Blood Reviews最新文献

{"title":"Treating large B-cell lymphoma: Current strategies and unmet needs across community and academic settings","authors":"Tara Graff,&nbsp;Edward Pearson,&nbsp;Sairah Ahmed,&nbsp;Krish Patel,&nbsp;Matthew Lunning","doi":"10.1016/j.blre.2026.101415","DOIUrl":"10.1016/j.blre.2026.101415","url":null,"abstract":"<div><div>Therapeutic advances in large B-cell lymphoma (LBCL) are rapidly emerging, but their development and availability are largely concentrated in academic centers. Most patients receive care within community health systems where more limited resources, infrastructure, and access to novel treatments may influence outcomes. This narrative review summarizes current treatment strategies and real-world outcomes for patients with relapsed or refractory (R/R) LBCL. Polatuzumab-based regimens remain standard for high-risk disease in the frontline setting and achieve durable responses; however, approximately 30–40% of patients experience R/R disease. While chimeric antigen receptor T-cell therapy offers curative potential, its use is constrained by logistical, socioeconomic, and geographic barriers. Novel therapies, including bispecific antibodies and antibody-drug conjugates, may improve treatment access in community settings. We also discuss patient- and practice-level factors affecting treatment strategies, unmet clinical needs, and the need for collaboration between community and academic centers in optimizing outcomes for patients with R/R LBCL.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"77 ","pages":"Article 101415"},"PeriodicalIF":7.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysbiosis and immunothrombosis – How platelets and the gut microbiome interact","authors":"Gerard Gurumurthy,&nbsp;Juditha Gurumurthy,&nbsp;Samantha Gurumurthy,&nbsp;Lianna Reynolds,&nbsp;Jecko Thachil","doi":"10.1016/j.blre.2026.101395","DOIUrl":"10.1016/j.blre.2026.101395","url":null,"abstract":"<div><div>Platelets are classically recognised for their role in haemostasis and thrombosis. They are now increasingly recognised as modulators of the immune system, referred to as immunothrombosis, and are thought to be closely associated with the gut microbiome. The gut microbiome shapes platelet phenotype through receptor-mediated sensing of microbial ligands and circulating metabolite-driven priming. Dysbiosis and barrier disruption increase systemic exposure to microbial-associated molecular patterns (MAMPs) which, in turn, engage platelet and vascular pattern-recognition receptors. Prothrombotic metabolites such as trimethylamine N-oxide has also been shown to modulate platelet activation by amplifying calcium-dependent activation and downstream inflammatory crosstalk. Other metabolites, such as phenylacetylglutamine, have been shown to increase platelet activation through adrenergic receptor-mediated pathways. In contrast, short-chain fatty acids may reduce this thromboinflammatory platelet phenotypes through anti-inflammatory signalling and potential effects on megakaryopoiesis and platelet reactivity. Therapeutic options that target these pathways between platelets and the microbiota have been explored. Examples include dietary modifications and microbiome-based interventions. Yet, whilst promising, significant gaps remain in understanding the long-term impacts of these strategies on platelet behaviour and overall disease outcomes.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"77 ","pages":"Article 101395"},"PeriodicalIF":7.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790446","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":"Artificial intelligence applications in thrombotic thrombocytopenic Purpura: A systematic review of diagnostic, risk stratification, and prognostic models","authors":"Hissa Mohamed Al-Kuwari,&nbsp;Deema Al-Hamed,&nbsp;Amna Al-Balushi,&nbsp;Ghalya Al-Abdulla,&nbsp;Haya Al-Ajmi,&nbsp;Alyaa Al-Sheraim,&nbsp;Mohamed Yassin","doi":"10.1016/j.blre.2026.101414","DOIUrl":"10.1016/j.blre.2026.101414","url":null,"abstract":"<div><div>Thrombotic thrombocytopenic purpura (TTP) is an uncommon but life-threatening thrombotic microangiopathy (TMA) caused by severe ADAMTS13 deficiency. Early diagnosis and prompt initiation of plasma exchange are critical; however, access to rapid ADAMTS13 testing remains variable across institutions. Clinical tools such as the PLASMIC and French scores assist risk assessment but have limited specificity. Artificial intelligence (AI) has emerged as a potential adjunctive approach to improve diagnostic and prognostic evaluation in TTP. This systematic review evaluated current evidence on AI applications in the diagnosis, risk stratification, and prognostic prediction of TTP. Following PRISMA guidelines (PROSPERO: CRD420261323545), PubMed, Scopus, Embase, and Web of Science were searched through January 9, 2026. Eight studies met inclusion criteria. Reported area under the curve (AUC) values ranged from 0.77 to 0.94. However, all studies were retrospective and relied on internal validation without external or prospective evaluation. Although several models demonstrated good discriminative performance, heterogeneity in study design and target populations limits direct comparison, evidence remains limited, and further externally validated studies are required before clinical implementation.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"77 ","pages":"Article 101414"},"PeriodicalIF":7.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148334655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What population-based databases reveal about equity in access to hematopoietic cell transplant and cellular therapy","authors":"Sanghee Hong,&nbsp;Manuel Ricardo Espinoza-Gutarra,&nbsp;Rahul Shah,&nbsp;Patrick Demartino,&nbsp;Stella M. Davies,&nbsp;Eneida Nemecek,&nbsp;Dianna Howard,&nbsp;Anna M. DeSalvo,&nbsp;Christa L. Meyer,&nbsp;Navneet S. Majhail,&nbsp;Jaime Preussler,&nbsp;Anurekha G. Hall,&nbsp;Alexandra Gomez Arteaga,&nbsp;Jeffery J. Auletta,&nbsp;Nandita Khera,&nbsp;On behalf of the American Society of Transplantation,&nbsp;Cellular Therapy (ASTCT)- National Marrow Donor Program (NMDP) ACCESS Initiative","doi":"10.1016/j.blre.2026.101417","DOIUrl":"10.1016/j.blre.2026.101417","url":null,"abstract":"<div><h3>Background</h3><div>Large population-based databases are increasingly used to study access to hematopoietic cell transplantation (HCT) and chimeric antigen receptor T-cell (CAR-T) therapy.</div></div><div><h3>Methods</h3><div>We conducted a systematic scoping review of studies using US databases (1/2008–2/2025) to examine access to HCT or CAR-T therapy for hematologic malignancies to identify limitations and explain differences in reported disparities.</div></div><div><h3>Results</h3><div>Thirty-five studies met inclusion criteria, and 46% used linked databases. Across data sources, older age, racial and ethnic minoritized status, lower neighborhood socioeconomic status, and non-private insurance were associated with lower likelihood of HCT and CAR-T receipt. However, disparities varied substantially by databases due to differences in eligible populations, data availability, and ability to identify treatment candidacy.</div></div><div><h3>Conclusion</h3><div>No single database adequately characterizes disparities in access to cellular therapies. Equity-focused research requires deliberate alignment of research questions with database strengths and greater investment in data standardization and inclusion of social determinants of health.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"77 ","pages":"Article 101417"},"PeriodicalIF":7.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407066","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 CD38 in immune thrombocytopenia: Rationale and a scoping review of daratumumab","authors":"Abdulrahman F. Al-Mashdali,&nbsp;Ayman Abdullah Dalol,&nbsp;Leen Haj Saleh,&nbsp;Ruba Adel Aweer,&nbsp;Mohammed Abdulgayoom,&nbsp;Honar Cherif,&nbsp;Shehab F. Mohamed","doi":"10.1016/j.blre.2026.101409","DOIUrl":"10.1016/j.blre.2026.101409","url":null,"abstract":"<div><div>Immune thrombocytopenia (ITP) remains therapeutically challenging in patients with refractory or relapsed disease despite expanding second-line options. Increasing evidence implicates autoreactive plasma cells in treatment resistance, providing a rationale for anti-CD38 therapy. In this review, we place anti-CD38 therapy in ITP within its broader biological and emerging clinical context, while formally synthesizing the published daratumumab literature through a scoping review. The available evidence suggests that anti-CD38 therapy, particularly daratumumab, may induce rapid platelet responses and durable remissions in a subset of heavily pretreated patients. However, the current evidence base is heterogeneous and largely uncontrolled, spanning different patient populations, treatment settings, response definitions, and concomitant therapies. Safety reporting is inconsistent, although infusion-related reactions, infections, and hypogammaglobulinemia are recurring concerns. Anti-CD38 therapy represents a promising investigational approach for refractory ITP, with daratumumab currently supported by most robust clinical data; however further prospective studies are needed to better define its optimal use, safety profile, and durability of response.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"77 ","pages":"Article 101409"},"PeriodicalIF":7.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clostridioides difficile infection in non-transplanted adults with haematological malignancy: Systematic review and meta-analysis on behalf of European Conference on Infections in Leukemia (ECIL) and Infectious Diseases Working Party (IDWP) of the European Society for Blood and Marrow Transplantation (EBMT)","authors":"Chiara Oltolini,&nbsp;Agnieszka Piekarska,&nbsp;Alessio Signori,&nbsp;Christine Robin,&nbsp;Dionysios Neofytos,&nbsp;Elena Reigadas,&nbsp;Lidia Gil,&nbsp;Roy Chemaly,&nbsp;Andreas H. Groll,&nbsp;Patricia Munoz,&nbsp;Benjamin W. Teh,&nbsp;Malgorzata Mikulska","doi":"10.1016/j.blre.2026.101396","DOIUrl":"10.1016/j.blre.2026.101396","url":null,"abstract":"<div><div><em>Clostridioides difficile</em> infection (CDI) is a frequent complication in patients with haematological malignancies (HM). No meta-analysis on its incidence and outcomes in non-transplanted adults with HM is available.</div><div>Pubmed/Medline database was searched for articles published between 2010 and 2026 to reflect current epidemiology. Studies including exclusively children or haematopoietic cell transplant recipients (HCT-r) were not included. Pooled estimates were calculated using a random-effects model with DerSimonian and Laird (DL) variance, and Paule-Mandel tau² and Hartung-Knapp-Sidik-Jonkman (PM-HKSJ) estimations.</div><div>Thirty-one studies were included, and eighteen studies with data from 1,766,024 non-transplanted HM adults were identified to assess the pooled incidence of CDI, being 5.55% (95% CI, 3.71–8.22). The incidence of CDI was significantly higher among patients with acute leukemia (8.33%, 95%CI 6.24–11.04) than those with chronic HM (2.62%, 95% CI 2.31–2.96, <em>p</em> &lt; 0.001). Among 1047 patients with CDI, the incidence of recurrent CDI was 16.30% (95% CI, 13.80–19.16). The pooled incidence of severe and severe-complicated CDI was 14.49% (95% CI, 11.72–17.78) and 4.60% (95% CI, 2.17–9.47), respectively. Among 54,394 HM patients with CDI, the incidence of all-cause mortality was 20.49% (95% CI, 18.41–22.75), and the CDI-related mortality was 10.49% (95% CI, 6.57–16.33). High heterogeneity of studies was observed. In the sensitivity analyses, the rates were similar or higher when studies including also HCT-r were excluded.</div><div>CDI is frequent in patients with HM, particularly in those with acute leukemia. The rate of recurrence was similar to other populations. Low rate of severe CDI might stem from the lack of severity criteria applicable to HM population, or from the lack of inflammatory response in neutropenic patients. The considerable all-cause mortality highlights that CDI might be one of various factors associated with poor prognosis in this population, which deserves specific strategies for CDI prevention and treatment.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"77 ","pages":"Article 101396"},"PeriodicalIF":7.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supportive strategies in thrombocytopenia: Platelet transfusion and beyond","authors":"Tomás José González-López,&nbsp;David J. Kuter,&nbsp;Drew Provan","doi":"10.1016/j.blre.2026.101394","DOIUrl":"10.1016/j.blre.2026.101394","url":null,"abstract":"<div><div>Thrombocytopenia is a frequent hematological disorder associated with an increased risk of bleeding across diverse clinical settings. Supportive management aims to prevent hemorrhagic complications, relieve symptoms, and address underlying causes. This narrative review summarizes evidence from randomized trials, systematic reviews, and international guidelines on the supportive management of thrombocytopenia in hematological, oncological, surgical, and critical care settings. Platelet transfusion remains the cornerstone of supportive treatment in patients with severe thrombocytopenia or active bleeding. Prophylactic transfusion is generally recommended in high-risk patients with bone marrow suppression, although thresholds vary according to clinical context and bleeding risk. Therapeutic transfusion is indicated in the presence of active bleeding or prior to urgent procedures. Adjunctive hemostatic therapies may provide additional benefit in selected scenarios. In many clinical situations, recommendations are based on limited evidence, supporting an individualized and restrictive transfusion approach.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"77 ","pages":"Article 101394"},"PeriodicalIF":7.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823800","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":"Biomarkers of joint and bone diseases, and their associations to haemophilic arthropathy in people with haemophilia: A first systematic review","authors":"M. Piccand,&nbsp;A. Schmidt,&nbsp;H. Stephan,&nbsp;U.F. Wehmeier,&nbsp;F. Tomschi,&nbsp;T. Hilberg","doi":"10.1016/j.blre.2026.101418","DOIUrl":"10.1016/j.blre.2026.101418","url":null,"abstract":"<div><h3>Background</h3><div>Despite therapeutic progress, haemophilic arthropathy persists due to recurrent haemarthrosis. With joint preservation as a central objective, sensitive and standardised biomarkers are needed.</div></div><div><h3>Objectives</h3><div>To review molecular biomarkers of inflammation, joint and bone diseases in people with haemophilia (PwH) compared with healthy controls and assess associations with arthropathy.</div></div><div><h3>Methods</h3><div>Systematic searches (PubMed, Web of Science) and PICOS-based selection of cross-sectional/case-control studies.</div></div><div><h3>Results</h3><div>Thirty-four studies were included; Compared with controls, PwH showed higher inflammatory activity as well as altered cartilage and bone turnover. Associations with imaging and clinical scores were present but heterogeneous, influenced by factors such as bleed timing, age, treatment exposure, comorbidities, and assay variability.</div></div><div><h3>Conclusions</h3><div>Current biomarkers distinguish PwH from healthy controls but lack standardisation, specificity and validated prognostic value. Priorities include harmonisation and longitudinal validation of multi-biomarker panels integrated with imaging and patient-reported outcomes to monitor subclinical disease and guide personalised therapy.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"77 ","pages":"Article 101418"},"PeriodicalIF":7.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632920","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":"Challenges in the treatment of adolescent and young adult acute lymphoblastic leukemia: A comprehensive review","authors":"Madelyn Burkart,&nbsp;Shira Dinner","doi":"10.1016/j.blre.2026.101397","DOIUrl":"10.1016/j.blre.2026.101397","url":null,"abstract":"<div><div>Advancements in the treatment of adolescents and young adults (AYA) with acute lymphoblastic leukemia (ALL) (AYA-ALL) have resulted in significant survival improvements over the last decade, however AYA patients continue to face worse outcomes compared to the pediatric population. Tailoring treatments to address these differences, alongside refining supportive care and psychosocial interventions, is essential to improving the prognosis and quality of life for this unique patient population. Here we review the multiple challenges faced when treating AYA-ALL including disease biology, treatment optimization, psychosocial issues and behavioral and life stressors.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"77 ","pages":"Article 101397"},"PeriodicalIF":7.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRD in multiple myeloma: Moving from “minimal” to “measurable”","authors":"Raffaella Cassano Cassano,&nbsp;Rahul Banerjee,&nbsp;Aimaz Afrough,&nbsp;Andrew J. Portuguese,&nbsp;Richa Thakur,&nbsp;Kara Cicero,&nbsp;Mary Kwok,&nbsp;Laahn Foster,&nbsp;Gabriele Buda,&nbsp;Silviya Meletath,&nbsp;Sara Galimberti,&nbsp;Gaetano Serviddio,&nbsp;Madhav V. Dhodapkar,&nbsp;Danai Dima","doi":"10.1016/j.blre.2026.101413","DOIUrl":"10.1016/j.blre.2026.101413","url":null,"abstract":"<div><div>The assessment of <em>minimal</em> residual disease (MRD) is an important prognostic factor in hematologic malignancies, including multiple myeloma (MM). Historically defined as cancer cells undetectable by conventional morphology, MRD is now more appropriately termed measurable residual disease, reflecting its quantitative and clinically actionable nature. Advances in next-generation flow cytometry and next-generation sequencing have enabled detection of disease at sensitivities as low as 10⁻⁶ and even 10⁻⁷, redefining the concept of complete response. Nonetheless, challenges remain regarding assay sensitivity, standardization, and interpretation of results. Achieving MRD-negativity is a strong and independent predictor of improved survival outcomes in both newly diagnosed and relapsed/refractory MM. Consequently, MRD negativity has increasingly been accepted by regulatory agencies as an intermediate endpoint supporting accelerated drug approval. This review summarizes MRD detection methodologies, clinically relevant thresholds, and therapeutic implications, highlighting the paradigm shift from “<em>minimal</em>” to measurable residual disease.</div></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":"77 ","pages":"Article 101413"},"PeriodicalIF":7.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364039","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}