BJH - volume 15, issue 4, june 2024
J. Brijs MD, M. André MD, PhD, S. Bailly MD, K. Beel MD, PhD, C. Bonnet MD, G. Crochet MD, P. De Paepe MD, PhD, D. Dierickx MD, PhD, C. Jacquy MD, PhD, K. Saevels MD, S. Snauwaert MD, PhD, E. Van den Neste MD, PhD, V. Vergote MD
Diffuse large B-cell lymphoma (DLBCL) is an aggressive B-cell lymphoma and represents the most common subtype of B-cell non-Hodgkin lymphomas. The majority of patients (60–70%) can nowadays be cured with first line chemo-immunotherapy (CIT), mostly a combination of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). The remaining 30–40% of patients with relapsing or refractory (R/R) disease have an unfavourable prognosis. Until recently, these patients could only be cured with platinum-based salvage CIT followed by high-dose chemotherapy and an autologous stem cell transplantation, but with rather disappointing outcomes. However, new and promising treatments for these patients have now found their way into clinical practice, with good response and survival rates and manageable toxicity rates. This article will briefly review the latest advances in the treatment of DLBCL in Belgium, both for newly diagnosed disease and for R/R disease. We will focus on the role of polatuzumab vedotin in first line, chimeric antigen receptor (CAR) T-cell therapy in second line, tafasitamab-lenalidomide in second line or higher, and bispecific antibodies in third line or higher. New treatment algorithms, both for untreated and for R/R DLBCL, clinically oriented and adapted to the Belgian reimbursement criteria, are also presented.
(BELG J HEMATOL 2024;15(4):147–57)
Read moreBJH - volume 13, issue 4, june 2022
M. Janssens MD, K. Saevels MD, V. Vergote MD, J. Lemmens MD, S. Bailly MD, A. Janssens MD, PhD, S. Snauwaert MD, PhD, M. André MD, PhD
Besides disease-directed therapy, patients with lymphoma are in need of a wide range of supportive measures. In the second part of this guideline, the prevention and treatment of tumour lysis syndrome, cardiac support and physiotherapy are discussed.
(BELG J HEMATOL 2022;13(4):149–55)
Read moreBJH - volume 13, issue 3, may 2022
M. Janssens MD, K. Saevels MD, V. Vergote MD, J. Lemmens MD, S. Bailly MD, A. Janssens MD, PhD, S. Snauwaert MD, PhD, M. André MD, PhD
Besides disease-directed therapy, patients with lymphoma are in need of a wide range of supportive measures. In the first part of this guideline the use of anti-emetic therapy, the use of granulocyte colony stimulating factor (G-CSF) and antibiotic prophylaxis for pneumocystis jirovecii are discussed. In part 2 of this guideline we will discuss cardiac support, prevention and treatment of tumour lysis syndrome and the role of physiotherapy.
(BELG J HEMATOL 2022;13(3):116–23)
Read moreBJH - volume 13, issue 2, march 2022
A. Wolfromm MD, S. Bailly MD, E. Van den Neste MD, PhD, M. André MD, PhD, K. Saevels MD, H. Antoine-Poirel MD, PhD, T. Tousseyn MD, PhD, V. Van Hende MD, S. Snauwaert MD, PhD, A. Janssens MD, PhD, C. Jacquy MD, PhD, C. Bonnet MD
Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of aggressive diseases associated with poor outcomes. Recent progress in understanding of the biology and pathogenesis based on molecular profiling and next-generation sequencing has led to the introduction of new provisional entities in the World Health Organization (WHO) classification system of 2017 and to the emergence of new drugs.1 Previous Belgian guidelines were published in 2013.2 This review will discuss the diagnosis, work-up and treatment of PTCL including these advances as well as the limitation of the availability of drugs according to the Belgian reimbursement rules.
(BELG J HEMATOL 2022;13(2):65–80)
Read moreBJH - volume 12, issue 7, november 2021
S. Snauwaert MD, PhD, V. Van Hende MD, A. Janssens MD, PhD, M. André MD, PhD, S. van Hecke MD, E. Van den Neste MD, PhD, On behalf of the lymphoproliferative disease committee BHS
Classical Hodgkin’s lymphoma (cHL) is a rather rare disease with an incidence of 2-3/100,000 per year and typically presents in patients at the age of 20–30. It is however well known that a second peak occurs at the age of 60–65 years.1 Nowadays Hodgkin is a curable disease for most of the younger patients but treatment is more difficult and less successful in the older patient population. In this review, we want to summarise the possibilities for the treatment of cHL patients above 60 years, with a focus on evidence from the rather rarely available clinical trials. We also look at future treatments. In this article we will use the term ‘older patients’ for patients of 60 years and older at diagnosis. We will make a distinction between fit patients older than 60 years and frail or vulnerable patients (so called elderly).
(BELG J HEMATOL 2021;12(7):296–304)
Read moreBJH - volume 12, issue 4, june 2021
C. Vandenbriele MD, PhD, L. Van der Linden PhD, PharmD, L.N.L. Van Aelst MD, PhD, B. Schwagten MD, PhD, F. van Heuverswyn MD, S. Meers MD, PhD, V. Galle MD, T. Van Nieuwenhuyse PharmD, K.L. Wu MD, PhD, M. André MD, PhD, C. Hermans MD, PhD, A. Janssens MD, PhD
Over the last decade, the oral Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib induced a paradigm shift in the treatment of patients with chronic lymphocytic leukaemia (CLL), mantle cell lymphoma (MCL), and Waldenströms macroglobulinemia (WM). In clinical trials and in real-world studies, ibrutinib proved to be an effective agent with an overall favourable safety and tolerability profile. However, compared with standard chemo-immunotherapy (CIT), ibrutinib was associated with a higher incidence of atrial fibrillation (AF). The patho-physiological mechanisms underlying this increased AF incidence are not completely understood, but it is thought to be related to off-target inhibitory effects of ibrutinib on the Tec protein tyrosine kinase (TEC) in cardiac cells. The prevalence of AF in patients treated with ibrutinib is highest during the first three months of therapy, which warrants an increased vigilance during this treatment phase. However, AF in patients treated with ibrutinib is generally well manageable without ibrutinib discontinuation. Prior to the start of ibrutinib treatment, identification and addressing modifiable risk factors for AF is a first important step. The threshold for haematologists to consult a cardiologist or a cardio-oncologist should be low and a close collaboration between both specialties is warranted. Unnecessary ibrutinib interruptions should be avoided, and uncomplicated AF is not a valid reason to discontinue or interrupt ibrutinib. If anticoagulation is required, direct oral anticoagulants are preferred. In this paper, a panel of haematology and cardiology specialists have provided practical guidance on how to evaluate patients prior to ibrutinib treatment and monitor during ibrutinib therapy. Furthermore, they have provided practical guidance on how to manage AF in ibrutinib-treated patients.
(BELG J HEMATOL 2021;12(4):155-64)
Read moreBJH - 2021, issue 2, march 2021
G. Crochet MD, E. Collinge MD, H. Vellemans MD, A. Bosly MD, PhD, M. André MD, PhD
Recently, the use of chimeric antigen receptor modified T cells or CAR-T cells has emerged in the therapeutic arsenal of several hematological pathologies, including lymphoma. These CAR-T cells are the product of extensive research on understanding the mechanisms of tumour immunity and are the product of cellular engineering. By combining the specific recognition of an antibody and the activation pathways of a cytotoxic cell, CAR-T cells allow promising clinical results, but they also see the occurrence of side effects that are more specific to these treatments, which it is essential to manage in a multidisciplinary team. Different CAR-T cells are currently available, particularly in diffuse large cell B lymphoma. The trials that have enabled their use differ on many points, including patient selection, the manufacture of the CAR or the pre-therapeutic conditioning. In the future, the use of this expensive therapy could be extended to other lymphomas and new generations of CAR-T cells could emerge.
(BELG J HEMATOL 2020;12(2):77-84)
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