Eliana Cristina Martins Miranda

Background: Peripheral T-cell lymphomas (PTCLs) are rare and heterogeneous malignancies associated with poor outcomes. Although ¹⁸F-fluorodeoxyglucose PET/CT is routinely used for staging and response assessment, the complementary prognostic value of baseline total metabolic tumour volume (TMTV) and end-of-treatment PET response remains incompletely defined. We assessed their integrated prognostic value in an international cohort embedded within the prospective T-Cell Project 2.0 (TCP 2.0).Methods: Patients enrolled in the TCP 2.0 with newly diagnosed PTCL from eight international centers were included if baseline or end-of-treatment PET images were available for central review. Baseline TMTV was calculated using a fixed absolute SUV threshold of 4·0, excluding lesions smaller than 3 mL and diffuse splenic uptake, and was analysed continuously per 100 mL increase. End-of-treatment PET response was assessed using the Deauville score. Progression-free survival (PFS), freedom from progression (FFP), and overall survival (OS) were analyzed using Cox proportional hazards models. An integrated model combining continuous TMTV and Deauville score was internally validated using 1000 bootstrap resamples.Findings: Between [month, year] and [month, year], 104 patients were included. Median follow-up was 39 months (95% CI 32–45), and 2-year PFS and OS were 47% and 59%, respectively. Median baseline TMTV was 98 mL (range 0·6–1231). End-of-treatment PET was evaluable in 93 patients. Compared with Deauville score 1–3, Deauville score 4–5 was associated with inferior PFS (hazard ratio [HR] 5·52, 95% CI 2·68–11·4; p<0·001) and OS (3·55, 1·71–7·35; p=0·001). In univariable analyses, each 100 mL increase in baseline TMTV was associated with inferior PFS (HR 1·06, 95% CI 1·01–1·12; p=0·026) and OS (1·08, 1·02–1·14; p=0·010). The integrated analysis included 79 patients. Deauville score remained independently associated with PFS, FFP, and OS, whereas TMTV provided an additional independent contribution for FFP (HR 1·21 per 100 mL, 95% CI 1·05–1·41; p=0·010), but not for PFS or OS. The integrated model had a C-index of 0·718 for PFS and 0·762 for FFP. In exploratory stratified analyses, the association between increasing TMTV and progression risk was most evident among patients with Deauville score 1–3.Interpretation: End-of-treatment Deauville score was the dominant PET-derived prognostic factor in PTCL. Baseline TMTV provided additional information on progression risk and might refine risk estimation among patients achieving a favourable metabolic response. External validation and prospective studies are required before this approach can inform PET-adapted treatment decisions.

Summary: Although adult T‐cell leukaemia/lymphoma (ATL) has a higher burden in certain world regions, outcomes have not been directly compared across regions. We conducted a multicentre cohort study comparing the distribution of ATL subtypes and overall survival (OS) across 1090 adults (≥18 years) diagnosed with ATL during 2000–2023 in Japan ( n = 366), South America ( n = 364), the United States ( n = 275) and the United Kingdom ( n = 85). Survival was estimated using Kaplan–Meier methods. Acute ATL was more frequent in Japan (59%) than in the United States (45%), South America (36%) and the United Kingdom (24%) ( p _{heterogeneity} < 0.0001). Conversely, lymphomatous ATL predominated in the United Kingdom (53%), South America (51%) and the United States (45%) relative to Japan (20%) ( p _{heterogeneity} < 0.0001). With a median follow‐up of 38 months interquartile range (IQR 14–68), 3‐year OS across regions ranged from 10% to 25% for acute, 16%–34% for lymphomatous, 49%–86% for chronic and 60%–83% for smouldering ATL. Evidence of regional differences in OS was observed for acute, lymphomatous and chronic ATL but not for smouldering ATL. In conclusion, the distribution of ATL subtypes varies globally, and OS for aggressive subtypes (i.e. acute and aggressive) remains poor across regions. Our findings could guide the design of clinical studies aimed at developing accessible therapies through international collaboration.

Purpose: [¹⁸F]FDG PET/CT has been widely used in oncology for diagnosis and treatment monitoring. Reduced cerebral [¹⁸F]FDG uptake has been observed in patients with disseminated malignancies, potentially associated with the Warburg effect and elevated lactate levels. This study investigated the prognostic relevance of the brain-to-liver [¹⁸F]FDG uptake ratio (BLR) in MM patients who underwent PET/CT at diagnosis. Methods: BLR was calculated as the ratio between the mean standardized uptake value (SUV) of the whole brain and that of the liver. A total of 72 patients were retrospectively included in the study (58% male; median age 65 years (IQR55;70); 67% were classified as ISS stage III). Results: BLR, as a continuous variable, showed a statistically significant difference between groups according to sex ( p = 0.004), overweight status ( p = 0.005), and ISS stage ( p = 0.03), and was negatively correlated with β₂-microglobulin ( r = − 0.42, p < 0.001). With a median follow-up of 23 months (IQR 8; 65), 74% patients had died from MM-related causes. Patients with BLR > 2.7 demonstrated superior 60-month overall survival (52%vs.10%, p = 0.002) and progression-free survival (19%vs.3%, p = 0.003), respectively. Multivariate Cox regression confirmed BLR (HR 1.86 95%CI: 1.03–3.33, p = 0.038 (OS); HR 1.93 95%CI: 1.13–3.29, p = 0.016 (PFS))as an independent factor and the use of autologous hematopoietic cell transplantation (HCT) as consolidation for both OS and PFS. In addition, ISS stage III was also a prognostic factor for OS. Conclusion: Higher brain-to-liver [¹⁸F]FDG uptake ratio (> 2.7) at diagnosis predicts better clinical outcomes in multiple myeloma. BLR is significantly associated with established clinical markers of tumor burden in multiple myeloma. These findings suggest that BLR is a feasible and reproducible metric with potential prognostic value in multiple myeloma.

Hematopoietic cell transplantation is a data-driven field, and reporting to outcomes registries has become a common practice worldwide. However, comprehensive transplant data collection requires dedicated professionals who can accurately capture data, follow international guidelines, and maintain reliable databases for the evaluation of transplant outcomes. This article describes the development and evolution of the Brazilian Data Managers Working Group (GTGD) and its contributions to professional education, collaborative networking, registry implementation, data quality improvement, and scientific engagement in hematopoietic cell transplantation and cellular therapy in Brazil. The transition from single-center reporting to the establishment of a national transplant registry required collaboration among centers, partnership between the Brazilian Society of Cellular Therapy and Bone Marrow Transplantation (SBTMO) and the Center for International Blood and Marrow Transplant Research (CIBMTR), and the development of the GTGD to ensure the sustainability of this effort. The GTGD originated from a grassroots collaboration among data managers and transplant centers seeking to address limited professional recognition, inconsistent reporting practices, and restricted access to specialized training. Supported by collaboration with the SBTMO and CIBMTR, the initiative evolved into a nationally coordinated network. Over the decade, the GTGD promoted structured education, knowledge sharing, professional development, operational support, standardized data-management practices, quality-improvement initiatives, and scientific collaboration. In parallel, participation in the national multicenter protocol expanded to 95 centers, with 51 centers reporting data to the CIBMTR by 2025. The group also developed educational resources, supported benchmarking and cellular therapy reporting, strengthened national and international collaboration, and increased the visibility and professional identity of data managers within transplant programs. This experience demonstrates how coordinated engagement, continuous education, institutional collaboration, and professional advocacy can contribute to the development of national registry infrastructure and the generation of reliable real-world evidence in hematopoietic cell transplantation and cellular therapy.

Variances in global access to drugs and treatment practices make it challenging to understand the benefit of contemporary therapies in patients with relapsed and refractory (R/R) mature T-cell and natural killer–cell lymphomas (MTCL and MNKCL). We conducted an international retrospective cohort study of 925 patients with R/R MTCL and MNKCL. In peripheral T-cell lymphoma–not otherwise specified and anaplastic lymphoma kinase–negative anaplastic large cell lymphoma (ALK– ALCL), patients with relapsed lymphoma demonstrated a superior median overall survival (OS) relative to refractory from the time of second-line treatment. We identified several independent predictors of OS for R/R lymphoma including age >60 years, primary refractory disease, histological subtype other than angioimmunoblastic T-cell lymphoma (AITL), extranodal sites >1, Ki67 ≥40%, and absolute lymphocyte count less than the lower limit of normal. A multivariable model incorporating these formed the basis for a prognostic index for R/R TCL, in which patients are stratified into low-risk (0-1 risk factor), intermediate-risk (2-3 risk factors), or high-risk (≥4 risk factors) groups, which were associated with 3-year OS of 57.14%, 23.3%, and 7%, respectively. Patients received either a "novel" single agent (SA; 35%) or cytotoxic chemotherapy (CC; 60%) for their second-line treatment. Higher progression-free survival was observed with SA over CC for the entire cohort with a higher 3-year OS in AITL and ALK– ALCL. Among the SA, small-molecule inhibitors demonstrated OS advantage relative to CC in AITL. Our results highlight continued efficacy of novel drugs globally and the potential of a new prediction model in informing heterogeneous prognosis within the R/R population of MTCL and MNKCL.

The Brazilian Hematopoietic Cell Transplantation and Cellular Therapy (HCT-CT/BR) Registry depends on data manager (DM) training to ensure sustainability, for which it is essential to standardize processes. The objectives of this study were to describe the development of a support manual for Brazilian DMs reporting to the Center for International Blood and Marrow Transplant Research and to present quality assessment results. The descriptive study (Feb–Aug 2024) included structuring, content creation, and dissemination of the manual. Survey assessed satisfaction. The manual was launched at the XXVIII Brazilian Society of Cellular Therapy and Bone Marrow Transplantation Congress. Thirty-nine professionals rated it 9.3/10 for satisfaction and 9.4/10 for recommendation. A manual is crucial for standardizing processes and ensuring data quality, offering clear and up-to-date guidance.

This study investigates COVID-19 outcomes and immune response in chronic myeloid leukemia (CML) patients post-SARS-CoV-2 vaccination, comparing effectiveness of various vaccine options. Data from 118 CML patients (85 in Brazil, 33 in the US) showed similar infection rates prior (14% Brazil, 9.1% US) and post-vaccination (24.7% vs. 27.3%, respectively). In Brazil, AstraZeneca and CoronaVac were the most commonly used vaccine brands, while in the US, Moderna and Pfizer-BioNTech vaccines dominated. Despite lower seroconversion in the Brazilian cohort, all five vaccine brands analyzed prevented severe COVID-19. Patients who received mRNA and recombinant viral vector vaccines (HR: 2.20; 95%CI 1.07-4.51; p < .031) and those that had achieved at least major molecular response (HR: 1.51; 95% CI 1.01-3.31; p < .0001) showed higher seroconversion rates. Our findings suggest that CML patients can generate antibody responses regardless of the vaccine brand, thereby mitigating severe COVID-19. This effect is more pronounced in patients with well-controlled disease.