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

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

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

Is it different than early mobility that we always encourage?

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

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

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

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

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...

Common thought is that FVIII may be used for differentiating coagulopathy in liver disease (normal to increased, from reduced clearance of VWF/FVIII) ...

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

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

I.e. platelet count <30. Would your management change if HIT were only suspected rather than confirmed?  

Practice is variable in the community, with some hematologists frequently prescribing ESAs for severe anemia that is mostly inflammatory. Do the risks...

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

In FRAIL-AF, switching VKA therapy to a NOAC was associated with higher risk of bleeding in elderly, frail patients. 

Hb <11, low iron saturation (<10%), high ferritin (>900), and low reticulocyte hemoglobin equivalent.

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

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

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

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

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

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

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

In FRAIL-AF, participants were switched from VKA to dabigatran, rivaroxaban, apixaban, and edoxaban.

If so, would you start immediately or wait for the second set of labs to confirm before initiating blood thinners?

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

What is the work up and what is the duration of anticoagulation if used?

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

Would you continue KEYNOTE-522 neoadjuvant therapy? The patient has a PMH of sarcoidosis with no stroke risk factors. No residual deficits. 

E.g. Normal F8, VWF activity ~50%, VWF antigen ~100%, ratio 0.5 sent in a patient with positive bleeding history Is there any clinical significance t...

Do you always avoid heparin/enoxaparin or rechallenge if antibodies are negative?

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

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

Significant history of autoimmune diseases and DVT in family, recent PE/DVT for a month

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

Provided that the platelet count is normal, do you usually consider this to be a potential erroneous result or do you pursue additional workup for RBC...

Do you consider "bridging" therapy prior to transplant, and if so, what are your thoughts on the intensity of the chemotherapy?  

Such as in a patient with essential thrombocythemia with a CALR mutation, younger than age 60, no history of thrombosis, no bleeding or vasomotor symp...

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

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

Is patch or gel HRT with ASA prophylaxis a reasonable option after counseling? Or do you add a prophylactic DOAC? 

How often do you see non transfusion-dependent thalassemia and how do you approach the treatment?

Although TIBC is negative acute phase reactant, would it be a better indicator of iron deficiency (in combination with ferritin)?

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

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

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

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

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

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

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

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

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

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

If so, would you do bone marrow biopsy or send for NGS panel in blood to look for high risk mutations? NCCN lists this as the risk criteria. 

Would it change your management if the thrombus was symptomatic? Or if larger >3 cm?

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

For example, a patient with a bone marrow biopsy that shows normocellular bone marrow. Prior management with leflunomide and HCQ with neutropenia attr...

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

Are there any instances where you would prefer a biosimilar rather than the reference product? 

Patient with stable disease on maintenance therapy with lenalidomide and dexamethasone

What can you recommend that might help keep them out of the hospital? Do you consider a program of exchange transfusions in this situation?

Would you bridge with enoxaparin 0.7 mg/kg/day in an ESKD patient, as described in a previous retrospective study (Pon et al., PMID: 24718051)?

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

If hydroxyurea modifies the course of sickle cell disease by increasing fetal hemoglobin, is there any benefit to using it in patients with fetal hemo...

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

For example: In a patient presenting with left arm swelling and found to have a left cephalic vein occlusive thrombus on ultrasound

 Should they be placed on routine EGD surveillance and if yes at what intervals?

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

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

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

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

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

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

For example, concerning throbocytopenia or neutropenia during anal cancer treatment with concurrent mitomycin/5FU, or other pelvic malignancies treate...

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

What is the ideal approach for female adolescent athletes if they have complaints of fatigue and dizziness and are diagnosed with mild iron deficiency...

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

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

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

In your practice, what is the proportion of patients receiving neoadjuvant chemotherapy who are diagnosed with VTE? Does this differ from patients rec...

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

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

That is, extra copy of one of the alpha genes resulting in an atypical alpha thalassemia for the patient, and beta thalassemia heterozygous carrier fo...

Please comment on temperature recommendations and role of exchange transfusion. 

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?

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

Since both pregnancy and cancer are risk factors for VTE, is there data to guide when or if we should prophylactically anticoagulate? If so, what shou...

Do you wait 12 weeks for confirmation to begin treatment if patient is declining?

In the absence of concerning bleeding or thrombosis, family history of coagulopathy, current anticoagulant use, or malnutrition

Specifically - patient who had mild aggregation defect with ADP which corrected in third trimester of pregnancy. Would it be appropriate or necessary ...

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

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

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

When it seems fairly certain that this is a drug effect is it something that can just be monitored or requires a change in approach?

If work-up is sent and the patient is found to have a persistently positive antiphospholipid antibody, particularly lupus anticoagulant, would you con...

What parameters/goals/targets do you use?  Do you treat PV, ET, and MF differently?

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

What type, dosage, and duration of treatment do you use? How does your practice change when there is an inhibitor?

What is your preferred agent (DOAC, warfarin, enoxaparin), and is periprocedural bridging necessary?

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

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

Ferritin uptrending >1000, no additional lab abnormalities. HFE wildtype. Too young for age-appropriate cancer screening. Asymptomatic except fatig...

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

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

If so, is there one type of antibody that is more likely to cause this false positive test? 

What is the risk of pregnancy loss in absence of anticoagulation? What would you suggest if the patient had anticoagulation in prior pregnancies and r...

Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?

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

Please specify your approach in elective and emergency surgical situations

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

Patient with high titer acquired FVIII inhibitor with no causative etiology.  Bleeding is well-controlled on emicizumab, but inhibitor has failed...

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

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

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

The patient has no personal history of VTE, but has positive family history of VTE.  Any prophylactic anticoagulation options? How would manage...

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

For instance, if clonal hematopoiesis of indeterminate potential (CHIP) suspected 

Do we prophylactically place patients on anticoagulation after one episode? Besides MRI/MRV brain, are there other diagnostic imaging that should b...

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

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

I.e., what constitutes well-controlled cancer, IBD, nephrotic syndrome, etc. What other diseases do you put in this category (obesity, autoimmune dise...

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

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

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

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

APLA syndrome, obesity, non compliance ruled out and prefers another oral anticoagulation. Is higher dose of rivaroxaban or apixaban an option?

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

Given the rarity of this diagnosis (5-7% of all AL amyloidosis cases), and the prognostic and clinical differences when compared to non IgM-AL am...

Secondary MF such as post-PV, for example. Do you apply the same prognostic scoring systems? 

My experience has been that patients can be neurologically devastated years out from WBRT. In Medical Oncology practice at my institution, we do not r...

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

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

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

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

Should we stop checking factor VIII levels as part of thrombosis workup?

In the setting of no personal or family history and no other risk factors for thrombosis, is systemic anticoagulation warranted if local treatments (e...

How would the approach differ if the patient had a significant bleeding phenotype vs only minor bruising and mucosal bleeding?

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

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

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

In the absence of a VTE would you consider prophylaxis after a surgical procedure? Often non-hematologists order this testing but we are consulted for...

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

FVL heterozygotes are often treated similarly to the general population. Aside from avoiding other VTE risk factors, are there situations where prophy...

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

Do you routinely check IgA anticardiolipin and beta-2 glycoprotein antibody IgA in your practice? And how would a positive result change your manageme...

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

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

How does cirrhosis and/or underlying thrombophilia affect your decision?

Conversion tables suggest starting the new drug with the next dose but do not seem to answer this question (i.e. if switching from rivaroxaban 20 mg d...

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

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

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

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

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

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...

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

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

For example, for outpatients or resource-limited settings with a moderate probability 4-T score (but low clinical suspicion), would you ever consider ...

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

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

Please also discuss the type and duration of anticoagulation.

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

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...

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

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

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

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

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

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

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

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...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 ...

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

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?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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...

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 long after eculizumab infusion would you wait before giving blood transfusions?

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

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

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

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

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

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

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

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

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

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

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

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...

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

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

For a patient with low ferritin, but high TSAT?

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

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

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

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?&...

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

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

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.

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

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

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

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

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

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

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

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

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

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

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...

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

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

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...

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

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

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

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

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

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

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

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

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

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

Especially in a patient without hemophilia or thrombosis history?

Do you only give intrathecal chemotherapy or systemic therapy?

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

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

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

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

In patients who are intolerant to hydroxyurea, anagrelide and interferon

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

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

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

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

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

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

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

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

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

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

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

At what age would you treat an early stage hodgkins lymphoma patient with ABVD + RT (adult treatment) vs OEPA x 2 or AV-PC x 3 (pediatric paradigm)?&n...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Would you give 3 cycles of RCHOP followed by consolidative IFRT or 6 cycles of R-mini CHOP? Is there a role for 3 cycles of R-mini CHOP followed by IF...

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

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

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

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

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

I.e., Can day 2 Rituximab (RCHOP) or day 6 Rituximab (DA-EPOCH, Hyper CVAD) be given? Or should only Day 1 Rituximab be used with chemoimmunotherapy i...

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

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

Since ECHELON-1 trial showed an improvement in PFS (but not OS), are there any situations where you would replace bleomycin with brentuximab...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Shanafelt et al. recently presented results from the phase III E1912 study at ASH 2018. Will you still utilize FCR as first-line or now use Ritux...

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

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

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

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

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

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

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

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

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

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

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

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

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

Does the more recent data regarding the continued utility of brentuximab vedotin and the utility of PD-1 inhibitors factor in to your reasoning at all...

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

Does it differ from the treatment of other relapsed peripheral T-cell lymphomas? Are there any clinical trials or case series focused on SPTCL? Is t...

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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