Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How do you work up patients with low level monoclonal lymphocytosis and adenopathy?
Asymptomatic patients who have MBL (<5 x 10⁹/L malignant B-cells in blood) and associated lymph node disease that is palpable have the diagnosis of CLL/SLL. If they are asymptomatic, I do not scan these individuals or biopsy the palpable lymph node. My approach here would be to: Initiate prognostic...
What is your approach to screening for malignancy in dermatomyositis patients who do not have a high risk antibody profile and whose disease responds well to treatment?
This is a great question and one that is very relevant to our clinical practice. Different myositis specific and associated antibodies seem to carry different risks in their associations with cancer. My colleague, Dr. Alexander Oldroyd, has written our current guidelines on cancer screening for pati...
How should elevated PT of unclear etiology and significance be evaluated?
Mild prolongation of the prothrombin time (PT) may represent a normal ‘outlier’. If there is no obvious explanation for a moderate to marked prolongation of the PT (for example, anticoagulation therapy effect, liver disease, nutritional deficiency like vitamin K deficiency. then the next step is to ...
In patients with essential thrombocythemia (ET) receiving hydroxyurea for cytoreduction who develop anemia — whether hydroxyurea-induced or from a concurrent etiology such as CKD — would you use ESAs?
This is an important question. Patients with ET should not have anemia related to the ET itself. Thus, assessing the etiology of the anemia is very important. If the anemia is from hydroxyurea, the first step is to lower the dose of the hydroxyurea. Controlling platelets should not come at the expen...
What are your top takeaways in Hematologic Malignancies from ASH 2025?
The PARADIGM study is a very important one that may result in a paradigm change for the treatment of AML. The study showed that outcomes are equal or better with AZA + VEN among patients with AML suitable for intensive chemotherapy. The efficacy was superior in response rate and EFS (but not overall...
What are your top takeaways in Lymphoma from ASH 2025?
Fixed-duration versus continuous targeted treatment for previously untreated chronic lymphocytic leukemia: Results from the randomized CLL17 trial — This trial may change practice by using the combination of BTK-I and Ven without CD20 antibodies. This time-limited option led to MRD, and I would expe...
How do you approach imetelstat therapy in MDS patients with baseline neutropenia or thrombocytopenia?
Given the fact that the major treatment-emergent adverse events noted on the phase III IMERGE study in the imetelstat-treated arm were neutropenia (68% Grade 3+ tox) and thrombocytopenia (62% Grade 3+ tox), it makes it somewhat difficult to utilize imetelstat (Platzbecker et al., PMID 38048786) in p...
How would you manage superficial thrombophlebitis of the great saphenous vein involving the knee and calf?
I would point you to an excellent algorithm created by Sherry Scovell on UpToDate, "Superficial Vein Thrombosis and Phlebitis of the Lower Extremity Veins" which has informed my practice. The highlights of the approach utilized are to perform imaging with Doppler ultrasound to determine the length o...
Would you treat an early stage transformed DLBCL from indolent lymphoma in the same way as a standard, newly diagnosed de novo DLBCL?
To my knowledge, all studies in limited-stage LBCL excluded prior indolent lymphoma. Therefore, we do not have prospective data to support shorter courses of CIT. It will be an interesting subject of investigation. However, given that, in general, cell of origin or MYC double-hit status does not rea...
Do you routinely check serum phosphorus levels after IV iron therapy?
Only before and after FCM. I hold subsequent doses if phosphorus low. There is no need to monitor with the other formulations. For people needing multiple doses of IV iron (IBD, bariatric surgery, heavy uterine bleeding, angiodysplasia), I avoid FCM.