皆方 大佑

This single-institution retrospective study evaluated a measurable residual disease (MRD)-guided induction intensification strategy in transplant-eligible patients with newly diagnosed multiple myeloma treated in the anti-CD38 antibody era. Sixty patients undergoing autologous stem cell transplantation (ASCT) between 2020 and 2025 were included. Most received bortezomib, lenalidomide, and dexamethasone as initial therapy. Patients with persistent MRD by multiparameter flow cytometry underwent treatment intensification, commonly with daratumumab, carfilzomib, and dexamethasone before ASCT. Among 52 evaluable patients, 35 (67.3%) achieved MRD negativity before ASCT, and 30 of 32 (93.8%) were MRD-negative after ASCT. Stem cell mobilization and engraftment were successful. After median follow-up of 28.5 months, 2-year progression-free and overall survival were 87.3% and 98.0%. R-ISS stage III and extramedullary disease were associated with inferior progression-free survival. High-risk cytogenetics showed poorer outcomes. This MRD-adapted strategy was feasible, achieved deep responses, and preserved mobilization, but high-risk disease remained prone to relapse, supporting post-transplant intensification.

R-GDP has been established as an effective salvage treatment for Rel/Ref DLBCL. We aimed to clarify the efficacy of R-GDP therapy. We included 41 consecutive patients with Rel/Ref DLBCL, who received R-GDP therapy as salvage chemotherapy at our hospital between January 2014 and August 2024. Thirty-three patients received R-GDP therapy as a 2nd-line regimen, whereas 8 received R-GDP as a 3rd or later-line regimen. The ORR was 70.7%. 23 out of 25 relapsed patients (92%) responded to R-GDP therapy, whereas only 6 out of 16 refractory patients responded (37.5%). With regard to the duration of response, the response rates in 19 patients with late relapse (at least 12 months) and 6 with early relapse (less than 12 months) were 94.7% and 83.3% (p = 0.43). Overall, the 2-year PFS and OS rates were 48.8% and 74.2%, respectively. 18 responders underwent ASCT with a 2-year PFS after ASCT of 61.2%. Although CAR-T is recommended in patients with Rel/Ref DLBCL, R-GDP is a realistic option given the limited availability of immediate CAR-T therapy. Further studies including genomic profiles are warranted to identify factors that can predict a response to R-GDP in Rel/Ref DLBCL.

This study evaluated cytomegalovirus (CMV) reactivation after allogeneic stem cell transplantation (allo-SCT) using both CMV-PCR and antigenemia assays in 109 adult recipients. CMV-PCR and antigenemia values had a moderate linear correlation. In total, 58 patients exhibited CMV-PCR positivity before starting antigenemia-based preemptive treatment. Excluding the two patients with persistent PCR positivity, the antigenemia value subsequently reached the threshold in 31 of 54 patients. On the other hand, 25 patients had spontaneous clearance of viremia without preemptive treatment. Spontaneous clearance was associated with letermovir use and the absence of graft-versus-host disease. The clinical course of CMV infection was simulated using various CMV-PCR thresholds (range 50-1000 IU/mL). In high-risk patients not treated with letermovir, a threshold of 50 IU/mL enables preemptive treatment initiation without increasing overtreatment risk in patients with spontaneous clearance. However, in high-risk patients treated with letermovir, thresholds > 150 IU/mL delayed the start of preemptive treatment. In low-risk patients, a threshold of 500-750 IU/mL balances avoiding spontaneous resolution and increasing delayed treatment. PCR thresholds of 50 and 150 IU/mL may be appropriate for initiating preemptive therapy in high-risk patients treated and not treated with letermovir, respectively, while 500-750 IU/mL may be optimal for low-risk patients.

This study evaluated the cost-effectiveness of blinatumomab for adult Philadelphia chromosome-negative (Ph-negative) patients with B-cell acute lymphoblastic leukaemia (B-ALL) who were in measurable residual disease (MRD)-negative first remission, according to the ECOG1910 trial. A Markov model was created to compare the cost-effectiveness of four cycles of blinatumomab alternating with chemotherapy versus standard-of-care chemotherapy (SOC), in both Japan and the United States. The analysis was conducted over a lifetime horizon. Incremental cost-effectiveness ratios (ICERs) were calculated, with willingness-to-pay (WTP) thresholds set at \7 500 000 in Japan and $150 000 in the United States. A discount rate was set at 3%. In Japan, blinatumomab led to incremental costs of \27 472 739 and yielded 3.82 quality-adjusted life years (QALYs), resulting in an ICER of \7 193 601 per QALY. In the United States, incremental costs were $463 539 with 3.45 QALYs, yielding an ICER of $134 298 per QALY. When the 3-year progression-free survival (PFS) with blinatumomab was assumed as 80%, it was cost-effective unless the 3-year PFS for SOC exceeded 64.9% in Japan and 65.6% in the United States. Blinatumomab was less cost-effective for patients older than 51.6 years in Japan and 55.6 years in the United States. Blinatumomab is cost-effective as consolidation therapy for MRD-negative Ph-negative B-ALL patients, with sensitivity to age and PFS gains.