PRACTICE GUIDELINES

BHS guidelines for the treatment of newly diagnosed diffuse large B-cell lymphoma (DLBCL) anno 2020

SUMMARY

Diffuse large B-cell lymphoma is the most common subtype of non-Hodgkin lymphoma. Prognosis of diffuse large B-cell lymphoma has improved dramatically since the introduction of rituximab and about two thirds of patients can be cured with immunochemotherapy. In the last twenty years, it became clear that diffuse large B-cell lymphoma is a very heterogeneous disease and based on the genetic mutation landscapes numerous efforts have been made to develop novel treatment strategies to improve the prognosis of diffuse large B-cell lymphoma further. This article provides an update of diagnosis, current treatment guidelines and novel treatment strategies for newly diagnosed patients with diffuse large B-cell lymphoma in Belgium. It will also focus on treatment of elderly patients and high-grade B-cell lymphoma.

(BELG J HEMATOL 2020;11(2):56–66)

Diagnostic testing in myeloid malignancies by next-generation sequencing: recommendations from the Commission Personalised Medicine

SUMMARY

Molecular diagnostics have an increasing impact on diagnosis, risk stratification and targeted treatment in haemato-oncology. In the framework of a pilot study for the implementation of next-generation sequencing in the Belgian healthcare system, the Commission of Personalised Medicine was founded to give professional and evidence-based advice on the molecular analysis in haemato-oncology. This paper describes its recommendations for NGS analysis in myeloid malignancies. In addition, the minimally required set of genes that must be analysed is defined and algorithms for molecular workflow in myeloid malignancies are proposed.

(BELG J HEMATOL 2019;10(6):241–9)

BHS clinical guidelines on the management of acute complications in sickle cell disease

With the increasing prevalence of sickle cell disease patients in Western countries, it is of importance to improve awareness among medical doctors of its complications. To reduce long-term morbidity and mortality, the prompt recognition and treatment of acute complications is important. The existing clinical guideline ‘Follow-up and treatment of patients with sickle cell disease hospitalised for Vaso Occlusive Crisis or infection’, published in 2012 by the Belgian Haematological Society, was revisited to better suit the practical needs of first-line practitioners.

(BELG J HEMATOL 2019;10(4):165–8)

BHS guidelines for the treatment of marginal zone lymphomas: 2018 update

Marginal zone lymphomas (MZL) are a heterogeneous subtype of indolent B-non-Hodgkin lymphomas that includes distinct entities:

• Extranodal mucosa-associated lymphoid tissue lymphoma arises in a variety of tissue but primarily in the stomach. They are usually localised and often associated with chronic antigenic stimulation by microbial pathogens. Eradication of the pathogen is a major part of the first-line therapy. The prognosis is excellent in early stages. In advanced stages, observation, anti-CD20 antibodies and/or cytostatic drugs are therapeutical approaches.
• Nodal MZL is usually confined in lymph nodes, bone marrow and peripheral blood. The prognosis is somewhat worse in this entity. Current recommendations suggest that they should be managed as follicular lymphomas.
• Splenic MZL is a unique entity involving the spleen, bone marrow and blood. Hepatitis infection should be eradicated before considering treatment. These lymphomas have an indolent behaviour, and only symptomatic patients should be treated by splenectomy and/or anti-CD20 antibodies.
• Two novel entities are described, non-chronic lymphocytic leukaemia monoclonal B-cell lymphocytosis, probably closely related to splenic MZL lymphoma, and a less well-defined provisional entity involving primarily the spleen called splenic B-cell lymphoma/leukaemia, unclassifiable, including splenic diffuse red pulp lymphoma and hairy-cell leukaemia variant.

This review will discuss separately the diagnosis, work-up and treatment of extranodal mucosa-associated lymphoid tissue lymphoma, nodal MZL and splenic MZL. These guidelines include the recently published ESMO consensus conference on malignant lymphoma.^1–3

(BELG J HEMATOL 2019;10(4):153–64)

Practical management of newly-diagnosed multiple myeloma: 2018 update for transplant eligible patients

With the introduction of immunomodulatory agents and proteasome inhibitors, major improvements have been achieved in the treatment and outcome of multiple myeloma. Different treatment combinations are now in use and newer therapies are being developed. Nevertheless, autologous stem cell transplantation remains the corner stone of therapy for fit, newly-diagnosed multiple myeloma patients. Based on an extensive review of the recent literature, we propose recommendations on myeloma care, to be used by haematologists as a reference for daily practice.

(BELG J HEMATOL 2019;10(3):113–21)

Guidelines of the Belgian Hematology Society on the use of stem cell transplantation in lymphoproliferative diseases

High-dose chemotherapy and autologous or allogeneic haematopoietic stem cell transplantation are widely used in the treatment of lymphoproliferative diseases. For chemo-sensitive relapsed lymphoma (Hodgkin’s and non-Hodgkin’s lymphoma) high-dose chemotherapy and autologous stem cell transplantation are generally accepted as a standard treatment. Emerging data exist for the use of haematopoietic stem cell transplantation in other disease stages for mantle cell lymphoma, follicular lymphoma and some T-cell lymphomas. The use of haematopoietic stem cell transplantation in other conditions is more controversial and remains a clinical option for selected patients or experimental within the framework of a clinical trial.

(BELG J HEMATOL 2019;10(2):69–79)

Cytogenetic and molecular testing in lymphoma patients: Part 2

SUMMARY

It is now well demonstrated that cytogenetic and molecular testing are valuable tools for the diagnostic, prognostication and decision of treatment strategy in lymphoproliferative disorders. This study gives an overview of the genetic tests that represent current and future clinical assessment tools in the context of lymphoid malignancies. This review has been divided into two distinct but complementary parts. The already published part 1 addressed the genetic aspects of low grade B-cell lymphomas and very briefly described the different technical methods that can be used in routine practice for the clinical management of lymphoid malignancies. This second part covers aggressive B- and T/NK-cell lymphomas as well as Hodgkin lymphoma.

(BELG J HEMATOL 2018;9(7):266–78)