7^th World Hematologists Congress

Biography

Biography: Rouslan Kotchetkov

Abstract

Characterization and management of patients with a synchronous dual hematological malignancy (SDHM) is not well described. In our database, we identified 41 patients with clonally unrelated SDHM, a prevalence of 1.35%, median age 75 years (23-90) and male predominance. 31.7% had concomitant solid cancers, suggesting increased susceptibility to SDHM or impaired immunity. Referrals from general practitioners were for a general diagnosis (65%) or for a non-specific symptom (35%). With referrals from specialists only asymptomatic secondary diagnoses were missed. SDHMs were diagnosed incidentally or because of discordance in clinical/laboratory findings. Three combinations of SDHMs were identified. In the myeloid+lymphoid group, concomitant MGUS was most frequent. Within the lymphoid+lymphoid group, SDHM combinations were random. There were only three myeloid+myeloid SDHMs. 70.7% required therapy for primary malignancy, 29.3% needed active surveillance. For a secondary diagnosis, 70.7% patients were actively monitored, and 29.3% needed treatment. At the completion of treatment for primary malignancy, 90% were either in remission/non-progressing disease or 10% progressed. Overall SDHM survival was 82.9% vs. 87.2% of control. Our management experience of SDHM is following: Have low threshold for intensive investigations if there are discordant data; patients with low-grade/low-acuity SDHM can be on active surveillance with early re-evaluation of both diseases if conditions change; if two malignancies require treatment, aim therapy at the more aggressive one; ABVD chemotherapy completely resolves cutaneous T-cell lymphoma lesions; cladribine has no effect on concomitant chronic myelomonocytic leukemia; ruxolitinib precipitates chronic lymphocytic leukemia; hydroxyurea decreases M-spikes in MGUS, regardless of type; azacitidine improves mast cell leukemia, bone marrow fibrosis, but has no effect on follicular lymphoma and; phlebotomized patients with polycythemia vera may develop profound anemia on chemotherapy, requiring holding phlebotomies, IV iron, erythropoietin-stimulating agents/red cell transfusions. Further studies of SDHM, exploring different cohorts and ethnicities, are needed.