Homdutt Sharma

MD- Internal Medicine, DM -
Clinical Hematology (AIIMS Delhi)

Consultant- Hemato-oncology and BMT Physician

[Prantar Chakrabarti 3.0 @prantar]

Is the @AyushmanNHA even aware that there is a species of #hematooncologists who treat the most difficult cancers ie. #bloodcancers ? Do you want us to stop treating blood cancers by issuing such stupid notifications? We can assure you that we will have more peaceful lives. Don't forget that we have treated even prime ministers of this country who had multiple myeloma. It is high time that @PMOIndia @MoHFW_INDIA @NMC_BHARAT take a decision regarding #hematooncology #tumorboard . Will @ishbtish please stand up? @DrRahulBhargav1 @DrPMPGI @drtulikahemat @mathewsvikram

[Aman Dubey @Amandud2]

Rahul Gandhi says Modi & the ECI should prove they aren’t doing “Vote Chori.”

An uncle had a hilarious counter-question for him: “I have a feeling Rahul Gandhi isn’t Rajiv Gandhi’s son. Now let Rahul Gandhi prove that he is!” 😹😂

[Vincent Rajkumar @VincentRK]

Please for heavens sake DON’T put your patients at risk. I recommend both Daratumumab based therapy and plasma exchange for acute light chain cast nephropathy specially in newly diagnosed myeloma.

These papers which mix up patients cause me more problems. Dara VCd plus plasma exchange is the best therapy for acute light chain cast nephropathy. If you treat patients with some other cause for renal failure with this approach it won’t help. If you have a doubt on the diagnosis of acute light chain cast nephropathy, renal biopsy will be needed.

If you start therapy late when the renal failure has been there for over a month therapy won’t work. If you give suboptimal therapy (Dara alone etc) you cannot hope for the plasma exchange to work. If you give Dara based therapy without plasma exchange you can’t hope for renal recovery quickly because it takes 2-4 weeks for the therapy to work and in that time the kidney is getting damaged. You need BOTH in a timely manner.

[Suprvirat @MostlyKohli]

Abhijeet Dipke keeps getting exposed by the media 🚨

Abhijeet Dipke - Police is so scared and coward that they sent female officers to detain us

Reporter - So you think female officers are weak? Female officers are more than capable of detaining many like you

Abhijeet Dipke - That's not what I meant. Modi police didn’t even let me talk to my relatives or parents. They’re not even showing the clip where I asked for my phone

Reporter - Your friend Ashutosh Ranka said Police didn’t let you talk to your cousins. Your family said you didn’t receive any such news. You never came on camera or even tweeted that both of them were wrong. Delhi Police had informed you and also gave you a chance to talk to your cousins, but you refused. Isn’t this manipulation?

Abhijeet Dipke - I get it, you’re paid by Godi media. Don't make this obvious

Reporter - I’m just a true journalist. If they hadn’t recorded you, you could’ve spread the agenda that they didn’t even let you talk to your parents. And if they’re arranging a flight for you, doesn’t that mean you can straightaway meet your family? How come a phone became more important than family? Reality is you just wanted sympathy around this scenario

Abhijeet Dipke got triggered and had no factual reply to counter this reporter. He literally exposed his entire narrative to portray the police as villains in front of the public 🙏

[Vincent Rajkumar @VincentRK]

A tribute to Bob Kyle shown today at the Annual Meeting of the International Myeloma Society. #IMS26 #IMS2026
A role model and inspiration to many. Bookmark!

We will miss him. @Myeloma_Society @IMFmyeloma @Myeloma_mSMART

[Reform India @ReformMov_India]

तेलंगाना में 1 स्कोर वाला Orthopaedics में एडमिशन पा रहा है, राजस्थान में -9 स्कोर वाला शिक्षक बनने जा रहा है।

ऐसे कैसे हम विश्वगुरु बनेंगे? 🤔
एक Gen Z बस इतना पूछ रही है ?

[Anuradha Tiwari @talk2anuradha]

> Got Reservations in MBBS admission
> Got a waiver in admission fees
> Got same books & teachers
> Yet could only score 1/800 in NEET PG
> Got MS Ortho seat

What an absolute joke !

[Homdutt Sharma @HomduttSharma]

@AshokShrivasta6 @abhijeet_dipke

[Homdutt Sharma @HomduttSharma]

@abhijeet_dipke Dekho...kuchh karo....Hit karo

[The Analyzer (News Updates🗞️) @Indian_Analyzer]

🚨 SHOCKING 🚨

A girl who scored 299.175 out of 300 in the Jharkhand PGT exam still remained UNSELECTED 🤯

“What more should a student do to get selected?” she asks.

[Nehra Ji @nehraji778]

"छात्र गेंग बनाकर पेपर लीक करते है "

"पेपर लीक के जिम्मेदार छात्र खुद है "

-- CM अशोक गहलोत 2022 मे

कॉंग्रेस शासन मे पेपर लीक के जिम्मेदार--- छात्र

BJP शासन मे जिम्मेदार --शिक्षा मंत्री

--बेशर्मी की पराकाष्ठा पार कर चुके है

[Homdutt Sharma @HomduttSharma]

@worshipVK ye log cockroach nahi dimak hai...desh ko khaa rahe hai

[Dr. Chokri Ben Lamine @abouabdrahman0]

🩸 Romiplostim in Severe Aplastic Anemia (SAA)

📚 2026 comprehensive review: 19 studies involving >390 adults and children.

🔬 Mechanism
Romiplostim is a weekly injectable TPO-receptor agonist that stimulates primitive hematopoietic stem/progenitor cells → multilineage recovery, not merely platelet production.

📈 Clinical efficacy

✅ Hematologic response: 41–95%
✅ Trilineage recovery: up to 55%
✅ Transfusion independence achieved in many responders
✅ Responses may deepen beyond 6 months—do not declare failure too early
✅ Activity retained after eltrombopag failure, suggesting incomplete cross-resistance

💉 Dose matters

🔹 Most effective studies started at 10 µg/kg SC weekly
🔹 Titration up to 20 µg/kg/week was often required
🔹 Lower-dose cohorts showed substantially poorer responses

🎯 Best predictors of response

🕐 Shorter duration from diagnosis
🔴 Higher baseline reticulocyte count
🟣 Higher baseline platelet count
⚡ Earlier initiation appears preferable to late salvage

🆕 Frontline setting

Romiplostim + ATG/CsA achieved:

🔸 Adults: ORR approximately 76.5% at week 27
🔸 Children: ORR 89.5%, with 75% of initially transfusion-dependent patients becoming transfusion-independent

🔁 R/R SAA

High-dose romiplostim produced responses exceeding 70% in several cohorts—including patients refractory/intolerant to eltrombopag.

⚠️ Safety & monitoring

Generally well tolerated, but clonal risk is low—not zero: isolated MDS/clonal-expansion events occurred.

🔍 Long-term surveillance should include CBC/smear, marrow morphology and cytogenetics/appropriate molecular testing.

💡 Take-home: Romiplostim is a valuable SAA option, particularly in refractory or eltrombopag-intolerant disease. Frontline use is promising, but optimal combinations, duration and comparative efficacy still require prospective trials.

📖 Saleh et al. Annals of Hematology, 2026⁠

#AplasticAnemia #Romiplostim #TPO_RA #Hematology #BoneMarrowFailure

[Homdutt Sharma @HomduttSharma]

@nihardesai89 @ASH_hematology @docakx Acute chest syndrome.
nRBC--? sequestration

[Homdutt Sharma @HomduttSharma]

@nihardesai89 @UHN @pmcancercentre @UofT @PanktiMehta24 Congratulations Sir

[Dr. Chokri Ben Lamine @abouabdrahman0]

💊 Posaconazole in Hematology 🩸🍄

🛡️ Posaconazole (Noxafil®) is a broad-spectrum triazole antifungal with potent activity against:
🍄 Aspergillus spp.
🍄 Candida spp. (including many azole-resistant isolates)
🍄 Mucorales (Mucormycosis) – one of the few azoles with activity
❌ No activity against Pneumocystis jirovecii (requires TMP-SMX or alternative prophylaxis).

👥 Who should receive prophylaxis?
✅ AML/MDS during intensive induction or re-induction chemotherapy
✅ Allogeneic HSCT recipients with acute or chronic GVHD requiring significant immunosuppression
✅ Selected prolonged severe neutropenia (>7–10 days)
✅ Other very high-risk hematology patients based on institutional protocols.

💉 Dosing
🔹 Delayed-release tablets (preferred):
➡️ 300 mg PO BID on Day 1
➡️ Then 300 mg PO once daily

🔹 IV:
➡️ 300 mg IV BID on Day 1
➡️ Then 300 mg IV daily

🔹 Oral suspension (less preferred due to variable absorption):
➡️ 200 mg PO TID with a high-fat meal.

📈 Therapeutic Drug Monitoring (TDM)
🎯 Prophylaxis target trough: ≥0.7 mg/L
🎯 Treatment target trough: ≥1–1.25 mg/L (many experts aim >1.25–1.5 mg/L for invasive disease)
🕒 Check trough after 5–7 days, after dose/formulation changes, or if absorption is uncertain.

⚠️ Major drug interactions (CYP3A4 inhibitor)
🚫 Tacrolimus: reduce dose ~66–75%; monitor levels frequently
🚫 Cyclosporine: reduce ~25–50%
🚫 Sirolimus: generally contraindicated
🚫 Venetoclax: reduce dose by ≥75% during concomitant use
🚫 Midazolam, fentanyl, oxycodone, many statins: increased exposure
🚫 QT-prolonging drugs: use caution
🚫 Avoid rifampin, carbamazepine, phenytoin, St John’s wort (markedly reduce posaconazole levels).

🩺 Monitoring
🧪 LFTs before and during therapy
🧪 Electrolytes (K, Mg, Ca)
🧪 QTc on ECG in high-risk patients
🧪 Drug levels (TDM)
🧪 Calcineurin inhibitor/mTOR inhibitor levels if co-administered.

⚠️ Adverse effects
🤢 Nausea, vomiting, diarrhea
🧫 Hepatotoxicity
❤️ QT prolongation (rare torsades)
🩸 Hypertension and hypokalemia
🧂 Rare pseudohyperaldosteronism (hypertension + hypokalemia + metabolic alkalosis)
🫀 Rare adrenal steroidogenesis interference.

🍽️ Administration pearls
✅ Delayed-release tablets can be taken with or without food (food may improve absorption slightly)
✅ Oral suspension must be taken with food or nutritional supplements
❌ Do not interchange tablet and suspension milligram-for-milligram.

📚 Evidence
🏆 Posaconazole significantly reduces invasive fungal infections and improves overall survival compared with fluconazole/itraconazole in AML induction chemotherapy and in allogeneic HSCT patients with GVHD, making it the preferred prophylactic azole in most international guidelines.

📖 Key references
• Cornely OA, et al. Posaconazole vs fluconazole/itraconazole for prevention of invasive fungal infections in neutropenic patients. N Engl J Med. 2007;356:348–359.
• Ullmann AJ, et al. Posaconazole vs fluconazole for prophylaxis in GVHD. N Engl J Med. 2007;356:335–347.
• Maertens JA, et al. ECIL-10 Guidelines for antifungal prophylaxis in leukemia and HSCT. 2025.
• NCCN Prevention and Treatment of Cancer-Related Infections Guidelines⁠
• IDSA Aspergillosis Guidelines (updated guidance)⁠

[𝗔𝘀𝗵𝘂𝘁𝗼𝘀𝗵 𝗕𝗿𝗶𝗷𝘄𝗮𝘀𝗶 @VedicAshutosh]

काकरोचों के सरगना की पोल खोल दी😅

[Lala @LalaXd]

Dancer Dahiya trapped by this reporter 🔥

He abused Hinduism during the protest. But when asked about another religions, he said, ‘talk only about the protest’🤡🤡🤡

[𝗔𝘀𝗵𝘂𝘁𝗼𝘀𝗵 𝗕𝗿𝗶𝗷𝘄𝗮𝘀𝗶 @VedicAshutosh]

हर कोई काकरोच जनता पार्टी की पोल खोले दे रहा है😂

[Praffulgarg @praffulgarg97]

Sita ji ke pati ka naam lekar, Neeta ji ke pati ki sunte hain - Kunal Kamra and Abhjit Dipkee clapping laughing while Sonam ji is on 18th day of protest! Good man in a bad company! Government should have a dialogue with him immediately!

[THE JAT ASSOCIATION @Jatassociation]

धीरे धीरे सारी परतें खुल रही हैं की दिल्ली जंतरमंतर पर छात्रों के नाम पर जो सड़क घेरो अभियान चल रहा है |

असल में यह छात्रों का आंदोलन नहीं बल्कि दुनिया भर के हिंदुत्व विरोधिओं का अंतिम गठबंधन है |

जिस आंदोलन में छात्रों को छोड़ कर मीठे फीके और मवा लि सब मौजूद हैं |