Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What is your approach to the decision to use CPX-351 or standard 7+3 for de novo AML?
CPX-351 is a dual-drug liposomal encapsulation of cytarabine and daunorubicin that delivers a synergistic 5:1 drug ratio into leukemia cells to a greater extent than normal bone marrow cells. It was approved by the FDA in 2017 for the treatment of adults with newly-diagnosed therapy-related acute my...
For a patient with diffuse large B-cell lymphoma of the testicle, do you irradiate the contralateral testicle alone or do you recommend radiation to the lymphatics and remaining testicle?
The most common clinical scenario for primary testicular lymphoma is an older man presenting with a painless testicular mass who undergoes orchiectomy and is found to have DLBCL. Many patients will have stage I disease with post-orchiectomy PET-CT showing no other sites of involvement. Occasionally,...
What is the role for maintenance lenalidomide in elderly patients with DLBCL?
The REMARC study was a phase III trial of maintenance with lenalidomide versus placebo in patients aged 60-80 years old who were in a PR or CR after RCHOP for newly diagnosed DLBCL (Thieblemont et al. JCO 35:2471-2481, 2017.). The results of this large study (650pts) with a median follow up of over ...
Does isolated del(5q) have the same prognostic implications for post-PV secondary myelofibrosis as it does in MDS?
Karyotypic abnormalities are rare in PV and ET. Abnormalities in myelofibrosis (MF) that are associated with an inferior prognosis are: 20q-, 13q-, +9, chromosome 1 translocation/duplication, -Y or sex chromosome abnormality other than –Y. There are few reports of del5q in MPN in general and not eno...
Would you offer scrotal radiation to a patient with a stage IIE bilateral testicular DLBCL treated with a bilateral orchiectomy and chemotherapy?
Bilateral orchiectomy is considered an alternative for those who refuse ISRT to the testicles, so I agree with you that there does not appear to have strong indication for RT in this case. However, there may be a lot of other nuances to this case. I would talk to the surgeon to make sure there was n...
Do you perform biomarker-based screening for AL amyloidosis in patients with newly diagnosed MGUS?
No, unless the patient has signs and symptoms or imaging studies that suggest systemic Amyloidosis.
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?
My approach depends on the number of cycles the patient has received and the response to those cycles, along with reason for neutropenia (all treatment based vs disease related). If a patient has significant neutropenia from treatment/therapy, my initial approach would be to add GCSF for the next cy...
How would you treat a younger patient with relapsed mantle cell lymphoma after treatment with hyperCVAD?
In front line therapy for MCL patients, induction followed by ASCT should be the standard of care followed by rituximab maintenance and follow up for MRD.In relapsed MCL, after anthracycline and cytrabine containing therapy, BTK inhibitors appear to be the most affective agents.Results of a pooled a...
What is your general approach to post-allogeneic HSCT maintenance therapy for AML?
I use midostaurin starting 60-90 days after allogeneic transplant continued till 1 yr post transplant for patients with Flt-3 mutations. Some of my colleagues prefer sorafenib for post transplant maintenance in this setting. I have not yet started using IDH inhibitors post allogeneic transplant. HMA...
What is your approach to CMV prophylaxis in the post-allogeneic stem cell transplant setting?
We do not routinely use letermovir but we are looking carefully at this data. We use prophylactic ganciclovir pre transplant and high dose acyclovir post transplant in high risk patients and are reviewing this data as well.