We retrospectively evaluated the safety and diagnostic utility of small bowel capsule endoscopy (SBCE) in 45 patients (66 procedures) who developed gastrointestinal symptoms after allogeneic hematopoietic cell transplantation (allo-HCT). Despite a high proportion of patients with poor performance status (≥2: 43 procedures) and thrombocytopenia (platelet counts <20,000/µl in 10 procedures, <50,000/µl in 25 procedures), which are generally considered high-risk conditions for conventional esophagogastroduodenoscopy (EGD) and colonoscopy (CS), SBCE demonstrated a 0% adverse event rate and 89.2% complete small bowel observation rate, which are comparable to outcomes previously reported in non-transplant patients. Evaluation of all three gastrointestinal regions (stomach, small bowel, and colon), including exploratory observation, was feasible in 55 of 66 procedures, and small bowel lesions were identified in 28 procedures. In 6 of these (10.9%), lesions were confined exclusively to the small bowel, making them difficult to detect using conventional EGD and CS, and SBCE findings guided treatment decisions. In conclusion, SBCE can be safely performed in patients with gastrointestinal symptoms after allo-HCT and may provide unique diagnostic value, particularly in the evaluation of small bowel lesions.

To address the challenges of regional collaboration in the treatment of hematologic malignancies, we conducted a prospective clinical study of a healthcare communication platform (Dr2GO^®) designed to ensure seamless continuity of care by streamlining inter-hospital transfer coordination. By the end of 2024, nineteen patients were enrolled across the four participating institutions. The most frequently used clinical pathway was vaccination after allogeneic hematopoietic stem cell transplantation (7 cases). The median time from the referral request by the hub hospital to confirmation by the community institution was 15 hours. Among the cases requested during regular working hours, 83% were confirmed within 30 minutes. The median duration of pathway continuation was 9.5 months, with a continuation rate of 78.9%. In a survey, 75% of respondents reported faster medical coordination. During the study period, 26 chat entries were recorded, with a median of one entry per patient. These findings suggest that the Dr2GO^®-based electronic clinical pathway both facilitates rapid transfer coordination and efficient information sharing, while potentially reducing physician workload and promoting task shifting.

Idecabtagene vicleucel (ide-cel) is effective for relapsed/refractory multiple myeloma (RRMM), but real-world data in Japan are limited. We retrospectively analyzed 11 patients with RRMM who received ide-cel at our institution. The median age at infusion was 67 years (range, 54-71), and the median number of prior lines of therapy was 4 (range, 3-6). At best response, the overall response rate was 90.0%, with a complete response rate of 60.0%. With a median follow-up of 530 days (range, 198-1,032) among survivors, the 1-year overall survival and progression-free survival rates were 90.9% and 71.6%, respectively. Cytokine release syndrome (CRS) occurred in all patients, including one fatal grade 5 event. Analysis of peripheral blood chimeric antigen receptor T-cell (CAR-T) kinetics showed a trend toward better progression-free survival in patients with greater expansion from day0 to day28. Although the efficacy of ide-cel for RRMM in our cohort was comparable to that in previous reports, the management of severe CRS remains a challenge. Further investigation in a larger cohort is required to establish predictive factors for safety and efficacy in Japanese clinical practice.

A 55-year-old man started imatinib at 400 mg/day in 2002 for chronic myeloid leukemia in chronic phase (CML-CP). He maintained a complete cytogenetic response and achieved undetectable BCR::ABL1 mRNA levels by 2015, indicating a deep molecular response (DMR). He discontinued tyrosine kinase inhibitor (TKI) therapy in 2018 after maintaining DMR for over two years, but lost DMR in December 2022. Nine months later, BCR::ABL1 mRNA was detected at 0.08% IS. Although we recommended resuming TKI therapy, the patient declined. Within two months, a blood test revealed a lymphoblast ratio of 56.7%, leading to a diagnosis of lymphoid blast crisis. The patient achieved complete hematological remission after one cycle of dasatinib combined with hyper-CVAD/MA. Measurable residual disease persisted, and he underwent two cycles of inotuzumab ozogamicin therapy followed by allogeneic hematopoietic stem cell transplantation. This case highlights the critical need for vigilant follow-up in CML patients after prolonged TFR, given the risk of progression to blast crisis.

A 30-year-old man presented with fever of unknown origin, pancytopenia, and hepatosplenomegaly. Peripheral blood analysis revealed elevated Epstein-Barr virus (EBV) DNA levels, with EBV detected in the NK cell fraction, leading to a diagnosis of chronic active EBV disease (CAEBV). Despite immunosuppressive and etoposide therapy, fever and organ dysfunction worsened. He subsequently underwent peripheral blood stem cell transplantation (PBSCT) from an HLA-haploidentical donor with post-transplant cyclophosphamide. On day86 post-transplant, the patient developed fever, recurrent pancytopenia, elevated peripheral blood EBV-DNA levels, and abnormal lymphocytes in both peripheral blood and bone marrow, leading to a revised diagnosis of relapsed/refractory aggressive NK-cell leukemia (ANKL). The patient underwent a second haploidentical PBSCT with alemtuzumab and achieved remission for 264 days before dying of Fusarium-related infective endocarditis. Alemtuzumab, an anti-CD52 antibody, is approved for GVHD prophylaxis in allogeneic hematopoietic stem cell transplantation and may also offer antitumor effects against ANKL.

Allogeneic hematopoietic stem cell transplantation is the only curative treatment for myelofibrosis. However, the high risk of non-relapse mortality and the difficulty of finding an HLA-matched sibling donor are obstacles, given the advanced age at disease onset. Here, we report four cases of transplantation from an HLA-haploidentical donor using post-transplant cyclophosphamide (PTCy-haplo) in three recipients with primary (n=1) and secondary (n=2) myelofibrosis. The median age was 52 years, and one patient had received JAK2 inhibitor therapy prior to transplantation. The sources were bone marrow and peripheral blood stem cells (two cases each); myeloablative conditioning was used in two cases. Neutrophil engraftment was achieved in all cases (median 19 days); however, prolonged G-CSF administration (median 44 days) was required, and platelet engraftment was delayed (median 68 days). Two patients survived without relapse, with observation periods of 3.5 and 8 years, respectively. One patient relapsed 17 months after the first transplantation and died of pneumonia 49 days after second PTCy-haplo. These findings suggest that PTCy-haplo is a feasible option for patients with myelofibrosis; however, the risk of delayed hematopoietic recovery should be noted.

Fibrin-associated large B-cell lymphoma is an extremely rare subtype of LBCL, characterized by distinctive pathological findings and symptoms, and is generally considered to follow an indolent clinical course. Here we report a case of fibrin-associated large B-cell lymphoma arising in association with an incidentally discovered left atrial myxoma, which has remained in remission with surgical resection alone. The patient was an 84-year-old woman. In September 2023, a routine preoperative chest X-ray performed prior to surgery for osteoarthritis of the shoulder revealed an abnormal shadow. Subsequent echocardiography demonstrated an intracardiac mass in the left atrium, and the patient was referred to our cardiology department. Echocardiography at our hospital revealed a pedunculated mass attached to the atrial septum, consistent with a diagnosis of left atrial myxoma. The mass measured approximately 80 mm and prolapsed between the left atrium and ventricle. Given the risk of obstruction, urgent surgical resection was performed. Histopathological examination of the resected specimen confirmed the diagnosis of fibrin-associated large B-cell lymphoma, and the patient was subsequently referred to the hematology department. A systemic workup revealed no evidence of additional disease. She has remained disease-free without any further therapy.

A 55-year-old man was referred to our hospital with weight loss, somnolence, and dysarthria. Laboratory tests revealed elevation of serum creatinine (2.17 mg/dl), serum corrected calcium (16.3 mg/dl), and parathyroid hormone-related protein (PTHrP, 3.7 pmol/l). ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) demonstrated splenomegaly and increased FDG uptake in the spleen and in bone marrow throughout the body. Bone marrow biopsy showed infiltration of large atypical lymphoid cells. The neoplastic cells were positive for CD20, BCL-6, MUM1, PTHrP, and PTH1 receptor on immunohistochemical staining, prompting a diagnosis of PTHrP-producing diffuse large B-cell lymphoma (DLBCL). After one cycle of R-CHOP chemotherapy, the PTHrP level became undetectable; after four cycles, a complete metabolic response was confirmed on PET/CT. The patient subsequently underwent autologous peripheral blood stem cell transplantation and achieved long-term complete remission. PTHrP-producing DLBCL is extremely rare, and further investigation is needed to better understand its disease characteristics and pathophysiology.

We report a rare case of JAK2 V617F-positive essential thrombocythemia (ET) followed by BCR::ABL1-positive chronic myeloid leukemia (CML) in a 47-year-old woman. Dasatinib induced deep molecular remission; however, persistent thrombocytosis required hydroxyurea. The persistence of the JAK2 V617F mutation despite BCR::ABL1 suppression suggests distinct clonal populations. This case underscores the importance of vigilance for secondary myeloproliferative neoplasms (MPNs) and clonal evolution when a new hematologic phenotype emerges in a patient with an established MPN. The coexistence of JAK2 V617F and BCR::ABL1 mutations is exceedingly rare and presents significant diagnostic and therapeutic challenges.

All-trans retinoic acid (ATRA) is essential in treating acute promyelocytic leukemia (APL), but has been linked to adverse events such as differentiation syndrome and intracranial hypertension. Hearing impairment associated with intracranial hypertension is rare but clinically relevant. We report the case of a 6-year-old girl with APL who developed transient low-frequency sensorineural hearing impairment during ATRA/arsenic trioxide therapy. No headache or neurologic signs suggesting intracranial hypertension were observed, and both hearing symptoms and low-frequency audiometric changes resolved spontaneously without corticosteroids or treatment modification. This case suggests that ATRA-related hearing impairment may occur even without intracranial hypertension, and careful monitoring may enable continuation of therapy.

Adoptive transfer of chimeric antigen receptor (CAR)-engineered T cells has been successfully established in B-cell malignancies and multiple myeloma. The fitness of infused CAR-T cells is closely associated with durable clinical responses. Terminal differentiation, which compromises long-term persistence, and exhaustion, which dampens effector function, are major drivers of T-cell dysfunction. Recent studies have demonstrated that genetic engineering approaches that modulate gene expression and epigenetic programs can counteract these mechanisms and enhance T-cell function. In addition, strategies to augment T-cell function through artificial cytokine signaling have been extensively investigated. This review discusses these recent advancements.

Chimeric antigen receptor T-cell (CAR-T) therapy has revolutionized the treatment of relapsed/refractory hematologic malignancies, achieving remarkable response rates in B-cell acute lymphoblastic leukemia and lymphomas. However, treatment responses and toxicities vary substantially among patients, necessitating the establishment of robust predictive biomarkers for optimal patient stratification and treatment personalization. This review systematically categorizes key factors affecting CAR-T therapy efficacy into tumor-intrinsic and T cell-intrinsic components. Tumor-intrinsic factors include tumor burden, antigen expression heterogeneity, and immunosuppressive components within the tumor microenvironment, such as regulatory T cells, myeloid-derived suppressor cells, tumor-associated macrophages, and inhibitory cytokines (e.g., TGF-β and IL-10). T cell-intrinsic factors encompass memory T cell subset composition, particularly central memory and stem cell memory populations, CAR expression density and transduction efficiency, polyfunctional cytokine production profiles, mitochondrial function and metabolic fitness, and expression of immune checkpoint molecules. Recent technological advances in single-cell RNA sequencing, comprehensive proteomics, and high-dimensional immunophenotyping combined with machine learning algorithms enable increasingly precise biomarker identification and predictive modeling. Integration of these multidimensional biomarkers into unified prediction models holds substantial promise for personalizing therapy, enhancing efficacy while minimizing adverse events, and ultimately achieving durable remission in patients receiving CAR-T therapy.

Mentorship is a critical mechanism for the growth and career development of young physicians and plays an especially decisive role in addressing the “leaky pipeline” faced by women in medicine. In this article, we first clarify the distinctions between four forms of support—mentor, sponsor, ally, and coach—and review initiatives at the levels of professional societies, institutions, and individuals. We then present concrete examples from Japan: the Japanese Data Center for Hematopoietic Cell Transplantation, which combines a registry scientist training program with flexible work arrangements; Chiba University, where a formal mentoring system for medical students and a team-based clinical structure provide embedded, structural mentorship; and a small survey of women physicians in general hospitals, which reveals limited formal mentoring systems and diverse needs regarding mentor characteristics. Drawing on these experiences, we describe key attributes of effective mentors, including accessibility, reliability, and respect for mentees’ values and goals, and we highlight three central mentoring roles: supporting academic success, promoting sustainable work-life balance, and fostering leadership development. To create an environment in which women physicians can fully realize their potential, high-quality mentorship must be strengthened across academic societies, healthcare institutions, and individual practitioners.