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Marginal zone lymphoma (MZL) is an indolent B-cell lymphoma arising from marginal zone B cells within lymphoid follicles, accounting for approximately 5%-15% of non-Hodgkin lymphomas. MZL is characterized by diagnostic challenges and diverse treatment options, making it a challenging subtype in clinical practice. In recent years, with the rapid progress in lymphoma research, the understanding of MZL has improved significantly worldwide. To further standardize the diagnosis and treatment of MZL in China, the Chinese Workshop of Indolent Lymphomas convened a panel of national experts. Based on thorough discussion and consensus, this guideline was developed to provide a reference for medical practitioners.

This study retrospectively analyzed 12 patients with transfusion-dependent, non-severe aplastic anemia (TD-NSAA) refractory to cyclosporine A (CsA) , who were treated with lusutrombopag monotherapy. These patients either had a variety of chronic comorbidities or medication-related risks, or they were unresponsive to or intolerant of other thrombopoietin receptor agonists (TPO-RA) . The median treatment duration with lusutrombopag was 4 months (range: 3-11 months) , while the median follow-up period was 8 months (range: 6-11 months) . The overall response (OR) rates at months 3, 6, and the end of follow-up were 50.0%, 58.3%, and 50.0%, respectively, with a median time to OR of 2 months (range: 1-4 months) . Complete response (CR) rates were 8.3%, 16.7%, and 16.7% at the same time points, with a median time to CR of 4 months (range: 2-5 months) . Adverse events were all Grade 1, with an incidence rate of 25.0%. During follow-up, one patient experienced a loss of OR after discontinuing treatment, with a relapse rate of 14.3%; no clonal evolution or mortality was observed. These findings suggest that lusutrombopag is both effective and well-tolerated in CsA-refractory TD-NSAA patients and represents a promising therapeutic option for those with poor treatment tolerability.

Objective: To identify the risk factors for acute graft-versus-host disease (aGVHD) in patients with acute myeloid leukemia (AML) undergoing haploidentical hematopoietic stem cell transplantation (HID-HSCT) . Methods: A total of 141 AML patients who underwent HID-HSCT at the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, from January 2020 to July 2021 were included. The cumulative incidence of aGVHD was analyzed using the Fine-Gray competing risk model, with relapse and death as competing events, to compare differences between groups. Potential risk factors were evaluated by univariable and multivariable Cox proportional hazards regression analyses to determine their independent effects on aGVHD. Results: Among the 141 patients, 86 (61.0%) were male and 55 (39.0%) were female, with a median age at transplantation of 34 years. Within 100 days post-transplant, 59 patients developed grade Ⅱ-Ⅳ aGVHD, whereas 86 patients experienced no or grade Ⅰ aGVHD (the grade 0-Ⅰ aGVHD group) . Survival analysis showed that the 3-year overall survival was 68.7% (95% CI: 57.7%-81.9%) in the grade Ⅱ-Ⅳ aGVHD group, compared with 78.8% (95% CI: 70.4%-88.3%) in the grade 0 - Ⅰ aGVHD group, with the difference not being statistically significant (P=0.190) . Univariable analysis identified donor age (P=0.020, HR=1.020, 95% CI: 1.000-1.040) and the female donor-male recipient sex combination (P=0.033, HR=1.980, 95% CI: 1.160-3.380) as risk factors for grade Ⅱ-Ⅳ aGVHD. Multivariable analysis confirmed that donor age (P=0.005, HR=1.026, 95% CI: 1.008-1.047) and the female donor-male recipient sex combination (P=0.002, HR=2.339, 95% CI: 1.354-4.037) were independent risk factors for aGVHD. Patients receiving grafts from donors aged >45 years had a significantly higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD compared with those receiving grafts from donors ≤45 years [54.7% (95% CI: 42.3%-67.0%) vs 31.6% (95% CI: 21.0%-42.1%) , P=0.006]. Similarly, patients with the female donor-male recipient sex combination had a higher 100-day cumulative incidence of grade Ⅱ-Ⅳ aGVHD than those with other sex combinations [56.8% (95% CI: 40.4%-73.1%) vs 36.9% (95% CI: 27.5%-46.3%) , P=0.015]. Conclusion: Older donor age and the female donor-male recipient sex combination remain independent risk factors for aGVHD in patients with AML undergoing HID-HSCT.

Donor-specific anti-HLA antibodies (DSA)-induced primary graft failure remains a significant cause of mortality in patients undergoing HLA-mismatched allogeneic hematopoietic stem cell transplantation. In recent years, significant advances have been made in understanding the association between DSA and prognosis following HLA-mismatched transplantation, as well as in the development of DSA desensitization therapies. Based on these advances, the Hematopoietic Stem Cell Application Group, Chinese Society of Hematology, Chinese Medical Association has developed this consensus to better guide the clinical practice of desensitization therapy for DSA-positive, HLA-mismatched transplant candidates.

Antibodies against human leukocyte antigens (HLA) are closely related to engraftment, hematopoietic reconstitution, graft-versus-host disease, and are crucial for guiding treatment strategies and prognostic assessment in allogeneic hematopoietic stem cell transplantation (allo-HSCT) . The anti-HLA antibody detection and result analysis are not only affected by the inherent limitations and sensitivity of the testing methods, but also depend on the performance validation of key procedures, comprehensive quality, and standardized data analysis, which demand higher standards for result interpretation and reporting. To address these issues, the Experimental Diagnostics Group, Chinese Society of Hematology, Chinese Medical Association has developed this expert consensus, aiming to make the anti-HLA antibody detection play a more important role in the clinical diagnosis and treatment of allo-HSCT.

Objectives: To investigate the incidence of tyrosine kinase inhibitor (TKI) withdrawal syndrome and psychological issues, and their associated factors, in patients with chronic-phase chronic myeloid leukemia (CML-CP) after TKI discontinuation. Methods: We retrospectively analyzed the clinical data of CML-CP patients who discontinued TKI therapy at Peking University People's Hospital after September 2012. Logistic regression models were used to identify independent factors associated with the occurrence of TKI withdrawal syndrome and psychological issues. Results: A total of 158 patients were included, of whom 92 (58%) were female. The median age at discontinuation was 50 (IQR, 35-60) years. With a median follow-up of 25 (IQR, 11-49) months, the 4-year rate of sustained major molecular response (MMR) was 60% (95% CI: 51%-70%) . Fifty-one (32%) patients experienced TKI withdrawal syndrome at a median of 1.3 (IQR, 0.5-2.0) months after TKI discontinuation. Fifty-one (32%) patients reported psychological issues such as anxiety. These concerns stemmed from fears of fluctuating BCR::ABL1 levels or disease relapse, and, for those who discontinued TKI for pregnancy, worries about adverse fetal effects and/or the fetus inheriting CML. Multivariable analyses revealed that older age at discontinuation [P=0.003 when adjusting for TKI therapy duration; P=0.002 when adjusting for deep molecular response (DMR) duration], longer TKI therapy duration (P=0.010) , and longer DMR duration before discontinuation (P=0.005) were significantly associated with a higher risk of TKI withdrawal syndrome; a university degree or higher (P=0.010) and TKI discontinuation due to pregnancy or adverse events (P=0.001) were significantly associated with psychological issues after discontinuation. The occurrence of TKI withdrawal syndrome or psychological issues had no impact on the probability of major molecular response loss after discontinuation. Conclusion: TKI withdrawal syndrome and psychological issues are common in CML patients who discontinue TKI therapy. Older age at discontinuation and longer TKI therapy duration or DMR duration are significantly associated with TKI withdrawal syndrome. Higher education level and TKI discontinuation due to pregnancy or adverse events are significantly associated with psychological issues.

Chest CT pulmonary angiography (CTPA) has certain auxiliary diagnostic value for the clinical diagnosis of invasive pulmonary aspergillosis (IPA) . Three patients with hematological malignancies were reported, including 2 ones after allogeneic hematopoietic stem cell transplantation and 1 ones after chemotherapy for refractory recurrent leukemia. Each patient was treated with antibiotics for at least 48 hours after the onset of fever, they all underwent chest high-resolution CT (HRCT) scans without fever resolution. CT revealed at least one dense pulmonary consolidation shadow with a diameter greater than 10 mm, and subsequently a CTPA examination was performed to observe the effect of CTPA imaging signs for the diagnosis of IPA. There were 2 patients with positive vascular occlusion sign (VOS) and 1 patient with negative VOS detected by CTPA. Among them, 2 patients with positive VOS were diagnosed with possible IPA and received with diagnosis-driven antifungal treatment, which improved their conditions. One patient with negative VOS sign was diagnosed with diffuse large B-cell lymphoma involving the lungs. After receiving anti-lymphoma treatment, the lesions significantly reduced in size. The vascular occlusion sign detected by CTPA is relatively characteristic. For high-risk IPA patients, it helps to improve the specificity of imaging diagnosis and guide clinical treatment decisions.

Human immunodeficiency virus infection related diffuse large B cell lymphoma (HIV(+) DLBCL) exhibits a low incidence and a challenging diagnosis, with a lack of standardized treatment protocols. To improve the understanding of HIV(+) DLBCL among clinical physicians in China and enhance diagnostic and treatment levels, the Lymphoid Disease Group, Chinses Society of Hematology, Chinese Medical Association, Lymphoma Integrative Rehabilitation Professional Committee of Chinese Anti-Cancer Association (CACA) and the Central and Western China AIDS Lymphoma League (CALL), Lymphoma Expert Committee of Chinese Society of Clinical Oncology (CSCO) have organized relevant experts to formulate this consensus.

Objective: To investigate the prognostic value of circulating plasma cell (CPC) in patients with newly diagnosed multiple myeloma (NDMM) undergoing induction therapy with bortezomib, lenalidomide, and dexamethasone (VRD) regimen. Methods: This study retrospectively analyzed clinical data of 152 patients with NDMM treated with the VRD regimen as induction therapy in the Hematology Department of Jiangsu Provincial People's Hospital from January 2019 to March 2024. The clinical characteristics, efficacy, and prognosis of patients with high and low CPC proportions are compared. The prognosis of patients in the CPC-positive group, CPC-negative conversion group, and CPC-negative group was analyzed. Results: This study included 152 patients with NDMM, comprising 76 males and 76 females, with a median age at onset of 62 (40-77) years. Compared with the group with CPC proportion of <0.105%, patients with CPC proportion of ≥0.105% demonstrated a higher proportion of International Staging System (ISS) stage Ⅲ (P<0.001), Revised ISS stage Ⅲ (P=0.023), HGB≤100 g/L (P=0.015), β(2)-microglobulin ≥3.5 g/L (P<0.001), shorter median progression-free survival (PFS) period (24 months vs 52 months, P<0.001), and shorter median overall survival (OS) period (52 months vs not achieved, P=0.005). Patients in the CPC-negative group demonstrated a longer median PFS period (not reached vs 41 months vs 19 months, P<0.001) and median OS period (not reached vs not reached vs 26 months, P<0.001) compared with patients in the CPC-negative conversion group and CPC-positive group. Multivariate analysis revealed CPC proportion of ≥0.105% (HR=3.79, 95% CI: 1.95-7.38, P<0.001), positive CPC after induction therapy (HR=3.54, 95% CI: 1.41-8.87, P=0.007), and cytogenetic high risk (HR=3.69, 95% CI: 1.85-7.37, P<0.001) as independent risk factors affecting the PFS of patients. Meanwhile, CPC of ≥0.105% (HR=3.50, 95% CI: 1.29-9.48, P=0.014) and positive CPC after induction therapy (HR=4.12, 95% CI: 1.13-15.03, P=0.032) are independent risk factors affecting the OS of patients. Conclusion: Patients with NDMM demonstrating high CPC expression have a worse prognosis, with CPC level as an independent prognostic factor.