Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is your approach to a patient with systemic AL amyloidosis who has achieved a hematologic response but not an organ response with CyBorD?
I would leave them alone. Treating to organ response is wrong and dangerous. Hematologic response is quick, organ response is delayed. The goal is hematologic remission; after that allow the body the time needed to heal the organs.
What is your approach in a transplant-eligible patient with relapsed classical Hodgkin lymphoma who has an area of refractory disease after salvage chemotherapy?
The goal here, especially in Hodgkin's lymphoma, is to achieve complete metabolic remission (CMR) by PET before high dose chemotherapy and autoSCT as data is clear in terms of difference in the outcome in favor of patients achieving CMR vs. those who achieved < CMR. So I would do what it takes to ac...
Do you recommend lenalidomide for high risk smoldering multiple myeloma?
If you want to push the can down the road that is a good approach. High risk SMM is more like early stage myeloma. Treating them with single agent does not make sense as we know that combination therapy and total therapy approach is superior. The ECOG study was perfect 15 years ago but not today.
Do you ever start with lower than standard doses of TKIs when initiating treatment for chronic phase CML?
Not usually with the exception of bosutinib. I specifically start bosutinib at 200 mg and go up by 100 mg every week until the patient is at full dose. I find this helps manage the initial diarrhea associated with the drug. Otherwise, I start at the standard dose for all drugs. I may decrease the do...
Can a rituxumab biosimilar be used for a high grade lymphoma?
Rituximab (Rituximab) was the landmark addition to treatment of B cell-Non Hodgkin Lymphoma in the late 1990s. It changed the treatment for B cell NHL. Rituximab is also used in many other off label indications (as for example ITP, TTP etc.). Recently two bio-similars were approved by US FDA: Truxim...
Would you recommend scrotal RT in a patient with stage IV primary testicular lymphoma with CNS involvement after CR to RCHOP and MTX?
Irradiation to the contralateral testis is an important component of any successful curative regimen for patients with all stages of disease.In a survey by IELSG (JCO 2003), patients who did not receive contralateral testicular RT had a 43% incidence of testicular failure after CR to anthracycline b...
What is your recommendations for vaccines to prevent shingles in CLL patients?
In October 2017, the U.S. FDA licensed the adjuvanted, recombinant zoster vaccine (Shingrix). Phase 1/2a studies in immunocompromised subjects, including autologous hematopoietic cell transplant recipients and HIV- infected adults, have confirmed that Shingrix is immunogenic and safe with no documen...
Do you alter your management of Stage I-II DLBCL if it's double or triple hit?
Why do we immediately perform CNS staging with a LP at diagnosis of ALL when the risk of seeding is highest with a high lymphoblast count?
We wait until circulating blasts are cleared from PB before doing LP.
How do you approach a patient with IgM monoclonal gammopathy associated with severe neuropathy of unclear etiology?
I usually confirm if the patient does not have AL Amyloidosis or POEMS, and as part of work up for IgM MGUS, I order MYD 88 mutation. If all are negative and I still believe that neuropathy is caused from his/her MGUS, you can try IVIG for the neuropathy as a trial (of course after using gabapentin,...