Articles

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)

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Defeating cytomegalovirus, the transplantation troll: can letermovir do the job?

BJH - volume 10, issue 4, june 2019

B. Calcoen MD, S. van Hecke MD, K. Lagrou PhD, PharmD, J. Maertens MD, PhD

Letermovir (AIC246, MK-8228) is a novel anti-cytomegalovirus (CMV) agent that inhibits CMV replication by targeting the viral terminase complex. In December 2017, letermovir was approved by the Food and Drug Administration (FDA) for the prophylaxis of CMV infection and disease in adult CMV-seropositive recipients of an allogenic haematological stem cell transplantation. Letermovir shows a favourable pharmacokinetic profile in haematological stem cell transplantation recipients after oral administration. The recommended dose for CMV-prophylaxis is once daily 480 mg (oral or intravenous). Letermovir demonstrated superiority in a placebo (plus polymerase chain reaction-monitoring and pre-emptive therapy)-controlled phase III randomised clinical trial. Letermovir is an inhibitor of the cytochrome P450 (CYP)3A family, CYP2B8 and an inducer of the CYP2C9/19. Dose-adjustments (240 mg/day) are necessary when letermovir is combined with cyclosporine. Combinations of letermovir with either voriconazole, midazolam and rosiglitazone require close monitoring of the plasma levels of the latter agents. Letermovir-resistant CMV mutants share mutations that are mostly located between the codon range 230–370 of the UL56 gene. Letermovir is not nephrotoxic nor myelotoxic, but slightly higher rates of atrial fibrillation and tachycardia have been described. In conclusion, letermovir is the first FDA approved anti-CMV agent for prophylaxis in haematological stem cell transplantation patients.

(BELG J HEMATOL 2019;10(4):136–45)

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Causes, diagnosis and management of congenital or acquired neutropaenia

BJH - volume 10, issue 3, may 2019

S. van Hecke MD, P. Vandenberghe MD, PhD, A. Janssens MD, PhD

Neutropaenia is a common incidental finding on routine blood studies. This manuscript will focus on the possible causes, challenging differential diagnosis and appropriate management of neutropaenia. Different mechanisms may explain a decreased production, impaired development or increased destruction of neutrophilic granulocytes. We distinguish between congenital and acquired causes. The former includes benign ethnic neutropaenia, severe congenital neutropaenia and cyclic neutropaenia. For the latter, infections, drugs, auto-immune reactions, nutritional deficiencies as well as haematological malignancies are all possible reasons of neutropaenia. The risk of infection in those with non-chemotherapy-induced neutropaenia mainly depends on the bone marrow reserve. Asymptomatic patients with mild or moderate neutropaenia can be observed with serial blood counts at increasing intervals. Infections should always be treated according to the severity of neutropaenia. Therapy with growth factors, drug discontinuation and immunosuppressive therapy can be considered depending on the underlying cause.

(BELG J HEMATOL 2019;10(3):103–12)

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