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Clonal cytopenia of undetermined significance (CCUS) represents a distinct disease entity characterized by myeloid-related somatic mutations with a variant allele fraction of ≥2% in individuals with unexplained cytopenia(s) but without a myeloid neoplasm (MN). Notably, CCUS carries a risk of progressing to MN, particularly in cases featuring high-risk mutations. Understanding CCUS requires dedicated studies to elucidate its risk factors and natural history. Our analysis of 357 CCUS patients investigated the interplay between clonality, cytopenia, and prognosis. Multivariate analysis identified 3 key adverse prognostic factors: the presence of splicing mutation(s) (score = 2 points), platelet count

Background: The Molecular International Prognostic Scoring System (IPSS‐M) is the new gold standard for diagnostic outcome prediction in patients with myelodysplastic syndromes (MDS). This study was designed to assess the additive prognostic impact of dynamic transfusion parameters during early follow‐up. Methods: We retrieved complete transfusion data from 677 adult Swedish MDS patients included in the IPSS‐M cohort. Time‐dependent erythrocyte transfusion dependency (E‐TD) was added to IPSS‐M features and analyzed regarding overall survival and leukemic transformation (acute myeloid leukemia). A multistate Markov model was applied to assess the prognostic value of early changes in transfusion patterns. Results: Specific clinical and genetic features were predicted for diagnostic and time‐dependent transfusion patterns. Importantly, transfusion state both at diagnosis and within the first year strongly predicts outcomes in both lower (LR) and higher‐risk (HR) MDSs. In multivariable analysis, 8‐month landmark E‐TD predicted shorter survival independently of IPSS‐M (p < 0.001). A predictive model based on IPSS‐M and 8‐month landmark E‐TD performed significantly better than a model including only IPSS‐M. Similar trends were observed in an independent validation cohort (n = 218). Early transfusion patterns impacted both future transfusion requirements and outcomes in a multistate Markov model. Conclusion: The transfusion requirement is a robust and available clinical parameter incorporating the effects of first‐line management. In MDS, it provides dynamic risk information independently of diagnostic IPSS‐M and, in particular, clinical guidance to LR MDS patients eligible for potentially curative therapeutic intervention. [ABSTRACT FROM AUTHOR]

Narrow-band UVB phototherapy and psoralen-ultraviolet a photochemotherapy in the treatment of cutaneous mastocytosis: a study in 20 patients. 14 Prignano F, Troiano M, Lotti T. Cutaneous mastocytosis: successful treatment with narrowband ultraviolet B phototherapy. A case of pediatric indolent systemic mastocytosis: The role of UVB-NB phototherapy in the treatment of cutaneous lesions. [Extracted from the article]

Early therapies to prevent severe COVID-19 have an unclear impact on patients with hematological malignancies. The aim of this study was to assess their efficacy in this group of high-risk patients with COVID-19 in preventing hospitalizations and reducing the SARS-CoV-2 shedding. This was a single-center, retrospective, observational study conducted in the Fondazione IRCSS Policlinico San Matteo of Pavia, Northern Italy. We extracted the data of patients with hematologic malignancies and COVID-19 who received and did not receive early COVID-19 treatment between 23 December 2021, and May 2022. We used a Cox proportional hazard model to assess whether receiving any early treatment was associated with lower rates of hospitalization and reduced viral shedding. Data from 88 patients with hematologic malignancies were extracted. Among the patients, 55 (62%) received any early treatment, whereas 33 (38%) did not. Receiving any early therapy did not significantly reduce the hospitalization rate in patients with hematologic malignancies (HR 0.51; SE 0.63; p-value = 0.28), except in the vaccinated non-responders subgroup of patients with negative anti SARS-CoV-2 antibodies at the time of infection, who benefited from early therapies against SARS-CoV-2 (HR 0.07; SE 1.04; p-value = 0.001). Moreover, no difference on viral load decay was observed. In our cohort of patients with hematologic malignancies infected with SARS-CoV-2, early treatment were not effective in reducing the hospitalization rate due to COVID-19, neither in reducing its viral shedding. [ABSTRACT FROM AUTHOR]

The impact of secondary infections (SI) on COVID‐19 outcome in patients with hematological malignancies (HM) is scarcely documented. To evaluate incidence, clinical characteristics, and outcome of SI, we analyzed the microbiologically documented SI in a large multicenter cohort of adult HM patients with COVID‐19. Among 1741 HM patients with COVID‐19, 134 (7.7%) had 185 SI, with a 1‐month cumulative incidence of 5%. Median time between COVID‐19 diagnosis and SI was 16 days (IQR: 5–36). Acute myeloid leukemia (AML) and lymphoma/plasma cell neoplasms (PCN) were more frequent diagnoses in SI patients compared to patients without SI (AML: 14.9% vs. 7.1%; lymphoma/PCN 71.7% vs. 65.3%). Patients with SI were older (median age 70 vs. 66 years, p = 0.002), with more comorbidities (median Charlson Comorbidity Index 5 vs. 4, p < 0.001), higher frequency of critical COVID‐19 (19.5% vs. 11.5%, p = 0.046), and more frequently not in complete remission (75% vs. 64.7% p = 0.024). Blood and bronchoalveolar lavage were the main sites of isolation for SI. Etiology of infections was bacterial in 80% (n = 148) of cases, mycotic in 9.7% (n = 18) and viral in 10.3% (n = 19); polymicrobial infections were observed in 24 patients (18%). Escherichia coli represented most of Gram‐negative isolates (18.9%), while coagulase‐negative Staphylococci were the most frequent among Gram‐positive (14.2%). The 30‐day mortality of patients with SI was higher when compared to patients without SI (69% vs. 15%, p < 0.001). The occurrence of SI worsened COVID‐19 outcome in HM patients. Timely diagnosis and adequate management should be considered to improve their prognosis. [ABSTRACT FROM AUTHOR]

Mastocytosis encompasses a subset of rare diseases, characterized by the presence and accumulation of abnormal neoplastic MC in various organ systems, including skin, bone marrow, spleen and gastrointestinal tract. Clinical manifestations are highly heterogeneous, as they result from both MC mediator release and MC organ infiltration. Both pregnancy, a lifetime dominated by huge physiological changes, and labor can provide triggers that could induce worsening of mastocytosis symptoms. On the other hand, mastocytosis has relevant implications in obstetric management and prenatal care during all the pregnancy. In this review article, current knowledge about the impact of mastocytosis on fertility and pregnancy outcome will be reviewed and discussed, with the aim to provide clinical practice guidance for the evaluation and management of pregnancy and delivery in patients with cutaneous and systemic mastocytosis. [ABSTRACT FROM AUTHOR]

When delaying treatment is not an option, to reduce the risk of infection during treatment and to prevent in-hospital spread of virus among patients and staff is a priority. Here we report the results of systematic screening for SARS-CoV2 infection in asymptomatic patients with hematologic malignancies on active treatment in the outpatient setting. In one patient resulting positive at screening swab during maintenance with obinotuzumab, who subsequently developed interstitial pneumonia, treatment was permanently discontinued as he was in complete remission and the risk/benefit ratio of restarting treatment was considered too high. [Extracted from the article]