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Ben Lakhal R, Hdiji S, Zriba S, Mokrani A, Laatiri MA, BenYoussef Y, Ezzaier F, Toumi N, Ladeb S, BenSalah H, Tebra S, Frikha H, Messai T, Daoued J, Bouaouina N, Maalej M, Frikha M, BenOthmen T, BenAhmed S, Khelif A, Msaddek F, Mezlini A, Elloumi M, Meddeb B. Protocole national Tunisien prospectif de traitement du Lymphome de Hodgkin de l’adulte : résultats d’un schéma thérapeutique adapté à la réponse par tomodensitométrie à 2 cycles, à propos de 444 patients. Bull Cancer 2018; 105:562-572. [DOI: 10.1016/j.bulcan.2018.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/29/2018] [Accepted: 04/03/2018] [Indexed: 12/22/2022]
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Ben Lakhal R, Ghedira H, Bellaaj H, Ben Youssef Y, Menif S, Manai Z, Bedoui M, Lakhal A, M'Sadek F, Elloumi M, Khélif A, Ben Romdhane N, Laatiri MA, Ben Othmen T, Meddeb B. Chronic myeloid leukemia patients in Tunisia: epidemiology and outcome in the imatinib era (a multicentric experience). Ann Hematol 2018; 97:597-604. [PMID: 29305630 DOI: 10.1007/s00277-017-3224-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 12/23/2017] [Indexed: 11/26/2022]
Abstract
Data are limited in developing countries regarding the clinicopathologic features and response to therapy of chronic myeloid leukemia (CML) in the era of imatinib (IM). The objective of this study is to report on the clinicoepidemiologic features of CML in Tunisia, to evaluate the long-term outcome of patients in chronic (CP) or accelerated phase (AP) treated with IM 400 mg daily as frontline therapy, and to determine imatinib's efficacy and safety. From October 2002 to December 2014, 410 CML patients were treated with IM in six Tunisian departments of hematology. Response (hematologic, cytogenetic, and molecular responses) and outcome-overall survival (OS), event-free survival (EFS), and progression-free survival (PFS)-were evaluated. The following prognostic factors were analyzed for their impact on the European leukemia net (ELN) response, OS, EFS, and PFS at 5 years: age, sex, leukocyte count, Sokal score, European Treatment and Outcome Study (EUTOS) score, CML phase, time to starting IM, and impact of adverse events. The median age was 45 years (3-85 years). Two hundred ten (51.2%) patients were male. Splenomegaly was present in 322 of the 410 (79%). Additional cytogenetic abnormalities were encountered in 25 (6.3%) patients. At diagnosis, 379 (92.4%) patients were in CP, 31 (7.6%) were in AP. The Sokal risk was low in 87 (22.5%), intermediate in 138 (35.7%), and high in 164 patients (41.9%). The EUTOS risk was low in 217 (74%), and high in 77 (26%) patients. The rates of cumulative complete cytogenetic response (CCyR), major molecular response (MMR), and molecular response 4/5 log (MR4.5) in CP/AP-CML patients were 72, 68.4, and 46.4%, respectively. The median time to reach CCyR, MMR, and MR4.5 was 6 months (3-51), 18 months (3-72), and 24 months (3-100), respectively. According to the ELN criteria, optimal, suboptimal response, and failure were noted in 206 (51.8%), 61 (15.3%), and 125 (31.4%) patients, respectively. Five-year event-free survival (EFS), progression-free survival (PFS), and overall survival (OS) were 81, 90, and 90%, respectively. By multivariate analysis, AP, high EUTOS risk, and baseline WBC ≥ 150G/l remained independent predictive factors of non-optimal response to IM. The adverse events (AE) of IM were moderate and tolerable. With the caveats that the monitoring of the disease was not optimal, response rates were similar to those reported in previous studies. It is clear to us that improvements should be made in treatment of AP-CML and high Sokal risk group of CP-CML. The frontline use of second-generation tyrosine kinase inhibitor (TKI) is expected to improve the results of the first-line treatment of these high-risk Tunisian patients, but cost and accessibility of this therapy remain the problems in developing countries.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/adverse effects
- Antineoplastic Agents/therapeutic use
- Child
- Child, Preschool
- Female
- Follow-Up Studies
- Humans
- Imatinib Mesylate/adverse effects
- Imatinib Mesylate/therapeutic use
- Leukemia, Myeloid, Accelerated Phase/diagnosis
- Leukemia, Myeloid, Accelerated Phase/drug therapy
- Leukemia, Myeloid, Accelerated Phase/epidemiology
- Leukemia, Myeloid, Accelerated Phase/pathology
- Leukemia, Myeloid, Chronic-Phase/diagnosis
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Leukemia, Myeloid, Chronic-Phase/epidemiology
- Leukemia, Myeloid, Chronic-Phase/pathology
- Male
- Middle Aged
- Practice Patterns, Physicians'
- Prognosis
- Protein Kinase Inhibitors/adverse effects
- Protein Kinase Inhibitors/therapeutic use
- Retrospective Studies
- Splenomegaly/etiology
- Splenomegaly/pathology
- Splenomegaly/prevention & control
- Survival Analysis
- Tumor Burden/drug effects
- Tunisia/epidemiology
- Young Adult
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Affiliation(s)
- Raihane Ben Lakhal
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia.
| | - Hela Ghedira
- Hematology Department, Military Hospital Tunis, Tunis, Tunisia
| | - Hatem Bellaaj
- Hematology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | | | | | - Zeineb Manai
- Hematology Department, La Rabta Hospital, Tunis, Tunisia
| | - Manel Bedoui
- Hematology Department, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Amel Lakhal
- Centre national de greffe de moelle osseuse, Tunis, Tunisia
| | - Fehmi M'Sadek
- Hematology Department, Military Hospital Tunis, Tunis, Tunisia
| | - Moez Elloumi
- Hematology Department, Hedi Chaker Hospital, Sfax, Tunisia
| | | | | | | | | | - Balkis Meddeb
- Department of Haematology, Aziza Othmana University Hospital, Tunis, Tunisia
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Menif S, Ben Youssef Y, Bellaaj H, Ben Lakhal R, Laatiri A. Molecular monitoring of Tunisian patients with chronic myeloid leukemia. Tunis Med 2017; 95:229-231. [PMID: 29878287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND bcr-abl fusion gene is the hallmark of chronic myeloid leukemia (CML). RQ-PCR provides an accurate measure of the total leukemia cell mass and the degree to which bcr-abl transcripts are reduced by therapy correlates with progression free survival. AIM We report molecular assessment of residual disease in CML Tunisian patients. METHODS Between June 2003 and December 2014 we measured bcr-abl mRNA levels in peripheral blood from all Tunisian patients by quantitative real time polymerase chain reaction (RQ-PCR). RESULTS A total of 708 patients with a mean age of 42 years were included in this study. Based on European Leukemia Net 2013, 80% of the patients achieved an optimal response 20% were in treatment failure. 38% of the patients achieved RM4 which corresponds to a bcr-abl/abl ratio <0.01%, 13% of the patients achieved RM4.5corresponding to bcr-abl/abl ratio of 0.0032%. CONCLUSION CML patients had a good response to tyrosine kinase inhibitors treatment. RQ-PCR is helpful in detecting any residual disease and determining the depth of the treatment response.
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MESH Headings
- Adolescent
- Adult
- Aged
- Biomarkers, Pharmacological/analysis
- Biomarkers, Tumor/genetics
- Drug Monitoring/methods
- Female
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Molecular Diagnostic Techniques/methods
- Monitoring, Physiologic/methods
- Neoplasm, Residual
- Protein Kinase Inhibitors/therapeutic use
- Real-Time Polymerase Chain Reaction
- Retrospective Studies
- Treatment Outcome
- Tunisia
- Young Adult
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Ben Lakhal R, Hdiji S, Ben Youssef Y, Laariri MA, Zriba S, Toumi N, Mokrani A, Ezzaier F, Ladb S, Frikha H, Mesai T, Ben Salah H, Tebra S, Daoued J, Bouaouina N, Maalej M, Frikha M, Ben Ahmed S, Mezlini A, Ben Othmen T, Msaddek F, Khelif A, Elloumi M, Meddeb B. Tunisian adult's Hodgkin lymphoma Study Group. Tunis Med 2016; 94:706. [PMID: 28994864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Tunisian adult's Hodgkin lymphoma (HL) Study Group was created in 1999. It aimed to improve the management of this curable hematologic malignancy by standardizing the diagnosis, assessment of disease, treatment management and therapeutic evaluation in different Tunisian centers (Hematology, oncology and radiotherapy).Since 1998, four versions of the prospective national protocol for treating adult Hodgkin lymphoma have succeeded (MDH99, MDH2002, MDH2008, MDH2015). Each version was based on the results of the previous version and analyzed according to new data from the literature. Due to this national study group, the number of patients lost to follow decreased significantly (30% before the creation of the group and only 3% for patients treated with MDH2008), the complete and uncertain response rates have improved (75% before the creation of the group and 92% in patients treated with MDH2008) with dramatically improved rates of overall survival from 57% to 90%. On the other hand there was an improvement of toxic death rate (13% of toxic deaths in MDH2002 to 4.37% in the MDH2008) with a decrease of the respective rate of primary failure and relapse by 17% and 12.5% in MDH2002 against the 11.4% and 7.8% in the MDH2008. This resulted in an improvement in overall survival (90%) and event-free survival at 5 years (75%). Now with the introduction of positron emission tomography in Tunisia, we hope yet to finalize the assessment of response and thus better adapt the treatment of this disease. Our objective remains the improvement of event-free survival rate to reach 80%.
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Chaabouni H, Kacem K, Zriba S, Mansouri R, Ghédira H, Lakhal RB, Zarrouk M, Abdennebi YB, Neji HB, Aïssaoui L, Ali ZB, Abid HB, Sadek FM, Meddeb B. Solid tumors after chronic lymphocytic leukemia patients: Report of six cases and review of the literature. Gulf J Oncolog 2015; 1:28-32. [PMID: 26499827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Malignancies have been reported to occur with increased frequency in chronic lymphocytic Leukemia (CLL) patients. The aim of this study was to describe which second malignancies occur in patients with CLL, whether these malignancies are related to CLL, its treatment, or both. We also attempt to study factors predicting the development of other malignancies. PATIENTS AND METHODS Between 1995 and 2009, six cases of CLL associated with solid tumor were diagnosed in Hematology Department of Military Hospital of Tunis. The diagnosis of CLL was made by immunophenotyping of peripheral blood circulating B cells, and the diagnosis of solid tumors was made by biopsy with anatomopathological exam and immunohistochemical study. RESULTS The mean age of patients was 71 years. Five patients were male. The CLL was classified Stage A in one case, Stage B in three cases and Stage C in two cases. Two patients had abnormal karyotype. Three patients have not received specific treatment for their CLL. Solid tumors were represented by skin cancer in three cases, lung cancer in two cases and breast cancer in one case. The median time between diagnosis of CLL and that of solid tumor was 53 months. CONCLUSION Patients with CLL have an increased risk of developing a second cancer. Awareness of risk factors could permit early detection.
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Affiliation(s)
- H Chaabouni
- Clinical hematology department, Military Hospital of Tunis, Tunisia
| | - K Kacem
- Clinical Hematology Department, Aziza Othama Hospital, Tunis, Tunisia
| | - S Zriba
- Clinical hematology department, Military Hospital of Tunis, Tunisia
| | - R Mansouri
- Clinical Hematology Department, Aziza Othama Hospital, Tunis, Tunisia
| | - H Ghédira
- Clinical hematology department, Military Hospital of Tunis, Tunisia
| | - R B Lakhal
- Clinical Hematology Department, Aziza Othama Hospital, Tunis, Tunisia
| | - M Zarrouk
- Clinical Hematology Department, Aziza Othama Hospital, Tunis, Tunisia
| | - Y B Abdennebi
- Clinical Hematology Department, Aziza Othama Hospital, Tunis, Tunisia
| | - H B Neji
- Clinical Hematology Department, Aziza Othama Hospital, Tunis, Tunisia
| | - L Aïssaoui
- Clinical Hematology Department, Aziza Othama Hospital, Tunis, Tunisia
| | - Z B Ali
- Clinical Hematology Department, Aziza Othama Hospital, Tunis, Tunisia
| | - H B Abid
- Clinical Hematology Department, Aziza Othama Hospital, Tunis, Tunisia
| | - F M Sadek
- Clinical hematology department, Military Hospital of Tunis, Tunisia
| | - B Meddeb
- Clinical Hematology Department, Aziza Othama Hospital, Tunis, Tunisia
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Zriba S, Jeddi R, Kacem K, Ben Neji H, Aissaoui L, Ben Lakhal R, Belhadj Ali Z, Ben Abid H, Battikh R, Meddeb B. [Malignant external otitis due to Aspergillus niger in leukemic patient: a case report]. Tunis Med 2014; 92:582-583. [PMID: 25815549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Kacem K, Zriba S, Lakhal RB, Bouteraa W, Aissaoui L, Amor RB, Abdennebi YB, Ali ZB, Abid HB, Meddeb B. Primary adrenal lymphoma. Turk J Haematol 2014; 31:188-91. [PMID: 25035679 PMCID: PMC4102049 DOI: 10.4274/tjh.2012.0125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 01/18/2013] [Indexed: 12/01/2022] Open
Abstract
Primary non-Hodgkin's lymphoma of the adrenal gland is rare. We report the case of a 56-year-old patient suffering from B symptoms. The CT scan showed a bilateral adrenal mass without any lymph nodes. Scan-guided biopsies led to the diagnosis of diffuse large B-cell lymphoma. The medullar biopsy eliminated a secondary lymphoma. The patient was treated by immunochemotherapy with a complete response before autologous stem cell transplantation.
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Affiliation(s)
- Karima Kacem
- Tunis El Manar University Faculty of Medicine, Aziza Othmana Hospital, Department of Hematology, Tunis, Tunisia
| | - Sami Zriba
- Tunis El Manar University Faculty of Medicine, Military Hospital, Department of Internal Medicine, Tunis, Tunisia
| | - Raihane Ben Lakhal
- Tunis El Manar University Faculty of Medicine, Aziza Othmana Hospital, Department of Hematology, Tunis, Tunisia
| | - Walid Bouteraa
- Tunis El Manar University Faculty of Medicine, Aziza Othmana Hospital, Department of Hematology, Tunis, Tunisia
| | - Lamia Aissaoui
- Tunis El Manar University Faculty of Medicine, Aziza Othmana Hospital, Department of Hematology, Tunis, Tunisia
| | - Ramzi Ben Amor
- Tunis El Manar University Faculty of Medicine, Aziza Othmana Hospital, Department of Hematology, Tunis, Tunisia
| | - Yosr Ben Abdennebi
- Tunis El Manar University Faculty of Medicine, Aziza Othmana Hospital, Department of Hematology, Tunis, Tunisia
| | - Zaher Belhadj Ali
- Tunis El Manar University Faculty of Medicine, Aziza Othmana Hospital, Department of Hematology, Tunis, Tunisia
| | - Hela Ben Abid
- Tunis El Manar University Faculty of Medicine, Aziza Othmana Hospital, Department of Hematology, Tunis, Tunisia
| | - Balkis Meddeb
- Tunis El Manar University Faculty of Medicine, Aziza Othmana Hospital, Department of Hematology, Tunis, Tunisia
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Jeddi R, Achour M, Amor RB, Aissaoui L, Bouterâa W, Kacem K, Lakhal RB, Abid HB, BelHadjAli Z, Turki A, Meddeb B. Factors associated with severe sepsis: prospective study of 94 neutropenic febrile episodes. Hematology 2013; 15:28-32. [DOI: 10.1179/102453310x12583347009577] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Ramzi Jeddi
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Mériem Achour
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Ramzi Ben Amor
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Lamia Aissaoui
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Walid Bouterâa
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Karima Kacem
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Raihane Ben Lakhal
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Héla Ben Abid
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Zaher BelHadjAli
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Amel Turki
- Department of Microbiology and Biochemical AnalysisAziza Othmana University Hospital, Tunis, Tunisia
| | - Balkis Meddeb
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
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9
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Jeddi R, Ghédira H, Ben Amor R, Turki A, Kacem K, Ben Abdennebi Y, Ben Lakhal R, Aissaoui L, Ben Abid H, Bel Hadjali Z, Meddeb B. Risk factors of septic shock in patients with hematologic malignancies andPseudomonasinfections. Hematology 2013; 16:160-5. [DOI: 10.1179/102453311x12953015767293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ramzi Jeddi
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Héla Ghédira
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Ramzi Ben Amor
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Amel Turki
- Department of MicrobiologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Karima Kacem
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Yosr Ben Abdennebi
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Raihane Ben Lakhal
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Lamia Aissaoui
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Héla Ben Abid
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Zaher Bel Hadjali
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
| | - Balkis Meddeb
- Department of HematologyAziza Othmana University Hospital, Tunis, Tunisia
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Jeddi R, Ghédira H, Ben Amor R, Ben Abdennebi Y, Karima K, Mohamed Z, Ben Neji H, Aissaoui L, Ben Lakhal R, Ben Salah N, Menif S, Belhadjali Z, Ben Abid H, Gouider E, Hafsia R, Saad A, Fenaux P, Meddeb B. Treatment of Acute Promyelocytic Leukemia with AIDA Based Regimen. Update of a Tunisian Single Center Study. Mediterr J Hematol Infect Dis 2011; 3:e2011033. [PMID: 22084648 PMCID: PMC3212966 DOI: 10.4084/mjhid.2011.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 08/01/2011] [Indexed: 01/26/2023] Open
Abstract
In Tunisia, the ATRA era began in 1998 with the use, consecutively, of two regimens combining ATRA and an anthracycline with cytarabine (APL93), and without cytarabine (LPA99). From 2004, 51 patients with confirmed APL either by t(15;17) or PML/RARA were treated according to the PETHEMA LPA 99 trial. Forty three patients achieved CR (86%). The remaining seven patients had early death (one died before treatment onset): four caused by differentiation syndrome (DS) and three died from central nervous system hemorrhage. Multivariate analysis revealed that female gender (P=0.045), baseline WBC> 10 G/L (P=0.041) and serum creatinine > 1.4mg/dl (P=0.021) were predictive of mortality during induction. DS was observed in 16 patients (32%) after a median onset time of 15 days from treatment onset (range, 2-29). Body mass index ≥ 30 (P=0.01) remained independent predictor of DS. Occurrence of hypertensive peaks significantly predicted occurrence of DS (P=0.011) and was significantly associated with high BMI (p=0.003). With a median follow-up of 50 months, 5 year cumulative incidence of relapse, event free and overall survival were 4.7%, 74% and 78%, respectively.
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Affiliation(s)
- Ramzi Jeddi
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Hèla Ghédira
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Ramzi Ben Amor
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Yosr Ben Abdennebi
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Kacem Karima
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Zarrouk Mohamed
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Hend Ben Neji
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Lamia Aissaoui
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Raihane Ben Lakhal
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Naouel Ben Salah
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Samia Menif
- Department of molecular analysis, Pasteur Institute, Tunis, Tunisia
| | - Zaher Belhadjali
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Hela Ben Abid
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Emna Gouider
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Raouf Hafsia
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
| | - Ali Saad
- Department of cytogenetic analysis, Farhat Hached Hospital, Sousse, Tunisia
| | - Pierre Fenaux
- Hematology Department, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, Paris 13 University, Paris, France
| | - Balkis Meddeb
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia
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Jeddi R, Ghédira H, Ben Abdennebi Y, Kacem K, Ben Amor R, Aissaoui L, Bouterâa W, Ben Lakhal R, Ben Abid H, Menif S, Belhadjali Z, Meddeb B. ATRA and anthracycline-based chemotherapy in the treatment of childhood acute promyelocytic leukemia (APL): A 10-year experience in Tunisia. Med Oncol 2010; 28:1618-23. [PMID: 20697840 DOI: 10.1007/s12032-010-9642-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 07/27/2010] [Indexed: 10/19/2022]
Abstract
Reports on childhood APL from developing countries are scarce. We treated 65 APL with two consecutive trials combining ATRA and chemotherapy. Twenty (30.7%) were aged less than 20 years including 11 girls and 9 boys, with a median age of 12 years. Fever at presentation (P=0.002) and variant APL (P=0.044) were more frequent in children, while there were no significant difference between children and adults for WBC count, Sanz's score distribution and additional cytogenetic abnormalities. The CR rate was 95% (19/20) in children and 80% (36/45) in adults (P=0.13). Differentiation syndrome (DS) was less often observed in children (1/20) than in adults (13/45) (P=0.031). Two children relapsed and died during salvage therapy, and 2 died in CR from infection and from cardiac failure attributed to anthracyclines, while other children remained alive in CR. With a median follow-up of 4 years, 4-year EFS was 75% in children and 71.1% in adults (P=0.57), while 4-year OS was 75% in children vs. 73.3% in adults (P=0.72). Our results suggest that, even in the absence of optimal socio-economic condition, ATRA combined with anthracycline-based chemotherapy gives adequate results in childhood APL, as in adults.
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Affiliation(s)
- Ramzi Jeddi
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia.
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Jeddi R, Kacem K, Ben Neji H, Mnif S, Gouider E, Aissaoui L, Ben Amor R, Ben Lakhal R, Ben Abid H, Belhadjali Z, Meddeb B. Predictive factors of all-trans-retinoic acid related complications during induction therapy for acute promyelocytic leukemia. ACTA ACUST UNITED AC 2008; 13:142-6. [PMID: 18702871 DOI: 10.1179/102453308x316112] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The combination of all-trans-retinoic acid (ATRA) and chemotherapy has made acute promyelocytic leukemia (APL) a highly curable leukemia. However, several complications are reported with this treatment the most serious and life threatening being Retinoic Acid Syndrome (RAS). We aimed at identifying factors that could predict complications caused by ATRA during induction treatment of APL. PATIENTS Forty-two patients with confirmed APL (by t(15;17) and/or PML/RARA) treated at our institution (University hospital of Tunis) between January 1998 and June 2006 using two consecutive protocols: European APL93 trial (24 patients) until February 2004 and Spanish PETHEMA LPA99 trial (18 patients) more recently. Induction regimen consisted of ATRA 45 mg/m(2)/d until CR combined to DNR 60 mg/m(2)/d x 3+Cytarabine 200 mg/m(2)/d x 7 (APL93) and Idarubicin 12 mg/m(2) d2, 4, 6, 8 (LPA99). Prednisone (0.5 mg/kg d1-d15) was added if WBC >10 x 10(9)/L to prevent RAS in LPA 99. RESULTS Median age was 36 yr (7-64 yr), M/F=16/26 (0.61), median WBC was 2.4 x 10(9)/L (range 0.6-100 x 10(9)/L). WBC >10 x 10(9)/L was noted in 14 patients (33%). Additional cytogenetic abnormalities were seen in 12/42 (28%). Median body mass index (BMI=weight/height(2):N 20-25) was 24 kg/m(2) (range 16-40 kg/m(2)), BMI >30 was noted in nine patients (8F and 1M). Thirty-three patients achieved CR (78.57%):18/24 (75%) in APL93 versus 15/18 (83%) in LPA99. Nine patients (21.42%) had early death. Causes of early death were: RAS (6) and CNS hemorrhage (3). Complications due to ATRA were: RAS (10), Scrotal ulcerations (3), Sweet syndrome (2), Perineal ulcerations (1), and Pseudotumor cerebri (1). Prognostic factors for complications of ATRA (Fisher exact test) were: BMI >35 (p=0.055), induction treatment without cytarabine (LPA99 trial) (p=0.047), whereas age (p=0.74), gender (p=0.51), initial WBC (p=0.47), and additional cytogenetic abnormalities (p=0.83) were not predictive. Retinoic Acid Syndrome was more reported in patients with initial WBC >10 x 10(9)/L (p=0.08). CONCLUSION We found high BMI (>35) in female and treatment without Cytarabine to increase the risk of developing complications with ATRA.
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Affiliation(s)
- Ramzi Jeddi
- Hematology Department, Aziza Othmana University Hospital, Tunis, Tunisia.
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Jeddi R, Kacem K, Ben Lakhal R, Aissaoui L, Ben Abid H, Belhadj Ali Z, Meddeb B. [Pseudotumor cerebri with all-trans retinoic acid. A case report]. Tunis Med 2006; 84:827-9. [PMID: 17288291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The diagnosis of pseudotumor cerebri (PC) is based on the triad of: (1) papilledema, (2) elevated intracranial pressure with a normal cerebrospinal constituency and (3) normal central nervous system imaging studies. It is an uncommon complication of all-trans-retinoic acid (ATRA) therapy in children treated for acute promyelocytic leukaemia (APL). Its occurrence is rare among adult patients with APL and treated with ATRA . We report a case of an adult with APL who developed PC during induction therapy with ATRA-PC was managed with repeated lumbar punctures and corticotherapy.
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Affiliation(s)
- Ramzi Jeddi
- Service d'Hénmatologie clinique, Hôpital Aziza Othmnana
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14
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Jeddi R, Hdiji S, Kacem K, Ben Lakhal R, Aissaoui L, Ben Abid H, Belhadj Ali Z, Meddeb B. [Therapeutic results with apl 93 protocol in acute promyelocytic leukemia (34 cases)]. Tunis Med 2006; 84:717-20. [PMID: 17294898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Acute promyelocytic leukaemia (APL) account for approximately 10% to 15% of all AML in most reports. Clinical features includes the presence in 80% to 90% of patients of a severe hemorrhagic syndrome, a specific balanced translocation between chromosomes 15 and 17 with a fusion of a large pert of the retinoic acid receptor a gene (RARa) on chromosome 17 to a part of the promyelocytic leukaemia (PML) gene on chromosome 15. More than 75% of patients (under 65 years of age) can be cured, with the application of a combination of anthracyclines and all-trans retinoic acid (ATRA), followed by maintenance therapy. AIM of the study was to assess of the therapeutic management of APL 93 protocol in acute promyelocytic leukemia. METHODS We present here the results of a retrospective study concerning 34 patients with APL included between 1998 and 2004 in the APL 93 protocol : 20 in group B and 14 in group C. CR was 82 %. RESULTS Failure is only due to toxic death (18%) Event free survival at 4 years is 63,47% with relapse rate at 14.25%. Overall survival at 4 years is 69,72%. Our results are acceptable and can be improved with reduction of failure due to toxic death, probably with omission of cytarabine from induction and consolidation adapted by the Spanish PETHEMA Group.
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MESH Headings
- Adolescent
- Adult
- Anthracyclines/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Child
- Chromosomes, Human, Pair 15/genetics
- Chromosomes, Human, Pair 17/genetics
- Female
- Humans
- Leukemia, Promyelocytic, Acute/diagnosis
- Leukemia, Promyelocytic, Acute/drug therapy
- Leukemia, Promyelocytic, Acute/genetics
- Leukemia, Promyelocytic, Acute/mortality
- Male
- Middle Aged
- Pilot Projects
- Receptors, Retinoic Acid
- Remission Induction
- Retinoic Acid Receptor alpha
- Retrospective Studies
- Survival Analysis
- Translocation, Genetic
- Tretinoin/administration & dosage
- Tunisia
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Affiliation(s)
- Ramzi Jeddi
- Service d'hématologie de I'hôpital Aziza Othmunana Tunis
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Ben Lakhal R, Aissaoui L, Jeddi R, Ayari B, Ben Abid H, Belhadj Ali Z, Gouider E, Meddeb B, Hafsia R, Hafsia A. [Alpha interferon in children with Philadelphia chromosome-positive chronic myeloid-leukaemia]. Tunis Med 2005; 83:296-9. [PMID: 16044905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The present work focuses on the therapeutic efficacy and the toxicity of alpha interferon in patients younger than age 18 years. 5 patients younger than 18 years were treated and followed up between 1990 and 1999 at the department of haematology (Aziza Othmana Hospital) Hydroxyurea was given as initial treatment to all patients. After a median period of 8 months, these patients received alpha interferon (5 millions units/m2 once). Six months after the beginning of the alpha interferon a complete hematologic response was obtained in all patients. The median overall survival was of 66 months: 3 patients are still alive (2 patients in an advanced stage and one patient in chronic phase) and 2 patients died after transformation. The most common reported side effects of alpha interferon were asthenia, weight loss, fever, myalgia, chills and headaches--these toxic manifestations were mild and were noticed in all our patients. Myelosuppression was noted in two patients. Interferon is well tolerated in patients younger than age years 18 old, with CML. It may offer an alternative to bone marrow transplantation in children in the chronic phase of CML without histocompatible donor. The role of new agents such as STI 571 needs to be evaluated as well.
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Affiliation(s)
- Raihane Ben Lakhal
- Service d'hématologie de l'hôpital Aziza Othmana, Place du gouvernement la Kasba, Tunis
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Sendi HS, Hichri H, Elghezal H, Gribaa M, Laatiri A, Elloumi M, Ben Lakhal R, Saad A. Cytogenetic survey of 117 Tunisian patients with de novo myelodysplastic syndrome. Ann Genet 2002; 45:131-5. [PMID: 12381443 DOI: 10.1016/s0003-3995(02)01123-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Cytogenetic studies were performed on 117 Tunisian patients with de novo myelodysplastic syndromes (MDS). According to the French-American-British (FAB) criteria 40 patients presented with refractory anaemia (RA, 34%), eight with refractory anaemia with ringed sideroblasts (RARAS, 7%), 19 with refractory anaemia with excess of blasts (RAEB, 16%), 16 with refractory anaemia with excess of blasts in transformation (RAEB-t, 14%), 18 had chronic myelomonocytic leukaemia (CMML, 15%) and 16 unclassifiable MDS (14%). Seventy-five were men and forty-two were women. Five were children and 112 were adults with a median age of 58 years. Fifty-five per cent of the patients presented clonal chromosome abnormalities. Rates of abnormality varied from one FAB subtype to the other: 55% in RA, 75% in RARAS, 63% in RAEB, 75% in RAEB-t and 28% in CMML. The most frequent chromosome abnormalities were del(5q) (22 cases), monosomy 7 (12 cases), del(12p) (6 cases), and trisomy 8 (5 cases). Rare abnormalities were also found: ring of chromosome 12 and trisomy 15. Conventional cytogenetics remains the basic technique in identifying chromosomal abnormalities associated with MDS.
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Affiliation(s)
- Halima Sennana Sendi
- Laboratoire de cytogénétique et de biologie de la reproduction, CHU Farhat Hached, 4000, Sousse, Tunisia
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