Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
What is your approach to vaccinations and titers for patients with myeloma, who are immunosuppressed and do not have appropriate antibody responses to vaccines?
It depends on the vaccine and prior immunization history. Not all vaccines require an antibody response to be at least partially efficacious. In addition, with any immunocompromised host, reduced effectiveness for all vaccines is expected, but is not a reason to not vaccinate. Serologic testing is h...
Are you still recommending autologous stem cell transplantation (ASCT) for all eligible myeloma patients who achieve remission after induction with a quadruplet regimen?
Our institution still recommends upfront autologous transplant for most fit patients. We appreciate the recent results from CEPHEUS and BENEFIT, but if we believe that achieving MRD negativity is important, the addition of autologous transplant improves the rate of MRD negativity, which ultimately s...
How does one interpret an SPEP showing potentially obscured but non-quantifiable M-spike however an IFE showing monoclonal protein?
Not all patients with monoclonal gammopathies make a detectable paraprotein on SPEP, or, in some cases like IgA gammopathies, it may be 'hidden' in the beta-region of the SPEP, or the rare IgD and IgE gammopathies may be too low to detect on the SPEP. In addition, for the 15-20% of patients who have...
Would you use sutimlimab for cold agglutinin disease/syndrome in patients with a concurrent hematologic malignancy?
The CARDINAL trial excluded patients with active malignancy, and thus in general I would not use sutimlimab in patients with CAD in context of a concurrent hematologic malignancy. Additionally, one would hope that treating the hematologic malignancy would address CAD mediated hemolysis, without requ...
How would you manage elevated vWF and FVIII levels in a patient with a family history of coagulopathy?
Hard to be specific without more clinical details. I would not repeat levels. Although the higher the FVIII and VWF levels, the higher the risk of thrombosis, but there is no known specific cut-off. Currently, there is no role for empiric anticoagulation. As with all patients, DVT prophylaxis in hig...
How would you manage BCR-ABL CML that is resistant to imatinib, with concurrent JAK2 mutation?
As Dr. Tremblay mentioned, it’s important to separate the JAK2 component from CML. If the patient truly has a JAK2 mutant MPN, I would treat it depending on what the manifestations of that disease are. On the CML front, I would manage the imatinib resistance the same way you would any other patient....
How would you manage superficial vein thrombosis that persists on imaging after treatment with full dose anticoagulation?
This is a challenging yet instructive real-life case in clinical decision-making, highlighting variations in practice that often diverge from existing evidence.Before answering let me make some assumptions: Duplex Ultrasound Findings: I assume that Duplex ultrasound did not reveal thrombus extension...
With the data from AALL1731, how is blinatumomab being implemented for SR and HR leukemia patients not previously planned/randomized to receive blinatumomab?
We have incorporated blinatumomab for most patients as two non-consecutive cycles. Once in maintenance, we have not uniformly added blinatumomab, although we have interrupted maintenance to offer blinatumomab to select patients (high-risk genetics or those who had significant treatment modifications...
Would you combine sutimlimab with bendamustine rituximab for cold agglutinin disease if patient continues to hemolyze during treatment?
In my experience, virtually all patients with true cold agglutinin disease respond to sutimlimab quite quickly. While there may be sub-clinical evidence of hemolysis for some time, generally hemoglobin improves to normal or close to this. Adding therapy to sutimlimab really depends upon the clinical...
How do you monitor multiple myeloma in patients receiving dialysis?
In brief, it depends. I’ve had some patients on dialysis whose light chains completely normalize with treatment and continue to remain normal - and others where the light chains never drop below 100 mg/L even in the setting of MRD negativity. This probably has something to do with the fact that not ...