Non-Hodgkin Lymphoma | Age 44 | New Dx

44 y/o male with recent hx of worsening abdominal pain, fullness, and fatigue. Labs show mild lymphocytosis (wbc 11.3), mild anemia and thrombocytopenia (hgb 12.3, plt 92k). Iron studies showed ferritin 700, iron 30, transferrin sat 9. CT CAP showed severe splenomegaly with spleen size 24cm. I am concerned about HCL/SMZL/MPN/CLL. I needed help with the initial workup. I ordered... Anything else? What labs would you order on the marrow? Any special NGS orders?

Lung Cancer | Age 71 | New Dx

Newly diagnosed stage IVB NSCLC (adeno) with primarily skeletal and lung disease. Her biopsy has returned as a poorly differentiated adenocarcinoma. Molecular data include PD-L1 TPS <1%, EGFR G719A, ERBB2 p.S310F. No other actionable mutations. She is still post operative from her spinal decompression and ECOG 2. Should I target her uncommon EGFR mutation or Her2 mutation up front?

Breast Cancer

65 yr old female who just completed neoadjuvant Taxol/Herceptin/Perjeta for 1.9cm T1cN0 Her2+/ER+ IDC. Lumpectomy and SLNB: 1.4 mm residual disease, ypT1aN0. Would you offer Kadcyla? ECOG 0. Or what benefit should I explain for her to choose between that an Herceptin/AI.

MDS | New Dx

I have MDS patient with EB-2, 15% by IHC (CD34 and CD117) and 7% by flow, normal cytogenetics, NGS does not have TP53, IPSS-R, and IPSS-M are high. Would you go blasts by flow or by IHC? Would you give HMA alone or HMA with Ven or take the patient directly to transplant?

CLL | R/R

Patient with CLL (del 13q, IGHV unmutated), history of autoimmune hemolytic anemia s/p rituximab, started ven/obin for frontline treatment 5 years ago. He has continued on venetoclax monotherapy at the end of his one year of treatment with ven/obin. Peripheral blood MRD has been positive since 3 years ago. Patient would like to lengthen the duration he can be in remission prior to needing his next line of therapy (with a BTK inhibitor). Is it reasonable to try obin at this time to achieve MRD negativity?

MPN | Age 75

75 yr old male who recently transferred care to me w/ pmh of P Vera treated with phlebotomy and ASA. He was noted to have a rising WBC count. Also on Hydrea with issues with thrombocytopenia despite low doses. underwent a BM biopsy which reported changes compatible with post-polycythemia vera myelofibrosis. JAK2 V617F and TET2 mutated. In terms of symptoms: fatigue and weight loss are affecting his QOL. Palpable splenomegaly w/ early satiety. My question was treatment recommendations.