Articles

Leishmaniasis: A potential lymphoma Mimicker

BJH - volume 13, issue 2, march 2022

B. Heyrman MD, S. Heyman MD, N. Granacher MD, G. Van den Eynden MD, PhD

SUMMARY

In Belgium, a 53-year old Caucasian man presented at the haematology consultations with weight loss and night sweats in the last six weeks. Apart from a cholecystectomy and appendectomy, he had no medical history. He had no pets; his last journey abroad was to Spain eight months ago. On physical examination, splenomegaly was noted. Blood testing revealed a microcytic anaemia (Hb 9.3g/dl), leukopenia (2.63x10E9/L) with normal formula, normal liver testing and crp of 47.9g/dl. Serologic testing for HIV, CMV, HepB, HepC, and Toxoplasma was negative. Trephine biopsy was normal. PET/CT scan demonstrated splenomegaly with high FDG-avidity. Splenectomy was performed. Small granules (amastygotes) were seen by the pathologist suggestive for Leishmaniasis. Serologic testing and PCR confirmed the diagnosis. He was subsequently treated with liposomal amphotericin B. Our patient is now in optimal condition. Earlier serologic testing for this rare tropical disease in a non-endemic region could have prevented splenectomy.

(BELG J HEMATOL 2022;13(2):92–4)

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Highlights in myelodysplastic Syndromes

BJH - volume 13, issue 1, february 2022

B. Heyrman MD

SUMMARY

The first hybrid ASH meeting lived up to the expectation of bringing new data forward that will change the life of MDS patients. Implementation of NGS in daily practice has unveiled intimate information of the disease and is moving forward into risk scores. A new and better standard risk score will change our treatment approach thereby changing the outcome of our patients. For now, we are watching new molecules grow through different trial phases and becoming impatient to install them into daily practice in the near future. A summary of the most appealing data in the field of MDS is presented here.

(BELG J HEMATOL 2022;13(1):25-8)

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AML and MDS: a virtual experience of real world data

BJH - volume 12, issue 5, september 2021

B. Heyrman MD

INTRODUCTION

The general poor prognosis of AML has stimulated the haematology society and industry to move forward in recent years. Because of these efforts, you could easily imagine yourself at a myeloma session during EHA2021. For patients non-eligible for intensive chemotherapy, the therapeutic arsenal has never been so wide and is constantly expanding. In Belgium, haematologists are bound to strict regulations making ‘game-changing’ data scarce at international congresses. However, the experts in the field shared their strategies in daily practice, which might be even more useful. Nevertheless, one rule remains that it is our duty to include patients in clinical trials whenever possible.

(BELG J HEMATOL 2021;12(5):197-200)

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Belgian guidelines for diagnosis and treatment of chronic myelomonocytic leukaemia

BJH - 2021, issue 2, march 2021

M. Beckers MD, PhD, S. Sid MD, A. De Becker MD, B. Heyrman MD, N. Granacher MD, D. Mazure MD, S. Meers MD, PhD, M-C. Vekemans MD, PhD, On behalf of the other members of MDS and MPN committee

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)

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Emerging pharmaceuticals: Mutant isocitrate dehydrogenase (mIDH) inhibitors

BJH - volume 10, issue 2, march 2019

B. Heyrman MD

Alterations in genes involved in cellular metabolism and epigenetic regulation are common in myeloid malignancies. In approximately 20% of acute myeloid leukaemia patients and 5% of patients suffering from myelodysplastic syndromes, recurring mutations in isocitrate dehydrogenase (IDH) are found. Wild-type IDH catalyses the oxidative decarboxylation of isocitrate, thereby contributing to histone demethylation, DNA modification and cellular adaptation to hypoxia. Mutant IDH has neomorphic activity and reduces α-ketoglutarate to 2-hydroxyglutarate. High levels of 2-hydroxyglutarate are associated with hypermethylation, altered gene expression and differentiation block of haematopoietic progenitor cells. There is no prognostic significance of mutant IDH using standard treatment approaches. However, new oral treatments specifically targeting mutant IDH have shown promising results in inducing responses and are well tolerated. Novel combinations with drugs with non-overlapping mechanisms are underway and may address the clonal heterogeneity of myeloid malignancies. For now, only enasidenib and ivosidinib are FDA approved, but the field of mutant IDH inhibitors is rapidly moving.

(BELG J HEMATOL 2019;10(2):80–4)

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When winter is coming, you better keep warm

BJH - volume 10, issue 2, march 2019

B. Heyrman MD, E. Heylen PhD

A 75-year-old patient presented with fluctuating swelling around the eyes, vasculitis at the lower legs and back of the upper legs and an extreme hypogammaglobulinaemia. An extensive work-up revealed the presence of secondary immunoglobulin M cryoglobulinaemia related to a monoclonal B-cell lymphocytosis. Precipitation of proteins also resulted in a decreased C1-esterase inhibitor causing angioedema. She was treated with an elderly chronic lymphocytic leukaemia regimen consisting of obinutuzumab and chlorambucil with a subsequent clinical and haematological remission.

(BELG J HEMATOL 2019;10(2):85–8)

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Highlights in myelodysplastic syndromes and myeloproliferative neoplasms

BJH - volume 9, issue 4, august 2018

B. Heyrman MD

SUMMARY

Novel therapeutic options for patients suffering from myelodysplastic syndromes (MDS) have not managed to climb the stage in recent years. However, clinical trials with new agents were ongoing under the radar. During the 2018 annual EHA meeting, new results were presented that may be inspiring for new clinical trials leading to drug approvals and the expansion of our therapeutic arsenal in this difficult-to-treat patient population. In addition to MDS, this overview will also address the key data on myeloproliferative diseases presented at EHA 2018.

(BELG J HEMATOL 2018;9(4):157–60)

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