Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Would you treat with AZA + venetoclax to achieve CR2 before proceeding to allogeneic stem cell transplant in a young, fit patient with favorable risk AML who relapsed within a year after 7+3 and HIDAC consolidation?
It would be important to know what type of "favorable risk" AML the patients had and also what the current NGS shows. I would wait on NGS results to return to see what the options are first in targeted therapies a potential option. If the patient had Core Binding Factor (CBF) AML, a high dose cytara...
For hypogammaglobulinemia as a complication of successful treatment, do you empirically start prophylaxis with either 400 mg/kg monthly for IVIG or 100 mg/kg weekly for subcutaneous immune globulin?
Most of the data to support IVIG for hypogam comes from CLL literature. Data in those post-transplant and post-CAR T are limited. IVIG has a reputation of being a bit of a panacea, but I challenge that notion. We investigated the implementation of an IVIG stewardship plan to limit IVIG usage just fo...
How do you decide between using ropeginterferon alfa-2b and peginterferon alfa-2a in MPN?
In general, I favor ropeginterferon as it is FDA-approved and allows for less frequent, every 2-week dosing as compared to peginterferon which is used off-label and requires weekly dosing. However, ropeginterferon is not currently approved for ET and in patients where I decide to use interferon in t...
Do you do prophylactic LP/IT chemotherapy in high risk APML prior to starting consolidation?
Extramedullary disease such as CNS involvement is quite uncommon at diagnosis in acute promyelocytic leukemia (APL). However, it can be seen in patients with relapsed disease. Both isolated CNS relapse and CNS relapse associated with morphologic or molecular relapse can occur. Yet one has the impres...
What are common indications for ordering NGS of peripheral blood?
I am delighted that someone posed this question because, in my experience as a consultant hematologist, it appears that advances in DNA sequencing technology have outstripped the knowledge base of many practitioners. This is not due to lack of interest or due diligence on their part, but rather beca...
What would you use for cytoreduction in a pregnant patient with high risk ET and APLS?
My first instinct in replying to this question is to understand the basis for the diagnosis of “high-risk ET”. Since the patient is pregnant, the basis for the designation “high-risk” must be a history of a prior thrombotic event, either arterial or venous. However, the purveyors of the various MPN ...
Would you change therapy for a CML patient in hematologic remission on imatinib found with positive qualitative BCR-ABL1 for the p230 protein?
It would depend on how long the patient has been on imatinib and the sensitivity of PCR testing. Being able to monitor the p230 transcript at the level of 0.1% or even deeper would be helpful to characterize if the patient has achieved a major molecular response or not. This publication outlines the...
What is your approach for bulky stage I primary mediastinal B-cell lymphoma in a patient with a positive post-chemotherapy PET-CT (residual mass and Deauville 5)?
Interpreting end-of-treatment PET in PMBL can be tricky. False positives here are very common! Fake-outs include thymic rebound masquerading as refractory disease; avidity at rim (which is almost always biopsy-neg); or residual avidity throughout residual mass which again can be biopsy negative. I w...
Does aspirin dose (81 mg vs 325 mg) matter for secondary stroke prevention?
This topic has been debated extensively. There are two camps in this debate: Aspirin with a dose of 81 mg is adequate for platelet inhibition in the general population. Aspirin with a dose of 325 mg may be needed for individuals who weigh more (>70 kg) to achieve appropriate platelet inhibition. T...
Are you including Bortezomib as standard of care in the upfront treatment of T lymphoblastic-lymphoma?
We do use bortezomib in the upfront treatment of T-cell lymphoblastic lymphoma in children and AYA. For those familiar with the topic, the results of two successive large clinical trials in T-LLy done by COG, AALL0434, and AALL1231, were confusing. Due to the rarity of the disease, overlapping trial...