Many somatic genetic abnormalities have been identified in T-cell acute lymphoblastic leukemia (T-ALL) but each individual

In elderly patients with acute myeloid leukemia (AML) treated intensively, no best postremission strategy has emerged yet. This clinical trial enrolled 416 patients with AML aged 65 years or older who were considered eligible for standard intensive chemotherapy, with a first randomization comparing idarubicin with daunorubicin for all treatment sequences. After induction, an ambulatory postremission strategy based on 6 consolidation cycles administered monthly in outpatients was randomly compared with an intensive strategy with a single intensive consolidation course similar to induction. Complete remission (CR) rate was 57% with 10% induction deaths, and estimated overall survival was 27% at 2 years and 12% at 4 years, without notable differences between anthracycline arms. Among the 236 patients who reached CR, 164 (69%) were randomized for the postremission comparison. In these patients, the multivariate odds ratio in favor of the ambulatory arm was 1.51 for disease-free survival (P ‫؍‬ .05) and 1.59 for overall survival from CR (P ‫؍‬ .04). Despite repeated courses of chemotherapy associated with a longer time under treatment, the ambulatory arm was associated with significantly shorter rehospitalization duration and lower red blood cell unit and platelet transfusion requirements than observed in the intensive arm. In conclusion, more prolonged ambulatory treatment should be preferred to intensive chemotherapy as postremission therapy in elderly patients with AML reaching CR after standard intensive remission induction.

Gut invasive aspergillosis is an extremely rare infection in immunocompromised patients. The goal of this retrospective multicentre study is to report on cases of gut aspergillosis in haematology patients, including clinical presentation, risk factors, and outcome. Twenty-one patients from nine centres were identified. Eight had isolated gut aspergillosis, with no evidence of other infected sites, and 13 had disseminated aspergillosis. Thirteen patients had acute leukaemia. Nine were allogeneic stem cell transplant recipients. Clinical symptoms and imaging were poorly specific. The galactomannan antigenaemia test result was positive in 16/25 (64%) patients, including in four of the eight cases of isolated gut aspergillosis. Five of 21 patients had a dietary regimen rich in spices, suggesting that, in these cases, food could have been the source of gut colonization, and then of a primary gut Aspergillus lesion. The diagnosis was made post-mortem in six patients. The mortality rate in the remaining patients at 12 weeks was 7/15 (47%). Gut aspergillosis is probably misdiagnosed and underestimated in haematology patients, owing to the poor specificity of symptoms and imaging. Patients with a persistently positive galactomannan antigenaemia finding that is unexplained by respiratory lesions should be suspected of having gut aspergillosis in the presence of abdominal symptoms, and be quickly investigated. In the absence of severe abdominal complications leading to surgery and resection of the lesions, the optimal treatment is not yet defined.

No abstract

On March 11th, 2006, a radiation accident occurred in an industrial radiation facility, in the city of Fleurus (Belgium). An operator entered an irradiation room without noticing that the cobalt-60 source (activity of 3x104 TBq) was out of the security position. Few hours after the exposure, the victim had nausea and vomiting, but these clinical signs were confounded with a benign gastroenteritis. Eighteen days later, the patient consulted for persistent nausea and headache, transitory and refractory diarrhoea and hair loss. The occurrence of a radiation accident was then proposed as an explanation for these symptoms, and the patient was taken in charge by the medical staff of Percy hospital (Clamart, France). Cytogenetic dosimetry was used to define the radiation dose and heterogeneity received by the victim. This cytogenetic analysis indicated a mean radiation dose of 4.5 Gy, based upon dicentric chromosome frequency, reciprocal translocations and total translocations. However, the presence of 18.8% of cells without dicentric chromosomes suggested of an heterogeneous irradiation. This was confirmed by the physical dosimetry, which suggested an anterior-posterior gradient of dose. The patient was then followed by the mean of several new biological indicators of radiation-induced damages to specific organs and physiological systems. The blood Flt3 ligand concentration was used to evaluate and follow the hematopoietic syndrome. Initial measurement gave <2500 pg FL/ml of plasma, indicating a severe hematopoietic syndrome, with some evidence of a residual hematopoiesis. As soon as the patient received a cytokine treatment, a rapid and sustained hematopoietic recovery was observed. Citrulline concentration was used to evaluate damage to the mucosal epithelium of the small bowel. However, citrulline concentration was in the range of normal values, indicating the absence of significant damage to the mucosal epithelium. Several oxysterols were used to evaluate damages to the cardiovascular system and to the liver lipid metabolism. The decrease over time observed in 7α-hydroxycholesterol (7α-OH-Chol) concentration was indicative of a liver damage, as confirmed by decrease in AST and ALT concentrations and in Apolipoproteins A1 and B. The 27α-OH-Chol was strongly decreased over time, in parallel to an increase in CK-MB. This suggested radiation-induced damages to the cardiovascular system. Overall, our results show that these new biological indicators are useful for the initial evaluation of radiation-induced damages to specific organs and physiological systems, but also for the monitoring of pathophysiological evolution of the patient, in combination with existing scoring for radiation