Hadj TOUHAMI (1), F. TOUHAMI (1), M.A. BEKADJA (1), M. BELHANI (2),

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Presentation transcript:

EVALUATION DE LA PRISE EN CHARGE ACTUELLE DE LA MALADIE DE HODGKIN EN ALGERIE Hadj TOUHAMI (1), F. TOUHAMI (1), M.A. BEKADJA (1), M. BELHANI (2), L. LOUANCHI (2), S. HAMMACHE (2), H. AIT ALI (3), Z. ZOUAOUI et col. (4), S.M. SIDI MANSOUR (5),N. MESLI (6), H. MEHENNAOUI, F. GRIFFI (7), M. TALBI (8) 1 Service Hématologie CHU. Oran 2 Service Hématologie Beni Messous Alger 3 Service Hématologie CHU. Tizi Ouzou 4 Service Hématologie CHU. SBA 5 Service Hématologie CHU. Constantine 6 Service Hématologie CHU. Tlemcen 7 Service Hématologie CHU. Annaba 8 Service Hématologie HOPITAL de BECHAR

Beni-Messous Pr. Belhani 1/98 -12/02 5 113 PATIENTS ET METHODES Services Chef Service Période Nbre/An Nbre Beni-Messous Pr. Belhani 1/98 -12/02 5 113 Annaba Pr.Grifi 1/99 -12/03 5 74 Béchar Dr. Talbi 1/95 -12/03 9 33 Constantine Pr.S.Mansour 1/94 -12/02 9 200 Oran Pr.Touhami 1/94 -12/03 10 387 SBA Pr.Zouaoui 2/94 -02/04 10 73 Tizi Ouzou Pr. Ait Ali 1/85 -12/99 15 81 Tlemcen Dr. Mesli 1/93 -12/03 11 98 9 1059

REPARTITION H et F , SEX-RATIO CENTRES Nbre/cas H. F. Sex-ratio Beni-Messous 113 59 54 1,09 Annaba 74 42 32 1,3 Béchar 33 17 16 1,06 Constantine 200 102 98 1,04 Oran 387 209 178 1,17 SBA 73 37 36 1 Tizi-Ouzou 81 44 37 1,2 Tlemcen 98 65 33 1,98 1059 575 484 1,18 54 % 46 %

TYPES HISTOLOGIQUES Villes Nbre/cas Histologie 1 2 3 4 ? 1 2 3 4 ? Beni Messous 113 5 ans Annaba 74 5 ans Béchar 33 9 ans 0 16 14 3 Cosntantine 200 8 ans 5 73 110 0 12 Oran 387 10 ans 17 41 205 112 12 SBA 73 10 ans 6 31 30 6 Tizi Ouzou Tlemcen 98 11 ans 25 49 13 4 784 53 210 372 125 24 7% 27% 47% 16% 3%

BILAN D ’EXTENSION CENTRES I II III IV Beni Messous 07 45 37 24 Annaba 17 28 15 14 béchar 00 08 07 18 Constantine 25 68 76 42 Oran 52 146 65 124 SBA 11 30 20 12 Tizi Ouzou 15 22 21 23 Tlemcen 21 32 19 26 Total 148 379 249 283 14 % 36 % 23 % 27 %

Évolutivité clinique Centres Evolutivité clinique A B Beni messous Annaba Béchar 5 15 % 28 85 % Constantine 71 35,5 % 129 64,5 % Oran 72 19 % 315 81 % SBA 26 36 % 47 64 % Tizi Ouzou Tlemcen Total 174 25 % 519 75 %

TRAITEMENTS CENTRES PROTO. Nbre Suivis RT Beni Messous 52 ABVD 94 100 % 42 ABVD Plt. Annaba 67 ABVD 73 67 % 7 ABVD Plt Béchar 19 ABVD 33 49 % 14 MOPP Constantine 200 ABVD 200 100 % Oran 317 ABVD 32 COPP 369 73 % 20 ABVD plat

TRAITEMENT (2) CENTRES PROTO. Nbre Suivis RT SBA 48 ABVD 09 MOPP ? 41 10 MOPP/ABV 06 autres Tizi Ouzou 70 ABVD 70 83 Tlemcen 83 ABVD 15 MOPP 98 83 08 autres

RESULTATS CENTRES RC Rin Echec Beni Messous. T 75 12 A 73 09 P 78 14 Annaba 84,5 5 3,5 Béchar 55 36 06 Constantine 66 15 19 Oran 62 28 9,5

RESULTATS 1059 PATIENTS 1019 SUIVIS 856 ABVD 84 % 69 ABVD PLAT 6,7 % 70 MOPP 7 % 14 AUTRES 1,3 % 10 MOPP-ABV 1%

RESULTATS (2) CENTRES RC Rin Echec SBA 76 16 08 Tizi Ouzou 86 5,7 8,5 Tlemcen 70 14 08 72 24 9,5

RESULTATS CENTRE Rechute DFS OS PDV Beni Messous A / / 90 % 17 % P / 25m 85 % 07 % Annaba / / / 07 % Béchar / / / 03 % Constantine 08 % / / / Oran 23 % IA IIA 81 89 20 % IIB IIIA 70 76 au delà IIIB IV 48 67 5 ans

RESULTATS CENTRE Rechute DFS OS PDV SBA / / / / Tizi Ouzou 15 / 79% 13% 6 ans Tlemcen / 73% 81% 5 ans 5 ans

COMMENT AMELIORER NOS RESULTATS ? DISCUSSION COMMENT AMELIORER NOS RESULTATS ? 1 - DC PRECOCE : * REDUIRE DELAI SYMPTOME DIAG. = 9 MOIS 9 MOIS = 9 ABVD ! 2 - AMELIORER GESTION MEDICAMENTS 3 - STRATEGIE THERAPEUTIQUE 3.1 - STADES LOCALISES : CT STANDARD = ABVD RT = 20 Gy. ? 40 Gy ?, CHAMPS, ...

QUELLE CT ? AVEC OU SANS RT DISCUSSION - 3.2 - STADES ETENDUS : QUELLE CT ? AVEC OU SANS RT Loeffler M et al. Meta-analysis of chemotherapy versus combined modality treatment trials in Hodgkin’s disease. J. Clin. Oncol. 1998, 16 : 818 (1740 patients : 16 essais) Andrieu J.M et al. MOPP versus ABVD and low-dose versus high dose irradiation in Hodgkin’s disease at intermediate and advanced stages : analysis of a meta-analysis by clinicians. J. Clin. Oncol. 1999, 17 :730 Loeffler M et al. In reply. J. Clin. Oncol. 1999, 17 : 732 Fermé C et al. Comparaison of chemotherapy to RT as consolidation of complete or food partial response after six cycles of chemotherapy in patients with advanced Hodgkin’s disease : Gela. Blood 2000, 95 : 2246.(418 patients)