Episode Description:

In this episode of HemeTalks, we are joined by Neha Mehta-Shah, MD, MSCI, Associate Professor of Medicine at Washington University in St. Louis, to discuss the evolving management of peripheral T-cell lymphomas (PTCL), with a focus on differences by histologic subtype. Through a case-based discussion, Dr. Mehta-Shah explores the diagnostic challenges of PTCL, including the role of repeat biopsies, expert pathology review, and molecular testing. She reviews frontline treatment approaches, including CHOP-, CHOEP-, and brentuximab vedotin-based regimens, and discusses the role of autologous transplantation in first remission. The conversation then turns to relapsed disease, highlighting emerging therapeutic strategies, genomic insights, and consideration of allogeneic transplantation. Listeners will gain practical guidance for managing one of the most challenging groups of hematologic malignancies.

Clinical Perls

1. Peripheral T-cell lymphomas frequently present diagnostic challenges and may require repeat biopsies, specialized hematopathology review, and integration of clinical, morphologic, and molecular findings to establish an accurate diagnosis.
2. Frontline treatment involves an anthracycline backbone regardless of histologic subtype. BV-CHP is the standard of care for ALCL patients based on results of ECHELON-2 which enriched this patient population. Other histologic subtypes have less clear evidence for frontline BV regardless of CD30 status and CHOP or CHOEP are reasonable. The addition of etoposide is less clear and mainly benefits patients younger than 60 years old.
3. In the relapsed or refractory setting, histologic subtype can possibly guide treatment choice. Duvelisib and histone deacetylase (HDAC) inhibitors have shown efficacy for the T follicular helper phenotype which was previously referred to as angioimmunoblastic T cell lymphoma.

This podcast episode is supported by Secura Bio.

In this episode of HemeTalks, we are joined by Mr. Sean Powell as he shares his experiences as a former patient and now patient advocate for a rare blood disorder known as warm autoimmune hemolytic anemia (wAIHA). Sean shares his story of how he was diagnosed, the initial management, drug toxicities, and subsequent investigations that he underwent. Our patient advocate episodes highlight the importance of advocacy, community, and shared understanding between patients and their healthcare providers.

Key Takeaways

1. wAIHA can sometimes be associated with an underlying condition. Mr. Powell’s journey illustrates how wAIHA occasionally occurs alongside other diagnoses, highlighting the value of ongoing clinical vigilance and open communication between patients and their care team.

2. Steroid therapy carries significant side effects that patients are often unprepared for. Mr. Powell experienced severe prednisone toxicities, including rage, insomnia, and extreme hunger, and his hemolysis was only transiently controlled. His experience highlights the need for proactive patient counseling about steroid side effects and the importance of escalating to second-line therapies like rituximab when steroids fail.

3. The emotional and psychological burden of transitioning from active treatment to remission is often underestimated. Even after achieving remission, Mr. Powell faced intense anxiety, isolation, and loneliness — feelings that emerged precisely when formal support structures faded. Routine referrals to behavioral health specialists and survivorship programs should be considered a standard part of care, not an afterthought.

This podcast episode is supported by Johnson & Johnson.

In this episode of Heme Talks, we are joined by Allyson Pishko, MD, MSCE, Classical Hematologist and Assistant Professor of Medicine at the University of Pennsylvania, to discuss a rare blood disorder known as warm autoimmune hemolytic anemia (wAIHA). In this episode, Dr. Pishko shares her approach to diagnosis and management of this disorder, and how she approaches discussions about this diagnosis with her patients. Dr. Pishko also discusses promising future options for patients with wAIHA.

Clinical Perls:

1. Warm autoimmune hemolytic anemia is a complex diagnosis. In addition to a careful history, key lab data to support the diagnosis can include an acute drop in hemoglobin, elevated bilirubin, elevated lactate dehydrogenase (LDH), reduced haptoglobin, an elevated reticulocyte count, and a positive Coombs’ test. Microspherocytes may also be visible on a smear. However, not all patients will present with all of these findings, and it is also important to consider the patient’s comorbid conditions when interpreting labs.
2. Corticosteroids remain the backbone of treatment with a slow taper over many weeks pending clinical improvement. Additional therapies include rituximab and immunosuppressive agents.
3. For refractory patients, additional options to consider agents including fostaminib and rilzabrutinib. Nipocalimab is currently also being reviewed by the FDA.

This podcast episode is supported by Johnson & Johnson.