Publications by authors named "Michel Van Gelder"

Cyclosporine A combined with mycophenolate mofetil (CsA/MMF) has become an established regimen for the prevention of graft-versus-host disease (GVHD) following non-myeloablative (NMA) allogeneic hematopoietic stem cell transplantation (alloHSCT). However, the optimal duration of immunosuppression (IS) has not yet been defined and overtreatment is of concern. We hypothesized that time-restricted IS with CsA/MMF would increase the proportion of patients with non-severe GVHD compared to standard-duration IS, thereby resulting in reduction of the relapse rate and improvement of progression-free survival (PFS) and overall survival (OS).

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Given the selection of elderly patients with AML in first complete remission (CR1) the advantage of consolidation with allogeneic hematopoietic cell transplantation (HCT) over chemotherapy is still unclear. Newly diagnosed AML patients in CR1 aged 60-75 years were registered and a donor search initiated. After one consolidation cycle, patients with a matched donor were randomized to HCT with fludarabine/low-dose total body irradiation and cyclosporine/mycophenolate mofetil immunosuppression or conventional non-HCT.

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Article Synopsis
  • - In patients with myelodysplastic syndrome (MDS), higher revised International Prognostic Scoring System (IPSS-R) scores are linked to poorer transplant outcomes, leading to the idea that lowering these scores before transplant could be helpful, but there's currently no evidence to back this up.
  • - A study analyzing 1,482 MDS patients found that changes in IPSS-R scores before transplantation did not significantly impact outcomes for untreated patients, while beneficial results were seen in those improved by chemotherapy.
  • - Overall, prior treatments including hypomethylating agents showed no clear advantage in improving transplant outcomes, suggesting that the effectiveness of pre-transplant therapies in altering IPSS-R scores is limited and raising questions about their role in managing
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Background: We recently reported results of the prospective, open-label HOVON-100 trial in 334 adult patients with acute lymphoblastic leukemia (ALL) randomized to first-line treatment with or without clofarabine (CLO). No improvement of event-free survival (EFS) was observed, while a higher proportion of patients receiving CLO obtained minimal residual disease (MRD) negativity.

Aim: In order to investigate the effects of CLO in more depth, two multi-state models were developed to identify why CLO did not show a long-term survival benefit despite more MRD-negativity.

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  • Management of Richter transformation (RT) poses significant challenges, with patient survival often under one year; this study analyzes outcomes of 66 patients who received allogeneic hematopoietic cell transplantation (allo-HCT) between 2008 and 2018.
  • The majority of patients were treated with reduced intensity conditioning, and 42.4% achieved complete remission (CR) before undergoing allo-HCT, with a median follow-up of 6.6 years.
  • Survival rates were promising, showing 1-year overall survival at 65%, but the study highlights the need for strategies to reduce high rates of non-relapse mortality (NRM) and chronic graft versus host disease (GVHD), which were observed at
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In this retrospective international multicenter study, we describe the clinical characteristics and outcomes of patients with chronic lymphocytic leukemia (CLL) and related disorders (small lymphocytic lymphoma and high-count monoclonal B lymphocytosis) infected by SARS-CoV-2, including the development of post-COVID condition. Data from 1540 patients with CLL infected by SARS-CoV-2 from January 2020 to May 2022 were included in the analysis and assigned to four phases based on cases disposition and SARS-CoV-2 variants emergence. Post-COVID condition was defined according to the WHO criteria.

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Background: The outcome in older patients with acute lymphoblastic leukemia (ALL) remains unsatisfactory due to high relapse and nonrelapse mortality (NRM) rates. Allogeneic stem cell transplantation (alloHSCT) as postremission therapy has an important role in reducing relapse rate, albeit its application is limited in older adult patients due to alloHSCT-related morbidity and mortality. Reduced-intensity conditioning (RIC) alloHSCT has been developed as a less toxic conditioning regimen, but comparative studies with myeloablative conditioning (MAC) are limited in patients with ALL.

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Chronic lymphocytic leukemia (CLL)-related symptoms and morbidity related to the advanced age at diagnosis impairs the well-being of older adult patients. Therefore, it is essential to tailor treatment according to geriatric characteristics and aim for an improvement in health-related quality of life (HRQoL) as a primary treatment goal. In the HOVON139/GiVe trial, 12 cycles of fixed-duration venetoclax plus obinutuzumab (Ven-O) were shown to be effective and tolerable in FCR (fludarabine, cyclophosphamide, rituximab)-unfit patients with CLL (n = 67).

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Allogeneic transplantation (allo-HCT) is a curative treatment in CLL whose efficacy including the most severe forms had led to the 2006 EBMT recommendations. The advent after 2014 of targeted therapies has revolutionized CLL management, allowing prolonged control to patients who have failed immunochemotherapy and/or have TP53 alterations. We analysed the pre COVID pandemic 2009-2019 EBMT registry.

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Background: Patients with chronic lymphocytic leukemia (CLL) may be more susceptible to COVID-19 related poor outcomes, including thrombosis and death, due to the advanced age, the presence of comorbidities, and the disease and treatment-related immune deficiency. The aim of this study was to assess the risk of thrombosis and bleeding in patients with CLL affected by severe COVID-19.

Methods: This is a retrospective multicenter study conducted by ERIC, the European Research Initiative on CLL, including patients from 79 centers across 22 countries.

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Article Synopsis
  • - The management of chronic lymphocytic leukemia (CLL) is evolving due to new therapies and advancements in treatment options, prompting a revision of Dutch guidelines.
  • - The updated guidelines from the HOVON CLL working group emphasize evidence from clinical trials, focusing on factors like efficacy, toxicity, treatment duration, and intensity.
  • - The article offers recommendations on diagnosing CLL, treatment strategies for both newly diagnosed and relapsed patients, and supportive care for complications related to the disease, tailored to current treatment availability in the Netherlands.
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Background: Fixed-duration 12 cycles of venetoclax plus obinutuzumab is established as first-line treatment for patients with chronic lymphocytic leukaemia. We aimed to determine the activity and safety of 12 cycles of venetoclax consolidation after fixed-duration venetoclax plus obinutuzumab for previously untreated patients with chronic lymphocytic leukaemia who were unfit for fludarabine-based treatment, and whether this could be guided by minimal residual disease status.

Methods: We conducted an open-label, randomised, parallel-group, phase 2 trial (HOVON 139/GiVe) at 25 hospitals in the Netherlands.

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Article Synopsis
  • Graft-versus-host disease (GVHD) is a major complication following allogeneic hematopoietic stem cell transplantation (alloHSCT), and this study compared two treatment regimens to reduce its severity.
  • In a clinical trial involving 160 high-risk hematological cancer patients, one group received posttransplant cyclophosphamide (PT-Cy) with cyclosporine A (CsA), while the other received CsA with mycophenolic acid (MPA).
  • Results showed that the PT-Cy/CsA group had lower rates of severe acute and chronic GVHD and significantly improved GVHD-free, relapse-free survival (GRFS), indicating a more effective treatment approach.
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  • Clofarabine (CLO) is a treatment evaluated in a study for adults with newly diagnosed acute lymphoblastic leukemia (ALL), comparing its addition to standard induction and consolidation treatments.
  • The study involved 340 patients, revealing similar 5-year event-free survival rates (EFS) of 50% for those on CLO compared to 53% without CLO, with younger patients showing slightly better outcomes than older ones.
  • Although CLO resulted in a higher rate of minimal residual disease (MRD) negativity and complete remission (CR) rates were similar across groups, increased serious adverse events and toxicity were noted in patients treated with CLO, which may have countered potential benefits.
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Patients with chronic lymphocytic leukemia (CLL) may be more susceptible to Coronavirus disease 2019 (COVID-19) due to age, disease, and treatment-related immunosuppression. We aimed to assess risk factors of outcome and elucidate the impact of CLL-directed treatments on the course of COVID-19. We conducted a retrospective, international study, collectively including 941 patients with CLL and confirmed COVID-19.

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Natural killer (NK)-cell-based immunotherapies are an attractive treatment option for cancer. We previously showed that alloreactive mouse NK cells cured mice of 4T1 breast cancer. However, the tumor microenvironment can inhibit immune responses, and these suppressive factors must be overcome to unfold the NK cells' full anti-tumor potential.

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Objectives: The aim of this study was to describe real-world data on outcomes of T cell replete haploidentical hematopoietic stem cell transplantation (HSCT) after the introduction of this modality in a single center and to compare them with different donor types.

Method: Outcomes of 30 consecutive patients with hematological malignancies that received T cell replete haploidentical HSCT with posttransplantation cyclophosphamide (PTCY) from 2016 to 2018 in our center were analyzed and compared to the outcome of human leukocyte antigen (HLA)-related and unrelated matched donor HSCT ( = 97) and to a historical cohort of T cell depleted haploidentical HSCT ( = 11).

Results: One year graft-versus-host-free, relapse-free survival in haploidentical HSCT was comparable with other donor types (haplo 40%, matched related donor [MRD] 33%, matched unrelated donor [MUD] 25%,  = 0.

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Results from registry studies suggest that harnessing Natural Killer (NK) cell reactivity mediated through Killer cell Immunoglobulin-like Receptors (KIR) could reduce the risk of relapse after allogeneic Hematopoietic Cell Transplantation (HCT). Several competing models have been developed to classify donors as KIR-advantageous or disadvantageous. Basically, these models differ by grouping donors based on distinct KIR-KIR-ligand combinations or by haplotype motif assignment.

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No studies have been reported so far on bridging treatment with idelalisib for patients with chronic lymphocytic leukemia (CLL) prior to allogeneic hematopoietic cell transplantation (alloHCT). To study potential carry-over effects of idelalisib and to assess the impact of pathway-inhibitor (PI) failure we performed a retrospective EBMT registry-based study. Patients with CLL who had a history of idelalisib treatment and received a first alloHCT between 2015 and 2017 were eligible.

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