Pub Date : 2026-01-01DOI: 10.1016/j.clml.2025.08.009
Trung Minh Nguyen , Jason Lu , Danielle Guffey , Rockbum Kim , Abiodun Oluyomi , Omar Rosales , Raka Bandyo , Courtney N. Miller-Chism , Mark M. Udden , Martha P. Mims , Tareq Abuasab , Akiva Diamond , Purnima S. Teegavarapu , Chijioke Nze , Christopher R. Flowers , Ang Li , Jun Yang Jiang
Background
There is limited data on outcomes and patterns of care for patients with classical Hodgkin lymphoma (cHL) who are uninsured or have adverse social determinants of health.
Methods
We conducted a retrospective cohort study of patients with newly diagnosed cHL treated in a large safety-net hospital system between January 2011 and December 2021.
Results
Of the 231 patients aged ≥18 years diagnosed with cHL at Harris Health, Houston, TX, the median age was 39 years, 82% were uninsured, and 87% lived in a neighborhood with an Area Deprivation Index below the national median. Most (73%) had stage III/IV disease; 19% had a history of HIV. The median diagnosis-to-treatment interval was 24 days. The median follow-up interval was 72.3 months. Among 217 evaluable patients, 67% achieved a complete response, and 7% had a partial response. Twenty-two (61%) of 36 eligible patients underwent hematopoietic stem cell transplantation. At 5 years, event-free and overall survival (OS) rates were 62.7% and 79.6%, respectively. Factors associated with OS in multivariable analysis included age (hazard ratio [HR] 1.34 per 10-year increase, P = .007), Eastern Cooperative Oncology Group performance status (HR 2.35 for 2-4 vs. 0-1, P = .026), serum creatinine (HR 2.94 per mg/dL increase, P = .006), and serum albumin (HR 0.59 per g/dL increase, P = .014).
Conclusion
In this health system with financial assistance and access to cell therapies, uninsurance was not associated with inferior outcomes. Small survival differences may be due to a greater proportion of patients with advanced-stage, higher-risk, and HIV-associated disease.
{"title":"Clinical Outcomes and Patterns of Care Among Patients With Newly Diagnosed Classical Hodgkin Lymphoma in a Safety-Net Health System","authors":"Trung Minh Nguyen , Jason Lu , Danielle Guffey , Rockbum Kim , Abiodun Oluyomi , Omar Rosales , Raka Bandyo , Courtney N. Miller-Chism , Mark M. Udden , Martha P. Mims , Tareq Abuasab , Akiva Diamond , Purnima S. Teegavarapu , Chijioke Nze , Christopher R. Flowers , Ang Li , Jun Yang Jiang","doi":"10.1016/j.clml.2025.08.009","DOIUrl":"10.1016/j.clml.2025.08.009","url":null,"abstract":"<div><h3>Background</h3><div>There is limited data on outcomes and patterns of care for patients with classical Hodgkin lymphoma (cHL) who are uninsured or have adverse social determinants of health.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of patients with newly diagnosed cHL treated in a large safety-net hospital system between January 2011 and December 2021.</div></div><div><h3>Results</h3><div>Of the 231 patients aged ≥18 years diagnosed with cHL at Harris Health, Houston, TX, the median age was 39 years, 82% were uninsured, and 87% lived in a neighborhood with an Area Deprivation Index below the national median. Most (73%) had stage III/IV disease; 19% had a history of HIV. The median diagnosis-to-treatment interval was 24 days. The median follow-up interval was 72.3 months. Among 217 evaluable patients, 67% achieved a complete response, and 7% had a partial response. Twenty-two (61%) of 36 eligible patients underwent hematopoietic stem cell transplantation. At 5 years, event-free and overall survival (OS) rates were 62.7% and 79.6%, respectively. Factors associated with OS in multivariable analysis included age (hazard ratio [HR] 1.34 per 10-year increase, <em>P</em> = .007), Eastern Cooperative Oncology Group performance status (HR 2.35 for 2-4 vs. 0-1, <em>P</em> = .026), serum creatinine (HR 2.94 per mg/dL increase, <em>P</em> = .006), and serum albumin (HR 0.59 per g/dL increase, <em>P</em> = .014).</div></div><div><h3>Conclusion</h3><div>In this health system with financial assistance and access to cell therapies, uninsurance was not associated with inferior outcomes. Small survival differences may be due to a greater proportion of patients with advanced-stage, higher-risk, and HIV-associated disease.</div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"26 1","pages":"Pages e12-e20.e5"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.clml.2025.08.020
Jelena Jelicic , Karen Juul-Jensen , Zoran Bukumiric , Mikkel Runason Simonsen , Michael Roost Clausen , Ahmed Ludvigsen Al-Mashhadi , Robert Schou Pedersen , Christian Bjørn Poulsen , Anne Ortved Gang , Peter Brown , Tarec Christoffer El-Galaly , Thomas Stauffer Larsen
Background
The International prognostic index (IPI) is a widely used model for identifying trial-eligible patients with diffuse large B-cell lymphoma (DLBCL). However, the applicability of prognostic models in identifying trial-eligible high-intermediate (HI) and high-risk (H), particularly younger patients, has not been extensively studied.
Methods
Patients with newly diagnosed DLBCL were identified in the Danish Lymphoma Registry (LYFO). To evaluate the impact of IPI and age-adjusted IPI (aaIPI) on identifying higher-risk (HI and H-risk) trial-eligible patients, we retrieved the eligibility criteria for the frontMIND trial (NCT04824092).
Results
Of 6252 patients with DLBCL registered in the LYFO, 3725 (59.6%) were trial-eligible. The dataset included all IPI/aaIPI groups. However, 46% of 3725 patients would meet trial eligibility if IPI and aaIPI higher-risk patients were selected. The 5-year progression-free (PFS) and overall survival (OS) were 61.7% and 70.5%, respectively. Among patients aged ≤ 60 years (35.5%; 1321/3725), 29.5% were frontMIND-eligible based on aaIPI, with 5-year PFS and OS of 72.3% and 82.8%, respectively. Combining IPI and aaIPI did not improve the identification of patients who did not respond to standard treatment, and utilizing this strategy for trial selection was not superior to using IPI or NCCN-IPI alone.
Conclusions
Prognostic models can help in selecting trial-eligible HI and H-risk patients, thereby increasing the chances of identifying those who do not respond to standard treatment. However, the currently used prognostic indices fail to accurately recognize some high-risk patients, particularly young patients. Therefore, additional risk factors beyond prognostic models are needed to improve patient selection for trial participation.
{"title":"International Prognostic Models as Tools for Selection of Higher-risk Trial-eligible Patients With Diffuse Large B-Cell lymphoma","authors":"Jelena Jelicic , Karen Juul-Jensen , Zoran Bukumiric , Mikkel Runason Simonsen , Michael Roost Clausen , Ahmed Ludvigsen Al-Mashhadi , Robert Schou Pedersen , Christian Bjørn Poulsen , Anne Ortved Gang , Peter Brown , Tarec Christoffer El-Galaly , Thomas Stauffer Larsen","doi":"10.1016/j.clml.2025.08.020","DOIUrl":"10.1016/j.clml.2025.08.020","url":null,"abstract":"<div><h3>Background</h3><div>The International prognostic index (IPI) is a widely used model for identifying trial-eligible patients with diffuse large B-cell lymphoma (DLBCL). However, the applicability of prognostic models in identifying trial-eligible high-intermediate (HI) and high-risk (H), particularly younger patients, has not been extensively studied.</div></div><div><h3>Methods</h3><div>Patients with newly diagnosed DLBCL were identified in the Danish Lymphoma Registry (LYFO). To evaluate the impact of IPI and age-adjusted IPI (aaIPI) on identifying higher-risk (HI and H-risk) trial-eligible patients, we retrieved the eligibility criteria for the frontMIND trial (NCT04824092).</div></div><div><h3>Results</h3><div>Of 6252 patients with DLBCL registered in the LYFO, 3725 (59.6%) were trial-eligible. The dataset included all IPI/aaIPI groups. However, 46% of 3725 patients would meet trial eligibility if IPI and aaIPI higher-risk patients were selected. The 5-year progression-free (PFS) and overall survival (OS) were 61.7% and 70.5%, respectively. Among patients aged ≤ 60 years (35.5%; 1321/3725), 29.5% were frontMIND-eligible based on aaIPI, with 5-year PFS and OS of 72.3% and 82.8%, respectively. Combining IPI and aaIPI did not improve the identification of patients who did not respond to standard treatment, and utilizing this strategy for trial selection was not superior to using IPI or NCCN-IPI alone.</div></div><div><h3>Conclusions</h3><div>Prognostic models can help in selecting trial-eligible HI and H-risk patients, thereby increasing the chances of identifying those who do not respond to standard treatment. However, the currently used prognostic indices fail to accurately recognize some high-risk patients, particularly young patients. Therefore, additional risk factors beyond prognostic models are needed to improve patient selection for trial participation.</div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"26 1","pages":"Pages e62-e76"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.clml.2025.07.008
Julia Llinares , Sofía Toribio-Castelló , Luis Fernando García , Tamara Iglesias , Ana Heredero , Pablo Rebollo , Isabel Ricote , María-Victoria Mateos
Objective
We aim to describe multiple myeloma (MM) characteristics and treatment patterns in Spain, focusing on triple-class exposed (TCE) population.
Methods
In this non-interventional, cross-sectional, retrospective study, real-world treatment data between October 2022 and September 2023 were collected from Oncology Dynamics and Oncology Advantage datasets. The proportion of TCE patients was described by line of therapy (LOT).
Results
In total, 1206 MM patients were analyzed. Of them, 717 patients were newly diagnosed MM and 489 were relapsed and refractory MM (RRMM) patients. In RRMM patients, treatment patterns were heterogeneous, mainly with lenalidomide- and pomalidomide-based regimens in the second and third/subsequent LOT, respectively. Among patients with ≥ 3 LOT, 82 different treatment sequences were identified. Currently, a total of 331 (27.4%) patients were TCE, with a notably increase by LOT: 15.9% receiving triple-class agents in the first, 56.9% in the second and 62.1% in the third/subsequent LOTs. To note, only a 7.13% of patients (n = 86) were TCE at the beginning of their current treatment.
Conclusions
This study shows the increasingly incidence of TCE-MM patients, appearing from the first LOT. TCE treatment is challenging and identifying treatments with new mechanism of actions regardless of LOTs, will be key to optimize the management of this population.
{"title":"Treatment Patterns of Patients With Multiple Myeloma in a Real-World Setting in Spain. How are Triple-Class Exposed Patients Being Managed?","authors":"Julia Llinares , Sofía Toribio-Castelló , Luis Fernando García , Tamara Iglesias , Ana Heredero , Pablo Rebollo , Isabel Ricote , María-Victoria Mateos","doi":"10.1016/j.clml.2025.07.008","DOIUrl":"10.1016/j.clml.2025.07.008","url":null,"abstract":"<div><h3>Objective</h3><div>We aim to describe multiple myeloma (MM) characteristics and treatment patterns in Spain, focusing on triple-class exposed (TCE) population.</div></div><div><h3>Methods</h3><div>In this non-interventional, cross-sectional, retrospective study, real-world treatment data between October 2022 and September 2023 were collected from Oncology Dynamics and Oncology Advantage datasets. The proportion of TCE patients was described by line of therapy (LOT).</div></div><div><h3>Results</h3><div>In total, 1206 MM patients were analyzed. Of them, 717 patients were newly diagnosed MM and 489 were relapsed and refractory MM (RRMM) patients. In RRMM patients, treatment patterns were heterogeneous, mainly with lenalidomide- and pomalidomide-based regimens in the second and third/subsequent LOT, respectively. Among patients with ≥ 3 LOT, 82 different treatment sequences were identified. Currently, a total of 331 (27.4%) patients were TCE, with a notably increase by LOT: 15.9% receiving triple-class agents in the first, 56.9% in the second and 62.1% in the third/subsequent LOTs. To note, only a 7.13% of patients (<em>n</em> = 86) were TCE at the beginning of their current treatment.</div></div><div><h3>Conclusions</h3><div>This study shows the increasingly incidence of TCE-MM patients, appearing from the first LOT. TCE treatment is challenging and identifying treatments with new mechanism of actions regardless of LOTs, will be key to optimize the management of this population.</div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"26 1","pages":"Pages 34-41"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carfilzomib (K) is approved in France to treat multiple myeloma in second line or later (2L+) with dexamethasone (Kd), lenalidomide and dexamethasone (KRd), daratumumab and dexamethasone (D-Kd). We assessed K utilization and outcomes in a French real-world cohort (2017-2022).
Results
Overall, 972 patients-initiated K treatment in 2L (21%), 3L (23%) and 4L+ (56%). Patients were largely exposed (96%) and refractory (75%) to immunomodulatory drugs. The most frequent regimens in 2L were KRd (33%) and D-Kd (24%), in 3L were Kd (27%) and K with pomalidomide and dexamethasone (KPd; 27%) and in 4L+ was Kd (49%). Of the 224 elderly patients (≥ 75 years), 45% received Kd in 4L+. Since 2018, KRd and Kd use declined in favor of D-Kd and KPd. The recommended K dose was mostly used despite some variability. In 2022, once-weekly dosing was used in most D-Kd and KRd patients, and half of Kd and KPd patients. Effectiveness of K-based regimens was similar regardless of starting K once-weekly and twice-weekly. Overall response rate (ORR) for KRd in 2L was 81%, with median overall survival (mOS) not reached (NR). ORR for D-Kd was 76% (78% in 2L) and mOS 32.0 months (NR in 2L). For KPd, ORR was 69% with mOS of 26.4 months. For Kd, ORR was 54% in 4L, 51% among elderly patients, and mOS was 15.5 months.
Conclusions
This real-world study confirms carfilzomib effectiveness at both dosing frequencies. K triplets resulted in long survivals and Kd remained satisfactory to treat heavily pretreated patients.
{"title":"Real-World Utilization of Carfilzomib (Once or Twice Weekly) Initiated in Patients After a First Relapse Between 2017 and 2022 in France: An Analysis From a Large-Scale Epidemiology of Multiple MYeloma (EmmY) Cohort","authors":"Cyrille Hulin MD , Karim Belhadj Merzoug , Bruno Royer , Denis Caillot , Arthur Bobin , Margaret Macro , Lionel Karlin , Mohamad Mohty , Laurent Frenzel , Aurore Perrot , Laure Vincent , Mammoun Dib , Frédérique Orsini Piocell , Riad Benramdane , Claire Calmettes , Thomas Chalopin , Ronan Garlantézec , Gaëlle Désaméricq , Hakima Mechiche , Olivier Decaux","doi":"10.1016/j.clml.2025.08.002","DOIUrl":"10.1016/j.clml.2025.08.002","url":null,"abstract":"<div><h3>Purpose</h3><div>Carfilzomib (K) is approved in France to treat multiple myeloma in second line or later (2L+) with dexamethasone (Kd), lenalidomide and dexamethasone (KRd), daratumumab and dexamethasone (D-Kd). We assessed K utilization and outcomes in a French real-world cohort (2017-2022).</div></div><div><h3>Results</h3><div>Overall, 972 patients-initiated K treatment in 2L (21%), 3L (23%) and 4L+ (56%). Patients were largely exposed (96%) and refractory (75%) to immunomodulatory drugs. The most frequent regimens in 2L were KRd (33%) and D-Kd (24%), in 3L were Kd (27%) and K with pomalidomide and dexamethasone (KPd; 27%) and in 4L+ was Kd (49%). Of the 224 elderly patients (≥ 75 years), 45% received Kd in 4L+. Since 2018, KRd and Kd use declined in favor of D-Kd and KPd. The recommended K dose was mostly used despite some variability. In 2022, once-weekly dosing was used in most D-Kd and KRd patients, and half of Kd and KPd patients. Effectiveness of K-based regimens was similar regardless of starting K once-weekly and twice-weekly. Overall response rate (ORR) for KRd in 2L was 81%, with median overall survival (mOS) not reached (NR). ORR for D-Kd was 76% (78% in 2L) and mOS 32.0 months (NR in 2L). For KPd, ORR was 69% with mOS of 26.4 months. For Kd, ORR was 54% in 4L, 51% among elderly patients, and mOS was 15.5 months.</div></div><div><h3>Conclusions</h3><div>This real-world study confirms carfilzomib effectiveness at both dosing frequencies. K triplets resulted in long survivals and Kd remained satisfactory to treat heavily pretreated patients.</div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"26 1","pages":"Pages e1-e11.e4"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.clml.2025.09.001
Sonia Morè , Massimo Offidani , Laura Corvatta , Silvia Aloisi , Tommaso Za , Francesca Fazio , Martina Gherardini , Velia Bongarzoni , Barbara Anaclerico , Luca Franceschini , Silvia Ferraro , Luca Cupelli , Carmine Liberatore , Francesca Fioritoni , Laura De Padua , Angela Rago , Silvia Gentili , Roberto Latagliata , Mariagrazia Garzia , Giancarlo Discepoli , Maria Teresa Petrucci
We retrospectively analysed cytogenetics by fluorescence in situ hybridization (FISH) in 1.026 patients with multiple myeloma treated in real-world with the aim to establish its role in daily clinical practice. Thirty-seven percent of patients had no FISH data available. Based on median PFS of each cytogenetic abnormality found, we identified 3 group of patients with a significantly different PFS and determined which patients can best benefit from anti-CD38 regimens and double transplant. These findings support cytogenetic testing in all patients at diagnosis.
Background
Cytogenetics by fluorescence in situ hybridization (FISH) plays an increasing prognostic role in multiple myeloma (MM).
Methods
we analysed cytogenetics and its implications in 1.026 patients treated in real-world from 2019 to 2023. Low-risk (LR) patients had normal cytogenetic or del(13q); intermediate-risk (IR) had t(11;14), hyperdiploidy, gain(1q) or del(1p); high-risk (HR) group had del(17p)/TP53, amp1q21, t(4;14), t(14:16) or t(14;20). Co-existence of 2 high risk abnormalities was named double hit.
Results
FISH data were not evaluable in 383 patients (37%). Out of 643 evaluable patients, chromosome 1 alterations were observed in 119 (18.5%), high risk chromosome 14 translocations in 65 (10%), del(17p)/TP53 in 37 (6%) and double-hit in 7 patients (1%). Cytogenetic was normal or hyperdiploid in 252 (39%) and 59 (13%) patients, respectively. Median PFS of LR, IR and HR group were 57.5, 43.2 and 30.5 months, respectively (P < .001). Although anti-CD38 regimens resulted in significantly longer PFS in both TE and NTE pts, in the former significant benefit was documented in the LR and IR group but not in HR group while in the latter only in the LR group. Tandem transplantation did not improve PFS both overall and in the 3 risk groups. Multivariate Cox regression analysis selected ECOG-PS ≥2, R-ISS II-III and our cytogenetic score HR as factors affecting PFS.
Conclusions
in real world, more than one third of MM patients do not have baseline FISH data. Nevertheless, cytogenetics and ECOG PS can be used for prognostic staging and for tailoring therapy.
{"title":"Cytogenetic Features and Their Implications in Clinical Practice: A Real-World Analysis of a Large Cohort of Multiple Myeloma Patients","authors":"Sonia Morè , Massimo Offidani , Laura Corvatta , Silvia Aloisi , Tommaso Za , Francesca Fazio , Martina Gherardini , Velia Bongarzoni , Barbara Anaclerico , Luca Franceschini , Silvia Ferraro , Luca Cupelli , Carmine Liberatore , Francesca Fioritoni , Laura De Padua , Angela Rago , Silvia Gentili , Roberto Latagliata , Mariagrazia Garzia , Giancarlo Discepoli , Maria Teresa Petrucci","doi":"10.1016/j.clml.2025.09.001","DOIUrl":"10.1016/j.clml.2025.09.001","url":null,"abstract":"<div><div>We retrospectively analysed cytogenetics by fluorescence in situ hybridization (FISH) in 1.026 patients with multiple myeloma treated in real-world with the aim to establish its role in daily clinical practice. Thirty-seven percent of patients had no FISH data available. Based on median PFS of each cytogenetic abnormality found, we identified 3 group of patients with a significantly different PFS and determined which patients can best benefit from anti-CD38 regimens and double transplant. These findings support cytogenetic testing in all patients at diagnosis.</div></div><div><h3>Background</h3><div>Cytogenetics by fluorescence <em>in situ</em> hybridization (FISH) plays an increasing prognostic role in multiple myeloma (MM).</div></div><div><h3>Methods</h3><div>we analysed cytogenetics and its implications in 1.026 patients treated in real-world from 2019 to 2023. Low-risk (LR) patients had normal cytogenetic or del(13q); intermediate-risk (IR) had t(11;14), hyperdiploidy, gain(1q) or del(1p); high-risk (HR) group had del(17p)/TP53, amp1q21, t(4;14), t(14:16) or t(14;20). Co-existence of 2 high risk abnormalities was named double hit.</div></div><div><h3>Results</h3><div>FISH data were not evaluable in 383 patients (37%). Out of 643 evaluable patients, chromosome 1 alterations were observed in 119 (18.5%), high risk chromosome 14 translocations in 65 (10%), del(17p)/TP53 in 37 (6%) and double-hit in 7 patients (1%). Cytogenetic was normal or hyperdiploid in 252 (39%) and 59 (13%) patients, respectively. Median PFS of LR, IR and HR group were 57.5, 43.2 and 30.5 months, respectively (<em>P</em> < .001). Although anti-CD38 regimens resulted in significantly longer PFS in both TE and NTE pts, in the former significant benefit was documented in the LR and IR group but not in HR group while in the latter only in the LR group. Tandem transplantation did not improve PFS both overall and in the 3 risk groups. Multivariate Cox regression analysis selected ECOG-PS ≥2, R-ISS II-III and our cytogenetic score HR as factors affecting PFS.</div></div><div><h3>Conclusions</h3><div>in real world, more than one third of MM patients do not have baseline FISH data. Nevertheless, cytogenetics and ECOG PS can be used for prognostic staging and for tailoring therapy.</div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"26 1","pages":"Pages e83-e91"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.clml.2025.09.013
Diana Cirstea , Kathleen Gallagher , Maxx King , Paola Dal Cin , Mark J Sloan , Marcela V Maus , Noopur Raje , Matthew Frigault , Valentina Nardi
•
The introduction of anti-BCMA CAR T-cell therapies has improved the prognosis for patients with multiple myeloma. However, long-term remission remains elusive for many patients due to various resistance mechanisms. Here we discuss a unique case of a 56-year-old woman whose multiple myeloma transdifferentiated into myeloid sarcoma shortly after receiving BCMA-targeted CAR T-cell therapy (ciltacabtagene autoleucel).
•
Our report presents the first documented case of multiple myeloma transdifferentiating into myeloid sarcoma following BCMA-targeted CAR T-cell therapy, specifically with ciltacabtagene autoleucel, making a novel observation in the field of oncology.
•
Myeloid sarcoma cells retaining the same genetic abnormalities as the original myeloma cells, including the IgH/FGFR3 translocation, suggest a clonal relationship, highlighting potential lineage plasticity in myeloma and its role in therapy resistance.
•
Clinicians should be vigilant for signs of lineage switch in patients undergoing CAR T-cell therapy, particularly in those with high-risk genetic features.
•
In cases of suspected transdifferentiation, a multidisciplinary approach involving hematology, oncology, and pathology is essential for diagnosis and management.
•
This case underscores the need for further research into the mechanisms of lineage plasticity in multiple myeloma and the potential role of CAR T-cell therapy in driving such changes.
•抗bcma CAR - t细胞疗法的引入改善了多发性骨髓瘤患者的预后。然而，由于各种耐药机制，许多患者的长期缓解仍然难以捉摸。在这里，我们讨论一个56岁的女性，她的多发性骨髓瘤在接受bcma靶向CAR -t细胞治疗后不久就转分化为髓系肉瘤。•我们的报告提出了第一个记录的多发性骨髓瘤在bcma靶向CAR -t细胞治疗后转分化为髓系肉瘤的病例，特别是西他卡他烯自体甲醇，在肿瘤学领域进行了新的观察。•髓系肉瘤细胞保留与原始骨髓瘤细胞相同的遗传异常，包括IgH/FGFR3易位，表明存在克隆关系，突出了骨髓瘤中潜在的谱系可塑性及其在治疗耐药性中的作用。•临床医生应警惕接受CAR - t细胞治疗的患者谱系转换的迹象，特别是那些具有高风险遗传特征的患者。•在疑似转分化的病例中，包括血液学、肿瘤学和病理学在内的多学科方法对诊断和治疗至关重要。•该病例强调需要进一步研究多发性骨髓瘤谱系可塑性的机制以及CAR - t细胞治疗在推动这种变化中的潜在作用。
{"title":"Transdifferentiation From Multiple Myeloma to Myeloid Sarcoma in the Setting of CAR T-Cell Therapy","authors":"Diana Cirstea , Kathleen Gallagher , Maxx King , Paola Dal Cin , Mark J Sloan , Marcela V Maus , Noopur Raje , Matthew Frigault , Valentina Nardi","doi":"10.1016/j.clml.2025.09.013","DOIUrl":"10.1016/j.clml.2025.09.013","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>The introduction of anti-BCMA CAR T-cell therapies has improved the prognosis for patients with multiple myeloma. However, long-term remission remains elusive for many patients due to various resistance mechanisms. Here we discuss a unique case of a 56-year-old woman whose multiple myeloma transdifferentiated into myeloid sarcoma shortly after receiving BCMA-targeted CAR T-cell therapy (ciltacabtagene autoleucel).</div></span></li><li><span>•</span><span><div>Our report presents the first documented case of multiple myeloma transdifferentiating into myeloid sarcoma following BCMA-targeted CAR T-cell therapy, specifically with ciltacabtagene autoleucel, making a novel observation in the field of oncology.</div></span></li><li><span>•</span><span><div>Myeloid sarcoma cells retaining the same genetic abnormalities as the original myeloma cells, including the IgH/FGFR3 translocation, suggest a clonal relationship, highlighting potential lineage plasticity in myeloma and its role in therapy resistance.</div></span></li><li><span>•</span><span><div>Clinicians should be vigilant for signs of lineage switch in patients undergoing CAR T-cell therapy, particularly in those with high-risk genetic features.</div></span></li><li><span>•</span><span><div>In cases of suspected transdifferentiation, a multidisciplinary approach involving hematology, oncology, and pathology is essential for diagnosis and management.</div></span></li><li><span>•</span><span><div>This case underscores the need for further research into the mechanisms of lineage plasticity in multiple myeloma and the potential role of CAR T-cell therapy in driving such changes.</div></span></li></ul></div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"26 1","pages":"Pages e127-e131.e1"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.clml.2025.08.004
Sarah Zhao , Cameron Wellard , Elizabeth M Moore , Andrew Spencer , Hang Quach , P. Joy Ho , Emma-Jane McDonald , Peter Mollee , Simon J Harrison , Bradley Augustson , Erica M Wood , Zoe K McQuilten , Rajeev Rajagopal
Background
Real-world data on treatment outcomes for elderly transplant-ineligible patients with newly diagnosed multiple myeloma are limited. The difference in treatment subsidization in Australia compared with New Zealand enables comparison of bortezomib-cyclophosphamide-dexamethasone (VCd), lenalidomide-bortezomib-dexamethasone (VRd) with Rd maintenance, and continuous Rd.
Methods
Using data from the ANZ Myeloma and Related Diseases Registry, we evaluated 1092 patients over 70 years of age between February 2013 and February 2024. Those who received Rd, VRd or VCd induction, and did not undergo an autologous stem cell transplant were included.
Results
Overall response rates were 85.6%, 73.7%, and 91.5% for VCd, Rd, and VRd, respectively (P < 0.001). At a median follow-up of 37 months, VRd showed the longest median progression-free survival (PFS) of 27.5 months, compared to 23.7 months for Rd and 20.5 months for VCd (P = 0.01). After adjustment, PFS for VRd and Rd remained superior compared to VCd. Rd patients had the longest median time to next treatment (35.1 months), compared to 28.7 months for VRd and 20.1 months for VCd. Overall survival (OS) was superior with VRd (P = 0.039), with 3-year survival rates of 80% for VRd, 67% for Rd, and 67% for VCd. However, multivariate analysis did not show a significant difference in OS.
Conclusion
Our study confirms VRd demonstrates superior PFS compared to Rd and VCd, but was underpowered to detect a significant difference in OS. More prospective real-world studies are needed to establish the optimal choice of induction therapy balancing efficacy and toxicity for this cohort in resource limited settings.
{"title":"Real-World Comparison of Treatment Outcomes for Multiple Myeloma in Elderly Transplant Ineligible Patients Receiving First-Line VRd, Rd and VCd: Results From the Australian and New Zealand Myeloma and Related Diseases Registry","authors":"Sarah Zhao , Cameron Wellard , Elizabeth M Moore , Andrew Spencer , Hang Quach , P. Joy Ho , Emma-Jane McDonald , Peter Mollee , Simon J Harrison , Bradley Augustson , Erica M Wood , Zoe K McQuilten , Rajeev Rajagopal","doi":"10.1016/j.clml.2025.08.004","DOIUrl":"10.1016/j.clml.2025.08.004","url":null,"abstract":"<div><h3>Background</h3><div>Real-world data on treatment outcomes for elderly transplant-ineligible patients with newly diagnosed multiple myeloma are limited. The difference in treatment subsidization in Australia compared with New Zealand enables comparison of bortezomib-cyclophosphamide-dexamethasone (VCd), lenalidomide-bortezomib-dexamethasone (VRd) with Rd maintenance, and continuous Rd.</div></div><div><h3>Methods</h3><div>Using data from the ANZ Myeloma and Related Diseases Registry, we evaluated 1092 patients over 70 years of age between February 2013 and February 2024. Those who received Rd, VRd or VCd induction, and did not undergo an autologous stem cell transplant were included.</div></div><div><h3>Results</h3><div>Overall response rates were 85.6%, 73.7%, and 91.5% for VCd, Rd, and VRd, respectively (<em>P</em> < 0.001). At a median follow-up of 37 months, VRd showed the longest median progression-free survival (PFS) of 27.5 months, compared to 23.7 months for Rd and 20.5 months for VCd (<em>P</em> = 0.01). After adjustment, PFS for VRd and Rd remained superior compared to VCd. Rd patients had the longest median time to next treatment (35.1 months), compared to 28.7 months for VRd and 20.1 months for VCd. Overall survival (OS) was superior with VRd (<em>P</em> = 0.039), with 3-year survival rates of 80% for VRd, 67% for Rd, and 67% for VCd. However, multivariate analysis did not show a significant difference in OS.</div></div><div><h3>Conclusion</h3><div>Our study confirms VRd demonstrates superior PFS compared to Rd and VCd, but was underpowered to detect a significant difference in OS. More prospective real-world studies are needed to establish the optimal choice of induction therapy balancing efficacy and toxicity for this cohort in resource limited settings.</div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"26 1","pages":"Pages 49-56"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.clml.2025.09.011
Claudia Giordano, Marco Picardi, Annamaria Vincenzi, Alessia Scarpa, Fabrizio Pane
Introduction
To evaluate the impact of long-term peripherally inserted central catheters (PICC) on symptomatic venous thrombosis (s-VT), we reviewed clinical charts of patients suffering from chronic hematological diseases with in-situ PICC placement for at least 90 days after catheterization at the Hematology Unit of the Federico II University Medical School of Naples (Italy). The period of observation was between January 2014 and December 2023.
Methods
A total of 1150 PICCs were inserted into 1150 patients at the hematologic diagnosis. Underlying chronic diseases were the following: non-Hodgkin lymphoma (n = 760, 66.1%), Hodgkin lymphoma (n = 200, 17.4%), multiple myeloma (n = 100, 8.7%), chronic lymphocytic leukemia (n = 50, 4.3%), severe aplastic anemia (n = 15, 1.3%), sickle cell disease (n = 10, 0.9%), thalassemia (n = 10, 0.9%), and hemophilia (n = 5, 0.4%). PICCs were successfully inserted in all cases. The median duration of in-situ PICC placement was 300 days (range, 120-400 days).
Results
A s-VT occurred in 30 cases (2.6%), with a rate of 0.13 (95% CI, 0.04-0.30) per 1000 implantation days. The median period time between PICC insertion and thrombotic episode was 30 days (range, 4-95 days). No serious complication was associated with these events. Hodgkin lymphoma (compared to the other diseases) resulted in a numerically higher incidence of PICC-related s-VT.
Conclusion
PICCs represent a useful and safe frontline central vascular approach for patients with chronic hematologic diseases, with a thrombotic risk profile comparable to that reported with centrally inserted totally implantable venous access devices (TIVADs).
{"title":"Intravascular Complications of Central Venous Catheterization in Chronic Hematological Diseases: Low Risk with Peripherally Inserted Catheters in a Single-Center Retrospective Large Study","authors":"Claudia Giordano, Marco Picardi, Annamaria Vincenzi, Alessia Scarpa, Fabrizio Pane","doi":"10.1016/j.clml.2025.09.011","DOIUrl":"10.1016/j.clml.2025.09.011","url":null,"abstract":"<div><h3>Introduction</h3><div>To evaluate the impact of long-term peripherally inserted central catheters (PICC) on symptomatic venous thrombosis (s-VT), we reviewed clinical charts of patients suffering from chronic hematological diseases with in-situ PICC placement for at least 90 days after catheterization at the Hematology Unit of the Federico II University Medical School of Naples (Italy). The period of observation was between January 2014 and December 2023.</div></div><div><h3>Methods</h3><div>A total of 1150 PICCs were inserted into 1150 patients at the hematologic diagnosis. Underlying chronic diseases were the following: non-Hodgkin lymphoma (n = 760, 66.1%), Hodgkin lymphoma (n = 200, 17.4%), multiple myeloma (n = 100, 8.7%), chronic lymphocytic leukemia (n = 50, 4.3%), severe aplastic anemia (n = 15, 1.3%), sickle cell disease (n = 10, 0.9%), thalassemia (n = 10, 0.9%), and hemophilia (n = 5, 0.4%). PICCs were successfully inserted in all cases. The median duration of in-situ PICC placement was 300 days (range, 120-400 days).</div></div><div><h3>Results</h3><div>A s-VT occurred in 30 cases (2.6%), with a rate of 0.13 (95% CI, 0.04-0.30) per 1000 implantation days. The median period time between PICC insertion and thrombotic episode was 30 days (range, 4-95 days). No serious complication was associated with these events. Hodgkin lymphoma (compared to the other diseases) resulted in a numerically higher incidence of PICC-related s-VT.</div></div><div><h3>Conclusion</h3><div>PICCs represent a useful and safe frontline central vascular approach for patients with chronic hematologic diseases, with a thrombotic risk profile comparable to that reported with centrally inserted totally implantable venous access devices (TIVADs).</div></div>","PeriodicalId":10348,"journal":{"name":"Clinical Lymphoma, Myeloma & Leukemia","volume":"26 1","pages":"Pages e114-e119"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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