Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How would you manage biopsy-proven DLBCL in a patient who was treated with 6 cycles of R-CHOP 15 years ago for DLBCL?
It will be difficult to tell if this is a relapse vs. de novo DLBCL unless you have the old pathology slides available and if a skilled pathologist is able to tell. In general, patients with late relapses > 24 months from achieving remission have favorable outcomes with salvage chemotherapy and auto...
How would you manage a patient with NLPHL and CKD who relapsed after a long disease free interval (i.e. 7 years) following bendamustine?
I honestly might consider BR again depending on the counts. I personally use as little as possible - often stopping the B after 3-4 cycles if the patient is in remission.
Is it possible to give Inotuzumab ozogamicin in the front line setting for an older patient with Ph- Pre-B-ALL?
Yes - there are encouraging data from early-phase trials looking at InO-containing regimens in the frontline setting. Some of these include: Alliance A041703 (InO followed by blinatumomab for older adults with CD22+, CD19+, Ph-negative B-ALL): Wieduwilt et al., Journal of Clinical Oncology 2023, sup...
Would concurrent CRLF2/IgH rearrangement affect your treatment recommendations for an adult patient with Ph+ p190 high risk (Age>35, WBC >30) B-cell ALL that was started on induction therapy with ponatinib + blinatumomab?
Short answer: No. Longer answer: We lack a clear understanding of how to change treatment for adults with CRLF2 fusions with Ph- ALL, and this is the situation where it is more clearly understood to have prognostic significance (Roberts et al., PMID 27870571). In my view, it would be very difficult ...
What are your management strategies for patients with chronic kidney disease attributed to deferasirox use who require frequent blood products for a hematologic disorder?
It depends on the type and severity of the hematological disorder as well as the extent of CKD. Currently, two oral chelators; deferasirox and deferiprone, are available, in addition to deferoxamine, which can be administered SubQ or IV. These can be mixed and combined, and combination therapy may b...
Do you prefer to use 7+3 or CPX-351 as standard induction therapy in younger patients with AML-MRC or t-AML?
I prefer to use 7+3 based on the fact that Lancet et al., PMID 30024784, that showed the benefit of CPX-351 was in adults over 60.A paper by Othman et al., PMID 37171402 showed no overall survival benefit to CPX-351 when compared to FLAG-Ida in younger adults with high-risk AML/MDS.
How would you manage a young patient with HL who develops HF (EF < 30%) after 4 cycles of A+AVD who obtained a PET2 CR?
This is a tough case, and the management would depend on the extent of disease. Assuming that this is advanced stage HL, given the use of BV+AVD, I would be in favor of completing 6 cycles of therapy with a non-anthracycline-based regimen. You can consider consolidative radiation, but this would nee...
What is your approach to the management of essential thrombocytosis in a woman planning to start a family?
This is an important question because it directly addresses what it means for a patient to have an MPN, and what it means for the physicians who treat them. The first is diagnosis: what is essential thrombocytosis (ET)? Some “experts” state that it is “related” to polycythemia vera (PV), or represen...
Would you treat the mandible if the patients has osteonecrosis from zoledronic acid but also multiple myeloma in this region, biopsy proven?
Plasma cells can be seen in mandible biopsy without myeloma in that region. Have had a similar patient. However, if the patient has confirmed myeloma relapse elsewhere or systemically then would treat relapse with chemo. Denosumab or zometa is contraindicated due to confirmed osteonecrosis. Not sure...
How would you manage a case of subcutaneous panniculitis-like T cell lymphoma (A/B) who is already on steroids and methotrexate for autoimmune disease?
First, I would want to be assured that the diagnosis is truly panniculitis T cell lymphoma and not lupus profundus. The two can be hard to differentiate microscopically with T cell gene rearrangement positive in the lymphoma. If the diagnosis is lupus profundus, this would be managed as per rheumato...