Clinical Lymphoma, Myeloma & Leukemia最新文献_第2页

Barriers to Investigator-Initiated Clinical Trial Enrollment in Frontline Large B-Cell Lymphoma 一线大b细胞淋巴瘤研究者发起的临床试验入组的障碍。

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia

Pub Date : 2026-03-01 Epub Date: 2025-11-04 DOI: 10.1016/j.clml.2025.11.002

Carrie Ho , Neena Kennedy , Mengyang Di , Ajay K. Gopal , Ryan C. Lynch , Kevin Ng , Qian V. Wu , Christina Poh , Vikram Raghunathan , Heather Rasmussen , Mazyar Shadman , Brian G. Till , Chaitra S. Ujjani , Stephen D. Smith

Background

Frontline therapy fails to cure ∼ 25% of patients with large B-cell lymphoma (LBCL), underscoring the need for clinical trials to improve outcomes. However, enrollment remains limited by logistical and structural barriers. Investigator-initiated trials (IITs) at our center enroll patients 5 to 10 times faster than industry-sponsored trials, yet the influence of geography and socioeconomic status on participation remains poorly understood.

Methods

We retrospectively reviewed adults with newly diagnosed large B-cell lymphoma (LBCL) referred to Fred Hutchinson Cancer Center (FHCC) between October 2022 and June 2024. Patients were prescreened by a clinical research nurse and investigators for frontline IIT eligibility. Demographic, geographic, and socioeconomic data were collected, including sex, race, ethnicity, distance from FHCC, area deprivation index, insurance, and interpreter need. Logistic and elastic net regression were used to evaluate predictors of trial enrollment. Trial-ineligible patients were analyzed descriptively.

Results

Of 153 patients, 68 (44%) were trial-eligible; 24 (35%) enrolled. Enrolled patients lived closer to FHCC (median 15 vs. 50 miles; P = .00015) and had lower ADI scores (median 8 vs. 21; P = .006) than non-enrolled eligible patients. In univariate analysis, both distance and ADI were associated with enrollment; in multivariable stepwise regression, only distance remained significant. Elastic net regression identified both distance and ADI as frequently selected predictors. Among 85 trial-ineligible patients, 61% had already initiated treatment; these patients also lived farther away and in more deprived areas.

Conclusion

Geographic distance and neighborhood deprivation significantly influenced trial enrollment, even in investigator-initiated trials (IITs). Decentralized trial models, telemedicine triage, and system-level interventions are needed to reduce these inequities.

背景：一线治疗不能治愈约25%的大b细胞淋巴瘤（LBCL）患者，这强调了临床试验改善预后的必要性。然而，入学人数仍然受到后勤和结构障碍的限制。在我们的研究中心，研究者发起的试验（iit）招募患者的速度比行业赞助的试验快5到10倍，但地理和社会经济地位对参与的影响仍然知之甚少。方法：我们回顾性分析了2022年10月至2024年6月期间Fred Hutchinson癌症中心（FHCC）新诊断的大b细胞淋巴瘤（LBCL）的成人患者。患者由临床研究护士和调查人员预先筛选一线IIT资格。收集了人口统计、地理和社会经济数据，包括性别、种族、民族、与FHCC的距离、地区剥夺指数、保险和翻译需求。采用Logistic和弹性网络回归评价试验入组的预测因素。对不符合试验条件的患者进行描述性分析。结果：153例患者中，68例（44%）符合试验条件；24人（35%）入学。入组患者居住距离FHCC较近（中位数15 vs 50英里，P = 0.00015）， ADI评分较低（中位数8 vs 21， P = 0.006）。在单变量分析中，距离和ADI都与入组相关；在多变量逐步回归中，只有距离仍然显著。弹性网回归确定了距离和ADI作为经常选择的预测因子。在85名不符合试验条件的患者中，61%已经开始治疗；这些病人也住得更远，住在更贫困的地区。结论：地理距离和邻里剥夺显著影响试验入组，即使在研究者发起的试验（IITs）中也是如此。分散的试验模式、远程医疗分诊和系统级干预需要减少这些不公平现象。

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引用次数: 0

Dismal Outcome of EBV-Positive Nodal T/NK-Cell Lymphoma: A Multicenter Retrospective Study ebv阳性淋巴结T/ nk细胞淋巴瘤的惨淡结局：一项多中心回顾性研究。

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia

Pub Date : 2026-03-01 Epub Date: 2025-11-23 DOI: 10.1016/j.clml.2025.11.008

Satoshi Ichikawa , Noriko Fukuhara , Yuna Katsuoka , Yuki Ishizawa , Kosuke Kamata , Masahiko Fukatsu , Takayo Nagao , Kazunori Murai , Hisayuki Yokoyama , Yoshiko Tamai , Takayuki Ikezoe , Ryo Ichinohasama , Shigeki Ito , Naoto Takahashi , Hideo Harigae

Background

Epstein-Barr virus (EBV)-positive nodal T- and natural killer (NK)-cell lymphoma (EB-nTNKL) is a newly defined, rare, and aggressive EBV-driven lymphoid malignancy that typically affects older individuals, predominantly male, of East Asian descent. It is characterized by a cytotoxic T-cell phenotype, with only a limited number of cases documented to date.

Methods

We performed a multicenter retrospective analysis of 11 patients diagnosed with EB-nTNKL via lymph node biopsy in Japan in order to better characterize its clinicopathological features and outcomes.

Results

The median age at diagnosis was 65 years (range 24-81), and most patients presented with advanced-stage (III/IV) disease, B symptoms, and high-risk International Prognostic Index scores. Elevated serum lactate dehydrogenase (median 614 U/L) and soluble interleukin-2 receptor (median 5247 U/mL) levels were observed in all cases. All cases expressed cytotoxic molecules (granzyme B and/or TIA-1), indicating a cytotoxic T/NK-cell phenotype, and 8 cases were CD8-positive. Responses to conventional chemotherapy were poor. The median overall survival was only 2.9 months, with 6 of 11 patients dying within 3 months of diagnosis.

Conclusions

EB-nTNKL represents a distinct clinicopathological entity with a fulminant clinical course and profound chemoresistance, resulting in an extremely poor prognosis. However, differentiation from other EBV-associated T/NK-cell neoplasms, particularly those arising in younger patients, remains a diagnostic challenge and warrants further clinicopathological investigation. These dismal outcomes underscore an urgent need to develop more effective therapeutic strategies.

背景：eb病毒（EBV）阳性淋巴结T细胞和自然杀伤（NK）细胞淋巴瘤（EB-nTNKL）是一种新定义的、罕见的、侵袭性eb病毒驱动的淋巴细胞恶性肿瘤，通常影响东亚血统的老年人，主要是男性。它的特征是细胞毒性t细胞表型，迄今为止只有有限数量的病例记录。方法：我们对日本通过淋巴结活检诊断为EB-nTNKL的11例患者进行了多中心回顾性分析，以更好地表征其临床病理特征和预后。结果：诊断时的中位年龄为65岁（范围24-81岁），大多数患者表现为晚期（III/IV）疾病，B型症状和高风险国际预后指数评分。所有病例血清乳酸脱氢酶（中位值614 U/L）和可溶性白介素-2受体（中位值5247 U/mL）水平均升高。所有病例均表达细胞毒性分子（颗粒酶B和/或TIA-1），提示细胞毒性T/ nk细胞表型，8例cd8阳性。常规化疗反应较差。中位总生存期仅为2.9个月，11例患者中有6例在诊断后3个月内死亡。结论：EB-nTNKL是一种独特的临床病理实体，具有暴发性临床病程和深刻的化疗耐药，导致预后极差。然而，与其他ebv相关的T/ nk细胞肿瘤的分化，特别是在年轻患者中出现的，仍然是一个诊断挑战，需要进一步的临床病理研究。这些令人沮丧的结果强调了迫切需要开发更有效的治疗策略。

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引用次数: 0

SOHO State of the Art Updates and Next Questions | The Promise of Immunotherapies in T-Cell Lymphoma 免疫疗法治疗t细胞淋巴瘤的前景。

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia

Pub Date : 2026-03-01 Epub Date: 2025-09-10 DOI: 10.1016/j.clml.2025.09.006

Colin J. Thomas , Stefan K. Barta

T-cell non-Hodgkin lymphomas (NHL) are a heterogenous group of malignancies that represent a minority of all NHL cases world-wide. Outcomes with traditional chemotherapy-based regimens remain poor with notably dismal outcomes in the relapsed/refractory setting. The power of immunotherapy has revolutionized treatments and outcomes for hematologic malignancies and has already made significant strides in addressing the treatment needs in T-cell NHLs. Given the heterogeneity of T-cell lymphoma subtypes and biology, a wide variety of innovative immunotherapies have been evolving to treat these various malignancies. Here, we review the promising advancement of various immunotherapies in T-cell NHLs including antibody-based therapies targeting T-cell surface antigens and checkpoint signaling, as well as the expanding strategies for chimeric antigen receptor T-cell (CAR-T) therapy in this difficult to treat disease space.

t细胞非霍奇金淋巴瘤（NHL）是一种异质性的恶性肿瘤，在全球所有NHL病例中占少数。传统化疗方案的预后仍然很差，复发/难治性患者的预后尤其令人沮丧。免疫疗法的力量已经彻底改变了血液恶性肿瘤的治疗方法和结果，并且已经在解决t细胞nhl的治疗需求方面取得了重大进展。鉴于t细胞淋巴瘤亚型和生物学的异质性，各种各样的创新免疫疗法已经发展到治疗这些不同的恶性肿瘤。在这里，我们回顾了各种免疫疗法在t细胞nhl中的有希望的进展，包括靶向t细胞表面抗原和检查点信号的基于抗体的疗法，以及在这种难以治疗的疾病领域中嵌合抗原受体t细胞（CAR-T）治疗的扩展策略。

引用次数: 0

Real-World Evidence on Ibrutinib in First-Line Chronic Lymphocytic Leukemia/ Small Lymphocytic Lymphoma: A Comprehensive Review 伊鲁替尼治疗一线慢性淋巴细胞白血病/小淋巴细胞淋巴瘤的真实世界证据：全面回顾。

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia

Pub Date : 2026-03-01 Epub Date: 2025-12-19 DOI: 10.1016/j.clml.2025.12.012

Nilanjan Ghosh , John N. Allan , Sabyasachi Ghosh , Zaina P. Qureshi , Alex Bokun , Susan O’Brien

Ibrutinib, a Bruton tyrosine kinase inhibitor, is a cornerstone of first-line treatment for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). While generally well tolerated, dose adjustments may be used in some patients to manage adverse events or tolerability issues. This review examines the real-world outcomes such as the effectiveness and duration of therapy of first-line ibrutinib treatment in patients with CLL/SLL, including those with high-risk genomic features. The role of flexible dosing strategies, including dose adjustments or interruptions, and their role in optimizing ibrutinib treatment duration and outcomes are explored. Consistent with results from clinical trials, real-world evidence supports the effectiveness of ibrutinib dosing flexibility in managing adverse events while maintaining long-term clinical benefits. Ibrutinib dose adjustments help optimize treatment persistence and reduce treatment discontinuations, thereby enabling continuous ibrutinib treatment. Furthermore, real-world evidence suggests that ibrutinib dose flexibility contributes to reduced healthcare resource utilization, including fewer hospitalizations and outpatient visits, thus lowering the economic burden of CLL/SLL treatment. Long-term effectiveness, together with lower costs and the ability to tailor ibrutinib dosing to individual patients, supports ibrutinib as a pivotal agent in the management of CLL/SLL.

Ibrutinib是一种布鲁顿酪氨酸激酶抑制剂，是慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL/SLL）一线治疗的基石。虽然通常耐受性良好，但剂量调整可用于某些患者以控制不良事件或耐受性问题。本综述研究了现实世界的结果，如一线伊鲁替尼治疗CLL/SLL患者的有效性和治疗持续时间，包括那些具有高风险基因组特征的患者。灵活的给药策略的作用，包括剂量调整或中断，以及它们在优化伊鲁替尼治疗持续时间和结果中的作用。与临床试验结果一致，实际证据支持伊鲁替尼灵活剂量管理不良事件的有效性，同时保持长期临床获益。依鲁替尼剂量调整有助于优化治疗持久性，减少治疗中断，从而实现持续的依鲁替尼治疗。此外，现实证据表明，伊鲁替尼剂量的灵活性有助于减少医疗资源的利用，包括减少住院和门诊就诊，从而降低CLL/SLL治疗的经济负担。长期的有效性，加上较低的成本和针对个体患者量身定制伊鲁替尼剂量的能力，支持伊鲁替尼作为CLL/SLL治疗的关键药物。

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引用次数: 0

Undetectable Minimal Residual Disease in Multiple Myeloma: Bridging the Gap Between Clinical Trials and Real-life Application 多发性骨髓瘤中检测不到的微小残留疾病：弥合临床试验和实际应用之间的差距。

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia

Pub Date : 2026-03-01 Epub Date: 2025-12-24 DOI: 10.1016/j.clml.2025.12.016

Roberto Mina , Elisabetta Antonioli , Gregorio Barilà , Niccolò Bolli , Cirino Botta , Anna Furlan , Carmine Liberatore , Marina Martello , Sonia Moré , Stefania Oliva , Bernardo Rossini , Elona Saraci , Antonio Giovanni Solimando , Paola Storti , Elena Zamagni

Much evidence supports the assessment of minimal residual disease (MRD) status in the clinical management of multiple myeloma (MM). Using highly sensitive next-generation flow cytometry and next-generation sequencing tests to detect MRD enables clinicians to evaluate the depth of response and therefore the prognosis of patients with MM as achieving deep and sustained (≥ 12 months) undetectable MRD correlates with prolonged survival in patients with MM. Because of this, undetectable MRD (also referred to as MRD-negativity) has been recognized and approved by the FDA as an early endpoint in clinical trials to accelerate regulatory approval of new treatments for MM. However, many questions remain around how (methods, sensitivity levels), who (all patients vs. those achieving complete/partial response), and when to test in relation to treatment phases, defining the optimal duration for sustained undetectable MRD, and how MRD can be used to guide treatment strategies in clinical practice. This narrative review has examined data from key clinical trials in MM to analyze the implementation of MRD testing in the newly-diagnosed and relapsed/refractory MM settings. We have also summarized trials that test MRD-driven approaches.

许多证据支持评估最小残留病（MRD）状态在多发性骨髓瘤（MM）的临床管理。使用高灵敏度的下一代流式细胞术和下一代测序检测来检测MRD，使临床医生能够评估反应的深度，因此MM患者的预后，因为实现深度和持续（≥12个月）不可检测的MRD与MM患者的延长生存期相关。不可检测的MRD（也被称为MRD阴性）已被FDA认可并批准为临床试验的早期终点，以加速MM新疗法的监管批准。然而，围绕如何（方法，敏感性水平），谁（所有患者与实现完全/部分缓解的患者）以及何时进行与治疗阶段相关的测试，确定持续不可检测MRD的最佳持续时间，仍然存在许多问题。以及如何在临床实践中使用MRD来指导治疗策略。这篇叙述性综述研究了MM的关键临床试验数据，以分析MRD检测在新诊断和复发/难治性MM中的实施情况。我们还总结了测试mrd驱动方法的试验。

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引用次数: 0

Improved Outcomes Following the Adoption of Targeted Therapies in High-Risk Chronic Lymphocytic Leukemia Treated in Southern Finland 芬兰南部高危慢性淋巴细胞白血病采用靶向治疗后的预后改善

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia

Pub Date : 2026-03-01 Epub Date: 2025-12-11 DOI: 10.1016/j.clml.2025.12.002

Tuija Tapaninen , Vesa Lindström , Olivia Hölsä , Emma-Leena Alarmo , Liisa Ukkola-Vuoti , Kimmo Porkka , Oscar Brück

Background

Targeted therapies have replaced chemoimmunotherapy for chronic lymphocytic leukemia (CLL), but high-risk CLL patients with TP53 aberrations continue to represent a significant unmet medical need. We profiled treatment patterns, outcomes, and adverse effects in a large, unselected cohort of high-risk CLL patients.

Patients and Methods

This study retrospectively analyzed clinical data from 1,720 CLL patients diagnosed between 2012 and 2023 within the Helsinki University Hospital district in Southern Finland. We focused on 543 patients who received first-line (1 L) systemic treatment.

Results

Of the 543 treated patients, 78 (14.4%) had a TP53 aberrations. A clear shift in treatment patterns occurred after 2018, with targeted therapies comprising over one-third of 1 L regimens. For high-risk patients, ibrutinib use at the 1 L stage rose dramatically after 2018, replacing chemoimmunotherapy as the most common treatment. This change coincided with a marked increase in the median time-to-next-treatment (TTNT) for high-risk patients, from 21.2 months (2012-2017) to 26.0 months (2018-2023). Increased TP53 and IGHV mutation testing rates facilitated more personalized treatment approaches over time. Adverse events were less frequent in patients receiving targeted therapies (62.1%) compared to those on non-targeted regimens (73.5%). Despite these improvements, the median overall survival (OS) for high-risk patients remained challenging at 47.1 months after 1 L treatment.

Conclusion

The transition to targeted therapies has improved outcomes for high-risk CLL patients. Nevertheless, outcomes for high-risk CLL patients remain inferior to those reported in clinical trials, underscoring the need for real-world evidence and improved therapies.

背景：针对慢性淋巴细胞白血病（CLL）的靶向治疗已经取代了化学免疫治疗，但TP53异常的高危CLL患者仍然是一个显著的未满足的医疗需求。我们分析了高风险CLL患者的治疗模式、结果和不良反应。患者和方法：本研究回顾性分析了2012年至2023年芬兰南部赫尔辛基大学医院区诊断的1720例CLL患者的临床数据。我们重点研究了543例接受一线（1l）全身治疗的患者。结果：543例患者中，78例（14.4%）存在TP53异常。2018年之后，治疗模式发生了明显转变，靶向治疗占1l方案的三分之一以上。对于高危患者，2018年之后，伊鲁替尼在1l期的使用急剧增加，取代化学免疫治疗成为最常见的治疗方法。这一变化与高危患者的中位下一次治疗时间（TTNT）显著增加相吻合，从21.2个月（2012-2017年）增加到26.0个月（2018-2023年）。随着时间的推移，TP53和IGHV突变检测率的增加促进了更个性化的治疗方法。接受靶向治疗的患者的不良事件发生率（62.1%）低于非靶向治疗的患者（73.5%）。尽管有这些改善，高风险患者的中位总生存期（OS）在1l治疗后仍为47.1个月。结论：向靶向治疗的过渡改善了高危CLL患者的预后。然而，高风险CLL患者的结果仍然不如临床试验报告的结果，这强调了对真实世界证据和改进治疗的需求。

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引用次数: 0

Persistent COVID-19 in Patients With Hematological Malignancies: A Focused Review in the Omicron Era 血液系统恶性肿瘤患者的持续性COVID-19：基因组时代的重点回顾

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia

Pub Date : 2026-03-01 Epub Date: 2025-12-01 DOI: 10.1016/j.clml.2025.11.009

Hajime Yasuda , Jun Ando , Miki Ando

COVID-19 is a threat to patients with hematological malignancies (HM) even in the Omicron era, because mortality rates are still high in HM patients, and a significant number of patients develop a protracted disease course called “persistent COVID-19 (pCOVID-19)” which can continue for weeks to months. pCOVID-19 can be life-threatening by itself, but also drastically affects the disease course of the underlying HM by delaying or terminating chemotherapy. Also, patients with pCOVID-19 can be potentially contagious, and timing of ending isolation is a dilemma the hematology ward faces. Furthermore, pCOVID-19 has been reported to lead to acquisition of SARS-CoV-2 multidrug-resistant mutations, which is an alarming issue for both the patient and public health. The optimal management method of pCOVID-19 is currently unknown, and because HM patients are excluded from randomized clinical trials, evidence is limited to case reports and small case series. We carried out a comprehensive literature review of Omicron pCOVID-19 occurring in HM patients, compiled the scattered evidence, and provide practical recommendations which can be of guide to clinicians. Main topics discussed within this review include efficacy of vaccinations in HM patients, risk factors for developing pCOVID-19 (B-cell depleting agents, bendamustine + rituximab therapy, bispecific T-cell engagers, etc.), treatment of pCOVID-19 including extended/sequential/combination therapy incorporating antivirals (nirmatrelvir/ritonavir, remdesivir, molnupiravir, and ensitrelvir) and convalescent plasma/intravenous immunoglobulin therapy, monitoring pCOVID-19 with reverse transcription (RT)-PCR, and optimal target cycle threshold values as goals of therapy.

即使在欧米克隆时代，COVID-19对血液系统恶性肿瘤（HM）患者也是一个威胁，因为HM患者的死亡率仍然很高，而且相当多的患者会出现一种称为“持续性COVID-19 （pCOVID-19）”的长期病程，这种病程可能持续数周至数月。pCOVID-19本身可能危及生命，但也会通过延迟或终止化疗来极大地影响潜在的HM的病程。此外，pCOVID-19患者可能具有潜在传染性，结束隔离的时机是血液科病房面临的一个难题。此外，据报道，pCOVID-19会导致获得SARS-CoV-2多药耐药突变，这对患者和公共卫生都是一个令人担忧的问题。目前尚不清楚pCOVID-19的最佳管理方法，并且由于HM患者被排除在随机临床试验之外，证据仅限于病例报告和小病例系列。我们对HM患者发生的Omicron pCOVID-19进行了全面的文献综述，整理了零散的证据，并提出了可指导临床医生的实用建议。本综述中讨论的主要主题包括：接种疫苗对HM患者的疗效、发生pCOVID-19的危险因素（b细胞消耗剂、苯达莫司汀+利妥昔单抗治疗、双特异性t细胞参与剂等）、pCOVID-19的治疗包括抗病毒药物（尼马特利韦/利托那韦、瑞德西韦、莫努匹拉韦和恩西瑞韦）的延长/序贯/联合治疗和恢复期血浆/静脉注射免疫球蛋白治疗。用逆转录(RT)-PCR监测pCOVID-19，并将最佳靶周期阈值作为治疗目标。

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引用次数: 0

SOHO State of the Art Updates and Next Questions | SOHO 2025 Next Questions: Acute Lymphoblastic Leukemia SOHO国家的艺术更新和下一个问题| SOHO 2025下一个问题：急性淋巴细胞白血病。

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia

Pub Date : 2026-03-01 Epub Date: 2026-01-03 DOI: 10.1016/j.clml.2025.12.018

Hannah Goulart , Elias Jabbour

The treatment landscape of B-cell acute lymphoblastic leukemia (B-ALL) has been transformed by the incorporation of immunotherapy and potent tyrosine kinase inhibitors (TKIs) into frontline regimens, resulting in meaningful improvements in long-term survival. Such advances have allowed for a reduction in both the intensity and duration of chemotherapy without compromising outcomes, a particularly important goal for older adults, who are less tolerant to intensive chemotherapy and often harbor higher-risk disease features, including TP53 mutations that confer resistance to traditional chemotherapy. Largely chemotherapy-free regimens may alleviate some of the poor outcomes that older patients experience; such regimens are under investigation. While the risk factors that portend inferior outcomes for patients with Philadelphia (Ph)-positive B-ALL are still being defined in the setting of immunotherapy-based regimens and more potent TKIs, it is evident that an elevated baseline white blood cell count is a strong predictor of relapse. The role of chimeric antigen receptor (CAR) T-cell therapy as consolidation for patients with high-risk Ph-positive B-ALL is actively being explored, alongside efforts to identify factors that influence CAR T-cell expansion and persistence as determinants of response durability. Advances in more sensitive assessments of measurable residual disease (MRD) using next generation sequencing (NGS) will help inform which patients may benefit from additional consolidative strategies. Novel agents under development include the subcutaneous (SC) form of blinatumomab, which has demonstrated efficacy even in patients with prior blinatumomab exposure. Altogether, these developments frame the next set of questions in ALL, which will be addressed in this review.

b细胞急性淋巴细胞白血病（B-ALL）的治疗前景已经被免疫疗法和强效酪氨酸激酶抑制剂（TKIs）纳入一线方案所改变，导致长期生存有意义的改善。这些进步使得减少化疗的强度和持续时间而不影响结果成为可能，这对老年人来说是一个特别重要的目标，因为老年人对强化化疗的耐受性较差，而且往往具有高风险的疾病特征，包括对传统化疗产生耐药性的TP53突变。大部分无化疗方案可能会减轻老年患者所经历的一些不良后果；目前正在对这些方案进行调查。虽然预示费城（Ph）阳性B-ALL患者预后较差的危险因素仍在免疫治疗方案和更有效的TKIs的背景下被定义，但很明显，基线白细胞计数升高是复发的有力预测因子。目前正在积极探索嵌合抗原受体（CAR） t细胞治疗作为高危ph阳性B-ALL患者巩固治疗的作用，同时努力确定影响CAR - t细胞扩增和持久性的因素，作为反应持久性的决定因素。使用下一代测序（NGS）对可测量残余疾病（MRD）进行更敏感评估的进展将有助于告知哪些患者可能从额外的整合策略中受益。正在开发的新型药物包括皮下（SC）形式的blinatumomab，即使在先前暴露于blinatumomab的患者中也已证明有效。总之，这些发展构成了ALL的下一组问题，这些问题将在本次审查中讨论。

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引用次数: 0

Bispecific Antibody Therapy for Multiple Myeloma: A Practical Toolkit 双特异性抗体治疗多发性骨髓瘤：一个实用的工具包。

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia

Pub Date : 2026-03-01 Epub Date: 2025-12-26 DOI: 10.1016/j.clml.2025.12.015

Cesar Rodriguez , Cyrille Touzeau , Edvan de Queiroz Crusoe , Fernando Vieira Pericole , Vania Hungria

Purpose

Bispecific antibodies emerged as a new class of treatment for patients with relapsed/refractory multiple myeloma. Education on the practicalities of delivery and patient management is vital to optimize outcomes with these novel agents.

Methods

A group of 5 experienced hematologists from centers in the United States, Europe and Latin America met to discuss key considerations for bispecific antibody therapy and agree on best practice advice.

Results and Discussion

This paper presents advice for best practice at each stage of the bispecific antibody therapy patient journey: patient eligibility, pretreatment medication, step-up dosing, treatment, management of adverse events and long-term care.

Conclusion

We believe that the expert insights presented here will help to educate healthcare professionals and optimize patient outcomes by guiding the implementation of bispecific antibody therapy into real-world practice.

目的：双特异性抗体作为一种新的治疗复发/难治性多发性骨髓瘤的方法出现。教育的实用性交付和患者管理是至关重要的，以优化这些新型药物的结果。方法：一组来自美国、欧洲和拉丁美洲中心的5名经验丰富的血液学家开会讨论双特异性抗体治疗的关键因素，并就最佳实践建议达成一致。结果和讨论：本文提出了双特异性抗体治疗患者旅程的每个阶段的最佳实践建议：患者资格，预处理药物，增加剂量，治疗，不良事件管理和长期护理。结论：我们相信，这里提出的专家见解将有助于教育医疗保健专业人员，并通过指导双特异性抗体治疗在现实世界中的实施来优化患者的结果。

引用次数: 0

SOHO State of the Art Updates and Next Questions | Addressing the Transformative Questions in Aggressive B-Cell Lymphomas. SOHO国家的艺术更新和下一个问题b|解决变革性问题在侵袭性b细胞淋巴瘤。

IF 2.7 4区医学 Q2 HEMATOLOGY

Clinical Lymphoma, Myeloma & Leukemia

Pub Date : 2026-02-27 DOI: 10.1016/j.clml.2026.01.011

Gonca Ozcan, Mark Roschewski

Large B-cell lymphoma (LBCL) is a heterogeneous disease for which anthracycline-based chemoimmunotherapy cures most patients. However, a substantial minority of patients experience refractory disease or relapse, and outcomes remain poor. Improving frontline cure rates therefore remains a fundamental objective in the lymphoma field and has led to the development of multiple therapeutic strategies. Herein, we discuss approaches aimed at improving outcomes beyond standard chemotherapy and address 4 transformative questions in LBCL: (1) can immunotherapy improve frontline cure rates; (2) is precision medicine a sound approach to overcome genetic heterogeneity; (3) can LBCL be cured without chemotherapy; (4) can circulating tumor DNA (ctDNA) aid clinical decision-making in response-adapted strategies. Together, these approaches reflect evolving strategies that may improve frontline outcomes and inform future treatment paradigms for patients with LBCL.

大b细胞淋巴瘤（LBCL）是一种异质性疾病，以蒽环类药物为基础的化学免疫治疗可以治愈大多数患者。然而，大量少数患者出现难治性疾病或复发，结果仍然很差。因此，提高一线治愈率仍然是淋巴瘤领域的一个基本目标，并导致多种治疗策略的发展。在此，我们讨论了旨在改善标准化疗之外的结果的方法，并解决了LBCL的4个变革性问题：(1)免疫治疗能否提高一线治愈率；(2)精准医疗是克服遗传异质性的有效途径吗？(3) LBCL不用化疗就能治愈吗？(4)循环肿瘤DNA （ctDNA）能否帮助临床决策应对策略？总之，这些方法反映了不断发展的策略，可以改善一线结果，并为LBCL患者的未来治疗范例提供信息。

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