You Make the Call: ASH Meeting on Hematologic Malignancies Edition
The American Society of Hematology’s 2017 Meeting on Hematologic Malignancies (MHM), held
September 8-9 in Chicago, featured top experts in the field sharing insights into the treatment of
leukemia, lymphoma, myelodysplastic syndromes, myeloma, and myeloproliferative neoplasms.
The MHM program content was structured as “How I Treat” presentations that showcased each
speaker’s treatment approaches. During their presentations, the experts asked the audience how they
would respond to challenging patient cases, with audience members voting live at the meeting via an
audience response system, but we wanted to know what our readers would do.
See below for a comparison between audience members’ and ASH Clinical News readers’ responses
to the three questions we shared via email during the meeting. There were some clear differences in
opinion – particularly in determining the prognosis for a patient with bulky follicular lymphoma.
Each day, we also randomly selected a respondent to receive an ASH Clinical News–themed prize.
Thank you to everyone who participated, and congratulations to the winners!
Case #1: How would you treat a 62-year-old man diagnosed with
myelodysplastic syndromes whose disease has not responded to
azacitidine?
A 62-year-old man who was diagnosed with myelodysplastic syndromes nine months
ago presents with:
• Hgb 7.2 g/dL
• MCV 108 fL
• WBC 1,900/µL
• ANC 740/µL
• platelet count 41,0000/µL
Bone marrow biopsy showed hypercellularity and 11 percent blasts, consistent with
refractory anemia with excess blasts-2. Karyotyping showed 46,XY,del(20).
He received eight cycles of seven days of azacitidine 75mg/m 2 intravenously. He
experienced no toxicity, but remained red blood cell transfusion–dependent (2 units/
month). After cycle eight, a bone marrow biopsy showed 18 percent blasts. Karyotyping
showed 46,XY,del(20). His Karnofsky performance status is 80 percent.
This patient wants to consider all available options for his therapy. What would you
offer him now that azacitidine has not been effective?
A. Monthly transfusion support
B. Switch to decitabine
C. Add another agent to azacitidine
AUDIENCE
RESPONSE
D. Treat like acute myeloid leukemia, with 7+3 of cytarabine and an anthracycline
ASH
CLINICAL NEWS
READERS’
RESPONSE
E. Look for a clinical trial at the nearest academic center
F. HLA type and move to hematopoietic cell transplantation ASAP
WINNER: .
Gabrielle Meyers, MD
Oregon Health & Science University School of Medicine
Portland, OR
52
ASH Clinical News
10% Switch to decitabine
1% Add another agent to azacitidine
22% Treat like acute myeloid
leukemia, with 7+3
25% Look for a clinical trial at the
nearest academic center
41% HLA type and move to HCT ASAP
6% Switch to decitabine
10% Treat like acute myeloid
leukemia, with 7+3
31% Look for a clinical trial at the
nearest academic center
53% HLA type and move to HCT ASAP
October 2017