Mona vijayaran

Myeloma Signal: TP53 TP53 is the guardian of genomic integrity. Cyclin D powers the cell. TP53 keeps it under control. Monoallelic loss: → genomic instability begins → subclones emerge Biallelic inactivation: → checkpoint failure → clonal evolution accelerates → therapy resistance dominates This is not just high-risk disease. This is evolution without control.

Explore the @ASH_hematology 2026 #AcuteLymphoblasticLeukemia guidelines for asparaginase management, including recommendations on dosing, premedication, TDM, and switching formulations in AYA patients with #ALL. bit.ly/48n4lGo #ALLsm #leusm #MedEd

🩸📊 Statistical Tools in Hematology — Retrospective vs Clinical Trials 🔎 1️⃣ Retrospective Studies (Real-World / Registry / Cohort) 1️⃣ 📉 Kaplan–Meier → OS / PFS description 2️⃣ ⚖️ Log-rank test → Group comparison 3️⃣ 🧮 Cox regression (multivariable) → Adjust confounders (HR reporting) 4️⃣ 🎯 Propensity Score Matching (PSM) → Reduce selection bias 5️⃣ ⚙️ IPTW weighting → Alternative to PSM 6️⃣ 📊 Fine–Gray competing risks → Relapse vs NRM (post-SCT mandatory) 7️⃣ 📍 Logistic regression → Response (CR/MRD negativity) 8️⃣ 📉 Chi-square / Fisher’s exact → Categorical comparison 9️⃣ 📐 Linear / mixed models → Longitudinal labs (counts, ferritin) 🔟 📈 Time-dependent covariates → GVHD, DLI, maintenance 💡 Key Point: Retrospective = 🔥 hypothesis-generating, but always control for bias & confounding. ⸻ 🧪 2️⃣ Prospective Clinical Trials (Phase I–III) 1️⃣ 📊 Power & sample size calculation → Designed before enrollment 2️⃣ 🎲 Randomization → Eliminates selection bias 3️⃣ 📦 Intention-to-Treat (ITT) → Primary efficacy analysis 4️⃣ 📋 Per-protocol analysis → Secondary supportive analysis 5️⃣ 📈 Kaplan–Meier + Cox model → Time-to-event endpoints 6️⃣ 📉 Stratified Cox → Risk-stratified randomization 7️⃣ 📊 Interim analysis → DSMB monitoring 8️⃣ 🚦 O’Brien–Fleming / Pocock boundaries → Early stopping rules 9️⃣ 📍 Subgroup interaction testing → True heterogeneity assessment 🔟 📈 Restricted Mean Survival Time (RMST) → If PH violated 💡 Key Point: Clinical trials = 🥇 highest level of evidence when well powered & executed. ⸻ 🔬 3️⃣ Modern Advanced Hematology Analyses (Both Designs) 🔹 🧬 MRD kinetic modeling 🔹 🔎 ROC/AUC for diagnostic thresholds 🔹 🧠 Machine learning (risk prediction AML/SCT) 🔹 📊 Cumulative incidence curves in transplant 🔹 🔁 Mixed-effects models (CAR-T cytopenias dynamics) ⸻ 🧠 Practical Take-Home 📌 SCT relapse analysis → Always use competing-risk models 📌 Observational study → Must adjust with PSM/IPTW 📌 Phase III RCT → ITT + stratified Cox mandatory 🔥 A strong adult hematology paper typically includes: Kaplan–Meier + Cox ± Fine–Gray ± Multivariable adjustment #Hematology #ClinicalTrials #RealWorldData #AML #StemCellTransplant #KFSHRC

🔥 Lymph Node (LN) Examination – 50 Clinical Pearls for Hematologists 1️⃣ 🧠 Always start with inspection before palpation. 2️⃣ 👐 Warm hands = better relaxation = better exam. 3️⃣ 📍 Examine systematically: cervical → supraclavicular → axillary → epitrochlear → inguinal. 4️⃣ 👀 Look for asymmetry before touching. 5️⃣ 📏 Measure in cm, not “small/large.” 6️⃣ 📌 Document exact location, not just “neck LN.” 7️⃣ 🔵 Size >1 cm abnormal (except inguinal up to 1.5–2 cm). 8️⃣ 🪨 Hard, fixed = think malignancy. 9️⃣ 🧀 Rubbery = classic lymphoma feel. 🔟 🥚 Soft, tender = reactive/infectious. 1️⃣1️⃣ 🤕 Tenderness suggests inflammation, not lymphoma (usually). 1️⃣2️⃣ 📦 Matted nodes → TB or lymphoma. 1️⃣3️⃣ 📌 Fixed to skin/deep tissue → metastatic disease risk. 1️⃣4️⃣ 🎯 Supraclavicular LN = high-risk site. 1️⃣5️⃣ ⬅️ Left supraclavicular (Virchow) = abdominal/thoracic malignancy suspicion. 1️⃣6️⃣ 🧍 Cervical chain: anterior vs posterior matters. 1️⃣7️⃣ 🦠 Posterior cervical → viral causes (EBV/CMV). 1️⃣8️⃣ 🧴 Preauricular → conjunctival infections. 1️⃣9️⃣ 🦷 Submandibular → dental/oral pathology. 2️⃣0️⃣ 💉 Epitrochlear >0.5 cm = abnormal. 2️⃣1️⃣ 💪 Axillary LNs → breast exam mandatory. 2️⃣2️⃣ 🦵 Inguinal LNs common benign enlargement. 2️⃣3️⃣ 🌙 Night sweats + LN = B-symptoms red flag. 2️⃣4️⃣ ⚖️ Weight loss? Document precisely (% & time). 2️⃣5️⃣ 🌡 Fever pattern matters (Pel-Ebstein rare but classic). 2️⃣6️⃣ 🧬 Generalized lymphadenopathy (>2 noncontiguous areas) → systemic disease. 2️⃣7️⃣ 💊 Drug history: phenytoin, allopurinol → reactive LN. 2️⃣8️⃣ 🧫 Autoimmune diseases cause LN enlargement. 2️⃣9️⃣ 🦠 HIV → chronic generalized lymphadenopathy. 3️⃣0️⃣ 🦠 TB: firm, matted, possible sinus tract. 3️⃣1️⃣ 📊 Node growth rate: rapid growth → aggressive lymphoma/metastasis. 3️⃣2️⃣ ⏳ Stable >1 year → lower malignancy risk (but not zero). 3️⃣3️⃣ 🔁 Always compare bilaterally. 3️⃣4️⃣ 👤 Palpate behind SCM for deep cervical nodes. 3️⃣5️⃣ 📌 Roll LN over underlying tissue to assess fixation. 3️⃣6️⃣ 🧴 Check overlying skin: erythema? ulcer? 3️⃣7️⃣ 🩸 Hepatosplenomegaly? Always examine together. 3️⃣8️⃣ 🫛 Splenomegaly + LN → think lymphoma/CLL. 3️⃣9️⃣ 🧪 CBC with differential mandatory next step. 4️⃣0️⃣ 🧬 LDH elevated → high tumor burden/aggressive disease. 4️⃣1️⃣ 🎯 Best biopsy = excisional, not FNA (for lymphoma). 4️⃣2️⃣ ✂️ Avoid smallest LN for biopsy. 4️⃣3️⃣ 🧊 Avoid necrotic LN center for sampling. 4️⃣4️⃣ 🧫 Ask for flow cytometry + IHC. 4️⃣5️⃣ 🧬 Request molecular if lymphoma suspected. 4️⃣6️⃣ 📸 Imaging guides deep LNs (CT/PET). 4️⃣7️⃣ 🔬 PET-avid doesn’t equal lymphoma always. 4️⃣8️⃣ 🧭 Think anatomy drainage pattern (metastatic tracing). 4️⃣9️⃣ 📁 Always draw LN map in notes. 5️⃣0️⃣ 👑 Clinical exam still precedes imaging—master the hands before the scanner. ⸻ 🎓 MCQ A 45-year-old with painless, rubbery 3 cm supraclavicular LN, night sweats & weight loss. Best next step? A) FNA B) Antibiotics C) Excisional biopsy D) Repeat exam in 6 weeks ✅ Perfect Answer: C) Excisional biopsy (Needed for architecture, flow, IHC—lymphoma workup.) ⸻ 🎤 OSCE Scenario Patient with bilateral posterior cervical LNs after sore throat. Tender, soft, 1.5 cm. No B-symptoms. 👉 Most likely: Reactive viral lymphadenopathy 👉 Management: Observe + supportive, no immediate biopsy. ⸻ Mastering LN exam = diagnosing lymphoma before the scan. 💪🔥 #HemaBoard #ClinicalPearls #AdultHematology #ESH #EmiratesHematologySociety

Melphalan 100 / m2 is better sometimes

How To Choose a Good Scientific Problem

🚀Eleven clinical trials that will shape medicine in 2026 👉nature.com/articles/s4159… #science #research #MedX @1989_mariab @World_Data_A @OncoAlert @DeryaTR_

The power of composition [📹 kortafilms]

Thank you for this! my snapshot comparing #AML #MRD 2021 vs. 2025 more details in the paper👇

🧬 Itacitinib for CRS prevention 1️⃣ SR(2 studies, n=89): JAK-1 inhibition to prevent CRS 2️⃣ CAR-T: CRS 65% vs 80% placebo; no ≥G3 CRS 3️⃣ ICANS reduced 🧠: 13% vs 35% with placebo; no grade 4 events 4️⃣ Post-haplo HCT: only grade 1–2 CRS; no severe GVHD 5️⃣ 1-yr OS ~80%

🧬 Post-Transplant Maintenance (HCT) – Key Points By Prof. Ayman • 🔥 FLT3+ AML → Gilteritinib maintenance for 2 years if MRD+ (pre- or post-HCT). • 💊 Ph+ ALL → TKI maintenance for 2 years (improves DFS & OS). • 🎯 Goal: reduce relapse, deepen remission, maintain donor chimerism. • 🛑 Stop/adjust if GVHD flare or drug toxicity. #HCT #BMT #Leukemia #AML #ALL #SOHO #SOHOKSA #KFSHRC #ESH #ASH

Molecular subtypes of DLBCL: are we ready to translate our knowledge into the change of treatment paradigms? ashpublications.org/hematology/art… #lymsm #ASH25

At #ASH25, Dr. Marlise Luskin presented a phase 1 trial of venetoclax plus inotuzumab ozogamicin for patients with hard-to-treat acute lymphoblastic leukemia. The combination was well tolerated and produced deep responses, supporting further study as a promising option.

CAR for GVHD: - first-in-human Phase 1 study of donor-derived CD6-CAR Tregs for steroid-refractory/dependent cGVHD (n=6) - no CRS/ICANS or DLTs - all patients with ≥3-month follow-up achieved PR with ongoing FFS #ASH25

BMT CTN 1506: - in pts ≥60 years, gilteritinib maintenance after alloHCT for FLT3-ITD AML did not improve RFS or OS - relapse was reduced (16% vs 32%) but offset by higher NRM (27% vs 11%). Toxicity limited therapy completion - better-tolerated strategies needed #ASH25

Early data from a phase 1 study of Orca-T with reduced-intensity conditioning - strong engraftment, high donor chimerism and remarkably low acute and chronic GvHD. - One-year OS 85%, RFS 81% - outpatient RIC cohort shows 0% NRM. Supports upcoming multicenter trials #ASH25

UK IMPACT COSI randomized trial: - Adding thiotepa to Flu/Bu conditioning (MAC or RIC) in AML/MDS does not improve OS - thiotepa increased TRM in both settings - Flu/Bu remains the safer backbone pending further studies Amazing effort @charliecraddock #ASH25

Transplant in myeloma: what is its role? ashpublications.org/hematology/art… #ASH25 #mmsm

British Journal of Haematology | Wiley Online Library - Investigation and management of thrombocytosis without JAK2, CALR or MPL mutations: A British Society for Haematology Guideline onlinelibrary.wiley.com/doi/10.1111/bj…

🚨 This is it people … you heard it first at #ASH25 🚨 ELN #MRD 205 guidelines are in press in @BloodPortfolio Bad news: It’s more complicated than before… 🤯 Good news: there’s an app for it 😉 eln-aml-mrd-2025.vercel.app