Late relapse after hematopoietic stem cell transplantation for acute leukemia: a retrospective study by SFGM-TC.

peer reviewedLate relapse (LR) after allogeneic hematopoietic stem cell transplantation (AHSCT) for acute leukemia is a rare event (nearly 4.5%) and raises the questions of prognosis and outcome after salvage therapy. We performed a retrospective multicentric study between January 1, 2010, and December 31, 2016, using data from the French national retrospective register ProMISe provided by the SFGM-TC (French Society for Bone Marrow Transplantation and Cellular Therapy). We included patients presenting with LR, defined as a relapse occurring at least 2 years after AHSCT. We used the Cox model to identify prognosis factors associated with LR. During the study period, a total of 7582 AHSCTs were performed in 29 centers, and 33.8% of patients relapsed. Among them, 319 (12.4%) were considered to have LR, representing an incidence of 4.2% for the entire cohort. The full dataset was available for 290 patients, including 250 (86.2%) with acute myeloid leukemia and 40 (13.8%) with acute lymphoid leukemia. The median interval from AHSCT to LR was 38.2 months (interquartile range [IQR], 29.2 to 49.7 months), and 27.2% of the patients had extramedullary involvement at LR (17.2% exclusively and 10% associated with medullary involvement). One-third of the patients had persistent full donor chimerism at LR. Median overall survival (OS) after LR was 19.9 months (IQR, 5.6 to 46.4 months). The most common salvage therapy was induction regimen (55.5%), with complete remission (CR) obtained in 50.7% of cases. Ninety-four patients (38.5%) underwent a second AHSCT, with a median OS of 20.4 months (IQR, 7.1 to 49.1 months). Nonrelapse mortality after second AHSCT was 18.2%. The Cox model identified the following factors as associated with delay of LR: disease status not in first CR at first HSCT (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.04 to 1.64; P = .02) and the use of post-transplantation cyclophosphamide (OR, 2.23; 95% CI, 1.21 to 4.14; P = .01). Chronic GVHD appeared to be a protective factor (OR, .64; 95% CI, .42 to .96; P = .04). The prognosis of LR is better than in early relapse, with a median OS after LR of 19.9 months. Salvage therapy associated with a second AHSCT improves outcome and is feasible, without creating excess toxicity

La psychologie et ses domaines : de Freud à Lacan, pratique et critique de la psychologie (2 éd. revue et complétée) / J.M. Fournier, M. Richard, J.F. Skrzypczak

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Cultura e inteligência: reflexões antropológicas sobre aspectos não físicos da evolução em chimpanzés e humanos Culture and intelligence: anthropological reflections on non-physical aspects of evolution in chimpanzees and humans

Trata da história recente dos estudos sobre o comportamento de chimpanzés, enfatizando os resultados das pesquisas, as proposições acerca da existência de 'culturas de chimpanzés' e sua validade. O trabalho problematiza a ideia a partir dos mecanismos de transmissão e aprendizado social bem como de concepções antropológicas e paleoantropológicas de cultura que associam tal fenômeno, entre humanos modernos, às suas capacidades simbólicas e cognitivas.<br>The scope of this work is the recent history of studies on the behavior of chimpanzees, emphasizing research results, propositions about the existence of 'chimpanzee cultures' and their validity. The work discusses the idea based on transmission mechanisms and social learning as well as anthropological and paleoanthropological concepts of culture that associate such phenomena, among modern humans, to their symbolic and cognitive abilities