BJH - volume 4, issue 1, march 2013
A. Janssens MD, PhD, C. Lambert MD, G. Bries MD, PhD, A. Bosly MD, PhD, D. Selleslag MD, Y. Beguin MD, PhD
The Belgian Hematological Society (BHS) guideline panel on adult primary immune thrombocytopenia (ITP) reviewed the recent literature on diagnosis and treatment to make recommendations on the best strategies for frontline and subsequent-line treatment. No treatment is necessary for patients with platelet counts higher than 30000/μl in the absence of bleeding symptoms. Patients newly diagnosed or relapsing after a long-term treatment-free period can be managed with corticosteroids with or without intravenous immunoglobulins. A second line therapy is indicated for those patients who are intolerant or unresponsive to or relapse after initial corticosteroid treatment and have a risk of bleeding. The guideline panel recommends splenectomy as it is the treatment with the highest curative potential and an acceptable safety profile. If possible, splenectomy should be delayed to at least twelve months after diagnosis as spontaneous remission can occur in this time period. Thrombopoietin receptor (TPO-R) agonists are recommended for patients who are refractory to or relapse after splenectomy or who have a contra-indication to splenectomy irrespective of the duration of ITP. The guideline panel agrees that rituximab, azathioprine, cyclophosphamide, cyclosporine A, danazol, dapsone, mycophenolate mofetil and vincristine/vinblastine are potential treatment options, especially for patients refractory to TPO-R agonists.
(BELG J HEMATOL 2013;1:11–20)
Read moreBJH - 2013, issue BHS Abstractbook, january 2013
H. Maes , G. Verhoef MD, PhD, D. Kuypers , P. Schöffski , T. Tousseyn MD, PhD, M. Delforge MD, PhD, T. Devos MD, PhD, A. Janssens MD, PhD, J. Maertens MD, PhD, H. Schoemans MD, PhD, D. Dierickx MD, PhD
BJH - volume 3, issue 4, december 2012
A. Janssens MD, PhD, E. Van den Neste MD, PhD, W. Schroyens MD, PhD, M. André MD, A. Van Hoof MD, PhD, V. De Wilde MD, PhD, G. Verhoef MD, PhD, F. Offner MD, PhD, D. Bron MD, PhD
Tremendous improvements in treatment outcome have been obtained over the past decade but for most of the patients chronic lymphocytic leukaemia (CLL) still remains an incurable disease. We eagerly await tools incorporating patient related, disease related and treatment related factors, in order to balance efficacy and toxicity and to personalise treatment in a more rational manner. No treatment is necessary for patients without active and/or advanced disease, regardless of prognostic factors. When treatment is indicated we recommend fludarabine, cyclophosphamide, rituximab (FCR) as front-line strategy for fit patients, bendamustine, rituximab (BR) for patients unfit for FCR and chlorambucil for older patients with a geriatric profile or patients with major comorbidities or a reduced performance status. The choice of treatment for patients with recurrent advanced and/ or active disease depends on the duration of response to the previous treatment and on the type of treatment refractoriness. Reduced intensity conditioning allogeneic stem cell transplantation should be considered for patients with a de novo or an acquired 17p deletion, for patients refractory to F, or F and alemtuzumab, or for patients with an early relapse after chemo-immunotherapy.
We encourage patients to enter clinical trials exploring new agents. Among these new approaches, the signal transduction inhibitors have shown remarkable activity in very advanced disease, independent of genetic aberrations.
(BELG J HEMATOL 2012;3: 134–143)
Read moreBJH - volume 3, issue 2, june 2012
S. Debussche MD, A. Van Hoof MD, PhD, A. Sonnet MD, PhD, C. Bonnet MD, PhD, A. Janssens MD, PhD, G. Verhoef MD, PhD, D. Dierickx MD, PhD, V. De Wilde MD, PhD, D. Bron MD, PhD, W. Schroyens MD, PhD, E. Van den Neste MD, PhD, F. Offner MD, PhD
Follicular lymphoma is an indolent lymphoma that has occurred more frequently over the last decades. In this article we present an overview of the diagnosis and initial work-up, prognostic scoring system and choice of therapy. For limited stage disease radiotherapy is the treatment of choice, and may have a curative potential. For advanced stages treatment should be initiated upon certain criteria, and is essentially based on immunochemotherapy, rituximab plus chemotherapy. The choice of chemotherapy depends on age, frailty, and specific toxicities of chemotherapy. Maintenance therapy with rituximab after induction has become standard practice. Since virtually all patients relapse eventually, an overview of the treatment in the relapsed setting is given. The treatment is then again based on immunoche-motherapy but there is also a place for radio-immunotherapy, or immunotherapy alone. For young patients, high dose chemotherapy with autologous stem cell rescue should be considered. A brief overview on novel agents, and agents that are in the pipeline, is given. We conclude with some recommendations for follow-up.
(BELG J HEMATOL 2012;3:41–50)
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