Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is your preferred iron loading strategy for patients with anemia of chronic kidney disease?
I prefer to give ferumoxytol 510 mg X 2 doses of available.
In a patient with cardiac light chain amyloid who has significant heart failure symptoms, including inotrope dependence at presentation, how much clinical benefit does treatment provide?
In patients with cardiac light chain (AL) amyloidosis who present with significant heart failure symptoms and inotrope dependence, the clinical benefit of treatment is a complex and nuanced issue. This scenario often reflects an extreme end of the disease spectrum. Historically, patients with advanc...
Is there a role for anti-fibrinolytic agents in patients with hyperfibrinolytic disseminated intravascular coagulation?
DIC is a complex clinicopathologic syndrome. There are no randomized trials to support evidence-based practice. The following principles apply: 1) antifibrinolytics should not be used in patients with organ failure or those that are asymptomatic. One could justify their use in this group of patients...
Would you consider octreotide as an adjunctive therapy for patients experiencing an acute life-threatening hemorrhage, outside of standard indications such as variceal or AVM bleeding?
In very selective scenarios, when the patient is experiencing an acute life-threatening bleeding while variceal or AVM bleeding remains on the differential, yes, I would consider octreotide as an adjunctive therapy, but only as a bridge to definitive diagnosis and treatment and not as a substitute f...
How soon after initiating oral anticoagulation therapy for atrial fibrillation can it be interrupted for surgery or procedures?
As with most things medical, multiple answers. If a patient walks into my office for preOp "clearance" and behold, they are in atrial fib, but asymptomatic, then it would depend on the urgency of their surgery. If elective, then you have time to work up his atrial fib and look for a reversal cause (...
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...
Is there specific data on using luspatercept for sickle beta+ thalassemia with transfusion-dependent anemia?
The mechanism of action of luspatercept is to trap and remove ligands of the TGF beta superfamily of ligands, specifically the growth and development factors (GDFs) 11 nd 15. This allows more maturation and differentiation of the erythroid precursors, and an increase in red cell production and relea...
Is the PFS benefit sufficient to adopt up front acalabrutinib plus BR for all patients with MCL?
In my opinion, PFS is not sufficient to adopt BR-acala as a universal treatment, but this can be an important treatment option for many patients. I would offer the BR-acala combo in patients who value maximizing duration of treatment response, recognizing this is a continuous regimen. On the other h...
What factors drive your selection between tafasitamab and epcoritamab for a patient with relapsed/refractory follicular lymphoma?
For an older patient or a patient with comorbidities, if one is prioritizing outpatient simplicity, tafasitamab + R² delivers an NCCN category 1 benefit with substantially lower acute immune toxicity. If CD19 CAR-T is the next planned therapy, however, the CD19-targeting overlap is a consideration t...
Following the ECHO trial, are you routinely incorporating acalabrutinib plus bendamustine-rituximab into your frontline treatment approach for patients with MCL?
I routinely discuss the combination of BR+ acalabrutinib for my patients with TP53 WT disease, but am upfront that it is not a "once size fits all" approach. I discuss that we are clearly seeing a progression free benefit of adding acala to BR, but we don't actually know at this time if giving them ...