AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study.

BACKGROUND: Previous studies have indicated that accompanying socially underserved cancer patients through Patient Navigator (PN) or PN-derived procedures improves therapy management and reassurance. At the Cancer Institute of Toulouse-Oncopole (France), we have implemented AMA (Ambulatory Medical Assistance), a PN-based procedure adapted for malignant lymphoma (ML) patients under therapy. We found that AMA improves adherence to chemotherapy and safety. In low-middle income countries (LMIC), refusal and abandonment were documented as major adverse factors for cancer therapy. We reasoned that AMA could improve clinical management of ML patients in LMIC. METHODS: This study was set up in the Abidjan University Medical Center (Ivory Coast) in collaboration with Toulouse. One hundred African patients were randomly assigned to either an AMA or control group. Main criteria of judgment were refusal and abandonment of CHOP or ABVD chemotherapy. RESULTS: We found that AMA was feasible and had significant impact on refusal and abandonment. However, only one third of patients completed their therapy in both groups. No differences were noted in terms of complete response rate (CR) (16% based on intent-to-treat) and median overall survival (OS) (6 months). The main reason for refusal and abandonment was limitation of financial resources. CONCLUSION: Altogether, this study showed that PN may reduce refusal and abandonment of treatment. However, due to insufficient health care coverage, its ultimate impact on OS remains limited.

The Effect of Imatinib Mesylate for Newly Diagnosed Philadelphia Chromosome-Positive, Chronic-Phase Myeloid Leukemia in Sub-Saharan African Patients: The Experience of Côte d'Ivoire.

Imatinib mesylate, showed encouraging activity in chronic myelogenous leukemia. However, there are few data regarding his efficacy and response monitoring in Sub-Saharan African patients. Our objective was to assess response to imatinib mesylate (Glivec) in Côte d'Ivoire patients with newly diagnosed Chronic Myeloid Leukemia (CML). From May 2005 to September 2009, we treated 42 patients (40 years; range 16-69) with Philadelphia chromosome (Ph+) positive in chronic phase CML with oral imatinib mesylate at daily doses of 400 mg. Overall survival (OS) and frequency of complete or major cytogenetic remission (CCR/MCR) were evaluated. At a median follow up of 32 (range 7.6-113) months, the CHR rate in our study group was 76%. A major CR was found in 19 patients (45%) with 17% and 29% complete and partial CR respectively. There were no significant differences in the incidence of major cytogenetic response by known prognostics factors. Median time to CHR was 8 months (range 0.4-25), and 16 months (range: 0.1-36) for CR. Projected 5-year OS rate was 72% (95%CI 42-88). We conclude that imatinib therapy sub-Saharan African CML patients is very promising and has favorably changed the prognosis for black African patients with CML.

[Evaluation of the protocol CMA reinforced in the treatment of endemic Burkitt lymphoma at CHU of Yopougon in Abidjan]. / Evaluation du protocole CMA renforcé dans le traitement du lymphome de Burkitt endémique au CHU de Yopougon à Abidjan.

We report the results of the protocol CMA (cyclophosphamide, methotrexate, Aracytine) reinforced of 26 patients affected by Burkitt lymphoma in facial-maxillary localisation, in a retrospective study from January 2000 till December 2007 and prospective from January till September 2008. Their average age was 7.89 years, with a sex ratio of 2.71. The global response to the treatment was 92.3% with 57.7% of complete remission and 34.6% of incomplete remission. The morbidity related to treatment was essentially a haematological complication (84.6%) and hydroelectrolytic complication (84.6%). Evolution was made towards death in 30.8 and 15.4% were lost of view. The median monitoring was 18.2 months. Treatment response was linked to the therapeutic compliance (P < 0.001), and the delay of consultation (P = 0.01).

[Therapeutic impact of alpha interferon in chronic myelogenous leukaemia]. / Impact therapeutique de l'interferon alpha dans la prise en charge des patients atteints de leucemie myeloide chronique.

CONTEXT: Ten years after the use of alpha interferon in chronic myelogenous (CML) leukaemia treatment, we review this treatment. OBJECTIVE: We propose through this study to evaluate the therapeutic answer of the patients reached of CML in chronic phase and to study its impact on survival. MATERIAL AND METHODS: To be done we carried out a descriptive and analytical retrospective study concerning 40 patients carrying Chronic Myelogenous Leukaemia. RESULTS: The average age was 39.05 years and ratio sex was 0.9. 60% of the patients profited from the arm Hydroxyurea + Interferon alpha + Cytosine Arabinoside and 40% from Hydroxyurea + Interferon. The complete haematological answer was observed in 85.5%. The cytogenetic answer was documented only for two cases, and it acted of complete answer. On the evolutionary level, it was noted 27.5% of deaths related to a blastic transformation. The side effects were marked by occurred of alopecia, herpes and the gripal syndrome. The median of survival observed was 68.233 months or 5.68 years. The age, socioeconomic level, delay of treatment started, therapeutic protocol, length and regularity of treatment influenced the therapeutic response. CONCLUSION: Many factors influence the treatment response.

Impact therapeutique de l'interferon alpha dans la prise en charge des patients atteints de leucemie myeloide chronique

Contexte : Dix annees apres l'utilisation de l'interferon alpha dans le traitement de la leucemie chronique; dans le service d'hematologie clinique du CHU de yopougon; nous faisons le point de cette therapeutique. Objectif : nous nous proposons a travers cette etude d'evaluer la reponse therapeutique des patients atteints de leucemie myeloide chronique en phase chronique et d'etudier l'impact de ce traitement sur la survie. Materiel et methodes : nous avons effectue une etude retrospective descriptive et analytique concernant 40 patients porteurs de leucemie myeloide chronique. Resultats : l'age moyen etait de 39.05 ans et le sex ratio de 0.9. Les patients ont beneficie dans 60du bras Hydroxyuree + Interferon alpha + Cytosine Arabinoside et dans 40de l'association Hydroxyuree + Interferon alpha. La reponse hematologique complete a ete observee dans 85.5des cas. La reponse cytogenetique a ete documentee seulement dans deux cas; et il s'agissait de reponses completes. Sur le plan evolutif; il a ete note 27.5de deces lies a une transformation blastique. Les effets secondaires ont ete marques par la survenue d'alopecie; d'herpes et de syndrome grippal. La mediane de survie observee etait de 68.233 mois soit 5.68 ans. L'age; le niveau socioeconomique; le delai de prise en charge; le protocole therapeutique; la duree du traitement; la compliance influencaient la reponse therapeutique. Conclusion : de nombreux facteurs influencent la reponse au traitement

[Chronic lymphocytic leukemia in Subsaharian Africa: clinical outcome experience of Côte d'Ivoire]. / La leucémie lymphoïde chronique du Noir en Afrique subsaharienne : caractéristiques cliniques thérapeutiques et pronostiques (cas de la Côte d'Ivoire).

We reported in this retrospective study the clinical outcome of 56 chronic lymphoïd leukemia of black African in Ivory Coast and the predicting prognosis factors. The mean age was 62 years old with average of 38 to 84 years. According to Binet staging, 29 patients with stage A, and respectively 11 and 16 patient for stage B and C. All patient received chemotherapy protocol regimens (CVP, chlorambucil, CHOP). The global response was 51.78%. The death occurred in 29 patients. The mean survival was 8.22 years. The disease free survival was 58.8% at 5 years. In univariate analysis, factors with high-risk of death are patients age above 60 years, the presence of node, liver involvement, Spleen large IV and V of Hackett classification, WBC superior to 100,000/microL, lymphocytosis superior to 63,000/microL, Anaemia inferior to 10 g/dL, thrombopenia inferior to 100,000/microL, medullar lymphocytosis superior to 73% and Binet Stage B and C. In multivariate analysis, only age, adenopathy, hepatomegaly and lymhocytosis were an independent prognostic factor for predicting survival.

Les aplasies médullaires : profils épidémiologique; clinique; étiologique et évolutif. A propos de 34 cas colligés au CHU de Yopougon

Buts : Dans nos pays, l'aplasie médullaire a été peu étudiée. Le but de cette étude était de préciser les particularités de l'aplasie médullaire chez le noir africain. Patients et méthodes : L'étude rétrospective et prospective de l'aplasie médullaire chez 34 patients nous a permis de mettre en évidence ces particularités. Résultats : Sur le plan épidémiologique, l'âge moyen était de 38.09 ans, avec une prédominance de la tranche d'âge comprise entre 31 et 45 ans ; le sex ratio de 1.13. Concernant l'activité professionnelle, les ménagères venaient en tête. Sur le plan clinique, les circonstances de découverte étaient dominées par la pancytopénie. A la biologie, il s'agissait essentiellement d'une moelle hypoplasique ou désertique. L'aplasie médullaire idiopathique prédominait au plan étiologique. Le traitement était à la fois symptomatique (transfusions) et spécifique (corticothérapie). La morbidité (76.5%) et la mortalité (35.3%) étaient élevées. La médiane de survie était de 51 mois. Conclusion : Ainsi, le pronostic était globalement défavorable

[Anemic complications of sickle cell disease: frequency and evolution of 338 cases reported at Yopougon Teaching Hospital]. / Les complications anémiques de la drépanocytose homozygote: fréquence et évolution. A propos de 338 cas au CHU de Yopougon.

INTRODUCTION: Anemic complications of sickle cell disease are defined as all acute or chronical complications due to anemia. In order to describe complications of sickle cell disease, authors reported frequency and course of anemic manifestations. METHOD: This is a descriptive study based on retrospective analysis of data about 338 patients with sickle cell disease collected in the Service d'hematologie Clinique of Yopougon Teaching Hospital over a period of 11 years (March 1994 to September 2005). RESULTS: Mean age of our patients was 21.34 years, ranging from 7 months and 62 years.Majority of patients (68.93%) are aged 15 years or more. Male patients are predominant, with a sex-ratio of 1.36 and most of our patients (98.82%) are from low social condition. Anemic complications were the most occurring complications in our patients with a frequency of 18.78%. Acute anemic complications are the most frequently noticed (87.87%), among which acute crises of deglobulization are mainly present (94.27%). Chronical anemic complications are noticed in 23.67%of our patients and consist mainly of gall bladder lithiasis (20.12%). Death occurred in 10.35% of our patients and was due to anemic complications in 42.86% of cases. COMMENTS: The predominance of acute anemic complications may be due to the comorbidity observed in most of our major sickle cell disease patients. It may turn a chronical haemolytic anemia in acute hemolysis which is a major complication. CONCLUSION: Sickle cell disease has become nowadays a disease of little letality. Its anemic complications are the most important ones in our working conditions.

[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).

[Salmonella meningitis in Ouagadougou, Burkina Faso, from 2000 to 2004]. / Méningites dues à Salmonella au CHU de Ouagadougou, Burkina Faso (2000-2004).

56 strains of Salmonella were isolated from the cerebro-spinal fluids (CSF) from meningitis suspected patients at the Yalgado-Ouédraogo University hospital center in Burkina Faso, from January 2000 to December 2004. 75% of the patients were less than 3 years old; 71.4% of the CSF were purulent, with an average of 523 leucocytes/mm3 and 78% of neutrophile polynuclears. The strains identified belonged mostly to Salmonella O: 4.5 group (51.8%). In vitro, 92.7% of the strains were resistant to ampicillin and this resistance was partially restored with amoxicillin/clavulanic acid; however no strain was resistant to ceftriaxone. For the overall 56 patients, 20 different antibiotherapy regimes were used and they were successful in only 27% cases while 71% of patients died and 2% escaped from the hospital. Neurologic sequels were found in a patient treated with both ceftriaxone and chloramphenicol. These results showed that the illness occurred mainly in infants and was associated with high mortality rate. Most of the Salmonella strains were multi-drug resistant. In spite of strains multi-antibiotics resistance, adequate definition of therapeutic lines and early treatment including ceftriaxone could lead to higher cure rates and may improve the outcome.

[Evaluation of clinical response by hydroxyurea in 132 patients with major sickle cell anemia]. / Evaluation des effets cliniques de l'hydroxyuree chez 132 patients drepanocytaires homozygotes.

Hydroxyurea is used since close to 10 years in the treatment of major sickle cell anemia. In African sub Sahara, very little study have been dedicated. Yet, this drug represents nowadays, an alternative tot the bone marrow transplantation in the treatment of this illness. This study permits to illustrate the beneficial effects of this drung on 132 patients affected by of major sickle cell anemia. It is about patients whose middle age is of 28 years (range 14 and 54 years), most frequently masculine sex, followed regularly in the service of haematology of CHUB. The treatment consisted to the administration of the hydroxyurea to the posology between 10 and 30 mg/kg per day. The essentially clinical assessment focused on the sickle cell anemia crises and the modifications of hematologic's parameters. The experimentation has been pursued beyond the 18th month among 108 patients. It takes out again of this survey disappearances of the vasculo occlusive crises among 103 patients on 132 (78.03%) during the first 18 months of the survey. Only 10 patients (7.57%) benefited blood transfusion during the period of the survey because of the infectious complications. The hydroxyurea led a meaningful and spontaneous increase of the haemoglobin rate (+2,54 g/dl) of the middle globular volume (+ 16,02 femtolitres) as well as of the rate of haemoglobin foetale on 65 estimated patients. The hydroxyurea didn't bring any objective improvement on the pre-existing dénénératives complications. The treatment has been interrupted precociously among 5 patients for cytopenia. This survey confirms to short and middle term the beneficial effects of the hydroxyurea on the major sickle cell anaemia.

[Epidemiologic and cytologic configuration of acute leukaemia at University Hospital of Brazzaville]. / Configuration épidemiologique et cytologique des leucémies aiguës au Centre Hospitalier et Universitaire de Brazzaville.

The authors report the epidemiologic and cytological aspects of 77 patients hospitalized between January 1995 and December 2002 in the clinical hematologic service in University hospital complex of Brazzaville, greatest hospital of the country. During this period, 7155 patients were hospitalized in this service as a frequency of (107%). reported to the number of inpatients admitted on a total of 52,458 patients. The hospital frequency of disease is 0.15%. There's no specific age for this affection (age median = 21-24 years) and all socio-professional categories can be affected with a prevalence of low income patients what complicates extremely the treatment Ratio Man/Woman is 0.8 showing a light female prevalence. On the level of the epidemiologic investigation (limited because of the insufficiency of the means), nothing is retained except rare acute leukaemias secondary to chronic myeloproliferative disorders as well as association with 2 cases of homozygous sickle cell anaemia. Mortality by acute leukaemia in the service is very high, due to lack of equipment. In the cytological plan, there's a light prevalence of the cases of acute lymphoblastic leukaemias of which some could profit from an immunological typing compared to the cases of myeloblastic acute leukaemias

[Results of treatment of 62 cases of Hodgkin's disease in Côte d'Ivoire]. / Résultats du traitement de 62 cas de maladie de Hodgkin en Côte d'Ivoire.

This study reports the follow-up after 22 years of 62 treated cases of Hodgkin's disease. Complete remission was obtained in 66% of cases versus 31% of incomplete remission and 3% of failures. Overall survival of patients ranged from 10 days to 48 months. Real event-free survival was difficult to estimate given that 40% were completely lost to follow-up. The most frequently encountered disorders were haematologic ones. The difficulties were directly linked to precarious socio-economic conditions for most patients.

Le protocole CMA dans le traitement du lymphome de Burkitt africain

Une etude prospective sur la place du protocole cyclophosphamide-methotrexate-Aracytine (CMA) a ete entreprise d'octobre 1994 a fevrier 1999; sur 50 patients. Les resultats enregistres peuvent etre resumes en : remission complete; 76d'une duree moyenne de 24 mois; 5 cas de guerison a 5 ans; des survies allaient de 6 mois a 5 ans. Le pourcentage de deces a ete de 35. Les criteres de bonnes reponses therapeutiques ou protocole CMA; ont aussi ete determine.s

Aspects epidemiologiques des leucemies aigues en Cote d'Ivoire

Les auteurs rapportent un etude epidemiologique des leucemies aigues allant d'octobre 1991 a fevrier 1999. La prevalence hospitaliere est de 23;86pour 1000 malades hospitalises. Il y avait 59;09de leucemies aigues lymphoblastique (LAL) et 40;91de leucemies aigues myeloide (LAM). L'age global etait de 29;13 ans et 60;60des patients etaient ages de 2 a 30 ans. Il a ete note une legere predominance masculine. Les hydrocarbures aromatiques (benzene et ses derives) sont fortement incrimines

[Infection profile in sickle cell anemia]. / Profil infectieux chez le drépanocytaire.

Our objectives were to determine aetiology and localisation of infection in sickle cell anaemia patients. The origin of fever was malaria in 47% of cases, 50% of bacterial infections and 3% of viral infections. Respiratory infections were concerned in 61% of cases, versus 24% of osteomyelitis. Salmonella were found in 37%, Haemophilus (16%), Staphylococcus (14%), Streptococcus (10%) and Pneumococcus (9%). We found more bacterial infection in anaemic forms (SS and SFA2) and more bacterial infection anemic forms (SC, SAFA2). In view of these findings, we preconize malaria prophylaxis and vaccination against Salmonella, Haemophilus and Pneumococcus in sickle cell anemia patients.

[Epidemiologic, clinical and hematologic profile of K Woolwich hemoglobinopathies in Ivory Coast]. / Profil épidémiologique, clinique et hématologique de l'hémoglobine K Woolwich en Côte d'Ivoire.

From 1968 to 1992, the hematology laboratory at the University Hospital Center of Abidjan performed 197705 hemoglobin electrophoreses. Isoelectric focusing using the Basset technique allowed identification of hemoglobin K Woolwich. This abnormality of hemoglobin structure (beta 132 (H10) Lys ... Glu) was detected in 130 cases, i.e. 0.065%. It was homozygous in 3 cases, heterozygous in 110 cases, and associated with other hematologic abnormalities in 17 cases. The abnormality was asymptomatic and did not cause any hematological disturbance. Due to autosomal transmission, hemoglobin K Woolwich is a trait of Akan populations (75% of cases) in which it is dominant in the Attie subgroup. Given its ethnic specificity, this abnormality is of anthropological interest.

[Clinical and hematological profile of Lepore Hemoglobin in Ivory Coast]. / Profil clinique et hématologique de l'hémoglobine Lepore en Côte d'Ivoire.

Out of 97320 hemoglobin electrophoreses performed in Abidjan between January 1976 and January 1991, all subjects with hemoglobin Lepore were isolated. This trait was identified by three techniques, i.e., alkaline pH electrophoresis, acid pH electrophoresis, and isoelectric focusing. Seventy-nine cases of hemoglobin Lepore were observed. All were heterozygotes with type HbA-Lepore (n = 54), HbC-Lepore (n = 8) or HbS Lepore (n = 17). Where heterozygosis A and C had clinically silent, heterozygosis Hb-S Lepore resulted in a moderate chronic hemolytic anemia and, in all cases, painful episodes similar to those observed during homozygote sickle-cell disease. However the onset of episodes was later and their occurrence was less frequent. On hemograms, the Lepore trait (HbA Lepore) appeared as a pseudo-polyglobulia with microcytosis; similar features were observed for heterozygosis HbC Lepore. Heterozygosis HbS Lepore caused moderate anemia (mean hemoglobin level: 10.66 g/dl) and microcytosis (MGV = 68.8 fl). The characteristics show that the clinical and hematological behavior of hemoglobin Lepore, a rare hemoglobin, is similar to heterozygous beta-thalassemia.

Profil evolutif de la drepanocytose homozygote suivie : experience du service d'hematologie clinique du CHU de Yopougon

La drepanocytose constitue un probleme de sante publique en Cote d'Ivoire. Elle est responsable d'une morbidite importante qui impose une prise en charge medico-sociale reguliere a vie. Le but de cette etude est de preciser le profil evolutif et les caracteristiques de prise en charge de la forme homozygote SS.Pour cela 162 cas hospitalises dans notre service sur une periode de 10 ans (1990 a 1999) ont permis de tirer certaines conclusions :- L'age des patients varie de 2 a 38 ans; avec un age moyen de 14.6 ans; un ecart type de 8.8 ; un sex-ratio de 1.13 ; une predominance des groupes ethniques Kwa et Mande; ainsi que des eleves et etudiants ;- les crises sont toujours declenchees; et le plus souvent par une fievre d'origine palustre ;- on note une moyenne de 2 crises par an; et 2 hospitalisations par patient ;- la moyenne du taux d'hemoglobine (Hb) S est de 84.8et celle du taux d'Hb de 6.4 g/dl ;- l'age de prise en charge est tres variable (1 a 35 ans) et la duree de cette prise en charge se situe entre 1 et 5 ans dans plus de la moitie des cas. Le suivi medical est le plus souvent irregulier ;- des complications d'ordre anemique surtout (144 cas); infectieux (80 cas); ischemique (14 cas) ont ete notees ; de meme que 12 cas de deces; l'anemie aigue constituant la premiere cause de deces