Expérience du blinatumomab dans les leucémies aiguës lymphoblastiques de l’enfant et de l’adolescent dans l’interrégion Grand Ouest : une chance pour tous

INTRODUCTION: Relapsed/refractory acute lymphoblastic leukemia (ALL) in children has a pejorative prognosis and justifies to be treated by hematopoietic stem cell transplantation (HSCT). A minimal residual disease (MRD) before transplantation is a major part of prognosis. Blinatumomab, a bispecific antibody CD19/CD3, allowed to achieve a cytologic and molecular complete remission in adults with refractory B-precursor ALL. This retrospective study analyses results from a pediatric cohort treated by blinatumomab thanks to an interregional structuring consortium. PATIENTS AND METHODS: Patients between 0 and 23 years old, from the 7 centers of the french "Grand Ouest" interregional network, treated by blinatumomab for a relapsed or refractory ALL, from January 2015 to January 2018, were included. The efficiency of blinatumomab was assessed in terms of complete remission, minimal residual disease, overall survival, and tolerability of treatment. RESULTS: Thirteen of 18 patients achieved a complete remission, with negative minimal residual disease for ten of them. Fourteen patients proceeded to stem cell transplantation,. Eight out of 14 patients obtained long term remission after HSCT. As far as tolerance is concerned, no serious adverse event, neurological or psychiatric disorder, was observed. CONCLUSION: Thanks to an interregional network collaboration, all children with high risk ALL coming from the western french interregion could be treated by blinatumomab. Blinatumomab offered good hematological conditions to undergo HSCT with a good tolerability

Differential impact of drugs on the outcome of ETV6-RUNX1 positive childhood B-cell precursor acute lymphoblastic leukaemia : results of the EORTC CLG 58881 and 58951 trials

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Évaluation de la gastrostomie précoce dans la prise en charge des tumeurs osseuses primitives malignes de l’enfant. Expérience du groupe Grand Ouest Cancer de l’Enfant (GOCE) sur 10 ans [Assessment of early gastrostomy in the treatment of primary malignant bone tumors in children. A report from the French children's oncology study Group GOCE]

International audiencePurpose. - Patients in pediatric oncology are at high risk of undernourishment, especially during intensive treatment such as malignant primary bone tumors. Many consequences of malnutrition have been highlighted, yet the nutritional care is not standardized. We evaluated the nutritional benefits and the feasibility of enteral nutrition on early gastrostomy, by comparison to other methods of nutritional support during the treatment of malignant primary bone tumor in children. Methods. - The characteristics of patients with malignant primary bone tumors have been retrospectively analyzed in Western regions of France from 2003 to 2013. The census of complications of early gastrostomy and the nutritional parameters of patients (Z-scores weight for height and height for age and body mass index) allowed the evaluation of its feasibility and effectiveness. Complications data, nutritional status and oncology treatment were also analyzed in the groups of patients who received enteral nutrition through nasogastric tube and those who did not receive it. Results. - Early gastrostomy was inserted in 58 patients, a nasogastric tube in 20 and 60 did not receive any of these two nutritional supports. Early gastrostomy is a purveyor of complications (82 for 58 patients) but they are minor and not specific (92.7%). No difference between the three groups has been demonstrated about the frequency of complications, the number of hospitalization or their duration. Early gastrostomy avoided a deterioration of the nutritional status as soon as the preoperative stage unlike the two other groups. No significant difference in survival at 4 years was found between the three groups. Conclusion. - Early gastrostomy is an effective nutritional support which does not increase complications and which does not affect the oncologic prognosis. Its psychological evaluation and nutritional impact in the long term are to be assessed on a prospective group. (C) 2017 Elsevier Masson SAS. All rights reserved

CNS-3 status remains an independent adverse prognosis factor in children with acute lymphoblastic leukemia (ALL) treated without cranial irradiation: Results of EORTC Children Leukemia Group study 58951

International audienceTo evaluate the prognostic significance of initial central nervous system (CNS) involvement of children with acute lymphoblastic leukemia (ALL) enrolled in the EORTC 58951 trial.Patients and methods: From 1998 to 2008, 1930 ALL patients were included in the randomized EORTC 58951 trial. Overall treatment intensity was adjusted according to known prognostic factors including the level of minimal residual disease after induction treatment. CNS-directed therapy comprised four to 11 courses of i.v. methotrexate (5g/m2), and 10 to 19 intrathecal chemotherapy injections, depending on risk group and CNS status. Cranial irradiation was omitted for all patients.Results: The overall 8-year event-free survival (EFS) and overall survival (OS) rates were 81.3% and 88.1%, respectively. In the CNS-1, TPL+, CNS-2, and CNS-3 groups, the 8-year EFS rates were 82.1%, 77.1%, 78.3%, and 57.4%, respectively. Multivariable analysis indicated that initial CNS-3 status, but not CNS-2 or TLP+, was an independent adverse predictor of outcome. The 8-year incidence of isolated CNS relapse was 1.7% and of isolated or combined CNS relapse it was 3.7%. NCI high-risk group, male sex, CNS-2 and CNS-3 status were independent predictors for a higher incidence of any CNS relapse.Conclusions: CNS-3 status remains associated with poor prognosis and requires intensification of both systemic and CNS-directed therapy. This trial was registered at https://clinicaltrials.gov/under/NCT00003728