Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What dose and fractionation do you use to palliate mycosis fungoides lesions?
I will admit that I utilize a wide range of fractionation schedules, depending on the clinical circumstances when treating mycosis fungoides. The data suggests that 2 Gy x2 is not an effective palliative schedule, with a CR rate of only ~30% with almost all lesions requiring re-treatment (Neelis et ...
How do you manage MPN patients with acquired VWD in the perioperative setting?
The greatest risk of a very high platelet is bleeding not thrombosis, and it is fair to say that this appears to apply to myeloproliferative (MPN) thrombocytosis as opposed to reactive thrombocytosis (there is no correlation between the platelet count and thrombosis with either cause of thrombocytos...
Can defibrotide be given safely for VOD in patients with refractory thrombocytopenia to platelet transfusions?
The short answer is "yes."The slightly longer answer is: “Yes, and in patients with veno-occlusive disease (VOD), the use of defibrotide is potentially life-saving (Richardson et al., PMID 26825712).” In the cited study, which led to its FDA approval for this indication, there was no significant dif...
Would you consider splenic radiation in stage IV CD5+ DLBCL involving the bone marrow in patients who initially presented with symptomatic splenomegaly, anemia, and thrombocytopenia but achieved complete response on PET after 6 cycles of R-miniCHOP?
CD5 positivity is an adverse prognostic factor in DLBCL. About 5% of patients with DLBCL are CD5+. Other adverse risk factors are often present in these patients (advanced age, non-germinal center histology, high IPI, etc.). More generally speaking, the role of consolidation RT in advanced DLBCL is ...
For early stage indolent NHL (low grade follicular, MALT) involving midline structures of the head and neck (ie base of tongue, soft palate) how do you apply the concepts of ISRT?
@Dr. First Last,I think your question is a good one and probably not one answerable by definitive data. However, the recent publication of the ILROG guidelines on extranodal disease (Yahalom et al, https://www.ncbi.nlm.nih.gov/pubmed/25863750) and bulk of available data I believe suggest that it’s o...
Would you consider a patient with DLBCL to have CNS involvement if no brain lesion is seen on imaging, CSF flow cytometry is negative, but PCR is positive for MYD88 and KMT2D mutations?
Cerebrospinal fluid (CSF) is an ultrafiltrate of plasma contained within the ventricles of the brain and the subarachnoid spaces of the cranium and spine. It is possible that cfDNA fragments containing MYD88 and KMT2D mutations may have found their way into the CSF and thereby detected by PCR techni...
What dose and fractionation would you deliver to the sole of the foot in a patient with multifocal cutaneous DLBCL that is resistant to systemic therapy?
We need some more information here. Does multifocal mean the patient has multiple skin lesions? The diagnosis of cutaneous DLBCL is also somewhat ambiguous. Is this cutaneous DLBCL leg type, a specific entity in the WHO pathology classification, or perhaps the older WHO classification is being used ...
How do you differentiate atopic dermatitis from mycosis fungoides histologically?
Differentiating mycosis fungoides from any spongiotic process (atopic dermatitis, allergic contact dermatitis, etc.) is extremely difficult and typically requires correlation with clinical features and sometimes molecular findings. Some features that favor mycosis fungoides are: Lymphocytic exocyto...
What is your practice regarding giving G-CSF to patients with ALL during initial induction?
My colleagues and I do not use G-CSF in either ALL or AML unless the neutropenia is unusual and prolonged and associated with infection. The use of G-CSF has been shown to shorten neutropenia by a few days but does not prevent the drop and theoretically, at least it may prolong thrombocytopenia by p...
What is your approach to treatment of relapsed, high-risk MDS with TP53 mutation in a patient that is not considered a transplant candidate?
I don't think that there is a particular answer for those with TP53 mutation with the exception of poor prognosis with whatever will be offered to them. I suggest azacitidine-based therapy based on improved overall survival (OS) compared with other approaches. Azacitidine is the treatment of choice ...