Heme

56 y/o F with NF1, sarcoma s/p resection, DVT in lower extremity was on xarelto now with clot extension. She is on oxcarbazepine so might be the reason why she “fail AC”. Are other DOAc such as Padraxa less likely to be affected/less interactions with oxcarb (must have for her)?

Breast Cancer | Age 56 | R/R

Would you combine fam-trastuzumab deruxtecan with endocrine therapy? Results of Phase IB DESTINY-Breast08 trial was promising. I have a 56 yo with metastatic HR+, HER2 low breast cancer who progressed on first line endocrine therapy with anastrozole and Verzenio.

NHL | Age 45 | New Dx

Patient is a 45 y/o female, ECOG PS 0, with no pmh, presents with diffuse lymphadenopathy and B-symptoms positive. Core needle biopsy showed High-grade B-cell lymphoma, Ki67 90%. FISH showed Gain of BCL2 or chromosome 18/18q, and Gain of BCL6 or chromosome 3/3q. No DH/TH. PET/CT was very concerning: disease is extensive. With that kind of extensive disease and high Ki67 of 90%, would you still consider DA-R-EPOCH rather than R-CHOP?

Breast Cancer | Age 61 | New Dx

61y female with bilateral breast cancers s/p upfront bilateral mastectomies, referral for adjuvant systemic therapy. Right breast - triple negative, pT1c pN0 Left breast - triple positive, pT1c pN0 Germline testing negative. Given TN histology, my plan would be to incorporate anthracycline based regimen (AC-T). What would be your preferred regimen for adjuvant?

MDS

90+ y.o old male with recurrent admission for CHF, Hb 7 range. Bone marrow showed MDS/MPN vs MDS with increased blasts, 90% cellular, 5-6% blasts, atypical megs, 10% ring sideroblasts, 30% monocytes. FISH/cytogenetics normal but NGS: JAK2V617F, TET2 and ZRSR2. I had started him on luspatercept before receiving NGS and he has responded nicely with Hb up to 11.4. Is that ok to continue given his age and that anemia was most bothersome symptom?

Heme | Age 54 | R/R

When switching between TPO-RAs in patients with ITP, are there any guidelines for dosing? For example, I am switching a patient who is on max dose avatrombopag to romiplostim, should I start romiplostim at the max dose or start lower and titrate up like in a treatment naïve patient?