Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How would you manage BCR-ABL CML that is resistant to imatinib, with concurrent JAK2 mutation?
As Dr. Tremblay mentioned, it’s important to separate the JAK2 component from CML. If the patient truly has a JAK2 mutant MPN, I would treat it depending on what the manifestations of that disease are. On the CML front, I would manage the imatinib resistance the same way you would any other patient....
How would you manage superficial vein thrombosis that persists on imaging after treatment with full dose anticoagulation?
This is a challenging yet instructive real-life case in clinical decision-making, highlighting variations in practice that often diverge from existing evidence.Before answering let me make some assumptions: Duplex Ultrasound Findings: I assume that Duplex ultrasound did not reveal thrombus extension...
With the data from AALL1731, how is blinatumomab being implemented for SR and HR leukemia patients not previously planned/randomized to receive blinatumomab?
We have incorporated blinatumomab for most patients as two non-consecutive cycles. Once in maintenance, we have not uniformly added blinatumomab, although we have interrupted maintenance to offer blinatumomab to select patients (high-risk genetics or those who had significant treatment modifications...
Would you combine sutimlimab with bendamustine rituximab for cold agglutinin disease if patient continues to hemolyze during treatment?
In my experience, virtually all patients with true cold agglutinin disease respond to sutimlimab quite quickly. While there may be sub-clinical evidence of hemolysis for some time, generally hemoglobin improves to normal or close to this. Adding therapy to sutimlimab really depends upon the clinical...
How do you monitor multiple myeloma in patients receiving dialysis?
In brief, it depends. I’ve had some patients on dialysis whose light chains completely normalize with treatment and continue to remain normal - and others where the light chains never drop below 100 mg/L even in the setting of MRD negativity. This probably has something to do with the fact that not ...
Would you recommend oral or intravenous iron in a chronic kidney disease stage 4 patient who is not on an ESA and has a hemoglobin of 12.7 g/dl and an iron saturation of less than 20%?
I would not necessarily treat this patient with iron at all. I would check serum ferritin. If low would do a colonoscopy or look for causes of iron deficiency. If not low would observe. In general though for patients with CKD (not on dialysis yet) who need iron therapy, I would try oral iron first. ...
For incidentally found stage I indolent non-Hodgkin's lymphoma in young patients, which subtypes would more strongly warrant a consideration for curative-intent radiation?
In general, national guidelines recommend definitive RT for early-stage, low-grade NHLs. These are a diverse collection of diseases with different natural histories and outcomes after treatment. In brief... 1. Follicular lymphoma - typically a disease of older adults with ~20% presenting with early-...
For plasmablastic lymphoma responsive to treatment except for a recurrent lymph node eroding into a vertebral body at the end of chemotherapy, would you cover the entire vertebral body in your CTV, or treat only the involved lymph node with a margin?
Plasmablastic lymphoma is an aggressive NHL that typically occurs in the H&N region, typically in immunosuppressed individuals. Most patients present with advanced disease. The role of RT is not firmly established. That said, in a patient only achieving a PR to systemic therapy with localized residu...
Does variable allele frequency (VAF) of JAK mutation affect your clinical decision-making in MPN in any scenario?
If they have a very low JAK2 (i.e. <1%) and erythrocytosis or thrombocytosis, I always make sure to look for another possible cause. A bone marrow biopsy may be helpful (and I agree with Dr. @Dr. First Last that it is a good thing to do in all MPN patients). In patients with erythrocytosis and a low...
Do you consider starting hydroxyurea in a patient with hemoglobin S-beta thalassemia with chronic kidney disease secondary to FSGS?
I consider initiating hydroxyurea in all individuals with sickle cell disease, even if they have rare or infrequent acute pain episodes. This is because pain is just one manifestation of the disease and ongoing hemolysis leads to a state of chronic inflammation characterized by cytokines, activation...