Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
When would you use rusfertide to treat polycythemia vera?
I think of rusfertide as being a very effective adjunctive therapy for patients with PV who are on cytoreduction and still requiring phlebotomy! Given the impact of inducing a molecular response when using a cytoreductive therapy in the treatment of PV, as has been seen across a variety of studies, ...
How do you approach second-line options for relapsed myeloma after front-line quadruplet therapy?
It depends on the patient's case. In the setting of high-risk disease, whether clinically high risk or with HRC would prefer to use CAR-T in the second line. Currently, SoC allows for bispecific use beyond the 4th line, therefore would use triplet such as DPd (APOLLO) or IsaPD (ICARIA) second line f...
With the recent FDA approval of nipocalimab and the emerging LUMINA 2 data for rilzabrutinib, what is your approach to wAIHA refractory to or relapsed after steroids and rituximab?
Probably because of its rarity (1–3 new cases per 100,000 people), we often joke that there are more treatments at our disposal for the management of wAIHA than the number of cases any hematologist sees on an annual basis—or even during their lifetime. A partial list includes typical first-line trea...
Would you recommend anticoagulation prophylaxis for a pediatric patient admitted with COVID-19?
COVID-19 disease in children seems to be less severe than adults based on the current literature and our personal experience at Children's Hospitals. Among adults, the coagulopathy is beginning to be described with elevated inflammatory markers and other markers of coagulation activation, including ...
What tips do you provide patients on therapeutic LMWH who have difficulty with injections and are bothered by bruising?
I counsel patients that injection site bruising is extremely common and should be expected. To try to limit the impact, they should make sure they are avoiding injection into the superficial blood vessels on either side of the abdomen. Sometimes moving to thighs or upper arms can help. If injections...
How do you approach the use of teclistamab plus daratumumab in patients with relapsed/refractory multiple myeloma who have previously been exposed to daratumumab or isatuximab?
MajesTEC-3 required no daratumumab refractoriness for enrollment. Per IMWG, this means no progression on or within 60 days of daratumumab. However, only 5% of the patients enrolled had prior daratumumab.In addition to its anti-myeloma effects, daratumumab might make bispecific antibodies more effect...
After the MAJESTEC-3 results, what is your approach to choosing between tec-dara vs. cilta-cel versus another triplet for multiple myeloma in first relapse?
This is an excellent question, and literally a million-dollar question for various companies involved. It's worth noting that the US FDA can change the package insert at will (and has done so) compared to what the trials did, so there's no guarantee as of yet that Tec-Dara (based on MajesTEC-3) will...
Have you changed your practice in treating CRAO with IV thrombolysis?
The recent THEIA trial had a limited sample size to draw conclusions, even though there was a non-significant trend of improved visual acuity initially in the thrombolysis group. Even the TenCRAOS trial had a small sample size with recruitment challenges, where subtle small differences cannot be acc...
How do you manage patients with atrial fibrillation having a thromboembolic infarct despite being on adequate anticoagulation?
This scenario is always challenging. In terms of anticoagulation, the efficacy of DOACs in preventing embolic events in AF patients is around 70%, which is impressive compared to warfarin but not foolproof. In cases of a second embolic event while on anticoagulation, two reasonable approaches are of...
In a patient who has been receiving 1L Ibrutinib for TP53+ CLL for years with complete hematologic response but detectable MRD, is there any role to switch to the novel BTKi agents given better PFS?
There are a couple of features to this question that need comment. First, the goal of therapy with a single-agent BTKi, regardless of ibrutinib, acalabrutinib, zanubrutinib, or pirtobrutinib, is NOT to achieve undetectable MRD. Very few patients will achieve this milestone due to the drug's MOA. BTK...