Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
For pregnant nontransfusion dependent beta thalassemia patients, when would you consider ESAs for worsening anemia?
Non-transfusion-dependent thalassemia (NTDT) patients tend to have elevated erythropoietin (EPO) levels already, proportionate to their degree of anemia. The basic pathophysiology of thalassemia is ineffective erythropoiesis (IE), in which proliferation, in response to high EPO levels, is already su...
What could explain failure to luspatercept in patients with transfusion-dependent beta thalassemia?
Luspatercept works by trapping TGF beta ligands (GDF 11 and 15) and optimizing maturation and differentiation of erythroid precursors, thus facilitating increased output of red cells.In individuals who have beta zero-beta zero thalassemia, this must mean that the cells coming out would contain hemog...
How would you select patients for epcoritamab + R² versus R² or other regimens at second-line relapsed/refractory follicular lymphoma?
It depends on what they received as first-line therapy and the duration of response to that treatment. The disease burden at the time of relapse would also be a key factor. The rate of infections was notably higher in the epcor + R² group. In the subgroup analysis, the benefit amongst older patients...
When do you consider certolizumab for pregnant women with antiphospholipid syndrome with positive lupus anticoagulant?
Certolizumab is a TNF-α antagonist with minimal or no transfer across the placenta. It was evaluated in the phase 2, open-label IMPACT (Improve Pregnancy in APS with Certolizumab Therapy) trial to prevent placenta-mediated adverse outcomes in pregnant patients with antiphospholipid antibody syndrome...
In patients with lupus nephritis, and MAHA with positive anti-phospholipid autoantibodies, what are the considerations to use or not use anti-coagulation therapy?
I support anticoagulation and C5 inhibition for such patients if they are not adequately responding.
Does anyone utilize P2Y12 assays to determine if clopidogrel may be ineffective when used for DAPT?
Yes, I use P2Y12 assays in two distinct settings. Medical management: If a patient on clopidogrel mono/dual therapy has disease progression with ICAD or experiences a recurrent ischemic event, I obtain a P2Y12 assay to assess responsiveness. This helps guide the decision to switch to ticagrelor and ...
Does the recent publication of EPCORE FL-1 (Epcoritamab + R2) change your preferred 2L SOC for R/R FL?
The approval of the combination of epcoritamab + R2 for relapsed/refractory FL based on the data from the EPCORE FL-1 study has provided an additional effective option for the treatment of patients with relapsed/refractory FL, and I have incorporated it into my practice for patients in the 2L settin...
Are there still clinical situations in which you deliberately treat patients with a DOAC besides apixaban?
Thank you for your question. Apixaban has been my preferred agent for a long time for patients requiring therapeutic anticoagulation. Apixaban’s lower bleeding risk was shown prior to and now has additional evidence to support this with the COBRRA trial. The risk is also ameliorated by the safety in...
Do you offer enasidenib with azacitadine in AML with an IDH2 mutation for patients ineligible for intensive induction chemotherapy?
I typically do not give enasidenib with azacitidine upfront for patients with AML with IDH2 mutation and ineligible for intensive induction chemotherapy. Based on the results of the VIALE-A study (DiNardo et al, NEJM 2020), I usually give venetoclax with azacitidine to those patients. In addition to...
How do you decide if a patient should get follow-up perfusion imaging after acute PE when they are minimally symptomatic?
I practice essentially as reflected in the most recent AHA/ACC/ACCP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Diagnosis and Management of Acute Pulmonary Embolism in Adults.Figure 8. Evaluating Ongoing Symptoms Following Acute PE - concisely outlines the workup of patients with ongoing symptoms f...