Jung-Hee Lee

Objectives: A simplified comorbidity index (SCI) was recently introduced and demonstrated effective risk stratification for non-relapse mortality (NRM) in cohorts from MSKCC and Sheba Medical Center. Methods: We retrospectively analysed registry data from 1,677 patients with haematologic malignancies or bone marrow failure syndromes who underwent allogeneic HCT with unmanipulated grafts between 2008 and 2019 at Asan Medical Center, Seoul, Korea. Results: In univariate analyses, the 5-year NRM rates by HCT-CI scores (0, 1, 2, 3, ≥4) were 8.3%, 22.9%, 15.1%, 17.2%, and 23.4%, respectively (P<0.001); by SCI scores (0, 1, 2, 3, ≥4), they were 17.9%, 15.5%, 16.0%, 24.2%, and 28.5%, respectively (P<0.001). Notably, SCI scores of 0–2 did not effectively stratify NRM risk. In multivariate analysis, an SCI score of ≥3 was independently associated with increased NRM (hazard ratio [HR], 1.68; P<0.001) and decreased overall survival (OS) (HR, 1.39; P<0.001). An exploratory Revised SCI incorporating clinically anchored threshold adjustments showed enhanced beta coefficients across comorbidity components. Conclusions: SCI score of ≥3 predicted increased NRM and decreased OS following HCT. The Revised SCI provided a hypothesis-generating basis for future prospective validation in independent cohorts.

Summary: Myelodysplastic neoplasms (formerly myelodysplastic syndromes, MDS) are heterogeneous clonal haematological malignancies that primarily affect the elderly, though a notable proportion of patients are diagnosed at younger ages. We retrospectively analysed 1437 patients diagnosed or treated at Asan Medical Center between 1989 and 2022, comparing clinical and genetic characteristics by age group. Younger patients (≤50 years) demonstrated improved overall survival (OS) and leukaemia‐free survival (all p < 0.001), a higher proportion of females, lower platelet levels, reduced bone marrow blasts, decreased mutation burden and lower scores on the International Prognostic Scoring System. In contrast, the response rates to hypomethylating agents did not significantly differ between age groups ( p = 0.543); however, SF3B1 mutation predicted favourable therapeutic response. Mutations in ASXL1 , DDX41 , DNMT3A , RUNX1 , SF3B1 , SRSF2 , TET2 , TP53 and ZRSR2 occurred more frequently in older MDS patients, whereas SAMD9 mutations predominated in younger cohort. In patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT), OS did not differ significantly between younger and older patients; only TP53 mutation reliably predicted inferior post‐HSCT OS (hazard ratio 3.099, p = 0.003). In analyses limited to younger patients, the presence of DNMT3A , TP53 and U2AF1 mutations was associated with worse OS. These findings suggest that younger patients represent a biologically distinct subset of MDS.

Background: The myelodysplastic syndromes (MDS) frequently present with heterogeneous autoimmune diseases (AD). However, the pathobiology and prognostic impact of AD in MDS have not been fully elucidated. Therefore, we aimed to investigate cytogenetic and molecular characteristics and prognostic significance of autoimmune disease in MDS.Methods: We retrospectively analyzed 1456 patients diagnosed with MDS at Asan Medical Center, Seoul, Korea, between 1989 and 2021.Results: Among all patients, 90 (6.2%) had AD. The most frequent cytogenetic abnormalities in AD+ group were trisomy 8 (22.2%), complex karyotypes (5.6%), and der (1;7) (q10;p10) (4.4%). BCORL1 (9.8% vs. 1.2%, P=0.006) and DNAH9 mutations (11.9% vs. 0%, P=0.014) were significantly more frequent in AD+ patients. SETD2 (4.9% vs. 0.7%, P=0.069) and WT1 mutations (7.3% vs. 1.7%, P=0.055) showed a trend toward higher frequency in the AD+ group. The MDS patients with AD+ demonstrated significantly higher overall survival (OS) (58.7% vs. 40.7% at 5 years, P=0.011) and leukemia-free survival (LFS) rates (53.9% vs. 34.7%, P=0.006) compared to those without AD. The favorable prognostic impact of AD was significant, particularly in higher-risk MDS. The skin manifestation of AD and diagnosis of AD (> 1 month) after MDS onset predicted better survival.Conclusion: AD in MDS is associated with distict clinical and molecular features and a more favorable prognosis, especially in higher-risk MDS. Trisomy 8 and der (1;7) as well as somatic mutations in BCORL1, DNAH9, SETD2, and WT1, may be associated with the co-occurrence of AD in MDS.

Jang HM, et al. J Korean Med Sci. 2026 Sep;41:e228. https://doi.org/10.3346/jkms.2026.41.e228

Jiyeon Kim, M.D., Miyoung Kim, M.D., Ph.D., Daehyun Chu, M.D., Young-Uk Cho, M.D., Ph.D., Sang-Hyun Hwang, M.D., Ph.D., Seongsoo Jang, M.D., Ph.D., Eul-Ju Seo, M.D., Ph.D., Eun-Ji Choi, M.D., Ph.D., Han-Seung Park, M.D., Ph.D., Jung-Hee Lee, M.D., Ph.D., Je-Hwan Lee, M.D., Ph.D., Dok Hyun Yoon, M.D., Ph.D., Heounjeong Go, M.D., Ph.D., Chan Sik Park, M.D., Ph.D., Kyoo-Hyung Lee, M.D., Ph.D., Chan-Jeoung Park, M.D., Ph.D., and Seungwoo Hwang, Ph.D.. Ann Lab Med -0001;0:. https://doi.org/10.3343/alm.2025.0395

Taegeun Lee, M.D., Daehyun Chu, M.D., Miyoung Kim, M.D., Ph.D., Young-Uk Cho, M.D., Ph.D., Sang-Hyun Hwang, M.D., Ph.D., Jung-Hee Lee, M.D., Ph.D., Dok Hyun Yoon, M.D., Ph.D., Hyungwoo Cho, M.D., Ph.D., and Seongsoo Jang, M.D., Ph.D.. Ann Lab Med -0001;0:. https://doi.org/10.3343/alm.2025.0274

Background: Carbapenemase-producing Enterobacteriaceae (CPE) are globally concerning pathogens due to limited therapeutic options. Despite the increasing incidence of CPE infections, evidence supporting effective empirical treatments for individuals undergoing hematopoietic stem cell transplantation (HSCT) remains limited. Methods: From January 2019 to December 2023, individuals undergoing HSCT screened for CPE colonization via perianal swabs upon admission before HSCT were retrospectively analyzed. Culture-based identification and carbapenemase-specific polymerase chain reaction were performed. The occurrence of Enterobacteriaceae bacteremia within 100 days post-HSCT was monitored. Propensity-score (PS) matching and competing risk analyses were used to evaluate the relationship between CPE colonization and bacteremia risk. Results: Among 649 patients undergoing HSCT, 70 (11%) were colonized with CPE. Enterobacteriaceae bacteremia occurred in 20 (29%) CPE-colonized and 56 (10%) noncolonized individuals (P < .001). Among these cases, 17/20 (85%) in the colonized group and 12/56 (21%) in the noncolonized group were caused by CPE (P < .001). After 1:2 PS matching, these rates remained consistent (85% vs 22%, P = .004). All CPE isolates recovered from blood were identical in species and carbapenemase type to those detected in pre-HSCT swabs. Competing risk analyses showed that pre-HSCT CPE colonization was significantly associated with CPE bacteremia (subdistribution hazard ratio [sHR] 13.1, 95% confidence interval [CI] 6.27–27.3, P < .001; after matching: sHR 19.1, 95% CI 4.42–82.20, P < .001). Conclusions: Pre-HSCT CPE colonization increases Enterobacteriaceae bacteremia risk. Routine screening and empirical CPE-directed therapy are essential to improving clinical outcomes.

Central nervous system (CNS) relapse in acute myeloid leukemia (AML) is uncommon but associated with poor outcomes. This retrospective study analyzed 960 AML patients who underwent hematopoietic cell transplantation (HCT) at Asan Medical Center between 2000 and 2020 to assess the efficacy of prophylactic intrathecal chemotherapy. Per protocol, patients received up to four intrathecal methotrexate (MTX). CNS relapse occurred in 2.8%, with a median onset of 6.3 months post-HCT. The 5-year CNS relapse rate was lower in the prophylactic MTX group compared to the non-MTX group (2.7% vs. 7.4%, p = 0.132), though not statistically significant. Increased number of intrathecal treatments did not reduce CNS relapse. Risk factors for CNS relapse included high white blood cell count, extramedullary disease, FAB M3/M4, and poor-risk cytogenetics. Prior CNS involvement was significant only in univariate analysis. These findings suggest intrathecal prophylaxis may benefit high-risk patients but is not necessary for all AML patients undergoing HCT.

Background: Scoring systems developed for predicting survival after allogeneic hematopoietic cell transplantation (HCT) show suboptimal prediction power, and various factors affect posttransplantation outcomes. Objective: A prediction model using a machine learning–based algorithm can be an alternative for concurrently applying multiple variables and can reduce potential biases. In this regard, the aim of this study is to establish and validate a machine learning–based predictive model for survival after allogeneic HCT in patients with hematologic malignancies. Methods: Data from 1470 patients with hematologic malignancies who underwent allogeneic HCT between December 1993 and June 2020 at Asan Medical Center, Seoul, South Korea, were retrospectively analyzed. Using the gradient boosting machine algorithm, we evaluated a model predicting the 5-year posttransplantation survival through 10-fold cross-validation. Results: The prediction model showed good performance with a mean area under the receiver operating characteristic curve of 0.788 (SD 0.03). Furthermore, we developed a risk score predicting probabilities of posttransplantation survival in 294 randomly selected patients, and an agreement between the estimated predicted and observed risks of overall death, nonrelapse mortality, and relapse incidence was observed according to the risk score. Additionally, the calculated score demonstrated the possibility of predicting survival according to the different transplantation-related factors, with the visualization of the importance of each variable. Conclusions: We developed a machine learning–based model for predicting long-term survival after allogeneic HCT in patients with hematologic malignancies. Our model provides a method for making decisions regarding patient and donor candidates or selecting transplantation-related resources, such as conditioning regimens.

Introduction Nonsecretory multiple myeloma (NSM) is a rare variant of multiple myeloma, accounting for approximately 1%-5% of all reported cases. We compared the characteristics of NSM and secretory multiple myeloma (SM). Methods We examined clinical and laboratory characteristics of 17 patients diagnosed with NSM and 40 patients diagnosed with SM. NSM was diagnosed based on findings of bone marrow (BM) examination, serum-free light chain (sFLC) assay, flow cytometric (FCM) immunophenotyping, chromosomal analysis, and imaging studies. Results No patient with NSM had hypercalcemia or renal insufficiency at diagnosis. Patients with NSM were less anemic (p < .05) but had higher lactate dehydrogenase levels (p < .05) than patients with SM. In addition, patients with NSM had a lower percentage of plasma cells in the BM, confirmed by manual differential count (p < .05) and FCM immunophenotyping (p < .05). The sFLC ratio in patients with NSM was abnormal (15/17, 88.2%) and was lower than that in patients with SM (p < .05). Risk stratification in Revised International Staging System revealed a low-risk tendency in patients with NSM (p = .235). Conclusion NSM patients showed different clinical and laboratory characteristics from SM patients. FCM immunophenotyping and sFLC assay particularly had differences between NSM patients and SM patients. Thus, they are essential for diagnosing NSM.