Objective: This study aimed to develop a methodology for detecting FMS-like tyrosine kinase 3 (FLT3) gene internal tandem duplication (ITD) mutation burden using polymerase chain reaction-next-generation sequencing (PCR-NGS). The prognostic value of FLT3-ITD mutation burden detected with PCR-NGS in patients with acute leukemia (AL) before allogeneic hematopoietic cell transplantation (allo-HSCT) is investigated. Methods: This retrospective study developed a methodology for detecting FLT3-ITD mutational burden in bone marrow samples isolated from 65 patients with AL with FLT3-ITD mutations who received allo-HSCT from January 2021 to June 2024 at Ruijin Hospital. PCR-NGS was used for data analysis, and results were compared with conventional quantitative PCR (qPCR) . Results: The PCR-NGS assay demonstrated robust performance, with a sensitivity of 10(-6). Pretransplant complete remission with FLT3-ITD negativity via qPCR was achieved in 58 patients, comprising 25 with FLT3-ITD positivity in PCR-NGS [median VAF:0.629% (0.004% -26.350% ) ]. The 2-year probability of relapses and event-free survival (EFS) were 11.2% and 86.2% for patients with FLT3-ITD VAF of <0.1% and 30.6% and 64.5% for those having FLT3-ITD VAF of ≥0.1%, respectively (relapse: HR=3.159, 95% CI: 0.950-10.510, P=0.048; EFS: HR=2.846, 95% CI: 0.953-8.500, P=0.050). Two-year probability of relapses and EFS were 12.5% and 84.4% for patients with both negative PCR-NGS and qPCR, 26.2% and 73.8% for those with positive PCR-NGS and negative qPCR, and 28.6% and 57.1% for patients with both positive PCR-NGS and qPCR (relapse: HR=2.892, 95% CI: 1.122-7.451, P=0.0321; EFS: HR=1.784, 95% CI: 0.880-3.615, P=0.248), respectively, before allo-HSCT. Maintenance therapy with FLT3 inhibitors is a protective factor for reduced relapse rate and better overall survival rate after allo-HSCT. Conclusion: A highly sensitive PCR-NGS assay for FLT3-ITD mutational burden has been developed. Compared with qPCR, PCR-NGS demonstrates superior sensitivity and enables more accurate prediction of posttransplant outcomes in patients with AL undergoing allo-HSCT.

The coexistence of chronic myelomonocytic leukemia (CMML) and T-lymphoblastic lymphoma (T-LBL) is extremely rare. We report a 65-year-old female patient who presented with occipitocervical masses, fever, and night sweats for 1 month. Comprehensive examinations, including bone marrow aspiration, lymph node biopsy, flow cytometry, and molecular profiling, confirmed the diagnosis of CMML-1 combined with T-LBL. The patient achieved complete remission of T-LBL after VDCP chemotherapy (vindesine, daunorubicin, cyclophosphamide, and dexamethasone), but later relapsed and progressed to T-lymphoblastic leukemia (T-ALL). After unsuccessful salvage therapies, she was treated with venetoclax combined with the CHG regimen, which induced a second complete remission of T-ALL. Notably, the CMML remained indolent throughout the clinical course. This article, supplemented with a literature review, emphasizes the clinicopathological features, molecular mechanisms, and therapeutic strategies for this rare coexistence, thereby highlighting the importance of multidisciplinary collaboration and individualized management in rare hematologic malignancies.

Remission rate of newly diagnosed B-cell acute lymphoblastic leukemia (B-ALL) based on chemotherapy was high; however, recurrence and refractory diseases still affect long-term survival, especially in adult patients. Chimeric antigen receptor T-cell (CAR-T cell) therapy is an important salvage treatment for patients with relapsed/refractory B-ALL, and it significantly improves the response rate, response quality, and survival of such patients. The mechanism and adverse reactions of CAR-T cellular therapy differed from those of traditional chemotherapy, molecular targeted drugs, antibody drugs, etc. Further, it has unique and, in some cases, more serious adverse reactions, despite its relatively high remission rate. Strengthening the full-process management of CAR-T cellular therapy helps achieve higher efficacy with better safety. The article takes one patient with relapsed/refractory B-ALL treated with CD19 CAR-T at our center as an example, and introduces the full-process management strategy of CAR-T cellular therapy, including patient selection, bridging therapy, lymphodepletion treatment, and adverse reaction management.

Peripheral T-cell lymphomas (PTCL) are a common type of non-Hodgkin lymphoma in China, with a higher incidence compared to Western countries. Apart from extranodal NK/T-cell lymphoma, nodal PTCL is the most prevalent subtype in China. Nodal PTCL is highly aggressive with a poor prognosis. Significant differences in molecular characteristics and clinical manifestations are observed among various subtypes, and the efficacy of conventional chemotherapy is limited. In recent years, the application of targeted therapies has significantly improved outcomes for some patients and is changing treatment paradigms for initial, maintenance, and relapsed disease. Based on these advancements, the Lymphoma Expert Committee of Chinese Society of Clinical Oncology and Lymphoid Disease Group, Chinese Society of Hematology, Chinese Medical Association have organized a panel of experts to develop this consensus, aiming to promote standardized diagnosis and treatment of nodal PTCL among clinicians in China, as well as to facilitate clinical research and application of novel therapies.

Objective: This study aimed to retrospectively analyze the impact of different induction regimens on autologous hematopoietic stem cell mobilization in the peripheral blood of patients with multiple myeloma in the new drug era. Methods: This study retrospectively analyzed the data of 140 patients with newly diagnosed multiple myeloma who underwent autologous hematopoietic stem cell mobilization at Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from November 2022 to November 2024. The patients were categorized based on their treatment regimens into the bortezomib-based group (V, 37 cases), bortezomib + lenalidomide-based group (VR, 28 cases), and daratumumab + bortezomib + lenalidomide-based group (DVR, 75 cases). The study compared the effects of different induction chemotherapy regimens in terms of hematopoietic stem cell mobilization, collection success rate, and quality rate. Results Among the 140 patients, 73 were males and 67 were females, and the median age was 58 (range, 34-71) years. The success rates of first-time hematopoietic stem cell collection were 94.6%, 82.1%, and 73.3% in the V, VR, and DVR groups, respectively (P<0.05). The quality rates of first-time hematopoietic stem cell collection were 70.3%, 50.0%, and 36.0% in the V, VR, and DVR groups, respectively (P<0.01). Multivariate logistic regression analysis revealed that lenalidomide use for ≥2 cycles was an adverse factor affecting collection success (OR=0.25, 95% CI: 0.08-0.78, P<0.05), whereas daratumumab use for ≥2 cycles was an adverse factor for collection quality (OR=0.40, 95% CI: 0.20-0.82, P<0.05). A premobilization platelet count ≥150×10(9)/L (OR=7.89, 95% CI: 2.43-25.62, P<0.001) and a CD34(+) cell count of ≥2/μl on the day before collection (OR=14.85, 95% CI: 4.67-47.16, P<0.001) were considered independent predictors of successful collection. A premobilization white blood cell count of ≥4.5×10(9)/L (OR=2.35, 95% CI: 1.01-5.45, P=0.046), a premobilization platelet count of ≥150×10(9)/L (OR=5.85, 95% CI: 1.72-19.94, P<0.005), and a CD34(+) cell count of ≥10/μl on the day before collection (OR=10.45, 95% CI: 4.26-25.63, P<0.001) were considered independent predictors for collection quality. Timely administration of plerixafor based on the CD34(+) cell count on the day before collection improved the success rate by 27.8% and the quality rate by 5.0% . Conclusion: In the new drug era, different induction chemotherapy regimens significantly impact hematopoietic stem cell mobilization and collection, with lenalidomide and daratumumab exhibiting notable effects. Timely administration of plerixafor for salvage mobilization based on CD34(+) cell counts on the day before collection improves both the success rate and quality rate of hematopoietic stem cell collection.

Objective: This study aimed to investigate the clinical characteristics and therapeutic outcomes of hemophagocytic lymphohistiocytosis (HLH) during pregnancy. Methods: Clinical data, including disease features, treatment responses, and maternal-fetal outcomes, of nine pregnant patients diagnosed with HLH at Jiangsu Province Hospital from January 2010 to December 2023 were retrospectively analyzed. Results: Among the 9 patients, HLH onset occurred in the first, second, and third trimesters in 1 (11.11% ), 4 (44.44% ), and 4 (44.44% ) cases, respectively. Five patients (55.56% ) were primigravida, whereas four (44.44% ) were multiparous. Hepatic dysfunction is the initial manifestation in six (66.67% ) patients. Pregnancy termination was performed in 5 cases (55.56% ), with fetal death observed in 3 cases (33.33% ) during early/mid trimester and fetal survival in 2 cases (22.22% ) during the third trimester. Seven patients (77.78% ) received glucocorticoids alone, achieving a complete response (CR) in three cases (33.33% ). One patient (11.11% ) attained a CR after cyclophosphamide, vincristine, and dexamethasone chemotherapy, whereas one (11.11% ) declined treatment. The median follow-up was 5.0 months (range, 0.6-103.7 months). Six patients (66.67% ) died, whereas three (33.33% ) remained disease-free. Conclusion: HLH during pregnancy is characterized by an insidious onset, with abnormal liver function being the primary presenting feature in most cases. Early and accurate diagnosis is crucial to initiate timely treatment and improve maternal survival. High-dose glucocorticoids are a prioritized treatment to control inflammatory storms in HLH during pregnancy, particularly for patients with autoimmune comorbidities or those requiring fetal protection. Individualized decision-making regarding the timing of pregnancy termination is crucial.

The guideline for the diagnosis and treatment of chronic myeloid leukemia (CML) in China (2025 edition) has been revised based on its 2020 version, incorporating advances in the field of CML diagnosis and treatment over the past 5 years. With reference to the revised 2022 International Consensus Criteria, the threshold for lymphoblasts in lymphoid blast transformation is clearly defined. The EUTOS Long-Term Survival score is recommended to evaluate the patient's risk status at diagnosis. Meanwhile, a prediction model for tyrosine kinase inhibitor (TKI) treatment failure derived from Chinese multicenter data is also recommended. The prognostic significance of cytogenetic and molecular abnormalities should be considered. Newly therapeutic drugs include asciminib, olverembatinib, and ponatinib. This version of the guideline systematically elaborates on the decision-making principles for first-line and later-line medications. Milestone responses are of guiding significance for treatment strategy adjustments; however, we emphasize that molecular milestone responses should be interpreted individually. Concurrently, it proposes TKI dose optimization based on efficacy and safety. The implementation criteria for treatment-free remission, postdiscontinuation monitoring, and fertility-related issues have been adjusted to minimize toxicities and improve quality of life while ensuring efficacy. Allogeneic hematopoietic stem cell transplantation remains valuable for patients with multidrug TKI resistance or intolerance and those in advanced phases.

To analyze the clinical characteristics of post-allogeneic hematopoietic stem cell transplantation (allo-HSCT) lymphoproliferative disorders and to explore the clinical guidance provided by the latest nomenclature for post-transplant lymphoproliferative disorders (PTLD) in the 2022 World Health Organization Classification of Hematologic and Lymphoid Tumors (WHO-HAEM5). A retrospective analysis was conducted on the clinical data of 35 patients diagnosed with PTLD after allo-HSCT at the Department of Hematology, Fifth Medical Center, Chinese PLA General Hospital, from January 1, 2016, to December 15, 2024. Among these, 11 cases were clinically diagnosed, and 24 cases were pathologically confirmed. The 24 pathologically confirmed PTLD cases were renamed according to the latest WHO-HAEM5 nomenclature. Monomorphic PTLD, corresponding to the lymphoma subtype of PTLD, exhibited the poorest prognosis with a over survival rate of only 54.5% (6/11). All deceased patients had severe aplastic anemia (SAA) as the primary disease; one death resulted from chemotherapy-related complications, while the remaining four died due to explosive PTLD progression. PTLD patients with SAA as the primary diagnosis exhibit poor prognosis, necessitating more aggressive clinical intervention strategies.

Objective: This study aimed to compare the efficacy and safety of maribavir and valganciclovir in the treatment of asymptomatic cytomegalovirus (CMV) infection in hematopoietic stem cell transplant (HSCT) recipients. Methods: In this phase 3, multicenter, randomized, double-blind, positive-controlled study, subjects with first episode of asymptomatic CMV infection post-HSCT were randomly assigned in a 1∶1 ratio to receive maribavir (400 mg, twice daily) or valganciclovir (dose-adjusted for renal clearance) for 8 weeks with a follow-up period spanned from 8 to week 20. The primary efficacy endpoint includes confirmed CMV viremia clearance at 8 weeks. Safety assessment included treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs) . Results: The Chinese population subgroup included 18 subjects, comprising 9 subjects each in the maribavir and valganciclovir arms. At 8 weeks, 77.8% of the subjects in both arms achieved confirmed CMV viremia clearance, with an unadjusted difference (maribavir vs valganciclovir) of 0.0% (95% CI: -38.4% to 38.4% ). The proportions of responders who achieved CMV viremia clearance at 8 weeks and maintained it until 16 weeks were 44.4% and 55.6% in the maribavir and valganciclovir arms, respectively, with an unadjusted difference of -11.1% (95% CI: -57.0% to 34.8% ). During the treatment observation period, 100% of subjects in both the maribavir and valganciclovir arms experienced at least one TEAE, causing 11.1% and 33.3% of subjects, respectively, to discontinue the study drug. The incidence of treatment-related SAEs was 0 and 22.2% in the maribavir and valganciclovir arms, respectively. Further, the incidence of neutropenia during the treatment observation period was lower in the maribavir arm than in the valganciclovir arm (22.2% vs 55.6% ) . Conclusion: In the Chinese population, maribavir may be comparable to valganciclovir in clearing CMV viremia to treat HSCT recipients with asymptomatic CMV infection, with acceptable safety and good tolerability, especially being numerically lower than valganciclovir in terms of neutropenia.