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To avoid repeated apheresis, the objective of this study was to analyse the predictive factors for a single successful cytapheresis during the first mobilisation. The pre-collection characteristics of 170 lymphoma and 95 myeloma patients were analysed. Among 60 lymphoma patients who had less than 30 CD34 cells/mm(3) the day before the first apheresis, an increase in the CD34 cell count between Day -1 and Day 1 was predictive of first stem cell mobilisation success, with a sensitivity of 100% if the Day 1 was higher than 30/mm(3) (10/60 patients). Success rate of obtaining an appropriate number of stem cells in one apheresis was 120 among 170 patients.

We prospectively evaluated in high-risk myeloma patients the efficacy and toxicity of tandem autologous hematopoietic stem cell transplantation (auto-HSCT) followed by reduced-intensity conditioning (RIC) and allogeneic (allo)-HSCT with bortezomib and donor lymphocyte infusions introduction after allo-HSCT (group 1). Results were compared with results from tandem auto-RIC-allo-HSCT without bortezomib (group 2). Groups 1 and 2 were compared to matched patients not receiving allo-HSCT from the Intergroupe Francophone du Myelome prospective studies. Allo-HSCT groups included 25 patients (12 in group 1, 13 in group 2). All patients engrafted. There were 8 acute GVHD (7 grade II [3 in group 1], 1 grade III in group 1)] and 11 chronic GVHD (3 limited [in group 1], 8 extensive [1 in group 1]). Matched population included 36 controls for group 1 and 39 for group 2. After a median follow-up of 55 months (range, 3–142 months), median overall survival was not reached in group 1 versus 65 months (51-not reached [NR]) in its matched group ( p = 0.027); it was 96 months (49-NR) in group 2 versus 91 months (32-NR) in its matched group ( p = 0.77). Median progression-free survival was 49 months (29-NR) in group 1 and was 25 months (range, 21–35 months) in its matched group ( p = 0.0045); it was 31 months (22-NR) in group 2 and 28 months (range, 21–40 months) in its matched group ( p = 0.0776). Tandem auto-RIC–allo-HSCT including new molecules and immunomodulation after transplantation could be used as a first-line treatment for high-risk myeloma patients.

Background: This prospective multicentric phase II study aimed to confirm the results of the C5R protocol of high-dose methotrexate (MTX)-based chemotherapy (CT) for immunocompetent primary central nervous system lymphoma. Patients and methods: A total of 99 patients received age-adapted CT (C5R protocol) followed by radiotherapy. Patients younger than 61 years (group 1, n = 45) received the full C5R with MTX, doxorubicin, vincristine, cyclophosphamide, and cytarabine. Patients aged 61-70 years (group 2, n = 36) received reduced doses. Patients older than 70 years (group 3, n = 18) received four courses of MTX, cyclophosphamide, and etoposide. Results: Median age was 63 years and 51% of patients had performance status of more than one. Seventeen patients died of toxicity during CT. Complete response was achieved in 56%, 53%, and 28% of patients in groups 1, 2, and 3, respectively. With a median follow-up of 83 months, the 5-year progression-free survival was 31%, 28%, and 11% and the 5-year overall survival 42%, 31%, and 17% for groups 1, 2, and 3, respectively. Leukoencephalopathy occurred in 32% of assessable patients, in both group 1 and groups 2-3. Conclusion: The C5R protocol was feasible in the multicentric setting with favorable long-term survival in patients younger than 60 years. Despite dose adaptation, results in older patients were disappointing.

Outcome of adult acute lymphoblastic leukemia (ALL) with central nervous system (CNS) involvement is not clearly defined. We studied 104 patients presenting with CNS involvement at diagnosis among 1493 patients (7%) included into the LALA trials, and 109 patients presenting CNS disease at the time of first relapse among the 709 relapsing patients (15%). Eighty-seven patients (84%) with CNS leukemia at diagnosis achieved complete remission (CR). Fifty-three patients underwent stem cell transplantation (SCT): 25 allogeneic SCT, 28 autologous SCT, while 34 continued with chemotherapy alone. Seven-year overall survival (OS) and disease-free survival (DFS) were 34% and 35%, respectively. There were no significant differences in terms of CR, OS and DFS among patients with CNS involvement at diagnosis and those without CNS disease. There were also no differences among the two groups regarding T lineage ALL, B lineage ALL, and among those who underwent SCT. After a first relapse, 38 patients with CNS recurrence (35%) achieved a second CR. The median OS was 6.3 months. Outcome was similar to that of relapsing patients without CNS disease. CNS leukemia in adult ALL is uncommon at diagnosis as well as at the time of first relapse. With intensification therapy, patients with CNS leukemia at diagnosis have a similar outcome than those who did not present with CNS involvement. CNS leukemia at first relapse remains of similar poor prognosis than all other adult ALL in first relapse.

Resume Deux observations de nephropathies associees a l'emploi d'interferon alpha sont rapportees: il s'agit d'une glomerulopathie membranoproliferative et d'une microangiopathie thrombotique. Elles sont l'occasion de faire une revue de la litterature et de discuter la physiopathologie de ces atteintes.

Resume Quatre observations d'intoxication aigue par chlorate de sodium sont rapportees. Dans quatre cas, il existe une methemoglobinemie, une hemolyse et une atteinte multiviscerale de gravite variable. Dans chaque cas, la presence d'une hyperleucocytose majeure est constatee. La discordance entre les chiffres annonces par les appareils automatiques et le frottis sanguin montre qu'il existe un artefact dans la technique de mesure. Les mecanismes a l'origine de cette hyperleucocytose « facticesont discutes. La prise en compte par les appareils des corps de Heinz pour des leucocytes est une explication possible. L'hyperleucocytose factice, presente dans les quatre observations et reproductible experimentalement, pourrait etre proposee comme element d'orientation diagnostique devant une methemoglobinemie associee a une hemolyse.

Resume Les septicemies a Clostridium perfringens au cours du traitement des leucemies aigues sont rares et souvent mortelles en particulier chez l'enfant. L'antibiotherapie est indispensable mais avantageusement aidee par l'augmentation du nombre de polynucleaires, soit par transfusions, soit par le biais de facteurs de croissance hematopoietiques. Nous rapportons le cas d'une septicemie a C perfringens avec cellulite perineale chez une jeune fille de 12 ans traitee pour une leucemie aigue lymphoblastique. L'evolution est particuliere par l'obtention de la guerison malgre un terrain fragilise.

With the growing number of patients surviving cancer, there is an increasing concern with their long-term adaptation. A cross-sectional study was performed in 1995 focusing on physical, psychological, social and familial sequelae in Hodgkin's disease patients who survived 4 years or more from initial treatment. Patients were selected from the Calvados General Cancer Registry if they were treated during the 1978–1990 period, did not develop a second malignancy, remained free of disease since 01.01.1991, and were aged 18 years or more at interview. Information was taken from a self questionnaire sent by mail. The EORTC QLQ-C30 core questionnaire was used to evaluate the quality of life. Clinical data were obtained from medical records. At March 1st, 1995,107 patients (male/female ratio 1.4; mean age 32 years, range 3 to 78) were selected of whom 67% presented with early stages, 38% with B symptoms. Initial therapy consisted of irradiation (RT) in 29%, combination RT and chemotherapy (CT, mostly MOPP) in 66%, and CT alone in 5%. The mean follow-up was 123 months (57 to 203). Overall, 59% of patients developed mild (27%), moderate (25%) or severe (7%) clinical complications. Complications did not correlate with follow-up, clinical stage and RT extent In contrast, complications correlated with CT ( P = 0.058), independently of RT. Results concerning the survey and the quality of life in these patients will be presented.

Resume A propos d'une observation, les auteurs rappellent le role favorisant des therapeutiques immuno-suppressives dans la survenue d'une leishmaniose viscerale chez le transplante renal. En presence d'une fievre, d'une pancytopenie, d'une splenomegalie, la notion d'un sejour en pays d'endemie est capitale a obtenir. Le myelogramme confirme alors le diagnostic. Le traitement repose sur les derives stibies qui doivent etre manies avec prudence sur ce terrain.