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Conflicting results have been published on prognostic significance of central venous to arterial PCO2 difference (∆PCO2) after cardiac surgery. We compared the prognostic value of ∆PCO2 on intensive care unit (ICU) admission to an original algorithm combining ∆PCO2, ERO2 and lactate to identify different risk profiles. Additionally, we described the evolution of ∆PCO2 and its correlations with ERO2 and lactate during the first postoperative day (POD1). In this monocentre, prospective, and pilot study, 25 patients undergoing conventional cardiac surgery were included. Central venous and arterial blood gases were collected on ICU admission and at 6, 12 and 24 h postoperatively. High ∆PCO2 (≥ 6 mmHg) on ICU admission was found to be very frequent (64% of patients). Correlations between ∆PCO2 and ERO2 or lactate for POD1 values and variations were weak or non-existent. On ICU admission, a high ∆PCO2 did not predict a prolonged ICU length of stay (LOS). Conversely, a significant increase in both ICU and hospital LOS was observed in high-risk patients identified by the algorithm: 3.5 (3.0–6.3) days versus 7.0 (6.0–8.0) days (p = 0.01) and 12.0 (8.0–15.0) versus 8.0 (8.0–9.0) days (p

Le chapitre consacre a la description des hemopathies malignes rares de l’adulte a ete un peu artificiellement subdivise en deux categories (les hemopathies lymphoides d’un cote et les hemopathies myeloides de l’autre), pour plus de clarte. Comme dans toutes tumeurs rares, les donnees d’incidence et de survie spontanee ou sous traitement sont tres parcellaires et souvent meconnues. Malgre leur caractere orphelin, certaines hemopathies malignes rares ont beneficie de l’apport recent de nouvelles therapeutiques qui ont transforme le pronostic et la survie des patients traites.

Abstract 2195 Poster Board II-172 The results of the treatment of blast crisis CML remain still disappointing with poor overall survival rates, despite the introduction of imatinib (IM) in the therapeutic arsenal of Ph+ leukemias. This compound alone provides 24% of overall initial hematologic responses in myeloid blast crisis (MBC) IM-naive patients (pts), with 7 months of median overall survival rates. Dasatinib remains disappointing with 34% of major hematological responses (MaHRs, Cortes, Blood, 2007) in IM-resistant pts. The combination of IM to daunorubicin (3 days) and cytarabine (7 days) AML schedule (“3+7”) might improve responses and survival rates with 55.5 % of complete remissions (CR) and a median overall survival of 15.9 months (B. Deau, submitted). In this preliminary pilot study, we proposed to test the combination of daunorubicin + cytarabine to dasatinib in MBC CML in order to improve outcome. Fifteen patients have been enrolled [8M, 7F, median age at diagnosis 45 (28-64) years]. Prior to enrollment, 5 pts were in chronic phase (CP), 2 in accelerated phase (AccP) on IM. Eight pts were in MBC at diagnosis, and IM-naive. Additional chromosomal abnormalities (ACA) were present at diagnosis in 5 pts [+8 (2 pts), +21 (2 pts), t(3;21) (1 pt), add(1) (1 pt), complex abnormalities (1 pt), variant Ph (2 pts)]. For CP pts Sokal index was low for 2, intermediate for 1, unknown for 2, and none had any additional chromosomal abnormality at diagnosis. One patient had an e1a2 transcript, others a M-BCR transcript. Nine pts/15 had IM prior to combined therapy [best responses to IM prior to MBC were for 5 pts in CP: 3 complete hematologic remissions (CHR), 2 major molecular responses (MMR), for 2 pts in AccP: 2 CHR, for 2 in MBC: 1 complete cytogenetic remission (CCR) and 1 hematologic response (HR)]. In these 9 pts, 1 developed IM hematologic resistance in CP, 5 cytogenetic resistance, 1 molecular progression, and 2 entered MBC. Nine were screened for BCR-ABL mutations and only one was harboring a G250E mutation. The median interval between IM start and progression to MBC was 27 (1.1-65) months. Only 2 pts were exposed to dasatinib prior to combined therapy. At MBC, 7/15 pts had ACA, 10/15 screened were unmutated, 3 mutated (G250E, and 2 unknown). The pts received a median dose of 60 mg/m2/d of daunorubicin 3 days + a median dose of 200 mg/m2/d of cytarabine for 7 days and a median dose of 140 mg/d of dasatinib starting at day 1. Eight pts/15 had G-CSF after induction chemotherapy as planned by the study, for a median of 18 (5-28) days. The induction chemotherapy was well tolerated with no pleural effusions or other particular toxicities. A median of 37 days of neutropenia ( This strategy provides encouraging initial results compared to TKIs alone, without specific toxicity, however, it does not translate into survival improvement, but might still represent a suitable preparative regimen for allogeneic transplant whenever it is possible. Disclosures: No relevant conflicts of interest to declare.