BJH - volume 11, issue 2, march 2020
M. Clauwaert MD, V. Galle MD, M. Maerevoet MD, A. Janssens MD, PhD, K. Saevels MD, S. Snauwaert MD, PhD, C. Springael MD, PhD, V. Van Hende MD, G. Verhoef MD, PhD, F. Offner MD, PhD
Follicular lymphoma is the most common low-grade non-Hodgkin lymphoma. Survival rates have been rising over time mainly due to advancing therapeutic strategies. As the last Belgian guidelines date from 2012, we present an update of the scientific evidence regarding diagnosis, staging, treatment and follow-up, and confront these to the Belgian reimbursement rules anno 2019. Follicular lymphoma grade 3B is classified as high-grade lymphoma and treated accordingly, and will not be discussed in this paper. Early stage disease can be treated with involved-field radiotherapy, which has curative potential. Advanced stage disease is virtually incurable, but many treatment options are available with good results. In first line, treatment is mostly based on chemotherapy combined with rituximab; the latter can be continued as maintenance therapy. In relapsed setting, introduction of the newer and more potent anti-CD20-antibody obinutuzumab, also in combination with chemotherapy, can lead to improved survival in high-risk patients. For older patients with comorbidities, rituximab monotherapy is the preferred option. In further lines, PI3K-inhibition with idelalisib and radioimmunotherapy are available. Finally, autologous or allogeneic stem cell transplantation remain an option in a small group of selected patients.
(BELG J HEMATOL 2020;11(2):67–74)
Read moreBJH - volume 9, issue 3, june 2018
M. de Vicq de Cumptich MD, C. Springael MD, PhD, J. Somja MD, C. Bonnet MD, PhD, P. Heimann MD, PhD, U. Sass MD, A. Janssens MD, PhD, D. Bron MD, PhD
Primary cutaneous lymphomas are a heterogeneous group of diseases with indolent or aggressive behaviour, skin-limited or systemic extension, from T or B cell origin. The optimal management requires the multi-disciplinary approach with dermatologists, hemato-oncologists, pathologists and molecular biologists. The objective of this review is to harmonise the work-up and the treatment of these different entities of cutaneous T or B cell lymphoma in Belgium, according to the availability of the drugs and specialised treatment such as extracorporeal photopherisis or total skin electron beam therapy.
(BELG J HEMATOL 2018;9(3):86–100)
Read moreBJH - volume 8, issue 6, october 2017
V. Delrieu MD, C. Springael MD, PhD, K.L. Wu MD, PhD, G. Verhoef MD, PhD, A. Janssens MD, PhD, On behalf of the BHS Lymphoproliferative Working Party
Hairy cell leukaemia is a rare chronic B-cell lymphoproliferative disorder characterised by a long natural course with, in most of cases, an excellent response to a single course of purine analogue monochemotherapy. Making the right diagnosis, excluding the chemo resistant variant form of hairy cell leukaemia, and making progresses in the treatment of relapsing and/or refractory disease remains challenging up to date. In recent years, exciting results with new agents are emerging and clinical trials are ongoing to optimize the management of hairy cell leukaemia and its variant form.
(BELG J HEMATOL 2017;8(6):222–8)
Read moreBJH - volume 8, issue 3, june 2017
D. Bron MD, PhD, C. Springael MD, PhD, M. Maerevoet MD, M. de Vicq MD, A. Kolivras MD
Cutaneous T-cell lymphoma is a heterogeneous group of T-cell neoplasms presenting in the skin, mycosis fungoides being the most common subtype and Sézary syndrome the leukemic form. Treatment is dependant on stage and responses to previous therapy. Treatments are divided into ‘skin-directed therapies’, which are first-line for early stage diseases, and ‘systemic therapies’ reserved for advanced stages or refractory cutaneous T-cell lymphoma. There are currently no curative therapies for cutaneous T-cell lymphoma and consecutive treatments have to be given in function of the progression of the disease. There is an urgent need for new therapies to treat symptoms, particularly pruritus and pain, and to prolong survival. This paper summarises new drugs available for cutaneous T-cell lymphoma and their mode of action. Most new drugs for cutaneous T-cell lymphoma have response rates between 30% and 50% with response durations being less than a year. New studies looking at combination or maintenance therapies may improve quality of life and disease outcome.
(BELG J HEMATOL 2017;8(3):102–6)
Read moreBJH - volume 7, issue 3, june 2016
C. Springael MD, PhD, V. Delrieu MD, K.L. Wu MD, PhD, W. Schroyens MD, PhD, C. Bonnet MD, PhD, D. Bron MD, PhD, A. Janssens MD, PhD, On behalf of the BHS Lymphoproliferative Working Party
Large granular lymphocyte and prolymphocytic leukaemias are rare chronic lymphoproliferative disorders. Large granular lymphocyte leukaemias consist of indolent disorders such as T-cell large granular lymphocyte and chronic lymphoproliferative disorder of natural killer cells and the very rare but aggressive natural killer cell leukaemia. Treatment of the indolent large granular lymphocyte leukaemias is necessary in case of symptomatic cytopaenias or non-haematological autoimmune disorders. First line therapy of these two disorders is based on three immunosuppressive drugs: methotrexate, cyclophosphamide and cyclosporine A. Aggressive natural killer cell leukaemia needs an L-asparaginase containing regimen as induction followed by allogeneic stem cell transplantation to prolong remission. T-cell prolymphocytic leukaemia always follows an aggressive course even after an indolent onset. The optimal treatment strategy should exist of remission induction with alemtuzumab intravenously followed by autologous or allogeneic stem cell transplantation. Treatment indications for B-cell prolymphocytic leukaemia follow the criteria described by the chronic lymphocytic leukaemia guidelines. After induction with fludarabine, cyclophosphamide, rituximab or bendamustine in patients without a p53 mutation and/or a 17p deletion and alemtuzumab in case of a p53 mutation and/or a 17p deletion, stem cell transplantation must be considered.
(BELG J HEMATOL 2016; 7(3):103–11)
Read moreBJH - volume 7, issue Abstract Book BHS, january 2016
F. Van Obbergh MD, L. Knoops MD, PhD, Y. Beguin MD, PhD, C. Graux MD, PhD, S. Benghiat MD, PhD, K. Kargar-Samani , D. Bauwens , A. Efira MD, C. Dubois , C. Springael MD, PhD, L. Montfort , T. Connerotte , A. Delannoy , P. Wallemacq
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