Description of multiple myeloma cases and assessment of survival and mortality factors in Madagascar.

INTRODUCTION: In Madagascar, the epidemiologic, therapeutic, and evolutionary aspects of multiple myeloma remain poorly understood. Our objectives were to describe the cases, report factors associated with mortality, and estimate patient survival. PATIENTS AND METHOD: This was a retrospective descriptive and analytical study conducted in five teaching hospitals in Madagascar: HJRA and CENHOSOA (Antananarivo), CHUPZAGA (Mahajanga), CHUAT (Toamasina) and CHUT (Fianarantsoa). The study included patients diagnosed with multiple myeloma between January 1, 2010 and December 31, 2021. RESULTS: Of the 11,374 cancer patients, 75 (0.66%) had multiple myeloma. The mean age of the patients was 59.9 years (±8.9) and the sex ratio was 1.5. Arterial hypertension was observed in 32% of the patients. The most common symptom of myeloma was bone pain (n = 48; 64%). Forty-six patients (61%) were diagnosed with stage III myeloma and 28 patients (37.3%) with stage IIIA myeloma according to the Durie-Salmon classification. Anemia, renal failure, hypercalcemia and fractures were present in 53%, 37%, 21% and 28% of cases, respectively. Fifty-four patients received specific treatment. The combination of melphalan-prednisone-thalidomide was used in 79.63% of cases, and one patient had received autologous stem cell transplantation. Eleven patients (14.67%) died. Chronic kidney disease (p = 0.009), smoking (p = 0.028) and two associated comorbidities (p = 0.035) were associated with mortality. The median overall survival was 45.5 months. CONCLUSION: Patient survival is shorter than reported in the literature. The high mortality rate is due to comorbidities and limited access to recommended therapies.

Methotrexate-induced toxidermia and pancytopenia in a patient with ectopic pregnancy: a case report.

BACKGROUND: Methotrexate is an anticancer drug from the antimetabolite class. It is also used in gynecology and obstetrics and is the molecule of choice for the medical treatment of ectopic pregnancies. We report a case of toxidermia associated with severe pancytopenia induced by methotrexate for ectopic pregnancy. CASE PRESENTATION: A 30-year-old Malagasy (African) woman was admitted to the Emergency and Intensive Care Department for probable toxidermia following injection of 75 mg of methotrexate for an ectopic pregnancy. She had developed generalized erythema, which started 48 hours after the injection. The secondary onset of phlyctenular maculopapular skin lesions, generalized purpura, and erosions of the oral mucosa in a context of febrile jaundice prompted her hospitalization. On admission, the patient presented with febrile neutropenia, pancytopenia, renal failure, and hepatic cytolysis. She received transfusions of fresh whole blood, erythromycin, and amphotericin B. The course was fatal within 2 days of hospitalization. The patient died of multiple organ failure. CONCLUSIONS: Our case is mainly distinguished by the lack of use of granulocyte growth factors and folinic acid. In the event of severe reactions to methotrexate, the management should be multidisciplinary and as much as possible within an intensive care unit.

Survival of Patients with Epidermal Growth Factor Receptor-Mutated Metastatic Non-Small Cell Lung Cancer Treated beyond the Second Line in the Tyrosine Kinase Inhibitor Era.

BACKGROUND: The identification of activating mutations in specific genes led to the development of targeted therapies for NSCLC. TKI directed against EGFR-mutations were the first to prove their major efficacy. Medical associations recommend their use as first and second-line metastatic treatments in EGFR-mutated patients. Our objective was to analyze the survival of EGFR-mutated patients treated beyond the second line of treatment. METHODS: We performed a longitudinal, retrospective and analytical study at APHP (Assistance Publique Hopitaux de Paris) Saint Louis, Paris, France, from 1 January 2010 to 31 December 2020 (11 years), on EGFR-mutated patients with metastatic NSCLC which received TKI or chemotherapy (CT) in third-line. RESULTS: Out of about 107 EGFR-mutated patients, 31 patients who benefited from TKI or CT in the third line of treatment were retained for this study. The mean age was 60.03 ± 11.93 years and the sex ratio male/female was 0.24. Mutations of exon 19, 21 and 20 were found in 21 (67.7%), 7 (22.6%) and 7 (22.6%) patients, respectively. Third-line treatment was CT for 16 patients (51.6%) and TKI for the 15 remaining patients (48.4%). Osimertinib was the most used TKI in third-line (n = 10/15; 66.67%). The median duration of third-line treatment was 5.37 months (range 0.53-37.6) and the median follow-up duration was 40.83 months (range 11.33-88.57). There was a significant difference in PFS between patients treated with TKI and CT in third-line (p = 0.028). For patients treated with CT in second-line, there was a significant difference of PFS (p < 0.001) and OS (p = 0.014) in favor of the use of TKI in third-line. CONCLUSIONS: For patients receiving CT in second-line, TKI appears to be a better alternative in third-line compared to CT. Osimertinib may be used in third line treatment if not used before.

ABO blood group in Malagasy patients with cancer: which group predominates?

The blood group of Malagasy patients with cancer have never been the subject of previous publications. Our objective was to determine the blood group of Malagasy patients with cancer followed in the Medical Oncology Unit of the Soavinandriana Teaching Hospital, Antananarivo. This was a one-year retrospective study (November 2012 to October 2013) in patients over the age of 15 with histological or pathological evidence of their cancer. One hundred and thirty of the 258 patients identified had an ABO blood group determination (50.39%). Among these 130 patients, 114 patients (87.69%) had solid tumors and 16 patients (12.31%) had hematologic malignancies. Thirty seven (28.49%) patients were transfused and 93 (71.54%) not transfused. There were 57 men and 73 women (sex ratio = 0.78), the average age was 55.11 +/- 14.76 years. With regard to their blood group, 52 patients (40%) were blood group B, 44 (33.84%) group O, 27 (20.76%) group A and 7 (5.38%) group AB. The order of blood group frequency of cancer patients in our series differs from other studies. This study has allowed us to know the proportion of each blood group in our Unit and thus help us in the management of stocks of labile blood products in our hospital.

[Thymic neuroendocrine tumor: about a case and review of the literature]. / Carcinome neuroendocrine thymique: à propos d'un cas et revue de la littérature.

Thymic neuroendocrine tumors (TNET) are rare, with little-known prognosis. This study aims to report a case of TNET and to highlight the diagnostic and therapeutic difficulties in low-resource settings. A 60-year-old man presented with chest pain, greasy cough and recent weight loss. Chest CT scan showed anterior mediastinal tissue mass. Histologic evaluation of a 4 months-biopsy specimen obtained from anterior mediastinotomy showed a well differentiated TNET, labeled intensely positive for chromogranin and synaptophysin. The search for other neuroendocrine tumors and the extent of extension were negative. The tumor was immediately inextricable and radiation therapy was unavailable. The patient underwent two lines of first line chemotherapy. At 16 months follow-up, the patient was asymptomatic but showed tumor progression. The diagnosis of TNET may be delayed when immunohistochemistry is not routinely performed. Chemotherapy is associated with symptoms improvement in palliative care situation.