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Dijon, France

Barral M.,Paris West University Nanterre La Defense | Taouli B.,Body MR Imaging and Translational and Molecular Imaging Institute | Guiu B.,Hopital Le Bocage | Koh D.-M.,Royal Marsden Hospital | And 5 more authors.

Advances in image quality over the past few years, mainly due to refinements in hardware and coil systems, have made diffusion-weighted (DW) magnetic resonance (MR) imaging a promising technique for the detection and characterization of pancreatic conditions. DW MR imaging can be routinely implemented in clinical protocols, as it can be performed relatively quickly, does not require administration of gadolinium-based contrast agents, and enables qualitative and quantitative assessment of tissue dif-fusivity (diffusion coefficients). In this review, acquisition parameters, postprocessing, and quantification methods applied to pancreatic DW MR imaging will be discussed. The current common clinical uses of DW MR imaging (ie, pancreatic lesion detection and characterization) and the less-common applications of DW MR imaging used for the diagnosis of pancreatic parenchymal diseases will be reviewed. Also, the limitations of the technique, mainly image quality and reproducibility of diffusion parameters, as well as future directions for pancreatic DW MR imaging will be discussed. The utility of apparent diffusion coefficient (ADC) measurement for the characterization of pancreatic lesions is now well accepted but there are a number of limitations. Future well-designed, multicenter studies are needed to better determine the most appropriate use of ADC in the area of pancreatic disease. © RSNA, 2015. Source

Gobert D.,Hopital Henri Mondor | Bussel J.B.,New York Medical College | Cunningham-Rundles C.,Mount Sinai School of Medicine | Dechartres A.,University of Paris Descartes | And 6 more authors.
British Journal of Haematology

Patients with common variable immunodeficiency (CVID) are at high risk of developing immune thrombocytopenia (ITP) and/or autoimmune haemolytic anaemia (AHA). Given their underlying immunodeficiency, immunosuppressive treatment of these manifestations may increase the risk of infection. To assess efficacy and safety of rituximab in patients with CVID-associated ITP/AHA, a multicentre retrospective study was performed. Thirty-three patients, 29 adults and four children, were included. Patients received an average of 2·6 treatments prior to rituximab including steroids, intravenous immunoglobulin and splenectomy (21%). The median ITP/AHA duration at time of first rituximab administration was 12months [range 1-324] and the indication for using rituximab was ITP (22 cases), AHA (n=5) or both (n=7); 1 patient was treated sequentially for ITP and then AHA. The overall initial response rate to rituximab was 85% including 74% complete responses. After a mean follow-up of 39±30months after rituximab first administration, 10 of the initial responders relapsed and re-treatment with rituximab was successful in 7/9. Severe infections occurred after rituximab in eight adults (24%), four of whom were not on immunoglobulin replacement therapy. In conclusion, rituximab appears to be highly effective and relatively safe for the management of CVID-associated severe immune cytopenias. © 2011 Blackwell Publishing Ltd. Source

Hermet E.,Estaing University Hospital Center | Cabrespine A.,Estaing University Hospital Center | Guieze R.,Estaing University Hospital Center | Tempescul A.,Hopital Augustin Morvan | And 11 more authors.
Journal of Geriatric Oncology

Introduction: Limited data is available on the feasibility of high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (AHSCT) in elderly patients over 70. years of age with non-Hodgkin's lymphoma (NHL). Materials and Methods: In the setting of the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC) group, we retrospectively analyzed 81 consecutive patients with NHL over 70. years of age who received AHSCT. Results: The median age at AHSCT was 72.3years [70-80]. Patients' were diagnosed with diffuse large B-cell lymphoma (n=40), follicular lymphoma (n=16), mantle cell lymphoma (n=15), T-cell lymphoma (n=5), and other (n=5). Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) was 0 in 73% of patients. Main conditionings were BEAM (Carmustine-Etoposide-Cytarabine-Melphalan, n=61) and melphalan alone (n=14). Median delays to reach 0.5×109/L neutrophils and 20×109/L platelets were of 12 [9-76] days and 12 [0-143] days, respectively. One hundred day and one year cumulative incidence of NRM was 5.4% and 8.5%, respectively. The main cause of death remains relapse. Conclusion: In conclusion, this study revealed that AHSCT seemed to be acceptable in patients over 70. years of age with NHL. Patient age is not a limiting factor if clinical condition is adequate. © 2015 Elsevier Inc. Source

Gallamini A.,Center Antoine Lacassagne | Barrington S.F.,Kings College London | Biggi A.,center | Chauvie S.,Medical Physics Unit | And 20 more authors.

A retrospective, international, multicenter study was undertaken to assess: (i) the prognostic role of 'interim' positron emission tomography performed during treatment with doxorubicin, bleomycin, vinblastine and dacarbazine in patients with Hodgkin lymphoma; and (ii) the reproducibility of the Deauville five-point scale for the interpretation of interim positron emission tomography scan. Two hundred and sixty patients with newly diagnosed Hodgkin lymphoma were enrolled. Fifty-three patients with early unfavorable and 207 with advanced-stage disease were treated with doxorubicin, bleomycin, vinblastine and dacarbazine ± involved-field or consolidation radiotherapy. Positron emission tomography scan was performed at baseline and after two cycles of chemotherapy. Treatment was not changed according to the results of the interim scan. An international panel of six expert reviewers independently reported the scans using the Deauville five-point scale, blinded to treatment outcome. Forty-five scans were scored as positive (17.3%) and 215 (82.7%) as negative. After a median follow up of 37.0 (2-110) months, 252 patients are alive and eight have died. The 3-year progression-free survival rate was 83% for the whole study population, 28% for patients with interim positive scans and 95% for patients with interim negative scans (P<0.0001). The sensitivity, specificity, and negative and positive predictive values of interim positron emission tomography scans for predicting treatment outcome were 0.73, 0.94, 0.94 and 0.73, respectively. Binary concordance amongst reviewers was good (Cohen's kappa 0.69-0.84). In conclusion, the prognostic role and validity of the Deauville five-point scale for interpretation of interim positron emission tomography scans have been confirmed by the present study. © 2014 Ferrata Storti Foundation. Source

Berriolo-Riedinger A.,Center Georges Francois Leclerc | Tychyj-Pinel C.,Center Hospitalier Lyon Sud | Tilly H.,Center Henri Becquerel | Gallamini A.,Azienda Ospedaliera S. Croce | And 6 more authors.
Journal of Clinical Oncology

Purpose: [18F]Fluorodeoxyglucose positron emission tomography (PET) is widely used for the staging and restaging of patients with aggressive lymphoma, but less is known about the utility of PET in patients with follicular lymphoma (FL). In a prospective study, we evaluated the prognostic value of PET performed during treatment and at the end of treatment in 121 patients with FL treated with first-line immunochemotherapy. Patients and Methods: Patients with previously untreated high-tumor burden FL were treated with six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) plus two cycles of rituximab, without rituximab maintenance. PET was performed before treatment, after four cycles of R-CHOP (interim PET), and at the end of treatment (final PET). PET scans were centrally reviewed. Results: The total number of patients included was 121. Median age was 57 years. After central review, interim PET (n = 111) was negative in 76% of patients, and final PET (n = 106) was negative in 78%. With a median follow-up of 23 months, 2-year progression-free survival rates were 86% for interim PET-negative versus 61% for interim PET-positive patients (P = .0046) and 87% for final PET-negative versus 51% for final PET-positive patients (P < .001), respectively. Two-year overall survival also significantly differed according to final PET results: 100% versus 88% (P = .0128). Conclusion: PET performed either after four cycles of R-CHOP or at the end of therapy was strongly predictive of outcome in this prospective study. Therapeutic intervention based on PET results during or after inductive treatment should be evaluated. © 2012 by American Society of Clinical Oncology. Source

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