Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Do you consider thrombocytopenia a contraindication for fibrinolytic therapy for a massive PE?
If one has access to mechanical thrombectomy devices and operators, they should be considered before systemic thrombolytics unless the massive PE is causing imminent danger to the patient/patient is going to code/die, in which case the risk of dying from said PE is higher than potential bleeding eve...
What is your target Hgb/Hct for women who are pregnant and have sickle cell disease in whom you are doing scheduled transfusions?
Hg 10-11. My main goal is to suppress reticulocytosis and therefore, the production of more sickled cells.
In a patient with negative Hep B surface Ag, Hep B surface antibody+, and Hep B core antibody+ serologies, do you initiate antiviral prophylaxis (e.g. entecavir) prior to starting rituximab?
I would use entecavir for Hep B reactivation prophylaxis in this case - based on recommendations from AGA 2025 guidelines, which does classify b-cell depleting agents as higher risk for reactivation for both Hep B surface Ag-positive and Hep B surface Antigen neg/core positive patients. It should be...
What is your approach to initial management of patients with suspected or confirmed primary cutaneous CD8+ positive aggressive epidermotropic T- cell lymphoma (PCAECTCL)?
PCAECTCL is an exceptionally rare and clinically aggressive subtype of cutaneous T-cell lymphoma, characterized by a rapidly progressive course, ulcerated or necrotic skin lesions, and early dissemination to extracutaneous sites. Due to its rarity and lack of standardized guidelines, management is l...
In a newly diagnosed elderly patient with AML who harbors an IDH1 mutation, would you treat with upfront with ivosidenib/HMA or would you proceed with venetoclax and HMA as your first line treatment?
For me, the decision whether to treat this patient with IDH1 inhibitor monotherapy (ivosidenib) vs. venetoclax/HMA depends on how fit this patient is and his/her desire for aggressive therapy and inpatient vs ambulatory care. Prior data suggests very high response rates (90-100%) following venetocla...
How would you manage a solitary, painful, lytic bony lesion in a patient with negative PET/CT but bone marrow biopsy confirmation of multiple myeloma?
This is a palliative scenario, but the approach may differ based on the clinical circumstances. If Heme Onc is planning on administering systemic therapy, then a short course of palliative RT to expedite pain control would be appropriate. Treatment of many sites (e.g., femur) can be done very quickl...
How do you choose between liso-cel and axi-cel in patients with early relapse DLBCL for whom you are recommending CAR T-cell therapy?
Axi-cel and liso-cel are anti-CD19 chimeric antigen receptor (CAR) T-cell products approved for primary refractory or early relapsed (<1 year from initial chemoimmunotherapy) diffuse large B-cell lymphoma (DLBCL). Both products exhibit excellent efficacy (overall response rates >80%) and are potenti...
How would you treat a stage I fully resected double hit DLBCL?
In patients with fully resected DLBCL, I still give chemotherapy. That also applies to double-hit lymphomas. Limited stage DHL does not seem to have a poorer prognosis than non-DHL, and intensive regimens do not make a difference. I would treat with RCHOPx3-4 cycles.Torka et al., PMID 31945157Lue et...
How would you manage relapsed DLBCL in a patient who received second line CD19 CART treatment?
With commercial CD19 CAR-T therapy moving into earlier lines of therapy, post-CAR-T relapses are now more common. There are still many options depending on what first-line/bridging therapy was given, CD19/20/30 expression, and patient preferences. I always get a biopsy if feasible to confirm relapse...
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...