Articles

The role of thrombopoietin receptor agonists in the management of chemotherapy-induced thrombocytopenia

BJH - volume 15, issue 3, may 2024

A. Janssens MD, PhD, C. Lambert MD, PhD

SUMMARY

Chemotherapy-induced thrombocytopenia (CIT) is a common complication of cancer treatment that poses a severe clinical burden to patients with solid or haematologic malignancies. As this thrombocytopenia can present a barrier to continue chemotherapy at full dose and on schedule, it can hamper the patient’s long-term oncologic outcomes. Despite the clinical challenges related to CIT, there are currently no available agents approved by the FDA or EMA for the treatment or prevention of CIT. However, treatment with thrombopoietin receptor agonists (TPO-RAs) may increase platelet counts and benefit the safe administration of full-dose chemotherapy without dose delays. This not only reduces the patient’s bleeding risks, but also benefits the long-term oncologic outcomes. To date, most evidence for the use of TPO-RAs in the setting of CIT come from trials with romiplostim.

(BELG J HEMATOL 2024;15(3):94–102)

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BHS guidelines for the management of small lymphocytic lymphoma and chronic lymphocytic leukaemia, anno 2024

BJH - volume 14, issue 7, november 2023

A. Janssens MD, PhD, On behalf of the BHS Lymphoproliferative Disease Committee 2023: Marc André , Christophe Bonnet , Sarah Bailly , Veerle Beckers , Dominique Bron , Rutgers Callens , Charlotte Caron , Maxim Clauwaert , Sarah Debussche , Ciel De Vriendt , Virginie De Wilde , Vanessa Delrieu , Daan Dierickx , Pierre Heimann , Jan Lemmens , Marie Maerevoet , Claire Maquet , Fulvio Massaro , Caressa Meert , Marie-Christine Ngiribacu , Fritz Offner , Juliette Rademaekers , Ornella Rizzo , Kirsten Saevels , Liesbeth Schauvliege , Sylvia Snauwaert , Joan Somja , Cécile Springael , Thomas Tousseyn , Eric Van Den Neste , Sam Vandermeeren , Sam Van Hecke , Vanessa Van Hende , Marie Vercruyssen , Vibeke Vergote , Inge Vrelust , Alice Wolfromm , Ka Lung Wu.

SUMMARY

The Belgian Haematological Society (BHS) Lymphoproliferative disease (LPD) committee updated the existing recommendations on diagnosis, prognostic scores, best strategies for front-line and subsequent-line treatment of small lymphocytic lymphoma (SLL)/chronic lymphocytic leukaemia (CLL), according to robust new data.

(BELG J HEMATOL 2023;14(7):278–303)

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Rethinking the reimbursement of innovative medicines in oncology: Looking beyond overall survival

BJH - volume 14, issue 6, october 2023

M. Piccart MD, PhD, J. Vansteenkiste MD, PhD, H. Prenen MD, PhD, F. Duhoux MD, PhD, A. Janssens MD, PhD, M. Delforge MD, PhD, A. Awada MD, PhD, P. Neven MD, PhD, A. Sibille MD, B. Neyns MD, PhD

SUMMARY

The oncological treatment landscape is evolving at a very rapid pace with a continuous stream of novel treatment options. To fully leverage these therapeutic advances in clinical practice it is important to facilitate a rapid access to innovative anticancer drugs for patients. Specifically for Belgium, the delay from EMA approval to reimbursement for anticancer drugs is very long, with an average of almost 600 days, and a substantial proportion of innovative drugs never make it to the patient. The stringent focus of the Belgian Commission for Reimbursement of Medicines (CRM) on overall survival (OS) data in reimbursement decisions is believed to be an important contributor to this situation. However, the ever-increasing pace at which new anticancer therapies are being developed in combination with an earlier detection of cancer will make it increasingly difficult to present mature OS data at the time of regulatory approval in the years to come. As such, there is an urgent need for a debate with the regulators to consider more readily available endpoints in their reimbursement assessments. In fact, when a strong treatment effect is seen on an intermediate endpoint such as disease-free or progression-free survival, a benefit in OS is quite likely. As such, our reimbursement system needs to be adapted to better align with the scientific progress in oncology. In this, a temporary reimbursement decision based on intermediate endpoints could give Belgian patients earlier access to promising lifesaving medicines. In this, we as oncologists, including specialists in haematology, respiratory oncology, and gastrointestinal cancer, strongly encourage the CRM to use the grading provided by the ESMO magnitude of clinical benefit scale to evaluate the clinical added value of future cancer treatments. This will not only facilitate a faster patient access to innovative therapies, but will also help policy-makers in advancing ‘accountability for reasonableness’ in their resource allocation deliberations.

(BELG J HEMATOL 2023;14(6):245–9)

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Highlights in chronic lymphocytic leukaemia

BJH - volume 14, issue 5, september 2023

A. Janssens MD, PhD

SUMMARY

Most of the selected abstracts deal with longer-term results of clinical trials already presented previously and urgent medical needs still existing in chronic lymphocytic leukaemia (CLL).

(BELG J HEMATOL 2022;14(5):201–6)

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BHS guidelines on the management of relapsed and refractory diffuse large B-cell lymphoma: Part 2

BJH - volume 14, issue 4, june 2023

U. Douven MD, A. Janssens MD, PhD, G. Crochet MD, S. Bailly MD, C. Bonnet MD, PhD, C. Jacquy MD, PhD, F. Offner MD, PhD, S. Snauwaert MD, PhD, E. Van den Neste MD, PhD, M. Vercruyssen MD, D. Dierickx MD, PhD, P. Vandenberghe MD, PhD, V. Vergote MD

SUMMARY

Approximately 30–40% of patients with diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS), will relapse or are unable to obtain a complete remission (CR) after frontline treatment. These patients have a poor prognosis and represent a therapeutic challenge. In this article, we reviewed the recent literature to update the practice guidelines of the Belgian Hematology Society (BHS) Lymphoproliferative Disease Committee for the treatment of relapsed or refractory (R/R) DLBCL. In the first part, we will focus on first relapse and the role of CAR T-cell therapy in first and second relapse. In the second part, we will focus on novel treatment options for patients with a second or higher relapse, secondary central nervous system (CNS) relapse and high-grade lymphoma.

(BELG J HEMATOL 2023;14(4):170–7)

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Diagnosis and treatment of Waldenström Macroglobulinaemia

BJH - volume 14, issue 3, may 2023

S. van Hecke MD, V. Van Hende MD, A. Janssens MD, PhD

SUMMARY

Waldenström Macroglobulinaemia is a rare indolent B-cell lymphoproliferative disorder, which is characterised by infiltration of the bone marrow by lymphoplasmacytic cells in combination with a monoclonal IgM gammopathy. In 2015, the first Belgian guidelines on diagnosis, staging and treatment were published with a first update in 2018. Since then, however a lot has changed. The discovery of the molecular markers MYD88 affected the diagnostic work up. There have also been radical changes in treatment and prognosis due to the use of Bruton tyrosine kinase inhibitors. In this second update, we revise both diagnosis and treatment and we have a look at the future.

(BELG J HEMATOL 2023;14(3):122–34)

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BHS guidelines on the management of relapsed and refractory diffuse large B-cell lymphoma: Part 1

BJH - volume 14, issue 3, may 2023

U. Douven MD, A. Janssens MD, PhD, G. Crochet MD, S. Bailly MD, C. Bonnet MD, PhD, C. Jacquy MD, PhD, F. Offner MD, PhD, S. Snauwaert MD, PhD, E. Van den Neste MD, PhD, M. Vercruyssen MD, D. Dierickx MD, PhD, P. Vandenberghe MD, PhD, V. Vergote MD

SUMMARY

Approximately 30–40% of patients with diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS), will relapse or are unable to obtain a complete remission (CR) after frontline treatment. These patients have a poor prognosis and represent a therapeutic challenge. In this article, we reviewed the recent literature to update the practice guidelines of the Belgian Hematology Society (BHS) Lymphoproliferative Disease Committee for the treatment of relapsed or refractory (R/R) DLBCL. In the first part, we will focus on first relapse and the role of CAR T-cell therapy in first and second relapse. In the second part, we will focus on novel treatment options for patients with a second or higher relapse, secondary central nervous system (CNS) relapse and high-grade lymphoma.

(BELG J HEMATOL 2023;14(3):114–21)

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