A. De Becker MD

Venetoclax-Azacitidine, the new standard of care for AML patients unfit for intensive treatment: A guide for clinical practice

SUMMARY

Acute myeloid leukaemia is an aggressive form of bone marrow cancer with poor prognosis, especially in elderly, unfit patients. The VIALE-A study showed an impressive improvement in complete remission rate and overall survival with the addition of venetoclax, a BCL-2 inhibitor, to azacitidine. This combination therapy is now reimbursed in Belgium for newly diagnosed adult AML patients who are considered unfit for intensive chemotherapy based on age and/or comorbidities. In this article, we provide recommendations on the use of this new combination, as well as on prophylaxis and management of specific side effects.

(BELG J HEMATOL 2023;14(2):59–66)

Epidemiology of COVID-19 infections in haematology patients and prognostic factors for outcome: A national, multicentre retrospective study

SUMMARY

In the early weeks of the ongoing COVID-19 pandemic, little was known about the risk factors of this novel disease in haematology patients. We therefore created a national, multi-center, retrospective study via a national consortium of haematology centres in Belgium to investigate the incidence and clinical characteristics of COVID-19 in haematology patients. By combining these data with data collected through the national public health institute Sciensano and the national Belgian Cancer Registry, we were able to show that haematology patients were at an increased risk of being hospitalised with COVID-19 (1 in 250 haematology patients versus 1 in 2000 in the general population). Furthermore, we found that patients with multiple myeloma and acute leukaemia were overrepresented in these hospitalisations. Mortality at 90 days was 38% during the first wave, compared to 19.3% in the general population. We therefore conclude that haematology patients with COVID-19 are at a significantly higher risk of both hospitalisation and death.

(BELG J HEMATOL 2022;13(7):269–76)

Highlights in transplantation

SUMMARY

Allogeneic haematopoietic cell transplantation (alloHCT) is a complex procedure that involves many different factors: patient characteristics, disease characteristics, donor choice, stem cell source, choice of conditioning regimen, graft versus host disease (GvHD) prevention and treatment, prevention and treatment of disease relapse and management of (non-)infectious complications. This paper discusses some key studies that were presented regarding patient characteristics, donor choice, GvHD prophylaxis and treatment and treatment of disease relapse after alloHCT. Now two years into the pandemic, it is impossible to ignore SARS-CoV-2, seroconversion after mRNA vaccination of alloHCT recipients in France will be discussed.

(BELG J HEMATOL 2022;13(1):43-7)

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)

Caplacizumab, a game changer in the treatment of acquired thrombotic thrombocytopenic purpura

SUMMARY

Acquired or immune-mediated thrombotic thrombocytopenic purpura (aTTP) is a life-threatening auto-immune disorder caused by a functional deficiency of the von Willebrand factor-cleaving protease ADAMTS13, leading to thrombotic microangiopathy. The introduction of plasma-exchange has reduced mortality from over 90% to 10–20%. However, over the last two decades the treatment outcomes have not changed substantially. Caplacizumab, a humanised nanobody directed to the A1 domain of VWF, inhibits this lethal thrombotic cascade and is therefore essential for symptom control and prevention of irreversible end-organ damage. Both TITAN and HERCULES trials demonstrated that treatment with caplacizumab significantly reduced mean duration of hospitalisation and number of days of plasma-exchange. Moreover, no deaths were observed in caplacizumab-treated patients. Therefore, we can state that caplacizumab has changed the treatment paradigm of aTTP.

(BELG J HEMATOL 2020;11(3):120–7)

O.6 Multipotent mesenchymal stromal cells for poor graft function after allogeneic hematopoietic cell transplantation – a multicenter prospective study

Highlights in acute leukaemia

Summary

This article will summarise the key studies in the field of acute leukaemia presented at the 2019 annual meeting of the American Society of Hematology (ASH). The selected abstracts in the field of acute myeloid leukaemia (AML) mainly focus on precision medicine, measurable residual disease (MRD) and maintenance treatment. In addition, results of the phase I trial using CD19/CD22 bispecific CAR T cells in paediatric and adult patients with acute lymphoblastic leukaemia (ALL) will be discussed.

(BELG J HEMATOL 2020;11(1):18–20)