Questions discussed in this category
Is there a role for nelarabine and venetoclax in this setting?
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...
Patient developed atrial fibrillation on Ibrutinib, severe fatigue and intolerance to Zanubrutinib and a maculopapular rash (grade 2) on Acalabrutinib
If yes, would you go with Zidovudine monotherapy versus combining with interferon-alpha? And what would be the preferred dose and duration?
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...
Have you changed your practice given BMT-CTN 1506/Morpho results?
Would you utilize maintenance therapy in patients who achieve MRD- remission?
How does graft source, conditioning regimen, and indication for transplant affect your decision regarding G-CSF?
Is there a specific tyrosine kinase inhibitor that you would prefer to use?
At the time of count recovery or do you continue it throughout induction and consolidation?
Comorbidities: morbid obesity, diabetes, hypertension
The patient also has transfusion-dependent anemia secondary to the LGL leukemia.
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...
Work-up was performed for isolated anemia which resolved to >11 g/dl after the reversible cause was treated.
For a pediatric patient with B-ALL who needs elective surgery during maintenance, what are potential treatment options during the month recommended fo...
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?
Data exists for imatinib Dasatinib and nolotinib
Presuming there are no matched unrelated donors.
What would you want community oncologists to know when following these patients? Are there any other special issues to follow especially in AYA?
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>...
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...
It is understood that the trial's experience was to keep on treatment indefinitely until progression or unacceptable toxicity. We are asking about rea...
For patients not on study, would you consider replacing missed doses of peg with a non-asparaginase based chemotherapy?
There are conflicting reports whether it contributes to renal insufficiency. If you do switch, what is your preferred TKI in this scenario?
If indefinite treatment is recommended, is there an optimal maintenance dose?
Would you use a trial of dexamethasone for a patient with thrombocytopenia?
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?
What is the role of PD-1 inhibitors after CAR-T infusion, either as maintenance therapy or in the setting of relapsed disease?
Does the safety profile impact your choice significantly?
Does your first choice vary by disease histology?
The said patient has been on Imatinib for 2.5 years and is In MMR. Last rt-PCR was 0.04.
If not, what instructions do you give to patients regarding checking temperature at home/return precautions?
What would you consider as contra-indications to Cladribine?
Are there other supportive care interventions that would otherwise be covered by hospice?
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...
Especially with the current drug shortage of nelarabine.
Is it safe to challenge with other CD20 monoclonal antibodies such as obinutuzumab?
Would you plan straight pediatric dosing using 2500 Units/m2 or a cap of 3750 Units as used in some adult ALL regimens due to excess liver/pancreas to...
Is Ommaya placement with CNS-directed therapy preferred to intrathecal or cranial irradiation? How do you interweave this therapy with systemic therap...
Relapsed disease occurred 3.5 years after initial treatment
Many patients have had prior chemotherapy exposure with newly diagnosed AML that may not have classic therapy-related cytogenetics. How do you a...
Patient's leukemia has both T and Myeloid lineages
Does the absence of an OS benefit in the AG221-AML-005 presented at ASCO 2020 deter you from this strategy?
Would you consider “bridging” therapy with something like an HMA?
Is it at neutrophil recovery, at documentation of CR on bone marrow biopsy, or is there a different point in time?
Does acute leukemia sub-type affect your decision?
What is your preferred treatment?
For instance, would you discontinue when there is resolution of adenopathy and normalization of counts? If so, do you overlap ibrutinib with other the...
The NCCN recommends both regimens.
Do you limit it to post-pubertal patients? Do you offer it only if they will proceed with bone marrow transplantation after CAR-T?
Or do you consider addition of this agent in the re-induction setting for refractory disease?
If the patient has not experienced significant infectious complications? If so, what agent?
For instance, do you ever start with dasatinib 50 mg daily? Are there any titration schedules that you follow?
if so, are there specific cytogenetic, molecular, clinical, or hematologic factors that you take into consideration?
Thrombosis was ruled out and no etiology was found. Would you start ponatinib back at a lower dose, transition to omacetaxine or begin transplan...
Would this affect your decision regardless of the stage and symptoms?
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.
FDA package insert lists posaconazole as strong cyp3A4 inhibitor and states to consider other therapies.
Can it be added after 2 or 3 cycles of HMA?
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?
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...
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 ...
Do you have experience administering these agents in the outpatient setting?
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 ?
Do we continue the hypomethylating agent indefinitely?
Technically, you can have up to 55% of larger cells circulating and still be called CLL.
How do you choose between 3 and 4?
Do you follow treatment guidelines for indolent lymphoma or CLL? How do you get 17p testing on someone with only lymphadenopathy?
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...
In the absence of any other classic CLL indications for treatment.
Would it change your management if patient if IgVH mutated?
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, 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?
Specifically, do you just wait for count recovery? Do you check for morphologic or molecular remission at all during this time?
What re-induction regimen without cytarabine or an anthracycline is likely to be most effective?
What is the utility of repeating FISH studies to evaluate for clonal evolution if FISH studies were done at diagnosis?
What dose do you recommend?
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