Results of treatment with CMA, a low intermediate regimen, in endemic Burkitt lymphomas in sub-Saharian Africa: experience of Côte d'Ivoire.

African Burkitt lymphomas (BL) are highly aggressive lymphomas mainly affecting children and young adults in Africa. This lymphoma was marked by its high sensitivity to chemotherapy in comparison to Sporadic Burkitt lymphoma. In this study, we evaluated the treatment response and survival of patients with CMA protocol. Eighty-five of the 105 children registered were evaluated for response; there were 46 boys and 39 girls, whose age at diagnosis ranged from 3 to 18 years (median 11 years), admitted to the Hematology National Teaching Hospital of Abidjan in the period 1998-2008 with a diagnosis of BL on histological review and who were given CMA chemotherapy with curative intent are included in this analysis. CMA protocol is a low intermediate regimen of 3 drugs [Cytarabin (ara-C), Methotrexate (MTX), and Cyclophosphamide] with CNS-directed treatment by intrathecal MTX, ara-C and corticosteroid. Fifty-five of 85 patients obtained CR after induction therapy and 10 after 3 supplementary cycle because of partial response. The overall complete remission was 76%. Fifty-three of patients were alive in first CR at a median survival rate period of 2 years (range 82 days to 9 years) and are continuously disease free from Burkitt lymphomas. Twelve patients relapse after CR and died of lymphoma progression. More than 32 patients died, as a result of lymphoma progression. Among the 32 dead, 10 were in Murphy stage IV and all the patients who presented bone marrow involvement died. The projected 5-year overall survival rate was 62%. In conclusion, CMA protocol shows the high sensitivity of African Burkitt lymphoma. This can be considered as a successful result for people living in poor socio-economic conditions with no health insurance.

[Is hepatomegaly a prognosis factor of chronic myeloid leukaemia among African blacks?]. / L'hepatomegalie est-elle un facteur pronostic de la LMC du Noir Africain?

It acts of a retrospective study relating to 74 patients reached of chronic Leukaemia myeloid (LMC) over one 5 year period followed in the clinical service of hematology of the University Hospital of Yopougon (Abidjan, Ivory Coast). The splenomegaly is quasi-constant in chronic phase of the disease often associated hepatomegaly in 20.27% of the cases which constitutes a pejorative factor of the LMC. Indeed, the hyperleukocytosis of more than 300,000 white globules is correlated with the presence of hepatomegaly (p=0.0005) with risks of portal hypertension. 80% of the patients carrying the LMC with a clinical hepatomegaly in chronic phase of the disease have against an incomplete hematologic remission 20% of complete remission (P = 0.002) among patients without hepatomegaly. The strong rate of death (73.33%) recorded occurred among patients carrying a hepatomegaly against 15.25% of death without hepatomegaly (P = 0.0001). The overall rates Total survival is on average 17 months against 20 months 28 days in the event of absence of the hepatomegaly (P = 0.0001).

[Therapeutic results and evolution of Black African patients with follicular lymphoma: Ivory Coast experience]. / Caractéristiques thérapeutiques et évolutives des lymphomes folliculaires du Noir africain: expérience de la Côte d'Ivoire.

We reported in this study a treatment results about 36 Africans patients with follicular lymphoma. The average age of patients was 18 to 73 years old with a median age at 50.83 years old and a sex ratio of 1. Clinical characteristics of patients are mainly represented by advance stage with 70% of stage III and IV of Ann Arbor classification. Histological, we mainly notified follicular lymphoma constituted of small cells 50%, followed by mixed follicular and large cells lymphomas with respectively 27.78 and 22.22%. Using varieties of therapeutics regiments, we obtained 41.67% of complete remission. There were significant correlations between complete remission and histology subtypes. Indeed, the follicular lymphomas constituted by large cells and mixed cells had higher rate of complete remission with respectively 46.67% and 40% in relation with those of small cells with a higher failure rate. Median follow-up was 24 months, the estimated 5-years overall survival and event-free survival were 22%. After a long period, 25 cases of death have been reported, 5 cases of losing sight and 6 patients are still alive and following treatment. Our results are lowers than the reported case in developing country. This none satisfying was in relation with the lower socio-economical level of the main part of the patients. The short survival delay time of our patients didn't permit time to observe transformation case in diffuse large cell lymphomas.

[Maternal and neonatal iron status in Ivory Coast]. / Métabolisme du fer et valeurs érythrocytaires du nouveau-né ivoirien: relation avec le statut en fer de la mère.

Despite the high prevalence of neonatal anemia in Côte d'Ivoire, complete blood counts and iron studies have not been adequately explored. The authors studied complete blood counts (from peripheral blood mononuclear cells), hemoglobin electrophoresis results, and serum iron, ferritin and transferrin levels in 40 newborns and their mothers. The neonatal results (mean +/- SD) were: hemoglobin: 14.96 +/- 2.24 g/dl; serum iron: 16.88 +/- 7.29 micromol/l; total iron-binding capacity (TIBC): 39.88 +/- 14.85 micromol/l; transferrin: 2 +/- 0.65 g/l; ferritin: 116.20 +/- 105.25 microg/l; and hemoglobin electrophoresis: 22.5% of infants showed some hemoglobinopathy (FAC, FAS, FSA(2)). Maternal serum iron levels were positively correlated with the newborns' TIBC (r = 0.362, p<0.05), maternal ferritin with neonatal transferrin (r = 0.374, p<0.05), maternal transferrin coefficient of saturation (CS) with neonatal TIBC (r = 0.554, p<0.01). These results suggest a high prevalence of iron deficiency in mothers and a consequent potential risk of iron deficiency in their newborns in the absence of iron supplementation.

[Antibiotherapy in osteoarticular infections in children suffering from hemoglobinopathy in the University Teaching Hospital of Yopougon]. / L'antibiothérapie dans les infections ostéo-articulaires chez l'enfant atteint d'hémoglobinopathie au CHU de Yopougon.

OBJECTIVE: The objective of this work was to evaluate antibiotherapy in osteo-articular infections found in children with henioglobinopathy, by identifying the antibiotics used and their mode of action. Their cost and efficacy were also assessed. MATERIALS AND METHOD: The study was retrospective and it took place in the haematology unit, the paediatric surgical department and the central pharmacy of the University Teaching Hospital of Yopougon from 1991 through 1998. Thirty-two medical records of children, carriers of osteo-articular infections (OAI), were selected. Amongst these patients, most of whom had sickle-cell anaemia (97%), 50% were homozygous. Osteomyelitis represented 78% of these infections (salmonella infections being the most frequent cause, amounting to 35%). RESULTS: Fifteen types of antibiotics amongst 57 from 5 families of drugs were used, with biotherapy (association of two drugs) being used in 69% of cases. The association of pefloxacine and netilmicine was the most frequently used and it was found to be the most expensive. The treatment was judged efficacious, with a satisfactory result in 75% of cases, based on the clinical criteria. DISCUSSION: Bitherapy is the type of treatment, which is often of concern to many authors and relies on the general consensus surrounding the most likely emergency treatment of osteo-articular infections. Certain particularities are worth mentioning regarding this utilisation: the multiplicity of the molecules due to frequent rupture of hospital stock; the use of fluoroquinolones exceptionally prescribed in children under 15. CONCLUSION: This antibiotherapy is justified owing to its efficacy on a sensitive issue concerning a pathology with grave sequellae, where long-term monitoring is necessary.

Reduced levels of T-cell subsets CD4+ and CD8+ in homozygous sickle cell anaemia patients with splenic defects.

T-lymphocyte subsets were studied in two patient groups: (1) 50 patients with homozygous sickle cell anaemia (SCA) (mean age 12 (range 3-32) years old) in good health at the time of the study who showed no infectious complication. (2) 50 patients (mean age 13 (range 4-29) years old) with normal haemoglobin rate. The global response revealed a significant increase in levels of CD3+ (P=0.04) and CD8+ (P=0.04) cells when compared with the control group, there was no significant difference in levels of CD4+ cells (P=0.05) between the two groups. However, there was a relationship between T-cell subpopulation levels and spleen status. The average values of T-cell subsets (CD4+ and CD8+) in patients with SCA-induced splenic defects (asplenic, splenomegaly or splenectomized patients) were significantly reduced when compared to SCA patients with normal spleens and the control groups. These data show that T-cell activity was reduced in patients with splenic defects. A correlation between splenic status and a perturbed host defence system in patients with SCA suggests that monitoring T-cell subsets might have prognostic value in the course of sickle cell disease.

[The impact of chemotherapy on haematological and biochemical profiles during malignant blood diseases in Abidjan, Côte d'Ivoire]. / Impact de la chimiothérapie sur les profils hématologiques et biochimiques au cours des hémopathies malignes à Abidjan (Côte d'lvoire).

Our research concerned the impact of chemotherapy on the haematological and biochemical profiles of patients diagnosed with malignant blood diseases and receiving treatment in Abidjan. The study covered 57 patients, 26 of whom were receiving treatment. Burkitt's lymphoma was the most common type of malignant blood disease encountered (33%). The proportion of men was slightly higher, at 54%, and the average age of patients was 26. Hyperleucocytosis, anaemia and medullar blastosis were the most common blood disorders. The tumours arising from hyperleucocytosis and medullar blastosis caused increases in proteins from inflammatory reaction. The increase was moderate for alpha 1 globulins and haptoglobin and high (at least twice the reference levels) for C Reactive Protein (CRP) and orosomucoid. Full remission was only achieved in the cases of Burkitt's lymphoma, in which the haematological and biochemical parameters reached near-normal levels following treatment. In cases of chronic myeloid leukaemia the treatment lowered the hyperleucocytosis but the high rate of CRP might indicate that the disease was reaching a more acute phase. In the cases of acute leukaemia, chemotherapy did not achieve full remission: the alpha 1 globulins, including orosomucoids, were the most sensitive proteins to treatment. Even though the rate of CRP was lowered, it remained high in all cases of acute leukaemia. Neither haematological nor biochemical data proved superior to the other in monitoring the effectiveness of the treatment or the gradual return of the disease. It would be beneficial to combine them in order to obtain a clearer assessment of the effectiveness of chemotherapy.