{"title":"Hodgkin lymphoma","authors":"David Wrench","doi":"10.1016/j.mpmed.2025.02.013","DOIUrl":"10.1016/j.mpmed.2025.02.013","url":null,"abstract":"<div><div>Hodgkin lymphoma typically presents as a painless mass and can be subclassified into classical and nodular lymphocyte-predominant forms, each with characteristic age of incidence peaks. Most patients who develop Hodgkin lymphoma can now be cured. In view of this, initial treatment can be adapted to disease response demonstrated on interim positron emission tomography/computed tomography. This enables patients with good-risk disease to benefit from early attenuation of therapy (to limit the risks of long-term treatment-associated complications) while maintaining treatment efficacy, and patients with poor-risk disease to benefit from early treatment escalation. A minority of patients are either refractory to or relapse after first-line therapy, but novel agents are overcoming chemotherapy resistance. Furthermore, the incorporation of these new treatments in the initial therapy heralds improvements in tolerability of treatment and reductions in risk of early progressive disease.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 5","pages":"Pages 312-318"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Non-Hodgkin lymphoma","authors":"James Paterson, Jonathan Lambert","doi":"10.1016/j.mpmed.2025.02.011","DOIUrl":"10.1016/j.mpmed.2025.02.011","url":null,"abstract":"<div><div>Non-Hodgkin lymphoma (NHL) is the seventh most common cancer in the UK and represents a heterogenous group of malignancies. This article gives a brief overview of the current classification of B and T cell NHL, the molecular and cytogenetic abnormalities associated with their pathogenesis, and principles for managing them. Although advances in immuno-chemotherapy and supportive care have resulted in better patient outcomes, many challenges remain, especially for individuals with relapsed and refractory disease.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 5","pages":"Pages 319-324"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute leukaemia","authors":"Aditya Tedjaseputra, Richard Dillon, Kavita Raj","doi":"10.1016/j.mpmed.2025.03.004","DOIUrl":"10.1016/j.mpmed.2025.03.004","url":null,"abstract":"<div><div>The acute leukaemias consist of acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL), which typically present in older adults and childhood, respectively. Uncontrolled proliferation of abnormal, immature blasts leads to bone marrow failure and cytopenias, which may present as medical emergencies (e.g. leukostasis, catastrophic coagulopathy). Approximately 90% of children with ALL are cured. The outcomes of AML patients are more heterogenous but have improved significantly in recent years through optimization of supportive care and incorporation of targeted therapies. Lineage distinction (AML vs ALL) is attained first through morphology and flow cytometry. Exclusion of acute promyelocytic leukaemia, an AML subtype with a very high early death rate without appropriate treatment, must occur within hours of presentation of a patient with suspected acute leukaemia. Cytogenetics and comprehensive molecular testing further delineate specific subtypes, prognosis and therapeutic targeting. Treatment of acute leukaemias is centred around three aims: (1) attainment of complete remission (CR) via induction; (2) maintenance of CR via consolidation and/or maintenance therapy, including consideration of allogeneic stem cell transplant for high-risk patients; and (3) early detection of impending relapse through measurable residual disease monitoring, affording early pre-emptive therapy. Cumulatively, these approaches have improved the outlook of patients with acute leukaemias.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 5","pages":"Pages 288-297"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Approach to the investigation of lymphadenopathy and splenomegaly","authors":"Catherine A Cox","doi":"10.1016/j.mpmed.2025.02.008","DOIUrl":"10.1016/j.mpmed.2025.02.008","url":null,"abstract":"<div><div>Lymphadenopathy and splenomegaly, alone or in combination, are common presentations with a diverse range of causes. These can range from a normal physiological response to a simple, acute infection, to the first presentation of malignancy. As such, timely diagnostics is crucial. Understanding the function of these organs is a necessary step to forming a differential diagnosis. This article breaks down the roles of the lymph nodes and spleen within the immune system and common causes of lymphadenopathy and splenomegaly. It then provides a structure to history-taking and examination. An algorithm for a diagnostic approach is presented into which this information can be fed. It highlights important red flag symptoms and critical tests that should be performed to lead to timely diagnosis and treatment.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 5","pages":"Pages 308-311"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Haematological emergencies","authors":"Shahira Butt, Merrina Gregory, Priya Sriskandarajah, Natalia Curto-Garcia","doi":"10.1016/j.mpmed.2025.03.006","DOIUrl":"10.1016/j.mpmed.2025.03.006","url":null,"abstract":"<div><div>This article provides an overview of the management of common haematological emergencies. Individuals with haematological disorders often present with co-morbidities and/or undergo chemotherapy, which can pose challenges to clinicians who are unfamiliar with these conditions. Accurate interpretation of laboratory data, in-depth knowledge of disease-related complications and strong clinical skills are critical for diagnosing and managing haematological emergencies. This review focuses on the key principles involved in diagnosing and managing the most frequently encountered emergencies in these patients.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 5","pages":"Pages 343-350"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Myelodysplastic neoplasms","authors":"Jiexin Zheng","doi":"10.1016/j.mpmed.2025.02.007","DOIUrl":"10.1016/j.mpmed.2025.02.007","url":null,"abstract":"<div><div>Myelodysplastic neoplasms (MDSs) are rare clonal haematological neoplasms that result from disordered haematopoiesis. MDSs typically present in elderly individuals with cytopenia in one or more blood cell lineages. MDSs are diagnosed based on clinical, morphological, cytogenetic and genetic changes, with the latest international MDS classifications in 2022 incorporating these disease features into different MDS subtypes. Prognostic scoring systems can be used in individuals with MDS at presentation, to confer an estimated overall survival as well as guide appropriate treatment; this should be tailored based on the prognostic score as well as individual clinical factors.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 5","pages":"Pages 278-281"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Myeloproliferative neoplasms","authors":"Laura Li Gagnon, Claire N Harrison","doi":"10.1016/j.mpmed.2025.02.006","DOIUrl":"10.1016/j.mpmed.2025.02.006","url":null,"abstract":"<div><div>Myeloproliferative neoplasms (MPNs), polycythaemia vera, essential thrombocythaemia and myelofibrosis – are uncommon clonal haematological malignancies generally diagnosed from late middle age onwards, although they can occur in children and young adults. They should be suspected in patients with elevated blood counts, atypical thrombosis or splenomegaly. Their clinical courses share similarities, including thrombosis, haemorrhage and a tendency to progress to myelofibrosis or acute myeloid leukaemia. Myelofibrosis has a poorer prognosis and significant disease burden affecting quality of life. Advances in diagnostics and genomics have recently been used to stratify risk more accurately. Furthermore, the development of treatment modalities aimed at targeting specific molecular pathways, such as Janus kinase inhibitors, has resulted in a therapeutic paradigm shift. Several ground-breaking studies have proved the efficacy of the first such agents and they are now licensed as first-line therapy in myelofibrosis and as second line in polycythaemia vera. Additional targets, such as <em>CALR</em>, are under evaluation in clinical trials. However, the mainstay of treatment for polycythaemia vera and essential thrombocythaemia remains aggressive management of thrombotic risk factors, antiplatelet therapy for most patients, and cytoreductive agents such as hydroxycarbamide and interferon for patients at high risk of thrombosis. This is, nevertheless, a rapidly evolving landscape.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 5","pages":"Pages 282-287"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"AL amyloidosis","authors":"Sajitha Sachchithanantham, Majid Kazmi","doi":"10.1016/j.mpmed.2025.02.005","DOIUrl":"10.1016/j.mpmed.2025.02.005","url":null,"abstract":"<div><div>Amyloidosis is a rare group of disorders with protean manifestations characterized by tissue deposition of misfolded protein. This causes progressive accumulation of amyloid deposits and disruption of organ function. Among patients with systemic amyloidosis, AL-type protein is the most common. This article focuses on AL amyloidosis, formerly known as primary amyloidosis, which usually affects the kidneys, heart, liver and peripheral nervous system. Diagnosis is rarely made until symptoms are referable to a particular organ. Untreated, it is progressive and fatal. Prognosis is determined by the extent of cardiac involvement. The three-step approach to diagnosis and investigation involves confirmation of amyloid and type, assessing the extent of organ involvement and confirmation of an underlying plasma cell dyscrasia/lymphoma. Treatment aims to reduce production of amyloidogenic light chains and stop progressive organ function deterioration. New drug classes such as proteasome inhibitors, immunomodulatory agents and anti-CD38 monoclonal antibodies have shown promise in reducing the light-chain burden, halting amyloid production and subsequently improving organ response and survival. Autologous stem cell transplantation has improved survival rates but is available only to a limited patient cohort. Bispecific antibodies, chimeric antigen receptor T cell therapies and agents directly removing amyloid fibrils in development show encouraging results in selected group of patients.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 5","pages":"Pages 331-333"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ethan Wong, Aaryan Godhamgaonkar, Donal P McLornan
{"title":"Principles of haemopoietic stem cell transplantation","authors":"Ethan Wong, Aaryan Godhamgaonkar, Donal P McLornan","doi":"10.1016/j.mpmed.2025.02.012","DOIUrl":"10.1016/j.mpmed.2025.02.012","url":null,"abstract":"<div><div>Rapid developments within the field of stem cell transplantation and cellular therapy have occurred over the last few decades. Improvements in conditioning regimens coupled with advances in supportive and anti-infective care have in general correlated with improved survival compared with historical cohorts. Rapid adoption of haploidentical donors has allowed more patients without a matched sibling or well-matched unrelated donor to proceed with allogeneic transplantation as a therapeutic modality. Here, we highlight the main indications for autologous and allogeneic stem cell transplantations, with a focus on stem cell harvesting and graft-versus-host disease. Key areas of current research focus are highlighted, as is the exploration of novel immunotherapeutic approaches including chimeric antigen receptor T cell therapies.</div></div>","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 5","pages":"Pages 334-339"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Self-assessment/CPD answers","authors":"","doi":"10.1016/j.mpmed.2025.03.005","DOIUrl":"10.1016/j.mpmed.2025.03.005","url":null,"abstract":"","PeriodicalId":74157,"journal":{"name":"Medicine (Abingdon, England : UK ed.)","volume":"53 5","pages":"Pages 351-354"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143924662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}