Pauli MD

M.Interna-Hematología-Especialista en Trasplante de Progenitores Hematopoyéticos -HECAM-CIEHEM

[Pauli MD @mdpauli]

@Salud_Ec @Salud_Ec @fabriciovelav @federacion médica

[Ronak H. Mistry, DO @rmistry91]

#ICYMI: the long-awaited updated @ASH_hematology #ITP guidelines are here!

With so many new agents for managing ITP, I’m excited for these recs to better help our patients achieve durable platelet responses and improved QOL

Link: https://t.co/QY57AsYnBE

[Benlazar S M A @smbenlazar]

First line treatment of mantle cell lymphoma : EHA guide lines #lymsm

[Dr. Arkadip MD @pathognosis22]

Hey! A short illustration on the approach of #lymphoma! Hope it may help! #pathology #pathresident #pathognosis

[Henry C Fung| MM, lymphoma, leukemia & CART @HenrychihangFu1]

Cardiac AL Amyloidosis = Hematologic EMERGENCY 🆘

Not just deposition — it’s toxin-mediated cardiomyopathy on a ticking clock

Key points:
• Confirm AL → type the amyloid (don’t confuse with ATTR)
• Light chains = direct cardiotoxins
• Stage for prognosis — don’t delay treatment
• EKG + Echo mismatch = infiltrative clue
• Response is graded → depth and speed matter
• Real-world therapy is often diluted → prolonged toxicity

Treat like AML. Act now.

Outcome depends on:
• how FAST LC falls
• how DEEP NT-proBNP falls
• how LONG patient stays toxic

Time above toxic light chains determines survival

✍️ Dr Fun + G

#Amyloidosis #Myeloma #Hemetwitter

[Henry C Fung| MM, lymphoma, leukemia & CART @HenrychihangFu1]

💣 AZA + VEN doesn’t fail—execution does.

Day 21 marrow decides everything.
Shorten VEN, not AZA.
Don’t wait for perfect counts.

Here’s how we induce AML in 2026 👇

Please let us know your approach.

#AML #HemeTwitter

Dr Fun + G

[Benlazar S M A @smbenlazar]

How I select hematopoietic cell donors in the era of posttransplant cyclophosphamide https://t.co/icJEKdWB44

[Dr. Chokri Ben Lamine @abouabdrahman0]

🩸 Von Willebrand Disease (vWD) – Type 1 vs Type 2 vs Type 3
Adult hematology high-yield comparison 👇

⸻

🟢 Type 1 – Partial Quantitative Deficiency (~70–80%)

📉 vWF ↓ proportionally
🧪 vWF:Ag ↓
🧪 vWF activity (GPIb/ristocetin) ↓ (parallel to Ag)
🧪 FVIII normal or mildly ↓
🧫 Multimers: normal distribution
🧬 AD inheritance
🩸 Mild mucocutaneous bleeding
💊 Responds well to DDAVP

🎯 Most common & usually mild

⸻

🟡 Type 2 – Qualitative Defect (~20–25%)

🔬 vWF present but dysfunctional
🧪 vWF:Ag normal or mildly ↓
🧪 vWF activity ↓ more than Ag (ratio <0.7 ⚠)
🧫 Multimers abnormal (except 2N)
🧬 Usually AD (except 2N AR)
🩸 Variable severity

Subtypes 👇

🔹 2A – Loss of high-molecular-weight multimers
🔹 2B – ↑ platelet binding → thrombocytopenia
🔹 2M – ↓ function, multimers normal
🔹 2N – ↓ FVIII binding → mimics mild hemophilia A

💊 DDAVP response variable (avoid in 2B ⚠)

⸻

🔴 Type 3 – Severe Quantitative Deficiency (<5%)

🚫 vWF nearly absent
🧪 vWF:Ag undetectable
🧪 vWF activity undetectable
🧪 FVIII markedly ↓ (may resemble moderate–severe hemophilia A)
🧫 Multimers absent
🧬 AR inheritance
🩸 Severe bleeding (joint/muscle bleeding possible)

💊 Requires vWF-containing concentrates
🚫 DDAVP ineffective

⸻

📊 Quick Memory Pearl

🟢 Type 1 = Less
🟡 Type 2 = Wrong
🔴 Type 3 = None

⸻

🧠 OSCE Pearl

If:
• vWF activity << vWF Ag → think Type 2
• Very low FVIII + low vWF → Type 3
• Mild ↓ both equally → Type 1

⸻

💎 Practical Lab Clues

📌 Always check:
✔ vWF:Ag
✔ vWF activity (GPIb or RCo)
✔ FVIII
✔ Activity/Ag ratio
✔ Multimers when Type 2 suspected

⸻

Guidelines:
• ASH ISTH NHF WFH 2021 VWD Guidelines
https://t.co/6EnSsQesbI
• ISTH SSC consensus on VWD classification
https://t.co/NDDGz750ih

High-yield board & clinical distinction ⚡

[Dr Rishabh Jain @DrRishabhOnco]

🎬 T-ALL: The “T-cell that never graduates” story! 🧬🎓

Inside the thymus, every T-cell goes to “Thymic High School.”

T-ALL happens when one of them drops out early!

Let’s meet our 3 troublemakers in this thread 👇
(1/4)

@RanjitKSMD
@ASCO @myESMO @EricTopol @OncoAlert @NCIcancer @VPrasadMDMPH @ASH_hematology

#OncoTwitter #PathTwitter #Leukemia #HemePath #MedEd

[Dr. Chokri Ben Lamine @abouabdrahman0]

🧬 DLBCL Relapse >12 Months Post R-CHOP — Second-Line Therapy

💡 Correct Answer: D – R-ICE chemotherapy, if responds followed by auto-SCT

🔹 32-year-old male with non-GCB DLBCL relapsed 18 months post-RCHOP → late relapse.
🔹 For late relapses (>12 mo), standard approach = salvage chemo (R-ICE, R-DHAP, R-GDP) → if responsive → autologous SCT.
🔹 CAR-T (Axi-cel/Tisa-cel) reserved for primary refractory or early relapse (<12 mo).
🔹 Tafasitamab + Lenalidomide used for non–transplant-eligible or relapsed/refractory post–2L setting, not curative here.
🔹 Thus, curative intent = R-ICE → auto-SCT.
🔹 If fails to respond → proceed to CAR-T therapy.
📚 Source: Best Practices in Hematology I — Dr. Jeremy Abramson, Massachusetts General Hospital / GW Cancer Center.
#DLBCL #RICE #AutoSCT #CAR_T #Lymphoma #HemaFellows #ESH #EmiratesHematologySociety

[Dr. Chokri Ben Lamine @abouabdrahman0]

NCCN 2026 – CML: Discontinuation of TKI Therapy

📌 General Principles

✅ TKI discontinuation safe in selected CP-CML pts

💬 Shared decision with CML specialist on risks/benefits & TKI withdrawal syndrome

⚠️ Avoid if ever had AP-CML or BP-CML
⚠️ Avoid if MMR not regained within 3 mo after restart
🧬 Requires more frequent molecular monitoring than during TKI use
👩‍⚕️ Consider only if all eligibility criteria met
🧾 Eligibility Criteria for TKI Stop
📈 CP-CML only (no prior AP/BP phase)

💊 ≥3 yrs on approved TKI (imatinib, dasatinib, nilotinib)

🔬 Documented quantifiable BCR::ABL1 transcript

🟢 Stable deep molecular response (MR4; BCR::ABL1 ≤0.01% IS) for ≥2 yrs
 – confirmed by ≥4 tests, ≥3 mo apart
🧪 Reliable qPCR lab with sensitivity to MR4.5
⏱️ Frequent PCR monitoring
 – q1–2 mo in first 6 mo post-stop
 – q2 mo during months 7–12
 – q3 mo thereafter if remains in MMR (≤0.1% IS)
🔁 If Molecular Relapse (loss of MMR)
🔴 Restart TKI within 4 weeks
📈 Monitor monthly until MMR regained, then q3 mo
♻️ If not regained by 3 mo ➡️ continue TKI & test for BCR::ABL1 KD mutation
⏳ Continue TKI for ≥6 mo before considering second stop attempt
⚠️ Do NOT Attempt TFR
If ever in AP-/BP-CML

If not in sustained DMR ≥2 yrs

If no access to standardized high-sensitivity qPCR

If patient unwilling/unable for frequent monitoring
📌 Key Notes
💡 Evidence for TFR strongest with imatinib, dasatinib, nilotinib
🟢 Patients in MR4 at ≥2 yrs likely eligible (based on EURO-SKI, STIM trials)

🚫 Patients with high Sokal risk, prior resistance, or low NK cells less likely to maintain TFR

#CML #NCCN2026 #TKI #TFR #MR4 #BCRABL1 #Oncology

[Ahmed Kotb @AhmedKo45911157]

🤰🩸 ASH guidance: thromboprophylaxis in pregnancy w/ thrombophilia
✅ Homozygous FVL or combined FVL+PGM → antepartum + postpartum
✅ Antithrombin, Protein C/S deficiency → postpartum (if +FH)
❌ Heterozygous FVL/PGM → no routine prophylaxis
#ASH #VTE

[Ahmed Kotb @AhmedKo45911157]

🧪 Thrombophilia testing pitfalls
⚠️ False ↓ PC/PS/AT in: acute VTE, heparin, warfarin, pregnancy, liver disease, chemo
💊 DOACs affect functional assays → confirm assay type
👉 Always interpret results in clinical context
#ASH #VTE

[Ahmed Kotb @AhmedKo45911157]

🔄 R/R LBCL (2025)
🧪 Biopsy first
⏱️ &lt;12m: CAR-T (axi/liso) ➝ if not: Glofitamab+GemOx/2L Tx
⏱️ &gt;12m: Tx eligible ➝ Immuno-chemo + HDT/ASCT | if not: Glofitamab+GemOx/2L Tx
3L+: CAR-T, bispecifics, tafasi-LEN, Pola-BR

#DLBCL #Lymphoma #CAR_T #HemaSphere2025

[Ahmed Kotb @AhmedKo45911157]

🧾1L LBCL Treatment Algorithm 2025
🔹0 RF:R-CHOP×4(bulky➝×6)
🔹1 RF:R-CHOP×6
🔹≥2 RF:Pola-R-CHP×6
🧠High CNS risk➝HD-MTX
⚡Double/Triple hit➝intensive regimen(DA-EPOCH-R,etc)
🎯PMBCL➝R-CHOP14/ DA-EPOCH-R
💪Frail/elderly➝R-miniCHOP or alternatives
🧬Tailored for CNS,testicle

[Benlazar S M A @smbenlazar]

A proposed treatment algorithm of patients with HR-MDS in 2025 https://t.co/KQQDYZD5Jl #mds @Dr_AmerZeidan

[Benlazar S M A @smbenlazar]

A proposed treatment algorithm of patients with LR-MDS in 2025 https://t.co/KQQDYZDDyT #mds @Dr_AmerZeidan

[Pauli MD @mdpauli]

@MargaritaRobell @cubalondra Típica tonta sin argumentos, por eso tu ataque cobarde es burlarte

[Ahmed Kotb @AhmedKo45911157]

🧫 Infection risk in CAR T-cell therapy:

Early (&lt;30d): Bacteria, fungi ➡️ Fluoroquinolones, antifungals

Prolonged (30–90d): Viruses 🦠

Late (&gt;90d): Reactivations (HSV/VZV)

Prophylaxis: Antiviral, antifungal, G-CSF, IVIG 💉
#CAR-T #ASH24

[Pauli MD @mdpauli]

@ecuainm_oficial Y los hospitales reagendar a toda esa gente que viene esperando turno tanto tiempo quimioterapias de hospital de día suspendidas ?