PRACTICE GUIDELINES

Practical management of chronic myeloid leukaemia in Belgium

BJH - volume 6, issue 1, march 2015

B. Dessars MD, PhD, F. S. Benghiat MD, PhD, G. Verhoef MD, PhD, K. Van Eygen MD, L. Knoops MD, PhD, N. Straetmans MD, PhD, P. Lewalle MD, PhD, P. Mineur MD, T. Devos MD, PhD, Y. Beguin MD, PhD

Summary

Imatinib has drastically changed the outcome of patients with chronic myeloid leukaemia, with the majority of them showing a normal life span. Recently, the development of second and third generation tyrosine kinase inhibitors and the possibility of treatment discontinuation made the management of these patients more challenging. In this review, practical management guidelines of chronic myeloid leukaemia are presented adapted to the Belgian situation in 2014. In first line chronic phase patients, imatinib, nilotinib and dasatinib can be prescribed. While second generation tyrosine kinase inhibitors give faster and deeper responses, their impact on long-term survival remain to be determined. The choice of the tyrosine kinase inhibitor depends on chronic myeloid leukaemia risk score, priority for a deep response to allow a treatment-free remission protocol, age, presence of comorbid conditions, side effect profile, drug interactions, compliance concerns and price. Monitoring the response has to be done according the 2013 European LeukemiaNet criteria, and is based on the bone-marrow cytogenetic response during the first months and on the blood molecular response. Molecular follow-up is sufficient in patients with a complete cytogenetic response. For patients who fail frontline therapy, nilotinib, dasatinib, bosutinib and ponatinib are an option depending on the type of intolerance or resistance. T315I patients are only sensitive to ponatinib, which has to be carefully handled due to cardiovascular toxicity. Advanced phase diseases are more difficult to handle, with treatments including allogeneic stem cell transplantation, which is also an option for patients failing at least two tyrosine kinase inhibitors. The possibility of treatment-free remission and pregnancy are also discussed.

(BELG J HEMATOL 2015;6(1): 16–32)

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Update on the initial therapy of multiple myeloma

BJH - volume 5, issue 4, december 2014

A. Deweweire MD, A. Kentos MD, A. Vande Velde MD, B. De Prijck MD, C. Doyen MD, PhD, F. Offner 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, KL. Wu MD, PhD, M-C. Vekemans MD, M. Delforge MD, PhD, N. Meuleman MD, PhD, P. Mineur MD, R. Schots MD, PhD, V. Delrieu MD

Summary

With the introduction of immunomodulatory drugs and proteasome inhibitors, major improvements have been achieved in the treatment and prognosis of multiple myeloma. Different treatment combinations are now in use and innovative therapies are being developed. This rapidly changing therapeutic landscape calls for an update on the Belgian myeloma guidelines, published in 2010.1 Based on an extensive review of the recent literature, the myeloma study group of the Belgian Hematology Society has revised the consensus recommendations on myeloma care, to be used by haematologists as a reference for daily practice. When applicable, comments with regards to the Belgian reimbursement modalities are included. The full text with appendices can be downloaded from the Belgian Hematology Society website (www.bhs.be) and from the Belgium Journal of Hematology website (www.ariez.com).

(BELG J HEMATOL 2014;5(4):125–36)

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Treatment of mantle cell lymphomas: recommendations of the Belgian Hematological Society

BJH - volume 5, issue 3, september 2014

A. Bosly MD, PhD, A. Janssens MD, PhD, A. Sonet MD, A. Van Hoof MD, PhD, C. Bonnet MD, PhD, C. Doyen MD, PhD, C. Hermans MD, PhD, E. Mourin MD, E. Van den Neste MD, PhD, G. Verhoef MD, PhD, L. Michaux MD, PhD, M. André MD, P. Zachée MD, PhD, V. De Wilde MD, PhD, W. Schroyens MD, PhD

Summary

Mantle cell lymphoma was recognised in the nineties and is characterised by the t(11;14)(q13;q32) translocation which results in overexpression of cyclin D1.1 This disease represents approximately 6% of all non-Hodgkin’s lymphomas. Mantle cell lymphoma generally affects patients over 60 years-old. Most patients have advanced disease (>70 % Ann Arbor stage IV). Several efforts have been made to predict outcome in mantle cell lymphoma. The cell-proliferation marker Ki-67, the Mantle Cell Lymphoma International Prognostic Index, fluorodeoxyglucose positron emission tomography and minimal residual disease are prognostic tools. For young patients, chemoimmunotherapy followed by high-dose chemotherapy plus stem cell transplantation is the treatment of choice. For the main group of older patients, chemo-immunotherapy followed by maintenance with rituximab is the gold standard. In relapses, temsirolimus is actually registered and new drugs, such as ibrutinib, are currently evaluated with promising preliminary results.2–5

(BELG J HEMATOL 2014;5(3):89–96)

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Vaccination guidelines in haematopoietic transplant patients: recommendations from the BHS Transplant Committee

BJH - volume 5, issue 2, june 2014

H. Schoemans MD, PhD, I. Moors MD, S. Callens MD, PhD, T. Kerre MD, PhD, Y. Beguin MD, PhD

Summary

Haematopoietic stem cell transplantation is increasingly used as consolidation therapy in severe haematological diseases. In the post-transplantation period, the immunity of haematopoietic stem cell transplantation recipients is impaired due to toxicity of the pre-haematopoietic stem cell transplantation treatment (chemo- and/or radiotherapy), the conditioning regimen with a reset of the immune system, and – in case of allogeneic haematopoietic stem cell transplantation – the use of immunosuppressive drugs and potentially graft-versus-host-disease. This leads to a considerably increased risk of infections, with high morbidity and mortality. Therefore, prevention of infections, i.a. by revaccination, is of major importance to improve outcomes. We present the Belgian guidelines for vaccination after haematopoietic stem cell transplantation, based on available data in the literature and international guidelines, taking into account the availability of vaccines and – if applicable – their reimbursement in Belgium. We describe a general vaccination schedule for post-haematopoietic stem cell transplantation patients, indications for pre-transplant vaccination and donor vaccination and an overview of special indications, such as travel vaccinations, vaccinations of close contacts and health care workers, with recommendations for titer follow-up.

(BELG J HEMATOL 2014;5(2):44–54)

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BHS guidelines for the treatment of marginal zone lymphomas

BJH - volume 5, issue 1, march 2014

A. Janssens MD, PhD, A. Kentos MD, A. Van Hoof MD, PhD, C. Bonnet MD, PhD, D. Bron MD, PhD, E. Van den Neste MD, PhD, F. Offner MD, PhD, G. Verhoef MD, PhD, W. Schroyens MD, PhD

Summary

Marginal zone lymphomas are a heterogeneous subtype of indolent B-non-Hodgkin Lymphoma that includes three distinct diseases: Extranodal mucosa associated lymphoid tissue lymphoma, nodal marginal zone lymphoma and splenic marginal zone lymphoma lymphocytes +/− villous lymphocytes. The different diagnosis, work up and treatment options are discussed in these guidelines.

(BELG J HEMATOL 2014;5(1):12–21)

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Disease characteristics in Belgian myelofibrosis patients and management guidelines anno 2013

BJH - volume 4, issue 4, december 2013

C. Schuermans MD, G. Verhoef MD, PhD, L. Knoops MD, PhD, N. Straetmans MD, PhD, P. Lewalle MD, PhD, P. Mineur MD, S. Benghiat MD, PhD, T. Devos MD, PhD, V. Robin MD

Summary

Diagnostic and management guidelines for myelofibrosis patients are presented in this paper. As a consequence of the rapid evolution and progress in this domain over the last years, the need was felt by the BHS MPN subcommittee to update these guidelines for our country. The different prognostic scores in myelofibrosis, the diagnostic tools and treatment options with the focus on new possibilities are discussed.

(BELG J HEMATOL 2013;4(4): 127–137)

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Treatment of peripheral T-cell lymphomas: recommendations of the Belgian Hematological Society (BHS)

BJH - volume 4, issue 3, september 2013

A. Janssens MD, PhD, A. Kentos MD, A. Sonet MD, A. Van Hoof MD, PhD, B. Deprijck MD, C. Bonnet MD, PhD, D. Bron MD, PhD, D. Dierickx MD, PhD, E. Van den Neste MD, PhD, F. Offner MD, PhD, F. Van Obbergh MD, G. Verhoef MD, PhD, M. André MD, P. Zachée MD, PhD, V. De Wilde MD, PhD, W. Schroyens MD, PhD

Summary

The sub-committee on lymphoproliferative disorders of the Belgian Hematological Society has met several times to prepare guidelines on the management of patients with peripheral T-cell lymphomas. Each panellist’s expert provided interpretation of the evidence, based on literature review and personal experience. The available evidence was systematically discussed prior to formulating recommendations. A systematic approach to obtain consensus of expert opinion was used. After each meeting, the draft guideline was circulated to all experts for comment and approval. The present guidelines focus on general management of peripheral T-cell lymphomas with special emphasis on more specific disease-adapted strategies.

(BELG J HEMATOL 2013;4(3):90–101)

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