Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Would you consider daratumumab monotherapy as standard of care for smoldering multiple myeloma based on the AQUILA trial?
AQUILA is out! There MIGHT be a survival advantage (p<0.05) to early intervention, but to avoid p-hacking all we have now is a healthy hazard ratio and a confidence interval that juts right up to 1 - it was 0.97. If a patient meets the criteria for this trial, considering Dara makes some sense. I do...
Would you offer TPO-RAs to a steroid-refractory chronic ITP patient with history of stroke?
Yes, if needed, though with a bit of trepidation, and it probably wouldn't be my first choice. Second-line chronic ITP treatment can include TPO-RA, rituximab, or splenectomy, and no one treatment is clearly better than the others (Neunert et al., PMID 31794604). Both splenectomy and TPO-RAs have in...
In light of data from TRIANGLE, ECHO, and ENRICH, what is the best strategy to treat newly diagnosed patients with the blastoid variant MCL?
The management of MCL for almost 2 decades was driven by extrapolated data from aggressive B-cell lymphoma. However, aggressive chemotherapy and stem cell transplantation have failed to produce a plateau on overall survival curves, and patients inevitably have relapsed. It is now clear that MCL, par...
What treatment considerations do you make for elderly patients with relapsed/refractory follicular lymphoma?
Treatment options for R/R FL patients depend not only on the condition of the patient but what was received in 1st line and the duration of that line of therapy. Given that if a patient has received chemo-immunotherapy in the frontline setting and had a prolonged remission (> 5 years), then these ag...
What treatment do you recommend for marginal zone lymphoma in a patient who previously received bendamustine and rituximab for MALT?
RCHOP or a BITE; I would use cladribine + GAZYVA with curative intent.
How would you manage a patient with polycythemia and MPN symptoms (aquagenic pruritus, fatigue) that is JAK2/CALR/MPL negative but peripheral blood NGS positive for IDH2?
I would approach this through the framing of a polycythemia/erythrocytosis workup and then consider MPN-related interventions if a diagnosis is made! This is an excellent review that provides an overview of erythrocytosis investigation (Noumani et al., PMID 38695361). In brief, I would be thinking a...
How do you approach prophylactic antibiotics in patients who continue to have recurrent neutropenic fever following chemotherapy for solid tumors despite chemotherapy dose reduction and growth factor support?
This has to be individualized to the patient. It depends on the length of neutropenia, previous infections, and local antibiotic resistance. If the patient develops neutropenic fever after every cycle of chemotherapy and no obvious nidus of infection has been identified, a trial of a fluoroquinolone...
In older male patients with a history of underlying autoimmune disease, what clinical manifestations would prompt you to evaluate for VEXAS Syndrome?
Hello!!!Skin lesions, elevated MCV, elevated inflammatory markers.
How should community oncologists practically counsel patients with aggressive lymphomas on the potential treatment course as they move into 2L/3L therapies?
For those who relapse after first line therapy, treatment recommendations are dependent on the timing of relapse. For those who relapse within 12 months of completing first-line therapy and are fit, I would strongly consider referral to a center with CAR T-cell capabilities. As noted before, 5-year ...
Which patients with relapsed/refractory NHL are appropriate for pre-CAR-T bridging radiation therapy?
Before answering this important question, I think that we, as Radiation Oncologists, should give serious consideration to moving past the terminology of "bridging radiation therapy" and instead refer to it as "pre-CAR-T infusion radiation therapy." Bridging therapy was initially an apt name; we were...