30-Second Takeaway
- Updated HCL guidelines formalize BRAF-stratified diagnosis and distinct management for HCL versus HCL-variant.
- A shorter diagnosis-to-treatment interval in follicular lymphoma independently flags higher-risk disease after immunochemotherapy.
- Plasma cfDNA MRD and CXCR4/MRD profiling in AML refine relapse risk around transplant and consolidation.
Week ending April 18, 2026
Refining risk, donor choice, and targeted strategies across leukemias and cellular therapy
Updated HCL guidelines cement BRAF-driven classification and tailored therapy
These international guidelines reaffirm classic hairy cell leukemia as a BRAF V600E–driven entity in over 95% of patients with excellent purine analog responses. They emphasize routine BRAF testing to distinguish classic HCL from BRAF-wild-type hairy cell leukemia variant, which has inferior prognosis. For HCL, purine analogs remain frontline, with BRAF inhibitors incorporated for selected relapsed or refractory cases. For HCL-variant, the guideline recommends combined purine analog plus rituximab rather than purine analog monotherapy, acknowledging less-durable remissions. The document provides structured diagnostic criteria and treatment pathways for both entities, integrating emerging targeted options.
Short diagnosis-to-treatment interval signals adverse risk in follicular lymphoma
This study shows that a shorter diagnosis-to-treatment interval in follicular lymphoma is independently associated with inferior outcomes after immunochemotherapy. The prognostic effect persists beyond established indices, indicating added information about disease tempo or biology. Diagnosis-to-treatment interval is routinely captured, inexpensive, and immediately available at treatment decision. The authors propose incorporating this metric into risk stratification and caution that rapid-treatment trials may overrepresent aggressive disease.
Personalized plasma cfDNA assay sensitively tracks AML burden around allo-HCT
In 30 AML patients undergoing allogeneic transplantation, a personalized v96 assay found residual leukemia in all patients despite clinical remission. Conventional assays detected disease in only 20% of cases, highlighting markedly superior sensitivity of the mutation-panel approach. Plasma cell-free DNA was more sensitive than bone marrow cell DNA for identifying residual leukemia before and after transplant. Higher pre-transplant mutant burden in plasma strongly associated with subsequent relapse risk. Serial testing showed declining leukemic signal in most patients, often only after immunosuppression withdrawal, supporting a graft-versus-leukemia effect.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.