Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
At our institution, we have comprised a multidisciplinary team to help treat these patients. The team or "HLH task force" as we like to call ourselves is comprised of a clinical immunologist, rheumatologist, dermatologist, critical care physician, hepatologist, BMT attending/hematologist, infectious...
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-...
In pediatric patients with newly diagnosed B-cell ALL and underlying Lynch syndrome, how does the MMR deficiency inform your treatment planning and survivorship surveillance?
Treat B-cell ALL with chemotherapy appropriate for risk category and usual follow-up. MRI Brain Q 6 months up to age 20, then annually Colonoscopy annually starting at age 6 years Upper endoscopy at age 10 years and annually Whole body low dose MRI annually Physical examination and skin exam every ...
What are your management strategies for malignant pericardial effusion with a high risk of spontaneous hemorrhage, particularly in patients requiring anticoagulation for chronic atrial fibrillation?
We have many patients with malignant pericardial effusion who tolerate anticoagulation for DVT/PE/afib. In those patients, when AC is restarted (for example after pericardiocentesis), close monitoring with serial echo in a few days would be performed to see if effusion reaccumulates faster. Also, th...
How do you counsel patients on the risk of thromboembolic complications with use of immunotherapy in NSCLC?
Patients with metastatic lung cancer are at increased risk of thromboembolic events with an estimated frequency of 13.9% (Connolly et al., PMID 23026639). Preclinical data show that PD-1/PD-1 pathway blockade may lead to increased levels of pro-inflammatory cytokines and T cell driven progression an...
For a patient with lenalidomide-refractory R/R multiple myeloma at first or second relapse, how would MeziKd (if approved based on SUCCESSOR-2) factor into your sequencing decision relative to BCMA-directed and other available options?
There is never a good time to be a myeloma patient, but this is the best time it has ever been.Tldr; I would still prefer a BCMA-directed strategy for patients with BCMA-naive relapsed MM.The recently reported results of the phase 3 SUCCESSOR-2 trial demonstrated the efficacy of mezigdomide, a novel...
How would you approach iron supplementation in a beta thalassemia trait patient with restless leg syndrome?
Thalassemia does not alter my decision. I don't use PO iron for RLS as it is enormously more toxic. A ferritin of 75 is a light-year away from iron overload, and a total dose infusion of IV iron can be administered with impunity. This patient should be treated with a gram of LMW iron dextran over on...
What clinical or logistical factors influence your choice of anti-CD38 antibody in first-line treatment of multiple myeloma?
I generally use daratumumab, because subcutaneous is more convenient for patients, and we go to once-a-month dosing much quicker with daratumumab compared to isatuximab. Once isatuximab subcutaneous is available, this advantage of daratumumab may be lost, but given comfort and familiarity with darat...
What is your approach to iron supplementation in patients with an active infection?
In patients with active infections, I generally avoid intravenous iron due to the potential for promoting pathogen growth, a practice supported by cautions from nephrology and gastroenterology society guidelines. However, evidence for the risk of infection with IV iron is inconsistent, underpowered,...
Would you stop current immunosuppressive therapy or delay starting immunosuppressive therapy in a patient with aplastic anemia who has been infected with COVID-19?
This is an interesting question. Based on personal communication (Italy, Germany, Israel), we have not seen increased risk for pediatric patients with hematological diseases and COVID-19. There was one case reported in China, but it was inconclusive (nearly 50 y.o. patient with aplastic anemia—seeme...