Background: Autologous stem cell transplantation (ASCT) remains a cornerstone in the management of multiple myeloma (MM). However, the optimal timing of ASCT and the factors determining whether patients ultimately undergo transplantation remain unclear in real-world practice. The Revised Myeloma Comorbidity Index (R-MCI) was developed to quantify patient fitness but its influence on transplant eligibility and timing has not been fully characterized. Methods: We conducted a retrospective single-center study including 137 patients with newly diagnosed MM between 2015 and 2025. Clinical parameters recorded at diagnosis included age, sex, performance status, renal and pulmonary function, cytogenetic risk, International Staging System (ISS) stage, and bone marrow plasma cell infiltration. The R-MCI was calculated for all patients. Transplant timing was categorized as early (≤12 months) or delayed (>12 months) after diagnosis. Logistic regression analysis was performed, and variables with p < 0.10 in univariate analyses were included in the multivariate model. Early versus delayed ASCT was defined as ≤12 months or >12 months from diagnosis, respectively. Results: ASCT was performed in 61/137 patients (44.5%), while 42.6% of these underwent early transplantation. Transplanted patients were significantly younger (<65 years: 82.0% vs. 25.0%, p < 0.001) and had lower R-MCI scores (median 0 vs. 1, p < 0.001) compared with non-transplanted patients, while plasma cell infiltration and ISS stage did not differ. In multivariate analysis, R-MCI was the only variable showing a trend toward predicting early transplantation (OR 0.27, 95% CI 0.07–1.06, p = 0.06). Conclusions: In real-world MM management, patients quantified by R-MCI appear to play a more prominent role than disease burden in determining both eligibility for and timing of ASCT. Incorporating comorbidity indices alongside ISS may enhance individualized transplant decision-making and optimize treatment outcomes.

Background: Infections are a leading cause of morbidity and mortality in multiple myeloma (MM), particularly during the induction phase. Identifying real-world infection patterns and predictors is crucial for guiding preventive strategies. Methods: This retrospective cohort study included 161 newly diagnosed MM patients who received standard induction therapy at a single tertiary center between 2016 and 2024. Clinical, laboratory, and infection-related parameters were analyzed over the first 12 months. Results: Infections occurred in 50.9% of patients, with the highest incidence within the first 3 months (27.3%, p = 0.004). Pneumonia was the most common type (34.1%), and gram-negative bacteria, particularly Escherichia coli , Klebsiella spp. , and Pseudomonas aeruginosa , were predominant. Antibiotic resistance to TMP-SMX and levofloxacin was observed in E. coli isolates. Multivariate analysis identified advanced ISS stage (OR: 3.83), diabetes mellitus (OR: 3.64), and chronic kidney disease (OR: 6.01) as independent predictors of infection ( p < 0.05). Lymphocyte counts were significantly lower in febrile episodes ( p = 0.040), highlighting a possible early immune marker. Hospitalization was more common in patients with advanced ISS and kidney disease. No significant differences were found between induction regimens. Conclusion: Infections pose a significant burden during the first year of MM treatment, particularly in high-risk patients during early induction. Readily available clinical parameters can aid in early risk stratification. These findings support a risk-adapted approach to prophylaxis, including the selective use of levofloxacin in patients with diabetes or kidney disease during the first 3 months of therapy.

Background/aim: Chronic lymphocytic leukemia (CLL) exhibits marked biological heterogeneity, and immunoglobulin heavy chain variable (IgHV) mutation status remains a key prognostic biomarker. We evaluated patient IgHV status via RNA sequencing (RNA-seq) and examined real-life clinical outcomes in a retrospective CLL cohort. Materials and methods: Eighty-seven adults diagnosed with CLL between 2020 and 2022 at three centers were included. Total RNA from peripheral blood underwent anchored multiplex polymerase chain reaction with the Immunoverse BCR-IGH IGKL v1.0 kit (Integrated DNA Technologies) and was sequenced on the MiSeq platform (Illumina). IgHV mutation status was determined according to ERIC 2022 guidelines, specifically regarding classification of “challenging” double-rearranged cases, with discordant productive rearrangements (one mutated, one unmutated) categorized as unmutated (u-IgHV) to ensure prognostic reliability. Clinical characteristics, treatment patterns, and survival outcomes were analyzed and overall survival (OS) was estimated by the Kaplan–Meier method. Results: Median age at diagnosis was 60 years and 64% of patients were male. RNA-seq identified double IgHV rearrangements in 73% (n = 63) of patients, 63% of whom harbored two productive rearrangements without evidence of biclonality. Unmutated IgHV (u-IgHV) was observed in 53% (n = 46). Compared to mutated IgHV (m-IgHV), patients with u-IgHV more frequently required first-line therapy (66% vs. 34%) and proceeded to second-line treatment more rapidly. Deletion 17p was significantly more common in the u-IgHV group. After median follow-up of 37.5 months, the 3-year OS rate was 91.9%, with no significant difference in OS between the m-IgHV and u-IgHV cohorts. Conclusion: RNA-seq provided detailed insight into IgHV mutation status and revealed a higher incidence of challenging double-rearranged cases. These real-life findings underscore the clinical utility of RNA-based IgHV profiling and support its use. Prospective studies comparing RNA- and DNA-based assays are warranted to validate concordance and inform risk-adapted management strategies in the treatment of CLL.

Background and Objectives: The optimal treatment strategy for older patients with acute myeloid leukemia (AML) remains uncertain because treatment selection is influenced by age, comorbidity, functional status, and disease biology. This study explored real-world outcomes with intensive and non-intensive treatment strategies. Materials and Methods: We retrospectively analyzed 69 patients aged ≥ 65 years diagnosed with AML between 2012 and 2022 at a tertiary center. Treatment intensity was defined by regimen. Baseline demographic, clinical, and laboratory parameters were recorded. Progression-free survival (PFS) and overall survival (OS) were estimated by the Kaplan–Meier method and compared using log-rank tests. Results: A total of 69 patients were included, with a median age of 71 years. Intensive and non-intensive therapies were administered in 24.2% and 75.8% of treated patients, respectively. The median PFS was 6.7 months, and the median OS was 7.8 months. One- and two-year OS rates were 29% and 9.2%, respectively. No significant differences in PFS or OS were observed between treatment intensity groups. Among response-evaluable patients, complete remission/complete remission with incomplete hematologic recovery (CR/CRi) was achieved in 58.0% of intensively treated patients and 43.3% of those receiving hypomethylating agent (HMA)-based therapy. Among the evaluated baseline variables, only Eastern Cooperative Oncology Group (ECOG) performance status was significantly associated with overall survival. Patients with an ECOG performance status ≥ 2 had significantly shorter OS than those with ECOG <2 (median OS: 4.85 vs. 8.60 months, p = 0.009). Conclusions: In this real-world cohort of older patients with AML, no statistically significant differences in PFS or OS were observed between intensive and non-intensive treatment strategies. Although CR/CRi rates were numerically higher with intensive therapy, disease progression remained frequent among patients who achieved a response. ECOG performance status was significantly associated with overall survival, highlighting the relevance of functional status in individualized treatment selection. These findings should not be interpreted as evidence of therapeutic equivalence.