Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Is there a role for ruxolitinib in essential thrombocythemia?
There have been two larger publications supporting the use of ruxolitinib in ET. However, it is only useful in certain situations after standard therapies like hydroxyurea and pegylated interferon. Certainly, if a patient is symptomatic with cytokine-related symptoms, heading towards post-ET MF, or ...
Would you offer chestwall RT after capsultectomy+explant for an implant-related ALCL?
Breast implant-associated ALCL is a provisional entity in the most recent WHO classification system with a relatively low incidence. In contrast to most other lymphomas, surgery plays an integral role in the management of this disease. Most patients present with a spontaneous fluid collection around...
What would be the preferred chemotherapy regimen in elderly patients with advanced stage classical Hodgkin Lymphoma and contraindication to doxorubicin and bleomycin?
First, I’d seek clarification as to what contraindications were present. Contraindications to either can be absolute or more relative. A Hgb-adj DLCO of less than 50% in the presence of known lung disease is an absolute contraindication to bleo, whereas a DLCO of 65 perhaps contributed to by HL itse...
How long do you treat recurrent classical Hodgkin lymphoma with brentuximab/nivolumab if the patient does not want to proceed to BMT?
The phase 1/2 study of BV/nivolumab combination aimed to maximize response with a goal to proceed with autologous SCT. In the trial protocol, patients would receive 4 cycles of therapy (Blood 2018).If a patient changed their mind and does not want autologous SCT, then I would drop BV (assuming they ...
For inpatient treatment of lymphoma and ALL, can rituximab be delayed?
Although I am not aware of published data on this issue, at least for patient receiving DA-R-EPOCH, I have learned that it is common practice to delay the day 1 rituximab because of the reimbursement issue you refer to. I don't think the effect of this has been studies systematically, but i'm not aw...
What is your preferred TKI and dosing for AYAs or adult patients with Ph+ ALL?
We typically follow the MD Anderson updated approach of adding dasatinib 100mg daily for first 2 weeks in cycle 1 and then 70mg daily starting cycle 2 (Cancer 2015; 121:4158).How long to continue? That’s a tough one with essentially no mature data. The COG study continued for only 2 years, though da...
How would you approach primary CNS lymphoma in an elderly patient over 80 years old?
Patients >70-75 are poorly represented in trials and retrospective studies, and are in need of novel therapies with minimal toxicity. We know that radiation therapy is associated with increased neurocognitive morbidity in patients >60, but is often the only feasible approach if chemotherapy cannot b...
Would you offer next-line systemic therapy to a patient with LGL leukemia with chronic severe neutropenia, who has had treatment failure with methotrexate, cyclophosphamide, cyclosporine, and danazol?
Response can be slow and delayed. Treatment failure is usually considered after 4 months of therapy. Steroids can be used with methotrexate in severe neutropenia with a slow taper over 4-6 weeks. This strategy seems to potentiate the effect of methotrexate. Evidence after these therapies is limited....
What would be your choice for treatment for an HIV positive patient with no detectable viral load with CD20 negative and CD30 positive DLBCL?
I would really question the diagnosis, especially with the CD30 positivity. Consider peripheral T-cell lymphomas, which are typically CD30+ (ALCL, PTCL-NOS, AICL).
Would you offer maintenance lenalidomide or rituximab in a patient with DLBCL transformed from a marginal zone lymphoma in a young, fit patient?
No. There is no role for maintenance therapy in aggressive lymphomas (transformed or not). This is based on the assumption that DLBCL is curable and randomized trials evaluating maintenance therapy in de novo disease did not show an improvement in survival (see HOVON Nordic trial). Dedicated trials ...