Lymphoma&nbsp;&nbsp;&nbsp;

Given the data from SWOG 1826 suggesting that Nivo-AVD is likely the preferred regimen for advanced Hodgkin lymphoma patients, are there scenarios where BV-AVD may still be preferred?

Is your standard of care for newly diagnosed advanced classical Hodgkin now nivolumab-AVD based on SWOG 1826?

How do you time CSF analysis for suspected CNS lymphoma in patients who are on steroids?

What chemotherapy, if any, would you offer for an elderly patient with congestive heart failure with completely excised Stage I classical Hodgkin lymphoma?

What about if the patient has mediastinal disease and ISRT is not an option?

For a patient with ENKTL nasal type (nose/sinus involvement) who has hepatic toxicity with pegasparaginase but a CR after 2 cycles of chemotherapy with a plan for "sandwich" radiotherapy - what, if any, chemotherapy would you resume after completion of radiation?

I am not sure there is much efficacy for a regimen that does not include asparaginase. The patient received 2 cycles of P-GemOx, then was admitted for...

When would you use AVD + brentuximab instead of ABVD for newly diagnosed stage 3 or 4 Hodgkin lymphoma?

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

When would you consider treating an asymptomatic patient with follicular lymphoma?

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

Can acalabrutinib be used after ibrutinib failure in relapsed/refractory mantle cell lymphoma?

Or would you sequence a different BTKi?

5 Answers available

How would you consolidate a patient with primary refractory double hit lymphoma with secondary CNS involvement?

At the time of initial diagnosis, there was no clear CNS involvement. When it became clinically apparent disease was refractory to EPOCH, there was CS...

For patients diagnosed with T-cell lymphoblastic lymphoma with CNS involvement (CSF), what is your approach to the typical schedule for IT chemotherapy?

How do you incorporate radiation therapy in patients undergoing CAR T-cell therapy for DLBCL?

How would you treat an elderly patient with Stage IIA cHL with 3 nodal sites of involvement who has a contraindication to bleomycin?

DLCO 65% that is of unclear etiology but not due to disease and no cardiac or pulmonary functional limitations.

Is it appropriate to substitute vincristine for vinblastine in ABVD for systemic therapy of Hodgkins lymphoma?

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

How would you treat an elderly newly diagnosed tDLBCL that has previously seen R-CHOP and Bendamustine-Obinutuzumab prior to the transformative event?

7 Answers available

What chemotherapy regimen would you offer to a patient with DLBCL who was originally diagnosed and treated (R-CHOP) 15 years ago, now with a 2nd primary/late recurrence of DLBCL?

What cardiac surveillance would you do for an asymptomatic male patient with a remote history of mantle field radiation for Hodgkin's lymphoma?

Does tolerance of prior BTKi therapy or specific agent used (e.g., ibrutinib, acalabrutinib) influence your starting dose of pirtobrutinib?

How does pirtobrutinib compare to other available therapies for relapsed/refractory CLL after BTK inhibitor treatment, particularly in terms of efficacy and tolerability?

What post-protocol therapies did patients on the BRUIN trial in CLL receive, and how did these therapies impact outcomes?

How do CLL patients with downstream treatment-resistant mutations such as PLCG2 respond to pirtobrutinib?

Are there other mutations/biomarkers in CLL which may specifically predict for response or resistance to pirtobrutinib?

For patients with primary CNS lymphoma and less than a CR to chemotherapy, in what situation would you consider partial or focal radiation?

How would you treat an elderly male with history of mantle cell lymphoma who relapsed after chemoimmunotherapy and cBTKi w/ multiple co-morbidities including CKD and CHF w/ low EF?

What is your preferred second line regimen for follicular lymphoma that has relapsed four years out since receiving BR?

Would you consider replacing ibrutinib with acalabrutinib or zanubrutinib in the TRIANGLE regimen for MCL in a patient with atrial fibrillation or high risk coronary syndromes who is otherwise fit for aggressive induction therapy?

TRIANGLE study

How would you manage a patient with p53 mutated MCL who has progressed after a BTKi and CAR-T with a CD20 negative clone?

How do you approach delivering ISRT to nodular lymphocyte predominant Hodgkin Lymphoma that has responded on FDG-PET/CT after chemotherapy?

Does the stage at diagnosis affect your decision?

How would you manage a pre-menopausal woman with extranodal marginal zone lymphoma confined to the bladder wall?

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

What is your preferred salvage therapy for patients with follicular lymphoma who relapsed within 24 months of completing front-line chemoimmunotherapy (POD24) and will proceed to high-dose therapy with Auto-SCT?

Do you have a preference on the regimen or cycle number, and how and when do you assess response prior to transplant?

What is your preferred induction regimen prior to allo-HCT for mantle cell lymphoma?

What is your frontline treatment of choice for patients with systemic and secondary CNS involvement by DLBCL?

What is the optimal choice of therapy for a patient with Hodgkin variant of Richter's transformation from underlying CLL/SLL?

Does age influence your choice of regimen?

How would you manage a primary dural low-grade lymphoma?

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

How would you treat a patient who received 2 cycles of R-CHOP for DLBCL who was subsequently diagnosed with follicular lymphoma?

Would you continue R-CHOP or would you switch therapy?

How would you treat an older patient with B symptoms and biopsy consistent with grade 3 follicular lymphoma but noted to have a PET scan with SUV readings of > 20?

How would you manage a case of subcutaneous panniculitis-like T cell lymphoma (A/B) who is already on steroids and methotrexate for autoimmune disease?

How would you manage biopsy-proven DLBCL in a patient who was treated with 6 cycles of R-CHOP 15 years ago for DLBCL?

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

How would you manage a young patient with HL who develops HF (EF < 30%) after 4 cycles of A+AVD who obtained a PET2 CR?

How do you approach CNS prophylaxis in patients with DLBCL?

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...

How would you treat a patient with Hodgkin lymphoma who has an isolated relapse within the CNS?

What is your preferred third-line therapy for a fit patient with symptomatic, relapsed follicular lymphoma who has failed bendamustine-rituximab and lenalidomide-rituximab?

How would you manage a patient with NLPHL and CKD who relapsed after a long disease free interval (i.e. 7 years) following bendamustine?

Would you offer XRT as bridging for all patients with limited pre CAR-T disease or as consolidation for only those with residual PET-avidity on day+30 post CAR-T?

How would you manage relapsed DLBCL in a patient who received second line CD19 CART treatment?

Is there an optimal salvage radiation dose for relapsed post-CART disease?

What are your practical considerations for incorporating bispecific antibody therapy into treatment of relapsed DLBCL?

How are you deciding between available third line therapies for post-transplant relapsed DLBCL?

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? ...

How should community oncologists practically counsel patients with aggressive lymphomas on the potential treatment course as they move into 2L/3L therapies?

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...

What salvage chemotherapy, if any, would you recommend for a patient with primary refractory DLBCL who progressed after two cycles of R-CHOP?

5 Answers available

What is the preferred treatment for a patient with an EBV+ monomorphic PTLD (DLBCL) not currently on immunosuppressive therapy?

Following the BRUIN data in mantle cell lymphoma, will you routinely treat with pirtobrutinib following a covalent BTKi?

Is the data sufficient to change your practice?

Will you recommend pirtobrutinib following a prior covalent BTKi in patients with cardiac comorbidities?

Does cumulative exposure to BTKi increase potential risk of cardiac toxicity?

What subsequent therapies did patients receive after progressing on pirtobrutinib in the mantle cell BRUIN trial population?

Should pirtobrutinib be viewed as a bridge to CAR-T or transplant or a destination therapy?

Are there biomarkers or other factors to help predict which patients with MCL are most likely to benefit, or not, from pirtobrutinib following a prior covalent BTKi?

How do you predict which patients may be in a high risk group and less likely to benefit from a second BTKi?

What are the factors that convince you to not immediately treat mantle cell lymphoma and to follow a course of "active surveillance"?

Is there a specific Ki67 percentage? P53-negativity?

How do you manage grade 1-3A Follicle Center Lymphoma of the lower female genital tract, presenting with a cervical mass?

How do you pursue fertility preservation in younger females with this presentation?

How do you choose between axicabtagene ciloleucel and tisagenlecleucel in patients with follicular lymphoma for whom you are recommending CAR T-cell therapy?

What treatment considerations do you make for elderly patients with relapsed/refractory follicular lymphoma?

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

What therapy do you usually choose in patients with previously treated follicular lymphoma who experience early relapse (< 2 years)?

What factors do you consider when sequencing bispecific T-cell engaging antibodies and CAR T-cell therapies for the treatment of follicular lymphoma?

How would you treat a BTKi naive p53 mutated MCL in 1st relapse with disease noted both systemically and in the CNS?

When do you recommend consolidative XRT for patients with advanced stage (III-IV) DLBCL who achieve CR to chemoimmunotherapy?

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...

In patients with early-stage follicular lymphoma undergoing definitive RT, do you approach grade 3a disease any differently than grade 1-2 (radiation dose, fields/margins, systemic therapy)?

How would you approach treatment for a R/R mantle cell lymphoma patient with a history of autoimmune hepatitis who has progressed on both a covalent and non-covalent BTKi?

What is the preferred initial therapy for T-cell lymphoblastic lymphoma in non-AYA, non-elderly adults?

How would you approach therapy for a patient with newly diagnosed non-GC DLBCL with previous anthracycline exposure?

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

How would you approach therapy for a patient with symptomatic secondary CNS marginal zone lymphoma, but with low-volume systemic disease that would otherwise not warrant therapy?

Would your approach differ for a 30 year old and a 70 year old?

How often should you screen for lymphoma in patients with primary Sjogren's syndrome?

How would you treat DLBCL of the terminal ileum in an otherwise healthy patient?

What is your approach to curative-intent therapy for a young, fit patient with newly-diagnosed monomorphic epitheliotropic intestinal T cell lymphoma (MEITL)?

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

How do you approach a cervical node biopsy-proven follicular lymphoma in situ in a symptomatic patient with night sweats and PET findings of low SUV uptake throughout the body?

Would you biopsy another site or treat the patient?

In light of the TRIANGLE data at ASH, how should we now approach a transplant-eligible patient with a new diagnosis of aggressive mantle cell lymphoma?

How would you manage a transplant-eligible patient with DLBCL who relapsed 6-12 months following a CR1 to R-CHOP and then attained a CR2 to platinum-based salvage chemoimmunotherapy?

How do you choose between CAR-T and autoSCT, for example?

How would you treat a fit patient with a history of relapsed CLL who now presents with Richter transformation s/p autologous anti-CD19 chimeric antigen receptor (CAR) T-cells?

Would it be reasonable to offer a patient with CLL a treatment break from acalabrutinib or any BTK inihibitor after a period of time, assuming good response?

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 do you manage bruising in patients on ibrutinib?

7 Answers available

How would you approach therapy for a transplant-eligible patient with peripheral T cell lymphoma NOS who experiences early relapse after CHOEP, but achieves remission to salvage therapy?

Would you still go to auto or consider allo?

How would you approach treating a patient with active rheumatoid arthritis and a history of treated lymphoma that is currently in remission?

Given the controversy in the literature regarding TNFi or MTX associated lymphoma in patients with RA.

How would treat a patient with good performance status with PTCL-NOS found to have leptomeningeal disease during treatment course with CHOEP?

Would you intercalate HD-MTX with her CHOEP?

How would you treat lymphoplasmacytic lymphoma (LPL) with a non-IgM paraprotein?

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

What is your preferred BTK inhibitor for patients with relapsed/refractory mantle cell lymphoma?

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

How would you approach mantle cell lymphoma in very elderly patients?

How would you confirm the diagnosis of splenic marginal zone lymphoma without utilizing splenic biopsy or splenectomy?

How do you choose bridging therapy prior to CAR-T leukapheresis?

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

How would you treat a patient with recurrent DLBCL 15 years after definitive treatment of initial de novo disease with R-CHOP?

How would you manage a CLL patient with Richters transformation that is resistant to R-CHOP with transfusion dependent cytopenias and a marrow demonstrating significant involvement by DLBCL and CLL?

Is concurrent intrathecal therapy necessary with HD-MTX for CNS lymphoma?

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

How would you approach a young patient with stage I follicular lymphoma of the mesenteric lymph nodes?

What treatment margins/set-up/on-board imaging would you use?

What is your approach in a fit patient, advanced stage, bulky classical Hodgkin lymphoma who has decreased disease burden in areas but a persistent, hypermetabolic (Deauville 5) anterior mediastinal mass following two cycles of AAVD?

How would you approach a patient with high-grade gastric lymphoma who achieved a CR following chemotherapy?

If radiation is indicated, what dose would you use?

How does your surveillance for DLBCL change given the new role of CAR-T in 2nd line treatment?

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

What is the best approach for patients with DLBCL with early relapse (< 6 months) after initially attaining a CR with 6 cycles RCHOP?

Does this differ for a patient who had a longer remission before relapse?

How do you prepare patients with DLBCL on the potential need for cellular therapies after progression on first line regimens?

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

How do you incorporate CAR-T cell therapy for DLBCL in transplant-eligible patients?

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

How would you treat an elderly patient with CD30 negative PTCL NOS involving base of tongue, vallecula and bilateral cervical lymph nodes?

Would you utilize radiation along with systemic therapy?

How do you treat a young woman of child bearing age group diagnosed with primary CNS lymphoma?

The CALGB regimen is quite complicated.

If a patient had a grade 2 infusion reaction to initial dose of IV Rituximab, can you give subcutaneous Rituximab for cycle 2 or continue with IV Rituximab?

How do you choose which BTK inhibitor to use in NHL?

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

How do you approach treating a patient with IgM-AL amyloidosis?

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...

For primary CNS lymphoma, when do you refer for whole brain radiation therapy (WBRT)?

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...

How would you approach therapy for a patient with a history of classical HL who achieved a CR to 6 cycles of Brentuximab plus AVD who now presents with widespread non-GC DLBCL?

How would you approach therapy for BR-refractory Waldenstrom Macroglobulinemia when there is a mixed response to zanabrutinib?

What treatment would you recommend in an older patient with multiply relapsed double-hit lymphoma with recurrence following ASCT, pola-BR, and CAR-T therapy?

How would you treat a patient with blastoid mantle cell lymphoma with hepatic involvement causing significantly elevated bilirubin?

Would you recommend allogeneic stem cell transplantation for consolidation in a patient with follicular lymphoma who relapsed within 13 months of initial chemo-immunotherapy?

What is the optimal treatment for a fit, elderly patient with NGC diffuse large B cell lymphoma that recurred about 1 year after dose-attenuated R-CHOP?

How would you treat gray zone lymphoma which initially achieved a CR after 2 cycles of DA-R-EPOCH, but end-of-treatment PET demonstrates progression with new sites of biopsy-proven disease?

Are BTK inhibitors safe to use in patients with severe renal failure?

eg. eGFR < 30 ml

Do you avoid using tafasitamab in germinal center subtype diffuse large B-cell lymphoma?

For primary MZL of the breast, do you do whole breast to 24 Gy or ISRT?

Do you routinely offer antiviral prophylaxis for patients receiving chemoimmunotherapy?

If so, what regimen do you utilize?

In light of ALK-directed therapy, what is the role of chemotherapy for patients with newly diagnosed ALK+ DLBCL?

What is current practice for sparing a tissue strip in extremity radiation?

In a refractory DLBCL of entire circumference of leg below knee, how do you spare a tissue strip for lymph node drainage?

How do you sequence therapy in an older patient with newly-diagnosed blastoid mantle cell lymphoma with a 17p deletion?

Do you consider EBUS TBNA in the diagnostic evaluation of patients with mediastinal lymphadenopathy with concern for lymphoma?

How would you approach therapy for relapsed/refractory mantle cell lymphoma restricted to the CNS?

How would you approach therapy for newly diagnosed germinal-center DLBCL who previously received an unknown systemic regimen with radiation for history of Hodgkin Lymphoma?

Would you give R-CHOP without knowing if there was use of prior anthracycline?

How long do you give systemic therapies or skin directed therapies to work before changing treatments in patients with diffuse skin limited mycoses fungoides?

Do you have a preferred sequence of therapies for diffuse skin limited MF?

Does R-CHOP provide durable remission in low-risk pediatric Burkitt or Burkitt-like lymphoma?

What is the role of splenectomy versus systemic therapy in splenic marginal zone lymphoma?

How do you treat primary refractory diffuse large B cell lymphoma in elderly patients with good performance status?

Do you give an etoposide-based regimen/more aggressive therapy for lymphoma-associated HLH, such as da-EPOCH-R over R-CHOP?

What about changing standard regimens for TCL with HLH?

How do you manage severe thrombocytopenia due to splenomegaly and bone marrow involvement in CLL when starting obinituzumab and venetoclax?

How would you treat a young patient with classical intermediate-risk Hodgkin lymphoma who has an underlying DNA repair-deficiency disorder, such as congenital mismatch repair disorder or ataxia telangiectasia?

How does your treatment approach vary depending on the underlying predisposition?

How will you use Pola-R-CHP in the frontline treatment of DLBCL?

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...

How would you approach older patients who are not fit or frail with stage 1 favorable classical Hodgkin lymphoma?

Is there any role for radiation therapy alone?

What is your approach to a patient with an advanced stage diffuse large B-cell lymphoma treated with chemotherapy alone (with a PET CR) who then develops an isolated CNS relapse?

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

How would you manage an asymptomatic elderly frail patient with newly diagnosed mantle cell lymphoma with TP53 mutation?

Ki67 = 90% with multiple small nodes on PET scan and normal CBC

How would you manage a patient with history of follicular lymphoma treated with Bendamustine-Rituximab who now has a new FDG avid lesion that is biopsy proven CD30 positive CD20 negative DLBCL?

What's the optimal management of stage IA nodal ATLL in a young fit patient?

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

How long should patients treated with frontline therapy for Hodgkin lymphoma wait before attempting to conceive a child?

Do your recommendations differ between those who receive ABVD and escalated BEACOPP? Do you recommend consultation with fertility specialists for all...

Would you recommend RT for DLBCL of a pre-isthmus node incidentally found during thyroidectomy for papillary thyroid cancer?

If the patient has received RCHOPx3 and the post treatment PET is negative, what would your management be?

How would you treat newly diagnosed advanced stage Hodgkin's lymphoma in a patient with significant cardiac systolic dysfunction?

What would you recommend in the case of ABVD or BEACOPP?

Would you offer RT to a patient with a stage I low grade follicular lymphoma in the groin/upper thigh (7 cm) s/p complete excision with negative margins?

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

Do you intensify treatment for patients with double-hit lymphoma or double expressor lymphoma?

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?

5 Answers available

What is the optimal initial therapy and management of Erdheim-Chester disease without actionable mutations such as BRAF or MAPK-ERK pathway alterations?

Is there an absolute IgM level, in an asymptomatic patient on surveillance that initiation of therapy would be considered for Waldenstrom's macroglobulinemia?

Does the rate of progression of IgM influence your decision?

Do children with intermediate-risk Burkitt lymphoma benefit from adding rituximab?

What is the role of targeted therapy in relapsed/refractory ALK+ anaplastic large cell lymphoma?

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 ...

Do you offer maintenance rituximab in transplant ineligible patients with mantle cell lymphoma?

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

Can radiation therapy alone for localized recurrence of high-grade B-cell lymphoma be considered for those that previously received rituximab-based chemotherapy?

In particular, for frail patients to avoid toxicity or for those that do not want chemotherapy

Would you consider use of upfront BV plus nivolumab to treat Hodgkin Lymphoma in elderly patients unable to receive standard chemotherapy?

Are there other regimens you employ for patients unsuitable for standard chemotherapy?

How do you treat a low-grade B-cell lymphoma with plasmacytic differentiation (Waldenstrom's) confined to the CNS?

How would you approach treatment of a bulky stage II DLBCL in a patient >80 with a contraindication to anthracyclines but otherwise good performance status?

When do you consider including Rituximab into the treatment regimen for a pediatric or AYA patient with intermediate and advanced-stage nodular lymphocyte-predominant Hodgkin lymphoma?

How do you choose your systemic treatment for primary mediastinal grey zone lymphomas?

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

Would you initiate chemoimmunotherapy (e.g. RCHOP) in a symptomatic patient with DLBCL who tested positive for COVID19?

How would you manage a stage IE DLBCL of the stomach, non-germinal center type by IHC, and Ki-67 of 70%, but negative for double/triple hit by FISH?

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

How do you approach patients with a history of lymphoma in remission who are in need of immunosuppressive (e.g. TNF blockers, 6MP) or other therapies (e.g. JAK inhibitors) for autoimmune disease that have been linked with the development of lymphoma?

How would you time COVID-19 vaccination with someone on R-CHOP chemotherapy?

How would you manage a patient with Stage IVB DLBCL with refractory disease in the retroperitoneum and spleen after 6 cycles of RCHOP?

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?&...

For AYA patients with early-stage Hodgkin's lymphoma being treated with ABVD, how many cycles of chemotherapy do you administer, and when can radiation be avoided?

Have the RAPID or CALGB 5064 studies changed your treatment approach?

Would you offer rituximab maintenance for 2 years after a successful response to induction in a patient with splenic marginal zone lymphoma?

When do you consider splenectomy? Is there a role for splenic radiation in non-surgical candidates?

For incidentally found stage I indolent non-Hodgkin's lymphoma in young patients, which subtypes would more strongly warrant a consideration for curative-intent radiation?

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

Would you consider splenectomy for an early stage l/ll primary splenic diffuse large B cell lymphoma followed by R-CHOP?

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

Would you offer treatment for asymptomatic CLL with WBC of ~300k or greater, high risk cytogenetics, or doubling time of 6-12 months?

How would you treat stage IV DLBCL with severe liver involvement?

How would you approach a fit older (>70 years) with grade I-II, bulky, follicular lymphoma causing ureteral obstruction and renal failure?

Bulky adenopathy compressed bilateral ureters, CrCl < 30, post stent placement, but renal function has plateaued

What is your preferred treatment for non-contiguous Stage IIA Nodular Lymphocyte Predominant Hodgkin's Lymphoma (NLPHL)?

NCCN recommends either ISRT with rituximab/chemotherapy or ISRT alone in this scenario. What factors help your decision making?

Is there any role for post chemotherapy (R CHOP x 6) radiation therapy after a splenectomy for a stage IE diffuse large B-cell lymphoma involving only the spleen?

What if it is a young patient?

How do you define bulky mediastinal disease in Hodgkin's lymphoma?

We have a patient with stage IIa Hodgkin's disease with a cluster of lymphadenopathy in the cervical area. The diameter of the cluster is 6.1cm per CT...

Is it okay to use belimumab to treat SLE in a patient who has a history of lymphoma and is on a Bruton's tyrosine kinase inhibitor (such as ibrutinib)?

How do you approach CNS prophylaxis in double-hit lymphoma patients?

Do you only give intrathecal chemotherapy or systemic therapy?

What is the role of radiation in a patient with stage IV DLBCL with bilateral testicular involvement?

How do you approach B-cell lymphoblastic lymphoma (without bone marrow involvement) in older adults (>65-70 years)?

Do you treat as you would a B-ALL? Does amount of nodal stations/disease matter?

Do you rebiopsy grade 1-2 follicular lymphoma if SUV is high by PET?

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

How would you treat a young patient with symptomatic Rosai-Dorfman disease who has recurrent, life-threatening pericardial and pleural effusions?

CT scans show omental and pelvic disease.

How do you dose chemotherapy (R-EPOCH or R-CHOP) in patients with aggressive lymphoma involving liver leading to elevated bilirubin and liver enzymes?

How would you approach langerhans cell histiocytosis involving a single bone site after resection?

Would you recommend consolidative RT for an HIV-positive patient with Stage I bulky DLBCL of the mediastinum s/p R-EPOCH?

Would your recommendation change if the patient was HIV positive?

How would you approach a patient with advanced stage DLBCL with a single-site of residual FDG-avid disease after completion of R-CHOP in the frontline setting?

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...

Do you offer adjuvant chemoimmunotherapy after IFRT for Stage I to II low grade follicular lymphoma?

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...

Do you routinely recommend consolidative radiation to bulky site(s) in the setting of advanced stage DLBCL?

What frontline treatment would you offer a patient with AITL who is not a candidate for an anthracycline due to baseline cardiomyopathy?

Do you apply PET-adapted therapy (FLYER trial) and omit radiation therapy for older patients (> 60 years) with early stage, non-bulky, DLBCL?

Would you choose a different anti-CD20 antibody in early relapsed (< 6 months) DLBCL treated with rituximab?

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

What is your approach to advanced Hodgkin Lymphoma when bleomycin is contraindicated and infectious complications arise with A-AVD?

What is your preferred induction regimen for primary CNS lymphoma in a young patient?

Would you hold rituximab for newly diagnosed B-cell lymphoma if the patient is COVID-19 positive?

What if the patient has a history of confirmed COVID-19 but has since recovered?

How do you determine whether to treat a young adult with stage IA Hodgkin Lymphoma with the adult or pediatric treatment paradigm?

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...

Should maintenance rituximab be held due to COVID-19 in patients with advanced bulky follicular lymphoma who attain a PR/CR to weekly rituximab?

Would you consider giving ESA for anemia secondary to chronic kidney disease in a patient with follicular lymphoma in remission and on rituximab maintenance?

How do you decide on the modality of consolidative treatment after a CR in primary CNS lymphoma patients treated with a high-dose methotrexate regimen?

How do you decide between WBRT, maintenance chemotherapy, or stem cell transplantation?

In what situations do you utilize G-CSF in germ cell tumors or Hodgkin lymphoma patients receiving bleomycin?

There are conflicting reports of increased incidence of bleomycin-induced lung toxicity with G-CSF.

How would you treat Burkitt Lymphoma during an uncomplicated pregnancy?

What is your preferred salvage chemotherapy regimen for bridge to auto SCT for patients with relapsed classical Hodgkin Lymphoma?

There are multiple regimens including IGEV and most recently reported results of BEGEV without preference on NCCN guidelines.

Would you give CNS prophylaxis to a patient with Waldeyer's ring diffuse large B cell lymphoma if it is not triple or double hit ?

Risk of CNS relapse in a reported series is less than 5%.

How would you approach primary CNS lymphoma in an elderly patient over 80 years old?

How does your approach differ when managing a "triple hit" versus a "double hit" or "double expressor" lymphoma?

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

What is the preferred approach for gastric MALT lymphoma with histologic and radiographic partial response after radiation?

Would you monitor or directly offer systemic therapy?

Is there a role for maintenance lenalidomide after non anthracycline regimens in elderly patients with DLBCL?

Do we need to continue dose escalations wtih DA REPOCH after a negative interim PET scan for PMBCL?

Would you offer consolidative autologous stem cell transplant in CR1 for high risk diffuse large B-cell lymphoma (DLBCL)?

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)?

Would you substitute vinblastine for vincristine in RCHOP?

There is a national shortage of vincristine.

How long do you treat recurrent classical Hodgkin lymphoma with brentuximab/nivolumab if the patient does not want to proceed to BMT?

How do you decide on a salvage regimen for relapsed/refractory DLBCL, assuming a patient is transplant eligible?

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...

What dosing schedule of cladribine do you use for newly diagnosed hairy cell leukemia in need of treatment?

Can a rituxumab biosimilar be used for a high grade lymphoma?

How do you manage patients who develop de novo or recurrent skin cancers (SCC or BCC) while on lenalidomide?

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

What is the preferred approach for giving high dose methotrexate in double or triple hit lymphomas being treated with dA-EPOCH-R?

What volumes do you treat for ISRT for extranodal DLBCL?

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...

Do you consider discontinuing brentuximab in stage III-IV classical Hodgkin lymphoma patients on AVD+brentuximab who have a good response to 2 cycles?

(ie Deuvelle criteria 1-3) Is it appropriate to discontinue brentuximab like you would with bleomycin?

Would you offer consolidative RT to a patient with early stage, non-bulky, high-grade non-Hodgkin's lymphoma of the orbit after 6 cycles of RCHOP + IT chemotherapy?

How do you approach maintenance therapy for relapsed follicular lymphoma?

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

What would be your choice for treatment for an HIV positive patient with no detectable viral load with CD20 negative and CD30 positive DLBCL?

Would you offer maintenance lenalidomide or rituximab in a patient with DLBCL transformed from a marginal zone lymphoma in a young, fit patient?

Do you alter your management of Stage I-II DLBCL if it's double or triple hit?

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

Would you recommend consolidative radiation therapy to an isolated frontal dural MALT lymphoma after complete response to chemotherapy?

How do you treat a composite NHL of various subtypes?

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

Are you de-escalating treatment for favorable risk Stage I-II DLBCL patients to 4 cycles of R- CHOP with 2 additional rituximab cycles?

Have you changed your practice based off the FLYER trial presented at ASH 2018?

How would you approach treatment of DLBCL in a patient on hemodialysis?

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

Is there a role at this time for chemo-immunotherapy in the upfront treatment of classic Hodgkin lymphoma?

Although not approved, for example, are you every using AVD-nivolumab?

When treating DLBCL with induction therapy with R-CHOP, if after 2 cycles, you have a mixed response on PET, would you consider that treatment failure or would you continue R-CHOP?

How would you treat an elderly fit patient with stage IE DLBCL (single skin lesion)?

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...

What is your first line treatment of choice for advanced (stage IIIA) follicular lymphoma, histologic grade 1-2 in an otherwise young healthy patient in 2019?

Assuming the patient has an indication for treatment.

Is a very rapidly rising WBC count ever an indication for the upfront treatment of CLL?

Assuming there are no other indications at the moment.

What is your approach for bulky stage I primary mediastinal B-cell lymphoma in a patient with a positive post-chemotherapy PET-CT (residual mass and Deauville 5)?

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

For inpatient treatment of lymphoma and ALL, can rituximab be delayed?

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...

How do you approach front line treatment for TP53 mutated mantle cell lymphoma?

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

What would be the preferred chemotherapy regimen in elderly patients with advanced stage classical Hodgkin Lymphoma and contraindication to doxorubicin and bleomycin?

Should consolidation autologous stem cell transplant be considered for de novo follicular lymphoma transformation to DLBCL after achieving a PR with R-CHOP x 6 cycles, if residual disease showed original indolent follicular lymphoma?

For an otherwise healthy individual, what would be your front line choice for de novo Richter’s transformation?

Pathology is clear this is not a concurrent DLBCL and is indeed transformed CLL

How would you treat low grade follicular lymphoma with diffuse epidural involvement? Would you give intratheracal or high dose systemic methotrexate in addition to systemic chemoimmunotherapy?

How early have you been able to detect a response with CAR-T in patients with relapsed DLBCL?

How long after high-dose IV methothrexate for chemo-refractory CNS lymphoma do you wait before giving brain radiation?

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

What is your preferred chemotherapy regimen for a fit younger patient with mantle cell lymphoma?

What recommendations do you make regarding the use of biologics for uncontrolled Crohn's disease in patient's who have a history of DLBCL that developed while on infliximab and azathioprine and whose lymphoma is essentially cured?

I have received inquiry from a patient's gastroenterologist regarding use of Entyvio or Stelara in such a situation.

Do you routinely order double-hit assessment in cutaneous DLBCL?

What volume and dose would you use for a Stage I MALT lymphoma of the lung?

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

With new data now available for use of brentuximab in ALK positive, CD30 anaplastic large cell lymphoma, what is your first line regimen?

What CTV margins should be used with early stage favorable Hodgkin's Lymphoma in the illiac chain if they had a complete response on PET after 2 cycles of ABVD?

Should prechemo PET positive disease from bowel or other structures be carved out?

How do you approach fit patients with quickly relapsed Hodgkin lymphoma (disease-free interval less than or equal to one year) after 6 cycles of ABVD and radiation therapy?

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)?

Will you offer Ibrutinib and Rituximab for untreated patients with CLL without a 17p deletion?

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...

Which regimen do you prefer for patients with newly diagnosed DLBCL that are not candidates for doxorubicin secondary to low ejection fraction?

Do you use etoposide-based regimens such as R-CEPP? How about substitution with liposomal doxorubicin?

In which patients with early-stage favorable Hodgkin's lymphoma, if any, would you consider omitting consolidation RT after ABVD chemotherapy?

How do you approach incidentally diagnosed mantle cell lymphoma found on a routine screening colonoscopy?

How would you treat a younger patient with relapsed mantle cell lymphoma after treatment with hyperCVAD?

How about if disease is found in the CSF?

What is your alternative first line approach to follicular lymphoma that requires treatment if initial treatment with BR leads to significant neutropenia despite G-CSF?

Would you consider switching regimens?

How would you treat an elderly, transplant-ineligible patient with recurrent DLBCL?

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

What is your approach to treating limited stage DLBCL of the colon?

What is the role for maintenance lenalidomide in elderly patients with DLBCL?

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

Do you routinely add eight extra rituximab doses to six cycles of R-CHOP in elderly patients with DLBCL treated with miniR-CHOP as done in SMARTE-R-CHOP-14 trial ?

Does anything need to be done if hyperlymphocytosis (i.e. ALC > 300K) develops in a CLL patient just starting ibrutinib?

Does CD5 positivity by itself in DLBCL pose a high risk of CNS recurrence and necessitate CNS prophylaxis?

In classical hodgkin's lymphoma patients with a postive PET after 2 cycles, are you routinely transitioning to escalated BEACOPP?

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...

Do you have a preferred strategy for front line induction therapy in DLBCL patients who have asymptomatic depressed ejection fraction and thus concern about anthracycline dosing?

What is your approach to treating relapsed subcutaneous panniculitis-like T-cell lymphoma?

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...

What is the best dose to treat splenomegaly with pancytonenia in the setting of myelofibrosis?

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

What are your radiotherapy recommendations for a unilateral primary intraocular large B-cell lymphoma following high-dose methotrexate and rituximab?

What factors influence your choice to treat as well as dose and target?

What is an appropriate dose for nodular lymphocyte predominant, stage 1 Hodgkin lymphoma following nodal excision?

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...

How do you approach previously treated grade 1 follicular lymphoma now with transformation to a large cell lymphoma?

What chemotherapy regimen would you recommend for a patient with symptomatic cutaneous B cell lymphoma?

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...

Would you use Ibrutinib plus Venetoclax as second line therapy in relapsed/refractory mantle cell lymphoma?

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...

How would you approach a completely resected DLBCL of the appendix if PET scan and bone marrow biopsy suggest no other disease?

Would you consolidate marginal zone lymphoma transformed to a high grade B-cell lymphoma with a stem cell transplant?

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 ...

How would you approach a Follicular grade 1-2 NHL found on a terminal ileum biopsy with otherwise negative EGD and colonoscopy and contrast enhanced CT scan?

Would you consider resection? Or maybe anti-CD20 monoclonal antibody?

What growth factor would you use with A+AVD, if any at all?

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

Do you prefer a chemo-radiation combination or chemotherapy followed by sequential radiation approach for early stage NK/T-cell lymphoma?

How do you approach the development of an LGL clone in a NHL patient actively getting therapy?

How would you treat stage 3 lymphocyte-predominant Hodgkin Lymphoma that is CD20 negative ?

Are there any indications on advanced stage Hodgkins disease that one might consider stopping the bleomycin after first two cycles?

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

What is the role of radiation treatment of stage IA ALK negative anaplastic large cell lymphoma?

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

What is your approach to the upfront treatment of anaplastic large cell lymphoma, ALK positive, with low IPI score in a young person?

With the advent of many new agents, any thought to initial therapy different from CHOP or CHOEP?

What is the optimal regimen for advanced stage Nodular Lymphocyte Predominant Hodgkin Lymphoma?

Does rituximab + lenalidomide have a role in advanced follicular lymphoma?

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

Do you use anti-microbial prophylaxis when you prescribe ibrutinib?

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

Do you choose to include or omit growth factor support in the treatment of Hodgkins lymphoma?

When determining treatment approach to newly-diagnosed follicular lymphoma (e.g. watchful waiting vs chemotherapy), do you take the intensity of the SUV measurements on PET into account?

What is your preferred approach to a patient with newly diagnosed primary mediastinal B-cell lymphoma in the upfront setting?

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

For patients with stage 1A-E extra nodal marginal zone lymphoma that has been completely excised, would you still consider radiation?

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

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?

What is the recommended initial treatment for spinal cord compression due to non-Hodgkin lymphoma (e.g. diffuse large B-cell lymphoma)?

When treating with radiation therapy, what dose-fractionation do you typically utilize?

How would you treat Classic Hodgkin's lymphoma when the nodal sites are non-contiguous?

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

Given the improved ability to spare heart, kidney and liver, should IMRT be the standard of care for gastric MALT lymphoma (despite the low dose needed to effectively treat these patients)?

If so, what data should be presented to insurance companies to cover the cost?

Would you irradiate all borderline suspicious lymph node regions on PET/CT in stage IIA nodular lymphocyte predominant Hodgkin's lymphoma treated with ISRT alone?

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

Should whole brain radiation therapy and orbital radiation therapy be administered in situations of ocular B-cell lymphoma recurrence 2 years after primary CNS lymphoma treated with intrathecal methotrexate and no prior cranial irradiation?

How would you treat a pediatric patient with Stage IVB Hodkin lymphoma who still has persistent PET+ disease after dose-escalated chemotherapy?

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...

What is the best management of a lacrimal gland MALToma?

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

Is there a role for radiation therapy after chemotherapy for localized anaplastic large cell lymphoma?

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

Do you omit consolidative RT in pediatric patients with intermediate risk, non-bulky Hodgkin lymphoma who have a rapid early response to chemotherapy?

Are the results of AHOD0031 practice changing?

What is the role of radiation consolidation after chemotherapy for residual splenic involvement in follicular lymphoma?

What dose do you feel comfortable treating the entire circumference of an extremity to before you are concerned about chronic toxicity?

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...

Is there a role for consolidation radiation in a patient with stage I low grade follicular lymphoma treated with chemotherapy?

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...

What is the best radiation dose to treat primary cutaneous B cell lymphoma?

Specifically for marginal zone or follicle center?

What is the best treatment volume and dose for a marginal zone orbital lymphoma?

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

What is the appropriate treatment for marginal zone lymphoma of the parotid following surgery?

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

Is it acceptable to treat pediatric Hodgkin's lymphoma with an involved nodal field outside the setting of a clinical trial?

What is the treatment volume for primary breast lymphoma?

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...

What is the appropriate RT dose for an advanced stage follicular lymphoma?

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

Is IMRT preferred over 3D conformal RT for lymphoma of the head and neck?

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

Can you observe low grade follicular lymphoma if the involved node(s) have been surgically removed?

Is it time to start incorporating involved site irradiation for all lymphomas?

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

What is the appropriate dose of radiation for a primary osseous non-Hodgkin's lymphoma?

Specifically, for a diffuse large B cell lymphoma of the femur?

Is it preferable to simulate pediatric Hodgkin's lymphoma patients with arms up or akimbo?

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.

What is the difference between involved node and involved site irradiation?