Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is the risk of breast cancer that you quote to young women with early stage Hodgkin's lymphoma receiving involved field/site radiation therapy?
The risk depends on many different factors, including the amount of breast exposure to radiation, age of the patient, chemotherapy regimen, etc. Patients at greatest risk are likely those with axillary involvement who are < 30, where a large portion of their breast maybe unintentionally irradiated. ...
Can we ever observe newly diagnosed chronic phase CML patients and not immediately start them on therapy?
I can't think of a situation that would justify a "watch and wait" approach to CML. There are a number of effective therapies. Even if a patient has side effects from one TKI, there are others to choose from. What justification is there for not using an effective therapy? What is the rationale? Da...
Has the combination of daratumumab, bortezomib, and dexamethasone been tried for the treatment of plasma cell leukemia?
Do you ever discontinue ibrutinib in patients with CLL who have a good response?
For patients who are responding well to ibrutinib and tolerating the drug well, I do not discontinue ibrutinib. The clinical trials of single agent BTK inhibitors have all continued therapy indefinitely, which is a logical approach considering that very few will attain minimal residual disease negat...
Is there any role for post chemotherapy (R CHOP x 6) radiation therapy after a splenectomy for a stage IE diffuse large B-cell lymphoma involving only the spleen?
Quite an interesting presentation in terms of extranodal site and age. I would say no for consolidative RT here. For Lugano PET CR after R-CHOPx6, the added benefit of ISRT in a young patient is low and counterbalanced by a real long term 2nd malignacy risk. Other than bulky >7.5cm sites, 'special' ...
What is the optimal regimen for advanced stage Nodular Lymphocyte Predominant Hodgkin Lymphoma?
I do not believe that there is an "optimal" chemotherapy regimen for advanced nodular lymphocytic predominant Hodgkin lypmhoma. The most commonly used regimen is probably ABVD +/- rituximab. CHOP-R might be a good choice when the question of early transformation to diffuse large B-cell lymphoma is s...
What is the preferred regimen for testicular lymphoma with de novo symptomatic CNS involvement and systemic disease at the time of presentation ?
I often consider treating with high dose methotrexate alternating with R-CHOP in such cases. At the end of treatment, I consider radiation to the contralateral testicle. Others have treated similar patients with Hyper-CVAD (Park et al. Am J Hematology 2007)
For multiple myeloma patients with vertebral lesions requiring palliative radiation (e.g. 20-30 Gy in 10fx), do you treat concurrently with modern systemic myeloma agents such as lenalidomide and bortezomib?
We found in an institutional retrospective experience that patients with MM can safely be treated with lenalidomide, bortezomib, and cytotoxic therapy with palliative xrt.https://www.ncbi.nlm.nih.gov/pubmed/25176474
How would you approach a chronic phase CML patient who is responding to second generation TKI but not yet in molecular remission and is now pregnant?
If the patient is now pregnant, I would stop the TKI immediately, and initiate therapy with interferon. If that is not tolerable, I'd recommend hydroxyurea, although it will likely not control relapse into overt chronic phase.
For male patients in chronic phase CML on a TKI and not yet in a MMR, is there a preferred amount of time spent in a MMR before discontinuing TKI therapy to conceive or bank sperm ?
Hard to answer this one. My preference would be that the patient be in MMR confirmed by two readings three months apart before experiencing a dose interruption.