Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is your preferred maintenance therapy in young, fit patients with de novo plasma cell leukemia who achieve complete response after autologous stem cell transplantation?
Plasma cell leukemia is routinely excluded from post-transplant maintenance studies, so we cannot look to any of the randomized maintenance studies performed over the past decade. I would consider plasma cell leukemia to fit into the category of ultra-high risk myeloma, and would use lenalidomide pl...
Is there a role at this time for chemo-immunotherapy in the upfront treatment of classic Hodgkin lymphoma?
Would you require pre-RT dental evaluation and clearance for a patient who is being treated with ISRT to Waldeyer's ring/BOT area to 30 - 36Gy?
Yes. In the pre IMRT days, we certainly experienced some dryness and dental issues at dose of 30Gy, albeit much less severe than with typical carcinoma doses. With IMRT and salivary gland sparing the problem is clearly less, but it's hard to argue against a good dental evaluation pre RT. Talk with t...
What is the role of consolidative RT to initially bulky sites (>8cm) in a patient with stage III triple hit lymphoma who has tolerated only 4 cycles of DA-EPOCH-R?
I am going to expand the question to consider the role of RT in the curative rx of stage III/IV DLBCL triple hit or not. Conventional wisdom, e.g. NCCN guidelines suggest no role but I respectfully disagree. We reviewed the data in 2014 (Oncology 1074-1082, Dec 2014) and also recommend Dabaja et al ...
How do you decide to transition a patient with stable PNH on eculizumab to extended half-life ravulizumab?
It is not complicated to do the eculizumab->ravulizumab transition. When the next dose of eculizumab is due, I just substitute ravulizumab. The first one is the loading dose and 2 weeks later, the maintenance dose. Following the first maintenance dose, the schedule is every 8 weeks.
How would you approach treatment of DLBCL in a patient on hemodialysis?
For R- CHOP based therapy it can be administered the day before dialysis with no dose adjustments. Only Cyclophosphamide has renal clearance and should be reduced by 50%. For more aggressive regimens it becomes more challenging as there is not enough data. This is what we would consider doing for E...
Are you de-escalating treatment for favorable risk Stage I-II DLBCL patients to 4 cycles of R- CHOP with 2 additional rituximab cycles?
In general I could see this being an option in select patients (not localized stage II or patients who have a contraindication to XRT) but for the most part these patients in my practice are not treated with 6 cycles of R-CHOP. I treat most patients with Stage I and localized stage II with 3 cycles ...
What are the options of induction treatment of young AML patients who are on CRRT, continuous renal replacement therapy ?
Hypomethylating agent like decitabine and venetoclax will be good options. C1 decitabine for 10 days and venetoclax for 28 days. Then C2 decitabine for 5 days and venetoclax every 28 days. Bone marrow biopsy should be done on day 21. There is, however, no strong literature support regarding pharmaco...
Do you prefer hyper-CVAD or the CALGB 9111 protocol for high intensity remission induction treatment in Ph-negative ALL patients?
It depends on the patient's age. Historically, the adolescents and young adults (AYAs) population, arbitrarily defined by the National Cancer Institute as those between the ages of 15 to 39 years old, had worse outcomes compared to children with B-ALL (EFS of 30-40%). This is largely driven by adver...
What therapy do you usually choose in patients with previously treated follicular lymphoma who experience early relapse (< 2 years)?
My approach to POD24 patients is to first ensure there is no evidence of transformed disease. According to a retrospective analysis led by @Dr. First Last at Memorial Sloan Kettering, as many as 40% of the POD24 patients have evidence of transformed disease if a biopsy is pursued. Clinical indicator...