Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How do you approach management of a patient with mast cell leukemia?
Mast cell leukemia (MCL) is a rare and aggressive subtype of systemic mastocytosis defined by ≥20% mast cells in the bone marrow aspirate. A recent multicenter analysis of 92 patients with MCL had a median overall survival (OS) of 1.6 years. Midostaurin was the most common first-line therapy (45% of...
What is your preferred treatment agent for type 1 von Willebrand patients needing minor procedures if they have a history of severe hyponatremia with DDAVP?
I would avoid DDAVP. I typically individualize hemostatic management based on the procedure- related risk of bleeding and severity of the VWD. For example, for dental extraction, tranexamic acid alone may suffice; however, communication with the proceduralist to use topical agents such as topical th...
For low/intermediate essential thrombocythemia not on cytoreduction, would you temporarily cytoreduce in anticipation of surgery?
First, I am going to answer this question with a question. What is low/intermediate essential thrombocytosis (ET)? I ask this question because we are living in the 21st century in the midst of the genomic era, and it is far past the time that we should be dwelling on phenotype instead of employing p...
Would you give adjuvant radiation after complete resection of a small primary cutaneous follicular lymphoma of the scalp?
Not a lot of data, but here goes. First, one has to go back decades in the literature to find series of patients with lymphoma rx'd with surgical resection alone. In general addition of RT improved outcome even when ostensibly resected with neg margins. With today's technology risk of additional RT ...
What are your top takeaways in Classical Hematology from ASH 2025?
My top 3 takeaways in classical hematology:1) ITP - much controversy at the education program session about the draft 2025 guidelines, where TPO mimetic + steroids is going to be recommended in the front line. There does not appear to be compelling new data that supports the revision of this guideli...
Do you routinely check serum phosphorus levels after IV iron therapy?
I do not routinely monitor serum phosphorus levels after intravenous iron therapy if ferric carboxymaltose (FCM) is not being administered. At our institution, the top two formulary choices for outpatient use for iron repletion are iron sucrose and ferumoxytol, neither of which is associated with a ...
Is your standard of care for newly diagnosed advanced classical Hodgkin now nivolumab-AVD based on SWOG 1826?
I think the new standard of care for newly diagnosed patients with advanced classical Hodgkins Lymphoma is now nivolumab-AVD based on the early data from SWOG 1826. While we often wait for more mature data, the early improvement in PFS and the more favorable toxicity profile of this regimen over BvA...
Should other treatment options be considered for MALT lymphoma if the lacrimal gland will be included in the radiation field in a patient with Sjögren's disease?
The orbit is the second most common site of origin for extranodal marginal zone lymphoma (MZL). Involved orbital structures include the bulbar and/or palpebral conjunctiva, lacrimal gland, and periorbital soft tissues. Patients with Sjögren’s syndrome (SS) are at increased risk for developing extran...
For biopsy proven extranodal marginal zone lymphoma involving two small bilateral lung nodules, would you consider definitive treatment to both nodules with radiation therapy?
It has been observed that many patients treated with radiation therapy for an extranodal MZL in a paired organ (orbital and parotid, in particular) will develop metachronous disease recurrence in the contralateral organ (Goda et al., PMID 20564130). In fact, it is relatively common for patients with...
For stage III-IV Hodgkin's lymphoma, would you consider consolidative radiation for bulky disease after a complete response was seen using N-AVD per the S1826 trial?
I would offer consolidative radiation only for PET-positive residual disease.