Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What are your top takeaways in Hematology from ASCO 2025?
I would say: CARTITUDE-1 updates – first time we are seeing a plateau in a MM trial, that too in the relapsed/refractory setting with 5+ years follow-up. JNJ-5322 Trispecific – dual antigen targeting with less frequent dosing; 100% response rate in BCMA/GPRC5D naïve relapsed/ref MM patients; safety...
How, if at all, should a positive thrombophilia result influence the duration of anticoagulation following a first VTE provoked by a transient risk factor?
The answer depends on how we characterize a “transient” risk factor. The “provoked” vs “unprovoked” approach to the duration of anticoagulation rests on the assumption that, in patients with VTE, anticoagulation should continue until the risk of recurrence declines to the baseline level seen in the ...
When do you pursue MRI iron quantification for elevated ferritin with normal TSat, and when do you consider rare diagnoses like ferroportin disease or aceruloplasminemia?
Serum ferritin is an acute-phase reactant, so it can often be elevated without true iron overload, especially in the setting of viral illnesses or other inflammatory events. It is best not to do the test when something like that has occurred in the past 3-4 weeks or so. Overnight fasting is key to t...
Do you defer bispecific antibody therapy in CAR-T-eligible patients with relapsed myeloma to keep CAR-T viable as a future option?
A Carvykti CAR-T has the highest response proportion and may have the longest PFS in patients with relapsed myeloma who have received one prior line of therapy, and my general approach is to always use my best treatment first, as you never know whether this will be the patient's last line of therapy...
How do you decide whether to use pharmacologic VTE prophylaxis in hospitalized patients with decompensated cirrhosis?
For all patients, I begin by using a standard risk prediction tool to determine if the patient is appropriate for pharmacologic VTE prophylaxis. At our institution, the Padua risk prediction tool is embedded in our electronic health record/admission set. Clinical guidelines- including those from the...
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...
What is your standard for monitoring triglyceride level during therapy for ALL, particularly in regards to receiving pegaspargase?
Routine monitoring of triglyceride levels is not considered standard practice during pegaspargase therapy. Although hypertriglyceridemia is a common side effect of asparaginase treatment, it typically has no significant clinical impact on management decisions or future use of asparaginase. The condi...
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 are your practical considerations for incorporating bispecific antibody therapy into treatment of relapsed DLBCL?
CD20xCD3 bispecific antibodies are a very promising class of drugs available for relapsed DLBCL, with response rates ~50-60% as monotherapy and approaching 70% in combination with chemotherapy (GemOx). Glofitamab or epcoritamab in combination with GemOx is available in the 2nd-line setting if the pa...
How do you counsel patients on the risk of thromboembolic complications with use of immunotherapy in NSCLC?
Patients with metastatic lung cancer are at increased risk of thromboembolic events with an estimated frequency of 13.9% (Connolly et al., PMID 23026639). Preclinical data show that PD-1/PD-1 pathway blockade may lead to increased levels of pro-inflammatory cytokines and T cell driven progression an...