{"id":2060,"date":"2016-10-01T01:00:00","date_gmt":"2016-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/cas-cliniques-deux-diagnostics-de-deficit-en-dpd-en-une-semaine-epidemie\/"},"modified":"2018-10-20T18:40:22","modified_gmt":"2018-10-20T16:40:22","slug":"cas-cliniques-deux-diagnostics-de-deficit-en-dpd-en-une-semaine-epidemie","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/cas-cliniques-deux-diagnostics-de-deficit-en-dpd-en-une-semaine-epidemie\/","title":{"rendered":"Cas cliniques. Deux diagnostics de d\u00e9ficit en DPD en une semaine : \u00e9pid\u00e9mie?"},"content":{"rendered":"<p><strong>2016<\/strong><\/p>\n<p><em>A.PELAQUIER, G. BARJONET, C. BRUGERE, M.POUSSIER, H. OSMAN, Service d&rsquo;H\u00e9pato-Gastro-Ent\u00e9rologie et de chirurgie visc\u00e9rale, CH MONTELIMAR<\/em><\/p>\n<p><strong>Gastroent\u00e9rologie <\/strong>&#8211; \u00a02016-05-18 &#8211;\u00a0CO &#8211;<\/p>\n<p>________________________________<\/p>\n<p>CAS CLINIQUES<br \/>\nDeux patients de respectivement 68 et 72 ans, en cours de traitement adjuvant par FOLFOX, apr\u00e8s colectomie partielle pour n\u00e9oplasie colique stade III, ont faits l&rsquo;objet d&rsquo;une recherche positive en d\u00e9ficit en dihydropyrimidine deshydrog\u00e9nase (DPD). Ce d\u00e9ficit est partiel pour les deux patients. Le diagnostic a \u00e9t\u00e9 pos\u00e9 suite \u00e0 une d\u00e9faillance multivisc\u00e9rale (aplasie f\u00e9brile profonde, abc\u00e8s p\u00e9rin\u00e9al, ict\u00e8re, confusion&#8230;) d\u00e9butant \u00e0 J1 de l&rsquo;ablation de l&rsquo;infuseur, lors de la deuxi\u00e8me cure de chimioth\u00e9rapie, pour le premier patient; et \u00e0 des neutrop\u00e9nies avec complications infectieuses r\u00e9currentes, impactant le bon d\u00e9roulement du traitement adjuvant et la qualit\u00e9 de vie du deuxi\u00e8me patient.<br \/>\nCes d\u00e9ficits ont \u00e9t\u00e9 diagnostiqu\u00e9s \u00e0 une semaine d&rsquo;intervalle, la gravit\u00e9 du premier patient ayant permis, par retour d&rsquo;exp\u00e9rience imm\u00e9diat, d&rsquo;\u00e9voquer la probable mutation du g\u00e8ne DPD du second malade. <\/p>\n<p>Des actions d\u2019am\u00e9liorations ont alors \u00e9t\u00e9 envisag\u00e9es, planifi\u00e9es et mises en \u0153uvre dans le service et en RCP, suite \u00e0 ces deux \u00e9v\u00e9nements ind\u00e9sirables li\u00e9s aux soins.<\/p>\n<p>Les d\u00e9ficits en DPD se manifestent principalement au niveau du tractus digestif et de la moelle osseuse, voire du syst\u00e8me nerveux central, et peuvent aboutir \u00e0 une toxicit\u00e9 polyvisc\u00e9rale grave, potentiellement mortelle, chez les patients trait\u00e9s par 5 FU. Elles ont pu \u00eatre rapport\u00e9es \u00e0 des d\u00e9ficits en DPD, partiels ou complets, dont les fr\u00e9quences dans la population sont estim\u00e9es \u00e0 3-5 % et 0,2 % respectivement.<\/p>\n<p>Le d\u00e9pistage des d\u00e9ficits en DPD, dont le r\u00e9sultat est d\u00e9livr\u00e9 en 7 \u00e0 10 jours, est parfaitement compatible avec l\u2019administration du 5-FU et des prodrogues orales en pratique clinique courante. Cette recherche doit \u00eatre accompagn\u00e9s d\u2019un conseil th\u00e9rapeutique, puisque le diagnostic de d\u00e9ficit, m\u00eame majeur, ne contre-indique le plus souvent pas l\u2019administration de fluoropyrimidine, sous r\u00e9serve d\u2019une surveillance \u00e9troite clinique, par dosages pharmacocin\u00e9tiques et adaptation individuelle des doses.<br \/>\nLes enjeux th\u00e9rapeutiques, et m\u00e9dicaux ne sont donc pas n\u00e9gligeables, et impliquent de rechercher imp\u00e9rativement cette mutation devant toute mauvaise tol\u00e9rance au 5 FU. Se doit-elle d&rsquo;\u00eatre recherch\u00e9e syst\u00e9matiquement en amont d&rsquo;un traitement par 5 FU et plus particuli\u00e8rement avant un traitement adjuvant?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>2016 A.PELAQUIER, G. BARJONET, C. BRUGERE, M.POUSSIER, H. OSMAN, Service d&rsquo;H\u00e9pato-Gastro-Ent\u00e9rologie et de chirurgie visc\u00e9rale, CH MONTELIMAR Gastroent\u00e9rologie &#8211; \u00a02016-05-18 &#8211;\u00a0CO &#8211; ________________________________ CAS CLINIQUES Deux patients de respectivement 68 et 72 ans, en cours de traitement adjuvant par FOLFOX, apr\u00e8s colectomie partielle pour n\u00e9oplasie colique stade III, ont faits l&rsquo;objet d&rsquo;une recherche positive en [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[27],"class_list":["post-2060","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-27"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Cas cliniques. 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