Background: Cytomegalovirus (CMV) reactivation and graft-versus-host disease (GVHD) are major causes of morbidity and non-relapse mortality following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Although their association has been extensively investigated, the temporal relationship between these complications and their impact on survival remain incompletely understood, particularly in centers where routine letermovir prophylaxis is unavailable and CMV is managed using a pre-emptive treatment strategy. This study evaluated the bidirectional temporal association between CMV reactivation and GVHD using time-dependent analyses and assessed their impact on survival in a real-world allo-HSCT cohort. Methods: We retrospectively analyzed 100 consecutive adult patients who underwent allo-HSCT for hematologic malignancies between January 2016 and February 2025. CMV surveillance was performed by weekly quantitative CMV-DNA PCR, and reactivation was managed using a standardized pre-emptive treatment strategy. Patients who relapsed or died within the first 100 days after transplantation were excluded. The incidence, temporal sequence, risk factors, and prognostic impact of CMV reactivation and GVHD were evaluated. Overall survival (OS) and relapse-free survival (RFS) were estimated using the Kaplan–Meier method, while temporal associations were assessed using time-dependent Cox regression analyses. Results: CMV reactivation occurred in 72 patients (72%), whereas GVHD developed in 51 patients (51%). Among patients who experienced both complications, CMV reactivation preceded GVHD in 32 patients, while GVHD preceded CMV reactivation in 14 patients. Older recipient age (42.3 ± 13.5 vs. 35.4 ± 11.2 years, p = 0.018) and older donor age (37.2 ± 10.9 vs. 32.5 ± 9.7 years, p = 0.048) were associated with CMV reactivation. Older donor age was also associated with GVHD development (38.1 ± 10.7 vs. 33.6 ± 10.5 years, p = 0.037). The median time to CMV reactivation was 37 days, and CMV end-organ disease occurred in 13.9% of affected patients. No significant differences in OS or RFS were observed according to CMV reactivation or GVHD status in the day-100 landmark cohort. In the AML subgroup, both CMV reactivation and GVHD showed a trend toward inferior OS and RFS without reaching statistical significance. Time-dependent Cox regression demonstrated that CMV reactivation independently increased the subsequent risk of GVHD (HR 2.93, 95% CI 1.51–5.69; p = 0.001), whereas GVHD also independently increased the subsequent risk of CMV reactivation (HR 1.98, 95% CI 1.06–3.71; p = 0.032). Conclusions: CMV reactivation was highly prevalent after allo-HSCT and frequently preceded GVHD, supporting a bidirectional temporal relationship between these complications. Older donor age was associated with both CMV reactivation and GVHD. Although survival did not significantly differ according to CMV or GVHD status in this day-100 landmark cohort, clinically important CMV-related complications, including end-organ disease and platelet engraftment failure requiring eltrombopag, remained common. These findings indicate that a standardized pre-emptive strategy did not completely prevent CMV-associated morbidity. Because letermovir was not evaluated in this cohort, any potential benefit of prophylaxis should be interpreted as an inference from external evidence rather than as a direct finding of this study. Prospective multicenter studies incorporating immune reconstitution analyses are warranted.

Background: The role of salvage autologous stem cell transplantation (ASCT) in relapsed/refractory multiple myeloma (R/R MM) is being reconsidered in the era of novel immunotherapies. We evaluated the long-term efficacy and safety of salvage ASCT in a real-world single-center cohort. Methods: We retrospectively analyzed 57 patients with R/R MM who underwent salvage ASCT between March 2012 and August 2025. Clinical characteristics, treatment responses, toxicities, progression-free survival (PFS), overall survival (OS), and prognostic factors were assessed. Results: The mean age at salvage ASCT was 60.2 ± 8.2 years. Before salvage ASCT, 50.9% of patients achieved complete response or very good partial response, increasing to 80.7% by day +100. Transplant-related mortality was 3.5%, while infection or febrile neutropenia occurred in 77.2%. Median PFS and OS after salvage ASCT were 34.0 months (95% CI, 28.8–39.2) and 67.2 months (95% CI, 46.2–88.2), respectively. Median OS from diagnosis was 130.5 months. In multivariate analysis, higher LDH and pre-transplant refractory status were independently associated with PFS, whereas age at salvage ASCT and beta-2 microglobulin level were independently associated with OS. Conclusions: Salvage ASCT was associated with durable disease control and acceptable transplantation-related outcomes in this carefully selected cohort. Its comparative role relative to contemporary immunotherapies requires prospective evaluation.

Multipl miyelomda (MM) modern tedavi yaklaşımları sayesinde sağkalım süreleri belirgin olarak uzamıştır. Ancak sağkalımdaki bu artışa paralel olarak, uzun dönem tedaviye bağlı komplikasyonlar daha sık bildirilmeye başlanmıştır. Bu yazıda, iki kez OHKHN uygulanmış ve uzun süreli lenalidomid idame tedavisi alan MM hastasında gelişen sekonder Philadelphia kromozomu (Ph) pozitif B-hücreli akut lenfoblastik lösemi (B-ALL) olgusu sunulmuştur. Bu olgu, MM hastalarında gelişen yeni sitopenilerin yalnızca relaps veya tedavi toksisitesi açısından değil, tedavi ilişkili sekonder hematolojik maligniteler açısından da dikkatle değerlendirilmesi gerektiğini göstermektedir.

Background: T-cell lymphomas (TCLs) constitute a heterogeneous group of mature T-cell neoplasms characterized by aggressive clinical behavior and poor outcomes, particularly in the relapsed/refractory (R/R) setting. Belinostat is a pan-HDAC inhibitor approved for R/R peripheral T-cell lymphomas. In this retrospective study, we analyze the real-world outcomes of single-agent belinostat in Turkish patients with R/R TCLs. Methods: Patients with R/R TCLs across Turkey who received at least one course of belinostat were included in the study. The primary end point was the overall response rate (ORR). The secondary end points included progression-free survival (PFS), overall survival (OS) and duration of response (DOR). Results: A total of 59 patients with R/R TCL were enrolled in the study, with a median age of 62 years. The median number of previous lines of therapy before belinostat was 2.5. The ORR for belinostat was 30.5% in the overall study cohort. Response assessment was available in 53 patients, among whom the ORR was 34% (18/53). The median PFS was 3 months. The median OS was 12 months, and the median DOR was not reached in responders. At least one adverse event occurred in 39.0% of patients. Conclusions: Belinostat produced objective responses in a subset of patients. These findings support belinostat as a potential individualized treatment option rather than a broadly effective standard for all patients with R/R TCLs. This multicenter real-world study demonstrates that the observed response rates closely mirror those reported in prospective clinical trials, confirming the reproducibility of belinostat efficacy in routine clinical practice.