T-Cell and B-Cell Non-Hodgkin’s Lymphoma Revisited: Therapeutic Paradigms and Advances

This issue of Grand Rounds in Hematology covers a number of diverse topics related to the diagnosis and treatment of and T-cell lymphomas and highlights an evening educational session at the 2009 American Society of Hematology meeting in San Francisco. Several key opinion leaders in the field gathered to present their thoughts on a number of topics, including the pathophysiology of T-cell lymphoproliferative disorders, current treatment options for patients with peripheral T-cell lymphomas (PTCL), treatment strategies for patients with cutaneous T-cell lymphomas (Mycosis fungoides and Sézary syndrome), an overview of the biology and treatment options for extranodal gastric marginal zone lymphomas of mucosalassociated lymphoid tissue (MALT), and fi nally approaches to the treatment of primary central nervous system lymphomas (PCNSL).

Front Line Therapy For Multiple Myeloma And Mantle Cell Lymphoma: The Role of Hematopoietic Cell Transplantation and Proteasome Inhibition Therapies

The management of multiple myeloma has changed dramatically over the past 2 decades. Testing of new treatment options continues at a rapid pace. The advances have resulted in improved survival rates not only in clinical trial participants, but these benefits have been applied to general practice and survival rates are improving in population-based studies as well. Although cure largely remains beyond a realistic prospect, durable control of disease is achievable in the majority of patients.

Maximizing Treatment Outcomes for MDS in the Transplant Patient

Although the myelodysplastic syndromes (MDS) are not curable without hematopoietic cell transplant (HCT), advances in non-transplant therapies today offer considerable benefit to our patients. Over the years, prognostic algorithms have been developed and validated and these are useful guides to allow us to more accurately predict the likely trajectory of disease progression in a group of syndromes that have a notorious heterogeneity.

Current Advances in the Treatment of Acute and Chronic Graft-versus-Host Disease

The alloreactive potency of the hematopoietic stem cell graft provides powerful anticancer activity. Unfortunately, the potential for harm (by graft-versus-host disease [GVHD]) is often as strong as the potential for good. The measures used to control GVHD, such as steroids and antithymocyte globulin, often seem like elephant guns causing similar harmful effects (toxicity and vulnerability for infection) as the GVHD itself, and they rob much of the anticancer effects of the donor graft. GVHD is indeed the thorniest problem of allogeneic hematopoietic cell transplantation (HCT).

Managing the Myelodysplastic Syndrome Patient Through Transplantation

The myelodysplastic syndromes (MDS) have often been called the poster child for apoptosis gone awry: in some cases death (to hematopoietic progenitors) comes too infrequently, in other cases it comes too readily. The quest to better understand its basis and to translate this understanding into therapeutics is only beginning, but already several therapies have emerged and others are in development. For now, there is only one curative therapy for MDS: hematopoietic cell transplantation (HCT).

Insights Into Early Empiric or Prophylactic Antifungal Therapy in a Transplant Setting

Invasive fungal infections have become the chief infectious threat to allogeneic hematopoietic cell transplant (HCT) recipients. New drugs such as the echinocandins (caspofungin, micafungin, and anidulafungin) and the extended-spectrum azoles (itraconazole, voriconazole, and posaconazole) offer more effective and safer options today. Although these potent antifungal agents make treatment prospects better, there still is considerable risk for death from Candida, Aspergillus, and other mold infections.

Improving the Treatment of Hematologic Malignancies: Chronic Lymphocytic Leukemia

This Grand Rounds in Hematology monograph, Improving the Treatment of Hematologic Malignancies:
Chronic Lymphocytic Leukemia, is based on our selection of key abstracts from the ASH meeting in December 2006 and related publications in the following areas of chronic lymphocytic leukemia (CLL): new advances in prognosis, approaches to frontline therapy including the use of chemoimmunotherapies, management of the relapsed refractory patient, and, finally, novel drugs for the treatment of CLL.