AML

53 year old woman who is ~160 days from her allotransplant for AML, who presented with worsening cytopenias, Hgb 6.5 (baseline 9), platelets 6 (baseline 60s), normal WBC.She was noted to have hemolytic labs positive, and smear shows significant schistocytes. No evidence of AML. Tacrolimus was discontinued six days ago but no difference in hemolysis. Patient is requiring RBC transfusion every fifth day and platelet transfusion once a week. Do you think this is TA-TMA?

MPN | Age 67 | R/R

67 year old male with hx of CML since 2005. He progressed on multiple medications. Currently he's on asciminib since early 2023. Initially has reduction of BCR/ABL from 10% to nadir of 2% and now increasing to 11%. He continues to have hematological response. Bone marrow biopsy is pending. How would you approach this condition?

Heme | Age 21 | New Dx

21yo woman who presented with 6 months of worsening abdominal pain with 5 days of fevers and nausea, found to have thrombocytopenia to 20K (MPV 9.5) on admission with elevated ferritin to 20,985 and elevated LFTs. Her HIV, and hepatitis serologies are negative, undetectable acetaminophen and ethanol levels, and no splenomegaly or evidence of cirrhosis on imaging. We recommended checking B12, folate, copper, H. pylori, NK cell activity, CD25, CXCL9, EBV PCR, CMV PCR, autoimmune work-up though wanted to reach out if you had any additional work-up recommendations for her thrombocytopenia, elevated ferritin, and elevated liver enzymes?

Lung | Age 85 | New Dx

85-year-old female patient with ECOG PS of 2 diagnosed with stage IV adenocarcinoma of right lung with a right pleural effusion (not sampled), mediastinal adenopathy, and bone metastases. Her tumor ancillary pathology testing has demonstrated an EGFR E709-T710delinsD mutation and a TP53 mutation with no other actionable findings. Do you think afatinib, osimertinib, or some other treatment approach would be reasonable for her?

Lung | Age 50 | R/R

50yo man with metastatic ALK+ adenocarcinoma of the lung who progressed on crizotinib (was on this for two years) and alectinib (was on this for 4 years). He is now on lorlatinib and wanted to ask about prognosis. We found some studies that suggested a 9 month progression free survival for lorlatinib, but is there more helpful information you may know?

AML | Age 38 | New Dx

38 y/o F with favorable risk AML, biallelic CEBPA and RAD21 E148, normal karyotype, who I inherited post-induction (FLAG-IDA-VEN) from another institution due to insurance issues. Achieved a CR. I am planning HiDAC consolidation. Would you consider adding gemtuzumab even though she did not receive it with induction?