Non-cryopreserved peripheral blood stem cells autologous transplantation in multiple myeloma: Bicentric study.

OBJECTIVES: The objective of this study is to evaluate the toxicity of autologous transplantation of non-frozen peripheral blood stem cells in Moroccan patients with multiple myeloma. MATERIAL AND METHODS: This was a bicentric retrospective study conducted in the Clinical Haematology Department of Mohammed V Military Teaching Hospital and at the Al Madina Clinic in Casablanca. The study period was from January 2015 to June 2019. All patients with multiple myeloma who had undergone an autologous peripheral stem cell transplant without freezing were included. Mobilisation was performed with lenograstim alone and the collected stem cells were stored for 24-48hours in a blood bank refrigerator at a temperature of 4°C. After standard conditioning with high-dose melphalan, the peripheral blood stem cells were reinjected 24 h following conditioning. RESULTS: Over the study period, 55 patients received an autologous transplant using non-frozen peripheral blood stem cells. The median richness of the CD34 cells collected was 4.5×106 CD34/kg (range: 2-12.2). The time required for neutrophil recovery was 12 days (range: 7-19). The time required for platelet recovery was 14 days (range: 9-32). The mortality rate within 100 days post-transplant was 3.6%. We did not observe any cases of graft failure. CONCLUSION: Our study finds good feasibility and low toxicity of autologous peripheral stem cell transplantation without freezing in patients with multiple myeloma.

[Thrombo-haemorrhagic disease-related hypoprothrombinemia-lupus anticoagulant syndrome revealing a light chains multiple myeloma]. / Un tableau thrombo-hémorragique en rapport avec un syndrome hypoprothrombinémie ­ anticoagulant lupique révélant un myélome multiple à chaînes légères.

Thrombosis and hemorrhage are two opposing manifestations of multiple myeloma. These hemostatic disorders are present in less than 12% of patients at diagnosis and involve various pathophysiological mechanisms. We report the case of a 39-year-old patient with multiple myeloma revealed by the association of a hemorrhagic syndrome and deep vein thrombosis related to a hypoprothrombinemia-anticoagulant lupus syndrome.

[Pyoderma gangrenosum following hematopoietic stem cell transplantation]. / Pyoderma gangrenosum après allogreffe de cellules souches hématopoïétiques.

BACKGROUND: Pyoderma gangrenosum (PG) is a rare form of neutrophilic dermatosis and is a potential complication in a number of systemic diseases. These include blood diseases, which represent 3.5% of cases, with the main forms being monoclonal gammopathy and acute myeloid leukemia. PATIENTS AND METHODS: Herein we report a case of pyoderma gangrenosum in a female patient who had undergone haematopoietic stem cell allograft six months earlier as part of her treatment for acute T-cell leukemia. DISCUSSION: This condition forms one of the general disorders potentially associated with PG and is a dermatological disorder that can occur in marrow graft patients.

[Orbital mantle cell lymphoma]. / Lymphome du manteau orbitaire.

Ophthalmological involvement in mantle cell lymphoma is rare. An 84-year-old man presented with bilateral proptosis. Orbital biopsy established the diagnosis of mantle cell lymphoma. The diagnosis of mantle cell lymphoma is anatomopathological and immuno-histochemical. Orbital involvement is found most often in advanced stages of the disease, but may be the presenting sign as in the case of our patient. Treatment has improved with the use of rituximab, especially in elderly patients not eligible for autologous hematopoietic stem cell transplant.

Thrombotic microangiopathy with skin localization secondary to cytarabine-daunorubicin association: report of a case.

The thrombotic microangiopathy is a syndrome characterized by the combination of mechanical hemolytic anemia, peripheral thrombocytopenia, and organ failure of variable severity. In addition to the idiopathic form, several cases are identified as secondary to pregnancy, infections, disease systems, organ transplants, and cancer. Other forms are secondary to drugs including antimitotics. We report the case of a patient followed for acute myelogenous leukemia. She received induction chemotherapy combining daunorubicin and cytarabine, complicated by thrombotic thrombocytopenic purpura.

Bing and neel syndrome.

Introduction. We report the case of a Bing and Neel syndrome revealed by an isolated left ptosis. Case Report. a 57-year-old man was followed up since October 2003 for a typical Waldenström's macroglobulinemia. A first complete remission was obtained with chlorambucil. In August 2004, he relapsed. A second complete remission was obtained with RFC chemotherapy regimen (rituximab, fludarabine, and cyclophosphamide). In October 2009, the patient presented with an isolated left ptosis revealing a Bing and Neel syndrome. The diagnosis was suspected on MRI and confirmed by the detection in the CSF of a monoclonal IgM similar to the one found in the plasma. A quite good partial remission has been obtained after one course of RDHAP (rituximab, dexamethasone, cytarabine, and cisplatin) and 3 courses of RDHOx (rituximab, dexamethasone, cytarabine, and oxaliplatin), in addition to ten intrahectal chemotherapy injections. The treatment was followed by intensification and autologous stem cell transplantation. At D58, the patient died due to a septic shock. Conclusion. BNS is a rare and potentially treatable complication of WM. It should be considered in patients with neurologic symptoms and a history of WM.

Monoclonal gammopathies in a Moroccan military hospital.

The aim of this study was to describe biological features and aetiology of monoclonal gammopathy diagnosed during a 10-year period in the biochemistry department of the Moroccan Military Hospital Mohamed V in Rabat. The study was performed from 1 January 2000 to 31 December 2009. The records of 261 patients living in the Rabat area in which either serum protein electrophoresis and serum and/or urine immunofixation were performed at the biochemistry department of Military Instruction Hospital in Rabat were analysed. A cohort of 182 (70%) men and 79 (30%) women, the mean ± SD (range) ages were 60.21 ± 12.56 years. All patients were Caucasian. Electrophoresis found that 211 (80.84%) of the patients had a monoclonal gammopathy. Immunofixation confirmed that 251 (96.17%) patients had a monoclonal band in serum. In our cohort, MM was the most frequent diagnosis, our patients were late diagnosed.

[Blood isolates epidemiology in a clinical haematology department]. / Epidémiologie des isolats d'hémocultures: expérience d'un service d'hématologie clinique.

Cancer chemotherapy is responsible for infections by decreasing the phagocytosis and chemotaxis of polymorphonuclear. We conducted a retrospective analysis during the period from 18/10/2006 to 21/05/2008, on all bacteria isolated from blood cultures performed in the department of clinical hematology at the hospital military instruction Mohamed V. One hundred and sixty two blood isolates were selected; Gram positive cocci (CGP) accounted for 60.34% and Gram negative bacilli (GNB) for 24.14%. Coagulase negative staphylococci (SNA) and S. aureus presented a resistance to methicilline respectively 54.55% and 22.22%. Prevalence of Gram positive cocci is consistent with the results of the EORTC (International Antimicrobial Therapy Cooperative Group). Analysis of resistance patterns of all species, except for staphylococci, showed phenotypes essentially community, sometimes wild. In conclusion probabilistic antibiotic treatement of bacteraemia in the haematology department should focus among other staphylococci resistant to methicilline.

[Cutaneous blastomycosis revealing intravascular B-cell lymphoma: a case in Morocco]. / Blastomycose cutanée révélant un lymphome B intravasculaire: une observation marocaine.

Blastomycosis is a systemic fungal infection caused by a thermally dimorphic fungus, Blastomyces dermatitidis. The incidence in immunocompromised patients has increased in the last two decades. A 55-year-old man consulted for inflammatory nodules on the forearm. Biopsy of one nodules showed a pseudoepitheliomatous hyperplastic epidermis overlaying a dense agranulomatous inflammatory infiltrate containing free-formed ovoid bodies enclosing giant macrophageous cells. These findings were consistent with blastomycosis. After a month of treatment cutaneous lesions regressed partially but the patient's general status continued to deteriorate with the appearance of an edematous-ascitic syndrome and icterus. Laboratory blood testing demonstrated cholestasia and abdominal ultrasound showed hepatosplenomegaly. Needle liver biopsy revealed giant B-cell lymphomatous infiltration of the hepatic ducts. The patient's condition worsened rapidly and he died five months after diagnosis despite four rounds of chemotherapy. Blastomycosis is rare in Morocco. Primary infection is usually a pneumonic process. Isolated cutaneous infection is possible but uncommon. To our knowledge the association of blastomycosis and intravascular lymphoma has not been previously reported. In immunocompromised patients, clinical findings can be alarming and the outcome can be rapidly fatal.

[Non-secreting myeloma associated with nephrotic syndrome]. / Myélome non excrétant révélé par un syndrome néphrotique.

The non-secreting myeloma is a rare form of myeloma. Its association with a nephrotic syndrome is exceptional. The observation which we report below described the history of a 66 years old patient who presents a non-secreting myeloma revealed by a nephrotic syndrome. Various assumptions on the mechanism of no excretion were put forth. Nevertheless, several points are to be elucidated as for the pathogenesis of the association non-secreting myeloma and nephrotic syndrome.

[Hepatosplenic and kidneys candidasis complicating an acute myeloblastic leukemia. A case treated with voriconazole and caspofungin]. / Candidose hépato-spléno-rénale compliquant une leucémie aiguë myéloblastique. A propos d'un cas traité par l'association voriconazole et caspofungine.

We report the observation of hepato-splenic and kidneys candidiasis complicating the chemotherapy of a myeloblastic leukemia (LAM5b). Following the lack of effectiveness of a first line treatement, using amphotericine B liposomale and 5-fluorocytosine, implementation of an association of new molecules, a triazole of second generation (voriconazole) and an echinocandine (caspofungine) has allowed a successful result.

[Hodgkin's disease with bone marrow involvement. The role of positron tomography]. / Maladie de Hodgkin avec atteinte médullaire. Intérêt de la tomodensitométrie par émissions de positons.

INTRODUCTION: Hodgkin's disease with initially predominant bone marrow involvement is observed in 1% of cases. OBSERVATION: A case of Hodgkin's disease with massive bone marrow invasion, manifested by pancytopenia in the context of fever and alteration in general status of health, with little or non superficial peripheral lymph nodes. The bone marrow biopsy revealed extensive myelofibrosis with rare Reed-Sternberg cells. DISCUSSION: This case report is inscribed within the framework of the exceptional massive bone marrow forms of Hodgkin's disease, described by Duhamel et al. in 1979. We believe that metabolic imaging with 18F-FDG positron emission tomography (PET) is a valid examination in orienting diagnosis and post-therapy assessment.

[A 7-year survey of strains identified in blood cultures in a clinical hematology unit]. / Etude sur sept ans des isolats d'hémocultures dans un service d'hématologie clinique.

GOAL: This study had for aim to analyze the epidemiology of strains identified in blood cultures (hôpital d'instruction des armées Percy, Clamart, France, hematology unit) to compare the rate of identified micro-organisms with literature data, and to search for a possible correlation between antibiotherapy management and evolution of resistance profiles. MATERIAL AND METHODS: All the micro-organisms (N = 690) collected over seven years (January 1996 to December 2002), from blood cultures of hospitalized patients in conventional and sterile sector were studied. RESULTS: Gram positive cocci rate (GPC) was 62.6% and Gram negative bacilli (GNB) 31.3%. Evolution in time showed a decrease of GPC and an increase of GNB, notably the non fermenting Gram negative bacilli, leading to an equal rate by 2001-2002. The most frequently identified species were Staphylococcus epidermidis (36.4%), Escherichia coli (8.7%), Pseudomonas aeruginosa (6.8%), and Staphylococcus aureus (4.9%). The rate of methicillin-resistant staphylococci was 63.6%. Fifty-five percent of E. coli strains had a penicillinase phenotype. Pseudomonas aeruginosa resistance was 8.5, 8.5, 6.4 and 8.5%, respectively for ceftazidime, piperacillin-tazobactam, imipenem, and amikacin. CONCLUSION: This study showed a tendency to inversion of former bacteremia epidemiology with increasing negative Gram bacilli. It justifies the antibiotherapy protocols adopted in the hematology unit.