Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How would you manage a young patient with Sjogrens disease with extranodal marginal zone lymphoma involving bilateral parotid glands with bilateral cervical lymphadenopathy?
For patients with low-grade NHLs (e.g., follicular lymphoma, marginal zone lymphoma), staging dictates treatment. If a patient has a localized process (e.g., contiguous stage I-II disease), then a definitive course of RT is typically recommended. The conventional approach is 24-30 Gy, though a dose-...
How do you decide when to pursue malignancy workup for patients with cryptogenic stroke?
Agree with above. I would also pursue malignancy work-up in this scenario as well: currently on anticoagulation (whether for afib or another medical reason) and has an ischemic stroke on top of that.
For pediatric patients with iron overload (high ferritin and transferrin saturation), do you perform HFE screening first, or proceed to non-HFE gene sequencing upfront to evaluate for HJV mutation as well?
Because there is no recommended "screening" scenario for iron overload in pediatrics (especially with no family history), the question for me revolves around "why did the patient get tested in the first place?" If it were a routine screen for iron deficiency, which affects millions of children at an...
How do you approach management of a patient with mast cell leukemia?
Mast cell leukemia (MCL) is a rare and aggressive subtype of systemic mastocytosis defined by ≥20% mast cells in the bone marrow aspirate. A recent multicenter analysis of 92 patients with MCL had a median overall survival (OS) of 1.6 years. Midostaurin was the most common first-line therapy (45% of...
For low/intermediate essential thrombocythemia not on cytoreduction, would you temporarily cytoreduce in anticipation of surgery?
First, I am going to answer this question with a question. What is low/intermediate essential thrombocytosis (ET)? I ask this question because we are living in the 21st century in the midst of the genomic era, and it is far past the time that we should be dwelling on phenotype instead of employing p...
Would you give adjuvant radiation after complete resection of a small primary cutaneous follicular lymphoma of the scalp?
Not a lot of data, but here goes. First, one has to go back decades in the literature to find series of patients with lymphoma rx'd with surgical resection alone. In general addition of RT improved outcome even when ostensibly resected with neg margins. With today's technology risk of additional RT ...
What are your top takeaways in Classical Hematology from ASH 2025?
My top 3 takeaways in classical hematology:1) ITP - much controversy at the education program session about the draft 2025 guidelines, where TPO mimetic + steroids is going to be recommended in the front line. There does not appear to be compelling new data that supports the revision of this guideli...
Should other treatment options be considered for MALT lymphoma if the lacrimal gland will be included in the radiation field in a patient with Sjögren's disease?
The orbit is the second most common site of origin for extranodal marginal zone lymphoma (MZL). Involved orbital structures include the bulbar and/or palpebral conjunctiva, lacrimal gland, and periorbital soft tissues. Patients with Sjögren’s syndrome (SS) are at increased risk for developing extran...
For biopsy proven extranodal marginal zone lymphoma involving two small bilateral lung nodules, would you consider definitive treatment to both nodules with radiation therapy?
As is often the case with questions addressed to theMednet, one would like to know a little more about the patient before making a definitive recommendation, age, symptoms, general medical condition, etc. Also, the volume of lung that would need to be treated. (Would not rx lymphatics). However, I'l...
For stage III-IV Hodgkin's lymphoma, would you consider consolidative radiation for bulky disease after a complete response was seen using N-AVD per the S1826 trial?
I would offer consolidative radiation only for PET-positive residual disease.