Hematology Pills

Mattioli Health
  • 5.0 (2)
  • MEDICINE

Hematology Pills is a new format based on monthly discussions between Prof. Robin Foà (Rome) and Dr. Filippo Milano (Seattle). Each episode explores the latest breakthroughs in gene therapy, immunotherapy, and clinical innovation, while addressing also ethical and practical challenges that shape the field. Our podcast offers a clear and compelling look at the evolving landscape of blood disorders and treatments for hematologists, researchers and healthcare professionals. Stay informed, inspired, and connected with Hematology Pills – a source off hematology updates, one episode at a time.

  1. 4D AGO

    AI in Hematology and Beyond: Transforming Diagnostics, Research, and Care – A dialogue between Robin Foà and Filippo Milano

    In this episode, Prof. Robin Foà and Dr. Filippo Milano explore the rapidly expanding role of Artificial Intelligence in medicine, reflecting on a transformation that feels both inevitable and profound. Much like past technological revolutions, AI is already reshaping daily clinical practice—supporting communication, improving academic writing, and streamlining routine tasks—while quietly redefining how physicians interact with information. The discussion moves into concrete clinical applications, from radiology and pathology to hematology, where AI is accelerating diagnostics and enhancing the analysis of complex biological data. Large-scale projects and global datasets are becoming accessible through machine learning, while real-time tools are beginning to assist physicians directly during patient encounters. These advances raise the possibility of more efficient care, improved outcomes, and more precise decision-making. Yet, alongside these opportunities, important concerns emerge. The reliability of AI-generated information, risks to academic integrity, and the protection of sensitive patient data all require careful consideration. Above all, the conversation returns to a central question: how will AI influence the human dimension of medicine? While technology can augment clinical reasoning, the empathy, trust, and personal connection between doctor and patient remain irreplaceable. A balanced and thought-provoking dialogue on the promises and limits of AI—where innovation must evolve hand in hand with responsibility.

    23 min

  2. MAR 19

    Iron Biology Unveiled: Hepcidin, Erythroferrone and the Modern Understanding of Iron Metabolism – A dialogue between Robin Foà, Filippo Milano e Clara Camaschella

    In this episode, Prof. Robin Foà and Dr. Filippo Milano are joined by Dr. Clara Camaschella to explore the evolution of iron metabolism, tracing one of the most elegant and coherent stories in modern hematology. From the early conceptual models of iron regulation to the molecular breakthroughs that defined the field, the discussion reflects on what has been described as a true “golden age” of iron biology. The conversation revisits the fundamental principles of iron homeostasis, highlighting the central role of recycling over absorption and the absence of a regulated excretory pathway—features that make systemic control both essential and uniquely complex. From the pioneering work of Clement Finch to the discovery of HFE and the unraveling of genetic heterogeneity, the speakers guide listeners through the key milestones that shaped current understanding. At the heart of the episode is the discovery of hepcidin, the master regulator of iron metabolism, and the mechanisms that govern its interaction with ferroportin. The dialogue also explores the role of erythroferrone in linking erythropoiesis to iron availability, providing a molecular explanation for long-standing physiological hypotheses and shedding light on conditions such as thalassemia. Despite these advances, therapeutic strategies remain rooted in traditional approaches such as phlebotomy, raising important questions about the translation of molecular insights into clinical practice. Looking ahead, the discussion expands toward emerging fields including ferroptosis, immunity, and the role of iron in cardiovascular biology. A rich and reflective journey through discovery, this episode captures both the clarity and the complexity of iron metabolism—an essential system where biology, genetics, and clinical medicine converge.

    26 min

  3. FEB 20

    The Cost of Progress: Funding, Pharma, and the Future of Hematology – A dialogue between Robin Foà e Filippo Milano

    In this episode, Prof. Robin Foà and Dr. Filippo Milano reflect on a striking paradox: while research has revolutionized hematology over the past decades, the sustainability of this progress is now in question. Innovation has transformed patient outcomes, yet rising costs and shrinking public funding threaten to slow the pace of discovery. The discussion highlights the growing crisis of academic support, from declining NIH grant success rates in the United States to shifting governmental priorities in Europe. As public investment contracts, the pharmaceutical industry has taken a leading role in driving research—reshaping priorities toward larger markets and increasing the financial burden of clinical trials. At the same time, the soaring costs of advanced diagnostics, such as next-generation sequencing and measurable residual disease monitoring, risk widening disparities in access to care across countries. Philanthropy emerges as a crucial, though complex, pillar sustaining research—whether through major private donations in the US or collective funding models like AIRC in Italy. The episode closes with a sober reflection on how geopolitical tensions further fragment scientific collaboration, reminding us that progress in hematology depends not only on discovery, but on shared commitment and global cooperation. A thoughtful and timely conversation on the future of innovation in our field.

    30 min

  4. JAN 20

    From chemotherapy to targeted precision: A paradigm shift in the frontline treatment of Ph+ ALL - A dialogue between Robin Foà, Filippo Milano and Sabina Chiaretti

    In this episode, Prof. Robin Foà, Prof. Filippo Milano and Prof. Sabina Chiaretti explore the first results of a worldwide randomized phase 3 trial that challenges a long-standing paradigm in adult Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL): the necessity of frontline chemotherapy. The discussion focuses on a direct comparison between a fully chemo-free strategy—combining Ponatinib and Blinatumomab—and the conventional standard of care based on Imatinib plus chemotherapy. The trial enrolled 236 patients with no upper age limit and introduced age-adapted dosing of Ponatinib alongside strictly biology-driven criteria for allogeneic transplantation, based on molecular response, ABL1 mutations, and the Ikaros-plus genotype. Intensified central nervous system prophylaxis addressed the historically high risk of CNS relapse in this disease. The speakers highlight the superiority of the chemo-free arm, which achieved higher hematological and molecular remission rates, improved event-free survival, and a marked reduction in the need for transplantation. These benefits were accompanied by better tolerability, with fewer severe adverse events and no excess cardiovascular toxicity compared with chemotherapy. Looking ahead, the episode reflects on the broader clinical implications of these findings, particularly for elderly patients and those unfit for intensive therapy. The discussion also opens the door to the possibility of long-term treatment-free remission in patients achieving deep and durable molecular responses, while acknowledging ongoing challenges in global access to advanced diagnostics and targeted therapies. A concise yet in-depth conversation on how precision medicine is reshaping the future of Ph+ ALL—moving the field closer to effective, chemotherapy-free frontline care.

    25 min

  5. 12/03/2025

    The New Era of CLL Therapy: From Chemo-Free Strategies to Fixed-Duration Regimens - A dialogue Between Robin Foà, Filippo Milano and Mazyar Shadman

    In this episode, Prof. Robin Foà and Dr. Filippo Milano sit down with Dr. Mazyar Shadman, a leading voice in immunotherapy and one of the foremost experts in chronic lymphocytic leukemia (CLL). Together, they explore how rapidly—and profoundly—the therapeutic landscape of CLL has transformed, moving away from chemo-immunotherapy toward a new era defined entirely by targeted agents. The conversation opens with a reflection on the radical shift that has occurred in frontline management. Where fludarabine-based regimens once dominated the care of younger and fit patients, the field has now embraced treatments that no longer rely on chemotherapy at all. Randomized studies consistently show improved progression-free survival—and in some cases overall survival—making targeted therapies the undisputed standard in countries where access is guaranteed. Against this backdrop, the speakers examine the evolving first-line strategies: continuous BTK inhibition; fixed-duration venetoclax plus obinutuzumab; and the fully oral combination of ibrutinib and venetoclax. The recent CLL17 trial, a plenary abstract at ASH, provides one of the first head-to-head comparisons among these approaches. Early results suggest that fixed-duration treatments are not inferior to continuous BTK inhibition, underscoring how meaningful “time off therapy” has become for both patients and clinicians. A central theme of the episode is the complexity behind treatment selection. Age, comorbidities, logistical constraints, and patient preference all interplay—yet Dr. Shadman emphasizes that even in older individuals, therapeutic choices should not be dictated by age alone. For some, the simplicity of a continuous oral regimen is preferable; for others, the goal of achieving deep remission and eventually stopping therapy is paramount. Prognostic markers, particularly TP53 disruption, continue to inform expectations and guide nuanced discussions around the trade-offs between durability and freedom from treatment. The dialogue then turns to measurable residual disease (MRD). Although MRD negativity remains an important biological milestone, Dr. Shadman cautions against extending therapy beyond predefined durations solely to chase deeper responses—except in selected high-risk settings. Ongoing studies like CLL18 may soon clarify whether MRD-guided strategies can outperform fixed-duration regimens. One of the most challenging areas discussed is the management of double-refractory CLL. CAR-T cell therapy, while transformative in other lymphoid malignancies, has delivered only modest long-term outcomes in CLL. Early referral is critical, ideally while patients are beginning treatment with the non-covalent BTK inhibitor pirtobrutinib. Real-world data suggest that cytoreduction and disease control before CAR-T may be key to improving responses. Allogeneic transplant, though reserved for the most refractory cases, remains a necessary option for younger patients when CAR-T is not accessible or feasible. In closing, the speakers reflect on the ultimate goal of therapy—whether cure or functional cure—and how this must be tailored to the individual sitting in front of the clinician. For some, decades of remission represent success; for others, especially the very elderly, sustained disease control may be an equally meaningful outcome. Yet global inequities remain stark: while some countries benefit from cutting-edge targeted agents, many regions still rely on chemotherapy due to economic constraints. This episode offers a thoughtful, forward-looking examination of where CLL therapy stands today—an arena shaped by scientific progress, clinical judgment, and the persistent drive to offer patients treatments that are not only effective but also aligned with their lives and priorities.

    23 min

  6. 10/27/2025

    Acute Myeloid Leukemia: Progress, Plateau, and the Path Ahead – A Dialogue Between Robin Foà, Filippo Milano and Fred Appelbaum

    In this episode, Prof. Robin Foà and Dr. Filippo Milano are joined by Dr. Fred Appelbaum from the Fred Hutchinson Cancer Center to reflect on the persistent challenges and evolving landscape of acute myeloid leukemia (AML). Unlike other hematologic malignancies that have seen major therapeutic revolutions, AML remains bound to the traditional 7+3 regimen, a reminder of how complex its biology truly is. The conversation delves into the biological roots of AML, emphasizing that the disease originates in the myeloid stem cell—an essential element of hematopoiesis that cannot be eradicated without profound consequences. This fundamental limitation has slowed progress compared with CML, CLL, or ALL, where targeted therapies have reshaped outcomes. Dr. Appelbaum reflects on the need to understand the molecular journey from normal stem cells to leukemic clones, envisioning future treatments capable of selectively eliminating malignant mutations while preserving healthy hematopoiesis. A major theme of the discussion is the impact of Venetoclax, which has transformed induction therapy for elderly patients, offering higher remission rates and better tolerability. Yet, the question remains whether this improvement translates into cure or simply extends survival. Dr. Milano highlights its role as a bridge to transplant, while both he and Prof. Foà note the growing challenge of Venetoclax resistance and the need for more durable solutions. The debate then turns to the role of transplantation in intermediate-risk AML. When should patients undergo transplant in first remission (CR1), and how should minimal residual disease (MRD) guide this decision? While studies suggest comparable outcomes between early and delayed transplantation, the practical reality is more nuanced, depending on MRD status, patient age, and access to specialized centers. Prof. Foà voices caution about relying on non-standardized, in-house MRD assays, stressing the ethical and clinical importance of centralized and validated methodologies. Throughout the discussion, the speakers underscore how scientific progress in AML remains uneven—marked by breakthroughs like Venetoclax but constrained by the disease’s intrinsic biology. As the episode closes, they draw inspiration from the success story of acute promyelocytic leukemia (APL), once one of the deadliest forms of AML and now often cured without chemotherapy or transplant. This dialogue is a candid examination of both frustration and hope—a reminder that even in areas where progress has lagged, persistent research and collaboration continue to push the boundaries of what is possible in the treatment of AML.

    23 min

  7. 08/25/2025

    Ph-Positive Acute Lymphoblastic Leukemia, 25 Years of Progress – A Dialogue Between Robin Foà and Filippo Milano

    In this episode, Prof. Robin Foà and Dr. Filippo Milano look back on twenty-five years of remarkable progress in the treatment of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). Once regarded as one of the most devastating hematologic malignancies, with prognosis considered among the worst in oncology, Ph+ ALL has undergone a dramatic transformation thanks to targeted therapies and innovative treatment strategies. The conversation traces the pioneering decision to replace intensive chemotherapy with tyrosine kinase inhibitors and steroids, a bold approach that opened the way to higher remission rates and better tolerability, especially for older patients. From the early use of Imatinib to the evolution toward second- and third-generation TKIs, this paradigm shift has steadily improved outcomes and reshaped clinical practice. The discussion also highlights the D-ALBA study, where Dasatinib combined with Blinatumomab marked a new era by eliminating both induction and consolidation chemotherapy while achieving durable survival in the majority of patients. Foà and Milano explore how minimal residual disease monitoring has become central to guiding therapy and reconsidering the role of transplant, once seen as the only curative option. They also reflect on the challenges that remain, including unequal access to modern therapies and the need for standardized laboratory infrastructures worldwide. While CAR-T cells play an expanding role in other leukemias, their use in Ph+ ALL remains limited in the frontline setting, reinforcing the centrality of TKIs and immunotherapy as the foundation of treatment. This dialogue is both a scientific journey and a story of hope, showing how determined research, clinical innovation, and international collaboration have turned a disease once defined by despair into one where cure is now a realistic possibility for many patients.

    20 min

  8. 07/21/2025

    Evolving Strategies in ALL: CAR-T Cells, MRD, and the Decline of Transplant – A Dialogue Between Robin Foà and Filippo Milano

    In this episode, we delve into the evolving landscape of Acute Lymphoblastic Leukemia (ALL) treatment, with a focus on cutting-edge therapies and their impact on patient outcomes. We explore the rapid integration of CAR T-cell therapy, now being used earlier in treatment and its effects on survival rates. The discussion also addresses the shifting role of allogeneic transplantation, particularly in light of the economic and clinical advantages of newer therapies. We highlight the importance of minimal residual disease (MRD) monitoring and its ability to guide treatment decisions, potentially sparing patients from invasive procedures. Additionally, we examine the transformative effects of immunotherapies like blinatumomab and inotuzumab, and their role in reducing the reliance on traditional chemotherapy and transplantation. As the field continues to evolve, we consider the future of ALL treatment, including the challenges posed by economic constraints and the move toward personalized medicine. Tune in for an in-depth analysis of these groundbreaking advances in ALL therapy and their potential to redefine treatment paradigms.

    14 min
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Ratings & Reviews

5
out of 5
2 Ratings

About

Hematology Pills is a new format based on monthly discussions between Prof. Robin Foà (Rome) and Dr. Filippo Milano (Seattle). Each episode explores the latest breakthroughs in gene therapy, immunotherapy, and clinical innovation, while addressing also ethical and practical challenges that shape the field. Our podcast offers a clear and compelling look at the evolving landscape of blood disorders and treatments for hematologists, researchers and healthcare professionals. Stay informed, inspired, and connected with Hematology Pills – a source off hematology updates, one episode at a time.

Information

  • Creator
    Mattioli Health
  • Years Active
    2025 - 2026
  • Episodes
    14
  • Rating
    Clean
  • Copyright
    © Mattioli Health
  • Show Website
    Hematology Pills