High frequency of central nervous system involvement in transformed Waldenstrom macroglobulinemia

Histologicaltransformation (HT) to diffuse large B-cell lymphoma (DLBCL) is a rare event in Waldenström macroglobulinemia (WM) and is associated with a poor prognosis.1-4 It confers an inferior outcome compared with WM patients without HT.2,3 Most transformed WM patients present with elevated serum lactate dehydrogenase (LDH) levels and extranodal disease.1 Among extranodal sites, the central nervous system (CNS) is one of the most frequently involved sites identified at diagnosis of transformed WM (ranging from 13% to 18%).1,3 However, the prognostic value of CNS involvement is unknown, and the rate of CNS involvement at relapse has not been previously reported in this setting.This work was supported by Cancer Research UK [C355/A26819], FC AECC, and AIRC under the “Accelerator Award Program” [EDITOR] to M.A. and R.G.-S

Combining local resources and mobile telephony to increase resort to care and reduce child mortality in Mali

In Mali, 1 child out of 6 does not reach the age of five. Most of these deaths could be avoided: children die mostly from untreated benign pathologies that could be easily cured locally. Though medical treatments are available in the local primary health centers, people resort too little and too late to healthcare, for cultural, financial and geographical reasons. Pesinet deploys an innovative health service that aims to drive prevention, detection and early-treatment of benign diseases. Agents make regular home visits to subscribed families in order to monitor the health of their children. They enter simple health data into a mobile phone and send it to the nearest medical center where the doctor reviews it and summons children at risk. This ongoing health monitoring system is combined with medical insurance at the local healthcare center. For a very affordable monthly fee, subscribing families benefit from the home visits, reductions on check-ups and medications, and education to prevention. This service is currently in operation in the city center of Bamako, and will be adapted for application in rural zones. Pesinet focuses on recourse to care by populations rather than on supply of new medical resources. By helping under-used primary health centers connect with populations, its objective is to generate a cultural change in the behaviors of populations and give health centers the capacity to improve the quality of the health services they offer. This paper intends to explain how this demand-driven approach could contribute to driving a sustainable change in the healthcare situation of Mali, and presents the promising results in terms of increase in resort to healthcare and local acceptability already encountered by the program

Rendre l'avortement plus sûr : un impératif

Selon l'OMS, les avortements à risques causent 8 % des décès maternels dans le monde (25 millions par an, dont 97 % dans les pays à revenu faible et intermédiaire). L'avortement est une procédure médicale efficace et sans risque lorsqu'elle est pratiquée correctement. Dans les contextes où l'avortement est légalement restreint, le recours informel à l'avortement médicamenteux et les SAA (Soins après avortement) permettent de réduire les risques sanitaires liés aux avortements clandestins

Rendre l’avortement plus sûr : un impératif

Selon l’OMS, les avortements à risques causent 8 % des décès maternels dans le monde (25 millions par an, dont 97 % dans les pays à revenu faible et intermédiaire). L’avortement est une procédure médicale efficace et sans risque lorsqu’elle est pratiquée correctement. Dans les contextes où l’avortement est légalement restreint, le recours informel à l’avortement médicamenteux et les SAA (Soins après avortement) permettent de réduire les risques sanitaires liés aux avortements clandestins

Prevalence of BTK and PLCG2 mutations in a real-life CLL cohort still on ibrutinib after 3 years: a FILO group study

International audienc

Prevalence of BTK and PLCG2 mutations in a real-life CLL cohort still on ibrutinib after 3 years: a FILO group study

International audienc

Prevalence of BTK and PLCG2 mutations in a real-life CLL cohort still on ibrutinib after 3 years: a FILO group study

International audienceMutational analyses performed following acquired ibrutinib resistance have suggested that chronic lymphocytic leukemia (CLL) progression on ibrutinib is linked to mutations in Bruton tyrosine kinase (BTK) and/or phospholipase Cγ2 (PLCG2) genes. Mutational information for patients still on ibrutinib is limited. We report a study aimed to provide a "snapshot" of the prevalence of mutations in a real-life CLL cohort still on ibrutinib after at least 3 years of treatment. Of 204 patients who initiated ibrutinib via an early-access program at 29 French Innovative Leukemia Organization (FILO) centers, 63 (31%) were still on ibrutinib after 3 years and 57 provided a fresh blood sample. Thirty patients had a CLL clone ≥0.5 × 109/L, enabling next-generation sequencing (NGS); BTK and PLCG2 mutations were detected in 57% and 13% of the NGS samples, respectively. After median follow-up of 8.5 months from sample collection, the presence of a BTK mutation was significantly associated with subsequent CLL progression (P = .0005 vs no BTK mutation). Our findings support that mutational analysis should be considered in patients receiving ibrutinib who have residual clonal lymphocytosis, and that clinical trials are needed to evaluate whether patients with a BTK mutation may benefit from an early switch to another treatment

Fig 1 -

EPIGRAM study: Site location in France (1a) and diagram flow (1b).</p

Characteristics of the children included in the EPIGRAM study at baseline (N = 89).

Characteristics of the children included in the EPIGRAM study at baseline (N = 89).</p