Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What scenarios do you utilize CT venography in the workup of suspected DVT?
There are likely a limited number of scenarios in which a CT venogram should be ordered. My own approach is as follows: Bilateral deep venous thrombosis: to exclude IVC obstruction. Anecdotally, in the younger patients, we have made a diagnosis of IVC atresia. Suspected May-Thurner syndrome: typica...
How do you approach managing depression symptoms in patients who have had repeated high risk of bleeding?
Overall, evidence suggests that while SSRIs do increase the risk of bleeding. The absolute risk of a bleeding event remains low and is usually not serious. A 2017 meta-analysis by Laporte et al., suggested that overall bleeding risk is increased by at least 36% while other meta-analyses suggest that...
What are your practical considerations for incorporating bispecific antibody therapy into treatment of relapsed DLBCL?
In relapsed/refractory DLBCL, if the patient has not yet received bispecific antibody (BsAb) and/or CAR T-cells, and the patient is eligible and able to receive CAR T-cells, I favor CAR T-cells before BsAb, given extensive follow-up time demonstrating CAR T-cells are a potentially curative approach ...
How do you address logistic barriers related to blinatumomab when treating relapsed B-ALL?
This is a very challenging issue that speaks to an incredibly important aspect of delivering not only this drug but others like it. Despite the strong evidence that supports the use of blinatumomab in a variety of clinical scenarios for patients with B-cell ALL [e.g., Gökbuget et al., PMID 29358182;...
How do you incorporate CAR-T cell therapy for DLBCL in transplant-eligible patients?
The role of sequential therapy including CARs vs high dose chemotherapy + ASCT post primary induction failure/relapse in large cell lymphoma is a matter of active research. Given the present FDA indication of CARs is in relapsed/refractory large cell lymphoma after failure of at least 2 lines of pri...
What are your top takeaways in Hematologic Malignancies from ASCO 2026?
Phase III SENTRY study of ruxolitinib +/- selinexor in myelofibrosis - The combination arm met the spleen response endpoint, had similar rates of symptom improvement compared to ruxolitinib, and, with short follow-up, there appears to be a signal towards survival benefit. Longer-term follow-up will...
How do you choose between liso-cel and axi-cel in patients with early relapse DLBCL for whom you are recommending CAR T-cell therapy?
Axi-cel and liso-cel are anti-CD19 chimeric antigen receptor (CAR) T-cell products approved for primary refractory or early relapsed (<1 year from initial chemoimmunotherapy) diffuse large B-cell lymphoma (DLBCL). Both products exhibit excellent efficacy (overall response rates >80%) and are potenti...
How do you choose between axicabtagene ciloleucel and tisagenlecleucel in patients with follicular lymphoma for whom you are recommending CAR T-cell therapy?
This is an area of uncertainty. There are no head-to-head data to bring to bear, of course (and, if there were, you probably wouldn’t need to ask). The toxicity profile of the two cells is clearly different, with lower rates of severe toxicity with tisacel than with axicel. As neither product has be...
Do you use G-CSF for a patient with ALL admitted for febrile neutropenia with prolonged count recovery?
I agree with this response. To highlight one other consideration: G-CSF is not routinely given during COG-based, pediatric-inspired therapy like the C10403 regimen (Stock et al., PMID 30658992). However, when patients treated with this approach in our system develop neutropenic fever, we will usuall...
In pediatric patients with newly diagnosed B-cell ALL and underlying Lynch syndrome, how does the MMR deficiency inform your treatment planning and survivorship surveillance?
Treat B-cell ALL with chemotherapy appropriate for risk category and usual follow-up. MRI Brain Q 6 months up to age 20, then annually Colonoscopy annually starting at age 6 years Upper endoscopy at age 10 years and annually Whole body low dose MRI annually Physical examination and skin exam every ...