30-Second Takeaway
- HMA maintenance after allo-HSCT lowers relapse and improves survival in adverse-risk AML, especially with myelodysplasia-related mutations.
- Nearly one-quarter of platelet transfusions are guideline-noncompliant, with major overuse in cardiac surgery and prophylaxis settings.
- Pola-R-CHP improves 1-year PFS versus R-CHOP but leaves CNS and extranodal relapses largely unchanged in frontline DLBCL.
Week ending December 27, 2025
Targeted advances and practice gaps in hematologic malignancy and transplant care
Post-transplant HMA maintenance improves outcomes in adverse-risk AML
Among 469 adverse-risk AML allo-HSCT recipients, HMA maintenance reduced 3-year relapse versus no maintenance (19.2% vs 34.0%). HMA maintenance improved 3-year event-free survival (68.6% vs 43.4%), relapse-free survival (69.1% vs 48.6%), and overall survival (72.1% vs 61.0%). Benefit was greatest in AML with myelodysplasia-related gene mutations, with an event-free survival hazard ratio of 0.47. Patients transplanted in CR1 with undetectable MRD appeared to derive little benefit from maintenance. Results were consistent across centers, supporting HMA maintenance in genetically high-risk, MRD-positive subgroups.
Large multicenter audit exposes pervasive platelet transfusion overuse
Across 821,950 admissions at 22 hospitals, 56,825 platelet transfusion events were evaluated against evidence-based thresholds. Overall, 23.2% of platelet transfusions were guideline-noncompliant, indicating substantial avoidable use. Noncompliance was highest with antiplatelet therapy (48.5%), cardiac surgery (49.7%), invasive procedures (29.2%), immune thrombocytopenia (32.9%), and primary prophylaxis (47.2%). Academic centers had fewer noncompliant transfusions than community hospitals (adjusted OR 0.768). Physician specialty, but not gender or years in practice, influenced compliance, identifying clear targets for stewardship interventions.
Real-world Pola-R-CHP improves early PFS over R-CHOP in DLBCL
In a multicentre real-world propensity-matched cohort of 370 untreated DLBCL patients, Pola-R-CHP improved 1-year PFS versus R-CHOP (86.7% vs 73.5%). One-year overall survival was similar between Pola-R-CHP and R-CHOP (92.8% vs 89.6%). Pola-R-CHP significantly reduced 1-year nodal relapse compared with R-CHOP (2.1% vs 10.9%), while extranodal relapse remained similar (3.8% vs 5.2%). Within Pola-R-CHP, CNS-IPI stratified CNS relapse risk, ranging from 0% to 4.5% across risk groups. These data support Pola-R-CHP as a more effective frontline regimen but highlight persistent early CNS and extranodal failure.
References
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Additional Reads
Optional additional studies from this edition.