Our hematology and oncohematology teams made of 5 doctors and clinical pathologist combine their complementary expertise to facilitate the patient's management by the clinician at diagnosis and during therapeutic follow-up.
Lymphocytosis is a frequent anomaly of the hemogram, most of the time unexpected discovered at the white blood cell. Being without consequence in many benign cases (in particular in viral infections), it may also reflect a circulating phase of a lymphoproliferative malignancy. This book reviews the various diagnostic tools at our disposal to differentiate from a reactionnal lymphocytosis and a chronic lymphoproliferative syndrome (CLS). It emphasizes the importance of the morphological study of lymphoid cells on a blood smear, an absolutely necessary and sometimes sufficient step to demonstrate a reactional characteristik cytological aspect or to orientate towards a lymphoproliferative syndrome with specific cytology. The immunophenotyping by flow cytometry comes as a complementary tool to refine the diagnosis thanks to the existence of characteristic phenotypic profiles, based on the use of specific markers. Finaly, conventional and molecular cytogenetic techniques (karyotype and FISH) and molecular biology (B and T clonality) enable to clarify the diagnosis for atypical cases and provide prognostic elements that are essential for the therapeutic management of many lymphoproliferative disorders.
Haemoglobinopathies are genetic disorders that affect the protein portion of Hb. They are the most common hereditary disorders in the world: an estimated 7% of the world's population are heterozygous carriers. Endemic in some populations, haemoglobinopathies are becoming increasingly prevalent in Northern Europe due to population migrations. Although heterozygous subjects are generally asymptomatic, compound homozygous or heterozygous subjects are at risk of serious and even fatal complications known as major sickle cell syndromes and thalassaemias. The number of asymptomatic carriers in France is not known. In the case of symptomatic patients, however, more than 10,000 sickle-cell patients were listed in the national registers in 2009. Cases of thalassaemia major or intermedia are much rarer; only 380 patients have been reported and this number appears to be stable. The prevention of haemoglobinopathies involves screening of asymptomatic carriers for the sickle-cell trait or the thalassaemia trait.
Our guide « Recommendations for the execution and interpretation of haemoglobin tests » (download below) is intended to help clinical pathologists in using decision trees to diagnose haemoglobinopathies. It emphasises the importance of prescription and reminds the reader that haemoglobin (Hb) electrophoresis is insufficient when used alone.
For 10 years, a number of national and international clinicians have entrusted the genetic and biological monitoring of MGUS (monoclonal gammopathy of unknown significance) for 20,000 of their patients to Laboratoire Cerba. Our laboratory also plays a major role in the evaluation of new treatments and in understanding the biology of these conditions, by treating more than 6,000 patients a year in international clinical trials. To do this, we strive to pool the expertise necessary for these special tests on a single platform, thus facilitating therapeutic management for clinicians, who continue to submit their biological and genetic tests to us on behalf of their patients. The main challenge is to define the best strategy for treating such diseases, symptomatic multiple myeloma especially.
At diagnosis, the clinical management of these conditions involves an increasing number of specialist tests, from biology to genetics, which thus determine the diagnostic and prognostic criteria and treatment strategy.
During therapeutic follow-up, these parameters are used to define the criteria for response to treatment according to the recommendations by the HAS and the IMWG, International Myeloma Working Group.
Our brochure “comprehensive biological monitoring of multiple myeloma” (download below) describes all of the tests carried out by Laboratoire Cerba for the treatment of multiple myeloma.
Cancer is uncontrolled cell proliferation. This results from specific alterations acquired from the DNA of the cells. Molecular biology techniques, most recently Next Generation Sequencing (NGS), have allowed the identification of genetic determinants that affect the sensitivity of cancer cells to anticancer treatments. In blood disorders, it is the genetic abnormalities that must be identified in order to propose to groups of patients, with similar molecular characteristics, treatments adapted to the severity of the disease and / or targeted on the genetic abnormalities found. The number of patients requiring NGS analysis is constantly increasing. Drug prescriptions guided by molecular analyzes of cancers correspond to a medicine much more precise than conventional chemotherapy and which is, by extension, qualified as "personalized medicine" or "precision medicine". The continued arrival of new targeted therapeutics foreshadows a profound evolution of clinical practice in onco-hematology. The molecular analyzes implied by this precision medicine impose major technological and organizational evolutions in the laboratories. The learned societies and the National Cancer Institute have thus determined lists of clinically relevant genes by subtypes of hematological malignancies and whose sequencing is to be included in the diagnostic report. The Cerba Laboratory, at the forefront of innovation in the field of specialized biology, has on its Saint-Ouen-L'Aumône site, technology and technical expertise, bioinformatics and medical to perform these analyzes high-throughput sequencing in onco-hematology according to the recommendations of national and international learned societies. The Cerba Laboratory working in close interaction with clinical physicians, allows access to this precision medicine to a larger number of patients.
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