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Dit volledig vernieuwde handboek is bedoeld als inleiding tot de klinische hematologie. Op basis van de richtlijnen van 'evidence based medicine' bundelt dit boek de ontwikkelingen in de hematologie van de afgelopen decennia. Tegelijk licht het een tip van de sluier van meer experimentele benaderingen en mogelijke toekomstscenario's in het onderzoek.Alle relevante aspecten van de volwassen en pediatrische klinische hematologie komen aan bod: van aangeboren of erfelijke afwijkingen van het bloed en beenmerg, over ijzer- en vitaminetekorten, naar meer kwaadaardige stoornissen zoals leukemieën, lymfeklierkankers en myelomen.Bovendien schenkt het boek aandacht aan diagnostische technieken, moleculaire en cytogenetische aspecten, klinische transfusie, stollingsstoornissen, stamceltransplantatie en verpleegkundige aspecten van de zorg rondom de hematologische patiënt.Klinische hematologie is geschikt voor studenten in de opleidingen geneeskunde of beginnende specialisatie, biomedische wetenschappen, verpleegkunde, medische laboratoriumtechnologie en andere paramedische richtingen. Ook huisartsen, patiënten, gezondheidswerkers en eenvoudigweg iedereen met interesse voor bloedziekten en de behandeling ervan kunnen er gebruik van maken.

Hematologie. --- leukemie --- lymfomen --- hemostase --- anemie --- Pathological haematology --- stamceltransplantatie --- hematologie --- Glandular pathology. Haemopoietic pathology --- leukocytosis --- trombocytopenie --- Pathology of the circulatory system --- Hematologie --- Blood --- Diseases --- Handbooks, manuals, etc. --- Hematology --- Diagnosis --- klinische hematologie --- 616.15 --- Bloed --- 612.4 --- bloed --- 616.15 Blood. Plasma. Serum. Sanguineous complaints. Clinical haematology --- Blood. Plasma. Serum. Sanguineous complaints. Clinical haematology --- Bloed. Plasma. Serum. Bloedziekten. Klinische hematologie --- Anemie --- Leukemie --- Lymfoom

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Prevention of organ rejection and graft-versus-host disease following solid organ and hematopoietic stem cell transplantation requires long term immunosuppressive therapy, leading to an increased risk of both infections and malignancies. Despite the fact that skin cancers are the most common malignancies, posttransplant lymphoproliferative disorder (PTLD) comprises one of the most serious complications following transplantation with high morbidity and mortality rates. Although the interest in diagnosis, pathogenesis, treatment and prevention of this disorder obviously has increased during the last decade, these different aspects have been characterized by a huge heterogeneity. In this work we tried to put some different pieces (illustrated by the large number of involved disciplines) of the PTLD puzzle together, aiming to obtain a global approach of this disorder. From a clinicopathological point of view we analysed a large cohort of transplant patients diagnosed with PTLD in our center. Although not randomized or prospective, the patient cohort is representative of the general PTLD population, providing a real life picture of the incidence, the clinic-pathological features, the therapeutic changes over the last decade and the outcome of patients diagnosed with PTLD. The results of this retrospective cohort study should enable clinicians, at least in part, to base their clinical management strategies for PTLD on systematically acquired evidence recovered from a representative large study population, in the absence of prospective studies. Based on this database we also analysed some specific rare subtypes of PTLD, in particular T-cel non-Hodgkin lymphoma PTLD and plasmablastic lymphoma PTLD. In a second part of our work we were able to show that 18F-fluorodeoxyglucose-positron emission tomography (PET scan) is highly sensitive for detecting PTLD and has an excellent ability to differentiate PTLD from non-malignant diseases. In addition, compared with CT scan PET may be more prefereable due to other reasons. As extranodal involvement is a frequent feature of PTLD, CT scan may not be the most appropriate staging tool. Another potential problem is the need for intravenous contrast with CT, which is relatively contra-indicated in transplant patients due to the relative frequent co-existing renal impairment. Based on this PET project our center was asked to organize the central PET review program of an upcoming international European PTLD trial. The pathogenesis of PTLD is only poorly understood and studied. In order to improve our knowledge we performed gene expression profiling on a large set of PTLD samples. This study revealed that the samples show clustering according to the underlying EBV status rather than to the immune state. A viral response signature clearly segregates EBV+ cases (PTLD) from EBV- cases (both PTLD and immune competent diffuse large B cell lymphomas) cases. In future we wil further try to integrate different molecular and cytogenetic techniques in an attempt to unravel the complex pathogenesis of the disorder. Finally we joined and actively participated in a European PTLD-1 Study Group, consisting of different experts in the field of PTLD. This Study Group initiated a European Phase II trial investigating the efficacy and safety of sequential immunochemotherapy in patients diagnosed with PTLD following solid organ transplantation. After an interim analysis the trial was amended in 2007 introducing risk stratification according to the response to rituximab. This trial is currently ongoing aiming to recruit 150 patients in the different participating European and Australian centers. In 2012 a scheduled interim analysis was presented of 91 patients treated with the risk stratification strategy, of which 18.7% were treated in Leuven. In the meantime the PTLD-1 Study Group is preparing a new trial (PTLD-2) integrating extended risk stratified sequential treatment, introducing PET scan in risk stratification and also focusing on new molecular techniques. Taken together, in this work, we tried to integrate clinical, diagnostic, pathogenic and therapeutic issues involved in PTLD. However, many more questions remain. Further research, translational and clinical studies are needed in this rapidly changing field with increasing transplant activities worldwide and the use of new and very potent immunosuppressive therapy. In the future we hope we can further contribute in this project.