Prophylactic Fluconazole andCandida kruseiInfections

Assessment of Mobilization Cost for Multiple Myeloma Using 2 Different Mobilization Strategies: High-Dose Cyclophosphamide Versus Plerixafor. on Behalf of IFM

Abstract Background. Peripheral blood stem cell (PBSC) collection prior to high dose chemotherapy for autologous transplantation (ASCT) is a standard of care, and an attractive alternative to the use of bone marrow cells, for transplantation in Multiple Myeloma (MM). The optimal methodology for mobilizing PBSC has yet to be defined, both G-CSF and GM-CSF can be used; although, the stimulatory effect may be more pronounced when given after high dose cyclophosphamide (usually administered at a dose of 1.5 to 6g/m2 IV for one to two days) and use of Plerixafor, a CXCR4 antagonist (Mozobil®). The latter 2 options are preferred, overall, in France. Indeed, it was shown that the most recent combi…

Profiles and seasonal distribution of airborne fungi in indoor and outdoor environments at a French hospital

International audience; A one-year prospective survey of fungal air contamination was conducted in outdoor air and inside two haematological units of a French hospital. Air was sampled with a portable Air System Impactor. During this period of survey, the mean viable fungal load was 122.1 cfu/m(3) in outdoor air samples, and 4.1 and 3.9 cfu/m(3) in samples from adult and pediatric haematology units, respectively. In outdoor samples, Cladosporium was the dominant genus (55%) while in the clinical units, Penicillium sp. (23 to 25%), Aspergillus sp. (15 to 23%) and Bjerkandera adusta (11 to 13%) were the most frequently recovered airborne fungi. The outdoor fungal load was far higher in autumn…

Antiplatelet Antibodies Do Not Predict the Response to Intravenous Immunoglobulins during Immune Thrombocytopenia

Immune thrombocytopenia (ITP) is a rare autoimmune disease due to autoantibodies targeting platelet glycoproteins (GP). The mechanism of platelet destruction could differ depending on the specificity of antiplatelet antibodies: anti-GPIIb/IIIa antibodies lead to phagocytosis by splenic macrophages, in a Fc&gamma

Surgical management of invasive pulmonary aspergillosis in neutropenic patients.

Background The aim of our study was to clarify the indications for operation in invasive pulmonary aspergillosis. Methods Nineteen patients with hematologic malignancy, in whom invasive pulmonary aspergillosis developed during the course of neutropenia, had operations. Neutropenia lasted 28 days (range, 15 to 45 days). The preoperative diagnosis of invasive pulmonary aspergillosis was based on computed tomographic scan findings (halo or air crescent signs). Results Eight patients underwent emergency operations, before marrow recovery, for prevention of massive hemoptysis. The criterion for operation was an aspergillosis lesion that contacted the pulmonary artery on computed tomography. A lo…

Identification of novel, clonally stable, somatic mutations targeting transcription factors PAX5 and NKX2-3, the epigenetic regulator LRIF1, and BRAF in a case of atypical B-cell chronic lymphocytic leukemia harboring a t(14;18)(q32;q21)

Diagnosis of B-cell chronic lymphocytic leukemia (B-CLL) is usually straightforward, involving clinical, immunophenotypic (Matutes score), and (immuno)genetic analyses (to refine patient prognosis for treatment). CLL cases with atypical presentation (e.g., Matutes ≤ 3) are also encountered, and for these diseases, biology and prognostic impact are less clear. Here we report the genomic characterization of a case of atypical B-CLL in a 70-yr-old male patient; B-CLL cells showed a Matutes score of 3, chromosomal translocation t(14;18)(q32;q21) (BCL2/IGH), mutated IGHV, deletion 17p, and mutations in BCL2, NOTCH1 (subclonal), and TP53 (subclonal). Quite strikingly, a novel PAX5 mutation that w…

Caractérisation de l’anémie hémolytique auto-immune associée aux hémopathies lymphoïdes à partir du registre des hémopathies malignes de Côte d’Or

Introduction L’anemie hemolytique auto-immune (AHAI) est une cytopenie auto-immune (CAI) caracterisee par une destruction des globules rouges par des auto-anticorps diriges contre certains de leurs antigenes de surface. Son incidence est estimee entre 1 et 3/100 000 personnes-annees (PA). Les AHAI a auto-anticorps chauds sont les plus frequentes et les formes secondaires, observees dans la moitie des cas, ont tendance a augmenter avec l’âge, notamment en association aux hemopathies malignes. Les donnees de la litterature reposent cependant sur de faibles cohortes ou des centres tertiaires, avec un possible biais de recrutement. L’objectif de notre etude est de decrire la frequence de l’AHAI…

Transient Pulmonary Infiltrates during Treatment with Anti-Thymocyte Globulin

We report the case of a 54-year-old woman with aplastic anemia, who developed transient pulmonary infiltrates following intravenous infusion of rabbit antithymocyte globulin (ATG) for 3 days. There was no other explanation than the infusion of ATG for the infiltrates. Rechallenge with ATG induced the recurrence of opacities on the chest radiograph. Although rarely involved with only 4 previous reports, ATG should be included in the list of drugs capable of inducing pulmonary infiltrates.

Generic vancomycin products: Analysis of serum concentrations in patients with acute myeloid leukemia.

Summary Concerns have recently emerged about the quality of generic vancomycin products. Our aim is to analyze serum vancomycin concentrations measured 48 hours after the start of an empirical treatment regimen in patients with acute myeloid leukemia (AML) who received one of the two generic vancomycin products available in France. Patients and methods Seventy-nine AML patients treated with vancomycin during two study periods were included in the study. Our vancomycin dosing regimen was based on the patients’ total body weight adjusted for renal clearance. Results A total of 93 serum vancomycin concentrations were collected: 31 in period 1 and 62 in period 2. In bivariate analysis, the mean…

Évaluation des coûts médicamenteux évités grâce aux inclusions des patients atteints d’hémopathie maligne dans les essais cliniques

Resume Introduction Les essais cliniques (EC) sont indispensables pour evaluer l’efficacite et l’innocuite de nouveaux traitements. Ils peuvent representer une mesure d’economie grâce a la fourniture des medicaments par le promoteur. Objectif L’objectif de cette etude est d’evaluer les couts evites en medicament hors-GHS ou sous Autorisation Temporaire d’Utilisation (ATU) par l’inclusion d’un patient dans un EC d’Hematologie. Materiels et methodes C’est une etude de cout, retrospective, monocentrique, observationnelle. La perspective de l’etude est elargie du point de vue de l’assurance maladie obligatoire. Nous avons inclus les EC d’Hematologie ayant eu au moins une dispensation entre 2007…

Caractérisation de la thrombopénie immunologique associée aux hémopathies lymphoïdes à partir du registre des hémopathies malignes de Côte d’Or

Introduction Le purpura thrombopenique immunologique (PTI) est une cytopenie auto-immune (CAI) caracterisee par une diminution de la duree de vie des plaquettes liee a la fois a leur destruction peripherique par les macrophages spleniques et a un defaut de production medullaire. Son incidence est estimee entre 3 et 4/100 000 personnes-annees (PA). S’il est le plus souvent primaire, il est associe dans 15–20 % des cas a d’autres maladies auto-immunes ou a des hemopathies malignes. Pour ces dernieres, les associations les plus frequentes sont rapportees avec la leucemie lymphoide chronique (LLC), la leucemie a grands lymphocytes T granuleux (LGL) et le lymphome de Hodgkin (LH) mais les donnee…

Adherence to immunomodulatory drugs in patients with multiple myeloma

Background Immunomodulatory drugs (thalidomide, lenalidomide and pomalidomide; IMID) are widely used in the treatment of multiple myeloma patients. To date, few data are available on IMID adherence in multiple myeloma patients. The aim of our study was to evaluate IMID adherence and to compare two indirect methods to measure IMID adherence in multiple myeloma patients: a specific questionnaire and the medication possession ratio (MPR). Another aim was to explore this specific questionnaire for the assessment of IMID adherence in multiple myeloma patients. Methods All consecutive multiple myeloma patients, with at least two consecutive dispensations of thalidomide, lenalidomide or pomalidomi…

IMPAIRMENT OF DIASTOLIC FUNCTION DURING SHORT-TERM ANTHRACYCLINE CHEMOTHERAPY

International audience; Abstract: Objective-To assess the early changes in left ventricular diastolic and systolic function due to anthracycline treatment. Design-A prospective study of cardiac function by radionuclide angiography in adults before and one month after the end of anthracycline treatment. Patients-60 patients without cardiac disease treated with chemotherapy containing anthracycline. Methods-Cardiac function was assessed by radionuclide measurement throughout treatment. Ejection fraction, peak ejection rate, time to peak ejection rate, filling rate, and time to peak filling rate were measured before and after treatment, To normalise radionuclide measurements of the left ventri…

Infection pulmonaire invasive à Trichoderma longibrachiatum, à propos d’un cas

Introduction : Trichoderma longibrachiatum est un champignon filamenteux appartenant à la famille des hyalohyphomycètes, rarement isolé lors d’infections fongiques invasives chez l’Homme mais quelques cas ont déjà été décrits chez des sujets immunodéprimés. Observation : Un homme de 69 ans a développé un syndrome fébrile une semaine après la fin d’une chimiothérapie pour le traitement d’une leucémie aiguë myéloïde alors qu’il était en aplasie profonde (GB Aspergillus Galactomannan test), un scanner thoracique est réalisé. L’aspect scannographique (signe du halo) était évocateur d’une aspergillose pulmonaire invasive (API), motivant la réalisation d’un lavage broncho-alvéolaire (LBA). Le LBA…

Self‐management of immunomodulatory drug treatment in multiple myeloma patients

Objective Immunomodulatory drugs (IMIDs: thalidomide, lenalidomide and pomalidomide) are widely used in patients with multiple myeloma (MM). The aim of our study was to validate a questionnaire to evaluate the self-capacity of MM patients to manage IMID treatment including side effects. Methods We used a method adapted from the recommendations of the European Organisation for Research and Treatment of Cancer (EORTC) to validate a French questionnaire for patients with MM treated with IMIDs. Results The face validity was evaluated in 15 patients and the construct validity in 56 patients. For discriminant validity, two groups were constituted by gender and depending on whether they had a prev…

Trends in Incidence and Survival of Myeloid Malignancies Since 1980, in the Côte D'or Department, Burgundy, France.

Abstract Abstract 3122 Poster Board III-59 Objective The Registry of Haematological Malignancies (HM) has been established on January 1st, 1980 in the department of Côte d'Or (pop 500 000 inhabitants). It was the first specialized registry in haematology in the world. During the course of 25 years (1980-2004), 5026 cases of HM were recorded including 1553 Myeloid malignancies (MM) in which entities not initially considered as malignant were taken in account such as Myelodysplastic syndrome (MDS) and some Myeloproliferative neoplasms (MPN). This allow us to present trends in incidence and survival of myeloid malignancies by entities since 1980. Method MM diagnosed in the population between …

Preferential splenic CD8+ T-cell activation in rituximab-nonresponder patients with immune thrombocytopenia

The pathogenic role of B cells in immune thrombocytopenia (ITP) has justified the therapeutic use of anti-CD20 antibodies such as rituximab (RTX). However, 60% of ITP patients do not respond to RTX. To decipher the mechanisms implicated in the failure of RTX, and because the spleen plays a well-recognized role in ITP pathogenesis, 12 spleens from ITP patients who had been nonresponders to RTX therapy were compared with 11 spleens from RTX-untreated ITP patients and 9 controls. We here demonstrate that in RTX-nonresponder ITP patients, preferential Th1 and Tc1 T lymphocyte polarizations occur, associated with an increase in splenic effector memory CD8(+) T-cell frequency. Moreover, in the RT…

Safety of ninety-minute daratumumab infusion.

Purpose Daratumumab is the first anti-CD38 monoclonal antibody of the class approved for recurrent and refractory multiple myeloma. Grade 3 and 4 Infusion-Related Reactions (IRRs) are frequent during the first and second infusions. Due to the risks associated with severe IRRs, daratumumab is systematically administered over a period of 3.5 hours. The main objective of this study was to evaluate the safety of a 90-minute daratumumab infusion from the third infusion. Patients and methods All patients who had received two or more doses of daratumumab in monotherapy or in combination with standard infusion rates were included. We excluded patients enrolled in clinical trials. For the rapid infu…

Lenalidomide Maintenance After Autologous Stem-Cell Transplantation in Newly Diagnosed Multiple Myeloma: A Meta-Analysis

Purpose Lenalidomide maintenance therapy after autologous stem-cell transplantation (ASCT) demonstrated prolonged progression-free survival (PFS) versus placebo or observation in several randomized controlled trials (RCTs) of patients with newly diagnosed multiple myeloma (NDMM). All studies had PFS as the primary end point, and none were powered for overall survival (OS) as a primary end point. Thus, a meta-analysis was conducted to better understand the impact of lenalidomide maintenance in this setting. Patients and Methods The meta-analysis was conducted using primary-source patient-level data and documentation from three RCTs (Cancer and Leukemia Group B 100104, Gruppo Italiano Malatti…