Frontiers in hematology最新文献

Background: Multiple myeloma (MM) is the second most common blood cancer after leukemia in adults. Despite advancements in treatment that have extended survival, MM remains incurable and the cancer and its treatment result in adverse acute, long-term and latent side-effects, necessitating a focus on strategies to attenuate these side-effects and improve quality of life. This narrative review highlights MM patient preferences for exercise and/or diet interventions relative to complete and ongoing interventions to identify gaps and needs for future lifestyle interventions in MM patients aimed at improving MM survivorship care.

Methods: This updated review was completed using a comprehensive search that was conducted using PubMed and ClinicalTrials.gov databases using keywords related to MM, exercise, physical activity, diet, nutrition and patient preferences. Studies involving adults diagnosed with MM were included.

Results: Among published studies, there are five exercise interventions and four diet and nutrition observational studies. The importance of individualized exercise interventions tailored to MM patients' needs was emphasized. Supervised exercise interventions showed higher adherence and engagement compared to unsupervised interventions. Observational diet/nutrition studies demonstrated that decreased gut microbiome diversity post-transplant is linked to poorer outcomes. Additionally, nutritional status and dietary patterns, such as high-carbohydrate and plant-based diets, can significantly impact clinical outcomes in MM patients, including sustained minimal residual disease negativity. Current clinical trials are primarily focused on feasibility and adherence, with a limited emphasis on long-term outcomes. In ClinicalTrials.gov, there are six ongoing exercise interventions, with an additional seven that are completed with no published results, one suspended trial and one active but not recruiting. Additionally, there are two combined diet and exercise interventions that are currently recruiting, with one active but no longer recruiting. Among diet and nutrition ongoing trials, there are currently two actively recruiting, two completed with no primary paper published and one study that was withdrawn.

Discussion: These findings underscore the need for more comprehensive, long-term and adequately powered studies on the impact of exercise and diet interventions in MM patients. Patient education and empowerment within these trials are crucial for enhancing engagement and adherence to these interventions.

Maternal obesity, often linked to the consumption of a high-fat Western-style diet (WSD), poses significant risks to both maternal and fetal health. This review explores the impact of maternal obesity on fetal hematopoietic stem and progenitor cells (HSPCs), highlighting how metabolic and inflammatory shifts in the maternal environment affect HSPC proliferation, differentiation, and long-term immune system development. Maternal obesity leads to hormonal imbalances, increased inflammatory cytokines, placental insufficiency, and altered nutrient availability that disrupt normal HSPC function, potentially predisposing offspring to immune dysfunction, metabolic disorders, and cardiovascular diseases later in life. Notably, maternal obesity skews HSPC differentiation toward the myeloid lineage, which can impair adaptive immune responses and increase the risk of autoimmune diseases and infections. Furthermore, maternal diet-driven epigenetic and transcriptional reprogramming of fetal HSPCs exacerbates chronic inflammation, reinforcing a pro-inflammatory phenotype in downstream progeny that persists into postnatal stages. The review also emphasizes the need for further research to clarify the mechanisms underlying these effects across different species and developmental stages, as well as the potential for targeted interventions to mitigate the adverse impacts of maternal obesity on fetal hematopoiesis and lifelong health outcomes.

Hematopoietic stem cells (HSCs) undergo a functional decline during aging. The intrinsic characteristics of aged HSCs have been well-described and include a strong myeloid bias, an increase in total number, and a decrease in functionality during transplantation. The impact of the aged bone marrow microenvironment, or niche, on HSCs is less well understood. It is critical to understand the changing condition of the niche during aging, and its ability to support HSCs, as this could reveal the very signals and mechanisms needed to improve HSC fitness. Furthermore, heterochronic transplantation provides an approach to test the influence of an aged recipient niche on young donor HSCs, and conversely, of a young recipient niche on aged donor HSCs. Importantly, these experiments demonstrated that donor HSC engraftment is reduced if the recipient niche is aged, and conversely, the young niche can rejuvenate aged donor HSCs. Here we will focus on the interactions between aged HSCs and their microenvironment. We will highlight current controversies, research gaps, and future directions.