Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
For biopsy proven extranodal marginal zone lymphoma involving two small bilateral lung nodules, would you consider definitive treatment to both nodules with radiation therapy?
As is often the case with questions addressed to theMednet, one would like to know a little more about the patient before making a definitive recommendation, age, symptoms, general medical condition, etc. Also, the volume of lung that would need to be treated. (Would not rx lymphatics). However, I'l...
For stage III-IV Hodgkin's lymphoma, would you consider consolidative radiation for bulky disease after a complete response was seen using N-AVD per the S1826 trial?
I would offer consolidative radiation only for PET-positive residual disease.
Do you continue to check tryptase levels in your patients with idiopathic anaphylaxis despite normal levels >5 on repeated checks?
Baseline serum tryptase levels have been reported to be quite stable in the vast majority of patients, but can vary more in people with HaT or mastocytosis. With a bST <8 ng/ml, there is no obvious reason to continue to check it. However, even with normal bST, the Practice Parameters recommend furth...
How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?
That is a good question. Adding on to Dr. @Dr. First Last's response, rituximab has been shown to cause hypogammaglobulinemia that can persist or worsen with ongoing therapy. In a study published by Barmettler and colleagues, 133 patients out of a cohort of 8633 patients had serum IgG levels checked...
What is your approach to treatment of mantle cell lymphoma in someone with a mutated gene downstream of the BTK receptor, such as mutated CARD11?
For those with primary refractory MCL after a cBTKi, I would still not proceed with chemotherapy, given the limited data to support benefit after a patient progresses on a cBTKi. Only data thus far is with a bendamustine/cytarabine-based regimen, which, if/when they relapse, would potentially impact...
Do you utilize ctDNA-based MRD testing after frontline chemotherapy for DLBCL?
I do not, as part of the standard of care, in part because of limitations of the ClonoSeq assay in this setting, and in part because of a lack of clarity around how best to manage a positive. However, there are a number of sophisticated clinical trials exploring this question prospectively, with a f...
What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them. No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
Does the recent publication of EPCORE FL-1 (Epcoritamab + R2) change your preferred 2L SOC for R/R FL?
Partially! Epcoritamab certainly has a role in patients with FL who have more aggressive behaving disease but there is a plethora of choices in that setting. It may not be suitable for patients treated in the community away from my center because of the unique toxicities. It does have a role in that...
How do you manage anticoagulation/antiplatelet therapies with strong indications for uninterrupted therapy in setting of urgent procedures?
If anticoagulation is absolutely contraindicated because of the bleeding risk of the procedure, then "bridging" will usually make the most sense, most of the time, with low molecular weight heparin such as enoxaparin. If dual antiplatelet agents are contraindicated, particularly in the first month a...
How does pirtobrutinib compare to other available therapies for relapsed/refractory CLL after BTK inhibitor treatment, particularly in terms of efficacy and tolerability?
We have limited data for cross-study comparison of pirtobrutinib versus venetoclax. In the BRUIN trial, in patients who were cBTKi-exposed and BCL2i-naïve (n=154), the ORR was 83%, the median PFS was 23 months, and the 1-year and 2-year OS were 90% and 83%, respectively (Woyach et al., ASH 2023). In...