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.

GI Cancer | Age 45 | New Dx

45 YO F with T3N0 anal SCC. She developed severe mucositis, diarrhea, and skin rash after cycle 1 of chemorad (5FU-Mitomycin) and was hospitalized for that. We are suspecting DPD deficiency. What are other chemo options if she truly has DPD deficiency?

Classical Hematology | Age 24 | New Dx

24yo with PMH SLE on plaquenil, autoimmune hemolytic anemia who was admitted due to thrombocytopenia with platelet count 5. Further labs showing hgb 10.4, hapto <10, LDH 979, and tbili 2.2. Despite her labs, she was fully oriented with no neurologic symptoms and hemodynamically stable without any evidence of end organ damage. ADAMTS13 level 11% with inhibitor 0.7, confirming the diagnosis of TTP. Would you use Rituximab and/or Caplacizumab in this case and what helps guide that decision?