BJH - volume 11, issue 7, november 2020
S. Kennes MD, I. Moors MD, dr. A. Delie MD, S. Anguille MD, PhD, D. Breems MD, PhD, D. Selleslag MD, T. Kerre MD, PhD
In hyperleukocytic acute myeloid leukaemia (AML) the risk of leukostasis is high due to the rapid increase in WBC count and the size of the myeloid blasts. It is associated with poor prognosis due to an increased risk of early death and relapse. Immediate initiation of cytoreductive treatment is essential to improve outcome, but evidence to prefer hydroxyurea, leukapheresis, intensive chemotherapy (IC) or a combination treatment, is lacking. Therefore, we decided to investigate the current approach of hyperleukocytic AML in Belgium.
A brief questionnaire on the management of hyperleukocytic AML was sent to all Belgian centres currently treating AML with IC and was replied by ten centres. Four centres agreed to a more detailed retrospective analysis. All newly diagnosed AML patients presenting with hyperleukocytosis between January 2013 and April 2019 were included. Patient and disease characteristics were collected, as well as treatment choice and outcome parameters.
We included 121 patients with a median WBC count of 116,360/µL. Mortality at day 21 was 20% and overall mortality was 64% at a median follow-up of six months. Twenty percent received leukapheresis, which was started within 24 hours. There was no difference in age distribution, treatment intensity or time to start IC between patients receiving leukapheresis or not. Although the leukapheresis group had a more severe presentation with a higher median WBC and blast count and a worse performance status, there was no difference in response to therapy, early or long-term mortality. In a multivariate analysis, age at diagnosis and treatment modality (IC vs non-IC) were the only independent parameters that significantly affected early death.
Evidence on optimal treatment options in hyperleukocytic AML is lacking. We could not demonstrate any added value of leukapheresis. To improve the prognosis of this dramatic presentation, national or even European databases should be used to document and learn from the outcome of current practice.
(BELG J HEMATOL 2020;11(7):325-34)
Read moreBJH - volume 11, issue 6, october 2020
I. Moors MD, dr. A. Delie MD
Therapy-related myeloid neoplasms are increasingly seen in our daily practice, as a consequence of increased long-term cancer survivorship and an aging population. Typically, there is an overrepresentation of high-risk cytogenetics and TP53 mutations. In recent years, there have been new insights in the pathogenesis of these neoplasms, especially with regard to the role of CHIP (clonal haematopoiesis of indeterminate potential) in patients receiving cytotoxic therapy for a malignant or non-malignant disorder. Unfortunately, prognosis seems worse in comparison to de novo AML, despite intensive induction and consolidation with allogeneic stem cell transplantation, with a high frequency of treatment-related toxicity and relapse. However, there is hope for the future with the emergence of novel therapies that could be of special interest in the context of these poor-risk leukaemias.
(BELG J HEMATOL 2020;11(6):261-7)
Read moreBJH - volume 11, issue Abstract Book BHS, february 2020
S. Bonte PhD, S. Van Gassen , A. Couckuyt , V. Janda , I. Moors MD, dr. A. Delie MD, S. Kennes MD, J. Philippé MD, PhD, Y. Saeys , T. Kerre MD, PhD
BJH - volume 9, issue 7, december 2018
dr. A. Delie MD, T. Kerre MD, PhD, I. Moors MD
Since several years, it has become clear that intermediate-risk acute myeloid leukaemia patients in an acceptable clinical condition can benefit from allogeneic stem cell transplantation thanks to the improvement in relapse free survival. This study retrospectively analysed the outcome of all intermediate-risk acute myeloid leukaemia patients treated with intensive chemotherapy at the Ghent University Hospital between 01-01-2013 and 30-04-2017 in an effort to determine the impact of a new in-hospital treatment guideline adopted in April 2015. This guideline recommends all intermediate-risk acute myeloid leukaemia patients who are fit for intensive therapy to proceed to allogeneic stem cell transplantation in first complete remission. Unfortunately, we could not demonstrate an improvement in the relapse free survival after implementation of the treatment guideline. Nevertheless, exploratory analysis of the entire group suggests a survival benefit from allogeneic stem cell transplantation, with significantly improved relapse free survival and a trend towards a better overall survival.
(BELG J HEMATOL 2018;9(7):285–9)
Read moreBJH - 2018, issue Abstract Book BHS, february 2018
M. Hofmans MD, PhD, dr. A. Delie MD, K. Vandepoele PhD, N. Van Roy PhD, J. Van der Meulen , J. Philippé MD, PhD, I. Moors MD
BJH - 2018, issue Abstract Book BHS, february 2018
dr. A. Delie MD, P. Vlummens MD, N. Van Roy PhD, F. Offner MD, PhD, T. Kerre MD, PhD
BJH - volume 8, issue Abstract Book BHS, february 2017
dr. A. Delie MD, M. Hofmans MD, PhD, P. Vlummens MD
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