PRACTICE GUIDELINES

Practice guidelines for the therapeutic drug monitoring of asparaginase in acute lymphoblastic leukaemia

BJH - volume 13, issue 6, october 2022

V. Mondelaers MD, T. Lammens PhD, M. de Jong , L. Deneweth , K. Vandemeulebroecke , B. De Moerloose MD, PhD

SUMMARY

Asparaginase is an essential therapeutic in the treatment of acute lymphoblastic leukaemia (ALL) in children and adults. Currently, there are three asparaginase products in clinical use: native Escherichia coli asparaginase, Erwinia chrysanthemi asparaginase and PEG-asparaginase. One of the important side effects is the occurrence of hypersensitivity reactions, such as clinical allergy or silent inactivation that can lead to inactivation of asparaginase with a negative impact on the outcome of the patient. Therapeutic drug monitoring (TDM) has proven to be a valuable tool to monitor asparaginase activity and detect decreased or absent activity at an early stage. Therefore, many contemporary paediatric ALL protocols include TDM of asparaginase as standard of care. In this report, the background of asparaginase hypersensitivity and silent inactivation is described and a practical flowchart regarding the use and TDM of PEG- and Erwinia asparaginase for patients with ALL is introduced.

(BELG J HEMATOL 2022;13(6):236–42)

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BHS guidelines on supportive care in lymphoma: Part 2

BJH - volume 13, issue 4, june 2022

M. Janssens MD, K. Saevels MD, V. Vergote MD, PhD, J. Lemmens MD, S. Bailly MD, A. Janssens MD, PhD, S. Snauwaert MD, PhD, M. André MD, PhD

SUMMARY

Besides disease-directed therapy, patients with lymphoma are in need of a wide range of supportive measures. In the second part of this guideline, the prevention and treatment of tumour lysis syndrome, cardiac support and physiotherapy are discussed.

(BELG J HEMATOL 2022;13(4):149–55)

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BHS guidelines on supportive care in lymphoma: Part 1

BJH - volume 13, issue 3, may 2022

M. Janssens MD, K. Saevels MD, V. Vergote MD, PhD, J. Lemmens MD, S. Bailly MD, A. Janssens MD, PhD, S. Snauwaert MD, PhD, M. André MD, PhD

SUMMARY

Besides disease-directed therapy, patients with lymphoma are in need of a wide range of supportive measures. In the first part of this guideline the use of anti-emetic therapy, the use of granulocyte colony stimulating factor (G-CSF) and antibiotic prophylaxis for pneumocystis jirovecii are discussed. In part 2 of this guideline we will discuss cardiac support, prevention and treatment of tumour lysis syndrome and the role of physiotherapy.

(BELG J HEMATOL 2022;13(3):116–23)

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Diagnosis and treatment of peripheral T-cell lymphomas: Update recommendations of the Belgian Hematology Society (BHS)

BJH - volume 13, issue 2, march 2022

A. Wolfromm MD, S. Bailly MD, E. Van den Neste MD, PhD, M. André MD, PhD, K. Saevels MD, H. Antoine-Poirel MD, PhD, T. Tousseyn MD, PhD, V. Van Hende MD, S. Snauwaert MD, PhD, A. Janssens MD, PhD, C. Jacquy MD, C. Bonnet MD, PhD

SUMMARY

Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of aggressive diseases associated with poor outcomes. Recent progress in understanding of the biology and pathogenesis based on molecular profiling and next-generation sequencing has led to the introduction of new provisional entities in the World Health Organization (WHO) classification system of 2017 and to the emergence of new drugs.1 Previous Belgian guidelines were published in 2013.2 This review will discuss the diagnosis, work-up and treatment of PTCL including these advances as well as the limitation of the availability of drugs according to the Belgian reimbursement rules.

(BELG J HEMATOL 2022;13(2):65–80)

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Guidelines of the Belgian Hematology Society for imaging in multiple myeloma

BJH - volume 12, issue 8, december 2021

N. Meuleman MD, PhD, J. Caers MD, PhD, K. Fostier MD, P. Vlummens MD, S. Pans MD, L. Goethals MD, PhD, J. Alexiou MD, M. Cliquennois MD, C. Doyen MD, PhD, A. de Weweire MD, R. Schots MD, PhD, M. Delforge MD, PhD, M-C. Vekemans MD, PhD

SUMMARY

Despite major improvements in the diagnosis and treatment of multiple myeloma (MM), bone damage remains a major feature of this disease. With the development of new diagnostic tools, conventional skeletal studies have been progressively replaced by novel imaging techniques. Today, imaging plays a crucial role in defining symptomatic multiple myeloma, measurement of the extent of skeletal involvement and assessing therapeutic response including minimal residual disease (MRD). Based on an extensive review of the recent literature, we propose an array of Belgian recommendations for myeloma imaging to be used as a reference by haematologists in their daily practice.

(BELG J HEMATOL 2021;12(8):338–43)

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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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Management of polycythemia vera: Recommendations from the BHS MPN subcommittee anno 2021

BJH - volume 12, issue 6, october 2021

C. Schuermans MD, D. Mazure MD, K. Van Eygen MD, L. Van Aelst MD, PhD, S. Benghiat Fleur MD, PhD, T. Devos MD, PhD

SUMMARY

Polycythemia vera (PV) is classified by the World Health Organization (WHO) under the BCR-ABL-negative myeloproliferative neoplasms (MPNs) and is characterised by clonal proliferation of myeloid cells, which leads primarily to an increased red blood cell mass. Bone marrow morphology remains the cornerstone of diagnosis. Patients can present with thrombosis, microcirculatory symptoms, haemorrhage, splenomegaly, pruritus and other symptoms that reduce their quality of life and they are at risk of transformation to secondary myelofibrosis (MF) or acute myeloid leukaemia (AML). The main goal of therapy in PV is to minimise the thrombotic risk. To achieve this goal PV patients are being treated with low-dose aspirin and phlebotomies to reach a target haematocrit below 45%. In addition, high-risk patients are being treated with cytoreductive agents. Over the last years, new insights in the pathophysiology, diagnosis and prognosis of polycythemia vera were acquired and novel therapeutic options are available. In this paper we give an update on PV and provide diagnostic and therapeutic recommendations, taking into account the Belgian situation.

(BELG J HEMATOL 2021;12(6):258-74)

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