Salvage use of allogeneic hematopoietic stem cell transplantation after reduced intensity conditioning from unrelated donors in multiple myeloma. A study by the Plasma Cell Disorders subcommittee of the European Group for Blood and Marrow Transplant Chronic Malignancies Working Party

Non peer reviewe

Unrelated stem cell transplantation for severe acquired aplastic anemia: improved outcome in the era of high-resolution HLA matching between donor and recipient

Background and Objectives Severe acquired aplastic anemia (SAA) is a potentially fatal bone marrow failure syndrome occurring mainly in children and young adults. Immunosuppressive regimens and hematopoietic stem cell transplantation (HSCT) are the only two available curative treatments. Patients who lack an HLA-identical sibling donor may receive HSCT from an unrelated donor, a strategy historically associated with high mortality rates. Thus, for patients refractory to immunosuppressive regimens, the decision to transplant stem cells from unrelated donors is weighed against supportive care and often represents a dilemma for physicians. We aimed to determine whether outcome after unrelated HSCT has improved in recent years and, if so, to determine the factors responsible for the improvement.Design and Methods We analyzed the outcome of 89 patients (median age 17 years, range 0–52) with acquired SAA undergoing HSCT from an unrelated donor between 1989 and 2004. Cases were consecutively reported to the French Registry (SFGM-TC) by 25 centers.Results Patients transplanted during two successive time-periods (1989–1998 and 1999–2004) had different 5-year survival probabilities (±95% confidence interval): 29±7% and 50±7%, respectively (

Outcome after allogeneic stem cell transplantation with haploidentical versus HLA-matched donors in patients with higher-risk MDS.

peer reviewedAllogeneic hematopoietic stem cell transplantation remains the best curative option for higher-risk myelodysplastic syndrome. The presence of monosomal karyotype and/or complex karyotype abnormalities predicts inferior survival after allo-SCT in MDS patients. Haploidentical allo-SCT has been increasingly used in acute leukemia (AL) and has similar results as using HLA-matched donors, but data on higher-risk MDS is sparse. We compared outcomes in 266 patients with higher-risk MDS after HLA-matched sibling donor (MSD, n = 79), HLA-matched unrelated donor (MUD, n = 139) and HLA haploidentical donor (HID, n = 48) from 2010 to 2019. Median donor age differed between the three groups (p < 0.001). The overall survival was significantly different between the three groups with a better OS observed in the MUD group (p = 0.014). This observation could be explained by a higher progression-free survival with MUD (p = 0.014). The cumulative incidence of grade 2-4 acute GvHD was significantly higher in the HID group (p = 0.051). However, in multivariable analysis, patients transplanted using an HID had comparable mortality to patients transplanted using a MUD (subdistribution hazard ratio [sHR]: 0.58 [0.32-1.07]; p = 0.080) and a MSD ([sHR]: 0.56 [0.28-1.11]; p = 0.094). MUD do not remain a significant positive predictor of survival, suggesting that beyond the donor-recipient HLA matching, the donor age might impact recipient outcome

Bone marrow graft versus peripheral blood graft in haploidentical hematopoietic stem cells transplantation: a retrospective analysis in1344 patients of SFGM-TC registry.

peer reviewedThe use of peripheral blood (PB) or bone marrow (BM) stem cells graft in haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide (PTCy) for graft-versus-host disease (GVHD) prophylaxis remains controversial. Moreover, the value of adding anti-thymoglobulin (ATG) to PTCy is unknown. A total of 1344 adult patients received an unmanipulated haploidentical transplant at 37 centers from 2012 to 2019 for hematologic malignancy. We compared the outcomes of patients according to the type of graft, using a propensity score analysis. In total population, grade II-IV and III-IV acute GVHD (aGVHD) were lower with BM than with PB. Grade III-IV aGVHD was lower with BM than with PB + ATG. All outcomes were similar in PB and PB + ATG groups. Then, in total population, adding ATG does not benefit the procedure. In acute leukemia, myelodysplastic syndrome and myeloproliferative syndrome (AL-MDS-MPS) subgroup receiving non-myeloablative conditioning, risk of relapse was twice greater with BM than with PB (51 vs. 22%, respectively). Conversely, risk of aGVHD was greater with PB (38% for aGVHD II-IV; 16% for aGVHD III-IV) than with BM (28% for aGVHD II-IV; 8% for aGVHD III-IV). In this subgroup with intensified conditioning regimen, risk of relapse became similar with PB and BM but risk of aGVHD III-IV remained higher with PB than with BM graft (HR = 2.0; range [1.17-3.43], p = 0.012)

Attention disorders in adults with epilepsy. Determinants and therapeutic strategies

International audienceCognitive consequences in epilepsy are often described in the following domains: verbal memory, language, executive functions, and attention. Attention is involved in all cognitive activities, and attention disorders (AD) are reported in patients with various neurological diseases. This paper proposes to define the concept of AD and its assessment, to consider their determinants in epilepsy and potential therapies (drug or not). ADs are reported in new onset epilepsy, generalized epilepsy of presumed genetic origin, and in focal epilepsy. In focal epilepsy, alertness and divided attention impairment are observed and seem to improve after successful curative surgery. Additional studies are needed to assess the prevalence and nature of AD related to status epilepticus. In the field of therapeutic strategies, anti-epileptic drugs show an impact on AD. Effects of antidepressive drug therapy are not reported, as well as psychotherapy. Cognitive rehabilitation on AD is a promising therapeutic intervention but specific studies are needed to assess its efficacy

Do trees use reserve or newly assimilated carbon for their defense reactions ? A 13C labeling approach with young Scots pines inoculated with a bark-beetle-associated fungus (Ophiostoma brunneo ciliatum)

Three-year-old saplings of Pinus sylvestris L. were labeled with 13CO2 prior to inoculating the trunk with Ophiostoma brunneo ciliatum, a blue-staining fungus usually associated to Ips sexdentatus. During incubation, half the trees were submitted to a severe drought that decreased photosynthesis and natural 13C content in non-labeled saplings. A large 13C-excess was obtained in wood and phloem, especially in the fractions of soluble proteins, starch and soluble sugars of labeled saplings. Drought increased 13C-excess, due to reduced photosynthesis and smaller dilution of 13C by the addition of newly assimilated 12C. The induced-reaction zones in inoculated saplings displayed large total C (58 g 100 g−1) because of the accumulation of secondary metabolites. They also showed much larger 13C-excess than any other compartment: the contribution of stored C to the reaction zones was much higher than that of currently assimilated C. Moreover, drought lowered the contribution of the latter, as shown by the increase of 13C in the reaction zones. We conclude that stored C was readily mobilized for the construction of reaction tissues, and that the contribution of currently assimilated C was only minor.De jeunes pins sylvestres (Pinus sylvestris L.) âgés de trois ans ont été marqués avec du 13CO2 puis inoculés dans le tronc avec Ophiostoma brunneo ciliatum, un champignon habituellement associé au scolyte Ips sexdentatus. Pendant l’incubation, la moitié des arbres a été soumise à une sécheresse sévère qui a fortement réduit la photosynthèse et l’abondance naturelle en 13C des individus non marqués. Un fort excès en 13C a été détecté dans le bois et le phloème ainsi que dans les protéines solubles, l’amidon et les sucres solubles des individus marqués. La sécheresse a amplifié cet excès, du fait d’une photosynthèse réduite et donc d’une moindre dilution du 13C par du 12C récemment assimilé. Les zones de réaction induite autour des points d’inoculation présentaient de fortes teneurs en C (58 g 100 g−1), du fait de l’accumulation massive de métabolites secondaires. Elles présentaient également un excès de 13C plus marqué que n’importe quel autre tissu : ces zones de réaction étaient donc essentiellement constituées à partir de C provenant des réserves avec une faible contribution de C récemment assimilé. De plus, la sécheresse a augmenté la contribution du C de réserve, comme le montre l’augmentation de l’excès de 13C dans les zones de réactio

Images et imaginaires dans la ville à l’époque moderne

Inspiré par un des axes d'enseignement du DEA Sciences de la Ville de l'université François-Rabelais, ce livre croise réflexion méthodologique et études de cas appartenant aux espaces français, allemands, anglais et italiens au long d'une époque moderne largement taillée. Il réunit les contributions de onze historiens de Tours, Angers et Orléans : Florence ALAZARD, Les livrets d'entrées royales : une source pour l'histoire urbaine. Pascal BRIOIST, Hooke et Pepys : deux espaces-vécus du Londres du XVIIe. Gérald CHAIX, Histoire : Libertés - Justice. L'hôtel de ville de Cologne (XIIe - XVIIe siècle). Bernard CHEVALIER, L'éloge de Tours de Francesco Florio (1477). Entre la tradition médiévale et le discours humaniste. François COMTE, Angers à travers ses plans (1652-1813) : une cité immobile ? Natacha COQUERY, La beauté d'une ville : un château bien Pâti ou un théâtre magnifique ? Nantes d'après Brackenhoffer (1643-1644) et Young (1788). Brigitte MAILLARD, L'air, l'eau, la ville et le médecin au XVIIIes. Vincent MILLIOT, La ville au miroir des métiers. Représentations du monde du travail et imaginaires de la ville (XVIe - XVIIIe). Claude PETITFRÈRE, Une ville mise en scène : Tours d'après l'iconographie générale des XVIes au XVIIIes. Robert SAUZET, L'image de Nîmes antique dans l'historiographie et la mémoire collective au XVIIes et XVIIIes. Denise TURREL, La couleur de la ville : les représentations urbaines dans les cartes de l'Ancien Régime. L'ouvrage s'organise en trois parties : La ville vécue par le citadin et la ville racontée par l'historien, la ville donnée à lire par le visiteur étranger ou le médecin, la ville mise en scène par le cartographe, le dessinateur, le graveur, le peintre et l'architecte

Human metapneumovirus pneumonia in patients with hematological malignancies

International audienc