This Week in Hematology — May 14, 2026

Welcome to This Week in Hematology. This week we're covering 10 notable papers spanning new approaches to risk stratification in malignant hematology, real-world data on novel therapies and transplant strategies, and practice-changing findings in benign hematology, including anemia and thrombosis. Let's dive in.

New Approaches to Risk Stratification First, we’ll look at three papers refining how we assess risk, from pre-malignancy through to advanced disease. In mantle cell lymphoma, the MIPI score is a cornerstone of prognostication, but it lacks input from tumor biology. A study in the *British Journal of Haematology* addresses this by developing a new index called MIPI53 [4]. Investigators analyzed a real-world cohort of 143 newly diagnosed MCL patients and incorporated TP53 mutational status alongside LDH, ECOG performance status, and age. The resulting MIPI53 index stratified patients into low, intermediate, and high-risk groups with dramatically different outcomes. For example, 5-year overall survival was over 92% for the low-risk group, but fell to just under 34% for the high-risk group. The model's robustness was confirmed in an external validation cohort, suggesting that integrating TP53 status is critical for accurately predicting outcomes in MCL.

Just as genetics refines risk in lymphoma, a study in the *American Journal of Hematology* shows that the timing and pattern of disease spread are critical in multiple myeloma [6]. Current risk models like the R2-ISS largely omit these dynamics. Using whole-body imaging in a cohort of 543 patients, researchers modeled extraosseous disease as a time-varying factor. They found a clear prognostic hierarchy. Compared to patients with marrow-confined disease, prognosis worsened progressively for those with primary paraskeletal lesions at diagnosis, who had more than double the risk of death. It was worse still for those who developed secondary paraskeletal lesions, and became an ultra-high-risk situation for those with secondary extramedullary disease, who had over an eight-fold increased risk of death. This prognostic impact was independent of R2-ISS and cytogenetics, and importantly, was not driven by the volume or location of the extraosseous tumor. This study argues that we must integrate the timing and spatial pattern of disease spread into future risk models.

Moving to the earliest stages of risk, a perspective in *Blood Cancer Journal* provides a practical roadmap for establishing clinics for clonal hematopoiesis of indeterminate potential, or CHIP [3]. The authors outline the key elements for creating these specialized, multidisciplinary clinics in both academic and community settings. The paper discusses identifying patients, recruiting personnel, and creating workflows. The goal of these clinics is to formalize the management of this pre-malignant condition, provide real-world risk assessment, offer enrollment in clinical trials, and establish research registries. This piece serves as a blueprint for translating our growing knowledge of CHIP into a tangible framework for preventive hematology.

Novel Therapies and Transplant Strategies Next, we turn to treatment, with updates on bispecific antibodies, targeted therapy in AML, and long-term outcomes for CAR-T cell therapy. A real-world analysis from the United Kingdom, published in *Haematologica*, gives us our first large-scale look at how the CD20xCD3 bispecific antibodies glofitamab and epcoritamab are performing in relapsed or refractory large B-cell lymphoma [7]. The study included 332 high-risk patients, over half of whom had primary refractory disease and half of whom were post-CAR-T therapy. The overall and complete response rates were 43% and 24%, respectively. While these numbers are more modest than those seen in pivotal trials, it's notable that for the subset of patients who would have been eligible for those trials, the complete response rate was 43%. The median overall survival was just under 7 months, but for patients who achieved a complete response, the median duration of response was not reached. The data confirm the activity of these agents in a very challenging, real-world population.

Also in *Haematologica*, a surprising post-hoc analysis from the QUIWI trial challenges our assumptions about transplant in newly diagnosed FLT3-ITD-*negative* acute myeloid leukemia [8]. The phase 2 trial randomized patients to receive the FLT3 inhibitor quizartinib or placebo alongside standard chemotherapy. This analysis modeled allogeneic hematopoietic cell transplant as a time-dependent variable. The results showed that quizartinib improved both overall and disease-free survival compared to placebo, regardless of whether patients went on to receive a transplant in first remission. In fact, transplant itself was not significantly associated with an overall survival benefit. The clinical benefit of quizartinib appeared to be more evident in the patients who did not proceed to transplant. This finding suggests that for FLT3-ITD-negative AML, the addition of quizartinib may provide a survival benefit that is independent of consolidative transplant.

In contrast, for relapsed or refractory B-cell acute lymphoblastic leukemia, a study with a remarkable 6-year follow-up in the *American Journal of Hematology* reinforces the critical role of consolidative transplant after CAR-T therapy [9]. The study followed 122 patients who achieved an MRD-negative remission after anti-CD19 CAR-T. Fifty-five of these patients proceeded to a haploidentical stem cell transplant. With a median follow-up of over 72 months, the transplant recipients had a significantly higher 5-year overall survival compared to the non-transplant group: 53.5% versus 25.6%. A key determinant of success was achieving MRD negativity *before* the transplant. Patients who were MRD-negative before transplant had a 5-year overall survival of 62%, compared to just 30.5% for those who were MRD-positive. This long-term data solidifies the strategy of using transplant to consolidate CAR-T induced remissions in B-ALL.

Updates in Benign Hematology Finally, we’ll cover four important papers in benign hematology, with implications for managing thrombosis, anemia, and postpartum hemorrhage. First, a large registry study from the *Journal of Thrombosis and Haemostasis* argues that isolated distal deep vein thrombosis, or iDDVT, is not a benign condition [5]. Analyzing over 8,400 patients, investigators found that while recurrent DVT was the most common complication at 4.3%, symptomatic pulmonary embolism occurred in 1.4% and major bleeding in 1.6%. Crucially, the study revealed distinct phase-specific risk profiles. Thrombotic events were more frequent after stopping anticoagulation, while most bleeding episodes occurred during treatment. Alarmingly, major bleeding carried the highest 10-day mortality at 15%, exceeding that of pulmonary embolism. The analysis identified different predictors for complications during and after treatment, which could help guide personalized decisions on anticoagulation duration and intensity.

Staying on the topic of hemostasis, a large phase 3 randomized trial in the *BMJ* provides a clear answer on prophylactic tranexamic acid for women with placenta previa undergoing caesarean delivery [10]. Nearly 1,700 women were randomized to receive either one gram of tranexamic acid or placebo intravenously after umbilical cord clamping. The primary outcome, defined as postpartum hemorrhage of at least 1000 mL or need for red cell transfusion, occurred in 29.7% of the tranexamic acid group compared to 35.1% of the placebo group. This represents a statistically significant, albeit modest, reduction in risk. Importantly, there was no difference in the rate of serious adverse events like thrombosis between the two groups, confirming the safety of this intervention.

Moving to anemia, a cost-effectiveness analysis in *Blood Advances* makes a strong case for universal iron deficiency screening in pregnancy in the United States, where no such guidelines currently exist [1]. The study modeled three strategies: no screening, screening with a ferritin threshold of 15 micrograms per liter, or screening with a threshold of 30. The conclusion was unequivocal: screening at a ferritin threshold of 30 was the preferred strategy across all analyses, with an incremental cost-effectiveness ratio of $34,000 per quality-adjusted life-year compared to no screening. This outcome held true in 100% of 10,000 simulations, suggesting that regular screening for iron deficiency in the second and third trimesters should be considered for all pregnant women in the United States.

Finally, a study in the *American Journal of Hematology* uses advanced diffusion imaging to reveal the neurologic consequences of chronic anemia [2]. Researchers compared patients with sickle cell disease and thalassemia to healthy controls. They found widespread white matter damage characteristic of demyelination that extended beyond typical vascular watershed areas. This damage was directly proportional to the severity of the anemia. While the changes largely resolved after controlling for hemoglobin levels, patients with sickle cell disease exhibited residual abnormalities that were linked to markers of hemolysis, like LDH. From a functional standpoint, the degree of white matter damage correlated with neuropsychological processing speed, demonstrating that chronic anemia is associated with diffuse brain injury that has tangible cognitive consequences.

Editor's Pick If you only have time for one paper this week, make it the post-hoc analysis of the QUIWI study in *Haematologica* [8]. The finding that quizartinib improved survival in newly diagnosed FLT3-ITD-*negative* AML, regardless of whether patients received a transplant, is provocative and may change how we approach consolidation therapy in this population.

Clinical Bottom Line Here are the key takeaways from this week in Hematology.

First, for mantle cell lymphoma and multiple myeloma, new data show that integrating genetic markers like TP53 and imaging-defined patterns of extraosseous spread are essential for accurate prognostication, going beyond traditional clinical scores [4, 6].

Second, in acute leukemia, quizartinib shows a survival benefit in newly diagnosed FLT3-ITD-negative AML, even without transplant [8], while for relapsed/refractory B-ALL, consolidative transplant after CAR-T remains critical for long-term survival, especially for patients who are MRD-negative pre-transplant [9].

Third, real-world data on bispecific antibodies in large B-cell lymphoma show more modest response rates than pivotal trials but confirm their activity in a heavily pre-treated, high-risk population [7].

Fourth, in non-malignant hematology, isolated distal DVT should not be considered benign, with significant risks of PE and major bleeding that have distinct phase-specific predictors [5]. Additionally, prophylactic tranexamic acid offers a modest but significant benefit in preventing postpartum hemorrhage for women with placenta previa [10].

Finally, two papers highlight the systemic effects of anemia: a cost-effectiveness analysis strongly supports universal screening for iron deficiency in pregnancy using a ferritin threshold of 30 micrograms per liter [1], and advanced imaging links chronic anemia severity directly to widespread white matter demyelination in the brain [2].

That's your roundup for This Week in Hematology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.