Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
How are you making the diagnosis of chronic lymphocytic leukemia transforming to prolymphocytic leukemia?
Looking at the trend of pro-lymphocyte increase will help in addition to clinical signs of progressive disease (splenomegaly). It is useful to check for TP53 and MYC translocations since these are common in PLL. As you mentioned, >55% pro-lymphocytes has been used to diagnosed PLL based on a report ...
Do you think there will be a role for duvelisib in the treatment of relapsed/refractory chronic lymphocytic leukemia?
I believe this agent could find a home for therapy in CLL as it is given by itself provided that further efficacy is demonstrated in a population where it would be most likely used, ibrutinib resistant CLL. Additionally, incorporation into non-BTK inhibitor combinations would also be possible. Given...
Would you consolidate marginal zone lymphoma transformed to a high grade B-cell lymphoma with a stem cell transplant?
The transformed lymphoma that develops out of indolent small B cell lymphoma such as marginal zone lymphoma, follicular lymphoma or lymphoplasmacytic lymphoma, is typically diffuse large B cell lymphoma (DLBCL). When this type of transformed DLBCL develops in a patient who has not previously receive...
What is your experience with liposomal-encapsulated daunorubicin and cytarabine (CPX-351) for first line treatment of therapy-related AML or AML with myelodysplasia-related changes in elderly patients?
Our center has been administering CPX-351 to outpatients for the last few months. We monitor the patient closely in the first week for tumor lysis. Since the neutropenic fever rate is the same as 7&3 we have need to admit many of the patients at some point in the cycle but overall it has gone very w...
Do you give 3 or 4 cycles of HiDAC during consolidation for good/intermediate-risk AML without an available allotransplant donor?
This is a complicated question because risk stratification of AML has rapidly transitioned from including clinical presenting features (age, WBC, co-morbid diseases) with cytogenetics/select mutations to now multiple mutations and other biologic features. An example is core binding factor AML with a...
How would you approach a patient with smoldering myeloma that has a quickly rising and very high M-spike (6 g/dL range)?
The level is very high and worrisome for tumor lysis syndrome and cytokines related symptoms. I would do a bone marrow biopsy first and check free light chain assay. This may confirm the diagnosis of symptomatic myeloma. Also bone imaging study to find any lesions. Once you decide to treat I would ...
Would you treat a patient with definitive local XRT without systemic therapy if he/she presents with pathology showing a PTCL NOS from a small (1.5 cm) lesion of the skin of the chin?
For background, there are several T-cell primary cutaneous lymphomas. Several are treated routinely with radiation therapy alone, including primary cutaneous anaplastic large cell lymphoma (ALCL) and primary cutaneous CD4 positive small/medium T-cell lymphoma. Other T-cell primary cutaneous lymphoma...
What are your radiotherapy recommendations for a unilateral primary intraocular large B-cell lymphoma following high-dose methotrexate and rituximab?
Primary intraocular lymphoma is quite rare without standard treatment guidelines. As PCNSL often involves the globe, at initial diagnosis and/or at relapse, I view isolated intraocular disease as a subset of primary CNS lymphoma. HD-MTX regimens are typically utilized. As the disease is localized, c...
How do you approach previously treated grade 1 follicular lymphoma now with transformation to a large cell lymphoma?
I believe the question is an important one that has not been addressed by an adequately powered prospective study. These patients are often folded into studies of relapsed and refractory disease. The consensus is that these patients have a poorer prognosis than those with de novo diffuse large B-cel...
Would you use Ibrutinib plus Venetoclax as second line therapy in relapsed/refractory mantle cell lymphoma?
I may consider this for the right patient with Mantle cell lymphoma that has relapsed with TP53 and high risk prognostic score. Even though the data is very exciting it is a single arm study with a small patient cohort, I would want to see a randomized data to make a definitive switch. The CR rates ...