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?

Breast Cancer | Age 54

54 year old female with ER/PR pos, HER2 neg metastatic breast cancer with extensive bone metastasis, started on 1L therapy with palbociclib + exemestane, now with progression of osseous metastasis. Guardant 360 liquid bx showed ESR1 and RB1 mutation. Plan to switch to Elacestrant. Question is - is there any role for continuing the Palbociclib?

Hematology | Age 76

76 y.o presented with constitutional symptoms and pancytopenia, most notably severe thrombocytopenia. No significant splenomegaly. Bone marrow biopsy revealed marked fibrosis, megakaryocytic dysplasia, 2% blasts, del20q, trisomy 21, JAK2, TET2, U2AF1. We tried him for a few months on Vonjo, everything is basically unchanged, he still has severe thrombocytopenia. Hgb and white count are low but not severely. Any suggestions to help with the thrombocytopenia?