Good evening, colleagues and fellow enthusiasts of "Frontiers in Blood and Bone Marrow"!
Tonight, I have curated 5 high-impact articles recently published in top-tier journals for everyone. These cover practical medication choices for coagulation and thrombosis, as well as the latest treatment strategies and MRD monitoring for acute leukemia, ranging from pediatric to elderly patients. I hope this provides you with the latest professional insights that can immediately impact your clinical practice amidst your busy schedules!
【Hemostasis & Thrombosis】1.Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism (Acute Venous Thromboembolism: Comparison of Bleeding Risk between Apixaban and Rivaroxaban)
Published in: The New England Journal of Medicine
Key Summary: Within the 3-month treatment window for acute PE/proximal DVT, the rate of "clinically relevant bleeding" was significantly lower with apixaban compared to rivaroxaban (3.3% vs 7.1%; RR 0.46). This magnitude of difference is highly likely to change first-line DOAC prescribing habits for populations "already at risk of bleeding" (e.g., elderly, history of bleeding, complex medication regimens).
Paper Link: https://doi.org/10.1056/NEJMoa2510703
Published in: The New England Journal of MedicineKey Summary: Within the 3-month treatment window for acute PE/proximal DVT, the rate of "clinically relevant bleeding" was significantly lower with apixaban compared to rivaroxaban (3.3% vs 7.1%; RR 0.46). This magnitude of difference is highly likely to change first-line DOAC prescribing habits for populations "already at risk of bleeding" (e.g., elderly, history of bleeding, complex medication regimens).Paper Link: https://doi.org/10.1056/NEJMoa25107032.Romiplostim versus Placebo for Chemotherapy-Induced Thrombocytopenia (Randomized Trial of Romiplostim vs. Placebo for Chemotherapy-Induced Thrombocytopenia)
Journal: The New England Journal of Medicine
Key Summary: There has long been a lack of high-quality RCT evidence and widely approved treatments for chemotherapy-induced thrombocytopenia (CIT). This study utilizes a placebo-controlled design to provide critical clinical signals for TPO-RA intervention, which holds significant practical implications for the management of "chemotherapy dose intensity" and "bleeding/transfusion" events. In clinical practice, strict monitoring of thrombotic risks, tumor-associated coagulation activation, and individualized timing for discontinuation/adjustment remains essential.
Paper Link: https://doi.org/10.1056/NEJMoa2511882
Journal: The New England Journal of MedicineKey Summary: There has long been a lack of high-quality RCT evidence and widely approved treatments for chemotherapy-induced thrombocytopenia (CIT). This study utilizes a placebo-controlled design to provide critical clinical signals for TPO-RA intervention, which holds significant practical implications for the management of "chemotherapy dose intensity" and "bleeding/transfusion" events. In clinical practice, strict monitoring of thrombotic risks, tumor-associated coagulation activation, and individualized timing for discontinuation/adjustment remains essential.Paper Link: https://doi.org/10.1056/NEJMoa2511882【Acute Myeloid Leukemia & Myelodysplastic Syndromes (AML & MDS)】3.A low- versus standard-dose regimen as induction for pediatric AML: a multicenter, randomized noninferiority trial
Journal: Blood
Key Summary: Low-dose induction (low-dose cytarabine + mitoxantrone/idarubicin + G-CSF) was noninferior to standard induction in terms of CR/CRi, MRD, and 4-year OS/EFS (e.g., CR/CRi: 95.1% vs 95.3%; 4-year OS: 81.3% vs 83.6%), with faster hematologic recovery. If consistent with subsequent external validation, this "de-escalation without compromising efficacy" strategy could substantially reduce infections and ICU admissions, while improving bed turnover and the burden of supportive care.
Paper Link: https://doi.org/10.1182/blood.2025030972
Journal: BloodKey Summary: Low-dose induction (low-dose cytarabine + mitoxantrone/idarubicin + G-CSF) was noninferior to standard induction in terms of CR/CRi, MRD, and 4-year OS/EFS (e.g., CR/CRi: 95.1% vs 95.3%; 4-year OS: 81.3% vs 83.6%), with faster hematologic recovery. If consistent with subsequent external validation, this "de-escalation without compromising efficacy" strategy could substantially reduce infections and ICU admissions, while improving bed turnover and the burden of supportive care.Paper Link: https://doi.org/10.1182/blood.20250309724.Long-term results of the RELAZA2 trial of azacitidine to treat measurable residual disease in patients with acute myeloid leukemia and myelodysplastic syndrome (RELAZA2 long-term follow-up: Azacitidine intervention for molecular relapse/MRD in AML/MDS)
Journal: Blood
Key Summary: RELAZA2 represents a significant milestone in the "MRD-driven, preemptive" treatment paradigm. This long-term follow-up further reinforces that treating MRD as an actionable clinical signal and intervening early at the stage of molecular relapse may secure longer relapse-free survival and provide a window for subsequent treatment for some patients. Clinically, it supports the integration of MRD monitoring results into decision-making regarding whether to administer additional therapy or to plan for early transplantation or maintenance therapy.
Paper Link: https://doi.org/10.1182/blood.2025030816
Journal: BloodKey Summary: RELAZA2 represents a significant milestone in the "MRD-driven, preemptive" treatment paradigm. This long-term follow-up further reinforces that treating MRD as an actionable clinical signal and intervening early at the stage of molecular relapse may secure longer relapse-free survival and provide a window for subsequent treatment for some patients. Clinically, it supports the integration of MRD monitoring results into decision-making regarding whether to administer additional therapy or to plan for early transplantation or maintenance therapy.Paper Link: https://doi.org/10.1182/blood.20250308165.American Society of Hematology 2026 guidelines for treating newly diagnosed acute myeloid leukemia in older adults (American Society of Hematology 2026 Guidelines: Updated treatment recommendations for newly diagnosed AML in older adults)
Published in: Blood Advances
Key Summary: These guidelines break down "real-world decision-making" for older adults with AML into actionable recommendations: from choosing between intensive therapy vs. supportive care, the positioning of venetoclax-based regimens, and when to incorporate targeted therapies (e.g., FLT3/IDH inhibitors), to scenarios where hematopoietic stem cell transplantation should be actively considered. The greatest value for clinical practice is that it organizes "common but controversial" management issues into a framework that can be utilized for shared decision-making and the design of care pathways.
Paper Link: https://doi.org/10.1182/bloodadvances.2025017934
Published in: Blood AdvancesKey Summary: These guidelines break down "real-world decision-making" for older adults with AML into actionable recommendations: from choosing between intensive therapy vs. supportive care, the positioning of venetoclax-based regimens, and when to incorporate targeted therapies (e.g., FLT3/IDH inhibitors), to scenarios where hematopoietic stem cell transplantation should be actively considered. The greatest value for clinical practice is that it organizes "common but controversial" management issues into a framework that can be utilized for shared decision-making and the design of care pathways.Paper Link: https://doi.org/10.1182/bloodadvances.2025017934
Editor's Note:From comparing bleeding risks of DOACs and de-escalated induction therapy for pediatric AML, to the latest ASH 2026 guidelines for newly diagnosed AML in the elderly, it is clear that personalized medicine and precise assessment are fundamentally transforming our daily clinical decisions. Which research finding resonated with you the most? Feel free to leave a comment below and share your clinical experience with us!
