Publications by Author: Nacer, R. Ahmed

2018
Mehdid F, Rekkab N, Oukid S, Abad MT, Bradai M, Hamdi S, Boukhemia F, Hamladji RM, Nacer RA, Allouda M, et al. Epidemiological Study of Aplastic Anemia in Algeria for 844 Cases over 10 Years (2007-2016). BloodBlood. 2018;132 :5109.Abstract
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.
Grifi F, Djenouni A, Bougherira S, Abad MT, Boucherit C, Boudjerra N, Zidani N, Aboura C, Aribi A, Belhani M, et al. Epidemiological Study on β-Thalassemia in Algeria. BloodBlood. 2018;132 :4902.Abstract
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.
2016
Boudjerra N, Oukid S, Abad MT, Aboura C, Louanchi L, Ramaoun M, Belhani M, Allouda M, Aftisse H, Ait-Ali H, et al. Descriptive Study of Diffuse Large B Cell Lymphoma in Algeria and Tunisia over a Period of 5 Years. BloodBlood. 2016;128 :5412.Abstract
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.
Hamdi S, Bentahar I, Harbadji H, Grifi F, Bougherira S, Filali T, Allouda M, Mesli N, Berber B, Bouzid K, et al. Epidemiology of Extranodal Diffuse Large B Cell Lymphomas in Algeria: A Study of the Algerian Group of Extranodal Lymphomas (GALEG). BloodBlood. 2016;128 :5403.Abstract
Introduction: Primitive extranodal lymphomas are a heterogeneous group of malignant lymphoid hematological developed from the mucosa-associated lymphoid tissue (MATL) or sites that have acquired MALT after repeated stimulation. The particularity of this type of affection reside: the access to diagnosis which is difficult and therapeutic approach which respond to the ATB, antiviral, surgery and RT. They represent 24-48% of lymph node lymphomas and they are increasing. The incidence of lymphoma is growing in the world, it is approximately 16.8 / 105inhabitants. In Algeria in 2012, the incidence of lymph node lymphomas in adults was 2.24 / 100,000. Lymphomas Diffuse large B-cell phenotype (DLBCL) represent 50-60% of lymphomas, it is the most common histological type. Goals of the study: 1-analyze the epidemiological characteristics (gender, age, geographical distribution, annual incidence). 2- Identify anatomical sites. 3- Specify the clinical and prognostic features Patients and methods: It’s is a multicenter, retrospective study over a period between 2010-2014. The study population included all pts over 15 years and having an extranodal DLBCL at 18 hematology centers and 4 cancer centers. Data were collected on data sheets distributed to the various services involved in the study. The diagnosis is made on the histological examination of a biopsy of the affected organ. The clinical, biological and imaging results allowed us to classify and identify prognostic factors for pts. Results: Among 1057 sheets of extranodal lymphomas, the type DLBCL is specified in 562 (53%) cases, distributed in 325 men and 237 women (sex ratio M/F: 1.36). The average age at diagnosis is 51 years (16-88) with a peak in the age group 50-60 years. The overall annual incidence of 0.31/105 inhabitants/year and the specific incidence for patients over 15 years is 0.42 / 105inhabitants/year. PS 0-1: 323 / 543pts (60%). Number of pts (pts) by place of care: Annaba 65, Sétif: 60, CAC Constantine: 53, Tizi Ouzou: 49, Blida Cac: 41, CMPC-hematology: 40, Tlemcen: 30, Beni- Méssous- hematology: 29, CAC CPMC: 24, EHUOran: 23, hematology CAC Batna: 22, CHU Oran: 19, HMRUO: 17, Blida-hematology: 16, HCA:16, SBA: 15, CAC Béni-Messous: 14, EPH Mascara: 10, HMRU Oran: 9, Bejaia: 7, hematology CHU Batna: 2, hematology Cne:1. Number of cases according to anatomical localisation: Stomach: 180, Intestine: 31, Colon 12, Tonsils: 70, Cavum: 31, nasal cavities: 11, Bones: 43, mediastinum: 41, SNC: 29, Skin: 25, Rate / MO :15, Thyroid: 12, soft Parties: 10, Breast: 6, lung / pleural: 5, Liver: 5, Others: 36. The clinical symptomatology is very heterogeneous, specifically of the affected organ. Clinical stage is specified in 549 cases, according to Ann Arbor: SCIE: 272 (49%), SCIIE: 149 (27%), SCIIIE: 31 (6%), SCIV: 97 (18%). The International Prognostic Index adjusted for age (IPIaa) include: for pts less than 60 years: Low (F): 70 (23%), lower intermediate (IF): 130 (43%), intermediate high (IE) : 69 (23%), high (H): 32 (11%); for over 60 years Topics: F: 33 (23%), MI: 53 (37%) IE: 41 (28%), E: 17 (12%). Comments: As with other types of lymphoma, there is a male predominance and a peak incidence in the age group 50-60 years. The higher number of pts in the center and east of the country is probably related to a denser population in these regions. The histological type DLBCL at 53% is in agreement whith what it is conventionally reported. The incidence of 0.31/105inhabitants/year extranodal DLBCL is lower than the overall nodal DLBCL, however, the incidence of extranodal NHL is rarely determined. The number of cases of extranodal lymphomas described in this study is certainly below the actual number because this group of disorders is supported by various specialties related to the location of lymphoma. Extranodal lymphomas has a clinical polymorphism, but it is recognized that gastric and tonsillar locations are the most common, the other despite their rarity, require attention from management. This type of lymphoma is characterized by a preponderance of localized stages unlike ganglion lymphomas where the extended stages predominate. Likewise distribution by IPIaa not exceeding one pejorative factor is more common. Conclusion: Extranodal DLBCL are rare, they are characterized by a diversity clinicopathological that challenges us to homogenization of their treatment in multidisciplinary level. Disclosures No relevant conflicts of interest to declare.