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Jollant F.,McGill University | Garre J.-B.,CHU dAngers | Richard-Devantoy S.,McGill University | Richard-Devantoy S.,University of Angers
Geriatrie et Psychologie Neuropsychiatrie du Vieillissement | Year: 2012

Objective: Late-life depression has been associated with frontostriatal abnormalities that are thought to lead to deficits of cognitive inhibition. However, it remains unclear, whether age-of-onset identifies subgroups of depression. The objective of this study was to compare cognitive inhibition in depressed women aged 60 and older, according to age of the first onset depression (before or after 60 years old). Methods:We compared 10 currently depressed women (HDRS-17.18) with a late-onset depression to 10 depressed women with an early-onset depression, and to 10 healthy controls.We examined cognitive inhibition (Stroop, Hayling, Go/No-Go), shifting (TMT), updating inworking memory (WAIS) and executive functions (BREF). All groups were matched for age, education level, and MMSE score (MMSE.24). Results: Depressed elderly women with a late and an early-onset depression had a greater impairment in executive functions and cognitive inhibition compared with healthy controls (p<0,001), but without significant differences according to the age of the first onset depression. Futhermore, late-onset depression in women was significantly correlated with a deficit of cognitive inhibition (rs=0.55; p=0.012). Conclusion: Cognitive inhibition should be assessed in late-life depression. Interventions may be developed to specifically target cognitive impairment in the prevention of late-life depression, to identify those who are the most vulnerable to relapse.

Gouraud-Tanguy A.,Nantes University Hospital Center | Berlioz-Thibal M.,Nantes University Hospital Center | Brisseau J.-M.,Nantes University Hospital Center | Aoudia V.O.,Nantes University Hospital Center | And 3 more authors.
Geriatrie et Psychologie Neuropsychiatrie du Vieillissement | Year: 2012

Anticholinergic medications are responsible for most frequent adverse drug effects. Two scales have been elaborated as tools for prescribers: the Anticholinergic Drug Scale (ADS) of Carnahan et al., and the Anticholinergic Risk Scale (ARS) of Rudolph et al. The objective of this study was to analyze the diagnostic performance of both scales for predicting signs related to an anticholinergic effect. Method: Medical records of 1379 patients aged 75 years or older hospitalized in a geriatric acute care unit between 2002 and 2005 were studied. The analyze was made retrospectively, but data were collected prospectively. Results: Risk of appearance of total anticholinergic signs (ADS : OR 1,45, CI 95% [1,03-2,03], p=0,037 and ARS : OR 1,98, CI 95% [1,19-3,28] p<0,01) and peripheral signs (ADS: OR 1,66, CI 95% [1,22-2,26], p<0,01 and ARS : OR 1,81, CI 95% [1,19-2,75], p<0,01) increased when score was ≥ 3 with both scales, which wasn't the case for central signs. Conclusion: Both scales permitted to detect an increased risk of appearance of total and peripheral anticholinergic signs, but not the centrals as delirium. Interest of total anticholinergic burden remains to be demonstrated, especially for delirium risk assessment.

Bachy E.,University of Lyon | Houot R.,University of Rennes 1 | Morschhauser F.,Lille 2 University of Health and Law | Sonet A.,Catholic University of Louvain | And 10 more authors.
Haematologica | Year: 2013

Anti-CD20-containing chemotherapy regimens have become the standard of care for patients with follicular lymphoma needing cytotoxic therapy. Four randomized trials demonstrated a clinical benefit for patients treated with rituximab. However, no long-term follow up (i.e. > 5 years) of these trials is yet available. Between May 2000 and May 2002, 358 newly diagnosed patients with high tumor burden follicular lymphoma were randomized to receive cyclophosphamide, adriamycin, etoposide and prednisolone plus interferon-α2a or a similar chemotherapy- based regimen plus rituximab, and outcome was up-dated. With a median follow up of 8.3 years, addition of rituximab remained significantly associated with prolonged event-free survival (primary end point) (P=0.0004) with a trend towards a benefit for overall survival (P=0.076). The Follicular Lymphoma International Prognostic Index score was strongly associated with outcome for both event-free and overall survival in univariate analysis and its prognostic value remained highly significant after adjusting for other significant covariates in multivariate models (P<0.0001 and P=0.001, respectively). Considering long-term toxicity, the addition of rituximab in the firstline setting was confirmed as safe with regards to development of secondary malignancies. Long-term follow up of patients with follicular lymphoma treated in the FL2000 study confirms the sustained clinical benefit of rituximab without long-term toxicity. This study was registered at ClinicalTrials.gov.

Huguet F.,HOpital Purpan | Vey N.,Institute Paoli Calmettes | Ifrah N.,CHU dAngers
Leukemia and Lymphoma | Year: 2015

Abstract Clofarabine, a second-generation purine analog displaying potent inhibition of DNA synthesis and favorable pharmacologic profile, is approved for the treatment of acute lymphoblastic leukemia (ALL) after failure of at least two previous regimens in patients up to 21 years of age at diagnosis. Good neurologic tolerance, synergy with alkylating agents, management guidelines defined through pediatric ALL and adult acute myeloid leukemia, have also prompted its administration in more than 100 adults with Philadelphia chromosome-positive and negative B lineage and T lineage ALL, as single agent (40 mg/m2/ day for 5 days), or in combination. In a Group for Research on Adult Acute Lympho- blastic Leukemia (GRAALL) retrospective study of two regimens (clofarabine ± cyclophosphamide + / - etoposide (ENDEVOL) ± mitoxantrone ± asparaginase ± dexamethasone (VANDEVOL)), remission was achieved in 50% of 55 relapsed/refractory patients, and 17-35% could proceed to allogeneic stem cell. Clofarabine warrants further exploration in advanced ALL treatment and bridge-to-transplant. © 2015 Informa UK, Ltd.

Gressin R.,Grenoble University Hospital Center | Gressin R.,French Institute of Health and Medical Research | Caulet-Maugendre S.,Rennes University Hospital Center | Deconinck E.,Besancon University Hospital Center | And 16 more authors.
Haematologica | Year: 2010

Background There is currently no international consensus for first-line treatment (prior to autologous stem cell transplantation) in mantle cell lymphoma patients. Here, we investigated the efficacy and tolerance of VAD associated with chlorambucil (VAD+C) and rituximab or not before autologous stem cell transplantation. Design and Methods Between 1996 and 2005, 113 previously untreated mantle cell lymphoma patients were enrolled in two consecutive prospective phase II studies. Responses and response factors to the (R)VAD+C regimen were evaluated. The survival prognostic value of the MIPI score and Ki67 were also analyzed. Results The induction phase of 4 courses of (R)VAD+C showed very low hematologic and extra-hematologic toxicity (grade 3-4 thrombopenia and neutropenia, 9% and 2.7%, respectively and grade 3-4 extra-hematologic toxicities, 1.6%). Overall and complete response rates were 73% and 46%, respectively, and rose to 83% and 51% for the 70% of patients with less than two independent response factors (LDH, B symptoms and lymphocytosis). At the end of treatment, 65% of patients were in complete remission. Progression free and overall survival were significantly better in the transplanted population. The MIPI score was confirmed as a predictor of survival. Ki67, serum LDH, Performance Status (PS) and B symptoms were identified as independent prognostic factors of survival. A prognostic scoring system could stratify patients into three risk groups with markedly different median overall survival of 112, 44 and 11 months, respectively. Conclusions The (R)VAD+C is an effective regimen with very low toxicity. In addition to the MIPI score, Ki67 expression provides additional independent prognostic information for the prediction of overall survival (ClinicalTrials.gov Identifier: NCT00285389). © 2010 Ferrata Storti Foundation.

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