Intensive consolidation therapy compared with standard consolidation and maintenance therapy for adults with acute myeloid leukaemia aged between 46 and 60 years: final results of the randomized phase III study (AML 8B) of the European Organization for Research and Treatment of Cancer (EORTC) and the Gruppo Italiano Malattie Ematologiche Maligne dell’Adulto (GIMEMA) Leukemia Cooperative Groups

The most effective post-remission treatment to maintain complete remission (CR) in adults aged between 46 and 60 years with acute myeloid leukaemia (AML) is uncertain. Previously untreated patients with AML in CR after induction chemotherapy with daunorubicin and cytarabine were randomized between two intensive courses of consolidation therapy containing high-dose cytarabine, combined with amsacrine or daunorubicin and a standard consolidation and maintenance therapy containing standard dose cytarabine and daunorubicin. One hundred fifty-eight CR patients were assigned to the intensive group and 157 patients to the standard group. After a median follow-up of 7.5 years, the 4-year survival rate was 32 % in the intensive group versus 34 % in the standard group (P = 0.29). In the intensive group, the 4-year relapse incidence was lower than in the standard group: 55 and 75 %, respectively (P = 0.0003), whereas treatment-related mortality incidence was higher: 22 versus 3 % (P < 0.0001). Two intensive consolidation courses containing high-dose cytarabine as post-remission treatment in patients with AML aged between 46 and 60 years old did not translate in better long-term outcome despite a 20 % lower relapse incidence. Better supportive care and prevention of treatment-related complications may improve the overall survival after intensified post-remission therapy in this age group

Ethical and Clinical Aspects of Intensive Care Unit Admission in Patients with Hematological Malignancies: Guidelines of the Ethics Commission of the French Society of Hematology

Admission of patients with hematological malignancies to intensive care unit (ICU) raises recurrent ethical issues for both hematological and intensivist teams. The decision of transfer to ICU has major consequences for end of life care for patients and their relatives. It also impacts organizational human and economic aspects for the ICU and global health policy. In light of the recent advances in hematology and critical care medicine, a wide multidisciplinary debate has been conducted resulting in guidelines approved by consensus by both disciplines. The main aspects developed were (i) clarification of the clinical situations that could lead to a transfer to ICU taking into account the severity criteria of both hematological malignancy and clinical distress, (ii) understanding the process of decision-making in a context of regular interdisciplinary concertation involving the patient and his relatives, (iii) organization of a collegial concertation at the time of the initial decision of transfer to ICU and throughout and beyond the stay in ICU. The aim of this work is to propose suggestions to strengthen the collaboration between the different teams involved, to facilitate the daily decision-making process, and to allow improvement of clinical practice

DE L'EFFERVESCENCE DES ESPRITS AUX ELANS DU COEUR (ELEMENTS D'HISTOIRE DE NOTIONS VITALES, LE SOUFFLE, LA CHALEUR ET LA FORCE)

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

SDF et politiques publiques : institutionnalisation et fragmentation

Actes à paraîtr

SDF et politiques publiques : institutionnalisation et fragmentation

Actes à paraîtr

Vers une politique de l'urgence sociale ? Les SDF. Entre éclatement et coordination, les paradoxes d'une action publique locale à destination des sans-abri

116 p.A intervalles réguliers, souvent au gré des crises et des saisons, les « SDF » occupent le devant de la scène médiatique suscitant de multiples réactions et mobilisations. L'abondance des réactions d'indignation face à ces « oubliés », la diversité des actions et des dispositifs battis dans l'urgence pour lutter contre la faim ou le froid et la présence nombreuse des associations et du secteur public fortement mobilisés semblent ainsi dessiner les contours d'un secteur d'intervention solidement structuré et opérationnel.Et pourtant, cette apparente solidité résonne contradictoirement avec à la fois son caractère répétitif – pourquoi faut-il mobiliser dans l'urgence si le problème est identifié, récurrent et prévisible – et avec les images des sans-abri apparaissant le plus souvent seuls dans le froid, images que diffusent les journaux de vingt-heures. Est-on face à un secteur d'intervention solidement structuré et opérationnel comme le prouve la capacité de réaction apparente ou s'agit-il, au contraire, d'une sorte de « vide » que les images diffusées de sans-abri ne font que dénoncer ? Les actions menées à destination des « SDF » forment-elles un ensemble cohérent et stable ou sont-elles un assemblage de façade cachant une fragmentation, une dispersion voire une contradiction ? Et ces « SDF » sont-ils les mêmes pour tous ses intervenants ou, au contraire chacun dispose de sa propre définition, de son explication et de sa représentation ?Cet ouvrage se propose ainsi d'ausculter ce monde particulièrement complexe de l'intervention d'urgence à partir d'une étude comparative portant sur trois villes, Lyon, Grenoble et Oléans

L'institutionnalisation d'actions publiques locales à destination des SDF

2 11 085660

Prognostic value of cytologic parameters in acute myelogenous leukemia

The prognostic value of some current cytologic characteristics was assessed in 174 adult patients with acute myelogenous leukemia (AML) treated according to the AML‐5 protocol of the EORTC Leukemia and Hematosarcomas Group. A significantly higher rate of complete remission (CR) was observed in patients with low bone‐marrow (BM) cellularity, with BM blasts less than 80%, and with Auer rod positive cells more than 2.5% of the total blast cell population. A leukocyte count of less than 50 × 109/1 in the peripheral blood was also associated with a higher CR rate. No significant difference was found between the various French‐American‐British (FAB) subtypes, in spite of a trend towards a lower CR rate in patients with an M1, myeloblastic, poorly differentiated, subtype. The leukocyte count and the percentage of Auer rod positive cells were the only significant parameters for duration of survival from the beginning of maintenance treatment. However these features had no prognostic value for the duration of remission. It seems therefore that patients with a higher percentage of Auer‐rod‐positive cells and lower peripheral leukocyte counts can enter remission more easily, and can also more readily achieve subsequent remissions following relapse. The prognostic value of these routine cytologic features is probably related to their relationship with proliferative activity and tumor burden: the percentage of Auer‐rod‐positive cells correlates inversely with the leukocyte count, whereas leukocyte count, BM cellularity, and percentage of BM blasts are linked together. Copyright © 1984 American Cancer SocietySCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe