BJH - volume 8, issue 2, march 2017
M-C. Vekemans MD, K. Beel MD, PhD, J. Caers MD, PhD, N. Meuleman MD, PhD, G. Bries MD, PhD, H. Demuynck MD, B. De Prijck MD, H. De Samblanx MD, A. Deweweire MD, K. Fostier MD, A. Kentos MD, P. Mineur MD, M. Vaes MD, I. Vande Broek MD, PhD, A. Vande Velde MD, J. Van Droogenbroeck MD, PhD, P. Vlummens MD, K.L. Wu MD, PhD, R. Schots MD, PhD, M. Delforge MD, PhD, C. Doyen MD, PhD, On behalf of the Multiple Myeloma Study Group of the Belgian Haematology Society (BHS)
The prognosis for multiple myeloma patients has improved substantially over the past decade with the development of more effective chemotherapeutic agents and regimens that possess a high level of anti-tumour activity. However, nearly all multiple myeloma patients ultimately relapse, even those who experience a complete response to initial therapy. Management of relapsed disease remains a critical aspect of multiple myeloma care and an important area of ongoing research. This manuscript from the Belgian Haematology Society multiple myeloma subgroup provides some recommendations on the management of relapsed disease.
(BELG J HEMATOL 2017;8(2):53–65)
Read moreBJH - volume 7, issue 6, december 2016
A. Awada MD, PhD, J-F. Baurain MD, PhD, P. Clement MD, PhD, P. Hainaut MD, PhD, S. Holbrechts MD, PhD, J-M. Hougardy , K. Jochmans MD, PhD, V. Mathieux MD, PhD, J. Mebis MD, PhD, M. Strijbos MD, PhD, C. Vulsteke MD, PhD, P. Verhamme MD, PhD
Venous thrombosis is a common complication in cancer patients and thromboembolism is the second most common cause of death. Several practice guidelines provide recommendations for the management of cancer-associated thrombosis. However, these guidelines do not sufficiently cover commonly encountered clinical challenges. With this expert panel, consisting of medical oncologists, haematologists, internists and thrombosis specialists, we aimed to develop a practical Belgian guidance for adequate prevention and treatment of cancer-associated thrombosis that covered several challenging situations encountered in daily clinic. This paper discusses the following topics: type and treatment duration of anticoagulant therapy, recurrent VTE despite anticoagulation, anticoagulation in case of renal impairment, liver disease and thrombocytopenia, the role of anti-Xa monitoring, central venous catheter-associated thrombosis, the position of direct oral anticoagulants and thromboprophylaxis, both in ambulatory and hospitalised patients. For an overview of the recommendations formulated by the expert panel, we refer to the key messages for clinical practice in this article.
(BELG J HEMATOL 2016;7(6):217–23)
Read moreBJH - volume 7, issue 6, december 2016
S. Wittnebel MD, PhD
The management of acute promyelocytic leukaemia has evolved considerably. The standard front-line approach with all-trans retinoic acid and chemotherapy has recently been challenged by the chemo-free combination of all-trans retinoic acid and arsenic trioxide, which has emerged as the new standard of care for non-high-risk disease. This review gives an update of the management of acute promyelocytic leukaemia.
(BELG J HEMATOL 2016;7(6):224–8)
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 2, april 2016
V. De Wilde MD, PhD, D. Dierickx MD, PhD, W. Schroyens MD, PhD, E. Van den Neste MD, PhD, C. Bonnet MD, PhD, M. André MD, A. Janssens MD, PhD, V. Van Hende MD, A. Van Hoof MD, PhD
Primary central nervous system lymphoma is a rare form of extranodal B cell lymphoma of the brain, the eyes, the meninges or the spinal cord in the absence of systemic lymphoma. The management of primary central nervous system lymphoma remains controversial, which is related to the rarity of the cases and the small number of controlled studies available. The present consensus report provides the guidelines proposed by the Belgian Hematology Society Lymphoproliferative Working Party for treating immunocompetent adult patients with primary central nervous system lymphoma.
(BELG J HEMATOL 2016;7(2):69–78)
Read moreBJH - volume 6, issue 5, december 2015
V. Vergote MD, A. Janssens MD, PhD, E. Van den Neste MD, PhD, G. Verhoef MD, PhD, E. Mourin MD, M. André MD, A. Van Hoof MD, PhD
Mantle cell lymphoma is a rare B-cell non-Hodgkin’s lymphoma characterised by a t(11;14) translocation resulting in overexpression of cyclin D1 and cell cycle dysregulation. Mantle cell lymphoma represents approximately 7–9% of all lymphomas in Europe.1 Although new treatment regimens have improved the outcomes over the last decades, mantle cell lymphoma is still considered one of the worst prognosis B-cell non-Hodgkin’s lymphoma with a median overall survival of less than five years.2 In September 2014 the Belgian Hematological Society recommendations for the treatment of mantle cell lymphoma were published.3 Since then, novel therapies such as ibrutinib and bortezomib have been approved by the European Medicines Agency in the treatment of mantle cell lymphoma. We present the new updated recommendations of the Belgian Hematological Society Lymphoproliferative Working Party. For young patients, the first line therapy remains an AraC-containing chemo-immunotherapy followed by high dose chemotherapy and autologous stem cell transplantation. For the main group of elderly patients, chemo-immunotherapy followed by maintenance with rituximab appears to be the gold standard. In relapse we can recommend treatment with BTK-inhibitor ibrutinib as first choice. Temsirolimus is reimbursed as third line treatment. Relapse patients should also be considered for allogeneic stem cell transplantation if eligible.
(BELG J HEMATOL 2015;6(5):203–8)
Read moreBJH - volume 6, issue 5, december 2015
K. Beel MD, PhD, M-C. Vekemans MD, G. Bries MD, PhD, J. Caers MD, PhD, B. De Pryck MD, K. Fostier MD, A. Kentos MD, N. Meuleman MD, PhD, P. Mineur MD, I. Van de Broek MD, PhD, K.L. Wu MD, PhD, C. Doyen MD, PhD, M. Delforge MD, PhD
Immunoglobulin light chain amyloidosis is a clonal plasma cell dyscrasia, historically associated with a very poor prognosis. Prompt diagnosis is critical to preserve organ function and improve survival in immunoglobulin light chain amyloidosis patients. The severity of cardiac involvement and response to treatment are the most important prognostic factors. Serum free light chain ratio and cardiac biomarkers troponin T and N-terminal pro-brain natriuretic peptide are powerful tools for the evaluation of prognosis and treatment response. Historically, treatment with autologous stem cell transplantation appears to offer a survival benefit, but is only an option in a minority of patients. IMiDs, and especially proteasome inhibitors, have shown promising activity in immunoglobulin light chain amyloidosis. Supportive care should be integrated in the treatment plan and requires a multidisciplinary approach. These guidelines summarise a consensus of the myeloma subcommittee of the Belgian Hematological Society on diagnosis, cytoreductive and supportive treatment of immunoglobulin light chain amyloidosis, based on an extended review of the literature. Where applicable, comments were added with respect to the Belgian reimbursement modalities.
(BELG J HEMATOL 2015;6(5):187–94)
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