Articles

Highlights in AML and MDS

BJH - volume 13, issue 5, september 2022

D. Selleslag MD

SUMMARY

Very important changes in the field of AML and MDS have been presented at the meeting and have very recently been published in top journals. First of all, the new M-IPSS integrating molecular analysis in a prognostic score for MDS was discussed by Elli Papaemmanuil and published by Elsa Bernard in June 2022 in NEJM Evid.1 Secondly, the fifth edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms was published by J. Khoury.2 It introduced new entities in MDS and AML. Finally, the updated ELN (European Leukemia Net) guidelines for diagnosis and management of AML were published in Blood in July 2022 by Hartmut Döhner.3 The impact of these three 2022 publications on the management of MDS and AML cannot be overestimated. They are not part of this report but we strongly recommend reading these papers as a background. This report is focussing on the abstracts with potential clinical impact on the treatment of AML or MDS.

(BELG J HEMATOL 2022;13(5):190–9)

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Primary immune thrombocytopenia in adults: Belgian recommendations for diagnosis and treatment anno 2021 made by the Belgian Hematology Society

BJH - volume 12, issue 3, may 2021

A. Janssens MD, PhD, D. Selleslag MD, J. Depaus MD, Y. Beguin MD, PhD, C. Lambert MD

SUMMARY

The Belgian Hematology Society (BHS) updated the 2013 guidelines for diagnosis and treatment of primary immune thrombocytopenia (ITP).1 As knowledge about ITP pathophysiology is increasing, the mode of action of old therapies is better understood and novel drugs are introduced to target more specific pathways. Corticosteroids with or without intravenous immunoglobulins (IgIV) remain the first line treatment. According to the updated international guidelines, a short course of corticosteroids rather than a prolonged treatment has to be recommended. The same guidelines stress that consequent therapies as thrombopoietic agents (TPO-RAs) and rituximab should be available independent of duration of ITP. Although the majority of recommendations is based on very low-quality evidence, it is strongly advised to individualise the ITP management taking patient values and preferences in account. The main treatment goal in all ITP patients must be to maintain a safe platelet count to prevent or stop bleeding with a minimum of toxicity and not to normalise the platelet count.

(BELG J HEMATOL 2020;12(3):112-27)

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A multicentric observational study on the management of hyperleukocytic acute myeloid leukaemia in Belgium

BJH - volume 11, issue 7, november 2020

S. Kennes MD, I. Moors MD, dr. A. Delie MD, S. Anguille MD, PhD, D. Breems MD, PhD, D. Selleslag MD, T. Kerre MD, PhD

SUMMARY

INTRODUCTION

In hyperleukocytic acute myeloid leukaemia (AML) the risk of leukostasis is high due to the rapid increase in WBC count and the size of the myeloid blasts. It is associated with poor prognosis due to an increased risk of early death and relapse. Immediate initiation of cytoreductive treatment is essential to improve outcome, but evidence to prefer hydroxyurea, leukapheresis, intensive chemotherapy (IC) or a combination treatment, is lacking. Therefore, we decided to investigate the current approach of hyperleukocytic AML in Belgium.

METHODS

A brief questionnaire on the management of hyperleukocytic AML was sent to all Belgian centres currently treating AML with IC and was replied by ten centres. Four centres agreed to a more detailed retrospective analysis. All newly diagnosed AML patients presenting with hyperleukocytosis between January 2013 and April 2019 were included. Patient and disease characteristics were collected, as well as treatment choice and outcome parameters.

RESULTS

We included 121 patients with a median WBC count of 116,360/µL. Mortality at day 21 was 20% and overall mortality was 64% at a median follow-up of six months. Twenty percent received leukapheresis, which was started within 24 hours. There was no difference in age distribution, treatment intensity or time to start IC between patients receiving leukapheresis or not. Although the leukapheresis group had a more severe presentation with a higher median WBC and blast count and a worse performance status, there was no difference in response to therapy, early or long-term mortality. In a multivariate analysis, age at diagnosis and treatment modality (IC vs non-IC) were the only independent parameters that significantly affected early death.

CONCLUSION

Evidence on optimal treatment options in hyperleukocytic AML is lacking. We could not demonstrate any added value of leukapheresis. To improve the prognosis of this dramatic presentation, national or even European databases should be used to document and learn from the outcome of current practice.

(BELG J HEMATOL 2020;11(7):325-34)

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Highlights of myelodysplastic syndromes and acute myeloid leukemia

BJH - volume 11, issue 5, september 2020

D. Selleslag MD

SUMMARY

This report is summarising the key presentations on Myelodysplastic Syndromes (MDS) and Acute Myeloid Leukaemia (AML) from the virtual 2020 EHA meeting. The summary is focusing on novel treatment modalities and updates of important clinical studies in the field.

(BELG J HEMATOL 2020;11(5):216-21)

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P.44 Donor cell-derived acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation: molecular confirmation by next-generation sequencing

BJH - volume 11, issue Abstract Book BHS, february 2020

L. Nevejan , D. Selleslag MD, S. Huygens , B. Cauwelier MD, PhD, J. Emmerechts MD, PhD, H. Devos MD

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

BJH - volume 11, issue Abstract Book BHS, february 2020

S. Servais MD, PhD, prof. F. Baron , C. Lechanteur PhD, E. Baudoux MD, A. Briquet PhD, D. Selleslag MD, J. Maertens MD, PhD, X. Poiré MD, PhD, W. Schroyens MD, PhD, C. Graux MD, PhD, A. De Becker MD, R. Schots MD, PhD, P. Zachée MD, PhD, A. Ory , J. Herman , T. Kerre MD, PhD, Y. Beguin MD, PhD

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Targeted next generation DNA sequencing for the detection of clonal haematopoiesis in idiopathic cytopaenia of undetermined significance (ICUS)

BJH - volume 10, issue 6, october 2019

Y. Wouters PharmD, F. Nollet PhD, MSc, B. Cauwelier MD, PhD, J. Emmerechts MD, PhD, D. Selleslag MD, H. Devos MD

SUMMARY

Patients lacking diagnostic criteria for myelodysplastic syndrome, but who show an unexplained persistent cytopaenia are classified as patients suffering from idiopathic cytopaenia of undetermined significance (ICUS). A fraction of these patients carry somatic mutations in genes which are also mutated in myeloid neoplasms. The significance of these mutations in ICUS patients is not well known and only few research papers have tried to correlate them with clinical outcome. ICUS patients carrying somatic mutations seem to have a higher progression rate to myeloid malignancies compared to unmutated patients. Some mutation profiles also show lower overall survival, similar to patients with (low-risk) myelodysplastic syndrome. Therefore, it seems useful to screen for somatic mutations in cytopaenic patients. The goal of this paper is to review recent literature regarding the significance of somatic mutations in cytopaenic patients and propose a screening protocol by evaluating a test protocol at the AZ Sint-Jan hospital Brugge-Oostende.

(BELG J HEMATOL 2019;10(6):231–40)

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