Metabolic Dysregulation in Hematological Malignancies: Emerging Insights and Therapeutic Implications

Pengpeng Liu¹JIAO MA²Zizhen XU^1,3*

• ¹Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
• ²Shanghai Jiao Tong University, Shanghai, China
• ³Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

synthesis and bone marrow adipocytes for lipid supply. Disrupted lipid metabolism fosters an immunosuppressive microenvironment involving lipid-rich tumor-associated macrophages, though the precise mechanisms remain unclear. Targeting lipid uptake and metabolism is emerging as a promising strategy in MM therapy. Chiral Metabolome Analysis in Pediatric BCP-ALL Collins et al. identified a distinct chiral metabolic phenotype in IgH-aberration-positive B-cell precursor acute lymphoblastic leukemia (BCP-ALL) patients. Notably, D-amino acids were detected in leukemic cells for the first time, and chiral metabolic signatures correlated with treatment resistance, offering potential diagnostic and prognostic biomarkers. Nutritional Status and MM Outcomes Jin et al. conducted a meta-analysis (9 studies, 1,176 patients) linking high Controlling Nutritional Status (CONUT) scores to worse overall survival in MM (HR = 1.87, *p* < 0.001), though no significant association was found with progression-free survival. These findings underscore the importance of nutritional assessment in MM management. Hyperuricemia and Hyperuricosuria in Lymphoma/MPN Kunlayawutipong et al. reported high prevalence rates of hyperuricemia (43.6%) and hyperuricosuria (39.4%) in lymphoma and myeloproliferative neoplasm (MPN) patients. Key risk factors included: Lymphoma: Reduced kidney function (eGFR <90) and elevated LDH (≥250 U/L) for hyperuricemia; high LDH for hyperuricosuria. MPN: Hemoglobin <10 g/dL and LDH ≥640 U/L predicted hyperuricosuria. These insights could guide uric acid-lowering therapies to prevent complications. Conclusion Metabolic research is uncovering pivotal biomarkers and therapeutic vulnerabilities in hematologic malignancies. From mitochondrial gene signatures to lipid metabolism and nutritional influences, these advances pave the way for innovative, targeted treatments. We hope this synthesis of recent findings provides valuable insights for researchers and clinicians alike.