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In this episode, Associate Editor Dr. Philippe Armand discusses the Review Series on mantle cell lymphoma with author Dr. Christine Ryan. Both were authors of "Frontline management of mantle cell lymphoma", and discuss shifts in treatments and new research.Find the full review series in Volume 145 Issue 7 of Blood: "Review series on mantle cell lymphoma: sands shifting in the darkness"
Dr. Anne Marie Morse walks into the studio like a one-woman Jersey Broadway show and leaves behind the best damn TED Talk you've never heard. She's a neurologist, sleep medicine doc, narcolepsy expert, founder of D.A.M.M. Good Sleep, and full-time myth buster in a white coat. We talk about why sleep isn't a luxury, why your mattress does matter, and how melatonin is the new Flintstones vitamin with a marketing budget. We unpack the BS around sleep hygiene, blow up the medical gaslighting around “disorders,” and dig into how a former aspiring butterfly became one of the loudest voices for patient-centered science. Also: naps, kids, burnout, CPAPs, co-sleeping, airport pods, the DeLorean, and Carl Sagan. If you think you're getting by on five hours of sleep and vibes, you're not. This episode will make you want to take a nap—and then call your doctor.RELATED LINKSdammgoodsleep.com: https://www.dammgoodsleep.comLinkedIn: https://www.linkedin.com/in/anne-marie-morse-753b2821/Instagram: https://www.instagram.com/dammgoodsleepDocWire News Author Page: https://www.docwirenews.com/author/anne-marie-morseSleep Review Interview: https://sleepreviewmag.com/practice-management/marketing/word-of-mouth/sleep-advocacy-anne-marie-morse/Geisinger Bio: https://providers.geisinger.org/provider/anne-marie-morse/756868SWHR Profile: https://swhr.org/team/anne-marie-morse-do-faasm/FEEDBACKLike this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship inquiries, email podcast@matthewzachary.com.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
As an attending physician, principal investigator and academic publisher, Dr. Ashita Batavia has a deep appreciation for the importance of data in clinical development. In her role as Head of Hematology and Oncology Data Sciences, R&D, at Johnson & Johnson, she's helping shape the future of clinical trials.In this podcast episode, Dr. Batavia shares her ideas for improving clinical trials and delivering better therapies to patients. She is particularly interested in pragmatic trial designs where data and AI help reduce the burden of trial participation for patients and providers without compromising the collection of safety and efficacy data.Dr. Batavia leaves us with her belief that bringing together multimodal health data is key to fully unlocking advanced analytics capabilities in clinical research and explains why achieving a first win is the springboard to building a culture of data-driven innovation.
In this episode, Jesus Berdeja, MD; Amrita Krishnan, MD, FACP; and Sagar Lonial, MD, FACP, discuss key topics with CELMoD therapy for multiple myeloma, including: Mechanistic differences between CELMoDs and IMiDsEmerging data with CELMoDs and their potential therapeutic roles across the disease continuum of multiple myelomaThe clinical implications of MRD negativity as a surrogate marker of long-term outcomes in clinical trials in multiple myelomaPresenters:Jesus Berdeja, MDDirector of Myeloma ResearchGreco-Hainsworth Centers for ResearchTennessee OncologyNashville, TennesseeAmrita Krishnan, MD, FACPDirector, Judy and Bernard Briskin Center for MyelomaExecutive Director of HematologyCity of Hope Orange CountyProfessor of Hematology/HCTCity of Hope Cancer CenterIrvine, CaliforniaSagar Lonial, MD, FACPChair and ProfessorDepartment of Hematology and Medical OncologyAnne and Bernard Gray Family Chair in CancerChief Medical OfficerWinship Cancer InstituteEmory UniversityAtlanta, GeorgiaContent based on an online CME program supported by an independent educational grant from Bristol Myers Squibb.Link to full program: https://bit.ly/3IwbslQ
Decode low neutrophils, recognize thalassemia without chasing iron, and sharpen your approach to bleeding disorders in primary care. Crack the code on confusing labs. Learn from Dr. Bradley Beeler, an academic hematologist, how to recognize thalassemia without over-ordering tests, why a low neutrophil count in a healthy patient might not be a problem, and how to tackle bleeding disorders in primary care. Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Case 1: Duffy-null associated neutrophil count Case 2: Bleeding disorders Case 3: Thalassemia Outro Credits Written and produced by Paul Wurtz MD. Show notes, cover art, and infographic also created by Paul Wurtz MD. Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Reviewer: Sai S Achi MD, MBA, FACP Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Bradley Beeler MD Disclosures Dr. Beeler reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Sponsor: Panacea Search The Podcast for Doctors (By Doctors) on Spotify, Apple Podcasts, or wherever you listen. Sponsor: Locumstory Locumstory.com is simply a free, unbiased educational resource about locum tenens. Sponsor: Continuing Education Company Curbsiders listeners get 45% off select online courses — that's the biggest discount CEC has ever offered, and it's exclusive to you with promo code Curb45, through July 30. You can also use Curb30 for 30% off all webcasts and on demand replay courses. Check it all out at CMEmeeting.org/curbsiders.
In today's episode, supported by Thermo Fisher Scientific, we had the pleasure of speaking with Apar Kishor Ganti, MD; and Allison Cushman-Vokoun, MD, PhD, FCAP, about the FDA approval of the Oncomine DX Express Test for use as a companion diagnostic for sunvozertinib (Zegfrovy) in EGFR exon 20 insertion mutation–positive non–small cell lung cancer and for use in tumor profiling. Dr Ganti is a professor in the University of Nebraska Medical Center (UNMC) Division of Oncology & Hematology, the Dr. and Mrs. D. Leon UMNC Research Fund Chair in Internal Medicine, and the associate director for Clinical Research at the Fred & Pamela Buffett Cancer Center in Omaha. Dr Cushman is the Henry F. Krous Professor of Pathology, a professor in the UNMC Department of Pathology, Microbiology and Immunology, director of the Division of Diagnostic Molecular Pathology and Human Genetics, medical director of the Molecular Diagnostics and Personalized Medicine Laboratory at Nebraska Medicine, director of the Molecular Genetic Pathology Fellowship Program, and associate director of the UMNC MD-PhD Scholars Program. In our exclusive interview, Drs Ganti and Cushman discussed the significance of the launch of the Oncomine DX Express Test, the benefits and limitations of rapid next-generation sequencing, and features that set Oncomine DX apart from other available tests.
A cardiologist by training, Isabelle Mahé is Professor of Internal Medicine at Université Paris Cité. She is Head of the Internal Medicine Department at a teaching hospital (Louis Mourier, Assistance Publique Hôpitaux de Paris, Paris, France), which includes an oncology unit and a vascular disease unit. She established a tele-expertise service to help physicians manage patients with anticoagulant concerns. She is also chair of the scientific council for the INNOVTE-FCRIN Network (Investigation Network On Venous Thrombo-Embolism) and for a patients' association for anticoagulant therapy (Anticoag PASS S2D). She has broad experience in methodology and in clinical trials evaluating anticoagulants in different cardiologic or vascular indications. Her own research projects have resulted in a better management of anticoagulants in complex patients (renally impaired, elderly and cancer patients. She is leading the international prospective randomised API-CAT Study (focusing on the extended anticoagulant treatment in patients with cancer-associated thrombosis).Sebastian Szmit graduated from the Military Medical Academy in Poland (2002). From 2002 to 2012 he worked at the Military Institute of Medicine in the (1) Emergency Department, (2) Department of Internal Medicine and Cardiology, (3) Department of Oncology. From 2012 to 2022 he was employed by the Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology as cardiologist consultant of the Department of Oncology at the European Health Centre Otwock. In December 2022 he was appointed the Head of the Department of Cardio-Oncology, Centre of Postgraduate Medical Education at the Institute of Hematology and Transfusion Medicine & Consultant of the Cancer Diagnostics and Cardio-Oncology at the Maria Skłodowska-Curie National Research Institute of Oncology (Warsaw, Poland). He is cardiologist & clinical oncologist.Read the full trial results here: https://www.nejm.org/doi/full/10.1056/NEJMoa2416112
In this episode, we review the high-yield topic Acute Hemolytic Reaction from the Hematology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic Polycythemia Rubra Vera from the Hematology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic Lead Poisoning from the Hematology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic Autoimmune Hemolysis from the Hematology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In today's episode, supported by Coherus BioSciences, we had the pleasure of speaking with Justine Bruce, MD, about the ongoing evolution of nasopharyngeal carcinoma management. Dr Bruce is a faculty member in the Division of Hematology, Medical Oncology and Palliative Care within the Department of Medicine at the University of Wisconsin, as well as the director of the VA Medical Oncology Clinical Research Program and chair of the Protocol Review and Monitoring Committee at the University of Wisconsin Carbone Cancer Center in Madison. In our exclusive interview, Dr Bruce discussed evolving treatment strategies for nasopharyngeal cancer, emphasizing the shift from chemoradiation followed by adjuvant chemotherapy to induction chemotherapy with gemcitabine and cisplatin. She also noted how toripalimab-tpzi (Loqtorzi) combined with gemcitabine and cisplatin showed improved overall survival (OS) in the first-line setting in the phase 3 JUPITER-02 trial (NCT03581786). Bruce also expressed her preference for OS as the gold standard for determining the efficacy of nasopharyngeal cancer treatments and noted the need for more US-based trials to reflect the local patient population.
In this week's episode, we'll learn about rapid, high-sensitivity diagnostic assays for TTP, or thrombotic thrombocytopenic purpura, that can reduce unnecessary treatments. After that: enhancing PD-1 blockade in relapsed/refractory extranodal NK/T-cell lymphoma. In a single-arm, phase 2 study, combined CD38 and PD-1 inhibition demonstrated durable responses and manageable safety. Finally, a lymphoma horror story with a happy ending. CREBBP mutations create a zombie enzyme that competes with its wild-type counterparts. By enforcing CD40 signaling, a bispecific antibody overcomes this effect and induces lymphoma cell death.Featured Articles:Rapid ADAMTS13 activity assays for thrombotic thrombocytopenic purpura: a systematic review and meta-analysisEfficacy of combined CD38 and PD-1 inhibition with isatuximab and cemiplimab for relapsed/refractory NK/T-cell lymphomaBlunted CD40-responsive enhancer activation in CREBBP-mutant lymphomas can be restored by enforced CD4 T-cell engagement
In this episode, we review the high-yield topic Paroxysmal Nocturnal Hemoglobinuria (PNH) from the Hematology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we dissect the phase 3 MIDAS trial in newly diagnosed transplant-eligible multiple myeloma with Dr. Meera Mohan. https://pubmed.ncbi.nlm.nih.gov/39841461/https://pubmed.ncbi.nlm.nih.gov/40459097/
Gigi Robinson grew up with Ehlers-Danlos syndrome, a disease that turns your joints into overcooked spaghetti. Instead of letting it sideline her, she built a career out of telling the truth about invisible illness. We talk about what it takes to grow up faster than you should, why chronic illness is the worst unpaid internship, and how she turned her story into a business. You'll hear about her days schlepping to physical therapy before sunrise, documenting the sterile absurdity of waiting rooms, and finding purpose in the mess. Gigi's not interested in pity or polished narratives. She wants you to see what resilience really looks like, even when it's ugly. If you think you know what an influencer does, think again. This conversation will challenge your assumptions about work, health, and what it means to be seen.RELATED LINKSGigi Robinson Website: https://www.gigirobinson.comLinkedIn: https://www.linkedin.com/in/gigirobinsonInstagram: https://www.instagram.com/itsgigirobinsonTikTok: @itsgigirobinsonA Kids Book About Chronic Illness: https://akidsco.com/products/a-kids-book-about-chronic-illnessFEEDBACKLike this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship inquiries, email podcast@matthewzachary.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
In this episode, we review the high-yield topic Pathological RBC Forms from the Hematology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
Video: https://mehlmanmedical.com/hy-usmle-q-1418-hematologyIG: https://www.instagram.com/mehlman_medical/Telegram: https://mehlmanmedical.com/subscribe/FB: https://www.facebook.com/mehlmanmedical
In this episode, we review the high-yield topic Diamond-Blackfan Anemia from the Hematology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
In this episode, we review the high-yield topic of Disseminated Intravascular Coagulation (DIC) from the Hematology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this episode, we review the high-yield topic of Bernard-Soulier Disease from the Hematology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this episode, we review the high-yield topic of Acute Intermittent Porphyria from the Hematology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this episode, we review the high-yield topic of Blood Cell Types from the Hematology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this week's episode we'll learn more about a novel mouse model that recapitulates many of the properties of human sickle cell SC disease; results from the induction phase of the risk-adapted MIDAS trial of isatuximab, carfilzomib, lenalidomide, and dexamethasone in newly diagnosed, transplant-eligible multiple myeloma; and a link between splicing factor mutations and competitive fitness in myelodysplastic syndrome stem cells.Featured articles:A novel mouse model of hemoglobin SC disease reveals mechanisms underlying beneficial effects of hydroxyureaIsatuximab, carfilzomib, lenalidomide, and dexamethasone induction in newly diagnosed myeloma: analysis of the MIDAS trialCell-autonomous dysregulation of interferon signaling drives clonal expansion of SRSF2-mutant MDS stem/progenitor cells
In this episode, we review the high-yield topic of Anemia of Chronic Disease from the Hematology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
Episode Description:If you've ever wondered what happens when a Bronx-born pediatric nurse with stage 4 colon cancer survives, raises a kid, becomes a policy shark, and fights like hell for the ignored, meet Vanessa Ghigliotty. She's not inspirational. She's a bulldozer. We go way back—like pre-Stupid Cancer back—when there was no “young adult cancer movement,” just a handful of pissed-off survivors building something out of nothing. This episode is personal. Vanessa and I built the plane while flying it. She fought to be heard, showed up in chemo dragging her kid to IEP meetings, and never stopped screaming for the rest of us to get what we needed. We talk war stories, progress, side-eyeing advocacy fads, TikTok activism, gatekeeping, policy wins, and why being loud is still necessary. And yeah—she's a damn good mom. Probably a better one than you. You'll laugh. You'll cry. You'll want to scream into a pillow. Come for the nostalgia. Stay for the righteous anger and iced coffee.RELATED LINKSVanessa on LinkedInColorectal Cancer Alliance: Vanessa's StoryZenOnco Interview with VanessaFEEDBACKLike this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship inquiries, email podcast@matthewzachary.com.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
In this episode, we review the high-yield topic of Lead Poisoning from the Hematology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this episode, we review the high-yield topic of Pathologic RBC Forms from the Hematology section.Follow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbullets
In this week's episode, we'll learn about using AI to assess transplant risk in myelofibrosis. In a step toward personalized medicine, researchers report on a machine learning model that identifies 25% of patients with poor outcomes. After that: preventing priapism in men with sickle cell anemia. A recent phase 2 feasibility study shows high rates of recruitment, retention, and adherence to oral therapies, coupled with a significant reduction in the risk of this difficult complication. Finally, new research indicates that hallmarks of terminal T-cell exhaustion are absent in multiple myeloma, from diagnosis through maintenance therapy. We explore these provocative and counterintuitive findings arising from profiling of blood and marrow samples.Featured Articles:Use of machine learning techniques to predict poor survival after hematopoietic cell transplantation for myelofibrosisA controlled trial for preventing priapism in sickle cell anemia: hydroxyurea plus placebo vs hydroxyurea plus tadalafilHallmarks of T-cell exhaustion and antigen experience are absent in multiple myeloma from diagnosis to maintenance therapy
In today's episode, supported by Daiichi Sankyo, we had the pleasure of speaking with Misako Nagasaka, MD, PhD, about the use of fam-trastuzumab deruxtecan-nxki (T-DXd; Enhertu) in pretreated patients with HER2-mutated non–small cell lung cancer (NSCLC). Dr Nagasaka is an associate professor in the Division of Hematology and Oncology and the Division of Medicine at the University of California Irvine School of Medicine. In our exclusive interview, Dr Nagasaka discussed current second-line treatment standards for patients with HER2-mutated NSCLC, how the use of T-DXd in this setting may evolve with the emergence of investigational agents, and the importance of integrating HER2 immunohistochemistry testing into clinical practice.
Risa Arin doesn't just talk about health literacy. She built the damn platform. As founder and CEO of XpertPatient.com (yes, expert with no E), Risa's taking a wrecking ball to how cancer education is delivered. A Cornell alum, cancer caregiver, and ex-agency insider who once sold Doritos to teens, she now applies that same marketing muscle to helping patients actually understand the garbage fire that is our healthcare system. We talk about why she left the “complacent social safety” of agency life, how her mom unknowingly used her own site during treatment, what it's like to pitch cancer education after someone pitches warm cookies, and why healthcare should come with a map, a translator, and a refund policy. Risa brings data, chutzpah, and Murphy Brown energy to the conversation—and you'll leave smarter, angrier, and maybe even a little more hopeful.RELATED LINKS• XpertPatient.com• Risa Arin on LinkedIn• XpertPatient & Antidote Partnership• XpertPatient Featured on KTLA• 2024 Health Award BioFEEDBACKLike this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship inquiries, email podcast@matthewzachary.com.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
In this episode, we took a deep dive intro the landscape of menin inhibitors in AML with Dr. Eytan Stein from MSKCC. Here are the key trials and studies we discussed: ELN 2022 AML Classification https://ashpublications.org/blood/article/140/12/1345/485817/Diagnosis-and-management-of-AML-in-adults-2022Predictors of outcomes in adults with AML and KMT2A rearrangements: https://www.nature.com/articles/s41408-021-00557-6DOT1L inhibitor https://ashpublications.org/blood/article/131/24/2661/37193/The-DOT1L-inhibitor-pinometostat-reduces-H3K79AUGMENT 101: https://ascopubs.org/doi/10.1200/JCO.24.00826Menin inhibition with revumenib for NPM1-mutated relapsed or refractory acute myeloid leukemia: the AUGMENT-101 study: https://ashpublications.org/blood/article/doi/10.1182/blood.2025028357/537139/Menin-inhibition-with-revumenib-for-NPM1-mutatedKOMET-001: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(24)00386-3/abstractSAVE trial: https://ashpublications.org/blood/article/144/Supplement%201/216/530724/Phase-I-II-Study-of-the-All-Oral-Combination-ofKOMET-007: https://library.ehaweb.org/eha/2025/eha2025-congress/4159213/harry.erba.ziftomenib.combined.with.intensive.induction.chemotherapy.2872B329.in.html?f=menu%3D6%2Abrowseby%3D8%2Asortby%3D2%2Amedia%3D3%2Ace_id%3D2882%2Aot_id%3D31560%2Amarker%3D5843%2Afeatured%3D19595MEN1 mutations: https://www.nature.com/articles/s41586-023-05755-9
Listen to Journal of Clinical Oncology's Art of Oncology poem, "Transcription: Phone Call, 2018” by Elane Kim, a student at Harvard College. The poem is followed by an interview with Kim and host Dr. Mikkael Sekeres. Kim shares her poem that lingers in the spaces between words; a mother and daughter navigating illness and memory. TRANSCRIPT Narrator: Transcription: Phone Call, 2018, by Elane Kim Spiculated mass, irregular contours. Can you come to translate these words? Something in the lung. Yes, I am eating well. Birds, green ones, are nesting outside the window. Singing as if they aren't young but dying. Lately, I have been singing. Since we last spoke, the snow has melted into pearls. Rare and pale, glittering like it's the last time you'll ever see it. Will you come see it? In Korea, we say magpies bring good luck. I dreamt of one the last night I slept well. Though you are my daughter, I feel like a child. In our language, the word for cancer comes from the character for mouth. The fruit you bought is too tough to swallow. The cough is worse in the mornings and after rain. When you were younger, you loved the rain. If I could do anything, I would like to see the snow. To see it for the first time again, the cold a shivering afterthought. Time passes in pieces: one appointment, then the next. Monday, can you ask the doctor about the prescription? Will it be stronger? Every new day is an empty one. No appetite. No warmth. I hope I did not give you a rotten body, my body. Will I be stronger? I feel a shattering inside. Hello? You are breaking up. Remember to eat well, daughter. Remember to call home. Dr. Mikkael Sekeres: Hello and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the oncology field. I'm your host, Mikkael Sekeres. I'm Professor of Medicine and Chief of the Division of Hematology at the Sylvester Comprehensive Cancer Center, University of Miami. Today we are joined by Elane Kim, a student at Harvard College. In this episode, we will be discussing her Art of Oncology poem, “Transcription: Phone Call 2018.” At the time of this recording, our guest has no disclosures. Elane, what a joy to have you on our podcast. Welcome and thank you for joining us. Elane Kim: Thank you so much for having me - very excited. Dr. Mikkael Sekeres: So am I actually. Elane, I was wondering, I think you may be one of the youngest authors we've accepted a piece from. You had an absolutely gorgeous poem that you submitted to us and we were so thrilled that you chose us for your submission and ultimately that we were able to publish it. Elane Kim: Oh, that's so exciting. Dr. Mikkael Sekeres: So, can we start out with just kind of some general questions about you? Can you tell us about yourself? Where are you from? And walk us through how you reached this point in your career. Elane Kim: I'm originally from California, but I moved to the East Coast for college and I'm also a writer. I love to write fiction and poetry. When I first started writing, I wrote for fun for a really long time, but I started to kind of take it seriously in middle school because I went to this one slam poetry event and I remember I went home and I told my mom, “I am going to be a poet.” And so ever since then, I've been writing poetry and it's been really awesome for me because it's my way of expressing myself and translating my world into words and having a space where I'm able to experiment fearlessly. So I love to write and it's been a journey for me because I started publishing little poems here and there. And now my debut full length is coming out early next year with a small and lovely press. So I'm very excited and also honored to be on this podcast with you. Dr. Mikkael Sekeres: Elane, I can tell you as a parent of a daughter who's a rising senior in college, it's every parent's dream when your child comes home and says, “I want to be a poet.” So the question I wanted to ask is, are you a writer who dipped her toe into medicine or are you an aspiring doctor who dipped her toe into writing? Elane Kim: Oh my gosh, it's hard to say. I really love science, but I also really love writing. So I think maybe it comes from a place of wanting to do both because I also think that, I don't know, I really, really admire doctors for everything they do because from everything I've seen, I feel like medicine is a place where I think you need to have very deep empathy in order to proceed. So I also think writing is a place where you need empathy and so I think maybe a little bit of both. It's sort of hard for me to see which angle. Dr. Mikkael Sekeres: That's okay. You still have a couple years in college and, of course, the rest of your life to figure that out. But I think you're right. We obviously meet a lot of doctors who are writers. That's probably the main phenotype of the sort of person who submits something to the Art of Oncology at JCO. But I've always felt there's a lot of overlap between the two because inherently medicine is about storytelling. A patient comes to us with a story of illness. We tell that story to ourselves, to our colleagues when we're getting consults, and eventually we're trying to find the denouement of that story, where we have an answer for the story of illness. So I think it's great that you're still open to both aspects of this, writing and medicine, and I completely agree with you. I do think there's a lot of overlap between the two. Elane Kim: I think that's really beautiful. Dr. Mikkael Sekeres: Tell us about your journey as a writer then. So you talked about going to a poetry slam, but of course, you had to have gone there with a piece of poetry to participate. So when did you start writing poetry? Elane Kim: I always wrote poetry for fun. I loved making cards and stuff for my parents and my family for every little event. So I was my own like Hallmark factory. So I used to write really silly things and so whenever like people wanted cards or anything, I always had a poem ready. But then I started taking it seriously after this slam poetry event. I feel like slam poetry is very rooted in emotion and performance. And so all the poets there are so awesome and they really like are able to get into character and share their story in a very like raw way, which I thought was so, so awesome. And it was sort of the first time I had seen poetry as less of a vehicle for like a Valentine's Day joke or something and more of an actual story with like a punchline with a lot of character and individuality. And so that was sort of a space where I saw all these poets who were so excited about what they were doing and able to tell a story about something bigger than themselves. And so I think that was kind of a turning point and little middle school me, I was like, “This is totally what I want to do and totally something I want to pursue.” And although I no longer am like strictly in the spoken word space, I still think every single poem should be read aloud and should be shared with people in a space where everyone's listening and everyone's able to gain something new from it. Dr. Mikkael Sekeres: It's beautifully stated. And you know, that notion of reading words aloud is so important and that's advice that I give to some of my mentees even in scientific writing. As they're moving along, I'll actually say to them, “Okay, now read that paragraph or those sentences out loud and tell me if they make sense.” And as they're reading them, they'll often realize, “Wait a second, it's constructed the wrong way. And I'm burying the lead or the grammar doesn't quite work out.” And they rewrite it. So I love the fact that you talk about writing as something that should be read out loud. I think that's true whether you're writing creatively with poems or narrative pieces or even in scientific writing. Can you tell us what prompted you to write “Transcription: Phone Call 2018?” Elane Kim: Kind of like the title suggests, I wrote this poem after I had a phone call with a loved one that really stayed with me because I think there were a lot of, I guess, distances that were traversed through that phone call and it was a little bit more about what was left unsaid as opposed to what was said. So the poem is- it kind of addresses this, but there are language barriers, generational gaps, and also like the weight of illness that's bearing on this conversation that sort of bleeds into everyday life. And so I was thinking a little bit about how people can often carry conversations across physical distance and also emotional distance, especially in immigrant families, for example, where a lot of the times communication is something more emotional or cultural rather than something that's, you know, said through sentences. And so I think that the poem is both like a literal transcription of a phone call that's like spliced up, but also maybe like an emotional transcription where we're trying to preserve this moment of love and tenderness between a mother and a daughter. Dr. Mikkael Sekeres: It's really a terrific piece. I keep saying this over and over again. You captured so much in so few words, which of course, is the goal of poetry. One of the things that I loved about your poem is how you captured the fractured nature of phone calls, particularly if you're hearing bits and pieces on either side of the phone call. You start the poem focusing on otherness. I mean, right out of the gates, on being an outsider. Your first line is “Spiculated mass, irregular contours,” which is some of our medical speak. And then the next line immediately says, “Can you translate these words?” You're already saying the person, the character who's speaking that line doesn't get it, right? It doesn't make sense to them. They need help in figuring it out. Can you talk about this from the perspective of coming from another country or culture and as a neophyte to medical terminology? Elane Kim: Definitely. It's so awesome that you're able to notice all these small details and everything. That's so awesome. Dr. Mikkael Sekeres: It's a testimony to your writing. You're a great writer. Elane Kim: That's so kind of you, but I'm very excited to get to talk about all this. Yeah, like you said, there's like an insider/outsider dynamic. I guess as somebody who might be new to this country, there's also somebody who's new to medicine and how there can be a lot of barriers there where if you don't have somebody who's acting as somebody who can be in both worlds at once and translate these things, then you're sort of left in the dark. And I think the role of translator is very important here because you're not totally in one world or the other. You're kind of this floating being who is in charge of traversing both worlds and bringing, in this case, the mother from one to the next. But because of this, I think that sort of suggests that the person who is receiving the phone call is not totally comfortable in one world or the other world. They're sort of playing this mediator role. And I think that also maybe speaks to belonging in this poem as well. Dr. Mikkael Sekeres: Yeah. It really emphasizes how critical it is, particularly with serious diagnoses in medicine like cancer, that people bring with them another set of ears, or sometimes we'll joke and we'll say they bring an ectopic brain with them, someone else who can listen because it's not only the medical terminology that people trip over, but like you say, it's the emotions of the diagnosis and how receptive people are to the information. So they need somebody else there as another source of truth and another advocate to ask the right questions and also make sure that what the patient is hearing is what's being said and vice versa. So, are there poets who've been particular influences on you and if I could ask, who and how? Elane Kim: When I was first starting out, I really appreciated slam poets and I still do. I love slam poets. I remember I would go home and watch YouTube videos like over and over of these poets performing their work. For example, I really love Sarah Kay. I also really love Hieu Minh Nguyen. Both of them, oh my gosh, so, so awesome. And I think they bring a lot of, especially Sarah Kay, she brings a lot of whimsy into her work and also a lot of naturalistic references and also like scientific references that you wouldn't necessarily expect. Like, she has this one poem about these birds called starlings and when they fly together, they fly in the big shape of another starling, which is really fascinating, but also very poetic. I listened to that. I was like, “Wait, that is so awesome that nature knows to do that.” So things like that, I think I take a lot of inspiration from whenever there's something I learn about in, say, like my bio class. I'm like, “Write that down, write that down.” Because I'm like, “Oh, that could be something I put in my next poem.” But I also really love a lot of Asian and Asian American writers who have been big inspirations to me. I really love Jenny Xie. She has a collection called Eye Level, which blows me away every time I see a poem from it. I also love Chen Chen. He has this one poem, “When I Grow Up I Want to Be a List of Further Possibilities,” and I love that poem. It was one of the first poems I really fell in love with. Dr. Mikkael Sekeres: You've given me and our listeners a list of people to look up and to read. It's great. I'm curious about your writing process. What triggers a poem and how do you face the dreaded blank page on your computer? Elane Kim: So the way you avoid that is you never have it for too long. My method of writing, tried and true, is I have this one document where I collect everything and it's like my scraps and even the most random, like, ‘this would never go in a poem' random like throwaway lines, I put them all in one ginormous document. I don't know what I'm going to do if I lose access to it, to be honest, because it's like many, many pages. Basically, I just collect everything there. Like I will be in class and I will hear someone say something that's like just in a conversation, but I'm like, “Wait, that's kind of poetic.” And I write it down or like walking down the street and I'm looking at the water. I'm like, “Huh, that water looks a lot like this.” And I write that down. And so I have this huge, huge running document that has all these random lines. And so for me, I think writing is less about going into a document and like just type, type, type, type. It's more about for me like, how can I take these fragments and put them into a story? Like these random fragments. How can I tell a story out of these pieces that seem disparate initially? For me, I don't have a blank page for too long. My issue is like, how can I make this random mess of words into something that actually tells a story? But I think that's the most fun part of writing also is like putting together this puzzle. Dr. Mikkael Sekeres: I have to say it's also the most fun part of medicine. We're handed chaos in oncology and we're asked to put it together into a story and hopefully a story with a happy ending. So that's great. Elane Kim: I love that. Dr. Mikkael Sekeres: So you're welcome to write that down in your scraps. Elane Kim: Oh my gosh, it's going in there. Dr. Mikkael Sekeres: So, I wanted to end by actually quoting the end of your poem, which was amazing. And the poem reads like this and one of the characters says, “I feel a shattering inside. Hello? You're breaking up. Remember to eat well, daughter. Remember to call home.” And it's a marvelous, marvelously unsettling ending where both the phone call and the character are breaking up, while the character maintains her concern for her daughter. Do you think she's retaining some control of a cancer that obviously has gone beyond her control by expressing her maternal concerns about her daughter's welfare? Elane Kim: Definitely. I think this poem is a lot about how the mother experiences this loss of control. I think there's a moment where the mother and daughter sort of switch roles during the process of her care. She talks about how she starts to feel like a child again or she starts to feel less like a mother and more like the daughter. But I think at the end of the day, the way she expresses her care for her daughter is the way that she always has through like these small gestures. No matter how sick she is, her first concern is always her daughter and whether, you know, she's getting her meals in and just hearing her voice over the phone is something that she looks forward to. And so I think being able to like put somebody else above yourself even when your body is at its most sick is something that, I don't know, I think I find it very sad, but also I think a lot of mothers would also relate to putting your child above other things in moments of illness. And so I think it's a very poignant moment, but also, yeah, one that kind of rings true. Dr. Mikkael Sekeres: It's a poignant moment in an extremely poignant poem and beautifully written. We've been talking to Elane Kim about her poem, “Transcription: Phone Call 2018.” Elane, I want to thank you so much for joining us today. You are so incredibly accomplished and I can't wait to read all of your future pieces as well. Elane Kim: Oh, thank you so much. Narrator: Until next time, thank you for listening to JCO's Cancer Stories, The Art of Oncology. Don't forget to give us a rating or review or follow us and be sure to subscribe so you never miss an episode. You can find all of ASCO's shows at asco.org/podcasts. Until next time, thanks for joining us. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bio: Elane Kim is a student at Harvard College.
In this week's episode, we'll learn more about social determinants of health that impact access to allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia, or AML; use of megakaryocyte growth factor receptor-based stem cell depletion as part of pretransplant conditioning in ex vivo autologous gene therapy; and identification of an eight-protein risk signature as well as a novel single protein biomarker, soluble oncostatin M receptor, for risk stratification in AML.Featured Articles:Social Determinants of Health and Access to Allogeneic Hematopoietic Cell Transplantation for Acute Myeloid LeukemiacMPL-Based Purification and Depletion of Human Hematopoietic Stem Cells: Implications for Pretransplant ConditioningBlood-Based Proteomic Profiling Identifies OSMR as a Novel Biomarker of AML Outcomes
In today's episode, we had the pleasure of speaking with Alexey Danilov, MD, PhD, about current challenges and emerging treatment approaches for the management of leukemia and lymphoma that were published in a manuscript based on proceedings from the inaugural Bridging the Gaps in Leukemia, Lymphoma, and Multiple Myeloma Conference. Dr Danilov is the Marianne and Gerhard Pinkus Professor of Early Clinical Therapeutics, medical director of the Early Phase Therapeutics Program for the Systems Clinical Trials Office, co-director of the Toni Stephenson Lymphoma Center, and a professor in the Division of Lymphoma in the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope in Duarte, California. In our exclusive interview, Dr Danilov highlighted recent advances and controversies in the treatment of select patients with hematologic malignancies. He noted chemotherapy-free regimens that are shifting treatment paradigms in mantle cell lymphoma, preferred and emerging BTK inhibitors for the management of chronic lymphocytic leukemia, and the evolution of CD19-directed CAR T-cell therapies for diffuse large B-cell lymphoma. Dr Danilov concluded by taking a forward glance at future developments like BTK degraders and novel CAR T-cell therapy targets.
A full-service clinic focused on Oncology and Hematology services at Oaklawn Hospital is up and running.The Oncology and Hematology Clinic is back to full service, thanks to a partnership with Bronson Battle Creek.In this Oaklawn Health Matters episode, lead Oncology/Hematology registered nurse Alicia Lang talks about what it means for patients in Marshall and Calhoun County.Episode ResourcesOaklawn Hospital website and Oncology/HematologyAbout OaklawnOaklawn was founded in 1925 as a 12-bed hospital in a residential home, funded by a group of visionary philanthropists. Now, almost ten decades later, we've evolved into a highly regarded regional health care organization, licensed for 77 acute care beds and a 17-bed inpatient psychiatric unit. We've continued to be an independently owned not-for-profit hospital, with our main campus residing on the same site as the original hospital, providing facilities, equipment and technology that are usually only found at larger health systems. We enjoy a reputation for advancing medicine and providing compassionate, personal care. Our service area includes Calhoun County and parts of Branch and Eaton counties with a medical staff of more than 300 providers representing over 55 specialties. For information, visit www.oaklawnhospital.org.Oaklawn Health Matters is produced by Livemic Communications.
Blood editor Dr. Laurie Sehn discusses the topic of "Aggressive non-Hodgkin lymphoma: defining and managing high-risk subsets" featuring Drs. Mark Roschewski, Grzegorz Nowakowski, and Neha Mehta-Shah, who each contributed to the articles featured in the review series on high-risk aggressive lymphoma.See the full review series on high risk lymphoma in volume 144, issue 25 of Blood.
JCO PO author Dr. Philip Philip at Henry Ford Cancer Institute and Wayne State University shares insights into his JCO PO article, “Incorporating Circulating Tumor DNA Testing Into Clinical Trials: A Position Paper by the National Cancer Institute GI Oncology Circulating Tumor DNA Working Group.” Host Dr. Rafeh Naqash and Dr. Philip discuss how prospective trials are required to clarify the role of ctDNA as a valid surrogate end point for progression-free or overall survival in GI cancers. Transcript Dr. Rafeh Naqash: Hello and welcome to JCO Precision Oncology Conversations, where we bring you engaging conversations with authors of clinically relevant and highly significant JCO PO articles. I'm your host, Dr. Rafeh Naqash, Podcast Editor for JCO Precision Oncology and Assistant Professor at the OU Health Stephenson Cancer Center at the University of Oklahoma. Today, we are excited to be joined by Dr. Philip Philip, Chair of Hematology and Oncology, as well as leader of GI and Neuroendocrine Oncology. He's also the Professor of Oncology and Pharmacology, as well as Co-Leader of the Pancreatic Cancer Program and Medical Director of the Cancer Clinical Trial and Translational Research Office at the Henry Ford Cancer Institute at Wayne State University. Dr. Philip is also the Senior Corresponding Author of the JCO Precision Oncology article entitled, "Incorporating Circulating Tumor DNA Testing into Clinical Trials: A Position Paper by the National Cancer Institute GI Oncology Circulating Tumor DNA Working Group." At the time of this recording, our guest's disclosures will be linked in the transcript. Dr. Philip, welcome to our podcast, and thank you so much for joining us today. Dr. Philip Philip: Thank you so much, Dr. Naqash, for providing me this opportunity to be discussing this with you. Dr. Rafeh Naqash: This is a very timely and interesting topic. We've done a couple of podcasts on ctDNA before, but none that is an opinion piece or a guidance piece based on what you guys have done. Could you tell us what led to this perspective piece or guidance manuscript being published? There is some background to this. Could you tell us, for the sake of our listeners, what was the initial thought process of why you all wanted to do this? Dr. Philip Philip: The major reason for this was the fact that investigators were considering using ctDNA as a primary endpoint in clinical trials. Obviously, you hear my focus will be on gastrointestinal cancers. So, the idea was, can we use ctDNA instead of using the traditional endpoints such as disease-free survival, progression-free survival, or overall survival? And the question was, do we have enough data to support that in patients with gastrointestinal cancers? Now, the article obviously goes over some review of the data available, but the core of the article was not to do a comprehensive review of ctDNA use and the evidence so far, although we used that in really putting our recommendations. So, we really had to evaluate available data. But the focus was, what are the gaps? What do we need to do? And are we ready to use ctDNA as a primary endpoint in clinical trials? Dr. Rafeh Naqash: Thank you for giving us that background. Obviously, a very broad, complicated topic with a bunch of emerging data that you've highlighted. But most importantly, for the sake of, again, trainees and listeners, could you help us understand the difference between tumor-informed and non-tumor-based ctDNA assessments? Dr. Philip Philip: Sure. So, the tumor-informed is simply meaning that you're taking the genomic makeup or the DNA fingerprint of the cancer in a given patient, and you create a profile, and then use that profile to see whether that DNA is present in the blood. So, it's very simple. It's like barcoding DNA and then going and looking for it in the blood, which means that you have to have the primary tumor. When I say primary tumor, you need to have the tumor to start off with. It doesn't really apply, maybe easily, if you just have a fine-needle aspirate and things like that. So, you really have to have a good amount of the tumor for you to be able to do that. So, that's a tumor-informed, and from the name, you can easily understand how it's done, compared to the other one, which is uninformed, whereby off-the-shelf probes are used to look for tumor DNA. And again, they're based on prior experience and prior identification of the key DNA changes that will be seen in tumors. So, that's the difference between the two in terms of the principle of the test. The uninformed will not require you to send the original tumor that you're trying to test. However, the informed, you do. The turnaround time is, again, a bit different because, as you would expect, it's shorter in the uninformed. And the reason for that, again, is the initial preparation of the profile that is going to be used in the future when you do serial testing. The sensitivity has been a bit of a discussion. Initially, people have thought that tumor-informed assays are more sensitive, more specific, more sensitive, et cetera. But in our review, we come to the conclusion saying that we don't think that's going to be a major difference. And there are obviously improvements happening in both types of assays. The sensitivities have been improving. So, at this point in time, we do feel that you have two types of assays, and we didn't feel strongly about recommending one over the other. Dr. Rafeh Naqash: Thank you for that description. You mentioned something about sensitivity, specificity. Obviously, many of us who have ordered both tumor-informed and tumor-uninformed, we understand the differences with respect to the timing. The tumor-informed one can take more time. The uninformed one, being a sort of a liquid biopsy, may not necessarily have as much of a turnaround time. Could you briefly speak to those limitations or advantages in the context of the two versions? Dr. Philip Philip: I just really want to also highlight that when we say turnaround time, so for the tumor-informed assays, the first assay that we do will be requiring a turnaround time. But once the pattern has been set and the profile has been documented, the subsequent testing doesn't require much in the way of waiting. However, when you're using this for the minimal residual disease, then you have a window of opportunity to work at. That's number one. So, it means that in patients who have resected cancer, you may end up having to wait longer than the tumor-uninformed assay, especially if you don't have easy access to your material for the baseline material to send. And also, what we'd like to do is not do the test immediately after the operation or soon after the operation. Give it some time. There's a window where you can work at, and starting minimally two weeks after the surgery. But in my experience, I'd like to wait at least four weeks just to make sure that we got an accurate reading. Sometimes when you do it very early after surgery, because of the effect of the surgery and the release of the normal DNA is also, it may dilute the tumor DNA, and then you may get a false negative. So, basically, it depends on the clinical situation. And your question is, is one better to be used than the other? I think ultimately, it ends up with the turnaround time not being as much of an issue. It might be in certain situations, depending on when you see the patients after the operation or any definitive treatment you've done and you want to look for minimal residual disease. But in general, I don't think that's going to be a real major issue. Dr. Rafeh Naqash: I remember discussing this with one of the tumor-informed platforms with regards to this barcode you mentioned. They generate a fingerprint of sorts for the tumor on the tissue, then they map it out in the blood and try to assess it longitudinally. And one of the questions and discussions we had was around the fact that most of the time, these barcoded genes are not the driver genes. If you have a KRAS mutant tumor, it's not going to be the KRAS gene that they map out. It's something that is specific. So, is there a possibility that when you are mapping out, let's say, a metastatic tumor where there is truncal and subclonal mutations at different sites, that you capture something that is not necessarily truncal, and that does not necessarily reflect some other metastatic site having a recurrence? So basically, over time, you don't see a specific mutational pattern or the signature on the tumor-informed, and then you see something on the scan which makes you think, "Well, it was not the right test," but actually it could be a different subclone or a clone mutation at a different site. Is there a concept that could help us understand that better? Dr. Philip Philip: I think you raise a very important point. Although, I have to say from my practical experience, that is not a common thing to see. In fact, for some reason, we don't see it that often in any frequency that should, at this point in time, make us concerned about the serial testing. But what you were mentioning is a real challenge which can happen. Now, the question is, how often does the clonal evolution or the divergence happen to the point that it's going to be like a false negative, is what you're saying. At this point in time, we don't really have good information on that, or any good information, practical information. And when we went through the literature and we were looking for the evidence, that wasn't something which was there clearly telling us. Although, this is something that has to be studied further prospectively. And I don't know of a study, but I might be missing it, I don't know of a study which is systematically looking at this. Although it's a very valid hypothesis and theoretical basis for it, but in real life, we still have to see how much does it really interfere with the validity of this kind of testing. Dr. Rafeh Naqash: Which brings us to the more important discussion around your manuscript. And I think that the overarching theme here is the consensus panel that you guys had recommended that ctDNA-based metrics be used as a co-primary endpoint. Could you tell us, for early-phase trials, maybe phase two studies for that matter, could you tell us what were some of the aspects that led to this consensus being formed from your working group? Dr. Philip Philip: Well, there were a number of reasons, in any order of priority, but one of them is we don't have a good sense of dynamics of the ctDNA. And again, remember this article was about gastrointestinal cancers. Maybe we know more about colon cancer, but, or colorectal cancer, but we don't know that well about the upper GI, like gastroesophageal, pancreatic, et cetera. So, we don't know what is the false negative percentages. And in fact, we know that there are certain sites of the disease, metastases, that do not lead to enough shedding of the DNA into the circulation. So, that was something else. I mean, false negativity, not knowing exactly what the dynamics are, especially in different disease types. So, that was another reason, which we felt that it may not be at this time primetime to really have those ctDNA tests as a primary endpoint. We wanted to make sure that, on the other hand, we wanted to make sure that people consider including ctDNA more like a secondary endpoint so that we can gain the information that we're lacking, at least the ones I mentioned to you. So, that was an important point of our discussions and deliberations when we were writing the article. Dr. Rafeh Naqash: And I myself have been on both sides of the aisle where - I treat people with lung cancer, you mentioned appropriately that most of the data that we have for ctDNA is generated from GI cancers, especially colorectal - on the lung cancer side, I myself had a patient with an early-stage cancer, had treatment, surgery, immunotherapy, and then had ctDNA that was tumor-informed, was positive four to five months before the imaging actually showed up. And on the other side, I've also had an individual where early-stage lung cancer, surgery, immunotherapy, and then had PET scans that showed a positive finding, but the ctDNA, tumor-informed ctDNA, was negative multiple times. So, I've seen both aspects of it, and your paper tries to address some of these questions on how to approach a negative, radiologically negative imaging but positive ctDNA potentially, and vice versa. Could you elaborate upon that a little bit? Dr. Philip Philip: Well, obviously, we do see this in practice. Again, I do GI oncology. I have patients who, you do ctDNA. I mean, my advice to anyone, when you order a test, you have to make sure that you know what you're going to do with the test, because that's the most important thing. You get a positive test, you do something. You get a negative test, you do something. But most importantly, our patients who you're following up, they are very anxious for a diagnosis they have that is not- I mean, it's cancer. If you're doing these tests, if we get continuous, repeatedly negative testing, then you really have to also tell the patient that there's a false negativity. And I mentioned to you earlier, there are certain sites of disease, like peritoneal, they may not be producing enough, or there are some tumors, their biology is such that they don't release as much to be detected in the blood. Now, one day we will get maybe a more sensitive test, but I'm talking about the tests we have now. On the other hand, if you get a positive testing, you have to make a distinction for ctDNA in the minimal residual disease situation. If you get a positive test, there is enough evidence that the patient has a worse prognosis. There's evidence for that. No one can dispute that. Again, I'm talking about colorectal cancer where there are a lot of data for that. So, in that situation, there are studies that are looking, if you get a positive test in someone who you're not intending to give any adjuvant treatment, there are studies looking into that, both in terms of intensifying, like chemotherapy, in certain patients. And also, there's work being done, if you have a negative test in someone who has stage III disease, for example, or definitely stage II disease, they may not need to give them chemo. Those things are happening. But in metastatic disease, it's a different situation. Or even in someone who has received surgery, adjuvant chemotherapy, in those patients where they, whether they're now under, in the surveillance mode, those patients, if you have a positive, it may be positive. I had a recent patient like those, eight months before we saw anything on the scans. So, the question is, if you have a positive test, is there any advantage in giving them treatment, systemic treatment? Of course, we're assuming that the PET scan is negative. So, is there really any advantage in giving someone treatment ahead of time, before you see the imaging changes? That kind of data, in my opinion, is not really available or strong. You can always think of it in different ways, explain it in different ways. It's minimal disease, maybe you get a better response. But I don't know if we really can justify at this time. Therefore, in my practice, my own practice, I do not treat just a positive ctDNA. Again, that's different than after surgery when you're thinking of whether to give adjuvant treatment, no adjuvant treatment. But someone who's finished treatments and then you're just serially monitoring the disease, those patients, I do not treat them with chemotherapy. And that was something which, based on the literature we reviewed, there was nothing out there to definitely- I mean, if you see something positive, you will do a scan earlier, you will talk to the patient, examine the patient, whatever. But if there's nothing there, starting a treatment, that's not justified at this point in time. Now, you need to do a study like that. Definitely, you need to do a study. But I can tell you that from my experience, having been involved with study design and all that, it's not an easy trial to do. It's going to be a trial- at a minimum, it will take many patients, it will take longer time to complete, and there are a number of variables there. If someone is willing to put a lot of money into it, it can be done. But I can tell you that that kind of intention to do a study like that has been very much a challenge at this time. Dr. Rafeh Naqash: Of course, as you mentioned, the follow-up time that you need for a study like that is going to be very long to get to meaningful outcomes. Dr. Philip Philip: You need to be very patient to do such a study. But the problem with a very long study is that things change, standard of care changes with time, and the assays will change. So, that's why we don't have that kind of data. I'm not sure if there are people in the community or in the academic centers who do treat based on only positive ctDNA. The other thing is that you really have to always consider the psychological impact of these tests on patients and caregivers. Sometimes it can be really very stressful, burdensome to people to sit there just waiting for the disease to show up on a scan. And therefore, in my opinion, I'm not saying definitely don't use it in that situation, I'm just saying that you have to personalize it also, to see the patient who you would like to do it and then other patients who may not do it, or you think that it's not good for them to do it. And the patient also has to understand the outcome of the test and how you're going to be interpreting it. Dr. Rafeh Naqash: That's a lot of great insights, Dr. Philip, and I know you've been involved in trial designs. I'm sure NCT and cooperative groups are actively thinking and incorporating ctDNA-based metrics as one of the endpoints in their trial. I know of a GU study that's, I think it's an Alliance study, trying to de-escalate treatment based on ctDNA. I have one of my colleagues who's also a GU investigator at OU, he's doing a ctDNA-based, tumor-informed-based de-escalation. So, obviously, more and more data, hopefully, that'll be generated in the next couple of years. Dr. Philip Philip: But remember, these studies are not using it as an endpoint. They're using it as a means of optimizing treatment, which is a bit different. So, as an endpoint, can you do a phase III trial of, let's say, a thousand patients, and your primary endpoint is not survival, but you're saying, "Can I reduce the ctDNA, clear it earlier, or whatever?" That's the sort of thing this article was about. We can't do that at this time. Dr. Rafeh Naqash: I totally understand. Thank you for explaining the difference, and hopefully more to come in this space in the next couple of years. I briefly wanted to touch upon your personal career and journey based on all that you've done and accomplished. Could you tell us about how you started, what your journey has been like, and how that connects with what you're doing right now, including mentoring other trainees and junior faculty? Dr. Philip Philip: Well, when I was in high school, I wanted to be an engineer, but I grew up in Baghdad, and all my friends wanted to do medicine, so I went with the tide, so I did medicine. I don't regret that. I would do it again if I had the opportunity. The reason why I did oncology was, I left the country and did a PhD in clinical pharmacology at the University of London. And that really got me, it was a topic which included, which was on cancer. So, I really got interested in a disease that is really a lot of science, and things are new, or were new at the time. And if I want to look back what I was doing, the beginning of my training in the 80s, second half of the 80s, and now, it's unbelievable how things have changed. But one of the things which I really have to say is that almost all my life I've been in what we call academic institutions. But I firmly believe that for people, whether academic or not, you have to be a very good, astute clinician, because many of the things we do, really, we're trying to put the patients in the center. It's not only doing fancy science, it's to do things that help the patients. And you can bring in bits and pieces of fancy science or less fancy science, but that's something which is really extremely important for us to think about, being a very good clinician, very good doctor, because medicine is a science, whether you're practicing as a solo practitioner or you're part of a large academic center. It's the way you think, the way you interrogate things that you're not sure of, the way you collaborate, the way you learn every day. I mean, at my age, I still don't like to miss any tumor board, because in each tumor board, there's something you learn, even if you think that you know everything. So, that's really the whole thing of it, is that be a very good clinician, be open-minded. Always, you have to think of things that, they look interesting, they look somehow unexplained. Always try to help find the solutions and do that. One of the major things that I feel that people should do is being also very focused on things. I mean, you have to also know what you want to do in the next 5, 10, 15 years. Because although everyone is in it in the same way when we start, but there are different things that drive people, people who want to do more of the formal research, like being an academic-like institution. But there are also a lot of people who are very successful outside of a- what we call an academic setting. In the United States, most people are not working in an academic kind of setting. Although, for me, the distinction between academic and community is getting less and less, because if you think that you do phase I trials in academia only, that's not true, because there are, in fact, in the state of Michigan, the most active phase I doctor is not even in academia, he's in private practice. So, you can do all these things. It's a matter of what you like to do, and you really have to make sure you know what you want to do. Because sometimes people are, especially early on, they get a bit confused, “What I want to do.” There's an issue of doing general oncology versus subspecialist. If you're a subspecialist doing only GI, you have to make sure that you really also have some kind of recognition that you're only a GI oncologist, recognition regional, national, international, but some degree of recognition that you feel that people are coming to you for advice as a second opinion or whatever it is. But again, you have to decide what you think you want to be, how you want to be, because there's a lot of options here between community practice, academic practice, industry, and of course, there's always the administrative thing. Some people tend to be more like going into the line of being an administrator. So, there's a lot of options for you. Dr. Rafeh Naqash: Well, thank you again, Dr. Philip, for those pearls of wisdom. I think that was very insightful. I'm sure all the trainees and early-career investigators will find all that advice very helpful. Thank you again for joining us today. Thank you for listening to JCO Precision Oncology Conversations. Don't forget to give us a rating or review, and be sure to subscribe so you never miss an episode. You can find all ASCO shows at asco.org/podcast. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Dr. Philip Philip Disclosures Honoraria: Bayer, Ipsen, incyte, Taiho Pharmaceutical, Astellas Pharma, BioNTech SE, Novocure, TriSalus Life Sciences, SERVIER, Seagen Consulting or Advisory Role: Celgene, Ipsen, Merck, TriSalus Life Sciences, Daiichi Sankyo, SynCoreBio, Taiho Pharmaceutical Speakers' Bureau: Incyte Research Funding: Bayer (Inst), incyte (Inst), Merck (Inst), Taiho Pharmaceutical (Inst), novartis (Inst), Regeneron (Inst), Genentech (Inst), halozyme (Inst), Lilly (Inst), Taiho Pharmaceutical (Inst), merus (Inst), BioNTech SE (Inst) Uncompensated Relationships: Rafael Pharmaceuticals, Caris MPI
Dr. Jamie Wells is back—and this time, she brought a book. We cover everything from biomedical design screwups to the glorified billing software known as the EHR. Jamie's new book, A Clinical Lens on Pediatric Engineering, is a masterclass in what happens when you stop treating kids like small, drunk adults and start designing medicine around actual human factors. We talk about AI in pediatric radiology, why drug repurposing might save lives faster than biotech IPOs, and the absurdity of thinking one-size-fits-all in healthcare still works.Jamie's a former physician, a health policy disruptor, a bioethicist, an MIT director, and a recovering adjunct professor. She's also a unicorn. We dig into the wonk, throw shade at bad design, and channel our inner Lisa Simpsons. This one's for anyone who ever wondered why kids' hospitals feel like hell and why “make it taste like bubblegum” might be the most important clinical innovation of all time. You'll laugh, you'll learn, and you might get angry enough to fix something.RELATED LINKSJamie Wells on LinkedInBook: A Clinical Lens on Pediatric Engineering (Amazon)Book on SpringerDrexel BioMed ProfileGlobal Blockchain Business CouncilJamie's HuffPost ArticlesFEEDBACKLike this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship inquiries, email podcast@matthewzachary.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Drs. Brander and Cohen discuss the growing role of measurable residual disease (MRD) testing in CLL and its clinical implications.
This National Blood Week, the team sit down with Anita Gandhi, Vice President, Translational Development, BMS, to explore the last decade of innovation in hematology and what lies ahead for the space. Together, Anita and Jade discuss Anita's route into the pharmaceutical industry, the current unmet needs of patients with blood cancer, what the future of innovation looks like in hematology and what Anita's HBA Rising Star Award means to her a decade on. A little more on EMJ GOLD's guest… Anita is currently the Vice President of Translational Development at BMS, leading not only hematology translational development at the company, but solid tumour, immunology, cardiology and neurology as well. She has over 20 years of industry experience including drug discovery and translational development, and she was the recipient of the HBA Rising Star Award in 2015.
Drs. Cohen and Brander review toxicity and treatment management in CLL, specifically addressing the considerations that go into subsequent lines of treatment for patients who relapse following doublet, or even triplet, therapy.
HY USMLE Q #1402 – Hematology
Drs. Brander and Cohen discuss an ongoing debate in the management of CLL about BTK and BCL2 inhibitor combinations in the frontline treatment of CLL. Is it better to combine BTK and BCL2 inhibitors, or to start with one or the other as monotherapy?
Drs. Lipsky and Allan discuss the emerging role of immunotherapy in the management of patients with CLL, including CAR T-cell therapy and bispecific antibodies.
This month's FLOW delves into the 'Iron Ladies' research - they investigate iron deficiency's prevalence among women with bleeding disorders, the importance of routine screening, the challenges in setting standardized care practices, and the historical exclusion of women from clinical trials. Featuring Dr. Megnahn McCormick, a doctor passionate about treating iron deficiency. Program Notes: Episode Links: Bloodstream Media: https://www.bloodstreammedia.com/ The Iron Ladies Study: The Iron Ladies: Prevalence and Risk Factors of Iron Deficiency in Females With Bleeding Disorders - McCormick - Haemophilia - Wiley Online Library A study presenting the data available through the ATHN dataset on women and girls with bleeding disorders* A Cross-Sectional Study of Women and Girls with Congenital Bleeding Disorders: The American Thrombosis and Hemostasis Network Cohort | Journal of Women's Health *includes a discussion on how participation in the dataset is not complete and how work is being done to remedy this! An article about the impact of Thalidomide on FDA regulation: How medical research changed after thalidomide More in depth on Thalidomide: Clinical Trials in Pregnancy and the “Shadows of Thalidomide”:Revisiting the Legacy of Frances Kelsey - PMC Information about what is identified as a “normal” hemoglobin; and how women who are iron-replete hemoglobin values are similar to men: “These findings highlight sex-based inequities that lead to normalization of disease states and the critical need to update hematologic ranges truly reflective of iron repletion.” Sex, lies, and iron deficiency: a call to change ferritin reference ranges | Hematology, ASH Education Program | American Society of Hematology 2021 article, Iron Ladies: Variation in the Identification and Management of Iron Deficiency in Women with Bleeding Disorders: https://www.sciencedirect.com/science/article/pii/S0006497121030202 How's Your Flow? We wanna know (Calendly link): https://calendly.com/flowtalk/flow-talk-period-pain-stories HOST: Jessica RIchmond Website: jrich.online IG, @jessicalaurenrichmond Twitter @geniuspills Tik Tok @jrichsocal HOST: Sarah Watson Website: sarahwatsonlpc.com Podcast: Behind The Bedroom Door Facebook: @sarahwatsonlpcsextherapy IG @swsxtherapy Twitter @swsextherapy Presenting Sponsor: #Takeda, visit bleedingdisorders.com to learn more. Connect with BloodStream Media: Find all of our bleeding disorders podcasts on BloodStreamMedia.com BloodStream on Facebook BloodStream on Twitter Check out Believe Limited's Other Work: BloodFeed: bloodfeed.com Bombardier Blood: bombardierblood.com Hemophilia: The Musical: breakingthroughhemophilia.com My Beautiful Stutter: mybeautifulstutter.com/ Stop The Bleeding!: stbhemo.com Teen Impact Awards: teenimpactawards.com The Science Fair: thesciencefair.org
In this week's episode, we' ll learn about how TET3 has a key role in GVHD. In mice, a deficiency of Tet3 in donor T cells inhibited pathogenic immunoglobulin class switching and suppressed lung fibrosis. Accordingly, TET3 may be a new therapeutic target in chronic GVHD. After that: rilzabrutinib, a BTK inhibitor for ITP. In a randomized, placebo-controlled trial, treatment produced rapid and durable platelet responses, with acceptable safety, in adults with immune thrombocytopenia who had failed multiple previous therapies. Finally: exploring pre-TCR surface expression patterns in T-cell ALL. Co-inhibition of the interleukin-7 receptor and pre-T cell receptor pathways may play a therapeutic role for a subset of T-lymphoblastic leukemias.Featured Articles: Deficiency of T follicular helper cell Tet3 DNA demethylation inhibits pathogenic IgG2c class switching and chronic GVHDSafety and efficacy of rilzabrutinib vs placebo in adults with immune thrombocytopenia: the phase 3 LUNA3 studySurface pTα expression predicts LCK activation and preclinical synergy of LCK and JAK coinhibition in adult T-ALL
Erica Campbell walked away from corporate life, took a hard left from the British Embassy, and found her calling writing checks for families nobody else sees. As Executive Director of Pinky Swear Foundation, she doesn't waste time on fluff. Her team pays rent, fills gas tanks, and gives sick kids' parents the one thing they don't have—time. Then, breast cancer hit her. She became the patient. Wrote a book about it. Didn't sugarcoat a damn thing. We talk about parking fees, grief, nonprofit burnout, and how the hell you decide which families get help and which don't. Also: AOL handles, John Hughes, and letters from strangers that make you cry. Erica is part Punky Brewster, part Rosie the Robot, and part Lisa Simpson—with just enough GenX Long Island sarcasm to make it all land. This one sticks.RELATED LINKSPinky Swear FoundationThe Mastectomy I Always Wanted (Book)Erica on LinkedInThink & Link: Erica Campbell“Like the Tale of a Starfish” - Blog Post“Cancer Diagnosis, Messy Life, Financial Support” - Blog PostFEEDBACKLike this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship inquiries, email podcast@matthewzachary.com.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Allyson with a Y. Ocean with two Ls. And zero chill when it comes to changing the face of cancer care. Dr. Allyson Ocean has been quietly—loudly—at the center of every major cancer breakthrough, nonprofit board, and science-backed gut punch you didn't know you needed to hear. In this episode, she joins me in-studio for a conversation two decades in the making. We talk twin life, genetics, mitochondrial disease, and why she skipped the Doublemint Twins commercial but still ended up as one of the most recognizable forces in oncology. We cover her nonprofit hits, from Michael's Mission to Let's Win Pancreatic Cancer to launching the American Jewish Medical Association—yes, that's a thing now. We get personal about compassion in medicine, burnout, bad food science, and microplastics in your blood. She also drops the kind of wisdom only someone with her résumé and sarcasm can. It's raw. It's real. It's the kind of conversation we should've had 20 years ago—but better late than never.RELATED LINKS:– Dr. Allyson Ocean on LinkedIn– Let's Win Pancreatic Cancer– NovoCure Leadership Page– Michael's Mission– American Jewish Medical Association– The POLG Foundation– Cancer Buddy App (Bone Marrow and Cancer Foundation)– Dr. Ocean at OncLiveFEEDBACK:Like this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship inquiries, email podcast@matthewzachary.com.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
Sponsored by Invivyd, Inc.Nobody wants to hear about COVID-19 anymore. Especially not cancer patients. But if you've got a suppressed immune system thanks to chemo, radiation, stem cell transplants—or any of the other alphabet soup in your chart—then no, it's not over. It never was. While everyone else is getting sweaty at music festivals, you're still dodging a virus that could knock you flat.In this episode, Matthew Zachary and Matt Toresco say the quiet part out loud: many immunocompromised people may not even know they have options beyond vaccines. Why? Because the system doesn't bother to tell them. So we're doing it instead. We teamed up with Invivyd to help get the word out about tools other than vaccines that can help prevent COVID-19. We break down the why, the what, and the WTF of COVID-19 risk for cancer patients and why every oncologist should be talking about this.No fear-mongering. No sugarcoating. Just two guys with mics who've been through it and want to make sure you don't get blindsided. It's fast, funny, and furious—with actual facts. You've got more power than you think. Time to use it.RELATED LINKSExpand Their OptionsInvivydMatt Toresco on LinkedInOut of Patients podcastFEEDBACKLike this episode? Rate and review Out of Patients on your favorite podcast platform. For guest suggestions or sponsorship inquiries, email podcast@matthewzachary.com.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.
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