TRAINING and EDUCATION
You Make the Call
Each month in “You Make the Call,” we’ll pick a challenging clinical question submitted through ASH’s Consult a Colleague
program and post the expert’s response, but we also want to know what you would do. Send in your responses to next month’s
clinical dilemma and see how your answer matches up to the experts’ in the next print issue.
This month, Jonathan E. Kolitz, MD, discusses treating a patient with acute lymphocytic leukemia who is of advanced age.
Clinical Dilemma:
An otherwise fit 92-year-old who presented with pancytopenia was diagnosed with Philadelphia chromosome negative
(Ph-) B-cell acute lymphocytic leukemia (B-ALL). I am worried about using anthracycline-based chemotherapy
because of his age. I am considering vincristine plus prednisone (low-intensity therapy). Would you consider
alternative therapies (e.g., inotuzumab ozogamicin or blinatumomab) in the upfront setting?
Expert Opinion
Consult a Colleague
Through ASH
Jonathan E. Kolitz, MD
Professor of Medicine, Zucker School of Medicine at Hofstra/Northwell
Hempstead, New York
Associate Chief, Hematologic Oncology, Monter Cancer Center
Lake Success, NY
Managing an advanced age patient with ALL is challenging.
Less than 10 percent of patients with ALL over age 60 are
long survivors. There may be no long survivors among
patients older than 80 to 90 years. Older patients with
ALL are more likely to have comorbidities and adverse
cytogenetic findings. The Ph chrom