Quatre personnes pensent construire une société plus belle et avoir enfin trouvé le bonheur de vivre. Amours, amitiés, fêtes, gourmandises, poésies, jardins, convivialité, sculptures, rencontres, partages... agrémentent leur quotidien à la « Concorde », plus particulièrement dans le groupement G28 chargé de la gestion du grain de l'ensemble des Concordiers. Mais le travail est difficile et le fonctionnement de la « Concorde » parfois nébuleux. Alors, survient le renouveau et la modernité qui doit rétablir la confiance de toutes et tous. Toute ressemblance de cette société imaginaire avec notre réalité quotidienne n'est peut-être pas le fruit du hasard.

Abstract: The deletion (5q) karyotype (del [5q]) in patients with myelodysplastic syndrome (MDS) is the most common karyotypic abnormality in de novo MDS. An increased number of blasts and additional karyotypic abnormalities (del [5q]+) are associated with a poor outcome. We analyzed the outcome of allogeneic hematopoietic cell transplants (HCT) in patients suffering from MDS with only del (5q) or del (5q)+ . A total of 162 patients, of median age 54 years (range, 9 to 73), having MDS and del (5q) abnormalities received HCT from identical siblings (n = 87) or unrelated donors (n = 75). The cumulative incidence of nonrelapse mortality and relapse incidence at 4 years was 29% (95% CI, 22 to 36) and 46% (95% CI, 38 to 54), whereas the estimated 4 year survival, relapse-free and overall, was 25% (95% CI, 18 to 33) and 30% (95% CI, 23 to 38), respectively. In a multivariate analysis patients with del (5q) and a blast excess displayed poorer survival (hazard ratio, 2.38; 95% CI, 1.44 to 3.93; P

Abstract: Deletion 5q or monosomy 5 (-5/5q-) in acute myeloid leukemia (AML) is a common high-risk feature that is referred to allogeneic stem cell transplantation. However, -5/5q- is frequently associated with other high-risk cytogenetic aberrations such as complex karyotype, monosomal karyotype, monosomy 7 (-7), or 17p abnormalities (abn (17p)), the significance of which is unknown. In order to address this question, we studied adult patients with AML harboring -5/5q- having their first allogeneic transplantation between 2000 and 2015. Five hundred and one patients with -5/5q- have been analyzed. Three hundred and thirty-eight patients (67%) were in first remission and 142 (28%) had an active disease at time of allogeneic transplantation. The 2-year probabilities of overall survival and leukemia-free survival were 27% and 20%, respectively. The 2-year probability of treatment-related mortality was 20%. We identified four different cytogenetic groups according to additional abnormalities with prognostic impact: -5/5q- without complex karyotype, monosomal karyotype or abn(17p), -5/5q- within a complex karyotype, -5/5q- within a monosomal karyotype and the combination of -5/5q- with abn(17p). In multivariate analysis, factors associated with worse overall survival and leukemia-free survival across the four groups were active disease, age, monosomal karyotype, and abn(17p). The presence of -5/5q- without monosomal karyotype or abn(17p) was associated with a significantly better survival rate while -5/5q- in conjunction with monosomal karyotype or abn(17p) translated into a worse outcome. The patients harboring the combination of -5/5q- with abn(17p) showed very limited benefit from allogeneic transplantation

Abstract: Second allogeneic stem-cell transplantation (SCT2) is a therapeutic option for patients with AML relapsing after a first transplant. Prior studies have shown similar results after SCT2 from the same or different donor; however, there are limited data on second non-T-depleted haplo-identical transplant in this setting. We retrospectively analyzed SCT2 outcomes in 556 patients, median age 46 years, relapsing after first transplant given in CR1. Patients were divided into three groups based on SCT2 donor (donor2): same donor (n = 163, sib/sib-112, UD/UD-51), different matched donor (n = 305, sib/different sib-44, sib/UD-93, UD/different UD-168), or haplo-donor (n = 88, sib/haplo-45, UD/haplo-43). Two-year leukemia-free survival (LFS) rate after SCT2 was 23.5%, 23.7%, and 21.8%, respectively (P = 0.30). Multivariate analysis showed no effect of donor2 type on relapse: hazard ratio (HR) 0.89 (P = 0.57) and 1.11 (P = 0.68) for different donor and haplo-donor compared to same donor, respectively. However, donor2 did predict for non-relapse mortality (NRM) after SCT2: HR 1.21 (P = 0.50) and 2.08 (P = 0.03), respectively, and for LFS: HR 1.00 (P = 0.97) and 1.43 (P = 0.07), respectively. In conclusion, SCT2 with the same or different matched donor is associated with similar outcomes in patients with relapsed AML. Non-T-depleted haplo-identical transplant may be associated with higher NRM, similar relapse rate and with no better results in this setting

Dans la mythologie grecque, la Chimère est une créature fantastique ayant une tête de lion, un corps de chèvre et une queue de dragon, qui crache du feu et dévore les humains. Au figuré, elle désigne un projet vain, impossible à réaliser, une utopie, une figure imaginaire. En génétique, un organisme possédant deux ou plusieurs génotypes distincts : ainsi, dans le champ de la greffe de moelle, le receveur devient une chimère, constitué de ses propres cellules hématopoïétiques et de ceux du donneur. Cet ouvrage réunit psychologues, psychiatres, psychanalystes et hématologues, cancérologues, tous praticiens d'hématologie et de greffe pour une réflexion polyphonique sur les incidences psychiques de ces soins hautement techniques qui provoquent de multiples bouleversements tant physiques que psychoaffectifs sur le malade et sa famille. Yolande Arnault est psychologue clinicienne, Département de psychologie clinique, institut Paoli-Calmettes, Marseille. Patrick Ben Soussan est psychiatre, responsable du Département de psychologie clinique, institut Paoli-Calmettes, Marseille. Didier Blaise est hématologue, professeur des Universités, responsable du Département d'onco-hématologie et de transplantation et thérapie cellulaire, institut Paoli-Calmettes

Dans la mythologie grecque, la Chimère est une créature fantastique ayant une tête de lion, un corps de chèvre et une queue de dragon, qui crache du feu et dévore les humains. Au figuré, elle désigne un projet vain, impossible à réaliser, une utopie, une figure imaginaire. En génétique, un organisme possédant deux ou plusieurs génotypes distincts : ainsi, dans le champ de la greffe de moelle, le receveur devient une chimère, constitué de ses propres cellules hématopoïétiques et de ceux du donneur. Cet ouvrage réunit psychologues, psychiatres, psychanalystes et hématologues, cancérologues, tous praticiens d'hématologie et de greffe pour une réflexion polyphonique sur les incidences psychiques de ces soins hautement techniques qui provoquent de multiples bouleversements tant physiques que psychoaffectifs sur le malade et sa famille.

Abstract: Background: The role of high-dose chemotherapy with autologous stem cell transplantation (ASCT) in the treatment of soft-tissue sarcoma (STS) remains an unsettled issue. Prospective clinical trials failed to prove a benefit of the procedure but were limited by small and heterogeneous patient cohorts. Thus, it is unknown if ASCT may be a valuable treatment option in specific patient subgroups. Methods: The purpose of this study was to investigate the value of ASCT according to histological subtype in STS patients who were registered in the European Society for Blood and Marrow Transplantation database between 1996 and 2016. Results: Median progression-free (PFS) and overall survival (OS) in the entire cohort of 338 patients were 8.3 and 19.8 months, respectively, and PFS and OS at 5 years were 13% and 25%, respectively. Analysis of outcomes in different subgroups showed that younger age, better remission status before transplantation and melphalan-based preparative regimen were predictive of benefit from ASCT, whereas histology and grading had no statistically significant impact. Conclusions: Outcomes after ASCT compared favorably to those of recent trials on conventional chemotherapies and targeted therapies in STS, including histology-tailored approaches. ASCT, thus, should be reinvestigated in clinical trials focusing on defined patient subgroups