G. Verhoef MD, PhD

P.21 Coincidence of renal cell carcinoma and post-transplant lymphoproliferative disorder following kidney transplantation

Treatment of posttransplant lympho-proliferative disorders following solid organ transplantation

Summary

Prevention of organ rejection following solid organ transplantation requires long term immunosuppressive therapy, leading to an increased risk of both infections and malignancies. Although skin cancers are the most common malignancies, posttransplant lymphoproliferative disorder (PTLD) comprises one of the most serious complications following transplantation with high morbidity and mortality rates. Here we will review current treatment options for PTLD following solid organ transplantation (SOT).

(BELG J HEMATOL 2012;3: 121–127)

T-cell/histiocyte-rich large B-cell lymphoma: review on pathologic diagnosis, current therapeutic options and new targets for therapy

Summary

T-cell/histiocyte rich large B-cell lymphoma (THRLBCL) is a rare variant of diffuse large B-cell lymphoma (DLBCL) with an aggressive behaviour. Clinically, THRLBCL affects a young, predominantly male population. Pathologically, it is characterised by fewer than 10% of large neoplastic B-cells in a background of abundant T-cells with or without the presence of histiocytes. Differentiating THRLBCL from other lymphoproliferative disorders can be difficult but is achieved by morphologic and immunohistochemical characterisation of the tumour cells in the appropriate stromal microenvironment. Despite these clinical and pathologic differences, treating THRLBCL is not different from treating stage-matched DLBCL and can result in a comparable outcome. Comparative studies, however, on outcome of THRLBCL and DLBCL are methodologically weak and include small numbers of patients. Recently, gene expression profiling showed a predominant role for a distinct host immune response in THRLBCL, leading to tumor tolerance. Targeting specific molecules responsible for this tumour tolerance could lead to novel therapeutic options.

(BELG J HEMATOL 2012;3: 128–133)

BHS guidelines for the treatment of chronic lymphocytic leukaemia anno 2012

Summary

Tremendous improvements in treatment outcome have been obtained over the past decade but for most of the patients chronic lymphocytic leukaemia (CLL) still remains an incurable disease. We eagerly await tools incorporating patient related, disease related and treatment related factors, in order to balance efficacy and toxicity and to personalise treatment in a more rational manner. No treatment is necessary for patients without active and/or advanced disease, regardless of prognostic factors. When treatment is indicated we recommend fludarabine, cyclophosphamide, rituximab (FCR) as front-line strategy for fit patients, bendamustine, rituximab (BR) for patients unfit for FCR and chlorambucil for older patients with a geriatric profile or patients with major comorbidities or a reduced performance status. The choice of treatment for patients with recurrent advanced and/ or active disease depends on the duration of response to the previous treatment and on the type of treatment refractoriness. Reduced intensity conditioning allogeneic stem cell transplantation should be considered for patients with a de novo or an acquired 17p deletion, for patients refractory to F, or F and alemtuzumab, or for patients with an early relapse after chemo-immunotherapy.

We encourage patients to enter clinical trials exploring new agents. Among these new approaches, the signal transduction inhibitors have shown remarkable activity in very advanced disease, independent of genetic aberrations.

(BELG J HEMATOL 2012;3: 134–143)

Dasatinib (Sprycel®) use in daily clinical practice: a Belgian observational retrospective study in patients with chronic myeloid leukaemia and Philadelphia positive acute lymphatic leukaemia who are resistant or intolerant to prior therapies including imatinib

Summary

This study aimed to collect information on daily clinical use of dasatinib (Sprycel®) in Belgium, when used for treating patients with chronic myeloid leukaemia (CML) and Philadelphia chromosome positive acute lymphoblastic leukaemia (Ph+ ALL) with resistance or intolerance to prior therapies including imatinib.

We used an observational retrospective approach to collect data from 84 patients (72 CML and 12 Ph+ ALL) from 23 Belgian centres who received dasatinib in the period between October 1, 2007 and October 31, 2009.

The majority of patients had been diagnosed with chronic phase CML (69%). All patients had received prior treatment with imatinib before initiation of dasatinib. Main reasons for switching to dasatinib were development of resistance (65%) or intolerance (31%). In 89% of chronic and accelerated phase CML patients, dasatinib therapy induced complete haematological response (CHR). Major cytogenetic response (MCyR) was observed in 63% and 67% of chronic and accelerated phase patients, respectively.

This study population is representative for patients receiving dasatinib treatment in Belgium. Dasatinib was well tolerated and patient outcome confirmed dasatinib use has significant clinical value in the treatment of CML and Ph+ ALL patients with resistance or intolerance to prior imatinib therapy.

(BELG J HEMATOL 2012;3:51–58)

Guidelines of the Belgian Hematological Society for newly diagnosed and relapsed follicular lymphoma 2012

Summary

Follicular lymphoma is an indolent lymphoma that has occurred more frequently over the last decades. In this article we present an overview of the diagnosis and initial work-up, prognostic scoring system and choice of therapy. For limited stage disease radiotherapy is the treatment of choice, and may have a curative potential. For advanced stages treatment should be initiated upon certain criteria, and is essentially based on immunochemotherapy, rituximab plus chemotherapy. The choice of chemotherapy depends on age, frailty, and specific toxicities of chemotherapy. Maintenance therapy with rituximab after induction has become standard practice. Since virtually all patients relapse eventually, an overview of the treatment in the relapsed setting is given. The treatment is then again based on immunoche-motherapy but there is also a place for radio-immunotherapy, or immunotherapy alone. For young patients, high dose chemotherapy with autologous stem cell rescue should be considered. A brief overview on novel agents, and agents that are in the pipeline, is given. We conclude with some recommendations for follow-up.

(BELG J HEMATOL 2012;3:41–50)