ASH Clinical News ACN_5.1_Digital

You Make the Call: Readers’ Response Is the diagnosis non-classical lymphocyte- predominant Hodgkin lymphoma? The de- scription doesn’t mention the size of nodes, but why not give rituximab as an option? Lauren C. Pinter-Brown, MD University of California, Irvine Orange County, CA I would use a non-fertility altering regimen such as R-ABVD (rituximab, doxorubicin, bleomycin, vinblastine, dacarbazine) or R-AVD. I appreciate that R-CHOP is standard of care, but the chance of salvaging this patient and avoiding fertility issues with second-line treatment is high. Antoine Sayegh, MD Roseville, CA I would go with R-ABVD (rituximab, doxorubicin, bleomycin, vinblastine, dacarbazine) as done by MD Anderson Cancer Center in the past. Thomas C. Shea, MD University of North Carolina, Chapel Hill Chapel Hill, NC See more reader responses at ashclinicalnews.org/ you-make-the-call. We asked, and you answered! Here are a few responses from this month’s “You Make the Call.” For the full description of the clinical dilemma, and to see how the expert responded, turn to page 27. Clinical Dilemma: I have a 22-year-old female patientwith stage 2a lymphocyte- predominant Hodgkin lymphoma involving lymph nodes in the pelvis who presented while pregnant and needs to begin therapy. The radiation oncologist does not want to treat her because it may affect future fertility. The recommendation at our lymphoma rounds was for six cycles of R-CHOP rather than an ABVD regimen. What would you do? 1. 2. 3. 4. 5. What are the risk factors? Score on the Hasenclever Index? Is there splenic involvement? CT and PET/CT staging done, SUV>10? Occult diffuse large B-cell lymphoma? Biopsy? Is the lymphoma CD20-positive? Limited stage: radiation; advanced stage classical Hodgkin lymphoma: chemotherapy with or without anti- CD20 antibody Heinz-Gert Hoeffkes, MD Fulda, Germany Nuclear export dysregulation is stealing the cell’s valuable anti-tumor defenses 1 IT’S ONE OF THE GREATEST HEISTS IN CANCER, AND NO ONE SAW IT COMING. Dysregulated nuclear export has been secretly depleting the nucleus of key anti-oncogenic proteins, allowing the tumor to proliferate and survive. 1,2 I think R-CHOP (rituximab, cyclophospha- mide, doxorubicin, vincristine, prednisone) is the right approach. Add a luteinizing hormone-releasing hormone (LHRH) agonist after her treatment ends. Anastasia Skandali, MD Hygeia Hospital Athens, Greece Investigate the evidence at NuclearExport.com R-CHOP plus LHRH agonist. Sahra Ali, FRCPath Castle Hill Hospital Cottingham, United Kingdom References: 1. Gupta A, Saltarski JM, White MA, Scaglioni PP, Gerber DE. Therapeutic targeting of nuclear export inhibition in lung cancer. J Thorac Oncol. 2017;12(9):1446-1450. 2. Sun Q, Chen X, Zhou Q, Burstein E, Yang S, Jia D. Inhibiting cancer cell hallmark features through nuclear export inhibition. Signal Transduct Target Ther. 2016;1:16010. Karyopharm and the logo designs presented in this material are registered trademarks of Karyopharm Therapeutics. Karyopharm Therapeutics | 85 Wells Ave, Newton, MA 02459 © 2018 Karyopharm Therapeutics. All rights reserved. US-NON-09/18-00004 ASHClinicalNews.org

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