Clinical, electroretinographic and histomorphometric evaluation of the retina in sheep with natural scrapie

Background: The retina is part of the diencephalon in a peripheral location and may be involved in prion diseases. Retinal function and structural changes were assessed in naturally scrapie-affected red face Manech ewes presenting the classical signs of the disease, and clinically healthy age-matched subjects for controls. Ophthalmic examination was done prior to electroretinography (ERG), which was carried out under conditions that allowed photopic and scotopic activities to be assessed. Histomorphometry of the inner and outer retinal layers was performed post-mortem, and retinas were also examined for evidence of abnormal prion protein (PrPSc) accumulation and glial fibrillary acidic protein (GFAP) upregulation as a marker of gliosis. Scrapie status was determined by examination of brain tissue Results: Ocular reflexes and ophthalmoscopy did not reveal any difference between scrapie affected and control animals. Although the light-and dark-adapted ERG responses of both rod-and cone-mediated functions had a similar waveform in scrapie-affected and control sheep, a significant reduction in the amplitude of the ERG a-and b-waves was observed in affected animals compared to controls. These functional alterations were correlated with a substantial loss of cells in the outer nuclear layer (ONL), lengthening and disorganization in photoreceptor segments, and substantial reduction in cellularity and thickness of the inner nuclear layer (INL). The degenerative changes in the INL and ONL were most marked in the central and paracentral areas of the scrapie retinas, and were accompanied in all scrapie retinas by PrPSc deposition in the ganglion cell and synaptic layers. GFAP immunoreactivity was mainly increased in the ganglion cell and inner plexiform layers. Conclusions: No appreciable fundoscopic changes were observed in the scrapie-affected ewes although reproducible changes in retinal function as measured by ERG were observed in these animals. The alterations in the receptoral and post-receptoral pathways corresponded to the degenerative lesions observed in the ONL and INL of the scrapie retinas. The retinal degeneration was associated with prion protein infectivity which presumably spread via the optic nerve

Ruxolitinib as a promising treatment for corticosteroid-refractory graft-versus-host disease

International audienc

Clinical, electroretinographic and histomorphometric evaluation of the retina in sheep with natural scrapie

Abstract Background The retina is part of the diencephalon in a peripheral location and may be involved in prion diseases. Retinal function and structural changes were assessed in naturally scrapie-affected red face Manech ewes presenting the classical signs of the disease, and clinically healthy age-matched subjects for controls. Ophthalmic examination was done prior to electroretinography (ERG), which was carried out under conditions that allowed photopic and scotopic activities to be assessed. Histomorphometry of the inner and outer retinal layers was performed post-mortem, and retinas were also examined for evidence of abnormal prion protein (PrPSc) accumulation and glial fibrillary acidic protein (GFAP) upregulation as a marker of gliosis. Scrapie status was determined by examination of brain tissue Results Ocular reflexes and ophthalmoscopy did not reveal any difference between scrapie affected and control animals. Although the light-and dark-adapted ERG responses of both rod-and cone-mediated functions had a similar waveform in scrapie-affected and control sheep, a significant reduction in the amplitude of the ERG a-and b-waves was observed in affected animals compared to controls. These functional alterations were correlated with a substantial loss of cells in the outer nuclear layer (ONL), lengthening and disorganization in photoreceptor segments, and substantial reduction in cellularity and thickness of the inner nuclear layer (INL). The degenerative changes in the INL and ONL were most marked in the central and paracentral areas of the scrapie retinas, and were accompanied in all scrapie retinas by PrPSc deposition in the ganglion cell and synaptic layers. GFAP immunoreactivity was mainly increased in the ganglion cell and inner plexiform layers. Conclusions No appreciable fundoscopic changes were observed in the scrapie-affected ewes although reproducible changes in retinal function as measured by ERG were observed in these animals. The alterations in the receptoral and post-receptoral pathways corresponded to the degenerative lesions observed in the ONL and INL of the scrapie retinas. The retinal degeneration was associated with prion protein infectivity which presumably spread via the optic nerve.</p

Thiotepa, Busulfan, Cyclophosphamide: Effective but Toxic Conditioning Regimen Prior to Autologous Hematopoietic Stem Cell Transplantation in Central Nervous System Lymphoma

In primary central nervous system lymphoma, two-year progression-free survival rates of up to 63 percent have been reported for first-line autologous stem cell transplantation after conditioning with the thiotepa busulfan cyclophosphamide regimen. However, 11 percent of the patients died due to toxicity. Besides conventional survival, progression-free survival and treatment related mortality analyses, a competing-risk analysis was applied to our cohort of twenty-four consecutive patients with primary or secondary central nervous system lymphoma who underwent autologous stem cell transplantation after thiotepa busulfan cyclophosphamide conditioning. The two-year overall survival and progression-free survival rates were 78 percent and 65 percent, respectively. The treatment-related mortality rate was 21 percent. The competing risks analysis demonstrate that age 60 or over and the infusion of less than 4.6 &times; 106/kg CD34+ stem cells were significant adverse prognostic factors for overall survival. Autologous stem cell transplantation with thiotepa busulfan cyclophosphamide conditioning was associated with sustained remission and survival. Nevertheless, the intensive thiotepa busulfan cyclophosphamide conditioning regimen was highly toxic, especially in older patients. Thus, our results suggest that future studies should aim at identifying the subgroup of patients who will really benefit of the procedure and/or to reduce the toxicity of future conditioning regimen

THIOTEPA BUSULFAN CYCLOPHOSPHAMIDE, A TOXIC CONDITIONING FOR AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION IN CENTRAL NERVOUS SYSTEM LYMPHOMA: REMISSION OR INFECTION?

22nd Congress of the European-Hematology-Association, Madrid, SPAIN, JUN 22-25, 2017International audienc

THIOTEPA BUSULFAN CYCLOPHOSPHAMIDE, A TOXIC CONDITIONING FOR AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION IN CENTRAL NERVOUS SYSTEM LYMPHOMA: REMISSION OR INFECTION?

22nd Congress of the European-Hematology-Association, Madrid, SPAIN, JUN 22-25, 2017International audienc

Sequential conditioning in unfavorable AML: a single center experience

44th Annual Meeting of the European-Society-for-Blood-and-Marrow-Transplantation (EBMT), Lisbon, PORTUGAL, MAR 18-21, 2018International audienc

Sequential conditioning in unfavorable AML: a single center experience

44th Annual Meeting of the European-Society-for-Blood-and-Marrow-Transplantation (EBMT), Lisbon, PORTUGAL, MAR 18-21, 2018International audienc

Impact of Residence in an Agricultural Zone on AML Characteristics

International audienceBackground: Acute Myeloid Leukemia (AML) is associated with several well-established risk factors. These include cigarette smoking, exposure to benzene, to ionizing radiation, and previous exposure to chemotherapy. Interestingly, studies have observed higher incidence rates of AML in farming regions, suggesting that farming activities and related exposures, such as pesticides, may increase the risk. However, data regarding the potential variations in clinical, cytogenetic, and molecular profiles between individuals living in rural and urban areas are lacking. Therefore, we aim to specifically examine the characteristics and the outcomes of AML patients living in agricultural areas. Patients and methods: We performed a retrospective analysis including 315 patients newly diagnosed with AML from two French institutions, namely Amiens University Hospital and Lille University Hospital, from 2008 to 2013. We collected patient demographics, along with comprehensive data encompassing clinical and biological information, including cytogenetics and molecular data. The data was obtained from the Observatoire des Hauts-de-France, enabling a comprehensive and exhaustive review of the AML cases in this specific region. We geocoded the patients' residential addresses. This process involved linking the patient's location to the corresponding agricultural areas per municipality, by using geographical information from the French Ministry of Agriculture's statistics department (AGRESTE, https://www.agreste.agriculture.gouv.fr). This enabled us to establish a connection between the patients' locations and the specific agricultural regions they resided in. We categorized the population into terciles based on the proportion of local companies engaged in farming activities. Results: Approximately one-third (n=108) of patients were living in areas with less than 1.3% of farm companies, one-third (n=102) lived in regions with a percentage ranging from 1.3% to 6.9%, while the remaining third (n=105) lived in areas where the proportion of farm companies exceeded 6.9%. Sex ratio (p=0.7) and median age at diagnosis (60 vs 60.5 vs 58 years, p=0.5) were similar between the 3 groups. There was no difference in body mass index (BMI), smoking activity, alcohol consumption and performance status score between the three groups. At baseline, there was no difference in blood counts (hemoglobin, platelets, leukocytes, and circulating blasts levels), bone marrow blasts percentage, AML type (de novo vs. post MDS or MPN), or WHO classification between the 3 groups. Regarding cytogenetic abnormalities, people living on agricultural lands had fewer normal karyotypes (27% vs 33% and 43%, p=0.045) and more MLL rearrangement (20% vs 8% and 5%, p=0.013). However, there was no difference in the SWOG and ELN 2017 classifications. Regarding molecular characteristics, NPM1 mutations were found less frequently in people living in agricultural regions (13% vs 30% and 29%, p=0.021). There was no difference for FLT3-ITD positivity and CEBPA mutation. There was no difference in complete remission rate and hematopoietic stem cell transplantation treatment though we could underline an especially low rate of HSCT in the &lt; 1.3% group. OS was also similar between the three groups (Table 1.). Conclusions: Our study showed a correlation between living in agricultural areas and a higher prevalence of unfavorable cytogenetic and molecular features in AML patients, although clinical outcomes remain unchanged. These findings suggest that the proximity to agricultural activities could have an impact on leukemogenesis, by increasing the rate of MLL rearrangements and chromosomic abnormalities

Immunomodulation with azacytidine and donor lymphocyte infusion following sequential conditioning allogenic stem cell transplantation improves outcome of unfavorable AML

61st Annual Meeting and Exposition of the American-Society-of-Hematology (ASH), Orlando, FL, DEC 07-10, 2019International audienceBackground:Patients with acute myeloid leukemia in relapse or refractory to induction therapy have dismal prognosis. Response rates to common salvage regimens are low and allogenic hematopoietic stem cell transplantation is the only curative option. Several studies have demonstrated that salvage chemotherapy with sequential conditioning could reduce leukemia relapse risk with an acceptable toxicity profile for unfavorable acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). [1] Therefore, we decided to assess this procedure in our center at Amiens University Hospital.MethodsWe conducted a monocentric retrospective study, including 53 patients aged over 18 years undergoing a hematopoietic stem cell transplant (HSCT) with sequential conditioning between January 2012 and December 2018, for relapse/refractory AML or high risk MDS. 44 (83%) patients received sequential conditioning containing clofarabine (SET-RIC) or Amsacrine (FLAMSA) and 9 (17%) thiotepa based (TEC-RIC) with post-transplant cyclophosphamide for mismatched donors. Patients who were GVHD free after immunosuppressors withdrawal received immunomodulation as relapse prevention with azacytidine 37.5mg/m²/day 5 days every 4 weeks for 12 cycles with 3 donor lymphocyte infusions (DLI) alterned between azacytidine cycles.ResultsThe median age was 52 years (range 18-70). Before conditioning, 48 patients had unfavorable AML with ELN intermediate score refractory to at least one course of induction therapy or in relapse, or unfavorable ELN score; 5 patients had high risk MDS with complex karyotype. 32 patients (60,5%) had active disease and 21 (39,5%) were in complete remission (CR) including 12 with positive MRD. 13 (24,5%) patients had HLA-identical sibling donors, 27 (51%) match unrelated donors (MUD), 4 (7,5%) mismatch unrelated donors (MMD) and 9 (17%) haploidentical donors. Majority of patients (90,5%) received peripheral blood stem cell (PBSC) PBSC with median CD34+ count of 7,94.106/kg (1,84-8,44). Acute GvHD prophylaxis with Ciclosporin A, in combination with Mycophenolate mofetil for MUD/MMR/Haplo, was withdrawal with a median time of 90 days.With a median follow-up of 40 months, overall survival (OS) at 1 and 2 years was 68% and 52%. Median OS was 18,7 months (0-72,4 months) and median disease free survival (DFS) was 14,9 months (0-72,4 months). 17 patients (32%) experienced relapse after HSCT with a median time from HSCT to relapse of 6 months (1-35 months). 22 (41,5%) of patients presented with grade I-II acute graft versus host disease (GVHD) and 6 (11,3%) with grade III IV aGVHD . GVHD free relapse free survival (GRFS) at 1 and 2 years was 53% and 34,2%. One-year cumulative incidence of disease related death and non-relapse mortality was 12,6% and 17% respectively. 19 patients received immunomodulation with 5 Azacitidine and DLI if no GVHD occurred within day 120. OS was 79 % in the 19 patients receiving DLI. In univariate analysis immunomodulation post HSCT (Figure 1) was significantly associated with overall survival and leukemia free survival (p=0,0164 and p=0,0359 respectively) but not the disease status before HSCT (p=0,7). Immunomodulation administration with azacytidine and DLI was not significantly associated with cGVHD occurrence (p=0.31). Benefit of immunomodulation OS persisted in multivariate analysis (p=0.0284).Conclusion:Sequential conditioning regimen on refractory AML with secondary immunomodulation with azacytidine and DLI shows very good results with an acceptable toxicity profile in unfavorable AML. We achieve very good OS and DFS whatever disease status before HSCT. GRFS is also encouraging comparing to previously report datas [1]