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?

CRC | Age 58 | R/R

58 y.o healthy female. rectal cancer w/ large liver and lung mets. pMMR, Her-2. Muncinous. NRAS mutated. Tempus has no suggestions. Seen FOLFOX and FOLFIRI+bev with no meaningful response. Now starting Lonsurf+bev. I don't have an NRAS mutation trial near me, but I don't know how helpful that would be anyway. Other suggestions for effective tx?

Hodgkin Lymphoma

With many options, interested to hear about your approach to unfavorable risk, localized HL?