You Make the Call
Each month in “You Make the Call,” we’ll pick a challenging clinical question
submitted through the Consult-a-Colleague program and post the expert’s
response. But, what would YOU do? We’ll also pose a submitted question
and ask you to send your responses. See how your answer matches up to the
experts in the next print issue.
This month, Arnold S. Freedman, MD, answers a question about restarting
rituximab as part of a new chemotherapy regimen for a patient with diffuse
large B-cell lymphoma.
Clinical Dilemma:
In 2012, I treated a young man with follicular lymphoma with four cycles of bendamustine/rituximab. He developed
prolonged neutropenia (presumed rituximab associated) that lasted eight months. He now has diffuse large B-cell
lymphoma (DLBCL). Would you restart rituximab as part of a new chemotherapy regimen? Is he at higher risk for
recurrence of rituximab-associated neutropenia?
Consult a Colleague
Through ASH
Consult a Colleague is a service for ASH
members that helps facilitate the exchange of information between hematologists and their peers. ASH members
can seek consultation on clinical cases
from qualified experts in 11 categories:
• Anemias
• Hematopoietic cell
transplantation
• Hemoglobinopathies
• Hemostasis/thrombosis
Experts Make the Call
• Lymphomas
• Lymphoproliferative disorders
Arnold S. Freedman, MD
Professor of Medicine
Harvard Medical School;
Department of Medical Oncology
Dana-Farber Cancer Institute
Boston, MA
• Leukemias
• Multiple myeloma & Waldenström
macroglobulinemia
• Myeloproliferative disorders
• Myelodysplastic syndromes
• Thrombocytopenias
I would suspect that bendamustine is more likely the
cause of the neutropenia. I would perform a bone
marrow biopsy and send for cytogenetics. I think
you have to use R-CHOP at this time for the DLBCL.
IV IgG anecdotally helps reverse the neutropenia of
rituximab.
Assigned volunteers (“colleagues”) will
respond to inquiries within two business
days (either by email or phone).
Saikia TK, Menon H, Advani SH. Prolonged neutropenia following anti CD20 therapy in a
patient with relapsed follicular non-Hodgkin’s lymphoma and corrected with IVIG. Ann Oncol.
2001 Oct;12:1493-4.
Have a puzzling clinical dilemma?
Submit a question, and read more
about Consult-a-Colleague volunteers at
hematology.org/Clinicians/Consult.aspx
or scan the QR code.
DISCLAIMER: ASH does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and
disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this article is
solely at your own risk.
*If you have a request related to a
hematologic disorder not listed here, please
email your recommendation to ashconsult@
hematology.org so it can be considered for
addition in the future.
Next Month’s Clinical Dilemma:
recommendations regarding pregnancy?
ADDITIONAL RESOURCE
A 31-year-old female, who had a recent
miscarriage at six weeks of pregnancy,
was participating in boot camp. She
developed sudden onset left arm pain
and numbness and was found to have
82
ASH Clinical News
brachial and axillary artery thromboses.
She underwent an emergent
thrombectomy. She was noted to have
a dual brachial system, and a subacute
thrombus was removed. An ECHO was
negative for cardiac thrombus or defect.
Her angiogram was negative for stenosis
or dissection. A hypercoaguable workup
was negative. The patient was placed on
rivaroxaban; she wants to conceive again
as soon as she can. How long should
she continue anticoagulation, and any
How would you respond? Email us at
[email protected].
December 2016