Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Would you recommend anticoagulation prophylaxis for a pediatric patient admitted with COVID-19?
COVID-19 disease in children seems to be less severe than adults based on the current literature and our personal experience at Children's Hospitals. Among adults, the coagulopathy is beginning to be described with elevated inflammatory markers and other markers of coagulation activation, including ...
Are there any alternative, hypofractionated RT courses for patients with DLBCL that can be used during the COVID-19 pandemic?
ILROG recently came out with guidelines pasted below: Synopsis of ILROG Recommendations for Administering Radiotherapy for Hematological Malignancies During Emergency Conditions of the COVID-19 Pandemic • We are facing an increased demand for RT to substitute or complement systemic therapy deemed i...
Besides GI evaluation and testing for celiac, what other testing do you consider with a patient with unexplained Iron deficiency anemia and a negative bleeding history?
I assume this question comes after endoscopies are negative. Autoimmune gastritis is 30 times more frequent that celiac. So anti-parietal cell antibody should be ordered. >30 likely, >50 usually diagnostic. If still negative a history of long duration therapy for reflux will explain iron deficiency ...
How do you counsel patients on the risk of thromboembolic complications with use of immunotherapy in NSCLC?
Patients with metastatic lung cancer are at increased risk of thromboembolic events with an estimated frequency of 13.9% (Connolly et al., PMID 23026639). Preclinical data show that PD-1/PD-1 pathway blockade may lead to increased levels of pro-inflammatory cytokines and T cell driven progression an...
How do you approach immediate management of paraspinal extramedullary hematopoiesis in patients with transfusion-dependent thalassemia when lesions are enlarging or causing neurologic symptoms?
In general, the goal of transfusion therapy in transfusion-dependent thalassemia (TDT) is to suppress ineffective erythropoiesis. It is the rationale for maintaining a higher pre-transfusion hemoglobin level, at 9.5-10.5 g/dl, well above the general threshold for PRBC transfusion used in oncology pa...
Do you offer enasidenib with azacitadine in AML with an IDH2 mutation for patients ineligible for intensive induction chemotherapy?
I typically do not give enasidenib with azacitidine upfront for patients with AML with IDH2 mutation and ineligible for intensive induction chemotherapy. Based on the results of the VIALE-A study (DiNardo et al, NEJM 2020), I usually give venetoclax with azacitidine to those patients. In addition to...
Are there still clinical situations in which you deliberately treat patients with a DOAC besides apixaban?
Thank you for your question. Apixaban has been my preferred agent for a long time for patients requiring therapeutic anticoagulation. Apixaban’s lower bleeding risk was shown prior to and now has additional evidence to support this with the COBRRA trial. The risk is also ameliorated by the safety in...
Would you continue venetoclax indefinitely beyond standard fixed-duration therapy with ven/obinutuzumab for a patient with high-risk TP53-mutated/del17p CLL refractory to initial acalabrutinib with ALC doubling time < 6 months without BTK resistance mutations?
This patient has covalent BTKi (cBTKi) resistance without a resistance mutation and was transitioned to venetoclax + obinutuzumab. Overall, this patient is not going to do well and in addition to initiating therapy, the provider should refer this patient to a CLL expert provider for co-management. T...
Have you utilized a dose-reduced approach for elderly patients receiving frontline Pola-R-CHP, similar to R-miniCHOP?
I have utilized a dose-reduced approach for Pola-R-CHP for patients who are elderly, whom I would normally treat with R-miniCHOP, based on the early safety data from the POLAR BEAR trial. This randomized trial compared pola-r-miniCHP to R-miniCHOP in patients >80 years of age or >/=75 with comorbid ...
How would you approach radiation for a cutaneous T-cell lymphoma on the nose?
"Cutaneous T-cell lymphoma" (CTCL) comprises a number of different lymphoma subtypes that arise within the skin. Mycosis fungoides (MF) is, by far, the most prevalent. Consequently, the terms CTCL and MF are often used interchangeably. The treatment for each of these lymphomas is different. Furtherm...