PRACTICE GUIDELINES

Guidelines for newly diagnosed diffuse large B-cell lymphoma (DLBCL) and relapsed DLBCL

BJH - volume 4, issue 2, june 2013

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

Summary

The guidelines for adult patients in this article are based on 2011 ESMO and NCCN version 4.2011 guidelines and amended for the particular Belgian context of label prescription and reimbursement. Levels of evidence for the use of treatment recommendations are given in square brackets. Statements without grading were considered justifed standard clinical practice by the experts of the BHS-lymphoma working party.

(BELG J HEMATOL 2013;4(2):51–57)

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Primary immune thrombocytopenia in adults

BJH - volume 4, issue 1, march 2013

A. Bosly MD, PhD, A. Janssens MD, PhD, C. Lambert MD, D. Selleslag MD, G. Bries MD, PhD, Y. Beguin MD, PhD

Summary

The Belgian Hematological Society (BHS) guideline panel on adult primary immune thrombocytopenia (ITP) reviewed the recent literature on diagnosis and treatment to make recommendations on the best strategies for frontline and subsequent-line treatment. No treatment is necessary for patients with platelet counts higher than 30000/μl in the absence of bleeding symptoms. Patients newly diagnosed or relapsing after a long-term treatment-free period can be managed with corticosteroids with or without intravenous immunoglobulins. A second line therapy is indicated for those patients who are intolerant or unresponsive to or relapse after initial corticosteroid treatment and have a risk of bleeding. The guideline panel recommends splenectomy as it is the treatment with the highest curative potential and an acceptable safety profile. If possible, splenectomy should be delayed to at least twelve months after diagnosis as spontaneous remission can occur in this time period. Thrombopoietin receptor (TPO-R) agonists are recommended for patients who are refractory to or relapse after splenectomy or who have a contra-indication to splenectomy irrespective of the duration of ITP. The guideline panel agrees that rituximab, azathioprine, cyclophosphamide, cyclosporine A, danazol, dapsone, mycophenolate mofetil and vincristine/vinblastine are potential treatment options, especially for patients refractory to TPO-R agonists.

(BELG J HEMATOL 2013;1:11–20)

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BHS guidelines for the treatment of chronic lymphocytic leukaemia anno 2012

BJH - volume 3, issue 4, december 2012

A. Janssens MD, PhD, A. Van Hoof MD, PhD, D. Bron MD, PhD, E. Van den Neste MD, PhD, F. Offner MD, PhD, G. Verhoef MD, PhD, M. André MD, V. De Wilde MD, PhD, W. Schroyens MD, PhD

Summary

Tremendous improvements in treatment outcome have been obtained over the past decade but for most of the patients chronic lymphocytic leukaemia (CLL) still remains an incurable disease. We eagerly await tools incorporating patient related, disease related and treatment related factors, in order to balance efficacy and toxicity and to personalise treatment in a more rational manner. No treatment is necessary for patients without active and/or advanced disease, regardless of prognostic factors. When treatment is indicated we recommend fludarabine, cyclophosphamide, rituximab (FCR) as front-line strategy for fit patients, bendamustine, rituximab (BR) for patients unfit for FCR and chlorambucil for older patients with a geriatric profile or patients with major comorbidities or a reduced performance status. The choice of treatment for patients with recurrent advanced and/ or active disease depends on the duration of response to the previous treatment and on the type of treatment refractoriness. Reduced intensity conditioning allogeneic stem cell transplantation should be considered for patients with a de novo or an acquired 17p deletion, for patients refractory to F, or F and alemtuzumab, or for patients with an early relapse after chemo-immunotherapy.

We encourage patients to enter clinical trials exploring new agents. Among these new approaches, the signal transduction inhibitors have shown remarkable activity in very advanced disease, independent of genetic aberrations.

(BELG J HEMATOL 2012;3: 134–143)

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Point of view about new guidelines on ESAs (erythropoiesis-stimulating agents)

BJH - volume 3, issue 3, september 2012

L. Plawny MD

Summary

Recent concerns about the safety of erythropoietin stimulating agents (ESAs) in cancer patients have led to a reformulation of the guidelines issued by NCCN, ASH/ASCO and ESMO. The goal of this review is to comment on various safety issues like mortality or thromboembolism or iron supplementation and to summarise the views of the three working groups concerning ESA treatment in cancer patients.

(BELG J HEMATOL 2012;3:88–94)

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Guidelines of the Belgian Hematological Society for newly diagnosed and relapsed follicular lymphoma 2012

BJH - volume 3, issue 2, june 2012

A. Janssens MD, PhD, A. Sonnet MD, PhD, A. Van Hoof MD, PhD, C. Bonnet MD, PhD, D. Bron MD, PhD, D. Dierickx MD, PhD, E. Van den Neste MD, PhD, F. Offner MD, PhD, G. Verhoef MD, PhD, S. Debussche MD, V. De Wilde MD, PhD, W. Schroyens MD, PhD

Summary

Follicular lymphoma is an indolent lymphoma that has occurred more frequently over the last decades. In this article we present an overview of the diagnosis and initial work-up, prognostic scoring system and choice of therapy. For limited stage disease radiotherapy is the treatment of choice, and may have a curative potential. For advanced stages treatment should be initiated upon certain criteria, and is essentially based on immunochemotherapy, rituximab plus chemotherapy. The choice of chemotherapy depends on age, frailty, and specific toxicities of chemotherapy. Maintenance therapy with rituximab after induction has become standard practice. Since virtually all patients relapse eventually, an overview of the treatment in the relapsed setting is given. The treatment is then again based on immunoche-motherapy but there is also a place for radio-immunotherapy, or immunotherapy alone. For young patients, high dose chemotherapy with autologous stem cell rescue should be considered. A brief overview on novel agents, and agents that are in the pipeline, is given. We conclude with some recommendations for follow-up.

(BELG J HEMATOL 2012;3:41–50)

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