[Impact of neoadjuvant chemotherapy on therapeutic management of muscle-invasive bladder cancer]. / Impact de la chimiothérapie néoadjuvante sur la prise en charge des tumeurs de vessie infiltrant le muscle.

OBJECTIVE: Assess the toxicity of neoadjuvant chemotherapy (NAC), its impact on surgical schedule and postoperative morbidity of cystectomy for muscle-invasive bladder cancer (MIBC). PATIENTS AND METHODS: Retrospective multicentric study of 78 patients who underwent a cystectomy from January 2009 to March 2012 for MIBC. The following criteria have been studied: toxicity of NC (WHO classification), precystectomy interval, postoperative morbidity (Clavien), duration of stay, downsizing on CT-scan before cystectomy, and free of cancer pathology (pT0). RESULTS: Seventy-eight patients had been included, thirty-nine had a NAC. Thirty-three percent had a incomplete chemotherapy because of toxicity. Forty-eight percent had a significant toxicity and grade ≥ 3 toxicity was 33%. Median time between diagnosis and cystectomy was 12.6 weeks (0.7-38), 18 weeks with NAC (group 1) versus eight weeks without NAC (group 2) (P=0.01). In case of toxicity, the delay was 3.5 weeks longer (P=0.12). After cystectomy, 60% of patients had at least one postoperative complication; including 23% had major morbidity. NAC did not increase neither postoperative morbidity (P=0.15) nor duration of stay (18 vs 20 days; P=0.2). Radiological response rate to NC was 38%. pT0 rate was 79 vs 7.7%. The increase of precystectomy interval after NC did not worsen the pathological stage (P=0.5). CONCLUSION: NC had a high toxicity, but without impact on postoperative morbidity, and precystectomy interval did not have any impact on the prognosis. LEVEL OF EVIDENCE: 5.

Rituximab-related late-onset neutropenia after autologous stem cell transplantation for aggressive non-Hodgkin's lymphoma.

Rituximab, an anti-CD20 monoclonal antibody, is increasingly used in the treatment of B-cell non-Hodgkin's lymphoma. Late-onset neutropenia in relation to rituximab has been recently described. In this report, we present six cases occurring after stem cell transplantation and discuss the potential impact of this complication.