Rafalimumab

Booking is now open for Lymphoma Management! - leading event for healthcare professionals  -online course focused on diagnosis & management of lymphoma. - Webinars delivered virtually on four consecutive Monday nights in September 2026 - Bargain price! lymphoma-action.org.uk/LymphomaManage…

How to remember NHL translocations

50 pearls — ICAHT (CAR-T hematotoxicity) 🧠💉 (tweet emojis style) (Based on EHA/EBMT consensus ) 🧬 1️⃣ ICAHT = most common toxicity after CAR-T 🧬 2️⃣ Cytopenias can be profound & prolonged 🧬 3️⃣ Major driver of infections & NRM 🧬 4️⃣ Occurs across all CAR targets (CD19, BCMA…) 🧬 5️⃣ Seen across LBCL, ALL, MCL, MM 📅 6️⃣ Early ICAHT = D0–30 📅 7️⃣ Late ICAHT = >D+30 📅 8️⃣ Early grading = depth + duration 📅 9️⃣ Late grading = depth only 📅 🔟 Neutropenia = key driver clinically 🧪 1️⃣1️⃣ ANC <500 = critical threshold 🧪 1️⃣2️⃣ ANC <100 = very severe 🧪 1️⃣3️⃣ Duration ≥14 days = high-risk phenotype 🧪 1️⃣4️⃣ Biphasic recovery pattern common 🧪 1️⃣5️⃣ Can persist months–years 🔥 1️⃣6️⃣ Pathophysiology = inflammation + marrow reserve 🔥 1️⃣7️⃣ CRS cytokines → myelosuppression 🔥 1️⃣8️⃣ Baseline inflammation predicts toxicity 🔥 1️⃣9️⃣ Ferritin & CRP important markers 🔥 2️⃣0️⃣ BM aplasia may be refractory ⚠️ 2️⃣1️⃣ Risk: high disease burden ⚠️ 2️⃣2️⃣ Risk: prior therapies/lines ⚠️ 2️⃣3️⃣ Risk: prior HSCT ⚠️ 2️⃣4️⃣ Risk: baseline cytopenias ⚠️ 2️⃣5️⃣ Risk: BM infiltration 📊 2️⃣6️⃣ CAR-HEMATOTOX score = key tool 📊 2️⃣7️⃣ Uses ANC, Hb, platelets, CRP, ferritin 📊 2️⃣8️⃣ Predicts prolonged neutropenia 📊 2️⃣9️⃣ High score → infection risk 📊 3️⃣0️⃣ High NPV → good rule-out tool 🔍 3️⃣1️⃣ Workup stepwise (Tier 1 → Tier 2) 🔍 3️⃣2️⃣ Rule out drugs, infection, deficiency 🔍 3️⃣3️⃣ Always check viral PCRs 🔍 3️⃣4️⃣ Consider relapse/BM disease 🔍 3️⃣5️⃣ BM biopsy if persistent 🧫 3️⃣6️⃣ HLH overlap must be suspected 🧫 3️⃣7️⃣ Clues: ferritin ↑, cytopenia, inflammation 🧫 3️⃣8️⃣ Use H-score / HLH-2004 🧫 3️⃣9️⃣ Treat with steroids + anakinra 🧫 4️⃣0️⃣ Refractory → ruxolitinib / emapalumab 💊 4️⃣1️⃣ G-CSF safe from D+2 (selected pts) 💊 4️⃣2️⃣ Reduces febrile neutropenia 💊 4️⃣3️⃣ Does NOT worsen severe CRS/ICANS 💊 4️⃣4️⃣ GM-CSF → avoid (↑ inflammation) 💊 4️⃣5️⃣ G-CSF response helps phenotype (aplasia vs recovery) 🩸 4️⃣6️⃣ Transfusions = cornerstone 🩸 4️⃣7️⃣ Use irradiated products (–7d → +90d) 🩸 4️⃣8️⃣ Antiviral + PJP prophylaxis mandatory 🩸 4️⃣9️⃣ Antifungal if ANC <500 + high-risk 🩸 5️⃣0️⃣ Allo-HCT = last resort (persistent grade 4) #CAR_T #Hematology #ICAHT #KFSHRC

Expert Opinion on the Diagnosis and Treatment of Hematologic Malignancies During Pregnancy ascopubs.org/doi/10.1200/JC…

Current treatment algorithm for DLBCL nature.com/articles/s4140… #oncology #hematology #medtwitter #DLBCL

Breakthrough thrombosis in cancer: 50 pearls Credits for sharing to Dr Raizah Source: How I treat breakthrough thrombosis in patients with cancer 🩸 1) Breakthrough VTE in cancer is not rare despite anticoagulation. 🩸 2) Reported 6-month cumulative incidence is ~5%–8%. 🩸 3) In cancer, recurrence on treatment is more common than in non-cancer patients. 🩸 4) Before changing treatment, first ask: Is this true recurrence or residual old clot? 🩸 5) Only about one-quarter of suspected recurrent VTE cases are objectively confirmed. 🩸 6) Post-thrombotic syndrome can mimic recurrent DVT. 🩸 7) Post-PE syndrome can mimic recurrent PE. 🩸 8) Cancer-related pain, swelling, dyspnea, edema, and lymphedema can all confuse the picture. 🩸 9) The most important diagnostic step is careful imaging review. 🩸 10) Best practice: compare with a postindex baseline scan done after initial treatment. 📸 11) Residual thrombus is very common after treated DVT. 📸 12) At ~6 months, many patients still have residual venous obstruction. 📸 13) In cancer, residual abnormalities can persist even more often than in non-cancer patients. 📸 14) After PE, residual radiologic changes may still be present up to 1 year later. 📸 15) So a “filling defect” on imaging is not automatically new VTE. 📸 16) Acute recurrent DVT is suggested by new noncompressibility of a previously compressible segment. 📸 17) Increase in residual thrombus diameter may support recurrence, but measurements have interobserver variability. 📸 18) Acute PE is suggested by new intraluminal filling defects or extension of prior defects. 📸 19) Features such as partial recanalization, thin webs, irregular wall thickening favor chronic clot. 📸 20) If imaging looks chronic and no baseline exists, a reasonable approach can be repeat ultrasound in 7–10 days rather than immediate escalation. 🧠 21) A major concept: confirm first, escalate later. 🧠 22) In suspected breakthrough VTE, D-dimer is not very helpful in most cancer patients. 🧠 23) Why? Cancer + prior VTE already push pretest probability upward. 🧠 24) D-dimer remains sensitive, but specificity is poor in cancer. 🧠 25) ASH/ISTH guidance generally favors direct imaging over D-dimer in this setting. 🧠 26) If tumor is causing extrinsic venous compression, the issue may be mechanical, not purely hypercoagulable. 🧠 27) In mechanical compression, treating the cancer may be more important than simply escalating anticoagulation. 🧠 28) Selected symptomatic cases may need interventional options like venous stenting. 🧠 29) Always ask whether symptoms are driven by mixed pathology: clot + tumor + lymphatic obstruction. 🧠 30) Baseline imaging after ~6 months of anticoagulation is an excellent practical habit in cancer-associated thrombosis. 💊 31) Once true breakthrough thrombosis is confirmed, first assess adherence. 💊 32) Nonadherence is a major and common reason for apparent treatment failure. 💊 33) Take a detailed medication history: missed doses, wrong timing, self-held doses, cost/access issues. 💊 34) Drug levels can sometimes help confirm nonadherence when history is unclear. 💊 35) For DOACs and LMWH, anti-Xa assays may show whether meaningful drug exposure is present. 💊 36) A negative anti-Xa near the expected window strongly suggests little or no anticoagulant effect. 💊 37) If nonadherence is confirmed, manage as a new acute VTE episode. 💊 38) For DOAC restart, use the appropriate loading regimen when indicated. 💊 39) If twice-daily adherence is poor, a once-daily option may sometimes be more practical. 💊 40) If LMWH is chosen after nonadherence, restart at full weight-based therapeutic dose. ⚠️ 41) In patients on LMWH, think about HIT if thrombosis occurs with new thrombocytopenia or platelet drop. ⚠️ 42) HIT is uncommon with LMWH, but it is important because it is prothrombotic. ⚠️ 43) Also think of acquired antithrombin deficiency, especially with asparaginase exposure.

Pathogenesis of MDS . doi.org/10.1038/s41571… #oncology #hematology #medtwitter

Glad to share our @Yale tour-de-force review of #MDSsm published in @Nature Reviews of Clinical Oncology (Free online read at rdcu.be/fdl9e) which has to be the most comprehensive review we have ever written on the subject covering all relevant areas from epidemiology, pathogenesis, diagnosis, risk stratification, to current and evolving therapies for lower and higher risk disease @YaleCancer @YaleHematology @YaleMed

🩸 Recommendations for Allogeneic HSCT – Key Pearls 🔬 Evaluate iron overload with liver & cardiac MRI before HSCT 💊 Initiate iron chelation pre-HSCT; consider phlebotomy post-HSCT 🧒 Optimal timing before age 10 in chronically transfused patients 🍼 Preferably between 2–5 years to minimize transplant-related toxicity 👩‍⚕️ Consider HSCT after age 10 in selected cases with optimal organ function 🧑‍⚕️ In adults, HSCT is generally not advised solely to avoid transfusion dependence ⚠️ Indications (in increasing urgency): 💉 Steroid-refractory transfusion dependence 🧲 Non-manageable iron overload or chelation failure 🩸 RBC alloimmunization due to chronic transfusions 🛡️ Severe immunodeficiency or multilineage cytopenia 🧬 Evolution to myelodysplastic syndrome or acute myeloid leukemia 👨‍👩‍👧 Donor hierarchy (most to least optimal): 🥇 HLA-matched sibling donor (after excluding donor disorders) 🥈 Matched unrelated donor (10/10 HLA match) 🥉 HLA-mismatched unrelated or haploidentical donor when no alternatives exist 💊 Conditioning regimens: 🔥 Myeloablative Busulfan or Treosulfan + Fludarabine ➕ Consider Thiotepa in selected cases 🚫 Avoid total body irradiation when possible 🌱 Stem-cell source: 🦴 Bone marrow – preferred source 🧫 Cord blood from a healthy sibling as an alternative 🚫 Avoid unmanipulated mobilized peripheral blood stem cells 🛡️ GVHD prophylaxis: 💊 Calcineurin inhibitor (Tacrolimus or Cyclosporine) ➕ Methotrexate or Mycophenolate Mofetil 🧬 Serotherapy when indicated 📚 Based on international expert recommendations. Credits: Prof. Mahmoud Aljurf #HSCT #AlloHSCT #BMT #Hematology #EBMT #EHA #KFSHRC

🩸 Recommendations for Allogeneic HSCT – Key Pearls 🔬 Evaluate iron overload with liver & cardiac MRI before HSCT 💊 Initiate iron chelation pre-HSCT; consider phlebotomy post-HSCT 🧒 Optimal timing before age 10 in chronically transfused patients 🍼 Preferably between 2–5 years to minimize transplant-related toxicity 👩‍⚕️ Consider HSCT after age 10 in selected cases with optimal organ function 🧑‍⚕️ In adults, HSCT is generally not advised solely to avoid transfusion dependence ⚠️ Indications (in increasing urgency): 💉 Steroid-refractory transfusion dependence 🧲 Non-manageable iron overload or chelation failure 🩸 RBC alloimmunization due to chronic transfusions 🛡️ Severe immunodeficiency or multilineage cytopenia 🧬 Evolution to myelodysplastic syndrome or acute myeloid leukemia 👨‍👩‍👧 Donor hierarchy (most to least optimal): 🥇 HLA-matched sibling donor (after excluding donor disorders) 🥈 Matched unrelated donor (10/10 HLA match) 🥉 HLA-mismatched unrelated or haploidentical donor when no alternatives exist 💊 Conditioning regimens: 🔥 Myeloablative Busulfan or Treosulfan + Fludarabine ➕ Consider Thiotepa in selected cases 🚫 Avoid total body irradiation when possible 🌱 Stem-cell source: 🦴 Bone marrow – preferred source 🧫 Cord blood from a healthy sibling as an alternative 🚫 Avoid unmanipulated mobilized peripheral blood stem cells 🛡️ GVHD prophylaxis: 💊 Calcineurin inhibitor (Tacrolimus or Cyclosporine) ➕ Methotrexate or Mycophenolate Mofetil 🧬 Serotherapy when indicated 📚 Based on international expert recommendations. Credits: Prof. Mahmoud Aljurf #HSCT #AlloHSCT #BMT #Hematology #EBMT #EHA #KFSHRC

A symbol of wealth in the pigeon community.

La LAL Ph+ entra en una nueva era. El protocolo LAL Ph-2022 de PETHEMA impulsa: ✔️ TKIs + inmunoterapia
✔️ Menos quimioterapia
✔️ Decisiones guiadas por EMR
✔️ Trasplante selectivo 👉 Más precisión, menos toxicidad, mejores resultados. #LAL #PETHEMA

The Vatican once declared a 150lb rodent to be a fish Venezuelan clergy wrote to Rome in 1784 They were surrounded by capybaras and facing 40 days of Lent Their description: semi-aquatic, webbed feet, tastes like fish Rome had never seen one, but approved it Capybara is still a traditional Good Friday delicacy in Venezuela today The dispensation was never rescinded

VEXAS Sd. @TheIACH @Mohty_EBMT @TheEBMT #EBMT26

como dijo hugo cabezas: equis

🧬 Post-Transplant AML Relapse – 50 Pearls 1.🚨 Early relapse (<6 months) = very poor prognosis 2.🧬 Most common cause of allo-SCT failure 3.🔬 Mechanisms: immune escape + clonal evolution 4.🎯 Goal = re-induce remission + GVL effect 5.💊 Aza/Ven commonly used salvage 6.🔄 Donor lymphocyte infusion (DLI) key strategy 7.🧬 Immunosuppression taper enhances GVL 8.⚠️ Infection risk high during relapse 9.🧫 TB/fungal infections complicate management 10.🧪 Bone marrow confirms relapse burden 11.🧬 NGS shows clonal shifts 12.📊 MRD monitoring critical 13.🔄 Second transplant option in selected patients 14.🧠 CNS relapse rare but assess if symptoms 15.💊 Targeted therapy if mutation present 16.⚠️ Venetoclax interactions with antimicrobials 17.🧬 FLT3 relapse → FLT3 inhibitors 18.📉 Cytopenia persistent 19.🧪 LDH reflects disease burden 20.🧠 Performance status dictates therapy 21.⚠️ Avoid aggressive chemo if frail 22.🧬 Extramedullary relapse common 23.🔬 Chimerism monitoring helpful 24.🔄 Mixed chimerism predicts relapse 25.🧪 Infection vs relapse overlap 26.💧 Supportive care critical 27.⚠️ Drug toxicity cumulative 28.🧬 GVL effect central for cure 29.📊 Response rates modest 30.🔄 Trial enrollment encouraged 31.🧠 Pulmonary involvement common 32.🧪 Imaging adjunct to marrow 33.⚠️ Avoid delays in therapy 34.🧬 Early DLI improves outcomes 35.💊 Hypomethylating agents enhance GVL 36.🔬 Resistance mechanisms complex 37.🧠 Neurologic symptoms → evaluate CNS 38.🧪 Electrolyte disturbances common 39.⚠️ DI and endocrine issues may coexist 40.🧬 Multidisciplinary approach essential 41.📉 Prognosis worse with early relapse 42.🔄 Sequential therapy approach needed 43.🧪 Viral monitoring (CMV/EBV) 44.🧬 Molecular relapse precedes morphologic 45.💊 Maintenance strategies evolving 46.⚠️ Toxicity limits therapy 47.🧬 Consider palliative intent if refractory 48.🔬 MRD negativity rare but goal 49.🧠 Quality of life considerations 50.🎯 Best outcomes with remission + DLI/SCT

La Guía PETHEMA convierte el conocimiento en cooperación científica global.” Desarrollada por el Grupo Español de Mieloma (GEM), la Guía de Mieloma Múltiple 2025:
✔️ Unifica criterios
✔️ Mejora decisiones clínicas
✔️ Promueve equidad en salud #CooperaciónInternacional

Así suena un fanático disociado. Cuando se quiere ser más papista que el Papa.

Grande @monicahemato 💪🏻💪🏻

La terapia #CART está suponiendo una revolución en el mundo de la #hematología pero va a serlo también en otras disciplinas como #autoinmunes o #tumoressólidos Merecido reconocimiento a los Dr. Sadelain y June! lavanguardia.com/ciencia/202602… #SomosHUVR @HospitalUVRocio @ibis_sevilla