Articles

Acalabrutinib, a next-generation Bruton’s tyrosine kinase inhibitor

BJH - volume 13, issue 4, june 2022

T. Van Nieuwenhuyse PharmD, A. Janssens MD, PhD

SUMMARY

Bruton’s tyrosine kinase (BTK) inhibitors have demonstrated impressive clinical activity and tolerability in several B-cell malignancies, both as single agent or in combination with anti-CD20 monoclonal antibodies. Acalabrutinib, a next-generation BTK inhibitor, has been reimbursed recently by the Belgian national public health insurance for the treatment of chronic lymphocytic leukaemia (CLL). This review describes mechanism of action, dosage and administration, efficacy, and tolerability.

(BELG J HEMATOL 2022;13(4):156–64)

Read more

BHS guidelines on supportive care in lymphoma: Part 2

BJH - volume 13, issue 4, june 2022

M. Janssens MD, K. Saevels MD, V. Vergote MD, J. Lemmens MD, S. Bailly MD, A. Janssens MD, PhD, S. Snauwaert MD, PhD, M. André MD, PhD

SUMMARY

Besides disease-directed therapy, patients with lymphoma are in need of a wide range of supportive measures. In the second part of this guideline, the prevention and treatment of tumour lysis syndrome, cardiac support and physiotherapy are discussed.

(BELG J HEMATOL 2022;13(4):149–55)

Read more

BHS guidelines on supportive care in lymphoma: Part 1

BJH - volume 13, issue 3, may 2022

M. Janssens MD, K. Saevels MD, V. Vergote MD, J. Lemmens MD, S. Bailly MD, A. Janssens MD, PhD, S. Snauwaert MD, PhD, M. André MD, PhD

SUMMARY

Besides disease-directed therapy, patients with lymphoma are in need of a wide range of supportive measures. In the first part of this guideline the use of anti-emetic therapy, the use of granulocyte colony stimulating factor (G-CSF) and antibiotic prophylaxis for pneumocystis jirovecii are discussed. In part 2 of this guideline we will discuss cardiac support, prevention and treatment of tumour lysis syndrome and the role of physiotherapy.

(BELG J HEMATOL 2022;13(3):116–23)

Read more

Diagnosis and treatment of peripheral T-cell lymphomas: Update recommendations of the Belgian Hematology Society (BHS)

BJH - volume 13, issue 2, march 2022

A. Wolfromm MD, S. Bailly MD, E. Van den Neste MD, PhD, M. André MD, PhD, K. Saevels MD, H. Antoine-Poirel MD, PhD, T. Tousseyn MD, PhD, V. Van Hende MD, S. Snauwaert MD, PhD, A. Janssens MD, PhD, C. Jacquy MD, C. Bonnet MD, PhD

SUMMARY

Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of aggressive diseases associated with poor outcomes. Recent progress in understanding of the biology and pathogenesis based on molecular profiling and next-generation sequencing has led to the introduction of new provisional entities in the World Health Organization (WHO) classification system of 2017 and to the emergence of new drugs.1 Previous Belgian guidelines were published in 2013.2 This review will discuss the diagnosis, work-up and treatment of PTCL including these advances as well as the limitation of the availability of drugs according to the Belgian reimbursement rules.

(BELG J HEMATOL 2022;13(2):65–80)

Read more

How to treat classical Hodgkin’s lymphoma in older patients: Belgian expert opinion

BJH - volume 12, issue 7, november 2021

S. Snauwaert MD, PhD, V. Van Hende MD, A. Janssens MD, PhD, M. André MD, PhD, S. van Hecke MD, E. Van den Neste MD, PhD, On behalf of the lymphoproliferative disease committee BHS

SUMMARY

Classical Hodgkin’s lymphoma (cHL) is a rather rare disease with an incidence of 2-3/100,000 per year and typically presents in patients at the age of 20–30. It is however well known that a second peak occurs at the age of 60–65 years.1 Nowadays Hodgkin is a curable disease for most of the younger patients but treatment is more difficult and less successful in the older patient population. In this review, we want to summarise the possibilities for the treatment of cHL patients above 60 years, with a focus on evidence from the rather rarely available clinical trials. We also look at future treatments. In this article we will use the term ‘older patients’ for patients of 60 years and older at diagnosis. We will make a distinction between fit patients older than 60 years and frail or vulnerable patients (so called elderly).

(BELG J HEMATOL 2021;12(7):296–304)

Read more

Ibrutinib and atrial fibrillation: A Belgian expert consensus paper

BJH - volume 12, issue 4, june 2021

C. Vandenbriele MD, PhD, L. Van der Linden PhD, PharmD, L.N.L. Van Aelst MD, PhD, B. Schwagten MD, PhD, F. van Heuverswyn MD, S. Meers MD, PhD, V. Galle MD, T. Van Nieuwenhuyse PharmD, K.L. Wu MD, M. André MD, PhD, C. Hermans MD, PhD, A. Janssens MD, PhD

SUMMARY

Over the last decade, the oral Bruton’s tyrosine kinase (BTK) inhibitor ibrutinib induced a paradigm shift in the treatment of patients with chronic lymphocytic leukaemia (CLL), mantle cell lymphoma (MCL), and Waldenströms macroglobulinemia (WM). In clinical trials and in real-world studies, ibrutinib proved to be an effective agent with an overall favourable safety and tolerability profile. However, compared with standard chemo-immunotherapy (CIT), ibrutinib was associated with a higher incidence of atrial fibrillation (AF). The patho-physiological mechanisms underlying this increased AF incidence are not completely understood, but it is thought to be related to off-target inhibitory effects of ibrutinib on the Tec protein tyrosine kinase (TEC) in cardiac cells. The prevalence of AF in patients treated with ibrutinib is highest during the first three months of therapy, which warrants an increased vigilance during this treatment phase. However, AF in patients treated with ibrutinib is generally well manageable without ibrutinib discontinuation. Prior to the start of ibrutinib treatment, identification and addressing modifiable risk factors for AF is a first important step. The threshold for haematologists to consult a cardiologist or a cardio-oncologist should be low and a close collaboration between both specialties is warranted. Unnecessary ibrutinib interruptions should be avoided, and uncomplicated AF is not a valid reason to discontinue or interrupt ibrutinib. If anticoagulation is required, direct oral anticoagulants are preferred. In this paper, a panel of haematology and cardiology specialists have provided practical guidance on how to evaluate patients prior to ibrutinib treatment and monitor during ibrutinib therapy. Furthermore, they have provided practical guidance on how to manage AF in ibrutinib-treated patients.

(BELG J HEMATOL 2021;12(4):155-64)

Read more

A Belgian retrospective analysis of the use of venetoclax monotherapy in patients with chronic lymphocytic leukaemia in routine clinical practice

BJH - volume 12, issue 3, may 2021

A. Janssens MD, PhD, L. Stas MSc, M. Van den Enden MD, E. Van den Neste MD, PhD

SUMMARY

Chronic lymphocytic leukaemia (CLL) is a slow-progressing cancer that results in uncontrolled proliferation and accumulation of B-lymphocytes in the blood and bone marrow and is the most common form of leukaemia in the western world. CLL patients harbouring a deletion of chromosome 17 (del17p) or the TP53 mutation, who progress after treatment with immunological, chemotherapeutic as well as targeted agents such as ibrutinib have poor prognosis signifying a population with an unmet medical need. Clinical studies showed that venetoclax, a selective; orally bioavailable Bcl-2 inhibitor, induces CLL cell apoptosis, and offers an alternative therapeutic option for CLL, either as a monotherapy or in combination with rituximab. BRAVe was a multicentre, observational retrospective study, conducted in Belgium. The main objectives of this study were to evaluate the safety and effectiveness of venetoclax monotherapy in Belgian patients with CLL, as well as the utilisation of resources in a real life setting. The results show a manageable/favourable safety profile for venetoclax with limited burden for patients and sites, and a good overall response rate in pre-treated CLL patients in the relapsed/refractory setting.

(BELG J HEMATOL 2020;12(3):106-11)

Read more
X