Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Does your treatment approach for NK/T cell lymphoma of the nasal cavity differ depending on the volume and extent of disease?
There has been a recent (2021), updated review of treatment guidelines published by ILROG which provides very detailed recommendations including some considerations about systemic therapy. Qi et al., PMID 33581262.They offer treatment field suggestions based on the anatomic location of the tumor, di...
When would you consider upfront eculizumab for sickle cell hyperhemolysis?
How would you treat a de novo CLL with WBC of 1,000,000 and no overt signs of leukostasis?
This is an interesting question. I haven't seen anyone with a WBC count this high except when they had other factors influencing the count such as dehydration or systemic infection such as c diff and it was a reactive process in addition to CLL. It would be interesting to know what else was going on...
What is the optimal age at which a patient with sickle cell disease should undergo allogeneic stem cell transplant?
Ideally, would be at diagnosis to limit sickle related injury and generally, younger patients have less complications but since curative treatment is not perfect, it depends mainly on the donor. For matched sibling donor transplant, under age 5yrs has best outcomes with over 15yrs having more GVHD a...
What factors do you consider when sequencing bispecific T-cell engaging antibodies and CAR T-cell therapies for the treatment of follicular lymphoma?
I always choose CART first. It is unclear how much bispecific antibodies will affect CART manufacturing or T-cell fitness. There is a good date of efficacy post CART relapsed with bispecific antibodies.
For patients with incidental findings of venous thromboembolism during workup of a treatable malignancy, how do you approach discontinuation after the treatment is complete?
Your approach to incidental thromboembolism found on the workup of malignancy should be similar to any evaluation of a thrombosis. It should be a structured approach with the following questions evaluated before deciding on long-term or short-term anticoagulation. First, one should determine the loc...
For patients with essential thrombocythemia who develop venous thrombosis in the setting of elevated platelet counts, would you continue lifelong anticoagulation even after cytoreduction is achieved?
This is a fantastic question, a true real-life scenario, with unfortunately little data to drive clinical decision making. What we do have to work with is that the combination of ASA plus anticoagulation increases the risk of bleeding, but does not decrease the risk of recurrent thrombosis in MPNs. ...
What would be a reasonable radiation approach and dose for a patient with multiple myeloma with brain involvement?
I would first wish to clarify what is meant by "brain involvement."When plasma cell neoplasms of the brain occur, they are usually the result of significant marrow involvement of calvarium and/or skull base with focal intracranial extension, or plasma cell infiltration of the leptomeninges and dura....
How do you treat refractory cold agglutinin disease?
If the patient has refractory cold agglutinin disease not associated with malignant lymphoproliferative disease, I have used intermediate dose Cytoxan. However, there is recent evidence that inhibition of C1s and thus complement activation by a monoclonal antibody sutimlimab markedly reduces hemolys...
Is it true that a ferritin above 200 essentially rules out iron deficiency?
No, I do not think that a ferritin >200 ug/L essentially "rules out" iron deficiency. Ferritin is an acute phase reactant and can be elevated in myriad conditions including kidney disease, autoimmune disorders, etc. The transferrin saturation (measure of serum iron/TIBC) is an important marker of ir...