Hematology
Clinical discussions on blood disorders, coagulation, transfusion medicine, and hematologic malignancies.
Recent Discussions
How do you counsel patients on the risk of thromboembolic complications with use of immunotherapy in NSCLC?
Patients with metastatic lung cancer are at increased risk of thromboembolic events with an estimated frequency of 13.9% (Connolly et al., PMID 23026639). Preclinical data show that PD-1/PD-1 pathway blockade may lead to increased levels of pro-inflammatory cytokines and T cell driven progression an...
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 do you approach a patient with high titer ANA and a new diagnosis of ITP, but no other signs or symptoms suggestive of active rheumatologic disease?
I would certainly treat the ITP with hematology involvement if necessary but would continue to monitor for lupus or similar CTDs. I have seen patients present with an ITP-like picture for years before lupus declared itself eventually. It may take years. I would also check a UA for proteinuria. This ...
For a patient with lenalidomide-refractory R/R multiple myeloma at first or second relapse, how would MeziKd (if approved based on SUCCESSOR-2) factor into your sequencing decision relative to BCMA-directed and other available options?
There is never a good time to be a myeloma patient, but this is the best time it has ever been.Tldr; I would still prefer a BCMA-directed strategy for patients with BCMA-naive relapsed MM.The recently reported results of the phase 3 SUCCESSOR-2 trial demonstrated the efficacy of mezigdomide, a novel...
Do you attempt treatment breaks from bispecific antibody therapy in patients with relapsed myeloma who achieve a sustained MRD-negative complete response?
I have not seen any reported data on this, so no. Here is the only information that I have adjacent to this question: I generally don't repeat bone marrow biopsies on patients receiving bispecific antibody therapy, so I have little experience with sustained MRD-negative CR's. I certainly have done ...
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
At our institution, we have comprised a multidisciplinary team to help treat these patients. The team or "HLH task force" as we like to call ourselves is comprised of a clinical immunologist, rheumatologist, dermatologist, critical care physician, hepatologist, BMT attending/hematologist, infectious...
How do you manage anticoagulation/antiplatelet therapies with strong indications for uninterrupted therapy in the setting of urgent procedures?
If anticoagulation is absolutely contraindicated because of the bleeding risk of the procedure, then "bridging" will usually make the most sense, most of the time, with low molecular weight heparin such as enoxaparin. If dual antiplatelet agents are contraindicated, particularly in the first month a...
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 ...
How do you manage hyperhemolysis syndrome in a patient with life-threatening anemia and evidence of end-organ ischemia who requires emergent transfusion despite the risk of worsening hemolysis?
Any sudden onset rapid hemolysis could be encompassed by the term hyperhemolysis, for instance following a mismatched transfusion, a delayed hemolytic transfusion reaction (DHTR), hemolysis triggered by an autoantibody, or a toxin in someone with G6PD deficiency or an infection in someone with spher...
Are there any alternative, hypofractionated RT courses for patients with DLBCL that can be used during the COVID-19 pandemic?
ILROG recently came out with guidelines pasted below: Synopsis of ILROG Recommendations for Administering Radiotherapy for Hematological Malignancies During Emergency Conditions of the COVID-19 Pandemic • We are facing an increased demand for RT to substitute or complement systemic therapy deemed i...