Functional and quantitative evaluation of the 20S proteasome in serum and intracellular in145 moroccan patients with hematologic malignancies.

BACKGROUND: Regulatory degradation of intracellular proteins plays an essential role in most biological processes, particularly in the control of cell proliferation and differentiation. In eukaryotes, intracellular proteolysis is largely provided by the Ubiquitin / Proteasome system. Alterations and dysfunction of protein degradation by the Ubiquitin / Proteasome system, such as transcription factors, cell cycle regulators or tumor suppressor proteins, have been linked to human. Pathologies, including blood cancers. Mainly localized in the nucleus and cytoplasm of cells, the proteasome can be detected in the cell culture supernatant or in the peripheral blood of patients. This study deals with the problems of the search for serum markers specific to certain pathologies and which would be useful in the prevention, diagnosis and monitoring of cancers and which could be used as a therapeutic tool. METHODS: The functional and quantitative analysis of the proteasome is carried out at the serum and subcellular level during a pathological phenomenon in a population of 145 Moroccan patients (sex ratio: 1.10 / average age: 47.9 ± 15, 3 years) using an indirect ELISA test and a follow-up of the fluorescence emitted after enzymatic digestion of specific peptides by proteolytic activity (chymotrypsin-like). RESULTS: The evolutionary trend proteasome subcellular is significantly linked to the rate of chymotrypsin-like activity. The entire population of 60 patients called back for a second blood test. After three months of treatment reported a significant drop in the rate and the activity of the proteasome in serum and intracellular level. CONCLUSIONS: Although the serum proteasome level is a potential new tool for the monitoring of. Patientswithliquid cancer. TRIAL REGISTRATION: retrospectively registered.

Prognostic Impact and Phenotype of Residual Acute Myeloid Leukemia Stem Cells.

BACKGROUND: Leukemia stem cells (LSCs) have been demonstrated to be more therapy-resistant than leukemic blast cells reflecting measurable residual disease (MRD). CD34+CD38- cell frequency is an independent factor for relapse prediction and could therefore be used in the future to improve MRD assessment in acute myeloid leukemia (AML). This protocol is designed to enable accurate and reproducible immunophenotypic detection of measurable residual stem cell disease necessary for proper therapeutic decision and report their prognostic value in AML patients. METHODS: Fifty-four Novo AML adult patients diagnosed in the onco-hematology service of the "20 August 1953" Hospital in Casablanca. We analyzed phenotype and frequency of CD45dim CD34+CD38- cells in bone marrow samples from patients with AML and non-myeloid malignancies using six-color flow cytometry and a simple one-tube essay. RESULTS: For evaluation of leukemic stem cells, our gate strategy was based on the selection of CD34+CD38 - stem cells and leukemia associated immunophenotype approach. Positivity of CD123 or/and aberrant expression of primitive markers CD117 and HLA DR on stem cells discriminate leukemia stem cells from normal hematopoietic stem cells. We reported a statistically significant difference between expressions of primitive markers (CD117 and HLA DR) on leukemic stem cells. In addition, the frequency of LSCs after complete remission in post-induction was persistent in 50% of AML patients. CONCLUSIONS: Overall, we show that CD34+CD38-CD123+ as a basic phenotype, with aberrant phenotype detection of HLA DR and CD117 markers on stem cells, contributes to detecting LSCs which indicates the poor prognosis.

[Multiple myeloma and autologous haematopoietic stem-cell transplantation without cryopreservation: experiences of the Clinical Hematology Department of Casablanca, Morocco]. / Myélome multiple et autogreffe des cellules souches hématopoïétiques sans cryoconservation: expérience du Service d´Hématologie Clinique de Casablanca au Maroc.

High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (AHSCT) is the gold standard treatment for multiple myeloma in subjects aged ≤ 65 years. In developing countries, AHSCT without cryopreservation reduces the costs of hospitalization and all necessary equipments. We conducted a longitudinal, prospective, open study to evaluate this procedure at the Department of Clinical Hematology, Casablanca, Morocco. Data from the medical records of 64 patients were collected over a period of 24 months. After induction therapy, the overall response (complete remission + very good partial response) was 67.2% (43 patients). The mean CD34-cell count in the autograft was 12.97*106 /kg [2.4- 53*106 Cd34+/kg] and the median length of hospitalization was 20.5 days [14-60 days]. The overall response after autograf was 84% (54 patients). At 24 months follow-up, overall survival (OS) was 83.5%, median OS was not reached and progression-free survival (PFS) was 65.9%, with a median PFS of 24.1 months with 95% confidence interval [21.7-26.5 months]. Autologous hematopoietic stem cell transplantation without cryopreservation is an excellent alternative in our context reducing wait times and freezing costs.

[Establishment of Hematopoietic cell transplantation program in developing countries : Guidelines from the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC)]. / Mise en place d'un programme de greffe de cellules souches hématopoïétiques dans les pays en voie de développement. Recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC).

Hematopoietic cell transplantation (HCT) is the curative treatment for many malignant and non-malignant blood disorders and some solid cancers. However, transplant procedures are considered tertiary level care requiring a high degree of technicality and expertise and generating very high costs for hospital structures in developing countries as well as for patients without health insurance. During the 11th annual harmonization workshops of the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC), a designated working group reviewed the literature in order to elaborate unified guidelines, for developing the transplant activity in emerging countries. Access to infrastructure must comply with international standards and therefore requires a hospital system already in place, capable of accommodating and supporting the HCT activity. In addition, the commitment of the state and the establishment for the financing of the project seems essential.

[Cutaneous complications following hematopoietic stem cell transplantation]. / Complications cutanées post-allogreffe de cellules souches hématopoïétiques.

BACKGROUND: Hematopoietic stem cell allograft is a treatment for patients with severe constitutional or acquired hematopoietic system diseases. This act is always linked to complications requiring multidisciplinary care. Our study describes the post-allograft cutaneous complications. METHODS: A prospective study was conducted at the Hematology department of "20 Août Hospital" in Casablanca during a period going from January 2018 to December 2020; including all patients who presented acute or chronic cutaneous complications post-allograft. RESULTS: Twenty-five patients were included. All patients received induction chemotherapy (Busulfan/Fludarabine or Busulfan/Melphalan). A skin infection was found in 8 patients : four cases of Malassezia folliculitis, one case of perineal zona, one case of genital herpes, one case of varicella and one case of Candida sepsis. The acute graft versus host reaction was found in 3 patients, revealed by an erythematous rash all over the body. The chronic graft versus host reaction was found in five patients on a lichenoid form. Nine patients had a hyperpigmentation of the folds followed by detachment in the same areas, concluding to a Busulfan toxidermy. DISCUSSION: Hematopoietic stem cell allograft has many complications. The literature mainly specifies hematological and digestive complications, while skin complications are little described. Our series is special by reporting different types and mechanisms of skin complications that can occur; with a predominance of skin graft-on-host reactions and infections. It also reports an unusual Busulfan toxidermy.

Results of 25 years of Maghrebian scientific medical research in the Grand Maghreb. Bibliometric analysis of the Scimago platform (1996-2020).

OBJECTIVE: Describe the trend and the characteristics of the positioning of Maghreb medical production and its visibility, at the global, African and Arab level, following an in-depth reading of the Scimago platform, over a period of 25 years (1996-2020 ). METHODS: This is an in-depth reading, centered on the Maghreb, of the Maghreb medical production referenced on the Scimago platform, from 1996 to 2020. The bibliometric extracts were based on the number of published "documents" and the index H: number of articles (h) from a country having received at least h citations. The benchmarking of the productivity and medical visibility of the five Maghreb countries (Tunisia, Morocco, Algeria, Libya, Mauritania) was carried out at the global (237 countries), African (59 countries) and Arab (21 countries) level. RESULTS: Following the first African countries producing the most medical documents (South Africa, Egypt and Nigeria), the position of the Maghreb countries varied from 4 in Tunisia to 36 in Mauritania. In Arab countries, the position of medical production, dominated by Egypt and Saudi Arabia, was 12 and 18, successively in Algeria and Libya. The evolution of medical documents recorded a cross between Tunisia and Morocco in 2014, followed by a deceleration in Moroccan production. In the Maghreb, the h index varied from 154 in Tunisia to 29 in Mauritania. CONCLUSION: In addition to its weak position in the world, African and Arab rankings over the past 25 years, Maghreb medical research has been characterized by a major fluctuation. The "Alliance for Excellence" charter of the PRP2S Network, based on the promotion of university essays and electronic journals, constitutes an operational roadmap for the development of the production and visibility of research in the Maghreb.

[Imatinib in the treatment of chronic myeloid leukemia in Morocco]. / Imatinib dans le traitement de la leucémie myéloide chronique au Maroc.

INTRODUCTION: The treatment of chronic myeloid leukemia (CML) has been revolutionized by the advent of tyrosine kinase inhibitors. The results of the IRIS trial demonstrated the efficacy and long-term safety profile of Imatinib. The objective of our work is to report the results at 15 years of treatment of CML in chronic phase with Imatinib in Morocco. PATIENTS AND METHODS: Retrospective study realized at the hematology unit of CHU d'Ibn-Rochd in Casablanca, from January 2003 to September 2018, including all CML patients in the chronic phase at diagnosis, were treated with Imatinib for a minimum duration of 6 months. RESULTS: In total, 318 patients were collected, the median age was 41.5 years, the sex ratio M/F was 0.7, the Sokal score was high in 56% of cases. The complete hematological response at 3 months was 92%, the complete cytogenetic response at 12 months and the cumulative response were obtained in 43% (29/67) and 55% (153/279) of the cases respectively, the molecular response was evaluated in 125 patients witch 85% were on major molecular response. On a median follow-up of 44 months, the OS and EFS at 10 years were 86% and 59%, respectively. DISCUSSION: Our profile is characterized by a young age of the patients, the female predominance and a high Sokal score. The rate of complete cytogenetic response remains lower compared to what is described, however the survival rates as well as the tolerance were similar to those of the literature.

Metro-SMHOP 01: Metronomics combination with cyclophosphamide-etoposide and valproic acid for refractory and relapsing pediatric malignancies.

BACKGROUND: In low- and middle-income countries, therapeutic options for advanced, refractory, or relapsing malignancies are limited due to local constraints such as cost of drugs, distance from oncology centers, and lack of availability of new anticancer drugs. Metronomics, which combines metronomic chemotherapy (MC) and drug repositioning, allows for the provision of new therapeutic options for patients in this setting. AIM OF THE STUDY: To evaluate the activity and toxicity of a metronomic regimen in Moroccan pediatric patients with refractory or relapsing malignancies. PATIENTS AND METHODS: From July 2014 to January 2018, patients with refractory/relapsing solid tumors treated in five pediatric oncology centers were consecutively enrolled. The metronomic regimen consisted of 28-day cycles with daily oral administration of cyclophosphamide (30 mg/m2 ) from days 1 to 21, together with oral etoposide (25 mg/m2 ) from days 1 to 21 followed by break of one week and daily valproic acid (20 mg/kg) from days 1 to 28. RESULTS: Ninety-eight children (median age, 8 years) were included. Underlying malignancies were neuroblastoma (24 patients), Ewing sarcoma (18), osteosarcoma (14), rhabdomyosarcoma (14), and miscellaneous tumors (28). A total of 557 cycles were given (median: 6; range, 1-18 cycles). One-year progression-free survival of our patients was 19%, and one-year overall survival was 22%. Complete response was obtained in three cases (3%), partial response in 11 cases (11%), and tumor stabilization for more than six months in 28 cases (28%). CONCLUSION: This three-drug metronomic combination was well tolerated and associated with tumor response and disease stabilization in 42 patients even for a long period.

Counter-COVID- 19 pandemic strategy in the Maghreb Central. Qualitative study of the perceptions of health professionals.

CONTEXT: The Maghreb Central, like all the countries of the world, was strongly mobilized (governments, ministries of health, population, civil society) in the response against COVID-19, immediately after the registration of the first cases on its territory (end of February, beginning of March) and according to pre-established control strategies. OBJECTIVES: Describe the perceptions of health professionals in the Central Maghreb (Tunisia, Algeria and Morocco) as to the Strengths/Opportunities and Weaknesses/Threats of the national response plans against COVID-19, during the first weeks of their execution, and report their proposals for optimizing the performance of control strategies. METHODS: This is a qualitative study of the perceptions of health professionals in the Maghreb Central regarding their experience of the first six weeks of fighting the COVID-19 pandemic. The data was collected using the "Delphi" technique in one turn, based on an electronic form such as "Google Form", developed according to SWOT analysis. The respondents' verbatim was grouped into homogeneous groups of items, the occurrence of which was subsequently measured. RESULTS: A total of 382 health professionals from the Maghreb Central participated in this study, with a median age of 37 years and a median professional tenure of 10 years. The major force of the Maghreb response strategies, the most shared by the respondents, was the performance of the human resources mobilized (doctors, biologists, nurses, etc.) who succeeded in quickly learning from the international epidemiological expertise accumulated in Asia and in Europe. The fight against COVID-19 in the Central Maghreb was confronted with the general and chronic fragility of the national health systems and the low support of the general population for the recommendations of the steering committees of response, threatening the capacity of the Maghreb to confront new epidemics. CONCLUSION: The success of the national response plans against COVID-19 and of possible epidemics or pandemics in the Central Maghreb, is strongly attributed to the commitment of health professionals and to community participation, necessitating the launch of assistant motivation programs. and development of health personnel and mobilization and loyalty of civil society.

Special report: Summary of the first meeting of African Blood and Marrow Transplantation (AfBMT) group, Casablanca, Morocco, April 19-21, 2018 held under the auspices of the Worldwide Network for Blood and Marrow Transplantation (WBMT).

The first meeting of the African Blood and Marrow Transplantation (AfBMT) was held in Casablanca from April 19, 2018 to April 21, 2018, with the aim of fostering hematopoietic stem cell transplantation (HSCT) activity in Africa. Out of the 54 African countries, HSCT is available only in six (Algeria, Egypt, Morocco, Nigeria, South Africa, and Tunisia). During this meeting, African teams and international experts from the Worldwide Network for Blood and Marrow Transplantation (WBMT) gathered to share their experience and discussed ways to help fill the gap. Nurses and patients held their meeting in parallel. International support and collaboration can help by providing expertise adapted to local resources and regional population needs. Local engagement including government and private participants are necessary to initiate and develop local HSCT capability.

[Management of CAR-T cell-related encephalopathy syndrome in adult and pediatric patients: Recommendations of the French Society of Bone Marrow transplantation and cellular Therapy (SFGM-TC)]. / Prise en charge pratique d'une encéphalopathie liée au traitement par cellules CAR-T chez l'adulte et l'enfant : recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC).

CAR-T cell-related encephalopathy syndrome (CRES) reflects the potential neurotoxicity of this therapeutic approach and must be considered in the presence of any neurological symptom after the infusion of the CAR-T. This is the second most common adverse event under this therapy and its incidence varies between 12 and 55%. The median time of the onset of the first neurologic symptoms is 4days after CAR-T infusion. The duration of CRES symptoms is generally between 2 and 4days, but late CRES may occur. Monitoring and diagnosis of CERS includes clinical exam, magnetic resonance imaging and electroencephalography. In addition to symptomatic treatments, corticosteroids represent the cornerstone of the high-grade CERS treatment. Drugs targeting IL-6 should be restricted to severe forms, especially those associated with cytokine release syndrome. The purpose of this workshop is to provide practical help in dealing with this complication.

Radiation therapy in mycosis fungoid patient.

Mycosis fungoid (MF) is a non-Hodgkin's T-cell lymphoma determined by primary cutaneous involvement. It is a slow-progressing chronic indolent disease characterized by atypical T-cells with a cerebral nucleus. Management of this disease depends on the stage and is based essentially on the systemic treatment. Radiotherapy intervenes in case of localized or extended tumor, indeed, the radiosensibility of this tumor, like any other hematological affection, makes it possible to obtain a high rate of response. Clinical case: we report the observation of a 46-year-old patient followed since 2012 for mycosis fungoid revealed by a papullo-squamous lesion located at the level of the right lumbar fossa. The diagnosis was confirmed by cutaneous biopsy, showing the presence of T lymphocytes expressing CD2, CD3, CD4, CCR4, CD45RO markers. Initial assessment included a thoraco-abdominal pelvic CT, which was normal, an accelerated sedimentation rate at the 1st hour, a high C reactive protein (CRP), the electrolytic, renal, hepatic status and the hemogram were normal. Patient received 6 courses of chemotherapy according to the COPP protocol with a decrease in the size of the lesion estimated at 40%. A norm fractionated radiation therapy was delivered at the dose of 36Gy. The evolution was marked by a complete remission, maintained after 6 months of the treatment. Mycosis fungoid is a rare disease, whose management must be discussed in a multidisciplinary team. Radiotherapy remains an interesting option for all stages, but has to be validated in largest studies.

Cytogenetic profile of a representative cohort of young adults with de novo acute myéloblastic leukaemia in Morocco.

BACKGROUND: We analyzed the cytogenetic characteristics of a representative population of young adults with de novo acute myéloblastic leukemia (AML) treated in a single center institution. METHODS: Patients with de novo AML included were aged between 20 and 60 years. Cytogenetic analysis was done at diagnosis. Twenty cells were analyzed, although examination of lower numbers of metaphases was also acceptable if an abnormal clone was detected. FINDINGS: From 1/1/04 to 31/12/2014, among 1315 adult patients, 1055 (80%) patients were aged between 20 and 60 years. Karyotype was done in 927 (88%) patients and cytogenetic analysis failed in 32 cases (3·4%). Clonal abnormalities were observed in 520 (58%) patients. 175 (19·5%) were classified in the favorable group, 609 were in the intermediate group and 111 (12·5%) were in the adverse group. The most frequent chromosomal abnormality observed was t(8;21) in 112 (12·5%). Thirty three (3·7%) patients had t(15;17) and 30 (3·3%) had inv16, trisomy 8 was found in 47 (5·2%), 11q23 rearrangements in 32 (3·6%), 67 (7·4%) had a complex karyotype, -5/del(5q) and -7/del(7q) were seen in, respectively, 11(1%) and 27 (3%). Monosomy occurred in 115 (13%) patients, 70 (8%) responded to the definition of monosomal karyotypes. INTERPRETATION: This is the largest study done in Morocco, Africa and Middle East. Epidemiological studies involving different ethnic populations and geographic regions of the world should help unfold the true nature of environmental and genetic interplay in the development of AML. Our cytogenetic profile reveals some particularities when compared to other populations; it does not seem to be similar neither to eastern or western countries.

[Management of cytokine release syndrome in adult and pediatric patients undergoing CAR-T cell therapy for hematological malignancies: Recommendation of the French Society of Bone Marrow and cellular Therapy (SFGM-TC)]. / Prise en charge pratique du syndrome de relargage des cytokines (CRS) post-CAR-T cells chez l'adulte et l'enfant : recommandation de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC).

The cytokine release syndrome (CRS) is the most common complication after adoptive immunotherapies such as chimeric antigen receptor T cells (CAR-T). The incidence varies from 30 to 100% depending on the CAR-T construct, cell doses and the underlying disease. Severe cases may involve 10 to 30% of patients. The triggering event is the activation of the CAR-T, after meeting with their target. The T cell activation leads to the release of effector cytokines, such as IFNγ, TNFα and IL2, that are responsible for the activating of monocyte/macrophage system, resulting in the production of pro-inflammatory cytokines, (including IL6, IFN-γ, IL10, MCP1) and associated with a significant elevation of CRP and ferritin. The CRS usually appears between 1 and 14days after the infusion of the cells and can last from 1 to 10days. Rare fatal cases have been reported in the literature. The first symptom is often a fever, sometimes very high, which must alert and reinforce the surveillance. In moderate forms, one can find fatigue, headache, rash, arthralgia and myalgia. T cell-related encephalopathy (CRES) syndrome may occur concomitantly. In case of aggravation, a vasoplegic shock associating capillary leakage and respiratory distress can occur. Close clinical monitoring is essential right from the injection to quickly detect the first symptoms. The treatment of severe forms, in addition to symptomatic management involves monoclonal antibodies targeting the IL6 or IL6 receptor, and sometimes steroids. Close cooperation with intensive care units is essential since 20 to 50% of patients require intensive care unit transfer.

Acute Myeloid Leukemia (AML) In Elderly: Cytogenetic Characteristics of Patients Treated At Hematology and Pediatric Oncology Center in Casablanca.

AIM: The goals of this paper are: to report the incidence of AML in elderly, to describe cytogenetic characteristics of this population, to observe rare and novel cytogenetic abnormalities and lastly, to compare our finding with that previously reported in the literature. METHODS: We conducted a retrospective analysis of 283 patients with acute myeloid leukaemia (AML) treated in our unit, we will report the incidence of AML in elderly, describe cytogenetic characteristics of this population, observe rare and novel cytogenetic abnormalities and compare our finding with that previously reported in the literature. RESULTS: Among the 283 patients, 157 (54.4%) patients performed the karyotype, the cytogenetic analysis failed in 17 cases (11%). Prognostic group distribution was found to be favorable in 8 patients (6%) with 6 cases of t (8; 21) and 2 cases of inv (16), intermediate group in 94 patients (67%), including 58 cases (41,5%) with a normal karyotype, and an unfavorable group in 38 patients (27%) including complex karyotype (15%), -5 or del 5q (3%), -7 or del 7q (3.5%), t (9; 22) (2%). Some rare anomalies were observed. CONCLUSION: However, the occurrence of a complex karyotype was more frequent than younger patients. In our unit, elderly benefit from supportive care, our study shows that it is a heterogeneous group and our treatment approach have to change especially for the patient from favourable risk group who can benefit from intensive chemotherapy. We have to improve our diagnosis with including molecular genetics that provides a documented substrate for a thoughtfully considered treatment plan.

Secondary Thymoma among Adult Treated For Acute Lymphoblastic Lymphoma/Leukemia: Report of a Case and Review of the Literature.

BACKGROUND: Concomitant thymoma and T- lymphoblastic/leukaemia lymphoma is possible. Secondary thymoma after treatment for T-lymphoblastic/leukaemia lymphoma was also occasionally reported, although this is quite rare. CASE REPORT: We report a case of 44-year-old women with secondary thymoma after chemotherapy treatment for T Acute Lymphoblastic leukaemia/lymphoma. Diagnosis of lymphoblastic/leukaemia lymphoma was made in 2015 by morphological and histological study. The patient underwent Moroccan protocol for acute lymphoblastic leukaemia (MARALL) from 2015 to 2017 and achieved complete remission. One year later, the patient developed an anterior mediastinal mass, relapse was suspected, but the surgical biopsy was performed and histological, the mass showed thymoma. CONCLUSION: At the time of diagnosis of thymoma for a patient treated for T-lymphoblastic/leukaemia lymphoma it is necessary to eliminate a relapse because the distinction between thymoma and T-lymphoblastic/leukaemia lymphoma is sometimes difficult, and the association is possible.

[Primary colonic extranasal NK/T-cell lymphoma: about a case]. / Lymphome T/NK extra-nasal à localisation colique primitif: à propos d'un cas.

To better understand this cancer, we here report the case of a 43-year old patient diagnosed with localized and isolated primary colonic NK/T-cell lymphoma without associated enteropathy, treated wih 3 cycles of AspaMetDex with a poor response who died during treatment with a clinical picture of acute abdomen. Primary intestinal NK/T-cell lymphoma most commonly affects the young subject with poor prognosis. It is difficult to distinguish between intestinal NK/T-cell lymphoma and inflammatory or infectious intestinal disorders because of its non-specific clinical and endoscopic features. The histopathological and immunohistochemical data as well as the study of DNA allow to adjust the diagnosis and to classify this lymphoma according the European Enteropathy type T-cell lymphoma (ETL).

[Primary hodgkin lymphoma of thyroid: case report]. / Lymphome de hodgkin primitif de la thyroïde: à propos d'un cas.

Primary thyroid lymphoma is a rare clinical entity, which does not exceed 5% of the diagnosed lymphomas, occur more frequently in women than in men, with a peak incidence in the sixth decade of life. The relationship with chronic thyroiditis is well known. The Hodgkin subtype even rarer; little described in the literature; Posing a diagnostic problem. Diagnostic confirmation is usually carried out on the surgical specimen. To better understand this entity, we report the case of a 64-year-old patient, with no notion of chronic thyroiditis, admitted for Hodgkin's lymphoma of the thyroid, diagnosed on an anterior cervical mass. Thyroidectomy with histopathological and immunohistochemical studies confirmed the diagnosis. The patient had received chemotherapy type ABVD (Adriblastin-Bleomycin-Vinblastine-Dacarbazine) and programmed for radiotherapy.