PRACTICE GUIDELINES

Updated BHS guidelines for the treatment of diffuse large B-cell lymphoma (DLBCL): Novelties anno 2024

BJH - volume 15, issue 4, june 2022

J. Brijs MD, M. André MD, PhD, S. Bailly MD, K. Beel MD, PhD, C. Bonnet MD, G. Crochet MD, P. De Paepe MD, PhD, D. Dierickx MD, PhD, C. Jacquy MD, PhD, K. Saevels MD, S. Snauwaert MD, PhD, E. Van den Neste MD, PhD, V. Vergote MD

SUMMARY

Diffuse large B-cell lymphoma (DLBCL) is an aggressive B-cell lymphoma and represents the most common subtype of B-cell non-Hodgkin lymphomas. The majority of patients (60–70%) can nowadays be cured with first line chemo-immunotherapy (CIT), mostly a combination of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). The remaining 30–40% of patients with relapsing or refractory (R/R) disease have an unfavourable prognosis. Until recently, these patients could only be cured with platinum-based salvage CIT followed by high-dose chemotherapy and an autologous stem cell transplantation, but with rather disappointing outcomes. However, new and promising treatments for these patients have now found their way into clinical practice, with good response and survival rates and manageable toxicity rates. This article will briefly review the latest advances in the treatment of DLBCL in Belgium, both for newly diagnosed disease and for R/R disease. We will focus on the role of polatuzumab vedotin in first line, chimeric antigen receptor (CAR) T-cell therapy in second line, tafasitamab-lenalidomide in second line or higher, and bispecific antibodies in third line or higher. New treatment algorithms, both for untreated and for R/R DLBCL, clinically oriented and adapted to the Belgian reimbursement criteria, are also presented.

(BELG J HEMATOL 2024;15(4):147–57)

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Multiple myeloma: Practical recommendations for the management of early relapses 2024

BJH - volume 15, issue 4, june 2022

M.C. Vekemans MD, N. Kint MD, PhD, G. Claes MD, C. Doyen MD, V. Galle MD, C. Jacquy MD, PhD, H. Maes MD, N. Meuleman MD, PhD, O. Rizzo MD, A. Salembier MD, H. Schots MD, PhD, G. Verstraete MD, M. Delforge MD, PhD

SUMMARY

Despite the increasing availability of more effective treatments for newly diagnosed multiple myeloma (NDMM) patients that provide longer disease-free periods, almost all patients will experience a relapse. Managing relapse after regimens that have included a proteasome inhibitor (PI), an immunomodulatory drug (IMID), and often an anti-CD38 monoclonal antibody can be challenging, but therapeutic options have greatly increased over the past decades. This review covers the current second-line therapeutic options and provides updated information on novel agents for the treatment of early relapses in MM patients.

(BELG J HEMATOL 2024;15(4):158–64)

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Multiple myeloma: Practical recommendations for front-line therapy 2024

BJH - volume 15, issue 3, may 2024

M.C. Vekemans MD, N. Meuleman MD, PhD, N. Kint MD, PhD, G. Claes MD, C. Doyen MD, V. Galle MD, C. Jacquy MD, PhD, H. Maes MD, O. Rizzo MD, A. Salembier MD, H. Schots MD, PhD, G. Verstraete MD, M. Delforge MD, PhD

SUMMARY

With the introduction of immunomodulatory drugs, proteasome inhibitors and anti-CD38 monoclonal antibodies, major improvements have been achieved in the treatment and outcome of multiple myeloma. Different treatment combinations are now in use and quadruplets have been investigated with success. This rapidly changing therapeutic landscape urges for an update on practical guidelines. Based on an extensive review of the recent literature, we propose recommendations on myeloma management, to be used by haematologists as a reference for daily practice.

(BELG J HEMATOL 2024;15(3):103–16)

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BHS guidelines for the management of small lymphocytic lymphoma and chronic lymphocytic leukaemia, anno 2024

BJH - volume 14, issue 7, november 2023

A. Janssens MD, PhD, On behalf of the BHS Lymphoproliferative Disease Committee 2023: Marc André , Christophe Bonnet , Sarah Bailly , Veerle Beckers , Dominique Bron , Rutgers Callens , Charlotte Caron , Maxim Clauwaert , Sarah Debussche , Ciel De Vriendt , Virginie De Wilde , Vanessa Delrieu , Daan Dierickx , Pierre Heimann , Jan Lemmens , Marie Maerevoet , Claire Maquet , Fulvio Massaro , Caressa Meert , Marie-Christine Ngiribacu , Fritz Offner , Juliette Rademaekers , Ornella Rizzo , Kirsten Saevels , Liesbeth Schauvliege , Sylvia Snauwaert , Joan Somja , Cécile Springael , Thomas Tousseyn , Eric Van Den Neste , Sam Vandermeeren , Sam Van Hecke , Vanessa Van Hende , Marie Vercruyssen , Vibeke Vergote , Inge Vrelust , Alice Wolfromm , Ka Lung Wu.

SUMMARY

The Belgian Haematological Society (BHS) Lymphoproliferative disease (LPD) committee updated the existing recommendations on diagnosis, prognostic scores, best strategies for front-line and subsequent-line treatment of small lymphocytic lymphoma (SLL)/chronic lymphocytic leukaemia (CLL), according to robust new data.

(BELG J HEMATOL 2023;14(7):278–303)

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BHS guidelines on the management of relapsed and refractory diffuse large B-cell lymphoma: Part 2

BJH - volume 14, issue 4, june 2023

U. Douven MD, A. Janssens MD, PhD, G. Crochet MD, S. Bailly MD, C. Bonnet MD, C. Jacquy MD, PhD, F. Offner MD, PhD, S. Snauwaert MD, PhD, E. Van den Neste MD, PhD, M. Vercruyssen MD, D. Dierickx MD, PhD, P. Vandenberghe MD, PhD, V. Vergote MD

SUMMARY

Approximately 30–40% of patients with diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS), will relapse or are unable to obtain a complete remission (CR) after frontline treatment. These patients have a poor prognosis and represent a therapeutic challenge. In this article, we reviewed the recent literature to update the practice guidelines of the Belgian Hematology Society (BHS) Lymphoproliferative Disease Committee for the treatment of relapsed or refractory (R/R) DLBCL. In the first part, we will focus on first relapse and the role of CAR T-cell therapy in first and second relapse. In the second part, we will focus on novel treatment options for patients with a second or higher relapse, secondary central nervous system (CNS) relapse and high-grade lymphoma.

(BELG J HEMATOL 2023;14(4):170–7)

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BHS guidelines on the management of relapsed and refractory diffuse large B-cell lymphoma: Part 1

BJH - volume 14, issue 3, may 2023

U. Douven MD, A. Janssens MD, PhD, G. Crochet MD, S. Bailly MD, C. Bonnet MD, C. Jacquy MD, PhD, F. Offner MD, PhD, S. Snauwaert MD, PhD, E. Van den Neste MD, PhD, M. Vercruyssen MD, D. Dierickx MD, PhD, P. Vandenberghe MD, PhD, V. Vergote MD

SUMMARY

Approximately 30–40% of patients with diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS), will relapse or are unable to obtain a complete remission (CR) after frontline treatment. These patients have a poor prognosis and represent a therapeutic challenge. In this article, we reviewed the recent literature to update the practice guidelines of the Belgian Hematology Society (BHS) Lymphoproliferative Disease Committee for the treatment of relapsed or refractory (R/R) DLBCL. In the first part, we will focus on first relapse and the role of CAR T-cell therapy in first and second relapse. In the second part, we will focus on novel treatment options for patients with a second or higher relapse, secondary central nervous system (CNS) relapse and high-grade lymphoma.

(BELG J HEMATOL 2023;14(3):114–21)

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Diagnosis and treatment of Waldenström Macroglobulinaemia

BJH - volume 14, issue 3, may 2023

S. van Hecke MD, V. Van Hende MD, A. Janssens MD, PhD

SUMMARY

Waldenström Macroglobulinaemia is a rare indolent B-cell lymphoproliferative disorder, which is characterised by infiltration of the bone marrow by lymphoplasmacytic cells in combination with a monoclonal IgM gammopathy. In 2015, the first Belgian guidelines on diagnosis, staging and treatment were published with a first update in 2018. Since then, however a lot has changed. The discovery of the molecular markers MYD88 affected the diagnostic work up. There have also been radical changes in treatment and prognosis due to the use of Bruton tyrosine kinase inhibitors. In this second update, we revise both diagnosis and treatment and we have a look at the future.

(BELG J HEMATOL 2023;14(3):122–34)

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