CLL | R/R

Pt with CLL for many years, not on treatment, asymptomatic, with counts between 100k-150k that doubled in a day to 300k

CRC | Age 68 | New Dx

68-year-old female with High Risk Stage II Colon Cancer - Right Sided - p MMR intact pT3pN0 s/p Right colectomy earlier this year with only LVI as high risk feature

CLL | Age 67 | New Dx

67-year-old woman with recently diagnosed aggressive SLL. he presented with lymphadenopathy and biopsy of neck lymph node revealed "accelerated" SLL with Ki-67 30%. Gave her Neulasta to try and improve her neutrophil count, but suspect it may have limited benefit since the likely etiology is marrow infiltration. She consented to start treatment with acalabrutinib. Would you start treatment ASAP regardless of her ANC (and if so would you dose reduce the acala) or are there any strategies to improve her hematologic reserve before starting treatment?

AL Amyloidosis

65 y/o patient with initially smoldering myeloma (20-30% plasma cells on marrow, IgA lambda, lambda light chain 25, M spike 1.8, no CRAB findings) who was found to have biopsy proven cardiac AL amyloidosis, Mayo 2012 cardiac stage II She is now on Dara-CyBorD x2 cycles thus far and appears to be responding, light chains have normalized and M spike is 0.9. Do you typically recommend auto transplant for these patients?

NHL | Age 78 | New Dx

I have a new diagnosis of Mantle Cell Lymphoma in a 78 year old, who has extensive disease burden in lymph node, skeleton. He is high risk per MIPI although LDH is normal. I dont know about p53 status [never checked] and or morphology of MCL. We have a clinical trial open, with Rituximab and Zanubrutinib. I worry with disease burden, it will be difficult to give rituximab with standard premeds of Tylenol and Benadryl. Would you agree to it?

GU | Age 76 | New Dx

76 year old ECOG 1 patient with multiple cardiac comorbidities with a high grade papillary urothelial carcinoma of the renal pelvis. It measured 7x11 mm on CT imaging as a filling defect. She had a R ureteroscopy which again characterized high grade non-invasive urothelial carcinoma without muscularis propria visible. She is queued up for a nephro-ureterectomy with the question for role of neoadjuvant chemo. Questions: 1. Do you typically aim for a neoadjuvant approach if patients are functional?