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Résumé: Les leucémies prolymphocytaires B et T sont des maladies rares et complexes, avec un pronostic défavorable. La survie globale médiane est évaluée à trois ans. Les propositions thérapeutiques sont modestes, l'alemtuzumab est l'immunothérapie de premier choix offrant les meilleurs résultats, et l'allogreffe de cellules souches hématopoïétiques est la seule stratégie thérapeutique permettant d'obtenir une réponse durable. Les avancés dans la compréhension de la pathogénie de ces entités ouvrent la voie à l'utilisation de nouvelles thérapies ciblées prometteuses. [ABSTRACT FROM AUTHOR]

Les lymphomes T sont un ensemble heterogene d'hémopathies derivant des lymphocytes T. Leur classification a eté révisee par l'Organisation mondiale de la sante en 2016. Elle est basée sur des données cliniques, morphologiques, immunophenotypiques et moleculaires. Grâce aux connaissances acquises ces dernières annees, notamment sur le plan genetique et moleculaire, plusieurs entités ont eté précisees. Ainsi, certains lymphomes T peripheriques sans spécification (NOS) derivant des lymphocytes T follicular helper (TFH) ont eté rapproches des lymphomes T angio-immunoblastiques (LAIT). Les lymphomes anaplasiques è grandes cellules ALK négatifs sont dorénavant mieux caractérisés sur le plan moleculaire. Quels que soient les différents sous-groupes histologiques, le schema cyclophosphamide + hydroxyadriamycine + vincristine ± étoposide + prednisone (CHO [E]P) reste, faute de mieux, le traitement d'induction de première ligne le plus utilisé. L'intensification thérapeutique avec autogreffe en consolidation d'une remission peut, pour certains groupes, etre considérée comme une stratégie de reference, en premiere ligne mais n'est pas consensuelle. Elle reste une option thérapeutique en deuxieme ligne a mettre en perspective avec les résultats obtenus avec l'allogreffe. Les traitements chimiothérapiques, en rechute, ont une efficacite limitee. Les therapies cibées trouvent une place prometteuse dans les sous-groupes histologiques exprimant le CD30 et la proteine ALK. [ABSTRACT FROM AUTHOR]

Background: Pain management is an essential and complex issue for non-communicative patients undergoing sedation in the intensive care unit (ICU). The Behavioral Pain Scale (BPS), although not perfect for assessing behavioral pain, is the gold standard based partly on clinical facial expression. NEVVA © , an automatic pain assessment tool based on facial expressions in critically ill patients, is a much-needed innovative medical device., Methods: In this prospective pilot study, we recorded the facial expressions of critically ill patients in the medical ICU of Caen University Hospital using the iPhone and Smart Motion Tracking System (SMTS) software with the Facial Action Coding System (FACS) to measure human facial expressions metrically during sedation weaning. Analyses were recorded continuously, and BPS scores were collected hourly over two 8 h periods per day for 3 consecutive days. For this first stage, calibration of the innovative NEVVA © medical device algorithm was obtained by comparison with the reference pain scale (BPS)., Results: Thirty participants were enrolled between March and July 2022. To assess the acute severity of illness, the Sequential Organ Failure Assessment (SOFA) and the Simplified Acute Physiology Score (SAPS II) were recorded on ICU admission and were 9 and 47, respectively. All participants had deep sedation, assessed by a Richmond Agitation and Sedation scale (RASS) score of less than or equal to -4 at the time of inclusion. One thousand and six BPS recordings were obtained, and 130 recordings were retained for final calibration: 108 BPS recordings corresponding to the absence of pain and 22 BPS recordings corresponding to the presence of pain. Due to the small size of the dataset, a leave-one-subject-out cross-validation (LOSO-CV) strategy was performed, and the training results obtained the receiver operating characteristic (ROC) curve with an area under the curve (AUC) of 0.792. This model has a sensitivity of 81.8% and a specificity of 72.2%., Conclusion: This pilot study calibrated the NEVVA © medical device and showed the feasibility of continuous facial expression analysis for pain monitoring in ICU patients. The next step will be to correlate this device with the BPS scale., Competing Interests: MB and DCh participated in scientific board of SAMDOC Medical Technologies who develops NEVVA©; medical device. JL, TC, AH and TG were employed by Samdoc Medical Technologies Company. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Bellal, Lelandais, Chabin, Heudron, Gourmelon, Bauduin, Cuchet, Daubin, De Carvalho Ribeiro, Delcampe, Goursaud, Joret, Mombrun, Valette, Cerasuolo, Morello, Mordel, Chaillot, Dutheil, Vivien and Du Cheyron.)