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Waldenström's disease is a B-cell neoplasm characterized by the accumulation of lymphoplasmacytic cells (LPCs) in the bone marrow, and more rarely in the lymph nodes and the spleen, which produce a monoclonal immunoglobulin M (IgM) protein. The diagnosis requires the identification of LPCs in the bone marrow, using specific markers in flow cytometry. The MYD88L265P mutation is found in 95% of cases and the CXCR4 mutation in 30-40% of cases. These markers must be sought because they have a diagnostic and prognostic role, and they might become predictive in the future. The clinical presentation is very variable, and includes anomalies related to the bone marrow infiltration of the LPCs (such as anemia), but also anomalies of the physico-chemical and/or immunological activity of the overproduced IgM (hyperviscosity, AL amyloidosis, cryoglobulinemia, anti-MAG neuropathies, etc.). Prognostic scores (IPSSWM) now make it possible to understand the prognosis of symptomatic WM requiring appropriate treatment. The therapeutic management depends on many parameters, such as the specific clinical presentation, the speed of evolution and of course the age and comorbidities. Immuno-chemotherapy is often the 1st line treatment (rituximab-cyclophosphamide-dexamethasone (RCD) or bendamustine-rituximab (BR)) but the role of targeted therapies is becoming preponderant. Bruton tyrosine kinase inhibitors (BTKi) are used today in first relapse. Other therapeutic perspectives will certainly allow us tomorrow to better understand this incurable chronic disease, such as new generations of BTKi, BCL2 inhibitors, anti-CXCR4, bi-specific antibodies, and CAR-T cells., (Copyright © 2022 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Chronic lymphocytic leukemia is the most frequent adult leukemia. Eighty per cent of the patients are asymptomatic at diagnosis and 30% of the patients will be never treated. The diagnosis is based on the blood smear examination and immunophenotyping by flow cytometry of blood lymphocytes. The first line option is immunochemotherapy in 90% of the patients without genetic abnormalities associated with chemo resistance. The use of new compounds targeting different pathways is more frequent especially in relapsing patients and could be an alternative to the chemotherapy in the future. Asymptomatic patients with a stable disease assessed by the specialist can be followed by the general practitioner with a blood count and clinical examination every six months or once a year., (Copyright © 2019. Published by Elsevier Masson SAS.)

Waldenström macroglobulinaemia. Waldenström macroglobulinaemia (WM) is a rare, indolent B-cell lymphoproliferative disorder characterized by cellular involvement in bone marrow and monoclonal IgM production. Symptoms can be related to cytopenias, tumoural involvement, or IgM-related disorders. Somatic mutations in the MYD88 gene have been described in the majority of WM cases. Treatments are started when WM is symptomatic, following systematic biological and morphological assessments. Therapeutic choice depends on age, frailty and urgent efficacy need. In first line, the majority of patients are treated with monoclonal anti- CD20 antibody-based regimens combined with cytotoxic chemotherapy. Rituximab, cyclophosphamide and dexamethasone remain the most commonly used regimen with good safety. Nevertheless, increasing numbers of new drugs are becoming available or are in development. Bruton tyrosine kinase (BTK) inhibitor demonstrated excellent results and is now available for relapse/ refractory disease or as first line for some patients., Competing Interests: L. Simon déclare n’avoir aucun lien d’intérêts. V. Leblond déclare avoir des liens ponctuels avec Acerta, Cellectis, Janssen, Janssen-Cilag, Gilead, GSK, Mundipharma et Pharmacyclics Roche, et avoir été prise en charge lors de congrès par Mundipharma, Pfizer et Roche.

Introduction: High-dose methotrexate (at least 1g/m 2 ) is used to treat haematologic malignancies and osteosarcomas. Acute kidney injury is a well-known adverse-event after high-dose methotrexate and may lead to delayed drug elimination. Besides usual therapeutics (hyperhydration, urine alkalinisation, leucovorin rescue, renal replacement therapy), a costly specific enzymatic treatment (glucarpidase) is now available but its clinical impact remains elusive., Patients and Methods: We analysed high-dose methotrexate prescription charts in 11 clinical centres during the last 15 years to identify and describe adult patients who developed acute kidney injury (according to KDIGO classification). Glucarpidase use was recorded (French temporary regulatory approval criteria: methotrexate at least 10μmol/L at 48h or at least 3μmol/L at 48h associated with acute kidney injury)., Results: Seventy-six acute kidney injury cases have been studied. Mean peak creatinine was 206μmol/L after a mean delay of 5.6 days, with 19 cases of stage 1 acute kidney injury (25%), 29 cases of stage 2 (38%) and 27 cases of stage 3 (36%). Anuria (one case) and need for renal replacement therapy (four cases) were unusual whereas fluid overload was often observed (29%). Three months after high-dose methotrexate treatment, mortality-rate was 17%, and 12% of surviving patients developed renal sequelae., Conclusion: Sixty-one percent of patients received a glucarpidase perfusion during acute kidney injury. Despite a dramatic decrease of methotrexate serum levels, glucarpidase as compared with conservative treatment did not modify acute kidney injury stage, recovery delay, need for renal replacement therapy or the incidence of extrarenal toxicities. Net clinical benefit was not observed even after stratification according to eligibility criteria for glucarpidase use. Glucarpidase has probably no or little effects on methotrexate localized into tubular lumen or proximal tubular cells and that may account for the absence of nephroprotective effect for enzymatic treatment., (Copyright © 2018 Association Société de néphrologie. Published by Elsevier Masson SAS. All rights reserved.)

Ambulatory care management of patient with chronic lymphocytic leukemia; a new concept. In recent years, considerable progress has been made in the treatment and management of hematalogic malignancies. In particular, a new medical practice paradigm is emerging for chronic lymphocytic leukemia (CLL) with more and more targeted oral therapies, often for older and elderly patients with multimorbidity (or multiple chronic diseases) and polypharmacy requiring a new concept of multidisciplinary care so as to avoid discontinuities in treatment and optimize management of adverse reactions and drug-drug interactions. There is a shift away from 'hospital-centered' management to patient-centered home care guided by the hospital. Decisions have to be made with health establishments, hospital and primary healthcare professionals, patient-centered networks and patient associations, organized around several objectives: the proper use of medication, coordination of hospital and home care, patient information and the training of healthcare professionals., Competing Interests: V. Leblond déclare avoir des liens d’intérêts ponctuels avec Acerta, Cellectis, Janssen, Janssen- Cilag, Gilead, GSK, Mundipharma, Pharmacyclics Roche et avoir été prise en charge lors de congrès par Mundipharma, Pfizer et Roche. A. Bellanger déclare des liens ponctuels avec Roche ; et avoir été prise en charge lors de congrès par Novartis, Roche, Takeda et Amgen.

Competing Interests: V. Leblond déclare avoir des liens d’intérêts ponctuels avec Acerta, Cellectis, Janssen, Janssen-Cilag, Gilead, GSK, Mundipharma, Pharmacyclics Roche et avoir été prise en charge lors de congrès par Mundipharma, Pfizer et Roche.

Competing Interests: V. Leblond déclare avoir des liens d’intérêts ponctuels avec Acerta, Cellectis, Janssen, Janssen- Cilag, Gilead, GSK, Mundipharma, Pharmacyclics Roche et avoir été prise en charge lors de congrès par Mundipharma, Pfizer et Roche. A. Bellanger déclare des liens ponctuels avec Roche ; et avoir été prise en charge lors de congrès par Novartis, Roche, Takeda et Amgen.

acroglobulinemia, AL amyloidosis and the POEMS syndrome. The hematologist must characterize the hematological disorder, evaluate the need for treatment, and choose the best treatment option. The neurologist must define the type of neuropathy and evaluate the relationship between the abnormal immunoglobulin and the peripheral neuropathy. Thus, close co-operation between the hematologist and neurologist is necessary when a patient presents with both monoclonal immunoglobulin and peripheral neuropathy.

Medical doctors are required to provide information to their patients regarding their medical procedures according to the law on patient information enacted on March 4, 2002. The objective of this study was to assess patients' awareness and satisfaction with respect to their perception of information obtained prior to or during a medical examination. A self-descriptive patient survey was conducted at the Groupe Hospitalier of Pitié-Salpêtrière in 2005 for this purpose. Data were collected at three distinct moments using a standard questionnaire. 147 patients were interviewed (101 had received and MRI and 46 a bronchoscopy). Twenty percent of the participants reported that they had not been provided with any specific medical or paramedical information before the examination and 4% had received no information at all. Health professionals must ensure that information is given to their patients in a manner that takes into account their expectations and responds to their concerns before a medical procedure is performed in order to improve its delivery and its intrinsic quality.

Management of cancer in the older-aged patient is an increasingly common problem in our occidental societies. Cancer is a disease primarily of older persons: over 60% of all cases of cancer are diagnosed after age 65 - an age group that constitutes less than 20% of the western population and the risk of persons over 65 years of age developing cancer is at least 10 times that of those under 65. Cancer in older persons may be considered a different disease from cancer in the younger in that way that biology of the host could influence the growth of cancer, that the management of the disease deserved an individualized approach. Indeed, the normal process of aging is associated with a progressive age-related reduction in function of many organs, including losses such as renal, pulmonary, cardiac, immune, hepatic, haematological, muscles, osseous, sight, hearing and brain functions. The consequences of these changes with age, added to comorbid diseases, have major implications on toxicities of anti-cancer therapies, surgery, radiotherapy as well as chemotherapy. However chronologic age should not be used as a guide to cancer therapy. Performance status and physiologic performance of the older patient are of prime importance to decide and conduct chemotherapy.

Post-transplantation lymphoproliferative disorders (PTLD) represent a severe complication of organ transplantation, so the determination of prognostic factors for the response and the survival is of major interest. Studies on PTLD are hindered by the small number of cases, explaining the conflicting published results. In order to identify, prognostic factors in this kind of disease, 61 patients have been analyzed in a retrospective multicenter study. A new index is proposed to assess the survival probability, it is composed of two factors: the performance status (PS < or = 1 versus 2-3) and the number of involved sites (1 versus > 1). This index seems to be more accurate in PTLD than the IPI, the reference in immunocompetent patients with non Hodgkin lymphomas. However, a similar analysis in a more homogeneous population remains necessary.