F. Offner 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)

BHS guidelines on the management of relapsed and refractory diffuse large B-cell lymphoma: Part 2

SUMMARY

Approximately 30–40% of patients with diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS), will relapse or are unable to obtain a complete remission (CR) after frontline treatment. These patients have a poor prognosis and represent a therapeutic challenge. In this article, we reviewed the recent literature to update the practice guidelines of the Belgian Hematology Society (BHS) Lymphoproliferative Disease Committee for the treatment of relapsed or refractory (R/R) DLBCL. In the first part, we will focus on first relapse and the role of CAR T-cell therapy in first and second relapse. In the second part, we will focus on novel treatment options for patients with a second or higher relapse, secondary central nervous system (CNS) relapse and high-grade lymphoma.

(BELG J HEMATOL 2023;14(4):170–7)

BHS guidelines on the management of relapsed and refractory diffuse large B-cell lymphoma: Part 1

SUMMARY

Approximately 30–40% of patients with diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS), will relapse or are unable to obtain a complete remission (CR) after frontline treatment. These patients have a poor prognosis and represent a therapeutic challenge. In this article, we reviewed the recent literature to update the practice guidelines of the Belgian Hematology Society (BHS) Lymphoproliferative Disease Committee for the treatment of relapsed or refractory (R/R) DLBCL. In the first part, we will focus on first relapse and the role of CAR T-cell therapy in first and second relapse. In the second part, we will focus on novel treatment options for patients with a second or higher relapse, secondary central nervous system (CNS) relapse and high-grade lymphoma.

(BELG J HEMATOL 2023;14(3):114–21)

Guidelines of the Belgian Hematological Society for newly diagnosed and relapsed follicular lymphoma anno 2019

SUMMARY

Follicular lymphoma is the most common low-grade non-Hodgkin lymphoma. Survival rates have been rising over time mainly due to advancing therapeutic strategies. As the last Belgian guidelines date from 2012, we present an update of the scientific evidence regarding diagnosis, staging, treatment and follow-up, and confront these to the Belgian reimbursement rules anno 2019. Follicular lymphoma grade 3B is classified as high-grade lymphoma and treated accordingly, and will not be discussed in this paper. Early stage disease can be treated with involved-field radiotherapy, which has curative potential. Advanced stage disease is virtually incurable, but many treatment options are available with good results. In first line, treatment is mostly based on chemotherapy combined with rituximab; the latter can be continued as maintenance therapy. In relapsed setting, introduction of the newer and more potent anti-CD20-antibody obinutuzumab, also in combination with chemotherapy, can lead to improved survival in high-risk patients. For older patients with comorbidities, rituximab monotherapy is the preferred option. In further lines, PI3K-inhibition with idelalisib and radioimmunotherapy are available. Finally, autologous or allogeneic stem cell transplantation remain an option in a small group of selected patients.

(BELG J HEMATOL 2020;11(2):67–74)

O.1 Real World Population-Based Exploration of the Pathology Subtyping and Treatment-Modalities of Diffuse Large B-Cell Lymphoma in Belgium in Relation to Survival

BHS guidelines for the treatment of marginal zone lymphomas: 2018 update

Marginal zone lymphomas (MZL) are a heterogeneous subtype of indolent B-non-Hodgkin lymphomas that includes distinct entities:

• Extranodal mucosa-associated lymphoid tissue lymphoma arises in a variety of tissue but primarily in the stomach. They are usually localised and often associated with chronic antigenic stimulation by microbial pathogens. Eradication of the pathogen is a major part of the first-line therapy. The prognosis is excellent in early stages. In advanced stages, observation, anti-CD20 antibodies and/or cytostatic drugs are therapeutical approaches.
• Nodal MZL is usually confined in lymph nodes, bone marrow and peripheral blood. The prognosis is somewhat worse in this entity. Current recommendations suggest that they should be managed as follicular lymphomas.
• Splenic MZL is a unique entity involving the spleen, bone marrow and blood. Hepatitis infection should be eradicated before considering treatment. These lymphomas have an indolent behaviour, and only symptomatic patients should be treated by splenectomy and/or anti-CD20 antibodies.
• Two novel entities are described, non-chronic lymphocytic leukaemia monoclonal B-cell lymphocytosis, probably closely related to splenic MZL lymphoma, and a less well-defined provisional entity involving primarily the spleen called splenic B-cell lymphoma/leukaemia, unclassifiable, including splenic diffuse red pulp lymphoma and hairy-cell leukaemia variant.

This review will discuss separately the diagnosis, work-up and treatment of extranodal mucosa-associated lymphoid tissue lymphoma, nodal MZL and splenic MZL. These guidelines include the recently published ESMO consensus conference on malignant lymphoma.^1–3

(BELG J HEMATOL 2019;10(4):153–64)

Is it possible to predict who may never need treatment for B-CLL?

SUMMARY

Chronic lymphocytic leukaemia has a very heterogeneous disease evolution. Prognostic factors of B-CLL overall survival have been extensively studied. However, much less is known about prognostic factors that can identify patients who will never develop an indication for treatment, at the time of their initial diagnosis. In this study we give an overview of variables that have a predictive value for treatment free survival. Subsequently, we try to develop a novel prognostic index, to address the question ‘who will never need treatment for B-CLL?’.

(BELG J HEMATOL 2018;9(3):124–9)