ABSTRACT
We report the clinical case of a patient presenting with an acute myocardial infarction with ST- segment elevation. The patient is affected by polycythemia vera for many years and doesn't have any other cardiovascular risk factors. The frequency of thrombotic events in polycythemia vera (and more particularly myocardial infarction), their predictive factors, pathophysiology and treatment will be discussed.
Nous présentons le cas clinique d'un patient ayant présenté un infarctus aigu du myocarde avec sus-décalage du segment ST dans un contexte de polycythémie vraie (maladie de Vaquez) diagnostiquée plusieurs années auparavant. Le patient ne présente aucun autre facteur de risque cardio-vasculaire. La fréquence des événements thrombotiques (et plus particulièrement des infarctus du myocarde) chez les patients atteints de polycythémie vraie, les facteurs prédictifs de ces derniers, leur physiopathologie et le traitement à proposer seront discutés.
Subject(s)
Myocardial Infarction/etiology , Polycythemia Vera/complications , Coronary Angiography , Humans , Male , Middle Aged , Myocardial Infarction/diagnosis , Polycythemia Vera/diagnosisABSTRACT
Chronic myelomonocytic leukemia (CMML) is a disease typically of the elderly. It is suspected when monocytosis reaches 1000/microl. It may be associated with "B" symptoms (fever, sweating, and weight loss) but also visceral, skin and autoimmune complications. Current treatment strategies aim at reducing the symptoms and have no curative goals. In this context hypomethylating agents have shown a good efficacy. Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only curative option but remains difficult to perform in elderly patients population, even if transplantation with a reduced intensity conditioning has reduced the risks. A new prognostic scoring helps to recognize the patients with poor prognosis and to better selected candidates for the HSCT.
Subject(s)
Leukemia, Myelomonocytic, Chronic/diagnosis , Leukemia, Myelomonocytic, Chronic/therapy , Algorithms , Antineoplastic Agents/therapeutic use , Diagnosis, Differential , Hematopoietic Stem Cell Transplantation , Humans , PrognosisABSTRACT
Mantle cell lymphoma is a rare form of non Hodgkin lymphomas. Diagnosis is made by demonstrating a typical immunophenotype as well as the presence of a translocation between chromosomes 11 and 14 with overexpression of cyclin D1. First line therapy for young patients consists in 3 cycles of "R-CHOP21" alternated with 3 "R-DHAP21" and followed by an autograft conditioned by total body irradiation, cyclophosphamide and aracytine. For patients over 65 years of age, the treatment of choice consists in 8 cycles of "R-CHOP21". Maintenance treatment is under evaluation. Allografting is the only chance of cure in relapsed patients with good performance status. Targeted therapies will improve the prognosis of this disease.
Subject(s)
Lymphoma, Mantle-Cell/diagnosis , Lymphoma, Mantle-Cell/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Hematopoietic Stem Cell Transplantation , Humans , Prognosis , Radiotherapy, AdjuvantABSTRACT
This article reviews the incidence, risk factors and prevention of secondary malignancies after allogeneic hematopoietic cell transplantation.
Subject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Neoplasms/etiology , Humans , Neoplasm Metastasis , Neoplasms/epidemiology , Neoplasms/pathology , Risk FactorsSubject(s)
CD8-Positive T-Lymphocytes/immunology , Hematologic Neoplasms/surgery , Lymphocyte Depletion , Peripheral Blood Stem Cell Transplantation/methods , Transplantation Conditioning/methods , Adult , Aged , Carcinoma, Renal Cell/secondary , Carcinoma, Renal Cell/surgery , Disease-Free Survival , Female , Follow-Up Studies , Humans , Immunosuppressive Agents/therapeutic use , Kaplan-Meier Estimate , Kidney Neoplasms/pathology , Male , Middle Aged , Myelodysplastic Syndromes/surgery , Myeloproliferative Disorders/surgery , Peripheral Blood Stem Cell Transplantation/statistics & numerical data , Transplantation, Homologous , Vidarabine/analogs & derivatives , Vidarabine/therapeutic use , Whole-Body IrradiationABSTRACT
Hematopoietic cell transplantation (HCT) following nonmyeloablative conditioning (NMSCT) may be associated with a reduced risk of infection compared to standard allogeneic HCT. We retrospectively analyzed incidence and risk factors of infection in 62 patients undergoing NMSCT with low-dose TBI +/- fludarabine and postgrafting CsA and MMF. The proportion of patients with any infection was 77%, but the majority of infectious events occurred beyond day 30. Donor other than sibling, older age, early disease and male gender were significant risk factors. The incidence of bacteremia was 55% at 1 year and the number of bacteremic episodes was 0.9 per patient (0.08 before day 30). The risk of bacteremia increased with older age and the use of a donor other than an HLA-identical sibling, but not with neutropenia. The incidence of infections other than bacteremia correlated with the use of corticosteroids. The risk of CMV infection increased with high-risk CMV serology, and risk of CMV disease with high-risk CMV serology, older age, first transplantation and a diagnosis of lymphoma. In conclusion, after NMSCT, infections are not frequent in the first 30 days post transplant but careful long-term monitoring is necessary thereafter.
Subject(s)
Carcinoma, Renal Cell/therapy , Hematologic Neoplasms/therapy , Hematopoietic Stem Cell Transplantation , Infections/epidemiology , Transplantation Conditioning/methods , Adrenal Cortex Hormones/adverse effects , Belgium/epidemiology , Cytomegalovirus Infections/epidemiology , Cytomegalovirus Infections/etiology , Female , Follow-Up Studies , Graft vs Host Disease/prevention & control , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Incidence , Infections/etiology , Male , Middle Aged , Multivariate Analysis , Retrospective Studies , Risk Factors , Transplantation, HomologousABSTRACT
This review article describes the identification of the tyrosine kinase BCR/ABL as the hallmark of chronic myeloid leukemias (CML) as well as the development of a specific inhibitor of this tyrosine kinase, the STI571 (Glivec, imatinib mesylate). The authors discuss the results of a phase I and three phase II trials reporting the efficacy of STI571 as treatment for CML patients and propose two simplified algorithms that may help to guide decision-making for the individual patient.
