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In recent years, considerable progress has been made in frontline therapy for elderly/physically unfit patients with CLL. The combination of obinutuzumab and chlorambucil (O-Clb) has been shown to prolong progression free survival (PFS, median PFS-31.5 months) and overall survival (OS) compared to chlorambucil alone. More recently, obinutuzumab given in combination with either ibrutinib or venetoclax improved PFS but not OS when compared to O-Clb. In this retrospective multinational, multicenter co-operative study, we evaluated the efficacy and safety of frontline treatment with O±Clb in unfit patients with CLL, in a "real-world" setting. Patients with documented del(17p13.1)/TP53mutation were excluded. A total of 437 patients (median age, 75.9years; median CIRS score, 8; median creatinine clearance, 61.1 mL/min)were included. The clinical overall response rate was 80.3% (clinical complete and partial responses in 38.7% and 41.6% of patients, respectively). Median observation time was 14.1 months and estimated median PFS was 27.6 months (95%CI, 24.2-31.0). In a multivariate analysis, high-risk disease [del(11q22.3) and/or IGHV-unmutated], lymph nodes of diameter >5cm, obinutuzumab monotherapy and reduced cumulative dose of obinutuzumab, were all independently associated with shorter PFS. The median OS has not yet been reached and estimated 2-year OS is 88%. In conclusion, in a "real-world" setting, frontline treatment with O-Clb achieves PFS comparable to that reported in clinical trials. Inferior outcomes were noted in patients with del(11q22.3) and/or unmutated IGHV and those treated with obinutuzumab-monotherapy. Thus, O-Clb can be still considered as legitimate frontline therapy for unfit CLL patients with low-risk disease. This article is protected by copyright. All rights reserved.

Recent evidence suggests that complex karyotype (CK) defined by the presence of >= 3 chromosomal aberrations (structural and/or numerical) identified by using chromosome-banding analysis (CBA) may be relevant for treatment decision-making in chronic lymphocytic leukemia (CLL). However, many challenges toward the routine clinical application of CBA remain. In a retrospective study of 5290 patients with available CBA data, we explored both clinicobiological associations and the clinical impact of CK in CLL. We found that patients with >= 5 abnormalities, defined as high-CK, exhibit uniformly dismal clinical outcomes, independently of clinical stage, TP53 aberrations (deletion of chromosome 17p and/or TP53 mutations [TP53abs]), and the expression of somatically hypermutated (M-CLL) or unmutated immunoglobulin heavy variable genes. Thus, they contrasted with CK cases with 3 or 4 aberrations (low-CK and intermediate-CK, respectively) who followed aggressive disease courses only in the presence of TP53abs. At the other end of the spectrum, patients with CK and 112,119 displayed an exceptionally indolent profile. Building upon CK, TP53abs, and immunoglobulin heavy variable gene somatic hyper-mutation status, we propose a novel hierarchical model in which patients with high-CK exhibit the worst prognosis, whereas those with mutated CLL lacking CK or TP53abs, as well as CK with 112,119, show the longest overall survival. Thus, CK should not be axiomatically considered unfavorable in CLL, representing a heterogeneous group with variable clinical behavior. High-CK with >= 5 chromosomal aberrations emerges as prognostically adverse, independent of other biomarkers. Prospective clinical validation is warranted before ultimately incorporating high-CK in risk stratification of CLL.

© Athens Medical Society. Allergic rhinitis is a serious global health problem which affects approximately 10–20% of the European population. In 1999, during a workshop of WHO, the project Allergic Rhinitis and its Impact on Asthma (ARIA) was developed. Its objective was to propose a new classification of allergic rhinitis according to the severity and the duration of the symptoms, to promote the idea of multimorbidity of allergic rhinitis and asthma, and to create guidelines for global use, with the help of local stakeholders and experts from all the countries involved. The focus of ARIA during recent years has been the use of new technologies for individualized medical care and prevention. The MASK instrument uses smartphone technology to create care pathways for controlling rhinitis, for both multidisciplinary care teams and the patients themselves. Using a mobile app (Allergy Diary), a patient can assess symptoms, control and productivity using a visual analog scale, which is connected with a clinical decision support system. The information is sent to an interoperable tablet where healthcare professionals can be informed about the patient’s rhinitis management. As the European population is ageing, the novel approach of ARIA aims to provide active and healthy ageing in order to improve the quality of life of patients with allergic rhinitis. In Greece, ARIA has been implemented since the early 2000s. In 2017 a new ARIA implementation group was established, consisting of a large number of health care professionals from both Greece and Cyprus. The MASK Allergy Diary has been translated into Greek and is currently being used in clinical practice and research protocols with great enthusiasm. In order to rectify the lack of recent studies on the epidemiology of allergic rhinitis in Greece, MASK will be the instrument which, in combination with aerobiological studies, will form the basis for reporting allergic rhinitis activity around the country. ispartof: ARCHIVES OF HELLENIC MEDICINE vol:35 issue:6 pages:824-833 status: published

Resume Une experience de 50 tentatives de catheterisme de la veine humerale profonde est rapportee. La veine satellite interne est ponctionnee, apres mise en place d'un garrot veineux, en dedans de l'artere humerale, un centimetre au-dessus du pli du coude. La veine a pu etre catheterisee dans 72 % des cas (36 malades). Le seul incident a ete a six reprises la ponction accidentelle de l'artere humerale. La duree moyenne du catheterisme a ete de 20 jours. Cette technique simple peut etre utilisee chaque fois que les veines peripheriques superficielles sont inutilisables et lorsque l'abord des gros troncs veineux centraux est dangereux ou impossible.

Recent evidence suggests that complex karyotype (CK) defined by the presence of =3 chromosomal aberrations (structural and/or numerical) identified by chromosome banding analysis (CBA) may be relevant for treatment decision-making in chronic lymphocytic leukemia (CLL). However, many challenges towards routine clinical application of CBA remain. In a retrospective study of 5290 patients with available CBA data, we explored both clinicobiological associations and the clinical impact of CK in CLL. We found that patients with =5 abnormalities, defined as high-CK, exhibit uniformly dismal clinical outcome, independently of clinical stage, TP53 aberrations (deletion of chromosome 17p and or TP53 mutations, TP53abs) and the expression of somatically hypermutated (M-CLL) or unmutated (U-CLL) immunoglobulin heavy variable genes (IGHV). Thus, they contrasted CK cases with 3 or 4 aberrations (low-CK and intermediate-CK, respectively) who followed aggressive disease courses only in the presence of TP53abs. At the other end of the spectrum, patients with CK and +12,+19 displayed an exceptionally indolent profile. Building upon CK, TP53abs and IGHV gene somatic hypermutation status, we propose a novel hierarchical model where patients with high-CK exhibit the worst prognosis, while M-CLL lacking CK or TP53abs as well as CK with +12,+19 show the longest overall survival. In conclusion, CK should not be axiomatically considered unfavorable in CLL, representing a heterogeneous group with variable clinical behavior. High-CK with =5 chromosomal aberrations emerges as prognostically adverse, independently of other biomarkers. Prospective clinical validation is warranted before finally incorporating high-CK in risk stratification of CLL.