Blood Research最新文献

Clonal hematopoiesis (CH), characterized by the expansion of hematopoietic stem and progenitor cells harboring somatic mutations, has emerged as a significant age-related phenomenon with profound implications for human health. While initially recognized in the 1960s, recent technological advances have revealed its complex nature and widespread prevalence, affecting up to 84% of individuals aged ≥ 70 years. The clinical significance of CH extends beyond its well-established role as a precursor to hematological malignancies, encompassing its association with cardiovascular diseases, chronic kidney disease, and other non-malignant disorders. This comprehensive review synthesizes the current understanding of CH, focusing on recent advances in genetic and molecular mechanisms, particularly the roles of commonly mutated genes such as DNMT3A, TET2, and ASXL1. We address the emerging distinction between myeloid and lymphoid CH, their differential impacts on disease progression, and the complex interplay between CH and inflammation. Special attention is given to newly identified genetic determinants of clonal expansion rates and their implications for disease progression. The review also examines the revolutionary concept of passenger-approximated clonal expansion rate and its utility in understanding CH dynamics. Furthermore, we discuss therapeutic strategies targeting inflammatory pathways and their potential in mitigating CH-associated complications. By integrating recent findings from genetic, molecular, and clinical studies, this review provides a framework for understanding CH as a systemic condition and highlights promising directions for therapeutic interventions.

Large Language Models (LLMs), such as ChatGPT (OpenAI, CA, US), have revolutionized scientific writing and research processes across academic disciplines, providing comprehensive support throughout the entire research lifecycle. Generative artificial intelligence (GAI) tools enhance every aspect of scientific writing, from hypothesis generation and methodology design to data analysis and manuscript preparation. This review examines the applications of LLMs in hematological research, with particular emphasis on advanced techniques, including prompt engineering and retrieval augmented generation (RAG) frameworks. Prompt engineering methods, including zero-shot and few-shot learning along with a chain-of-thought approach, enable researchers to generate more precise context-specific content, especially in scientific writing. Integrating RAG frameworks with the current medical literature and clinical guidelines significantly reduces the risk of misinformation while ensuring alignment with contemporary medical standards. Even though these GAI tools offer remarkable potential for streamlining research writing and enhancing documentation quality, the study also addresses the critical importance of maintaining scientific integrity, ethical considerations, and privacy concerns in hematological research.

Allogeneic stem cell transplantation (allo-SCT) is a salvage treatment option for patients with relapsed or refractory lymphoid malignancies. However, the clinical variables impacting outcomes in these patients remain unclear. We analyzed 58 patients who underwent allo-SCT for lymphoid malignancies, including B-cell lymphoma (BCL, n = 20), Hodgkin's disease (n = 3), multiple myeloma (n = 9), natural killer/T-cell lymphoma (NK/TCL, n = 4), and TCL (n = 22). The median progression-free survival (PFS) was 27.4 months, while the median overall survival (OS) was 30.6 months. In univariate analysis, human leukocyte antigen (HLA) matching and complete remission status post-transplantation were associated with improved PFS and OS. However, only post-transplant response remained significant for both survival outcomes in the multivariate analysis. Moreover, HLA matching was associated with a significantly improved PFS in patients with BCL and NK/TCL, but with better OS only in those with BCL. Complete remission after transplantation was associated with better PFS and OS in patients with BCL, NK/TCL, and TCL. Our results indicate that post-transplant response is an important prognostic indicator in allo-SCT for lymphoid malignancies and may guide clinical decisions and additional treatment.

Background: t(11;14) is considered a standard risk factor in multiple myeloma (MM). However, recent studies suggested that its impact in the context of novel agents remained controversial.

Methods: This retrospective analysis examined the clinical profiles of 375 newly diagnosed patients with MM and compared the outcomes between those with t(11;14) and those with normal cytogenetics.

Results: The median progression-free survival (PFS) of the 84 patients with t(11;14) was 36 months (95% confidence interval (CI), 23.5-48.5), which was significantly shorter than the median PFS of 65 months (95% CI, 23.0-107.0) for the 59 patients with normal cytogenetics (p = 0.011). Median overall survival (OS) was not reached in either group (p = 0.977). When combined with 1q21 + , t(11;14) showed a trend toward poorer PFS (median PFS: 36 vs. 65 months; p = 0.130). In the presence of high-risk cytogenetics (HRCAs), t(11;14) was associated with a worse PFS (median PFS: 9 vs. 38 months, p = 0.015) and a trend toward shorter OS (median OS: 33 vs. 49 months, p = 0.096). Multivariate analysis indicated that t(11;14) was a poor prognostic factor for PFS. 1q21 + was a detrimental prognostic factor, particularly in the t(11;14) group. Autologous stem cell transplantation (ASCT) may be a beneficial treatment option for patients with t(11;14).

Conclusion: In this study, patients with MM with t(11;14) demonstrated poorer PFS than those with normal cytogenetics. Further investigations are required to evaluate the impact of t(11;14) in patients newly diagnosed with MM in the era of novel agents.

The efficacy and safety of polatuzumab vedotin combined with rituximab, cyclophosphamide, doxorubicin, and prednisolone (pola-R-CHP) in patients aged ≥ 80 years with untreated diffuse large B-cell lymphoma (DLBCL) remain largely unexplored. In this study, we administered a reduced-dose pola-R-CHP regimen to 38 patients with DLBCL aged > 80 years. Extending the findings of the POLARIX trial in this older individuals' cohort, we conducted a retrospective analysis to assess the efficacy and safety of the treatment in a real-world clinical setting. After 12 months, the overall and progression-free survival rates were 86.2% (95% confidence interval [CI]: 70.0-94.0) and 78.5% (95% CI: 59.2-89.5), respectively. Although the incidence of febrile neutropenia was relatively high (32%), an increased risk was observed in patients with an average relative dose intensity of < 70%, even with reduced treatment intensity. Notably, none of the patients required a dose reduction of polatuzumab vedotin owing to peripheral neuropathy. Therefore, our findings indicate that a reduced-dose pola-R-CHP regimen may be a viable and effective treatment option for older patients newly diagnosed with DLBCL.

Multiple myeloma (MM), a hematological malignancy, is characterized by malignant plasma cell proliferation in the bone marrow. Recent treatment advances have significantly improved patient outcomes associated with MM. In this study, we aimed to develop comprehensive, evidence-based guidelines for the diagnosis, prognosis, and treatment of MM. We identified 12 key clinical questions essential for MM management, guiding the extensive literature review and meta-analysis of the study. Our guidelines provide evidence-based recommendations by integrating patient preferences with survey data. These recommendations include current and emerging diagnostic tools, therapeutic agents, and treatment strategies. By prioritizing a patient-centered approach and rigorous data analysis, these guidelines were developed to enhance MM management, both in Korea and globally.