Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
Would you anticoagulate a patient with splenic infarctions in the setting of CMV viremia?
Based on my general knowledge/experience, I would consider CMV viremia as temporary, short-lived risk factor for a thrombotic event on a part of other inflammatory conditions, and outside of other indications for anticoagulation (e.g., atrial fibrillation, etc), my inclination would be to conclude ...
Does the presence of asparaginase antibodies on Granger Genetics testing indicate need to switch asparaginase formulations?
I would rely on the serum asparaginase activity (SAA) assay rather than the antibody testing. SAA has proven to be a reliable predictor of asparagine depletion and is a widely acceptable method for therapeutic drug monitoring. On the other hand, asparaginase antibody testing has not been consistentl...
What CTV margins should be used with early stage favorable Hodgkin's Lymphoma in the illiac chain if they had a complete response on PET after 2 cycles of ABVD?
Involved site radiation therapy (ISRT) is currently the methodology of planning a course of RT for patients with lymphoma. It should be emphasized that ISRT is NOT synonymous with "small" radiation fields. It is a system whereby 3D anatomy is utilized (instead of bony landmarks) to delineate a GTV, ...
How do you approach evaluation and management of arthralgia in a patient after CAR-T cell therapy?
This is a great question - part of cytokine release at syndrome includes joint pain. So my questions are: How far after? What was the reason for the CAR-T? These are vital questions to understand first. To that be said - the answers will determine if you give a one-and-done treatment or long-term....
Is there a role for hydroxychloroquine for secondary prevention in patients with APS without SLE?
There are no prospective trials to answer this question. In one cross-sectional study (Erkan et al., PMID 12154210) there was a suggestion of a protective effect of hydroxychloroquine. However, patients were also on aspirin and it may be difficult to sort out which of these agents had the protective...
How do you manage the development of neuropathy in patients receiving bortezomib for multiple myeloma?
Bortezomib and thalidomide cause the bulk of the neuropathy in myeloma patients worldwide, although thalidomide is rarely used in the U.S. because of more effective immune modulating drugs (IMiD's) available such as lenalidomide and pomalidomide. Pre-existing peripheral neuropathy is the biggest ris...
How would you manage a patient with p53 mutated MCL who has progressed after a BTKi and CAR-T with a CD20 negative clone?
Venetoclax + CD19 or CD22 mab if available
Would you irradiate all borderline suspicious lymph node regions on PET/CT in stage IIA nodular lymphocyte predominant Hodgkin's lymphoma treated with ISRT alone?
ISRT fields for lymphocyte predominant HL when treating without chemotherapy should be more generous in the nodal chain region than if treated with chemotherapy. We conducted a survey of expert lymphoma radiation oncologists published in the IJROBP, which demonstrated some differences in opinion. Ho...
What is the best treatment volume and dose for a marginal zone orbital lymphoma?
It would depend on the location- retrobulbar, conjunctival or lacrimal gland. Imaging, including MRI, helps in evaluating the site of origin and extent of involvement. Some advocate treating the entire orbit for all orbital lymphomas to be comprehensive, as the total dose is low, and this away we av...
How do you follow patients after radiation treatment for orbital MALT lymphoma?
Local control is extraordinarily high after definitive RT (24 Gy) for orbital MALT lymphoma (>95%). It is not uncommon for patients with retro-orbital disease to have residual masses after RT that remain stable during follow-up. One should be cautious about pursuing additional therapy for presumed "...