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Sarkozy C, Callanan MB, Thieblemont C, Obéric L, Burroni B, Bouabdallah K, Damaj G, Tessoulin B, Ribrag V, Houot R, Morschhauser F, Griolet S, Joubert C, Cacheux V, Delwail V, Safar V, Gressin R, Cheminant M, Delfau-Larue MH, Hermine O, Macintyre EA, Le Gouill S. Obinutuzumab versus Rituximab in transplant-eligible Mantle cell lymphoma patients. Blood 2024:blood.2024023944. [PMID: 38669626 DOI: 10.1182/blood.2024023944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/01/2024] [Accepted: 03/18/2024] [Indexed: 04/28/2024] Open
Abstract
Obinutuzumab (O) and Rituximab (R) are two CD antibodies that have never been compared in a prospective randomised trial in mantle cell lymphoma (MCL). Herein, we report the long-term outcome of the LYMA-101 (NCT02896582) trial, in which newly diagnosed MCL patients were treated with chemotherapy plus O before transplantation followed by O maintenance (O group). We then compared these patients to those treated with the same treatment design with Rituximab instead of O (R group) (NCT00921414). A propensity score matching (PSM) was used to compare the two populations (O vs R groups) in terms of MRD at the end of induction (EOI), PFS and OS. In LYMA-101, the estimated five-year PFS and OS since inclusion (n=85) were 83.4% (95%CI: 73.5-89.8%) and 86.9% (95%CI: 77.6-92.5%), respectively. At EOI, patients treated in the O group had more frequent bone marrow MRD negativity than those treated in the R group (83.1% vs 63.4% Chi2 p=0.007). The PSM resulted in 2 sets of 82 patients with comparable characteristics at inclusion. From treatment initiation, the O group had a longer estimated five-year PFS (p=0.029; 82.8% versus 66.6%, HR 1.99, IC95 1.05-3.76) and OS (p=0.039; 86.4% versus 71.4% (HR 2.08, IC95 1.01-4.16) compared to the R group. Causes of death were comparable in the 2 groups, the most common cause being lymphoma. Obinutuzumab prior to transplantation and in maintenance provides better disease control and enhances PFS and OS, as compared to Rituximab in transplant-eligible MCL patients.
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Affiliation(s)
| | | | - Catherine Thieblemont
- AP-HP, Hôpital Saint-Louis, Hemato-oncologie, DMU DHI,F-75010 Paris, France, Paris, France
| | - Lucie Obéric
- Department of Hematology, Institut universitaire du cancer Toulouse- Oncopole, Toulouse, France
| | - Barbara Burroni
- Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Ghandi Damaj
- Normandy University, Hematology Institute, Caen, France
| | | | | | - Roch Houot
- CHU Rennes, University of Rennes, Rennes, France
| | | | - Samuel Griolet
- LYSARC, Statistics, Pierre-Benite, Pierre-Bénite, France
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Chaubard S, Marouf A, Lavergne D, Lemonnier F, Rossignol J, Clavert A, Gressin R, Cartron G, Waultier-Rascalou A, Vargaftig J, Salles G, Bachy E, Ghesquières H, Tournilhac O, Chauchet A, Le Gouill S, Damaj G, Fornecker LM, Sibon D, Obéric L, Michot JM, Gaulard P, Hermine O, Couronné L, Jaccard A. Efficacy of a short sandwich protocol, methotrexate, gemcitabine, L-asparaginase and dexamethasone chemotherapy combined with radiotherapy, in localised newly diagnosed NK/T-cell lymphoma: A French retrospective study. Br J Haematol 2023; 201:673-681. [PMID: 36799516 DOI: 10.1111/bjh.18689] [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: 11/24/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/18/2023]
Abstract
Extranodal NK/T-cell lymphoma, nasal type is a rare and aggressive form of lymphoma, historically associated with poor prognosis. We report here the results of a retrospective multi-centre study evaluating the efficacy of MGAD (methotrexate, gemcitabine, L-asparaginase and dexamethasone) regimen (two cycles) combined with 'sandwich' radiotherapy in 35 patients with localised newly diagnosed extranodal NK/T-cell lymphoma. Thirty-two patients (91%) reached complete remission. With a long median follow-up of 59.6 months, progression-free and overall survival at 2 and 5 years were 71%, 80% and 53%, 73%, respectively. Around one third of the patients experienced relapse within a median time of 14.5 months. Side-effects were manageable with grades 3-4 cytopenias, mucositis and infection in 50%, 24% and 21% of the cases, respectively. Monitoring of asparaginase activity was performed in 13 patients and showed inactivation of the drug in seven (54%) patients. Our results indicate that a short therapy by sandwich MGAD chemoradiotherapy is a tolerable and effective treatment option in localised newly diagnosed extranodal NK/T-cell lymphoma patients.
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Affiliation(s)
- Sammara Chaubard
- Hematology Department, Limoges University Hospital, Limoges, France
| | - Amira Marouf
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, INSERM U1163, Imagine Institute, Université Paris Cité, Paris, France
| | - David Lavergne
- Hematology Department, Limoges University Hospital, Limoges, France
| | - François Lemonnier
- Hematology Department, Henri Mondor University Hospital, Assistance Publique des Hôpitaux de Paris, INSERM U955, Mondor Institute for Biomedical Research, Paris-Est Créteil University, Créteil, France
| | - Julien Rossignol
- Hematology Department, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Aline Clavert
- Hematology Department, Angers University Hospital, Angers, France
| | - Rémy Gressin
- Hematology Department, Grenoble University Hospital, Grenoble, France
| | - Guillaume Cartron
- Hematology Department, University Hospital Center UMR-CNRS 5235, Montpellier, France
| | | | - Jacques Vargaftig
- Hematology Department, René Huguenin Hospital-Curie Institute, Saint-Cloud, France
| | - Gilles Salles
- Hematology Department, Lyon-Sud Hospital, University of Lyon, Lyon, France
| | - Emmanuel Bachy
- Hematology Department, Lyon-Sud Hospital, University of Lyon, Lyon, France
| | - Hervé Ghesquières
- Hematology Department, Lyon-Sud Hospital, University of Lyon, Lyon, France
| | - Olivier Tournilhac
- Hematology Department, Clermont University Hospital of Clermont-Ferrand, Clermont Auvergne University, Clermont-Ferrand, France
| | - Adrien Chauchet
- Hematology Department, Jean Minjoz University Hospital, Besançon, France
| | - Steven Le Gouill
- Service d'Hématologie Clinique, Hôtel-Dieu, CHU Nantes, INSERM, CNRS, CRCINA Nantes, Université de Nantes, Faculté de Médecine, Nantes, France
| | - Gandhi Damaj
- Hematology Institute, Caen University Hospital, Normandy University, Caen, France
| | | | - David Sibon
- Hematology Department, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Lucie Obéric
- Hematology Department, Toulouse-Oncopole University Cancer Institute (IUCT-O), Toulouse, France
| | - Jean-Marie Michot
- Gustave Roussy Institute, Département des Innovations Thérapeutiques et Essais Précoces, Université Paris-Saclay, Villejuif, France
| | - Philippe Gaulard
- Pathology Department, Henri Mondor University Hospital, Assistance Publique des Hôpitaux de Paris, INSERM U955, Mondor Institute for Biomedical Research, Paris-Est Créteil University, Créteil, France
| | - Olivier Hermine
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, INSERM U1163, Imagine Institute, Université Paris Cité, Paris, France.,Hematology Department, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Lucile Couronné
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutic Implications, INSERM U1163, Imagine Institute, Université Paris Cité, Paris, France.,Laboratory of Onco-Hematology, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Arnaud Jaccard
- Hematology Department, Limoges University Hospital, Limoges, France
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3
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Gallais F, Ysebaert L, Despas F, De Barros S, Obéric L, Allal B, Chatelut E, White-Koning M. Population PK-PD Modeling of Circulating Lymphocyte Dynamics in Chronic Lymphocytic Leukemia Patients Under Ibrutinib Treatment. Clin Pharmacol Ther 2021; 110:220-228. [PMID: 33539551 DOI: 10.1002/cpt.2189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/27/2021] [Indexed: 11/05/2022]
Abstract
Ibrutinib is indicated for the treatment of chronic lymphocytic leukemia (CLL). Absolute lymphocyte count (ALC) is a clinical criterion used for the monitoring of CLL. Ibrutinib has several effects on lymphocytes, and has highly variable pharmacokinetics (PK). The objective of this work was to build a PK-pharmacodynamic (PD) model describing ALC dynamics under ibrutinib treatment in patients with CLL. ALC observations before and after ibrutinib treatment initiation in patients with CLL were included in the analysis. A population PK-PD model was developed based on physio-pharmacological knowledge. Individual PK concentrations at each hospital visit were included in the model. The association between PD parameters and lymphocytosis, and between PD parameters and response to treatment were assessed. A total of 94 patients, 658 ALC and 1,501 PK observations were included in model development. The final PK-PD model accurately described ALC dynamics for different patient profiles. It consisted in two compartments (tissues and blood circulation) with ibrutinib plasmatic concentration inducing two drug effects: stimulation of lymphocyte redistribution and death. Patients with hyperlymphocytosis had significantly higher tissues to circulation baseline lymphocyte count ratio, and lower death effect. Patients who progressed under ibrutinib had significantly lower baseline lymphocyte counts in tissues (2-fold lower) and blood (3-fold lower). The first PK-PD model for ALC in patients with CLL under ibrutinib treatment was developed. This model suggests that estimated lymphocyte counts in tissues and blood could be used as an early predictor of response in patients with CLL.
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Affiliation(s)
- Fanny Gallais
- Cancer Research Center of Toulouse, INSERM UMR-1037, CNRS ERL5294, Paul Sabatier University, Toulouse, France
| | - Loïc Ysebaert
- Cancer Research Center of Toulouse, INSERM UMR-1037, CNRS ERL5294, Paul Sabatier University, Toulouse, France.,Department of Hematology, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Fabien Despas
- Department of Medical and Clinical Pharmacology, Centre of PharmacoVigilance, Pharmacoepidemiology and Drug Information, INSERM UMR-1027, Pharmacoepidemiology, Assessment of Drug Utilization and Drug Safety, CIC 1426, Toulouse University Hospital, Toulouse, France
| | - Sandra De Barros
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Lucie Obéric
- Department of Hematology, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Ben Allal
- Cancer Research Center of Toulouse, INSERM UMR-1037, CNRS ERL5294, Paul Sabatier University, Toulouse, France.,Laboratory of Pharmacology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Etienne Chatelut
- Cancer Research Center of Toulouse, INSERM UMR-1037, CNRS ERL5294, Paul Sabatier University, Toulouse, France.,Laboratory of Pharmacology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Mélanie White-Koning
- Cancer Research Center of Toulouse, INSERM UMR-1037, CNRS ERL5294, Paul Sabatier University, Toulouse, France
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Gallais F, Ysebaert L, Despas F, De Barros S, Dupré L, Quillet-Mary A, Protin C, Thomas F, Obéric L, Allal B, Chatelut E, White-Koning M. Population Pharmacokinetics of Ibrutinib and Its Dihydrodiol Metabolite in Patients with Lymphoid Malignancies. Clin Pharmacokinet 2020; 59:1171-1183. [DOI: 10.1007/s40262-020-00884-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Thieblemont C, Howlett S, Casasnovas RO, Mounier N, Perrot A, Morschhauser F, Fruchart C, Daguindau N, van Eygen K, Obéric L, Bouabdallah R, Pica GM, Nicolas-Virezelier E, Abraham J, Fitoussi O, Snauwaert S, Eisenmann JC, Lionne-Huyghe P, Bron D, Tricot S, Deeren D, Gonzalez H, Costello R, Le Du K, da Silva MG, Grosicki S, Trotman J, Catalano J, Caballero D, Greil R, Cohen AM, Gaulard P, Roulin L, Takeshita K, Casadebaig ML, Tilly H, Coiffier B. Lenalidomide maintenance for diffuse large B-cell lymphoma patients responding to R-CHOP: quality of life, dosing, and safety results from the randomised controlled REMARC study. Br J Haematol 2019; 189:84-96. [PMID: 31702836 PMCID: PMC7154674 DOI: 10.1111/bjh.16300] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/13/2019] [Indexed: 12/11/2022]
Abstract
Lenalidomide maintenance therapy prolonged progression‐free survival (PFS) versus placebo in elderly patients with diffuse large B‐cell lymphoma (DLBCL) responding to induction chemotherapy in the phase 3 REMARC study. This subpopulation analysis assessed the impact of lenalidomide maintenance and treatment‐emergent adverse events (TEAEs) on health‐related quality of life (HRQOL). Global health status (GHS), and physical functioning and fatigue subscales were evaluated in patients who completed the European Organisation for Research and Treatment of Cancer quality‐of‐life questionnaire‐C30 v3.0. The impact of TEAEs classified post hoc as subjective (patients can feel) or observable (only measurable by physicians) on dose reductions and discontinuations was assessed. Among 457 patients (lenalidomide, n = 229; placebo, n = 228), mean (standard deviation) GHS was similar between treatment arms [68·2 (20·7) Versus 72·0 (17·8)] at randomisation and remained similar during maintenance. Patients receiving lenalidomide experienced no meaningful changes in GHS, physical functioning, or fatigue. Observable TEAEs were more common (81·1% Versus 66·3%) and more likely to lead to dose reductions, than subjective TEAEs in both arms. PFS was superior in the lenalidomide arm regardless of dose reduction. Lenalidomide maintenance prolonged PFS and did not negatively impact HRQOL in patients with DLBCL despite TEAEs being more common, when compared with placebo.
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Affiliation(s)
| | | | - René-Olivier Casasnovas
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Dijon and INSERM UMR1231, Dijon, France
| | - Nicolas Mounier
- Hématologie, Centre Hospitalier Universitaire de Nice - Hôpital de l'Archet, Nice, France
| | - Aurore Perrot
- Service d'Hématologie, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Franck Morschhauser
- Institute of Hematology-Transfusion, Centre Hospitalier Universitaire Régional de Lille, Lille, France
| | - Christophe Fruchart
- Service d'Hématologie, Institut d'Hématologie de Basse-Normandie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Nicolas Daguindau
- Service d'Hématologie Clinique, Centre Hospitalier Annecy Genevois, Annecy, France
| | - Koen van Eygen
- Oncologisch Centrum, AZ Groeninge Hospital, Kortrijk, Belgium
| | - Lucie Obéric
- Hôpital de Purpan, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Reda Bouabdallah
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | | | | | - Julie Abraham
- Centre Hospitalier Universitaire Dupuytren, Limoges, France
| | - Olivier Fitoussi
- Hematology/Oncology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | | | | | | | - Sabine Tricot
- Centre Hospitalier de Valenciennes, Valenciennes, France
| | | | | | | | | | | | | | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Concord, NSW, Australia
| | - John Catalano
- Frankston Hospital and Monash University, Frankston, Vic., Australia
| | | | - Richard Greil
- Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute, Salzburg, Austria
| | - Amos M Cohen
- Rabin Medical Center, Beilinson Hospital, Davidoff Cancer Center, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | | | - Louise Roulin
- Lymphoid Malignancies Unit, AP-HP, Groupe Hospitalier Mondor, Créteil, France
| | | | | | - Hervé Tilly
- Department of Hematology, Centre Henri Becquerel, UNIROUEN, INSERMU1245, Rouen, France
| | - Bertrand Coiffier
- Department of Hematology, INSERM U1052 Hospices Civils de Lyon, Pierre-Bénite, France
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Protin C, Abravanel F, Alric L, Tavitian S, Obéric L, Izopet J, Martin-Blondel G, Ysebaert L. Ribavirin for Chronic Hepatitis E Virus Infection in Ibrutinib-Exposed Patients. Open Forum Infect Dis 2019; 6:ofz345. [PMID: 31660412 PMCID: PMC6798245 DOI: 10.1093/ofid/ofz345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/23/2019] [Indexed: 12/22/2022] Open
Abstract
Ibrutinib is an oral first-in-class Bruton's tyrosine kinase inhibitor approved for the therapy of various B-cell lymphoid malignancies. Among ibrutinib-related infections, viral hepatitis are poorly described. We report our single-center experience with 4 cases of chronic hepatitis E virus infection and their management with ribavirin.
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Affiliation(s)
- Caroline Protin
- Hematology Department, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Florence Abravanel
- Laboratory of Virology, CHU Purpan, Toulouse, France
- University Toulouse III-Paul Sabatier, France
- INSERM U1043 - CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | - Laurent Alric
- Internal Medicine-Digestive Department CHU Toulouse, UMR 152 IRD Toulouse 3 University, France
- University Toulouse III-Paul Sabatier, France
| | - Suzanne Tavitian
- Hematology Department, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Lucie Obéric
- Hematology Department, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Jacques Izopet
- Laboratory of Virology, CHU Purpan, Toulouse, France
- University Toulouse III-Paul Sabatier, France
- INSERM U1043 - CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, Toulouse University Hospital, France
- University Toulouse III-Paul Sabatier, France
- INSERM U1043 - CNRS UMR 5282, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | - Loic Ysebaert
- Hematology Department, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
- University Toulouse III-Paul Sabatier, France
- INSERM U1037, Centre de Recherche en Cancérologie de Toulouse, France
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7
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Gauthier M, Durrieu F, Martin E, Peres M, Vergez F, Filleron T, Obéric L, Bijou F, Quillet Mary A, Ysebaert L. Prognostic role of CD4 T-cell depletion after frontline fludarabine, cyclophosphamide and rituximab in chronic lymphocytic leukaemia. BMC Cancer 2019; 19:809. [PMID: 31412798 PMCID: PMC6694602 DOI: 10.1186/s12885-019-5971-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 07/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Eradication of minimal residual disease (MRD), at the end of Fludarabine-Cyclophosphamide-Rituximab (FCR) treatment, is a validated surrogate marker for progression-free and overall survival in chronic lymphocytic leukaemia. But such deep responses are also associated with severe immuno-depletion, leading to infections and the development of secondary cancers. Methods We assessed, blood MRD and normal immune cell levels at the end of treatment, in 162 first-line FCR patients, and analysed survival and adverse event. Results Multivariate Landmark analysis 3 months after FCR completion identified unmutated IGHV status (HR, 2.03, p = 0.043), the level of MRD reached (intermediate versus low, HR, 2.43, p = 0.002; high versus low, HR, 4.56, p = 0.002) and CD4 > 200/mm3 (HR, 3.30, p < 0.001) as factors independently associated with progression-free survival (PFS); neither CD8 nor NK counts were associated with PFS. The CD4 count was associated with PFS irrespective of IGHV mutational status, but only in patients with detectable MRD (HR, 3.51, p = 0.0004, whereas it had no prognostic impact in MRD < 10− 4 patients: p = 0.6998). We next used a competitive risk model to investigate whether immune cell subsets could be associated with the risk of infection and found no association between CD4, CD8 and NK cells and infection. Conclusions Consolidation/maintenance trials based on detectable MRD after FCR should investigate CD4 T-cell numbers both as a selection and a response criterion, and consolidation treatments should target B-cell/T-cell interactions.
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Affiliation(s)
- Martin Gauthier
- Department of Haematology, Toulouse-Oncopole University Cancer Institute (IUCT-O), 1 Avenue Irene Joliot-Curie, 31059, Toulouse, France
| | - Françoise Durrieu
- Department of Biology Haematology, Institut Bergonié, Bordeaux, France
| | - Elodie Martin
- Department of Biostatistics, Institut Claudius Regaud, IU, CT-O, Toulouse, France
| | - Michael Peres
- Department of Biology Haematology, Toulouse-Oncopole University Cancer Institute (IUCT-O), Toulouse, France
| | - François Vergez
- Department of Biology Haematology, Toulouse-Oncopole University Cancer Institute (IUCT-O), Toulouse, France
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius Regaud, IU, CT-O, Toulouse, France
| | - Lucie Obéric
- Department of Haematology, Toulouse-Oncopole University Cancer Institute (IUCT-O), 1 Avenue Irene Joliot-Curie, 31059, Toulouse, France
| | - Fontanet Bijou
- Department of Medical Haematology, Institut Bergonié, Bordeaux, France
| | - Anne Quillet Mary
- Inserm UMR1037, Cancer Research Centre of Toulouse, Toulouse, France
| | - Loic Ysebaert
- Department of Haematology, Toulouse-Oncopole University Cancer Institute (IUCT-O), 1 Avenue Irene Joliot-Curie, 31059, Toulouse, France. .,Inserm UMR1037, Cancer Research Centre of Toulouse, Toulouse, France.
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Quintyn JC, Olle P, Courtade-Saidi M, Laurent C, Obéric L, Quintyn-Ranty ML. Cytological diagnosis of vitreoretinal lymphomas: A case series. Cytopathology 2019; 30:385-392. [PMID: 31033057 DOI: 10.1111/cyt.12711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the cytological diagnosis and follow-up of patients suffering from vitreoretinal lymphoma (VRL) diagnosed in our institution. METHODS AND RESULTS From January 2010 to June 2017, we collected 15 patients with VRL. Twelve patients had diffuse large B-cell lymphoma (DLBCL); of these, 11 had primary central nervous system (CNS) DLBCL, one had ocular localisation of follicular lymphoma, one had extranodal NK/T-cell nasal type lymphoma and one had chronic lymphocytic leukaemia. The results of the cytological examination (cell morphology and immunocytochemistry) of the vitreous fluid were available for 9/15 VRL. The interleukin-10/-6 ratio was >1 in eight of 12 DLBCL. Molecular testing was useful in 6/15 cases (clonality evaluation or MYD88 L265P mutation testing). Eight out of 11 primary CNS DLBCL patients had CNS involvement, with 22-month progression-free survival. In our series, only two out of 11 CNS DLBCL patients died of disease after 2 and 5 years, respectively. CONCLUSIONS The short delay to assert the diagnosis of VRL could explain the quite good prognosis in our series, which highlights the need to consider a diagnosis of DLBCL as first step. The cytological features, as a reliable way to identify VRL, must always guide the choice of techniques for further investigations given the small amount of vitreous fluid available for analysis.
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Affiliation(s)
- Jean-Claude Quintyn
- Ophthalmology Department, CHU, Purpan University Hospital, Toulouse, France.,Ophthalmology Department, CHU, Caen, France.,Normandie University, UNICAEN, CHU de Caen Normandie, Unité de recherche, UMR-S 1075 INSERM-UNICAEN, Caen, France
| | - Priscille Olle
- Ophthalmology Department, CHU, Purpan University Hospital, Toulouse, France
| | - Monique Courtade-Saidi
- Pathology and Cytology Department, CHU, Institut Universitaire du Cancer-Oncopole, University Hospital, Toulouse, France
| | - Camille Laurent
- Pathology and Cytology Department, CHU, Institut Universitaire du Cancer-Oncopole, University Hospital, Toulouse, France
| | - Lucie Obéric
- Hematology Department, CHU, Institut Universitaire du Cancer-Oncopole, University Hospital, Toulouse, France
| | - Marie-Laure Quintyn-Ranty
- Pathology and Cytology Department, CHU, Institut Universitaire du Cancer-Oncopole, University Hospital, Toulouse, France.,Pathology Department, CHU, Caen, France
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Rossi C, Gilhodes J, Maerevoet M, Herbaux C, Morschhauser F, Brice P, Garciaz S, Borel C, Ysebaert L, Obéric L, Lazarovici J, Deau B, Dupuis J, Chauchet A, Abraham J, Bijou F, Stamatoullas-Bastard A, Malfuson JV, Golfier C, Laurent C, Pericart S, Traverse-Glehen A, Kanoun S, Filleron T, Casasnovas RO, Ghesquières H. Efficacy of chemotherapy or chemo-anti-PD-1 combination after failed anti-PD-1 therapy for relapsed and refractory Hodgkin lymphoma: A series from Lysa centers. Am J Hematol 2018; 93:1042-1049. [PMID: 29884994 DOI: 10.1002/ajh.25154] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [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: 03/28/2018] [Revised: 05/11/2018] [Accepted: 05/20/2018] [Indexed: 12/13/2022]
Abstract
Anti-PD-1 therapy provides high response rates in Hodgkin lymphoma (HL) patients who have relapsed or are refractory (R/R) to autologous stem cell transplantation (ASCT) and brentuximab vedotin (BV), but median progression free survival (PFS) is only one year. The efficacy of treatment following anti-PD-1 is not well known. We retrospectively investigated the efficacy of salvage therapies for unsatisfactory response to anti-PD-1 therapy, assessed by PET-CT according to the Lugano criteria, in 30 R/R HL patients. Patients were highly pre-treated before anti-PD-1 (70% received ASCT and 93% BV). Unsatisfactory responses to anti-PD1 therapy were progressive disease (PD) (n=24) and partial response (PR) (n=6). For the 24 PD patients, median anti-PD-1 related PFS was 7.5 months (95%CI, 5.7-11.6); 17 received subsequent CT alone (Group 1) and 7 received CT in addition to anti-PD-1 (Group 2). 16/24 patients (67%) obtained an objective response. In the 15 patients treated with the same CT, twelve obtained PR or complete response (CR). In Group 1, there were 7 CR (41%), 3 PR (18%), and 7 PD (41%). In Group 2, there were 4 CR (57%), 2 PR (29%), and 1 SD (14%). No unexpected toxicity was observed. Six patients who achieved response proceeded to allogeneic SCT. With a median follow-up of 12.1 months (7-14.7), the median PFS following the initiation of CT was 11 months (95%CI, 6.3; not reached) and the median of overall survival was not reached. These observations in highly pre-treated HL patients suggest that anti-PD-1 therapy might re-sensitize tumor cells to CT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Cédric Rossi
- Cancer Research Centre of Toulouse (CRCT), UMR1037 INSERM, Université Toulouse III Paul-Sabatier, ERL5294 CNRS, Université de Toulouse, Toulouse, France
- Department of Hematology, Dijon University Hospital, Dijon, France
| | - Julia Gilhodes
- Clinical trials office, Institut universitaire du cancer Toulouse- Oncopole, Toulouse, France
| | | | - Charles Herbaux
- Department of Hematology, Unité GRITA, CHRU Claude Huriez, Lille, France
| | | | - Pauline Brice
- Department of Hematology, CHU Paris-GH St-Louis Lariboisière F-Widal - Hôpital Saint-Louis, Paris, France
| | - Sylvain Garciaz
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Cécile Borel
- Department of Hematology, Institut universitaire du cancer Toulouse- Oncopole, Toulouse, France
| | - Loïc Ysebaert
- Department of Hematology, Institut universitaire du cancer Toulouse- Oncopole, Toulouse, France
| | - Lucie Obéric
- Department of Hematology, Institut universitaire du cancer Toulouse- Oncopole, Toulouse, France
| | - Julien Lazarovici
- Department of Hematology, Institut Gustave-Roussy, Villejuif, France
| | | | - Jehan Dupuis
- Department of Hematology, CHU Henri Mondor, Créteil, France
| | | | - Julie Abraham
- Department of Hematology, CHU Limoges, Limoges, France
| | - Fontanet Bijou
- Department of Hematology, Institut Bergonié, Bordeaux, France
| | | | - Jean-Valère Malfuson
- Department of Hematology, hôpital d'instruction des armées Percy, Clamart, France
| | - Camille Golfier
- Department of Hematology, Dijon University Hospital, Dijon, France
| | - Camille Laurent
- Anatomy-pathology Department, Institut universitaire du cancer Toulouse-Oncopole, Toulouse, France
| | - Sarah Pericart
- Anatomy-pathology Department, Institut universitaire du cancer Toulouse-Oncopole, Toulouse, France
| | | | - Salim Kanoun
- Nuclear Medecine Unit, Institut universitaire du cancer Toulouse-Oncopole, Toulouse, France
| | - Thomas Filleron
- Clinical trials office, Institut universitaire du cancer Toulouse- Oncopole, Toulouse, France
| | - René-Olivier Casasnovas
- Department of Hematology, Dijon University Hospital, Dijon, France
- INSERM UMR 1231 CHU Dijon, France
| | - Hervé Ghesquières
- Department of Hematology, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
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10
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Thieblemont C, Casasnovas R, Mounier N, Perrot A, Morschhauser F, Tilly H, Fruchart C, Corront B, Haouin C, Van Eygen K, Obéric L, Bouabdallah R, Sebban C, Bordessoule D, Fitoussi O, Van Hoof A, Eisenmann J, Lionne-Huyghe P, Deeren D, Gomes Da Silva M, Trotman J, Grosicki S, Greil R, Caballero D, Coiffier B. REMARC STUDY: CORRELATION OF LYMPHOMA PD AND DEATH AND HEALTH-RELATED QOL WITH MAINTENANCE LENALIDOMIDE VS PLACEBO IN ELDERLY DLBCL PATIENT RESPONDERS TO R-CHOP. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_91] [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: 11/06/2022]
Affiliation(s)
- C. Thieblemont
- Hemato-Oncology, APHP; Hôpital Saint-Louis; Paris France
| | - R. Casasnovas
- Service d'Hématologie Clinique; CHU Dijon and INSERM UMR1231; Dijon France
| | - N. Mounier
- Service d'Onco-Hématologie, CHU Nice, Hôpital Archet 1; Nice France
| | - A. Perrot
- Hematology Department; University Hospital; Vandoeuvre Les Nancy France
| | - F. Morschhauser
- Institute of Hematology-Transfusion; Centre Hospitalier Universitaire Régional de Lille; Lille France
| | - H. Tilly
- Department of Hematology, Centre Henri Becquerel; UNIROUEN, INSERMU1245; Rouen France
| | - C. Fruchart
- Hématologie; Institut d'Hématologie de Basse Normandie, CHU; Caen France
| | - B. Corront
- Service d'Hématologie Clinique, CHR Annecy; Annecy France
| | - C. Haouin
- Lymphoid Malignancies Unit, AP-HP; Groupe Hospitalier Mondor; Créteil France
| | - K. Van Eygen
- Oncologisch centrum; AZ Groeninge Hospital, President Kennedylaan 4; Kortrijk Belgium
| | - L. Obéric
- Département d'Hématologie; Institut Universitaire du Cancer-Oncopole de Toulouse; Toulouse France
| | - R. Bouabdallah
- Department of Hematology; Institut Paoli Calmettes; Marseille France
| | - C. Sebban
- Onco-hematology, Centre Leon Berard; University Claude Bernard Lyon 1; Lyon France
| | - D. Bordessoule
- Hematology; CHU de Limoges - Hôpital Universitaire Dupuytren; Limoges France
| | - O. Fitoussi
- Hematology/Oncology; Polyclinique Bordeaux Nord Aquitaine; Bordeaux France
| | - A. Van Hoof
- Hematologie, A.Z. Sint Jan AV; Brugge Belgium
| | | | | | - D. Deeren
- Hematologie, AZ Delta; Roeselare Belgium
| | - M. Gomes Da Silva
- Hematology; Insituto Portuges de Oncologia de Lisboa; Lisbon Portugal
| | - J. Trotman
- Haematology Department, Concord Repatriation General Hospital; University of Sydney; Concord Australia
| | - S. Grosicki
- Department of Cancer Prevention, School of Public Health; Medical University of Silesia; Katowice Poland
| | - R. Greil
- IIIrd Medical Department, Paracelsus Medical University Salzburg; Salzburg Cancer Research Institute; Salzburg Austria
| | - D. Caballero
- Department of Hematology/IBSAL; Hospital Universitario de Salamanca; Salamanca Spain
| | - B. Coiffier
- Department of Hematology, INSERM U1052 Hospices Civils de Lyon; Pierre-Bénite France
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Lazarovici J, Dartigues P, Brice P, Obéric L, Gaillard I, Hunault-Berger M, Broussais-Guillaumot F, Gyan E, Bologna S, Nicolas-Virelizier E, Touati M, Casasnovas O, Delarue R, Orsini-Piocelle F, Stamatoullas A, Gabarre J, Fornecker LM, Gastinne T, Peyrade F, Roland V, Bachy E, André M, Mounier N, Fermé C. Nodular lymphocyte predominant Hodgkin lymphoma: a Lymphoma Study Association retrospective study. Haematologica 2015; 100:1579-86. [PMID: 26430172 DOI: 10.3324/haematol.2015.133025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/25/2015] [Indexed: 12/18/2022] Open
Abstract
Nodular lymphocyte predominant Hodgkin lymphoma represents a distinct entity from classical Hodgkin lymphoma. We conducted a retrospective study to investigate the management of patients with nodular lymphocyte predominant Hodgkin lymphoma. Clinical characteristics, treatment and outcome of adult patients with nodular lymphocyte predominant Hodgkin lymphoma were collected in Lymphoma Study Association centers. Progression-free survival (PFS) and overall survival (OS) were analyzed, and the competing risks formulation of a Cox regression model was used to control the effect of risk factors on relapse or death as competing events. Among 314 evaluable patients, 82.5% had early stage nodular lymphocyte predominant Hodgkin lymphoma. Initial management consisted in watchful waiting (36.3%), radiotherapy (20.1%), rituximab (8.9%), chemotherapy or immuno-chemotherapy (21.7%), combined modality treatment (12.7%), or radiotherapy plus rituximab (0.3%). With a median follow-up of 55.8 months, the 10-year PFS and OS estimates were 44.2% and 94.9%, respectively. The 4-year PFS estimates were 79.6% after radiotherapy, 77.0% after rituximab alone, 78.8% after chemotherapy or immuno-chemotherapy, and 93.9% after combined modality treatment. For the whole population, early treatment with chemotherapy or radiotherapy, but not rituximab alone (Hazard ratio 0.695 [0.320-1.512], P=0.3593) significantly reduced the risk of progression compared to watchful waiting (HR 0.388 [0.234-0.643], P=0.0002). Early treatment appears more beneficial compared to watchful waiting in terms of progression-free survival, but has no impact on overall survival. Radiotherapy in selected early stage nodular lymphocyte predominant Hodgkin lymphoma, and combined modality treatment, chemotherapy or immuno-chemotherapy for other patients, are the main options to treat adult patients with a curative intent.
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Affiliation(s)
| | - Peggy Dartigues
- Département de Biologie et Pathologie Médicales, Gustave Roussy, Villejuif, France
| | - Pauline Brice
- Hopital Saint-Louis APHP, Université Paris Diderot, France
| | - Lucie Obéric
- Department of Hematology, IUC Toulouse Oncopole, France
| | | | | | | | - Emmanuel Gyan
- Service d'hématologie et thérapie cellulaire, Centre Hospitalier Universitaire, Tours, France
| | - Serge Bologna
- Department of Hematology, CHU Nancy-Brabois, Vandoeuvre, France
| | | | | | | | | | | | | | - Jean Gabarre
- Department of Hematology, Hopital Pitié Salpétrière AP-HP, Paris, France
| | - Luc-Matthieu Fornecker
- Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, France
| | | | - Fréderic Peyrade
- Department of onco-hematology Centre Antoine Lacassagne-Comprehensive anticancer center, Nice, France
| | - Virginie Roland
- Service d'hématologie clinique, Centre Hospitalier Saint Jean, Perpignan, France
| | - Emmanuel Bachy
- Department of Hematology, Lyon Sud Hospital, Pierre Benite, France
| | - Marc André
- Hematology, CHU Dinant Godinne, UCL Namur, Yvoir, Belgium
| | | | - Christophe Fermé
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
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12
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Bouvet E, Borel C, Obéric L, Compaci G, Cazin B, Michallet AS, Laurent G, Ysebaert L. Impact of dose intensity on outcome of fludarabine, cyclophosphamide, and rituximab regimen given in the first-line therapy for chronic lymphocytic leukemia. Haematologica 2012; 98:65-70. [PMID: 23065520 DOI: 10.3324/haematol.2012.070755] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Fludarabine-cyclophosphamide-rituximab is the most efficient first-line treatment for chronic lymphocytic leukemia patients. Many dose adjustments of the original MD Anderson Cancer Center regimen have been proposed. However, whether fludarabine-cyclophosphamide-rituximab relative dose intensity may have an impact on outcome has not yet been investigated. We retrospectively assessed relative dose intensity in 106 community-based patients included in our regional healthcare network from 2004-11, all receiving fludarabine-cyclophosphamide-rituximab as first-line treatment outside clinical trials. Dose reductions were observed in 51.4% of patients, mainly decided by the individual physician and not based on recommendations (52.7%), while there were fewer reports of toxicity or dose reduction because of impaired renal function. Progression-free survival was significantly reduced in patients who had a reduction in dose intensity of more than 20% in fludarabine-cyclophosphamide and/or rituximab. Multivariate analysis showed dose of rituximab had a significant impact on minimal residual disease and progression-free survival. Although prophylactic granulocyte-colony stimulating factor significantly reduced the rate of grade 3-4 neutropenia and febrile neutropenia, it had no impact on relative dose intensity and outcome. This study shows that, in routine clinical practice, there is low adherence to the original MD Anderson Cancer Center fludarabine-cyclophosphamide-rituximab schedule, and that the decision to modify dosage was mostly taken by the individual physician and was based on anticipated toxicity. This study shows that reduction of fludarabine-cyclophosphamide and, more importantly, of rituximab doses seriously interferes with progression-free survival.
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Affiliation(s)
- Emmanuelle Bouvet
- Department of Hematology, Purpan University Hospital, Toulouse, France
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13
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Compaci G, Ysebaert L, Obéric L, Derumeaux H, Laurent G. Effectiveness of telephone support during chemotherapy in patients with diffuse large B cell lymphoma: The Ambulatory Medical Assistance (AMA) experience. Int J Nurs Stud 2011; 48:926-32. [DOI: 10.1016/j.ijnurstu.2011.01.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2010] [Revised: 01/13/2011] [Accepted: 01/16/2011] [Indexed: 10/18/2022]
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