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Le paysage de la prise en charge des lymphomes de Hodgkin (LH) avances s’est sensiblement modifie durant les 10 dernieres annees. L’introduction de nouveaux schemas therapeutiques plus intenses permet d’ameliorer le controle de la maladie, mais la meilleure balance entre efficacite et toxicite des traitements reste a trouver. Par ailleurs, la recente introduction de l’imagerie fonctionnelle dont la sensibilite est meilleure que celle du scanner, a permis d’une part d’identifier plus frequemment des patients ayant un stade avance [1], et d’autre part de developper des strategies therapeutiques adaptees au risque d’echec du traitement evalue par la sensibilite precoce a la chimiotherapie.

Le lymphome de Hodgkin (LH)reste une entite distincte au sein des lymphomes malins. C’ est une affection dont le diagnostic repose sur un critere uniquement morphologique: la presence de cellules de Sternberg au sein d’un infiltrat cellulaire polymorphe et variable. La maladie atteint essentiellement des ganglions superficiels sur lesquels l’histologie affirme le diagnostic, puis un bilan d’extension sera etabli a la recherche d’adenopathies profondes, d’une atteinte splenique et de localisations extranodales. Le plus souvent,les localisations ganglionnaires sont cervicales et mediastinales. Dans deux tiers des cas, elles sont sus-diaphragmatiques.

Les lymphomes malins non hodgkiniens (LMNH)sont des proliferations malignes du tissu lym- phoide dont le diagnostic resulte toujours de l’examen d’une biopsie tissulaire.Celle-ci permet de les distinguer du lymphome de Hodgkin.Elle porte habituellement sur une tumeur ganglionnaire ou extraganglionnaire superficielle ou profonde.Les differentes localisations tumorales seront recherchees dans le bilan d’extension de la maladie.Leur classification a fait l’objet en 2001,sous l’egide de l’OMS,d ’un consensus rassemblant les differentes classifications utilisees auparavant dans le monde (1)et n’a donc pas ete appliquee ici.

Fifty percents of cancer arise in people older than 65-year-old. Most clinical trials in cancer treatment are limited in patients younger than 65-year-old. We review literature-describing particularity of cancer treatment in elderly patients.Therapeutic decisions should be based on an estimation of the patient's life expectancy, and risks and benefits should be weighted up accordingly. Geriatric oncology is made of a geriatric evaluation of patient and of knowledge of clinical trial about elderly patients.We present in this issue the principle of geriatric evaluation and the results of recent clinical trial on elderly cancer patients.

Haematological, immunophenotypic and cytogenetic characteristics were analysed in 241 patients with acute myeloid leukaemia (AML) M0, including 58 children. Children3 years and adults between 60 and 70 years of age were most frequently affected. Immunophenotyping showed a heterogeneous phenotype. Anti-myeloperoxidase was positive in about half of the patients. Cytogenetic data were available from 129 (54%) patients. A normal karyotype was found in only 24%. Most of the abnormalities were unbalanced and the chromosomes 5, 7, 8 and 11 were the most frequently affected. Survival data were available from 152 treated patients (63%). The median overall survival for all patients was 10 months, 20 months for children (n = 36), 10 months for the young adult group (n = 50) and 7 months for the elderly patients (n = 66) (P = 0.09). Karyotype was not a prognostic factor influencing survival. AML M0 shows the immunological characteristics of early progenitor cells, but the expression of the different markers and cytogenetic abnormalities is heterogeneous. The prognosis is poor compared with other de novo AML and similar to that of AML with multilineage dysplasia or AML following myelodysplastic syndromes.