Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
In a patient with persistent, otherwise unexplained mild anemia (e.g., Hb 12 g/dL) and a pathogenic somatic mutation identified on peripheral blood myeloid NGS, when do you pursue bone marrow biopsy to evaluate for CCUS/MDS rather than monitoring expectantly?
In situations where a mild but otherwise unexplained clonal cytopenia is present, the decision to pursue a bone marrow biopsy can depend on the impact that the bone marrow results would have on clinical care and the likelihood of making a diagnosis. For example, a mild stable anemia in an older pati...
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 ...
How have the results of the SUNMO trial with mosunetuzumab/polatuzumab vedotin impacted your treatment choices for transplant ineligible relapsed/refractory DLBCL?
The SUNMO trial results have provided another option for patients with relapsed and/or refractory disease who aren't fit enough for more intensive therapy, whether it be salvage + ASCT for relapsed or CAR-T/bispecific + CIT for those with refractory disease. As well, the regimen is likely to have le...
If tafasitamab/lenalidomide plus R-CHOP (frontMIND) is approved/utilized for frontline treatment, how would you approach second-line therapy in transplant-ineligible patients with relapsed/refractory DLBCL?
I do not think my approach to transplant-ineligible R/R DLBCL will significantly change, other than not using Tafasitamab-Len. I will still consider CAR-T cell therapy as a treatment option, as Tafa does not seem to affect the efficacy of CD19 CAR-T (Sakemura et al., PMID 37879074, and also Bastos-O...
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 approach symptomatic thalassemia intermedia patients from beta thal trait with alpha gene duplication?
Individuals with the beta-thalassemia trait and alpha-globin gene duplication have an intermediate phenotype. The severity depends on the type of beta mutation and whether the duplication is of alpha-1 or alpha-2, since these determine the imbalance between alpha and beta globin production. Individu...
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...
How do you approach laboratory assessment for anticoagulation adherence when working up anticoagulation failure?
When faced with an anticoagulation failure, my go-to test for adherence is looking at the medication-dispense report (if you have this available at your institution, it is very handy for understanding the patient's adherence to anticoagulation). Typically, this will either show intermittent dispensi...
How do you approach the use of teclistamab plus daratumumab in patients with relapsed/refractory multiple myeloma who have previously been exposed to daratumumab or isatuximab?
The treatment of patients at first relapse has changed dramatically over the last few years - first with the option of Carvykti (cilta-cel) for fit patients, and now the option of teclistamab-based regimens. At first we were only able to use teclistamab + daratamumab as a result of MajesTEC-3, and m...
How do you approach the second-line treatment for a patient with high-risk myeloma relapse early post-autoHCT after Dara-RVD induction?
Depending on the nature of the relapse, I would salvage with DCEP, or carfilzomib-based triplet (KCyD, KPd) with ciltacel as the next step.