CLL | New Dx

73 yo man with recent diagnosis of CLL who has received 3 doses of obinituzumab with robust cytoreduction, WBC dropped from 250 to 5. He still have bulky lymphadenopathy in axilla and inguinal area. I wanted to start venetoclax or BTKi but any oral therapy is cost prohibitive. What IV therapy would you recommend?

Heme | Age 71

Refractory ITP 71-year-old male Afib, PAD, on methotrexate golimumab for psoriatic arthritis presented with thrombocytopenia, IPF fraction was high, thrombocytopenia determined to be in setting of ITP. Tried steroids and IVIG. Next my plan was to have him start rituximab from next week, however hepatitis surface antibody and core antibody positive. Would you recommend starting him on rituximab or Romiplostin next?

NHL

Could you guide me with the management of mucositis? I know it is a step-up approach and we usually start up with topical solutions such as Maalox Benadryl lidocaine. Then there is role of oral suctioning and oral hygiene. My patient is having gag reflex with all of these. Are there any other topical options we could consider?

GYN | Age 77 | New Dx

Patient with 2cm FIGO Grade 1 endometrioid adenocarcinoma with tumor invading > 50% of myometrial depth. Cervical stromal invasion and extensive (>3 vessel) lymphovascular invasion were seen. Negative margins. pT2Nx FIGO stage II. Molecular markers with pMMR, wild type p53, POLE testing pending, ER 91-100%, PR 71-80%, HER2 0+. Would you consider completion lymphadenectomy or move on to adjuvant EBRT?

Heme | Age 34 | New Dx

34 yo male with lymphocytosis. Flow cytometry at his PCP's hospital showed concerns for LGL, so he was referred to hematology. At our facility we repeated another flow cytometry and our pathologist reported flow to be normal without any concerns for LGL. He is clinically asymptomatic without any symptoms and no symptoms related to any chronic infections. We have been monitoring his counts for over a year, ALC is about the same without any other cytopenias. an you please suggest if I need to do any other work up?

Non-Hodgkin Lymphoma

78 yo male with DLBCL is now s/p 6 Pola CHP with complete response. I did not do baseline MRI or LP before starting Pola C HP. He does not have any other high risk features that predispose him to CNS disease, no testicular involvement no primary cutaneous diffuse large B cell, no kidney or adrenal involvement. However, given I do not know whether he had the MYC Bcl-2 BCL6 rearrangements, and no baseline MRI and LP, would you give CNS intrathecal prophylaxis, or skip it?