Search Results (1,499)

Parkinson’s disease (PD) involves oxidative stress, proteotoxic aggregation, and neurotransmitter dysfunction, yet current therapies remain largely symptomatic. This study investigated whether Jujube polysaccharides (ZJP), a food-derived polysaccharide, confer neuroprotective and anti-aging benefits in Caenorhabditis elegans. ZJP was characterized for physicochemical features, antioxidant capacity, and in vivo safety. Effects were evaluated in wild-type N2 and PD models by measuring lifespan, locomotion, pharyngeal pumping, chemotaxis, α-syn::YFP fluorescence intensity, dopaminergic neuron integrity, adenosine triphosphate (ATP), reactive oxygen species (ROS), superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), and lipofuscin. Stress resilience was assessed under heat (37 °C) and H₂O₂ exposure. RT-qPCR profiled genes related to stress responses and neurotransmission. ZJP showed no detectable toxicity at tested doses. ZJP extended mean lifespan in N2 (10.3–14.1%) and NL5901 (9.1%), improved locomotion, pharyngeal pumping, and chemotaxis, reduced lipofuscin (26.8–50.6%), and increased survival under heat (23.6%) and oxidative stress (38.1%). In PD models, ZJP reduced α-syn::YFP fluorescence by up to 54.9%, protected dopaminergic neurons, and increased ATP. It also lowered ROS and MDA levels while raising SOD and CAT activities. Gene expression changes were associated with enhanced oxidative stress resistance and with altered expression of genes involved in SKN-1/DAF-16-related stress-response signaling. These findings provide preliminary evidence that ZJP may promote longevity, stress resilience, and neuroprotection in C. elegans models of PD, supporting its potential as a candidate for further investigation in neuroprotection. Full article

Background: Chemotherapy and radiation accelerate aging of multiple systems, including the immune and musculoskeletal systems. Resistance training may mitigate some of the late physiologic effects of cancer therapy. Methods: We developed a community-based pilot study of resistance training for long-term cancer survivors meeting criteria for pre-frailty or frailty (N = 8; 6 allogeneic hematopoietic cell transplant, 1 autologous hematopoietic transplant, 1 breast cancer survivor) and their caregivers (N = 8 healthy controls) consisting of a baseline assessment, 10 weeks of personalized resistance training at least once weekly as a group and as many additional times on an individual basis as their schedule allowed, and an end-of-study assessment to measure change in strength and body composition. Blood samples were collected at the start of the study and after the 10-week training program to assess changes in peripheral blood mononuclear cell DNA methylation patterns, gene expression measured by RNA sequencing, and stool microbiome analysis using metagenomics. The median number of resistance training sessions was 25 sessions. Results: Cancer survivors and controls both more than doubled their squat and press volume after 10 weeks. At baseline, cancer survivors exhibited a pro-inflammatory transcriptomic and epigenetic profile with elevated interferon signaling and reduced naïve T cell signatures compared to healthy controls, consistent with immune senescence. After 10 weeks of resistance training, these differences normalized, suggesting that exercise exerted anti-inflammatory and immune-restorative effects in cancer survivors at both gene expression and methylation levels. Ten fecal microbial pathways that were lower in relative abundance in patients compared with controls at baseline were no longer significantly different post-exercise. Conclusions: Our data suggest that in addition to beneficial changes in body composition, resistance training may exert an immune restorative effect in cancer survivors. Full article

Geroprotective molecules are currently being actively investigated for the prevention of skin aging. An overview of geroprotectors in dermatology encompasses agents such as antioxidants, ultraviolet (UV) photoprotective agents, chemical peels, and carbon dioxide (CO₂) lasers, each with inherent limitations, including poor tolerability in individuals with sensitive skin. Regarding biostimulators, high-molecular-weight peptides (exceeding 500 kDa) exhibit limited cutaneous bioavailability, underscoring the need for low-molecular-weight geroprotective compounds. One such candidate is dehydroepiandrosterone DHEA, a neurosteroid with anti-aging and anti-stress properties, which also serves as a precursor to sex steroids. Although topical hormone replacement therapy with estrogens and androgens is being utilized, it remains confined to formal hormone replacement regimens and is associated with a significant adverse effect profile. The aim of this review was to analyze the key molecular mechanisms underlying the effects of DHEA on the skin, with particular emphasis on its metabolism and sex- and age-dependent mechanisms of action. Additionally, this review seeks to elucidate the factors contributing to the absence of approved topical DHEA formulations and to outline the potential of DHEA as an anti-aging agent in dermatological applications. DHEA has demonstrated significant skin-improving effects in several studies; its investigation has been predominantly confined to postmenopausal women. Furthermore, the outcome measures employed in these studies lacked specificity. DHEA is not permitted for use in cosmetic products within the European Union due to its hormonal activity. Its use is only allowed as an extemporaneous formulation under the established regulatory frameworks of individual countries. The indications for its use and the appropriate dosage for men and women must be clearly defined based on the results of future clinical studies. Promising research directions include the pharmacogenetic characterization of steroidogenic enzymes and sex hormone receptors, as well as the evaluation of DHEA in both sexes, specifically in premenopausal women and in men presenting with late-onset hypogonadism. Additionally, the biological effects of the primary metabolites of DHEA, androstenedione, and 5-androstenediol, on the cutaneous function remain unexplored, including their potential anti-aging activity mediated through retinoid receptor activation. Full article

Neuroinflammation is increasingly recognized as a key modulator of therapeutic response and adverse events in Alzheimer’s disease (AD), especially during anti-amyloid-β (Aβ) monoclonal antibody (Aβ-mAb) treatment. We applied longitudinal translocator protein (TSPO) positron emission tomography (PET) to evaluate TSPO-associated neuroinflammatory responses to chronic Aβ-mAb therapy and their modulation by the peroxisome proliferator-activated receptor γ (PPARγ) agonist pioglitazone. App^NL-G-F knock-in mice underwent TSPO-PET and Aβ-PET imaging at 5, 7.5, and 10 months of age across four treatment arms: placebo, Aβ-mAb, pioglitazone, and combination therapy. TSPO-PET detected early and progressive neuroinflammatory responses to Aβ-mAb that appeared lower with pioglitazone co-treatment. Both mono- and combination therapy were associated with altered temporal and spatial dynamics of the TSPO-PET signal. In addition, we applied a previously validated microglia desynchronization index based on TSPO-PET connectivity, which captured individual variation in regional TSPO-PET organization and correlated with cognitive performance. Together, TSPO-PET and its regional synchronicity can quantify longitudinal, region-specific treatment effects, which may help differentiate harmful from adaptive neuroinflammatory responses. These findings highlight the potential of TSPO-PET as a stratification biomarker to optimize therapeutic interventions. TSPO-PET therefore enables in vivo tracking of treatment-associated neuroinflammatory responses during anti-Aβ immunotherapy and provides a non-invasive framework for evaluating combination strategies targeting amyloid pathology and immune regulation in AD. Full article

The hypothesis that Group A beta-haemolytic Streptococcus (GAS) triggers an autoimmune cascade targeting basal ganglia dopaminergic circuits—producing obsessive–compulsive disorder (OCD), tic disorders, or chorea depending on the receptor subtype involved—is biologically compelling and supported by emerging molecular evidence. Yet PANDAS has remained a diagnostic conundrum since its original description in 1998, with ongoing uncertainty surrounding diagnostic criteria, the interpretation of streptococcal serology, and the distinction from primary neurodevelopmental disorders. This study aimed to review the diagnostic challenges of PANDAS, with focus on streptococcal serology interpretation, advances in dopamine receptor autoantibody biology, the genetic epidemiology of primary tic disorders, and the differential diagnosis of acute neuropsychiatric presentations in children. A structured narrative review was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Library for publications from 1998 to early 2025 addressing PANDAS, PANS, streptococcal antibodies, childhood movement disorders, autoimmune encephalitis, and the genetics of tic disorders. No currently available biomarker—including ASO, anti-DNase B, anti-basal-ganglia antibodies, or the Cunningham Panel—has demonstrated adequate individual-level diagnostic accuracy for PANDAS. Emerging molecular evidence identifies anti-D1R autoantibodies, acting via G protein-and beta-arrestin-mediated signalling, as candidate biomarkers for PANDAS/PANS neuropsychiatric phenotypes, and anti-D2R autoantibodies for Sydenham chorea movement phenotypes; independent replication in unselected populations is required. Primary tic disorders carry heritability estimates of 50–80% and first-degree familial risk ratios of approximately 18-fold in large population-based cohorts. Prospective blinded studies have not demonstrated a consistent population-level association between GAS infections and tic or OCD exacerbations: PANDAS and PANS remain diagnoses of exclusion. The high background prevalence of both GAS exposure and primary neurodevelopmental disorders in overlapping paediatric age ranges creates conditions for incidental temporal co-occurrence. In the absence of validated molecular biomarkers, diagnostic imprecision carries direct clinical consequences: children may be exposed to treatments with significant risk profiles—including IVIG, plasma exchange, and prolonged antibiotic prophylaxis—while evidence-based therapies are delayed. A stepwise diagnostic approach incorporating the full differential diagnosis is both an epistemological and a patient safety imperative. Full article

Background/Objectives: Congenital esophageal stenosis (CES) is a rare condition that may present with feeding difficulties in infancy, often becoming evident during weaning. We report a case of CES presenting with progressive dysphagia during the introduction of solid foods. Methods: Clinical evaluation, contrast esophagography, endoscopy, and magnetic resonance imaging were performed to characterize the stenosis and guide management. Results: Imaging revealed a fixed narrowing of the mid-distal esophagus with minimal passage of contrast and proximal dilatation. Endoscopy confirmed a non-traversable intrinsic stenosis with macroscopically normal mucosa. The patient underwent three endoscopic dilation sessions under general anesthesia using Savary-Gilliard bougies with progressive diameters (3–5 mm, 3–7 mm, and 7–11 mm). No major procedural complications occurred. At 2-month follow-up after the last dilation, feeding was appropriate for age, dysphagia had improved, and growth was regular. Conclusions: CES should be suspected in infants with feeding difficulties that worsen during weaning, particularly when symptoms are resistant to anti-reflux therapy. Endoscopic dilation can improve feeding tolerance, although repeated and staged sessions may be required. The role of adjunctive therapies such as topical budesonide remains uncertain. Full article

The global population is ageing rapidly; adults aged ≥ 60 years are projected to exceed 2 billion by 2050. Ageing is a major risk factor for chronic and degenerative disorders and is increasingly viewed as a modifiable biological program. Oxidative stress is a central driver: sustained ROS/RNS accumulation damages lipids, proteins and nucleic acids and amplifies mitochondrial dysfunction, inflammaging, cellular senescence, impaired autophagy and telomere instability. Targeting these shared mechanisms may therefore deliver multi-disease benefits beyond single-disease therapy. Medicinal plants provide chemically defined monomers that can act as direct antioxidants and, more importantly, restore redox homeostasis by modulating conserved signaling axes, including Nrf2/FOXO/SIRT1, AMPK/mTOR and NF-κB. However, the current evidence base remains highly heterogeneous, and reliable clinical validation is still limited. In this review, we summarize studies published over the last decade on medicinal plant-derived monomers with reported anti-ageing relevance in the context of oxidative stress and redox homeostasis. We compare major redox-centered pathways, molecular targets, model systems, and outcome measures, and evaluate the evidence with attention to its strength, consistency, and translational relevance. Particular emphasis is placed on current limitations, including model dependence, variable bioavailability, uncertain dose–exposure relationships, and the lack of well-designed clinical studies. These considerations are intended to provide a more cautious and evidence-based framework for future mechanistic and translational research. Full article

Sirtuin 1 (SIRT1) is an important protein for maintaining cellular homeostasis, and targeting SIRT1 represents a promising strategy for alleviating osteoporosis. The discovery of highly potent and safe SIRT1 activators therefore holds significant translational value for clinical anti-osteoporosis therapies. In this study, we performed deep mining of high-throughput RNA-sequencing (RNA-seq) data from 576 young and aged skeletal stem/progenitor cells (SSPCs) and identified SIRT1 downregulation as a critical hallmark of SSPC ferroptosis during aging-related osteoporosis. In SIRT1 heterozygous deficiency (SIRT1^+/−) mice, we found that SIRT1 deficiency triggered SSPC ferroptosis and induced premature osteoporosis. Computer-aided drug design (CADD) was employed to screen 9634 compounds targeting the SIRT1 active site, leading to the identification of the natural compound Hydroxygenkwanin (HGK) as a novel SIRT1 activator. HGK treatment effectively restored SIRT1 activity, suppressed ferroptosis in SSPCs in vitro, and ameliorated osteoporosis in vivo. Through transcriptomic analysis and lactylation profiling, we further found that HGK can activate SIRT1 and reverse the lactylation-mediated suppression of the enzymatic activities of SOD1 and PRDX1. This mechanism may underlie the ability of HGK to reduce SSPC ferroptosis and alleviate osteoporosis. Overall, our findings suggest that HGK possesses translational potential for the treatment of osteoporosis through SIRT1 activation. Full article

Background/Objectives: Acanthamoeba keratitis (AK) is a rare but sight-threatening corneal infection. This study reviews the clinical profile, diagnostic pathways, treatment strategies, and outcomes of AK cases managed over a 34-year period. Methods: We conducted a retrospective analysis of 52 microbiologically AK cases from 1983 to 2017. Results: The mean age at presentation was 27.7 ± 9.4 years, with a female predominance (63.5%). The majority (82.7%) were contact lens users, almost exclusively soft lens wearers, with documented risk behaviors such as poor hygiene and sleeping with lenses. 44.2% were initially misdiagnosed as nonspecific microbial keratitis. Common clinical findings included epithelial defects (30.8%), ring infiltrates (44.2%), superficial infiltrates (53.8%), hypopyon (30.8%), and corneal thinning (13.5%). Diagnosis was confirmed by culture/stain in 61.5% of cases, while others required confocal microscopy or corneal biopsy. Co-infections with bacteria were noted in ~20%. Prior to referral, 82.7% of patients had received empirical topical therapy. At KKESH, all received dual anti-Acanthamoeba therapy, and 69.2% underwent surgical intervention, including tectonic PKP (46.2%) and optical PKP (19.2%). Visual acuity improved from a mean logMAR of 1.51 at presentation to 0.87 at last follow-up. Anti-Acanthamoeba therapy was discontinued in 95.9% of patients by the end of follow-up, with steroid use tapering from 61.5% at 3 months to 16.3% at final visit. Conclusions: Acanthamoeba keratitis in Saudi Arabia predominantly affects young female contact lens users and often presents with diagnostic delays and misclassification as herpetic or bacterial keratitis. Despite aggressive medical and surgical therapy, visual outcomes remain suboptimal in many cases. Full article

Background: Retinal vascular diseases, including neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), retinal vein occlusion (RVO), and myopic choroidal neovascularization (mCNV), often require repeated intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. Although ranibizumab is well established, long-term affordability remains challenging. Objective: To compare the functional, anatomical, treatment-burden, and safety outcomes of biosimilar ranibizumab (Ranieyes) and innovator ranibizumab (Lucentis/Accentrix) in routine clinical practice. Methods: This multicenter retrospective comparative study included 4997 eyes from 3577 patients treated across five tertiary eye-care centers in India. The biosimilar group comprised 2543 eyes from 1812 patients (10,893 injections), and the innovator group comprised 2454 eyes from 1765 patients (10,136 injections). Eligible indications were nAMD, DME, BRVO, CRVO, mCNV, and an exploratory miscellaneous preoperative adjunct subgroup. BCVA (logMAR), central subfield thickness (CST; µm), injection burden, and ocular/systemic adverse events were assessed over 24 months. Results: Both groups showed early improvement in BCVA and CST across the major disease categories, followed by long-term stabilization. Between-group differences were generally small, not sustained over follow-up, and of limited clinical magnitude. Serious ocular and systemic adverse events were rare in both groups, and no new safety signal emerged. Conclusions: In this large real-world cohort, the biosimilar ranibizumab Ranieyes showed outcomes broadly comparable to innovator ranibizumab across the major retinal disease subgroups, although these findings should be interpreted as observational comparative evidence rather than formal proof of equivalence. Full article

Background/Objectives: Idiopathic inflammatory myopathies (IIMs) are chronic immune-mediated disorders, causing striated muscle weakness and extramuscular symptoms. Real-world, single-centre data are needed to interpret phenotype patterns and evolving therapies. Methods: A single-centre, retrospective cohort study was conducted at the Rheumatology Clinic of the National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland from 1 January 2022 to 31 December 2025. Data included demographics, IIM subtypes, extramuscular involvement, co-existing Sjögren disease (SD), biopsy results, autoantibodies, and treatment. Due to sample size, descriptive analysis was used. Results: The study included 35 patients (31.4% men). Mean age was 50.7 years; mean body mass index (BMI) was 26.0 kg/m². The cohort consisted of 10 dermatomyositis (DM), one polymyositis (PM), two immune-mediated necrotising myopathy (IMNM), one inclusion body myositis (IBM), 16 anti-synthetase syndrome (ASyS), four juvenile dermatomyositis (JDM), and one clinically amyopathic dermatomyositis (CADM). SD co-occurred in eight cases, including six cases of ASyS. Anti-Jo1 was observed in 13 ASyS cases and one DM. Glucocorticoids (GCSs) were administered in all patients for induction in addition to cyclophosphamide (28.6%), mycophenolate mofetil (MMF) (51.4%), and methotrexate (MTX) (17.1%). Maintenance therapy included MTX (20%), MMF (31.4%), rituximab (34.3%), azathioprine (AZA) (42.9%), and others. Two DM, two JDM, and one ASyS patient received JAK inhibitors, one DM and one JDM anifrolumab, one IBM sirolimus, and four patients with interstitial lung disease (ILD) nintedanib. Conclusions: This Polish single-centre cohort shows effective use of novel therapies for IIM. Sirolimus, JAK inhibitors, and nintedanib were effective. Co-occurrence of SD in ASyS patients requires further research. Full article

Background and Aims: Understanding regulatory interactions between hepatitis B virus (HBV) and host factors is essential for the development of next generation host-directed antiviral therapies and the achievement of a functional HBV cure. Here, we investigated HBV-induced alterations in host gene expression in primary human hepatocytes (PHH) to identify host factors exploited by the virus for replication and persistence. Whole-transcriptome sequencing (WTS) of HBV-infected PHH identified host pathways with potential roles in the HBV life cycle. RNA interference-based functional screening of dysregulated candidate genes identified cyclin L1 (CCNL1) as a key host factor. RNAi-mediated knockdown of CCNL1 reduced HBV gene expression, including hepatitis B surface antigen (HBsAg). Mechanistically, CCNL1 regulates phosphorylation of the C-terminal domain (CTD) of RNA polymerase II (RNAPII) at serine 2 (S2), consistent with a role in transcriptional regulation. CCNL1 knockdown further reduced the binding of total and phospho- (Ser2/Ser5) RNAPII, pan-acetylated histone H3 (H3ac), and H3K27ac to HBV covalently closed circular DNA (cccDNA), indicating impaired cccDNA-dependent transcription. In addition, CCNL1 expression was elevated in chronic hepatitis B patients compared with those with resolved infection. Collectively, these data demonstrate that CCNL1 promotes HBV transcription and replication through modulation of RNAPII phosphorylation and chromatin-associated transcriptional activity, identifying CCNL1 as a potential host susceptibility factor for HBV. Importance: Hepatitis B virus infection remains a major threat to human health in areas with high prevalence. There is need to fully understand the complex interactions between the virus and human host factors/processes to support ongoing efforts to develop anti-HBV therapies that can be used with existing therapies to achieve a better cure. HBV relies on host cellular factors and biological processes to establish and maintain efficient infection, making host–virus interactions attractive targets for therapeutic intervention. Thus, identifying host factors that support and/or restrict HBV infection is essential for understanding the molecular basis of chronic HBV infection and for developing host-targeting anti-HBV drugs. This study identifies cyclin L1 (CCNL1) as a host susceptibility factor that promotes HBV transcription and replication through regulation of RNA polymerase II activity and or post-transcriptional mechanisms. Full article

Background/Objectives: Knee osteoarthritis (OA) is a common degenerative joint disease for which conservative treatments often provide limited long-term benefit. Adipose-derived stromal cells delivered as stromal vascular fraction (SVF) represent a minimally invasive orthobiological approach with potential anti-inflammatory and regenerative effects. This study aimed to evaluate the clinical effectiveness and safety of intra-articular autologous SVF therapy and to explore patient- and treatment-related factors influencing outcomes over one year. Methods: This single-center retrospective study included 48 patients with knee OA Kellgren–Lawrence (KL) grade II–III treated with a single intra-articular injection of autologous SVF between June 2020 and February 2022. Clinical outcomes were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and at 3 and 12 months post-treatment. Associations between clinical outcomes and age, sex, body mass index (BMI), OA grade, and administered cell dose were analyzed. Results: Significant improvements were observed in all KOOS domains at 3 months post-treatment (p < 0.001). At 12 months, improvements remained significant across domains, although Symptom scores showed slight attenuation. Higher administered cell dose was associated with greater improvement in KOOS Quality of Life (CFU-F indicators, r_s = 0.41–0.45, p < 0.01) and Sport and Recreation (TNC indicators, r_s = 0.36–0.38, p < 0.05) at 12 months, while younger age predicted greater QoL improvement and normal BMI was associated with better Symptom outcomes. Radiographic OA severity did not significantly influence treatment response, and sex-related differences were minimal. No serious adverse events were recorded. Discussion: SVF therapy was associated with sustained functional improvement and demonstrated a favorable safety profile in patients with moderate knee OA. Although demographic and treatment-related factors showed limited influence, cell dose, BMI, and age may affect selected outcomes. Prospective controlled studies with larger cohorts and longer follow-up are required to optimize patient selection and treatment protocols. Conclusions: These findings suggest that autologous SVF therapy may represent a safe and effective complementary treatment option for patients with moderate knee osteoarthritis seeking alternatives to more invasive interventions; however, these results should be confirmed in prospective controlled studies. Full article

Osteoarthritis (OA) is a degenerative, age-related joint disease involving bone remodeling and damage to articular cartilage. OA is the most common form of arthritis, causing pain, swelling, stiffness, and reduced mobility. Given the limited efficacy of current therapies, there is growing interest in natural compounds with anti-inflammatory and immunomodulatory properties. Crocus sativus L., known as saffron, contains more than 150 biologically active compounds with proven antioxidant and anti-inflammatory effects, making it a promising candidate for modulating OA-related processes. The aim of the study was to evaluate the effects of saffron extract on immune cell function, osteoclast differentiation, and joint pathology in collagenase-induced osteoarthritis (CIOA) mouse model. OA was induced by intra-articular injection of Collagenase type IA, followed by daily treatment with saffron extract for 30 days. Flow cytometry, apoptosis, Western blot and proliferation assays were performed to analyze the phenotype and activity of bone marrow and synovium cells, as well as histological evaluation of joint tissues. Saffron therapy promoted an anti-inflammatory immune profile, reduced T-cell apoptosis and proliferation, and inhibited osteoclast differentiation. These changes were accompanied by improved histological manifestations of the joints. Overall, the findings suggest that saffron may modulate key inflammatory and cellular mechanisms involved in OA, although further research is needed to confirm its therapeutic relevance in humans. Full article

Background/Objectives: The survival of patients experiencing transformation of follicular lymphoma (tFL) is generally inferior to that of their non-transformed FL counterparts. While rituximab (R) has been shown to reduce transformation rates, data on Obinutuzumab (O), a third generation anti-CD20 monoclonal antibody, are limited. Methods: This retrospective study analyzed risk factors for tFL and evaluated outcomes following transformation in 1145 consecutive patients with FL (2010–2023). Results: Over a median follow-up of 70 months, 9% (n = 103) of FL patients developed tFL, with a median time of 36 months from FL diagnosis to transformation. In multivariate analysis, O-based, compared to R-based regimens and maintenance therapy (compared to no maintenance), were independently associated with reduced risk of histologic transformation (HR 0.40, 95% CI 0.19–0.90, p = 0.026 and HR 0.42, 95% CI 0.23–0.77, p = 0.005, respectively). Transformed FL was associated with shorter overall survival (OS) from FL diagnosis compared to non-transformed FL (median not reached, p < 0.001), while prior exposure to anti-FL chemoimmunotherapy predicted shorter OS following transformation (median 34.6 months vs. not reached, p = 0.001). Multivariate analysis confirmed prior exposure to anti-FL therapy (HR 5.27, p < 0.001), male sex (HR 2.36, p = 0.014), and age over 65 (HR 2.54, p = 0.019) to be associated with shorter OS among patients with tFL. Conclusions: These findings, although requiring further validation, suggest that O-based regimens may reduce the risk of transformation and support prior studies demonstrating adverse survival outcomes in previously treated tFL patients. Full article