Questions discussed in this category
DLCO 65% that is of unclear etiology but not due to disease and no cardiac or pulmonary functional limitations.
Given nationwide shortage in vinblastine, several of my patients under active therapy are facing delays in their therapies. Is it appropriate to subst...
Are there other mutations/biomarkers in CLL which may specifically predict for response or resistance to pirtobrutinib?
Given pelvic RT is likely to induce ovarian dysfunction/menopause, would you consider systemic options?
Do you have a preference on the regimen or cycle number, and how and when do you assess response prior to transplant?
Does age influence your choice of regimen?
Would you continue R-CHOP or would you switch therapy?
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...
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...
Are there characteristics which could help identify whether a follicular lymphoma might behave more indolently vs aggressively and inform treatment se...
Is the data sufficient to change your practice?
Does cumulative exposure to BTKi increase potential risk of cardiac toxicity?
Should pirtobrutinib be viewed as a bridge to CAR-T or transplant or a destination therapy?
How do you predict which patients may be in a high risk group and less likely to benefit from a second BTKi?
Is there a specific Ki67 percentage? P53-negativity?
How do you pursue fertility preservation in younger females with this presentation?
Are you more inclined to use non cytotoxic regimens such as R2 or PI3K inhibitors?
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...
240-300 mg/m2 prior exposure. How would your management change in young fit/older individuals with comorbidities? Would you obtain interval TTE during...
Would your approach differ for a 30 year old and a 70 year old?
Do you incorporate PEG-asparaginase or brentuximab vedotin (for CD30-expressing malignant cells) into anthracycline-based induction regimens? Do you c...
Would you biopsy another site or treat the patient?
How do you choose between CAR-T and autoSCT, for example?
It is understood that the trial's experience was to keep on treatment indefinitely until progression or unacceptable toxicity. We are asking about rea...
Or would you sequence a different BTKi?
Would you intercalate HD-MTX with her CHOEP?
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...
Are there agents (eg. bendamustine) or modalities to avoid?
Does washout times prior to collection vary between modalities?
How do you determine whether to add intrathecal chemotherapy in patients with +CSF? Would your approach change for primary vs secondary CNS lymphoma?
What treatment margins/set-up/on-board imaging would you use?
If radiation is indicated, what dose would you use?
How do you assess if a patient may be a candidate for CAR-T cell therapy?
Does this differ for a patient who had a longer remission before relapse?
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-...
Would you utilize radiation along with systemic therapy?
The CALGB regimen is quite complicated.
Does the safety profile impact your choice significantly?
Does your first choice vary by disease histology?
Given the rarity of this diagnosis (5-7% of all AL amyloidosis cases), and the prognostic and clinical differences when compared to non IgM-AL am...
My experience has been that patients can be neurologically devastated years out from WBRT. In Medical Oncology practice at my institution, we do not r...
If so, what regimen do you utilize?
Would you give R-CHOP without knowing if there was use of prior anthracycline?
Do you have a preferred sequence of therapies for diffuse skin limited MF?
What about changing standard regimens for TCL with HLH?
How does your treatment approach vary depending on the underlying predisposition?
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...
Is there any role for radiation therapy alone?
If the patient cannot tolerate methotrexate or further chemotherapy, how effective is radiation therapy (e.g. WBRT) in rendering the patient disease-f...
Ki67 = 90% with multiple small nodes on PET scan and normal CBC
Patient in mid-30s with no major medical history presented with isolated left neck swelling. Incisional biopsy w/ HTLV1/2 associated ATLL, Ki67 of >...
Do your recommendations differ between those who receive ABVD and escalated BEACOPP?
Do you recommend consultation with fertility specialists for all...
How does age play a role in this decision? If you do intensify therapy, how do you explain the negative results of CALGB/Alliance 50303?
Does the rate of progression of IgM influence your decision?
Would you use ALK inhibitors such as crizotinib based on recent phase II data?
Are there any research efforts to combine ALK inhibitors with current ...
Are there any subsets of patients that you're more inclined to offer maintenance?
In particular, for frail patients to avoid toxicity or for those that do not want chemotherapy
Are there other regimens you employ for patients unsuitable for standard chemotherapy?
Do you prefer a cHL chemotherapy backbone or PMBL chemotherapy backbone?
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 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?&...
Have the RAPID or CALGB 5064 studies changed your treatment approach?
When do you consider splenectomy? Is there a role for splenic radiation in non-surgical candidates?
An otherwise healthy patient with spleen only diffuse large B cell lymphoma with mild spleenomegaly, Spleenectomy plus Rchop or Rchop plus RT?
Bulky adenopathy compressed bilateral ureters, CrCl < 30, post stent placement, but renal function has plateaued
NCCN recommends either ISRT with rituximab/chemotherapy or ISRT alone in this scenario. What factors help your decision making?
Do you only give intrathecal chemotherapy or systemic therapy?
Do you treat as you would a B-ALL? Does amount of nodal stations/disease matter?
What are the scenarios in which a rebiopsy is warranted for follicular lymphoma?
CT scans show omental and pelvic disease.
Would you consider this refractory disease and go on to salvage regimen and auto-SCT, or is there a role for definitive XRT to the site of residual di...
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...
Is there a preference for obinutuzumab over rituximab in early relapsed DLBCL, or in primary refractory disease?
What if the patient has a history of confirmed COVID-19 but has since recovered?
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...
How do you decide between WBRT, maintenance chemotherapy, or stem cell transplantation?
There are conflicting reports of increased incidence of bleomycin-induced lung toxicity with G-CSF.
There are multiple regimens including IGEV and most recently reported results of BEGEV without preference on NCCN guidelines.
Risk of CNS relapse in a reported series is less than 5%.
Given the rarity of DLBCL with MYC/BCL2/BCL6 rearrangements, do you approach this disease differently than DLBCL with MYC/BCL2 or BCL6 rearrangement, ...
Would you monitor or directly offer systemic therapy?
Would your choice be affected by which high risk features the patient has (eg. double- or triple-hit status vs IPI score of 3-4)?
There is a national shortage of vincristine.
There are multiple options that carry a category 2B recommendation in the NCCN guidelines. Does germinal B center type vs activated B-cell type play a...
Do these events mandate discontinuation of lenalidomide therapy or switching to a different agent? Can appropriate therapy for these skin cancers be r...
(ie Deuvelle criteria 1-3) Is it appropriate to discontinue brentuximab like you would with bleomycin?
Specifically, do you consider repeating maintenance therapy after second line therapy if a patient had already received 2 years of maintenance rituxim...
Specifically, do you utilize 3 cycles of chemo with ISRT or 6 cycles? Do you use R-EPOCH or R-CHOP in these cases?
e.g. mixed indolent/aggressive NHL, mixed NHL/HL? Is there a definitive way to discern composite from transformation? NCCN does not list recommendatio...
Have you changed your practice based off the FLYER trial presented at ASH 2018?
How would you handle high risk features (eg double hit) with the limitations of dialysis?
Although not approved, for example, are you every using AVD-nivolumab?
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...
Assuming the patient has an indication for treatment.
Assuming there are no other indications at the moment.
Some specific questions:
Would you recommend repeat biopsy to confirm residual disease?
How would your recommendations vary if the patient had pre...
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...
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...
Pathology is clear this is not a concurrent DLBCL and is indeed transformed CLL
I have received inquiry from a patient's gastroenterologist regarding use of Entyvio or Stelara in such a situation.
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)?
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...
Do you use etoposide-based regimens such as R-CEPP? How about substitution with liposomal doxorubicin?
How about if disease is found in the CSF?
Would you consider switching regimens?
Would you treat differently for de novo disease vs disease arising from large cell transformation of an indolent NHL?
Does their candidacy for autologous HSCT affect your decision to use maintenance lenalidomide?
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...
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...
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 ...
Would you consider resection? Or maybe anti-CD20 monoclonal antibody?
If filgrastim, how many days would you give? Pegfilgrastim is often not covered by payers if given less than 14 days before chemotherapy.
Specifically I am thinking if a PET scan shows complete response, would it be reasonable to stop bleomycin and continue AVD?
PET/CT/bone marrow biopsy negative for evidence of distant disease. Following 4 cycles of combination chemotherapy with no evidence of progressive dis...
With the advent of many new agents, any thought to initial therapy different from CHOP or CHOEP?
Although bendamustine + rituximab is a standard option for advanced follicular lymphoma when treatment is required, does the regimen rituximab + lenal...
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, is there still a role for dd RCHOP followed by ICE, or do you recommend DA-R-EPOCH for all patients?
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 with stage I, low grade follicular lymphoma achieves a complete response after rituxan and treanda is there any role for consolidative ra...
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