Hematology Pills

In this episode, Prof. Robin Foà and Dr. Filippo Milano arejoined by Prof. Stefano Pileri, one of the world's leading hematopathologistsand a key contributor to the WHO Classification of Hematolymphoid Tumors. Inspired by his recent book, Where do we come from? What are we? Where are we going? A journey through theevolution of Pathological Anatomy over the last half century, the conversation retraces the remarkable evolution of hematopathology—from the era of purely morphological diagnosis to the integration of molecular technologies and artificial intelligence.
The discussion explores the milestones that transformed the field, including the introduction of immunohistochemistry, the discovery ofdisease-defining biomarkers such as CD30, and the transition toward molecular diagnostics and next-generation sequencing. These advances have progressively reduced diagnostic subjectivity while enabling increasingly precise disease classification and the development of targeted therapies.
A central theme of the episode is the growing need for highly specialized reference centers. As diagnostic techniques become more sophisticated, accurate pathological assessment has become essential not only for selecting the most appropriate therapy but also for avoiding unnecessary treatments and optimizing healthcare resources. The speakers also emphasize the importance of multidisciplinary collaboration, where pathologists and clinicians combine increasingly complex biological data to guide patient care.
Looking to the future, the discussion turns to digital pathology, tele pathology, and artificial intelligence. While AI promises to improve standardization and diagnostic consistency, it is seen as a tool that will support—rather than replace—the expertise and clinical judgment of experienced pathologists. A thoughtful conversation on how technological innovation has transformed hematopathology and how it will continue to shape precision medicine in the years ahead.

In this episode, Prof. Robin Foà, Dr. Filippo Milano, and Dr. Jerald Radich revisit the extraordinary journey of chronic myeloid leukemia (CML), one of the greatest success stories in modern hematology and the disease that transformed precision medicine from concept to clinical reality.
The discussion retraces the evolution of CML treatment, from an era when bone marrow transplantation represented the only curative option to the revolutionary introduction of tyrosine kinase inhibitors (TKIs), which have dramatically changed the natural history of the disease. Today, most patients receiving TKI therapy can expect a life expectancy comparable to that of the general population, making CML the prototype of targeted cancer therapy.
The conversation also highlights the global impact of scientific innovation through the partnership with The Max Foundation, an initiative that has expanded access to molecular diagnostics and lifelong TKI treatment for tens of thousands of patients in low- and middle-income countries. By combining innovative diagnostic strategies with worldwide collaboration, the program has demonstrated that precision medicine can become a global reality rather than a privilege limited to high-income healthcare systems.
Looking toward the future, the episode explores MyeloMatch, the largest precision medicine trial ever conducted in acute myeloid leukemia (AML). By integrating rapid molecular profiling, next-generation sequencing, and targeted therapies, the initiative aims to redefine frontline AML treatment while advancing increasingly sensitive measurable residual disease (MRD) assessment. The discussion examines both the promise and the challenges of applying precision medicine to a biologically complex disease such as AML, where molecular diversity continues to shape prognosis and therapeutic decision-making.
A compelling conversation on how decades of scientific discovery have reshaped leukemia care—demonstrating how precision medicine, global collaboration, and molecular innovation continue to redefine the future of hematology.

In this episode, Prof. Robin Foà and Prof. Filippo Milano reflect on a groundbreaking phase two study out of Seattle that introduces a novel and highly effective approach to cord blood transplantation. Unlike traditional double cord blood transplants, which have historically been hindered by severe complications when T-cells from both units interact, this new methodology overcomes these major disadvantages to reshape patient outcomes.
The conversation delves into the biological mechanics of this pioneering technique. Prof. Milano details how his research team successfully combined a single matched cord blood unit with an off-the-shelf product made from a pool of six to eight different units. By meticulously CD34-selecting and expanding these pooled cells for 14 days on a Notch platform, they created a therapeutic product rich in CD34 and monocytic cells, yet completely lacking T-cells.
A major theme of the discussion is the striking clinical success of this trial. Among approximately 30 patients, the approach yielded a 96% overall survival rate and a remarkable 0% incidence of acute grade 3 and 4 Graft-Versus-Host Disease (GVHD). Beyond survival metrics, the episode explores a fascinating biological phenomenon observed between day 7 and 10 post-transplant: a massive spike in active CD8 lymphocytes. Single-cell RNA sequencing revealed that these monoclonal cells originated from the matched unit, reacting to the mixed HLA of the pooled product. Prof. Milano highlights ongoing research using mouse models to see if this immune response can be predictably directed to enhance the Graft-Versus-Leukemia (GVL) effect, which would be especially beneficial for patients with active disease.
The debate then turns to the broader structural challenges facing the field today. With the overall number of cord blood transplants declining and public banks shrinking—even halting collections in major cities like New York—Prof. Milano strongly advocates for the preservation of this critical resource. Cord blood remains a vital, immediately available, pre-typed stem cell source, a readiness that proves essential during unexpected global emergencies like pandemics.
As the episode closes, the speakers look ahead to the future, discussing plans to test this pooled cell product in mismatched related haploidentical transplants. This dialogue is a candid examination of both scientific ingenuity and systemic challenges—a reminder that persistent innovation and dedicated research continue to push the boundaries of what is possible in the field of hematopoietic stem cell transplantation.

In this episode, Prof. Robin Foà and Dr. Filippo Milano explore the evolving treatment landscape of Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL), focusing on the transition from intensive chemotherapy and transplantation toward targeted therapies combined with immunotherapy. What emerges from the discussion is not only a new therapeutic strategy, but a deeper understanding of how these treatments profoundly reshape the immune system.
The conversation centers on the biological effects of combining tyrosine kinase inhibitors with blinatumomab, revealing unexpected patterns of immune activation. Patients treated with Dasatinib showed significant expansion of T cells and NK cells, while the addition of blinatumomab further enhanced immune responses and reduced immunosuppressive regulatory T cells. Particularly striking was the observation that patients achieving early complete molecular responses also displayed the strongest immune modulation, suggesting a direct link between immune activation and clinical outcome.
The episode also examines the differences between Dasatinib and Ponatinib. While Dasatinib appears to induce a broad quantitative immune response, Ponatinib seems to act more through qualitative and phenotypic changes, promoting maturation and functional activity of immune effector cells. These findings highlight how different TKIs may interact with the immune system in distinct ways, opening new perspectives for individualized treatment strategies.
Looking ahead, the discussion expands to the broader role of the tumor microenvironment, checkpoint inhibition, and CAR-T cell therapy, emphasizing how future advances in Ph+ ALL will increasingly depend on understanding the dialogue between leukemia cells and host immunity at the single-cell level.
A thoughtful exploration of how targeted therapy and immunotherapy are redefining the concept of leukemia treatment—moving beyond disease control toward immune-driven eradication of residual disease.

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.