Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
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...
What factors do you consider when choosing between asciminib vs TKI in a newly diagnosed CML patient?
I think any patient is a good candidate for asciminib, with the exception of those with atypical transcripts (e.g., b2a3, b3a3). The decision would mostly depend on the goals of the patient and the availability and access. Asciminib is particularly well suited for patients who would be interested in...
How would you manage a pre-menopausal woman with extranodal marginal zone lymphoma confined to the bladder wall?
Marginal Zone Lymphoma (MZL) when localized is curable in most instances with modest doses of RT (24-30 Gy), perhaps even less when the primary site is the orbit. It typically responds to rituximab but relapses occur in most cases. Therefore, definitive RT is the treatment of choice in the great maj...
For primary MZL of the breast, do you do whole breast to 24 Gy or ISRT?
Without knowledge of the age of this patient and whether the concern of carcinogenicity from half the normal dose of traditional whole breast radiation (which we obviously do all the time for breast cancer) is enough to warrant omission of curative intent therapy in what is otherwise described as a ...
Is there a role to continue aspirin in patients with myeloproliferative disorders who have never had a thrombotic event that are starting DOAC for stroke prophylaxis with newly diagnosed atrial fibrillation?
Aside from treating erythromelalgia, transient ischemic attacks (TIA) such as ocular migraine or documented atherosclerotic disease, aspirin has no role in the management of the MPN, despite the widely published recommendations for its use, particularly in so-called "high risk" polycythemia vera (PV...
What are your top takeaways in Hematology from ASCO 2025?
I would say: CARTITUDE-1 updates – first time we are seeing a plateau in a MM trial, that too in the relapsed/refractory setting with 5+ years follow-up. JNJ-5322 Trispecific – dual antigen targeting with less frequent dosing; 100% response rate in BCMA/GPRC5D naïve relapsed/ref MM patients; safety...
When would you treat mild anemia from low testosterone in an older male?
The primary indication for testosterone treatment is symptomatic hypogonadism and not anemia. Given the risk for adverse events in terms of erythrocytosis, cardiovascular events, and potential prostate diseases, the risk of providing testosterone for asymptomatic, mild anemia outweighs its benefits,...
What is your approach to an infant (<12 mo) with new onset petechiae and thrombocytopenia, with labs consistent with ITP?
In an older (1-6 year old) child with apparent ITP, less work up might be needed. While many tests are possible, in this case, labs consistent with ITP, I would interpret as including a CBC otherwise normal for age without blasts on a smear (if this is not true, the differential is much wider). If i...
How would you approach treatment in an older (>65), but fit patient with intermediate-risk AML, but with MRD persistence after induction with 7+3?
The presence of measurable or minimal residual disease (MRD) after induction chemotherapy, before allogeneic transplant or after transplant is associated with risk of relapse. (Araki et al. J Clin Oncol. 34:329-36) The detection and measurement of MRD by flow cytometry requires specific expertise in...
For patients with VEXAS syndrome and good response to azacitidine, what duration of therapy do you consider?
The short answer: as long as azacitidine is controlling inflammation, reducing/eliminating steroid dependence, and/or improving cytopenias, keep using it. Don't stop (or if the patient is being bridged to alloSCT, continue until BMT).The long answer:VEXAS is an autoinflammatory disease wherein patie...