Eosinophilia may occur in various clinical conditions, including hematological malignancies such as Hodgkin lymphoma (HL), although it is usually diagnosed simultaneously with the disease. We report a case of a 72-year-old woman with persistent eosinophilia initially evaluated for hypereosinophilic syndrome. Despite extensive diagnostic workup, no cause of eosinophilia was identified. Six months later, imaging revealed multiple liver lesions, and liver biopsy confirmed classical HL, nodular sclerosis subtype. The patient’s condition rapidly deteriorated despite chemotherapy. This case highlights that persistent unexplained eosinophilia may precede HL diagnosis and requires continued clinical surveillance.

Gene expression is regulated through the multilayer cellular mechanism, of which epigenetics is thought to have a significant impact. Cross-talk between epigenetic mechanisms such as DNA methylation, non-coding RNAs, and histone methylation/acetylation controls a cell's destiny. Protein acetylation is the most studied histone modification. Precise regulation of this posttranslational modification is vital for appropriate gene expression. Unlike histone methylation, acetylation has a significant impact on the physical properties of the nucleosome, weakening the interaction between DNA and histones. As a result, less dense chromatin conformation is present, allowing further transcription regulation. Due to the high impact on gene regulation, cancer cells can modify histone acetylation homeostasis for their own good. B-cell lymphomas, originating from B-cells at different stages of development include mature B-cell neoplasms, Hodgkin lymphomas, and plasma cell neoplasms such as multiple myeloma, diffuse large B-cell lymphoma, mantle lymphoma, and follicular lymphoma. These distinct pathologies share some common genetic and epigenetic abnormalities that can serve as an “anchor” for therapies. The protein machinery controlling histone acetylation can be altered to benefit patients. Although many preclinical studies are ongoing, aiming for a better understanding of histone acetylation, only a few small-molecule inhibitors have reached clinical trial testing in humans. Here, we summarize and discuss selected clinically tested histone acetylation modifiers in B-cell malignancies.

Introduction: Primary immune thrombocytopenia (ITP) is the most common thrombocytopenic disorder in children. The aim of this study was to assess the epidemiology and current therapeutic practices in children with ITP in Poland. Material and methods: A survey was conducted in 19 pediatric hematology centers. The analysis covered the period of 2022–2023. The survey included 14 questions regarding the number of patients diagnosed and treated for ITP. The centers provided separate data for each year. Results: In the years 2022–2023, a new diagnosis of primary immune thrombocytopenia (nITP) was made in 814 patients. A subgroup of 130 children with persistent ITP (16%) and a total of 452 with chronic ITP were treated. nITP was treated with IVIG (627; 77%) or steroids (154; 19%). TPO agonist drugs were administered as follows: eltrombopag in 215 (26%) patients, romiplostim in 115 (14%) patients, and avatrombopag in 6 (0.7%) patients. Other conservative therapies were administered to 38 (4.6%) patients, including: mycophenolate mofetil (n = 16), rituximab (n = 9), azathioprine (n = 3), sirolimus (n = 2), vincristine (n = 1), vinblastine (n = 1), cyclophosphamide (n = 1), mercaptopurine (n = 1), chronic steroid therapy (n = 2), and dexamethasone + eltrombopag (n = 1). Surgical treatment was performed in 4 patients, including splenectomy (n = 3) and splenic artery embolization (n = 1). Discussion: A low level of adherence to the ASH 2019 recommendations regarding the use of steroids in nITP was noted. Oral TPO agonists were used twice as frequently compared to the subcutaneous form. Conclusions: In the years 2022–2023, ITP was diagnosed in an average of 407 children annually. Immunosuppressive treatment was applied in 4.6% and surgical treatment in 0.5% of children with ITP.

Myelodysplastic syndromes (MDS) are clonal hematopoietic disorders characterized by cytopenias, ineffective hematopoiesis, and an increased risk of progression to acute myeloid leukemia (AML). Diagnosis continues to rely on peripheral blood cytopenias, bone marrow dysplasia, blast percentage, and cytogenetic abnormalities, although molecular profiling is now increasingly integrated into the diagnostic process. The 2022 World Health Organization (WHO) and International Consensus Classification (ICC) systems incorporate genomic features such as < em data-start="549" data-end="556" > SF3B1 < /em > and < em data-start="561" data-end="567" > TP53 < /em > mutations and differ slightly in blast count thresholds and recognition of germline predisposition syndromes, including < em data-start="688" data-end="695" > DDX41 < /em > -associated MDS. < /p > < p data-start="715" data-end="1237" > Pre-MDS entities such as clonal hematopoiesis of indeterminate potential (CHIP) and clonal cytopenia of undetermined significance (CCUS) — characterized by clonal mutations without overt dysplasia — have gained attention for their prognostic significance and potential as early therapeutic targets. MDS often coexists with other conditions, including cardiovascular disease, chronic inflammation, VEXAS syndrome, and paroxysmal nocturnal hemoglobinuria (PNH), all of which may influence prognosis and treatment response. < /p > < p data-start="1239" data-end="1576" > Prognostic assessment has evolved from the Revised International Prognostic Scoring System (IPSS-R) to the more precise IPSS-M, which integrates molecular data for improved survival and transformation prediction. Patient-related factors, such as performance status and comorbidities, also remain essential for accurate prognostication. < /p > < p data-start="1578" data-end="2050" > Treatment of higher-risk MDS (HR-MDS) remains centered on azacitidine, with limited benefit observed from combination regimens and curative potential restricted to allogeneic hematopoietic stem cell transplantation. In lower-risk MDS (LR-MDS), novel agents such as luspatercept and imetelstat have expanded therapeutic options for anemic patients. Emerging artificial intelligence tools show promise in early diagnosis and risk prediction but require further validation. < /p > < p style="text-align: justify;" data-start="2052" data-end="2208" data-is-last-node="" data-is-only-node="" > This review summarizes the current state of MDS diagnosis, prognosis, and treatment, emphasizing molecular insights and personalized therapeutic approaches. < /p > < /div >

ChatGPT powiedział: Introduction: The population pharmacokinetic (PK) analysis of clotting factor VIII (FVIII) enables individual PK value estimation and hemophilia treatment personalization. Aim: To compare the number of bleeding episodes and standard half-life (SHL) FVIII (SHL-FVIII) consumption before and after PK-based dosing adjustment in adult patients with severe hemophilia A. Material and methods: The prospective, 18-month study had three phases: (1) before FVIII dosing adjustment, (2) dosing adjustment based on FVIII PK analysis, and (3) after FVIII dosing adjustment. During phases 1 and 3 of the study, patients frequently changed SHL-FVIII concentrates and recorded FVIII consumption and bleeding episodes in electronic diaries (myPKFiT® licensed for octocog alfa). In phase 2, PK analysis was performed following the infusion of octocog alfa. Annualized bleeding rates (ABRs) and SHL-FVIII consumption in phases 1 and 3 were compared. Results: The clearance of octocog alfa ranged from 0.014 to 0.051 dL/h/kg, half-life from 9.1 to 27.9 h, and time to reach 1 IU/dL from 51 to 179 h. Seventeen of 22 included male patients modified treatment according to the PK analysis, which resulted in a 3.1-fold decrease in total ABR (p = 0.02), a 3.3-fold decrease in spontaneous ABR (p = 0.06), and a 3.1-fold decrease in injury-related ABR (p = 0.072) compared to phase 1. The total consumption of SHL-FVIII increased by 16.8% (p = 0.052), while the consumption due to bleeds decreased by 77% (p = 0.034). Conclusions: Personalizing FVIII replacement therapy lowers bleeding risk, with a statistically non-significant increase in drug consumption in patients with severe hemophilia A. Treatment based on octocog alfa PK analysis was successfully applied to other SHL-FVIII products.

In this study, we assessed a number of factors influencing the cost of Sanger sequencing and next-generation sequencing (NGS), including patient population and indications for genetic testing, reimbursement status of the described procedures, and material and personnel costs based on the example of the Department of Hematology and Genetic Diagnostics at The University Hospital in Krakow, Poland. We discuss the advantages and disadvantages of the innovative technology used for routine genetic diagnostics of patients in relation to the latest World Health Organization guidelines. As understanding of the genetic basis of diseases expands, and the range of available diagnostic methods increases, the cost of genetic testing continues to rise. This trend includes diagnostic tests based on NGS technology, which is constantly evolving to offer an increasingly broad range of studies of changes to the genome. Therefore, the challenge for healthcare funders is to ensure that reimbursement is commensurate with the capabilities of modern diagnostics, and that a lack of funding does not inhibit the ability to provide optimal care to patients.