Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is your escalation strategy for chronic GvHD?
There are now several available options for steroid resistant cGVHD. The old standbys - ECP and rituxan are useful in about 30% of patients. Ibrutinib was the first new drug to get FDA approval. Unfortunately, I don't think the real-world experience is anywhere near as good as the trial (Chin et al....
Will you use vadadustat in place of an ESA in treating anemia of chronic kidney disease?
Vadadustat is approved by the FDA only for patients who have been on dialysis for at least 3 months. It is not approved for patients with CKD not on dialysis. Its efficacy and safety are comparable to that of ESAs. I would consider using vadadustat in two patient populations: those on home dialysis ...
How would you approach an asymptomatic older female patient with eosinophilia to 17,000, present for years, and normal eosinophilia workup including marrow and negative FLIP1?
Interesting case. Eos have been in the 17K range for years? Was it incidentally noted? Could just be idiopathic HES. I would worry about cardiac infiltration in an older patient, but if there have never been cardiac issues and no evidence of a myeloid variant, I would probably defer to the patient a...
After induction therapy for acute promyelocytic leukemia with arsenic trioxide and ATRA, at what point do you start consolidation?
During induction, I wait for count recovery (ANC above 1000, transfusion independent- typically around Day 30, but +/- 5 days) and perform a bone marrow biopsy at that point. Patients routinely are still (but not always) + for PML-RAR at this biopsy, but that doesn't matter. As long as the marrow is...
How would you approach choosing a regimen for a patient with multiple myeloma refractory to Daratumumab and Lenalidomide, with severe neuropathy from Bortezomib?
That's an excellent question with many answers. Ideally, CAR-T therapy is a strong option, particularly based on the findings from the CARTITUDE-4 trial. If the patient is uncertain about CAR-T, then carfilzomib-based therapy is a viable alternative. This option can be effectively combined with eith...
How do you approach the second-line treatment for a patient with high-risk myeloma relapse early post-autoHCT after Dara-RVD induction?
Depending on the nature of the relapse, I would salvage with DCEP, or carfilzomib-based triplet (KCyD, KPd) with ciltacel as the next step.
How would you manage a CVST secondary to a traumatic brain injury with the presence of intracranial hemorrhage?
When dealing with CVST after TBI, the mechanism of injury is not the same as a spontaneous CVST. There is often direct injury to the vein or the area overlying it. Given that these patients often have other traumatic injuries, and given the lack of clear evidence to support one therapy or another, I...
Can AMPLIFY data be extrapolated to use of other BTKi's in combination with venetoclax or would you only ever use acalabrutinib/venetoclax in first line?
Indirect comparisons, including network meta-analyses and matching-adjusted indirect comparisons, suggest that zanubrutinib monotherapy may offer superior progression-free survival compared to fixed-duration acalabrutinib–venetoclax in low-risk, treatment-naïve CLL. However, these analyses rely on a...
How will you utilize the PARADIGM study results from ASH 2025, comparing azacitidine/venetoclax to intensive induction chemotherapy for fit patients with newly diagnosed AML?
It was very exciting to see PARADIGM presented as a plenary at ASH, and I look forward to the manuscript! Interpreting the findings in the context of the enrolled patients is very important. The median age of enrolled patients was approximately 65 years in both arms, and ~75% of enrolled patients ha...
Does the presence of paraneoplastic pemphigus influence your treatment options in CLL?
Paraneoplastic pemphigus is often difficult to treat, and if traditional measures do not control it, I often will use continuous therapy for CLL to both eliminate the disease and continue suppressing the autoimmune source of this paraneoplastic complication.