British Journal of Haematology最新文献

Several tools have been developed to provide prognostic indicators that are more accurate than chronological age alone because choosing the best treatment for older lymphoma patients is challenging. For older patients with diffuse large B-cell lymphoma (DLBCL), one of these prognostic indicators is patient fitness; its definition has been validated, its assessment is recommended by international guidelines and it is currently integrated into several clinical trials. In terms of fitness, frailty is emerging as a major barrier to curative options for older patients with Hodgkin lymphoma (HL) as well, and the preliminary data now available support geriatric assessment in this setting. This review presents and discusses the robust results on the prognostic value of assessing fitness achieved in DLBCL and the early findings of geriatric studies conducted in HL, including promising novel approaches to defining patient fitness.

Donor age is an important factor influencing outcomes after allogeneic haematopoietic stem cell transplantation (allo-HSCT), but its relevance across donor types and distinct disease biology in acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) remains unclear. We analysed 320 patients with AML/MDS who underwent first allo-HSCT between 2016 and 2024. Donors were categorized as matched or mismatched and further stratified as young (<35 years) or old (≥35 years). Matched donors achieved superior survival compared with mismatched donors, while outcomes with young mismatched donors were intermediate and old mismatched donors were inferior driven by high non-relapse mortality. This effect was most evident in MDS, where young mismatched donors achieved survival similar to matched donors, while old mismatched donors were associated with inferior overall survival (hazard ratio [HR] 2.66) and relapse-free survival (HR 2.45). By contrast, in AML, survival did not differ by donor age; instead, disease biology dominated prognosis, with marrow blasts and European LeukemiaNet (ELN) risk strongly predicting outcomes. In conclusion, donor age interacts with donor type to shape allo-HSCT outcomes, with a marked impact in MDS but limited effect in AML. These findings suggest that old mismatched donors should be avoided in MDS and underscore the importance of disease-specific considerations in donor selection.

T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) is an uncommon aggressive large B-cell lymphoma variant which can develop synchronously or following a diagnosis of nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). There is morphological, immunophenotypic and molecular overlap between THRLBCL and NLPHL suggesting that these two entities may lie on the same spectrum. Due to the rarity of THRLBCL, accurate diagnosis can be challenging and there is a paucity of data on which to base treatment decisions. The management has largely followed diffuse large B-cell lymphoma (DLBCL) with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone established as the standard of care in the first line, with outcomes comparable to international prognostic index matched DLBCL. In the relapsed/refractory (R/R) setting, there is no standard of care. There is a move towards inclusion of THRLBCL patients in clinical trials evaluating novel agents, although historically they were commonly excluded. Due to the small numbers included in clinical trials, it has been difficult to discern the effect of novel agents in this cohort. Thus, we are reliant on larger real-world datasets to inform our understanding. This review will examine the data available in the first line and R/R setting with a focus on immunotherapeutic approaches.

This is a new British Society of Haematology (BSH) guideline which focuses on the management of hepatitis B and C (HBV and HCV) infection affecting people with bleeding disorders (PwBD), including those who cleared the infection many years previously. It is based on the European Association for the Study of the Liver (EASL) guidance and is a succinct practical guide for haematologists to support joint care with hepatology. It is compatible with the joint international guidance from the European Association for Haemophilia and Allied Disorders, European Haemophilia Consortium, International Society on Thrombosis and Haemostasis (ISTH) and World Federation of Hemophilia 2024. However, it provides more specific guidance on investigations for fibrosis/cirrhosis and thresholds for onwards referral to hepatology in those who cleared HCV historically (either through spontaneous clearance or following effective treatment). The aim of this guideline is to improve the management of this group of patients nationally as well as potentially supporting the management of this group of patients internationally. It also contributes to the delivery of recommendations made by the UK Infected Blood Inquiry 2024.

We evaluated the tolerability and efficacy of pegylated interferon alfa-2B (peg-IFNα; PegIntron, MSD) combined with nilotinib in the Australasian Leukaemia and Lymphoma Group CML11 (Pinnacle) study. This phase II study started patients on nilotinib 300 mg twice daily. Subcutaneous peg-IFNα was added at 30-50 50 μg/week from 3 months until 24 months as tolerated. Sixty patients were enrolled with a median age of 48.5 years (range 19-72); 45% were female. With a median follow-up of 60 months, 40 patients (67%) remain on study. The proportion of patients who received ≥50% and ≥85% of their assigned peg-IFNα doses were 58% and 35% respectively. Common reasons for peg-IFNα discontinuation were mood disturbance (5), thyroid disease (4) and myalgia (4). The cumulative incidence of Major Molecular Response (MMR, BCR::ABL1≤0.1%) was 87% by 12 months; Molecular Response 4.5 (MR4.5, BCR::ABL1≤0.0032%) incidence at 24 and 60 months was 55% and 82% respectively. Thirty-seven patients (62%) had MR4.5 for >24 months, 14 of whom attempted treatment-free remission (TFR); 13 remained in TFR at a median follow-up of 32 months. CML11 demonstrated that peg-IFNα with nilotinib leads to high rates of molecular response, with tolerability similar to prior studies. Trial registration ANZCTRN12612000851864.

Allogeneic haematopoietic stem cell transplantation (ASCT) is a curative treatment for acute myeloid leukaemia (AML) but carries a high risk of gonadotoxicity. Ovarian tissue cryopreservation (OTC) offers a fertility preservation option, yet its safety in AML remains uncertain due to the risk of leukaemic cell reintroduction. The FERTILAM pilot study evaluated measurable residual disease (MRD) in ovarian tissue collected at complete remission (CR) from nine AML patients undergoing OTC before ASCT. MRD was assessed using patient-specific clonal markers via droplet digital polymerase chain reaction on DNA and RNA from bone marrow (BM), ovarian cortex and medulla. At CR, MRD-DNA was detected in ovarian cortex of four of nine patients, all with concurrent MRD positivity in BM. Three patients were negative in both BM and ovarian tissue. Paired cortex/medulla analyses showed concordant MRD-DNA results in five of six patients. BM MRD-RNA and MRD-DNA were fully concordant, whereas two discrepancies were observed between MRD-DNA and MRD-RNA in ovarian tissue. These findings suggest potential leukaemic cell persistence in ovarian tissue despite CR and highlight the need for sensitive molecular assays to assess safety prior to ovarian tissue transplantation.