In this episode, Anthony and Bernie are joined by the great Dr. Bixby to discuss the difficulties in the diagnosis and treatment of acute leukemias of mixed or ambiguous lineage (ALAL/MPAL).

We discuss:

- Diagnostic uncertainties and how the criteria for diagnosis have changed over the years

- Data behind the optimal treatment of MPAL and uncertainties in the literature

- Promising data for the FLAG-VIPR hybrid regimen and other novel treatment strategies

In this episode, Bernie and Anthony are joined by Myeloma Man Manni Mohyuddin, MD to discuss the debate surrounding the treatment of first relapse in multiple myeloma. Should we be using CAR-T? Bispecifics? How does the new mezigdomide data from ASCO 2026 inform our practice? Listen in for a spicy discussion!

Articles discussed:

• Nature Reviews Commentary: https://www.nature.com/articles/s41571-026-01159-6
• CARTITUDE-4: https://www.nature.com/articles/s41571-026-01159-6
• MajesTEC-3: https://www.nejm.org/doi/full/10.1056/NEJMoa2514663

• MajesTEC-9: https://www.nejm.org/doi/abs/10.1056/NEJMoa2603870
• Control arms in multiple myeloma trials: https://ashpublications.org/bloodadvances/article/doi/10.1182/bloodadvances.2026020329/567836/Improving-Control-Arms-in-2026-U-S-Myeloma-Trials
• Predictors for CAR T cell therapy-associated immune-related adverse events? https://pubmed.ncbi.nlm.nih.gov/41540109/
• Dex prophylaxis for lymphocytosis: https://ashpublications.org/bloodadvances/article/10/10/3629/567462/Dexamethasone-prophylaxis-for-excessive-lymphocyte
• Mezi-KD vs. KD ASCO 2026: https://ascopubs.org/doi/10.1200/JCO.2026.44.17_suppl.LBA7506

“However much we flatter ourselves about our individual rationality, a good story, no matter how analytically deficient, lingers in the mind, resonates emotionally, and persuades more than the most dispositive facts or data.”

Inspired by the article "The impact of cult behavior on haematopoietic cell transplant practices: believers and non-believers" (https://www.nature.com/articles/s41409-021-01473-w), in this episode, Anthony and Bernie are joined by transplant experts Tate Feeney, PharmD, BCOP and Aaron "Papa heme" Goodman, MD, to discuss "cult-like thinking" in hematology and BMT. We discuss why this occurs, go through some provocative examples, and talk about how to identify bias or ”cult-like thinking” in our own practices!

Grab your favorite drink and prepare to join the wolverheme cult!