TRAINING and EDUCATION
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, Sonali M. Smith, MD, advises on the use of
pegfilgrastim with ABVD for treating Hodgkin lymphoma.
Next Month’s Clinical Dilemma:
Clinical
Dilemma:
How would you respond? Email us at
[email protected].
What is your opinion on the use of
pegfilgrastim with ABVD for classical
Hodgkin lymphoma? Is it necessary,
or would you treat without regard to
neutrophil count and include it only
if the patient has a neutropenic fever
event?
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:
Experts Make
the Call
Sonali M. Smith, MD
Associate Professor of
Medicine
Director, Lymphoma Program
The University of Chicago Medicine
An every-two-week regimen would not be appropriate for a long-lasting growth factor.
For these reasons, our practice has been to use
prophylactic antimicrobials (usually aciclovir,
sulfamethoxazole/trimethoprim, and a quinolone) if there is prolonged neutropenia and to
give this prophylaxis for the duration of therapy.
If a patient develops a neutropenic infection,
then we add in support with filgrastim.
ASH Clinical News
Assigned volunteer (“colleagues”) will
respond to inquiries within two business
days (either by email or phone).
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.
Reference
1. Evens AM, Helenowski I, Ramsdale E, et al. A retrospective multicenter analysis of
elderly Hodgkin lymphoma: outcomes and prognostic factors in the modern era.
Blood. 2012;119:692-5.
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.
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• Anemias
• Hematopoietic cell
transplantation
• Hemoglobinopathies
• Hemostasis/thrombosis
• Lymphomas
• Lymphoproliferative disorders
• Leukemias
• Multiple myeloma & Waldenström
macgroglobulinemia
• Myeloproliferative Disorders
• Myelodysplastic Syndromes
• Thrombocytopenias
Micrograph of Hodgkin lymphoma:photo by Nephron
For unclear reasons, most patients with ABVDassociated neutropenia (especially younger
patients) actually do quite well and do not
develop neutropenic fevers or other related
consequences.
In addition, there are retrospective data from
several institutions demonstrating that the addition of pegfilgrastim to a bleomycin-containing
regimen is associated with an increased risk of
bleomycin-induced lung injury. We published
our own citywide experience with elderly patients with Hodgkin lymphoma in Blood.1 In this
population, the risk of lung injury with growth
factors led to a very high percentage of pneumonitis, which was fatal in 30 percent of cases.
The American Society of Clinical Oncology and
National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology recommend
restricting pegfilgrastim use to regimens with at
least 21 days between exposure to chemotherapy.
Is it reasonable to use rivaroxaban as an
antithrombotic drug in patients with very
high body mass index (>40 kg/m2)?
*If you have a request related to a
hematologic disorder not listed here,
please email your recommendation
to [email protected] so it can
be considered for addition in the future.
December 2014