[Sezary syndrome treated by cytapheresis. Short and long-term results]. / Syndrome de Sézary traité par cytaphérèses. Résultats à court et à long terme.

INTRODUCTION: Sezary syndrome is usually resistant to most treatments. The aim of this work was to evaluate short and long-term results of cytapheresis in patients with Sezary syndrome. PATIENTS AND METHODS: Twenty-two patients with Sezary syndrome were included in the study (13 men, 9 women, man age 58 +/- 35.4 years). The mean duration of Sezary syndrome before cytapheresis was 6.5 +/- 2 months. Extra-cutaneous involvement was observed in 16 of the patients. Each patient underwent 33 +/- 63 cytapheresis sessions (total number = 685). Complete remission in "responders" was defined as the absence of clinical signs and Sezary cells < 1,000/mm3. In "non responders" partial remission was defined as incomplete regression of clinical signs and Sezary cells > 1,000/mm3 and failure as lack of improvement or worsened clinical situation. RESULTS: Complete remission was obtain in 10/22 patients (45.5 p. 100), partial remission in 4/22 (18 p. 100) and failure in 8/22 (36.5 p. 100). There was no significant difference between responders and non-responders for age, duration of the Sezary syndrome before cytapheresis, the number of sessions, extracutaneous involvement, or another associated treatment. In the responders, mean survival was 90 +/- 42 months. Two patients were alive at 5 years and 1 at 10 years. In the non responders, mean survival was 8 +/- 1.4 months and median survival was 11 months. CONCLUSION: There was no significant evidence suggesting a difference between responders and non-responders. Nevertheless, mean survival was longer in patients who had achieved complete remission. Cytapheresis is thus justified for the treatment of patients with Sezary syndrome.

[Bone marrow autograft in the treatment of cutaneous lymphoma]. / Autogreffe de moelle osseuse dans le traitement des lymphomes cutanés.

INTRODUCTION: The prognosis of advanced stage or high grade cutaneous lymphomas is very poor in case of recurrence after conventional polychemotherapy. Recent studies have confirmed the importance of intensified treatment with autologous bone marrow transplantation in case of recurrence. We used this method in patients with a cutaneous lymphoma with poor prognosis. PATIENTS AND METHODS: Seven patients with a high-grade or disseminated cutaneous lymphoma were given an autologous bone marrow graft in case of recurrence after one or more polychemotherapy protocols. In 4 patients, treatment included total body irradiation and high-dose chemotherapy (cyclophosphamide/etoposide, or aracytine/melphalan) and in the 3 others chemotherapy alone (BEAM or BEAC) was used prior to transplantation. RESULTS: Two complete remissions of 46 and 34 months duration after graft were achieved without complementary treatment. One patient had partial remission. Recurrence was observed in 2 patients 5 months after the graft and in 1 other 30 months later. Prolonged complete remission was observed in patients given total body irradiation and the early recurrences in those given chemotherapy alone. DISCUSSION: This pilot study demonstrates that patients with a poor prognosis cutaneous lymphoma can achieve prolonged complete remission by therapy intensification using autologous bone marrow transplantation after total body irradiation.

[Inflammatory rheumatism flare-up after surgical treatment of Cushing's disease: two cases]. / Poussée de rhumatisme inflammatoire après cure chirurgicale d'une maladie de Cushing: deux cas.

The anti-inflammatory effect of natural glucocorticoids is often overlooked, as shown by these two cases of inflammatory rheumatism flare-up which occurred after surgical treatment of Cushing's syndrome. The disorder in the first case was exacerbation of a probable rheumatoid arthritis; in the second case an unlabelled inflammatory rheumatism appeared in a context of postoperative corticotropic deficiency. In both cases a purely substitutive hydrocortisone therapy resulted in dramatic regression of the articular symptoms. It is well known that rheumatismal manifestations may occur in patients with slow adrenal failure. The determinant factor seems to be a glucocorticoid deficiency, either isolated or associated with others, since cortisol exerts and anti-inflammatory activity. In patients with corticotropic deficiency following surgical treatment of Cushing's disease, the endogenous corticosteroid therapy of hypercortisolism is interrupted, allowing the aggravation or emergence of inflammatory rheumatism.

[Trial of immunodiffusion on cellulose acetate. Application to the estimation of immunoglobulins A and serum transferrin. Results in alcoholism and cirrhosis (author's transl)]. / Essai d'électro-immunodiffusion sur acétate de cellulose. Application au dosage des immunoglobulines A et de la transferrine sériques. Résultats dans l'alcoolisme et la cirrhose.

The authors propose electro-immunodiffusion on cellulose acetate instead of agar gel. This simple, rapid and economical method was applied to the estimation of serum immunoglobulins A and transferrin. The following results were obtained for the IgA/transferrin ratio in 108 cases: Normal: 0.87 +/- 0.29; alcoholics without proved cirrhosis: 1.61 +/- 0.95; alcoholic cirrhosis: 3.36 +/- 2.30. The interest of this determination in detection is increased by this simple test.