Effects of azacitidine in 93 patients with IDH1/2 mutated acute myeloid leukemia/myelodysplastic syndromes: a French retrospective multicenter study

Isocitrate dehydrogenase 1 (IDH1) and 2 (IDH2) mutations in Myeloid Neoplams (MNs) exhibit DNA hypermethylation via 2-hydroxyglutarate (2HG) over-production. Clinical impact of azacitidine (AZA) remains inconsistent in IDH1/2-mutated MNs and the potential of serum 2HG as a suitable marker of response to AZA is unknown. To address these questions, we retrospectively analyzed 93 MNs patients (78 AML, 11 MDS, 4 CMML) with IDH1/2 mutations treated with AZA. After a median of 5 cycles of AZA, overall response rate was 28% (including 15% complete remission) and median OS was 12.3 months (significantly shorter in AML compared to MDS/CMML patients). In multivariate analysis of AML patients, DNMT3A mutation was associated with shorter OS while IDH1/2 mutation subtypes had no independent impact. No difference was observed in serum 2HG levels upon AZA treatment between responding and refractory patients suggesting that serum 2HG cannot be used as a surrogate marker of AZA response.

Geographic disparities in bladder cancer incidence among women in the department of Bouches-du-Rhône

Key messages

We identify for the first time a cluster of bladder cancers in women in France. Practitioners need to think about bladder cancers in women with urinary signs because this cancer will become a public health issue in the future.

Geographic disparities in bladder cancer incidence among men in the department of Bouches-du-Rhône

Key messages

Geographic disparities exist in bladder cancer incidence among men at a commune level in the department of Bouches-du-Rhône. Spatial analysis show excess of risk of bladder cancer in the south-east of the department including the urban area of Marseille.

Implications of estimating road traffic serious injuries from hospital data

To determine accurately the number of serious injuries at EU level and to compare serious injury rates between different countries it is essential to use a common definition. In January 2013, the High Level Group on Road Safety established the definition of serious injuries as patients with an injury level of MAIS3+(Maximum Abbreviated Injury Scale). Whatever the method used for estimating the number or serious injuries, at some point it is always necessary to use hospital records. The aim of this paper is to understand the implications for (1) in/exclusion criteria applied to case selection and (2) a methodological approach for converting ICD (International Classification of Diseases/Injuries) to MAIS codes, when estimating the number of road traffic serious injuries from hospital data. A descriptive analysis with hospital data from Spain and the Netherlands was carried out to examine the effect of certain choices concerning in- and exclusion criteria based on codes of the ICD9-CM and ICD10. The main parameters explored were: deaths before and after 30 days, readmissions, and external injury causes. Additionally, an analysis was done to explore the impact of using different conversion tools to derive MAIS3 + using data from Austria, Belgium, France, Germany, Netherlands, and Spain. Recommendations are given regarding the in/exclusion criteria and when there is incomplete data to ascertain a road injury, weighting factors could be used to correct data deviations and make more real estimations.

Radioimmunotherapy ((90) Y-Ibritumomab Tiuxetan) for Posttransplant Lymphoproliferative Disorders After Prior Exposure to Rituximab

Posttransplantation lymphoproliferative disorders (PTLDs) are life-threatening complications after solid organ and hematopoietic stem cell transplantation. Only half of CD20-positive PTLDs respond to rituximab monotherapy, and outcomes remain poor for patients with relapsed/refractory disease, especially those who do not qualify for an anthracycline containing regimen due to frailty or comorbidities. Radioimmunotherapy (RIT) might be an option in this particular setting. We report a panel of eight patients with rituximab refractory/relapsed CD20-positive PTLDs including three ineligible for subsequent CHOP-like chemotherapy who received (90) Y-Ibritumomab tiuxetan as a single agent (n = 7) or combined to chemotherapy (n = 1). Five out of eight patients were kidney transplant recipients, while 2/8 had a liver transplant and 1/8 had a heart transplant. Patients received a median of two previous therapies. Overall response rate was 62.5%. Importantly, all responders achieved complete response. At a median follow-up of 37 months [5; 84], complete response was ongoing in four patients. Toxicity was predominantly hematological and easily manageable. No graft rejection was noticed concomitantly or following RIT administration despite immunosuppression reduction after diagnosis of PTLDs. This report emphasizes the potential efficiency of salvage RIT for early rituximab refractory PTLDs without any unexpected toxicity.

Short-term associations between fine and coarse particles and hospital admissions for cardiorespiratory diseases in six French cities

OBJECTIVES

Little is known about the potential health effects of the coarse fraction of ambient particles. The aim of this study is to estimate the links between fine (PM(2.5)) and coarse particle (PM(2.5-10)) levels and cardiorespiratory hospitalisations in six French cities during 2000-2003.

METHODS

Data on the daily numbers of hospitalisations for respiratory, cardiovascular, cardiac and ischaemic heart diseases were collected. Associations between exposure indicators and hospitalisations were estimated in each city using a Poisson regression model, controlling for confounding factors (seasons, days of the week, holidays, influenza epidemics, pollen counts, temperature) and temporal trends. City-specific findings were combined to obtain excess relative risks (ERRs) associated with a 10 mug/m(3) increase in PM(2.5) and PM(2.5-10 )levels.

RESULTS

We found positive associations between indicators of particulate pollution and hospitalisations for respiratory infection, with an ERR of 4.4% (95% CI 0.9 to 8.0) for PM(2.5-10 )and 2.5% (95% CI 0.1 to 4.8) for PM(2.5). Concerning respiratory diseases, no association was observed with PM(2.5), whereas positive trends were found with PM(2.5-10), with a significant association for the 0-14-year-old age group (ERR 6.2%, 95% CI 0.4 to 12.3). Concerning cardiovascular diseases, positive associations were observed between PM(2.5) levels and each indicator, although some did not reach significance; trends with PM(2.5-10 )were weaker and non-significant except for ischaemic heart disease in the elderly (ERR 6.4%, 95% CI 1.6 to 11.4).

CONCLUSIONS

In accordance with other studies, our results indicate that the coarse fraction may have a stronger effect than the fine fraction on some morbidity endpoints, especially respiratory diseases.

[Trends in hospital admissions for asthma in France, 1998-2002]

BACKGROUND

As the quality of asthma care influences hospital admission rates, we described hospitalizations for asthma and studied trends in admission rates in France from 1998 to 2002.

METHODS

Using data from the French hospital information system, admissions for asthma were defined by the J45 or J46 codes (ICD-10) as primary diagnosis, and admissions for acute respiratory failure (ARF) associated with asthma by the J96.0 code as primary diagnosis and the J45 or J46 codes as an associated diagnosis. Annual rates of admission adjusted for age and sex were calculated.

RESULTS

During the study period, the adjusted asthma admission rate decreased by 5% per year (from 10.8/10,000 in 1998 to 8.6/10,000 in 2002). A significant decrease was observed in children aged 10-14 years (-5%/year) and in older people (from -7%/year in 15-19 years old to -9%/year in people aged 50 years or more), whereas no significant decrease was seen in youngest children (-2%/year in children aged 0-1 or 5-9 years, +0.1%/year in those aged 2-4 years). Although not statistically significant, an increase in admission rate for ARF associated with asthma was observed (+5%/year).

CONCLUSION

Admission rates for asthma decreased between 1998 and 2002 in people aged 10 years and older. However, changes in coding practices or admission policies cannot be excluded and the extent to which the observed trends reflect changes in preventive care among patients with asthma remains to be assessed.

Estimation de la mortalité attribuable aux particules (PM10) dans les 9 villes françaises participant au programme européen Apheis

The relationship between air pollution and mortality is now admissible with a sufficiently high level of causality proven. This link allows for health impact assessment to be carried out with a significant degree of accuracy, such as the case for the results which are presented here from the nine French cities involved in the Apheis programme. This health impact assessment is based on the methodology developed by the World Health Organization. The number of avoidable deaths is contained between categories ranging from 2.0 to 4.3, 4.0 to 8.9, and from 15.0 to 31.5 per 100,000 inhabitants according to very short term effects, short term effects and long term effects, respectively. There are two scenarios which can be envisioned for the reduction of fine particles levels which are capable of obtaining similar results for both very short term and short term effects. The first involves diminishing the daily concentrations which are above 20 microg/m3 until they reach this value, and the second entails systematically decreasing the daily levels by 5 microg/m3. The first strategy of reducing values to stabilize at 20 microg/m3 has been shown to be the one most favourable and promising for the long term effects. This strategy therefore confirms the reliability and strength of the recommendation formulated at the national level.

Retentissement de la pollution atmosphérique sur la santé

OBJECTIVES

To quantify the short term effects of air pollution on mortality and hospitalisation for cardiovascular or respiratory disorders in the nine French cities (Bordeaux, Le Havre, Lille, Lyon, Marseille, Paris, Rouen, Strasbourg and Toulouse) of the Surveillance Air et Santé program.

METHODS

Data were available on mortality and hospitalisation were available, respectively, from 1990 to 1997 and 1995 to 1999. Exposure data were the concentrations of sulphur dioxide, particles with a diameter of less than or equal to 10 mm, black smoke, nitrogen dioxide, ozone, and carbon monoxide. The analysis assessed the relationships, in each of the cities, between the daily numbers of deaths and hospitalisations and the daily levels of polluting agents, taking into account confounding factors. A combined relative risk was calculated for all the cities. The number of deaths and hospitalisations attributable to air pollution was then estimated for each of the cities, based on the relative risk.

RESULTS

Significant relationships were found for mortality, from whatever cause, and for hospitalisations for respiratory disorders in children aged under 15. If the levels of air pollution were reduced to 10 microg/m3 in the nine cities, 2800 premature deaths and 750 hospitalisations for respiratory disorders in children would be avoided, every year.

CONCLUSION

Today, it is possible to assess the benefits of reducing air pollution in terms of health in the short term. These analyses would provide a sanitary dimension to the strategies for the reduction of urban pollution on local and European level.

[Short-term relationships between urban atmospheric pollution and respiratory mortality: time series studies]

Time series studies conducted in the field of air pollution aim at testing and quantifying short-term relations which can exist between daily air pollution levels and daily health effects. The method used for this type of survey has sometimes been misunderstood mainly because individual factors and indoor exposure to air pollutants were not taken into account. The adjustment on these individual confounding factors commonly used in classic epidemiologic studies (case-control studies, cohort studies) is not adequate to times series studies which are based on aggregate data. This is different for those factors that change over time according to the levels of air pollution (meteorological conditions, influenza epidemics, trend of health cases) which, when being analysed, must be taken into account either indirectly through time modelling or directly through non-linear modelling processes. During this last decade, numerous studies using the time series method have been published and have found short-term associations between daily levels of air pollution commonly observed and daily respiratory mortality. The consistency of the numerous results published in the international literature are more arguments in favour of non-confounding short-term relations between air pollution and respiratory mortality.

[Surveillance of short-term effects of urban air pollution on mortality. Results of a feasibility study in 9 French cities]

BACKGROUND

This study aims at quantifying air pollution effects on mortality and at evaluating the feasibility of a standardized epidemiological surveillance system of air pollution in 9 French cities.

METHODS

Data collection and analysis followed a standardized protocol. Data pollution depended on the development of local air quality surveillance networks (number of indicators, number of stations.). The Generalised Additive Models (GAM) were used to quantify the association between air pollution and mortality.

RESULTS

In the 9 studied areas, associations between all causes, cardiovascular and respiratory mortality, and air pollution indicators were observed. These associations were linear without threshold. Depending on the pollutants, excess in mortality related to an interquartile increase in acid-particulate pollution varied between 0.3 and 3.5% for total mortality, 0.5 and 6.3% for cardiovascular mortality, and between 0.1 and 12% for respiratory mortality. Photochemical air pollution varied between 0.4 and 7.3% for total mortality, 1.4 and 6.7% for cardiovascular mortality, and between 1.7 and 30.4% for respiratory mortality.

CONCLUSION

In spite of a standardized common protocol, some disparities, inherent to the local characteristics, were noted (length of time series, numbers of ambient urban stations selected and pollutants available.). Nevertheless, this pilot study showed that multicentric epidemiological monitoring of air pollution effects on health was feasible. Yet, this requires to validate the results obtained through a re-analysis of the mortality data on a longer period of study. It also requires to study the feasibility and the relevance of the use of other health indicators, such as hospital admissions.

[Relevance and feasibility of a surveillance system of the effects of atmospheric pollution]

New regulations on the quality of air together with the epidemiological results obtained in the last 10 years on the short-term effects of air pollution on health have led the InVS to set up a program of epidemiological surveillance in 9 French cities. The first phase of this program was dedicated to the study of feasibility of such a surveillance system. Metrological and health data collection was conducted at both local and national levels in order to obtain significant data in close collaboration with experts of each field. The analysis of the relationship between temporal variations of daily series of the two types of indicators have allowed to obtain dose-response relationships between air pollution and mortality. The organisational and technical feasibility of such a surveillance system was confirmed in the first phase of the program.

Gaseous air pollution and atopy

BACKGROUND

Photochemical air pollutants are commonly thought to be implicated in the gradual increase in the prevalence of atopy. However, no epidemiological data are available.

METHODS

To clarify this issue, we performed a cross-sectional epidemiological survey in 2604 primary school children, 10 and 11 years old, living in seven communities among which some have the highest photochemical exposure in France. The mean levels of the main gaseous air pollutants (SO2, NO2 and O3) were measured during a 2-month period in 1993. The protocol included a standardized questionnaire, skin prick tests to common aeroallergens and in the atopic children, collection of a sample of mattress dust to measure group 1 mite allergens. Atopy was only defined on the basis of the skin prick tests.

RESULTS

Percentage of positive skin tests and the number of positive skin tests were similar in the different communities looked at. The distribution of dust samples with a group 1 allergen level greater than 2 microg/g dust, was also similar. Logistic regression analysis including potential confounding factors, as well as the mean level of air pollutants, did not demonstrate any association between atopy and mean SO2, NO2 and O3 levels.

CONCLUSION

The increase in photochemical air pollutants is unlikely to be a major determinant for the recent increase in the prevalence of atopy.

Gaseous air pollution and atopy

BACKGROUND

Photochemical air pollutants are commonly thought to be implicated in the gradual increase in the prevalence of atopy. However, no epidemiological data are available.

METHODS

To clarify this issue, we performed a cross-sectional epidemiological survey in 2604 primary school children, 10 and 11 years old, living in seven communities among which some have the highest photochemical exposure in France. The mean levels of the main gaseous air pollutants (SO2, NO2 and O3) were measured during a 2-month period in 1993. The protocol included a standardized questionnaire, skin prick tests to common aeroallergens and in the atopic children, collection of a sample of mattress dust to measure group 1 mite allergens. Atopy was only defined on the basis of the skin prick tests.

RESULTS

Percentage of positive skin tests and the number of positive skin tests were similar in the different communities looked at. The distribution of dust samples with a group 1 allergen level greater than 2 microg/g dust, was also similar. Logistic regression analysis including potential confounding factors, as well as the mean level of air pollutants, did not demonstrate any association between atopy and mean SO2, NO2 and O3 levels.

CONCLUSION

The increase in photochemical air pollutants is unlikely to be a major determinant for the recent increase in the prevalence of atopy.

The prevalence of reported asthma is independent of exposure in house dust mite-sensitized children

In areas with low house dust mite (HDM) allergen exposure, both mite sensitization and asthma prevalence are low. In most other areas, HDM allergen exposure is higher than the threshold for sensitization. In this setting, is HDM allergen exposure a factor which is causally related to the development of asthma in HDM-sensitive individuals? To answer this question, the cumulative prevalence of asthma was evaluated in a group of 157 schoolchildren, aged 10 and 11 yrs, who were allergic to HDM allergen, and compared it with HDM allergen exposure and atopic status, using univariate and multivariate analysis. HDM allergen levels were measured in mattress dust using an enzyme-linked immunosorbent assay (ELISA) method. Of mattress dust samples, 94% had an HDM allergen level >2 microg x g dust(-1). Atopy was evaluated by means of skin prick tests using five common allergens. Among the predictive variables studied by means of univariate analysis, only the number of positive skin tests and male sex correlated with asthma prevalence, but not HDM allergen exposure. Logistic regression analysis also demonstrated that the number of positive skin tests correlated with asthma prevalence (odds ratio (OR)=1.38, p=0.05), whereas the OR for HDM allergen exposure was 1.0. This survey suggests that, in a geographical area with high HDM allergen exposure, asthma prevalence is not linked with HDM allergen levels.

[Resistance to vecuronium in burnt patients. Influence of the burnt surface on the effectiveness of the dose 95]

OBJECTIVE

To assess the neuromuscular blocking effect of vecuronium in adult burn patients, to draw dose-response curves, to determine the ED 95 according to burn surface area, to analyze the time course of this pattern in order to recognize the development of a resistance according to the length of postinjury period.

STUDY DESIGN

Prospective open study, extending over a 12 month period.

PATIENTS

Sixty-three consecutive adult burn patients in an acute phase and 13 control patients who had been thermally injured at least 500 days before their inclusion in the study.

METHODS

Anaesthesia was achieved with thiopentone, fentanyl and vecuronium in patients undergoing excision and autograft surgery. Neuromuscular blockade was assessed by thumb adduction, measured by electromyography using evoked train of four responses to ulnar nerve stimulation. Dose-response curves were determined using the single dose method from only one predetermined dose of vecuronium per patient on each day of the study. Dose-response curves were compared using linear regression and ED 95 were calculated from log-probit data.

RESULTS

In the control group, ED 95 was 53 mg.kg-1. Before the 7th postinjury day, patients did not differ from controls. Between the 7th and the 70th postinjury day the ED 95 increased significantly. Patients with a burn surface area (BSA) of less than 20% had a ED 95 of 69 mg.kg-1, between 20% and 40% of BSA the ED 95 was 103 mg.kg-1, between 40% and 60% BSA the ED 95 was 134 mg.kg-1 and patients with a BSA over 60% had a ED 95 at 154 mg.kg-1. The onset of action increased in all groups and was significantly different from control group.

CONCLUSION

Acutely burn patients become resistant to the neuromuscular blocking effect of vecuronium. This resistance is related to the magnitude of burn injury. The mechanism of resistance is related to an increase in nicotonic acetylcholine receptors. In these patients, the dose of vecuronium must be titrated to achieve effective muscular paralysis: the correcting factor is 1.3 for a BSA under 20%, 1.9 for a BSA between 20 and 40%, 2.5 for a BSA between 40 and 60%, and 2.9 for a BSA above 60%.

[Patient-controlled analgesia: a study of fentanyl requirements in burnt patients during the acute phase]

This study assessed over the first post-burn week the patients' demands for opiates delivered with a PCA device, changes in opioid delivery along the day, especially during painful events and the incidence of side effects. Twenty-two patients (8 women, 14 men), mean age 33 years (+/- 12 SD), mean BSA 21% (+/- 13 SD), mean deep dermal burn 12% (+/- 11 SD) were included. Fentanyl was delivered by i.v. route using a PCA device during the first 6 days post burn. Bolus dose was fixed at 1 microgram.kg-1, lock-out time at 30 min and the 4 h limit dose at 7 micrograms.kg-1. The following data were collected every day: satisfied and non-satisfied demands, total daily dose, demands during and after dressing change period (4 h), during afternoon (10 h) and overnight periods (10 h). Heart rate (HR), respiratory rate (RR), blood pressure (BP), Paco2 and Spo2 were also monitored. The mean total daily demands were similar from D1 to D6 (28 +/- 7). Around 7 demands/day were not satisfied. The mean total daily satisfied demands were also the same: 21 +/- 5. Individual demands were over a wide range (minimum: 15, maximum: 41 demands/day for total demands and 13 and 34 respectively for the satisfied ones). Mean fentanyl delivery was 1.7 +/- 0.1 microgram.kg-1.h-1 during dressing period, 0.9 +/- 0.3 microgram.kg-1.h-1 during afternoon period (10 h) and 0.5 +/- 0.2 during overnight period (10 h). No-satisfied demands were around 4 boluses during dressing change period, 2 boluses during afternoon period, and one bolus during overnight period.(ABSTRACT TRUNCATED AT 250 WORDS)