Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Is there a role to continue aspirin in patients with myeloproliferative disorders who have never had a thrombotic event that are starting DOAC for stroke prophylaxis with newly diagnosed atrial fibrillation?
Aside from treating erythromelalgia, transient ischemic attacks (TIA) such as ocular migraine or documented atherosclerotic disease, aspirin has no role in the management of the MPN, despite the widely published recommendations for its use, particularly in so-called "high risk" polycythemia vera (PV...
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...
When would you treat mild anemia from low testosterone in an older male?
The primary indication for testosterone treatment is symptomatic hypogonadism and not anemia. Given the risk for adverse events in terms of erythrocytosis, cardiovascular events, and potential prostate diseases, the risk of providing testosterone for asymptomatic, mild anemia outweighs its benefits,...
What is your approach to an infant (<12 mo) with new onset petechiae and thrombocytopenia, with labs consistent with ITP?
In an older (1-6 year old) child with apparent ITP, less work up might be needed. While many tests are possible, in this case, labs consistent with ITP, I would interpret as including a CBC otherwise normal for age without blasts on a smear (if this is not true, the differential is much wider). If i...
How would you approach treatment in an older (>65), but fit patient with intermediate-risk AML, but with MRD persistence after induction with 7+3?
The presence of measurable or minimal residual disease (MRD) after induction chemotherapy, before allogeneic transplant or after transplant is associated with risk of relapse. (Araki et al. J Clin Oncol. 34:329-36) The detection and measurement of MRD by flow cytometry requires specific expertise in...
For patients with VEXAS syndrome and good response to azacitidine, what duration of therapy do you consider?
The short answer: as long as azacitidine is controlling inflammation, reducing/eliminating steroid dependence, and/or improving cytopenias, keep using it. Don't stop (or if the patient is being bridged to alloSCT, continue until BMT).The long answer:VEXAS is an autoinflammatory disease wherein patie...
What is your approach to curative-intent therapy for a young, fit patient with newly-diagnosed monomorphic epitheliotropic intestinal T cell lymphoma (MEITL)?
If >= 10% of the cells express CD30 by IHC, I would treat with BV+CHP x 6 cycles rather than CHOP according to the ECHELON-2 trial (although this trial included only 3 patients with EATL). Historically, the 5-year OS rate with anthracycline-based chemotherapy alone is approximately 10 to 20%, so for...
Would you offer definitive radiotherapy for prostate cancer (or another solid organ malignancy) to a patient on maintenance Rituximab for lymphoma?
Good question and a somewhat increasingly common issue in the general sense of patients with overlapping hematologic and prostate malignancies. For starters, I would think hard about the risk group of this patient and competing risks. If this patient has an aggressive or relapsed lymphoma with favor...
What adverse events would make you switch off nivo + AVD therapy and to what second line therapy in patients with Hodgkin Lymphoma?
The question of how to handle severe IRAEs when using the N+AVD regimen is an important one. First, of course, is to hold CPI therapy, empirically treat as indicated to avoid ongoing or worsening organ injury, and concurrently ensure that there is no other cause for the observed event(s). But if you...
What radiation dose would you use to treat a symptomatic osseous lesion secondary to AL-amyloidosis?
Extrapolating from our tracheobronchial experience, we’ve used 20 Gy in 10 fractions to target the underlying plasma cells that produce amyloid production. We’ve also used this regimen for ocular and GU (ureteric and bladder) amyloidosis. If there are obstructive or symptomatic lesions, then surgica...