Hematology&nbsp;&nbsp;&nbsp;

Given the data from SWOG 1826 suggesting that Nivo-AVD is likely the preferred regimen for advanced Hodgkin lymphoma patients, are there scenarios where BV-AVD may still be preferred?

Is your standard of care for newly diagnosed advanced classical Hodgkin now nivolumab-AVD based on SWOG 1826?

What is your surveillance protocol for patients with common variable immunodeficiency receiving chronic IVIG therapy?

Is there a target IgG level to aim for? What should hematologists be aware of in monitoring these patients?

How do different inflammatory markers like CRP and ferritin contribute differently, if at all, to the monitoring of CART neurotoxicity?

For von Willebrand type 2B, do you expect a decline in platelet count over time as vWF increases with age?

Can anti-cardiolipin or anti-beta-2 glycoprotein antibodies cause prolonged PTT in the absence of a lupus anticoagulant?

Labs with normal PT, but prolonged PTT (47 sec, ULN 40 sec) that does not correct on immediate mix. Lupus anticoagulant negative (DRVVT and hexagonal ...

Can defibrotide be given safely for VOD in patients with refractory thrombocytopenia to platelet transfusions?

Is there any benefit of using aspirin to mitigate VTE risk in testosterone-induced polycythemia?

For patients with Stage IIIB or IV HD flowing Bv-AVEPC with initial large mediastinal adenopathy, how can we avoid ISRT?

Per the NCCN guideline for HR HD, if treated per OEPA-COPDAC, you can omit ISRT. This patient received treatment per AHOD1331, which recommends ISRT f...

Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?

For mild to moderate hemophilia B, do you routinely screen for inhibitors?

Assume the patient has infrequent bleeding events every few years, with use of FIX replacement for acute bleeds only.

How do you approach the work-up for a patient with iron deficiency anemia who is not responding to oral iron therapy?

Presuming good medication adherence.

Is it necessary to prescribe a steroid taper after two weeks of high-dose prednisone (60 mg daily)?

How do you manage significant asymptomatic indirect hyperbilirubinemia in patients with hemolytic diseases (SCD, HS, etc.)?

Do you consider starting Ursodiol? Do you perform routine abdominal ultrasound to monitor for cholelithiasis?

What are the treatment options for relapsed T-ALL in a patient who was nonadherent with AALL and hyper-CVAD regimens?

Is there a role for nelarabine and venetoclax in this setting?

When would you initiate exchange transfusion in babesiosis and significant hemolysis?

Is parasitemia >10% and severe hemolysis with Hb less than 7 enough to initiate this?

How quickly do you expect iron stores to decrease after starting iron chelators?

After what time period would you consider adding a second iron chelator?

How do you counsel sickle cell patients on the use of G-CSF to treat neutropenia from other causes, like malignancy?

Do you discuss the risk of sickle cell crises with G-CSF? What about for patients with sickle cell trait?

How often do you monitor AML patients after transplant for recurrence?

What is your preferred graft source and conditioning regimen in a patient with Fanconi anemia and AML undergoing stem cell transplant?

Is there a role for non-myeloablative regimens?

What would you recommend for long term management of extensive dural venous sinus thrombosis (CVST) in young females when the only provoking risk factor is combined OCP?

Thrombophilia testing, including JAK2 is negative. When would you stop anticoagulation?

When would you consider using G-CSF in patients with rheumatic disease who have received cyclophosphamide?

Is there any benefit to using desmopressin over vWF replacement therapy for vWD?

If not, has your practice changed to use vWF replacement therapy more routinely for perioperative or acute bleeding management? Do you still perform D...

How would you approach secondary stroke prevention in an adult with Hemoglobin SC disease?

Would you consider chronic RBC exchange versus HU?

How do you decide between HSCT and immunosuppressive therapy for treating hepatitis associated aplastic anemia?

How would you approach post-operative VTE prophylaxis for renal transplant in patients with a prior history of provoked VTE?

Are there specific guidelines for managing this patient population?

For patients diagnosed with T-cell lymphoblastic lymphoma with CNS involvement (CSF), what is your approach to the typical schedule for IT chemotherapy?

How do you approach managing depression symptoms in patients who have had repeated high risk of bleeding?

When do you determine SSRI therapy is unsafe to pursue in such situations?

Can a patient still have primary HLH even in the absence of any HLH associated genetic mutations?

rWGS did not demonstrate any HLH definable or associated mutations.

Would you change therapy for a CML patient in hematologic remission on imatinib found with positive qualitative BCR-ABL1 for the p230 protein?

qPCR for BCR/ABL was negative. FISH remained positive.

Is there any indication for hydroxyurea in patients with sickle cell trait?

What would your next line of treatment be for a patient with Hb SC with history of recurrent VOC and new bone infarct who is already on hydroxyurea and phlebotomy?

Hb at goal of 9-10

How would you treat suspected secondary HLH in patients whom etoposide is contraindicated?

No clear inciting etiology found. Would you consider dexamethasone +/- cytokine blockade (IL-1, IL-6, or IFN-g)? What do you think about the data for...

How is your experience with point-of-care INR systems for home monitoring of vitamin K antagonists?

Are the INRs reliable? In what scenarios would you not recommend POC INR use for warfarin monitoring? Are these typically covered by insurance? Are t...

How do you manage arthritis resulting from deferiprone in transfusion dependent thalassemia?

Is it appropriate to substitute vincristine for vinblastine in ABVD for systemic therapy of Hodgkins lymphoma?

Given nationwide shortage in vinblastine, several of my patients under active therapy are facing delays in their therapies. Is it appropriate to subst...

Would you consider continuing or re-trialing hydroxyurea for sickle cell patients after development of a leg ulcer?

Does your evaluation of a young person with spontaneous upper extremity DVT vary as compared to lower extremity DVT?

Do you do additional workup for venous obstruction or any other different testing/evaluation?

Do you use direct oral anticoagulants to treat port-a-cath related VTE in patients with an active malignancy?

Do social or economic factors (i.e., relative cost of acquiring LMWH, the patient being injection averse) affect your decision to use DOACs? Do you s...

How do you treat factor XI deficient patients with surgery or trauma related bleeding?

Is there a factor XI goal that you target? Would you consider FVIIa products instead?

How do you manage hemophilia A carriers with no history of bleeding complications but with mildly low factor VIII activity (6-40%)?

How would you counsel a female to male transgender patient regarding VTE risk with testosterone therapy, who has additional mild-moderate risk factors for thrombosis?

Additional risk factors could be family history of VTE or thrombophilia, such as antithrombin deficiency.

What subset of sickle cell disease patients are you offering sickle cell disease gene therapy?

How do you manage hyperalgesia in patients with sickle cell disease?

What hemoglobin level do you target for adult beta thalassemia intermedia patients with a pre-transfusion Hb >7 g/dl?

Should adult hemoglobin targets be different than pediatrics?

Do you recommend lifelong antibiotic prophylaxis, or do you prefer a more selective approach based on risk factors in asplenic patients without a history of severe infections?

How do you incorporate blinatumomab into therapy for a pediatric or AYA patient with isolated CNS relapse of B-ALL, if at all?

Is it true that a ferritin above 200 essentially rules out iron deficiency?

Does this hold true when the patient has significant inflammation?

How do you utilize cytokine panels in your clinical practice?

Is there utility when classic inflammatory markers (ESR,CRP) or disease specific markers (C3, C4, dsDNA) do not correlate with patients disease activi...

When would you use proximal complement inhibitors like pegcetacoplan over terminal complement inhibitors for initial treatment of paroxysmal nocturnal hemoglobinuria?

What parameters would you use to monitor and interpret iron levels in a hemochromatosis patient where ferritin is unreliable due to underlying chronic inflammation?

How would your recommendation change if the patient has H63 homozygous mutation?

What is your strategy for optimizing hydroxyurea dosage in patients with symptomatic sickle cell disease, particularly for genotypes HbSS and HbS/Beta thal?

What is your target Hgb/Hct for women who are pregnant and have sickle cell disease in whom you are doing scheduled transfusions?

Do you screen children with sickle cell disease for silent cerebral infarcts?

Are you including Bortezomib as standard of care in the upfront treatment of T lymphoblastic-lymphoma?

For patients with suspected complement-mediated TMA, are there specific clinical or laboratory parameters that can help guide the decision for starting empirical treatment (e.g., eculizumab) while awaiting the results of complement testing?

When would you initiate chronic therapeutic phlebotomy in a patient with erythrocytosis secondary to a high hemoglobin-oxygen affinity hemoglobinopathy?

How would you work up a patient with cutaneous mastocytosis?

Is a BM biopsy a must when there is skin involvement? If tryptase level is mildly elevated but less than 20 would you recommend a BM biopsy?

Do you screen adults in your practice with sickle cell disease for silent cerebral infarcts?

The ASH 2020 guidelines have "recommended that adults with HbSS or HbSβ0 thalassemia be screened at least once for silent cerebral infarcts even ...

Does the use of A+AVD versus ABVD affect your decision for consolidation RT for bulky Hodgkin lymphoma?

How do you manage steroid-refractory acute GVHD following allogeneic transplant?

What criteria do you use to define steroid-refractory disease? Does your management different by organ system involved - GI vs skin vs other?

What antibiotic, antifungal and antiviral prophylaxis you give post CAR-T therapy, and what is the duration?

Would you offer intensive CNS prophylaxis to Ph negative B-ALL patients who have possible mandibular nerve involvement on MRI face?

The patient presented with a numb chin, more to the right of his face; an MRI did report mandibular nerve opacity, which is non-specific per neuro-rad...

How do you address logistic barriers related to blinatumomab when treating relapsed B-ALL?

For example, if patients are unable to receive continuous infusion from home health agencies, or if prolonged hospitalization is cost-prohibitive.&nbs...

How do you monitor risk of erythrocytosis from testosterone use for female to male transgender patients?

How do you manage severe hypertriglyceridemia in the adolescent & young adult population receiving chemotherapy for ALL, in the absence of complications related to hypertriglyceridemia?

How do you approach autologous stem cell transplant in T-cell lymphomas/PTCL after induction chemotherapy with achievement of CR1?

NCCN says "consider autologous HCT" while retrospective data seems to support SCT in most histologies like AITL

What is your current approach to maintenance therapy in FLT3-mutant AML post allogeneic HCT?

Have you changed your practice given BMT-CTN 1506/Morpho results? Would you utilize maintenance therapy in patients who achieve MRD- remission?

Does the presence of asparaginase antibodies on Granger Genetics testing indicate need to switch asparaginase formulations?

In what situations do you use G-CSF for patients undergoing allogeneic HSCT to facilitate engraftment?

How does graft source, conditioning regimen, and indication for transplant affect your decision regarding G-CSF?

For AML patients, when do you stop antiinfective agents?

At the time of count recovery or do you continue it throughout induction and consolidation?

For a patient with May-Thurner syndrome and DVT, would you recommend anticoagulation for 3-6 months or indefinitely?

How would you approach treatment in a patient with Fanconi anemia and glioblastoma?

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?

NGS results are pending

What is your practice regarding giving G-CSF to patients with ALL during initial induction?

The patient was recently diagnosed with pre-B ALL and is on day 10 of CALGB 10403. He is expectedly neutropenic as he received daunorubicin and vincri...

How would you manage a young patient with HL who develops HF (EF < 30%) after 4 cycles of A+AVD who obtained a PET2 CR?

How do you manage mild Type 1 von Willebrand disease undergoing wisdom teeth removal?

Antifibrinolytic therapy alone +/- DDAVP?

What additional testing is recommended with heterozygous HFE C282Y mutation whose ferritin is elevated and transferrin saturation percentage is at baseline?

Ferritin >2200, TSAT >80%

What is your preferred formulation of parenteral iron?

There are various formulations of intravenous iron; each with varying costs, test dose requirement, elemental dose, and number or time of infusions ne...

Would you extend the duration of anticoagulation in patients with a provoked DVT, but evidence of residual clot at 3 months?

While follow up ultrasound is not usually recommended in provoked DVT, it often is done either for other reasons or by other physicians. Would this in...

For pediatric patients with localized diffuse large B-cell lymphoma being treated per COG ANHL 1131 in group B, do you feel it is necessary to complete all lumbar punctures with IT therapy?

How do you approach an ITP patient who responds very well to steroids but the response is short-lived?

How would you counsel the patient if he/she wants to continue on steroids?

Do you use FVIII levels to differentiate between DIC and coagulopathy of liver disease?

Common thought is that FVIII may be used for differentiating coagulopathy in liver disease (normal to increased, from reduced clearance of VWF/FVIII) ...

How do you approach anticoagulation in the setting of HIT and thrombocytopenia?

I.e. platelet count <30. Would your management change if HIT were only suspected rather than confirmed?

How would you treat a patient with Hodgkin lymphoma who has an isolated relapse within the CNS?

What are your top takeaways from ASH 2023?

7 Answers available

How would you treat a woman with iron deficiency anemia, unresponsive to iron sulfate, and with allergic reaction to iron sucrose?

Anemia is secondary to menorrhagia. No gynecologic interventions were possible.

Are there any possible scenarios where you would do phlebotomies for heterozygous hemochromatosis?

How soon after CAR T-cell therapy can salvage radiation be delivered?

What is your approach to cancer patients who inquire about alternative or complementary treatments?

8 Answers available

What is your approach to using medications that can cause bone marrow suppression in SLE patients who have persistent leukopenia?

Would you anticoagulate a patient with splenic infarctions in the setting of CMV viremia?

If so, for how long?

Which patients with relapsed/refractory NHL are appropriate for pre-CAR-T bridging radiation therapy?

How do you interpret a low VWF activity/antigen ratio, when both activity and antigen levels are above 50%?

E.g. Normal F8, VWF activity ~50%, VWF antigen ~100%, ratio 0.5 sent in a patient with positive bleeding history Is there any clinical significance t...

What is the ideal period to wait until curative surgery for patients with acute pulmonary embolism and solid malignancy?

Specifically, asymptomatic subsegmental PE diagnosed within a month from planned bilateral mastectomy for breast cancer.

What is the preferred treatment for a patient with an EBV+ monomorphic PTLD (DLBCL) not currently on immunosuppressive therapy?

How do you approach evaluation and management of arthralgia in a patient after CAR-T cell therapy?

What is the role of radiation therapy in recurrent Rosai-Dorfman disease after surgical resection, which manifests as many cutaneous lesions on the arms and buttocks?

Does the fact that the patient is on methotrexate alter your choice?

Do you recommend continued PCR testing in a CML patient who underwent allogeneic stem cell transplantation with an identical match about 20 years ago?

How do you approach the management of GVHD prophylaxis in the setting of severe infection?

How do you approach a persistently elevated mean platelet volume and immature platelet fraction in an otherwise healthy patient with a normal platelet count?

Provided that the platelet count is normal, do you usually consider this to be a potential erroneous result or do you pursue additional workup for RBC...

When should you use caplacizumab in the treatment of acute TTP patients?

Would you consider post-BMT maintenance therapy for patients with Ph-like ALL with a JAK2 mutation?

Is there a correlation between spleen size and degree of thrombocytopenia?

How would you adjust the steroid dose for steroid-induced psychosis in a patient being treated for secondary HLH with the HLH-94 protocol?

How would you approach microcytosis without anemia with high TSAT and ferritin?

How often do you see non transfusion-dependent thalassemia and how do you approach the treatment?

How is transferrin saturation a reliable indicator for any parameter if serum iron is not reliable?

Although TIBC is negative acute phase reactant, would it be a better indicator of iron deficiency (in combination with ferritin)?

What are common indications for ordering NGS of peripheral blood?

Would a negative NGS eliminate the possibility of MDS? Is bone marrow biopsy indicated in a patient with pancytopenia with a negative NGS panel?

Should testing for genetic causes of HLH be performed in all patients with MAS or secondary HLH regardless of the patient's age?

What is your practice for work up and treatment of incidental splenic infarcts with or without splenomegaly in patients without sickle cell disease?

For patients with microcytosis MCV 75-79 and normal Hb, low TIBC, and normal ferritin do you always rule out thalassemia?

What else would you consider in your differential?

5 Answers available

Based on recently published data from COG ANHL12P1, how will you use crizotinib in pediatric and AYA patients with ALK+ anaplastic large cell lymphoma?

How would the risk of VTE associated with crizotinib affect your decision? Should we consider using crizotinib in combination with brentuximab?

How do you approach very treatment-refractory ITP?

Such as the case in which a patient is unresponsive to steroids, IVIG, TPO-agonist, rituximab, splenectomy, and even fostamitinib.

How do you approach dosing of anakinra in MAS?

How do you manage severe cytarabine syndrome in AML patients, manifesting as severe hypotension, fevers, rash, and myalgias?

Do you re-challenge them? If so, what pre-medications do you give? Do you dose reduce the cytarabine? Or do you switch another regimen?

For patients with incidental findings of venous thromboembolism during workup of a treatable malignancy, how do you approach discontinuation after the treatment is complete?

Would you consider low dose indefinite anticoagulation in any scenario? Any difference in approach between hematological malignancy and solid tum...

In a young female with severe osteoporosis due to congenital estrogen deficiency, can estrogen be prescribed if genetic testing for congenital disorders reveals a heterozygous Factor V Leiden mutation?

No prior thrombosis; no family history of thrombosis. As per endocrine, the only useful therapy for the osteoporosis is estrogen.

How do you approach diagnosis and treatment of HLH/MAS following CAR T-cell therapy?

How is this entity distinct from other secondary HLH entities?

Do you routinely use G-CSF post-allogeneic transplant for non-haploidentical transplants?

What is your approach to treatment of infection-triggered HLH that does not respond to treatment of the underlying infection?

In the setting of secondary HLH associated with initial diagnosis of lymphoma, would you adjust steroid dose and type to account for differences in HLH and lymphoma treatment protocols?

When should I consider anticoagulation in an unprovoked upper extremity superficial venous thrombosis?

Would it change your management if the thrombus was symptomatic? Or if larger >3 cm?

Can Hodgkin-like PTLD be treated with Rituximab and weaning of immunosuppression, or is Hodgkin-directed chemotherapy necessary for cure?

What are the best labs to trend improvement in HLH?

Do you check asparaginase levels for all patients receiving receiving E. coli-derived products, or only in certain clinical situations?

How do you mitigate 6-MP-induced GI toxicity in pediatric and AYA patients with leukemia?

What is your approach to further work-up and management of neutropenia in patients with SLE/RA overlap?

For example, a patient with a bone marrow biopsy that shows normocellular bone marrow. Prior management with leflunomide and HCQ with neutropenia attr...

What is your approach to treating a young adult with severe aplastic anemia unresponsive to steroids and TPO-mimetics?

What would your next line therapy be? If the patient had no matched related or unrelated donors, would you consider haploidentical transplant?

Would you use a matched sibling donor with a germline heterozygous BRCA1 mutation for stem cell transplant?

Presuming there are no matched unrelated donors.

In a patient hospitalized for several days with a refractory pain crisis would you ever consider transfusion, either simple or possibly exchange in an attempt to get the patient over the crisis?

Do you recommend hydroxyurea in patients with sickle cell disease with hereditary persistence of fetal hemoglobin who have recurrent vaso-occlusive crises requiring hospital admission?

If hydroxyurea modifies the course of sickle cell disease by increasing fetal hemoglobin, is there any benefit to using it in patients with fetal hemo...

When do you refer AYA patients with newly diagnosed severe aplastic anemia for transplant?

Would you give a trial of IST first or immediately refer for SCT if the patient has matched siblings?

Would you use PCC for clotting factor repletion in acute life threatening hemorrhage in a patient with elevated INR from coagulopathy of liver disease?

For T cell ALL treated in CR (without transplant), how often do you do BM biopsies as part of surveillance, and for how long?

What would you want community oncologists to know when following these patients? Are there any other special issues to follow especially in AYA?

How do you approach a patient with chronic low ADAMTS13 activity and low level of inhibitor without signs of thrombocytopenia or hemolysis?

ADAMTS13 level <5% Inhibitor level <1

How do you explain TTP to patients?

When patients develop headaches from luspatercept, do they tend to improve over time?

How can oncologists be more collaborative with palliative care physicians?

How can these interactions be improved?

Would you consider TPO mimetics for chemotherapy induced thrombocytopenia that persists despite dose reductions?

Do you repeat images in patients with venous thrombosis to inform decision about duration of anticoagulation?

E.g. pulmonary embolism, portal vein thrombosis, cerebral venous sinus thrombosis

Do you recommend starting an antiplatelet for primary prophylaxis in post splenectomy thrombocytosis given there is some increased risk of venous thrombosis?

If so, what platelet count threshold would you use? Would age impact your decision? Would you do a bone marrow to rule out primary MPD in adults if th...

What is the optimal age at which a patient with sickle cell disease should undergo allogeneic stem cell transplant?

What is your ferritin threshold to prescribe iron to female adolescent athletes who have symptomatic iron deficiency without anemia?

What is the ideal approach for female adolescent athletes if they have complaints of fatigue and dizziness and are diagnosed with mild iron deficiency...

Would you recommend adding a TKI to a pediatric regimen for a AYA B-ALL patient with IKZF1 mutation?

How do you perform fertility counseling for a patient with a duplication of one of the alpha genes and their partner who has a beta chain point mutation?

That is, extra copy of one of the alpha genes resulting in an atypical alpha thalassemia for the patient, and beta thalassemia heterozygous carrier fo...

What precautions do you take prior to CABG in a patient with sickle cell trait?

Please comment on temperature recommendations and role of exchange transfusion.

In sickle cell patients with continued pain crises despite hydroxyurea, how do we sequence the use of newer agents?

While L-glutamine has minimal side effects and would likely be added after hydrea, how do you decide between the use of voxelotor and crizanlizumab?

How do you approach low to moderate titer of APLS when working up unprovoked DVT if it is persistent on repeat testing?

Would you consider using DOACs in a young patient with SLE and Libman-Sacks endocarditis, who is negative for APS?

Do you switch from imatinib to another TKI in patients with chronic phase CML who develop renal insufficiency?

There are conflicting reports whether it contributes to renal insufficiency. If you do switch, what is your preferred TKI in this scenario?

Do you screen for VWD in all women with menorrhagia severe enough to cause iron deficiency anemia?

How should elevated PT of unclear etiology and significance be evaluated?

In the absence of concerning bleeding or thrombosis, family history of coagulopathy, current anticoagulant use, or malnutrition

Do you typically see peripheral neuropathy in patients with castleman syndrome?

How would you approach a low to moderate titer of one of the APLS antibodies in a patient with a strong family history but no personal history of thrombosis?

Although testing was not indicated, what do u do with these results? Other hypercoagulability work up negative

What are your top takeaways from ASH 2022?

8 Answers available

Is rituximab for refractory ITP contraindicated in the setting of an active COVID infection, particularly in a patient with asymptomatic COVID?

Would you discontinue anticoagulation in patients with antiphospholipid antibody syndrome, who have a remote history of thrombotic events and are now negative for pathogenic antiphospholipid antibodies?

Would the answer differ if the index event was arterial vs venous?

How do you advise patients with sickle cell disease on contraception?

Do you advise against combination OCPs?

Do you do prophylactic LP/IT chemotherapy in high risk APML prior to starting consolidation?

How would you approach management of bleeding risk and factor VIII replacement in a patient with severe hemophilia A undergoing stem cell transplant?

What is your perioperative approach for a patient with severe hemophilia?

What type, dosage, and duration of treatment do you use? How does your practice change when there is an inhibitor?

How would you work up a mildly neutropenic patient (ANC >800) with family history of neutropenia and personal history of occasional mouth sore?

What are indications to order gene mutation studies (e.g. ELANE) and how would it help the patient?

How do you manage prophylactic antimicrobial medications in patients who undergo ATG/cyclosporine/eltrombopag induction for severe aplastic anemia?

What would you recommend within the first year after ATG and thereafter if still maintained on cyclosporine?

What is your approach to BK hemorrhagic cystitis not responding to cidofovir?

Which patients with acute promyelocytic leukemia do you consider maintenance after completing consolidation?

How do you work up a young patient with increasing ferritin and normal TSAT without infectious, inflammatory, or liver disorders?

Ferritin uptrending >1000, no additional lab abnormalities. HFE wildtype. Too young for age-appropriate cancer screening. Asymptomatic except fatig...

In a patient with Type I von Willebrand disease with history of VTE and heavy menses, would tranexamic acid be a treatment option?

Is thrombotic risk too significant? Patient failed OCPs.

Do you stop hydroxyurea or switch to an alternative therapy in a male patient with controlled Hb SC disease who is interested in having children?

What is the treatment of choice for mixed phenotype ALL?

What are the differences in approach to B lymphoid/myeloid and T lymphoid/myeloid MPAL?

At what ferritin threshold would a patient with anemia of inflammation or malignancy no longer benefit from iron supplementation for functional iron deficiency?

For example, if TSAT is less than 20% but ferritin is over 200.

Do you recommend continuous antibiotic prophylaxis for patients on complement inhibitors such as eculizumab?

Do you just use antibiotic prophylaxis if therapy is started prior to meningococcal vaccination?

Should post-transplant cyclophosphamide be utilized for all matched unrelated donor peripheral blood stem cell transplants for hematologic malignancy?

If not, how do you choose GVHD prophylaxis regimen? Is there a preference?

Based on recent data would you consider adding ATRA to low dose rituximab for steroid refractory ITP?

Wu et al., PMID 34665865

How would you approach cytopenias 5 weeks after initial dosing in a young patient with MDS treated with Azacitadine as a bridge to transplant?

E.g. would you dose-reduce or continue at same dose? Baseline ANC was in the normal range

Is there a role for IL2-receptor antagonists and TNF-alpha inhibitors in cytokine release syndrome as a complication of CAR-T or immunotherapy?

When do you stop trying to eradicate an acquired factor VIII inhibitor?

Patient with high titer acquired FVIII inhibitor with no causative etiology. Bleeding is well-controlled on emicizumab, but inhibitor has failed...

What recommendations do you have for a transgender female patient with history of prothrombin gene mutation who is interested in starting gender affirming hormone therapy?

The patient has no personal history of VTE, but has positive family history of VTE. Any prophylactic anticoagulation options? How would manage...

Do you hold IV iron in the setting of active infection?

Do you routinely send NGS testing from bone marrow samples in patients with unexplained cytopenia or cytoses?

For instance, if clonal hematopoiesis of indeterminate potential (CHIP) suspected

How would you approach an early stage II unfavorable Hodgkins lymphoma following 6 cycles ABVD with persistent Deauville 5 with negative biopsy?

iPET2 and iPET4 showed Deauville 5 response. CT biopsy after 4 cycles was negative. Patient is currently scheduled for 2 additional cycles of ABVD.

In patients with severe hemophilia A on emicizumab for prophylaxis, in case of noncompliance leading to a lapse of more than 2-3 months off therapy, do you reload with emicizumab?

When using daratumumab in the setting of post-transplant red cell aplasia or post-transplant immune-mediated cytopenias, do you hold the drug for certain ANC parameters?

In patients who develop a VTE, what conditions do you consider as persistent, provoking risk factors, and at what point are they controlled enough to stop anticoagulation?

I.e., what constitutes well-controlled cancer, IBD, nephrotic syndrome, etc. What other diseases do you put in this category (obesity, autoimmune dise...

What are your recommendations for a male patient who was recently started on imatinib and wants to conceive?

How soon do you anticipate response to cyclosporine in red cell aplasia and what cyclosporine trough levels do you target?

How would you work up and manage persistent lymphopenia in an asymptomatic patient?

ALC<200

Do you consider travel as a risk factor for DVTs in the absence of any other underlying predisposing factors?

i.e. long car rides or plane rides

What is the benefit of cytoreduction with Hydroxyurea for patients with newly diagnosed chronic phase CML with a WBC count >100 prior to the initiation of a TKI?

Do you offer iron supplementation to a non-anemic adolescent athlete with a low ferritin?

Is an elevated CRP an expected finding in an otherwise healthy patient with hemoglobin S - alpha thalassemia?

CRP 39 mg/L (normal < 10) and normal ESR

What is your first line of therapy for refractory Hodgkin lymphoma in an AYA patient?

Which, if any, young/fit intermediate-risk AML patients would you not offer allogeneic transplant to in MRD- CR1?

Does normal methylmalonic acid levels absolutely rule out vitamin B12 deficiency?

How do you define bulky disease for Hodgkin's lymphoma which is outside the mediastinum?

Do you use a cutoff of 10 cm? Do you measure the size of the largest node or measure the largest conglomerate or measure the total length of the entir...

In a patient with sickle cell disease on hydroxyurea who is planning to have a family, for how long should they be off the drug before trying to conceive?

How do you manage a patient with a history of high-risk leukemia who has increasing loss of donor chimerism in the post-transplant setting in the absence of disease relapse?

How does graft function play into your decision making? How do you utilize post allogeneic transplant chimerism in clinical practice? Do you obta...

What criteria is needed in relapsed/refractory B-cell ALL to choose CAR-T therapy over conventional stem cell transplant as destination therapy?

At what platelet count would you feel comfortable dosing aspirin 81 mg for coronary artery disease in a patient with ITP?

Presuming strong indication for ASA - eg history of NSTEMI

How do you counsel patients with elevated factor VIII levels for their thrombosis risk?

Should we stop checking factor VIII levels as part of thrombosis workup?

How do you interpret elevations in antiphospholipid antibodies that are lower than Sapporo criteria?

(e.g. beta 2 glycoprotein IgM > 20 but <40)

How has the virtual aspect of tumor boards impacted their educational quality in the Covid-19 era?

Is there any benefit to transplant patients with Ph+ ALL who have achieved MRD-negativity?

Would you give antithrombin concentrate for surgical VTE prophylaxis in case of congenital AT deficiency?

What is your approach to pediatric or AYA patients with B-cell ALL who relapse after CD-19 CAR-T?

How do you manage patients who develop minor antigen antibodies and require multiple blood transfusions?

e.g. K, Fya, s, etc

How do you manage a patient with sickle cell disease during pregnancy?

How do you manage real-time release of pathology and radiology results to oncology patients following enaction of the CURES act?

How do you approach IVIG replacement for pediatric patients with low IgG during treatment for hematologic malignancies?

Do you routinely check IgG levels during therapy, if not indicated by a study protocol?

Do you routinely offer antiviral prophylaxis for patients receiving chemoimmunotherapy?

If so, what regimen do you utilize?

Would you anticoagulate recurrent venous thromboembolism in a patient with Ehlers Danlos syndrome?

How would the approach differ if the patient had a significant bleeding phenotype vs only minor bruising and mucosal bleeding?

Do you recommend the use of dexamethasone and anakinra as upfront treatment in a pediatric patient with secondary HLH (nonrheumatic) who is too ill to tolerate etoposide?

This type of etoposide sparing therapy has been previously described in a case series at https://pubmed.ncbi.nlm.nih.gov/32725881/

Would you retry rituximab in steroid refractory warm autoimmune hemolytic anemia which responded to rituximab before?

Last rituximab 6 months ago

Would you check vitamin B6 routinely in the work up of anemia?

Are there best practices or data regarding the use of open notes among oncology patients?

What is the impact among patients and providers? Has your documentation been adjusted now that patients can readily review?

How do you approach heparin management in patients who have suprathetherapeutic Xa levels on minimal heparin?

Do you repeat antiphospholipid antibody testing in a patient that previously met criteria for APLS?

If so, how long after diagnosis do you do so?

Does R-CHOP provide durable remission in low-risk pediatric Burkitt or Burkitt-like lymphoma?

How do you interpret a Deauville score of 3 on PET when performing mid-treatment assessments in patients with Hodgkin lymphoma?

Are there situations in which a Deauville 3 would cause you to escalate therapy?

When do you consider plasma exchange for multiorgan failure in a patient with sickle cell disease?

Do you recommend routine use of Evusheld for pre-exposure prophylaxis for patients on immunosuppression?

Does treatment with B-cell depletion and/or negative anti-spike antibody status despite COVID mRNA vaccination influence your decision?

Are there any situations you would recommend prophylactic anticoagulation for a patient with Factor V heterozygosity?

FVL heterozygotes are often treated similarly to the general population. Aside from avoiding other VTE risk factors, are there situations where prophy...

When would you consider an umbilical cord blood transplant over a haploidentical transplant with post-transplant cyclophosphamide, or using a desensitization protocol for high donor-specific antibodies?

In which platelet function disorders would you consider use of Novoseven as opposed to platelet transfusion?

Are there particular clinical scenarios that would affect your decision?

Should we recommend the COVID-19 booster vaccine to patients who had a DVT or any other complications such as hemolytic anemia or thrombocytopenia from prior vaccine doses?

In a patient with a heterozygous prothrombin gene mutation who has COVID with minimal symptoms, do you recommend prophylactic and/or therapeutic anticoagulation?

How do you manage drug-induced thrombocytopenia when the implicated drug is essential?

e.g. DITP from eptifibatide after a cardiac intervention

For treatment of ITP, what would you add to dexamethasone to achieve the fastest recovery in a patient waiting for a procedure?

IVIG, TPO, or other agents?

When would you consider stopping chronic transfusion therapy in a sickle cell patient with history of abnormal TCDs but no stroke?

How do you approach relapsed idiopathic HLH?

How will you use Pola-R-CHP in the frontline treatment of DLBCL?

Given the POLARIX study data presented at ASH 2021, will this replace R-CHOP as the standard of care therapy in your practice? If not, how will y...

What are contraindications for growth factors in patients with hematologic malignancies?

Do you routinely check platelet counts after COVID-19 vaccines in patients with chronic ITP?

How do you counsel male-to-female transgender patients on the VTE risk of hormonal therapy?

How do you manage a patient with superficial venous thrombosis with close proximity (<3 cm) to deep veins and an inherited thrombophilia ?

Would you offer indefinite anticoagulation if the event is unprovoked and the patient has low bleeding risk?

Is there experience/reports of using voxelotor in sickle cell patients who are Jehovah Witnesses with few crises but who have fatigue and/or dyspnea?

Also is there value in using voxelotor for the purpose of reducing hemolysis, and if so what parameters do you use to determine when to initiate voxel...

Is there a role for radiation therapy in the treatment of a lymphoproliferative disorder involving the orbit?

If so, what dose and fractionation would you recommend?

What is the typical time course of cytopenias after CAR-T therapy, and how do you treat them?

What is your preferred approach for patients with anti-phospholipid syndrome with recurrent thrombosis on coumadin and LMWH?

How would you approach moderate neutropenia (ANC < 1000) in a solid organ transplant recipient?

Is there a particular sequence you would adjust contributing antirejection or antimicrobial medications? Is the use of G-CSF appropriate and at what c...

What is your escalation strategy for chronic GvHD?

How does belumosudil now fit in your approach to steroid refractory chronic graft-versus-host disease?

What is the role of hydroxyurea in variant sickle cell genotypes?

Hydroxyurea is demonstrated to reduce complications and improve long-term outcomes in severe genotypes HbSS and sickle beta0 thalassemia. What clinica...

How do you diagnose sickle hepatopathy?

In what circumstances would you give G-CSF to a patient with severe neutropenia and HLH?

How do you approach conversations regarding discontinuation of transfusions in patients with advanced hematologic malignancies who are otherwise appropriate for hospice?

Are there other supportive care interventions that would otherwise be covered by hospice?

What is your approach to a patient with positive antiphospholipid antibodies who otherwise do not meet clinical criteria for APS?

What if the patient is triple-positive or has continued seropositivity on repeat lab testing? What is the appropriate interval of monitoring and does ...

Do you utilize D-dimer to inform anticoagulation duration in the treatment of VTE?

Provoked or unprovoked VTE: Do you use D-Dimer (or even repeat imaging to reassess residual clot) in any capacity to guide anticoagulation duration? E...

When is a lumbar puncture indicated in a lymphoma staging work up for a pediatric or AYA patient?

Is an LP only recommended in the setting of particular subtypes of lymphoma or symptoms of CNS disease?

How would you manage VTE in a patient with bleeding disorder such as hemophilia?

Have you used anticoagulants other than coumadin? Or is that the only appropriate agent given monitoring is based on PT/INR?

What regimen would you offer a young patient with T-cell ALL who recurred a short time after allo-transplant and was initially treated with CALGB10403?

Especially with the current drug shortage of nelarabine.

Would you start TKI therapy in a patient with new diagnosis of T-ALL without BCR-ABL gene rearrangement on FISH but found to have very low level p190 transcript on RT-PCR?

How do you approach management of sickle cell patients who mistrust Western medicine and prefer naturopathic therapies?

While building a trusting patient-physician relationship, what therapies could be discussed that may be aligned with naturopathic medicine? (i.e. L-gl...

What is the maximum pRBC volume you can transfuse when performing a manual exchange transfusion in an adult-sized patient with sickle cell disease?

How do you approach treatment of vasculitis in a sickle cell disease patient?

There are multiple difficulties that could be seen: steroids can precipitate a sickle cell crisis, vasculitis and sickle cell can produce similar clin...

Do you use premedications (acetaminophen, diphenhydramine) before pRBC and plt transfusions to prevent febrile nonhemolytic transfusion reactions and allergic reactions?

Does manipulation of blood products (leukoreduction, irradiated) affect your approach? There is growing evidence that routine premedication (at least ...

Under what circumstances would you consider anticoagulation in a young female patient with persistently elevated factor XI activity?

While this is a known risk factor for venous [Meijers et al NEJM 2000] and potentially arterial [Yang et al, Am J Clin Pathol 2006] thrombosis, it is ...

Are there any special considerations when evaluating patients with non-malignant hematologic or immunodeficiency disorders for allogeneic transplant?

Are there major differences in standard conditioning and/or GVHD prophylaxis regimens utilized? Does the non-relapse mortality different significantl...

How would you optimally manage a patient with a MDS/MPN overlap syndrome who has both transfusion-dependent anemia and marked thrombocytosis?

Would this change with someone who has a history of thrombosis (e.g. DVT/PE, MI, CVA)? Would this change with someone who is more fit vs more frail?

Should assessing for a MTHFR mutation be part of the thrombophilia evaluation in a patient presenting with a thrombus?

How would you approach immunosuppression for patients with severe aplastic anemia who are not transplant or ATG candidates?

Such as patients who are frail, elderly, renally impaired? Would you consider sirolimus over cyclosporine or tacrolimus for safer nephrotoxicity prof...

How long do you continue caplacizumab in relapsed refractory TTP?

How often do you monitor ADAMTS-13 levels off therapy?

Are there any reasons to consider a prolonged course of steroids with taper over a shorter course of pulsed steroids in the treatment of ITP?

For example, do we prefer one regimen over the other in patients with a bleeding history or who have relapsed after a lengthy remission?

What strategies have you found to be most effective in engaging PCPs in a primary-care or shared-care model of survivorship for pediatric and AYA patients who will receive ongoing care in their communities away from their primary oncology treatment site?

In follow up to @Jacqueline Casillas presentation at ASCO 2021 regarding models of survivorship care delivery for AYA patients.

With new data showing similar outcomes of mismatched unrelated donor and haploidentical related donor allogeneic transplants using post transplant cyclophosphamide, how does one decide which donor is optimal?

If given both options, which donor would one prefer: haploidentical related donor or 7/8 mismatched unrelated donor using post transplant cyclophospha...

Would you consider bone marrow transplant in a pediatric patient with recurrent HLH with no identified exogenous trigger or HLH-associated mutation?

How would you approach chronic isolated severe non-cyclic neutropenia with negative bone marrow and rheumatologic work-up?

Is there a role for empiric antibiotics if there is history of opportunistic infection?

What further genetic testing would you perform on a pediatric patient with cyclic neutropenia who is negative for the most common associated mutations?

With a strong family history

In patients with autoimmune cytopenias, is there any reservation for COVID vaccination?

While benefits outweigh known harms and limited data, do you worry about vaccination in patients with a history of or active autoimmune cytopenias (e....

How do you approach the use of low-dose aspirin for primary prevention in non-pregnant patients with SLE and positive aPL antibodies, without clinical criteria for APS?

Do you follow the 2019 EULAR Guidelines that SLE patients with asymptomatic, positive aPL should be on low-dose ASA?

How would you evaluate a patient with an isolated high RBC count but with a normal hemoglobin and hematocrit?

Would you consider this type of patient as having polycythemia?

When would you consider upfront eculizumab for sickle cell hyperhemolysis?

How long after eculizumab infusion would you wait before giving blood transfusions?

When (if ever) do you check for anti-platelet antibodies for workup of thrombocytopenia?

Do you offer iron supplementation to a patient with iron studies that are normal (including normal ferritin) except for low iron saturation?

What is the potential differential diagnoses for low iron saturation?

What additional testing, if any, should be performed for an adolescent patient with heavy menstrual bleeding and a negative von Willebrand disease evaluation?

When can defibrotide be discontinued before the 21-day treatment course is completed in a pediatric patient with SOS?

Do you always treat with the full 21-day treatment course, or can defibrotide be stopped if certain criteria are met sooner?

How do you choose your systemic treatment for primary mediastinal grey zone lymphomas?

Do you prefer a cHL chemotherapy backbone or PMBL chemotherapy backbone?

What workup do you perform to evaluate for underlying triggers/associated conditions in a pediatric patient with autoimmune hemolytic anemia?

Should patients receive thrombophilia testing in the setting of a provoked VTE secondary to hormonal therapy/OCPs?

While thrombophilia testing is not routinely recommended prior to starting OCPs, how about after the development of a VTE?

How would you manage a patient with antiphospholipid syndrome in the setting of severe steroid-refractory thrombocytopenia?

Especially in a triple-positive patient with an acute ischemic stroke who may have urgency for anticoagulation with high bleeding risk and severe thro...

How do you treat refractory cold agglutinin disease?

The patient who has not responded to steroids, rituximab/bendamustine, and splenectomy?

How can healthcare providers better serve as allies of the sickle cell community?

Has your medical practice taken any steps either in community outreach or within the clinic to show support for this medically vulnerable population, ...

When would you recommend using a DOAC in a pediatric patient with VTE?

What are the current official guidelines regarding COVID-19 vaccination for patients with cancer or for hematologic conditions?

Is a patient with secondary myeloid sarcoma a candidate for hematopoietic stem cell transplant?

How would you time COVID-19 vaccination with someone on R-CHOP chemotherapy?

How would you approach the treatment of patients with von Willebrand disease or hemophilia A previously managed with intranasal DDAVP during the recall?

During the Stimate recall, how are we performing DDAVP challenges for newly diagnosed hemophilia A or von Willebrand disease?

What is your preferred oral iron formulation and dosing for treatment of iron deficiency anemia?

Are most places administering oral iron as once daily or every other day dosing due to upregulation of hepicidin receptors following oral iron adminis...

How many years of oral antibiotics prophylaxis do you recommend for a teenager with hereditary spherocytosis post-splenectomy?

There is no uniform guideline in the literature. AAP recommends until 5 years old or 1-year post-splenectomy. Some for 5 years post-splectomy.

Is there a role for G-CSF treatment for SLE patients with persistent neutropenia?

How do you counsel patients who are candidates for a clinical trial regarding their options?

Specifically, are there strategies you use to 1) empower patients to participate in decision-making and 2) reassure patients who may be skeptical?

In which patients with atypical HUS would you consider eculizumab discontinuation?

Given the high cost of eculizumab, are there patient characteristics that inform which patients, if any, should be on indefinite therapy versus a time...

How do you manage a delayed hemolytic transfusion reaction in a patient with sickle cell disease?

How do you manage an uncomplicated DHTFR versus a hyperhemolysis?

What is your threshold for pursuing bone marrow biopsy in a lupus patient with cytopenias?

What is the target ferritin level for patients with hereditary hemochromatosis and signs of end-organ damage?

For example, a patient with hypogonadism unless it matters which organ is involved. Are other markers of iron storage useful in guiding therapy?

How do you approach anticoagulation in patients with catastrophic antiphospholipid syndrome and thrombocytopenia?

When would you consider splenectomy or other immunosuppressive/cytotoxic therapy for steroid-refractory warm autoimmune hemolytic anemia?

For example, in a patient who is steroid-refractory, requiring regular transfusion, and has not had response to rituximab after several weeks.

What are your thoughts on adding mycophenolate to steroids in the first line treatment of ITP based on the results of the FLIGHT trial?

Presented at ASH: FLIGHT trial

For which rituximab infusion reaction symptoms do you consider it safe to re-challenge in the office with adjusted rates and pre-medications?

What are your indications for pursuing a rheumatologic workup in a pediatric patient with ITP?

If so, what additional testing do you send?

When would you perform a thrombophilia workup in a pediatric patient presenting with VTE?

Is there a role for anti-neutrophil antibody testing in the workup of neutropenia?

If autoimmune neutropenia already suspected, is this test informative or unnecessary?

Do hemoglobin S levels always correlate with SCD phenotype?

What is the lowest level you have seen with uncomplicated or complicated crises?

How do you manage VTE in the setting of persistent severe thrombocytopenia?

Is there a preferred strategy of transfusional support versus reduced-dose anticoagulation during the duration of thrombocytopenia?

Is there any role for direct oral anticoagulants in the treatment of antiphospholipid syndrome?

What if this was "triple-negative" antiphospholipid syndrome?

Would you start a patient with sickle cell disease and COVID-19 on prophylactic anticoagulation?

When would you consider transplant for a patient with a bone marrow failure syndrome (FA, DC, etc.)?

How would you treat a young patient with symptomatic Rosai-Dorfman disease who has recurrent, life-threatening pericardial and pleural effusions?

CT scans show omental and pelvic disease.

How would you approach treatment in an otherwise young, fit patient with transformed AML currently in remission with a plan for transplant and was found to have an invasive fungal infection not amenable to resection upon recovery from induction?

Would you consider “bridging” therapy with something like an HMA?

Do you recommend that children with sickle cell disease refrain from returning to school during the COVID-19 pandemic?

During induction therapy for acute leukemia, when do you decide to discontinue the antimicrobial prophylaxis?

Is it at neutrophil recovery, at documentation of CR on bone marrow biopsy, or is there a different point in time?

What are the options of induction treatment of young AML patients who are on CRRT, continuous renal replacement therapy ?

How would you manage a patient with severe aplastic anemia and a large PNH clone?

For pre-menopausal female patients who present with acute leukemia in need of urgent anti-neoplastic therapy, what is your preferred approach in effort to preserve fertility?

Does acute leukemia sub-type affect your decision?

How would you evaluate a pediatric patient referred to rule out cancer due to an isolated significantly elevated vitamin B12 level?

Assuming CBC w/ different and complete metabolic panel are within normal limits, what (if any) further evaluation or management is needed?

When during ALL induction therapy are you checking for MRD?

Would you recommend prophylactic cranial irradiation (PCI) for a teenager with a T cell acute lymphoblastic leukemia in remission?

If so, what dose would you recommend?

How do you determine whether to treat a young adult with stage IA Hodgkin Lymphoma with the adult or pediatric treatment paradigm?

At what age would you treat an early stage hodgkins lymphoma patient with ABVD + RT (adult treatment) vs OEPA x 2 or AV-PC x 3 (pediatric paradigm)?&n...

Would you stop current immunosuppressive therapy or delay starting immunosuppressive therapy in a patient with aplastic anemia who has been infected with COVID-19?

Would you recommend anticoagulation prophylaxis for a pediatric patient admitted with COVID-19?

Are patients with bleeding disorders receiving plasma-derived products at increased risk of acquiring COVID-19?

Should patients with bleeding disorders increase their home supplies of clotting factors foreseeing a possible shortage of product availability due to COVID-19?

How would you manage a patient with sickle cell disease who is infected with COVID-19?

Do you have preferred regimens for young patients (<30 y/o) with early stage DLBCL?

Guidelines indicate RCHOPx3 +RT as category I and RCHOP x 6 below that; long term f/u for SWOG 8736 showed similar PFS and OS. Do you have and approac...

When would you consider treating a testicular relapse with definitive radiation in a child with ALL?

What is the risk of breast cancer that you quote to young women with early stage Hodgkin's lymphoma receiving involved field/site radiation therapy?

We often see young women with favorable, early stage disease in the mediastinum who have had a complete response to chemotherapy. With current smaller...

When would you consider testicular RT prior to TBI for BMT?

What dose do you recommend?

How would you treat a pediatric patient with Stage IVB Hodkin lymphoma who still has persistent PET+ disease after dose-escalated chemotherapy?

After ABVE-PC X4 and Ifos/vinorelbine x 2 per AHOD 0831 (and is unable to have these sites biopsied), what dose would you treat to and what volume wou...

Do you omit consolidative RT in pediatric patients with intermediate risk, non-bulky Hodgkin lymphoma who have a rapid early response to chemotherapy?

Are the results of AHOD0031 practice changing?

Is it acceptable to treat pediatric Hodgkin's lymphoma with an involved nodal field outside the setting of a clinical trial?

Is it preferable to simulate pediatric Hodgkin's lymphoma patients with arms up or akimbo?

It seems that with the arms up, you get better lung blocking but with arms akimbo, you might have a lower dose to the humeral head.