Introduction: Geriatric interventions (GI) are specialized care or strategies aimed to improve or palliate impairments affecting several aspects of the older adult condition (e.g. autonomy, nutritional status, cognition, social situation). In the general geriatric population, programmes linking a multidimensional geriatric assessment with interventions and follow-up are effective for improving functional status and survival of the patients.

La dépression, préoccupation majeure de santé mentale pour l'OMS, est particulièrement fréquente et sous diagnostiquée chez les personnes âgées. Les études sur la dépression du sujet âgé sont rares en Afrique subsaharienne et en particulier au Sénégal.Le but de cette étude était de déterminer les caractéristiques de la dépression dans une population de personnes âgées sénégalaises reçues en consultation.Il s'agit d'une étude rétrospective, descriptive à visée analytique, chez des patients âgés de 65 ans et plus vus en consultation de gériatrie au CHU de Fann du 1er janvier 2015 au 31 décembre 2018. Les caractéristiques sociodémographiques, cliniques, thérapeutiques et évolutives ont été analysées.Notre échantillon était constitué de 784 dossiers de patients âgés de 65 ans et plus. L'âge moyen des patients était de 73 ans ± 7 ans avec un sexe ratio H/F = 0,53. La prévalence de la dépression était estimée à 5,23 %. Les comorbidités étaient dominées par l'hypertension artérielle (63,41 %), les pathologies ostéoarticulaires (22 %), le diabète (15 %) et les antécédents d'accident vasculaire (15 %). Parmi les facteurs de risque, seules les séparations (divorces et autres) ont été retrouvées associées à la dépression de façon significative (p = 0,016). Les inhibiteurs sélectifs de la recapture de la sérotonine étaient les plus utilisés comme traitement. Il était constaté un bon niveau d'implication familiale (90 %) ce qui pourrait être considéré comme une forme de psychothérapie augmentant l'adhérence au traitement. Chez 51,6 % des patients l'évolution était favorable.Chez les patients sénégalais âgés en dépression, les comorbidités sont dominées par les pathologies cardiovasculaires et seules les séparations sont un facteur de risque associé à la dépression de façon significative. Une bonne implication familiale est à conseiller car étant un facteur important de guérison.Depression, a major mental health concern for WHO, is particularly common and underdiagnosed among older people. Studies on depression among the elderly are rare in sub-Saharan Africa and particularly in Senegal.The aim of this study was to determine the epidemiological, clinical, therapeutic and outcome characteristics of depression in a population of elderly Senegalese people in the geriatrics department of the FANN Teaching Hospital in Dakar.This was a retrospective, descriptive, analytical study among patients aged 65 and over seen in geriatric consultation at Fann University Hospital from January 1, 2015 to December 31, 2018. Sociodemographic, clinical, therapeutic and outcome characteristics were analyzed.Our sample consisted of 784 records of patients aged 65 and over. The mean age of the patients was 73 ± 7 years with a gender ratio M/F of 0.53. The prevalence of depression was estimated at 5.23 %. Comorbidities were dominated by hypertension (63.41 %), osteoarticular pathologies (22 %) diabetes (15 %) and a history of stroke (15 %). Among the risk factors, only separations (divorce and other) were found to be significantly associated with depression (P = 0.016). Selective serotonin reuptake inhibitors were the most commonly used treatment. There was a good level of family involvement (90 %) which could be considered to be a form of psychotherapy increasing adherence to treatment. For 51.6 % of patients the outcome was favorable.Depression remains a reality in our context. Among patients with depression, comorbidities were dominated by cardiovascular pathologies, and only separations were found to be significantly associated with depression. Good family involvement should be promoted because it is an important factor in recovery.

e19699 Background: The majority of cancer incidence and mortality occurs in individuals aged older than 65 years, and the number of older adults with cancer is projected to significantly increase. As such, understanding the changes accompanying age in the context of the cancer patient is of critical importance. Age-related changes can impact tolerance of anticancer therapy and can shift the overall risk-benefit ratio of such treatment. It is increasingly recognized that several laboratory markers may predict morbidity and mortality in older adults; these biologic variables may further aid in stratifying this group of patients based on risk. In this study we evaluated. In this study we examine inflammatory and angiogenic markers in cancer patients classified according to there age in older adults. Methods: Using ELISA test circulating Il-6, TNF alpha and vegf were measured in the sera of 80 patients with different cancer of whom 38 (48%) were female in comparison to 40 healthy controls.Three groups of patients were studied, the first consisted of 25 patients (age 30-40 years); the second of 25 (age 40-70 years), the third group of 30 elderly persons (>70 years). Results: Serum IL-6 and VEGF levels were higher in cancer patients as compared to control group.serum IL-6, TNF alpha and VEGF levels were higher in cancer patients as compared to control group. When patients were classified according to their age, a significant age-related increase of IL-6 and VEGF were observed (p=0.009 and 0.034 respectively) but not with TNF alpha. Furthermore, high IL-6 and VEGF level were associated with further functional adverse outcomes. Conclusions: A specific inflamatory and angiogenic status exist for elderly patients. the increased level of these markers might predispose these patients to clinical manifestations and non tolerence of the treatment. However, a study comparing these parameters only in elderly patients (> 70 years) and relation to there clinical status are necesseary to confirme these results.

e19614 Background: Nutritional aspects remain an important problem in elderly cancer patients care and cure. However, the real impact of chemotherapies regimens in elderly patients is not clearly e...

e19662 Background: More and more elderly cancer patients are treated with cytotoxic agents. Elderly patients represent an heterogeneous population in which anticancer therapeutic decision is often difficult and consequences of chemotherapy regimens not clearly established notably in term of renal aspects. Physiological changes such as declining renal function are particularly associated with aging. The present study was conducted in order to evaluate the impact on renal function in a series of elderly cancer patients treated by common chemotherapies regimens. Methods: From May 2005 to October 2009, 375 patients aged over 70 years with solid malignancies were systematically treated by common chemotherapies regimens and registered in a prospective databank at the salpetriere hospital, in Paris, France. Glomerular filtration rate (GFR) was estimated at baseline and before every chemotherapeutic cycle by creatinine clearance (CrCl) measurements. CrCl was calculated by the Cockcroft-Gault formula and values were in ml/min. CrCl under 30 (IV) was defined as severe renal impairment, between 30–60 (III) moderated renal impairment, 60–80 (II) low renal impairment and over 80 (I) normal function. Results: One hundred sixty five male and 210 female with a mean age of 76.3 years (range 70-101.3) were evaluated. Each patient received between 1 to 16 lines of chemotherapy (median of 2) for a total of 1135 lines. More than 75 % of patients had a colorectal, breast, lung, ovary and prostate cancer treated regarding common chemotherapies guidelines. At baseline out of 375 elderly patients, 68 patients (18.1 %) presented a CrCl noted I, 119 (31.7 %) presented a CrCl noted II, 188 (50.1 %) presented a CrCl noted III. At the last evaluation, did not significantly change during the course although a certain decrease of CrCL was found in most of the patients comparing to baseline values. Conclusions: In this representative cohort of elderly cancer patients treated by standard chemotherapeutic regimens, there is no significant impact on the renal functions. However, regarding the degree of the decrease of the glomerular function, physicians must be aware in order to give adapted dose regimen. No significant financial relationships to disclose.

9505 Background: Elderly patients represent an heterogeneous population in which anticancer therapeutic decision is often difficult and may be helped by CGA. We report 2 years activity of the geriatric assessment consultation of our institution, and its impact on therapeutic decision Methods: Since January 2007, we propose a geriatric consultation for elderly cancer patients for whom therapeutic decision appears complex to oncologists. This consultation included a CGA, with focuses on items like comorbidity, dependance, cognitive impairment, depression and malnutrition using international well known scales. Results: 161 patients (57 men, 104 women) (median age 82,4 years, extremes 73 -97) were seen at the geriatric consultation. Most of the patients (134/161) were in fist line treatment for colorectal (54), other digestive (28), breast (30) and pulmonary (14) cancers. Cancer was metastatic in 86 patients (53 %). Geriatric assessment found: severe comorbidity (grade 3 or 4 in CIRS-G scale) in 75 patients, dependance for at least one activity of daily living (ADL) in 52 patients, cognitive impairment in 42 patients, including 13 patients with already diagnosed Alzheimer disease, malnutrition in 104 patients (65 %), depression in 39 patients. According to prior oncologist decision, there have been no change in therapeutic decision in 29 patients only. Geriatric interventional treatment was delivered to 122 patients (76 %). Anticancer treatment was changed in 79 patients (49 %), including delayed therapy in 5 patients, less intensive therapy in 29 patients and more intensive therapy in 45 patients. Patients for whom final decision was delayed or less intensive therapy had significantly more frequent severe comorbidity (23/34, p < 0.01) and dependance for at least one ADL (19/34, p < 0.01). Patients for whom final decision was more intensive therapy had significantly more frequent metastatic disease (33/45, p < 0.01) Conclusions: Geriatric evaluation did influence therapeutic decision in 82 % of the patients. Follow up data will be presented to evaluate quality of final therapeutic decision, especially data concerning dose intensity and toxicity for patients with a more intensive therapy final decision. No significant financial relationships to disclose.

Les cryoglobulinémies sont de véritables complexes immuns précipitant au froid. La cryoglobuline peut rester une anomalie biologique isolée ou être responsable d’une vascularite des vaisseaux de petit calibre avec une atteinte préférentielle de la peau, des articulations, du système nerveux périphérique et du rein.D’importantes avancées physiopathologiques et thérapeutiques ont fait suite à la découverte du virus de l’hépatite C, reconnu comme la cause majeure des cryoglobulinémies. Les facteurs associés à la production d’une cryoglobulinémie mixte sont le sexe féminin, une consommation d’alcool supérieure à 50 g/j, une fibrose hépatique extensive et la présence d’une stéatose. Le caractère symptomatique de la cryoglobuline (vascularite) est associé à un âge avancé, une durée d’infection plus longue et aux caractéristiques de la cryoglobulinémie elle-même (type II, IgM kappa, taux sériques élevés). Tous les acteurs du système immunitaire sont impliqués dans la physiopathologie complexe : immunité humorale, immunité lymphocytaire B et T. Un rôle direct du virus lui-même est plus douteux. La combinaison Peg-interféron-alpha plus ribavirine permet d’obtenir une réponse virologique et clinique de la vascularite cryoglobulinémique chez 70 % des patients. Le rituximab (anticorps anti-CD20), utilisé dans les formes résistantes, permet d’obtenir une bonne réponse chez 80 % des patients, mais avec une rechute chez 42 %, sept mois après la dernière perfusion.De nouvelles stratégies associant le rituximab et une combinaison anti-virale par Peg-interféron-alpha et ribavirine sont en cours d’évaluation. Des essais contrôlés multicentriques seront indispensables pour mieux préciser les séquences thérapeutiques optimales.Cryoglobulinemia are immune complexes that may induce systemic cryoglobulinemic vasculitis. Cryoglobulin may be an isolated biological abnormality or may induce clinical manifestations of a systemic vasculitis, involving the skin, the joints, the peripheral nerve system and the kidneys.During the last 15 years, major advances have been obtained after the discovery of the hepatitis C virus, the main cause of cryoglobulins. Main factors associated with cryoglobulin production are female gender, alcohol intake above 50 g per day, extensive liver fibrosis and steatosis. Symptomatic cryoglobulins (i.e., vasculitis) are associated with older age, longer duration of infection and main characteristics of cryoglobulin itself (type II, IgM kappa, high serum levels). The pathophysiology is complex and involves humoral immunity, B and T cellular immunity, but not directly the virus itself. Peg-interferon-alpha and ribavirin combination leads to a virological and clinical response of the vasculitis in about 70% of patients. In non responders, recent open series suggested the efficacy of rituximab with a good response in up to 80% of patients, but a relapse in 42% seven months after the last infusion.New therapeutic strategies include a combination of best antiviral treatment with Peg-interferon-alpha plus ribavirin and rituximab. Multicenter controlled trials are mandatory.

Le myélome est une hémopathie maligne dont la fréquence augmente avec l’âge. Au cours des dix dernières années, sont apparues trois nouvelles molécules qui représentent une avancée majeure dans le traitement de cette affection, en particulier chez les personnes non éligibles pour une autogreffe (personnes âgées). Il s’agit du thalidomide, du bortézomib et du lénalidomide. Bien qu’il persiste des inconnues en matière de réponse, de posologie et de toxicité dans la population âgée non sélectionnée, l’association melphalan–prednisone–thalidomide tend à devenir le traitement de référence du myélome multiple des personnes de plus de 65 ans.

OBJECTIVES AND SETTINGS: The authors had for aim to study the incidence of symptomatic urinary infections (SUTI) in elderly patients, to describe their clinical and microbiologic characteristics and first-line treatment in a geriatric hospital with 902 beds: 124 in acute care (ACF), 293 in rehabilitation and intermediate-care (RICF), and 485 in long-term-care-facilities (LTCF).During two months in 2003, all positive urine cultures detected by the laboratory were sent to the clinician with a questionnaire on clinical signs, diagnosis of SUTI and antibiotic treatment.SUTI was diagnosed in 85 out of 204 positive urine cultures (40%). The incidence of SUTI was 1.86 per 1,000 patient-days (with rates of 2.63, 2.49, 1.41 per 1,000 patients-days for the ACF, RICF, LTCF respectively). For 51 cases (60%) there were only general symptoms, for 24 cases (28.2%) there were only urinary symptoms, and for 10 cases (11.8%) there were both. Escherichia coli and Proteus mirabilis were the main bacterial species involved in 57 and 14% respectively. E. coli strains were 59% resistant to amoxicillin, 55% resistant to amoxicillin-clavulanic acid, and 39% resistant to fluoroquinolones. The main antibiotics were fluoroquinolones, ceftriaxone, and amoxicillin-clavulanate, prescribed respectively in 52.5, 19, and 9% of the cases.SUTI was diagnosed in only in 40% of positive urine cultures from elderly patients hospitalized in our hospital. To improve the management of SUTI in this population, we changed our recommendations for diagnosis and treatment.

Objectives and settings. - The authors had for aim to study the incidence of symptomatic urinary infections (SUTI) in elderly patients, to describe their clinical and microbiologic characteristics and first-line treatment in a geriatric hospital with 902 beds: 124 in acute care (ACF), 293 in rehabilitation and intermediate-care (RICF), and 485 in long-term-care-facilities (LTCF).Method. - During two months in 2003, all positive urine cultures detected by the laboratory were sent to the clinician with a questionnaire on clinical signs, diagnosis of SUTI and antibiotic treatment.Results. - SUTI was diagnosed in 85 out of 204 positive urine cultures (40%). The incidence of SUTI was 1.86 per 1,000 patient-days (with rates of 2.63, 2.49, 1.41 per 1,000 patients-days for the ACF, RICF, LTCF respectively). For 51 cases (60%) there were only general symptoms, for 24 cases (28.2%) there were only urinary symptoms, and for 10 cases (11.8%) there were both. Escherichia coli and Proteus mirabilis were the main bacterial species involved in 57 and 14% respectively. E. coli strains were 59% resistant to amoxicillin, 55% resistant to amoxicillin clavulanic acid, and 39% resistant to fluoroquinolones. The main antibiotics were fluoroquinolones, ceftriaxone, and amoxicillin clavulanate, prescribed respectively in 52.5, 19, and 9% of the cases.Conclusion. - SUTI was diagnosed in only in 40% of positive urine cultures from elderly patients hospitalized in our hospital. To improve the management of SUTI in this population, we changed our recommendations for diagnosis and treatment. (C) 2007 Elsevier Masson SAS. Tous droits reserves.

Les objectifs de l’évaluation gériatrique globale sont de décrire réellement les patients âgés atteints de cancer, de diagnostiquer et traiter leurs comorbidités et d’adapter les traitements anticancéreux à l’état réel de ces patients plutôt qu’à leur âge. Des essais cliniques ont montré la valeur pronostique de paramètres gériatriques comme la comorbidité. La validation de grilles de dépistage gériatrique est importante pour que tous les patients âgés cancéreux puissent bénéficier d’une évaluation gériatrique.

Background: Treatment of elderly patients with metastatic breast cancer (MBC) is not clearly defined and seems to vary according to the subjective appreciation of the physician.Patients and methods: After interviewing 107 French specialists qualified in oncology, data concerning 1009 MBC patients were collected: 500 patients were between 65 and 74 years and 509 were > 75 years of age. Differences in diagnosis and treatment strategy were analyzed for both age groups to identify the physician's criteria of choice and the eventual use of the geriatric assessment among those criteria.Results: At diagnosis, synchronous metastatic disease was more frequent in patients over 75 years old (52% versus 39%; P < 0.001). Physicians indicated that treatment was based on age and on a subjective evaluation of the patient's general status. Sixty-eight per cent of younger patients and only 31% of older ones received chemotherapy (P < 0.001). In the older group drug doses were lower than those usually recommended in three-quarters of cases. Only 10% of physicians considered that they under-treat patients using the FEC 50 regimen. Over 75 years of age, hormone therapy was offered to most patients, including 8% with hormone-independent tumors. Geriatric covariates were never considered. Geriatricians rarely, if ever, played a role in the therapeutic decision.Conclusions: Inclusion of elderly patients with MBC in prospective trials is warranted to define standards of care and reduce heterogeneity in the decision-making process.

Background: Anemia of MDS is common in elderly patients. Recombinant Erythopoietin (EPO) alfa or beta, when used alone, improves anemia in 20 to 30 % of MDS in general population. In older patients with MDS, anemia is usually treated by transfusion supportive regimens. We report the results of a prospective study we conducted on the use of Epoetin Beta in anemic elderly patients with MDS. Patients and Treatment: Inclusion criteria were patient aged 75 years and over with MDS chronic anemia requiring transfusion or Hb exclusion of other causes of anemia. Patients were treated with Epoetin beta 150 IU/ kg x 3/week during at least 8 weeks. In the absence of response, Epoetin beta dose was increased to 300 IU/ kg x 3/week and a new evaluation made after 8 weeks. Response was evaluated based on IWG criteria. In patients responding to Epoetin Beta, intervals between injections were adjusted to maintain Hb levels between 11 and 13g/dl. Seventy five patients (25 men, 50 women), median age 87.7 years (75 – 103), median creatinine clearance (CrCl) 36 ml/min (15 – 86) were included. They were classified as follows, 1 RARS, 54 RCMD, 17 RAEB1, 2 RAEB2, 1 5q- syndrome. There was not statistically significant correlation between pretreatment serum epo level and CrCl. Anemia was associated with neutropenia and/or thrombopenia in 19 patients and required transfusion in 44 patients. Karyotype was not performed in most of the patients. The median interval between onset of anemia and study treatment was 9 months (range 4 – 48). None of the patients had previously received EPO alfa or beta or Darbopoetin. Results: Sixty one of the 75 patients (81 %), including the patient with 5q- syndrome, had major erythroid haematological improvement (EHI) (transfusion independence in formerly transfused patients or rise of at least 2 g/dl of haemoglobin level in formerly non transfused patients). EHI was obtained with Epoetin beta lowest dose in 50/61 patients. No effect was seen on granulocytes and platelets. No side effects were observed. The response rates were 85 %, 68.5 % for RCMD and RAEB, respectively (p=NS). Pretreatment serum epo level was lower in responding patients than in non responding patients (median level 34 and 104 UI/l respectively, p or Conclusion: In elderly patients with MDS, EPO appears to be an effective treatment to correct anemia. Our results may be superior to those obtained in general population because of lowest pretreatment serum EPO levels and more frequent low risk MDS in elderly patients. In studies evaluating the effect of EPO on the anemia of MDS patients, response rates should be analyzed according to age especially if old and very old patients are included.

Journal of the American Geriatrics SocietyVolume 53, Issue 5 p. 913-914 NEW BASES FOR PERCUTANEOUS CAVAL FILTER PLACEMENT ON SITE IN GERIATRIC INSTITUTION IN PATIENTS AGED 75 AND OLDER Alain F. Le Blanche MD, PhD, Alain F. Le Blanche MD, PhD Radiology and Medical ImagingSearch for more papers by this authorCatherine Marteau MD, Catherine Marteau MD Geriatric Department ‘La Triade’Search for more papers by this authorSorina Sime-Bohus MD, Sorina Sime-Bohus MD Radiology and Medical ImagingSearch for more papers by this authorEric Pautas MD, Eric Pautas MD Unit of Acute Geriatric MedicineSearch for more papers by this authorJean-Yves Beinis MD, Jean-Yves Beinis MD d' Heur & Delatour Geriatric FoundationSearch for more papers by this authorFrançois Piette MD, François Piette MD Geriatric Department ‘La Triade’, Charles Foix University Hospital, Ivry-sur-Seine, FranceSearch for more papers by this authorPascal Chaibi MD, Pascal Chaibi MD Geriatric Department ‘La Triade’, Charles Foix University Hospital, Ivry-sur-Seine, FranceSearch for more papers by this author Alain F. Le Blanche MD, PhD, Alain F. Le Blanche MD, PhD Radiology and Medical ImagingSearch for more papers by this authorCatherine Marteau MD, Catherine Marteau MD Geriatric Department ‘La Triade’Search for more papers by this authorSorina Sime-Bohus MD, Sorina Sime-Bohus MD Radiology and Medical ImagingSearch for more papers by this authorEric Pautas MD, Eric Pautas MD Unit of Acute Geriatric MedicineSearch for more papers by this authorJean-Yves Beinis MD, Jean-Yves Beinis MD d' Heur & Delatour Geriatric FoundationSearch for more papers by this authorFrançois Piette MD, François Piette MD Geriatric Department ‘La Triade’, Charles Foix University Hospital, Ivry-sur-Seine, FranceSearch for more papers by this authorPascal Chaibi MD, Pascal Chaibi MD Geriatric Department ‘La Triade’, Charles Foix University Hospital, Ivry-sur-Seine, FranceSearch for more papers by this author First published: 04 May 2005 https://doi.org/10.1111/j.1532-5415.2005.53278_4.xCitations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume53, Issue5May 2005Pages 913-914 RelatedInformation

8218 Background: Nearly 2/3 of MCC patients (pts) are over 70 years (y) old (Yancik, Cancer, 2002). O, I, F, and L are the mainstay of MCC treatment (Grothey, JCO, 2004). Chronotherapy (CT) enhances tolerability and/or activity of these drugs (Lévi, Cancer 2003). Methods: This study assessed the relevance of a combined Comprehensive Geriatric Assessment (CGA, Balducci, Oncology, 2000) and drug dose adjustment, at baseline, for improving outcome of 35 MCC pts ≥ 70 y receiving high dose CT. Dose adjustments are based on CGA result as well as on tolerability of prior O, I, F-containing regimens, if it existed. Treatment consisted of either 4-day chrono FLO q 2 weeks (w) through a multichannel pump (Mélodie, Aguettant, F) (15 pts, starting doses: F, 2800, L, 1200, O, 80 mg/m2/c) or 5-day chrono IFLO through Mélodie q 3 w (20 pts, starting dose: I, 180; F, 2800; L, 1200; O, 80 mg/m2/c). A CGA was performed at baseline for 24 pts (69%). Results: Median age: 74 years (70–85); Female/Male: 15/20; number of organs involved: 1/2/3+: 13/14/8 pts; sites of metastases: Liver/Lung/Peritoneum: 30/18/7 pts. Prior chemotherapy lines: 0/1/2+: 10/5/20 pts. 51% pts had drug doses reduction at first course (c) by ≥15%. A total of 239 c were administered, with a median of 6 c (2–28). Main grade 3–4 CTC toxicities were fatigue (66% pts, 18% c), neutropenia (31% pts, 9% c), diarrhea (31% pts, 5% c), sensory neuropathy (57% pts). Major toxicities requiring hospitalization were observed in 31% pts (7% c). One pt died of grade 4 febrile neutropenia with septic shock. Stable disease and objective response were obtained in 19 and 9 pts, respectively (RR= 26%). Median time to progression is 4.6 months (m). At 1 year, overall survival rate is 38% [95% CI, 23 to 56]. The CT regimen did not influence survival. Pts who had both CGA and dose adjustment experienced fewer hospitalizations for toxicity (p < 0.0001), less fatigue (p = 0.02) and tended to survive longer (48 vs 13% at 1-year, p = 0.02). Conclusion: Elderly pts with MCC benefit from systemic chronotherapy. Efficacy and tolerability of administered drugs are improved by a combined geriatric and oncologic management. No significant financial relationships to disclose.

We report a case of primary plasma cell leukaemia, with an absolute count of plasma cells of 53 Giga/L, diagnosed in a 83-year-old woman. The patient's condition improved, with no circulating plasma cells after 3 weeks of treatment, in response to the combination of thalidomide and dexamethasone administered for 5 days followed by thalidomide alone. The clinical presentation, the morphological, flow cytometric and pathophysiological characteristics of the plasma cell leukaemia and the treatment are summarised in this paper.