Heme | Age 21 | New Dx

21yo woman who presented with 6 months of worsening abdominal pain with 5 days of fevers and nausea, found to have thrombocytopenia to 20K (MPV 9.5) on admission with elevated ferritin to 20,985 and elevated LFTs. Her HIV, and hepatitis serologies are negative, undetectable acetaminophen and ethanol levels, and no splenomegaly or evidence of cirrhosis on imaging. We recommended checking B12, folate, copper, H. pylori, NK cell activity, CD25, CXCL9, EBV PCR, CMV PCR, autoimmune work-up though wanted to reach out if you had any additional work-up recommendations for her thrombocytopenia, elevated ferritin, and elevated liver enzymes?

Lung | Age 85 | New Dx

85-year-old female patient with ECOG PS of 2 diagnosed with stage IV adenocarcinoma of right lung with a right pleural effusion (not sampled), mediastinal adenopathy, and bone metastases. Her tumor ancillary pathology testing has demonstrated an EGFR E709-T710delinsD mutation and a TP53 mutation with no other actionable findings. Do you think afatinib, osimertinib, or some other treatment approach would be reasonable for her?

Lung | Age 50 | R/R

50yo man with metastatic ALK+ adenocarcinoma of the lung who progressed on crizotinib (was on this for two years) and alectinib (was on this for 4 years). He is now on lorlatinib and wanted to ask about prognosis. We found some studies that suggested a 9 month progression free survival for lorlatinib, but is there more helpful information you may know?

AML | Age 38 | New Dx

38 y/o F with favorable risk AML, biallelic CEBPA and RAD21 E148, normal karyotype, who I inherited post-induction (FLAG-IDA-VEN) from another institution due to insurance issues. Achieved a CR. I am planning HiDAC consolidation. Would you consider adding gemtuzumab even though she did not receive it with induction?

CLL | New Dx

73 yo man with recent diagnosis of CLL who has received 3 doses of obinituzumab with robust cytoreduction, WBC dropped from 250 to 5. He still have bulky lymphadenopathy in axilla and inguinal area. I wanted to start venetoclax or BTKi but any oral therapy is cost prohibitive. What IV therapy would you recommend?

Heme | Age 71

Refractory ITP 71-year-old male Afib, PAD, on methotrexate golimumab for psoriatic arthritis presented with thrombocytopenia, IPF fraction was high, thrombocytopenia determined to be in setting of ITP. Tried steroids and IVIG. Next my plan was to have him start rituximab from next week, however hepatitis surface antibody and core antibody positive. Would you recommend starting him on rituximab or Romiplostin next?