Introduction: The aim of this work is to establish an epidemiological approach of aplastic anemia (AA) in Algeria, to identify the different therapeutic strategy and the patients outcomes.

Material and methods: This is a retrospective multi-center epidemiological study over 10 years (from 01 January 2007 to 31 December 2016). The source of information is represented by the medical files and the consultation sheets. The collection of information is ensured by the fact sheets established and distributed to the departments Hematology and Pediatrics at the national level.

Results: A total of 844 cards were received, concerning 844 patients including 746 adults and 94 children. The overall incidence of the disease is 0.21, it varies from 0.16 to 0.28 / 100000 inhabitants / year depending on the year. The average age is 34.7 years with extremes ranging from 1 month to 91 years, the sex ratio (M / F) is 1 (420/424). In adults there is a slight male predominance: sex ratio is 1.11 (421/378). AA is acquired in 806 patients (95.4%) and congenital in 38 patients (4.6%). Among the acquired AA: idiopathic = 694 (86.1%), toxic = 18 (2.23%), viral: 17 (2.1%): HBV = 13, HCV = 3, HIV = 1, drug = 13 (1.6%), gestational = 9, (1.1%), hematopoietic tuberculosis = 1. The presence of an HPN clone in 55 out of 261 patients studied was 21%, associated with a dysimmunitary disease = 5. In congenital AM, Fanconi anemia = 35, Blackfand-Diamond = 2, congenital dyskeratosis = 1. The prognostic classification according to the Camitta criteria and the EBMT criterion: out of 540 evaluable records found: very severe = 83 (15.3%), severe = 291 (53.8%), moderate = 166 (30.7%). CsA-SAL reference immunosuppressive therapy was instituted in only 49 pts (13.1%) with severe and very severe forms. It resulted in a hematologic response in 18 patients (36.5%), 15 patients died and 16 patients were probably lost to follow-up. Three hundred and twenty-seven pts (38.7%) received allogeneic hematopoietic stem cell transplant at CPMC (n = 316) and EHU (n = 11); = 277), Fanconi anemia (n = 44), amgacaryocytosis in its aplastic form (n = 3), erythroblastopenia in aplastic form (n = 2), untagged constitutional medullary aplasia (n = 1). As of 31/12/2016: 344 pts are alive, 208 died, 194 lost sight of and 98 pts whose fate is not specified on the cards.

Conclusion: AA is a rare , the incidence is 0.2 / 100000 inhabitants / year. It affects young adults with a slight male predominance in adults, idiopathic forms are in the foreground and severe forms predominat

Disclosures

No relevant conflicts of interest to declare.

Introduction : Among genetic diseases in hematology, β Thalassemia ranks second after sickle cell disorders in Algeria. Given the seriousness and cost of the care that arises, a national action plan is needed. As a starting point, a national survey is essential to know the epidemiological situation of this disease.

Objective : To determine the soci-demographic, diagnosis and evolution characteristics of major and intermediate thalassemia in Algeria.

Materiels and Methods : This is a multicenter, retrospective, analytical study of 775 patients with thalassemia major (TM: 598 cases) and intermediate (TI: 177 cases). This national survey is representative of 21 services (Hematology: 19, Pediatrics: 03). The data was collected from medical records on a survey card distributed to all relevant services.

Results : As of January 1, 2017, the prevalence of β Thalassemia estimated from this study is of the order of 3.47 cases per 100 000 inhabitants. The current average age of major thalassemia (MT) is 17.90 years, with extremes of [1-44 years], that of intermediate form (IT) is 23 years old with extremes of [1-61 years], the sex ratio is 1.15. The concept of consanguinity is specified in 499 patients and is present in 49.30% of cases, the geographical origin of patients is variable, 53% are from the center of the country and 43% from the east. The circumstances of the diagnosis are known in 87.25% of subjects, these are clinical symptoms in 93.91% of patients, with an average age at diagnosis of 16.31 months for MT and 5.5 years for IT. The diagnosis is neonatal in only 5.68% of cases. Blood cells transfusion needs are known in 80% of our cohort, 86% receive a systematic and regular diet; 554 patients are on chelation therapy, the main modality being deferoxamine or Deferasirox type monotherapy. 40 MT patients received Hematopoetic Stem Cell Transplantation. The monitoring of iron overload was based mainly on the determination of ferritinemia, only 8.8% of patients received cardiac and hepatic MRI. Various complications associated with iron overload have been reported, the most common being: Hepatic injury (48%), heart disease (36%), diabetes (30%), hypothyroidism (29.17). %), with average ages of onset of 26.67, 18, 19, and 14.50 years, respectively. In addition, viral serology was performed in 536 patients, 64 (11.9%) of whom were carriers of anti-HCV Ab.

Conclusion : The quality and life expectancy of thalassemic patients has improved significantly in recent years; complications related to iron overload remain the leading cause of death, the means of evaluation remain insufficient in our country. In addition, the care of our patients must be standardized on the national territory.

Disclosures

No relevant conflicts of interest to declare.

Introduction: Multiple myeloma (MM) is the second hematological malignancy in Western countries with varying incidence across countries and ethnicities. In France, the incidence rate in 2012 is 4.2 in men and 2.0 in women, in USA it is 5.6 but in the population of African origin it is 11.1. In Maghreb, the incidence is 1,1 in Algeria and Morocco and 1.4 in Tunisia in 2004. Although epidemiological transition has taken place in our country, the results of epidemiological data on cancers in general and hematological malignancies in particular are remarkably different from those described in the Western literature.

Aims : Two epidemiological approaches were carried out in Algeria, the first covering a period of 12 years (1995-2005) and the second of 2006-2012, the incidence of MM was the same of 1.1 and 1.01 respectively. These were retrospective studies with the limitations of this type of study, hence the need to create a register that would collect the data in a prospective and real-time manner. This register, known as AMMR (Algerian Multiple Myeloma Registry) belongs to the SAHTS (Algerian Society of Hematology), was created in 2014 after obtaining the approval of the Ministry of Health. The objectives of this register are:

- Obtain reliable epidemiological data

- Describe the profile of Algerian patients (pts)

- To have an analysis of the diagnostic approaches in all the hematology departments

- And measure diagnostic and prognostic difficulties.

The AMMR is a prospective, observational, multicenter study.

Materials and methods: With the support of a contracted clinical research company, we developed a 19 pages case report form (CRF) which registered all newly pts with MM, plasmocytomas. The main registered variables at diagnosis are patient demographics, disease characteristics, complications, biology, imaging, diagnosis, prognosis and only one item on treatment. All hematology services (17) participated in the study with the help of 23 investigators to inform the CRF. The diagnostic criteria used are those of the IMWG 2003, the prognosis is evaluated according to the classification of Salmon and Durie and the International Staging System.

Results: Thus, 1010 pts are collected during these 2 years, 505 men and 505 women. The median age is 63 years (29-100 years), 53% are under 65 years, 13% under 50 years and 18% more than 75 years old. The age-standardized incidence rate (world population WHO 2000-2025) of MM for the year 2015 is 1.71 / 10⁵ inhabitants (1.75 for men and 1.68 for women). In this series: 975 pts (96.53%) are secreting MM and 20 non-secretory MM(1.98%), 4 plasmocytoma (0.40%) and 2 plasma cell leukemias (0.20%). According to the geographical distribution, 62% of the patients are in the middle of Algeria, 19% of the western region and 19% of the eastern region. Among the risk factors for the occurrence of MM, a MGUS is found in 16 pts, a professional activity at risk in 96 pts of which 57 workers of the earth. The clinical feature at diagnosis is dominated by bone syndrome since 92% have bone symptoms, pain in 80.4% of cases and pathological fractures for 96 pts (12%). Neurological signs related to medullary compression are described in 89 pts, anemia is the second complication (56% of the pts). Biological characteristics, the immunological type are IgG type in 50.67% of cases, IgA in 26.36%, light chains in 21.64% of the secreeting MM. All the pts are classified according to the classification of Salmon and Durie, 82% are stages III and 13% of the stages II, among them 24% are classified B. The ISS classification is used in 72% of the pts, with 16.21% stage I, 18.56% stage II and 36.92% stage III. Flow cytometry is performed only in 45 pts (4.5%) and cytogenetics in only one patient.

Comments and conclusion: This study shows that the number of pts with MM is important in our country: more than 1000 in 2 years, whereas the previous data did not exceed 350 pts/year. The median age is 63 years, with 53% under 65 years candidates for therapeutic intensification. On the other hand the incidence is 1.71 higher than the two previous studies; this is explained by the rigor of the prospective studies but not by an increase of the frequency. The data collected still show pts diagnosed later (82% stage III) with complications. We deplore the lack of genetics study for our pts. The AMMR is the first hematological malignancy registry in Algeria, is a reliable data bank, which will allow us to claim more diagnostic, pronostic assessment and care for our pts.

Disclosures

No relevant conflicts of interest to declare.

Background: Diffuse Large B Cell Lymphoma (DLBCL) is the most common form of aggressive non-Hodgkin's lymphoma (NHL) accounting for approximately 40 % of all NHL cases. The aim of our study is to carry out an epidemiologic description and to compute the incidence of DLBCL in 2North African countries, Algeria and Tunisia.

Patients and methods: This is a multicenter retrospective and descriptive study, covering a period of 5 years (January 2010 - December 2014), carried out in 17 centers in Algeria and 5 centers in Tunisia. Patients aged less than 15 years were excluded. We used the classification of World Health Organization. We used Epi info 6 software to analyze the data.

Results: 1432 cases were identified, 1175 in Algeria and 257 in Tunisia. The sex distribution of DLBCL was as follows: males 837 (58.4 %), females 591 (41.6 %), male-to-female ratio 1.40. The age of patients ranged from 16 to 96 years (median 52 years) and 64.2 % of the patients are less than 60. The incidence estimates for the years 2012 and 2013 are respectively 0.86 and 0.87 for 100,000 inhabitants. The most frequent occupation of the cases is farmworker (11.5%). The average time between the date of diagnosis and clinical examination is 31 days. The average delay between the first clinical sign and the date of diagnosis is 133 days. A familial history of cancer is found in 10% of the cases. The lymph node biopsy was undertaken in 30.7% of the cases in the cervical area and in 15% of cases in the mediastinal area. A reexamination of the slides was undertaken in 20% of cases while 61.6% of them were found to be advanced clinical stages (III + IV). Splenomegaly was found in 16% of the cases and hepatomegaly in 7%. ORL damage was found in 16% of the cases and marrow infiltration in 10.2%. A Prognostic Score IPI ≥ 2 is found in 38% of the patients.

Comments: On a previous Algerian study concerning all lymphomas diagnosed over a period of 6 years (2007-2012) (Journal of Hematology No. 10-11, 2015), 485 new cases of lymphoma were diagnosed on average per year. In the present study, the average number of new cases of DLBCL was 235 and the average proportion was 48% of all lymphomas. It should be emphasized that all cases underwent an immunohistochemical study and that lymphatic cases were excluded (digestive, bone, skin). The national incidence rate is low compared to that of international studies, a fact that is probably due to difficulties in the diagnosis including lack of implementation of immunohistochemistry techniques in our region.

Disclosures

No relevant conflicts of interest to declare.

Introduction: Chronic myeloid leukemia (CML) accounts for 7%-15% of all leukemias affecting adults. The incidence in Algeria is 0.4/100,000 inhabitants in 2009. The aim of this study is to establish an Algerian-Tunisian epidemiological approach of CML and to know the characteristics of the disease in both countries.

Materials and methods: This is a retrospective, longitudinal and multicenter study, including Algerian and Tunisian patients with CML diagnosed between January 2010 and December 2014. Through a data form distributed to various hematology departments, we collected and analyzed the following information: Patient's general characteristics, profession, circumstances of discovery of the disease, clinical and para-clinical examinations outcomes at the time of diagnosis including blood count, blood smear, bone marrow aspiration, cytogenetics, molecular biology, stages of the disease and the Sokal and Eutos prognostic classification scores. Bio-statistical tests: incidence, prevalence and rate of prevalence or relative prevalence (reported to 100,000 inhabitants / year). The descriptive analysis of quantitative and qualitative variables as percentages and 95% confidence interval. The Chi2 test is used to compare two variables.

Results: We collected 1349 cases, including 325 from 06 Tunisian hematology units and 1024 from 18 Algerian units. The incidence in the Algerian-Tunisian population was 0.67/100,000 inhabitants with a prevalence rate of 2.72/100,000 inhabitants. The incidence in Tunisia was 0.50 / 100,000 inhabitants with a prevalence of 227 cases in 2014. In Algeria the incidence was 0.53/100,000 inhabitants with a prevalence of 1030 in 2014. The median age is 48 years (03-90) with a peak incidence in the age group (45-49 ans) and slight male predominance (sex ratio: 1,2). There was any notion of risk exposure. The average time between the start of the unrest and the date of diagnosis is 127 days (1-667). The circumstances of discovery: fortuitous in 30.5% (n = 355), splenomegaly in 39.7% (n = 463), asthenia in 24.6% (n = 287), a complication in 8.4% (n =95). Clinical examination includes general signs in 424 cases (36.4%): Weight loss 22.6% (n = 263), profuse sweating 13.8% (n = 13, 8%), bone pains found in 7.8%, splenomegaly in 81.7% (n = 952) with an overhang splenic average of 11.5 ± 5.3 cm (1-28), cutaneous and subcutaneous bleeding: 13.5% (n = 97), thrombosis 0.9% (n = 09). Biological characteristics: the Complete blood count (n = 1185) shows a white blood cells average rate of 171,223 G/L (34,700-984,800), hemoglobin average rate of 10.2 g/dl (4-17), platelets at 394,070 g/l (85-1340). Blood smear 96.3% (n = 1121): the average myelemia was 43.2% (10-98%). The Myelogram is practiced in 55% (n = 641), the average rate of the granular 76,5% (40-99%), erythroblasts 10.5% (0-82%), average blasts 3.6%. The karyotype 38.1% (n = 444), the Philadelphia chromosome was found in 423 cases (95, 3%); additional abnormalities were found in 17 cases (3.8%). The Fish was practiced in 281 cases (24.1%) and transcribed bcr/abl was found in 257 cases (91.4%). Molecular biology is practiced in 672 cases (57.7%) the transcript bcr/abl is found in 100%, the transcript of the type is specified in 373 cases, it is kind of b2a2 in 159 cases (42.6%), a b3a2 type in 180 cases (48.3%) and other transcribed in 34 cases (9.1%). CML chronic phase is diagnosed in 88.8% (n = 1051), acceleration phase in 9% (n = 107) acutisation phase in 3.1% (= 37). The distribution of pts according to Sokal prognostic classification (n = 948) describes a predominance of intermediate risk in 54% (n = 511), high risk in 30.3% (n = 287) and low risk in 16% (n = 152). The Eutos score is specified in 769 cases (66%), it is less than 87 in 661 cases (86%) and more than 87 in 108 cases (14%).

Conclusion: The incidence of CML in the Algerian-Tunisian population is 0.67/100,000 population with a prevalence rate of 2.72/100,000 inhabitants. The young adult is more affected with a peak incidence between 45 and 49. The average time between the onset of the disease and the diagnosis remains long and the delay probably explains the frequency of tumor forms encountered in Algeria and the prevalence of high and intermediate risk, according to Sokal prognostic classification.

Disclosures

No relevant conflicts of interest to declare.

Introduction: Chronic lymphocytic leukemia (CLL) is the most frequent leukemia of the adult in Europe and North Africa. It is rare on the Asian and African continents. It affects mainly elderly people over 60 years. The main objective is determining the rate of average annual incidence, and secondly establishing the distribution of this complaint according to the different health regions of the country and precise the epidemiological characteristics.

Patients and Methods: It is a national, descriptive, retrospective epidemiological study carried out for a period of 05 years : from January 2009 to December 2013. Information collection is done thanks to the setting up of a technical data sheet sent out to the appropriate services. This technical data sheet is about the geographic data of the patient (place of birth, place of residence, place of taking charge of the disease and the date of the diagnosis), anthropologic data (age at the diagnosis, sex), as well as the clinico-biological data. The working of the responses was done on SPSS 19 .0. In our study, the diagnosis is carried before an hyperlymphocytosis > 5000/ mm³, a cytological examination of the blood smear and an immunophenotyping operation by cytometer operation in flow.

Results: 17 hematology departments have participated in this study with 1210 cases listed, of which 68,1% (824 pts) are men. The average annual recruitment is of 242 cases. The average annual incidence rate, calculated according to the data of the national statistics office is estimated at 0,66 / 100.000 inhabitants.This incidence does not increase over the years and stays relatively stable (2009 = 0,67; 2010 = 0,57; 2011 = 0,63; 2012 = 0,67; 2013 = 0,74/100.000 inhts). The geographic distribution of the pts according to their places of residence, shows that the majority among them are from the north of the country particularly the center (0,80/100.000 inhts). Incidence increases over age, going among men from 0,06 for 100.000 inhts between 30 - 39 years to 11,94 / 100.000 inhts at 80 years and over and among women from 0,04 for 100.000 inhts to 6,08 for 100.000 inhts. The average incidence rate is of 0,85/100.000 inhts among men and of 0,42/100.000 inhts among women. The average age at the diagnosis is of 67,5 years (33 - 98 years). 30,1% (365 pts) incident cases are observed among the patients over 75 years and 14,1% (171 pts) among the patients below the age of 55 years. The profession that is most found is farming 12.2% (78/635 precised). The diagnosis is late in Algeria, the first symptome which brings the patient to consultation is the tumoral syndrome (44% (363 / 825 precised)) in an average diagnosis period of time of 07 months (01 - 96 months). The stage C (classification of Binet) is equally predominant, found in 41,1% (492 / 1172 precised). In terms of biology : the average rate of lymphocytes is of 92500/mm3 (5000-900 000/mm³). The morphological study on blood smear finds 88,2% (1066 / 1208 precised) of typical CLL and 50% of Gambrest cells. The cytometer operation in flow done in 746 cases (61,6%) shows a score of matutes > 4 in 92,3% and in 7,7% is equal to 3. the cytogenetic operation (Caryotype and Fish) done in only one hematology department (CAC of Blida) among 102 patients (8.4%).

Comments: The rate of incidence in Algeria is weak compared to that of other countries. The rate of incidence standardized to the world population is of 0,52 cases/100.000 inhts and to the European population is of 0,68 cases p 100.000 inhts. The young age of the population may explain this incidence and that some patients at the stage A are not diagnosed. The CLL affects more frequently men. The average age at the diagnosis is of 67,5 year. However, 30,1% of the incident cases are observed among the patients over 75 years in Algeria versus 45 à 50% of incident cases in Europe and this may be explained by the young age of our population. The CLL are placed 5th among the malignant hemopathies: the rate of incidence for the year 2009 : LNH = 1.96; LH = 1.2; MM = 0.96; AML = 0.85; CLL = 0.67; CML = 0.44; ALL = 0.32.

Conclusion: the CLL can be diagnosed and differentiated from the other lymphoproliferative syndromes thanks to the morphological examination of the lymphocytes at the blood smear completed by an immunophenotyping operation of the peripheral blood . This study represents only an epidemiological approach of the CLL in Algeria. The incidence is still weak in our country; it affects as in the other countries the elderly people with a masculin predominance.

Disclosures

No relevant conflicts of interest to declare.