D. Selleslag MD

Venetoclax-Azacitidine, the new standard of care for AML patients unfit for intensive treatment: A guide for clinical practice

SUMMARY

Acute myeloid leukaemia is an aggressive form of bone marrow cancer with poor prognosis, especially in elderly, unfit patients. The VIALE-A study showed an impressive improvement in complete remission rate and overall survival with the addition of venetoclax, a BCL-2 inhibitor, to azacitidine. This combination therapy is now reimbursed in Belgium for newly diagnosed adult AML patients who are considered unfit for intensive chemotherapy based on age and/or comorbidities. In this article, we provide recommendations on the use of this new combination, as well as on prophylaxis and management of specific side effects.

(BELG J HEMATOL 2023;14(2):59–66)

Epidemiology of COVID-19 infections in haematology patients and prognostic factors for outcome: A national, multicentre retrospective study

SUMMARY

In the early weeks of the ongoing COVID-19 pandemic, little was known about the risk factors of this novel disease in haematology patients. We therefore created a national, multi-center, retrospective study via a national consortium of haematology centres in Belgium to investigate the incidence and clinical characteristics of COVID-19 in haematology patients. By combining these data with data collected through the national public health institute Sciensano and the national Belgian Cancer Registry, we were able to show that haematology patients were at an increased risk of being hospitalised with COVID-19 (1 in 250 haematology patients versus 1 in 2000 in the general population). Furthermore, we found that patients with multiple myeloma and acute leukaemia were overrepresented in these hospitalisations. Mortality at 90 days was 38% during the first wave, compared to 19.3% in the general population. We therefore conclude that haematology patients with COVID-19 are at a significantly higher risk of both hospitalisation and death.

(BELG J HEMATOL 2022;13(7):269–76)

Highlights in AML and MDS

SUMMARY

Very important changes in the field of AML and MDS have been presented at the meeting and have very recently been published in top journals. First of all, the new M-IPSS integrating molecular analysis in a prognostic score for MDS was discussed by Elli Papaemmanuil and published by Elsa Bernard in June 2022 in NEJM Evid.¹ Secondly, the fifth edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms was published by J. Khoury.² It introduced new entities in MDS and AML. Finally, the updated ELN (European Leukemia Net) guidelines for diagnosis and management of AML were published in Blood in July 2022 by Hartmut Döhner.³ The impact of these three 2022 publications on the management of MDS and AML cannot be overestimated. They are not part of this report but we strongly recommend reading these papers as a background. This report is focussing on the abstracts with potential clinical impact on the treatment of AML or MDS.

(BELG J HEMATOL 2022;13(5):190–9)

Primary immune thrombocytopenia in adults: Belgian recommendations for diagnosis and treatment anno 2021 made by the Belgian Hematology Society

SUMMARY

The Belgian Hematology Society (BHS) updated the 2013 guidelines for diagnosis and treatment of primary immune thrombocytopenia (ITP).¹ As knowledge about ITP pathophysiology is increasing, the mode of action of old therapies is better understood and novel drugs are introduced to target more specific pathways. Corticosteroids with or without intravenous immunoglobulins (IgIV) remain the first line treatment. According to the updated international guidelines, a short course of corticosteroids rather than a prolonged treatment has to be recommended. The same guidelines stress that consequent therapies as thrombopoietic agents (TPO-RAs) and rituximab should be available independent of duration of ITP. Although the majority of recommendations is based on very low-quality evidence, it is strongly advised to individualise the ITP management taking patient values and preferences in account. The main treatment goal in all ITP patients must be to maintain a safe platelet count to prevent or stop bleeding with a minimum of toxicity and not to normalise the platelet count.

(BELG J HEMATOL 2020;12(3):112-27)

A multicentric observational study on the management of hyperleukocytic acute myeloid leukaemia in Belgium

SUMMARY

INTRODUCTION

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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)

Highlights of myelodysplastic syndromes and acute myeloid leukemia

SUMMARY

This report is summarising the key presentations on Myelodysplastic Syndromes (MDS) and Acute Myeloid Leukaemia (AML) from the virtual 2020 EHA meeting. The summary is focusing on novel treatment modalities and updates of important clinical studies in the field.

(BELG J HEMATOL 2020;11(5):216-21)

P.44 Donor cell-derived acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation: molecular confirmation by next-generation sequencing