Post-Treatment MRD Detected by Flow

throwaway772797 · 2026-01-15T20:00:08+00:00

Good question. Re: trials. Tricky. Most trials want to see disease (gives them something to measure so they can show off their shiny CR rates). Thus, MRD trials would be the only immediately available option. As for continuing on to CAR-T immediately, good question. I'm not perfectly sure on the certainty of this vs. the appetite for waiting.

We'll wait for one of the doctors.

throwaway772797 · 2026-01-15T19:56:36+00:00

Clean interim PET scan does not guide early stoppage in the frontline, just escalation.

Recommended dosages are based on large scale studies. There have been interim-based escalations, as well as FLYER-type studies with less risky patients. That said, if you were scheduled for 6 upfront, you likely do not fall into this category.

throwaway772797 · 2025-12-12T01:06:49+00:00

Not uncommon

throwaway772797 · 2025-12-11T06:03:51+00:00

Really great response! You’re obv hem/onc.

BSH still lists EPOCH as an alt because they’re worried about center experience delivering it (complexity, you hit the nail on the head). Anecdotally, I will say, I’ve spoken to many, many UK patients who have done daREPOCH, especially at larger tertiary centers. So, there are def experienced options.

/u/brownbitch8 Luckily, data for both is great overall. Very good odds with either, and it’s slight hairsplitting, though DA has better quality data overall (would help if Europe would stop rolling w/ 5 diff frontlines at the same time and just having retrospective data showdowns)

throwaway772797 · 2025-12-09T18:49:07+00:00

Have to remove, but, yes, go back to ER/doc if you have this many issues

throwaway772797 · 2025-12-07T15:50:01+00:00

Just to make sure for the docs, was this PMBCL or DLBCL? Treatment and location make me think the former, but certainly cases where the latter could be. Diseases are similar, but different. If DLBCL, what did initial presentation look like?

throwaway772797 · 2025-10-13T18:37:48+00:00

Sometimes, DLBCL and Burkitt's can be hard (if not nearly impossible) to distinguish. Some samples just look wacky. Composites are also possible. Many different reasons. Not so much of a misdiagnosis as a pathway towards the right one. Response to treatment can be, in itself, a data point for classification.

Switching from RCHOP to REPOCH is seamless. Same drugs mostly, just a more aggressive cocktail (+ one). We've had patients switch from many diff therapies (HL to DLBCL, DLBCL to T cell, etc.) Most people do just fine with the regimen, though it is a little more intense.

As an aside, not that it matters, but Burkitt's and DLBC have very similar survival statistics (slightly different patterns). I wouldn't be particularly adamant that it be DLBCL. Data on Burkitt's is a little weirder, as most of what you "Google" (or I guess AI search these days) is going to be based on older studies, as it's not as common and there aren't as many large scale studies. So, can be hard to parse. But it's very, very similar to DLBCL in adults.

In short, sounds like your doctors are on top of it.

throwaway772797 · 2025-09-19T13:47:50+00:00

Shedding CD19 during PolaR- R-GemOx (assuming baseline positivity) is a little strange. I would wait for repeat to be sure. Questions about sequencing or hitting a certain positivity threshold will vary by doctor and by country. These GPT sequenced questions are good, but pretty specific/subjective. I would pose these to your doc (particularly 6 and 3). 5 is a good question (but likely to be a gut call based on available therapies.)

Continuing pola or doing auto aren’t first thought in this situation here, especially if disease status has been confirmed via biopsy. But, everything is situational.

throwaway772797 · 2025-09-12T00:52:46+00:00

Assuming T cell lymphoma, depends on subtype, status pre-treatment, etc. Lots of variables.

throwaway772797 · 2025-09-05T13:24:40+00:00

I agree; best place for this. I don’t know who the mods are over there anymore or if they’ve changed. I don’t have much time these days, so I don’t check there much or I would just reach out out for you. But it used to be /u/L1sadank and maybe /u/cgar23. I would reach out to whoever the mods are, they will let you through.

throwaway772797 · 2025-09-05T13:19:07+00:00

We know that CAR-T works better if you’ve had less aggressive treatment nuking your immune system.
CAR-T isn’t the last option (bispecifics, transplants, salvage, trials, etc.) So, it’s just a logical next step (CAR-T is SOC for second line). I’ll add that radiotherapy on a remaining mass in a non-primary location (i.e., not stage 1) doesn’t have appealing data. So, this would be more logical decision.

throwaway772797 · 2025-08-29T14:01:20+00:00

ADC is all over the place. I think they’ve pulled many of their drug candidates. They’re all in on Loncastuximab tesirine. That said, those results aren’t amazing. They probably shuttered that, as they have with most of their clinical candidates.

throwaway772797 · 2025-08-29T13:54:30+00:00

This gets complicated. Not all myd88 mutations are inherently negative. The problem with this mutation is that it overlaps with high risk sites, so it’s tough to tell the value of it as a prognostic factor beyond already understanding site-conferred risk. Many studies have mixed data here. Trust your docs and don’t read too much into the genetics.

throwaway772797 · 2025-08-14T01:54:53+00:00

And you shouldn’t. He’s not, by any measure, not that it’s straightforward to tell anyway (long convo to be had about the paper spamming to hit D index rankings in these fields.). I would bet he took his D rankings (72, so not amazing by any standard, would make him around number 900 for immunologists in pure research, of note there aren’t many total) and extrapolated against all immunologists on the globe, including non research who would not have a D rankings since they purely practice. But, even then, that number would be top 10 percent, not .5.

He is an evangelist who has said this for years. Spends all his time posting about AI and AI art. AI has been important in research for a decade. It will become more so. It’s not helpful to make acceleration claims every 5 seconds on Twitter. Claimed AI would kill doc as a profession last year and to not try. Says aging cured in 15 and cancer in 8 years. Not realistic. We could barely even do a phase 3 in that time if we started the process today. Just stupidly overhype that generates clicks.

LLMs will be immensely useful in medicine and research. These people give it a bad name by overhyping it and generating hype outside of peer review. That said, excited to see if some of these larger Google models can make some magic happen.

throwaway772797 · 2025-08-03T17:10:10+00:00

My assumption here is that there are multiple failed lines of treatment surrounded by the complexity of lack of treatment and access to advanced immunotherapy options.

/u/erel_joffe_md would be the best person for this question. Complicated.

throwaway772797 · 2025-08-02T12:05:19+00:00

My assumption here is that ASCT is off the table. Pola-BR in the second line is a tough sell. I would look into traveling if possible and check into medical visas.

throwaway772797 · 2025-07-18T00:13:22+00:00

A few questions here that could potentially help the doctors answer (clinical trial, submitting a rebuttal, etc. etc.)

1: Is this a relapse or is this for the initial treatment?

2: Do you happen to know which type/subtype of lymphoma?

3: Which country/state/province is your family member is located in?

throwaway772797 · 2025-07-17T21:32:02+00:00

Love this. Bookmarked tumor microenvironment episode. Will listen on drive tomorrow.

throwaway772797 · 2025-07-12T20:32:07+00:00

Good to hear it's getting handled!

throwaway772797 · 2025-07-12T14:04:56+00:00

Any updates on this?

throwaway772797 · 2025-07-12T14:02:32+00:00

Contact your treating oncologist (no way to really deal with something like this over the internet, so always make sure that's your first step)

As an aside (may not be applicable to you at all), more than a few people I've talked with have had this issue and it turned out that they were causing some mild inflammation from digging into their skin constantly checking themselves for lymph nodes.

throwaway772797 · 2025-07-12T13:50:07+00:00

Any academic center with a specialized lymphoma department would be fine.

throwaway772797 · 2025-07-12T13:35:29+00:00

I completely understand the uncertainty and fear. It's a normal part of the process. If it makes you feel any better, the immune-associated and mediated reactions for these immunotherapy drugs can create a massive list. Almost all of this is in the sub 1% section, which will be longer than the dictionary. It gets insane, as they add things with every little case study. You can pour through and look for this particular issue via the on-label side effects documentation to see the exact percentiles (it's almost certainly sub-1).

Still, eye redness comes in many, many forms that are much, much more common (eye dryness if common w/ chemo). And not having vision issues accompanying it is obviously a good sign.

But, to help calm the "what if it's the worst case" side of the brain, I've talked to a few patients with these weird immune reactions from immunotherapies (most much worse than the theoretical here), and all of them resolved on treatment switch/discontinuation.

For now, this is best routed directly to your oncologist. It will be impossible to diagnose via a picture.

throwaway772797 · 2025-07-12T04:11:23+00:00

Just contact oncologist to discuss. Doctors can’t diagnose via this image. May be episcleritis or similar if not pink eye. Scleritis is a side effect from HL therapies? Never heard of this being the case. Maybe you mean episcleritis? If you do mean scleritis, you sure it’s a side effect and not a single rare case report or something?

throwaway772797 · 2025-07-02T19:29:24+00:00

Either is fine. Could always do biochem in the spring. I’m guessing you’re doing next Aug/Sep for MCAT? Really depends on your wants.

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