Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is your approach to managing follicular lymphoma with central nervous system involvement?
Not really an expert on this issue. Fairly uncommon to have a follicular lymphoma-associated CNS disease. Our usual is for high-dose methotrexate, Temodar, and rituximab. Potentially followed by autologous stem cell transplant.
How do you manage anticoagulation in a patient with DVT from likely malignant mechanical obstruction?
This is a very difficult situation to manage. Would promptly initiate therapeutic anticoagulation as long as no increased risks for bleeding. The surgery to remove the uterine mass is likely urgent. I would confirm with gynecologic oncology (or the team planning on removing the mass) that it is not...
For patients with Stage IIIB or IV HD flowing Bv-AVEPC with initial large mediastinal adenopathy, how can we avoid ISRT?
It is true that on the clinical trial AHOD1331, patients who presented with large mediastinal adenopathy received radiation therapy as did patients who were slow early responders (Deauville 4 or 5 after two cycles of therapy). It is noteworthy that 3-year event-free survival was extremely high for a...
Is there a role for CRS prophylaxis with tocilizumab during bispecific T cell engager initiation for myeloma?
I would not use Toci prophylactically. I see more problems with ICANS/confusion in MM bispecifics, and this responds to steroids, not Toci, or resolves on its own.
What experience have you had with familial clustering of polycythemia vera?
JAK2 V617F is a somatic mutation that can be acquired as early as in utero based on elegant work by Williams et al., PMID 35058638.There is some data available regarding familial MPN predisposition syndromes and this review very nicely summarizes much of the available data (Lim et al., PMID 39316992...
Do you have a preferred IV iron formulation for pregnant women?
I prefer INFeD, Feraheme, Monoferric, and FCM is okay. INFeD, Feraheme, and Monoferric are also preferred in non-pregnant patients. FCM in non-pregnant patients has a risk of hypophosphatemia, but for some reason, FCM (InjectaFer) does not cause hypophosphatemia in pregnancy, likely due to renal ada...
How do you dose apixaban in patients with CrCl <30 mL/minute?
Patients with chronic kidney disease are challenging to treat with anticoagulation as they have an increased risk of both venous thromboembolism and bleeding. Treatment should be individualized after weighing the risks and benefits of anticoagulation as well as the indication for anticoagulation. Th...
How do you manage a patient with JAK2+ ET without history of thrombosis during pregnancy?
Great question. We've recently published our experience here How et al., PMID 33022566. Patients with ET that are pregnant and that don't have a history of thrombosis are likely to be in the very low/low risk categories by R-IPSET, many of these women are likely not on any treatment prior to startin...
What radiation treatment volume and dose would you deliver to an isolated DLBCL relapse in the left eye s/p vitrectomy and intraocular methotrexate?
This is a case of secondary ocular lymphoma but the management of primary ocular lymphoma may be helpful to consider. For patients with primary ocular lymphoma, a significant number of patients present with bilateral disease at initial diagnosis or will relapse in the contralateral eye after unilate...
Is prophylactic anticoagulation indicated in patients with frequent ulcerative colitis flares?
Background: We know that inflammatory bowel disease (IBD) is a risk for incident and recurrent venous thromboembolism (VTE). What is not clearly established is whether the IBD needs to be 'active' in order for it to be a risk factor, e.g. would patients who have had proctocolectomy (and perhaps no e...