Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How would you approach a low to moderate titer of one of the APLS antibodies in a patient with a strong family history but no personal history of thrombosis?
I do not do anything as there are no data to support intervention in this case.
How would you counsel a patient with active SLE on treatment, low to moderate level of one of the APLS antibodies, and remote history of provoked blood clot regarding perioperative anticoagulation?
Without knowing more specific details, my approach would be to repeat the full panel of antiphospholipid antibodies, institute treatment with HCQ if not there already, discontinue all estrogen products and counsel the patient against smoking. I would coordinate perioperative anticoagulation with a h...
What would you use for a maintenance regimen after high dose chemotherapy and autologous stem cell transplant for a patient with 17p-deleted multiple myeloma?
PI/IMiD maintenance — if RVd +/- Dara is used as induction, then Len with Bortezomib q 2 weeks. If KRd is used as induction, then Len with Carfilzomib q 2 weeks. Adjust dose/schedule based on tolerance/side effects.
What would be your next step in workup for a patient with IgG Kappa Monoclonal protein detected on SPEP and free lambda light chains found in the urine, with chronic diarrhea for 3 years and concern for GI amyloidosis?
This is a great question. I think the most important thing when it comes to the consideration of amyloidosis is thinking of it in the first place! For patients with MGUS (or myeloma) but with red flag symptoms of amyloidosis, it is important to work these up. The studies recommended may differ base...
How do you manage a patient with a nonspecific platelet function disorder and heterozygous protein C deficiency during pregnancy?
Assuming platelet function testing was done as part of a more comprehensive assessment of hemostasis and that there are no other detectable hemostatic defects (e.g., low von Willebrand factor level prior to 3rd trimester), I would not recommend giving DDAVP unless the patient has a significant bleed...
How would you approach therapy for a transplant-eligible patient with peripheral T cell lymphoma NOS who experiences early relapse after CHOEP, but achieves remission to salvage therapy?
Not an easy question, and certainly, not one with a single right answer. The body of literature comparing auto to allo in r/r PTCL-NOS while mixed can be reasonably distilled to the observation that both are appropriate, but neither is definitively better. Therefore, there's a lot that goes into th...
Do you typically see peripheral neuropathy in patients with castleman syndrome?
Castleman's is a rare disorder. It has been associated with POEMS in which severe neuropathy is part of the syndrome, but is not as common an association as myeloma. But neurologists only see the patients who have neurologic symptoms. My brief look at review articles on Castleman's suggests that POE...
Do you recommend prophylactic anticoagulation to pregnant women undergoing chemotherapy for breast cancer?
It is a very interesting thought but no, to my knowledge, there is no data to support anticoagulation of pregnant women receiving chemotherapy for breast cancer, and it is not a standard practice nor is it part of the guidelines around treating breast cancer in pregnancy.
What is your first line strategy for TP53 mutant AML?
I think most would avoid induction-like chemotherapy opting for new regimens such as azacitidine + venetoclax. However, in many instances, the mutation panel comes back after you start treatment which provides a real challenge to use this infuriation in real-time. I hope that faster TAT on NGS panel...
How long do you continue treatment with imatinib in a patient with chronic eosinophilic leukemia who achieves remission?
This has not been clearly established. If the patient has the FIP1L1/PDGFR rearrangement, these patients need very low doses for excellent response, typically 100 mg daily. If not, response rates are lower and they usually require higher doses. I would continue therapy indefinitely as TFR has not be...