D. Bron MD, PhD

Onco-haematology geriatry: impact of cognitive disorders

Summary

A Comprehensive Geriatric Assessment is recommended to detect vulnerable cancer patients for whom chemotherapy may lead to severe impairment on functionality, quality of life, or survival. Although Comprehensive Geriatric Assessment is useful for better management of older patients with unsuspected problems, little is known about the reliability of the Comprehensive Geriatric Assessment to optimise the therapeutic approach in a specific patient with a malignant haemopathy. Particularly, the prognostic value of cognitive impairment in clinically fit older patients with haematological malignancies admitted to receive chemotherapy, are poorly investigated. This article investigated this question and tries to explain links between cognitive impairment and poor overall survival. Finally, this article tries to propose supportive interventions to reduce morbidity and mortality in older cancer patients with cognitive impairment.

(BELG J HEMATOL 2016;7(5):180–3)

BHS guidelines for the treatment of large granular lymphocyte and chronic prolymphocytic leukaemias

Summary

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)

O.6 Effect of bone marrow-mesenchymal stromal cell derived extracellular vesicles on survival, migration and chemoresistance of Chronic Lymphocytic Leukemia B-cells

PP1.5 Epigenetics in chronic lymphocytic leukemia: significance of TET and IDH enzymes expression on prognosis and influence of microenvironment

PP2.4 Identifying infectious triggering factors even in the presence of known predisposing diseases is mandatory in hemophagocytic lymphohistiocytosis, a review of 35 cases in two Belgian hospitals

P1.12 Identification of clinical and biological parameters predictive of chemotherapy completion and two-year overall survival in clinically fit older patients with haematological malignancies

Updated BHS guidelines for the treatment of chronic lymphocytic leukaemia anno 2016

summary

The Belgian Hematological Society Lymphoproliferative Working Party updated the 2012 recommendations on the best strategies for front-line and subsequent-line treatment of small lymphocytic leukaemia/chronic lymphocytic leukaemia. No treatment is necessary for patients without active and/or advanced disease, regardless of prognostic factors. When front-line treatment is indicated we recommend adding an anti-CD20 monoclonal antibody to chemotherapy except in frail patients: fludarabine, cyclophosphamide, rituximab for fit patients; bendamustine, rituximab for fit patients >65 years or unfit for fludarabine, cyclophosphamide, rituximab; and chlorambucil with obinutuzumab or rituximab for older patients with a geriatric profile, major comorbidities or a reduced performance status. The choice of treatment for patients with recurrent disease depends on the duration of response to the previous treatment, the type of treatment refractoriness and the presence of a 17p deletion/p53 mutation. As an alternative, chemoimmunotherapy can be proposed for patients with a late relapse. The novel B-cell receptor inhibitors are the best choice for those relapsing early, who have refractory disease or are unfit for chemoimmunotherapy. The B-cell receptor inhibitors are also first choice for each patient with a de novo or acquired 17p deletion/p53 mutation. Reduced intensity conditioning allogeneic stem cell transplantation should still be considered for patients with high-risk disease after response induction by the B-cell receptor inhibitors. We still have to encourage patients to enter clinical trials exploring new drug combinations.

(BELG J HEMATOL 2015;6(5): 195–202)