bims-hemali Biomed News
on Hematologic malignancies
Issue of 2025–06–22
thirteen papers selected by
Alexandros Alexandropoulos, Γενικό Νοσοκομείο Αθηνών Λαϊκό



  1. Blood Adv. 2025 Jun 15. pii: bloodadvances.2025016483. [Epub ahead of print]
      Follicular lymphoma (FL) has a clinical course often defined by high response rates to first-line therapy, followed by multiple relapses over a prolonged natural history. Currently, there are multiple possible approaches to frontline therapy for untreated advanced-stage FL, with debate remaining as to what is the preferred approach. Given prior benefits seen in combining lenalidomide, an immunomodulatory agent, with rituximab, an anti-CD20 antibody, we aimed to evaluate the safety and efficacy of lenalidomide in combination with obinuzutumab, an anti-CD20 antibody with enhanced antibody-dependent cellular cytotoxicity (ADCC). Eligibility criteria included a diagnosis of FL, grade 1-3a, stage II-IV, ECOG ≤ 2, adequate organ function, and high tumor burden according to Groupe d'Étude des Lymphomes Folliculaires (GELF) criteria. Participants received six cycles of induction with the combination, followed by 24 cycles of maintenance. Among 90 patients, the primary endpoint, 2-year PFS, was 93.3% (95% confidence interval (CI), 88.2-98.6%), and median progression-free survival (PFS) was not reached with a median follow up of 70.7 months. The complete response rate (CRR) at 30 months was 89.7% (95% CI, 81.3-95.2%). The most common adverse events (AEs) of any grade were diarrhea (61.1%), maculopapular rash (53.3%), and fatigue (52.2%). The most common AEs ³ grade 3 were neutropenia (18.9%), maculopapular rash (11.1%), and pneumonia (6.7%). In this single-center trial, these findings indicate that for patients with previously untreated, high tumor burden FL, obinutuzumab and lenalidomide resulted in robust and durable responses with favorable 2-year PFS and manageable safety profile. This study was registered at clinicaltrials.gov (NCT02871219).
    DOI:  https://doi.org/10.1182/bloodadvances.2025016483
  2. J Clin Oncol. 2025 Jun 16. JCO2500204
      Older patients with classic Hodgkin lymphoma (cHL) have inferior survival compared with younger patients. We report a subset analysis of older patients (60 years and older) enrolled in the phase three S1826 trial conducted by SWOG that randomly assigned patients with newly diagnosed advanced-stage (III-IV) cHL to six cycles of nivolumab (N)-AVD or brentuximab vedotin (BV)-AVD. Of 103 enrolled patients 60 years and older, 99 were eligible. At a median follow-up of 2.1 years, the 2-year progression-free survival was 89% after N-AVD (n = 50) and 64% after BV-AVD (n = 49, HR 0.24, 95%CI 0.09-0.63, 1-sided stratified log-rank P = .001). The 2-year OS was 96% with N-AVD versus 85% with BV-AVD (HR 0.16, 95%CI 0.03-0.75 stratified 1-sided log-rank P = .005). Six cycles were delivered without dose reduction in 69% on N-AVD and 26% on BV-AVD; 55% discontinued BV, and 14% discontinued nivolumab. The nonrelapse mortality was 16% with BV-AVD and 6% with N-AVD. Despite more neutropenia with N-AVD, febrile neutropenia, sepsis, and infections were higher with BV-AVD, as was peripheral neuropathy. Patient-reported outcomes of key adverse events confirmed the improved toxicity profile of N-AVD over BV-AVD. N-AVD was better tolerated and more effective than BV-AVD and is therefore a new standard of care for older patients with advanced-stage cHL fit for anthracycline-based combination therapy.
    DOI:  https://doi.org/10.1200/JCO-25-00204
  3. Noncoding RNA Res. 2025 Oct;14 14-24
      Tyrosine kinase inhibitors (TKI), such as imatinib, have revolutionized chronic myeloid leukemia (CML) treatment. Despite this success, TKI intolerance and resistance remain significant clinical challenges. A promising therapeutic approach is to simultaneously target the BCR::ABL1 oncogene and other oncogenic drivers. The polycistronic miR-17-92 cluster is known to contribute to CML development and progression, but the specific roles of miR-92a-1-5p within this cluster remain unclear. In this study, we assess the roles of this microRNA and evaluate the therapeutic potential of combining microRNA inhibition with imatinib to improve treatment outcome. Our results show that miR-92a-1-5p is downregulated by imatinib in myeloid cell lines harboring BCR::ABL1 and in CML patient samples. Inhibition of miR-92a-1-5p reduces proliferation and enhances imatinib-induced cell death, while its overexpression increases proliferation and counteracts the effects of imatinib on cell death. This decrease in proliferation caused by miR-92a-1-5p inhibition is rescued after simultaneous inhibition of two newly identified target genes: BNIP3L (NIX) and TP53INP1. We confirm that miR-92a-1-5p regulates proliferation and cell cycle by targeting TP53INP1 and decreases autophagy by targeting BNIP3L. Our data suggest that miR-92a-1-5p plays a role in CML progression, and its inhibition enhances imatinib anti-leukemic efficacy, making it a potential therapeutic target.
    Keywords:  BNIP3L; TP53INP1; chronic myeloid leukemia; imatinib; miR-92a-1-5p
    DOI:  https://doi.org/10.1016/j.ncrna.2025.05.008
  4. J Clin Oncol. 2025 Jun 18. JCO2500481
       PURPOSE: Improved outcomes are needed for patients with high-risk (HR) large B-cell lymphoma (LBCL) who have <50% chance of cure with first-line (1L) R-CHOP chemotherapy. Patients with high burden or rapid progression are often excluded from 1L trials due to screening requirements. We report the investigator-initiated, phase II COALITION trial of the CD20xCD3 bispecific antibody glofitamab combined with R-CHOP or Pola-R-CHP in younger patients with HR features, designed to minimize time between diagnosis and treatment.
    METHODS: Patients age ≤65 years with LBCL and at least one HR feature (international prognostic index [IPI] ≥3, National Comprehensive Cancer Network-IPI ≥4, or rearrangements of MYC and BCL2 and/or BCL6) received one cycle of R-CHOP and were randomly assigned to five cycles of Glofit-Pola-R-CHP (n = 40) or Glofit-R-CHOP (n = 40), and two cycles of glofitamab consolidation. Enrollment occurred before or after a cycle of R-CHOP. The primary objective was safety and treatment deliverability. Secondary end points included response rates and survival.
    RESULTS: Eighty evaluable patients with a median age of 58 years and total metabolic tumor volume of 842 cm3 were included and began treatment a median of 14 days from diagnosis. Over 95% of patients completed all therapy and the median relative dose intensity was >94%. Cytokine release syndrome was observed in 21% of patients, all ≤grade 2 and manageable. Overall and complete response rates were 100% and 98%, respectively. At 20.7-month median follow-up, the estimated 2-year progression-free survival and overall survival were 86% and 92%, respectively.
    CONCLUSION: The combination of glofitamab with R-CHOP or Pola-R-CHP is deliverable and results in high rates of durable response in this population of younger patients with high-burden, HR LBCL, supporting its ongoing exploration as a 1L treatment.
    DOI:  https://doi.org/10.1200/JCO-25-00481
  5. Clin Ther. 2025 Jun 13. pii: S0149-2918(25)00172-9. [Epub ahead of print]
       PURPOSE: Venetoclax in combination with hypomethylating agents (HMAs) has become the standard treatment for acute myeloid leukemia (AML) patients ineligible for intensive chemotherapy. However, its high cost limits its accessibility in low- and middle-income countries. This study aims to evaluate the efficacy and safety of grapefruit juice combined with low-dose venetoclax and azacitidine as a feasible cost-reduction strategy.
    METHODS: This prospective single-center study included 44 newly diagnosed elderly or unfit AML patients treated at our hospital between December 2020 and May 2024. Patients were assigned to two cohorts in parallel: 34 patients received standard-dose venetoclax combined with azacitidine (cohort 1), whereas 10 patients received low-dose venetoclax combined with grapefruit juice and azacitidine (cohort 2). The response to treatment, overall survival (OS), and progression-free survival (PFS) were evaluated. The peak venetoclax concentration (Cmax) and side effects of the patients were also monitored.
    FINDINGS: The median age of participants was 67.5 years (25 males and 19 females). The overall response rate (ORR) after the first treatment cycle was 85.3% in cohort 1 and 100% in cohort 2 (P = 0.5730), and the best ORR was 91.2% in cohort 1 and 100% in cohort 2 (P > 0.9999). The median OS was 9 months in cohort 1 and 8.15 months in cohort 2 (P = 0.7103). The median PFS was 7 months in cohort 1 and 6.15 months in cohort 2 (P = 0.7068). The median Cmax of venetoclax in the whole cohort was 1664 ng/mL, with no significant difference between groups (P = 0.1614), and no significant correlation observed between venetoclax Cmax and age (P = 0.4575). The most common adverse events were thrombocytopenia, anemia, and neutropenia.
    IMPLICATIONS: The combination of grapefruit juice with low-dose venetoclax demonstrates comparable efficacy and safety to the standard-dose regimen, while achieving a 75% reduction in drug costs. This approach offers a cost-effective treatment option for AML patients in resource-limited settings. Further large-scale, multicenter studies are required to validate the clinical feasibility of this regimen.
    Keywords:  Acute myeloid leukemia; CYP3A4; Grapefruit juice; Low-dose; Venetoclax
    DOI:  https://doi.org/10.1016/j.clinthera.2025.05.008
  6. Front Neurol. 2025 ;16 1570224
       Background: Relapsed or refractory central nervous system lymphoma (rrCNSL) lacks established preferred treatment and carries an inferior prognosis. Bruton's tyrosine kinase inhibitor (BTKi) showed promising effectiveness. Orelabrutinib is a second-generation BTKi with a high concentration in cerebrospinal fluid.
    Methods: In this retrospective analysis, the outcomes of 37 relapsed or refractory central nervous system diffuse large B-cell lymphoma patients who received orelabrutinib, high-dose methotrexate, ifosfamide, etoposide, and dexamethasone (Ore-MIED) or orelabrutinib, high-dose methotrexate, temozolomide and dexamethasone (Ore-MTD) were evaluated.
    Results: Of the 37 patients included, 11 received Ore-MTD, and 26 received the Ore-MIED regimen. The overall response rate in our cohort was 89.2%, with complete remission achieved in 51.4% of patients and partial remission in 37.8% of patients. The median progression-free survival was observed to be 7.0 months. No statistically significant difference was found in the median progression-free survival between patients receiving different treatment regimens (5.0 months for Ore-MTD versus 13.0 months for Ore-MIED; p = 0.29). Moreover, the median overall survival has not been reached in this cohort, indicating a promising outcome despite the aggressive nature of the disease.
    Conclusion: Our study confirms the effectiveness and safety of Ore-MIED/Ore-MTD in rrCNSL patients, even in those with previous exposure to multiple lines of treatment.
    Keywords:  Bruton’s tyrosine kinase inhibitor; central nervous system lymphoma; methotrexate; orelabrutinib; relapsed or refractory
    DOI:  https://doi.org/10.3389/fneur.2025.1570224
  7. Hematol Oncol. 2025 Jun;43 Suppl 2 e70080
      Nodular lymphocyte-predominant B-cell/Hodgkin lymphoma (NLPB/HL) accounts for roughly 5% of all Hodgkin lymphoma (HL) cases. In contrast to classic HL (cHL), the malignant cells in NLPB/HL lack CD30 expression but maintain a complete phenotype of mature B-cells including CD20 and IgG, but occasionally show IgD expression. The tumor cells are known as lymphocyte-predominant (LP) cells and grow in a T-cell and histiocyte rich microenvironment against a background of follicular dendritic cells. Transformation to large B cell lymphoma may occur and requires excisional lymph node biopsies. Most patients with NLPB/HL present in early stages. The disease usually has an indolent clinical course. Approaches applied in cHL result in very good outcomes with only limited excess mortality in comparison with the general population. Activity has also been demonstrated for rituximab-containing regimens commonly used in indolent B-cell non-Hodgkin lymphoma. The present article reviews pathological characteristics, treatment options and tools that might improve risk stratification in NLPB/HL.
    Keywords:  Hodgkin lymphoma; T‐cell and histiocyte reach large B‐cell lymphoma; immuno‐architectural patterns; lymphoma transformation; nodular lymphocyte‐predominant B‐cell/Hodgkin lymphoma
    DOI:  https://doi.org/10.1002/hon.70080
  8. Hematol Oncol. 2025 Jun;43 Suppl 2 e70064
      The management of relapsed/refractory (R/R) chronic lymphocytic leukemia (CLL), particularly when patients have double-refractory CLL with progression after both covalent Bruton's tyrosine kinase inhibitors (BTKi) and venetoclax, as well as Richter Transformation (RT) remain significant clinical challenges. These patients face poor outcomes, necessitating novel treatment approaches. Recently approved therapies such as a non-covalent BTKi and CAR-T cells provide new options, while BTK degraders and bispecific antibodies are showing early promise in clinical trials. For RT, venetoclax-based chemoimmunotherapy combinations may increase rates of complete response, but remain inadequate for many, highlighting the need for novel therapeutic approaches. This review synthesizes recent advancements in R/R CLL and RT treatment, discussing approved therapies, investigational agents, and combination strategies aimed at improving outcomes in these high-risk populations.
    Keywords:  BTK inhibitors; CAR‐T therapy; Richter's Transformation (RT); bispecific antibodies; chronic lymphocytic leukemia (CLL); double‐refractory
    DOI:  https://doi.org/10.1002/hon.70064
  9. Hematol Oncol. 2025 Jun;43 Suppl 2 e70069
      Peripheral T-cell lymphoma (PTCL) is a rare and heterogeneous group of diseases, with over 30 subtypes according to the International Consensus Classification of Mature Lymphoid Neoplasms (ICC) and World Health Organization Classification of Hematolymphoid Tumors (WHO-HEM) 2022. The classification complexity reflects the underlying genetic and biological diversity of PTCL. For decades, distinct PTCL subtypes have been uniformly treated with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) or CHOP-like regimens originally developed for mainly B-cell lymphoma. Attempts to improve frontline CHOP-plus strategies have failed mainly due to toxicities and lack of biological rationale. Only the ECHELON-2 trial succeeded as more than 70% of patients had anaplastic large cell lymphoma (ALCL), where brentuximab vedotin (BV) is most effective. Looking ahead to 2025 and beyond, future treatment strategies for PTCL should be guided by a deeper understanding of its underlying biology rather than relying on empirical extrapolations from other lymphomas.
    Keywords:  CHOP; brentuximab‐vedotin; follicular helper T‐cell lymphoma; peripheral T‐cell lymphoma
    DOI:  https://doi.org/10.1002/hon.70069
  10. Blood. 2025 Jun 20. pii: blood.2025028412. [Epub ahead of print]
      Disease-defining signatures in lymphomas, driven by intricate molecular mechanisms, have advanced molecular taxonomies, refined classification, and may guide clinical management; however, the role of these signatures in driving disease hallmarks including subtype-specific organotropism remains largely unexplored. Primary mediastinal large B-cell lymphoma (PMBCL) is an exemplary lymphoma characterized by disease manifestations in the thymic niche, unique genetic alterations and immune escape. Here, we identified IRF4-C99R mutations uniquely occurring in PMBCL through mutational meta-analysis of large-scale datasets. Our functional studies, integrating multi-omics approaches with genome editing in PMBCL cells, revealed that IRF4-C99R contributes to a differentiation block phenotype. Specifically, we showed that IRF4-C99R reduces its binding to the ISRE motif within PRDM1, which encodes a key transcriptional regulator of B-cell differentiation, resulting in decreased PRDM1 expression. Additionally, IRF4-C99R suppresses TNIK, a key IFNγ pathway regulator, by impairing ISRE motif binding, thereby reducing IFNγ signaling and increasing thymus and activation-regulated chemokine (TARC) expression, which drives TARC-mediated chemotaxis of T regulatory cells. We also revealed that IRF4-C99R upregulates Ephrin Type-B Receptor 1 (EPHB1) through non-canonical AICE motif binding, and showed that overexpression of EPHB1 in an immunocompetent syngeneic lymphoma model influenced organotropism to favor thymic localization, without affecting tumor burden in other organs. IRF4-C99R mutation-induced phenotypes were validated in primary PMBCL tissues using single-nuclei RNA sequencing, confirming that the molecular mechanisms observed in vitro align with the pathophysiology of PMBCL in patients. Together, these findings demonstrate how a single genetic mutation orchestrates the coordinated regulation of hallmark traits including thymus-specific tropism in PMBCL.
    DOI:  https://doi.org/10.1182/blood.2025028412
  11. Hematol Oncol. 2025 Jun;43 Suppl 2 e70071
      Waldenström macroglobulinemia (WM) is an IgM secreting lymphoplasmacytic lymphoma. Mutations in MYD88 (95%-97%) and CXCR4 (30%-40%) are common in patients with WM. TP53 is also altered in up to 30% of WM patients, particularly those previously treated. Mutated MYD88 triggers the expression and activation of HCK that drives multiple pro-survival signaling cascades, including BTK. There are over 40 CXCR4 mutation types in WM. WM patients bearing nonsense CXCR4 variants can present with symptomatic hyperviscosity and show greater resistance to covalent BTK inhibitors (cBTK-i). The cBTK-i zanubrutinib shows greater response activity and/or improved progression-free survival in WM patients with wild-type MYD88, mutated CXCR4, or altered TP53. New or emerging options for patients progressing on c-BTKi include pirtobrutinib, BGB-16673, venetoclax, and sonrotoclax. Combinations of BTK inhibitors with chemoimmunotherapy and BCL2 antagonists have advanced. Algorithms for patients with treatment-naïve and previously treated WM based on genomics, disease characteristics, and co-morbidities are discussed.
    Keywords:  BTK; CXCR4; MYD88; TP53; Waldenström macroglobulinemia; lymphoplasmacytic lymphoma
    DOI:  https://doi.org/10.1002/hon.70071