Articles

Acute graft-versus-host disease: diagnosis, pathophysiology and prevention

BJH - volume 11, issue 4, june 2020

B. Vandenhove PhD student, L. Canti PhD student, H. Schoemans MD, PhD, Y. Beguin MD, PhD, F. Baron MD, PhD, E. Willems MD, PhD, C. Graux MD, PhD, T. Kerre MD, PhD, S. Servais MD, PhD

SUMMARY

Acute graft-versus-host disease (aGVHD) remains a severe complication after allogeneic stem cell transplantation (alloHCT). It is a disregulated immune process, during which the immune cells of the donor attack the healthy tissues in the immunocompromised host. Over the past two decades, progress in understanding its pathophysiology have helped redefine aGVHD reactions and clinical presentations. Typically, the disease presents with serious inflammatory lesions mainly in the skin, gut and liver. Its severity is assessed by gathering clinical signs and dysfunctions of each organ. Despite standard prophylaxis regimens, aGVHD still occurs in approximately 30–60% of transplanted patients and remains a major cause of transplant-related morbidity and mortality. Hence, there is an urgent need for optimising preventive strategies. In this review, we give insights on how to make an accurate diagnosis and scoring assessment of aGVHD, propose a short overview of the current knowledge about its immunobiology and discuss the current and developing strategies for prevention.

(BELG J HEMATOL 2020;11(4):159–173)

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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, F. Baron MD, PhD, 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, prof. dr. P. Zachée MD, PhD, A. Ory , J. Herman , T. Kerre MD, PhD, Y. Beguin MD, PhD

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Chimeric antigen receptor T-cells: a new therapeutic option for relapsed/refractory B-cell malignancies and beyond

BJH - volume 10, issue 8, december 2019

T. Feys MBA, MSc, G. Roex , Y. Beguin MD, PhD, T. Kerre MD, PhD, X. Poiré MD, PhD, P. Lewalle MD, PhD, P. Vandenberghe MD, PhD, D. Bron MD, PhD, S. Anguille MD, PhD

Chimeric antigen receptor (CAR) T-cell therapy is a new cancer immunotherapy targeting specific cell surface antigens. This type of adoptive cell immunotherapy has been a breakthrough in the treatment of aggressive B-cell lymphoma and B-cell precursor acute lymphoblastic leukaemia (ALL) and is currently also being studied in other cancer types, including multiple myeloma and chronic lymphocytic leukaemia. This review will discuss the recent clinical developments and future perspectives of CAR T-cell therapy, with a focus on the clinical trials that led to the FDA and EMA approval of tisagenlecleucel (Kymriah®, Novartis) and axicabtagene ciloleucel (Yescarta®, Gilead) for the treatment of childhood/adult relapsed/refractory (r/r) B-cell precursor ALL and aggressive B-cell non-Hodgkin lymphoma.

(BELG J HEMATOL 2019;10(8):301–10)

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Erythropoiesis and iron metabolism after haematopoietic stem cell transplantation

BJH - volume 10, issue 2, march 2019

A. Jaspers MD, PhD, Y. Beguin MD, PhD

After haematopoietic stem cell transplantation (HCT), many patients present anaemia, which can persist for months due to an inadequate erythropoietin production for the degree of the anaemia. In this thesis, we performed two randomised studies with erythropoiesis-stimulating agents therapy after allogeneic (including myeloablative and non-myeloablative conditioning) and autologous transplantation. We showed a great efficacy of this growth factor to ensure full erythroid reconstitution when initiated soon after engraftment and not immediately after the transplant. Furthermore, as iron parameters are quite disturbed following HCT, we sought to study iron metabolism after HCT (which has not been much investigated), integrating the role of hepcidin, the key regulator in iron metabolism. Hence, we demonstrated that hepcidin levels prior to and following autologous HCT were influenced by iron stores and changes in erythropoietic activity.

(BELG J HEMATOL 2019;10(2):89–95)

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01 A pilot study to assess the feasibility of unrelated umbilical cord blood transplantation with coinfusion of third-party mesenchymal stromal cells after myeloablative or non-myeloablative conditioning in patients with haematological malignancies

BJH - volume 10, issue Abstract Book BHS, february 2019

A. De Becker MD, R. Schots MD, PhD, T. Kerre MD, PhD, D. Mazure , J. Maertens MD, PhD, E. Baudoux , C. Lechanteur , Y. Beguin MD, PhD

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Extracorporeal photochemotherapy for graft-versus-host disease: Where we are now and where we are going!

BJH - volume 9, issue 7, december 2018

P. Lewalle MD, PhD, Y. Beguin MD, PhD

SUMMARY

Graft-versus-host disease remains the leading cause of morbidity, non-relapse mortality and treatment failure after allogeneic haematopoietic stem cell transplantation. So far, steroids are the first line treatment, but around 40% of patients become steroid-resistant or fail to respond at a safe dose. Patients who fail to respond to the initial therapy have a dismal prognosis, and no standard treatment is well established for them to date. Treatments that modulate the immune system rather than directly suppressing its function, although not dampening a potential graft-versus-malignancy effect, would therefore be highly desirable, and extracorporeal photopheresis appeared as being a good candidate to fill in these criteria. Multiple reports of treatments in both paediatric and adult patients with graft-versus-host disease have been published, and the overall favourable profile compared with other available immunosuppressive therapies continues to make extracorporeal photopheresis appealing despite all of the unknowns. In this article, we review the use of extracorporeal photopheresis for the treatment of graft-versus-host disease, including technical aspects, mechanism of action, safety profile and clinical efficacy data.

(BELG J HEMATOL 2018;9(7):254–65)

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A Belgian consensus protocol for autologous haematopoietic stem cell transplantation in multiple sclerosis

BJH - volume 9, issue 5, september 2018

A. Van De Velde MD, B. Willekens , L. Vanopdenbosch MD, O. Deryck , D. Selleslag MD, M. D’Haeseleer , A. De Becker MD, B. Dubois MD, PhD, D. Dierickx MD, PhD, G. Perrotta , V. De Wilde MD, PhD, V. Van Pesch MD, PhD, N. Straetmans MD, PhD, D. Dive MD, Y. Beguin MD, PhD, B. Van Wijmeersch MD, PhD, K. Theunissen , T. Kerre MD, PhD, G. Laureys MD, PhD

SUMMARY

Multiple sclerosis is considered to be an immune mediated inflammatory disorder of the central nervous system. It mainly affects young, socioeconomic active patients. Although our armamentarium for this disease has significantly evolved in recent years some patients remain refractory to conventional therapies. In these cases, autologous haematopoietic stem cell transplantation can be considered as a therapeutic option. Decreasing morbidity, mortality and increasing patient awareness have led to rising inquiry by our patients about this treatment option. With the aim of a standardised protocol and data registration, a Belgian working party on stem cell therapy in multiple sclerosis was established. In this paper, we report the consensus protocol of this working party on autologous haematopoietic stem cell transplantation in multiple sclerosis.

(BELG J HEMATOL 2018;9(5):167–74)

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