HemeTalks: Conversations in Hematology Education

 In this episode of HemeTalks: Conversations in Hematology, hosts Dr. Ronak Mistry and Dr. Vivek Patel are joined by Dr. Enrico Novelli, Professor of Medicine at the University of Maryland and leader of its sickle cell disease program, for a deep dive into the biology and management of sickle cell disease. Dr. Novelli unpacks molecular pathways beyond vaso-occlusion, including hyper-adhesion, oxidative stress, and hemolysis, that drive disease complications and are opening the door to new therapeutic targets. The conversation covers why hydroxyurea remains the treatment backbone despite being underutilized, the challenges of designing clinical trials with meaningful endpoints, and when to reach for exchange transfusion in both acute and chronic settings. A must-listen for anyone caring for patients with sickle cell disease.Clinical Pearls:Hydroxyurea is an underutilized but critical backbone of therapy for treating patients with sickle cell disease.Clinical trials for sickle cell disease need better, more diverse clinical endpoints.Limited options are currently available on the market for the management of sickle cell disease. Options include crizanlizumab and L-glutamine. Mitapivat is currently pending approval. Curative options, including stem cell transplant and gene therapy, are also available, but selecting the appropriate therapy is now the challenge.Exchange transfusions remain a powerful tool. Consider them in the acute setting for patients needing a higher level of care and in the outpatient setting for patients with complications of disease despite maximal doses of agents, such as hydroxyurea.Trust-based, longitudinal care is central to high-quality sickle cell disease care.This episode was supported by Sanofi.

In this patient advocate episode, Ms. Barbara Pruitt shares what it's like to live with immune thrombocytopenia (ITP), a condition she has had since age four. Barbara takes us through more than six decades of treatments, from childhood steroids and a splenectomy to today's newer therapies. She describes growing up without meeting anyone else with ITP and the moment a patient organization changed that. She also talks about the everyday adjustments that let her keep traveling, dancing, and enjoying life, and how a hematologist's words can either wound or empower. Hosts Drs. Ronak Mistry and Vivek Patel explore what clinicians can learn from her story, including why quality of life matters as much as lab values. Barbara closes with advice for anyone newly diagnosed.Key Takeaways:Treat the diagnosis as an emotional event, not just a clinical one. Barbara reminds physicians to acknowledge the emotional weight of the diagnosis, and connect patients to peer communities and support resources early, especially children and teens. Look beyond the platelet count. Barbara's current therapy hasn't raised her count, but less bruising and fewer petechiae make it worth continuing. She urges clinicians not to abandon a therapy over a small fluctuation and encourages listeners to ask about other symptoms of ITP including fatigue, bleeding, and energy, which are often dismissed. Ask about symptoms and function at every visit, and weigh them alongside the number when judging whether a treatment is working. Plan the treatment around the patient's life.Consider how treatment options impact our patient’s quality of life. Present all reasonable options with their pros and cons, and think through practical fit, such as injections versus oral drugs and food interactions. Invite questions about activities and alternative therapies, because patients will otherwise go looking on their own. For additional ASH resources related to ITP, please consider visiting our ASH Clinical Practice Guidelines on Immune Thrombocytopenia web page.This episode was supported by Sanofi. 

In this episode of HemeTalks, we are joined by Ms. Elise Burton, who shares her experience living with paroxysmal nocturnal hemoglobinuria (PNH). Elise describes how her journey began several years earlier with a diagnosis of aplastic anemia, before her condition was later recognized as PNH after she developed evidence of unexplained hemolysis. She walks through her treatment journey, including eculizumab, ravulizumab, and enrollment in a danicopan clinical trial, as well as the side effects she experienced, the financial navigation required to stay on therapy, and the routine health maintenance that can be displaced when managing a rare disease becomes all-consuming. She also discusses the patient communities and advocacy organizations that supported her. Our patient advocate episodes highlight the importance of advocacy, community, and shared understanding between patients and their health care providers. Key Takeaways:1. Preemptive anticipatory counseling is critical for patients, particularly those with rare diseases, to ensure rapid access to life-saving care in emergencies. Elise shares how her hematologist made sure she understood her condition and gave her essential contact information, along with a letter detailing her condition to share with healthcare professionals if she ever needed emergency medical attention. Equipping patients with a plan before a crisis can meaningfully change the care they receive.2. Rare disease care can become a part-time job, and general health maintenance can get lost. Patients with chronic hematologic diseases have medical needs beyond their hematologic condition. Hematologists can help by acknowledging the administrative burden, connecting patients with organizations such as AAMDS, NORD, The Assistance Fund, and the Patient Advocate Foundation, and reinforcing the importance of routine health screenings.To access the PNH patient resources mentioned in this episode, please refer to the link provided here.This episode was supported by Alexion.

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 Sanofi.

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 HemeTalks, 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.

In this episode of Heme Talks, we are joined by Allyson Pishko, MD, MSCE, Classical Hematologist and Assistant Professor of Medicine at the University of Pennsylvania, to discuss a rare blood disorder known as warm autoimmune hemolytic anemia (wAIHA). In this episode, Dr. Pishko shares her approach to diagnosis and management of this disorder, and how she approaches discussions about this diagnosis with her patients. Dr. Pishko also discusses promising future options for patients with wAIHA. Clinical Perls:Warm autoimmune hemolytic anemia is a complex diagnosis. In addition to a careful history, key lab data to support the diagnosis can include an acute drop in hemoglobin, elevated bilirubin, elevated lactate dehydrogenase (LDH), reduced haptoglobin, an elevated reticulocyte count, and a positive Coombs’ test. Microspherocytes may also be visible on a smear. However, not all patients will present with all of these findings, and it is also important to consider the patient’s comorbid conditions when interpreting labs.  Corticosteroids remain the backbone of treatment with a slow taper over many weeks pending clinical improvement. Additional therapies include rituximab and immunosuppressive agents. For refractory patients, additional options to consider agents including fostaminib and rilzabrutinib. Nipocalimab is currently also being reviewed by the FDA.  This podcast episode is supported by Johnson & Johnson.

In this episode of Heme Talks, we are joined by Dr. Sai Jambunathan as she shares her experiences with the diagnosis and management of a rare blood disorder known as AL amyloidosis. As a patient herself, listeners will gain insights into the complex initial workup and what the treatment journey is like for patients with this condition. Our patient advocate episodes highlight the importance of advocacy, community, and shared understanding between patients and their healthcare providers. Key Takeaways:AL amyloidosis can present without classic symptoms, making early recognition challenging. Dr. Jambunathan's initial symptoms — fatigue, shortness of breath, and night sweats — were subtle and initially attributed to other causes. Clinicians should maintain a broad index of suspicion, as timely diagnosis significantly impacts prognosis. Clear, compassionate communication from the care team makes a meaningful difference for patients and families. From explaining the diagnosis in accessible language to giving family members direct reassurance, Dr. Jambunathan's experience shows how much patients value providers who take the time to communicate honestly, patiently, and with empathy. Community, advocacy, and peer support are powerful tools for patients navigating a rare disease. Dr. Jambunathan found strength through patient support groups, faith communities, and caregivers — and channeled her experience into advocacy, helping pass an AL amyloidosis awareness month in New Jersey. Organizations like the Amyloidosis Research Consortium offer valuable resources for patients and families seeking connection and information. This podcast episode is supported by Alexion.