Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Do you recommend a workup for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?
While IgM monoclonal disorders, amyloidosis, and POEMS syndrome may all be associated with peripheral neuropathy, they are not often confused with one another. A patient with a peripheral neuropathy can be diagnosed most simply by a serum protein electrophoresis. The presence of a monoclonal IgM spi...
How would you treat a patient with stage IE gastric MALT lymphoma with negative testing for H. pylori?
Standard of care treatment in these patients mostly includes local radiotherapy. You need to be certain that the patient is truly HP-negative; the gold standard for this is negative histopathology for HP. In patients with negative HP histology, you should still rule out HP with non-invasive measures...
How have the results of the SUNMO trial with mosunetuzumab/polatuzumab vedotin impacted your treatment choices for transplant ineligible relapsed/refractory DLBCL?
The SUNMO trial results have provided another option for patients with relapsed and/or refractory disease who aren't fit enough for more intensive therapy, whether it be salvage + ASCT for relapsed or CAR-T/bispecific + CIT for those with refractory disease. As well, the regimen is likely to have le...
Do you routinely repeat imaging for PE after anticoagulation treatment to establish a new baseline?
We only do imaging if the patient is symptomatic still after a few weeks or has persistent chest pain or clinical signs of pulmonary hypertension. Rarely I have seen recurrent or progressive thromboembolic disease on anticoagulation. Another possible reason if the patient needs to go to surgery in t...
What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them. No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
Would you consider weekly low dose decitabine and weekly venetoclax (metronomic dosing) in frail patients with high-risk MDS?
I find the metronomic dosing regimen of decitabine + venetoclax in high-risk myeloid malignancies (particularly TP53-mutated malignancies) very intriguing but have used the regimen sparingly thus far in the absence of randomized data supporting its use.When thinking about higher-risk MDS, we have da...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
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...
How do you utilize lenalidomide maintenance in non-transplant eligible myeloma?
Maintenance is a standard of care management for both transplant eligible and transplant ineligible, regardless of type of induction regimen. Studies have shown benefit for both groups. Time to progression (PFS) almost twice as long for both groups with maintenance compared to no maintenance. - For ...
Can RT to non-bulky sites be omitted in an early stage (stage I or II) classical Hodgkin's lymphoma case with a CR by PET/CT?
Randomized studies have consistently demonstrated that combined modality therapy is superior to chemotherapy alone in regards to progression-free survival in early-stage Hodgkin lymphoma. The magnitude of the benefit varies across studies, but a relative risk reduction of ~50% can be expected which ...