Hodgkin lymphoma (HL) is prevalent worldwide and typically presents symptoms like sudden pain, swelling, and weight loss. Classical HL (cHL) is largely treatable with modern risk-adapted and response-based therapy. cHL represents one of the most common malignancies occurring during the course of evolution in patients living with HIV. The present manuscript aimed to present the diagnostic work-up with an emphasis on flow cytometry in patients with HIV-associated lymphoma, of important clinical benefit both in the HIV-endemic setting as well as in state-of-the-art pathology departments. Three clinical cases of HIV patients, including HIV-associated cHL, are presented in the chapter dedicated to HIV-induced lymphomas diagnosed by FC, as Supporting Information, to support the particularities of the abundance of clonal B-cell populations among different types of HIV-related lymphomas. This adds to the proof-of-concept that the specific antibody panel design may help practitioners in discriminating among similar subtypes of HIV-associated lymphomas. Recent data emphasise the importance of FC detection of cHL rapidly and effectively, adding diagnostic value to these small biopsies. FC is an important tool for clinical decision-making in the management of HL patients, providing a noninvasive and accurate biomarker evaluation. For these considerations, we can conclude that FC is a very useful research tool, and the clinical cases presented in this paper indicate their importance in the rapid diagnosis of cHL as well.

Venetoclax (VEN), a selective BCL-2 inhibitor and VEN-based combinations represent a cornerstone of modern chronic lymphocytic leukemia (CLL) management and allow deep remissions and fixed-duration, chemotherapy-free treatment options. Our narrative review aims to provide an overview of VEN-based targeted and immunotherapy combinations in both newly-diagnosed and relapsed/refractory CLL. We summarize pivotal clinical trials evaluating VEN in combination with anti-CD20 monoclonal antibodies, Bruton's tyrosine kinase inhibitors (BTKi), bispecific antibodies and chimeric antigen receptor (CAR) T-cells. The regimens we discuss in this paper achieved high overall response rates, durable progression-free survival, and substantial rates of undetectable minimal residual disease, often translating into prolonged treatment-free intervals. For instance, fixed-duration VEN-obinutuzumab/rituximab regimens demonstrated superiority over chemoimmunotherapy, while combinations of VEN with BTKi further improved depth of response and reduced resistance rates. MRD-guided strategies are discussed, their superiority over fixed-duration approaches, however, remains unproven. Emerging data on retreatment, sequencing strategies, dose optimization, and next-generation BTKi are also highlighted. We also identify current knowledge gaps because future studies directly comparing regimens and integrating MRD-driven decision-making will be critical to defining optimal therapeutic strategies.

Adult T-cell leukemia/lymphoma (ATLL) is an aggressive lymphoma with a poor prognosis. The human T-lymphotropic virus 1 (HTLV-1) is associated with immunodeficiency and increased extranodal involvement in patients with diffuse large B-cell lymphoma (DLBCL). We report on a 47-year-old woman with spastic paraparesis and hepatitis B who was diagnosed with the acute form of ATLL. The clinical picture reveals peripheral generalized lymphadenopathy and splenomegaly. Findings on a hematologic exam indicated leukocytosis with lymphocytosis. A bone marrow biopsy/aspiration confirmed 50% T-cell lymphoid infiltration. Biochemistry results revealed hypercalcemia and a high lactate dehydrogenase value. Results of a CT scan indicated abdominal and thoracic adenopathy as well as moderate splenomegaly. A supraclavicular lymph node biopsy established a DLBCL diagnosis. The final diagnosis was composite lymphoma, DLBCL, and ATLL. The CHOP (cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate [Oncovin], and prednisone) regimen was chosen due to the patient's ECOG performance status. Multiple infectious complications were diagnosed during chemotherapy-induced secondary aplasia. A complete remission, confirmed via PET-CT imaging, was obtained. After 1 month, a skin tumor on the upper right thigh was discovered and biopsied, and the histopathological exam and immunochemistry findings indicated Epstein-Barr virus-DLBCL lymphoma. The association of 2 aggressive lymphomas in a single HTLV-1 carrier is a rare report, and the evolution was severe, complicated by opportunistic infections, and unfavorable.

Systemic mastocytosis (SM) is a spectrum of hematologic disorders characterized by accumulation of atypical mast cells (MCs) in extracutaneous organs. SM with an associated hematologic neoplasm (SM-AHN), the most frequent subtype of advanced SM, is predominantly associated with myeloid neoplasms, consistent with shared clonal architecture. Because of its rarity and heterogeneity, robust outcome data aligned with contemporary classifications are needed to inform risk stratification. We analyzed the 10th data wave of the European Competence Network on Mastocytosis registry (34 European centers and 1 US center). SM and AHN diagnoses followed the 2022 World Health Organization classification. Baseline characteristics and overall survival (OS) were compared between patients with myeloid SM-AHN and SM without AHN (SM-no-AHN). Within SM-AHN, outcomes were analyzed by SM component (advanced: aggressive SM [ASM] or MC leukemia [MCL] vs. non-advanced: bone marrow mastocytosis, indolent SM, or smoldering SM) and AHN subtype. Among 3,925 patients with SM, 467 (11.9

Measurable residual disease (MRD) assessment has become a cornerstone in the management of acute myeloid leukemia (AML), offering critical prognostic information and guiding post-remission therapy. Conventional MRD detection methods, including multiparameter flow cytometry (MFC), quantitative PCR (qPCR), and next-generation sequencing (NGS), have demonstrated strong predictive value but are limited by technical complexity, marker specificity, and accessibility. This review explores the current landscape of MRD monitoring in AML, covering cytogenetic, immunophenotypic, and molecular approaches, with particular emphasis on the strengths and limitations of each. We further examine promising emerging technologies—namely DNA methylation profiling and surface-enhanced Raman scattering (SERS)—as non-invasive alternatives. DNA methylation-based assays capitalize on the epigenetic dysregulation characteristic of AML, while proof-of-concept studies indicate SERS as a promising alternative for cancer subtypes, stages or specific mutation detection by analyzing biofluids or extracted DNA from blood. Together, these developments hold the potential to overcome current diagnostic limitations, enabling more universal and precise MRD assessment. Ongoing research and validation will determine their future integration into standard clinical practice.

Extramedullary disease (EMD) in multiple myeloma (MM) represents a distinct clinical entity associated with poor prognosis, therapeutic resistance, and aggressive behavior. EMD can occur at diagnosis or during relapses, either contiguous with bone lesions or as soft tissue plasmacytomas due to hematogenous spread. This review outlines the current understanding of EMD pathophysiology, diagnostic challenges, and therapeutic approaches. The review differentiates between bone-related and non-bone-related EMD, highlighting their prognostic implications. Diagnostic strategies rely on advanced imaging modalities, including PET-CT and MRI, and require histopathological confirmation through biopsy and immunohistochemistry. Management includes local therapies, primarily radiotherapy and, in selected cases, surgery, alongside systemic treatments involving proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies. New emerging therapies, such as chimeric antigen receptor T cells (CAR-T) and bispecific antibodies, are under evaluation for the treatment of relapsed/refractory EMD. Autologous stem cell transplantation is recommended for eligible patients, with tandem procedures considered in high-risk cases. The role of minimal residual disease (MRD) monitoring is emphasized, employing next-generation sequencing (NGS), flow cytometry, and imaging, with MRD negativity serving as a surrogate marker for treatment efficacy and survival prediction. Despite therapeutic advances, the prognosis for patients with EMD remains unfavorable. The review underscores the necessity of a multidisciplinary approach for accurate diagnosis, individualized treatment, and consistent monitoring. Recognizing EMD as a high-risk MM variant mandates the integration of novel diagnostics and therapies. Future clinical trials must incorporate EMD-specific endpoints to optimize treatment and improve outcomes.

Multiple myeloma is a hematological malignancy mostly diagnosed in the elderly. It is characterized by a chronic evolution with alternating periods of remission and relapses. Plasmacytoma, a tumor comprised of monoclonal plasma cells, is a typical finding in multiple myeloma patients, being more frequently observed during relapses. The most involved sites are bones, kidneys, liver, skin, ear, nose and throat. Extramedullary lung plasmacytomas are a rare presentation, with an incidence of well under 5% of all plasmacytomas. The clinical manifestations are heterogeneous and depend on the affected site. Differentiating plasmacytoma from other pathologies can be challenging, with the diagnosis being established via tumor biopsy. The presence of plasmacytoma is associated with poor prognosis and is a marker of rapid disease progression. We report the case of a 63-year-old patient diagnosed with IgA lambda multiple myeloma, stage IIIB Salmon-Durie complicated by lung plasmacytoma identified in the setting of relapse. Despite undergoing treatment, the disease exhibited an aggressive course, rapidly progressive towards death. The case underlines the rarity of pulmonary plasmacytoma and the diagnostic challenges.

A case of acute monocytic leukemia in an elderly patient

Background: Suboptimal cure rates with frontline therapy and limited treatment tolerance in elderly and frail patients were two major challenges in diffuse large B-cell lymphoma (DLBCL). We evaluated a novel chemotherapy-free regimen including polatuzumab vedotin, zanubrutinib, rituximab, lenalidomide and prednisone (Pola-ZR2P) as induction therapy for previously untreated patients with DLBCL to investigate its efficacy and safety. Methods: Newly diagnosed patients with DLBCL were enrolled and received Pola-ZR2P regimen every 21 days for 6 cycles. Polatuzumab vedotin was given at a dosage of 1.8 mg/kg intravenously on day 1, zanubrutinib was given 160 mg orally twice a day, from day 1 to day 21, lenalidomide was given 25 mg orally once a day, from day 1 to day 14, rituximab was administered at a dosage of 375 mg/m2 intravenously on day 1 and prednisone was given 60 mg/m2 orally once a day, from day 1 to day 5. Positron emission tomography/computed tomography (PET/CT) scan was used to evaluate interim therapeutic effects. If patients received complete response (CR) or partial response (PR) after 2-4 cycles, remaining cycles will be finished. Overall response rate (ORR) and adverse events were evaluated.(NCT06664411) Results: Between October 2024 and July 2025, 4 newly diagnosed DLBCL patients were enrolled. Patient 1 was a 72-year-old female patient diagnosed with de novo DLBCL NOS, stage IVB, high-risk (IPI score 5), GCB subtype, genetically classified as BN2. The patient was complicated with hereditary hemorrhagic telangiectasia and pulmonary hypertensionPET-CT evaluation after 3 cycles of Pola-ZR2P showed complete response (CR). Treatment was interrupted after cycle 1 due to gastrointestinal bleeding and intestinal infection (Candida albicans), and after cycle 2 due to grade 4 myelosuppression, but resumed in the subsequent cycle successfully. Patient 2was a 38-year-old female patient diagnosed with de novo DLBCL NOS, stage IA, low-risk (IPI score 0), GCB subtype, with no definitive genetic mutations identified. PET-CT evaluation after 4 cycles of Pola-ZR2P showed CR. During cycle 1, the patient developed septic shock and recovered following anti-infective therapy. Patient 3 was a 63-year-old female patient diagnosed with de novo DLBCL NOS, stage IVA, high-risk (IPI score 5), GCB subtype, genetically classified as EZB. She had a history of arrhythmia managed with intermittent propafenone. PET-CT evaluations after both cycle 3 and cycle 6 confirmed CR. During cycle 1, she developed rash and pruritusand resolved by anti-allergy treatment, and During cycle 3, she developed COVID-19 and recovered following antiviral therapy. Patient 4 was a 68-year-old male patient diagnosed with DLBCL NOS transformed from follicular lymphoma, stage IIIB, high-risk (IPI score 5), non-GCB subtype, genetically classified as ST2 and TP53. The patient was complicated with coronary artery disease and hypertension. The patient has completed 6 cycles to date. PET-CT evaluation after 3 cycles of Pola-ZR2P showed CR, and assessment after cycle 6 is pending. Treatment was interruptedduring cycle 1 due to severe pulmonary infection (Citrobacter braakii, HHV-6B, Mycoplasma), and resumed treatment at cycle 2 following anti-infective therapy. In conclusion, all 4 patients achieved complete response (CR) (3 at interim assessment, 1 at EOT assessment). The most common grade ≥3 adverse events (AEs) were infection, neutropenia and gastrointestinal bleeding, and most occurred after the first cycle. Grade 1 skin hyperpigmentation, potentially treatment-related, was observed in all patients. Treatment was interrupted due to AEs in two patients but was successfully resumed in the subsequent cycle. No fatal AEs were observed. Conclusion: Pola-ZR2P regimen demonstrated promising efficacy and a manageable safety profile in this cohort of previously untreated DLBCL patients. This report provides clinical evidence on the efficacy and safety of Pola-ZR2P regimen as the frontline immunochemotherapy in previously untreated DLBCL patients. Further enrollment of more patients is necessary to better clarify the effectiveness and safety of Pola-ZR2P regimen as the frontline chemotherapy in DLBCL patients.

Introduction:Systemic mastocytosis (SM) is a heterogeneous clonal disorder characterized by the accumulation of abnormal mast cells in various tissues, predominantly the bone marrow. Given the rarity of the disease, the available data in Romania are extremely limited. It is estimated that the total number of diagnosed patients is approximately 170. In recent years, significant advances have been made in understanding the molecular pathogenesis of SM, leading to the development of targeted therapies that have transformed the management of this condition. The approval of tyrosine kinase inhibitors (TKIs), particularly midostaurin and avapritinib, has provided new therapeutic options for patients with advanced SM, demonstrating significant improvements in overall survival (OS) and symptom control. Objective:To conduct a systematic review of clinical trials, observational studies and international or national guidelines published since 2000 to evaluate the efficacy, safety and mechanistic rationale of innovative therapeutic approaches for SM - including KIT inhibitors, monoclonal antibody-based therapies, stem cell transplant - and to compare the impact of these interventions with conventional cytoreductive and symptomatic treatments on overall response rate, survival, mediator-related symptom burden, quality of life and treatment-related adverse events. Materials and methods:A comprehensive search was performed in MEDLINE ( via PubMed), Embase, the Cochrane Central Register of Controlled Trials and Web of Science from 1 January 2000 to 1 May 2025. ClinicalTrials.gov, WHO ICTRP. Search strings combined controlled vocabulary ( e.g. , "Mastocytosis") and free-text terms for the disease (systemic mastocytosis, advanced SM, indolent SM) with key innovative interventions (KIT inhibitors, avapritinib, midostaurin, monoclonal antibodies, stem cell transplant). No language limits were set at the search stage; non-English full texts were excluded only if an accurate translation could not be obtained. As the review relied exclusively on published or publicly available data, ethical approval and informed consent were not required. Conclusion:The present review provides an updated overview of the evolving therapeutic landscape of SM, emphasizing recent clinical trial data, novel targeted therapies and emerging treatment paradigms. We discuss the implications of this progress on patient outcomes and future directions for personalized medicine in SM.

Background: The survival rate of patients diagnosed with acute myeloid leukemia (AML) has shown improvement in recent decades. However, the induction chemotherapy regimen for AML still relies on the standard 7+3 regimen. Standard 7+3 regimen can achieve a complete response (CR) rate of 70%-80% in AML patients up to 60 years of age and 50% in older patients. After years of development, the CR rate has shown improvement in both young and elderly AML patients. However, more than 20%-30% of patients still fail to achieve a response after induction chemotherapy, particularly among elderly patients who are deemed unfit. Based on this premise, we endeavored to develop a low-dose, long-course CHG regimen (cytarabine, homoharringtonine, and granulocyte stimulating factor) in combination with the demethylating agent azacytidine and the Bcl-2 inhibitor venetoclax as an induction regimen(NCT06470841). Our aim is to investigate a more efficient and safer induction chemotherapy regimen. Methods: Adult patients with AML were enrolled to receive VACHG induction chemotherapy treatment (venetoclax 100mg po qd d1, 200mg po qd d2, 400mg po qd d3-14; azacytidine 75 mg/m2 subcutaneous injection qd d1-7; homoharringtonine 1mg/m2 iv qd d1-14; cytarabine 10mg/m2 subcutaneous injection q12h d1-14; granulocyte stimulating factor 250ug/m2 subcutaneous injection qd d0-14). After induction therapy, patients will be given standardized treatment according to risk stratification according to NCCN guidelines (NCT06470841). Results: We have currently enrolled a total of 5 patients with acute myeloid leukemia. Among them, 3 patients were over 65 years of age with newly diagnosed acute myeloid leukemia, while the remaining 2 patients were under 60 years of age with refractory/refractory acute myeloid leukemia. One patient achieved CRi after receiving daunorubicin plus cytarabine (DA) induction chemotherapy. However, the patient relapsed after completing 2 courses of consolidation chemotherapy (1 course of DA and 1 course of venetoclax + azacytidine + sorafenib). The patient then obtained CR after completing 1 course of VACHG reinduction chemotherapy. In another patient, non-response (NR) was observed after 1 course of idarubicin plus cytarabine. After the second course of venetoclax + azacytidine(VA) induction chemotherapy, the patient still achieved NR. Then, the patient underwent treatment with the VACHG regimen and achieved CR after a single course of induction chemotherapy using the VACHG regimen. Three additional elderly patients, who were newly diagnosed with AML, achieved a complete response after receiving a single course of VACHG chemotherapy. All the 2 refractory/relapsed AML patients and 3 newly diagnosed elderly AML patients achieved complete remission by a single course of VACHG induction chemotherapy. Grade Ⅳ myelosuppression and infection were observed in all five patients. Two patients experienced gastrointestinal hemorrhage, while one patient suffered from acute kidney injury. Side effects were effectively managed. Following the achievement of complete response, the two refractory/relapsed patients underwent allogeneic hematopoietic stem cell transplantation. The three elderly patients received consolidation and maintenance therapy after achieving complete response. Conclusion: In this trial, we utilized a low-dose, long-course regimen of CHG in combination with the demethylating drug azacytidine and the Bcl-2 inhibitor venetoclax as an induction regimen. Notably, all 5 patients achieved complete remission by a single course of VACHG induction chemotherapy, and the combined chemotherapy regimen demonstrated excellent tolerance in both young and elderly patients. This combined chemotherapy regimen demonstrated remarkable efficacy and merits further implementation. Further enrollment of more patients is necessary to better clarify the effectiveness and safety of VACHG regimen as induction chemotherapy in AML patients.

Systemic mastocytosis (SM) is a rare clonal mast cell disease characterized by heterogeneous clinical presentations and molecular features that vary across different regions; however, data from Central-Eastern Europe remain limited. This study aimed to describe the demographic, clinical, laboratory, and molecular characteristics of Romanian adults diagnosed with SM and followed at the national reference center for mast cell disorders in Bucharest, while also exploring real-world management patterns and outcomes. We conducted a retrospective observational study including 162 adult patients evaluated between January 2006 and March 2025 who met the 2022 World Health Organization criteria for SM. Data extracted from electronic medical records included WHO subtype, KIT mutation status, serum tryptase levels, organ involvement, treatment history, and survival outcomes. A descriptive statistical approach was used, with continuous variables expressed as medians and interquartile ranges, and categorical variables as counts and percentages. A subset of eight patients underwent bone marrow flow cytometry immunophenotyping to assess the diagnostic contribution of CD2 and CD25. Among the entire cohort, indolent SM was the most frequent form (53.1%), followed by cutaneous mastocytosis (17.3%), smoldering SM (5.6%), aggressive SM (3.7%), and SM with associated hematologic neoplasm (8%). The KIT D816V mutation was detected in 43% of tested individuals, and the median baseline serum tryptase was 20.55 μg/L. Common organ-related findings included osteoporosis (17.9%), osteopenia (21.7%), cutaneous lesions (29%), and hepatomegaly (4%). First-line symptomatic therapy (H1/H2 antihistamines ± montelukast) was administered to 77% of patients, while four patients with advanced disease received midostaurin treatment. Immunophenotyping confirmed aberrant expression of CD2 and CD25 in all eight analyzed cases. This first national series from Romania underscores the predominance of indolent SM and the clinical burden of organ involvement, reinforcing the need for early diagnosis and personalized, risk-adapted therapeutic approaches.

Expression of CD2, CD25 and/or CD30 in extracutaneous mast cells (MC) is a minor diagnostic criterion for systemic mastocytosis (SM) in the classification of the World Health Organization and International Consensus Classification. So far, it remains unknown whether expression of these antigens on MC is of prognostic significance in SM. We performed a retrospective multi-center study of patients with SM using the data set of the registry of the European Competence Network on Mastocytosis, including 5034 patients with various MC disorders. The percentage of CD2-, CD25+ and/or CD30+ MC was considerably lower in patients with indolent SM compared to patients with advanced SM, including aggressive SM and MC leukemia. Whereas CD25 and CD30 expression in MC could not be associated with prognosis, we found that lack of CD2 expression in MC is associated with a significantly reduced overall survival (OS) in patients with SM (p < 0.0001). Lack of CD2 was also associated with the presence of extramedullary involvement affecting the spleen, liver, and/or lymph nodes (odds ratio 2.63 compared to SM with CD2+ MC). Together, lack of CD2 expression in MC is a prognostic marker and indicator of reduced OS and extramedullary disease expansion in patients with SM.

Systemic mastocytosis (SM) is a rare and heterogeneous disorder characterized by clonal proliferation and accumulation of neoplastic mast cells in one or more organs, most commonly the bone marrow, liver, spleen, and skin. Among its clinical variants, aggressive SM (ASM) presents organ damage and debilitating symptoms due to extensive mast cell infiltration. The management of ASM remains challenging, primarily because treatment must address both symptom control and disease progression. Background/Objectives: Recent therapeutic approaches have focused on tyrosine kinase inhibitors (TKIs) that target the oncogenic KIT driver mutation, predominantly the D816V mutation, which is implicated in mast cell proliferation. We report a case series of four patients diagnosed with ASM to highlight the real-world experience in the management of ASM. All patients had confirmed KIT D816V mutations and presented with signs of advanced organ dysfunction, such as marked hepatosplenomegaly, cytopenia, and significant bone marrow infiltration. First-line therapies, including cytoreductive agents or other TKIs were used. Responses varied in these patients, and ultimately, they were initiated on or transitioned to midostaurin, a multikinase TKI. Results: All four patients, after the initiation of midostaurin, presented clinical and biological improvement—at least a clinical improvement response according to the International Working Group-Myeloproliferative Neoplasms Research and Treatment & European Competence Network on Mastocytosis (IWG-MRT-ECNM) criteria. These findings highlight the benefits of KIT inhibition in managing ASM, especially for patients with inadequate responses to traditional therapies. The impact of midostaurin on organ function, mast cell burden, and symptom control emphasizes the importance of the timely integration of TKIs into therapeutic protocols. However, optimal treatment duration, long-term safety, and the development of acquired resistance remain critical questions that warrant further studies. Larger prospective trials are needed to better delineate the prognostic factors associated with sustained response, refine patient selection, and explore combination strategies that may enhance therapeutic efficacy. Conclusions: The patients presented in this case series benefited from midostaurin therapy, showing either a clinical improvement or partial response according to the IWG-MRT-ECNM criteria. Our case series illustrates that KIT inhibitors can offer meaningful clinical benefit in ASM, reinforcing their position as an emerging cornerstone option in ASM management.

This single centre retrospective study evaluated treatment outcomes and minimal residual disease (MRD) monitoring in 55 Romanian patients with multiple myeloma (MM) who underwent autologous stem cell transplantation (ASCT) between 2018 and 2025. Patients received triplet or quadruplet induction regimens, including daratumumab-based therapy (Dara-VTD), with MRD assessed by multiparameter flow cytometry on day +100 post-ASCT. MRD negativity was achieved in 60% of patients and was associated with a trend toward improved overall survival (OS) and progression-free survival (PFS), although these differences did not reach statistical significance. Similarly, daratumumab exposure before ASCT was associated with a trend towards better OS. No transplant-related mortality was observed. This study underscores the feasibility and clinical relevance of MRD assessment in real-world settings, highlighting the potential benefit of incorporating daratumumab in first-line treatment. Limitations include the small sample size and absence of cytogenetic risk stratification. These findings support the need for larger, multicenter studies to validate MRD as aprognostic tool and to refine treatment strategies for transplant-eligible MM patients in Romania and Eastern Europe.

The body's defense against environmental factors is realized by physical barriers and cells of both the innate and adaptive immune systems. Patients with end stage kidney disease (ESKD), especially those treated by hemodialysis, have changes in both the function and the number or percent of different leukocyte subsets. Changes were described at the level of monocytes and lymphocyte subsets, which are associated with immunodeficiencies and pro-inflammatory status correlated with degenerative changes and increased cardiovascular risk. These abnormalities have been compared over the past years with alterations appearing as a result ageing. Also, similitudes regarding immunosenescence observed in ESKD patients, in combination with chronic inflammation, are described as the so-called" inflammaging syndrome".

Background Primary pulmonary B-cell lymphomas are a rare group of extranodal B-cell non-Hodgkin lymphomas, the consequence of bronchial-associated lymphoid tissue (BALT) proliferation. Materials and Methods We report here of a 67-yearold patient who was diagnosed by computed tomography (CT) with a bulky mass occupying the entire middle lobe of the right lung and mild hepatosplenomegaly. The histopathological examination of the sample obtained by bronchoscopy indicated B-cell extranodal lymphoma with CD20+, CD5–, cyclin D–, KI67 5% to 7%, a marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT). Bone marrow biopsy/aspiration confirmed mild B-cell lymphoid infiltration (15%). Biochemistry revealed a high LDH of 350 IU/L (<1.5 upper limit of normal) and a high IgM of 1.5 g/dL. The final diagnosis was marginal B-cell lymphoma of pulmonary determination. The RCHOP protocol was chosen with good response. Conclusion Transbronchial biopsy is very useful for patients with bulky lung mass. Lymphoma is very rarely diagnosed in patients with a bulky lung mass, but in this case, chemotherapy and radiotherapy are very useful to achieve complete remission.

Profound immune dysregulation and impaired response to the SARS-CoV-2 vaccine put patients with chronic lymphocytic leukemia (CLL) at risk of severe COVID-19. We compared humoral memory and T-cell responses after booster dose vaccination or breakthrough infection. (Green) Quantitative determination of anti-Spike specific antibodies. Booster doses increased seroconversion rate and antibody titers in all patient categories, ultimately generating humoral responses similar to those observed in the postinfection cohort. In detail, humoral response with overscale median antibody titers arose in >80% of patients in watch and wait, off-therapy in remission, or under treatment with venetoclax single-agent. Anti-CD20 antibodies and active treatment with BTK inhibitors (BTKi) represent limiting factors of humoral response, still memory mounted in ~40% of cases following booster doses or infection. (Blue) Evaluation of SARS-CoV-2-specific T-cell responses. Number of T-cell functional activation markers documented in each patient. The vast majority of patients, including those seronegative, developed T-cell responses, qualitatively similar between treatment groups or between vaccination alone and infection cases. These data highlight the efficacy of booster doses in eliciting T-cell immunity independently of treatment status and support the use of additional vaccination boosters to stimulate humoral immunity in patients on active CLL-directed treatments.