Measurable residual disease (MRD) is highly prognostic for relapse and overall survival (OS) in acute lymphoblastic leukemia (ALL), although many patients with apparent "MRD negativity" by standard assays still relapse. We evaluated the clinical impact of a highly sensitive next-generation sequencing (NGS) MRD assay in 74 adults with ALL undergoing frontline therapy. Among remission samples that were MRD negative by multiparameter flow cytometry (MFC), 46% were MRD+ by the NGS assay. After 1 cycle of induction chemotherapy, MRD negativity by MFC at a sensitivity of 1 × 10-4 and NGS at a sensitivity of 1 × 10-6 was achieved in 66% and 23% of patients, respectively. The 5-year cumulative incidence of relapse (CIR) among patients who achieved MRD negativity by MFC at complete remission (CR) was 29%; in contrast, no patients who achieved early MRD negativity by NGS relapsed, and their 5-year OS was 90%. NGS MRD negativity at CR was associated with significantly decreased risk of relapse compared with MRD positivity (5-year CIR, 0% vs 45%, respectively; P = .04). Among patients who were MRD negative by MFC, detection of low levels of MRD by NGS identified patients who still had a significant risk of relapse (5-year CIR, 39%). Early assessment of MRD using a highly sensitive NGS assay adds clinically relevant prognostic information to standard MFC-based approaches and can identify patients with ALL undergoing frontline therapy who have a very low risk of relapse and excellent long-term survival.
Background: Many tools have been developed for the standardized collection of cancer family history (fh). However, it remains unclear which tools have the potential to help health professionals overcome traditional barriers to collecting such histories. In this review, we describe the characteristics, validation process, and performance of existing tools and appraise the extent to which those tools can support health professionals in identifying and managing at-risk individuals. Methods: Studies were identified through searches of the medline, embase, and Cochrane central databases from October 2015 to September 2016. Articles were included if they described a cancer fh collection tool, its use, and its validation process. Results: Based on seventy-nine articles published between February 1978 and September 2016, 62 tools were identified. Most of the tools were paper-based and designed to be self-administered by lay individuals. One quarter of the tools could automatically produce pedigrees, provide cancer-risk assessment, and deliver evidence-based recommendations. One third of the tools were validated against a standard reference for collected fh quality and cancer-risk assessment. Only 3 tools were integrated into an electronic health records system. Conclusions: In the present review, we found no tool with characteristics that might make it an efficient clinical support for health care providers in cancer-risk identification and management. Adequately validated tools that are connected to electronic health records are needed to encourage the systematic identification of individuals at increased risk of cancer.
Une des missions de l'Afic est de permettre a ses adherents de participer a des cessions de formation professionnelle pour enrichir leurs competences dans des domaines tres varies. Catherine Palliere, cadre infirmier a l'hopital des Diaconesses, a ainsi pu participer, le 17 octobre dernier, a une journee dont le theme etait : cancerologie et soins palliatifs. L'assemblee etait composee d'infirmieres, d'aides soignantes, de medecins, de psychologues de cadres de sante, de socio-educateurs et de pharmaciens. Nous vous proposons un apercu de cette journee a laquelle une centaine de personnes, venant le plus souvent d'etablissements publics, ont participe. Le contenu de cette formation professionnelle etait divise en trois temps.
Abstract Kernberg's (1984) model of personality describes 3 personality organizations (POs)-psychotic, borderline, and neurotic-each of which has specific characteristics in terms of relationship schemas, defense mechanisms, identity diffusion, and reality testing. The Core Conflictual Relationship Theme (CCRT) method (Luborsky, 1998a) is a measure of central relationship schemas as revealed by relationship narratives. It identifies 3 components: the patient's wishes (Ws), the responses from others (ROs), and the responses of self (RSs). The goals of this study were to compare 2 methods for scoring ROs and RSs and to examine whether different POs vary in terms of their relationship schemas as measured by the CCRT. Eighty-one participants were included in this study. A PO diagnosis was made with the Personality Organization Diagnostic Form (Diguer & Normandin, 1997). Results showed that both scoring methods were equivalent in all dimensions. We found more similarities than differences between the 3 PO groups with respect to Ws, ROs, and RSs. The psychotic PO group presented the flattest CCRT profiles, the least negative responses, and the lowest narrative complexity. These results are discussed in relation to Kernberg's model and the development of the CCRT method.
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