This week we kick off a two-part update to our CLL series, covering what has changed in frontline management since our original episodes. Using the case of a 68-year-old man with newly diagnosed, symptomatic CLL, we revisit the essential steps before treatment: confirming an indication to treat, ruling out Richter's transformation, and risk stratification, with the history behind FISH cytogenetics, IGHV status, and the CLL-IPI. We then trace how continuous BTK inhibitors and fixed-duration venetoclax-obinutuzumab displaced chemoimmunotherapy, before digging into the trials reshaping practice in 2026: AMPLIFY, SEQUOIA Arm D, and CLL17. Along the way, we cover the open questions for TP53-aberrant disease and why MRD, although prognostic, is not yet a reliable guide for treatment decisions with novel agents.

If you haven’t done so, be sure to check out our original CLL Series, as these updates will draw on concepts covered previously!

**This episode is sponsored by The Lymphoma, Leukemia and Myeloma Congress! To learn more and register for the meeting, click here! Be sure to use our SPECIAL TFOC code TFOC40 to save 40% off registration.

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This week the Head and Neck series turns to what happens when local therapy isn't enough — recurrent, relapsed, and metastatic disease. Using the case of a woman with a laryngeal cancer recurrence, we work through the first and most important question (recurrence versus second primary), the workup and biomarkers that steer therapy, local salvage options, the CPS-driven first-line systemic algorithm, second-line and beyond, the distinct world of nasopharyngeal cancer, oligometastatic disease, and the central role of early palliative and supportive care. As always, if you haven't heard the earlier episodes in this series, start there first.

**This episode is sponsored by Primum! Sign up for your free account at primum.co/fellows

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This week the Head and Neck series turns to radiation oncology, with guest Dr. David Palma, a Professor and Radiation Oncologist at the Verspeeten Family Cancer Centre and professor at the Schulich School of Medicine and Dentistry, Western University (London, Ontario). A clinician-scientist who splits his time between clinical-trials research and treating head and neck and lung cancers, David walks us through how radiation actually works and gets planned, the de-escalation question, PET after treatment, larynx preservation, re-irradiation, oligometastatic disease, and the proton-versus-photon debate - all with some of the best analogies we've had on the show.

**This episode is sponsored by Primum! Sign up for your free account at primum.co/fellows

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This week, we are so excited to share the third episode of our Career Development Series episodes, developed in partnership with The American Society of Hematology, The ASH Trainee Council, and Hematopoiesis!

For years, our listeners have reached out to our show asking for guidance to help navigate their careers. We are so excited to be partnering with an amazing organization like ASH to help make this happen!

This week, we interview Hanny Al-Samkari, MD as he shares his insights on what constitutes clinical research, what a career in clinical research might look like, and how trainees can get involved in clinical research.

** This episode is created in partnership with The American Society of Hematology (https://www.hematology.org/), The ASH Trainee Council (https://www.hematology.org/education/trainees/fellows/trainee-council), and Hematopoiesis (https://www.hematology.org/education/trainees/fellows/hematopoiesis)

** Want to review the show notes for this episode and others? Check out our website.

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Throughout this series, we have discussed how multidisciplinary the management of head and neck cancer is and the critical role that our surgical colleagues play in the management of this disease. This week, we welcome Dr. Michael Topf, Associate Professor for Associate Professor of Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center to our show to share with us how he determines which patients are appropriate for surgery, what his approach is, and so much more. It’s rare that we get insights into the factors that our surgery colleagues think about when determining surgical candidacy and surgical approaches and so get ready for an incredibly informative conversation! Another high yield episode you do not to miss!

**This episode is sponsored by Primum! Sign up for your free account at primum.co/fellows

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This week we get into treatment. Building on Part 1's (episode 158: https://www.thefellowoncall.com/tfocpodcast/hncintro) workup and staging, we walk through three cases to highlight the important distinguishing details: an oral cavity cancer, a locally advanced oropharynx cancer, and a larynx cancer.

Content:

- Approach to locoregional oral, oropharynx, and larynx cancers

- How we arrived at the current dosing paradigms for chemotherapy for chemoRT

- Is there a role for induction therapy?

- What are the data for immunotherapy in this space?

- High risk factors and why they matter

**This episode is sponsored by Primum! Sign up for your free account at primum.co/fellows

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This week, we kick off our Head and Neck Cancer series. Using the case of a man with a painless neck mass, we build a framework for the whole series.

Content:

- Why head and neck cancer is really two distinct diseases

- The biology behind HPV-associated oropharyngeal cancer

- How to work up a neck mass and hunt for an unknown primary

- The cervical lymph node levels, and AJCC 8th edition staging

- How "Stage IV" does not mean metastatic in HPV-positive disease

**This episode is sponsored by Primum! Sign up for your free account at primum.co/fellows

** Want to review the show notes for this episode and others? Check out our website.

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This week, we put everything we talked about in our ITP series together and talk about how we manage ITP in complicated patient scenarios. Through a case-based discussion, we discuss how to we would approach each of these complicated scenarios. If you haven’t done so already, be sure to check out episodes 155 and 156!

Content:

- ITP management in pregnancy

- ITP management in a patient with new VTE

- ITP management in a patient with acute bleeding

- Refractory thrombocytopenia management despite multiple lines of therapy

- ITP management in a patient with TPO-RA side effect intolerance

** Want to review the show notes for this episode and others? Check out our website.

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This week, we move to the relapsed/refractory ITP setting, focusing on what options are available to patients after their initial treatment with steroids ± IVIg, which we discussed in Episode 155. If you have not done so already, definitely listen to that episode as we build on the topics discussed here today!

Content:

- What are options after steroids?

- How to counsel patients on options?

- Is there a correct way to sequence available options?

** Want to review the show notes for this episode and others? Check out our website.

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This week, we go back to Classical Hematology! We previously discussed the initial workup and management of ITP in Episode 009, but now it’s time to dig deeper. What do we do once we make the diagnosis? How do we approach management when we have a new diagnosis?

Content:

- Refresher on diagnosis of ITP

- Response criteria

- What warrants a hospital admission vs. outpatient management?

- What is our approach to initial inpatient management?

- When is it safe to discharge a patient from the hospital?

** Want to review the show notes for this episode and others? Check out our website.

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