Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How do you decide the dose of aspirin to use in MPN patients?
The standard dose for aspirin in the USA for MPN patients is aspirin 81 mg daily. I sometimes use 81 mg BID for patients with significant CV comorbidities. Some patients with headaches or microcirculatory symptoms may improve symptomatically with BID aspirin. Lastly, patients with erythromelalgia wi...
What volumes do you treat for ISRT for extranodal DLBCL?
It is important to remember that ISRT, for both Hodgkin and non-Hodgkin lymphoma, consists of a set of principles that can be used to design rational radiation fields in the context of modern treatment planning. In general, only sites of original involvement are treated when patients also receive, a...
When utilizing ISRT for Hodgkin lymphoma, what volumetric expansions (ITV and PTV) are appropriate on top of the CTV that includes the original pre-systemic therapy disease?
First, it is important to realize that involved-site radiation therapy (ISRT) for Hodgkin lymphoma is not a formulaic approach to field design. It requires careful evaluation of pre-chemotherapy imaging, fusing these with post-chemotherapy planning CT scans for optimal target delineation, evaluating...
What is the appropriate RT dose for an advanced stage follicular lymphoma?
Based on the study for patients of early stage low grade lymphoma treated with curative intent, the dose should be 24 Gy.For those treated with palliative intent, 2gy x2 should be preferred, as the majority have good palliation with that dose. In the minority where symptoms persists, one can treat a...
How long would you wait after a cycle of IT MTX to treat a spinal lesion causing cord compression in a patient with stage IV DLBCL?
Intrathecal methotrexate has biphasic half-lives of about 5 hours and 14 hours (Bleyer, Cancer Treat Rep 1977). ILROG recommends typically waiting minimum interval 2 weeks between last IT or high-dose IV methotrexate before starting CNS radiotherapy for CNS leukemia, but urgent radiotherapy may be c...
How do you counsel patients with minimally symptomatic factor VII deficiency about procedures and periprocedural management?
Partial Factor VII deficiency is relatively easy to discover (long PT/INR) but the bleeding risk tends to be over-estimated. The available evidence (Peyvandi et al., PMID 22321862) suggests that significant bleeding is uncommon unless the factor VII level is less than about 15% of normal. I would th...
Do you account for the effect of coffee on platelet aggregation studies?
Although recommendations from the International Society of Thrombosis and Haemostasis (ISTH) [1] suggest that individuals should avoid caffeine for at least 2 hours before blood is drawn for light transmission platelet aggregation studies, (and be fasting, be rested for 30 minutes, and avoid smoking...
What is your approach for choosing between Imetelstat and Luspatercept in managing MDS related anemia?
In the past 18 months, between the COMMANDS trial looking at Luspatercept in expanded indications beyond just patients with MDS-RS and the IMerge trial looking at the use of Imetelstat in patients with low-risk MDS, we now have many more options for these patients.The COMMANDS trial looked at Luspat...
For patients with a JAK2 positive myeloproliferative neoplasm, do you always perform a bone marrow biopsy at diagnosis?
A bone marrow biopsy is very helpful at diagnosis for patients with MPN as it can clearly establish a diagnosis. Although many times we can guess a diagnosis by looking at peripheral blood counts, we can often miss pre-MF or overt MF without a bone marrow biopsy. For young patients especially, a bon...
How do you monitor and manage minimal residual disease (MRD) in patients with core-binding factor (CBF) AML who are in remission post-induction and consolidation therapy?
For the purposes of this question, we will presume this refers to patients who are MRD-negative by a PCR-based methodology and have completed induction chemotherapy and consolidation.Puckrin et al., PMID 31896684 reported on 114 patients with CBF-AML who were treated with intensive chemotherapy and ...