Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
When are you recommending bone marrow transplant recipients receive the SARS-CoV-2 vaccine?
The CIBMTR and EBMT data indicate a 20-30% mortality in transplant patients. Risk factors are age >50, male, and <12 months from HSCT. Unfortunately, the complexity of immunological recovery after transplant makes inferring the likelihood of response to a new vaccine formulation impossible. In gener...
What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?
There are a number of resources available to guide clinicians on these decisions. I recommend the COVID-19 Resources webpage curated by the American Society of Hematology (COI, I'm the editor of that website). https://www.hematology.org/covid-19 This website includes guidance on immunizations in the...
What is the best way to monitor intraoperative heparin use in a patient with factor XII deficiency?
Generally, the baseline ACT may or may not be prolonged, so one should be obtained pre-operatively. The surest way to monitor is with the heparin anti-Xa assay.
How can healthcare providers better serve as allies of the sickle cell community?
Yes, the medical community should absolutely advocate for our patients with sickle cell disease (SCD). The vast majority of Americans with SCD are of African or Hispanic descent, and the overlay of racial inequality and healthcare disparities negatively impact their health outcomes (1-5). In additio...
How do you approach patients with a history of lymphoma in remission who are in need of immunosuppressive (e.g. TNF blockers, 6MP) or other therapies (e.g. JAK inhibitors) for autoimmune disease that have been linked with the development of lymphoma?
Dierickx et al., PMID 26384356. Yes, you can resume immunosuppression (IS) safely. If rituximab can be used for auto immune disease treatment that would be perfect.The prior treatment for lymphoma if it included rituximab would have taken care of the b cell reservoir.If high risk for recurrence of l...
How do you decide between CPX-351 and HMA + Venetoclax in treating transplant eligible AML-MRC?
I would consider CPX-351 (liposomal daunorubicin and cytarabine) in anyone who you would consider to be an induction chemotherapy (7+3) candidate. The indication is for newly diagnosed MDS/AML (AML-MRC) or treatment related MN (t-AML). Benefit is the response can be seen quicker in 1 cycle as oppose...
Should patients receive thrombophilia testing in the setting of a provoked VTE secondary to hormonal therapy/OCPs?
Given that oral contraceptives are considered a provoking event (Ortel et al., PMID 33007077), ASH Choosing Wisely guidelines recommend against thrombophilia testing since the recommended duration of anticoagulation is only 3 months. (Hicks et al., PMID 24307720 & Hicks et al., PMID 25472968).
How do you approach the treatment of ITP in a pregnant patient who did not respond to prednisone?
We usually stay away from dex because of the toxicity and use the absolutely smallest dose of prednisone we can. Usually, unless the count is very low, I start at about 20mg since we’re just trying to get the count up not get a CR. We manage a lot of patients with IVIg alone, but it can get expensiv...
Would you consider adding midostaurin to azacitadine in elderly patients with newly diagnosed AML with FLT3-ITD mutations in the frontline setting?
Yes, would consider adding midostaurin to azacitidine in an elderly patient with newly diagnosed AML with FLT3 as long as if ITD allelic ratio is high where benefit outweighs risks of cytopenias and infections. Dose reductions can be considered based on tolerance. I would use the same regimen as stu...
How would you manage a stage IE DLBCL of the stomach, non-germinal center type by IHC, and Ki-67 of 70%, but negative for double/triple hit by FISH?
Nijland et al., PMID 29083044. This shows that you can use either option, 3 cycles RCHOP+ XRT or 6 cycles RCHOP with no difference in relapse or DFS.My bias would be to treat with 6 cycles of RCHOP as I look at DLBCL as a systemic disease and risk for systemic relapse even with early presentation.If...