Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What are your top takeaways from ISTH 2025?
MAYARI trial - this trial was a single-arm trial for "non-severe" iTTP (excluding patients with significant cardiac or neurologic involvement) where PLEX was only used as a rescue therapy. Patients were started on caplacizumab and immunosuppression with steroids and rituximab. A large number of pa...
How do you manage persistent cytopenias after FCR chemotherapy for treatment of CLL?
For persistent cytopenias after FCR, the initial approach would be supportive care. If no recovery after 12 weeks, consideration should be for a bone marrow biopsy to evaluate for aplasia, an autoimmune process like PRCA, or early MDS. The therapy after the bone marrow would be based on the result. ...
What is your approach to a situation where DILI is suspected secondary to an important medication (e.g., anticoagulation, antibiotics, etc.), but the diagnosis is uncertain and the liver injury is relatively mild?
If the drug suspected to induce liver injury causes symptoms and ALT is >3 times the upper limit of normal (ULN), I would stop the drug and find an alternative. Even if no symptoms are present, I would stop if ALT is >5 times ULN. Any level increase of ALT below the above parameters would still requ...
How do you approach delivery planning in patients with T1 vWD?
For VWD, I recommend that the mode and timing of delivery be obstetric-based (i.e., the presence of VWD has no effect on the decision). If a CSX is needed, I consider an epidural safe if preceded by VWD-specific therapy. I base the duration of VWD-specific therapy on clinical history and 3rd-trimest...
Has the data for the ENRICH study changed your practice for the initial treatment of mantle-cell lymphoma?
While the information presented was intriguing, it has not yet caused any change in my approach to initial therapy for MCL. I say this due to the fact that the IR arm did not seem better than BR, save for those with a P53 mutation. I have routinely avoided CIT in this patient population, so this inf...
Is obinutuzumab obligatory with AV combination for patients with unmutated IGHV?
Obinutuzumab certainly improves PFS and TTNT but it's important to recall that the OS (in the non-COVID-19 adjusted data) was inferior with AVO in the full cohort. I will certainly discuss adding obinutuzumab for patients with unmutated IgHV with all patients, but will recommend it only for patients...
In which patients with essential thrombocythemia would you use ropeginterferon alfa-2b?
Currently, the FDA's only indication for Besremi (ropeginterferon) is polycythemia vera (PV). I am not sure why this is since there is ample data on treating essential thrombocytosis (ET) patients with pegylated interferon. So, if still available, my answer covers the use of either. It also covers E...
When testing for patients with symptoms of MPN, do you prefer to do JAK2 cascade testing or a leukemia NGS testing panel?
Oftentimes, the symptoms related to MPNs are quite non-specific (fatigue, anorexia), so I typically look for other pieces of information from the CBC with differential and physical exam (e.g., splenomegaly). If the clinical suspicion for an MPN is high and I am pursuing confirmatory testing with a b...
What is your preferred strategy for young adults with ITP complicated by recurrent autoimmune neutropenia?
This is a great question, and I'll say that AIN can be particularly difficult to treat! I'd first ask how low the ANC is and if the patient is presenting with frequent infections/hospitalizations. If not, there may not be a need to treat the AIN (we may just be treating ourselves); oftentimes, there...
What are your practical considerations for incorporating bispecific antibody therapy into treatment of relapsed DLBCL?
In relapsed/refractory DLBCL, if the patient has not yet received bispecific antibody (BsAb) and/or CAR T-cells, and the patient is eligible and able to receive CAR T-cells, I favor CAR T-cells before BsAb, given extensive follow-up time demonstrating CAR T-cells are a potentially curative approach ...