Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How does your surveillance for DLBCL change given the new role of CAR-T in 2nd line treatment?
There were at least 2 large studies from Europe showing that surveillance imaging for lymphoma patients in remission after completion of upfront treatments don’t improve survival (regardless of histology). I don’t usually get any imaging for DLBCL in remission after the end of treatment imaging. Pos...
In the era of MEK inhibitors and BRAF V600E-targeted therapy, what is the role of traditional vinorelbine/prednisone in the management of Langerhans cell histiocytosis?
A similar question came up during rounds this week, and I recalled seeing this question here.I assume the asker meant vinblastine, and not vinorelbine; the combination of vinblastine and prednisone is considered standard therapy, whereas vinorelbine has not generally been used in LCH.Let's first bet...
In treatment naive CLL without del(17p)/TP53, will the recent interim analysis of fixed duration acalabrutinib plus venetoclax +/- obinutuzumab vs chemoimmunotherapy in the AMPLIFY trial change your practice?
The interim analysis of the AMPLIFY trial, published in the New England Journal of Medicine, presents strong evidence that could influence clinical practice for treatment-naïve chronic lymphocytic leukemia (CLL) patients without del(17p) or TP53 mutations. The AMPLIFY trial is the first phase 3 stud...
Would you consider the use of ruxolitinib for tumor fevers and leukocytosis?
No.
How do you manage catheter-associated, upper extremity superficial venous thrombosis?
I manage catheter-associated upper extremity superficial venous thrombosis (SVT) conservatively with arm elevation, warm compresses, NSAIDs, and topical creams containing NSAIDs. Upper extremity SVT is primarily caused by indwelling intravenous catheters, so I do strongly recommend catheter removal ...
What are your top takeaways in Classical Hematology from ASH 2024?
In the category of continuing what I already do, ASH 2024 provided an important confirmatory study of how to approach the treatment of patients with high-risk venous thromboembolism (VTE).In the EINSTEIN CHOICE (Rivaroxaban) and the AMPLIFY-EXT (Apixaban) studies, extended reduced-dose anti-coagulat...
What volume and dose would you use for a Stage I MALT lymphoma of the lung?
MALT lymphomas are highly radiosensitive. Curative standard doses are 24 Gy in 12 fractions and 30 Gy in 20 fractions. The latter and slower dose fractionation (30 Gy in 20) is best used specifically in the setting of stage IAE Gastric MALT - a unique site with significant risk of radiation induced ...
How do you manage newly diagnosed multiple myeloma patients who have a contraindication to steroids?
This is a rather rare situation, but it can happen. Each patient will be different here. In my experience, this has been to psychosis/mania with previous steroid exposure.There is clear data that you can omit steroids following cycle 1 with daratumumab-based induction, cited here, but there are othe...
Under what circumstances is it okay to initiate treatment for suspected multiple myeloma without a bone marrow biopsy?
Excellent question! It is uncommon to start treatment for any malignancy without a pathologic proof and the age-old principle of 'Tissue is the Issue' applies to multiple myeloma as well. Having said that, certain emergent situations do merit starting treatment early without waiting for the biopsy o...
In patients with CML who are receiving 1st line TKI with good molecular response, are you continuing therapy or switching to asciminib based on the ASC4FIRST data?
For a CML patient with optimal response and excellent tolerability to their current TKI, there should not be impetus to switch to asciminib. For patients with less than optimal response, diminished quality of life, and in certain settings of adverse effects from current therapy, consideration of TKI...