Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is the treatment volume for primary breast lymphoma?
This is a rare presentation for DLBCL. In most instances tumor fairly small and lumpectomy can be performed and usually has been before dx is established. Post chemo I usually rx whole breast to 30gy. One could argue against RT theoretically if lumpectomy with neg margins has been performed but it i...
When do you recommend consolidative XRT for patients with advanced stage (III-IV) DLBCL who achieve CR to chemoimmunotherapy?
The cornerstone of therapy for advanced DLBCL is chemoimmunotherapy (R-CHOP). Efforts to improve upon this with systemic therapy have been largely unsuccessful (dose-dense chemotherapy, maintenance R, more intensive chemotherapy, high-dose chemotherapy and autologous SCT, etc.). There are increasing...
What is the role of radiation consolidation after chemotherapy for residual splenic involvement in follicular lymphoma?
Recommend 3000 cGy in 15 fractions
In which patients with early-stage favorable Hodgkin's lymphoma, if any, would you consider omitting consolidation RT after ABVD chemotherapy?
The GHSG HD16 randomized trial was recently reported at ASH (Abstract 925). Patients with early-stage, favorable HL (per GHSG criteria) were randomized to standard treatment (ABVD X 2 followed by 20 Gy of RT) or a PET-directed approach. If PET negative after 2 cycles (defined as Deauville 1-2), then...
In Stage I-II primary mediastinal B-cell lymphoma (PMBL), bulky or non-bulky, is post-chemotherapy radiotherapy still standard in patients with a complete response to CHOP-R chemotherapy?
Primary mediastinal B-cell lymphoma (PMBCL) is a rare subtype of DLBCL. It is a clinicopathologic entity by WHO criteria (which makes it occasionally difficult to conclusively diagnose). The typical patient is young, female, with a large, anterior mediastinal mass. The optimal therapy for PMBCL is c...
Is there a role for consolidation radiation in a patient with stage I low grade follicular lymphoma treated with chemotherapy?
First, while there is no "standard" treatment for stage I follicular lymphoma due to a scarcity of randomized studies, most North American and European guidelines indicate that the "preferred" treatment is radiation therapy. This is based on several single institution series demonstrating that radia...
What dose do you feel comfortable treating the entire circumference of an extremity to before you are concerned about chronic toxicity?
The doses for lymphoma will depend on the histology , use of chemotherapy , response to chemotherpy . I am comfortable in giving 3600cGy at 180 cGy per fraction .
For patients with stage 1A-E extra nodal marginal zone lymphoma that has been completely excised, would you still consider radiation?
Not if it has been excised completely
Is there a role for radiation therapy after chemotherapy for localized anaplastic large cell lymphoma?
Hard to answer this question as posed. ALCL when localized is primarily confined to skin. Treatment of choice in this circumstance is RT alone, generally 40 gy in conventional fractions. ALCL not primarily in the skin is a systemic disease best rx'd with chemo, rarely localized. For the latter, I wo...
What is the best management of a lacrimal gland MALToma?
Ocular MALT can occur in the conjunctiva, lacrimal gland or retroorbital tissue. Although chlamydia can cause this, treatment with antibiotics without documenting infection has not been reported to have a significant response rate. Even in patients who test positive for DNA, I have seen mixed respon...