M. Vercruyssen MD

BHS guidelines on the management of relapsed and refractory diffuse large B-cell lymphoma: Part 2

SUMMARY

Approximately 30–40% of patients with diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS), will relapse or are unable to obtain a complete remission (CR) after frontline treatment. These patients have a poor prognosis and represent a therapeutic challenge. In this article, we reviewed the recent literature to update the practice guidelines of the Belgian Hematology Society (BHS) Lymphoproliferative Disease Committee for the treatment of relapsed or refractory (R/R) DLBCL. In the first part, we will focus on first relapse and the role of CAR T-cell therapy in first and second relapse. In the second part, we will focus on novel treatment options for patients with a second or higher relapse, secondary central nervous system (CNS) relapse and high-grade lymphoma.

(BELG J HEMATOL 2023;14(4):170–7)

BHS guidelines on the management of relapsed and refractory diffuse large B-cell lymphoma: Part 1

SUMMARY

Approximately 30–40% of patients with diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS), will relapse or are unable to obtain a complete remission (CR) after frontline treatment. These patients have a poor prognosis and represent a therapeutic challenge. In this article, we reviewed the recent literature to update the practice guidelines of the Belgian Hematology Society (BHS) Lymphoproliferative Disease Committee for the treatment of relapsed or refractory (R/R) DLBCL. In the first part, we will focus on first relapse and the role of CAR T-cell therapy in first and second relapse. In the second part, we will focus on novel treatment options for patients with a second or higher relapse, secondary central nervous system (CNS) relapse and high-grade lymphoma.

(BELG J HEMATOL 2023;14(3):114–21)

Bispecific antibodies: New hope in multiple myeloma

SUMMARY

Multiple myeloma is the second most common haematological cancer in adults, reaching 1.8% of all neoplasms. Despite a dramatic improvement in the treatment, multiple myeloma is still an incurable disease with a median overall survival of five years. Therefore, new therapeutic approaches are needed to further improve outcomes, especially for high-risk myeloma that are often refractory, rapidly relapsing, and/or harbouring more aggressive features. Bispecific antibodies simultaneously target tumour cells and patient’s own effector immune cells, activating the latter close to the former leading to the killing of myeloma cells. Various targets on myeloma cells have been selected and are now part of clinical trials with very promising results. This review reports the latest data of the main ongoing studies and proposes a place for this new treatment in the large armamentarium against multiple myeloma.

(BELG J HEMATOL 2022;13(2):81–3)

Highlights in multiple myeloma

SUMMARY

Major progress has been made in the treatment of Multiple Myeloma (MM) and new current standard of care has been recently published and includes the introduction of triplet and quadruplet combinations, even in first-line, and the concept of continuous treatment.¹ Several new drugs and new associations have been approved and have considerably improved the prognosis of the patients. However, MM remains an incurable disease and patients with high-risk (HR) disease will still experience early relapse. During the European Hematology Association’s annual congress (EHA 2021), results from different trials have highlighted the best options for HR MM, the role of autologous stem cell transplantation, and the exciting results of new anti BCMA-targeting therapy, and have confirmed the results of daratumumab based therapy in first-line treatment.

(BELG J HEMATOL 2021;12(5):220-2)

Diagnosis and treatment of AL amyloidosis: Belgian guidelines

SUMMARY

Immunoglobulin light chain (AL) amyloidosis is a rare and serious disease due to the deposition of amyloid fibrils. In the past years, improvements have been made in the diagnosis, treatment and response criteria. Based on an extensive review of the recent literature on AL amyloidosis, we propose practical recommenddations that can be used by Belgian haematologists as a reference for daily practice. Management of other types of amyloidosis will not be covered by this review. Levels of evidence and grades of recommendations are based on previously published methods.¹ We recommend participation in clinical trials to gain knowledge in this evolving field.

(BELG J HEMATOL 2020;11(8):343-56)

Adult T-cell leukaemia-lymphoma: Pathogeny and clinical recommendations

SUMMARY

Human T-cell leukaemia virus type 1 (HTLV-1) was the first human oncogenic virus discovered. It is endemic in some regions of the world but increasingly prevalent in our countries as globalisation is progressing. After several decades of asymptomatic carrying, approximately 2–5% of infected individuals will develop adult-T-cell leukaemia-lymphoma (ATL). Despite significant progress in the physiopathology and therapeutic interventions, the prognosis of this rare disease is dismal. An update of classification, clinical features, diagnosis and recent treatment recommendations is outlined in this review.

(BELG J HEMATOL 2019;10(7):277–84)

What is new in MGUS and smoldering multiple myeloma

SUMMARY

Multiple Myeloma (MM) and other plasma cell malignancies initially present as an asymptomatic precursor state, known as monoclonal gammopathy of undetermined significance (MGUS). When confronted to a monoclonal protein in blood or urine tests, physicians should first exclude the presence of a treatment-requiring MM. They should be aware that there are two benign precursor states, that do not require anti-myeloma treatment. Both MGUS and Smoldering Multiple Myeloma (SMM) need an initial visit by a haematologist, with further follow-up tailored to the individual patient and disease characteristics. In the current article we describe both entities, discuss their monitoring and resume the latest publications in their field.