Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How do you manage a patient who has developed a symptomatic pleural effusion while on dasatinib?
A variety of approaches to dasatinib-induced pleural effusion are possible. It is common to rechallenge the patient with dasatinib once the effusion resolves. You can rechallenge with the standard dose if the grade of the initial effusion was grade 1 or 2 (by CTAE grading) or at 50 mg if the effusio...
How do you approach maintenance therapy for relapsed follicular lymphoma?
In general, patients who received 2 years of maintenance rituximab in first-line settings are unlikely to benefit from more maintenance rituximab in second-line. This is especially true if relapse occurs within 24 months of first-line therapy.A meta-analysis (JNCI 2011) did show a small benefit in o...
What is the risk of breast cancer that you quote to young women with early stage Hodgkin's lymphoma receiving involved field/site radiation therapy?
The risk depends on many different factors, including the amount of breast exposure to radiation, age of the patient, chemotherapy regimen, etc. Patients at greatest risk are likely those with axillary involvement who are < 30, where a large portion of their breast maybe unintentionally irradiated. ...
Can we ever observe newly diagnosed chronic phase CML patients and not immediately start them on therapy?
I can't think of a situation that would justify a "watch and wait" approach to CML. There are a number of effective therapies. Even if a patient has side effects from one TKI, there are others to choose from. What justification is there for not using an effective therapy? What is the rationale? Da...
Has the combination of daratumumab, bortezomib, and dexamethasone been tried for the treatment of plasma cell leukemia?
Do you ever discontinue ibrutinib in patients with CLL who have a good response?
For patients who are responding well to ibrutinib and tolerating the drug well, I do not discontinue ibrutinib. The clinical trials of single agent BTK inhibitors have all continued therapy indefinitely, which is a logical approach considering that very few will attain minimal residual disease negat...
Does rituximab + lenalidomide have a role in advanced follicular lymphoma?
There has been much interest in replacing traditional chemo-immunotherapy (generally R-bendamustine, R-CHOP or R-CVP) with noncytotoxic therapy such as rituximab plus lenalidomide in patients with previously untreated advanced stage follicular lymphoma. Studies in relapsed/refractory patients have s...
Is there any role for post chemotherapy (R CHOP x 6) radiation therapy after a splenectomy for a stage IE diffuse large B-cell lymphoma involving only the spleen?
Quite an interesting presentation in terms of extranodal site and age. I would say no for consolidative RT here. For Lugano PET CR after R-CHOPx6, the added benefit of ISRT in a young patient is low and counterbalanced by a real long term 2nd malignacy risk. Other than bulky >7.5cm sites, 'special' ...
What is the optimal regimen for advanced stage Nodular Lymphocyte Predominant Hodgkin Lymphoma?
I do not believe that there is an "optimal" chemotherapy regimen for advanced nodular lymphocytic predominant Hodgkin lypmhoma. The most commonly used regimen is probably ABVD +/- rituximab. CHOP-R might be a good choice when the question of early transformation to diffuse large B-cell lymphoma is s...
What is the preferred regimen for testicular lymphoma with de novo symptomatic CNS involvement and systemic disease at the time of presentation ?
I often consider treating with high dose methotrexate alternating with R-CHOP in such cases. At the end of treatment, I consider radiation to the contralateral testicle. Others have treated similar patients with Hyper-CVAD (Park et al. Am J Hematology 2007)