A. Van De Velde MD, PhD

Practical recommendations for the management of late relapsed and refractory multiple myeloma in 2024

SUMMARY

Despite significant advances in therapeutic modalities, the treatment of relapsed and refractory multiple myeloma (RRMM) is still challenging. In this publication, we aim to provide an update on therapeutic modalities for RRMM in Belgium. First, novel combinations of well-established therapeutic agents will be discussed. Second, T-cell redirection therapies will be addressed. These include bispecific antibodies, both anti-BCMA x CD3 and anti-GPRC5D x CD3, as well as chimeric antigen receptor (CAR) T cell therapy. Third, we discuss novel modalities such as antibody-drug conjugates, selinexor, venetoclax, melflufen and CELMoDs. Finally, a general flowchart regarding overall treatment sequencing will be proposed, providing an integrated treatment recommendation from frontline to relapse.

(BELG J HEMATOL 2024;15(6):225–32)

Highlights in red blood cell disorders

SUMMARY

Insightful research into both sickle cell disease (SCD) and beta-thalassemia was presented at EHA 2021. Firstly, an overview of the worldwide mortality and morbidity of SCD was presented, which highlighted the treatment advances of the past twenty years, as well as the emerging co-morbidities that arise as SCD patients live longer. In this regard, SCD-associated cognitive dysfunction that arises from neurovascular complications were detailed, and the YEARS pulmonary embolism (PE) clinical decision algorithm was evaluated in SCD patients. Additionally, a phase II, double-blind, placebo-controlled study of luspatercept highlighted the drug’s ability to induce a clinically meaningful increase in Haemoglobin (Hb) in non-transfusion dependent beta-thalassemia.

(BELG J HEMATOL 2021;12(5):189-94)

Highlights in red blood cell disorders

SUMMARY

Transfusion-dependent β-thalassemia (TDT) and sickle cell disease (SCD) are severe monogenic diseases with potentially life-threatening manifestations. In recent years, the FDA approved several disease-modifying therapies for these patients, including like L-glutamine, voxelotor, crizanlizumab and luspatercept. During ASH 2020, updated results for some of these agents were presented in addition to data with other disease-modifying agents, including the E-selectin inhibitor rivipansel and the P-selectin inhibitor crizanlizumab. With respect to TDT, ASH 2020 featured the presentation of quality-of-life data with luspatercept in the pivotal BELIEVE trial. In the second part of this congress highlights article the focus shifts to gene editing techniques, which potentially hold the promise for a cure for patients with these genetic disorders.

(BELG J HEMATOL 2021;12(1):29-32)

Vaccination policy in adult patients with hematological malignancies or asplenia without stem cell transplantation: Recommendations from the advisory board on vaccination of the Belgian Hematological Society

SUMMARY

Patients with hematological malignancies suffer from widely varying degrees of immunodeficiency, which leads to an increased susceptibility to a wide range of infections. Some of these, such as influenza and invasive pneumococcal disease, are vaccine preventable. During the Covid19 pandemic these past months patients with hematological malignancies have already shown to be at greater risk of dying, with mortality rates of up to 30% in hospitalized patients.^1,2 This has once again highlighted the importance of robust and widely spread vaccination strategies, also we eagerly await an available vaccine for Covid19. In this review, the advisory board on vaccination of the Belgian Hematological Society (BHS), consisting of experts from various disease committees as well as two infectious disease experts attempts to provide clear recommendations regarding vaccinations in patients with hematological malignancies and asplenia. Although transplant recipients share many of the immunodeficiencies of those not transplanted, clear guidelines and vaccination schedules have already been published.³

(BELG J HEMATOL 2020;11(7):305-316)

Targeted therapies in multiple myeloma: new antibodies and CAR-T cells

SUMMARY

New therapeutic antibodies and T cells redirected to specific antigen targets with engineered chimeric antigen receptors (CARs) are emerging as powerful therapies in haematologic malignancies and multiple myeloma (MM). Various designs, manufacturing processes, and study populations, among other variables, have been tested and reported in clinical trials in MM. Here, we review and compare ongoing trials and the results of the reported clinical trials. We also discuss the outlook for CAR-T cell therapies, including managing toxicities and expanding the availability of personalized cell therapy as a promising approach to all haematologic malignancies.

A Belgian consensus protocol for autologous haematopoietic stem cell transplantation in multiple sclerosis

SUMMARY

Multiple sclerosis is considered to be an immune mediated inflammatory disorder of the central nervous system. It mainly affects young, socioeconomic active patients. Although our armamentarium for this disease has significantly evolved in recent years some patients remain refractory to conventional therapies. In these cases, autologous haematopoietic stem cell transplantation can be considered as a therapeutic option. Decreasing morbidity, mortality and increasing patient awareness have led to rising inquiry by our patients about this treatment option. With the aim of a standardised protocol and data registration, a Belgian working party on stem cell therapy in multiple sclerosis was established. In this paper, we report the consensus protocol of this working party on autologous haematopoietic stem cell transplantation in multiple sclerosis.

(BELG J HEMATOL 2018;9(5):167–74)

P35 PD-1 blockade in a patient with relapsed Hodgkin lymphoma post-allogeneic hematopoietic cell transplant: complete metabolic response without graft-versus-host-disease