Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How do you interpret a Deauville score of 3 on PET when performing mid-treatment assessments in patients with Hodgkin lymphoma?
A Deauville score of 3 or less in an area of disease previously positive (Deauville score of 4 or 5) at interim assessment is considered to be a complete metabolic response (Lugano criteria, Cheson et al. JCO 2014). Some studies evaluating a de-escalation of therapy based on interim assessment may c...
Does R-CHOP provide durable remission in low-risk pediatric Burkitt or Burkitt-like lymphoma?
It depends on your definition of "low-risk". Historically, the FAB defined low risk as FAB Group A (resected Murphy stage 1 tumor and resected Murphy stage 2 abdominal primary). Gerard's paper in BJH in 2008 reported a 98% EFS with two cycles of COPAD (basically CHOP with fractionated cytoxan) and n...
When do you consider plasma exchange for multiorgan failure in a patient with sickle cell disease?
The first choice for treating multiorgan failure in sickle cell disease is exchange transfusion that should be started as soon as possible. Sometimes the clinical and hematologic features of sickle cell multiorgan failure resemble and overlap those of thrombotic microangiopathies like TTP. Also, tru...
For relapsed/refractory myeloma, how long of a disease-free interval from first autologous transplant do you recommend before considering a second autologous transplant?
This is an excellent question, and I appreciate Dr. @Dr. First Last's choice of "second ASCT" and not "salvage ASCT" - I still catch myself saying the latter, but the wording is as patient-unfriendly as it gets.When considering a second ASCT (whether with repeat collection or with cells saved up fro...
Would you check vitamin B6 routinely in the work up of anemia?
I only consider it when I see ringed sideroblasts in the marrow. It is on the differential of things that lead to ringed sideroblasts. "Pyridoxine responsive anemia", which can be inherited or acquired. However, in my experience, it is very rare. Even the couple of people I have had with mildly decr...
What would be your approach to initial treatment of a patient with standard-risk myeloma unwilling to undergo autologous stem cell transplant, if practicing in a resource-limited setting?
For non-transplant candidates or patients unwilling to have transplant with standard risk MM, these are my 2 choices: RVd: len/velcade/dex: based on the SWOG S077 compared to Rd: Durie et al., PMID 28017406. Dara Rd: Daratumumab/Revlimid/dex: based on the MAIA study compared to Rd: Facon et al., PMI...
What is your recommended management algorithm for bleeding associated with an acquired factor VIII inhibitor?
Fragner et al., Cureus 2022.
How would you approach the treatment of cytopenia related to NK cell LGL leukemia?
You could use filgrastim and erythropoietin but I prefer to treat the underlying leukemia with low dose methotrexate or cytoxan. It may take up to 6 months to see responses to cytotoxic agents and you would need to support the patient during this time with transfusions or growth factors. Thrombocyto...
Would you discontinue anticoagulation in patients with antiphospholipid antibody syndrome, who have a remote history of thrombotic events and are now negative for pathogenic antiphospholipid antibodies?
I would certainly consider stopping anticoagulation in selected patients after an in-depth discussion about potential risks and benefits. I would not consider stopping AC in patients with a history of recurrent events, arterial events, or multiple risk factors for thrombosis (e.g. nephrotic syndrome...
Are there best practices or data regarding the use of open notes among oncology patients?
The 21st Century Cures Act regulation (effective April 2021) required that clinical notes such as consult and office notes be shared with patients, e.g. “open notes.” In general, surveys of patients with cancer and their clinicians suggest that open notes are viewed favorably (Salmi et al., PMID 330...