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URL : https://hal.archives-ouvertes.fr/hal-01004302
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, Annexes Matériel supplémentaire article#1, Bories et al, Am J, 2014174.
, Matériel supplémentaire article#2, Bories et al, Haematologica, pp.2018-179
, Matériel supplémentaire article#3, Bories et al, soumis Blood Cancer Journal???????????, p.193
, Matériel supplémentaire article#4, Bories et al, manuscrit en préparation?????????????
, Annexe I : Matériel supplémentaire article#1, Bories et al, AJH, 2014.
, In which hospital do you practice? (optional question) Please write your answer here
, What is your current position? ? Head of department, professor or assistant professor
, You just have to decide as if you were really facing this choice task 8, Choice, vol.1
, Low-intensity therapy (hypomethylating agent or low-dose cytarabine)
, A 72-year-old woman, with no comorbidity. Normal cardiac function. She has an history of untreated low-risk MDS since 2013 (IPSS 0.5). Worsening of cytopenias in, 2016.
, WBC 1G/L incl. neutrophils count 0.3G/L and 5% peripheral blood (PB) blasts, Hgb 100g/L
, Bone marrow aspiration: FAB1 AML with BM blast count 40 %, and adverse karyotype
, Low-intensity therapy (hypomethylating agent or low-dose cytarabine)
, A 75-year-old man, with an history of coronary artery disease with anterior interventricular artery stenting in 2010. He as controlled ischemic cardiopathy with medication (LVEF 52%), ECOG 2, recent weight loss 4kg. CBC: WBC count 75 G/L, PB blast count 40%, p.60
, Low-intensity therapy (hypomethylating agent or low-dose cytarabine)
, A 77-year-old woman, with an 8-year history of hypertension controlled with angiotensin-convertingenzyme inhibitor, a recent echocardiogram showed a LV ejection fraction of 55%
, CBC: WBC 18G/L incl. 25% peripheral blast, Hgb 100g/L, platelet count 80 G/L, Bone marrow aspiration: FAB4 AML with favorable karyotype (inv16) Which therapeutic option would you recommend? ? 1. Intensive chemotherapy ? 2. Low-intensity therapy, She is natural helper of her husband affected by Alzheimer's disease
, A 63-year-old-man, with a 5-year-history of asymptomatic Parkinson disease and recently diagnosed with an asymptomatic carotid artery stenosis (90%)
, CBC: WBC 2G/L incl. 5% PB blast count, Hgb 80g/L
, Bone marrow aspiration: FAB2 AML (30% BM blast, tri-lineage dysplasia) with complex Karyotype incl. inv3, -5q
, Low-intensity therapy (hypomethylating agent or low-dose cytarabine)
Best supportive care 14.Vignette#5: Patient from the Vignette#4 but 73-year-old A 73-year-old-man, with a 5-year-history of asymptomatic Parkinson disease and recently diagnosed with an asymptomatic carotid artery stenosis (90%) ,
, CBC: WBC 2G/L incl. 5% PB blast, Hgb 80g/L
, Bone marrow aspiration: FAB2 AML (30% BM blast, tri-lineage dysplasia) with complex Karyotype incl. inv3, -5q
, Low-intensity therapy (hypomethylating agent or low-dose cytarabine)
, Vignette#6: Patient from Vignette#4 but with WBC count 40 g/L incl. PB blast count of 25%
, A 63-year-old-man, with a 5-year-history of asymptomatic Parkinson disease and recently diagnosed with an asymptomatic carotid artery stenosis (90%)
, CBC: WBC 40G/L incl. 25% PB blast, Hgb 80g/L
, Bone marrow aspiration: FAB2 AML (30% BM blast, tri-lineage dysplasia) with complex Karyotype incl. inv3, -5q
, Low-intensity therapy (hypomethylating agent or low-dose cytarabine)
, Vignette#7: patient from Vignette#4 in complete remission after intensive chemotherapy A 63-year-old-man, with a 5-year-history of asymptomatic Parkinson disease and recently diagnosed with an asymptomatic carotid artery stenosis (90%)
, CBC: WBC 2G/L incl. 5% PB blast count, Hgb 80g/L
, Bone marrow aspiration: FAB2 AML (30% BM blast, tri-lineage dysplasia) with complex Karyotype incl. inv3, -5q
, No significant complication during aplasia. He as an HLA-identical sibling donor. Which therapeutic option would you recommend? ? 1. Allogeneic Stem Cell Transplantation with reduced-intensity conditioning ? 2. Consolidation with 2 courses of intermediate-dose cytarabine (1,5g/m²/12h, 3d) ? 3. Consolidation with 6 courses of low-dose cytarabine, CR after an induction regimen with idarubicin (8mg/m²/d, 5 days) combined with cytarabine (100mg/m², 7days)
, Vignette#8: patient from Vignette#4 in complete remission after 6 courses of azacitidine A 63-year-old-man, with a 5-year-history of asymptomatic Parkinson disease and recently diagnosed with an asymptomatic carotid artery stenosis (90%)
, CBC: WBC 2G/L incl. 5% PB blast count, Hgb 80g/L
, Bone marrow aspiration: FAB2 AML (30% BM blast, tri-lineage dysplasia) with complex Karyotype incl. inv3, -5q
, He has an HLA-identical sibling donor. Which therapeutic option would you recommend? ? 1. Allogeneic Stem Cell Transplantation with reduced-intensity conditioning ? 2. Azacitidine until disease progression ? 3. Consolidation with 2 courses of intermediate, CR after 6 cycles of azacitidine