Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How do you approach IVIG replacement for pediatric patients with low IgG during treatment for hematologic malignancies?
We monitor IgG levels at the beginning of each chemotherapy cycle for infants, for patients with Down syndrome, for those receiving blinatumomab, and for patients who are hypogammaglobulinemic with recurrent bacterial infections, and we replace when IgG levels are <400 mg/DL for down syndrome and <5...
For pediatric patients with localized diffuse large B-cell lymphoma being treated per COG ANHL 1131 in group B, do you feel it is necessary to complete all lumbar punctures with IT therapy?
For unresected group B/DLBL patients, most centers continue to give the IT therapy which included 9 prophylactic IT therapies. There is no published data that I am aware of reducing the IT dosing. We recently completed a pilot reducing the number of ITs to 5 by incorporating 2 doses of depocyt (whic...
What is your current approach to maintenance therapy in FLT3-mutant AML post allogeneic HCT?
I would offer maintenance with FLT3 inhibitor with gilteritinib (NCT02997202: MORPHO trial, not yet published), sorafenib (SORMAIN trial), or midostaurin (RADIUS trial), whichever agent is available. In my experience, gilteritinib appears to be the most tolerable. I suggest beginning maintenance as ...
How do you counsel sickle cell patients on the use of G-CSF to treat neutropenia from other causes, like malignancy?
G-CSF is contraindicated in sickle cell disease. There have been many case reports of severe complications, including death in patients with SCD receiving G-CSF. I would only use it in neutropenic sepsis with transfusion support to prevent vaso-occlusive complications and after a discussion about it...
Would you consider caplacizumab in a pregnant patient with iTTP?
As noted, caplacizumab was not studied in pregnancy (was an exclusion criteria) and is not approved in this setting.With that being said, as noted, caplacizumab use in pregnancy has been described in case reports (1, 2, 3) and in the post-partum setting (4). I would consider the use of caplacizumab ...
How often do you monitor AML patients after transplant for recurrence?
Assuming that your patient was transplanted in CR and there is no plan for maintenance treatment, we typically repeat BM A/Bx at D100, 6 and 12 months after alloSCT. We continue to follow PB myeloid R/D chimerism studies regularly after (q 2-3 months for the next 2 years), obviously with CBC. We do ...
What would be the main indications for opting for biosimilars over an original biologic, outside of insurance barriers?
A timely question, as we head to 2023! The only reason to use biosimilars is for the broad purpose of resource stewardship. There isn't a medical reason to prefer a biosimilar over a reference product (or vice versa), because if a product were found to have a significantly different therapeutic effe...
How do you approach monitoring for lymphoproliferative disease in Sjogren's patients?
I have an increased index of suspicion for lymphoma, myeloma, and amyloid in Sjogren's. Increased age, longer disease duration, and greater disease activity increase the lymphoproliferative risk.Persistent unilateral parotid or other salivary gland enlargements, lymphadenopathy, vasculitis (purpura,...
What is your preferred induction regimen prior to allo-HCT for mantle cell lymphoma?
I commonly use a reduced-intensity conditioning regimen before alloSCT for patients with MCL especially since most of these patients have received prior autoSCT, are older, and are heavily treated. I try to incorporate low dose TBI in the regimen such as TBI 200 cGy x 2 sessions in one day. Frequent...
Would you consider holding treatment with hypomethylating agents and venetoclax in elderly patients diagnosed with AML who achieve CR and are MRD negative?
At this point there is no data demonstrating that azacitidine venetoclax is curative even in those who achieve MRD negative CR. As such, we continue cycles of therapy with timing and duration of therapy adjusted based on count recovery as long as there is continued evidence of response.