Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Is there a role for assessing measurable/minimal residual disease (MRD) in multiple myeloma at this time?
MRD assessment in myeloma is challenging. The EuroFlow standard and Adaptive ClonoSEQ technologies seem to be winning out for the moment, but the Mayo Clinic mass spectrometry peripheral blood assay may be the next generation. The advantage of the flow-cytometry based assay is that it involves live ...
With new data now available for use of brentuximab in ALK positive, CD30 anaplastic large cell lymphoma, what is your first line regimen?
I would say in the light of ECHLON-II data with a PFS and OS advantage specifically in ALCL and Advanced stage ALK positive disease Brentuximab-CHP would be the most beneficial option and standard of care.
Will you offer Ibrutinib and Rituximab for untreated patients with CLL without a 17p deletion?
The ECOG 1912 study presented at ASH this week showed better OS and PFS in younger patients with ibrutinib, which was great news. I used to use FCR in these patients as it was said to have a higher rate of MRD but potentially dangerous myelo- and immunotoxicity and of course there's concerning issue...
What is your preferred first-line therapy for a patient with standard risk multiple myeloma?
Tough question. Let's do the easy ones first. The low risk (R-ISS 1) fit patient could be treated any number of ways with Bortezomib+Lenalidomide+Dexamethasone (RVd), Carfilzomib+Lenalidomide+Dexamethasone (KRd), or Daratumumab+Lenalidomide+Dexamethasone (Dara-Rd). Bortezomib can lead to neuropathy...
How would you treat a patient with a refractory primary splenic marginal zone lymphoma with symptomatic splenomegaly (20 cm) and a mild pancytopenia?
Radiation therapy is utilized in two primary settings to palliate symptoms of splenomegaly in patients with hematologic malignancies.First, extramedullary hematopoiesis within the spleen can lead to symptomatic splenomegaly in a variety of hematologic malignancies (e.g., myelofibrosis). In this sett...
How would you treat DLBCL of the terminal ileum in an otherwise healthy patient?
Primary intestinal Diffuse large B cell lymphoma (PI-DLBCL), even if found incidentally on a screening colonoscopy in an asymptomatic patient, should be treated with systemic chemotherapy similar to what is done with nodal DLBCL. With this approach, the prognosis for PI-DLBCL is very good based on t...
In transplant-eligible, fit patients with primary refractory myeloma, what is the optimal timing for stem cell collection?
In fit patients with less than a partial response to induction therapy, i.e. primary refractory, the optimal timing for stem cell collection is NEVER. If they don't respond to three drug induction (proteasome inhibitor + IMiD + steroid), they are unlikely to respond durably to a standard high dose m...
In transplant-eligible, fit patients with multiple myeloma who have an inadequate response to front-line therapy, what regimen would you choose for second-line?
for transplant eligible patients who you want to get to transplant but have not achieved an adequate response for stem cell collection, there are 3 senarios: 1: if no response at all to front line therapy (VRd) say <PR: would do VDPACE x 2-3 cycles, using the last cycle as chemo mobilization with co...
In staging Hodgkin's lymphoma, would you identify a PET+ bony focus as disease when there are no associated bone changes on CT and a biopsy was not obtained?
PET is generally the most sensitive indicator for-involvement with HL, so I would not let the absence of CT findings deter one from diagnosing bone disease if the PET is convincingly positive. One should also weigh the clinical circumstances and consider how likely the pt is to have bone involvement...
How do you approach front line treatment for TP53 mutated mantle cell lymphoma?
For patients with TP53 mutations based on the information presented by Eskelund et al. and previous experience. Given the knowledge that the mutation is a dominant negative which eliminates and functional activity of the tumor suppressor it stands to reason that an durable response with chemotherapy...