[Complications other than infections, CRS and ICANS following CAR T-cells therapy: Recommendations of the Francophone Society of bone marrow transplantation and cell therapy (SFGM-TC)]

CAR-T cells are an innovative treatment for an increasing number of patients, particularly since the extension of their indication to mantle lymphoma and multiple myeloma. Several complications of CAR T-cell therapy, that were first described as exceptional, have now been reported in series of patients, since its first clinical use in 2011. Among them, cardiac complications, delayed cytopenias, acute and chronic Graft versus Host Disease, and tumoral lysis syndrome are recognized as specific potent complications following CAR T-cells infusion. During the twelfth edition of practice harmonization workshops of the Francophone society of bone marrow transplantation and cellular therapy (SFGM-TC), a working group focused its work on the management of these complications with focuses the epidemiology, the physiopathology and the risk factors of these 4 side effects. Our recommendations apply to commercial CAR-T cells, in order to guide strategies for the management of complications associated with this new therapeutic approach.

[Isolated diastolic hypotension in hemodialysis: Risk factor for novel cardiovascular complications and all-cause mortality]

Intra dialytic hypotension is the most common complication in hemodialysis. However, isolated diastolic hypotension (IDH) in hemodialysis is asymptomatic and its detection requires repeated monitoring of blood pressure during dialysis sessions. To study this phenomenon, we conducted a prospective study over a period of 5 years in 45 chronic hemodialysis patients. The IDH, was noted in 42% at inclusion, and in 59,5% of the cases at the end of the study. IDH was associated with advanced age, female gender, high relative critical blood volume, cardiac arrhythmias and diastolic dysfunction of the left ventricle. IDH was also significantly associated with novel cardiovascular complications (P=0.004) and all-cause mortality (P=0.038). Isolated diastolic hypotension is a particularly common phenomenon in hemodialysis. Our data encourage in-depth reflection on this subject in hemodialysis. In addition, our study highlights the value of screening for IDH by close monitoring of hemodynamic parameters, and calls for personalized dialysis management based on the analysis of the demonstrated risk factors and on the study of the associated comorbidities.

[The characteristics of arterial hypertension in postmenopausal women in the area of Blida (Algeria)]

OBJECTIVE

Assess the prevalence, the degree of control, and the comorbidities of hypertension in postmenopausal women.

DESIGNS AND METHODS

This is a cohort descriptive and prospective study conducted in 2years in a population with hypertension treated for arterial hypertension in specialized university hospital in Blida, which included one thousand seven hundred and twenty-one postmenopausal women with amenorrhea fore more than 12 consecutive months. All anthropometric data were recorded. All cardiovascular complications were sought. All calculations and statistical analysis are processed by the SPSS 20.0.

RESULTS

The mean age of onset menopause is 50.7±6.2yearsold. The prevalence of hypertension is 71%, significantly higher in postmenopausal women aged 65 and over. Among women, 82.3% had a systolic arterial pressure>150mmHg and 42.2% had a diastolic arterial pressure>90mmHg. The prevalence of diabetes was 34.8%, and 88.4% presented type 2 diabetes. Tobacco in 1.3%, hypoHDLmia in 52%, the hypertriglyceridemia in 43.5%, obesity in 31.7%. The metabolic syndrome in 57.8%. The major cardiovascular complications observed are: stroke in 26.4%, heart failure in 14.8%, myocardial infarction in 13.2%, renal failure in 10.1%. The control of high blood pressure is achieved only in 31.7%.

CONCLUSIONS

The systolic blood pressure is more important than the diastolic blood pressure in postmenopausal women. The cerebral vascular accident remains the most feared complication. The control of hypertension remains not enough and the balance of arterial pressure figures is highly recommended to avoid morbidity and fatal complications.

[The metabolic syndrome in hypertensive black population of South Algeria]

INTRODUCTION

The metabolic syndrome is a risk factor for cardiovascular diseases. It exposes to two main complications: cardiovascular diseases and type II diabetes. This risk is higher among women. It causes a high cardiovascular mortality.

OBJECTIVES

Assess the prevalence of the metabolic syndrome (MS) among our black hypertensive population. Study of the distribution of the different criteria in the cluster. Search cardiovascular complications.

MATERIALS AND METHODS

This longitudinal study that was carried out included one thousand five hundred and fifty subjects of both sexes from black and white populations aged 40 and older, living in the Algerian Sahara and reviewed after six years of decline. The control consisted of filling a questionnaire oriented on civil status, in addition to a clinical examination, including morphometry, measurement of blood pressure performed with validated electronic device (OMRON 705 CP). Also, a biological check-up was done (glycemy, HDL, cholesterol). A univariate and multivariate analysis have been carried out. All calculations and statistical analyzes are processed by the SPSS 17.0 and Epi Info6 software.

RESULTS

The MS frequency is 20.8%, more frequent among women than among men, with a significant difference (28.4% versus 15.1%, P<0.001). We found out a difference between black and white populations in terms of obesity (37.6% versus 31.1%), hypertension (60.6% versus 55.0%), diabetes (25.2% versus 19.2%) or other metabolic syndrome criteria. The most frequent complications according to decreasing frequency are: hospitalization for cardiovascular diseases 8.9%, stroke 6.3%, heart failure 5.8%, myocardial infarction 3.6%. The mortality rate is 14.7% among the blacks and 11.3% among the whites without difference. The survival rate of the population is influenced by the MS and by a non-checked blood pressure by an antihypertensive treatment.

CONCLUSION

The MS is highly prevailing among hypertensive black population, and significantly higher among women. The ranking of the cluster elements frequency shows clearly the specifities of our population. It is necessary to elaborate an adequate strategy to prevent such cardiovascular morbidity and mortality.