#DUKEhemeDEBATES DrKantiRai @NorthwellHealth suggests that it is too soon to use Venetoclax as first line Rx for CLL, reminding us of the cautionary tale of late emerging immune mediated toxicities with idelalisib. There may be as yet unknown toxicities that mandate caution.

#DUKEhemeDEBATES DrDanielleBrander @DukeCancer presents argument that Venetoclax leads to more MRD negativity in CLL (predictive for better outcomes) and is well tolerated. Nonetheless, need close monitoring for cytopenias and other toxicity.

#DUKEhemeDEBATES DrMattMcKinney@Duke summarizes debate over #brentuximab: Value of A + AVD vs ABVD in HodgkinDz is unclear; still need long term outcome data. A+AVD may only be right in subgroups; needs careful discussion with pt.

#DUKEhemeDEBATES DrMattMcKinney@Duke argues A+AVD has more toxicity than ABVD in Stg III/IV HodgkinDz. Alternate strategy could be dropping Bleo: ClinTrial showed no diff in OS for pts randomized to ABVD x 4 vs AVD x 4 after CR on PET following ABVD x 2 cycles

#DUKEhemeDEBATES Dr AhmedGalal @Duke debates benefits of #brentuximab in Stg III/IV HodgkinDz. Pulm toxicity w ABVD unpredictable and sometimes fatal. Notes increased periph neuropathy/febrile neutropenia; fewer deaths during & after treatment w A+AVD but OS data not yet mature

#DUKEhemeDEBATES DrMichelKhouri@Duke notes 3D echo LVEF more accurate/reproducible than usual 2D Echo. Emerging modality of Speckle-tracking strain echo reveals tissue deformation – ie damage earlier that echo LVEF. Combo of strain/troponin improve predictability of CVD

#DUKEhemeDEBATES DrMichelKhouri@Duke urges prevention, early detection/treatment of cardiac toxicity/disease in pts with cancer. Accelerated CV aging seen in pts with cancer and cancerRx may be due to proinflam mediators in both CVD/Ca.

#DUKEhemeDEBATES DrAraMetjian @Duke debates the need for longterm AC in first unprovoked DVT/PE; notes more often than not, pts don’t recur. Longterm AC increases risk of bleeding/death in some who would never recur.

#DUKEhemeDEBATES DrEwaWysokinska @Duke urges longterm continued AC in pts with first unprovoked DVT/PE given high risk of recurrence. Notes the novel AC agents have equal efficacy but decreased bleeding risk c/w warfarin. Reassess risk/benefit annually.

#DUKEhemeDEBATES DrCarlosDecastro @DUKE argues NextGenSequ’g doesn’t impact diagnosis. Impact on prognosis does not yet translate into better/different response to treatment. Emerging data for TP53. MDS is complex and may require computational modeling.

#DUKEhemeDEBATES Dr. Pemmarajuf MD Anderson @doctorpemm argues NextGenSequ’g should be done in all MDS pts despite costs, etc. Adverse markers (#ASXL1 #RUNX1 #TP53 #>/=3 mutations) and favorable markers (#SB3F1) can impact treatment options

#DUKEhemeDEBATES Dr William Blum of @emoryhealthcare indicates Gemtuzumab Ozogamicin #Mylotarg has signif impact on EFS and RFS for CD33+ AML with favorable Intermediate cytogentics even if OS not significantly impacted fractionated dosing as in #ALFA-0701 FrenchTrial reduces tox

#DUKEhemeDEBATES Dr Naveen Pemmaraju of MDAnderson reports purple #Vyxeos statistically improves OS in AML pts 60-75 even up to PS 2. Cautioned prolonged cytopenias but notes more pts went on to Stem cell transplant (34%) compared with 7+3 standard Rx (25%) even in pts over 70.

#DUKEhemeDEBATES Dr. Lindsay Rein asks “Should we rock the boat with improved survival from TKIs in CML?" Notes negative health impact in younger pts; #financialtox overall; cautions not yet enough data to stop TKIs as SOC #ImatinibWithdrlSyndrom (?other TKIs) needs more research

#DUKEhemeDEBATES DrJoeMoore–TKIs have changed the lives of pts with CML. Moore cautions that TKIs can be stopped after prolonged treatment (>3 yrs) with durable MMR, only select pts willing/able to follow strict observation guidelines; restart TKI promptly 4 relapse occurs

#DUKEhemeDEBATES Drs Rizzieri/Chao @Duke explore possibility of overcoming immune evasion by AML through #microtransplantation. Clinical trial for pts aged >65 to open @Duke soon.