PRACTICE GUIDELINES

BHS guidelines for the diagnosis and the treatment of hairy cell leukaemia

BJH - volume 8, issue 6, october 2017

A. Janssens MD, PhD, C. Springael MD, PhD, G. Verhoef MD, PhD, K.L. Wu MD, PhD, On behalf of the BHS Lymphoproliferative Working Party , V. Delrieu MD

SUMMARY

Hairy cell leukaemia is a rare chronic B-cell lymphoproliferative disorder characterised by a long natural course with, in most of cases, an excellent response to a single course of purine analogue monochemotherapy. Making the right diagnosis, excluding the chemo resistant variant form of hairy cell leukaemia, and making progresses in the treatment of relapsing and/or refractory disease remains challenging up to date. In recent years, exciting results with new agents are emerging and clinical trials are ongoing to optimize the management of hairy cell leukaemia and its variant form.

(BELG J HEMATOL 2017;8(6):222–8)

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New therapeutic approaches in cutaneous T-cell lymphomas

BJH - volume 8, issue 3, june 2017

A. Kolivras MD, C. Springael MD, PhD, D. Bron MD, PhD, M. de Vicq MD, M. Maerevoet MD

SUMMARY

Cutaneous T-cell lymphoma is a heterogeneous group of T-cell neoplasms presenting in the skin, mycosis fungoides being the most common subtype and Sézary syndrome the leukemic form. Treatment is dependant on stage and responses to previous therapy. Treatments are divided into ‘skin-directed therapies’, which are first-line for early stage diseases, and ‘systemic therapies’ reserved for advanced stages or refractory cutaneous T-cell lymphoma. There are currently no curative therapies for cutaneous T-cell lymphoma and consecutive treatments have to be given in function of the progression of the disease. There is an urgent need for new therapies to treat symptoms, particularly pruritus and pain, and to prolong survival. This paper summarises new drugs available for cutaneous T-cell lymphoma and their mode of action. Most new drugs for cutaneous T-cell lymphoma have response rates between 30% and 50% with response durations being less than a year. New studies looking at combination or maintenance therapies may improve quality of life and disease outcome.

(BELG J HEMATOL 2017;8(3):102–6)

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Update on therapy of relapsed and refractory multiple myeloma

BJH - volume 8, issue 2, march 2017

A. Deweweire MD, A. Kentos MD, A. Vande Velde MD, B. De Prijck MD, C. Doyen MD, PhD, G. Bries MD, PhD, H. De Samblanx MD, H. Demuynck MD, I. Vande Broek MD, PhD, J. Caers MD, PhD, J. Van Droogenbroeck MD, K. Beel MD, PhD, K. Fostier MD, K.L. Wu MD, PhD, M-C. Vekemans MD, M. Delforge MD, PhD, M. Vaes MD, N. Meuleman MD, PhD, On behalf of the Multiple Myeloma Study Group of the Belgian Haematology Society (BHS) , P. Mineur MD, P. Vlummens MD, R. Schots MD, PhD

SUMMARY

The prognosis for multiple myeloma patients has improved substantially over the past decade with the development of more effective chemotherapeutic agents and regimens that possess a high level of anti-tumour activity. However, nearly all multiple myeloma patients ultimately relapse, even those who experience a complete response to initial therapy. Management of relapsed disease remains a critical aspect of multiple myeloma care and an important area of ongoing research. This manuscript from the Belgian Haematology Society multiple myeloma subgroup provides some recommendations on the management of relapsed disease.

(BELG J HEMATOL 2017;8(2):53–65)

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Guidance for the prevention and treatment of venous thromboembolism in cancer patients

BJH - volume 7, issue 6, december 2016

A. Awada MD, PhD, C. Vulsteke MD, PhD, J-F. Baurain MD, PhD, J-M. Hougardy , J. Mebis MD, PhD, K. Jochmans MD, PhD, M. Strijbos MD, PhD, P. Clement MD, PhD, P. Hainaut MD, PhD, P. Verhamme MD, PhD, S. Holbrechts MD, PhD, V. Mathieux MD, PhD

Summary

Venous thrombosis is a common complication in cancer patients and thromboembolism is the second most common cause of death. Several practice guidelines provide recommendations for the management of cancer-associated thrombosis. However, these guidelines do not sufficiently cover commonly encountered clinical challenges. With this expert panel, consisting of medical oncologists, haematologists, internists and thrombosis specialists, we aimed to develop a practical Belgian guidance for adequate prevention and treatment of cancer-associated thrombosis that covered several challenging situations encountered in daily clinic. This paper discusses the following topics: type and treatment duration of anticoagulant therapy, recurrent VTE despite anticoagulation, anticoagulation in case of renal impairment, liver disease and thrombocytopenia, the role of anti-Xa monitoring, central venous catheter-associated thrombosis, the position of direct oral anticoagulants and thromboprophylaxis, both in ambulatory and hospitalised patients. For an overview of the recommendations formulated by the expert panel, we refer to the key messages for clinical practice in this article.

(BELG J HEMATOL 2016;7(6):217–23)

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Belgium recommendations for the management of acute promyelocytic leukaemia

BJH - volume 7, issue 6, december 2016

S. Wittnebel MD, PhD

Summary

The management of acute promyelocytic leukaemia has evolved considerably. The standard front-line approach with all-trans retinoic acid and chemotherapy has recently been challenged by the chemo-free combination of all-trans retinoic acid and arsenic trioxide, which has emerged as the new standard of care for non-high-risk disease. This review gives an update of the management of acute promyelocytic leukaemia.

(BELG J HEMATOL 2016;7(6):224–8)

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BHS guidelines for the treatment of large granular lymphocyte and chronic prolymphocytic leukaemias

BJH - volume 7, issue 3, june 2016

A. Janssens MD, PhD, C. Bonnet MD, PhD, C. Springael MD, PhD, D. Bron MD, PhD, K.L. Wu MD, PhD, On behalf of the BHS Lymphoproliferative Working Party , V. Delrieu MD, W. Schroyens MD, PhD

Summary

Large granular lymphocyte and prolymphocytic leukaemias are rare chronic lymphoproliferative disorders. Large granular lymphocyte leukaemias consist of indolent disorders such as T-cell large granular lymphocyte and chronic lymphoproliferative disorder of natural killer cells and the very rare but aggressive natural killer cell leukaemia. Treatment of the indolent large granular lymphocyte leukaemias is necessary in case of symptomatic cytopaenias or non-haematological autoimmune disorders. First line therapy of these two disorders is based on three immunosuppressive drugs: methotrexate, cyclophosphamide and cyclosporine A. Aggressive natural killer cell leukaemia needs an L-asparaginase containing regimen as induction followed by allogeneic stem cell transplantation to prolong remission. T-cell prolymphocytic leukaemia always follows an aggressive course even after an indolent onset. The optimal treatment strategy should exist of remission induction with alemtuzumab intravenously followed by autologous or allogeneic stem cell transplantation. Treatment indications for B-cell prolymphocytic leukaemia follow the criteria described by the chronic lymphocytic leukaemia guidelines. After induction with fludarabine, cyclophosphamide, rituximab or bendamustine in patients without a p53 mutation and/or a 17p deletion and alemtuzumab in case of a p53 mutation and/or a 17p deletion, stem cell transplantation must be considered.

(BELG J HEMATOL 2016; 7(3):103–11)

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BHS guidelines for primary central nervous system lymphoma

BJH - volume 7, issue 2, april 2016

A. Janssens MD, PhD, A. Van Hoof MD, PhD, C. Bonnet MD, PhD, D. Dierickx MD, PhD, E. Van den Neste MD, PhD, M. André MD, V. De Wilde MD, PhD, V. Van Hende MD, W. Schroyens MD, PhD

Summary

Primary central nervous system lymphoma is a rare form of extranodal B cell lymphoma of the brain, the eyes, the meninges or the spinal cord in the absence of systemic lymphoma. The management of primary central nervous system lymphoma remains controversial, which is related to the rarity of the cases and the small number of controlled studies available. The present consensus report provides the guidelines proposed by the Belgian Hematology Society Lymphoproliferative Working Party for treating immunocompetent adult patients with primary central nervous system lymphoma.

(BELG J HEMATOL 2016;7(2):69–78)

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