Pierre Biron

E21145 Background: Lymphopenia (lyp) is associated with an increased risk of toxicity and early death after cytotoxic chemotherapy (CT) in cancer patients (pts) and is also a prognostic factor for overall survival (OS) and progression free survival (PFS) in lymphoma, breast, and sarcoma pts. We report here the impact of CD4 lyp on patient survival after 10 years. Methods: 220 HIV negative pts treated in 2C dept in the Centre L.Bérard (Lyon, France) were included in this study from 04/99 to11/00. 98 (45%) had lymphoma or myeloma, 58 (26%) sarcoma, 21 (9%) breast cancer and 43 (19%) for other cancers. Two groups of diseases: 1) chemocurable diseases (NHL or germ cell tumors), 2) seldom chemocurable disease (advanced carcinomas and sarcomas). Phenotypic analysis of peripheral blood lymphocyte (ly) subsets on d1 of CT was determined using flow cytometry. Prognostic factors were analyzed univariate and multivariate analysis using Cox model. Results: With a minimum follow-up of 10 years in the entire group, age>60, PS >1, stage, tumor type, baseline ly <700/uL, CD4 count<450/uL CD8<400/uL correlated to OS in univariate analysis. Using Cox model, age, PS, stage, tumor type, use of high-risk CT, and ly subsets independently correlated to OS. In lymphoma pts, baseline ly count<700/uL, CD4 count<450/uL, CD56 count <100/uL were independent prognostic factors for OS and PFS using Cox model. In sarcoma pts, baseline ly count <700/uL, CD4 count <450/uL and CD8 count <400/uL were independent risk factors for OS and PFS in multivariate analysis. In pts with seldom chemocurable diseases (advanced carcinomas and sarcomas), all pts with total ly < 400/ uL or CD4 ly < 200/ uL died within 18 months (median: 6 mos). In lymphoma and germ cell tumor pts, all pts but one with ly< 200/ uL or CD4 lymphocytes < 100/ uL relapsed and died. Conclusions: Peripheral blood lymphocyte subsets prior to initiation of CT is a strong predictor of OS and PFS in this series. All pts with advanced breast carcinoma or sarcoma and CD4 count<200/uL had a very short term survival.

Sarcomas are rare malignant tumors. Accurate initial histological diagnosis is essential for adequate management. We prospectively assessed the medical management of all patients diagnosed with sarcoma in a European region over a one-year period to identify the quantity of first diagnosis compared to central expert review (CER).

Objectives: The purpose of this workis to develop a health information platform connecting most health facilities in the Rhône-Alpes region. The health platform called SIS-RA is used through a Web interface. An iconic interface is dedicated to the platform and presents information in a unique way for all users. Methods: Newtechniques have been used to develop this platform which will be used by a great number of Rhône-Alpes doctors in the future. We chose a user-centered design which takes into account doctors’ requirements (hospital and GP). We also consider that no system has to be rebuilt, but a direct connection to the legacysystems should be provided. Results: The platform permits fast and more appropriate medical decisions than those made without this information system. The iconic interface presents all medical documents in a uniform way. Currently, 11 healthcare facilities and 15 community health networks are connected to SIS-RA sharing more than 60,000 records with 1.2 million indexed items. 3200 doctors use the system. Conclusion: The platform is approved by French supervision authorities (regional hospitals association (ARH)), regional practitioners union (URML) and Rhônes-Alpes region administration and is known as the official shared health record.

9019 Objectives: Based on a previous monocentric phase II trial with neoadjuvant ifosfamide CDDP based regimen in adults, a multicentric phase II study of neoadjuvant chemotherapy for osteosarcoma of patients over 16 years was initiated in 1993 in the French Sarcoma Group. Methods: Four preoperative courses of ifosfamide 9g/m2 in 3 days and CDDP 100mg/m2 on day 4 (SHOC) were given, followed by local treatment. Post operative chemotherapy was adapted according to pathological response, doxorubicin (60mg/m2) being added (HOCA regimen) in patients with tumors >10% of viable tumor cells. Pathological response rate) was the principal objective of the study. Results:Between January 94 and June 1998, 63 pts were included, 14 females, 49 males, with a median age of 27 (range: 16–63). Primary tumors were femur (39%), tibia (12%), humerus (10%), flat bones (28%). Grade 3 and 4 neutropenia, febrile neutropenia, thrombopenia and rehospitalisation occured after 58%, 17%,17% and 22% of courses of SHOC and 76%, 28%,47%, 47% of the courses of HOCA. Respectively 13%, 19%, 24%, 32% and 12% of patients had grade 4, 3, 2, 1, and non evaluable pathological response to preoperative chemotherapy. Good pathological response was observed in 20 (31%) of included patients. With a 68 months median follow-up, overall and progression-free survival at 5 year are 54% and 47% both (PFS 72% and 35%, and OS 81% and 50% respectively for good and poor responders) Conclusions: In adult patients, preoperative high dose ifosfamide and CDDP (SHOC) regimen yields response rate and survival comparable to that achieved with doxorubicin containing regimen. No significant financial relationships to disclose.

The main risk factors of infectious complications in cancer patients result from immune deficiency more or less related to cancer. Prognosis is related to the type and grade of the underlying disease. Prospective studies should be conducted to update data on the frequency of infections, morbidity and mortality (expert agreement). Prospective studies are needed to follow the epidemiology in cancer patients, particularly in neutropenic patients (expert agreement). Prospective studies should be conducted to determine prognosis factors allowing precise recognition of "low-risk" neutropenic patients with fever who could benefit from home care (expert agreement). When infection is suspected, the first criterion determining the therapeutic attitude concern signs of gravity requiring emergency care (septic shock). Beyond this situation, the first criterion determining the therapeutic attitude is the severity of the neutropenia. Microbial diagnosis is essential for initiating and later adapting anti-infectious treatment as well as for assessing efficacy.

Excepting emergency and aplasia: two to three blood samples should be draw for culture an hour apart within a 24 period (standard). For emergency or aplasia: two to three blood samples should be drawn for culture before initiating early antibiotic therapy. The delay between samples drawn from different sites should be less than one hour (standard). For patients on antibiotics: four to six blood samples should be drawn for culture within 48 hours, outside ongoing antibiotic administration. If the patient is given corticosteroids, it is recommended to draw two or three blood samples in case of deterioration (agreement of the experts). Rigorous aseptic techniques must be used (standard). Culture media are chosen according to the institution's microbial ecology (standard). The volume of blood drawn should be adapted to the system used (standard). Culture positivity is determined at 24 to 48 hours.