Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
In classical hodgkin's lymphoma patients with a postive PET after 2 cycles, are you routinely transitioning to escalated BEACOPP?
Based on the study by Johnson Et al. NEJM 2016 that would be an appropriate action and a strategy that most academic centers undertook prior to the Echelon 1 study. This early in the treatment algorithm to consider either agent although you could consider the combination based on the recent blood p...
What is your approach to treating newly diagnosed plasma cell leukemia?
For fit patients, I am very aggressive in treatment; I use VDTPACE x 2 cycles followed by tandem transplant, then maintenance therapy using a PI and an IMiD, per our observation that showed better results comparing to those who had one transplant. I had no updates on newer agents to use upfront such...
Do you routinely do imaging on patients to look for intrathoracic or abdominal lymphadenopathy in newly diagnosed patients with CLL?
As a general rule, I do not routinely obtain CT imaging studies in all newly diagnosed CLL cases, noting that the Rai and Binet staging systems still widely used today are based on clinical assessments of palpable lymphadenopathy and splenomegaly, and do not require radiographic imaging for completi...
Under what circumstances do you consider double autologous stem cell transplants for patients with multiple myeloma?
I agree. In addition, light chain disease and extramedullary manifestations can present with aggressive disease. However, in the right patient with aggressive disease, there are also other options to consider-including an allogeneic PBSCT or CAR-T on protocols.
What are some preferred steroid sparing regimens for untreated multiple myeloma patients who have type 1 diabetes mellitus?
The amount of dexamethasone used in current regimens is less than historical regimens of 40 mg daily x 4 days, etc. based on an ECOG trial comparing 40 mg weekly to the older standard (both in combination with Revlimid) https://www.ncbi.nlm.nih.gov/pubmed/19853510. Nevertheless, the amount is still ...
How do you approach treating a patient with IgM-AL amyloidosis?
Good question. As pointed out, about 5% of lymphomas have a diagnosis of lymphoplasmacytic lymphoma (aka Waldenstroms) instead of a plasma cell dyscrasia. Small burdens of LPL can be difficult to detect unless specific testing is done (e.g., flow for clonal B cells) and intraclonal differentiation (...
What is your approach to treating relapsed subcutaneous panniculitis-like T-cell lymphoma?
Over the years the SPTL has been characterized better and the latest WHO lists it under PTCL with an α/β T-cell phenotype (SPTL-AB) and this has to be distinguished from primary cutaneous TCL with a γδ T-cell phenotype (PTCL-GD). Since they are so rare a workshop of the multidisciplinary EORTC Cutan...
How early have you been able to detect a response with CAR-T in patients with relapsed DLBCL?
Responses to CAR-T cell therapy is generally very rapid. As seen in the ZUMA-1 trial median time to response was 30 days. Having said that there are patients in whom continued responses can be seen as late as 5-6 months post therapy, so patient who are in a PR at 1 month, it may be reasonable to jus...
If you decide to discontinue TKI after prolonged molecular remission in CML, how often would you follow the BCR/ABL after discontinuation?
The NCCN has updated the guidelines and included specific and detailed criteria for TKI discontinuation. Per the NCCN guidelines: "Monthly molecular monitoring for one year, then every 6 weeks for the second year, and every 12 weeks thereafter (indefinitely) is recommended for patients who remain in...
What is an appropriate dose for definitive radiation of a stage IE EBV+ polymorphic B-cell lymphoproliferative disorder?
This is a very unusual presentation for EBV associated polymorphic B-cell lymphoproliferative disorder as most cases are seen in the post-transplant or other immune-compromised patients. In immuno-competent patients, this condition is felt to be related to immune senescence. The range of clinical be...