We investigated noninvasive procedures by hybrid imaging to assess the sites of active or inactive hematopoiesis in patients with primary myelofibrosis (PMF). To this end, we used two radionuclides, technetium 99m (99mTc) and indium 111‐chloride (111In‐Cl3), coupled with single‐photon emission tomography/computed tomography (SPECT/CT). We studied five patients with PMF and one with secondary myelofibrosis (MF). The classical pattern of lower fixation of both tracers at the axial skeleton where the myelofibrotic process occurs and the reactivation of sites of active hematopoiesis at the distal skeleton were confirmed. Coupling both radionuclides to SPECT/CT imaging allowed for more precise visualization of the sites of extramedullary hematopoiesis as those observed in the spleen and liver. Splenic high uptake of 111In‐Cl3 coupled with SPECT/CT represents a pathognomonic feature of PMF. We conclude that, the hybrid imaging procedures that we studied might constitute an alternative noninvasive method for the screening of the whole‐body marrow and, by this way, to assess the impact of targeted therapies in PMF patients in whom it is well known that the distribution of the hematopoietic active areas is disturbed. Hybrid imaging could also be useful for diagnostic purposes in cases of early PMF or in suspected cases of myelofibrosis secondary to polycythemia vera or essential thrombocythemia.

Objectives The impact of conventional treatment for acute myeloid leukemia (AML) on the nutritional, cognitive, and functional status of elderly patients is seldom studied. This assessment was performed in the context of the LAMSA 2007 trial. Methods The trial enrolled 424 patients with de novo AML. Among them, 316 benefited from geriatric assessment (GA) including nutritional, cognitive, and functional status and were scored according to Eastern Cooperative Oncology Group (ECOG) and sorror for the prediction of treatment toxicity, morbidity, and mortality. Patients were investigated at diagnosis for three times during follow‐up. Results This study showed that AML and its treatment have no impact on cognitive (P = .554) nor functional status (P = .842 for Activity of Daily Living and P = .087 for Instrumental Activities of Daily Living). The nutritional status improved over time (P = .041). None of these three parameters at baseline, associated or not with ECOG and sorror scores, impacted survivals or toxicities. Conclusions The cognitive, functional, and nutritional status had no impact in this cohort of fit elderly AML patients without unfavorable cytogenetics. The GA tools used provided no additional information compared with ECOG and sorror scores, to predict toxicity, morbidity, or mortality due to intensive chemotherapy.

We assessed the development of an adherent stromal layer in peripheral blood progenitor cells (PBPC) collections of 17 patients with solid tumors and hematological malignancies (n = 38), as well as in normal and disease-free bone marrow samples (n = 14). Light-density mononuclear cells from peripheral blood leukapheresis maintained in long term culture (LTC) conditions for at least 3 weeks failed to develop a stromal layer as was observed in all bone marrow samples. We found no differences with regard to CFU-GM growth, CD34+ percentage or cytological morphology. Our results indicate that spindle-shaped fibroblastoid cell progenitors present in the bone marrow are not mobilized towards peripheral blood by chemotherapy and/or growth factor stimulation, contrasting with hematopoietic progenitors, which, as is well known, are able to circulate. The absence of stromal progenitors in PBPC autografts does not appear to be relevant for a successful hematopoietic engraftment.

Using three different statistical tests in parallel, we showed in a preliminary study that neither mononuclear cells, CD34+33+ or 33− cells, nor CD34+38+ cells significantly correlated with engraftment kinetics following autologous blood cell transplantation (ABCT). We additionally demonstrated here, in a series of patients suffering from malignant diseases, that the graft content in CD34+38− cells is individually a more sensitive indicator of the earliest, as well as the latest post‐ABCT trilineage hematopoietic recovery than the colony‐forming units‐granulocyte‐macrophage and even the total CD34+ cell content. This suggests that the CD34+38− cell population is itself subdivided into two more subsets, one being already lineage‐committed and responsible for short‐term engraftment, the other containing only very primitive hematopoietic cells responsible for sustained engraftment. Strong arguments favor the probability that these subsets correspond to HLA‐DR+ and DR− cells, respectively. We also defined an optimal threshold value of 0.05 × 106 CD34+38− cells/kg of the patient's body weight (b.w.) above which a rapid and sustained trilineage engraftment safely occurs. In fact, infusion of lower numbers of cells seems to have a more significant impact on long‐term compared to short‐term neutrophil recovery and on platelet kinetics engraftment. We additionally looked for the eventual influence on engraftment time of the type of disease, and of post‐ABCT administration of hematopoietic growth factors (HGF). When the type of disease appeared to have no influence on the engraftment time, posttransplant HGF administration significantly reduced the time to trilineage engraftment in patients transplanted with < 0.05 × 106 CD34+38+ cells, thus justifying it in case of reinfusion of low numbers of CD34+38+ cells. On the other hand, the administration of HGF after infusion of more than 0.05 × 106 CD34+38− cells/kg b.w. did not hasten more, or only very little, the engraftment time, thus becoming not only unprofitable for the patients but costly as well.

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