Purpose:This paper reports up-to-date expert consensus from the Asian Lymphoma Study Group (ALSG) on treatment recommendations for mantle cell lymphoma (MCL) in Asia. Materials and Methods:A closed session meeting of the ALSG was convened in August 2025 to discuss MCL management practices in Asia. Consensus recommendations from that meeting are summarized here, and take into consideration international guidelines, the current treatment landscape in Asia, and global and Asia-specific literature. Results:In Asia, effective MCL management is limited by difficulties in accessing Bruton's tyrosine kinase inhibitors (BTKi) and other novel agents. For patients with indolent and stage I/II disease, active surveillance and involved-site radiotherapy (with/without immunochemotherapy), respectively, can be considered. In advanced MCL, less intensive immunochemotherapy is recommended for elderly, unfit patients; young, fit patients typically receive aggressive cytarabine-based regimens prior to consolidation autologous hematopoietic stem cell transplantation (HSCT). If accessible, covalent BTKi (cBTKi) can be integrated into the first line, and clinical trial enrollment is strongly encouraged for patients with high-risk features. Rituximab maintenance with/without cBTKi is recommended following first-line treatment. In the relapsed/refractory (R/R) setting, cBTKi are more widely used, and novel agents like non-covalent BTKi and chimeric antigen receptor T-cell therapies can be considered where available. Allogeneic HSCT is an option for high-risk or R/R transplant-eligible patients. Conclusion:These recommendations aim to guide MCL management in Asia. Given the heterogeneity of the disease, diverse healthcare systems, and variable treatment access across the region, there is no one-size-fits-all approach and resource-stratified approaches should be considered.
Purpose:Fecal immunochemical tests (FIT) are widely used for colorectal cancer (CRC) screening. This systematic review and meta-analysis evaluated the diagnostic accuracy of quantitative FIT for CRC and advanced neoplasm (AN), and examined variations in performance by sex, geographic region, study design, FIT platform, and positivity threshold. Materials and Methods:A comprehensive search of MEDLINE, Embase, Cochrane Library, and KoreaMed was conducted. Studies evaluating the accuracy of quantitative FIT for CRC or AN using colonoscopy as a reference standard were included. The pooled sensitivity and specificity were estimated using a bivariate random-effects model. Meta-regression analysis was performed to analyze the diagnostic differences between sexes. Results:Thirty-three studies were included. FIT showed higher sensitivity for CRC than for AN (78.6% vs. 32.3%), with high specificity for both outcomes (93.7% and 95.2%, respectively). Case-control studies yielded a significantly higher AN sensitivity than cohort studies (50.7% vs. 29.7%; p<0.05). Western studies showed significantly higher AN sensitivity and lower specificity than Eastern studies (31.6% vs. 24.2%, p<0.05; and 95.0% vs. 96.5%, p<0.05, respectively). In the sex-stratified analyses, males showed higher AN sensitivity than females (34.1% vs. 30.8%) and significantly lower CRC specificity (90.1% vs. 93.1%; p<0.05); however, the meta-regression showed no significant sex effect on the overall diagnostic accuracy for CRC or AN. Conclusion:Quantitative FIT demonstrated strong performance for CRC detection but limited sensitivity for AN. Variations in the study design, FIT platform, threshold, region, and sex should be considered when interpreting FIT accuracy.
Purpose:Chemoimmunotherapy has improved outcomes in extensive-stage small-cell lung cancer (ES-SCLC), but its benefit in older adults remains uncertain because this population is underrepresented in clinical trials. We evaluated the real-world efficacy of first-line atezolizumab plus etoposide-carboplatin according to age in patients with ES-SCLC. Materials and Methods:We conducted a multicenter retrospective study across seven Korean institutions and identified patients with ES-SCLC treated between 2016 and 2022 with atezolizumab plus etoposide-carboplatin or etoposide-platinum chemotherapy alone. Patients with recurrence after prior limited-stage disease or incomplete records were excluded. End points were overall response rate (ORR), progression-free survival (PFS), and overall survival (OS), assessed using Kaplan-Meier methods and Cox regression models. Results:Among 550 identified patients, 538 were included: 247 received atezolizumab plus chemotherapy and 291 received chemotherapy alone. Overall, 111 patients (20.2%) were aged 75-80 and 57 (10.4%) were older than 80years. In the overall population, atezolizumab was associated with improved PFS (hazard ratio [HR], 0.78; 95% CI, 0.65 to 0.93; p=0.006) and OS (HR, 0.76; 95% CI, 0.63 to 0.93; p=0.006). Age-stratified analyses showed significant PFS benefit only in patients aged 70-75 (HR, 0.67; p=0.049) and significant OS benefit only in patients aged 65-70 (HR, 0.65; p=0.044). Beyond 75 years, neither PFS nor OS was significantly improved. Patients aged ≥75years also had lower ORR and more progressive or non-evaluable disease compared with <75years. Conclusion:The clinical benefit of adding atezolizumab appears attenuated in ES-SCLC patients age 75 years or older, supporting careful selection and age-adapted treatment strategies.
Purpose:The role of autologous stem cell transplantation (ASCT) in transplant-eligible patients with dialysis-dependent multiple myeloma (DDMM) remains unclear. We compared outcomes between ASCT and non-ASCT approaches in newly diagnosed DDMM. Materials and Methods:In this multicenter retrospective study, 117 patients with newly diagnosed DDMM who remained dialysis-dependent throughout induction therapy were included. Patients who achieved dialysis independence during induction were excluded. In the ASCT group, patients also remained dialysis-dependent at transplantation. Results:Post-induction overall response and ≥VGPR rates were comparable between groups. In the ASCT group, responses deepened significantly after transplantation. Among 53 paired-evaluable patients, ≥CR increased from 18.9% before ASCT to 60.4% after ASCT, while ≥VGPR from 52.8% to 83.0%; 67.9% experienced response deepening. In diagnosis-anchored analyses, ASCT was associated with significantly longer progression-free survival (PFS) (median, 39.4 vs. 12.1 months; p<0.001) and overall survival (OS) (median, 71.4 vs. 40.3 months; p=0.020); however, when ASCT was modeled as a time-dependent covariate and adjusted for baseline covariates, neither PFS (HR, 0.63; p=0.122) nor OS (HR, 0.78; p=0.463) remained statistically significant, indicating that the apparent survival advantage should be regarded as hypothesis-generating. Early post-transplant mortality was 5.5%, and non-relapse mortality was 3.6%. Durable dialysis discontinuation occurred in 16.4% and 12.9% of the ASCT and non-ASCT groups, respectively (p=0.611). Conclusion:In transplant-eligible patients with DDMM, ASCT was feasible and was associated with substantial deepening of response. After accounting for immortal time bias, the apparent survival advantage was attenuated and should be regarded as hypothesis-generating, warranting confirmation in prospective studies.
Purpose:To describe perioperative imatinib continuation patterns and explore associations with long-term outcomes in patients with locally advanced gastrointestinal stromal tumors (GIST) undergoing curative-intent surgery after neoadjuvant therapy. Materials and Methods:We retrospectively screened 395 patients receiving preoperative imatinib at two centers from 2012 to 2024. The analytic cohort comprised 171 patients with primary locally advanced GIST who underwent curative-intent surgery after neoadjuvant imatinib. Total perioperative exposure combined neoadjuvant and adjuvant treatment durations. Kaplan-Meier, Cox regression, and a 36-month landmark analysis were performed. Recurrence patterns and post-recurrence management were reviewed in 39 recurrent cases. Results:Median follow-up was 46 months; 39 patients (22.8%) recurred and 20 (11.7%) died. Five-year overall survival was 76.1%, 91.7%, and 96.7% for total exposure ≤36, >36 to ≤48, and >48 months, respectively, whereas recurrence-free survival did not differ significantly. In the landmark cohort (n=97), exposure >36 months was not significantly associated with post-landmark recurrence-free survival (HR, 0.881; 95% CI, 0.319 to 2.431; P=0.807) or overall survival (HR, 0.238; 95% CI, 0.043 to 1.303; P=0.098). Liver metastasis (53.8%) and peritoneal/abdominal dissemination (48.7%) were the most frequently documented first recurrence sites; 38.5% had multisite recurrence and 15.4% received local treatment. Conclusion:Longer perioperative imatinib exposure showed favorable survival patterns in fixed-exposure analyses, but the association was attenuated in landmark analysis. These surgery-conditioned findings are exploratory and do not establish an optimal treatment duration.
