Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
Should FISH studies be repeated when CLL patients under active surveillance have progressive disease warranting treatment?
FISH studies should be performed on a newly diagnosed patient with CLL as well as those who have progressive disease and now warrant additional therapy. It is important to identify those patients who may have acquired additional cytogenetic abnormalities due to clonal evolution/resistance/etc as thi...
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?
CLAG-M (cladribine, Ara-C, mitoxantrone, with G-CSF priming)
What is the best treatment management of low grade early stage follicular lymphoma of the mesentery?
If a patient has a single mesenteric mass or lymph node that is demonstrated to be low-grade follicular lymphoma after biopsy, and there is no evidence of disease elsewhere by PET-CT or bone marrow biopsy, then definitive RT (24-30 Gy) would be appropriate. Mesenteric lymph nodes can be more challen...
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?
The role of involved site radiotherapy after effective chemotherapy is to treat sites of previously known disease, not to address unknown regions of micrometastatic disease. If the gross disease was confined to the cervix and/or uterus, a hysterectomy is an acceptable substitute for consolidative ra...
What dose/fractionation schedule should be used for adjuvant RT after surgical decompression of a spinal cord compression from multiple myeloma osseous lesions?
Although myeloma is radiosensitive, since it has caused metastatic epidural spinal cord compression, I will still offer 30 Gy in 10 fxs or 37.5 Gy in 15 fxs, a dose closer to a definitive dose for plasma cell tumors, in order to provide a more durable local control. See variant 2:ACR appropriateness...
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?
DLBCL arising from a low-grade lymphoma, typically follicular lymphoma, is relatively common. It occurs at a rate of 2-3%/year. Presumably, in this case the patient had an undiagnosed FL with early transformation. Review of the pathological specimens may shed light on this possibility. In any case, ...
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?
Does radiation improve bone health and allow for healing of a pathological fracture in a patient with multiple myeloma refusing surgery?
Radiation for myeloma lesions does allow for recalcification of lytic lesions about 50% of the time. There is a suggestion that higher doses increases the degree of recalcification (increasing doses from 20 Gy to 30 Gy increased recalcification by 12% according to Matuschek C et al. Radiat Oncol. 20...
What is your preferred approach to a patient with newly diagnosed primary mediastinal B-cell lymphoma in the upfront setting?
I recommend DA-R-EPOCH in almost all patients. For the rare patients with stage 3-4 disease, I consider RCHOPx4 followed by ICE (unpublished data from Memorial Sloan Kettering).
How do you manage severe cytarabine syndrome in AML patients, manifesting as severe hypotension, fevers, rash, and myalgias?
The cytarabine syndrome is a well-described (Castleberry et al. (1981) Medical and Pediatric Oncology 9:257) syndrome mediated by pro-inflammatory cytokines that are associated with fever, hypotension, rash, and often renal failure. In my experience, its most severe manifestations occur when a patie...