Malaysian Society of Haematology

11/07/2026

Tailored Approaches & Treatment Paradigms in Mantle Cell Lymphoma
Ong Shin Yeu, SGH

Mantle cell lymphoma (MCL) management is undergoing a significant transformation, with advances in molecular profiling, measurable residual disease (MRD) assessment, and targeted therapies reshaping traditional treatment approaches. In this excellent lecture, delivered by Dr Ong Shin Yeu from Singapore General Hospital and chaired by Prof Goh Yeow Tee, the latest evidence was reviewed to illustrate how frontline management is being reshaped by covalent BTK inhibitors while highlighting the persistent challenges posed by biologically high-risk disease.

Risk assessment remains central to treatment selection. TP53 mutation, high p53 expression, blastoid or pleomorphic morphology, elevated Ki67 and complex karyotype consistently identify patients with poorer outcomes. Recent data also reinforce the limitations of p53 immunohistochemistry alone, with TP53 sequencing providing more reliable prognostic information. At the same time, MRD is emerging as an important tool to individualise therapy, with the EA4151 study demonstrating that patients achieving MRD-negative complete remission after induction derived no additional benefit from routine autologous transplantation, while MRD-positive patients converting after transplant experienced outstanding three-year progression-free and overall survival.

Perhaps the most practice-changing data come from the incorporation of BTK inhibitors into first-line treatment. The phase III TRIANGLE study demonstrated that adding ibrutinib to intensive frontline therapy improved failure-free survival from 70% to 82% at 55 months, alongside an approximate 10% improvement in four-year overall survival. Importantly, transplant did not confer additional benefit when combined with BTK inhibitor-based therapy, supporting a progressively diminishing role for routine autologous transplantation. Rituximab maintenance remained beneficial even after two years of BTK inhibitor therapy, reinforcing the value of maintenance strategies alongside targeted treatment.

For older or less fit patients, the phase III ECHO trial established acalabrutinib plus bendamustine-rituximab as an effective frontline option, extending median progression-free survival from approximately 50 to 66 months, increasing complete remission rates by around 13%, and reducing the risk of progression or death by up to 36% after prespecified COVID-adjusted analyses. Benefit was consistently observed across several high-risk biological subgroups, including TP53-mutated, blastoid and highly proliferative disease, while maintaining an acceptable safety profile with relatively low rates of off-target toxicities compared with first-generation BTK inhibition.

The lecture also explored how treatment paradigms continue to evolve beyond conventional chemoimmunotherapy. The ENRICH study suggested that chemo-free ibrutinib-rituximab can outperform immunochemotherapy overall, although the benefit was largely driven by inferior R-CHOP outcomes rather than superiority over bendamustine-rituximab. Real-world analyses further raised the question of whether sequential therapy may remain appropriate for selected standard-risk patients, whereas upfront triplet strategies and BTK inhibitor-based combinations appear most justified for biologically high-risk disease. In the relapsed setting, outcomes after covalent BTK inhibitor failure remain poor, with median progression-free survival for many currently available agents measured in months. By contrast, CAR T-cell therapy continues to deliver the most durable disease control in this setting, underscoring the importance of early referral and treatment planning before clinical deterioration.

Overall, the lecture highlighted a clear shift towards biologically informed, risk-adapted management of MCL. Frontline BTK inhibitor-based therapy is increasingly becoming the standard of care, MRD is poised to guide decisions regarding transplant, and the role of routine autologous transplantation continues to diminish. As molecular profiling, MRD assessment and cellular therapies become more widely integrated into practice, treatment decisions are likely to become increasingly personalised, with the greatest opportunity to influence long-term outcomes lying in selecting the optimal first-line strategy.

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10/07/2026

Updates on Management of Chronic Lymphocytic Leukaemia
Thomas Chan, Hong Kong

Chronic lymphocytic leukaemia (CLL) management continues to evolve rapidly as targeted therapies redefine both frontline and relapsed treatment strategies. In this online lecture, Dr Thomas Chan (Queen Mary Hospital, Hong Kong) provided an excellent evidence-based overview of current CLL management, contrasting continuous BTK inhibition with fixed-duration venetoclax-based therapy, while discussing how patient-specific factors increasingly drive treatment selection. The session was chaired by Prof Goh Yeow Tee.

Long-term follow-up continues to support continuous BTK inhibition as one of the most durable treatment approaches in CLL. Nearly ten years of follow-up from RESONATE-2 demonstrated a median progression-free survival (PFS) of 8.9 years with ibrutinib, while E1912 established superior progression-free and overall survival with ibrutinib-rituximab over FCR, firmly establishing targeted therapy as the preferred frontline approach. Importantly, continuous BTK inhibition appears to overcome the adverse prognostic impact of unmutated IGHV, while pooled analyses reported four-year PFS of approximately 72% even among patients with TP53 aberrations or del(17p).

Second-generation BTK inhibitors have further refined this strategy. In ELEVATE-TN, both acalabrutinib alone and acalabrutinib-obinutuzumab significantly outperformed obinutuzumab-chlorambucil, with durable benefit extending beyond six years. Similarly, SEQUOIA demonstrated sustained efficacy with zanubrutinib, reporting approximately 74% PFS at four years in standard-risk disease and 64% PFS at six years in patients with del(17p). Head-to-head studies have also shown improved cardiovascular safety compared with ibrutinib, although cumulative toxicities remain an important consideration with lifelong treatment.

Fixed-duration venetoclax-based therapy offers a different treatment philosophy by aiming for deep remission followed by treatment-free intervals. CLL14 demonstrated a median PFS of approximately 76 months following one year of venetoclax-obinutuzumab, with high rates of undetectable MRD and durable disease control despite gradual molecular relapse over time. Importantly, treatment-related cytopenias and infection risk generally improve after therapy cessation, although patients with TP53 disruption continue to experience shorter disease control than standard-risk cohorts.

Combination targeted therapy continues to raise the bar. In CLL13, five-year PFS reached 81.3% with obinutuzumab-ibrutinib-venetoclax compared with 69.8% for obinutuzumab-venetoclax, particularly benefiting patients with unmutated IGHV. More recently, the landmark CLL17 trial demonstrated that fixed-duration venetoclax-based regimens achieved progression-free survival that was non-inferior to continuous ibrutinib, while venetoclax-obinutuzumab produced the deepest MRD responses. These gains, however, came at the expense of higher rates of grade ≥3 neutropenia and infections, emphasising the need to balance efficacy against toxicity.

The overarching message was clear: there is no single best regimen for every patient. Instead, treatment should be individualised according to disease biology, cardiovascular and renal comorbidities, treatment goals, logistical considerations and patient preference. As the therapeutic landscape continues to expand with BTK inhibitor combinations, non-covalent BTK inhibitors and cellular therapies, optimising patient selection has become just as important as selecting the therapy itself.

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06/07/2026

Cross-Border Learning Session: Empowering Voices – Legal Identity and Digital Inclusion

The Malaysian Society of Haematology (MSH) would like to share the following virtual learning opportunity organised by DHRRA Malaysia.

This cross-border learning session will explore the role of digital identity systems in improving access to healthcare, education, employment and other essential services, while examining the challenges faced by vulnerable and marginalised communities in ensuring equitable digital inclusion.

Date: Thursday, 16 July 2026
Time: 1.00 pm – 4.00 pm (Malaysia Time)
Platform: Zoom

Members with an interest in healthcare access, digital health, public policy and health equity may find the discussion of interest.

Registration can be made via the organiser's registration link provided in the event invitation.

This event is organised by DHRRA Malaysia and is shared by MSH for the information of our members. The views and opinions expressed during the event are those of the organisers and speakers.

26/06/2026

One of the highlights of the recent educational programme was an outstanding lecture by Prof Elias Jabbour (MD Anderson Cancer Center, Houston, USA) on the contemporary management of Philadelphia chromosome-positive acute lymphoblastic leukaemia (Ph-positive ALL). The session, expertly moderated by Dr Jerome Tan, traced one of the most remarkable success stories in modern haematology. Below is my summary of the key learning points from the presentation.

Historically, Ph-positive ALL carried one of the worst prognoses in adult leukaemia. Long-term survival was approximately 10% without allogeneic stem cell transplantation and only around 30% even with transplant. The introduction of BCR::ABL1 tyrosine kinase inhibitors (TKIs) fundamentally altered this landscape. Early imatinib-based studies achieved complete remission (CR) rates approaching 96%, with three-year overall survival improving to 76%. However, MRD negativity after induction remained low (9%), increasing to only 42% before transplant, while transplant-related mortality remained significant at 18%.

Second- and third-generation TKIs further improved outcomes. Hyper-CVAD combined with dasatinib produced CR/CRi rates of approximately 88% and long-term survival approaching 60–70%, while Hyper-CVAD plus ponatinib achieved MRD negativity by flow cytometry in 99% of patients and BCR::ABL1 RT-PCR negativity in 84%, translating into six-year overall survival of approximately 75%. Ponatinib's ability to overcome the T315I resistance mutation represents a major advance, although this must be balanced against recognised vascular toxicity.

Perhaps the greatest paradigm shift has been the emergence of chemotherapy-minimised regimens incorporating blinatumomab. The Italian D-ALBA study demonstrated cumulative molecular remission rates approaching 90%, with four-year overall survival of 81% and event-free survival of 75%. Likewise, the SWOG 1318 study in older patients (median age 73 years) reported complete remission in 92%, while MRD negativity improved from 38% after dasatinib induction to 63% after blinatumomab, resulting in a remarkable three-year overall survival of 75% despite near-complete avoidance of transplantation.

The most compelling contemporary evidence comes from the MD Anderson ponatinib–blinatumomab programme. Among 88 newly diagnosed patients, complete remission reached 95%, RT-PCR molecular remission 83%, and next-generation sequencing (NGS) MRD negativity 95%, with three-year overall survival approaching 90%. Propensity-matched analyses further demonstrated superior progression-free and overall survival compared with Hyper-CVAD plus ponatinib, along with fewer relapses, fewer deaths in complete remission, and substantially reduced reliance on allogeneic transplantation.

One of the most thought-provoking aspects of the lecture was the evolving understanding of measurable residual disease. Prof Jabbour highlighted that BCR::ABL1 RT-PCR and NGS do not necessarily measure the same biological process. Approximately one-quarter of patients demonstrate discordance, with persistent BCR::ABL1 transcripts despite eradication of lymphoblastic disease by NGS. Importantly, patients who remain NGS MRD-negative appear to have comparable survival irrespective of persistent PCR positivity, challenging the long-held practice of recommending transplantation based solely on detectable BCR::ABL1 transcripts.

The lecture also emphasised that not all patients derive equal benefit from treatment de-escalation. High presenting white blood cell counts (>70–75 × 10⁹/L), IKZF1-plus disease and CNS relapse remain important adverse prognostic features. These patients may still benefit from treatment intensification, novel consolidation approaches or CAR T-cell therapy. Early frontline CAR T-cell studies from China have already reported two-year overall survival exceeding 90%, raising the possibility that cellular therapy may eventually replace transplantation for selected high-risk patients.

Overall, this lecture illustrated how the treatment philosophy for Ph-positive ALL has evolved from simply achieving remission to achieving deep molecular remission using increasingly precise and less toxic therapies. Modern management is becoming progressively individualised through potent TKIs, bispecific antibodies, highly sensitive MRD assessment and emerging CAR T-cell strategies. Survival approaching 90% is now a realistic expectation for many newly diagnosed patients—an extraordinary achievement that would have seemed almost unimaginable only two decades ago.

25/06/2026

The Malaysian Society of Haematology (MSH) is honoured to have been part of the launch of the Clinical Practice Guidelines on the Management of Myeloproliferative Neoplasms (Second Edition), held today at Hospital Ampang.

Representing MSH at the ceremony was Dr Lily Wong, Vice President of MSH and Head of Service for Haematology, Ministry of Health Malaysia, who received the official copy of the guideline on behalf of the Society.

The publication of this updated guideline reflects the collaborative efforts of clinicians, academicians and professional organisations dedicated to advancing the care of patients with myeloproliferative neoplasms in Malaysia. MSH is proud to have contributed to this important national initiative, which will help promote evidence-based practice, standardise patient care, and support clinicians across the country.

We would also like to extend our heartfelt congratulations to Dr Lau Ngee Siang, a valued MSH member and Chairman of the Guideline Development Committee, for his outstanding leadership in steering this important national project to completion. His dedication, together with the commitment of the entire guideline panel, has resulted in a comprehensive, evidence-based resource that will benefit both clinicians and patients throughout Malaysia.

MSH also extends its sincere appreciation to the Ministry of Health Malaysia, the Academy of Medicine of Malaysia, and all members of the guideline development committee for their invaluable contributions in bringing this second edition to fruition.

Together, we continue to strengthen haematology practice and improve outcomes for patients nationwide.

16/06/2026

ABSTRACT SUBMISSION DEADLINE EXTENDED

For those considering submitting their work to ICBMT 2026, the organisers have announced that the abstract submission deadline has been extended until 26 June 2026.

ICBMT 2026, held in conjunction with the 30th Anniversary Congress of the Korean Society of Blood and Marrow Transplantation (KSBMT), will take place in Busan, Korea, from 17–19 September 2026.

This extension provides an additional opportunity for colleagues involved in haematopoietic stem cell transplantation, cellular therapy, and related fields to share their research and clinical experience on an international platform.

Further information and abstract submission details are available at:
https://icbmt.co.kr

16/06/2026

The Malaysian Society of Haematology is pleased to share the announcement of the 31st Annual Congress of the Asia-Pacific Blood and Marrow Transplantation Group (APBMT 2026), which will be held from 1–4 October 2026 at the Crowne Plaza Manila Galleria, Quezon City, Metro Manila, Philippines.

This premier regional meeting brings together physicians, nurses, scientists, pharmacists, and allied health professionals involved in blood and marrow transplantation and cellular therapy from across the Asia-Pacific region.

We encourage members with an interest in transplantation and cellular therapy to consider participating in this important scientific and networking opportunity.

Please refer to the attached poster for further details and registration information.

08/06/2026

The Malaysian Society of Haematology (MSH) is pleased to share that abstract submissions are now open for the 6th Annual Scientific Meeting of the Association for Haemophilia and Allied Disorders – Asia Pacific (AHAD-AP).

This meeting provides an excellent opportunity for healthcare professionals involved in haemophilia and inherited bleeding disorders to showcase their research, clinical experience, quality improvement initiatives, and multidisciplinary care projects on a regional platform.

We warmly encourage colleagues from Malaysia and across the Asia-Pacific region to consider submitting their work and contributing to the advancement of haemophilia care.

Please refer to the poster below for submission details and further information.

07/06/2026

The Malaysian Society of Haematology is pleased to share that abstract submission is now open for the Bloodless Medicine & Surgery Society (BMSS) Annual Scientific Conference 2026.

We encourage clinicians, researchers, nurses, pharmacists, allied healthcare professionals, and trainees with an interest in bloodless medicine and surgery to consider submitting their work and contributing to this growing field.

The conference welcomes abstracts across a range of topics, including newer technologies and innovations, education in bloodless medicine and surgery, iron therapy and erythropoiesis stimulation, perioperative bloodless surgery techniques, ethics and consent, and outcomes of bloodless care.

Abstracts should be submitted in English using the official submission form, with a maximum of 250 words and a structured format comprising Introduction, Methods, Results, and Conclusions. Abstract submissions will remain open until 1 September 2026, with notification of acceptance expected by 30 September 2026.

This is an excellent opportunity to showcase original research, share clinical experience, and engage with an international multidisciplinary community committed to advancing patient-centred blood management and bloodless care.

For submission guidelines and abstract details, please visit the BMSS Annual Scientific Conference 2026 website.

We wish all prospective authors every success with their submissions.

More information can be found on the BMSS website -

25/05/2026

Clinical Evidence for Epcoritamab in Relapsed/Refractory DLBCL
Dr Daryl Tan
Mount Elizabeth Novena Hospital

The treatment landscape for relapsed/refractory diffuse large B-cell lymphoma (DLBCL) continues to evolve rapidly, with increasing movement away from conventional salvage chemotherapy towards earlier integration of CAR T-cell therapy and bispecific antibodies.

In a highly practical and data-rich scientific discussion, Dr Daryl Tan reviewed the persistent limitations of frontline therapy, noting that approximately one-third of patients still fail R-CHOP, with most relapses occurring within the first year. Even with pola-R-CHP, around 30% of patients with IPI ≥2 continue to relapse. POLARIX demonstrated an approximate 6–7% improvement in cure rates in high-risk patients, while Asian subgroup analyses showed clearer separation of PFS and OS curves, potentially reflecting the higher prevalence of ABC-type DLBCL in Asian populations.

The session strongly emphasised upfront identification of biologically and clinically high-risk disease, including ABC-type DLBCL, double-expressor lymphoma, double-hit lymphoma, high IPI, extranodal disease, frailty, and concurrent CNS involvement. CNS disease was repeatedly highlighted as a major adverse feature requiring urgent intervention before irreversible neurological decline.

A memorable case discussion involved a 35-year-old patient with ABC-type DLBCL, MYC rearrangement, MYC/BCL2 double-expressor biology, Ki-67 of 90%, extensive extranodal and marrow involvement, renal impairment, and leptomeningeal CNS disease. Despite frontline pola-R-CHP and intensive intrathecal therapy, the patient deteriorated rapidly with cranial nerve palsy, aspiration pneumonia, ICU admission, and acute kidney injury. Following failure of polatuzumab, rituximab, and lenalidomide, third-line epcoritamab produced rapid neurological recovery and PET-confirmed complete remission after two cycles, with sustained remission maintained one year later.

The historical prognosis of primary refractory DLBCL remains extremely poor. SCHOLAR-1 reported median overall survival of less than six months, with chemotherapy response rates below 6% and complete responses rarely achieved. In contrast, second-line CAR T-cell studies including ZUMA-7 and TRANSFORM demonstrated clear superiority over salvage chemotherapy and autologous transplant in early relapse, with long-term survival plateaus approaching 40%.

Bispecific antibodies are now emerging as a major therapeutic platform in R/R DLBCL. Single-agent glofitamab and epcoritamab achieve ORR of approximately 50–60% with CR rates around 40% in clinical trials, although real-world CR rates may be lower at approximately 20%. Importantly, the discussion repeatedly stressed that complete remission — rather than partial response — is the critical determinant of durable survival.

During the subsequent expert discussion and audience interaction, emerging combination approaches involving bispecific antibodies were also explored, including ongoing experiences and early-phase studies combining bispecifics with GemOx or lenalidomide-based platforms. These discussions reflected growing interest in moving bispecific therapies earlier into the treatment algorithm, particularly in patients unsuitable for transplant or CAR T-cell therapy, although several approaches discussed remain investigational or are not currently approved in routine practice.

A recurring biological principle throughout the session was the importance of T-cell fitness. Because bispecific antibodies rely on endogenous T-cell activity, repeated chemotherapy exposure may reduce effectiveness through T-cell exhaustion. The discussion therefore reinforced the importance of timely escalation before prolonged treatment exposure and physiological decline.

The session also addressed practical Asia-Pacific challenges including reimbursement barriers, outpatient feasibility, ICANS and CRS monitoring, bendamustine exposure prior to CAR T-cell collection, CD20 reassessment at relapse, and the continuing role of autologous stem cell transplantation in late relapse. While CAR T-cell therapy remains highly effective, rapidly progressive patients may not survive long enough for manufacturing timelines, making immediately available bispecific therapy increasingly relevant in urgent disease settings.

Overall, the session reflected a major strategic shift in DLBCL management: earlier recognition of high-risk biology, faster escalation before physiological decline, and increasing integration of bispecific antibodies alongside CAR T-cell therapy and transplantation to maximise the likelihood of complete remission and durable survival.

Disclaimer: The views and reflections above represent personal academic interpretation and discussion points arising from the session. Any mention of investigational or off-label approaches reflects scientific exchange during expert discussion and should not be interpreted as promotional recommendation or formal prescribing guidance. The event organised by AbbVie was conducted as a scientific educational discussion forum intended for healthcare professionals.