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Nicot AB, Harb J, Garcia A, Guillot F, Mai HL, Mathé CV, Morille J, Vallino A, Dugast E, Shah SP, Lefrère F, Moyon M, Wiertlewski S, Le Berre L, Renaudin K, Soulillou JP, van Pesch V, Brouard S, Berthelot L, Laplaud DA. Aglycosylated extracellular loop of inwardly rectifying potassium channel 4.1 (KCNJ10) provides a target for autoimmune neuroinflammation. Brain Commun 2023; 5:fcad044. [PMID: 36910419 PMCID: PMC9994600 DOI: 10.1093/braincomms/fcad044] [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: 04/01/2022] [Revised: 09/20/2022] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Multiple sclerosis is an autoimmune disease of the central nervous system. Yet, the autoimmune targets are still undefined. The extracellular e1 sequence of KCNJ10, the inwardly rectifying potassium channel 4.1, has been subject to fierce debate for its role as a candidate autoantigen in multiple sclerosis. Inwardly rectifying potassium channel 4.1 is expressed in the central nervous system but also in peripheral tissues, raising concerns about the central nervous system-specificity of such autoreactivity. Immunization of C57Bl6/J female mice with the e1 peptide (amino acids 83-120 of Kir4.1) induced anti-e1 immunoglobulin G- and T-cell responses and promoted demyelinating encephalomyelitis with B cell central nervous system enrichment in leptomeninges and T cells/macrophages in central nervous system parenchyma from forebrain to spinal cord, mostly in the white matter. Within our cohort of multiple sclerosis patients (n = 252), 6% exhibited high anti-e1 immunoglobulin G levels in serum as compared to 0.7% in the control cohort (n = 127; P = 0.015). Immunolabelling of inwardly rectifying potassium channel 4.1-expressing white matter glia with the anti-e1 serum from immunized mice increased during murine autoimmune neuroinflammation and in multiple sclerosis white matter as compared with controls. Strikingly, the mouse and human anti-e1 sera labelled astrocytoma cells when N-glycosylation was blocked with tunicamycin. Western blot confirmed that neuroinflammation induces Kir4.1 expression, including its shorter aglycosylated form in murine experimental autoencephalomyelitis and multiple sclerosis. In addition, recognition of inwardly rectifying potassium channel 4.1 using mouse anti-e1 serum in Western blot experiments under unreduced conditions or in cells transfected with the N-glycosylation defective N104Q mutant as compared to the wild type further suggests that autoantibodies target an e1 conformational epitope in its aglycosylated form. These data highlight the e1 sequence of inwardly rectifying potassium channel 4.1 as a valid central nervous system autoantigen with a disease/tissue-specific post-translational antigen modification as potential contributor to autoimmunity in some multiple sclerosis patients.
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Affiliation(s)
- Arnaud B Nicot
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Jean Harb
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Alexandra Garcia
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Flora Guillot
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Hoa-Le Mai
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Camille V Mathé
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Jérémy Morille
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Amélie Vallino
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Emilie Dugast
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Sita P Shah
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Fabienne Lefrère
- Service de Neurologie, CHU Nantes, Nantes 44000, France.,CIC Inserm 1413, CHU Nantes, Nantes 44000, France
| | - Mélinda Moyon
- Service de Neurologie, CHU Nantes, Nantes 44000, France.,CIC Inserm 1413, CHU Nantes, Nantes 44000, France
| | - Sandrine Wiertlewski
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France.,Service de Neurologie, CHU Nantes, Nantes 44000, France.,CIC Inserm 1413, CHU Nantes, Nantes 44000, France
| | - Ludmilla Le Berre
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Karine Renaudin
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Jean-Paul Soulillou
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Vincent van Pesch
- Neurologie, Institute of Neuroscience, Université Catholique de Louvain, Bruxelles 1200, Belgium
| | - Sophie Brouard
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - Laureline Berthelot
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France
| | - David-Axel Laplaud
- INSERM, Nantes Université, CHU Nantes, Center for Research in Transplantation and Translational Immunology (CR2TI), UMR 1064, Nantes 44000, France.,Service de Neurologie, CHU Nantes, Nantes 44000, France.,CIC Inserm 1413, CHU Nantes, Nantes 44000, France
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2
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Hengeveld M, Suciu S, Chelgoum Y, Marie JP, Muus P, Lefrère F, Mandelli F, Pane F, Amadori S, Fioritoni G, Labar B, Baron F, Cermak J, Bourhis JH, Storti G, Fazi P, Hagemeijer A, Vignetti M, Willemze R, de Witte T. High numbers of mobilized CD34+ cells collected in AML in first remission are associated with high relapse risk irrespective of treatment with autologous peripheral blood SCT or autologous BMT. Bone Marrow Transplant 2014; 50:341-7. [PMID: 25402418 DOI: 10.1038/bmt.2014.262] [Citation(s) in RCA: 12] [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] [Received: 12/27/2013] [Revised: 09/18/2014] [Accepted: 09/19/2014] [Indexed: 11/09/2022]
Abstract
The faster hematopoietic recovery after autologous peripheral blood SCT (APBSCT) in patients with AML may be offset by an increased relapse risk as compared with autologous BMT (ABMT). The EORTC and GIMEMA Leukemia Groups conducted a trial (AML-10) in which they compared, as second randomization, APBSCT and ABMT in first CR patients without an HLA compatible donor. A total of 292 patients were randomized. The 5-year DFS rate was 41% in the APBSCT arm and 46% in the ABMT arm with a hazard ratio (HR) of 1.17; 95% confidence interval=0.85-1.59; P=0.34. The 5-year cumulative relapse incidence was 56% vs 49% (P=0.26), and the 5-year OS 50% and 55% (P=0.6) in the APBSCT and ABMT groups, respectively. APBSCT was associated with significantly faster recovery of neutrophils and platelets, shorter duration of hospitalization, reduced need of transfusion packed RBC and less days of intravenous antibiotics. In both treatment groups, higher numbers of mobilized CD34+ cells were associated with a significantly higher relapse risk irrespective of the treatment given after the mobilization. Randomization between APBSCT and ABMT did not result in significantly different outcomes in terms of DFS, OS and relapse incidence.
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Affiliation(s)
- M Hengeveld
- Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - S Suciu
- EORTC Headquarters, Brussels, Belgium
| | | | | | - P Muus
- Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - F Lefrère
- Necker-Institut Curie, Paris, France
| | | | - F Pane
- Federico II University, Napoli, Italy
| | - S Amadori
- Tor Vergata University Hospital, Roma, Italy
| | | | - B Labar
- University Hospital Rebro, Zagreb, Croatia
| | - F Baron
- CHU Sart-Tilman, Liège, Belgium
| | - J Cermak
- Institute Hematology, Prague, Czech Republic
| | - J-H Bourhis
- Gustave Roussy Comprehensive Cancer Center, Villejuif, France
| | - G Storti
- A.O.R.N. San Giuseppe Moscati, Avelino, Italy
| | - P Fazi
- GIMEMA Data Center, Roma, Italy
| | - A Hagemeijer
- Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
| | | | - R Willemze
- Leiden University Medical Center, Leiden, The Netherlands
| | - T de Witte
- Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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3
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Chiche L, Perrin A, Stern L, Kutikova L, Cohen-Nizard S, Lefrère F. [Cost per responder associated with romiplostim and rituximab treatment for adult primary immune thrombocytopenia in France]. Transfus Clin Biol 2014; 21:85-93. [PMID: 24797790 DOI: 10.1016/j.tracli.2014.03.007] [Citation(s) in RCA: 3] [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: 08/08/2013] [Accepted: 03/26/2014] [Indexed: 02/03/2023]
Abstract
PURPOSE OF THE STUDY This analysis compared the response rates and cost per responder associated with romiplostim and rituximab in adult immune thrombocytopenia from the French National Health System payer perspective. METHODS A decision analytic model was developed to estimate the cost per patient and per responder of treating adult immune thrombocytopenia patients with romiplostim versus rituximab over 6 months. A systematic literature review identified phase 3 randomized controlled trials. Published response rates were extracted (response definition: ≥50×10(9) platelets/liter). Resource utilization was based on French and international treatment guidelines, and clinical expert opinion. Unit costs were derived from literature and French reimbursement lists, and included the costs of routine physician visits, treatment administration, and emergency care. Non-responders incurred bleeding-related event costs. RESULTS The literature review identified a phase 3 randomized controlled trial for romiplostim with a response rate of 83%. Due to a lack of phase 3 randomized controlled trials for rituximab, a systematic review of studies was selected as the best source, reporting a response rate of 62.5%. Romiplostim and rituximab were associated with similar treatment costs, with an estimated cost per patient for romiplostim of €17,456 and €17,068 for rituximab. Rituximab resulted in a 30% higher cost per responder (€27,308 for rituximab versus €21,031 for romiplostim). Romiplostim use reduced drug administration, intravenous immunoglobulin, and bleeding-related hospitalization costs compared to rituximab. CONCLUSIONS Due to its high efficacy leading to lower bleeding-related costs, romiplostim represents an efficient use of resources for adult immune thrombocytopenia patients in the French healthcare system.
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Affiliation(s)
- L Chiche
- Service de médecine interne, centre de compétence PACA ouest pour la prise en charge des cytopénies autoimmunes, hôpital de la Conception, Aix-Marseille université, 13005 Marseille, France
| | - A Perrin
- LA-SER Analytica, 24, West 40th Street, Floor 8, 10018 New York, États-Unis.
| | - L Stern
- LA-SER Analytica, 24, West 40th Street, Floor 8, 10018 New York, États-Unis
| | - L Kutikova
- Amgen (Europe) GmbH, Dammstrasse 23, Opus 105, 6301 Zug, Suisse
| | - S Cohen-Nizard
- Amgen SAS, Building B, 62/64 boulevard Victor-Hugo, 92200 Neuilly, France
| | - F Lefrère
- Service de biothérapie, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
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4
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Michel L, Vukusic S, De Seze J, Ducray F, Ongagna JC, Lefrère F, Jacq-Foucher M, Confavreux C, Wiertlewski S, Laplaud DA. Mycophenolate mofetil in multiple sclerosis: a multicentre retrospective study on 344 patients. J Neurol Neurosurg Psychiatry 2014; 85:279-83. [PMID: 23704316 DOI: 10.1136/jnnp-2013-305298] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Mycophenolate mofetil (MMF) is an immunosuppressive agent, sometimes used as a disease-modifying therapy for multiple sclerosis (MS). Several studies have reported the relative safety of this treatment but, to date, its efficacy has rarely been described. We performed a retrospective study to assess the safety and efficacy of MMF in patients with MS. METHODOLOGY Three French MS centres included all of their patients treated by MMF. The main outcome criterion was annualised relapse rate (ARR) in the 1 year period after onset of MMF compared with the 1 year control period. Treatment with another immunosuppressive drug, such as mitoxantrone or cyclophosphamide, in the 2 years preceding initiation of MMF was included in a subgroup analysis. MMF safety and progression of the Expanded Disability Status Scale (EDSS) score were also assessed. RESULTS 344 patients were included; 149 patients were previously treated with another immunosuppressant (IS group). Mean MMF treatment duration was 25.3±1.1 months. During the 1 year control period, ARR was 1.11±0.08, and for the 1 year treatment period, ARR was reduced significantly to 0.35±0.05 (p<0.0001, Wilcoxon paired test). Adverse events (occurring in 11% of patients) were mainly digestive disorders, benign infections, asthenia and transitory lymphopenia. Concerning the progression of disability, in the subgroup of patients without previous immunosuppressant treatment, EDSS remained stable between initiation and 1 year after the beginning of MMF. INTERPRETATION Our results suggest that MMF can improve or stabilise MS patients and can be used as an alternative therapy.
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Affiliation(s)
- L Michel
- Service de Neurologie, CHU Nantes, , Nantes, France
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Michel L, Chesneau M, Manceau P, Garcia A, Salou M, Ngono AE, Pallier A, Jacq-Foucher M, Lefrère F, Wiertlewski S, Soulillou JP, Degauque N, Laplaud DA, Brouard S. No lack of regulatory B cells in patients with Multiple Sclerosis. Lab Invest 2012. [PMCID: PMC3508973 DOI: 10.1186/1479-5876-10-s3-o4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Laure Michel
- INSERM, UMR 1064, Nantes, France,CHU Nord Laennec, Service de Neurologie, Nantes, France,CHU de Nantes, ITUN, Nantes, France
| | - Mélanie Chesneau
- INSERM, UMR 1064, Nantes, France,CHU de Nantes, ITUN, Nantes, France
| | | | - Alexandra Garcia
- INSERM, UMR 1064, Nantes, France,CHU de Nantes, ITUN, Nantes, France
| | - Marion Salou
- INSERM, UMR 1064, Nantes, France,CHU de Nantes, ITUN, Nantes, France
| | - Annie Elong Ngono
- INSERM, UMR 1064, Nantes, France,CHU de Nantes, ITUN, Nantes, France
| | - Annaïck Pallier
- INSERM, UMR 1064, Nantes, France,CHU de Nantes, ITUN, Nantes, France
| | | | | | | | | | - Nicolas Degauque
- INSERM, UMR 1064, Nantes, France,CHU de Nantes, ITUN, Nantes, France
| | - David-Axel Laplaud
- INSERM, UMR 1064, Nantes, France,CHU Nord Laennec, Service de Neurologie, Nantes, France,CHU de Nantes, ITUN, Nantes, France
| | - Sophie Brouard
- INSERM, UMR 1064, Nantes, France,CHU de Nantes, ITUN, Nantes, France
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Bahbouhi B, Pettré S, Berthelot L, Garcia A, Elong Ngono A, Degauque N, Michel L, Wiertlewski S, Lefrère F, Meyniel C, Delcroix C, Brouard S, Laplaud DA, Soulillou JP. T cell recognition of self-antigen presenting cells by protein transfer assay reveals a high frequency of anti-myelin T cells in multiple sclerosis. ACTA ACUST UNITED AC 2010; 133:1622-36. [PMID: 20435630 DOI: 10.1093/brain/awq074] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Although peripheral blood myelin-autoreactive T cells are thought to play a key role in multiple sclerosis, they are generally considered to have qualitative differences rather than quantitative ones when compared to those found in healthy individuals. Here, we revisited the assessment of myelin-autoreactive T cells in a new approach based on their combined ability to acquire membrane proteins from autologous antigen presenting cells, and to respond to whole myelin extract as the stimulating autoantigen. Using this approach, the myelin-autoreactive T cell frequency in patients with multiple sclerosis was found to be unexpectedly high (n = 22, subtracted values median 2.08%, range 0-6%; background median 1%, range 0-4%) and to exceed that of age/gender-matched healthy individuals significantly (n = 18, subtracted values median 0.1%, range 0-5.3%, P < 0.0001; background median 1.45%, range 0.1-4%). Higher anti-myelin autoreactivity was stable in patients with multiple sclerosis after several months. These data correlated with whole myelin-induced gamma interferon-enzyme-linked immunosorbent spot assay performed under the same conditions, although the values obtained with enzyme-linked immunosorbent spot assay under all conditions were 58 times lower than with this new method. The myelin-autoreactive T cells were memory T cells expressing CD40L with a CD62(low) phenotype, suggesting their ability for homing to tissues. Collectively, these new data show a higher frequency of autoreactive T cells during multiple sclerosis than in age/gender-matched healthy individuals, and support an autoimmune aetiology in multiple sclerosis.
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Berthelot L, Miqueu P, Pettré S, Guillet M, Moynard J, Wiertlewski S, Lefrère F, Brouard S, Soulillou JP, Laplaud DA. Failure of glatiramer acetate to modify the peripheral T cell repertoire of relapsing-remitting multiple sclerosis patients. Clin Immunol 2010; 135:33-42. [PMID: 20116333 DOI: 10.1016/j.clim.2009.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 11/10/2009] [Accepted: 12/15/2009] [Indexed: 10/19/2022]
Abstract
Glatiramer acetate (GA) is a random copolymer used as an immunomodulatory treatment in relapsing-remitting multiple sclerosis (RR-MS). Its mechanisms of action are poorly understood, and several hypotheses have been put forward, the majority of which rely on in vitro studies. It has been hypothesised that further to processing by APC, GA could provide a large number of different epitopes with a possible sequence similarity to auto-antigens, which are able to stimulate a large proportion of T cells. Given that in a previous study we showed that the circulating T cells of MS patients present more alterations of the Vbeta T cell receptor (TCR) usage than normal individuals, we explored the possible effect of GA on the ex vivo T cell repertoire of MS patients. Here we used quantitative PCR and electrophoresis to longitudinally analyse (and without any ex vivo stimulation), the CDR3 length distribution (LD) and the amount of Vbeta TCR, as well as various cytokines, in the blood T cells of 10 RR-MS patients before and after 3 months and 2 years of GA treatment. In addition, we also determined the status of responder and non-responder patients after 24 months of GA treatment based on clinical and radiological criteria. We found no significant modification of cytokine production, Vbeta TCR mRNA accumulation or CDR3-LD in the patients after short-term and long-term treatment. In addition, we did not observe any difference in CDR3-LD in the GA responder patients (n=6) compared to non-responder patients (n=4). Focusing our study on responder patients, we performed TCR repertoire analysis in the CD4+ and CD8+ compartment. Alterations of CDR3-LD were predominantly found in the CD8+ compartment, without any significant influence of GA treatment. Finally, the T cell repertoire variations in MS patients treated with GA and healthy controls were equivalent. Collectively, our data suggest that GA therapy does not induce significant variations in cytokine production or TCR usage in MS patients.
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Mahevas M, Fain O, Chèze S, Lefrère F, Marjanovic Z, Chauveheid MP, Khellaf M, Limal N, Languille L, Michel M, Bierling P, Godeau B. Le rituximab peut-il guérir le purpura thrombopénique immunologiques ? Résultats de l’évolution à long terme de 29 adultes sélectionnés pour avoir initialement répondu au rituximab avec 1 an de recul. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.027] [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: 10/20/2022]
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Canaud G, Zuber J, Sberro R, Royale V, Anglicheau D, Snanoudj R, Gaha K, Thervet E, Lefrère F, Cavazzana-Calvo M, Noël LH, Méjean A, Legendre C, Martinez F. Intensive and prolonged treatment of focal and segmental glomerulosclerosis recurrence in adult kidney transplant recipients: a pilot study. Am J Transplant 2009; 9:1081-6. [PMID: 19344432 DOI: 10.1111/j.1600-6143.2009.02580.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
No treatment has consistently induced long-term remission of proteinuria in adult patients with focal segmental glomerulosclerosis (FSGS) recurrence after kidney transplantation. We undertook an open-label, nonrandomized pilot trial of intensive and prolonged treatment of FSGS recurrence. Over an 18-month period, 10 adult kidney transplant recipients with FSGS recurrence received concomitantly high-dose steroids, intravenous cyclosporine for 14 days followed by oral cyclosporine therapy, and an intensive and prolonged course of plasma exchanges (PE). We compared this treatment with those of a control group of 19 patients with a FSGS recurrence transplanted between 1997 and 2005. Complete, rapid (mean 23 +/- 7 days) and sustained remission was obtained in 9/10 patients (90%) as opposed to 27% in the control group. At month 3 and month 12, proteinuria was 0.16 g/day (range 0.05-0.3 g/day) and 0.19 g/day (range 0.05-1 g/day) respectively. Only one patient remained in partial remission at month 12 but he had already lost two previous grafts due to FSGS recurrence. PEs were stopped at month 9 in all patients except for the patient with a partial remission who remains PE-dependent. This small pilot study provides very encouraging results demonstrating that this treatment rapidly achieves complete and sustained remission in a high proportion of patients.
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Affiliation(s)
- G Canaud
- Université Paris Descartes, 7 Rue de l'Ecole de Médecine, Paris 75007, France.
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10
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Michel L, Berthelot L, Pettré S, Wiertlewski S, Lefrère F, Braudeau C, Brouard S, Soulillou JP, Laplaud DA. Patients with relapsing-remitting multiple sclerosis have normal Treg function when cells expressing IL-7 receptor alpha-chain are excluded from the analysis. J Clin Invest 2008; 118:3411-9. [PMID: 18769633 DOI: 10.1172/jci35365] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Accepted: 07/16/2008] [Indexed: 12/25/2022] Open
Abstract
Multiple sclerosis (MS) is a chronic inflammatory disease that results in demyelination in the central nervous system, and a defect in the regulatory function of CD4+CD25high T cells has been implicated in the pathogenesis of the disease. Here, we reanalyzed the function of this T cell subset in patients with MS, but we depleted cells expressing IL-7 receptor alpha-chain (CD127), a marker recently described as present on activated T cells but not Tregs. Similar to other studies, we observed a marked defect in the suppressive function of unseparated CD4+CD25high T cells isolated from MS patients. However, when CD127(high) cells were removed from the CD4+CD25high population, patient and control cells inhibited T cell proliferation and cytokine production equally. Likewise, when the CD25 gate used to sort the cells was stringent enough to eliminate CD127high cells, CD4+CD25high T cells from patients with MS and healthy individuals had similar regulatory function. Additional analysis indicated that the CD127high cells within the CD4+CD25high T cell population from patients with MS appeared more proliferative and secreted more IFN-gamma and IL-2 than the same cells from healthy individuals. Taken together, we conclude that CD4+CD25highCD127low Tregs from MS patients and healthy individuals exhibit similar suppressive functions. The decreased inhibitory function of unfractioned CD4+CD25high cells previously observed might be due to abnormal activation of CD127high T cells in patients with MS.
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Affiliation(s)
- Laure Michel
- INSERM U643, CHU Nantes, Institut de Transplantation et de Recherche en Transplantation (ITERT), and Faculté de Médecine, Université de Nantes, Nantes, France
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Berthelot L, Laplaud DA, Pettré S, Ballet C, Michel L, Hillion S, Braudeau C, Connan F, Lefrère F, Wiertlewski S, Guillet JG, Brouard S, Choppin J, Soulillou JP. Blood CD8+ T cell responses against myelin determinants in multiple sclerosis and healthy individuals. Eur J Immunol 2008; 38:1889-99. [PMID: 18506883 DOI: 10.1002/eji.200838023] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patients with multiple sclerosis (MS) display significant peripheral blood CD8(+) T cell receptor biases, suggesting clonal selection. Our objective was to identify relevant myelin-derived peptides capable of eliciting responses of fresh blood CD8+ T cells in MS patients. We focused our analysis on the HLA supertypes (HLA-A3, -A2, -B7, -B27, -B44) predominant in a patient cohort. Three myelin protein (MBP, PLP and MOG) sequences were screened for HLA binding motifs and peptides were tested for their binding to HLA molecules. The cellular responses of 27 MS patients and 19 age- and sex-matched healthy controls (HC) were tested in IFN-gamma ELISPOT assays only detecting pre-committed CD8+ T cells. Sixty-nine new epitopes elicited positive responses, with MOG-derived peptides being the most immunogenic and peptides binding to HLA-A3 being the most frequent. However, MS patients and HC displayed the same frequency of autoreactive cells. The epitopes inducing the strongest responses were not those with the highest HLA binding, suggesting an effective thymic selection in MS patients. Our data extend the concept that the frequency of myelin-reactive T cells in MS patient blood is not increased compared to HC. The description of this set of myelin-derived peptides (MHC class I restricted, recognized by CD8+ T cells) offers new tools to explore the CD8+ cell role in MS.
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Guilpain P, Montani D, Damaj G, Achouh L, Lefrère F, Le Pavec J, Marfaing-Koka A, Dartevelle P, Simonneau G, Humbert M, Hermine O. Pulmonary hypertension associated with myeloproliferative disorders: a retrospective study of ten cases. Respiration 2007; 76:295-302. [PMID: 18160817 DOI: 10.1159/000112822] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 10/16/2007] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a severe hemodynamic disorder in which the pulmonary artery pressure is persistently elevated, leading to right-sided heart failure. Some studies have suggested an association between PH and myeloproliferative diseases (MPD). OBJECTIVES This study describes clinical, hematological and hemodynamic characteristics of PH associated with MPD. METHODS We retrospectively reviewed 10 cases of PH associated with MPD: polycythemia vera (8 patients) and essential thrombocythemia (2 patients), followed between 1993 and 2002. The baseline evaluation was established by right-sided heart catheterization, ventilation/perfusion lung scan and pulmonary angiography if required. RESULTS Six patients had confirmed chronic thromboembolic pulmonary hypertension (CTEPH) and 4 had pulmonary arterial hypertension (PAH) associated with MPD without other risk factors for PAH. The hemodynamic characteristics of CTEPH and PAH associated with MPD were similar. The diagnosis of CTEPH was concomitant to that of MPD in all cases (5 polycythemia vera and 1 essential thrombocythemia). The PAH associated with MPD occurred later in the evolution of the MPD (3 polycythemia vera and 1 essential thrombocythemia) with a median of 162 months after the diagnosis of MPD, and it was associated with myeloid metaplasia (p < 0.01). CONCLUSION We describe 2 distinct forms of PH in the context of MPD: CTEPH, which is diagnosed at an early stage of the MPD, and PAH, which occurs later in the course of the MPD and is associated with myeloid metaplasia. Progressively increasing dyspnea in a patient with an MPD warrants further investigation to rule out PAH and CTEPH, while a diagnosis of CTEPH warrants ruling out MPD.
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Affiliation(s)
- P Guilpain
- Department of Clinical Hematology, Hôpital Necker-Enfants-Malades, Assistance Publique - Hôpitaux de Paris, Université Paris-V, Paris, France
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13
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Laplaud DA, Lefrère F, Leray E, Barrière P, Wiertlewski S. Augmentation du risque de poussée de sclérose en plaques après stimulation ovarienne pour fécondation in vitro. ACTA ACUST UNITED AC 2007; 35:1047-50. [DOI: 10.1016/j.gyobfe.2007.07.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2007] [Accepted: 07/06/2007] [Indexed: 10/22/2022]
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14
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Jehn U, Suciu S, Thomas X, Lefrère F, Muus P, Berneman Z, Marie JP, Adamo F, Fillet G, Nobile F, Ricciuti F, Leone G, Rizzoli V, Montanaro M, Beeldens F, Fazi P, Mandelli F, Willemze R, de Witte T, Amadori S. Non-infusional vs intravenous consolidation chemotherapy in elderly patients with acute myeloid leukemia: final results of the EORTC-GIMEMA AML-13 randomized phase III trial. Leukemia 2006; 20:1723-30. [PMID: 16932345 DOI: 10.1038/sj.leu.2404356] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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] [Indexed: 12/29/2022]
Abstract
In this trial, acute myeloid leukemia patients (pts) aged 61-80 years received MICE (mitoxantrone, etoposide and cytarabine) induction chemotherapy in combination with different schedules of granulocyte colony-stimulating factor administration. Pts in complete remission were subsequently randomized for two cycles of consolidation therapy: mini-ICE regimen (idarubicin, etoposide and cytarabine) given according to either an intravenous (i.v.) or a 'non-infusional' schedule. Among the 346 pts randomized for the second step, 331 pts received consolidation-1 and 182 consolidation-2. A total of 290 events (255 relapses, 35 deaths in first CR) have been reported. The median follow-up was 4.4 years. No significant differences were detected in terms of disease-free survival (median 9 vs 10.4 months, P=0.15, hazard ratio (HR) =1.18, 95% confidence interval (CI) 0.94-1.49) - primary end point - and survival (median 15.7 vs 17.8 months, P=0.19, HR=1.17, 95% CI 0.92-1.50). In the 'non-infusional' arm grade 3-4 vomiting (10 vs 2%; P=0.001) and diarrhea (10 vs 4%; P=0.03) were higher than in the 'i.v.' arm, whereas time to platelet recovery >20 x 10(9)/l (median: 19 vs 23 days; P=0.02) and duration of hospitalization (mean: 15 vs 27 days; P<0.0001) was shorter. The 'non-infusional' consolidation regimen resulted in an antileukemic effect similar to the intravenous regimen, which was less myelosuppressive and associated with less hospitalization days.
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Affiliation(s)
- U Jehn
- Department of Hematology, Klinikum Grosshadern, Ludwig-Maximilians University, Munich, Germany
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15
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Lefrère F, Zohar S, Ghez D, Delarue R, Audat F, Suarez F, Hermine O, Damaj G, Maillard N, Ribeil JA, Azagury M, Misbahi R, Jondeau K, Cavazzana-Calvo M, Dal Cortivo L, Varet B. The VAD chemotherapy regimen plus a G-CSF dose of 10 μg/kg is as effective and less toxic than high-dose cyclophosphamide plus a G-CSF dose of 5 μg/kg for progenitor cell mobilization: results from a monocentric study of 82 patients. Bone Marrow Transplant 2006; 37:725-9. [PMID: 16518433 DOI: 10.1038/sj.bmt.1705308] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A study was conducted to compare the efficiency and toxicity of two peripheral blood stem cell (PBSC) mobilization procedures for newly diagnosed patients with multiple myeloma. Patients from group 1 (n=51) were treated by high-dose cyclophosphamide (HD-CY) plus G-CSF (5 microg/kg/day), and the second group (n=31) by VAD regimen plus G-CSF administration (10 microg/kg/day). Successful mobilization, defined by a minimal count of 2.5 x 10(6) CD34(+) cells/kg collected, was achieved in 96 and 90% of patients in groups 1 and 2, respectively (P=0.15). The mean peripheral blood CD34(+) cells concentration and the mean CD34(+) cells/kg collected were higher in group 2 than in the group 1 (P=0.05). The mean number of leukaphereses necessary to collect a count of 2.5 x 10(6) CD34(+) cells/kg was reduced in group 2 compared to group 1. Adverse events, blood products consumption and time spent in the hospital were significantly greater after HD-CY. In conclusion, VAD plus a G-CSF dose of 10 microg/kg administration seems preferential to HD-CY plus a G-CSF dose of 5 microg/kg for PBSC collection because of equivalent or better efficiency in stem cell mobilization, strong favorable toxicity profile and reduced cost.
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Affiliation(s)
- F Lefrère
- Service de Biothérapies, Hôpital Necker, AP-HP, Paris, France.
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16
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Lefrère F, Lévy V, François S, Delarue R, Ifrah N, Tilly H, Valensi F, Troussard X, Varet B, Hermine O. Fludarabine therapy in patients with splenic lymphoma with villous lymphocytes: an update. Leukemia 2004; 18:1924-5. [PMID: 15385943 DOI: 10.1038/sj.leu.2403440] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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17
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18
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Damaj G, Verkarre V, Delmer A, Solal-Celigny P, Yakoub-Agha I, Cellier C, Maurschhauser F, Bouabdallah R, Leblond V, Lefrère F, Bouscary D, Audouin J, Coiffier B, Varet B, Molina T, Brousse N, Hermine O. Primary follicular lymphoma of the gastrointestinal tract: a study of 25 cases and a literature review. Ann Oncol 2003; 14:623-9. [PMID: 12649111 DOI: 10.1093/annonc/mdg168] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To describe better the clinical, biological, endoscopic and pathological presentations, as well as the outcome, of primary follicular lymphoma (FL) of the gastrointestinal (GI) tract. PATIENTS AND METHODS From November 1983 to February 2001, 25 eligible patients with primary FL of the GI tract were retrieved from several French Departments of Pathology departments based on histological diagnosis and immunophenotype. Median age was 56 years (range 44-71) with a sex ratio female/male of 2 (17/8). RESULTS Abdominal pain was the main presenting symptom followed by intestinal obstruction. The small intestine was the most common site of involvement. Lesions were unifocal in the majority of patients (15/25). A pattern similar to lymphomatous polyposis was observed in 50% (7/14) of patients. Twelve patients had stage I, 10 patients stage II and three patients stage IV disease, and there was minimal extra intestinal involvement. Lymphoma tissues were composed of neoplastic follicles, most of which were grade 1 according to the World Health Organization (WHO) classification. The immunophenotype of the lymphoma cells was CD20+, CD10+, bcl2+ and CD5-. In tissue samples, IgH/bcl2 rearrangement at the MBR locus was present in 11 of 14 patients tested. Seven patients did not receive any treatment; four of them progressed after a median follow-up of 37.5 months. Treatment was otherwise heterogeneous, and complete remission was obtained in 15 patients which lasted for a median of 31 months. Relapses were either in the GI tract (n = 3) or outside the GI tract (n = 3). After a median follow-up of 34 months (range 5-203), 22 patients were still alive (complete remission, 11; partial remission, three; stable disease, six; progressive disease, two). CONCLUSIONS Primary FL of the GI tract is a predominantly female lymphoma that most frequently involves the small intestine. Since the endoscopic and clinical presentation may not be different from lymphomatous polyposis, which is often associated with mantle cell origin of tumor cells, it is mandatory to perform an immunohistological and, if possible, a molecular analysis of GI lymphoma. The course of the disease is indolent and does not differ from nodal FL. Thus, therapy may not be required unless significant clinical symptoms are present or until disease progression.
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Affiliation(s)
- G Damaj
- Hôpital Necker Enfants-Malades, Paris, France.
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19
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Damaj G, Lefrère F, Canioni D, Rubio MT, Radford-Weiss I, Valensi F, Varet B, Hermine O. Remission of transformed myelodysplastic syndrome with fibrosis after danazol therapy. Eur J Haematol 2002; 68:233-5. [PMID: 12071939 DOI: 10.1034/j.1600-0609.2002.01669.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Danazol has been used with success in some hematological diseases, but there is no report of this treatment in acute leukemia. We report here a case of remission of myelodysplastic syndrome with myelofibrosis in transformation after danazol therapy in a 72-yr-old man. The role of danazol in remission induction is briefly discussed.
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Affiliation(s)
- G Damaj
- Department of Clinical Hematology, Hôpital Necker Enfants-Malades, Paris, France.
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20
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Lefrère F, Delmer A, Suzan F, Levy V, Belanger C, Djabarri M, Arnulf B, Damaj G, Maillard N, Ribrag V, Janvier M, Sebban C, Casasnovas RO, Bouabdallah R, Dreyfus F, Verkarre V, Delabesse E, Valensi F, McIntyre E, Brousse N, Varet B, Hermine O. Sequential chemotherapy by CHOP and DHAP regimens followed by high-dose therapy with stem cell transplantation induces a high rate of complete response and improves event-free survival in mantle cell lymphoma: a prospective study. Leukemia 2002; 16:587-93. [PMID: 11960337 DOI: 10.1038/sj.leu.2402406] [Citation(s) in RCA: 118] [Impact Index Per Article: 5.4] [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: 02/27/2001] [Accepted: 11/16/2001] [Indexed: 11/09/2022]
Abstract
Mantle cell lymphoma (MCL) is a distinct clinico-pathological entity with a poor prognosis. We have conducted a prospective study in patients with MCL to evaluate a therapeutic strategy in which CHOP polychemotherapy was followed by DHAP if CHOP failed to induce complete remission. Responding patients then proceeded to an intensification therapy with autologous peripheral blood stem cell transplantation (APBSCT). Twenty-eight consecutive patients with newly diagnosed aggressive MCL were included. After four cycles of CHOP regimen, two complete responses (CR) were obtained (7%) and 14 (50%), five (18%) and seven (25%) patients achieved partial (PR), minor (MR) and no response, respectively (one patient died from septic complications during CHOP induction). The two patients in CR after CHOP underwent intensification with TBI, high-dose cyclophosphamide-etoposide and APBSCT. The other twenty-five patients received DHAP and in this group a response rate of 92% (21 CR (84%), two PR (8%)) was observed. Two patients had progressive disease. The twenty-three responding patients received high-dose therapy (TAM8 regimen: TBI-cytarabine-melphalan) followed by APBSCT. One of the two partial responding patients achieved CR after TAM8. After a median follow-up of 47.6 months (range, 14-70), seven patients have relapsed. Our data confirm that: (1) CHOP regimen induces a low CR rate in MCL; (2) CHOP plus DHAP appears to be much more efficient and allows a large proportion of patients to proceed to high-dose therapy in CR; (3) consolidation therapy including TBI and high-dose Arac-C followed by APBSCT may improve event-free survival.
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Affiliation(s)
- F Lefrère
- Service d'Hématologie Adultes, Hôpital Necker, Paris, France
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21
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Damaj G, Delabesse E, Le Bihan C, Asnafi V, Rachid M, Lefrère F, Radford-Weiss I, Macintyre E, Hermine O, Varet B. Typical essential thrombocythaemia does not express bcr-abelson fusion transcript. Br J Haematol 2002; 116:812-6. [PMID: 11886385 DOI: 10.1046/j.0007-1048.2002.03343.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Essential thrombocythaemia (ET) is a chronic myeloproliferative disorder (MPD) characterized by an elevated platelet count and no identifiable underlying primary cause. According to the diagnostic criteria of the Polycythemia Vera Study Group (PVSG), ET lacks features diagnostic for other MPDs, including the Philadelphia chromosome (Ph) or bcr-abl rearrangement. Recently, some authors have reported bcr-abl transcript positivity in ET patients, but these findings remain controversial. The aim of this study was to investigate whether the bcr-abl transcript could be found in ET patients and to verify the hypothesis of a new ET variant. ET patients (n = 121) with a median age at diagnosis of 55 years were enrolled. The bcr-abl transcript status was examined by multiplex reverse transcription-polymerase chain reaction. Only two cases were positive for bcr-abl, one of which had the Ph at diagnosis. The positive bcr-abl transcript was associated, in both cases, with mild basophilia at diagnosis. After a median follow-up of 43 months (0-309 months), two patients in the bcr-abl-negative group developed Ph and bcr-abl-negative acute myeloid leukaemia (AML). In contrast, one of the two patients in the bcr-abl-positive group died from AML 13 years after diagnosis. In conclusion, our data on a large group of patients shows the rarity of the bcr-abl transcript in well-established ET. However, a subset of patients with apparent ET and basophilia may express the transcript and may constitute a novel entity intermediate between chronic myeloid leukaemia (CML) and typical ET. A prospective study is warranted in order to define better the clinical and biological characteristics of bcr-abl-expressing ET.
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Affiliation(s)
- G Damaj
- Service d'Hématologie, Service d'Hématologie Biologique, Département de Biostatistique et d'Informatique Médicale, and Laboratoire de Cytogénétique, Hôpital Necker Enfants-Malades, Paris, France.
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22
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Bernard M, Gressin R, Lefrère F, Drénou B, Branger B, Caulet-Maugendre S, Tass P, Brousse N, Valensi F, Milpied N, Voilat L, Sadoun A, Ghandour C, Hunault M, Leloup R, Mannone L, Hermine O, Lamy T. Blastic variant of mantle cell lymphoma: a rare but highly aggressive subtype. Leukemia 2001; 15:1785-91. [PMID: 11681422 DOI: 10.1038/sj.leu.2402272] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The blastic variant (BV) form of mantle cell lymphoma (MCL) is considered to be a very aggressive subtype of non-Hodgkin's lymphoma (NHL). In order to determine its clinico-biological features and response to therapy we studied 33 patients (17%) out of 187 suffering from MCL who were diagnosed with a BV of MCL. Blastic variant was diagnosed according to histopathological patterns, immunophenotyping, and bcl1 gene rearrangement and/or cyclin D1 overexpression. Three patients initially diagnosed with large cell NHL were classified as BV. Patients received front-line therapy including CHOP-like regimen or CVP (n = 29), or chlorambucil (n = 4) and CHOP or ESAP as second-line therapy. High-dose intensification with stem cell transplantation (SCT) was performed in 11 cases (autoSCT, n = 8; alloSCT, n = 3). All but two patients were in complete remission (CR) at the time of transplant (CR1, n = 5; CR2, n = 4). Clinical and biological characteristics did not differ from those of the common form of MCL. The median age was 62 years (29-80), with a sex ratio (M/F) of 2.6:1. Of the 33 patients, 66% had extranodal site involvement, 85% had an Ann Arbor stage IV, and 82% had peripheral lymphadenopathy. Circulating lymphomatous cells were seen in 48% of cases. Twelve patients (36%) entered a CR1 with a median duration of 11 months. Fifteen patients (46%) failed to respond and rapidly died of progressive disease. Second-line therapy led to a 26% (6/23) CR2 rate. Nine patients relapsed after high-dose therapy. Twenty-two of the 33 patients (66%) died of refractory or progressive disease. Median overall survival (OS) time was 14.5 months for the 33 BV patients as compared to 53 months for the 154 patients with a common form of MCL, P <0.0001. In the univariate analysis, OS was influenced by age, extranodal site involvement, circulating lymphomatous cells, and international prognosis index (IPI). In the multivariate analysis, only IPI affected OS: patients with IPI > or =2 had 8 months median OS as compared to 36 months median OS for patients with IPI <2, P = 0.003. Blastic variant is one of the worst forms of NHL. An improved recognition of BV of MCL is required, particularly in high-grade CD5+ NHL using immunophenotyping and bcl1 molecular study. Standard therapy using anthracycline or even high-dose intensification produce poor results and an alternative treatment should be proposed to such patients.
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23
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Lefrère F. [Autoimmune thrombocytopenias]. Rev Prat 2001; 51:1558-63. [PMID: 11757272] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Primary immune thrombocytopenic purpura is a hematological disorder for which appropriate diagnosis and treatment strategies are uncertain. Usually, it has a benign course associated to anti-platelet antibodies. Diagnosis is established from an acquired peripheral thrombocytopenia after ruling out drug or viral casualties. A larger auto-immune disease such as systemic lupus erythematous must be also excluded. Below 20 x 10(9) platelets/L however therapy is required but the choice between glucocorticoid and/or intravenous immunoglobulins (IVIg) remains controversial. IVIg allow a faster response than glucocorticoids but are more expensive. From 20 to 50 x 10(9) platelets/L, the choice between specific therapy and abstention is also matter of controversy. Above 50 x 10(9) platelets/L, no therapy is provided. For children, PTIP is often spontaneously resolutive. In contrast, adults often present a chronic course; if platelet count is less than 50 x 10(9)/L, splenectomy is warranted.
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Affiliation(s)
- F Lefrère
- Service d'hématologie adultes Hôpital Necker 75743 Paris.
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24
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Challine D, Roudot-Thoraval F, Sarah T, Laperche L, Boisson B, Mauberquez S, Dubernet F, Rigot P, Lefrère F, Mercier B, Brossard Y, Rouet F, Girot R, Loiseau P, Girard D, Claquin J, Loty B, Lerable J, Mariotti M, Pawlotsky JM, Lefrère JJ. Seroprevalence of human herpes virus 8 antibody in populations at high or low risk of transfusion, graft, or sexual transmission of viruses. Transfusion 2001; 41:1120-5. [PMID: 11552068 DOI: 10.1046/j.1537-2995.2001.41091120.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The routes of transmission of human herpes virus 8 (HHV-8) remain unclear. In particular, HHV-8 transmission by blood components and organ transplantation is still debated and raises public health issues. The objective of this study was to determine the prevalence of anti-HHV-8 in selected populations of persons or patients with or without risk factors for the transmission of viral infections, in order to determine the routes of HHV-8 transmission. STUDY DESIGN AND METHODS A total of 1431 persons or patients at low or high risk of sexually, blood-, or graft-transmitted viral infections were tested by means of a standardized immunofluorescence serologic assay detecting anti-HHV-8. RESULTS The persons or patients could be classified into three distinct groups according to anti-HHV-8 prevalence: a low prevalence group (0.0% to 5.0%), including healthy blood donors, healthy pregnant women, multiply transfused patients with thalassemia major, and IV drug users; an intermediate prevalence group (5.0% to 20.0%), including organ donors, kidney transplant recipients, and multiply transfused patients with sickle cell disease; a high prevalence group (>20.0%), including HIV-negative persons at high risk of sexually-transmitted viral infections, and HIV-infected homosexual men and heterosexuals. CONCLUSION The sexual route appears to be the main route of HHV-8 transmission; bloodborne transmission of HHV-8, if it exists, is rare. In contrast, organ transplantation recipients might be exposed to HHV-8 transmission by the transplanted organ, which raises the issue of systematic screening of organ donors.
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Affiliation(s)
- D Challine
- Bacteriology and Virology Laboratory, Henri Mondor Hospital, Paris XII University, Créteil, France
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25
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Lefrère F, Hermine O, François S, Panelatti G, Valensi F, Grosbois B, Misset JL, Varet B, Troussard X. Lack of efficacy of 2-chlorodeoxyadenoside in the treatment of splenic lymphoma with villous lymphocytes. Leuk Lymphoma 2000; 40:113-7. [PMID: 11426611 DOI: 10.3109/10428190009054887] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Splenic lymphoma with villous lymphocytes (SLVL) is a B-cell chronic lymphoproliferative disorder. Splenectomy and/or chlorambucil (CLB) are usually regarded as the most effective treatment in SLVL patients. However, a few patients relapse and the second line therapy remains questionable. Although 2-Cda has been evaluated in patients with chronic lymphoid leukemia (CLL) and hairy cell leukemia (HCL), it has been reported as the treatment of SLVL in only one case report. Therefore, we have evaluated its efficacy and toxicity in 7 SLVL patients. The median duration between diagnosis and treatment was 18 months (range, 1 to 59). The patients received 2-CdA (0.1 mg/kg/d) by venous infusion for 7 days with a median number of 1 cycle (range, 1 to 2) either as a first line therapy (one patient) or after a failure of other therapies (splenectomy, chemotherapy). Two patients achieved a complete response. The first one maintained his CR during a follow-up of 9 months and then relapsed; the second patient remained in CR after a follow-up of 20 months. Four patients achieved a partial response and relapsed after a median follow-up of 3.5 months (range, 1 to 4). One patient had no response. The treatment was not well tolerated with many infectious events. In the limits of our study, 2-Cda does not appear to be efficient therapy for SLVL and is not well tolerated for patients in relapse after splenectomy or resistant to CLB.
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Affiliation(s)
- F Lefrère
- Service d'Hématologie Adultes, Hĵpital Necker, Paris, France
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26
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Lefrère F, Hermine O, Belanger C, François S, Tilly H, Lebas de La Cour JC, Valensi F, Varet B, Troussard X. Fludarabine: an effective treatment in patients with splenic lymphoma with villous lymphocytes. Leukemia 2000; 14:573-5. [PMID: 10764141 DOI: 10.1038/sj.leu.2401710] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Splenic lymphoma with villous lymphocytes (SLVL) is a B cell chronic lymphoproliferative disorder. Splenectomy and/or chlorambucil are usually regarded as the most effective treatment in SLVL patients. However, a few patients relapse and the second-line treatment remains questionable. In a retrospective study, we evaluated the efficacy and toxicity of fludarabine (FDR) in 10 SLVL patients. The median duration between diagnosis and treatment was 17 months (range, 1-30). Two patients were previously untreated. The patients received FDR 25 mg/m2/day by venous infusion for 5 days with a median of four cycles of chemotherapy (range, 2-6). All patients were assessable: five patients achieved a good and persistent response after a median follow-up of 14 months (5-31), two achieved a good response but relapsed after a follow-up of 15 and 36 months. One out of the three partial responders have a persistent response. The treatment was well tolerated. FDR appears to be an efficient therapy with a favorable toxicity profile for patients in relapse after splenectomy or resistant to CLB. Furthermore it could constitute an alternative to splenectomy in older patients. A longer follow-up and the study of a larger group of patients are warranted to confirm our findings.
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Affiliation(s)
- F Lefrère
- Service d'Hématologie Adultes, Hôpital Necker, Paris, France
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Lefrère JJ, Roudot-Thoraval F, Lefrère F, Kanfer A, Mariotti M, Lerable J, Thauvin M, Lefèvre G, Rouger P, Girot R. Natural history of the TT virus infection through follow-up of TTV DNA-positive multiple-transfused patients. Blood 2000; 95:347-51. [PMID: 10607723] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Little is known about the natural history and the pathogenicity of the TT virus (TTV). We present our findings of a cross-sectional study based on the TTV DNA screening of 173 multiple-transfused patients and a longitudinal study based on the follow-up of TTV DNA-positive patients. Overall, 48 patients (27.7%) tested positive for TTV DNA. The influence of the number of blood donor exposures on the prevalence of blood-borne viral infection indicates that TTV, hepatitis C virus (HCV), and an RNA virus known as GB virus C/hepatitis G virus (GBV-C/HGV) share a parenteral transmission, but that TTV, in contrast to the 2 other viruses, is also transmitted by at least another efficient means. The patients having a well-defined date of TTV infection were positive for TTV DNA during a mean period of 3.1 years. A chronic infection was observed in 31 cases (86%). TTV carriage appeared clinically benign in all patients. No clinical evidence of a disease potentially linked to the TTV infection was observed in patients with TTV DNA carriage over several years. The majority of TTV carriers had no biochemical evidence of liver disease. The prevalence of elevated serum alanine aminotransferase (ALT) level was higher in the TTV DNA-positive group, even in the absence of HCV infection, but the observed peaks of ALT level were most often transient and very mild. The prevalence of TTV DNA observed in blood recipients is consistent with that of TTV infection observed in blood donors. TTV infection frequently tends to persist. (Blood. 2000;95:347-351)
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Affiliation(s)
- J J Lefrère
- Institut National de la Transfusion Sanguine, and Faculté Saint-Antoine, Université Pierre et Marie Curie 75012 Paris, France.
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Lefrère F, Belanger C, Audat F, Hermine O, Cavazzana-Calvo M, Arnulf B, Buzyn A, Varet B. The dose of granulocyte-colony-stimulating factor after chemopriming treatment does not influence apheresis yield of progenitor cells: a retrospective study of 91 cases. Transfusion 1999; 39:1207-11. [PMID: 10604247 DOI: 10.1046/j.1537-2995.1999.39111207.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The optimal dose of post-chemotherapy granulocyte-colony-stimulating factor (G-CSF) administration before peripheral blood progenitor cell (PBPC) collection has not been determined as yet, although 5 microg per kg per day has been recommended as the standard dose. This study retrospectively analyzed the effect of G-CSF dose on peripheral blood CD34+ cell collection from 91 patients with hematologic malignancies. STUDY DESIGN AND METHODS Various doses of G-CSF were administered after several chemotherapeutic PBPC mobilization regimens. According to the dose of G-CSF administered, patients were assigned to two groups. Group 1 included 46 patients who received a low dose of G-CSF (median, 3.6 [range, 2.8-4.6] microg/kg/day). Group 2 included 45 patients who received a standard G-CSF dose of 6.0 (5.5-8. 1) microg per kg per day. Patients in the two groups were matched for age, diagnosis, previous therapy, and chemotherapeutic PBPC mobilization regimens. RESULTS No difference was observed in the median number of CD34+ cells harvested from each group. The number of leukapheresis procedures necessary to obtain a minimum of 3 x 10(6) CD34+ cells per kg was the same in both groups, and the percentage of patients who failed to achieve adequate PBPC collections was similar in the two groups. CONCLUSION The administration of low-dose G-CSF after chemotherapy appears equivalent to administration of the standard dose in achieving satisfactory PBPC collection. This approach could allow significant savings in medical cost. A randomized and prospective study is necessary, however, to assess the validity of these conclusions.
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Affiliation(s)
- F Lefrère
- Department of Adult Hematology and the Blood Bank Center, Necker Hospital, Paris, France.
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29
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Lefrère F, Bernard M, Audat F, Cavazzana-Calvo M, Belanger C, Hermine O, Arnulf B, Buzyn A, Varet B. Comparison of lenograstim vs filgrastim administration following chemotherapy for peripheral blood stem cell (PBSC) collection: a retrospective study of 126 patients. Leuk Lymphoma 1999; 35:501-5. [PMID: 10609787 DOI: 10.1080/10428199909169614] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Mobilization techniques for peripheral blood stem cell (PBSC) collection include the administration of chemotherapy followed by hematopoietic growth factors or growth factors alone. Two forms of recombinant human granulocyte colony-stimulating factor (rhG-CSF) are available for PBSC mobilization: lenograstim and filgrastim which are the glycosylated and non-glycosylated forms respectively. In order to determine the influence of the two forms of G-CSF following chemotherapy on PBSC collection, we conducted a retrospective study in 126 patients with various hematological malignancies: 65 and 61 for the lenograstim and filgrastim groups respectively. No significant differences between the two groups were observed in terms of sex, age and diagnosis. Prior therapies and PBSC mobilization regimen were also equivalent. No significant difference was observed between the groups for the median CD34+ cells harvested. The number of leukapheresis necessary to obtain a minimal number of 3 x 10(6) CD34+ cells/kg was equivalent for the two groups. The proportion of patients affected by a failure in PBSC collection was similar in the two groups. Our data suggest that lenograstim and filgrastim are equivalent for PBSC mobilization after chemotherapy.
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Affiliation(s)
- F Lefrère
- Department of Hematology, Necker Hospital, Paris, France
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Bouabdallah R, Lefrère F, Rose C, Chaïbi P, Harousseau JL, Vernant JP, Castaigne S, Bauduer F, Zini JM, Coso D, Varet B, Robert J, Fenaux P. A phase II trial of induction and consolidation therapy of acute myeloid leukemia with weekly oral idarubicin alone in poor risk elderly patients. Leukemia 1999; 13:1491-6. [PMID: 10516747 DOI: 10.1038/sj.leu.2401522] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We have conducted a phase II outpatient trial testing weekly oral administration of idarubicin (ZAVEDOS-ZVD) alone to determine the rate of objective response and toxicity in poor risk acute myeloid leukemia (AML) patients over 60 years of age. The treatment consisted of three phases: induction, with 20 mg/m2 of ZVD on days 1, 8, 15 and 22; consolidation with 20 mg/m2 of ZVD for 4 weeks; and maintenance with six cycles lasting 3 months and consisting of oral 6 mercapto-purine 2 mg/kg/day, 4 days a week for 2 months; subcutaneous cytarabine 1 mg/kg, once a week for 2 months; and oral ZVD 20 mg/m2 on day 1 and day 8 of the third month. In case of failure after induction course, patients received salvage treatment with 4 weekly oral doses of 40 mg/m2 ZVD. Fifty-one patients with a median age of 76 years were enrolled and could receive induction course. Of these 51 patients, 37 could receive subsequent courses, which consisted either of consolidation, or salvage. Only 11 patients underwent maintenance treatment. Sixty-three percent of patients had to be hospitalized during induction, for a median duration of 14.5 days, and 87% required hospitalization during salvage for a median duration of 17.5 days. Only five patients (38%) required hospitalization during consolidation. There were three toxic deaths (6%), two from hemorrhage and one from pulmonary embolism. The overall response rate was 29%, with 12 patients in complete response (25%) and two in partial response (4%). The median overall survival rate is 4 months for the whole population, and the median DFS is 9.6 months among the 14 responding patients. The results of this trial show that this new weekly schedule of oral ZVD chemotherapy is feasible and effective in poor risk elderly patients with AML. This regimen may be helpful for patients unable to tolerate intensive intravenous regimens, and is a real alternative to palliative treatments.
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Affiliation(s)
- R Bouabdallah
- Department of Hematology of Institut J Paoli-I Calmettes-Université de la Méditerranée, Marseille, France
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31
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Lefrère F, Audat F, Hermine O, Cavazzana-Calvo M, Belanger C, Arnulf B, Buzyn A, Varet B. The timing of granulocyte-colony-stimulating factor administration after chemotherapy does not affect stem and progenitor cell apheresis yield: a retrospective study of 65 cases. Transfusion 1999; 39:561-4. [PMID: 10378834 DOI: 10.1046/j.1537-2995.1999.39060561.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The optimal time for postchemotherapy granulocyte-colony stimulating factor (G-CSF) administration before peripheral blood stem and progenitor cell (PBPC) collection is not well defined. The impact of G-CSF scheduling on the number of CD34+ cells collected by leukapheresis from 65 patients with malignant disease was studied retrospectively. STUDY DESIGN AND METHODS Chemotherapy was performed on Days 1 and 2 and was followed by G-CSF to mobilize PBPCs. In Group 1, 30 patients received the first dose of G-CSF immediately after the end of chemotherapy, as commonly recommended. In Group 2, 35 patients received the first G-CSF dose after the end of chemotherapy (Days 7 or 8). RESULTS No difference was observed between the two groups in white cell recovery and the median number of CD34+ cells harvested. The number of leukapheresis procedures necessary to obtain the minimal number of 3 x 10(6) CD34+ cells per kg was the same. The proportion of patients with a failure of PBPC collection was similar, and G-CSF consumption was reduced in Group 2 without increasing infectious risks. CONCLUSION Early administration of G-CSF after chemotherapy appears not to be a prerequisite for satisfactory PBPC collection. This approach could allow significant savings in terms of medical cost. A randomized and prospective study would be necessary, however, to assess the validity of these conclusions.
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Affiliation(s)
- F Lefrère
- Department of Hematology and the Blood Center, Necker Hospital, Paris, France.
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32
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Godeau B, Chevret S, Lefrère F, Bassompière F, Zini J, Chastang C, Varet B, Bierling P. Traitement du purpura thrombopénique auto-immun sévère de l’adulte: résultats d’une étude multicentrique prospective comparant les immunoglobulines intraveineuses et les bolus de méthylprednisolone suivis ou non d’une corticothérapie orale comme traitement de première ligne. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(00)87624-9] [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: 11/28/2022]
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Lefrère F, Hermine O, Audat F, Buzyn A, Cavazzana-Calvo M, Boccaccio C, Varet B. The feasibility of peripheral blood stem cell collection for autograft following failure in bone marrow aspiration. Hematol Cell Ther 1998; 40:133-7. [PMID: 9698222] [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] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
High doses of cytotoxic drugs may impair stem cell collection. Failure in stem cell collection by bone marrow aspiration can be rescued by harvesting Peripheral Blood Stem Cell (PBSC) after a combination of chemotherapy and hematopoietic growth factor. We, therefore, retrospectively evaluated the possibility of collecting PBSC after chemotherapy and/or G-CSF administration in 12 patients with insufficient Granulocyte-macrophage colony-forming unit (CFU-GM) counts after bone marrow aspiration (all patients had previously received heavy chemotherapy for hematologic malignancies); median collection of CFU-GM/kg count was 2,9 x 10(4)/kg (range 0,4 to 8 x 10(4)/kg) whereas the minimal count required for autografting is 10 x 10(4)/kg. Median collections of CFU-GM from PBSC were 5,8 x 10(4)/kg. While the CFU-GM collected in PBSC was higher than after bone marrow aspiration, only 5 patients had enough PBSC for autografting. In another case, addition of cells collected from both PBSC and bone marrow aspiration yielded a sufficient number of CFU-GM to allow autografting. Therefore in this selected and small group of patients, failure in bone marrow aspiration does not seem to be predictive of a low PBSC collection but a long therapy free interval and use of G-CSF alone for PBSC mobilization could constitute a valuable alternative. Three patients had a successful short term hematologic reconstitution out of the four patients having had an autograft.
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Affiliation(s)
- F Lefrère
- Department of Haematology, Necker Hospital, Paris, France
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34
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Lefrère F, Audat F, Bourquelot P, Hermine O, Buzyn A, Cavazzana-Calvo M, Varet B. P3-15 Faisabilité et risques de la collection de cellules souches périphériques parmi les patients atteints d'amylose AL. Transfus Clin Biol 1998. [DOI: 10.1016/s1246-7820(98)80055-4] [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: 12/01/2022]
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35
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Lefrère F, Audat F, Arnulf B, Buzyn A, Cavazzana-Calvo M, Boccaccio C, Varet B. P3-16 Reconstitution hématologique après autogreffe de cellules souches périphériques selon la quantité de CFU-GM mesurée après décongélation. Transfus Clin Biol 1998. [DOI: 10.1016/s1246-7820(98)80056-6] [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: 11/26/2022]
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36
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Morand-Joubert L, Vittecoq D, Roudot-Thoraval F, Mariotti M, Lefrère F, Heshmati F, Audat F, Lambin P, Barré-Sinoussi F, Lefrère JJ. Virological and immunological data of AIDS patients treated by passive immunotherapy (transfusions of plasma rich in HIV-1 antibodies). Vox Sang 1997; 73:149-54. [PMID: 9358616 DOI: 10.1046/j.1423-0410.1997.7330149.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES In human immunodeficiency virus (HIV) infections, passive immunotherapy can be carried out through infusions of virus-inactivated plasma from symptomless HIV-infected persons with abundant HIV antibodies. MATERIALS AND METHODS We carried out a prospective, randomized, double-blind, controlled, passive immunotherapy study, which compared two groups. One received plasma rich in HIV antibodies, the other a standard seronegative plasma. RESULTS Measurement of the plasma HIV RNA load showed in both groups a significant decrease in the mean viral copy number at the end of the first month, followed by an increase at the third month. Beyond the third months, a significant decrease in viral load was observed only in the treatment group. A significant difference in favor of the treatment group was observed for plasma viremia by HIV culture. For the cytokines involved in the viral replication and for the immune activation markers such as neopterin and beta 2-microglobulin, the biological analysis in plasma failed to show a significant difference in either group. Clinically, the treatment group benefited by delay in the appearance of the first AIDS-defining event and reduction in the cumulative incidence of such events. CONCLUSION One possible interpretation is that passive immunotherapy affects plasma viral load, but there is no evidence that HIV-specific antibodies are exclusively responsible for the observed effects.
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37
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Lefrère JJ, Guiramand S, Lefrère F, Mariotti M, Aumont P, Lerable J, Petit JC, Girot R, Morand-Joubert L. Full or partial seroreversion in patients infected by hepatitis C virus. J Infect Dis 1997; 175:316-22. [PMID: 9203652 DOI: 10.1093/infdis/175.2.316] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Cases of partial seroreversion have been reported in hemodialyzed or immunodepressed patients, but spontaneous clearance of viremia associated with a disappearance of specific antibodies or clearance while receiving therapy has not been precisely documented in immunocompetent hepatitis C virus (HCV)-infected persons. A longitudinal study of markers of HCV infection in a cohort of 178 multitransfused patients followed over an 8-year period was done to establish well-documented cases of partial or full seroreversion. Thirty (16.8%) of 178 patients were HCV-infected; among them, 5 had partial or full seroreversion. Seroreversion to an anti-HCV-negative state is characterized by a quantitative decrease in antibody. A seroreversion may be observed in three circumstances: spontaneously, induced by therapy, and in conjunction with human immunodeficiency virus infection. Long-term follow-up of seroreverters will establish whether they have definitively eradicated HCV from their systems.
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Affiliation(s)
- J J Lefrère
- Institut National de la Transfusion Sanguine, Hôpital Saint-Antoine, Paris, France
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Mouly S, Hermine O, Lefrère F, Cramer E, Varet B. Maladie du pool vide et myélofibrose idiopathique chez une femme de 73 ans: une association rare. Rev Med Interne 1997. [DOI: 10.1016/s0248-8663(97)80634-0] [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: 10/18/2022]
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Hardy-Baylé MC, Sarfati Y, Olivier V, Besche C, Lefrère F, Passerieux C. [Intentional awareness and schizophrenia]. Encephale 1996; 22 Spec No 3:104-7. [PMID: 9036001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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40
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Lefrère F, Besson C, Datry A, Chaibi P, Leblond V, Binet JL, Sutton L. Transmission of Plasmodium falciparum by allogeneic bone marrow transplantation. Bone Marrow Transplant 1996; 18:473-4. [PMID: 8864468] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe a case of Plasmodium falciparum infection in a Comorian patient undergoing BMT. The patient's last visit to an endemic area was 1 year prior to BMT. The donor left the Comoro Islands 2 months before marrow harvesting. They had both had previous episodes of malaria and were seropositive for Plasmodium falciparum. At the time of BMT, blood smears were negative in both the donor and recipient. On day 12 post-BMT the patient was asymptomatic but a blood smear revealed 12.5% parasitemia. We consider that donors and recipients at risk pre-BMT should routinely be given specific treatment before marrow harvesting and conditioning, independent of the appearance of blood smears.
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Affiliation(s)
- F Lefrère
- Departement d'Hématologie, Hôpital Pitié-Salpétrière, Paris, France
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Chevret S, Kirstetter M, Mariotti M, Lefrère F, Frottier J, Lefrère JJ. Provirus copy number to predict disease progression in asymptomatic human immunodeficiency virus type 1 infection. J Infect Dis 1994; 169:882-5. [PMID: 7907643 DOI: 10.1093/infdis/169.4.882] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
To evaluate the prognostic value of provirus copy number through quantitative DNA polymerase chain reaction (PCR) in early stages of human immunodeficiency virus type 1 (HIV-1) infection, 42 untreated and asymptomatic HIV-1-seropositive subjects with baseline CD4+ cell counts > 200 x 10(6)/L were included in a prospective study and followed over a median of 27 months. Disease progression was defined as decrease in CD4+ cells to < 200 (14 events). At enrollment, provirus copy number was associated with CD4+ cell count and percentage, serum IgA, and p24 antigenemia. Elevated provirus copy number above 20 allowed identification of patients at high risk of a subsequently decreasing CD4+ cell count, even after adjusting for baseline CD4+ cell count (P = .003). Measuring provirus copy number by PCR at early stages of HIV-1 infection could offer a useful early means to predict progression to AIDS.
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Affiliation(s)
- S Chevret
- Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, Paris, France
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42
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Mariotti M, Wattel E, Lefrère F, Demange F, Lefrère JJ. Polymerase chain reaction procedure for rapid diagnosis of HIV infection. AIDS 1993; 7:1680-1. [PMID: 8286083 DOI: 10.1097/00002030-199312000-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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43
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de Montalembert M, Wattel E, Lefrère F, Mariotti M, Agis F, Ferrer-le-Coeur F, Girot R, Lefrère JJ. Human T-cell lymphotropic virus type I and II DNA amplification in seropositive and seronegative at-risk individuals. Transfusion 1993; 33:106-10. [PMID: 8430447 DOI: 10.1046/j.1537-2995.1993.33293158040.x] [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] [Indexed: 01/30/2023]
Abstract
To determine the presence or the absence of human T-lymphotropic virus type I and/or II (HTLV-I/II) DNA in at-risk individuals who were persistently negative for specific serologic assays, polymerase chain reaction with two primer pairs in common and conserved regions of HTLV-I and -II genomes was used. Seronegative individuals at risk for HTLV-I/II infection (15 heterosexual partners of seropositive individuals, 17 breastfed children born to HTLV-I-infected mothers, 47 multiply transfused patients, 22 intravenous drug users) were studied (n = 101); 35 seropositive individuals and 25 seronegative low-risk individuals were used as positive and negative controls, respectively. No positive polymerase chain reaction was observed in the seronegative at-risk individuals or in the negative controls. Positive controls gave positive results with at least one primer pair in all cases except one. A latent HTLV-I/II infection with a persistently negative serologic test for HTLV-I/II seems unlikely.
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Affiliation(s)
- M de Montalembert
- Molecular Biology Laboratory, National Institute of Blood Transfusion, Hospital Saint-Antoine, Paris, France
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44
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Lefrère JJ, Mariotti M, Wattel E, Lefrère F, Inchauspe G, Costagliola D, Prince A. Towards a new predictor of AIDS progression through the quantitation of HIV-1 DNA copies by PCR in HIV-infected individuals. Br J Haematol 1992; 82:467-71. [PMID: 1419830 DOI: 10.1111/j.1365-2141.1992.tb06446.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The proviral copy (PVC) number in peripheral blood mononuclear cells (PBMCs) of human immunodeficiency virus (HIV)-infected individuals was measured by a quantitative polymerase chain reaction (PCR) assay to determine over time the relation between the viral load and the evolution towards the disease in HIV-infected people: 67 anti-HIV-1 positive individuals (60 stage II/III, 7 stage IV) were studied. The mean PVC number per 1.5 x 10(5) PBMCs in stage II/III individuals (14.4 +/- 14.2) and in stage IV individuals (32.2 +/- 22.9) was significantly different (P < 0.02). PVC number was inversely correlated to the CD4 lymphocyte count (P < 0.01). In the logistic regression, the PVC number was a better marker of evolution towards the disease than the CD4 lymphocyte count. The mean proportion of HIV-infected PBMCs in stage IV individuals and in stage II/III individuals was 1/4606 and 1/10714, respectively.
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Affiliation(s)
- J J Lefrère
- Institut National de Transfusion Sanguine, Paris, France
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45
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Lefrère F, Wattel E, Mariotti M, Agis F, Gordien E, Lefrère JJ. Absence of human T cell lymphotrophic virus (HTLV) type I and II DNA in French anti-HTLV-I/II-negative intravenous drug users. J Infect Dis 1992; 166:212-3. [PMID: 1607702 DOI: 10.1093/infdis/166.1.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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