Articles

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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Bispecific antibodies for the treatment of lymphomas

BJH - volume 14, issue 2, march 2023

J. Brijs MD, J. Neefs PharmD, A. Janssens MD, PhD

SUMMARY

Lymphomas are the most common haematological malignancy and represent a heterogenous group of lymphoproliferative diseases with a variable prognosis. Chemotherapy and radiotherapy, and anti-CD20 immunotherapy for B-cell lymphomas, currently form the basis of lymphoma treatment. New agents, especially new forms of cancer immunotherapy, such as bispecific antibodies (bsAbs), have expanded therapeutic approaches in the last years. bsAbs have two different antigen binding sites, which enables them to simultaneously target tumour cells and immune effector cells (T-cells). By binding and activating T-cells in the proximity of tumour cells, an effective T-cell mediated anti-tumour response can be achieved. Target antigens in lymphomas are mostly CD19 or CD20 on the malignant B-cell and CD3 on the T-cell. This article will briefly review the basic principles and mechanisms of action of bsAbs, discuss the molecules approved or in advanced clinical development for lymphomas with their most relevant (dose-escalation/dose-expansion) trials, and pay attention to possible adverse events and future perspectives of bsAbs.

(BELG J HEMATOL 2023;14(2):67–72)

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

BJH - volume 13, issue 7, november 2022

T. Mercier MD, PhD, S. Fieuws PhD, K. Theunissen MD, M-C. Ngirabacu MD, PhD, N. Straetmans MD, PhD, C. Spilleboudt MD, D. Mazure MD, V. De Wilde MD, PhD, A. De Becker MD, D. Selleslag MD, D. Breems MD, PhD, D. Deeren , S. Servais MD, PhD, C. Jacquy MD, PhD, H. Poirel MD, PhD, D. Van Beckhoven MD, K. Blot MD, PhD, A. Janssens MD, PhD, H. Schoemans MD, PhD

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)

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Primary vitreoretinal lymphoma: Single centre experience and review of literature

BJH - volume 13, issue 6, october 2022

C. Debergh MD, A. Janssens MD, PhD, D. Dierickx MD, PhD, R. Van Ginderdeuren MD, T. Tousseyn MD, PhD, J. Van Calster MD, V. Vergote MD

SUMMARY

BACKGROUND: Primary vitreoretinal lymphoma (PVRL) is a rare and difficult to diagnose lymphoma. The goal of this retrospective monocentric study was to obtain clinical characteristics, to evaluate median time to diagnosis, different treatment modalities and survival outcomes.

METHODS: PVRL cases were selected from the database of the University Hospitals Leuven (Belgium) from 1st January 2012 until 1st January 2021. A review of the available literature was performed.

RESULTS: We included eleven cases of PVRL with a median age of 76 years (Interquartile range (IQR): 68–81). Median time to diagnosis was seven months (Range: 3–16). Presenting symptoms were blurred vision (n=11, 100%) and floaters (n=3, 27%). Bilateral eye involvement was seen in 42% (n=5). Diagnosis was made by vitrectomy and immunocytochemistry in all cases. Histopathological diagnosis was diffuse large B-cell lymphoma in all cases. Flow cytometry was used in 55% (n=6) of patients to confirm diagnosis. Initial treatment included local therapy in all patients. A combination of local and systemic therapy was given to three patients (27%). Seven patients (64%) were diagnosed with CNS relapse. No systemic relapse was seen. Median progression-free survival (PFS) and overall survival (OS) were ten (IQR: 6–32) and 26 months (IQR: 12–37). Median PFS of patients treated with local versus combined therapy was 9.7 and 18 months, respectively. However, OS of patients with local versus combination therapy was 29 and 19 months, respectively.

CONCLUSION: We analysed the clinical characteristics of eleven patients with PVRL in our hospital. The majority of these cases will eventually progress to CNS lymphoma. We saw a prolonged PFS for patients treated with combination therapy in first-line, compared to local therapy alone. However, OS was longer in patients treated with local therapy only. Despite the small cohort, these results are comparable to previous literature. Based on larger retrospective studies we conclude that local therapy as first line treatment in PVRL results in similar OS rates with less systemic toxicity compared to combination therapy.

(BELG J HEMATOL 2022;13(6):228–235)

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