1
|
Schavgoulidze A, Corre J, Samur MK, Mazzotti C, Pavageau L, Perrot A, Cazaubiel T, Leleu X, Macro M, Belhadj K, Roussel M, Brechignac S, Montes L, Caillot D, Frenzel L, Rey P, Schiano JM, Chalopin T, Jacquet C, Richez V, Orsini Piocelle F, Fontan J, Manier S, Martinet L, Sciambi A, Mohty M, Avet-Loiseau H. RAS/RAFlandscape in monoclonal plasma cell conditions. Blood 2024:blood.2023022295. [PMID: 38643494 DOI: 10.1182/blood.2023022295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Multiple Myeloma (MM) is characterized by a huge heterogeneity at the molecular level. The RAS/RAF pathway is the most frequently mutated, in about 50% of the patients. However, these mutations are frequently subclonal, suggesting a secondary event. Since these genes are part of our routine next-generation sequencing (NGS) panel, we analyzed >10,000 patients with different plasma cell disorders in order to describe the RAS/RAF landscape. In this large cohort of patients, almost 61% of the patients presented a RAS/RAF mutation at diagnosis or relapse, but much lower frequencies in pre-symptomatic cases. Of note, the mutations were different from that observed in solid tumors (higher proportions of Q61 mutations). In 29 patients with two different mutations, we were able to perform single cell sequencing, showing that in most cases, mutations occurred in different subclones, suggesting an ongoing mutational process. These findings suggest that RAS/RAF pathway is not an attractive target, both on therapeutic and residual disease assessment points of vue.
Collapse
Affiliation(s)
| | - Jill Corre
- Institut Universitaire du Cancer de Toulouse-Oncopole, TOULOUSE, France
| | - Mehmet K Samur
- Dana-Farber Cancer Institute and Harvard School of Public Health, Boston, Massachusetts, United States
| | | | | | | | | | | | | | - Karim Belhadj
- Service d'Hematologie Clinique, Hopital Henri Mondor, Creteil, Creteil, France
| | | | | | | | | | - Laurent Frenzel
- Service d'Hématologie Adulte et unité d'hémostase clinique, Hôpital Necker, Institut IMAGINE - INSERM U 1163 / CNRS ERL 8254, Paris France, Paris, France
| | | | | | | | | | | | | | | | | | | | - Adam Sciambi
- Mission Bio, Inc., South San Francisco, California, United States
| | - Mohamad Mohty
- Hôpital Saint-Antoine, INSERM UMRs 938, and Université Sorbonne, Paris, France
| | | |
Collapse
|
2
|
Caillot L, Leclerc M, Sleiman EJR, Sloma I, Wagner-Ballon O, Claudel A, Beckerich F, Redjoul R, Robin C, Parinet V, Pautas C, Menouche D, Bouledroua S, Cabanne L, Nait-Sidenas Y, Gautier E, Rouard H, Lafon I, Chalandon Y, Boissel N, Caillot D, Maury S. Long-term outcome after autologous BCR::ABL1-negative peripheral blood stem cell transplantation in adults with Philadelphia-positive acute lymphoblastic leukemia: a comparative study. Haematologica 2024; 109:1264-1268. [PMID: 38031800 PMCID: PMC10985448 DOI: 10.3324/haematol.2023.283742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023] Open
Abstract
Not available.
Collapse
Affiliation(s)
- Leo Caillot
- Hematology Department, CHU Francois Mitterrand, Dijon
| | - Mathieu Leclerc
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010
| | | | - Ivan Sloma
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010
| | - Orianne Wagner-Ballon
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010
| | - Alexis Claudel
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010
| | - Florence Beckerich
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010
| | - Rabah Redjoul
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010
| | - Christine Robin
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010
| | - Vincent Parinet
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010
| | - Cecile Pautas
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010
| | - Dehbia Menouche
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010
| | - Selwa Bouledroua
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010
| | - Ludovic Cabanne
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010
| | - Yakout Nait-Sidenas
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010
| | - Eric Gautier
- Etablissement Francais du Sang, Ile de France, UPEC University, Creteil, F-94010
| | - Helene Rouard
- Etablissement Francais du Sang, Ile de France, UPEC University, Creteil, F-94010
| | - Ingrid Lafon
- Hematology Department, CHU Francois Mitterrand, Dijon
| | - Yves Chalandon
- Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva, Switzerland
| | - Nicolas Boissel
- AP-HP, Paris Cite University, Unite d'Hematologie Adolescents et Jeunes Adultes, Hopital Saint Louis, Paris
| | - Denis Caillot
- Hematology Department, CHU Francois Mitterrand, Dijon
| | - Sebastien Maury
- AP-HP, UPEC University, Henri Mondor Hospital, Hematology Department, Creteil, F-94010.
| |
Collapse
|
3
|
Caillot L, Sleiman E, Lafon I, Chretien ML, Gueneau P, Payssot A, Pedri R, Lakomy D, Bailly F, Guy J, Quenot JP, Avet-Loiseau H, Caillot D. Early Chimeric Antigen Receptor T Cell Expansion Is Associated with Prolonged Progression-Free Survival for Patients with Relapsed/Refractory Multiple Myeloma Treated with Ide-Cel: A Retrospective Monocentric Study. Transplant Cell Ther 2024:S2666-6367(24)00253-7. [PMID: 38458477 DOI: 10.1016/j.jtct.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/12/2024] [Accepted: 03/04/2024] [Indexed: 03/10/2024]
Abstract
The outcomes of patients with relapsed and refractory multiple myeloma (RRMM) previously treated with the 3 main classes of myeloma therapy-immunomodulatory drugs, proteasome inhibitors, and anti-CD38 antibodies-remain poor. Recently, based on the phase II pivotal KarMMa trial showing prolonged overall survival (OS) and progression-free survival (PFS) in heavily treated patients, idecabtagene vicleucel (ide-cel), a B cell maturation antigen (BCMA)-directed chimeric antigen receptor (CAR) T cell therapy (CAR-T) product, was approved in the United States for the treatment of RRMM. In France, since June 2021, an early access program has authorized the use of ide-cel in the setting of RRMM (defined as progressive myeloma after at least 3 previous regimens, including the 3 main antimyeloma therapies). We report the first French experience through this early access program in a retrospective study of 24 consecutive patients treated with ide-cel at our institution. The patients were evaluated according to International Myeloma Working Group criteria and by positron emission tomography computed tomography (PET-CT) at 1, 3, 6, 9, and 12 months after ide-cel infusion. Most patients had adverse cytogenetic abnormalities, and RRMM with triple-refractory drugs were seen in 79%. Bridging therapy was required for 19 of 24 patients. Before CAR-T cell infusion, lymphodepletion with fludarabine and cyclophosphamide was systematically performed. The median follow-up was 15.2 months. At 3 months after ide-cel infusion, 92% of patients achieved at least a partial response, and 50% achieved a complete response or better (≥CR). At 6 months, 70% of patients had a persistent ≥CR. At 3 and 6 months, bone marrow minimal residual disease (10-6 level) was undetectable in 79% and 75% of patients, respectively. At 6 months, CR as assessed by PET-CT was achieved in 15 of 20 patients (75%). The median PFS was 14.8 months, and median OS was not reached. Notably, an expansion of circulating CAR-T cells to >180/mm3 after infusion was strongly associated with prolonged PFS. Additionally, the level of soluble BCMA measured before infusion was identified as a prognostic factor for PFS, likely correlated to the tumor burden. Grade 1-2 cytokine release syndrome (CRS) occurred in 22 of 24 patients (92%). Only 1 patient (4%) experienced grade ≥3 CRS. The occurrence of neurologic toxicity was infrequent (12.5%) and reversible in all cases. Hematologic toxicity was relatively common, and secondary hypogammaglobulinemia occurred in most patients. Infections (mostly viral) were frequent but most often nonsevere. This study echoes the promising results of the KarMMa trial and identifies possible prognostic indicators in RRMM patients treated with ide-cel, potentially refining treatment strategies and improving outcomes in this challenging context.
Collapse
Affiliation(s)
- Leo Caillot
- Clinical Hematology, CHU Dijon, Dijon, France
| | | | - Ingrid Lafon
- Clinical Hematology, CHU Dijon, Dijon, France; Burgundy Cancer Institute, Dijon, France
| | | | | | | | | | - Daniela Lakomy
- Specialized Biochemistry Laboratory, CHU Dijon, Dijon, France
| | | | - Julien Guy
- Hematology Laboratory, CHU Dijon, Dijon, France
| | | | | | - Denis Caillot
- Clinical Hematology, CHU Dijon, Dijon, France; Burgundy Cancer Institute, Dijon, France.
| |
Collapse
|
4
|
Sierra J, Montesinos P, Thomas X, Griskevicius L, Cluzeau T, Caillot D, Legrand O, Minotti C, Luppi M, Farkas F, Bengoudifa BR, Gilotti G, Hodzic S, Rambaldi A, Venditti A. Midostaurin plus daunorubicin or idarubicin for young and older adults with FLT3-mutated AML: a phase 3b trial. Blood Adv 2023; 7:6441-6450. [PMID: 37581981 PMCID: PMC10632658 DOI: 10.1182/bloodadvances.2023009847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/17/2023] Open
Abstract
The pivotal RATIFY study demonstrated midostaurin (50 mg twice daily) with standard chemotherapy significantly reduced mortality in adult patients (<60 years) with newly diagnosed (ND) FLT3mut acute myeloid leukemia (AML). Considering that AML often present in older patients who show poor response to chemotherapy, this open-label, multicenter phase 3b trial was designed to further assess safety and efficacy of midostaurin plus chemotherapy in induction, consolidation, and maintenance monotherapy in young (≤60 years) and older (>60 years) patients with FLT3mut ND-AML. Compared with RATIFY, this study extended midostaurin treatment from 14 days to 21 days, substituted anthracyclines (idarubicin or daunorubicin), and introduced variation in standard combination chemotherapy dosing ("7+3" or "5+2" in more fragile patients). Total 301 patients (47.2% >60 years and 82.7% with FLT3-ITDmut) of median age 59 years entered induction phase. Overall, 295 patients (98.0%) had at least 1 adverse event (AE), including 254 patients (84.4%) with grade ≥3 AE. The grade ≥3 serious AEs occurred in 134 patients. No difference was seen in AE frequency between age groups, but grade ≥3AE frequency was higher in older patients. Overall, complete remission (CR) rate including incomplete hematologic recovery (CR + CRi) (80.7% [95% confidence interval, 75.74-84.98]) was comparable between age groups (≤60 years [83.5%]; >60 to ≤70 years [82.5%]; in patients >70 years [64.1%]) and the type of anthracycline used in induction. CR + CRi rate was lower in males (76.4%) than females (84.4%). Overall, the safety and efficacy of midostaurin remains consistent with previous findings, regardless of age, sex, or induction regimen. The trial is registered at www.clinicaltrials.gov as #NCT03379727.
Collapse
Affiliation(s)
- Jorge Sierra
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute. Universitat Autonoma of Barcelona, Barcelona, Spain
| | - Pau Montesinos
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
- CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - Xavier Thomas
- Department of Hematology, Hospices Civils de Lyon, Lyon-Sud Hospital, Lyon, France
| | - Laimonas Griskevicius
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Hematology, Oncology and Transfusion Medicine Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Thomas Cluzeau
- Department of Hematology, CHU de Nice, Cote D’Azur University, Nice, France
- Sophia Antipolis University, Nice, France
- INSERM U1065, Mediterranean Center of Molecular Medicine, Cote D’Azur University, Nice, France
- Equipe Labellisée par la Ligue Nationale Contre le Cancer, Paris, France
| | - Denis Caillot
- Department of Hematology, Dijon University Hospital, Dijon, France
| | - Ollivier Legrand
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, Assistance Publique–Hôpitaux de Paris, Paris, France
- UMRS 938, INSERM, Paris, France
- Université Pierre et Marie Curie Paris VI, Sorbonne University, Paris, France
| | - Clara Minotti
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Mario Luppi
- Hematology Unit, Azienda Ospedaliera Universitaria di Modena and Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Firas Farkas
- Department of Hematology and Transfusion Medicine, Faculty of Medicine of Comenius University, University Hospital, Bratislava, Slovakia
| | | | | | - Sejla Hodzic
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Alessandro Rambaldi
- Department of Oncology and Hematology, University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Adriano Venditti
- Hematology, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| |
Collapse
|
5
|
Rosiñol L, Hebraud B, Oriol A, Colin AL, Ríos Tamayo R, Hulin C, Blanchard MJ, Caillot D, Sureda A, Hernández MT, Arnulf B, Mateos MV, Macro M, San-Miguel J, Belhadj K, Lahuerta JJ, Garelik MB, Bladé J, Moreau P. Integrated analysis of randomized controlled trials evaluating bortezomib + lenalidomide + dexamethasone or bortezomib + thalidomide + dexamethasone induction in transplant-eligible newly diagnosed multiple myeloma. Front Oncol 2023; 13:1197340. [PMID: 38023148 PMCID: PMC10652744 DOI: 10.3389/fonc.2023.1197340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/09/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Providing the most efficacious frontline treatment for newly diagnosed multiple myeloma (NDMM) is critical for patient outcomes. No direct comparisons have been made between bortezomib + lenalidomide + dexamethasone (VRD) and bortezomib + thalidomide + dexamethasone (VTD) induction regimens in transplant-eligible NDMM. Methods An integrated analysis was performed using patient data from four trials meeting prespecified eligibility criteria: two using VRD (PETHEMA GEM2012 and IFM 2009) and two using VTD (PETHEMA GEM2005 and IFM 2013-04). Results The primary endpoint was met, with VRD demonstrating a noninferior rate of at least very good partial response (≥ VGPR) after induction vs VTD. GEM comparison demonstrated improvement in the ≥ VGPR rate after induction for VRD vs VTD (66.3% vs 51.2%; P = .00281) that increased after transplant (74.4% vs 53.5%). Undetectable minimal residual disease rates post induction (46.7% vs 34.9%) and post transplant (62.4% vs 47.3%) support the benefit of VRD vs VTD. Treatment-emergent adverse events leading to study and/or treatment discontinuation were less frequent with VRD (3%, GEM2012; 6%, IFM 2009) vs VTD (11%, IFM 2013-04). Conclusion These results supported the benefit of VRD over VTD for induction in transplant-eligible patients with NDMM. The trials included are registered with ClinicalTrials.gov (NCT01916252, NCT01191060, NCT00461747, and NCT01971658).
Collapse
Affiliation(s)
- Laura Rosiñol
- Department of Hematology, Hospital Clínic Institut d’investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Benjamin Hebraud
- Hematology Department, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Albert Oriol
- Institut Català d’Oncologia I Institut Josep Carreras, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Anne-Laurène Colin
- Service de Pharmacologie Médicale et Clinique, Centre Hospitalier et Universitaire de Toulouse, Toulouse, France
| | - Rafael Ríos Tamayo
- Department of Hematology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Cyrille Hulin
- Department of Hematology, Hôpital Haut-Lévêque, Bordeaux Pessac, France
| | | | | | - Anna Sureda
- Institut Català d’Oncologia-Hospitalet i Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | | | - Bertrand Arnulf
- Centre Hospitalier Universitaire, Hôpital St-Louis, Paris, France
| | - Maria-Victoria Mateos
- Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | - Margaret Macro
- Institut d’Hématologie de Basse Normandie, Centre Hospitalier et Universitaire de Caen, Caen, France
| | - Jesús San-Miguel
- Clínica Universidad de Navarra (CUN), Centro de Investigación Médica Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain
| | - Karim Belhadj
- Lymphoid Malignancies Unit, Centre Hospitalier et Universitaire Henri Mondor, Creteil, France
| | - Juan José Lahuerta
- Clínica Universidad de Navarra (CUN), Centro de Investigación Médica Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Pamplona, Spain
| | | | - Joan Bladé
- Department of Hematology, Hospital Clínic Institut d’investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France
| |
Collapse
|
6
|
Schavgoulidze A, Perrot A, Cazaubiel T, Leleu X, Montes L, Jacquet C, Belhadj K, Brechignac S, Frenzel L, Chalopin T, Rey P, Schiano de Collela JM, Dib M, Caillot D, Macro M, Fontan J, Buisson L, Pavageau L, Roussel M, Manier S, Mohty M, Martinet L, Avet-Loiseau H, Corre J. Prognostic impact of translocation t(14;16) in multiple myeloma according to the presence of additional genetic lesions. Blood Cancer J 2023; 13:160. [PMID: 37880285 PMCID: PMC10600097 DOI: 10.1038/s41408-023-00933-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Anaïs Schavgoulidze
- Unit for Genomics in Myeloma, University Hospital IUCT-Oncopole, Toulouse, France
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Aurore Perrot
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
- Hematology Department, IUCT-Oncopole, Toulouse, France
| | | | - Xavier Leleu
- Hematology Department, University Hospital, Poitiers, France
| | - Lydia Montes
- Hematology Department, University Hospital, Amiens, France
| | | | - Karim Belhadj
- Hematology Department, University Hospital, Créteil, France
| | | | - Laurent Frenzel
- Hematology Department, Necker University Hospital, Paris, France
| | | | - Philippe Rey
- Hematology Department, Centre Léon Bérard, Lyon, France
| | | | - Mamoun Dib
- Hematology Department, University Hospital, Angers, France
| | - Denis Caillot
- Hematology Department, Institut de Cancérologie de Bourgogne, Dijon, France
| | - Margaret Macro
- Hematology Department, University Hospital, Caen, France
| | - Jean Fontan
- Hematology Department, University Hospital, Besançon, France
| | - Laure Buisson
- Unit for Genomics in Myeloma, University Hospital IUCT-Oncopole, Toulouse, France
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Luka Pavageau
- Unit for Genomics in Myeloma, University Hospital IUCT-Oncopole, Toulouse, France
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | | | - Salomon Manier
- Hematology Department, University Hospital, Lille, France
| | - Mohamad Mohty
- Hematology Department, Saint-Antoine University Hospital, Paris, France
| | - Ludovic Martinet
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Hervé Avet-Loiseau
- Unit for Genomics in Myeloma, University Hospital IUCT-Oncopole, Toulouse, France
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Jill Corre
- Unit for Genomics in Myeloma, University Hospital IUCT-Oncopole, Toulouse, France.
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France.
| |
Collapse
|
7
|
Dumontet C, Demangel D, Galia P, Karlin L, Roche L, Fauvernier M, Golfier C, Laude M, Leleu X, Rodon P, Roussel M, Azaïs I, Doyen C, Slama B, Manier S, Decaux O, Pertesi M, Beaumont M, Caillot D, Boyle EM, Cliquennois M, Cony‐Makhoul P, Doncker A, Dorvaux V, Petillon MO, Fontan J, Hivert B, Leduc I, Leyronnas C, Macro M, Maigre M, Mariette C, Mineur P, Rigaudeau S, Royer B, Vincent L, Mckay J, Perrial E, Garderet L. Clinical characteristics and outcome of 318 families with familial monoclonal gammopathy: A multicenter Intergroupe Francophone du Myélome study. Am J Hematol 2023; 98:264-271. [PMID: 36588407 PMCID: PMC10107808 DOI: 10.1002/ajh.26785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 01/03/2023]
Abstract
Familial forms of monoclonal gammopathy, defined as multiple myeloma (MM) or Monoclonal Gammopathy of Undetermined Significance (MGUS), are relatively infrequent and most series reported in the literature describe a limited number of families. MM rarely occurs in a familial context. MGUS is observed much more commonly, which can in some cases evolve toward full-blown MM. Although recurrent cytogenetic abnormalities have been described in tumor cells of sporadic cases of MM, the pathogenesis of familial MM remains largely unexplained. In order to identify genetic factors predisposing to familial monoclonal gammopathy, the Intergroupe Francophone du Myélome identified 318 families with at least two confirmed cases of monoclonal gammopathy. There were 169 families with parent/child pairs and 164 families with cases in at least two siblings, compatible with an autosomal transmission. These familial cases were compared with sporadic cases who were matched for age at diagnosis, sex and immunoglobulin isotype, with 10 sporadic cases for each familial case. The gender distribution, age and immunoglobulin subtypes of familial cases were unremarkable in comparison to sporadic cases. With a median follow-up of 7.4 years after diagnosis, the percentage of MGUS cases having evolved to MM was 3%. The median overall survival of the 148 familial MM cases was longer than that of matched sporadic cases, with projected values of 7.6 and 16.1 years in patients older and younger than 65 years, respectively. These data suggest that familial cases of monoclonal gammopathy are similar to sporadic cases in terms of clinical presentation and carry a better prognosis.
Collapse
Affiliation(s)
- Charles Dumontet
- Hospices Civils de LyonLyonFrance
- CRCL, UMR INSERM 1052/CNRS 5286/University of Lyon‐FranceLyonFrance
| | | | | | | | | | | | | | | | | | | | | | | | | | - Borhane Slama
- Clinical Hematology DepartmentCH AvignonAvignonFrance
| | | | - Olivier Decaux
- Hematology DepartmentCHU Rennes, Inserm UMR1236RennesFrance
| | - Maroulio Pertesi
- Genetic Cancer Susceptibility, International Agency for Research on CancerLyonFrance
- Department of Laboratory MedicineHematology and Transfusion MedicineLundSweden
| | | | - Denis Caillot
- Clinical Hematology DepartmentHôpital F. Mitterrand, CHU DijonDijonFrance
| | - Eileen M. Boyle
- Perlmutter Cancer CenterNYU Langone HealthNew YorkNew YorkUSA
| | | | | | | | - Véronique Dorvaux
- Clinical Hematology DepartmentCHR Metz‐ThionvilleMetz‐ThionvilleFrance
| | | | - Jean Fontan
- Hematology DepartmentCHU BesançonBesançonFrance
| | | | | | | | | | - Michel Maigre
- Internal Medicine DepartmentCH ChartresChartresFrance
| | | | - Philippe Mineur
- Clinical Hematology DepartmentGrand Hôpital de CharleroiCharleroiBelgium
| | | | - Bruno Royer
- Clinical Hematology and Cell Therapy DepartmentAmiensFrance
| | | | - James Mckay
- Genetic Cancer Susceptibility, International Agency for Research on CancerLyonFrance
| | - Emeline Perrial
- CRCL, UMR INSERM 1052/CNRS 5286/University of Lyon‐FranceLyonFrance
| | - Laurent Garderet
- HU PITIE SALPETRIERE APHPParisFrance
- Centre de Recherche Saint‐Antoine‐Team Hematopoietic and Leukemic DevelopmentSorbonne Université‐INSERM, UMR_S 938ParisFrance
| |
Collapse
|
8
|
Kraeber-Bodéré F, Zweegman S, Perrot A, Hulin C, Caillot D, Facon T, Leleu X, Belhadj K, Itti E, Karlin L, Bailly C, Levin MD, Minnema MC, Jamet B, Bodet-Milin C, de Keizer B, Béné MC, Avet-Loiseau H, Sonneveld P, Pei L, Rigat F, de Boer C, Vermeulen J, Kampfenkel T, Lambert J, Moreau P. Prognostic value of positron emission tomography/computed tomography in transplant-eligible newly diagnosed multiple myeloma patients from CASSIOPEIA: the CASSIOPET study. Haematologica 2022; 108:621-626. [PMID: 36263839 PMCID: PMC9890028 DOI: 10.3324/haematol.2021.280051] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- Françoise Kraeber-Bodéré
- Service de Médecine Nucléaire, University Hospital Hôtel-Dieu, Nantes, France; CRCI2NA, INSERM, CNRS, Université d'Angers, Nantes Université, Nantes.
| | - Sonja Zweegman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Department of Hematology, Amsterdam, the Netherlands
| | - Aurore Perrot
- CHU de Toulouse, IUCT-O, Université de Toulouse, UPS, Service d’Hématologie, Toulouse, France
| | - Cyrille Hulin
- Department of Hematology, Hôpital Haut Lévêque, University Hospital Bordeaux, Pessac, France
| | | | - Thierry Facon
- University of Lille, CHU Lille, Service des Maladies du Sang, Lille, France
| | - Xavier Leleu
- CHU Poitiers, Hôpital la Milétrie, Poitiers, France
| | - Karim Belhadj
- Hôpital Henri Mondor, Lymphoid Malignancies Unit, Créteil, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Hôpital Henri Mondor, Créteil, France
| | - Lionel Karlin
- Centre Hospitalier Lyon-Sud Hématologie (HCL), Pierre–Bénite, France
| | - Clément Bailly
- Service de Médecine Nucléaire, University Hospital Hôtel-Dieu, Nantes, France,CRCI2NA, INSERM, CNRS, Université d’Angers, Nantes Université, Nantes, France
| | | | - Monique C. Minnema
- Department of Hematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bastien Jamet
- Service de Médecine Nucléaire, University Hospital Hôtel-Dieu, Nantes, France
| | - Caroline Bodet-Milin
- Service de Médecine Nucléaire, University Hospital Hôtel-Dieu, Nantes, France,CRCI2NA, INSERM, CNRS, Université d’Angers, Nantes Université, Nantes, France
| | - Bart de Keizer
- Department of Nuclear Medicine and Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie C. Béné
- CRCI2NA, INSERM, CNRS, Université d’Angers, Nantes Université, Nantes, France,Hematology Biology, University Hospital Hôtel Dieu, Nantes, France
| | | | | | - Lixia Pei
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - Fabio Rigat
- Janssen Research & Development, LLC, Buckinghamshire, UK
| | - Carla de Boer
- Janssen Research & Development, LLC, Leiden, the Netherlands
| | | | | | - Jérôme Lambert
- Biostatistical Department, Hôpital Saint Louis, Paris, France
| | - Philippe Moreau
- CRCI2NA, INSERM, CNRS, Université d’Angers, Nantes Université, Nantes, France,Hematology, University Hospital Hôtel-Dieu, Nantes, France
| |
Collapse
|
9
|
Trad R, Warda W, Alcazer V, Neto da Rocha M, Berceanu A, Nicod C, Haderbache R, Roussel X, Desbrosses Y, Daguindau E, Renosi F, Roumier C, Bouquet L, Biichle S, Guiot M, Seffar E, Caillot D, Depil S, Robinet E, Salma Y, Deconinck E, Deschamps M, Ferrand C. Chimeric antigen receptor T-cells targeting IL-1RAP: a promising new cellular immunotherapy to treat acute myeloid leukemia. J Immunother Cancer 2022; 10:jitc-2021-004222. [PMID: 35803613 PMCID: PMC9272123 DOI: 10.1136/jitc-2021-004222] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Background Acute myeloid leukemia (AML) remains a very difficult disease to cure due to the persistence of leukemic stem cells (LSCs), which are resistant to different lines of chemotherapy and are the basis of refractory/relapsed (R/R) disease in 80% of patients with AML not receiving allogeneic transplantation. Methods In this study, we showed that the interleukin-1 receptor accessory protein (IL-1RAP) protein is overexpressed on the cell surface of LSCs in all subtypes of AML and confirmed it as an interesting and promising target in AML compared with the most common potential AML targets, since it is not expressed by the normal hematopoietic stem cell. After establishing the proof of concept for the efficacy of chimeric antigen receptor (CAR) T-cells targeting IL-1RAP in chronic myeloid leukemia, we hypothesized that third-generation IL-1RAP CAR T-cells could eliminate AML LSCs, where the medical need is not covered. Results We first demonstrated that IL-1RAP CAR T-cells can be produced from AML T-cells at the time of diagnosis and at relapse. In vitro and in vivo, we showed the effectiveness of IL-1RAP CAR T-cells against AML cell lines expressing different levels of IL-1RAP and the cytotoxicity of autologous IL-1RAP CAR T-cells against primary cells from patients with AML at diagnosis or at relapse. In patient-derived relapsed AML xenograft models, we confirmed that IL-1RAP CAR T-cells are able to circulate in peripheral blood and to migrate in the bone marrow and spleen, are cytotoxic against primary AML cells and increased overall survival. Conclusion In conclusion, our preclinical results suggest that IL-1RAP CAR T-based adoptive therapy could be a promising strategy in AML treatment and it warrants the clinical investigation of this CAR T-cell therapy.
Collapse
Affiliation(s)
- Rim Trad
- TIMC, EFSBFC, INSERM UMR1098 RIGHT,UFC, Besancon, France
| | - Walid Warda
- TIMC, EFSBFC, INSERM UMR1098 RIGHT,UFC, Besancon, France.,CanCell Therapeutics, Besancon, France
| | | | - Mathieu Neto da Rocha
- TIMC, EFSBFC, INSERM UMR1098 RIGHT,UFC, Besancon, France.,CanCell Therapeutics, Besancon, France
| | - Ana Berceanu
- Clinical Hematology, C.H. Univ Jean Minjoz, Besancon, France
| | | | | | - Xavier Roussel
- Clinical Hematology, C.H. Univ Jean Minjoz, Besancon, France
| | | | | | - Florain Renosi
- TIMC, EFSBFC, INSERM UMR1098 RIGHT,UFC, Besancon, France
| | | | - Lucie Bouquet
- TIMC, EFSBFC, INSERM UMR1098 RIGHT,UFC, Besancon, France
| | - Sabeha Biichle
- TIMC, EFSBFC, INSERM UMR1098 RIGHT,UFC, Besancon, France
| | - Melanie Guiot
- TIMC, EFSBFC, INSERM UMR1098 RIGHT,UFC, Besancon, France
| | - Evan Seffar
- TIMC, EFSBFC, INSERM UMR1098 RIGHT,UFC, Besancon, France
| | - Denis Caillot
- Clinical Hematology, CHU François Mitterrand, Dijon, France
| | | | | | - Yahya Salma
- Laboratory of Applied Biotechnology (LBA3B), Lebanese University, Tripoli, Lebanon
| | - Eric Deconinck
- Clinical Hematology, C.H. Univ Jean Minjoz, Besancon, France
| | - Marina Deschamps
- TIMC, EFSBFC, INSERM UMR1098 RIGHT,UFC, Besancon, France.,CanCell Therapeutics, Besancon, France
| | - Christophe Ferrand
- TIMC, EFSBFC, INSERM UMR1098 RIGHT,UFC, Besancon, France .,CanCell Therapeutics, Besancon, France
| |
Collapse
|
10
|
Touzeau C, Perrot A, Hulin C, Manier S, Macro M, Caillot D, Karlin L, Decaux O, Jacquet C, Tiab M, Leleu X, Planche L, Avet-Loiseau H, Moreau P. Daratumumab carfilzomib lenalidomide and dexamethasone as induction therapy in high-risk, transplant-eligible patients with newly diagnosed myeloma: Results of the phase 2 study IFM 2018-04. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8002 Background: High-risk (HR) cytogenetic is associated with poor outcome in transplant eligible (TE) newly diagnosed myeloma multiple myeloma (NDMM). The triplet combination carfilzomib lenalidomide and dexamethasone (KRD) plus transplantation demonstrated high efficacy with favorable safety profile in TE-NDMM patients (FORTE). The addition of daratumumab (Dara) to frontline therapy also improved response rate and progression free-survival in TE-NDMM patients (CASSIOPEIA, GRIFFIN). Double transplant also improved outcome of HR TE NDMM patients (EMN02, STAMINA). The phase 2 trial 2018-04 from the Intergroupe Francophone du Myelome (IFM) is evaluating an intensive strategy with Dara-KRD induction and consolidation plus double transplant in HR TE NDMM (NCT03606577). Methods: HR MM was defined by the presence of del17p, t(4;14) and/or t(14;16). Stategy includes Dara-KRD induction (6 cycles), autologous stem cell transplantation (ASCT), Dara-KRD consolidation (4 cycles), second ASCT, Dara-lenalidomide maintenance. The primary endpoint was the feasibility of this intensive strategy. Here, we report efficacy and safety analysis of Dara-KRD induction. Results: Fifty patients with previously untreated NDMM were included from july 2019 to march 2021 in 11 IFM centers Median age was 57 (range 38 -65). ISS stage 3 was present in 12 (24%) patients. Based on inclusion criteria, all patients had HR cytogenetic, including 17p deletion (n = 20, 40%), t(4;14) (n = 26, 52%) or t(14;16) (n = 10,20%). Forty-six patients completed Dara-KRD induction. Two patients discontinued treatment due to severe adverse event (COVID-19 infection, n = 1 ; drug-induced hepatitis, n = 1) and 2 patients discontinued treatment due to disease progression. Grade 3-4 treatment related adverse event ( > 5% of patients) were neutropenia (38%), anemia (14%), thrombocytopenia (8%), infection (6%), renal insufficiency (6%) and deep-vein thrombosis (6%). Two patients (6%) experienced stem-cell collection failure. Overall response rate was 96%, including 92 % > very good partial response. Among 37 (/46) evaluable patients post induction, Minimal Residual Disease negativity rate (NGS, 10-5) was 62%. Conclusions: Dara-KRD as induction prior ASCT is safe and allows deep responses in TE NDMM patients with high-risk cytogenetic profile. IFM 2018-04 study is ongoing and longer follow-up is needed to evaluate safety and efficacy of the overall strategy with Dara-KRD induction and consolidation plus double transplant in this subset of HR patients. Clinical trial information: NCT03606577.
Collapse
Affiliation(s)
| | - Aurore Perrot
- Centre Hospitalier, Universitaire de Toulouse, Service d'Hematologie, Toulouse, France
| | - Cyrille Hulin
- Department of Hematology, Hôpital Haut Lévêque, University Hospital Bordeaux, Pessac, France
| | - Salomon Manier
- Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Margaret Macro
- Centre Hospitalier Universitaire (CHU) de Caen, Caen, France
| | | | - Lionel Karlin
- Service d’Hématologie Clinique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | | | - Caroline Jacquet
- Department of Hematology Centre Hospitalier Universitaire, Nancy, France
| | | | - Xavier Leleu
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Lucie Planche
- Département de recherche clinique, CHU Hotel Dieu, Nantes, France
| | - Herve Avet-Loiseau
- Unit for Genomics in Myeloma, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital & Centre de Recherche en Cancérologie de Toulouse, INSERM U1037, Toulouse, France
| | - Philippe Moreau
- Hematology Clinic, University Hospital Hôtel-Dieu, Nantes, France
| |
Collapse
|
11
|
Devaux M, Boulin M, Mounier M, Caillot D, Ahwij N, Herbin A, Bastie JN, Favennec C, Robert P, Pistre P, Bost S, Amiot P, Jacquesson L, Casasnovas O, Rossi C, Gueneau P. Clinical and Economic Impact of a Multidisciplinary Follow-Up Program in Lymphoma Patients. Cancers (Basel) 2022; 14:cancers14102532. [PMID: 35626136 PMCID: PMC9139274 DOI: 10.3390/cancers14102532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: The UMACOACH Lymphoma is a multidisciplinary monitoring program for patients initiating a first highly haematotoxic treatment for Hodgkin or non-Hodgkin lymphoma. Patient follow-up is based on consultation with a pharmacist and planed phone calls by nurses supervised by a clinical haematologist. Our objective was to assess effectiveness and cost of the UMACOACH Lymphoma Program (ULP) and to investigate patient satisfaction and quality of life (QoL). Methods: This French monocentric case-control study included all patients enrolled in the ULP over a one-year period (cases) matched with retrospective patients receiving usual care (controls). Numbers of adverse events (AEs), re-hospitalisations, average relative dose intensity (ARDI), treatment response and survival were compared between the two groups. Among cases, patient satisfaction and QoL using the EORTC-QLQC30 questionnaire before and after treatment were evaluated. Results: Seventy-eight cases were matched to 78 controls. Twenty-six percent grade 3−4 AEs were observed in cases versus 38% in controls (p = 0.001). There were 76 and 88 re-hospitalisations in the case and control groups, respectively (p = 0.217). ARDI > 85% was observed in 92% and 82% of cases and controls, respectively (p = 0.138). No differences were observed in terms of treatment responses and survival. Estimated cost savings were of EUR 81,782 in favour of the case group. An improvement of 5.1 points was observed in the total QoL score before and after treatment in cases. Conclusions: A nurse−pharmacist−haematologist collaboration seems to be promising to reduce grade 3−4 AEs in HL and NHL patients receiving highly haematotoxic chemotherapy regimens. Cost savings from hospitalisation being avoided were also shown.
Collapse
Affiliation(s)
- Madeline Devaux
- Department of Pharmacy, University Hospital, F-21000 Dijon, France; (P.P.); (S.B.); (P.G.)
- Correspondence:
| | - Mathieu Boulin
- Department of Pharmacy, University Hospital and EPICAD LNC UMR1231, University of Burgundy & Franche Comte, F-21000 Dijon, France;
| | - Morgane Mounier
- Registre des Hémopathies Malignes de Côte d’Or, Dijon-Bourgogne University Hospital, F-21000 Dijon, France;
- INSERM, U1231, University of Burgundy & Franche Comte, UMR 1231, F-21000 Dijon, France
| | - Denis Caillot
- Department of Clinical Hematology, University Hospital INSERM UMR1231 and SAPHIIR-UMR 1231, University of Burgundy & Franche Comte, F-21000 Dijon, France; (D.C.); (O.C.)
| | - Nuri Ahwij
- Department of Clinical Hematology, University Hospital, F-21000 Dijon, France; (N.A.); (A.H.); (J.N.B.); (C.F.); (P.R.); (P.A.); (L.J.)
| | - Adélie Herbin
- Department of Clinical Hematology, University Hospital, F-21000 Dijon, France; (N.A.); (A.H.); (J.N.B.); (C.F.); (P.R.); (P.A.); (L.J.)
| | - Jean Noël Bastie
- Department of Clinical Hematology, University Hospital, F-21000 Dijon, France; (N.A.); (A.H.); (J.N.B.); (C.F.); (P.R.); (P.A.); (L.J.)
| | - Camille Favennec
- Department of Clinical Hematology, University Hospital, F-21000 Dijon, France; (N.A.); (A.H.); (J.N.B.); (C.F.); (P.R.); (P.A.); (L.J.)
| | - Philippine Robert
- Department of Clinical Hematology, University Hospital, F-21000 Dijon, France; (N.A.); (A.H.); (J.N.B.); (C.F.); (P.R.); (P.A.); (L.J.)
| | - Pauline Pistre
- Department of Pharmacy, University Hospital, F-21000 Dijon, France; (P.P.); (S.B.); (P.G.)
| | - Stephanie Bost
- Department of Pharmacy, University Hospital, F-21000 Dijon, France; (P.P.); (S.B.); (P.G.)
| | - Pauline Amiot
- Department of Clinical Hematology, University Hospital, F-21000 Dijon, France; (N.A.); (A.H.); (J.N.B.); (C.F.); (P.R.); (P.A.); (L.J.)
| | - Laurence Jacquesson
- Department of Clinical Hematology, University Hospital, F-21000 Dijon, France; (N.A.); (A.H.); (J.N.B.); (C.F.); (P.R.); (P.A.); (L.J.)
| | - Olivier Casasnovas
- Department of Clinical Hematology, University Hospital INSERM UMR1231 and SAPHIIR-UMR 1231, University of Burgundy & Franche Comte, F-21000 Dijon, France; (D.C.); (O.C.)
| | - Cédric Rossi
- Department of Clinical Hematology, University Hospital and SAPHIIR-UMR 1231, University of Burgundy & Franche Comte, F-21000 Dijon, France;
| | - Pauline Gueneau
- Department of Pharmacy, University Hospital, F-21000 Dijon, France; (P.P.); (S.B.); (P.G.)
| |
Collapse
|
12
|
Roussel M, Lauwers-Cances V, Macro M, Leleu X, Royer B, Hulin C, Karlin L, Perrot A, Touzeau C, Chrétien ML, Rigaudeau S, Dib M, Nicolas-Virelizier E, Escoffre-Barbe M, Belhadj K, Mariette C, Stoppa AM, Araujo C, Doyen C, Fontan J, Kolb B, Garderet L, Brechignac S, Malfuson JV, Jaccard A, Lenain P, Borel C, Hebraud B, Benbrahim O, Dorvaux V, Manier S, Augeul-Meunier K, Vekemans MC, Randriamalala E, Chaoui D, Caers J, Chaleteix C, Benboubker L, Vincent L, Glaisner S, Zunic P, Slama B, Eveillard JR, Humbrecht-Kraut C, Morel V, Mineur P, Eisenmann JC, Demarquette H, Richez V, Vignon M, Caillot D, Facon T, Moreau P, Colin AL, Olivier P, Wuilleme S, Avet-Loiseau H, Corre J, Attal M. Bortezomib and high-dose melphalan conditioning regimen in frontline multiple myeloma: an IFM randomized phase 3 study. Blood 2022; 139:2747-2757. [PMID: 35511184 DOI: 10.1182/blood.2021014635] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/28/2022] [Indexed: 12/22/2022] Open
Abstract
High-dose melphalan (HDM) and transplantation are recommended for eligible patients with multiple myeloma. No other conditioning regimen has proven to be more effective and/or safer. We previously reported in a phase 2 study that bortezomib can safely and effectively be combined with HDM (Bor-HDM), with a 32% complete response (CR) rate after transplantation. These data supported a randomized phase 3 trial. Randomization was stratified according to risk and response to induction: 300 patients were enrolled, and 154 were allocated to the experimental arm (ie, arm A) with bortezomib (1 mg/m2 intravenously [IV]) on days -6, -3, +1, and +4 and melphalan (200 mg/m2 IV) on day -2. The control arm (ie, arm B) consisted of HDM alone (200 mg/m2 IV). There were no differences in stringent CR + CR rates at day 60 posttransplant (primary end point): 22.1% in arm A vs 20.5% in arm B (P = .844). There were also no differences in undetectable minimum residual disease rates: 41.3% vs 39.4% (P = .864). Median progression-free survival was 34.0 months for arm A vs 29.6 months for arm B (adjusted HR, 0.82; 95% CI, 0.61-1.13; P = .244). The estimated 3-year overall survival was 89.5% in both arms (hazard ratio, 1.28; 95% CI, 0.62-2.64; P = .374). Sixty-nine serious adverse events occurred in 18.7% of Bor-HDM-treated patients (vs 13.1% in HDM-treated patients). The proportion of grade 3/4 AEs was similar within the 2 groups (72.0% vs 73.1%), mainly (as expected) blood and gastrointestinal disorders; 4% of patients reported grade 3/4 or painful peripheral neuropathy in arm A (vs 1.5% in arm B). In this randomized phase 3 study, a conditioning regimen with Bor-HDM did not improve efficacy end points or outcomes compared with HDM alone. The original trial was registered at www.clinicaltrials.gov as #NCT02197221.
Collapse
Affiliation(s)
- Murielle Roussel
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
- USMR, Centre Hospitalo-universitaire (CHU) de Toulouse, Toulouse, France
| | | | - Margaret Macro
- Centre Hospitalo-universitaire (CHU) Côte de Nacre, Caen, France
| | - Xavier Leleu
- Centre Hospitalo-universitaire (CHU) La Mileterie, INSERM CIC 1402, Poitiers, France
| | - Bruno Royer
- Centre Hospitalo-universitaire (CHU) Amiens sud, Amiens, France
- Hôpital St Louis, Paris, France
| | - Cyrille Hulin
- Centre Hospitalo-universitaire (CHU) Haut Lévêque, Bordeaux, France
| | | | - Aurore Perrot
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
- USMR, Centre Hospitalo-universitaire (CHU) de Toulouse, Toulouse, France
- Centre Hospitalo-universitaire (CHU) Côte de Nacre, Caen, France
- Centre Hospitalo-universitaire (CHU) La Mileterie, INSERM CIC 1402, Poitiers, France
- Centre Hospitalo-universitaire (CHU) Amiens sud, Amiens, France
- Centre Hospitalo-universitaire (CHU) Haut Lévêque, Bordeaux, France
- Hospices Civils de Lyon, Pierre Bénite, France
- Centre Hospitalo-universitaire (CHU), Vandoeuvre Les Nancy, France
| | - Cyrille Touzeau
- Centre Hospitalo-universitaire (CHU) Hôtel Dieu, Nantes, France
| | | | | | | | | | | | - Karim Belhadj
- Centre Hospitalo-universitaire (CHU) Henri Mondor, Créteil, France
| | | | | | - Carla Araujo
- Centre Hospitalier de la côte basque, Bayonne, France
| | - Chantal Doyen
- Centre Hospitalo-universitaire (CHU) UCL Namur site Godinne, Yvoir, Belgium
| | - Jean Fontan
- Centre Hospitalo-universitaire (CHU), Besançon, France
| | | | - Laurent Garderet
- Hôpital Saint Antoine, Paris, France
- Hematology Hôpital Avicenne, Bobigny, France
| | | | | | - Arnaud Jaccard
- Centre Hospitalo-universitaire (CHU) Dupuytren, Limoges, France
| | | | - Cécile Borel
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Benjamin Hebraud
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | | | | | | | | | | | | | | | - Jo Caers
- Hôpital Du Sart-Tilman, Liège, Belgium
| | - Carine Chaleteix
- Centre Hospitalo-universitaire (CHU) d'Estaing, Clermont-Ferrand, France
| | | | | | | | - Patricia Zunic
- Cliniques universitaires Saint-Luc, UCL, Brussels, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | - Philippe Moreau
- Centre Hospitalo-universitaire (CHU) Hôtel Dieu, Nantes, France
| | - Anne-Laurène Colin
- Pharmacovigilance des essais, Centre Hospitalo-universitaire (CHU) de Toulouse, Toulouse, France
| | - Pascale Olivier
- Pharmacovigilance des essais, Centre Hospitalo-universitaire (CHU) de Toulouse, Toulouse, France
| | - Soraya Wuilleme
- Hématologie Biologique, Centre Hospitalo-universitaire (CHU) Hôtel Dieu, Nantes, France; and
| | - Hervé Avet-Loiseau
- UGM, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Université de Toulouse, UPS, Toulouse, France
| | - Jill Corre
- UGM, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Université de Toulouse, UPS, Toulouse, France
| | - Michel Attal
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| |
Collapse
|
13
|
Michallet M, Sobh M, Morisset S, Deloire A, Raffoux E, de Botton S, Caillot D, Chantepie S, Girault S, Berthon C, Bertoli S, Lepretre S, Leguay T, Castaigne S, Marolleau JP, Pautas C, Malfuson JV, Veyn N, Braun T, Gastaud L, Suarez F, Schmidt A, Gressin R, Bonmati C, Celli-Lebras K, El-Hamri M, Ribaud P, Dombret H, Thomas X, Bergeron A. Antifungal Prophylaxis in AML Patients Receiving Intensive Induction Chemotherapy: A Prospective Observational Study From the Acute Leukaemia French Association (ALFA) Group. Clin Lymphoma Myeloma Leuk 2022; 22:311-318. [PMID: 34895843 DOI: 10.1016/j.clml.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although recommended in patients with acute myeloblastic leukaemia (AML) after induction chemotherapy, real-life use of antifungal prophylaxis (AFP) is different among centres. MATERIALS AND METHODS This is an ancillary study to a randomized trial on intensive induction chemotherapy in AML patients (ALFA-0702/NCT00932412), where AFP with posaconazole was recommended. IFIs were graded by investigators and by central reviewers according to the revised EORTC definitions. Experts conclusions were compared to the investigators' ones. RESULTS A total of 677 patients were included. Four AFP strategies were reported: Group-1: no AFP (n = 203, 30%), Group-2: posaconazole (n = 241, 36%), Group-3: posaconazole with other AFP (n = 142, 21%), Group-4: other AFP (n = 91, 13%). Experts graded more IFI than investigators: proven/probable IFI, 9.0% (n = 61) versus 6.2% (n = 42). The cumulative incidence at day60 of probable/proven IFI was 13.9% (Group-1); 7.9% (Group-2); 5.6% (Group-3); and 6.6% (Group-4). IFI onset was 26 (19-31) days after induction in Groups 2-3, versus 16 (9-25) days in Group 1 and 20 (12-24) days in Group 4 (P< .001). After a median follow-up of 27.5 months (0.4-73.4), the mortality rate was 38.3%, with 5.4% attributed to IFI. In multivariate analysis, IFI occurrence was an independent risk of death (HR5.63, 95%-CI 2.62-12.08, P< .001). EORTC recommendations were applied in only 57% of patients. In patients without IFI, the rate of AML complete remission was higher. CONCLUSIONS In AML patients, AFP delayed the onset of IFI in addition of decreasing their rate. The frequent misidentification of IFI impacts their appropriate management according to recommendations. hematological remission was more frequent in patients without IFI.
Collapse
Affiliation(s)
| | - Mohamad Sobh
- Hematology department, Anticancer Centre Léon Bérard, Lyon, France
| | | | | | | | | | - Denis Caillot
- Hématologie Clinique, Dijon University Hospital, Dijon, France
| | | | | | | | - Sarah Bertoli
- Service d'hématologie, Institut Universitaire du Cancer de Toulouse - Oncopole, CHU de Toulouse, Toulouse, France
| | - Stephane Lepretre
- Inserm U1245 and Department of Hematology, Centre Henri Becquerel and Normandie Univ UNIROUEN, Rouen, France
| | | | | | | | | | | | - Norbert Veyn
- Hematology, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Felipe Suarez
- Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | | | | | | | | | - Mohamed El-Hamri
- Haematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | | | - Herve Dombret
- Hematology Department, Saint Louis Hospital, Paris, France
| | - Xavier Thomas
- Haematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Anne Bergeron
- Pneumology department, Saint Louis Hospital, AP-HP, Paris, France
| |
Collapse
|
14
|
Michallet M, Cheikh JE, Herbrecht R, Yakoub-Agha I, Caillot D, Gangneux JP. Systemic antifungal strategies in allogeneic hematopoietic stem cell recipients hospitalized in french hematology units: a post-hoc analysis of the cross-sectional observational AFHEM study. BMC Infect Dis 2022; 22:352. [PMID: 35397492 PMCID: PMC8994341 DOI: 10.1186/s12879-022-07216-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Invasive fungal diseases (IFD) remain a major complication of allogeneic hematopoietic stem cell transplantation (alloHSCT) and are associated with high mortality rates in patients receiving alloHSCT. Antifungal prophylaxis is increasingly being used in the management of IFDs in patients receiving alloHSCT.
Methods
A post-hoc analysis of the cross-sectional observational AFHEM study was carried out to describe the use of antifungal drugs in real-life clinical practice in alloHSCT recipients hospitalized in French hematological units.
Results
A total of 147 alloHSCT recipients were enrolled; most were adults (n = 135; 92%) and had received alloHSCT < 6 months prior to enrollment (n = 123; 84%). Overall, 119 (81%) patients received a systemic antifungal therapy; of these, 95 (80%) patients received antifungal prophylaxis. Rates of patients receiving systemic antifungal treatment were similar irrespective of transplant time, neutropenic, and graft-versus-host disease status. Among patients on systemic antifungal treatment, 83 (70%) received an azole, 22 (18%) received an echinocandin, and 16 (13%) received a polyene.
Conclusions
This work provides evidence of the antifungal strategies used in alloHSCT recipients hospitalized in French hematological units. Unlike earlier studies, the AFHEM study showed that prophylaxis appears to be the leading antifungal strategy used in alloHSCT recipients in France.
Collapse
|
15
|
Baumelou M, Payssot A, Row C, Racine J, Lafon I, Bastie J, Chevreux S, Chrétien M, Maynadié M, Caillot D, Guy J. Early achievement of measurable residual disease negativity in the treatment of multiple myeloma as predictor of outcome. Br J Haematol 2022; 197:e82-e85. [DOI: 10.1111/bjh.18103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Marion Baumelou
- Service d'Hématologie biologique Centre Hospitalier Universitaire de Dijon Dijon France
| | - Alexandre Payssot
- Service d'Hématologie clinique Centre Hospitalier Universitaire de Dijon Dijon France
| | - Celine Row
- Service d'Hématologie biologique Centre Hospitalier Universitaire de Dijon Dijon France
| | - Jessica Racine
- Service d'Hématologie biologique Centre Hospitalier Universitaire de Dijon Dijon France
| | - Ingrid Lafon
- Service d'Hématologie clinique Centre Hospitalier Universitaire de Dijon Dijon France
| | - Jean‐Noél Bastie
- Service d'Hématologie clinique Centre Hospitalier Universitaire de Dijon Dijon France
| | - Steeve Chevreux
- Service d'Hématologie clinique Centre Hospitalier Universitaire de Dijon Dijon France
| | | | - Marc Maynadié
- Service d'Hématologie biologique Centre Hospitalier Universitaire de Dijon Dijon France
| | - Denis Caillot
- Service d'Hématologie clinique Centre Hospitalier Universitaire de Dijon Dijon France
| | - Julien Guy
- Service d'Hématologie biologique Centre Hospitalier Universitaire de Dijon Dijon France
| |
Collapse
|
16
|
Millon L, Caillot D, Berceanu A, Bretagne S, Lanternier F, Morio F, Letscher-Bru V, Dalle F, Denis B, Alanio A, Boutoille D, Bougnoux ME, Botterel F, Chouaki T, Charbonnier A, Ader F, Dupont D, Bellanger AP, Rocchi S, Scherer E, Gbaguidi-Haore H, Herbrecht R. Evaluation of serum Mucorales PCR for the diagnosis of Mucormycoses: The MODIMUCOR prospective trial. Clin Infect Dis 2022; 75:777-785. [PMID: 34986227 DOI: 10.1093/cid/ciab1066] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Early diagnosis and prompt initiation of specific antifungal treatment is essential for improving the prognosis of mucormycosis. We aimed to assess the performance of serum Mucorales quantitative PCR (qPCR) for the early diagnosis and follow-up of mucormycosis. METHODS We prospectively enrolled 232 patients with suspicion of invasive mold disease, evaluated using standard imaging and mycological procedures. Thirteen additional patients with proven or probable mucormycosis were included to analyze DNA load kinetics. Serum samples were collected twice-a-week for Mucorales qPCR tests targeting the Mucorales species Lichtheimia, Rhizomucor and Mucor/Rhizopus. RESULTS The sensitivity was 85·2%, specificity 89·8%, and positive and negative likelihood ratios 8·3 and 0·17, respectively in this prospective study. The first Mucorales qPCR-positive serum was observed a median of four days (IQR, 0-9) before sampling of the first mycological or histological positive specimen and a median of one day (IQR, (-2)-6) before the first imaging was performed. Negativity of Mucorales qPCR within seven days after liposomal-amphotericin B initiation was associated with an 85% lower 30-day mortality rate (adjusted hazard Ratio = 0·15, 95%CI [0·03-0·73], p = 0·02). CONCLUSION Our study argues for the inclusion of qPCR for the detection of circulating Mucorales DNA for mucormycosis diagnosis and follow-up after treatment initiation. Positive results should be added to the criteria for the consensual definitions from the European Organization for the Research and Treatment of Cancer/ Mycoses Study Group Education and Research Consortium (EORTC/MSGERC), as already done for Aspergillus PCR.
Collapse
Affiliation(s)
- Laurence Millon
- Laboratoire de Parasitologie-Mycologie, CHU Besançon, Besançon, France.,UMR 6249 CNRS Chrono-Environnement, Univ Bourgogne Franche-Comté, Besançon, France
| | - Denis Caillot
- Department of Clinical Hematology, CHU Dijon, Dijon, France
| | - Ana Berceanu
- Service d'Hematologie, CHU Besançon, Besançon, France
| | - Stéphane Bretagne
- Institut Pasteur, CNRS, Molecular Mycology Unit, National Reference Center for Invasive Mycoses & Antifungals, UMR2000, Paris, France.,Laboratoire de Parasitologie-Mycologie, Hôpital Saint Louis, AP-HP, Paris, France.,Université de Paris, Paris, France
| | - Fanny Lanternier
- Institut Pasteur, CNRS, Molecular Mycology Unit, National Reference Center for Invasive Mycoses & Antifungals, UMR2000, Paris, France.,Université de Paris, Paris, France.,Necker Pasteur Center for Infectious Diseases and Tropical Medicine, Hôpital Necker Enfants malades, AP-HP, IHU Imagine, Paris, France
| | - Florent Morio
- Laboratoire de Parasitologie-Mycologie, CHU Nantes, Nantes, France.,Département de Parasitologie et Mycologie Médicale, EA1155 - IICiMed, Nantes Université, Nantes, France
| | - Valérie Letscher-Bru
- Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg Strasbourg, France
| | - Frédéric Dalle
- Laboratoire de Parasitologie-Mycologie, Plateforme de Biologie Hospitalo-Universitaire Gérard Mack, Dijon France.,UMR PAM Univ Bourgogne Franche-Comté - AgroSup Dijon - Equipe Vin, Aliment, Microbiologie, Stress, Dijon, France
| | - Blandine Denis
- Infectious Diseases Department, APHP, Saint-Louis Hospital, Paris, France
| | - Alexandre Alanio
- Institut Pasteur, CNRS, Molecular Mycology Unit, National Reference Center for Invasive Mycoses & Antifungals, UMR2000, Paris, France.,Laboratoire de Parasitologie-Mycologie, Hôpital Saint Louis, AP-HP, Paris, France.,Université de Paris, Paris, France
| | - David Boutoille
- Unité Maladies Infectieuses et Tropicales, CHU Nantes, Nantes, France
| | - Marie-Elisabeth Bougnoux
- Parasitology-Mycology Unit, Necker Enfants Malades Hospital, APHP, Paris, France.,Fungal Biology and Pathogenicity Unit - INRA USC 2019. Institut Pasteur, Paris, France
| | - Françoise Botterel
- EA Dynamyc 7380 UPEC, ENVA, Faculté de Médecine, Créteil, France.,Unité de Parasitologie - Mycologie, Département de Virologie, Bactériologie-Hygiène, Mycologie-Parasitologie, DHU VIC, CHU Henri Mondor, Créteil, France
| | - Taieb Chouaki
- Laboratoire de Parasitologie et Mycologie Médicales, Centre de Biologie Humaine, CHU Amiens Picardie, Amiens, France.,Equipe AGIR : Agents Infectieux, Résistance et Chimiothérapie UR4294, Université de Picardie Jules Verne, Amiens, France
| | - Amandine Charbonnier
- Department of Clinical Hematology and Cellular Therapy, Amiens University Medical Center, Amiens, France
| | - Florence Ader
- Hospices Civils de Lyon, Département des Maladies Infectieuses et Tropicales, F-69004, Lyon, France
| | - Damien Dupont
- Institut des Agents Infectieux, Parasitologie Mycologie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Anne-Pauline Bellanger
- Laboratoire de Parasitologie-Mycologie, CHU Besançon, Besançon, France.,UMR 6249 CNRS Chrono-Environnement, Univ Bourgogne Franche-Comté, Besançon, France
| | - Steffi Rocchi
- Laboratoire de Parasitologie-Mycologie, CHU Besançon, Besançon, France.,UMR 6249 CNRS Chrono-Environnement, Univ Bourgogne Franche-Comté, Besançon, France
| | - Emeline Scherer
- Laboratoire de Parasitologie-Mycologie, CHU Besançon, Besançon, France.,UMR 6249 CNRS Chrono-Environnement, Univ Bourgogne Franche-Comté, Besançon, France
| | - Houssein Gbaguidi-Haore
- UMR 6249 CNRS Chrono-Environnement, Univ Bourgogne Franche-Comté, Besançon, France.,Infection Control Department, CHU Besançon, Besançon, France
| | - Raoul Herbrecht
- Université de Strasbourg, INSERM, IRFAC UMR-S1113, Strasbourg, France.,Service d'Hématologie, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| |
Collapse
|
17
|
Facon T, Cook G, Usmani SZ, Hulin C, Kumar S, Plesner T, Touzeau C, Bahlis NJ, Basu S, Nahi H, Goldschmidt H, Quach H, Mohty M, Venner CP, Weisel K, Raje N, Hebraud B, Belhadj-Merzoug K, Benboubker L, Decaux O, Manier S, Caillot D, Ukropec J, Pei H, Van Rampelbergh R, Uhlar CM, Kobos R, Zweegman S. Daratumumab plus lenalidomide and dexamethasone in transplant-ineligible newly diagnosed multiple myeloma: frailty subgroup analysis of MAIA. Leukemia 2022; 36:1066-1077. [PMID: 34974527 PMCID: PMC8979809 DOI: 10.1038/s41375-021-01488-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022]
Abstract
In the phase 3 MAIA study of patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), daratumumab plus lenalidomide/dexamethasone (D-Rd) improved progression-free survival (PFS) versus lenalidomide/dexamethasone (Rd). We present a subgroup analysis of MAIA by frailty status. Frailty assessment was performed retrospectively using age, Charlson comorbidity index, and baseline Eastern Cooperative Oncology Group performance status score. Patients were classified as fit, intermediate, non-frail (fit + intermediate), or frail. Of the randomized patients (D-Rd, n = 368; Rd, n = 369), 396 patients were non-frail (D-Rd, 196 [53.3%]; Rd, 200 [54.2%]) and 341 patients were frail (172 [46.7%]; 169 [45.8%]). After a 36.4-month median follow-up, non-frail patients had longer PFS than frail patients, but the PFS benefit of D-Rd versus Rd was maintained across subgroups: non-frail (median, not reached [NR] vs 41.7 months; hazard ratio [HR], 0.48; P < 0.0001) and frail (NR vs 30.4 months; HR, 0.62; P = 0.003). Improved rates of complete response or better and minimal residual disease (10-5) negativity were observed for D-Rd across subgroups. The most common grade 3/4 treatment-emergent adverse event in non-frail and frail patients was neutropenia (non-frail, 45.4% [D-Rd] and 37.2% [Rd]; frail, 57.7% and 33.1%). These findings support the clinical benefit of D-Rd in transplant-ineligible NDMM patients enrolled in MAIA, regardless of frailty status.
Collapse
Affiliation(s)
- Thierry Facon
- grid.503422.20000 0001 2242 6780University of Lille, CHU Lille, Service des Maladies du Sang, Lille, France
| | - Gordon Cook
- grid.415967.80000 0000 9965 1030Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Saad Z. Usmani
- grid.468189.aLevine Cancer Institute/Atrium Health, Charlotte, NC USA
| | - Cyrille Hulin
- grid.42399.350000 0004 0593 7118Department of Hematology, Hôpital Haut Lévêque, University Hospital, Pessac, France
| | - Shaji Kumar
- grid.66875.3a0000 0004 0459 167XDepartment of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Torben Plesner
- grid.417271.60000 0004 0512 5814Vejle Hospital and University of Southern Denmark, Vejle, Denmark
| | - Cyrille Touzeau
- grid.277151.70000 0004 0472 0371Centre Hospitalier Universitaire, Nantes, France
| | - Nizar J. Bahlis
- grid.22072.350000 0004 1936 7697University of Calgary, Arnie Charbonneau Cancer Research Institute, Calgary, AB Canada
| | - Supratik Basu
- grid.6374.60000000106935374The Royal Wolverhampton Hospitals NHS Trust, University of Wolverhampton, Wolverhampton, UK
| | - Hareth Nahi
- grid.24381.3c0000 0000 9241 5705Karolinska Institute, Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm, Sweden
| | - Hartmut Goldschmidt
- grid.5253.10000 0001 0328 4908University Clinic Heidelberg, International Medicine V and National Center of Tumor Diseases (NCT), Heidelberg, Germany
| | - Hang Quach
- grid.1008.90000 0001 2179 088XUniversity of Melbourne, St. Vincent’s Hospital, Melbourne, VIC Australia
| | - Mohamad Mohty
- grid.412370.30000 0004 1937 1100Sorbonne University, Department of Hematology, Saint-Antoine Hospital, Paris, France
| | - Christopher P. Venner
- grid.17089.370000 0001 2190 316XCross Cancer Institute, University of Alberta, Edmonton, AB Canada
| | - Katja Weisel
- grid.13648.380000 0001 2180 3484Department of Oncology, Hematology and Bone Marrow Transplantation With Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Noopur Raje
- grid.32224.350000 0004 0386 9924Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA USA
| | - Benjamin Hebraud
- grid.411175.70000 0001 1457 2980Institut Universitaire du Cancer and University Hospital, Toulouse, France
| | - Karim Belhadj-Merzoug
- grid.412116.10000 0001 2292 1474Hémopathies Lymphoïdes, Hôpital Henri Mondor, Créteil, France
| | | | - Olivier Decaux
- grid.410368.80000 0001 2191 9284Clinical Haematology Department, University of Rennes, CHU Rennes, CIC INSERM 1414, Rennes, France
| | - Salomon Manier
- grid.503422.20000 0001 2242 6780University of Lille, CHU Lille, Service des Maladies du Sang, Lille, France
| | - Denis Caillot
- grid.31151.37CHU Dijon, Hôpital du Bocage, Dijon, France
| | - Jon Ukropec
- Janssen Global Medical Affairs, Horsham, PA USA
| | - Huiling Pei
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Titusville, NJ USA
| | | | - Clarissa M. Uhlar
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Spring House, PA USA
| | - Rachel Kobos
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Raritan, NJ USA
| | - Sonja Zweegman
- grid.12380.380000 0004 1754 9227Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
18
|
Cottin Y, Boulin M, Doisy C, Mounier M, Caillot D, Chretien M, Bodin A, Herbert J, Bonnotte B, Zeller M, Maynadie M, Fauchier L. Mortality and major cardiovascular events among patients with multiple myeloma: Analysis from a nationwide French medical information database. Archives of Cardiovascular Diseases Supplements 2022. [DOI: 10.1016/j.acvdsp.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
19
|
Cottin Y, Boulin M, Doisy C, Mounier M, Caillot D, Chretien ML, Bodin A, Herbert J, Bonnotte B, Zeller M, Maynadie M, Fauchier L. Mortality and major cardiovascular events among patients with multiple myeloma: analysis from a nationwide French medical information database. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiovascular disease (CVD) in patients with multiple myeloma (MM) may derive from multiple factors unrelated to the disease (age, diabetes, dyslipidemia, obesity, prior CV diseases), related to the disease and/or related to antimyeloma treatment. Based on a nationwide hospitalization database, we aimed to assess the risk of all-cause death, and CV outcomes in MM patients.
Methods
From 1st January 2013 to 31st December 2013, 3,381,472 adults (age ≥18 years) were hospitalized for any reason in French hospitals and then had at least 5 years of complete follow-up (or suffered death earlier). We identified 15,774 patients diagnosed with known MM at baseline. The outcome analysis (all-cause death, cardiovascular [CV] death, myocardial infarction (MI), ischemic stroke or hospitalization for major bleeding) was performed with follow-up starting at the time of last event. For each patient with MM, a propensity score-matched patient with no MM was selected (1:1) using the one-to-one nearest neighbor method.
Findings
The mean follow-up in the propensity-score-matched population was 3.7±2.3 years, median 5.0, IQR 1.3–5.7 years. During follow-up, matched patients with MM (15 774 patients) had a higher risk of all-death (yearly rate 20.02 vs 11.39%/year) than patients without MM. No difference was observed between MM group and no myeloma group for CV death (2.00 vs 2.02%/year). The rate of MI and stroke was markedly lower in the MM group, respectively for incidence rate, 0.86 vs 0.97%/year and 0.85 vs 1.10%/year. In contrast, MM group had a higher rate of rehospitalization for major bleeding with an incidence rate of 3.61 vs 2.24%/yr and a higher risk of intracranial bleeding (1.03 vs 0.84%/yr). Results were similar in sensitivity analysis limited to patients with recent MM (i.e. diagnosed within the 3 previous months).
Interpretation
From a large nationwide database, we show that although patients with MM are not at higher risk of CV death, they had a higher risk of mortality due to major bleeding and intracranial bleeding. Our findings highlight the key issue of anticoagulation treatment management in patients with MM.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- Y Cottin
- University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France
| | - M Boulin
- University of Bourgogne Franche Comté, Pharmacy departement, EPICAD LNC UMR 1231, Dijon, France
| | - C Doisy
- University of Bourgogne Franche Comté, Pharmacy departement, EPICAD LNC UMR 1231, Dijon, France
| | - M Mounier
- France Registre des Hémopathies Malignes de Côte d'OR, U1231, University Hospital, Dijon, France
| | - D Caillot
- University Hospital, Hematology Department, Dijon, France
| | - M L Chretien
- University Hospital, Hematology Department, Dijon, France
| | - A Bodin
- Trousseau Hospital and University François Rabelais, Cardiology Department, Tours, France
| | - J Herbert
- Trousseau Hospital and University François Rabelais, Cardiology Department, Tours, France
| | - B Bonnotte
- University Hospital of Dijon, Internal medicine, Dijon, France
| | - M Zeller
- University of Bourgogne Franche Comte, Equipe PEC2, EA 7460, UFR Sciences de Santé, Dijon, France
| | - M Maynadie
- France Registre des Hémopathies Malignes de Côte d'OR, U1231, University Hospital, Dijon, France
| | - L Fauchier
- Department of Cardiology, University Teaching Hospital of Trousseau and University François Rabelais, Tours, France
| |
Collapse
|
20
|
Cottin Y, Boulin M, Doisy C, Mounier M, Caillot D, Chretien ML, Bodin A, Herbert J, Bonnotte B, Zeller M, Maynadie M, Fauchier L. New onset atrial fibrillation and heart failure among patients with multiple myeloma: analysis from a nationwide french medical information database. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Over the last decade, new therapies, screening optimization, and cardiovascular management have changed the cardiovascular prognosis of patients with multiple myeloma (MM). Older studies suggested that MM could be associated with increased risk of heart failure (HF). Based on a nationwide hospitalization database, we aimed to assess the risk of hospitalization for Heart failure (HF) and/or Atrial fibrillation (AF).
Methods
From 1st January 2013 to 31st December 2013, 3,381,472 adults (age ≥18 years) were hospitalized for any reason in French hospitals and then had at least 5 years of complete follow-up (or suffered death earlier). We identified 15,774 patients diagnosed with known MM at baseline. The outcome analysis on hospitalization for new onset HF or AF was performed with follow-up (FU) starting at the time of last event. For each patient with MM, a propensity score-matched patient with no MM was selected (1:1) using the one-to-one nearest neighbor method (n=15774 in each group).
Findings
In the propensity-score-matched population, mean±SD FU was 3.7±2.3 years, median (IQR)5.0 (1.3–5.7) years, mean age was 71±12y, and most were female (55%). When compared with patients without MM, MM patients were more likely to have history of HF (16.8% vs. 10.5%, p<0.0001), pulmonary edema (1.5 vs. 0.8%, p<0.0001), or AF (13.4% vs. 9.6%, p<0.0001). At FU, MM patients had a higher risk of all-death (yearly rate 20.02 vs 11.39%/year). Moreover, yearly rates of new onset HF or AF, which were the common CV causes of re-hospitalisation, were higher in the MM group, i.e. respectively for incidence rate, 7.47 vs 5.42%/year (p<0.0001) and 4.57 vs 3.72%/year (p<0.0001). Multivariate analysis showed that MM remained significantly associated with a higher rate of HF and AF (HR (95% CI): 1.343 (1.276–1.413) and 1.196 (1.128–1.269), respectively). Results were similar in sensitivity analysis limited to patients with recent MM (i.e. diagnosed within the 3 previous months).
Interpretation
From a large nationwide hospitalization database, we show that patients with MM had a higher risk of new onset HF and AF. Our findings highlight the key issue of cardiovascular management in patients with MM.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- Y Cottin
- University Hospital Center Dijon Bourgogne, Cardiology Department, Dijon, France
| | - M Boulin
- University of Bourgogne Franche Comte, Pharmacy Departement, EPICAD LNC UMR 1231, Dijon, France
| | - C Doisy
- University of Bourgogne Franche Comte, Pharmacy Departement, EPICAD LNC UMR 1231, Dijon, France
| | - M Mounier
- University Hospital, France Registre des Hémopathies Malignes de Côte d'OR, U1231, Dijon, France
| | - D Caillot
- Hematology Department, University Hospital, Dijon, France
| | - M L Chretien
- Hematology Department, University Hospital, Dijon, France
| | - A Bodin
- Trousseau Hospital and University François Rabelais, Cardiology Department, Tours, France
| | - J Herbert
- Trousseau Hospital and University François Rabelais, Cardiology Department, Tours, France
| | - B Bonnotte
- Dijon University Hospital, Department of Internal Medicine, Dijon, France
| | - M Zeller
- University of Bourgogne Franche Comte, Equipe PEC2, EA 7460, UFR Sciences de Santé, Dijon, France
| | - M Maynadie
- University Hospital, France Registre des Hémopathies Malignes de Côte d'OR, U1231, Dijon, France
| | - L Fauchier
- Department of Cardiology, University Teaching Hospital of Trousseau and University François Rabelais, Cardiology Department, Trousseau Hospital and University François Rabelais, Tours, France
| |
Collapse
|
21
|
Silva Y, Riedinger JM, Chrétien ML, Caillot D, Corre J, Guillen K, Cochet A, Tabouret-Viaud C, Loffroy R. Comparison between tumour metabolism derived from 18F-FDG PET/CT and accurate cytogenetic stratification in newly diagnosed multiple myeloma patients. Quant Imaging Med Surg 2021; 11:4299-4309. [PMID: 34603985 DOI: 10.21037/qims-21-85] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/14/2021] [Indexed: 12/27/2022]
Abstract
Background 18F-fluorodeoxyglucose positron emission tomography integrated with computed tomography (18F-FDG PET/CT) is a useful tool for baseline staging in newly diagnosed multiple myeloma (MM) but also for prognostic stratification. This monocentric retrospective study aimed at examining the relation between baseline tumour metabolism assessed by 18F-FDG PET/CT and linear predictor (LP) score, a new cytogenetic stratification score. Methods From March 2012 to March 2019, 57 patients with newly diagnosed MM addressed to our institution for baseline 18F-FDG PET/CT were included. LP score was determined on systematic iliac crest bone marrow samples. Obtained on CD138-sorted bone marrow plasma cells, this recent composite cytogenetic stratification is a 6-marker based weighted score using fluorescence in situ hybridization (FISH) ± single nucleotide polymorphism (SNP) arrays. We compared quantitative metabolic parameters and LP score using a Kruskal-Wallis test and visual suspicion of diffuse bone marrow involvement (DBI; based on hepatic background as threshold of positivity) and cytogenetic data using a Chi-squared test. Results The distribution of total metabolic tumour volume (TMTV) and total lesion glycolysis (TLG) values among the three LP score categories was almost stochastic, with no significant association (P=0.70). Additionally, no significant association between TMTV/TLG and any of the six cytogenetic abnormalities included in LP score calculation. A significant association was found between visual high suspicion of DBI and LP score (P=0.036), and between this visual parameter and the presence of 1q gain (P=0.049). Conclusions There is no significant association between quantitative metabolic parameters assessed with 18F-FDG PET/CT and LP score in patients with newly diagnosed MM, suggesting a potential complementarity of these biomarkers for prognostic stratification. A significant association was found between high visual suspicion of DBI and LP score.
Collapse
Affiliation(s)
- Yannick Silva
- Department of Nuclear Medicine, Unicancer-Georges François Leclerc Cancer Center, Dijon, France
| | - Jean-Marc Riedinger
- Department of Nuclear Medicine, Unicancer-Georges François Leclerc Cancer Center, Dijon, France
| | | | - Denis Caillot
- Department of Clinical Haematology, François-Mitterrand University Hospital, Dijon, France
| | - Jill Corre
- Unit for Genomics in Myeloma, Institut Universitaire du Cancer-Oncopole, Toulouse, France.,Centre de Recherches en Cancérologie de Toulouse, INSERMU1037, Toulouse, France
| | - Kévin Guillen
- Department of Diagnostic and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| | - Alexandre Cochet
- Department of Nuclear Medicine, Unicancer-Georges François Leclerc Cancer Center, Dijon, France.,ImViA Laboratory-EA 7535, University of Bourgogne/Franche-Comté, Besançon, France
| | - Claire Tabouret-Viaud
- Department of Nuclear Medicine, Unicancer-Georges François Leclerc Cancer Center, Dijon, France
| | - Romaric Loffroy
- Department of Diagnostic and Interventional Radiology, François-Mitterrand University Hospital, Dijon, France
| |
Collapse
|
22
|
Moreau P, Hulin C, Perrot A, Arnulf B, Belhadj K, Benboubker L, Béné MC, Zweegman S, Caillon H, Caillot D, Corre J, Delforge M, Dejoie T, Doyen C, Facon T, Sonntag C, Fontan J, Mohty M, Jie KS, Karlin L, Kuhnowski F, Lambert J, Leleu X, Macro M, Orsini-Piocelle F, Roussel M, Stoppa AM, van de Donk NWCJ, Wuillème S, Broijl A, Touzeau C, Tiab M, Marolleau JP, Meuleman N, Vekemans MC, Westerman M, Klein SK, Levin MD, Offner F, Escoffre-Barbe M, Eveillard JR, Garidi R, Ahmadi T, Krevvata M, Zhang K, de Boer C, Vara S, Kampfenkel T, Vanquickelberghe V, Vermeulen J, Avet-Loiseau H, Sonneveld P. Maintenance with daratumumab or observation following treatment with bortezomib, thalidomide, and dexamethasone with or without daratumumab and autologous stem-cell transplant in patients with newly diagnosed multiple myeloma (CASSIOPEIA): an open-label, randomised, phase 3 trial. Lancet Oncol 2021; 22:1378-1390. [PMID: 34529931 DOI: 10.1016/s1470-2045(21)00428-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND CASSIOPEIA part 1 showed superior depth of response and significantly improved progression-free survival with daratumumab, bortezomib, thalidomide, and dexamethasone (D-VTd) versus bortezomib, thalidomide, and dexamethasone (VTd) as induction and consolidation in patients with autologous stem-cell transplant (ASCT)-eligible newly diagnosed multiple myeloma. In part 2, we compared daratumumab maintenance versus observation only. METHODS CASSIOPEIA is a two-part, open-label, randomised, phase 3 trial of patients aged 18-65 years with newly diagnosed multiple myeloma and Eastern Cooperative Oncology Group performance status 0-2, done in 111 European academic and community practice centres. In part 1, patients were randomly assigned (1:1) to induction and consolidation with D-VTd or VTd. Patients still on study who had a partial response or better were randomly assigned (1:1) by an interactive web-response system to daratumumab 16 mg/kg intravenously every 8 weeks (a reduced frequency compared with standard daratumumab long-term dosing) or observation only for up to 2 years. Stratification factors were induction treatment and depth of response in part 1. The part 2 primary endpoint was progression-free survival from second randomisation. This preplanned interim analysis of progression-free survival was done after 281 events and shall be considered the primary analysis of progression-free survival. Sponsor personnel and designees who were involved in the analysis were masked to treatment group until the independent data monitoring committee recommended that the preplanned interim analysis be considered the main analysis of progression-free survival in part 2. Otherwise, treatment assignments were unmasked. The interaction between induction and consolidation and maintenance was tested at a two-sided significance level of 0·05 by a stratified Cox regression model that included the interaction term between maintenance treatment and induction and consolidation treatment. Efficacy analyses were done in the maintenance-specific intention-to-treat population, which comprised all patients who underwent second randomisation. Safety was analysed in all patients in the daratumumab group who received at least one dose and all patients randomly assigned to observation only. This trial is registered with ClinicalTrials.gov, NCT02541383. Long-term follow-up is ongoing and the trial is closed to new participants. FINDINGS Between May 30, 2016, and June 18, 2018, 886 patients (458 [84%] of 543 in the D-VTd group and 428 [79%] of 542 in the VTd group) were randomly assigned to daratumumab maintenance (n=442) or observation only (n=444). At a median follow-up of 35·4 months (IQR 30·2-39·9) from second randomisation, median progression-free survival was not reached (95% CI not evaluable [NE]-NE) with daratumumab versus 46·7 months (40·0-NE) with observation only (hazard ratio 0·53, 95% CI 0·42-0·68, p<0·0001). A prespecified analysis of progression-free survival results showed a significant interaction between maintenance and induction and consolidation therapy (p<0·0001). The most common grade 3 or 4 adverse events were lymphopenia (16 [4%] of 440 patients in the daratumumab group vs eight [2%] of 444 patients in the observation-only group), hypertension (13 [3%] vs seven [2%]), and neutropenia (nine [2%] vs ten [2%]). Serious adverse events occurred in 100 (23%) patients in the daratumumab group and 84 (19%) patients in the observation-only group. In the daratumumab group, two adverse events led to death (septic shock and natural killer-cell lymphoblastic lymphoma); both were related to treatment. INTERPRETATION Daratumumab maintenance every 8 weeks for 2 years significantly reduced the risk of disease progression or death compared with observation only. Longer follow-up and other ongoing studies will shed further light on the optimal daratumumab-containing post-ASCT maintenance treatment strategy. FUNDING Janssen Research & Development, the Intergroupe Francophone du Myélome, and the Dutch-Belgian Cooperative Trial Group for Hematology Oncology.
Collapse
Affiliation(s)
- Philippe Moreau
- Hematology Clinic, University Hospital Hôtel-Dieu, Nantes, France.
| | - Cyrille Hulin
- Bordeaux University Hospital Center, Bordeaux, France
| | - Aurore Perrot
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Bertrand Arnulf
- Hematology and Oncology, Hôpital Saint Louis, APHP, Paris, France
| | | | | | - Marie C Béné
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Sonja Zweegman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hélène Caillon
- Biochemistry Laboratory, Nantes University Hospital, Nantes, France
| | - Denis Caillot
- Dijon University Hospital, Hôpital du Bocage, Dijon, France
| | - Jill Corre
- Unité de Genomique du Myélome, IUC-T Oncopole, Toulouse, France
| | - Michel Delforge
- Department of Hematology, University Hospital Leuven, Leuven, Belgium
| | - Thomas Dejoie
- Biochemistry Laboratory, Nantes University Hospital, Nantes, France
| | - Chantal Doyen
- Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | - Cécile Sonntag
- University Hospital, Hôpital Hautepierre, Strasbourg, France
| | - Jean Fontan
- University Hospital Jean Minjoz, Besancon, France
| | - Mohamad Mohty
- Hematology and Cellular Therapy Department of Saint-Antoine Hospital, Sorbonne University, Paris, France
| | | | - Lionel Karlin
- Lyon University Hospital, Hematology Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | | | | | - Xavier Leleu
- Poitiers University Hospital, CHU la Milétrie, Poitiers, France
| | | | | | | | | | | | - Soraya Wuillème
- Hematology Biology, Nantes University Hospital, Nantes, France
| | | | - Cyrille Touzeau
- Hematology Clinic, University Hospital Hôtel-Dieu, Nantes, France
| | - Mourad Tiab
- Centre Hospitalier Départemental Vendée, La Roche sur Yon, France
| | | | - Nathalie Meuleman
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | | | | | | | - Réda Garidi
- Saint-Quentin Hospital Center, Saint Quentin, France
| | | | | | - Ke Zhang
- Janssen Research & Development, La Jolla, CA, USA
| | - Carla de Boer
- Janssen Research & Development, LLC, Leiden, Netherlands
| | - Sanjay Vara
- Janssen Research & Development, High Wycombe, UK
| | | | | | | | | | | |
Collapse
|
23
|
Hulin C, Offner F, Moreau P, Roussel M, Belhadj K, Benboubker L, Caillot D, Facon T, Garderet L, Kuhnowski F, Stoppa AM, Kolb B, Tiab M, Jie KS, Westerman M, Lambert J, Pei L, Vanquickelberghe V, De Boer C, Vermeulen J, Kampfenkel T, Sonneveld P, Van de Donk NWCJ. Stem cell yield and transplantation in transplant-eligible newly diagnosed multiple myeloma patients receiving daratumumab + bortezomib/thalidomide/dexamethasone in the phase 3 CASSIOPEIA study. Haematologica 2021; 106:2257-2260. [PMID: 33657786 PMCID: PMC8327738 DOI: 10.3324/haematol.2020.261842] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Indexed: 01/16/2023] Open
Affiliation(s)
- Cyrille Hulin
- Department of Hematology, Hôpital Haut-Lévêque, University Hospital Bordeaux, Pessac.
| | | | - Philippe Moreau
- Service d'Hématologie Clinique, University Hospital Hôtel-Dieu, Nantes
| | | | - Karim Belhadj
- Hémopathies Lymphoïdes, Hôpital Henri Mondor, Creteil
| | | | | | - Thierry Facon
- University of Lille, CHU Lille, Service des Maladies du Sang, Lille
| | - Laurent Garderet
- Sorbonne Université, INSERM, UMR_S 938, Centre de Recherche Saint-Antoine, Team Proliferation and Differentiation of Stem Cells, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpetrière, Département d'Hématologie, Paris
| | | | | | | | | | | | | | | | - Lixia Pei
- Janssen Research and Development, LLC, Raritan, NJ
| | | | | | | | | | | | | |
Collapse
|
24
|
Guilhot F, Rigal-Huguet F, Guilhot J, Guerci-Bresler AP, Maloisel F, Rea D, Coiteux V, Gardembas M, Berthou C, Vekhoff A, Jourdan E, Berger M, Fouillard L, Alexis M, Legros L, Rousselot P, Delmer A, Lenain P, Escoffre Barbe M, Gyan E, Bulabois CE, Dubruille V, Joly B, Pollet B, Cony-Makhoul P, Johnson-Ansah H, Mercier M, Caillot D, Charbonnier A, Kiladjian JJ, Chapiro J, Penot A, Dorvaux V, Vaida I, Santagostino A, Roy L, Zerazhi H, Deconinck E, Maisonneuve H, Plantier I, Lebon D, Arkam Y, Cambier N, Ghomari K, Miclea JM, Glaisner S, Cayuela JM, Chomel JC, Muller M, Lhermitte L, Delord M, Preudhomme C, Etienne G, Mahon FX, Nicolini FE. Long-term outcome of imatinib 400 mg compared to imatinib 600 mg or imatinib 400 mg daily in combination with cytarabine or pegylated interferon alpha 2a for chronic myeloid leukaemia: results from the French SPIRIT phase III randomised trial. Leukemia 2021; 35:2332-2345. [PMID: 33483613 DOI: 10.1038/s41375-020-01117-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 11/20/2020] [Accepted: 12/15/2020] [Indexed: 01/29/2023]
Abstract
The STI571 prospective randomised trial (SPIRIT) French trial is a four-arm study comparing imatinib (IM) 400 mg versus IM 600 mg, IM 400 mg + cytarabine (AraC), and IM 400 mg + pegylated interferon alpha2a (PegIFN-α2a) for the front-line treatment of chronic-phase chronic myeloid leukaemia (CML). Long-term analyses included overall and progression-free survival, molecular responses to treatment, and severe adverse events. Starting in 2003, the trial included 787 evaluable patients. The median overall follow-up of the patients was 13.5 years (range 3 months to 16.7 years). Based on intention-to-treat analyses, at 15 years, overall and progression-free survival were similar across arms: 85%, 83%, 80%, and 82% and 84%, 87%, 79%, and 79% for the IM 400 mg (N = 223), IM 600 mg (N = 171), IM 400 mg + AraC (N = 172), and IM 400 mg + PegIFN-α2a (N = 221) arms, respectively. The rate of major molecular response at 12 months and deep molecular response (MR4) over time were significantly higher with the combination IM 400 mg + PegIFN-α2a than with IM 400 mg: p = 0.0001 and p = 0.0035, respectively. Progression to advanced phases and secondary malignancies were the most frequent causes of death. Toxicity was the main reason for stopping AraC or PegIFN-α2a treatment.
Collapse
Affiliation(s)
| | | | | | | | | | - Delphine Rea
- Department of Hematology, Hopital Saint-Louis, APHP, Paris, France
| | - Valérie Coiteux
- Clinical Hematology Department, Hospital Claude Huriez, CHRU, Lille, France
| | | | | | - Anne Vekhoff
- Clinical Hematology Department, Hospital St Antoine, APHP. Sorbonne Université, Paris, France
| | - Eric Jourdan
- Hématologie Clinique, Institut de Cancérologie du Gard, CHU de Nîmes, Nîmes, France
| | - Marc Berger
- Hematologie Biologique, CHU Estaing, Clermont Ferrand, France
| | | | - Magda Alexis
- Hématologie et Thérapie Cellulaire, Grand Hôpital de l'EST Francilien, Meaux, France
| | - Laurence Legros
- Department of Haematology, Hopital Paul Brousse, AP-HP, INSERM UMRS-MD1197, Villejuif, France
| | - Philippe Rousselot
- Hematology Department, Division of Innovative Therapies, Centre Hospitalier de Versailles, Versailles and Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Alain Delmer
- Clinical Hematology Department, CHU, Reims, France
| | - Pascal Lenain
- Clinical Hematology Department, Centre Henri Becquerel, Rouen, France
| | | | - Emmanuel Gyan
- Hematology and Cell Therapy Department, University of Tours, Tours, France
| | | | | | - Bertrand Joly
- Hématologie Clinique, CH Sud Francilien, Corbeil-Essonnes, France
| | - Bertrand Pollet
- Hématologie Clinique, CH Boulogne sur mer, Boulogne sur mer, France
| | | | | | - Melanie Mercier
- Service d'Dématologie Médecine Interne Maladies Infectieuses, Centre Hospitalier Bretagne Atlantique Vannes, Vannes, France
| | - Denis Caillot
- Hématologie Clinique, CHU Dijon Bourgogne, Dijon, France
| | - Aude Charbonnier
- Clinical Hematology Department, Institut Paoli Calmettes, Marseille, France
| | | | - Jacques Chapiro
- Service Hématologie Clinique, Hopitaux Civiles de Colmar, Colmar, France
| | - Amélie Penot
- Service Hématologie et Thérapie Cellulaire, CHU Limoges, Limoges, France
| | | | - Iona Vaida
- Hématologie Clinique, Centre Hospitalier René-Dubois, Cergy-Pontoise, France
| | | | - Lydia Roy
- Clinical Hematology Department, Hop Henri Mondor, APHP, UPEC, Créteil, France
| | - Hacene Zerazhi
- Service Oncologie Médicale et Hématologie Clinique, Centre Hospitalier Henri Duffaut, Avignon, France
| | | | | | | | - Delphine Lebon
- Service d'Hématologie Clinique CHU Amiens-Picardie, Amiens-Picardie, France
| | - Yazid Arkam
- Service d'Hématologie GHR Mulhouse, Mulhouse, France
| | | | - Kamel Ghomari
- Service d'Hématologie-Oncologie CH Beauvais, Beauvais, France
| | | | | | | | | | - Marc Muller
- Laboratoire de Génétique, CHRU Nancy, Nancy, France
| | - Ludovic Lhermitte
- Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Marc Delord
- Clinical Research Department, Hôpital André Mignot, Versailles, France
| | | | - Gabriel Etienne
- Clinical Hematology Department, Institut Bergonié, Bordeaux, France
| | | | | | | |
Collapse
|
25
|
Haderbache R, Warda W, Hervouet E, da Rocha MN, Trad R, Allain V, Nicod C, Thieblemeont C, Boissel N, Varlet P, Agha IY, Bouquet L, Guiot M, Venet F, Sujobert P, Roussel X, Rouzaire PO, Caillot D, Casasnovas O, Bories JC, Bachy E, Caillat-Zucman S, Deschamps M, Ferrand C. Droplet digital PCR allows vector copy number assessment and monitoring of experimental CAR T cells in murine xenograft models or approved CD19 CAR T cell-treated patients. J Transl Med 2021; 19:265. [PMID: 34154602 PMCID: PMC8215786 DOI: 10.1186/s12967-021-02925-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Genetically engineered chimeric antigen receptor (CAR) T lymphocytes are promising therapeutic tools for cancer. Four CAR T cell drugs, including tisagenlecleucel (tisa-cel) and axicabtagene-ciloleucel (axi-cel), all targeting CD19, are currently approved for treating B cell malignancies. Flow cytometry (FC) remains the standard for monitoring CAR T cells using a recombinant biotinylated target protein. Nevertheless, there is a need for additional tools, and the challenge is to develop an easy, relevant, highly sensitive, reproducible, and inexpensive detection method. Molecular tools can meet this need to specifically monitor long-term persistent CAR T cells. METHODS Based on 2 experimental CAR T cell constructs, IL-1RAP and CS1, we designed 2 quantitative digital droplet (ddPCR) PCR assays. By targeting the 4.1BB/CD3z (28BBz) or 28/CD3z (28z) junction area, we demonstrated that PCR assays can be applied to approved CD19 CAR T drugs. Both 28z and 28BBz ddPCR assays allow determination of the average vector copy number (VCN) per cell. We confirmed that the VCN is dependent on the multiplicity of infection and verified that the VCN of our experimental or GMP-like IL-1RAP CAR T cells met the requirement (< 5 VCN/cell) for delivery to the clinical department, similar to approved axi-cel or tisa-cel drugs. RESULTS 28BBz and 28z ddPCR assays applied to 2 tumoral (acute myeloid leukemia (AML) or multiple myeloma (MM) xenograft humanized NSG mouse models allowed us to quantify the early expansion (up to day 30) of CAR T cells after injection. Interestingly, following initial expansion, when circulating CAR T cells were challenged with the tumor, we noted a second expansion phase. Investigation of the bone marrow, spleen and lung showed that CAR T cells disseminated more within these tissues in mice previously injected with leukemic cell lines. Finally, circulating CAR T cell ddPCR monitoring of R/R acute lymphoid leukemia or diffuse large B cell lymphoma (n = 10 for tisa-cel and n = 7 for axi-cel) patients treated with both approved CAR T cells allowed detection of early expansion, which was highly correlated with FC, as well as long-term persistence (up to 450 days), while FC failed to detect these events. CONCLUSION Overall, we designed and validated 2 ddPCR assays allowing routine or preclinical monitoring of early- and long-term circulating approved or experimental CAR T cells, including our own IL-1RAP CAR T cells, which will be evaluated in an upcoming phase I clinical trial.
Collapse
Affiliation(s)
- Rafik Haderbache
- INSERM UMR1098, Right, EFSBFC, UFC, Laboratoire de Thérapeutique Immuno-Moléculaire Et Cellulaire Des Cancers, 8 rue du Dr Jean François Xavier Girod, 25020, Besançon, France
| | - Walid Warda
- INSERM UMR1098, Right, EFSBFC, UFC, Laboratoire de Thérapeutique Immuno-Moléculaire Et Cellulaire Des Cancers, 8 rue du Dr Jean François Xavier Girod, 25020, Besançon, France
| | - Eric Hervouet
- INSERM UMR1098, Right, EFSBFC, UFC, Laboratoire de Thérapeutique Immuno-Moléculaire Et Cellulaire Des Cancers, 8 rue du Dr Jean François Xavier Girod, 25020, Besançon, France
| | - Mathieu Neto da Rocha
- INSERM UMR1098, Right, EFSBFC, UFC, Laboratoire de Thérapeutique Immuno-Moléculaire Et Cellulaire Des Cancers, 8 rue du Dr Jean François Xavier Girod, 25020, Besançon, France
| | - Rim Trad
- INSERM UMR1098, Right, EFSBFC, UFC, Laboratoire de Thérapeutique Immuno-Moléculaire Et Cellulaire Des Cancers, 8 rue du Dr Jean François Xavier Girod, 25020, Besançon, France
| | - Vincent Allain
- Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Service d'Immunologie, Paris, France
| | - Clementine Nicod
- INSERM UMR1098, Right, EFSBFC, UFC, Laboratoire de Thérapeutique Immuno-Moléculaire Et Cellulaire Des Cancers, 8 rue du Dr Jean François Xavier Girod, 25020, Besançon, France
| | - Catherine Thieblemeont
- Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Service Hématologie, Paris, France
| | - Nicolas Boissel
- Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Service Hématologie, Paris, France
| | | | | | - Lucie Bouquet
- INSERM UMR1098, Right, EFSBFC, UFC, Laboratoire de Thérapeutique Immuno-Moléculaire Et Cellulaire Des Cancers, 8 rue du Dr Jean François Xavier Girod, 25020, Besançon, France
| | - Melanie Guiot
- INSERM UMR1098, Right, EFSBFC, UFC, Laboratoire de Thérapeutique Immuno-Moléculaire Et Cellulaire Des Cancers, 8 rue du Dr Jean François Xavier Girod, 25020, Besançon, France
| | - Fabienne Venet
- Hospices Civils de Lyon, Immunology Laboratory, Edouard Herriot Hospital, Lyon, France
| | - Pierre Sujobert
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Hématologie Biologique, Lyon, France
| | - Xavier Roussel
- INSERM UMR1098, Right, EFSBFC, UFC, Laboratoire de Thérapeutique Immuno-Moléculaire Et Cellulaire Des Cancers, 8 rue du Dr Jean François Xavier Girod, 25020, Besançon, France
| | - Paul-Oliver Rouzaire
- UFR de Pharmacie, EA CHELTER 7453, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Denis Caillot
- Hematology Clinical Department, Mitterrand Hospital, Dijon, France
| | | | | | - Emmanuel Bachy
- Hospices Civils de Lyon, Hospital Lyon Sud, Service d'Hématologie Clinique, Lyon, France
| | - Sophie Caillat-Zucman
- Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Service d'Immunologie, Paris, France
| | - Marina Deschamps
- INSERM UMR1098, Right, EFSBFC, UFC, Laboratoire de Thérapeutique Immuno-Moléculaire Et Cellulaire Des Cancers, 8 rue du Dr Jean François Xavier Girod, 25020, Besançon, France
| | - Christophe Ferrand
- INSERM UMR1098, Right, EFSBFC, UFC, Laboratoire de Thérapeutique Immuno-Moléculaire Et Cellulaire Des Cancers, 8 rue du Dr Jean François Xavier Girod, 25020, Besançon, France.
| |
Collapse
|
26
|
Bouvier A, Hamel JF, Delaunay J, Delabesse E, Dumas PY, Ledoux MP, Peterlin P, Luquet I, Roth Guepin G, Bulabois CE, Gallego Hernanz MP, Guillerm G, Guieze R, Hicheri Y, Simand C, Himberlin C, Hunault-Berger M, Bernard M, Jourdan E, Caillot D, Dorvaux V, Tavernier E, Daguindau E, Banos A, Ojeda-Uribe M, Gyan E, Alexis M, Marolleau JP, Turlure P, Bouscary D, Humbrecht C, Zerazhi H, Béné MC, Pigneux A, Carre M, Ifrah N, Blanchet O, Vey N, Récher C, Cornillet-Lefèbvre P. Molecular classification and prognosis in younger adults with acute myeloid leukemia and intermediate-risk cytogenetics treated or not by gemtuzumab ozogamycin: Final results of the GOELAMS/FILO acute myeloid leukemia 2006-intermediate-risk trial. Eur J Haematol 2021; 107:111-121. [PMID: 33765335 DOI: 10.1111/ejh.13626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/12/2022]
Abstract
In this randomized phase 3 study, the FILO group tested whether the addition of 6 mg/m2 of gemtuzumab ozogamycin (GO) to standard chemotherapy could improve outcome of younger patients with de novo acute myeloid leukemia (AML) and intermediate-risk cytogenetics. GO arm was prematurely closed after 254 inclusions because of toxicity. A similar complete remission rate was observed in both arms. Neither event-free survival nor overall survival were improved by GO in younger AML patients (<60 years) ineligible for allogeneic stem-cell transplantation. (P = .086; P = .149, respectively). Using unsupervised hierarchical clustering based on mutational analysis of seven genes (NPM1, FLT3-ITD, CEBPA, DNMT3A, IDH1, IDH2, and ASXL1), six clusters of patients with significant different outcome were identified. Five clusters were based on FLT3-ITD, NPM1, and CEBPA mutations as well as epigenetic modifiers (DNMT3A, IDH1/2, ASXL1), whereas the last cluster, representing 25% of patients, had no mutation and intermediate risk. One cluster isolated FLT3-ITD mutations with higher allelic ratio and a very poor outcome. The addition of GO had no impact in these molecular clusters. Although not conclusive for GO impact in AML patients <60 years, this study provides a molecular classification that distinguishes six AML clusters influencing prognosis in younger AML patients with intermediate-risk cytogenetic.
Collapse
Affiliation(s)
- Anne Bouvier
- Hématologie Biologique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Jean-François Hamel
- Departement de Biostatistiques, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Jacques Delaunay
- Hématologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Eric Delabesse
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopôle, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Pierre-Yves Dumas
- Hématologie Clinique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Marie-Pierre Ledoux
- Hématologie Clinique, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Pierre Peterlin
- Hématologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Isabelle Luquet
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopôle, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Claude Eric Bulabois
- Hématologie Clinique, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | | | - Gaëlle Guillerm
- Hématologie Clinique, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Romain Guieze
- Hématologie Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Yosr Hicheri
- Hématologie Clinique, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Célestine Simand
- Hématologie Clinique, Institut cancérologique de Strasbourg Europe, Strasbourg, France
| | - Chantal Himberlin
- Hématologie Clinique, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Mathilde Hunault-Berger
- Hématologie clinique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Inserm, CRCINA, Angers, France
| | - Marc Bernard
- Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Eric Jourdan
- Hématologie Clinique, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Denis Caillot
- Hématologie Clinique, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Véronique Dorvaux
- Hématologie Clinique, Centre Hospitalier Régional de Metz, Metz, France
| | | | - Etienne Daguindau
- Hématologie Clinique, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Anne Banos
- Hématologie Clinique, Centre Hospitalier Côte Basque, Bayonne, France
| | - Mario Ojeda-Uribe
- Hématologie Clinique, Centre Hospitalier Regional de Mulhouse, Mulhouse, France
| | - Emmanuel Gyan
- Service d'Hématologie et thérapie cellulaire, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Magda Alexis
- Hématologie Clinique, Centre Hospitalier Régional Orléans, Orléans, France
| | | | - Pascal Turlure
- Hématologie Clinique, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | | | | | - Hacène Zerazhi
- Hématologie Clinique, Centre Hospitalier d'Avignon, Avignon, France
| | - Marie-Christine Béné
- Hématologie Biologique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Arnaud Pigneux
- Hématologie Clinique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Martin Carre
- Hématologie Clinique, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Norbert Ifrah
- Hématologie clinique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Inserm, CRCINA, Angers, France
| | - Odile Blanchet
- Hématologie Biologique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Norbert Vey
- Hématologie Clinique, Institut Paoli-Calmettes, Marseille, France
| | - Christian Récher
- Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopôle, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | | |
Collapse
|
27
|
Burlet B, Ramla S, Fournier C, Abrey-Recalde MJ, Sauter C, Chrétien ML, Rossi C, Duffourd Y, Ragot S, Buriller C, Tournier B, Chapusot C, Nadal N, Racine J, Guy J, Bailly F, Martin L, Casasnovas O, Bastie JN, Caillot D, Albuisson J, Broccardo C, Thieblemont C, Delva L, Maynadié M, Aucagne R, Callanan MB. Identification of novel, clonally stable, somatic mutations targeting transcription factors PAX5 and NKX2-3, the epigenetic regulator LRIF1, and BRAF in a case of atypical B-cell chronic lymphocytic leukemia harboring a t(14;18)(q32;q21). Cold Spring Harb Mol Case Stud 2021; 7:mcs.a005934. [PMID: 33608382 PMCID: PMC7903887 DOI: 10.1101/mcs.a005934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/06/2021] [Indexed: 12/15/2022] Open
Abstract
Diagnosis of B-cell chronic lymphocytic leukemia (B-CLL) is usually straightforward, involving clinical, immunophenotypic (Matutes score), and (immuno)genetic analyses (to refine patient prognosis for treatment). CLL cases with atypical presentation (e.g., Matutes ≤ 3) are also encountered, and for these diseases, biology and prognostic impact are less clear. Here we report the genomic characterization of a case of atypical B-CLL in a 70-yr-old male patient; B-CLL cells showed a Matutes score of 3, chromosomal translocation t(14;18)(q32;q21) (BCL2/IGH), mutated IGHV, deletion 17p, and mutations in BCL2, NOTCH1 (subclonal), and TP53 (subclonal). Quite strikingly, a novel PAX5 mutation that was predicted to be loss of function was also seen. Exome sequencing identified, in addition, a potentially actionable BRAF mutation, together with novel somatic mutations affecting the homeobox transcription factor NKX2-3, known to control B-lymphocyte development and homing, and the epigenetic regulator LRIF1, which is implicated in chromatin compaction and gene silencing. Neither NKX2-3 nor LRIF1 mutations, predicted to be loss of function, have previously been reported in B-CLL. Sequencing confirmed the presence of these mutations together with BCL2, NOTCH1, and BRAF mutations, with the t(14;18)(q32;q21) translocation, in the initial diagnostic sample obtained 12 yr prior. This is suggestive of a role for these novel mutations in B-CLL initiation and stable clonal evolution, including upon treatment withdrawal. This case extends the spectrum of atypical B-CLL with t(14;18)(q32;q21) and highlights the value of more global precision genomics for patient follow-up and treatment in these patients.
Collapse
Affiliation(s)
- Bénédicte Burlet
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France.,Unit for innovation in genetics and epigenetics in oncology, Dijon University Hospital, 21079 Dijon, France
| | - Selim Ramla
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France.,Department of Pathology, Dijon University Hospital, 21079 Dijon, France
| | - Cyril Fournier
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France.,Unit for innovation in genetics and epigenetics in oncology, Dijon University Hospital, 21079 Dijon, France
| | - Maria Jimena Abrey-Recalde
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France
| | - Camille Sauter
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France
| | - Marie-Lorraine Chrétien
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France.,Hematology Laboratory, Dijon University Hospital, 21079 Dijon, France
| | - Cédric Rossi
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France.,Department of Clinical Hematology, Dijon University Hospital, 21079 Dijon, France
| | - Yannis Duffourd
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France
| | - Sylviane Ragot
- Unit for innovation in genetics and epigenetics in oncology, Dijon University Hospital, 21079 Dijon, France
| | - Céline Buriller
- Genetics Laboratory, Dijon University Hospital, 21079 Dijon, France
| | - Benjamin Tournier
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France.,Unit for innovation in genetics and epigenetics in oncology, Dijon University Hospital, 21079 Dijon, France.,Department of Pathology, Dijon University Hospital, 21079 Dijon, France
| | - Caroline Chapusot
- Department of Pathology, Dijon University Hospital, 21079 Dijon, France
| | - Nathalie Nadal
- Genetics Laboratory, Dijon University Hospital, 21079 Dijon, France
| | - Jessica Racine
- Hematology Laboratory, Dijon University Hospital, 21079 Dijon, France
| | - Julien Guy
- Hematology Laboratory, Dijon University Hospital, 21079 Dijon, France
| | - François Bailly
- Hematology Laboratory, Dijon University Hospital, 21079 Dijon, France
| | - Laurent Martin
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France.,Department of Pathology, Dijon University Hospital, 21079 Dijon, France
| | - Olivier Casasnovas
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France.,Department of Clinical Hematology, Dijon University Hospital, 21079 Dijon, France
| | - Jean-Noël Bastie
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France.,Department of Clinical Hematology, Dijon University Hospital, 21079 Dijon, France
| | - Denis Caillot
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France.,Department of Clinical Hematology, Dijon University Hospital, 21079 Dijon, France
| | - Juliette Albuisson
- Oncogenetics laboratory, Centre George François Leclerc, 21079 Dijon, France
| | - Cyril Broccardo
- Centre de Recherches en Cancérologie de Toulouse, Inserm UMR1037, Université de Toulouse III - Paul Sabatier, 31037 Toulouse, France
| | - Catherine Thieblemont
- Department of Hemato-oncology, Hôpital Saint-Louis, AP-HP, 75010 Paris, France.,Université de Paris, NF-kappaB, Différenciation et Cancer, 75006 Paris, France
| | - Laurent Delva
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France
| | - Marc Maynadié
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France.,Hematology Laboratory, Dijon University Hospital, 21079 Dijon, France.,Registre des hémopathies malignes de Côte d'Or, University of Burgundy, Faculty of Medicine, 21079 Dijon, France
| | - Romain Aucagne
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France.,Unit for innovation in genetics and epigenetics in oncology, Dijon University Hospital, 21079 Dijon, France
| | - Mary B Callanan
- University of Burgundy-ISITE-BFC-Institut national de la santé et de la recherche médicale (Inserm) UMR1231, Faculty of Medicine, 21079 Dijon, France.,Unit for innovation in genetics and epigenetics in oncology, Dijon University Hospital, 21079 Dijon, France
| |
Collapse
|
28
|
Zamagni E, Nanni C, Dozza L, Carlier T, Bailly C, Tacchetti P, Versari A, Chauvie S, Gallamini A, Gamberi B, Caillot D, Patriarca F, Macro M, Boccadoro M, Garderet L, Barbato S, Fanti S, Perrot A, Gay F, Sonneveld P, Karlin L, Cavo M, Bodet-Milin C, Moreau P, Kraeber-Bodéré F. Standardization of 18F-FDG–PET/CT According to Deauville Criteria for Metabolic Complete Response Definition in Newly Diagnosed Multiple Myeloma. J Clin Oncol 2021; 39:116-125. [DOI: 10.1200/jco.20.00386] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) is currently the standard technique to define minimal residual disease (MRD) status outside the bone marrow (BM) in patients with multiple myeloma (MM). This study aimed to define criteria for PET complete metabolic response after therapy, jointly analyzing a subgroup of newly diagnosed transplantation-eligible patients with MM enrolled in two independent European randomized phase III trials (IFM/DFCI2009 and EMN02/HO95). PATIENTS AND METHODS Two hundred twenty-eight patients were observed for a median of 62.9 months. By study design, PET/CT scans were performed at baseline and before starting maintenance (premaintenance [PM]). The five-point Deauville scale (DS) was applied to describe BM (BM score [BMS]) and focal lesion (FL; FL score [FS]) uptake and tested a posteriori in uni- and multivariable analyses for their impact on clinical outcomes. RESULTS At baseline, 78% of patients had FLs (11% extramedullary), 80% with an FS ≥ 4. All patients had BM diffuse uptake (35.5% with BMS ≥ 4). At PM, 31% of patients had visually detectable FLs (2% extramedullary), 24% and 67.7% of them with an FS of 3 and ≥ 4, respectively. At PM, 98% of patients retained residual BM diffuse uptake, which was significantly lower than at baseline (mainly between BMS 2 and 3, BMS was ≥ 4 in only 8.7% of patients). By both uni- and multivariable analysis, FS and BMS < 4 were associated with prolonged progression-free survival (PFS) and overall survival (OS) at PM (OS: hazard ratio [HR], 0.6 and 0.47, respectively; PFS: HR, 0.36 and 0.24, respectively) CONCLUSION FL and BM FDG uptake lower than the liver background after therapy was an independent predictor for improved PFS and OS and can be proposed as the standardized criterion of PET complete metabolic response, confirming the value of the DS for patients with MM.
Collapse
Affiliation(s)
- Elena Zamagni
- “Seragnoli” Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, L’Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Luca Dozza
- “Seragnoli” Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Thomas Carlier
- Nuclear Medicine Department, Nantes University Hospital, CRCINA INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
| | - Clément Bailly
- Nuclear Medicine Department, Nantes University Hospital, CRCINA INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
| | - Paola Tacchetti
- “Seragnoli” Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Annibale Versari
- Nuclear Medicine, AUSL-IRCSS of Reggio Emilia, Reggio Emilia, Italy
| | - Stephane Chauvie
- Medical Physics Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Andrea Gallamini
- Research and Innovation Department, Antoine Lacassagne Cancer Center, Nice, France
| | - Barbara Gamberi
- Hematology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Denis Caillot
- Hematology Department, University Hospital, Dijon, France
| | | | - Margaret Macro
- Hematology Department, University Hospital, Caen, France
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy
| | - Laurent Garderet
- Hematology Department, University Hospital, Pitié Salpétriere, Paris, France
| | - Simona Barbato
- “Seragnoli” Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, L’Azienda Ospedaliero-Universitaria Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Aurore Perrot
- Hematology Department, University Hospital, Nancy, France
| | - Francesca Gay
- Myeloma Unit, Division of Hematology, University of Torino, Torino, Italy
| | - Peter Sonneveld
- Department of Hematology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Lionel Karlin
- Hematology Department, University Hospital, Lyon, France
| | - Michele Cavo
- “Seragnoli” Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Caroline Bodet-Milin
- Nuclear Medicine Department, Nantes University Hospital, CRCINA INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
| | | | - Françoise Kraeber-Bodéré
- Nuclear Medicine Department, Nantes University Hospital, CRCINA INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
| |
Collapse
|
29
|
Grienay N, Mounier M, Rossi C, Berthier S, Caillot D, Maynadie M, Bonnotte B, Audia S. Caractérisation de l’anémie hémolytique auto-immune associée aux hémopathies lymphoïdes à partir du registre des hémopathies malignes de Côte d’Or. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
30
|
Praliaud R, Ghesquiere T, Caillot D, Payssot A, Samson M, Bonnotte B, Audia S. Syndrome TAFRO : une entité à connaître pour une prise en charge précoce. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
31
|
Moreau P, Hebraud B, Facon T, Leleu X, Hulin C, Hashim M, Hu Y, Caillot D, Benboubker L, Zweegman S, Merz M, Weisel K, Salwender H, Mai EK, Goldschmidt H, Bertsch U, Vanquickelberghe V, Kampfenkel T, Boer CD, Krotneva S, Proskorovsky I, He J, Lam A, Lee C, Cote S, Sonneveld P. Front-line daratumumab-VTd versus standard-of-care in ASCT-eligible multiple myeloma: matching-adjusted indirect comparison. Immunotherapy 2020; 13:143-154. [PMID: 33228440 DOI: 10.2217/imt-2020-0266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare daratumumab plus standard-of-care (SoC; bortezomib/thalidomide/dexamethasone [VTd]) and VTd alone with other SoC for transplant-eligible newly diagnosed multiple myeloma. Patients & methods: We conducted an unanchored matching-adjusted indirect comparison of progression-free and overall survival (PFS/OS) with D-VTd/VTd versus bortezomib/lenalidomide/dexamethasone (VRd), bortezomib/cyclophosphamide/dexamethasone (VCd) and bortezomib/dexamethasone (Vd). Results: After matching adjustment, significant improvements in PFS were estimated for D-VTd versus VRd (hazard ratio [HR]: 0.47 [95% CI: 0.33-0.69]), VCd (HR: 0.35 [95% CI: 0.21-0.58]) and Vd (HR: 0.42 [95% CI: 0.28-0.63]). OS was significantly longer with D-VTd versus VRd (HR: 0.31 [95% CI: 0.16-0.57]), VCd (HR: 0.35 [95% CI: 0.14-0.86]) and Vd (HR: 0.38 [95% CI: 0.18-0.77]). No significant PFS/OS differences were seen for VTd versus other SoC. Conclusion: This analysis supports front-line daratumumab for transplant-eligible newly diagnosed multiple myeloma.
Collapse
Affiliation(s)
- Philippe Moreau
- Service d'Hématologie Clinique, University Hospital Hôtel-Dieu, Nantes 44000, France
| | - Benjamin Hebraud
- Institut Universitaire du Cancer-Oncopole & Centre de Recherches en Cancerologie de Toulouse, Toulouse 31100, France
| | - Thierry Facon
- University of Lille, CHU Lille, Service des Maladies du Sang, Lille 59000, France
| | - Xavier Leleu
- CHU Poitiers - Hôpital la Milétrie, Poitiers 86021, France
| | - Cyrille Hulin
- Department of Hematology, Hospital Haut Leveque, University Hospital Bordeaux, Bordeaux 33600, France
| | | | - Yannan Hu
- Ingress Health, Rotterdam, 3012 NJ, The Netherlands
| | - Denis Caillot
- Hôpital Du Bocage, Centre Hospitalier Universitaire Dijon, Dijon 21000, France
| | - Lofti Benboubker
- Hôpital de Bretonneau, Centre Hospitalier Régional Universitaire de Tours, Tours 37000, France
| | - Sonja Zweegman
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam 1182 DB, The Netherlands
| | - Maximilian Merz
- University Hospital Heidelberg, Internal Medicine V & National Center for Tumor Diseases (NCT), Heidelberg 69120, Germany
| | - Katja Weisel
- University Medical Center of Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Hans Salwender
- Asklepios Tumorzentrum Hamburg, AK Altona & AK St. Georg, Hamburg 20099, Germany
| | - Elias K Mai
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Hartmut Goldschmidt
- University Hospital Heidelberg, Internal Medicine V & National Center for Tumor Diseases (NCT), Heidelberg 69120, Germany
| | - Uta Bertsch
- University Hospital Heidelberg, Internal Medicine V & National Center for Tumor Diseases (NCT), Heidelberg 69120, Germany
| | | | | | - Carla de Boer
- Janssen Research & Development, LLC, Leiden 2333, The Netherlands
| | | | | | - Jianming He
- Janssen Global Services, Raritan, NJ 08869, USA
| | - Annette Lam
- Janssen Global Services, Raritan, NJ 08869, USA
| | | | - Sarah Cote
- Janssen Global Services, Raritan, NJ 08869, USA
| | - Pieter Sonneveld
- Erasmus University Medical Center Cancer Institute, Rotterdam 3015 GD, The Netherlands
| |
Collapse
|
32
|
Cransac A, Aho S, Cosme E, Chretien ML, Favennec C, Schreder L, Boutet M, Gueneau P, Giroud M, Caillot D, Boulin M. Self-management of immunomodulatory drug treatment in multiple myeloma patients. Eur J Cancer Care (Engl) 2020; 30:e13356. [PMID: 33159353 DOI: 10.1111/ecc.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 07/10/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Immunomodulatory drugs (IMIDs: thalidomide, lenalidomide and pomalidomide) are widely used in patients with multiple myeloma (MM). The aim of our study was to validate a questionnaire to evaluate the self-capacity of MM patients to manage IMID treatment including side effects. METHODS We used a method adapted from the recommendations of the European Organisation for Research and Treatment of Cancer (EORTC) to validate a French questionnaire for patients with MM treated with IMIDs. RESULTS The face validity was evaluated in 15 patients and the construct validity in 56 patients. For discriminant validity, two groups were constituted by gender and depending on whether they had a previous IMID treatment. The median questionnaire score was 11.33/16 (IQR 9.75-12.08) with a minimum of 5.2 and a maximum of 14.75. For discriminant validity, a statistically significant difference was observed for patient capacity to contact healthcare professionals in specific situations and drug intake in case of swallowing disorder. Convergent validity showed an acceptable reliability for the scores of the different questions. CONCLUSION The questionnaire has shown to be a valid tool for the assessment of the adherence and side-effect management skills for MM patients with IMID treatment.
Collapse
Affiliation(s)
- Amélie Cransac
- Department of Pharmacy, Dijon University Hospital, Dijon, France.,LNC-UMR1231, University of Burgundy and Franche Comté, Dijon, France
| | - Serge Aho
- Hospital Epidemiology and Infection Control Department, Dijon University Hospital, Dijon, France
| | - Edouard Cosme
- Department of Pharmacy, Dijon University Hospital, Dijon, France
| | - Marie-Lorraine Chretien
- Department of Clinical Hematology, Dijon University Hospital, Dijon, France.,SAPHIIR-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - Camille Favennec
- Department of Clinical Hematology, Dijon University Hospital, Dijon, France
| | - Laure Schreder
- Oncology Coordination Center, Dijon University Hospital, Dijon, France
| | - Mérédith Boutet
- Department of Pharmacy, Dijon University Hospital, Dijon, France
| | - Pauline Gueneau
- Department of Pharmacy, Dijon University Hospital, Dijon, France
| | - Maurice Giroud
- LNC-UMR1231, University of Burgundy and Franche Comté, Dijon, France.,Department of Neurology, Dijon University Hospital, Dijon, France
| | - Denis Caillot
- Department of Clinical Hematology, Dijon University Hospital, Dijon, France
| | - Mathieu Boulin
- Department of Pharmacy, Dijon University Hospital, Dijon, France.,EPICAD LNC-UMR1231, University of Burgundy and Franche Comté, Dijon, France
| |
Collapse
|
33
|
Corre J, Montes L, Martin E, Perrot A, Caillot D, Leleu X, Belhadj K, Facon T, Hulin C, Mohty M, Fontan J, Macro M, Brechignac S, Jaccard A, Stoppa AM, Orsini-Piocelle F, Adiko D, Voillat L, Keddar F, Barry M, Demarquette H, Certain MN, Plantier I, Roussel M, Hébraud B, Filleron T, Attal M, Avet-Loiseau H. Early relapse after autologous transplant for myeloma is associated with poor survival regardless of cytogenetic risk. Haematologica 2020; 105:e480-483. [PMID: 33054068 PMCID: PMC7556617 DOI: 10.3324/haematol.2019.236588] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jill Corre
- Unit for Genomics in Myeloma, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, Toulouse; Centre de Recherche en Cancérologie de Toulouse, Institut National de la Santé et de la Recherche Médicale U1037, Toulouse.
| | - Lydia Montes
- Hematology Department, University Hospital, Amiens
| | - Elodie Martin
- Biostatistics Department, Institut Claudius Regaud, IUCT-O, Toulouse
| | | | | | - Xavier Leleu
- Hematology Department, University Hospital, Poitiers
| | | | | | - Cyrille Hulin
- Hematology Department, University Hospital, Bordeaux
| | | | - Jean Fontan
- Hematology Department, University Hospital, Besancon
| | | | | | | | | | | | - Didier Adiko
- Hematology Department, Department Hospital, Libourne
| | - Laurent Voillat
- Hematology Department, Department Hospital, Chalon-sur-Saône
| | - Faiza Keddar
- Hematology Department, Department Hospital, Valenciennes
| | - Marly Barry
- Hematology Department, Department Hospital, Boulogne-Sur-Mer
| | | | | | | | - Murielle Roussel
- Hematology Department, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, Toulouse, France
| | - Benjamin Hébraud
- Hematology Department, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, Toulouse, France
| | - Thomas Filleron
- Biostatistics Department, Institut Claudius Regaud, IUCT-O, Toulouse
| | - Michel Attal
- Centre de Recherche en Cancérologie de Toulouse, Institut National de la Santé et de la Recherche Médicale U1037, Toulouse; Hematology Department, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, Toulouse, France
| | - Hervé Avet-Loiseau
- Unit for Genomics in Myeloma, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, Toulouse; Centre de Recherche en Cancérologie de Toulouse, Institut National de la Santé et de la Recherche Médicale U1037, Toulouse
| |
Collapse
|
34
|
Lombardi J, Boulin M, Devaux M, Cransac A, Pistre P, Pernot C, Payssot A, Lafon I, Caillot D, Gueneau P. Safety of ninety-minute daratumumab infusion. J Oncol Pharm Pract 2020; 27:1080-1085. [PMID: 32865161 DOI: 10.1177/1078155220951231] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Daratumumab is the first anti-CD38 monoclonal antibody of the class approved for recurrent and refractory multiple myeloma. Grade 3 and 4 Infusion-Related Reactions (IRRs) are frequent during the first and second infusions. Due to the risks associated with severe IRRs, daratumumab is systematically administered over a period of 3.5 hours.The main objective of this study was to evaluate the safety of a 90-minute daratumumab infusion from the third infusion. PATIENTS AND METHODS All patients who had received two or more doses of daratumumab in monotherapy or in combination with standard infusion rates were included. We excluded patients enrolled in clinical trials. For the rapid infusion protocol, 20% of the dose was administered over 30 minutes and the remaining 80% over 60 minutes. RESULTS From April 1 to May 31, 2019, 25 patients received 53 90-minute infusions of daratumumab. Premedication included corticosteroids, antipyretics, antihistamines, and if necessary a leukotriene receptor antagonist. No grade 3 or grade 4 IRRs were observed. CONCLUSION From the third infusion, we found that a rapid administration of daratumumab (90 vs 210 minutes) was well tolerated and safe. It would be interesting to test this regimen from the second infusion.
Collapse
Affiliation(s)
| | - Mathieu Boulin
- Department of Pharmacy, University Hospital, and EPICAD LNC UMR1231, University of Burgundy & Franche Comte, Dijon, France
| | | | - Amélie Cransac
- Department of Pharmacy, Dijon University Hospital, Dijon, France & LNC-UMR1231, University of Burgundy & Franche Comté, Dijon, France
| | - Pauline Pistre
- Department of Pharmacy, University Hospital, Dijon, France
| | - Corinne Pernot
- Department of Pharmacy, University Hospital, Dijon, France
| | - Alexandre Payssot
- Department of Clinical Hematology, University Hospital, Dijon, France
| | - Ingrid Lafon
- Department of Clinical Hematology, University Hospital, Dijon, France
| | - Denis Caillot
- Department of Clinical Hematology, University Hospital, Dijon, France
| | | |
Collapse
|
35
|
Bridoux F, Arnulf B, Karlin L, Blin N, Rabot N, Macro M, Audard V, Belhadj K, Pegourie B, Gobert P, Cornec Le Gall E, Joly B, Karras A, Jaccard A, Augeul-Meunier K, Manier S, Royer B, Caillot D, Tiab M, Delbes S, Suarez F, Vigneau C, Caillard S, Arakelyan-Laboure N, Roos-Weil D, Chevret S, Fermand JP. Randomized Trial Comparing Double Versus Triple Bortezomib-Based Regimen in Patients With Multiple Myeloma and Acute Kidney Injury Due to Cast Nephropathy. J Clin Oncol 2020; 38:2647-2657. [PMID: 32574117 DOI: 10.1200/jco.20.00298] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE We report a multicenter controlled trial comparing renal recovery and tolerance profile of doublet versus triplet bortezomib-based regimens in patients with initial myeloma cast nephropathy (CN) and acute kidney injury (AKI) without need for dialysis. METHODS After symptomatic measures and high-dose dexamethasone, patients were randomly assigned to receive bortezomib plus dexamethasone (BD), or BD plus cyclophosphamide (C-BD). In patients with < 50% reduction of serum free light chains (sFLCs) after 3 cycles, chemotherapy was reinforced with either cyclophosphamide (BD group) or thalidomide (C-BD group). RESULTS Ninety-two patients were enrolled in each group. At random assignment, characteristics of the 2 groups were similar, including median age (68 years) and serum creatinine level (305.5 and 273.5 µmol/L in BD and C-BD group, respectively). At 3 months, renal response rate (primary end point) was not different (41 v 47 responders in the BD and C-BD groups, respectively; relative risk [RR], 0.87; P = .46). Very good partial response (free light chain reduction ≥ 90%) or more was achieved in 36 and 47 patients, respectively (RR, 0.76; P = .10). After 1 cycle of chemotherapy, 69 in the BD group and 67 patients in the C-BD group had achieved sFLC level ≤ 500 mg/L. Serious adverse events were recorded in 30 and 40 patients, respectively. At 12 months, 19 patients had died (9 in the BD group v 10 in the C-BD group), including 10 (6 in the BD group and 4 in the C-BD group) from myeloma progression and 3 (0 in the BD group and 3 in the C-BD group) from infection. Within median follow-up of 27 months, 43 and 42 patients switched to new therapy, respectively. Overall, 50 patients (24 in the BD group and 26 in the C-BD group) had died. CONCLUSION This randomized study did not show any benefit of C-BD compared with BD on renal recovery of patients with initial CN not requiring dialysis. Adding cyclophosphamide did not sufficiently improve the efficacy-toxicity balance. Patients with myeloma with AKI are fragile, and indication for doublet or triplet regimen should be adapted to frailty.
Collapse
Affiliation(s)
- Frank Bridoux
- Department of Nephrology, Centre Hospitalier Universitaire de Poitiers, INSERM CIC 1402, Poitiers University, France.,Centre de référence maladies rares "amylose AL et autres maladies par dépôt d'immunoglobulines monoclonales," Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,CNRS UMR 7276, Université de Limoges, Limoges, France
| | - Bertrand Arnulf
- Department of Hematology and Immunology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, INSERM UMR 1126, Paris, France
| | - Lionel Karlin
- Department of Clinical Hematology, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre-Benite, France
| | - Nicolas Blin
- Department of Hematology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Nolwenn Rabot
- Department of Nephrology and Clinical Immunology, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Margaret Macro
- Department of Hematology, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Vincent Audard
- Department of Nephrology and Renal Transplantation, Hôpital Henri Mondor, Créteil, Assistance Publique-Hôpitaux de Paris, INSERM U955, Université Paris Est Créteil, Créteil, France
| | - Karim Belhadj
- Department of Hematology, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil, France
| | - Brigitte Pegourie
- Department of Hematology, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Pierre Gobert
- Department of Nephrology, Centre Hospitalier Avignon, and Clinique Rhône Durance, Avignon, France
| | - Emilie Cornec Le Gall
- Department of Nephrology, Centre Hospitalier Universitaire de Brest, INSERM U1078, Université de Brest, Brest, France
| | - Bertrand Joly
- Department of Hematology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Arnaud Jaccard
- Centre de référence maladies rares "amylose AL et autres maladies par dépôt d'immunoglobulines monoclonales," Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,CNRS UMR 7276, Université de Limoges, Limoges, France.,Department of Hematology, Hôpital Dupuytren, Centre Hospitalier Universitaire de Limoges, Université de Limoges, Limoges, France
| | - Karine Augeul-Meunier
- Department of Hematology, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Salomon Manier
- Department of Hematology, Centre Hospitalier Universitaire de Lille, INSERM UMR-S1172, University of Lille, Lille, France
| | - Bruno Royer
- Department of Hematology, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Denis Caillot
- Department of Clinical Hematology, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Mourad Tiab
- Department of Clinical Hematology, Centre Hospitalier de Vendée, La Roche sur Yon, France
| | - Sébastien Delbes
- Department of Nephrology, Centre Hospitalier La Rochelle, La Rochelle, France
| | - Felipe Suarez
- Department of Hematology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cécile Vigneau
- Department of Nephrology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Sophie Caillard
- Department of Nephrology and Transplantation, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Nina Arakelyan-Laboure
- Department of Clinical Hematology and Cellular Therapy, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Damien Roos-Weil
- Department of Clinical Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sylvie Chevret
- Department of Biostatistics and Medical Information, UMR 1153, ECSTRRA Team, Inserm, Paris Diderot University, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean Paul Fermand
- Department of Hematology and Immunology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris, INSERM UMR 1126, Paris, France
| | | |
Collapse
|
36
|
Van de Wyngaert Z, Nerich V, Fouquet G, Chrétien ML, Caillot D, Azar N, Garderet L, Lenain P, Macro M, Bourhis JH, Belhocine R, Jaccard A, Karlin L, Bobin A, Moya N, Systchenko T, Gruchet C, Giraud C, Guidez S, Darras C, Princet I, Touzeau C, Moreau P, Hulin C, Deconinck E, Limat S, Leleu X. Cost and efficacy of peripheral stem cell mobilization strategies in multiple myeloma. Bone Marrow Transplant 2020; 55:2254-2260. [PMID: 32447348 DOI: 10.1038/s41409-020-0940-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/09/2022]
Abstract
Mobilization of peripheral blood stem cells (PBSC) can be performed using plerixafor, which is expensive, or high-dose cyclophosphamide (HDCy). We hypothesized that the overall cost of mobilization with plerixafor might not be greater if the cost of complication management was considered. We performed a cost analysis of these two strategies. This multicentric observational study recruited patients with myeloma who underwent a first PBSC mobilization. We considered direct medical costs, including hospitalization, mobilization agents, apheresis, and supportive treatments. We included 111 patients, 54 and 57 in the HDCy and plerixafor groups, respectively. Cost of mobilization with HDCy was 5097 ± 2982€ vs. 10958 ± 1789€ for plerixafor (p < 0.0001). Cost of agents used was 1287 ± 779€ vs. 6552 ± 509€, respectively (p = 0.0009). The mean number of days of hospitalization was 2 and 2.1 days, respectively (p = 0.035). All patients achieved the minimum PBSC collection target (p = 1.0); however, ASCT was performed with HDCy in 67% patients and with plerixafor in 86% (p = 0.02). Plerixafor mobilization incurred a greater cost, mostly due to the greater cost of the drug. Hospitalization length in the two groups was similar in our series. Interestingly, plerixafor appeared to be a very effective and safe mobilizing approach translating into a greater ASCT success.
Collapse
Affiliation(s)
- Zoé Van de Wyngaert
- CHU Lille, Service des Maladies du Sang, F-59000, Lille, France.,Hématologie et thérapie cellulaire, Hôpital Saint Antoine, APHP, Université Paris-Sorbonne, INSERM UMRs 938, Paris, France
| | - Virginie Nerich
- Department of Pharmacy, University Hospital of Besançon, Univ. Bourgogne Franche-Comté, Besançon, France.,INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | | | | | | | - Nabih Azar
- Hôpital Pitié Salpêtrière, Service d'Hématologie, F-75013, Paris, France
| | - Laurent Garderet
- Hématologie et thérapie cellulaire, Hôpital Saint Antoine, APHP, Université Paris-Sorbonne, INSERM UMRs 938, Paris, France.,Hôpital Pitié Salpêtrière, Service d'Hématologie, F-75013, Paris, France
| | | | | | | | - Ramdane Belhocine
- Hématologie et thérapie cellulaire, Hôpital Saint Antoine, APHP, Université Paris-Sorbonne, INSERM UMRs 938, Paris, France
| | - Arnaud Jaccard
- Hématologie clinique et thérapie cellulaire, CHU, Limoges, France
| | - Lionel Karlin
- Service d'Hématologie, Hospices Civils de Lyon, Lyon Sud, France
| | - Arthur Bobin
- Hematology and Inserm CIC 1402, CHU, Poitiers, France
| | - Niels Moya
- Hematology and Inserm CIC 1402, CHU, Poitiers, France
| | | | | | | | | | - Claire Darras
- Hematology and Inserm CIC 1402, CHU, Poitiers, France
| | | | - Cyrille Touzeau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | - Philippe Moreau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | | | | | - Samuel Limat
- Department of Pharmacy, University Hospital of Besançon, Univ. Bourgogne Franche-Comté, Besançon, France.,INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Xavier Leleu
- Hematology and Inserm CIC 1402, CHU, Poitiers, France.
| | | |
Collapse
|
37
|
Touzeau C, Moreau P, Perrot A, Hulin C, Dib M, Tiab M, Caillot D, Facon T, Leleu X, van de Donk NW, Broijl A, Zweegman S, Levin MD, Delforge M, Pei L, Vanquickelberghe V, De Boer C, Kampfenkel T, Vermeulen J, Sonneveld P. Daratumumab + bortezomib, thalidomide, and dexamethasone (D-VTd) in transplant-eligible newly diagnosed multiple myeloma (TE NDMM): Baseline SLiM-CRAB based subgroup analysis of CASSIOPEIA. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8538 Background: In the phase 3 CASSIOPEIA study, D-VTd significantly improved outcomes vs VTd in TE NDMM pts at an 18.8-mo median follow-up. To allow earlier diagnosis and treatment of MM, the IMWG added 3 validated biomarkers (≥60% clonal bone marrow plasma cells, serum free light chain ratio ≥100, and > 1 focal bone lesion by MRI; “slim”) to the conventional “CRAB” diagnostic criteria. We present a subgroup analysis of CASSIOPEIA based on baseline slimCRAB criteria. Methods: TE NDMM pts were randomized 1:1 to 4 pre-ASCT induction and 2 post-ASCT consolidation cycles of D-VTd or VTd. The “slim-only” subgroup excludes pts with ≥1 conventional CRAB criterion based on data collected at baseline; the remaining pts were included in the “CRAB” subgroup. Results: Of 1085 randomized pts (543 D-VTd; 542 VTd), 81 were included in the slim-only subgroup (36 D-VTd; 45 VTd) and 1004 were included in the CRAB subgroup. In slim-only vs CRAB pts, 22% vs 54% had an ECOG score of ≥1, 4% vs 16% had ISS Stage III disease, and 11% vs 16% had high-risk cytogenetics. For D-VTd vs VTd pts in the slim-only group, these rates were 22% vs 22%, 8% vs 0%, and 6% vs 16%, respectively. Overall response rates (ORR) and rates of sCR, ≥CR, and MRD negativity were similar between slim-only and CRAB pts; for slim-only pts, rates were significantly higher for D-VTd vs VTd (Table). After an 18.8-mo median follow-up, progression-free survival (PFS) was not significantly different in slim-only vs CRAB pts, or in D-VTd vs VTd slim-only pts (Table). For D-VTd vs VTd CRAB pts, 18-mo PFS rates were 92% vs 84%, and 24-mo PFS rates were 89% vs 76%. Conclusions: Baseline characteristics indicate that slim-only pts were slightly fitter and of lower risk status vs CRAB pts; however, response rates, MRD-negativity rates, and PFS did not differ significantly between these groups. Among slim-only pts, significantly higher response and MRD-negativity rates were achieved with D-VTd vs VTd. Among CRAB pts, PFS rates were higher with D-VTd vs VTd. Clinical trial information: NCT02541383 . [Table: see text]
Collapse
Affiliation(s)
| | | | - Aurore Perrot
- Hematology Department, University Cancer Institute IUCT, Toulouse, France
| | - Cyrille Hulin
- Department of Hematology, Hôpital Haut Lévêque, University Hospital Bordeaux, Pessac, France
| | | | | | | | - Thierry Facon
- University of Lille, CHU Lille, Service des Maladies du Sang, Lille, France
| | - Xavier Leleu
- CHU Poitiers-Hôpital la Milétrie, Poitiers, France
| | | | | | - Sonja Zweegman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Amsterdam, Netherlands
| | | | | | - Lixia Pei
- Janssen Research & Development, LLC, Raritan, NJ
| | | | - Carla De Boer
- Janssen Research & Development, LLC, Leiden, Netherlands
| | | | | | | | | |
Collapse
|
38
|
Roussel M, Hebraud B, Hulin C, Perrot A, Caillot D, Stoppa AM, Macro M, Escoffre M, Arnulf B, Belhadj K, Karlin L, Garderet L, Facon T, Guo S, Weng J, Dhanasiri S, Leleu X, Moreau P, Attal M. Health-related quality of life results from the IFM 2009 trial: treatment with lenalidomide, bortezomib, and dexamethasone in transplant-eligible patients with newly diagnosed multiple myeloma. Leuk Lymphoma 2020; 61:1323-1333. [DOI: 10.1080/10428194.2020.1719091] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Murielle Roussel
- Institut Universitaire du Cancer de Toulouse-Oncopole and University Hospital, Toulouse, France
| | - Benjamin Hebraud
- Institut Universitaire du Cancer de Toulouse-Oncopole and University Hospital, Toulouse, France
| | | | | | | | | | | | - Martine Escoffre
- Hematologie clinique, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Lionel Karlin
- Hématologie clinique, CHU de Lyon HCL – GH Sud, Pierre-Bénite, France
| | | | | | | | | | - Sujith Dhanasiri
- Celgene International, A Bristol-Myers Squibb Company, Boudry, Switzerland
| | | | | | - Michel Attal
- Institut Universitaire du Cancer de Toulouse-Oncopole and University Hospital, Toulouse, France
| |
Collapse
|
39
|
Jaccard A, Karlin L, Hebraud B, Frenzel L, Choquet S, Mohty M, Dib M, Vincent L, Slama B, Galicier L, Tournilhac O, Belhadj-Merzoug K, Moreau P, Decaux O, Benboubker L, Caillot D, Fontan J, Maisonneuve H, Bender S, Musset L, Fermand JP. A Prospective Phase II Trial of Lenalidomide and Dexamethasone in POEMS Syndrome. Clinical Lymphoma Myeloma and Leukemia 2019. [DOI: 10.1016/j.clml.2019.09.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
40
|
Rosinol L, Hebraud B, Oriol A, Colin AL, Tamayo RR, Hulin C, Blanchard MJ, Caillot D, Balari AS, Hernandez MT, Arnulf B, Mateos MV, Macro M, San-Miguel J, Belhadj K, Lahuerta JJ, Garelik MB, Blade J, Moreau P, Attal M. Integrated Analysis of Bortezomib-Lenalidomide-Dexamethasone vs Bortezomib-Thalidomide-Dexamethasone in Transplant-Eligible Newly Diagnosed Myeloma. Clinical Lymphoma Myeloma and Leukemia 2019. [DOI: 10.1016/j.clml.2019.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
41
|
Pertesi M, Vallée M, Wei X, Revuelta MV, Galia P, Demangel D, Oliver J, Foll M, Chen S, Perrial E, Garderet L, Corre J, Leleu X, Boyle EM, Decaux O, Rodon P, Kolb B, Slama B, Mineur P, Voog E, Le Bris C, Fontan J, Maigre M, Beaumont M, Azais I, Sobol H, Vignon M, Royer B, Perrot A, Fuzibet JG, Dorvaux V, Anglaret B, Cony-Makhoul P, Berthou C, Desquesnes F, Pegourie B, Leyvraz S, Mosser L, Frenkiel N, Augeul-Meunier K, Leduc I, Leyronnas C, Voillat L, Casassus P, Mathiot C, Cheron N, Paubelle E, Moreau P, Bignon YJ, Joly B, Bourquard P, Caillot D, Naman H, Rigaudeau S, Marit G, Macro M, Lambrecht I, Cliquennois M, Vincent L, Helias P, Avet-Loiseau H, Moreno V, Reis RM, Varkonyi J, Kruszewski M, Vangsted AJ, Jurczyszyn A, Zaucha JM, Sainz J, Krawczyk-Kulis M, Wątek M, Pelosini M, Iskierka-Jażdżewska E, Grząśko N, Martinez-Lopez J, Jerez A, Campa D, Buda G, Lesueur F, Dudziński M, García-Sanz R, Nagler A, Rymko M, Jamroziak K, Butrym A, Canzian F, Obazee O, Nilsson B, Klein RJ, Lipkin SM, McKay JD, Dumontet C. Exome sequencing identifies germline variants in DIS3 in familial multiple myeloma. Leukemia 2019; 33:2324-2330. [PMID: 30967618 PMCID: PMC6756025 DOI: 10.1038/s41375-019-0452-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Maroulio Pertesi
- Genetic Cancer Susceptibility, International Agency for Research on Cancer, Lyon, France
- Department of Laboratory Medicine, Division of Hematology and Transfusion medicine, Lund University, Lund, Sweden
| | - Maxime Vallée
- Genetic Cancer Susceptibility, International Agency for Research on Cancer, Lyon, France
| | - Xiaomu Wei
- Biological Statistics and Computational Biology, Cornell University, Ithaca, NY, USA
| | | | - Perrine Galia
- ProfilExpert, Lyon, France
- Hospices Civils de Lyon, Lyon, France
| | | | - Javier Oliver
- Genetic Cancer Susceptibility, International Agency for Research on Cancer, Lyon, France
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria; Institute of Biomedical Research in Malaga (IBIMA), CIMES, University of Málaga, Málaga, Spain
| | - Matthieu Foll
- Genetic Cancer Susceptibility, International Agency for Research on Cancer, Lyon, France
| | - Siwei Chen
- Biological Statistics and Computational Biology, Cornell University, Ithaca, NY, USA
| | - Emeline Perrial
- INSERM 1052, CNRS 5286, CRCL, Lyon, France
- University of Lyon, Lyon, France
| | - Laurent Garderet
- INSERM, UMR_S 938, Paris, France
- AP-HP, Hôpital Saint Antoine, Departement d'hematologie et de therapie cellulaire, Paris, France
- Sorbonne Universites, UPMC Univ Paris 06, UMR_S 938, Paris, France
| | - Jill Corre
- IUC-Oncopole and CRCT INSERM U1037, Toulouse, France
| | - Xavier Leleu
- Inserm CIC 1402 & Service d'Hématologie et Thérapie Cellulaire, CHU La Miletrie, Poitiers, France
| | | | - Olivier Decaux
- Service de Medecine Interne, CHU Rennes, Rennes, France
- Faculte de Medecine, Universite de Rennes 1, Rennes, France
- INSERM UMR U1236, Rennes, France
| | - Philippe Rodon
- Unite d'Hematologie et d'Oncologie, Centre Hospitalier, Perigueux, France
| | | | - Borhane Slama
- Service d'Onco hematologie, CH Avignon, Avignon, France
| | - Philippe Mineur
- Hematologie et pathologies de la coagulation, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Eric Voog
- Centre Jean Bernard, Institut Inter-regional de Cancerologie, Le Mans, France
| | - Catherine Le Bris
- Service post urgences, CHU de FORT DE FRANCE, pôle RASSUR, Martinique, France
| | - Jean Fontan
- Hopital Jean Minjoz, CHRU Besançon, Besançon, France
| | - Michel Maigre
- Service d'Hemato-Oncologie, CHU Chartres, Chartres, France
| | - Marie Beaumont
- Hematologie clinique et therapie cellulaire, CHU Amiens, Amiens, France
| | | | - Hagay Sobol
- Cancer Genetics Department, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | | | - Bruno Royer
- Service d'Immuno-hematologie, Hôpital Saint Louis, Paris, France
| | - Aurore Perrot
- Service d'Hematologie, CHU de Nancy, Universite de Lorraine, Vandoeuvre les Nancy, Nancy, France
| | | | | | | | - Pascale Cony-Makhoul
- Service d'Hematologie, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | | | | | | | - Serge Leyvraz
- Departement d'oncologie, CHUV, Lausanne, Switzerland
| | - Laurent Mosser
- Unite d'oncologie medicale, Pôle medical 2, Hôpital Jacques Puel, Rodez, France
| | | | - Karine Augeul-Meunier
- Service Hematologie, Institut de Cancerologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | | | - Cécile Leyronnas
- Institut Daniel Hollard, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Laurent Voillat
- Service hemato/oncologie, CH William Morey, Chalon sur Saône, France
| | | | - Claire Mathiot
- Intergroupe Francophone du Myelome (IFM), Bobigny, France
| | | | | | | | - Yves-Jean Bignon
- Laboratoire de Biologie Medicale OncoGènAuvergne; Departement d'oncogenetique, UMR INSERM 1240, Centre Jean Perrin, Clermont-Ferrand, France
| | - Bertrand Joly
- Service d'hematologie clinique, Pôle medecine de specialite, Centre Hospitalier Sud Francilien (CHSF), Corbeil-Essonnes, France
| | | | | | - Hervé Naman
- Hematologie - Oncologie medicale, Centre Azureen de Cancerologie, Mougins, France
| | - Sophie Rigaudeau
- Service d'Hematologie et d'Oncologie, CHU de Versailles, Le Chesnay, France
| | - Gérald Marit
- INSERM U1035, Universite de Bordeaux, Bordeaux, France
| | - Margaret Macro
- Hematologie Clinique, IHBN-CHU CAEN (University Hospital), Caen, France
| | - Isabelle Lambrecht
- Rheumatology Department, Maison Blanche Hospital, Reims University Hospitals, Reims, France
| | - Manuel Cliquennois
- Unite d'Hematologie clinique, Groupement des hôpitaux de l'Institut Catholique (GHICL), Universite Catholique de Lille, Lille, France
| | - Laure Vincent
- Departement d'hematologie clinique, CHU de Montpellier, Montpellier, France
| | - Philippe Helias
- Service d'Oncologie medicale, CHU de La Guadeloupe, Pointe-a-Pitre, Guadeloupe
| | - Hervé Avet-Loiseau
- Laboratory for Genomics in Myeloma, Institut Universitaire du Cancer and University Hospital, Centre de Recherche en Cancerologie de Toulouse, Toulouse, France
| | - Victor Moreno
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Biomarkers and Susceptibility, Cancer Prevention and Control Program, IDIBELL, Catalan Institute of Oncology; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Rui Manuel Reis
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Judit Varkonyi
- 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | | | - Annette Juul Vangsted
- Department of Haematology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Artur Jurczyszyn
- Jagiellonian University Medical College, Department of Hematology, Cracow, Poland
| | - Jan Maciej Zaucha
- Gdynia Oncology Center, Gdynia and Department of Oncological Propedeutics, Medical University of Gdańsk, Gdańsk, Poland
| | - Juan Sainz
- Genomic Oncology Area, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Malgorzata Krawczyk-Kulis
- Department of Bone Marrow Transplantation and Hematology-Oncology M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Marzena Wątek
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
- Holycross Cancer Center of Kielce, Hematology Clinic, Kielce, Poland
| | - Matteo Pelosini
- Department of Oncology, Transplants and Advanced Technologies, Section of Hematology, Pisa University Hospital, Pisa, Italy
| | | | - Norbert Grząśko
- Department of Experimental Hemato-oncology, Medical University of Lubli, Poland; Department of Hematology, St. John's Cancer Centre, Polish Myeloma Study Group, Lublin, Poland
| | - Joaquin Martinez-Lopez
- Hematology Department, Hospital 12 de Octubre, Universidad Complutense; CNIO, Madrid, Spain
| | - Andrés Jerez
- Hematology and Medical Oncology Department, Hospital Morales Meseguer, IMIB, Murcia, Spain
| | - Daniele Campa
- Department of Biology, University of Pisa, Pisa, Italy
| | - Gabriele Buda
- Holycross Cancer Center of Kielce, Hematology Clinic, Kielce, Poland
| | - Fabienne Lesueur
- Inserm U900, Institut Curie, PSL Research University, Mines ParisTech, Paris, France
| | | | - Ramón García-Sanz
- Hematology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Marcin Rymko
- Department of Hematology, Copernicus Hospital, Torun, Poland
| | - Krzysztof Jamroziak
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ofure Obazee
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Björn Nilsson
- Department of Laboratory Medicine, Division of Hematology and Transfusion medicine, Lund University, Lund, Sweden
| | - Robert J Klein
- Department of Genetics and Genomic Sciences and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - James D McKay
- Genetic Cancer Susceptibility, International Agency for Research on Cancer, Lyon, France.
| | - Charles Dumontet
- ProfilExpert, Lyon, France.
- Hospices Civils de Lyon, Lyon, France.
- INSERM 1052, CNRS 5286, CRCL, Lyon, France.
- University of Lyon, Lyon, France.
| |
Collapse
|
42
|
Gagelmann N, Eikema DJ, Koster L, Caillot D, Pioltelli P, Lleonart JB, Reményi P, Blaise D, Schaap N, Trneny M, Passweg J, Porras RP, Cahn JY, Musso M, Poiré X, Fenk R, Itälä-Remes M, Pavone V, Fouillard L, Maertens J, Bron D, Pouli A, Schroyens W, Schönland S, Garderet L, Yakoub-Agha I, Kröger N. Tandem Autologous Stem Cell Transplantation Improves Outcomes in Newly Diagnosed Multiple Myeloma with Extramedullary Disease and High-Risk Cytogenetics: A Study from the Chronic Malignancies Working Party of the European Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2019; 25:2134-2142. [PMID: 31288095 DOI: 10.1016/j.bbmt.2019.07.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 01/01/2023]
Abstract
Although high-dose therapy and autologous stem cell transplant combined with novel agents continues to be the hallmark of first-line treatment in newly diagnosed transplant-eligible multiple myeloma patients, the impact of tandem autologous or autologous/reduced-intensity allogeneic transplant for patients with extramedullary disease (EMD) and high-risk cytogenetics is not yet defined. Here, we analyzed clinical and cytogenetic data from 488 adult myeloma patients with EMD undergoing single autologous (n = 373), tandem autologous (n = 84), or autologous-allogeneic transplant (n = 31) between 2003 and 2015. At least 1 high-risk abnormality was present in 41% (n = 202), with del(17p) (40%) and t(4;14) (45%) the most frequent. More than 1 high-risk abnormality was found in 54%. High-risk cytogenetics showed worse 4-year overall survival (OS) and progression-free survival (PFS) of 54% and 29%, respectively, versus 78% and 49% for standard-risk cytogenetics (P < .001). Co-segregation of high-risk abnormalities did not seem to affect outcome. Regarding transplant regimen, OS and PFS were 70% and 43% for single autologous versus 83% and 52% for tandem autologous and 88% and 58% for autologous-allogeneic (P = .06 and P = .30). In multivariate analysis high-risk cytogenetics were associated with worse survival (hazard ratio [HR], 2.00; P = .003), whereas tandem autologous significantly improved outcome versus single autologous transplant (HRs, .46 and .64; P = .02 and P = .03). Autologous-allogeneic transplant did not significantly differ in outcome but appeared to improve survival, but results were limited because of small population (HR, .31). In conclusion, high-risk cytogenetics is frequently observed in newly diagnosed myeloma with EMD and significantly worsens outcome after single autologous, whereas a tandem autologous transplant strategy may overcome onset poor prognosis.
Collapse
Affiliation(s)
- Nico Gagelmann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | - Péter Reményi
- St. István and St. Laszlo Hospital, Budapest, Hungary
| | | | - Nicolaas Schaap
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marek Trneny
- Charles University Hospital, Prague, Czech Republic
| | | | | | | | | | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Roland Fenk
- Heinrich Heine University, Düsseldorf, Germany
| | | | | | | | | | | | | | | | - Stefan Schönland
- Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | | | - Nicolaus Kröger
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| |
Collapse
|
43
|
Moreau P, Attal M, Hulin C, Arnulf B, Belhadj K, Benboubker L, Béné MC, Broijl A, Caillon H, Caillot D, Corre J, Delforge M, Dejoie T, Doyen C, Facon T, Sonntag C, Fontan J, Garderet L, Jie KS, Karlin L, Kuhnowski F, Lambert J, Leleu X, Lenain P, Macro M, Mathiot C, Orsini-Piocelle F, Perrot A, Stoppa AM, van de Donk NW, Wuilleme S, Zweegman S, Kolb B, Touzeau C, Roussel M, Tiab M, Marolleau JP, Meuleman N, Vekemans MC, Westerman M, Klein SK, Levin MD, Fermand JP, Escoffre-Barbe M, Eveillard JR, Garidi R, Ahmadi T, Zhuang S, Chiu C, Pei L, de Boer C, Smith E, Deraedt W, Kampfenkel T, Schecter J, Vermeulen J, Avet-Loiseau H, Sonneveld P. Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): a randomised, open-label, phase 3 study. Lancet 2019; 394:29-38. [PMID: 31171419 DOI: 10.1016/s0140-6736(19)31240-1] [Citation(s) in RCA: 588] [Impact Index Per Article: 117.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/13/2019] [Accepted: 05/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bortezomib, thalidomide, and dexamethasone (VTd) plus autologous stem-cell transplantation is standard treatment in Europe for transplant-eligible patients with newly diagnosed multiple myeloma. We evaluated whether the addition of daratumumab to VTd before and after autologous stem-cell transplantation would improve stringent complete response rate in patients with newly diagnosed multiple myeloma. METHODS In this two-part, randomised, open-label, phase 3 CASSIOPEIA trial, we recruited transplant-eligible patients with newly diagnosed multiple myeloma at 111 European sites. Patients were randomly assigned (1:1) to receive four pre-transplant induction and two post-transplant consolidation cycles of VTd alone (VTd group) or in combination with daratumumab (D-VTd group). The primary endpoint of part 1 was stringent complete response assessed 100 days after transplantation. Part 2 (maintenance) is ongoing. The trial is registered with ClinicalTrials.gov, number NCT02541383. FINDINGS Between Sept 22, 2015, and Aug 1, 2017, 1085 patients were enrolled at 111 European sites and were randomly assigned to the D-VTd group (n=543) or the VTd group (n=542). At day 100 after transplantation, 157 (29%) of 543 patients in the D-VTd group and 110 (20%) of 542 patients in the VTd group in the intention-to-treat population had achieved a stringent complete response (odds ratio 1·60, 95% CI 1·21-2·12, p=0·0010). 211 (39%) patients in the D-VTd group versus 141 (26%) in the VTd group achieved a complete response or better, and 346 (64%) of 543 versus 236 (44%) of 542 achieved minimal residual disease-negativity (10-5 sensitivity threshold, assessed by multiparametric flow cytometry; both p<0·0001). Median progression-free survival from first randomisation was not reached in either group (hazard ratio 0·47, 95% CI 0·33-0·67, p<0·0001). 46 deaths on study were observed (14 vs 32, 0·43, 95% CI 0·23-0·80). The most common grade 3 or 4 adverse events were neutropenia (28% vs 15%), lymphopenia (17% vs 10%), and stomatitis (13% vs 16%). INTERPRETATION D-VTd before and after autologous stem-cell transplantation improved depth of response and progression-free survival with acceptable safety. CASSIOPEIA is the first study showing the clinical benefit of daratumumab plus standard of care in transplant-eligible patients with newly diagnosed multiple myeloma. FUNDING The Intergroupe Francophone du Myélome and Dutch-Belgian Cooperative Trial Group for Hematology Oncology.
Collapse
Affiliation(s)
| | - Michel Attal
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Cyrille Hulin
- Department of Hematology, Hopital Haut Leveque, University Hospital Bordeaux, Bordeaux, France
| | | | | | - Lotfi Benboubker
- Hôpital de Bretonneau, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Marie C Béné
- Hematology Biology, University Hospital Hôtel Dieu, Nantes, France
| | - Annemiek Broijl
- Erasmus University Medical Center Cancer Institute, Rotterdam, Netherlands
| | - Hélène Caillon
- Biochemistry Laboratory, Hospital of Nantes, Nantes, France
| | - Denis Caillot
- Hôpital Du Bocage, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - Jill Corre
- Unite de Genomique du Myelome, Institut universitaire du cancer de Toulouse Oncopole, Toulouse, France
| | | | - Thomas Dejoie
- Biochemistry Laboratory, Hospital of Nantes, Nantes, France
| | - Chantal Doyen
- Centre Hospitalier Universitaire UCL Namur-site Godinne, Yvoir, Belgium
| | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | | | - Laurent Garderet
- Team Proliferation and Differentiation of Stem Cells, Centre de Recherche Saint-Antoine, Inserm, Sorbonne Université, Paris, France; Département d'Hématologie et de Thérapie Cellulaire, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Lionel Karlin
- Service d'Hématologie Clinique, Centre Hospitalier Lyon-Sud, Lyon, France
| | | | - Jérôme Lambert
- Biostatistical Department, Hôpital Saint Louis, Paris, France
| | - Xavier Leleu
- Hôpital la Milétrie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Pascal Lenain
- Centre de Lutte Contre le Cancer-Centre Henri Becquerel, Rouen, France
| | | | | | | | - Aurore Perrot
- Hematology Department, Vandoeuvre Les Nancy, University Hospitals Nancy, France
| | | | - Niels Wcj van de Donk
- Department of Hematology, University Medical Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Soraya Wuilleme
- Hematology Biology, University Hospital Hôtel Dieu, Nantes, France
| | - Sonja Zweegman
- Department of Hematology, University Medical Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Brigitte Kolb
- Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Reims, France
| | | | - Murielle Roussel
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Mourad Tiab
- Centre Hospitalier Départemental Vendée, La Roche sur Yon, France
| | | | - Nathalie Meuleman
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | - Jean Paul Fermand
- Service d'Immuno-Hématologie, Département d'Immunologie Clinique, Inserm and Intergroupe Francophone du Myélome, Hôpital Saint-Louis, Paris, France
| | | | | | - Reda Garidi
- Hospital Center de Saint-Quentin, Saint Quentin, France
| | | | - Sen Zhuang
- Janssen Research & Development, Raritan, NJ, USA
| | | | - Lixia Pei
- Janssen Research & Development, Raritan, NJ, USA
| | - Carla de Boer
- Janssen Research & Development, LLC, Leiden, Netherlands
| | - Elena Smith
- Janssen Research & Development, LLC, High Wycombe, UK
| | | | | | | | | | - Hervé Avet-Loiseau
- Unite de Genomique du Myelome, Institut universitaire du cancer de Toulouse Oncopole, Toulouse, France
| | - Pieter Sonneveld
- Erasmus University Medical Center Cancer Institute, Rotterdam, Netherlands
| |
Collapse
|
44
|
Moreau P, Attal M, Hulin C, Béné MC, Broijl A, Caillot D, Delforge M, Dejoie T, Facon T, Lambert J, Leleu X, Macro M, Perrot A, Zweegman S, Ahmadi T, Chiu C, Pei L, Vermeulen J, Avet-Loiseau H, Sonneveld P. Phase 3 randomized study of daratumumab (DARA) + bortezomib/thalidomide/dexamethasone (D-VTd) vs VTd in transplant-eligible (TE) newly diagnosed multiple myeloma (NDMM): CASSIOPEIA Part 1 results. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8003 Background: VTd is a standard of care (SoC) for TE NDMM. CD38 mAb DARA significantly reduced the risk of progression/death and improved CR and MRD-negative rates in relapsed refractory MM or transplant-ineligible NDMM in phase 3 studies. We report the primary and final analysis of Part 1 of CASSIOPEIA. Methods: In Part 1, TE NDMM pts 18-65 y were randomized 1:1 to VTd (6 28-day cycles [C; 4 pre-ASCT induction, 2 post-ASCT consolidation] of V 1.3 mg/m2 SC BIW Week [W] 1-2; T 100 mg PO QD; d 40-80 mg/week PO or IV W 1-4 C 1-2, W 1-3 C 3-6) ± DARA (16 mg/kg IV QW C 1-2, Q2W C 3-6). Melphalan 200 mg/m2 was pre-ASCT HDT. The primary endpoint, post-consolidation sCR rate, was assessed at Day [D] 100 post-ASCT. Part 2 (maintenance) is ongoing. Results: A cohort of 1085 pts (D-VTd, 543; VTd, 542) was randomized. The D 100 post-ASCT sCR rate was significantly higher for D-VTd vs VTd (28.9% vs 20.3%; P = 0.0010; Table). At 18.8-mo median follow-up, PFS from first randomization favored D-VTd with HR 0.47 (95% CI, 0.33-0.67; P <0.0001). With median PFS NR in either arm, 18-mo PFS rates were 92.7% vs 84.6% for D-VTd vs VTd. Rates of ≥CR, ≥VGPR, and MRD negativity supported sCR results (Table). OS is immature with 46 deaths on study (D-VTd, 14; VTd, 32; HR, 0.43; 95% CI, 0.23-0.80). The most common (≥10%) grade 3/4 TEAEs (D-VTd/VTd) were neutropenia (27.6%/14.7%), lymphopenia (17.0%/9.7%), stomatitis (12.7%/16.4%), and thrombocytopenia (11.0%/7.4%). In the D-VTd arm, infusion-related reactions occurred in 35.4% of pts. Conclusions: D-VTd in induction prior to and consolidation after ASCT improved depth of response (sCR, ≥CR, and MRD negativity) and PFS with acceptable safety. The favorable benefit-risk profile supports the use of D-VTd in TE NDMM. CASSIOPEIA is the first study to demonstrate clinical benefit of DARA + SoC in TE NDMM. Clinical trial information: NCT02541383. [Table: see text]
Collapse
Affiliation(s)
| | - Michel Attal
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Cyrille Hulin
- Department of Hematology, Hospital Haut Leveque, University Hospital Bordeaux, Pessac, France
| | | | | | | | | | - Thomas Dejoie
- Biochemistry Laboratory, Hospital of Nantes, Nantes, France
| | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | - Jérôme Lambert
- Biostatistical Department, Hôpital Saint Louis, Paris, France
| | - Xavier Leleu
- CHU Poitiers-Hôpital la Milétrie, Poitiers, France
| | - Margaret Macro
- Centre Hospitalier Universitaire (CHU) de Caen, Caen, France
| | - Aurore Perrot
- Department of Hematology, University Hospital, Vandoeuvre-Lès-Nancy, France
| | - Sonja Zweegman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Hematology, Amsterdam, Netherlands
| | | | | | - Lixia Pei
- Janssen Research & Development, Raritan, NJ
| | | | | | | | | |
Collapse
|
45
|
Hulin C, Moreau P, Attal M, Belhadj K, Benboubker L, Caillot D, Facon T, Garderet L, Kuhnowski F, Stoppa AM, Kolb B, Tiab M, Sonneveld P, Jie KS, Westerman M, Pei L, Kampfenkel T, De Boer C, Vermeulen J, van de Donk NW. Stem cell (SC) yield and transplantation results from transplant-eligible newly diagnosed multiple myeloma (TE NDMM) patients (pts) receiving daratumumab (DARA) + bortezomib/thalidomide/dexamethasone (D-VTd) in the phase 3 CASSIOPEIA study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8042 Background: High-dose therapy (HDT) followed by autologous stem-cell transplantation (ASCT) is the standard of care in TE NDMM. In the phase 3 CASSIOPEIA study, D-VTd significantly improved stringent complete response (sCR), ≥CR, and minimal residual disease (MRD)-negative rates and reduced the risk of progression/death vs VTd in TE NDMM pts. We assessed SC yield and transplantation results among pts receiving D-VTd vs VTd induction prior to HDT/ASCT in Part 1 of CASSIOPEIA. Methods: In Part 1, TE NDMM pts ages 18-65 y were randomized 1:1 to 4 pre-transplant induction and 2 post-transplant consolidation cycles of DARA + VTd or VTd alone. After induction, pts underwent SC mobilization with cyclophosphamide 3 g/m2 (recommended dose) and GCSF. Peripheral blood SCs were harvested based on response to mobilization. Plerixafor was given if SC collection failed at first attempt and in accordance with institutional practice. Melphalan 200 mg/m2 IV was given as HDT prior to ASCT. Results: A total of 1085 pts were randomized (D-VTd, 543; VTd, 542). Among pts who completed mobilization (D-VTd, 506; VTd, 492), more pts receiving D-VTd vs VTd received plerixafor during mobilization (21.7% vs 7.9%). Pts underwent a median (range) of 2 (1-6) vs 1 (1-4) days of apheresis for D-VTd vs VTd. The median number of CD34+ cells collected was lower for D-VTd vs VTd (6.3×106/kg vs 8.9×106/kg). Nevertheless, a similar percentage of ITT pts receiving D-VTd vs VTd underwent ASCT (90.1% vs 89.3%). The median number of CD34+ cells transplanted for D-VTd vs VTd was 3.3×106/kg vs 4.3×106/kg. Hematopoietic reconstitution rates were high and similar for transplanted pts receiving D-VTd vs VTd (99.8% vs 99.6%). For D-VTd vs VTd, a median (range) of 13.0 (6-54) vs 13.0 (4-43) days was required to achieve sustained ANC > 500 cells/mm3, and a median (range) of 14.0 (2-56) vs 12.0 (1-47) days was required to achieve sustained platelets > 20,000 cells/mm3 without transfusion. Conclusions: SC mobilization and collection was feasible with D-VTd induction. Adding DARA to VTd allowed successful transplantation in pts with TE NDMM. Clinical trial information: NCT02541383.
Collapse
Affiliation(s)
- Cyrille Hulin
- Department of Hematology, Hospital Haut Leveque, University Hospital Bordeaux, Pessac, France
| | | | - Michel Attal
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | | | | | | | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | - Laurent Garderet
- Sorbonne Université, Centre de Recherche Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Département d'Hématologie et de Thérapie Cellulaire, Paris, France, Hôpital Pitié Salpetrière, département d'hématologie, Paris, France
| | | | | | | | - Mourad Tiab
- CHD Vendée, La Roche Sur Yon Cedex 9, France
| | | | | | | | - Lixia Pei
- Janssen Research & Development, Raritan, NJ
| | | | - Carla De Boer
- Janssen Research & Development, LLC, Leiden, Netherlands
| | | | | | | |
Collapse
|
46
|
Cransac A, Aho S, Chretien ML, Giroud M, Caillot D, Boulin M. Adherence to immunomodulatory drugs in patients with multiple myeloma. PLoS One 2019; 14:e0214446. [PMID: 30917164 PMCID: PMC6436707 DOI: 10.1371/journal.pone.0214446] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 03/13/2019] [Indexed: 01/08/2023] Open
Abstract
Background Immunomodulatory drugs (thalidomide, lenalidomide and pomalidomide; IMID) are widely used in the treatment of multiple myeloma patients. To date, few data are available on IMID adherence in multiple myeloma patients. The aim of our study was to evaluate IMID adherence and to compare two indirect methods to measure IMID adherence in multiple myeloma patients: a specific questionnaire and the medication possession ratio (MPR). Another aim was to explore this specific questionnaire for the assessment of IMID adherence in multiple myeloma patients. Methods All consecutive multiple myeloma patients, with at least two consecutive dispensations of thalidomide, lenalidomide or pomalidomide in our hospital were included in this prospective study. IMID adherence was measured using a specific questionnaire and the medication possession ratio. Relationship between the questionnaire scores and variables of interest was evaluated by multiple linear regression with a robust variance estimator. Findings Sixty-three patients were included in our study. The mean questionnaire score was 8.2±1.2 and the mean medication possession ratio value was 0.97±0.06. A total of 76% of patients were considered adherent according to the questionnaire (i.e. score ≥ 8), 94% according to the medication possession ratio (i.e. MPR ≥ 0.90), and 70% according to the questionnaire and the medication possession ratio. No statistically significant linear association was observed between the questionnaire score and any variables of interest including medication possession ratio. All Cronbach’s alpha were relatively low (range 0.0342–0.2443), showing a low correlation of the different questions with the questionnaire score. Conclusions Our study is the first prospective study evaluating IMID adherence in multiple myeloma patients in real life. The high adherence to IMIDs reported here, regardless of the drug, is encouraging considering the efficacy, toxicity and elevated cost of IMIDs. The specific questionnaire should be used with caution to evaluate IMID adherence.
Collapse
Affiliation(s)
- Amélie Cransac
- Department of Pharmacy, Dijon University Hospital and LNC-UMR1231, University of Burgundy & Franche Comté, Dijon, France
| | - Serge Aho
- Hospital Epidemiology and Infection Control Department, University Hospital, Dijon, France
| | - Marie-Lorraine Chretien
- Department of Clinical Hematology, University Hospital and SAPHIIR-UMR 1231, University of Burgundy & Franche Comté, Dijon, France
| | - Maurice Giroud
- Department of Neurology, Dijon University Hospital and LNC-UMR1231, University of Burgundy & Franche Comté, Dijon, France
| | - Denis Caillot
- Department of Clinical Hematology, University Hospital, Dijon, France
| | - Mathieu Boulin
- Department of Pharmacy, Dijon University Hospital and EPICAD LNC-UMR1231, University of Burgundy & Franche Comté, Dijon, France
| |
Collapse
|
47
|
Warda W, Larosa F, Neto Da Rocha M, Trad R, Deconinck E, Fajloun Z, Faure C, Caillot D, Moldovan M, Valmary-Degano S, Biichle S, Daguindau E, Garnache-Ottou F, Tabruyn S, Adotevi O, Deschamps M, Ferrand C. CML Hematopoietic Stem Cells Expressing IL1RAP Can Be Targeted by Chimeric Antigen Receptor-Engineered T Cells. Cancer Res 2018; 79:663-675. [PMID: 30514753 DOI: 10.1158/0008-5472.can-18-1078] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/09/2018] [Accepted: 11/29/2018] [Indexed: 12/16/2022]
Abstract
Chronic myeloid leukemia (CML) is a chronic disease resulting in myeloid cell expansion through expression of the BCR-ABL1 fusion transcript. Tyrosine kinase inhibitors (TKI) have significantly increased survival of patients with CML, and deep responders may consider stopping the treatment. However, more than 50% of patients relapse and restart TKI, subsequently suffering unknown toxicity. Because CML is a model immune system-sensitive disease, we hypothesize that chimeric antigen receptor (CAR) T cells targeting IL1 receptor-associated protein (IL1RAP) in quiescent CML stem cells may offer an opportunity for a permanent cure. In this study, we produced and molecularly characterized a specific monoclonal anti-IL1RAP antibody from which fragment antigen-binding nucleotide coding sequences were cloned as a single chain into a lentiviral backbone and secured with the suicide gene iCASP9/rimiducid system. Our CAR T-cell therapy exhibited cytotoxicity against both leukemic stem cells and, to a lesser extent, monocytes expressing IL1RAP, with no apparent effect on the hematopoietic system, including CD34+ stem cells. This suggests IL1RAP as a tumor-associated antigen for immunotherapy cell targeting. IL1RAP CAR T cells were activated in the presence of IL1RAP+ cell lines or primary CML cells, resulting in secretion of proinflammatory cytokines and specifically killing in vitro and in a xenograft murine model. Overall, we demonstrate the proof of concept of a CAR T-cell immunotherapy approach in the context of CML that is applicable for young patients and primary TKI-resistant, intolerant, or allograft candidate patients. SIGNIFICANCE: These findings present the first characterization and proof of concept of a chimeric antigen receptor directed against IL1RAP expressed by leukemic stem cells in the context of CML.
Collapse
Affiliation(s)
- Walid Warda
- INSERM UMR1098, EFS BFC, University of Bourgogne Franche-Comté, Besançon, France.,Laboratory of Applied Biotechnology, Azm Centre for Research in Biotechnology and its Applications, EDST and Faculty of Sciences 3, Lebanese University, Tripoli, Liban
| | - Fabrice Larosa
- Department of Hematology, University Hospital of Besancon, Besancon, France
| | | | - Rim Trad
- INSERM UMR1098, EFS BFC, University of Bourgogne Franche-Comté, Besançon, France
| | - Eric Deconinck
- INSERM UMR1098, EFS BFC, University of Bourgogne Franche-Comté, Besançon, France.,Department of Hematology, University Hospital of Besancon, Besancon, France
| | - Ziad Fajloun
- Laboratory of Applied Biotechnology, Azm Centre for Research in Biotechnology and its Applications, EDST and Faculty of Sciences 3, Lebanese University, Tripoli, Liban
| | - Cyril Faure
- Department of Internal Medicine, Hospital of Haute Saone, Vesoul, France
| | - Denis Caillot
- Department of Hematology, University Hospital of Dijon, Dijon, France
| | - Marius Moldovan
- Department of Internal Medicine, Hospital Nord Franche-Comté, Belfort, France
| | | | - Sabeha Biichle
- INSERM UMR1098, EFS BFC, University of Bourgogne Franche-Comté, Besançon, France
| | - Etienne Daguindau
- INSERM UMR1098, EFS BFC, University of Bourgogne Franche-Comté, Besançon, France.,Department of Hematology, University Hospital of Besancon, Besancon, France
| | | | | | - Olivier Adotevi
- INSERM UMR1098, EFS BFC, University of Bourgogne Franche-Comté, Besançon, France
| | - Marina Deschamps
- INSERM UMR1098, EFS BFC, University of Bourgogne Franche-Comté, Besançon, France
| | - Christophe Ferrand
- INSERM UMR1098, EFS BFC, University of Bourgogne Franche-Comté, Besançon, France.
| |
Collapse
|
48
|
Sautour M, Chrétien ML, Valot S, Lafon I, Basmaciyan L, Legouge C, Verrier T, Gonssaud B, Abou-Hanna H, Dalle F, Caillot D. First case of proven invasive pulmonary infection due to Trichoderma longibrachiatum in a neutropenic patient with acute leukemia. J Mycol Med 2018; 28:659-662. [PMID: 30477694 DOI: 10.1016/j.mycmed.2018.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/02/2018] [Accepted: 10/04/2018] [Indexed: 12/16/2022]
Abstract
Trichoderma species are saprophytic filamentous fungi that can be found all over the word. These fungi show increasing medical importance as opportunistic human pathogens, particularly in immunocompromised patients. Invasive infections due to Trichoderma are rare and definitive diagnosis is complex to achieve because of the lack of specific diagnosis tools. We report in this work the first proven case of invasive pulmonary infection due to T. longibrachiatum in a 69-year-old white male with hematologic malignancy. The patient was successfully treated initially with voriconazole alone followed by a combination of voriconazole and caspofungine.
Collapse
Affiliation(s)
- M Sautour
- UMR A PAM, Équipe Vin, Aliment, Microbiologie, Stress, Université Bourgogne Franche-Comté, AgroSup Dijon, 21078 Dijon cedex, France; Parasitology-Mycology Department, University Hospital of Dijon, 21000 Dijon, France
| | - M L Chrétien
- Department of Clinical Haematology, University Hospital of Dijon, 21000 Dijon, France
| | - S Valot
- Parasitology-Mycology Department, University Hospital of Dijon, 21000 Dijon, France
| | - I Lafon
- Department of Clinical Haematology, University Hospital of Dijon, 21000 Dijon, France
| | - L Basmaciyan
- UMR A PAM, Équipe Vin, Aliment, Microbiologie, Stress, Université Bourgogne Franche-Comté, AgroSup Dijon, 21078 Dijon cedex, France; Parasitology-Mycology Department, University Hospital of Dijon, 21000 Dijon, France
| | - C Legouge
- Department of Clinical Haematology, University Hospital of Dijon, 21000 Dijon, France
| | - T Verrier
- Parasitology-Mycology Department, University Hospital of Dijon, 21000 Dijon, France
| | - B Gonssaud
- Parasitology-Mycology Department, University Hospital of Dijon, 21000 Dijon, France
| | - H Abou-Hanna
- Department of Cardiovascular and Thoracic Surgery, University Hospital of Dijon, 21000 Dijon, France
| | - F Dalle
- UMR A PAM, Équipe Vin, Aliment, Microbiologie, Stress, Université Bourgogne Franche-Comté, AgroSup Dijon, 21078 Dijon cedex, France; Parasitology-Mycology Department, University Hospital of Dijon, 21000 Dijon, France.
| | - D Caillot
- Department of Clinical Haematology, University Hospital of Dijon, 21000 Dijon, France
| |
Collapse
|
49
|
Gangneux JP, El Cheikh J, Herbrecht R, Yakoub-Agha I, Quiniou JB, Caillot D, Michallet M. Systemic Antifungal Prophylaxis in Patients Hospitalized in Hematology Units in France: The AFHEM Cross-Sectional Observational Study. Infect Dis Ther 2018; 7:309-325. [PMID: 29948621 PMCID: PMC6098753 DOI: 10.1007/s40121-018-0203-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The frequency of invasive fungal diseases (IFDs) has increased in recent years. Within a context where both treatments and guidelines are fast evolving, we aim to shed new light on IFD management in hematologic departments in France. METHODS A multicenter cross-sectional observational study was prospectively conducted in 24 French centers in September and October 2013. RESULTS Four hundred ninety-four hospitalized children and adult patients suffering from hematologic malignancy were enrolled: 147 (30%) were allogeneic hematopoietic stem cell transplant (HSCT) recipients, 131 (27%) were patients with acute myeloblastic leukemia or myelodysplastic syndrome (MDS), 71 (14%) were patients with acute lymphoblastic leukemia who did not undergo allogeneic HSCT, and the 145 (29%) remaining patients did not belong to the three above groups. Two hundred forty-six patients (50%) received antifungal treatment, which was prophylactic in 187 (76%) treated patients. These rates were similar across all groups (63-80%). Patients received prophylaxis with an azole (79%), intravenous amphotericin B formulation (10%), echinocandin (9%), or two combination drugs (2%). CONCLUSION Results indicate that prophylaxis is the leading antifungal strategy in French hematology units, regardless of the disease condition, representing 76% of prescriptions for antifungal therapy. FUNDING Astellas Pharma France.
Collapse
Affiliation(s)
| | - Jean El Cheikh
- Department of Transplantation and Cellular Therapy, Paoli Calmettes Institute, Marseille, France
| | | | - Ibrahim Yakoub-Agha
- LIRIC INSERM U995, Affiliated University Hospital, Lille 2 University, Lille, France
| | | | - Denis Caillot
- Department of Clinical Hematology, Affiliated University Hospital, Dijon, France
| | | |
Collapse
|
50
|
Lambert J, Pautas C, Terré C, Raffoux E, Turlure P, Caillot D, Legrand O, Thomas X, Gardin C, Gogat-Marchant K, Rubin SD, Benner RJ, Bousset P, Preudhomme C, Chevret S, Dombret H, Castaigne S. Gemtuzumab ozogamicin for de novo acute myeloid leukemia: final efficacy and safety updates from the open-label, phase III ALFA-0701 trial. Haematologica 2018; 104:113-119. [PMID: 30076173 PMCID: PMC6312010 DOI: 10.3324/haematol.2018.188888] [Citation(s) in RCA: 199] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 07/25/2018] [Indexed: 11/23/2022] Open
Abstract
The randomized, phase III ALFA-0701 trial showed that a reduced and fractionated dose of gemtuzumab ozogamicin added to standard front-line chemotherapy significantly improves event-free survival (EFS) in adults with de novo acute myeloid leukemia (AML). Here we report an independent review of EFS, final overall survival (OS), and additional safety results from ALFA-0701. Patients (n=271) aged 50-70 years with de novo AML were randomized to receive conventional front-line induction chemotherapy (3+7daunorubicin+cytarabine) with/without gemtuzumab ozogamicin 3 mg/m2 on days 1, 4, and 7 during induction. Patients in remission following induction therapy received 2 courses of consolidation therapy (daunorubicin+cytarabine) with/without gemtuzumab ozogamicin (3 mg/m2/day on day 1) according to their initial randomization. The primary end point was investigator-assessed EFS. Secondary end points included OS and safety. A blinded independent review confirmed the investigator-assessed EFS results [August 1, 2011; hazard ratio (HR) 0.66; 95% Confidence Interval (CI): 0.49–0.89; 2-sided P=0.006], corresponding to a 34% reduction in risk of events in the gemtuzumab ozogamicin versus control arm. Final OS at April 30, 2013 favored gemtuzumab ozogamicin but was not significant. No differences in early death rate were observed between arms. The main toxicity associated with gemtuzumab ozogamicin was prolonged thrombocytopenia. Veno-occlusive disease (including after transplant) was observed in 6 patients in the gemtuzumab ozogamicin arm and 2 in the control arm. In conclusion, gemtuzumab ozogamicin added to standard intensive chemotherapy has a favorable benefit/risk ratio. These results expand front-line treatment options for adult patients with previously untreated AML. (Trial registered at clinicaltrials.gov; identifier: 00927498.)
Collapse
Affiliation(s)
- Juliette Lambert
- Service d'Hématologie et Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Cécile Pautas
- Service d'Hématologie et de Thérapie Cellulaire, Hôpital Henri Mondor, Créteil, France
| | - Christine Terré
- Laboratoire de Cytogénétique, Centre Hospitalier de Versailles, France
| | | | - Pascal Turlure
- Service d'Hématologie Clinique et Thérapie Cellulaire, Centre Hospitalier Universitaire, Limoges, France
| | - Denis Caillot
- Hematologie Clinique, Hôpital François Mitterrand, Centre Hospitalier Universitaire, Dijon, France
| | - Ollivier Legrand
- Hôpital Saint-Antoine (AP-HP), Université Paris Pierre et Marie Curie, France
| | - Xavier Thomas
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université Lyon 1, Pierre Benite, France
| | - Claude Gardin
- Hôpital Avicenne (AP-HP), Université Paris 13, Bobigny, France
| | | | - Stephen D Rubin
- Global Product Development, Pfizer Inc., Collegeville, PA, USA
| | | | | | - Claude Preudhomme
- Université Lille, INSERM, Centre Hospitalier Universitaire Lille, UMR-S 1172 - Jean-Pierre Aubert Center - Centre de Recherche, Lille, France
| | - Sylvie Chevret
- Departement de Biostatistique, Hôpital Saint-Louis (AP-HP), Universite Paris Diderot, INSERM S 717, France
| | - Herve Dombret
- Hopital Saint-Louis (AP-HP), Universite Paris Diderot, France
| | - Sylvie Castaigne
- Service d'Hématologie et Oncologie, Centre Hospitalier de Versailles, Université de Versailles Saint Quentin, Le Chesnay, France
| |
Collapse
|