HemeTalks: Conversations in Hematology Education

Dr. Cece Calhoun (Yale School of Medicine) joins Heme Talks to discuss one of the most vulnerable moments in sickle cell care: the transition from pediatric to adult management. Using a real case of a 24-year-old with hemoglobin SC disease re-establishing care after a lapse, Dr. Calhoun walks through how to build trust with adolescent and young adult patients, why sickle cell disease is a systemic vascular and inflammatory condition rather than "just pain," and how to explain complex pathophysiology in patient-friendly language. The conversation covers essential screening guidelines for new adult patients, strategies for community providers managing sickle cell without specialist access, the evolving role of hydroxyurea (including the PIVOT trial in hemoglobin SC disease), and a practical, patient-centered approach to outpatient pain management.Clinical Pearls:The first visit is about trust, not just data.  Understanding a patient's life context, not just their labs is foundational, especially for AYA patients re-entering care after a gap; overwhelming a new patient with testing can undermine that trust. Sickle cell disease is systemic, not just a localized vaso-occlusive crisis. Even "milder" genotypes like hemoglobin SC cause damage through chronic inflammation, hemolysis, and vascular interaction. The historical framing of SC as mild disease is outdated, and end-organ damage can appear early in young adults. Structured screening and collaboration close care gaps. New adult patients need a full baseline workup (CBC/retic, electrophoresis, renal and liver labs, brain MRI, ophthalmology referral), and providers without sickle cell specialization should identify a partner institution and use published NHLBI/ASH guidelines rather than navigating complex cases alone. Hydroxyurea remains foundational, even without perfect evidence in SC disease. It's the only FDA-approved therapy shown to prolong survival in sickle cell disease; while the PIVOT trial's data in hemoglobin SC disease is still limited, empiric use is reasonable in symptomatic patients showing signs of pain or end-organ damage. For additional ASH resources related to Sickle Cell Disease, please consider visiting our ASH Clinical Practice Guidelines on Sickle Cell Disease web page.This podcast episode is supported by Sanofi.

Immune thrombocytopenic purpura (ITP) is a diagnosis of exclusion but treating it is anything but straightforward. In this episode, Dr. Adam Cuker (University of Pennsylvania) joins us to break down how the management of ITP is evolving in real time, from diagnostic pitfalls to a preview of the newly released ASH ITP guidelines. We cover first-line corticosteroid strategies, when to add IVIG, how to choose between the many other available options in the second line and later settings. A world-expert in ITP management, Dr. Cuker shares many important clinical pearls and management strategies to help our listeners care for their patients with ITP.  Clinical Pearls:1. ITP remains a diagnosis of exclusion with no confirmatory gold-standard test; diagnostic confidence is ultimately established by a robust platelet response to ITP-directed therapy (steroids, IVIG). Roughly two-thirds to three-quarters of adults with primary ITP will follow a chronic course, which should inform prognostic counseling at diagnosis. 2. Frontline management is evolving away from steroid monotherapy. While corticosteroids (prednisone or high-dose dexamethasone) remain the backbone, forthcoming ASH guideline updates support pairing steroids with a thrombopoietin receptor agonist (TPO-RA) or rituximab upfront rather than delaying combination therapy, given emerging evidence this approach may reduce steroid exposure and improve long-term disease course. 3. In the second-line setting, TPO-RAs (eltrombopag, avatrombopag, romiplostim) are generally favored over rituximab given higher overall response rates, though rituximab may be preferable in patients with high thrombotic risk, those averse to chronic medication, or young women with ITP of less than one year's duration, who show higher observed response rates. TPO-RA switching is well supported (i.e., failure of one agent does not preclude response to another). 4. Third-line options (fostamatinib, mycophenylate mofetil, rilzabrutinib), often combined with a TPO-RA to hit multiple mechanisms, are reserved for refractory disease; splenectomy is now reserved for highly refractory patients, those failing hospital-based salvage therapy, or patients with a strong preference to avoid chronic medication. For additional ASH resources related to ITP, please consider visiting our ASH Clinical Practice Guidelines on Immune Thrombocytopenia web page.This podcast episode is supported by AutoLus.

In this episode of HemeTalks, we dive into the evolving landscape of B-cell acute lymphoblastic leukemia (B-ALL) management with Dr. Adam DuVall. We begin with newly diagnosed disease, discussing which patients qualify for asparaginase containing pediatric inspired induction regimens. We then shift to the relapsed/refractory setting, exploring the roles of blinatumomab and inotuzumab ozogamicin as off-the-shelf therapies. Finally, we take a deep dive into CAR T cell therapy — comparing the three approved products, their costimulatory domains, toxicity profiles, and the growing evidence supporting CAR T as a destination therapy for a meaningful subset of patients. This episode offers practical, up-to-date guidance for clinicians caring for patients with B-ALL at every stage of disease. Clinical Pearls:1. Asparaginase containing regimens are preferred induction for AYA patients with newly diagnosed B-ALL and early referral is critical. Applying pediatric-inspired protocols to patients aged from 18 to 50’s has meaningfully improved outcomes in this population. Referral to centers with experience using these regimens is important to optimize patient outcomes.  2. In relapsed/refractory B-ALL, blinatumomab and inotuzumab ozogamicin are important off the shelf options — but with distinct roles. Blinatumomab, a CD3-CD19 bispecific antibody, can achieve durable remissions in a subset of patients even without allogeneic transplant, but that patient population is yet to be determined. Inotuzumab ozogamicin, an anti-CD22 antibody-drug conjugate, is an effective bridge to transplant or CAR T but is not considered curative on its own. 3. CAR T cell therapy is a legitimate destination therapy for a meaningful subset of B-ALL patients. Approximately 40-60% of patients may be cured with CAR T alone, making it an important option for those without a suitable donor or who cannot proceed to allogeneic transplant. The three approved products differ in costimulatory domain and toxicity profile — obe-cel's novel CD19 binding mechanism and dosing strategy reduces CRS and ICANS while preserving efficacy. Dual-targeting CD19/CD22 CAR products are on the horizon. Consolidative allogeneic transplant is pursued for the majority of these adult patientsFor additional ASH resources related to ALL, please consider visiting our ASH Clinical Practice Guidelines on Acute Lymphoblastic Leukemia in Adolescents and Young Adults webpage.This podcast episode is supported by AutoLus.

Episode Description:In this episode of HemeTalks, we are joined by Neha Mehta-Shah, MD, MSCI, Associate Professor of Medicine at Washington University in St. Louis, to discuss the evolving management of peripheral T-cell lymphomas (PTCL), with a focus on differences by histologic subtype. Through a case-based discussion, Dr. Mehta-Shah explores the diagnostic challenges of PTCL, including the role of repeat biopsies, expert pathology review, and molecular testing. She reviews frontline treatment approaches, including CHOP-, CHOEP-, and brentuximab vedotin-based regimens, and discusses the role of autologous transplantation in first remission. The conversation then turns to relapsed disease, highlighting emerging therapeutic strategies, genomic insights, and consideration of allogeneic transplantation. Listeners will gain practical guidance for managing one of the most challenging groups of hematologic malignancies. Clinical Perls Peripheral T-cell lymphomas frequently present diagnostic challenges and may require repeat biopsies, specialized hematopathology review, and integration of clinical, morphologic, and molecular findings to establish an accurate diagnosis. Frontline treatment involves an anthracycline backbone regardless of histologic subtype. BV-CHP is the standard of care for ALCL patients based on results of ECHELON-2 which enriched this patient population. Other histologic subtypes have less clear evidence for frontline BV regardless of CD30 status and CHOP or CHOEP are reasonable. The addition of etoposide is less clear and mainly benefits patients younger than 60 years old.  In the relapsed or refractory setting, histologic subtype can possibly guide treatment choice. Duvelisib and histone deacetylase (HDAC) inhibitors have shown efficacy for the T follicular helper phenotype which was previously referred to as angioimmunoblastic T cell lymphoma.  This podcast episode is supported by Secura Bio.

In this episode of Heme Talks, we are joined by Mr. Sean Powell as he shares his experiences as a former patient and now patient advocate for a rare blood disorder known as warm autoimmune hemolytic anemia (wAIHA). Sean shares his story of how he was diagnosed, the initial management, drug toxicities, and subsequent investigations that he underwent. Our patient advocate episodes highlight the importance of advocacy, community, and shared understanding between patients and their healthcare providers.  Key Takeaways1. wAIHA can sometimes be associated with an underlying condition. Mr. Powell’s journey illustrates how wAIHA occasionally occurs alongside other diagnoses, highlighting the value of ongoing clinical vigilance and open communication between patients and their care team. 2. Steroid therapy carries significant side effects that patients are often unprepared for. Mr. Powell experienced severe prednisone toxicities, including rage, insomnia, and extreme hunger, and his hemolysis was only transiently controlled. His experience highlights the need for proactive patient counseling about steroid side effects and the importance of escalating to second-line therapies like rituximab when steroids fail.  3. The emotional and psychological burden of transitioning from active treatment to remission is often underestimated. Even after achieving remission, Mr. Powell faced intense anxiety, isolation, and loneliness — feelings that emerged precisely when formal support structures faded. Routine referrals to behavioral health specialists and survivorship programs should be considered a standard part of care, not an afterthought. This podcast episode is supported by Johnson & Johnson.