The Lancet最新文献

{"title":"Redefining consolidation in primary CNS lymphoma: autologous stem-cell transplantation as the standard.","authors":"Lauren R Schaff,Michael Scordo,Christian Grommes","doi":"10.1016/s0140-6736(26)00973-6","DOIUrl":"https://doi.org/10.1016/s0140-6736(26)00973-6","url":null,"abstract":"","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"351 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-dose chemotherapy followed by autologous stem-cell transplantation versus non-myeloablative consolidation in primary CNS lymphoma (MATRix/IELSG43): a randomised phase 3 trial.","authors":"Gerald Illerhaus,Andrés J M Ferreri,Julia Wendler,Mascha Binder,Peter Borchmann,Justin Hasenkamp,Stephan Stilgenbauer,Alexander Röth,Gerlinde Egerer,Thomas Ernst,Thomas Weber,Bernd Hertenstein,Georg Lenz,Martin Dreyling,Robert Möhle,Guido Kobbe,Christian A Schmidt,Uta Brunnberg,Jens Panse,Michael Kneba,Thomas Heinicke,Sebastian Schroll,Thomas S Larsen,Lorenz Thurner,Tobias Pukrop,Hans Salwender,Ralph Naumann,Georg Hess,Frank P Kroschinsky,Anne K Blystad,Ulrich Keller,Elisa J Pulczynski,Martin Bjerregård Pedersen,Francesca Re,Lorella Orsucci,Lisa Pospiech,Paul La Rosée,Martina Deckert,Maurilio Ponzoni,Dennis Gmehlin,Matthias Backenstrass,Antje Jensch,Elke Valk,Teresa Calimeri,Benjamin Kasenda,Martin Trepel,Heidi Fricker,Inna Semenova,Florian Scherer,Philipp von Gottberg,Elvira Burger,Olga Grishina,Claudia Hader,Gabriele Ihorst,Jürgen Finke,Emanuele Zucca,Elisabeth Schorb","doi":"10.1016/s0140-6736(26)00917-7","DOIUrl":"https://doi.org/10.1016/s0140-6736(26)00917-7","url":null,"abstract":"BACKGROUNDConsolidation therapy for primary CNS lymphoma (PCNSL) includes high-dose chemotherapy with autologous stem-cell transplantation (HCT-ASCT), yet its efficacy compared with non-myeloablative chemoimmunotherapy remains uncertain. This study aimed to provide randomised comparative evidence on the efficacy and safety of thiotepa-based HCT-ASCT versus non-myeloablative R-DeVIC consolidation after uniform MATRix induction in newly diagnosed PCNSL.METHODSThis open-label, randomised, phase 3 trial was conducted across 56 university and academic non-university hospitals with established transplantation facilities in five European countries. Eligible for inclusion were untreated, immunocompetent patients with B-cell PCNSL, aged 18-65 years regardless of Eastern Cooperative Oncology Group (ECOG) performance status, or 66-70 years with ECOG performance status 0-2. Pretreatment corticosteroids were permitted. Exclusion criteria included lymphoma manifestation outside the CNS, and congenital or acquired immunodeficiency. Patients received four cycles of MATRix induction (comprising rituximab, high-dose cytarabine, and thiotepa, in addition to high-dose methotrexate). Patients reaching at least partial response were randomly assigned (1:1) to two cycles of R-DeVIC (rituximab plus dexamethasone, etoposide, ifosfamide, and carboplatin) or HCT-ASCT with carmustine and thiotepa. The primary endpoint was progression-free survival, assessed in the full analysis set (excluding patients with major violations of entry criteria). The safety analysis set contained all randomised patients who initiated therapy. This study is registered with ClinicalTrials.gov (NCT02531841) and the EU Clinical Trials Register (EudraCT number 2012-000620-17). The study is completed.FINDINGSBetween July 16, 2014, and Aug 31, 2019, 368 patients were enrolled. 346 (94%) patients started induction treatment, and 230 were randomly assigned; 229 patients were analysed (R-DeVIC group, n=115; HCT-ASCT group, n=114). After a median follow-up of 45·3 months, 3-year progression-free survival was significantly superior in the HCT-ASCT group (hazard ratio 0·43 [95% CI 0·27-0·68]; p=0·0003). The 3-year progression-free survival was 78% (95% CI 69-85) in the HCT-ASCT group compared with 51% (41-60) in the R-DeVIC group. The mean number of adverse events per patient was 9·3 (SD 4·4) in the R-DeVIC group and 14·6 (5·8) in the HCT-ASCT group. Fatal serious adverse events following consolidation treatment occurred in two patients in the R-DeVIC group (both acute myeloid leukaemia) and in five patients in the HCT-ASCT group (infections and infestations [n=4], pulmonary embolism [n=1]); all of these events apart from the pulmonary embolism were judged to be possibly related to treatment.INTERPRETATIONIn the largest randomised trial in untreated PCNSL to date, HCT-ASCT significantly improved progression-free and overall survival compared with non-myeloablative consolidation in patients who had completed","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy as exclusion criterion in Ebola research: not again.","authors":"Lisa Schwartz,Eman Ahmed,Ana Palmero,Calvin Wai Loon Ho,Raffaella Ravinetto","doi":"10.1016/s0140-6736(26)01367-x","DOIUrl":"https://doi.org/10.1016/s0140-6736(26)01367-x","url":null,"abstract":"","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empirical treatment with valganciclovir in infants living with HIV and hospitalised with severe pneumonia in Africa: a multicentre, open-label, factorial, randomised, controlled, superiority trial.","authors":"Cinta Moraleda,Alfredo Tagarro,Sara Domínguez-Rodríguez,Victor Musiime,Hilda Mujuru,Chishala Chabala,Tisungane Mvalo,Pui-Ying Iroh-Tam,Justina Bramugy,Lola Madrid,Jahit Sacarlal,Alfeu Passanduca,Muhammad Sidat,Uneisse Cassia,Hellen Tukamuhebwa Aanyu,Abner Tagoola,Constantine Mutata,Bwendo Nduna,Chimwemwe Chawinga,Lughano Ghambi,Matthew Bates,Sheila Fernández-Luis,Amir Seni,Merunissa Gafur,Damalie Nalwanga,Denis Nansera,Mutsa Bwakura-Dangarembizi,Natasha Namuziya,Franklyn Nkongho Egbe,John Tembo,Álvaro Ballesteros,Raoul Moh,Lilit Manukyan,David Lora,Olivier Marcy,Tom G Jacobs,David Burger,Quique Bassat,Valeriane Leroy,Alessandra Nardone,W Chris Buck,Pablo Rojo, ","doi":"10.1016/s0140-6736(26)00754-3","DOIUrl":"https://doi.org/10.1016/s0140-6736(26)00754-3","url":null,"abstract":"BACKGROUNDMortality among infants with severe HIV-associated pneumonia remains high. This trial (EMPIRICAL) tested whether empirical valganciclovir treatment for cytomegalovirus improves survival in infants in Africa.METHODSThis multicentre, open-label, group-sequential designed, 2 × 2 factorial, randomised, controlled, superiority trial was conducted in 19 hospitals across Côte d'Ivoire, Malawi, Mozambique, Uganda, Zambia, and Zimbabwe. Infants aged 28-365 days admitted with severe HIV-associated pneumonia were centrally and individually randomly assigned (1:1:1:1) using a secure web-based system stratified by site and severity to receive standard of care (SOC) comprising treatment for bacterial (WHO-recommended antibiotics) and Pneumocystis jirovecii (cotrimoxazole and steroids) pneumonia, SOC plus 15 days of oral valganciclovir (16 mg/kg per 12 h), or SOC plus 6 months of tuberculosis treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol for 2 months, plus isoniazid and rifampicin for 4 subsequent months), or both interventions combined. The primary endpoint was all-cause mortality, assessed at day 15 and over 1-year follow-up in the intention-to-treat population. In this Article, we report results for the valganciclovir comparison groups. The trial is registered with ClinicalTrials.gov, NCT03915366 and is complete.FINDINGSFrom March 15, 2020, to Jan 31, 2024, 563 participants were enrolled; 558 were included in the analyses, with 276 allocated to valganciclovir groups (140 valganciclovir; 136 valganciclovir plus tuberculosis treatment) and 282 to groups without valganciclovir (142 SOC; 140 tuberculosis treatment). The median patient age was 4·4 months (IQR 3·2-7·4), and 274 (49%) were female. There was no evidence of interaction between valganciclovir and tuberculosis treatment (adjusted hazard ratio 1·19 [95% CI 0·73-1·95], heterogeneity p=0·48). At day 15, 64 (23%) of 276 participants in the valganciclovir group and 76 (27%) of 282 in groups without valganciclovir died (rate ratio 0·81 [95% CI 0·61-1·08], p=0·15). 24 (9%) of 276 participants and 13 (5%) of 282, respectively, were lost to follow-up. After 12 months, 119 (43%) of 276 participants in the valganciclovir groups and 134 (48%) of 282 in the groups without valganciclovir died (0·88 [95% CI 0·74-1·05] p=0·15). In a time-varying effects model, at day 15, the adjusted hazard ratio of death was 0·60 (95% CI 0·41-0·87, p=0·0063), and their hazard of death over 1 year was 0·79 (0·62-1·01; p=0·068), or 0·76 (0·58-1·00; p=0·0500) when excluding deaths within 48 h of treatment. Severe adverse events during follow-up were not more common in the valganciclovir treatment groups (odds ratio 0·64 [95% CI 0·35-1·16]).INTERPRETATIONEmpirical valganciclovir treatment appeared to be associated with a lower hazard of death in infants with severe HIV-associated pneumonia than SOC alone or SOC plus empirical tuberculosis treatment, and there was little evidence of associated harms.FUNDINGEurop","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148462670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiology-guided coronary artery bypass grafting in valve surgery – Authors' reply","authors":"Yunpeng Zhu, Mario Gaudino, Qiang Zhao","doi":"10.1016/s0140-6736(26)01132-3","DOIUrl":"https://doi.org/10.1016/s0140-6736(26)01132-3","url":null,"abstract":"","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"33 9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148460193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Child health and wellbeing in Ukraine","authors":"Rebecca Sers","doi":"10.1016/s0140-6736(26)01421-2","DOIUrl":"https://doi.org/10.1016/s0140-6736(26)01421-2","url":null,"abstract":"","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"231 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148461746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From targets to minutes: making movement advice actionable – Authors' reply","authors":"Ulf Ekelund, Jakob Tarp, Ding Ding, Knut Eirik Dalene, Morten W Fagerland","doi":"10.1016/s0140-6736(26)01130-x","DOIUrl":"https://doi.org/10.1016/s0140-6736(26)01130-x","url":null,"abstract":"","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148460196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The art of fidelity: clinical documentation and ambient AI","authors":"Victoria Ekstrom, John Launer","doi":"10.1016/s0140-6736(26)01388-7","DOIUrl":"https://doi.org/10.1016/s0140-6736(26)01388-7","url":null,"abstract":"","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148460227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anette Ziegler: breaking through boundaries in type 1 diabetes","authors":"Tony Kirby","doi":"10.1016/s0140-6736(26)01387-5","DOIUrl":"https://doi.org/10.1016/s0140-6736(26)01387-5","url":null,"abstract":"","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148461745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Bundibugyo virus treatment trial begins","authors":"Talha Burki","doi":"10.1016/s0140-6736(26)01420-0","DOIUrl":"https://doi.org/10.1016/s0140-6736(26)01420-0","url":null,"abstract":"","PeriodicalId":22898,"journal":{"name":"The Lancet","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148460192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}