Current transfusion practice and need for new blood products to ensure blood supply for patients with major hemorrhage in Europe

Background: New blood products are considered for treatment of patients with major hemorrhage. The aim of this report is to describe the current transfusion practices in Europe for patients with major hemorrhage and explore the need for new or modified blood products to ensure prehospital and in-hospital blood supply. Study Design and Method: The European Blood Alliance (EBA) Working Group on Innovation and New Blood Products' subgroup on major hemorrhage performed a survey among the EBA member states. Results: The response rate was 58% (17 responses from 15 of the 26 EBA member states). Of these, sixteen (94%) provide massive transfusion packages (MTPs) with balanced ratio of red blood cells and plasma. Seven of the respondents included platelets from the start of treatment. Eleven (65%) provide prehospital blood products, mainly red cell concentrates or dried and/or thawed plasma with 5 days of extended storage. Two countries provide prehospital whole blood. Twelve respondents (71%) saw a need for implementation of new or modified blood components in their institution. The top three priorities were whole blood (12 of 12, 100%), dried plasma (8 of 12, 67%), and cold-stored platelets (7 of 12, 58%). Discussion: Current national guidelines for use of blood products in patients with major hemorrhage in Europe agree on the use of balanced transfusion, however the timing and source of platelets differ. Blood products for prehospital transfusion are available in several European countries. An interest in new or modified blood products for patients with major hemorrhage was observed, especially for whole blood.publishedVersio

Leucémies aiguës myéloblastiques après 70 ans dans la période 1998-2008 à Rouen

Contexte : L'incidence des leucémies aiguës myéloblastiques (LAM) augmente fortement avec l'âge. Leur pronostic est plus péjoratif chez les sujets âgés, en raison de nombreuses anomalies cytogénétiques, d'une résistance aux chimiothérapies, de modifications pharmacodynamiques, de comorbidités, et de syndromes gériatriques. Peu de publications décrivent les choix thérapeutiques réellement effectués pour ces patients. Objectifs : Etudier la survie globale (SG), les caractéristiques au diagnostic, et le traitement retenu pour des LAM de nova après 70 ans, non-promyélocytaires , entre 1998 et 2008 dans les hôpitaux de Rouen (France). Patients & méthodes: 172 patients ont été retenus (70-91 ans, médiane 77 ans, durée de suivi minimum de 30 mois, maximum plus de 120 mois, moyenne 10.3 mois, survie médiane 3 mois). Les traitements reçus étaient répartis comme suit intensif n=58 patients (34%), aracytine faible dose n=47 (27%), traitement symptomatique n=67 (39%). Le choix thérapeutique a été effectué à l'époque sans évaluation gériatrique standardisée ni critères d'exclusion formalisés. Résultats : La médiane de survie est différente selon le traitement retenu (intensif: 9 mois, aracytine faible dose : 2 mois, traitement symptomatique, 2 mois, p= 80 ans, le taux de lacticodéshydrogénases (LDH) >= 480 UI/mL, le Performance Status (PS) >= 2 et le pronostic cytogénétique et moléculaire (PCM) défavorable ont un impact indépendant sur la SG (respectivement p=0.0003, 0.0041, 0.0015 et 0.058). La dénutrition, l'index de Charlson pondéré par l'âge >= 5 et des leucocytes > 30 Giga/L présentent également un impact significatif sur la survie . La SG des patients induits (57% de rémissions complètes) est liée au PCM (favorable : 33 mois, intermédiaire : 9 mois, défavorable : 7 mois, p=0,034) et aux LDH (19 mois vs. 8 mois, p=0,014). Les patients au PCM défavorable ne retirent pas de bénéfice du traitement intensif, même avant 80 ans. Les meilleurs candidats à l'induction sont les PCM favorables ou intermédiaires de moins de 80 ans, avec des LDH normales (médiane non atteinte). Les SG sont comparables aux données déjà publiées, discrètement plus élevées pour les traitements intensifs. Nous proposons un nouvel algorithme décisionnel basé sur ces résultats. Conclusion : Sur notre échantillon, l'âge >= 80 ans, des LDH élevées, un PS >= 2 et un PCM défavorable ont un impact indépendant sur la survie globale. Ces paramètres pourraient constituer un nouvel outil de classification pronostique des LAM des sujets âgés.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Optic Nerve Infiltration in Primary Central Nervous System Lymphoma

International audienceImportance: Visual impairment in primary central nervous system lymphoma (PCNSL) is caused mostly by intraocular lymphomatous involvement (vitritis and retinal infiltration), whereas optic nerve infiltration (ONI) is a rare condition.Objective: To describe the clinical presentation of ONI, its imaging characteristics, and outcome.Design, setting and participants: A total of 752 patients diagnosed with PCNSL were retrospectively identified from the databases of 3 French hospitals from January 1, 1998, through December 31, 2014. Of these, 7 patients had documented ONI. Exclusion criteria were intraocular involvement, orbital lymphoma, or other systemic lymphoma. Clinical presentation, neuroimaging, biological features, treatment, and outcomes were assessed.Main outcomes and measures: Treatment response was evaluated clinically and radiologically on follow-up magnetic resonance imaging (MRI) according to the International PCNSL Collaborative Group response criteria.Results: The 7 patients included 5 women and 2 men. Median age at diagnosis was 65 years (range, 49-78 years). Two patients had initial ONI at diagnosis, and 5 had ONI at relapse. Clinical presentation was marked by rapidly progressive and severe visual impairment for all patients. The MRI findings showed optic nerve enlargement in 3 patients and contrast enhancement of the optic nerve in all patients. Additional CNS lesions were seen in 4 patients. Examination of cerebrospinal fluid samples detected lymphomatous meningitis in 2 patients. Clinical outcome was poor and marked by partial recovery for 2 patients and persistent severe low visual acuity or blindness for 5 patients. Median progression-free survival after optic nerve infiltration was 11 months (95% CI, 9-13 months), and median overall survival was 18 months (95% CI, 9-27 months).Conclusions and relevance: Optic nerve infiltration is an atypical and challenging presentation of PCNSL. Its visual and systemic prognosis is particularly poor compared with vitreoretinal lymphomas even in response to chemotherapy. Although intraocular involvement is frequent in PCNSL and clinically marked by slowly progressive visual deterioration, lymphomatous ONI is rare and characterized by rapidly progressive severe visual impairment

Emerging RNA-Dependent RNA Polymerase Mutation in a Remdesivir-Treated B-cell Immunodeficient Patient With Protracted Coronavirus Disease 2019

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly discovered virus for which remdesivir is the only antiviral available. We report the occurrence of a mutation in RdRP (D484Y) following treatment with remdesivir in a 76-year-old female with post-rituximab B-cell immunodeficiency and persistent SARS-CoV-2 viremia. A cure was achieved after supplementation with convalescent plasma

Programmes for the management of preoperative anaemia: audit in ten European hospitals within the PaBloE (Patient Blood Management in Europe) working group

Background and objectives Preoperative anaemia is an independent risk factor for a higher morbidity and mortality, a longer hospitalization and increased perioperative transfusion rates. Managing preoperative anaemia is the first of three pillars of Patient Blood Management (PBM), a multidisciplinary concept to improve patient safety. While various studies provide medical information on (successful) anaemia treatment pathways, knowledge of organizational details of diagnosis and management of preoperative anaemia across Europe is scarce. Materials and methods To gain information on various aspects of preoperative anaemia management including organization, financing, diagnostics and treatment, we conducted a survey (74 questions) in ten hospitals from seven European nations within the PaBloE (Patient Blood Management in Europe) working group covering the year 2016. Results Organization and activity in the field of preoperative anaemia management were heterogeneous in the participating hospitals. Almost all hospitals had pathways for managing preoperative anaemia in place, however, only two nations had national guidelines. In six of the ten participating hospitals, preoperative anaemia management was organized by anaesthetists. Diagnostics and treatment focused on iron deficiency anaemia which, in most hospitals, was corrected with intravenous iron. Conclusion Implementation and approaches of preoperative anaemia management vary across Europe with a primary focus on treating iron deficiency anaemia. Findings of this survey motivated the hospitals involved to critically evaluate their practice and may also help other hospitals interested in PBM to develop action plans for diagnosis and management of preoperative anaemia

Carfilzomib Weekly Plus Melphalan and Prednisone in Newly Diagnosed Elderly Multiple Myeloma (IFM 2012-03) / 57th Annual Meeting of the American-Society-of-Hematology - Orlando, FL

WOS:000368020103223International audienceConference: 57th Annual Meeting of the American-Society-of-Hematology - Orlando, FL - DEC 05-08, 201

Carfilzomib Weekly plus Melphalan and Prednisone in Newly Diagnosed Transplant-Ineligible Multiple Myeloma (IFM 2012-03): A Phase I Trial.

Carfilzomib is a novel generation proteasome inhibitor. The Carmysap trial demonstrated that twice-weekly KMP (carfilzomib, melphalan, prednisone) might challenge the MPV (melphalan, prednisone, bortezomib) standard. We sought to study KMP weekly, allowing to increase carfilzomib's dose with maintained efficacy and improved safety profile.info:eu-repo/semantics/publishe