1
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Berton G, Sedaki B, Collomb E, Benachour S, Loschi M, Mohty B, Saillard C, Hicheri Y, Rouzaud C, Maisano V, Villetard F, Corda ED'I, Charbonnier A, Rey J, Hospital MA, Ittel A, Abbou N, Fanciullino R, Dadone-Montaudié B, Vey N, Venton G, Cluzeau T, Alary AS, Garciaz S. Poor prognosis of SRSF2 gene mutations in patients treated with VEN-AZA for newly diagnosed acute myeloid leukemia. Leuk Res 2024; 141:107500. [PMID: 38636413 DOI: 10.1016/j.leukres.2024.107500] [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: 03/04/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
Mutations in spliceosome genes (SRSF2, SF3B1, U2AF1, ZRSR2) correlate with inferior outcomes in patients treated with intensive chemotherapy for Acute Myeloid Leukemia. However, their prognostic impact in patients treated with less intensive protocols is not well known. This study aimed to evaluate the impact of Spliceosome mutations in patients treated with Venetoclax and Azacitidine for newly diagnosed AML. 117 patients treated in 3 different hospitals were included in the analysis. 34 harbored a mutation in at least one of the spliceosome genes (splice-mut cohort). K/NRAS mutations were more frequent in the splice-mut cohort (47% vs 19%, p=0.0022). Response rates did not differ between splice-mut and splice-wt cohorts. With a median follow-up of 15 months, splice mutations were associated with a lower 18-month LFS (p=0.0045). When analyzing splice mutations separately, we found SRSF2 mutations to be associated with poorer outcomes (p=0.034 and p=0.037 for OS and LFS respectively). This negative prognostic impact remained true in our multivariate analysis. We believe this finding should warrant further studies aimed at overcoming this negative impact.
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Affiliation(s)
- Guillaume Berton
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France.
| | - Bochra Sedaki
- Department of Hematology, University Hospital Centre L'Archet, Nice, France
| | - Erwann Collomb
- Department of Hematology and Cellular Therapy, La Conception Hospital, Marseille, France
| | - Sami Benachour
- Department of Hematology, University Hospital Centre L'Archet, Nice, France
| | - Michael Loschi
- Department of Hematology, University Hospital Centre L'Archet, Nice, France
| | - Bilal Mohty
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Colombe Saillard
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Yosr Hicheri
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Camille Rouzaud
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Valerio Maisano
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Aude Charbonnier
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Jerome Rey
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Marie-Anne Hospital
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France; Aix-Marseille University, INSERM U1068, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Antoine Ittel
- Department of Molecular Biology, Institut Paoli-Calmettes, Marseille, France
| | - Norman Abbou
- Department of Molecular Biology, Hôpital Nord, Marseille, France
| | - Raphaelle Fanciullino
- SMARTc: Simulation and Modeling: Adaptative Response for Therapeutics in Cancer, Marseille, France; Faculté de Pharmacie de Marseille, CRCM Inserm UMR, Marseille 1068, France; Pharmacy, Hôpital de la Conception, Marseille, France
| | | | - Norbert Vey
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France; Aix-Marseille University, INSERM U1068, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Geoffroy Venton
- Department of Hematology and Cellular Therapy, La Conception Hospital, Marseille, France
| | - Thomas Cluzeau
- Department of Hematology, University Hospital Centre L'Archet, Nice, France; INSERMU1065, C3M / Cote d'Azur University; Nice, France
| | - Anne-Sophie Alary
- Department of Molecular Biology, Institut Paoli-Calmettes, Marseille, France
| | - Sylvain Garciaz
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France; Aix-Marseille University, INSERM U1068, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
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2
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Gurnari C, Koster L, Baaij L, Heiblig M, Yakoub-Agha I, Collin M, Passweg J, Bulabois CE, Khan A, Loschi M, Carnevale-Schianca F, Crisà E, Caravelli D, Kuball J, Saraceni F, Olivieri A, Rambaldi A, Kulasekararaj AG, Hayden PJ, Badoglio M, Onida F, Scheid C, Franceschini F, Mekinian A, Savic S, Voso MT, Drozd-Sokolowska J, Snowden JA, Raj K, Alexander T, Robin M, Greco R, McLornan DP. Allogeneic hematopoietic cell transplantation for VEXAS syndrome: results of a multicenter study of the EBMT. Blood Adv 2024; 8:1444-1448. [PMID: 38330178 PMCID: PMC10955646 DOI: 10.1182/bloodadvances.2023012478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Affiliation(s)
- Carmelo Gurnari
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | | | | | - Mael Heiblig
- Department of Hematology, Centre Hospitalier Lyon Sud, Lyon, France
| | | | | | | | | | - Anjum Khan
- Yorkshire Blood & Marrow Transplant Program, Leeds, United Kingdom
| | | | | | - Elena Crisà
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | | | - Jürgen Kuball
- Department of Haematology, University Medical Centre, Utrecht, The Netherlands
| | | | | | - Alessandro Rambaldi
- Department of Oncology and Hematology, University of Milan and Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Patrick J. Hayden
- Department of Haematology, Trinity College Dublin, St. James’s Hospital, Dublin, Ireland
| | | | - Francesco Onida
- ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | | | - Franco Franceschini
- Rheumatology and Clinical Immunology, ASST Spedali Civili of Brescia and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Arsène Mekinian
- Sorbonne Université, Assistance Publique–Hôpitaux de Paris, Hôpital Saint Antoine, Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department, Paris, France
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals, NHS Trust, Leeds, United Kingdom
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Kavita Raj
- University College London Hospitals NHS Trust, London, United Kingdom
| | - Tobias Alexander
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Rheumatology and Clinical Immunology, Berlin, Germany
| | | | - Raffaella Greco
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Donal P. McLornan
- University College London Hospitals NHS Trust, London, United Kingdom
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3
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Villar S, Chevret S, Poire X, Joris M, Chevallier P, Bourhis JH, Forcade E, Chantepie S, Beauvais D, Raus N, Bay JO, Loschi M, Devillier R, Duléry R, Ceballos P, Rubio MT, Servais S, Nguyen S, Robin M. Transplantation for myelofibrosis patients in the ruxolitinib era: a registry study from the Société Francophone de Greffe de Moelle et de Thérapie Cellulaire. Bone Marrow Transplant 2024:10.1038/s41409-024-02268-5. [PMID: 38514813 DOI: 10.1038/s41409-024-02268-5] [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: 11/30/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/23/2024]
Abstract
In this SFGM-TC registry study, we report the results after stem cell transplantation (HSCT) in 305 myelofibrosis patients, in order to determine potential risk factors associated with outcomes, especially regarding previous treatment with ruxolitinib. A total of 102 patients were transplanted from an HLA-matched-sibling donor (MSD), and 143 patients received ruxolitinib. In contrast with previous studies, our results showed significantly worse outcomes for ruxolitinib patients regarding overall survival (OS) and non-relapse mortality (NRM), especially in the context of unrelated donors (URD). When exploring reasons for potential confounders regarding the ruxolitinib effect, an interaction between the type of donor and the use of ATG was found, therefore subsequent analyses were performed separately for each type of donor. Multivariable analyses did not confirm a significant negative impact of ruxolitinib in transplantation outcomes. In the setting of URD, only age and Fludarabine-Melphalan (FM) conditioning were associated with increased NRM. For MSD, only Karnoksfy <70% was associated with reduced OS. However, a propensity score analysis showed that ruxolitinib had a negative impact on OS but only in non-responding patients, consistent with previous data. To conclude, with all the precautions due to confounders and bias, ruxolitinib itself does not appear to increase mortality after HSCT.
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Affiliation(s)
- Sara Villar
- Service d'hématologie - greffe, Hôpital Saint Louis, APHP, Université de Paris, Paris, France
- Hematology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Sylvie Chevret
- APHP, Saint-Louis University Hospital, Department of Biostatistics, Paris, France
| | - Xavier Poire
- Cliniques Universitaires St-Luc, Brussels, Brussels, Belgium
| | | | | | | | - Edouard Forcade
- Service d'hématologie et thérapie Cellulaire, CHU Bordeaux, Hôpital Haut-Leveque, Pessac, France
| | | | | | | | - Jacques-Olivier Bay
- Department of Clinical Hematology and Cellular Therapy, CHU de Clermont-Ferrand, Site Estaing, Clermont-Ferrand, France
| | - Michael Loschi
- Hematology Department, Cote D'Azur University, CHU of Nice, Nice, France
| | | | - Remy Duléry
- Department of Clinical Hematology and Cellular Therapy, Centre de Recherche Saint-Antoine (CRSA), Saint-Antoine Hospital, Assistance Publique - Hôpitaux de Paris, INSERM UMRs 938 Sorbonne University, Paris, France
| | - Patrice Ceballos
- Hematology Department, Montpellier University Hospital, Montpellier, France, Montpellier, France
| | - Marie Thérèse Rubio
- Hematology Department, CHRU Brabois, Nancy, France
- CNRS UMR 7365, Équipe 6, Biopôle de L'Université de Lorraine, Vandoeuvre Les Nancy, France
| | - Sophie Servais
- Hematology Department, CHU Liege, University of Liege, Liege, Belgium
| | - Stephanie Nguyen
- Hematology Department, Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Marie Robin
- Service d'hématologie - greffe, Hôpital Saint Louis, APHP, Université de Paris, Paris, France.
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4
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Estran S, Loschi M, Benachour S, Soldati A, Chiche E, Sammut R, Robert G, Jacquel A, Chibois J, Schneider S, Cluzeau T. Improving nutritional status after allogeneic stem cell transplantation: results of phase 2 ALLONUT clinical trial. Bone Marrow Transplant 2024:10.1038/s41409-024-02271-w. [PMID: 38509196 DOI: 10.1038/s41409-024-02271-w] [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: 09/20/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
Malnutrition increases the risk of non-relapse mortality after allogeneic stem cell transplantation (aHSCT). Here are the results of the ALLONUT clinical trial designed to improve the nutritional outcome of patients receiving aHSCT. ALLONUT is a prospective open label phase 2 clinical trial assessing the efficacy of a close tailored nutritional support and management with traditional and original solutions to improve patients nutritional status following aHSCT. Nutritional status evaluation was performed before transplantation, on Day 0, 30, 100 and one year after transplantation. The study involved 70 patients treated by aHSCT. 10% of patients were moderately or severely malnutrition at baseline and 26.9 were severely malnutrition at D30. Patients' nutritional status improved thanks to the cooking classes and the personalized outpatient nutrition program. At D100, 23% were still malnutrition, while only 10.8% were severely malnutrition one year after transplantation. The QLQ-C30 show that quality of life (QoL) decreased until D30, and improve to reach the pre-transplant level on D100 before exceeding it on D360. The study confirmed that a close, personalized nutritional program combining traditional and original measures can improve both nutritional status and QoL for patients suffering from moderate or severe malnutrition after aHCST.
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Affiliation(s)
- Sophie Estran
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France
| | - Michael Loschi
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France
- INSERM U1065, Mediterranean center of molecular medicine, Nice, France
| | - Sami Benachour
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France
| | - Alizée Soldati
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France
| | - Edmond Chiche
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France
| | - Rinzine Sammut
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France
| | - Guillaume Robert
- INSERM U1065, Mediterranean center of molecular medicine, Nice, France
| | - Arnaud Jacquel
- INSERM U1065, Mediterranean center of molecular medicine, Nice, France
| | | | - Stephane Schneider
- Nutrition department, Nice University hospital, Cote d'Azur University, Nice, France
| | - Thomas Cluzeau
- Hematology department, Nice University hospital, Cote d'Azur University, Nice, France.
- INSERM U1065, Mediterranean center of molecular medicine, Nice, France.
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5
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Robin M, Iacobelli S, Koster L, Passweg J, Avenoso D, Wilson KMO, Salmenniemi U, Dreger P, von dem Borne P, Snowden JA, Robinson S, Finazzi MC, Schroeder T, Collin M, Eder M, Forcade E, Loschi M, Bramanti S, Pérez-Simón JA, Czerw T, Polverelli N, Drozd-Sokolowska J, Raj K, Hernández-Boluda JC, McLornan DP. Treosulfan compared to busulfan in allogeneic haematopoietic stem cell transplantation for myelofibrosis: a registry-based study from the Chronic Malignancies Working Party of the EBMT. Bone Marrow Transplant 2024:10.1038/s41409-024-02269-4. [PMID: 38491198 DOI: 10.1038/s41409-024-02269-4] [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: 11/07/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024]
Abstract
We aimed to compare outcomes following treosulfan (TREO) or busulfan (BU) conditioning in a large cohort of myelofibrosis (MF) patients from the EBMT registry. A total of 530 patients were included; 73 received TREO and 457 BU (BU ≤ 6.4 mg/kg in 134, considered RIC, BU > 6.4 mg/kg in 323 considered higher dose (HD)). Groups were compared using adjusted Cox models. Cumulative incidences of engraftment and acute GVHD were similar across the 3 groups. The TREO group had significantly better OS than BU-HD (HR:0.61, 95% CI: 0.39-0.93) and a trend towards better OS over BU-RIC (HR: 0.66, 95% CI: 0.41-1.05). Moreover, the TREO cohort had a significantly better Progression-Free-Survival (PFS) than both the BU-HD (HR: 0.57, 95% CI: 0.38-0.84) and BU-RIC (HR: 0.60, 95% CI: 0.39-0.91) cohorts, which had similar PFS estimates. Non-relapse mortality (NRM) was reduced in the TREO and BU-RIC cohorts (HR: 0.44, 95% CI: 0.24-0.80 TREO vs BU-HD; HR: 0.54, 95% CI: 0.28-1.04 TREO vs BU-RIC). Of note, relapse risk did not significantly differ across the three groups. In summary, within the limits of a registry-based study, TREO conditioning may improve PFS in MF HSCT and have lower NRM than BU-HD with a similar relapse risk to BU-RIC. Prospective studies are needed to confirm these findings.
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Affiliation(s)
- Marie Robin
- Hôpital Saint-Louis, APHP, Université de Paris Cité, Paris, France.
| | - Simona Iacobelli
- Deptartment of Biology, University of Rome Tor Vergata, Rome, Italy
| | | | | | | | | | | | | | | | - John A Snowden
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | | | - Matthew Collin
- Northern Centre for Bone Marrow Transplantation, Newcastle, England
| | | | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Bordeaux, F-33000, Bordeaux, France
| | | | - Stefania Bramanti
- Department of Oncology/Hematology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Jose Antonio Pérez-Simón
- Instituto de Biomedicina de Sevilla IBIS, CSIC, Hospital Universitario Virgen del Rocío Universidad de Sevilla, Sevilla, Spain
| | - Tomasz Czerw
- Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Nicola Polverelli
- Unit of Blood Diseases and Stem Cell Transplantation, University of Brescia-ASST Spedali Civili, Brescia, Italy
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Kavita Raj
- University College London Hospitals NHS Trust, London, UK
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6
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Iat A, Loschi M, Benachour S, Calleja A, Chiche E, Sudaka I, Aquaronne D, Ferrero C, Fenwarth L, Marceau A, Fournier E, Dadone‐Montaudie B, Cluzeau T. Comparison of clinical outcomes of several risk stratification tools in newly diagnosed AML patients: A real-world evidence in our current therapeutic era. Cancer Med 2024; 13:e7103. [PMID: 38506267 PMCID: PMC10952023 DOI: 10.1002/cam4.7103] [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: 11/23/2023] [Revised: 02/23/2024] [Accepted: 03/02/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND OF THE STUDY AML classification tools have been developed to stratify the risk at AML diagnosis. There is a need to evaluate these tools in the current therapeutic era. COHORT CHARACTERISTICS In this retrospective study, we compared five classifiers: ELN 2017, ELN 2022, ALFA classifier, Papaemmanuil et al. classifier, and Lindsley et al. classifier, in a real-life cohort of 281 patients newly diagnosed for AML in Nice University Hospital. In our cohort median age was 68 years old, sex ratio was M/F 56%/44%, performance status was lower than 2 in 73.1% of patients, AML subtype was "De novo" in 71.5%, "secondary" in 22.4%, and "therapy-related" in 6.0% of patients. Intensive chemotherapy was used in 53.0% of patients, and non-intensive chemotherapy in 40.6% of patients. Molecular analysis was available in a large majority of patients and the main mutations found were NPM1 (22.7%), DNMT3A (17.4%), TP53 (13.1%), TET2 (12.4%), and FLT3-ITD (12.4%). RESULTS In our findings, the comparison of overall survival between the three prognostic groups in the global cohort was statistically significant in all classifiers: ELN 2017 p < 0.0001, ELN 2022 p < 0.0001, ALFA classifier p < 0.0001, Papaemmanuil classifier p < 0.0001, Lindsley classifier p = 0.001. ELN 2017, ELN 2022, ALFA classifier, Papaemmanuil classifier, and Lindsley classifier were calculated respectively in 99%, 99%, 89%, 90%, and 89% of patients. CONCLUSIONS Using Akaike's information criteria (AIC) to compare all five classifiers, ELN 2022 is the best classifier into younger and older patients and for prognosis.
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Affiliation(s)
- Alexandre Iat
- Hematology departmentNice University HospitalNiceFrance
| | - Michael Loschi
- Hematology departmentNice University HospitalNiceFrance
- Mediterranean Center of Molecular Medecine, INSERMNiceFrance
- Cote d'Azur UniversityNiceFrance
| | | | - Anne Calleja
- Hematology departmentNice University HospitalNiceFrance
| | - Edmond Chiche
- Hematology departmentNice University HospitalNiceFrance
- Cote d'Azur UniversityNiceFrance
| | | | | | | | | | - Alice Marceau
- Hematology LaboratoryLille University HospitalLilleFrance
| | - Elise Fournier
- Hematology LaboratoryLille University HospitalLilleFrance
| | | | - Thomas Cluzeau
- Hematology departmentNice University HospitalNiceFrance
- Mediterranean Center of Molecular Medecine, INSERMNiceFrance
- Cote d'Azur UniversityNiceFrance
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7
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Loschi M, Alsuliman T, Cabrera Q, Desbrosses Y, Desmier D, Yakoub Agha I, Guillaume T. [Secondary cancers following allogeneic hematopoietic stem cell transplantation: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2024; 111:S22-S28. [PMID: 36922321 DOI: 10.1016/j.bulcan.2023.02.016] [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: 12/26/2022] [Revised: 02/10/2023] [Accepted: 02/26/2023] [Indexed: 03/15/2023]
Abstract
The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) held the 13th edition of the Clinical Practices Harmonization Workshops. Our workgroup reviewed the current data on the incidence, screening methods and international guidelines for the prevention of secondary solid cancers following allogeneic hematopoietic stem cell transplantation. The purpose of this workshop was to provide recommendations for the screening and prevention of secondary malignancies to Francophone transplantation centers.
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Affiliation(s)
- Michael Loschi
- CHU de Nice, université Cote d'Azur, Inserm 1065, service d'hématologie clinique et thérapie cellulaire, 06000 Nice, France.
| | - Tamim Alsuliman
- AP-HP, Sorbonne université, hôpital Saint-Antoine, service d'hématologie, 75012 Paris, France
| | - Quentin Cabrera
- CHU Réunion Sud, service d'hématologie clinique, site de Saint-Pierre, Saint-Pierre, Réunion
| | | | - Deborah Desmier
- CHU de Poitiers, onco-hématologie clinique et thérapie cellulaire, 86000 Poitiers, France
| | | | - Thierry Guillaume
- CHU de Nantes, Hôtel-Dieu, service d'hématologie clinique, 44000 Nantes, France
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8
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Durand C, Risso K, Loschi M, Retur N, Emery A, Courjon J, Cluzeau T, Carles M. Efficacy of an antimicrobial stewardship intervention for early adaptation of antibiotic therapy in high-risk neutropenic patients. Antimicrob Resist Infect Control 2024; 13:5. [PMID: 38233960 PMCID: PMC10795280 DOI: 10.1186/s13756-023-01354-5] [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: 09/28/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND The 4th European Conference on Infections in Leukemia recommends early adaptation of empirical antibiotic therapy (EAT) for febrile neutropenia in stable patients. OBJECTIVES To assess the efficacy of an antimicrobial stewardship (AMS) intervention promoting early de-escalation and discontinuation of EAT in high-risk neutropenic patients. METHODS This before-after study was conducted in the hematology department of the University Hospital of Nice, France. The AMS intervention included the development of clinical decision support algorithms, a twice-weekly face-to-face review of all antibiotic prescriptions and monthly feedback on the intervention. The primary endpoint was overall antibiotic consumption during hospital stay, expressed as days of therapy (DOT). RESULTS A total of 113 admissions were included: 56 during the pre-intervention period and 57 during the intervention period. Induction chemotherapy and conditioning for allogeneic stem cell transplantation were the most frequent reasons for admission. In the intervention period, there was a significant decrease in overall antibiotic consumption (median DOT 20 vs. 28 days, p = 0.006), carbapenem consumption (median DOT 5.5 vs. 9 days, p = 0.017) and anti-resistant Gram-positive agents consumption (median DOT 8 vs. 11.5 days, p = 0.017). We found no statistical difference in the rates of intensive care unit admission (9% in each period) and 30-day mortality (5% vs. 0%, p = 0.243). Compliance with de-escalation and discontinuation strategies was significantly higher in the intervention period (77% vs. 8%, p < 0.001). CONCLUSION A multifaceted AMS intervention led to high compliance with early de-escalation and discontinuation of EAT and lower overall antibiotic consumption, without negatively affecting clinical outcomes.
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Affiliation(s)
- Claire Durand
- Infectious Disease Department, University Hospital of Nice, Cote D'Azur University, Nice, France.
| | - Karine Risso
- Infectious Disease Department, University Hospital of Nice, Cote D'Azur University, Nice, France
| | - Michael Loschi
- Hematology Department, University Hospital of Nice, Cote D'Azur University, Nice, France
- Université Côte d'Azur, INSERM U1065, Cote D'Azur University, Nice, C3M, France
| | - Nicolas Retur
- Pharmacy Department, University Hospital of Nice, Cote D'Azur University, Nice, France
| | - Audrey Emery
- Bacteriology Department, University Hospital of Nice, Cote D'Azur University, Nice, France
| | - Johan Courjon
- Infectious Disease Department, University Hospital of Nice, Cote D'Azur University, Nice, France
- Université Côte d'Azur, INSERM U1065, Cote D'Azur University, Nice, C3M, France
| | - Thomas Cluzeau
- Hematology Department, University Hospital of Nice, Cote D'Azur University, Nice, France
- Université Côte d'Azur, INSERM U1065, Cote D'Azur University, Nice, C3M, France
| | - Michel Carles
- Infectious Disease Department, University Hospital of Nice, Cote D'Azur University, Nice, France
- Université Côte d'Azur, INSERM U1065, Cote D'Azur University, Nice, C3M, France
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9
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Lacan C, Lambert J, Forcade E, Robin M, Chevallier P, Loron S, Bulabois CÉ, Orvain C, Ceballos P, Daguindau E, Charbonnier A, Chalandon Y, Bernard M, Simand C, Rubio MT, Turlure P, Maertens J, Huynh A, Loschi M, Bay JO, Guillerm G, Alani M, Castilla-Llorente C, Poiré X, Chantepie S, Maillard N, Beguin Y, Marçais A, Cornillon J, Malfuson JV, Maury S, Meuleman N, Villate A, Bekadja MA, Walter-Petrich A, Jacque N, Srour M, Devillier R, Nguyen S. Bone marrow graft versus peripheral blood graft in haploidentical hematopoietic stem cells transplantation: a retrospective analysis in1344 patients of SFGM-TC registry. J Hematol Oncol 2024; 17:2. [PMID: 38185663 PMCID: PMC10773006 DOI: 10.1186/s13045-023-01515-4] [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: 10/03/2023] [Accepted: 11/25/2023] [Indexed: 01/09/2024] Open
Abstract
The use of peripheral blood (PB) or bone marrow (BM) stem cells graft in haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide (PTCy) for graft-versus-host disease (GVHD) prophylaxis remains controversial. Moreover, the value of adding anti-thymoglobulin (ATG) to PTCy is unknown. A total of 1344 adult patients received an unmanipulated haploidentical transplant at 37 centers from 2012 to 2019 for hematologic malignancy. We compared the outcomes of patients according to the type of graft, using a propensity score analysis. In total population, grade II-IV and III-IV acute GVHD (aGVHD) were lower with BM than with PB. Grade III-IV aGVHD was lower with BM than with PB + ATG. All outcomes were similar in PB and PB + ATG groups. Then, in total population, adding ATG does not benefit the procedure. In acute leukemia, myelodysplastic syndrome and myeloproliferative syndrome (AL-MDS-MPS) subgroup receiving non-myeloablative conditioning, risk of relapse was twice greater with BM than with PB (51 vs. 22%, respectively). Conversely, risk of aGVHD was greater with PB (38% for aGVHD II-IV; 16% for aGVHD III-IV) than with BM (28% for aGVHD II-IV; 8% for aGVHD III-IV). In this subgroup with intensified conditioning regimen, risk of relapse became similar with PB and BM but risk of aGVHD III-IV remained higher with PB than with BM graft (HR = 2.0; range [1.17-3.43], p = 0.012).
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Affiliation(s)
- Claire Lacan
- Clinical Hematology Unit, Groupe Hospitalier Pitié-Salpêtrière, APHP, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Jérôme Lambert
- Institut national de la santé et de la recherche médicale (INSERM), U1153 CRESS, Paris, France
- Service de Biostatistique et Information Médicale, Hôpital Saint Louis, APHP, Paris, France
| | - Edouard Forcade
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Marie Robin
- Clinical Hematology Unit, Hôpital Saint Louis, APHP, Paris, France
| | - Patrice Chevallier
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Sandrine Loron
- Clinical Hematology Unit, Hôpital Lyon Sud, HCL, Lyon, France
| | - Claude-Éric Bulabois
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Corentin Orvain
- Clinical Hematology Unit, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Patrice Ceballos
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Etienne Daguindau
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Amandine Charbonnier
- Clinical Hematology Unit, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Yves Chalandon
- Clinical Hematology Unit, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Marc Bernard
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Célestine Simand
- Clinical Hematology Unit, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Marie-Thérèse Rubio
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Pascal Turlure
- Clinical Hematology Unit, Centre Hospitalier Universitaire Dupuytren, Limoges, France
| | | | - Anne Huynh
- Clinical Hematology Unit, Oncopôle, Toulouse, France
| | - Michael Loschi
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Jacques-Olivier Bay
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Gaëlle Guillerm
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Mustafa Alani
- Clinical Hematology Unit, Centre Henri Becquerel, Rouen, France
| | | | - Xavier Poiré
- Clinical Hematology Unit, Clinique Universitaire Saint Luc, Leuven, Belgium
| | - Sylvain Chantepie
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Natacha Maillard
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Yves Beguin
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Liège and University of Liège, Liège, Belgium
| | - Ambroise Marçais
- Clinical Hematology Unit, Hôpital Necker-Enfants Malades, APHP, Paris, France
| | - Jérôme Cornillon
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
| | - Jean-Valère Malfuson
- Clinical Hematology Unit, Hôpitaux d'Instruction des Armées Percy, Clamart, France
| | - Sébastien Maury
- Clinical Hematology Unit, Hôpital Henri Mondor, APHP, Créteil, France
| | | | - Alban Villate
- Clinical Hematology Unit, Hôpital Bretonneau, Tours, France
| | - Mohammed-Amine Bekadja
- Clinical Hematology Unit, Clinic of Hematology and Cell Therapy, EHU 1St November, Oran, Algeria
| | - Anouk Walter-Petrich
- Institut national de la santé et de la recherche médicale (INSERM), U1153 CRESS, Paris, France
- Service de Biostatistique et Information Médicale, Hôpital Saint Louis, APHP, Paris, France
| | - Nathalie Jacque
- Clinical Hematology Unit, Groupe Hospitalier Pitié-Salpêtrière, APHP, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Micha Srour
- Clinical Hematology Unit, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Raynier Devillier
- Clinical Hematology Unit, Institut Paoli Calmette, Marseille, France
| | - Stéphanie Nguyen
- Clinical Hematology Unit, Groupe Hospitalier Pitié-Salpêtrière, APHP, 47-83 Bd de l'Hôpital, 75013, Paris, France.
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10
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Griffin M, Eikema DJ, Verheggen I, Kulagin A, Tjon JML, Fattizzo B, Ingram W, Zaidi U, Desnica L, Giammarco S, Drozd-Sokolowska J, Xicoy B, Patriarca A, Loschi M, Szmigielska-Kaplon A, Beier F, Cignetti A, Drexler B, Gavriilaki E, Lanza F, Orvain C, Risitano AM, De la Camara R, De Latour RP. SARS-CoV-2 vaccination in 361 non-transplanted patients with aplastic anemia and/or paroxysmal nocturnal hemoglobinuria. Haematologica 2024; 109:283-286. [PMID: 37584297 PMCID: PMC10772488 DOI: 10.3324/haematol.2023.283863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023] Open
Affiliation(s)
| | | | | | - Alexander Kulagin
- RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russian Federation
| | | | - Bruno Fattizzo
- SC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | | | - Uzma Zaidi
- National Institute of Blood Disease and Bone Marrow Transplantation, Karachi
| | | | - Sabrina Giammarco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome
| | | | - Blanca Xicoy
- Institut Català d'Oncologia-Hospital Universitari Germans Trias i Pujol; Josep Carreras Leukemia Research Institute, Barcelona
| | - Andrea Patriarca
- Azienda Ospedaliero-Universitaria Maggiore della Carità and translational medicine department University of Eastern Piedmont, Novara
| | | | | | - Fabian Beier
- Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, RWTH Aachen University, Aachen
| | | | | | | | - Francesco Lanza
- Metropolitan Transplant Network, Hospital Santa Maria delle Croci, Ravenna, Italy 21: Centre Hospitalier Universitaire d'Angers, Angers
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11
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Rey G, Daguenet E, Bonjean P, Devillier R, Fegueux N, Forcade E, Srour M, Chevallier P, Robin M, Suarez F, Micol JB, Labussière-Wallet H, Bilger K, Daguindau E, Bay JO, Fayard A, Bulabois CE, Nguyen-Quoc S, Genthon A, Orvain C, Turlure P, Loschi M, Poiré X, Guillerm G, Beguin Y, Maillard N, Mear JB, Chalayer E, Cornillon J, Tavernier E. Allogeneic hematopoietic stem cell transplantation for adults with therapy-related acute myeloid leukaemia: a retrospective multicentre study on behalf of the SFGM-TC. Bone Marrow Transplant 2023; 58:1331-1338. [PMID: 37653054 DOI: 10.1038/s41409-023-02082-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 09/02/2023]
Abstract
We report the results from a multicentre retrospective study of 220 adult patients who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT) for therapy-related acute myeloid leukaemia (t-AML). Median age at t-AML diagnosis was 56 years, with a prior history of haematological (45%) or breast (34%). Median time from cytotoxic exposure to t-AML diagnosis was 54.7 months. At transplant, around 20% of patients had measurable residual disease and 3% of patients were not in complete remission. The median follow-up was 21.4 months (Q1-Q3, 5.9-52.8). At 12 months, overall survival (OS), event-free survival (EFS), and graft-versus-host-disease (GVHD)-free-relapse-free survival (GRFS) were 60.7% (95% CI 54.6-67.5), 52.8% (95% CI 46.5-68.4), and 44.1% (95% CI 37.6-51.8), respectively. At 5 years, OS, EFS, and GRFS were 44.1% (95% CI 37.4-52.1), 40.4% (95% CI 33.9-48.1), and 35.3% (95% CI 28.8-43.3), respectively. At last follow-up, 44% of patients were in complete remission (n = 96) and transplant-related mortality accounted for 21% of all deaths (n = 119). Multivariable analysis revealed that uncontrolled t-AML at transplant was associated with lower EFS (HR 1.94, 95% CI 1.0-3.7, p = 0.041). In conclusion, alloHSCT for t-AML shows encouraging results and offers additional opportunity with the emergence of novel pre-graft therapies.
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Affiliation(s)
- Gaëlle Rey
- Département d'hématologie clinique, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Priest-en-Jarez, France
| | - Elisabeth Daguenet
- Département Universitaire de Recherche et d'Enseignement, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Priest-en-Jarez, France
| | - Paul Bonjean
- Unité de Recherche Clinique Innovation Pharmacologique, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Priest-en-Jarez, France
| | | | - Nathalie Fegueux
- Hôpital Saint Eloi, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Edouard Forcade
- Centre Hospitalier Universitaire Haut-Lévêque Magellan, Bordeaux, France
| | - Micha Srour
- Hôpital Claude Hurriez, Centre Hospitalier Universitaire de Lille, Lille, France
| | | | - Marie Robin
- Hôpital Saint-Louis, APHP, Université de Paris Cité, Paris, France
| | | | | | | | - Karin Bilger
- Centre Hospitalier Universitaire Hautepierre, Strasbourg, France
| | | | - Jacques-Olivier Bay
- Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Amandine Fayard
- Hôpital Estaing, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | | | - Pascal Turlure
- Centre Hospitalier Universitaire Dupuytren, Limoges, France
| | - Michael Loschi
- Hôpital de l'Archet, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Xavier Poiré
- Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Gaëlle Guillerm
- Centre Hospitalier Universitaire Augustin Morvan, Brest, France
| | - Yves Beguin
- CHU of Liège and University of Liège, Liège, Belgium
| | | | | | - Emilie Chalayer
- Département d'hématologie clinique, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Priest-en-Jarez, France
| | - Jérôme Cornillon
- Département d'hématologie clinique, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Priest-en-Jarez, France
| | - Emmanuelle Tavernier
- Département d'hématologie clinique, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Priest-en-Jarez, France.
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12
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Lemoine J, Bachy E, Cartron G, Beauvais D, Gastinne T, Di Blasi R, Rubio MT, Guidez S, Mohty M, Casasnovas RO, Joris M, Castilla-Llorente C, Haioun C, Hermine O, Loschi M, Carras S, Bories P, Fradon T, Herbaux C, Sesques P, Le Gouill S, Morschhauser F, Thieblemont C, Houot R. Nonrelapse mortality after CAR T-cell therapy for large B-cell lymphoma: a LYSA study from the DESCAR-T registry. Blood Adv 2023; 7:6589-6598. [PMID: 37672383 PMCID: PMC10641092 DOI: 10.1182/bloodadvances.2023010624] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023] Open
Abstract
CD19 chimeric antigen receptor (CAR) T cells can induce prolonged remissions and potentially cure a significant proportion of patients with relapsed/refractory large B-cell lymphomas. However, some patients may die of causes unrelated to lymphoma after CAR T-cell therapy. To date, little is known about the nonrelapse mortality (NRM) after CAR T-cell therapy. Using the French DESCAR-T registry, we analyzed the incidence and causes of NRM and identified risk factors of NRM. We report on 957 patients who received standard-of-care axicabtagene ciloleucel (n = 598) or tisagenlecleucel (n = 359) between July 2018 and April 2022, in 27 French centers. With a median follow-up of 12.4 months, overall NRM occurred in 48 patients (5.0% of all patients): early (before day 28 after infusion) in 9 patients (0.9% of all patients and 19% of overall NRM), and late (on/after day 28 after infusion) in 39 patients (4.1% of all patients and 81% of overall NRM). Causes of overall NRM were distributed as follows: 56% infections (29% with non-COVID-19 and 27% with COVID-19), 10% cytokine release syndromes, 6% stroke, 6% cerebral hemorrhage, 6% second malignancies, 4% immune effector cell associated neurotoxicities, and 10% deaths from other causes. We report risk factors of early NRM and overall NRM. In multivariate analysis, both diabetes and elevated ferritin level at lymphodepletion were associated with an increased risk of overall NRM. Our results may help physicians in patient selection and management in order to reduce the NRM after CAR T-cell therapy.
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Affiliation(s)
- Jean Lemoine
- Department of Hematology, CHU de Rennes, Rennes, France
| | - Emmanuel Bachy
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Benite, France
| | | | | | | | - Roberta Di Blasi
- Department of Hemato-Oncology, Saint Louis Hospital, Paris, France
| | | | | | - Mohamad Mohty
- Department of Hematology, Saint Antoine Hospital, Paris, France
| | | | - Magalie Joris
- Department of Hematology, CHU d’Amiens, Amiens, France
| | - Cristina Castilla-Llorente
- Department of Hematology and INSERM, UMR 1030, Université Paris-Saclay, Gustave Roussy Cancer Campus Grand Paris, Paris, France
| | - Corinne Haioun
- Lymphoid Malignancies, Henri Mondor Hospital, Créteil, France
| | | | | | - Sylvain Carras
- Department of Hematology, CHU de Grenoble, Grenoble, France
| | - Pierre Bories
- Hematology Laboratory, Onco-occitanie Network, Toulouse University Institute of Cancer-Oncopole, Toulouse, France
| | - Tom Fradon
- LYSARC, The Lymphoma Academic Research Organisation, Lyon-Sud Hospital, Pierre-Benite, France
| | - Charles Herbaux
- Department of Hematology, CHU de Montpellier, Montpellier, France
| | - Pierre Sesques
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Benite, France
| | | | | | | | - Roch Houot
- Department of Hematology, CHU de Rennes, Rennes, France
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13
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Sammut R, Feghoul L, Xhaard A, Dhedin N, Robin M, Michonneau D, Loschi M, Legoff J, de Peffault de Latour R, de Sicre de Fontbrune F. Clinical and immune features of human parvovirus B19 infection in allogeneic stem cell transplantation recipients: A retrospective monocentric study. Transpl Infect Dis 2023; 25:e14118. [PMID: 37594199 DOI: 10.1111/tid.14118] [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: 03/08/2023] [Revised: 07/08/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Human parvovirus B19 (B19V) infection is associated with pure red cell aplasia (PRCA) in immunocompromised patients; however, the spectrum of manifestations associated with B19V in allogeneic hematopoietic stem cell transplantation recipients (alloHSCT) has rarely been reported. METHODS In this study, we aimed to report clinical and immune features of B19V infection after alloHSCT. We retrospectively collected and analyzed clinical and microbiological data of all transplanted patients with B19V DNAmia or tissue infection detected by polymerase chain reaction (PCR) in our center from 2010 to 2021. RESULTS We report 35 cases of B19V infections in 33 patients. Median time from transplant to B19V first PCR positivity was 6.9 months (interquartile range (IQR) [1.6-18.9]). No preferential immune profile, type of transplantation or conditioning was identified. Hematological impairment was the most frequent sign, followed by rash and fever. Unconventional clinical forms were also detected, such as acute myelitis and myositis. For some cases, the direct relationship between symptoms and B19V infection was difficult to prove but was suggested by targeted tissue PCR positivity. When hematological impairment was not at the forefront, reticulocytopenia helped to diagnose B19V infections. Treatment was mainly based on high dose intravenous immunoglobulin. CONCLUSION Although hematological impairment was the most frequent sign, B19V can affect multiple targets and lead to atypical manifestations. Because of its heterogeneous clinical presentation, B19V infection is likely under-diagnosed. Diagnosis of unusual B19V organ involvement needs combination of arguments which can include targeted tissue PCR.
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Affiliation(s)
- Rinzine Sammut
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Linda Feghoul
- Université de Paris, Inserm U976, Insight team, F-75010, Paris France Unité Virologie et greffes, Département des agents infectieux, Hôpital Saint-Louis, APHP, Paris, France
| | - Alienor Xhaard
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Nathalie Dhedin
- Service d'hématologie Adolescents et Jeunes Adultes, Hôpital Saint Louis, AP-HP, Paris, France
| | - Marie Robin
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - David Michonneau
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
| | - Michael Loschi
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Nice, Nice, France
- INSERM U1065, Centre de Médecine Moléculaire Méditerranéen, Université Nice Cote d'Azur, Nice, France
| | - Jerome Legoff
- Université de Paris, Inserm U976, Insight team, F-75010, Paris France Unité Virologie et greffes, Département des agents infectieux, Hôpital Saint-Louis, APHP, Paris, France
| | - Regis de Peffault de Latour
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
- Université de Paris Cité, Paris, France
- Centre Français de Référence de l'Aplasie Médullaire et de l'Hémoglobinurie Paroxystique Nocturne, Paris, France
| | - Flore de Sicre de Fontbrune
- Service d'hématologie-greffe, Hôpital Saint-Louis, Université Paris Cité, Paris, France
- Centre Français de Référence de l'Aplasie Médullaire et de l'Hémoglobinurie Paroxystique Nocturne, Paris, France
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14
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Larson JH, Jin S, Loschi M, Bolivar Wagers S, Thangavelu G, Zaiken MC, McDonald-Hyman C, Saha A, Aguilar EG, Koehn B, Osborn MJ, Panoskaltsis-Mortari A, Macdonald KPA, Hill GR, Murphy WJ, Serody JS, Maillard I, Kean LS, Kim SV, Littman DR, Blazar BR. Enforced gut homing of murine regulatory T cells reduces early graft-versus-host disease severity. Am J Transplant 2023; 23:1102-1115. [PMID: 36878433 PMCID: PMC10475494 DOI: 10.1016/j.ajt.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/31/2023] [Indexed: 03/07/2023]
Abstract
Damage to the gastrointestinal tract following allogeneic hematopoietic stem cell transplantation is a significant contributor to the severity and perpetuation of graft-versus-host disease. In preclinical models and clinical trials, we showed that infusing high numbers of regulatory T cells reduces graft-versus-host disease incidence. Despite no change in in vitro suppressive function, transfer of ex vivo expanded regulatory T cells transduced to overexpress G protein-coupled receptor 15 or C-C motif chemokine receptor 9, specific homing receptors for colon or small intestine, respectively, lessened graft-versus-host disease severity in mice. Increased regulatory T cell frequency and retention within the gastrointestinal tissues of mice that received gut homing T cells correlated with lower inflammation and gut damage early post-transplant, decreased graft-versus-host disease severity, and prolonged survival compared with those receiving control transduced regulatory T cells. These data provide evidence that enforced targeting of ex vivo expanded regulatory T cells to the gastrointestinal tract diminishes gut injury and is associated with decreased graft-versus-host disease severity.
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Affiliation(s)
- Jemma H Larson
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sujeong Jin
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Loschi
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sara Bolivar Wagers
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Govindarajan Thangavelu
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael C Zaiken
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Cameron McDonald-Hyman
- Division of Hematology/Oncology/Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Asim Saha
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ethan G Aguilar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Brent Koehn
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mark J Osborn
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Angela Panoskaltsis-Mortari
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kelli P A Macdonald
- Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Immunology Department, Brisbane, Queensland, Australia
| | - Geoffrey R Hill
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA; Division of Medical Oncology, University of Washington, Seattle, Washington, USA
| | - William J Murphy
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California, USA; Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Jonathan S Serody
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Computational Medicine Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ivan Maillard
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leslie S Kean
- Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Sangwon V Kim
- Department of Microbiology and Immunology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Dan R Littman
- Molecular Pathogenesis Program, The Kimmel Center for Biology and Medicine of the Skirball Institute, New York University School of Medicine, New York, USA; Howard Hughes Medical Institute, New York University School of Medicine, New York, USA
| | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.
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15
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Malard F, Loschi M, Huynh A, Cluzeau T, Guenounou S, Legrand F, Magro L, Orvain C, Charbonnier A, Panz-Klapuch M, Desmier D, Mear JB, Cornillon J, Robin C, Daguindau E, Bilger K, Vehreschild MJ, Chevallier P, Labussière-Wallet H, Mediavilla C, Couturier MA, Bulabois CE, Camus V, Chantepie S, Ceballos P, Gaugler B, Holler E, Doré J, Prestat E, Gasc C, Plantamura E, Mohty M. Pooled allogeneic faecal microbiota MaaT013 for steroid-resistant gastrointestinal acute graft-versus-host disease: a single-arm, multicentre phase 2 trial. EClinicalMedicine 2023; 62:102111. [PMID: 37654670 PMCID: PMC10466244 DOI: 10.1016/j.eclinm.2023.102111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 09/02/2023] Open
Abstract
Background Failure of gastrointestinal acute graft-versus-host disease (GI-aGvHD) to respond to steroid therapy is associated with limited further therapeutic options. We aimed to assess the safety and efficacy of the first-in-human use of the pooled allogeneic faecal microbiota, MaaT013, for the treatment of steroid-refractory GI-aGvHD. Methods This prospective, international, single-arm, phase 2a study reports clinical outcomes from a 24-patient cohort with grade III-IV, steroid refractory GI-aGvHD treated with the pooled allogeneic faecal microbiota MaaT013. MaaT013 involved pooling faecal matter from 3 to 8 screened donors then transplanting the pooled batches into patients to treat GI-aGVHD. The 24 patients were treated in the HERACLES study (Aug 2018 to Nov 2020) at 26 sites in Europe and an additional 52 patients were treated in a compassionate use/expanded access program (EAP) in France (July 2018 to April 2021). The primary endpoint was GI response at day 28, defined as the proportion of patients with GI-aGvHD who had a complete response (CR) or very good partial response (VGPR). GvHD grading and staging were assessed according to the revised Glucksberg criteria. Adverse events and severe adverse events were monitored for 6 months and 12 months, respectively. The HERACLES study was registered with ClinicalTrials.gov (NCT03359980). Findings Compared with single donors, MaaT013 is characterised by higher microbial richness and reduced variability across batches. At day 28 (D28), the GI-overall response rate (ORR) was 38% in the prospective population, including 5 complete responses (CR), 2 very good partial responses (VGPR) and 2 partial responses (PR). In the EAP, the GI-ORR was 58% (17 CR, 9 VGPR and 4 PR). The 12-month overall survival (OS) was 25% in the prospective study and 38% in the EAP. Regarding safety, five infectious complications, including 3 sepsis, could not be excluded from being related to the study procedure in HERACLES. Shotgun sequencing analyses of the identified strains suggest that none were found in MaaT013. In the EAP, 18 pharmacovigilance cases were reported among 52 treated patients, including 11 bacteraemia/sepsis. In HERACLES, we observed in stools from responding patients at D28 a higher microbiota richness and increased levels of beneficial bacteria, in particular butyrate producers, along with increased levels of short-chain fatty acid and bile acids. In contrast, stools from non-responding (NR) patients displayed increased levels of pathogenic pro-inflammatory bacteria along with increased systemic inflammatory parameters. Interpretation Overall, MaaT013 was safe in this population of highly immunocompromised patients and was associated with responses in some patients with GI-aGvHD and deserves further investigation. Funding MaaT Pharma.
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Affiliation(s)
- Florent Malard
- Sorbonne Université, AP-HP, Centre de Recherche Saint-Antoine INSERM UMRs938, Service D'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Michael Loschi
- Haematology Department, CHU of Nice, Cote D'Azur University, France
| | - Anne Huynh
- Service Hématologie, CHU/IUCT-Oncopole, Toulouse Cédex 31059, France
| | - Thomas Cluzeau
- Haematology Department, CHU of Nice, Cote D'Azur University, France
| | - Sarah Guenounou
- Service Hématologie, CHU/IUCT-Oncopole, Toulouse Cédex 31059, France
| | - Faezeh Legrand
- Haematology Department, Institut Paoli Calmettes, Marseille, France
| | - Leonardo Magro
- Unité d'Allogreffe, Maladies du sang, CHRU, Lille 59000, France
| | | | | | - Marta Panz-Klapuch
- Department of Haematology and Bone Marrow Transplantation, School of Medicine in Katowice, Medical University of Silesia, Dąbrowski Street, 25, Katowice 40-032, Poland
| | - Deborah Desmier
- CHU de Poitiers, Service d’Hématologie et de Thérapie Cellulaire, Poitiers, France
| | | | - Jérôme Cornillon
- Département d’Hématologie Clinique et de Thérapie Cellulaire, CHU de St-Etienne, Saint-Etienne, France
| | - Christine Robin
- Hôpital Henri Mondor, Service d’Hématologie Clinique et de Thérapie Cellulaire, Créteil, France
| | | | - Karin Bilger
- Hôpital de Hautepierre, Pôle Oncologie-Hématologie, Strasbourg, France
| | | | | | | | | | | | | | - Vincent Camus
- Department of Haematology and INSERM U1245, Centre Henri Becquerel, Rouen, France
| | - Sylvain Chantepie
- Institut d’Hématologie de Basse Normandie, CHU Caen Normandie, Caen, France
| | | | - Béatrice Gaugler
- Sorbonne Université, AP-HP, Centre de Recherche Saint-Antoine INSERM UMRs938, Service D'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Ernst Holler
- Department of Internal Medicine III, University Medical Centre, Regensburg, Germany
| | - Joël Doré
- INRAE, MGP, Université Paris-Saclay, Jouy-en-Josas 78350, France
| | | | | | | | - Mohamad Mohty
- Sorbonne Université, AP-HP, Centre de Recherche Saint-Antoine INSERM UMRs938, Service D'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
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16
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de Masson A, Beylot-Barry M, Ram-Wolff C, Mear JB, Dalle S, d'Incan M, Ingen-Housz-Oro S, Orvain C, Abraham J, Dereure O, Charbonnier A, Cornillon J, Longvert C, Barete S, Boulinguez S, Wierzbicka-Hainaut E, Aubin F, Rubio MT, Bernard M, Schmidt-Tanguy A, Houot R, Pham-Ledard A, Michonneau D, Brice P, Labussière-Wallet H, Bouaziz JD, Grange F, Moins-Teisserenc H, Jondeau K, Michel L, Mourah S, Battistella M, Daguindau E, Loschi M, Picard A, Franck N, Maillard N, Huynh A, Nguyen S, Marçais A, Chaby G, Ceballos P, Le Corre Y, Maury S, Bay JO, Adamski H, Bachy E, Forcade E, Socié G, Bagot M, Chevret S, Peffault de Latour R. Allogeneic transplantation in advanced cutaneous T-cell lymphomas (CUTALLO): a propensity score matched controlled prospective study. Lancet 2023; 401:1941-1950. [PMID: 37105210 DOI: 10.1016/s0140-6736(23)00329-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Advanced-stage cutaneous T-cell lymphomas (CTCLs) are rare, usually refractory, and fatal diseases. Case series have suggested that allogeneic haematopoietic stem cell transplantation (HSCT) might improve the prognosis of advanced-stage CTCLs. The objective of this study was to investigate the effect of allogeneic HSCT compared with non-HSCT therapy on the outcome of individuals with advanced-stage CTCLs. METHODS In this prospective, multicentre, matched controlled trial, conducted at 30 hospitals, participants with advanced CTCLs were allocated treatment: if they had an available compatible related donor they were assigned to allogeneic HSCT, or if not they were allocated to non-allogeneic HSCT therapy. Key inclusion criteria were participants aged 18-70 years, with advanced stage mycosis fungoides or Sézary syndrome, and at least one poor prognostic criteria. Participants were excluded if they were not in complete or partial remission of the disease. Propensity score 1:1 matching with replacement (ie, that each participant treated with HSCT was matched to the participant with the closest propensity score treated with non-HSCT therapy, even if they had already been matched) was used to handle confounding factors, with the balance of covariate distribution between HSCT and non-HSCT groups assessed using standardised mean differences. The primary endpoint was progression-free survival in the matched intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02520908), and is currently active but not recruiting. FINDINGS From June 1, 2016, to March 3, 2022, total of 99 participants were enrolled at 17 centres in France. Participants with a sibling or matched unrelated donor were assigned to allogeneic HSCT (HSCT group, n=55 [56%]) and participants without a donor were assigned to non-allogeneic HSCT treatment (non-HSCT group, n=44 [44%]). The median follow-up among survivors was 12·6 months (IQR 11·0-35·2). In the HSCT group, 51 participants (93%) were 1:1 matched to participants from the non-HSCT group. In the intention-to-treat analysis, median progression-free survival was significantly longer in the HSCT group (9·0 months [95% CI 6·6-30·5]) than in the non-HSCT group (3·0 months [2·0-6·3]), with a hazard ratio of 0·38 (95% CI 0·21-0·69; p<0·0001). In the per-protocol population, 40 participants (78%) in the HSCT group had 101 serious events and 29 participants (67%) in the non-HSCT group had 70 serious adverse events. The most common serious adverse event other than graft-versus-host disease in both groups was infections, occurring in 30 participants (59%) in the HSCT group and in 19 participants (44%) in the non-HSCT group. INTERPRETATION Allogeneic HSCT was associated with significantly longer progression-free survival in participants with advanced-stage CTCLs. These results indicate that allogeneic HSCT treatment should be made available to individuals with high-risk, advanced-stage mycosis fungoides or Sézary syndrome who achieve pre-transplant disease remission. FUNDING French Ministry of Health, National Cancer Institute, Programme Hospitalier de Recherche Clinique en Cancérologie.
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Affiliation(s)
- Adèle de Masson
- Department of Dermatology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut National de la Santé et de la Recherche Médicale U976 Human Immunology, Pathophysiology and Immunotherapy, Institut de Recherche Saint-Louis, Paris, France; Université Paris Cité, Paris, France.
| | - Marie Beylot-Barry
- Department of Dermatology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut National de la Santé et de la Recherche Médicale U1312, Bordeaux Institute of Oncology, Team 5, University of Bordeaux, Bordeaux, France
| | - Caroline Ram-Wolff
- Department of Dermatology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Baptiste Mear
- Department of Hematology, L'Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Stéphane Dalle
- Department of Dermatology, Hôpital Lyon-Sud, Lyon, France
| | - Michel d'Incan
- Department of Dermatology, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, University Paris-Est Créteil, Créteil, France
| | - Corentin Orvain
- Department of Hematology, Centre Hospitalier Universitaire d'Angers, Angers, France; Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia, Angers, France; Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1307, Centre National de la Recherche Scientifique Unité Mixte de Recherche 6075, Nantes Université, Centre de Recherche en Cancérologie et Immunologie Nantes-Angers, Université d'Angers, Angers, France
| | - Julie Abraham
- Department of Hematology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Olivier Dereure
- Department of Dermatology and Institut National de la Santé et de la Recherche Médicale U1058 Pathogenesis and Control of Chronic and Emergent Infections, University of Montpellier, Montpellier, France
| | - Amandine Charbonnier
- Department of Hematology, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Jérôme Cornillon
- Department of Clinical Hematology and Cellular Therapy, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Etienne, France
| | - Christine Longvert
- Department of Dermatology, Centre Hospitalier Universitaire Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Stéphane Barete
- Department of Dermatology, Centre Hospitalier Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Serge Boulinguez
- Department of Dermatology, Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Ewa Wierzbicka-Hainaut
- Department of Dermatology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - François Aubin
- Department of Dermatology, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Marie-Thérèse Rubio
- Department of Hematology, Hôpital Brabois, Centre Hospitalier Régional Universitaire Nancy, Nancy, France; Centre National de la Recherche Scientifique Unité Mixte de Recherche 7365, Ingéniérie Moléculaire et Physiopathologie Articulaire, Biopole, University of Lorraine, Nancy, France
| | - Marc Bernard
- Department of Hematology, L'Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Aline Schmidt-Tanguy
- Department of Hematology, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Roch Houot
- Department of Hematology, L'Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France; Institut National de la Santé et de la Recherche Médicale U1236, Rennes, France
| | - Anne Pham-Ledard
- Department of Dermatology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut National de la Santé et de la Recherche Médicale U1312, Bordeaux Institute of Oncology, Team 5, University of Bordeaux, Bordeaux, France
| | - David Michonneau
- Department of Hematology and Bone Marrow Transplantation, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut National de la Santé et de la Recherche Médicale U976 Human Immunology, Pathophysiology and Immunotherapy, Institut de Recherche Saint-Louis, Paris, France; Université Paris Cité, Paris, France
| | - Pauline Brice
- Department of Hemato-Oncology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Jean-David Bouaziz
- Department of Dermatology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut National de la Santé et de la Recherche Médicale U976 Human Immunology, Pathophysiology and Immunotherapy, Institut de Recherche Saint-Louis, Paris, France; Université Paris Cité, Paris, France
| | - Florent Grange
- Department of Dermatology, Centre Hospitalier de Valence, Valence, France
| | - Hélène Moins-Teisserenc
- Hematology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, Paris, France
| | - Katayoun Jondeau
- Department of Hematology, Centre Hospitalier Universitaire Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Laurence Michel
- Institut National de la Santé et de la Recherche Médicale U976 Human Immunology, Pathophysiology and Immunotherapy, Institut de Recherche Saint-Louis, Paris, France; Université Paris Cité, Paris, France
| | - Samia Mourah
- Department of Tumor Genomics and Pharmacology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut National de la Santé et de la Recherche Médicale U976 Human Immunology, Pathophysiology and Immunotherapy, Institut de Recherche Saint-Louis, Paris, France; Université Paris Cité, Paris, France
| | - Maxime Battistella
- Pathology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut National de la Santé et de la Recherche Médicale U976 Human Immunology, Pathophysiology and Immunotherapy, Institut de Recherche Saint-Louis, Paris, France; Université Paris Cité, Paris, France
| | - Etienne Daguindau
- Department of Hematology, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Michael Loschi
- Department of Hematology, Hôpital L'Archet, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Alexandra Picard
- Department of Dermatology, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Nathalie Franck
- Department of Dermatology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Natacha Maillard
- Department of Hematology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Anne Huynh
- Department of Hematology, Centre Hospitalier Universitaire, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Stéphanie Nguyen
- Department of Hematology, Centre Hospitalier Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ambroise Marçais
- Department of Hematology, Centre Hospitalier Universitaire Necker, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Guillaume Chaby
- Department of Dermatology, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | - Patrice Ceballos
- Department of Hematology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Yannick Le Corre
- Department of Dermatology, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Sébastien Maury
- Department of Hematology, Centre Hospitalier Universitaire Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Jacques-Olivier Bay
- Department of Hematology, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Henri Adamski
- Department of Dermatology, L'Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Emmanuel Bachy
- Department of Hematology, Centre Hospitalier Universitaire de Lyon, Lyon, France
| | - Edouard Forcade
- Department of Clinical Hematology and Cellular Therapy, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Gérard Socié
- Department of Hematology and Bone Marrow Transplantation, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut National de la Santé et de la Recherche Médicale U976 Human Immunology, Pathophysiology and Immunotherapy, Institut de Recherche Saint-Louis, Paris, France; Université Paris Cité, Paris, France
| | - Martine Bagot
- Department of Dermatology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut National de la Santé et de la Recherche Médicale U976 Human Immunology, Pathophysiology and Immunotherapy, Institut de Recherche Saint-Louis, Paris, France; Université Paris Cité, Paris, France
| | - Sylvie Chevret
- Department of Biostatistics, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, Paris, France; Institut National de la Santé et de la Recherche Médicale U1153, Paris, France
| | - Régis Peffault de Latour
- Department of Hematology and Bone Marrow Transplantation, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Cité, Paris, France.
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Gérard AO, Merino D, Charbinat A, Fournier J, Destere A, Loschi M, Cluzeau T, Sicard A, Drici MD. CAR-T Cells and the Kidney: Insights from the WHO Safety Database. BioDrugs 2023:10.1007/s40259-023-00599-1. [PMID: 37166707 DOI: 10.1007/s40259-023-00599-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Chimeric antigen receptor T (CAR-T) cells have proven to be a game changer for treating several hematologic malignancies. Randomized controlled trials have highlighted potential life-threatening adverse drug reactions (ADRs), including cytokine release syndrome (CRS). Acute renal failure (ARF) has also been reported in 20% of the patients treated. However, an analysis of renal safety supported by large-scale real-life data seems warranted. PATIENTS AND METHODS We queried VigiBase® for all reports of the Standardised MedDRA Query "acute renal failure" (ARF) involving a CAR-T cell, registered until 24 July 2022. Disproportionality for this ADR was analyzed through calculation of the Information Component [IC (95% confidence interval)]. A positive lower end of the 95% confidence interval of the IC is the threshold used in statistical signal detection in VigiBase®. The same analysis was carried out for various hydroelectrolytic disorders. RESULTS We gathered 224 reports of ARF, and 125 reports of hydroelectrolytic disorders involving CAR-T cells. CAR-T cells were disproportionately reported with ARF [IC 1.5 (1.3-1.7)], even after excluding reports mentioning CRS. A significant disproportionate reporting was also found for hypernatremia [IC 3.1 (2.2-3.8)], hyperphosphatemia [IC 3.1 (1.8-3.9)], hypophosphatemia [IC 2.0 (0.6-2.9)], metabolic acidosis [IC 1.8 (1.2-2.2)], hyponatremia [IC 1.6 (1.1-2.0)], and hypercalcemia [IC 1.4 (0.5-2.1)]. There was no disproportionate reporting of dyskalemia. CONCLUSIONS This study is limited by the inherent flaws of pharmacovigilance approaches. Nonetheless, our findings suggest that ARF and an array of hydroelectrolytic disorders are potential ADRs of CAR-T cell therapy, in real-life settings and in a nonselected population.
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Affiliation(s)
- Alexandre O Gérard
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
- Department of Pharmacology and Pharmacovigilance, University Hospital Centre of Nice, Nice, France
- Laboratory of Molecular Physio Medicine (LP2M), UMR 7370, CNRS, University Côte d'Azur, Nice, France
| | - Diane Merino
- Department of Pharmacology and Pharmacovigilance, University Hospital Centre of Nice, Nice, France
| | - Alexis Charbinat
- Laboratory of Molecular Physio Medicine (LP2M), UMR 7370, CNRS, University Côte d'Azur, Nice, France
| | - Joseph Fournier
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
| | - Alexandre Destere
- Department of Pharmacology and Pharmacovigilance, University Hospital Centre of Nice, Nice, France
| | - Michael Loschi
- Department of Hematology, University Hospital Centre of Nice, Nice, France
| | - Thomas Cluzeau
- Department of Hematology, University Hospital Centre of Nice, Nice, France
| | - Antoine Sicard
- Department of Nephrology-Dialysis-Transplantation, University Hospital Centre of Nice, Nice, France
- Laboratory of Molecular Physio Medicine (LP2M), UMR 7370, CNRS, University Côte d'Azur, Nice, France
- Clinical Research Unit of University Côte d'Azur (UR2CA), University Côte d'Azur, Nice, France
| | - Milou-Daniel Drici
- Department of Pharmacology and Pharmacovigilance, University Hospital Centre of Nice, Nice, France.
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Gaffet M, Wiedemann A, Dalle JH, Bilger K, Forcade E, Robin M, Cornillon J, Labussière-Wallet H, Ceballos P, Bulabois CE, Loschi M, Orvain C, Rubio MT, Neven B, Pagliuca S, Pochon C. Efficacy of haematopoietic stem cell boost as a rescue for poor graft function after haematopoietic stem cell transplantation: A multicentre retrospective study on behalf of the Francophone Society for Bone Marrow Transplantation and Cell Therapy (SFGM-TC). Br J Haematol 2023. [PMID: 36974355 DOI: 10.1111/bjh.18744] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/29/2023]
Abstract
Haematopoietic stem cell reinjection may be a curative option for poor graft function after haematopoietic stem cell transplantation; however, literature supporting its use remains limited. We conducted a multicentre retrospective study on behalf of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy, including 55 patients. We demonstrated response rates of nearly 40% and two-year survival of more than 60% in the context of an otherwise deadly complication and we observed that the timing of injection and the degree of cytopenia are strongly associated with outcomes. This study shows the feasibility of the procedure informing on its epidemiology, outcomes and prognostic factors, setting the stage for future guidelines.
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Affiliation(s)
- M Gaffet
- Department of Pediatric Hematology Oncology, University Hospital of Nancy, Nancy, France
| | - A Wiedemann
- Department of Pediatric Intensive Care, University Hospital of Nancy, Nancy, France
| | - J-H Dalle
- Department of Pediatric Hematology, University Hospital of Robert Debré, Paris, France
| | - K Bilger
- Department of Hematology, University Hospital of Haute-Pierre, Strasbourg, France
| | - E Forcade
- Department of Hematology and Cell Therapy, University Hospital of Bordeaux, Bordeaux, France
| | - M Robin
- Department of Hematology, University Hospital of Saint Louis, Paris, France
| | - J Cornillon
- Department of Hematology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | - P Ceballos
- Department of Hematology, University Hospital of Montpellier, Montpellier, France
| | - C-E Bulabois
- Department of Hematology, University Hospital of Grenoble, Grenoble, France
| | - M Loschi
- Department of Hematology, University Hospital of Nice, Nice, France
| | - C Orvain
- Department of Hematology, University Hospital of Angers, Angers, France
| | - M T Rubio
- Department of Hematology, University Hospital of Nancy, Nancy, France
- CNRS UMR 7365, IMoPA, University of Lorraine, Nancy, France
| | - B Neven
- Department of Pediatric Immuno-Hematology, University Hospital of Necker, Paris, France
| | - S Pagliuca
- Department of Hematology, University Hospital of Nancy, Nancy, France
- CNRS UMR 7365, IMoPA, University of Lorraine, Nancy, France
| | - C Pochon
- Department of Pediatric Hematology Oncology, University Hospital of Nancy, Nancy, France
- CNRS UMR 7365, IMoPA, University of Lorraine, Nancy, France
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19
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Calleja A, Loschi M, Bailly L, Morisot A, Marceau A, Mannone L, Robert G, Auberger P, Preudhomme C, Raynaud S, Subtil F, Sujobert P, Cluzeau T. Real-life challenges using personalized prognostic scoring systems in acute myeloid leukemia. Cancer Med 2023; 12:5656-5660. [PMID: 36394159 PMCID: PMC10028034 DOI: 10.1002/cam4.5408] [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: 07/12/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022] Open
Abstract
Personalized medicine is a challenge for patients with acute myeloid leukemia (AML). The identification of several genetic mutations in several AML trials led to the creation of a personalized prognostic scoring algorithm known as the Knowledge Bank (KB). In this study, we assessed the prognostic value of this algorithm on a cohort of 167 real life AML patients. We compared KB predicted outcomes to real-life outcomes. For patients younger than 60-year-old, OS was similar in favorable and intermediate ELN risk category. However, KB algorithm failed to predict OS for younger patients in the adverse ELN risk category and for patients older than 60 years old in the favorable ELN risk category. These discrepancies may be explained by the emergence of several new therapeutic options as well as the improvement of allogeneic stem cell transplantation (aHSCT) outcomes and supportive cares. Personalized medicine is a major challenge and predictions models are powerful tools to predict patient's outcome. However, the addition of new therapeutic options in the field of AML requires a prospective validation of these scoring systems to include recent therapeutic innovations.
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Affiliation(s)
- Anne Calleja
- Hematology Department, Cote D'Azur University, Nice Sophia Antipolis University, CHU of Nice, Nice, France
- Mediterranean Center for Molecular Medecine, Cote d'Azur University, INSERM U1065, Nice, France
| | - Michael Loschi
- Hematology Department, Cote D'Azur University, Nice Sophia Antipolis University, CHU of Nice, Nice, France
- Mediterranean Center for Molecular Medecine, Cote d'Azur University, INSERM U1065, Nice, France
| | - Laurent Bailly
- Public Health Department, Centre Hospitalier Universitaire de Nice, Cote d'Azur University, Nice, France
| | - Adeline Morisot
- Public Health Department, Centre Hospitalier Universitaire de Nice, Cote d'Azur University, Nice, France
| | | | - Lionel Mannone
- Hematology Department, Cote D'Azur University, Nice Sophia Antipolis University, CHU of Nice, Nice, France
| | - Guillaume Robert
- Mediterranean Center for Molecular Medecine, Cote d'Azur University, INSERM U1065, Nice, France
| | - Patrick Auberger
- Mediterranean Center for Molecular Medecine, Cote d'Azur University, INSERM U1065, Nice, France
| | - Claude Preudhomme
- Public Health Department, Centre Hospitalier Universitaire de Nice, Cote d'Azur University, Nice, France
| | - Sophie Raynaud
- Cote D'Azur University, Nice Sophia Antipolis University, CHU of Nice, Onco-Hematology Laboratory, Nice, France
| | - Fabien Subtil
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Hématologie Biologique, Pierre-Bénite, France
| | - Pierre Sujobert
- Hospices Civils de Lyon, Service de Biostatistique, CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Lyon, France
| | - Thomas Cluzeau
- Hematology Department, Cote D'Azur University, Nice Sophia Antipolis University, CHU of Nice, Nice, France
- Mediterranean Center for Molecular Medecine, Cote d'Azur University, INSERM U1065, Nice, France
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20
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Kaphan E, Bettega F, Forcade E, Labussière-Wallet H, Fegueux N, Robin M, De Latour RP, Huynh A, Lapierre L, Berceanu A, Marcais A, Debureaux PE, Vanlangendonck N, Bulabois CE, Magro L, Daniel A, Galtier J, Lioure B, Chevallier P, Antier C, Loschi M, Guillerm G, Mear JB, Chantepie S, Cornillon J, Rey G, Poire X, Bazarbachi A, Rubio MT, Contentin N, Orvain C, Dulery R, Bay JO, Croizier C, Beguin Y, Charbonnier A, Skrzypczak C, Desmier D, Villate A, Carré M, Thiebaut-Bertrand A. Late relapse after hematopoietic stem cell transplantation for acute leukemia: a retrospective study by SFGM-TC. Transplant Cell Ther 2023:S2666-6367(23)01129-6. [PMID: 36849078 DOI: 10.1016/j.jtct.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
Late relapse (LR) after allogeneic hematopoietic stem cell transplantation (AHSCT) for acute leukemia is a rare event (nearly 4.5%) and raises the questions of prognosis and outcome after salvage therapy. We performed a retrospective multicentric study between January 1, 2010, and December 31, 2016, using data from the French national retrospective register ProMISe provided by the SFGM-TC (French Society for Bone Marrow Transplantation and Cellular Therapy). We included patients presenting with LR, defined as a relapse occurring at least 2 years after AHSCT. We used the Cox model to identify prognosis factors associated with LR. During the study period, a total of 7582 AHSCTs were performed in 29 centers, and 33.8% of patients relapsed. Among them, 319 (12.4%) were considered to have LR, representing an incidence of 4.2% for the entire cohort. The full dataset was available for 290 patients, including 250 (86.2%) with acute myeloid leukemia and 40 (13.8%) with acute lymphoid leukemia. The median interval from AHSCT to LR was 38.2 months (interquartile range [IQR], 29.2 to 49.7 months), and 27.2% of the patients had extramedullary involvement at LR (17.2% exclusively and 10% associated with medullary involvement). One-third of the patients had persistent full donor chimerism at LR. Median overall survival (OS) after LR was 19.9 months (IQR, 5.6 to 46.4 months). The most common salvage therapy was induction regimen (55.5%), with complete remission (CR) obtained in 50.7% of cases. Ninety-four patients (38.5%) underwent a second AHSCT, with a median OS of 20.4 months (IQR, 7.1 to 49.1 months). Nonrelapse mortality after second AHSCT was 18.2%. The Cox model identified the following factors as associated with delay of LR: disease status not in first CR at first HSCT (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.04 to 1.64; P = .02) and the use of post-transplantation cyclophosphamide (OR, 2.23; 95% CI, 1.21 to 4.14; P = .01). Chronic GVHD appeared to be a protective factor (OR, .64; 95% CI, .42 to .96; P = .04). The prognosis of LR is better than in early relapse, with a median OS after LR of 19.9 months. Salvage therapy associated with a second AHSCT improves outcome and is feasible, without creating excess toxicity.
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Affiliation(s)
- E Kaphan
- Department of Hematology-Transplantation, CHU Grenoble, Grenoble, France.
| | - F Bettega
- University Grenoble Alpes, Inserm, CHU Grenoble Alpes, Grenoble, France
| | - E Forcade
- Department of Hematology-Transplantation, Hôpital de Bordeaux, Bordeaux, France
| | - H Labussière-Wallet
- Department of Hematology-Transplantation, CHU Lyon Sud, Pierre-Bénite, France
| | - N Fegueux
- Department of Hematology, CHU Montpellier, Montpellier, France
| | - M Robin
- Department of Hematology-Transplantation, Hôpital Saint-Louis, APHP, Université de Paris, Paris, France
| | - R Peffault De Latour
- Department of Hematology-Transplantation, Hôpital Saint-Louis, APHP, Université de Paris, Paris, France
| | - A Huynh
- Department of Hematology, Transplantation, and Cellular Therapy, IUCT Oncopole, Toulouse, France
| | - L Lapierre
- Department of Hematology, Transplantation, and Cellular Therapy, IUCT Oncopole, Toulouse, France
| | - A Berceanu
- Department of Intensive Care and Transplantation, CHU Jean Minjoz, Besançon, France
| | - A Marcais
- Department of Hematology, Hôpital Necker, Paris, France
| | - P E Debureaux
- Department of Hematology-Transplantation, Hôpital Saint-Louis, APHP, Université de Paris, Paris, France
| | - N Vanlangendonck
- Department of Hematology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - C-E Bulabois
- Department of Hematology-Transplantation, CHU Grenoble, Grenoble, France
| | - L Magro
- Department of Hematology-Transplantation, CHRU Lille, Lille, France
| | - A Daniel
- Department of Hematology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - J Galtier
- Department of Hematology-Transplantation, Hôpital de Bordeaux, Bordeaux, France
| | - B Lioure
- Department of Hematology, CHRU Strasbourg, Strasbourg, France
| | - P Chevallier
- Department of Hematology, CHU Nantes, Nantes, France
| | - C Antier
- Department of Hematology, CHU Nantes, Nantes, France
| | - M Loschi
- Department of Hematology-Transplantation, CHU Nice, Nice, France
| | - G Guillerm
- Department of Hematology, CHRU Brest, Brest, France
| | - J B Mear
- Department of Hematology-Transplantation, Hôpital de Rennes, Rennes, France
| | - S Chantepie
- Basse-Normandie Hematology Institute, CHU Caen, Caen, France
| | - J Cornillon
- Department of Clincial Hematology and Cellular Therapy, CHU Saint-Étienne, Saint-Priest-en-Jarez, France
| | - G Rey
- Department of Clincial Hematology and Cellular Therapy, CHU Saint-Étienne, Saint-Priest-en-Jarez, France
| | - X Poire
- Department of Hematology, CHU Saint-Luc, Brussels, Belgium
| | - A Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - M T Rubio
- Department of Hematology, CHU Nancy, Nancy, France
| | - N Contentin
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | - C Orvain
- Department of Hematology-Transplantation, CHU Angers, Angers, France
| | - R Dulery
- Department of Clinical Hematology, CHU St Antoine, APHP, Paris, France
| | - J O Bay
- Department of Clinical Hematology and Cellular Therapy, CHU Estaing, Clermont-Ferrand, France
| | - C Croizier
- Department of Clinical Hematology and Cellular Therapy, CHU Estaing, Clermont-Ferrand, France
| | - Y Beguin
- CU of Liège and University of Liège, Liège, Belgium
| | - A Charbonnier
- Department of Hematology-Transplantation, CHU Amiens, Amiens, France
| | - C Skrzypczak
- Department of Hematology-Transplantation, CHU Amiens, Amiens, France
| | - D Desmier
- Department of Hematology, CHU Poitiers, Poitiers, France
| | - A Villate
- Department of Hematology, CHRU Tours, Tours, France
| | - M Carré
- Department of Hematology-Transplantation, CHU Grenoble, Grenoble, France
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21
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Michel C, Robin M, Morisset S, Blaise D, Maertens J, Chevalier P, Castilla-Llorente C, Forcade E, Ceballos P, Yakoug-Agha I, Poire X, Carre M, Bay JO, Beguin Y, Loschi M, Huynh A, Guillerm G, François S, Mear JB, Duléry R, Suarez F, Bilger K, Cornillon J, Chalandon Y, Maillard N, Labussière-Wallet H, Charbonnier A, Turlure P, Berceanu A, Chantepie S, Maury S, Bazarbachi A, Menard AL, Nguyen-Quoc S, Rubio MT, D'Aveni M. Outcome after allogeneic stem cell transplantation with haploidentical versus HLA-matched donors in patients with higher-risk MDS. Bone Marrow Transplant 2023; 58:534-543. [PMID: 36774430 PMCID: PMC10162937 DOI: 10.1038/s41409-023-01931-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/13/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation remains the best curative option for higher-risk myelodysplastic syndrome. The presence of monosomal karyotype and/or complex karyotype abnormalities predicts inferior survival after allo-SCT in MDS patients. Haploidentical allo-SCT has been increasingly used in acute leukemia (AL) and has similar results as using HLA-matched donors, but data on higher-risk MDS is sparse. We compared outcomes in 266 patients with higher-risk MDS after HLA-matched sibling donor (MSD, n = 79), HLA-matched unrelated donor (MUD, n = 139) and HLA haploidentical donor (HID, n = 48) from 2010 to 2019. Median donor age differed between the three groups (p < 0.001). The overall survival was significantly different between the three groups with a better OS observed in the MUD group (p = 0.014). This observation could be explained by a higher progression-free survival with MUD (p = 0.014). The cumulative incidence of grade 2-4 acute GvHD was significantly higher in the HID group (p = 0.051). However, in multivariable analysis, patients transplanted using an HID had comparable mortality to patients transplanted using a MUD (subdistribution hazard ratio [sHR]: 0.58 [0.32-1.07]; p = 0.080) and a MSD ([sHR]: 0.56 [0.28-1.11]; p = 0.094). MUD do not remain a significant positive predictor of survival, suggesting that beyond the donor-recipient HLA matching, the donor age might impact recipient outcome.
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Affiliation(s)
- Claire Michel
- Hematology department, University hospital of Nancy, Nancy, France
| | - Marie Robin
- Hematology department, Hôpital Saint-Louis, Paris, France
| | | | - Didier Blaise
- Hematology department, Institut Paoli Calmette, Marseille, France
| | - Johan Maertens
- Hematology department, Hôpital UZ Leuven, Louvain, Belgium
| | - Patrice Chevalier
- Hematology department, University hospital of Nantes, Nantes, France
| | | | - Edouard Forcade
- Hematology department, Hôpital Haut-Levêque, Bordeaux, France
| | | | - Ibrahim Yakoug-Agha
- Hematology department, CHU de Lille, Univ Lille, INSERM U1286, Infinite, Lille, France
| | - Xavier Poire
- Section of Hematology, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Martin Carre
- Hematology department, Hôpital Michallon, Grenoble, France
| | - Jacques-Olivier Bay
- Service de Thérapie Cellulaire et d'Hématologie Clinique Adulte, CHU Clermont-Ferrand Hôpital Estaing, Estaing, France
| | - Yves Beguin
- Hematology department, University hospital of Liège, Liège, Belgium
| | | | - Anne Huynh
- Hematology department, University hospital of Toulouse, Toulouse, France
| | - Gaëlle Guillerm
- Hematology department, University hospital of Brest, Brest, France
| | - Sylvie François
- Hematology department, University hospital of Angers, Angers, France
| | | | - Rémy Duléry
- Hematology department, Hôpital Saint-Antoine, Paris, France
| | - Felipe Suarez
- Hematology department, Hôpital Necker, Paris, France
| | - Karin Bilger
- Hematology department University hospital of Strasbourg, Strasbourg, France
| | - Jérôme Cornillon
- Hematology department University hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Yves Chalandon
- Hematology division, University hospital of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Natacha Maillard
- Hematology department University hospital of Poitiers, Poitiers, France
| | | | | | - Pascal Turlure
- Hematology department, Hôpital Dupuytren, Limoges, France
| | - Ana Berceanu
- Hematology department, University hospital of Besançon, Besançon, France
| | | | - Sébastien Maury
- Hematology department, Hôpital Henri Mondor, Créteil, France
| | - Ali Bazarbachi
- Hematology department, American university of Beyrouth, Beyrouth, Lebanon
| | | | | | | | - Maud D'Aveni
- Hematology department, University hospital of Nancy, Nancy, France.
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22
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Le Calvez B, Tessoullin B, Renaud L, Botella-Garcia C, Srour M, Le Gouill S, Guillerm G, Gressin R, Nguyen Quoc S, Furst S, Chauchet A, Sibon D, Lewalle P, Poiré X, Maillard N, Villate A, Loschi M, Paillassa J, Beguin Y, Dulery R, Tudesq JJ, Fayard A, Béné MC, Camus V, Chevallier P, Le Bourgeois A. Outcomes after allogeneic hematopoietic stem cell transplantation for adults with primary mediastinal B cell lymphoma: a SFGM-TC and LYSA study. Acta Oncol 2022; 61:1332-1338. [PMID: 36214787 DOI: 10.1080/0284186x.2022.2130709] [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] [Indexed: 11/01/2022]
Abstract
Background: Despite therapeutic progress, 10 to 30% of adult patients with primary mediastinal B cell lymphoma (PMBCL) are primary refractory or experience early relapse (R/R). Allogeneic stem cell transplantation (allo-HSCT) thus remains a potentially curative option in this setting.Material and Methods: In this multicenter retrospective study, the outcomes of 33 French and Belgian adult patients allo-transplanted for R/R PMBCL between January 1999 and December 2018, were examined.Results: At allo-HSCT time, patients had received a median of 3 treatment lines, 50% of them were in complete response, 40% in partial response and 10% had a progressive disease. Forty-two percent of the donors were siblings and 39% matched related. The median follow-up for alive patients was 78 months (3.5-157). Considering the whole cohort, 2-year overall survival (OS), progression free survival (PFS) and graft-versus-host disease-free/relapse-free survival (GRFS) were 48% (95%CI: 33-70), 47% (95%CI: 33-68) and 38.5% (95%CI: 25-60) respectively. Cumulative incidence of relapse and non-relapse mortality rates were respectively 34% (95%CI: 18-50) and 18% (95%CI: 7-34). Disease status at transplant was the only factor predicting survivals, patients with progressive disease showing significant lower 2-year PFS (HR: 6.12, 95%CI: 1.32-28.31, p = 0.02) and OS (HR: 7.04, 95%CI: 1.52-32.75, p = 0.013). A plateau was observed for OS and PFS after 4 years with 10 patients alive after this date, suggesting that almost one third of the patients effectively salvaged and undergoing allo-SCT could be cured.Conclusion: This study indicates that allo-HSCT is a valid therapeutic option for R/R PMBCL, providing durable remissions.
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Affiliation(s)
| | | | - Loïc Renaud
- AP-HP, Hôpital Saint-Louis, Hemato-oncologie, DMU DHI, Université de Paris, Paris, France
| | | | - Micha Srour
- Maladie du sang, CHU de Lille, Lille, France
| | | | | | - Rémy Gressin
- Hématologie Clinique, CHU de Grenoble, Grenoble, France
| | | | - Sabine Furst
- Hématologie Clinique, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | | | - David Sibon
- Hématologie Clinique, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Xavier Poiré
- Hématologie Clinique, Hôpital Saint-Luc, Bruxelles, Belgium
| | | | | | | | | | - Yves Beguin
- Hématologie Clinique, University of Liège and CHU of Liège, Liège, Belgium
| | - Rémy Dulery
- Hématologie Clinique, Hôpital Saint Antoine, Paris, France
| | | | - Amandine Fayard
- Hématologie Clinique, CHU de Clermont Ferrand, Clermont Ferrand, France
| | - Marie C Béné
- Hématologie Biologie, CHU de Nantes, Nantes, France
| | - Vincent Camus
- Département d'Hématologie, Centre Henri Becquerel, Rouen, France
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23
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Chiche E, Loschi M. Nouvelles AMMs : lisocabtagene maraleucel dans le traitement des patients ayant un lymphome B diffus à grandes cellules, un lymphome B à grandes cellules primitif du médiastin ou un lymphome folliculaire de grade 3B, en rechute ou réfractaire après au moins deux lignes de traitement systémique. Bull Cancer 2022; 109:879-880. [DOI: 10.1016/j.bulcan.2022.04.020] [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: 04/05/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
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24
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Thangavelu G, Andrejeva G, Bolivar-Wagers S, Jin S, Zaiken MC, Loschi M, Aguilar EG, Furlan SN, Brown CC, Lee YC, Hyman CM, Feser CJ, Panoskaltsis-Mortari A, Hippen KL, MacDonald KP, Murphy WJ, Maillard I, Hill GR, Munn DH, Zeiser R, Kean LS, Rathmell JC, Chi H, Noelle RJ, Blazar BR. Retinoic acid signaling acts as a rheostat to balance Treg function. Cell Mol Immunol 2022; 19:820-833. [PMID: 35581350 PMCID: PMC9243059 DOI: 10.1038/s41423-022-00869-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/14/2022] [Indexed: 02/03/2023] Open
Abstract
Regulatory T cells (Tregs) promote immune homeostasis by maintaining self-tolerance and regulating inflammatory responses. Under certain inflammatory conditions, Tregs can lose their lineage stability and function. Previous studies have reported that ex vivo exposure to retinoic acid (RA) enhances Treg function and stability. However, it is unknown how RA receptor signaling in Tregs influences these processes in vivo. Herein, we employed mouse models in which RA signaling is silenced by the expression of the dominant negative receptor (DN) RARα in all T cells. Despite the fact that DNRARα conventional T cells are hypofunctional, Tregs had increased CD25 expression, STAT5 pathway activation, mTORC1 signaling and supersuppressor function. Furthermore, DNRARα Tregs had increased inhibitory molecule expression, amino acid transporter expression, and metabolic fitness and decreased antiapoptotic proteins. Supersuppressor function was observed when wild-type mice were treated with a pharmacologic pan-RAR antagonist. Unexpectedly, Treg-specific expression of DNRARα resulted in distinct phenotypes, such that a single allele of DNRARα in Tregs heightened their suppressive function, and biallelic expression led to loss of suppression and autoimmunity. The loss of Treg function was not cell intrinsic, as Tregs that developed in a noninflammatory milieu in chimeric mice reconstituted with DNRARα and wild-type bone marrow maintained the enhanced suppressive capacity. Fate mapping suggested that maintaining Treg stability in an inflammatory milieu requires RA signaling. Our findings indicate that RA signaling acts as a rheostat to balance Treg function in inflammatory and noninflammatory conditions in a dose-dependent manner.
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Affiliation(s)
- Govindarajan Thangavelu
- Department of Pediatrics, Center for Immunology, University of Minnesota, Minneapolis, MN, USA.
| | - Gabriela Andrejeva
- Center for Immunobiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sara Bolivar-Wagers
- Department of Pediatrics, Center for Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Sujeong Jin
- Department of Pediatrics, Center for Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Michael C Zaiken
- Department of Pediatrics, Center for Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Michael Loschi
- Department of Pediatrics, Center for Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Ethan G Aguilar
- Department of Pediatrics, Center for Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Scott N Furlan
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Chrysothemis C Brown
- Howard Hughes Medical Institute, Immunology Program, and Ludwig Center, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yu-Chi Lee
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, USA
| | - Cameron McDonald Hyman
- Department of Pediatrics, Center for Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Colby J Feser
- Department of Pediatrics, Center for Immunology, University of Minnesota, Minneapolis, MN, USA
| | | | - Keli L Hippen
- Department of Pediatrics, Center for Immunology, University of Minnesota, Minneapolis, MN, USA
| | - Kelli P MacDonald
- Department of Immunology, Queensland Institute of Medical Research (QIMR) Berghofer Medical Research Institute and School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - William J Murphy
- Department of Dermatology, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ivan Maillard
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - David H Munn
- Georgia Cancer Center, Augusta University, Augusta, GA, USA
| | - Robert Zeiser
- Department of Haematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Freiburg University Medical Centre, Freiburg, Germany
| | - Leslie S Kean
- Boston Children's Hospital and the Dana-Farber Cancer Institute, Boston, MA, USA
| | - Jeffrey C Rathmell
- Center for Immunobiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hongbo Chi
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Randolph J Noelle
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, USA
| | - Bruce R Blazar
- Department of Pediatrics, Center for Immunology, University of Minnesota, Minneapolis, MN, USA
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25
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Bachy E, Le Gouill S, Sesques P, Di Blasi R, Guillaume M, Cartron G, Beauvais D, Roulin L, Gros FX, Rubio MT, Bories P, Bay JO, Castilla Llorente C, Choquet S, Casasnovas RO, Mothy M, Guidez S, Joris M, Loschi M, Carras S, Abraham J, Chauchet A, Drieu La Rochelle L, Zerbit J, Hermine O, Gastinne T, Tudesq JJ, Gat E, Broussais F, Thieblemont C, Houot R, Morschhauser F. S260: A MATCHED COMPARISON OF TISAGENLECLEUCEL AND AXICABTAGENE CILOLEUCEL CAR T CELLS IN RELAPSED OR REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA: A REAL-LIFE LYSA STUDY FROM THE FRENCH DESCAR-T REGISTRY. Hemasphere 2022. [DOI: 10.1097/01.hs9.0000843932.28141.4d] [Citation(s) in RCA: 1] [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] [Indexed: 11/25/2022] Open
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26
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Loschi M, Roux C, Sudaka I, Ferrero-Vacher C, Marceau-Renaut A, Duployez N, Passeron T, Cluzeau T. Allogeneic stem cell transplantation as a curative therapeutic approach for VEXAS syndrome: a case report. Bone Marrow Transplant 2022; 57:315-318. [PMID: 34999727 DOI: 10.1038/s41409-021-01544-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/18/2021] [Accepted: 11/26/2021] [Indexed: 11/09/2022]
Abstract
TO THE EDITOR VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a newly described entity linked to somatic mutation of UBA1, encompassing inflammatory disorders and hematological malignancies. Patients experiments symptoms related to inflammatory manifestations on the skin, joints, lungs. Most patients are refractory to usual anti-inflammatory or immunosuppressive treatments. Half of them will develop hematological diseases, mostly myelodysplastic syndromes. VEXAS patients with hematological malignancies have a poor outcome and no curative option has been described so far. Because in the first reported cohort of VEXAS patients the UBA1 mutation was only found in hematopoietic stem cells but not in fibroblasts, we hypothesized that bone marrow transplantation would provide a cure for the disease. Here we report the case of a VEXAS patient who successfully received an allogeneic hematopoietic stem cell transplantation as a curative option.
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Affiliation(s)
- Michael Loschi
- Hematology Department, Nice University Medical Center, Cote d'Azur University, Nice, France. .,Cote d'Azur University, INSERM U1065, C3M, Nice, France.
| | - Christian Roux
- Rheumatology Department, Nice University Medical Center, Nice, France.,University Côte d'Azur, LAMHESS, INSERM, iBV, U1091, Nice, France
| | - Isabelle Sudaka
- Laboratoire d'hématologie, CHU de Nice, Hospital Pasteur, Nice, France
| | | | - Alice Marceau-Renaut
- University of Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020-UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France
| | - Nicolas Duployez
- University of Lille, CNRS, Inserm, CHU Lille, Institut de Recherche contre le Cancer de Lille, UMR9020-UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, 59000, Lille, France
| | - Thierry Passeron
- Cote d'Azur University, INSERM U1065, C3M, Nice, France.,Department of Dermatology, CHU Nice, University Côte d'Azur, Nice, France
| | - Thomas Cluzeau
- Hematology Department, Nice University Medical Center, Cote d'Azur University, Nice, France.,Cote d'Azur University, INSERM U1065, C3M, Nice, France
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27
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Cluzeau T, Loschi M, Fenaux P, Komrokji R, Sallman DA. Personalized Medicine for TP53 Mutated Myelodysplastic Syndromes and Acute Myeloid Leukemia. Int J Mol Sci 2021; 22:ijms221810105. [PMID: 34576266 PMCID: PMC8471083 DOI: 10.3390/ijms221810105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/07/2021] [Accepted: 09/17/2021] [Indexed: 02/04/2023] Open
Abstract
Targeting TP53 mutated myelodysplastic syndromes and acute myeloid leukemia remains a significant unmet need. Recently, new drugs have attempted to improve the outcomes of this poor molecular subgroup. The aim of this article is to review all the current knowledge using active agents including hypomethylating agents with venetoclax, eprenetapopt or magrolimab. We include comprehensive analysis of clinical trials to date evaluating these drugs in TP53 myeloid neoplasms as well as discuss future novel combinations for consideration. Additionally, further understanding of the unique clinicopathologic components of TP53 mutant myeloid neoplasms versus wild-type is critical to guide future study. Importantly, the clinical trajectory of patients is uniquely tied with the clonal burden of TP53, which enables serial TP53 variant allele frequency analysis to be a critical early biomarker in investigational studies. Together, significant optimism is now possible for improving outcomes in this patient population.
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Affiliation(s)
- Thomas Cluzeau
- Hematology Department, University Hospital of Nice, Cote d’Azur University, 06200 Nice, France;
- INSERM U1065, Mediterranean Center of Molecular Medicine, Cote d’Azur University, 06200 Nice, France
- French Group of Myelodysplasia, 75010 Paris, France;
- Correspondence: ; Tel.: +33-492-035-841; Fax: +33-492-035-895
| | - Michael Loschi
- Hematology Department, University Hospital of Nice, Cote d’Azur University, 06200 Nice, France;
- INSERM U1065, Mediterranean Center of Molecular Medicine, Cote d’Azur University, 06200 Nice, France
| | - Pierre Fenaux
- French Group of Myelodysplasia, 75010 Paris, France;
- Senior Hematology Department, Saint Louis Hospital, Paris 7 University, 75010 Paris, France
| | - Rami Komrokji
- Moffit Cancer Center and Research Institute, Tampa, FL 33612, USA; (R.K.); (D.A.S.)
| | - David A. Sallman
- Moffit Cancer Center and Research Institute, Tampa, FL 33612, USA; (R.K.); (D.A.S.)
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Ferrete T, Rocher F, Elmaleh V, Loschi M, Tieulie N, Baillif S, Martel A. Eye amputation following lifitegrast treatment for ocular graft-versus-host disease - Response to Novartis. J Fr Ophtalmol 2021; 44:e525-e526. [PMID: 34511309 DOI: 10.1016/j.jfo.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- T Ferrete
- Ophthalmology department, university hospital of Nice, 30, voie Romaine, 06000 Nice, France
| | - F Rocher
- Pharmacovigilance department, university hospital of Nice, 30, voie Romaine, 06000 Nice, France
| | - V Elmaleh
- Ophthalmology department, university hospital of Nice, 30, voie Romaine, 06000 Nice, France
| | - M Loschi
- Hematology department, university hospital of Nice, 151, route Sainte-Antoine, 06200 Nice, France
| | - N Tieulie
- Rheumatology department, university hospital of Nice, 30, voie Romaine, 06000 Nice, France
| | - S Baillif
- Ophthalmology department, university hospital of Nice, 30, voie Romaine, 06000 Nice, France
| | - A Martel
- Ophthalmology department, university hospital of Nice, 30, voie Romaine, 06000 Nice, France.
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29
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Nicholls JH, Loschi M, Jin S, Wagers SB, Thangavelu G, Zaiken MC, McDonald-Hyman C, Saha A, Aguliar EG, Koehn B, Osborn MJ, MacDonald KP, Kim SV, Littman DR, Blazar BR. Targeted gastrointestinal tract homing of regulatory T-cells reduces acute graft-versus-host disease severity by simulating an increase in Treg dose in vivo. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.11.05] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
Damage to the gastrointestinal (GI) tract following hematopoietic stem cell transplant (HSCT) has been shown to drive the development of acute graft-versus-host disease (aGVHD). We have demonstrated clinically that infusing regulatory T-cells (Treg) during HSCT reduces aGVHD risk while supporting immune recovery; however, high Treg doses were necessary. Here we demonstrate that by promoting Treg homing to the GI tract early post-HSCT, aGVHD severity was reduced. Ex vivo expanded murine Treg were retrovirally transduced to overexpress the orphan chemoattractant receptor GPR15 for colon specific T-cell homing. Despite no change in Treg phenotype or in vitro suppressive function when administered to HSCT recipient mice at the time of transplantation, mice that received GPR15+ Treg exhibited significantly reduced aGVHD severity and prolonged survival compared to control Treg mice (p = 0.0035). To confirm that this resulted from an increased Treg accumulation in the GI tissues, we then assessed the frequency and retention of GPR15+ Treg in mice post-HSCT by in vivo and ex vivo bioluminescent imaging as well as flow analysis. From these data, we observed not only superior localization of GPR15+ Treg within GI tissues, but also significantly reduced inflammation and tissue damage in GPR15+ Treg recipient mice early post-HSCT. Our data provides evidence that deliberate targeting of ex vivo expanded Treg to the GI tract during HSCT significantly reduces injury to the GI tract and reduces aGVHD severity by simulating an increase in Treg dose in vivo. These data provide a rational for the future development of clinical Treg products for increased control of GI aGVHD following HSCT.
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Affiliation(s)
- Jemma H Nicholls
- 1Pediatrics, Univ. of Minnesota
- 2Pediatrics, Univ. of Minnesota, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - Dan R Littman
- 6Howard Hughes Medical Inst., New York Univ. Sch. of Med
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30
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Ferrete T, Rocher F, Elmaleh V, Loschi M, Tieulie N, Baillif S, Martel A. Eye amputation following lifitegrast treatment for ocular graft-versus-host disease: First case report. J Fr Ophtalmol 2021; 44:652-657. [PMID: 33858697 DOI: 10.1016/j.jfo.2020.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/11/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022]
Abstract
Graft-versus-host disease (GVHD) is a common complication in patients undergoing allogeneic stem cell transplantation for acute myeloblastic leukemia that could be very difficult to treat. Lifitegrast 5% (Xiidra@, Novartis), a new immunosuppressive eye drop, was recently approved by the FDA for the treatment of severe dry eye and is currently under review by the European Medicines Agency. In France, lifitegrast has been approved by the French authorities for temporary use in refractory dry eye syndrome resistant to tear substitutes and topical cyclosporine. To date, serious complications have been reported only exceptionally. In this article, we report the case of a 65-year-old patient with a medical history of acute myeloid leukemia (AML) diagnosed in 2015 who received a first matched related donor transplant. In 2019, this patient developed chronic GVH involving the skin, oral mucosa and eye. Despite taking topical and systemic medications for 3 months, the patient did not report relief of ocular symptoms. Therefore, lifitegrast was prescribed. To our knowledge, we report the first case of corneal perforation in which evisceration was required following treatment with topical lifitegrast for chronic GVH. In the case presented here, it can be assumed that the underlying mechanisms leading to corneal perforation are multifactorial. Using drug accountability criteria, lifitegrast appears to be strongly associated with the development of bacterial keratitis and corneal perforation.
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Affiliation(s)
- T Ferrete
- Ophthalmology department, University Hospital of Nice, 30, voie Romaine, 06000 Nice, France.
| | - F Rocher
- Pharmacovigilance department, University Hospital of Nice, 30, voie Romaine, 06000 Nice, France.
| | - V Elmaleh
- Ophthalmology department, University Hospital of Nice, 30, voie Romaine, 06000 Nice, France.
| | - M Loschi
- Hematology department, University Hospital of Nice, 151, route Sainte-Antoine, 06200 Nice, France.
| | - N Tieulie
- Rheumatology department, University Hospital of Nice, 30, voie Romaine, 06000 Nice, France.
| | - S Baillif
- Ophthalmology department, University Hospital of Nice, 30, voie Romaine, 06000 Nice, France.
| | - A Martel
- Ophthalmology department, University Hospital of Nice, 30, voie Romaine, 06000 Nice, France.
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31
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Cluzeau T, Sebert M, Rahmé R, Cuzzubbo S, Lehmann-Che J, Madelaine I, Peterlin P, Bève B, Attalah H, Chermat F, Miekoutima E, Rauzy OB, Recher C, Stamatoullas A, Willems L, Raffoux E, Berthon C, Quesnel B, Loschi M, Carpentier AF, Sallman DA, Komrokji R, Walter-Petrich A, Chevret S, Ades L, Fenaux P. Eprenetapopt Plus Azacitidine in TP53-Mutated Myelodysplastic Syndromes and Acute Myeloid Leukemia: A Phase II Study by the Groupe Francophone des Myélodysplasies (GFM). J Clin Oncol 2021; 39:1575-1583. [PMID: 33600210 PMCID: PMC8099409 DOI: 10.1200/jco.20.02342] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
TP53-mutated (TP53m) myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) have very poor outcome irrespective of the treatment received, including 40% responses (20% complete remission [CR]) with azacitidine (AZA) alone, short response duration, and a median overall survival (OS) of approximately 6 months. Eprenetapopt (APR-246), a novel first-in-class drug, leads to p53 protein reconformation and reactivates its proapoptotic and cell-cycle arrest functions.
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Affiliation(s)
- Thomas Cluzeau
- Cote d'Azur University, Hematology Department, Centre Hospitalier Universitaire of Nice, Nice, France.,Cote d'Azur University, Mediterranean Center of Molecular Medicine, INSERM U1065, Nice, France.,GFM
| | - Marie Sebert
- GFM.,Hematology Department, Hospital Saint Louis, Assistance Publique des Hopitaux de Paris (APHP), and Paris University, Paris, France
| | - Ramy Rahmé
- GFM.,Hematology Department, Hospital Saint Louis, Assistance Publique des Hopitaux de Paris (APHP), and Paris University, Paris, France
| | | | | | | | | | | | | | | | - Elsa Miekoutima
- Hematology Department, Hospital Saint Louis, Assistance Publique des Hopitaux de Paris (APHP), and Paris University, Paris, France
| | | | | | | | - Lise Willems
- GFM.,Hematology Department, Hospital Cochin, APHP, Paris, France
| | - Emmanuel Raffoux
- GFM.,Hematology Department, Hospital Saint Louis, Assistance Publique des Hopitaux de Paris (APHP), and Paris University, Paris, France
| | | | - Bruno Quesnel
- GFM.,Hematology Department, CHU of Lille, Lille, France
| | - Michael Loschi
- Cote d'Azur University, Hematology Department, Centre Hospitalier Universitaire of Nice, Nice, France.,Cote d'Azur University, Mediterranean Center of Molecular Medicine, INSERM U1065, Nice, France
| | | | - David A Sallman
- Hematology Unit, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Rami Komrokji
- Hematology Unit, Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Sylvie Chevret
- SBIM, Hospital Saint Louis, APHP, and Paris University, Paris, France
| | - Lionel Ades
- GFM.,Hematology Department, Hospital Saint Louis, Assistance Publique des Hopitaux de Paris (APHP), and Paris University, Paris, France
| | - Pierre Fenaux
- GFM.,Hematology Department, Hospital Saint Louis, Assistance Publique des Hopitaux de Paris (APHP), and Paris University, Paris, France
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32
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Bazarbachi AH, Al Hamed R, Labopin M, Halaburda K, Labussiere H, Bernasconi P, Schroyens W, Gandemer V, Schaap NPM, Loschi M, Jindra P, Snowden J, Wu D, Guffroy B, Rovira M, Chantepie SP, Poiré X, Lopez-Corral L, Nikolousis M, Pelosini M, Ciceri F, Baron F, Bazarbachi A, Corbacioglu S, Savani BN, Peric Z, Nagler A, Carreras E, Mohty M. Underdiagnosed veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) as a major cause of multi-organ failure in acute leukemia transplant patients: an analysis from the EBMT Acute Leukemia Working Party. Bone Marrow Transplant 2020; 56:917-927. [PMID: 33208915 DOI: 10.1038/s41409-020-01135-3] [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: 07/13/2020] [Revised: 09/28/2020] [Accepted: 11/02/2020] [Indexed: 01/22/2023]
Abstract
Allogeneic hematopoietic cell transplantation (alloHCT) is a complex, potentially fatal therapy featuring a myriad of complications. Triggering event(s) of such complications vary significantly, but often a so-called "multi-organ failure" (MOF) is reported as the leading cause of death. The identification of the exact trigger of MOF is critical towards early and disease-specific intervention to improve outcome. We examined data from 202 alloHCT patients reported to have died of MOF from the EBMT registry aiming to determine their exact cause of death focusing on veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS) due to its life-threatening, often difficult to capture yet preventable nature. We identified a total of 70 patients (35%) for whom VOD/SOS could be considered as trigger for MOF and leading cause of death, among which 48 (69%) were previously undiagnosed. Multivariate analysis highlighted history of hepatic comorbidity or gentuzumab use and disease status beyond CR1 as the only significant factors predictive of VOD/SOS incidence (OR = 6.6; p = 0.001 and OR = 3.3; p = 0.004 respectively). VOD/SOS-related MOF was widely under-reported, accounting for 27% of deaths attributed to MOF of unknown origin without a previous VOD/SOS diagnosis. Our results suggest most missed cases developed late VOD/SOS beyond 21 days post-alloHCT, highlighting the importance of the newly revised EBMT criteria.
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Affiliation(s)
- Abdul Hamid Bazarbachi
- Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, INSERM UMR 938, Paris, France.,Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Rama Al Hamed
- Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, INSERM UMR 938, Paris, France.,Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,Division of Infectious Diseases, Brigham & Women's, Harvard Medical School, Boston, MA, USA
| | - Myriam Labopin
- Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, INSERM UMR 938, Paris, France
| | - Kazimierz Halaburda
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Helene Labussiere
- Département d'Hématologie, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Paolo Bernasconi
- HSCT Unit, SC Ematologia, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Virginie Gandemer
- Department of Pediatric Oncology and Haematology, University Hospital of Rennes, Rennes, France
| | | | - Michael Loschi
- Service d'hématologie, Centre Hospitalier Universitaire, 06000, Nice, France
| | - Pavel Jindra
- Department of Haematology and Oncology, University Hospital Pilsen, Pilsen, Czech Republic
| | - John Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Depei Wu
- Department of Hematology, The Collaborative Innovation Center of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Blandine Guffroy
- Department of Hematology, Hopitaux Universitaires Strasbourg, Strasbourg, France
| | - Montserrat Rovira
- BMT Unit, Department of Hematology, IDIBAPS, Hospital Clinic, Institut Josep Carreras, Barcelona, Spain
| | | | - Xavier Poiré
- Department of Hematology, Saint-Luc University Hospital, Brussels, Belgium
| | - Lucia Lopez-Corral
- Hematology Department, Complejo Asistencial Universitario de Salamanca-IBSAL; Centro de Investigación del Cáncer-IBMCC, Salamanca, Spain
| | | | | | - Fabio Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Frederic Baron
- Department of Hematology, University and CHU of Liège, 4000, Liège, Belgium
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beirut, 1107 2020, Lebanon
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Franz-Josef-Strauss-Allee 11, University Hospital of Regensburg, Regensburg, Germany
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Zinaida Peric
- Department of Hematology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Arnon Nagler
- Hematology and Bone Marrow Transplantation Division, Chaim Sheba Medical Center, Tel-HaShomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Enric Carreras
- Josep Carreras Foundation and Research Institute, Hospital Clinic/University of Barcelona Campus, Barcelona, Spain
| | - Mohamad Mohty
- Sorbonne University, Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, INSERM UMR 938, Paris, France.
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Thangavelu G, Andrejeva G, Loschi M, Aguilar EG, Lee YC, Furlan SN, McDonald-Hyman C, Zaiken MC, Feser CJ, Panoskaltsis-Mortari A, Kean LS, Rathmell JC, Chi H, Noelle RJ, Blazar BR. Divergent roles of retinoic acid signaling in T regulatory cell function. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.228.4] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Regulatory T cells (Tregs) modulate immune responses to maintain immune homeostasis. Retinoic acid (RA) signaling promotes Treg generation and stability. Paradoxically, we observed that dominant negative RA receptor α expressed only in donor T cells (DNRARαfl/flCD4Cre) dampened inflammation and graft-versus-host disease (GVHD), while increasing Tregs. We found that diminishing RA signaling significantly enhanced their in vitro suppressive capacity. In vivo the adoptive transfer of DNRARαfl/flCD4Cre Tregs at the time of transplant was significantly (p<0.01) more effective than wild type (WT) controls in ameliorating GVHD. Mechanistically, enhanced suppression was associated with elevated expression of suppressive (CTLA-4, GITR, CD39) and fitness (CD25, pSTAT5) markers. To evaluate the intrinsic requirement of RA signaling in Tregs, we generated transgenic mice with conditional DNRARα expression in Tregs (DNRARαfl/fl x Foxp3YFPCre). Surprisingly, the extent of ablation of RA signaling resulted in divergent phenotypes. Heterozygous ablation (DNRARαfl/wt) was permissive of enhanced Treg suppression. In striking contrast and unexpectedly, homozygous ablation (DNRARαfl/fl) impaired Treg suppressive function and caused multi-organ (lung, liver) autoimmunity in >90% of females and males by 3 months of age. Poor suppression is not cell intrinsic as DNRARαfl/fl Tregs isolated from mixed bone marrow chimeras of congenic WT and DNRARαfl/fl x Foxp3YFP Cre had enhanced function. Our studies indicate that RA signaling in Tregs can be targeted to prevent autoimmunity by enhancing Treg suppression or alternatively, promote antitumor responses by reducing Treg function.
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Affiliation(s)
| | - Gabriela Andrejeva
- 2Center for Immunobiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | | | | | - Yu-Chi Lee
- 3Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, NH 03756, USA
| | - Scott N Furlan
- 4Department of Immunology, University of Washington School of Medicine, Seattle, WA
| | | | | | | | | | - Leslie S Kean
- 5Boston Children’s Hospital and the Dana-Farber Cancer Institute, Boston, MA, 02115, USA
| | - Jeffrey C Rathmell
- 2Center for Immunobiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Hongbo Chi
- 6Department of Immunology, St Jude Children’s Research Hospital, Memphis
| | - Randolph J Noelle
- 3Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, NH 03756, USA
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34
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Aguilar EG, Rhee S, Thangavelu G, Loschi M, Paz K, Saha A, Ly J, Sage P, Sharpe AH, Maillard I, Murphy WJ, Serody JS, Jin S, Wagers SB, Nicholls J, Hill G, MacDonald KPA, Compeer E, Dustin M, O’Connor R, Sparwasser T, Blazar BR. Inhibiting fatty acid synthesis (FAS) can prevent and treat chronic graft versus host disease (cGVHD). The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.87.2] [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] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Abstract
GVHD remains the primary complication of allogeneic hematopoietic stem cell transplantation. Considerable interest exists in understanding how metabolism affects immune cell function. We show targeting FAS represents an attractive strategy to ameliorate cGVHD. Acetyl-CoA carboxylase 1 (ACC1) catalyzes the first step of FAS, and can be pharmacologically inhibited with either Soraphen A or 5-(Tetradecyloxy)-2-furoic acid (TOFA). FAS is critical for T cell effector responses, a finding we confirmed using an in vivo multiorgan system cGVHD model with bronchiolitis obliterans, a model dependent on germinal centers (GC), IgG2c secretion, lung deposition and fibrosis. Compared to wild type T cells, cGVHD mice receiving CD4CreACC1fl/fl allogeneic T cells had reduced cGVHD severity assessed by pulmonary function test and immune phenotyping. As thymic regulatory T cell (tTreg) infusion can prevent and treat cGVHD, we examined tTreg FAS needs. Inhibiting FAS in sorted tTreg via drug (Soraphen A; TOFA) or genetic (FoxP3CreACC1fl/fl) strategies increased oxidative and glycolytic metabolism measured by Seahorse assay, that correlated with superior in vitro suppressor function. These findings were extended in vivo where transfer of FoxP3CreACC1fl/fl tTreg, at day 28 following disease establishment, decreased cGVHD severity. Daily treatment of cGVHD mice from day 28 to day 56 with TOFA reversed cGVHD. An in vitro assay in which T follicular regulatory cells suppress T follicular helper and GC B cell class switching showed that inhibiting tTreg FAS can increase their suppression of GC responses. These data provide evidence that inhibiting FAS can prevent or treat cGVHD and enhance Treg function, providing a new approach to ameliorate cGVHD.
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Affiliation(s)
| | | | | | | | | | | | | | - Peter Sage
- 2Brigham and Women’s Hospital, Harvard medical school
| | - Arlene H Sharpe
- 3Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women’s Hospital
| | - Ivan Maillard
- 4Institute for Immunology, Perelman School of Medicine, University of Pennsylvania
| | | | - Jonathan S Serody
- 6Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | - Geoffrey Hill
- 7Clinical Research Division, Fred Hutchinson Cancer Research Center
| | | | | | | | | | - Tim Sparwasser
- 11University Medical Center of the Johannes Gutenberg-University Mainz, Germany
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35
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Field CS, Baixauli F, Kyle RL, Puleston DJ, Cameron AM, Sanin DE, Hippen KL, Loschi M, Thangavelu G, Corrado M, Edwards-Hicks J, Grzes KM, Pearce EJ, Blazar BR, Pearce EL. Mitochondrial Integrity Regulated by Lipid Metabolism Is a Cell-Intrinsic Checkpoint for Treg Suppressive Function. Cell Metab 2020; 31:422-437.e5. [PMID: 31883840 PMCID: PMC7001036 DOI: 10.1016/j.cmet.2019.11.021] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 02/07/2023]
Abstract
Regulatory T cells (Tregs) subdue immune responses. Central to Treg activation are changes in lipid metabolism that support their survival and function. Fatty acid binding proteins (FABPs) are a family of lipid chaperones required to facilitate uptake and intracellular lipid trafficking. One family member, FABP5, is expressed in T cells, but its function remains unclear. We show that in Tregs, genetic or pharmacologic inhibition of FABP5 function causes mitochondrial changes underscored by decreased OXPHOS, impaired lipid metabolism, and loss of cristae structure. FABP5 inhibition in Tregs triggers mtDNA release and consequent cGAS-STING-dependent type I IFN signaling, which induces heightened production of the regulatory cytokine IL-10 and promotes Treg suppressive activity. We find evidence of this pathway, along with correlative mitochondrial changes in tumor infiltrating Tregs, which may underlie enhanced immunosuppression in the tumor microenvironment. Together, our data reveal that FABP5 is a gatekeeper of mitochondrial integrity that modulates Treg function.
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Affiliation(s)
- Cameron S Field
- Max Planck Institute for Immunobiology and Epigenetics, 79108 Freiburg, Germany
| | - Francesc Baixauli
- Max Planck Institute for Immunobiology and Epigenetics, 79108 Freiburg, Germany
| | - Ryan L Kyle
- Max Planck Institute for Immunobiology and Epigenetics, 79108 Freiburg, Germany
| | - Daniel J Puleston
- Max Planck Institute for Immunobiology and Epigenetics, 79108 Freiburg, Germany; The Kennedy Institute of Rheumatology, University of Oxford, Oxford, OX3 7FY, UK
| | - Alanna M Cameron
- Max Planck Institute for Immunobiology and Epigenetics, 79108 Freiburg, Germany
| | - David E Sanin
- Max Planck Institute for Immunobiology and Epigenetics, 79108 Freiburg, Germany
| | - Keli L Hippen
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Michael Loschi
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Govindarajan Thangavelu
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Mauro Corrado
- Max Planck Institute for Immunobiology and Epigenetics, 79108 Freiburg, Germany
| | - Joy Edwards-Hicks
- Max Planck Institute for Immunobiology and Epigenetics, 79108 Freiburg, Germany
| | - Katarzyna M Grzes
- Max Planck Institute for Immunobiology and Epigenetics, 79108 Freiburg, Germany
| | - Edward J Pearce
- Max Planck Institute for Immunobiology and Epigenetics, 79108 Freiburg, Germany; Faculty of Biology, University of Freiburg, 79104 Freiburg, Germany
| | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Erika L Pearce
- Max Planck Institute for Immunobiology and Epigenetics, 79108 Freiburg, Germany.
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36
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Thangavelu G, Lee YC, Loschi M, Schaechter KM, Feser CJ, Koehn BH, Nowak EC, Zeiser R, Serody JS, Murphy WJ, Munn DH, Chambon P, Noelle RJ, Blazar BR. Dendritic Cell Expression of Retinal Aldehyde Dehydrogenase-2 Controls Graft-versus-Host Disease Lethality. J Immunol 2019; 202:2795-2805. [PMID: 30885956 DOI: 10.4049/jimmunol.1800899] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 02/26/2019] [Indexed: 01/11/2023]
Abstract
Recent studies have underscored the critical role of retinoic acid (RA) in the development of lineage-committed CD4 and CD8 T cells in vivo. We have shown that under acute graft-versus-host disease (GVHD) inflammatory conditions, RA is upregulated in the intestine and is proinflammatory, as GVHD lethality was attenuated when donor allogeneic T cells selectively expressed a dominant negative RA receptor α that blunted RA signaling. RA can function in an autocrine and paracrine fashion, and as such, the host cell lineage responsible for the production of RA metabolism and the specific RA-metabolizing enzymes that potentiate GVHD severity are unknown. In this study, we demonstrate that enhancing RA degradation in the host and to a lesser extent donor hematopoietic cells by overexpressing the RA-catabolizing enzyme CYP26A1 reduced GVHD. RA production is facilitated by retinaldehyde isoform-2 (RALDH2) preferentially expressed in dendritic cells (DCs). Conditionally deleted RA-synthesizing enzyme RALDH2 in host or to a lesser extent donor DCs reduced GVHD lethality. Improved survival in recipients with RALDH2-deleted DCs was associated with increased T cell death, impaired T effector function, increased regulatory T cell frequency, and augmented coinhibitory molecule expression on donor CD4+ T cells. In contrast, retinaldehydrogenase isoform-1 (RALDH1) is dominantly expressed in intestinal epithelial cells. Unexpectedly, conditional host intestinal epithelial cells RALDH1 deletion failed to reduce GVHD. These data demonstrate the critical role of both donor and especially host RALDH2+ DCs in driving murine GVHD and suggest RALDH2 inhibition or CYP26A1 induction as novel therapeutic strategies to prevent GVHD.
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Affiliation(s)
- Govindarajan Thangavelu
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455
| | - Yu-Chi Lee
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, NH 03756
| | - Michael Loschi
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455
| | - K Melanie Schaechter
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455
| | - Colby J Feser
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455
| | - Brent H Koehn
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455
| | - Elizabeth C Nowak
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, NH 03756
| | - Robert Zeiser
- Department of Hematology, Oncology and Stem Cell Transplantation, University Medical Center, Albert Ludwig University of Freiburg, 79106 Freiburg, Germany
| | - Jonathan S Serody
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 79106
| | - William J Murphy
- Department of Dermatology, Center for Comparative Medicine, University of California, Davis School of Medicine, Sacramento, CA 95817
| | - David H Munn
- Department of Pediatrics, Georgia Health Sciences University, Augusta, GA 30912; and
| | - Pierre Chambon
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, CNRS UMR7104, INSERM U964, 67404 Illkirch Cedex, France
| | - Randolph J Noelle
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, NH 03756
| | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455;
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Yang J, Ramadan A, Reichenbach DK, Loschi M, Zhang J, Griesenauer B, Liu H, Hippen KL, Blazar BR, Paczesny S. Rorc restrains the potency of ST2+ regulatory T cells in ameliorating intestinal graft-versus-host disease. JCI Insight 2019; 4:122014. [PMID: 30694220 DOI: 10.1172/jci.insight.122014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 01/25/2019] [Indexed: 01/19/2023] Open
Abstract
Soluble stimulation-2 (ST2) is increased during graft-versus-host disease (GVHD), while Tregs that express ST2 prevent GVHD through unknown mechanisms. Transplantation of Foxp3- T cells and Tregs that were collected and sorted from different Foxp3 reporter mice indicated that in mice that developed GVHD, ST2+ Tregs were thymus derived and predominantly localized to the intestine. ST2-/- Treg transplantation was associated with reduced total intestinal Treg frequency and activation. ST2-/- versus WT intestinal Treg transcriptomes showed decreased Treg functional markers and, reciprocally, increased Rorc expression. Rorc-/- T cells transplantation enhanced the frequency and function of intestinal ST2+ Tregs and reduced GVHD through decreased gut-infiltrating soluble ST2-producing type 1 and increased IL-4/IL-10-producing type 2 T cells. Cotransfer of ST2+ Tregs sorted from Rorc-/- mice with WT CD25-depleted T cells decreased GVHD severity and mortality, increased intestinal ST2+KLRG1+ Tregs, and decreased type 1 T cells after transplantation, indicating an intrinsic mechanism. Ex vivo IL-33-stimulated Tregs (TregIL-33) expressed higher amphiregulin and displayed better immunosuppression, and adoptive transfer prevented GVHD better than control Tregs or TregIL-33 cultured with IL-23/IL-17. Amphiregulin blockade by neutralizing antibody in vivo abolished the protective effect of TregIL-33. Our data show that inverse expression of ST2 and RORγt in intestinal Tregs determines GVHD and that TregIL-33 has potential as a cellular therapy avenue for preventing GVHD.
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Affiliation(s)
- Jinfeng Yang
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Abdulraouf Ramadan
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dawn K Reichenbach
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael Loschi
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jilu Zhang
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brad Griesenauer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Hong Liu
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Keli L Hippen
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bruce R Blazar
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sophie Paczesny
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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38
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Priyadharshini B, Loschi M, Newton RH, Zhang JW, Finn KK, Gerriets VA, Huynh A, Rathmell JC, Blazar BR, Turka LA. Cutting Edge: TGF-β and Phosphatidylinositol 3-Kinase Signals Modulate Distinct Metabolism of Regulatory T Cell Subsets. J Immunol 2018; 201:2215-2219. [PMID: 30209190 DOI: 10.4049/jimmunol.1800311] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/19/2018] [Indexed: 01/25/2023]
Abstract
Murine Foxp3+ regulatory T cells (Tregs) differentiated in vitro (induced Tregs [iTregs]) in the presence of anti-inflammatory cytokine TGF-β rely predominantly upon lipid oxidation to fuel mitochondrial oxidative phosphorylation. Foxp3 expression underlies this metabolic preference, as it suppresses glycolysis and drives oxidative phosphorylation. In this study, we show that in contrast to iTregs, thymic-derived Tregs (tTregs), engage in glycolysis and glutaminolysis at levels comparable to effector T cells despite maintained Foxp3 expression. Interestingly, exposure of tTregs to the anti-inflammatory cytokine TGF-β represses PI3K-mediated mTOR signaling, inhibits glucose transporter and Hk2 expression, and reprograms their metabolism to favor oxidative phosphorylation. Conversely, replicating the effects of inflammation via elevation of PI3K signaling has minimal effects on tTregs but dramatically enhances the glycolysis of normally oxidative iTregs, resulting in reduction of Foxp3 expression. Collectively, these findings suggest both extrinsic and intrinsic factors govern the unique metabolic signature of Treg subsets.
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Affiliation(s)
- Bhavana Priyadharshini
- Department of Surgery and Center for Transplantation Sciences; Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129
| | - Michael Loschi
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455
| | - Ryan H Newton
- Department of Surgery and Center for Transplantation Sciences; Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129
| | - Jian-Wen Zhang
- Department of Surgery and Center for Transplantation Sciences; Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129.,Department of Liver Transplantation, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510630, People's Republic of China
| | - Kelsey K Finn
- Department of Surgery and Center for Transplantation Sciences; Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129
| | - Valerie A Gerriets
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN 37232; and
| | - Alexandria Huynh
- Department of Surgery and Center for Transplantation Sciences; Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129
| | - Jeffery C Rathmell
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN 37232; and
| | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455
| | - Laurence A Turka
- Department of Surgery and Center for Transplantation Sciences; Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129; .,Rheos Medicines, Cambridge, MA 02139
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39
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McDonald-Hyman C, Muller JT, Loschi M, Thangavelu G, Saha A, Kumari S, Reichenbach DK, Smith MJ, Zhang G, Koehn BH, Lin J, Mitchell JS, Fife BT, Panoskaltsis-Mortari A, Feser CJ, Kirchmeier AK, Osborn MJ, Hippen KL, Kelekar A, Serody JS, Turka LA, Munn DH, Chi H, Neubert TA, Dustin ML, Blazar BR. The vimentin intermediate filament network restrains regulatory T cell suppression of graft-versus-host disease. J Clin Invest 2018; 128:4604-4621. [PMID: 30106752 DOI: 10.1172/jci95713] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/26/2018] [Indexed: 01/04/2023] Open
Abstract
Regulatory T cells (Tregs) are critical for maintaining immune homeostasis. However, current Treg immunotherapies do not optimally treat inflammatory diseases in patients. Understanding the cellular processes that control Treg function may allow for the augmentation of therapeutic efficacy. In contrast to activated conventional T cells, in which protein kinase C-θ (PKC-θ) localizes to the contact point between T cells and antigen-presenting cells, in human and mouse Tregs, PKC-θ localizes to the opposite end of the cell in the distal pole complex (DPC). Here, using a phosphoproteomic screen, we identified the intermediate filament vimentin as a PKC-θ phospho target and show that vimentin forms a DPC superstructure on which PKC-θ accumulates. Treatment of mouse Tregs with either a clinically relevant PKC-θ inhibitor or vimentin siRNA disrupted vimentin and enhanced Treg metabolic and suppressive activity. Moreover, vimentin-disrupted mouse Tregs were significantly better than controls at suppressing alloreactive T cell priming in graft-versus-host disease (GVHD) and GVHD lethality, using a complete MHC-mismatch mouse model of acute GVHD (C57BL/6 donor into BALB/c host). Interestingly, vimentin disruption augmented the suppressor function of PKC-θ-deficient mouse Tregs. This suggests that enhanced Treg activity after PKC-θ inhibition is secondary to effects on vimentin, not just PKC-θ kinase activity inhibition. Our data demonstrate that vimentin is a key metabolic and functional controller of Treg activity and provide proof of principle that disruption of vimentin is a feasible, translationally relevant method to enhance Treg potency.
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Affiliation(s)
- Cameron McDonald-Hyman
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.,The Center for Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - James T Muller
- Skirball Institute of Biomolecular Medicine, and Department of Cell Biology, NYU School of Medicine, New York, New York, USA
| | - Michael Loschi
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.,The Center for Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Govindarajan Thangavelu
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.,The Center for Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Asim Saha
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.,The Center for Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Sudha Kumari
- Skirball Institute of Biomolecular Medicine, and Department of Cell Biology, NYU School of Medicine, New York, New York, USA
| | - Dawn K Reichenbach
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.,The Center for Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michelle J Smith
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.,The Center for Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Guoan Zhang
- Skirball Institute of Biomolecular Medicine, and Department of Cell Biology, NYU School of Medicine, New York, New York, USA
| | - Brent H Koehn
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.,The Center for Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jiqiang Lin
- Skirball Institute of Biomolecular Medicine, and Department of Cell Biology, NYU School of Medicine, New York, New York, USA
| | - Jason S Mitchell
- The Center for Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA.,Division of Rheumatology, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Brian T Fife
- The Center for Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA.,Division of Rheumatology, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Angela Panoskaltsis-Mortari
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Colby J Feser
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew Kemal Kirchmeier
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Mark J Osborn
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Keli L Hippen
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ameeta Kelekar
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonathan S Serody
- Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Laurence A Turka
- Center for Transplantation Sciences, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David H Munn
- Department of Pediatrics, Georgia Health Sciences University, Augusta, Georgia, USA
| | - Hongbo Chi
- Department of Immunology, Saint Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Thomas A Neubert
- Skirball Institute of Biomolecular Medicine, and Department of Cell Biology, NYU School of Medicine, New York, New York, USA
| | - Michael L Dustin
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA.,The Center for Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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40
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Pennell CA, Barnum JL, McDonald-Hyman CS, Panoskaltsis-Mortari A, Riddle MJ, Xiong Z, Loschi M, Thangavelu G, Campbell HM, Storlie MD, Refaeli Y, Furlan SN, Jensen MC, Kean LS, Miller JS, Tolar J, Osborn MJ, Blazar BR. Human CD19-Targeted Mouse T Cells Induce B Cell Aplasia and Toxicity in Human CD19 Transgenic Mice. Mol Ther 2018; 26:1423-1434. [PMID: 29735365 PMCID: PMC5986973 DOI: 10.1016/j.ymthe.2018.04.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 01/28/2023] Open
Abstract
The clinical success of chimeric antigen receptor (CAR) T cell therapy for CD19+ B cell malignancies can be limited by acute toxicities and immunoglobulin replacement needs due to B cell aplasia from persistent CAR T cells. Life-threatening complications include cytokine release syndrome and neurologic adverse events, the exact etiologies of which are unclear. To elucidate the underlying toxicity mechanisms and test potentially safer CAR T cells, we developed a mouse model in which human CD19 (hCD19)-specific mouse CAR T cells were adoptively transferred into mice whose normal B cells express a hCD19 transgene at hemizygous levels. Compared to homozygous hCD19 transgenic mice that have ∼75% fewer circulating B cells, hemizygous mice had hCD19 frequencies and antigen density more closely simulating human B cells. Hemizygous mice given a lethal dose of hCD19 transgene-expressing lymphoma cells and treated with CAR T cells had undetectable tumor levels. Recipients experienced B cell aplasia and antigen- and dose-dependent acute toxicities mirroring patient complications. Interleukin-6 (IL-6), interferon γ (IFN-γ), and inflammatory pathway transcripts were enriched in affected tissues. As in patients, antibody-mediated neutralization of IL-6 (and IFN-γ) blunted toxicity. Apparent behavioral abnormalities associated with decreased microglial cells point to CAR-T-cell-induced neurotoxicity. This model will prove useful in testing strategies designed to improve hCD19-specific CAR T cell safety.
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Affiliation(s)
- Christopher A Pennell
- Department of Laboratory Medicine and Pathology, Masonic Cancer Center, Center for Immunology, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Jessie L Barnum
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Cameron S McDonald-Hyman
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Angela Panoskaltsis-Mortari
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Megan J Riddle
- Stem Cell Institute, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Zhengming Xiong
- Division of Hematology and Oncology, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Michael Loschi
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Govindarajan Thangavelu
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Heather M Campbell
- Department of Laboratory Medicine and Pathology, Masonic Cancer Center, Center for Immunology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Meghan D Storlie
- Department of Laboratory Medicine and Pathology, Masonic Cancer Center, Center for Immunology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Yosef Refaeli
- Department of Dermatology, University of Colorado, Aurora, CO 80045, USA
| | - Scott N Furlan
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, The Ben Towne Center for Childhood Cancer, The Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98101, USA
| | - Michael C Jensen
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, The Ben Towne Center for Childhood Cancer, The Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98101, USA
| | - Leslie S Kean
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, The Ben Towne Center for Childhood Cancer, The Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA 98101, USA
| | - Jeffrey S Miller
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jakub Tolar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA; Stem Cell Institute, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Mark J Osborn
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Bruce R Blazar
- Division of Blood and Marrow Transplantation, Department of Pediatrics, Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
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41
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Hippen KL, Loschi M, Nicholls J, MacDonald KPA, Blazar BR. Effects of MicroRNA on Regulatory T Cells and Implications for Adoptive Cellular Therapy to Ameliorate Graft-versus-Host Disease. Front Immunol 2018; 9:57. [PMID: 29445371 PMCID: PMC5797736 DOI: 10.3389/fimmu.2018.00057] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 01/09/2018] [Indexed: 01/15/2023] Open
Abstract
Regulatory T cells (Tregs) are key mediators of the immune system. MicroRNAs (miRNAs) are a family of ~22 nucleotide non-coding RNAs that are processed from longer precursors by the RNases Drosha and Dicer. miRNA regulates protein expression posttranscriptionally through mRNA destabilization or translational silencing. A critical role for miRNA in Treg function was initially discovered when both Dicer and Drosha knockout (KO) mice were found to develop a fatal autoimmune disease phenotypically similar to Foxp3 KO mice.
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Affiliation(s)
- Keli L Hippen
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota Cancer Center, Minneapolis, MN, United States
| | - Michael Loschi
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota Cancer Center, Minneapolis, MN, United States
| | - Jemma Nicholls
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota Cancer Center, Minneapolis, MN, United States
| | - Kelli P A MacDonald
- The Antigen Presentation and Immunoregulation Laboratory and Bone Marrow Transplantation Laboratory, QIMR Berghofer Medical Research Institute, University of Minnesota Cancer Center, Brisbane, QLD, Australia
| | - Bruce R Blazar
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota Cancer Center, Minneapolis, MN, United States
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42
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Wang L, Raffoux E, Thomas X, Yakoub-Agha I, Bouhris JH, de Botton S, Michallet M, Quoc SN, Chantepie S, Deconinck E, Caillot D, Turlure P, Vigouroux S, Pigneux A, Huynh A, Malfuson JV, Loschi M, Socie G, Dombret H, de la Tour RP, Cluzeau T. Immune stimulation during chemotherapy increases incidence of acute graft versus host disease in acute myeloid leukemia: A study on behalf of SFGM-TC and ALFA. Leuk Res 2017; 54:12-16. [PMID: 28088653 DOI: 10.1016/j.leukres.2017.01.002] [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: 11/23/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
Abstract
60-70% of AML patients have an indication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) during their treatment. Graft versus host disease (GvHD), the major cause of mortality and comorbidities post-transplantation, develops by immunological mechanism and decides greatly prognosis and quality of life (QoL) of graft recipient. Current GvHD prophylaxis is not personalized. Infections, toxicities and leukemic infiltration complicate the first chemotherapy phases prior to allo-HSCT. They, to certain extent, induce local immune stimulation. Impact of immune stimulation of this period on incidence of GvHD has not been evaluated. We retrospectively studied 238 AML patients transplanted at first remission from 21 French centers in the ALFA-0702 protocol and found that cutaneous and digestive immune stimulation during induction increases the incidence of skin and gut aGVHD, respectively. Furthermore, prolonged febrile duration correlates with elevated incidence of grade II-IV aGvHD. Thus, we identified a group of patients with higher risk of aGvHD. The benefit of personalized GvHD prophylaxis should be explored in a prospective cohort to decrease incidence of aGvHD in these patients and improve their QoLs.
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Affiliation(s)
- Lining Wang
- Saint Louis Hospital, Hematology Department, Paris, France; Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Saint Louis Hospital, Stem Cell Transplantation Unit, Paris, France
| | | | - Xavier Thomas
- Centre hospitalier Lyon Sud, Hematology Department, Lyon, France
| | | | | | | | | | | | - Sylvain Chantepie
- Institut d'Hématologie de Basse-Normandie, Bâtiment Sud Avenue Côte de Nacre, Caen, France
| | | | | | | | - Stéphane Vigouroux
- CHU Bordeaux, Haut Leveque Hospital, Hematology Department, Pessac, France
| | - Arnaud Pigneux
- CHU Bordeaux, Haut Leveque Hospital, Hematology Department, Pessac, France
| | - Anne Huynh
- CHU Toulouse, Hematology Department, Toulouse, France
| | | | - Michael Loschi
- Centre Henri Becquerel, Hematology Department, Rouen, France
| | - Gerard Socie
- Saint Louis Hospital, Stem Cell Transplantation Unit, Paris, France
| | - Hervé Dombret
- Saint Louis Hospital, Hematology Department, Paris, France
| | | | - Thomas Cluzeau
- Saint Louis Hospital, Hematology Department, Paris, France; Mediterranean Center of Molecular Medicine, INSERM U1065, Nice, France.
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Loschi M, Porcher R, Barraco F, Terriou L, Mohty M, de Guibert S, Mahe B, Lemal R, Dumas PY, Etienne G, Jardin F, Royer B, Bordessoule D, Rohrlich PS, Fornecker LM, Salanoubat C, Maury S, Cahn JY, Vincent L, Sene T, Rigaudeau S, Nguyen S, Lepretre AC, Mary JY, Corront B, Socie G, Peffault de Latour R. Impact of eculizumab treatment on paroxysmal nocturnal hemoglobinuria: a treatment versus no-treatment study. Am J Hematol 2016; 91:366-70. [PMID: 26689746 DOI: 10.1002/ajh.24278] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/10/2015] [Accepted: 12/15/2015] [Indexed: 12/21/2022]
Abstract
Intravascular hemolysis in Paroxysmal nocturnal hemoglobinuria (PNH) can effectively be controlled with eculizumab, a humanized monoclonal antibody that binds complement protein C5. We report here a retrospective comparison study between 123 patients treated with eculizumab in the recent period (>2005) and 191 historical controls (from the French registry). Overall survival (OS) at 6 years was 92% (95%CI, 87 to 98) in the eculizumab cohort versus 80% (95%CI 70 to 91) in historical controls diagnosed after 1985 (HR 0.38 [0.15 to 0.94], P = 0.037). There were significantly fewer thrombotic events (TEs) in the group of patients treated with eculizumab (4% [1-10]) as compared to the historical cohort (27% [20-34]). However, we found that TEs may still occur after the initiation of eculizumab treatment and that previous TEs still have a negative impact on survival. Evolutions to myelodysplastic syndrome or acute leukemia were similar in both cohorts. There was less evolution to aplastic anemia in the treatment group. In multivariate analysis, absence of a previous TE and treatment with eculizumab were associated with a better OS. Treatment with eculizumab improves overall survival in classic PNH patients without increasing the risk of clonal evolution.
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Affiliation(s)
- Michael Loschi
- Hematology-Transplantation Department; AP-HP, Saint-Louis Hospital; Paris France
- Hematology Department; Centre Henri BECQUEREL; Rouen France
| | - Raphael Porcher
- Center for Clinical Epidemiology; AP-HP, Hotel-Dieu Hospital, Inserm U1153, University Paris Descartes; Paris France
| | - Fiorenza Barraco
- Hematology Department; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - Louis Terriou
- Hematology Department; Hôpital Claude Huriez; Lille France
| | - Mohamad Mohty
- Hematology Department; AP-HP, Saint Antoine Hospital; Paris France
| | - Sophie de Guibert
- Hematology Department; University Hospital Pontchaillou; Rennes France
| | - Beatrice Mahe
- Hematology Department; University Hospital; Nantes France
| | - Richard Lemal
- Hematology Department; University Hospital; Clermont Ferrand France
| | | | - Gabriel Etienne
- Hematology Department; Groupe Hospitalier Sud; Pessac France
| | - Fabrice Jardin
- Hematology Department; Centre Henri BECQUEREL; Rouen France
| | - Bruno Royer
- Hematology Department; University Hospital Amiens Sud; Amiens France
| | | | | | | | | | - Sebastien Maury
- Hematology Department; AP-HP, Henri-Mondor Hospital; Créteil France
| | - Jean-Yves Cahn
- Hematology Department; University Hospital; Grenoble France
| | - Laure Vincent
- Hematology Department; University Hospital; Montpellier France
| | - Thomas Sene
- Internal Medicine Department; Foch Hospital; Paris France
| | | | - Stephanie Nguyen
- Hematology Department; AP-HP, Pitié Salpetriere Hospital; Paris France
| | - Anne-Claire Lepretre
- Transfusion Department; Etablissement Français Du Sang, Site Saint-Louis; Paris France
| | - Jean-Yves Mary
- Statistics; AP-HP, Saint-Louis Hospital, Inserm U1153; Paris France
- Sorbonne Paris Cité; University Paris Diderot; Paris France
| | | | - Gerard Socie
- Hematology-Transplantation Department; AP-HP, Saint-Louis Hospital; Paris France
- Sorbonne Paris Cité; University Paris Diderot; Paris France
| | - Regis Peffault de Latour
- Hematology-Transplantation Department; AP-HP, Saint-Louis Hospital; Paris France
- Sorbonne Paris Cité; University Paris Diderot; Paris France
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Loschi M, Thill C, Gray C, David M, Bagatha MF, Chamseddine A, Contentin N, Jardin F, Lanic H, Lemasle E, Lenain P, Stamatoullas A, Tilly H, Lepretre S. Invasive aspergillosis in neutropenic patients during hospital renovation: effectiveness of mechanical preventive measures in a prospective cohort of 438 patients. Mycopathologia 2015; 179:337-45. [PMID: 25637199 DOI: 10.1007/s11046-015-9865-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/20/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Aspergillus species are the main cause of invasive fungal disease for patients with severe and prolonged neutropenia. Building or renovation works have been shown as one of the major causes of outbreaks of aspergillosis. OBJECTIVES This study aimed to assess the effectiveness of introduction and adaptation by air sampling of mechanical preventive measures on the incidence of invasive pulmonary aspergillosis in neutropenic patients during hospital renovation. PATIENTS All of the patients admitted for prolonged and severe neutropenia during a renovation period from 2003 to 2008 were prospectively enrolled. Invasive pulmonary aspergillosis (IPA) cases were classified as possible, probable, and proven, according to the 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group criteria. The effectiveness of preventive measures was determined by air sampling. RESULTS We recorded 705 hospitalizations for neutropenia concerning 438 patients. The majority of hospitalized neutropenic patients was treated for acute leukemia (38.3 %), followed by patients suffering from non-Hodgkin and Hodgkin lymphomas (33 %). The total cumulative incidence of probable and proven IPA was 4.1 %. Risk factors for developing IPA were underlying disease, treatment course at the time of hospitalization, and the mean duration of hospitalization and of neutropenia. CONCLUSIONS In this prospective study, the incidence of invasive pulmonary aspergillosis did not increase in neutropenic patients during a renovation period because of efficient mechanical preventive measures systematically adjusted using the results of air sampling.
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Affiliation(s)
- Michael Loschi
- Department of Hematology, Centre Henri Becquerel, 1 rue d'Amiens, 76000, Rouen, France
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Bastard AS, Loschi M, Figeac M, Penther D, Callat M, Lepretre S, Lenain P, Contentin N, Tilly H, Bastard C. 282 Familial myelodysplastic syndrome/acute myeloid leukemia (MDS/AML): Report of 2 families. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70284-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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