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Mahon F.-X.,University of Bordeaux 1 | Mahon F.-X.,University of Bordeaux Segalen | Mahon F.-X.,French Institute of Health and Medical Research | Rea D.,Service des Maladies du Sang | And 11 more authors.
The Lancet Oncology

Background: Imatinib treatment significantly improves survival in patients with chronic myeloid leukaemia (CML), but little is known about whether treatment can safely be discontinued in the long term. We aimed to assess whether imatinib can be discontinued without occurrence of molecular relapse in patients in complete molecular remission (CMR) while on imatinib. Methods: In our prospective, multicentre, non-randomised Stop Imatinib (STIM) study, imatinib treatment (of >2 years duration) was discontinued in patients with CML who were aged 18 years and older and in CMR (>5-log reduction in BCR-ABL and ABL levels and undetectable transcripts on quantitative RT-PCR). Patients who had undergone immunomodulatory treatment (apart from interferon α), treatment for other malignancies, or allogeneic haemopoietic stem-cell transplantation were not included. Patients were enrolled at 19 participating institutions in France. In this interim analysis, rate of relapse was assessed by use of RT-PCR for patients with at least 12 months of follow-up. Imatinib was reintroduced in patients who had molecular relapse. This study is registered with ClinicalTrials.gov, number NCT00478985. Findings: 100 patients were enrolled between July 9, 2007, and Dec 17, 2009. Median follow-up was 17 months (range 1-30), and 69 patients had at least 12 months follow-up (median 24 months, range 13-30). 42 (61%) of these 69 patients relapsed (40 before 6 months, one patient at month 7, and one at month 19). At 12 months, the probability of persistent CMR for these 69 patients was 41% (95% CI 29-52). All patients who relapsed responded to reintroduction of imatinib: 16 of the 42 patients who relapsed showed decreases in their BCR-ABL levels, and 26 achieved CMR that was sustained after imatinib rechallenge. Interpretation: Imatinib can be safely discontinued in patients with a CMR of at least 2 years duration. Imatinib discontinuation in this setting yields promising results for molecular relapse-free survival, raising the possibility that, at least in some patients, CML might be cured with tyrosine kinase inhibitors. Funding: French Ministry of Health (Programme Hospitalier de Recherche 2006 grants), Institut National du Cancer (INCA). © 2010 Elsevier Ltd. Source

Evaluation of: Sekeres MA, Tiu RV, Komrokji R et al. Phase 2 study of the lenalidomide and azacitidine combination in patients with higher-risk myelodysplastic syndromes. Blood 120(25), 4945-4951 (2012). High-risk myelodysplastic syndrome (MDS) patients have poor prognosis, and their median age is approximately 70 years. Allogeneic stem cell transplantation and high-dose chemotherapy are restricted to a relatively small minority of MDS. A hypomethylating agent, 5-azacytidine, has revolutionized the treatment of high-risk MDS patients by prolonging their survival by approximately 2 years. However this remains insufficient, and patients relapsing or refractory to 5-azacytidine have still a very poor prognosis. It is, therefore, necessary to improve the complete response rate obtained with 5-azacytidine alone and the combination with other molecules are mandatory. In this article, we resume the results and perspectives of a Phase II trial evaluating lenalidomide and 5-azacytidine combination in patients with higher-risk MDS. © 2013 Expert Reviews Ltd. Source

Kaiser-Guignard J.,Service dhematologie | Canellini G.,Service Route | Lion N.,Service Route | Abonnenc M.,Service Route | And 2 more authors.
Blood Reviews

Since 1990, several techniques have been developed to photochemically inactivate pathogens in platelet concentrates, potentially leading to safer transfusion therapy. The three most common methods are amotosalen/UVA (INTERCEPT Blood System), riboflavin/UVA-UVB (MIRASOL PRT), and UVC (Theraflex-UV). We review the biology of pathogen inactivation methods, present their efficacy in reducing pathogens, discuss their impact on the functional aspects of treated platelets, and review clinical studies showing the clinical efficiency of the pathogen inactivation methods and their possible toxicity. © 2014. Source

Moreau P.,University of Nantes | Attal M.,Service dhematologie | Facon T.,University Hospital Hurriez

In the past decade, one of the major advances in the management of patients with symptomatic newly diagnosed multiple myeloma has been the introduction of novel agents, thalidomide, bortezomib, and lenalidomide, as part of frontline treatment in both transplant and nontransplant candidates. These drugs have markedly improved the rate of complete remission, and time to progression, progression-free survival, and overall survival have significantly increased. This article focuses on more recent frontline therapeutic approaches both in older patients, not eligible for high-dose therapy and autologous stem cell transplantation (ASCT), and in younger patients eligible for early ASCT. © 2015 by The American Society of Hematology. Source

The training in the psychic care in cancer involves a work of reflection on the relation committed with the patient and/or his close relations. The emotional investment inherent to these relations (of support, accompaniment, and follow-up) asks to be thought so that it can be "therapeutic". Declined under various names (groups of words, clinical elaboration, analysis of practices, case study), the Balint groups' model seems to offer a convenient frame to this work of elaboration which constitutes the central element of learning to listen. © 2014 Springer-Verlag. Source

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