Comparison of the Hemostatic Efficacy of Pathogen-Reduced Platelets vs Untreated Platelets in Patients With Thrombocytopenia and Malignant Hematologic Diseases: A Randomized Clinical Trial

Importance: Pathogen reduction of platelet concentrates may reduce transfusion-transmitted infections but is associated with qualitative impairment, which could have clinical significance with regard to platelet hemostatic capacity. Objective: To compare the effectiveness of platelets in additive solution treated with amotosalen-UV-A vs untreated platelets in plasma or in additive solution in patients with thrombocytopenia and hematologic malignancies. Design, Setting, and Participants: The Evaluation of the Efficacy of Platelets Treated With Pathogen Reduction Process (EFFIPAP) study was a randomized, noninferiority, 3-arm clinical trial performed from May 16, 2013, through January 21, 2016, at 13 French tertiary university hospitals. Clinical signs of bleeding were assessed daily until the end of aplasia, transfer to another department, need for a specific platelet product, or 30 days after enrollment. Consecutive adult patients with bone marrow aplasia, expected hospital stay of more than 10 days, and expected need of platelet transfusions were included. Interventions: At least 1 transfusion of platelets in additive solution with amotosalen-UV-A treatment, in plasma, or in additive solution. Main Outcomes and Measures: The proportion of patients with grade 2 or higher bleeding as defined by World Health Organization criteria. Results: Among 790 evaluable patients (mean [SD] age, 55 [13.4] years; 458 men [58.0%]), the primary end point was observed in 126 receiving pathogen-reduced platelets in additive solution (47.9%; 95% CI, 41.9%-54.0%), 114 receiving platelets in plasma (43.5%; 95% CI, 37.5%-49.5%), and 120 receiving platelets in additive solution (45.3%; 95% CI, 39.3%-51.3%). With a per-protocol population with a prespecified margin of 12.5%, noninferiority was not achieved when pathogen-reduced platelets in additive solution were compared with platelets in plasma (4.4%; 95% CI, -4.1% to 12.9%) but was achieved when the pathogen-reduced platelets were compared with platelets in additive solution (2.6%; 95% CI, -5.9% to 11.1%). The proportion of patients with grade 3 or 4 bleeding was not different among treatment arms. Conclusions and Relevance: Although the hemostatic efficacy of pathogen-reduced platelets in thrombopenic patients with hematologic malignancies was noninferior to platelets in additive solution, such noninferiority was not achieved when comparing pathogen-reduced platelets with platelets in plasma. Trial Registration: clinicaltrials.gov Identifier: NCT01789762

Présentation du dossier « metal studies » : la naissance d'un champ

La rédaction de Volume ! voulait proposer, avec ce dossier de notes de lectures, un panorama de la recherche récente en metal studies, comme il est devenu commun d’appeler ce champ de recherches aujourd’hui au sein de la communauté internationale. Un domaine encore quasi-inexistant au début de ce siècle en sciences sociales (on n’employait d’ailleurs pas ce terme), mais qui se développe de manière exponentielle depuis 2008 au niveau mondial. Preuve en est le récent colloque « Heavy metal and ..

TRAITE A LA MACHINE DES CHÈVRES. COMPARAISON DE DEUX RAPPORTS DE PULSATION ET EFFICACITÉ DE LA PRÉPARATION DE LA MAMELLE AVANT LA TRAITE

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Estimation of milk leakage into the rumen of milk-fed calves through an indirect and repeatable method

In milk-fed calves, quantification of the milk that enters the rumen (ruminal milk volume, RMV) because of malfunction of the esophageal groove reflex may explain part of the variability observed between animals in their growth performance. The RMV can directly be quantified by adding an indigestible marker to the diet and measuring its recovery in the rumen at slaughter, but this technique cannot be repeated in time in the same animal. The objective of the study was to evaluate three indirect methods for estimating RMV. The first method was based on the assumption that ruminal drinking delays and limits acetaminophen appearance in blood after ingestion of milk supplemented with acetaminophen. The second method was based on a negative linear relationship between RMV and urinary recovery of non-metabolizable monosaccharides (3-O-methylglucose, l-rhamnose and d-xylose) added to the milk, owing to rumen fermentation. In the third method, RMV was calculated as the difference between total milk intake and the increase in abomasal milk volume (AMV) at feeding, measured through ultrasonography shortly after feeding, or estimated from the mathematical extrapolation of AMV to feeding time, based on consecutive measurements. These methods were tested in three experiments where calves (n=22, 10 and 13) were bucket fed or partly tube fed (i.e. by inserting milk replacer into the rumen via a tube to mimic ruminal drinking). In addition, Co-EDTA and Cr-EDTA were used as an indigestible marker in one experiment to trace bucket-fed or tube-fed milk replacer, respectively, to measure RMV. The relationship between AMV measured by ultrasonography and AMV measured at slaughter improved when kinetics of AMV were extrapolated to the time of slaughter by mathematical modeling (error between predicted and measured AMV equaled 0.49 l). With this technique, RMV during feeding averaged 17% and 24% of intake in Experiments 2 and 3, respectively. Plasma acetaminophen kinetics and recovery of non-metabolizable monosaccharides in urine were partly associated with ruminal drinking, but these techniques are not considered quantitatively accurate without further information of rumen degradation and absorption. The recovery of indigestible marker measured at slaughter gave a quantitative estimate of RMV (2% in Experiment 3), but improper measurement of emptying rate of fluid from the rumen may lead to underestimation. In conclusion, measuring changes in AMV by ultrasonography, in response to milk feeding, was the most promising indirect method to quantify RMV in veal calves

Utilisation of immunosuppressants in the prevention of a graft versus host reaction : report by the SFGM-TC

Dans une démarche qui vise à unifonniser les procédures d'allogreffe de cellules souches hématopoïétiques (CSH), la Société française de greffe de moelle et de thérapie cellulaire (SFGM-TC), a organisé les quatrièmes ateliers d'harmonisation des pratiques en septembre 2013 à Lille. Dans cet atelier nous abordons les immunosuppresseurs utilisés dans la prévention de la réaction du greffon contre l'hôte: rapport de la SFGM-TC.In the attempt to harmonize dinical practîces between different French transplantation centers, the Frenell Society of Bane Marrow Transplantation and Cell Therapy (SFGM-TC) set up the fourth annual series of workshops which brought together practitioners from all member centers and taak place in September 2013 in Lille. Here we report our recommendatÎons regarding the use of immunosuppressive treatment in the prevention of graft versus hast disease: repOlt by the SFGM-TC

VAC-02 - Réponse vaccinale après greffe allogénique de cellules souches hépatopoïétiques : étude de cohorte prospective

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Candidose disséminée chronique et leucémie aiguë : impact sur la survie et l’agenda de transplantation de cellules souches hématopoïétiques

International audienceOBJECTIVES: To study the management of chronic disseminated candidiasis (CDC) in patients presenting with acute leukemia. PATIENTS AND METHODS: Single-center retrospective study of acute leukemia patients (2006-2015) to investigate three aspects of CDC: its impact on the time interval between diagnosis and hematopoietic stem cell transplantation, when required (non-parametric Wilcoxon-Mann-Whitney test); its impact on overall survival (Cox proportional hazard regression model); antifungal therapeutic strategies implemented. RESULTS: A total of 639 patients presenting with acute leukemia were included; 144 were transplanted and 29 developed CDC. CDC did not significantly increase the time interval between diagnosis and transplantation, nor did it impact the overall survival of recipients. An improved overall survival was observed in non-transplanted acute leukemia patients presenting with CDC. CONCLUSION: CDC should not postpone transplantation if antifungal treatment is optimized.ObjectifsÉtudier la candidose disséminée chronique (CDC) associée à une leucémie aiguë.Patients et méthodesÉtude monocentrique rétrospective (2006–2015) chez des patients atteints de leucémie aiguë évaluant trois aspects de la CDC : son impact sur l’intervalle diagnostic-transplantation de cellules souches hématopoïétiques, quand requise (test non paramétrique de Wilcoxon-Mann-Whitney); son impact sur le pronostic global des patients (modèle de régression de Cox) ; stratégies antifongiques utilisées.RésultatsAu total, 639 patients atteints de leucémies aiguës ont été inclus ; 144 ont reçu une transplantation et 29 ont présenté une CDC. La CDC n’a pas significativement augmenté l’intervalle diagnostic-transplantation et n’a pas impacté la survie globale des patients transplantés. Une meilleure survie globale a été observée chez les patients atteints de leucémie aiguë non transplantés présentant une CDC.ConclusionLa CDC ne doit pas différer l’agenda de transplantation si le traitement antifongique est optimisé

Allogeneic Stem Cell Transplantation from Unmanipulated Haploidentical Donors Versus Unrelated Cord Blood in Patients with T-Cell non-Hodgkin Lymphoma: A Retrospective Study from the Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC)

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