Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What are your radiotherapy recommendations for a unilateral primary intraocular large B-cell lymphoma following high-dose methotrexate and rituximab?
Primary intraocular lymphoma is quite rare without standard treatment guidelines. As PCNSL often involves the globe, at initial diagnosis and/or at relapse, I view isolated intraocular disease as a subset of primary CNS lymphoma. HD-MTX regimens are typically utilized. As the disease is localized, c...
How do you approach previously treated grade 1 follicular lymphoma now with transformation to a large cell lymphoma?
I believe the question is an important one that has not been addressed by an adequately powered prospective study. These patients are often folded into studies of relapsed and refractory disease. The consensus is that these patients have a poorer prognosis than those with de novo diffuse large B-cel...
Would you use Ibrutinib plus Venetoclax as second line therapy in relapsed/refractory mantle cell lymphoma?
I may consider this for the right patient with Mantle cell lymphoma that has relapsed with TP53 and high risk prognostic score. Even though the data is very exciting it is a single arm study with a small patient cohort, I would want to see a randomized data to make a definitive switch. The CR rates ...
Is there a situation where you would use a purine analogue in combination with rituximab for the frontline line treatment of normal variant Hairy Cell Leukemia?
This is an excellent question, and I was assisted in this answer by Drs. @Dr. First Last and @Dr. First Last who are both hairy cell leukemia experts since there is really not a lot of trial data to guide this answer. There is limited data for the addition of rituximab in the frontline setting in vH...
When would you consider treating a testicular relapse with definitive radiation in a child with ALL?
I would strongly advise against treating with testicular radiotherapy alone at relapse given that testicular relapse is often a harbinger for systemic relapse (depending on the length of first clinical remission) which radiotherapy alone strategies will fail to address (PMID: 8275428). Radiotherapy ...
Do you have a preferred strategy for front line induction therapy in DLBCL patients who have asymptomatic depressed ejection fraction and thus concern about anthracycline dosing?
I generally replace the anthracycline in RCHOP with etoposide 50 mg/m2 IVPB Days 1-3 based on an ASH abstract #408 in 2009 by Sehn L et al. If the day 2 and 3 doses of etoposide are given orally rather than IV the dose would be 100 mg/ m2.
What is your preferred approach to the treatment of transplant ineligible multiple myeloma that has been treated with a triplet regimen and reached a plateau phase?
The depth of response translate into better PFS and OS. Partial response is not appropriate today. We have better combinations that can lead to that. We need to get our patients into CR as soon as possible. After we are there we can talk about maintenance.
In classical hodgkin's lymphoma patients with a postive PET after 2 cycles, are you routinely transitioning to escalated BEACOPP?
Based on the study by Johnson Et al. NEJM 2016 that would be an appropriate action and a strategy that most academic centers undertook prior to the Echelon 1 study. This early in the treatment algorithm to consider either agent although you could consider the combination based on the recent blood p...
What is your approach to treating newly diagnosed plasma cell leukemia?
For fit patients, I am very aggressive in treatment; I use VDTPACE x 2 cycles followed by tandem transplant, then maintenance therapy using a PI and an IMiD, per our observation that showed better results comparing to those who had one transplant. I had no updates on newer agents to use upfront such...
Do you routinely do imaging on patients to look for intrathoracic or abdominal lymphadenopathy in newly diagnosed patients with CLL?
As a general rule, I do not routinely obtain CT imaging studies in all newly diagnosed CLL cases, noting that the Rai and Binet staging systems still widely used today are based on clinical assessments of palpable lymphadenopathy and splenomegaly, and do not require radiographic imaging for completi...