Long-term outcomes after reduced-intensity conditioning allogeneic stem cell transplantation for low-grade lymphoma: a survey by the French Society of Bone Marrow Graft Transplantation and Cellular Therapy (SFGM-TC).

International audienceBACKGROUND AND OBJECTIVES: High-dose chemotherapy with allogeneic stem cell transplantation (SCT) has proven to be a successful treatment for low-grade lymphoma (LGL), but is associated with considerable transplant-related mortality (TRM). In an effort to reduce toxic mortality while maintaining the graft-versus-leukemia effect, allogeneic SCT has been combined with a reduced-intensity conditioning (RIC) regimen. The aim of this study was to determine the outcome of patients with LGL treated with RIC allogeneic SCT. DESIGN AND METHODS: This retrospective multicenter study included 73 patients with relapsed or refractory LGL allografted after a RIC regimen between 1998 and 2005 whose data were recorded in a French registry. RESULTS: Patients received a median of three lines of therapy prior to RIC allogeneic SCT. The most widely used conditioning regimens were fludarabine + busulfan + antithymocyte globulin (n=43) and fludarabine + total body irradiation (n=21). Prior to allografting, patients were in complete response (CR; n=21), partial response (PR; n=33) or had chemoresistant disease (n=19). The median follow-up was 37 months (range, 16 to 77 months). In patients in CR, PR and chemoresistant disease, the 3-year overall survival rates were 66%, 64% and 32%, respectively, while the 3-year event-free survival rates were 66%, 52% and 32%, respectively. The 3-year cumulative incidences of TRM were 32%, 28% and 63%, respectively. The incidence of relapse was 9.6%. INTERPRETATION AND CONCLUSIONS: Although associated with significant TRM, RIC allogeneic SCT in advanced chemosensitive disease leads to long-term survival

Contribution à l'étude des tumeurs de la tête et du cou (analyse critique de certaines voies d'abord chirurgicales des espaces rétro et latéro-pharyngés et des facteurs pronostiques des lymphomes malins non-hodgkiniens de la tête et du cou)

Les espaces rétro et latéro-pharyngés sont le siège de tumeurs de nature histologique très variée. Leur richesse en éléments lymphatiques les rend particulièrement exposés aux disséminations lymphatiques des carcinomes épidermoïdes mais aussi aux localisations primitives et secondaires des lymphomes malins de la tête et du cou. Leur abord à visée diagnostique ou thérapeutique reste délicat. La première partie de ce travail a permis de préciser la technique, les limites et les indications de trois voies d'abord peu usitées. La voie trans-orale permet l'exérèse de lésions de volume modéré et bien encapsulées de ces espaces avec une très faible morbidité. Les progrès de la chirurgie robotisée devraient permettre d'étendre ses indications. La voie cervico-transmandibulaire procure une parfaite exposition de la base du crâne et un excellent contrôle des éléments vasculo-nerveux qui en sortent. Elle apparaît indiquée pour l'exérèse des volumineuses tumeurs des espaces péripharyngés enchâssées contre la base du crâne, ou qui englobent la carotide interne. La voie infralabyrinthique s'adresse aux lésions du foramen jugulaire à développement essentiellement extra-crânien. Elle permet d'éviter un déroutement du nerf facial et peut, en cas de nécessité, être aisément convertie en une voie d'abord plus large. La deuxième partie de ce travail est consacrée à l'étude des lymphomes malins non hodgkiniens de la tête et du cou. Elle a permis, d'une part, de confirmer la faisabilité et les bons résultats d'un traitement combiné associant chimiothérapie et radiothérapie et, d'autre part, d'affiner les facteurs pronostiques déjà décrits dans le cadre des lymphomes non hodgkiniens quelle que soit leur localisation. Ainsi un âge supérieur à 45ans, une masse tumorale de plus de 5cm, une maladie localisée aux glandes salivaires et l'atteinte de plusieurs sites extra-ganglionnaires se sont révélés être de pronostic défavorable.Various histologic types of tumours can be found in the parapharyngeal spaces. Their access for diagnosis or treatment purpose remains delicate. The first part of this work focused on three rarely used surgical approaches in order to specify their technique, limits and indication. The trans oral route allows surgical removal of well encapsulated lesions of small volume with a low morbidity. The advances in robotic surgery should enlarge its indications. The cervical trans mandibular approach gives an excellent overview on the skull base and on the neuro-vascular structures coming out from it. It appeared to be indicated for removal of voluminous parapharyngeal lesions abutting the skull base or surrounding the internal carotid artery. The infralabyrinthique route concerns tumors of the jugular foramen with an extra cranial development. It avoids a facial nerve diversion and can easily be transformed, if needed, in a larger route. The second part of this work is dedicated to the study of head and neck non Hodgkin lymphomas. It first confirmed the feasibility and the good results of a combine treatment of high dose CHOP regimen and involved field radiotherapy. Secondly it refined the prognostic factors yet described for non Hodgkin lymphoma of any localization. Patient's age > 45 years old, bulky disease (> 5 cm), a disease localized to salivary glands, and multiple extra nodal site involvement were the main predictors of a worse outcome.ANGERS-BU Médecine-Pharmacie (490072105) / SudocSudocFranceF

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Molecular analysis of Philadelphia positive essential thrombocythemia.

Seven patients with Philadelphia (Ph) chromosome positive essential thrombocythemia (ET) were investigated for the presence of a rearrangement within the major breakpoint cluster region (M-bcr) using the Southern blot technique and, in six cases, for the presence of the hybrid bcr-abl mRNA using the polymerase chain reaction (PCR). The molecular studies showed rearrangement of M-bcr in all cases; there was evidence of the b2a2 mRNA junction in one case and of b3a2 junction in five cases. These findings are identical to what might have been expected in Ph-positive chronic myeloid leukemia. These features may explain the poor prognosis of Ph-positive ET in comparison with cytogenetically normal cases. Conversely, the differences in clinical presentation may be due to other genetic changes.Journal ArticleResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

IL-34 Induces the Differentiation of Human Monocytes into Immunosuppressive Macrophages. Antagonistic Effects of GM-CSF and IFNγ

International audienceIL-34 is a recently identified cytokine that signals via the M-CSF receptor and promotes monocyte survival. Depending on the environment, monocytes can differentiate into macrophages (MQ) or dendritic cells (DC). A wide spectrum of MQ and DC subsets, with distinct phenotypes and functions, has been described. To date, the phenotype of monocytes exposed to IL-34 remains unexplored. We report here that IL-34 induces the differentiation of monocytes into CD14 high CD163 high CD1a 2 MQ (IL-34-MQ). Upon LPS stimulation, IL-34-MQ exhibit an IL-10 high IL-12 low M2 profile and express low levels of the costimulatory molecules CD80 and CD86. IL-34-MQ exhibit poor T cell costimulatory properties, and have potent immunosuppressive properties (decrease of TCR-stimulated T cell proliferation). For all the parameters analyzed, IL-34-MQ are phenotypically and functionally similar to M-CSF-MQ. IL-34 appears as efficient as M-CSF in inducing the generation of immunosuppressive MQ. Moreover, the generation of IL-34-MQ is mediated through the M-CSF receptor, is independent of endogenous M-CSF consumption and is potentiated by IL-6. In an attempt to identify strategies to prevent a deleterious M2 cell accumulation in some pathological situations, we observed that IFNc and GM-CSF prevent the generation of immunosuppressive MQ induced by IL-34. IFNc also switches established IL-34-MQ into immunostimulatory MQ. In conclusion, we demonstrate that IL-34 drives the differentiation of monocytes into immunosuppressive M2, in a manner similar to M-CSF, and that IFNc and GM-CSF prevent this effect