BJH - volume 14, issue 4, june 2023
M. Cuykx PhD, B. Hodossy MD, I. Vrelust MD, M. Develter MD, B. Maes MD, PhD, J. Boes , J. Willemse PhD
In this case report, we describe two patients with systemic mastocytosis with an associated haematological neoplasm. The KIT c.2447A>T;p. (Asp816Val) (D816V) mutation, the original driver mutation of mastocytosis, can, in combination with additional genetic abnormalities, drive the clonal evolution towards an additional myelodysplastic or myeloproliferative neoplasia. When patients present with a dominant phenotype of the latter neoplasia, which is often the cause in chronic myelomonocytic leukaemia (CMML) or acute myeloid leukaemia (AML), the original mastocytosis could be overlooked, missing therapeutic opportunities.
(BELG J HEMATOL 2023;14(4):178–82)
Read moreBJH - volume 14, issue 3, may 2023
J. Nelissen MD, K.L. Wu MD, PhD, N. Granacher MD, D. Breems MD, PhD
Hereditary haemorrhagic telangiectasia (HHT) is a rare genetic disorder that causes mucocutaneous telangiectasia and visceral arteriovenous malformations (AVMs). Recurrent iron deficiency and anaemia are significant complications often treated by haematologists. Bevacizumab, an anti-VEGF monoclonal antibody, has been implemented to target elevated levels of VEGF as seen in HHT patients. We present a single centre case series of three patients with recurrent bleeding issues due to HHT who have been treated with bevacizumab. All three patients were benefited in terms of mean haemoglobin, need for iron infusions and number of haemostatic interventions. Based on our own case series and existing literature, systemic bevacizumab appears to be effective in the treatment of bleeding-related conditions. However, the optimal dose and treatment strategy has yet to be determined. Randomised controlled studies are needed to further support the indication of bevacizumab in HHT.
(BELG J HEMATOL 2023;14(3):135–8)
Read moreBJH - volume 14, issue 2, march 2023
R.M. Bouttelgier MD, M. Verhé MD, J. Van Droogenbroeck MD, L.J. Vanopdenbosch MD, PhD
In this article, we present a case of a 53-year-old female multiple myeloma patient who was diagnosed with leptomeningeal myelomatosis after two years of treatment. This extramedullary presentation is extremely rare and occurs in less than 1% of multiple myeloma patients. Leptomeningeal myelomatosis most commonly manifests with headache, confusion, cerebral nerve palsy and radiculopathy. When leptomeningeal myelomatosis is suspected, the first step in diagnosis is contrast-enhanced magnetic resonance imaging (MRI). However, cerebrospinal fluid (CSF) analysis is imperative for definite diagnosis. Leptomeningeal myelomatosis is commonly associated with high-risk genetic features including deletion of 17p (TP53), absence of CD56, IgA or IgD paraprotein and lambda subtype. Leptomeningeal myelomatosis has a poor prognosis with an expected survival in terms of months after diagnosis. There is no standard treatment. However, there is some evidence for promising results of therapy with marizomib and pomalidomide.
(BELG J HEMATOL 2023;14(2):73–6)
Read moreBJH - volume 13, issue 7, november 2022
N. Kint MD, PhD, M. Delforge MD, PhD
Plasma cell leukaemia (PCL) is a rare and aggressive plasma cell malignancy and is generally considered to be the final stage of multiple myeloma (MM). Although treatment modalities for MM have significantly evolved in the past decades, PCL unfortunately still retains an overall dismal prognosis, with most patients presenting with a highly symptomatic and aggressive disease course. We present a case of a transplant-ineligible patient diagnosed with a primary PCL who had an indolent presentation and achieved a durable complete remission after treatment via bortezomib-lenalidomide-dexamethasone (VRD). The present case illustrates the clinical heterogeneity of plasma cell disorders, and highlights the necessity of careful cytomorphological and flow cytometric analysis of aberrant lymphoid cells, even in the absence of stigmata of MM.
(BELG J HEMATOL 2022;13(7):277–80)
Read moreBJH - volume 13, issue 6, october 2022
G. Vermeersch MD, W. Janssens MD, PhD, S. Bos MD, M. Garmyn MD, PhD, J. Maertens MD, PhD
Yellow Nail Syndrome (YNS) is a rare entity characterised by the triad of nail discolouration, lung manifestations/sinusitis and lymphoedema. With ongoing debate, the exact aetiological mechanisms of YNS remain unknown. YNS is associated with various conditions such as malignancies, autoimmune and immuno-deficiency diseases. Some authors consider YNS as a paraneoplastic phenomenon due to its association with malignancies. Here we report the first patient presenting with the typical triad of YNS and a consecutive diagnosis of acute myeloid leukaemia with recurrent genetic abnormalities (KMT2A-PTD). Nail symptoms showed partial recovery after initiation of chemotherapy. Currently, the patient is off therapy and remains in first complete remission. More research to identify the exact pathophysiological mechanism and clinical significance of YNS is needed.
(BELG J HEMATOL 2022;13(6):249–52)
Read moreBJH - volume 13, issue 3, may 2022
C. De Crem MD, M. Hofmans MD, PhD, M. de Ville de Goyet MD, PhD, V. Mondelaers MD, B. Brichard MD, PhD, B. De Moerloose MD, PhD
Acute leukaemia with ZNF384-TCF3 fusion is considered high risk in contemporary frontline treatment protocols and will be treated by Hematopoietic Stem Cell Transplantation (HSCT) or Chimeric Antigen Receptor T-cell (CART) treatment in first complete remission. Although current cytogenetic and molecular work-up of newly diagnosed paediatric acute lymphoblastic leukaemia (ALL) includes the identification of the TCF3-ZNF384 fusion, this case underscores the importance of including this information in the choice of bridging therapy and the timing of CART treatment, as the high cytokine levels during high grade Cytokine Release Syndrome (CRS) might drive ALL cells to lineage switching.
(BELG J HEMATOL 2022;13(3):128–32)
Read moreBJH - volume 13, issue 2, march 2022
B. Heyrman MD, S. Heyman MD, N. Granacher MD, G. Van den Eynden MD, PhD
In Belgium, a 53-year old Caucasian man presented at the haematology consultations with weight loss and night sweats in the last six weeks. Apart from a cholecystectomy and appendectomy, he had no medical history. He had no pets; his last journey abroad was to Spain eight months ago. On physical examination, splenomegaly was noted. Blood testing revealed a microcytic anaemia (Hb 9.3g/dl), leukopenia (2.63x10E9/L) with normal formula, normal liver testing and crp of 47.9g/dl. Serologic testing for HIV, CMV, HepB, HepC, and Toxoplasma was negative. Trephine biopsy was normal. PET/CT scan demonstrated splenomegaly with high FDG-avidity. Splenectomy was performed. Small granules (amastygotes) were seen by the pathologist suggestive for Leishmaniasis. Serologic testing and PCR confirmed the diagnosis. He was subsequently treated with liposomal amphotericin B. Our patient is now in optimal condition. Earlier serologic testing for this rare tropical disease in a non-endemic region could have prevented splenectomy.
(BELG J HEMATOL 2022;13(2):92–4)
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