FRCPath Haem Part 1 MCQ-Malignant Haem 494

An 80-year-old man presented to haematology unit with ongoing fatigue and abdominal discomfort. The blood shows worsening of anemia. Blood film has a lot of red cell agglutinations. He had a bone marrow biopsy that showed lymphoplasmacytic infiltrate.  His serum IgM paraprotein concentration is 51 g/L. He is planned to receive dexamethasone, rituximab and cyclophosphamide (DRC).

Which of the following is the most appropriate management strategy?

A. Start the full DRC regimen immediately with TLS monitoring

B. Omit rituximab from the first cycle and introduce it later.

C. Permanently avoid rituximab because IgM flare is an absolute contraindication here.

D. Administer prophylactic platelet transfusions before rituximab to prevent IgM-mediated bleeding.

E. Start rituximab immediately and monitor the full blood count