1
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Alcazer V, Morisset S, Rea D, Legros L, Dulucq S, Hayette S, Cayuela JM, Huguet F, Mahon FX, Etienne G, Nicolini FE. Kinetics of molecular recurrence after tyrosine kinase inhibitor cessation in chronic phase chronic myelogenous leukaemia patients. Br J Haematol 2024; 204:1536-1539. [PMID: 38323384 DOI: 10.1111/bjh.19330] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 02/08/2024]
Affiliation(s)
- Vincent Alcazer
- Department of Haematology, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- French Group of CML, Centre Léon Bérard, Lyon, France
| | - Stéphane Morisset
- Department of Haematology, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Delphine Rea
- French Group of CML, Centre Léon Bérard, Lyon, France
- Department of Haematology, Hôpital Saint Louis, Paris, France
| | - Laurence Legros
- French Group of CML, Centre Léon Bérard, Lyon, France
- Department of Haematology, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Stéphanie Dulucq
- French Group of CML, Centre Léon Bérard, Lyon, France
- Laboratory of Haematology, CHU de Bordeaux, Pessac, France
| | - Sandrine Hayette
- French Group of CML, Centre Léon Bérard, Lyon, France
- Laboratory of Haematology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Jean-Michel Cayuela
- French Group of CML, Centre Léon Bérard, Lyon, France
- Laboratory of Haematology, Hôpital Saint Louis, Paris, France
| | - Françoise Huguet
- French Group of CML, Centre Léon Bérard, Lyon, France
- Department of Haematology, Institut Universitaire du Cancer de Toulouse, CHU de Toulouse, France
| | - François-Xavier Mahon
- French Group of CML, Centre Léon Bérard, Lyon, France
- Department of Haematology, Institut Bergonié, Bordeaux, France
| | - Gabriel Etienne
- French Group of CML, Centre Léon Bérard, Lyon, France
- Department of Haematology, Institut Bergonié, Bordeaux, France
| | - Franck E Nicolini
- Department of Haematology, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- French Group of CML, Centre Léon Bérard, Lyon, France
- Department of Clinical Haematology and INSERM U1052, CRCL, Centre Leon Bérard, Lyon, France
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2
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Pfirrmann M, Saussele S, Mahon FX, Richter J. How to interpret the EURO-SKI study and its treatment-free remission outcome. Reply to R.P. Gale and J. Chen. Leukemia 2024; 38:460-462. [PMID: 38172328 PMCID: PMC10844067 DOI: 10.1038/s41375-023-02124-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Medizinische Fakultät, Ludwig-Maximilians Universität München, Munich, Germany.
| | - Susanne Saussele
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - François-Xavier Mahon
- Bergonié Cancer Institute, INSERM UMR1312 Inserm, University of Bordeaux, Bordeaux, France
| | - Johan Richter
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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3
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Shah NP, García-Gutiérrez V, Jiménez-Velasco A, Larson SM, Saussele S, Rea D, Mahon FX, Levy MY, Gómez-Casares MT, Mauro MJ, Sy O, Martin-Regueira P, Lipton JH. Treatment-free remission after dasatinib in patients with chronic myeloid leukaemia in chronic phase with deep molecular response: Final 5-year analysis of DASFREE. Br J Haematol 2023; 202:942-952. [PMID: 37246588 PMCID: PMC10524617 DOI: 10.1111/bjh.18883] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 05/30/2023]
Abstract
Patients with chronic myeloid leukaemia in chronic phase (CML-CP) who have a sustained deep molecular response (DMR) are eligible to discontinue treatment and attempt treatment-free remission (TFR). In the DASFREE study (ClinicalTrials.gov; NCT01850004), the 2-year TFR rate after dasatinib discontinuation was 46%; here we present the 5-year update. Patients with a stable DMR after ≥2 years of dasatinib therapy discontinued treatment and were followed for 5 years. At a minimum follow-up of 60 months, in 84 patients discontinuing dasatinib, the 5-year TFR rate was 44% (n = 37). No relapses occurred after month 39 and all evaluable patients who relapsed and restarted dasatinib (n = 46) regained a major molecular response in a median of 1.9 months. The most common adverse event during the off-treatment period was arthralgia (18%, 15/84); a total of 15 withdrawal events were reported in nine patients (11%). At the 5-year final follow-up, almost half of the patients who discontinued dasatinib after a sustained DMR maintained TFR. All evaluable patients who experienced a relapse quickly regained a DMR after restarting dasatinib, demonstrating that dasatinib discontinuation is a viable and potentially long-term option in patients with CML-CP. The safety profile is consistent with the previous report.
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Affiliation(s)
- Neil P. Shah
- UCSF School of Medicine, San Francisco, California, USA
| | - Valentín García-Gutiérrez
- Servicio Hematología y Hemoterapia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Antonio Jiménez-Velasco
- Servicio de Hematología y Hemoterapia, Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Sarah M. Larson
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Susanne Saussele
- Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Delphine Rea
- Adult Hematology Department, Hôpital Saint-Louis, Paris, France
| | | | | | | | | | - Oumar Sy
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | | | - Jeffrey H. Lipton
- Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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4
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Dulucq S, Rigal-Huguet F, Nicolini FE, Cony-Makhoul P, Escoffre-Barbe M, Gardembas M, Legros L, Rousselot P, Liu J, Rea D, De Mas V, Hayette S, Raynaud S, Lacoste-Roussillon C, Robbesyn F, Klein E, Morisset S, Mahon FX, Etienne G. Efficacy and safety of nilotinib in chronic myeloid leukaemia patients who failed to achieve a treatment-free remission period after imatinib discontinuation: Results of the French Nilo post-STIM study. Br J Haematol 2023. [PMID: 37004981 DOI: 10.1111/bjh.18796] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
Molecular recurrence (MRec) occurs in about half of all patients with chronic myeloid leukaemia (CML) who discontinue tyrosine kinase inhibitors (TKI) in sustained deep molecular response. A second TKI discontinuation has been attempted in some patients who regain the discontinuation criteria after resuming treatment. Nilotinib treatment affords faster and deeper molecular responses than imatinib as first-line therapy. We prospectively evaluated the efficacy and safety of nilotinib (300 mg twice daily) in chronic-phase CML patients who experienced MRec, after imatinib discontinuation and analysed the probability of TFR after a new attempt in patients treated for 2 years with sustained MR4.5 for at least 1 year. A total of 31 patients were included in the study between 2013 and 2018. Seven (23%) patients experienced serious adverse events after a median of 2 months of nilotinib treatment leading to discontinuation of treatment. One patient was excluded from the study for convenience. Among the 23 patients treated for 2 years with nilotinib, 22 maintained their molecular response for at least 1 year (median: 22 months) and stopped nilotinib. The TFR rates at 24 and 48 months after nilotinib discontinuation were 59.1% (95% confidence interval [CI]: 41.7%-83.7%) and 42.1% (95% CI: 25%-71%) respectively (NCT #01774630).
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Affiliation(s)
- Stéphanie Dulucq
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac, France
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Françoise Rigal-Huguet
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Institut Universitaire du Cancer, CHU de Toulouse, Toulouse, France
| | - Franck E Nicolini
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- INSERM U590, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon, France
- Hematology Department, Centre Léon Bérard, Lyon, France
| | - Pascale Cony-Makhoul
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy, France
| | - Martine Escoffre-Barbe
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, CHU de Pontchaillou, Rennes, France
| | - Martine Gardembas
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, CHU, Angers, France
| | - Laurence Legros
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Philippe Rousselot
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Jixing Liu
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology & Oncology Department, Centre Hospitalier de Valence, Valence, France
| | - Delphine Rea
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Adult Hematology Department, Hôpital Saint Louis, Paris, France
| | - Véronique De Mas
- Laboratory of Hematology, Institut Universitaire du Cancer, CHU de Toulouse, Toulouse, France
| | - Sandrine Hayette
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Laboratory of Hematology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | - Sophie Raynaud
- Laboratory of Hematology, University Hospital of Nice, Nice, France
| | - Caroline Lacoste-Roussillon
- Clinical Research and Innovation Department, Safety and Vigilance Unit, Bordeaux University Hospital, Bordeaux, France
| | - Fanny Robbesyn
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac, France
| | - Emilie Klein
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac, France
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
| | - Stéphane Morisset
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- INSERM U590, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon, France
| | - François-Xavier Mahon
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Institut Bergonié, Bordeaux, France
- Hematology Department, CHU Bordeaux, Pessac, France
| | - Gabriel Etienne
- Groupe Fi-LMC, Centre Léon Bérard, Lyon, France
- Hematology Department, Institut Bergonié, Bordeaux, France
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5
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Bessede A, Marabelle A, Guegan JP, Peyraud F, Danlos FX, Cousin S, Chaput N, Spalato M, Roubaud G, Cabart M, Khettab M, Chaibi A, Rey C, Nafia I, Mahon FX, Soria JC, Italiano A. Impact of acetaminophen on the efficacy of immunotherapy in patients with cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12000] [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
12000 Background: Pain is the most common symptom experienced by patients with advanced cancer. Acetaminophen (APAP, commonly known as paracetamol) alone or in combination with a weak opioid, such as codeine or tramadol, is usually considered as the first-line strategy to manage mild-to-moderate pain in this setting. Although generally considered to be safe, several evidences suggest that APAP may have negative immunomodulatory effects. Randomized studies have shown that APAP use is associated with blunted vaccine immune responses. Given its potential to impair vaccine effectiveness, the World Health Organization stated in 2015 that administration of APAP before or at the time of vaccination is not recommended. This study aimed to assess APAP impact on efficacy of immunotherapy in patients with cancer. Methods: Exposure to APAP was assessed by plasma analysis and was correlated with clinical outcome in three independent cohorts of patients with advanced cancer who were treated with immune checkpoint blockers (ICB): the CheckMate 025 trial, n = 297 (NCT01668784, sponsor: Bristol Myers Squibb), the institutional biomarker program BIP n = 34 (NCT02534649, sponsor: Institut Bergonié, Bordeaux, France) and the institutional biomarker program PREMIS n = 297 (NCT03984318, sponsor: Gustave Roussy, Villejuif, France). APAP immunomodulatory effects were evaluated on a pre-clinical tumor model (MC38) and on human peripheral blood mononuclear cells (PBMCs) from healthy donors. Results: Detectable plasma APAP levels at treatment onset was associated with a significantly worse clinical outcome in ICB-treated cancer patients (HR for progression-free survival : 1.43, 95% CI 1.07–1.91, p = 0.015; HR for overall survival: 1.78 95% CI 1.18–2.68, p = 0.006), independently of other prognostic factors (age, performance status, number of previous lines of treatment, tumor type, number of metastatic sites, presence of liver metastases, LDH levels). APAP significantly reduced ICB efficacy in the pre-clinical MC38 model, as well as the production of PD1 blockade-related interferon-γ secretion by human PBMCs. Moreover, reduction of ICB efficacy in vivo was associated with significantly increased tumor infiltration by regulatory T cells (Tregs). Administration of APAP over 24 h induced a significant expansion of peripheral Tregs in healthy individuals. In addition, interleukin-10, a crucial mediator of Treg-induced immune suppression, was significantly upregulated upon treatment with ICB in cancer patients taking APAP. Conclusions: This study provides strong pre-clinical and clinical evidence of the role of APAP as a potential suppressor of antitumor immunity. Hence, APAP should be used with caution in patients treated with ICB.
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Affiliation(s)
| | | | | | | | | | | | - Nathalie Chaput
- Laboratory of Immunomonitoring in Oncology, Gustave Roussy, Villejuif, France
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Bessede A, Marabelle A, Guégan JP, Danlos FX, Cousin S, Peyraud F, Chaput N, Spalato M, Roubaud G, Cabart M, Khettab M, Chaibi A, Rey C, Nafia I, Mahon FX, Soria JC, Italiano A. Impact of acetaminophen on the efficacy of immunotherapy in cancer patients. Ann Oncol 2022; 33:909-915. [PMID: 35654248 DOI: 10.1016/j.annonc.2022.05.010] [Citation(s) in RCA: 4] [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] [Received: 03/31/2022] [Revised: 05/09/2022] [Accepted: 05/24/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Acetaminophen (APAP) use has been associated with blunted vaccine immune responses. This study aimed to assess APAP impact on immunotherapy efficacy in patients with cancer. PATIENTS AND METHODS Exposure to APAP was assessed by plasma analysis and was correlated with clinical outcome in three independent cohorts of patients with advanced cancer who were treated with immune checkpoint blockers (ICB). APAP immunomodulatory effects were evaluated on a pre-clinical tumor model and on human peripheral blood mononuclear cells (PBMCs) from healthy donors. RESULTS Detectable plasma APAP levels at treatment onset was associated with a significantly worse clinical outcome in ICB-treated cancer patients, independently of other prognostic factors. APAP significantly reduced ICB efficacy in the pre-clinical MC38 model, as well as the production of PD1 blockade-related interferon-γ secretion by human PBMCs. Moreover, reduction of ICB efficacy in vivo was associated with significantly increased tumor infiltration by regulatory T cells (Tregs). Administration of APAP over 24 h induced a significant expansion of peripheral Tregs in healthy individuals. In addition, interleukin-10, a crucial mediator of Treg-induced immune suppression, was significantly upregulated upon treatment with ICB in cancer patients taking APAP. CONCLUSION This study provides strong pre-clinical and clinical evidence of the role of APAP as a potential suppressor of antitumor immunity. Hence, APAP should be used with caution in patients treated with ICB.
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Affiliation(s)
- A Bessede
- Explicyte, 229 cours de l'Argonne, Bordeaux, France
| | - A Marabelle
- Département d'Innovation Précoce et d'Essais Thérapeutiques (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France
| | - J P Guégan
- Explicyte, 229 cours de l'Argonne, Bordeaux, France
| | - F X Danlos
- Département d'Innovation Précoce et d'Essais Thérapeutiques (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France
| | - S Cousin
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - F Peyraud
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - N Chaput
- Laboratory of Immunomonitoring in Oncology, Gustave Roussy Cancer Campus, CNRS-UMS 3655 and INSERM-US23, Villejuif, France; Faculty of Pharmacy, University Paris-Saclay, Chatenay-Malabry, France; Laboratory of Genetic Instability and Oncogenesis, UMR CNRS 8200, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - M Spalato
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - G Roubaud
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - M Cabart
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - M Khettab
- Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - A Chaibi
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - C Rey
- Department of Medicine, Institut Bergonié, Bordeaux, France
| | - I Nafia
- Explicyte, 229 cours de l'Argonne, Bordeaux, France
| | - F X Mahon
- Department of Medicine, Institut Bergonié, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - J C Soria
- Department of Medicine, Gustave Roussy, Villejuif, France
| | - A Italiano
- Département d'Innovation Précoce et d'Essais Thérapeutiques (DITEP), INSERM U1015 & CIC1428, Université Paris Saclay, Gustave Roussy, Villejuif, France; Department of Medicine, Institut Bergonié, Bordeaux, France; Faculty of Medicine, University of Bordeaux, Bordeaux, France.
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7
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Dulucq S, Nicolini FE, Rea D, Cony-Makhoul P, Charbonnier A, Escoffre-Barbe M, Coiteux V, Lenain P, Rigal-Huguet F, Liu J, Guerci-Bresler A, Legros L, Ianotto JC, Gardembas M, Turlure P, Dubruille V, Rousselot P, Martiniuc J, Jardel H, Johnson-Ansah H, Joly B, Henni T, Cayssials E, Zunic P, Berger MG, Villemagne B, Robbesyn F, Morisset S, Mahon FX, Etienne G. Kinetics of early and late molecular recurrences after first-line imatinib cessation in chronic myeloid leukemia: updated results from the STIM2 trial. Haematologica 2022; 107:2859-2869. [PMID: 35615931 PMCID: PMC9713567 DOI: 10.3324/haematol.2022.280811] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/08/2022] [Indexed: 12/14/2022] Open
Abstract
Discontinuation of tyrosine kinase inhibitors in chronic phase chronic myeloid leukemia is feasible in clinical practice based on recently published international recommendations. Nevertheless, factors predictive of molecular recurrence have not been fully elucidated and long-term follow-up of patients enrolled in clinical studies are required in order to update knowledge on discontinuation attempts particularly in terms of the safety and durability of treatment-free remission (TFR). In the current study, we updated results from the STIM2 study in the light of the consensual criterion of molecular recurrence reported in different international recommendations. Among the 199 patients included in the perprotocol study, 108 patients lost a major molecular response. With a median follow-up of 40.8 months (5.5-111 months), the probability of treatment-free remission was 43.4% [36.3-50.4] at 5 years, 40.9% [32.8-47.3] at 7 years and 34.5% [25.6- 43.3] at 9 years. Molecular recurrence occurred between 0 to 6 months, 6 to 24 months and after 24 months in 75 patients (69%), 15 patients (14%) and 18 patients (17%), respectively. Notably, the kinetics of molecular recurrence differed significantly between these three subgroups with a median time from loss of MR4 (BCR::ABL1 IS≤0.01%) to loss of major molecular response of 1, 7 and 22 months, respectively. Predictive factors of molecular recurrence differed according to the time of occurrence of the molecular recurrence. Durations of imatinib treatment and deep molecular response as well as BCR::ABL1/ABL1 levels at cessation of tyrosine kinase inhibitor treatment, as quantified by reverse transcriptase droplet digital polymerase chain reaction, are involved in molecular recurrence occurring up to 24 months but not beyond. (ClinicalTrial. gov Identifier NCT#0134373).
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Affiliation(s)
- Stéphanie Dulucq
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac,Groupe Fi-LMC, Centre Léon Bérard, Lyon,S. Dulucq
| | - Franck E. Nicolini
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,INSERM U1052, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon,Hematology Department, Centre Léon Bérard, Lyon
| | - Delphine Rea
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Adult Hematology Department, Hôpital Saint Louis, Paris
| | - Pascale Cony-Makhoul
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department & Clinical Investigation Center, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy
| | - Aude Charbonnier
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Paoli-Calmettes, Marseilles
| | - Martine Escoffre-Barbe
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU de Pontchaillou, Rennes
| | - Valérie Coiteux
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU Huriez, Lille
| | - Pascal Lenain
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Henri Becquerel, Rouen
| | - Françoise Rigal-Huguet
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Universitaire du Cancer, CHU de Toulouse, Toulouse
| | - Jixing Liu
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology & Oncology Department, Centre Hospitalier de Valence, Valence
| | - Agnès Guerci-Bresler
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHRU Brabois, Nancy
| | - Laurence Legros
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Hôpital Bicêtre, Le Kremlin-Bicêtre
| | | | - Martine Gardembas
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU, Angers
| | - Pascal Turlure
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU Dupuytren, Limoges
| | - Viviane Dubruille
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Hôtel Dieu, Nantes
| | - Philippe Rousselot
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier de Versailles, Le Chesnay
| | - Juliana Martiniuc
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier de Saint Brieuc, Saint Brieuc
| | - Henry Jardel
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier de Bretagne, Vannes
| | - Hyacinthe Johnson-Ansah
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Institute of Normandy, CHU de la Côte de Nacre, Caën
| | - Bertrand Joly
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CH Sud Francilien, Corbeil-Essonne
| | - Tawfiq Henni
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHR La Réunion
| | - Emilie Cayssials
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, CHU de Poitiers, Poitiers
| | - Patricia Zunic
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Centre Hospitalier, Saint Pierre de La Réunion
| | - Marc G. Berger
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology (Biology) Department, CHU Estaing, Clermont-Ferrand
| | - Bruno Villemagne
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Internal Medicine and Onco-hematology Department, La Roche sur Yon and
| | - Fanny Robbesyn
- Laboratory of Hematology, University Hospital of Bordeaux, Hôpital Haut Lévêque, Pessac
| | - Stephane Morisset
- INSERM U1052, Centre de Recherche de Cancérologie de Lyon, Centre Léon Bérard, Lyon
| | - François-Xavier Mahon
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Bergonié, Bordeaux, France,F-XM and GE contributed equally as co-senior authors
| | - Gabriel Etienne
- Groupe Fi-LMC, Centre Léon Bérard, Lyon,Hematology Department, Institut Bergonié, Bordeaux, France,F-XM and GE contributed equally as co-senior authors
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8
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Trinh A, Khamari R, Fovez Q, Mahon FX, Turcq B, Bouscary D, Maboudou P, Joncquel M, Coiteux V, Germain N, Laine W, Dekiouk S, Jean-Pierre S, Maguer-Satta V, Ghesquiere B, Idziorek T, Quesnel B, Kluza J, Marchetti P. Antimetabolic cooperativity with the clinically approved l-asparaginase and tyrosine kinase inhibitors to eradicate CML stem cells. Mol Metab 2021; 55:101410. [PMID: 34863941 PMCID: PMC8732793 DOI: 10.1016/j.molmet.2021.101410] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 11/08/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022] Open
Abstract
Objective Long-term treatment with tyrosine kinase inhibitors (TKI) represents an effective cure for chronic myeloid leukemia (CML) patients and discontinuation of TKI therapy is now proposed to patient with deep molecular responses. However, evidence demonstrating that TKI are unable to fully eradicate dormant leukemic stem cells (LSC) indicate that new therapeutic strategies are needed to control LSC and to prevent relapse. In this study we investigated the metabolic pathways responsible for CML surviving to imatinib exposure and its potential therapeutic utility to improve the efficacy of TKI against stem-like CML cells. Methods Using complementary cell-based techniques, metabolism was characterized in a large panel of BCR-ABL+ cell lines as well as primary CD34+ stem-like cells from CML patients exposed to TKI and L-Asparaginases. Colony forming cell (CFC) assay and flow cytometry were used to identify CML progenitor and stem like-cells. Preclinical models of leukemia dormancy were used to test the effect of treatments. Results Although TKI suppressed glycolysis, compensatory glutamine-dependent mitochondrial oxidation supported ATP synthesis and CML cell survival. Glutamine metabolism was inhibited by L-asparaginases such as Kidrolase or Erwinase without inducing predominant CML cell death. However, clinically relevant concentrations of TKI render CML cells susceptible to Kidrolase. The combination of TKI with Lasparaginase reactivates the intinsic apoptotic pathway leading to efficient CML cell death. Conclusion Targeting glutamine metabolism with the FDA-approved drug, Kidrolase in combination with TKI that suppress glycolysis represents an effective and widely applicable therapeutic strategy for eradicating stem-like CML cells.
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Affiliation(s)
- Anne Trinh
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Raeeka Khamari
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Quentin Fovez
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - François-Xavier Mahon
- Institut Bergonié, Université de Bordeaux, CNRS SNC5010, Inserm, U1218 ACTION, F - 33076, Bordeaux, France
| | - Béatrice Turcq
- Institut Bergonié, Université de Bordeaux, CNRS SNC5010, Inserm, U1218 ACTION, F - 33076, Bordeaux, France
| | - Didier Bouscary
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016, Paris, France; Assistance Publique-Hôpitaux de Paris. Centre-Université de Paris, Service d'Hématologie clinique, Hôpital Cochin, Paris, France
| | | | - Marie Joncquel
- Centre de Bio-Pathologie, Banque de Tissus, CHU Lille, France
| | - Valérie Coiteux
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Nicolas Germain
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - William Laine
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Salim Dekiouk
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Sandrine Jean-Pierre
- Centre de Recherche en Cancérologie de Lyon, Inserm U1052, CNRS UMR5286, Centre Léon Bérard, 69008, Lyon, France
| | | | | | - Thierry Idziorek
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Bruno Quesnel
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000, Lille, France
| | - Jerome Kluza
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000, Lille, France.
| | - Philippe Marchetti
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000, Lille, France; Centre de Bio-Pathologie, Banque de Tissus, CHU Lille, France.
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9
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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.
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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
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10
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Blay JY, Boucher S, Le Vu B, Cropet C, Chabaud S, Perol D, Barranger E, Campone M, Conroy T, Coutant C, De Crevoisier R, Debreuve-Theresette A, Delord JP, Fumoleau P, Gentil J, Gomez F, Guerin O, Jaffré A, Lartigau E, Lemoine C, Mahe MA, Mahon FX, Mathieu-Daude H, Merrouche Y, Penault-Llorca F, Pivot X, Soria JC, Thomas G, Vera P, Vermeulin T, Viens P, Ychou M, Beaupere S. Delayed care for patients with newly diagnosed cancer due to COVID-19 and estimated impact on cancer mortality in France. ESMO Open 2021; 6:100134. [PMID: 33984676 PMCID: PMC8134718 DOI: 10.1016/j.esmoop.2021.100134] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The impact of the first coronavirus disease 2019 (COVID-19) wave on cancer patient management was measured within the nationwide network of the Unicancer comprehensive cancer centers in France. PATIENTS AND METHODS The number of patients diagnosed and treated within 17 of the 18 Unicancer centers was collected in 2020 and compared with that during the same periods between 2016 and 2019. Unicancer centers treat close to 20% of cancer patients in France yearly. The reduction in the number of patients attending the Unicancer centers was analyzed per regions and cancer types. The impact of delayed care on cancer-related deaths was calculated based on different hypotheses. RESULTS A 6.8% decrease in patients managed within Unicancer in the first 7 months of 2020 versus 2019 was observed. This reduction reached 21% during April and May, and was not compensated in June and July, nor later until November 2020. This reduction was observed only for newly diagnosed patients, while the clinical activity for previously diagnosed patients increased by 4% similar to previous years. The reduction was more pronounced in women, in breast and prostate cancers, and for patients without metastasis. Using an estimated hazard ratio of 1.06 per month of delay in diagnosis and treatment of new patients, we calculated that the delays observed in the 5-month period from March to July 2020 may result in an excess mortality due to cancer of 1000-6000 patients in coming years. CONCLUSIONS In this study, the delays in cancer patient management were observed only for newly diagnosed patients, more frequently in women, for breast cancer, prostate cancer, and nonmetastatic cancers. These delays may result is an excess risk of cancer-related deaths in the coming years.
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Affiliation(s)
- J Y Blay
- Centre Leon Berard, Lyon, France.
| | | | | | - C Cropet
- Centre Leon Berard, Lyon, France
| | | | - D Perol
- Centre Leon Berard, Lyon, France
| | | | - M Campone
- Institut de Cancerologie de l'Ouest, Nantes et Angers, France
| | - T Conroy
- Institut de Cancerologie de Lorraine, Nancy, France
| | - C Coutant
- Centre George Francoise Leclerc, Dijon, France
| | | | | | - J P Delord
- Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | | | - J Gentil
- Centre George Francoise Leclerc, Dijon, France
| | - F Gomez
- Centre Leon Berard, Lyon, France
| | - O Guerin
- Institut de Cancerologie de l'Ouest, Nantes et Angers, France
| | | | | | - C Lemoine
- Institut Paoli-Calmettes, Marseille, France
| | - M A Mahe
- Centre François Baclesse, Caen, France
| | | | - H Mathieu-Daude
- Institut de Cancerologie de Montpellier, Montpellier, France
| | | | | | - X Pivot
- Centre Paul Strauss/ICANS, Strasbourg, France
| | | | - G Thomas
- Centre François Baclesse, Caen, France
| | - P Vera
- Centre Henri Becquerel, Rouen, France
| | | | - P Viens
- Institut Paoli-Calmettes, Marseille, France
| | - M Ychou
- Institut de Cancerologie de Montpellier, Montpellier, France
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11
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Etienne G, Faberes C, Bauduer F, Adiko D, Lifermann F, Dagada C, Lenoir C, Schmitt A, Klein E, Fort MP, Bijou F, Turcq B, Robbesyn F, Durrieu F, Versmée L, Madene S, Moldovan M, Katsahian S, Charles-Nelson A, Lascaux A, Mahon FX, Dulucq S. Relevance of treatment-free remission recommendations in chronic phase chronic leukemia patients treated with frontline tyrosine kinase inhibitors. Cancer Med 2021; 10:3635-3645. [PMID: 33988316 PMCID: PMC8178499 DOI: 10.1002/cam4.3921] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tyrosine kinase inhibitors (TKI) can be safely discontinued in chronic phase chronic myeloid leukemia (CP-CML) patients who had achieved a sustained deep molecular response. Based on the results of discontinuation trials, recommendations regarding patient selection for a treatment-free remission (TFR) attempt had been proposed. The aims of this study were to evaluate the rate of patients eligible for TKI discontinuation and molecular recurrence-free survival (MRFS) after stop according to recommendations. METHODS Over a 10-year period, newly diagnosed CP-CML patients and treated with first-line TKI in the nine French participating centers were included. Eligibility to treatment discontinuation and MRFS were analyzed and compared according to selection criteria defined by recommendations and first-line treatments. RESULTS From January 2006 to December 2015, 398 patients were considered. Among them, 73% and 27% of patients received imatinib or either second or third generation tyrosine kinase inhibitors as frontline treatment, respectively. Considering the selection criteria defined by recommendations, up to 55% of the patients were selected as optimal candidates for treatment discontinuation. Overall 95/398 (24%) discontinued treatment. MRFS was 51.8% [95% CI 41.41-62.19] at 2 years and 43.8% [31.45-56.15] at 5 years. Patients receiving frontline second-generation TKI and fulfilling the eligibility criteria suggested by recommendations had the lowest probability of molecular relapse after TKI stop when compare to others. CONCLUSION One third of CP-CML patients treated with TKI frontline fulfilled the selection criteria suggested by European LeukemiaNet TFR recommendations. Meeting selection criteria and second-generation TKI frontline were associated with the highest MRFS.
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Affiliation(s)
- Gabriel Etienne
- Département d'Hématologie, Institut Bergonié, Bordeaux, France.,Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, Bordeaux, France.,Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France
| | - Carole Faberes
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Fréderic Bauduer
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France.,Service d'Hématologie, Centre Hospitalier Côte Basque, Bayonne, France.,Collège des Sciences de la Santé, Université de Bordeaux, Bordeaux, France
| | - Didier Adiko
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France.,Service d'Hématologie, Centre Hospitalier de Libourne, Libourne, France
| | - François Lifermann
- Service de Médecine Interne, Centre Hospitalier de Dax-Côte d'Argent, Dax, France
| | - Corinne Dagada
- Service d'Oncologie-Hématologie, Centre Hospitalier de Pau, Pau, France
| | - Caroline Lenoir
- Service d'Hémato-Oncologie Radiothérapie, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Anna Schmitt
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Emilie Klein
- Laboratoire d'Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | | | - Fontanet Bijou
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Beatrice Turcq
- Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, Bordeaux, France.,Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France.,Centre National de la Recherche Scientifiue, SNC 5010, Bordeaux, France
| | - Fanny Robbesyn
- Laboratoire d'Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | | | - Laura Versmée
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Samia Madene
- Service de Médecine Interne et Hématologie, Centre Hospitalier Intercommunal Mont-de-Marsan - Pays des Sources, Mont de Marsan, France
| | - Marius Moldovan
- Hôpital de jour Hématologie-Oncologie, Centre Hospitalier de Périgueux, Périgueux, France
| | - Sandrine Katsahian
- Unité de Recherche Clinique et Centre Investigation Clinique-Epidémiologie, Hôpitaux Universitaires Paris-Ouest Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,Université Paris 5 Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Equipe 22, Paris, France
| | - Anais Charles-Nelson
- Unité de Recherche Clinique et Centre Investigation Clinique-Epidémiologie, Hôpitaux Universitaires Paris-Ouest Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, Module Epidémiologie Clinique, Paris, France
| | - Axelle Lascaux
- Service Des Maladies du Sang, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - François-Xavier Mahon
- Département d'Hématologie, Institut Bergonié, Bordeaux, France.,Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, Bordeaux, France.,Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France
| | - Stéphanie Dulucq
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, Pessac, France.,Laboratoire d'Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, Pessac, France
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12
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Astrugue C, Bénard A, Bosco-Levy P, Dulucq S, Rouyer M, Lassalle R, Hayes N, Mahon FX. Budget Impact of Tyrosine Kinase Inhibitor Discontinuation in Chronic Myeloid Leukemia With Sustained Deep Molecular Response. Value Health 2021; 24:683-690. [PMID: 33933237 DOI: 10.1016/j.jval.2020.11.010] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Tyrosine kinase inhibitors (TKIs) account for the vast majority of healthcare expenditure on patients with chronic myeloid leukemia (CML), and it has been demonstrated that TKI discontinuation in patients in long-term deep molecular remission (DMR) is safe and improves quality of life. Our objective was to estimate the budget impact of TKI discontinuation in CML patients in long-term DMR from the perspective of the French healthcare system. METHODS This analysis was conducted over a 5-year time horizon using a Markov model with cycles of 6 months. Transition probabilities were estimated through systematic reviews and meta-analyses. Costs were estimated from the French National Claims Database. Monte Carlo simulations were performed to take into account the uncertainty surrounding model parameters. Sensitivity analyses were carried out by varying the size of the target population and the cost of TKIs. RESULTS Over a 5-year period and for a target population of 100 patients each year eligible and agreeing to stop TKI, the TKI discontinuation strategy would save €25.5 million (95% confidence interval -39.3 to 70.0). In this model, the probability that TKI discontinuation would be more expensive than TKI continuation was 12.0%. In sensitivity analyses, mean savings ranged from €14.9 million to €62.9 million. CONCLUSIONS This study provides transparent, reproducible, and interpretable results for healthcare professionals and policy makers. Our results clearly show that innovative healthcare strategies can benefit both the healthcare system and patients. Savings from generalizing TKI discontinuation in CML patients in sustained DMR should yield health gains for other patients.
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Affiliation(s)
- Cyril Astrugue
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team EMOS, Bordeaux, France
| | - Antoine Bénard
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, team EMOS, Bordeaux, France; CHU de Bordeaux, Pôle de santé publique, Service d'information médicale, Bordeaux, France
| | | | | | - Magali Rouyer
- Bordeaux PharmacoEpi, University of Bordeaux, Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, University of Bordeaux, Bordeaux, France
| | - Nathalie Hayes
- CHU de Bordeaux, Direction de la Recherche Clinique et de l'Innovation, Bordeaux, France
| | - François-Xavier Mahon
- CHU de Bordeaux, Laboratoire d'hématologie, Bordeaux, France; Institut Bergonie, Cancer Center Bordeaux, University of Bordeaux, France.
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13
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Etienne G, Dulucq S, Bauduer F, Adiko D, Lifermann F, Dagada C, Lenoir C, Schmitt A, Klein E, Madene S, Fort MP, Bijou F, Moldovan M, Turcq B, Robbesyn F, Durrieu F, Versmée L, Katsahian S, Faberes C, Lascaux A, Mahon FX. Incidences of Deep Molecular Responses and Treatment-Free Remission in de Novo CP-CML Patients. Cancers (Basel) 2020; 12:cancers12092521. [PMID: 32899879 PMCID: PMC7565328 DOI: 10.3390/cancers12092521] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/26/2020] [Accepted: 08/29/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Tyrosine kinase inhibitors (TKI) can be safely discontinued in chronic myeloid leukemia patients. Achieving a sustained deep molecular response (DMR) before stop is recommended. Currently, the proportion of patients who achieve a sustained DMR remains to be determined. Based on the follow-up of 398 patients over a ten-years period, we evaluate that 46% of them have achieved a sustained DMR. Gender, BCR-ABL1 transcript type, and disease risk scores were significantly associated with the probability of achieving a DMR. 95/398 (24%) patients stopped TKI with a probability of maintaining molecular reponse without TKI resumption of 47% at 48 months after stop. In this study, TKI duration before stop and second (nilotinib, dasatinib, bosutinib) generation frontline TKI compared to imatinib were significantly associated with a lower risk of molecular relapse after stop in patients who have achieved a sustained DMR. Abstract Background: Tyrosine Kinase Inhibitors (TKIs) discontinuation in patients who had achieved a deep molecular response (DMR) offer now the opportunity of prolonged treatment-free remission (TFR). Patients and Methods: Aims of this study were to evaluate the proportion of de novo chronic-phase chronic myeloid leukemia (CP-CML) patients who achieved a sustained DMR and to identify predictive factors of DMR and molecular recurrence-free survival (MRFS) after TKI discontinuation. Results: Over a period of 10 years, 398 CP-CML patients treated with first-line TKIs were included. Median age at diagnosis was 61 years, 291 (73%) and 107 (27%) patients were treated with frontline imatinib (IMA) or second- or third-generation TKIs (2–3G TKI), respectively. With a median follow-up of seven years (range, 0.6 to 13.8 years), 182 (46%) patients achieved a sustained DMR at least 24 months. Gender, BCR-ABL1 transcript type, and Sokal and ELTS risk scores were significantly associated with a higher probability of sustained DMR while TKI first-line (IMA vs. 2–3G TKI) was not. We estimate that 28% of CML-CP would have been an optimal candidate for TKI discontinuation according to recent recommendations. Finally, 95 (24%) patients have entered in a TFR program. MRFS rates at 12 and 48 months were 55.1% (95% CI, 44.3% to 65.9%) and 46.9% (95% CI, 34.9% to 58.9%), respectively. In multivariate analyses, first-line 2–3G TKIs compared to IMA and TKI duration were the most significant factors of MRFS. Conclusions: Our results suggest that frontline TKIs have a significant impact on TFR in patients who fulfill the selection criteria for TKI discontinuation.
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Affiliation(s)
- Gabriel Etienne
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
- Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, 33000 Bordeaux, France; (S.D.); (E.K.); (B.T.)
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, 33600 Pessac, France;
- Correspondence: ; Tel.: +33-5633-3300; Fax: +33-547-306-060
| | - Stéphanie Dulucq
- Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, 33000 Bordeaux, France; (S.D.); (E.K.); (B.T.)
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, 33600 Pessac, France;
- Laboratoire d’Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, 33600 Pessac, France;
| | - Fréderic Bauduer
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, 33600 Pessac, France;
- Service d’Hématologie, Centre Hospitalier Côte Basque, 64100 Bayonne, France
- Collège des Sciences de la Santé, Université de Bordeaux, 33000 Bordeaux, France
| | - Didier Adiko
- Service d’Hématologie, Centre Hospitalier de Libourne, 33500 Libourne, France;
| | - François Lifermann
- Service de Médecine Interne, Centre Hospitalier de Dax-Côte d’Argent, 40107 Dax, France;
| | - Corinne Dagada
- Service d’Oncologie-Hématologie, Centre Hospitalier de Pau, 64000 Pau, France;
| | - Caroline Lenoir
- Service d’Hémato-Oncologie Radiothérapie, Polyclinique Bordeaux Nord Aquitaine, 33000 Bordeaux, France;
| | - Anna Schmitt
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
| | - Emilie Klein
- Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, 33000 Bordeaux, France; (S.D.); (E.K.); (B.T.)
- Laboratoire d’Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, 33600 Pessac, France;
| | - Samia Madene
- Service de Médecine Interne et Hématologie, Centre Hospitalier Intercommunal Mont-de-Marsan—Pays des Sources, 40024 Mont de Marsan, France;
| | - Marie-Pierre Fort
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
| | - Fontanet Bijou
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
| | - Marius Moldovan
- Service d’Hématologie-Oncologie, Centre Hospitalier de Périgueux, 24000 Périgueux, France;
| | - Beatrice Turcq
- Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, 33000 Bordeaux, France; (S.D.); (E.K.); (B.T.)
- Centre National de la Recherche Scientifique, SNC 5010, 33000 Bordeaux, France
| | - Fanny Robbesyn
- Laboratoire d’Hématologie, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, 33600 Pessac, France;
| | - Françoise Durrieu
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
| | - Laura Versmée
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
- Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sandrine Katsahian
- Unité de Recherche Clinique et Centre Investigation Clinique-Epidémiologie, Hôpitaux Universitaires Paris-Ouest Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris 5 Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Equipe 22, 75006 Paris, France;
| | - Carole Faberes
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
| | - Axelle Lascaux
- Service des maladies du sang, Hôpital Haut Lévêque Centre Hospitalier Universitaire de Bordeaux, 33600 Pessac, France;
| | - François-Xavier Mahon
- Service d’Hématologie, Institut Bergonié, 33076 Bordeaux, France; (A.S.); (M.-P.F.); (F.B.); (F.D.); (L.V.); (C.F.); (F.-X.M.)
- Institut National de la Santé et de la Recherche Médicale, U1218 ACTION, Université de Bordeaux, 33000 Bordeaux, France; (S.D.); (E.K.); (B.T.)
- Groupe France Intergroupe des Leucémies Myéloïdes Chroniques, Hôpital Haut-Lévêque, 33600 Pessac, France;
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14
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Hochhaus A, Baccarani M, Silver RT, Schiffer C, Apperley JF, Cervantes F, Clark RE, Cortes JE, Deininger MW, Guilhot F, Hjorth-Hansen H, Hughes TP, Janssen JJWM, Kantarjian HM, Kim DW, Larson RA, Lipton JH, Mahon FX, Mayer J, Nicolini F, Niederwieser D, Pane F, Radich JP, Rea D, Richter J, Rosti G, Rousselot P, Saglio G, Saußele S, Soverini S, Steegmann JL, Turkina A, Zaritskey A, Hehlmann R. European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia. Leukemia 2020; 34:966-984. [PMID: 32127639 PMCID: PMC7214240 DOI: 10.1038/s41375-020-0776-2] [Citation(s) in RCA: 706] [Impact Index Per Article: 176.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023]
Abstract
The therapeutic landscape of chronic myeloid leukemia (CML) has profoundly changed over the past 7 years. Most patients with chronic phase (CP) now have a normal life expectancy. Another goal is achieving a stable deep molecular response (DMR) and discontinuing medication for treatment-free remission (TFR). The European LeukemiaNet convened an expert panel to critically evaluate and update the evidence to achieve these goals since its previous recommendations. First-line treatment is a tyrosine kinase inhibitor (TKI; imatinib brand or generic, dasatinib, nilotinib, and bosutinib are available first-line). Generic imatinib is the cost-effective initial treatment in CP. Various contraindications and side-effects of all TKIs should be considered. Patient risk status at diagnosis should be assessed with the new EUTOS long-term survival (ELTS)-score. Monitoring of response should be done by quantitative polymerase chain reaction whenever possible. A change of treatment is recommended when intolerance cannot be ameliorated or when molecular milestones are not reached. Greater than 10% BCR-ABL1 at 3 months indicates treatment failure when confirmed. Allogeneic transplantation continues to be a therapeutic option particularly for advanced phase CML. TKI treatment should be withheld during pregnancy. Treatment discontinuation may be considered in patients with durable DMR with the goal of achieving TFR.
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MESH Headings
- Aniline Compounds/therapeutic use
- Antineoplastic Agents/therapeutic use
- Clinical Decision-Making
- Consensus Development Conferences as Topic
- Dasatinib/therapeutic use
- Disease Management
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Gene Expression
- Humans
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/mortality
- Life Expectancy/trends
- Monitoring, Physiologic
- Nitriles/therapeutic use
- Protein Kinase Inhibitors/therapeutic use
- Pyrimidines/therapeutic use
- Quality of Life
- Quinolines/therapeutic use
- Survival Analysis
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Affiliation(s)
- A Hochhaus
- Klinik für Innere Medizin II, Universitätsklinikum, Jena, Germany.
| | - M Baccarani
- Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - R T Silver
- Weill Cornell Medical College, New York, NY, USA
| | - C Schiffer
- Karmanos Cancer Center, Detroit, MI, USA
| | - J F Apperley
- Hammersmith Hospital, Imperial College, London, UK
| | | | - R E Clark
- Department of Molecular & Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - J E Cortes
- Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - M W Deininger
- Huntsman Cancer Center Salt Lake City, Salt Lake City, UT, USA
| | - F Guilhot
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - H Hjorth-Hansen
- Norwegian University of Science and Technology, Trondheim, Norway
| | - T P Hughes
- South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - J J W M Janssen
- Amsterdam University Medical Center, VUMC, Amsterdam, The Netherlands
| | | | - D W Kim
- St. Mary´s Hematology Hospital, The Catholic University, Seoul, Korea
| | | | | | - F X Mahon
- Institut Bergonie, Université de Bordeaux, Bordeaux, France
| | - J Mayer
- Department of Internal Medicine, Masaryk University Hospital, Brno, Czech Republic
| | | | | | - F Pane
- Department Clinical Medicine and Surgery, University Federico Secondo, Naples, Italy
| | - J P Radich
- Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - D Rea
- Hôpital St. Louis, Paris, France
| | | | - G Rosti
- Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - P Rousselot
- Centre Hospitalier de Versailles, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - G Saglio
- University of Turin, Turin, Italy
| | - S Saußele
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - S Soverini
- Department of Hematology/Oncology, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | | | - A Turkina
- National Research Center for Hematology, Moscow, Russian Federation
| | - A Zaritskey
- Almazov National Research Centre, St. Petersburg, Russian Federation
| | - R Hehlmann
- III. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany.
- ELN Foundation, Weinheim, Germany.
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15
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Dulucq S, Astrugue C, Etienne G, Mahon FX, Benard A. Risk of molecular recurrence after tyrosine kinase inhibitor discontinuation in chronic myeloid leukaemia patients: a systematic review of literature with a meta-analysis of studies over the last ten years. Br J Haematol 2020; 189:452-468. [PMID: 32072631 DOI: 10.1111/bjh.16408] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/25/2019] [Indexed: 12/28/2022]
Abstract
More than 10 years ago, the first pilot observational study of imatinib discontinuation was reported in chronic myeloid leukaemia (CML) patients in deep molecular response (DMR). Several studies have been published since then, in patients treated with frontline imatinib, or second-generation tyrosine kinase inhibitors (TKI) in first or second line but also on second attempt of TKI discontinuation. Our objective was to estimate, through meta-analyses of the literature data, the probability of molecular recurrence (MolRec) in the time periods of 0-6, 6-12, 12-18 and 18-24 months after a first and second TKI discontinuation and the probability of re-acquisition of DMR after MolRec. The Medline and Scopus databases were searched up to April 2019. The studies were selected by three independent reviewers. Random-effect meta-analyses were conducted using the MetaXL software. The probability of MolRec in the time periods 0-6, 6-12, 12-18 and 18-24 months after the first attempt was respectively 35%, 8%, 3% and 3%, whereas the probability of MolRec in the time periods 0-6, 6-12 and 12-18 after the second attempt was 48%, 27% and 12% respectively. Re-acquisition of a DMR was observed in 90% of patients. Most of the MolRec occur during the first six months in case of a first attempt, whereas the second MolRec occurs over a larger window of time.
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Affiliation(s)
- Stéphanie Dulucq
- Laboratory of Hematology, CHU de Bordeaux, Bordeaux, France.,INSERM, U1218, University of Bordeaux, Bordeaux, France
| | - Cyril Astrugue
- Pôle de santé publique, Unité d'Epidémiologie Clinique (USMR) & CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France.,ISPED, INSERM, U1219 - Bordeaux Population Health Research Centre, University of Bordeaux, Bordeaux, France
| | - Gabriel Etienne
- INSERM, U1218, University of Bordeaux, Bordeaux, France.,Institut Bergonié, Bordeaux, France
| | - François-Xavier Mahon
- INSERM, U1218, University of Bordeaux, Bordeaux, France.,Institut Bergonié, Bordeaux, France
| | - Antoine Benard
- Pôle de santé publique, Unité d'Epidémiologie Clinique (USMR) & CIC-EC 14-01, CHU de Bordeaux, Bordeaux, France.,ISPED, INSERM, U1219 - Bordeaux Population Health Research Centre, University of Bordeaux, Bordeaux, France
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16
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Etienne G, Dulucq S, Faberes C, Bijou F, Schmitt A, Klein E, Fort MP, Durrieu F, Toulza E, Mahon FX. A single center evaluation of cost savings related to treatment-free remission in chronic myeloid leukemia patients: the prerequisites of a pharmaco-economy larger study. Br J Haematol 2020; 189:e97-e100. [PMID: 32043283 DOI: 10.1111/bjh.16511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/16/2019] [Accepted: 01/06/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Gabriel Etienne
- Département d'Hématologie, Institut Bergonié, Bordeaux, France.,Laboratory of Mammary and Leukaemic Oncogenesis, INSERM U1218, Université de Bordeaux, Bordeaux, France.,Groupe Fi-LMC, Hôpital Haut-Lévêque, Pessac, France
| | - Stéphanie Dulucq
- Laboratoire d'Hématologie, Hôpital Haut Lévêque CHU de Bordeaux, Pessac, France
| | - Carole Faberes
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Fontanet Bijou
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Anna Schmitt
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Emilie Klein
- Laboratoire d'Hématologie, Hôpital Haut Lévêque CHU de Bordeaux, Pessac, France
| | | | | | - Emilie Toulza
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - François-Xavier Mahon
- Département d'Hématologie, Institut Bergonié, Bordeaux, France.,Laboratory of Mammary and Leukaemic Oncogenesis, INSERM U1218, Université de Bordeaux, Bordeaux, France.,Groupe Fi-LMC, Hôpital Haut-Lévêque, Pessac, France
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17
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Hähnel T, Baldow C, Guilhot J, Guilhot F, Saussele S, Mustjoki S, Jilg S, Jost PJ, Dulucq S, Mahon FX, Roeder I, Fassoni AC, Glauche I. Model-based inference and classification of immunological control mechanisms from TKI cessation and dose reduction in CML patients. Cancer Res 2020; 80:2394-2406. [DOI: 10.1158/0008-5472.can-19-2175] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/18/2019] [Accepted: 02/05/2020] [Indexed: 11/16/2022]
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18
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Shah NP, García-Gutiérrez V, Jiménez-Velasco A, Larson S, Saussele S, Rea D, Mahon FX, Levy MY, Gómez-Casares MT, Pane F, Nicolini FE, Mauro MJ, Sy O, Martin-Regueira P, Lipton JH. Dasatinib discontinuation in patients with chronic-phase chronic myeloid leukemia and stable deep molecular response: the DASFREE study. Leuk Lymphoma 2019; 61:650-659. [PMID: 31647335 DOI: 10.1080/10428194.2019.1675879] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Treatment-free remission (TFR) in patients with chronic myeloid leukemia in chronic phase (CML-CP) is considered a feasible option, especially with the ability of second-generation tyrosine kinase inhibitors to induce higher rates of sustained deep molecular response (DMR). DASFREE is an open-label, single-arm, multicenter phase II trial assessing TFR after dasatinib discontinuation in patients with CML-CP (N = 84). At 2 years, TFR was 46% in all patients. Multivariate analyses revealed statistically significant associations between 2-year TFR and duration of prior dasatinib (≥median; p = .0051), line of therapy (first line; p = .0138), and age (>65 years; p = .0012). No disease transformation occurred, and the most common adverse events experienced off treatment were musculoskeletal (observed in 30 patients); however, dasatinib withdrawal events were reported in nine patients (11%) by the investigator. Overall, these findings support the feasibility of discontinuing dasatinib for patients with CML-CP in sustained DMR in the first line and beyond.
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Affiliation(s)
- Neil P Shah
- Department of Medicine/Hematology-Oncology, UCSF School of Medicine, San Francisco, CA, USA
| | | | | | - Sarah Larson
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Susanne Saussele
- III, Med. Clinic, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim, Germany
| | - Delphine Rea
- Department of Hématologie, Hôpital Saint-Louis, Paris, France
| | - François-Xavier Mahon
- Department of Hématologie, Institut Bergonié, University of Bordeaux, Bordeaux, France
| | | | | | - Fabrizio Pane
- Dipartimento di Medicina clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
| | | | - Michael J Mauro
- Myeloproliferative Neoplasms Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oumar Sy
- Bristol-Myers Squibb, Princeton, NJ, USA
| | | | - Jeffrey H Lipton
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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19
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Shah NP, García-Gutiérrez JV, Jiménez-Velasco A, Larson S, Saussele S, Rea D, Mahon FX, Levy MY, Gómez-Casares MT, Luciano L, Nicolini FE, Mauro MJ, Sy O, Martin-Regueira P, Lipton JH. DASFREE: Treatment-Free Remission (TFR) After Discontinuation of Dasatinib in Patients with Chronic Myeloid Leukemia in Chronic Phase (CML-CP) and Deep Molecular Response (DMR). Clinical Lymphoma Myeloma and Leukemia 2019. [DOI: 10.1016/j.clml.2019.07.253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Lichou F, Orazio S, Dulucq S, Etienne G, Longy M, Hubert C, Groppi A, Monnereau A, Mahon FX, Turcq B. Novel analytical methods to interpret large sequencing data from small sample sizes. Hum Genomics 2019; 13:41. [PMID: 31470908 PMCID: PMC6717342 DOI: 10.1186/s40246-019-0235-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/06/2019] [Accepted: 08/19/2019] [Indexed: 01/12/2023] Open
Abstract
Background Targeted therapies have greatly improved cancer patient prognosis. For instance, chronic myeloid leukemia is now well treated with imatinib, a tyrosine kinase inhibitor. Around 80% of the patients reach complete remission. However, despite its great efficiency, some patients are resistant to the drug. This heterogeneity in the response might be associated with pharmacokinetic parameters, varying between individuals because of genetic variants. To assess this issue, next-generation sequencing of large panels of genes can be performed from patient samples. However, the common problem in pharmacogenetic studies is the availability of samples, often limited. In the end, large sequencing data are obtained from small sample sizes; therefore, classical statistical analyses cannot be applied to identify interesting targets. To overcome this concern, here, we described original and underused statistical methods to analyze large sequencing data from a restricted number of samples. Results To evaluate the relevance of our method, 48 genes involved in pharmacokinetics were sequenced by next-generation sequencing from 24 chronic myeloid leukemia patients, either sensitive or resistant to imatinib treatment. Using a graphical representation, from 708 identified polymorphisms, a reduced list of 115 candidates was obtained. Then, by analyzing each gene and the distribution of variant alleles, several candidates were highlighted such as UGT1A9, PTPN22, and ERCC5. These genes were already associated with the transport, the metabolism, and even the sensitivity to imatinib in previous studies. Conclusions These relevant tests are great alternatives to inferential statistics not applicable to next-generation sequencing experiments performed on small sample sizes. These approaches permit to reduce the number of targets and find good candidates for further treatment sensitivity studies. Electronic supplementary material The online version of this article (10.1186/s40246-019-0235-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Florence Lichou
- Laboratory of Mammary and Leukaemic Oncogenesis, Inserm U1218 ACTION, Bergonié Cancer Institute, University of Bordeaux, 146 rue Léo Saignat, bâtiment TP 4ème étage, case 50, 33076, Bordeaux, France
| | - Sébastien Orazio
- Team EPICENE, Inserm U1219 BPH, Bergonié Cancer Institute, University of Bordeaux, Bordeaux, France
| | - Stéphanie Dulucq
- Laboratory of Mammary and Leukaemic Oncogenesis, Inserm U1218 ACTION, Bergonié Cancer Institute, University of Bordeaux, 146 rue Léo Saignat, bâtiment TP 4ème étage, case 50, 33076, Bordeaux, France
| | - Gabriel Etienne
- Laboratory of Mammary and Leukaemic Oncogenesis, Inserm U1218 ACTION, Bergonié Cancer Institute, University of Bordeaux, 146 rue Léo Saignat, bâtiment TP 4ème étage, case 50, 33076, Bordeaux, France
| | - Michel Longy
- Laboratory of Mammary and Leukaemic Oncogenesis, Inserm U1218 ACTION, Bergonié Cancer Institute, University of Bordeaux, 146 rue Léo Saignat, bâtiment TP 4ème étage, case 50, 33076, Bordeaux, France
| | | | - Alexis Groppi
- The Bordeaux Bioinformatics Center (CBiB), University of Bordeaux, Bordeaux, France
| | - Alain Monnereau
- Team EPICENE, Inserm U1219 BPH, Bergonié Cancer Institute, University of Bordeaux, Bordeaux, France
| | - François-Xavier Mahon
- Laboratory of Mammary and Leukaemic Oncogenesis, Inserm U1218 ACTION, Bergonié Cancer Institute, University of Bordeaux, 146 rue Léo Saignat, bâtiment TP 4ème étage, case 50, 33076, Bordeaux, France
| | - Béatrice Turcq
- Laboratory of Mammary and Leukaemic Oncogenesis, Inserm U1218 ACTION, Bergonié Cancer Institute, University of Bordeaux, 146 rue Léo Saignat, bâtiment TP 4ème étage, case 50, 33076, Bordeaux, France.
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21
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Etienne G, Dulucq S, Huguet F, Schmitt A, Lascaux A, Hayette S, Fort MP, Sujobert P, Bijou F, Morisset S, Tavitian S, Bidet A, Turcq B, Robbesyn F, Chollet C, Belloc F, Durrieu F, Mahon FX, Nicolini FE. Incidence and outcome of BCR-ABL mutated chronic myeloid leukemia patients who failed to tyrosine kinase inhibitors. Cancer Med 2019; 8:5173-5182. [PMID: 31350815 PMCID: PMC6718576 DOI: 10.1002/cam4.2410] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 06/25/2019] [Accepted: 06/25/2019] [Indexed: 01/10/2023] Open
Abstract
Purpose To assess the incidence of BCR‐ABL kinase domain (KD) mutation detection and its prognostic significance in chronic phase chronic myeloid leukemia (CP‐CML) patients treated with tyrosine kinase inhibitors (TKIs). Patients and Methods We analyzed characteristics and outcome of 253 CP‐CML patients who had at least one mutation analysis performed using direct sequencing. Of them, 187 patients were early CP (ECP) and 66 were late CP late chronic phase (LCP) and 88% were treated with Imatinib as first‐line TKI. Results Overall, 80 (32%) patients harbored BCR‐ABL KD mutations. A BCR‐ABL KD mutation was identified in 57% of patients, who progressed to accelerated or blastic phases (AP‐BP), and 47%, 29%, 35%, 16% and 26% in patients in CP‐CML at the time of mutation analysis who lost a complete hematologic response, failed to achieve or loss of a prior complete cytogenetic and major molecular response, respectively. Overall survival and cumulative incidence of CML‐related death were significantly correlated with the disease phase whatever the absence or presence of a mutation was and for the latter the mutation subgroup (T315I vs P‐loop vs non‐T315I non‐P‐loop) (P<.001). Considering patients who were in CP at the time of mutation analysis, LCP mutated patients had a significantly worse outcome than ECP‐mutated patients despite a lower incidence of T315I and P‐loop mutations (P<.001). With a median follow‐up from mutation analysis to last follow‐up of 5 years, T315I and P‐loop mutations were not associated with a worse outcome in ECP patients (P = .817). Conclusion Our results suggest that early mutation detection together with accessibility to 2nd and 3rd generation TKIs have reversed the worst outcome associated with BCR‐ABL KD mutations whatever the mutation subgroup in CP‐CML patients.
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Affiliation(s)
- Gabriel Etienne
- Département d'Hématologie, Institut Bergonié, Bordeaux, France.,Laboratory of Mammary and Leukaemic Oncogenesis, INSERM U1218, Université de Bordeaux, Bordeaux, France.,Groupe Fi-LMC, Hôpital Haut-Lévêque, Pessac, France
| | - Stéphanie Dulucq
- Laboratoire d'Hématologie, Hôpital Haut Lévêque CHU de Bordeaux, Pessac, France
| | - Françoise Huguet
- Groupe Fi-LMC, Hôpital Haut-Lévêque, Pessac, France.,Service d'Hématologie, Institut Universitaire du Cancer Toulouse-Oncopole, Centre Hospitalier Universitaire, Toulouse, France
| | - Anna Schmitt
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Axelle Lascaux
- Service des maladies du sang, Hôpital Haut Lévêque CHU de Bordeaux, Pessac, France
| | - Sandrine Hayette
- Laboratoire d'Hématologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | | | - Pierre Sujobert
- Laboratoire d'Hématologie, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Fontanet Bijou
- Département d'Hématologie, Institut Bergonié, Bordeaux, France
| | | | - Suzanne Tavitian
- Service d'Hématologie, Institut Universitaire du Cancer Toulouse-Oncopole, Centre Hospitalier Universitaire, Toulouse, France
| | - Audrey Bidet
- Laboratoire d'Hématologie, Hôpital Haut Lévêque CHU de Bordeaux, Pessac, France
| | - Beatrice Turcq
- Laboratory of Mammary and Leukaemic Oncogenesis, INSERM U1218, Université de Bordeaux, Bordeaux, France
| | - Fanny Robbesyn
- Laboratoire d'Hématologie, Hôpital Haut Lévêque CHU de Bordeaux, Pessac, France
| | - Claudine Chollet
- Laboratoire d'Hématologie, Hôpital Haut Lévêque CHU de Bordeaux, Pessac, France
| | - Francis Belloc
- Laboratory of Mammary and Leukaemic Oncogenesis, INSERM U1218, Université de Bordeaux, Bordeaux, France
| | | | - François-Xavier Mahon
- Département d'Hématologie, Institut Bergonié, Bordeaux, France.,Laboratory of Mammary and Leukaemic Oncogenesis, INSERM U1218, Université de Bordeaux, Bordeaux, France.,Groupe Fi-LMC, Hôpital Haut-Lévêque, Pessac, France.,Laboratoire d'Hématologie, Hôpital Haut Lévêque CHU de Bordeaux, Pessac, France
| | - Franck E Nicolini
- Groupe Fi-LMC, Hôpital Haut-Lévêque, Pessac, France.,Hematology Department, Centre Léon Bérard, Lyon, France.,Service d'Hématologie et INSERM U 1052, CRCL, Centre Léon Bérard, Lyon, France.,INSERM U1052, CRCL, Centre Léon Bérard, Lyon, France
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22
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Dumas PY, Bérard E, Bréal C, Dulucq S, Réa D, Nicolini F, Forcade E, Dufossée M, Pasquet JM, Turcq B, Bidet A, Milpied N, Déchanet-Merville J, Lafarge X, Etienne G, Mahon FX. Killer immunoglobulin-like receptor genotypes and chronic myeloid leukemia outcomes after imatinib cessation for treatment-free remission. Cancer Med 2019; 8:4976-4985. [PMID: 31287239 PMCID: PMC6718597 DOI: 10.1002/cam4.2371] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 05/02/2019] [Revised: 06/12/2019] [Accepted: 06/12/2019] [Indexed: 12/26/2022] Open
Abstract
Background Natural Killer (NK) cells are innate lymphoid cells that can be cytotoxic toward a large panel of solid tumors and hematological malignancies including chronic myeloid leukemia (CML). Such a cytotoxicity depends on various receptors. Killer immunoglobulin‐like receptors (KIR) belong to these receptors and are involved in maturation process, then in the activation abilities of NK cells. Methods: We investigated the prognostic impact of the KIR2DL5B genotype in 240 CML patients included in two clinical trials investigating tyrosine kinase inhibitors (TKI) discontinuation: STIM and STIM2. Results: After adjustment for standard risk factors in CML, we found that the inhibitory receptor KIR2DL5B‐positive genotype was independently related to a delayed second deep molecular remission (HR 0.54, 95% CI [0.32‐0.91], P = 0.02) after TKI rechallenge but not to time to first deep molecular remission or treatment‐free remission rates. Conclusion: These results suggest that KIR2DL5B could carry a role in lymphocyte‐mediated control of leukemic residual disease control in patient with CML relapse.
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Affiliation(s)
- Pierre-Yves Dumas
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France.,Institut National de la Santé et de la Recherche Médicale INSERM U1035, Bordeaux, France
| | - Emilie Bérard
- Service d'Epidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,UMR 1027, INSERM-Université de Toulouse III, Toulouse, France
| | - Claire Bréal
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France.,Institut National de la Santé et de la Recherche Médicale INSERM U1035, Bordeaux, France
| | - Stéphanie Dulucq
- Laboratoire d'Hématologie, CHU Bordeaux, F-33000, Bordeaux, France
| | - Delphine Réa
- Service d'Hématologie, Hôpital Saint Louis, Paris, France
| | - Franck Nicolini
- Service d'Hématologie and INSERM U590, CRCL, Centre Léon Bérard, Lyon, France
| | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France
| | - Melody Dufossée
- Institut National de la Santé et de la Recherche Médicale INSERM U1035, Bordeaux, France
| | - Jean-Max Pasquet
- Institut National de la Santé et de la Recherche Médicale INSERM U1035, Bordeaux, France
| | - Béatrice Turcq
- Institut National de la Santé et de la Recherche Médicale INSERM U1218, Bordeaux, France
| | - Audrey Bidet
- Laboratoire d'Hématologie, CHU Bordeaux, F-33000, Bordeaux, France
| | - Noel Milpied
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France.,Institut National de la Santé et de la Recherche Médicale INSERM U1035, Bordeaux, France
| | | | - Xavier Lafarge
- Institut National de la Santé et de la Recherche Médicale INSERM U1035, Bordeaux, France.,Laboratoire d'Immunogénétique, Etablissement Français du Sang, Bordeaux, France
| | - Gabriel Etienne
- Institut National de la Santé et de la Recherche Médicale INSERM U1218, Bordeaux, France.,Centre de Lutte contre le Cancer, Institute Bergonié, Bordeaux, France
| | - François-Xavier Mahon
- Institut National de la Santé et de la Recherche Médicale INSERM U1218, Bordeaux, France.,Centre de Lutte contre le Cancer, Institute Bergonié, Bordeaux, France
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23
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Berger MG, Pereira B, Rousselot P, Cony-Makhoul P, Gardembas M, Legros L, Escoffre-Barbe M, Nicolini FE, Saugues S, Lambert C, Réa D, Guerci-Bresler A, Giraudier S, Guilhot J, Saussele S, Mahon FX. Longer treatment duration and history of osteoarticular symptoms predispose to tyrosine kinase inhibitor withdrawal syndrome. Br J Haematol 2019; 187:337-346. [PMID: 31271217 DOI: 10.1111/bjh.16083] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 03/25/2019] [Accepted: 05/07/2019] [Indexed: 01/07/2023]
Abstract
The effectiveness of tyrosine kinase inhibitors (TKIs) has made it possible to consider treatment discontinuation in chronic myeloid leukaemia (CML) patients that achieve an excellent response. However, a few of the patients included in the Europe Stop Tyrosine Kinase Inhibitors (EURO-SKI) trial reported musculoskeletal pain shortly after stopping TKIs, considered as a withdrawal syndrome (WS). To identify factors that may predispose to TKI WS, we analysed the pharmacovigilance declarations for the 6 months after stopping TKIs in a large cohort of CML (n = 427) that combined the French patients included in the STop IMatinib 2 (STIM2; n = 224) and EURO-SKI (n = 203) trials. Among these patients, 23% (99/427) developed TKI WS after stopping imatinib (77/373; 20·4%), nilotinib (12/29; 41·4%) or dasatinib (10/25; 40%). WS concerned mainly the upper body joints, and required multiple symptomatic treatments in 30% of patients. Univariate and multivariate analyses identified two risk factors: duration of TKI treatment [risk ratio (RR) = 1·68 (1·02-2·74)] with a 93-month cut-off time, and history of osteoarticular symptoms [RR = 1·84 (1·04-3·28)]. These findings confirm that WS is a TKI class effect. CML patients should be carefully screened before treatment initiation to identify pre-existent osteoarticular symptoms. Moreover, before TKI discontinuation, patients should be informed of the possibility of WS, particularly after a long treatment period.
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Affiliation(s)
- Marc G Berger
- CHU Clermont-Ferrand, Hôpital Estaing, Hématologie Biologique, Clermont-Ferrand Cedex, France.,Service d'Hématologie Clinique Adulte et Thérapie Cellulaire, CHU Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, Cedex, France.,Université Clermont Auvergne, EA 7453 CHELTER, Clermont-Ferrand, Cedex, France
| | - Bruno Pereira
- Délégation de la Recherche Clinique et de l'Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Philippe Rousselot
- Service d'Hématologie et d'Oncologie, CH de Versailles, Le Chesnay, France
| | - Pascale Cony-Makhoul
- Service Hématologie Clinique, Centre Hospitalier Annecy Genevois, Pringy, France
| | | | - Laurence Legros
- Service d'Hématologie Clinique, Hôpital Paul-Brousse (AP-HP), Villejuif, France
| | | | | | - Sandrine Saugues
- CHU Clermont-Ferrand, Hôpital Estaing, Hématologie Biologique, Clermont-Ferrand Cedex, France
| | - Céline Lambert
- Délégation de la Recherche Clinique et de l'Innovation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Delphine Réa
- Groupe Hospitalier Saint-Louis, Service d'Hématologie, Lariboisière, Fernand-Widal (AP-HP), Paris, France
| | | | | | | | - Susanne Saussele
- III Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
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24
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El Eit R, Itani AR, Nassar F, Rasbieh N, Jabbour M, Santina A, Zaatari G, Mahon FX, Bazarbachi A, Nasr R. Antitumor efficacy of arsenic/interferon in preclinical models of chronic myeloid leukemia resistant to tyrosine kinase inhibitors. Cancer 2019; 125:2818-2828. [PMID: 31034603 DOI: 10.1002/cncr.32130] [Citation(s) in RCA: 9] [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: 12/27/2018] [Revised: 02/12/2019] [Accepted: 03/05/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Tyrosine kinase inhibitors (TKIs) are the standard treatment for chronic myeloid leukemia (CML). Despite their clinical success, TKIs are faced with challenges such as treatment resistance, which may be driven by kinase domain mutations, and frequent disease relapse upon the cessation of treatment. The combination of arsenic trioxide (ATO) and interferon-α (IFN) was previously demonstrated to inhibit proliferation and induce apoptosis in CML cell lines, prolong the survival of primary wild-type CML mice, and dramatically decrease the activity of leukemia-initiating cells (LICs). METHODS The ATO/IFN combination was tested in vitro on imatinib (IMN)-resistant K562-R and Ar230-R cells. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling assays were used to evaluate proliferation and apoptosis, respectively. The acridine orange assay was used to assess autophagy, and quantitative reverse transcription-polymerase chain reaction was used to assess the involvement of the hedgehog (Hh) pathway. In vivo, a retroviral transduction/transplantation T315I BCR-ABL CML mouse model was used to assay the effect of the treatment on survival, tumor burden (histopathology and blood counts), and LIC activity (secondary transplantation). RESULTS In vitro, ATO/IFN synergized to inhibit proliferation and induce apoptosis of IMN-resistant cells with variant modes of resistance. Furthermore, the preclinical effects of ATO/IFN were associated with induction of autophagy along with inhibition of the Hh pathway. Most remarkably, ATO/IFN significantly prolonged the survival of primary T315I-CML mice and displayed a dramatic impairment of disease engraftment in secondary mice, which reflected decreased LIC activity. CONCLUSIONS Collectively, the ATO/IFN strategy has been demonstrated to have the potential to lead to durable remissions in TKI-resistant CML preclinical models and to overcome various TKI-specific mechanisms of resistance.
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Affiliation(s)
- Rabab El Eit
- Department of Anatomy, Cell Biology, and Physiological Sciences, American University of Beirut, Beirut, Lebanon
| | - Abdul Rahman Itani
- Department of Anatomy, Cell Biology, and Physiological Sciences, American University of Beirut, Beirut, Lebanon
| | - Farah Nassar
- Department of Anatomy, Cell Biology, and Physiological Sciences, American University of Beirut, Beirut, Lebanon
| | - Nagham Rasbieh
- Department of Anatomy, Cell Biology, and Physiological Sciences, American University of Beirut, Beirut, Lebanon
| | - Mark Jabbour
- Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - Ahmad Santina
- Department of Anatomy, Cell Biology, and Physiological Sciences, American University of Beirut, Beirut, Lebanon
| | - Ghazi Zaatari
- Department of Pathology and Laboratory Medicine, American University of Beirut, Beirut, Lebanon
| | - François-Xavier Mahon
- French National Institute of Health and Medical Research Unit 876, Laboratory of Hematology and Department of Blood Diseases, University Hospital Center of Bordeaux, Bordeaux Segalen University, Bordeaux, France
| | - Ali Bazarbachi
- Department of Anatomy, Cell Biology, and Physiological Sciences, American University of Beirut, Beirut, Lebanon.,Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Rihab Nasr
- Department of Anatomy, Cell Biology, and Physiological Sciences, American University of Beirut, Beirut, Lebanon
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25
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Dulucq S, Etienne G, Morisset S, Klein E, Chollet C, Robbesyn F, Turcq B, Tigaud I, Hayette S, Nicolini FE, Mahon FX. Impact of second decline rate of BCR-ABL1 transcript on clinical outcome of chronic phase chronic myeloid leukemia patients on imatinib first-line. Ann Hematol 2019; 98:1159-1168. [PMID: 30798348 DOI: 10.1007/s00277-019-03633-x] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/03/2019] [Indexed: 11/24/2022]
Abstract
Early molecular response has been associated with clinical outcome in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors. The BCR-ABL1 transcript rate decline from baseline to 3 months has been demonstrated to be more predictive than a single BCR-ABL1 level at 3 months (M3). However, it cannot be used routinely because ABL1, as an internal gene control, is not reliable for BCR-ABL1 quantification above 10%. This study aimed to compare clinical outcome and molecular response of chronic phase CML patients, depending on the percentage of BCR-ABL1 transcript decrease from month 3 to month 6 using ABL1 as an internal control gene. Two hundred sixteen chronic phase CML patients treated with imatinib 400 mg for whom M3 and month 6 molecular data were available were included in the study. Associations with event-free (EFS), failure-free (FFS), progression-free (PFS), and overall survivals (OS) molecular response 4 log and 4.5 log were assessed. The percentage of BCR-ABL1 decline from month 3 to month 6 was significantly linked to the EFS and the FFS (p < 0.001). A common cut-off of 67% of decline predicted the better risk of event. Patients with a decrease below 67% have worse EFS and FFS as compared to those having a higher decrease (p < 0.001). The impact was confirmed by multivariate analysis. Since the slope between diagnosis and 3 months cannot be reliable using ABL1 as an internal gene control, the second decline rate of BCR-ABL1 transcript between month 3 and month 6 could efficiently identify patients at higher risk of event.
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Affiliation(s)
- Stephanie Dulucq
- Laboratory of Hematology, Bordeaux University Hospital, Avenue de Magellan, 33604, Pessac Cedex, France. .,INSERM U1218, University of Bordeaux, 146 rue Léo Saignat CS 61292, 33076, Bordeaux Cedex, France. .,French Group of CML (Fi-LMC), Bergonié Cancer Institute, 229 Cours de l'Argonne, CS61283, 33076, Bordeaux Cedex, France.
| | - Gabriel Etienne
- French Group of CML (Fi-LMC), Bergonié Cancer Institute, 229 Cours de l'Argonne, CS61283, 33076, Bordeaux Cedex, France.,Bergonié Cancer Institute, 229 Cours de l'Argonne, CS61283, 33076, Bordeaux Cedex, France
| | - Stephane Morisset
- Lieu-dit La Caillatte, 01150, Chazey sur Ain, France.,Léon Bérard Cancer Institute and INSERM U1052, 28, rue Laennec, 69373, Lyon Cedex 08, France
| | - Emilie Klein
- Laboratory of Hematology, Bordeaux University Hospital, Avenue de Magellan, 33604, Pessac Cedex, France
| | - Claudine Chollet
- Laboratory of Hematology, Bordeaux University Hospital, Avenue de Magellan, 33604, Pessac Cedex, France
| | - Fanny Robbesyn
- Laboratory of Hematology, Bordeaux University Hospital, Avenue de Magellan, 33604, Pessac Cedex, France
| | - Beatrice Turcq
- INSERM U1218, University of Bordeaux, 146 rue Léo Saignat CS 61292, 33076, Bordeaux Cedex, France
| | - Isabelle Tigaud
- Laboratory of Hematology, Centre Hospitalier Lyon Sud, 165 chemin du Grand Revoyet, 69495, Pierre Bénite Cedex, France
| | - Sandrine Hayette
- French Group of CML (Fi-LMC), Bergonié Cancer Institute, 229 Cours de l'Argonne, CS61283, 33076, Bordeaux Cedex, France.,Laboratory of Hematology, Centre Hospitalier Lyon Sud, 165 chemin du Grand Revoyet, 69495, Pierre Bénite Cedex, France
| | - Franck E Nicolini
- French Group of CML (Fi-LMC), Bergonié Cancer Institute, 229 Cours de l'Argonne, CS61283, 33076, Bordeaux Cedex, France.,Léon Bérard Cancer Institute and INSERM U1052, 28, rue Laennec, 69373, Lyon Cedex 08, France
| | - François-Xavier Mahon
- INSERM U1218, University of Bordeaux, 146 rue Léo Saignat CS 61292, 33076, Bordeaux Cedex, France.,French Group of CML (Fi-LMC), Bergonié Cancer Institute, 229 Cours de l'Argonne, CS61283, 33076, Bordeaux Cedex, France.,Bergonié Cancer Institute, 229 Cours de l'Argonne, CS61283, 33076, Bordeaux Cedex, France
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26
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Dumas PY, Mansier O, Prouzet-Mauleon V, Koya J, Villacreces A, Brunet de la Grange P, Luque Paz D, Bidet A, Pasquet JM, Praloran V, Salin F, Kurokawa M, Mahon FX, Cardinaud B, Lippert E. MiR-10a and HOXB4 are overexpressed in atypical myeloproliferative neoplasms. BMC Cancer 2018; 18:1098. [PMID: 30419846 PMCID: PMC6233495 DOI: 10.1186/s12885-018-4993-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 12/04/2017] [Accepted: 10/24/2018] [Indexed: 11/19/2022] Open
Abstract
Background Atypical Myeloproliferative Neoplasms (aMPN) share characteristics of MPN and Myelodysplastic Syndromes. Although abnormalities in cytokine signaling are common in MPN, the pathophysiology of atypical MPN still remains elusive. Since deregulation of microRNAs is involved in the biology of various cancers, we studied the miRNome of aMPN patients. Methods MiRNome and mutations in epigenetic regulator genes ASXL1, TET2, DNMT3A, EZH2 and IDH1/2 were explored in aMPN patients. Epigenetic regulation of miR-10a and HOXB4 expression was investigated by treating hematopoietic cell lines with 5-aza-2’deoxycytidine, valproic acid and retinoic acid. Functional effects of miR-10a overexpression on cell proliferation, differentiation and self-renewal were studied by transducing CD34+ cells with lentiviral vectors encoding the pri-miR-10a precursor. Results MiR-10a was identified as the most significantly up-regulated microRNA in aMPN. MiR-10a expression correlated with that of HOXB4, sitting in the same genomic locus. The transcription of these two genes was increased by DNA demethylation and histone acetylation, both necessary for optimal expression induction by retinoic acid. Moreover, miR-10a and HOXB4 overexpression seemed associated with DNMT3A mutation in hematological malignancies. However, overexpression of miR-10a had no effect on proliferation, differentiation or self-renewal of normal hematopoietic progenitors. Conclusions MiR-10a and HOXB4 are overexpressed in aMPN. This overexpression seems to be the result of abnormalities in epigenetic regulation mechanisms. Our data suggest that miR-10a could represent a simple marker of transcription at this genomic locus including HOXB4, widely recognized as involved in stem cell expansion. Electronic supplementary material The online version of this article (10.1186/s12885-018-4993-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pierre-Yves Dumas
- CHU de Bordeaux, Hématologie Clinique et Thérapie Cellulaire, F-33000, Bordeaux, France.,INSERM U1035, Université de Bordeaux, Bordeaux, France
| | - Olivier Mansier
- INSERM U1218, Université de Bordeaux, Bordeaux, France.,CHU de Bordeaux, Laboratoire d'Hématologie, F-33000, Bordeaux, France
| | | | - Junji Koya
- Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, bunkyo-ku, Tokyo, 113-8655, Japan
| | | | - Philippe Brunet de la Grange
- Etablissement Français du Sang - Aquitaine Limousin, Laboratoire R&D d'Ingénierie Cellulaire, Université de Bordeaux, Bordeaux, France
| | | | - Audrey Bidet
- CHU de Bordeaux, Laboratoire d'Hématologie, F-33000, Bordeaux, France
| | | | - Vincent Praloran
- INSERM U1035, Université de Bordeaux, Bordeaux, France.,CHU de Bordeaux, Laboratoire d'Hématologie, F-33000, Bordeaux, France
| | - Franck Salin
- INRA, Plateforme Génome Transcriptome de Bordeaux, BIOGECO, UMR 1202, F-33610, Cestas, France
| | - Mineo Kurokawa
- Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo, 7-3-1, Hongo, bunkyo-ku, Tokyo, 113-8655, Japan
| | - François-Xavier Mahon
- INSERM U1218, Université de Bordeaux, Bordeaux, France.,Institut Bergonié, Bordeaux, France
| | - Bruno Cardinaud
- INSERM U1218, Université de Bordeaux, Bordeaux, France.,Bordeaux Institut National Polytechnique, F-33000, Bordeaux, France
| | - Eric Lippert
- INSERM U1035, Université de Bordeaux, Bordeaux, France. .,CHU de Bordeaux, Laboratoire d'Hématologie, F-33000, Bordeaux, France. .,CHRU de Brest, Service d'Hématologie Biologique et INSERM U1078, Université de Bretagne Occidentale, Brest, France.
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27
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Affiliation(s)
| | - Timothy P Hughes
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia (T.P.H.)
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Nicolini FE, Alcazer V, Cony-Makhoul P, Heiblig M, Morisset S, Fossard G, Bidet A, Schmitt A, Sobh M, Hayette S, Mahon FX, Dulucq S, Etienne G. Long-term follow-up of de novo chronic phase chronic myelogenous leukemia patients on front-line imatinib. Exp Hematol 2018; 64:97-105.e4. [PMID: 29800673 DOI: 10.1016/j.exphem.2018.05.003] [Citation(s) in RCA: 6] [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] [Received: 03/23/2018] [Revised: 05/11/2018] [Accepted: 05/12/2018] [Indexed: 02/01/2023]
Abstract
For the last 15years, imatinib mesylate (IM) has represented the gold standard treatment for chronic-phase chronic myelogenous leukemia (CP-CML); however, outcomes in the very long term remain unknown. We retrospectively analyzed the outcome of 418 IM first-line treated CP-CML patients followed in three reference centers over 15years in and outside of clinical trials, which is believed to represent the "real-life" care of such patients. Molecular analyses were standardized over the years. In case of intolerance or resistance or IM cessation and progression, all clinical data were collected and analyzed. After a median follow-up of 83 months (range 1-194), the overall survival (OS) rates were 91% and 82%, the progression-free survival (PFS) rates were 88.5% and 81%, and the event-free survival rates, including switching to another tyrosine kinase inhibitor, were 65% and 51%, respectively, at 5 and 10years. Thirteen patients (3%) entered blast crisis (BC) with a median survival of 2.2years after BC onset. Forty-nine percent of patients were in major molecular response at 1 year. Univariate analysis failed to detect any impact on survival of molecular response at 3 and 6 months. Sokal score had a significant impact on OS and PFS in a Cox model. Age had a significant impact on OS and PFS, mainly due to deaths in elderly patients unrelated to CML. Overall, 21% of patients reached a stable (≥1 year) molecular response 4 (MR4) and 6.5% reached MR4.5. At last follow-up, 63% of patients were still on IM and 19% were in treatment-free remission. We conclude that IM is an excellent therapeutic option providing impressive long-term OS rates.
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Affiliation(s)
- Franck Emmanuel Nicolini
- Hematology Department, Centre Léon Bérard, Lyon, France; INSERM U1052, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, Lyon, France; Groupe Fi-LMC, Institut Bergonié, Bodeaux, France.
| | | | - Pascale Cony-Makhoul
- Hematology Department, Centre Hospitalier Annecy-Genevois, Epagny Metz-Tessy, France; Groupe Fi-LMC, Institut Bergonié, Bodeaux, France
| | - Maël Heiblig
- Hematology Department, Centre Léon Bérard, Lyon, France
| | | | - Gaëlle Fossard
- INSERM U1052, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, Lyon, France
| | - Audrey Bidet
- Laboratory for Hematology, Hôpital Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Anna Schmitt
- Hematology Department, Institut Bergonié, Bordeaux, France
| | - Mohamad Sobh
- Hematology Department, Centre Léon Bérard, Lyon, France
| | - Sandrine Hayette
- Laboratory for Hematology and Molecular Biology, Centre Hospitalier Lyon Sud, Piere-Bénite, France; Groupe Fi-LMC, Institut Bergonié, Bodeaux, France
| | - François-Xavier Mahon
- Hematology Department, Institut Bergonié, Bordeaux, France; Groupe Fi-LMC, Institut Bergonié, Bodeaux, France
| | - Stéphanie Dulucq
- Laboratory for Hematology, Hôpital Haut Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France; Groupe Fi-LMC, Institut Bergonié, Bodeaux, France
| | - Gabriel Etienne
- Hematology Department, Institut Bergonié, Bordeaux, France; Groupe Fi-LMC, Institut Bergonié, Bodeaux, France
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Mahon FX, Boquimpani C, Takahashi N, Benyamini N, Clementino NCD, Shuvaev V, Merchant A, Lipton JH, Turkina AG, De Paz Arias R, Moiraghi B, Nicolini FE, Dengler J, Sacha T, Kim DW, Fellague-Chebra R, Acharya S, Chaturvedi S, Bouard C, Hughes TP. Long-term treatment-free remission (TFR) in patients (pts) with chronic myeloid leukemia in chronic phase (CML-CP) after stopping second-line (2L) nilotinib: ENESTop 144-wk results. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.7003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- François-Xavier Mahon
- Cancer Center of Bordeaux, Institut Bergonié, INSERM U1218, University of Bordeaux, Bordeaux, France
| | | | - Naoto Takahashi
- Department of Hematology, Akita University Hospital, Akita, Japan
| | | | | | - Vasily Shuvaev
- Russian Research Institute of Hematology and Transfusiology, Saint Petersburg, Russian Federation
| | - Akil Merchant
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jeffrey H. Lipton
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Beatriz Moiraghi
- Hospital General De Agudos J. M. Ramos Mejia, Buenos Aires, Argentina
| | | | | | - Tomasz Sacha
- Department of Hematology, Jagiellonian University Hospital, Kraków, Poland
| | - Dong-Wook Kim
- Seoul St Mary’s Hospital, Leukemia Research Institute, The Catholic University of Korea, Seoul, Korea, Republic of (South)
| | | | | | | | | | - Timothy P. Hughes
- SA Pathology and South Australian Health and Medical Research Institute, University of Adelaide, Adelaide, Australia
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Rea D, Ame S, Berger M, Cayuela JM, Charbonnier A, Coiteux V, Cony-Makhoul P, Dubruille V, Dulucq S, Etienne G, Legros L, Nicolini F, Roche-Lestienne C, Escoffre-Barbe M, Gardembas M, Guerci-Bresler A, Johnson-Ansah H, Rigal-Huguet F, Rousselot P, Mahon FX. Discontinuation of tyrosine kinase inhibitors in chronic myeloid leukemia: Recommendations for clinical practice from the French Chronic Myeloid Leukemia Study Group. Cancer 2018; 124:2956-2963. [DOI: 10.1002/cncr.31411] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/14/2018] [Accepted: 03/14/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Delphine Rea
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | - Shanti Ame
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | - Marc Berger
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | - Jean-Michel Cayuela
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | - Aude Charbonnier
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | - Valérie Coiteux
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | - Pascale Cony-Makhoul
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | - Viviane Dubruille
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | - Stéphanie Dulucq
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | - Gabriel Etienne
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | - Laurence Legros
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | - Franck Nicolini
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | | | | | - Martine Gardembas
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | - Agnès Guerci-Bresler
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
| | | | | | - Philippe Rousselot
- French Chronic Myeloid Leukemia Study Group, Bergonié Institute; Bordeaux France
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Mahon FX, Boquimpani C, Kim DW, Benyamini N, Clementino NCD, Shuvaev V, Ailawadhi S, Lipton JH, Turkina AG, De Paz R, Moiraghi B, Nicolini FE, Dengler J, Sacha T, Takahashi N, Fellague-Chebra R, Acharya S, Wong S, Jin Y, Hughes TP. Treatment-Free Remission After Second-Line Nilotinib Treatment in Patients With Chronic Myeloid Leukemia in Chronic Phase: Results From a Single-Group, Phase 2, Open-Label Study. Ann Intern Med 2018; 168:461-470. [PMID: 29459949 DOI: 10.7326/m17-1094] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [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: 11/22/2022] Open
Abstract
BACKGROUND Treatment-free remission (TFR)-that is, stopping tyrosine kinase inhibitor (TKI) therapy without loss of response-is an emerging treatment goal in chronic myeloid leukemia (CML). OBJECTIVE To evaluate TFR after discontinuation of second-line nilotinib therapy. DESIGN Single-group, phase 2, open-label study. (ClinicalTrials.gov: NCT01698905). SETTING 63 centers in 18 countries. PATIENTS Adults with CML in chronic phase who received TKI therapy for at least 3 years (>4 weeks with imatinib, then ≥2 years with nilotinib) and achieved MR4.5 (BCR-ABL1 ≤0.0032% on the International Scale [BCR-ABL1IS]) while receiving nilotinib entered a 1-year consolidation phase. Those with sustained MR4.5 during consolidation were eligible to enter TFR. INTERVENTIONS Patients received nilotinib during consolidation; those who entered TFR stopped treatment. Patients with loss of major molecular response (MMR) (BCR-ABL1IS ≤0.1%) or confirmed loss of MR4 (BCR-ABL1IS ≤0.01%) during TFR reinitiated nilotinib treatment. MEASUREMENTS Proportion of patients without loss of MMR, confirmed loss of MR4, or treatment reinitiation within 48 weeks of stopping treatment (primary end point). RESULTS 163 patients who had switched from imatinib to nilotinib (for reasons including resistance, intolerance, and physician preference) enrolled in the study and entered the consolidation phase. Of these patients, 126 met the criteria for entering the TFR phase, and 73 (58% [95% CI, 49% to 67%]) and 67 (53% [CI, 44% to 62%]) maintained TFR at 48 weeks (primary end point) and 96 weeks, respectively. Of the 56 patients who reinitiated nilotinib therapy, 55 regained MMR or better and 52 regained MR4.5. None had CML progression to accelerated phase or blast crisis. Musculoskeletal pain was more frequent during the first 48 weeks after nilotinib discontinuation. LIMITATION The study included a heterogeneous patient population and was not designed to compare outcomes between patients continuing and those stopping treatment. CONCLUSION TFR seems achievable in patients with sustained MR4.5 after switching to nilotinib. PRIMARY FUNDING SOURCE Novartis Pharmaceuticals Corporation.
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Affiliation(s)
| | - Carla Boquimpani
- Hemocentro do Rio de Janeiro, HEMORIO, Rio de Janeiro, Brazil (C.B.)
| | - Dong-Wook Kim
- The Catholic University of Korea, Seoul, South Korea (D.K.)
| | | | | | - Vasily Shuvaev
- Russian Research Institute of Hematology and Transfusiology, Saint Petersburg, Russia (V.S.)
| | | | | | - Anna G Turkina
- National Research Center for Hematology, Moscow, Russia (A.G.T.)
| | | | - Beatriz Moiraghi
- Hospital General De Agudos J. M. Ramos Mejia, Buenos Aires, Argentina (B.M.)
| | | | | | - Tomasz Sacha
- Jagiellonian University Hospital, Kraków, Poland (T.S.)
| | | | | | | | - Stephane Wong
- Novartis Oncology Precision Medicine, Cambridge, Massachusetts (S.W.)
| | - Yu Jin
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey (Y.J.)
| | - Timothy P Hughes
- University of Adelaide, Adelaide, South Australia, Australia (T.P.H.)
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Rinaldetti S, Pfirrmann M, Manz K, Guilhot J, Dietz C, Panagiotidis P, Spiess B, Seifarth W, Fabarius A, Müller M, Pagoni M, Dimou M, Dengler J, Waller CF, Brümmendorf TH, Herbst R, Burchert A, Janβen C, Goebeler ME, Jost PJ, Hanzel S, Schafhausen P, Prange-Krex G, Illmer T, Janzen V, Klausmann M, Eckert R, Büschel G, Kiani A, Hofmann WK, Mahon FX, Saussele S. Effect of ABCG2 , OCT1 , and ABCB1 ( MDR1 ) Gene Expression on Treatment-Free Remission in a EURO-SKI Subtrial. Clinical Lymphoma Myeloma and Leukemia 2018; 18:266-271. [DOI: 10.1016/j.clml.2018.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/02/2018] [Indexed: 12/17/2022]
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Affiliation(s)
- Delphine Rea
- Institut Bergonie Cancer Center, Department of Hematology, Universite Bordeaux, Bordeaux, Aquitaine, France
| | - Gabriel Etienne
- Institut Bergonie Cancer Center, Department of Hematology, Universite Bordeaux, Bordeaux, Aquitaine, France
| | - François-Xavier Mahon
- Institut Bergonie Cancer Center, Department of Hematology, Universite Bordeaux, Bordeaux, Aquitaine, France
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Abstract
During the last 10 years, clinical trials formally demonstrated that about 50% of patients with chronic phase (CP) chronic myeloid leukaemia (CML) who achieve and maintain deep molecular responses for a prolonged period of time during treatment with imatinib or new generation tyrosine kinase inhibitors (TKIs) may successfully stop their anti-leukaemic therapy. Based on the accumulated knowledge from abundant clinical trial experience, TKI discontinuation is becoming an important goal to achieve and is about to enter clinical practice. This review focuses on relapse definition, laboratory tests to identify relapse and relapse management after TKI discontinuation.
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Affiliation(s)
- Delphine Rea
- Service d'hématologie Adulte, Unité INSERM, UMR-1160 and France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Hôpital Saint-Louis, Paris, France
| | - François-Xavier Mahon
- Unicancer Center, Institut Bergonié and France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Bordeaux, France
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35
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Espadinha AS, Prouzet-Mauléon V, Claverol S, Lagarde V, Bonneu M, Mahon FX, Cardinaud B. A tyrosine kinase-STAT5-miR21-PDCD4 regulatory axis in chronic and acute myeloid leukemia cells. Oncotarget 2017; 8:76174-76188. [PMID: 29100302 PMCID: PMC5652696 DOI: 10.18632/oncotarget.19192] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 08/11/2016] [Accepted: 06/13/2017] [Indexed: 12/14/2022] Open
Abstract
MicroRNAs (miRNAs) are regulators of several key patho-physiological processes, including cell cycle and apoptosis. Using microarray-based miRNA profiling in K562 cells, a model of chronic myeloid leukemia (CML), we found that the oncoprotein BCR-ABL1 regulates the expression of miR-21, an “onco-microRNA”, found to be overexpressed in several cancers. This effect relies on the presence of two STAT binding sites on the promoter of miR-21, and on the phosphorylation status of STAT5, a transcription factor activated by the kinase activity of BCR-ABL1. Mir-21 regulates the expression of PDCD4 (programmed cell death protein 4), a tumor suppressor identified through a proteomics approach. The phosphoSTAT5 — miR-21 — PDCD4 pathway was active in CML primary CD34+ cells, but also in acute myeloid leukemia (AML) models like MV4.11 and MOLM13, where the constitutively active tyrosine kinase FLT3-ITD plays a similar role to BCR-ABL1 in the K562 cell line.
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Affiliation(s)
- Anne-Sophie Espadinha
- University of Bordeaux, INSERM U1035, Bordeaux, France.,University of Bordeaux, INSERM U1218, Bordeaux, France
| | - Valérie Prouzet-Mauléon
- University of Bordeaux, INSERM U1035, Bordeaux, France.,University of Bordeaux, INSERM U1218, Bordeaux, France
| | | | - Valérie Lagarde
- University of Bordeaux, INSERM U1035, Bordeaux, France.,University of Bordeaux, INSERM U1218, Bordeaux, France
| | - Marc Bonneu
- University of Bordeaux, Plateforme Protéome, CGFB, Bordeaux, France.,Bordeaux Institut National Polytechnique, Bordeaux, France
| | - François-Xavier Mahon
- University of Bordeaux, INSERM U1035, Bordeaux, France.,University of Bordeaux, INSERM U1218, Bordeaux, France
| | - Bruno Cardinaud
- University of Bordeaux, INSERM U1035, Bordeaux, France.,University of Bordeaux, INSERM U1218, Bordeaux, France.,Bordeaux Institut National Polytechnique, Bordeaux, France
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36
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Ianniciello A, Dumas PY, Drullion C, Guitart A, Villacreces A, Peytour Y, Chevaleyre J, Brunet de la Grange P, Vigon I, Desplat V, Priault M, Sbarba PD, Ivanovic Z, Mahon FX, Pasquet JM. Chronic myeloid leukemia progenitor cells require autophagy when leaving hypoxia-induced quiescence. Oncotarget 2017; 8:96984-96992. [PMID: 29228587 PMCID: PMC5722539 DOI: 10.18632/oncotarget.18904] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 09/01/2016] [Accepted: 06/17/2017] [Indexed: 12/15/2022] Open
Abstract
Albeit tyrosine kinase inhibitors anti-Abl used in Chronic Myeloid Leukemia (CML) block the deregulated activity of the Bcr-Abl tyrosine kinase and induce remission in 90% of patients, they do not eradicate immature hematopoietic compartments of leukemic stem cells. To elucidate if autophagy is important for stem cell survival and/or proliferation, we used culture in low oxygen concentration (0.1% O2 for 7 days) followed back by non-restricted O2 supply (normoxic culture) to mimic stem cell proliferation and commitment. Knockdown of Atg7 expression, a key player in autophagy, in K562 cell line inhibited autophagy compared to control cells. Upon 7 days at 0.1% O2 both K562 and K562 shATG7 cells stopped to proliferate and a similar amount of viable cells remained. Back to non-restricted O2 supply K562 cells proliferate whereas K562 shATG7 cells exhibited strong apoptosis. Using immunomagnetic sorted normal and CML CD34+ cells, we inhibited the autophagic process by lentiviral infection expressing shATG7 or using a Vps34 inhibitor. Both, normal and CML CD34+ cells either competent or deficient for autophagy stopped to proliferate in hypoxia. Surprisingly, while normal CD34+ cells proliferate back to non restricted O2 supply, the CML CD34+ cells deficient for autophagy failed to proliferate. All together, these results suggest that autophagy is required for CML CD34+ commitment while it is dispensable for normal CD34 cells.
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Affiliation(s)
- Angela Ianniciello
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1035 BMGIC, Université de Bordeaux, 33076 Bordeaux Cedex, France
| | - Pierre-Yves Dumas
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1035 BMGIC, Université de Bordeaux, 33076 Bordeaux Cedex, France
| | - Claire Drullion
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1035 BMGIC, Université de Bordeaux, 33076 Bordeaux Cedex, France
| | - Amélie Guitart
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1035 BMGIC, Université de Bordeaux, 33076 Bordeaux Cedex, France
| | - Arnaud Villacreces
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1035 BMGIC, Université de Bordeaux, 33076 Bordeaux Cedex, France
| | - Yan Peytour
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1035 BMGIC, Université de Bordeaux, 33076 Bordeaux Cedex, France
| | - Jean Chevaleyre
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1035 BMGIC, Université de Bordeaux, 33076 Bordeaux Cedex, France.,Etablissement Français du Sang Aquitaine-Limousin, 33075 Bordeaux, France
| | - Philippe Brunet de la Grange
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1035 BMGIC, Université de Bordeaux, 33076 Bordeaux Cedex, France.,Etablissement Français du Sang Aquitaine-Limousin, 33075 Bordeaux, France
| | - Isabelle Vigon
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1035 BMGIC, Université de Bordeaux, 33076 Bordeaux Cedex, France
| | - Vanessa Desplat
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1035 BMGIC, Université de Bordeaux, 33076 Bordeaux Cedex, France
| | - Muriel Priault
- UMR CNRS 5095, I.B.G.C, Université de Bordeaux, 33077 Bordeaux Cedex, France
| | - Persio Dello Sbarba
- Department of Experimental and Clinical Biomedical Sciences, Università degli Studi di Firenze, 50134 Firenze, Italia
| | - Zoran Ivanovic
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1035 BMGIC, Université de Bordeaux, 33076 Bordeaux Cedex, France.,Etablissement Français du Sang Aquitaine-Limousin, 33075 Bordeaux, France
| | | | - Jean-Max Pasquet
- Cellules Souches Hématopoïétiques Normales et Leucémiques, INSERM U1035 BMGIC, Université de Bordeaux, 33076 Bordeaux Cedex, France
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Etienne G, Mahon FX. No, treatment for CML should not continue indefinitely. Clin Adv Hematol Oncol 2017; 15:489-494. [PMID: 28749910] [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: 06/07/2023]
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Ducassou S, Prouzet-Mauléon V, Deau MC, Brunet de la Grange P, Cardinaud B, Soueidan H, Quelen C, Brousset P, Pasquet JM, Moreau-Gaudry F, Arock M, Mahon FX, Lippert E. MYB-GATA1 fusion promotes basophilic leukaemia: involvement of interleukin-33 and nerve growth factor receptors. J Pathol 2017; 242:347-357. [PMID: 28418072 DOI: 10.1002/path.4908] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 07/18/2016] [Revised: 03/02/2017] [Accepted: 03/31/2017] [Indexed: 12/29/2022]
Abstract
Acute basophilic leukaemia (ABL) is a rare subtype of acute myeloblastic leukaemia. We previously described a recurrent t(X;6)(p11;q23) translocation generating an MYB-GATA1 fusion gene in male infants with ABL. To better understand its role, the chimeric MYB-GATA1 transcription factor was expressed in CD34-positive haematopoietic progenitors, which were transplanted into immunodeficient mice. Cells expressing MYB-GATA1 showed increased expression of markers of immaturity (CD34), of granulocytic lineage (CD33 and CD117), and of basophilic differentiation (CD203c and FcϵRI). UT-7 cells also showed basophilic differentiation after MYB-GATA1 transfection. A transcriptomic study identified nine genes deregulated by both MYB-GATA1 and basophilic differentiation. Induction of three of these genes (CCL23, IL1RL1, and NTRK1) was confirmed in MYB-GATA1-expressing CD34-positive cells by reverse transcription quantitative polymerase chain reaction. Interleukin (IL)-33 and nerve growth factor (NGF), the ligands of IL-1 receptor-like 1 (IL1RL1) and neurotrophic receptor tyrosine kinase 1 (NTRK1), respectively, enhanced the basophilic differentiation of MYB-GATA1-expressing UT-7 cells, thus demonstrating the importance of this pathway in the basophilic differentiation of leukaemic cells and CD34-positive primary cells. Finally, gene reporter assays confirmed that MYB and MYB-GATA1 directly activated NTRK1 and IL1RL1 transcription, leading to basophilic skewing of the blasts. MYB-GATA1 is more efficient than MYB, because of better stability. Our results highlight the role of IL-33 and NGF receptors in the basophilic differentiation of normal and leukaemic cells. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Stéphane Ducassou
- ACTION Laboratory, INSERM Unit 1218, University of Bordeaux, Bordeaux, France.,Unité d'hématologie oncologie pédiatrique, CHU de Bordeaux, Bordeaux, France
| | | | - Marie-Céline Deau
- ACTION Laboratory, INSERM Unit 1218, University of Bordeaux, Bordeaux, France
| | - Philippe Brunet de la Grange
- Laboratoire R&D d'Ingénierie Cellulaire, Etablissement Français du Sang - Aquitaine Limousin, CIRID UMR5164, University of Bordeaux, Bordeaux, France
| | - Bruno Cardinaud
- ACTION Laboratory, INSERM Unit 1218, University of Bordeaux, Bordeaux, France.,Bordeaux INP, Bordeaux, France
| | - Hayssam Soueidan
- ACTION Laboratory, INSERM Unit 1218, University of Bordeaux, Bordeaux, France
| | - Cathy Quelen
- Centre de Recherches en Cancérologie de Toulouse, INSERM U1037, Toulouse, France
| | - Pierre Brousset
- Centre de Recherches en Cancérologie de Toulouse, INSERM U1037, Toulouse, France
| | - Jean-Max Pasquet
- Equipe thérapie génique, INSERM U 1035 Biothérapie des maladies génétiques et cancers, University of Bordeaux, Bordeaux, France
| | - François Moreau-Gaudry
- Equipe thérapie génique, INSERM U 1035 Biothérapie des maladies génétiques et cancers, University of Bordeaux, Bordeaux, France
| | - Michel Arock
- Laboratoire d'Hématologie, CHU Pitié-Salpêtrière, Paris, France
| | - François-Xavier Mahon
- ACTION Laboratory, INSERM Unit 1218, University of Bordeaux, Bordeaux, France.,Bergonié Cancer Institute, INSERM Unit 916, University of Bordeaux, Bordeaux, France
| | - Eric Lippert
- Equipe thérapie génique, INSERM U 1035 Biothérapie des maladies génétiques et cancers, University of Bordeaux, Bordeaux, France.,CHU de Brest and INSERM U1078, Université de Bretagne Occidentale, Brest, France
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Saglio G, le Coutre P, Cortes J, Mayer J, Rowlings P, Mahon FX, Kroog G, Gooden K, Subar M, Shah NP. Evaluation of cardiovascular ischemic event rates in dasatinib-treated patients using standardized incidence ratios. Ann Hematol 2017; 96:1303-1313. [PMID: 28534184 PMCID: PMC5486782 DOI: 10.1007/s00277-017-3012-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/27/2017] [Indexed: 12/18/2022]
Abstract
With high survival rates for chronic myeloid leukemia (CML) patients treated with BCR-ABL1 tyrosine kinase inhibitors (TKIs), emerging consequences, such as arterial ischemic events, require consideration when evaluating treatment options. Cardiovascular ischemic event incidence in clinical trials was evaluated in 2712 dasatinib-treated patients with Philadelphia chromosome-positive (Ph+) leukemias from 11 first- and second-line trials (pooled), newly diagnosed CML patients treated with dasatinib or imatinib (DASISION), and prostate cancer patients treated with dasatinib or placebo plus docetaxel/prednisone (READY). Overall, 2-4% of dasatinib-treated patients had cardiovascular ischemic events. Most dasatinib-treated patients with an event had a history of and/or risk factor for atherosclerosis (pooled 77 with history/risk and event/96 with events; DASISION 8/10; READY 15/18). Most cardiovascular ischemic events occurred within 1 year of initiating dasatinib (pooled 69/96; DASISION 7/10; READY 16/18). Comparison of observed and expected event rates through standardized incidence ratios indicates that dasatinib does not increase risk for cardiovascular ischemic events compared with external reference populations.
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Affiliation(s)
- Giuseppe Saglio
- Clinical and Biological Sciences of the University of Turin, San Luigi Hospital, 10043, Orbassano-Torino, Italy.
| | - Philipp le Coutre
- Charité, Campus Virchow Klinikum, Universitätsmedizin Berlin, Berlin, Germany
| | - Jorge Cortes
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jiří Mayer
- Department of Internal Medicine, Hematology and Oncology, Masaryk University Hospital Brno, Brno, Czech Republic
| | - Philip Rowlings
- Calvary Mater Newcastle Hospital, University of Newcastle, Waratah, NSW, Australia
| | - François-Xavier Mahon
- Laboratoire d'Hématologie et Service des Maladies du Sang, Bordeaux et Institut Bergonié, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | | | | | - Neil P Shah
- UCSF School of Medicine, San Francisco, CA, USA
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Rea D, Henry G, Khaznadar Z, Etienne G, Guilhot F, Nicolini F, Guilhot J, Rousselot P, Huguet F, Legros L, Gardembas M, Dubruille V, Guerci-Bresler A, Charbonnier A, Maloisel F, Ianotto JC, Villemagne B, Mahon FX, Moins-Teisserenc H, Dulphy N, Toubert A. Natural killer-cell counts are associated with molecular relapse-free survival after imatinib discontinuation in chronic myeloid leukemia: the IMMUNOSTIM study. Haematologica 2017; 102:1368-1377. [PMID: 28522576 PMCID: PMC6643734 DOI: 10.3324/haematol.2017.165001] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 05/08/2017] [Indexed: 12/20/2022] Open
Abstract
Despite persistence of leukemic stem cells, patients with chronic myeloid leukemia who achieve and maintain deep molecular responses may successfully stop the tyrosine kinase inhibitor imatinib. However, questions remain unanswered regarding the biological basis of molecular relapse after imatinib cessation. In IMMUNOSTIM, we monitored 51 patients from the French Stop IMatinib trial for peripheral blood T cells and natural killer cells. Molecular relapse-free survival at 24 months was 45.1% (95% CI: 31.44%–58.75%). At the time of imatinib discontinuation, non-relapsing patients had significantly higher numbers of natural killer cells of the cytotoxic CD56dim subset than had relapsing patients, while CD56bright natural killer cells, T cells and their subsets did not differ significantly. Furthermore, the CD56dim natural killer-cell count was an independent prognostic factor of molecular-relapse free survival in a multivariate analysis. However, expression of natural killer-cell activating receptors, BCR-ABL1+ leukemia cell line K562-specific degranulation and cytokine-induced interferon-gamma secretion were decreased in non-relapsing and relapsing patients as compared with healthy individuals. After imatinib cessation, the natural killer-cell count increased significantly and stayed higher in non-relapsing patients than in relapsing patients, while receptor expression and functional properties remained unchanged. Altogether, our results suggest that natural killer cells may play a role in controlling leukemia-initiating cells at the origin of relapse after imatinib cessation, provided that these cells are numerous enough to compensate for their functional defects. Further research will decipher mechanisms underlying functional differences between natural killer cells from patients and healthy individuals and evaluate the potential interest of immunostimulatory approaches in tyrosine kinase inhibitor discontinuation strategies. (ClinicalTrial.gov Identifier NCT00478985)
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Affiliation(s)
- Delphine Rea
- INSERM UMRS-1160, Paris, France .,Service d'Hématologie Adulte, Hôpital Saint-Louis, Paris, France.,France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Institut Bergonié, Bordeaux, France
| | - Guylaine Henry
- Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, Paris, France
| | - Zena Khaznadar
- INSERM UMRS-1160, Paris, France.,Institut Universitaire d'Hématologie, Université Paris Diderot-Paris 7, France
| | - Gabriel Etienne
- France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Institut Bergonié, Bordeaux, France.,Service d'Oncologie Médicale, Institut Bergonié, Bordeaux, France
| | - François Guilhot
- France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Institut Bergonié, Bordeaux, France.,INSERM CIC 1402, CHU de Poitiers, France
| | - Franck Nicolini
- France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Institut Bergonié, Bordeaux, France.,Service d'Hématologie Clinique, CHU Lyon Sud, Pierre Bénite, France
| | - Joelle Guilhot
- France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Institut Bergonié, Bordeaux, France.,INSERM CIC 1402, CHU de Poitiers, France
| | - Philippe Rousselot
- France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Institut Bergonié, Bordeaux, France.,Service d'Hématologie Oncologie et INSERM UMR-1173, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Françoise Huguet
- France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Institut Bergonié, Bordeaux, France.,Service d'Hématologie, IUCT Oncopole, Toulouse, France
| | - Laurence Legros
- France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Institut Bergonié, Bordeaux, France.,Service d'Hématologie Clinique, Hôpital de l'Archet, CHU de Nice, France
| | - Martine Gardembas
- France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Institut Bergonié, Bordeaux, France.,Service des Maladies du Sang, CHRU Angers, France
| | - Viviane Dubruille
- France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Institut Bergonié, Bordeaux, France.,Service d'Hématologie Clinique, Hôpital Hôtel Dieu, Nantes, France
| | - Agnès Guerci-Bresler
- France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Institut Bergonié, Bordeaux, France.,Service d'Hématologie, CHU Brabois, Vandoeuvre les Nancy, France
| | - Aude Charbonnier
- France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Institut Bergonié, Bordeaux, France.,Service d'Onco-Hématologie, Institut Paoli Calmettes, Marseille, France
| | - Frédéric Maloisel
- Groupe Oncologie-Maladies du Sang, Clinique Sainte Anne, Strasbourg, France
| | | | - Bruno Villemagne
- Service Médecine Onco-hématologie, CH de la Roche sur Yon, France
| | - François-Xavier Mahon
- France Intergroupe des Leucémies Myéloïdes Chroniques (Fi-LMC), Institut Bergonié, Bordeaux, France.,Service d'Oncologie Médicale, Institut Bergonié, Bordeaux, France
| | - Hélène Moins-Teisserenc
- INSERM UMRS-1160, Paris, France.,Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, Paris, France.,Institut Universitaire d'Hématologie, Université Paris Diderot-Paris 7, France
| | - Nicolas Dulphy
- INSERM UMRS-1160, Paris, France .,Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, Paris, France.,Institut Universitaire d'Hématologie, Université Paris Diderot-Paris 7, France
| | - Antoine Toubert
- INSERM UMRS-1160, Paris, France.,Laboratoire d'Immunologie et Histocompatibilité, Hôpital Saint-Louis, Paris, France.,Institut Universitaire d'Hématologie, Université Paris Diderot-Paris 7, France
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Rousselot P, Prost S, Guilhot J, Roy L, Etienne G, Legros L, Charbonnier A, Coiteux V, Cony-Makhoul P, Huguet F, Cayssials E, Cayuela JM, Relouzat F, Delord M, Bruzzoni-Giovanelli H, Morisset L, Mahon FX, Guilhot F, Leboulch P. Pioglitazone together with imatinib in chronic myeloid leukemia: A proof of concept study. Cancer 2016; 123:1791-1799. [PMID: 28026860 PMCID: PMC5434901 DOI: 10.1002/cncr.30490] [Citation(s) in RCA: 70] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/13/2016] [Accepted: 11/14/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND We recently reported that peroxisome proliferator‐activated receptor γ agonists target chronic myeloid leukemia (CML) quiescent stem cells in vitro by decreasing transcription of STAT5. Here in the ACTIM phase 2 clinical trial, we asked whether pioglitazone add‐on therapy to imatinib would impact CML residual disease, as assessed by BCR‐ABL1 transcript quantification. METHODS CML patients were eligible if treated with imatinib for at least 2 years at a stable daily dose, having yielded major molecular response (MMR) but not having achieved molecular response 4.5 (MR4.5) defined by BCR‐ABL1/ABL1IS RNA levels ≤ 0.0032%. After inclusion, patients started pioglitazone at a dosage of 30 to 45 mg/day in addition to imatinib. The primary objective was to evaluate the cumulative incidence of patients having progressed from MMR to MR4.5 over 12 months. RESULTS Twenty‐four patients were included (age range, 24‐79 years). No pharmacological interaction was observed between the drugs. The main adverse events were weight gain in 12 patients and a mean decrease of 0.4 g/dL in hemoglobin concentration. The cumulative incidence of MR4.5 was 56% (95% confidence interval, 37%‐76%) by 12 months, despite a wide range of therapy duration (1.9‐15.5 months), and 88% of 17 evaluable patients who were still on imatinib reached MR4.5 by 48 months. The cumulative incidence of MMR to MR4.5 spontaneous conversions over 12 months was estimated to be 23% with imatinib alone in a parallel cohort of patients. CONCLUSION Pioglitazone in combination with imatinib was well tolerated and yielded a favorable 56% rate. These results provide a proof of concept needing confirmation within a randomized clinical trial (EudraCT 2009‐011675‐79). Cancer 2017;123:1791–1799. © 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Pioglitazone is a peroxisome proliferator‐activated receptor gamma agonist that is able to target quiescent chronic myeloid leukemia stem cells. The combination of imatinib and pioglitazone was well tolerated in vivo and induced a cumulative incidence of conversion to molecular response 4.5 (MR4.5) of 56% by 12 months in 24 CML patients who had a major molecular response under imatinib alone.
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Affiliation(s)
- Philippe Rousselot
- Department of Hematology and Oncology, Centre Hospitalier de Versailles, INSERM UMR 1173, Université Versailles Saint-Quentin-en-Yvelines, Université Paris Saclay, Le Chesnay, France
| | - Stéphane Prost
- CEA, Institute of Emerging Diseases and Innovative Therapies, University Paris-Sud UMR 007, Fontenay-aux-Roses, France
| | | | - Lydia Roy
- Department of Hematology, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Gabriel Etienne
- Department of Hematology, Institut Bergonié, Bordeaux, France
| | | | - Aude Charbonnier
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Valérie Coiteux
- Valérie Coiteux, Department of Hematology, Hôpital Claude Huriez CHU de Lille, Lille, France
| | | | - Francoise Huguet
- Department of Hematology, Institut Universitaire du Cancer, Toulouse, France
| | | | - Jean-Michel Cayuela
- Laboratoire de Biologie Moléculaire, Hôpital Saint Louis AP-HP, Paris, France
| | - Francis Relouzat
- CEA, Institute of Emerging Diseases and Innovative Therapies, University Paris-Sud UMR 007, Fontenay-aux-Roses, France
| | - Marc Delord
- Institut Universitaire d'Hématologie, Université Paris VII, Paris, France
| | - Heriberto Bruzzoni-Giovanelli
- Heriberto Bruzzoni-Giovanelli, INSERM CIC 9504, Hôpital Saint-Louis, AP-HP, Paris, France.,University Paris Diderot, Sorbonne Paris Cité, UMRS 1160, Paris, France
| | - Laure Morisset
- Délégation pour la Recherche Clinique et l'Innovation, Centre Hospitalier de Versailles, Le Chesnay, France
| | - François-Xavier Mahon
- Laboratoire d'Hématologie, Hôpital Haut Lévèque CHU de Bordeaux, Institut Bergonie, Bordeaux, France
| | | | - Philippe Leboulch
- CEA, Institute of Emerging Diseases and Innovative Therapies, University Paris-Sud UMR 007, Fontenay-aux-Roses, France.,Philippe Leboulch, Genetics Division, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts.,Hematology Division, Ramathibodi Hospital and Mahidol University, Bangkok, Thailand
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Etienne G, Guilhot J, Rea D, Rigal-Huguet F, Nicolini F, Charbonnier A, Guerci-Bresler A, Legros L, Varet B, Gardembas M, Dubruille V, Tulliez M, Noel MP, Ianotto JC, Villemagne B, Carré M, Guilhot F, Rousselot P, Mahon FX. Long-Term Follow-Up of the French Stop Imatinib (STIM1) Study in Patients With Chronic Myeloid Leukemia. J Clin Oncol 2016; 35:298-305. [PMID: 28095277 DOI: 10.1200/jco.2016.68.2914] [Citation(s) in RCA: 304] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose Imatinib (IM) can safely be discontinued in patients with chronic myeloid leukemia (CML) who have had undetectable minimal residual disease (UMRD) for at least 2 years. We report the final results of the Stop Imatinib (STIM1) study with a long follow-up. Patients and Methods IM was prospectively discontinued in 100 patients with CML with UMRD sustained for at least 2 years. Molecular recurrence (MR) was defined as positivity of BCR-ABL transcript in a quantitative reverse transcriptase polymerase chain reaction assay confirmed by a second analysis point that indicated an increase of one log in relation to the first analysis point at two successive assessments or loss of major molecular response at one point. Results The median molecular follow-up after treatment discontinuation was 77 months (range, 9 to 95 months). Sixty-one patients lost UMRD after a median of 2.5 months (range, 1 to 22 months), and one patient died with UMRD at 10 months. Molecular recurrence-free survival was 43% (95% CI, 33% to 52%) at 6 months and 38% (95% CI, 29% to 47%) at 60 months. Treatment was restarted in 57 of 61 patients with MR, and 55 patients achieved a second UMRD with a median time of 4 months (range, 1 to 16 months). None of the patients experienced a CML progression. Analyses of the characteristics of the study population identified that the Sokal risk score and duration of IM treatment were significantly associated with the probability of MR. Conclusion With a median follow-up of more than 6 years after treatment discontinuation, the STIM1 study demonstrates that IM can safely be discontinued in patients with a sustained deep molecular response with no late MR.
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Affiliation(s)
- Gabriel Etienne
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Joëlle Guilhot
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Delphine Rea
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Françoise Rigal-Huguet
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Franck Nicolini
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Aude Charbonnier
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Agnès Guerci-Bresler
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Laurence Legros
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Bruno Varet
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Martine Gardembas
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Viviane Dubruille
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Michel Tulliez
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Marie-Pierre Noel
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Jean-Christophe Ianotto
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Bruno Villemagne
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Martin Carré
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - François Guilhot
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - Philippe Rousselot
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
| | - François-Xavier Mahon
- Gabriel Etienne and François-Xavier Mahon, Institut Bergonié, Bordeaux; Joëlle Guilhot and François Guilhot, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire (CHU) de Poitiers, Poitiers; Delphine Rea, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Bruno Varet, Hôpital Necker, AP-HP et Université Paris Descartes, Paris; Françoise Rigal-Huguet, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse; Franck Nicolini, Centre Hospitalier Lyon Sud, Pierre Bénite; Aude Charbonnier, Institut Paoli Calmette, Marseille; Agnès Guerci-Bresler, CHU Brabois Vandoeuvre, Nancy; Laurence Legros, Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice; Martine Gardembas, CHU d'Angers, Angers; Viviane Dubruille, CHU Hôtel-Dieu, Nantes; Michel Tulliez, Hôpital Henri Mondor, Créteil; Marie-Pierre Noel, Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire de Lille, Lille; Jean-Christophe Ianotto, CHU Morvan, Brest; Bruno Villemagne, Centre Hospitalier Départemental La Roche-Sur-Yon, La Roche-Sur-Yon; Martin Carré, Hôpital Albert Michallon, CHU de Grenoble, Grenoble; Philippe Rousselot, Hôpital André Mignot, Le Chesnay; and François-Xavier Mahon, CHU de Bordeaux, INSERM U1218, Bordeaux, France
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Lewis M, Copland M, Soverini S, Sadovnik I, Bedel A, Prost S, Italiano A, Mahon FX. What are the challenges in 2016 regarding resistance to tyrosine kinase inhibitors in chronic myeloid leukemia and cancer? Hematol Oncol 2016; 35:420-423. [PMID: 27435333 DOI: 10.1002/hon.2329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/31/2016] [Accepted: 06/11/2016] [Indexed: 11/09/2022]
Abstract
In the past decade, the treatment of chronic myeloid leukemia (CML) has undergone a drastic evolution. The discovery and success of imatinib and second-generation tyrosine kinase inhibitors have substantially increased the outcome for CML patients. The next step in medical and scientific research is to better understand the malignancy so as to eventually find a cure to eliminate all leukemic cells from patients. One of the key issues is about the resistance of the leukemic stem cells to tyrosine kinase inhibitors. Here, we briefly describe our current studies on CML resistance, and leukemic stem cell modeling and characterization.
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Affiliation(s)
- Matthieu Lewis
- Laboratory of Mammary and Leukemic Oncogenesis: Genetic Diversity and Resistance to Treatment, ACTION, INSERM U1218, University of Bordeaux, Bordeaux, Gironde, France
| | - Mhairi Copland
- Institute of Cancer Sciences, University of Glasgow, Glasgow, Glasgow City Counsil, UK
| | - Simona Soverini
- Department of Experimental, Diagnostic and Specialty Medicine, Haematology/Oncology "L. and A. Seràgnoli", University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Irina Sadovnik
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Vienna, Austria
| | - Aurélie Bedel
- Biothérapie de Maladies Génétiques et Cancer, INSERM U1035, Université de Bordeaux, Bordeaux, Gironde, France
| | - Stéphane Prost
- CEA, Institute of Emerging Diseases and Innovative Therapies (iMETI), F-92265, Fontenay-aux-Roses, Île de France, France
| | - Antoine Italiano
- Department of Medical Oncology, Bergonié Institute, Bordeaux, Gironde, France
| | - François-Xavier Mahon
- Laboratory of Mammary and Leukemic Oncogenesis: Genetic Diversity and Resistance to Treatment, ACTION, INSERM U1218, University of Bordeaux, Bordeaux, Gironde, France
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Springuel L, Losdyck E, Saussoy P, Turcq B, Mahon FX, Knoops L, Renauld JC. Loss of mutL homolog-1 (MLH1) expression promotes acquisition of oncogenic and inhibitor-resistant point mutations in tyrosine kinases. Cell Mol Life Sci 2016; 73:4739-4748. [PMID: 27436342 DOI: 10.1007/s00018-016-2310-2] [Citation(s) in RCA: 4] [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] [Received: 02/10/2016] [Revised: 07/11/2016] [Accepted: 07/15/2016] [Indexed: 11/29/2022]
Abstract
Genomic instability drives cancer progression by promoting genetic abnormalities that allow for the multi-step clonal selection of cells with growth advantages. We previously reported that the IL-9-dependent TS1 cell line sequentially acquired activating substitutions in JAK1 and JAK3 upon successive selections for growth factor independent and JAK inhibitor-resistant cells, suggestive of a defect in mutation avoidance mechanisms. In the first part of this paper, we discovered that the gene encoding mutL homolog-1 (MLH1), a key component of the DNA mismatch repair system, is silenced by promoter methylation in TS1 cells. By means of stable ectopic expression and RNA interference methods, we showed that the high frequencies of growth factor-independent and inhibitor-resistant cells with activating JAK mutations can be attributed to the absence of MLH1 expression. In the second part of this paper, we confirm the clinical relevance of our findings by showing that chronic myeloid leukemia relapses upon ABL-targeted therapy correlated with a lower expression of MLH1 messenger RNA. Interestingly, the mutational profile observed in our TS1 model, characterized by a strong predominance of T:A>C:G transitions, was identical to the one described in the literature for primitive cells derived from chronic myeloid leukemia patients. Taken together, our observations demonstrate for the first time a causal relationship between MLH1-deficiency and incidence of oncogenic point mutations in tyrosine kinases driving cell transformation and acquired resistance to kinase-targeted cancer therapies.
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Affiliation(s)
- Lorraine Springuel
- Ludwig Institute for Cancer Research, Brussels Branch, Avenue Hippocrate 74, 1200, Brussels, Belgium.,de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Elisabeth Losdyck
- Ludwig Institute for Cancer Research, Brussels Branch, Avenue Hippocrate 74, 1200, Brussels, Belgium.,de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Pascale Saussoy
- Hematology Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Béatrice Turcq
- Leukemic Hematopoiesis and Therapeutic Targets Laboratory, University of Bordeaux, Bordeaux, France
| | - François-Xavier Mahon
- Leukemic Hematopoiesis and Therapeutic Targets Laboratory, University of Bordeaux, Bordeaux, France
| | - Laurent Knoops
- Ludwig Institute for Cancer Research, Brussels Branch, Avenue Hippocrate 74, 1200, Brussels, Belgium. .,de Duve Institute, Université Catholique de Louvain, Brussels, Belgium. .,Hematology Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| | - Jean-Christophe Renauld
- Ludwig Institute for Cancer Research, Brussels Branch, Avenue Hippocrate 74, 1200, Brussels, Belgium. .,de Duve Institute, Université Catholique de Louvain, Brussels, Belgium.
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Mansier O, Migeon M, Saint-Lézer A, James C, Verger E, Robin M, Socié G, Bidet A, Mahon FX, Cassinat B, Lippert E. Quantification of the Mutant CALR Allelic Burden by Digital PCR. J Mol Diagn 2016; 18:68-74. [DOI: 10.1016/j.jmoldx.2015.07.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/07/2015] [Accepted: 07/22/2015] [Indexed: 01/07/2023] Open
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Fossard G, Blond E, Balsat M, Morisset S, Giraudier S, Escoffre-Barbe M, Labussière-Wallet H, Heiblig M, Bert A, Etienne M, Drai J, Sobh M, Redonnet-Vernhet I, Lega JC, Mahon FX, Etienne G, Nicolini FE. Hyperhomocysteinemia and high doses of nilotinib favor cardiovascular events in chronic phase Chronic Myelogenous Leukemia patients. Haematologica 2015; 101:e86-90. [PMID: 26635034 DOI: 10.3324/haematol.2015.135103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Gaëlle Fossard
- Hematology department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite
| | - Emilie Blond
- Laboratory of biochemistry, Centre Hospitalier Lyon Sud, Pierre Bénite INSERM U1060, CarMeN Laboratory, Lyon 1 University, INRA 1235, Oullins
| | - Marie Balsat
- Hematology department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite
| | - Stéphane Morisset
- Hematology department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite
| | - Stéphane Giraudier
- Laboratory of Hematology, Hôpital Henri Mondor, Créteil Groupe Fi-LMC, Hôpital Haut Lévêque, Pessac, France
| | - Martine Escoffre-Barbe
- Hematology department, Hôpital Pontchaillou, Rennes Groupe Fi-LMC, Hôpital Haut Lévêque, Pessac, France
| | | | - Maël Heiblig
- Hematology department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite
| | - Arthur Bert
- Hematology department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite
| | - Madeleine Etienne
- Hematology department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite Groupe Fi-LMC, Hôpital Haut Lévêque, Pessac, France
| | - Jocelyne Drai
- Laboratory of biochemistry, Centre Hospitalier Lyon Sud, Pierre Bénite INSERM U1060, CarMeN Laboratory, Lyon 1 University, INRA 1235, Oullins
| | - Mohamad Sobh
- Hematology department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite
| | | | | | - François-Xavier Mahon
- Département d'hématologie, Institut Bergonié, Bordeaux Groupe Fi-LMC, Hôpital Haut Lévêque, Pessac, France
| | - Gabriel Etienne
- Département d'hématologie, Institut Bergonié, Bordeaux Groupe Fi-LMC, Hôpital Haut Lévêque, Pessac, France
| | - Franck Emmanuel Nicolini
- Hematology department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite Inserm U1052, Centre de Recherche en Cancérologie de Lyon Groupe Fi-LMC, Hôpital Haut Lévêque, Pessac, France
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Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm characterized by the presence of an oncogenic fusion gene, BCR–ABL1. This fusion gene produces a cytoplasmic protein with tyrosine kinase activity that acts as a main driver of oncogenesis and abnormal proliferation of myeloid cells in CML. Targeted therapy with BCR–ABL1 tyrosine kinase inhibitors (TKIs) such as imatinib is followed by long-term responses in most patients. However, despite continuous treatment, relapses occur, suggesting the presence of TKI-resistant neoplastic stem cells in these patients. Here, we discuss potential mechanisms and signaling molecules involved in the prosurvival and self-renewal capacity of CML neoplastic stem cells as well as antigens expressed by these cells. Several of these signaling molecules and cell surface antigens may serve as potential targets of therapy and their use may overcome TKI resistance in CML in the future.
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Affiliation(s)
- Michel Arock
- Molecular & Cellular Oncology, LBPA CNRS UMR8113, Ecole Normale Supérieure de Cachan, Cachan, France
- Laboratory of Hematology, Pitié-Salpêtrière Hospital, Paris, France
| | - François-Xavier Mahon
- Laboratory of Hematology, CHU de Bordeaux, Bordeaux, France
- Laboratoire Hématopoïèse Leucémique et Cible Thérapeutique INSERM U1035, Université de Bordeaux, Bordeaux, France
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria
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48
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Gioia R, Trégoat C, Dumas PY, Lagarde V, Prouzet-Mauléon V, Desplat V, Sirvent A, Praloran V, Lippert E, Villacreces A, Leconet W, Robert B, Vigon I, Roche S, Mahon FX, Pasquet JM. CBL controls a tyrosine kinase network involving AXL, SYK and LYN in nilotinib-resistant chronic myeloid leukaemia. J Pathol 2015; 237:14-24. [PMID: 25965880 DOI: 10.1002/path.4561] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 10/02/2014] [Revised: 04/20/2015] [Accepted: 04/29/2015] [Indexed: 12/23/2022]
Abstract
A tyrosine kinase network composed of the TAM receptor AXL and the cytoplasmic kinases LYN and SYK is involved in nilotinib-resistance of chronic myeloid leukaemia (CML) cells. Here, we show that the E3-ubiquitin ligase CBL down-regulation occurring during prolonged drug treatment plays a critical role in this process. Depletion of CBL in K562 cells increases AXL and LYN protein levels, promoting cell resistance to nilotinib. Conversely, forced expression of CBL in nilotinib-resistant K562 cells (K562-rn) dramatically reduces AXL and LYN expression and resensitizes K562-rn cells to nilotinib. A similar mechanism was found to operate in primary CML CD34(+) cells. Mechanistically, the E3-ligase CBL counteracts AXL/SYK signalling, promoting LYN transcription by controlling AXL protein stability. Surprisingly, the role of AXL in resistance was independent of its ligand GAS6 binding and its TK activity, in accordance with a scaffold activity for this receptor being involved in this cellular process. Collectively, our results demonstrate a pivotal role for CBL in the control of a tyrosine kinase network mediating resistance to nilotinib treatment in CML cells.
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Affiliation(s)
- Romain Gioia
- Hématopoïèse Leucémique et Cibles Thérapeutiques, INSERM U1035, Université de Bordeaux, France
| | - Claire Trégoat
- Hématopoïèse Leucémique et Cibles Thérapeutiques, INSERM U1035, Université de Bordeaux, France
| | - Pierre-Yves Dumas
- Hématopoïèse Leucémique et Cibles Thérapeutiques, INSERM U1035, Université de Bordeaux, France
| | - Valérie Lagarde
- Hématopoïèse Leucémique et Cibles Thérapeutiques, INSERM U1035, Université de Bordeaux, France
| | - Valérie Prouzet-Mauléon
- Hématopoïèse Leucémique et Cibles Thérapeutiques, INSERM U1035, Université de Bordeaux, France
| | - Vanessa Desplat
- Hématopoïèse Leucémique et Cibles Thérapeutiques, INSERM U1035, Université de Bordeaux, France
| | - Audrey Sirvent
- CNRS UMR5237, Centre de Recherche de Biochimie Macromoléculaire, Montpellier, France
| | - Vincent Praloran
- Hématopoïèse Leucémique et Cibles Thérapeutiques, INSERM U1035, Université de Bordeaux, France
| | - Eric Lippert
- Hématopoïèse Leucémique et Cibles Thérapeutiques, INSERM U1035, Université de Bordeaux, France
| | - Arnaud Villacreces
- Hématopoïèse Leucémique et Cibles Thérapeutiques, INSERM U1035, Université de Bordeaux, France
| | - Wilhem Leconet
- Equipe Immunociblage et Radiobiologie en Oncologie, IRCM Institut de Recherche en Cancérologie de Montpellier, INSERM U896-Université Montpellier1-ICM, Montpellier, France
| | - Bruno Robert
- Equipe Immunociblage et Radiobiologie en Oncologie, IRCM Institut de Recherche en Cancérologie de Montpellier, INSERM U896-Université Montpellier1-ICM, Montpellier, France
| | - Isabelle Vigon
- Hématopoïèse Leucémique et Cibles Thérapeutiques, INSERM U1035, Université de Bordeaux, France
| | - Serge Roche
- CNRS UMR5237, Centre de Recherche de Biochimie Macromoléculaire, Montpellier, France
| | - François-Xavier Mahon
- Hématopoïèse Leucémique et Cibles Thérapeutiques, INSERM U1035, Université de Bordeaux, France
| | - Jean-Max Pasquet
- Hématopoïèse Leucémique et Cibles Thérapeutiques, INSERM U1035, Université de Bordeaux, France
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49
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Nicolini FE, Etienne G, Dubruille V, Roy L, Huguet F, Legros L, Giraudier S, Coiteux V, Guerci-Bresler A, Lenain P, Cony-Makhoul P, Gardembas M, Hermet E, Rousselot P, Amé S, Gagnieu MC, Pivot C, Hayette S, Maguer-Satta V, Etienne M, Dulucq S, Rea D, Mahon FX. Nilotinib and peginterferon alfa-2a for newly diagnosed chronic-phase chronic myeloid leukaemia (NiloPeg): a multicentre, non-randomised, open-label phase 2 study. Lancet Haematol 2015; 2:e37-46. [PMID: 26687426 DOI: 10.1016/s2352-3026(14)00027-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Nilotinib is now recommended for patients with newly diagnosed chronic myeloid leukaemia in chronic phase and leads to important rates of molecular response 4·5 log (MR(4·5)), allowing the prospect of therapy cessation. However, most patients do not reach this criterion and nilotinib is taken for lengthy periods, resulting in chronic or late-onset adverse events. Nilotinib combined with interferon might further increase rates of MR(4·5), avoid late side-effects, and allow therapy cessation. In a phase 2 trial we aimed to assess the feasibility, safety, and deep molecular response of the combination of nilotinib (600 mg daily) and peginterferon alfa-2a in newly diagnosed patients with chronic-phase chronic myeloid leukaemia (CML). METHODS In a non-randomised, open-label, phase 2 trial, we enrolled adult patients (age ≥18 years) without any organ failure who had BCR-ABL-positive, chronic-phase CML, at diagnosis. After a priming procedure with 90 μg per week of peginterferon alfa-2a alone for a month, we gave patients peginterferon alfa-2a 45 μg per week combined with nilotinib 600 mg daily until 24 months after interferon initiation. The primary endpoint was the cumulative incidence of MR(4·5) at 12 months after initiation of peginterferon alfa-2a. Data were analysed by a modified intention-to-treat principle. This trial is registered at the European Clinical Trials Database (EudraCT), number 2010-019786-28. FINDINGS Between March 24, 2011, and Sept 27, 2011, we enrolled 42 patients. One patient withdrew consent before receiving any study treatment so was excluded from analysis; 41 patients received treatment with peginterferon alfa-2a and nilotinib. At 12 months, seven (17%) patients had achieved MR(4·5). Haematological and hepatic adverse events were frequent-with grade 3-4 neutropenias occurring in ten (24%) patients, grade 3-4 thrombocytopenias occurring in ten (24%) patients, grade 3-4 cholestatic events occurring in seven (17%) patients, and grade 3-4 elevations in aspartate aminotransferase or alanine aminotransferase occurring in three (7% patients-particularly during the first 3 months. However, 30 (73%) patients remained on interferon therapy at 1 year. Three grade 3-4 cardiac events (7% of patients, all coronary stenoses) occurred at later timepoints. INTERPRETATION The combination of peginterferon alfa-2a resulted in good molecular responses in patients. Despite substantial toxic effects, most patients remained on the study drugs for more than a year. This combination should now be tested in a randomised controlled trial. FUNDING Novartis Pharma.
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Affiliation(s)
- Franck E Nicolini
- Haematology Department, Centre Hospitalier Lyon Sud, Pierre Bénite, France; INSERM U1052, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, Lyon, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France.
| | - Gabriel Etienne
- Haematology Department, Institut Bergonié, Bordeaux, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Viviane Dubruille
- Haematology Department, Hôtel Dieu, Nantes, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Lydia Roy
- Haematology and Cellular Therapy Department, University Hospital of Poitiers, Poitiers, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Françoise Huguet
- Haematology Department, Institut Universitaire du Cancer Toulouse Oncopôle, Toulouse, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Laurence Legros
- Haematology Department, Hôpital de l'Archet, Nice, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Stéphane Giraudier
- Laboratory for Haematology, Hôpital Henri Mondor, Créteil, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Valérie Coiteux
- Haematology Department, Hôpital Huriez, Lille, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Agnès Guerci-Bresler
- Haematology Department, Hôpital de Brabois, Vandoeuvre-lès-Nancy, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Pascal Lenain
- Haematology Department, Centre Henri Becquerel, Rouen, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Pascale Cony-Makhoul
- Haematology Department, Centre Hospitalier d'Annecy Genevois, Metz-Tessy, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Martine Gardembas
- Haematology Department, University Hospital of Angers, Angers, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Eric Hermet
- Haematology Department, CHU d'Estaing, Clermont-Ferrand, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Philippe Rousselot
- Haematology and Oncology Department, Hôpital A Mignot, Le Chesnay, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Shanti Amé
- Haematology Department, Hôpital Civil, Strasbourg, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | | | | | - Sandrine Hayette
- Laboratory of Molecular Biology, Centre Hospitalier Lyon Sud, Pierre Bénite, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Veronique Maguer-Satta
- INSERM U1052, Centre de Recherche en Cancérologie de Lyon, Centre Léon Bérard, Lyon, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Madeleine Etienne
- Haematology Department, Centre Hospitalier Lyon Sud, Pierre Bénite, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Stéphanie Dulucq
- Laboratory of Haematology, Hôpital Haut Lévêque, avenue de Magellan, 33604 Pessac, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - Delphine Rea
- Adult Haematology Department, Hôpital Saint Louis, AP-HP, Paris, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
| | - François-Xavier Mahon
- Laboratory of Haematology, Hôpital Haut Lévêque, avenue de Magellan, 33604 Pessac, France; French group of CML (Fi-LMC group), Laboratory of Haematology, Hôpital Haut Lévêque, Pessac, France
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50
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Etienne G, Dulucq S, Lascaux A, Schmitt A, Bidet A, Fort MP, Lippert E, Bureau C, Adiko D, Hayette S, Reiffers J, Nicolini FE, Mahon FX. ELN 2013 response status criteria: relevance for de novo imatinib chronic phase chronic myeloid leukemia patients? Am J Hematol 2015; 90:37-41. [PMID: 25293449 DOI: 10.1002/ajh.23864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 11/10/2022]
Abstract
The response definitions proposed by the European Leukemia Net (ELN) have been recently modified. We evaluated the new criteria for de novo imatinib (400 mg/d) chronic phase chronic myeloid leukemia (CP-CML) patients. Response status according to the 2009 and 2013 criteria were determined in 180 unselected patients. Outcome of the subgroups of patients were then compared. The 180 patients were classified as optimal responders (OR2009; n = 113, 62.7%), suboptimal responders (SOR2009; n = 47, 26.1%) and failures (FAIL2009; n = 20, 11.1%) according to the 2009 ELN criteria and optimal responders (OR2013; n = 77, 42.7%), warnings (WAR2013; n = 59, 32.7%), and failures (FAIL2013; n = 44, 24.4%) according to the 2013 ELN criteria. No difference in terms of outcome was observed between OR2009 patients who became WAR2013 when compared with OR2013 patients. When compared with FAIL2009 patients, SOR2009 patients who became WAR2013 had better EFS, FFS, PFS, and OS. No difference was observed in PFS or OS in SOR2009 patients who became FAIL2013. The 2013 ELN response status criteria have improved patients classification in terms of response status. However, in our patient population this improvement is related to a better definition of failure rather than that of optimal response for CP-CML patients treated with IM frontline therapy.
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Affiliation(s)
| | - Stéphanie Dulucq
- Hematology Laboratory, Hôpital Pellegrin; Centre Hospitalier Universitaire; Bordeaux France
| | - Axelle Lascaux
- Blood Disorders Service; Centre Hospitalier Universitaire; Bordeaux France
| | - Anna Schmitt
- Hematology Department; Institut Bergonié; Bordeaux France
| | - Audrey Bidet
- Hematology Laboratory, Hôpital Pellegrin; Centre Hospitalier Universitaire; Bordeaux France
| | | | - Eric Lippert
- Hematology Laboratory, Hôpital Pellegrin; Centre Hospitalier Universitaire; Bordeaux France
| | - Caroline Bureau
- Hematology Service; Polyclinique Bordeaux Nord Aquitaine; Bordeaux France
| | - Didier Adiko
- Hematology Service; Centre Hospitalier Robert Boulin; Libourne France
| | - Sandrine Hayette
- Laboratory of Cytogenetics and Molecular Biology; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - Josy Reiffers
- Hematology Department; Institut Bergonié; Bordeaux France
| | | | - François-Xavier Mahon
- Hematology Department; Institut Bergonié; Bordeaux France
- Blood Disorders Service; Centre Hospitalier Universitaire; Bordeaux France
- Hematopoiesis Leukemia and Therapeutic Targets, INSERM U 1035; Université Bordeaux; France
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