Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Would you recommend allogeneic stem cell transplantation for consolidation in a patient with follicular lymphoma who relapsed within 13 months of initial chemo-immunotherapy?
It depends so much on the patient, especially age. I think with CART being approved in FL, I’d probably hold allo until after CART in most cases.
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 ...
In a patient with a bleeding disorder, how would one approach anticoagulation during active COVID infection?
This is very dependent on what the bleeding disorder is, how severe it is, and what you think is the risk of clotting with this COVID infection in this individual. For example, if this is a mild-moderate type I VWD with very infrequent bleeding with a need for treatment, you could probably handle th...
In someone with an asymptomatic JAK2 V617 mutated and BCR/ABL negative MPN with a steadily rising WBC, when do you decide to start cytoreductive therapy and which agent(s) do you recommend?
First, let's abandon the phase "BCR/ABL-negative MPN". This is an oxymoron because BCR/ABL can be expressed in a JAK2 driver mutation-positive MPN. In fact, both BCR/ABL and JAK2 mutations can be expressed in normal individuals at very low levels without causing disease. Both mutations can also be p...
Is rituximab for refractory ITP contraindicated in the setting of an active COVID infection, particularly in a patient with asymptomatic COVID?
Given that we would delay rituximab treatment for many active infections, I would recommend that we apply the same restrictions. I would hold the rituximab for ten days after covid test confirmation.