Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How would you treat an elderly patient with stage I/II unfavorable classic Hodgkin Lymphoma, who could only tolerate 2 cycles of chemotherapy and has a Deauville 1-2 PET/CT re-staging scan?
Assuming a patient is responding favorably to therapy by PET/CT, there are 5 regimens that are supported by randomized trials and included in national guidelines: Chemotherapy-alone regimens ABVD x 2 + AVD x 4 (RATHL) BrECADD x 4 (HD21) Combined modality therapy regimens ABVD x 4 + RT (30 Gy) (H1...
Do you consider testing and treating IDA in unexplained thrombocytopenia?
I read that paper and was not convinced, but it was surely interesting. In reality, an enormously more likely platelet event with iron deficiency is a reactive thrombocytosis. Iron deficiency can occur in the extremely unlikely event of excess bleeding with thrombocytopenia, but as an epiphenomenon ...
What are your top takeaways in Lymphoma from ASH 2025?
Fixed-duration versus continuous targeted treatment for previously untreated chronic lymphocytic leukemia: Results from the randomized CLL17 trial — This trial may change practice by using the combination of BTK-I and Ven without CD20 antibodies. This time-limited option led to MRD, and I would expe...
What therapy do you usually choose in patients with previously treated follicular lymphoma who experience early relapse (<2 years)?
My approach to POD24 patients is to first ensure there is no evidence of transformed disease. According to a retrospective analysis led by @Dr. First Last at Memorial Sloan Kettering, as many as 40% of the POD24 patients have evidence of transformed disease if a biopsy is pursued. Clinical indicator...
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...
For patients with multiple myeloma receiving bispecific antibodies who have had a slightly extended treatment interval beyond what the FDA label specifies (e.g., 29-30 days instead of 28), is repeat step-up dosing clinically necessary, or are there situations where it can be safely omitted?
The data underpinning this label is what was done based on protocols that were written before much of the pharmacokinetics was known, and certainly before a pharmaceutical company was willing to adjust these safety practices; they would be severely financially penalized if safety events disrupt drug...
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...
Are there still clinical situations in which you deliberately treat patients with a DOAC besides apixaban?
Thank you for your question. Apixaban has been my preferred agent for a long time for patients requiring therapeutic anticoagulation. Apixaban’s lower bleeding risk was shown prior to and now has additional evidence to support this with the COBRRA trial. The risk is also ameliorated by the safety in...
What screening tools or signs do you use to predict if a cancer patient is near end-of-life?
For most of us, long-time practicing oncologists, all we have to do to determine that one of our patients is at the end of their life is to be in the same room with them. No special computer programs or calculators are needed. Just look closely at the patient's current weight, their level of conscio...
In patients with essential thrombocythemia (ET) receiving hydroxyurea for cytoreduction who develop anemia — whether hydroxyurea-induced or from a concurrent etiology such as CKD — would you use ESAs?
This is an important question. Patients with ET should not have anemia related to the ET itself. Thus, assessing the etiology of the anemia is very important. If the anemia is from hydroxyurea, the first step is to lower the dose of the hydroxyurea. Controlling platelets should not come at the expen...