中華民國血液病學會

1. Which statement is false?

A. HCT was recommended as the primary therapy option by NCCN guidelines for WM.

B. Plasmapheresis should be performed for patients with symptomatic hyperviscosity, and before treatment with rituximab-containing regimen in patients with IgM ≥4000 mg/dL.

C. Bleeding can also occur in the absence of thrombocytopenia in WM.

D. The prediction of an imminent bleeding event should not rely solely on a low platelet count.

2. Which statement is better recommendation?
A 45-year-old male patient had history of coronary artery disease (CAD) and under regular follow up in the cardiology clinic. The patient complained frequent epistaxis, gingival bleeding, and dizziness in July 2018. No significant abnormality was found by cardiac examinations, but anemia and thrombocytopenia were noticed. In hematology clinic, atypical lymphocytes and decreased renal function were also noticed. High total protein level, albumin/globulin ratio reversal resulted from extremely high immunoglobulin (Ig) M level (>12,000 mg/dL), and mild elevated β2-microglobulin were observed. Referring to all the reports from imaging and bone marrow studies, WM or lymphoplasmacytic lymphoma (LPL) with indolent nature was diagnosed.

A. Initial treatment with rituximab monotherapy is recommended.

B. According to NCCN guidelines, BR (bendamustine+rituximab) could be the initial treatment before plasma exchange for this patient.

C. Considering high IgM level with hyperviscosity symptoms, plasma exchange should be performed before anti-CD 20 treatment.

D. HCT was recommended as the primary therapy option for this patient.

3. Which statement is false?

A. Exposure to nucleoside analogs (fludarabine and cladribine) should be avoided in patients who may be potential autologous HCT candidates.

B. VGPR: A ≥90% reduction of serum IgM and decrease in adenopathy/organomegaly (if present at baseline) on physical examination or on CT scan. No new symptoms or signs of active disease.

C. Only Autogenetic HCT was recommended in NCCN guideline for WM.

D. Cardiovascular symptoms may occur in hyperviscosity syndrome.