BJH - volume 4, issue 4, december 2013
T. Bauters PharmD, PhD, V. Mondelaers MD, B. De Moerloose MD, PhD, H. Robays PharmD, Y Benoit MD, PhD
PEG-L-Asparaginase (Oncaspar®) is a major compound of antineoplastic combination therapy for reinduction in acute lymphoblastic leukaemia in children and adults with known hypersensitivity. In the United States, it has been approved for many years as first-line treatment of children with acute lymphoblastic leukaemia. Its clinical benefits have been extensively described. In this report, a cost-minimisation analysis comparing the direct cost of PEG-L-asparaginase with that of native E. coli and Erwinia L-asparaginase treatment is described.
(BELG J HEMATOL 2013; 4(4): 144–147)
Read moreBJH - volume 4, issue 4, december 2013
V. Mondelaers MD, T. Bauters PharmD, PhD, B. De Moerloose MD, PhD, Y Benoit MD, PhD
Asparaginase is an essential compound of combination chemotherapy in acute lymphoblastic leukaemia in children and adults. Essentially, three preparations of asparaginase are used in childhood acute lymphoblastic leukaemia: native Escherichia coli asparaginase, Erwinia chrysanthemi asparaginase and PEG-asparaginase. Although PEG-asparaginase seems to have some advantages over the other asparaginase preparations, its clinical use in Europe is limited to second-line therapy after allergic reactions to native asparaginase. This is in contrast to the United States, where PEG-asparaginase has been approved as first-line treatment of children with acute lymphoblastic leukaemia. This report describes the properties, clinical benefits and side effects of PEG-asparaginase.
(BELG J HEMATOL 2013;4(4): 138–143)
Read moreBJH - volume 4, issue 3, september 2013
D. Bron MD, PhD
The Bruton’s tyrosine kinase protein is expressed in most hematopoietic cells with the exception of T cells and natural killer cells, but the selective effect of Bruton’s tyrosine kinase mutations suggests that its primary functional role is in antigen receptor signalling in B cells. Ibrutinib (=PCI-32765) was designed as a selective and irreversible inhibitor of the Bruton’s tyrosine kinase protein. In vitro, PCI-32765 arrested cell growth and induced apoptosis in human B-cell lymphoma cell lines, and inhibited tumour growth in vivo in xenograft models. A first analysis performed on 116 naive chronic lymphocytic leukaemia patients with a median age of 71 (range: 65 – 84) shows an estimated 22-months progression-free survival rate of 96%; the median progression-free survival or overall survival had not been reached.1 In 61 patients with relapsed/ refractory chronic lymphocytic leukaemia/small lymphocytic lymphoma with a median age of 64 years (range: 40 – 81) and a high-risk cohort (24 patients), the estimated 22-months progression-free survival rate for the 85 relapse/refractory and high-risk patients was 76%. PCI-32765 (ibrutinib) has demonstrated promising activity in studies enrolling older patients with treatment-naive or relapsed/refractory chronic lymphocytic leukaemia and older patients with small lymphocytic lymphoma. Randomised phase III studies in naïve chronic lymphocytic leukaemia/small lymphocytic lymphoma patients are currently on-going.
(BELG J HEMATOL 2013;4(3): 102–105)
Read moreBJH - volume 4, issue 2, june 2013
S. Anguille MD, PhD, Z. Berneman MD, PhD
The prognosis of patients with acute myeloid leukaemia (AML) remains dismal, with a five year overall survival rate of only 5.2% for the continuously growing subgroup of AML patients older than 65 years. These patients are generally not considered eligible for intensive chemotherapy and/or allogeneic haematopoietic stem cell transplantation, emphasising the need for novel, less toxic treatment alternatives for the older-age category of AML patients. It is within this context that immunotherapy has gained attention in recent years. In this review, we focus on the use of dendritic cell (DC) vaccines for immunotherapy of AML. DCs are the central orchestrators of the immune system bridging innate and adaptive immunity and are critical to the induction of anti-leukaemia immunity. Here, we discuss the rationale and basic principles of DC-based therapy for AML and review the clinical experience that has been obtained so far with this form of immunotherapy in patients with AML.
(BELG J HEMATOL 2013;4(2):58–65)
Read moreBJH - volume 4, issue 1, march 2013
K. Fostier MD, A. De Becker MD, R. Schots MD, PhD
The immunomodulatory drugs (IMiDs) are a class of orally available compounds which are licensed for the treatment of multiple myeloma (thalidomide, lenalidomide) and transfusion-dependent low- and intermediate-risk myelodysplasia (MDS) with deletion of long arm of chromosome 5 (lenalidomide). Pomalidomide, a novel second generation IMiD, is entering clinical trials and seems to further broaden the therapeutic spectrum of these already pleiotropic drugs. Here we summarise new insights into the mechanism of action of IMiDs as well as new developments related to their clinical use, as maintenance therapy in multiple myeloma (MM), in the treatment of myeloproliferative neoplasm- associated myelofibrosis, other types of MDS, chronic lymphocytic leukaemia (CLL) and sickle cell disease (SCD).
(BELG J HEMATOL 2013;1:21–28)
Read moreBJH - volume 3, issue 4, december 2012
A. Van Hoof MD, PhD
Brentuximab vedotin is an anticancer antibody-drug conjugate: it comprises an anti-CD30 monoclonal antibody conjugated to MMAE ( monomethyl auristatin E), a synthetic tubulin polymerisation inhibitor. The drug is given intravenously every three weeks. It has been used in treatment of relapsed Hodgkin lymphoma (HL) and relapsed systemic anaplastic large cell lymphoma (sALCL). Excellent results were obtained in these indications. Trials are underway in combination with chemotherapy for first line treatment.
(BELG J HEMATOL 2012;4:145–149)
Read moreBJH - volume 3, issue 3, september 2012
K. Fostier MD, R. Schots MD, PhD
The proteasome is an important anticancer target. Bortezomib, as a first-in-class proteasome inhibitor has become a valuable drug in the therapeutic armamentarium against multiple myeloma. This drug-review summarises the current indications for the use of bortezomib in myeloma. In addition, its emerging role as a consolidating / maintenance agent after autologous stem cell transplantation and its use in patients with bad cytogenetical markers or renal impairment is addressed. We also include the available data on the subcutaneous route of administration as an alternative to mitigate peripheral neuropathy. The promising evidence of proteasome inhibitors in other haematological malignancies (low grade lymphomas, mantle cell lymphoma, Waldenström’s disease and systemic amyloidosis) is also summarised.
(BELG J HEMATOL 2012;3:95–104)
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