Clinical Advances in Hematology & Oncology最新文献

A growing body of evidence supports the use of remote symptom monitoring based on patient-reported outcomes (PROs) to manage symptoms, improve quality of life, and reduce inpatient hospitalizations and emergency department visits. Health systems, payers, and specialty societies support the collection of PROs. Oncology practices are integrating PROs into their electronic health records to monitor and manage patients' health status and symptoms. Despite a growing evidence base and enthusiasm for the use of PROs, collection in routine oncology practice remains limited, with persistent gaps in our understanding of the value of PRO collection and practical methods of implementation. Ongoing research seeks to define methods to overcome these barriers and gaps. This review summarizes the practical uses and potential benefits of PROs in routine oncology care, discusses continued knowledge gaps, and highlights recent examples of successful implementation.

Mantle cell lymphoma is a biologically and clinically heterogeneous subtype of non-Hodgkin lymphoma that affects predominantly older patients. The disease remains incurable with modern therapies. The integration of first- and now second-generation Bruton tyrosine kinase inhibitors (BTKis) into earlier-line settings appears to improve outcomes. Remaining questions in the field relate to the need for chemotherapy and the choice and duration of maintenance therapy, given its cost and infectious complications. In this review, we highlight clinical data showing BTKis targeting genetic vulnerabilities within mantle cell lymphoma cells. We then assess the integration of these agents into the first-line setting for all patients with newly diagnosed disease. Special consideration is given to patients with TP53-mutated disease, for which non-chemotherapy approaches are preferred.

Mature B-cell non-Hodgkin lymphomas (B-NHLs) comprise approximately 40% to 60% of all NHLs among children, adolescents, and young adults. Although overall survival with mature B-NHL approaches 90% in children younger than 15 years and 70% to 80% in adolescents and young adults, it is achieved with the use of intense therapeutic regimens, many of which lead to long-term effects that last for years after the patient's initial diagnosis and treatment. Chronic health issues, poor performance outcomes, impaired quality of life, and decreased fertility have all been associated with mature B-NHL therapy. As the role of targeted therapy in this population is elucidated, data continue to show that it can be incorporated safely into chemotherapy backbones, allowing a decrease in cytotoxic chemotherapy doses. These trends support ongoing efforts to find innovative combinatorial strategies that integrate new cell surface targets and use new classes of drugs, such as monoclonal antibodies, antibody-drug conjugates, checkpoint inhibitors, T-cell and natural killer-cell engagers, and chimeric antigen receptor T-cell therapy.

Early detection and improved cancer therapies have led to increases in cancer survivorship. There were 18.1 million cancer survivors in the United States alone in 2022, and this number will grow to 21.6 million by 2030. Cancer survivors are at increased risk for non-cancer-related morbidity and mortality, including cardiovascular disease. Cardio-oncology has emerged as a new subspecialty of medicine, dedicated to improving the cardiovascular health of patients with cancer and facilitating the administration of the best cancer therapy while optimizing cardiovascular health. Contemporary cancer treatments are associated with multiple types of cancer treatment-related cardiac dysfunction (CTRCD), including heart failure, vascular toxicities, arrhythmias/corrected QT prolongation, hypertension, and myocarditis. In 2022, the European Society of Cardiology published comprehensive guidelines that endorsed the Heart Failure Association/International Cardio-Oncology Society baseline risk stratification tool for assessing all patients with cancer before cancer therapy is started. Primary prevention strategies can be considered for patients at high risk and very high risk for CTRCD, with the goal of facilitating the delivery of cancer therapy while minimizing the risk of cardiovascular toxicity. Dedicated multidisciplinary cardio-oncology clinics have emerged across North America, Europe, South America, Asia, South Africa, and Australia to enhance cancer care while optimizing cardiovascular health.