Nicolas Stocker

MD, PhD | Hematologist at Saint-Antoine Hospital, Paris, France. @HopSaintAntoine @aphp @Sorbonne_Univ_ @crsa_paris

[Uriel Suárez @UsuarezMD]

Updated consensus guidelines for the diagnosis and management of patients with hairy cell leukemia (HCL) and HCL-variant | Blood | American Society of Hematology https://t.co/dgw2A2kqcG

[Blood Journals Portfolio @BloodPortfolio]

"How to determine the optimal duration of anticoagulation for VTE: an evidence-based decision-analytical approach" read the full study in Blood Advances: https://t.co/7WPh19UMRF #VTE #BloodAdvances

[Raul Cordoba, MD, PhD @DrRaulCordoba]

#Hematology Pirtobrutinib, a highly selective, noncovalent (reversible) BTKi in R/R marginal zone #lymphoma: phase 1/2 BRUIN study #lymsm https://t.co/xWd2ZSV4s7

[Mostafa Faisal @MostafaFaisal14]

First-Line Treatment of IGHV-Unmutated Chronic Lymphocytic Leukemia: A Network Meta-Analysis of Targeted and Chemoimmunotherapy Regimens
https://t.co/nBm9AQvOQN

[Raul Cordoba, MD, PhD @DrRaulCordoba]

#Hematology Treatment-related outcomes and patterns of relapse in secondary CNS involvement by large B-cell #lymphoma #lymsm https://t.co/zPadcvvfKW

[Mike Thompson, MD, PhD, FASCO @mtmdphd]

Fostamatinib [Syk inhib] effectiveness and safety for immune thrombocytopenia in clinical practice [August 8, 2024] @tomasjosegonza2 et al. @BloodPortfolio
https://t.co/wrctRVBZsJ #ITP 79% RR, 53.6% CR

[Dr. Chokri Ben Lamine @abouabdrahman0]

🔥 HLH Response Criteria & Treatment Pearls

🔬 How to Know if HLH is Responding to Treatment?

🩸 Clinical Improvement
✨ Defervescence within 48–72 hours
✨ Reduction in hepatosplenomegaly
✨ Improvement in organ dysfunction (liver, CNS, lungs)
✨ Stabilization of hemodynamics and reduced ICU support

📉 Laboratory Indicators of Response
✅ Ferritin: Decrease by ≥50% within 1–2 weeks
✅ Triglycerides: Declining levels toward normal
✅ Fibrinogen: Rising toward normal (>150 mg/dL)
✅ Cytopenias: Recovery of ANC, Hb, and platelets
✅ Transaminases & Bilirubin: Progressive normalization
✅ LDH & CRP: Downward trend
✅ sCD25 (Soluble IL-2 Receptor): Significant decline
✅ NK-cell activity: Improvement when measurable

🚨 Poor Response / Refractory HLH
❌ Persistent fever beyond 3–5 days
❌ Rising or persistently elevated ferritin (>10,000 ng/mL)
❌ Worsening cytopenias or organ failure
❌ Progressive CNS involvement
❌ Lack of improvement after 2 weeks of therapy

⸻

💊 HLH Treatment with Dosing

📘 HLH-94 / HLH-2004 Protocol
💉 Dexamethasone
•Weeks 1–2: 10 mg/m²/day
•Weeks 3–4: 5 mg/m²/day
•Weeks 5–6: 2.5 mg/m²/day
•Week 7: 1.25 mg/m²/day
•Week 8: Taper and discontinue

💉 Etoposide
•150 mg/m² IV twice weekly for the first 2 weeks
•Then 150 mg/m² weekly thereafter

💉 Cyclosporine A
•3–6 mg/kg/day
•Target trough: 200–400 ng/mL

🧠 CNS Involvement
•Intrathecal Methotrexate ± Hydrocortisone

⸻

🧬 Salvage and Targeted Therapies

🧪 Anakinra (IL-1 inhibitor)
•2–10 mg/kg/day SC or IV
•Up to 100–200 mg every 6–12 hours in severe cases

🧪 Ruxolitinib (JAK1/2 inhibitor)
•Adults: 5–10 mg orally twice daily

🧪 Emapalumab (Anti–IFN-γ)
•1 mg/kg IV twice weekly, titrated up to 10 mg/kg

🧪 Tocilizumab (IL-6 inhibitor)
•8 mg/kg IV for cytokine-driven HLH/macrophage activation

🧬 Definitive Therapy
🏆 Allogeneic HSCT for familial or refractory HLH

⸻

📊 Monitoring Schedule

📅 Daily
🔹 CBC, ferritin, liver enzymes, coagulation profile

📅 Twice Weekly
🔹 Fibrinogen, triglycerides, LDH

📅 Periodic
🔹 sCD25, NK-cell activity

⸻

📝 MCQ

❓ Which parameter best reflects early response to HLH therapy?
A) Hemoglobin level
B) Platelet count
C) Ferritin trend
D) ESR

✅ Correct Answer: C) Ferritin trend
📚 Ferritin decline correlates strongly with treatment response and prognosis.

⸻

🎓 OSCE Scenario

👨‍⚕️ A patient with HLH shows persistent fever and ferritin of 25,000 ng/mL after 7 days of therapy.
Next Step:
➡️ Escalate therapy with ruxolitinib or anakinra and reassess for refractory HLH while optimizing etoposide dosing.

⸻

📚 Key References

🔗 HLH-94 Treatment Protocol
https://t.co/QbfEPwmonh

🔗 Histiocyte Society Guidelines
https://t.co/R7eHWo20Wu

🔗 ASH Recommendations for HLH
https://t.co/tJ9p4fhZaP

🔗 Emapalumab Approval Study
https://t.co/fIz5AMlAsf

🔗 Consensus Guidelines for HLH in Adults
https://t.co/gqa4JSPXxH

#HLH #HemophagocyticSyndrome #Hematology #CriticalCare #CytokineStorm #MedTwitter

[AML Hub @AML_Hub]

New publication 📝 Phase II RELAZA2 final long-term results, published in @BloodPortfolio, show 63% of patients with MRD‑positive MDS/AML in CR/CRi were relapse-free 6 months after azacitidine initiation (p < 0.0001).

Learn more: https://t.co/KQuNjxEtgC

#AML #AMLsm #MedNews #MedEd

[Haute Autorité de santé @HAS_sante]

COLUMVI (glofitamab) avis favorable au remboursement uniquement en monothérapie dans le traitement du #lymphome diffus à grandes cellules B réfractaire ou en rechute après au moins 2 lignes de traitement systémique et en échec...
https://t.co/QyfDZagHpV

[Uriel Suárez @UsuarezMD]

Marginal Zone Lymphoma: 2026 Update on Diagnosis and Management - PubMed https://t.co/cGbCLcTYFL

[Uriel Suárez @UsuarezMD]

CAR T-cells vs. BsAb in R/R FL #EBMT26 @TheIACH @Mohty_EBMT @TheEBMT

[Rémy Duléry @RemyDulery]

Delighted to present at #EBMT26 our collaborative work on behalf of @TheEBMT Lymphoma Working Party.

In this large real-world study of CAR T in R/R PMBCL, outcomes favorable:
✅2y OS 75.5%, PFS 58.4%
✅2y RI 36.3%, NRM 5.3%
✅Outcomes mainly driven by disease status at infusion

[NEJM @NEJM]

In untreated chronic lymphocytic leukemia, fixed-duration venetoclax-based regimens were noninferior to continuous ibrutinib with regard to 3-year progression-free survival and were associated with higher MRD-negative rates. Full phase 3 CLL17 trial results and Research Summary: https://t.co/EQfrJ06UXj

[Raul Cordoba, MD, PhD @DrRaulCordoba]

#Hematology Older patients with LBCL #lymphoma show comparable outcomes to younger patients and product-specific profiles in #CARTcell therapy #lymsm https://t.co/rKRcghQYpu

[Mohamad Mohty @Mohty_EBMT]

Warmest congratulations to Prof. Eolia Brissot on her election as Chair of ⁦@TheEBMT⁩ Acute Leukemia Working Party. A well-deserved recognition of her remarkable expertise, dedication, and leadership in advancing the field. The ALWP will continue to thrive!
@theIACH

[Benlazar S M A @smbenlazar]

Marginal Zone Lymphoma: 2026 Update on Diagnosis and Management https://t.co/XOAnwuJZWm #lymsm

[MaaT Pharma @MaaT_Pharma]

Day 2 at @TheEBMT!
A key day for MaaT Pharma in Madrid, marked by strong engagement with the medical community.

🎤 Highlight of the day:
Prof. @Florent_Malard presented the final results from the Phase 3 ARES trial evaluating MaaT013 in gastrointestinal aGvHD during the Presidential Plenary Session. He also took part in a workshop on the current state of microbiota transfer in allo-HCT, suggesting the growing interest in microbiota-based therapeutic approaches.

📊 Our Phase 2b PHOEBUS trial evaluating MaaT033 in allo-HSCT was also heavily discussed during a dedicated poster session generating strong interactions with investigators and clinicians .

🔜 Looking ahead to Day 3: don’t miss our CHRONOS poster presentation, and feel free to stop by booth 49 to meet the team and discuss!

@HAffagard @Mohty_EBMT
#EBMT26

[Andrés Bonilla @linfoblastosabs]

Management algorithm for mantle cell lymphoma given by Dr. Dreger #EBMT26

[Ben Derman @bdermanmd]

CNS myeloma is a challenging and rare diagnosis, and there's not much data to guide us on the best management. The NCCN guidelines have been updated to include recommendations for diagnosis and management on this entity, and @crdangelo9 led an effort to put this in manuscript form!