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Thomas-Joulié A, Tran S, El Houari L, Seyve A, Bielle F, Birzu C, Lozano-Sanchez F, Mokhtari K, Giry M, Marie Y, Laigle-Donadey F, Dehais C, Houillier C, Psimaras D, Alentorn A, Laurenge A, Touat M, Sanson M, Hoang-Xuan K, Kas A, Rozenblum L, Habert MO, Nichelli L, Leclercq D, Galanaud D, Jacob J, Karachi C, Capelle L, Carpentier A, Mathon B, Belin L, Idbaih A. Prognosis of glioblastoma patients improves significantly over time interrogating historical controls. Eur J Cancer 2024; 202:114004. [PMID: 38493668 DOI: 10.1016/j.ejca.2024.114004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Glioblastoma (GBM) is the most common devastating primary brain cancer in adults. In our clinical practice, median overall survival (mOS) of GBM patients seems increasing over time. METHODS To address this observation, we have retrospectively analyzed the prognosis of 722 newly diagnosed GBM patients, aged below 70, in good clinical conditions (i.e. Karnofsky Performance Status -KPS- above 70%) and treated in our department according to the standard of care (SOC) between 2005 and 2018. Patients were divided into two groups according to the year of diagnosis (group 1: from 2005 to 2012; group 2: from 2013 to 2018). RESULTS Characteristics of patients and tumors of both groups were very similar regarding confounding factors (age, KPS, MGMT promoter methylation status and treatments). Follow-up time was fixed at 24 months to ensure comparable survival times between both groups. Group 1 patients had a mOS of 19 months ([17.3-21.3]) while mOS of group 2 patients was not reached. The recent period of diagnosis was significantly associated with a longer mOS in univariate analysis (HR=0.64, 95% CI [0.51 - 0.81]), p < 0.001). Multivariate Cox analysis showed that the period of diagnosis remained significantly prognostic after adjustment on confounding factors (adjusted Hazard Ratio (aHR) 0.49, 95% CI [0.36-0.67], p < 0.001). CONCLUSION This increase of mOS over time in newly diagnosed GBM patients could be explained by better management of potentially associated non-neurological diseases, optimization of validated SOC, better management of treatments side effects, supportive care and participation in clinical trials.
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Affiliation(s)
- A Thomas-Joulié
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France; AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service d'Oncologie-Radiothérapie, F-75013 Paris, France
| | - S Tran
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuropathologie-Escourolle, F-75013 Paris, France
| | - L El Houari
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Unité de Recherche Clinique, F-75013 Paris, France
| | - A Seyve
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - F Bielle
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuropathologie-Escourolle, F-75013 Paris, France
| | - C Birzu
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - F Lozano-Sanchez
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - K Mokhtari
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuropathologie-Escourolle, F-75013 Paris, France
| | - M Giry
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, F-75013 Paris, France
| | - Y Marie
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, F-75013 Paris, France
| | - F Laigle-Donadey
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - C Dehais
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - C Houillier
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - D Psimaras
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - A Alentorn
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - A Laurenge
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - M Touat
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - M Sanson
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - K Hoang-Xuan
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France
| | - A Kas
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Médecine Nucléaire, F-75013 Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75006 Paris, France
| | - L Rozenblum
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Médecine Nucléaire, F-75013 Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75006 Paris, France
| | - M-O Habert
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Médecine Nucléaire, F-75013 Paris, France; Laboratoire d'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, 75006 Paris, France
| | - L Nichelli
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuroradiologie, F-75013 Paris, France
| | - D Leclercq
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuroradiologie, F-75013 Paris, France
| | - D Galanaud
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neuroradiologie, F-75013 Paris, France
| | - J Jacob
- AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service d'Oncologie-Radiothérapie, F-75013 Paris, France
| | - C Karachi
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013 Paris, France
| | - L Capelle
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013 Paris, France
| | - A Carpentier
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013 Paris, France
| | - B Mathon
- Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurochirurgie, F-75013 Paris, France
| | - L Belin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Département de Santé Publique, Unité de Recherche Clinique Pitié-Salpêtrière-Charles Foix, Paris, France
| | - A Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie-Oncologie, F-75013 Paris, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Département de Santé Publique, Unité de Recherche Clinique Pitié-Salpêtrière-Charles Foix, Paris, France.
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Aboubakr O, Houillier C, Choquet S, Dupont S, Hoang-Xuan K, Mathon B. Epileptic seizures in patients with primary central nervous system lymphoma: A systematic review. Rev Neurol (Paris) 2023:S0035-3787(23)01116-5. [PMID: 38042665 DOI: 10.1016/j.neurol.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) accounts for less than 5% of primary brain tumors. Epileptic seizures are a common manifestation of brain tumors; however, literature on the prevalence, characteristics, and oncological implications of seizures in patients with PCNSL is limited, and the management of antiepileptic drugs (AEDs) is unclear. This review aimed to summarize the existing knowledge on seizures in PCNSL, their potential association with surgery, oncological treatment, survival rates, and management of AEDs. METHODS A systematic review was performed according to the PRISMA recommendations and included articles published between 1953 and 2023 describing seizures in patients with PCNSL. RESULTS The search identified 282 studies, of which 21 were included. Up to 33% of patients with PCNSL developed seizures, mostly at the initial presentation. Little information was found on changes in seizure incidence through the course of the disease, and no details were found on seizure frequency, the percentage of treatment-resistant patients, or the evolution of seizures at remission. Younger age, cortical location, and immunodeficiency have been identified as potential risk factors for seizures, but evidence is very limited. The growing use of vigorous treatments including intensive chemotherapy with autologous stem cell transplantation and immunotherapy with CAR-T cells is associated with a higher incidence of seizures. The association between seizure development and patient mortality in PCNSL remains unknown. There are no data on AED prophylaxis or the use of specific AEDs in PCNSL. CONCLUSIONS Further studies are needed to investigate seizures in larger cohorts of PCNSL, to clarify their prevalence, better characterize them, identify risk factors, analyze survival rates, and make recommendations on AED management. We recommend following general practice guidelines for seizures symptomatic of brain tumors and not to prescribe AED prophylaxis in PCNSL.
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Affiliation(s)
- O Aboubakr
- Sorbonne University, Department of Neurosurgery, la Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France
| | - C Houillier
- Department of Neurology 2 Mazarin, la Pitié-Salpêtrière Hospital, IHU, ICM, AP-HP, Sorbonne University, 75013 Paris, France
| | - S Choquet
- Department of Hematology, la Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France
| | - S Dupont
- Epileptology Unit, Department of Rehabilitation, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, 75013 Paris, France
| | - K Hoang-Xuan
- Department of Neurology 2 Mazarin, la Pitié-Salpêtrière Hospital, IHU, ICM, AP-HP, Sorbonne University, 75013 Paris, France
| | - B Mathon
- Sorbonne University, Department of Neurosurgery, la Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France; Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne University, UMRS 1127, 75013 Paris, France; GRC 23, Brain Machine Interface, la Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France.
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Rachdi A, Hernandez-Tost H, Herzi D, Morales-Martinez A, Hernández-Verdin I, Houillier C, Alentorn A, Hoang-Xuan K. Recent advances in the diagnosis and the treatment of primary CNS lymphoma. Rev Neurol (Paris) 2023; 179:481-489. [PMID: 37045615 DOI: 10.1016/j.neurol.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 04/14/2023]
Abstract
This review focuses on the recent progress in the management of primary central nervous system lymphoma (PCNSL). Multiomic analyses allowed to better understand the tumorigenesis of PCNSL and to establish a molecular classification with prognostic value that will optimize patient management and guide future targeted approaches. Cooperative clinical trials have demonstrated the feasibility and efficacy, in selected fit patients, of high-dose chemotherapy with autologous stem cell transplantation as post-induction consolidation, that will progressively replace whole brain radiotherapy associated with a much higher risk of delayed neurotoxicity. Several novel treatments have shown efficacy and overall good tolerance in PCNSL patients, such as Bruton's tyrosine kinase (BTK) inhibitors, imids, immune checkpoint inhibitors and chimeric antigen receptor T-cells (CAR-T). This opens promising therapeutic perspectives to improve the current standard treatment, especially for elderly and unfit patients who represent a growing population.
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Affiliation(s)
- A Rachdi
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Institut Mongi Ben Hamida de neurologie de Tunis, Tunis, Tunisia
| | - H Hernandez-Tost
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | - D Herzi
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | - A Morales-Martinez
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France
| | | | - C Houillier
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; LOC network, France
| | - A Alentorn
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Brain Institute-ICM, Inserm, Sorbonne université, CNRS, Paris, France; LOC network, France
| | - K Hoang-Xuan
- Service de neurologie 2, CHU Pitié-Salpêtrière, AP-HP, Sorbonne université, 47, boulevard de l'hôpital, 75013 Paris, France; Brain Institute-ICM, Inserm, Sorbonne université, CNRS, Paris, France; LOC network, France.
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4
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Dufour J, Choquet S, Hoang-Xuan K, Schmitt A, Ahle G, Houot R, Taillandier L, Gressin R, Casasnovas O, Marolleau JP, Tamburini J, Serrier C, Perez E, Paillassa J, Gyan E, Chauchet A, Ursu R, Kas A, Soussain C, Houillier C. Systemic relapses of primary CNS lymphomas (PCNSL): a LOC network study. Ann Hematol 2023; 102:1159-1169. [PMID: 36991231 DOI: 10.1007/s00277-023-05108-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/19/2023] [Indexed: 03/31/2023]
Abstract
Primary central nervous system lymphomas (PCNSLs) classically remain confined within the CNS throughout their evolution for unknown reasons. Our objective was to analyse the rare extracerebral relapses of PCNSL in a nationwide population-based study. We retrospectively selected PCNSL patients who experienced extracerebral relapse during their follow-up from the French LOC database. Of the 1968 PCNSL included in the database from 2011, 30 (1.5%, median age 71 years, median KPS 70) presented an extracerebral relapse, either pure (n = 20) or mixed (both extracerebral and in the CNS) (n = 10), with a histological confirmation in 20 cases. The median delay between initial diagnosis and systemic relapse was 15.5 months [2-121 months]. We found visceral (n = 23, 77%), including testis in 5 (28%) men and breast in 3 (27%) women, lymph node (n = 12, 40%), and peripheral nervous system (PNS) (n = 7, 23%) involvement. Twenty-seven patients were treated with chemotherapy, either with only systemic targets (n = 7) or mixed systemic and CNS targets (n = 20), 4 were consolidated by HCT-ASCT. After systemic relapse, the median progression-free survival and overall survival (OS) were 7 and 12 months, respectively. KPS > 70 and pure systemic relapses were significantly associated with higher OS. Extracerebral PCNSL relapses are rare, mainly extranodal, and frequently involve the testis, breast, and PNS. The prognosis was worse in mixed relapses. Early relapses raise the question of misdiagnosed occult extracerebral lymphoma at diagnostic workup that should systematically include a PET-CT. Paired tumour analysis at diagnosis/relapse would provide a better understanding of the underlying molecular mechanisms.
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Affiliation(s)
- J Dufour
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - S Choquet
- Hôpital Pitié-Salpêtrière, Service d'Hématologie clinique, Paris, France
| | - K Hoang-Xuan
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - A Schmitt
- Institut de Bergonie, Service d'Hématologie, Bordeaux, France
| | - G Ahle
- Hôpitaux civils de Colmar, Service de Neurologie, Colmar, France
| | - R Houot
- Hôpital Universitaire de Rennes, Service d'Hématologie, Rennes, France
| | - L Taillandier
- Hôpital Universitaire de Nancy, Service de Neurologie, Nancy, France
| | - R Gressin
- Hôpital Universitaire de Grenoble, Service d'Hématologie, Grenoble, France
| | - O Casasnovas
- Hôpital Universitaire de Dijon, Service d'hematologie clinique, Dijon, France
| | - J P Marolleau
- Hôpital Universitaire d'Amiens, Service d'Hematologie clinique, Amiens, France
| | - J Tamburini
- Hôpital Cochin, Service d'Hématologie, Paris, France
| | - C Serrier
- Centre Hospitalier de Perpignan, Service d'Hématologie, Perpignan, France
| | - E Perez
- Hôpital Universitaire de la Réunion, Service d'oncologie-hématologie, Paris, La Réunion, France
| | - J Paillassa
- Hôpital Universitaire d'Angers, Service d'Hématologie, Angers, France
| | - E Gyan
- Hôpital Universitaire de Tours, Service d'Hématologie, Tours, France
| | - A Chauchet
- Hôpital Universitaire de Besançon, Service d'Hématologie, Besançon, France
| | - R Ursu
- Hôpital Saint-Louis, Service de Neurologie à orientation oncologique, Paris, France
| | - A Kas
- Hôpital Pitié-Salpêtrière, Service de Médecine Nucléaire, Paris, France
| | - C Soussain
- Institut Curie, Service d'Hématologie, Saint-Cloud, France and INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - C Houillier
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France.
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Nguyen-Them L, Alentorn A, Ahle G, Soussain C, Mathon B, Le Garff Tavernier M, Houillier C, Hoang-Xuan K. CSF biomarkers in primary CNS lymphoma. Rev Neurol (Paris) 2023; 179:141-149. [PMID: 36336490 DOI: 10.1016/j.neurol.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/04/2022] [Accepted: 06/10/2022] [Indexed: 11/06/2022]
Abstract
PCNSL is a non-Hodgkin lymphoma (NHL) affecting brain, spinal cord, eyes and leptomeninges. In the past two decades, its prognosis significantly improved due to therapeutic advances but it remains a highly aggressive tumor and early diagnosis is necessary for optimal management. Diagnosis relies on the identification of lymphoma cells in brain tissue obtained by stereotactic biopsy. Alternatively, lymphoma cells may be found in CSF through lumbar puncture (LP) or by a vitrectomy. For several reasons, the diagnosis of PCNSL may be challenging. Misleading radiological presentations are frequent. Dramatic response to steroids may bias histological analysis and deep brain location or frail health status can contraindicate brain biopsy. In the follow-up of patients who have been previously treated, differential diagnosis between tumor relapse and post-treatment may be also difficult. Therefore, the development of complementary reliable diagnostic tools is needed. This review will summarize several diagnostic or prognostic CSF biomarkers which have been proposed in PCNSL, their interests and limits.
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Affiliation(s)
- L Nguyen-Them
- Centre Hospitalier Saint Jean, 20 Avenue du Languedoc, 66000 Perpignan, France; Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
| | - A Alentorn
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - G Ahle
- Hôpitaux Civils de Colmar, 39 Avenue Liberté, 68024 Colmar, France
| | - C Soussain
- Institut Curie - site de Saint Cloud, 35 Rue Dailly, 92210 Saint-Cloud, France
| | - B Mathon
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - M Le Garff Tavernier
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - C Houillier
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - K Hoang-Xuan
- Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
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Hernández-Verdin I, Kirasic E, Wienand K, Mokhtari K, Eimer S, Loiseau H, Rousseau A, Paillassa J, Ahle G, Lerintiu F, Uro-Coste E, Oberic L, Figarella-Branger D, Chinot O, Gauchotte G, Taillandier L, Marolleau JP, Polivka M, Adam C, Ursu R, Schmitt A, Barillot N, Nichelli L, Lozano-Sánchez F, Ibañez-Juliá MJ, Peyre M, Mathon B, Abada Y, Charlotte F, Davi F, Stewart C, de Reyniès A, Choquet S, Soussain C, Houillier C, Chapuy B, Hoang-Xuan K, Alentorn A. Molecular and clinical diversity in primary central nervous system lymphoma. Ann Oncol 2023; 34:186-199. [PMID: 36402300 DOI: 10.1016/j.annonc.2022.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare and distinct entity within diffuse large B-cell lymphoma presenting with variable response rates probably to underlying molecular heterogeneity. PATIENTS AND METHODS To identify and characterize PCNSL heterogeneity and facilitate clinical translation, we carried out a comprehensive multi-omic analysis [whole-exome sequencing, RNA sequencing (RNA-seq), methylation sequencing, and clinical features] in a discovery cohort of 147 fresh-frozen (FF) immunocompetent PCNSLs and a validation cohort of formalin-fixed, paraffin-embedded (FFPE) 93 PCNSLs with RNA-seq and clinico-radiological data. RESULTS Consensus clustering of multi-omic data uncovered concordant classification of four robust, non-overlapping, prognostically significant clusters (CS). The CS1 and CS2 groups presented an immune-cold hypermethylated profile but a distinct clinical behavior. The 'immune-hot' CS4 group, enriched with mutations increasing the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) and nuclear factor-κB activity, had the most favorable clinical outcome, while the heterogeneous-immune CS3 group had the worse prognosis probably due to its association with meningeal infiltration and enriched HIST1H1E mutations. CS1 was characterized by high Polycomb repressive complex 2 activity and CDKN2A/B loss leading to higher proliferation activity. Integrated analysis on proposed targets suggests potential use of immune checkpoint inhibitors/JAK1 inhibitors for CS4, cyclin D-Cdk4,6 plus phosphoinositide 3-kinase (PI3K) inhibitors for CS1, lenalidomide/demethylating drugs for CS2, and enhancer of zeste 2 polycomb repressive complex 2 subunit (EZH2) inhibitors for CS3. We developed an algorithm to identify the PCNSL subtypes using RNA-seq data from either FFPE or FF tissue. CONCLUSIONS The integration of genome-wide data from multi-omic data revealed four molecular patterns in PCNSL with a distinctive prognostic impact that provides a basis for future clinical stratification and subtype-based targeted interventions.
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Affiliation(s)
- I Hernández-Verdin
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - E Kirasic
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - K Wienand
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany; Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany; Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - K Mokhtari
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neuropathology, Groupe Hospitalier Pitié Salpêtrière, APHP, Paris, France
| | - S Eimer
- Department of Pathology, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - H Loiseau
- Department of Neurosurgery, Bordeaux University Hospital Center, Pellegrin Hospital, Bordeaux, France; EA 7435-IMOTION, University of Bordeaux, Bordeaux, France
| | - A Rousseau
- Department of Pathology, PBH, CHU Angers, Angers, France; CRCINA, Université de Nantes-université d'Angers, Angers, France
| | - J Paillassa
- Department of Hematology, CHU Angers, Angers, France
| | - G Ahle
- Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France
| | - F Lerintiu
- Department of Neuropathology, Hôpitaux Civils de Colmar, Strasbourg, France
| | - E Uro-Coste
- Department of Pathology, CHU de Toulouse, IUC-Oncopole, Toulouse, France; INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France
| | - L Oberic
- Department of Hematology, IUC Toulouse Oncopole, Toulouse, France
| | - D Figarella-Branger
- Neuropathology Department, University Hospital Timone, Aix Marseille University, Marseille, France; Inst Neurophysiopathol, CNRS, INP, Aix-Marseille University, Marseille, France
| | - O Chinot
- Department of Neuro-oncology, CHU Timone, APHM, Marseille, France; Institute of NeuroPhysiopathology, CNRS, INP, Aix-Marseille University, Marseille, France
| | - G Gauchotte
- Department of Biopathology, CHRU Nancy, CHRU/ICL, Bâtiment BBB, Vandoeuvre-lès-Nancy, France; Department of Legal Medicine, CHRU Nancy, Vandoeuvre-lès-Nancy, France; INSERM U1256, University of Lorraine, Vandoeuvre-lès-Nancy, France; Centre de Ressources Biologiques, BB-0033-00035, CHRU, Nancy, France
| | - L Taillandier
- Department of Neuro-oncology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - J-P Marolleau
- Department of Hematology, CHU Amiens-Picardie, Amiens, France
| | - M Polivka
- Department of Anatomopathology, Lariboisière Hospital, Assistance Publique-Hopitaux de Paris, University of Paris, Paris, France
| | - C Adam
- Pathology Department, Bicêtre University Hospital, Public Hospital Network of Paris, Le Kremlin Bicêtre, France
| | - R Ursu
- Department of Neurology, Université de Paris, AP-HP, Hôpital Saint Louis, Paris, France
| | - A Schmitt
- Department of Hematology, Institut Bergonié Hospital, Bordeaux, France
| | - N Barillot
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - L Nichelli
- Department of Neuroradiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - F Lozano-Sánchez
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | | | - M Peyre
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurosurgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - B Mathon
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurosurgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Y Abada
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - F Charlotte
- Department Pathology, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - F Davi
- Department Hematology, APHP, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - C Stewart
- Department Broad Institute of MIT and Harvard, Cambridge, USA
| | - A de Reyniès
- Department INSERM UMR_S1138-Centre de Recherche des Cordeliers-Université Pierre et Marie Curie et Université Paris Descartes, Paris, France
| | - S Choquet
- Department Pathology, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - C Soussain
- Department Hematology Unit, Institut Curie, Saint-Cloud, France
| | - C Houillier
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - B Chapuy
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany; Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Hoang-Xuan
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - A Alentorn
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France.
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7
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Tran S, Thomas A, Touat M, Karachi C, Lozano F, Mokhtari K, Dehais C, Feuvret L, Carpentier C, Giry M, Doukani H, Lerond J, Marie Y, Sanson M, Idbaih A, Carpentier A, Hoang-Xuan K, Capelle L, Bielle F. OS07.1.A A threshold of mitotic activity and post-surgery residual volume are independant prognostic factors in astrocytoma IDH-mutant. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.046] [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: 11/13/2022] Open
Abstract
Abstract
Background
The distinction between grade 2 and 3 is instrumental to choose between observational follow-up and adjuvant treatment in resected astrocytoma IDH-mutant. However, criteria of grade 2 versus 3 have not been updated since the WHO 2007 classification. There is no consensus on the method of evaluation of the mitotic activity or a cut-off of mitoses separating grade 2 and grade 3 tumors. The objectives were to evaluate the maximal mitotic activity on a series of resected astrocytoma IDH-mutant and assess its prognostic impact on survival.
Material and Methods
Maximal mitotic activity on consecutive high power fields corresponding to 3 mm2 was examined in 118 lower-grade astrocytoma IDH-mutant. The prognostic value for time-to-treatment (TTT) and overall survival (OS) of mitotic activity and other putative prognostic factors (including age, performance status, pre-surgical tumor volume, plurilobar involvement, post-surgical residual tumor volume, midline involvement) was assessed in tumors with (i) ATRX loss, and (ii) without CDKN2A homozygous deletion, lesional enhancement, histological necrosis nor microvascular proliferation.
Results
Among the 75 (64%) of tumors which had gone through observational follow-up after resection, the maximal mitotic activity, the post-surgical residual volume and the plurilobar involvement were independent prognostic factors of TTT (p < 0.0001). A threshold of mitotic activity for grade 2 was fitted on TTT and OS prognosis. Using this threshold, patients with “grade 2 tumors” had a median TTT of 55 months versus 19 months for “grade 3” (p = 0.0057) and a median OS of 102 months versus 73 months respectively (p = 0.001). Residual volume < 1 cm3 was associated with longer OS (113 months versus 88 months, p = 0.0021).
Conclusion
Mitotic activity and post-surgical residual volume can be combined to evaluate prognosis in resected astrocytoma IDH-mutant and could select the best candidates for observational follow-up.
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Affiliation(s)
- S Tran
- Pitie-Salpetriere Hospital, Department of Neuropathology , Paris , France
| | - A Thomas
- Institut de Cancérologie Strasbourg Europe, Department of Radiation Oncology , Strasbourg , France
| | - M Touat
- Pitie-Salpetriere Hospital, Department of Neurology Mazarin , Paris , France
| | - C Karachi
- Pitie-Salpetriere Hospital, Department of Neurosurgery , Paris , France
| | - F Lozano
- Pitie-Salpetriere Hospital, Department of Neurology Mazarin , Paris , France
| | - K Mokhtari
- Pitie-Salpetriere Hospital, Department of Neuropathology , Paris , France
| | - C Dehais
- Pitie-Salpetriere Hospital, Department of Neurology Mazarin , Paris , France
| | - L Feuvret
- Pitie-Salpetriere Hospital, Department of Radiotherapy , Paris , France
| | - C Carpentier
- Sorbonne Universite, Paris Brain Institute - ICM , Paris , France
| | - M Giry
- Sorbonne Universite, Paris Brain Institute - ICM , Paris , France
| | - H Doukani
- Sorbonne Universite INSERM, Plateforme post-genomique de la Pitie-Salpetriere , Paris , France
| | - J Lerond
- Sorbonne Universite, Paris Brain Institute - ICM , Paris , France
| | - Y Marie
- Sorbonne Universite, Paris Brain Institute - ICM , Paris , France
| | - M Sanson
- Pitie-Salpetriere Hospital, Department of Neurology Mazarin , Paris , France
| | - A Idbaih
- Pitie-Salpetriere Hospital, Department of Neurology Mazarin , Paris , France
| | - A Carpentier
- Pitie-Salpetriere Hospital, Department of Neurosurgery , Paris , France
| | - K Hoang-Xuan
- Pitie-Salpetriere Hospital, Department of Neurology Mazarin , Paris , France
| | - L Capelle
- Pitie-Salpetriere Hospital, Department of Neurosurgery , Paris , France
| | - F Bielle
- Pitie-Salpetriere Hospital, Department of Neuropathology , Paris , France
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8
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Desjardins C, Larrieu-Ciron D, Choquet S, Mokhtari K, Charlotte F, Nichelli L, Mathon B, Ahle G, Le Garff-Tavernier M, Dehais C, Hoang-Xuan K, Houillier C. P11.09.B Chemotherapy is an efficient treatment in primary CNS MALT lymphoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.198] [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: 11/13/2022] Open
Abstract
Abstract
Background
Mucosae-associated lymphoid tissue (MALT) lymphomas are a rare and still poorly understood form of primary central nervous system lymphoma (PCNSL). The aim of this study was to better describe these tumors and their management, and to better appreciate their long-term prognosis after treatment.
Material and Methods
Adult immunocompetent patients with primary CNS MALT lymphoma (PCNSML) were retrospectively selected from the database on PCNSL of the Pitié-Salpêtrière Hospital. All cases had double-read for pathology.
Results
Eleven PCNSML representing 1.7% of the 662 PCNSL included in the database were selected, There were 9 women and two men, all immunocompetent. Their median age was 56 years (min 29; max 78). The median time from first symptoms to diagnosis was 13 months and the median KPS at diagnosis was 90. Location was dural in 8 cases, suggestive of meningioma in 7 cases and of subdural hematoma in 1 case, and parenchymal in 3 cases. The disease was unifocal/localized in 4 cases and multifocal/diffuse in 7 cases. In 3 cases, it was the second reading that allowed making the diagnosis. In first-line treatment, all patients received chemotherapy (CT): “systemic” CT, i.e usually used in systemic MALT lymphomas, in 7 cases (n=7) and “CNS” CT, i.e usually used in CNS lesions in 4 cases. CT was preceded by surgery in 4 cases. No patient received radiotherapy in first line. According to the IPCG (International PCNSL Collaborative Group) criteria, the overall response rate was 7/11 (64%). At latest news, 5 patients had a persistent contrast enhancement, stable without any treatment since a median of 57 months, raising the question of complete response despite persisting contrast enhancement. No patient developed neurotoxicity except for one of the 2 patients who subsequently received radiotherapy. The median follow-up was 109 months. The median progression-free survival was 78.0 months (95% CI [43.4;NA[) and the 10-year overall survival rate was 90% (95% CI [0.7;1[).
Conclusion
This series confirms the classical clinical and radiological presentation of PCNSML. Compared to the literature where the treatment was based on radiotherapy in almost two thirds of cases, the therapeutic approach presented here appears unconventional. This is the first series demonstrating that chemotherapy is an efficient treatment in PCNSML, with an excellent long-term outcome and the absence of neurotoxicity, and calling into question the relevance of the IPCG criteria for the evaluation of their therapeutic response.
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Affiliation(s)
- C Desjardins
- Neuro-oncology department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France , Paris , France
| | - D Larrieu-Ciron
- Neurology department, Hôpital Purpan, CHU de Toulouse, France , Paris , France
| | - S Choquet
- Clinical Hematology department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - K Mokhtari
- Neuropathology department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - F Charlotte
- Service d’Anatomie et Cytologie Pathologiques, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Sorbonne Université , Paris , France
| | - L Nichelli
- Neuroradiology department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - B Mathon
- Neurosurgery department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - G Ahle
- Neurology department, Hospices Civils, Colmar, France , Paris , France
| | - M Le Garff-Tavernier
- Hematobiology department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - C Dehais
- Neuro-oncology department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France , Paris , France
| | - K Hoang-Xuan
- Neuro-oncology department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France , Paris , France
| | - C Houillier
- Neuro-oncology department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France , Paris , France
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9
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Jacob J, Feuvret L, Simon JM, Ribeiro M, Nichelli L, Jenny C, Ricard D, Psimaras D, Hoang-Xuan K, Maingon P. Neurological side effects of radiation therapy. Neurol Sci 2022; 43:2363-2374. [DOI: 10.1007/s10072-022-05944-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/05/2022] [Indexed: 10/19/2022]
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10
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Dufour J, Choquet S, Schmitt A, Ahle G, Houot R, Taillandier L, Ursu R, Hoang-Xuan K, Soussain C, Houillier C. P14.48 Extracerebral relapses of primary CNS lymphoma (PCNSL): a LOC network retrospective study. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.161] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Classically PCNSL remain confined within the CNS throughout their evolution for reasons still unknown (> 80% cerebral relapses). The aim of this study was to describe the characteristics and outcomes of the rare extracerebral relapses of PCNSL.
MATERIAL AND METHODS
This is a multicenter, retrospective study. We included all immunocompetent patients newly diagnosed with diffuse large B-cell PCNSL registered in the national LOC network database since 2010 and followed prospectively, who presented an extracerebral relapse, pure (extracerebral only site) or associated with concomitant CNS relapse (mixed). All had body scan and/or TEP -CT at diagnosis work up.
RESULTS
Of the 1968 PCNSL included in the database, 29 (1.5%) patients presented a systemic relapse [median age 71 years, median KPS 70% at relapse], either pure (n=19) or mixed (n=10), with a histological confirmation in 19 cases (66%). The median delay between initial diagnosis and systemic relapse was 15 months [2–49 months], with 5 very early relapses (<8 months) and 10 late relapses (>21 months). 27 patients had symptoms, 21 related to the location of relapse and 6 with only general symptoms. The localization was thoracic (n=11), abdominal/pelvic (n=14), head/neck (n=6) and limbs (n=9). We found visceral (n=24, 83%), including testis in 5 (28%) men and breast in 3 (27%) women, lymph node (n=12, 41%) and peripheral nervous system (PNS) (n=8, 28%; 4 plexus and 4 extradural roots) involvement. 27 patients were treated with chemotherapy, either with only systemic target (n=8) (R-CHOP alone) or mixed systemic and CNS target (n=19) (R-CHOP-MTX, R-ICE, GEMOX, RDHAC) and consolidated by high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) in 4 cases [median age 55 years, median KPS 80%], with 34% of complete response. After systemic relapse, median progression-free survival was 8 months and overall survival (OS) was 9 months, 15 months for pure systemic and 4.5 months for mixed relapses. KPS>70%, pure systemic relapses and complete response were significantly associated with higher OS in univariate analysis.
CONCLUSION
Extracerebral PCNSL relapses are very rare, mainly extranodal and involve a large spectrum of anatomical sites, the most frequent being testis, breast and PNS. Prognosis was worse in case of mixed relapse than in pure systemic relapse that was similar to non PCNSL lymphomas. Very early relapses raise the question of misdiagnosed occult extracerebral lymphoma at diagnostic work up that should include systematically a FDG PET-CT. More studies are needed to refine their treatment and to specify the role of HCT-ASCT. Paired tumor tissues at diagnosis (CNS)/relapse (extracerebral) analysis would provide a better understanding of underlying molecular mechanisms.
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Affiliation(s)
- J Dufour
- Hôpital Pitié-Salpêtriere, Paris, France
| | - S Choquet
- Hôpital Pitié-Salpêtriere, Paris, France
| | - A Schmitt
- Institut de Bergonie, Bordeaux, France
| | - G Ahle
- Centre hospitalier de Colmar, Colmar, France
| | - R Houot
- Hôpital Universitaire de Rennes, Rennes, France
| | | | - R Ursu
- Hôpital Saint-Louis, Paris, France
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11
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Nilles C, Delgadillo D, Martin Duverneuil N, Mokhtari K, Mathon B, Hoang-Xuan K, Duran-Pena A, Morales A, Houillier C. P03.04 Primary CNS lymphoma of the corpus callosum: presentation and neurocognitive prognosis. Study of a monocentric cohort of 27 patients. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.056] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The corpus callosum (CC) is frequently involved in primary central nervous system lymphomas (PCNSL). The aim of our study was to describe the impact of these lesions on neurocognition of patients presenting with PCNSL of the CC (PCNSL-CC) and their post-therapeutic evolution.
MATERIAL AND METHODS
This is a retrospective single-center study. Patients newly diagnosed at Pitié Salpêtrière Hospital from (1999–2018) were included in this study according to the following criteria: age >18, immunocompetent patient, pathological confirmation (Diffuse Large B cell lymphoma) and CC as main location of the tumor on MRI. Clinical, neuroradiological and neuropsychological data of the patients were collected. In addition, prognostic factors for the neurocognitive outcome of the patients were investigated.
RESULTS
27 patients were included (median age: 67 years, median KPS: 70). At the time of diagnosis, 74% of patients had cognitive impairment and 59% of patients had balance disorders. The cognitive functions most frequently affected were memory and executive functions. Tumor lesions in the CC had a median maximum diameter of 5 cm with a so called “butterfly pattern” in 92% of cases. All patients received a high dose methotrexate based polychemotherapy, including one with radiation therapy, and 67% of patients achieved a complete remission (CR). Median PFS and OS were 33.3 months and 177.9 months respectively. With a median follow-up of 48 months (range 6–156), despite CR, there were still abnormal values in 17% of patients on overall efficiency, 17–55% of patients on executive function tests, 45–55% of patients on memory tests. No significant impaired values were found for visuo-spatial and language tests. Splenial location and age ≥ 60 years were significantly associated with worse episodic memory scores throughout the follow-up.
CONCLUSION
PCNSL-CC are associated with frequent cognitive dysfunctions, especially memory impairment, which may recover only partially despite CR, that warrant specific rehabilitation. Older age (≥ 60) and splenial location have worse neurocognition outcome.
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Affiliation(s)
- C Nilles
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - D Delgadillo
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | | | - K Mokhtari
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - B Mathon
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - K Hoang-Xuan
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - A Duran-Pena
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - A Morales
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - C Houillier
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
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Valyraki N, Ahle G, Tabouret E, Houot R, Jardin F, Ghesquieres H, Choquet S, Moles M, Hoang-Xuan K, Houillier C. P14.54 Primary central nervous system lymphoma of the spinal cord: a LOC network cohort study. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.165] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Primary central nervous system lymphoma (PCNSL) mainly affects the brain (>90% of the cases), Very little data can be found in the literature on PCNSL with spinal cord localization.
MATERIAL AND METHODS
We present a retrospective study based on the French LOC network database. We selected adult immunocompetentpatients, with a histological or cytological diagnosis of PCNSL, and a spinal cord localization at initial diagnosis.
RESULTS
Of the 2043 PCNSLof the LOC database newly diagnosed since 2011, 14 patients (9 men, median age 68, median Karnofsky performance status 50%)met the selection criteria. The median diagnostic delay was 82 days (min 15-max 1080) compared to 35 days in primary cerebral lymphomas. At diagnosis, walking was impossible in 7/14 patients and 5/14 had indwelling urinary catheter. On MRI, 100% had enlargement of the spinal cord with homogeneous contrast enhancement in 13/14 cases. Spinal cord lesions were unique in 9/14 patients and multiples in 5/14 patients. CSF IL10 level was increased in 6/7 patients. Brain lesions were found in 9/14 patients, located in the posterior fossa in 5/9 cases. The diagnosis was made either on a brain biopsy (N=6), a spinal cord biopsy or surgery (N=5) or the cytologic analysis of the CSF (N=3).4/5 patients had neurological sequel after spinal cord biopsy or surgery. All the patients were treated by high-dose methotrexate-based chemotherapy, followed by spinal cord irradiation (N=1) or autograft (N=2). There was an overall response rate of 71% (complete response in 8/14). 8/14 patients relapsed, 5 in the brain, 2 in the spinal cord, and 1 both in the spinal cord and in the brain. 2-year PFS and OS were 45% and 64%, respectively. Among the long-term responders, 50% remained in wheel chair, while only 10% could walk normally.
CONCLUSION
Considering the high risk of a spinal cord biopsy,the rarity of the disease, as well as the numerous differential diagnoses, the diagnosis of spinal cord lymphoma is difficult. Searching for other lymphomatous locations or assaying CSF IL10 may be helpful in this disease where delay in diagnosis is often prolonged et can cause irreversible handicap.
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Affiliation(s)
- N Valyraki
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - G Ahle
- Hôpital Pasteur - Hôpitaux civils de Colmar, Colmar, France
| | - E Tabouret
- Hôpitaux Unoversitaires de la Timone, Marseilel, France
| | - R Houot
- Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - F Jardin
- Centre Henri Becquerel, Rouen, France
| | | | - S Choquet
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - M Moles
- Centre Hospitalier Universitaire d’Anger, Angers, France
| | - K Hoang-Xuan
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - C Houillier
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
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13
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Autier L, Le Garff-Tavernier M, Mathon B, Martin-Duverneuil N, Hoang-Xuan K, Houillier C. Cerebrospinal fluid interleukin-10 may be a useful biomarker for atypical primary central nervous system lymphoma relapse. Rev Neurol (Paris) 2020; 177:436-439. [PMID: 33190919 DOI: 10.1016/j.neurol.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 07/01/2020] [Accepted: 08/23/2020] [Indexed: 11/24/2022]
Affiliation(s)
- L Autier
- Department of neurology 2-Mazarin, IHU, institut du cerveau et de la moelle épinière (ICM), Sorbonne university, Pitié-Salpêtrière university hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris cedex 13, France.
| | - M Le Garff-Tavernier
- Inserm UMRS 1138, cell death and drug resistance in lymphoproliferative disorders, department of biological hematology, centre de recherche des Cordeliers, Pitié-Salpêtrière university hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris cedex 13, France
| | - B Mathon
- Department of neurosurgery, institut du cerveau et de la moelle épinière (ICM), Sorbonne university, Pitié-Salpêtrière university hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris cedex 13, France
| | - N Martin-Duverneuil
- Department of neuroradiology, Pitié-Salpêtrière university hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris cedex 13, France
| | - K Hoang-Xuan
- Department of neurology 2-Mazarin, IHU, institut du cerveau et de la moelle épinière (ICM), Sorbonne university, Pitié-Salpêtrière university hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris cedex 13, France
| | - C Houillier
- Department of neurology 2-Mazarin, IHU, institut du cerveau et de la moelle épinière (ICM), Sorbonne university, Pitié-Salpêtrière university hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris cedex 13, France
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14
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Jacob J, Ribeiro M, Benadjaoud M, Jenny C, Feuvret L, Simon J, Bernier M, Antoni D, Hoang-Xuan K, Psimaras D, Carpentier A, Ricard D, Maingon P. OC-0696: Development of dose constraints to the brain areas implied in cognition: a prospective study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00718-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Luna LP, Drier A, Aygun N, Mokhtari K, Hoang-Xuan K, Galanaud D, Donadieu J, Dormont D, Haroche J, Martin-Duverneuil N. MRI features of intra-axial histiocytic brain mass lesions. Clin Radiol 2020; 76:159.e19-159.e28. [PMID: 33077156 DOI: 10.1016/j.crad.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022]
Abstract
AIM To describe MRI features, including diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), and perfusion-weighted imaging (PWI), of intra-axial tumour-like presentations of four different subtypes of histiocytosis. MATERIAL AND METHODS The brain MRI findings of 23 patients with histologically proven histiocytosis were reviewed retrospectively (11 Langerhans cell histiocytosis [LCH], eight Erdheim-Chester disease [ECD], one overlap form LCH/ECD, two Rosai-Dorfman disease [RDD], and one haemophagocytic lymphohistiocytosis [HLH]) with single or multiple enhancing intraparenchymal brain lesions. RESULTS Histiocytic brain mass lesions show some similar MRI features including Supra and/or infratentorial and/or paraventricular subcortical well-delineated masses, linear ependymal enhancement along the ventricles and brain stem lesions. Masses always present with mixed hyper- and hypointense signal on T2-weighted imaging (WI). Their enhancement is often homogeneous. Apparent diffusion coefficient (ADC) values are often normal or elevated. CONCLUSION The presence of multiple periventricular and subcortical enhancing lesions with mixed signal intensity on T2WI and normal or high ADC values should lead radiologists to consider the diagnosis of histiocytic lesions and search for associated systemic lesions.
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Affiliation(s)
- L P Luna
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, USA.
| | - A Drier
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - N Aygun
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - K Mokhtari
- APHP, Department of Neuropathology, Pitié-Salpêtrière Hospital, Paris, France
| | - K Hoang-Xuan
- APHP, Department of Neuro-oncology, Pitié-Salpêtrière Hospital, Paris, France
| | - D Galanaud
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - J Donadieu
- APHP, Department of Hematology, Trousseau Hospital, Paris, France
| | - D Dormont
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - J Haroche
- APHP, Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France
| | - N Martin-Duverneuil
- APHP, Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
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16
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Jacob J, Clausse E, Benadjaoud M, Jenny C, Ribeiro M, Feuvret L, Mazeron JJ, Antoni D, Bernier MO, Hoang-Xuan K, Psimaras D, Carpentier A, Ricard D, Maingon P. Dose distribution of the brain tissue associated with cognitive functions in high-grade glioma patients. Cancer Radiother 2020; 24:1-10. [DOI: 10.1016/j.canrad.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
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17
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Lahmi L, Idbaih A, Rivin Del Campo E, Hoang-Xuan K, Mokhtari K, Sanson M, Canova CH, Carpentier A, Jacob J, Maingon P, Feuvret L. Whole brain radiotherapy with concurrent temozolomide in multifocal and/or multicentric newly diagnosed glioblastoma. J Clin Neurosci 2019; 68:39-44. [DOI: 10.1016/j.jocn.2019.07.065] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/12/2019] [Accepted: 07/17/2019] [Indexed: 11/15/2022]
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18
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Baldini C, Younan N, Castanon Alvarez E, Bahleda R, Hollebecque A, Dhermain F, Ammari S, Alentorn A, Dumont S, Frenel J, Di Stefano A, Bielle F, Hoang-Xuan K, Delattre J, Soria J, Sanson M, Idbaih A, Massard C, Touat M. OS4.3 Feasibility and benefit of Molecular Profiling to Guide Enrollment of Patients with Recurrent Gliomas in Early Phase Trials. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.033] [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: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Participation of glioma patients in early phase clinical trials has recently shown to be safe, although clinical benefits reported in this population were marginal. We aimed to evaluate whether an enrichment strategy based on molecular profiling associates with improved outcome in gliomas patients participating in early phase trials.
MATERIAL AND METHODS
Records of patients enrolled in early phase trials of cytotoxic therapies, small molecule inhibitors or monoclonal antibodies from 2008 to 2017 were analyzed for clinicopathological characteristics, toxicity, response, median progression-free survival (PFS) and overall survival (OS). The primary objective was to evaluate the feasibility and benefit of using molecular profiling to guide enrollment.
RESULTS
Ninety-one patients were enrolled, of whom 47/91 (51.6%) were molecularly oriented. Molecular targets included IDH1/2 (n=15) and BRAF (11) mutations, FGFR1-3 fusions (n= 10) and mutations (n = 4), mismatch repair deficiency (8), and MDM2 amplification (1). Grade 3/4 adverse events were reported in 9/91 (9.9%) patients. In patients with IDH1/2-wild-type high-grade glioma (n=45), the overall response rate (24.0% [95% CI 11.5–43.4] vs 0.0% [95% CI 0.0–16.1], P=0.027) was significantly higher in molecularly-oriented vs non-molecularly-oriented patients. Updated outcome results, and clinical and molecular factors associated with response, PFS and OS in multivariate analyses will be presented at the conference.
CONCLUSION
Using molecular profiling to guide enrollment in early phase trials is feasible and offers potential benefit to gliomas patients. Further studies are warranted to identify the population most likely to benefit from this approach.
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Affiliation(s)
| | - N Younan
- Hopital Pitié Salpétrière, Paris, France
| | | | | | | | | | - S Ammari
- Gustave Roussy, Villejuif, France
| | - A Alentorn
- Hopital La Pitié Salpêtrière, Paris, France
| | - S Dumont
- Gustave Roussy, Villejuif, France
| | - J Frenel
- Centre René Gauducheau, Saint-Herblain, France
| | | | - F Bielle
- Hopital La Pitié Salpêtrière, Paris, France
| | | | - J Delattre
- Hopital La Pitié Salpêtrière, Paris, France
| | - J Soria
- Gustave Roussy, Villejuif, France
| | - M Sanson
- Gustave Roussy, Villejuif, France
| | - A Idbaih
- Hopital La Pitié Salpêtrière, Paris, France
| | | | - M Touat
- Hopital La Pitié Salpêtrière, Paris, France
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19
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Lesueur P, Damaj G, Hoang-Xuan K, Rolland V, Schmitt A, Chinot O, Fabbro M, Agapé P, Chabrot C, Chebrek S, Feuvret L, Stefan D, Soussain C, Houillier C. P14.73 Toxicity and outcomes of reduced-dose whole brain radiotherapy as consolidation treatment for patients with CNS lymphoma in real life setting. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.308] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Optimal treatment strategy for newly diagnosed primary PCNSL remains controversial. The high risk of radio-induced late-delayed neurotoxicity in patients who achieve long-term disease control constrains the use of classical consolidation WBRT. So as to reduce side cognitive effects, Morris et al, reported a phase II study, to assess the efficacy and toxicity of consolidation reduced-dose (23.4Gy) WBRT (rdWBRT) for patients with complete response after high dose methotrexate based chemotherapy. The study reported a 2-year PFS rate for these patients of 77%, with no evidence of significant cognitive decline during the follow-up (FU) period. The aim of this retrospective study was to report toxicity and outcomes of rdWBRT, in patients < 60 years old with complete response (CR) after HD-MTX based chemotherapy, in real life setting, without selection bias.
MATERIAL AND METHODS
Patients were selected from the French LOC network database, a nationwide database centralizing since 2011 information from 28 different centers in France, representing the main centers involved in PCNSL management. Patients were retrospectively selected according to the following criteria: 1) Pathological diagnosis of diffuse large B cell PCNSL; 2) age>18 and <60 years; 3) immunocompetent status; 4) First line induction treatment based on high dose MTX (At least MTX>1.5 g/m2); 5) CR according to the IPCG criteria after first-line induction treatment. Patients should have received a rdWBRT (23.4Gy in 13 fractions of 1.8Gy).
RESULTS
Twenty seven patients, were included. The median FU from initial diagnosis was 28.5 months [9.6–50.7]. Median age was 50.2 years [25–60]. Median Karnofsky Performans Status (KPS) was 90% [40–100%]. Seventeen patients had a multi focal disease at diagnosis (meningeal involvement n=6, in ophthalmic involvement n=4). PFS rates were 85% IC95[76–100 %], 65% IC95 [45–85%] and 65% IC95 [45–85%] at 1, 2, and 3 years respectively. The OS rates were 100%, 90,5% IC95 [77–100%] and 85%IC95 [69–100%]. 8 patients relapsed, with a median time from radiotherapy to recurrence of 6.5months [2.4–17]. All recurrences were outside the initially involved site(s), and 62.5% of tumors recurred as multifocal disease. All patients received salvage treatment, including intensive chemotherapy with autologous stem cell transplantation in 4 cases. No acute grade III-IV toxicity related to rdWBRT was reported. Neuropsychological follow up was available for 14 patients with no cognitive impairment at last follow up.
CONCLUSION
This is the largest retrospective study evaluating outcomes of rdWBRT for PCNSL young patients with CR after HD-MTX chemotherapy. Real life setting data from this study are quite reassuring, and rdWBRT could be considered as an efficient and safe consolidation strategy in this population. We need a longer FU to confirm the absence of cognitive deterioration.
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Affiliation(s)
- P Lesueur
- Centre François Baclesse, Caen, France
| | | | | | | | | | - O Chinot
- Hôpital de la Timône, Marseille, France
| | - M Fabbro
- Institut Régional du Cancer de Montpellier, Montpellier, France
| | - P Agapé
- Institut de Cancerologie de l’Ouest, Nantes, France
| | - C Chabrot
- CHU de Clermont Ferrand, Clermont Ferrand, France
| | | | - L Feuvret
- La Pitié Salpetriere (AP-HP), Paris, France
| | - D Stefan
- Centre François Baclesse, Caen, France
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20
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Birzu C, Hillairet A, Giry M, Grandin N, Verrelle P, Mokhtari K, Marie Y, Hoang-Xuan K, Delattre J, Idbaih A, Charbonneau M, Sanson M, Alentorn A. OS9.7 Telomere length, TERTp mutation and ALT status in adult diffuse gliomas. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.065] [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: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The current classification of adult diffuse gliomas integrates two alternative telomere maintenance mechanisms: reactivation of telomerase activity by TERT promoter (TERTp) mutations or ATRX mutations associated with alternative length telomere (ALT). We investigated here the relation between these two mechanisms, telomere length, and outcome in a large series of diffuse gliomas.
MATERIAL AND METHODS
We performed C-circle assay (CCA) to determine ALT status, determined telomere length in tumor (RTLt) and leukocyte (RTLl) in a cohort of 354 adult diffuse gliomas, and sequenced ATRX gene. We calculated an age-adjusted telomere score considering tumor and leukocyte (blood) telomere length and corrected by age. This score was used in univariate and multivariate survival analyses to evaluate the potential impact of telomere length on the prognosis of gliomas. We used the TCGA LGG-GBM dataset to validate our findings in an independent cohort.
RESULTS
RTLl and RTLt were associated with ATRX mutation and ALT phenotype, and negatively associated with age and TERTp mutations. ATRX mutations (found in 52% (64/123) of samples) were mostly transitions (C>T or T>C), and were associated with ALT phenotype. None of 1p/19q co-deleted oligodendrogliomas harbored an ALT phenotype. No patients with TERTp mutations had ALT phenotype except for a very small subgroup of patients (3/87, 3.4%) suggesting that multiple ways of telomere maintenance, may co-exist in a single tumor, probably expressed in different clones. Telomere age-adjusted score was independently associated with better outcome (HR= 0.73 [95% CI 0.56–0.97], p-value 0.03 adjusted for age, TERTp mutation, IDH mutation, 1p/19q co-deletion and WHO grade). These results were validated using the LGG-GBM TCGA dataset.
CONCLUSION
We unravel the relation between RTLl and RTLt, TERTp mutation and ALT phenotype and describe a novel telomere age-adjusted score independently associated with better prognosis in adult diffuse gliomas.
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Affiliation(s)
- C Birzu
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, F-75013, Paris, France, Paris, France
| | - A Hillairet
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France, Paris, France
| | - M Giry
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France, Paris, France
| | - N Grandin
- Génétique, Reproduction et Développement, UMR CNRS 6293 – INSERM U1103 –Université Clermont Auvergne, Faculté de Médecine. BP38 63001 Clermont-Ferrand Cedex 1, France., Clermont Ferrand, France
| | - P Verrelle
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris, France; Institut Curie, PSL Research University, INSERM U1196/UMR9187, Orsay, France., Paris, France
| | - K Mokhtari
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Laboratoire de Neuropathologie R Escourolle, AP-HP, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Y Marie
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France, Paris, France
| | - K Hoang-Xuan
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, F-75013, Paris, France, Paris, France
| | - J Delattre
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, F-75013, Paris, France, Paris, France
| | - A Idbaih
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, F-75013, Paris, France, Paris, France
| | - M Charbonneau
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris, France; Institut Curie, PSL Research University, INSERM U1196/UMR9187, Orsay, France., Paris, France
| | - M Sanson
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, F-75013, Paris, France, Paris, France
| | - A Alentorn
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, F-75013, Paris, France, Paris, France
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21
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Berzero G, Di Stefano A, Ronchi S, Villa C, Marie Y, Hoang-Xuan K, Delattre J, Mokhtari K, Sanson M. P04.10 IDH-wildtype low grade gliomas: overall survival and prognostic indicators. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.105] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
IDH-wildtype WHO grade II diffuse gliomas represent a rare subgroup of low grade tumors characterized by poor prognosis. The clinical and molecular profile associated with these tumors has not been fully elucidated yet, and the ongoing uncertainties regarding their biological behavior hamper to establish a standard of treatment. The aim of this study is to define the median overall survival and the main prognostic factors associated with this rare tumor entity.
MATERIALS AND METHODS
We performed a retrospective research in our center for all patients diagnosed with diffuse WHO grade II and III gliomas from 1976 to 2018. WHO grade II and III gliomas were divided into three molecular subgroups according to the IDH1/2 mutation and the 1p/19q codeletion status (1: IDH-mutant, 1p/19q codeleted; 2: IDH-mutant, 1p/19q non codeleted; 3: IDH-wildtype). We analyzed the clinical and molecular characteristics of the three subgroups, and then the clinical, radiological, histological and molecular features of IDH-wildtype WHO grade II gliomas.
RESULTS
We identified 445 patients with diffuse WHO grade II gliomas, including 59 IDH1/2-wildtype tumors. IDH-wildtype grade II gliomas affected more frequently male (75% vs. 55%, p = 0.004) and older (mean age: 50.0 vs. 39.6 years, p<0.0001) patients, had frequent fronto-temporo-insular location (41%) and commonly underwent biopsy (53%) rather than resection. We found TERT promoter mutations (18/42, 43%), chromosome 7q gains (12/30, 40%), chromosome 10q losses (12/44, 27%), chromosome 9p losses (7/47, 15%), EGFR amplifications (5/51, 10%) and p16 deletions (4/50, 8%) but no P53 (0/16) mutations. Median overall survival was 46 months (vs. 98 for IDH-mutant non codeleted and 175 for IDH-mutant codeleted WHO grade II gliomas (p<0.0001); vs. 20 months for IDH-wildtype WHO grade III gliomas (p = 0.001)). Survival was not significantly influenced by age, preoperative KPS, tumor location, extent of resection or adjuvant treatment schemes. Chromosome 9p loss had a strong negative impact on overall survival (p=0.002).
CONCLUSION
The median overall survival associated with IDH-wildtype WHO grade II gliomas does not exceed 4 years from diagnosis. As some genetic alterations seem to have a strong prognostic impact, an exhaustive genetic assessment can be helpful in this rare tumor group for purposes of prognostic stratification and treatment decision.
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Affiliation(s)
- G Berzero
- APHP GH Pitié Salpetrière, Service de Neurologie 2-Mazarin, Paris, France
- Università degli studi di Pavia, Pavia, Italy
| | - A Di Stefano
- Department of Neurology, Foch Hospital, Suresnes, France
- Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
| | - S Ronchi
- APHP GH Pitié Salpetrière, Laboratoire R Escourolle, Paris, France
| | - C Villa
- Department of Pathology, Foch Hospital, Paris, France
| | - Y Marie
- Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
| | - K Hoang-Xuan
- APHP GH Pitié Salpetrière, Service de Neurologie 2-Mazarin, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
| | - J Delattre
- APHP GH Pitié Salpetrière, Service de Neurologie 2-Mazarin, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
| | - K Mokhtari
- APHP GH Pitié Salpetrière, Laboratoire R Escourolle, Paris, France
| | - M Sanson
- APHP GH Pitié Salpetrière, Service de Neurologie 2-Mazarin, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
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Abstract
Abstract
BACKGROUND
Optic neuropathy is an inflammation of the optic nerve leading to a rapidly progressive visual loss. Most frequent etiologies are multiple sclerosis, vasculitides, and infections. In the context of tumorous pathology, optic neuropathy can occur due to meningeal infiltration, tumoral compression, or antitumor therapeutics (radiation therapy, some targeted cancer therapies, and checkpoint inhibitors). In the current study, we examine radiation-induced optic neuropathy (RION), which is the most frequent among optic neuropathies caused by antitumor therapeutics.
MATERIAL AND METHODS
We present the cases of 3 patients who experienced RION. For each patient, we collected data on age, type of tumor, date and modalities of radiation-therapy, starting date of visual loss, ophthalmologic description, MRI images, treatment, and clinical and radiological evolution.
RESULTS
The three patients were aged 57 to 68 years old at the time of NORI. They had irradiation between 2013 and 2018. Two patients had proton therapy and one had whole brain irradiation. The visual loss occurred between seven and twelve months after the end of radiation therapy. In all patients the symptoms were bilateral and the loss of vision was rapidly worsened until culminating in almost total blindness. The MRI abnormalities were consistent with retrobulbar optic neuritis. The visual loss remained severe despite the treatment administered. High dose steroids had no clinical effect. Bevacizumab enabled a discrete subjective visual improvement in one patient, but a worsening of visual loss in another. Hyperbaric oxygen therapy had no clinical effect but was undertaken three months after the starting date of visual loss which is probably too late for efficiency. Interestingly one patient was treated with an anti-IL6 antibody (tocilizumab). It was administered in order to avoid fibrosis formation, which is the ultimate condition of the inflammatory process. The rationale is that radiation-induced opening of the bood-brain-barrier and destruction of endothelial and glial cells lead to reparation process through microglia activation. In-vitro studies showed an increased secretion of IL-6 (and other pro-inflammatory cytokines) by the activated microglia. Our patient could not experience benefit from tocilizumab, but the treatment was administered four months after the starting date of visual loss and fibrosis was probably already formed.
CONCLUSION
These cases are consistent with existing literature. The risk is mostly due to the total dose and dose per fraction of the irradiation and the prognosis is very poor with no efficient treatment at the present time. Anti-IL6 antibody could be an interesting treatment if administered at an early stage, but a future prospective clinical trial would be needed to clinically validate this hypothesis.
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Affiliation(s)
- A Thomas
- Radiotherapy department, Centre Paul Strauss, Unicancer, F-67065, Strasbourg, France, Strasbourg, France
| | - C Birzu
- Neurology department, Pitie-Salpetriere hospital, Paris, France, Paris, France
| | - L Feuvret
- Radiotherapy department, Pitie-Salpetriere hospital, Paris, France, Paris, France
| | - G Noël
- Radiotherapy department, Centre Paul Strauss, Unicancer, F-67065, Strasbourg, France, Strasbourg, France
| | - K Hoang-Xuan
- Neurology department, Pitie-Salpetriere hospital, Paris, France, Paris, France
| | - J Savatosky
- Department of Neuroradiology, Fondation Rothschild Hospital, Paris, France, Paris, France
| | - D Ricard
- Department of Neurology, Service de Santé des Armées, HIA de Percy, 101 avenue Henri Barbusse, 92140 Clamart, France, Clamart, France
| | - D Psimaras
- Neurology department, Pitie-Salpetriere hospital, Paris, France, Paris, France
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Soussain C, Choquet S, Blonski M, Leclercq D, Houillier C, Rezai K, Bijou F, Houot R, Boyle E, Gressin R, Nicolas-Virelizier E, Barrie M, Moluçon-Chabrot C, Lelez ML, Clavert A, Coisy S, Leruez S, Touitou V, Cassoux N, Daniau M, Ertault de la Bretonnière M, El Yamani A, Ghesquières H, Hoang-Xuan K. Ibrutinib monotherapy for relapse or refractory primary CNS lymphoma and primary vitreoretinal lymphoma: Final analysis of the phase II 'proof-of-concept' iLOC study by the Lymphoma study association (LYSA) and the French oculo-cerebral lymphoma (LOC) network. Eur J Cancer 2019; 117:121-130. [PMID: 31279304 DOI: 10.1016/j.ejca.2019.05.024] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary central nervous system lymphomas (PCNSLs) are mainly diffuse large B-cell lymphomas (DLBCLs) of the non-germinal centre B-cell subtype, with unmet medical needs. This study aimed to evaluate the efficacy and toxicity of ibrutinib in DLBCL-PCNSL PATIENTS AND METHODS: This prospective, multicentre, phase II study involved patients with relapse or refractory(R/R) DLBCL-PCNSL or primary vitreoretinal lymphoma. The treatment consisted of ibrutinib (560 mg/day) until disease progression or unacceptable toxicity occurred. The primary outcome was the disease control (DC) rate after two months of treatment (P0 < 10%; P1 > 30%). RESULTS Fifty-two patients were recruited. Forty-four patients were evaluable for response. After 2 months of treatment, the DC was 70% in evaluable patients and 62% in the intent-to-treat analysis, including 10 complete responses (19%), 17 partial responses (33%) and 5 stable diseases (10%). With a median follow-up of 25.7 months (range, 0.7-30.5), the median progression-free and overall survivals were 4.8 months (95% confidence interval [CI]; 2.8-12.7) and 19.2 months (95% CI; 7.2-NR), respectively. Thirteen patients received ibrutinib for more than 12 months. Two patients experienced pulmonary aspergillosis with a favourable (n = 1) or fatal outcome (n = 1). Ibrutinib was detectable in the cerebrospinal fluid (CSF). The clinical response to ibrutinib seemed independent of the gene mutations in the BCR pathway. CONCLUSION Ibrutinib showed clinical activity in the brain, the CSF and the intraocular compartment and was tolerated in R/R PCNSL. The addition of ibrutinib to standard methotrexate-base induction chemotherapy will be further evaluated in the first-line treatment. CLINICAL TRIAL NUMBER NCT02542514.
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Affiliation(s)
- C Soussain
- Hematology, Institut Curie, Site Saint-Cloud, France.
| | - S Choquet
- Hematology, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - M Blonski
- Neurology, Centre Hospitalier Universitaire de Nancy, France
| | - D Leclercq
- Neuro-Radiology, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - C Houillier
- APHP, Sorbonne Université, IHU, ICM, Neurology,Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - K Rezai
- Radio-Pharmacology, Institut Curie, Site Saint-Cloud, France
| | - F Bijou
- Hematology, Institut Bergonié, Bordeaux, France
| | - R Houot
- Univ. Rennes, CHU Rennes, Department of Hematology, Inserm, MICMAC (MIcroenvironment, Cell differentiation, iMmunology and Cancer), UMR_S 1236, F-35000, Rennes, France
| | - E Boyle
- Hematology, Centre Hospitalier Universitaire de Lille, France
| | - R Gressin
- Hematology, Centre Hospitalier Universitaire de Grenoble, France
| | | | - M Barrie
- Neuro-Oncology, Centre Hospitalier Universitaire la Timone, Marseille, France
| | - C Moluçon-Chabrot
- Hematology, Centre Hospitalier Universitaire de Clermont-Ferrand, France
| | - M L Lelez
- Ophthalmology, Centre Hospitalier Universitaire, Tours, France
| | - A Clavert
- Hematology, Centre Hospitalier Universitaire d'Angers, France
| | - S Coisy
- Ophthalmology, Centre Hospitalier Universitaire d'Angers, France
| | - S Leruez
- Ophthalmology, Centre Hospitalier Universitaire d'Angers, France
| | - V Touitou
- Ophthalmology, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - N Cassoux
- Ophthalmology, Institut Curie, Site Paris, Université Paris V Descartes et PSL (Paris Science et Lettre), Paris, France
| | - M Daniau
- Molecular biology, Institut du cerveau et de la moëlle, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - A El Yamani
- Hematology, Centre Hospitalier de Blois, France
| | - H Ghesquières
- Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - K Hoang-Xuan
- APHP, Sorbonne Université, IHU, ICM, Neurology,Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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24
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Choquet S, Baron M, Soussain C, Houillier C, Gyan E, Soubeyran P, Cassoux N, Touitou V, Bodaghi B, Hoang-Xuan K, Leblond V. TEMOZOLOMIDE IN RELAPSE/REFRACTORY PRIMARY VITREO-RETINAL LYMPHOMA (R/R PVRL): A SIMPLE, CHEAP, EFFECTIVE AND WELL TOLERATED TREATMENT. RESULT OF THE LARGEST STUDY ON R/R PVRL, FROM THE LOC NETWORK. Hematol Oncol 2019. [DOI: 10.1002/hon.79_2630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- S. Choquet
- Clinical Haematology; APHP, Pitie-Salpetriere; Paris France
| | - M. Baron
- Clinical Haematology; APHP, Pitie-Salpetriere; Paris France
| | - C. Soussain
- Clinical Haematology; Institut Curie, Rene Huguenin; Saint-Cloud France
| | - C. Houillier
- Neuro-Oncology; Pitie Salpetriere Hospital; Paris France
| | - E. Gyan
- Clinical Haematology; CHRU Trousseau; Chambray-lès-Tours France
| | - P. Soubeyran
- Clinical Haematology; Institut Bergonié; Bordeaux France
| | - N. Cassoux
- Ophtalmology; Institut Curie; Paris Paris France
| | - V. Touitou
- Ophtalmology; Pitie Salpetriere Hospital; Paris France
| | - B. Bodaghi
- Ophtalmology; Pitie Salpetriere Hospital; Paris France
| | - K. Hoang-Xuan
- Neuro-Oncology; Pitie Salpetriere Hospital; Paris France
| | - V. Leblond
- Clinical Haematology; APHP, Pitie-Salpetriere; Paris France
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25
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Ghesquieres H, Chevrier M, Laadhari M, Chinot O, Choquet S, Moluçon-Chabrot C, Beauchesne P, Gressin R, Morschhauser F, Schmitt A, Gyan E, Hoang-Xuan K, Nicolas-Virelizier E, Cassoux N, Touitou V, Le Garff-Tavernier M, Savignoni A, Turbiez I, Soumelis V, Houillier C, Soussain C. Lenalidomide in combination with intravenous rituximab (REVRI) in relapsed/refractory primary CNS lymphoma or primary intraocular lymphoma: a multicenter prospective 'proof of concept' phase II study of the French Oculo-Cerebral lymphoma (LOC) Network and the Lymphoma Study Association (LYSA)†. Ann Oncol 2019; 30:621-628. [PMID: 30698644 DOI: 10.1093/annonc/mdz032] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Primary central nervous system lymphomas (PCNSLs) are mainly diffuse large B-cell lymphomas (DLBCLs) of the non-germinal center B-cell (non-GCB) subtype. This study aimed to determine the efficacy of rituximab plus lenalidomide (R2) in DLBCL-PCNSL. PATIENTS AND METHODS Patients with refractory/relapsed (R/R) DLBCL-PCNSL or primary vitreoretinal lymphoma (PVRL) were included in this prospective phase II study. The induction treatment consisted of eight 28-day cycles of R2 (rituximab 375/m2 i.v. D1; lenalidomide 20 mg/day, D1-21 for cycle 1; and 25 mg/day, D1-21 for the subsequent cycles); in responding patients, the induction treatment was followed by a maintenance phase comprising 12 28-day cycles of lenalidomide alone (10 mg/day, D1-21). The primary end point was the overall response rate (ORR) at the end of induction (P0 = 10%; P1 = 30%). RESULTS Fifty patients were included. Forty-five patients (PCNSL, N = 34; PVRL, N = 11) were assessable for response. The ORR at the end of induction was 35.6% (95% CI 21.9-51.2) in assessable patients and 32.0% (95% CI 21.9-51.2) in the intent-to-treat analysis, including 13 complete responses (CR)/unconfirmed CR (uCR; 29%) and 3 partial responses (PR; 7%). The best responses were 18 CR/uCR (40%) and 12 PR (27%) during the induction phase. The maintenance phase was started and completed by 18 and 5 patients, respectively. With a median follow-up of 19.2 months (range 1.5-31), the median progression-free survival (PFS) and overall survival (OS) were 7.8 months (95% CI 3.9-11.3) and 17.7 months (95% CI 12.9 to not reached), respectively. No unexpected toxicity was observed. The peripheral baseline CD4/CD8 ratio impacted PFS [median PFS = 9.5 months (95% CI, 8.1-14.8] for CD4/CD8 ≥ 1.6; median PFS = 2.8 months, [95% CI, 1.1-7.8) for CD4/CD8 < 1.6, P = 0.03). CONCLUSIONS The R2 regimen showed significant activity in R/R PCNSL and PVRL patients. These results support assessments of the efficacy of R2 combined with methotrexate-based chemotherapy as a first-line treatment of PCNSL. CLINICAL TRIALS NUMBER NCT01956695.
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Affiliation(s)
- H Ghesquieres
- Department of Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite; Department of Hematology, Centre Léon Bérard, Université Claude Bernard Lyon 1, Lyon
| | - M Chevrier
- Departments of Biostatistics, Aix Marseille University, AP-HM, Marseille
| | - M Laadhari
- Radiology, Institut Curie, Saint-Cloud, Aix Marseille University, AP-HM, Marseille
| | - O Chinot
- Department of Neuro-Oncology, Hôpital de la Timone, Aix Marseille University, AP-HM, Marseille
| | - S Choquet
- Department of Hematology, Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris
| | | | | | - R Gressin
- Department of Hematology, CHU La Tronche, Grenoble
| | - F Morschhauser
- Department of Hematology, Centre Hospitalier Universitaire, Université de Lille, Lille
| | - A Schmitt
- Department of Hematology, Institut Bergonié, Bordeaux
| | - E Gyan
- Department of Hematology and Cellular Therapy, CIC INSERM U1517, Centre Hospitalier Universitaire, Université de Tours, Tours
| | - K Hoang-Xuan
- Department of Neurology 2 Mazarin, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne University, IHU, ICM, Paris
| | - E Nicolas-Virelizier
- Department of Hematology, Centre Léon Bérard, Université Claude Bernard Lyon 1, Lyon
| | - N Cassoux
- Department of Ophthalmology, Institut Curie - Site Paris, Paris
| | - V Touitou
- Department of Ophthalmology, Hôpital Pitié Salpetrière, Université Pierre et Marie Curie, Paris
| | - M Le Garff-Tavernier
- Groupe Hospitalier Pitié-Salpétrière, Biological Hematology, Paris, France; Paris University Sorbonne UPMC, INSERM UMRS 1138, Paris
| | - A Savignoni
- Departments of Biostatistics, Aix Marseille University, AP-HM, Marseille
| | - I Turbiez
- Departments of Biostatistics, Aix Marseille University, AP-HM, Marseille
| | - V Soumelis
- Clinical Immunology Laboratory, Department of Biopathology, INSERM U932, Immunity and Cancer, Institut Curie, Paris
| | - C Houillier
- Department of Neurology 2 Mazarin, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne University, IHU, ICM, Paris
| | - C Soussain
- Department of Hematology, Institut Curie, Saint-Cloud, France.
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26
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Ursu R, Thomas L, Psimaras D, Chinot O, Le Rhun E, Ricard D, Charissoux M, Cuzzubbo S, Sejalon F, Quillien V, Hoang-Xuan K, Ducray F, Portal JJ, Tibi A, Mandonnet E, Levy-Piedbois C, Vicaut E, Carpentier AF. Angiotensin II receptor blockers, steroids and radiotherapy in glioblastoma-a randomised multicentre trial (ASTER trial). An ANOCEF study. Eur J Cancer 2019; 109:129-136. [PMID: 30716716 DOI: 10.1016/j.ejca.2018.12.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/18/2018] [Accepted: 12/23/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Glioblastomas (GBMs) induce a peritumoural vasogenic oedema impairing functional status and quality of life. Steroids reduce brain tumour-related oedema but are associated with numerous side-effects. It was reported in a retrospective series that angiotensin receptor blockers might be associated with reduced peritumoural oedema. The ASTER study is a randomised, placebo-controlled trial to assess whether or not the addition of Losartan to standard of care (SOC) can reduce steroid requirement during radiotherapy (RT) in patients with newly diagnosed GBM. PATIENTS AND METHODS Patients with a histologically confirmed GBM after biopsy or partial surgical resection were randomised between Losartan or placebo in addition to SOC with RT and temozolomide (TMZ). The primary objective was to investigate the steroid dosage required to control brain oedema on the last day of RT in each arm. The secondary outcomes were steroids dosage 1 month after the end of RT, assessment of cerebral oedema on magnetic resonance imaging, tolerance and survival. RESULTS Seventy-five patients were randomly assigned to receive Losartan (37 patients) or placebo (38 patients). No difference in the steroid dosage required to control brain oedema on the last day of RT, or one month after completion of RT, was seen between both arms. The incidence of adverse events was similar in both arms. Median overall survival was similar in both arms. CONCLUSIONS Losartan, although well tolerated, does not reduce the steroid requirement in newly diagnosed GBM patients treated with concomitant RT and TMZ. Trial registration number NCT01805453 with ClinicalTrials.gov.
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Affiliation(s)
- R Ursu
- Department of Neurology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France.
| | - L Thomas
- Department of Neuro-Oncology, Hospices Civils de Lyon, Groupe Hospitalier Est, Lyon, France
| | - D Psimaras
- Department of Neurology Mazarin, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - O Chinot
- Department of Neuro-Oncology, CHU Timone, Marseille, France; Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - E Le Rhun
- University of Lille, Inserm, U-1192, F-59000 Lille, France; CHU Lille, General and Stereotaxic Neurosurgery Service, F-59000 Lille, France; Oscar Lambret Center, Neurology, Medical Oncology Department, F-59000 Lille, France
| | - D Ricard
- Department of Neurology, Hôpital d'Instruction des Armées Percy, Service de Santé des Armées, Paris, France
| | - M Charissoux
- Department of Radiation Oncology, Institut du Cancer de Montpellier, Montpellier cedex 5, France
| | - S Cuzzubbo
- Department of Neurology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - F Sejalon
- Department of Neurology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - V Quillien
- Centre de Lutte Contre le Cancer Eugène Marquis, F-35042 Rennes, France; INSERM U1242, "Chemistry, Oncogenesis, Stress, Signaling", Université de Rennes 1, Rennes, France
| | - K Hoang-Xuan
- Department of Neurology Mazarin, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - F Ducray
- Department of Neuro-Oncology, Hospices Civils de Lyon, Groupe Hospitalier Est, Lyon, France; Department of Cancer Cell Plasticity, Cancer Research Centre of Lyon, INSERM U1052, CNRS UMR5286, Lyon, France; University Claude Bernard Lyon 1, Lyon, France
| | - J-J Portal
- AP-HP, Unité de Recherche Clinique, Hôpital Fernand Widal, Université Paris-Diderot, Paris, France
| | - A Tibi
- Agence Générale des Equipements et Produits de Santé (AGEPS), Paris, France
| | - E Mandonnet
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France; University Paris 7, Paris, France; IMNC, UMR 8165, Orsay, France
| | - C Levy-Piedbois
- Ramsey Générale de Santé, Institut de Radiothérapie des Hauts-Energies, Bobigny, France
| | - E Vicaut
- AP-HP, Unité de Recherche Clinique, Hôpital Fernand Widal, Université Paris-Diderot, Paris, France
| | - A F Carpentier
- Department of Neurology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France
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Marabelle A, Chevret S, Janot F, Escudier B, Pouessel D, Tournigand C, Hoang-Xuan K, Mortier L, Rousseau BC, Schlumberger M, Ray-Coquard I, Blay JY, Niccoli P, Jaccard A, Couch D, Hoog-Labouret N, Pauporte I, Massard C. AcSé immunotherapy trials: Anti-PD-1 therapy for adult patients with selected rare cancer types. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy487.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Lahmi L, Idbaih A, Canova CH, Sanson M, Hoang-Xuan K, Mokhtari K, Capelle L, Jacob J, Maingon P, Feuvret L. Radiothérapie panencéphalique et témozolomide concomitant pour le traitement de première ligne des glioblastomes multifocaux. Cancer Radiother 2018. [DOI: 10.1016/j.canrad.2018.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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URSU R, Thomas L, Psimaras D, Chinot O, Le Rhun E, Ricard D, Charissoux M, Cuzzubbo S, Sejalon F, Quillien V, Hoang-Xuan K, Ducray F, Portal J, Levy-Piedbois C, Vicaut E, Carpentier A. OS2.4 Angiotensin II Receptor Blockers, steroids and radiotherapy in glioblastoma - A randomized multicenter trial (ASTER Trial). An ANOCEF Study. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R URSU
- Hopital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - L Thomas
- Hospices Civils de Lyon, Groupe Hospitalier Est, Lyon, Lyon, France
| | - D Psimaras
- Hopital Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - O Chinot
- Department of Neuro-Oncology, CHU Timone, Marseille, France
| | - E Le Rhun
- Oscar Lambret Center, Neurology, Medical Oncology Department, Lille, France
| | - D Ricard
- Department of Neurology, Hôpital d’Instruction des Armées Percy, Service de Santé des Armées, Paris, France
| | - M Charissoux
- Department of Radiation Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - S Cuzzubbo
- Hopital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - F Sejalon
- Hopital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - V Quillien
- Centre de lutte contre le cancer Eugène Marquis, Rennes, France
| | - K Hoang-Xuan
- Hopital Pitié - Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - F Ducray
- Department of Neuro-Oncology, Hospices Civils de Lyon, Groupe Hospitalier Est, Lyon, France
| | - J Portal
- AP-HP, Unité de Recherche Clinique, Hôpital Fernand Widal, Paris, France
| | - C Levy-Piedbois
- Ramsey Générale de Santé, Institut de Radiothérapie des Hauts-Energies, Bobigny, France
| | - E Vicaut
- AP-HP, Unité de Recherche Clinique, Hôpital Fernand Widal, Paris, France
| | - A Carpentier
- Hopital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
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30
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Le M, Garcilazo Y, Younan N, Houillier C, Hoang-Xuan K, Alentorn A. P05.87 Hemoglobin level is a relevant prognostic marker of overall survival in primary central nervous system lymphoma: a retrospective study on 160 PCNSL. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Le
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - Y Garcilazo
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - N Younan
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - C Houillier
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - K Hoang-Xuan
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Universités, UPMC, Univ Paris 06 UMR S 1127, Inserm 1127, CNRS UMR, ICM, Paris, France
| | - A Alentorn
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Universités, UPMC, Univ Paris 06 UMR S 1127, Inserm 1127, CNRS UMR, ICM, Paris, France
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31
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Alentorn A, Philippe C, Grigis A, Ibañez-Julia M, Younan N, Duran-Peña A, Royer-Perron L, Goya-Outi J, Buvat I, Frouin F, Jacob J, Conforti R, Hoang-Xuan K, Frouin V. P05.88 Radiomics analysis of brain metastases from non-small cell lung cancer brings relevant supplementary information to clinical scores. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Alentorn
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
| | - C Philippe
- UNATI, Neurospin, Institut Joliot, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - A Grigis
- UNATI, Neurospin, Institut Joliot, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - M Ibañez-Julia
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - N Younan
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - A Duran-Peña
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - L Royer-Perron
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - J Goya-Outi
- IMIV, Inserm, CEA, CNRS, Université Paris-Saclay, Orsay, France
| | - I Buvat
- IMIV, Inserm, CEA, CNRS, Université Paris-Saclay, Orsay, France
| | - F Frouin
- IMIV, Inserm, CEA, CNRS, Université Paris-Saclay, Orsay, France
| | - J Jacob
- Department of Radiation Oncology, Ap-HP, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - R Conforti
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Department of Medical Oncology, Paris, France
| | - K Hoang-Xuan
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
| | - V Frouin
- UNATI, Neurospin, Institut Joliot, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
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Bennedjai A, Houiller C, Choquet S, Cassoux N, Guesquières H, Marolleau J, Chabrot C, Jdid I, Lejeune C, Bodaghi B, Le Hoang P, Hoang-Xuan K, Soussain C, Touitou V. High-dose chemotherapy with autologus hematopoeitic stem cell transplantation in relapsing Vitreoretinal Lymphoma, a LOC network study. Acta Ophthalmol 2017. [DOI: 10.1111/j.1755-3768.2017.0s081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A. Bennedjai
- Ophtalmology; hôpital La Pitié Salpêtrière; Paris France
| | | | - S. Choquet
- Hematology; Pitié salpêtrière; Paris France
| | | | | | | | - C. Chabrot
- Hematology; CHU Clermont-Ferrand; Clermont-Ferrand France
| | - I. Jdid
- Hematology; CH Orléans; Orleans France
| | | | - B. Bodaghi
- Ophtalmology; Pitié Salpêtrièe; Paris France
| | - P. Le Hoang
- Ophtalmology; Pitié Salpêtrière; Paris France
| | | | | | - V. Touitou
- Ophtalmology; Pitié Salpêtrière; Paris France
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Soussain C, Choquet S, Houillier C, Bijou F, Houot R, Boyle E, Gressin R, Nicolas-Virelizier E, Barrie M, Moluçon-Chabrot C, Lelez M, Clavert A, Coisy S, de la Bretonnière ME, El Yamani A, Touitou V, Cassoux N, Boussetta S, Broussais F, Gelas-Dore B, Barzic N, Ghesquières H, Hoang-Xuan K. IBRUTINIB IN RELAPSE OR REFRACTORY PRIMARY CNS AND VITREO-RETINAL LYMPHOMA. RESULTS OF THE PRIMARY END-POINT OF THE I
LOC PHASE II STUDY FROM THE LYSA AND THE FRENCH LOC NETWORK. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- C. Soussain
- Hematology; Institut Curie; Saint-CLoud France
| | - S. Choquet
- Hematology; GH Pitié-Salpétrière; Paris France
| | - C. Houillier
- Neuro-oncology; GH Pitié-Salpétrière; Paris France
| | - F. Bijou
- Hematology; Institut Bergonié; Bordeaux France
| | - R. Houot
- Hematology; CHU Rennes; Rennes France
| | - E. Boyle
- Hematology; CHU Lille; Lille France
| | - R. Gressin
- Hematology; CHU Grenoble; Grenoble France
| | | | - M. Barrie
- Neuro-oncology; Hôpital de la Timone; Marseille France
| | | | - M. Lelez
- Ophthalmology; CHU Tours; Tours France
| | | | - S. Coisy
- Ophthalmology; CHU Angers; Angers France
| | | | | | - V. Touitou
- Ophthalmology; GH Pitié-Salpétrière; Paris France
| | - N. Cassoux
- Ophthalmology; Institut Curie; Paris France
| | | | | | | | - N. Barzic
- Clinical projects management; LYSARC; Lyon France
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Alentorn A, Daniau M, Royer-Perron L, Labreche K, Duran-Pena A, Marie Y, Hoang-Xuan K, Sanson M, Delattre J, Idbaih A. P09.14 Clonal and subclonal evolution of 1p/19q co-deleted oligodendrogliomas. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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35
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Royer-Perron L, Bruno A, Daniau M, Labrèche K, Mokhtari K, Nguyen Them L, Houillier C, Soussain C, Hoang-Xuan K, Alentorn A. P17.04 Radiomics analysis of primary central nervous system lymphoma (PCNSL) - A LOC network study. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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36
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Houillier C, Soussain C, Ghesquières H, Soubeyran P, Chinot O, Taillandier L, Houot R, Ahle G, Gyan E, Hoang-Xuan K. OS7.6 Management patterns and outcome of patients with primary CNS lymphoma (PCNSL) in France during 2011–2016. A LOC network study. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Boros A, Michot JM, Hoang-Xuan K, Mazeron R. [Role of radiotherapy in the treatment of NK/T-cell nasal type and primary cerebral lymphomas]. Cancer Radiother 2016; 20:535-42. [PMID: 27614517 DOI: 10.1016/j.canrad.2016.07.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 01/28/2023]
Abstract
The head and neck are common sites for extranodal non-Hodgkin lymphomas. Radiotherapy plays an important role in the treatment of low-grade lymphomas, with curative or palliative intent. In the case of high-grade lymphomas, its combination with chemotherapy is debated. Its role is however undeniable in two specific entities: NK/T-cell lymphoma NK/T nasal type, and primary central nervous system lymphomas, which are the subject of this review.
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Affiliation(s)
- A Boros
- Département d'oncologie radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France; Université Paris Saclay, 15, rue Georges-Clemenceau, 91400 Orsay, France
| | - J-M Michot
- Université Paris Saclay, 15, rue Georges-Clemenceau, 91400 Orsay, France; Département d'innovation thérapeutique et d'essais précoces, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - K Hoang-Xuan
- Département de neurologie, division Mazarin, centre hospitalier universitaire Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France; Institut du cerveau et de la moelle, CNRS UMR 7225, Inserm U 1127, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Réseau lymphomes oculocérébraux (LOC), 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - R Mazeron
- Département d'oncologie radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France; Université Paris Saclay, 15, rue Georges-Clemenceau, 91400 Orsay, France.
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Houot R, Soussain C, Tilly H, Haioun C, Thieblemont C, Casasnovas O, Bouabdallah K, Morschhauser F, Le Gouill S, Salles G, Hoang-Xuan K, Choquet S, Marchand T, Laurent C, Pangault C, Lamy T. Inhibition of Hedgehog signaling for the treatment of lymphoma and CLL: a phase II study from the LYSA. Ann Oncol 2016; 27:1349-50. [DOI: 10.1093/annonc/mdw138] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chardain A, Mesnage V, Alamowitch S, Bourdain F, Crozier S, Lenglet T, Psimaras D, Demeret S, Graveleau P, Hoang-Xuan K, Levy R. Posterior reversible encephalopathy syndrome (PRES) and hypomagnesemia: A frequent association? Rev Neurol (Paris) 2016; 172:384-8. [PMID: 27371132 DOI: 10.1016/j.neurol.2016.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 01/12/2016] [Accepted: 06/03/2016] [Indexed: 11/16/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a serious neurological condition encountered in various medical fields. Pathophysiological factor(s) common to PRES cases of apparently unrelated etiologies are yet to be found. Based on the hypothesis that hypomagnesemia might participate in the cascade leading to PRES, our study sought to verify whether hypomagnesemia is frequently associated with PRES regardless of etiology. From a retrospective study of a cohort of 57 patients presenting with PRES of different etiologies, presented here are the findings of 19 patients with available serum magnesium levels (SMLs) during PRES. In the acute phase of PRES, hypomagnesemia was present in all 19 patients in spite of differences in etiology (including immunosuppressive drugs, hypertensive encephalopathy, eclampsia, systemic lupus erythematosus, iatrogenic etiology and unknown). SMLs were within normal ranges prior to PRES and below normal ranges during the first 48h of PRES, with a significant decrease in SMLs during the acute phase. In this retrospective study, constant hypomagnesemia was observed during the acute phase of PRES regardless of its etiology. These results now require larger studies to assess the particular importance of acute hypomagnesemia in PRES and especially the possible need to treat PRES with magnesium sulfate.
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Affiliation(s)
- A Chardain
- Department of Neurology, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | - V Mesnage
- Department of Neurology, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - S Alamowitch
- Department of Neurology, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - F Bourdain
- Department of Neurology, Centre médico-chirurgical Foch, 92150 Suresnes, France
| | - S Crozier
- Department of Cerebrovascular Emergency, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - T Lenglet
- Department of Neurology, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - D Psimaras
- Department of Neurology, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - S Demeret
- Department of Neurological Intensive Care Unit, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - P Graveleau
- Department of Neurology, Centre médico-chirurgical Foch, 92150 Suresnes, France
| | - K Hoang-Xuan
- Department of Neurology, hôpital Pitié-Salpétrière, Assistance publique-Hôpitaux de Paris, 75013 Paris, France
| | - R Levy
- Department of Neurology, hôpital Saint-Antoine, Assistance publique-Hôpitaux de Paris, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
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Tabouret E, Houillier C, Martin-Duverneuil N, Blonski M, Soussain C, Ghesquieres H, Houot R, Delwail V, Soubeyran P, Gressin R, Gyan E, Lemercier S, Chinot O, Taillandier L, Tanguy M, Antonio O, Hoang-Xuan K. 2904 Patterns of response and relapse of primary central nervous system lymphomas (PCNSL) following first line of high-dose methotrexate-based chemotherapy (hdMTX): Independent review of a prospective ANOCEF randomized phase II trial. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31621-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kasenda B, Ferreri AJM, Marturano E, Forst D, Bromberg J, Ghesquieres H, Ferlay C, Blay JY, Hoang-Xuan K, Pulczynski EJ, Fosså A, Okoshi Y, Chiba S, Fritsch K, Omuro A, O'Neill BP, Bairey O, Schandelmaier S, Gloy V, Bhatnagar N, Haug S, Rahner S, Batchelor TT, Illerhaus G, Briel M. First-line treatment and outcome of elderly patients with primary central nervous system lymphoma (PCNSL)--a systematic review and individual patient data meta-analysis. Ann Oncol 2015; 26:1305-13. [PMID: 25701456 DOI: 10.1093/annonc/mdv076] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [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: 10/25/2014] [Accepted: 02/10/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND To investigate prognosis and effects of first-line therapy in elderly primary central nervous system lymphoma (PCNSL) patients. PATIENTS AND METHODS A systematic review of studies about first-line therapy in immunocompetent patients ≥60 years with PCNSL until 2014 and a meta-analysis of individual patient data from eligible studies and international collaborators were carried out. RESULTS We identified 20 eligible studies; from 13 studies, we obtained individual data of 405 patients, which were pooled with data of 378 additional patients (N = 783). Median age and Karnofsky Performance Score (KPS) was 68 years (range: 60-90 years) and 60% (range: 10%-100%), respectively. Treatments varied greatly, 573 (73%) patients received high-dose methotrexate (HD-MTX)-based therapy. A total of 276 patients received whole-brain radiotherapy (median 36 Gy, range 28.5-70 Gy). KPS ≥ 70% was the strongest prognostic factor for mortality [hazard ratio (HR) 0.50, 95% confidence interval (CI) 0.41-0.62]. After a median follow-up of 40 months, HD-MTX-based therapy was associated with improved survival (HR 0.70, 95% CI 0.53-0.93). There was no difference between HD-MTX plus oral chemotherapy and more aggressive HD-MTX-based therapies (HR 1.39, 95% CI 0.90-2.15). Radiotherapy was associated with an improved survival, but correlated with an increased risk for neurological side-effects (odds ratio 5.23, 95% CI 2.33-11.74). CONCLUSIONS Elderly PCNSL patients benefit from HD-MTX-based therapy, especially if combined with oral alkylating agents. More aggressive HD-MTX protocols do not seem to improve outcome. WBRT may improve outcome, but is associated with increased risk for neurological side-effects. Prospective trials for elderly PCNSL patients are warranted.
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Affiliation(s)
- B Kasenda
- Department of Oncology, University Hospital of Basel, Basel Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - A J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy
| | - E Marturano
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy
| | - D Forst
- Partners Neurology Residency Program, Harvard Medical School, Boston, USA
| | - J Bromberg
- Department of Neuro-Oncology, Daniel den Hoed Cancer Center, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - H Ghesquieres
- Department of Hematology, Centre Léon Bérard, University of Lyon, Lyon
| | - C Ferlay
- Department of Hematology, Centre Léon Bérard, University of Lyon, Lyon
| | - J Y Blay
- Department of Hematology, Centre Léon Bérard, University of Lyon, Lyon
| | - K Hoang-Xuan
- Department of Neurology Mazarin, LOC National Expert Center, APHP, IHU, UPMC, CRICM, GH Pitié-Salpêtrière, Paris, France
| | - E J Pulczynski
- Department of Haematology, Nordic Lymphoma Group, University Hospital Aarhus, Aarhus, Denmark
| | - A Fosså
- Norwegian Department of Oncology, Nordic Lymphoma Group, Radium Hospital, Oslo, Norway
| | - Y Okoshi
- Faculty of Medicine, Department of Hematology, University of Tsukuba, Tsukuba, Japan
| | - S Chiba
- Faculty of Medicine, Department of Hematology, University of Tsukuba, Tsukuba, Japan
| | - K Fritsch
- Department of Hematology/Oncology, University Hospital Freiburg, Freiburg, Germany
| | - A Omuro
- Department of Neurology Mazarin, LOC National Expert Center, APHP, IHU, UPMC, CRICM, GH Pitié-Salpêtrière, Paris, France
| | - B P O'Neill
- Department of Neurology, Mayo Medical School, Rochester, USA
| | - O Bairey
- Institute of Hematology, Rabin Medical Center, Beilinson Hospital, Tel Aviv Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Schandelmaier
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - V Gloy
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - N Bhatnagar
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - S Haug
- Psychiatry and Psychotherapy, University Hospital Freiburg, Freiburg
| | - S Rahner
- Medical Faculty, University of Freiburg, Freiburg, Germany
| | - T T Batchelor
- Partners Neurology Residency Program, Harvard Medical School, Boston, USA Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, USA
| | - G Illerhaus
- Stuttgart Cancer Center, Eva-Mayr-Stihl Tumor Center, Stuttgart, Germany
| | - M Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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Labussière M, Di Stefano AL, Gleize V, Boisselier B, Giry M, Mangesius S, Bruno A, Paterra R, Marie Y, Rahimian A, Finocchiaro G, Houlston RS, Hoang-Xuan K, Idbaih A, Delattre JY, Mokhtari K, Sanson M. TERT promoter mutations in gliomas, genetic associations and clinico-pathological correlations. Br J Cancer 2014; 111:2024-32. [PMID: 25314060 PMCID: PMC4229642 DOI: 10.1038/bjc.2014.538] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/18/2014] [Accepted: 09/12/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The role of telomerase reverse transcriptase (TERT) in gliomagenesis has been recently further strengthened by the frequent occurrence of TERT promoter mutations (TERTp-mut) in gliomas and evidence that the TERT SNP genetic rs2736100 influences glioma risk. TERTp-mut creates a binding site for Ets/TCF transcription factors, whereas the common rs2853669 polymorphism disrupts another Ets/TCF site on TERT promoter. METHODS We sequenced for TERTp-mut in 807 glioma DNAs and in 235 blood DNAs and analysed TERT expression by RT-PCR in 151 samples. TERTp-mut status and TERTp polymorphism rs2853669 were correlated with histology, genomic profile, TERT mRNA expression, clinical outcome and rs2736100 genotype. RESULTS TERTp-mut identified in 60.8% of gliomas (491 out of 807) was globally associated with poorer outcome (Hazard ratio (HR)=1.50). We defined, based on TERTp-mut and IDH mutation status, four prognostic groups: (1) TERTp-mut and IDH-mut associated with 1p19q codeletion, overall survival (OS)>17 years; (2) TERTp-wt and IDH-mut, associated with TP53 mutation, OS=97.5 months; (3) TERTp-wt and IDH-wt, with no specific association, OS=31.6 months; (4) TERTp-mut and IDH-wt, associated with EGFR amplification, OS=15.4 months. TERTp-mut was associated with higher TERT mRNA expression, whereas the rs2853669 variant was associated with lower TERT mRNA expression. The mutation of CIC (a repressor of ETV1-5 belonging to the Ets/TCF family) was also associated with TERT mRNA upregulation. CONCLUSIONS In addition to IDH mutation status, defining the TERTp-mut status of glial tumours should afford enhanced prognostic stratification of patients with glioma. We also show that TERTp-mut, rs2853669 variant and CIC mutation influence Tert expression. This effect could be mediated by Ets/TCF transcription factors.
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Affiliation(s)
- M Labussière
- 1] Sorbonne Universités, UMPC Univ Paris 06, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris 75013, France [2] INSERM U 1127, Paris 75013, France [3] CNRS, UMR 7225, Paris 75013, France
| | - A L Di Stefano
- 1] Sorbonne Universités, UMPC Univ Paris 06, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris 75013, France [2] INSERM U 1127, Paris 75013, France [3] CNRS, UMR 7225, Paris 75013, France [4] National Neurological Institute C. Mondino, University of Pavia, 27100 Pavia, Italy
| | - V Gleize
- 1] Sorbonne Universités, UMPC Univ Paris 06, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris 75013, France [2] INSERM U 1127, Paris 75013, France [3] CNRS, UMR 7225, Paris 75013, France
| | - B Boisselier
- 1] Sorbonne Universités, UMPC Univ Paris 06, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris 75013, France [2] INSERM U 1127, Paris 75013, France [3] CNRS, UMR 7225, Paris 75013, France [4] Institut du Cerveau et de la Moelle épinière (ICM), Plateforme de Génotypage Séquençage, Paris 75013, France
| | - M Giry
- 1] Sorbonne Universités, UMPC Univ Paris 06, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris 75013, France [2] INSERM U 1127, Paris 75013, France [3] CNRS, UMR 7225, Paris 75013, France
| | - S Mangesius
- 1] Sorbonne Universités, UMPC Univ Paris 06, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris 75013, France [2] INSERM U 1127, Paris 75013, France [3] CNRS, UMR 7225, Paris 75013, France
| | - A Bruno
- 1] Sorbonne Universités, UMPC Univ Paris 06, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris 75013, France [2] INSERM U 1127, Paris 75013, France [3] CNRS, UMR 7225, Paris 75013, France
| | - R Paterra
- Dipartimento di Neuro Oncologia Molecolare Fondazione I.R.C.C.S. Istituto Neurologico C. Besta, Milano 20134, Italy
| | - Y Marie
- 1] Institut du Cerveau et de la Moelle épinière (ICM), Plateforme de Génotypage Séquençage, Paris 75013, France [2] Onconeurothèque, Paris 75013, France
| | - A Rahimian
- 1] Sorbonne Universités, UMPC Univ Paris 06, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris 75013, France [2] INSERM U 1127, Paris 75013, France [3] CNRS, UMR 7225, Paris 75013, France [4] Onconeurothèque, Paris 75013, France
| | - G Finocchiaro
- Dipartimento di Neuro Oncologia Molecolare Fondazione I.R.C.C.S. Istituto Neurologico C. Besta, Milano 20134, Italy
| | - R S Houlston
- Division of Genetics and Epidemiology, Institute of Cancer Research, Surrey SM2 5NG, UK
| | - K Hoang-Xuan
- 1] Sorbonne Universités, UMPC Univ Paris 06, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris 75013, France [2] INSERM U 1127, Paris 75013, France [3] CNRS, UMR 7225, Paris 75013, France [4] AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2, Paris 75013, France
| | - A Idbaih
- 1] Sorbonne Universités, UMPC Univ Paris 06, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris 75013, France [2] INSERM U 1127, Paris 75013, France [3] CNRS, UMR 7225, Paris 75013, France [4] AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2, Paris 75013, France
| | - J-Y Delattre
- 1] Sorbonne Universités, UMPC Univ Paris 06, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris 75013, France [2] INSERM U 1127, Paris 75013, France [3] CNRS, UMR 7225, Paris 75013, France [4] Onconeurothèque, Paris 75013, France [5] AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2, Paris 75013, France
| | - K Mokhtari
- 1] Sorbonne Universités, UMPC Univ Paris 06, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris 75013, France [2] INSERM U 1127, Paris 75013, France [3] CNRS, UMR 7225, Paris 75013, France [4] Onconeurothèque, Paris 75013, France [5] AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Laboratoire de Neuropathologie R. Escourolle, Paris 75013, France
| | - M Sanson
- 1] Sorbonne Universités, UMPC Univ Paris 06, Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière, Paris 75013, France [2] INSERM U 1127, Paris 75013, France [3] CNRS, UMR 7225, Paris 75013, France [4] Onconeurothèque, Paris 75013, France [5] AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2, Paris 75013, France
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Cloughesy T, Wick W, Mason W, Henriksson R, Saran F, Nishikawa R, Carpentier AF, Hoang-Xuan K, Kavan P, Cernea D, Brandes AA, Revil C, Abrey L, Chinot OL. AT-18 * SURVIVAL ANALYSIS OF PATIENTS WITH A PFS EVENT WHO DID NOT RECEIVE POST-PROGRESSION THERAPY IN AVAGLIO (BEVACIZUMAB [BEV] PLUS RADIOTHERAPY [RT] AND TEMOZOLOMIDE [TMZ] FOR NEWLY DIAGNOSED GLIOBLASTOMA [GBM]). Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou237.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Verreault M, Levasseur C, Schmitt C, Guehennec J, Labussiere M, Marie Y, Haidar S, Mokhtari K, Hoang-Xuan K, Sanson M, Ligon K, Delattre JY, Idbaih A. ET-62 * HIGHLY SELECTIVE ACTIVITY OF MDM2 INHIBITOR RG7112 AGAINST MDM2-AMPLIFIED/TP53 WILD-TYPE GLIOBLASTOMAS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou255.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Blonski M, Simon L, Houillier C, Idbaih A, Wittwer B, Beauchesne P, Hoang-Xuan K, Taillandier L. P17.08 * RENAL THROMBOTIC MICROANGIOPATHY INDUCED BY BEVACIZUMAB IN HIGH GRADE GLIOMA PATIENTS - ABOUT SIX CASES. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bompaire F, Lahutte M, Psimaras D, Sallansonnet-Froment M, De Greslan T, Taillia H, Renard J, Alamovitch S, Hoang-Xuan K, Ricard D. O3.02 * RADIATION-INDUCED LEUKOENCEPHALOPATHY IS A DEFINITE TYPE OF SMALL VESSEL DISEASE - NEUROPSYCHOLOGICAL AND MRI DESCRIPTION IN 40 PATIENTS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Houillier C, Choquet S, Touitou V, Martin-Duverneuil N, Hoang-Xuan K. P11.05 * LENALIDOMIDE IN THE TREATMENT OF RELAPSED PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA (PCNSL). Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Larrieu D, Choquet S, Hoang-Xuan K, Mokhtari K, Navarro S, Martin-Duverneuil N, Leblond V, Charlotte F, Houillier C. P11.04 * MALT CNS LYMPHOMAS: A MONOCENTRIC EXPERIENCE. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ahle G, Hoang-Xuan K, Cassoux N, Touitou V, Soussain C, Humbrecht-Kraut C, Manoila I, Bouyon M, Schroers R, Houillier C. P11.03 * OPTIC NERVE INFILTRATION OF PRIMARY CNS LYMPHOMA. Neuro Oncol 2014; 16:ii59-ii59. [PMCID: PMC4185579 DOI: 10.1093/neuonc/nou174.226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
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Ahle G, Hoang-Xuan K, Cassoux N, Touitou V, Humbrecht-Kraut C, Gaultier C, Houiller C. Infiltration du nerf optique dans le cadre d’un lymphome primitif du système nerveux central (LPSNC) : à propos de 4 patients. Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2014.01.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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