Leukemia & Lymphoma最新文献

This retrospective study aimed to compare reduced-dose anti-thymocyte globulin (ATG) plus post-transplant cyclophosphamide (PTCy) versus standard ATG for GVHD prophylaxis in haplo-HSCT. A total of 61 patients (median age, 35 years; range, 4-62) who received a myeloablative conditioning regimen between 2019 and 2024 were included. Patients received either reduced-dose ATG with PTCy (n = 30) or standard ATG (n = 31). The primary outcome was chronic GVHD (cGVHD) incidence. With a 38.5-month median follow-up, the 2-year cGVHD rate was significantly lower in the ATG-PTCy group (10.0% vs. 38.7%, p = 0.012). Rates of grade II-IV acute GVHD, engraftment times, infections (CMV/EBV), non-relapse mortality, and relapse were statistically comparable between groups. Consequently, 2-year overall survival (83.3% vs. 77.4%) and disease-free survival (80.0% vs. 71.0%) showed no significant difference. A favorable trend toward less hemorrhagic cystitis was observed with ATG-PTCy. In conclusion, the combination of reduced-dose ATG with PTCy is associated with a significantly reduced risk of chronic GVHD after haplo-HSCT.

In randomized clinical trials (RCT), treatment effect is often measured using the hazard ratio (HR), with HR < 0.8 being of clinical interest. We hypothesized that absolute measures of effect are more meaningful for both practitioners and patients. We selected all articles in the English literature reporting results of RCTs evaluating targeted therapies in chronic lymphocytic leukemia. We digitized the survival curves and computed HR, differences in survival rates and in mean survival times, and net survival benefit by 6 and 12 months. A total of 20 articles were analyzed. All measures were roughly consistent, except the mean survival benefit. For HR < 0.8, 78% of comparisons showed a mean benefit of at least 2.5 months while 53% showed a mean benefit of 6 months. These figures dropped to 43% and 7%, respectively when the benefit was measured by OS. We suggest that absolute measures of treatment effect should be reported more systematically.

Complementary and integrative medicine (CIM) use is increasing among patients with hematologic diseases, yet determinants of CIM receipt in hematology settings are poorly characterized. We aimed to characterize hematologic patients receiving CIM. Adults with ≥5 annual visits in a tertiary hematology division were included in a retrospective study (2021-2024). Electronic medical record data were analyzed. Staff completed a questionnaire assessing referral practices. The primary outcome was receipt of CIM. Predictors of CIM use and adherence were analyzed with multivariable logistic and Poisson regression analyses. Of 391 patients, 138 (35%) received CIM, mainly younger, female, and hemato-oncologic patients. Among 23 staff respondents, 56% referred 1-5 patients monthly. Pain, anxiety/depression, and neuropathy were main referral indications, with high perceived effectiveness and no reported contraindications. CIM receipt is common in hematologic malignancies and associated with demographic and disease-related factors. Structured referral pathways and culturally adapted communication may enhance integrative hematology care.

T-cell-directed immunotherapies, including chimeric antigen receptor T-cell therapy (CAR-T) and bispecific antibodies (BsAbs), have revolutionized the management of B-cell lymphomas, yet options after treatment failure remain limited. We reviewed four patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) after BsAb or CAR-T exposure, and performed a systematic literature review. Three patients had large B-cell lymphoma, one had follicular lymphoma. Two achieved durable remission, whereas two experienced early relapse or transplant-related mortality. The literature search identified six studies, evaluating allo-HSCT as salvage therapy after CAR-T failure or as consolidation following BsAb response. One-year overall survival exceeded 50% after CAR-T failure, with non-relapse mortality ranging from 20% to 33%. Prior CAR-T exposure did not clearly increase transplant-related toxicity, while allo-HSCT following BsAb therapy warrants vigilant infection monitoring and further prospective evaluation. Allo-HSCT may serve as an effective curative treatment after CAR-T or BsAb therapy, particularly in patients with controlled disease.

Current guidelines recommend consideration of prophylactic anticoagulation in lymphoma, supported by the Khorana score, which assigns lymphoma 1 point for risk of developing venous thromboembolism (VTE). We hypothesized that different lymphoma types convey different risk of VTE. To better characterize VTE rates and predictive parameters, we assessed lower extremity deep vein thrombosis (DVT) and pulmonary embolism (PE) events in 879 lymphoma patients. VTE was found in 4.9%, with a higher incidence rate among patients with aggressive lymphoma (8.3%), compared with indolent lymphoma (1.9%) and Hodgkin lymphoma (0%). The International Prognostic Index (IPI) was a strong predictor of VTE. The Khorana score did not predict VTE within lymphoma but was and independent risk factor for mortality. VTE was also an independent risk factor for mortality. Our study confirms that lymphoma subtypes are associated with different VTE risks.