Questions discussed in this category
There are conflicting reports whether it contributes to renal insufficiency. If you do switch, what is your preferred TKI in this scenario?
How would the risk of VTE associated with crizotinib affect your decision? Should we consider using crizotinib in combination with brentuximab?
In the absence of concerning bleeding or thrombosis, family history of coagulopathy, current anticoagulant use, or malnutrition
Although testing was not indicated, what do u do with these results?
Other hypercoagulability work up negative
Would the answer differ if the index event was arterial vs venous?
Do you advise against combination OCPs?
What are indications to order gene mutation studies (e.g. ELANE) and how would it help the patient?
What would you recommend within the first year after ATG and thereafter if still maintained on cyclosporine?
Ferritin uptrending >1000, no additional lab abnormalities. HFE wildtype. Too young for age-appropriate cancer screening. Asymptomatic except fatig...
Is thrombotic risk too significant? Patient failed OCPs.
If hydroxyurea modifies the course of sickle cell disease by increasing fetal hemoglobin, is there any benefit to using it in patients with fetal hemo...
What are the differences in approach to B lymphoid/myeloid and T lymphoid/myeloid MPAL?
For example, if TSAT is less than 20% but ferritin is over 200.
Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?
If not, how do you choose GVHD prophylaxis regimen? Is there a preference?
E.g. would you dose-reduce or continue at same dose?
Baseline ANC was in the normal range
Patient with high titer acquired FVIII inhibitor with no causative etiology. Bleeding is well-controlled on emicizumab, but inhibitor has failed...
The patient has no personal history of VTE, but has positive family history of VTE.
Any prophylactic anticoagulation options?
How would manage...
For instance, if clonal hematopoiesis of indeterminate potential (CHIP) suspected
iPET2 and iPET4 showed Deauville 5 response. CT biopsy after 4 cycles was negative. Patient is currently scheduled for 2 additional cycles of ABVD.
I.e., what constitutes well-controlled cancer, IBD, nephrotic syndrome, etc. What other diseases do you put in this category (obesity, autoimmune dise...
Does the fact that the patient is on methotrexate alter your choice?
If so, what platelet count threshold would you use? Would age impact your decision? Would you do a bone marrow to rule out primary MPD in adults if th...
i.e. long car rides or plane rides
CRP 39 mg/L (normal < 10) and normal ESR
Do you use a cutoff of 10 cm? Do you measure the size of the largest node or measure the largest conglomerate or measure the total length of the entir...
How does graft function play into your decision making? How do you utilize post allogeneic transplant chimerism in clinical practice? Do you obta...
Presuming strong indication for ASA - eg history of NSTEMI
Should we stop checking factor VIII levels as part of thrombosis workup?
(e.g. beta 2 glycoprotein IgM > 20 but <40)
Do you routinely check IgG levels during therapy, if not indicated by a study protocol?
While L-glutamine has minimal side effects and would likely be added after hydrea, how do you decide between the use of voxelotor and crizanlizumab?
If so, what regimen do you utilize?
How would the approach differ if the patient had a significant bleeding phenotype vs only minor bruising and mucosal bleeding?
This type of etoposide sparing therapy has been previously described in a case series at https://pubmed.ncbi.nlm.nih.gov/32725881/
Last rituximab 6 months ago
What is the impact among patients and providers?
Has your documentation been adjusted now that patients can readily review?
If so, how long after diagnosis do you do so?
Are there situations in which a Deauville 3 would cause you to escalate therapy?
Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?
FVL heterozygotes are often treated similarly to the general population. Aside from avoiding other VTE risk factors, are there situations where prophy...
Are there particular clinical scenarios that would affect your decision?
Such as the case in which a patient is unresponsive to steroids, IVIG, TPO-agonist, rituximab, splenectomy, and even fostamitinib.
e.g. DITP from eptifibatide after a cardiac intervention
IVIG, TPO, or other agents?
Given the POLARIX study data presented at ASH 2021, will this replace R-CHOP as the standard of care therapy in your practice? If not, how will y...
Would you offer indefinite anticoagulation if the event is unprovoked and the patient has low bleeding risk?
Also is there value in using voxelotor for the purpose of reducing hemolysis, and if so what parameters do you use to determine when to initiate voxel...
If so, what dose and fractionation would you recommend?
Is there a particular sequence you would adjust contributing antirejection or antimicrobial medications? Is the use of G-CSF appropriate and at what c...
How does belumosudil now fit in your approach to steroid refractory chronic graft-versus-host disease?
Hydroxyurea is demonstrated to reduce complications and improve long-term outcomes in severe genotypes HbSS and sickle beta0 thalassemia. What clinica...
Are there other supportive care interventions that would otherwise be covered by hospice?
What if the patient is triple-positive or has continued seropositivity on repeat lab testing? What is the appropriate interval of monitoring and does ...
Provoked or unprovoked VTE: Do you use D-Dimer (or even repeat imaging to reassess residual clot) in any capacity to guide anticoagulation duration? E...
Is an LP only recommended in the setting of particular subtypes of lymphoma or symptoms of CNS disease?
Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?
Especially with the current drug shortage of nelarabine.
While building a trusting patient-physician relationship, what therapies could be discussed that may be aligned with naturopathic medicine? (i.e. L-gl...
There are multiple difficulties that could be seen: steroids can precipitate a sickle cell crisis, vasculitis and sickle cell can produce similar clin...
Does manipulation of blood products (leukoreduction, irradiated) affect your approach? There is growing evidence that routine premedication (at least ...
While this is a known risk factor for venous [Meijers et al NEJM 2000] and potentially arterial [Yang et al, Am J Clin Pathol 2006] thrombosis, it is ...
Are there major differences in standard conditioning and/or GVHD prophylaxis regimens utilized?
Does the non-relapse mortality different significantl...
Would this change with someone who has a history of thrombosis (e.g. DVT/PE, MI, CVA)?
Would this change with someone who is more fit vs more frail?
Such as patients who are frail, elderly, renally impaired?
Would you consider sirolimus over cyclosporine or tacrolimus for safer nephrotoxicity prof...
How often do you monitor ADAMTS-13 levels off therapy?
For example, do we prefer one regimen over the other in patients with a bleeding history or who have relapsed after a lengthy remission?
In follow up to @Jacqueline Casillas presentation at ASCO 2021 regarding models of survivorship care delivery for AYA patients.
If given both options, which donor would one prefer: haploidentical related donor or 7/8 mismatched unrelated donor using post transplant cyclophospha...
Is there a role for empiric antibiotics if there is history of opportunistic infection?
With a strong family history
While benefits outweigh known harms and limited data, do you worry about vaccination in patients with a history of or active autoimmune cytopenias (e....
Do you follow the 2019 EULAR Guidelines that SLE patients with asymptomatic, positive aPL should be on low-dose ASA?
Would you consider this type of patient as having polycythemia?
What is the potential differential diagnoses for low iron saturation?
Do you always treat with the full 21-day treatment course, or can defibrotide be stopped if certain criteria are met sooner?
Do you prefer a cHL chemotherapy backbone or PMBL chemotherapy backbone?
While thrombophilia testing is not routinely recommended prior to starting OCPs, how about after the development of a VTE?
Especially in a triple-positive patient with an acute ischemic stroke who may have urgency for anticoagulation with high bleeding risk and severe thro...
The patient who has not responded to steroids, rituximab/bendamustine, and splenectomy?
Would you give a trial of IST first or immediately refer for SCT if the patient has matched siblings?
Has your medical practice taken any steps either in community outreach or within the clinic to show support for this medically vulnerable population, ...
During the Stimate recall, how are we performing DDAVP challenges for newly diagnosed hemophilia A or von Willebrand disease?
Are most places administering oral iron as once daily or every other day dosing due to upregulation of hepicidin receptors following oral iron adminis...
There is no uniform guideline in the literature. AAP recommends until 5 years old or 1-year post-splenectomy. Some for 5 years post-splectomy.
Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?
Given the high cost of eculizumab, are there patient characteristics that inform which patients, if any, should be on indefinite therapy versus a time...
How do you manage an uncomplicated DHTFR versus a hyperhemolysis?
For example, a patient with hypogonadism unless it matters which organ is involved. Are other markers of iron storage useful in guiding therapy?
For example, in a patient who is steroid-refractory, requiring regular transfusion, and has not had response to rituximab after several weeks.
Presented at ASH: FLIGHT trial
If so, what additional testing do you send?
If autoimmune neutropenia already suspected, is this test informative or unnecessary?
What is the lowest level you have seen with uncomplicated or complicated crises?
There are various formulations of intravenous iron; each with varying costs, test dose requirement, elemental dose, and number or time of infusions ne...
Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?
What if this was "triple-negative" antiphospholipid syndrome?
CT scans show omental and pelvic disease.
Would you consider “bridging” therapy with something like an HMA?
Is it at neutrophil recovery, at documentation of CR on bone marrow biopsy, or is there a different point in time?
Does acute leukemia sub-type affect your decision?
Assuming CBC w/ different and complete metabolic panel are within normal limits, what (if any) further evaluation or management is needed?
If so, what dose would you recommend?
At what age would you treat an early stage hodgkins lymphoma patient with ABVD + RT (adult treatment) vs OEPA x 2 or AV-PC x 3 (pediatric paradigm)?&n...
Guidelines indicate RCHOPx3 +RT as category I and RCHOP x 6 below that; long term f/u for SWOG 8736 showed similar PFS and OS. Do you have and approac...
We often see young women with favorable, early stage disease in the mediastinum who have had a complete response to chemotherapy. With current smaller...
What dose do you recommend?
After ABVE-PC X4 and Ifos/vinorelbine x 2 per AHOD 0831 (and is unable to have these sites biopsied), what dose would you treat to and what volume wou...
Are the results of AHOD0031 practice changing?
It seems that with the arms up, you get better lung blocking but with arms akimbo, you might have a lower dose to the humeral head.
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