S. Meers MD, PhD

Ibrutinib and atrial fibrillation: A Belgian expert consensus paper

SUMMARY

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)

Belgian guidelines for diagnosis and treatment of chronic myelomonocytic leukaemia

SUMMARY

Chronic myelomonocytic leukaemia (CMML) is a rare haematological disease. Hallmark of the diagnosis is chronic monocytosis. Other clinical features include cytopenia, dysplasia with the associated complaints like fatigue or leucocytosis, splenomegaly with constitutional symptoms. Predicting prognosis and choosing the correct treatment can be challenging for the clinician. These guidelines cover the diagnosis and treatment of CMML and provide information on morphology, cytogenetics and molecular testing, clinical features including autoimmune manifestations, prognosis and risk assessment and a treatment algorithm for both the fit and unfit CMML patient.

(BELG J HEMATOL 2020;12(2):66-76)

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)

The diagnosis and treatment of lower risk myelodysplastic syndromes in the year 2018: update of the MDS guidelines

SUMMARY

The field of myelodysplastic syndromes has entered the molecular era. New diagnostic tools such as next-generation sequencing are rapidly entering clinical practice and will change the way we diagnose and manage patients with a myelodysplastic syndrome, especially patients considered lower risk by standard diagnostic tools. The treatment of lower risk patients has not changed much since the publication of the BHS recommendations in 2013. However, important trials in lower risk patients have recently been published and will be reviewed here. Finally, the recommendations from an international expert panel for allogeneic transplantation have been published. The key points of this paper will also be discussed as well as results of recently published trials.

(BELG J HEMATOL 2018;9(2):48–56)

Highlights in myelodysplastic syndromes

SUMMARY

The past years enormous progress has been made in the understanding of the pathogenesis of myelodysplastic syndromes (MDS).¹ The introduction of next-generation sequencing (NGS) and whole-exome sequencing (WES) has revealed that about 90% of patients with MDS harbor mutations in pathways such as spliceosome machinery, in epigenetic regulators and other genes previously unknown to be involved in MDS. At this year’s conference, the focus was on these mutations. There have been no major breakthroughs on the therapeutic side.

(BELG J HEMATOL 2017;8(4):146–8)

PP32 Retrospective real-world data confirms the efficacy and safety of decitabine in treating patients with acute myeloid leukemia in Belgium

P2.02 Belgian consensus on the diagnosis and management of Paroxysmal Nocturnal Hemoglobinuria