Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Would you consider prophylactic anticoagulation for May-Thurner syndrome in pregnancy if prior endovascular intervention has been completed?
In general, I have a very low threshold to initiate prophylactic anticoagulation in pregnancy. For a patient with a history of May-Thurner that has been endovascularly corrected and who has been maintained off of anticoagulation without issue, I would have a risk-benefit discussion about prophylacti...
Do you use MRD testing to guide maintenance therapy discontinuation in newly diagnosed non-high risk myeloma patients?
Major bias, incoming!The short answer is: yes, I use MRD to guide de-escalation and ultimately discontinuation in standard-risk patients with myeloma.Much of that sentiment comes from our work at the University of Chicago called MRD2STOP, where we allow patients to stop treatment if they are sustain...
Do you offer enasidenib with azacitadine in AML with an IDH2 mutation for patients ineligible for intensive induction chemotherapy?
I typically do not give enasidenib with azacitidine upfront for patients with AML with IDH2 mutation and ineligible for intensive induction chemotherapy. Based on the results of the VIALE-A study (DiNardo et al, NEJM 2020), I usually give venetoclax with azacitidine to those patients. In addition to...
How do you manage perioperative anticoagulation for a patient with a history of recent, surgically provoked VTE?
In most cases, bridging is rarely indicated because the bleeding risk usually outweighs the risk of VTE recurrence during a short (1–2 day) interruption of anticoagulation. However, after a recent VTE (defined as <3 months), the estimated risk of VTE recurrence is high (>15–20% per year) (still low ...
When would you use rusfertide to treat polycythemia vera?
I think of rusfertide as being a very effective adjunctive therapy for patients with PV who are on cytoreduction and still requiring phlebotomy! Given the impact of inducing a molecular response when using a cytoreductive therapy in the treatment of PV, as has been seen across a variety of studies, ...
How do you approach second-line options for relapsed myeloma after front-line quadruplet therapy?
It depends on the patient's case. In the setting of high-risk disease, whether clinically high risk or with HRC would prefer to use CAR-T in the second line. Currently, SoC allows for bispecific use beyond the 4th line, therefore would use triplet such as DPd (APOLLO) or IsaPD (ICARIA) second line f...
With the recent FDA approval of nipocalimab and the emerging LUMINA 2 data for rilzabrutinib, what is your approach to wAIHA refractory to or relapsed after steroids and rituximab?
Probably because of its rarity (1–3 new cases per 100,000 people), we often joke that there are more treatments at our disposal for the management of wAIHA than the number of cases any hematologist sees on an annual basis—or even during their lifetime. A partial list includes typical first-line trea...
Are there any alternative, hypofractionated RT courses for patients with DLBCL that can be used during the COVID-19 pandemic?
ILROG recently came out with guidelines pasted below: Synopsis of ILROG Recommendations for Administering Radiotherapy for Hematological Malignancies During Emergency Conditions of the COVID-19 Pandemic • We are facing an increased demand for RT to substitute or complement systemic therapy deemed i...
Would you recommend anticoagulation prophylaxis for a pediatric patient admitted with COVID-19?
COVID-19 disease in children seems to be less severe than adults based on the current literature and our personal experience at Children's Hospitals. Among adults, the coagulopathy is beginning to be described with elevated inflammatory markers and other markers of coagulation activation, including ...
What tips do you provide patients on therapeutic LMWH who have difficulty with injections and are bothered by bruising?
I counsel patients that injection site bruising is extremely common and should be expected. To try to limit the impact, they should make sure they are avoiding injection into the superficial blood vessels on either side of the abdomen. Sometimes moving to thighs or upper arms can help. If injections...