I. Moors MD

Improving care for critically ill haematological patients in the ICU: a modern perspective

Summary

Outcome of critically ill haematological patients in the intensive care unit has substantially improved during the past decades, with current estimates for intensive care unit survival of 70–75% and one-year survival of 40–45%. Based on new insights, the approach towards critically ill haematological patients is changing, with a focus on early recognition of deteriorating patients in the ward and early referral to the intensive care unit when necessary. Broad admission policies should become the standard, with regular re-assessment of the level of care administered, relative to survival expectations and burden for the patient and family. Close collaboration and communication between attending intensivists and referring haematologists with complementary skills is essential to provide good quality of care, be it either achieving short- and long-term survival and good quality of life, or timely withdrawal of aggressive therapy and institution of appropriate comfort care.

(BELG J HEMATOL 2016; 7(3):112–7)

Occurrence of mild spontaneous graft-versus-host disease after autologous stem cell transplantation for multiple myeloma: a case report and review of the literature

Summary

We present the case of a 68 year old woman with multiple myeloma, who developed mild persistent upper and lower gastrointestinal symptoms, together with a rash and abnormal liver function tests, in the early phase post-autologous stem cell transplantation. Pathology findings were compatible with graft-versus-host disease. Local treatment with corticosteroids resulted in a durable remission of the autologous graft-versus-host disease. A literature review reveals an incidence of mild gastrointestinal graft-versus-host disease in 13% of patients after autologous stem cell transplantation. Severe fatal autologous graft-versus-host disease has rarely been reported, and solely in multiple myeloma patients. In this article we discuss incidence, pathophysiology, outcome and treatment of these entities.

(BELG J HEMATOL 2016;7(2):83–6)

P3.09 Occurrence of mild spontaneous graft-versus-host-disease after autologous stem cell transplantation for multiple myeloma

Vaccination guidelines in haematopoietic transplant patients: recommendations from the BHS Transplant Committee

Summary

Haematopoietic stem cell transplantation is increasingly used as consolidation therapy in severe haematological diseases. In the post-transplantation period, the immunity of haematopoietic stem cell transplantation recipients is impaired due to toxicity of the pre-haematopoietic stem cell transplantation treatment (chemo- and/or radiotherapy), the conditioning regimen with a reset of the immune system, and – in case of allogeneic haematopoietic stem cell transplantation – the use of immunosuppressive drugs and potentially graft-versus-host-disease. This leads to a considerably increased risk of infections, with high morbidity and mortality. Therefore, prevention of infections, i.a. by revaccination, is of major importance to improve outcomes. We present the Belgian guidelines for vaccination after haematopoietic stem cell transplantation, based on available data in the literature and international guidelines, taking into account the availability of vaccines and – if applicable – their reimbursement in Belgium. We describe a general vaccination schedule for post-haematopoietic stem cell transplantation patients, indications for pre-transplant vaccination and donor vaccination and an overview of special indications, such as travel vaccinations, vaccinations of close contacts and health care workers, with recommendations for titer follow-up.

(BELG J HEMATOL 2014;5(2):44–54)

P4.12 A case of transplantation-associated thrombotic microangiopathy, with surprisingly suppressed ADAMTS-13 activity