ISH news • March 2022

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Mach 2022

Each month the members of the Scientific and Education Committee of the International Society of Hematology (ISH) write this newsletter for our subscribers featuring relevant news in Global Hematology.
In this issue we highlight several recently relevant publications in the field of autoimmune cytopenias and aplastic anemia and invite you to participate in the upcoming ISH World Congress taking place during the Spanish Hematology Society Meeting in Barcelona October 6-8 2022 (SEHH).

Should we do a routine biopsy in patients with autoimmune hemolytic anemia? 

A recent study authored by Ashlea Campbell, et al. published in Hemasphere reported on 87 patients with a median age above 60 years, who had undergone a routine bone marrow biopsy during the diagnosis of autoimmune hemolytic anemia, excluding that secondary to a previously known hematological neoplasm. They found that in 19 cases (22%) it was secondary to an undiagnosed lymphoproliferative disease. Features associated with a neoplasm were C3d positivity, raised B2M, hypogammaglobulinemia, and presence of a paraprotein. Five cases were related to cold agglutinin disease but diagnoses of other types of lymphoma (n=10) and monoclonal B-cell lymphocytosis (n=4) were also made, however 17/19 patients had other clinical features suggestive of a lymphoproliferative disorder. The authors suggest there is value of routine BM biopsy is low in the absence of other features suggestive of a lymphoproliferative disease, but higher in those with C3d positivity.

Randomized study sheds new light on the efficacy of ATRA in ITP

All-trans retinoic acid (ATRA) is an interesting immunomodulator which can have beneficial effects for persons with immune thrombocytopenia (ITP). ATRA has been compared previously with high dose dexamethasone in a random fashion showing higher sustained response rates and more recently, in an article published in Blood by Ye-Jun Wu, et al. showed a combination of ATRA 20 mg/m2 plus low dose rituximab (100 mg weekly for 6 weeks). In this randomized study, 112 patients received combination treatment and obtained an 80% overall response rate vs. 59% in 56 patients treated with rituximab alone. Relevant adverse events were not severe and included including dry skin, dizziness, and headaches in the ATRA group. The study did not complete its accrual but showed a higher sustained response rate in persons with combination treatment (61 vs. 41%).

Issues in the diagnosis of acquired aplastic anemia in countries with restricted resources

Recently in Bone Marrow Transplantation, the Eastern Mediterranean blood and marrow transplantation group (EMBMT) and severe aplastic anemia (AA) working party of the European Society for blood and marrow transplantation (SAAWP of EBMT) led by Raheel Iftikhar, et al. reported on issues present in resource constrained settings summarized below:
  • Few published data from the developing world.
  • Higher prevalence and younger age at diagnosis in Asia and Africa vs. Europe and the United States.
  • Higher prevalence of bone marrow failure syndromes and limited access to genomic testing.
  • Long time from presentation to diagnosis with risk for complications and transfusions.
  • High proportion of directed family donation of blood products.
  • Inadequate facilities in rural areas and long distances to specialized centers.
  • Lack of access to optimal immunosuppression therapy due to prohibitive costs of eltrombopag and ATG.
  •  Lack of access to unrelated donors, with haploidentical donors the only practical alternative option.
  • Increased use of peripheral blood stem cells vs bone marrow particularly in heavily transfused patients.
  • Limited access to ATG, total body irradiation for conditioning prior to BMT.



Limitations for the use of medications usually includes several issues like efficacy, adverse events and also cost and availability. Nowadays several drugs can be administered at a “low dose” without therapeutic disadvantage, examples of this are: thalidomide (100 mg per day), dasatinib (50 mg per day), nivolumab 40 mg and even all-trans retinoic acid at 20-25 mg/m2 per day. It is also important to note that low dose venetoclax in combination with azoles is another new option in several diseases like CLL, NHL and AML. But in my opinion, a history of success in the world of low-dose drugs is rituximab, this antibody is usually administered at the dose of 375/m2 on its number one indication: non-Hodgkin lymphoma. However, in the setting of hematological autoimmune disease 100 mg per week for 4-6 weeks is now commonly employed in several conditions like immune thrombocytopenia, autoimmune hemolytic anemia, and thrombotic thrombocytopenic purpura.  This alternative seems to be very effective, with a lower cost. Multiple articles describing positive results have been published from China, Italy, and Mexico among others. It is noteworthy that the American Society of Hematology’s ITP guidelines (2019) suggest, in a hallmark, that rituximab could be used in newly diagnosed ITP patients “if a rapid and sustained response is considered important”.  Low dose drugs is a field of research that is very important for low and middle income countries. Every effort to reduce costs in the treatment of hematological diseases, without losing response, are very welcome all over the world.
Keep safe,
David Gómez-Almaguer MD
ISH Chair of Council



The 38th World Congress of the International Society of Hematology will be taking place during the annual Spanish hematology meeting from the Sociedad Española de Hematología y Hemoterapia in the beautiful city of Barcelona, October 6-8 2022. The meeting will be hybrid taking place both in person and virtually. We’ll keep you posted regarding registration dates, abstract deadlines, and all meeting details soon. 



Become an ISH Delegate! Join the International Society of Hematology and connect with other professionals from all around the world who are interested in all areas of research, education, and healthcare policy.

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  • Opportunity to collaborate in ISH Committees
  • Submit and sponsor abstracts to the ISH World Congress
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Hematology is the official journal of the ISH published online by Taylor Francis.  It is an international open access journal publishing original research and reviews in the field of general hematology, including oncology, pathology, biology, clinical research, and epidemiology.
Hematology aims to bridge the interests and practice of both those carrying out laboratory work and those whose main inclination is patient care.  ISH members have a reduced author publishing fee to Hematology.

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