BJH - volume 14, issue 3, may 2023
M. Clauwaert MD, I. Moors MD
Introduction: Fit patients with acute myeloid leukaemia (AML) are treated with intensive therapy. This consists of an induction (intensive chemotherapy) and a consolidation (intensive chemotherapy and/or stem cell transplantation). Because of the risk of complications during these different cycles, patients are followed up in-hospital in most Belgian centres. However, the consolidation course is considered tolerable and could possibly be followed up on an outpatient basis, which may also have a financial and psychological benefit.
Objective: To identify patients for whom an outpatient approach is medically justified. To this end, prognostic factors predicting the development of neutropenic fever, intensive care unit (ICU) admission and chemotherapy-related mortality (day 30 mortality) were investigated.
Methods: Retrospective analysis of all patients aged sixteen years and older with a new diagnosis of AML who underwent at least one consolidation course at the Ghent University Hospital during the period February 2016 to November 2020.
Results: One hundred and fifty-five cycles of consolidation chemotherapy were listed in 83 patients. The average duration of hospitalisation was 22.4 days. At least one episode of neutropenic fever occurred in 52 courses (33.5%). The occurrence of neutropenic fever in the previous cycle of chemotherapy was significantly associated with a higher risk of developing neutropenic fever in the subsequent cycle (p = 0.04). In a multivariate analysis, this parameters were associated with neutropenic fever with an odds ratio of 1.9 (0.90–4.01) (p = 0.09). Given the rare occurrence of an ICU admission (n = 3) and early mortality (n = 1), it was not meaningful to perform statistical analysis on this.
Conclusion: Outpatient follow-up of a consolidation chemotherapy cycle for AML is feasible. Prospective follow-up research is needed to confirm this and to investigate the economical and psychological impact.
(BELG J HEMATOL 2023;14(3):139–44)
Read moreBJH - volume 11, issue 2, march 2020
M. Clauwaert MD, V. Galle MD, M. Maerevoet MD, A. Janssens MD, PhD, K. Saevels MD, S. Snauwaert MD, PhD, C. Springael MD, PhD, V. Van Hende MD, G. Verhoef MD, PhD, F. Offner MD, PhD
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)
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