Current Hematologic Malignancy Reports最新文献

Purpose of review: Myeloproliferative neoplasms (MPNs) lie at the intersection of malignancy and chronic inflammatory disease. This review summarizes current understanding of how inflammation drives MPN pathogenesis, from clonal initiation to progression and symptom burden, and explores how emerging therapies modulate the inflammatory microenvironment.

Recent findings: Evidence from human genetics, epidemiology, and experimental models shows that chronic inflammatory stress promotes the expansion of JAK2- and other MPN-associated clones. Inflammatory cytokine networks sustain myeloproliferation, reshape the bone marrow niche, and contribute to fibrosis. JAK inhibitors remain the cornerstone of therapy and exert much of their clinical benefit through suppression of cytokine signaling. Newer agents also mitigate inflammation through complementary mechanisms. Inflammation is inseparable from MPN biology and represents both a driver and a therapeutic target. Reframing MPN as a disorder of maladaptive immune and stromal interactions highlights opportunities to restore balance within this ecosystem and potentially alter disease course.

Purpose of review: Acute lymphoblastic leukemia (ALL) is a rare hematologic malignancy with a bimodal distribution of incidence in both pediatric/young adult and elderly patient populations. Despite the high complete remission rate, there is a high rate of relapse necessitating a need for therapy options in the relapsed/refractory setting. Given this, treatment paradigms for ALL have shifted towards targeted therapies and away from high-intensity chemotherapy. The efficacy of inotuzumab ozogamicin (InO) in the relapsed/refractory setting for pediatric and adult populations has led to incorporation of this targeted therapy into frontline regimens. In this review, the role of InO in the frontline, measurable residual disease (MRD) positive and relapsed/refractory settings is highlighted.

Recent findings: InO is a directed antibody-drug conjugate that binds to CD22 on the surface of leukemic blasts. The cell internalizes InO, prompting enzymatic cleavage in the lysosome that releases calicheamicin, inducing double-strand DNA breaks and causing apoptosis. However, off-target effects can lead to severe adverse events such as hepatotoxicity, including veno-occlusive disease, and myelosuppression. Prior studies have supported its use in the relapsed or refractory treatment setting; however, newer studies incorporating InO in the frontline have shown promising results. Newer studies have also shown evidence of utilization of InO in specific sub-populations of B-cell ALL, including those with MRD-positive disease and Philadelphia-positive (Ph +) disease, and as bridging therapy with CAR T-cell therapy, and in the post-transplant maintenance setting. This review evaluated the effectiveness of InO in clinical practice, associated adverse events, future directions in specific patient populations. Despite recent advancements, patients with B-cell ALL tend to have poorer outcomes, especially in the adult population. Future research and larger scale prospective studies are indicated to evaluate the efficacy of InO in different lines of therapy.

Purpose of review: Measurable residual disease (MRD) has emerged as the strongest prognostic biomarker in multiple myeloma (MM), providing a deeper assessment of treatment response than conventional serological tests. Sensitive MRD detection is helpful in risk stratification, prognostication, and early relapse prediction and is increasingly being used as an important clinical trial endpoint in MM. Moreover, MRD has emerged as a useful tool in guiding treatment intensity and duration.

Recent findings: MRD can be assessed using bone marrow-based, peripheral blood-based, or imaging-based techniques. Bone marrow-based next-generation flow cytometry and next-generation sequencing, with a minimum sensitivity of 10^- 5, remain the current standard for MRD testing in MM. However, limitations like the need for frequent bone marrow aspirations and false negative results in patchy marrow involvement or isolated extramedullary disease have accelerated the interest in peripheral blood-based MRD tools. Mass spectrometry-based approaches, including intact protein mass spectrometry (MALDI-TOF assays like 'MASS-FIX' and 'EXENT') and clonotypic peptide mass spectrometry (such as 'EasyM' and 'M-Insight'), have evolved as highly sensitive peripheral blood-based MRD detection tools for relatively non-invasive dynamic MRD monitoring. Newer technologies like droplet digital PCR, circulating tumor cell analysis using enriched flow cytometry, cell-free DNA sequencing, and emerging epigenetic and fragmentomic profiling are in various phases of research and have the potential to revolutionize the way we monitor and treat MM. Finally, numerous active clinical trials worldwide are exploring the role of MRD in guiding treatment and are expected to shed light on the optimal approach to MRD assessments in routine clinical practice.

Purpose of the review: Myelofibrosis (MF) is a myeloproliferative neoplasm (MPN) characterized by splenomegaly, constitutional symptoms, bone marrow fibrosis and potential progression to a blast phase. This review provides a comprehensive overview of the current molecular landscape of MF beyond canonical driver mutations (JAK2, MPL or CALR), emphasizing insights gained from murine models that served as valuable tools for understanding disease mechanisms.

Recent findings: High-throughput next-generation sequencing (NGS) has markedly enhanced our understanding of the molecular basis of MF, identifying numerous mutations beyond the canonical driver genes JAK2, MPL, and CALR, which are present in about 80% of patients. Additional mutations affect genes involved in DNA methylation (TET2, DNMT3A, IDH1, IDH2), histone modification (ASXL1, EZH2), mRNA splicing (SF3B1, SRSF2, U2AF1, ZRSR2), signaling pathways (CBL, NRAS, KRAS), and key transcription factors (RUNX1, NFE2, TP53). The presence and combination of these alterations influence clinical presentation, prognosis, and therapeutic response. This review offers an updated synthesis of the evolving molecular landscape of MF, highlighting how the intricate interplay among genetic alterations has deepened our understanding of disease heterogeneity, allowing refined risk stratification and therapeutic planning. Advances emerging from molecular research and experimental models are progressively translating into clinical practice, promoting more personalized and targeted approaches to the management of MF.

Purpose of review: The goal of this review is to provide an updated synthesis of therapeutic advances and remaining controversies in the management of Philadelphia chromosome-positive (Ph +) B-cell acute lymphoblastic leukemia (ALL). We sought to examine how modern tyrosine kinase inhibitors (TKIs), immunotherapies, and response-adapted strategies have reshaped treatment paradigms, including the role of allogeneic hematopoietic stem cell transplantation (allo-HCT), central nervous system (CNS) prophylaxis, and emerging chemotherapy-free approaches.

Recent findings: Successive generations of TKIs have transformed Ph + ALL from a uniformly fatal leukemia into a highly treatable disease, with dasatinib or ponatinib-based and TKI-blinatumomab regimens achieving high rates of complete molecular remission. Achieving early measurable residual disease (MRD) negativity predicts long-term survival and identifies patients who may safely defer allo-HCT. Genomic profiling has uncovered prognostic subgroups, notably IKZF1^plus, T315I mutated, and multilineage disease, which remain resistant or challenging to current therapy. Novel agents, including asciminib and olverembatinib, are expanding options for resistant or relapsed disease, while CAR-T cell therapy and next-generation bispecific T-cell engagers are emerging as promising tools for refractory and post-TKI settings. Ph + ALL exemplifies the paradigm shift toward precision, MRD-directed, and chemotherapy-sparing treatment. Integrating potent TKIs with immunotherapy enables deep and durable remissions, potentially eliminating the need for upfront transplantation in selected patients. Future research should define molecular predictors of treatment-free remission, optimize CNS prophylaxis in targeted regimens, and establish standardized monitoring for safe TKI discontinuation.

Purpose of review: Clonal hematopoiesis (CH) arises from the expansion of a single hematopoietic stem cell harboring somatic mutations that confer growth advantage. Recent studies highlight a substantial heritable component to CH, implicating germline mutations in DNA damage repair (DDR) genes. These genes are essential for maintaining genomic integrity and pathogenic variants in key DDR genes are well-established genetic underpinnings of several hereditary cancer syndromes. This review synthesizes current data linking germline DDR mutations - including ATM, CHEK2, TP53, PPM1D, BRCA1/2, and PARP1 - to CH and the development of myeloid malignancies.

Recent findings: Emerging evidence suggests that germline perturbations in DDR pathway contribute to CH, though mechanisms remain incompletely defined. Large scale genome-wide association studies (GWAS) have identified strong associations between ATM and CHEK2 variants and CH. Assessing prevalence and CH risk in individuals with germline TP53 variants presents unique challenges, as distinguishing between somatic and constitutional lesions is often complex and requires careful tissue evaluation. The link between germline BRCA1/2 and CH remains inconclusive, confounded by concurrent diagnosis of solid malignancy and prior exposure to chemoradiation therapy in studied patient populations. Although germline mutations in PPM1D and PARP1 are rare, a potential germline predisposition to CH cannot be excluded. The totality of current evidence suggests that germline DDR pathway mutations not only predispose to well-established solid malignancy syndromes but also to CH, which independently increases the risk of hematologic malignancies. Recognizing germline contributions to CH has broad implications for risk assessment, surveillance strategies, and development of preventive strategies in myeloid neoplasia.

Purpose of review: Despite increased recognition of FPDMM and advancements in genetic technologies that have improved carrier identification and our understanding of RUNX1 function, the mechanisms driving hematologic malignancy (HM) development in this disorder remain incompletely understood. Currently, there are no FPDMM-specific therapeutic strategies, and clinical management is largely confined to surveillance and supportive measures. This review aims to summarise emerging therapeutic strategies across all stages of disease progression, from early preventive interventions to treatments post-malignant transformation.

Recent findings: Recent studies have explored multiple experimental strategies addressing distinct aspects of RUNX1-FPDMM pathobiology. These include CRISPR/Cas9-mediated correction of pathogenic germline RUNX1 variants, approaches that stabilize or enhance RUNX1 protein function by preventing its degradation or inhibition, and modulation of deregulated signaling pathways downstream of RUNX1 dysfunction. In addition, emerging therapies aim to target high-risk somatic variants that arise during disease progression. Interventions directed at hyperactivated inflammatory pathways, including JAK1/2 and mTOR, have also shown potential in mitigating the proinflammatory environment that contributes to hematologic malignancy development in FPDMM. Therapeutic approaches for FPDMM are multi-modal with approaches including; correcting pathogenic RUNX1 gene variants, enhancing RUNX1 protein stability and protection, and modulating signaling pathways disrupted by its dysfunction to normalise the underlying hematological disturbances. Although several agents are in clinical studies, all approaches are at an early stage and there remains much work to be done to translate treatments for clinical benefit.