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

Phase 2 LYSA study of prednisone, vinblastine, doxorubicin, bendamustine for untreated older Hodgkin lymphoma patients.

Older classical Hodgkin lymphoma (cHL) patients require more effective and less toxic therapies. In this multicenter, prospective, phase 2 study, we investigated a new first-line therapy regimen comprising 6 cycles of prednisone (40 mg/m2 Day 1-5), vinblastine (6 mg/m2, Day 1), doxorubicin (40 mg/m2, Day 1), bendamustine (120 mg/m2, Day 1) (PVAB regimen) every 21 days for newly diagnosed classical HL patients aged 61 years or older with an advanced Ann Arbor stage. A Mini Nutritional Assessment (MNA) score ≥ 17 was the cutoff value for including patients ≥70 years old. The primary endpoint was the complete metabolic response (CMR) rate after 6 cycles. The median age of the 89 included patients was 68 years (range, 61-88), with 35 patients aged ≥70 years old (39%). Seventy-eight patients (88%) completed the 6 cycles. The toxicity rate was acceptable, with a 20% rate of related serious adverse events. CMR was achieved by 69 patients (77.5%; 95% CI, 67-86). After a median follow-up of 42 months, 31 patients progressed or relapsed (35%), and 24 died (27%) from HL (n=11), toxicity during treatment (n=4), secondary cancers (n=6), or other causes (n=3). The 4-year progression-free survival (PFS) and overall survival rates were 50% and 69%, respectively. Multivariate analysis showed that liver involvement (P =0.001), lymphopenia (P =0.001), CRP (P =0.0005), comedications (P =0.003) were independently associated with PFS. The PVAB regimen yielded a high CMR rate with acceptable toxicity. Over long-term follow-up, survival endpoints were influenced by unrelated lymphoma events. Registration at www.clinicaltrials.gov was NCT02414568

Subcutaneous Rituximab-MiniCHOP Compared With Subcutaneous Rituximab-MiniCHOP Plus Lenalidomide in Diffuse Large B-Cell Lymphoma for Patients Age 80 Years or Older

International audiencePURPOSE: The prognosis of elderly patients with diffuse large B-cell lymphoma (DLBCL) is worse than that of young patients. An attenuated dose of chemotherapy-cyclophosphamide, doxorubicin, vincristine, and prednisone plus rituximab (R-miniCHOP)-is a good compromise between efficacy and safety in very elderly patients. In combination with R-CHOP (R2-CHOP), lenalidomide has an acceptable level of toxicity and may mitigate the negative prognosis of the non-germinal center B-cell-like phenotype. The Lymphoma Study association conducted a multicentric, phase III, open-label, randomized trial to compare R-miniCHOP and R2-miniCHOP. PATIENTS AND METHODS: Patients of age 80 years or older with untreated DLBCL were randomly assigned into the R-miniCHOP21 group or the R2-miniCHOP21 group for six cycles and stratified according to CD10 expression and age. The first cycle of rituximab was delivered by IV on D1 after a prephase and then delivered subcutaneously on D1 of cycles 2-6. Lenalidomide was delivered at a dose of 10 mg once daily on D1-D14 of each cycle. The primary end point was overall survival (OS). RESULTS: A total of 249 patients with new DLBCL were randomly assigned (127 R-miniCHOP and 122 R2-miniCHOP). The median age was 83 years (range, 80-96), and 55% of the patients were classified as non-GCB. The delivered dose for each R-miniCHOP compound was similar in both arms. Over a median follow-up of 25.1 months, the intention-to-treat analysis revealed that R2-miniCHOP did not improve OS (2-year OS 66% in R-miniCHOP and 65.7% in R2-miniCHOP arm, P = .98) in the overall population or in the non-GCB population. Grade 3-4 adverse events occurred in 53% of patients with R-miniCHOP and in 81% of patients with R2-miniCHOP. CONCLUSION: The addition of lenalidomide to R-miniCHOP does not improve OS. Rituximab delivered subcutaneously was safe in this populati

Radiotherapy or Autologous Stem-Cell Transplantation for Primary CNS Lymphoma in Patients Age 60 Years and Younger: Long-Term Results of the Randomized Phase II PRECIS Study

International audienceClinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.We previously reported the results of a randomized phase II study in patients with newly diagnosed primary CNS lymphoma (age 18-60 years). Patients were treated with high-dose methotrexate-based induction chemotherapy followed by whole-brain radiotherapy (WBRT) or high-dose chemotherapy (thiotepa-busulfan-cyclophosphamide) with autologous stem-cell transplantation (ASCT). The median follow-up was 33 months. In this report, we provide long-term data (median follow-up, 8 years) regarding the outcomes and toxicities. Fifty-three and 44 patients received induction chemotherapy followed by WBRT or ASCT, respectively. Their 8-year event-free survival from random assignment was 67% and 39% in the ASCT and WBRT arms, respectively (P = .03), with a significantly lower risk of relapse after ASCT (hazard ratio = 0.13, P < .001). One third of patients who relapsed after WBRT were alive after salvage treatment. Five and four patients died of ASCT and WBRT-related toxicities, respectively. The 8-year overall survival was 69% and 65% in the ASCT and WBRT arms, respectively (not significant). Balance (52% v 10%, P ≤ 0.001) and neurocognition (64% v 13%, P < .001) significantly deteriorated after WBRT compared with ASCT during the follow-up. This study shows that 40 Gy WBRT should be avoided in first-line treatment because of its neurotoxicity and suboptimal efficacy in reducing relapses while ASCT appears to be highly efficient in preventing relapses

Clinical and biological characteristics of leukemia cutis in chronic lymphocytic leukemia: A study of the French innovative leukemia organization ( FILO )

International audienceNo abstract availabl

Clinical and biological characteristics of leukemia cutis in chronic lymphocytic leukemia: A study of the French innovative leukemia organization ( FILO )

International audienceNo abstract availabl