M. André MD, PhD

Ibrutinib and bleeding management: a Belgian expert consensus

SUMMARY

In recent years ibrutinib emerged as a paradigm shifting agent in the treatment of chronic lymphocytic leukaemia (CLL), mantle cell lymphoma (MCL) and Waldenström’s macroglobulinemia (WM). In clinical trials and in real-world studies ibrutinib proved to be an effective agent with an overall favourable tolerability profile. However, compared with standard chemo-immunotherapy (CIT), ibrutinib was associated with a higher incidence of clinically significant bleeding. This has been hypothesized to be linked to the platelet-specific effects of inhibiting Bruton’s tyrosine kinase (BTK). Most bleeding events under ibrutinib are low-grade with a decreasing incidence over time. However, bleeding can have a significant impact on patients and interfere with persistence and compliance of ibrutinib treatment. Currently, no clear consensus exists on the use of ibrutinib in patients with an increased bleeding risk, on the management of ibrutinib-induced bleeding and on the use of ibrutinib around surgery or invasive procedures. In this paper, a panel of Belgian haematology and haemostasis specialists formulated practical advice on bleeding prevention and management in ibrutinib-treated patients.

(BELG J HEMATOL 2020;11(4):174–84)

P.15 Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL): The Lymphoma Study Association (LYSA) Registry Data

P.46 Hepatitis E management in allogeneic Hematopoietic Stem Cell Transplant (HSCT) recipients: a case report

02 Unravelling the landscape of copy number aberrations in Hodgkin Lymphoma: a joint KU Leuven and Lysa study on circulating cell-free dna

Diffuse large B-cell lymphoma refractory to R-CHOP

SUMMARY

Rituximab with cyclophosphamide, adriamycin, vincristine and prednisone (R-CHOP) is the standard treatment for diffuse large B-cell lymphoma and is able to cure 50–60% of the patients. However, patients resistant to or in early relapse after R-CHOP have a very poor prognosis with a median overall survival of only six months, and very few patients have a long survival. Double-hit lymphoma (rearrangement MYC and BCL2) has a major risk of refractoriness, and more intense chemotherapy than R-CHOP is recommended. Early PET-CT could identify resistance to conventional chemotherapy. Intensification with autologous or allogeneic stem cell transplantation is recommended in case of a response to salvage regimen. New agents are expected and chimeric antigen receptor T-cell therapy is a very promising approach.

(BELG J HEMATOL 2018;9(7):249–53)

Management of extended breast implant-associated anaplastic large cell lymphoma

SUMMARY

We report the case of a 69-year-old woman who presented an aggressive breast implant-associated anaplastic large cell lymphoma with supra- and infradiaphragmatic disease. The diagnosis was made 17 years after her first prosthesis, following a right breast carcinoma, and three years after the replacement of this first prosthesis. Breast implant-associated anaplastic large cell lymphoma is a rare form of non-Hodgkin lymphoma caused by a breast implant. Unique features of this case include the fast clinical extension of a lymphoma that is indolent in the vast majority of the cases. Indeed, less than two months after the first symptoms on the breast, cutaneous metastasis appeared on the right arm. The key diagnosis exams are histology and immunohistochemistry including CD30 and cytotoxic markers and a PET-scan to evaluate the extension of the disease. The treatment should include removal of the prosthesis and any associated mass. Local residual or unresectable disease may benefit from radiation therapy to the chest wall. For regional lymph node involvement or confirmed extended disease, adjuvant chemotherapy more in line with systemic anaplastic large cell lymphoma anaplastic lymphoma kinase-negative treatments is recommended. Finally, brentuximab vedotin, an anti-CD30 monoclonal antibody, showed encouraging results in refractory disease but still needs more prospective trials.

(BELG J HEMATOL 2018;9(7):279–84)

Hodgkin’s lymphoma: Belgian Hematology Society guidelines in diagnosis, treatment and follow-up

SUMMARY

Hodgkin’s lymphoma (HL) is a rare B cell malignant neoplasm affecting approximately 300 new patients in Belgium annually. This disease represents approximately 11% of all lymphomas and comprises two discrete disease entities: classical HL and nodular lymphocyte-predominant HL. In recent years, treatment of HL patients has changed tremendously due to the use of interim PET-CT scan and the appearance of new molecules. In this article, the diagnosis, staging, treatment and long-term follow-up of patients with classical HL are discussed.

(BELG J HEMATOL 2018;9(6):214–24)