Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How would you approach re-irradiation to a localized DLBCL of the lower extremity?
Unfortunately I need a few more details to answer this. This appears to be a complicated difficult case. I presume the initial dx was DLBCL of the skin, leg type? Age of the patient? What was the response to R-EPOCH? Was the RT given as consolidation or was there disease present? If so, response to ...
How would you approach treatment in an otherwise young, fit patient with transformed AML currently in remission with a plan for transplant and was found to have an invasive fungal infection not amenable to resection upon recovery from induction?
This is an all too common problem. Firstly, "not resectable" is sometimes in the eye of the beholder. Ensure all effort is made to resect if this is isolated even if it's a brain lesion or needs a lung resection. Secondly, not all "fungi" are the same. If this is mold, you must be sure it is "not re...
How do you adjust the dose of Ibrutinib in hepatic dysfunction, particularly if disease related?
It's an interesting question, but I have never seen such a case. Ibrutinib rapidly clears tissue disease, and hence, the liver dysfunction, if truly CLL-related, should improve on therapy. Given the unusual scenario, I would consider starting at a low dose, 140 MG daily, and titrate up to 280 MG aft...
How would you treat a young patient with symptomatic Rosai-Dorfman disease who has recurrent, life-threatening pericardial and pleural effusions?
Rosai-Dorfman disease is the most tricky one of the top 3 histiocytosis (ECD, LCH, and RDD). It can behave as benign or as an aggressive disease. Given the rarity of the disease, there are no great prospective studies to guide optimal treatments. First-line treatment includes prednisone or other imm...
Do you rebiopsy grade 1-2 follicular lymphoma if SUV is high by PET?
When would you consider transplant for a patient with a bone marrow failure syndrome (FA, DC, etc.)?
At the time of early bone marrow failure - before they become transfusion-dependent or develop a significant risk for infection and/or bleeding. With Fanconi's and BRCA2 mutation - would follow bone marrow carefully (2x a year) as they have a risk of AML. Because both FA and DK are systemic disorder...
Would you recommend anticoagulation for patients with partial false lumen thrombosis in type B aortic dissection?
Type B aortic dissections are generally managed by vascular surgeons using endovascular techniques or surgery. Anticoagulation is not recommended for partial false lumen thrombosis. If complications arise such as downstream occlusion of vessels due to thrombosis or embolism, urgent surgical evaluati...
Are there any special considerations for treating CML in the very elderly, greater than 85 years old?
When approaching older patients with CML it is important to consider comorbid conditions, medications, organ function, and potential toxicity of therapy. This approach is not that different than it would be for younger patients. However, older patients are more likely to be on more medications or to...
What maintenance treatment would you recommend for Ph positive ALL following Hyper-CVAD, transplant eligible or ineligible?
While ABL kinase inhibitors (TKIs) are commonly recommended as maintenance post-transplant in Ph+ ALL, the data supporting this practice are relatively soft. Position statements from expert panels convened by EBMT (Giebel et al., PMID 27309127) and ASTCT (DeFilipp et al., PMID 31446198) both general...