Transplantation and Cellular Therapy最新文献

{"title":"Impact of Renal Impairment and Lymphodepletion Regimen on Outcomes after CAR T Cell Therapy in Relapsed/Refractory Multiple Myeloma","authors":"Nora Grieb, Thomas Wiemers, Patrick Born, David Fandrei, Luise Fischer, Maximilian Ferle, Stefan Franke, Johannes Keller, Song Yau Wang, Madlen Jentzsch, Carmen Herling, Klaus H. Metzeler, Marco Herling, Simone Heyn, Thomas Neumuth, Uwe Platzbecker, Vladan Vučinić, Georg-Nikolaus Franke, Maximilian Merz","doi":"10.1016/j.jtct.2026.05.022","DOIUrl":"10.1016/j.jtct.2026.05.022","url":null,"abstract":"<div><h3>Background</h3><div>Chimeric antigen receptor (CAR) T cell therapy revolutionized treatment for relapsed/refractory multiple myeloma (RRMM). The standard lymphodepletion (LDP) regimen is fludarabine and cyclophosphamide (Flu/Cy), but bendamustine has shown comparable efficacy with lower toxicity and is a potentially safer option for patients with renal impairment.</div></div><div><h3>Objectives</h3><div>This study retrospectively analyzes clinical outcomes and CAR T-cell dynamics in patients with RRMM receiving idecabtagene vicleucel (Ide-Cel) or ciltacabtagene autoleucel (Cilta-cel), with a particular focus on the impact of renal function and LDP regimen.</div></div><div><h3>Study Design</h3><div>We included a total of 87 patients who received CAR T-cell therapy: 54 with none/mild chronic kidney disease (CKD) and 33 with moderate/severe CKD. LDP consisted of standard-dose Flu/Cy in 67 patients, reduced-dose Flu/Cy in 11 patients, and bendamustine in 9 patients. Toxicity outcomes were monitored over more than 2000 patient-days, capturing over 20,000 individual data points.</div></div><div><h3>Results</h3><div>Patients with moderate/severe CKD received standard Flu/Cy conditioning less frequently (45.5% versus 96.3%, <em>P</em> < .001) and bendamustine-based LDP more often (27.3% vs. 0%, <em>P</em> < .001). In the survival analysis, we found that CKD status alone did not significantly impact outcomes (OS: <em>P</em> = .95; PFS: <em>P</em> = .76). Similarly, when stratified by CAR T-cell product, CKD status did not impact PFS in Ide-Cel recipients (<em>P</em> = .46). In contrast, among Cilta-Cel–treated patients, those with none/mild CKD demonstrated significantly improved PFS (<em>P</em> = .026). LDP regimen had no effect on PFS (<em>P</em> = .21). In Firth’s penalized Cox model, neither CKD nor LDP independently predicted PFS; however, a significant interaction between CKD status and CAR T product was observed (HR 8.82, 95% CI 1.33-100.45, <em>P</em> = .023). Subgroup analyses confirmed that Cilta-Cel conferred superior PFS compared with Ide-Cel in patients with none/mild CKD (<em>P</em> < .001), whereas no benefit was seen in those with moderate/severe CKD. The median absolute lymphocyte count (ALC) nadir was observed on day -1 in patients receiving Flu/Cy (0.033 × 10⁹/L) and on day +1 in those receiving bendamustine (0.059 × 10⁹/L). At the time of CAR T-cell infusion, median ALC was significantly higher in the bendamustine group compared to the complete dosage Flu/Cy cohort (<em>P</em> = .03). Overall CAR T-cell expansion kinetics did not differ according to CKD status or LDP regimen. Notably, at day 7, Cilta-Cel patients had significantly higher CD4 CAR T cell percentages (of total CD3 CAR T cells) compared to Ide-Cel in the none/mild CKD group (<em>P</em> < .001), a difference that persisted through days 14 (<em>P</em> < .001) and 30 (<em>P</em> < .001). Analysis of hematologic toxicities showed that bendamustine-ba","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1319-1334"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controversies Remain About the Optimal GVHD Prophylaxis: Commentary on Rodriguez-Rodriguez","authors":"Daniel J. Weisdorf, Margaret L. MacMillan","doi":"10.1016/j.jtct.2026.09.025","DOIUrl":"10.1016/j.jtct.2026.09.025","url":null,"abstract":"","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Page 1187"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Day +90 Donor Chimerism as a Prognostic Marker of Clinical Outcomes Among Allogeneic Hematopoietic Cell Transplant Recipients Who Received Myeloablative Conditioning","authors":"Sara Jubas, Kieran Collins, Kendall Obara, Hsuan-Hui (Grace) Liu, Ryan M. Kemper, Alexandra L.W. Kelley, Arushi Goel, Tyler C. Dunlap, Jing Zhu, Riley M. Randolph, Jonathan R. Ptachcinski, Morgan E. Bizzell, Paul M. Armistead, Ryan Shaw, Anson E. Snow, Daniel J. Crona","doi":"10.1016/j.jtct.2026.06.024","DOIUrl":"10.1016/j.jtct.2026.06.024","url":null,"abstract":"<div><h3>Background</h3><div>Allogeneic hematopoietic cell transplantation (allo-HCT) is potentially curative for hematologic malignancies. However, relationships between donor chimerism and clinical outcomes remain poorly characterized.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate associations between D+90 unfractionated and CD3+ donor chimerism and clinical outcomes, as well as associations between D+90 donor chimerism and myeloablative conditioning (MAC) regimens.</div></div><div><h3>Study Design</h3><div>This single-center, retrospective cohort study included allo-HCT recipients from 5/4/2011-2/18/2025. Subjects received MAC regimens prior to allo-HCT for hematologic malignancy diagnoses. Full donor chimerism was defined as >95% donor cells by D+90. The primary endpoint was 5-year overall survival (OS) among subjects who achieved D+90 full versus mixed unfractionated donor chimerism. Secondary endpoints included 5-year relapse-related mortality (RRM), non-relapse related mortality (NRM), and cumulative incidence of relapse (CIR) for both unfractionated and CD3+ chimerism, and 5-year OS for CD3+ chimerism. Additional secondary outcomes included differences in clinical outcomes based on D+90 donor chimerism among subjects diagnosed with a myeloid malignancy, differences in achieving full D+90 donor chimerism among subjects who received busulfan-containing conditioning versus cyclophosphamide plus total body irradiation with or without fludarabine (Cy/TBI or Flu/Cy/TBI), and differences in achieving full D+90 donor chimerism based on first-dose area under the curve (AUC<sub>0-inf</sub>) among subjects who received PK-guided busulfan dosing.</div></div><div><h3>Results</h3><div>A total of 256 subjects were included in the final analyses (n = 213 full; n = 43 mixed). Full unfractionated D+90 donor chimerism was associated with improved 5-year OS, CIR, RRM, and NRM (adj. HR 0.36, 95% CI 0.23 to 0.57, <em>P <</em> .0001; HR 0.45, 95% CI 0.21 to 0.99, <em>P</em> = .04; adj. HR 0.29, 95% CI 0.16 to 0.52, adj. <em>P</em> < .0001; adj. HR 0.48, 95% CI 0.24 to 0.94, adj. <em>P</em> = .03, respectively). Differences in OS, RRM, CIR, and NRM were not observed between CD3+ study groups (all <em>P</em> > .05). Subjects from the myeloid malignancy subgroup who achieved full unfractionated donor chimerism had significantly improved 5-year OS (HR 0.32, 95% CI 0.16 to 0.63, <em>P</em> < .0001), lower 5-year CIR (HR 0.50, 95% CI 0.21 to 0.98, <em>P</em> = .04), RRM (HR 0.27, 95% CI 0.11 to 0.67, <em>P</em> < .0001), and NRM (HR 0.39, 95% CI 0.18 to 0.85, <em>P</em> = .01) compared to those with mixed donor chimerism. Allo-HCT recipients who received Cy/TBI or Flu/Cy/TBI had an 18% reduced risk of mixed unfractionated donor chimerism by D+90 compared to those who received a busulfan-containing regimen (RR 0.82, 95% CI 0.73 to 0.98, <em>P</em> = .03). First-dose busulfan AUC<sub>0-inf</sub> did not predict wheth","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1299.e1-1299.e15"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dose, Interval, and Context: Interpreting SOS/VOD Risk after Inotuzumab Before Second Allogeneic Transplantation","authors":"Curtis Marcoux, Partow Kebriaei","doi":"10.1016/j.jtct.2026.06.018","DOIUrl":"10.1016/j.jtct.2026.06.018","url":null,"abstract":"","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1358.e1-1358.e2"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prior Malignancy History and Risk of Second Malignancies After Allogeneic Hematopoietic Cell Transplantation","authors":"Nihar Desai, Eshrak Al-Shaibani, Tommy Alfaro-Moya, Arjun D. Law, Wilson Lam, Ivan Pasic, Igor Novitzky-Basso, Auro Viswabandya, Dennis D. Kim, Rajat Kumar, Jeffrey H. Lipton, Jonas Mattsson, Fotios V. Michelis","doi":"10.1016/j.jtct.2026.05.018","DOIUrl":"10.1016/j.jtct.2026.05.018","url":null,"abstract":"","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1239.e1-1239.e3"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Milestones in the Evolution of Allogeneic Stem Cell Transplantation. Part 2","authors":"Jeffrey H. Lipton","doi":"10.1016/j.jtct.2026.09.023","DOIUrl":"10.1016/j.jtct.2026.09.023","url":null,"abstract":"","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1179-1183"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjusting Disease Risk Index for Regional Variations and Donor Selection","authors":"Makoto Iwasaki,&nbsp;Yachiyo Kuwatsuka,&nbsp;Hiromi Hayashi,&nbsp;Shinichi Kobayashi,&nbsp;Marie Ohbiki,&nbsp;Naoyuki Uchida,&nbsp;Noriko Doki,&nbsp;Takahiro Fukuda,&nbsp;Masatsugu Tanaka,&nbsp;Tetsuya Nishida,&nbsp;Yuta Hasegawa,&nbsp;Toshiro Kawakita,&nbsp;Yuta Katayama,&nbsp;Tetsuya Eto,&nbsp;Yoshinobu Kanda,&nbsp;Fumihiko Ishimaru,&nbsp;Tatsuo Ichinohe,&nbsp;Yoshiko Atsuta,&nbsp;Junya Kanda","doi":"10.1016/j.jtct.2026.06.005","DOIUrl":"10.1016/j.jtct.2026.06.005","url":null,"abstract":"<div><div>The Disease Risk Index (DRI) is a widely used prognostic tool following hematopoietic stem cell transplantation (HSCT), based on disease classification and status. However, the refined DRI (rDRI) does not fully account for regional variations in disease distribution and treatment practices. To refine the rDRI by accounting for underrepresented disease entities in the rDRI and by considering regional differences in HSCT treatment strategies, and to identify the most suitable donor selection strategy based on the newly developed disease risk criteria. We analyzed 7720 patients with hematologic malignancies who underwent their first allogeneic HSCT between 2014 and 2016 and developed a region-adjusted DRI (raDRI) using the Japanese registry database. We then validated predictive performance in 5108 patients transplanted between 2017 and 2018. The raDRI demonstrated superior accuracy compared with the rDRI (time-dependent AUC: .705 versus .670; integrated calibration index: .016 versus .017). In patients with low to intermediate raDRI, matched related donors (MRD) were associated with improved overall survival compared with matched unrelated bone marrow donors (bone marrow (BM): hazard ratio (HR) .50, 95% CI: .26 to .96; peripheral blood (PB): HR .54, 95% CI: .36 to .83), whereas no differences were seen in patients with high to very high raDRI (MRD-BM: HR: 1.03, 95% CI: .69 to 1.54, MRD-PB: 1.15, 95% CI: .89 to 1.49). Our findings underscore that prognostic indices such as the DRI are inherently shaped by the populations and clinical practices from which they are derived. Regional differences in disease prevalence, treatment strategies, and donor-source utilization can substantially influence risk stratification and transplant outcomes.</div></div>","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1293.e1-1293.e12"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung Complications After Allogeneic Hematopoietic Cell Transplant and Outcomes: Implications Beyond Bronchiolitis Obliterans Syndrome","authors":"Yu Kuang Lai,&nbsp;Husham Sharifi,&nbsp;Sally Arai,&nbsp;Amelia Scheck,&nbsp;Theresa Brondstetter,&nbsp;David J. Epstein,&nbsp;Joe L. Hsu","doi":"10.1016/j.jtct.2026.06.010","DOIUrl":"10.1016/j.jtct.2026.06.010","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Lung chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic cell transplantation (HCT) comprises heterogeneous pulmonary phenotypes known as lung complications after transplantation (LCAT). While bronchiolitis obliterans syndrome (BOS) is well recognized and is associated with poor survival, restrictive phenotypes—including HCT-associated organizing pneumonia (HCT-OP) and truncal sclerosis (TS)-remain poorly defined. Prior studies often grouped restrictive phenotypes, potentially obscuring phenotype-specific risk profiles and introducing survival bias by not taking into account the variable timing of LCAT onset. Direct comparison between specific LCAT phenotypes and patients with cGVHD without lung involvement is limited, leaving uncertainty regarding the relative prognostic impact of individual LCAT phenotypes. Using dynamic time-dependent Cox regression, we hypothesized that LCAT phenotypes represent clinically and prognostically distinct entities. We conducted a longitudinal retrospective cohort study of adults with cGVHD. LCAT phenotypes were adjudicated as BOS, HCT-OP, or TS based on clinical, physiologic, and radiographic criteria. Patients with cGVHD without lung involvement served as the control group. Baseline for all survival analyses was defined as the date of cGVHD diagnosis. Multivariable Cox proportional hazards models were fit with LCAT phenotype as a time-varying exposure to account for variable onset timing and mitigate immortal-time bias; adjusted survival curves were derived using dynamic standardization. Non-relapse mortality (NRM) was analyzed using cause-specific Cox models with relapse occurring after cGVHD onset as a competing event. Of 895 patients who met inclusion criteria, LCAT was identified in 183 patients: BOS (n = 85), HCT-OP (n = 42), TS (n = 32), and mixed phenotypes (n = 24). Median time from cGVHD diagnosis to LCAT onset differed significantly: 3.3 months for HCT-OP, 9.4 months for BOS and 20.5 months for TS (&lt;em&gt;P&lt;/em&gt; &lt; .001). Pulmonary function tests showed distinct patterns, with severe airflow obstruction in BOS, predominant diffusion impairment in HCT-OP; and restriction in TS. In multivariable time-dependent Cox models, BOS was independently associated with inferior OS (hazard ratio [HR] 2.14; 95% confidence interval [CI] 1.51 to 3.02; &lt;em&gt;P&lt;/em&gt; &lt; .001) and elevated NRM (HR 3.04; 95% CI 2.08 to 4.43; &lt;em&gt;P&lt;/em&gt; &lt; .001) relative to controls. TS was independently associated with increased NRM (HR 2.33; 95% CI 1.12 to 4.86; &lt;em&gt;P&lt;/em&gt; = .024) but not OS (HR 1.53; 95% CI 0.78 to 3.05; &lt;em&gt;P&lt;/em&gt; = .217). HCT-OP was not significantly associated with increased OS or NRM risk relative to controls, a finding confirmed by sensitivity landmark analyses. In the LCAT burden model, mixed LCAT (≥2 phenotypes) conferred the greatest risk for both OS (HR 3.22; 95% CI 1.78 to 5.83; &lt;em&gt;P&lt;/em&gt; &lt; .001) and NRM (HR 4.95; 95% CI 2.55 to 9.62; &lt;em&gt;P&lt;/em&gt; &lt; .001) compared with contro","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1295.e1-1295.e16"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148206169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Bridging Response on Outcomes after CD19 CAR T-Cell Therapy in Large B-Cell Lymphoma","authors":"Beatriz Wills,&nbsp;Sarah Samorodnitsky,&nbsp;Samantha Brown,&nbsp;Jessica R. Flynn,&nbsp;Sean Devlin,&nbsp;Michael Scordo,&nbsp;Sandeep Raj,&nbsp;Karthik Nath,&nbsp;Gunjan L. Shah,&nbsp;Juliana Castro,&nbsp;Jennifer E. Liu,&nbsp;Heiko Schoder,&nbsp;Burcin Agridag Ucpinar,&nbsp;Akshay Bedmutha,&nbsp;Ofrat Beyar-Katz,&nbsp;Iris Halamish,&nbsp;Andrew Ip,&nbsp;Brandon Imber,&nbsp;Sergio Giralt,&nbsp;Miguel-Angel Perales,&nbsp;Maria Lia Palomba","doi":"10.1016/j.jtct.2026.06.017","DOIUrl":"10.1016/j.jtct.2026.06.017","url":null,"abstract":"<div><div>Bridging therapy (BT) is frequently administered during CD19 CAR T-cell manufacturing for relapsed or refractory large B-cell lymphoma (LBCL), and although disease status at infusion has been associated with outcomes, the prognostic relevance of response to BT, independent of BT modality, has been variably defined in real-world cohorts. To assess the impact of bridging response on clinical outcomes after CD19 CAR T-cell therapy in patients with LBCL, and to determine whether response to BT or BT regimen type are associated with progression-free survival (PFS), overall survival (OS), and treatment-related toxicities. We conducted a retrospective multicenter study of 377 adults with relapsed/refractory LBCL treated with commercial CD19 CAR T-cell products (axicabtagene ciloleucel, tisagenlecleucel, and lisocabtagene maraleucel) between 2020 and 2024. BT was administered in 248 patients (66%) during the manufacturing period and categorized by regimen type. Response to BT and CAR T therapy were assessed using Lugano criteria. The primary endpoints were PFS and OS after CAR T infusion. Secondary endpoints included rates of cytokine release syndrome (CRS), immune effector cell–associated neurotoxicity syndrome (ICANS), and hematologic toxicity. Multivariable Cox regression models adjusted for performance status, lactate dehydrogenase (LDH), CAR T product, and BT category were applied to evaluate associations. Among patients receiving BT, the overall response rate prior to CAR T infusion was 49%, including complete response (CR) in 12%. Patients achieving CR or partial response (PR) to BT had significantly longer PFS and OS compared with those with stable or progressive disease (SD/PD) (median PFS and OS not reached vs shorter durations; <em>P</em> &lt; .01). In multivariable analysis, response to BT remained an independent predictor of both PFS (hazard ratio [HR] for SD/PD versus CR: 2.59, 95% confidence interval [CI] 1.28 to 5.22) and OS (HR: 4.53, 95% CI 1.64 to 12.5), while BT modality itself was not independently associated with survival outcomes. Patients with favorable BT responses demonstrated lower pre-infusion tumor burden and reduced systemic inflammatory markers. Rates of CRS and ICANS did not differ significantly by BT response category. Severe hematologic toxicity was more frequent following intensive chemotherapy-based BT regimens but was not independently associated with long-term outcomes. In this large observational real-world multicenter cohort, response to BT, rather than the specific BT modality, was strongly associated with improved survival outcomes after CD19 CAR T-cell therapy in LBCL. These findings emphasize the prognostic significance of pre-infusion disease control and support treatment strategies focused on achieving effective BT responses while balancing regimen toxicity.</div></div>","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1270-1282"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148240347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluid Overload Syndrome is Associated With Increased Non-Relapse Mortality After Allogeneic Hematopoietic Stem Cell Transplantation: A Systematic Review and Narrative Synthesis","authors":"Bastian Wobbe,&nbsp;Matthias Bröer","doi":"10.1016/j.jtct.2026.05.025","DOIUrl":"10.1016/j.jtct.2026.05.025","url":null,"abstract":"<div><div>Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains associated with substantial non-relapse mortality (NRM) despite advances in supportive care. Fluid overload syndrome is a frequent but underrecognized complication during conditioning and the early post-transplant period. Although fluid overload is known to worsen outcomes in critical illness and heart failure, its prognostic impact in allo-HSCT has not been systematically evaluated. The aim of this analysis was to systematically assess the association between fluid overload syndrome and survival outcomes following allogeneic hematopoietic stem cell transplantation. We conducted a systematic review in accordance with PRISMA guidelines and registered the protocol in PROSPERO (CRD42025634151). PubMed, Cochrane Register, ClinicalTrials.gov, and additional sources were searched for studies reporting fluid overload syndrome and survival outcomes after allo-HSCT. Study quality was assessed using the Newcastle-Ottawa Scale. Due to heterogeneity in definitions of fluid overload syndrome and in outcome reporting, a narrative synthesis was performed. We performed exploratory quantitative aggregation using Fisher’s combined <em>P</em>-value method. Nine retrospective single-center studies comprising 2410 patients met inclusion criteria. Definitions and grading systems for fluid overload syndrome varied substantially, with reported incidences ranging from 4% to 37%. Eight of nine studies demonstrated significantly reduced overall survival (OS) in patients who developed fluid overload syndrome. Five of six studies reported significantly increased NRM, with the remaining study showing a non-significant adverse trend. Fisher’s method demonstrated highly significant aggregated effects for OS (χ² = 96.9, <em>P</em> &lt; .0001) and NRM (χ² = 66.43, <em>P</em> &lt; .0001). Fluid overload syndrome is consistently associated with inferior overall survival and increased non-relapse mortality after allo-HSCT. Despite heterogeneity in definitions, the direction of effect is remarkably uniform across studies. Given that fluid administration is a modifiable component of supportive care, these findings support the integration of fluid stewardship strategies into transplant management. Standardized definitions, prospective multicenter studies, and mechanistic investigations are urgently needed to refine risk stratification and improve outcomes in allo-HSCT recipients.</div></div>","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":"32 10","pages":"Pages 1317.e1-1317.e5"},"PeriodicalIF":4.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147975783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}