Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How do you follow patients with Bronchus Associated Lymphoid Tissue Lymphoma treated with 2 Gy x 2 fractions?
For patients with localized MALT lymphoma of the lung, in a distribution amenable to definitive RT, I would typically treat with 24 Gy in 2 Gy fractions. The risk of in-field progression with this dose is expected to be very low. Given the rarity of the presentation, I have only treated a handful of...
How do you monitor risk of erythrocytosis from testosterone use for female to male transgender patients?
I utilize the Endocrine Society's guidelines for identifying secondary erythrocytosis secondary to gender affirming hormone therapy (GAHT) (PMID 28945902). For initial monitoring, at baseline and then every 3 month hematocrit for the first year and 1-2 times yearly thereafter is typically implemente...
Do you routinely offer consolidation RT to sites of previous bulky disease in stage III and IV Hodgkin's lymphoma who have a complete metabolic response on restaging PET/CT following 6 cycles of ABVD?
Update - 1/5/24Three important studies have been published in the last few years which shed light on the role of RT in advanced HL in the setting of a negative interim (and post-chemotherapy) PET-CT.The RATHL trial included 1,119 patients with IIB-IV (or IIA with either bulky disease or at least 3 s...
How do you manage acute keratoconjunctivitis following total skin electron therapy (TSET)?
Institutions approach total skin electron beam therapy (TSEBT) somewhat differently. I generally try to utilize external eye shields as much as possible. If a patient doesn't have active disease involving the eyelids or peri-orbital skin, this obviates the need for internal eye shields which reduces...
How would you approach treatment in a patient with Fanconi anemia and glioblastoma?
This is challenging due to the sensitivity of Fanconi anemia patients to DNA-damaging treatment. I would maximize resection if possible and then treat with radiation, since it is a mainstay of therapy, despite the risk. I would opt for proton radiation if possible to minimize exposure of normal tiss...
What is your frontline treatment of choice for patients with systemic and secondary CNS involvement by DLBCL?
It depends on the intent of treatment, the age, and the PS of the patient. If you are going for a potential curative intent, R-CHOP combined with high-dose methotrexate (R-CHOP-M) - Damaj et al., PMID 26185174, followed by thiotepa-based (thiotepa-BCNU) autoSCT in young, fit patients with chemorespo...
What is the appropriate treatment for marginal zone lymphoma of the parotid following surgery?
Definitive radiation therapy is the standard treatment for a patient with an uncomplicated case of localized marginal zone lymphoma of the parotid gland. The CTV would encompass the entire gland and the total dose would be 24 Gy. Occasionally patients will be diagnosed with MZL after parotidectomy, ...
Is it acceptable to treat pediatric Hodgkin's lymphoma with an involved nodal field outside the setting of a clinical trial?
It probably is. Although not proven by randomized trial/s in pediatric patients, the practice is accepted in adults. In children where long term morbidity of radiation therapy is of greater concern, it would not be unreasonable to use involved nodal field in combination with chemotherapy.
Is it preferable to simulate pediatric Hodgkin's lymphoma patients with arms up or akimbo?
We will be moving towards involved site radiotherapy for pediatric Hodgkin lymphoma. Consequently, you may want to match the simulation with the set up of their pre-treatment PET/CT scan (arms up vs arms down). This will allow you to have more certainty regarding the location of axiallary and subpec...
What is the difference between involved node and involved site irradiation?
In both involved node and involved site (ISRT), prechemotherapy GTV determines the CTV. However, ISRT accommodates cases in which optimal prechemotherapy imaging is not available to the radiation oncologist. In ISRT, clinical judgment in conjunction with the best available imaging is used to contour...