PRACTICE GUIDELINES

BHS guidelines on supportive care in lymphoma: Part 1

BJH - volume 13, issue 3, may 2022

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

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

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

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

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

A. Janssens MD, PhD, E. Van den Neste MD, PhD, M. André MD, PhD, On behalf of the lymphoproliferative disease committee BHS , S. Snauwaert MD, PhD, S. van Hecke MD, V. Van Hende MD

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

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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Belgian guidelines for diagnosis and treatment of chronic myelomonocytic leukaemia

BJH - 2021, issue 2, march 2021

A. De Becker MD, B. Heyrman MD, D. Mazure MD, M-C. Vekemans MD, PhD, M. Beckers MD, PhD, N. Granacher MD, On behalf of the other members of MDS and MPN committee , S. Meers MD, PhD, S. Sid MD

SUMMARY

Chronic myelomonocytic leukaemia (CMML) is a rare haematological disease. Hallmark of the diagnosis is chronic monocytosis. Other clinical features include cytopenia, dysplasia with the associated complaints like fatigue or leucocytosis, splenomegaly with constitutional symptoms. Predicting prognosis and choosing the correct treatment can be challenging for the clinician. These guidelines cover the diagnosis and treatment of CMML and provide information on morphology, cytogenetics and molecular testing, clinical features including autoimmune manifestations, prognosis and risk assessment and a treatment algorithm for both the fit and unfit CMML patient.

(BELG J HEMATOL 2020;12(2):66-76)

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