The management of chronic lymphocytic leukemia in clinical practice: what is new in 2024?

Sarah Bailly (1), Marie-Christiane Vekemans (1), Eric Van Den Neste (1) Published in the journal : July 2024 Category : Hématologie et Oncologie médicale

Chronic lymphocytic leukemia is the most common leukemia subtype, accounting for over one-third of leukemia cases in Belgium. Recent years have seen a significant expansion in the treatment range available to patients and clinicians. Today, we live in an era of targeted therapies and immunotherapies, relegating chemotherapy to very rare situations. These new treatments were shown to offer excellent prospects in terms of progression-free survival and quality of life for patients, but they have also introduced new toxicity profiles that clinicians must manage. This article sought to provide physicians with a condensed update on what they need to know about managing this disease in 2024.

Read more

Clinical methods for arthralgia and its differential diagnosis

Stéphanie Dierckx Published in the journal : July 2024 Category : Rheumatology

On the occasion of the ECU-UCL educational day on May 25, 2024, the author sought to highlight clinical or paraclinical characteristics that likely guide differential diagnosis, and to briefly discuss common and critical rheumatic disorders.

Read more

Rheumatology in the future

Frédéric A. Houssiau Published in the journal : July 2024 Category : Rheumatology

On the occasion of the ECU-UCL educational day on May 25, 2024, the author sought to predict the evolution of rheumatology by highlighting the decline in current rheumatic semiology, emergence of new diseases (particularly of environmental origin), contributions of network medicine, as well as the emergence of cell therapy.

Read more

Arthritis treatment in 2024

Patrick Durez Published in the journal : July 2024 Category : Rheumatology

On the occasion of the ECU-UCL educational day held on May 25, 2024, the author summarized the 2024 therapeutic approach to arthritis, covering both traditional pharmacological treatments and new targeted strategies based on biological agents and JAK kinase inhibitors.

Read more

How do you untangle the complex network of autoimmune tests?

Farah Tamirou Published in the journal : July 2024 Category : Rheumatology

Antinuclear autoantibodies (ANA) are commonly investigated, whereas their interpretation can be challenging, especially when the test is triggered by an unusual clinical presentation. Their detection is often incidental, the difficulty being the finding of a 'positive' result. This article sought to examine the role of ANA tests in clinical practice, along with their significance based on the patient context.

Read more

Joint pain in general medicine: Which strategy for prescribing medical imaging examinations?

Thomas Paul-Emile Kirchgesner Published in the journal : July 2024 Category : Rheumatology

• Radiography (X-ray) is the medical imaging examination of choice for the initial assessment of bone or joint pathologies of the limbs.

• Ultrasound is an excellent non-irradiating examination for the study of superficial and periarticular soft tissues, including the rotator cuff tendons of the shoulder, extensor apparatus of the knee, and the ligaments, and tendons of the ankle.

• When faced with spinal pain, the prescribing physician should look out for warning signs ("red flags") that will guide the choice of medical imaging examinations.

Read more

Risk perception of ductal carcinoma in situ and its clinical and societal consequences

Nadia Vonêche (1), Julia Riggi (2), Christine Galant (3), Martine Berlière (4), Mieke Van Bockstal (5) Published in the journal : July 2024 Category : Hématologie et Oncologie médicale

The incidence of ductal carcinoma in situ (DCIS) has considerably risen since the introduction of organized mammography screening programs in the general population. Currently, all DCIS are treated surgically, though most are believed to be indolent. The difficulty in determining which lesions are at risk of becoming invasive has likely led to overtreatment for many patients as well as confusion about the actual risk of developing invasive disease or dying from breast cancer. This misperception of risk has generated significant psychological stress for patients. In order to improve their quality of life, it is crucial to better understand the development of invasive breast cancers and enhance communication between doctors and patients. Some experts are even questioning the current terminology: Should DCIS still be referred as a form of cancer?

To address these issues, new research focusing on molecular, genetic, and microenvironmental aspects of DCIS progression to invasive breast cancer must be initiated. The identification of reliable biomarkers will likely allow for the development of accurate risk prediction that are models specific to DCIS, paving the way towards therapeutic de-escalation. Additionally, this research is likely to support the creation of communication and decision-support tools with treatments being primarily focused on the patient's needs.

Read more

The pathway of a patient with a pituitary adenoma: from diagnosis to surgery

Loïc de Nijs¹, Stefan Matei Constantinescu², Orsalia Alexopoulou², Edward Fomekong¹ Published in the journal : July 2024 Category : Hématologie et Oncologie médicale

Pituitary adenomas, recently renamed pituitary neuroendocrine tumors (PiNETs) according the new World Health Organization classification published in 2017, are one of the two most common intracranial tumors, with an estimated prevalence of 1 in 1,100 people.

A meticulous endocrine evaluation is the first therapeutic step in their management, aimed at detecting hormonal hypersecretion and anterior hypopituitarism. High-resolution magnetic resonance imaging (MRI) of the pituitary region using a dedicated protocol is then recommended to precisely localize the tumor and determine its extra-sellar extension. Each case is discussed weekly at our multidisciplinary meeting to determine the best therapeutic option for each individual patient.

The first-line treatment is usually transnasal transsphenoidal surgery, except for microprolactinomas that are effectively managed using dopamine agonist medication like cabergoline to control the endocrinopathy. Surgical resection in expert centers allows for elevated levels of hypersecreted hormone to be normalized in 50 to 90% of cases. In the event of failure or recurrence, a second surgery or radiotherapy can be proposed. Some PiNETs, including non-functional microadenomas, only require serial MRI monitoring without treatment.

Read more

Pediatric hemato-oncology: a specialty in itself

Gabriel Levy (1), Cécile Boulanger (1), Bénédicte Brichard (1), Manon Le Roux (1), Maelle de Ville de Goyet (1), An Van Damme (1) Published in the journal : July 2024 Category : Hématologie et Oncologie médicale

Pediatric hemato-oncology deals with cancers occurring in patients from birth to the age of 16 years. Due to the low prevalence of these diseases, which constitute 1% of all cancers, the therapies are thus directed at rare diseases. Pediatric cancers encompass more than 60 different entities, with their frequency varying according to children’s age. In absolute numbers and across all ages, hematological malignancies are the most common, accounting for 39% of cancers in children aged 0–14 years old (27% leukemias and 12% lymphomas), followed by central nervous system tumors (27%). Although the histology of pediatric cancers may be similar to that of adult neoplasias, their biology and predisposing factors are quite distinct. Treatment of pediatric tumors, conducted exclusively in tertiary centers, is multidisciplinary, aiming at treating the pathology but also at maintaining the children within their family and social environment. With survival rates exceeding 80%, the prevention and treatment of long-term side-effects also require special focus. Encouraged by international studies, pediatric oncology specialists are now seeking to collaborate with adult oncology colleagues to treat adolescents and young adults aged 16 to 35 years, covering a group with specific pathologies, as well as precise social and therapeutical needs. Keywords Pediatric hemato-oncology, predispositon, pediatric hemato-oncology center, Belgium, long-term side-effects, adolescents, young adults

Read more

Innovations in multiple myeloma management in 2024: the key role of immunotherapy

Marie-Christiane Vekemans Published in the journal : July 2024 Category : Hématologie et Oncologie médicale

In recent years, new therapies, mainly consisting of monoclonal antibodies like daratumumab and isatuximab, have revolutionized the management of patients with multiple myeloma (MM). Despite these advances, MM remains incurable, and patients who have become refractory to the three therapeutic classes of drugs, including proteasome inhibitors, immunomodulators, and monoclonal antibodies, have a particularly poor prognosis, which highlights the need for new treatment strategies. The development of novel immunotherapeutic approaches, such as antibody-drug conjugates, bispecific antibodies, and CAR T-cells, marks a turning point for heavily pre-treated patients, while revolutionizing their future. In this article, we have reviewed the contributions of these therapies to the current treatment landscape.

Read more