Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What dose/fractionation schedule should be used for adjuvant RT after surgical decompression of a spinal cord compression from multiple myeloma osseous lesions?
Although myeloma is radiosensitive, since it has caused metastatic epidural spinal cord compression, I will still offer 30 Gy in 10 fxs or 37.5 Gy in 15 fxs, a dose closer to a definitive dose for plasma cell tumors, in order to provide a more durable local control. See variant 2:ACR appropriateness...
How would you manage a localized low grade follicular lymphoma diagnosed shortly after a patient had a CR to an aggressive treatment regimen for DLBCL?
DLBCL arising from a low-grade lymphoma, typically follicular lymphoma, is relatively common. It occurs at a rate of 2-3%/year. Presumably, in this case the patient had an undiagnosed FL with early transformation. Review of the pathological specimens may shed light on this possibility. In any case, ...
Which chemotherapy regimen would you choose for a female adolescent with favorable prognosis stage I-II Classical Hodgkin lymphoma, assuming the patient prefers not to do IFRT if the initial PET response is good?
Does radiation improve bone health and allow for healing of a pathological fracture in a patient with multiple myeloma refusing surgery?
Radiation for myeloma lesions does allow for recalcification of lytic lesions about 50% of the time. There is a suggestion that higher doses increases the degree of recalcification (increasing doses from 20 Gy to 30 Gy increased recalcification by 12% according to Matuschek C et al. Radiat Oncol. 20...
What is your preferred approach to a patient with newly diagnosed primary mediastinal B-cell lymphoma in the upfront setting?
I recommend DA-R-EPOCH in almost all patients. For the rare patients with stage 3-4 disease, I consider RCHOPx4 followed by ICE (unpublished data from Memorial Sloan Kettering).
How do you manage severe cytarabine syndrome in AML patients, manifesting as severe hypotension, fevers, rash, and myalgias?
The cytarabine syndrome is a well-described (Castleberry et al. (1981) Medical and Pediatric Oncology 9:257) syndrome mediated by pro-inflammatory cytokines that are associated with fever, hypotension, rash, and often renal failure. In my experience, its most severe manifestations occur when a patie...
When determining treatment approach to newly-diagnosed follicular lymphoma (e.g. watchful waiting vs chemotherapy), do you take the intensity of the SUV measurements on PET into account?
The short answer is NO. The SUV value does not inform the decision between a "watch and wait" vs. chemotherapy approach. Overreliance on SUV values in newly diagnosed follicular lymphoma is not recommended. The intensity of SUV measurement may, however, aid in locating a site for biopsy. For example...
Should we continue to offer consolidative radiation for early stage, non-bulky Hodgkin's disease for individuals who have had a complete response (Deauville 1 or 2) after chemotherapy by PET?
The RAPID study was a non-inferiority trial. This requires a small editorial. Non-inferiority trials are designed to test that one approach is "not worse" than an accepted standard. However, in essence you are testing that one approach is "not unacceptably worse" than an accepted standard, because t...
How do you decide on the modality of consolidative treatment after a CR in primary CNS lymphoma patients treated with a high-dose methotrexate regimen?
Unless there are contraindications to autologous transplant I favor consolidation with autologous transplant. The long term complications of whole brain XRT include significant neurocognitive deficits. These approaches are rough equal with regards to efficacy.
Is there any data to support to use of Brentuximab in the up-front setting in the treatment of Hodgkin lymphomas?
Currently, Brentuximab vedotin is only approved in Hodgkin lymphoma 1) following failure of 2 multi-agent regimens or ASCT and 2) for post-ASCT maintenance. However, there are several ongoing phase II and III trials in both the US and EU examining Brentuximab vedotin in the up-front setting. The lar...