Pub Date : 2025-11-01DOI: 10.1016/j.blre.2025.101319
Fieke W. Hoff , Eduard Schulz , Steven Pavletic , Alain Mina
Anemia is a hallmark of myelodysplastic syndromes/neoplasms (MDS) and most patients with MDS chronically require red blood cell transfusions. Due to the body's inability to excrete excess iron, patients are at increased risk of iron overload, often defined by ferritin levels >1000 ng/mL. Iron overload can cause progressive organ damage from iron deposition in tissues and has been linked to increased mortality. In MDS patients undergoing allogeneic hematopoietic cell transplantation (HCT), iron overload has also been associated with increased non-relapse mortality, decreased overall survival, and a higher incidence of relapse. Prospective and retrospective studies have demonstrated the safety and clinical benefit of iron chelation therapy (ICT) in lower-risk MDS. Despite some common adverse effects associated with ICT, such as renal toxicity and gastro-intestinal symptoms, managing iron levels remains essential in transfusion-dependent MDS patients, and those who are undergoing HCT to optimize pre-transplant conditions, and enhance post-transplant outcomes.
{"title":"Iron chelation therapy in myelodysplastic syndromes and allogeneic hematopoietic cell transplantation, a delicate balance","authors":"Fieke W. Hoff , Eduard Schulz , Steven Pavletic , Alain Mina","doi":"10.1016/j.blre.2025.101319","DOIUrl":"10.1016/j.blre.2025.101319","url":null,"abstract":"<div><div><span><span><span><span><span>Anemia is a hallmark of myelodysplastic syndromes/neoplasms (MDS) and most patients with MDS chronically require </span>red blood cell transfusions<span>. Due to the body's inability to excrete excess iron, patients are at increased risk of iron overload, often defined by </span></span>ferritin levels >1000 ng/mL. Iron overload can cause progressive organ damage from iron deposition in tissues and has been linked to increased mortality. In MDS patients undergoing allogeneic hematopoietic </span>cell transplantation (HCT), iron overload has also been associated with increased non-relapse mortality, decreased </span>overall survival, and a higher incidence of relapse. Prospective and retrospective studies have demonstrated the safety and clinical benefit of iron </span>chelation therapy<span> (ICT) in lower-risk MDS. Despite some common adverse effects<span> associated with ICT, such as renal toxicity and gastro-intestinal symptoms, managing iron levels remains essential in transfusion-dependent MDS patients, and those who are undergoing HCT to optimize pre-transplant conditions, and enhance post-transplant outcomes.</span></span></div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"74 ","pages":"Article 101319"},"PeriodicalIF":5.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.blre.2025.101317
Baher Krayem , Avraham Frisch , Netanel Horowitz
The prognosis of patients with AML varies significantly with age, driven by biological heterogeneity and age-associated factors such as comorbidities, functional status, and hospitalization burden. Many novel therapies have been approved in recent years; however, pivotal trials often include patients within a restricted age range, limiting the extrapolation of their findings across the broader AML population. For example, the FLT3 inhibitor midostaurin was added to chemotherapy for patients aged 18–60 years, while the BCL-2 inhibitor venetoclax was combined with azacitidine in patients aged 75 years and older, leaving important knowledge gaps regarding their efficacy and safety in other age groups. Moreover, for several novel therapies, particularly in populations outside the original trial age range, supporting evidence is derived primarily from single-arm studies or real-world experience rather than randomized controlled trials, further complicating clinical decision-making. This review explores the efficacy and safety of widely used traditional and novel therapies for AML, with particular focus on the impact of age on these different therapeutic regimens.
{"title":"Novel therapies for acute myeloid leukemia. Does age still matter?","authors":"Baher Krayem , Avraham Frisch , Netanel Horowitz","doi":"10.1016/j.blre.2025.101317","DOIUrl":"10.1016/j.blre.2025.101317","url":null,"abstract":"<div><div><span>The prognosis of patients with AML<span><span> varies significantly with age, driven by biological heterogeneity and age-associated factors such as comorbidities, functional status, and hospitalization burden. Many novel therapies have been approved in recent years; however, pivotal trials often include patients within a restricted age range, limiting the extrapolation of their findings across the broader </span>AML population. For example, the </span></span><span><span>FLT3</span></span><span> inhibitor midostaurin was added to chemotherapy for patients aged 18–60 years, while the </span><em>BCL-2</em><span> inhibitor venetoclax<span><span> was combined with azacitidine in patients aged 75 years and older, leaving important knowledge gaps regarding their efficacy and safety in other age groups. Moreover, for several novel therapies, particularly in populations outside the original trial age range, supporting evidence is derived primarily from single-arm studies or real-world experience rather than </span>randomized controlled trials, further complicating clinical decision-making. This review explores the efficacy and safety of widely used traditional and novel therapies for AML, with particular focus on the impact of age on these different therapeutic regimens.</span></span></div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"74 ","pages":"Article 101317"},"PeriodicalIF":5.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acquired hemophilia A (AHA), a rare and life-threatening bleeding disorder of adults, caused by anti-factor VIII (FVIII) autoantibodies, is often underestimated, particularly in patients receiving antithrombotic therapy. AHA is often associated with autoimmune disease, cancer, infection or pregnancy.
AHA, characterized by severe spontaneous bleeding, particularly in muscles and subcutaneous tissues, requires a timely and accurate diagnosis. Delayed diagnosis worsens the prognosis and increases the risk of complications. Disease confirmation requires identification of FVIII deficiency and anti-FVIII antibodies. Treatment focuses on managing acute bleeding episodes, addressing the underlying condition and eradicating auto-antibodies through immunosuppressive therapy. Bypassing agents are used for treatment, but promising new therapeutic options such as emicizumab are under evaluation.
AHA remains a serious condition with high mortality from bleeding complications and adverse effects of immunosuppression. This review provides a comprehensive overview of current knowledge on AHA, including epidemiology, pathophysiology, diagnosis, prognostic factors and therapeutic strategies.
{"title":"Current trends and advances in the management of acquired Hemophilia A","authors":"Emilie Zuner , Stéphanie Désage , Hamdi Rezigue , Yesim Dargaud , Anne Lienhart , Christophe Nougier","doi":"10.1016/j.blre.2025.101320","DOIUrl":"10.1016/j.blre.2025.101320","url":null,"abstract":"<div><div>Acquired hemophilia A (AHA), a rare and life-threatening bleeding disorder of adults, caused by anti-factor VIII (FVIII) autoantibodies, is often underestimated, particularly in patients receiving antithrombotic therapy. AHA is often associated with autoimmune disease, cancer, infection or pregnancy.</div><div>AHA, characterized by severe spontaneous bleeding, particularly in muscles and subcutaneous tissues, requires a timely and accurate diagnosis. Delayed diagnosis worsens the prognosis and increases the risk of complications. Disease confirmation requires identification of FVIII deficiency and anti-FVIII antibodies. Treatment focuses on managing acute bleeding episodes, addressing the underlying condition and eradicating auto-antibodies through immunosuppressive therapy. Bypassing agents are used for treatment, but promising new therapeutic options such as emicizumab are under evaluation.</div><div>AHA remains a serious condition with high mortality from bleeding complications and adverse effects of immunosuppression. This review provides a comprehensive overview of current knowledge on AHA, including epidemiology, pathophysiology, diagnosis, prognostic factors and therapeutic strategies.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"74 ","pages":"Article 101320"},"PeriodicalIF":5.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.blre.2025.101306
Elie Azoulay , Lara Zafrani , Joseph Nates , Alexis Maillard , Dara Chean , Bruno Ferreyro , Judith E. Nelson , Philippe R. Bauer , Kathryn Puxty , Cristina Gutierrez , Naike Bigé , Eric Mariotte , Sandrine Valade , Boris Boell , Kathleen Puntillo , Antoine Lafarge , Marcio Soares , Peter Schellongowski , Emmanuel Canet , Pedro Castro , Ignacio Martin-Loeches
Hematological malignancies (HMs) are increasingly associated with life-threatening complications requiring intensive care unit (ICU) management. Recent advancements in therapies, diagnostics, and critical care protocols have improved outcomes for these patients, yet significant challenges persist. This manuscript explores the evolving landscape of critical care in hematology, emphasizing the unique complications, management strategies, and future directions in the field.
Patients with HMs are particularly vulnerable to infections, sepsis, organ dysfunction, and treatment-related toxicities such as cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and coagulopathies. Innovations in the management of acute respiratory failure, septic shock, and invasive fungal infections have contributed to better survival rates, yet outcomes remain suboptimal for certain high-risk groups. Furthermore, new therapies, including CAR-T cells, bispecific antibodies, and immune checkpoint inhibitors, present both opportunities and challenges in the ICU setting due to their potential toxicities.
Emerging trends emphasize the importance of early ICU admission, multidisciplinary collaboration, and precision medicine in improving patient care. The integration of biomarker-driven strategies, advanced diagnostics, and artificial intelligence holds promise for optimizing therapeutic interventions and enhancing antimicrobial stewardship. Additionally, patient-centered approaches, including time-limited trials and goal-oriented discussions, aim to balance aggressive care with quality-of-life considerations.
This review underscores the need for continued research to address disparities in access to care, improve long-term outcomes, and develop standardized protocols for managing critically ill hematology patients. By advancing the integration of oncology and critical care, clinicians can better navigate the complexities of modern therapies and provide holistic, evidence-based care that aligns with patient values and priorities.
{"title":"Advances in the critical care management for patients with hematological malignancies","authors":"Elie Azoulay , Lara Zafrani , Joseph Nates , Alexis Maillard , Dara Chean , Bruno Ferreyro , Judith E. Nelson , Philippe R. Bauer , Kathryn Puxty , Cristina Gutierrez , Naike Bigé , Eric Mariotte , Sandrine Valade , Boris Boell , Kathleen Puntillo , Antoine Lafarge , Marcio Soares , Peter Schellongowski , Emmanuel Canet , Pedro Castro , Ignacio Martin-Loeches","doi":"10.1016/j.blre.2025.101306","DOIUrl":"10.1016/j.blre.2025.101306","url":null,"abstract":"<div><div><span>Hematological malignancies (HMs) are increasingly associated with life-threatening complications requiring </span>intensive care unit<span> (ICU) management. Recent advancements in therapies, diagnostics, and critical care protocols have improved outcomes for these patients, yet significant challenges persist. This manuscript explores the evolving landscape of critical care in hematology, emphasizing the unique complications, management strategies, and future directions in the field.</span></div><div><span>Patients with HMs are particularly vulnerable to infections, sepsis, organ dysfunction, and treatment-related toxicities such as cytokine release syndrome (CRS), immune effector cell-associated </span>neurotoxicity syndrome<span><span> (ICANS), and coagulopathies<span><span>. Innovations in the management of acute respiratory failure, </span>septic shock, and </span></span>invasive fungal infections<span><span> have contributed to better survival rates, yet outcomes remain suboptimal for certain high-risk groups. Furthermore, new therapies, including CAR-T cells, bispecific antibodies, and </span>immune checkpoint inhibitors, present both opportunities and challenges in the ICU setting due to their potential toxicities.</span></span></div><div>Emerging trends emphasize the importance of early ICU admission, multidisciplinary collaboration, and precision medicine in improving patient care. The integration of biomarker-driven strategies, advanced diagnostics, and artificial intelligence holds promise for optimizing therapeutic interventions and enhancing antimicrobial stewardship. Additionally, patient-centered approaches, including time-limited trials and goal-oriented discussions, aim to balance aggressive care with quality-of-life considerations.</div><div>This review underscores the need for continued research to address disparities in access to care, improve long-term outcomes, and develop standardized protocols for managing critically ill hematology patients. By advancing the integration of oncology and critical care, clinicians can better navigate the complexities of modern therapies and provide holistic, evidence-based care that aligns with patient values and priorities.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"74 ","pages":"Article 101306"},"PeriodicalIF":5.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.blre.2025.101302
Shuang Liu , Yan Shen , Jiayi Chen , Zheng Ruan , Li Hua , Kankan Wang , Xiaodong Xi , Jianhua Mao
Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), is a complex vascular disorder with high morbidity and mortality, driven by Virchow's Triad: blood stasis, hypercoagulability, and endothelial injury. VTE is now recognized as an inflammatory process involving multiple components. Platelets are involved in the process of VTE, contributing to thrombosis initiation, progression, resolution and recurrence through coagulation activation, and interactions with immune and endothelial cells. Anticoagulation remains the cornerstone of VTE treatment; however, antiplatelet agents like aspirin have demonstrated therapeutic potential, particularly following major orthopedic surgeries. Furthermore, emerging platelet-targeted therapies and biomarkers offer new opportunities for improving VTE diagnosis and treatment. This review explores the evolving role of platelets in VTE pathophysiology, assesses current antiplatelet strategies, and highlights novel therapeutic approaches. Advancing platelet research in VTE may lead to safer, more effective interventions, optimizing outcomes for patients with this life-threatening condition.
{"title":"The critical role of platelets in venous thromboembolism: Pathogenesis, clinical status, and emerging therapeutic strategies","authors":"Shuang Liu , Yan Shen , Jiayi Chen , Zheng Ruan , Li Hua , Kankan Wang , Xiaodong Xi , Jianhua Mao","doi":"10.1016/j.blre.2025.101302","DOIUrl":"10.1016/j.blre.2025.101302","url":null,"abstract":"<div><div><span><span>Venous thromboembolism (VTE), encompassing </span>deep vein thrombosis<span> (DVT) and pulmonary embolism<span> (PE), is a complex vascular disorder with high morbidity and mortality, driven by Virchow's Triad<span><span><span>: blood stasis, </span>hypercoagulability, and </span>endothelial injury. VTE is now recognized as an inflammatory process involving multiple components. Platelets are involved in the process of VTE, contributing to thrombosis initiation, progression, resolution and recurrence through coagulation activation, and interactions with immune and </span></span></span></span>endothelial cells<span>. Anticoagulation<span><span> remains the cornerstone of VTE treatment; however, antiplatelet agents like </span>aspirin<span> have demonstrated therapeutic potential, particularly following major orthopedic surgeries. Furthermore, emerging platelet-targeted therapies and biomarkers offer new opportunities for improving VTE diagnosis and treatment. This review explores the evolving role of platelets in VTE pathophysiology<span>, assesses current antiplatelet strategies, and highlights novel therapeutic approaches. Advancing platelet research in VTE may lead to safer, more effective interventions, optimizing outcomes for patients with this life-threatening condition.</span></span></span></span></div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"74 ","pages":"Article 101302"},"PeriodicalIF":5.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.blre.2025.101327
Afif Mufarrij , Mohammad Hassan Hodroj , Nicole Charbel , Sacha El Khoury , Souraya Arabi , Ali Taher
β-thalassemia is a hereditary hemoglobinopathy characterized by ineffective erythropoiesis, chronic anemia, and iron overload. Improved survival rates due to advances in transfusion and iron chelation therapies have shifted the clinical burden toward managing complex, often acute, complications that commonly present to the emergency department (ED). This review provides an evidence-based, system-oriented framework for emergency physicians to recognize and manage β-thalassemia-related emergencies. Initial ED assessment should focus on hemodynamic stability, transfusion history, iron chelation regimen, and complications such as splenectomy or infections.
Common presentations include symptomatic anemia, cardiac decompensation, thromboembolic events, infections, and transfusion-related reactions. Cardiac complications, ranging from arrhythmias to iron-overload cardiomyopathy, are the leading cause of mortality and require urgent intervention. Pulmonary hypertension, high-output heart failure, and thromboembolic events are prevalent, particularly in non-transfusion dependent and splenectomized patients. Infectious complications, especially in asplenic individuals, can progress rapidly and warrant early empiric antibiotic therapy. Neurological presentations such as spinal cord compression or stroke may be under-recognized but necessitate immediate imaging and multidisciplinary care. Renal dysfunction, leg ulcers, cholelithiasis, and endocrinopathies further complicate emergency presentations.
Effective ED management relies on prompt recognition, appropriate diagnostics, and early consultation with hematology, cardiology, infectious disease, and surgical teams. Incorporating transfusion protocols, chelation adjustments, and disposition planning enhances continuity of care. By increasing awareness and training, ED providers can significantly impact outcomes in this growing patient population. This review aims to bridge the knowledge gap and provide practical guidance for acute care providers encountering β-thalassemia-related emergencies.
{"title":"Beyond the blood: A practical guide to thalassemia care in the emergency department","authors":"Afif Mufarrij , Mohammad Hassan Hodroj , Nicole Charbel , Sacha El Khoury , Souraya Arabi , Ali Taher","doi":"10.1016/j.blre.2025.101327","DOIUrl":"10.1016/j.blre.2025.101327","url":null,"abstract":"<div><div>β-thalassemia is a hereditary hemoglobinopathy characterized by ineffective erythropoiesis, chronic anemia, and iron overload. Improved survival rates due to advances in transfusion and iron chelation therapies have shifted the clinical burden toward managing complex, often acute, complications that commonly present to the emergency department (ED). This review provides an evidence-based, system-oriented framework for emergency physicians to recognize and manage β-thalassemia-related emergencies. Initial ED assessment should focus on hemodynamic stability, transfusion history, iron chelation regimen, and complications such as splenectomy or infections.</div><div>Common presentations include symptomatic anemia, cardiac decompensation, thromboembolic events, infections, and transfusion-related reactions. Cardiac complications, ranging from arrhythmias to iron-overload cardiomyopathy, are the leading cause of mortality and require urgent intervention. Pulmonary hypertension, high-output heart failure, and thromboembolic events are prevalent, particularly in non-transfusion dependent and splenectomized patients. Infectious complications, especially in asplenic individuals, can progress rapidly and warrant early empiric antibiotic therapy. Neurological presentations such as spinal cord compression or stroke may be under-recognized but necessitate immediate imaging and multidisciplinary care. Renal dysfunction, leg ulcers, cholelithiasis, and endocrinopathies further complicate emergency presentations.</div><div>Effective ED management relies on prompt recognition, appropriate diagnostics, and early consultation with hematology, cardiology, infectious disease, and surgical teams. Incorporating transfusion protocols, chelation adjustments, and disposition planning enhances continuity of care. By increasing awareness and training, ED providers can significantly impact outcomes in this growing patient population. This review aims to bridge the knowledge gap and provide practical guidance for acute care providers encountering β-thalassemia-related emergencies.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"74 ","pages":"Article 101327"},"PeriodicalIF":5.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.blre.2025.101329
Rohit Singh , Happy Agarwal , Ryan Bynum , Eli J. Isenberg , Mary Erdmann , Joshua Glover , Molly McNally , Jorge Gomez-Gutierrez , Lacey McNally , Jennifer Holter-Chakrabarty
Graft-versus-host disease (GVHD) is one of the major barriers to the clinical success of hematopoietic stem cell transplantation (HCT). Despite improvements in GVHD incidence with the use of post-transplant cyclophosphamide, cord blood transplantation, and improvement in donor identification and matching, it remains a major cause of death in HCT. Early and accurate identification of GVHD is required to improve HCT outcomes. Diagnosis ambiguity continues to be problematic, despite improvements in PCR based stool studies, immunohistochemical markers in tissue biopsy, and improvement in histopathological examination. Unfortunately, therefore, early diagnosis of GVHD suffers from the lack of established diagnostic biomarkers which could improve prompt identification and treatment of GVHD at a time when therapeutic outcome is most impactful. This review discusses available diagnostic serum biomarkers and imaging advancements available to predict onset, severity, and prognosis in GVHD. Additionally, this review highlights the differential diagnosis of GVHD from other related pathological conditions.
{"title":"DecodingAcute GVHD: The role of serum biomarkers and imaging in diagnosis and management","authors":"Rohit Singh , Happy Agarwal , Ryan Bynum , Eli J. Isenberg , Mary Erdmann , Joshua Glover , Molly McNally , Jorge Gomez-Gutierrez , Lacey McNally , Jennifer Holter-Chakrabarty","doi":"10.1016/j.blre.2025.101329","DOIUrl":"10.1016/j.blre.2025.101329","url":null,"abstract":"<div><div>Graft-versus-host disease (GVHD) is one of the major barriers to the clinical success of hematopoietic stem cell transplantation (HCT). Despite improvements in GVHD incidence with the use of post-transplant cyclophosphamide, cord blood transplantation, and improvement in donor identification and matching, it remains a major cause of death in HCT. Early and accurate identification of GVHD is required to improve HCT outcomes. Diagnosis ambiguity continues to be problematic, despite improvements in PCR based stool studies, immunohistochemical markers in tissue biopsy, and improvement in histopathological examination. Unfortunately, therefore, early diagnosis of GVHD suffers from the lack of established diagnostic biomarkers which could improve prompt identification and treatment of GVHD at a time when therapeutic outcome is most impactful. This review discusses available diagnostic serum biomarkers and imaging advancements available to predict onset, severity, and prognosis in GVHD. Additionally, this review highlights the differential diagnosis of GVHD from other related pathological conditions.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"74 ","pages":"Article 101329"},"PeriodicalIF":5.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.blre.2025.101339
Ali Mushtaq , Asfand Yar Cheema , Hossam M. Ali , Yara Shatnawi , Omer Ashruf , Eman Nayaz Ahmad , Olga Lytvynova , Mishaal Munir , Muhammad Anns Asif , Maheen Ahmad , Hamza Hassan , Abdullah M. Khan , Tara Roy , Aneela Majeed , Shahzad Raza , Sandra Mazzoni , Louis Williams , Jack Khouri , Jason Valent , Christy Samaras , Faiz Anwer
Multiple myeloma (MM), a clonal plasma cell malignancy, presents a therapeutic challenge, especially in selecting therapy for patients with relapsed/refractory MM (RRMM). Up to 1-3 prior lines of therapy in this population are considered early relapse. This review provides clinicians with a guide for personalized, evidence-based strategies for treatment of early RRMM. Factors influencing treatment selection, including patient-related factors (e.g., frailty and comorbidities), disease characteristics (e.g., high-risk cytogenetics), prior therapy response, and toxicity profiles, are highlighted. We outline current and emerging transformative novel therapeutics, including anti-CD38 and anti-SLAMF7 monoclonal antibodies, BCMA-directed immunotherapies, such as CAR T-cells, and bispecific antibodies. The review highlights key clinical trials on efficacy (response rates, progression-free survival, overall survival) and safety profiles (e.g., cytokine release syndrome, neurotoxicity, and infections). Crucially, it provides a practical framework for clinical decision-making, including guidance on selecting between different combination regimens, immunotherapy platforms, and considering meaningful therapeutic endpoints and survival. Relapse management following BCMA-directed therapy and potential salvage strategies are outlined. Future directions include next-generation cellular therapies, novel antibody constructs, CELMoDs, and strategies to enhance immunotherapy outcomes.
{"title":"Management of relapsed refractory multiple myeloma: Evidence-based guide to community oncologists","authors":"Ali Mushtaq , Asfand Yar Cheema , Hossam M. Ali , Yara Shatnawi , Omer Ashruf , Eman Nayaz Ahmad , Olga Lytvynova , Mishaal Munir , Muhammad Anns Asif , Maheen Ahmad , Hamza Hassan , Abdullah M. Khan , Tara Roy , Aneela Majeed , Shahzad Raza , Sandra Mazzoni , Louis Williams , Jack Khouri , Jason Valent , Christy Samaras , Faiz Anwer","doi":"10.1016/j.blre.2025.101339","DOIUrl":"10.1016/j.blre.2025.101339","url":null,"abstract":"<div><div>Multiple myeloma (MM), a clonal plasma cell malignancy, presents a therapeutic challenge, especially in selecting therapy for patients with relapsed/refractory MM (RRMM). Up to 1-3 prior lines of therapy in this population are considered early relapse. This review provides clinicians with a guide for personalized, evidence-based strategies for treatment of early RRMM. Factors influencing treatment selection, including patient-related factors (e.g., frailty and comorbidities), disease characteristics (e.g., high-risk cytogenetics), prior therapy response, and toxicity profiles, are highlighted. We outline current and emerging transformative novel therapeutics, including anti-CD38 and anti-SLAMF7 monoclonal antibodies, BCMA-directed immunotherapies, such as CAR T-cells, and bispecific antibodies. The review highlights key clinical trials on efficacy (response rates, progression-free survival, overall survival) and safety profiles (e.g., cytokine release syndrome, neurotoxicity, and infections). Crucially, it provides a practical framework for clinical decision-making, including guidance on selecting between different combination regimens, immunotherapy platforms, and considering meaningful therapeutic endpoints and survival. Relapse management following BCMA-directed therapy and potential salvage strategies are outlined. Future directions include next-generation cellular therapies, novel antibody constructs, CELMoDs, and strategies to enhance immunotherapy outcomes.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"74 ","pages":"Article 101339"},"PeriodicalIF":5.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145201470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.blre.2025.101328
Bruno Fattizzo , Leona E. Ling , Wilma Barcellini
Warm autoimmune hemolytic anemia (wAIHA) is the most prevalent form of autoimmune hemolytic anemia, where in most patients extravascular hemolysis is driven by immunoglobulin G (IgG) autoantibodies, with or without complement activation. While standard-of-care treatment with corticosteroids provides a high initial response rate, relapses are frequent, and most patients require additional immunosuppressive therapies. A high unmet medical need remains for patients with refractory or chronic relapsing wAIHA. Neonatal Fc receptor (FcRn) blockers are novel biologic therapies designed to provide a rapid, sustained decrease in circulating concentrations of IgG antibodies, including autoantibodies, and have been investigated in hematologic conditions like immune thrombocytopenia and hemolytic anemia of the fetus and newborn and other autoimmune conditions, such as generalized myasthenia gravis. FcRn blockade is currently under evaluation in patients with wAIHA to determine its potential as a safe, effective treatment option.
{"title":"Targeting the neonatal Fc receptor (FcRn) in hematologic conditions with a focus on warm autoimmune hemolytic anemia","authors":"Bruno Fattizzo , Leona E. Ling , Wilma Barcellini","doi":"10.1016/j.blre.2025.101328","DOIUrl":"10.1016/j.blre.2025.101328","url":null,"abstract":"<div><div>Warm autoimmune hemolytic anemia (wAIHA) is the most prevalent form of autoimmune hemolytic anemia, where in most patients extravascular hemolysis is driven by immunoglobulin G (IgG) autoantibodies, with or without complement activation. While standard-of-care treatment with corticosteroids provides a high initial response rate, relapses are frequent, and most patients require additional immunosuppressive therapies. A high unmet medical need remains for patients with refractory or chronic relapsing wAIHA. Neonatal Fc receptor (FcRn) blockers are novel biologic therapies designed to provide a rapid, sustained decrease in circulating concentrations of IgG antibodies, including autoantibodies, and have been investigated in hematologic conditions like immune thrombocytopenia and hemolytic anemia of the fetus and newborn and other autoimmune conditions, such as generalized myasthenia gravis. FcRn blockade is currently under evaluation in patients with wAIHA to determine its potential as a safe, effective treatment option.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"74 ","pages":"Article 101328"},"PeriodicalIF":5.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.blre.2025.101316
Alex Wonnaparhown , Talal Hilal , Albert Chong , Rafael Fonseca
The treatment of lymphoid malignancies is rapidly advancing with recognition of hypogammaglobulinemia (HG) and increased infection risk with the use of cellular-targeted therapies, such as chimeric antigen receptor (CAR) T cell and bispecific antibody (BsAb) therapy. Underlying adaptive immune dysfunction seen in malignancy, immunoparesis, and prior lines of B cell-targeting therapies also predispose patients to HG and infections prior to more advanced cellular therapies. Clinicians should become familiar with how to evaluate adaptive immunity and causes of HG. Various strategies exist to reduce infections in immunosuppressed patients, including risk-reducing practices, vaccination, prophylactic antibiotics, and IgG replacement therapy (IgG-RT). Future research should focus on identifying biomarkers to help with infectious risk-stratification and identify populations that would best benefit from IgG-RT.
{"title":"Exploring the depths of hypogammaglobulinemia in lymphoid malignancies: Pathophysiology, clinical implications, management options, and future directions","authors":"Alex Wonnaparhown , Talal Hilal , Albert Chong , Rafael Fonseca","doi":"10.1016/j.blre.2025.101316","DOIUrl":"10.1016/j.blre.2025.101316","url":null,"abstract":"<div><div>The treatment of lymphoid malignancies is rapidly advancing with recognition of hypogammaglobulinemia (HG) and increased infection risk with the use of cellular-targeted therapies, such as chimeric antigen receptor (CAR) T cell and bispecific antibody (BsAb) therapy. Underlying adaptive immune dysfunction seen in malignancy, immunoparesis, and prior lines of B cell-targeting therapies also predispose patients to HG and infections prior to more advanced cellular therapies. Clinicians should become familiar with how to evaluate adaptive immunity and causes of HG. Various strategies exist to reduce infections in immunosuppressed patients, including risk-reducing practices, vaccination, prophylactic antibiotics, and IgG replacement therapy (IgG-RT). Future research should focus on identifying biomarkers to help with infectious risk-stratification and identify populations that would best benefit from IgG-RT.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"74 ","pages":"Article 101316"},"PeriodicalIF":5.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号