Long-term follow-up of autologous stem cell transplantation after intensive chemotherapy in patients with myelodysplastic syndrome or secondary acute myeloid leukemia.

International audienceWe report on the outcomes of 53 patients with myelodysplastic syndromes (MDS) or acute myeloid leukemia secondary to MDS, autografted in first complete remission. Five (9.4%) died from the procedure whereas hematological reconstitution occurred in all the remaining patients. Forty patients (75%) relapsed, with 87.5% of the relapses occurring within 2 years of the autologous transplant. With a median follow-up of 6.2 years, the median actuarial disease-free survival and overall survival were 8 and 17 months after autograft, respectively. Karyotype was the only prognostic factor for disease-free and overall survival. The eight survivors (15%), including two patients with unfavorable or intermediate karyotype, remained in first complete remission 50+ to 119+ months after transplantation and are probably cured

Parenthood in survivors of Hodgkin lymphoma: an EORTC-GELA general population case-control study.

Contains fulltext : 108966.pdf (publisher's version ) (Open Access)PURPOSE: We investigated the impact of Hodgkin lymphoma (HL) on parenthood, including factors influencing parenthood probability, by comparing long-term HL survivors with matched general population controls. PATIENTS AND METHODS: A Life Situation Questionnaire was sent to 3,604 survivors treated from 1964 to 2004 in successive clinical trials. Responders were matched with controls (1:3 or 4) for sex, country, education, and year of birth (10-year groups). Controls were given an artificial date of start of treatment equal to that of their matched case. The main end point was presence of biologic children after treatment, which was evaluated by using conditional logistic regression analysis. Logistic regression analysis was used to analyze factors influencing spontaneous post-treatment parenthood. RESULTS: In all, 1,654 French and Dutch survivors were matched with 6,414 controls. Median follow-up was 14 years (range, 5 to 44 years). After treatment, the odds ratio (OR) for having children was 0.77 (95% CI, 0.68 to 0.87; P < .001) for survivors compared with controls. Of 898 survivors who were childless before treatment, 46.7% achieved post-treatment parenthood compared with 49.3% of 3,196 childless controls (OR, 0.87; P = .08). Among 756 survivors with children before treatment, 12.4% became parents after HL treatment compared with 22.2% of 3,218 controls with children before treatment (OR, 0.49; P < .001). Treatment with alkylating agents, second-line therapy, and age older than 35 years at treatment appeared to reduce the chances of spontaneous post-treatment parenthood. CONCLUSION: Survivors of HL had slightly but significantly fewer children after treatment than matched general population controls. The difference concerned only survivors who had children before treatment and appears to have more personal than biologic reasons. The chance of successful post-treatment parenthood was 76%

Impact pronostique des anomalies cytogénétriques dans les myélodysplasies (à propos d'une série de 560 patients)

Les syndromes myelodysplasiques (SMD) sont des affections clonales de la moelle osseuse se caracterisant par une apoptose intra medullaire responsable de cytopenies peripheriques. ils presentent un risque d'evolution en leucemie aigüe. des anomalies cytogenetiques sont presentes dans 50% des SMD. Elles jouent un rôle pronostique important et sont prises en compte dans l'index pronostique international (ipss). Le but de cette etude est d'analyser l'impact des anomalies cytogénétiques sur la survie au sein d'une base de données des SMD instaurée au centre Henri Becquerel depuis juin 1998. 560 patients ont ete inclus dans cette étude rétrospective selon la classification ipss les patients étaient répartis en 176 patients de bas grade (38%), 162 patients de risque intermediaire-1 (34,3%), 89 patients de risque intermediaire-2 (19,2%), 40 patients de haut risque (8,5%). 235 patients ont un caryotype normal et 240 un caryotype anormal (5 echecs). Les anomalies isolées les plus fréquemment retrouvées sont: 17 délétions 5q (3,54% survie médiane 125 mois), 26 pertes de l'y (5,4% survie mediane 62 mois), 18 délétions 200 (3,75% survie médiane 36 mois), 24 trisomies 8 (5% survie mediane 35 mois), 11 monosomies 7 (2,3% survie mediane 5 mois), 7 anomalies 11q (del1 10 et rearrangement 11q;1,45% survie mediane non atteinte), 6 réarrangements 3q26 (1,25% survie médiane 36 mois), 3 anomalies 17p (0,6% survie mediane 8,3 mois), 3 additions 12p12 (0,6% survie médiane 8,5 mois). L'étude de la survie des patients confirme que la présence d'un caryotype normal est favorable par rapport à un caryotype anormal et que la survie diminue lorsque le nombre d'anomalies croit. Dans notre étude certaines anomalies ont un impact pronostique favorable comme la délétion 5q, la perte de l'y, la délétion 20q, la trisomie 8, les anomalies 11q et le réarrangement 3q26, d'autres ont un pronostique défavorable ; c'est le cas de la monosomie 7, des anomalies 17p et de l'addition 12p12. ces resultats doivent être interprétés avec précaution du fait du faible nombre de patients dans chaque groupe.ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Reflex Sympathetic Dystrophy After Bone-marrow Transplantation

We report on three patients of 201 who, after bone marrow transplantation (BMT), developed reflex sympathetic dystrophy (RSD). The syndrome occurred on days + 40, + 43, and + 147, respectively, without known causes of RSD. The ankles, the feet, and the knees were affected. Long-lasting immobilization, slow bone marrow recovery, and other BMT-related factors could have predisposed to RSD

SUV max -based assessment of PET response shows a superior specificity to Deauville criteria for predicting recurrence in Hodgkin’s lymphoma

International audienceOne of the limitations of 18FDG PET/CT for therapeutic evaluation in Hodgkin's Lymphoma is the relatively high rate of false positive uptake. SUVmax reduction (ΔSUVmax) and tumor/liver ratio (TLr) are promising tools for response assessment in lymphoma. We determined the optimal cutoff values for ΔSUVmax and TLr and compared them to Deauville score (DS) after two and four cycles chemotherapy (PET2 and PET4 respectively) and at the end of treatment PET (PETeot) on a cohort of 362 patients. TLr showed better diagnostic performances than DS for predicting 5-year progression-free survival (PFS), especially on early PET/CT assessments. Positive predictive values at PET2 for TLr, ΔSUVmax and DS were 51%, 34% and 31% respectively. On the multivariable analysis, significant predictive factors of PFS were TLr (at PET2, PET4 and PETeot) and ΔSUVmax (at PET4 and PETeot). DS was not significantly associated with PFS at any PET timing

Relapsed and refractory classical Hodgkin lymphoma: could virotherapy help solve the equation?

Classical Hodgkin lymphoma is a neoplastic hematological disease. Standard first-line therapy, including chemotherapy and radiotherapy, is curative in >85% of early-stage patients, with a 5-year survival rate of >95%. However, approximately 15% of patients have hard-to-treat lymphoma with poor outcomes, and new treatment strategies are needed for these young adults. There are several well-documented cases in the medical literature on hematologic cancer remission following natural human viral infections. Therefore, hoping to reproduce these spontaneous tumor regressions, researchers have been investigating various viruses with oncolytic properties. There is a high rationale for using virotherapy in the treatment of Hodgkin lymphoma, in which tumor cells are often infected with the Epstein-Barr virus. Modern viral technologies and current knowledge about the relationship between viruses and cancer could accelerate the discovery of effective viral oncolytic therapies. This article reviews the use of oncolytic viruses as innovative therapies for treating Hodgkin lymphoma