Two of these disease are seen often on both the heme consult service and boards.
Cold Agglutinin Disease
Hemolytic anemia precipitated by cold
Monoclonal IgM binds RBCs (I antigen), agglutination, and fixes complement in cold->hemolysis
DAT+ for C3 and - for IgG
Associated with IgM gammopathies/LPL
Polyclonal form after Mycoplasma infection
Rx = Rituximab
Cold polyclonal IgG (Donath Landsteiner Ab)
Unlike cold-reacting IgM, no RBC agglutination
But able to fix 1st 2 components of complement in cold
Antibody dissociates at warmer temps
Complement cascade completed on rewarming and hemolysis occurs
Paroxysmal cold hemoglobinuria
Polyclonal IgG specific to P antigen of RBC
DAT positive (anti-C3)
Associated with secondary or tertiary syphilis
Clinical manifestations: Dark urine after exposure to cold
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Early stage DLBCL Tweetorial of all key trials from a presentation I just gave #Goodman_heme
See last slide/Tweet for my conclusions
SWOG 8736:
>18 years
Bulk (>10 cm) allowed
CHOPx 3+IFRT vs. CHOP x 3 +IFRT
OS⬆️with IFRT but no difference in OS with extended f/u
18 year f/u
ECOG 1484
>16 years
Bulk (>10 cm) allowed
CHOP x 8 if CR (by CT) randomized to IFRT vs observation
DFS improved with IFRT
No difference in OS
GELA/LNH 93-1
No adverse risk factors on aaIPI
Age <60 years
Bulk (> 10 cm) allowed
ACVBP x 3 vs CHOP x 3 + IFRT
EFS and OS improved with chemo alone
Very young favorable group but chemo alone works!