Devenir des patients atteints d'hémopathies malignes hospitalisés en hématologie et transférés en réanimation au CHU de Clermont-Ferrand entre 2007 et 2011 (étude rétrospective de 120 patients)

Contrairement aux études datant de plus de 15 ans, les travaux récents montrent une amélioration du devenir des patients d'onco-hématologie transférés en réanimation. L'objectif est d'évaluer la mortalité en réanimation et les facteurs pronostiques de décès. Il s'agit d'une étude rétrospective monocentrique clermontoise sur les patients d'onco-hématologie transférés en réanimation entre juin 2007 et avril 2011. 120 patients ont été transférés. 69 patients ont une leucémie aiguë, 31 ont eu une allogreffe de cellules souches hématopoiétiques. 38 patients sont transférés à la phase initiale de leur maladie, 64 sont en 1ère ligne de traitement. A l'admission en réanimation, l'IGS2 médian est à 58 [29-126], le SOFA médian à 8 [0-23]. La détresse respiratoire aiguë est le 1er motif de transfert (35%). 64 patients sont intubés. Le taux de décès en réanimation est de 57% pour l'ensemble des patients de l'étude, il est de 81% en cas de recours à la ventilation mécanique. La survie est de 32% à J100, 27% à 6 mois et 19% à 12 mois. En analyse multivariée, l'évolution des défaillances d'organe dans les 6 premiers jours, le recours à la ventilation mécanique et le recours à l'épuration extra-rénale sont pronostiques de mortalité en réanimation. Ce travail souligne l'importance de l'évolution des défaillances d'organes dans les 1ers jours suivant l'admission. Cela incite à la réévaluation régulière et concertée entre hématologues et réanimateurs des patients d'onco-hématologie admis en réanimation et encourage à la collaboration étroite entre les 2 disciplines pour détecter les 1ers signes d'aggravation.CLERMONT FD-BCIU-Santé (631132104) / SudocSudocFranceF

Evaluation du taux réponse histologique complète après un traitement néoadjuvant combinant docetaxel et trastuzumab chez des patientes porteuses d'un adénocarcinome mammaire localement avancé opérable et surexprimant HER2 (3+)

DIJON-BU Médecine Pharmacie (212312103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Radiotherapy or Autologous Stem-Cell Transplantation for Primary CNS Lymphoma in Patients Age 60 Years and Younger: Long-Term Results of the Randomized Phase II PRECIS Study

International audienceClinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.We previously reported the results of a randomized phase II study in patients with newly diagnosed primary CNS lymphoma (age 18-60 years). Patients were treated with high-dose methotrexate-based induction chemotherapy followed by whole-brain radiotherapy (WBRT) or high-dose chemotherapy (thiotepa-busulfan-cyclophosphamide) with autologous stem-cell transplantation (ASCT). The median follow-up was 33 months. In this report, we provide long-term data (median follow-up, 8 years) regarding the outcomes and toxicities. Fifty-three and 44 patients received induction chemotherapy followed by WBRT or ASCT, respectively. Their 8-year event-free survival from random assignment was 67% and 39% in the ASCT and WBRT arms, respectively (P = .03), with a significantly lower risk of relapse after ASCT (hazard ratio = 0.13, P < .001). One third of patients who relapsed after WBRT were alive after salvage treatment. Five and four patients died of ASCT and WBRT-related toxicities, respectively. The 8-year overall survival was 69% and 65% in the ASCT and WBRT arms, respectively (not significant). Balance (52% v 10%, P ≤ 0.001) and neurocognition (64% v 13%, P < .001) significantly deteriorated after WBRT compared with ASCT during the follow-up. This study shows that 40 Gy WBRT should be avoided in first-line treatment because of its neurotoxicity and suboptimal efficacy in reducing relapses while ASCT appears to be highly efficient in preventing relapses

Scedosporiosis/lomentosporiosis observational study (SOS): Clinical significance of Scedosporium species identification

International audienceScedosporiosis/lomentosporiosis is a devastating emerging fungal infection. Our objective was to describe the clinical pattern and to analyze whether taxonomic grouping of the species involved was supported by differences in terms of clinical presentations or outcomes. We retrospectively studied cases of invasive scedosporiosis in France from 2005 through 2017 based on isolates characterized by polyphasic approach. We recorded 90 cases, mainly related to Scedosporium apiospermum (n = 48), S. boydii/S. ellipsoideum (n = 20), and Lomentospora prolificans (n = 14). One-third of infections were disseminated, with unexpectedly high rates of cerebral (41%) and cardiovascular (31%) involvement. In light of recent Scedosporium taxonomic revisions, we aimed to study the clinical significance of Scedosporium species identification and report for the first time contrasting clinical presentations between infections caused S. apiospermum, which were associated with malignancies and cutaneous involvement in disseminated infections, and infections caused by S. boydii, which were associated with solid organ transplantation, cerebral infections, fungemia, and early death. The clinical presentation of L. prolificans also differed from that of other species, involving more neutropenic patients, breakthrough infections, fungemia, and disseminated infections. Neutropenia, dissemination, and lack of antifungal prescription were all associated with 3-month mortality. Our data support the distinction between S. apiospermum and S. boydii and between L. prolificans and Scedosporium sp. Our results also underline the importance of the workup to assess dissemination, including cardiovascular system and brain. Lay Summary Scedosporiosis/lomentosporiosis is a devastating emerging fungal infection. Our objective was to describe the clinical pattern and to analyze whether taxonomic grouping of the species involved was supported by differences in terms of clinical presentations or outcomes

Prognostic value of high-sensitivity measurable residual disease assessment after front-line chemoimmunotherapy in chronic lymphocytic leukemia

International audienceMeasurable residual disease (MRD) status is widely adopted in clinical trials in patients with chronic lymphocytic leukemia (CLL). Findings from FILO group trials (CLL2007FMP, CLL2007SA, CLL2010FMP) enabled investigation of the prognostic value of high-sensitivity (0.7 × 10-5) MRD assessment using flow cytometry, in blood (N = 401) and bone marrow (N = 339), after fludarabine, cyclophosphamide, and rituximab (FCR)-based chemoimmunotherapy in a homogeneous population with long follow-up (median 49.5 months). Addition of low-level positive MRD < 0.01% to MRD ≥ 0.01% increased the proportion of cases with positive MRD in blood by 39% and in bone marrow by 27%. Compared to low-level positive MRD < 0.01%, undetectable MRD was associated with significantly longer progression-free survival (PFS) when using blood (72.2 versus 42.7 months; hazard ratio 0.40, p = 0.0003), but not when using bone marrow. Upon further stratification, positive blood MRD at any level, compared to undetectable blood MRD, was associated with shorter PFS irrespective of clinical complete or partial remission, and a lower 5-year PFS rate irrespective of IGHV-mutated or -unmutated status (all p < 0.05). In conclusion, high-sensitivity (0.0007%) MRD assessment in blood yielded additional prognostic information beyond the current standard sensitivity (0.01%). Our approach provides a model for future determination of the optimal MRD investigative strategy for any regimen