Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
For transplant-ineligible aplastic anemia planned for immunosuppression, how do you approach duration and tapering of cyclosporine and eltrombopag?
One of the most common mistakes in the management of AA is premature tapering of cyclosporine or tacrolimus. If there is a complete remission, and by that I mean normalization of counts, not complete remission as defined in some papers (e.g., ANC 1000, Plts 100,000, Hb 10 as in de Latour et al., PMI...
After the MAJESTEC-3 results, what is your approach to choosing between tec-dara vs. cilta-cel versus another triplet for multiple myeloma in first relapse?
This is an excellent question, and literally a million-dollar question for various companies involved. It's worth noting that the US FDA can change the package insert at will (and has done so) compared to what the trials did, so there's no guarantee as of yet that Tec-Dara (based on MajesTEC-3) will...
How would you treat a patient with stage IE gastric MALT lymphoma with negative testing for H. pylori?
Standard of care treatment in these patients mostly includes local radiotherapy. You need to be certain that the patient is truly HP-negative; the gold standard for this is negative histopathology for HP. In patients with negative HP histology, you should still rule out HP with non-invasive measures...
What is the best way to prepare children with von Willebrand disease for tonsillectomy to reduce the risk of post-operative hemorrhage?
I am an adult provider, but the treatment is similar regardless of age. The exact treatment plan will vary depending on the type and severity of VWD (i.e., mild type 1 VWD vs type 2B VWD); however, for tonsillectomies, I provide VWF concentrate 40-80 IU/kg 5-30 min preoperatively, followed by postop...
Do you use particular cutoffs of troponin and BNP that you deem indicative of a hemodynamically significant/high-risk PE, or do you see any abnormal value as indicative?
Biomarkers are contributory variables in a multivariable assessment of any patient with pulmonary embolism. In light of the multiple factors that influence biomarker levels in a given patient, it is challenging to define one-size-fits-all cut points for meaning. It is also important to recognize tha...
How do you manage infection risk when using BTKi-chemoimmunotherapy combinations in MCL patients?
This is a broad question, but BTKi are used in younger/fit patients (TRIANGLE-like therapy, including cytarabine) and approved in combination with BR (acalabrutinib). Regarding the latter: bendamustine is known to be T-cell depleting and associated with zoster/HSV and risk of other viral infections....
When would you use rusfertide to treat polycythemia vera?
This is an interesting question, as the FDA only approved rusfertide (Mimrylo) just a few days ago based on the results of the VERIFY trial- a double-blind, placebo-controlled RCT (n=293). Patients were allowed to continue standard-of-care therapy; about 40% of patients continued hydroxyurea, but a ...
Do you attempt treatment breaks from bispecific antibody therapy in patients with relapsed myeloma who achieve a sustained MRD-negative complete response?
I don't attempt to stop therapy in people who achieve deep responses and are tolerating the drug, but this is mostly because there is currently a paucity of prospective trials, so the specific time at which stopping therapy is optimal has not been established. I do have a low threshold to space out ...
How will you utilize the PARADIGM study results from ASH 2025, comparing azacitidine/venetoclax to intensive induction chemotherapy for fit patients with newly diagnosed AML?
It was very exciting to see PARADIGM presented as a plenary at ASH, and I look forward to the manuscript! Interpreting the findings in the context of the enrolled patients is very important. The median age of enrolled patients was approximately 65 years in both arms, and ~75% of enrolled patients ha...
In patients with inflammatory arthritis (RA, psoriatic arthritis) and a history of MGUS are there any concerns regarding use of biologics?
There is no absolute contraindication to any particular biologic used to manage active RA in a patient with MGUS. The literature does point out a small potential risk associated with tocilizumab in terms of development of myeloma influenced by the IL-6 pathway (and I would tend to extend that potent...