B-cell lymphoma and lymphoproliferative diseases represent a heterogeneous and complex group of neoplasms that are accompanied by a broad range of immune regulatory disorder phenotypes. Clinical features of autoimmunity, hyperinflammation, immunodeficiency and infection can variously dominate, depending on the immune pathway most involved. Immunological imbalance can play a role in lymphomagenesis, also supporting the progression of the disease, while on the other hand, lymphoma acts on the immune system to weaken immunosurveillance and facilitate immunoevasion. Therefore, the modulation of immunity can have a profound effect on disease progression or resolution, which makes the immune system a critical target for new therapies. In the current therapeutic scenario enriched by chemo-free regimens, it is important to establish the effect of various drugs on the disease, as well as on the restoration of immune functions. In fact, treatment of B-cell lymphoma with passive immunotherapy that targets tumor cells or targets the tumor microenvironment, together with adoptive immunotherapy, is becoming more frequent. The aim of this review is to report relevant data on the evolution of the immune system during and after treatment with targeted therapy of B-cell lymphomas.

Background. Acquired hemophilia A (AHA) is a rare, potentially fatal autoimmune coagulopathy caused by the presence of neutralizing autoantibodies directed against factor VIII. It primarily affects older adults and is frequently underdiagnosed, resulting in diagnostic delays and fragmented care. This is associated with preventable bleeding complications, increased mortality, and rising healthcare costs. Despite the availability of effective hemostatic and immunosuppressive therapies, the long-term management of recurrent or refractory forms remains complex outside of specialized centers. Objectives. To establish a regional care pathway supported by a digital platform capable of connecting local and hospital services with a Hemophilia Reference Center, in order to accelerate diagnosis, guide initial treatment decisions, and improve the continuity and appropriateness of follow-up care.Methods. A secure digital platform was developed to connect emergency departments, hematology units, laboratories, local pharmacies, and primary care physicians with the Regional Hemophilia Reference Center in Palermo. The platform was designed based on actual clinical workflows and enables rapid teleconsultations in cases of suspected AHA, centralized interpretation of coagulation tests, and shared decision-making regarding hemostatic and immunosuppressive therapies. During follow-up, clinicians can update clinical data, bleeding events, treatments, and laboratory results in real time, allowing specialists to adjust treatment promptly. A dedicated patient section facilitates communication following discharge. Access to the platform is governed by differentiated authorization profiles and complies with current data protection regulations.Results. Development of the platform began on December 6, 2023, and regional implementation was completed in February 2025. Four physicians from four peripheral hospitals were involved—two from emergency departments and two from hematology units. Twelve specialist consultations for suspected AHA were conducted through the platform. Two patients with confirmed diagnoses were managed entirely through the shared care pathway—one identified in the emergency department and one in the hematology setting. After discharge, follow-up was ensured through regular clinical and laboratory updates entered by primary care physicians and reviewed by the referral center. In both cases, therapy was adjusted remotely, resulting in complete remission. In one patient, structured monitoring also enabled the diagnosis of a neoplasm during follow-up, highlighting the platform’s potential role in cancer surveillance as well, given the well-known association between AHA and neoplasms, which can sometimes be diagnosed after the onset of bleeding symptoms. In its first six months of operation, the platform improved communication between centers, strengthened continuity of care, and reduced unnecessary or inappropriate interventions.Conclusions. A digitally integrated care network can improve access to specialized expertise in rare diseases even when that expertise is centralized. In the AHA, it helps reduce diagnostic time, harmonize treatment decisions, and ensure structured long-term monitoring. This model can potentially be extended to other rare diseases, helping to improve equity of access, appropriateness of care, and efficiency of the National Health Service, as well as facilitating the collection of real-world data.

Background and Aims. Acquired Hemophilia A (AHA) is a rare, potentially life-threatening bleeding disorder caused by autoantibodies against factor VIII. It mainly affects older adults and is often associated with delayed diagnosis and fragmented care, particularly outside expert centers. The aim of this project was to develop a region-wide digital care pathway connecting peripheral services with the Regional Reference Hemophilia Center of the Policlinico Universitario Paolo Giaccone in Palermo to accelerate diagnosis, support treatment decisions, and improve follow-up of patients with AHA.Materials and Methods. A secure digital health platform was developed to link emergency departments, hematology units, laboratories, community pharmacies, and general practitioners with the reference center. The platform supports rapid teleconsultations for suspected AHA, centralized interpretation of coagulation tests, including FVIII activity and inhibitor evaluation, and shared decision-making on haemostatic and immunosuppressive treatment. During follow-up, clinicians can update symptoms, bleeding events, therapies, and laboratory results in real time, allowing specialists to remotely adjust treatment and monitor associated conditions. Access is role-based, and data protection measures comply with privacy requirements.Results. Development began on 6 December 2023, and the platform became fully operational across the region in February 2025. Four physicians from four community hospitals were onboarded, including two from emergency departments and two from hematology units. During the first six months, twelve expert consultations were requested for suspected AHA. Two confirmed AHA patients were managed end-to-end through the shared pathway, one from the emergency setting and one from a hematology unit. After discharge, general practitioners entered regular clinical and laboratory updates, reviewed by the reference center. In both cases, treatment was tailored remotely, and complete remission was achieved. Structured follow-up also enabled timely surveillance and led to the diagnosis of an early-stage cancer in one patient.Conclusions. A digitally connected care network can bring rare-disease expertise closer to patients, even when specialist knowledge is centralized. In AHA, this model may shorten time to diagnosis, align therapeutic decisions, and ensure safe monitoring after discharge, including surveillance for associated malignancy. This approach could be extended to other rare diseases, improving equity of access, continuity of care, and real-world evidence collection within the Italian National Health System.