Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
For a patient with May-Thurner syndrome and DVT, would you recommend anticoagulation for 3-6 months or indefinitely?
This is a very good question, there is little data on this and there are only a few case series. One case series of 8 patients showed a 25% risk of recurrence in one year with May-Thurner syndrome but too small of a sample to really know what the risk is, plus this probably included a heterogenous m...
For patients with newly diagnosed VTE on IV heparin planned for transition to DOAC, would you start at the loading or maintenance DOAC dose?
Agree with Dr. @Dr. First Last. In the clinical trials that led to rivaroxaban and apixaban approval, many patients had 2 days of injected anticoagulant first to arrive at successful outcomes leading to DOAC approval. I suggest IV heparin until hemodynamically normal (for PE), sq LMWH for a dose or ...
How does your surveillance for DLBCL change given the new role of CAR-T in 2nd line treatment?
There were at least 2 large studies from Europe showing that surveillance imaging for lymphoma patients in remission after completion of upfront treatments don’t improve survival (regardless of histology). I don’t usually get any imaging for DLBCL in remission after the end of treatment imaging. Pos...
In the era of MEK inhibitors and BRAF V600E-targeted therapy, what is the role of traditional vinorelbine/prednisone in the management of Langerhans cell histiocytosis?
A similar question came up during rounds this week, and I recalled seeing this question here.I assume the asker meant vinblastine, and not vinorelbine; the combination of vinblastine and prednisone is considered standard therapy, whereas vinorelbine has not generally been used in LCH.Let's first bet...
In treatment naive CLL without del(17p)/TP53, will the recent interim analysis of fixed duration acalabrutinib plus venetoclax +/- obinutuzumab vs chemoimmunotherapy in the AMPLIFY trial change your practice?
The interim analysis of the AMPLIFY trial, published in the New England Journal of Medicine, presents strong evidence that could influence clinical practice for treatment-naïve chronic lymphocytic leukemia (CLL) patients without del(17p) or TP53 mutations. The AMPLIFY trial is the first phase 3 stud...
Would you consider the use of ruxolitinib for tumor fevers and leukocytosis?
No.
What are your top takeaways in Classical Hematology from ASH 2024?
In the category of continuing what I already do, ASH 2024 provided an important confirmatory study of how to approach the treatment of patients with high-risk venous thromboembolism (VTE).In the EINSTEIN CHOICE (Rivaroxaban) and the AMPLIFY-EXT (Apixaban) studies, extended reduced-dose anti-coagulat...
What volume and dose would you use for a Stage I MALT lymphoma of the lung?
MALT lymphomas are highly radiosensitive. Curative standard doses are 24 Gy in 12 fractions and 30 Gy in 20 fractions. The latter and slower dose fractionation (30 Gy in 20) is best used specifically in the setting of stage IAE Gastric MALT - a unique site with significant risk of radiation induced ...
How do you manage newly diagnosed multiple myeloma patients who have a contraindication to steroids?
This is a rather rare situation, but it can happen. Each patient will be different here. In my experience, this has been to psychosis/mania with previous steroid exposure.There is clear data that you can omit steroids following cycle 1 with daratumumab-based induction, cited here, but there are othe...
Under what circumstances is it okay to initiate treatment for suspected multiple myeloma without a bone marrow biopsy?
Excellent question! It is uncommon to start treatment for any malignancy without a pathologic proof and the age-old principle of 'Tissue is the Issue' applies to multiple myeloma as well. Having said that, certain emergent situations do merit starting treatment early without waiting for the biopsy o...