American Journal of Hematology最新文献

{"title":"Balancing the Scales: Optimizing Reporting of Infection Rates in Clinical Trials of Bispecific Antibodies in Multiple Myeloma.","authors":"Joshua Richter, Madhav V Dhodapkar, Mengying Li, Mina Awad, Christian Hampp, Kate Knorr, Glenn Kroog, Tito Roccia, Naresh Bumma","doi":"10.1002/ajh.27618","DOIUrl":"https://doi.org/10.1002/ajh.27618","url":null,"abstract":"","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":" ","pages":""},"PeriodicalIF":10.1,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dirt Under the Finger-Nails—More Malignant Than Malignancy","authors":"Sumeet Mirgh, Sujata Lall, Sachin Punatar, Anant Gokarn, Nishant Jindal, Akanksha Chichra, Vivek Bhat, Navin Khattry","doi":"10.1002/ajh.27615","DOIUrl":"https://doi.org/10.1002/ajh.27615","url":null,"abstract":"A young boy developed steroid refractory GVHD post haploidentical transplant for relapsed B-ALL. He was on systemic immunosuppression with two immunosuppressants, and had history of CMV reactivation and tuberculosis. Eight months post-transplant, he was hospitalized with multi-drug-resistant gram-negative sepsis, and during the same episode, he developed penile lesions which progressed to dry gangrene of glans-penis. Fusarium grew in blood and penile lesions. On retrospective thinking, it was discerned that his onychomycoses were the probable cause of his penile lesions with hematogenous dissemination, as nails also grew Fusarium. This case highlights the need for a vigilant skin and nail examination in immunocompromised patients. This is important for two perspectives. First, cultures from potential colonized sources can help early identification and escalation of treatment. Secondly, appropriate precautions and treatment of superficial infections can help prevent dissemination.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"36 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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 Thalassemia: An Image Gallery Worth a Thousand Words","authors":"Khaled M. Musallam, Sujit Sheth, Thomas D. Coates, Hanny Al‐Samkari, Maria Domenica Cappellini, Kevin H. M. Kuo, Vip Viprakasit, Ali T. Taher","doi":"10.1002/ajh.27621","DOIUrl":"https://doi.org/10.1002/ajh.27621","url":null,"abstract":"","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"16 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Sleep Traits With Venous Thromboembolism: Prospective Cohort and Mendelian Randomization Studies","authors":"Yuqian Li, Feifei Sun, Chao Ji, Honghao Yang, Zheng Ma, Yuhong Zhao, Zhiying Zhao, Yang Xia","doi":"10.1002/ajh.27620","DOIUrl":"https://doi.org/10.1002/ajh.27620","url":null,"abstract":"Previous research indicates an association between sleep traits and venous thromboembolism (VTE) risk, though causal relationships remain uncertain. This study evaluated combined and independent associations between sleep traits and VTE risk using UK Biobank data and explored the causal associations between sleep traits and VTE through two-sample Mendelian randomization (MR) analyses. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the associations between the healthy sleep score, as well as individual sleep traits (including sleep duration, insomnia, daytime sleepiness, snoring, and chronotype), and VTE risk were calculated using Cox proportional hazards regression models. Additionally, the two-sample MR analyses used the inverse-variance weighted method to determine odds ratios (ORs) and 95% CIs for causal associations. In the cohort analysis, 314 077 VTE–free participants were followed for a median of 12.3 years, during which 7176 VTE cases occurred. In comparison to those with a sleep score of 0–1, participants with a score of 5 were associated with a 30% lower risk of VTE (HR: 0.70; 95% CI: 0.61–0.80). A U-shaped association was noted between sleep duration and VTE risk. Both short (≤ 6 h) and long (≥ 9 h) sleep durations increased VTE risk. Excessive daytime sleepiness, snoring, and evening chronotype also elevated VTE risk. MR analyses supported a causal relationship for short sleep duration (OR: 1.24; 95% CI: 1.04–1.47) with VTE risk, while other sleep traits showed no causal association. These findings underscore the importance of optimal sleep in reducing VTE risk.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"43 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elderly Patients With Aplastic Anemia: Treatment Patterns and Outcomes in the Real World","authors":"Bruno Fattizzo, Carmelo Gurnari, Sabrina Giammarco, Antony Ricchiuti, Hussein Awada, Marta Bortolotti, Nicole Galli, Giacinto Luca Pedone, Francesco Versino, Dario Consonni, Roochi Trikha, Shreyans Gandhi, Simona Sica, Jaroslaw P. Maciejewski, Austin Kulasekararaj, Wilma Barcellini","doi":"10.1002/ajh.27611","DOIUrl":"https://doi.org/10.1002/ajh.27611","url":null,"abstract":"We retrospectively analyzed a large international cohort of 1113 patients with aplastic anemia to evaluate treatment choice and outcome in elderly patients as compared with a younger population. Overall, 319 (29%) patients were &gt; 60 years old at diagnosis (60–64 years (<i>n</i> = 85), 106 65–69 years (<i>n</i> = 106), and 128 &gt; 70 years (<i>n</i> = 128)). Elderly patients showed a more severe thrombocytopenia at onset and a significantly lower overall response (complete plus partial) to first-line therapy at 6 months as compared to younger patients (47% vs. 65%, <i>p</i> &lt; 0.0001), irrespective of treatment modality (ATG or CyA combinations, eltrombopag, or androgens); 27 (8%) received transplant as second line therapy and 11 (41%) died, mainly due to transplant complications. The rate of evolution to MDS was greater in elderly patients (12% vs. 7% in younger AA, <i>p</i> = 0.002), whilst the rate of evolution to AML was similar (1.8 vs. 1.3%). By multivariable analysis, older age remained the main factor associated with mortality [HR 1.64 (95% CI 1.5–1.7), <i>p</i> &lt; 0.001], followed by disease severity by Camitta classification [HR 2.24 (95% CI 1.6–3.1) for severe AA; HR 3.8 (95% CI 2.4–6) for very severe AA], and male gender [1.45 (95% CI 1.1–1.8), <i>p</i> &lt; 0.001]. In this large study, elderly AA was associated with inferior outcome even in the TPO-RA era, highlighting the need for further optimization of clinical management.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"52 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143055300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Lymphocytic Leukemia: 2025 Update on the Epidemiology, Pathogenesis, Diagnosis, and Therapy","authors":"Michael Hallek","doi":"10.1002/ajh.27546","DOIUrl":"10.1002/ajh.27546","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Disease Overview&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Chronic lymphocytic leukemia (CLL) is the most frequent type of leukemia. It typically occurs in older patients and has a highly variable clinical course. Leukemic transformation is initiated by specific genomic alterations that interfere with the regulation of proliferation and apoptosis in clonal B-cells.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Diagnosis&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The diagnosis is established by blood counts, blood smears, and immunophenotyping of circulating B-lymphocytes, which identify a clonal B-cell population carrying the CD5 antigen as well as typical B-cell markers.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Prognosis and Staging&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Two clinical staging systems, Rai and Binet, provide prognostic information by using the results of physical examination and blood counts. Various biological and genetic markers provide additional prognostic information. Deletions of the short arm of chromosome 17 (del(17p)) and/or mutations of the &lt;i&gt;TP53&lt;/i&gt; gene predict a shorter time to progression with most targeted therapies. The CLL international prognostic index (CLL-IPI) integrates genetic, biological, and clinical variables to identify distinct risk groups of patients with CLL. The CLL-IPI retains its significance in the era of targeted agents, but the overall prognosis of CLL patients with high-risk stages has improved.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Therapy&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Only patients with active or symptomatic disease or with advanced Binet or Rai stages require therapy. When treatment is indicated, several therapeutic options exist: combinations of the BCL2 inhibitor venetoclax with obinutuzumab, or venetoclax with ibrutinib, or monotherapy with one of the inhibitors of Bruton tyrosine kinase (BTK). At relapse, the initial treatment may be repeated if the treatment-free interval exceeds 3 years. If the leukemia relapses earlier, therapy should be changed using an alternative regimen.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Future Challenges&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Combinations of targeted agents now provide efficient therapies with a fixed duration that generate deep and durable remissions. These fixed-duration therapies have gained territory in the management of CLL, as they are cost-effective, avoid the emergence of resistance, and offer treatment free time to the patient. The cure rate of these novel combination regimens is unknown. Moreover, the optimal sequencing of targeted therapies remains to be determined. A medical challenge is to treat patien","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"100 3","pages":"450-480"},"PeriodicalIF":10.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ajh.27546","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143050827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Prognostic Significance of Additional Chromosomal Abnormalities at Diagnosis of Chronic Myeloid Leukemia","authors":"Jiří Mayer, Petra Čičátková, Lenka Kováčová, Marie Jarošová, Michal Karas, Pavel Jindra, Hana Klamová, Kateřina Machová Poláková, Olga Černá, Eduard Cmunt, Petra Bělohlávková, Pavel Žák, Edgar Faber, Tomáš Papajík, Lukáš Stejskal, Ivana Ježíšková, Barbora Weinbergerová, Tomáš Jurček, Tomáš Horňák, Daniela Žáčková, Šárka Ransdorfová, Milena Holzerová, Tomáš Pavlík","doi":"10.1002/ajh.27608","DOIUrl":"https://doi.org/10.1002/ajh.27608","url":null,"abstract":"The influence of t(v;22) sole, major route ACAs all (+8, <i>n</i> = 14; +Ph, <i>n</i> = 10; +19, <i>n</i> = 1), and -Y sole on progression-free survival. Survival curves are compared with those of patients with the standard t(9;22) translocation. Other ACAs or complex karyotypes did not influence survival.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"55 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143050835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TP53 Mutations in Myeloproliferative Neoplasms: Context-Dependent Evaluation of Prognostic Relevance","authors":"Ayalew Tefferi, Maymona Abdelmagid, Giuseppe G. Loscocco, Saubia Fathima, Kebede H. Begna, Aref Al-Kali, James Foran, Jeanne Palmer, Talha Badar, Mrinal M. Patnaik, Kaaren K. Reichard, Rong He, Cinthya J. Zepeda Mendoza, Mithun Shah, Attilio Orazi, Daniel A. Arber, Animesh Pardanani, Alessandro M. Vannucchi, Devendra Hiwase, Naseema Gangat, Paola Guglielmelli","doi":"10.1002/ajh.27609","DOIUrl":"https://doi.org/10.1002/ajh.27609","url":null,"abstract":"The clinical relevance of <i>TP53</i> mutations (<i>TP53</i>^<i>MUT</i>) in myeloproliferative neoplasms (MPN) and their prognostic interaction with MPN subtype designation has not been systematically studied. In the current study, 114 patients with MPN harboring <i>TP53</i>^<i>MUT</i> (VAF ≥ 2%) were evaluated for overall survival (OS), calculated from the time of <i>TP53</i>^<i>MUT</i> detection: chronic phase myelofibrosis (MF-CP; <i>N</i> = 61); blast-phase (MPN-BP; <i>N</i> = 31) or accelerated-phase (MPN-AP; <i>N</i> = 16) MPN, and polycythemia vera/essential thrombocythemia (PV/ET; <i>N</i> = 6). Sixty-five (57%) patients harbored International Consensus Classification (ICC)-defined multihit <i>TP53</i>^<i>MUT</i> and 56 (49%) monosomal/complex karyotype (MK/CK). Majority of MPN-BP (90%) and MPN-AP (81%) while 39% of MF-CP and none of PV/ET patients harbored multihit <i>TP53</i>^<i>MUT</i>. OS in MPN-BP and MPN-AP was equally dismal (median 6 vs. 4.5 months, respectively; <i>p</i> = 1.0), regardless of multihit configuration (<i>p</i> = 0.44), while OS in <i>TP53</i>^<i>MUT</i> MPN-BP/AP (<i>N</i> = 47; median 4 months) was inferior to that of a separate cohort (<i>N</i> = 49) with <i>TP53</i> wild-type MPN-BP/AP (median 11 months; <i>p</i> &lt; 0.01). OS in MF-CP was significantly shorter with multihit versus non-multihit <i>TP53</i>^<i>MUT</i> (median 10 vs. 35 months; HR 2.9; <i>p</i> &lt; 0.01), independent of other MF-relevant genetic risk factors, including <i>ASXL1/SRSF2/U2AF1</i> mutations. Multihit <i>TP53</i>^<i>MUT</i> was also associated with inferior survival following allogeneic stem cell transplant (ASCT): median 9 months versus “not reached” in patients with (<i>N</i> = 9) versus without (<i>N</i> = 8) multihit <i>TP53</i>^MUT (<i>p</i> &lt; 0.01). The presence of multihit or non-multihit <i>TP53</i>^MUT in MPN-BP/AP or multihit <i>TP53</i>^MUT in MF-CP is associated with exceptionally poor prognosis and justifies inclusion into the ICC category of “myeloid neoplasms with mutated <i>TP53</i>.” By contrast, detection of non-multihit <i>TP53</i>^MUT, by itself, might not endanger short-term survival in MF-CP, PV, or ET.","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"22 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143050826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Pharmacokinetic Evaluation of Venetoclax in AML Supports Re-Evaluation of Recommended Dose Adjustments With Azole Antifungals","authors":"Jitesh D. Kawedia, Caitlin R. Rausch, Xiaoqian Liu, Wei Qiao, Courtney D. Dinardo, Naval Daver, Gautam Borthakur, Naveen Pemmaraju, Patrick Reville, Dimitrios P. Kontoyiannis, Nicholas Short, Marina Konopleva, Elias Jabbour, Guillermo Garcia-Manero, Farhad Ravandi, Hagop Kantarjian, Tapan M. Kadia","doi":"10.1002/ajh.27613","DOIUrl":"https://doi.org/10.1002/ajh.27613","url":null,"abstract":"&lt;p&gt;Incorporation of the BCL-2 inhibitor, venetoclax (VEN), into the treatment paradigm of acute myelogenous leukemia (AML) has led to a dramatic improvement in outcomes for older and unfit patients, demonstrating an overall survival benefit when added to azacitidine in patients with newly diagnosed (ND) AML ≥ 75 years, or otherwise ineligible for intensive chemotherapy [&lt;span&gt;1&lt;/span&gt;]. Posaconazole prophylaxis has improved overall survival in patients with ND AML undergoing remission induction chemotherapy anticipated to experience neutropenia for &gt; 7 days [&lt;span&gt;2&lt;/span&gt;]. As a result, prophylaxis with any mold-active triazole antifungal is recommended [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;The triazole antifungals inhibit CYP3A4, the enzyme responsible for VEN metabolism, to varying degrees. As a result, specific VEN dose reductions are recommended when co-administered with CYP3A4 inhibitors (CYP3A4i). A pharmacokinetic (PK) analysis of 11 patients receiving VEN with posaconazole 300 mg daily demonstrated an increase in mean &lt;i&gt;C&lt;/i&gt;&lt;sub&gt;max&lt;/sub&gt; by 53% and AUC by 76% with VEN 50 mg daily (VEN50), and a 93% increase in &lt;i&gt;C&lt;/i&gt;&lt;sub&gt;max&lt;/sub&gt; and 155% increase in AUC with VEN 100 mg (VEN100) [&lt;span&gt;4&lt;/span&gt;]. As a result, the FDA recommends VEN 70 mg daily in combination with posaconazole. Notably, in the VIALE-A trial, all patients receiving any strong CYP3A4i were dose-reduced to VEN50 [&lt;span&gt;1&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;We and others have reported a delay in time to platelet count recovery among patients with ND AML receiving increased VEN exposure as a result of increased VEN doses or when VEN is given in combination with azole antifungals, particularly posaconazole [&lt;span&gt;5, 6&lt;/span&gt;]. As a result, we hypothesized that VEN serum levels may be supratherapeutic when given in combination with posaconazole and that higher VEN levels could be associated with prolonged myelosuppression.&lt;/p&gt;\u0000&lt;p&gt;As part of an ongoing phase 2 study of VEN combined with cladribine and LDAC in older patients with ND AML (NCT03586609), we prospectively characterized VEN pharmacokinetics including &lt;i&gt;C&lt;/i&gt;&lt;sub&gt;max&lt;/sub&gt;, AUC, &lt;i&gt;C&lt;/i&gt;&lt;sub&gt;trough&lt;/sub&gt; and clearance when given with or without a strong CYP3A4i during induction. VEN100 was administered with voriconazole, VEN50 and VEN100 with posaconazole, and VEN 400 mg (VEN400) with caspofungin. Steady state VEN PK analysis was conducted on day 8. Blood samples were collected prior to the dose, and 2, 4, 8, and 24 h post dose. Trough (24-h post dose) levels were collected on days 12 and 16 of cycle 1 (Figure S1). We also evaluated the association between VEN trough levels and AUC as well as clinical outcomes. Complete methodology is in the Data S1.&lt;/p&gt;\u0000&lt;p&gt;Thirty-nine patients, median age 68 years (range, 61–77), were included for PK analysis (Table S1), of whom 33 (85%) achieved CR (&lt;i&gt;n&lt;/i&gt; = 29) or CRi (&lt;i&gt;n&lt;/i&gt; = 4) after induction. Among responders, 28 patients (85%) achieved MRD-negativity. Eighteen patients received VEN100 (&lt;i&gt;n&lt;/i&gt; =","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"206 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143050834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Red-Cell Transfusion in Childbirth and Long-Term Risk of Lymphoma and Autoimmune Disease: A Swedish Nationwide Cohort Study","authors":"Anne Brynolf, Anna Sandström, Henrik Hjalgrim, Gustaf Edgren","doi":"10.1002/ajh.27610","DOIUrl":"https://doi.org/10.1002/ajh.27610","url":null,"abstract":"&lt;p&gt;Red-cell transfusions during childbirth are essential for managing significant blood loss, but may have long-term immunological implications. While immediate risks like transfusion-transmitted infections are well-documented, less understood are the potential associated risks of future lymphoma and autoimmune disease [&lt;span&gt;1&lt;/span&gt;]. We performed a study that aimed to assess the long-term risk of developing non-Hodgkin lymphoma (NHL), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis, among women who received red-cell transfusions during childbirth.&lt;/p&gt;\u0000&lt;p&gt;A nationwide cohort study was conducted using data from SCANDAT3-S, the Swedish portion of the Scandinavian Donations and Transfusions database, covering blood donations and transfusions from 1968 to 2017. The database is linked to national health registers, including the National Patient Registers, National Medical Birth Register, National Cancer Register, and the National Prescribed Drug Register, providing comprehensive delivery information and health outcomes [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;\u0000&lt;p&gt;The study included women aged 18–50 years who had their first childbirth between January 1, 1987, and December 31, 2017. Women with prior diagnoses of autoimmune diseases, lymphoma, or those who had received blood transfusions before their first childbirth were excluded. The cohort comprised 1 043 713 women with 1 999 013 registered deliveries. Of these women, 42 333 (4.1%) received one or more red-cell transfusions during one or several deliveries.&lt;/p&gt;\u0000&lt;p&gt;The primary exposure was the receipt of at least one red-cell transfusion in the period from 3 days before delivery until 7 days postpartum. Exposure status was updated at each delivery; women who received transfusions during any delivery were categorized as “transfused” from that point onwards. The main outcomes were the first recorded diagnosis of NHL, SLE, systemic sclerosis, or RA, identified through the Swedish National Patient and Cancer Registers using ICD codes, which are available in Appendix A.&lt;/p&gt;\u0000&lt;p&gt;Cox proportional hazards models were used to estimate hazard ratios (HRs) for each outcome, comparing red-cell transfused women around delivery to those who were never transfused. We used “time since the most recent delivery” as the time scale, and follow-up began 6 months postpartum to minimize reverse causation. This choice allowed us to align the follow-up period with the postpartum interval for each childbirth. If a woman had more than one delivery during the study period, the time scale was reset at each delivery, and exposure status was updated accordingly.&lt;/p&gt;\u0000&lt;p&gt;Models were adjusted for potential confounders, including maternal age (years), body mass index (BMI), parity, mode of delivery, preeclampsia, socioeconomic factors (income, education), smoking status, ABO blood group, and birth origin. Follow-up continued until an outcome occurred, at which point a woman diagnosed with the outcome no longer contri","PeriodicalId":7724,"journal":{"name":"American Journal of Hematology","volume":"14 1","pages":""},"PeriodicalIF":12.8,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}