Prise en charge des hémopathies malignes au centre national d'oncologie médicale et de radiothérapie Alassane Ouattara d'Abidjan / Managem ent of hem atologic neoplasm sat the Centre National d'Oncologie Médicale et de Radiothérapie Alassane Ouattara ofAbidjan

Introduction. Les hémopathies malignes sont des proliférations anormales et anarchiques de cellules hématopoïétiques à point de départ médullaire ou périphérique. Notre étude qui avait pour objectif de faire le bilan de la prise en charge des hémopathies malignes au Centre national d'oncologie médical et de radiothérapie Alassane Ouattara. Méthodes. Il s'agissait d'une étude rétrospective descriptive d'une durée de 2 ans 3 mois allant du 1er janvier 2018 au 31 Mars 2020 portant sur 80 dossiers de malades porteurs d'hémopathies malignes et prise en charge dans le centre. Résultats. Notre étude a permis de recenser 2,2% d'hémopathies malignes sur les 3650 cas de pathologies cancéreuses recensées au CNRAO, soit une incidence 26,66 cas/an avec un sex-ratio 1,2. Les syndromes lymphoprolifératifs (SLP) sont les plus fréquents (96,25 %), sous trois principales formes: lymphomes malins non hodgkiniens (LMNH) non Burkitt (51,25%), leucémie myéloïde chronique (20%) et le myélome multiple (16,25%). Les LMNH représentent 51,25% des HM recensées avec 41,46 % de lymphomes de haut grade de malignité. La chimiothérapie était de mise chez tous nos patients. Ainsi sur 41 cas de LMNH, seulement 12 (29,27%) ont bénéficié du protocole R-CHOP. On notait 46,34% de réponse complète. Dans notre étude, le LH représentait 8,75% il était traité à 71,43% avec le protocole ABVD avec une réponse complète chez 6 patients. 37,5% des patients porteurs de leucémie myéloïde chronique ont reçu le Rituximab; ils ont été traités par les protocoles COP (31,25%), CHOP (31,25%), RCVP (12,5%) et R-CHOP (25%). La réponse thérapeutique était complète à 68,75%. Le protocole utilisé dans le traitement du myélome multiple a été le VMCD-REV à 76,92% avec pour réponse thérapeutique complète chez 6 patients, 3 réponses partielles et 4 en cours de traitement. Conclusion. Les SLP qui sont les plus fréquents des HM avec trois principales formes: LMNH non Burkitt, leucémie myéloïde chronique et myélome multiple. Nous avons cependant des difficultés quant à la mise en route de la chimiothérapie.

Introduction. Hematologic neoplasms are abnormal and anarchic proliferations of hematopoietic cells with a medullary or peripheral starting point. Our study aimed to report the management of hematological malignancies at the Centre National d'Oncologie Médicale et de Radiothérapie Alassane Ouattara (CNRAO). Methods. This was a descriptive retrospective study lasting 2 years 3 months from January 1st, 2018 to March 31st, 2020 concerning 80 patients with hematologic neoplasms who were managed in the CNRAO. Results. Hematologic neoplasms represented 2.2% of cancers (80/3650) at CNRAO, giving an annual incidence of 26.66 cases. The sex ratio was 1.2. Lymphoproliferative syndromes were the most common subgroups (96.25%). These were mainly non-Burkitt non Hodgkin lymphoma (51.25%), high grade lymphomas (41.46%), chronic lymphocytic lymphoma (20%) and multiple myeloma (16.25%). Chemotherapy was administered to all patients. Among 41 cases of non-Hodgkin lymphoma, 12 (29.27%) benefited from the R-CHOP protocol and full response was observed in 46.34% of them. We found 7 patients with Hodgkin lymphoma (8.75%) and the ABVD protocol was used for 6 cases (71.43%). Six out of these seven patients were in complete response. Among the 16 patients with chronic lymphocytic leukemia, 6 (37.5%) received Rituximab. The distribution of the patients with chronic lymphocytic leukemia was as follows: COP 31.25%, CHOP 31.25%, RCVP 12.5% and R-CHOP 25% and 68.75% had full response. The most common treatment protocol for multiple myeloma was VMCD-REV (76.92%). Six patients had complete response, 3 had partial response and 4 were in the course of treatment. Conclusion. In our practice, hematologic neoplasms are mainly lymphoproliferative syndromes and the most common varieties are non-Burkitt non Hodgkin lymphoma, high grade lymphomas, chronic lymphocytic lymphoma and multiple myeloma. We have difficulties in getting chemotherapy started.

Retrospective case-series analysis of haematological malignancies in goldmining areas of South Africa

Background. South Africa (SA)'s high levels of environmental contamination of mine tailings from uranium and its decay products, coupled with remarkably short distances between mine tailings and residential areas, raise concern about whether there is an association between environmental uranium exposure and risk of cancer, including haematological malignancies. Objectives. We reviewed information on cases from the central hospital offering cancer diagnostics and treatment in a major mining area of SA to describe their basic clinical and demographic characteristics, as part of assessing whether a cancer epidemiological study in this area would be feasible.Methods. Basic clinical, demographic and residential information on patients with haematological malignancy diagnosed between 2004 and 2013 was collected retrospectively from the patient files at Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg.Results. In total, 1 880 patients aged 18 - 94 years were identified. Referral from distant provinces was not uncommon, but >80% lived within 50 km of the hospital. Non-Hodgkin's lymphoma accounted for 44% of the haematological malignancies, followed by leukaemia with 26%. HIV status was known for 93% of the patients, of whom 47% were HIV-positive.Conclusions. Caution is required when interpreting spatial distributions of patients, given inaccuracies in residential addresses and referral patterns to the hospital, and with HIV and other infections probable important confounders. Our study therefore shows that active case recruitment is required for accurate assessment of residential information. However, some findings on spatial distributions in the study warrant the continuation of efforts to develop a study protocol to investigate the possible link between uranium exposure in mining areas and haematological malignancies in residents. Disproportionately high incidence rates of haematological malignancies observed in specific districts would be relevant for further investigation

Inter-observer variability influences the Lugano classification when restaging lymphoma

Background: Lymphoma is an important and potentially curable oncological disease in South Africa. The staging and restaging of lymphoma have evolved over the years, with the latest international consensus guideline being the Lugano classification (LC). Prior to routine implementation of the LC, its robustness in the local setting should be determined. Objectives: To determine the Inter-observer variability in response assignment when applying the LC in patients with lymphoma who were staged and restaged with computed tomography. In case of excessive discordance, specific mitigating measures will have to be taken before and during any proposed implementation of the LC. Method: A total of 61 computed tomography scans in 21 patients were evaluated independentlyby four reviewers according to the LC, of which 21 scans were done at baseline, 21 at initial restaging and 19 at follow-up restaging. A retrospective comparative analysis was performed. Kappa values were calculated to determine agreement between observers. Results: Only a moderate inter-observer agreement of 52% in the overall response classification was demonstrated. The most important sources of discrepancy were inconsistency in the assessment of target lesion regression to normal, determining the percentage change in the summed cross-sectional area of the target lesions and ascribing new lesions as either due to lymphoma or other causes. Conclusion: Implementing the Lugano classification when restaging lymphoma is desirable to improve consistency and to conform to international guidelines. However, our study shows substantial inter-observer variability in response classification, potentially altering the treatment plan. Dedicated training and continuous quality control should, therefore, accompany the process

Hémopathies malignes à Brazzaville (Congo) : analyse de situation

L'épidémiologie des hémopathies malignes au Congo n'est pas connue. L'objectif de cette étude était de rapporter la distribution des hémopathies malignes à Brazzaville.Patients et méthodes : Il s'agissait d'une étude transversale descriptive réalisée dans le Service d'Hématologie Clinique du CHU de Brazzaville au Congo. La période étudiée est de 10 ans (du 1er janvier 2006 au 31 décembre 2015). Ont été inclus dans l'étude tous les dossiers de consultation et d'hospitalisation portant le diagnostic d'hémopathie maligne.Résultats : Deux cent-soixante-deux cas d'hémopathies malignes ont été diagnostiquées durant la période d'étude.Les hémopathies malignes ont été de typelymphoprolifératif chronique dans 57,3% (n = 150), leucémie aiguë dans 24, 4% (n = 64) et myéloprolifératif dans 18,3% (n = 48) des cas. Le myélome multiple et la leucémie aigüe lymphoblastique représentaient respectivement 29,8% (n = 70) et 19,1% (n = 50) des groupes nosologiques lymphoprolifératifs chroniques et leucémies aiguës. La leucémie myéloïde chronique représentait 100% du groupe myéloprolifératif. Une prédominance féminine a été observée (sex-ratio = 0,65). Les pathologies lymphoprolifératives chroniques intéressaient la tranche d'âge de 45 à 59 ans (66,7%), a leucémie myéloïde chronique celle de 15-29 ans (45,8%) et la leucémie aiguë lymphoblastique avait une distribution pédiatrique : 0-14 ans (68%).Conclusion : Les hémopathies malignes constituent par leur fréquence un problème sanitaire. Elles plaident pour des études épidémiologiques analytiques afin de mettre en place une politique préventive de celles-ci

Algorithmic processing to aid in leukemia detection

Background: I present our medical context with some basic concepts in order to understand the results of our work, and then I begin the explanation of mathematical morphology. I will conclude by the description of algorithmic processing propose in this paper. Cancers, including leukemia and lymphoma, can cause uncontrolled growth of an abnormal type of blood cell in the bone marrow, resulting in a greatly increased risk for infection and or serious bleeding.Methods: We present detailed steps of our proposed systems, to obtain a final result that shows the detection of abnormal cells. It typically starts with a median filter pre-processing step and then applies different morphologic operator, which allows us to segment the original image and detect cancerous cells. The basic idea behind all the operators in the mathematical morphology is to compare the set of objects to analyze another object of known form, which is called a structuring element. The structuring element is a geometric figure, simple to form, known or arbitrary, and can be a circle, segment, square, or triangle.Results: We show the different results obtained after testing carried out in algorithmic processing using MATLAB: To ameliorate the visualization of the abnormal blood cells, we have applied the elements basis morphological operations in a different way. We have performed an opening by reconstruction and a closing by reconstruction. The obtained result show that we have obtained an efficient detection of the targeted objects (abnormal blood cells or leukemia).Conclusion: In this paper, we have utilized the operators of the mathematical morphology with the aim to detect abnormal cells for diagnostic aid and transmission of accurate and precise clinical information, which helps specialists in medicine (hematologists) to distinguish abnormal cells or cancerous and to follow the evolution of leukemia. The algorithmic processing presented in this article has been able to perform the task of detection of cancerous cells with success; it has produced remarkable and satisfactory results. We think of the future concept as a system of aid for diagnosis from microelectronics integration to the base of reconfigurable technologies applied to cells for the goal of quantification of the cancer region

Effusion Cytology at King Faisal Hospital; Kigali: A Review of 151 Cases

Introduction: The clinical management of patients presenting with effusions requires the determination of the cause of the effusion for direction of options of management. The cytologic examination of the effusion is usually required to rule out or confirm malignancy. This is a retrospective review of 151 effusions cytologically investigated at King Faisal Hospital. Methods: One hundred and fifty one effusions collected in EDTA tubes were investigated. The specimens were centrifuged; and from the sediment alcohol-fixed; air-dried smears were prepared for Papanicolaou and Diff-Quik staining; respectively. Results: From the total of 151 effusions; malignant cells were identified in 26 cases as follows: 15 pleural; 8 ascitic and 3 peritoneal malignancies consisted of 15 adenocarcinomas; 5 lymphomas; 3 mesotheliomas 2 myelomas and 1 small cell carcinoma. Conclusions: Malignant effusions constituted 17 percent of all the effusions examined. Adenocarcinomas were the most frequently diagnosed metastatic malignancies in both pleural and ascitic effusions and in both females and males. Primary sites of most of the malignancies could not be determined except for mesotheliomas and small cell carcinoma

Paediatric head and neck cancers in Nigeria: implications for treatment planning in resource limited settings

Background: The head and neck (H/N) is a common site for childhood cancers. This study examined all cases of H/N childhood cancers diagnosed in a major teaching hospital in Nigeria over 18 years to determine patterns of broad lineage cancer groups. Materials and Methods: Primary pediatric childhood malignancies diagnosed between 1990 and 2008 were analysed. Logistic regression models were fitted to determine significant clinical correlates of childhood cancer. Results: Lymphomas were the commonest cancers (49.5). After controlling for site and age; there was no significant difference in the incidence of Burkitt's lymphoma (BL) by sex ( P=0.423). The jaw bones (mandible and maxilla) were the commonest sites in the H/N for involvement of BL; with over 20 times the odds of occurrence when compared to other non-jaw sites of the H/N region (Adjusted Odds Ratio [AOR]=21.41; P0.001). Among the jaw bones; there was no significant difference in the occurrence of BL ( P

Ophthalmic disorders in Adult Lymphoma Patients in Africa

Context: Ocular manifestations of lymphoma are rare events. Most reports of ocular involvement in lymphoma are case reports or reports of a few patients. Aims: To determine the ophthalmic disorders in adult; African; lymphoma patients. Settings and Design: A prospective study of ocular disorders in adult patients with lymphoma was conducted at the University of Benin Teaching Hospital; Benin City; Nigeria; between July 2004 and June 2007. Materials and Methods: The patients were interviewed and examined by the authors and the ocular findings recorded. Statistical Analysis: Data was analyzed on computer with the aid of the Instat GraghPadT v2.05a statistical package software. The mean; standard deviation; Mann-Whitney U-statistic and P value were calculated. Results: A total of 111 patients with hematological malignancies were seen over a period of three years of which 62 (55.85) had lymphomas. Of these; 51(82.3) were non-Hodgkin's lymphoma and 11(17.7) were Hodgkin's lymphoma. Ocular disorders occurred in 16 patients (31.4) with non-Hodgkin's lymphoma and none of the patients with Hodgkin's lymphoma (Mann-Whitney U-statistic is equal to 7.500; U' is equal to161.50; P ; 0.0001). The ocular disorders due to non-Hodgkin's lymphoma were seen as - proptosis in six patients (11.8); retinopathies in three (5.9); conjunctival infiltration in three (5.9); optic atrophy in two (3.9); keratoconjunctivitis in one (two per cent); desquamating nodular lid lesions in one (two per cent); papilloedema in one (two per cent); and upper lid mass in one (two per cent). Four patients (6.5) had monocular blindness. Conclusions: Ophthalmic disorders are relatively common in non-Hodgkin's lymphoma. Ophthalmic evaluation is needed in these patients for early identification and treatment of potentially blinding conditions

Anti-Tumor Activity of Four Ayurvedic Herbs in Dalton Lymphoma Ascites Bearing Mice and their Short-term in Vitro Cytotoxicity on Dla- Cell-Line

The anti-tumor activity and chemopreventive potential of four Ayurvedic herbs viz. Curcuma longa L.; Ocimum sanctum L.; Tinospora cordifolia (Wild) Miers ex Hook.f et Thomas and Zizyphus mauritiana Lam. were evaluated using Dalton Lymphoma ascites (DLA) tumor model in Swiss Albino mice. The outcome was assessed using survival time; peritoneal ascitic fluid (Tumor volume) and hematological indices as parameters. Animals were divided into five groups (n = 6) viz. one DLA control and four Herb + DLA treated groups. All the four herb + DLA groups were pre-treated with respective herbs for 7 days and hematological indices were measured for entire five groups. On day-8 animals were inoculated with 1x106 DLA cells i.p.; and Herb + DLA groups were continued with oral herbal treatment for 21-days. Hematological parameters and tumor volume were assessed to find the effects of herbs. Short term in vitro cytotoxicity was determined by Trypan Blue exclusion method and LDH leakage assay using different concentrations of herbal extracts and 5-FU as a positive control and IC50 for each herbal extract and 5-FU were determined. Oral administration of crude herb increased the survival time and decreased the peritoneal ascitic fluid content significantly. Hb; RBCs and total WBC which were altered by DLA inoculation were restored significantly by all the herbs except O. sanctum. All the four herbs showed in vitro cytotoxic activity against DLA cell-line. Moreover inter group comparison of all the four herbs for anti-tumor activity showed efficacy in the following order- T. cordifolia Z. mauritiana = C. longa O. sanctum respectively

Lymphomes gastro-intestinaux au Togo : aspects epidemiologiques et histopronostiques

Le tube digestif est le site principal des lymphomes non hodgkinien extra ganglionnaires. Le but de notre travail etait de decrire l'epidemiologie et l'histopronostic des lymphomes gastro-intestinaux au Togo. Il s'est agi d'une etude retrospective portant sur 32 cas diagnostiques au Togo pendant 20 ans. Les lymphomes gastro-intestinaux constituent une affection peu frequente au Togo representant 5;6des cancers du tube digestif et survenant a un age moyen de 37 ans avec un sex-ratio H/F a 1;5. Au plan histologique; les lymphomes de grade intermediaire etaient les plus observes suivant la classification de la Working Formulation (62;6); alors que ce sont les lymphomes de MALT de haut grade de malignite qui predominaient suivant la classification d'Isaacson. Leur topographie preferentielle etait l'estomac (59des cas). L'etroitesse du plateau technique de notre Laboratoire d'Anatomie Pathologique pose d'enormes problemes diagnostiques de ces lymphomes

Les cancers de l'orbite et l'etude retrospective : a propos de 31 cas

Introduction : Les cancers de l'orbite sont rares. Ils sont caracterises par leur diversite histologique et leur agressivite locoregionale rendant le traitement difficile et mutilant. Dans ce travail; nous rapportons notre experience dans la prise en charge diagnostique et therapeutique de ces tumeurs. Materiels et methodes : Notre etude retrospective a concerne 31 cas de cancers de l'orbite colliges sur 13 ans (1993- 2005). Tous les patients ont beneficie d'un examen clinique complet; d'une imagerie du massif facial (TDM et/ou IRM) et d'une biopsie de la tumeur. Le traitement a ete base sur la chirurgie; la radiotherapie et/ou la chimiotherapie. Resultats : La symptomatologie clinique etait dominee par les signes ophtalmologiques et les algies faciales. L'imagerie a montre dans tous les cas un processus expansif tissulaire a point de depart orbitaire; avec lyse osseuse orbitaire chez 16 patients (51;6); une extension au massif facial chez 7 patients (22;6); endocraniennes chez 6 patients (19;4) et des formes bilaterales atteignant les deux orbites dans 3 cas (9;7) L'anatomopathologie montrait une predominance des lymphomes malins non hodgkiniens (32;3) et des carcinomes epidermoides (32;3); suivis des rhabdomyosarcomes embryonnaires (19;4). Douze patients ont ete traites par chirurgie et radiotherapie postoperatoire; dix patients par une association radio-chimiotherapie; et neuf autres par une chimiotherapie neo-adjuvante. La survie globale etait de 67;8 a 3 ans; 48;4 a 5 ans et 22;6a 10 ans

Lymphome malins non Hodgkiniens de faible grade de malignite : aspects epidemiologiques; cliniques et evolutifs

"Etude retrospective et prospective allant de Janvier 1991 a octobre 2002; notre travail portait sur les aspects epidemiologiques; cliniques et evolutifs les lymphomes malins non Hodgkiniens de faible grade de malignite. Il se degage de notre etude que:AU PLAN EPIDEMIOLOGIQUE-Les lymphomes de faible malignite ou lymphomes indolents representent 27pour cent des LMNH et domines par le type dit ""diffus"".-L'age:l'age moyen de nos patients est de 48 ans avec des extremes allant de 16ans a 75ans.- Le sexe: Notre population d'etude est marquee par une predominance masculine avec un sexe ratio de 1;38.-Le niveau socio-economique: On note une predominance des sujets de bas niveau socio-economique; 27 sujets sur 50 soft 54pour cent.AU PIAN ANATOMO-CLINIQUE-Notre serie montre une nette predominance des localisations ganglionnaires primitives (84pour cent); les adenopathies representant le principal motif de consultation (60pour cent des cas).-Les formes disseminees: stades III et IV d'ANN ARBOR dominaient les lymphomes Indolents de notre serie (70pour cent).-On note une absence des signes d'evolutivite clinique et/ou biologique dans notre serie. Ce qui justifie le terme de ""lymphomes Indolents"" donne aux LMNH de faible malignite.AU PLAN EVOLUTIF-Seulement 44pour cent de nos patients ont eu une remission complete contre 56pour cent d'echec therapeutique initial; tous nos patients ayant beneficie du protocoleCOP-La survie a survie globale de nos patients est de 1985 jours soit 5;43 ans.-Le taux de deces est de 48pour cent"

Interet du dosage de LDH et de la Beta-2 Microglobuline dans les lymphomes

VOIR THESE No3548

Panorama des hemopathies diagnostiquees au Laboratoire central du CHU de Treichville: bilan de 10 annees d'activites

Ce texte rapporte le bilan des hemopathies diagnostiquees dans le laboratoire central du CHU de Treichville. Ce travail a permis d'en souligner les caracteristiques generales. Il a ete collige au cours de cette periode 432 cas repartis de la facon suivante: leucemies (142;2 cas/an) aussi bien chez l'enfant que chez l'adulte; lymphomes 264 cas soit 26;4 cas par an avec 26 cas de maladies de Hodgkin; 238 cas de lymphomes non Hodgkiens parmi lesquels la maladie de Burkitt occupe une place importante avec 195 cas; et les autres lymphomes (43 cas). Concernant les dysglobulinemies; il a ete denombre 26 cas de myelomes. L'affection frappe les classes sociales les plus demunies; avec une predominance du sexe masculin

Le Synrome de Sezary : (a propos de 4 cas observes au Centre Hospitalier Universitaire de Treichville)

Les auteurs rapportent 4 cas d'un syndrome de sezary sur une periode de 8 ans. La frequence est de 1;2 pour 100.000 consultations enregistrees et de 1;4 pour 100 hospitalisations. L'age moyen est de 37 ans avec des extremes de 22 a 55 ans contrirement a la litterature ou il se situe a 61 ans. Aucune particularite du point de vue clinique n'a ete notee dans la serie

The distribution of non-Burkitt; non-Hodgkin's lymphomas in Uganda in relation to malarial endemicity

Biopsies of malignant lymphomas collected from all districts of Uganda; filed in the Kampala Cancer Registry for the 8-year period 1966-1973; were reviewed. This review confirmed a relatively low frequency of follicle-centre-cell lymphomas with a follicular growth pattern and the geographical co-distribution between malaria and Burkitt's lymphoma (BL). It also showed a similar; though less marked; association between non-Burkitt; non-Hodgkin's lymphoma (NBNHL) and malarial endemicity; and a correlation in the regional incidence between BL and NBNHL. In both comparisons; these associations were strong for high-grade lymphomas and weak for low-grade neoplasms. BL and other NHL may therefore share; to a varying degree; some common pathogenesis. The excess in frequency of NBNHL of high-grade malignancy in malarial endemic areas appears to be in contrast to Western countries where most non-Hodgkin's lymphomas are of low-grade malignancy