Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Is your standard of care for newly diagnosed advanced classical Hodgkin now nivolumab-AVD based on SWOG 1826?
I think the new standard of care for newly diagnosed patients with advanced classical Hodgkins Lymphoma is now nivolumab-AVD based on the early data from SWOG 1826. While we often wait for more mature data, the early improvement in PFS and the more favorable toxicity profile of this regimen over BvA...
What is your approach to chronic non-immune mediated thrombocytopenia management in children?
There are whole textbook chapters on this topic, and we use a variant of this question to review the differential diagnosis of thrombocytopenia with our fellows as a didactic exercise. So I take from this question, which is an important one, what might be a framework to consider the differential dx ...
What is your preferred first-line therapy for transfusion-dependent beta-thalassemia?
Transfusions are the backbone of therapy for these individuals. Reducing transfusion burden is advantageous to minimize iron loading, space out transfusions, and improve quality of life. At present, there are 2 agents available - luspatercept and mitapivat. The clinical trial endpoints for both are ...
What criteria is needed in relapsed/refractory B-cell ALL to choose CAR-T therapy over conventional stem cell transplant as destination therapy?
Currently, there are no standard criteria used to choose CAR-T over conventional stem cell transplant as destination therapy. However, there are many factors that often push us in one direction or the other. As we learn more about outcomes after CAR-T cell therapy, there are many factors we know are...
When consolidating DLBCL with radiotherapy, do you treat all originally involved sites, or just initially bulky and partial responder sites?
When consolidating DLBCL with radiotherapy, several parameters must be taken into consideration. a) Is radiation therapy part of the treatment plan "on top" of full systemic treatment because of a certain risk situation due to not-optimal response of disease to systemic treatment (for example, FDG-a...
Is enteric-coated aspirin acceptable to use in polycythemia vera or ET?
Admittedly, this is a question I had not considered before viewing this query, as I rarely, if ever, prescribe enteric-coated aspirin. In the absence of a bleeding diathesis such as von Willebrand disease, platelet count greater than one million/mm³, or active GI bleeding, low-dose aspirin (75/81/10...
Would you consider perioperative antifibrinolytics for mild factor 7 deficiency undergoing surgery?
I do use antifibrinolytics in factor VII deficiency; however, it depends on the specifics of the surgery (i.e., mucosal surface surgery, sequelae of bleeding should it occur - spine vs oral), the patient's bleeding history, and the factor VII level. Here, I wonder if the original diagnosis was corre...
Can aplastic anemia present with multiple infiltrative bone lesions, such as in the spine and pelvis?
There are several studies showing diffuse hypointense pictures with an infiltrative-like pattern on MRI in aplastic anemia and MDS. Some aplastic anemia and refractory cytopenia of childhood show patchy pattern of hematopoiesis with some regions having increased fat fraction and some remnants of hem...
Do you continue daratumumab beyond 24 months in first line treatment of amyloidosis?
This is an important and common clinical question, and one for which prospective data are currently limited. For background, the ANDROMEDA clinical trial (Kastritis et al., PMID 34192431) demonstrated that the addition of daratumumab to cyclophosphamide, bortezomib, and dexamethasone (CyBorD) signif...
In what scenarios do you use a chromogenic factor X assay in adjusting INR goals for patients on warfarin?
I do not use this method. It has been suggested that such assays be used in patients with lupus-type inhibitors who have significantly prolonged prothrombin times at baseline. In this setting, if the INR is "therapeutic," one would confirm an adequate warfarin effect if the factor X activity was in ...