Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What criteria is needed in relapsed/refractory B-cell ALL to choose CAR-T therapy over conventional stem cell transplant as destination therapy?
Currently, there are no standard criteria used to choose CAR-T over conventional stem cell transplant as destination therapy. However, there are many factors that often push us in one direction or the other. As we learn more about outcomes after CAR-T cell therapy, there are many factors we know are...
When consolidating DLBCL with radiotherapy, do you treat all originally involved sites, or just initially bulky and partial responder sites?
When consolidating DLBCL with radiotherapy, several parameters must be taken into consideration. a) Is radiation therapy part of the treatment plan "on top" of full systemic treatment because of a certain risk situation due to not-optimal response of disease to systemic treatment (for example, FDG-a...
Is enteric-coated aspirin acceptable to use in polycythemia vera or ET?
Admittedly, this is a question I had not considered before viewing this query, as I rarely, if ever, prescribe enteric-coated aspirin. In the absence of a bleeding diathesis such as von Willebrand disease, platelet count greater than one million/mm³, or active GI bleeding, low-dose aspirin (75/81/10...
Would you consider perioperative antifibrinolytics for mild factor 7 deficiency undergoing surgery?
I do use antifibrinolytics in factor VII deficiency; however, it depends on the specifics of the surgery (i.e., mucosal surface surgery, sequelae of bleeding should it occur - spine vs oral), the patient's bleeding history, and the factor VII level. Here, I wonder if the original diagnosis was corre...
Can aplastic anemia present with multiple infiltrative bone lesions, such as in the spine and pelvis?
There are several studies showing diffuse hypointense pictures with an infiltrative-like pattern on MRI in aplastic anemia and MDS. Some aplastic anemia and refractory cytopenia of childhood show patchy pattern of hematopoiesis with some regions having increased fat fraction and some remnants of hem...
In what scenarios do you use a chromogenic factor X assay in adjusting INR goals for patients on warfarin?
I do not use this method. It has been suggested that such assays be used in patients with lupus-type inhibitors who have significantly prolonged prothrombin times at baseline. In this setting, if the INR is "therapeutic," one would confirm an adequate warfarin effect if the factor X activity was in ...
Would you consider using transdermal estrogen in a patient with “high risk” APLS patient on warfarin?
Given her clinical diagnosis of high-risk APS, I would first trial nonhormonal therapies or progesterone-only therapies for management of her post-menopausal symptoms. Current ACR guidance recommends against hormone replacement therapy in patients with APS on anticoagulation (Sammaritano et al., PMI...
Would you use routine PET scans after two cycles of R-CHOP to guide first-line treatment de-escalation in low-risk (aaIPI = 0) DLBCL patients?
This phase III trial suggests that in very low-risk limited-stage DLBCL (aaIPI = 0), patients who achieve a negative PET after two cycles of R-CHOP can safely receive only four total cycles instead of six, with similar 3-year PFS (92% vs 89%) and less toxicity. However, the results apply to a highly...
How do you approach relapsed idiopathic HLH?
If the patient was previously in remission after etoposide and steroids, they may well respond to etoposide and steroids again. I strongly consider hematopoietic stem cell transplant in anyone who relapses after an episode of HLH, since it is usually a harbinger of recurrent and potentially life-thr...
Do you initiate anticoagulation prophylaxis for pediatric patients with vascular compression secondary to solid tumor/lymphoma?
It is an interesting question, but lacks critical details. Of course, most cancers are prothrombotic, and anticoagulation can have risks: Is it arterial or venous compression? Complete obstruction? Acute or chronic? Collaterals? Is it compromising an organ? Is thrombus seen, or is there blood flow?...