BJH - volume 13, issue 8, december 2022
A.M. Laheij, DDS, PhD, J.E. Raber-Durlacher, DDS, PhD, M.D. Hazenberg MD, PhD, M.C. Schoordijk , M.C. Huysmans, DDS, PhD, J.G. de Visscher, DDS, MD, PhD
Allogeneic stem cell transplantation recipients may develop chronic graft-versus-host disease (cGVHD). The oral and perioral tissues are commonly involved, clinically manifesting as mucosal lesions, salivary gland dysfunction and/or sclerotic changes. Oral cGVHD is associated with mucosal sensitivity and pain, (severe) oral dryness, altered taste, decreased mouth opening, all of which may contribute to a significant decrease of the patient’s quality of life. Hyposalivation may put patients at risk for mucosal infections and rampant dental caries. In addition, patients with (a history) of oral cGVHD are at increased risk for oral squamous cell carcinoma. The diagnosis of cGVHD is based on the patient’s medical history, clinical signs, and symptoms. In rare cases, a biopsy may provide clinically relevant information as the histopathology findings are mostly not very specific. Treatment of cGVHD is based on the patient’s symptoms and consists preferably of local immunosuppressants. In case of severe oral complaints and when other non-oral body are also involved systemic immunosuppressive therapy should be considered. Xerostomia can be alleviated with mechanical stimulation, topical dry mouth relief products or sialagogues. Dental professionals can provide supportive care aimed at reducing symptoms and prevention of further deterioration of oral health.
(BELG J HEMATOL 2022;13(8):302–9)
Read moreBJH - volume 13, issue 8, december 2022
S. Haggenburg MD, Q. Hofsink MD, A.E.C. Broers MD, PhD, J.A. van Doesum MD, C. van Elssen MD, PhD, R.S. van Binnendijk PhD, G. den Hartog PhD, J. Heijmans MD, PhD, P.G.N.J. Mutsaers MD, PhD, T. van Meerten MD, PhD, C.J.M. Halkes MD, PhD, M.H.M. Heemskerk MD, PhD, A. Goorhuis MD, PhD, C.E. Rutten MD, PhD, M.D. Hazenberg MD, PhD, I.S. Nijhof MD, PhD
Patients with haematologic diseases are at high risk for severe coronavirus disease 2019 (COVID-19) and COVID-19-related death. In early 2021, haematology patients were therefore prioritized for SARS-CoV-2 vaccination by the Dutch government. It was however not known whether they would be able to generate a protective immune response to SARS-CoV-2 vaccines, given the immunodeficiencies that often accompany hematologic conditions and the therapy thereof. National and international cohort studies demonstrated an adequate antibody response after a standard 2-dose mRNA vaccination schedule in a larger number of patients than expected. After the third dose, the majority of immunocompromised haematology patients obtained SARS-CoV-2 antibody concentrations similar to the antibody concentrations obtained by healthy individuals after the standard 2-dose mRNA-1273 schedule. The primary COVID-19 vaccination schedule for haematology patients should therefore consist of three instead of two mRNA vaccinations. B cell depleted patients and patients who received allogeneic hematopoietic progenitor cell transplantation (HCT) should be revaccinated. The number and the exact timing of revaccinations remains to be determined however. In conclusion, SARS-CoV-2 vaccination should not be postponed in patients on or shortly after therapy for hematologic conditions.
(BELG J HEMATOL 2022;13(8):310–5)
Read moreBJH - volume 12, issue 4, june 2021
F. Massaro MD, C. Vandevoorde , J. Ku MD, D. Papazoglou MD, A. Van Uytvanck MD, N. Meuleman MD, PhD, D. Bron MD, PhD
The majority of CLL patients are elderly, with a median age of those requiring a first line treatment, close to 76 years old. Nowadays, multiple treatment options are available for this disease, ranging from chemo immunotherapy regimens to biological therapies. The treatment decision in an older CLL patient is a four-step procedure, starting firstly with the assessment of treatment criteria. The second step is to evaluate the life-expectancy of the patient, its autonomy, vulnerabilities and the socio-economic status. The subsequent step is to define treatment options according to prognostic factors. Last, but not least, the patient should be involved in the final decision to know to what extend he is willing to receive a treatment with a potential curative or palliative intent. The assessment of an elderly CLL patient is a complex procedure, not only comprehending the evaluation of biological and hematological parameters but also clinical, social and psychological features, which equally contribute to the selection of the most valuable strategy.
(BELG J HEMATOL 2021;12(4):147-54)
Read moreBJH - volume 12, issue 3, may 2021
C. Van Laer PharmD, M. Jacquemin MD, PhD, K. Peerlinck MD, PhD, K. Freson PhD
The international study ThromboGenomics has developed and tested a targeted high-throughput sequencing (HTS) multi-gene panel test for diagnostics of patients with rare bleeding, thrombotic or platelet disorders (BTPD). After the initial validation of this research platform, 2396 index patients were sequenced and a mean diagnostic rate of 49.2% was reached for all thrombotic, coagulation, platelet count and function disorder patients while this rate dropped to 3.2% for patients with unexplained bleeding disorders that were characterised by normal haemostasis test results. Since early 2019, a similar HTS test for BTPD has been implemented in Belgium in a clinical diagnostic setting. This test screens 96 diagnostic-grade genes and is updated yearly with novel genes. Upon inclusion, clinicians can opt for one of the three panels: 1) (anti)coagulation panel test for abnormal bleeding or thrombosis, 2) platelet disorder panel test for inherited thrombocytopenia or known platelet dysfunctions and 3) the unexplained bleeding panel test but with evidence for Ehlers-Danlos Syndrome or Rendu-Osler-Weber disease. Inclusion and exclusion criteria for patients eligible for such HTS will be discussed. The submission of detailed information about clinical phenotype, family history and laboratory test results is critical for the interpretation of the genetic results. The aim is to provide results to clinicians and patients with a detailed report that discusses variant interpretation.
(BELG J HEMATOL 2020;12(3):99-105)
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BJH - volume 12, issue 3, may 2021
A. Janssens MD, PhD, L. Stas MSc, M. Van den Enden MD, E. Van den Neste MD, PhD
Chronic lymphocytic leukaemia (CLL) is a slow-progressing cancer that results in uncontrolled proliferation and accumulation of B-lymphocytes in the blood and bone marrow and is the most common form of leukaemia in the western world. CLL patients harbouring a deletion of chromosome 17 (del17p) or the TP53 mutation, who progress after treatment with immunological, chemotherapeutic as well as targeted agents such as ibrutinib have poor prognosis signifying a population with an unmet medical need. Clinical studies showed that venetoclax, a selective; orally bioavailable Bcl-2 inhibitor, induces CLL cell apoptosis, and offers an alternative therapeutic option for CLL, either as a monotherapy or in combination with rituximab. BRAVe was a multicentre, observational retrospective study, conducted in Belgium. The main objectives of this study were to evaluate the safety and effectiveness of venetoclax monotherapy in Belgian patients with CLL, as well as the utilisation of resources in a real life setting. The results show a manageable/favourable safety profile for venetoclax with limited burden for patients and sites, and a good overall response rate in pre-treated CLL patients in the relapsed/refractory setting.
(BELG J HEMATOL 2020;12(3):106-11)
Read moreBJH - 2021, issue 2, march 2021
P.K.J.D. de Jonge PhD, P.M.M. van Hauten MD, N.P.M. Schaap MD, PhD, H. Dolstra PhD
Natural killer cells are increasingly recognised as an attractive source of allogeneic immune effector cells in cancer immunotherapy. Over the past decade, several adoptive transfer trials using allogeneic NK cells from different sources have shown safety with little evidence of toxicities such as graft-versus-host disease, cytokine release syndrome or neurotoxicity that are often seen in T cell therapy. While clinical effects have been observed, improvements are warranted to increase relapse free survival and potentially cure cancer patients. Genetic engineering shows great potential for improving NK cell therapy through chimeric antigen receptors or knocking out immune checkpoints and MHC-I. Especially stem cell-derived natural killer cells are an ideal template as they can be cultured without T and B cell contamination and are relatively easy to genetically engineer compared to mature NK cells. Next to improving anti-tumour specificity, persistence can be improved by including cytokine domains in the chimeric antigen receptor, which is a great benefit over NK cell lines that need to be lethally irradiated to prevent uncontrolled proliferation. Importantly, the safety profile of adoptive NK cell transfer allows for minimal matching, which opens the door for large-scale production and cryopreservation to create an off-the-shelf therapy.
(BELG J HEMATOL 2020;12(2):59-65)
Read moreBJH - 2021, issue 2, march 2021
P. Beuselinck MD, Ir J. Van Ham , N. Boeckx MD, PhD, T. Devos MD, PhD, P. Vandenberghe MD, PhD, G. Verhoef MD, PhD
BACKGROUND: Tyrosine kinase inhibitors (TKIs) have improved the survival of patients with chronic myeloid leukaemia (CML). TKIs can be successfully discontinued in some CML patients who have achieved a stable deep molecular response.
OBJECTIVE: The purpose of this article is twofold. On the one hand, this review provides an overview of current use and discontinuation of TKIs in patients with CML. On the other hand, we retrospectively investigated the use and possible discontinuation of TKIs in a specific patient population with CML at the University Hospital of Leuven.
METHODS: A literature search was carried out in May 2019 to identify all relevant articles. Articles were searched on PubMed, Embase, Web of Science and Cochrane Library. Additionally, the articles found in the reference list were used.
RESULTS: This review included ten articles (two on imatinib, four on dasatinib, four on nilotinib), with 970 patients. Treatment free remission (TFR) ratio varied from 41–68% after one year. One study published the results of TFR after three years. In UZ Leuven, the TFR ratio was 60% after 106 weeks.
CONCLUSION: Tyrosine kinase inhibitor (TKI) therapy can be safely terminated in selected patient groups. About half of the patients retain the molecular remission after discontinuation of TKI therapy.
(BELG J HEMATOL 2020;12(2):52-8)
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