Service dHemato oncologie

Montréal, Canada

Service dHemato oncologie

Montréal, Canada
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Itzykson R.,University of Paris 13 | Thepot S.,University of Paris 13 | Beyne-Rauzy O.,Toulouse 1 University Capitole | Ame S.,University of Strasbourg | And 14 more authors.
Leukemia Research | Year: 2012

We studied a retrospective cohort of 282 higher-risk MDS treated with azacitidine, including 32 patients who concomitantly received an ESA for a median of 5.8. months after azacitidine onset. Forty-four percent of ESA and 29% of no-ESA patients reached HI-E (p= 0.07); 48% and 20% achieved transfusion independence (p= 0.01). Median OS was 19.6. months in the ESA and 11.9. months in the no-ESA groups (p= 0.04). Addition of an ESA significantly improved OS (p= 0.03) independently of azacitidine schedule and duration, and of our proposed azacitidine risk score (Blood 2011;117:403-11). Adding an ESA to azacitidine in higher-risk MDS should be studied prospectively. © 2011 Elsevier Ltd.

Itzykson R.,University of Paris 13 | Thepot S.,University of Paris 13 | Thepot S.,French Institute of Health and Medical Research | Quesnel B.,Lille University Hospital Center | And 26 more authors.
Blood | Year: 2011

Prognostic factors for response and survival in higher-risk myelodysplastic syndrome patients treated with azacitidine (AZA) remain largely unknown. Two hundred eighty-two consecutive high or intermediate-2 risk myelodysplastic syndrome patients received AZA in a compassionate, patient-named program. Diagnosis was RA/RARS/RCMD in 4%, RAEB-1 in 20%, RAEB-2 in 54%, and RAEB-t (AML with 21%-30% marrow blasts) in 22%. Cytogenetic risk was good in 31%, intermediate in 17%, and poor in 47%. Patients received AZA for a median of 6 cycles (1-52). Previous low-dose cytosine arabinoside treatment (P = .009), bone marrow blasts > 15% (P = .004), and abnormal karyotype (P = .03) independently predicted lower response rates. Complex karyotype predicted shorter responses (P = .0003). Performance status ≥ 2, intermediate- and poor-risk cytogenetics, presence of circulating blasts, and red blood cell transfusion dependency ≥ 4 units/8 weeks (all P < 10-4) independently predicted poorer overall survival (OS). A prognostic score based on those factors discriminated 3 risk groups with median OS not reached, 15.0 and 6.1 months, respectively (P < 10-4). This prognostic score was validated in an independent set of patients receiving AZA in the AZA-001 trial (P = .003). Achievement of hematological improvement in patients who did not obtain complete or partial remission was associated with improved OS (P < 10-4). In conclusion, routine tests can identify subgroups of patients with distinct prognosis with AZA treatment. © 2011 by The American Society of Hematology.

Dzoljic E.,University of Belgrade | Novakovic I.,University of Belgrade | Krajinovic M.,Service dHemato oncologie | Grbatinic I.,University of Belgrade | Kostic V.,University of Belgrade
International Journal of Neuroscience | Year: 2015

Parkinson's disease (PD) is a debilitating, demoralizing and financially devastating condition affecting 1% of population at the age of 60 years. Thus, very important issue to address is individual therapy optimization. Recent results have shown evidence that variable efficacy of treatment and risk of motor and mental complications could have genetic origin. Significant roles in that process play (pharmaco)genomic/genetic studies of PD. Variability in genes coding for drug-metabolizing enzymes, drug receptors and proteins involved in drug pathway signaling is an important factor determining inter-individual variability in drug responses. Interpersonal differences in drug responses are clearly documented although individualized treatment of PD is not widely known. Treatment with antiparkinsonian drugs is associated with the development of complications, such as L-DOPA-induced dyskinesia (LID), hallucinations and excessive daytime sleepiness. Carriers of specific genetic polymorphisms are particularly susceptible to development of some of these drug adverse effects. Pharmacogenomics aims to understand the relationship between genetic factors and inter-individual variations in drug responses, and to translate this information in therapy tailored to individual patient genetics. Relatively few efforts have been made to investigate the role of pharmacogenetics in the individual response to anti-PD drugs. Thus, many genetic variations and polymorphisms in myriad of different proteins can influence individual response to anti-PD drugs. © 2014 Taylor and Francis.

Sacre A.,Service de pneumologie | Brasseur M.,Service du laboratoire | Boulet D.,Service dhemato oncologie | Halloy J.-L.,Service de pneumo allergologie
Revue Francaise d'Allergologie | Year: 2010

Heparin is one of the oldest drugs on the market. Widely used for the prevention and treatment of thromboembolic diseases, its adverse effects are well-known. Allergic reactions are rare (0.2%), especially immediate hypersensitivity reactions, which are exceptional. We report a case of an immediate allergic reaction to nadroparine. We discuss diagnostic methods, the potential interest in the basophile activation test, cross-reactivity and therapeutic alternatives. © 2010 Elsevier Masson SAS.

Traverse-Glehen A.,University of Lyon | Bertoni F.,Southern Research Institute | Thieblemont C.,Service dHemato Oncologie | Zucca E.,Southern Research Institute | And 3 more authors.
Oncology | Year: 2012

In the last lymphoma classifications, three types of marginal zone lymphoma (MZL) were delineated: extranodal mucosa-associated lymphatic tissue (MALT) lymphoma, splenic MZL, and nodal MZL (NMZL). While MALT lymphoma is already well characterized and has been extensively studied, the pathogenesis of the other two types, especially that of NMZL, remains incompletely understood. The tumor is rather uncommon, although it shares morphologic and immunophenotypic similarities with the other MZLs. Few series have been published, and the description is quite heterogeneous, reflecting the lack of consensus criteria for its diagnosis; the ability to develop such criteria is impeded by the absence of specific immunological or molecular abnormalities. The disease develops from peripheral (mostly cervical) and abdominal lymph nodes, with or without bone marrow and blood involvement. How to differentiate NMZL from lymphoplasmacytic lymphoma remains a key point of debate. NMZL also represents a therapeutic dilemma, given the absence of published large or prospective series. The 5-year overall survival as well as the failure-free survival of patients appear to be lower than those of patients with extranodal MZL. The aim of this review is twofold: to summarize descriptions of the clinical presentation provided in published series in order to help clinicians recognize and treat patients, and to discuss diagnostic difficulties faced by hematopathologists when dealing with these lesions and others in the differential diagnosis that must be distinguished from one another.

For a patient suspected of thrombosis, angio-CT is the best tool, allowing an exhaustive study of thromboembolic disease. Additionally, in a significant number of situations, this examination could provide information on the underlying cancer that is known or unknown. The exploration should cover the thorax for the diagnosis of pulmonary embolism. The extension to the abdomen and pelvis for the analysis of the inferior vena cava could allow a complete assessment of the thrombotic disease and could seem appropriate in the search of an underlying neoplasm. The extension of the exploration to the lower limbs could be considered in order to completely assess the venous system. However, it would subject the patient to generate additional radiation. © 2012 Springer-Verlag France.

PubMed | Service de gastroenterologie, Service de cancerologie radiotherapie and Service dhemato oncologie
Type: Journal Article | Journal: Cancer radiotherapie : journal de la Societe francaise de radiotherapie oncologique | Year: 2016

Primary gastric and orbital MALT lymphomas are both low grade (indolent) B-cell non-Hodgkins lymphomas. Traditionally, these tumors are radiosensitive and have a good prognosis. In localized orbital and stages IE-IIE gastric MALT lymphomas without Helicobacter pylori infection or in case of persistent H.pylori infection after eradication therapy, several retrospective studies have shown that radiotherapy was an effective and well-tolerated treatment.

Gauvin F.,Unite de consultation en soins palliatifs | Humbert N.,Unite de consultation en soins palliatifs | Marzouki M.,Service dhemato oncologie | Daoust L.,Unite de consultation en soins palliatifs | And 3 more authors.
Medecine Palliative | Year: 2016

This article describes the guidelines established by the pediatric palliative care unit at Sainte-Justine hospital concerning palliative sedation in pediatric patients. The goal of palliative sedation is to relieve effectively and rapidly a patient from symptoms which are intolerable and refractory to all other therapeutic options. The decision to induce palliative sedation must be based on a rigorous process and must allow discussions to reach a consensus within the interdisciplinary team. In all cases, the objective is patient comfort, by titration of the sedation to relieve symptoms optimally. Palliative sedation is not intended to hasten death and this must always be clearly explained and communicated to families and caregivers. Continuous palliative sedation is rarely used in pediatrics. When palliative sedation is considered, four criteria are recommended: ensure that symptoms are really refractory; conduct an interdisciplinary meeting; conduct a meeting with the family (and the patient if he is apt); decide on the type and level of sedation. Subsequently, adequate monitoring and comfort care should be provided at all times to the patient. Assistance and support of family is paramount throughout the decision-making process and the course of sedation. The practice of palliative sedation must be supervised by medical and pharmacological guidelines and a clear institutional policy. © 2015 Elsevier Masson SAS.

PubMed | Service dHemato Oncologie
Type: Journal Article | Journal: Revue medicale de Bruxelles | Year: 2012

The acute chest syndrome (ACS) is one of the most frequent complications of sickle cell disease. It affects mostly young children and counts for one quarter of mortality in the young sickle cell disease (SCD) population. This retrospective study evaluates the impact of ACS among hospitalizations for other complications of SCD in patients at the University Childrens Hospital Reine Fabiola (Brussels, Belgium) in order to isolate clinical conditions associated with a high risk of ACS development. The medical records of all SCD patients aged up to 18 years admitted for all SCD related acute complications over a period of 13 month have been reviewed. Two patient groups have been formed based on the presence of an ACS within the study period. Epidemiologic data, medical history, the clinical presentation at admission but also blood counts in steady state, at admission and along the hospital stay were compared for a total of 96 hospital stays. There is no difference for age or hemoglobin phenotype between the two major patient groups. Male sex and having had a previous ACS episode in the past were significantly more important in the group of patients hospitalized for ACS. Thoracic pain in an SCD patient who doesnt show typical ACS symptoms should be interpreted as a risk factor for ACS. In conclusion, male sex, medical history of at least one ACS and thoracic pain at hospital admission are associated with high risk of developing ACS.

PubMed | Service dHemato Oncologie.
Type: Journal Article | Journal: Leukemia & lymphoma | Year: 2014

Splenectomy is considered as one of the first-line treatments for symptomatic patients with splenic marginal zone lymphoma (SMZL). Between 1997 and 2012, 100 hepatitis C virus-negative patients with SMZL were treated by splenectomy as first-line treatment. At 6 months, all patients but three recovered from all cytopenias. The median lymphocyte count at 6 months and 1 year was 11.51 10(9)/L and 6.9 10(9)/L, respectively. Median progression-free survival (PFS) was 8.25 years. The 5-year and 10-year overall survival (OS) rates were 84% and 67%, respectively. Histological transformation occurred in 11% of patients, and was the only parameter significantly associated with a shorter time to progression (p = 0.0001). Significant prognostic factors for OS were age (p = 0.0356) and histological transformation (p = 0.0312). In this large retrospective cohort, we confirmed that splenectomy as first-line treatment in patients with SMZL corrected cytopenias and lymphocytosis within the first year and was associated with a good PFS.

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