Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is an appropriate dose for nodular lymphocyte predominant, stage 1 Hodgkin lymphoma following nodal excision?
We would treat to 30 Gy and treat somewhat more than involved site, as patients receive RT alone. This means treating more like involved region which, in this case, would probably be the ipsilateral groin nodal region.See the attached recent update from German group:http://jco.ascopubs.org/content/e...
What is the role of radiation treatment of stage IA ALK negative anaplastic large cell lymphoma?
It would be helpful to know the site of origin. Most stage I ALCL alk neg would be in the skin, in which case RT is the treatment of choice with little role for chemotherapy. Stage I ALCL, other then skin, would be quite rare with no data to guide us, except that we know response to chemotherapy for...
How would you treat Classic Hodgkin's lymphoma when the nodal sites are non-contiguous?
The question has insufficient information. I'm going to assume that the patient had chemotherapy with a PET/CT complete response. Based on that assumption, then the general principles are that if the sites of involvement are > 5 cm, that you should have multiple treatment fields, but if they are les...
Is there any data on an effective RT regimen (dose/fractionation) for inducing an abscopal effect using a PD-1 inhibitor in refractory Hodgkin's lymphoma?
I'm not aware of any published data for HL. There is a phase I-II study on low-grade B-cell lymphoma: "In situ vaccination with a TLR9 agonist induces systemic lymphoma regression: a phase I/II study" by Brody et al (J Clin Oncol. 2010 Oct 1;28(28):4324-32) that used a dose of 2 Gy x 2. There is an ...
Should FISH studies be repeated when CLL patients under active surveillance have progressive disease warranting treatment?
FISH studies should be performed on a newly diagnosed patient with CLL as well as those who have progressive disease and now warrant additional therapy. It is important to identify those patients who may have acquired additional cytogenetic abnormalities due to clonal evolution/resistance/etc as thi...
How would you treat a young man with refractory AML after HIDAC induction who developed cerebellar toxicity to HIDAC and previously received doxorubicin (300 mg/m2) for lymphoma?
CLAG-M (cladribine, Ara-C, mitoxantrone, with G-CSF priming)
What is the best treatment management of low grade early stage follicular lymphoma of the mesentery?
If a patient has a single mesenteric mass or lymph node that is demonstrated to be low-grade follicular lymphoma after biopsy, and there is no evidence of disease elsewhere by PET-CT or bone marrow biopsy, then definitive RT (24-30 Gy) would be appropriate. Mesenteric lymph nodes can be more challen...
Is it appropriate to treat a Stage IE DLBCL of the cervix with close followup if a CR is achieved after 4 cycles of R-CHOP followed by a hysterectomy omitting RT?
The role of involved site radiotherapy after effective chemotherapy is to treat sites of previously known disease, not to address unknown regions of micrometastatic disease. If the gross disease was confined to the cervix and/or uterus, a hysterectomy is an acceptable substitute for consolidative ra...
What dose/fractionation schedule should be used for adjuvant RT after surgical decompression of a spinal cord compression from multiple myeloma osseous lesions?
Although myeloma is radiosensitive, since it has caused metastatic epidural spinal cord compression, I will still offer 30 Gy in 10 fxs or 37.5 Gy in 15 fxs, a dose closer to a definitive dose for plasma cell tumors, in order to provide a more durable local control. See variant 2:ACR appropriateness...
How would you manage a localized low grade follicular lymphoma diagnosed shortly after a patient had a CR to an aggressive treatment regimen for DLBCL?
DLBCL arising from a low-grade lymphoma, typically follicular lymphoma, is relatively common. It occurs at a rate of 2-3%/year. Presumably, in this case the patient had an undiagnosed FL with early transformation. Review of the pathological specimens may shed light on this possibility. In any case, ...