Classical Hematology | R/R

Patient with LGL and associated neutropenia. He's ANC continues to be below 500 (most recently 200.) I've had him on MTX weekly dosing that I've gone form 10 mg/m2 to 15 with no improvement. I've done courses of prednisone tapers that transiently improve his counts but for brief periods of time. He's never had an infection but I'm concerned with the prolonged periods of neutropenia and was hoping to hear your thoughts on other possible treatment options?

GI Cancer | Age 57

Fit 57 yr old female with T3N1 (by EUS) rectal cancer, MMR proficient, 6-8cm from anal verge. Would you do PROSPECT or TNT?

Non-Hodgkin Lymphoma | Age 54 | New Dx

54 yo female with 4-5 years of non-specific GI complaints. Presented to the hospital with small bowel obstruction. Had surgical resection of segment of small bowel revealing Follicular Lymphoma grade 1-2. Post-operative PET scan revealed multiple small retroperitoneal and mesenteric lymph nodes, highest SUV was 2.2.My recommendation is only active surveillance. Would you recommend any additional therapy?

Classical Hematology | Age 35 | New Dx

35 year old man with no other medical problems and new diagnosis of Paroxysmal Nocturnal Hemoglobinuria. What would you recommend first line treatment and how do you make the decision about transplantation?

GI Cancer | Age 54 | New Dx

54 yo patient with a large rectal mass that is 10 cm from the anus who has liver and lung metastasis. His path showed moderately differentiated adenocarcinoma of colorectal origin. My question is besides sending MSI/MMR, and NGS testing, would there be any role of checking Her2?

Lung Cancer | Age 71 | R/R

71 yo adenocarcinoma right middle lobe lung. Stage: clinical T2aN3M1 with solitary brain metastasis. EGFR exon 19 (+), TMB low. Completed chemoRT with Taxol/Carboplatin, but with sequelae of renal impairment. Subsequently started osimertinib. Recent MRI showed progression. Are there any other investigative studies that need to be undertaken? What would you recommend for next line of therapy?