Actualités thérapeutiques dans les lymphomes non hodgkiniens et le lymphome de Hodgkin

IF 1.126 (2016)International audienceIn this review, we report the main advances of the last years in the four most common lymphomas in France, namely Hodgkin lymphoma, large cell diffuse B lymphoma, follicular lymphoma and mantle cell lymphoma. We have identified consensual practices in first line in France and then distinguished the targeting by new molecules. Thus, we wanted to highlight the problems for each of these four lymphomas and understand the tools used to find solutions. Finally, this review makes it possible to understand to what extent the new molecules (targeted therapies, immunotherapy) make it possible to continuously improve the management of patients with lymphomas. The global dynamics seems to reduce the place of conventional chemotherapies in favor of these new molecules. However, because of the increase in therapeutic possibilities, the challenge remains to find the combination associated with the best risk-benefit ratio.Dans cette revue, nous rapportons les avancées majeures de ces dernières années en ce qui concerne les quatre lymphomes les plus fréquents, en France à savoir le lymphome de Hodgkin, le lymphome B diffus à grandes cellules, le lymphome folliculaire et le lymphome à cellules du manteau. Nous avons recensé les pratiques consensuelles en première ligne et distingué ensuite le ciblage par de nouvelles molécules. Ainsi, nous avons voulu mettre en exergue les problématiques pour chacun de ces quatre lymphomes et comprendre les moyens utilisés pour trouver des solutions. In fine, cette revue permet de comprendre dans quelle mesure les nouvelles molécules (thérapies ciblées, immunothérapie) permettent d’améliorer sans cesse la prise en charge des patients atteints de lymphomes. La dynamique globale semble réduire la place des chimiothérapies classiques au profit de ces nouvelles molécules. Cependant, devant la multiplication des possibilités thérapeutiques, le défi reste de trouver la combinaison associée offrant le meilleur ratio bénéfice/risque, sachant que ces nouvelles thérapies sont assorties d’effets secondaires dont la connaissance reste limitée pour l’instant

Lack of response to imatinib mesylate in a patient with accelerated phase myeloproliferative disorder with rearrangement of the platelet-derived growth factor receptor beta-gene

Imatinib mesylate has been reported to produce positive results in atypical chronic myeloproliferative disorders (CMD) with chromosomal translocations that disrupt the platelet-derived growth factor receptor beta gene (PDGFRB). We used imatinib to treat a 49-year old man with atypical CMD in accelerated phase and the H4 (D10S170)-PDGFRB fusion gene. After 3 months of treatment, we observed grade 4 hematologic toxicity and a lack of response

Secondary antifungal prophylaxis with voriconazole to adhere to scheduled treatment in leukemic patients and stem cell transplant recipients

International audienceAlthough the efficacy and safety of voriconazole to treat invasive fungal infections have been demonstrated in prospective trials, its use for secondary prophylaxis to prevent reactivation of these infections remains unknown. Delaying the scheduled treatment of leukemia until complete resolution of fungal infection may have major implications for prognosis. We report 11 leukemic patients with previous aspergillus (n = 10) and candida ( n = 1) infection who received voriconazole 400 mg/day intravenously or orally for between 44 and 245 days. Nine patients were scheduled for allogeneic stem cell transplant, and two for consolidation therapy for acute leukemia. None of the patients had a relapse of fungal infection, and scheduled treatment was delayed only once. Voriconazole was well tolerated, except in one patient who had abnormal liver tests secondary to hepatic graft-versus-host disease, and one who had visual disturbances. This small but homogeneous series indicates that voriconazole may be useful to prevent fungal relapse during at-risk periods in leukemic patients. Prospective trials are warranted to confirm these encouraging results

Secondary antifungal prophylaxis with voriconazole to adhere to scheduled treatment in leukemic patients and stem cell transplant recipients

This study has been partially presented as a poster at the 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, CA, 27–30 September 2002 (Abstract M 894)International audienceAlthough the efficacy and safety of voriconazole to treat invasive fungal infections have been demonstrated in prospective trials, its use for secondary prophylaxis to prevent reactivation of these infections remains unknown. Delaying the scheduled treatment of leukemia until complete resolution of fungal infection may have major implications for prognosis. We report 11 leukemic patients with previous aspergillus (n = 10) and candida ( n = 1) infection who received voriconazole 400 mg/day intravenously or orally for between 44 and 245 days. Nine patients were scheduled for allogeneic stem cell transplant, and two for consolidation therapy for acute leukemia. None of the patients had a relapse of fungal infection, and scheduled treatment was delayed only once. Voriconazole was well tolerated, except in one patient who had abnormal liver tests secondary to hepatic graft-versus-host disease, and one who had visual disturbances. This small but homogeneous series indicates that voriconazole may be useful to prevent fungal relapse during at-risk periods in leukemic patients. Prospective trials are warranted to confirm these encouraging results

Secondary antifungal prophylaxis with voriconazole to adhere to scheduled treatment in leukemic patients and stem cell transplant recipients

International audienceAlthough the efficacy and safety of voriconazole to treat invasive fungal infections have been demonstrated in prospective trials, its use for secondary prophylaxis to prevent reactivation of these infections remains unknown. Delaying the scheduled treatment of leukemia until complete resolution of fungal infection may have major implications for prognosis. We report 11 leukemic patients with previous aspergillus (n = 10) and candida ( n = 1) infection who received voriconazole 400 mg/day intravenously or orally for between 44 and 245 days. Nine patients were scheduled for allogeneic stem cell transplant, and two for consolidation therapy for acute leukemia. None of the patients had a relapse of fungal infection, and scheduled treatment was delayed only once. Voriconazole was well tolerated, except in one patient who had abnormal liver tests secondary to hepatic graft-versus-host disease, and one who had visual disturbances. This small but homogeneous series indicates that voriconazole may be useful to prevent fungal relapse during at-risk periods in leukemic patients. Prospective trials are warranted to confirm these encouraging results