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Practice Changing Hematology Updates By, Robert Robles, MD

Jan 02, 2017 12:49PM ● By Elena Hutslar

This year’s meeting of the American Society of Hematology (ASH), was less noticeable for blockbuster announcements than many potentially practice changing presentations.

For patients with chronic lymphocytic leukemia (CLL), the use of Obinatuzumab (Gazyva) in combination with standard chemotherapy was superior to the use of the standard therapy with Rituximab (Rituxan) in prolonging the time CLL remains under control. Two studies demonstrated the use of Lenalidomide (Revlimid) as a maintenance therapy after completion of standard chemotherapy also delayed the progression of CLL, since CLL by nature is a chronic disease with relapses and remissions. The availability of safe and well-tolerated therapies that prolong the interval between potentially more toxic therapies should be a welcome addition to the therapeutic armamentarium.

Diffuse large B cell non-Hodgkin’s Lymphoma is the most common subtype of non-Hodgkin’s Lymphoma. It is a potentially curable malignancy when treated with chemotherapy. However, since not all patients are cured, there has been continuous research to improve treatment results. A trial conducted in the U.S.A. compared standard chemotherapy, R-CHOP, with a more intensive and difficult to administer chemotherapy regimen called dose adjusted R-EPOCH. This trial showed the treatments to be equivalent. Although this trial did not show a benefit to any one treatment, the subtleties of why this result occurred are probably as important as the result of the trial. Regardless, the most important message from this trial is that more chemotherapy is not necessarily better. A better understanding of the subsets that make up the category we currently call diffuse large B cell non-Hodgkin’s Lymphoma will hopefully allow more targeted therapies to be developed.

A study from the University of Minnesota evaluated the safety and efficacy of new anticoagulants (Pradaxa, Eliquis, and Xarelto) in patients with cancer. The use of these new anticoagulants in patients with cancer has not been evaluated in a large number of patients. The study concluded these drugs appear to be safe and efficacious. Large studies evaluating the new anticoagulants to confirm their safety and efficacy are ongoing.

Robert Robles, MD is board certified in medical oncology and hematology. He practices with Diablo Valley Oncology & Hematology Medical Group, located at the California Cancer and Research Institute in Pleasant Hill, and he also sees patients in San Ramon. Dr. Robles has a special interest in treating hematologic cancers, lymphomas, and blood and clotting disorders. For more information, call 925-677-504 or visit