You Made the Call
We asked, and you answered! Here are a few responses
from this month’s “You Make the Call.”
I would follow her periodically by checking SPEP, serum
free light chain, CBC, and CMP. I would maybe ultrasound
the pelvis periodically, then just watch and follow.
For the full description of the clinical dilemma, and to
see how the expert responded, turn to page 27.
Manal Robin-Hanna, MD
Cancer Centers of South West Oklahoma
Lawton, OK
Clinical Dilemma:
A woman presented with a myeloid sarcoma. Several
surrounding lymph nodes were noted to contain similar
findings. A bone marrow biopsy was negative for acute
myeloid leukemia (AML). The patient has completed
chemotherapy with standard daunorubicin/cytarabine
and has pancytopenia. A bone marrow biopsy was
repeated and remains normal. How do I follow/assess
this patient’s response? What treatment should I give
after induction?
I would proceed with a bone marrow transplant after
assuring remission with CT or PET/CT. If no matched
siblings, I would consider an autologous bone marrow
transplantation.
Yusra Al Awami, MD
King Faisal University
Saudi Arabia
I would recommend allogeneic stem cell transplantation
if she has a match.
Bruce Raphael, MD
NYU Langone Medical Center
New York, NY
Abdul Hameed, MBBS, MD
Shaukat Khanum Memorial Cancer Hospital & Research
Centre
Lahore, Pakistan
I would give induction, followed by consolidation (AML
protocol). A CT scan could be done to assess the response.
I would recommend salvage therapy followed by BMT.
Kulumani Sivarajan, MD
Joliet Oncology-Hematology Associates
Joliet, IL
Perform PET-CT scan and type siblings for possible
match. I would then do three cycles of HiDAC.
Thomas Hyde, MD
Kaiser Permanente Rock Creek Medical Oncologists
Lafayette, CO
Bone marrow transplant ASAP.
Anastasia Skandali, MD
Hygeia Hospital
Athens, Greece
See more reader responses at ashclinicalnews.org/category/trainingeducation/you-make-the-call.
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