Ahmed Alnughmush

The prognostic relevance of multiple myeloma (MM)‐defined high‐risk (HR) cytogenetic abnormalities in AL amyloidosis is incompletely defined. We retrospectively evaluated 517 newly diagnosed AL amyloidosis patients seen at Mayo Clinic between 2012 and 2021 who had baseline plasma cell FISH. HR cytogenetics were defined as t (4;14), t (14;16), t (14;20), del(17p), or 1q gain/amplification (+1q). HR abnormalities were identified in 151 patients (29%); +1q accounted for most HR cases (122/151, 81%). Compared with standard‐risk (SR), patients harboring +1q demonstrated a greater clonal disease burden, including higher dFLC and bone marrow plasma cells, greater intact immunoglobulin secretion, higher plasma cell proliferative index, and enrichment for modified SLiM‐CRAB features. Hematologic and organ response patterns of +1q patients were generally comparable to SR patients, whereas non‐1q HR patients had a higher proportion of early hematologic responses. Patients harboring +1q demonstrated significantly inferior overall survival (OS) compared with both non‐1q HR patients and SR patients (median OS 57 months vs. not reached vs. 120 months, p = 0.02). In multivariable piecewise Cox analysis, the adverse prognostic impact of +1q was most evident beyond 24 months from diagnosis (HR 2.89, 95% CI 1.64–5.09, p < 0.001), whereas non‐1q HR lesions were not independently prognostic. These findings suggest that +1q identifies a biologically distinct AL amyloidosis subset characterized by plasma cell–dominant features and inferior long‐term disease control. In contrast, other MM‐defined HR cytogenetic abnormalities appear to have limited prognostic relevance in AL amyloidosis.

Diagnostic correlates and clonal progression patterns among 91 patients with low (< 1% VAF) or very low (< 0.1% VAF) JAK2 V617F allele burden encountered in routine clinical practice.

Summary: Allogeneic haematopoietic cell transplantation (HCT) offers a curative option for numerous haematological disorders; however, its myeloablative conditioning (MAC) regimens are associated with substantial toxicity. Reduced intensity conditioning (RIC) regimens were developed to mitigate transplant‐related toxicity and broaden eligibility—particularly for older or medically unfit patients—though their use in younger, fit patients remains debated. In this retrospective study, we compared outcomes between MAC and RIC in patients aged younger than 65 years undergoing allogeneic HCT with a unified graft‐versus‐host disease (GVHD) prophylaxis regimen comprising anti‐thymocyte globulin (ATG), post‐transplant cyclophosphamide (PTCy) and ciclosporin (CsA). Propensity score matching was applied to reduce confounding. At 2 years post‐transplant, there were no statistically significant differences in overall survival (OS) between the groups (MAC: 68.6% vs. RIC: 65.9%; p = 0.61) or in non‐relapse mortality (NRM) (MAC: 15.8% vs. RIC: 12.5%; p = 0.26). However, relapse incidence was significantly higher in the RIC group (27.0%) than in the MAC group (16.1%; p = 0.01). These findings reinforce the continued relevance of MAC in younger patients who are candidates for intensive therapy, as it appears to offer superior disease control without a concomitant increase in NRM. Prospective studies are warranted to further delineate the role of conditioning intensity in the context of contemporary GVHD prophylaxis.

Introduction: Myeloablative conditioning (MAC) for acute myeloid leukemia (AML) improves disease control by reducing relapse risk but is associated with higher non‐relapse mortality (NRM). Reduced‐intensity conditioning (RIC) aims to minimize toxicity but raises concerns about higher relapse rates. This study evaluates the impact of RIC versus MAC in AML patients under 65 years receiving GVHD prophylaxis with antithymocyte globulin, post‐transplant cyclophosphamide, and cyclosporine.Methods: We retrospectively analyzed 322 AML patients undergoing allogeneic HCT with uniform GVHD prophylaxis. Propensity score matching (PSM) was applied to adjust for baseline differences.Results: In the matched cohort, 2‐year overall survival (OS) did not differ significantly between RIC and MAC recipients (64.4% vs. 66.9%, p = 0.56). Relapse‐free survival (RFS) at 2 years was 65.0% for MAC and 52.7% for RIC (p = 0.20). Two‐year NRM was 19.4% for MAC and 19.1% for RIC (p = 0.84). Improved RFS was associated with non‐high‐risk DRI (HR: 0.39, p = 0.008), whereas conditioning intensity had no significant effect (HR: 0.98, p = 0.97). NRM was higher among patients with KPS < 90 (HR: 3.63, p = 0.01), with no significant impact observed from conditioning intensity (HR: 1.44, p = 0.43).Conclusion: In a relatively younger cohort, conditioning intensity did not significantly impact survival, and MAC was not associated with increased NRM.

Background.: Despite decades of post–allogeneic hematopoietic cell transplantation (HCT) growth factor utilization, its role remains undefined, leading to ongoing debates and research. The theoretical impacts of growth factors have been challenged in numerous studies. Methods.: In this retrospective cohort study conducted at the Princess Margaret Cancer Centre, we analyzed the clinical outcomes of 509 patients who underwent allogeneic HCT between May 1, 2019, and May 31, 2022. This study aimed to assess the impact of granulocyte colony-stimulating factor (G-CSF) administration posttransplantation on neutrophil and platelet engraftment, incidence of bloodstream infections (BSIs), graft-versus-host disease, engraftment syndrome (ES), and survival metrics including overall survival, nonrelapse mortality, and graft-versus-host disease–free/relapse-free survival. Results.: Our findings indicate that G-CSF administration expedited neutrophil engraftment (16 versus 18 d, P = 0.009) and was associated with a decreased incidence of BSI (9.4% versus 31.3%, P = 0.014). However, this benefit was counterbalanced by a significant delay in platelet engraftment (21 versus 17 d, P < 0.001). Multivariate logistic regression analysis identified mismatched donors (odds ratio, 1.72; 95% confidence interval, 1.03-2.88; P = 0.038) and the duration of G-CSF therapy (odds ratio, 1.04; 95% confidence interval, 1.00-1.09; P = 0.038) as independent predictors for the development of ES. Despite these hematological impacts, there was no observed advantage in overall survival, nonrelapse mortality, or graft-versus-host disease–free/relapse-free survival among patients who received G-CSF compared with those who did not. Conclusions.: Although G-CSF post-HCT expedited neutrophil engraftment and reduced BSI risk, it did not result in a survival advantage. The association with ES necessitates careful consideration.

Chemotherapy-induced cytopenia (CIC) is characterized by neutropenia, anemia, and thrombocytopenia, which are common and serious complications in cancer treatment. These conditions affect approximately 60% of patients undergoing chemotherapy and can significantly impact quality of life, treatment continuity, and overall survival. The use of growth factors, including granulocyte colony-stimulating factors (GCSFs), erythropoietin-stimulating agents (ESAs), and thrombopoietin receptor agonists (TPO-RAs), has emerged as a promising strategy for managing CIC. However, the use of these growth factors must be approached with caution. This review provides an overview of the mechanisms, efficacy, and safety of growth factors in the management of CIC. Additionally, we discuss predictive markers for treatment response, potential risks, and highlight areas for future research.

Purpose of review: This review aims to detail the characteristics and outcomes of duodenal-type follicular lymphoma (DTFL), a rare lymphoma variant. It focuses on integrating recent reports in treatment modalities and highlights emerging insights into the unique biological features of the disease. Recent finding: Recent studies confirm the indolent nature of DTFL, with extended follow-up periods showing favorable outcomes under watchful waiting strategies and a notable proportion of patients experiencing spontaneous remission. Additionally, advancements in understanding the disease's biology revealed that the tumor microenvironment is marked by specific genomic expressions indicative of chronic inflammation. Summary: The observations of spontaneous resolution and the generally favorable progression of DTFL call for a conservative approach in initiating treatment. Clinical management should judiciously consider the disease's typically benign course against the potential risks of intervention, promoting customized treatment protocols tailored for cases with clinical necessity. Additionally, the discovery of an inflammatory tumor microenvironment and molecular evidence suggesting an antigen-driven process highlight critical areas for future research.

Pediatric-type follicular lymphoma is an uncommon and newly recognized entity of lymphoid neoplasm commonly encountered in the young population. Despite its indolent clinical course and localized n...