BJH - volume 5, issue 2, june 2014
I. Moors MD, H. Schoemans MD, PhD, S. Callens MD, PhD, Y. Beguin MD, PhD, T. Kerre MD, PhD
Haematopoietic stem cell transplantation is increasingly used as consolidation therapy in severe haematological diseases. In the post-transplantation period, the immunity of haematopoietic stem cell transplantation recipients is impaired due to toxicity of the pre-haematopoietic stem cell transplantation treatment (chemo- and/or radiotherapy), the conditioning regimen with a reset of the immune system, and – in case of allogeneic haematopoietic stem cell transplantation – the use of immunosuppressive drugs and potentially graft-versus-host-disease. This leads to a considerably increased risk of infections, with high morbidity and mortality. Therefore, prevention of infections, i.a. by revaccination, is of major importance to improve outcomes. We present the Belgian guidelines for vaccination after haematopoietic stem cell transplantation, based on available data in the literature and international guidelines, taking into account the availability of vaccines and – if applicable – their reimbursement in Belgium. We describe a general vaccination schedule for post-haematopoietic stem cell transplantation patients, indications for pre-transplant vaccination and donor vaccination and an overview of special indications, such as travel vaccinations, vaccinations of close contacts and health care workers, with recommendations for titer follow-up.
(BELG J HEMATOL 2014;5(2):44–54)
Read moreBJH - volume 5, issue 1, march 2014
D. Bron MD, PhD, E. Van den Neste MD, PhD, A. Kentos MD, PhD, F. Offner MD, PhD, W. Schroyens MD, PhD, C. Bonnet MD, A. Van Hoof MD, PhD, G. Verhoef MD, PhD, A. Janssens MD, PhD
Marginal zone lymphomas are a heterogeneous subtype of indolent B-non-Hodgkin Lymphoma that includes three distinct diseases: Extranodal mucosa associated lymphoid tissue lymphoma, nodal marginal zone lymphoma and splenic marginal zone lymphoma lymphocytes +/− villous lymphocytes. The different diagnosis, work up and treatment options are discussed in these guidelines.
(BELG J HEMATOL 2014;5(1):12–21)
Read moreBJH - volume 4, issue 4, december 2013
T. Devos MD, PhD, N. Straetmans MD, PhD, C. Schuermans MD, S. Benghiat MD, PhD, V. Robin MD, P. Lewalle MD, PhD, P. Mineur MD, G. Verhoef MD, PhD, L. Knoops MD, PhD
Diagnostic and management guidelines for myelofibrosis patients are presented in this paper. As a consequence of the rapid evolution and progress in this domain over the last years, the need was felt by the BHS MPN subcommittee to update these guidelines for our country. The different prognostic scores in myelofibrosis, the diagnostic tools and treatment options with the focus on new possibilities are discussed.
(BELG J HEMATOL 2013;4(4): 127–137)
Read moreBJH - volume 4, issue 3, september 2013
F. Van Obbergh MD, A. Van Hoof MD, PhD, G. Verhoef MD, PhD, D. Dierickx MD, PhD, V. De Wilde MD, PhD, F. Offner MD, PhD, D. Bron MD, PhD, A. Sonet MD, M. André MD, PhD, A. Janssens MD, PhD, C. Bonnet MD, B. Deprijck MD, P. Zachée MD, PhD, A. Kentos MD, PhD, W. Schroyens MD, PhD, E. Van den Neste MD, PhD
The sub-committee on lymphoproliferative disorders of the Belgian Hematological Society has met several times to prepare guidelines on the management of patients with peripheral T-cell lymphomas. Each panellist’s expert provided interpretation of the evidence, based on literature review and personal experience. The available evidence was systematically discussed prior to formulating recommendations. A systematic approach to obtain consensus of expert opinion was used. After each meeting, the draft guideline was circulated to all experts for comment and approval. The present guidelines focus on general management of peripheral T-cell lymphomas with special emphasis on more specific disease-adapted strategies.
(BELG J HEMATOL 2013;4(3):90–101)
Read moreBJH - volume 4, issue 2, june 2013
G. Verhoef MD, PhD, W. Schroyens MD, PhD, D. Bron MD, PhD, C. Bonnet MD, V. De Wilde MD, PhD, A. Van Hoof MD, PhD, A. Janssens MD, PhD, D. Dierickx MD, PhD, M. André MD, PhD, E. Van den Neste MD, PhD
The guidelines for adult patients in this article are based on 2011 ESMO and NCCN version 4.2011 guidelines and amended for the particular Belgian context of label prescription and reimbursement. Levels of evidence for the use of treatment recommendations are given in square brackets. Statements without grading were considered justifed standard clinical practice by the experts of the BHS-lymphoma working party.
(BELG J HEMATOL 2013;4(2):51–57)
Read moreBJH - volume 4, issue 1, march 2013
A. Janssens MD, PhD, C. Lambert MD, PhD, G. Bries MD, PhD, A. Bosly MD, PhD, D. Selleslag MD, Y. Beguin MD, PhD
The Belgian Hematological Society (BHS) guideline panel on adult primary immune thrombocytopenia (ITP) reviewed the recent literature on diagnosis and treatment to make recommendations on the best strategies for frontline and subsequent-line treatment. No treatment is necessary for patients with platelet counts higher than 30000/μl in the absence of bleeding symptoms. Patients newly diagnosed or relapsing after a long-term treatment-free period can be managed with corticosteroids with or without intravenous immunoglobulins. A second line therapy is indicated for those patients who are intolerant or unresponsive to or relapse after initial corticosteroid treatment and have a risk of bleeding. The guideline panel recommends splenectomy as it is the treatment with the highest curative potential and an acceptable safety profile. If possible, splenectomy should be delayed to at least twelve months after diagnosis as spontaneous remission can occur in this time period. Thrombopoietin receptor (TPO-R) agonists are recommended for patients who are refractory to or relapse after splenectomy or who have a contra-indication to splenectomy irrespective of the duration of ITP. The guideline panel agrees that rituximab, azathioprine, cyclophosphamide, cyclosporine A, danazol, dapsone, mycophenolate mofetil and vincristine/vinblastine are potential treatment options, especially for patients refractory to TPO-R agonists.
(BELG J HEMATOL 2013;1:11–20)
Read moreBJH - volume 3, issue 4, december 2012
A. Janssens MD, PhD, E. Van den Neste MD, PhD, W. Schroyens MD, PhD, M. André MD, PhD, A. Van Hoof MD, PhD, V. De Wilde MD, PhD, G. Verhoef MD, PhD, F. Offner MD, PhD, D. Bron MD, PhD
Tremendous improvements in treatment outcome have been obtained over the past decade but for most of the patients chronic lymphocytic leukaemia (CLL) still remains an incurable disease. We eagerly await tools incorporating patient related, disease related and treatment related factors, in order to balance efficacy and toxicity and to personalise treatment in a more rational manner. No treatment is necessary for patients without active and/or advanced disease, regardless of prognostic factors. When treatment is indicated we recommend fludarabine, cyclophosphamide, rituximab (FCR) as front-line strategy for fit patients, bendamustine, rituximab (BR) for patients unfit for FCR and chlorambucil for older patients with a geriatric profile or patients with major comorbidities or a reduced performance status. The choice of treatment for patients with recurrent advanced and/ or active disease depends on the duration of response to the previous treatment and on the type of treatment refractoriness. Reduced intensity conditioning allogeneic stem cell transplantation should be considered for patients with a de novo or an acquired 17p deletion, for patients refractory to F, or F and alemtuzumab, or for patients with an early relapse after chemo-immunotherapy.
We encourage patients to enter clinical trials exploring new agents. Among these new approaches, the signal transduction inhibitors have shown remarkable activity in very advanced disease, independent of genetic aberrations.
(BELG J HEMATOL 2012;3: 134–143)
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