Sepsis and septic shock in patients with malignancies : a Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique study

Objectives: Cancer affects up to 20% of critically ill patients, and sepsis is one of the leading reasons for ICU admission in this setting. Early signals suggested that survival might be increasing in this population. However, confirmation studies have been lacking. The goal of this study was to assess trends in survival rates over time in cancer patients admitted to the ICU for sepsis or septic shock over the last 2 decades. Data Source: Seven European ICUs. Study Selection: A hierarchical model taking into account the year of admission and the source dataset as random variables was used to identify risk factors for day 30 mortality. Data Extraction: Data from cancer patients admitted to ICUs for sepsis or septic shock were extracted from the Groupe de Recherche Respiratoire en Reanimation Onco-Hematologique database (1994-2015). Data Synthesis: Overall, 2,062 patients (62% men, median [interquartile range] age 59 yr [48-67 yr]) were included in the study. Underlying malignancies were solid tumors (n = 362; 17.6%) or hematologic malignancies (n = 1,700; 82.4%), including acute leukemia (n = 591; 28.7%), non-Hodgkin lymphoma (n = 461; 22.3%), and myeloma (n = 244; 11.8%). Two-hundred fifty patients (12%) underwent allogeneic hematopoietic stem cell transplantation and 640 (31.0%) were neutropenic at ICU admission. Day 30 mortality was 39.9% (823 deaths). The year of ICU admission was associated with significant decrease in day 30 mortality over time (odds ratio, 0.96; 95% CI, 0.93-0.98; p = 0.001). Mechanical ventilation (odds ratio, 3.25; 95% CI, 2.52-4.19; p < 0.01) and vasopressors use (odds ratio, 1.42; 95% CI, 1.10-1.83; p < 0.01) were independently associated with day 30 mortality, whereas underlying malignancy, allogeneic hematopoietic stem cell transplantation, and neutropenia were not. Conclusions: Survival in critically ill oncology and hematology patients with sepsis improved significantly over time. As outcomes improve, clinicians should consider updating admission policies and goals of care in this population

Intérêt du dosage du récepteur soluble de la transferrine (sTfR) pour l'évaluation de l'érythropoïèse et de l'état du fer

peer reviewe

Increased mortality in hematological malignancy patients with acute respiratory failure from undetermined etiology : a Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologique (Grrr-OH) study

Background: Acute respiratory failure (ARF) is the most frequent complication in patients with hematological malignancies and is associated with high morbidity and mortality. ARF etiologies are numerous, and despite extensive diagnostic workflow, some patients remain with undetermined ARF etiology. Methods: This is a post-hoc study of a prospective multicenter cohort performed on 1011 critically ill hematological patients. Relationship between ARF etiology and hospital mortality was assessed using a multivariable regression model adjusting for confounders. Results: This study included 604 patients with ARF. All patients underwent noninvasive diagnostic tests, and a bronchoscopy and bronchoalveolar lavage (BAL) was performed in 155 (25.6%). Definite diagnoses were classified into four exclusive etiological categories: pneumonia (44.4%), non-infectious diagnoses (32.6%), opportunistic infection (10.1%) and undetermined (12.9%), with corresponding hospital mortality rates of 40, 35, 55 and 59%, respectively. Overall hospital mortality was 42%. By multivariable analysis, factors associated with hospital mortality were invasive pulmonary aspergillosis (OR 7.57 (95% CI 3.06-21.62); p 7 (OR 3.32 (95% CI 2.15-5.15); p < 0.005) and an undetermined ARF etiology (OR 2.92 (95% CI 1.71-5.07); p < 0.005). Conclusions: In patients with hematological malignancies and ARF, up to 13% remain with undetermined ARF etiology despite comprehensive diagnostic workup. Undetermined ARF etiology is independently associated with hospital mortality. Studies to guide second-line diagnostic strategies are warranted

Sialic acid content of erythrocytes in normal individuals and patients with certain hematologic disorders

The sialic acid content of erythrocytes from healthy individuals of different blood types and of patients with known hematological disorders has been determined. The sialic acid was completely released enzymatically with sialidase and quantitated by the thiobarbituric acid method. The sialic acid content of erythrocytes was constant irrespective of ABO blood type, or anticoagulant used; viz, 0.85–0.92 m̈moles/ml of packed erythrocytes or 46–53 × 10 6 sialyl residues per cell. Deviations from these normal values were obtained with erythrocytes from patients with a variety of hematological disorders. Patients with the following disorders have significantly (P < 0.01) lower sialic acid values compared to erythrocytes from healthy individuals (given in the order of decreasing sialic acid content): sickle cell anemia, acute lymphocytic leukemia, chronic lymphocytic leukemia, acute myelomonocytic leukemia, non‐Hodgkin lymphocytic lymphoma, chronic granulocytic leukemia, acute myelocytic leukemia, leukemia, and Hodgkin disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/101840/1/2830090405_ftp.pd

Lymphome Cérébral Primitif (LCP) du Sujet Immunocompétent: A Propos d’Un cas à l’Hôpital National de Niamey (HNN)

Le Lymphome Cérébral Primitif (LCP) du sujet immunocompétent est une entité rare des lymphomes Non Hodgkiniens en général et des tumeurs cérébrales en particulier. Il est caractérisé par sa sévérité clinique, mais aussi son mauvais pronostic. Nous rapportons un cas de LCP chez un sujet immunocompétent diagnostiqué au service de neurologie et pris en charge au service d’Onco-hématologie de l’Hôpital National de Niamey. &nbsp; Primary Cerebral Lymphoma (PCL) of the immunocompetent subject is a rare feature of non-Hodgkin's lymphoma in general and brain tumors in particular. It is characterized by its clinical severity, but also its poor prognosis. We report a case of LCP in an immunocompetent subject diagnosed in the neurology department and managed by Onco-hematology at the National Hospital of Niamey

Rituximab et maladie du greffon contre l'hôte chronique

La maladie du greffon contre l’hôte (« greffe-versus-hôte » – GVH) chronique (GVHc) est une complication fréquente des allogreffes de cellules souches hématopoïétiques (CSH). A l’heure actuelle, à l’exception des corticostéroïdes, peu de traitements se sont avérés réellement efficaces pour la prise en charge de la GVHc. Des données récentes suggèrent un rôle important des lymphocytes B (LB) dans la physiopathologie de la GVHc. Elles constituent le rationnel scientifique à une série d’études évaluant l’efficacité du rituximab, un anticorps monoclonal dirigé contre l’antigène CD20 exprimé à la surface des LB, dans la prévention ou le traitement de la GVHc.Peer reviewe

Ichthyosis, exocrine pancreatic insufficiency, impaired neutrophil chemotaxis, growth retardation, and metaphyseal dysplasia (Shwachman syndrome).

The Shwachman syndrome comprises exocrine pancreatic insufficiency, growth retardation, and bone marrow hypoplasia resulting in neutropenia. Clinical, morphological, and ultrastructural studies, as well as hair analysis, were performed in a patient with Shwachman's syndrome and severe ichthyosis. Clinical findings were lamellar ichthyosiform desquamation on the extremities. The hair was scanty and short on the scalp, in the eyelashes, and in the eyebrows. The nails were hyperkeratotic. Morphologic findings were slight, regular acanthosis and severe diffuse hyperkeratosis with variable parakeratosis. The granular layer was thickened. The papillary dermis showed very slight perivascular lymphocyte infiltration. The most prominent ultrastructural finding was the presence of solitary or multiple droplets of varying size in the cytoplasm of the keratinocytes. Hair analysis revealed no abnormalities; the cystine concentration in hair specimens was normal

Diagnostic et anomalies biologiques chez un drepanocytaire

La drépanocytose est une hémoglobinopathie grave, fréquemment rencontrée dans la race noire et qui se manifeste par une anémie hémolytique chronique. Son diagnostic chez l'adulte peut se faire au moyen de plusieurs tests simples ; mais la méthode diagnostique utilisant les techniques d'électrophorèse d'hémoglobine est la plus communément utilisée. Elle réalise le diagnostic positif et donne des résultats fiables. D'autres techniques plus précises telle l' isoélectrofocalisation sur gel d'acrylamide sont déjà mises au point mais ne sont pas encore d' utilisation courante dans les pays en développement. Dans la période néonatale, le diagnostic de la drépanocytose pose des problèmes d' interprétation avec la technique d'électrophorèse conventionnelle, du fait de la proportion élevée de l'hémoglobine foetale à cet âge. Il est possible de faire un diagnostic anténatal de la tare drépanocytaire. Celui-ci peut être effectué à partir de la 18è semaine d'aménorrhée ; ou même dès la 8è semaine. Il permet alors de réduire éventuellement la proportion relative des individus homozygotes mais exige une haute compétence en techniques obstétricales et en biologie moléculaire. La maladie drépanocytaire entraîne des anomalies biologiques d'une grande hétérogénéité, caractéristique de cette affection héréditaire. Mots cles: drépanocytose, diagnostic, anomalies biologiques Clinics in Mother and Child Health Vol. 1(1) 2004: 12-2

0195: Identification of patients (pts) with chronic myeloid leukemia (CML) at high risk of artery occlusive events (AOE) during treatment with the 2nd generation tyrosine kinase inhibitor (TKI) nilotinib

BackgroundNilotinib is approved for use in pts with CML after failure of imatinib and in newly diagnosed CP-CML. However, several studies report a nilotinib-associated risk of AOE (arterial occlusive event), especially in pts with preexisting risk factors for CVD. In this study, we aimed at determining whether CVD risk estimation using the 2012 ESC classification could be useful to identify patients at high risk of AOE during nilotinib therapy.MethodsPts (n=75) treated with nilotinib upfront or after failure of prior TKI at our institution were included provided that baseline CVD status could be retrospectively collected. Patients were categorized into 2 groups according to ESC 2012 classification: low/moderate (L/M) and high/very high (H/VH) CVD risk.ResultsAt nilotinib initiation, median age was 51 years (19-76), 41 pts (54.7%) were males. At baseline, medical history revealed H/VH risk category in 15 pts (20%) including established CVD in 6 pts (8%) (all diagnosed before CML), DM (diabete melitus) in 10 pts (13.3%), severe AH (arterial hypertension) in 1 pt (1.3%), familial dyslipidemia in 1 pt (1.3%) and a SCORE ≥5% in 2 pts (2.6%).AOE occurred in 12 pts with myocardial infarction (MI) or coronary heart disease (CHD) (n=3), cerebrovascular events (CeVD) (n=3) and peripheral artery disease (PAD) (n=6). Cumulative incidence of AOE by 48 months was 72.22% (95% CI: 47.46-100) in the H/VH group and only 12.13% (95% CI: 4.32-34.08) in the L/M group. Log Rank comparison of Kaplan Meier analysis of 48-month survival without AOE showed a significant difference between the 2 groups (27.78% (95% CI: 0-58.9) versus 84.38% (95% CI: 67.04-100) p=0.0001). Sensitivity of the ESC classification in nilotinib-treated patients was 67% and specificity 89%.ConclusionsIn our retrospective study, CVD risk estimation according to the 2012 ESC classification reveals that pts who belong to the H/VH risk group at baseline are at very high risk of AOE during nilotinib therapy. In this context, CVD risk should be reassessed throughout therapy and risk factors should be tightly controlled according to current guidelines