Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is the role (if any) for Rituximab in a patient with CD20+, Philadelphia chromosome positive ALL?
There are no good randomized data in PH+ disease, but the incorporation of rituximab for CD20+ and PH+ ALL has been standard practice on MD Anderson trials of HyperCVAD+TKI. The challenge has been more on the insurance side - but our approach is to include it if approved.
What factors do you consider when interpreting post treatment PET Deauville scores for patients treated with chemotherapy for classical Hodgkin Lymphoma?
PET-CT interpretation using Deauville Criteria (5 point scale) provides a more objective and descriptive methodology than previous scoring systems. However, there are still numerous limitations and challenges and I suspect refined methods to report PET-CT responses will evolve in the future. I utili...
How do you dose midostaurin in patients with AML who need azole antifungal prophylaxis?
Patients with acute myeloid leukemia are often neutropenic due to the disease or treatment. Anti fungal prophylaxis is often required. The azoles are attractive oral agents. However, they are Cyp3A4 inhibitors. Therefore, for patients taking Midostaurin we use micafungin for anti fungal prophylaxis....
When would you add daratumumab to a PI/IMiD/dex backbone for first-line treatment of transplant-eligible multiple myeloma?
Short answer - in patients with low risk disease.Long answer - CASSIOPEIA enrolled fit patients below 65 years of age with adequate kidney function (greater than or equal to 40 mL/min/1.73 m2) with predominantly stage 1 & 2 disease by the revised international staging system (91% in Dara-VTd, 90% VT...
Should consolidation autologous stem cell transplant be considered for de novo follicular lymphoma transformation to DLBCL after achieving a PR with R-CHOP x 6 cycles, if residual disease showed original indolent follicular lymphoma?
First, it is important to make sure that residual disease is FL rather than tFL, which it sounds like you have already done. However, the PET scan should be reviewed; if there is a different node that has very high FDG uptake, then that node should be sampled to rule out residual DLBCL. Historicall...
For an otherwise healthy individual, what would be your front line choice for de novo Richter’s transformation?
The management of de novo transformation of CLL to DLBCL is challenging. For young fit patients, the standard of care remains RCHOP chemoimmunotherapy. Limited data exist exploring other options, including retrospective data sets and small prospective studies, but nothing published convincingly esta...
Based on the SELECT-D trial, would you favor rivaroxaban over LMWH for treating cancer-associated VTE in patients with low risk of bleeding?
Both the SELECT-D trial and the HOKUSAI trial provide evidence that rivaroxaban and edoxaban respectively, have a role in the management of cancer-associated thrombosis (CAT). In addition, an oral presentation from ASH 2018, ADAM VTE trial, also supports a role for consideration of apixaban in the m...
Would using Obinutuzumab and Venetoclax second line after Bendamutine and Rituximab be a reasonable option for a patient with IGHV-unmutated CLL?
BR is still an option for frontline CLL, but since Venetoclax +obinutuzumab was approved for frontline therapy, the question you have posed is very relevant. Now it is more important than ever, for the treating physicians to ask what is the therapeutic objective in each case? If we are dealing with ...
What is your first line treatment of choice for advanced (stage IIIA) follicular lymphoma, histologic grade 1-2 in an otherwise young healthy patient in 2019?
When do you offer consolidative tandem autologous stem cell transplantation for high-risk multiple myeloma?
This is a great deal of debate regarding the question of tandem transplant. In the original IFM 94 study, only patients not achieving a VGPR benefited from a tandem transplant. However, that was in the era of pre-novel therapies. More currently, the BMT CTN 0702 (STAMINA) trial did NOT show a benefi...