Hematology&nbsp;&nbsp;&nbsp;

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...

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

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?

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...

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?

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?

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/

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

4 Answers available

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

Last rituximab 6 months ago

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

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?

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?

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.

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?

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

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?

4 Answers available

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?

How do you approach transfusing a patient with sickle cell disease who has a history of hyperhemolysis?

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?

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?

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?

4 Answers available

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...

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?

Do you offer iron supplementation to a non-anemic adolescent athlete with a ferritin < 40 ng/mL?

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?

0 Answers available

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?

0 Answers available

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.