Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi最新文献

{"title":"[Phenotypic and functional changes in endogenous T cells during the bystander effect in different disease states of lymphomas treated with CD19-targeted chimeric antigen receptor T cells].","authors":"F Yan, D H Tang, W W Li, Y Gu, C X Ren, W Sang, K Zhao","doi":"10.3760/cma.j.cn121090-20260129-00066","DOIUrl":"10.3760/cma.j.cn121090-20260129-00066","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the bystander effect of endogenous T cells within the tumor microenvironment, as well as their roles and phenotypic changes during remission and relapse in mice with B-cell lymphoma receiving CD19-targeted chimeric antigen receptor T (CAR-T) cell therapy. <b>Methods:</b> At the Institute of Hematology, Xuzhou Medical University, in vitro experiments and mouse models were established using BALB/c mice to evaluate the efficacy of CD19 CAR-T cells in treating CD19(-) and CD19(+)A20 lymphomas. In the in vitro experiments, the mice were categorized into the following groups based on the type of co-cultured cells: activated T cell (<i>n</i>=3) and CD19-targeted CAR-T cell (<i>n</i>=3) groups. In the CD19(-) A20 lymphoma mouse model, the mice were assigned to the activated T-cell (<i>n</i>=5) and CD19 CAR-T cell treatment (<i>n</i>=5) groups based on the type of cells used for treatment. For the CD19(+) A20 lymphoma mouse model, the mice were divided into the activated T cell treatment (<i>n</i>=3-8), CD19 CAR-T cell treatment (<i>n</i>=14), remission (clinical score ≤ 1), and relapse (clinical score >1) groups. Therapeutic efficacy was evaluated, and flow cytometry was used to analyze the subsets, activation status, and cytokine secretion profiles of endogenous T cells at different disease states. <b>Results:</b> In vitro experiments demonstrated that, compared with the activated T-cell group, CD19 CAR-T cells exerted no specific cytotoxic effect on CD19(-) A20 cells [survival rates: (40.83±1.70) %<i>vs</i> (39.07±1.40) %, <i>P</i>=0.238]. However, in immunocompetent mice, compared with the activated T-cell treatment, CD19-targeted CAR-T cell therapy resulted in reduced weight [ (0.14±0.10) <i>vs</i> (0.81±0.24) g, <i>P</i>=0.002] and significantly diminished subcutaneous CD19(-) A20 tumor volume [ (335.40±130.20) <i>vs</i> (542.00±302.40) mm(3), <i>P</i>=0.004], accompanied by increased infiltration of endogenous CD3(+) T cells [ (36.34±6.53) % <i>vs</i> (9.49±9.42) %, <i>P</i>=0.001]. CD8(+) T cells exhibited increased CD69 expression [ (21.38±4.85) % <i>vs</i> (3.15±1.16) %, <i>P</i>=0.001] and a trend toward decreased expression of exhaustion-associated molecules PD-1 and TIGIT (all <i>P</i> value >0.05). In the mouse model of CD19(+) A20 lymphoma remission and relapse, upon disease relapse, the proportion of endogenous CD8(+) T cells in the spleen (SP) and bone marrow (BM) showed a downward trend during disease relapse compared with that during the remission period, the CD69 expression intensity decreased (CD4(+) T cell: BM: 733.20±274.40 <i>vs</i> 1 093.00±131.20, <i>P</i>=0.013; SP: 290.50±142.40 <i>vs</i> 478.70±63.94, <i>P</i>=0.018; CD8(+) T cell: BM: 1 223.00±391.50 <i>vs</i> 1 892.00±540.40, <i>P</i>=0.041; SP: 342.30±258.10 <i>vs</i> 500.00±113.90, <i>P</i>=0.325) and the secretion levels of cytokines IFN-γ, TNF-α, GM-CSF, and granzyme B were all diminished (all <i>P</i> value <0.05). During relapse, ","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"47 8","pages":"777-784"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical characteristics of acute thrombocytopenia in newly diagnosed follicular lymphoma patients receiving obinutuzumab chemotherapy].","authors":"J X Zhou, L Gao, Y Xia, S C Qin, H N Tang, Y L Kong, L Fan, J Y Li, H Y Zhu","doi":"10.3760/cma.j.cn121090-20260225-00108","DOIUrl":"10.3760/cma.j.cn121090-20260225-00108","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the efficacy and safety of first-line immunochemotherapy with obinutuzumab in patients with follicular lymphoma (FL), with a particular focus on the clinical characteristics and potential risk factors of obinutuzumab-induced acute thrombocytopenia (OIAT) . <b>Methods:</b> The present retrospective study included 167 newly diagnosed FL patients receiving G-CHOP or GB regimens at Jiangsu Provincial People's Hospital between January 2021 and December 2024. The patients' baseline clinical characteristics and serial platelet (PLT) count were collected. In patients with OIAT, the nadir PLT count and recovery time were recorded. Logistic regression analysis was performed to identify the risk factors for OIAT. <b>Results:</b> Among the 167 patients, 65 (38.9%) developed OIAT, including 18 (27.7%) patients with grade 3-4 thrombocytopenia. The median time to OIAT onset was 1.0 (1.0, 2.0) days after the first administration, and the median recovery time was 8.0 (6.0, 16.0) days. Compared to patients without OIAT (102/167, 61.1%), those with OIAT had lower baseline neutrophil percentage [median: 3.4 (2.5, 4.9) % <i>vs</i> 4.3 (3.1, 6.6) %, <i>P</i>=0.005], lower D-dimer levels [0.2 (0.1, 0.7) mg/L <i>vs</i> 0.6 (0.3, 1.3) mg/L, <i>P</i>=0.001], higher IL-10 levels [8.0 (3.7, 32.0) ng/L <i>vs</i> 4.6 (2.4, 7.9) ng/L, <i>P</i>=0.008], higher β<sub>2</sub>-microglobulin levels [2.7 (1.8, 3.9) mg/L <i>vs</i> 2.2 (1.7, 3.0) mg/L, <i>P</i>=0.024], lower CD4(+) T cell counts [ (32.4 ± 17.6) cells/μl, <i>vs</i> (37.4 ± 11.8) cells/μl, <i>P</i>=0.043], and lower IgA levels [1.2 (1.0, 2.1) g/L <i>vs</i> 1.6 (1.2, 2.2) g/L, <i>P</i>=0.045]. Multivariate analysis showed that extranodal involvement (<i>OR</i>=3.395, 95% <i>CI</i>: 1.229-9.378, <i>P</i>=0.018), FLIPI-2 score >3 (<i>OR</i>=3.622, 95% <i>CI</i>: 1.192-10.973, <i>P</i>=0.023), and baseline PLT count of <150×10(9)/L (<i>OR</i>=3.216, 95% <i>CI</i>: 1.122-9.215, <i>P</i>=0.030) were the independent risk factors for OIAT. In patients with grade 1-2 and 3-4 OIAT, the use of thrombopoietic therapy had no significant effect on prolonged PLT recovery time [grade 1-2: median: 7.1 (5.0, 12.5) days <i>vs</i> 7.4 (5.2, 13.0) days, <i>P</i>=0.338; grades 3-4: (21.0 ± 14.4) days <i>vs</i> (15.5 ± 9.9) days, <i>P</i>=0.420]. However, patients with grade 3-4 OIAT had significantly prolonged PLT recovery time [median: 16.0 (8.0, 18.5) days <i>vs</i> 7.0 (5.0, 12.8) days, <i>P</i>=0.010] and were more likely to experience non-hematologic adverse events[incidence rate: 72.2% (13/18) <i>vs</i> 40.4% (19/47), <i>P</i><0.001]. <b>Conclusion:</b> OIAT commonly occurs after the initial drug administration, with the risk significantly increased in patients with high baseline tumor burden and impaired immune status. Grade 1-2 thrombocytopenia may be observed during follow-up, whereas Grade 3-4 cases require close monitoring and active intervention. Identifying high-risk patients and implementing s","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"47 8","pages":"754-760"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical characteristics and prognosis of patients with direct antiglobulin test-negative autoimmune hemolytic anemia].","authors":"J A Zhang, J W Qiu, J Shi, F K Zhang, Y Z Zheng, M L Ge, X Zhao","doi":"10.3760/cma.j.cn121090-20260507-00227","DOIUrl":"10.3760/cma.j.cn121090-20260507-00227","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the clinical characteristics and outcomes of direct antiglobulin test (DAT) -negative autoimmune hemolytic anemia (AIHA) and to provide evidence for the clinical diagnosis and management of this subtype. <b>Methods:</b> This was a single-center retrospective cohort study. Thirty patients with DAT-negative AIHA who were treated at the Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, between January 2014 and December 2023 were included. All included patients tested negative by the microcolumn gel method using both polyspecific and monospecific antiglobulin reagents, and those with other causes of hemolytic anemia were rigorously excluded. The patients' baseline laboratory parameters, outcomes, and treatment responses were analyzed. <b>Results:</b> A total of 30 patients with DAT-negative AIHA were included, accounting for 4.77% of all patients hospitalized with AIHA during the same period; 20 (66.7%) were female and 10 (33.3%) were male; 26 (86.7%) had primary AIHA and 4 (13.3%) had secondary AIHA cases. The age at diagnosis was (44.8±17.8) years. The nadir hemoglobin level at disease onset was (61.3±15.9) g/L. The overall response rate to first-line glucocorticoid therapy was 93.3% (28/30), and rituximab was the most commonly used second-line treatment. Both patients who failed to respond to glucocorticoids achieved remission following salvage treatment with ibrutinib plus rituximab and cyclosporine plus rituximab. At a median follow-up of 64 months, the all-cause mortality rate was 10.0% (3/30). The median event-free survival (EFS) was 17.0 months, with 1-, 3-, and 5-year EFS rates of 56.5%, 45.9%, and 37.5%, respectively. Relapses were mainly triggered by drug tapering (73.7%) and infection (21.1%) . <b>Conclusion:</b> After a comprehensive diagnostic workup to exclude other causes and immunoglobulin A (IgA) - or IgM-mediated AIHA, patients with DAT-negative AIHA generally have a relatively favorable prognosis and show good responses to glucocorticoids, rituximab, and other immunosuppressive therapies.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"47 8","pages":"748-753"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Chronic lymphocytic leukemia presenting initially as purpura nephritis: a case report].","authors":"M W Tong, W X Nong, D Q Zhang, X Pan","doi":"10.3760/cma.j.cn121090-20260117-00032","DOIUrl":"10.3760/cma.j.cn121090-20260117-00032","url":null,"abstract":"","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"47 8","pages":"811"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[From structure to function: new developments in the interaction of coagulation factor Ⅴ with tissue factor pathway inhibitor α].","authors":"B X Li, L H Yang, G Wang","doi":"10.3760/cma.j.cn121090-20251112-00523","DOIUrl":"10.3760/cma.j.cn121090-20251112-00523","url":null,"abstract":"<p><p>The interaction between coagulation factor Ⅴ (FⅤ) and tissue factor pathway inhibitor alpha (TFPIα) is a central regulator of hemostatic balance. The acidic region (AR2) of the FⅤ B domain interacts with either its basic region (BR) or the basic C-terminal tail of TFPIα, modulating FⅤ activity. Recent cryo-electron microscopy studies have resolved the high-resolution structures of FⅤ-short and full-length FⅤ, revealing that AR2 forms a negatively charged hydrophobic platform that mediates BR or TFPIα binding. These insights confirm the BR-AR2 interaction as crucial for maintaining FⅤ in its inactive state and clarify the molecular basis of FⅤ-related disorders, highlighting the FⅤ-TFPIα interface as a promising therapeutic target for bleeding and thrombotic diseases.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"47 8","pages":"812-817"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical analysis of nine pediatric cases of acute myeloid leukemia with NUP98 rearrangement].","authors":"C M Wang, X P Jia, J Luo, Y S Zhang, X J Xu, B Li, D Wang, Q H Yao, G Y Sheng","doi":"10.3760/cma.j.cn121090-20260319-00142","DOIUrl":"10.3760/cma.j.cn121090-20260319-00142","url":null,"abstract":"<p><p>A retrospective case analysis was conducted on nine newly diagnosed pediatric patients with NUP98-rearranged acute myeloid leukemia (AML) who were admitted to the First Affiliated Hospital of Zhengzhou University between January 2019 to June 2025. Nine patients (3 males and 6 females) accounted for 4.2% of the 214 children diagnosed with AML during the same period. The patients' median age at diagnosis was 7 years (range: 8 months to 14 years). This type of AML was classified as M₁, M₄, and M₅, with M₅ being the most common subtype (7/9, 77.8%). The most common fusion gene type was NUP98::NSD1 (6/9, 66.7%), which was frequently accompanied by gene mutations such as FLT3-ITD and NRAS. Six cases had normal chromosome karyotypes, whereas the remaining 3 cases had abnormal karyotypes. The complete remission (CR) rate after one course of induction chemotherapy was 77.8% (7/9), and four of the children with CR underwent bridging allogeneic hematopoietic stem cell transplantation (allo-HSCT) after two to three courses of consolidation therapy, and all survived without disease. The remaining three children who continued chemotherapy had a relapse and died; whereas the two children who did not achieve CR died due to disease progression. In conclusion, at this center, pediatric AML with NUP98 rearrangement was more common in females and was often seen in the M₅ subtype. NUP98::NSD1 was the most common fusion gene and was often accompanied by gene mutations, such as FLT3-ITD. Although the induction remission rate was high, the disease was prone to relaps. Allo-HSCT may improve the prognosis of these children.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"47 8","pages":"792-795"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Whole blood exchange for a critically ill patient with Hodgkin lymphoma complicated by severe autoimmune hemolytic anemia: a case report and literature review].","authors":"B Q Li, Y Xie, Z Y Liu, P Q Liang, T Xu, P Wang, L Li, J P Zhai, M Jiang, J H Fu, D P Wu","doi":"10.3760/cma.j.cn121090-20260428-00219","DOIUrl":"10.3760/cma.j.cn121090-20260428-00219","url":null,"abstract":"<p><p>This article reports the management of a patient with Hodgkin lymphoma (HL) complicated by refractory critical autoimmune hemolytic anemia (AIHA) and explores the value of whole blood exchange (WBE) after failure of conventional therapy and plasma exchange. The patient was a 52-year-old woman with a history of classical HL treated with anti-PD-1 therapy. She was admitted due to progressive fatigue and altered mental status, with a nadir hemoglobin level of 24 g/L and a positive direct antiglobulin test for both anti-immunoglobulin G and anti-C3d (1:256). She also presented with impaired consciousness and shock, leading to a diagnosis of critical AIHA. The patient failed to respond to multiple lines of treatment, including high-dose corticosteroids, intravenous immunoglobulin, rituximab, eculizumab, and plasma exchange, and experienced recurrent hypotension. After multidisciplinary consultation, WBE was performed. Within 24 hours after the procedure, her urine color turned from dark tea-colored to light yellow, with no recurrence of dark urine. The hemoglobin level increased to 52 g/L on day 5 and to 63 g/L on day 10 post-procedure. The lactate dehydrogenase level decreased from a peak level of 2 304 U/L to 481 U/L, and the total bilirubin level dropped to 20.4 μmol/L. The patient's hemodynamic status stabilized, and she was transferred out of the hematological intensive care unit on day 16. The present case demonstrates that for severe AIHA refractory to conventional immunosuppression and plasma exchange, WBE can rapidly remove sensitized erythrocytes and complement components, serving as an effective rescue therapy.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"47 8","pages":"801-805"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669429/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The risk and management strategies for second primary tumor after CAR-T cell therapy].","authors":"R N Li, W Y Wang, F Yang, L L Zhang, J Shi","doi":"10.3760/cma.j.cn121090-20260118-00036","DOIUrl":"10.3760/cma.j.cn121090-20260118-00036","url":null,"abstract":"<p><p>Chimeric antigen receptor T (CAR-T) cell therapy has revolutionized the treatment of refractory hematologic malignancies, but its long-term safety has become an increasing concern. Secondary primary malignancies (SPM) following CAR-T-cell therapy have emerged as a growing focus of clinical and translational research. Evidence to date suggests that the incidence of different types of SPMs vary, with a two-year cumulative incidence ranging from approximately 0.08% to 8% and a median time to onset of 9.7 to 26.4 months, predominantly involving myeloid malignancies such as myelodysplastic syndromes and acute myeloid leukemia, while solid tumors and rare T-cell lymphomas have also been reported. CAR transgenes have been detected in only a minority of T-cell lymphoma cases. The mechanisms involved vector-related genomic integration risks, genotoxic stress from prior chemotherapy or hematopoietic stem cell transplantation, immune dysregulation, and clonal hematopoietic expansion. Future research may focus on developing safer gene-editing technologies, moving CAR-T-cell therapy to earlier treatment lines to reduce cumulative toxicity from prior therapies, implementing genetic risk screening before treatment, and establishing long-term systematic monitoring after therapy. By optimizing full-process management, the risk of SPM can be minimized, thereby improving the long-term safety of CAR-T-cell therapy while maintaining its therapeutic efficacy.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"47 8","pages":"818-824"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Eculizumab resistance caused by C5 gene polymorphism in a patient with paroxysmal nocturnal hemoglobinuria: a case report].","authors":"R Q Zhou, W Zhou, Y L Xu, X W Chen, F Q Li, S Q Wang","doi":"10.3760/cma.j.cn121090-20260421-00205","DOIUrl":"10.3760/cma.j.cn121090-20260421-00205","url":null,"abstract":"","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"47 8","pages":"810"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[KMT2A-rearranged acute lymphoblastic leukemia with lineage switch following relapse: a case report and literature review].","authors":"Z Q Qiao, Y P Shi, L D Hu","doi":"10.3760/cma.j.cn121090-20260228-00114","DOIUrl":"10.3760/cma.j.cn121090-20260228-00114","url":null,"abstract":"<p><p>To enhance the understanding of lineage switch (LS), we retrospectively analyzed the clinical data of a patient with KMT2A-rearranged acute lymphoblastic leukemia (ALL) who underwent a LS at relapse and reviewed the relevant literature. The patient, a 23-year-old woman, was initially diagnosed with ALL (KMT2A::AFF1-positive). She experienced a relapse during consolidation chemotherapy and achieved a second remission following chemotherapy containing blinatumomab, subsequently bridging to allogeneic stem cell transplantation. Approximately 2 months after transplantation, extensive extramedullary relapse occurred. Immunohistochemical analysis of the extramedullary mass revealed a partial loss of CD19 expression and emergence of MPO expression, whereas the KMT2A rearrangement was retained. After receiving CD19-CAR-T therapy, the patient experienced another extramedullary relapse, at which time complete loss of CD19 expression and positivity for MPO were observed, leading to a diagnosis of myeloid sarcoma. Ultimately, the family opted to discontinue treatment and the patient was discharged to receive care locally. Following antigen-targeted immunotherapy, LS, as a potential mechanism of drug resistance and adaptation, warrants increased clinical attention.</p>","PeriodicalId":24016,"journal":{"name":"Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi","volume":"47 8","pages":"806-809"},"PeriodicalIF":0.0,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149138428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}