Raghuveer S Prabhu, Sarath R V S, Rahmathullah S N
{"title":"Large intramuscular hematoma due to acquired Factor VIII inhibitors in post Polycythemia Vera-Myelofibrosis.","authors":"Raghuveer S Prabhu, Sarath R V S, Rahmathullah S N","doi":"10.46989/001c.141157","DOIUrl":"10.46989/001c.141157","url":null,"abstract":"<p><p>A 59-year-old man with Janus kinase-2 (JAK2) V617F mutation-positive polycythemia vera, evolving to myelofibrosis presented with a right thigh hematoma. Further evaluation showed prolonged activated partial thromboplastin time (aPTT), which was partially corrected after mixing with pooled normal plasma (PNP) and, low factor VIII (F VIII) levels. He was diagnosed to have acquired F VIII inhibitors, and treated with prednisolone for inhibitor eradication. After four weeks of treatment, his aPTT normalized, F VIII rose to 86% and the hematoma was resolved. The case report is followed by a discussion on the topic, revisiting the handful of cases published so far, and the possible mechanisms leading to inhibitor formation in MPN. Further studies are required to elucidate the pathophysiology and the incidence of F VIII inhibitor development in myeloproliferative neoplasms.</p>","PeriodicalId":93942,"journal":{"name":"Clinical hematology international","volume":"7 3","pages":"14-19"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602465","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}
Jean El Cheikh, Ibrahim Hasan, Mustafa Saleh, Zyad Saifi, Mohamad Ammar Al Kouchak, Nour Moukalled, Iman Abu Dalle, Omar Fakhreddine, Ali Bazarbachi, Hadi Skouri
{"title":"The short-term Cardiotoxicity after Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective single center experience.","authors":"Jean El Cheikh, Ibrahim Hasan, Mustafa Saleh, Zyad Saifi, Mohamad Ammar Al Kouchak, Nour Moukalled, Iman Abu Dalle, Omar Fakhreddine, Ali Bazarbachi, Hadi Skouri","doi":"10.46989/001c.140766","DOIUrl":"10.46989/001c.140766","url":null,"abstract":"<p><p>Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered the best cure for many hematologic diseases, but it is associated with multiple short and long term cardiovascular adverse effects. This retrospective study assesses the short-term cardiovascular consequences after allo-HSCT and compares the risk of developing cardiotoxicity based on conditioning regimens and post-transplant prophylactic medications. A total of 310 patients were identified at the American University of Beirut Medical Center (AUBMC), of whom 255 were followed up for 100 days post-transplant. There was a significant decrease in left ventricular ejection fraction (LVEF), from a mean of 59.14% pre-transplant to 58.44% post-transplant (P= 0.037). Significant decreases were also noted in the E wave, E' wave, and E/A ratio (P <0.01, <0.001, and 0.006, respectively), while no significant changes were observed in A wave or E/E' ratio (P= 0.197 and 0.078, respectively). No significant decrease in global longitudinal strain was noted (P=0.18). Haploidentical transplants, cyclophosphamide, and sequential conditioning regimens were associated with reduced LVEF (P= 0.002, 0.007 and 0.019, respectively). Among those followed up for 100 days, 8 patients (3.2%) developed moderate or large pericardial effusion. While the average decrease in LVEF was of no clinical significance, the percentage of patients with reduced LVEF (<50%) increased from 3.1% pre-transplant to 6.7% at 100 days. These subclinical changes in LVEF and diastolic measurements are not fully understood. We recommend serial echocardiographic follow-ups to assess their potential clinical relevance and the risk of cardiotoxicity later in life, particularly those undergoing haploidentical transplant, receiving cyclophosphamide or sequential conditioning regimens.</p>","PeriodicalId":93942,"journal":{"name":"Clinical hematology international","volume":"7 3","pages":"1-13"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577245","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":"Moving the Needle in KMT2A Rearranged Pediatric B-Cell Acute Lymphoblastic Leukemia: Newer agents and novel approaches.","authors":"Anwesha Ray, Aditi Jain, Mona Vijayaran, Steve Thomas, Jayastu Senapati, Mukul Aggarwal","doi":"10.46989/001c.141198","DOIUrl":"10.46989/001c.141198","url":null,"abstract":"<p><p>Pediatric B-cell acute lymphoblastic leukemia (B-ALL) has been the poster child of progressive success in the development of leukemia therapy. Among the genomically defined high-risk subtypes of B-ALL are those with <i>KMT2A</i>-rearrangement (r) which are associated with inferior outcomes with chemotherapy-based approaches. <i>KMT2A</i>-r ALL is most common in the infantile period but can be seen beyond it and has remained a therapeutic challenge. Recent clinical trials have shown a significant improvement in response rates and survival outcomes in infantile and pediatric non-infant patients with <i>KMT2A</i>-r B-ALL when treated with blinatumomab-containing regimens. A single course of sequential blinatumomab added to Interfant-06 chemotherapy led to an exceptional improvement in 2-year disease free survival to 82% compared to 49% from historical chemotherapy only approach. In the salvage settings the use of tisagenlecleucel chimeric antigen receptor (CAR) T-cell therapy has led to high response rates and durable remissions in pediatric <i>KMT2A</i>-r B-ALL. Recently, inotuzumab ozogamicin was approved in pediatric (>1 year) relapsed/refractory B-ALL, widening immunotherapy-based salvage options. However, the efficacy of inotuzumab in <i>KMT2A</i>-r B-ALL remains questionable, given lower CD22 expression in this ALL genotype. Additionally, the approval of menin inhibitors like revumenib in <i>KMT2A</i>-r pediatric acute leukemias provides another treatment option in the salvage setting for this high-risk pediatric B-ALL subtype. These targeted agents are positively altering the treatment approaches and outcomes in pediatric <i>KMT2A</i>-r B-ALL, and the use of better residual disease monitoring with next generation sequencing might further help to refine treatment approaches in such high-risk pediatric ALL.</p>","PeriodicalId":93942,"journal":{"name":"Clinical hematology international","volume":"7 2","pages":"65-73"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531651","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}
Shehab Fareed, Abdulrahman Fadhl Al-Mashdali, Hawraa Shwaylia, Yahya Mulikandathil, Awni Alshurafa, Sarah Aldali, Deena Sideeg Mudawi, Dina Soliman, Feryal Abbas, Mohammed Abdulgayoom, Anil Yousef, Kaplana Singh, Honar Cherif, Mohamed Yassin
{"title":"Clinical Characteristics and Treatment Outcomes of Acute Myeloid Leukemia in Adolescent and Young Adult versus Adult Patients: A Single-Center Experience in Qatar.","authors":"Shehab Fareed, Abdulrahman Fadhl Al-Mashdali, Hawraa Shwaylia, Yahya Mulikandathil, Awni Alshurafa, Sarah Aldali, Deena Sideeg Mudawi, Dina Soliman, Feryal Abbas, Mohammed Abdulgayoom, Anil Yousef, Kaplana Singh, Honar Cherif, Mohamed Yassin","doi":"10.46989/001c.140933","DOIUrl":"10.46989/001c.140933","url":null,"abstract":"<p><p>Acute myeloid leukemia (AML) presents differently across age groups, with unique challenges in the adolescent and young adult (AYA) populations. This study compares clinical characteristics and outcomes between AYA and adult AML patients in Qatar. We conducted a retrospective analysis of 151 AML patients treated at the National Center for Cancer Care and Research, Qatar, between 2017-2021. Patients were divided into AYA (15-39 years, n=73) and adults (≥40 years, n=78) groups. Clinical characteristics, cytogenetic profiles, treatment approaches and survival outcomes were compared between groups. AYA patients (median age 30 years) showed distinct characteristics compared to adults (median age 53.9 years). AYA patients had lower platelet counts (62,900/mm³ versus 96,500/mm³, p=0.016) and higher blast percentages in peripheral blood and bone marrow (60% versus 40%, p=0.02). Core binding factor rearrangements were more common in AYA patients (32% versus 12%, p=0.03), while adult patients had more diploid karyotypes (55% versus 36%). AYA patients received more intensive therapy, with higher rates of FLAG-Ida salvage therapy (34% versus 15%) and allogeneic transplantation (32% versus 15%, p=0.01). While transplantation significantly improved survival in adults, its impact was less pronounced in AYA patients. Median overall survival was comparable between groups (23.14 versus 24.08 months, p=0.09). Our study reveals distinct biological and clinical characteristics between AYA and adult AML patients in Qatar. Despite receiving more intensive therapy, AYA patients showed comparable survival outcomes to adults, suggesting the need for age-specific treatment approaches. The differential impact of transplantation between age groups highlights the importance of personalized treatment strategies. These findings contribute to understanding age-specific differences in AML and may help optimize treatment approaches for both populations.</p>","PeriodicalId":93942,"journal":{"name":"Clinical hematology international","volume":"7 2","pages":"55-64"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12189011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499840","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}
Alfadil Haroon, Syed Osman Ahmed, Chokri Ben Lamine, Mahmoud Aljurf, Hazzaa Alzahrani
{"title":"Genetic and Clinical Progression of MYSM1 Related Bone Marrow Failure into Myeloid Malignancies: Case Series and Review of Literature.","authors":"Alfadil Haroon, Syed Osman Ahmed, Chokri Ben Lamine, Mahmoud Aljurf, Hazzaa Alzahrani","doi":"10.46989/001c.138314","DOIUrl":"10.46989/001c.138314","url":null,"abstract":"<p><p>MYSM1, located on chromosome 1p32.1, encodes histone H2A deubiquitinase, a transcription regulator involved in DNA damage response. Biallelic MYSM1 variants are linked to rare bone marrow failure syndromes, presenting with cytopenia, B-cell deficiency, hypogammaglobulinemia, and developmental abnormalities. We report four cases of MYSM1 mutations progressing from marrow failure to MDS or AML within 9-10 years. Genetic abnormalities, including TP53 mutation and chromosomal anomalies, suggest clonal evolution. Hematopoietic stem cell transplantation achieved remission in two patients with adverse cytogenetics. Further research is needed to refine management strategies and assess long-term outcomes in MYSM1-associated marrow failure and MDS.</p>","PeriodicalId":93942,"journal":{"name":"Clinical hematology international","volume":"7 2","pages":"46-54"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12176283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144328128","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}
Shea-Lee Godin, Christopher Hanna, Edgar Naut, Sudhanshu Mulay
{"title":"Impact of Anemia Management on Bleeding Outcomes in Anticoagulated Patients: A Retrospective Cohort Analysis.","authors":"Shea-Lee Godin, Christopher Hanna, Edgar Naut, Sudhanshu Mulay","doi":"10.46989/001c.138102","DOIUrl":"10.46989/001c.138102","url":null,"abstract":"<p><p>Anticoagulation therapy is essential to manage thromboembolic conditions such as atrial fibrillation and venous thromboembolism. While effective, it carries significant bleeding risks, with annual rates ranging from 10-17% for all events and 2-5% for major bleeding. Anemia is an independent risk factor for anticoagulation-associated bleeding; however, guidelines lack recommendations for anemia screening and management before initiation. In a retrospective analysis of 170 anticoagulated patients (mean age 63.7; 96 males, 74 females), 51.2% had baseline anemia. Anemia severity was significantly associated with bleeding events (χ²=15.7, p=0.003). Multivariate analysis confirmed that moderate (aOR=0.26, 95% CI:0.08-0.82, p=0.021) and no anemia (aOR=0.42, 95% CI:0.22-0.82, p=0.011) were associated with lower bleeding risk than mild anemia, while severe anemia remained uninterpretable due to small sample size. Patients aged ≥65 had higher bleeding risk (OR=2.8, 95% CI:1.5-5.1, p<0.01), though this did not reach significance in multivariate analysis (aOR=1.80, 95% CI:0.95-3.41, p=0.073). Multivariate analysis confirmed higher bleeding risks for warfarin (aOR=4.13, 95% CI:1.91-8.96, p<0.001) and rivaroxaban (aOR=3.67, 95% CI:1.69-7.97, p=0.001) compared to apixaban. Our study found an association between anemia and bleeding events, though severe anemia did not correlate with bleeding, possibly due to small sample size. Direct oral anticoagulants like apixaban and rivaroxaban present lower bleeding risks than warfarin. Given anemia's role in bleeding risk, we recommend routine screening before initiating anticoagulation to improve patient safety. Early assessment may help reduce bleeding complications, particularly in high-risk populations. Future studies should focus on multi-center trials to validate these findings and explore anemia subtypes.</p>","PeriodicalId":93942,"journal":{"name":"Clinical hematology international","volume":"7 2","pages":"34-45"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12121077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183164","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}
Ahmad Alhuraiji, Khalil Al Farsi, Kayane Mheidly, Hesham Elsabah, Honar Cherif, Anas Hamad, Mahmoud Marashi, Hussni Al Hateeti, Hani Osman, Mohamad Mohty
{"title":"Relapsed/refractory multiple myeloma: standard of care management of patients in the Gulf region.","authors":"Ahmad Alhuraiji, Khalil Al Farsi, Kayane Mheidly, Hesham Elsabah, Honar Cherif, Anas Hamad, Mahmoud Marashi, Hussni Al Hateeti, Hani Osman, Mohamad Mohty","doi":"10.46989/001c.137860","DOIUrl":"https://doi.org/10.46989/001c.137860","url":null,"abstract":"<p><p>Clinical management of patients with relapsed/refractory multiple myeloma (RRMM) can be challenging, whereby each relapse is associated with progressively poorer outcomes. In addition, changes in disease biology and patient characteristics hamper treatment strategies in this setting, as do toxicities accumulated across previous lines of therapy. The availability of several new treatment classes has brought about improvements in outcomes, but with median survival in the RRMM setting at only ~32 months, a review of current standard of care treatments and considerations for optimizing care in this setting is warranted. Here, we discuss our preferred approach to treating patients with RRMM, based on our collective experience across the Gulf region. We present position statements for the treatment of lenalidomide-sensitive and -refractory patients, as well as for those patients experiencing late relapse. We discuss the major impact that anti-CD38 agents daratumumab and isatuximab have had on the management of RRMM, which is reflected in our preferred use of daratumumab-based regimens across the lenalidomide-sensitive and -refractory settings. For late-relapse settings, we discuss how bispecific antibodies and chimeric antigen receptor [CAR]-T cells are among the biggest breakthroughs in recent years, achieving excellent responses in triple-class exposed patients. While the use of these agents is not yet widespread in the Gulf region, we advocate their use where available and discuss strategies to manage and minimize common toxicities and adverse events associated with their use.</p>","PeriodicalId":93942,"journal":{"name":"Clinical hematology international","volume":"7 2","pages":"20-33"},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044697","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}
Wenming Chen, Zhen Cai, James Cs Chim, Wee Joo Chng, Juan Du, Chengcheng Fu, Ichiro Hanamura, Jian Hou, Jeffrey Shang-Yi Huang, Tadao Ishida, Aijun Liu, Vadim Ptushkin, Anastasiya Semenova, Naoki Takezako, Raymond Siu Ming Wong
{"title":"Consensus Guidelines and Recommendations for The CD38 Monoclonal Antibody-based Quadruplet Therapy and Management in Clinical Practice for Newly Diagnosed Multiple Myeloma: From the Pan-Pacific Multiple Myeloma Working Group.","authors":"Wenming Chen, Zhen Cai, James Cs Chim, Wee Joo Chng, Juan Du, Chengcheng Fu, Ichiro Hanamura, Jian Hou, Jeffrey Shang-Yi Huang, Tadao Ishida, Aijun Liu, Vadim Ptushkin, Anastasiya Semenova, Naoki Takezako, Raymond Siu Ming Wong","doi":"10.46989/001c.133682","DOIUrl":"https://doi.org/10.46989/001c.133682","url":null,"abstract":"<p><p>The therapeutic outcomes of clinical trials for incorporating anti-CD38 monoclonal antibodies (including isatuximab and daratumumab) into the bortezomib/lenalidomide/dexamethasone (VRd) triplet therapy backbone as the first-line treatment for newly diagnosed multiple myeloma (NDMM) have demonstrated significant improved efficacies. From a safety perspective, the addition of anti-CD38 monoclonal antibodies into the triplet therapies did not raise additional safety concerns. Based on the promising results, the National Comprehensive Cancer Network (NCCN) Guidelines Version 1.2025 had updated the quadruplet therapy incorporating anti-CD38 monoclonal antibodies with VRd-based therapies as the primary therapy for both transplantation-eligible and transplantation-ineligible NDMM patients. Thus, a panel of experts in hematology and oncology with extensive experience in the treatment of NDMM was convened in 2024 to develop consensus recommendations based on recent evidence from pivotal clinical trials and real-world practices, providing clear guidance for optimizing treatment strategies in both transplantation-eligible and transplantation-ineligible patients. The main topics identified for discussion and recommendation were: (i) the benefits and indications for quadruplet therapy for NDMM; (ii) the optimization of quadruplet therapy strategies; (iii) the management and monitoring of potential adverse events for quadruplet therapy, and (iv) the impact of quadruplet regimens on tandem stem cell transplantation and maintenance treatment. Recommendations were then presented to the entire panel for further discussion and amendment before voting. This manuscript presents the recommendations developed, including findings from the expert panel discussions, consensus recommendations and a summary of evidence supporting each recommendation.</p>","PeriodicalId":93942,"journal":{"name":"Clinical hematology international","volume":"7 2","pages":"1-19"},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000136","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}
Robin Noel, Aude Charbonnier, Bérénice Schell, Arthur Dony, Charles Toulemonde, François Eisinger, Olivier Decaux, Joanna Lotocka, Edith Julia, Alya Perthus, Mathilde Seguin, Aurélie Cabannes-Hamy, Pierre Sujobert, Laurie Marrauld, Caroline Besson
{"title":"It is time to consider the climate crisis in haematology.","authors":"Robin Noel, Aude Charbonnier, Bérénice Schell, Arthur Dony, Charles Toulemonde, François Eisinger, Olivier Decaux, Joanna Lotocka, Edith Julia, Alya Perthus, Mathilde Seguin, Aurélie Cabannes-Hamy, Pierre Sujobert, Laurie Marrauld, Caroline Besson","doi":"10.46989/001c.133524","DOIUrl":"10.46989/001c.133524","url":null,"abstract":"","PeriodicalId":93942,"journal":{"name":"Clinical hematology international","volume":"7 1","pages":"55-59"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756469","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":"Prolonged Cytopenia with CAR-T Cell Therapy and Management Recommendations.","authors":"Debolanle Dahunsi, Cynthia Eleanya, Akintomiwa Akintunde, Olalekan Oluwole","doi":"10.46989/001c.126463","DOIUrl":"10.46989/001c.126463","url":null,"abstract":"<p><p>Chimeric antigen receptor T-cell (CAR T-cell) therapy has revolutionized the treatment of lymphoid malignancies. Prolonged cytopenias, though poorly understood, have emerged as important considerations in the treatment process. In this review, we classified cytopenias into early (< 30 days post CAR T infusion), and late-occurring (after day 30 post infusion). We identified previous chemotherapy and lymphodepletion chemotherapy as the major risk factors contributing to early cytopenia. Product characteristics, such as costimulatory domains, and side effects of therapy such as cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS) were identified as contributing factors to prolonged cytopenias occurring more than 30 days post CAR-T infusion. We recommend close monitoring with frequent checks, enhanced care with granulocyte colony stimulating factor (GCSF) support for grade 3-4 neutropenia, blood transfusion for severe anemia (Hb < 7g/dL), platelets for severe thrombocytopenia (< 10,000/µL) and thrombopoietin (TPO) mimetics such as eltrombopag or romiplostim for prolonged severe thrombocytopenia in patients at high-risk of hemorrhagic complications.</p>","PeriodicalId":93942,"journal":{"name":"Clinical hematology international","volume":"7 1","pages":"47-54"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756471","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}