Leukemia & Lymphoma最新文献

The risk factors and prognostic impact of extramedullary involvement (EMI) before and after allogeneic hematopoietic stem-cell transplantation (allo-HSCT) in t(8;21)(q22;q22) acute myeloid leukemia (AML) remain inconclusive. We performed a multicenter retrospective study including 560 t(8;21) AML patients from 15 Chinese hematology centers. KIT mutations were more frequently observed in patients with EMI at diagnosis. EMI at diagnosis was not an independent risk factor for overall survival (OS) after adjustment for KIT mutations. The 3-year post-transplant OS rates between isolated extramedullary relapse (EMR) and bone marrow relapse after allo-HSCT were comparable. Chronic graft-versus-host disease (cGVHD) was associated with increased incidence of isolated EMR (HR = 2.33, p = 0.048). Pre- and post-transplant minimal residual disease (MRD), measured by RUNX1-RUNX1T1 transcript levels, showed no significant association with isolated EMR. In conclusion, EMI at diagnosis may not significantly impact survival in t(8;21) AML. For patients with cGVHD after allo-HSCT, EMR should be monitored.

The relationship between an early decrease in the difference between involved and uninvolved free light chains (dFLC) and clinical outcomes in AL amyloidosis is significant. We conducted a multicenter study (n = 86, baseline dFLC ≥ 50 mg/L) in which all patients received frontline daratumumab-bortezomib therapy. ROC analysis identified a dFLC reduction after one cycle (87% reduction, AUC = 0.82) as predictive of complete hematologic response (CHR). Patients achieving >87% dFLC or a very good partial response after one cycle were classified as optimal responders (O-HR), while those who did not were classified as suboptimal response (S-HR). The O-HR group had higher rate of CHR (90.5% vs. 43.5%, p < 0.001), cardiac response (68.9% vs. 36.8%, p = 0.017), and renal response (76.6% vs. 50.0%, p = 0.045) than the S-HR group. Profound dFLC decrease after one cycle suggests high CHR and organ response likelihood, supporting early treatment modification.

To assess the impact of imatinib compared to 2 G-TKIs on hemoglobin (Hb) in the long-lasting frontline treatment, 242 patients with chronic myeloid leukemia (CML) from 2 Centers still receiving frontline TKI after 5 years [186 (76.8%) imatinib and 56 (23.2%) 2 G-TKIs] were evaluated. Baseline rate of patients with mild/moderate anemia (Hb < 11 g/dl) was lower in those treated with imatinib (18.2% vs 35.7% with 2 G-TKIs, p = 0.006), while at the 60^th month became significantly higher in those treated with imatinib (15.6% vs 3.6% with 2 G-TKI, p = 0.018). Event-free and Overall Survival beyond the 60^th month in patients receiving imatinib with anemia at that time-point were significantly shorter than in patients without anemia (p < 0.001 and p = 0.002, respectively). Long-lasting treatment with imatinib caused late anemia in about 15% of patients at the 60^th month. This event, which seems very rare with 2 G-TKIs, affected survival and should be recognized in the long-term management of CML patients.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been a cornerstone in the treatment of adult acute lymphoblastic leukemia (ALL). Its indications have evolved with the adoption of pediatric-inspired protocols, refined risk stratification based on minimal residual disease (MRD), the identification of high-risk genetic subtypes, and the emergence of novel immunotherapies. Agents such as blinatumomab and inotuzumab ozogamicin can induce deep remissions and increasingly challenge traditional transplant algorithms. Chimeric antigen receptor T cell (CAR T-cell) therapies further reshape post-relapse strategies, while advances in conditioning regimens and donor selection have broadened allo-HSCT applicability. Current evidence supports allo-HSCT in patients with high-risk features or persistent MRD, though its benefit is increasingly debated in MRD-negative responders. This review synthesizes evolving data on indications, timing, modalities, and outcomes of allo-HSCT in adult ALL and highlights the need for personalized, MRD and genomics-guided approaches to optimize cure while minimizing transplant-related risks in the immunotherapy era.

We aimed to analyze survival outcomes and failure patterns in stage I/II extranodal NK/T-cell lymphoma (ENKTCL) treated with involved site radiotherapy (ISRT) combined with asparaginase-containing chemotherapy regimens. Kaplan-Meier method was performed to calculate overall survival (OS) and progression-free survival (PFS). Univariate and multivariate Cox proportional hazards models were employed to identify independent prognostic factors for OS and PFS. The 2-year, 5-year OS and 2-year, 5-year PFS were 90.6%, 87.5% and 88.3%, 82.2%, respectively. Univariate and multivariate analyses identified primary tumor location, Lugano stage, and radiotherapy doses as prognostic factors for PFS. A total of 27 patients developed recurrence, 3 patients (1.8%) developed in-field recurrence, 3(1.8%) patients developed concurrent in-field and out-of-field recurrence and 21 (12.3%) patients developed out-of-field recurrence. The 5-year local recurrence-free rate of 96.5%. Patients with stage I/II ENKTCL treated with ISRT combined with asparaginase-containing chemotherapy regimens exhibit favorable prognoses.

This retrospective study analyzed EHR data from 2,736 adult MDS patients (IPSS-R risk >1.5), newly diagnosed between January 2011 and January 2021, evaluating characteristics, treatment patterns, and outcomes across IPSS-R categories within the US community oncology setting. Overall, 61.7% initiated 1 L treatment, with higher initiation in higher-risk (IPSS-R > 3) versus low-risk (IPSS-R ≤ 3) patients (74.2% vs. 35.5%). Monotherapy HMA predominated as 1 L therapy, used by 93.4% overall and 95.2% of higher-risk patients. Most discontinued 1 L, with few advancing to 2 L, indicating limited options beyond conventional treatments. Median OS was 22.5 versus 67.2 months for higher- versus low-risk patients, underscoring IPSS-R's prognostic value and poor survival in higher-risk profiles. Allogenic hematopoietic stem cell transplant utilization was low (∼10%) among a subset of higher-risk patients, reflecting eligibility and donor availability constraints. This study highlights real-world MDS treatment patterns and outcomes, emphasizing the need for novel therapies, especially for higher-risk MDS.

Telomere length serves as a prognostic factor in hematologic diseases. However, its role in myelodysplastic syndrome (MDS) is unclear. We investigated the prognostic role of telomere length in 71 MDS patients receiving hypomethylating agents (HMAs), using bone marrow samples stored at the Asan Bio-Resource Center. Longer telomere length (median >0.94 kb) before HMA treatment was the only indicator predicting a better overall response rate (ORR) and prolonged progression-free survival (PFS) (ORR = 38.2% vs. 61.8%; odds ratio 2.654, p = 0.046; 1-year PFS, 37.4% vs. 65.6%; hazard ratio 2.356, p = 0.044). However, telomere length showed no association with overall survival (OS), whereas younger age (≤60 years) and allogeneic stem cell transplantation were linked to better OS. No significant differences in telomere length before and during HMA treatment were found. Telomere length may serve as a prognostic biomarker in patients with MDS receiving HMA chemotherapy.

The evaluation of measurable residual disease (MRD) in multiple myeloma now integrates multiple techniques, including next-generation flow cytometry (NGF), next-generation sequencing (NGS), PET/CT, and mass spectrometry. Discrepancies often arise due to differing sensitivities and methodologies - for instance, NGS (10^-6) detects lower disease levels than NGF (10^-5-10^-6). This can yield conflicting results, such as NGF negativity with NGS positivity, or discordance between bone marrow MRD and PET/CT findings. Such 'MRD paradox' demonstrates that heightened sensitivity may complicate clinical interpretation. Consequently, treatment decisions now require nuanced integration of multidimensional MRD data, beyond simple complete response. This review examines causes and implications of technical discordance and proposes an evidence-based integrative framework for MRD assessment to optimize individualized patient management.