Le Centre Hospitalier Universitaire de Toulouse

The present review will examine bone disease in mastocytosis, analyze the existing literature on its management, and propose a strategy for osteoporosis treatment in systemic mastocytosis. This strategy is based on both the available scientific evidence and the experience gained at our expert center (CEREMAST).

Systemic mastocytosis is a rare disorder, primarily affecting the bone and leading to osteoporosis, bone pain, and bone structural abnormalities. While traditionally described in indolent systemic mastocytosis, bone involvement is also observed in bone marrow mastocytosis. The true prevalence of systemic mastocytosis is likely underreported, highlighting the importance for clinicians to be familiar with the condition, particularly in cases of osteoporosis. Osteoporosis management typically involves bisphosphonates, with potential benefits from combining them with specific treatments like interferon in severe osteoporosis with vertebral fractures. The potential of new mast cell-targeting molecules to treat bone involvement needs to be demonstrated.

This review provides a guide for osteoporosis and bone pain management in systemic mastocytosis.

Knee muscle strength recovery after anterior cruciate ligament reconstruction (ACLR) is crucial for a safe return to sport (RTS) but it is poorly described in the adolescent population. Therefore, we compared the knee muscle strength at 6 months post-surgery in adults and adolescents. We hypothesized a greater muscular strength in adolescents 6 months after ACLR.

This was a retrospective analysis of 55 adolescents (13-18 years old) and 76 adults (19-39 years old) who underwent ACLR with autograft bone-patellar-tendon-bone (BPTB), subjected to isokinetic tests 6 months after surgery. The following outcomes were analyzed: (1) the maximum torque of hamstrings (H) and quadriceps (Q) during flexion and extension at 30°/s normalized by body weight; (2) hamstrings to quadriceps strength ratio (HQ ratio); (3) injured to uninjured leg muscle strength ratio (limb-symmetry index, LSI).

Both adults and adolescents produced lower Q torque with the injured leg compared with uninjured, but similar H torque. In adolescents, the injured Q torque and the Q-LSI were higher compared with adults. In both populations, the Q-LSI was lower than the H-LSI and the HQ ratio in the injured leg was higher compared with uninjured. Adolescents showed a lower HQ ratio in injured legs.

At 6 months after ACLR both adolescents and adults did not recover Q strength in the injured leg. However, adolescents showed larger Q strength compared with adults. The HQ ratio analysis showed that 6 months after surgery both groups are not ready for a safe RTS.

Lung transplant (LT) recipients are at greater risk of complications from COVID-19. Treatment options are limited partly due to interactions with immunosuppressive agents. Convalescent plasma (CP) is a potential treatment option, but it has not been extensively studied in LT patients. We aimed to assess the efficacy and safety of CP use in France for COVID-19 infected LT patients.

We retrospectively recruited LT patients followed up in the 10 French LT centers, older than 18 years, infected with SARS-CoV-2 between the pandemic onset and July 1, 2023, and treated with high-titer CP.

We collected the data from 27 patients who received CP for a COVID-19 infection in six out of the 10 French LT centers. The average delay between symptom onset and CP administration was 19.5 days, and 51.8 % of patients received four units. In patients treated within the first 9 days of infection, the survival rate was 100 % at one and three months vs. 75 % (p = 0.28) for late administration patients. Average loss of forced expiratory volume in 1 second at three months was 10.5 % in the early group vs. 3.3 % in the late group (p = 0.58). The average length of hospital stay was 18 and 24 days respectively (p = 0.07). Early use of CP was also more frequent in 2023.

In this study highlighting the French experience for the use of CP in LT patients, we observed a limited, heterogenous but well-tolerated use of this therapy.