Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How do you interpret elevations in antiphospholipid antibodies that are lower than Sapporo criteria?
I would refer to the following article that provides the most up-to-date definitions (including the definitions for low-level antibodies) and risk stratification tools including APL-S and GAPSS that are developed for people with autoimmune conditions. The article also discusses the levels of evidenc...
How would you treat gray zone lymphoma which initially achieved a CR after 2 cycles of DA-R-EPOCH, but end-of-treatment PET demonstrates progression with new sites of biopsy-proven disease?
While admittedly the (non randomized) data comes from HL, would consider pembro-GDP vs BV/nivo with the plan to go to auto.
How does the presence of concurrent infections or wound issues affect your choice and timing of induction in patients with AML or MDS with excess blasts?
Many patients are diagnosed with AML or MDS with excess blasts after presenting with acute infections. In these circumstances, early recognition and initiation of broad spectrum antibiotics to prevent sepsis is essential. We typically delay induction chemotherapy until the infection is under control...
Would you recommend allogeneic stem cell transplantation for consolidation in a patient with follicular lymphoma who relapsed within 13 months of initial chemo-immunotherapy?
Updated answer - 9/18/23 The role for allogeneic stem cell transplantation in follicular lymphoma has become increasingly narrow as the therapeutic armamentarium has expanded. In the current state, even for early-relapsing patients, it would generally not be an early consideration; such patients are...
What is the benefit of cytoreduction with Hydroxyurea for patients with newly diagnosed chronic phase CML with a WBC count >100 prior to the initiation of a TKI?
For newly diagnosed patients with CML, there is no benefit to using hydroxyurea before TKI. Using HU oftentimes ends up causing cytopenias and it then makes it challenging to keep patients on their TKI when it is started. There are some scenarios where it is reasonable to use- if you don’t yet know ...
What are your top takeaways in Hematologic Malignancies from ASCO 2022?
Each year the American Society of Oncology Annual Meeting offers new or updated information that has the potential to change how we care for our patients. Here I highlight three hematology studies that are highly impactful, and which were rightfully highlighted at ASCO 2022. They serve to reinforce ...
In patients with CML on imatinib and newly diagnosed breast cancer now requiring radiation therapy, should we hold imatinib?
There's not a lot of data regarding the best course of action in these rare situations. Anecdotally, I've had one CML patient who had been on dasatinib and was diagnosed with breast cancer a year or two after her CML diagnosis. Her local oncologist did hold her TKI while she was receiving radiation ...
How would you treat a patient with blastoid mantle cell lymphoma with hepatic involvement causing significantly elevated bilirubin?
Tough situation. Ideally, if the cause of the liver dysfunction is the disease then based on age. The goal would be to start therapy in order to alleviate some of the disease burden to reduce the bilirubin level; if this isn't amendable, stenting or percutaneous drainage. If bilirubin can be improve...
Are there situations where you would start treatment for cardiac amyloid in a patient with amyloid seen on biopsy, but still pending mass spectrometry results?
I do not think of treating cardiac amyloid without the results of mass spec. You really need to know what type of amyloid you are dealing with.
How do you define bulky disease for Hodgkin's lymphoma which is outside the mediastinum?
Definition of bulk in lymphoma is not homogenous among countries, study groups, and diseases.Overall, 10 cm is considered the cutoff by some. Recently, the cutoffs of 7 or 7.5 cm have been introduced, especially in DLBCL. The definition tends to be disease-specific sometimes, since landmark studies ...