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CAR-T cell therapy for multiple myeloma: An update on the current state and future potential CAR-T细胞治疗多发性骨髓瘤:现状和未来潜力的最新进展
IF 2 4区 医学 Q3 HEMATOLOGY Pub Date : 2025-10-04 DOI: 10.1016/j.beha.2025.101659
Prateek Pophali , Jacalyn Rosenblatt , David Avigan
The field of multiple myeloma (MM) has seen significant therapeutic advances over the last decade including the recent advent of Chimeric Antigen Receptor T cell (CAR-T) therapy. Currently there are two FDA approved CAR-T products for MM, both targeting B cell maturation antigen (BCMA). These agents have demonstrated striking therapeutic efficacy in patients with advanced disease and are now also approved in earlier relapse. CAR-T therapy is associated with unique toxicities including cytokine release syndrome, neurotoxicity, hypogammaglobulinemia, risk of infections and cytopenias. While response rates are dramatic, most patients ultimately experience disease progression due to therapeutic resistance potentially arising from lack of persistence and exhaustion of CAR-T cells, emergence of antigen negative variants, and the immunosuppressive tumor microenvironment. Significant efforts in the field are dedicated towards improving the efficacy and mitigating the toxicity of CAR-T cell therapy. In this publication, we review the approved and investigational CAR-T models for MM.
在过去的十年中,包括嵌合抗原受体T细胞(CAR-T)疗法的出现在内,多发性骨髓瘤(MM)领域的治疗取得了重大进展。目前,FDA批准了两种针对MM的CAR-T产品,均针对B细胞成熟抗原(BCMA)。这些药物在晚期疾病患者中显示出惊人的治疗效果,现在也被批准用于早期复发。CAR-T疗法与独特的毒性相关,包括细胞因子释放综合征、神经毒性、低γ -球蛋白血症、感染风险和细胞减少症。虽然应答率是惊人的,但由于CAR-T细胞缺乏持久性和耗竭、抗原阴性变异的出现以及免疫抑制肿瘤微环境的出现,大多数患者最终会经历疾病进展。该领域的重大努力致力于提高CAR-T细胞疗法的疗效和减轻毒性。在这篇文章中,我们回顾了已批准的和正在研究的治疗MM的CAR-T模型。
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引用次数: 0
Cancer vaccines in hematologic malignancy: A systematic review of the rational and evidence for clinical use 恶性血液病肿瘤疫苗:临床使用的合理性和证据的系统回顾
IF 2 4区 医学 Q3 HEMATOLOGY Pub Date : 2025-08-20 DOI: 10.1016/j.beha.2025.101650
T. Anders Olsen , Kevin J. Barnum , David Avigan , Jacalyn Rosenblatt
Immunotherapy, including immune checkpoint blockade, CART cells and bispecific antibodies have resulted in dramatic improvements in outcomes for patients with hematological malignancies, demonstrating the unique potency of the immune system in targeting malignant cells. The development of cancer vaccines aims to evoke an activated effector cell population and a memory response to provide long term immune surveillance to protect from relapse. Developing a potent cancer vaccine relies on identifying appropriate antigen targets, enhancing antigen presentation, and overcoming the immune suppressive milieu of the micro-environment. Critical advances include the identification of neoantigens as targets for high affinity T cells, multi-antigenic targets via whole-cell or multi-peptide platforms, dendritic cell-based strategies, and adjunct immunoregulatory agents to enhance response. In the present review, we examine the current understanding of immune dysregulation in hematologic malignancies, the rationale for cancer vaccines, and the clinical and immunologic response data available from preclinical and clinical settings.
免疫疗法,包括免疫检查点阻断、CART细胞和双特异性抗体,已经显著改善了血液学恶性肿瘤患者的预后,证明了免疫系统在靶向恶性细胞方面的独特效力。癌症疫苗的开发旨在唤起激活的效应细胞群和记忆反应,以提供长期的免疫监测,以防止复发。开发一种有效的癌症疫苗依赖于确定适当的抗原靶点、增强抗原呈递和克服微环境的免疫抑制环境。关键的进展包括鉴定作为高亲和力T细胞靶点的新抗原,通过全细胞或多肽平台的多抗原靶点,基于树突状细胞的策略,以及辅助免疫调节剂来增强应答。在本综述中,我们研究了目前对恶性血液病免疫失调的理解,癌症疫苗的基本原理,以及临床前和临床环境中可获得的临床和免疫应答数据。
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引用次数: 0
Bispecific T-cell engager therapy for multiple myeloma 双特异性t细胞接合疗法治疗多发性骨髓瘤
IF 2 4区 医学 Q3 HEMATOLOGY Pub Date : 2025-08-05 DOI: 10.1016/j.beha.2025.101649
Diana Cirstea , Benjamin Puliafito , Bridget E. Kim , Matt Lei , Noopur Raje
With upfront use of triplet- and quadruplet-based regimens coupled with autologous stem cell transplant (ASCT) and maintenance lenalidomide, a high proportion of multiple myeloma (MM) patients are achieving deep and durable responses. Yet, myeloma invariably relapses, with refractoriness to one or more drugs at first relapse. This therapeutic gap has been partially filled by T-cell engager (TCE) therapies that have demonstrated remarkable response rates and prolonged remissions in heavily pretreated patients with MM, providing off-the-shelf immunotherapy options leading to the U.S. Food and Drug Administration (FDA) approval of three bispecific TCEs teclistamab, elranatamab, and talquetamab. We review the most salient aspects of TCE design and clinical experience in MM treatment. Combination approaches overcome resistance mechanisms, while earlier TCE use could enhance depth and durability of response. Outpatient step-up dosing (SUD) further enables community adoption.
前期使用以三胞胎和四胞胎为基础的方案,结合自体干细胞移植(ASCT)和维持性来那度胺,高比例的多发性骨髓瘤(MM)患者获得了深度和持久的应答。然而,骨髓瘤总是复发,在第一次复发时对一种或多种药物具有难治性。t细胞参与(TCE)疗法已经部分填补了这一治疗空白,该疗法在重度预治疗的MM患者中表现出显著的反应率和长期缓解,提供了现成的免疫治疗选择,导致美国食品和药物管理局(FDA)批准了三种双特异性TCE, teclistamab, elranatamab和talquetamab。我们回顾了TCE设计的最突出方面和MM治疗的临床经验。联合方法克服了抵抗机制,而早期使用TCE可以提高反应的深度和持久性。门诊增加剂量(SUD)进一步使社区采用。
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引用次数: 0
Corrigendum to “Precision immunomodulation: Understanding and harnessing cytokine pathways to treat and prevent immune-related adverse events (irAEs)” [Best Pract Res Clin Haematol 38 2 2025] “精确免疫调节:理解和利用细胞因子途径来治疗和预防免疫相关不良事件(irAEs)”的勘误表[最佳实践Res临床血血学38 2 2025]
IF 2.2 4区 医学 Q3 HEMATOLOGY Pub Date : 2025-07-18 DOI: 10.1016/j.beha.2025.101648
Matthew J. Hadfield , Ross D. Merkin , Sherin J. Rouhani , Kerry L. Reynolds
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引用次数: 0
Precursor plasma cell disorders: Classification, risk stratification, and emerging role of early interception 前体浆细胞疾病:分类、风险分层和早期阻断的新作用
IF 2.2 4区 医学 Q3 HEMATOLOGY Pub Date : 2025-07-09 DOI: 10.1016/j.beha.2025.101641
Tarek H. Mouhieddine , Irene M. Ghobrial , Omar Nadeem
Precursor plasma cell disorders include monoclonal gammopathy of undermined significance (MGUS) and smoldering multiple myeloma (SMM). These conditions carry a variable risk of progression to symptomatic myeloma and there are ongoing efforts to improve risk stratification to identify patients that are at highest risk of progression. Advanced imaging plays a crucial role in diagnosis and monitoring, and more sensitive tools to measure serum monoclonal proteins and circulating tumor cells are being developed. The data for early intervention in SMM continues to evolve, with several phase III studies demonstrating benefit compared to observation. There are ongoing studies evaluating the role of combination and T cell immunotherapies in patients with precursor plasma cell disorders. This review will highlight the current state of the art tools in diagnosis, risk stratification, and data for early interception in patients with precursor plasma cell dyscrasias.
前体浆细胞疾病包括单克隆性显著性γ病(MGUS)和阴燃性多发性骨髓瘤(SMM)。这些疾病进展为症状性骨髓瘤的风险是可变的,目前正在努力改善风险分层,以确定进展风险最高的患者。先进的影像学在诊断和监测中起着至关重要的作用,更敏感的工具来测量血清单克隆蛋白和循环肿瘤细胞正在开发中。SMM早期干预的数据在不断发展,与观察相比,一些III期研究显示了益处。目前正在进行的研究评估联合免疫疗法和T细胞免疫疗法在前体浆细胞疾病患者中的作用。本综述将重点介绍前体浆细胞异常患者在诊断、风险分层和早期阻断方面的最新工具。
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引用次数: 0
Immune therapy of haematological cancers 血液学癌症的免疫治疗
IF 2.2 4区 医学 Q3 HEMATOLOGY Pub Date : 2025-06-04 DOI: 10.1016/j.beha.2025.101640
Bin Pan , Robert Peter Gale MD, PhD, DSc(hc), FACP, FRCP, FRCPI(hc), FRSM
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引用次数: 0
Precision immunomodulation: Understanding and harnessing cytokine pathways to treat and prevent immune-related adverse events (irAEs) 精确免疫调节:理解和利用细胞因子途径治疗和预防免疫相关不良事件(irAEs)
IF 2.2 4区 医学 Q3 HEMATOLOGY Pub Date : 2025-06-01 DOI: 10.1016/j.beha.2025.101625
Matthew J. Hadfield , Ross D. Merkin , Sherin J. Rouhani , Kerry L. Reynolds
The utilization of immune checkpoint inhibitors has fundamentally changed both the treatment landscape for a multitude of malignancies as well as our understanding of cancer biology. Despite profound advancements, the utilization of these drugs is often limited by the development of immune-related adverse events (irAEs), characterized by off-target toxicity to healthy tissue secondary to treatment. Currently, irAEs are often treated with high-dose corticosteroids, with additional immunosuppressive agents added for severe or refractory irAEs. Cytokine pathway inhibitors, particularly anti-TNFa and anti-IL-6R antibodies, are commonly used as second-line immunosuppression. The efficacy of blocking these pathways in treating irAEs, as well as their potential impact on anti-tumor response, will be discussed. Additionally, this review will also explore other cytokines implicated in irAE pathophysiology, including interleukin-17 (IL-17), interleukin-23 (IL-23), interleukin-4/13 (IL-4/IL-13) and interleukin-5 (IL-5) which play important roles in the inflammatory cascades underlying specific irAEs such as colitis, dermatitis, and eosinophilia-related toxicities.
免疫检查点抑制剂的使用从根本上改变了多种恶性肿瘤的治疗前景以及我们对癌症生物学的理解。尽管取得了长足的进步,但这些药物的使用往往受到免疫相关不良事件(irAEs)的限制,其特征是治疗后对健康组织的脱靶毒性。目前,irAEs通常使用高剂量皮质类固醇治疗,对严重或难治性irAEs添加额外的免疫抑制剂。细胞因子途径抑制剂,特别是抗tnfa和抗il - 6r抗体,通常被用作二线免疫抑制。我们将讨论阻断这些途径在治疗irae中的功效,以及它们对抗肿瘤反应的潜在影响。此外,本综述还将探讨与irAE病理生理相关的其他细胞因子,包括白细胞介素-17 (IL-17)、白细胞介素-23 (IL-23)、白细胞介素-4/13 (IL-4/IL-13)和白细胞介素-5 (IL-5),它们在特异性irAE的炎症级联反应中发挥重要作用,如结肠炎、皮炎和嗜酸性粒细胞相关毒性。
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引用次数: 0
Advances in NK cell therapy for multiple myeloma NK细胞治疗多发性骨髓瘤的进展
IF 2.2 4区 医学 Q3 HEMATOLOGY Pub Date : 2025-05-28 DOI: 10.1016/j.beha.2025.101639
Najing Liu , Yujin Zeng , Ying Wang , Congyue Wang , Nuoxian Li , Jinge Xu
Multiple myeloma (MM) is a malignant disease in which clonal plasma cells proliferate abnormally. In patients with MM, the number and function of NK cells are suppressed, resulting in reduced immune surveillance and clearance of myeloma cells. Restoring or enhancing the killing effect of NK cells on myeloma cells is an important strategy for MM immunotherapy. At present, a series of great progress has been made in preclinical and clinical studies for NK cell adoptive therapy and CAR-NK therapy. This article introduces the current status of various treatment strategies for MM, NK cells in MM, and reviews the latest results of NK cell immunotherapy for MM.
多发性骨髓瘤(MM)是一种克隆性浆细胞异常增殖的恶性疾病。在MM患者中,NK细胞的数量和功能受到抑制,导致免疫监视和骨髓瘤细胞清除减少。恢复或增强NK细胞对骨髓瘤细胞的杀伤作用是骨髓瘤免疫治疗的重要策略。目前,NK细胞过继疗法和CAR-NK疗法在临床前和临床研究方面取得了一系列重大进展。本文介绍了MM的各种治疗策略的现状,MM中的NK细胞,并综述了NK细胞免疫治疗MM的最新成果。
{"title":"Advances in NK cell therapy for multiple myeloma","authors":"Najing Liu ,&nbsp;Yujin Zeng ,&nbsp;Ying Wang ,&nbsp;Congyue Wang ,&nbsp;Nuoxian Li ,&nbsp;Jinge Xu","doi":"10.1016/j.beha.2025.101639","DOIUrl":"10.1016/j.beha.2025.101639","url":null,"abstract":"<div><div>Multiple myeloma (MM) is a malignant disease in which clonal plasma cells proliferate abnormally. In patients with MM, the number and function of NK cells are suppressed, resulting in reduced immune surveillance and clearance of myeloma cells. Restoring or enhancing the killing effect of NK cells on myeloma cells is an important strategy for MM immunotherapy. At present, a series of great progress has been made in preclinical and clinical studies for NK cell adoptive therapy and CAR-NK therapy. This article introduces the current status of various treatment strategies for MM, NK cells in MM, and reviews the latest results of NK cell immunotherapy for MM.</div></div>","PeriodicalId":8744,"journal":{"name":"Best Practice & Research Clinical Haematology","volume":"38 3","pages":"Article 101639"},"PeriodicalIF":2.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144178128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adoptive cellular therapies in multiple myeloma 多发性骨髓瘤的过继细胞治疗
IF 2.2 4区 医学 Q3 HEMATOLOGY Pub Date : 2025-05-27 DOI: 10.1016/j.beha.2025.101638
David Kegyes , Bogdan Borlea , Marc Damian , Adrian Bogdan Tigu , Madalina Nistor , Diana Cenariu , Raluca Munteanu , Diana Gulei , Angela Dascalescu , Ion Antohe , Alina Tanase , Evangelos Terpos , Hermann Einsele , Ciprian Tomuleasa
Plasma cell myeloma (multiple myeloma) is a blood cancer characterized by the clonal proliferation of plasma cells in the bone marrow. Treatment strategies evolve year by year, new drugs getting Food and Drug Administration (FDA)-approved each year. Chimeric antigen receptor (CAR) therapies are an advanced form of immunotherapy that engineer T cells to recognize and destroy cancer cells. In recent years, adoptive cellular therapies have been successfully used to treat relapsed or refractory patients. Now, growing evidence supports their effectiveness when used earlier in treatment, even as an alternative to autologous hematopoietic stem cell transplantation. Ongoing research is expanding CAR therapy to solid tumors and enhancing safety and efficacy through innovative designs and combination strategies. In this paper, we aim to highlight the brief history and the latest advancements in CAR T-cell and NK-cell therapies for plasma cell myeloma.
浆细胞骨髓瘤(多发性骨髓瘤)是一种以骨髓浆细胞克隆性增殖为特征的血癌。治疗策略每年都在发展,每年都有新药获得美国食品和药物管理局(FDA)的批准。嵌合抗原受体(CAR)疗法是一种先进的免疫疗法,通过改造T细胞来识别和摧毁癌细胞。近年来,过继细胞疗法已成功用于治疗复发或难治性患者。现在,越来越多的证据支持它们在早期治疗时的有效性,甚至作为自体造血干细胞移植的替代方法。正在进行的研究正在将CAR疗法扩展到实体肿瘤,并通过创新的设计和联合策略提高安全性和有效性。在本文中,我们旨在重点介绍CAR - t细胞和nk细胞治疗浆细胞骨髓瘤的简史和最新进展。
{"title":"Adoptive cellular therapies in multiple myeloma","authors":"David Kegyes ,&nbsp;Bogdan Borlea ,&nbsp;Marc Damian ,&nbsp;Adrian Bogdan Tigu ,&nbsp;Madalina Nistor ,&nbsp;Diana Cenariu ,&nbsp;Raluca Munteanu ,&nbsp;Diana Gulei ,&nbsp;Angela Dascalescu ,&nbsp;Ion Antohe ,&nbsp;Alina Tanase ,&nbsp;Evangelos Terpos ,&nbsp;Hermann Einsele ,&nbsp;Ciprian Tomuleasa","doi":"10.1016/j.beha.2025.101638","DOIUrl":"10.1016/j.beha.2025.101638","url":null,"abstract":"<div><div>Plasma cell myeloma (multiple myeloma) is a blood cancer characterized by the clonal proliferation of plasma cells in the bone marrow. Treatment strategies evolve year by year, new drugs getting Food and Drug Administration (FDA)-approved each year. Chimeric antigen receptor (CAR) therapies are an advanced form of immunotherapy that engineer T cells to recognize and destroy cancer cells. In recent years, adoptive cellular therapies have been successfully used to treat relapsed or refractory patients. Now, growing evidence supports their effectiveness when used earlier in treatment, even as an alternative to autologous hematopoietic stem cell transplantation. Ongoing research is expanding CAR therapy to solid tumors and enhancing safety and efficacy through innovative designs and combination strategies. In this paper, we aim to highlight the brief history and the latest advancements in CAR T-cell and NK-cell therapies for plasma cell myeloma.</div></div>","PeriodicalId":8744,"journal":{"name":"Best Practice & Research Clinical Haematology","volume":"38 3","pages":"Article 101638"},"PeriodicalIF":2.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144203182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Adoptive cellular therapies in non-Hodgkin lymphomas 非霍奇金淋巴瘤的过继细胞治疗
IF 2.2 4区 医学 Q3 HEMATOLOGY Pub Date : 2025-05-22 DOI: 10.1016/j.beha.2025.101637
David Kegyes , Bogdan Borlea , Marc Damian , Adrian Bogdan Tigu , Madalina Nistor , Diana Cenariu , Raluca Munteanu , Diana Gulei , Angela Dascalescu , Ion Antohe , Alina Tanase , Anca Colita , Nazar Shokun , Tetiana Skrypets , Hermann Einsele , Massimo Federico , Ciprian Tomuleasa
Lymphomas are a group of malignant proliferations of B, T or NK-lymphoid cells at different stages of maturation. While they primarily occur in lymph nodes or lymphatic tissues, they can also involve bone marrow, blood, or other organs. Despite advances in treatment, many patients experience relapse, or develop refractory disease, prompting the development of new therapies. One of the most promising innovations is represented by chimeric antigen receptors (CAR) T-cell therapy, that works by genetically modifying a patient's T lymphocytes to better target and kill their cancer cells. Currently, all FDA-approved CAR T-cell therapies target CD19 (a surface protein expressed on B lymphocytes), however, ongoing research includes CAR-Ts that address novel targets or target multiple antigens. This study aims to provide a comprehensive overview on the clinical use and therapeutic efficacy of both approved and emerging CAR-Ts in the treatment of lymphoma.
淋巴瘤是一组处于不同成熟阶段的B、T或nk淋巴样细胞的恶性增生。虽然它们主要发生在淋巴结或淋巴组织,但也可能涉及骨髓、血液或其他器官。尽管治疗取得了进展,但许多患者复发或发展为难治性疾病,促使新疗法的发展。最具前景的创新之一是嵌合抗原受体(CAR) T细胞疗法,它通过对患者的T淋巴细胞进行基因修饰,以更好地靶向和杀死癌细胞。目前,所有fda批准的CAR- t细胞疗法靶向CD19(一种表达在B淋巴细胞上的表面蛋白),然而,正在进行的研究包括靶向新靶点或靶向多种抗原的CAR- t。本研究旨在全面概述已批准和新兴car - t治疗淋巴瘤的临床应用和治疗效果。
{"title":"Adoptive cellular therapies in non-Hodgkin lymphomas","authors":"David Kegyes ,&nbsp;Bogdan Borlea ,&nbsp;Marc Damian ,&nbsp;Adrian Bogdan Tigu ,&nbsp;Madalina Nistor ,&nbsp;Diana Cenariu ,&nbsp;Raluca Munteanu ,&nbsp;Diana Gulei ,&nbsp;Angela Dascalescu ,&nbsp;Ion Antohe ,&nbsp;Alina Tanase ,&nbsp;Anca Colita ,&nbsp;Nazar Shokun ,&nbsp;Tetiana Skrypets ,&nbsp;Hermann Einsele ,&nbsp;Massimo Federico ,&nbsp;Ciprian Tomuleasa","doi":"10.1016/j.beha.2025.101637","DOIUrl":"10.1016/j.beha.2025.101637","url":null,"abstract":"<div><div>Lymphomas are a group of malignant proliferations of B, T or NK-lymphoid cells at different stages of maturation. While they primarily occur in lymph nodes or lymphatic tissues, they can also involve bone marrow, blood, or other organs. Despite advances in treatment, many patients experience relapse, or develop refractory disease, prompting the development of new therapies. One of the most promising innovations is represented by chimeric antigen receptors (CAR) T-cell therapy, that works by genetically modifying a patient's T lymphocytes to better target and kill their cancer cells. Currently, all FDA-approved CAR T-cell therapies target CD19 (a surface protein expressed on B lymphocytes), however, ongoing research includes CAR-Ts that address novel targets or target multiple antigens. This study aims to provide a comprehensive overview on the clinical use and therapeutic efficacy of both approved and emerging CAR-Ts in the treatment of lymphoma.</div></div>","PeriodicalId":8744,"journal":{"name":"Best Practice & Research Clinical Haematology","volume":"38 3","pages":"Article 101637"},"PeriodicalIF":2.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144189302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Best Practice & Research Clinical Haematology
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