DR JOHL: A supportive care question about what cutoffs do you use for a nonbleeding patient in terms of transfusion of platelets and red cells to decrease utilization of blood products for leukemia patients. So I typically in my practice don’t transfuse platelets unless less than 10,000 or transfuse red cells unless less than hemoglobin of 7, although I’ve seen institutions where they go as low as 7,000 platelets or 5,000. Blood product utilization is a big deal.

DR CORTES: Yes. I think that there’s a number of factors. And I think that our guidelines are very similar to yours. You have to individualize, of course. If there’s a patient that’s having some sort of bleeding already, you have to transfuse no matter what. If the patients are having symptoms that are clearly from anemia, hemoglobins of 8.5 or something like that, you have to transfuse. Or older patients, you probably need to keep them a little higher than 7 versus a 30-year-old who probably tolerates that better.

So you have to individualize, so more than cutoffs or guidelines, because you always have to put it in the context of the patient. But we certainly have to be very cognizant of the fact that these resources are not unlimited and you need to manage them well.

And the other thing is that, for example, for thrombocytopenic patients, it is very different. If my platelets go down to 50 tomorrow, I’ll probably have some nosebleed or something like that. But if you’ve been living on a platelet count of 10 or 15 for a long time like these patients have, they don’t bleed as much. I mean, there’s adaptation of other elements of the bleeding cascade and the coagulation factors and the vascular factors, et cetera. So, I mean, you have to put all these terms into consideration.

But there’s no question that the thresholds that we had before that were pretty high are not necessary. You can be much lower, perhaps very close to what you do, which is similar to what we do.

Module 1: Current and future approaches to targeted therapy for acute myeloid leukemia (AML)

Module 2: Other clinical issues in AML management

Module 3: Case discussions