Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is your preferred BTK inhibitor for patients with relapsed/refractory mantle cell lymphoma?
The majority of patients with relapsed/refractory MCL will respond to single agent BTKi therapy and this is my preferred treatment in patients at first relapse when a clinical trial is not available, and they have not been exposed to a BTKi (for example, on a frontline clinical trial). I often used ...
In light of the TRIANGLE data at ASH, how should we now approach a transplant-eligible patient with a new diagnosis of aggressive mantle cell lymphoma?
The TRIANGLE data presented by Dr. Dreyling on behalf of the European Mantle Cell Network are certainly provocative. Adding ibrutinib to induction pre-BEAM and maintenance post-BEAM (A+I) led to improved FFS compared to standard-of-care induction and maintenance (A). Not surprising, and doesn't tell...
How would you treat a fit patient with a history of relapsed CLL who now presents with Richter transformation s/p autologous anti-CD19 chimeric antigen receptor (CAR) T-cells?
This is very challenging and essentially in a data-free zone. There are some data on off-label use of axi-cel for Richter, and liso-cel technically has a label for Richter. Results appear encouraging, but treatment and outcomes after CART failure are unknown. I would consider everything possible – c...
What are your top takeaways in Hematologic Malignancies from ASCO 2023?
There was a time when those of us in the myeloma field could focus on ASH each year as our main source of updated practice-changing abstracts. No longer! Many exciting oral and poster abstracts were presented around multiple myeloma at the 2023 ASCO meeting in Chicago. Here are the top three that st...
Are there biomarkers or other factors to help predict which patients with MCL are most likely to benefit, or not, from pirtobrutinib following a prior covalent BTKi?
In the phase I/II BRUIN trial, responses with pirtobrutinib occurred across prespecified subgroups regardless of demographics, number of prior lines of therapy, or prior therapy. Responses were seen in patients with blastoid and pleomorphic histology, regardless of the number of prior lines of thera...
What subsequent therapies did patients receive after progressing on pirtobrutinib in the mantle cell BRUIN trial population?
Not all post-protocol therapy was reported; however, nearly 20% of patients who were treated with pirtobrutinib on trial went on to receive CAR-T therapy. Pirtobrutinib’s ideal use is dependent on patient and disease characteristics. In the BRUIN trial, the median PFS, DOR, and OS of MCL patients wa...
When would you consider treating an asymptomatic patient with follicular lymphoma?
The decision of when to initiate treatment of low-grade follicular lymphoma is, of course, part art and part science. It largely remains the standard of care to defer initiation of treatment when not required, but when is it required? The question identifies symptoms attributed to disease as a clear...
Would you consider replacing ibrutinib with acalabrutinib or zanubrutinib in the TRIANGLE regimen for MCL in a patient with atrial fibrillation or high risk coronary syndromes who is otherwise fit for aggressive induction therapy?
Generally, if a patient is significantly symptomatic or intolerant due to atrial fibrillation, or other arrhythmia or even heart failure, it is reasonable to consider a next generation BTKI (acalabrutinib or zanubrutinib). As a cardiologist, I will defer to my cancer colleagues on efficacy across ad...
What post-protocol therapies did patients on the BRUIN trial in CLL receive, and how did these therapies impact outcomes?
The patients with CLL enrolled in the BRUIN study were heavily pre-treated with a median number of 3 prior therapies. All the patients in the BRUIN study had prior exposure to covalent BTK inhibitors and 40% of them also had been treated with a BCL2 inhibitor. As expected for patients offered a phas...
How would you consolidate a patient with primary refractory double hit lymphoma with secondary CNS involvement?
Thiotepa-based transplants are particularly rough. We haven't had good outcomes with them in terms of relapse and mortality is much higher than BEAM or Mel autos.Having said that, this patient has chemo-refractory disease. The initial concern with CAR-T in primary CNS or secondary involvement was th...