PRACTICE GUIDELINES

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, PhD, 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, PhD, 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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Venetoclax-Azacitidine, the new standard of care for AML patients unfit for intensive treatment: A guide for clinical practice

BJH - volume 14, issue 2, march 2023

I. Moors MD, D. Deeren , C. Jacquy MD, PhD, A. Jaspers MD, PhD, T. Kerre MD, PhD, V. Havelange MD, PhD, D. Selleslag MD, C. Spilleboudt MD, N. Straetmans MD, PhD, F. Van Obbergh MD, A. De Voeght MD, S. Anguille MD, PhD, A. Schauwvlieghe MD, PhD, N. De Beule MD, PhD, A. De Becker MD, D. Breems MD, PhD

SUMMARY

Acute myeloid leukaemia is an aggressive form of bone marrow cancer with poor prognosis, especially in elderly, unfit patients. The VIALE-A study showed an impressive improvement in complete remission rate and overall survival with the addition of venetoclax, a BCL-2 inhibitor, to azacitidine. This combination therapy is now reimbursed in Belgium for newly diagnosed adult AML patients who are considered unfit for intensive chemotherapy based on age and/or comorbidities. In this article, we provide recommendations on the use of this new combination, as well as on prophylaxis and management of specific side effects.

(BELG J HEMATOL 2023;14(2):59–66)

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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, 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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