B. De Moerloose MD, PhD

Big Children or Small Adults? Acute Myeloid Leukaemia (AML) Treatment in Adolescence and Young Adulthood

SUMMARY

Adolescents and young adults (AYAs), aged 15 to 39 years, with newly diagnosed acute myeloid leukaemia (AML) differ from both younger and older patients in terms of patient-specific as well as disease-specific factors. The improvement in outcome over time for this group is noticeably less than for their younger and older counterparts. Reasons for this are thought to be lack of standardisation of therapy, being treated with either adult or paediatric regimens, low trial participation and specific psychosocial factors. In this article, we review the distinct characteristics of AYA AML in order to address this issue and conclude that an AYA-specific approach and research are warranted to overcome stagnating outcome results.

(BELG J HEMATOL 2020;11(3):98–101)

Big Children or Small Adults? Leukaemia Treatment in Adolescence and Young Adulthood

SUMMARY

The outcome of adolescents and young adults (AYAs) with acute lymphoblastic leukaemia (ALL) has improved dramatically over the last decades by using paediatric and paediatric-inspired protocols in this age group. The outcome of different paediatric, paediatric-inspired and adult-based regimens are compared in this review. Despite pre-existing fear among clinicians to use these high-intensity paediatric regimens in AYAs, toxicities seem manageable, with treatment-related mortality comparable to that seen with adult protocols. In paediatric protocols, the use of allogeneic stem cell transplantation is restricted to certain high-risk groups and prophylactic cranial irradiation is omitted. In recent years, evaluation of minimal residual disease is increasingly used as prognostic marker and as a tool to guide therapy. In Philadelphia-positive ALL, the use of tyrosine-kinase inhibitors has completely changed prognosis and therapeutic decisions.

(BELG J HEMATOL 2020;11(3):88–97)

Recent advances in the genomic and epigenomic biology of juvenile myelomonocytic leukaemia

SUMMARY

Juvenile myelomonocytic leukaemia is a heterogeneous disease caused by constitutional activation of the Ras signal transduction pathway. The clinical course of the disease is variable and non-specific. In the majority of patients prompt hematopoietic stem cell transplantation is necessary for long-term survival, whereas in a minority the disease will resolve without treatment. In more than 90% of the patients, mutations in one or more of the following genes can be found (somatic NRAS, KRAS and PTPN11, germline NF1 and CBL). However, these canonical mutations are insufficient to explain the phenotypic heterogeneity of this disease. More recently, secondary mutations, non-coding RNA expression, and genomic DNA methylation have led to a better understanding of the pathobiology of the disease, and shown to play a role in the classification and prognostication of this rare disease. In addition, this novel information has been crucial for novel drug development and introduction of novel patient-tailored therapies, which are currently being tested in vitro or in vivo in clinical trials.
(BELG J HEMATOL 2020;11(2):49–55)

Severe neutropenia in an infant after treatment with infliximab during pregnancy

SUMMARY

We describe a 7-month-old girl with severe neutropenia born to a mother treated for ulcerative colitis with infliximab until the 24^th week of pregnancy. Despite the recommendation of using Tumour Necrosis Factor inhibitors (TNFi) only in the first and second trimester of pregnancy, significant levels of TNFi in offspring are possible. Hence, drug-induced neutropenia should be considered in the differential diagnosis of infants with severe neutropenia if these were exposed to TNFi in utero. Moreover, additional information is given on the risk of infection and dysfunctional immune development in these new-borns.

(BELG J HEMATOL 2019;10(7):285–9)

The impact of chemotherapy on the host microbiota in the context of oral and gastrointestinal mucositis

SUMMARY

In this PhD thesis, we investigated the impact of chemotherapy on the microbiota in the context of mucositis by using different experimental set-ups. Using bacterial monocultures, we showed that exposure to 5-fluorouracil at physiologically relevant concentrations differentially impacts oral microorganisms. Despite this difference in microbial sensitivity to 5-fluorouracil in pure cultures, we showed that the impact of 5-fluorouracil, as well as irinotecan, towards highly diverse gastrointestinal microbial populations is only marginal. These findings were generated with two different model systems that exclude host cells and this led us to conclude that the host is crucial in the establishment of chemotherapy-induced shifts in microbial composition and functionality. The next step in our research entailed the use of an in vitro wound healing model, where we demonstrated that the presence of microbiota negatively impacts the wound healing capacity of damaged oral epithelial cells. This indicates that microbial presence can delay the recovery from mucositis. Yet, we also found that microbial composition, which is for instance disturbed in patients receiving cancer therapy, is an additional determinant of aggravated wound healing. We further substantiated this conclusion with an in vivo longitudinal monitoring study of paediatric patients treated for haematological malignancies. While shifts in the oral microbial community during and following chemotherapy were mostly patient-specific, clear associations were made with the use of systemic antibiotics and antibacterial mouth rinses, which create microbial dysbiosis. In view of these findings we propose that the preventive use of antimicrobials needs careful consideration given the profound impact on the microbiome and subsequent consequence for the host.

(BELG J HEMATOL 2018;9(2):68–70.)

Retrospective study of infant leukaemia in the University Hospitals of Leuven and Ghent

SUMMARY

Infant leukaemia is a rare disease but the 3^rd most frequent malignancy in this age group. Both acute lymphoblastic leukaemia and acute myeloid leukaemia in the first year of life have particular clinical and biological characteristics such as B-cell phenotype with co-expression of myeloid markers in acute lymphoblastic leukaemia, FAB M5 or M7 in acute myeloid leukaemia, the presence of extramedullary symptoms and a high frequency of KMT2A rearrangements. Survival rates for infant acute leukaemia are worse than for older children. In this study, the characteristics and outcome of 50 infants with acute lymphoblastic leukaemia and acute myeloid leukaemia treated at the University Hospitals of Ghent and Leuven between 1989 and 2015 were studied and correlated with literature data. With event-free survival and overall survival rates of 44% and 52% for the entire cohort, the outcome of these patients was comparable to those in published clinical trials. In general, the event-free survival and overall survival was superior in acute myeloid leukaemia compared to acute lymphoblastic leukaemia infants and not influenced by age (< or ≥6 months), white blood cell count at diagnosis or presence of a KMT2A rearrangement. For future trials in infant leukaemia, the high number of early deaths, toxic deaths and relapses remain the most challenging problems.

(BELG J HEMATOL 2018;9(2):57–63.)

PP01 Exploring the long non-coding RNA landscape in Juvenile Myelomonocytic Leukemia