7th Magharebian Congress of Hematology (MCH-7)

Transcription

21st to 23rd May 2010,
Zawia Jewel Hotel, Libya
ORGANIZED BY
Libyan Association Against Cancer
African Oncology Institute
and
Magharebian Hematology Associations
Bureau de la Société Marocaine d’Hématologie (SMH)
Bureau Societe Tunisienne D’hematologie (STH)
Nouveau Bureau De La Societe Algerienne D’hematologie
Et De Transfusion Sanguine (SAHTS)
UNDER AUSPICES OF
International Union Aginst Cancer (UICC)
and
Arab Medical Association Against cancer (AMAAC)
ABSTRACTS BOOK
LIBYAN ASSOCIATION AGAINST CANCER
LIBYA
AFRICAN ONCOLOGY INSTITUTE
SABRATHA, LIBYA
Web: www.laac.ly
Web: www.ncisabratha.ly
BUREAU SOCIETE TUNISIENNE
D’HEMATOLOGIE
TUNISIA
Designed by M. Alsharif
NOUVEAU BUREAU DE LA SOCIETE
ALGERIENNE D’HEMATOLOGIE ET
DE TRANSFUSION SANGUINE
ALGERIA
BUREAU DE LA SOCIÉTÉ MAROCAINE D’HÉMATOLOGIE
MOROCCO
ADDRESS
It is my pleasure to welcome all delegates, both from abroad and from within Libya, on behalf of
African Oncology Institute and its academic staff. We are proud and honored to organize Maghrebian
Hematology Conference this year. We try to work as a catalyst to bring together people from home
and abroad with mutual interest of having a better understanding of hemato-oncologic conditions
and advancing the patient care. I hope that the participants will try to extract maximum benefit out of
this rare opportunity where so many scientific minds are gathered. I am grateful to all the speakers
and presenters from within and outside Libya to make it convenient to attend and make this meeting
a success. I hope that the foreign delegates will have an opportunity to see the beautiful coastline,
modern fast growing cities of Libya, glorious archeological sites, and local traditional cuisine. I wish
they will enjoy traditional hospitality, and will have a comfortable and enjoyable stay.
I will also take the opportunity to show my gratitude to all who worked out their best in organizing this conference from its initial plan to final execution. There is always room for improving the
endeavors to make the future even better. We are thus open to receive any positive comments and
suggestions to improve our future efforts.
Dr. Hussein El-Hashmi
President, Scientific Committee
7th Maghrebian Hematology Conference
III
ADDRESS
We have been enriched by our experience from organizing international oncology conferences
and now this 7th Maghrebian Hematology Conference will add another milestone in our efforts to
achieve excellence in hemato-oncology patient management. As obvious from the program schedule, this conference will provide immense opportunities for sharing of experience and knowledge
among various international, maghrebian, and national clinicians. With this, our senior managers will
recharge and the amateurs will nourish their armaments against disease.
The conference is being organized over a period of 3 days and will touch nearly all clinical aspects ranging from problems of epidemiology to recent advancements in stem-cell transplants. This
coverage will serve a wider audience and we hope this to reflect as one of our upfront steps and a
marker of our concern and motivation for the cause of Libyan patients.
In addition, the region of Magreb has similar scenario in the field of hemato-oncology and exchange of ideas on a common podium like 7th Maghrebian Hematology Conference will provide
a good opportunity to achieve this. We wish to promote cooperation among south Mediterranean
countries in the field of hematology-oncology to improve the outcome in ways of diagnosis and treatment.
One of the important arms in our efforts is the release of this abstract book. The book covers
essential program details and abstracts including both oral as well as poster presentations. These
abstracts include nearly all aspects of hematology and oncology including epidemiology and biotechnology. First section is a tabulated conference schedule. This is followed by section comprised
of abstracts from oral presentation sessions while next section includes our poster presentations.
Due to inherent limitations, the presentations which could not be included for oral presentations
have been shifted to our poster sessions after obtaining consent from their authors.
We regret the absence of a few abstract which could not be managed in-time while we aimed for
a timely publication of this manuscript. We hope that printing errors will be shadowed by the importance of content and the respect for time.
Dr. Abugeila Abussa
Secretary, Scientific Committee
IV
ADDRESS
Imparting scientific knowledge and practical clinical skills is the pivotal exercise of a scientific
community. Professionalism, evidence-based medicine, and good clinical practice is the mainstay
of any clinical community. Hematology-Oncology has seen and will continue to witness the rapid
and fastest growth in research, experience, and clinical practice. New concepts and strategies are
incorporated in clinical protocols at a very rapid pace. It is imperative to survive as isolated clinician
in a global village. The close collaboration, association, and interaction within the clinical community
are the only way to acquire maximum knowledge or experience in a very short life span of a human
being.
The 7th Maghrebian Hematology Conference will provide a spring board for interaction among
the clinical community from within and outside the country. Hands-on workshop will provide an opportunity to the beginners to learn more and can further sharpen their existing skills. The conference
will provide an opportunity to share ideas, exchange views, upgrade knowledge, and clear concepts.
This will lead to a better understanding of disease process, improving diagnosis, and to have better
patient care with improved outcomes.
The scientific committee worked hard to give a due and justified representation in the scientific
program; according to our local requirements and disease burden. We tried to induct newer subjects
and to invite eminent scholars from home, Maghreb, and abroad. The poster presentation will be a
valuable academic and research exercise for the participants. We sincerely hope and wish that all
the delegates will use this opportunity to its maxim for improving their knowledge and skills with the
ultimate aim of improving patient management.
We are indebted to those who managed to participate from home and abroad, and we regret that
many could not find a place as a speaker or presenter due to limited slots and shortage of time. We
will be pleased to have constructive criticism for future endeavors.
Dr Naji Jornaz
Chairman, Scientific Committee
V
SCIENTIFIC COMMITTEE
Dr. Hussein ElHashmi, President
President, Conference
Dr. Abugiela Abussa, Secretary
General Secretary, Conference
Dr. Ramah Ramaih
Chairman, Scientific Committee
Members – Scientific Committee
Dr. Naji Jornaz
Dr. Abdullatif Khamaj
Dr. Nubila Sassi
Dr. Miloud Dardouri
Dr. Itrat Mehdi
Dr. Kamel Verma
LIST OF ABBREVIATIONS
VI
OR
Oral Presentation
PO
Poster Paper
DISCLAIMER
All the abstracts received have been published in this abstract book, as received in original format.
The conference organizers or scientific committee does not necessarily agree with the context,
comments, data, or conclusion drawn. As such the responsibility and authorship remains with the
authors, and contributors.
Scientific Committee
VII
CONTENTS
21st to 23rd May 2010, Zawia Jewel Hotel, Libya
CONTENTS
ORAL PRESENTATIONS
1
POSTER SESSION CONTENTS
53
ORAL PRESENTATION
P. No.
OR- 01
Titles and Authors
THE USEFULNESS AND LIMITATIONS OF COMBINED FINE-NEEDLE ASPIRATION IMPEDANCEMETRY AND FLOW CYTOMETRY IN THE DIAGNOSIS AND SUBCLASSIFICATION OF NON-HODGKIN’S LYMPHOMA.
M. Brahimi, D. Saidi, A. Arabi, M. Bey, H. Berredouane, N. Yafour, S. Osmani,
H Touhami, M A Bekadja.
OR- 02
P.P.
3
FACTEURS PRONOSTIQUES ET EVALUATION DE LA REPONSE AU
PROTOCOLES CHOP OU R-CHOP DES LYMPHOME DIFFUS A GRANDES
CELLULES B DU SUJET JEUNE ≤ 60 ANS
SE Belakehal, H Mansour, S Baghdad, MC Rahali, D Saber-Cherif, FZ Ardjoun.
4
(Translation to English).
PROGNOSTIC FACTORS AND EVALUATION OF THE ANSWER TO PROTOCOLS CHOP OU R-CHOP OF THE DIFFUSE LARGE B CELL LYMPHOMA OF THE YOUNG SUBJECT ≤ 60 YEARS.
OR- 03
ASPECTS CLINIQUE ET HISTOLOGIQUE DES LYMPHOMES MALINS
NON HODGKINIENS.
S. Dechir, M. Allouda, O. Ouanes, H. Aftisse, S. Gherras, N. Dali, K. Ait-Seddik, H. Laga, R. Drif Et H. Ait-Ali.
OR- 04
8
TUNISIAN EXPERIENCE IN THE TREATMENT OF AGGRESSIVE NON
HODGKIN’S LYMPHOMA IN ADULTS: ABOUT 337 PATIENTS.
Mohamed Adnène Laatiri.
OR- 05
6
9
AGGRESSIVE B-CELL LYMPHOMA.
Norbert Scmitz
10
XI
CONTENTS
ORAL PRESENTATION
P. No.
OR- 06
Titles and Authors
MEDIASTINAL LOCALIZATION OF NON-HODGKIN LYMPHOMA
DIAGNOSTIC THERAPEUTIC AND PROGNOSTIC APPROACH.
C. Aboura L. Louanchi S. Nekkal M.Ramaoun Z.Kaci M. Belhani
OR- 07
12
CONVENTIONAL AND MOLECULAR CYTOGENETIC (FISH) FOR ASSESSING DIAGNOSIS AND PROGNOSIS OF HEMATOLOGIC MALIGNANCIES.
S. Taoussi, M. T. Abad
OR- 9
11
ADULT HODGKIN LYMPHOMA (HL) TREATMENT IN TUNISIA.
Ben Lakhal R
OR- 08
P.P.
14
CYTOGENETICS ASPECTS OF ACUTE MYELOBLASTIC LEUKAEMIA IN
ADULTS IN MOROCCO
M Lamchahab
OR- 10
ASPECTS CLINIQUE, BIOLOGIQUE ET THERAPEUTIQUE DES LEUCEMIES AIGUES MYELOBLASTIQUES CHEZ L’ADULTE
N. Dali, K. Ait-Seddik, M. Allouda, O. Ouanes,S. Gherras, H. Aftisse, H. Ait-Ali
OR- 11
24
NEW TREATMENTS FOR FIT AND UNFIT PATIENTS WITH CLL
Marco Gobbi
XII
22
DIAGNOSTIC, MANAGEMENT AND OUTCOME OF CML PATIENTS: A TUNISIAN MULTI-CENTER STUDY
Ben Amor R, Ben Lakhal R, Ghedira H, Belaaj H, Laatiri MA, Ben Youssef Y,
Ben Romdhane N, M’sadek F, Menif S, Elloumi M, Khelif A, Meddeb B.
OR- 16
21
ASPECTS CLINIQUE BIOLOGIQUE ET THERAPEUTIQUE DES LEUCEMIES AIGUES LYMPHOBLASTIQUES DE L’ADULTE
K. Ait-Seddik, N.Dali, M.Allouda, O.Ouanes, S.Gherras, H.Aftisse, H.Ait-Ali
OR- 15
20
ACUTE MYELOID LEUKEMIA, A PROSPECTIVE
STUDY OF 83 TUNISIANS PATIENTS
Ben Amor R, Jeddi R, Ben Neji H, Aissaoui L, Kacem K, Bouteraa W, B.
Abdennebi Y, B. Lakhal R B. Abid H, Belhadjali Z, and Meddeb B
OR- 14
19
MANAGEMENT OF ACUTE MYELOBLASTIC LEUKAEMIA IN ADULTS:
MOROCCAN EXPERIENCE
A.Quessar
OR- 13
17
AML
Bacigulapo
OR- 12
16
26
CONTENTS
ORAL PRESENTATION
P. No.
OR- 17
Titles and Authors
ADVANCES IN MANAGEMENT OF MULTIPLE MYELOMA.
Moulod EL-Agnaf.
OR- 18
29
TREATMENT OUTCOME OF THALIDOMIDE BASED REGIMEN IN NEWLY
DIAGNOSED AND POST AUTOLOGOUS STEM CELL TRANSPLANTATION MULTIPLE MYELOMA PATIENTS: A TUNISIAN EXPERIENCE.
Lakhal A, Ladeb S, Torjman L, Bettaieb J, Abdelkefi A, Ben Abdeladhim A,
Ben Othmen T.
OR- 21
28
PRELIMINARY RESULTS OF BORTIZOMIB–DEXAMETHAZONE PROTOCOL FOLLOWED BY THERAPEUTIC INTENSIFICATION BY MELPHALAN
200 AND AUTOLOGOUS STEM CELL TRANSPLANT IN MULTIPLE MYELOMA.
N. Yafour, M. Brahimi, A. Arabi, S. Osmani, F. Attaf, F. Tadj, B. EntaSoltan, H.
Berradouane, B. Benzineb, M. Bey, MA Bekadja.
OR- 20
27
TREATMENT OF MULTIPLE MYELOMA IN THE DEPARTMENT OF HAEMATOLOGY AND BONE MARROW TRANSPLANTATION – EHU 1st NOVEMBER 1954 - ORAN –ALGERIA.
A.Arabi, F.Attaf, M.Bey, B.Benzineb,N.Yafour, H.Berredouane, B.Enta
Soltane, S.Osmani, M.Brahimi, H.Tedj, N.Bahlat, MA Bekadja.
OR- 19
P.P.
31
ANALYSE CYTOLOGIQUE ET IMMUNOCHIMIQUE DE 40 CAS DE MYÉLOME MULTIPLE À CHAÎNES LÉGÈRES = CYTOLOGICAL AND IMMUNOCHEMICAL ANALYSIS OF 40 CASES OF LIGHT CHAIN MULTIPLE
MYELOMA.
MC Rahali; L Bouteldja; SE Belakehal; S Baghdad; FZ Ardjoun.
34
(Translation to English ).
ANALYSE CYTOLOGIQUE ET IMMUNOCHIMIQUE DE 40 CAS DE MYÉLOME MULTIPLE À CHAÎNES LÉGÈRES = CYTOLOGICAL AND IMMUNOCHEMICAL ANALYSIS OF 40 CASES OF LIGHT CHAIN MULTIPLE
MYELOMA.
OR- 22
HAEMATOLOGICAL MALIGNANCIES IN BENGHAZI IN THE YEAR 2009
Mohamed Lateiwish, Muftah Elsahati, Abdulhadi Haweel
OR- 23
36
DESCRIPTIVE STUDY OF SERIES OF 104 PATIENTS AFFECTED BY HAEMOPHILIA.
N.Saidane; Y.Ouarhlent; C.Derdous; M.Saïdi.
OR- 24
35
38
MANAGEMENT OF AML IN CHILDREN: MOROCCAN EXPERIENCE.
S.Cherkaoui.
40
XIII
P. No.
OR- 25
Titles and Authors
P.P.
BURKITT’S LYMPHOMA IN CHILDREN.
Hasna Driouchi.
OR- 26
41
ITP.
Ramdan Allous.
OR- 27
42
TRANSPLANTATION FOR MM.
Nuri Hwaje.
OR- 28
43
BONE MARROW TRANSPLANT.
Andrea Bachigulapo.
OR- 29
44
HIGH-DOSE CYCLOPHOSPHAMIDE, ETOPOSIDE AND BCNU WITH
NON-CRYOPRESERVED AUTOLOGOUS HAEMATOPOIETIC STEM CELL
TRANSPLANTATION FOR POOR PROGNOSIS HODGKIN’S LYMPHOMA.
MA. Bekadja, M. Brahimi, N. Yafour, S. Osmani, F. Attaf, F. Tadj, A. Arabi, B.
Enta-Soltan, H, Berredouane, B. Benzineb, M. Bey, N. Bahlat.
OR- 30
LIBYAN EXPERIENCE IN BMT
Nubila Sassi Abdulrahman
OR- 31
46
ALLOGENEIC HEMATOPOIETIC STEM CELL
TRANSPLANTATION FOR 37 PATIENTS
WITH FANCONI ANEMIA
R. Ahmed Nacer, F. Mehdid, N. Rahmoune, M. Benakli, R. Belhadj, M.
Baazizi, F. Harieche, F. Zerhouni, RM. Hamladji.
OR- 32
48
USING COMPUTERS TO IMPROVE DONOR MANAGEMENT AND TRANSFUSION SAFETY.
Ktari Kamel.
OR- 34
50
I‹Å’\ ◊Œfi’;ÏË]ÕÊ’\;k\Ô\Öp¸\
ÍÑÊÕÖŒ’\ ÿ˜p
XIV
47
EVALUATION OF PATIENTS WITH MYELODYSPLASTIC SYNDROMES. A
RETROSPECTIVE STUDY.
S.Bougherira, F.Grifi, B.Rached, H.Mehennaoui.
OR- 33
45
51
CONTENTS
POSTER SESSION
POSTER SESSION CONTENTS
No.
PO- 01
Titles and Authors
CLINICAL ANALYSIS, OF MALIGNANT NON HODGKIN’S LYMPHOMA
OF THE ORBITAL REGION: 02 CASES.
A.Salmi and PRN Mesli.
PO- 02
63
LYMPHOMES OSSEUX B PRIMITIF A LOCALISATION DIFFUSE A PROPOS D’UN CAS.
N. Dali, M. Allouda, K. Ait-Seddik, O. Ouanes, S. Gherras, H. Aftisse, Et H.
Ait-Ali, M. DJENANE.
PO- 09
61
THE NON HODGKIN’S LYMPHOMAS OF ADULT IN THE NORTH–EAST
OF ALGERIA: ANATOMO–CLINICAL STUDY.
Mehennaoui-Toumi H., Lankar A., Boughrira S., Grifi F.
PO- 08
60
ABOUT A CASE OF NON-HODGKIN LYMPHOMA OF HIGH GRADE MALIGNANCY.
N. Hout; , Mesli N.
PO- 07
59
THE PRIMITIVE GYNECOLOGICAL LYMPHOMAS: A REPORT OF 3 CASES
S. Hamdi; I. Bentahar; N. Belahdaia; N.Zatout.
PO- 06
57
MEDIASTINAL LARGE B-CELL LYMPHOMA A CLINICOPATHOLOGIC REVIEW OF 17 CASES.
S. Hamdi; FZ.Touil; A.Achichi; Z.Bouhadda; S. Lekhel; Z. Nasri.
PO- 05
56
LYMPHOME DIFFUS A GRANDES CELLULES B À LOCALISATIONS MULTIVISCERALE A PROPOS D’UNE OBSERVATION.
F. Fergane, K. Benallaoua, H. Laga, W. Chaba, S. Dechir, R. Drif, N. Dali, O.
Ouanes, K. Ait Seddik, M. Alllouda, S. Gherras, H. Aftisse, A. Graine, Et Pr.
H. Ait Ali.
PO- 04
55
SPLENIC LYMPHOMAS: A REPORT OF 18 CASES.
S. Hamdi; M. Dali; FZ.Benkhodja; A. Amoura; N. Zatout; F. Z.Nasri.
PO- 03
P.
64
RESULTS ABVD PROTOCOL IN THE TREATMENT OF HODGKIN LYMPHOMA IN ADULTS.
M. Zaidani, N. Bouanani, L. Jabri, N. Benchekroun, A. Abdelouafi, S.
Benchekroun, A. Quessar.
66
XV
CONTENTS
POSTER SESSION
No.
PO- 10
Titles and Authors
MEDIASTINAL LARGE B CELL LYMPHOMA ABOUT 12 CASES.
F. Belhadri, H. Moussaoui, F. Boukhemia, N. Abdennebi, S. Belattaf L.
Kouici, D. Benali, S. Zeghouati, N. Boudjerra, RMH. Hamladji.
PO- 11
77
A CASE HODGKIN LYMPHOMA RELAPSE AND PYODERMA GANGRENOSUM.
M.Benlazar, A.Hadjeb, A.El Mestari, N.Zemri, K.Tayebi, N.Siali, R.Messaoudi,
Z.Zouaoui.
XVI
76
PRIMARY CEREBRAL LYMPHOMA; A RARE LYMPHOMA LOCALISATION. ABOUT A CASE.
R. Khelifi Touhami, S. Boughrira, F. Grifi.
PO- 19
75
ASCT IN HODGKIN AND NON HODGKIN LYMPHOMA: A SINGLE CENTER EXPERIENCE ABOUT 27 PATIENTS.
Bach Hamba S, Ben Amor R, Ben lakhal R, Jeddi R, Aissaoui L, Kacem K,
Bouteraa W, Abdennebi Y, Ben Abid H, Bel Hadj Z, Balkis M.
PO- 18
74
T-NK LYMPHOMAS OF NASAL TYPE: CLINICAL ANATOMY STUDY OF
SEVEN CASES.
Mehennaoui-Toumi H., Bencheikh N., Boughrira S., Grifi F.
PO- 17
73
CHARACTERISTIC OF NON HODGKIN’S LYMPHOMA IN ALGERIA ABOUT
FOUR YEARS: 2006 – 2009.
N Boudjerra.
PO- 16
71
COMPOSITE LYMPHOMAS ABOUT ONE CASE.
Menad.A,Bensmaine. m.a, Yachekour. T, Aberkane.m, Zouani.s, Taibi.k,
Touhami.f, khalfi.a, Belazreg.a, Touhami.h.
PO- 15
70
DIAGNOSIS OF LYMPHOPROLIFERATIVE DISEASES BY FLOW CYTOMETRY (FCM).
S. Taoussi, S. Oukid; M.T. Abad.
PO- 14
69
PRIMARY NON HODGKIN’S LYMPHOMA OF THE ADRENAL GLAND:
CASE REPORT AND REVIEW OF THE LITERATURE
Semoud.I -Djennouni.A-Bencheikh.N-Boughrira.S -Grifi.F
PO- 13
67
ACTIVITY OF ALGERIAN STUDY GROUP ALGERIAN OF LYMPHOMA
(GEAL): SUB GROUP OF PATHOLOGY OF MIDDLE CENTER.
K. Mekhelef ,F. Acherar, K. Bendisari,B. Latreche, O. Tebbakha, R. BabaAhmed, Z.C.Amir, A. Belarbi, F. Asselah,M.C. Cherid, A. Tidadini , N. Terki, A.
Abdennebi, N. Benmebarek, K. Kalem, C. Graredj, Y. Lamouti Y. Ighil-Agha,
W. Ouahioune, M.C.Benremouga, A. Kacimi,S. Benabidellah, N. Hennab, J.
Audouin, N. Boudjerra.
PO- 12
P.
78
CONTENTS
POSTER SESSION
No.
PO- 20
Titles and Authors
ANATOMICAL AND CLINICAL CORRELATION OF LYMPHATIC DRAINAGE PERTAINING TO LYMPHOMA.
Hassan Mohammad.
PO- 21
86
RITUXIMAB-BASED CHEMOTHERAPY FOR AUTOIMMUNE CYTOPENIA
OF CHRONIC LYMPHOCYTIC LEUKEMIA.
S.Bougherira – F.Grifi.
PO- 28
85
ASPECTS CLINIQUES ET BIOLOGIQUES DE LA LEUCEMIE MYELOIDE
CHRONIQUE.
K. Benallaoua, F.Fergane, W.Chaba, H.Laga, R.Drif, S.Dechir, N.Dali,
O.Ouanes, K.Ait Seddik, M.Allouda, S.Gherras, H.Aftisse, A.Graine Et Pr
H.Ait Ali.
PO- 27
83
EVALUATION DU PROTOCOLE LINKER DANS LE TRAITEMENT DES
LEUCEMIES AIGUES LYMPHOBLASTIQUES DE L’ADULTE.
K.Ait-Seddik, N.Dali, M.Allouda, O.Ouanes,S.Gherras, H.Aftisse, H.Ait-Ali.
PO- 26
82
ACUTE LEUKAEMIA: USEFULNESS OF RED BLOOD CELL CONCENTRATES TRANSFUSION IN FOR THE PREVENTION OF THE HEMORRHAGIC RISK.
F.Attaf, H.Tadj, M.Brahimi, S.Osmani, A.Arabi, B.Entasoltane, MA Bekadja.
PO- 25
81
PRIMARY NON-HODGKIN LYMPHOMA OF THE BONE: A CASE REPORT.
Sami Alabed Abdulrahman.
PO- 24
80
NON-HODGKIN LYMPHOMA OF THE THYMUS.
Kauthar Ali Elmaawi, Sami Alabed Abdulrahman.
PO- 23
79
HODGKIN LYMPHOMA.
Sami Alabed Abdulrahman.
PO- 22
P.
88
CHRONIC LYMPHOCYTIC LEUKEMIA: ABOUT A SERIES OF 40 CASES.
R. Messaoudi,F.Ouadah H.Amirouche.El Mestari.Pr Z Zouaoui
90
(Translation to French ).
MANIFESTATIONS THROMBOTIQUES RÉVÉLATRICES D’UNE LEUCÉMIE
MYÉLOÏDE CHRONIQUE.
PO- 29
91
LES INFECTIONS RENCONTRÉES AU COURS DES NEUTROPÉNIES FÉBRILES INDUITES PAR CHIMIOTHÉRAPIE D’INDUCTION DES LEUCÉMIES AIGUES OU ACQUISES AU COURS DE L’APLASIE MÉDULLAIRE.
N. Dali, M. Allouda, O. Ouanes, S. Gherras, K. Ait-seddik, H. Aftisse, H. Ait-Ali.
92
XVII
CONTENTS
POSTER SESSION
No.
PO- 30
Titles and Authors
LEUCEMIES AIGUES PROMYELCYTAIRES: ASPECTS CLINIQUES, BIOLOGIQUES ET THERAPEUTIQUES.
N. Dali – K. Ait-Seddik – M. Allouda – O. Ouanes S. Gherras – H. Aftisse – H.
Ait-Ali.
PO- 31
96
ADULT GAUCHER DISEASE (GD) IN ASSOCIATION WITH CHRONIC MYELOID LEUKEMIA (CML). A CASE STUDY.
F. Belhadri, H. Moussaoui, F. Harièche: N. Abdennebi; D. Benali M. Maidat;
RM.Hamaldji.
PO- 33
94
CHRONIC MYELOID LEUKEMIA WITH MENINGEAL LOCATION. ABOUT
ONE CASE.
F.Belhadri, F.Hariéche, N.Abdennebi, S.Zeghouati, S.Saidani, K.Tarhi,
RM.Hamladji.
PO- 32
P.
97
ASPECTS CLINIQUES ET BIOLOGIQUES DE LA LEUCEMIE MYELOIDE
CHRONIQUE.
K. Benallaoua, F.Fergane, W.Chaba, H.Laga,R.Drif, N.Dali, O.Ouanes, K.Ait
Seddik, M.Allouda, S.Gherras, H.Aftisse, A.Graine Et Pr H.Ait Ali.
98
CLINICAL AND BIOLOGICAL ASPECTS OF CHRONIC MYELOID LEUKEMIA (CML).
PO- 34
100
LES LEUCEMIES AIGUES: DE LA MORPHOLOGIE AU SEQUENÇAGE IMMUNOPHENOTYPIQUE PAR CYTOMETRIE EN FLUX.
SE Belakehal, H Mansour, S Baghdad, MC Rahali, A Maatalah, L Lazfen, D
Saber-Cherif, FZ Ardjoun.
102
ACUTE LEUKEMIAS: MORPHOLOGY WITH SEQUENCING IMMUNOPHENOTYPE BY FLOW CYTOMETRY.
PO- 35
FLUDARABINE PLUS CYCLOPHOSPHAMIDE (FC) IN FIRST LINE TREATMENT OF CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL): A PROSPECTIVE
STUDY IN BLIDA,ALGERIA.
S. Taoussi, Y. Bouchakor, N. Rekab, S. Oukid, H. Brahimi, MT Abad.
PO- 36
106
CONVENTIONAL AND MOLECULAR CYTOGENETIC (FISH) FOR ASSESSING DIAGNOSIS AND PROGNOSIS OF HEMATOLOGIC MALIGNANCIES.
S. Taoussi, M. T. Abad.
XVIII
104
108
CONTENTS
POSTER SESSION
No.
PO- 37
Titles and Authors
PYODERMA GANGRENOSUM (PG) AND ACUTE LEUKEMIA, ABOUT
THREE CASES.
Yachekour. T, Aberkane M, Bensmaine. M.A, Zouani.S, Taibi K, Touhami F,
boudjouras yahia,A , Touhami.H. Sairi.H, Hambil.N.
PO- 38
118
HLA-DR AND CD34 EXPRESSION IN 339 CASES OF MYELOÏD ACUTE
LEUKEMIA .
Jaouadi L. Ben Salah N. Gouider E. Siala R. El Borgi W.Ben Lakhal F. Hafsia R.
PO- 46
117
MYELOPROLIFERATIVES SYNDROMES IN CHILDHOOD 6 CASES REPORT
I.Ben amor, M.Mdhaffar, S.Hdiji, Ch. Kallel, S.Mnif, H.Sennena, S.Makni,
A.Saad, T.Boudawara, M.Elloumi.
PO- 45
115
JAK2 MUTATION IN TUNISIAN PATIENTS WITH MYELOPROLIFERATIVE
NEOPLASMS.
S. Boukhris; H. Khemakhem; H. Regaieg; L. Ifa; H. Hmida; S. Hadhri; H. Skouri.
PO- 44
114
CONTRIBUTION OF REAL TIME PCR IN THE MONITORING OF RESIDUAL
DISEASE IN CML PATIENTS.
Gabsi N; Menif S.;Msaddek F.;Elloumi M.;Ben ABID H.;Belakhal R.; Ben Romdhane N.; Laatiri A.;Khelif A.;Meddeb B.
PO- 43
113
CHRONIC MYELOID LEUKEMIA IN CENTRAL TUNISIA.
Ben Youssef Y,Zaier M, Bouallegue S, Ben Fredj W, Regaieg H, Achour B,
Khelif A.
PO- 42
112
SAFETY OF FLUDARABINE, CYCLOPHOSPHAMIDE AND RITUXIMAB
REGIMEN IN CHRONIC LYMPHOCYTIC LEUKEMIA: ABOUT 68 COURSES: A SINGLE CENTER EXPERIENCE.
Kacem K, Massmoudi S, Ben Lakhal R, Manaï Z, Bouteraa W, Aissaoui L, Ben
Abdennebi Y, Ben Amor R, Jeddi R, Bel Hadj Ali Z, Ben Abid H, Meddeb B.
PO- 41
111
ACUTE CARDIOTOXICITY OF THE ANTHRACYCLINE, ABOUT 2 CASES.
Yachekour. T, Aberkane.M, Bensmaine. M.A, Boussadia.D, Baroudi.N,
Zouani.S, Taibi.K, Touhami.H, Baazi.M, Messameh.M, Hammou.L.
PO- 40
110
ASSOCIATION LEUCÉMIE AIGUE MYÉLOBLASTIQUE ET TUBERCULOSE
MULTIFOCALE.
S.En-nasri,S.Nait Mbarek,H.Nafil,L.Mahmal.
PO- 39
P.
119
ANTIGEN EXPRESSION IN AML: RELATIONSHIP WITH PATIENT OUTCOME.
Ben Salah N, Souli N, Jaoubli M, Skhiri H,, Borji W, Ben Lakhal F, Jeddi R,
Gouider E, Hafsia R.
120
XIX
CONTENTS
POSTER SESSION
No.
PO- 47
Titles and Authors
STUDY OF ABERRANT ANTIGEN EXPRESSION IN ACUTE MYELOID
LEUKEMIA (AML): ABOUT 370 CASES.
Ben Lakhal F, Ben Salah N, Gouider E, Mannougui I, Siala R, Borgi W, Hafsia R.
PO- 48
133
STEM CELL TRANSPLANTATION.
Aaml Ali Alayeb.
XX
132
CLINICAL AND BIOLOGICAL CHARACTERISTICS OF ADULT BIPHENOTIPIC ACUTE LEUKEMIA (BAL): A SERIES OF 45 ALGERIAN PATIENTS.
A.Talbi; F.Harièche; N.Ait Amer; F.Tensaout; M.Benakli; S.Akhrouf;
F.Boumansour; F.Zerhouni; R.M.Hamladji.
PO- 57
131
RARE ASSOCIATION: RECKLINGHAUSEN’S DISEASE AND ACUTE LEUKAEMIA.
C. Kerar, M. Ramaoun, L. Louanchi, H. Terfaia, H. Ahmidatou, L. Bouriche, M.
Belhani.
PO- 56
130
ASSOCIATION OF SOLID TUMORS AND CHRONIC MYELOID LEUKEMIA.
C. Kerar, M. Ramaoun, L. Louanchi, H. Terfaia, H. Ahmidatou, L. Bouriche, M.
Belhani.
PO- 55
128
HAEMATOLOGICAL MALIGNANCIES: INCIDENCE IN BATNA FOR 20032007.
A.Bouhidel; ML.Bouhidel; M.Saïdi; Y.Ouarhlent; H.Bouncer.
PO- 54
127
ASSESSMENT OF A CYTOLOGY DIAGNOSIS UNIT.
N.Kara Mostefa; H.Otmani; FZ. Neche; H.Zidani2 ;K. Kouidri; M. Saidi.
PO- 53
126
EFFICACY OF IMATINIB IN CHRONIC MYELOID LEUKEMIA ACUTE PHASE:
ABOUT 3 CASES.
H. Zidani; Y.Ouarhlent ; K. Kouidri; N. Kara Mostefa; R. Chafai; M. Saïdi.
PO- 52
124
DE NOVO CHILDHOOD ACUTE MYELOID LEUKAEMIA: ABOUT 54 CASES
O. Kassar, F. Kallel, Th. Kammoun, I. Jedidi, Ch. Kallel3 H. Sennana, S. Hdiji, L.
Ben Mansour, H. Bellaaj, N. Ajmi, A.Saad, M. Hachicha, M. Elloumi.
PO- 51
122
TREATMENT OF CHILDHOOD ACUTE MYELOID LEUKEMIA IN TUNISIAN
PATIENTS (EXPERIENCE OF 6 YEARS).
Aissaoui L, Ben Hassen I, Ben Abdennebi Y, Jeddi R, Bouterâa W, Ben Amor R,
Kacem K, Ben Lakhal R, Bel Hadj Ali Z, Ben Abid H, Meddeb B.
PO- 50
121
THE OUTCOME OF CHILDREN WITH T(8,21) ACUTE MYELOID LEUKEMIA TREATED WITH CHEMOTHERAPY ALONE.
Aissaoui L, Ben Hassen I, Ben Abdennebi Y, Bouterâa W, Jeddi R, Ben Amor R,
Kacem K, Ben LakhalR, Bel Hadj Ali Z, Ben Abid H, Meddeb B.
PO- 49
P.
134
CONTENTS
POSTER SESSION
No.
PO- 58
Titles and Authors
GRANULOCYTIC SARCOMA, MYELOBLASTOMA {EXTRAMEDULLARY
ACUTE MYELOID LEUKEMIA OR CHLOROMA}.A CASE REPORT.
Najah Abdulnabe Omer.
PO- 59
142
VAD AS INTRAVENOUS BOLUS AS FIRST-LINE
TREATMENT IN UNTREATED MULTIPLE MYELOMA.
K.Kouidri; H.Zidani; R.Chafai; Y.Ouarhlent;M.Saïdi.
PO- 67
141
ORAL MELPHALAN AND PREDNISONE CHEMOTHERAPY PLUS THALIDOMIDE IN ELDERLY PATIENTS WITH MULTIPLE MYELOMA.
M.Mdhaffar, I.Ben amor, S.Hdiji, N.Ajmi, H.Belaaj, O. Kassar, M.Elloumi,
K.Jammoussi, Y.Hadj hmida, F.Ayédi, H.Masmoudi.
PO- 66
140
MULTIPLE MYELOMA IN THE ELDERLY: TOLERANCE AND EFFICACY OF
MPT PROTOCOL.
Bouteraa W; Aissaoui L; Ben abdennbi Y; Kacem K; Ben Amor R; Jeddi R; Belakhal R; Ben Abid H; Belhaj Ali Z; Meddeb B
PO- 65
139
CD45 EXPRESSION BY BONE MARROW PLASMA CELLS AT DIAGNOSIS
IN MULTIPLE MYELOMA: CORRELATION WITH MINIMAL RESIDUAL DISEASE.
Safra I, Lakhal A, Ladeb S, Ben jemaa R, Torjemane L, Abdeladhim B, Ben Othman T.
PO- 64
138
MULTIPLE MYELOMA PATIENTS RECEIVING THALIDOMIDE.
Bouteraa W; Aissaoui L; Ben abdennbi Y; Kacem K; Ben Amor R; Jeddi R; Belakhal R; Ben Abid H; Belhaj Ali Z; Meddeb B.
PO- 63
137
SOLITARY PLASMACYTOMA OF BONE-A CASE REPORT.
Anilmohanrao.S, Mehmood El Hamidi, Khalid Abdulmoula.
PO- 62
136
TYROINE KINASE INHIBITOR (TKI)IMATINIB MESYLATE (GLIVEC) IS
EFFECTIVE IN ALL PHASES OF CMLGLIVEC BLOCK BCRL ABL
EXPRESSION AND CAN INDUCE HAEMATOLOGICAL AND CYTOGENETIC
REMISSION AND THE INTRODUCTION OF THESE SPECIFIC TYROSINE
KINASE INHIBITION CHANGE ATTITMCTES OF THE THERAPY OF CML
Rabia Omar Nafo
PO- 61
135
ACUTE MYELOBLASTIC LEUKEMIA PRESENTING
AS MARROW HYPOPLASIA.
M.Benlazar, A.Hadjeb, A.El Mestari, N.Zemri, K.Tayebi, N.Siali, R.Messaoudi,
Z.Zouaoui.
PO- 60
P.
143
SURGICAL SYNOVECTOMY OF THE KNEE IN YOUNG HEMOPHILIACS.
F.Benmegherbi, M.Bensadok, M.Belhani, S.Fourmas, A.Benbouzid, S.Khiar.
144
XXI
CONTENTS
POSTER SESSION
No.
PO- 68
Titles and Authors
IRON STATUS OF VOLUNTARY BLOOD DONORS AT CHU TLEMCEN.
N.Merad-Boudia; F Zadjaoui; A.Ghaffour; S.Ayad; K.Dib.
PO- 69
151
CLINICAL AND SCALABLE MYELODYSPLASTIC SYNDROMES.
A. Graine, S. Gherras, O. Ouanes, M. Allouda. N. Dali,H. Aftisse, K. Benallaoua,
H. Ait-Ali.
PO- 74
150
CHARACTERISTICS OF PATIENTS WITH HEREDITARY SPHEROCYTOSIS
IN ANNABA.
S.Bougherira – F.Grifi
PO- 73
148
ROSAI DORFMAN DISEASE: A CASE REPORT.
B Benzineb, A Arabi. S. Osmani,M Brahimi, B Enta Soltane, F Attaf, M Bey, H
Tedj, N Yafour, H Berredouane, M A Bekadja.
PO- 72
147
HAEMATOLOGICAL MALIGNANCIES IN BENGHAZI IN THE YEAR 2009.
Mohamed Lateiwish, Muftah Elsahati, Abdulhadi Haweel.
PO- 71
146
PAROXYSMAL NOCTURNAL HEMOGLOBINURIA: 3CASES REPORT.
F.Benmegherbi, M.Ramaoun, C.Kerrar, L.Louanchi, H.Ahmidatou, L.Bouriche,
M.Belhani.
PO- 70
P.
152
PRISE EN CHARGE THERAPEUTIQUE DE LA FEMME ENCEINTE AVEC
UN SYNDROME DREPANOCYTAIRE MAJEUR: A PROPOS DE 3 OBSERVATIONS, AVEC REVUE DE LA LITTERATURE.
SE Belakehal, S Baghdad, MC Rahali, D Saber-Cherif, H Mansour, FZ Ardjoun.
153
THERAPEUTIC ASSUMPTION OF RESPONSIBILITY OF THE EXPECTANT
MOTHER WITH A SYNDROME SICKLE CELL DISEASE: A 3 CASES REPORT, WITH REVIEW OF THE LITERATURE.
PO- 75
THROMBOPÉNIE NÉO NATALE ALLO IMMUNE.
Merine S, Houalef O, Abdi R ,Chalabi-Benabdallah A.
PO- 76
158
IRON DEFICIENCY ANEMIA AMONG WOMEN.
M.T. Abad, N. Rekab, F. Lamraoui, S. Taoussi, S. Chebrek, S. Oukid,, C. Guezlane, C. Boucherit, K. Benlabiod, A. Bouchakor, H. Brahimi.
XXII
157
HYDROXYUREA (HU) IN SICKLE CELL DISEASE (SCD): EXPERIENCE OF
A SINGLE CENTER
F. Lamraoui, C. Boucherit, M.T. Abad.
PO- 77
155
159
CONTENTS
POSTER SESSION
No.
PO- 78
Titles and Authors
LAPAROSCOPIC SPLENECTOMY IN SEVERE IMMUNE THROMBOCYTOPENIC PURPURA (ITP).
C. Guezlane , R. Benhizia , S. Oukid, S. Taoussi, S. Chebrek, F. Lamraoui, E.M.
Si Ahmed, M.T. Abad.
PO- 79
170
IMMUNOSUPPRESSIVE THERAPY IN SEVERE APLASTIC ANEMIA: A SINGLE CENTER EXPERIENCE ABOUT 13 CASES.
Saidi I, Ben amor R, Jeddi R, Aissaoui L, Kacem K, Bouteraa W, Abdennebi Y,
Ben abid H, Bel hadj Z, Ben lakhal R, Meddeb B.
PO- 87
169
TRANSFUSION VIRUSES MARKERS AMONG HAEMOPHILIACS ; A STUDY
ABOUT 58 CASES.
T. Rekik., N. Hentati., M. Rekik., I. Ben Amor., N. Ajmi, H. Rekik., M Elloumi. et
J. Gargouri.
PO- 86
168
VIROLOGICAL FOLLOW-UP OF PATIENTS WITH CONGENITAL BLEEDING
DISORDERS OTHER THAN HAEMOPHILIA. STUDY ABOUT 33 PATIENTS.
N. Louati, A. Dhieb, J. Cherif, I. Ben Amor, H. Bellaaj, H. Rekik, M. Elloumi,J. Gargouri.
PO- 85
166
SPECIFICITIES OF UNEXPECTED ANTIBODIES TO RED BLOOD CELLS:
ABOUT 154 CASES.
H. Khemakhem, S. Boukhriss, L Ifa, H Guedria, S. Hadhri, H Skouri.
PO- 84
165
SEVERE CONGENITAL NEUTROPENIA: CASE STUDY.
C.Aboura, N.Zidani, M.Bensadok, L Oukrif, A.Bensenouci, M.Belhani.
PO- 83
164
SEROPREVALENCE OF HEPATITIS C AMONG PATIENTS WITH HEMOGLOBINOPATHIES.
A. Djenouni, F. Grifi, Amoura, Dekhil.
PO- 82
163
THE BLOOD TRANSFUSION PROGRAM FOR Β THALASSEMIA PATIENTS:
METHODS AND RESULTS.
F. Grifi – H. Belaidi – N. Meliani – A. Djenouni.
PO- 81
161
PROGRAM OF EXCHANGE TRANSFUSIONNEL TO THE DREPANOCYTIC:
EXPERIENCE OF HAEMATOLOGY DEPARTMENT CHU ANNABA.
H Belaidi - H. Hamdane - L. Oulad diaf- F. Grifi.
PO- 80
P.
171
RED CELL EXCHANGES IN SICKLE CELL DISEASE. A STUDY ABOUT 20
CASES.
S. Chortani, I. Rekik, I. Ben Amor, T. Rekik, O. kassar, F. Ben Said, H. Rekik, M.
Elloumi, J. Gargouri.
173
XXIII
CONTENTS
POSTER SESSION
No.
PO- 88
Titles and Authors
MASSIVE TRANSFUSION: RISK FACTORS AND CLINICAL OUTCOME.
H. Hmida ; S. Boukhris ; L. Ifa ; H. Khemakhem ; H. Regaieg ; S. Hadhri ;
H.Guedria ; H. Skouri.
PO- 89
180
TRANSFUSIONS REGISTER IN HAEMATOLOGY: ESSENTIAL SUPPORT
OF HEMOVIGILANCE.
F.Soltani; F.Kacha;A.Ounissi;H.Hamza ;S.Chichoune;H.Zidani;K.Kouidri;
M.Saïdi.
PO- 94
178
INVESTIGATIONS ABOUT TRANSFUSION INCIDENTS: 13 CASES REPORTED.
S.Chichoune; F.Soltani; F.Kacha; A.Ounissi; H.Hamza; H.Zidani; K.Kouidri;
M.Saidi.
PO- 93
177
GAUCHER DISEASE: HEMATOLOGICAL ASPECTS AND DIAGNOSIS.
H. Ahmidatou, M. Ramaoun, M. Bensadok, L. Bouriche, C. Kerrar, L. Louanchi,
M. Belhani.
PO- 92
176
RED BLOOD CELLS TRANSFUSION IN A TUNISIAN HAEMATOLOGY DEPARTMENT: ASSETS AND PROSPECTS.
Hentati N, Ben Salah N, Jaouadi L, Belakhal F, El Borgi W, Gouider E, Hafsia R.
PO- 91
175
SEROPREVALENCE VIRAL MARKERS IN HEMOGLOBIN DISORDERS. STUDY
ABOUT 101 PATIENTS.
A. Dhieb, I. Rekik, T. Rekik, J. Cherif, N. Louati, I. Ben Amor, H. Rekik, J. Gargouri.
PO- 90
P.
181
EVALUATION OF ANGIOGENISIS ACTIVITY IN UNTREATED ERYTHROCYTOSIS PATIENTS.
C. Maktouf, A. Bounemra, S.Mahjoub, F. Msadek, A.Khlif, M.Karoui, S.Hdiji,
S.Zriba, N.Ben Romdhane, M. Elloumi.
182
(Translation to French).
EVALUATION OF ANGIOGENISIS ACTIVITY IN UNTREATED ERYTHROCYTOSIS PATIENTS.
PO- 95
THROMBOCYTÉMIE ESSENTIELLE RÉVÉLÉE PAR UNE NÉCROSE CUTANÉE CHEZ UN SUJET JEUNE.
PO- 96
183
184
SERUM ERYTHROPOIETIN LEVEL IN ERYTHROCYTOSIS.
C. Maktouf, A. Bounemra, S.Mahjoub, F. Msadek, A.Khlif, M.Karoui, S.Hdiji,
S.Zriba, N.Ben Romdhane, M. Elloumi.
185
(Translation to french).
TAUX DE L’ÉRYTHROPOÏÉTINE SÉRIQUE AU COURS DES ERYTHROCYTOSES.
XXIV
186
CONTENTS
POSTER SESSION
No.
PO- 97
Titles and Authors
RESULTS OF THE HEMOGLOBIN ELECTROPHORESIS DURING A PERIOD
OF TWO YEARS IN LABORATORY OF HEMATOLOGY.
H.Otmani; I.Rahal; F.Z. Néche; A.Boumlit; M. Saidi.
PO- 98
196
THROMBOPHILIE ET DRÉPANOCYTOSE.
M.Chekkal. K.Moulassedoun. M.C.A Rahal.F.Seghier.
PO- 107
195
HISTIOCYTOSE LANGERHANSIENNE(HX) GRAVE CUTANEOSPLENIQUE.
PO- 106
194
MYELOPROLIFERATIVE DISORDES IN TRIPOLI.
Kalthoum Elwaer, Abukris Alwindi.
PO- 105
192
PROSPECTIVE VALIDATION OF A NOVEL MYELOABLATIVE CONDITIONING REGIMEN: FLUDARABINE - IV BUSULFAN, IN 38 PATIENTS WITH
ACUTE MYELOID LEUKEMIA(AML).
A.Talbi, R-M Hamladji, M.Benakli, R. Ahmed-Nacer, R.Belhadj, F.Mehdid,
N.Rahmoune, F.Harièche, F.Zerhouni.
PO- 104
191
ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION (HSCT)
IN CHRONIC MYELOID LEUKAEMIA (CML): LONG TERM RESULTS
M.Benakli, R. Ahmed Nacer, A. Talbi, F. Mehdid, R. Belhadj, M. Bazizi, N. Rahmoune, F. Harieche, F. Zerhouni, RM. Hamladji.
PO- 103
190
ALLOGENEIC HEMATOPOIETIC STEM CELLS TRANSPLANTATION (HSCT),
FROM HLA IDENTICAL SIBLING DONORS, FOR 20 PATIENTS WITH PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (PNH).
R. Ahmed Nacer, F. Mehdid, F. Harieche, M. Benakli, R. Belhadj, N. Rahmoune, M.
Baazizi, D. Aitouali, M.Ouzeghdouh, S.Abderrhmani, F. Zerhouni, RM. Hamladji .
PO- 102
189
MICROBIOLOGICAL SAFETY OF BLOOD COMPONENTS DURING STORAGE
M Khalil, A Jebriel
PO- 101
188
RHABDOMYOSARCOME PARATESTICULAIRE.
S.En-nasri,S.Nait Mbarek,H.Nafil,L.Mahmal
PO- 100
187
HÉMORRAGIE CÉRÉBRALE ET MÉNINGÉE AVEC UN HÉMATOME SOUS
DURAL SPONTANÉS CHEZ UN ENFANT PORTEUR D’UNE HÉMOPHILE A
MAJEURE.
S.En-nasri, S.Nait M’barek, H.Nafil, L.Mahmal
PO- 99
P.
197
THE INTERMEDIATE THALASSEMIAS.
Zatla L,Elalia H, Bousmaha N, Charef l,Boudjoras YA, Sfaoui W, Rahal Y,Touhami H.
198
XXV
CONTENTS
POSTER SESSION
No.
PO- 108
Titles and Authors
PREVALENCE OF JAK2-V617 MUTATION IN ALGERIAN PATIENTS WITH
MYELOPROLIFERATIVE DISORDERS.
N. Benchikh, A. Messaoudi, M. Nachi, C. Belarbi, R. Moussaoui, A. Bekadja, M.
Brahimi, A. Arabi.
PO- 109
PO- 112
200
TOXOPLASMA AND CMV SERO-PREVALENCE IN
THE BCIDI COHORT OF PATIENTS.
Amina Abusedra & Fatma Najem.
PO- 111
199
PLATELET TRANSFUSION REFRACTORINESS AND ALLOIMMUNIZATION
IN PATIENTS WITH ONCOLOGIC BLOOD DISORDERS.
H. Brouk, C. Martageix, G. Bertrand, S. Zitouni, I. Houar, B. Zermat, A. Djenouni, F.
Griffi, C. Kaplan & H. Ouelaa.
PO- 110
P.
202
ACQUIRED APLASTIC ANEMIA: EXPERIENCE OF THE HEMATOLOGY DEPARTMENT OF CASABLANCA.
A.Hmimech; N.Khoubila; F.Merimi; A.Quessar; S.Benchekroun.
203
LYMPHOME MALIN NON HODGKINIEN LOCALISATION OSSEUSE CHEZ
UNE PETITE FILLE DE 3 ANS À PROPOS D’UN CAS.
205
R.Mecifi, M.Brahimi, M Dib, M. Daouadji, M.Djebour.
PO- 113
EVALUATION DU PROTOCOLE MDH 90 CHEZ L’ENFANT CANCÉREUX AU
CENTRE EMIR ABDELKADER ORAN.
R.Mecifi, M.Brahimi, M Dib, M. Daouadji, M.Djebour.
XXVI
207
THE ABSTRACTS
Section I: Oral Presentation
OR-01
THE USEFULNESS AND LIMITATIONS OF COMBINED
FINE-NEEDLE ASPIRATION IMPEDANCEMETRY AND FLOW
CYTOMETRY IN THE DIAGNOSIS AND SUBCLASSIFICATION
OF NON-HODGKIN’S LYMPHOMA
M. Brahimi1, D. Saidi2, A. Arabi1, M. Bey1, H. Berredouane1,
N. Yafour1, S. Osmani1, H Touhami2, M A Bekadja1.
1 Clinic of Haematology and Cell Therapy, University Hospital 1st November, Oran Algéria
2 Clinic of Haematology, University Hospital, Oran Algéria
Objective:
The primary diagnosis of non-Hodgkin`s lymphoma (NHL) based on fine needle aspiration by
combining impedancemetry and flow cytometry seems to be good tools. We therefore reviewed
our experience with these two methods to determine their usefulness based on the new WHOclassification of malignant lymphoma.
Study design:
Impedance size distribution histograms and flow cytometry reports of patients who underwent
both methods at the same time were examined. Both methods were classified according to the
new WHO-classification of malignant lymphoma 2008.
Results:
There were total 50 cases included in this study. In seven cases FNA failed in gathering
sufficient material for immunophenotyping. In ten cases there was no monoclonality B or T (5
Hodgkin’s lymphomas, 3 carcinomas, and 2 lymphadenitis). 33 cases were diagnosed as NHL
and were classified on impedancemetry as predominant small cells (19) and large cells (14) and
on flow cytometry T NHL (4) and B NHL (29). Light chain restriction was demonstrated in 19/29
cases of B-NHL. With the help of combined impedancemetry and flow cytometry, it was possible
to sub-classify 16 cases of the 33 NHL (48%) according to WHO classification. 17 cases were
labelled as NHL not otherwise specified (NHL-NOS).
Conclusion:
Impedancemetry combined with flow cytometry may be helpful in accurately diagnosing and
sub-classifying NHL into B or T types and small or large cell types.
These methods are not sufficient to sub-classify all lymphomas according to WHO classification and the histopathology remains the main tool for the WHO classification.
3
OR-02
FACTEURS PRONOSTIQUES ET EVALUATION DE LA
REPONSE AU PROTOCOLES CHOP OU R-CHOP DES
LYMPHOME DIFFUS A GRANDES CELLULES B DU SUJET
JEUNE ≤ 60 ANS
SE Belakehal, H Mansour, S Baghdad,
MC Rahali, D Saber-Cherif, FZ Ardjoun
Service d’hématologie, Hôpital Central de l’Armée, Alger, Algérie
Introduction:
Le début des années 2000 fut marqué par l’utilisation par le groupe d’étude des lymphomes de
l’adulte (GELA) de l’anticorps monoclonal CD20, rituximab (375mg/m2) associé au régime CHOP
standard chaque 21 jours, dans le traitement de première ligne des lymphome diffus à grandes
cellules B. L’addition du rituximab a permis d’améliorer le taux de RC, et le taux de survie.
Patients et méthodes:
Il s’agit d’une étude rétrospective, entre [mai 2006 et octobre 2009], 72 cas de lymphomes
malins, sont colligés. 10 cas de lymphome diffus à grandes cellules B du sujet jeune ≤ 60 ans
traités par CHOP (n= 4) ou R-CHOP (n=6). Le nombre de cures est de 6 à 8 cures. L’évaluation
a été faite après chaque cure et en fin de traitement.
L’âge moyen est de 36 ans [22 et 60 ans]. Le sex-ratio = 2,33 [7hommes pour 3 femmes].
Le délai moyen de diagnostic est de 6 mois [1 mois à 14 mois]. 3 patients ont présenté au
départ un problème diagnostique (1 cas avec un carcinome, et 2 cas avec une maladie de Hodgkin).
Les signes généraux sont présents dans 8 cas (80%). L’indice de performance est égal à 1
dans 5 cas (50%), et de 2 à 3 dans 5 cas (50%). Le stade Ann Arbor est égal à I, dans 1 cas
(10%) / à II, dans 4 cas (40%) / à III, dans 1 cas (10%) / et à IV, dans 4 cas (40%). On a noté 3
cas (30%) avec Bulky, et 8 cas (80%) avec des localisations extra-ganglionnaires. Le taux de
LDH est élevé dans 7 cas (70%).
Les groupes pronostiques selon IPI: faible (n=4), faible intermédiaire (n=0), haut intermédiaire
(n=6), haut (n=1).
Résultats:
Le suivi médian est de 21 mois [6 à 39 mois].
La réponse globale en fonction du protocole:
4
Protocole
CHOP (n=4)
RCHOP (n=6)
RC
2 (50%)
4 (67%)
RP
2
1
Réponses
4
5
Echecs
0
1
Rechutes
2
0
Décès
1
1
La réponse globale en fonction du protocole et de IPI:
IPI
Faible
Faible intermédiaire
Haut intermédiaire
Haut
RC
1
1
RP
1
1
-
CHOP
Réponses
1
2
1
Echec
-
RC
3 (50%)
1
-
RP
1
-
R-CHOP
Réponses
3 (50%)
2
-
Echec
1
-
Analyse des rechutes avec le protocole CHOP: 2 patients ont fait une rechute précoce: 1 patient est décédé, et 1 patient est en RP (rattrapage avec du R-CHOP).
Analyse des échecs avec le protocole R-CHOP: 1 patient est décédé dans un tableau de détresse cardio-respiratoire.
Commentaires et conclusion:
Nos résultats thérapeutiques paraissent satisfaisants. La rémission complète avec le R-CHOP
est estimée à 67%, dont 75% sont dans les groupes à faible risque. Il est nécessaire de poursuivre l’étude et d’évaluer la survie à long terme.
5
Translation to English:
OR-02
PROGNOSTIC FACTORS AND EVALUATION OF THE ANSWER
TO PROTOCOLS CHOP OU R-CHOP OF THE DIFFUSE LARGE B
CELL LYMPHOMA OF THE YOUNG SUBJECT ≤ 60 YEARS
SE Belakehal, H Mansour, S Baghdad, MC Rahali,
D Saber-Sherif, FZ Ardjoun
Service of haematology, Central Hospital of the Army, Algiers, Algeria
Communication affichée
Introduction:
The beginning of the year 2000 was marked by the use by the group of study of the lymphomas of the adult (GELA) of monoclonal antibody CD20, rituximab (375mg/m2) associated with
standard mode CHOP each 21 days, in the treatment of first line of the diffuse large B cell lymphoma. the addition of the rituximab made it possible to improve the rate of complete remission
(CR), and the rate of survival.
Patients and methods:
It is about a retrospective study, between [May 2006 and October 2009], 72 cases of malignant
lymphomas, were analysed. 10 cases of diffuse large B cell lymphoma of the young subject ≤ 60
years treated by CHOP (n= 4) or R-CHOP (n=6). The number of cures is from 6 to 8 cures. The
evaluation was made after each cure and at the end of the treatment.
The middle age is 36 years [22 at 60]. The sex-ratio = 2.33 [7M/3 W].
The average time of diagnosis is 6 months [1 at 14]. 3 patients presented at the beginning a
diagnostic problem (1 case with a carcinoma, and 2 cases with a Hodgkin lymphoma).
The general signs are present in 8 cases (80%). The index of performance is equal to 1 in 5
cases (50%) and from 2 to 3 in 5 cases (50%). The Ann Arbor stage is equal to I, in 1 case (10%)
/ to II, in 4 cases (40%) / to III, in 1 case (10%) / and to IV, in 4 cases (40%). We noted 3 cases
(30%) with Bulky, and 8 cases (80%) with extra-nodal localizations. The rate of LDH is high in 7
cases (70%).
Prognostic groups according to IPI: weak (n=4), weak intermediary (n=0), high intermediary
(n=6), high (n=1).
Results:
The median follow-up is 21 month [6 to 39].
The total answer according to the protocol
Protocol
CHOP (n=4)
RCHOP (n=6)
6
CR
2 (50%)
4 (67%)
PR
2
1
Answers
4
5
Failures
0
1
Relapses
2
0
Décès
1
1
The total answer according to the protocol and IPI
IPI
Weak
weak intermediary
high intermediary
High
CHOP
CR
PR
1
1
1
1
-
Answers
1
2
1
Failures
-
R-CHOP
CR
3 (50%)
1
-
PR
1
-
Answers
3 (50%)
2
-
Failures
1
-
Relapses analyzes with protocol CHOP: 2 patients made an early relapse: 1 patient is died,
and 1 patient is in PR (correction with R-CHOP). Failures analyzes with protocol R-CHOP: 1
patient is died in a cardiorespiratory attack.
Comments and conclusion:
Our therapeutic results appear satisfactory. The complete remission with the R-CHOP is estimated at 67%, of which 75% are in the groups at the weak risk. It is necessary to continue the
study and to evaluate long term survival.
7
OR-03
ASPECTS CLINIQUE ET HISTOLOGIQUE DES LYMPHOMES
MALINS NON HODGKINIENS
S. Dechir, M. Allouda, O. Ouanes, H. Aftisse, S. Gherras, N. Dali, K. AitSeddik, H. Laga, R. Drif Et H. Ait-Ali.
Service d’hématologie CHU Tizi-Ouzou.
INTRODUCTION:
Les lymphomes malins non Hodgkinien (LNH) sont des hémopathies malignes caractérisés
par une prolifération de cellules lymphoïdes monoclonales B ou T dans les ganglions ou les
structures lymphoïdes extra ganglionnaires. Leur incidence augmente de façon constante ces
dernières années.
L’essor des techniques immunohistochimiques et le développement des anticorps monoclonaux ont permis d’individualiser différentes entités de lymphomes B et T et d’adapter la prise en
charge thérapeutique. Nous rapportons ici notre expérience sur une période de 06 ans (2004
– 2009).
PATIENTS ET METHODES:
Il s’agit d’une étude rétrospective faite sur l’analyse des dossiers de malades suivis dans notre
service sur une période de 6 ans (2004 – 2009). Les variables étudiées sont: l’âge, le sexe, la
localisation du lymphome, le type histologique et le stade anatomoclinique.
RESULTATS:
Nous avons colligé 155 patients: 81 (52%) hommes et 74 (48%) femmes, sexe ratio: 1,09,
l’âge moyen est de 52 ans avec des extrêmes de 17 et 88 ans. Les 155 patients se repartissent
en 113 (73%) LNH ganglionnaire et 42 (27%) LNH extra ganglionnaires: 21 LNH digestifs, 08
localisation ORL, 05 localisation osseuses, et 08 autres localisations plus rares: 1 ophtalmique,
2 linguales, 1 massif facial, 1 pulmonaire, 1 cutanée et 1 gynécologique. Selon le stade anatomoclinique: les 113 LNH ganglionnaires sont répartis en 29 (26%) stades localisés et 84 (74%)
stades étendus. Les 42 LNH extra-ganglionnaires sont répartis en 29 (69%) stades localisés et
13 (31%) stades étendus.
Sur le plan histologique (immunohistochimie (IHC) faite chez 103 patients): 99 (64%) sont des
LNH de haut grade de malignité, 56 (36%) sont des LNH de faible grade de malignité.
CONCLUSION:
Les LNH sont des hémopathies malignes dont la classification anatomopathologique reste
difficile et dont 1/3 de nos patients ne sont pas classés sur le plan immunohistologique. Les localisations ganglionnaires restent classiquement les plus fréquentes. 75% de nos patients sont
des stades étendus, expliqués par les consultations tardives des patients.
8
OR-04
TUNISIAN EXPERIENCE IN THE TREATMENT OF
AGGRESSIVE NON HODGKIN’S LYMPHOMA IN ADULTS:
ABOUT 337 PATIENTS
Mohamed Adnène Laatiri
GELT group
From January 1997 to December 2005, 337 patients with aggressive non Hodgkin’s lymphoma
were treated with one of the two successive multicentric non randomized protocols established
in Tunisia. The mean age was 53 years. Most patients had diffuse large cell lymphoma with B
phenotype in 86 % and T in 14 %. The performance status was 2 or 3 in 34 % of cases. The LDH
were elevated in 74 % of cases. Advanced disease (III or IV stage) was noted in 59 % of cases
and 10 % had a tumoral mass greater than 10 cm. According to the international prognostic index
(IPI) adjusted to age, we distinguish four groups: group 1 (0 factor and age < 70 years), group
2 (1-3 factors and age ≤ 60 years), group 3 (1-3 factors and age between 61 and 70 years) and
group 4 (1-3 factors and age > 70 years). The patients of group 1 (n=47) received 3 courses of
CHOP regimen followed by irradiation. The patients of group 2 (n=160) received 4 courses of
ACVBP regimen (+ Rituximab for 21 patients) followed by consolidation (n=92) or peripheral
blood progenitor cell transplantation (n=20). The patients of group 3 (n=61) received 8 courses of
CHOP regimen (+ Rituximab for 20 patients). The patients of group 4 (n=69) received 6 courses
of miniCEOP regimen (n=48) or 6 courses CVP regimen (n=21).
The 4-year overall survival was 56 % and the 4-year event free survival was 49 %.
9
OR-05
AGGRESSIVE B-CELL LYMPHOMA
Norbert Scmitz
Abstract not received till going to publication.
10
OR-06
MEDIASTINAL LOCALIZATION OF NON-HODGKIN
LYMPHOMA: DIAGNOSTIC THERAPEUTIC
AND PROGNOSTIC APPROACH
C. Aboura L. Louanchi S. Nekkal M.Ramaoun Z.Kaci M. Belhani
Hematology Department / Blood banking centre, CHU Beni Messous Algiers Algeria
INTRODUCTION:
Involved mediastinal site during non-Hodgkin lymphoma is characterized by a relatively high
frequency, the diagnosis can be difficult in the presence of isolated mediastinum and poor prognosis when there are signs of compression requiring emergency treatment.
PATIENTS AND METHODS:
We report the results of a retrospective study over 4 years: from 2006 to 2009. 118 lymphomas were supported in our service, with 30 mediastinal localization (25%). The sex ratio is 0.9
(14 ♂ and 16 ♀). The average age is 27 years with a range [18 -53 years]. The period between
first symptom and diagnosis ≈ 06 months. A vena cava syndrome with signs of compression was
noted in 21 cases (70%) and thrombosis of the vena cava in 02 cases. In 6 patients an extra node
affection is found (ovary, thyroid...). A Bulky affection is present in all patients The diagnosis is
cytological and histological. Lymph node biopsy (16 cases); trans thoracic biopsy (11 cases); Fine
needle aspiration biopsy and bone marrow biopsy (03 cases). The histology: diffuse large B-cell
lymphoma CD20 + (21 cases), lymphoblastic lymphoma (04 cases), centrocytic lymphoma (01
case), Not specified (04 cases), the immunohistochemistry is routinely performed: Type B (21
cases) and Type T (04 cases) Not specified (05 cases). Clinical stages localized (18) extended
(12) General symptoms: B (26) A(04).Prognostic factors according to IPI low (03), lower intermediate (15), intermediate high (07), high (05). The following protocols were used:
RC2H20PA CHOP RCHOP LINKER
R Fludarabine
COP
Results:
Complete remission 6 cases (20%) ; Partial remission 12 cases (40%).
The shortening of diagnosis time and the use of more aggressive protocols should improve
therapeutic results.
11
OR-07
ADULT HODGKIN LYMPHOMA (HL) TREATMENT IN TUNISIA
Ben Lakhal R
le groupe d’étude du lymphome hodgkinien de l’adulte
The first Tunisian adult HL treatment consensus was elaborated in 1999: Prospective non
randomized national trial (1st version: MDH 99).
This strategy was based on the use of the EORTC prognostic factors in early stage HL and
the use of ABVD regimen: 3 cycles for favorable (Fav) early stage (G1) 6 cycles for unfavorable
(unfav) early stages (Gr 2) and stage III A (G3) and 8 cycles for advanced stages. Involved field
(IF) radio therapy (RT) at 36 Gy was combined to chemotherapy (CT) for early stage and stage
III A.
At the first analysis of MDH 99 in October 2001, 2 problems were detected: High treatment
failure rates (42%) and high number of early relapses in advanced stages. To solve these 2 problems, a second version of the prospective national protocol was elaborated in 2002 (MDH 2002).
In this version advanced stages were staged according to the international prognostic scoring
(IPS)
Intensive CT (4 escalated BEACOPP + 4 Baseline BEACOPP) was used for un Fav advanced
stages (IPS ≥3): G4, GCSF was given after each escalated BEACOPP course. Fav advanced HL
(IPS ≤ 2) received 8 ABVD (G5)
Between 2002 and 2006, 251 consecutive eligible patients from 6 Tunisian departments with
newly diagnosed HL were enrolled in this prospective trial (MDH 2002)
Results:
Median age at presentation was 31 years (range 15-70) with 140M and 111F.
50 % patients (pt) had advanced disease and 44% pts had Bulky mediastinal disease and 69%
had B symptoms. 40% pts were treated in G2, 29% in G4, 17% in G5 and only 9% in G1. Eleven
(4.3%) toxic death were observed during treatment including 10 deaths in the 72 pts treated with
escalated BEACOPP. Of the remaining pts, 83% had CR and 17% had primary failure at the
end of the planned treatment (14% with response < 50% and 3% with response between 50 and
75%). Twenty five relapses (12%) were observed with a median time to relapse of 9 months: 9
(10%) in G2, 6 (8%) in G4 and 10(23%) in G5. Five years OS, EFS and RFS were respectively
88%, 73% and 88%. In multivariate analysis, the unfavorable prognostic factors emerging were
12
Bulky mediastinal disease for EFS (55% vs 80%, p = 0.03) and remission status at the end of
therapy which influenced EFS (87% vs 50% vs 5%, p = 0.0000) and OS (96% vs 62% vs 55%,
p = 0.001).
Conclusion:
The high rate of relapse (23%) in fav advanced HL (IPS ≤ 2) and the adverse prognostic factor
of mediastinal bulky disease were the major issues detected in MDH 2002.
To solve these 2 problems a new prognostic staging have decided in third version of the national protocol (MDH 2008) including 3 stages: Favorable (Fav early stage), intermediate (unfav
early stage with no bulky mediastinal disease) and unfavorable (stage II+ bulky mediastinal disease, stage III and IV).
Intensive chemotherapy (4 escalated BEACOPP + 4 baselines BEACOPP) is currently the
treatment of unfavorable stages. The MDH 2008 is used in Tunisia since 2008, results are ongoing
13
OR-08
CONVENTIONAL AND MOLECULAR CYTOGENETIC (FISH)
FOR ASSESSING DIAGNOSIS AND PROGNOSIS OF
HEMATOLOGIC MALIGNANCIES
Department of Haematology, EHS ELCC Blida, Algeria
Introduction:
Fluorescent in situ hybridization (FISH), providing additional diagnostic, therapeutic and prognostic factor in the evaluation of hematologic malignancies. To improve diagnosis and treatment
of hematologic malignancies in our country, we apply the cytogenetic examinations.
Methods:
We present the results of 136 hematologic malignancies typed by these procedures (chronic
myelogenous leukaemia (CML), chronic lymphocytic leukaemia (CLL), multiple myeloma (MM),
acute leukemia) (ALL). For each patient, we perform a metaphase and interphase FISH using
a panel of probes dedicated to each disorder: CML: bcr-abl probes single and or double fusion;
CLL: CEP 12 probe, 13q14-q34 probe, ATM-p53, 6q21 probe. AML: CBFB t (16, 16) inv (16)
probe, AML / ETO t (8; 21) probe, PML / RARA t (15, 17) probe, MLL (11q23) probe; ALL: bcr-abl
simple fusion probe; myeloma: 13q14-q34 probe.
Results:
136 malignancies were studied: CML: 54 cases, LLC: 34 cases, MM 30 cases, LAA: 18 cases.
CML Group: CML in chronic phase: 67 examinations of 54 patients: - 31 at diagnosis (30 in
chronic phase and 1 in blast crisis). The signal fusion Bcr-Abl was found in 30 cases, 1 case
confirming a complex abnormality t (1, 9, 22) found on the karyotype. - 23 in therapeutic evaluation: 20 in chronic phase at 3, 6, 9, and 12 months of taking imatinib, 3 cases in acutisation, for
assessing results of therapy.
CLL Group: 34 patients: 12 including seven isolated trisomy 12, twelve 13q14deletions including nine isolated (two: loss of 2 copies and two: loss of one copie), 5 ATM (11q22.1) deletions
with two isolated, 4 P53 deletions all associated, three 6q21 deletions associated with ATM, p53
and 13q14, no abnormality in 7 cases.
Myeloma Group: 14 of 30 patients with a 13q14 deletion and 4 cases with abnormal numbers.
ALL Group: 7 LAL: failure of 1 in culture, presence of bcr-abl signal in 2 / 6 cases.
AML: 11 cases: PML-RAR positive in a case of LAM3. invert 16: 2/4 cases; t (8; 21) and MLL
14
gene rearrangement studied in 5 cases of AML2, results in progress.
Comments:
The assessment of therapeutic response to imatinib by karyotyping and metaphase /interphase FISH allowed us to exercise our terms of monitoring cytogenetic remission patients and
guide the therapeutic approach. In chronic lymphocytic leukaemia, the importance of abnormalities of poor prognosis (ATM del, p53 del) and atypical (+12) gives a specific profile for our patients to be confirmed on a larger series. In multiple myeloma: the rate of del 13q14 joined that of
the literature. The prognostic evaluation of LA is in progress.
15
OR-9
CYTOGENETICS ASPECTS OF ACUTE MYELOBLASTIC
LEUKAEMIA IN ADULTS IN MOROCCO
M Lamchahab
16
OR-10
ASPECTS CLINIQUE, BIOLOGIQUE ET THERAPEUTIQUE DES
LEUCEMIES AIGUES MYELOBLASTIQUES CHEZ L’ADULTE
N. Dali, K. Ait-Seddik, M. Allouda, O. Ouanes,
S. Gherras, H. Aftisse, H. Ait-Ali
Service Hematology Chu Tizi-Ouzou, Algeria
Introduction:
Le pronostic des leucémies aigues myéloblastiques (LAM) aussi bien de l’enfant que l’adulte
est péjoratif.
L’allogreffe de moelle osseuse permet d’améliorer la survie et espérer la guérison.
On se propose de rapporter dans ce travail, les résultats thérapeutiques de 148 patients
adultes colligés sur une période de 10 ans.
Patients: de 2000 à 2009 nous avons répertorié 147 de LAM, les extrêmes sont de 15 ans
à 82 ans avec une moyenne d’age de 43 ans, 57 sont de sexe masculin et 90 de sexe féminin
avec ratio H/F: 0.60.
Méthodes: les 147 patients sont diagnostiqués par la cytologie classique (FAB) sur frottis
sanguin et médullaire colorés au MGG, complétés le plus souvent par une coloration spécifique
au noir soudan.
Il s’agit: de 93 LAM2 (69%): 27 LAM1 (20%), 05 M4 (04%), 05 M5 (04%), 03 M6 (03%).
Les signes cliniques les plus fréquents: la pâleur cutanéo-muqueuse (94%), le syndrome hémorragiques (54%) et le syndrome infectieux 34%. Le syndrome tumoral a été retrouvé chez 39
patients (26%).
Sur le plan biologique: l’hémogramme a objectivé: une anémie chez 139 patients. Le taux
d’hémoglobine moyen est de 07,2g/dl une hyperleucocytose > 50.000/mm3 chez 28 malades
(27%) avec un taux moyen 47171/mm3. le taux de plaquettes varie de 9000/mm3 à 190000/
mm3 correspondant à un taux moyen de 49119/mm3.
La CIVD a été positive chez 30 malades (20%).
Traitement:
Le traitement comportait la rubidomycine et l’aracytine chez 103 patients les autres ont reçu
d’autres thérapeutiques.
17
Résultats:
Sur les 147 patients, seuls 114 sont évaluables, 33 n’ont reçu aucune thérapeutique spécifique, ils sont décédés précocement.
Parmi les 114 évaluables, 31 (27%) sont décédés pendant l’induction.
60 (72%) sont mis en RC dont la médiane est de30mois (03 mois – 117 mois).
38 sur 60 sont toujours vivants au première RC dont 25 parmi les greffés.
02 sont décédés après greffe.
Conclusion:
Le pronostic des leucémies aigues myéloblastiques reste mauvais, mais la greffe de moelle
osseuse allogenique a permis d’améliorer la survie à long terme pour les patients en rémission
et ayant un donneur HLA compatible.
18
OR-11
AML
Bacigulapo
19
OR-12
MANAGEMENT OF ACUTE MYELOBLASTIC LEUKAEMIA IN
ADULTS: MOROCCAN EXPERIENCE
A.Quessar
20
OR-13
ACUTE MYELOID LEUKEMIA, A PROSPECTIVE
STUDY OF 83 TUNISIANS PATIENTS
Ben Amor R, Jeddi R, Ben Neji H, Aissaoui L, Kacem K, Bouteraa W, B.
Abdennebi Y, B. Lakhal R B. Abid H, Belhadjali Z, and Meddeb B
Department of Clinical Hematology, Aziza Othmana Hospital, Tunis
Objective:
The main objective of this study was to evaluate the therapeutic results in AML young patients
treated according the national Tunisian protocol and to compare the prognostic to literature and
suggest any changes to improve their issue.
Patients and Methods:
In our prospective study, between January 2003 and December 2006, 83 de novo AML patients aged between 18 and 55 years were included (acute promyelocytic leukemia was excluded). They were diagnosed and treated, according to the national protocol, in the Hematology
Clinical Unit of AZIZA OTHMANA hospital.
Results:
The median age of our patients was 41 years. The karyotype was normal in 47.2 % of cases.
According to “the Medical Research Council cytogenetic risk group”: 13.5% of patients were
low-risk, 77% intermediate risk and only 9.5% were high risk. The Complete induction-remission
rate was 75.9%. Among clinical and biological parameters analyzed at diagnosis, only karyotype
influenced the achievement of complete remission: 100 % in low risk group, 82.6% in intermediate risk group and 28.5 % in high risk group (p = 0.006). Induction mortality was 16.8% caused
by an infectious cause in 71% of the cases. The 4-years overall survival was 48.6%. The 4-Years
relapse-free survival was 34.9%. The global relapse rate was 41.2%. Relapse-free survival at
18 months was 55% in intermediate risk, 0% in high risk and only 18.5% in low risk (p = 0.05).
Univariate study revealed that; age between 18-50 years (p = 0.05), myelo-peroxydase positivity
(p = 0.04) and nonexistence of a HLA identical donor (p = 0.03) influenced favorably the overall
survival. Multivariate study revealed that mortality relative risk was 3.96 for patients older than
50 years.
Conclusion:
We note that our results are approximating those reported in literature data (excluding the
worse issue of our low risk group patients). We also believe that these results could be improved
by: increasing alloSCT number, a better supportive care and a better molecular follow up. Finally,
we have to re-consider the place of AutoSCT, as an alternative post induction therapy, because
of the poor development and the limited indications of allograft in our country.
21
OR-14
ASPECTS CLINIQUE BIOLOGIQUE ET THERAPEUTIQUE DES
LEUCEMIES AIGUES LYMPHOBLASTIQUES DE L’ADULTE
K. Ait-Seddik, N.Dali, M.Allouda, O.Ouanes,
S.Gherras, H.Aftisse, H.Ait-Ali
Algeria
Introduction:
Le pronostic des leucémies aigues lymphoblastiques des adultes reste très défavorable.
L’amélioration des stratégies thérapeutiques et utilisation de protocoles plus intensifs ont permit d’obtenir une survie plus longue. On se propose de rapporter dans ce travail les aspects
cliniques, biologiques et thérapeutiques de 94 patients adultes colligés sur une période de 10
ans.
Patients: de 2000 à 2009: nous avons répertoriés 94 cas de LAL, soit une moyenne de: 09 cas
par an. Les extrêmes sont de 15 ans et 86 ans avec un âge moyen de 37 ans, 51 sont de sexe
masculin et 43 de sexe féminin, avec un ratio H/F de 1,18
Méthodes: les 94 patients sont diagnostiqués par la cytologie classique (FAB) sur frottis sanguin et médullaire colorés au MGG, complété par une coloration spécifique au noir soudan.
Il s’agit de 54 LAL2, 35 LAL1 et 05 LAL3. Les signes cliniques les plus fréquents sont: PCM
62%, syndrome tumoral 58%, syndrome hémorragique: 40% et le syndrome infectieux: 22%.
L’atteinte neuroméningée a été retrouvé chez 03 patients (0,03%), 70 patients (74%) avaient un
taux d’HB<10g/dl ;42 patients (44%) tx GB> 30000/mm3 et 46 patients (48%), plq<5000/mm3.
Traitement:
Comportait: Linker chez 62 patients (65%) COAP: 09 patients: 01% V+P: 09 patients: 01%
Résultats:
22
Sur les 94 patients seuls 80 sont évaluables: 14 n’ont reçu aucun traitement spécifique, ils
sont décédés précocement. Parmi les 80 malades traités: 35 (44%) sont décédés pendant
l’induction.
45(56%) sont mis en rémission dont la médiane est de 21 mois (1 mois—111mois).
23/45 patients sont toujours vivants en rémission complète dont 4 parmi les greffés.
14/45 patients mis en rémission ont rechuté.
4 décédés en rémission (réinduction).
4 sont décédés après greffe.
Conclusion:
49 patients sur 94, soit 52% sont décédés avant ou en cours du traitement.
45 sur les 80 évaluables, soit 56% sont mis en rémission complète, 23 sont encore vivants
dont 4 parmi les greffés.
Les résultats restent mauvais, une meilleure connaissance des facteurs pronostic (immunophenotypage caryotype)
permettra de cibler les patients qui nécessitent un traitement intensif.
23
OR-15
DIAGNOSTIC, MANAGEMENT AND OUTCOME OF CML
PATIENTS: A TUNISIAN MULTI-CENTER STUDY
Ben Amor R, Ben Lakhal R, Ghedira H, Belaaj H, Laatiri MA, Ben Youssef
Y, Ben Romdhane N, M’sadek F, Menif S, Elloumi M, Khelif A, Meddeb B.
Introduction:
Imatinib was the first treatment for chronic myeloid leukemia (CML) that specifically targeted
the causative BCR-ABL transcript, producing high response rates in most patients. In this multicentre study, we retrospectively evaluate cytogenetic and molecular response to Imatinib and
analyze the predictive resistance factors and their impact on event free survival (EFS) and overall survival (OS).
Patients:
From July 2002 to June 2009, 116 CML patients were included: 104 in chronic phase (CP) and
12 in accelerated phase (AP). Median age was 44 years (13 – 76 years). BCR-ABL transcript
was initially studied in only 81 patients (70%). Sokal score, calculated in 110 patients, was high
in 21 cases (18%), Intermediate in 53 cases (46%) and low in 36 cases (31%).
Methods:
First-line treatment in all patients was Imatinib 400mg/day, initiated in a median of 3 months
(1-12months). ELN criteria were used for response evaluation.
Results:
Complete cytogenetic response (CCyR) was achieved in 76% of cases with a median of 12
months (3-36 months). Molecular monitoring was performed in 80% of patients. Major molecular
response (MMR) was achieved in 62% of cases with a median of 18 months (6-48 months). 33%
of patients were in optimal response (OpR), 46 % in suboptimal response (SubOpR) and 21% in
primary resistance (PR). 11% of patients had a secondary resistance. Imatinib dose escalation
benefit to 18/25 patients in PR (72%). Only five of them did achieve a CCyR. Predictive factors of
CCyR were Sokal score and treatment discontinuation (toxicity or non adherence). Sokal score
was the only predictive factor of MMR. The 5 years EFS was 79%. EFS varied significantly according to 6 months CCyR (92% vs 58%, p=.00001), to initial disease status (CP: 87% vs AP:
58%; p=.002) and to initial response (PR: 87% vs OpR-SubOpR 68%, p=.008).The 5 years OS
was 88%. Only CCyR had a significant impact on OS. MMR had no impact neither on EFS nor
on OS.
24
Conclusion:
In our study we note that management of resistance and suboptimal responses was not harmonized. In fact, Imatinib dose escalation benefit to only 42 % of patients eligible for escalation
(38/91). Despite this difficulty EFS, OS and CCyR are hopeful and may be improved by better
management synchronization. We note also that maintain and escalation of Imatinib permitted
the reaching of CCyR in some cases but did not increase survival. The recent use of second
generation tyrosine-kinase inhibitors drugs may also contribute to improve the outcome of these
patients.
25
OR-16
NEW TREATMENTS FOR FIT
AND UNFIT PATIENTS WITH CLL
Marco Gobbi
University of Genova Italy
Chronic lymphocytic leukemia has been for long time a sort of “Cinderella” for biological understanding and treatment approaches. In recent years the entire issue has evolved rapidly and
now several therapeutic strategies are available for different clinical situations. If the reduction of
the disease expansion and the steady state maintenance has been the goal in the past, at present for the first time fit patients could experience molecular remission that can greatly influence
progression free survival and overall survival.
The standard treatment is the combination of Fludarabine cyclophoshamide and Rituximab
(FCR) recently introduced by the german group that significantly increase the results in all fit
patients except in those bearing 17 p– chromosomal abnormality.
In these patients Flu – Cam protocol (Fludarabine plus Alentuzumab (Camparth) seems to
offer better results; however in selected patients allogeneic stem cell transplant should be offered.
For older patients and for those with comorbidities there are several possibilities: low dose
FC + R, Chlorambucil + R and Bendamustina +R are the most used protocols. In these patients
although an effective increment of the overall survival duration has not jet demonstrated, the
percentage and the quality of the remission obtained are significantly increased.
The appropriate evaluation of the biological risk for each patient in a hand and the introduction of Rituximab in the majority of patients and Alentuzumab in selected ones in the other, have
greatly contributed to the recent advances in this disease.
Now a new generation of anti CD 20 monoclonal antibodies is being evaluated in clinical trials
and is expected to even increase the results in the next future.
26
OR-17
ADVANCES IN MANAGEMENT
OF MULTIPLE MYELOMA
Moulod EL-Agnaf
In recent years, our understanding of the biology of multiple myeloma has vastly improved.
As a result an array of effective treatments were developed. Survival in multiple myeloma has
improved, although in the vast majority of patients, myeloma remains an incurable disease.
In my short talk, I will focus on the recent development in treatment. I will also discuss a
number of practice changing clinical trials in myeloma.
27
OR-18
TREATMENT OF MULTIPLE MYELOMA IN THE DEPARTMENT
OF HAEMATOLOGY AND BONE MARROW TRANSPLANTATION
– EHU 1st NOVEMBER 1954 - ORAN –ALGERIA
A.Arabi, F.Attaf, M.Bey, B.Benzineb,N.Yafour, H.Berredouane, B.Enta
Soltane, S.Osmani, M.Brahimi, H.Tedj, N.Bahlat, MA Bekadja
Therapeutic options for multiple myeloma (MM) patients have changed quickly in recent years
and uncertainty has arisen about optimal approaches to therapy. A reasonable goal of MM treatment in younger “transplant eligible” patients is to initiate therapy with a target goal of durable
complete remission
In our service, between 1st August 2007 and 31 January 2010, we have treated 48 patients
with Multiple Myeloma:
-Age: 64,2 years (37 – 83)
-Sex Ratio: 1,63
-diagnosis was based on clinical features, X-ray of bones, bone marrow aspiration, protein
electrophoresis, identification of the serum monoclonal protein (in some cases), presence of
Bence Jones protein (in some cases)
-complications like elevation of calcium were identified and treated
-ISS classification was adopted
For the treatment, we distinguish two periods:
Before November 2008, patients were treated essentially by Alexanian protocol
After November 2008, National consensus was adopted:
* Patients < 65 years: Cyclophosphamid-Thalidomide-Dexamethasone or BortezomidDexamethasone: if complete response, autologous bone marrow transplantation
* Patients > 65 years: Melphalan-Prednisone-Thalidomide
28
OR-19
PRELIMINARY RESULTS OF BORTIZOMIB–DEXAMETHAZONE
PROTOCOL FOLLOWED BY THERAPEUTIC INTENSIFICATION
BY MELPHALAN 200 AND AUTOLOGOUS STEM CELL
TRANSPLANT IN MULTIPLE MYELOMA
N. Yafour, M. Brahimi, A. Arabi, S. Osmani, F. Attaf, F. Tadj,
B. EntaSoltan, H. Berradouane, B. Benzineb, M. Bey, MA Bekadja
Hematology and Cell Therapy department, University Hospital “1er Novembre” Oran Algeria
Introduction:
Multiple myeloma is a haematological malignancy that has gained many therapeutic advances
these last years. It is believed that obtaining a complete remission after a therapeutic intensification followed by autologous stem cell transplant is the only guaranty of a long survival.
Our study is a preliminary evaluation of Bortizomib-Dexametazone protocol as an induction
therapy followed by 200mg/m2 conditioning regimen in multiple myeloma.
In May 2009 we have started a prospective study concerning patients with multiple myeloma,
less than 65 years old, with no co morbidities.
The induction therapy combined Bortizomib 1,3 mg/m2 D1, D4, D8, D11 and Dexamethazone
40mg/m2 D1 to D4; D8 to D11; D15 to D18 from the 1st to 2nd cycle and from D1 to D4 form 3rd to
4th cycle, with one cycle each 28 days. The evaluation of the remission was done according to
the EBMT criteria.
Stem cell mobilisation was accomplished with G-CSF 15μg/kg for 5 successive days.
Stem cell collection was preformed by cytapheresis then an intensification with Melphalan
200mg/m2 (MEL200).
The graft has been stocked in refrigerator at +4°C for 24 to 48 hours then reinfused 24 hours
after intensification by MEL200
The post-transplant evaluation was preformed at D100.
The maintenance therapy with Thalidomid 50mg/d and Acetylsalicylic Acid 100mg/d was introduced at D30.
Results:
From May 2009 to February 2010, seven (07) patients with multiple myeloma and less than 65
years old were included in the study. Six males and one female with a median age of 51 years
[34 to 57], ISS stage: 6 intermediate and 1 low. 5 patients had received 2 lines of regimens and
2 patients were newly treated.
29
Median time of follow-up: 03 months and post-transplant status was as follows: 5 CR and 2
VGPR.
Conclusion:
Even if this study is preliminary it shows that the induction with Bortizomib – Dexamethazon is
very useful to maintain a complete remission
30
OR-20
TREATMENT OUTCOME OF THALIDOMIDE BASED REGIMEN
IN NEWLY DIAGNOSED AND POST AUTOLOGOUS STEM CELL
TRANSPLANTATION MULTIPLE MYELOMA PATIENTS:
A TUNISIAN EXPERIENCE
Lakhal A1, Ladeb S1, Torjman L1, Bettaieb J2, Abdelkefi A1, Ben
Abdeladhim A1, Ben Othmen T1
Centre National De Greffe De Moelle Osseuse De Tunis Tunisie
Département de médecine préventive et communautaire. Faculté de médecine de Tunis
Introduction
Thalidomide in combination with dexamethasone (TD) as short upfront therapy has demonstrated improved response rates and progression-free survival rates compared to dexamethasone alone and VAD in previously untreated multiple myeloma (MM) younger patients. In the
setting of post-autologous stem cell transplantation (ASCT) therapy, thalidomide maintenance
resulted in significant benefit in terms of event free survival (EFS) and progression free survival
(PFS); however, overall survival (OS) was improved in only some studies.
Purpose
The aim of this retrospective study is to update outcomes of TD as initial front line treatment
in newly MM patients undergoing ASCT and to assess potential benefits with thalidomide as
maintenance therapy after ASCT.
Patients and methods
Untreated Durie-Salmon stage II or III MM patients younger than 65 years, received first-line
therapy combined thalidomide at a dose of 200 mg per day for 75 days and dexamethasone at
a dose of 20 mg/m2 body surface area on days 1 to 4, 9 to 12 and 17 to 20 on the first and third
month of therapy and 20 mg/m2 body on days 1 to 4, the second month. Almost all patients were
administered associated thromboprophylaxis to TD. To proceed to peripheral blood stem cells
(PBSCs) collection after first-line therapy, either high-dose cyclophosphamide (HD-CY) (4g/m2)
and granulocyte colony-stimulating factor (G-CSF) (5 μg/kg/day) starting on day+3 from HD-CY
or G-CSF alone (10μg/kg/day) on days 1 to 5 was used. PBSCs were harvested usually between
days + 11 and days+13 after HD-CY. A minimum of 3 million CD 34+ per kilogram was collected.
Conditioning regimen preceeding ASCT consisted on Melphalan (200mg/ m2). G-CSF was administered from day+5 after stem cells transplantation until neutropenic engraftment. Between
April 2003 and December 2006, patients were included in a randomized study comparing tow
arms, arm A: tandem ASCT within 6 months of the first ASCT with the same conditioning regimen
and arm B:one ASCT followed by 6 months maintenance therapy with thalidomide at a dose 100
mg per day starting 3 months post-ASCT. A second ASCT was received in case of relapse or
disease progression after maintenance therapy. At the end of this randomized study, all patients
were treated after induction therapy by ASCT followed by thalidomide maintenance therapy. The
31
response criteria used in this study were based on the European Group for Blood and Marrow
Transplantation and the International Myeloma Working Group Uniform Response Criteria. Evaluation of response to TD was performed after the end of induction therapy, before ASCT, every
three months after ASCT and thalidomide maintenance therapy.
Results
Between April 2003 and October 2009, 137 patients (58 female, 79 male) with newly diagnosed
MM received front-line therapy with TD. Patient’s characteristics are summarized on Table1.
Table1. Patient’s characteristics
Age (years)
≤ 36- 50
≤ 51- 63
M component isotype
IgG (g/dl)
IgA (g/dl)
Bence Jones (g/24h)
Stage
II
III
A
B
Conventional cytogenetics
Normal
Absence of cell growth
Unknown
Abnormal
International Staging System
I
II
III
Unknown
Tandem ASCT
ASCT+ Thalidomide maintenance
Median (range) Patients, n (%)
53 (36-63)
52 (38)
85 (62)
69 (51)
36 (26)
32 (23)
6 (4)
131(96)
114(84)
23 (6)
67(49)
48 (36)
10 (7)
12(8)
22 (16)
32 (24)
25 (18)
58 (42)
36 (26)
101 (74)
The median time from the end of TD induction and HD-CY was 34 days (range, 10-300). A peripheral blood stem-cell collection was performed in all patients. A median number of 9.71million
CD34 cells per kilogram were collected (range, 1.68-76). The median time from diagnosis and
ASCT was 8 months (range, 1-23). In the tandem ASCT group (n=36), 27 patients (75%) underwent a second transplantation. In the thalidomide maintenance group (n=101), 23 patients (46%)
have a second transplant for a progression or disease relapse and 76 patients (75%) received
maintenance therapy by thalidomide. The median time from the first to the second transplantation was 7 months (range, 2-59 months). The overall response rates (ORR) at the end of induction therapy, prior to high dose therapy and after thalidomide maintenance therapy are shown in
table 2.
32
Table 2. Overall response rate
Post induction DT therapy
Before first ASCT
3 months after first ASCT
Before second ASCT
6 months post second ASCT
VGPR1 or greater and CR2
37%
42%
56%
36%
62%
PR3
33%
30%
27%
6%
28%
MR4 and progression
21%
21%
8%
48%
8%
NE5
9%
7%
9%
2%
1 VGPR: very good partial remission ; 2 CR: complete remission ; 3 PR: partial remission ; 4 MR: minimal response ;
5 NE: non evaluable
Median follow up was 41 months (range, 6-77). Three year overall survival in tandem ASCT
patients and in thalidomide maintenance post transplant therapy patients were 51.8, 72.4% respectively (p=0.05).
Conclusion
Our study demonstrates that thalidomide combined with dexamethasone used as front-up
short induction therapy prior to ASCT was an effective therapy in MM untreated MM patients. In
addition, thalidomide administered as maintenance therapy provided impressive survival benefit.
33
OR-21
ANALYSE CYTOLOGIQUE ET IMMUNOCHIMIQUE DE 40 CAS
DE MYÉLOME MULTIPLE À CHAÎNES LÉGÈRES = CYTOLOGICAL AND IMMUNOCHEMICAL ANALYSIS OF 40 CASES OF
LIGHT CHAIN MULTIPLE MYELOMA
MC Rahali ; L Bouteldja ; SE Belakehal ; S Baghdad ; FZ Ardjoun;
Service Hématologie HCA ; Alger ; ALGERIE
Nous rapportons dans ce travail une analyse clinique, cytologique et immunochimique de 40
cas de myélome multiple à chaînes légères, colligés au Service Hématologie /HCA depuis 20
ans (1990-2010), représentant 33% de l’ensemble des malades myélomateux répertoriés pendant cette période, sex-ratio= 1, avec un age moyen 64 ans (extrêmes 46-74 ans).
Selon les critères bio-cliniques de classification de SALMON et DURIE, nous observons une
prédominance des malades au stade III: 32 cas (80%). Le syndrome anémique avec Hb ≤ 8g/dl
est retrouvé dans 26 cas (65%), l’hypo gamma-globulinémie est de règle à l’exception de 9 cas
ou le profil électrophoretique est revenu normale. La plasmocytose médullaire est inférieure à
30% dans 55% des cas, entre 30 et 60% dans 30% des cas et supérieure à 60% dans 15% des
cas. L’étude immunochimique révèle 34 cas de MM à Ig Mc subdivisés en 18 cas à cL λ et 16
cas à cL κ. Les 6 cas restants de MM, la recherche de Ig Mc est non identifiée mais associés à
des chaînes légères libres lambda (λ) anormale dans les urines. La protéinurie de Bense Jones
est présente dans 38% des cas. L’insuffisance rénale organique est retrouvée dans 12 cas
(30%), fréquente dans les cas à cL λ (45%) versus cL κ (19%), l’hypercalcémie est noté dans
20% des cas.
Selon la littérature, Le myélome multiple à chaînes légères représente 20% de l’ensemble
des myélomes, la complication rénale dont le pronostic est habituellement péjoratif est retrouvée
dans prés de 65% des cas au diagnostic.
34
Translation to English
OR-21
ANALYSE CYTOLOGIQUE ET IMMUNOCHIMIQUE DE 40 CAS
DE MYÉLOME MULTIPLE À CHAÎNES LÉGÈRES = CYTOLOGICAL AND IMMUNOCHEMICAL ANALYSIS OF 40 CASES OF
LIGHT CHAIN MULTIPLE MYELOMA
MC Rahali ; L Bouteldja ; SE Belakehal ; S Baghdad ; FZ Ardjoun;
Service Hématologie HCA ; Alger ; ALGERIE
We attribute this work analysis clinical, cytological and immunochemical 40 cases of light
chain multiple myeloma, strings to the Hematology Service /HCA during 20 years (1990-2010),
representing 33 percent of all patients listed during this period, sex ratio = 1, with an average age
64 years (46-74 years). According to the classification of SALMON and DURIE bio-clinical criteria, we observe a predominance of patients with stage III: 32 cases (80%). Anaemic syndrome
with Hb ≤ 8 g/dl is found in 26 cases (65%), low gamma-globulin is rule except for 9 cases with
EPS profile came back normal. The Medullary plasmocytose is less than 30% in (55%) of cases,
between 30 and 60% in (30%) of cases and more than 60% in (15%) of cases.
The immunochemical study reveals 34 MM to Ig Mc cases subdivided into 18 cases to cL λ
and 16 cases to cL κ. 6 MM remaining cases, the Ig Mc research is not identified, but associated
strings light free lambda (λ) abnormal in the urine. Bense Jones proteinuria is present in 38% of
cases. Organic renal insufficiency is found in 12 cases (30%), frequent in cases to cL λ (45%)
versus cL κ (19%), the hypercalcémie with bone complications is noted in 20% of cases.
According to literature, the multiple myeloma light chain represents 20% of the total of the
myeloma, the renal complications which the prognosis is usually pejorative is found in meadows
of 65% of cases at diagnosis.
35
OR-22
HAEMATOLOGICAL MALIGNANCIES
IN BENGHAZI IN THE YEAR 2009
Hematology unit, Jamhoria hospital, Benghazi
Introduction:
The Haematological Malignancies are a group of neoplasms that arise through malignant
transformation of bone marrow derived cells. The great diversity seen in this group of disorders
is a reflection of the complexity of normal haematopoiesis and the immune system.
Aim of the study:
The study was designed to present:
1) The demographic characters of the Libyan patients with hematological malignancies in Benghazi in the year 2009.
2) The incidence of the hematological malignancies among Libyan population in Benghazi in the
year 2009.
3) The pattern of hematological malignancies in Benghazi in the year 2009.
4) The incidence of death among Libyan hematological malignancy patients in Benghazi in the
year 2009.
Material and Method
A retrospective study was carried out in “hematology unit at “ Jamhoria hospital”, Benghazi.
The data was extracted from the files of hematological malignancy patients who were diagnosed
in the year 2009. SPSS was used for data analysis. Statistics used; mean, standard deviation,
median and percentages. Incidence rates and mortality rates among the patients were also calculated.
Results:
71 cases of malignant hematological diseases were registered in the year 2009 in the hematology unit at Jamhoria Hospital. Male to female ratio was 1.4: 1, the age of the patients ranged from
18 to 100 years, median age was 54 years, the overall incidence of hematological malignancy
among Libyan population in Benghazi was 17.74 per 100000, the most frequent malignancy was
Non Hodgkin lymphoma (25.35% of all the cases) and its incidence was 4.5 per 100000. Acute
lymphocytic leukemia, myelofibrosis, and Waldenstrom’s macroglobulinemia had the lowest frequencies (1.41% of all the cases), their incidence was 0.25 per 100000. By the end of the year
36
2009, 8 out of the 71 cases were died with mortality rate of 11.27%.
Conclusion:
In conclusion the distribution of the various hematological malignancies in this study is similar
to the pattern reported in other studies. There appears to be generally a lower incidence of hematological malignancies recorded when compared to other studies. Late presentation, interference
with the early start of treatment by the patients’ family as well as shortage of supportive treatment
were the most common cause of death.
37
OR-23
DESCRIPTIVE STUDY OF SERIES OF 104
PATIENTS AFFECTED BY HAEMOPHILIA
N.Saidane*; Y.Ouarhlent* ; C.Derdous** ; M.Saïdi*.
*Haematology, University Hospital;**Orthopedic department, University Hospital, Batna, Algeria.
Haemophilia prevalence in Algeria reached of 1445 cases counted until March 2010. Despite
the project of haemophilia national register, we remain far from real assessments because of the
misunderstanding of this pathology in a lot of regions in Algeria. The main objective of this study
is to obtain exhaustive information on the characteristics and the evolution of haemophiliacs
managed by University Hospital of Batna (south east Algeria), which represent 7, 26 % of the
estimated number in all algerian territory.
This is a prospective monocentric study about 104 patients affected with haemophilia (A or
B), living in the region of Batna and its neighborhood, including 63 adults and 41 children. Those
patients had come either directly to haematology consultation at University Hospital of Batna, or
they were oriented to us by the other nearby structures.
Results:
Among 104 patients, 82% had type A haemophilia, of which 78 % severe forms, 20 % moderate forms and 2 % minor forms. Haemophilia B occupies 18 % with 63 % for severe forms, 32
% moderate forms and 5 % minor forms. Patients have a median age of 19 years (1 month- 52
years) and 85 % of them are less than 30 years old. About 33% of patients did not report any
family history, and 63 % of them have at least an affected brother. Viral infections were stated at
58 patients among whom 1 patient was infected by HIV and 9 patients by HCV.Only 17 patients
of the series were vaccinated against hepatitis B. Presence of inhibitors against coagulation factors was checked at 29 patients, and only 3 of them have inhibitors.
In the context of multidisciplinary consultation (hematologist, orthopedist, pediatrician and physician doctor), assessment of: age and circumstances of diagnosis, professional activity, handicap degree evaluation, irregular agglutinins research and hemoglobin rate, orthopedic status
and its management were stated for 34 patients (12 children and 22 adults) of the series at the
cut of the analysis (march 2010). Data analyze showed following results: about 78% of severe
haemophiliacs were being diagnosed at around 6 - 12 months of age. The disease is revealed
by bruises and/or hematomas in 48 % of cases, haemarthritis, wounds and circumcision in 9 %
each of them. Familial inquiry is the origin of diagnosis in 15 % of cases. Only 6 patients from
22 adults reported professional activities. Among 34,twenty three patients totally independent in
38
their displacements and daily activities, and 11 patients need assistance to performing some activities.Irregular agglutinins are absent in those patients, and one patient/ four presents anaemia
with haemoglobin rate between 8-10 g / dl.
Data about orthopedic status and its management for each of 34 patients will be published.
Conclusion:
This study takes a census of haemophiliacs managed in our center and performs a preliminary
evaluation of complications. That draws many perspectives of work: management of orthopedic
complications,care health of HCV+ and HIV+ patients, put an anti-hepatitis B vaccination program for patients not vaccinated, care health of anemia cases, and especially manage patients
having developed inhibitors against coagulation factors. That also enables the institution of an
adequate prophylaxis schema and estimating financial costs.
39
OR-24
MANAGEMENT OF AML IN CHILDREN:
MOROCCAN EXPERIENCE
S.Cherkaoui
40
OR-25
BURKITT’S LYMPHOMA IN CHILDREN
Hasna Driouchi
41
OR-26
ITP
Ramdan Allous
42
OR-27
TRANSPLANTATION FOR MM
Nuri Hwaje
43
OR-28
BONE MARROW TRANSPLANT
Andrea Bachigulapo
44
OR-29
HIGH-DOSE CYCLOPHOSPHAMIDE, ETOPOSIDE AND BCNU
WITH NON-CRYOPRESERVED AUTOLOGOUS
HAEMATOPOIETIC STEM CELL TRANSPLANTATION
FOR POOR PROGNOSIS HODGKIN’S LYMPHOMA
MA. Bekadja, M. Brahimi, N. Yafour, S. Osmani, F. Attaf, F. Tadj, A. Arabi,
B. Enta-Soltan, H, Berredouane, B. Benzineb, M. Bey, N. Bahlat.
Clinic of Haematology and Cell Therapy, University Hospital 1st November, Oran Algéria
Several high dose chemotherapy regimens have been used in autologous transplants for
Hodgkin’s lymphomas (HL). Most of these high-dose therapy schedules were designed to deliver cytotoxic drugs over a number of days [e.g. 6 days for BEAM, CBV or ICE], freezing of the
harvest product was traditionally carried out to maintain cell viability until stem-cell reinfusion.
Unfortunately cryopreservation unities are not available in many developing countries so the
liquid storage of harvested stem cells, in standard blood refrigerators, is an alternative to cryopreservation.
The aim of this study is to demonstrate the feasibility and safety of autotransplants with noncryopreserved peripheral blood stem cells.
10 patients with poor prognosis malignant Hodgkin’s lymphoma were treated with high-dose
cyclophosphamide (120 mg/kg), etoposide (2100 mg/m2) and BCNU (400mg/m2) followed by
reinfusion of autologous non-frozen PSC, which had been stored for 72 hours at 4°C.
The median time to achieve an absolute neutrophil count greater than 0.5_109/l was 13 days
(range 11–20 days). The median time to self-sustained platelet count greater than 20_109/l was
20 days (range 15–30 days). Eight of the 10 patients are still alive and disease free and one
patient died of severe infection.
We conclude that high-dose chemotherapy with non-frozen autologous bone marrow transplantation is safe in terms of haematopoietic reconstitution and the preliminary follow-up data
suggest a useful efficacy. The procedure is easy to perform without requiring costly cryopreservation.
45
OR-30
LIBYAN EXPERIENCE IN BMT
Nabila Sassi Abdulrahman
African Oncology Institute, Sabratha, Libya
Hematopoietic SCT is now an established treatment modality with definitive indications for
many hematological disorders. However, this line of treatment requires tremendous resources,
and it becomes increasingly difficult for transplanters practicing in the developing world to reconcile the difference between what is possible and what is available.
The SCT program in Libya started in 2007 on a narrow scale. In 2009 the transplant rate increased dramatically. The total number of transplants performed till April 2010 is 15 cases all are
autologous.
46
OR-31
TRANSPLANTATION FOR 37 PATIENTS
WITH FANCONI ANEMIA
R. Ahmed Nacer, F. Mehdid, N. Rahmoune, M. Benakli, R. Belhadj, M.
Baazizi, F. Harieche, F. Zerhouni, RM. Hamladji
Departement of hematology and BMT unit, Pierre and Marie Curie center, Algiers, Algeria
Introduction:
Fanconi anemia (FA) is an autosomal recessive disease frequently evolves to bone marrow
failure and acute myeloid leukemia. Allogeneic hematopoietic stem cell (HSCT) is the treatment
of choice for patients with FA, it leads to normal complete hematopoietic recovery and prevention
of acute leukemia.
Materials and methods:
From June 1998 to November 2008 (125 months period) 37 patients with FA underwent 38 allogeneic HSCT (from HLA-identical sibling donors: 32 and pheno identical: 4, mismatch cord unrelated donor: 1); median age 11 years (5 to 24); sex ratio (M/F) 1; median interval from diagnosis to
transplant 24,9 months (5 to 60); 12 patients (44,3%) had received more than 20 transfusions before allograft. Two conditioning regimens was used: BU-Cy protocol with busulfan 6 mg / Kg and
cyclophosphamide 40 mg/Kg for 9 patients (23,7%) and Flu-Cy-ATG protocol with fludarabin 150
mg /m2, Cy 20 mg/kg and anti thymocyte globulin (Fresenius) 40 mg/Kg for 28 patients (73,7%).
GVHD prophylaxis associated cyclosporin and methotrexate 5 mg/m2 (J1-J3-J6). Four patients
received bone marrow transplant and 31 patients peripheral blood stem cell and 2 patients died
before allograft. At May 2009 maximal follow up is 131 months and minimal 6 months.
Results:
The median time to engrafment was 13 days (10 to 21). Twenty patients (54 %) are alive
with success engrafment after median follow up 39 months (6 to126):2/9 patients (22.2%) had
BU-Cy conditioning and 18/28 (64.3%) Flu-Cy-ATG conditioning. Late graft failure (J60 to J511)
was observed in 5 patients (13,5%). Acute GVHD occured in 13 patients (43,3%) with 10 grade
II-IV (33,3%) and chronic GVHD in 5 patients (20,8%) with 3 extensive. Seventeen patients died
(45,9 %): 11 patients (29,7%) by transplant related mortality (TRM): infectious: 4, grade II-IV
acute GVHD: 4, extensive chronique GVHD: 1, hemorrhage: 2. Six patients by another causes
of death: graft rejection: 4, secondary neoplasia: 1, unknown: 1. Actuarial overall survival (OS) is
49,8% at 9 years. TRM was higher in Bu-Cy conditioning group (44,4%) than Flu-Cy-ATG conditioning group (25%; p = 0,07)) and OS is 63% at 9 years in Flu-Cy-ATG group.
Conclusion:
Flu-Cy-ATG conditioning regimen appears better than BU-Cy. A best outcome can be reached
by precoce diagnosis and by reduction of interval from diagnosis to allograft.
47
OR-32
EVALUATION OF PATIENTS WITH MYELODYSPLASTIC SYNDROMES. A RETROSPECTIVE STUDY.
S.Bougherira, F.Grifi, B.Rached, H.Mehennaoui.
Department of Haematology – CHU ANNABA. ALGERIA
Background:
Myelodysplastic syndrome (MDS) is a clonal haematopoietic stem cell disorder, characterized
by ineffective dysplastic haematopoiesis, and peripheral cytopenias. It is considered a pre-leukemic disease (about 30% of MDS turn into acute leukemia) which is associated with cytogenetic
abnormalities.
The aim of this study is to collect the epidemiological data and clinical characteristics; and to
evaluate the therapy of MDS.
Retrospective study between 2005 to 2009, including 60 patients treated in our department for
MDS. The median age was 59 years (range 10 to 83), gender 30 women and 27 men. The diagnosis is based in analysis of the blood film and the bone marrow aspirate and trephine biopsy.
Resultats:
Time for diagnosis, varied from one week to 36 months. The mean clinical features of our
cohort anaemia’s syndrome was present in all patients, splenomegaly only in 11 % of cases occurs in CMML, recurrent infection and bleeding‘s syndrome. Biological methods found moderate
cytopenia; Blood and marrow cytological analysis show, among all patients, signs of dysplastic
cells. Perls colouring was used only for 05 patients; cytogenetic analysis was done in three cases
(1 pt with normal karyotype, 1 pt with 5q-, 1 pt with complex abnormalities involve chromosome
5 with monosomy 7).
The distribution of patients according to classifications’:
AR
18
FAB Classification
ASIA AREB AREB-t
05
22
08
LMMC
07
AR
15
AS pure
04
WHO Classification
AR/CRDM AREB I
12
12
AREB II
10
SMD/SMP
07
While there is new treatment approved for MDS, supportive care remains an integral component of care for these diseases. All patients received supportive care: RBC transfusions for
symptomatic anemia as needed, platelet transfusions for thrombocytopenia or bleeding, management of iron overload, and recently hematopoietic growth factors. Chemotherapy in some
48
cases. The only curative treatment is stem cell transplantation. The evolution was marked by
occurrence of an acute leukaemia of unfavourable prognosis.
Conclusion:
MDS are a relatively frequent affection raising difficulties in therapy in spite of the advent of
new strategies and new molecules.
49
OR-33
USING COMPUTERS TO IMPROVE DONOR MANAGEMENT
AND TRANSFUSION SAFETY
Ktari Kamel
The objective of transfusion (patient) safety makes blood transfusion increasingly complex.
The progress of medicine and the discovery of new pathogens increase the number of tests
required. Their modes of contamination and the serological window bring greater complexity in
the medical interview and induce complex treatments for securing certain products. The long
period of serological window, as well as the fear of presence of unsuspected pathogens forces to
maintain traceability over periods exceeding 30 years. Recently this traceability was extended to
all staffs, equipments and consumables involved in the process. The multiplicity of tasks, and the
vast amount of information to manipulate and then to store make the mission of blood transfusion
centres impossible to achieve manually and lead to significant decrease in the patient safety. We
will see in this presentation how information technology can help blood transfusion centres to
reach their aim and improve the transfusion safety.
50
OR-34
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51
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52
THE ABSTRACTS
Section II: Poster Session
PO-01
CLINICAL ANALYSIS, OF MALIGNANT NON HODGKIN’S
LYMPHOMA OF THE ORBITAL REGION: 02 CASES
A.Salmi and PRN Mesli
Hematologie clinical hospital Tlemcen Algeria
Purpose:
Diagnostic and therapeutic management about two cases of malignant non-Hodgkin’s lymphoma of the orbital region.
Patients and method:
We report the cases of two patients referred for acute or chronic loss of visual acuity. The first
patient has consult for a tumor of the left eye and dacryoadenite. The second patient has consult
for the same symptoms and exopthalmous associated with a ptosis. All of them suffered from
uveitis or scleritis resistant to corticoid treatment. Search for an infections or immune malignant
disease was negative.
Results:
Diagnosis of high grad malignant non-Hodgkin s lymphoma centroblastique in the first and
low grad lymphoplasmocytaire in the second was assessed after biopsy of the tumor orbital.the
immunohistochemical analysis is not available. The two patients underwent chemotherapy associated with chirurgical for one patient. The lesion were stable in one case but the acuite visual
has disappear
Discussion:
The diagnosis of malignant non-Hodgkin s lymphoma of the orbital must be assessed by an
early biopsy and immunoistochemical analysis. Then a specific treatment must be instituted to
limit the loss of the vision. All cases of chronic and cornea resistant uveitis require a specialised
radiological evaluation followed if necessary by multiples orbital biopsies
55
PO-02
SPLENIC LYMPHOMAS:
A REPORT OF 18 CASES
S. Hamdi; M. Dali; FZ.Benkhodja;
A. Amoura; N. Zatout; F. Z.Nasri.
Department of Hematology - CHU de Setif – Algeria
Introduction:
If the spleen secondary damage is very common in lymphomas, the primary achievement is
rare (0.5 to 2%). The primitive splenic lymphomas are characterized by the presence of splenomegaly without lymphadenopathy surface, possibly associated with bone marrow infiltration.
The imunophénotypage allows for the differential diagnosis between lymphoid proliferations. We
report 18 cases of splenic lymphoma followed between 1998-2009.
This is a retrospective study comprising 10 men and 8 women, mean age was 57 years (21-71
years). The diagnosis is established after a splenectomy (6cas) and after biopsy (12cas). Immunophenotyping was performed in 8 patients. The staging is done according to the terms of nodal
NHL. The protocols used: CHOP (n = 9), 3 with rituximab, COP (n = 2), CF (n = 1), endoxan (n =
3), three patients were not treated.
Results:
The histology shows: lymphocytic and lymphoplasmacytic lymphoma (6 cases), marginal zone
lymphoma (5 cases), diffuse small cell Centrocytic lymphoma (1case) and large cell lymphoma
(6cases) including 2 cases of phenotype T. Circumstances of discovery: splenomegaly: 100% of
cases. PS0-1: 67%. LDH in 50% normal, bone marrow affected in 83% of cases. Therapeutic
results in 16 evaluable patients: RC: 8cas (50%), PR: 4 (25%), Failed: 4 (25%) deaths: 5 (31%)
relapsed: 3 (37%). Overall survival (OS) and Disease free survival (DFS) respectively 70% and
50% at 7 years.
Conclusion:
The primitive splenic lymphomas are rare and have the distinction of being associated with
bone marrow. Splenic lymphomas are generally indolent and According to the WHO classification, the entity lymphoma marginal zone is the most common. The therapeutic results are within
the range of published series. Splenectomy combined with chemotherapy is the treatment of
choice.
56
PO-03
LYMPHOME DIFFUS A GRANDES CELLULES B
À LOCALISATIONS MULTIVISCERALE
A PROPOS D’UNE OBSERVATION
F. Fergane, K. Benallaoua, H. Laga, W. Chaba, S. Dechir, R. Drif,
N. Dali, O. Ouanes, K. Ait Seddik, M. Alllouda,
S. Gherras, H. Aftisse, A. Graine, Et Pr. H. Ait Ali
Service d’Hématologie CHU de TIZI- OUZOU
Introduction:
Les lymphomes diffus à grandes cellules B sont la variété la plus fréquente des lymphomes
non Hodgkiniens (LNH), ils représentent un tiers de l’ensemble des lymphomes. Cependant les
localisations multiviscérale restent rares.Nous rapportons l’observation d’un patient atteint d’un
LNH B à localisations multiviscérale, révélé par une atteinte cérébrale et associant des localisations cutanée, pulmonaire, rénale et mésentérique.
Observation:
IL s’agit d’un patient âgé de 44 ans, sans ATCD pathologiques, admis le 04/10/2008 pour prise
en charge d’un LNH à grandes cellules B.
Le début remonte à Février 2008 par une hémiparésie droite avec à l’ IRM cérébrale de multiples lésions nodulaires de la substance blanche pariéto-insulaire gauche, une origine tuberculeuse à été évoquée (IDR à la tuberculine 15 mm), donc il a été mis sous anti- tuberculeux mais
sans résultats. Six mois après, le patient présente des nodules cutanés et des ADP inguinales.
L’étude histologique de biopsies ganglionnaire et d’un nodule cutané est revenue en faveur d’un
LNH à grandes cellules B, CD 20 positif.
L’examen à l’admission: patient en état général conservé, présentant des signes généraux
(sueurs nocturne, amaigrissement), ADP axillaires et inguinales bilatérales, hémiparésie droite
avec dysarthrie,
Bilan d’ extension: TLT: ADP médiastinales (IMT: 0, 34), TDM thoracique: ADP médiastinales,
et nodules pulmonaires bilatéraux,TDM Abdominale: reins globuleux siège de multiples formations nodulaires, des nodules mésentériques ainsi que des ADP intra et rétro- péritonéales.Le
bilan hépatique et la biopsie médullaire sont sans anomalie.
Il s’agit donc d’un LNH à grandes cellules B CD20 positif stade IV B (classification d’ Ann Arbor) avec localisations multiviscérale (cérébrale, cutanée, pulmonaire, rénale et mésentérique).
Décision thérapeutique: 08 cures R- CHOP associées à une chimiothérapie intra-thécale (06
inj).
Le patient est vivant, en rémission complète depuis 13mois, mais ayant gardé une démarche
57
en fauchant du membre inférieur droit ainsi qu’une main en griffe, séquelles de la localisation
cérébrale.
Conclusion:
l’atteinte multiviscérale au cours des LNH à grandes cellules reste rare, la localisation et le
pronostic souvent réservé, mais une rémission complète avec une chimiothérapie de première
ligne reste possible, c’est le cas chez notre patient.
58
PO-04
MEDIASTINAL LARGE B-CELL LYMPHOMA
A CLINICOPATHOLOGIC REVIEW OF 17 CASES
S. Hamdi; FZ.Touil; A.Achichi; Z.Bouhadda; S. Lekhel; Z. Nasri.
Department of Hematology - CHU Setif - Algeria
Introduction:
The primitive lymphoma of the mediastinal (LPM) is rare, they account for 6-10% of all nonHodgkin lymphomas and their histological type varies by age. In adults, lymphoma diffuse large
B cell sclerosis is an anatomo-clinical entity now well defined and their frequency is 2.4% of all
lymphomas, located in the anteroposterior region of the mediastinal, they come from B cells the
thymic medulla. We report 17 cases followed between 2000 and July 2009.
The diagnosis is made following a pleural biopsy in 7 cases, transparietal biopsy in 10 cases.
The histological type is diffuse large B-cells in all patients. Immunophenotyping done in 10 subjects reveal a tumor population expressing CD20, CD79a + and CD 23 expressing neither EMA
nor CD30.
Results:
Age below 40 years for 13 patients (76%), the average age is 31 years. There are 13 women
and 4 men. The circumstances of discovery are represented by chest pain associated with cough
in 53% and a superior vena cava in 35%. The prognostic factors are present in 2 / 3 of patients
about (LDH> normal in 70%, Bulky mediastinal mass > 10 cm in 71%). The extra nodal sites
are contiguous with the lung (29%), pericardium (24%) and pleura (35%). Other visceral are the
bone marrow (6%) and liver (6%). Protocols used: COP / BLAM III: 8 cases - C2H2OPA: 8cases
+ rituximab: 4cases and RCHOP: 1cases. Follow-up:7 – 54 months. Results: complete response
(CR): 59%, Partial response (PR): 18%, failure: 23%, relapse: 30%. We record 9 deaths (53%).
Overall survival (OS) and disease free survival (DFS) respectively 45% and 30% at 5 years
Comments and conclusions:
The primitive lymphoma of the mediastinal with large B cells respond well to a particular entity.
Indeed, the differences compared to other aggressive nodal lymphomas are: female, median age
30 years, the tumor bulky (> 7cm) with involvement of contiguous sites (pleura, lung and pericardium), the rate LDH often high and the clinical stage usually localized. The rate of complete
response is a share in the range of series reported in the literature and secondly, it has improved
since the introduction of rituximab and the intensification of CHOP, however, the series is limited
and the short period. Moreover, optimization of improvement lies in the practice of intensified
consolidation therapy followed by autologous stem cells.
59
PO-05
THE PRIMITIVE GYNECOLOGICAL LYMPHOMAS:
A REPORT OF 3 CASES
S. Hamdi; I. Bentahar; N. Belahdaia; N.Zatout.
Department of Hematology - CHU de Setif - Algeria
Introduction:
The gynecologic organ involvement by non-Hodgkin lymphoma is rare (less than 1%). We
report two cases of ovarian lymphoma and one case in the cervix.
1st observation: Girl 25 years old, single, PS: 2. Consults for abdominopelvic mass accompanied by pain without lymphadenopathy. A laparotomy with oophorectomy left + right oophorectomy were performed. The histological study objective NHL diffuse small cell ovarian localization.
Staging allows to classify the disease stage IV according to Ann-Arbor’s classification (liver).
2nd observation: Woman 36ans, mother 2enfants, PS 2, has abdominal pain without pelvic
lymph nodes, the scanner showed a tumor of ovarian 75/57mm. Histology: NHL diffuse large cell
B. Staging allows to classify the disease stage I according to Ann- Arbor. It received 5 courses
of CHOP, after complete remission, she is put under rituximab maintenance. She is alive at 25
months.
3rd observation Female 48 years old, mother of 09 children. PS: 1; this pelvic pain, ultrasound
objective abdominopelvic solid mass in the vagina de7/6cm. The scan shows a pelvic mass occupying the lower cervical region. The biopsy of the tumor to objectively review the pathological
the NHL diffuse large cell. The staging allows the patient to classify the stage IE. She received 6
courses of CHOP but lost sight in 6months.
Comments- conclusions:
The primitive sites (ovaries and cervix) without lymphadenopathy confirm the location as extranodal. The existence of primary ovarian lymphoma is now recognized by highlighting different
study by the presence of aggregates of lymphoid cells in normal ovarian parenchyma, and the
existence of long-term survivors in complete remission after treatment. That of cervical lymphoma is even rarer because sixty cases were reported in the literature.
60
PO-06
ABOUT A CASE OF NON-HODGKIN LYMPHOMA
OF HIGH GRADE MALIGNANCY
N. Hout; , Mesli N.
Department of Clinical Hematology - University Hospital Tlemcen, Algeria.
Introduction:
The non-Hodgkin lymphoma represents a group of lymphoproliferative disorders, characterized by their heterogeneous clinical, histological, therapeutic and prognostic, results of infiltration
(nodal and extra nodal) by malignant lymphoid cells from either line B or T.
Goal
The purpose of this presentation is to present a real therapeutic problem facing a case of nonHodgkin lymphoma initially chemo sensitive node in a immunocompetent man who later relapsed
with cutaneous localization highly chemo-resistant
Comment:
We report a case of non-Hodgkin lymphoma of high grade malignancy diagnosed in 2006 in a
patient aged 27, male, immunocompetent diagnosis by pathologic study of lymph node biopsy,
which revealed the nature of the anaplastic lymphoma tumor proliferation suggestive of NHL of
high grade malignancy. In staging the patient was classified stage III A.
Therapeutically the patient received CHOP chemotherapy was the second course, loss of
peripheral tumor syndrome. After six months of treatment (08 treatments), the patient returned to
full remission. We undertook a quarterly monitoring clinical and laboratory until the end of 2009
the patient presented a resumption of tumor syndrome associated with superficial and deep to a
secondary location said diagnostic skin biopsy of the skin lesion which immunostaining said the
phenotype of T malignant proliferation. The patient received two treatments MBACOD but due
to the disruption of the renal doses were adjusted according to creatinine clearance ; two DHAP
courses and one EPOCH courses. After each course we noticed a tumor regression syndrome
as well as the size of the training skin but short with relapse in inter cure made a resumption of
tumor syndrome and a widening of the training skin associated with the development of a new
headquarters location of secondary bladder.
Discussion:
* CHOP chemotherapy given in remission forms favorable; but the risk of relapse after discontinuation is inevitable.
* Installing a secondary cutaneous localization and bladder chemoresistance compromises the
61
prognosis
* The introduction of multiple chemotherapy exposes my patient at important hematologic and
renal toxicity.
* It is treated within the protocols of the nodal primitive or adds to the treatment indicated in
cases of secondary locations including skin.
* Chemoresistance to different protocols introduced us to face a therapeutic impasse.
Conclusion:
The natural history of NHL remains burdened extended relapse less sensitive to chemotherapy practitioners posing a real problem of therapeutic management compromising the prognosis
and quality of life of patients.
62
PO-07
THE NON HODGKIN’S LYMPHOMAS OF ADULT IN THE
NORTH–EAST OF ALGERIA: ANATOMO–CLINICAL STUDY
Mehennaoui-Toumi H.1, Lankar A.2, Boughrira S.1, Grifi F.1
(1) Heamatology Service, Dr. Dorban Hospital, C.H.U. Annaba (Algeria)
(2) Pathological Anatomy Service, Ibn Rochd Hospital, C.H.U. Annaba (Algeria)
The non-Hodgkin’s lymphomas are lymphoid malignancy, derived from lines B or T. Their incidence has increased dramatically in the past decades. Our study is descriptive and is 7 years
long, from January 2000 up to December 2004, for retrospective study, and from Junuary 2005
up to December 2006, for the prospective study. It has interested 111 patients who present a lymphoma of the lymph node. The median age is 52 years (range 16 - 96 years). The ratio-sex (M/F)
is equal to 1,85. The diagnostic mean deadline is 4,5 months. The clinical array is dominated
by the adenopathies. The most frequent associated extra nodal localisations are: oral, pleuropulmonar and digestive. The anatomo-pathologic diagnostic has revealed a net predominance
of the aggressive lymphomas (75%). The immunohistochemical study carried over 37 patients
has allowed to state that the frequency of type B is 89%. The extension bilan shows that 63% of
the patients are on the extended stages of the sickness (III and IV). The appreciated prognostic,
from I.P.I. point of view, for the aggressive lymphomas reveals a rate of 70% of patients of pejorative risk (high and high intermediate) and the predominance of cases of big tumor mass for the
indolent lymphomas. The most used protocole is the CHOP. Because of immunohistochemistry,
patients have been treated by monoclonal antibody (anti-CD 20). The ratio of global reaction
observed on patients who present aggressive lymphomas following a retrospective study is 64,1
% whereas in the prospective study it is 78,2 %. In the case of indolent lymphomas, the complete reaction is observed on 63 % of patients treated in the retrospective study and is 83 % on
patients from the prospective group. The median steady period of the aggressive lymphomas is
20,2 months (range 1 - 73 months). The median time up to progression for the indolent lymphomas is 31,6 months.
63
PO-08
LYMPHOMES OSSEUX B PRIMITIF A LOCALISATION
DIFFUSE A PROPOS D’UN CAS
N. Dali1, M. Allouda1, K. Ait-Seddik1, O. Ouanes1, S. Gherras1, H. Aftisse1,
Et H. Ait-Ali1, M. DJENANE2
1 Service d’Hématologie, CHU DE TIZI-OUZOU.
2 Service de Rhumatologie, CHU DE TIZI-OUZOU.
Introduction:
Des lymphomes osseux primitifs (LOP) représentent 1% de l’ensemble des lymphomes, 5%
des présentations extranodales et 07% de l’ensemble des tumeurs osseuses malignes. Le mode
de révélation clinique est celui de toute tumeur osseuse: douleurs, fracture. Les os longs sont
plus souvent concernés que le squelette axial. Les LOP se présentent comme une lésion unique,
localisée. Le phénotype B est le plus souvent rencontré. Nous rapportons l’observation d’un patient atteint d’un LNH B à localisations osseuses diffuses exceptionnelles.
Observation:
Il s’agit d’un homme de 65 ans, sans antécédents notables, qui présente depuis 02 mois des
douleurs osseuses avec conservation de l’état général. L’examen clinique retrouve une tuméfaction siégeant au niveau de la clavicule droite, fixe, sans signes inflammatoires en regard. Par
ailleurs absence de syndrome tumoral périphérique et profond.
La radiographie des membres supérieurs, inférieurs, crâne et thoracique a objectivé un processus lésionnel tumoral ostéolytique très important (tibia péroné - carpes – métacarpes- humérus, cubitus, radius, tarses, métatarses, fracture de la clavicule, crâne) faisant évoquer un
diagnostic de métastases osseuses ou maladie de paget. Le bilan d’extension initial était strictement normal confirmant le caractère primitif. L’histologie de la biopsie claviculaire conclue à un
plasmocytome mais le bilan d’un myélome multiple était négatif. Médullogramme, électrophorèse
des protéines, protéinurie de 24h, bilan phosphocalcique normaux. En quelques mois, l’état général du malade s’est dégradé rapidement, avec apparition de lésions cutanées multiples de 4 à
5 cm de diamètre de siège diverses (cuir chevelu, front, face interne des 02 jambes et coudes).
La 2ème TDM thoraco-abdomino-pélvienne retrouve des nodules pulmonaires du lobe supérieur gauche et des adénopathies iliaques. Sur le plan biologique, on a noté une hypercalcémie
maligne à 200 mg/l nécessitant une réanimation et un traitement par biphosphonate. L’histologie
de la biopsie cutanée et l’immunohistochimie de la biopsie claviculaire concluent à un LNH de
haut grade de malignité de phénotype B. Ce diagnostique a été confirmé par le groupe d’études
Algérien des lymphomes (GEAL).
Le patient a bénéficié d’une chimiothérapie: 03 cures de (R-CHOP) avec une réponse favorable à 60 %, mais malheureusement il a présenté une toxicité cardiaque. Les traitements de
64
relais étaient sans succès avec apparition d’autres localisations notamment cérébrales et ophtalmiques. Le malade est vivant en échec thérapeutique.
Conclusion:
Notre observation est exceptionnelle par la localisation osseuse diffuse, mais ayant les mêmes
particularités para cliniques et histologiques que celles rencontrées dans la littérature.
65
PO-09
RESULTS ABVD PROTOCOL IN THE TREATMENT
OF HODGKIN LYMPHOMA IN ADULTS
M. Zaidani1, N. Bouanani1, L. Jabri2, N. Benchekroun3, A. Abdelouafi4, S.
Benchekroun1, A. Quessar1
1. Service d’Hématologie et d’Oncologie pédiatrique, Hôpital 20 Août 1953 ; CHU Ibn Rochd, Casablanca, Maroc
2. Laboratoire d’Anatomo-pathologie, Hôpital Ibn Rochd, CHU Ibn Rochd, Casablanca, Maroc
3. Service de Radiothérapie, Hôpital Ibn Rochd ; CHU Ibn Rochd, Casablanca, Maroc
4. Service de Radiologie, Hôpital 20 Août 1953 ; CHU Ibn Rochd, Casablanca, Maroc
Introduction:
The ABVD protocol is a gold standard treatment for Hodgkin lymphoma (HL). In this study, we
present the results of prospective study, spanning the period from March 2007 to March 2009,
our aim objectives are to analyze the efficacy of this combination in the treatment of patients with
HL.
Methods:
The HL has been confirmed, according to the WHO classification, the stages were identified after a staging systematic: clinical examination, ESR Blood Chemistry, CBC, bone marrow
biopsy, chest radiograph and CT scan. The chemotherapy program was ABVD (doxorubicin,
bleomycin, vinblastine and Dacrabazine). The number of cycles was determined by prognostic
groups (EORTC prognostic), Patients with early stages (favorable group received 4 cycles and
6 cycles for the unfavorable group) followed by radiotherapy IF; patients with advanced stage
received 8 cycles, only those with bulky tumor received radiotherapy.
Results:
During 2 years, 94 cases were included, the mean age was 35 years [17-60], more men (63%)
than women (37%). the nodular sclerosis subtype was predominant (62.8%). Bulky tumor mass
was present in 36 cases. 40 patients were early stage (44.5%), only 4 of them had a favorable
prognosis. Advanced stages represent 55.5% with a high score (IPSS> 2) in 46 cases.
In The early stage group, the complete remission was obtained in 34 patients (85%), 6 patients
field to achieve CR, only one of them achieved CR after intensification, any case of relapse was
noted. Thirty eight patients among advanced stage group achieved CR (70,4%), the failure was
observed in 9 cases; 6 patients lost during treatment, the relapse was noted in 4 cases, 7 patients died in failure or after relapse.
The Overall survival at 36 months was 100% for the early stage group and 78% in advanced
stage group; the event free survival was 85% in the early stage group and 64,3% advanced stage
group.
Conclusion:
The results obtained with the ABVD protocol in our study were correlated with clinical stages
and join those in the literature. However, the problem of patients lost to follow-up make difficult a
proper interpretation of these results.
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PO-10
MEDIASTINAL LARGE B CELL
LYMPHOMA ABOUT 12 CASES
F. Belhadri, H. Moussaoui, F. Boukhemia, N. Abdennebi, S. Belattaf L.
Kouici, D. Benali, S. Zeghouati, N. Boudjerra, RMH. Hamladji.
Department of Haematology and Bone Marrow Transplantation; Pierre and Marie Curie center, Algiers, Algeria
Introduction:
The mediastinal large B cell lymphoma is a recent individualized entity, described the first time
in 80’s.It develops from B cells of the thymus medulla with distinctive clinical, histological, immunohistochemistrical and genetic features. It represents 2.4% of non-Hodgkin lymphoma and
5% of large B cell lymphoma.
Material and methods
From September 2006 to September 2009, 12 cases of large B cell lymphoma of the mediastinum were diagnosed. 5 patients were treated according to protocol R-CHOP (Rituximab 375mg
/ m2 day 1, Adriamycin 50 mg/ m2 day 1, cyclophosphamide 750 mg/ m2 d1, Oncovin 1.4 mg / m2
d1 and Prédnissone 40mg/ m2 of d1-d5) at the rate of a cure every 21 days and 6 patients were
treated according to Protocol RC2H2OPA (Rituximab 375mg/ m2 IV in d1,, Cyclophosphamide
1.5 g/ m2 IV d2, Adriamycin 90 mg/ m2 IV d1, Oncovin 1.4 mg / m2 IV d1, Ara-C 100mg / m2 d1
to d3 in subcutaneous, Prednisone 80mg / m2 d1 to d5 or SLM 100 mg/ m2), at the rate of a cure
every 21 days.
Results
The median age of 12 patients (pts) is 27 years (17 to 37 y) and sex ratio (M / F) 1. Clinically,
the reason for consultation is dominated by the functional respiratory signs, present with 5 pts
(42%), the superior vena cava syndrome with 4 pts (33%) and chest pain with 3 pts (25%), 8
pts (67%) had ECOG 1 and 4 pts ECOG 2 (33%), the general signs found with 4 pts (33%)
and in physical examination 10 pts (83%) had a superior vena cava syndrome. The diagnosis
was established by histology after image-guided percutaneous needle aspiration biopsy of the
mediastinum for 08 pts (67%) and after thoracotomy for 4 pts (33%), it was mediastinal large B
cell NHL for 04 pts (33 %), thymoma for 06 pts (50%), Hodgkin’s disease or thymoma for 01 pt
and Hodgkin’s disease for 01 pt. The average diagnostic delay of 03 months (o1-11), a bulky
mediastinum was noted in all patients with MTI (mid-thoracic index) through 0.45 (0, 30 -0.68),
two pleural effusions, two pericardial effusions and jugular vein thrombosis in 6 pts (85%) for 7
Doppler ultrasound done.
Therapeutically, 4 pts received 8 cycles of R-CHOP, one patient received 5 courses with 2
incomplete remissions (RIC) and 3 fails, one patient received radiation, not made for the other
67
patients because of the evolutive disease, intensification with autologous made for one patient.
One patient is alive and in CR with a survival of 11 months, four (4) died with median survival 16
months (14 to 30).
Six (6) pts were treated according to Protocol RC2H2OPA with one complete remission and
5 incomplete remissions. Six (6) pts received radiation therapy, one patient underwent an intensification with autologous bone marrow transplantation. One patient died at 15 months, five (5)
pts are alive with a median survival of 10 months (7-19). One patient was treated according to
protocol RDHAP (for patient already treated with max doses of anthracyclines), in the end the
treatment failed (died).
For the protocol RCHOP good tolerance was observed in all pts, for protocol RC2H2OPA cytopenia after the first course was observed with two pts, whose nadir (GB 200: mm3, HB 8.9 g /
dl, PLQ 54,000 / mm3)
Conclusion
The Mediastinal large B cell lymphoma is a pathology of young patient. Superior vena cava
syndrome is predominant, the tumor is large. A diagnosis problem with thymoma and Hodgkin’s
disease, where the interests of the immuno histochemistry. R-CHOP is ineffective in our series.
The RC2H2OPA is better than R-CHOP but now the decline is insufficient.These results require
us to be careful in the diagnosis and to adapt a therapeutic strategy to improve the overall survival of these young patients.
68
PO-11
ACTIVITY OF ALGERIAN STUDY GROUP ALGERIAN
OF LYMPHOMA (GEAL):
SUB GROUP OF PATHOLOGY OF MIDDLE CENTER
K. Mekhelef ,F. Acherar, K. Bendisari1,B. Latreche, O. Tebbakha,
R. Baba-Ahmed2, Z.C.Amir, A. Belarbi, F. Asselah3,M.C. Cherid,
A. Tidadini , N. Terki4, A. Abdennebi, N. Benmebarek, K. Kalem5,
C. Graredj, Y. Lamouti6 Y. Ighil-Agha, W. Ouahioune7, M.C.Benremouga,
A. Kacimi8,S. Benabidellah, N. Hennab9, J. Audouin10, N. Boudjerra11
1:CHU Beni Messous, 2: CHU Bab El Oued , 3: CHU Mustapha , 4: EHS Pierre et Marie Curie,
5: CHU Hussein Dey, 6: CHU Blida , 7: CHU Douera , 8: HCA Ain Naadja , 9: CHU Tizi Ouzou ,
10: Hôtel Dieu Paris , 11: National Co-ordinating of Lymphoma
Introduction:
Non Hodgkin’s Lymphomas are cancers that originate from B or T lymphocytes and rarely
from Natural Killer)NK cells). They encompass an extremely heterogeneous group of diseases ;
the heterogeneity is based on the multiplicity of histology sub types, clinical presentations)nodal
and /or extra nodal), tumor behavior)localized vs disseminated), and the presence /absence of
concomitant disease impacting treatment option.
For this reasons the Algerian Study Group of Lymphomas)GEAL) created on the 26th. A sub
group created to deal with the pathologist of the Middle centre.
Materiel and methods:
Diagnosis of lymphoma always require biopsy or resection followed by full pathologic analysis
including cytology and immunology. CD 20 and CD3 antigen positive tissue indicates either B
or T cell lymphoma. In all difficult cases, the diagnostic must be confirmed by more pathologists
specializing in the diagnosis of lymphoproliférative disorders.
From February 2007 to Mars 2010, 237 difficult cases of lymphomas (nodal and / or extra
nodal) were analyzed by the sub group of pathology.
Results:
The nodal Lymphomas are predominant (65%), the Diffuse Large B Cell Lymphoma (DLCL)
accounts 47.5 % of all lymphomas, the median age was 45 years. The initial diagnostic histology
is confirmed in 70 %.
Conclusion:
The diagnosis of lymphoma require a good biopsy, and analysis including cytology and immunology. The confirmation by more pathologists is very important in the difficult cases.
69
PO-12
PRIMARY NON HODGKIN’S LYMPHOMA OF THE ADRENAL
GLAND: CASE REPORT AND REVIEW OF THE LITERATURE
Semoud.I -Djennouni.A-Bencheikh.N-Boughrira.S -Grifi.F
Service of Hematology, CHU Annaba, Algeria.
Introduction:
The primary lymphoma of the adrenal gland is very rare, less than 100 cases have been reported in the literature.
Comment:
We report the case of a patient aged 52 years admitted to: General symptoms: fever,
asthenia,weight loss and lumbar pain. Abdominal CT scan objective left adrenal mass. The diagnosis of B cell lymphoma of the adrenal gland was made after immunohistochemical study of
the surgical resection piece. The staging did not show any other lymph node or visceral location
and concluded to primitive NHL.
The patient subsequently developed thrombosis of the inferior vena cava with pleural effusion.
She received chemotherapy R / CHOP with symptomatic treatment. After 6 cycles, the results
are favorable with a retroperitoneal fibrosis. After 12 months of follow-up, the patient is always
in remission.
Conclusion:
The adrenal gland lymphoma is rare and should be considered in any adrenal mass to avoid
the use of aggressive surgical exploration.
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PO-13
DIAGNOSIS OF LYMPHOPROLIFERATIVE
DISEASES BY FLOW CYTOMETRY (FCM)
S. Taoussi, S. Oukid; M.T. Abad
Department of Hematology, EHS CAC, Blida, Algeria
Background:
The approach to the classification of hematologic neoplasms by FCM gives us the large
amounts of valuable information to define and specify the monoclonality of these tumors. Flow
cytometry (FCM) is on use consistently in our laboratory in complement to cytology and histology.
We report the results of 149 patients that have chronic lymphocytosis evaluated by flow cytometry in the hematology department EHS CAC, Blida.
The methods are based on clinical examination, a cytological study and immunophenotyping
performed on a blood sample in 149 patients and a bone marrow sampling in 02 patients; In the
first approach, the samples are analyzed with a large panel of monoclonal anti bodies. The number of antibodies in the panel is sufficiently extensive to permit a full characterization of lymphoid
proliferations of B, T and NK cells.In the second approach, the FCM study starts with a limited
and selected panel.The results are based on using the Matutes score and the percentage and
intensity of positive cells.
Results:
CLL: 94 patients with a Matutes score: 3 / 5: 03 Pts, 4 / 5: 44 pts and 5 / 5: 47 pts.
Mantle NHL: 20 pts.
Villous NHL: 09 pts.
Follicular NHL: 08 pts.
NHL of marginal zone: 06 pts
Prolymphocytic leukemia: 01
T leukaemic NHL: 01 pts.
Undefined NHL: 05 pts.
Hairy cell leukemia: 04 pts.
Normal: 01 pt
71
Comments:
FCM has proven to be extremely helpful in diagnosing and classifying mature B-cell neoplasms.In our population, FCM specified the nature of lymphomatous monoclonal populations
in most patients. Correlation among the FCM data, lymphocyte count, blood, marrow or lymph
node smear morphology, and clinical findings is therefore often necessary. Immunophenotyping
by flow cytometry should be a routine method for diagnosis when lymphoproliferative disease is
suspected.
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PO-14
COMPOSITE LYMPHOMAS ABOUT ONE CASE
Menad.A,Bensmaine. m.a, Yachekour. T, Aberkane.m,
Zouani.s, Taibi.k, Touhami.f, khalfi.a, Belazreg.a, Touhami.h,
Sc of hematology CHU of Orane.ALGERIA
Introduction:
The composite lymphomas represent an entity individualized within the lymphomas defined
by an association of two lymphoid malignant hemopathy at the same patient. In the majority of
the cases in the literature, it is about the association of hodgkinien lymphoma and no hodgkinien
lymphoma. We report a case of them.
In our presentation: bringing back a case of association: multiple myeloma with a diffuse large
B- cell lymphoma (DLBCL).
H B.A age 69 years old in September 2009 the diagnosis of a multiple myeloma with IgA λ
stage III B and diffuse large B- cell lymphoma (DLBCL) stage VI,medullary and hepatic,diagnoses
posed on a Lymphnod biopsy and osteomédullary biopsy, treated by protocol VAD after 3 courses à RP 50% for the NHL we started protocol CHOP after 06 COURSES a RCU of the lymphoma
was obtained then one took again the treatment of the myeloma protocol VMCP, after 10 of
chemotherapy course
Conclusion:
The composite lymphomas pose a problem of diagnosis and therapeutic and which does not
appear in classification WHO 2008.
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PO-15
CHARACTERISTIC OF NON HODGKIN’S LYMPHOMA
IN ALGERIA ABOUT FOUR YEARS: 2006 – 2009
N Boudjerra
Algerian Study Group of Lymphoma (GEAL)
Introduction:
Non Hodgkin’s Lymphoma (NHL) is composed of a group of lymphoid malignancies that has
been increasing in incidence at an annual rate of 4 % to 7%, over the last 20 years in both United
States and Europe, this analyses suggest that it is also the case in developing countries.
Methods:
1100 patients were studied about four years (2006 – 2009), eleven centers of hematology in
Algeria participated for this study.
Results:
We observe increase of lymphoma , the number of diagnosed cases was 186 in 1998 and
342 in 2008. The World Health Organization (WHO) classification was utilized by all, the Diffuse
Large B cell Lymphoma (DLCL) account 47.5 %, the mean age of patients was 48 years, sex
ratio M/ F: 1.40. Consensus therapeutic was adopted since 2007: CHOP or R CHOP (indolent
or aggressive lymphoma), C2H2OPA (Mediastinal lymphoma), COPADEM (burkitt’s lymphoma),
Linker (lymphoblastic lymphoma).
Conclusion:
Lymphomas are group of cancers that share a common cell of origin and a particular mode of
development. They consist of numerous subgroups, some of which can be cured with conventional therapy, while others more intensive treatments.
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PO-16
T-NK LYMPHOMAS OF NASAL TYPE:
CLINICAL ANATOMY STUDY OF SEVEN CASES
Mehennaoui-Toumi H., Bencheikh N., Boughrira S., Grifi F.
Heamatology Service, Dr. Dorban Hospital, C.H.U. Annaba (Algeria)
Introduction:
The T-NK lymphomas of nasal type represent a rare but aggressive form of malign lymphatic
proliferations.
We report through our experiment of taking in charge 7 patients, the clinical, the anatomopathologic and the evolutive characteristics of this pathology.
The medical files of 7 patients (4 women and 3 men) have been studied for the years from
2003 to 2009.
Results:
The average age of our patients is 45,7 years where the extrema are 19 and 74 years. The
clinical table associates the ORL manifestations of type dysphonia, nasal obstruction, epistaxis,
disphagia, hypacousia. In most cases, the sickness is localised (IE, IIE), the IPI is less than or
equal to 2 in all cases. The anatomo-pathologic study confirms the tumoral proliferation made
of positive big cells with the 45CD and the 3CD. The therapeutic choice is directed toward the
L-Asparaginase-Dexamethasone Velbé association to 4 patients and the response is good for 2
cases. The patients who are initially treated by CHOP have rapidly relapsed. In the terms of our
study, 5 patients are alive: 2 in complete relapse after one chemotherapeutic line and 3 after the
second and third chemotherapeutic line. Two patients have died. The average survival is of 27
months (2-69).
Conclusion:
The T-NK lymphomas of nasal type are a form of lymphatic proliferations with a poor prognosis. The presentation is often localised. The CHOP protocole seems inefficient in this pathology.
The association including the L Asparaginase is efficace but is not exempt of relapses
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PO-17
ASCT IN HODGKIN AND NON HODGKIN LYMPHOMA:
A SINGLE CENTER EXPERIENCE ABOUT 27 PATIENTS
Bach Hamba S, Ben Amor R, Ben lakhal R, Jeddi R, Aissaoui L, Kacem
K, Bouteraa W, Abdennebi Y, Ben Abid H, Bel Hadj Z, Balkis M.
Aziza Othmana Hospital, Tunis.
Introduction:
Autologous hematopoietic stem-cell transplantation (ASCT) is an effective treatment for recurrent or refractory Hodgkin lymphoma (HL) and for advanced or refractory Non Hodgkin Lymphoma (NHL). In this study, we retrospectively evaluate results and outcome of patients with HL
and NHL benefiting of ASCT in Aziza Othmana Hospital.
We collect data from 27 patients who received ASCT between July 07 and December 09. The
conditioning regimen consisted of carmustine, etoposide, cytarabin and melphalan (BEAM). 14
patients had HL and 13 patients had NHL (Diffuse Large B-cell Lymphoma n = 8, Mantle cell
Lymphoma n = 2, Anaplasic Cell Lymphoma n = 2, Follicular Lymphoma n= 1). All patients with
HL had a recurrent or refractory disease. Concerning NHL, ASCT was performed as conventional consolidation treatment for advanced forms in complete remission (CR) in 8 cases and
as salvage therapy for refractory patients in 5 cases. At time of ASCT, the patients were: in CR
(n = 22), PR (n = 3) and in progressive disease (n = 2). The median age was 32 years (18 – 56
years). Sex ratio: 1,25 (15M/12F). The graft consisted of peripheral blood in all patients with a
median CD34 cell dose injection of 6,16 x 10.6/Kg (2,6 – 11,3 x 10.6). Patients received GCSF
at day 5 post transplant.
Results:
Median delay of hospitaliza.tion was 17 days (13 – 21 days). The median delay of chemotherapy induced neutropenia was 8 days (5 – 11 days) with fever in all patients. No major complications or toxicity was noted in hospitalization. 6 patients died in the 6 months following ASCT;
5 from progressive disease and 1 from late pulmonary infection. With a median follow up of 18
months (4 – 33 months): 20 patients (74%) were in CR, 3 patients (11%) in PR and 4 patients
(18%) were still in stable disease despite progression (two of them benefit of other salvage
therapy). The OS at 18 months was 77%.
Conclusion:
The first experience of ASCT in our center is encouraging. In accordance with previous studies, disease status at transplant was the most important factor of outcome in our patients. In fact
90% of patients transplanted in CR (18/20) were in good response. We need larger patient’s
number to proceed to statistics analyzes.
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PO-18
PRIMARY CEREBRAL LYMPHOMA;
A RARE LYMPHOMA LOCALISATION. ABOUT A CASE
R. Khelifi Touhami, S. Boughrira, F. Grifi.
Department of Hematology, Dorban hospital, Annaba, Algeria
Introduction:
Primary cerebral lymphomas are malignant non Hodgkin lymphoma developed in the cerebral
parenchyma. They represent 2% of extra nodal lymphoma and 5% of primitive brain tumors.
Their increased incidence is noted for 20 years, now it is decreasing.
No epidemiological factors are known, they are developed most often a condition of congenital
immunodeficiency (Wiscott Aldrich syndrome), but mostly acquired (HIV, immunosuppressive
therapy).
Observation:
Patient aged 24 years, without medical history, present since 8 months of intense headaches
refracted to usual painkillers. The table was complicated by the installation of seizures with motor
weakness located (upper left). The biological and the metabolic assessments were without abnormalities. The radiographic assessment showed a round image localized on para-sagittal right
measuring 6 of 5 cm. The patient underwent partial resection of the mass. Histological examination and immunohistochemical study of the specimen was in favor of non Hodgkin lymphoma
with large cell phenotype B. After a negative staging, chemotherapy was setup type R-COPADEM associated with intra techal chemotherapy. Clinical and radiological evolutions were good
after 2 cycles of treatment. Therapy maintains type CYME is expected with radiotherapy.
Conclusion:
Primary cerebral lymphoma is relatively rare tumor involving the brain tissue.
Potential unfavorable prognostic factors for survival are: age > 60 years, WHO performance
status > 2, pre-treatment and neurological function, extensive tumor spread, no administration of
chemotherapy, CSF protein level at diagnosis > 0.6 g/l.
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PO-19
A CASE HODGKIN LYMPHOMA RELAPSE
AND PYODERMA GANGRENOSUM
M.Benlazar, A.Hadjeb, A.El Mestari, N.Zemri, K.Tayebi, N.Siali,
R.Messaoudi, Z.Zouaoui.
Hematology unit, Hospital of Sidi Bel Abbés, Algeria.
Introduction:
Pyoderma gangrenosum (PG) is un uncommon ulcerative cutaneous condition of uncertain
etiology. It is classified as a neutrophilic dermatosis, and exhibits intense dermal inflammatory
infiltrates composed of neutrophils with little evidence of primary vasculitis. Etiology is believed
to represent a manifestation of altered immunologic reaction and it responds to immunosuppressive therapy. Approximately 50% of PG cases are associated with a specific systemic disorder. These include inflammatory bowel disease, rheumatoid arthritis, non Hodgkin lymphomas,
chronic myeloproliferative disorders and acute leukemias.
Case study:
We report the case of 39 years old female patient, treated in April 1996 for Hodgkin lymphoma.
The patient was staged IIB and received six cycles of M.O.P.P regimen. She achieved a complete remission and did not accept radiotherapy.
Ten years after, in April 2006, the patient came to the dermatologist observation because of an
extensive, bilateral and violaceous skin nodules on the anterior sides of the legs. These nodules
became wider and reached a diameter of 10 cm on the left leg with much ulceration. We find
bilateral cervical and axillary nodes.
Total body C.T scan showed a mediastinal involvement.The dermatologist suspected the diagnosis of PG and the histology of the skin confirmed his diagnosis. The biopsy of a left large
cervical node confirmed the Hodgkin lymphoma. The patient was staged IIIA according to ANN
Arbor Staging System, and therapy was treated with steroids (Prednisone, 100mg/day). On the
seventh day of this therapy, a regression of the skin lesion was noted. The Hodgkin lymphoma
chemotherapy was started 10 days later, the patient received A.B.V.D without an important regression of the nodes. The skin lesions disappeared and we switched the lymphoma chemotherapy to D.H.A.P. A complete remission was achieved after four cycles of D.H.A.P. The patient
did not accept radiotherapy, she is alive and in complete remission.
Conclusion:
Our case underlines that PG should be included in the differential diagnosis of any nodular and
ulcerative cutaneous eruption in patients with Hodgkin lymphoma. It responds to steroids and
has not any prognosis impact on the lymphoma.
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PO-20
ANATOMICAL AND CLINICAL CORRELATION OF
LYMPHATIC DRAINAGE PERTAINING TO LYMPHOMA
Hassan Mohammad, Mahmoud El Hamidi
Department of Anatomy, Faculty of Medical Technology, Sorman, 7th April University,Libya
Cancer is a common condition that affects millions of people throughout the world.Around
the world, roughly 22 million people suffer from cancer; each year 10 million cases are newly
diagnosed and 6 million people die of cancer. The World Health Organisation(WHO) estimates
that these figures will rise over the next 20 years by up to 50%. Cancer can develop from various
types of tissues. It causes an uncontrolled and uninhibited growth of the affected tissue type.
Lymphatic system provides an important immune mechanism for the body and involved in the
metastasis of cancer cells. Metastasis or spread of malignant tumor to neighbouring organs are
the reason that most cancers eventually lead to the death of the patients. The lymphatic vessels
are not generally visible in dissections but are the major route by which carcinoma metastasizes.
The lymph nodes serve as filters. The cancer cells in lymph vessels migrate or metastasize to
lymph nodes and tend to remain within them, proliferating and gradually destroying them. The
lymphomas are the malignant manifestations of the cells of the lymph glands. They are normally
considered in two major groups-Hodgkin’s diseases and the non-Hodgkin’s lymphomas and together account for approximately 4% of all cancers.
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PO-21
HODGKIN LYMPHOMA
Sami Alabed Abdulrahman
Hodgkin lymphoma (HL) is a potentially curable malignant lymphoma. As classified by WHO,
HL exists in 5 types. Four of these, nodular sclerosis, mixed cellularity, lymphocyte depleted, and
lymphocyte rich, are referred to as classic Hodgkin disease.The fifth type, nodular lymphocyte
predominant Hodgkin disease. HL have a bimodal distribution in both sexes, peaking in young
adults (aged 15-34 y) and older individuals (>55 y). HL more common in male. HL is treated either with chemotherapy alone or in combination with radiotherapy. Our study includes the adult
Hodgkin lymphoma patients with regular follow up at African Oncology Institute in the period from
January 2006 to December 2008. A total of 37 cases of HL were seen with a M: F ratio of 1:1.
51% of cases were the age group between 15-25 years old. The histological subtype seen was
nodular sclerosis (43%). Clinical stage at diagnosis were stage I (10.8%), stage II (29.7%), stage
III (29.7%), and stage IV (29.7%). B symptoms were present in 75% of cases.
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PO-22
NON-HODGKIN LYMPHOMA OF THE THYMUS
Kauthar Ali Elmaawi, Sami Alabed Abdulrahman
Diffuse large B cell lymphoma is the most common type of lymphoid malignancy, constituting 30–40% of adulthood non-Hodgkin lymphoma. Primary low-grade B-cell lymphomas of the
thymus are rare, and usually presents with bulky mediastinal lesions. We report a case of diffuse
large B cell lymphoma of thymus which is a 28 years old female presented with dry cough and
dyspnea. Biopsy from anterior mediastinal mass (thymus) yielded histopathological characteristics consistent with diffuse large B cell non-Hodgkin lymphoma. Patient received 8 cycles of
CHOP-R chemotherapy and radiotherapy to the mediastinum. The patient was followed for 2
months, during which time she exhibited no evidence of disease.
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PO-23
PRIMARY NON-HODGKIN LYMPHOMA
OF THE BONE: A CASE REPORT
Sami Alabed Abdulrahman
African Oncology Institute – Sabratha-Libya
Primary non-Hodgkin’s lymphoma of bone (PBL) is rare, and generally presents as a single
extensive and destructive bone lesion. Histopathologically, most cases present as diffuse large
B-cell lymphoma, and T-cell lymphoma is rare. The incidence of PBL is7% of all malignant bone
tumors, 4–5% of all extranodal non-Hodgkin lymphoma and less than 1% of all malignant lymphomas. We report a case of a diffuse large B-cell lymphoma of the clavicle, in which the patient
presented with a diffuse swelling on the right clavicle. A subsequent biopsy and immunohistochemistry were instrumental in this diagnosis. The patient was treated with CHOP-R chemotherapy. The swelling regressed completely and lymph nodes disappeared following the chemotherapy regimen, with no sign of recurrence observed over the last seven months.
82
PO-24
ACUTE LEUKAEMIA: USEFULNESS OF RED BLOOD CELL
CONCENTRATES TRANSFUSION IN FOR THE PREVENTION
OF THE HEMORRHAGIC RISK
F.Attaf, H.Tadj, M.Brahimi, S.Osmani, A.Arabi,
B.Entasoltane, MA Bekadja.
Service Hématologie et Thérapie Cellulaire, EHU 1er Novembre, Oran, Algeria
Introduction:
The management of acute leukemia requires besides of an adapted hospitalization structure
(protected individual room), an efficient haematological supportive care and the availability of
blood component materials in order to face the complications of the aplastic phase of post- induction chemotherapy
The goal of our study is to demonstrate that a transfusion supply of RCC in time and in sufficient quantity allows preventing serious hemorrhagic risks threatening patient life, in case of
severe thrombopenia.
Patient and methods:
On a period of 13 months (from January 2009 to January 2010), 23 patients with acute leukaemia were admitted to our Haematology department. 15 men and 8 women (sex ratio of 1.8) with
a median age at the diagnosis was 40 years [16-73 years]. The diagnosis has been established
by cytomorphology and flow cytometry, showing 6 ALL and 17 AML. The induction chemotherapy
included for the ALL: GRALL 94 protocol and vincristine-prednisone, and for the AML: Aracytine 100 mg/m2-Daunorubicine 45 mg/m (3+7) protocol and ATRA-Idarubicine for patients with
(AML3). Prophylactic treatment of the infections associated the Bactrim®, Ciprolon®, Fluconazole and Aciclovir. A curative antibiotherapy has been started if there was an appearance of a
38.5°C documented or not fever. Anemia and severe thrombopenia were treated by RCC = Red
blood cell concentrates, CPP = Plateletpheresis product.
Two groups of patients have been studied, those having a sufficient transfusional regiment
with maintain of their Hb level between 11 and 12 g/dl with platelet count <15.000/μl (first Group)
and those having had some difficulties to be transfused properly and of which the level of Hb
was between 6 and 10 g/dl with a platelet count <15.000/i.il (G2). The statistical assessment was
based on the χ 2 test.
Results:
23 patients with acute leukemia have been collected. The classification was as follow: 06 ALL
(1 ALL T, 5 ALL BS), 17 AML (2M1, 4M2, 1M3, 2M4, 6M5, 1M6, 1M7). The median time of survival
= 4 months [1-9 months]. The rate of post-induction response for the ALL: 5 CR and 1 death, for
83
the AML,: 12CR (71%), 4 deaths (24%), 1 partial responsanswer. The median time of the phase
of aplasia was 24 days [16-37 days]. The table below shows the results of the transfusion of RCC
correlated to the haemorrhagic syndrome.
median age:
median Number of RCC
median Number of CPP
Absence of haemorrhage:
Minimal haemorrhage:
Serious haemorrhage:
Death by haemorrhage:
first group (n=15)
Hb [11-12 g/dI] platelets <15000/p.l
43 years [16-73]
11[8-20]
3 [1-5]
12 (80%)
3 (20%)
0 (0%)
0 (0%)
second group (n=8) Hb [6-10 g/dI]
platelets <15000/pi
46 years [16-58 ]
6 [4 - 15]
4 [2 - 6]
2 (25%)
0 (0)
6 (75%)
5 (83%)
(n = number of patients, Hb = haemoglobin, CCR = Red blood cell concentrates, CPP = Plateletpheresis product)
Conclusion:
During the severe thrombopenia of the aplastic phase of post induction of the acute leukemias, the rate of hemoglobin (<10 g/dl or 11 g/dl) can be considered as predictve a factor of the
intervening of the hemorragic syndrome and it’s severity. Our preliminary results suggest that
hemoglobin of 11 g/dl is a protective factor against this risk. It should be validated by the pursuit
of this work
84
PO-25
EVALUATION DU PROTOCOLE LINKER DANS LE TRAITEMENT
DES LEUCEMIES AIGUES LYMPHOBLASTIQUES DE L’ADULTE
K.Ait-Seddik, N.Dali, M.Allouda, O.Ouanes,S.Gherras, H.Aftisse, H.Ait-Ali
Service d’hématologie CHU de TIZI OUZOU
Introduction:
Les leucémies aigues lymphoblastiques représentent 20% des leucémies aigues de l’adulte.
Différents protocoles d’induction ont été utilisés: le protocole linker a été introduit dans notre service en 2000 et représente le protocole de choix dans le traitement des LAL de l’adulte jeune.
Il comporte une polychiomiothérapie d’induction associant Rubidomycine 50mg/m2 (3j), Vincristine 1,4mg/m2 (j1-j8-j15-j22) et Asparaginase 6000 UI/m2 (j17 à j28) et Prednisone 60mg/m2
à 28j.
- Une conclusion BFM comportant: Purinéthol, Aracytine et Endoxan.
- Plus 9 réinductions mensuelle M1 à M9 et un traitement d’entretien associant Purinéthol et
Méthotréxate pendant 02 ans.
62 patients ont été traités de janvier 2000 à décembre 2009.
Les extrêmes sont de 15 à 57 ans: avec un âge moyen de 27 ans.
25 sont des femmes et 37 sont des hommes avec un sexe ratio H/F 1.5.
Les patients ont tous reçu le traitement linker associé un protocole prophylaxie neuroméningé
Résultats:
Chez les 62 patients ainsi traités.
16 soit 25% sont décédés en induction et 08 échecs soit 13%.
38 soit 62% sont mis en rémission dont la médiane est de 22 mois (02 à 111mois).
Au total: devenir des 38 malades en RC:
- 18 vivants en RC, médiane de suivi: 35 mois.
- 16 rechutes → dont 1 seul vivant en 2e RC: après greffe, délai de suivi: 70 mois.
- 4 DCD (réinductions).
Conclusion:
Le TRT linker a permis d’améliorer le pronostic des leucémies aigues lymphoblastiques de
l’adulte dans notre service mais il reste insuffisant pour le maintien de la survie à long terme.
85
PO-26
ASPECTS CLINIQUES ET BIOLOGIQUES
DE LA LEUCEMIE MYELOIDE CHRONIQUE
K. Benallaoua, F.Fergane, W.Chaba, H.Laga, R.Drif, S.Dechir,
N.Dali, O.Ouanes, K.Ait Seddik, M.Allouda, S.Gherras,
H.Aftisse, A.Graine Et Pr H.Ait Ali
Introduction:
La leucémie myéloïde chronique est un syndrome myéloprolifératif rare représentant 15 % des
leucémies de l’adulte dont l’étiologie reste inconnue dans la majorité des cas. Les traitements
conventionnels tels l’hydrea ou le busulfan ne modifient que très peu la survie, et l’allogreffe de
moelle osseuse permet de guérir mais ne peut être proposée qu’à un nombre limité de patients.
Le pronostic s’est nettement amélioré grâce à des thérapeutiques innovantes et ciblées (imatinib, dasatinib, interféron). Nous rapportons ici notre expérience sur une série de 44 patients
colligés sur une période de 05 ans (2005-2009).
Patients et Methodes:
Patients: De 2005 à 2009 nous avons répertorié 44 patients atteints de LMC, 23 sont des hommes et 21 des femmes, le sex-ratio est de 1,09. L’âge moyen est de 52 ans avec des extrêmes
de 20 et 89 ans avec deux pics de fréquence 40-50 ans et supérieur à 60 ans.
Méthodes: Tous les patients ont été recrutés à partir de la consultation, le diagnostic était posé
sur la clinique (splénomégalie) et la biologie (hémogramme).
Resultats:
Le délai diagnostic est d’environ 01 à 06 mois et la présentation clinique est caractérisée
par une splénomégalie chez 39 patients(88%) allant du type I à V associée à une hépatomégalie 04(09%),une pâleur cutanéomuqueuse 24(54%),un syndrome hémorragique 06(13%) et 03
(07%)pts étaient asymptomatiques.
Sur le plan biologique ; 38(86%) avaient une hyperleucocytose>150000/mm3, 22(50%) un
taux d’Hb <10gr/dl et 07(16%) une thrombopénie et 13(28%) une thrombocytose.
La quasi-totalité des patients étaient en phase myélocytaire 37(84 %) et seulement 05(11%)
en accélération et 02(05%) en acutisation.
37patients (84 %) ont un Score de SOKAL intermédiaire et 04 (09 %) élevé et 03 (07 %)
faible.
86
Conclusion:
Le diagnostic de leucémie myéloïde chronique est facile et se fait précocement mais malheureusement à des stades avancés (SPMG III à V) d’où l’intérêt d’un dépistage précoce (examens
systématiques).
Par ailleurs une étude cytogénétique et moléculaire est impérative dés la suspicion d’un syndrome myéloprolifératif à des stades précoces.
87
PO-27
RITUXIMAB-BASED CHEMOTHERAPY FOR
AUTOIMMUNE CYTOPENIA OF CHRONIC
LYMPHOCYTIC LEUKEMIA
Department of Haematology – CHU ANNABA. ALGERIA
Background:
Chronic lymphocytic leukemia (CLL) is characterized by an acquired immune defect that can
cause autoimmune complications, including anemia (AIHA) and thrombocytopenia (ITP). AIHA
occurs in 10% of advanced stage CLL patients; ITP occurs in 2 – 3% in early stage disease and
may be a presenting manifestation. And there are limited effective treatment options for steroid
refractory autoimmune cytopenias. Rituximab, an active agent against B cell malignancies, has
also been noted to be active in certain autoimmune hematologic disorders.
The purpose of this study was to evaluate the safety and efficacy of Rituximab-based chemotherapy in this complication of CLL.
Patients & methods:
This prospective study examines the outcome in CLL patients with autoimmune phenomena
(AIHA, Evans’ syndrome). Five patients were treated at our institution. Two patients who had
been previously treated with alkylating agents (CHOP/CVP), one of them had received Fludarabine, two patients were newly diagnosed and had not receive any treatment.
Treatment regimen (RCD): Rituximab was given at a dose of 375/m2 intravenously (i.v.) on day
1 (D-1). Dexamethasone 40 mg i.v. D-1. Cyclophosphamide at a dose of 1000 mg (total dose) i.v
D-1. The treatment was repeated every 2 weeks of a total of six cycles.
Results:
Median age was 65 years (range 44 -74) and there were five male patients. All of them had
Binet stage C disease, and ECOG performance status was 1. Response in autoimmune cytopenias was evaluated by frequent blood counts and Coombs test. 4 of five patients achieved a
remission of their cytopenia. One of them is still received the treatment. Median pretreatment
hemoglobin was 6.7 g/dl and post-treatment hemoglobin was 12.3 g/dl. The mean pretreatment
platelet was 147 G/L and post treatment was 213 G/L. Three patients converted to Coombs
negative after RCD. Median duration of response was 14 months. The patients were evaluative
for toxicity: grade ¾ toxicity neutropenia was noted in one patient and needed supportive care by
haemopoitic growth factors. One patient died of progressive disease (CLL) 06 months after the
response to RCD therapy.
88
Conclusion:
Autoimmune phenomena, largely related to blood cells, are based in the immune dysregulation of CLL. Our results indicate that a rituximab-based combination regimen (RCD) is highly
effective in treating this complication of CLL, and show a safety profile.
89
PO-28
CHRONIC LYMPHOCYTIC LEUKEMIA:
ABOUT A SERIES OF 40 CASES
R. Messaoudi,F.Ouadah H.Amirouche.El Mestari.Pr Z Zouaoui
University Hospital of Sidi Bel Abbes Algeria
Introduction:
Chronic lymphocytic leukemia is the most common leukemia in Western countries with a median age at diagnosis less than 65 years.
Methods:
This is a retrospective study of 10 years (2000-2009) included patients followed at the hematology department for chronic lymphocytic leukemia.
Results:
40 observations were analyzed, 30 men (75%) and 10 women (25%), sex ratio: 3 and the
average age of 70.70 + / - 11.3 years. According to the Binet classification, we note 20% of stage
A, 25% of stage B and 55% of stage c.the mean hemoglobin was 10.32 + / - 2.95 g / dl. The
average platelet count is 164.242/mm 3 with a lymphocytosis averaging 99,720 + / - 12930/mm
3. 30 patients received chimiothérapie. Overall median survival was 51 months out of 10 years.
Evolution is enameled with a case of Richter’s syndrome and 60% of patients who have infectious syndrome.
Conclusion:
Chronic lymphocytic leukemia is common in elderly patients, whose diagnosis is made late in
our series. The value of early detection to improve their care.
90
Translation to French
PO-28
MANIFESTATIONS THROMBOTIQUES RÉVÉLATRICES
D’UNE LEUCÉMIE MYÉLOÏDE CHRONIQUE
R.Messaoudi1, F.Ouadeh2, A.Meghraoui2.Hadjeb2, PrZ.Zouaoui
Service d’Hématologie, Centre Hospitalo-universitaire de Sidi Bel Abbés, ALGERIE.
Mots clefs: leucémie myéloïde chronique, thrombose, priapisme.
Introduction:
La leucémie myéloïde chronique est un syndrome myéloprolifératif chronique associée une
augmentation du risque thrombotique qui peut toucher les artères de grands, moyens et petits
calibres et le système veineux. Les mécanismes impliqués sont multiples et intriqués (stase, état
pro-thrombotique et envahissement vasculaires).
Observations:
Il s’agit de 3 patients âgés respectivement de 49ans, 33ans, 21ans ne présentant aucuns antécédents pathologiques particuliers dont le diagnostic d’une leucémie myéloïde chronique a été
posé suite a l’exploration d’une complication thrombotique type priapisme ayant nécessite une
intervention chirurgical au niveau du service d’Urologie.
Conclusion:
Les complications thrombotiques peuvent précéder un syndrome myéloprolifartif type leucémie myéloïde chronique dans de rares cas d’où l’intérêt d’une exploration hématologique rapide
(hémogramme et frottis de sang) avant tous actes chirurgicales et traiter précocement et efficacement par un traitement spécifique (étiologique) afin d’améliorer le pronostic.
91
PO-29
LES INFECTIONS RENCONTRÉES AU COURS DES
NEUTROPÉNIES FÉBRILES INDUITES PAR CHIMIOTHÉRAPIE
D’INDUCTION DES LEUCÉMIES AIGUES OU ACQUISES AU
COURS DE L’APLASIE MÉDULLAIRE
N. Dali, m. Allouda, o. Ouanes, s. Gherras,
k. Ait-seddik, h. Aftisse, h. Ait-ali
Introduction:
Les neutropénies induites par le traitement des hémopathies malignes aigues, sont à l’origine
d’infections fréquentes et très souvent grave qui déterminent le pronostic de ces patients. La
neutropénie est également un événement régulièrement rencontré au cours d’une aplasie
médullaire. Le risque infectieux est proportionnel à la sévérité et la durée de la neutropénie, il
représente la cause principale de décès chez les malades en aplasie si des mesures préventives
et précoces ne sont pas instaurées.
Patients et Méthodes:
Il s’agit d’une étude rétrospective menée sur une période de 03 ans (2006-2008) dans laquelle
nous avons répertorié les épisodes fébriles en relation avec une infection chez des patients
neutropeniques. L’étude a conserné 150 patients (89 LAM, 38 LAL, 5 LA non typée, 18 aplasies
médullaires). L’âge de nos patients varie entre 17 à 86 ans avec une médiane de 44 ans. Il
s’agissait de 84 femmes et 66 hommes. Le statut hématologique: taux moyen: GB / 2000/mm3,
PN: 100/mm3, Hb: 07g/dl, Plq: 30000/mm3. La recherche étiologique consiste, en plus d’un examen clinique soigneux, à pratiquer systématiquement une enquête bactériologique: hémocultures, bilan radiologiques et des prélèvements dirigées par la symptomatologie clinique.
Résultats:
117 /150 (78%) patient ayant présenté, un ou plusieurs épisodes fébriles, chez lesquels 207
épisodes fébriles d’origine infectieuse ont été diagnostiqués et repartis comme suit: - infections
cliniquement documentées: 53 (25%). - Les infections de la sphère ORL (22) les plus fréquentes,
cutanées (13) pulmonaire (07), digestif (08), urinaire (03). - Infections microbiologiquement documentées: 67 (46%) (37 hémocultures + 30 prélèvements): bactériémies à bacilles gram négatif
(BGN) (28), bactériémies à cocci gram positif: 08, et 1 candidose systémique. L’enquête bactériologique a révélé plusieurs souches bactériennes: BGN (59 %) représentés principalement
par le klebsiellas pneumonoe (12,5) et eccherichia coli (12%). Les coci gram (+) ne représentent
que 29% de l’écologie du service. On ne note que 14 % de candida albicans. - infections non
documentées, mais régressant sous antibiothérapies probabilistes: (42 %).
92
Commentaires:
Dans cette étude, les résultats de la recherche bactériologique ne correspondent pas à ceux
décrits dans la littérature avec un pourcentage très important de BGN contrairement aux coccis
gram (+) et ceci peut être expliqué par l’absence d’utilisation des cathéters centraux au sein de
notre service. - les infections non documentées rejoignent les données de la littérature.
Conclusion:
Un patient neutropenique constitue un terrain très favorable aux infections surtout au milieu
hospitalier avec un risque de mortalité. Une difficulté d’un diagnostique microbiologique, justifie
une antibiothérapie probabiliste visant à couvrir la majorité des germes, à modifier ou à optimiser
en fonction de l’état du patient.
93
PO-30
LEUCEMIES AIGUES PROMYELCYTAIRES:
ASPECTS CLINIQUES, BIOLOGIQUES ET THERAPEUTIQUES
N. Dali – K. Ait-Seddik – M. Allouda –
O. Ouanes S. Gherras – H. Aftisse – H. Ait-Ali
Introduction:
La leucémie aigue promyélocytaire (LAP) représente 5% des LAM mais elle est tout à fait singulière par ses mécanismes d’oncogenèse parfaitement identifiés et par son pronostic favorable.
Nous rapportons ici le cas de 15 patients atteints de LAP pris en charge au service d’hématologie
de TIZI-OUZOU.
Matériels et méthodes:
Il s’agit d’une étude rétrospective réalisée sur dossiers chez 15 patients atteints de LAP diagnostiqués sur une période de 06 ans (03/2004 au 03/2009). L’âge moyen au diagnostic est de
36 ans avec des extrêmes allant de 16 à 70 ans: 08 femmes et 07 hommes avec un ratio (F/H):
1,14. Le diagnostic a été posé par l’étude morphologique des frottis sanguins et médullaires
selon la classification FAB. Tous les malades ont bénéficié d’un traitement symptomatique (transfusions sanguines, plaquettaires et PFC). Le traitement spécifique a comporté une induction par
chimiothérapie selon le protocole (rubidomycine – aracytine + atra) pour 11 patients. 03 patients
n’ont pas été traités car décédés précocement.
Résultats:
- sur le plan clinique: un syndrome anémique et hémorragique ont été retrouvés chez tous
les patients dont 03 présentaient d’emblée un tableau grave: hémoptysies et hémorragies cerebro-méningées. Le syndrome tumoral a été absent dans tous les cas - sur le plan biologique:
l’hémogramme a objectivé: une anémie chez tous les patients. Le taux d’hémoglobine moyen
est de 08,5g/dl. Une hyperleucocytaire dans 09 cas (60% cas) avec un taux moyen de 16040/
mm3. Le taux de plaquettes varie de 15000 à 106000/mm3, correspondant à un taux moyen de
34333/mm3. 05 patients présentaient des signes de mauvais pronostic: une hyperleucocytose >
5000/mm3 et une thrombopénie < 40.000/mm3. Le caryotype n’a pu être réalisé. La CIVD a été
positive chez 10 malades (66%). - sur le plan évolutif: 03 patients sont décédés avant traitement
d’hémorragies cérébrales et hémoptysies (non évaluables). 03 malades sont décédés en induction dont 02 suite à un syndrome d’ATRA et le 3ème par infection. La rémission complète a été
obtenues chez 09 patients (82%). Ces 09 pts sont toujours vivants avec un délai médian de suivi
de 40 mois (09 mois – 69 mois).
94
Conclusion:
Notre petite série de LAP reflète le caractère favorable de cette hémopathie comme en témoigne le taux de rémission complète et la médiane de suivi. Le problème que pose cette leucose est de résoudre les problèmes de la CIVD sévère qui représente la principale cause de
mortalité.
95
PO-31
CHRONIC MYELOID LEUKEMIA WITH
MENINGEAL LOCATION. ABOUT ONE CASE
F.Belhadri, F.Hariéche, N.Abdennebi, S.Zeghouati,
S.Saidani, K.Tarhi, RM.Hamladji
Department of Hamatology and Bone Marrow Transplantation; Pierre and Marie Curie center, Algiers, Algeria
Introduction:
The meningeal location of chronic myeloid leukemia (CML) is exceptional, no case has been
reported in the literature. We report a patient of 52 years old who have CML with meningeal location.
Comment:
The patient of 52 years old who consults his physician in emergency, the leukocytosis was
found. Physical examination objectified splenomegaly type III. The blood count showed leukocytosis 175000/mm3 with myeleamia 41%. He has treated by Hydrea (2000mg capsules per day).
One week later he consults again for headache,optic fundus examination reveals the retinal
hemorrhage and a normal CTscan of brain. He was sent to hematology department. Physical
examination at admission showed a patient with average general condition without meningeal
syndrome, without tumor, the blood count showed leukocytosis 149,000 with a myeleamia 38%,
Hb level 12.3 g/dL, platelet 332,000 / mm3. The patient received supportive treatment with maintenance of Hydrea, a week after the patient was in complete hematologic remission (CHR) with
persistent severe headache; refractory to analgesics, a optic fundus examination shows remade
punctiform retinal hemorrhage on the right eye, analysis of cerebrospinal fluid (CSF) showed a
CSF glycorrachia at 0, 21 g / l and CSF protein 0.58 g / l, hypercytose to 550/mm3 (myelocytes
and metamyelocytes)and 83 RBC and a direct negative bacteriological examination. The RX
chest, CTscan and MR of brain are normal. The search for a transcript BCR-ABL positive type b2
a2 confirming the diagnosis of CML. Therapeutically patient received intrathecal chemotherapy
every tow days (a total of 9 injections) with the following normalization of CSF. The treatment was
completed by cranial radiation to 24 gy. The patient was treated by dasatinib with 2 capsules per
day to 50mg depending on availability and tolerance. After a year of follow up the patient is still
in CHR.
Conclusion:
The unusual meningeal location in CML was diagnosed in this patient because of
symptoms with intense headache rebel to analgesics. The treatment of choice in this
case is the first Dasatinib intension which penetrates the meningeal contrast to imatinib.
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PO-32
ADULT GAUCHER DISEASE (GD) IN ASSOCIATION WITH
CHRONIC MYELOID LEUKEMIA (CML). A CASE STUDY
F. Belhadri, H. Moussaoui, F. Harièche:
N. Abdennebi; D. Benali M. Maidat; RM.Hamaldji
Department of Haematology and Bone Marrow Transplantation; Pierre and Marie Curie center, Algiers, Algeria
Introduction:
Gaucher disease (GD) is an inherited recessive autosomal metabolic defect due to a deficiency of the lysosomal enzyme β-glucocerebrosidase. The GD may be associated with neoplastic
lesions (myeloma, NHL, melanoma and pancreatic cancer). We report the case of a woman of 46
years old with coexisting type I Gaucher’s disease (GD) and chronic myeloid leukemia (CML).
Comment:
The woman of 46 years old, without notable medical history, followed by gastro-enterologist for
GD type 1 for two years The patient suffered from hepatosplenomegaly and thrombocytopenia.
After one year of follow up, she presented a 30000/mm3 Leukocytosis with myeleamia 28% (4%
promyelocytes, myelocytes 15%, metamelocytes 9%), a search of a transcript BCR-ABL was
positive b2a2 type. Examination showed a patient with average general conditions, a hepatosplenomegaly with a larger liver to16 cm and a larger spleen to 26cm, the blood count showed
leukocytosis with 73000/mm3 with myeleamia 28%, hemoglobin level to 11, 6g/dl and thrombocytopenia à 24000/mm3. A splenectomy was performed before starting treatment specifically
because of the large volume of spleen and thrombocytopenia. A month after the splenectomy
the patient presents with a good general conditions, normalization of blood counts (WBC: 9500/
mm3, Hb: 12g/dl, platelets: 250000/mm3), a normal blood smear and extended portal thrombosis, treated by anticoagulants (VKA). After four months of monitoring the patient presented a
progressive increase of leukocytosis 28000/mm3 without myeleamia. A check of the transcript
BCR-ABL b2a2 confirms the type has a rate of 2.65. The patient was treated by Hydrea (imatinib
has not been prescribed because the drug interferes with the AVK). After 16 months of follow up
the patient is still in hematologic remission with Hydrea.
Conclusion:
The GD is a rare disease, but has several points of interest in hematology, in diagnosis of the
hematologic manifestations and its frequent association with hematologic malignancies which
pathophysiological links are not known at this time.
97
PO-33
ASPECTS CLINIQUES ET BIOLOGIQUES
DE LA LEUCEMIE MYELOIDE CHRONIQUE
K. Benallaoua, F.Fergane, W.Chaba, H.Laga,R.Drif, N.Dali, O.Ouanes,
K.Ait Seddik, M.Allouda, S.Gherras, H.Aftisse, A.Graine Et Pr H.Ait Ali
Introduction:
La leucémie myéloïde chronique est un syndrome myéloprolifératif rare représentant 15 % des
leucémies de l’adulte dont l’étiologie reste inconnue dans la majorité des cas. Les traitements
conventionnels tels l’hydrea ou le busulfan ne modifient que très peu la survie, et l’allogreffe de
moelle osseuse permet de guérir mais ne peut être proposée qu’à un nombre limité de patients.
Le pronostic s’est nettement amélioré grâce à des thérapeutiques innovantes et ciblées (imatinib, dasatinib, interféron). Nous rapportons ici notre expérience sur une série de 44 patients
colligés sur une période de 05 ans (2005-2009).
Patients et Methodes:
Patients: De 2005 à 2009 nous avons répertorié 44 patients atteints de LMC, 23 sont des hommes et 21 des femmes, le sex-ratio est de 1,09. L’âge moyen est de 52 ans avec des extrêmes
de 20 et 89 ans avec deux pics de fréquence 40-50 ans et supérieur à 60 ans.
Méthodes: Tous les patients ont été recrutés à partir de la consultation, le diagnostic était posé
sur la clinique (splénomégalie) et la biologie (hémogramme).
Resultats:
Le délai diagnostic est d’environ 01 à 06 mois et la présentation clinique est caractérisée
par une splénomégalie chez 39 patients(88%) allant du type I à V associée à une hépatomégalie 04(09%),une pâleur cutanéomuqueuse 24(54%),un syndrome hémorragique 06(13%) et 03
(07%)pts étaient asymptomatiques.
Sur le plan biologique ; 38(86%) avaient une hyperleucocytose>150000/mm3, 22(50%) un
taux d’Hb<10gr/dl et 07(16%) une thrombopénie et 13(28%) une thrombocytose.
La quasi-totalité des patients étaient en phase myélocytaire 37(84 %) et seulement 05(11%)
en accélération et 02(05%) en acutisation.
37patients (84 %) ont un Score de SOKAL intermédiaire et 04 (09 %) élevé et 03 (07 %)
faible.
98
Conclusion:
Le diagnostic de leucémie myéloïde chronique est facile et se fait précocement mais malheureusement à des stades avancés (SPMG III à V) d’où l’intérêt d’un dépistage précoce (examens
systématiques).
Par ailleurs une étude cytogénétique et moléculaire est impérative dés la suspicion d’un syndrome myéloprolifératif à des stades précoces.
99
PO-33
CLINICAL AND BIOLOGICAL ASPECTS OF
CHRONIC MYELOID LEUKEMIA (CML)
K. Benallaoua, F.Fergane, W.Chaba, H.Laga, R.Drif,, N.Dali, O.Ouanes,
K.Ait Seddik, M.Allouda, S.Gherras, H.Aftisse, A.Graine Et Pr H.Ait Al
Introduction:
Chronic myeloid leukemia is a rare myeloproliferative disorder characterized by the increased
and unbalanced growth of myeloid cells in the bone marrow and their accumulation in the blood,
it represents 15% of all cases of adults’ leukemia and until now the cause is unknown.
Conventional treatments are given (hydroxyurea, busulfan) with no real surviving benefit, but
now a targeted therapies have been developed (imatinib, dasatinib, nilotinib, and immunotherapy).
Stem cell transplantation is only recommended for some patients.
We report here our experience about 44 patients during a five years period (2005-2009).
Patients: from 2005 to 2009 we included 44 patients with sex-ratio=1, 09. The average age is
52 within a range of 20 and 89 with two peaks of frequency 40 -50 years and >60 years.
Methods: all patients were chosen from the consultation and the diagnosis was determined
according to the clinical symptoms (splenomegaly) and the biology (complete blood count CBC)
Results:
The diagnosis deadline is about 01 to 06 months and the clinical manifestations are characterized by a splenomegaly (39 patients –pts-88%) type I to V, associated to an hepatomegaly
(04 patients 09%),pale skin (24 patients 54%), hemorrhages (06 patients 13%) and 03 patients
(07%) were asymptomatic.
Biologically, 38 patients (86%) had an elevated white blood cell count >150000/mm3, 22 patients (50%) hemoglobin <10gr/dl, 07 patients (16%) thrombocytopenia and 13 patients (28%)
thrombocytosis.
37 patients (84%) were diagnosed in chronic phase and only 05 patients (11%) in accelerated
phase, 02 patients (05%) in blast crisis.
37patients (84%) have intermediate risk (SOKAL SCORE), 04 patients 09% with elevated risk
and 03 patients (07%) with low risk.
100
Conclusion:
The diagnosis of CML is easy and can be made early but unfortunately in latest stages (SPMG
III to V) so an early detection is necessary (systematic tests).
However, a cytogenetic and molecular analysis is imperative once a myeloproliferative disorder in its early stages is suspected.
101
PO-34
LES LEUCEMIES AIGUES: DE LA MORPHOLOGIE
AU SEQUENÇAGE IMMUNOPHENOTYPIQUE
PAR CYTOMETRIE EN FLUX
SE Belakehal, H Mansour, S Baghdad, MC Rahali, A Maatalah, L Lazfen,
D Saber-Cherif, FZ Ardjoun
Service d’hématologie, Hôpital Central de l’Armée, Alger, Algérie
Introduction
Parmi les analyses pratiquées dans un service d’hématologie, l’étude immunophénotypique
par cytométrie en flux (CMF). La CMF s’est imposée comme la technique de choix dans le diagnostic et la classification des leucémies aigues (LA). C’est un complément à l’étude cytologique
et aux colorations cytochimiques. Nous rapportons les résultats immunophénotypiques par CMF
des patients adressés pour suspicion de LA depuis l’introduction de cette technique dans notre
service en 2006.
Matériel et méthodes
Il s’agit d’une étude rétrospective de [septembre 2006 à décembre 2009], qui porte sur 73
patients. L’âge moyen est de 43 ans [3 ans à 83 ans]. Le sex-ratio = 2,84 [54F/19H].
Nous avons pratiqué systématiquement un hémogramme avec une étude cytologique des
cellules blastiques sur frottis sanguin et/ou frottis médullaire, une coloration cytochimique au noir
soudan, et une étude immunophénotypique par CMF avec un panel d’anticorps monoclonaux ciblant: les cellules immatures (CD34, et HLA-DR), les cellules lymphoïdes B (CD20, CD19, CD22,
CD79a, chaîne μ intracellulaire, FMC7, et CD10), les cellules lymphoïdes T (CD3, CD7, CD2, et
CD5), les cellules myéloïdes (CD33, CD13, CD117, MPO intra, et CD14), et d’autres marqueurs
à la demande (CD64, CD36, TdT, CD1a, glycophotine A, CD41, CD42).
Résultats
- L’hémogramme montre un taux de globules blancs moyen = 63 784 /mm3 [950 à 249 300],
un taux d’hémoglobine moyen = 7,67 g/dl [3 à 14], et un taux de plaquettes moyen = 55 200
/mm3 [4000 à 280 000].
- L’Etude cytologique et la coloration cytochimique (noir soudan) ont conclu à: LMC en transformation (n = 3), SMD en transformation (n = 5), LMNH en transformation (n = 4), LAM (n =
28), LAL (n = 10), LAL ou LAM (n = 3), et LA (n = 20).
- L’Etude immunophénotypique est pratiquée sur: sang dans 38 cas, sur moelle (MO) dans 34
cas, et sur sang et MO dans 1 cas.
- La CMF a conclu à:
102
LAL
LAM
LA Biphéno
Nulles Pro-B
0
1
M0
M1
3
8
LALB + LAM
12
Pré-PréB
Pré-B
8
2
M2
M3
14
6
LALB+LALT
0
T
LAL mature
4
1
M4
M5
7
1
LALT + LAM
2
M6
1
M7
1
M inclassable
2
Commentaires et Conclusion:
Depuis son introduction en 2006 dans notre service, la cytométrie en flux a été d’un grand apport dans le diagnostic et la classification des leucémies aigues. Elle a été souvent décisive dans
l’affirmation du type de LA et par conséquent dans la décision thérapeutique.
103
Translation to English:
PO-34
ACUTE LEUKEMIAS: MORPHOLOGY WITH SEQUENCING
IMMUNOPHENOTYPE BY FLOW CYTOMETRY
SE Belakehal, H Mansour, S Baghdad, MC Rahali,
A Maatalah, L Lazfen, D Saber-Sherif, FZ Ardjoun
Introduction:
Among analyzes the practiced in a service of haematology, the immunophenotypic study by
flow cytometry (CMF). The CMF was essential like the technique of choice in the diagnosis and
the classification of acute leukaemia (LA). It is a complement under investigation cytological and
cytochemical. We report the results immunophenotypic by CMF of the patients addressed for
suspicion of since the introduction of this technique into our service in 2006.
Material and methods:
It is about a retrospective study of [September 2006 to December 2009], which relates to 73
patients. The Middle Age is 43 years [3 at 83]. The sex-ratio = 2.84 [54W/19M].
We systematically practiced a hemogramme with a cytological study of the blastic cells on
blood smear and/or medullar smear, a cytochemical coloring with the Sudan black, and a immunophenotypic study by CMF with a targeting panel of monoclonal antibodies: immature cells
(CD34, and HLA-DR), lymphoid cells B (CD20, CD19, CD22, CD79a, chains μ intracellular,
FMC7, and CD10), lymphoid cells T (CD3, CD7, CD2, and CD5), the myeloid cells (CD33, CD13,
CD117, MPO, and CD14), and other markers with request (CD64, CD36, TdT, CD1a, glycophorin
A, CD41, CD42).
Results:
- The modification hemogramme: white globules average = 63,784 /mm3 [950 to 249,300], an
average rate of haemoglobin = 7.67 g/dl [3 to 14], and an average rate of plates = 55,200
/mm3 [4000 to 280,000].
- The cytological study and cytochemical coloring (Sudan black) concluded with: transformation MCL (N = 3), transformation SMD (N = 5), transformation lymphoma (N = 4), AML (N =
28), ALL (N = 10), ALL or AML (N = 3), and AL (N = 20).
- The immunophenotypic study is practiced on: blood in 38 cases, on marrow in 34 cases, and
blood and marrow in 1 case.
- The CMF concluded:
104
ALL
AML
AL Biphéno
nulles Pro-B
0
1
M0
M1
3
8
B-ALL + AML
12
Pré-PréB Pré-B
8
2
M2
M3
14
6
B-ALL+T-ALL
0
mature ALL T-AL
4
1
M4
M5
7
1
T-ALL + AML
2
M6
1
M7
1
M unclassable
2
Comments and conclusion
If its introduction in 2006 into our service, the flow cytometry was of a great contribution in the
diagnosis and the classification of acute leukaemia. It was often decisive in the assertion of the
type of and consequently in the therapeutic decision.
105
PO-35
FLUDARABINE PLUS CYCLOPHOSPHAMIDE (FC) IN FIRST
LINE TREATMENT OF CHRONIC LYMPHOCYTIC LEUKAEMIA
(CLL): A PROSPECTIVE STUDY IN BLIDA,ALGERIA
S. Taoussi, Y. Bouchakor, N. Rekab, S. Oukid, H. Brahimi, MT Abad
Department of Haematology, EHS ELCC Blida, Algeria.
Background:
Chronic lymphocytic leukaemia (CLL) affects more and more patients under 65 years legitimately eligible for treatment inducing complete remission or at least prolonged event free survival; conventional therapeutic approaches do not reach these objectives. Fludarabine in association with Cyclophosphamide results in optimal responses.
Aims:
To evaluate efficacy and tolerance of FC in our country.
From January 2007 to December 2009, 34 CLL treated with FC: 7 women, 27 men (sex ratio
= 3.8). Average age = 58.9 years. Median leucocyte count = 145 x 109/l. Immunophenotyping:
29 patients: Matutes 5: 13 cases, 4: 14, 3: 2. CD38 > 30% = 17 cases. Hypogammaglobulinemia
<7g / l: 6 cases. Bone marrow biopsy: 34 (diffuse: 27, nodular: 3, interstitial: 3,1failed). Binet
stage: Stage B: 13, stage C: 21.
Cytogenetics in 17 patients: 5 with deletions of 2 copies of 13q14 and 1 associated with a 6q21
deletion, 4 trisomy 12 and one associated with 6q21deletion, 3 ATM deletions associated with a
6q21 deletion, one p53 deletion associated with a 6q21 deletion, no abnormality in 4 cases. FC:
Fludarabine 25 mg / m² i.v (d 1-3), Cyclophosphamide 250 mg / m² i.v (d 1-3) every 28 days;
prophylaxis by antimicrobial and antiviral daily during treatment and 6 months after completion of
treatment. Evaluation of response according to NCI criteria.
Results:
For 22 patients that have completed 06 cycles of FC: CR: 09 (40%), PR: 02 (09%), NPR: 10
(45.4%), Failed: 01 (4.5%). Toxicity evaluated in 32 patients who received ≥ 3cycles of FC: 165
cycles: neutropenia grade 3 and 4: 51.5% ; lymphocytopenia: 29%; thrombocytopenia <50x10 ³
/ mm3 at 5.4%. The average duration of aplasia: 10 days without GCSF. 25 infectious episodes
(15.1%): lung 68% (including one case of pulmonary tuberculosis), urinary 24%, chicken pox 8%.
Becoming of patients: 22 patients have ended their treatment: One died 4 months after failed
treatment: overall survival 12 months. 2 patients with PR received a consolidation with 3 cycles
of FC: CR in one case nPR in other case. Among the 10 CR: 3 patients relapsed after a period
106
of CR of 14, 15 and 25 months. The remaining 7 are still in CR: EFS = 3 to 29 months. Among
9 nPR: 2 were lost to follow in nPR after a period of follow-up 6 and 10 months and one patient
relapsed after an EFS of 12 months;
7 patients are still alive in nPR with EFS 1 to 27 months. 09 patients are under treatment. 03
patients died before the end of treatment: 1 due to progression of the disease, 2 with severe pulmonary infection; death related to toxicity in 5.8%. Overall rate of death over 3 years of follow-up
= 14.7%.
Conclusion
FC protocol improved significantly the overall response rate, the complete remission rate and
the progression free survival time.FC combination caused severe side effects; the death rate in
our study is partly correlated with the high rate of stage C and the predominance of cytogenetic
abnormalities with poor prognosis.
107
PO-36
CONVENTIONAL AND MOLECULAR CYTOGENETIC (FISH)
FOR ASSESSING DIAGNOSIS AND PROGNOSIS
OF HEMATOLOGIC MALIGNANCIES
Department of Haematology, EHS ELCC Blida, Algeria
Introduction
Fluorescent in situ hybridization (FISH), providing additional diagnostic, therapeutic and prognostic factor in the evaluation of hematologic malignancies. To improve diagnosis and treatment
of hematologic malignancies in our country, we apply the cytogenetic examinations.
Methods
We present the results of 136 hematologic malignancies typed by these procedures (chronic
myelogenous leukaemia (CML), chronic lymphocytic leukaemia (CLL), multiple myeloma (MM),
acute leukemia) (AL). For each patient, we perform a metaphase and interphase FISH using a
panel of probes dedicated to each disorder: CML: bcr-abl probes single and or double fusion;
CLL: CEP 12 probe, 13q14-q34 probe, ATM-p53, 6q21 probe. AML: CBFB t (16, 16) inv (16)
probe, AML / ETO t (8; 21) probe, PML / RARA t (15, 17) probe, MLL (11q23) probe; ALL: bcr-abl
simple fusion probe; myeloma: 13q14-q34 probe.
Results
136 malignancies were studied: CML: 54 cases, LLC: 34 cases, MM 30 cases, LA: 18 cases.
CML Group: CML in chronic phase: 67 examinations of 54 patients: - 31 at diagnosis (30 in
chronic phase and 1 in blast crisis). The signal fusion Bcr-Abl was found in 30 cases, 1 case
confirming a complex abnormality t (1, 9, 22) found on the karyotype. - 23 in therapeutic evaluation: 20 in chronic phase at 3, 6, 9, and 12 months of taking imatinib, 3 cases in acutisation, for
assessing results of therapy.
CLL Group: 34 patients: 12 including seven isolated trisomy 12, twelve 13q14deletions including nine isolated (two: loss of 2 copies and two: loss of one copie), 5 ATM (11q22.1) deletions
with two isolated, 4 P53 deletions all associated, three 6q21 deletions associated with ATM, p53
and 13q14, no abnormality in 7 cases.
Myeloma Group: 14 of 30 patients with a 13q14 deletion and 4 cases with abnormal numbers.
AL Group: 7 LAL: failure of 1 in culture, presence of bcr-abl signal in 2 / 6 cases.
AML: 11 cases: PML-RAR positive in a case of LAM3. Invert 16: 2/4 cases; t (8; 21) and MLL
108
gene rearrangement studied in 5 cases of AML2, results in progress.
Comments
The assessment of therapeutic response to imatinib by karyotyping and metaphase /interphase FISH allowed us to exercise our terms of monitoring cytogenetic remission patients and
guide the therapeutic approach. In chronic lymphocytic leukaemia, the importance of abnormalities of poor prognosis (ATM del, p53 del) and atypical (+12) gives a specific profile for our patients to be confirmed on a larger series. In multiple myeloma: the rate of del 13q14 joined that of
the literature. The prognostic evaluation of LA is in progress.
109
PO-37
PYODERMA GANGRENOSUM (PG) AND
ACUTE LEUKEMIA, ABOUT THREE CASES
Yachekour. T1, Aberkane M1, Bensmaine. M.A1, Zouani.S1, Taibi K1,
Touhami F1, boudjouras yahia,A 1, Touhami.H1. Sairi.H2, Hambil.N2,
1 Service hematology CHU of Oran, ALGERIA
2 Service of dermatology CHU of Oran.ALGERIA
Introduction:
The pyoderma gangrenosum (PG) is an ulcerative neutrophilic dermatosis of quick change, of
etiology unknown, chronic, very invalidating, generally occurring in partnership with a systemic
disease, during inflammatory entéropathy (rectocolitis hemorrhagic), characterized in particular
by the presence of ulcerations irregular, purplished red, whose edges are dug in purulent rabbit
burrow. More rarely in partnership with malignant hemopathy especially the MDS,
In our publication bringing back three cases of PG to us associate has IT.
1° Case: A 26 years old an, in January 2009 PG in post partum, very wide woman with the
lips, center, backs of the hands and feet. The patient was trachéostomizing, follows of a laryngé
oedema. in August 2009 a LAM5 is diagnosed, treated by Protocol mini CHA, patient dead 17
days after induction in a septic table of shock.
2° Case: 32 years old young woman, followed in dermatology for a PG, was addressed to us
for the exploration of a arégénératif anemia normochrome normocytic. With the myelogram, one
discovers a refractory anemia with excess of blastes at 12%. Under Aracytine with low dose,
survival was 11 months.
3° Case: A 42 years old man, followed in hematology and dermatology for a PG, with vitiligo
and an anemia of Biermer. At the end of one year of treatment for the PG and Biermer, the patient presents a pancytopenia progressive installation. The myelogram revealed the invasion of
marrow by 22% of blastis of pace myéloide. Put under weak Macaw-C proportions, survival was
9 months.
Comments:
The frequent association of the PG to the hémopathy is known and tends to return the PG like
a symptom very serious precedent of the hémopathy of all kinds. The forecast of the PG as that
of the diseases which join it remain very held.
110
PO-38
ASSOCIATION LEUCÉMIE AIGUE MYÉLOBLASTIQUE
ET TUBERCULOSE MULTIFOCALE
Service d’hematologie.CHU Med VI.Marrakech,Maroc
La tuberculose est une infection opportuniste très fréquente chez l’immunodéprimé notamment les patients porteurs d’hémopathies malignes chroniques. Mais la tuberculose multifocale
reste une forme rare dans le contexte des leucémies aigues.
Nous rapportons le cas de Mr N.M âgé de 42 ans, sans antécédent pathologique, qui a
présenté progressivement depuis 5 mois, un syndrome d’insuffisance médullaire complet, et des
poly adénopathies cervicales. L’examen clinique trouve un patient fébrile à 39 °C, pâle, et qui a
des poly adénopathies cervicale, sans hépatomégalie ni splénomégalie. L’hémogramme montre une anémie à 7g/dl normochrome normocytaire,une hyperleucocytose à 56000/mm3 avec
90% des blastes,et une thrombopénie à 14 000/mm3. Le myélogramme réalisé était en faveur
d’une leucémie aigue myéloblastique type 4, avec R +++,M+,et plus de 20% de myéloblastes.
L’immunophénotypage confirme le diagnostic de leucémie aigue myéloblastique.
Le patient était mis sous poly chimiothérapie d’induction selon le protocole AML -03. L’évolution
a été marquée par une fièvre à 41 °C et la persistance de deux adénopathies latéro-cervicales
droites, alors que toutes les autres adénopathies ont fondu sous chimiothérapie. La radiographie thoracique a montré des micronodules disséminés dans les deux champs pulmonaires,
l’échographie abdominale a montré de multiples nodules siégeant au niveau rénal et splénique.
L’administration d’une bi antibiothérapie à large spectre associée secondairement à des antifongiques n’a pas permis de mettre le malade en apyrexie.
Vu le contexte clinique, la non amélioration du syndrome infectieux sous biantibiothérapie
à large spectre et antifongique, la persistance des adénopathies et l’aspect radiologique ; le
diagnostic de la tuberculose multifocale a été évoqué. La recherche de BK dans les expectorations est négative, la biopsie ganglionnaire ne pouvait pas se faire vue l’aplasie médullaire
post chimiothérapie. Le patient a été alors mis sous traitement anti bacillaire selon le régime
2RHZEb/7RH. Le diagnostic de tuberculose a été secondairement confirmé par la biopsie d’une
des adénopathies cervicales après la sorite de l’aplasie médullaire post chimiothérapie.
Le patient est en rémission complète de sa leucémie aigue, l’évolution clinique et radiologique
est bonne sous traitement anti bacillaire.
Ainsi la tuberculose doit rester présente à l’esprit des cliniciens et doit être évoquée devant
des adénopathies même si le contexte clinique n’est pas toujours très évocateur et les moyens
diagnostics limités.
111
PO-39
ACUTE CARDIOTOXICITY OF THE ANTHRACYCLINE,
ABOUT 2 CASES
Yachekour. T1, Aberkane.M1, Bensmaine. M.A1, Boussadia.D1, Baroudi.N1,
Zouani.S1, Taibi.K1, Touhami.H1, Baazi.M2, Messameh.M2, Hammou.L2
Sc hématology CHU Oran1 Sc cardiology CHU Oran1
Introduction:
The anthracyclines are inhibitors of topo-isomérase II with a broad spectrum of anti tumoral
activity, but their regulation is limited by their cardiotoxicity which exists in three forms: acute,
subacute and chronic. Chronic toxicity depends on the serum peak of concentration and of the
accumulated dose of the anthracycline while acute toxicity is rare, an early and adequate assumption of responsibility preserves the vital prognosis. We report 2 cases of them.
Case N° 1: H/A.H, 16 years old known since July 2008, for LAL T, the cardiac echography
of the assessment pretherapeutic finds a VG not dilated of good total and segmentary systolic
function, ejection fraction: 68%, not of dilation of the cardiac cavities, not of anomaly of the mitral
and aortic structures. Induction by the protocol GRAALL 94, J1 the 7/12/08. The anthracyclines
used is the doxorubicin with the amount of 30 mg/m2, 1day day2 day3 day15 day16 (total amount
25O mg), with J 50 of induction a total cardiac failure was noted with a HTAP and a reduction in
the fraction of ejection to 30%, put under diuretic, cardiotonic, IEC. a total recovery of the noted
cardiac function two months. Curently the patient is in complete remission.
Case N°2: F/B.F 26 years since November 2009, for LAM and hepatitis B. the cardiac echography into pre therapeutic finds a VG not dilated with EF: 64%. The protocol of induction of the
CR is Rubidomycine-Aracytine whose J1 was managed 19 /11/09. After a total amount of 210
mg of Rubidomycine a table of total cardiac failure with EF: 20% with a general deterioration of
the state. The patient was put under cardiotonic, IEC, diuretic. 26 days of intensive treatments,
with cooperation of the cardiologists, a total recovery of the cardiac function after. The fraction of
ejection went back to 57%. The patient is currently in therapeutic failure of sound.
Discussion:
During acute cardiotoxicity of the anthracyclines, cardiac echography very often reveals a reduction in the ventricular fraction of ejection. The myocardic biopsy is the only specific test making it possible precociously to diagnose this toxicity induced by the anthracyclines. This cardiac
toxicity can be decreased thanks to modifications in the methods of administration of the anthracycline, thanks to the use of cardioprotecteurs. The preference of derived from the doxorubicine
having a reduced cardiotoxicity, as the anthracyclines liposomales would be another solution.
112
PO-40
SAFETY OF FLUDARABINE, CYCLOPHOSPHAMIDE AND
RITUXIMAB REGIMEN IN CHRONIC LYMPHOCYTIC LEUKEMIA: ABOUT 68 COURSES: A SINGLE CENTER EXPERIENCE
Kacem K, Massmoudi S, Ben Lakhal R, Manaï Z, Bouteraa W,
Aissaoui L, Ben Abdennebi Y, Ben Amor R, Jeddi R,
Bel Hadj Ali Z, Ben Abid H, Meddeb B.
Haematology Department of AZIZA OTHMANA Hospital, Tunisia
Recent advances in the management of chronic lymphocytic Leukemia (CLL) have seen the
development of highly effective regimens capable of producing complete remissions. The CLL
8 trial showed the superiority of R-FC with no increase in the toxicity in comparison of FC regimen. We report our experience with R-FC combination. A total of 68 cycles were assessable for
toxicity.
Between March 2008 and January 2010, 68 courses of R-FC have been done for 14 patients
with CLL in haematology department of AZIZA OTHMANA Hospital. The R-FC regimen consisted
of Fludarabine 30 mg/m2/day orally on days 1-5; Cyclophosphamide 200mg/m2/ day orally on
days 1-5 and Rituximab375 mg/m2/day on the first cycle then at 500mg/m2/day for cycle 2 to 6.
This course was repeated monthly for up to 6 cycles. Antimicrobial prophylaxis comprised trimethoprim/sulfamethoxazole and acyclovir. G-CSF is prescribed if the rate of PNN< 500/mm3.
The median age was 58 years (range 28-64), 13/14 were male, 8/14 patients were in Binet
stage C and 6/14 patients were in Binet stage B with a progression disease as defined by the
National Cancer Institute sponsored working group (NCI-WG) 1996 criteria. Cytogenetic abnormalities were found in 55%.
Grade III/IV neutropenia episodes were observed in 54.4% of cycles. However, only 13.5% of
minor infections (fever of unknown origin) were notified. Thrombocytopenia episodes were observed in 14.7% of cycles and were all of grade I/II. Gastro intestinal toxicity was limited to grade
II/III with nausea/vomiting in 19.1% leading to discontinue the treatment in 6 patients on day 4.
Prophylactic ondansetron was administered to all patients. Grade II/III mucositis was present in
4.4 % of cycles. One patient died within 3 months of starting therapy (after 2 courses of R-FC).
He showed a reactivation of B virus hepatitis with gastro intestinal bleeding. Another patient
showed a reactivation of B virus hepatitis 15 days after the end of the 6th cycle.
Among the nine patients assessable for the response, eight are in complete response (RC).
The 4 others are not yet evaluated.
Richter syndrome (Hodgkin lymphoma) occurred in one patient at 11 months after RC.
There was no statistically significant association between adverse events and pre-treatment
characteristics such as age, stage of CLL, initial lymphocytosis and lymphopenia. The incidence
of neutropenia is mostly observed in the fourth cycle.
R-FC regimen is well tolerated as published in large studies.
113
PO-41
CHRONIC MYELOID LEUKEMIA IN CENTRAL TUNISIA
Ben Youssef Y,Zaier M, Bouallegue S, Ben Fredj W,
Regaieg H, Achour B, Khelif A.
Hematology Clinic. Farhat Hached Hospital. Susah. Tunisia
Objectives:
To determine the clinical, hematological and cytogenetic characteristics at diagnosis in CML
patients.
To evaluate the hematologic, cytogenetic and molecular responses of CML patients treated
with imatinib mesylate.
Design:
Records of 43 patients diagnosed with CML between January 2000 and December 2009 were
retrospectively analyzed.
Setting:
Hematology Clinic at Farhat Hached teaching Hospital.
Methods:
The daily dose of Imatinib was 400 mg. Serial quantitative PCR assays were performed at
Pasteur institute, Tunis, using Taq-man technology.
Results:
The median age was 40 years (05 – 71). Gender: 18 male, 25 female. Sex ratio: 0,72.
Ninety percent of the patients presented to the hematology clinic within 6 months of the onset
of the symptoms. Splenomegaly and weight loss were the most frequent presenting features.
CML was discovered incidentally in 7 patients. The Sokal risk was low in 25, 5 %, intermediate in
51 % and high in 23, 5 %. The Ph chromosome was found in 42/43 patients. In the Ph negative
case, the CML diagnosis was made on the presence of bcr-abl transcript. Additional cytogenetic
abnormalities were observed in 6 cases.
The median time between dia5gnosis and treatment initiation with Imatinib was 8 months (150 months). Adverse events were noted in 11/43 patients. Complete hematologic remission rate
was 97,7%. Complete cytogenetic remission at 6 months was 70 %. Major molecular response
at 18 months, evaluated by Real-time PCR, was 60 %. Two patients have progressed to accelerated phase/blastic crisis, despite Imatinib dose escalating. Five patients were subsequently
treated with second generation TKI.
Conclusion
Hematologic, cytogenetic and molecular responses in our series appear to be comparable
with western experience.
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CONTRIBUTION OF REAL TIME PCR IN THE MONITORING
OF RESIDUAL DISEASE IN CML PATIENTS
Gabsi N; Menif S.;Msaddek F.;Elloumi M.;Ben ABID H.;Belakhal R.; Ben
Romdhane N.; Laatiri A.;Khelif A.;Meddeb B.
Hematology Department Pasteur Institut, Hematology department Aziza Othmana Hospital
Hematology Department Farhat Hached Hospital, Hematology Department Hedi Chaker Hospital
Hematology Department Rabta Hospital
Introduction:
Chronic myeloid leukemia (CML) is a myeloproliferatif disorder (MPD) characterized by a
specific molecular hallmark: Bcr-Abl fusion gene. The introduction of Imatinib, the first tyrosine
kinase, in the last decade has revolutionized the prognosis of CML. Since several trials have
demonstrated the importance of the residual disease as prognosis factor in patients with CML
receiving Imatinib, researches have been trying so hard to improve therapy with aim of obtaining
a minimal residual disease at the molecular level. So that, Quantitative Real Time-PCR assays
which is by far the most sensitive assay in this context has been used for the quantification of
Bcr-Abl transcript level in the peripheral blood.
The target of this study is to underline the place of rigorous molecular monitoring in the management of the residual disease to predict a subsequent relapse by Quantitative Real-Time
PCR.
Patients & methods:
We conducted a retrospective study in which 93 patients (50 males and 43 females) with
chronic myeloid leukemia in the chronic phase who had been undergoing treatment with Imatinib
(400 mg/day) and had been monitored with real-time quantitative PCR had been included.
All patients were BCR-ABL1-positive and Ph-chromosome-positive at diagnosis. The median
age at diagnosis was 42 years (6-72 years). The median follow-up after beginning treatment was
42 months (24–96).
A total of 591 samples of peripheral blood were analyzed. The median of samples test was
6 samples from each patient during the course of the disease (4- 15 samples). Each sample
was processed the same day of collection in optimal condition including RNA extraction, RNA
retrotranscription (using Random hexmers), Real-Time Quantitative PCR (using TaqMan probe).
Absolute copy numbers of Bcr-Abl transcripts are expressed as a ratio to the absolute copy numbers of the control gene “Abl” transcripts. Analysis was based on a major molecular response
(MMolR) which corresponds to a BCR-ABL/ABL ratio ≤ 0.1%.
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Results:
The mean value of Abl transcripts was 12000 copy numbers.
The R-T Q PCR data in the first 18 months divide patients into 2 groups:
- The first group has a continuous decrease of the ratio until MMolR or undetectable Bcr-Abl
transcripts level
- the second group keeps high load of tumor cells with constant or upward ratio
The MMolR or undetectable Bcr-Abl transcripts was obtained in 67% of our patients at one
moment of the evolution. Two third of patients in MMolR (45%) have maintained the response
so far for a median period of 25.5 months up to the last samples included in this study. However,
22% of these patients who were in MMolR have lost it, although a cytogenetic remission.
Patients who belong to the second group were 33%: the BCR-ABL/ABL ratio ranges between
0.9% and 25% and they have never been in MMolR with a median follow-up of 42 months.
Discussion & conclusion:
The molecular kinetics of residual disease has become one of the most substantial components in the monitoring of patient with CML in the Imatinib era. Since, the recognition of relapse
at the molecular level allows therapeutic intervention while the burden of disease is still relatively
low. Those results show that rising or persistently high levels of Bcr-Abl mRNA can be detected
although cytogenetic or hematological remission showing that conventional analysis offers only
limited information, whereas Quantitative RT-PCR assay can detect a single leukemia cell in a
background of 104 -105 normal cells. Indeed, after treatment by Imatinib, serial Quantitative RTPCR analysis of peripheral blood specimens can effectively distinguish those patients who are
destined to remain in remission as longer as possible from those who are destined to relapse
although a cytogenetic remission. That is to say, R-T Quantitative PCR is a reliable and sensitive
technique which can predict long term stability of the disease and pattern of response.
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JAK2 MUTATION IN TUNISIAN PATIENTS WITH
MYELOPROLIFERATIVE NEOPLASMS
S. Boukhris; H. Khemakhem; H. Regaieg;
L. Ifa; H. Hmida; S. Hadhri; H. Skouri
Laboratoire Hématologie et Banque du Sang – CHU Sahloul Sousse Tunisie
Background:
JAK2 V617F is an acquired mutation present in a considerable proportion of patients with
myeloproliferative neoplasms (MPN) and thromboembolic diseases.
Aim:
We aimed to determine the prevalence of the JAK2 V617F mutation in Tunisian patients with
MPN.
Methods:
We retrospectively analyzed our lab’s registry data and medical records concerning patients
with MPN, since February 2007 to February 2010. The JAK2 V617F was assessed by means of
nested PCR SSP which has a sensibility of 2% for mutant allele.
Results:
During 3 years, 274 patients with MPN were included: Polycythemia Vera (PV) (n=134), thrombocytemia essential (TE) (n=101), chronic myeloproliferatif leukaemia (CML) (n=25), chronic
idiopathic myelofibrose (CIM) (n=14). The JAK2 mutation was detected in 33.2% (91/274) patients. Sex and age seem to be correlated to the JAK2 mutation: females were more likely than
males to have JAK2 mutation (P=0.0001; OR=2.76); JAK2 mutated patients were older (P=0.017
; OR=1.86).
Conclusions:
The prevalence of JAK2 V617F mutations in Tunisian patients with MPN was 33.2%. Further
studies with quantification of JAK2 mutation load will be help for therapy monitoring.
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MYELOPROLIFERATIVES SYNDROMES
IN CHILDHOOD 6 CASES REPORT
I.Ben amor1, M.Mdhaffar1 , S.Hdiji1, Ch. Kallel2, S.Mnif3, H.Sennena4,
S.Makni 5, A.Saad4, T.Boudawara5, M.Elloumi1
1:Service hématologie, Sfax, 2: laboratoire d’hématologie, Sfax, 3: laboratoire d’hématologie, institue pasteur, Tunis,
4: laboratoire de cytoénétique, Sousse, 5: laboratoire d’anatomopathologie, Sfax
Introduction:
Myeloproliferative syndromes (MPS) affected specially adult older than 60 years. There are
rare in children. We report 6 childhood cases of MPS, we detail the diagnostic criteria and therapeutics features.
Materiel and Methods:
Patients collected are aged 5to 20 years old. Two male patients had chronic myelogenous
leukemia (CML), three female patients had an essential thrombocythemia (ET), and one male
patient had idiopathic myelofibrosis (IMF). The investigations contain a hemogramme, a bone
marrow aspiration, a bone marrow biopsy, a karyotype, and a molecular biology to study the bcrabl rearrangement and the Jak2 mutation. We have excluded the secondary causes of thrombocytosis. For these patients we detailed the therapeutics and evolutives features.
Results:
Two patients aged 13 years had a CML. The first was in chronic phase and the second in
accelerated phase. The two patients hadn’t a HLA histocompatible donor. The treatment was
imatinib, 400mg daily for the patient in chronic phase who had a complete cytogenetic response
and major molecular response in 40 months of follow-up. The other patient in accelerated phase
received 600mg/day then 800mg/day with failure and evolution to the blast crisis. Three patients aged of 5, 9, and 19 years had an ET with a negative Jak2 mutation. Hydroxyurée was
administered with an anti platelet aggregation treatment (aspegic) allowing to reduce the platelet
count<600.000 without bleeding or thrombosis complications. One patient had IMF was treated
by corticotherapy at the dose of 0, 5 mg/ kg with transient responses.
Conclusion:
The MPS is a rare entity in childhood, whose diagnostic criteria are similar to adults. However
they present therapeutic problems: the place of allogeneic stem-cell transplantation, the duration of treatment and the toxicity of some medicines: teratogenesis of the hydroxyurée, very long
treatment with imatinib.
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PO-45
HLA-DR AND CD34 EXPRESSION IN 339 CASES
OF MYELOÏD ACUTE LEUKEMIA
Jaouadi L. Ben Salah N. Gouider E. Siala R.
El Borgi W.Ben Lakhal F. Hafsia R.
Laboratoire d’Hématologie Biologique de L’Hôpital Aziza Othmana
Introduction:
Immunophenotyping is a widely used method, complementing morphology, cytochemistry and
karyotype study to make diagnosis and classification of acute myeloid leukemia (AML).
The objective of this study is to evaluate the expression of HLA-DR and CD34 in myeloid non
promyelocytic AML diagnosed in the laboratory of hematology in Aziza Othmana hospital.
Materials:
From April 2005 to December 2009, 339 AML (APL excluded) were diagnosed. Immunophenotyping analysis of the bone marrow samples was performed by flow cytometry (cytometer
Beckmann Coulter ® XL-MCL) using a large panel of monoclonal antibodies including myeloid,
lymphoid and immaturity markers labeled with different fluorochromes.
Results:
The results of HLA-DR and CD34 expressions are resumed in the table below:
Frequencies
HLA-DR+
CD34+
74,55%
56,88%
HLA-DR+
CD34+
47,9%
HLADR+
CD3426,65%
HLADRCD34+
8,99%
HLA-DRCD3416,46%
Discussion:
As reported in the literature, HLA-DR is expressed in the majority of AML non APL.CD34 is
less frequently expressed. The absence of HLA DR and CD34 is known to be useful for distinguishing APL from other AML subtypes. In our study 16,46% of AML did not show neither HLA DR
nor CD34.The review of literature, revealed that 9 to 19% of non APL AML lack these antigens.
This study shows the large heterogeneity of immaturity markers in AML non APL.
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ANTIGEN EXPRESSION IN AML:
RELATIONSHIP WITH PATIENT OUTCOME
Ben Salah N, Souli N, Jaoubli M, Skhiri H,, Borji W, Ben Lakhal F, Jeddi
R, Gouider E, Hafsia R.
Introduction:
Acute myeloid leukemia (AML) involves the presence of a clonal expansion of neoplastic myeloid cells in the blood, bone marrow, and various tissues. Its represents a broad variety of
distinct entities. Immunophenotyping is a widely used method to diagnose and classify acute
leukemia. The objective of our study is to evaluate the contribution of Immunophenotyping in
predicting patient outcome.
Materials and Methods:
Our study is retrospective (October 2005 - July 2007), it concerned 56 patients aged from 18
to 55 years and treated for de novo LAM of adult (AML 3 excluded).The immunophenotype was
performed by flow cytometry (Beckman-Coulter XL MCL ®). We use a wide panel of antibodies
including: Immaturity, Lymphoid B, T and myeloid markers. The diagnosis of AML is retained according to criteria of the European Group for the Immunological characterization of Leukemias
(EGIL).
Results:
Out of 56 patients, 42(75%) achieved complete remission (CR) after remission induction therapy. None of the antigens tested except for the CD7 were associated with a higher or lower CR
rate. The difference in complete remission between CD7+ patients (50%) and CD7- patients
(85.4%) is statistically significant (P= 0,044). None of the antigens tested were associated with
overall survival or with disease free survival.
Discussion:
The prognostic implication of the immunophenotype in AML remains controversial. Comparing
results can be hampered by methodologies differences in the detection of antigen expression,
patient populations studied and treatment regimens administered. The prognostic value of CD7
expression in AML is uncertain, several studies reports a poor response to induction chemotherapy among patients CD7+.
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STUDY OF ABERRANT ANTIGEN EXPRESSION IN
ACUTE MYELOID LEUKEMIA (AML): ABOUT 370 CASES
Ben Lakhal F, Ben Salah N, Gouider E, Mannougui I,
Siala R, Borgi W, Hafsia R.
Service d’Hématologie Biologique. Hopital Aziza Othmana. Tunis
Immunophenotyping is a widely used method to diagnose and classify acute leukemia, thereby complementing morphology and cytochemistry. Aberrant antigen expression of T or B- cell
lineage antigens can variably be detected on the leukemic cells of AML cases.
From April 2005 to December 2009, 370 cases of AML were diagnosed in Aziza Othmana
Hospital.
Flow cytometry is performed on bone marrow blast cells using a Beckman Coulter XL MCL®.
An aberrant expression of a lymphoid antigen was found in 17% of the cases. T lymphoid
antigens were more expressed than B lymphoid antigens: 81% versus 35%. CD7 was the most
frequently expressed (55,55%). CD2 was expressed in 17,46%, its association with the variant
promyelocytic leukemia was found in 10% of the cases. CD19, cytoplasmic CD22, CD10 and
CD8 were expressed in respectively 17%, 6%, 11% and 5%. The expression of cytoplasmic CD3
and CD5 was noted in one case respectively. CD1a and CD3 were not expressed in our study.
Several studies reported an aberrant expression of lymphoid antigens in AML. Its biological
and clinical significance are not clearly established. It reflects the heterogeneity of immunophenotyping of AML.
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THE OUTCOME OF CHILDREN WITH T(8,21) ACUTE MYELOID
LEUKEMIA TREATED WITH CHEMOTHERAPY ALONE
Aissaoui L, Ben Hassen I, Ben Abdennebi Y, Bouterâa W, Jeddi R, Ben
Amor R, Kacem K, Ben LakhalR, Bel Hadj Ali Z, Ben Abid H, Meddeb B
Department of Hematology. Aziza Othmana Hospital, Tunis-TUNISIA
Introduction:
The t(8,21) acute myeloid leukemia corresponds to one of the core binding factor acute myeloid leukemias(CBF-AML) characterized by the good outcome when treated with intensive chemotherapy with high-dose cytarabine and not considered as candidates for intensification with
allogeneic stem cell transplantation in first complete remission.
Between January 2003 and December 2008, among 32 children with acute myeloid leukemia
enrolled in department of Hematology of Aziza Othmana Hospital, 8(25%) t(8,21) were noted.
We propose to study only patients treated with chemotherapy alone.
Seven patients were enrolled.
The median age was 12.5 years (10-15 years). The median WBC was 11.000/mm2 (2.20030.100). The diagnosis of AML was done by BM smears and immunophenotyping (CMF) using
EGILE scoring. The t(8,21) was detected by conventional cytogenetic
All patients were treated according to the French multicenter protocol ELAM02 with an anthracycline (mitoxantrone) and cytarabine –based induction followed by 3 courses of consolidation
therapy among them 2 courses with high dose cytarabine.
Results:
Complete remission (CR) was achieved in all patients (100%).
One toxic death occurred in the second course of consolidation.
One relapse occurred 5 years of CR. The patient was allograft in CR2.
OS (4years)=85.7% vs 59% in the other AML and EFS(4years)=71.4% vs 45.5% in the other
AML. DFS(4 years)=83.3%.
Discussion:
Our results are similar to those of literature. Even, if we study the prognostic significance of Kit
mutations which are implicated as a prognostic factor in adults, their presence does not provide
rationale for alteration of therapy.
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Conclusion:
Patients with t(8,21) have been considered a favorable risk group than non t(8,21) AML given
their superior OS and EFS and must be treated solely with chemotherapy even if a matched
family donor is available because the hematopoietic stem cell transplantation does not improve
neither the OS nor the EFS.
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TREATMENT OF CHILDHOOD ACUTE MYELOID LEUKEMIA
IN TUNISIAN PATIENTS (EXPERIENCE OF 6 YEARS)
Aissaoui L, Ben Hassen I, Ben Abdennebi Y, Jeddi R, Bouterâa W, Ben
Amor R, Kacem K, Ben Lakhal R, Bel Hadj Ali Z, Ben Abid H, Meddeb B
Department of Hematology. Aziza Othmana Hospital, Tunis-TUNISIA
Introduction:
Acute myeloid leukemia (AML) accounts for one fourth of the acute leukemia in children, but it
is responsible for more than half of the leukemic deaths in this patient population. In contrast to
the tremendous success in the treatment of acute lymphoblastic leukemia(ALL) in the last three
decades, resulting in a >80% cure rate, improvements in AML therapy have been limited, and
only about half of the patients with AML are cured of their disease.
Between January 2003 and December 2008, among 214 children acute leukemia enrolled
in department of Hematology of Aziza Othmana Hospital, 32(15%) de novo AML were noted
(Down’s syndrome and FAB M3 were excluded).
The median age was 11.5 years (2.2-17 years). The median WBC was 16.500/mm3. Two
(7.7%) patients have CNS disease. The diagnosis of AML was done by BM smears and immunophenotyping (CMF) using EGILE scoring. The distribution of FAB types: 10M1, 13M2, 3M4,
4M5, 1M6 and 1M7 Cytogenetic study was done in all patients and it was informative in 28 cases
(87.5%). According to the Medical Research Council’s Trial (MRC): 9 patients (32%) were classified into favorable group or CBF leukemia, 18(64.5%) into intermediate group and only 1(3.5%)
into unfavorable group.
All patients were treated according to the French multicenter protocol ELAM 02 with an anthracycline (mitoxantrone) and cytarabine –based induction than 3 courses of consolidation therapy
among them, 2 courses with high dose cytarabine. Patients in CR with a matched sibling donor
were eligible for allogeneic stem cell transplantation. Children with CNS disease received twice
weekly triple intrathecal therapy for 6 doses, then monthly until the end of therapy.
Results:
Complete remission (CR) was achieved in 28 patients (87.5%). Toxic death and induction
failure were respectively 3% and 9.3%. Eighteen patients (64%) had a matching sibling donor
of which 5 CBF-AML but stem transplantation was done only in 7(39%) because of problem of
feasibility. Two of them died by GVHD but no relapse occurred in this group. Relapse occurred in
10 patients (35.7%) in median period of 9 months.
OS (3years) and EFS(3years) were respectively 57.8% and 55%
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Discussion:
Cytogenetic has consistently been shown to carry major prognostic significance in AML and
there were clear differences in the distribution of cytogenetic risk groups and the outcome. Despite of the low number of patients, our results seem to be near those reported in large studies.
Conclusion:
In childhood AML, patients with non- CBF AML having a matched family donor had to undergo
allogeneic hematopoietic stem cell transplant in first CR to improve their OS and EFS.
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DE NOVO CHILDHOOD ACUTE MYELOID
LEUKAEMIA: ABOUT 54 CASES
O. Kassar1, F. Kallel1, Th. Kammoun2, I. Jedidi3, Ch. Kallel3,
H. Sennana4, S. Hdiji1, L. Ben Mansour2, H. Bellaaj1,
N. Ajmi1, A.Saad4, M. Hachicha2, M. Elloumi1
1 Department of hematology, CHU Hedi Chaker Sfax
2 Department of pediatry, CHU Hedi Chaker Sfax
3 Hematologic laboratory, CHU Habib Bourguiba Sfax
4 Cytogenetic laboratory, CHU Farhat Hached Sousse
ABSTRACT
Introduction:
Childhood acute myeloid leukemia (AML) represents 20% of childhood AL. They remain of bad
prognosis, in spite of intensive therapeutic protocols. We study here the diagnostic and therapeutic aspects of children de novo AML in a personal series.
This is a retrospective study including 54 children (age<=16years) affected by de novo AML
between 1996 and 2009 followed in Sfax hospital. Diagnosis has been established according to
FAB classification. We analyze here epidemiological characteristic and diagnostic (clinic, biology) of these patients.
Results:
The series included 31girls and 23 boys (SexRatio=0.64). The median age was of 11 years.
Splenomegaly and adenopathies were noted in 57%.only one patient had a meningal infiltration
in the diagnosis.The median of WBC count at diagnosis was 52000/mm3 and hyperleucocytosis
more than 50000/mm3 was noted in 28% of the patients.We noted anemia in all patients;the
median count of platelet was 56000/mm3 and sever thrombopenia (platelet<50000/ mm3)was
noted in74%.Distribution according FAB classification was: 13%of AML1; 22%of AML2;13% of
AML3;11% of AML4; 24%ofAML5 ;4%of AML6 and 13% unclassified. Cytogenetic of bone marrow cells showed chromosomal abnormalities in24% of cases; only 7% of patients had favourable abnormalities.
Conclusion:
Epidemiologic aspects of our patients showed more girls affected by leukemia than boy unlike to the literature results.The most frequent reason of consultation is anemia.The frequency of
Tumoral syndrome (57%),the results of hemogram noted in our study are similar than rapported.
The results of distribution according FAB classification is different from those found in the literature showing more frequency of type2(22%)and type5(24%). However, for cytogenetic results,
the most of our karyotype is normal (74%) and this is not the case in the literature in which more
than 90% show chromosomal abnormalities.
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EFFICACY OF IMATINIB IN CHRONIC MYELOID LEUKEMIA
ACUTE PHASE: ABOUT 3 CASES
H. Zidani; Y.Ouarhlent ; K. Kouidri;
N. Kara Mostefa; R. Chafai; M. Saïdi
Haematology, University Hospital of Batna.
Introduction:
If the treatment of chronic myeloid leukemia (CML) in chronic phase has been revolutionized
by the use of an inhibitor of tyrosine kinase: imatinib mesylate, one of the more acute phase(AcP)
is deploring and prognosis. There is no well defined protocol, but treatment for the type of acutisation (ALL or AML) is often attempted in order to restore a phase myeloid and propose a possible allograft.
We report three cases of acute phase in which different conventional chemotherapy were tried
without success, but who responded to imatinib (IM) dose of 600mg/ day.
Observations:
The first case: man 40 years old, with CML since September 2001treated by Hydrea*. An
acutisation is diagnosed in November 2008, chemotherapy was attempted without success (Rubidomycine: 45mg/m2 / Aracytine 100mg/m2 day 1 and during 5 days).The patient is put under IM
600mg / d, after 20 days, a clear objective improved clinical status, regression of splenomegaly
with reduced leukocytosis.Eighty days after treatment the patient is in complete hematological
remission(CHR).He is alive 16 months after AcP and September months of IM.
The second case: a woman 39 years old, with CML since July 2007.
In June 2009, she presents a poor condition, splenomegaly (DS: 15cm) and AcP which 17%
of myeloblasts in blood and 23% in bone marrow.Treated by IM 600mg/d. At d45, she presents in
complete haematological remission. She is alive for 8 months. HLA typing is not found in HLA
The third case: man, 56 years, with CML since June 2009 put on Hydrea. An AcP in February
2010with a splenomegaly (DS: 17cm), complete blood count showed leukocytosis has 70500/
mm3, Hb: 6.1 g / dl, PLQ: 35000/mm3, a 34% blood blasts and 41% in marrow. We have started
IM 600mg / d, an improvement of clinical status and normalization of blood counts and blood
smear is obtained at d18.
Comments:
It should be noted that these patients did not receive IM in chronic phase, which may explain
this sensitivity. The more acute phase of CML is certainly the most often resistant to conventional
chemotherapy regimens, these findings demonstrate that high-dose IM is an interesting alternative but surely transient (insufficient decline in these two patients) hence the need to consider an
allograft.
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ASSESSMENT OF A CYTOLOGY DIAGNOSIS UNIT
N.Kara Mostefa1; H.Otmani 1; FZ. Neche 1;
H.Zidani2 ;K. Kouidri2; M. Saidi2
1.Laboratory of Hematology; 2. Hematology,University Hospital, Batna,Algeria.
Introduction:
In practice, the cytology diagnosis is an indispensable part in hematology and remains (despite new technology) of a certain contribution should not be overlooked. It will benefit from being
developed and supplemented by tests such as flow cytometry and cytogenetics.Convinced of
this importance, we have reinforced this activity:
- Centralizing the blades in laboratory hematology.
- Affecting the specialized personnel: hematologists and Hemobiologists.
- Putting in place specific staining.
This is a retrospective study of 2009 (January 1 to December 31) in which we have collected
and listed the activity of this unity. The sampling comes from clinical services: hematology, pediatrics, internal medicine,intensive care unit, infectious diseases, pneumo-phtisiology, maternity.
They are: peripheral blood smear, bone marrow puncture,bone marrow, nodal puncture aspiration, cytology of effusion fluids. The cytochemical stains like sudan black, peroxydase and perls
are also performed.
Results:
We analyzed 447 blood and marrow smears stained with MGG: 293 Hematology, 95 pediatrics,
internal medicine 40, and 19 other services that have laid the following diagnosis: megaloblastic anemia: 75 cases,acute leukemia: 54, multiple myeloma: 30, lymphoproliferative disease:
12,chronoic myeloîde leukemia (CML): 12, CML in blast crisis: 03, myelodysplastic syndrome:
04, invasion by a large cell lymphoma: 07, bone marrow metastasis (adenocarcinoma of the
prostate): 01, bone marrow localization of Hodgkin’s disease: 01,hemophagocytic syndrome: 02,
visceral leishmaniasis: 02 cases.
The diagnosis of acute leukemia is complemented by cytochemical staining: peroxidases:
28 (17 positive and 11 negative) or sudan black: 15 (06 positive cases and 09 negative cases)
who have distinguished: 34 AML and 20 ALL. Perls staining was performed on 04 medullogram
suspected myelodysplasia. The study product of ganglionic puncture aspiration: 41 samples from
the hematology service that helped guide the diagnosis of Hodgkin disease 06, 09 large-cell
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NHL, 03 lymphoblastic NHL, infiltration by small mature lymphocytes in 15 samples, 02 of hemophagocytic syndrome, a metastatic lymphadenitis.
Comments / Conclusion:
This work aims to identify various diseases diagnosed by cytological studies alone that remains
a cornerstone diagnostic biological hematology. It highlights the role of cytochemical staining in
the diagnosis of acute leukemia in the absence of immunophenotype but also the vital interest
of the latter in cases where non-obvious and cytochemical stains were negative (LAM0,LAL
biphenotypic..).The nodal puncture aspiration must be systematic in any chronic lymphadenopathy, which allowed us to compare the cytology and pathology.
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HAEMATOLOGICAL MALIGNANCIES:
INCIDENCE IN BATNA FOR 2003-2007
A.Bouhidel1; ML.Bouhidel1; M.Saïdi2;
Y.Ouarhlent2; H.Bouncer1.
1. Epidemiology department,University Hospital, Batna, Algeria
2. Hematology department, University Hospital, Batna, Algeria.
The aim of this study is to present the incidence of the hematological malignancies (HM) in the
department of Batna (Middle East Algeria).
We extracted the data from the “Registre du Cancer de la Wilaya de Batna” created in 1995.
This department has 1.120 000 persons. The HM diseases were coded using the third edition of
the International Classification of Oncologic diseases (CIM.O). Three hundred sixty new cases
(327 adults and 33children) HM were registered over the period 2003-2007 and 2780 cancers in
the same time, so the MH represents 13% of all cancers.
The most frequent HM are: the Non-Hodgkin’s malignant lymphomas (NHML): 114 cases, followed by acute leukemia: 98 cases(61AML, 27ALL), Hodgkin’s lymphomas (HL): 65 cases and
the multiple myeloma in the fourth position with 41 cases.
The others are: chronic lymphocytic leukemia (CLL) 18pts, chronic myeloid leukemia (CML):
16 cases and 6 polycythemia Vera.
In children less than 15years, the MH represent 30% of all cancers, the annual incidence is
0.7/105 children.
Conclusion.
The MH represents 13% of cancers in adults and 30% in children.
The NHML are the first cause of HM in adults quite as other cancer registries. For more and
appropriate information a HM registry has to be created.
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ASSOCIATION OF SOLID TUMORS AND
CHRONIC MYELOID LEUKEMIA
C. Kerar, M. Ramaoun, L. Louanchi, H. Terfaia,
H. Ahmidatou, L. Bouriche, M. Belhani
Hematology department Beni-Messous hospital Algeries, Algeria
Introduction
Among risk factors of solid tumors and blood cancer (chronic myeloid leukemia), we incriminate the benzene and ionizing radiation, in addition, the treatment of chronic myeloid leukemia
increases this risk (alkylating agents, inhibitors of tyrosine kinase). We report 3 cases of chronic
myeloid leukemia associated with cancers. 120 cases of chronic myeloid leukemia, were retrospectively analyzed during 10 years, we found 3 associations of chronic myeloid leukemia and
cancers (solid tumors).
1st patient: a woman of 83 year-old, she underwent a gastrectomy for gastric carcinoma without chemotherapy, she develops 17 years later a chronic myeloid leukemia.
2nd patient: a woman who is 62 year-old, she underwent a mastectomy alone for breast cancer,
30 years ago. She presented with diffuse bone pain and splenomegaly. Full blood count showed
a leukocytosis, a bone scintigraphy showed increased concentration of the tracer in some region
but tumor markers were negative, bcr-abl fusion gene was found in PCR.
3rd patient: a man of 50 years old at diagnosis, exposed to ionizing radiations, presented with
splenomegaly, leukocytosis and 20% of myeloid cells in blood smear, the diagnosis of chronic
myeloid leukemia was made. He was given hydroyurea, purinethol and imatinib. Seven years
later, he develops an endothelial bladder cancer.
Discussion:
In the first two cases, the occurrence of chronic myeloid leukemia was at a distance from the
neoplasm, without chemotherapy or radiotherapy (surgery alone). Isn’t it en relationship with a
particular terrain? In the third case, the patient was accidentally exposed to ionizing radiations
and treated for his chronic myeloid leukemia(alkylating agents, inhibitors of thyrosine kinase),
beside the radiations, treatment can also be incriminated in the genesis of the tumor.
Conclusion:
Many factors can be incriminated in the oncogenesis of solid tumors during myeloproliferative
syndromes related to environmental, viral, genetic factors or linked to there own treatment.
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RARE ASSOCIATION: RECKLINGHAUSEN’S
DISEASE AND ACUTE LEUKAEMIA
C. Kerar, M. Ramaoun, L. Louanchi, H. Terfaia,
H. Ahmidatou, L. Bouriche, M. Belhani
Hematology department Beni-Messous hospital Algeries, Algeria
Introduction:
Neurofibromatosis type 1(Recklinghausen’s disease) is an autonomic dominant disorder; its
annual incidence at birth is 1 per 3500. Neurofibromatosis gene acts like a suppressant; the consequence of its mutation is the activation of corresponding oncogene. It’s an inherited disease
predisposing for a wide variety of malignant haematological pathologies (juvenile myelomonocytic leukaemia, chronic myelomonocytic leukaemia, monosomy 7 associated with myeloproliferatif
syndrome). It develops early in childhood, adult form is very rare, and one case of acute myeloid
leukaemia was reported.
Methods:
We report a case of a woman who’s 62 year-old, she was diagnosed with neurofibromatosis
when she was 20 year-old, she presented with a few weeks history of asthenia and pallor, on
examination, there were a lot of neurofibroma on her skin and a splenomegaly. The full blood
count showed a leukocytosis with anaemia and thrombocytopenia. Blood smear and bone marrow aspiration cytology returned in favour of acute myeloid leukaemia. We gave her a symptomatic treatment associated with low dose chemotherapy (cytarabine). After 6 months treatment,
we achieved a complete remission: normalization of full blood count and undetectable level of
leukaemic blasts.
Conclusion:
Neurofibromatosis is a rare disease, it’s important to evoke its association with an acute leukaemia in front of haematological manifestations.
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CLINICAL AND BIOLOGICAL CHARACTERISTICS OF
ADULT BIPHENOTIPIC ACUTE LEUKEMIA (BAL):
A SERIES OF 45 ALGERIAN PATIENTS
A.Talbi; F.Harièche; N.Ait Amer; F.Tensaout; M.Benakli; S.Akhrouf;
F.Boumansour; F.Zerhouni; R.M.Hamladji
Departement of haematology and BMT unit, Pierre and Marie Curie, Algiers; Algeria
Background:
BAL display features of both myeloid and lymphoid lineage. It is rare, actually well diagnose
thanks to the immunophenotype. We present here the clinical and the biological characteristics
and the out come of BAL in our experience.
Design and Methods:
We analysed 45 adult BAL patients (pts),diagnosed between January 2002 and December
2009 according to the European group for the Immunological characterization of leukemia (EGIL),
among 429 adult acute leukemia pts diagnosed according to FAB classification.
Results:
During the period of 7 years, of 452 acute leukemia pts, 45 cases of BAL were diagnosed in
our unit (10,4%), among them 33 (73,7%) were B lymphoid and myeloid (B/M), and 12 (26,6%)
were T lymphoid and myeloid (T/M), no case of B/T or trilineage differenciation. The median age
is 27 years old (15-81), the sex ratio is 1,6 (28 M/17 F). The median count of white cells, hemoglobin and platelet is respectively 30, 9 (1,1 - 239) x 109/L, 81 (44-159)/L and 64 (9 – 477)/L,
respectively. The median prevalence of blast in bone marrow was 94% (27 -100). Nine patients
(20%) have extra medullary infiltration, which most commonly affect the mediastinum, the central
nervous system was affected in 4pts(8,8%).Lymph nodes was affected in 18pts (40%), spleen in
13pts (28,8%) and both in 11pts(24,4%). The incidence of CD34 antigen expression were 73,3%;
58,3% of them were T/M. Above Fifty patients who has a genetic profil, 3 has t (9-22), 2pts has
t(8-21), and 1 a SIL- TAL transcript. The induction regimen was Vincristin, Daunorubicin and L
Asparaginase in 42 pts (97,6%) with negative myeloperoxydase coloration, and Daunorubicine
– Cytarabine in 3 pts (6,9%) with positive ones, 2 pts do not have any treatment. The complete
remission rate was 81,5%.The median follow up is 5 years, twenty(44,4%) patients are still alive,
2 are in relapse, 25pts died (55,5%),2 before treatement,7 pts after relapse (16,2%), 7 are refractory (16,2%), 4pts(9,3%) in complete remission and 5 pts (11%) during the induction. The overall
survival is 28.8% and the disease free survival is 26.6%.
Conclusion:
The prognostic of BAL pts is poor. They showed a higher extra medullary infiltration, relapse
and resistance to therapy after relapse. In our series the rate of death in complete remission is
still too high, because of the remoteness of sanitary structure inducing late treatment of some
infectious problems.
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STEM CELL TRANSPLANTATION
Aaml Ali Alayeb,
Faculty of Medicine / Surman
The stem cell transplantation (SCT) represents the most active form of cancer therapy.
The advances in the transplant technology and the differentiation with the availability of stem
cells and supportive care not only have resulted in improved outcomes but also expanded the
transplant options.
The variety of stem cells have been extensively studied, and the strategies are being proposed
for treating massive cancers
However post transplant relapse and transplant related mortality remain the main causes of
failure of this therapeutic approach. This study is going on to focus on the recent progress that
leads to enhance the treatment by this approach and their applications in various kinds of diseases.
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GRANULOCYTIC SARCOMA, MYELOBLASTOMA
{EXTRAMEDULLARY ACUTE MYELOID LEUKEMIA
OR CHLOROMA}.A CASE REPORT
Najah Abdulnabe Omer
Background:
Acute Myeloid leukemia (AML) is a malignant tumor of hematopoitic precursor cells of non
lymphoid lineage arising in the bone marrow. Chloroma is an extramedullary acute myelogeneous leukemia, that occur in 2 -14% of cases. It is a localized tumor seen at diagnosis of AML
or very rarely preceeding diagnosis and soon or later(within weeks to months average 7 months)
patient develops AML, and most cases develops (t 8:21). Common sites reported in literature
are orbit and paranasal sinuses, It can also involve bone, periosteum, soft tissues, lymph nodes
and skin. In most cases, diagnosis is missed and diagnosed as diffuse large B- cell lymphoma if
there are no blasts in the peripheral blood or bone marrow. The diagnosis is made if Auer Rods
are detected or if myeloid origin is confirmed by cytochemical or immunohistochemical methods.
Chloroma is Radiosensitive but systemic chemotherapy as for AML is indicated in most cases.
Case Report:
A 50-years-old Libyan female transferred to African oncology institute (AOI) as a case of
Rhabdomyosarcoma. She presented with big gluteal mass progressively increase in size & MRI
showed big subcutaneous mass. Second H/P opinion done in AOI and diagnosed as a case
of lymphoblastic lymphoma (without immune stain of complete panel). We sent slides for 3d
opinion to Germany and diagnosed by morphology and immune stain as a case of Chloroma or
Extramedullary AML. Immune stains result showed: expression of CD43 (which favours of tumor
of the hematopoietic origin and exclude sarcoma), expression of CD 34,CD33 and absence of
lymphatic antigen is typical for AML. Workup (PBF, BMA & BMB) showed no blasts in the peripheral blood or bone marrow. Patient treated by induction of remission two cycles 3+7 protocol,
she tolerated chemo well,and clinically patient improved dramatically regarding the pain and she
could sit which she could not before, she planned for re-evaluation by MRI, if achieves complete
remission she is for consolidation by HAM protocol.
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ACUTE MYELOBLASTIC LEUKEMIA PRESENTING
AS MARROW HYPOPLASIA
M.Benlazar, A.Hadjeb, A.El Mestari, N.Zemri,
K.Tayebi, N.Siali, R.Messaoudi, Z.Zouaoui.
Hematology unit, Hospital of Sidi Bel Abbés, ALGERIA.
Introduction:
In rare cases, transient marrow hypoplasia can precede acute myeloid leukemia. This episode
is defined as a ‘preleukemic state’ which ineluctably leads a frankly leukemic phase.
Case report:
We report a case of a forty eight years old woman who had an episode of marrow suppression
in June 2008 and which evolved six months after to an acute myeloid leukemia. The first episode
of marrow hypoplasia was resolved after transfusion and antibiotic therapy the underlying infection. The bone marrow biopsy showed aplastic histological features without fibrosis and no blasts
was detected. In July, the patient was asymptomatic and her blood count was normal.
In October 2008, the patient presented a second episode of severe pancytopenia with pallor
and fatigue, fever and pneumonia. The bone marrow examination showed 92% of myeloblasts,
and the diagnosis of acute myeloid leukemia FAB1 by flow cytometry. The patient received induction chemotherapy (aracyitine and daunorubicin, 3+7 standard regimen) and achieved a complete remission.
Conclusion,
Patients with marrow hypoplasia carried a risk for subsequent development of acute myeloid
leukemia, and the relation between the two affections is not clear. In these cases, the medical
surveillance is of a great importance.
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TYROINE KINASE INHIBITOR (TKI)IMATINIB MESYLATE
(GLIVEC) IS EFFECTIVE IN ALL PHASES OF CML
GLIVEC BLOCK BCRL ABL EXPRESSION AND CAN INDUCE
HAEMATOLOGICAL AND CYTOGENETIC REMISSION AND THE
INTRODUCTION OF THESE SPECIFIC TYROSINE KINASE
INHIBITION CHANGE ATTITMCTES OF THE THERAPY OF
CML
Rabia Omar Nafo
Benghazi
ABSTRACT
Aim:
Aim of the study: to assess treatment response of CML patients to imatinib meslate
Methods:
A total 59 patients with Philadelphia positive CML were treated with imatinib (glivec at dose
400mg). Fifty patients were in chronic phase and 9 patients were in accelerated phase. Patients
were followed up at haematology clinic and evaluated for haematological and cytogenetic remission.
Results:
Fifty patients out of 59 patients were in chronic phase of CML. Eight patients in chronic phase
achieved complete haematological and cytogenetic remission and 5 patients achieved complete
haematological remission and partial cytogenetic remission and 2 patients achieved haematological and major cytogenetic remission. Patients achieved complete haematological remission
only 30, and 6 patients achieved no haematological or cytogenetic remission. Nine patients were
in accelerated phase. Two patients achieved hematological and cytogenetic remissioms and 2
patients still in accelerated phase. Five patients transformed to blastic phase.
Conclusion:
Imatinib induces heamatological and cytogenetic remission in majority of paticnts with chronic
phase CML, but not in advanced phase (accelerated and blastic phase of CML phase) their response is likely to be much inferior to that in chronic phase.
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PO-61
SOLITARY PLASMACYTOMA
OF BONE-A CASE REPORT
Anilmohanrao.S, Mahmoud El Hamidi, Khalid Abdulmoula
Faculty of Medicine-Sorman Medical College-Seventh of April University,-Zawia.
A 50-year-old male patient presented with pain in the back of Neck of 3-4 months duration.
This is associated with quadriplegia. Radiological [X-ray] examination showed destruction of
most of 3,4,5 cervical vertebral bodies. A clinical diagnosis of tuberculosis of cervical spine is
made and biopsy is done from lesional site which is subjected to histopathology.
ConclusionMicroscopic Examination showed tumour composed of sheets of proliferating plasma cells
along with some binucleated cells,suggestive of solitary plasmacytoma of bone.
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PO-62
PROPHYLAXIS OF VENOUS THROMBOEMBOLIC EVENTS IN
MULTIPLE MYELOMA PATIENTS RECEIVING THALIDOMIDE
Bouteraa W; Aissaoui L; Ben abdennbi Y; Kacem K; Ben Amor R;
Jeddi R; Belakhal R; Ben Abid H; Belhaj Ali Z; Meddeb B
Hematology department Aziza Othmana Hospital - Tunis - TUNISIA
The incidence of venous thromboembolism (VTE) is more than 1% annually in the general
population and increases further in cancer patients. The risk of VTE is higher in multiple myeloma (MM) patients who receive immunomodulatory drugs, especially in combination with steroid
or chemotherapy. Various VTE prophylaxis strategies, such as low-molecular weight heparin
(LMWH), warfarin or aspirin, have been investigated.
We report our experience in the prophylaxis of VTE in myeloma patients treated with thalidomide.
Thirty-three cases of MM diagnosed between June 2008 and January 2010 in the department
of haematology in Aziza Othmana hospital and treated with regimens containing thalidomide
(association thalidomide and dexamethasone for patients eligible for ASCT (group 1) or MPT
protocol for elderly patients (group 2)).
- In the first group, the thalidomide was given at 200mg/day for 75 days. 19 patients were assessed, the median age was 54 years (41 to 64 years) with a sex ratio at 0.9.
To prevent VTE, Initially our patients received Acénocoumarol (Sintrom*) and the target INR
was 2-3. 6 patients took this treatment. We don’t assess any VTE event but it was very difficult to
manage this treatment especially for the patients who are leaving far from the hospital. For the 13
remaining patients, we choose to change to Aspirin (100mg/day). Only one event (7.6%) of VTE
was diagnosed in a case of women patient with other comorbidities (diabetes, confinement).
- For the second group, the thalidomide was given at 100mg/day for 18 months. 14 patients
older than 65 years were assessed. The median age was 68.5 years old (63 to 85 years), the
sex ratio was 1. All these patients had received Aspirin to prevent VTE. No VTE event was observed with a median follow up of 11.5 months.
In the absence of clear data from randomized studies as a foundation for recommendations,
the IMWG recommend that individual, myeloma-related risks of VTE and therapy-related risk
factors should be taken into account in determining the type of thromboprophylaxis (a risk-assessment model).
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CD45 EXPRESSION BY BONE MARROW PLASMA CELLS AT
DIAGNOSIS IN MULTIPLE MYELOMA: CORRELATION WITH
MINIMAL RESIDUAL DISEASE
Safra I, Lakhal A, Ladeb S, Ben jemaa R, Torjemane L, Abdeladhim B, Ben Othman T.
Background:
Multiple myeloma (MM) is characterized by accumulation of clonal plasma cells (PCs) in bone
marrow. CD45, a key regulator of antigen-mediated signalling and activation in lymphocytes, is
present in early stages of PCs development. CD45 is now established as a critical component of
the signal transduction machinery of lymphocytes.
Aims:
In the present work we are interested in tracking the pattern of expression of CD 45 by malignant plasma cells at diagnosis in comparison with the degree of minimal residual disease after
induction by Thalidomide and Dexamethasone.
Methods:
CD45 expression on multiple myeloma plasma cells and minimal residual disease quantification were studied by flow cytometry (FCM). A total of 14 patients (13 H, 1F) were studied at diagnosis and after first line therapy. Intensity of expression and the percentage of plasma cells are
taken into account when determining the expression profile of CD45. Samples were considered
CD45 positive, if they present more than 20% of plasma cells with bright CD45 expression (>
102). Response to treatment was evaluated by quantification of CD38 high CD138+ CD56+ cells.
A lower threshold of 10-2 defined good response to treatment.
Results:
At diagnosis, the average of plasma cell bone marrow infiltration was 35% by cytology and
25% by FCM. There is a correlation between the percentage of plasma cells estimated by cytology and FCM with a significant value (p = 0.005). The expression of CD 45 was predominantly
negative in 9 (64%) of 14 samples.
Minimal residual disease separate two groups of patients: The first group: 6 patients with MRD
> 10-2 and a profile CD 45 predominantly negative (only one sample was CD45 positive) and
a second group: 8 patients with MRD < 10-2 with five samples were CD45 positive. Negative
expression of CD45 is correlated with bad response to treatment (p = 0.05).
Conclusion:
In this study, we report a positive correlation between the expression of CD 45 and the therapeutic response. Further prospective studies are necessary to confirm this concept.
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PO-64
MULTIPLE MYELOMA IN THE ELDERLY:
TOLERANCE AND EFFICACY OF MPT PROTOCOL
Bouteraa W; Aissaoui L; Ben abdennbi Y; Kacem K; Ben Amor R;
Jeddi R; Belakhal R; Ben Abid H; Belhaj Ali Z; Meddeb B
Haematology department Aziza Othmana Hospital - Tunis - TUNISIA
Patients with multiple myeloma aged older than 65 years have traditionally received an oral
regimen combining Melphalan and Prednisone (MP). The introduction of novel agents, such as
immunomodulatory drugs and proteasome inhibitors, has substantially changed the treatment
paradigm of this disease and reported an improvement in response rate and generally in survival.
We report 14 cases of MM aged than 65 years diagnosed between June 2008 and January
2010 in the department of haematology in Aziza Othmana hospital and treated according to the
MPT protocol.
The median age was 68.5 years old (63 to 85 years), the sex ratio was 1. All patients were
stage III A according to Durie and Salmon. Only one was B because of renal dysfunction. The
majority of our patients (65%) had an IgG monoclonal component in the serum immunoelectrophoresis and 64% of cases had a kappa light chain. One patient presented a kappa light chain
multiple myeloma.
The assessment of the ISS was not possible for all the patients because of the lack of β2 microglobulin level in some cases.
All the patients received MPT protocol (IFM 99-01) with Thalidomide dose at 100mg/day for
12 cycles. Only one patient (IgM Myeloma) received an escalated dose of 150mg/day after one
cycle because of the hyperviscosity signs. The tolerance was excellent, Grade I peripheral neuropathy in two cases (14%), Grade I constipation in one patient (7%), Grade II neutropenia in one
case (7%). All patients received Aspirin at 100mg/day as prophylaxis of venous thromboembolic
events. We don’t assess any case of thrombotic events.
Ten patients were assessable for response: complete remission (2 patients), Partial response
(7 patients) and one patient had a response < 50%. All patients had a very good quality of life.
Thalidomide in association with MP protocol is well tolerated and resulted a higher PR, VGPR,
PFS and in some studies OS than MP alone. Actually data lend support to the use of MPT as the
standard of care.
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PO-65
ORAL MELPHALAN AND PREDNISONE
CHEMOTHERAPY PLUS THALIDOMIDE IN
ELDERLY PATIENTS WITH MULTIPLE MYELOMA
M.Mdhaffar1, I.Ben amor1, S.Hdiji1, N.Ajmi1, H.Belaaj1, O. Kassar1,
M.Elloumi1, K.Jammoussi2, Y.Hadj hmida3, F.Ayédi2, H.Masmoudi3
1:Service hématologie de Sfax, 2: Laboratoire de biochimie de Sfax, 3: Laboratoire d’immunologie de Sfax
Introduction:
Since1960, oral melphalan and prednisone has been the treatment of choice in multiple myeloma for patients older than 65 years. Recently the efficiency of the association melphalanprednisone and thalidomide (MP-T) has been proved in some studies. The objective of our study
is to analyse the efficiency and tolerance of this association in patients treated in our department
of haematology.
We included patients older than 65 years treated since 2006 for MM. Treatment consists of
oral administration of melphalan at 5,5mg/m2 on days 1-4 or 4mg/m2 on days 1-7 and oral prednisone at a dose of 60mg/m2 on day 1-4 or 40mg/m2 on day 1-7. Each cycle was repeated every 4
weeks for six cycles. Thalidomide was administered at 100mg per day continuously during the six
MPT cycles. The dose of thalidomide was reduced or stopped for sides effects. Anticoagulation
prophylaxis was given by salicylic acid during Thalidomide treatment. The response to treatment
was monitored by measurement of protein in serum or urine. We evaluated the hematologic and
neurologic tolerance, and thrombotic complications.
Results:
Eleven patients were required aged 65 to 78 years having multiple myeloma (MM) de novo.
The monoclonal myeloma protein was class Ig A in 6 cases, and class Ig G in 5 cases. 10 patients
was stage III A and one patient was stage III B. After 6 cycles MP-T, 1 patient had near complete response, 6 patients had partial response and 4 had stable disease. Peripheral neuropathy
(grade 2 to3) was reported in 5 patients, and thalidomide was reduce to 50% in 3 patients and
stopped in 2 patients. One patient had developed a myocardial infarction despite the anti thrombosis prophylaxis with any deep veinous thrombosis. Constipation was noted in 2 cases and
somnolence was noted in 1case. Two patients had developed haematologic toxicity to MP-T.
Conclusion:
According to the literature, the protocol MP-T became the reference treatment of the first line
of multiple myeloma in patient older than 65 years, with a global response of 76% and global survival of 80%. In our study this protocol allowed to obtain a response of 63% of case with relatively
acceptable toxicity. Such results lead us to continue this therapeutic.
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VAD AS INTRAVENOUS BOLUS AS FIRST-LINE
TREATMENT IN UNTREATED MULTIPLE MYELOMA
K.Kouidri; H.Zidani; R.Chafai; Y.Ouarhlent;M.Saïdi.
Haematology, University Hospital, Batna, Algeria.
Background:
The classic VAD regimen is administered as a continuous infusion during four days induces
rapid response without prejudicing stem cell mobilisation, but one of the disadvantages of this
regimen is the need for a peripheral line that imposes in hospitalisation during the treatment. We
examined and report the feasibility of VAD bolus as an outpatient schedule using 4 days of rapid
infusion in patients with untreated multiple myeloma(MM) where high dose therapy is planned
(young patients) or older with complications like: renal failure, hypercalcemia or neurological
complications in which a rapid response is needed.
Seven diagnosed patients(pts) with symptomatic MM were included in a prospective study
in our center. The VAD regimen consisted of vincristine 0,4mg and doxorubicin 9mg/m2 both in
100ml NaCl 0,9% by IV infusion(30mn) for 4 consecutive days.The dexamethasone was given
by IVD at a dose of 40mg on days 1-4 and IM on days 9-12; 17-21 during uneven cycles. This
regimen is administered every 28 days.
Results:
The 7 patients are 02 male and 05 female, the median age is 58,2 years(39-71 y); 05patients
are less than 65years old. Staging was performed according to Durie and Salmon: stage IIIA:06,
IIIB:01, all patients(100% stage III) had poor features. The response was evaluated according to
the criteria of the ECOG one month after the last cycle of VAD bolus in 07 patients.
An objective response was documented in 6pts (85,8%) whose achieved a partial response
(PR) no patients achieved a complete response(CR) and one failure. The main toxicities was
peripheral neuropathy in 02 patients (28,7%), infections reported in 01 patient (pulmonary infection).
Conclusion:
The VAD as rapid infusion is an effective induction regimen for multiple myeloma with 85% %
response rate, acceptable toxicity and less cost. This regimen is interesting in our country because: the majority of poor prognosis, the majority of young patients before ASCT, the possibility
of outpatient administration.
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SURGICAL SYNOVECTOMY OF THE
KNEE IN YOUNG HEMOPHILIACS
F.Benmegherbi, M.Bensadok, M.Belhani1,
S.Fourmas, A.Benbouzid2, S.Khiar3
1 (Departement of hematology and blood transfusion: CHU Béni Messous)
2 (Orthopedics and Trauma Unit: CHU BenAknoun)
3 (Physiotherapy, CHU BenAknoun)
Background:
In Algeria; after a census of hemophiliacs in 2009, their number is of 1435 patients, of which
524 have less than 19 years and 250 whose age is not determined.
Aim:
The aim of this study is to assess the evolution of the results of synovectomy in the treatment
of hemophilic arthropathies.
Method:
Between 2008 and 2010, 24 hemophilic patients of type A or type B were subjected to a total
of 29 surgical procedures of which 14 orthopedic surgical procedures carried out in 11 children
hemophiliacs.
Eight synovectomies were performed in the Orthopedics and Trauma Unit in seven hemophilic children, of which 2 carried out on the same patient.
The haemophilia was severe in all patients. Patients were between 7 and 16 years old at surgery. The viral contamination (HIV, HCV) was absent in all patients as well as the inhibitors.
Indications of the synovectomy: too frequent hemarthroses, chronic hemarthrose, pain and
deterioration of the function that was significant in all patients, the arthropathy is of stage III and
IV of Arnold Hilgartner and the mobility of knee was of 102°.
Substitution by antihemophilie factor was maintained during a couple of postoperative week,
and then twice a week to ensure functional rehabilitation. The patients hemophiliacs has had
consumed on average during their hospitalization 50000UI of factor VIII and 22500UI of factor IX,
and between 48000UI and 96000UI for each factor, to cover functional rehabilitation.
No hemorrhagic complications neither infectious, nor appearance of inhibitors after the surgery.
The results after operations on moderate and severe chronic knee arthropathy were evaluated, with approximately 13 months follow-up period.
144
Results:
This type of management yielded good and satisfactory results. In more than half of the knees,
no episode of recurrent bleeding occurred. The effect of surgery on the range of motion was moderate with a usual loss of mobility of knee between 8,7° and 14°, recovered completely in some
patients after rehabilitation. At one patient; the synovectomy was complicated of a stiffness of the
member requiring 2 mobilizations under anesthesia.
Conclusion:
Elective surgery in moderate to severe chronic arthropathy produces good results when performed in a specialized centre and with multi-disciplinary approach; synovectomy gives good
long-term results in term of bleeding recurrence and overall function.
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IRON STATUS OF VOLUNTARY
BLOOD DONORS AT CHU TLEMCEN
N.Merad-Boudia; F Zadjaoui; A.Ghaffour; S.Ayad; K.Dib
Hematology biological hospital, Tlemcen, Algeria
Do not harm donor is part of the blood donation ethical rules. However, it has been often found
a significant reduction in iron stores at the donors of blood across many studies among this
population. The aim of our study is to evaluate the status of iron among a population of no regular
blood donors with a normal complete blood count at CHU Tlemcen.
The total number of donors apparently healthy is 100 with an average age of 34 years, and a
neat male predominancy (men: 73).The average rate of hemoglobin is 14.02 g/dl and the mean
corpuscular volume is 87.75FL.
The analysis of serum iron did not reveal hyposidérémie in most cases, but it has shown a
depletion of iron stores at 38% in men (28 cases) versus 7. 4 %
(2 cases) in women.
The assessment of iron functional with soluble transferring receptors measurement has
showed a decrease of iron functional in 28% of cases and a distribution relatively identical into
the two sexes.
Through the results of this preliminary study, would it undesirable to systematically fortify our
blood donors?
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PO-69
PAROXYSMAL NOCTURNAL HEMOGLOBINURIA:
3CASES REPORT
F.Benmegherbi, M.Ramaoun, C.Kerrar, L.Louanchi, H.Ahmidatou,
L.Bouriche, M.Belhani.
Departement of hematology and blood transfusion: CHU Béni Messous
Paroxysmal nocturnal hémoglobinuria described for the first time at the end of the XIXe century, is a disease of the hematopoietic stem cell, and the consequence of a somatic change of
gene PIG - A Xp 22 which blocks the synthesis of GPI protein of anchoring of many proteins on
the cellular surface: the DAF or CD55 and the MIRL or CD59 whose role is to inhibit the action
of the complement.
It is characterized by an important clinical polymorphism, it is a rare disease: 220 cases
diagnosed in 40 years [SFH].
The diagnosis is ensured by the flow cytometry which allows the fast analysis of the various
leucocytic and lymphocytic populations on peripheral blood.
We report 3 cases of confirmed PNH followed in our consultation, 26 years old man and 30
years and 34 year old women, reveal by anemia, ictère with of dark urines in 2 patients, with a
hemorrhagic syndrome in one patient, without thrombosis.
Biology: pancytopenia in all patients with poor marrow in one patient, and rich with myelodysplasia (marrow and PBO) in the others, hémolysis was observed in all patients, and the diagnosis
was confirmed by the flow cytometry.
The treatment was symptomatic in all patients: blood and/or platelet transfusion. Danazol
prescribe in all patients for 8 months average duration, with a good answer in 2 patients and
stabilization in the other with a transfusional independence. The bone marrow transplant was
indicated in one patient whose aplasia was severe, but without sibling donor.
They are young patients, the anemia and hémolysis are constant, without thrombosis, the
diagnosis of the PNH was confirmed by flow cytometry, Danazol is effective.
Some drugs are potentially useful in this disease: the immunosuppresseurs employed successfully in very pancytopenic forms, the androgens seem to have an effectiveness, the allogenic
BMT is the only curative therapeutic, but it is burdened with a heavy mortality in patients often
multitraities, the targeted therapy: the éculizumab brought recently real hopes for the treatment
of anemia.
There are few patients by service of hematology, from where the interest to gather cases in
Algeria, to develop the diagnosis means, and to propose a therapeutic strategy.
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HAEMATOLOGICAL MALIGNANCIES
IN BENGHAZI IN THE YEAR 2009
Hematology unit – Jamhoria hospital – Benghazi
Introduction
The Haematological Malignancies are a group of neoplasms that arise through malignant
transformation of bone marrow derived cells. The great diversity seen in this group of disorders
is a reflection of the complexity of normal haematopoiesis and the immune system.
Aim of the study:
The study was designed to present:
1) The demographic characters of the Libyan patients with hematological malignancies in
Benghazi in the year 2009.
2) The incidence of the hematological malignancies among Libyan population in Benghazi in
the year 2009.
3) The pattern of hematological malignancies in Benghazi in the year 2009.
4) The incidence of death among Libyan hematological malignancy patients in Benghazi in
the year 2009.
Material and Method
A retrospective study was carried out in “hematology unit – Jamhoria hospital – Benghazi.
The data was extracted from the files of hematological malignancy patients who were diagnosed
in the year 2009. SPSS was used for data analysis. Statistics used; mean, standard deviation,
median and percentages. Incidence rates and mortality rates among the patients were also calculated.
Results:
Seventy-one cases of malignant hematological diseases were registered in the year 2009 in
the hematology unit at Jamhoria Hospital.
Male to female ratio was 1.4: 1, the age of the patients ranged from 18 to 100 years, median
age was 54 years, the overall incidence of hematological malignancy among Libyan population
in Benghazi was 17.74 per 100000, the most frequent malignancy was non Hodgkin lymphoma
(25.35% of all the cases) and its incidence was 4.5 per 100000. Acute lymphocytic leukemia,
myelofibrosis, and Waldenstrom’s macroglobulinemia had the lowest frequencies (1.41% of all
148
the cases), their incidence was 0.25 per 100000.
By the end of the year 2009, 8 out of the 71 cases were died with mortality rate of 11.27%.
Conclusion:
The distribution of the various hematological malignancies in this study is similar to the pattern reported in other studies. There appears to be generally a lower incidence of hematological
malignancies recorded when compared to other studies. Late presentation, interference with the
early start of treatment by the patients’ family as well as shortage of supportive treatment were
the most common causes of death.
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ROSAI DORFMAN DISEASE:
A CASE REPORT
B Benzineb, A Arabi. S. Osmani,M Brahimi, B Enta Soltane, F Attaf, M
Bey, H Tedj, N Yafour, H Berredouane, M A Bekadja.
Department of haematology and bone marrow transplantation, University Hospital 1st November 1954-Oran-Algeria
Rosai Dorfman disease is very rare histiocytosis syndrome (sinus histiocytosis with massive
lymphadenopathy) ; the histological diagnosis is not easy.
This is a case report of patient admitted in our service for pancytopenia on January 2009
He has no medical or familial antecedent. Clinical features are only pallor, asthenia, fever ;
there were no adenopathy, no splenomegaly and no hepatomegaly. The bone marrow aspiration
was poor ; a biopsy of bone marrow was made ; the diagnosis was tuberculosis and the patient
received specific treatment during 40 days without any amelioration. A second bone marrow biopsy was made ; the diagnosis was metastatic process of renal cancer. Scanner of the abdomen
show nothing in the renal site ; so, re-examination of the biopsy completed with immunophenotypic analysis showed a “Rosai Dorfman disease”
In the literature, treatment of this pathology is not well established ; the patient received 1 cycle
of COAP (cyclophosphamid – Oncovin – Adriamycine –Prednisone), with growth factor G-CSF,
but the patient dies after 13 days of haemorrhage.
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CHARACTERISTICS OF PATIENTS WITH
HEREDITARY SPHEROCYTOSIS IN ANNABA
Department of Hematology, University Hospital of Annaba.
Background.
Hereditary spherocytosis is a very heterogeneous form of hemolytic anemia, the most common inherited RBC membrane defect. The aim is to provide the clinico-biological patterns RBC
membrane disease in our department.
Methods.
Retrospective study collected 29 patients with HS diagnosed and treated between 1999-2009.
The diagnosis was based upon the physical findings, blood cell examination, reticulocyte count,
and osmotic fragility test.
Results.
Of 26 patients (11 men, 18 women), the mean age at diagnosis was 19 years (03 - 49 years),
family history was positive in only 27% of cases, splenomegaly appeared in 88%,cholethiasis
was present in 45%, haemolytic crises in 35% with 5% aplastic phases. The mean hemoglobin
rate was 10 g/dl (5 - 15 g/dl), the mean reticulocyte count was 330 G/L, and the blood film shows
spherical cells. The red cell osmotic fragility was increased in 85%. The transfusion was needed
by 40%; splenectomy was performed in 40% and anemia being corrected in all cases.
Conclusion.
The definition of the red cell membrane defect in HS has no major clinical implications that are
why it must be considered as a benign disease which is associated with a long survival.
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CLINICAL AND SCALABLE
MYELODYSPLASTIC SYNDROMES
A. Graine, S. Gherras, O. Ouanes, M. Allouda. N. Dali,
H. Aftisse, K. Benallaoua, H. Ait-Ali
Service Hematology Chu Tizi-Ouzou Algeria
Introduction:
The myelodysplastic syndromes (MDS) are clonal diseases, especially neoplastic affecting
the elderly. They represent an heterogeneous group of acquired disorders of hematopoietic stem
cells with dysmyélopoeise, giving rise to ineffective hematopoiesis and peripheral cytopenias.
Development comes to bone marrow failure or AML. We report a retrospective study of 26 cases
of MDS.
Materials and Method:
26 cases of MDS were diagnosed in 1 period of 6 years (2003 to 2008). The average age is
66ans years, with extremes of 19 to 83 years, there is a female predominance (sex ratio 0.57).
The diagnosis was made on the NSF, reticulocyte count, blood smear and medullogram, complemented by the color of pearls. The karyotype was not performed. The FAB classification was
used. The treatment was mainly symptomatic transfusion of blood and platelets, erythropoeitine,
androgens, B1 B6 Vitamin, iron chelator.
Results:
According to the FAB classification found in categories: Refractory anemia: 15 cases, refractory sideroblastic anemia: 3 cases, refractory anemia with excess blasts: 7 cases and CMML: 1
case. Overall survival was 50% at 5 years.
Conclusion:
MDS are evolving hematologic malignancies, to the worsening of cytopenias or LA. Better
biological exploration (determination of erythropoeitine) and especially cytogenetics is essential
to clarify the prognosis (according to IPSS) and best adapted treatement.
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PRISE EN CHARGE THERAPEUTIQUE DE LA FEMME
ENCEINTE AVEC UN SYNDROME DREPANOCYTAIRE
MAJEUR: A PROPOS DE 3 OBSERVATIONS,
AVEC REVUE DE LA LITTERATURE
SE Belakehal, S Baghdad, MC Rahali,
D Saber-Cherif, H Mansour, FZ Ardjoun
Service d’hématologie, HCA
Introduction
La grossesse au cours d’un syndrome drépanocytaire majeur est associée à une augmentation
du risque de morbidité et de mortalité maternelle périnatale. Par conséquent leur prise charge au
sein d’une équipe pluridisciplinaire avec un suivi biologique spécifique est nécessaire.
A partir de 3 gestantes drépanocytaires, nous illustrons les problèmes qui peuvent survenir
chez cette catégorie de patientes et nous faisons une mise au point sur la prise en charge. Nous
avons relevé les signes cliniques et biologiques des patientes, le mode de prise en charge, le
traitement et le pronostic maternel et périnatal.
Résultats
− Résultats des paramètres biologiques et gynéco obstétricaux avant l’accouchement:
Cas
Origine
1 CY Laghouat
2
BL
3
AS
Blida
Ténès
Age du
Age à la
Diagnostic grossesse
ATCD
Biologie
Echographie
31 ans
G1P0
8°mois
Mort né
- Hb:10 g/dl
- F14%
SS
84%
- RAI +
- Activité fœtale:
Nle
Phlébite MI
- Placenta
preavia
Néant
- Hb: 7,7 g/dl
- SS 78%
- RAI -
Nle
Néant
- Placenta
normal
ONTF
- Hb: 9 g/dl
Nle
- S60%C40%
Néant
- Placenta
- RAI normal
18 mois
16 ans
33 ans
29 ans
30 ans
Complications
de la grossesse
153
− Traitement et évolution:
Cas
1
CY
2
BL
3
AS
Traitement avant accouchement
- Repos à partir du 3è T
- Héparinothérapie en sc
- 3 Transfusion de CGPF
- Ac folique 20 mg/j
- 3 Transfusions de CGPF + 4 Echanges
transfusionnels
- 3 Transfusions de CGPF + 3 Echanges
transfusionnels
Accouchement
- oxygénothérapie
- césarienne prophylactique
(39° semaine)
- Nné: masculin, 2620g, VBP
- oxygénothérapie
(39° semaine)
- Nné: VBP
- oxygénothérapie
(39° semaine)
- Nné: VBP
Evolution
Bonne suite opératoire
Levée précoce
Antibiothérapie
Lovenox
Levée précoce
Antibiothérapie
Lovenox 3 jours
Levée précoce
Antibiothérapie
Lovenox 3 jours
Commentaires et conclusion
La survenue d’une grossesse auprès des patientes drépanocytaires demeure une situation
à risque malgré les progrès enregistrés dans la prise en charge des patients drépanocytaires.
Une prise en charge multidisciplinaire et précoce, une amélioration de la qualité des soins et
une adhésion de la patiente, du couple et de la famille sont indispensables pour améliorer ce
pronostic.
La transfusion sanguine prophylactique ou les échanges transfusionnels en cas de drépanocytose majeure avaient été réalisés par beaucoup d’auteurs. C’est ce que nous avons préconisé
dans notre petite série.
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THERAPEUTIC ASSUMPTION OF RESPONSIBILITY
OF THE EXPECTANT MOTHER WITH A
SYNDROME SICKLE CELL DISEASE:
A 3 CASES REPORT, WITH REVIEW OF THE LITERATURE
SE Belakehal, S Baghdad, MC Rahali, D Saber-Sherif,
H Mansour, FZ Ardjoun
Introduction
The pregnancy with syndrome sickle cell disease is associated with an increase in the risk of
morbidity and perinatal maternal death. Such a program includes a close multidisciplinary approach for the duration of the pregnancy, with a specific biological follow-up is necessary.
From 3 cases, we illustrate the problems which can occur at this category of patients. The
knowledge of these problems has contributed to the implementation of specific management
program and to a better outcome of pregnancy.
Results:
case
Origin
Birth oh
Birth of
ATCD
Diagnostic pregnancy
Biologic
parametres
Echography
Complications
1 CY
Laghouat 31 years
33 years
- Hb:10 g/dl
G1P0
- F14%
SS
8°month
death born 84%
- RAI +
2 BL
Blida
18 months
29 years
nothing
- Hb: 7,7
g/dl
- SS 78%
- RAI -
- Fetal activity:
Nle
- Placenta: Nle
nothing
3 AS
Ténès
16 years
30 years
ONTF
- Hb: 9 g/dl
- 60%C40%
- RAI -
- Fetal activity:
Nle
- Placenta: Nle
nothing
- Fetal activity: phlebitis
Nle
Placenta
preavia
155
Multidisciplinary approach for the duration of the pregnancy and the postpartal period
Case
1 CY
2 BL
3 AS
Antepartal period
- Rest (3è T)
- Héparinothérapy en sc
- Blood transfusion (3CGPF)
- Rest (3è T)
+ 4 transfusional Exchanges
- Rest (3è T)
+ 3 transfusional Exchanges
Hang the Childbirth
- oxygénothérapy
- prophylactic Cesarean (39° weak)
- alive newborn
- oxygénothérapy
- alive newborn
- oxygénothérapy
- alive newborn
postpartal period
Good
Early lifting
Antibiothérapy
Lovenox 6 months
Good
Early lifting
Antibiothérapy
Lovenox 3 days
Good
Early lifting
Antibiothérapy
Lovenox 3 days
Comments and Conclusion:
Pregnancy in SCD women, with a major sickle cell syndrome, is a high-risk situation and is
associated with raised incidence of maternal and fetal morbidity and mortality, mainly in late
pregnancy, during delivery and in the postpartal periods. Pregnancy increases the incidence of
sickle cell specific complications. The knowledge of these risks has contributed to the implementation of specific management program and to a better outcome of pregnancy. Such a program
includes a close multidisciplinary approach for the duration of the pregnancy. The prophylactic
blood transfusion or the transfusional exchanges in the event of a major sickle cell syndrome had
been carried out per many authors. It is what we recommended in our small series.
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THROMBOPÉNIE NÉO NATALE ALLO IMMUNE
Merine S, Houalef O, Abdi R ,Chalabi-Benabdallah A.
Alors que l’allo-immunisation érythrocytaire est régulièrement rencontrée en Pédiatrie néonatale,
l’allo-immunisation plaquettaire foeto maternelle est rare et peut être sévère en cas d’hémorragie
intra crânienne.Elle résulte de l’immunisation maternelle contre les antigènes plaquettaires foetaux hérités du père et absents chez la mère. Dans la population caucasoïdel’antigène plaquettaire (Human Platelet Antigen) HPA-1a est le plus souvent impliqué. Les anticorps maternels
IgG traversent le placenta et reconnaissent pour cibles les plaquettes foetales.
Nous en rapportons un cas sévère, admis dans notre service.Observation: il s’agit d’un nouveau né admis à 24 h de vie pour un purpura thombopénique extensif apparu vers les heures
précédentes et qui a nécessité 2unités plaquettaires en raison d’une thrombopénie à 5000. Dans
les antécédents, on retrouve 2 avortements et une mort in utéro. Il existe une incompabilité foeto
maternelle dans le système RH, mais les tests de Coombs direct et indirect sont négatifs. Les
échographies prénatales avaient dépisté dés la 34é semaine une hydrocéphalie,qui a été confirmé après la naissance dans le service par le scanner cérébral, au niveau triventriculaire sans
hémorragie intra crânienne. Le diagnostic de Thrombopénie néo natale allo immune, cliniquement évident peut être confirmé par un la mise en évidence d’une incompatibilité antigénique
plaquettaire parentale avec présence d’un allo-anticorps maternel dirigé contre l’antigène paternel incriminé.Le risque de récidive très élevé (80%) doit faire envisager une prise en charge dans
les grossesses ultérieures.
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HYDROXYUREA (HU) IN SICKLE CELL DISEASE (SCD):
EXPERIENCE OF A SINGLE CENTER
F. Lamraoui, C. Boucherit, M.T. Abad
Department of Hematology, EHS CAC, Blida, Algeria
Introduction
Hydroxyurea is recommended in severe forms of sickle cell disease; HU significantly reduced
the vaso-occlusive crises and mortality of the disease.
Aims:
To evaluate use of HU in patients (pts) with severe sickle cell syndromes in our country.
From 2001 to 2009, 32 patients followed for SCD have been put under Hydroxyurea protocol,
21 S / S and 11 S / beta thalassemia, including 19 male and 13 female. Average age: 18.59 years
ranging from 4 - 44 years. Average Hb S: 71.35%. Average Hb F: 22%. Average number of vasoocclusive crises (VOC) per year requiring hospitalization (28 pts): 5.62 (2-12). ACS: 1.4 (1-3).
Number of blood transfusions (BT): 2 pts: no BT. 15 pts: under 15 BT. 14 pts: beyond 20 BT: 4
of which have received more than 40 BT. Splenic sequestration: 2 cases. Hypersplenism: 7 pts.
Splenectomy: 10 pts. Hb: Average: 6.22 g / dl (5 to 8.5 g / dl). Criteria for inclusion in the protocol:
severe VOC: 28 pts: 5.25 episodes / year (2 - 12), at least 1 episode of ACS was noted in 10 pts.
Severe anemia: 5 pts. Priapism: 2 pts. Protocol: HU: Mean dose 14mg/Kg/j (12- 20mg/kg/j).
Results
Assessment of protocol HU: December 2009
Average VOC / year requiring hospitalization for 10 pts: 1, 6 (1-4). In 20 pts: total disappearance of the VOC; worsening of symptoms in 1 patient (no compliance to protocol), few episodes
per year in 7 pts: 1.2 (1- 4). No SCA has been reported, no episode of priapism. Hb: 8g/dl (6
- 10g/dl), average gain of Hb = 2.1 g / dl in pts with severe anemia (Hb <7g/dl). Patients that receive punctually BT: 9 pts: 5 S / S, 4 S / beta thalassemia: 4 following a severe VOC, 3 following
a severe anemia, 1 exchange BT for priapism, 1 patient S / beta thalassemia has a pulmonary
and glandular sarcoidosis (parotid), he is still treated with steroids.
Conclusion
HU improves significantly outcome of SCD and quality of life in our country.
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IRON DEFICIENCY ANEMIA AMONG WOMEN
M.T. Abad, N. Rekab, F. Lamraoui, S. Taoussi, S. Chebrek, S. Oukid,, C.
Guezlane, C. Boucherit, K. Benlabiod, A. Bouchakor, H. Brahimi.
Department of Haematology, EHS CAC Blida, Algeria.
Introduction
Iron deficiency anemia is the most common anemia in women in daily practice in hematology.
Patients and Methods
This retrospective case study examined 3865 cases of anemia observed over a period of 10
years (January 1999-December2008). It has identified 1746 cases of iron deficiency anemia in
women.
Results
Median age was 31 years (16 - 94). The woman in genital activity represents the largest proportion of recruitment with 83.27%. Iron deficiency anemia was diagnosed during an ongoing
pregnancy in 7.15%. The socio-economic conditions are bad in 25.3% of cases. The functional
signs of anemia were the principal reason for visit (80%), rarely digestive disorders (0.63%) and
bleeding (1.48%). In 16% of cases the discovery of anemia was made at a biological assessment
for another reason. Clinically, anemic syndrome was associated with signs of iron deficiency in
50.6% of cases. Anemia was severe in 45.7% (Hb <7g/dL). The average MCV was 64.3 fl and
MCHC averaged 27.6%. An iron status was performed only in 58% of cases;
In most cases a therapeutic test with iron was made: he came back positive in 90% of cases:
patients gained an average of 3, 4g/dl of hemoglobin in 3 weeks, the average basic rate of Hb
was 7.3 and an average final rate 1O, 7 g / dl, an average gain corresponding to half of the deficit
of hemoglobin. Mixed deficiency (iron and vitamin B9) was observed in 7.9% cases (average
MCV = 86.8 fl) Severe anemia requiring blood transfusion was present in 46 cases (2.63%). The
mechanisms of anemia were:
• inadequate intake in 53.42% cases.
• haemorrhagic syndrome in 32.58% of cases (haemorrhage: genitalia in 90.33% cases gastric
in 7.73% cases, 1.94% in other cases
• bad absorption in 4% of cases (celiac disease: 68.2%, gastric damage: 31.8%)
• increased requirements in 10% of cases.
159
We further note after the etiological investigation cancer in 4 cases: 1 cervical cancer, 1 liver
cancer, 1 sigmoid cancer, 1 bladder cancer.
Comments
Iron deficiency anemia is very common in haematology, it has 3 aspects: habitual and obvious
presentation (presence of clinical and biological signs), already under treatment, latent often discovered accidentally. If the first presentation may be supported by any physician on the basis of
a therapeutic test, the last two may require the determination of iron status and / or serum ferritin.
Our study shows that the most common cause is the lack of supply due to poor socioeconomic
conditions followed closely by the excessive losses.
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LAPAROSCOPIC SPLENECTOMY IN SEVERE
IMMUNE THROMBOCYTOPENIC PURPURA (ITP)
C. Guezlane
1,
R. Benhizia 2, S. Oukid 1, S. Taoussi 1, S. Chebrek
Lamraoui 1, E.M. Si Ahmed2, M.T. Abad 1
1,
F.
1: Department of Haematology, EHS CAC Blida, Algeria 2: Department of Surgery, University Hospital Blida, Algeria
Classic splenectomy was the only abdominal surgical approach for removing the spleen until
the advent of laparoscopic splenectomy.
Aims:
To assess the results of laparoscopic splenectomy performed in our patients since three years,
we present a preliminary study of 20 patients splenectomized by this method.
Materials and methods)
From January 2006 to December 2007 18 patients were splenectomized by laparoscopy,14
adults and 4 children, male in 06 cases and female in 12 cases. The mean age at diagnosis was
25 years (07-58 years).
In biological terms, severe thrombocytopenia (platelets <20 000 / mm 3) was found in 66% of
these patients. The first therapeutic weapon was corticosteroids in all cases.
In the evaluation of corticosteroid therapy, 06 patients were corticodependance, 07 patients in
total failure, 05 were submitted after remission of 1 to 7 months of recurrent thrombocytopenia.
Preparation for splenectomy included systematically bolus of steroids the day before surgery,
and a hospitalization for one day.
Results)
Splenectomy was performed within 03 to 48 months after diagnosis (mean: 15 months). During abdominal exploration, accessory spleens were systematically explored. After splenectomy,
complete remission (CR) was achieved immediately in 14 (77%) patients, failure in 2 (8.6%)
patients. A failure is a patient died of diabetes known before ITP. After splenectomy, the surgical
stay does not exceed 03 days.
The postoperative course was simple: no incident of infection or bleeding was noted. An early
thrombocytosis was noted in 16 patients without thrombosis proved. The study of pathological
part of splenectomy has solved a case of non-Hodgkin’s splenic lymphoma.
In the long term evaluation (24 to 36 months), 11 patients (61%) were considered cured, 03
patients (17%) initially in CR relapsed after one to 06 months and released under steroids RC.
161
The median survival was 39 months (33-48 months).
Overall, laparoscopic splenectomy is a procedure therapeutic alternative to splenectomy
bloody. The latter benefits are numerous: reduced anesthesic risk, shortened hospitalization,
reduced infectious complications.
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PROGRAM OF EXCHANGE TRANSFUSIONNEL
TO THE DREPANOCYTIC: EXPERIENCE OF
HAEMATOLOGY DEPARTMENT CHU ANNABA
H Belaidi - H. Hamdane - L. Oulad diaf- F. Grifi.
Haematology department of Annaba, Algeria
Introduction:
The Transfusional Exchange (TE) is one of the means of fight against the complications of the
sickle cell disease, uses in fall of certain severe complications or in prevention in situations has
risks, with the aim of reducing the concentration of the haemoglobin S.
Retrospective, descriptive study, spreading out over 2 years (January 2008 - December 2009),
including the drepanocytic patients to whom we realized TE for diverse indications. The preliminary biological examinations were: erythrocytaire phenotype, FBC and blood film, electrophoresis of the haemoglobin, the serology HCV, HBs, HIV, and in a fickle way: ferritine, renal and
hepatic balance assessment, echocardiography. For all the patients we have used phenotyping
red blood cells transfusion.
Results:
25 patients collected 7 men and 18 women, the average age of which is of 31 years (17 - 45
years). The majority of these patients are homozygous drepanocytic (14 patients). The pregnancies and the cholecystectomys were the most frequent indications. 2 patients had a positive
preliminary serology the one for the HCV, the other one for the HBs. The average number of
sessions of TE by patient was 2.8 (1 - 6). A good profile of tolerancy was note at all the patients.
The rate of Hb S achieves later TE: 40 % (14 patients), 30 % (5 patients), and > 40 % for 6 patients. All the deliveries took place normally except one case of death. The surgical operations
are realized without complication. One patient died, 20 days after her first session of TE in acute
chest syndrome.
Conclusion:
Transfusional Exchange is a major therapeutic weapon in the care and the prevention of the
numerous complications.
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THE BLOOD TRANSFUSION PROGRAM FOR Β
THALASSEMIA PATIENTS: METHODS AND RESULTS
F. Grifi – H. Belaidi – N. Meliani – A. Djenouni.
Haematology department of Annaba, Algeria
Introduction:
The blood transfusion program of CG in the purpose of maintaining a haemoglobin rate compatible with the lifespan, is the basis to take charge of β-Thalassemias major patients. But these
frequent blood transfusions generate complications which need prevention and case management.
A case-control study on a cohort of 40 β-Thalassemia main patients, taken in at the haematology department during 2009. The diagnosis was applied at the paediatric department, where a
blood transfusion program has started and continued till the age of 06. At our level, the blood
transfusion program is followed by phenotypes CG.
Results:
Only 25% of patients receive blood. The blood transfusion rate is different according to the
requirements of patients: every 21 days for 8 patients, all months for 5, every two months for 12,
every three months for a transfusion after more than three months for 9.3 of our patients have
received no blood transfusion during 2009. 62.5% of the patients are given hydroxyurea, 85%
were under splenectomy.
Iron chelation is made through desferal in bolus for most patients (34 patients), only 6 patients
use the subcutaneous way by a pump.
17 patients have a ferritinemy rate <2000 ng/ml, 2 patients have more than 10000 ng/ml. The
degenerative visceral complications are dominated by the cardiopathies (9 patients). 8 patients
were given a seroconversion towards HEPATITIS C VIRUS. Most of our patients have a failure
to thrive.
Conclusion:
The blood transfusion program remains a major element in taking in charge β-thalassemias
patients which do not respond to the hydroxyurea, but which advantage is limited by many inconveniences: iron excess, viral transmission, which are difficult for the patients.
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SEROPREVALENCE OF HEPATITIS C AMONG
PATIENTS WITH HEMOGLOBINOPATHIES
A.djenouni1-f.grifi1-amoura2-dekhil2
1 - Hematology Department CHU Annaba
2 - Laboratory of Bacteriology CHU Annaba
3 - Faculty of Medicine Badji Mokhtar Annaba, ALGERIA
Introduction:
The prevalence of hepatitis C in the haemoglobinopathies is important in relation to transfusion
therapy. Hepatitis C leads to a greater liver mortality in these patients favored by iron overload.
Objective:
This work aims to determine the seroprevalence of hepatitis C among patients with hemoglobinopathies, followed at our department.
Patients and Method:
This cross-sectional study, 263 patients followed with interest for a hemoglobinopathy:- 205
major sickle cell syndromes- 42 β thalassemia major - 16 cases of hemoglobinopathies. The
study extends from the recruitment of patients until December 2009.Viral serology (ELISA for 3rd
generation) is done systematically and regularly with varying frequency depending on the type
of haemoglobinopathy and transfusion rate, if this test is positive a second time and again by a
complete liver function and a PCR order assess the viral load and have the genotype.
Results:
Of 263 patients, 41 had a positive HCV serology, an overall prevalence of 15.5%, a rate higher
than that found in the general population. The average age of these patients was 28 years with
a range of [15-58 years], sex-ratio is 2.4. The sero-prevalence in each type of hemoglobinopathy
is as follows:- Sickle cell syndromes-major: 15%, 65% are homozygous forms- β thalassemia
major: 19% - Hemoglobin C: 6%. 60% of cases with positive HCV antibodies have a history of
transfusion, of which 54% are multitransfused. In 54% of patients, hepatitis C has evolved to
chronicity and 5% liver cirrhosis.
Conclusion:
The life expectancy of patients with congenital hemolytic anemia has considerably improved,
particularly in patients with thalassemia and sickle cell disease. But it remains a significant morbidity and mortality secondary to viral infections.
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SEVERE CONGENITAL NEUTROPENIA: CASE STUDY
C.Aboura, N.Zidani, M.Bensadok, L Oukrif, A.Bensenouci, M.Belhani
Service Hematologie CHU BeniMessous
Service Pediatrie CHU BeniMessous
Introduction:
The severe congenital neutropenia (SCN) a heterogeneous group of hematologic
disorders,pose a molecular diagnosis problem,the vital prognosis would be fatal shortly by recurrent severe bacterial infections very early in the neonatal period.
Defining characteristic of all these diseases is the presence of severe neutropenia with absolute neutrophil counts less than 0.5X109/L
Bone marrow objective a maturation arrest of myelopoiesis at the promyelocyte stage of development.
The introduction of recombinant human granulocyte-colony stimulating factor (rHuG-CSF can
maintain ANC above 1.0 × 109/l. and thus substantially reduce the risk of infection. The hematopoietic stem cell transplantation (HSCT) is still the only currently available treatment.
The Prognosis depends on the response to growth factors,and the evolution to leukemia.
Case report:
An infant of 9 months
Personal history: Born at term of pregnancy without problems,he has received the vaccination
of first month. Family history: Born from a nonconsanguineous marriage.
5th in a family of 05 children,no similar cases in the family.
History of disease: From the fifth day of life the infant presented repeated infections: omphalitis, furunculosis and urinary tract infection. At 45th day he presented minor salmonella septicemia.
At 90th day he presented a consequent otitis of mastoiditis which was treated surgically, but a
complicated specis wall with sepsis was treated by ablation of the pinna. Transfused twice for
severe anemia with a hemoglobin level 3g/dl rate,WBC: 6000 but ANC not done. Determination
of immunoglobulin + test nitroblue tetrazolium reduction = normal. At admission, the child had a
deterioration of general state- fever and an intense cutaneous mucus paleness with stomatitis.
He had an abscess of anal margin and foot. Peripheral facial paralysis, without tumor or hemorrhagic syndrome.
166
Hematological exploration:
Complete blood count WBC= 4400 and severe neutropenia,absolute neutrophil counts (ANC)
=352/mm3 + hypochromic anemia with hemoglobin 5.4g/dl, Bone marrow:became rich, megakaryocytes are present but abnormal, granular 24% with maturation arrest of the granular promyelocytes, erythroblasts 44% = 3% lymphocytes, with signs of myelodysplasia. Molecular biology:
not done. Karyotype: not done
Treatment and follow-up: Treatment of the bacterial infections and treated with recombinant
human granulocyte-colony stimulating factor (rHuG-CSF daily as subcutaneous injection with
individual doses ranging between 0.27 and 120 mcg/kg/day at 20th day of treatment WBC: 480/
mm3. Despite no significant response, reduction of development frequency and severity of infections is noted.
Comments:
The severity of the clinical pattern is based on:
-Repeated bacterial infections.
- Permanent neutropenia with presence of monocytes and absence of lymphopenia.
-Maturation arrest at the stage of granular promyelocytes.
-Hypergammaglobulinemia
The diagnosis is probably: severe congenital neutropenia with ELA2 mutation. Our patient
belongs to the group of patients at particularly high risk of leukemia: -Signs of myelodysplasia in
medullogram. - Lower neutrophil responds poorly under high doses of G-CSF. The only treatment
is hematopoietic stem cell transplantation (HSCT)
Conclusion
Early diagnosis prevents children from irreversible complications (removal of the external
ear in our patient
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SPECIFICITIES OF UNEXPECTED ANTIBODIES TO RED
BLOOD CELLS: ABOUT 154 CASES
H. Khemakhem, S. Boukhriss, L Ifa, H Guedria, S. Hadhri, H Skouri
Laboratoire Hématologie et Banque du Sang – CHU Sahloul Sousse – TUNISIE
Background and objective:
The blood transfusion exposes to two major complications: immunological accidents and
transmission of infectious agents. The rules to prevent such complications have been already
specified by Tunisian laws, especially the circular 49/05. The search for unexpected antibodies
to red blood cells (UAR) is indicated mainly in pregnant women, patient to be transfused and
polytransfused patients.
Through our experience at the blood bank of the Universitary Hospital Sahloul in Sousse, we
report indications and methods of practice for UAR as well as specificities of the found antibodies.
From the lab’s register for UAR, initiated since August 1995, we analyzed various specificities
of the found antibodies. The search for unexpected antibodies was carried out following transfusion reactions, incompatible crossmatch and systematically for polytransfused patients. The
search for UAR included screening and identification by means of Coombs LISS and enzymatic
methods using microgel Diamed technique.
Results:
Over a 15 years period, 4656 search for UAR were carried out, of which 154 (3.3%) were positive. The immunization against Rhesus system was the most prevalent (63 cases): (anti-D:34
cases, anti-E:14 cases, anti-C:8 cases, anti-e:4 cases and anti-C:3 cases). In 91 cases, they
found specificity is different from Rhesus system, including 27 non interpretable cases.
The high rate of anti-red cells immunization found in our study could be explained by the load
of transfusions received and/or the multiparity.
Conclusion:
Collaboration between laboratory and clinical departments is necessary to promise blood
transfusion safety.
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VIROLOGICAL FOLLOW-UP OF PATIENTS WITH
CONGENITAL BLEEDING DISORDERS OTHER
THAN HAEMOPHILIA. STUDY ABOUT 33 PATIENTS
N. Louati*, A. Dhieb*, J. Cherif *, I. Ben Amor*,
H. Bellaaj**, H. Rekik, M. Elloumi**,J. Gargouri *
* RCBT-Sfax, ** Department of clinical hematology-Sfax-Tunisia.
Introduction
Assuring transfusion viral safety is a medical and public preoccupation. The surveillance of
multitransfused patients is one of its facets. In this frame, we notify the seroconversion rates of
the viral markers of hepatitis B (HBV) and C (HCV) viruses and human immune deficiency virus
(HIV) in patients with congenital bleeding diseases other than hemophilia who are repeatedly
transfused with cryoprecipitate or fresh frozen plasma.
Our prospective study was conducted between 1994 and 2009 and concerned 33 patients:
13 with von Willebrand disease, 15 with factor XIII deficiency, 4 with factor VII deficiency and 1
with factor XI deficiency. The screening of the viral markers of HBV, HCV and HIV was performed
every 6 months using the last generation of immunoenzymatic techniques of instant: hepatitis B
surface antigen, HIV antibody then antigen P24 and HIV antibody and HCV antibody then HCV
antigen and antibody (successively 2nd, 3rd, and 4th generations). The confirmation of HCV or HIV
positive serology was carried out using Immuno-Blot. Biological screening of blood donations
was instituted, in Tunisia, in 1971 for HBV, in 1987 for HIV and in 1994 for HCV.
Results
The total number of labile blood plasmatic products transfused was 6567 (199 / patient, extremes: 3-1422) including 5016 cryoprecipitate for von Willebrand disease (385,84 / patient,
extremes: 30-1422) and 1551 fresh frozen plasma for other disorders (77,55 / patient, extremes:
3-499). In inclusion, 4 patients (2 men, 2 women), transfused before 1994, had a positive HCV
serology. During the follow-up, we noted one case of seroconversion for HCV (3 %) (in 1996) at
von Willebrand’ patient transfused since 1993. There was no case of seroconversion for HIV or
HBV.
Conclusion
The residual risk of transfusion transmitted viral diseases, even very low, persists due to the
serological window. The sensitization of doctors of blood collect and the blood donors themselves is more beneficial for transfusion safety particularly by auto-exclusion and improvement
of regular donations. The development of autologous blood transfusion and the implementation
of viral inactivation methods would more enhanced transfusion safety.
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TRANSFUSION VIRUSES MARKERS AMONG
HAEMOPHILIACS ; A STUDY ABOUT 58 CASES
T. Rekik.*, N. Hentati.*, M. Rekik.*, I. Ben Amor.*,
N. Ajmi**, H. Rekik.*, M Elloumi.** et J. Gargouri.*
* RCBT - Sfax, ** department of clinical hématology - H. Chaker university hospital - Sfax, Tunisia
Introduction
Hemovigilance is a system of surveillance and alert which contributes to improved the transfusion safety. Preventing transmission of infectious diseases is a principal safety concern. A regular
follow-up of the viral markers of hepatitis B (HBV) and C (HCV) viruses and human immune deficiency virus (HIV) in multitransfused hemophiliacs was introduced in our blood transfusion centre
since 1993. We report seroconversion rates among these patients transfused with local plasma
derived products and clotting factor concentrates imported from Western Europe.
Our prospective study (1993-2009) included 58 hemophiliacs aged between 1 and 64 years:
50 hemophiliacs A transfused with cryoprecipitate and factor VIII concentrates and 8 hemophiliacs B transfused with fresh frozen plasma and factor IX concentrates. The detection of HBs
antigen, HIV antibodies then HIV antigen and antibodies (2008) and HCV antibodies then HCV
antigen and antibodies (2007) was carried out every 6 months by immunoenzymatic technique.
The confirmation of seroconversion for HCV and HIV was made by Immuno-Blot. It should be
noted that, in Tunisia, screening of blood donations was implemented in 1971, 1987 and 1994,
respectively, for HBV, HIV and HCV.
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IMMUNOSUPPRESSIVE THERAPY IN SEVERE APLASTIC
ANEMIA: A SINGLE CENTER EXPERIENCE ABOUT 13 CASES
Saidi I, Ben amor R, Jeddi R, Aissaoui L, Kacem K, Bouteraa W,
Abdennebi Y, Ben abid H, Bel hadj Z, Ben lakhal R, Meddeb B.
Aziza Othmana Hospital, Tunis
Background:
Immunosuppressive therapy (IST) with antithymocyte globulin (ATG) plus cyclosporine (CSA)
is standard therapy in patients with severe aplastic anemia (SAA) who do not have an available
HLA-matched sibling donor. We retrospectively analyzed the data of patients with SAA, to evaluate results and feasibility of the IST in our center.
Between February 08 and December 09: 13 patients, with confirmed SAA and no related donor, were treated in the Hematologic Unit of Aziza Othmana Hospital. Seven patients (53%) were
from north Tunisia (5 north west), 4 from south and 2 from center of Tunisia. The initial symptoms
were hemorrhage in 12 patients, associated to anemia or fever in 8 patients. Isolated anemia
was noted in one patient. All patients received IST with either rabbit ATG (n = 9) or horse ATG
(n = 4) plus cyclosporine (CSA) and supportive care until recovery of hematopoietic function. No
G-CSF used.
Results:
The median age was 19 years (7- 57). Sex ratio: 3,3 (10M/3F). At diagnosis: all patients had
a platelet count lower than 20.000/mm3, 7 patients had a neutrophil count rather than 200/mm3
(very SAA) and a median of Hemoglobin level at 6,7 g/dl. HPN clone was positive in 4 cases.
The median delay between first symptoms and diagnostic was 5 weeks and between diagnosis
and treatment 10 weeks. Three refractory patients died from bleeding respectively at 1 month, 5
months and 6 months. At 6 months; 6 patients did achieve a complete (n=5) or a partial response
(n=1). A second course of treatment was performed in only 50% of refractory cases (2/4) and
permitted the achievement of partial response, 5 months later, in one case. Actually, with a median follow up of 15 months (3-26): 8 patients (62 %) had a significant response: 5 patients (40%)
are still in complete response and 3 patients (22%) are in partial response without supportive
transfusion needed.
Conclusion:
In our study 85% of patients with neutrophils count ≥ 200/mm3 (6/7) and 75% of patients with
HPN clone (3/4) at diagnosis; did achieve good responses. These two criteria are largely de-
171
scribed in literature, but we need a larger number of patient’s panel, to have a significant statistics
study. We note also that delays between first symptoms, diagnostic and treatment are extended
(15 weeks), which may contribute to failure of response. Finally, our, first experience results, are
encouraging and may be compared to those described in the different publications.
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RED CELL EXCHANGES IN SICKLE CELL
DISEASE. A STUDY ABOUT 20 CASES
S. Chortani*, I. Rekik*, I. Ben Amor*, T. Rekik, O. kassar**,
F. Ben Said***, H. Rekik*, M. Elloumi**, J. Gargouri*
* RCBT - Sfax, ** department of clinical hématology - H. Chaker university hospital - Sfax, *** regional hospital of
Gabes - Tunisia
Introduction
Red cell exchange is important in the management and the prevention of complications of
sickle cell disease. They permit to avoid hyperviscosity and martial overload. Our aim was to
evaluate the benefits of red cell exchanges in the care of sickle cell patients.
Twenty patients were enrolled in our prospective study (1996- 2009): 15 homozygous sicklecell disease S/S, 1 heterozygous sickle-cell disease S/A, 2 sickle cell-beta-thalassemia, 2 sickle
cell-hemoglobin C disease. Red cell exchange was carried out, at the beginning, using a manual
technique (10 procedures) then, since 2004, using a continuous flow blood cell separator (Cobe
Spectra) (63 procedures). Replacement was done with phenotyped (Rhesus- kell) and deleucocytated (since 2000) red cell concentrates. Biological controls were done before and after each
procedure (hemogram, ionogram, PT, ACT, calcemy and haemoglobin electrophoresis).
Results
The mean age of patients was 22,52 years (extremes: 11-48) and the sex-ratio was 4. A total
of 73 procedures of red cell exchanges have been performed (mean: 3,61, extremes: 1- 25),
including 47 procedures done within a prophylactic transfusion program(every 2 months) in 3
patients with a history of sickling complications. Red cell exchange was indicated in several
circumstances: severe painful crises, stroke, acute chest syndrome, priapism, osteonecrosis,
or in preoperative. The mean duration of the red cell exchanges was of 96,52 min (extremes:
60-178 min) with a mean exchanged volume of 2021 ml (extremes: 1118-2879 ml) and a mean
decrease of 61,59% (extremes: 35,46-77,85 %) in the circulating sickle haemoglobin (HbS) level.
The haematocrit was growed from 28.89% before exchange (extremes: 15,3-36%) to 31,22%
after exchange (extremes: 25-39%). The clinical evolution was favorable with a clear improvement of symptomatology. Red cell exchange was well tolerated by most patients. Adverse effects
were limited to shivers hyperthermia (2 cases), painful crisis having yielded under antalgic and
morphinic treatment (2 cases). A premature stop of the procedure was noted in 1 case (problem
of veins).
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Conclusion
Though constraining and expensive, red cell exchange is an effective treatment of sickle cell
anemia. It enables a rapid decrease of percentage of circulating HbS levels either prophylactically or therapeutically. Moreover, they make possible a comfort notable life to the patients. Automated methods using cell separators allow this procedure to be performed rapidly, effectively
and safely.
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MASSIVE TRANSFUSION:
RISK FACTORS AND CLINICAL OUTCOME
H. Hmida; S. Boukhris; L. Ifa; H. Khemakhem;
H. Regaieg; S. Hadhri; H.Guedria; H. Skouri
Laboratoire Hématologie et Banque du Sang – CHU Sahloul – Sousse -TUNISIE
Background and objective:
Emergency and massive transfusion (MT) represents a particular challenge for clinician and
transfusion medicine specialist. We retrospectively assessed the incidence of MT at our institution during a 10 years period.
Local blood bank records were searched for MT episodes occurred from January 1999 to
December 2009. MT was defined as the transfusion of 10 or more packed red cell (PRC) units
within 24h. Clinical data were collected from medical records of patients.
Results:
One hundred and four patients had a massive transfusion. (125 men and 49 women; mean
age 55 years (13-81)). They received 13.14 PRC units (10-33), 17 fresh frozen plasma (FFP),
and 10 packs of standard platelets (0-33); in the context of cardiovascular surgery (n=112), polytrauma (n=36), upper digestive bleeding (n=10), others (n=16). Patients were hospitalized in
intensive care unit (n=57), department of cardiovascular surgery (n=112), others (n=5). Mortality
rate was 51%. Multivariate analysis identified renal failure (OR=4.32 ; 95% confidence interval
[CI], 1.4-3.1), acidosis (OR=4.8 ; 95% CI, 2.5-9.5), acute pulmonary edema (OR=9.5 ; 95% CI,
2.1-43) as significant independent predictors of mortality.
Conclusion:
Overall, the mortality rate among patients receiving MT was very high, and was influenced by
renal failure, acidosis and acute pulmonary edema.
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SEROPREVALENCE VIRAL MARKERS IN HEMOGLOBIN
DISORDERS. STUDY ABOUT 101 PATIENTS
A. Dhieb, I. Rekik, T. Rekik, J. Cherif, N. Louati,
I. Ben Amor, H. Rekik, J. Gargouri
RCBT-Sfax -Tunisia.
Introduction
The infectious safety of blood transfusion has steadily improved in recent years. The goal is
to achieve “zero” risk. In Tunisia, the transfusion safety is assured by medical selection of blood
donors and a screening of markers of hepatitis B virus (HBV) since 1971, human immune deficiency virus (HIV) since 1987 and hepatitis C virus (HCV) since 1994. However, it still remains a
very low residual risk related to virological window period.
The purpose of our study was to report seroconversion rates of HBV, HCV and HIV among
multitransfused patients suffering from hemoglobinopathies.
It is a prospective study (1994 - 2010) conducted on 101 patients with hemoglobin disorders:
68 sickle-cell disease, 28 beta-thalassemia and 5 sickle cell-beta-thalassemia. These patients
have required repeated transfusions of labile blood products (LBP) or red cell exchanges. detection of viral markers has been made to the demand of the first LBP then every 6 months using
the last generation of immunoenzymatic techniques of instant (hepatitis B surface antigen, HIV
antibody then antigen P24 and HIV antibody and HCV antibody then HCV antigen and antibody
(successively 2nd, 3rd, and 4th generations). The confirmation of HCV or HIV positive serology has
been achieved by Immuno-Blot.
Result:
The mean age of patients was 13,16 years (extremes: 1 - 45 years) at the time of their inclusion. The sex-ratio was 1,4 (59 men, 42 women). These patients received a total of 3 721 LBP
with an average of 45,93 LBP per patient (extremes: 1-291).
In inclusion, one patient had hepatitis B positive serology. During the follow-up, we have noted
1 HBV seroconversion (0,9%) in 2009 after transfusion of 97 red cell concentrates, 1 HCV seroconversion (0,9%) in 2004 after transfusion of 17 CGR and no case of HIV seroconversion.
Conclusion:
Monitoring multitransfused patients enters a general framework of hemovigilance. Its aim is to
evaluate the blood viral safety and to make the necessary corrective actions. Moreover, carrying
out viral transmission enquiries would lead to better transfusion risk estimation.
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RED BLOOD CELLS TRANSFUSION IN A TUNISIAN
HAEMATOLOGY DEPARTMENT: ASSETS AND PROSPECTS
Hentati N, Ben Salah N, Jaouadi L, Belakhal F,
El Borgi W, Gouider E, Hafsia R
Blood transfusion is an integral part of the daily activities in the department of haematology
of Aziza Othmana hospital. It is a high risk activity which is governed by legislative and lawful
texts.
This is a descriptive study which is carried out from January 1, 2007 to December 31, 2009.
During this period, 12194 RBC transfusions were done. The blood grouping is done into micro
plate. A chart of blood group is delivered to the patient after having validated his group and phenotype by two determinations carried out of two distinct lacings. All the patients are transfused
by RBC concentrates phenotyped in the Rhesus and Kell systems. Deleucocytation of RBC concentrates is done when required. The research for irregular antibodies (RAI) is not compulsory in
Tunisia; it is done before the first transfusion and in the follow-up. On the whole, 2358 search for
irregular antibodies were carried out of which 83 were positive due to allo antibodies. Conformely
to the law, the direct test of compatibility was done in all cases by indirect antiglobuline test. We
noted an incompatibility in 144 cases (1, 18%) which correspond to 56 patients (18 auto antibodies, 19 allo antibodies, 15 positive direct coombs test of the RBC concentrates, 4 antiprivate antibodies). Compatible RBC concentrates were found and delivered in all these cases. The ultimate
test at the bed of the patient, obligatory in Tunisia, is regularly done before each transfusion. The
blood bank did create a computer file in order to follow up transfused patients. The transfusion
register is updated, but there are insufficiencies concerning the cards of transfusion which are
missing in the medical record of almost all patients. Declaration of transfused incidents did start
only since January 2009. Only 13 incidents were noted (allergic reaction, thrill hyperthermia reactions). We did not note any severe haemolytic incident. In the aim to reduce the time of satisfaction of the demands, a transfusion program was developed for the regular transfused patients.
Nevertheless, delays of satisfaction of the demands still have to be improved.
Among efforts to respect the law and to improve quality of life of our patients, many measures
should be taken, essentially in hemovigilance and in delays of distribution of blood.
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GAUCHER DISEASE: HEMATOLOGICAL
ASPECTS AND DIAGNOSIS
H. Ahmidatou, M. Ramaoun, M. Bensadok,
L. Bouriche, C. Kerrar, L. Louanchi, M. Belhani
Hematology department beni-Messous hospital Algeries Algeria
Introduction
Gaucher disease is the most frequent storage disease and corresponds to an inherited deficiency of glucocerebrosidase. Due to excessive accumulation of glucocerebroside in macrophage present especially in bone marrow, cytopenia and splenomegaly occur.
Objectives
Gaucher disease remains a rare pathology, the aim of our study is to:
- show the process of diagnosis in front of hematological manifestations
- classify the patients into 3 types
- Discuss the enzymotherapy replacement indication.
Methods
We reported 4 cases of patients with Gaucher disease, 3 were women and 1 was a man, mean
age at diagnosis was 30 years.
Results
The main features were: splenomegaly (1), bleeding (ecchymosis, epistaxis) (5), pallor (3).
Laboratory tests showed: anemia (3), thrombocytopenia (2), bicytopenia (2) and hyperferritinemia (1).
The diagnosis was evoked by the bone marrow aspiration cytology and obtained by the identification of Gaucher’s cells on bone marrow biopsy examination for our 4 patients, confirmed by
the enzymatic activity dosage only for 2 patients. Our patients present Gaucher disease type 1,
form without neurological manifestations. Substitutive enzymoyherapy was not performed for our
patients; they had just needed a regular follow-up.
Discussion
The diagnosis of Gaucher disease was made in adult age in our study, forms discovered at
this age are frequent. This result is similar to those found in previous studies. Splenomegaly was
found only in one patient, when, it’s present in 90% of patients in other series. The diagnosis
178
was easy for 3 patients; bone marrow aspiration was done at the first examination but, for the 4th
patient, the diagnosis was made after exclusion of all the other causes of hyperferritinemia.
Enzyme replacement therapy is now available, it’s indicated when the hematological manifestations are severe, our patients have mild symptoms, and they haven’t needed any treatment at
all.
Conclusion
Gaucher disease often appears in childhood, some patients are diagnosed in adulthood. It’s
important to evoke this disease in front of unknown etiology hematological manifestations. It’s the
bone marrow aspiration cytology which allows the diagnosis
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INVESTIGATIONS ABOUT TRANSFUSION INCIDENTS:
13 CASES REPORTED
S.Chichoune; F.Soltani; F.Kacha; A.Ounissi;
H.Hamza; H.Zidani; K.Kouidri; M.Saidi.
Blood transfusion consists of 03 major adverse effects that can make patient’s life in danger,
are: immunologic risk, infectious risk and the risk of over loading. At the present time the grave
immunologic accidents are exceptional, the immunologic incidents remain particularly frequent
in our patients.
It’s about a retrospective study, analysing a number of incidents met in the haematology unit
during the last year.
Results:
Among 1312 LBP transfusions effected, 13 incidents of immunologic and allergic type were met 1%:
- shudder fever syndrome: 4,
- allergic reactions: 08,
- TRALLI syndrome: 01.
These complications were met among polytransfused patients:
- aplastic anemia: 05 patients
- acute leukemia: 04,
- thalassemia: 02,
- myelodysplasia: 01.
The nature of LBP(labile Blood Product) offending is divided into: 07 incidents were in relation
with transfusion of platelets: 06 of SP(Standard Platelets) and 06 after red blood cells(RB).
The TRALLI syndrome occurred during RB transfusion in a young poly transfused patient,
manifesting with dyspnea,hypotension, crackles, and hypoxia, resolved after the stopping of
transfusion and oxygen therapy.
Conclusion:
The frequency of immunologic and allergic incidents is not rare: 01% occurred in particular
patients: poly transfused and immunodeficiency. The platelet transfusion is the most frequent in
these incidents specially the standard platelets which provide in multiple donors. Single donor
aphaeresis must be necessary provided. However, the practise of immunologic tests(research of
HLA antibodies among the giver and recipient) is not performed.
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TRANSFUSIONS REGISTER IN HAEMATOLOGY:
ESSENTIAL SUPPORT OF HEMOVIGILANCE
F.Soltani; F.Kacha;A.Ounissi;H.Hamza ;
S.Chichoune;H.Zidani;K.Kouidri; M.Saïdi
Introduction:
Transfusions are medical acts largely practised in haematology. This gesture is not divided of
risks, it is recommended to make a register are listed all the transfusion of labile blood products
LBP as suggested by the regulator and any anomalies encountered in upstream or downstream
of the transfusion.
Methods:
This retrospective analysis, effected on the register taken by nurses, we have studied the datum recorded during 2009 and compared with those set down on the patient’s files.
Results:
During this year: 1344 LBP transfusions have been registered: 650 packed red blood cells, 540
SP(standard platelets) and 56 AD(single donor apheresis platelets) and 78 FP(frozen plasma);
mean 3,6 acts / day. The major indications are acute leukaemia and aplastic anaemia.
When comparing with the real transfusion reported on medical files we find that 46 transfusions were not reported (3,6 %).Only 3events are registered among 13 real.
Commentaries:
This work helps us to make a look on the person who is using this therapeutique procedure
that seems saving but can be dangerous when all precaution were not taken. The deficiencies
revealed in maintaining the register as the non-registration of some transfusion (3.6%) the results
of compatibility tests and incidents encountered and are not always mentioned 3/13.
Conclusion:
When looking to these insufficiencies, it is essential to carry out a pedagogic work related to
the blood transfusion, recapture the fundamental notions of hemovigilance the nurses well as the
medical ones, also the practical application of these notions must be materialised on the transfusion register that makes an important support for traceability.
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EVALUATION OF ANGIOGENISIS ACTIVITY
IN UNTREATED ERYTHROCYTOSIS PATIENTS
C. Maktouf1, A. Bounemra2, S.Mahjoub3a, F. Msadek4a, A.Khlif5a,
M.Karoui6a, S.Hdiji7a, S.Zriba4a, N.Ben Romdhane3 A, M. Elloumi7a
1- Nuclear Medicine and biomedical research department - Pasteur Institute of Tunis; 2- National transfusion blood
center ; A- hematology department, 3-La Rabta hospital, 4-Tunis Military hospital, 5-Farhat Hached hospital,6-Charles
Nicolle hospital, 7-Hedi Chaker hospital,
The aim of this prospective study was to investigate the involvement of angiogenesis in the
etiopathogenesis of the different classes of erythrocytosis (polycythemia vera PV, idiopathic
erythrocytosis and secondary erythrocytosis). The angiogenic activity was evaluated by the assessment of the serum VEGF levels in 78 untreated erythrocytosis patients and 21 healthy subjects.
The results indicated that VEGF was overproduced in advanced and untreated PV patients
and at less degree in early PV a subgroup of idiopathic erythrocytosis, thus confirming an increased angiogenic activity. However VEGF doesn’t play an angiogenic role in secondary erythrocytosis.
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Translation to French:
PO-94
EVALUATION OF ANGIOGENISIS ACTIVITY
IN UNTREATED ERYTHROCYTOSIS PATIENTS
L’objectif de cette étude prospective était d’examiner l’implication de l’angiogénèse dans
l’étiopathogénie des différentes classes d’érythrocytose (maladie de Vaque PV, érythrocytose idiopathique et érythrocytose secondaire). L’activité angiogénique a été évaluée par la mesure des
taux de VEGF sérique chez 78 malades présentant une érythrocytose non traitée et 21 sujets
sains. Les résultats ont révélé une surproduction du VEGF chez les malades atteints de la maladie de Vaquez non traitée et à moindre degré chez les patients ayant une polyglobulie primitive
débutante (un sous-groupe d’érythrocytose idiopathique), confirmant ainsi une augmentation
de l’activité angiogénique. Cependant l’angiogénèse est absente dans les polyglobulies secondaires.
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THROMBOCYTÉMIE ESSENTIELLE RÉVÉLÉE PAR
UNE NÉCROSE CUTANÉE CHEZ UN SUJET JEUNE
S.En-nasri,S.Nait Mbarek,H.Nafil,L.Mahmal1
I.Esqalli,O.Elatiqi,I.Abkari,F.Ait Essi,Y.Najeb,M.Latifi(2)
Service d’hematologie-CHU Med VI-Marrakech-Maroc(1)
Service de traumatologie orthopedique B -CHU Med VI-Marrakech-Maroc(2)
La thrombocytémie est un syndrome myéloprolifératif caractérisé par une thrombocytose majeure. C’est une maladie monoclonale de la cellule souche multipotente. Elle s’accompagne
d’anomalies morphologiques et fonctionnelles des plaquettes.
Ce taux excessif de plaquette est souvent découvert fortuitement lors d’un examen hématologique systématique. L’âge moyen de découverte est de 60 ans, elle est très rare chez le sujet
jeune surtout de sexe masculin.
Nous rapportons l’observation d’un patient âgé de 28 ans, hospitalisé au service de traumatologie pour nécrose cutanée post traumatique.
L’examen clinique a montré une nécrose de la face interne de la jambe, sans signe hémorragique ni hépato ou splénomégalie. Le reste de l’examen était normal.
Un bilan préopératoire fait avant la nécrosectomie a montré une hyperplaquettose à 1 116 000/
mm3, Hb:8,3 g/dl ,VGM: 88fl, TCMH:28pg , Hématocrite:27%,et les globules blancs à 12 000/ul,
PNN:8500/ul,Lc:1300/ul.
Le bilan fait dans le cadre du diagnostic étiologique de la thrombocytose a montré une ferritinémie à 287ng/ml, et une vitesse de sédimentation à 132 mm.
Le myélogramme est richement cellulaire, avec une richesse élevée en mégacaryocytes évoquant un syndrome myéloprolifératif chronique.
La biopsie ostéomédullaire a montré une moelle riche avec une hyperplasie de la lignée mégacaryocytaire.
Au total il s’agit d’une thrombocytémie essentielle chez un jeune homme de 28 ans.
La recherche de la mutation Jack 2 en cours.
Le patient était mis sous hydroxyurée avec une bonne évolution:le chiffre de plaquette actuel
est de 500 000/ul.
La thrombocytémie essentielle est une étiologie rare des thrombocytoses, Il n’y a pas de signe
pathognomonique clinique ou biologique et le diagnostic est un diagnostic d’exclusion avec les
thrombocytoses réactionnelles ou les autres syndromes myéloprolifératifs chroniques. Sa révélation par une nécrose cutanée est tres rare.
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SERUM ERYTHROPOIETIN
LEVEL IN ERYTHROCYTOSIS
Aim:
To evaluate the erythropoitin serum level (EPO) measured by standardized technique in untreated erythrocytosis patient and to discuss its diagnostic value and its pathophysiological role
in the various classes of this disease.
This was a prospective, multicenter study on 78 patients suspected to have polycythemia
(hematocrit greater than 50% in men and 48% among women).Before any therapeutic treatment
(phlebotomy or chemotherapy), standardized series of investigations was done to these patients.
The assays of EPO have been made from frozen serum by ELISA using a standardized commercial kit. (Quantikine; R&D Systems, Minneapolis, MN, USA)
Results:
According to the OMS criteria of Polycythemia, our 78 untreated patients were divided into
four groups - Group 1: polycythemia vera (23M-22F ; mean age 59,3 ±13.7 years) - Group 2:
idiopathic eythrocytosis (16 M ; mean age 41,1 ± 15,1 years)- Group 3: secondary erythrocytosis
(14 M; mean age 53.2 ± 13,0 years) - Group 4: apparent erythrocytosis (3 M; mean age 43,6 ±
12,5 years)
The serum erythropoietin level of these patients was compared to those of a healthy control
group (21 M ; mean age 45,5 ± 14.7 years).The average serum level of EPO is collapsed in
polycythemia vera patient group (3 ± 2.3 mIU / mL) compared to the serum EPO levels in normal
controls (11.4 ± 5.9 mIU / mL). Its positive predictive value was 97.67%. This level was normal in
idiopathic erythrocytosis patient (9.2 ± 4.4 mIU / mL) and in the apparent erythrocytosis patients
(7.6 ± 2.1 mIU / mL) but it was higher among the group of secondary polycythemia (26.7 ± 18.2
mIU / mL).
Conclusion:
A lower value of serum erythropoietin guides to the diagnosis of polycythaemia vera, whereas
a high value is for a secondary origin. Let the hypothesis that a group of heterogeneous entity
that is the idiopathic erythrocytosis is an early form of polycythemia vera, the mechanism of the
decrease of the serum EPO level during evolution is to study.
185
Translation to french:
PO-96
TAUX DE L’ÉRYTHROPOÏÉTINE SÉRIQUE
AU COURS DES ERYTHROCYTOSES
Objectif:
Evaluer les taux sériques de l’érythropoïétine sériques dosés par technique standardisée
au cours des polyglobulies non traitées, discuter sa valeur diagnostique et son rôle physiopathologique dans les différentes classes de cette pathologie.
Patients et Méthodes:
Il s’agit d’une étude prospective, multicentrique concernant 78 patients suspect avoir une
polyglobulie (hématocrite supérieure à 50% chez les hommes et 48% chez les femmes). Ils ont
bénéficié avant toute prise en charge thérapeutique (saignées ou chimiothérapie) d’une série
d’explorations standardisés. Les dosages de l’EPO ont été réalisés, à partir de sérum congelé,
par technique ELISA à l’aide d’un kit commercial standardisé. (Quantikine; R&D Systems, Minneapolis, MN, USA)
Résultats:
Selon les critères du diagnostic de l’OMS nos 78 patients non traités ont été divisés en quatre
groupes - Groupe 1: polyglobulie primitive (23M-22F, âge moyen 59,3 ± 13,7 ans) - Groupe 2:
eythrocytose idiopathique (16 M; âge moyen 41,1 ± 15,1 ans) - Groupe 3: polyglobulie secondaire (14 M, âge moyen 53,2 ± 13,0 ans) - Groupe 4: érythrocytose apparente (3 M, âge moyen
43,6 ± 12,5 ans). Le niveau de l’érythropoïétine sérique de ces patients a été comparée à celles
d’un groupe de témoins normaux (21 M, âge moyen 45,5 ± 14,7 ans).
Le taux sérique moyen de EPO est effondré au cours de la polyglobulie de vaquez il est de 3
± 2.3 mUI/mL comparativement au taux de EPO sérique chez les témoins normaux (11.4 ± 5.9
mUI/mL). Sa valeur prédictive positive est de 97.67%. Ce taux est normal au cours des polyglobulies idiopathiques (9.2 ± 4.4 mUI/mL) et au cours des fausses polyglobulies (7.6 ± 2.1 mUI/mL)
Cependant il est élevé chez le groupe des polyglobulies secondaires (26.7 ± 18.2 mUI/mL).
Conclusion:
Une valeur basse de l’érythropoïétine sérique oriente vers le diagnostic de la polyglobulie primitive alors qu’une valeur élevée est en faveur d’une origine secondaire . Admettons
l’hypothèse qu’un groupe de l’entité hétérogène qu’est l’érythrocytose idiopathique est une forme
débutante de la polyglobulie primitive, le mécanisme de la baisse de érythropoïétinémie au cours
de l’évolution est à étudier.
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PO-97
RESULTS OF THE HEMOGLOBIN ELECTROPHORESIS DURING
A PERIOD OF TWO YEARS IN LABORATORY OF HEMATOLOGY
H.Otmani1; I.Rahal1; F.Z. Néche1; A.Boumlit1; M. Saidi2.
1Laboratory of Hematology; Hematology, University Hospital; Batna, Algeria.
Introduction:
The hereditary defects in the synthesis of hemoglobin, are the most common severe monogenic diseases. Thalassemia and sickle cell disease represents a serious public health problem
given its frequency and difficulty to take of charge the patients. In Algeria 2% of the population of
β thalassemia heterozygotes, 10% of newborns have a trait of α thalassemia and many parts in
Algeria have a high frequency of hemoglobin S.
Study made during a period of two years (marsch2008-march2010) in Hematology Laboratory
on 328 subjects to detect the abnormal hemoglobin on electrophoresis. The hemoglobin electrophoresis was done for cellulose acetate and by Capillarys Sebia system.
Result:
The results of the hemoglobin electrophoresis performed on 328 subjects, we are found 71
(21.64%) abnormal electrophoresis,which are:
- 09 (12,6) β+ thalassemia homozygote,
- 40(56.3%) β thalassemia heterozygotes)
- 09 (12,6%) hemoglobin S (sickle cell disease)
- 09 hemoglobin C,
- 01 hemoglobin H and 1 hemoglobin O Arabic,
- 02 decrease Hb A2, related with iron deficiency.
Conclusion:
We can say that β thalassemia, hemoglobin S, hemoglobin C are most frequent of all abnormal hemoglobin in this region.It’s necessary to program an epidemiological study to assess exact
prevalence of these different defects.
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PO-98
HÉMORRAGIE CÉRÉBRALE ET MÉNINGÉE AVEC UN
HÉMATOME SOUS DURAL SPONTANÉS CHEZ
UN ENFANT PORTEUR D’UNE HÉMOPHILE A MAJEURE
S.En-nasri, S.Nait M’barek, H.Nafil, L.Mahmal
Service d’hématologie,CHU Mohammed VI,Marrakech,Maroc
L’hémophilie A est une anomalie constitutionnelle de la coagulation sanguine en rapport avec
un déficit du facteur VIII de la coagulation. Elle est dite majeure lorsque le taux du facteur VIII
est inférieur à 1 %.
Cette pathologie est responsable d’hémorragies cérébrales sévères pouvant entraîner des
manifestations cliniques invalidantes menaçant le pronostic vital.
L’hémorragie cérébrale spontanée est une complication très rare, elle représente seulement 2
% des complications hémorragiques chez l’hémophile.
Nous rapportons le cas d’un enfant hémophile âgé de 11 ans avec un taux de facteur VIII à
1%, ayant deux frères hémophiles, qui a présenté d’une façon brutale et atraumatique un syndrome d’hypertension intracrânienne. L’examen clinique n’a pas noté de déficit neurologique ni
d’hématome ou de lésion traumatique du cuir chevelu. la TDM cérébrale a objectivé un hématome sous dural temporal gauche, deux foyers hémorragiques temporal et pariétal gauches avec
une hémorragie méningée, sans anomalie vasculaire sous jacente. L’artériographie n’a pas été
réalisée. Le patient a été traité par le facteur VIII recombinant à la dose de 16 UI/kg en une seule
prise par jour pendant 5 jours.
L’évolution a été marquée par la disparition des signes cliniques au bout de 6 jours. Le scanner cérébral de contrôle à J7 a montré une régression de l’hématome sous dural ainsi que des
foyers hémorragiques et de l’hémorragie méningée.
La littérature préconise une posologie du facteur VIII en fonction de la sévérité de l’accident
hémorragique selon la formule suivante: Nombre d’unité nécessaires est égale au poids corporel
(kg) multiplié par l’augmentation souhaitée du taux de facteur VIII (% de la normale) x 0.5
Dans les hémorragies cérébrales on vise un taux de facteur VIII entre 60 % et 80%,ce qui
donne à notre patient une posologie de 40 UI/kg, dose qui est supérieure à celle administrée au
cas étudié.
L’hémophilie est une étiologie des hémorragies intra cérébrales à connaitre, bien que rare,
nécessitant une approche thérapeutique personnalisée, qui permettra la réduction des doses du
facteur VIII qui est très onéreux et au dessus des bourses de nos malades
188
PO-99
RHABDOMYOSARCOME PARATESTICULAIRE
Le rhabdomyosarcome (RMS) est une tumeur mésenchymateuse maligne,rare, caractérisée
par la présence des cellules identifiables aux rhabdomyoblastes.Il s’ agit d’une tumeur intra
scrotale localisée aux structures para testiculaires:vaginale, épididyme ou cordon spermatique.
Le diagnostic est histologique.Il existe plusieurs formes dont la plus fréquente est l’embryonnaire
qui se voit chez l’enfant.Le pronostic est mauvais et le traitement repose sur l’association de la
chirurgie, la chimiothérapie et la radiothérapie .
Nous rapportons le cas d’un enfant de 2 ans et 9 mois, sans antécédents pathologiques particuliers, qui a présenté une grosse bourse droite indolore, évoluant de façon progressive depuis
2 mois avec altération de l’état général. L’examen clinique trouve une masse scrotale droite
dure, non douloureuse à la palpation et sans signes inflammatoires.Le reste de l’examen clinique
est sans particularité. L’échographie scrotale avait montré une masse tissulaire scrotale droite
hétérogène aux dépens de parenchyme testiculaire et du cordon spermatique.L ‘échographie
abdominale, radiographie du thorax, le bilan biologique sont normaux.
L’intervention a consisté en orchidectomie totale avec ligature haute du cordon par voie inguinale. L ‘étude histologique de la pièce opératoire a conclu à un rhabdomyosarcome embryonnaire type I.Une chimiothérapie complémentaire (VAD, VAC) est en cours.L’ évolution a été
marquée par une rémission complète.
Le RMS para testiculaire est une tumeur rare, elle nécessite un diagnostic précoce et un
bilan d’extension précis.Le traitement est bien codifié et c’est grâce à l’association chirurgie,
polychimiothérapie et radiothérapie que le pronostic s’est nettement amélioré.Une surveillance
adéquate à long terme doit être instauré afin de détecter les rechutes qui sont généralement
fatales
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PO-100
MICROBIOLOGICAL SAFETY OF BLOOD
COMPONENTS DURING STORAGE
M Khalil, A Jebriel
Department of Transfusion Medicine, Misurata oncology institute Misurata Libya
Purpose:
Because of conflicting result in the literature we studied the microbial safety of blood during
shelf life.
Methods:
Blood bags from 121 blood donors were drawn by venous puncture. The whole blood was
separated using 3 bags system (Biotrans NPBI), into erythrocytes, Buffy coat (BC) and plasma.
BC was stored at 4C. Samples were taken by sterile-docking on day 1, 3, 6, 35, and 42 in 150
ml transfer bag.
From this material was taken by a syringe and 5 ml each were inoculated into culture flasks
(Bactec plus Aerobic/F an Anaerobic/F; Becton Dickinson). Before inoculation, the rubber membranes of the flasks were disinfected with Cutasept F (Bode Chemie). Bacterial growth of a total
of 1210 samples was monitored for seven days in a Bactec 9120/9240-analyzer. In addition on
day 1 CRP was also measured in the BC material.
Results:
The CRP was normal in all BC»s. In contrast, 3BC samples contained bacteria, while no bacteria were found in 1204 (99.5%) of the BC samples tested. All positive BC samples contained
Staphylococcus species: 1 Staph. epidermidis (storage day 3). 1. Staph. hominis (storage day
35) and 1 Staph. capitis (storage day 35) Because of the positive results, a second samples was
taken from the three original BC»s and Retested for microbial Contamination. These samples
showed no bacterial growth, though the positive results were due to secondary contamination
during the inoculation procedure. So, all Blood bags could be released for transfusion.
Conclusions:
Blood bags are microbiologically safe for up to 42 days storage. All contaminations detected
belonged to the skin flora. They proved to be secondary and occurred during the inoculation procedure. So it is of utmost importance to avoid these secondary contaminations in microbiological
testing of blood products.
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PO-101
ALLOGENEIC HEMATOPOIETIC STEM CELLS
TRANSPLANTATION (HSCT), FROM HLA IDENTICAL
SIBLING DONORS, FOR 20 PATIENTS WITH PAROXYSMAL
NOCTURNAL HEMOGLOBINURIA (PNH)
R. Ahmed Nacer, F. Mehdid, F. Harieche, M. Benakli,
R. Belhadj, N. Rahmoune, M. Baazizi, D. Aitouali,
M.Ouzeghdouh , S.Abderrhmani, F. Zerhouni, RM. Hamladji
Department of Hematology and BMT unit, Pierre and Marie Curie Center, Algiers, Algeria
Introduction:
Paroxysmal nocturnal hemoglobinuria is a haematological disorder characterized by the clinical triad of intravascular hemolysis, marrow failure and venous thrombosis. HSCT is a treatment
of choice for marrow failure form and also for recurrent hemolysis and thrombophilia after Eculizumab treatment failure.
Material and méthods:
From April 2005 to November 2009 (59 months period) 20 patients (pts) with PNH in aplastic
form underwent allogeneic HSCT from HLA identical siblings donors; median age 23,7 years
(range 15 to 34); sex-ratio (M/F) 3; median interval from diagnosis and transplant 16,3 months
(range 2 to 120); 3 pts received more than 20 transfusions before allograft. Diagnosis was performed by flow cytometry. All pts received conditioning regimen with chemotherapy alone: 17 with
cyclophosphamide (Cy) alone at dose 200 mg/Kg BW and 3 pts with association of procarbazine
37.5 mg/Kg, Cy 200 mg/Kg and ATG (Fresenius) 40 mg / Kg. GVHD prophylaxis associated
methotrexate and cyclosporin (Seattle protocol). All pts were grafted with peripheral blood stem
cell and 21 grafts (within one boost) were used for 20 pts: median CD34+ cells 4.52 x 106 / Kg
BW (range 1.83 to 8.84). Chimerism was studied for 18 pts by STR-PCR method. At February
2010 maximal follow up is 59 months ant minimal 4 months.
Résults:
The median time to engraftment was 14 days (11 to 19). Seventeen pts are alive (85%) within
16 pts (80%) with success engraftment after median follow up 17 months (range 4 to 59); median
chimerism donor at D30: 98, 3%, at D60: 100% and at D100: 100%.
Acute GVHD occurred in 8 pts (40%) with grade II-IV and chronic GVHD in 4 patients (23,
5%) which 2 extensive. Graft failure was observed and confirmed by chimerism study in 2 pts:
one pt recovered hematopoiesis occurring after boost without conditioning and the second pt is
alive with cyclosporin treatment and less frequent transfusion. Three pts died (15%) by transplant
related mortality (TRM): Acute GVHD. The actuarial overall survival (OS) is 84% at 54 months.
Conclusion:
Our study concerns a small cohort and shows a good results with TRM: 15% and OS: 84%.
Our results seem better than literature (OS: 50-60%) and it should be confirmed by long term
follow-up and a biggest cohort.
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PO-102
TRANSPLANTATION (HSCT) IN CHRONIC
MYELOID LEUKAEMIA (CML): LONG TERM RESULTS
M.Benakli, R. Ahmed Nacer, A. Talbi, F. Mehdid, R. Belhadj, M. Bazizi, N.
Rahmoune, F. Harieche, F. Zerhouni, RM. Hamladji
Hematology-BMT Unit, Pierre and Marie Curie Center, Algiers, Algeria
Background:
Allogeneic HSCT is recognized as being the only effective treatment in the CML with cure. We
report our experiment of this procedure with a comparative study between myéloablative and
reduced intensity conditioning regimen.
From July 98 to June 2009, 274 patients (pts) with CML underwent allogeneic HSCT with HLA
identical sibling donors. The myeloablative stem cell transplantation (MST) based on Tushka
protocol was employed in 101 pts including 56 in first chronic phase(CP), 39 in accelerated
phase (AP) and 6 in blast crisis(BC). The prevention of the graft versus host (GVHD) associated
ciclosporine and méthotréxate according to Seattle protocol. The non myeloablative SCT (NST)
based on the use of Fludarabine and Busulfan was employed in 173 pts including 149 pts in first
CP and 24 in AP. The GVHD prophylaxis consisted of cyclosporine with mycophenolate mofetil.
The median age of the pts at transplant for MST and NST is 24 years (4-44) and 36 years (1855) respectively with a significant difference (p<0,01). The sex-ratio is 1,2 and 0,96 respectively;
interval diagnosis was longer in MST pts: 15 months (3-82) than in NST pts: 11 months (4-58)
(p<0,01). The grafts used are peripheral blood stem cells (MST=90, NST=173), bone marrow (9
MST) and umbilical cord blood (2 MST).
Results:
Aplasia is occurred in 76 pts (44%) NST group and all pts of MST group (100%), (p<10-8). The
incidence of acute GVHD was the same in the MST and NST group (p=0,35) with respectively
48 pts (47,5%) and 72 pts (42,8%). The incidence of chronic GVHD was also the same (p=0,14),
58 MST pts (63,7%) and 114 NST pts (71,2%). The cytomegalovirus (CMV) infection was seen
in 23 MST pts (22,7%) and 28 NST pts (16%) without significant difference (p=0,16). Relapse of
disease occurred in 15 MST pts (14,8%) and complete remission was obtained in 5 pts ( immunosuppression discontinuation:1, DLI: 2 and Imatinib: 2); In the group NST 31 pts relapsed (17,9%)
and in 15 pts remission obtained after salvage treatment (immunosupression discontinuation: 8,
DLI: 3 and 2d myeloablative allograft: 4) (p=0,7). At December 2009, 56 MST pts (55,4%) and
109 NST pts (63%) are alive with a median follow-up in 69 months and 64 months respectively.
The Overall Survival (OS) is 41,9% for the MST group and 56,8% for NST group (p<0,001); Event
192
Free Survival (EFS) is 36,7% and 49,5% respectively with significant difference (p<0,001).
Conclusion:
No differences were observed between MST and NST group concerning acute and chronic
GHVD, CMV infection and incidence of relapse. However in long term results, OS and EFS are
better in NST group than MST group.
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PO-103
PROSPECTIVE VALIDATION OF A NOVEL MYELOABLATIVE
CONDITIONING REGIMEN: FLUDARABINE - IV BUSULFAN, IN
38 PATIENTS WITH ACUTE MYELOID LEUKEMIA(AML)
A.Talbi, R-M Hamladji, M.Benakli, R. Ahmed-Nacer, R.Belhadj,
F.Mehdid, N.Rahmoune, F.Harièche, F.Zerhouni
Hematology-Bone marrow transplantation unit, Pierre and Marie Curie center (CPMC), Algiers Algeria
Introduction:
Allogeneic hematopoietic stem cell transplant (HSCT) has the goal of inducing a graft versus
tumor immune effect, however the choice of the conditioning may have an impact on the overall out
come, in fact more intensive regimens can cause greater morbidity and mortality, on the other hand
the reduced intensity conditioning (RIC) may have less anti tumor effect. In this study we used a
conditioning regimen with Fludarabine (FLU) and IV Busulfan (BU) at myeloablative dose.
Between February 08 and June 09, 38 Adults pts with AML received a geno identical allogeneic peripheral blood HSCT, with FLU (200mg/m²) and one daily iv BU (12,8mg/Kg) total dose
conditioning; the median age is 35 years (22-55), the sex ratio is 1,9 (25/13); the cytologic types
of AML (FAB: M1=12, M2=16, M3=1, M4=2, M5=5, M6=2); 31HSCT were performed in first remission (81,5%), 5 in second remission, and 2 in relapse. The median time from the diagnosis
to transplant is 4,4 months (2-10), GVHD prophylaxis associated ciclosporin and methotrexate
(Seattle).. At September 2009, maximal follow up is 17 month, and minimal 3 month.
Results:
The overall median time to achieve a neutrophil count > 0,5x109/L was the day 14 (9-18), and
a platelet count > 20000 was the day 13 (8-16); the median duration of the neutropenia is 9 days
(1-16). Six pts (16,2%) have a CMV reactivation at day 98 (40-210) Acute GVHD was observed
in 10pts (27%), (Grade II=4, grade III=2, grade IV=4). Chronic GVHD was observed in 11pts
(34,4%), severe cGVHD: 10pts. Four pts (10,8%) relapsed, at a median time of 192 days (102 330), 2pts were in 1st CR, and 2pts in 2nd CR, none of these pts have presented GVHD. Eight pts
(21%) died; 4pts after aGVHD; 2 after relapse, 1 after unknown extra hematological cause, and
the last one was a graft failure. At one year, TRM was about 10,8%. Thirty pts (84,2%) are still
alive; 28 pts(73,6%) are in complete remission; 2 pts are alive in relapse. The median following
is 7 (3 - 17). Overall survival and DFS are respectively 74,5 and 64,4%.
Conclusion:
This study show that FLU-BU myeloablative regimen causes limited hematological and extra
hematological toxicity; it can be successfully used in older pts. The rate of relapse seams not
higher than what we observed with other myeloablative conditioning regimen (12,8% in CPMC
study EBMT 08, 37% GOELAM –Blood 97.
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PO-104
MYELOPROLIFERATIVE DISORDES IN TRIPOLI
Kalthoum Elwaer, Abukris Alwindi
Department of Oncology and Hematology, Tripoli Medical center, Tripoli, Libya
Department of Oncology and Hematology, Tripoli Medical center between January 2007 to
March 2010.
Polycythemia rubra vera [PRV] was by far the commonest disorder representing 46% of the
cases.
Splenomegaly or hepatosplenomegaly was present in 31% of patients with polycythemia rubra
vera and in 100% of patiens with myelofibrosis, 22% of patients with essential thrombocythemia
had splenomegaly.
Patients with PRV tended to be older than patients with essential thrombocythemia of myelofibrosis.
The median age of PRV patients 60 years, essential thrombocythosis 53.5, and myelofibrosis
50 years.
JAK2 mutation was looked for in 15 patients. All six patients with PRV tested positive as were
the three patients with otherwise non specified MPD. Half of the patients with essential thrombocythosis tested positive for the JAK2.
195
PO-105
HISTIOCYTOSE LANGERHANSIENNE(HX)
GRAVE CUTANEOSPLENIQUE
L’histiocytose X (HX) ou histiocytose langerhansienne est définie par la prolifération de cellules mononuclées qui renferment des granules de Birbck intracytoplsmiques et qui présentent
a leur surface les marqueurs antigéniques CDIa et la protéine S100.Touchant l’enfant et l’adulte
jeune c’est une maladie de spectre clinique très divers,allant du simple granulome éosinophile
a la forme grave multi viscérale avec dysfonctionnement d’organe.sa prise en charge thérapeutique est encore aujourd’hui controversée.
M .H âgé de 18 mois présentant un syndrome anémique et hémorragique (purpura en maillot
de bain)avec splénomégalie débordant l’ombilic depuis 6 mois,le tout dans un contexte de fièvre
et d’altération de l’état général.le myélogramme fait était normal ,la biopsie des lésions cutanées
a posées le diagnostic d’hystiocytose X.le dosage des marqueur CD n’a pas été fait.
Dans notre cas il s’agit de la maladie de Letterer-Siwe qui présente une forme de l’histiocytose
du nourrisson associant l’altération de l’état général et l’atteinte cutanée et multi viscérale (splénique essentiellement).
Le cumul de facteurs de mauvais pronostic (classification de Lahey-Osband) ont compromis
l’effet des différents protocoles de chimiothérapies utilisées rendant inéluctable le décès de la
patiente.
La nécessité d’avancer dans la compréhension de la pathogénie de cette maladie, et la diversité du traitement et de la prise en charge des enfants atteints justifient la réalisation d’un
protocole de diagnostic et de traitement multicentrique, qui pourra permettre de rationaliser les
attitudes thérapeutiques et d’améliorer le pronostic des formes graves.
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THROMBOPHILIE ET DRÉPANOCYTOSE
M.Chekkal. K.Moulassedoun. M.C.A Rahal.F.Seghier
Service d’Hémobiologie.CHU d’Oran. Algérie.
Notre étude a été réalisée au niveau du service d’hémobiologie du CHU d’Oran sur une période de 07mois s’étalant du mois de novembre 2008 au mois de mai 2009.
Elle a concerné 40 patients atteints de la drépanocytose dont 11 sont homozygotes, 10 hétérozygotes composites S/β°thal et 19 hétérozygotes en dehors de toute crise vasoocclusive en
ne recevant aucun traitement interférant avec le bilan de thrombophilie.
Nous avons recherché l’existence d’un processus thrombotique aggravant la maladie drépanocytaire par le dosage des inhibiteurs physiologiques de la coagulation (protéine C, protéine
S libre et antithrombine), dosage du facteur VIII de la coagulation et par la recherche des anticorps antiphospholipides.
Les résultats obtenus sont les suivants:
• Déficit en protéine C chez 45,4% des homozygotes, 33,3% des composites S/βthal et 5,2%
des hétérozygotes.
• Déficit en protéine S chez 54,5% des homozygotes, 33,3% des composites S/βthal et 5,2%
des hétérozygotes.
• Déficit en antithrombine 27,2% des homozygotes alors que les composites S/βthal et les
hétérozygotes ne présentent pas de déficit.
• Augmentation du taux du facteur VIII de la coagulation chez 100% des homozygotes,
44,4% des composites S/βthal et 31,5% des hétérozygotes.
• La recherche des anticorps antiphospholipides de type lupique est négative chez tous les
malades.
Ces anomalies de l’hémostase traduisent donc l’existence d’un état pro thrombotique au cours
de la maladie drépanocytaire qui favoriserait la survenue d’accidents vaso- occlusifs.
Le Facteur VIII de la coagulation constamment élevé chez les drépanocytaires peut ainsi constituer une cible thérapeutique privilégiée dans le traitement des manifestations thrombotiques
de la maladie.
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PO-107
THE INTERMEDIATE THALASSEMIAS
Zatla L,Elalia H, Bousmaha N, Charef l,Boudjoras YA,
Sfaoui W, Rahal Y,Touhami H
Division of haematology, CHUoran, Ageria
Introduction
The thalassemias are hemolytic anemia of varying severity: asymptomatic intermediate or
severe. The thalassemia intermedia is a heterogeneous group of thalassemia whose molecular
mechanism is complex with multiple genotypes and phenotypic expression variable: severe or
asymptomatic. The major criteria for lediagnotic of the thalassemia intermedia are the late age of
onset (> 2 years), anemia (Hb = 7 to 10 g / dl) microcytic, not transfusion dependent splenomegaly consistent with varying facial dysmorphia. Our objective is to make a focus on our patients
with a review of the literature.
72 thalassemia syndromes are followed by the Division of Hematology adult: 11 thalassemia
major, thalassemia intermediate 4 and 18 S beta. The 4 patients with thalassemia intermediate
(TI) of sontags respectively 20,21,40, and 41 years including 3 sisters.a retard is found in a patient who is not their brother, moderate splenomegaly is constant, facial dimorphism in a patient.
There is no infectious or immunological complication. Three are transfused occasionally but the
sister was transfused once a month (bleeding). Three patients received chelating.
Discussion
IT are classified into three groups: IT fairly moderate TI moderate enough IT Severe complications are frequent thrombophilia after splenectomy, cardiac complications 20% extramedullary
hematopoiesis, leg ulcers of 20 to 30% endocrinopathies rare late, osteoporosis and hypersplenism late. Treatment of IT based on episodic late transfusions, their indications are hypersplenism
extramedullary hematopoiesis and heart failure. Splenectomy is indicated if hypersplenism and
if transfusion requirements increase.
Conclusion
The B thalassemia intermediate is a very heterogeneous group.Its treatment varies depending
on the phenotype of transfusion with minimal or splenectomy if hypersplenism.
198
PO-108
PREVALENCE OF JAK2-V617 MUTATION IN ALGERIAN
PATIENTS WITH MYELOPROLIFERATIVE DISORDERS
N. Benchikh(1), A. Messaoudi(1), M. Nachi(1), C. Belarbi(1), R. Moussaoui(1),
A. Bekadja(2), M. Brahimi(2), A. Arabi(2)
(1)Department of Biochemistry, EHU 1er Novembre Oran, Algeria.
(2)department of hematology, EHU 1er Novembre Oran, Algeria.
Aims
An acquired mutation of the Janus Kinase 2 gene (JAK2) which involves a Valin substitution
by Phenylalanine in position 617 is implied in the pathogenesis of myeloproliferative disorders
[1, 2, 3, 4].
The aim of our study is to detect this mutation among patients with myeloproliferative disorders
in western areas of Algeria.
This study focused on 77 patients, recruited in various departments of hematology from the
west of Algeria. The mutation was detected by Amplification Refractory Mutation System – Polymerase Chain Reaction (ARMS-PCR) [5].
Results:
The prevalence of V617F JAK2 mutation in polycethemia vera, essential thrombocytemia, primary myelofibrosis and myeloid splenomegaly are respectively:81,48%,45%,66,66% and 40%.
This mutation was not found in atypical SMP, in secondary polyglobuly or thrombocytosis, and in
chronic myeloid leukemias.
Conclusions:
Our study is the first to evaluate the JAK2 V617F mutation among patients with myeloproliferative disorders in the west of Algeria. Our results confirm that JAK2 V617F mutation is specific, but
unequally found in myeloproliferative disorders.
199
PO-109
PLATELET TRANSFUSION REFRACTORINESS AND
ALLOIMMUNIZATION IN PATIENTS WITH ONCOLOGIC
BLOOD DISORDERS
H. Brouk(1), C. Martageix(2), G. Bertrand(2), S. Zitouni(1), I. Houar(1), B.
Zermat(1), A. Djenouni(3), F. Griffi(3), C. Kaplan(2) & H. Ouelaa(1)
(1) Service d’Hémobiologie & Centre de Transfusion Sanguine. CHU Ibn Rochd Annaba. Algérie.
(2) Laboratoire d’Immunologie Plaquettaire. Institut National de la Transfusion Sanguine Paris. France
(3) Service d’Hématologie. CHU Dorban Annaba. Algerie
Introduction:
Platelet transfusions are effective therapy for hemorrhage in thrombocytopenic patients. A major complication of multiple transfusions is still platelet transfusion refractoriness. Despite most
cases are secondary to non-immune causes (80%), the most severed cases are associated with
alloimmunization. The prevalence and consequences of HLA and HPA antibodies in that setting
are unknown in Algeria.
Aim:
To prospectively determine clinical and laboratory factors affecting the post-transfusion platelet increment, frequency and characteristics of post transfusion alloimmunization.
Patients with recently diagnosed leukaemia and undergoing chemotherapy requiring multiple
transfusions were included in that study. Antibodies against the platelet glycoproteins GPIaIIa,
GPIIbIIIa, GPIbIX and anti-HLA classe I were identified with a monoclonal antibody-specific immobilization of platelet antigens technique (MAIPA).
Results:
HLA antibodies were found in 30 cases (28.55%), and specific platelet antibodies in 6 of 105
patients (5.71%). Among these six patients, 5 contained additional HLA antibodies.
The following platelet-specific antibodies were identified: anti HPA-1a (n=2), anti HPA-1b (n=2),
anti HPA-5b (n=1) and anti HPA-3a (n=1). The prevalence of platelet alloimmunization in Algeria
is higher than the prevalence found in Europe (< 4%) but lower than the prevalence found in Asia
(20-26%). Six sera contained panreactive antibodies against platelet glycoproteins (GP): anti-GP
IIbIIIa (n=3), anti-GP IaIIa (n=1) and anti-GP IbIX (n=2). Platelet refractoriness appeared in 31/47
receiving only platelet transfusions: 6 cases (19.35%) with alloimmunization (4 cases with antiHLA antibodies, 1 case with anti-HPA antibody and 1 case with both HLA and HPA antibodies), 17
cases (54.83%) with non-immune platelet consumption and 19 cases (61.29%) with insufficient
dosing of transfused platelets.
200
Conclusion:
Platelet transfusion refractoriness is a major complication of long-term platelet supportive care
and may lead to fatal bleeding complication in thrombocytopenic patients.
HPA antibodies play a minor but relatively important role in patients with HLA antibodies. In
case of HLA and/or HPA alloimmunization associated with refractoriness, matched platelet transfusions are indicated.
201
PO-110
TOXOPLASMA AND CMV SERO-PREVALENCE IN
THE BCIDI COHORT OF PATIENTS
Amina Abusedra & Fatma Najem
Background:
Toxoplasmosis and Cytomegalovirus (CMV) are important pathogens which contribute to the
morbidity and mortality associated with HIV disease. Sparse data are available concerning the
prevalence of these two diseases in Libya The objective our study was to evaluate the seroprevalence of toxoplasmosis and CMV in the cohort of HIV patients of the BCIDI.
Method
A cross sectional study among the BCIDI cohort was conducted between June and December
2009. All patients from the BCIDI cohorts were susceptible to be screened if attending the center
during this period. The samples were serologically tested to detect the presence of antibodies of
Toxoplasmosis Gondii and/or CMV using the ELISA linked florescent assay (ELfA) techniques
according to the manufactur`s instructions VIDAS. All data needed for this study was extracted
from the Medical Information System (MIS) of the BCIDI. Analysis was performed on SPSS.
Results:
Three hundreds thirty six patients were tested for toxoplasmosis out of whom 240 were less
than 15 years old (71.4%) and192 were male (57.1%).Three hundreds forty three patients were
tested for CMV, out of whom 266 were less than 15 years old (80.6%) and 195 were male
(56.9%) We found overall seroprevalences of 13.2 % for toxoplasmosis and 91.5% for CMV. For
toxoplasmosis, the seroprevalence is higher in adults than in children (11.7% vs 27.1%, p<0.001)
and in female compared to male (20.1 vs 13.0, p=0.08). The seroprevalence of CMV varies
slightly depending of the age and the sex but globally it is very high in the overall cohort ranging
between 88 and 96%.
Discussion and conclusion
This study is one of the first studies performed in Libya assessing the level of infection of two
common HIV co-infection. It might be useful to confront these results with estimation done in
other places of Libya. The result of our study might help to guide the clinical management of the
BCIDI patients.
202
PO-111
ACQUIRED APLASTIC ANEMIA: EXPERIENCE OF
THE HEMATOLOGY DEPARTMENT OF CASABLANCA
A.Hmimech; N.Khoubila; F.Merimi; A.Quessar; S.Benchekroun
Service d’hématologie et oncologie pédiatrique de Casablanca, Maroc
Introduction:
Aplastic anemia is defined as a quantitative bone marrow failure secondary to partial or complete loss of hematopoietic tissue, without abnormal tissue proliferation. This is a rare disease,
whose etiology is found in only 20% of cases.
Few studies have been conducted in Morocco, but it is a serious disease, hence the difficulty
of care. The purpose of this study is to evaluate the epidemiological, clinical, biological and therapeutic of aplastic anemia collected at the Hematology department of Casablanca over 11 years.
Were excluded from the study all congenital aplastic anemia. All patients underwent a bone
marrow biopsy, confirming the diagnosis of aplastic anemia. The rest of paraclinical assessment
included a complete blood count (CBC) with reticulocyte assay, the viral serology (HCV, HIV and
HbS), radiographs, immunophenotyping of peripheral lymphocytes (CD55, CD59). The severity
of aplastic anemia was judged by the criteria of Camitta. Treatment options were, symptomatic
treatment, no drug therapy with monitoring, androgens, cyclosporin A, antilymphocyte serum +
cyclosporine.
The therapeutic choice depends on the severity of the disease and the average patient. The
criteria of response to treatment were complete remission (Hb> 11 ANC> 1500 Platelets> 100
000), partial remission (Hb> 8 ANC> 500 Platelets> 20 000), and treatment failure.
Results:
267 cases were collected between January 1999 and December 2009. The sex-ratio H / F was
1, 2. The mean age was 32 years (4-79 years). The mean delay to diagnosis was 2 months (10
days -24 months). The bone marrow failure syndrome was complete in 63% of cases; a hemorrhagic syndrome was found in 86% of cases and was severe in 13% of cases. The aplastic
anemia was severe in 56% cases, very severe in 13% of cases and not severe in 31% of cases.
The aplastic anemia was idiopathic in 86% of patients, associated with the use of drugs in 4% of
patients, with toxicity in 5% of patients, post tuberculosis in 2% of cases, post hepatitis in 2% of
patients and associated with paroxysmal nocturnal hemoglobinuria in 1 % of patients. 162 patients were treated, of which 62.5% by cyclosporin A, 28% by androgens, 9% with cyclosporine
203
+ anti-lymphocytic serum, only 1 patient received allogeneic bone marrow transplantation. 22
patients have received treatment for 2nd line, including 8 by cyclosporin A, 4 by anti-lymphocyte
serum + cyclosporine and 10 by androgens. At a mean of 30 months, 13% of patients were in
complete remission, 23% in partial remission, 36% failed, 15% were lost to follow and 13% died
(8 due to septic shock, 13 with hemorrhagic shock).
Conclusion:
The frequency of aplastic anemia is difficult to assess in Morocco. It mainly affects young
adult males (20-30yr). Its treatment is difficult in our context because of the existence of a single
hematology service in Morocco and the high cost of treatment, hence the need to standardize
its care.
204
PO-112
LYMPHOME MALIN NON HODGKINIEN LOCALISATION
OSSEUSE CHEZ UNE PETITE FILLE DE 3
ANS À PROPOS D’UN CAS
R.Mecifi, M.Brahimi, M Dib, M. Daouadji, M.Djebour,
Centre Anti Cancer Emir Abdelkader, Algeria
Introduction:
Le lymphome osseux est rare chez l’enfant, sa traduction clinique et radiologique est celle
d’une lésion tumorale lytique, localisée sur la métaphyse des os long ou le squelette axial [1].
Les lymphomes malins se distinguent des leucémies de l’enfant par la quantité de blastes dans
la moelle osseuse qui est < 25% [2]. Nous rapportons le cas de la petite fille lynda âgée de 3ans,
l’unique fille d’un couple jeune en bon état de santé, consanguin au 1er degré, admise à notre
service pour la prise en charge d’un LMNH localisation osseuse (métaphyse du tibia droit).
Le début remonte à quelques mois avant le diagnostique, par une douleur osseuse de la
jambe droite, associé a une boiterie, plusieurs consultations avec traitements symptomatiques
mais sans réponse favorable, devant l’apparition d’une tuméfaction du1/3 < de la jambe droite,
un scanner a été demandé qui a montré une lésion lytique de la métaphyse du tibia droite, avec
une réaction périostée; posant l’indication d’une biopsie osseuse, l’étude histologique faite par Pr
MAALEM de CHU d’Oran confirme qu’il s’agit d’un lymphome osseux. Bilan d’extension retrouve
un envahissement médullaire entre26% à 33%. Bilan biologique: LDH élevé 3 fois la normale.
CALCEMIE légèrement augmenté / à son age.
La petite été mise sous protocole (des leucémies) EORTC58881 risque très élevé
L’évaluation de la maladie après un mois de traitement été marquée par une rémission médullaire a 3% de blastes, cliniquement reprise de la marche, biologiquement normalisation de la
calcémie et le taux de LDH ce qui nous a poussé à continuer avec le même protocole. A mi chemin de la phase intermédiaire, on a remarqué la reprise de la boiterie et la douleur du membre
inférieur, une scintigraphie osseuse faite qui retrouve une fixation condensante au niveau de la
zone d’appel. Ceci à justifier une mauvaise réponse à EORTC58881 et la petite Lynda est mise
sous protocole LMB89 groupe C thérapeutique.
Objectif:
Le but de cette présentation est d’exposer un vrai problème diagnostique et thérapeutique:
- 1/ S’agit t’il d’un lymphome osseux avec envahissement médullaire ou d’une leucémie avec
métastase osseuse ?
-2/ Faut t’il le traiter selon le protocole des lymphomes risque élevé (groupe C), ou
205
Protocole des leucémies risque élevé ?
Coclusion:
Le lymphome malin non hodgkinien a localisation osseuse est rare, difficile à prendre en
charge, le risque de rechute est plus élevé que dans les autres localisations.
Dans notre cas, l’envahissement médullaire est supérieur à ce de la littérature. En revanche le
résultat du scanner de contrôle après les deux phases thérapeutiques ne montre pas une bonne
réponse osseuse au traitement.
206
PO-113
EVALUATION DU PROTOCOLE MDH 90 CHEZ L’ENFANT
CANCÉREUX AU CENTRE EMIR ABDELKADER ORAN
R.Mecifi, M.Brahimi, M Dib, M. Daouadji, M.Djebour,
Centre Anti Cancer Emir Abdelkader
Introduction:
Le Centre Emir Abdelkader « CEA » est le seul centre anti-cancer pédiatrique de l’ouest Algérien. Notre centre a recruté environ 230 nouveaux cas de cancer pédiatrique pendant l’année
2009. La maladie d’hodgkin est une hémopathie maligne du tissu lymphatique particulièrement
rare chez l’enfant, elle représentait en l’an 2000 selon Benammar et coll. 7% du recrutement du
CEA soit en moyenne 9 nouveaux cas par an. Le but de ce travail est de présenter les aspects
épidémiologiques et d’évaluer le protocole MDH90.
Materiels et methodes:
Il s’agit d’une étude rétrospective et descriptive sur une période de 54 mois (janvier 2004
à juin 2008) portant sur des enfants âgés de moins de 15 ans suivie au sein du CEA pour
maladie d’Hodgkin. Support de travail: fiches de collectes comportant l’âge, le sexe, l’origine
géographique, les signes cliniques et para cliniques ainsi que la prise en charge thérapeutique.
Resultats:
40 nouveaux cas en 5 ans soit 10 cas par an
L’age des enfants varie de 3 à 15 ans avec une médiane de 9 ans
Le sex ratio= H/F = 4.5
La médiane de survie globale à 5 ans est de 81%
Conclusion:
Les résultats de notre étude étaient comparables à ceux qui sont rapportés dans la littérature.
207
ORGANIZED BY
UNDER AUSPICES OF
General Peoples Committee of Health and Environment
SPONSORED BY

7th Magharebian Congress of Hematology (MCH-7)

Transcription

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