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Sarcoid-like granulomatosis (SLG) reaction caused by immunotherapy remains poorly understood. This study aims to investigate the outcome of patients with cancer and SLG associated with immunotherapy.Between April 2016 and June 2020, 434 patients with immunological adverse events were screened from the ImmunoTOX assessment board of Gustave Roussy, an academic cancer centre in France. Among them, 28 patients had SLG associated with immunotherapy (SLG cohort) and 406 patients had other immunological adverse events (control cohort). Clinical characteristics and outcome of patients were compared from SLG and control cohort.The SLG cohort consisted of 28 patients, 14 women and 14 men, with the median (range) age of 56.5 (28.7-75.3) years. Patients in the SLG cohort with sarcoidosis were asymptomatic (only radiographical finding) in 13 (46.4%) cases; otherwise, the most frequent symptoms were dyspnoea in 8 (28.6%) patients and cough in 5 (17.8%) patients. The computerised tomography scan found sarcoidosis localisations in mediastinal or peri-hilar thoracic lymph nodes in 26 (92.9%) patients, and lung parenchymal involvement was found in 14 (50.0%) patients. The radiographic Scadding stages for sarcoidosis classification were distributed in stages 0, I, II, III and IV in 2 patients (7.1%), 13 patients (46.4%), 11 patients (39.3%), 1 patient (3.6%) and 1 patient (3.6%), respectively. Compared with patients with other immunological toxicities (cohort control), patients with sarcoidosis presented most frequently with melanoma (75.0% versus 21.9% of patients; p 0.001) and more often received combined therapies of anti-programmed cell death 1 plus anti-cytotoxic T-lymphocyte antigen 4 protein (46.4% versus 12.6% of patients; p = 0.002). Patients with sarcoidosis had an improved overall survival (OS); the median OS was not reached in the SLG cohort and 40.4 months in the control cohort, hazard ratio = 0.232 (95% confidence interval: 0.086-0.630) (p = 0.002).Sarcoidosis-like reactions in patients receiving immunotherapy were reported as non-severe immunological reactions in most cases and were correlated with improved OS. SLG should not be misdiagnosed as tumour progression in patients receiving immunotherapy treatment for cancer.

Background. We sought to determine whether invasive aspergillosis (IA) during the first year after lung transplantation increased the risk of chronic lung allograft dysfunction (CLAD). Methods. We retrospectively reviewed the records of 191 patients who underwent lung transplantation at our institution between January 2013 and December 2017. Screening for Aspergillus was with bronchial aspirates, bronchoalveolar lavage if indicated or during surveillance bronchoscopy, radiography, and computed tomography. We used Fine and Gray multivariable regression to identify potential risk factors for CLAD. Results. During the first posttransplant year, 72 patients had at least 1 deep-airway sample positive for Aspergillus; 63 were classified as having IA and were included in the study. Median number of endoscopies per patient during the first year was 9 (range, 1–44). Median time from transplantation to first Aspergillus-positive sample was 121 d. Bronchial aspirate samples and bronchoalveolar lavage fluid were positive in 71 and 44 patients, respectively. Aspergillus fumigatus (n = 36, 50%) predominated; bacterial samples were also positive in 22 (31%) patients. IA within 4 mo after transplantation was independently associated with CLAD development (subdistribution hazard ratio, 3.75; 95% confidence interval [CI], 1.61-8.73; P < 0.01) by regression analysis. Survival at 3 and 5 y conditional on 1-y CLAD-free survival was 37% (95% CI, 24%-58%), and 24% (95% CI, 11%-52%) in the IA

Introduction L’oxygenotherapie haut debit (OHD) est de plus en plus utilisee pour traiter l’insuffisance respiratoire aigue, mais peu de donnees existent quant a son utilisation a domicile pour l’insuffisance respiratoire chronique (IRC). Notre centre instaure l’OHD au long cours chez les patients insuffisants respiratoires chroniques. Notre but est de rapporter son utilisation ainsi que le pronostic de ces patients. Methodes Nous avons conduit une etude monocentrique retrospective incluant tous les patients places sous OHD au long cours, entre janvier 2011 et avril 2018 au CHU de Rouen. Les patients ont ete divises en 2 groupes : ceux traites par OHD nasale (OHD-n) afin de traiter une IRC hypoxique et ceux tracheotomises, traites par OHD tracheale (OHD-t) a visee d’humidification. Resultats Soixante et onze patients ont ete places sous OHD longue duree. Quarante-trois (61 %) dans le groupe OHD-n et 28 (39 %) dans le groupe OHD-t. Dans le groupe d’OHD-n, les etiologies d’IRC etaient : les pathologies interstitielles (n = 15, 35 %), l’hypertension pulmonaire (n = 12, 28 %), les cancers pulmonaires (n = 9, 21 %) et les maladies obstructives pulmonaires (n = 7, 16 %). Dans le groupe OHD-t, le nombre d’hospitalisations pour exacerbation a diminue de −0,78/an [−2 a 0] (p = 0,045). Au total, 51 patients (72 %) ont pu rentrer a domicile et 20 (28 %) en soins de suite. La survie mediane sous OHD etait de 7,5 mois. La survie mediane etait significativement plus basse dans le groupe OHD-n (3,6 mois), alors que la survie mediane dans le groupe OHD-t n’a pas ete atteinte (p Tableau 1 ). Conclusion L’utilisation de l’OHD au long cours permet a des patients severes de sortir des unites de soins intensifs a un cout raisonnable.

Idiopathic pulmonary fibrosis (IPF) is characterized by relentlessly progressive lung function impairment that is consistently fatal in the absence of lung transplantation, as no curative pharmacological treatment exists. The pace of progression varies across patients, and acute life-threatening exacerbations occur unpredictably, causing further sharp drops in lung function. Recently introduced antifibrotic agents slow the pace of disease progression and may improve survival but fail to stop the fibrotic process. Moreover, the magnitude and kinetics of the response to these drugs cannot be predicted in the individual patient. These characteristics require that lung transplantation be considered early in the course of the disease. However, given the shortage of donor lungs, lung transplantation must be carefully targeted to those patients most likely to benefit. Current guidelines for lung transplantation listing may need reappraisal in the light of recent treatment advances. Patients with IPF often have multiple comorbidities such as coronary heart disease, frailty, and gastro-oesophageal reflux disease (GERD). Consequently, extensive screening for and effective treatment of concomitant conditions is crucial to appropriate candidate selection and outcome optimisation. A multidisciplinary approach is mandatory. Pulmonologists with expertise in IPF must work closely with lung transplant teams. Careful consideration must be given to preoperative optimisation, surgical technique, and pulmonary rehabilitation to produce the best post-transplantation outcomes.

Background. We sought to determine whether invasive aspergillosis (IA) during the first year after lung transplantation increased the risk of chronic lung allograft dysfunction (CLAD). Methods. We retrospectively reviewed the records of 191 patients who underwent lung transplantation at our institution between January 2013 and December 2017. Screening for Aspergillus was with bronchial aspirates, bronchoalveolar lavage if indicated or during surveillance bronchoscopy, radiography, and computed tomography. We used Fine and Gray multivariable regression to identify potential risk factors for CLAD. Results. During the first posttransplant year, 72 patients had at least 1 deep-airway sample positive for Aspergillus; 63 were classified as having IA and were included in the study. Median number of endoscopies per patient during the first year was 9 (range, 1–44). Median time from transplantation to first Aspergillus-positive sample was 121 d. Bronchial aspirate samples and bronchoalveolar lavage fluid were positive in 71 and 44 patients, respectively. Aspergillus fumigatus (n = 36, 50%) predominated; bacterial samples were also positive in 22 (31%) patients. IA within 4 mo after transplantation was independently associated with CLAD development (subdistribution hazard ratio, 3.75; 95% confidence interval [CI], 1.61-8.73; P < 0.01) by regression analysis. Survival at 3 and 5 y conditional on 1-y CLAD-free survival was 37% (95% CI, 24%-58%), and 24% (95% CI, 11%-52%) in the IA

Introduction La toxicite pulmonaire touche 3 a 7% des patients traites par immunotherapie et le traitement repose classiquement sur l’utilisation d’une corticotherapie orale. Toutefois, il existe peu de donnees detaillees portant sur les benefices de ce traitement. Methodes Etude monocentrique retrospective de patients traites par Ac anti-PD1 ou anti-PD-L1 avec toxicite pulmonaire ≥ grade2. Description des donnees cliniques, fonctionnelles et scanographiques avant/apres corticotherapie. Resultats Entre novembre 2016 et octobre 2019, 26 patients traites par immunotherapies ont presente une toxicite pulmonaire de grade ≥ 2 justifiant une corticotherapie orale. Parmi eux, 16 (62%) etaient des hommes et l’âge median etait de 65 [58–73] ans. Soixante-seize pour cent etaient exposes a un tabagisme. Les cancers faisant porter l’indication d’immunotherapie etaient principalement pulmonaires et melanomes metastatiques dans 11 (42%) et 6 (22%) des cas respectivement. La nature de l’immunotherapie etait un anti-PD1 en monotherapie dans 17 (65%). Les grades de toxicite etaient 2, 3 et 4 dans 22 (86%), 2 (7%) et 2 (7%), respectivement avec un delai moyen de survenue de 3,8 [2,4–8,4] apres l’institution de l’immunotherapie. Les motifs scanographiques dominants etaient consolidation, n = 12 (46%), verre depoli, n = 6 (23%) et infiltrats non specifiques, n = 8 (31%). La dose mediane de corticotherapie etait de 0,75 [0,5–1] mg/kg/j pour une duree mediane de 74 [51–150] jours. L’evaluation de la reponse au traitement montrait une resolution dans 12 (46%) cas, une amelioration dans 11 (42%) cas, une stabilite dans 1 (4%) cas et une aggravation chez 2 (8%) patients. Les donnees principales des epreuves fonctionnelles respiratoires montraient les evolutions suivantes : CVF passant de 3090 ± 660 mL a 3208 ± 1079 mL (p = 0,28) et DLCO passant de 54 ± 14% a 63 ± 17% (p = 0,03). Les plus grands benefices d’amelioration des parametres respiratoires etaient observes dans la population des patients avec consolidation (p = 0,007). Une reprise du traitement etait realisee chez 8 (32%) des patients, emaillee d’une recidive de toxicite dans 1 (12%) cas. Conclusion Le traitement des toxicites pulmonaires d’immunotherapie s’accompagne dans la grande majorite des cas d’une resolution ou d’une amelioration de l’atteinte. La DLCO apparait etre un outil pertinent de suivi. Les patients avec consolidation au scanner semblent les plus repondeurs au traitement, soulevant la question d’un raccourcissement de la duree du traitement dans ce sous-groupe.

Introduction L’obesite et la denutrition des patients en attente de greffe, definis par l’indice de masse corporelle (IMC), sont actuellement consideres comme des contre-indications relatives a la transplantation pulmonaire. L’albuminemie est un autre marqueur de denutrition. L’objectif de l’etude est d’evaluer l’impact de l’etat nutritionnel sur les resultats de la transplantation pulmonaire dans notre centre. Methodes Nous avons evalue, de facon retrospective, le resultat fonctionnel et la survie des patients adultes greffes pulmonaires et cardiopulmonaires a l’hopital Marie-Lannelongue de juillet 2014 a juillet 2018. Les marqueurs nutritionnels utilises sont l’IMC et l’albuminemie en pre-transplantation. Trois groupes de patients ont ete identifies : les patients « denutris » (IMC 30). Resultats Au total, 218 patients ont ete inclus dans l’etude, parmi lesquels 24 patients ont un IMC 30 kg/m2. Le taux median d’albumine est de 36 g/L, sans difference entre les trois groupes de patients. Il n’y a aucune difference significative entre les 3 groupes concernant la survenue d’une dysfonction primaire du greffon, la survie, la duree d’hospitalisation, l’incidence de rejet cellulaire ou humoral ou la presence d’une dysfonction chronique du greffon a 1 an de la transplantation. Seule l’albuminemie est un facteur pronostique avec une surmortalite chez les patients ayant un taux d’albumine Conclusion Cette etude montre que l’IMC n’est pas un bon facteur pronostique en transplantation pulmonaire. L’hypoalbuminemie est le seul facteur pronostique dans cette cohorte. Ces resultats meritent d’etre completes lors d’une etude prospective, incluant d’autres parametres evaluant plus specifiquement l’etat general des patients en pre-greffe.

Introduction: Number of patients treated with home mechanical ventilation is increasing. Reliability of home ventilators is unknown. Primary objective of our work was to report the annual incidence of ventilator related incidents. Secondary objectives were to describe the incidents, how and when they happened and to report the outcome of hospitalisation induced by ventilator failure in a subgroup population. Methods: Prospective nationwide database held by the ANTADIR collecting all incidents occurring on home ventilators managed by 25 healthcare providers from 2003 to 2017. Results: Forty thousand four hundred and forty-five ventilators were bought by the ANTADIR. Nine hundred twenty-nine ventilator associated incidents were reported. Incidents were classified as severe (n:45, 5.8%), moderate (n:105, 11.3%) or mild (n:779, 82.9%). Incident annual incidence rate was 0.47% per year [0.39 – 0.61]. Severe incidents were more likely to occur on life support ventilators: RR: 5.94 [95%CI: 4.83 to 7.30] (p Conclusion: Home ventilators are reliable devices but need regular follow-up.