[Interferons and hematology]. / Interféron et hématologie.

BACKGROUND: IFN alpha are cytokines used for a number of years in the treatment of certain hemopathies, i.e. of a myeloid and lymphoid etiology. IFN alpha are a family of polypeptides produced by eukaryote cells in response to various stimulant agents. The first trials using this cytokine in humans were carried out by H. Strander in the years 1965-1970. IFN alpha contain anti-viral, anti-proliferative and immunomodulatory properties. The access of clinicians to IFN alpha molecules, in addition to elements produced by genetic engineering for approximately the past 20 years, has permitted a number of therapeutic trials to be carried out. In hematology the clinical interest of IFN alpha was primarily in chronic myeloid and lymphoid proliferating syndromes. Certain indications have to date been well demonstrated. However, the impact of IFN alpha on therapeutic care of certain hemopathies as compared to conventional treatment remains controversial. At the same time, the frequency of side effects from treatment with IFN alpha and its cost should be taken into consideration. CURRENT POSITION AND MAJOR POINTS: The therapeutic trials carried out over the past ten years have proven the interest of IFN alpha in, essentially, two diseases: on one hand chronic myeloid leukemia with the acquisition of cytogenetic remission and on the other malignant non-Hodgkin's follicular type lymphoma. However, as regards other hemopathies the place of IFN alpha remains debatable. PERSPECTIVES: The future of IFN alpha use in the treatment of hemopathies appears to be linked to its association with new treatments, an association, however, where its efficacy and superiority should be demonstrated. This is the case in chronic myeloid leukemia where IFN alpha could be associated with aracytine or the inhibitors of tyrosine kinase. Also, in the treatment of malignant non-Hodgkin's lymphomas as well as the studies concerning the association between IFN alpha and monoclonal antibodies, in particular antibody anti-CD 20.

[Treatment of high-grade, disseminated non-Hodgkin's lymphoma in elderly patients]. / Traitement du lymphome malin non hodgkinien de haut grade et de stade disséminé du sujet âgé.

PURPOSE: Treatment of non-Hodgkin's lymphoma (NHL) in the elderly is difficult because of an increased risk of toxicity and frequent chronic or debilitating diseases. The aim of this paper is to describe the main studies in this field. CURRENT KNOWLEDGE AND KEY POINTS: Most recent clinical trials deal with anthracyclin or assimilated drugs regimens. Potential interest of chemotherapy and associated immunotherapy is on study. Without any influence on survival duration, haematopoietic growth factors seem to improve the tolerance of the treatment. FUTURE PROSPECTS AND PROJECTS: For elderly patients with good performance status and without severe co morbidity, curative strategy with anthracyclin-containing regimen like CHOP is still the standard chemotherapy. Association with rituximab improves the prognosis. For patients with poor performance status and/or associated disease, optimal strategy remains to be defined with quality of life evaluation.

Interferon-alpha: mechanisms of action in chronic myelogenous leukemia in chronic phase.

Interferon-alpha has been shown to induce complete haematologic responses in chronic myelogenous leukemia patients and also cytogenetic responses. There is a clear correlation between cytogenetic responses and survival improvement. There is not a unique mechanism of action of IFN-alpha. IFN-alpha acts directly against leukemic cells and there are also other mechanisms of action such as immune stimulation, gene regulation and growth factors or interleukin stimulation.