1
|
Burton C, Allen P, Herrera AF. Paradigm Shifts in Hodgkin Lymphoma Treatment: From Frontline Therapies to Relapsed Disease. Am Soc Clin Oncol Educ Book 2024; 44:e433502. [PMID: 38728605 DOI: 10.1200/edbk_433502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Combination chemotherapy with or without radiation has served as the primary therapeutic option for classic Hodgkin lymphoma (cHL), leading to durable remission in a majority of patients with early- and advanced-stage cHL. Patients with relapsed/refractory (RR) cHL could still be cured with salvage chemotherapy and autologous stem-cell transplantation. Brentuximab vedotin (BV) and the anti-PD-1-blocking antibodies, nivolumab and pembrolizumab, are highly effective treatments for cHL and have revolutionized the management of the disease. Recent studies incorporating BV and PD-1 blockade into salvage therapy for RR cHL and into frontline treatment regimens have changed the cHL treatment paradigm. The novel agents are also useful in the treatment of older patients who have poor outcomes with traditional therapy. This manuscript will review current strategies for approaching the management of previously untreated, RR, and challenging populations with cHL, including how to incorporate the novel agents.
Collapse
Affiliation(s)
- Cathy Burton
- Department of Haematology, St James's University Hospital, Leeds, United Kingdom
| | - Pamela Allen
- Department of Hematology and Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Alex F Herrera
- Division of Lymphoma, Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| |
Collapse
|
2
|
Zilioli VR, Cencini E, Lorenzo SD, Pezzullo L, Merli M, Rivellini F, Muzi C, Emiliano B, Marcheselli L, Luminari S. Real-life study on the use of response adapted therapy in patients with Hodgkin Lymphoma: Results from a multicenter experience. Hematol Oncol 2024; 42:e3273. [PMID: 38661120 DOI: 10.1002/hon.3273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/11/2024] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
Few data are known regarding the use of interim positron emission tomography (iPET) after the first two cycles (iPET2) of chemotherapy in treatment-naïve classical Hodgkin lymphoma (cHL) in routine clinical practice, and about the real-life adoption of intensification strategies for iPET positive patients. We conducted a multicenter retrospective study on cHL to investigate the use of iPET in the real-life setting, its prognostic role and outcomes of patients early shifted to intensification. Six hundreds and forty-one patients were enrolled (62% had advanced stage). iPET2 was positive in 89 patients (14%) including 8.7% and 17% early and advanced stage patients, respectively (p = 0.003). Among iPET 2 positive cases treatment was immediately modified in 19 cases; in 14 cases treatment was modified after an additional positive iPET4. Overall 56 iPET2 positive patients never received intensified therapies. Most frequently used intensified therapy was autologous stem cell transplantation followed by BEACOPP. After a median follow-up of 72 months, the 5-year progression-free survival (PFS) was 82% with iPET2 positive patients showing a worse PFS compared with iPET2 negative cases: 31% versus 85%. Focusing on advanced stage patients with a positive iPET2, the 5-year PFS was 59% for patients shifted to intensified therapy at any time point versus 61% for patients who never received intensified therapy. Our study confirmed the higher curability of naïve cHL patients in a real-world setting, and the prognostic role of iPET2 in this setting. A poor adherence to response-adapted strategy which however did not translate into a difference in patient outcomes.
Collapse
Affiliation(s)
| | - Emanuele Cencini
- Hematology, Azienda Ospedaliera Universitaria Senese & University of Siena, Siena, Italy
| | - Sonya De Lorenzo
- U.O.C. Ematologia e T.M.O., AORN "S.G. Moscati", Avellino, Italy
| | - Luca Pezzullo
- U.O.C. di Ematologia con Trapianto di Midollo Osseo, A.U.O. "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | - Michele Merli
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
- Hematology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Flavia Rivellini
- U.O.C. Ematologia e T.M.O., AORN "S.G. Moscati", Avellino, Italy
| | - Cristina Muzi
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Barbieri Emiliano
- Doctorate School of Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Stefano Luminari
- Hematology Unit, Arcispedale S. Maria Nuova, Azienda Unità Sanitaria Locale - IRCCS, University of Modena and Reggio Emilia, Reggio Emilia, Italy
- Chimomo Department, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|
3
|
Parihar AS, Pant N, Subramaniam RM. Quarter-Century PET/CT Transformation of Oncology: Lymphoma. PET Clin 2024; 19:281-290. [PMID: 38403384 DOI: 10.1016/j.cpet.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
The clinical landscape of lymphomas has changed dramatically over the last 2 decades, including significant progress made in the understanding and utilization of imaging modalities and the available treatment options for both indolent and aggressive lymphomas. Since the introduction of hybrid PET/CT scanners in 2001, the indications of 18F-fluorodeoxyglucose (FDG) PET/CT in the management of lymphomas have grown rapidly. In today's clinical practice, FDG PET/CT is used in successful management of the vast majority patients with lymphomas.
Collapse
Affiliation(s)
- Ashwin Singh Parihar
- Mallinckrodt Institute of Radiology; Siteman Cancer Center, Washington University School of Medicine, St Louis, MO, USA.
| | | | - Rathan M Subramaniam
- Faculty of Medicine, Nursing, Midwifery & Health Sciences, The University of Notre Dame Australia, Sydney, Australia; Department of Radiology, Duke University, Durham, NC, USA; Department of Medicine, University of Otago Medical School, Dunedin, New Zealand
| |
Collapse
|
4
|
Vassilakopoulos TP, Liaskas A, Pereyra P, Panayiotidis P, Angelopoulou MK, Gallamini A. Incorporating Monoclonal Antibodies into the First-Line Treatment of Classical Hodgkin Lymphoma. Int J Mol Sci 2023; 24:13187. [PMID: 37685994 PMCID: PMC10487754 DOI: 10.3390/ijms241713187] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/06/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023] Open
Abstract
The long-term survival of Hodgkin lymphoma (HL) patients treated according to the current standard of care is excellent. Combined-modality schedules (ABVD plus radiotherapy) in early-stage disease, along with treatment intensity adaptation to early metabolic response assessed by PET/CT in advanced stage HL, have been the cornerstones of risk stratification and treatment decision-making, minimizing treatment-related complications while keeping efficacy. Nevertheless, a non-negligible number of patients are primary refractory or relapse after front-line treatment. Novel immunotherapeutic agents, namely Brentuximab Vedotin (BV) and immune checkpoint inhibitors (CPI), have already shown outstanding efficacy in a relapsed/refractory setting in recent landmark studies. Several phase 2 single-arm studies suggest that the addition of these agents in the frontline setting could further improve long-term disease control permitting one to reduce the exposure to cytotoxic drugs. However, a longer follow-up is needed. At the time of this writing, the only randomized phase 3 trial so far published is the ECHELON-1, which compares 1 to 1 BV-AVD (Bleomycin is replaced by BV) with standard ABVD in untreated advanced-stage III and IV HL. The ECHELON-1 trial has proven that BV-AVD is safe and more effective both in terms of long-term disease control and overall survival. Just recently, the results of the S1826 SWOG trial demonstrated that the combination nivolumab-AVD (N-AVD) is better than BV-AVD, while preliminary results of other randomized ongoing phase 3 trials incorporating anti-PD-1 in this setting will be soon available. The aim of this review is to present the recent data regarding these novel agents in first-line treatment of HL and to highlight current and future trends which will hopefully reshape the overall management of this disease.
Collapse
Affiliation(s)
- Theodoros P. Vassilakopoulos
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (A.L.); (P.P.); (M.K.A.)
| | - Athanasios Liaskas
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (A.L.); (P.P.); (M.K.A.)
| | - Patricio Pereyra
- Department of Hematology, National Hospital Alejandro Posadas, Buenos Aires 1684, Argentina;
| | - Panayiotis Panayiotidis
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (A.L.); (P.P.); (M.K.A.)
| | - Maria K. Angelopoulou
- Department of Hematology and Bone Marrow Transplantation, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece; (A.L.); (P.P.); (M.K.A.)
| | - Andrea Gallamini
- Research and Clinical Innovation Department, Antoine Lacassagne Cancer Center, 06100 Nice, France;
| |
Collapse
|
5
|
Heger JM, Ferdinandus J, Mattlener J, Borchmann S. Clinical applications of circulating tumor DNA in Hodgkin lymphoma. Semin Hematol 2023; 60:157-163. [PMID: 37422345 DOI: 10.1053/j.seminhematol.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/15/2023] [Accepted: 06/24/2023] [Indexed: 07/10/2023]
Abstract
Hodgkin lymphoma is a B-cell lymphoma often affecting young adults. Outcomes following intensive chemo- and radiotherapy are generally favourable but leave patients at high risk for early and late toxicities frequently reducing quality of life. Relapsed/refractory disease is regularly difficult to treat and ultimately results in death in a relevant subset of patients. Current strategies for risk stratification and response evaluation rely on clinical features and imaging only, and lack discriminatory power to detect patients at risk for disease progression. Here, we explore how circulating tumor DNA sequencing might help to overcome these shortcomings. We provide an overview over recent technical and methodological developments and suggest potential use cases for different clinical situations. Circulating tumor DNA sequencing offers the potential to significantly augment current risk stratification strategies with the ultimate goal of further individualizing treatment strategies for patients with HL.
Collapse
Affiliation(s)
- Jan-Michel Heger
- Department I of Internal Medicine, Center for Integrated Oncology (CIO) Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany; Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany; Cologne Lymphoma Working Group (CLWG), Cologne, Germany.
| | - Justin Ferdinandus
- Department I of Internal Medicine, Center for Integrated Oncology (CIO) Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany; Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), Cologne, Germany
| | - Julia Mattlener
- Department I of Internal Medicine, Center for Integrated Oncology (CIO) Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany; Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany; German Hodgkin Study Group (GHSG), Cologne, Germany
| | - Sven Borchmann
- Department I of Internal Medicine, Center for Integrated Oncology (CIO) Aachen Bonn Cologne Duesseldorf, University of Cologne, Medical Faculty and University Hospital Cologne, Cologne, Germany; Cancer Center Cologne Essen - Partner Site Cologne, CIO Cologne, University of Cologne, Cologne, Germany; Cologne Lymphoma Working Group (CLWG), Cologne, Germany; German Hodgkin Study Group (GHSG), Cologne, Germany.
| |
Collapse
|
6
|
Zeman MN, Akin EA, Merryman RW, Jacene HA. Interim FDG-PET/CT for Response Assessment of Lymphoma. Semin Nucl Med 2023; 53:371-388. [PMID: 36376131 DOI: 10.1053/j.semnuclmed.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022]
Abstract
The clinical use and prognostic value of interim FDG-PET/CT (iPET/CT), which is performed after treatment initiation but prior to its completion, varies by lymphoma subtype. Evidence supporting the prognostic value of iPET/CT is more robust for classical Hodgkin lymphoma (cHL), and in this lymphoma subtype, response-adapted treatment approaches guided by iPET/CT are a widely used standard of care for first-line therapy. The data supporting use of iPET/CT among patients with non-Hodgkin lymphoma (NHL) is less well-established, but failure to achieve complete metabolic response on iPET/CT is generally considered a poor prognostic factor with likely consequences for progression free survival. This review will present the available evidence supporting use of iPET/CT in lymphoma patients, particularly as it relates to prognostication and the ability to inform response-adapted treatment strategies. The latter will be addressed through a discussion on the major iPET-response adapted clinical trials with mention of ongoing trials. Special attention will be given to cHL and a few subtypes of NHL, including diffuse large B cell lymphoma (DLBCL), follicular lymphoma (FL), and peripheral T cell lymphoma (PTCL).
Collapse
Affiliation(s)
- Merissa N Zeman
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Esma A Akin
- Department of Radiology, Division of Nuclear Medicine, George Washington University, Medical Faculty Associates, Washington, DC
| | - Reid W Merryman
- Harvard Medical School, Boston, MA; Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA
| | - Heather A Jacene
- Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Imaging, Dana-Farber Cancer Institute, Boston, MA.
| |
Collapse
|
7
|
Influence of Sociodemographic Determinants on the Hodgkin Lymphoma Baseline Characteristics in Long Survivors Patients Enrolled in the Prospective Phase 3 Trial AHL2011. Cancers (Basel) 2022; 15:cancers15010053. [PMID: 36612050 PMCID: PMC9817794 DOI: 10.3390/cancers15010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Whereas numerous studies on several cancers describe the link between social conditions and disease severity, little is known about the social and demographic characteristics of Hodgkin lymphoma (HL) patients. At diagnosis, 10-15% of the patients in the advanced stages have a well-known poor outcome owing to their chemoresistance, but the determinants of the more advanced stages remain elusive. The objective of the present study was to decipher the potential impact of social disparities on the disease features at diagnosis and analyze how the sociodemographic patient features could impact the HL outcome of patients with advanced-stage HL enrolled in the AHL2011 trial. METHODS This ancillary study was conducted on a cohort of patients from French centers that had recruited more than five patients in the phase III AHL2011 study (NCT0135874). Patients had to be alive at the time of the ancillary study and had to have given their consent to answer the questionnaire. Pre-treatment data (age, gender, stage, B symptoms, IPS), the treatment received, the responses to PET-CT, and the presence of serious adverse events (serious adverse events-SAEs) were all extracted from the AHL2011 trial database. Sociodemographic data-marital status, living area, level of education, socio-professional category, and professional situation-were extracted from the questionnaires. The population density at the point of diagnosis was determined based on ZIP Code, and the distance from the reference medical center was then calculated by the road network. Baseline PET acquisition was performed before any treatment. PET images at baseline were centrally reviewed. The total metabolic tumor volume (TMTV) at the baseline was calculated using a 41% SUVmax cutoff for each lesion. Progression-free survival was defined as the time from randomization to the first progression, relapse, or death from any cause or the last follow-up. The data cutoff for the analyses presented here was 31 October 2017. The progression-free survival was analyzed on an intention-to-treat basis. RESULTS Among the 823 patients enrolled in the AHL2011 study, the questionnaire was sent to 394 patients, of whom 232 (58.9%) responded. At the time of HL diagnosis, 61.9% (N = 143) of patients declared that they were not socially isolated, 38.1% (N = 88) that they were single, 163 (71.2%) had a professional activity, and 66 (28.8%) were inactive owing to unemployment, retirement, or sick leave. Of the patients, 31.1% (N = 71) lived in a rural region, compared to 68.9% (N = 157) that lived in an urban region. The residence ZIP Code at the time of HL diagnosis was available for 163 (70%). Sociodemographic characteristics did not influence the presence of usual prognostic factors (ECOG, B symptoms, bulky mass, IPS) except for professional activity, which was associated with more frequent low IPS (0-2) (79 (48.5%) active versus 20 (30.3%) inactive patients; p = 0.012). Likewise, no correlation was observed between TMTV and sociodemographic characteristics. However, the TMTV quartile distribution was different according to the living area, with the two upper quartiles being enriched with patients living in a rural area (p = 0.008). Moreover, a negative correlation between the average number of the living area's inhabitants and TMTV (R Pearson = -0.29, p = 0.0004) was observed. CONCLUSION This study focused on sociodemographic parameters in advanced-stage HL patients and shows that professional activity is associated with more favorable disease features (low IPS), while patients living in rural or low-populated areas are more likely to have an unfavorable HL presentation with a high tumor burden (high TMTV). These data suggest that some patient sociodemographic characteristics might impact either access to medical care or environmental exposure, leading to a higher frequency of unfavorable presentations. Further prospective sociodemographic studies are necessary to confirm these preliminary results.
Collapse
|
8
|
Ansell SM. Hodgkin lymphoma: 2023 update on diagnosis, risk-stratification, and management. Am J Hematol 2022; 97:1478-1488. [PMID: 36215668 DOI: 10.1002/ajh.26717] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 01/28/2023]
Abstract
DISEASE OVERVIEW Hodgkin lymphoma (HL) is an uncommon B-cell lymphoid malignancy affecting 8540 new patients annually and representing approximately 10% of all lymphomas in the United States. DIAGNOSIS HL is composed of two distinct disease entities: classical HL and nodular lymphocyte-predominant HL. Nodular sclerosis, mixed cellularity, lymphocyte depletion, and lymphocyte-rich HL are subgroups of classical HL. RISK STRATIFICATION An accurate assessment of the stage of disease in patients with HL is critical for the selection of the appropriate therapy. Prognostic models that identify patients at low or high risk for recurrence, as well as the response to therapy as determined by positron emission tomography scan, are used to optimize therapy. RISK-ADAPTED THERAPY Initial therapy for HL patients is based on the histology of the disease, the anatomical stage, and the presence of poor prognostic features. Patients with early-stage disease are typically treated with combined modality strategies utilizing abbreviated courses of combination chemotherapy followed by involved-field radiation therapy, while those with advanced-stage disease receive a longer course of chemotherapy, often without radiation therapy. However, newer agents, including brentuximab vedotin and anti-programmed death-1 (PD-1) antibodies, are now being incorporated into frontline therapy. MANAGEMENT OF RELAPSED/REFRACTORY DISEASE High-dose chemotherapy (HDCT) followed by an autologous stem cell transplant (ASCT) is the standard of care for most patients who relapse following initial therapy. For patients who fail HDCT with ASCT, brentuximab vedotin, PD-1 blockade, non-myeloablative allogeneic transplant, or participation in a clinical trial should be considered.
Collapse
|
9
|
Haslam A, Prasad V. Brentuximab Vedotin in Advanced Hodgkin's Lymphoma. N Engl J Med 2022; 387:1527. [PMID: 36260800 DOI: 10.1056/nejmc2211125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Alyson Haslam
- University of California, San Francisco, Mission Bay, San Francisco, CA
| | - Vinay Prasad
- University of California, San Francisco, Mission Bay, San Francisco, CA
| |
Collapse
|
10
|
Le Dû K, Alarion N, Rabi H, Casasnovas O, Robert P, Durand A, Burlet B, Tabouret-Viaud C, Ramla S, Martin L, Rossi C. Extranodal classical Hodgkin lymphoma involving the spinal cord: case report and review of the literature. CNS Oncol 2022; 11:CNS88. [PMID: 35694977 PMCID: PMC9280417 DOI: 10.2217/cns-2021-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Primary CNS involvement is very rare in Hodgkin lymphoma. Here we present two cases of spinal cord dissemination. Two women of 40 and 65 years of age presented symptoms of spinal cord injury; imaging showed an intramedullary mass in T10 and T2, respectively, without vertebral involvement and upper diaphragmatic lymph nodes. Lymph-node biopsy confirmed the diagnosis of classical Hodgkin lymphoma in both patients. The first patient received four cycles of chemotherapy (escalated BEACOPP and ABVD) with intrathecal therapy, and the second four cycles of doxorubicin, vinblastine, dacarbazine (AVD) and local irradiation after surgery decompression. Complete metabolic response was obtained at the end of treatment. After 5 and 7 years of follow-up respectively, neurological deficits persisted in both. Lymph-node infiltration is the most common presentation in Hodgkin lymphoma at diagnosis. Primary extranodal involvement is rare and spinal cord infiltration exceptional. Back pain, tingling and vesico-sphincter dysfunctions are the main symptoms. 18F-fluorodeoxyglucose (FDG) PET and MRI can detect the location and extension of neurological involvement. We present here two cases of tumoral myelitis and a review of the literature. Local treatment (surgery/radiotherapy) is often administered together with chemotherapy to optimize local control and to avoid long-term sequelae.
Collapse
Affiliation(s)
- Katell Le Dû
- Department of Hematology, Confluent Private Hospital, Nantes, France
| | - Nicolas Alarion
- Nuclear Medecine, Institut Inter-RégionaL de Cancérologie Jean Bernard, Victor Hugo Medical Center, Le Mans, France
| | - Hassan Rabi
- Radiologic Department, Maine Image Santé, Le Mans, France
| | - Olivier Casasnovas
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
| | - Philippine Robert
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
| | - Amandine Durand
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
| | - Bénédicte Burlet
- INSERM UMR1231 UFR Bourgogne, Dijon, France.,Biology Department, University Hospital Center, Dijon, France
| | | | - Selim Ramla
- Department of Pathology, University Hospital Center, Dijon, France
| | - Laurent Martin
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
| | - Cédric Rossi
- Department of Hematology, University Hospital Center, Dijon, France.,INSERM UMR1231 UFR Bourgogne, Dijon, France
| |
Collapse
|