Introduction: The prognosis of metastatic renal cell carcinoma (mRCC) varies significantly, and early treatment failure is common. Systemic inflammation and nutritional indicators may predict the survival outcomes of patients with renal cell carcinoma (RCC) receiving targeted therapy. However, an integrated evaluation of the prognostic value of these markers is still lacking. This study aims to comprehensively assess and compare the prognostic significance of various systemic inflammation and nutritional indicators for the overall survival (OS) and progression-free survival (PFS) of patients with RCC undergoing targeted therapy through systematic review and meta-analysis. Methods: According to PRISMA guidelines, a systematic search was performed across PubMed, Embase, Cochrane Library, Web of Science, Scopus, Medline up to October 17, 2025. Retrospective cohort studies evaluating the correlation between baseline inflammatory/nutritional indicators and OS/PFS in RCC patients receiving targeted therapy were included. And biomarkers included Neutrophil-to-Lymphocyte Ratio (NLR), C-Reactive Protein (CRP), Platelet-to-Lymphocyte Ratio (PLR), Body Mass Index (BMI), Albumin (Alb), Prognostic Nutritional Index (PNI), Systemic Immune-Inflammation Index (SII), Neutrophil Count (NEU), and hemoglobin (Hb). Two researchers independently performed literature screening, data extraction, and quality assessment. Meta-analysis was performed using Stata 18.0. The pooled hazard ratio (HR) and its 95% confidence interval (CI) were calculated. And heterogeneity tests, sensitivity analyses, subgroup analyses, and publication bias assessments were conducted. This analysis has been registered in PROSPERO (CRD420251167462). Results: A total of 152 retrospective cohort studies involving 33,842 patients were included. The meta-analysis revealed that high baseline NLR, NEU, SII, and low Hb levels were significantly associated with poorer OS. The combined HR values were as follows: NLR for OS: HR = 1.82, 95% CI = 1.67–1.99; NEU for OS: HR = 1.88, 95% CI = 1.67–2.12; SII for OS: HR = 1.92, 95% CI = 1.72–2.15; Hb for OS: HR = 1.74, 95% CI = 1.58–1.92. Additionally, NLR (HR = 1.51, 95% CI = 1.38–1.65) was also significantly associated with poorer PFS. Discussion: NLR, NEU, SII and Hb are robust and consistent prognostic predictors for patients with RCC receiving targeted therapy. The evidence all stems from retrospective observational studies therefore selection bias and the influence of unmeasured confounding factors could not be fully controlled for. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251167462 , PROSPERO: CRD420251167462.

Hematologic malignancies are frequently complicated by malnutrition, a condition that remains underrecognized yet strongly associated with impaired treatment tolerance, immune recovery, and survival. Unlike solid tumors, hematologic malignancies are characterized by diffuse marrow and immune system involvement, rendering host metabolism highly vulnerable to tumor-driven inflammation and therapy-induced immune stress. Accumulating evidence indicates that nutritional deterioration in hematologic malignancies reflects a state of integrated immunometabolic vulnerability—driven by hyperinflammation, anabolic resistance, gastrointestinal injury, and psychosocial stress—rather than inadequate caloric intake alone. This review synthesizes current evidence on the biological basis, clinical assessment, and management of malnutrition in hematologic malignancies, with particular emphasis on hematopoietic stem cell transplantation and cellular therapies. We propose that nutritional care in hematologic malignancies should evolve from supportive supplementation toward mechanism-informed, precision nutritional strategies aimed at modulating host metabolism and immune function to improve clinical outcomes.

Invasive fungal disease (IFD) remains a life-threatening complication in patients with hematological diseases. Isavuconazole was approved by the FDA for primary treatment of invasive aspergillosis and mucormycosis. While clinical trials have demonstrated its efficacy, data on its use in hematology patients remain limited. This study aims to evaluate the real-world effectiveness and safety of isavuconazole in this population. We conducted a single-center, retrospective study of hematology patients who received isavuconazole for IFD between 1 June 2022, and 31 July 2024, at West China Hospital, Sichuan University. A total of 66 patients with proven (n = 9), probable (n = 17), or possible (n = 40) IFD were included in the study. Acute leukemia (AL) was the most common underlying disease, affecting 27 patients (40.9%), followed by non-Hodgkin’s lymphoma (NHL) and myelodysplastic syndrome (MDS). Over 80.0% of patients received oral isavuconazole. At 6 weeks of follow-up, a favorable response was observed in 57.6% of patients, increasing to 71.2% at 12 weeks. Factors associated with achieving complete response in isavuconazole treatment included receiving isavuconazole as primary treatment (OR = 0.10, p = 0.01) and reaching complete/partial remission (CR/PR) of the primary hematological disease (OR = 0.07, p = 0.003). The all-cause mortality rates were under 30.0%. The use of isavuconazole as primary antifungal therapy (p < 0.05) and achieving CR/PR in the underlying hematological disease (p < 0.05) were two independent predictors of improved clinical outcomes. Adverse events were reported in 33.3% of patients, and no adverse events led to discontinuation of treatment. Our study demonstrated that isavuconazole is an effective and well-tolerated treatment for IFD in hematology patients. The oral formulation provided comparable efficacy and enhanced compliance, potentially leading to improved outcomes and optimizing the management strategy. The generalizability of our findings may be limited by the single-center, retrospective nature; further validation through prospective, multi-center studies is needed.

Tuberculosis is a rare but fatal trigger of secondary hemophagocytic lymphohistiocytosis (HLH). Its diagnosis is challenging because clinical manifestations overlap with HLH, and immunological tests may be falsely negative in HLH-related immune dysfunction. We report a case of a 34-year-old male with fever and pancytopenia. The patient’s diagnostic course was protracted and misleading: all conventional tuberculosis immunological tests were negative, and he initially did not meet HLH-2004 criteria. The diagnosis of TB-HLH was eventually established by a second bone marrow biopsy and metagenomic next-generation sequencing. We also reviewed 66 TB-HLH cases, revealing frequent negative immunological test results and showing that timely anti-tuberculosis therapy was associated with reduced mortality (78.3% vs. 15.0%, p < 0.001). This case and our review underscore the importance of early bone marrow biopsy and molecular testing in unexplained HLH, particularly when tuberculosis tests are negative. Given the high mortality and frequent diagnostic delay, clinicians should maintain a high index of suspicion and pursue aggressive diagnostic workup for tuberculosis in HLH patients without a clear trigger. Furthermore, we emphasize the need to raise awareness of TB-HLH and to interpret immunological test results with caution in HLH patients, as negative findings should not be used to exclude tuberculosis.