Candida infections are among the most common fungal diseases worldwide and are associated with notable morbidity and mortality, particularly in immunocompromised and critically ill patients. Moreover, the emergence and spread of antifungal resistance pose an increasing threat to global public health. Therefore, evidence-based recommendations are urgently needed to guide the surveillance and control of Candida infections. A multidisciplinary guidance development group comprising experts of infectious diseases, clinical microbiology, pharmacology, infection control, and guideline methodology jointly developed the present clinical practice guidance. The process followed internationally recognized grading of recommendations, assessment, development and evaluation (GRADE) framework. Clinical questions were formulated based on priority issues or areas of uncertainty in current practice, and corresponding recommendations were developed after systematic review and synthesis of the best available evidence. The strength of recommendations was classified as strong or conditional (weak), and the certainty of evidence was graded from high to low. The guidance provides recommendations on diagnostic strategies, antifungal therapy, and infection prevention and control measures for Candida infections, integrating both global evidence and national clinical experience. The target users include clinicians, microbiologists, infection control practitioners, and policymakers involved in the management of fungal diseases. The guidance aims to support optimized clinical decision-making, improve antifungal stewardship, and strengthen infection control strategies to address the growing challenge posed by Candida infections.

While peripheral blood hematopoietic stem cell transplantation (PB-HSCT) supports rapid engraftment and reduces graft failure risk in aplastic anemia (AA) patients, it compromised higher risk of acute graft-versus-host disease (aGVHD), highlighting the need for more effective prophylactic strategies. This phase II clinical trial was designed to assess the efficacy and safety of ruxolitinib, a JAK1/2 inhibitor, as part of GVHD prophylaxis regimen following PB-HSCT. This open-label, single-arm, Phase II clinical trial (ClinicalTrials.gov: NCT05914714) enrolled patients with AA between June 2023 and December 2024. Ruxolitinib was initiated at the start of conditioning and continued for 3 months post-transplant at a dose of 5 mg twice daily. A historical control cohort receiving standard GVHD prophylaxis between January 2019 and May 2023 was included for comparison. To address baseline imbalances, propensity score–based inverse probability of treatment weighting (IPTW) was applied. The primary objective was the incidence of aGVHD six months after HSCT. Secondary endpoints included one-year overall survival (OS) and GVHD-free, failure-free survival (GFFS). Immune reconstitution—including T cells, B cells, NK cells—and levels of pro-inflammatory cytokines were also evaluated to explore potential mechanisms. A total of 82 patients were enrolled (ruxolitinib group n = 46, historical control cohort n = 36). Comparative analysis showed that ruxolitinib significantly reduced the cumulative incidence of grade II–IV aGVHD (HR 0.24; p = 0.004) and severe aGVHD (0

Although acute myeloid leukemia (AML) with CBFB::MYH11 rearrangement is classified as favorable-risk, approximately 40% of patients experience relapse. We evaluated the prognostic impact of CBFB::MYH11 transcript levels and the optimal timing of allogeneic hematopoietic cell transplantation (allo-HCT) at first complete remission (CR1). A total of 186 patients with CBFB::MYH11-rearranged AML treated with intensive induction chemotherapy were included. CBFB::MYH11 levels after cycles 2 and 3 were strongly correlated (P < 0.001). The post-cycle 2 CBFB::MYH11 transcript level emerged as the strongest prognostic marker for both disease-free survival (DFS) and overall survival (OS), outperforming assessments after cycles 1 or 3. CBFB::MYH11 ≥ 1% after cycle 2 was independently associated with inferior DFS (HR 3.84, P < 0.001) and OS (HR 3.98, P = 0.003). Among patients with post-cycle 2 CBFB::MYH11 ≥ 1.0%, the 3-year DFS and OS were both 91.7% in patients who received allo-HCT at CR1, compared with 47.8% and 72.9%, respectively, in the chemotherapy consolidation group. Multivariate analysis indicated that allo-HCT in CR1 improved 3-year DFS compared with chemotherapy consolidation (HR 0.24; P = 0.023). However, no significant improvement in OS was observed during follow-up. These findings suggest that post-cycle 2 CBFB::MYH11 level ≥1.0% identifies a high-risk subgroup that may benefit from allo-HCT in CR1.

Relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the leading cause of treatment failure in acute myeloid leukemia (AML), yet the non-coding RNA-mediated regulatory mechanisms in relapse-driving tumor clones are not fully understood. In this study, we performed transcriptomic profiling of CD34+ cells from the bone marrow of patients who had relapsed after allo-HSCT and from those in sustained remission, and observed that long non-coding RNAs (lncRNAs) exhibited the largest magnitude of differential expression relative to other RNA classes. To systematically elucidate their function, we integrated correlation analysis, neighborhood topology, and thermodynamic modeling to construct relapse-associated competing endogenous RNA (ceRNA) networks. These networks highlighted multiple lncRNA-miRNA-mRNA axes potentially promoting leukemic progression. Functional interrogation using CRISPR-based xenograft assays and a single-cell CRISPR screening platform (Perturb-seq-like strategy) revealed that relapse-associated lncRNAs regulate AML cell proliferation and survival. Among them, SNHG8 emerged as a representative regulator that promotes relapse through the SNHG8-miR-625-ZC3H13/15 signaling axis. SNHG8 knockdown markedly impaired AML cell growth and triggered apoptosis. Furthermore, treatment with hypomethylating agents (HMAs) such as azacitidine and decitabine differentially modulated lncRNA/ceRNA expression signatures, thereby linking clinical interventions to transcriptomic regulation. Together, our findings identify lncRNA-ceRNA networks in post-transplant relapse of AML and identify the SNHG8 axis as a potential therapeutic vulnerability, providing a rationale for further investigation of lncRNA-targeted strategies in this clinical setting.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has improved outcomes in patients with acute myeloid leukemia (AML) harboring FLT3-internal tandem duplication (FLT3-ITD) mutations. However, relapse still occurs in 15–35

BACKGROUND:Invasive fungal infections remain a major cause of morbidity and mortality among allogeneic hematopoietic stem cell transplantation recipients. There is still limited high-quality comparative evidence for antifungal agents. METHODS:We conducted a systematic review and network meta-analysis of randomized controlled trials and observational studies (PROSPERO: CRD420251270033), with databases search updated to September 2025. A prespecified assumption-based proportional imputation method was applied to estimate outcomes in mixed populations. Relative risks (RRs) were synthesized using a frequentist random-effects model, and treatments were ranked using surface under the cumulative ranking curve (SUCRA). RESULTS:Thirty-two studies were selected, including 10 006 hematopoietic stem cell transplantation recipients. Across randomized controlled trials, posaconazole (RR, 0.19; 95% confidence interval, 0.08-0.44) and voriconazole (RR, 0.20; 95% confidence interval, 0.09-0.42) demonstrated the strongest efficacy against invasive fungal infections compared with placebo. Posaconazole ranked first for preventing invasive aspergillosis (SUCRA, 77.1%) and fungus-related mortality (SUCRA, 91.9%), while micafungin had the lowest discontinuation risk (SUCRA, 95.5%). Observational data favoured posaconazole tablets (SUCRA, 90.3%) over suspension (SUCRA, 75.2%). Isavuconazole showed lower hepatotoxicity-related discontinuation (5.3% vs. 22.9%; P = 0.0002), though these findings are based on limited cases. Trials implementing therapeutic drug monitoring showed a non-significant trend towards improved efficacy. CONCLUSIONS:Posaconazole and voriconazole demonstrate strong efficacy. Posaconazole tablets offer a favourable balance between benefit and risk. However, the potential safety benefits of isavuconazole warrant further evidence accumulation.

Introduction:Steroid-refractory (SR) hepatic acute graft-versus-host disease (aGVHD) remains a life-threatening complication following allogeneic hematopoietic stem cell transplantation, characterized by limited responsiveness to both first- and second-line therapies and an overall poor prognosis. This study aimed to evaluate the efficacy and safety of cyclophosphamide (CTX) as a salvage treatment for SR- hepatic aGVHD. Methods:A total of 50 patients with SR-hepatic aGVHD who underwent CTX treatment were retrospectively included in the analysis. Seventeen patients (34.0%) received CTX as second-line therapy, whereas the majority (n=33, 66.0%) were administered CTX as salvage therapy following failure of prior second-line interventions. Results:The overall response rate (ORR) at day 28 was 70.0%, with a durable ORR of 66.0% at day 56. Patients with the hepatitic variant of aGVHD showed a superior response compared to those with the classic variant (complete response: 6 of 8 [75.0%] vs. 14 of 42 [33.3%], P = 0.042). The probabilities of overall survival (OS) and nonrelapse mortality (NRM) at 3 years after CTX treatment were 36.9% (95% CI, 24.8%-54.9%) and 56.5% (95% CI, 41.4%-71.6%). Using propensity score matching (PSM), we compared 35 patients receiving CTX with 35 BAT (best available treatment) controls during the same study period. CTX initiation occurred later than BAT (median line: 3 vs 2, P < 0.001). Response rates and survival outcomes were comparable between two groups and CTX demonstrated consistent efficacy even when used as later-line therapy. Additionally, CTX did not significantly increase the risk of adverse events compared to the BAT group up to day 28. The most common adverse events in both groups were neutropenia (71.4% in the CTX group vs. 62.9% in the BAT group, P = 0.445), anemia (68.6% vs. 60.0%, P = 0.454), and cytomegalovirus infection (51.4% vs. 45.7%, P = 0.632). Discussion:These findings suggest that CTX is a promising and well-tolerated treatment option for patients with SR-hepatic aGVHD.

Background:Enterococcal bloodstream infection (EBSI) carries high mortality in hematologic patients, yet no prognostic model tailored to this population exists. Methods:We retrospectively analyzed 192 hematologic patients (≥14 years) with EBSI admitted between 2014 and 2024. Clinical features, microbiology, treatment, and outcomes were assessed. Candidate predictors for 30-day mortality were selected by LASSO and entered into multivariable logistic regression. A simplified risk score was derived from regression coefficients and internally validated by bootstrap resampling. Results:The median patient age was 43 years, and acute leukemia was the predominant underlying disease (72.4%). Enterococcus faecium was the leading pathogen (71.4%), with low vancomycin resistance (1.6%). Most cases (71.9%) occurred as breakthrough infections, mainly during carbapenem therapy, and 72.9% met mucosal barrier injury laboratory-confirmed bloodstream infection criteria. The 14- and 30-day all-cause mortality rates were 13.5% and 22.4%, respectively. Independent predictors of 30-day mortality included age ≥50 years (aOR=2.29, p=0.038), severe graft-versus-host disease (aOR=6.06, p=0.003), septic shock (aOR=30.01, p<0.001). The final predictive model, incorporating these three factors along with pneumonia and high-risk hematologic disease, demonstrated optimal discrimination (AUROC 0.79, 95% CI 0.705-0.867) and calibration. A derived risk score stratified patients into low- (<2 points) and high-risk (≥2 points) groups, with markedly different 30-day mortality (11.3% vs. 39.0%, P<0.001). Conclusions:In hematologic patients, EBSIs commonly arise as breakthrough infections despite broad-spectrum antibiotic coverage, most often associated with mucosal barrier injury. Our parsimonious risk score enables early identification of patients at high risk of 30-day mortality to guide timely interventions.

BACKGROUND:Previous research indicated that physicians possess limited knowledge of the diagnosis and treatment of invasive fungal disease (IFD). OBJECTIVE:This study aimed to assess the efficacy of training via video or PDF formats in increasing physicians' knowledge of IFD. METHODS:This was a multicentre, cluster-randomised controlled trial involving 18 tertiary hospitals in China. Physicians specialising in IFD clinical diagnosis and treatment from four departments were randomised 1:1 into a video training group or PDF training group, and questionnaires were completed before and after training. The primary outcome was the change in total questionnaire score before and after training. RESULTS:Of the 294 participants, 146 were assigned to the video group and 148 to the PDF group. Engagement with the training materials was observed among 127 participants from the video group and 135 from the PDF group. In the per-protocol set (PPS), post-training score improvements for total scores (p = 0.008), invasive candidiasis scores (p < 0.001), and invasive aspergillosis scores (p = 0.044) in the video group were significantly greater than those in the PDF group. Overall, 161 (61.5%) physicians in the PPS exhibited enhanced total scores post-training, with the video group outperforming the PDF group (70.9% vs. 52.6%, p = 0.002). The findings in the FAS were largely consistent with those observed in the PPS. CONCLUSION:Both video and PDF training modules are appealing to physicians. Further, the video training module displayed superior efficacy in improving physicians' knowledge of IFD.

Acute myeloid leukaemia (AML) patients with concurrent FMS-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD), nucleophosmin 1 (NPM1) and DNA methyltransferase 3 alpha (DNMT3A) mutations exhibit heterogeneous treatment outcomes. To identify optimal strategies for this subset, we retrospectively analysed 2541 AML patients with next-generation sequencing from 2016 to 2023. Among them, 113 harboured triple mutations and had treatment outcomes: 79 received allogeneic haematopoietic stem cell transplantation (allo-HSCT), and 34 underwent continuous chemotherapy (CMT). Compared with CMT, allo-HSCT was associated with superior 2-year overall survival (OS) (62.2% vs. 17.8%, p < 0.001). However, no clear additional benefit from allo-HSCT was observed in patients who achieved composite complete remission (CRc) with DNMT3A measurable residual disease (MRD) negativity or complete remission with negative multiparameter flow cytometry MRD after the first cycle of CMT (CMT1st). Among patients who underwent allo-HSCT, those in CRc after CMT1st had significantly improved post-transplant 2-year OS (71.9% vs. 44.1%, p = 0.028), leukaemia-free survival (65.4% vs. 40.2%, p = 0.029) and non-relapse mortality (17.4% vs. 40.4%, p = 0.037). CRc rates were higher with venetoclax-based intensive (88.2%) or non-intensive (63.6%) CMT than with CMT alone (p = 0.001). In conclusion, this study offers a potential treatment paradigm for AML patients with co-occurring FLT3-ITD, NPM1 and DNMT3A mutations.

IntroductionSteroid-refractory acute graft-versus-host disease (SR-aGVHD) represents a severe and persistent complication that can arise following allogeneichematopoietic stem cell transplantation (allo-HSCT). This study aimed toassess the effectiveness and safety of basiliximab compared with those of a humanized anti-CD25 monoclonal antibody (xenopax) in the treatment of SR-aGVHD in patients who underwent allo-HSCT.MethodsThis retrospective trial included 32 patients diagnosed with SR-aGVHD who were administered xenopax at 1 mg/kg on days 1, 4, and 8, and weekly thereafter until aGVHD severity was reduced to below grade 2. A historical cohort of 37 patients received basiliximab, which is a chimeric mouse-human anti-CD25 antibody.ResultsThe overall response (OR) rate on day 28 was not significantly different between The xenopax and basiliximab groups, with rates of 82% and 72%, respectively (p=0.57). Additionally, no differences were observed between the groups regarding the safety profile. The 1-year overall survival (OS) and non-relapse mortality (NRM) rates in the xenopax and basiliximab cohorts were 64% versus 40% (p=0.06) and 45% versus 48% (p=0.46), respectively.DiscussionIn conclusion, no significant differences were observed in efficacy or adverse events between chimeric mouse-human and humanized anti-CD25 monoclonal antibodies for the treatment of SR-aGVHD. Further studies with larger cohorts are necessary to validate these findings.

In patients with hematological disorders, the high risk of complex infections caused by immune dysfunction and intensive therapies poses a major challenge to the use of conventional microbiological tests (CMTs). Plasma cell-free DNA (cfDNA) metagenomic next-generation sequencing (mNGS) has emerged as a revolutionary noninvasive tool that enables unbiased, broad-spectrum, and rapid pathogen identification directly from blood samples. This review summarizes the core applications of plasma cfDNA mNGS in patients with hematological disorders, including the diagnosis of febrile neutropenia, bloodstream infections, focal infections, and infections caused by uncommon/fastidious pathogens. It highlights the advantages of this technology in overcoming antibiotic interference, enabling early detection, and providing diagnostic value in cases without clear infection foci or when invasive sampling is not feasible. This review further discusses how China has facilitated the widespread adoption of this technology through a localized application model, cost reduction, and the development of clinically relevant interpretation models. Nevertheless, challenges remain, such as lower sensitivity than site-specific specimens in focal infections, and the difficulty in predicting antimicrobial resistance (AMR) on the basis of cfDNA mNGS. Future developmental directions should focus on technical optimization (eg, combined plasma cell-fraction testing), quality assurance and quality control management, multidimensional data integration (eg, host immune response analysis), artificial intelligence (AI)–assisted interpretation, and cost reduction through technology popularization and insurance coverage. These efforts will advance cfDNA mNGS from a pathogen detection tool toward an intelligent clinical decision-support platform, ultimately improving the diagnostic accuracy and clinical outcomes of hematological patients with infections.

Conditioning regimens are critical for patients with relapsed/refractory (R/R) malignant hematologic diseases. Thiotepa, an alkylating agent with excellent cytotoxicity and blood‒brain barrier permeability, has been widely used in conditioning regimens for lymphoma and has recently been used in patients with acute leukemia with central nervous system involvement. The aim of this retrospective study was to observe the efficacy and safety of a conditioning regimen comprising thiotepa, busulfan, and cyclophosphamide (TBC) for allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with R/R hematologic diseases. Between July 2022 and December 2023, 27 patients were selected. With a median follow-up of 609 (243-954) days, the 1-year and estimated 2-year overall survival (OS) rates were 85.2% ± 6.8% and 76.5% ± 8.5%, respectively. The 1-year and estimated 2-year disease-free survival (DFS) rates were 81.5% ± 7.5% and 62.8% ± 12.2%, respectively. Six patients experienced relapse, and the 1-year and estimated 2-year cumulative incidence of relapse (CIR) rates were 14.8% ± 6.8% and 31.0% ± 12.6%, respectively. Two patients died from graft-versus-host disease (GVHD) or infection. The 1-year and estimated 2-year nonrelapse mortality (NRM) rates were 4.2% ± 4.1% and 8.5% ± 5.8%, respectively. 14 (51.9%) patients received maintenance therapy after allo-HSCT. Regimen-related toxicities were mostly well tolerated. Multivariate analysis revealed that failure to achieve first complete remission (CR1) before HSCT and previous treatment with CAR-T cell were predictors of poor DFS. This study suggests that the TBC conditioning regimen may be a promising option for patients with R/R hematologic diseases undergoing allo-HSCT.

BACKGROUND:Beyond their classical roles in haemostasis and thrombosis, platelets have been recognised as active regulators of immune responses. However, whether platelets can function as immune sensors capable of monitoring immune status remains largely unexplored. METHODS:We first analysed platelet transcriptomes from patients at different stages following haematopoietic stem cell transplantation (HSCT) to assess their ability to capture immune reconstitution dynamics. We then employed immune cell-platelet co-incubation experiments to elucidate the mechanistic role of RNA transfer in reshaping platelet immune molecular profiles. Subsequently, platelet transcriptomes were examined in immune-related conditions, including HSCT-associated acute graft-versus-host disease (aGVHD), cytomegalovirus (CMV) DNAemia, and immune-inflammatory diseases such as systemic lupus erythematosus (SLE) and ulcerative colitis (UC), to evaluate their capacity to identify disease-specific immune dysregulation. Finally, machine learning models were developed based on platelet immune gene signatures to assess diagnostic performance. FINDINGS:Platelet transcriptomes accurately reflected the dynamics of immune reconstitution following HSCT. Mechanistically, immune cells directly reprogrammed platelet immune-related molecular features through RNA transfer. Moreover, platelets sensitively detected immune alterations associated with transplant complications, including aGVHD and CMV DNAemia, and effectively monitored immune activity and inflammatory states in SLE and UC. Machine learning models based on platelet immune gene profiles further improved diagnostic accuracy across disease settings. INTERPRETATION:This study establishes platelets as precise, readily accessible, and noninvasive immune sensors, extending their functional repertoire from immune regulation to immune surveillance and diagnosis in immune-related diseases. FUNDING:National Natural Science Foundation of China; CAMS Innovation Fund for Medical Sciences; Science and Technology Projects of Xizang Autonomous Region, China; National Key Research and Development Program of China; Tianjin Municipal Science and Technology Commission Grant; and Natural Science Foundation of Tianjin.

Bacterial and fungal pulmonary infections (BFPI) are common in hematological patients and pose significant diagnostic challenges. Metagenomic next-generation sequencing (mNGS) is valuable for diagnosing BFPI. However, for hematological patients with limited access to lower respiratory tract samples (LRTS), the clinical value of blood-mNGS compared to LRTS-mNGS requires further investigation. A retrospective analysis was conducted on 160 cases with suspected pneumonia who underwent both blood-mNGS and LRTS-mNGS within one week. Diagnostic performance and impacts on antimicrobial adjustments were evaluated using clinical composite diagnosis (CCD) as the reference. Compared to CCD, LRTS-mNGS showed significantly higher positive percent agreement (PPA) than blood-mNGS [93.7

Cytomegalovirus (CMV) is an increasingly recognized complication of chimeric antigen receptor T-cell (CAR-T) and bispecific antibody (BsAb) therapies for hematologic malignancies, driven by therapy-related immunosuppression and cumulative exposure to lymphodepleting or steroid regimens. Given China's high adult CMV IgG seroprevalence (>90%), baseline risk, interpretation of low-level DNAemia, and operational thresholds differ from low-seroprevalence settings, requiring context-specific guidance. This China-adapted, evidence-graded consensus was developed by a multidisciplinary panel from major centers using a modified Delphi process and Oxford Centre for Evidence-Based Medicine levels to translate international guidance into a high-seroprevalence setting. Recommendations prioritize early risk stratification and pragmatic surveillance. We advise routine CMV monitoring by real-time quantitative PCR during the first 30 days after therapy, with risk-adapted extension thereafter. Interpretation and treatment triggers are anchored to WHO-traceable IU/mL and specified by specimen matrix to support comparability across assays. Consideration of prophylaxis is proposed for well-defined high-risk subgroups, acknowledging the need for prospective validation. Syndrome-based diagnostic and treatment algorithms are provided for tissue-invasive disease, including CMV pneumonia and encephalitis, with guidance on antiviral induction, step-down, and monitoring for virologic response and drug toxicity. This consensus explicitly adapts international recommendations to China's epidemiology, assay practice, and drug accessibility. By standardizing prevention, surveillance, and management in CAR T-cell and BsAb recipients, this consensus aims to lower non-relapse mortality and improve long-term outcomes. Priority research needs include harmonized viral-load thresholds, validation of risk-adapted prophylaxis strategies, and studies that clarify the significance of low-level DNAemia in this population.

BackgroundThe Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) assigns a high-risk score to patients who develop secondary hematologic malignancies following solid tumors, indicating an increased risk of non-relapse mortality (NRM). This study aimed to evaluate the impact of prior solid tumors on outcomes after hematopoietic stem cell transplantation (HSCT).MethodsFrom a cohort of 2,382 patients who underwent HSCT for acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), or myelodysplastic syndrome (MDS) between January 2014 and July 2024, we included 43 (1.8%) with a history of prior solid tumors and 82 matched controls for analysis by 1:2 propensity score matching.ResultsThe solid tumor cohort predominantly comprised breast cancer (48.8%). With a median follow-up of 31.0 months, only one patient exhibited post-transplant relapse or metastasis of the solid tumor. Compared to the control group, patients with solid tumors exhibited higher ECOG scores (≥ 2: 23.1% vs. 9.5%, P = 0.049), lower platelet counts (35.5 vs. 72×109/L, P = 0.010), a higher incidence of complex karyotypes (16.3% vs. 3.7%, P = 0.031). No significant differences were noted in 3-year overall survival (OS) (64.3% vs. 71.9%, P = 0.468), leukemia-free survival (LFS) (57.6% vs. 70.8%, P = 0.218), graft-versus-host disease/relapse-free survival (GRFS) (43.3% vs. 53.0%, P = 0.359) and NRM (23.9% vs. 11.7%, P = 0.246). In an exploratory landmark analysis, the solid tumor cohort appeared to have significantly lower OS (P = 0.030), LFS (P = 0.009), and GRFS (P = 0.038) from 2 years after transplantation. Multivariable analysis identified age greater than 55 years, baseline platelet counts less than 50×109/L as significant predictors of inferior OS and LFS in solid tumor patients.ConclusionPatients with hematologic diseases secondary to solid tumors showed no significant increase in overall transplantation risk. However, their adverse clinical characteristics and reduced long-term survival rates beyond 2 years post-transplantation, underscore the need to refine HCT-CI scoring and improve management strategies.

Multidrug-resistant (MDR) Acinetobacter spp. bloodstream infection (BSI) is concerning in hematologic patients, but integrated clinical and genomic analyses are scarce. We retrospectively analyzed 62 hematologic patients with Acinetobacter spp. BSI over 13 years, including 30 MDR and 32 non-MDR cases. Whole-genome sequence (WGS) was conducted on 23 MDR isolates. Checkerboard assays evaluated the in vitro activity of eravacycline combined with sulbactam, meropenem, cefoperazone–sulbactam, polymyxin B, and levofloxacin. Female (66.67

BackgroundAntineoplastic agents significantly contribute to drug-induced liver injury (DILI). This study evaluates magnesium isoglycyrrhizinate (MgIG) for preventing DILI in hematological malignancy patients receiving novel antitumor therapies.MethodsThis multicenter retrospective analysis included hematological malignancy patients treated with hepatoprotective agents across 13 Chinese centers (December 2023–February 2024). Primary outcomes assessed liver injury incidence and severity at 21, 30, and 60 days; secondary outcomes evaluated safety.ResultsPropensity score-matched cohorts (MgIG = 324, control = 182) showed balanced baselines. MgIG recipients had higher chemotherapy (91.4 vs. 64.3%, P < 0.001) and Venetoclax exposure (26.2 vs. 2.2%, P < 0.001). Baseline AE incidence was higher with MgIG (4.6 vs. 0.5%, P = 0.014), but subsequent follow-ups showed comparable AE rates. Hepatic injury incidence was similar (4.2 vs. 4.0%, P > 0.05). Controls exhibited greater ALT, AST and γ-GGT elevations at day 30 and γ-GGT elevation at day 60 (all P < 0.05). MgIG reduced overall hepatic AEs (48.0 vs. 66.7%, P < 0.001), driven by fewer grade 1–2 abnormalities (43.5 vs. 60.3%, P < 0.001), though grade ≥2 events remained comparable. Interim assessments revealed higher hepatic AE rates in controls at day 21 (54.5 vs. 37.1%) and day 30 (55.7 vs. 34.1%; P < 0.001), with elevated grade ≥2 AEs by day 60 (18.6 vs. 8.6%, P = 0.022).ConclusionsProphylactic MgIG attenuates antineoplastic therapy-induced ALT/AST/TBiL elevations in hematological malignancies, demonstrating hepatoprotective efficacy. While its impact on overall DILI incidence remains unclear, longitudinal data suggest clinically meaningful mitigation of hepatotoxicity severity in high-risk subgroups during critical phases.