The British Journal of Haematology publishes original research papers in clinical, laboratory and experimental haematology. The Journal also features annotations, reviews, short reports, images in haematology and Letters to the Editor.

While implanted port catheters (“PORTs”) have historically been the standard device for intravenous systemic anticancer therapy, the use of peripherally inserted central catheters (PICCs) has increased continuously and reliable catheter selection guidelines are lacking. We compare complication rates of PORTs and PICCs in cancer treatment in a retrospective study of 3365 patients with both solid organ (n = 2612) and hematologic (n = 753) malignancies, between 2001 and 2021. 26.4% (n = 890) of all patients were treated via PICCs and 73.6% (2475) via PORTs. 20.7% (578) experienced a major catheter‐related complication with a higher rate in PICCs than in PORTs (23.5% vs 14.9%, P < .001). Among major complications, infections and mechanical complications were more common in PICCs than in PORTs (11.9% vs 6.4%, P = .001, 7.3% vs 4.2%, P = .002), whereas the rate of thrombosis was similar (3.4% vs 3.0%, P = .9). While PORTs had a higher rate of periprocedural complications (2.7% vs 1.1%, P < .05), PICCs overall complication rate exceeded PORTs within 3 days from implantation. Median follow‐up was 49 (PICC) and 60 weeks (PORT). PORTs are safer and therefore should be preferred in this setting regardless of catheter dwell time.

Hematopoietic cell transplantation from haploidentical donors (haploHCT) has facilitated treatment of AML and MDS by increasing donor availability and became more feasible since the introduction of post-transplant cyclophosphamide (ptCY). In our single-center retrospective analysis including 213 patients with AML or MDS, we compare the outcome of haploHCT (n = 40) with ptCY with HCT from HLA-identical MRD (n = 105) and MUD (n = 68). At 2 years after transplantation, overall survival (OS) after haploHCT was not significantly different (0.59; 95% confidence interval 0.44–0.79) compared to MRD (0.77; 0.67–0.88) and MUD transplantation (0.72; 0.64–0.82, p = 0.51). While progression-free survival (PFS) was also not significantly different (haploHCT: 0.60; 0.46–0.78, MRD: 0.55; 0.44–0.69, MUD: 0.64; 0.55–0.74, p = 0.64), non-relapse mortality (NRM) was significantly higher after haploHCT (0.18; 0.08–0.33) vs. MRD (0.029; 0.005–0.09) and MUD (0.06; 0.02–0.12, p < 0.05). Higher NRM was mainly caused by a higher rate of fatal infections, while deaths related to GvHD or other non-relapse reasons were rare in all groups. As most fatal infections occurred early and were bacterial related, one potential risk factor among many was identified in the significantly longer time to neutrophil engraftment after haploHCT with a median of 16 days (interquartile range; 14.8–20.0) vs. 12 days (10.0–13.0) for MRD and 11 days (10.0–13.0) for MUD (p = 0.01).

Further line treatment of patients with advanced stage AL amyloidosis with cardiac involvement is challenging. Venetoclax is a promising option, especially in t(11;14) and BCL2 expression.In our multicentre observational study, we report the 3-year follow-up of Venetoclax treatment in 9 patients with advanced, relapsed or refractory AL amyloidosis with t(11;14) and BCL-2 expression in > 50% of plasma cells. At baseline, all patients had been previously treated with daratumumab, all had cardiac involvement with revised Mayo stage III or IV/ European modification of Mayo 2004 IIIA or IIIB (1/9 unclassified due to missing troponin T), 5/9 patients had renal involvement.After a median of 35 months (range 25–49) since the start of Venetoclax, 8/9 patients were still alive (OS 89%). First and best hematological responses were observed after a median of 26 days (11–125) and 106 days (35–659), overall response rate was 100% (7/9 CR, 2/9 VGPR). Where observed, organ response was documented within the first 6 months of therapy, including cardiac (6/9) and renal (3/5) improvements. Venetoclax was discontinued in 6/9 patients after a median of 15 months (11–48) due to toxicity (2/9), disease progression (2/9), fixed treatment duration (1/9), or safety concerns (1/9).In conclusion, Venetoclax induces a rapid and deep hematologic response with consistent improvement in organ function with an acceptable safety profile in patients with pretreated, advanced stage AL amyloidosis with cardiac involvement and BCL2 expression with and potentially without detected t(11:14), which warrants further investigation.

Tyrosine kinase inhibitors (TKIs) and blinatumomab have improved outcomes in Philadelphia‐positive B‐lymphoblastic leukemia (Ph + B‐ALL). However, the efficacy of TKI and blinatumomab as a standalone regimen compared to the standard chemotherapy‐plus‐TKI approach remains uncertain. We conducted a single‐center retrospective analysis of 47 patients, including 18 treated with TKI and blinatumomab (de novo: N = 13; relapsed: N = 5) and 29 treated with chemotherapy and TKI. Patients in the blinatumomab cohort were significantly older (median age 65 years vs. 48 years), had higher rates of active central nervous system disease (27.7% vs. 0%) and were less frequently consolidated with allogeneic stem cell transplantation (33% vs. 79%, p < .05). Despite these differences, overall survival (2‐year OS: 87% vs. 78%), progression‐free survival (PFS: 81% vs. 54%), and non‐relapse mortality (NRM: 6.3% vs. 14%) were comparable. Severe treatment‐related adverse events were significantly less frequent in the TKI and blinatumomab cohort, with no difference in early molecular complete response rates. Our findings, consistent with published prospective trials, highlight the safety and efficacy of TKI and blinatumomab in managing Ph + B‐ALL.

Despite advances in kidney transplant surgery and immunosuppression, lymphoceles remain a frequent complication in the early postoperative period following kidney transplantation, often requiring reintervention. While long-term outcomes such as patient and allograft survival are well studied, the impact of lymphocele formation on mid-term allograft function remains unclear. This multicentric study included 711 recipients of living donor kidney transplants to investigate the impact of lymphocele formation on mid-term graft function. Outcomes assessed included estimated glomerular filtration rate (eGFR) at 12 months, eGFR slope, and both patient and allograft survival. Lymphoceles were detected in 17.4% of the recipients, with a median volume of 129 ml, and 71.8% of these patients required intervention. Patients without lymphocele formation had a significantly higher median eGFR at 12 months (52.1 ml/min/1.73 m²) compared to those with lymphoceles (48.7 ml/min/1.73 m²). Additionally, patients with lymphocele formation demonstrated a steeper median eGFR slope (-2.3 ml/min/1.73 m²/year) than those without (-0.3 ml/min/1.73 m²/year). No significant difference was observed in the composite outcome of allograft survival and patient death between the two groups. Lymphocele formation after living donor kidney transplantation is associated with a steeper decline in graft function. They may reflect a disturbed microvasculature and warrant closer control of cardiovascular risk factors and allograft monitoring of affected patients. Not applicable, the study is not a clinical trial.