Blood Reviews最新文献

{"title":"Artificial intelligence in myeloproliferative neoplasms: From digital bone marrow pathology to clinical decision support.","authors":"Andrea Duminuco, Patrick Harrington, Adrian Mosquera Orgueira, Elena Torre, Massimo Breccia, Francesca Palandri, Giuseppe A Palumbo","doi":"10.1016/j.blre.2026.101440","DOIUrl":"https://doi.org/10.1016/j.blre.2026.101440","url":null,"abstract":"<p><p>Myeloproliferative neoplasms (MPN) are clonal hematopoietic stem cell disorders whose diagnosis, prognostication, and management depend on integrating heterogeneous clinical, morphological, and molecular data. This narrative review (PubMed/MEDLINE searched through August 2026, supplemented by hand-searching and conference abstracts) appraises the evidence for AI applications across the MPN continuum. Artificial intelligence (AI), and its principal subfields, machine learning (ML) and deep learning (DL), learn predictive patterns directly from data rather than from explicitly programmed rules, and are increasingly suited to this multidimensional complexity. Across the MPN continuum, AI has produced substantial technical progress across several domains: automated bone marrow biopsy analysis and continuous quantification of fibrosis and megakaryocyte morphology; peripheral blood- and complete blood count-based diagnosis, including blood-based prediction of marrow fibrosis and emerging liquid-biopsy approaches; quantitative disease assessment such as spleen volume segmentation; risk stratification for survival, thrombosis, disease progression, and post-transplant outcomes; therapy response prediction; in silico drug discovery; and natural language processing for large-scale mining of electronic health records; maturity and level of validation differ markedly across these domains. External validation is increasingly reported in selected applications, though most published models to date remain confined to internal or single-cohort validation, and prospective evaluation has been reported only for blood count-based fibrosis prediction. Correspondingly, to our knowledge, no tool has yet been shown to change clinical decision-making or improve patient outcomes, and predictive performance should not be conflated with clinical utility. As multimodal data integration, foundation models, and generative approaches mature, AI has the potential to support a faster, more objective, and more personalized diagnostic and decision-making pathway in MPN.</p>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":" ","pages":"101440"},"PeriodicalIF":7.2,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149277512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transformed mycosis fungoides: Biological heterogeneity, clinicopathological features, and prognostic determinants.","authors":"Bruno de Castro E Souza, José Antonio Sanches","doi":"10.1016/j.blre.2026.101439","DOIUrl":"https://doi.org/10.1016/j.blre.2026.101439","url":null,"abstract":"<p><p>Mycosis fungoides (MF) is the most common primary cutaneous T-cell lymphoma. A subset of patients develops large cell transformation, a biological and histopathological event associated with advanced-stage disease and poor outcomes. This narrative review summarizes current evidence on the biology, clinicopathological features, prognostic factors, and therapeutic implications of transformed MF. Available data indicate that transformation reflects clonal evolution accompanied by genomic instability, dysregulated oncogenic signaling, and gene-expression signatures consistent with an immunosuppressive tumor microenvironment. The most consistently reported adverse prognostic factors include advanced clinical stage, older age, elevated serum lactate dehydrogenase, and absent or low CD30 expression, while emerging biomarkers such as GATA3 may further refine risk stratification. Although treatment generally follows the principles of advanced MF, localized radiotherapy, CD30-directed therapy, and early consideration of allogeneic hematopoietic cell transplantation have particular relevance. Future advances will depend on biomarker-driven risk stratification and prospective studies dedicated to transformed MF.</p>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":" ","pages":"101439"},"PeriodicalIF":7.2,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149277518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The blind spots of post-transplant AML relapse: from clinical signal to mechanism-matched therapy.","authors":"Michael D Ashby, David J Curtis","doi":"10.1016/j.blre.2026.101437","DOIUrl":"https://doi.org/10.1016/j.blre.2026.101437","url":null,"abstract":"<p><p>Relapse after allogeneic haematopoietic stem cell transplantation remains the dominant cause of death in acute myeloid leukaemia (AML), and outcomes after relapse remain poor despite substantial advances in supportive care, monitoring and therapy. Contemporary practice includes detailed monitoring and offers an expanding therapeutic toolkit including GVHD prophylaxis, engineered grafts, maintenance and targeted therapies. The biological understanding required to apply these tools selectively has, however, not kept pace. In this review we present an integrated clinical approach that connects the monitoring signal at impending relapse to the mechanism of graft-versus-leukaemia failure and the mechanism-matched therapeutic choice. We comprehensively review transplant care from conditioning through maintenance and relapse and highlight unresolved questions organised around graft versus host disease and graft versus leukaemia, fixed or reversible mechanisms of failure and maintenance therapies. We use TP53-mutated AML as an integrated case study of multi-mechanism failure. We conclude with practice points, a research agenda, and future considerations for the mechanism-defining studies required to make further progress.</p>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":" ","pages":"101437"},"PeriodicalIF":7.2,"publicationDate":"2026-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149277563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolving landscape of tyrosine kinase inhibitors in chronic-phase chronic myeloid leukemia: A 25-year journey.","authors":"Fadi G Haddad, Jeffrey H Lipton, Elias J Jabbour, Hagop M Kantarjian, Yifan Zhai","doi":"10.1016/j.blre.2026.101436","DOIUrl":"https://doi.org/10.1016/j.blre.2026.101436","url":null,"abstract":"<p><p>BCR::ABL1 tyrosine kinase inhibitors (TKIs) have transformed the treatment landscape of chronic-phase chronic myeloid leukemia, normalizing life expectancy for most patients. However, potential ABL1 kinase domain mutation-driven treatment resistance and intolerance are perennial clinical challenges. For frontline therapy, generically available first-generation BCR::ABL1 TKI imatinib is a rational and cost-effective approach to optimize survival. Second-line options are more likely to elicit deep molecular responses and treatment-free remission. However, achievement of these milestones has not been associated with improved overall survival as compared with imatinib. The \"gatekeeper\" T315I ABL1 kinase domain mutation confers resistance to imatinib and all second-generation TKIs. For patients with this mutation and/or resistance or intolerance to prior TKIs, third-generation ponatinib, first-in-class specifically targeting the Abl myristoyl pocket inhibitor asciminib, or (upon regulatory approval) potentially olverembatinib may be appropriate alternatives. Considerable finesse is warranted to tailor a range of efficacious and well-tolerated therapies to the individual needs of patients.</p>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":" ","pages":"101436"},"PeriodicalIF":7.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Targeting tomorrow: Evaluation of novel agents for infants with KMT2A-rearranged acute lymphoblastic leukaemia.","authors":"Taylor A Ferguson, Stephen C C Dymock, Sung K Chiu, Laurence C Cheung, Rishi S Kotecha","doi":"10.1016/j.blre.2026.101435","DOIUrl":"https://doi.org/10.1016/j.blre.2026.101435","url":null,"abstract":"<p><p>Infants with KMT2A-rearranged (KMT2A-r) acute lymphoblastic leukaemia (ALL) have a historically poor prognosis with high rates of relapse. Further treatment intensification with conventional chemotherapy is precluded by dose-limiting toxicities. Extensive preclinical evaluation has been performed to identify novel therapies to improve outcome for infants with KMT2A-r ALL. However, there is considerable heterogeneity regarding the extent of experimental research conducted and combined with the increasing volume of preclinical studies, presents a barrier to selecting the best agents for translation into clinical trials. In addition, the relative rarity of infant ALL limits the number of novel therapies that can be clinically evaluated at any one time. In this systematic review, we detail the preclinical studies of novel agents performed for KMT2A-r infant ALL and highlight areas for further investigation, providing the basis to enhance future preclinical research and integrate novel agents into clinical practice to improve outcomes for infants with KMT2A-r ALL.</p>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":" ","pages":"101435"},"PeriodicalIF":7.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal antiphospholipid syndrome-associated thrombosis: Diagnostic pitfalls and therapeutic frontiers.","authors":"Evdokia Tzatzadaki-Amantou, Alexandra Lianou, Andreas G Tsantes, Anastasia Batsiou, Vasiliki Mougiou, Zoi Iliodromiti, Theodora Boutsikou, Argyrios Tsantes, Nicoletta Iacovidou, Rozeta Sokou","doi":"10.1016/j.blre.2026.101433","DOIUrl":"https://doi.org/10.1016/j.blre.2026.101433","url":null,"abstract":"<p><p>Neonatal antiphospholipid syndrome (APS) is an exceptionally rare but clinically significant thrombotic disorder associated with antiphospholipid antibodies (aPL) in the neonatal period. Two principal pathogenic mechanisms have been proposed: passive transplacental transfer of maternal antiphospholipid antibodies and de novo neonatal production of aPL. Although approximately 30% of neonates born to aPL-positive mothers exhibit detectable antibodies at birth, thrombotic complications remain exceedingly uncommon. A \"second-hit\" model involving additional prothrombotic triggers such as infection, perinatal stress, inherited thrombophilia, or vascular catheters likely contributes to thrombogenesis. Available evidence from case reports and small series indicates that arterial thrombosis predominates, particularly neonatal arterial ischemic stroke, while venous thrombosis is less frequent. Diagnosis remains challenging because no validated neonatal-specific classification criteria exist, and interpretation of laboratory findings is confounded by transient maternal antibody transfer. Current diagnostic approaches rely on clinical suspicion, thrombosis confirmation, maternal antibody testing, serial neonatal aPL measurements, and exclusion of other prothrombotic conditions. Management strategies are extrapolated from pediatric and adult APS guidelines, with low-molecular-weight heparin representing the mainstay of anticoagulant therapy in affected neonates. Neonatal APS remains a diagnostic challenge due to its rarity and atypical presentations. Establishing age-specific criteria and long-term neurodevelopmental follow-up is critical for improving clinical outcomes and understanding the prognosis of this early-onset autoimmune condition. This narrative review aims to summarize current evidence regarding the pathophysiology, clinical manifestations, diagnostic challenges, and management of APS-associated thrombosis regarding the distinct neonatal population.</p>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":" ","pages":"101433"},"PeriodicalIF":7.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the platelet count: A systematic review of artificial intelligence in immune thrombocytopenia.","authors":"Emad Addin M AbuOsba, Baha H Abuajameia, Sherif Elgohary, Mohamed Yassin","doi":"10.1016/j.blre.2026.101434","DOIUrl":"https://doi.org/10.1016/j.blre.2026.101434","url":null,"abstract":"<p><p>Immune thrombocytopenia (ITP) is an acquired autoimmune bleeding disorder with variable disease course, bleeding risk, and treatment response. Artificial intelligence (AI) and machine learning (ML) approaches may address diagnostic and therapeutic challenges by identifying complex patterns across heterogeneous clinical and biological data. A systematic search of PubMed, Embase, Web of Science and Scopus from inception to 13 August 2026 was conducted for studies applying ML to patient-level prediction in primary or disease-associated secondary ITP. Twelve studies were included, eleven from China, applying a range of machine learning approaches. Reported areas under the curve ranged from 0.693 to 0.937, but only two studies reported estimates from independent cohorts. Risk of bias was assessed using PROBAST+AI and eleven of the 12 studies were at high risk of bias. Further development with external validation and prospective evaluation in real-world clinical workflows is needed before these tools can be integrated into clinical practice.</p>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":" ","pages":"101434"},"PeriodicalIF":7.2,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequencing CD19-targeted therapies in patients with relapsed/refractory large B-cell lymphoma: A narrative review.","authors":"Paolo F Caimi, Romano Danesi, Gloria Iacoboni, Manali Kamdar, Megan Melody, Mehdi Hamadani","doi":"10.1016/j.blre.2026.101432","DOIUrl":"https://doi.org/10.1016/j.blre.2026.101432","url":null,"abstract":"<p><p>CD19 is expressed on B cells from an early stage and in most B-cell malignancies, but not in hematopoietic stem cells or other normal tissues, thereby making it an attractive therapeutic target for the treatment of patients with relapsed or refractory (R/R) large B-cell lymphomas. While CD19-targeted chimeric antigen receptor T-cell (CAR-T) therapies, monoclonal antibodies, and antibody-drug conjugates are effective therapies for B-cell lymphomas, outcomes in the R/R setting may depend on exposure to prior treatments with the same antigen. There are limited data on the impact of sequencing these treatment modalities. This review highlights recent trial and real-world data focusing on the efficacy and safety of the CD19-targeted agents tafasitamab-lenalidomide and loncastuximab tesirine before and after CAR-T therapy in patients with R/R B-cell lymphoma and addresses the importance of assessing pretreatment target antigen levels as well as identifying common molecular mechanisms of treatment failure. Additionally, this analysis discusses the unmet needs in patients with high-risk disease and the challenges of sequencing these therapeutic strategies, while providing expert clinical practice recommendations to optimize patient outcomes.</p>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":" ","pages":"101432"},"PeriodicalIF":7.2,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reframing chronic myeloid leukemia outcomes beyond survival: a perspective of quality of life and patient-centered data.","authors":"Jeffrey H Lipton, Elisabetta Abruzzese, Robert Peter Gale, Christopher Hillis, Qian Jiang, Delphine Rea, Giora Sharf, Meinolf Suttorp","doi":"10.1016/j.blre.2026.101431","DOIUrl":"https://doi.org/10.1016/j.blre.2026.101431","url":null,"abstract":"<p><p>The introduction and refinement of tyrosine kinase inhibitors (TKIs) over the past 25 years have resulted in dramatic improvements in life expectancy in individuals with chronic myeloid leukemia (CML). There are now multiple effective and well-tolerated TKIs available, and because most patients will be receiving TKIs for their lifetime, quality-of-life (QoL) considerations are an increasing concern. Patients with CML receiving TKIs have worse QoL than the general population, but TKIs have a generally less negative impact on QoL factors than previously available treatments for CML. Commonly used TKIs (imatinib, nilotinib, dasatinib, bosutinib, ponatinib, asciminib, and olverembatinib) all have positive and negative impacts on QoL, each of which can be impacted by patient preference and priorities, as well as line of therapy. The inclusion of patient-reported QoL outcomes in clinical trials will be vital to helping physicians understand the patient experience of CML and thereby improve disease management.</p>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":" ","pages":"101431"},"PeriodicalIF":7.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-transfusion-dependent β-thalassemia: A disease of clinical paradoxes.","authors":"Khaled M Musallam, Sujit Sheth, Gian Luca Forni, Farrukh T Shah, Maria Domenica Cappellini, Ali T Taher","doi":"10.1016/j.blre.2026.101430","DOIUrl":"https://doi.org/10.1016/j.blre.2026.101430","url":null,"abstract":"<p><p>Non-transfusion-dependent β-thalassemia (NTDT) was historically regarded as a relatively mild form of thalassemia because patients survive without regular transfusion therapy. However, growing evidence has challenged this perception and uncovered substantial morbidity and premature mortality driven by chronic anemia, iron overload, and hypercoagulability. This review examines three major clinical paradoxes that have reshaped the understanding of NTDT: the anemia paradox, whereby transfusion-independent patients may actually benefit from anemia correction; the iron overload paradox, characterized by clinically significant iron accumulation despite minimal or no transfusion exposure; and the hypercoagulability paradox, whereby chronic anemia coexists with a prothrombotic state. These evolving concepts have transformed NTDT from a condition traditionally managed through observation into a disease requiring proactive, risk-based intervention.</p>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":" ","pages":"101430"},"PeriodicalIF":7.2,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}