BJH - volume 9, issue 3, june 2018
C. Lambert MD, B. Dubois MD, PhD, D. Dive MD, A. Lysandropoulos MD, D. Selleslag MD, L. Vanopdenbosch MD, V. Van Pesch MD, PhD, B. Van Wijmeersch MD, PhD, A. Janssens MD, PhD
Alemtuzumab (Lemtrada®) is a humanised monoclonal antibody indicated for the treatment of adult patients with relapsing/remitting multiple sclerosis with active disease defined by clinical or imaging features. Alemtuzumab demonstrated superior efficacy over active comparator in both treatment naive patients and those with inadequate response to prior therapy. Alemtuzumab is associated with a consistent and manageable safety and tolerability profile. Treatment with alemtuzumab for multiple sclerosis increases the risk for autoimmune adverse events including immune thrombocytopenia. Complete blood counts with differential should be obtained prior to initiation of treatment and at monthly intervals thereafter for 48 months after the last infusion. After this period of time, testing should be performed based on clinical findings suggestive of immune thrombocytopenia. If immune thrombocytopenia onset is confirmed, appropriate medical intervention should be promptly initiated, including immediate referral to a specialist. This paper presents the consensus of Belgian multiple sclerosis specialists and haematologists to guide the treating physician with practical recommendations.
(BELG J HEMATOL 2018;9(3):118–23)
Read moreBJH - volume 8, issue 7, december 2017
A. Janssens MD, PhD
Venetoclax, the first-in-class bcl-2 antagonist, has demonstrated deep and durable remissions as a single agent in relapse/refractory chronic lymphocytic leukaemia patients with a 17p deletion or chronic lymphocytic leukaemia refractory to B-cell receptor inhibitors or progressive after B-cell receptor inhibitor discontinuation. As reimbursement of venetoclax by the Belgian national public health insurance has been provided, this review describes mechanism of action, dosage and administration, efficacy and tolerability. As venetoclax can rapidly reduce the chronic lymphocytic leukaemia load, precautions to avoid tumour lysis syndrome depending on risk assessment is a sine qua non. Despite the convenience afforded by this oral, once daily formulation, treating physicians and patients must be aware of drug adherence and drug-drug interactions which can challenge treatment benefits and risks.
(BELG J HEMATOL 2017;8(7):265–71)
Read moreBJH - volume 8, issue 6, october 2017
K.L. Wu MD, PhD
The ubiquitin-proteasome system is a major pathway for the degradation of most intracellular proteins and therefore plays an essential regulatory role in cellular processes including cell cycle progression, proliferation, differentiation and apoptosis. The recognition of its importance in tumorigenesis has led to the development of agents that target this pathway as cancer therapeutics. Bortezomib is the first proteasome inhibitor approved for clinical use and has a profound impact on the survival of patients with multiple myeloma. Ixazomib is a promising second generation proteasome inhibitor.
(BELG J HEMATOL 2017;8(6):229–31)
Read moreBJH - volume 8, issue 6, october 2017
C. Meert MD, D. Dierickx MD, PhD, V. Vergote MD, G. Verhoef MD, PhD, A. Janssens MD, PhD
Although it doesn’t occur frequently, central nervous system relapse in aggressive non-Hodgkin lymphoma carries a very dismal prognosis. Indications for the use of prophylactic strategies are clear-cut in Burkitt and lymphoblastic lymphoma. However, this remains subject to much debate in other types of aggressive non-Hodgkin lymphoma, like diffuse large B-cell lymphoma. Available strategies consist of intrathecal administration of chemotherapy, the systemic use of high-dose central nervous system-penetrating cytotoxic agents or a combination of both. Nevertheless, all known methods entail a certain risk for toxicity in patients. Hence, great effort has been put in the search for risk factors and scores to identify high-risk patients who have benefit from central nervous system-prophylaxis and to exclude those who do not. This article aims to provide an overview of existing strategies, pharmacological properties and side effects of available cytotoxic agents, as well as an update on the current guidelines for the implementation of central nervous system prophylaxis in different types of non-Hodgkin lymphoma. However, due to lack of qualitative prospective data, a golden standard in this field is still lacking.
(BELG J HEMATOL 2017;8(6):232–8)
Read moreBJH - volume 8, issue 5, september 2017
G. Verhoef MD, PhD
Most patients with Hodgkin lymphoma are cured by modern treatment. For patients with a relapse/refractory disease after autologous stem cell transplantation and brentuximab vedotin, prognosis is dismal. Checkpoint inhibitors are very active in this group of patients and may offer a bridge to allogeneic stem cell transplantation.
(BELG J HEMATOL 2017;8(5):192–4)
Read moreBJH - volume 8, issue 3, june 2017
C. Graux MD, PhD
Immunotherapy is an alternative treatment modality for poor conditions associated with chemoresistance like refractory/relapsing primary B-precursor acute lymphoblastic leukaemia or minimal residual disease persistence. The immunotherapeutic effect of allogeneic stem cell transplantation is largely exploited in this context but graft-versus-host disease remains a major concern. Recently, improvements have been made in selectively engaging the immune system against the persistent disease. Blinatumomab is a dual binding antibody construct that redirects any T lymphocytes against B-precursor acute lymphoblastic leukaemia blasts. It shows a very good activity in monotherapy in those poor risk conditions and is associated with a low toxicity profile suggesting this use earlier and in combination in the therapeutic course of B-precursor acute lymphoblastic leukaemia patients. In this article, after a short overview of immunotherapeutic advances in B-precursor acute lymphoblastic leukaemia, the results of the main trials conducted with blinatumomab are discussed and put in perspective.
(BELG J HEMATOL 2017;8(3):107–12)
Read moreBJH - volume 8, issue 2, march 2017
R. Heusschen PhD, J. Muller MSc, N. Withofs MD, PhD, prof. F. Baron , Y. Beguin MD, PhD, J. Caers MD, PhD
Multiple myeloma bone disease is a major cause of morbidity and mortality in multiple myeloma patients and persists even in patients in remission. Multiple myeloma bone disease is caused by an uncoupling of bone remodelling, with increased osteoclast activity and decreased osteoblast activity, culminating in lytic bone destruction. Bisphosphonates are the current standard-of-care but new therapies are needed. As the molecular mechanisms controlling multiple myeloma bone disease are increasingly understood, new therapeutic targets are extensively explored in the preclinical setting and initial clinical trials with novel compounds show promising results. In this review, we provide a comprehensive overview of the biology of multiple myeloma bone disease, summarise its current clinical management and discuss preclinical and clinical data on next generation therapies.
(BELG J HEMATOL 2017;8(2):66–74)
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