Multiple Myeloma | Age 71

71 y/o female diagnosed with high risk smoldering myeloma initially (M protein 2.1 IgG lambda and 50% plasma cells on BMBx). She was treated with Len-Dex for 15 months. She then started to show signs of progression (M protein elevated to 2.7, hemoglobin worsening to 8 with no other cause). What are thoughts on treatment with Dara-VD considering that she is Len refractory now. She is a poor transplant candidate. After treatment with triplet Dara-VD, what are thoughts on Dara maintenance?

GI Cancer | New DX

49-year-old patient who underwent distal subtotal pancreatectomy and splenectomy in 2022 for a pancreatic body adenocarcinoma, stage IIB (pT2N1 G2 R0), with perineural and lymphovascular invasion and tumor involvement in 1/8 regional lymph nodes. He began adjuvant FOLFIRINOX in 2023. He developed significant worsening of his peripheral neuropathy after his fourth cycle of FOLFIRINOX and declined further oxaliplatin. Given his neuropathy and poor tolerance of irinotecan-based chemotherapy, would it be reasonable to change him to gemcitabine-capecitabine for the remainder of his adjuvant chemotherapy?

GU | Age 76 | R/R

76-year-old man with a history of non-muscle invasive bladder cancer (5-cm mass) diagnosed 2015. Due to the size of the mass, he underwent concurrent chemo-radiation with cisplatin and 64.8 Gy, completed 2016. He has since had cystoscopies that have found atypia in cells, but most recently had a carcinoma in situ lesion (Tis). Urology is planning on administering intravesicular BCG. Is there any contraindication to BCG administration with a history of bladder radiation?

CLL | Age 55 | New Dx

55 y/o M with new diagnosis of CLL, presented with WBC 250, Hgb 6.5, PLT 15, +splenomegaly on imaging. Is there any role for cytoreduction prior to starting BTKi given the expected initial rise in lymphocytosis on these agents? Alternatively, venetoclax-based therapy would be high risk for TLS so I am curious if you have a preferred approach when patients requiring treatment also present with high WBC.

Multiple Myeloma | Age 55 | New Dx

55 y/o F with AL amyloidosis, presenting with biopsy-proven cardiac involvement with EF 24%, recurrent pleural effusions requiring frequent therapeutic thoracentesis. Her Mayo Cardiac stage is IIIB. I'm inclined to follow the ANDROMEDA protocol (Dara-CyBorD). Would agree or take a different approach, given the overall poor prognosis/aggressiveness of cardiac stage IIIB disease? 

Pancreas | Age 79 | New Dx

79 year woman very complex medical history including cardiac arrest after hernia repair surgery last year presented with jaundice found to have a pancreatic mass 2.4 x2.6 cm FNA positive for adenocarcinoma, brushings from the biliary tree also positive for adenocarcinoma. She is not interested in undergoing a Whipple but interested in receiving other forms of treatment. How would you approach this case?