Academic literature on the topic 'G 60 UL 2011 F486'

Background:The risk for opportunistic infections in patients with autoimmune diseases requiring intensive immunosuppressive therapy is high and cytomegalovirus (CMV) infection is one of the most common opportunistic infections. Since 2011, we have performed weekly CMV pp65 antigen testing for patients at risk of opportunistic infections owing to autoimmune diseases to ensure appropriate patient management.Objectives:To evaluate the risk factors that predict CMV infection in patients that received remission-induction therapy for autoimmune diseases.Methods:We enrolled 254 patients (93 male, 161 female) from our hospital with autoimmune disease and who received remission-induction therapy with prednisolone at a dose greater than 0.5 mg/kg/day between January 2011 and December 2018. We retrospectively analysed their clinical characteristics and laboratory data, including treatment regimens and CMV pp65 antigen test results. The presence of more than five CMV pp65 antigen-positive cells over two slides was considered a positive result. We conducted univariate and multivariate analyses to extract CMV risk factors.Results:Of the patients we evaluated, 60 suffered from systemic lupus erythematosus (SLE), 55 from anti-nucleolar cytoplasmic antibody-associated vasculitis (AAV), 31 from dermatomyositis (DM), 14 from interstitial pneumonia with anti-aminoacyl tRNA synthetase antibody, 14 from adult-onset Still’s disease (AOSD), 14 from rheumatoid arthritis (RA), 11 from mixed connective tissue disease (MCTD), 10 from Takayasu’s aortitis, and 45 suffered from other autoimmune diseases. Pulse therapy with methylprednisolone (mPSL) and immunosuppressive reagents were administered to 103 (40.6 %) and 97 (38.2 %), respectively. The median follow-up period was 61.0 days, and 66 patients became CMV pp65 antigen-positive during this period (SLE, 15; DM, 14; AAV, 9; AOSD, 8; and other, 20). Univariate analysis revealed that when compared to patients testing negative for the CMV pp65 antigen patients testing positive had lower total lymphocyte count (TLC) (825 /uL vs. 1220 /uL; p < 0.01), a lower serum albumin level (2.70 g/dL vs. 3.30 g/dL; p < 0.01), a higher HbA1c level (6.3 % vs. 5.9 %; p<0.01), and were older (66.0 vs. 59.5 year old; p < 0.01). Forty-nine of the 66 patients in the positive group received mPSL pulse therapy (p < 0.01), and 38 received immunosuppressive reagents (p < 0.01). Logistic regression analyses indicated that a higher age by decade (OR; 1.46 [95%CI 1.06 - 2.00]), a lower TLC per 100/uL (OR; 0.83 [95%CI 0.73 -0.94]), a higher HbA1c level per 1% (OR; 2.37 [95%CI 1.25-4.53]), and mPSL pulse therapy (OR; 3.92 [95%CI 1.33-11.5]) were risk factors for CMV pp65 antigen positivity.Conclusion:Higher age, lower TLC, higher HbA1c, and treatment with mPSL pulse therapy were risk factors for acquiring CMV infection, as measured by the presence of the CMV pp65 antigen, in patients receiving remission-induction therapy for autoimmune diseases. Careful monitoring of these, at risk, patients is necessary.Disclosure of Interests:None declared

Abstract Background: There is evidence of a leukemogenic effect of purine analogues, mainly when combined with DNA-damaging agents. Various series report an approximately 5% rate of t-MDS/AML in patients treated with a fludarabine-based regimen. Patients are generally old, and old age is associated with worse outcomes. To date, there is no established standard therapy recommendation for this group of patients, and results of prospective treatment evaluations are scarce. Aim: To determine the characteristics and treatment outcomes of patients with CLL and t-MDS/AML. Methods: We analyzed a group of 6 patients with newly diagnosed t-MDS/AML who were treated in our institution from September 2011 to July 2014. Patients were enrolled in a phase II trial of azacitidine (75 mg/m2 IV daily x 5 days) in combination with vorinostat (200 mg orally three times daily x 5 days) (Arm A) or azacitidine alone (Arm B), with courses repeated every 3-8 weeks. This trial was designed to uniformly treat patients not eligible for other leukemia protocols due to comorbidities. Results: At baseline, all patients had an underlying diagnosis of CLL that was in remission or minimally active. The median percentage of CLL bone marrow involvement was 10% (range 0-60%), and ALC was 0.9 K/uL (range 0.2-9.79). The median number of prior CLL treatments was 2 (range 0-3). All patients had previously received fludarabine-based regimens. The median time from chemotherapy to t-MDS/AML diagnosis was 10 years (range 4-10). All patients were male, and the median age was 72 years (range 52-72). All patients had 3-line cytopenia, with median WBC 2.3 K/uL (range 0.8-8.9), ANC 0.55 K/uL (range 0-1.22), hemoglobin 9.6 G/DL (range 8.3-10.4), platelets 39 K/uL (range 6-80), and bone marrow blast percentage of 5% (range 1-18%). The karyotype was complex in all patients. Molecular studies showed that 3 patients had TP53 gene mutations. Five patients received treatment in Arm A, and only 1 patient was randomized to Arm B. Patients received a median of 4 cycles (range 2-7) and remained in the study for a median time of 216 days (range 86-329) before progression. None of the patients achieved remission, but stable disease was observed in 5 out of 6 patients. At the time of this analysis, 4 patients are dead and 2 are still alive: one discontinued treatment because of prolonged myelosuppression and is receiving best supportive care, and the other is recovering from cycle number 4 of treatment. The median survival in the group from the time of treatment initiation was 10.1 months and from the time of study discontinuation was 3.1 months. Further therapy was attempted in 3 patients without response. Conclusion: This is a group of patients with poor prognostic features. Azacytidine and vorinostat have been previously reported to be a safe combination (Garcia-Manero et al. ASH 2010, abstract 604) and may constitute a reasonable treatment alternative. Further prospective studies involving larger numbers of patients are required. Abstract 5627. Table 1: Baseline Patient Characteristics. Patient Age WBC K/uL Hb G/DL Plt K/uL BM Blast % CLL BM % Cytogenetic Molecular Prior CLL Treatments Treatment Arm Best Response 1 52 11 9.6 6 18 60 -3,-4,-5q,-6,-7, -7p,-12, +16 TP53 mutation 1.FCR x 62. Rituximab + Lenalidomide A NR 2 74 1 10 41 3 10 -3p,-5q,-7,-15,-17,-19 TP53 mutation 1. FCR x 42. FCR x 53. BR x 2 A SD 3 68 2.2 9.4 27 6 30 +7,-7p,t(7,21) Negative 1. FCR x 62. FCR x 4 B SD 4 73 2.3 9.7 39 6 0 +2,-5q,+8,-17,-18,+19,+20,-Y Negative 1. FCR x 6 A SD 5 71 0.8 8.3 39 4 0 +2,+4,t(5;17),+6,-7,-9, +13, +15,-16,-17,+18,+19,-20,+21 Negative 1. FR x 12. BR x43. MEDI-551 A SD 6 74 2.4 10.4 80 1 10 t(1;3),inv3,-5q,-18 TP53 mutation 1. R-CHOP x 62. BR x 13. FCR x 4 A SD WBC: White blood cells, Hb: hemoglobin, Plt: Platelets, BM: Bone Marrow, CLL: Chronic Lymphocytic Leukemia, F: Fludarabine, C: Cyclophosphamide, R: Rituximab, B: Bendamustine, MEDI-551: anti-CD19 antibody, NR: no response, SD: stable disease. Disclosures O'Brien: Amgen, Celgene, GSK: Consultancy; CLL Global Research Foundation: Membership on an entity's Board of Directors or advisory committees; Emergent, Genentech, Gilead, Infinity, Pharmacyclics, Spectrum: Consultancy, Research Funding; MorphoSys, Acerta, TG Therapeutics: Research Funding. Kantarjian:ARIAD, Pfizer, Amgen: Research Funding.

Abstract Abstract 4326 Background: Extramedullary (EM) disease is a well-known manifestation of acute myeloid leukemia (AML). Despite its recognized incidence, little is known about organ-specific EM-AML, including genitourinary (GU) AML. The purpose of this study is to identify the patients (pts) who develop GU-AML and to characterize the clinicopathologic, cytogenetic, and molecular features of this population. Methods: A database of 2,181 consecutive patients who were diagnosed with AML and underwent induction therapy from 2000 to 2011 at M.D. Anderson Cancer Center was reviewed retrospectively. All pts with histologically proven EM-AML were included in this series. Clinicopathologic, cytogenetic, and molecular data were examined and statistically analyzed. Results: A total of 1,120 pts underwent at least one EM biopsy and 244 were diagnosed with EM-AML. Of these, 9 pts (6 females) demonstrated GU-AML (0.4% of total population, 3.7% of EM-AML pts). Furthermore, 3 GU-AML pts demonstrated additional EM-AML in non-GU sites. At AML dx, GU-AML pts demonstrated median bone marrow blasts of 35% (range 1–69%) and median peripheral blood blasts of 1% (range 0–46%). CBC included median WBC of 3.5 K/uL (range 1.6–21.0 K/uL), median Hgb level of 9.4 g/dL (range 8.0–14.3 g/dL), and median platelet count of 118 K/uL (range 28–206 K/uL). Median age of AML dx in GU-AML pts was 45 years (range 28–69 years) and was significantly younger than the median age of AML dx in all other non-GU pts (60 years, range 12–89 years, p=0.025, Student's t-test). A total of 78% of GU-AML dx were made before or at AML presentation and 89% of GU-AML dx were made within 3 months of AML presentation. A total of 67% of GU-AML pts demonstrated cytogenetic abnormalities. Cytogenetic features included inversion 16 (inv (16), 33%), trisomy 8 (33%), diploid (33%), trisomy 22 (22%) and complex (22%). For all pts with GU-AML, no molecular mutations were present in RAS (0/9), FLT3 (0/7), NPM1 (0/2) or JAK2 (0/2). CR was achieved by 78% of pts with GU-AML. The pts who did not achieve CR expired early in induction therapy (within 29 days) due to sepsis. Of the GU-AML pts with CR, CR duration was 50.7 months (95% CI 15.2–86.2 months). CR duration of GU-AML pts was significantly longer than that of EM-AML pts with no GU sites (18.0 months, 95% CI 14.1–22.0 months, p=0.03, Kaplan-Meier method). Overall survival (OS) for all GU-AML pts was 41.6 months (95% CI 12.7–70.5 months) and was statistically equal to OS of pts without GU-AML and to OS of EM-AML pts with no GU sites. Conclusion: GU-AML is a rare but noteworthy manifestation of AML that tends to be diagnosed before or at AML presentation. Pts with GU-AML developed AML at a significantly younger age by 15 years than pts without GU-AML (p=0.025). Most GU-AML pts demonstrated cytogenetic abnormalities but none demonstrated molecular mutations. The presence of GU-AML, rather than EM-AML in other sites, may contribute to extended duration of CR (p=0.03). However, despite this finding and other advantages such as majority achievement of CR and young age of AML dx, there was no statistical advantage in OS in pts with GU-AML compared to those pts without GU-AML or to pts with EM-AML in non-GU sites. Disclosures: No relevant conflicts of interest to declare.

Abstract Telomeres, the terminal complex of hexameric repeats and shelterin protein of linear chromosomes, shorten with every mitosis. Telomere attrition is accelerated in patients with mutations in telomerase complex genes (Calado and Young, NEJM 2009) and with replicative stress, as in chronic bone marrow failure. Historically, male hormones were effective in some patients with aplastic anemia (AA), and case reports and retrospective observations have suggested hematologic improvement in patients with telomeropathies treated with male hormones. Exposure of normal lymphocytes and CD34+ cells to androgens increased telomerase activity in vitro, and in cells from individuals carrying loss-of-function TERT mutations to normal levels (Calado et al. Blood 2009). We have conducted a phase I/II single-center trial (www.clinicaltrials.gov NCT01441037) assessing the safety and the effect of male hormones on telomere attrition in patients with telomere disease. Entry criteria included age-adjusted mean telomere content ≤1%ile, ± identified mutations in telomerase complex genes, and low blood counts (hemoglobin <9.5g/dL, platelets <30,000/uL, or neutrophils <1,000/uL) and/or pulmonary fibrosis. Danazol, 800 mg/day, was administered for 2 years. Primary protocol objectives were safety and activity of danazol in slowing telomere attrition. Secondary endpoints were hematologic response at 3 and 6 months (increase in hemoglobin >1.5 g/dL or platelets >20,000/uL or neutrophils >500/uL). Twenty seven patients were enrolled, accrual commencing August 2011. Most patients had moderate (n=20) or severe (n=4) AA, one had myelodysplasia, and two pulmonary fibrosis. Median age was 41 years (range 17-66); 15 patients were females. There was only one severe adverse event possibly related to drug. Frequent reported symptoms were muscle cramping with dehydration and exacerbation of headaches. Changes in serum lipid profiles were observed in all patients, with increased serum LDL and decreased HDL. Severe elevation in liver enzymes was not observed. One death occurred on study, not treatment related (pneumonia in a pulmonary fibrosis case). Mean telomere content of leukocytes at enrollment was compared with mean telomere content at 6, 12, and 24 months on drug as well as available samples before starting danazol. Telomere attrition prior to protocol entry, determined by q-pcr, was estimated at loss of 227 bp/year (95% CI, 58-368bp; p=0.009). Androgen administration appeared to elongate telomeres: the average increase in telomere length at 6 months was 205 bp (95% CI, 82-329 bp; p=0.002), at 12 months 441 bp (95% CI, 263-620 bp; p=0.0001), and at 24 months 347 bp (95% CI, 87-607 bp; p=0.01). A similar trend of increase in mean telomere content with danazol was confirmed in flow-sorted lymphocytes. Hematologic response rate, as defined by protocol, was 67% at 3 months and 60% at 6 months. Nine of eleven patients who required RBCs became transfusion-independent; two of them also became platelet transfusion independent. Liver cirrhosis was present in 6 patients at enrollment; worsening of liver disease in one occurred with continued alcohol abuse. To date 8 patients have completed two years of danazol, all of them responders; 10 patients remain on danazol, and 9 patients stopped drug prior to 2 years. Blood counts in all patients have been stable with drug discontinuation, with median follow up of 258 days (range 31-335). In conclusion, male hormones are safe and efficacious in patients with inherited bone marrow failure associated with telomeropathies, producing clinically meaningful hematologic improvement. Increased mean telomere content in patients, suggests that in vitro demonstration of up-regulation by sex hormones of TERT and of telomerase enzymatic activity is the mechanism of action of androgens in vivo. To our knowledge, this is the first successful prospective effort to favorably modulate telomere length by pharmacologic intervention in humans. Sex hormones may be useful in other conditions of accelerated telomere attrition, as for example after chemotherapy, and other drugs and small molecules may be usefully screened for their effects on telomerase in vitro. Disclosures Off Label Use: we want to determine if treatment with male hormone danazol is safe and improves hematologic response as first-line treatment in patients with AA and telomere disease(www.clinicaltrials.gov NCT01441037)..

Abstract Metastatic disease of the bone is a rare complication of chronic lymphocytic leukemia (CLL), it may be result from richter's transformation or metastatic from non lymphoid malignancies. CLL is the most common form of adult leukemia, with the median age of 70 years at diagnosis [Siegel et al. 2013]. The diagnosis is established by blood counts, blood smears, and immunophenotyping of circulating B-lymphocytes.The result is the increased number of lymphocytes in the peripheral blood, leukocytosis with absolute lymphocytosis, the increase of the lymphnodes, the increase in size of the spleen. The diagnosis of chronic lymphocytic leukemia B requires the presence of Clonal B cells in the peripheral blood at or above 5,000 / ul for at least 3 months. Typing immunophenotypical pathological lymphocytes are positive for surface antigens CD5, CD19, CD23, weakly positive for CD20 and CD22, generally negative FMC7 and CD79b; also expressing surface immunoglobulins. The Rai and Binet staging systems, which are established by physical examination and blood counts, have been recognized as standards for deciding whether to begin treatment. Patients with active or symptomatic disease or with advanced Binet or Rai stages require therapy. For fit patients, chemoimmunotherapy with fludarabine, cyclophosphamide, and rituximab represents the current standard therapy. For unfit patients, treatment with an anti-CD20 antibody (obinutuzumab, rituximab, ofatumumab) plus a milder chemotherapy (Chlorambucil) may be applied. At relapse, if the treatment-free interval exceeds two to three years, the initial treatment may be repeated, if the disease relapses earlier, drugs such as bendamustine (plus rituximab), alemtuzumab, lenalidomide, ofatumumab, ibrutinib, or idelalisib, must be choosen. Patients with a del(17p) or TP53 mutation can be treated with ibrutinib or a combination of idelalisib and rituximab. in relapsing patients with TP53 mutations or del(17p) or patients that are refractory to repeated chemoimmunotherapies, an allogeneic SCT may be considered [Hallek M 2015]. In this article we show a case of a 66-year-old man with CLL and a bone localization. In 2011 diagnosis of CLL, Rai Stage 0, Binet Stage A. Principal characteristics at diagnosis: HB 13.2 g /dl, White Blood Cells 15.800 / mm3, lymphocytes 61%, neutrophils 32%, monocytes 4%, platelets 141.000/mm3; normal hepatic end renal function; flowcytometric immunophenotyping of the peripheral blood revealed B-cell CLL; prognostic factors: CD38 negative, ZAP70 positive, rearrangement of the immunoglobulins mutated; FISH: negative; CT chest / abdomen / pelvis: presence of multiple aorto-pulmonary and axillary adenopathies (max diameter of 2 centimeters); bone marrow biopsy: infiltration of CLL equal to 60% of global cellularity. The patient was only observed until January 2015, when he was hospitalized due to acute anemia, requiring supportive therapy, and right foot pain . So it was decided to re-evaluate the whole disease in order to decide whether to start chemotherapy. The disease was staged again with instrumental and laboratory tests: presence of renal insufficiency, egd and colonoscopy negative, Coombs' test negative, bone marrow biopsy confirmed the diagnosis of chronic lymphocytic with bone marrow infiltration of 90%, abdomen ultrasound showed only moderate splenomegaly. On February, persistence of right foot pain and appearance of swelling, assessed by the orthopedic as a suspected algic and dystrophic syndrome. So he suggested to perform scintigraphy which revealed: pronounced inflammatory osteometabolic reaction of the right tibia/fibula/ankle third distal which could be referred, in the first evaluation, to algic and dystrophic syndrome. However, a local biopsy was performed: localization of chronic lymphocytic leukemia. On March 2015 a total body TC showed 2 nodular calcifications in the right lung lobe, multiple right paratracheal, barety space, aortopulmonary and axillary adenopathies. Prostate size increased. In order to study carefully the liver and prostate lesions, an ultrasound abdomen was performed that documented only enlarged spleen, normal size liver, free of focal disease, increased prostate due to symmetric bilobate hypertrophy . After the second cycle of chemotherapy, prolonged thrombocytopenia, so he continues only with a radiotherapy program. Disclosures No relevant conflicts of interest to declare.

Abstract Abstract 654 Unrelated cord blood (UCB) transplantation is a useful alternative for patients with hematological malignancies or non-malignant hematological disorders lacking an HLA matched donor. However, outcomes for patients with severe aplastic anemia (SAA) undergoing either a single or dual UCB transplant have been disappointing. A recent EBMT/ Eurocord study reported engraftment and 3 year survival rates of only 51% and 38% respectively (Perrault de Latour, Biol Blood Marrow Transplant 2011). We investigated whether co-infusion of a single UCB unit with CD34+ selected cells from a haploidentical relative following a highly immunosuppressive conditioning regimen could improve transplant outcome for patients with SAA refractory to immunosuppressive therapy that lack an HLA matched donor. Subjects with SAA and life-threatening neutropenia (ANC <500) refractory to 2 or more immunosuppressive agents were eligible for enrollment if they lacked an HLA matched related or unrelated donor. Conditioning consisted of cyclophosphamide (120 mg/kg), fludarabine (125 mg/m2), equine ATG (160 mg/kg) and one dose of 200 cGy of total body irradiation. Patients received a G-CSF mobilized, T-cell depleted CD34+ selected stem cell product prepared from a haplo-identical donor using the Miltenyi CliniMacs system combined with a single ≥ 4/6 HLA antigen matched UCB unit. Eight patients with treatment refractory SAA (median age 18 years; range 9–20), including 1 patient with SAA evolved to MDS, have been transplanted. All patients were platelet and RBC transfusion-dependent with severe neutropenia (median ANC 60 neutrophils/ul; range 0–260). Patients were at high risk for graft rejection, being heavily transfused, having failed a median 3 (range 2–4) immunosuppressive regimens, and 4 (50%) were HLA alloimmunized. Six patients received a single 4/6 HLA matched UCB unit and 2 received a 5/6 HLA-matched unit. Transplanted allografts contained a median 2.9 × 107 CB TNCs/kg (range 2.6–7.3), 1.5 × 105 CB CD34+cells /kg (range 0.4–3.2), and 3.3 ×106 CD34+cells/kg (range 2.6–3.6) from the haploidentical relative. All patients achieved the primary study endpoint of donor engraftment with an ANC of >500 by day 42, 7 of 8 achieving a UCB-derived ANC >500 cells/μl. The median time to neutrophil recovery was 10 days (range 10–18 days). One patient failed to engraft with the cord unit, but has had sustained engraftment from the haploidentical donor, and is transfusion independent with a normal neutrophil count >25 months post transplant. Acute GVHD grade II developed in 2 patients and one developed limited chronic GVHD. Early T-cell engraftment was predominantly UCB in 7 cases; on day 21, T-cell chimerism was a median 100% cord in origin (range 0–100%). In contrast, myeloid chimerism at engraftment was predominantly haplo-donor in origin and showed 3 phases of engraftment: 1) early myeloid engraftment from the haplo-CD34+ cell donor 2) delayed myeloid engraftment from the cord unit resulting in dual myeloid chimerism and 3) disappearance of the haplo-donor cells with transition towards full cord donor myeloid chimerism (see figure). Mixed lymphocyte reactivity assays performed on post transplant PBMCs showed increasing alloreactivity of cord blood T-cells against the haploidentical donor during the period when myeloid chimerism transitioned towards cord, indicating that the disappearance of haplo-donor myeloid cells occurred as a consequence of rejection by engrafting cord blood T-cells. At a median follow-up of 9 months (range 75 days to 3 years), 7 patients survive, and all are transfusion–independent. One patient died 14 months after transplantation from complications related to CMV pneumonitis. In conclusion, transplantation of haploidentical CD34+ cells can shorten the time to neutrophil recovery in SAA pts undergoing a single UCB transplant. Furthermore, durable full engraftment from donor haploidentical CD34+ cells can occur in the context of cord graft failure. These data suggest co-infusion of allogeneic cord blood with haploidentical CD34+ cells can improve the outcome of UCB transplantation for SAA. Disclosures: Wilder: NCI: Funded in part by NCI contract No. HHSN261200800001E.

Le delta du Danube est un des derniers grands espaces naturels de l’Europe. De nombreuses menaces pèsent sur cette zone humide qui abrite la plus grande roselière au monde. Le Danube traversant une dizaine d’États européens, la préservation de son delta passe nécessairement par une gestion intégrée à tous les niveaux d’échelle. L’Union européenne (UE) s’est très tôt mobilisée pour répondre aux enjeux environnementaux du delta, en adoptant une importante législation dans ce domaine. L’application des directives « Habitats » et « Oiseaux » contraint la Roumanie, devenue le 27ème État membre de l’UE en 2007, à prendre des mesures pour garantir un bon état écologique dans le delta. Un débat persiste encore quant au mode de gestion à mettre en œuvre dans les sites du réseau écologique européen Natura 2000. La Commission européenne privilégie l’approche intégrée par l’élaboration d’un plan de gestion, qui garantit selon elle l’application des principes du développement durable. Mots clés : Roumanie – Delta du Danube – Union européenne – Développement durable – Conservation – Politique environnementale – Natura 2000 – Gouvernance – Participation publique – Gestion environnementale
The Danube Delta is one of the last great natural spaces in Europe. Many threats weigh heavy on this wetland which supports the largest reed bed in the world. As the Danube stretches through ten European countries, preservation of its delta requires an integrated management at all levels of government. The European Union (EU) responded proactively to environmental issues by adopting an important legislation in this area. The “Habitats” and “Birds” directives application forced Romania, which became the 27th Member State of the EU in 2007, to take steps to ensure a sound environmental situation in the Delta. The best management strategy to be implemented in the Natura 2000 European ecological network sites is currently in debate. The European Commission prefers an integrated approach through development of a management plan, which would guarantee according to the Commission an application of the principles of sustainable development. Keywords: Romania – Danube Delta – European Union – Sustainable Development – Conservation – Environmental Policy – Natura 2000 – Governance – Public Participation – Environmental Management

Ce projet traite du rôle joué par la Russie dans le conflit syrien. Il a comme objectif principal de documenter les diverses raisons qui motivent la Russie à s’être impliquée politiquement et militairement dans un conflit pourtant loin de ses frontières. En outre, il permettra aussi de renseigner sur la place qu’occupe la Russie au sein de la dynamique géopolitique du Moyen-Orient. Ce projet de maîtrise met en relation plusieurs thématiques rarement abordées dans le cadre de recherches en sciences géographiques, lui donnant un degré d’originalité fort pertinent du point de vue scientifique. La Russie s’est toujours positionnée du côté du régime depuis le début des protestations et a catégoriquement condamné toute intervention extérieure, perçue comme de l’ingérence visant à déstabiliser un régime souverain et légitime. Trois thématiques évoquées à de multiples reprises dans les médias de masse ainsi que dans certaines publications comme étant les facteurs qui expliqueraient les motivations de Moscou ont été reprises et analysées. Historiquement parlant, la Russie et la Syrie n’ont pas des liens assez forts pour expliquer un soutien aussi important tout au long du conflit. Le commerce de l’armement n’est pas non plus un facteur d’importance car Moscou vend ses armes en quantités beaucoup plus importantes à la Chine, au Vietnam et à l’Algérie. La base navale de Tartous, souvent citée dans la presse, n’est qu’un héritage soviétique et à peine en état de fonctionner. Ne disposant pas de la capacité de gérer des opérations navales depuis Tartous, Moscou se sert de cette base comme d’un simple point de ravitaillement. Le terrorisme en Russie existe depuis longtemps mais le conflit syrien aura une faible incidence sur l’intégrisme domestique. L’effet à en fait été contraire, dans le sens que l’exode de combattants russes vers la Syrie a fait chuté le degré de violence dans certaines régions du Caucase du Nord. La Russie se serait plutôt positionnée de la sorte en Syrie pour rétablir son influence dans la région et paver la voie vers un multilatéralisme intégrant des États influents au sein de la dynamique régionale du Moyen-Orient.
This project analyses the role played by Russia in the Syrian conflict. This project primary objective is to investigate the various reasons that motivates Russia to be implicated militarily and politically in a conflict that is far away from its own borders. In addition, this project will allow the reader to be better informed about Russia’s present place in middle eastern geopolitical dynamics. This master’s degree project puts in relation many themes that are rarely addressed in geographical studies, giving it a degree of originality that is highly relevant in contemporary scientific studies. Russia has always positioned itself besides the Syrian regime since the beginning of the population uprising in 2011. It has also condemned any exterior intervention, perceived as a way to destabilize a legitimate and sovereign regime. Three main recurring themes, described as explaining Russia’s actions in Syria, found many times in mass medias and in certain publications, were analyzed. Historically speaking, Russia and Syria don’t have strong enough relations that could explain why Moscow is showing such a strong support for the regime in place. The Russian weapon’s trade with Syria isn’t important enough either; Russia sells bigger volumes of weaponry to China, Vietnam and Algeria. The Russian naval base located in Tartus, cited many times in the medias, is nothing else but a soviet heritage that can only manage to maintain basic resupply functions. As it has no command and control capabilities, Moscow is only using these floating piers as a logistical asset in the conflict. Terrorism in Russia exists since a long time but the Syrian conflict will have a reduced impact on domestic radicalism. The effect was quite the opposite of what was expected; the migration of Russian fighters towards Syrian battlefields lowered the percentage of violent and armed crimes in certain regions of the North Caucasus. Russia adopted its stance in Syria to re-establish its influence in the region and to pave the road for a dynamic of multilateralism in the Middle East that would integrate key states that are influent in the region.

L’objectif de cette thèse est de comprendre l’influence réciproque entre la territorialité et la revitalisation d’un quartier. En effet, un des enjeux de la revitalisation urbaine est le réaménagement des espaces publics. Pour ce faire, nous avons eu recours à des mémoires et des rapports de consultations publiques, à des entretiens semi-dirigés et à l’observation directe, dans le quartier Saint-Roch, à Québec. Si, plusieurs recherches qui ont été consacrées à la revitalisation urbaine ont démontré que la mixité sociale domine dans les discours des acteurs, notre étude demeure originale. Nous avons constaté que les raisons qui poussent les acteurs à choisir la mixité sociale diffèrent. D’une part, en optant pour la mixité sociale, les acteurs conservent la possibilité de se reconnaître dans leur quartier : la variété de la population augmente les chances de rencontrer des personnes qui leur ressemblent en reflétant une ou plusieurs facettes de leur identité. De cette façon, les répondants peuvent trouver et conserver leur place dans leur quartier. L’extériorité et l’altérité, composantes de la territorialité, font alors office de miroir, miroir qui réfléchit les faces sombres, les faces idéales ou les multiples facettes de chacun. D’autre part, choisir la mixité sociale peut produire de l’exclusion. En effet, sous couvert de vouloir attirer une population diversifiée, certaines catégories socioéconomiques se trouvent exclues des projets d’aménagement et leur présence n’est pas désirée. Tel est le cas des itinérants qui ont de plus en plus de difficultés à rester dans le quartier en raison de l’augmentation de la présence policière et des mesures visant à améliorer la sécurité des habitants, des personnes à petits revenus qui doivent s’approvisionner régulièrement à l’extérieur de leur quartier et des personnes à mobilité réduite ou qui ont des difficultés à se déplacer (comme c’est le cas de certains aînés) qui n’ont plus accès l’ensemble des services du quartier. Mots clefs : territorialité, miroir, mixité sociale, exclusion, revitalisation urbaine