The "News Express" column serves as a bridge between cutting-edge research and clinical practice, enabling hematology enthusiasts and professionals to swiftly capture industry trends, ignite innovative thinking, and broaden their professional perspectives. Hematology Frontier carefully selects the latest hematological research findings from top global journals. Each article is a brilliant spark of science and clinical practice, delivering the latest advancements in hematology directly to you. Let knowledge know no boundaries, and let exploration never cease. We invite you to follow the column and join global hematology experts on a journey of scientific discovery! This special issue compiles notable leukemia research from the past six months in Blood Reviews. We invite you to explore these highlights.- Advances in the Treatment of Philadelphia Chromosome Negative Acute Lymphoblastic Leukemia https://doi.org/10.1016/j.blre.2024.101208
Summary: Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph- ALL) is a genetically diverse disease, with various genetic or molecular abnormalities significantly impacting disease progression and prognosis. Historically, adult patients with Ph- ALL, especially older adults, have faced lower long-term survival rates, underscoring the need for improved treatment strategies.
Over the past decade, there have been notable advances in Ph- ALL treatment, including a deeper understanding of the disease’s molecular mechanisms, the introduction of new drugs, optimization of chemotherapy regimens, improvements in MRD monitoring, allogeneic hematopoietic stem cell transplantation, and supportive care. Younger patients tend to follow pediatric-like treatment protocols, while older patients often receive more gentle chemotherapy. The use of new drugs in relapse or frontline settings may reduce reliance on chemotherapy. MRD monitoring provides crucial information for treatment decisions, enhancing outcomes. However, relapse remains a challenge, necessitating further research to explore new therapeutic directions. This study reviews the current state of Ph- ALL treatment across different age groups, highlighting treatment progress and potential future research paths.
- Prevention and Management of Infectious Complications in Patients with Chronic Lymphocytic Leukemia (CLL) Treated with BTK and BCL-2 Inhibitors: Focus on Current Guidelines https://doi.org/10.1016/j.blre.2024.101180
Summary: For patients with hematologic malignancies, particularly those with chronic lymphocytic leukemia (CLL), understanding and preventing infectious complications is crucial. While the use of new drugs such as Bruton’s tyrosine kinase inhibitors (BTKi) or B-cell lymphoma-2 inhibitors (BCL-2i) in CLL treatment does not significantly increase infection risk, treatment strategies and preventive measures must be tailored based on the type and severity of infections.
This study reviews international guidelines, emphasizing that not all patients require prophylactic anti-infective therapy. For patients carrying the hepatitis B virus (HBV), preventing viral reactivation is critical. For HBsAg-negative but HBcAb-positive patients, preventive measures should be adjusted based on specific drugs, with immunization recommended before treatment. For patients with hypogammaglobulinemia or recurrent infections, immunoglobulin therapy can help reduce infection incidence, although its impact on mortality is limited.
- Down Syndrome and Leukemia: An Insight into the Disease Biology and Current Treatment Options https://doi.org/10.1016/j.blre.2023.101154
Summary: Children with Down syndrome (DS) have a 10 to 20 times higher risk of developing acute leukemia compared to the general population, particularly myeloid leukemia (ML-DS). Although ML-DS generally has a good prognosis, relapse leads to a poor outlook. ML-DS often follows transient abnormal myelopoiesis (TAM) in infancy, which typically resolves spontaneously, but about 10% to 25% of DS patients eventually develop ML-DS. Compared to non-DS patients, ML-DS patients are more likely to have low white blood cell and platelet counts and to develop megakaryocytic/erythroid leukemia.
Acute lymphoblastic leukemia in DS (DS-ALL) generally has a poorer prognosis, with a high relapse rate, and is mostly of the B-cell precursor type, with T-cell types being rare. DS-ALL lacks a pre-leukemia phase, usually occurs at an older age, and exhibits cytogenetic and genomic heterogeneity.
Research has deepened the understanding of the mutational landscape in DS leukemia, revealing mechanisms of disease initiation and progression. This review discusses treatment strategies for DS leukemia, challenges related to chemotherapy toxicity, disease mechanisms, and new molecular targets showing promise in preclinical trials that could translate into future clinical treatments.
- Practical Considerations in Clinical Application of WHO 5th and ICC Classification Schemes for Acute Myeloid Leukemia https://doi.org/10.1016/j.blre.2023.101156
Summary: Acute myeloid leukemia (AML) is a heterogeneous disease characterized by the abnormal growth and differentiation of myeloid blood cells. Initially classified based on morphology and immunophenotyping using the FAB classification, this system provided clinical guidance but, with the advancement of cytogenetics and molecular genetics, these abnormalities became more critical for predicting AML prognosis and treatment response.
The 5th edition WHO and ICC classification systems for AML integrate these genetic insights, offering more precise diagnoses and disease definitions. However, there are differences in some definitions and classifications between these systems, posing challenges for clinicians in diagnosing and treating AML.
This article reviews updates in these classification systems, compares their differences, and provides recommendations for applying these classifications in AML patient management.
- Revolutionizing Chronic Lymphocytic Leukemia Diagnosis: A Deep Dive into the Diverse Applications of Machine Learning https://doi.org/10.1016/j.blre.2023.101134
Summary: Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are mature B-cell tumors characterized by the accumulation of abnormal B lymphocytes, with CLL primarily affecting the blood and SLL affecting the lymph nodes. CLL is the most common leukemia in Western countries, accounting for 25% of all leukemias. Patients may be asymptomatic, or present with painless lymphadenopathy, lymphoma symptoms, or immune complications.
CLL is a heterogeneous disease with a wide range of prognoses. Clinically, the Rai and Binet staging systems are used for risk stratification and treatment guidance. Not all CLL patients require immediate treatment; asymptomatic early-stage patients can be managed with an active surveillance strategy. Indications for treatment include bone marrow failure, progressive splenomegaly, systemic symptoms, autoimmune complications, and significant or rapidly doubling lymphocyte counts.
Currently, frontline treatment for CLL includes inhibitors targeting enzymes in the B-cell receptor signaling pathway (such as BTK inhibitors) and proteins regulating apoptosis (such as BCL2 inhibitors). Additionally, machine learning and artificial intelligence are increasingly applied in hematology, improving the diagnosis, classification, and treatment of CLL. This review discusses the advancements, benefits, and limitations of machine learning in CLL applications.
Journal Overview
Blood Reviews is a highly regarded international journal, serving as a vital resource in the field of hematology. It compiles reviews and research from recognized experts, ensuring comprehensive global coverage across all branches of hematology. The peer-reviewed articles in Blood Reviews cover every aspect of clinical and laboratory hematology practice and research, making it an essential read for those in the field.
