Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
For otherwise transplant-eligible patients with myeloma, given developments of bispecifics and CAR-T, what is your age cutoff for consolidative autologous transplant?
For any lawyers reading this, there is no upper age cutoff for consideration of transplantation. For the physicians and other healthcare providers reading this, it's much more nuanced. As the question poster alluded to, this isn't 2010 and we have many more treatment options available. I have many p...
In a young female with severe osteoporosis due to congenital estrogen deficiency, can estrogen be prescribed if genetic testing for congenital disorders reveals a heterozygous Factor V Leiden mutation?
First of all, I don't think testing for inherited thrombophilia is warranted in a patient with no personal or family history of thrombosis. Given the multigenic nature of thrombophilia and our limited ability to test for it, it's difficult if not impossible to determine an individual's risk of throm...
Is there a role for phlebotomy in secondary polycythemia?
Prefatory to answering the question, I think it's important to specify the full nature of the problem because there is confusion in the hematology literature about the criterion used to define erythrocytosis as well as the phlebotomy target in secondary erythrocytosis. Currently, hematologists use t...
Do you offer iron supplementation to a patient with iron studies that are normal (including normal ferritin) except for low iron saturation?
The answer is absolutely and positively yes. A low percent saturation of transferrin has an extremely high concordance with absent marrow hemosiderin and frankly, in today’s parlance is the best indicator of “iron need”. While the ferritin is marvelous at confirming iron deficiency if low (with or w...
How do you follow patients with Bronchus Associated Lymphoid Tissue Lymphoma treated with 2 Gy x 2 fractions?
For patients with localized MALT lymphoma of the lung, in a distribution amenable to definitive RT, I would typically treat with 24 Gy in 2 Gy fractions. The risk of in-field progression with this dose is expected to be very low. Given the rarity of the presentation, I have only treated a handful of...
How do you monitor risk of erythrocytosis from testosterone use for female to male transgender patients?
I utilize the Endocrine Society's guidelines for identifying secondary erythrocytosis secondary to gender affirming hormone therapy (GAHT) (PMID 28945902). For initial monitoring, at baseline and then every 3 month hematocrit for the first year and 1-2 times yearly thereafter is typically implemente...
Do you routinely offer consolidation RT to sites of previous bulky disease in stage III and IV Hodgkin's lymphoma who have a complete metabolic response on restaging PET/CT following 6 cycles of ABVD?
Update - 1/5/24Three important studies have been published in the last few years which shed light on the role of RT in advanced HL in the setting of a negative interim (and post-chemotherapy) PET-CT.The RATHL trial included 1,119 patients with IIB-IV (or IIA with either bulky disease or at least 3 s...
How do you manage acute keratoconjunctivitis following total skin electron therapy (TSET)?
Institutions approach total skin electron beam therapy (TSEBT) somewhat differently. I generally try to utilize external eye shields as much as possible. If a patient doesn't have active disease involving the eyelids or peri-orbital skin, this obviates the need for internal eye shields which reduces...
How would you approach treatment in a patient with Fanconi anemia and glioblastoma?
This is challenging due to the sensitivity of Fanconi anemia patients to DNA-damaging treatment. I would maximize resection if possible and then treat with radiation, since it is a mainstay of therapy, despite the risk. I would opt for proton radiation if possible to minimize exposure of normal tiss...
What is your frontline treatment of choice for patients with systemic and secondary CNS involvement by DLBCL?
It depends on the intent of treatment, the age, and the PS of the patient. If you are going for a potential curative intent, R-CHOP combined with high-dose methotrexate (R-CHOP-M) - Damaj et al., PMID 26185174, followed by thiotepa-based (thiotepa-BCNU) autoSCT in young, fit patients with chemorespo...