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Ghesquières H, Cherblanc F, Belot A, Micon S, Bouabdallah KK, Esnault C, Fornecker LM, Thokagevistk K, Bonjour M, Bijou F, Haioun C, Morineau N, Ysebaert L, Damaj G, Tessoulin B, Guidez S, Morschhauser F, Thiéblemont C, Chauchet A, Gressin R, Jardin F, Fruchart C, Labouré G, Fouillet L, Lionne-Huyghe P, Bonnet A, Lebras L, Amorim S, Leyronnas C, Olivier G, Guieze R, Houot R, Launay V, Drénou B, Fitoussi O, Detourmignies L, Abraham J, Soussain C, Lachenal F, Pica GM, Fogarty P, Cony-Makhoul P, Bernier A, Le Guyader-Peyrou S, Monnereau A, Boissard F, Rossi C, Camus V. Challenges for quality and utilization of real-world data for diffuse large B-cell lymphoma in REALYSA, a LYSA cohort. Blood Adv 2024; 8:296-308. [PMID: 37874913 PMCID: PMC10824688 DOI: 10.1182/bloodadvances.2023010798] [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: 05/30/2023] [Revised: 09/05/2023] [Accepted: 10/01/2023] [Indexed: 10/26/2023] Open
Abstract
ABSTRACT Real-world data (RWD) are essential to complement clinical trial (CT) data, but major challenges remain, such as data quality. REal world dAta in LYmphoma and Survival in Adults (REALYSA) is a prospective noninterventional multicentric cohort started in 2018 that included patients newly diagnosed with lymphoma in France. Herein is a proof-of-concept analysis on patients with first-line diffuse large B-cell lymphoma (DLBCL) to (1) evaluate the capacity of the cohort to provide robust data through a multistep validation process; (2) assess the consistency of the results; and (3) conduct an exploratory transportability assessment of 2 recent phase 3 CTs (POLARIX and SENIOR). The analysis population comprised 645 patients with DLBCL included before 31 March 2021 who received immunochemotherapy and for whom 3589 queries were generated, resulting in high data completeness (<4% missing data). Median age was 66 years, with mostly advanced-stage disease and high international prognostic index (IPI) score. Treatments were mostly rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone (R-CHOP 75%) and reduced dose R-CHOP (13%). Estimated 1-year event-free survival (EFS) and overall survival rates were 77.9% and 90.0%, respectively (median follow-up, 9.9 months). Regarding transportability, when applying the CT's main inclusion criteria (age, performance status, and IPI), outcomes seemed comparable between patients in REALYSA and standard arms of POLARIX (1-year progression-free survival 79.8% vs 79.8%) and SENIOR (1-year EFS, 64.5% vs 60.0%). With its rigorous data validation process, REALYSA provides high-quality RWD, thus constituting a platform for numerous scientific purposes. The REALYSA study was registered at www.clinicaltrials.gov as #NCT03869619.
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Affiliation(s)
- Hervé Ghesquières
- Department of Hematology, Hopital Lyon Sud, Claude Bernard Lyon 1 University, Pierre Benite, France
| | - Fanny Cherblanc
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Aurélien Belot
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | | | - Krimo K. Bouabdallah
- Hematology and Cell Therapy Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Luc-Matthieu Fornecker
- Institut de Cancérologie Strasbourg Europe (ICANS) and University of Strasbourg, Strasbourg, France
| | | | - Maxime Bonjour
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Fontanet Bijou
- Department of Hematology, Institut Bergonie, Bordeaux, France
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Assistante Publique Hôpitaux de Paris APHP, Hopital Henri Mondor, Creteil, France
| | - Nadine Morineau
- Department of Hematology, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Loïc Ysebaert
- Institut universitaire du cancer de Toulouse Oncopole, Toulouse, France
| | - Gandhi Damaj
- Hematology Institute of Basse Normandie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Benoit Tessoulin
- Department of Hematology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Stéphanie Guidez
- Department of Hematology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Franck Morschhauser
- Department of Hematology, Universite de Lille, Centre Hospitalier Universitaire de Lille, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Catherine Thiéblemont
- Université Paris Cité, Assistante Publique Hôpitaux de Paris, Hôpital Saint-Louis, Service d’Hémato-Oncologie, Paris, France
| | - Adrien Chauchet
- Department of Hematology, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Rémy Gressin
- Department of Hematology, Centre Hospitalier Universitaire de Grenoble, Institute for Advanced Biosciences, INSERM U1209/CNRS UMR 5309/Grenoble Alpes University, Grenoble, France
| | - Fabrice Jardin
- Department of Clinical Hematology, INSERM U1245 Unit, Centre Henri Becquerel, Rouen, France
| | | | - Gaëlle Labouré
- Deparment of Hematology, Centre Hospitalier de Libourne, Libourne, France
| | - Ludovic Fouillet
- Department of Hematology, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
| | | | - Antoine Bonnet
- Department of Hematology, Centre Hospitalier de Bretagne Atlantique, Vannes, France
| | - Laure Lebras
- Department of Hematology, Leon Berard Cancer Center, Lyon, France
| | - Sandy Amorim
- Department of Hematology, Hopital Saint Vincent de Paul, Lille, France
| | - Cécile Leyronnas
- Department of Hematology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Gaelle Olivier
- Department of Hematology, Centre Hospitalier de Niort, Niort, France
| | - Romain Guieze
- Department of Hematology, Centre Hospitalier Universitaire de Clermont Ferrand, Clermont Ferrand, France
| | - Roch Houot
- Department of Hematology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Vincent Launay
- Department of Hematology, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Bernard Drénou
- Department Hematology, Groupe Hospitalier Mulhouse Sud Alsace, Mulhouse, France
| | - Olivier Fitoussi
- Department of Hematology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | - Julie Abraham
- Department of Hematology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Carole Soussain
- Department of Hematology, Institut Curie, Saint-Cloud, France
| | - Florence Lachenal
- Department of Hematology, Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France
| | - Gian Matteo Pica
- Department of Hematology, Centre Hospitalier Metropole Savoie, Chambery, France
| | - Patrick Fogarty
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Pascale Cony-Makhoul
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Adeline Bernier
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Sandra Le Guyader-Peyrou
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonié, University of Bordeaux, Inserm, Team EPICENE, Bordeaux, France
| | - Alain Monnereau
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonié, University of Bordeaux, Inserm, Team EPICENE, Bordeaux, France
| | | | - Cédric Rossi
- Department of Hematology, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
| | - Vincent Camus
- Department of Clinical Hematology, INSERM U1245 Unit, Centre Henri Becquerel, Rouen, France
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Carras S, Torroja A, Emadali A, Montaut E, Daguindau N, Tempescul A, Moreau A, Tchernonog E, Schmitt A, Houot R, Dartigeas C, Barbieux S, Corm S, Banos A, Fouillet L, Dupuis J, Macro M, Fleury J, Jardin F, Sarkozy C, Damaj G, Feugier P, Fornecker LM, Chabrot C, Dorvaux V, Bouabdallah K, Amorim S, Garidi R, Voillat L, Joly B, Morineau N, Moles MP, Zerazhi H, Fontan J, Arkam Y, Alexis M, Delwail V, Vilque JP, Ysebaert L, Burroni B, Callanan M, Le Gouill S, Gressin R. Long-term analysis of the RiBVD phase II trial reveals the unfavorable impact of TP53 mutations and hypoalbuminemia in older adults with mantle cell lymphoma; for the LYSA group. Haematologica 2023. [PMID: 38031755 DOI: 10.3324/haematol.2023.283724] [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: 06/29/2023] [Indexed: 12/01/2023] Open
Abstract
Between 2011 and 2012, a phase II trial evaluated the use of the RiBVD (Rituximab, Bendamustine, Velcade and Dexamethasone) combination as first-line treatment for mantle cell lymphoma (MCL) patients aged over 65. We have now re-examined the classic prognostic factors, adding an assessment of the mutation status of TP53. Patients (n=74; median age 73 years) were treated with the RiBVD combination. Median Progression Free Survival (mPFS) was 79 months, and median Overall Survival (mOS) was 111 months. TP53 mutation status was available for 54/74 (73%) patients. TP53 mutations (TP53mt) were found in 12 patients (22.2%). In multivariate analysis, among the prognostic factors (PF) evaluated, only TP53mt and an albumin level below 3.6 g/dL (Alb<3.6 g/dL) were independently associated with a shorter mPFS. A hazard ratio (HR) of 3.16 (1.3-9.9, p=0.014) was obtained for TP53mt versus TP53wt, and 3.6 (1.39-9.5, p=0.009) for Alb<3.6 g/dL vs Alb≥3.6 g/dL. In terms of mOS, multivariate analysis identified three PFs: TP53mt (HR: 5.9 (1.77-19.5, p=0.004)), Alb<3.6 g/dL (HR: 5.2 (1.46-18.5, p=0.011)), and ECOG=2 (HR: 3.7 (1.31-10.6, p=0.014)). Finally, a score combining TP53 status and albumin level distinguished three populations based on the presence of 0, 1, or 2 PF. For these populations, mPFS was 7.8 years, 28 months and 2.5 months, respectively. Our prolonged follow-up confirmed the efficacy of the RiBVD regimen, comparing it favorably to other regimens. TP53mt and hypoalbuminemia emerge as strong PF that can be easily integrated into prognostic scores for older adult patients with MCL.
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Affiliation(s)
- Sylvain Carras
- Univ. Grenoble Alpes. University Hospital, Grenoble France, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Molecular biology department; Univ. Grenoble Alpes. University Hospital, Grenoble France, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Oncohematology department
| | - Alexia Torroja
- Univ. Grenoble Alpes. University Hospital, Grenoble France, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Oncohematology department
| | - Anouk Emadali
- Univ. Grenoble Alpes. University Hospital, Grenoble France, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Research and innovation unit
| | - Emilie Montaut
- Univ. Grenoble Alpes. University Hospital, Grenoble France, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Research and innovation unit
| | | | | | - Anne Moreau
- Pathology Department, University Hospital, Nantes
| | | | - Anna Schmitt
- Hematology Department, Cancerology Institute Bergonie, Bordeaux
| | - Roch Houot
- Hematology Department, University Hospital, Rennes
| | | | | | | | - Anne Banos
- Hematology Department, Bayonne Cote Basque Hospital
| | | | - Jehan Dupuis
- Lymphoid malignancies Unit, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil
| | | | - Joel Fleury
- Hematology Department, Cancerology Institute, Clermont-Ferrand
| | | | | | - Ghandi Damaj
- Hematology Department, University Hospital, Caen
| | | | | | - Cecile Chabrot
- Hematology Department, University Hospital, Clermont-Ferrand
| | | | | | - Sandy Amorim
- Hematology and cellular therapy Department, Hospital Saint Vincent de Paul, Université catholique de Lille
| | - Reda Garidi
- Hematology Department, Hospital Saint Quentin
| | | | | | | | | | | | - Jean Fontan
- Hematology Department, University Hospital, Besançon
| | | | | | - Vincent Delwail
- Onco-Hematology Department, University Hospital Poitiers and INSERM, CIC 1402, University of Poitiers
| | | | - Loic Ysebaert
- Institut universitaire du cancer de Toulouse Oncopole
| | - Barbara Burroni
- Assistance Publique - Hôpitaux de Paris (APHP), Hôpital Cochin, Department of Pathology; Centre de Recherche des Cordeliers, Sorbonne University, Inserm, UMRS 1138, Université Paris Cité, F-75006 Paris
| | - Mary Callanan
- Unit For Innovation in Genetics and Epigenetics and Oncology. Dijon University Hospital
| | | | - Rémy Gressin
- Univ. Grenoble Alpes. University Hospital, Grenoble France, Institute For Advanced Biosciences (INSERM U1209, CNRS UMR 5309, UGA), Oncohematology department
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Al Tabaa Y, Casasnovas RO, Baillet C, Bachy E, Nicolas-Virelizier E, Schiano De colella JM, Bailly C, Kanoun S, Guidez S, Gyan E, Gressin R, Morineau N, Ysebaert L, Le Gouill S, Tilly H, Houot R, Morschhauser F, Cartron G, Herbaux C. Prospective evaluation of lymphoma response to immunomodulatory therapy criteria in GATA trial from the LYSA group. Blood Adv 2023; 7:3735-3738. [PMID: 37067945 PMCID: PMC10368761 DOI: 10.1182/bloodadvances.2023009911] [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: 02/03/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023] Open
Affiliation(s)
| | - Rene Oliver Casasnovas
- Hematology, Le Centre Hospitalier Universitaire (CHU) François Mitterrand, Dijon, France
| | | | | | | | | | | | - Salim Kanoun
- Team 9, Centre de Recherche Clinique de Toulouse, Toulouse, France
| | | | - Emmanuel Gyan
- Hematology and cell therapy Department, CIC INSERM U1415, CHU Tours, University of Tours, Tours, France
| | | | | | | | | | - Herve Tilly
- Hematology, Centre Henri Becquerel, Rouen, France
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4
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Cartron G, Bachy E, Tilly H, Daguindau N, Pica GM, Bijou F, Mounier C, Clavert A, Damaj GL, Slama B, Casasnovas O, Houot R, Bouabdallah K, Sibon D, Fitoussi O, Morineau N, Herbaux C, Gastinne T, Fornecker LM, Haioun C, Launay V, Araujo C, Benbrahim O, Sanhes L, Gressin R, Gonzalez H, Morschhauser F, Ternant D, Xerri L, Tarte K, Pranger D. Randomized Phase III Trial Evaluating Subcutaneous Rituximab for the First-Line Treatment of Low-Tumor Burden Follicular Lymphoma: Results of a LYSA Study. J Clin Oncol 2023:JCO2202327. [PMID: 37071836 DOI: 10.1200/jco.22.02327] [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] [Indexed: 04/20/2023] Open
Abstract
PURPOSE Rituximab improves progression-free survival (PFS) and time to next treatment (TTNT) when compared with the watch and wait strategy for patients with low-tumor burden follicular lymphoma (FL). Prolonged rituximab maintenance did not prolong TTNT, whereas it raises concerns about resources use and patient adhesion. Our aim was then to investigate the use of short rituximab maintenance using the subcutaneous (SC) route in patients with low-tumor burden FL. METHODS Patients with histologically confirmed CD20+ low-tumor burden FL were randomly assigned to receive either rituximab, 375 mg/m2 once daily on D1, D8, D15, and D22, intravenous route (IV, control arm), or rituximab, 375 mg/m2, on day 1 (D1), IV followed by rituximab 1,400 mg total dose, SC once daily on D8, D15, and D22, with maintenance at months 3 (M3), M5, M7, and M9 (experimental arm). The primary end point was PFS. Secondary end points included safety, overall response rates, TTNT, and overall survival (OS). RESULTS Two hundred two patients with low-tumor burden FL were randomly assigned to the experimental (n = 100) or control arm (n = 102). The primary end point was met: the 4-year PFS was 58.1% (95% CI, 47.5 to 67.4) and 41.2% (95% CI, 30.6 to 51.6) in experimental and control arms, respectively (hazard ratio, 0.585 [0.393 to 0.871]; P = .0076). Complete response (CR) rates were 59.0% (95% CI, 48.7 to 68.7) in the experimental arm and 36.3% (95% CI, 27.0 to 46.4) in the control arm (P = .001). TTNT and OS were not significantly different. CR was associated with longer PFS and TTNT. High rituximab exposure during the first three months was independently associated with higher CR, PFS, and TTNT. CONCLUSION SC rituximab improves PFS for patients with low-tumor burden FL when used in induction followed by short maintenance. High rituximab exposure during the first 3 months after treatment initiation is, however, the only parameter influencing patient outcomes.
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Affiliation(s)
- Guillaume Cartron
- Department of Hematology, UMR CNRS 5535, University Hospital, Montpellier, France
| | - Emmanuel Bachy
- Department of Hematology, University Hospital, Lyon, France
| | - Hervé Tilly
- Department of Hematology, U1245, Henri Becquerel Institute, Rouen, France
| | - Nicolas Daguindau
- Departement of Hematology, Annecy-Genevois Hospital Centre, Annecy, France
| | | | - Fontanet Bijou
- Departement of Hematology, Bergonié Institute, Bordeaux, France
| | - Christiane Mounier
- Departement of Hematology, Oncology and Hematology Institute, Sainte-Etienne, France
| | - Aline Clavert
- Departement of Hematology, University Hospital, Angers, France
| | | | - Borhane Slama
- Departement of Hematology, Hospital Centre, Avignon, France
| | | | - Roch Houot
- Departement of Hematology, University Hospital, Rennes, France
| | | | - David Sibon
- Departement of Hematology, Necker Hospital, APHP, Paris, France
| | - Olivier Fitoussi
- Departement of Hematology, Polyclinic Bordeaux Nord, Bordeaux, France
| | - Nadine Morineau
- Departement of Hematology, Hospital Centre, La Roche-sur-Yon, France
| | - Charles Herbaux
- Department of Hematology, UMR CNRS 5535, University Hospital, Montpellier, France
| | - Thomas Gastinne
- Departement of Hematology, University Hospital, Nantes, France
| | | | - Corinne Haioun
- Departement of Hematology, Lymphoma Malignancies Unit, Henri Mondor Hospital, APHP, Créteil, France
| | - Vincent Launay
- Departement of Hematology, Hospital Centre, Saint-Brieuc, France
| | - Carla Araujo
- Departement of Hematology, Hospital Centre, Bayonne, France
| | - Omar Benbrahim
- Departement of Hematology, Hospital Centre, Orléans, France
| | - Laurence Sanhes
- Departement of Hematology, Hospital Centre, Perpignan, France
| | - Remy Gressin
- Departement of Hematology, University Hospital, Grenoble, France
| | - Hugo Gonzalez
- Departement of Hematology, Hospital Centre, Pontoise, France
| | - Franck Morschhauser
- Department of Hematology, ULR 7365 GRITA, University Hospital, Lille, France
| | - David Ternant
- UMR7292, University François-Rabelais, Tours, France
| | - Luc Xerri
- Department of Biopathology, Paoli-Calmettes Institue, Marseille, France
| | - Karin Tarte
- UMR1236, Department of Immunology, Rennes I University, Rennes, France
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Marmouset V, Decroocq J, Garciaz S, Etienne G, Belhabri A, Bertoli S, Gastaud L, Simand C, Chantepie S, Uzunov M, Genthon A, Berthon C, Chiche E, Dumas PY, Vargaftig J, Salmeron G, Lemasle E, Tavernier E, Delage J, Loirat M, Morineau N, Blanc-Durand F, Pautier P, Vergé V, Auger N, Thomas M, Stefani L, Lepelley M, Boyer T, Thepot S, Gourin MP, Bourquard P, Duchmann M, Morice PM, Michallet M, Adès L, Fenaux P, Récher C, Dombret H, Pagès A, Marzac C, Leary A, Micol JB. Therapy-related Myeloid Neoplasms Following PARP Inhibitors: Real-life Experience. Clin Cancer Res 2022; 28:5211-5220. [PMID: 36201165 DOI: 10.1158/1078-0432.ccr-22-1622] [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: 05/24/2022] [Revised: 07/27/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023]
Abstract
PURPOSE To provide insights into the diagnosis and management of therapy-related myeloid neoplasms (t-MN) following PARP inhibitors (PARPi). EXPERIMENTAL DESIGN In a French cancer center, we identified and described the profiles of 13 t-MN diagnosed among 37 patients with ovarian cancer referred to hematology consultation for cytopenia under PARPi. Next, we described these 13 t-MN post-PARPi among 37 t-MN post ovarian cancer according to PARPi exposure. Finally, we described 69 t-MN post-PARPi in a national cohort. RESULTS From 2016 to 2021, cumulative incidence of t-MN was 3.5% (13/373) among patients with ovarian cancer treated with PARPi. At time of hematologic consultation, patients with t-MN had a longer PARPi exposure (9 vs. 3 months, P = 0.01), lower platelet count (74 vs. 173 G/L, P = 0.0005), and more cytopenias (2 vs. 1, P = 0.0005). Compared with t-MN not exposed to PARPi, patients with t-MN-PARPi had more BRCA1/2 germline mutation (61.5% vs. 0%, P = 0.03) but similar overall survival (OS). In the national cohort, most t-MN post-PARPi had a complex karyotype (61%) associated with a high rate of TP53 mutation (71%). Median OS was 9.6 months (interquartile range, 4-14.6). In multivariate analysis, a longer time between end of PARPi and t-MN (HR, 1.046; P = 0.02), olaparib compared with other PARPi (HR, 5.82; P = 0.003) and acute myeloid leukemia (HR, 2.485; P = 0.01) were associated with shorter OS. CONCLUSIONS In a large series, we described a high incidence of t-MN post-PARPi associated with unfavorable cytogenetic and molecular abnormalities leading to poor OS. Early detection is crucial, particularly in cases of delayed cytopenia.
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Affiliation(s)
- Vincent Marmouset
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Interception Program, Personalized Cancer Prevention Center, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Justine Decroocq
- Assistance Publique-Hôpitaux de Paris, Centre-Université de Paris, Service d'Hématologie Clinique, Hôpital Cochin, Paris, France
| | - Sylvain Garciaz
- Institut Paoli Calmettes, Marseille, France
- Cancer Research Center of Marseille, INSERM U1068, Aix-Marseille University, Marseille, France
| | | | - Amine Belhabri
- Department of Oncology, Centre Leon Berard, Lyon, France
| | - Sarah Bertoli
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Célestine Simand
- Department of Hematology, Institute for Cancer Strasbourg-Europe (ICANS), Strasbourg University, Strasbourg, France
| | - Sylvain Chantepie
- Department of Clinical Hematology, Caen University Hospital, Caen, France
| | - Madalina Uzunov
- Service d'hématologie adulte, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alexis Genthon
- Department of Clinical Hematology, Saint Antoine Hospital, Sorbonne University, INSERM UMR-S 938, Paris, France
| | - Céline Berthon
- Department of Hematology, CHU Lille, Lille, France
- University of Lille, CNRS, Inserm, CHU Lille, IRCL, UMR9020 - UMR1277 - Canther - Cancer heterogeneity, plasticity and resistance to therapies, Lille, France
| | | | - Pierre-Yves Dumas
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | | | | | - Emilie Lemasle
- Département d'hématologie, Hôpital Henri Becquerel, Rouen, France
| | - Emmanuelle Tavernier
- Hématologie, Institut de Cancérologie-Hématologie Universitaire de Saint Etienne, France
| | - Jérémy Delage
- Département d'hématologie clinique, Saint Eloi, Montpellier, France
| | - Marion Loirat
- Service d'hématologie, Hôpital Saint Nazaire, Saint-Nazaire, France
| | | | - Félix Blanc-Durand
- Department of Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- INSERM U981, Villejuif, France
- Interception Program, Personalized Cancer Prevention Center, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Patricia Pautier
- Department of Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- INSERM U981, Villejuif, France
- Interception Program, Personalized Cancer Prevention Center, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Véronique Vergé
- Department of Biology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Nathalie Auger
- Department of Biology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | | | - Marion Lepelley
- Centre Régional de Pharmacovigilance - Addictovigilance, CHU de Grenoble-Alpes, France
| | - Thomas Boyer
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire d'Amiens, Amiens, France
| | | | | | | | - Matthieu Duchmann
- Université de Paris, Génomes, Biologie Cellulaire et Thérapeutique Unité (U)944, INSERM, Centre National de la Recherche Scientifique (CNRS), Paris, France
| | - Pierre-Marie Morice
- Department of Clinical Hematology, Caen University Hospital, Caen, France
- UNICAEN, INSERM U1086 ANTICIPE (Interdisciplinary Research Unit for Cancer Prevention and Treatment), Normandie University, Caen, France
| | | | - Lionel Adès
- Hématologie Sénior Hôpital Saint Louis, Assistance publique hôpitaux de paris, and Université de Paris Cité, Paris, France
| | - Pierre Fenaux
- Hématologie Sénior Hôpital Saint Louis, Assistance publique hôpitaux de paris, and Université de Paris Cité, Paris, France
| | - Christian Récher
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Hervé Dombret
- Adult Hematology Department, Saint-Louis Hospital, APHP, URP3518, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Arnaud Pagès
- Bureau de Biostatistique et d'Épidémiologie - Gustave Roussy Équipe Oncostat - CESP U1018 - Inserm, France
| | - Christophe Marzac
- Department of Biology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Alexandra Leary
- Department of Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- INSERM U981, Villejuif, France
- Interception Program, Personalized Cancer Prevention Center, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jean-Baptiste Micol
- Department of Hematology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Interception Program, Personalized Cancer Prevention Center, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- INSERM U1287, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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6
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Cartron G, Bachy E, Tilly H, Daguindau N, Pica GM, Bijou F, Mounier C, Clavert A, Damaj GL, Slama B, Casasnovas O, Houot R, Bouabdallah K, Sibon D, Fitoussi O, Morineau N, Morschhauser F, Xerri L, Tarte K, Pranger D. Subcutaneous rituximab induction followed by short rituximab maintenance to improve progression-free survival in patients with low-tumor burden follicular lymphoma: Final results of FLIRT phase III trial, a LYSA study. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7512 Background: In low–tumor burden follicular lymphoma (FL), maintenance rituximab (MR) has been shown to improve progression-free survival (PFS) when compared with observation. RESORT study (Kahl et al. 2014) clearly showed that Rituximab (R) retreatment strategy provided similar time to treatment failure that maintenance strategy with less rituximab use. It is not known whether short MR using sub-cutaneous (sc) route could improve PFS while reducing R infusions. Methods: Patients with the diagnosis of low-tumor burden FL (GELF criteria) within the last 4 months before signing informed consent were randomly assigned to either Iv-Arm : 4-weekly iv infusions of R 375 mg/m2 or Sc-Arm: one iv infusion of R (D1, 375 mg/m2) followed by 3 sc infusions of R (1400 mg, on days 8, 15 and 22) followed by Rsc maintenance on months (M) 3, 5, 7 and 9. The primary endpoint was PFS and secondary endpoints included safety, response rates (M3, M12), duration of response (DOR), time to next anti-lymphoma treatment (TTNTL) and overall survival (OS). Results: A total of 202 patients were included, 102 in Iv-Arm and 100 in Sc-Arm and constitute the intent to treat population. The median uses of R were 4 infusions (range: 1-4, Iv-Arm) and 8 infusions (range: 2-8, Sc-Arm). With a median follow-up of 50.2 months (95% CI: 48.3-54.5), 4‐year PFS was 41.2% (95% CI: 30.6%; 51.6%) in Iv-Arm and 58.1% (95% CI: 47.5%; 67.4%) in Sc-Arm. Median PFS was then 36.1 months (95% IC: 23.9-52.6) in Iv-Arm and 73.8 months (95% CI: 39.4-NA) in Sc-Arm (Fig 1.) (HR: 0.58; 95% CI: 0.39-0.87; P = 0.0076). Patients with at least one AE grade ≥ 3 were 8 (7.8%) and 12 (12.4%) in Iv-Arm and Sc-Arm, respectively. According to Cheson criteria, ORR at M3 were: 83% and 80% including 38% and 29% of CR/CRu, in Iv-Arm and Sc-Arm, respectively. According to Lugano criteria, 36.3% (Iv-Arm; 95% CI: 27.0%. 46.4%) and 59.0% (Sc-Arm; 95% CI: 48.7%; 68.7%) were in CMR at M12. The median DOR was 32.7 months (95% IC: 20.6-49.7) and 70.8 months (36.4-NR) (HR: 0.56; 95% IC: 0.37-0.84) in Iv-Arm and Sc-Arm, respectively. 4-year TTNLT was 54% (95% CI: 42.9%; 63.8%) in Iv-Arm and 61.8% (95% CI: 50.8.6%; 71.0%) in Sc-Arm (HR: 0.81, 95% IC: 0.53-1.24). 4-year TTNLT chemotherapy was 60.8 % (95% CI: 49.6%; 70.3%) in Iv-Arm and 71.4% (95% CI: 60.7%; 79.8%) in Sc-arm (HR: 0.69, 95% IC: 0.42-1.12) (Fig 2.). OS was not different according to treatment arm, 4-year OS was 95.0% (95% CI: 88.5%; 97.9%) in Iv-Arm and 96.7% (95% CI: 89.9%; 98.9%) in Sc-Arm. Conclusions: This phase III study met its primary endpoint and demonstrated that Rsc induction followed by a short MRsc improves PFS of patients with low-tumor burden. MRsc did not however improved TTNLT. R in low-tumor burden FL allowed to avoid cytotoxic use in most patients 6 years after treatment initiation. Clinical trial information: NCT02303119.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Roch Houot
- Hopital Pontchaillou CHU Rennes, Rennes, France
| | | | | | | | | | | | - Luc Xerri
- Institut Paoli-Calmettes, Marseille, France
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7
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Al Tabaa Y, Casasnovas O, Baillet C, Bachy E, Virelizier EN, Schiano de Colella JM, Bailly C, Kanoun S, Guidez S, Gyan E, Gressin R, Morineau N, Ysebaert L, Le Gouill S, Tilly H, Houot R, Morschhauser F, Cartron G, Herbaux C. PROSPECTIVE EVALUATION OF LYMPHOMA RESPONSE TO IMMUNOMODULATORY THERAPY CRITERIA (LYRIC) IN GATA TRIAL FROM THE LYSA GROUP. Hematol Oncol 2021. [DOI: 10.1002/hon.157_2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Y. Al Tabaa
- Scintidoc Nuclear Medicine Center Montpellier France
| | | | | | | | | | | | - C. Bailly
- CHU Nantes Nuclear Medicine Nantes France
| | - S. Kanoun
- Oncopole Toulouse Nuclear Medicine Toulouse France
| | - S. Guidez
- CHU Poitiers Hematology Poitiers France
| | - E. Gyan
- CHU Tours Hematology Tours France
| | | | - N. Morineau
- CHD Vendée Hematology La Roche sur Yon France
| | - L. Ysebaert
- Oncopole Toulouse Hematology Toulouse France
| | | | - H. Tilly
- Centre Henri Becquerel Hematology Rouen France
| | - R. Houot
- CHU Rennes Hematology Rennes France
| | | | - G. Cartron
- CHU Montpellier Hematology Montpellier France
| | - C. Herbaux
- CHU Montpellier Hematology Montpellier France
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8
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Herbaux C, Schiano de Colella JM, Thieblemont C, Guidez S, Ysebaert L, Tilly H, Gouill S, Houot R, Bachy E, Laurent C, Damaj G, Feugier P, Morineau N, Tarte K, Morschhauser F, Cartron G. ATEZOLIZUMAB + OBINUTUZUMAB + VENETOCLAX IN PATIENTS WITH RELAPSED OR REFRACTORY MARGINAL ZONE LYMPHOMA: PRIMARY ANALYSIS OF A PHASE 2 TRIAL FROM LYSA. Hematol Oncol 2021. [DOI: 10.1002/hon.57_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- C. Herbaux
- CHU Montpellier, Hématologie Clinique Montpellier France
| | | | | | | | | | - H. Tilly
- CHB Unicancer, Hematology Rouen France
| | | | | | | | | | | | | | - N. Morineau
- CHD Vendée, Hematology La Roche sur Yon France
| | | | | | - G. Cartron
- CHU Montpellier, Hématologie Clinique Montpellier France
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9
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Cartron G, Bachy E, Guidez S, Gyan E, Gressin R, Morineau N, Sibon D, Casasnovas O, Le Gouill S, Tilly H, Ysebaert L, Schiano de Colella JM, Feugier P, Virelizier EN, Haioun C, Damaj G, Tarte K, Laurent C, Houot R, Thieblemont C, Morschhauser F, Herbaux C. ATEZOLIZUMAB + OBINUTUZUMAB + VENETOCLAX IN PATIENTS WITH RELAPSED OR REFRACTORY FOLLICULAR LYMPHOMA: PRIMARY ANALYSIS OF A PHASE 2 TRIAL FROM LYSA. Hematol Oncol 2021. [DOI: 10.1002/hon.22_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- G. Cartron
- CHU Montpellier Hématologie Cliniqu Montpellier France
| | | | | | | | | | - N. Morineau
- CHD Vendée Hematology La Roche sur Yon France
| | | | | | | | - H. Tilly
- CHB Unicancer Hematology Rouen France
| | | | | | | | | | | | | | | | | | | | | | | | - C. Herbaux
- CHU Montpellier Hématologie Cliniqu Montpellier France
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10
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Herbaux C, Ghesquieres H, Bouabdallah R, Guidez S, Gyan E, Gressin R, Morineau N, Ysebaert L, Le Gouill S, Laurent C, Tilly H, Houot R, Damaj G, Sibon D, Feugier P, Thieblemont C, Haioun C, Tarte K, Morschhauser F, Cartron G. Atezolizumab + obinutuzumab + venetoclax in patients with relapsed or refractory indolent non-Hodgkin’s lymphoma (R/R iNHL): Primary analysis of a phase 2 trial from LYSA. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.7544] [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] [Indexed: 11/20/2022] Open
Abstract
7544 Background: R/R iNHL treatment remains challenging. Atezolizumab (ATE) and obinutuzumab (OBI) are monoclonal antibodies acting respectively to inhibit T-lymphocyte exhaustion or by inducing lymphoma cells cytotoxicity, whereas venetoclax (VEN) is a small molecule inhibiting BCL-2. Combining tumor-targeted therapies with agents that enhance anti-tumor immunity represents an attractive treatment paradigm. This LYSA sponsored multicenter phase 2 trial (NCT03276468) evaluated ATE, OBI and VEN combination in R/R B-cell lymphomas. Herein, we present primary efficacy and safety data from the iNHL cohort including Follicular Lymphoma (FL) and Marginal Zone Lymphomas (MZL). Methods: Patients ≥18 years with biopsy-confirmed R/R FL and MZL who failed at least one line of therapy were eligible. OBI was given IV at 1 g on day (D) 1, 8 and 15 of cycle (C) 1 and on D1 from C2 to C8 every 3 weeks. ATE was given IV, 1.2 g every 3 weeks, started at D2 of C1, then administered at D2 of each cycle for 24 cycles. VEN was given orally at 800 mg/D at full dose, starting on D8C1 for 24 cycles. The primary endpoint was the Overall Response Rate (ORR) evaluated by Lugano criteria at the end of induction (EOI) after 8 cycles of ATE, OBI and VEN (M6) or at premature treatment discontinuation. Results: At the time of the primary analysis (08 Jan 2021), 78 patients were enrolled. FL cohort (n = 58): the median follow-up was 14.5 months. Main baseline characteristics were: Ann Arbor Stage III/IV, 85.7%; FLIPI HR, 47.3%; > 2 prior lines of therapy, 32.1%; and exposed to ASCT, 30.4%. The ORR on PET scan at EOI was measured at 53.6% [41.8%-65.1%], including 30.4% of CMR. 37 patients (63%) received the full induction treatment. MZL cohort (n = 20; 13 nMZL, 5 eMZL, 2 sMZL): the median follow-up was 11.9 months. Main baseline characteristics were: Ann Arbor Stage IV, 100%; bone marrow infiltration, 38.9%; ≥ 2 extra-nodal sites, 50%; and > 2 prior lines of therapy, 22.2%. The ORR on CT scan at EOI was measured at 66.76% [44.6%-84.4%], including 16.7% of CR and 50.0% PR. 11 patients (55%) received the full induction treatment. At time of the present analysis, responses in the 2 cohorts seem durable with only 21,4% of responders who have reported relapse/progression. Out of the 78 pts, a total of 55 (70.5%) pts experienced grade 3–4 adverse event (AE) and 1 patient experienced an AE that led to discontinuation of any drug. Main AE of grade 3 or more were hematologic cytopenias, with only one febrile neutropenia (1.3%). Three pts experienced immune-related AE (1 grade 2 myositis and 2 grade 3 colitis), no tumor lysis syndrome was observed. Conclusions: ATE, OBI and VEN triplet appears to be well tolerated, with no unexpected toxicity brought by the combination. The ORR at EOI seems to be comparable to other innovative regiments in this setting, with durable responses to date. Clinical trial information: NCT03276468.
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Affiliation(s)
- Charles Herbaux
- Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille, France
| | | | | | | | - Emmanuel Gyan
- Tours University Hospital and CNRS ERL7001 LNOX, EA7501, Tours, France
| | - Remi Gressin
- Université Grenoble Alpes, Institut Albert Bonniot, Departement d’Hématologie Clinique, Centre Hospitalier et Universitaire de Grenoble-Alpes, Grenoble, France
| | | | - Loic Ysebaert
- Department of Haematology, Institut Universitaire du Cancer de Toulouse— Oncopôle, Toulouse, France
| | | | | | - Herve Tilly
- Department of Hematology, Centre Henri Becquerel, University of Rouen, Rouen, France
| | - Roch Houot
- Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | - Gandhi Damaj
- Department of Hematology, University Hospital, School of Medicine, Caen, France
| | - David Sibon
- Hôpital Necker-Enfants Malades Hematology, Paris, France
| | - Pierre Feugier
- CHU Brabois Service d'Hématologie et Médecine Interne, Vandoeuvre Les Nancy, France
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11
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Ghesquières H, Rossi C, Cherblanc F, Le Guyader-Peyrou S, Bijou F, Sujobert P, Fabbro-Peray P, Bernier A, Belot A, Chartier L, Fornecker LM, Baldi I, Bouabdallah K, Laurent C, Oberic L, Morineau N, Le Gouill S, Morschhauser F, Haioun C, Damaj G, Guidez S, Labouré G, Fitoussi O, Lebras L, Gressin R, Salles G, Ysebaert L, Monnereau A. A French multicentric prospective prognostic cohort with epidemiological, clinical, biological and treatment information to improve knowledge on lymphoma patients: study protocol of the "REal world dAta in LYmphoma and survival in adults" (REALYSA) cohort. BMC Public Health 2021; 21:432. [PMID: 33653294 PMCID: PMC7927409 DOI: 10.1186/s12889-021-10433-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/12/2021] [Indexed: 12/24/2022] Open
Abstract
Background Age-adjusted lymphoma incidence rates continue to rise in France since the early 80’s, although rates have slowed since 2010 and vary across subtypes. Recent improvements in patient survival in major lymphoma subtypes at population level raise new questions about patient outcomes (i.e. quality of life, long-term sequelae). Epidemiological studies have investigated factors related to lymphoma risk, but few have addressed the extent to which socioeconomic status, social institutional context (i.e. healthcare system), social relationships, environmental context (exposures), individual behaviours (lifestyle) or genetic determinants influence lymphoma outcomes, especially in the general population. Moreover, the knowledge of the disease behaviour mainly obtained from clinical trials data is partly biased because of patient selection. Methods The REALYSA (“REal world dAta in LYmphoma and Survival in Adults”) study is a real-life multicentric cohort set up in French areas covered by population-based cancer registries to study the prognostic value of epidemiological, clinical and biological factors with a prospective 9-year follow-up. We aim to include 6000 patients over 4 to 5 years. Adult patients without lymphoma history and newly diagnosed with one of the following 7 lymphoma subtypes (diffuse large B-cell, follicular, marginal zone, mantle cell, Burkitt, Hodgkin, mature T-cell) are invited to participate during a medical consultation with their hematologist. Exclusion criteria are: having already received anti-lymphoma treatment (except pre-phase) and having a documented HIV infection. Patients are treated according to the standard practice in their center. Clinical data, including treatment received, are extracted from patients’ medical records. Patients’ risk factors exposures and other epidemiological data are obtained at baseline by filling out a questionnaire during an interview led by a clinical research assistant. Biological samples are collected at baseline and during treatment. A virtual tumor biobank is constituted for baseline tumor samples. Follow-up data, both clinical and epidemiological, are collected every 6 months in the first 3 years and every year thereafter. Discussion This cohort constitutes an innovative platform for clinical, biological, epidemiological and socio-economic research projects and provides an opportunity to improve knowledge on factors associated to outcome of lymphoma patients in real life. Trial registration 2018-A01332–53, ClinicalTrials.gov identifier: NCT03869619. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10433-4.
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Affiliation(s)
- Hervé Ghesquières
- Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France.
| | - Cédric Rossi
- CHU Dijon, 10 Boulevard Maréchal De Lattre De Tassigny, 21000, Dijon, France
| | - Fanny Cherblanc
- LYSARC, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | | | - Fontanet Bijou
- Bergonié Institute, 229 Cours de l'Argonne, 33076, Bordeaux, France
| | - Pierre Sujobert
- Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | | | - Adeline Bernier
- LYSARC, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Aurélien Belot
- LYSARC, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Loic Chartier
- LYSARC, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Luc-Matthieu Fornecker
- Cancerology Institute Strasbourg Europe, Avenue Molière, BP 428, 67098, Strasbourg, France
| | - Isabelle Baldi
- Inserm U1219 - EPICENE team, Université de Bordeaux, Bordeaux, France
| | | | - Camille Laurent
- Toulouse Research Center in Cancerology, 2 Avenue Hubert Curien, 31037, Toulouse, France
| | - Lucie Oberic
- IUCT Oncopole, 1 Avenue Irène Joliot Curie, 31100, Toulouse, France
| | - Nadine Morineau
- CHD Vendée, Boulevard Stéphane Moreau, 85000, La Roche-sur-Yon, France
| | | | | | - Corinne Haioun
- Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Gandhi Damaj
- Hematology Institute of Basse Normandie, 6 Avenue Côte de Nacre, 14033, Caen, France
| | | | - Gaëlle Labouré
- CH Libourne, 112 Rue de la Marne, 33500, Libourne, France
| | - Olivier Fitoussi
- Polyclinique Bordeaux Nord Aquitaine, 15-35 Rue Claude Boucher, 33300, Bordeaux, France
| | - Laure Lebras
- Léon Bérard Center, 28 rue Laennec, 69008, Lyon, France
| | - Rémy Gressin
- CHU Grenoble, Bd de la Chantourne BP 217, 38043, Grenoble, France
| | - Gilles Salles
- Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Loïc Ysebaert
- IUCT Oncopole, 1 Avenue Irène Joliot Curie, 31100, Toulouse, France
| | - Alain Monnereau
- Inserm U1219 - EPICENE team, Université de Bordeaux, Bordeaux, France
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12
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Vantyghem S, Peterlin P, Thépot S, Ménard A, Dubruille V, Debord C, Guillaume T, Garnier A, Le Bourgeois A, Wuilleme S, Godon C, Theisen O, Eveillard M, Delaunay J, Maisonneuve H, Morineau N, Villemagne B, Vigouroux S, Subiger F, Lestang E, Loirat M, Parcelier A, Godmer P, Mercier M, Trebouet A, Luque Paz D, Le Calloch R, Le Clech L, Bossard C, Moreau A, Ugo V, Hunault M, Moreau P, Le Gouill S, Chevallier P, Béné MC, Le Bris Y. Diagnosis and prognosis are supported by integrated assessment of next-generation sequencing in chronic myeloid malignancies. A real-life study. Haematologica 2021; 106:701-707. [PMID: 32241844 PMCID: PMC7927891 DOI: 10.3324/haematol.2019.242677] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Indexed: 12/15/2022] Open
Abstract
Next-generation sequencing (NGS) is used to investigate the presence of somatic mutations. The utility of incorporating routine sequencing to guide diagnosis and therapeutic decisions remains unclear. We report the findings of an observational, multicenter study that aimed to assess the impact of somatic mutation testing by NGS in a reallife setting of chronic myeloid malignancies. A total of 177 patients were enrolled, partitioned into two overlapping groups. In group A (n=94), the indication was to search for clonal hematopoiesis, in a context of suspected myelodysplastic syndrome or myeloproliferative neoplasia. In group B (n=95), the theranostic impact of somatic mutations was studied. A panel of 34 genes was used on DNA extracted from blood or bone marrow samples. Within group A, the detection of clonal hematopoiesis supported the diagnosis of chronic myeloid malignancies for 31 patients while the absence of clonal hematopoiesis ruled out the suspected diagnosis in 47 patients. Within group B, NGS identified prognostically relevant somatic mutations in 32 patients, which had a therapeutic impact in 18 cases. By determining the presence or absence of somatic mutations, the application of NGS in daily practice was found to be useful for an integrated final diagnosis in 83% of the patients. Moreover, the search for somatic mutations had a prognostic impact that led to treatment modification in 19% of the cases. This study outlines the fact that adequate implementation of new investigations may have a significant positive medico-economic impact by enabling appropriate management of patients.
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Affiliation(s)
| | | | - Sylvain Thépot
- Hematology Clinic, Angers University Hospital, Angers,CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Pays de la Loire
| | - Audrey Ménard
- Hematology Biology, Nantes University Hospital, Nantes
| | | | | | | | - Alice Garnier
- Hematology Clinic, Nantes University Hospital, Nantes
| | | | | | | | | | - Marion Eveillard
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Pays de la Loire,Hematology Biology, Nantes University Hospital, Nantes
| | | | | | | | | | | | | | - Elsa Lestang
- Hematology Clinic, Saint Nazaire Hospital, Saint Nazaire
| | - Marion Loirat
- Hematology Clinic, Saint Nazaire Hospital, Saint Nazaire
| | | | - Pascal Godmer
- Hematology Clinic, Bretagne Atlantique Hospital, Vannes
| | | | | | - Damien Luque Paz
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Pays de la Loire,Hematology Biology, Angers University Hospital, Angers
| | | | | | - Céline Bossard
- Pathology Department, Nantes University Hospital, Nantes, France
| | - Anne Moreau
- Pathology Department, Nantes University Hospital, Nantes, France
| | - Valérie Ugo
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Pays de la Loire,Hematology Biology, Angers University Hospital, Angers
| | - Mathilde Hunault
- Hematology Clinic, Angers University Hospital, Angers,CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Pays de la Loire
| | - Philippe Moreau
- Hematology Clinic, Nantes University Hospital, Nantes,CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Pays de la Loire
| | - Steven Le Gouill
- Hematology Clinic, Nantes University Hospital, Nantes,CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Pays de la Loire
| | - Patrice Chevallier
- Hematology Clinic, Nantes University Hospital, Nantes,CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Pays de la Loire
| | - Marie C Béné
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Pays de la Loire,Hematology Biology, Nantes University Hospital, Nantes
| | - Yannick Le Bris
- CRCINA, INSERM, CNRS, Université de Nantes, Université d'Angers, Pays de la Loire,Hematology Biology, Nantes University Hospital, Nantes
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13
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Herbaux C, Casasnovas O, Feugier P, Damaj G, Bouabdallah R, Guidez S, Ysebaert L, Tilly H, Le Gouill S, Fornecker L, Daguindau N, Morineau N, Haioun C, Gyan E, Sibon D, Gressin R, Houot R, Salles GA, Morschhauser F, Cartron G. Atezolizumab + obinutuzumab + venetoclax in patients with relapsed or refractory diffuse large B-cell Lymphomas (R/R DLBCL): Primary analysis of a phase II trial from LYSA. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.8053] [Citation(s) in RCA: 3] [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] [Indexed: 11/20/2022] Open
Abstract
8053 Background: R/R DLBCL treatment remains challenging. Atezolizumab (ATE) and obinutuzumab (OBI) are monoclonal antibodies acting respectively to inhibit T-lymphocyte exhaustion or by inducing lymphoma cells cytotoxicity, whereas venetoclax (VEN) is a small molecule inhibiting BCL-2. Combining tumor-targeted therapies with agents that enhance anti-tumor immunity represents an attractive treatment paradigm. This LYSA sponsored multicenter phase 2 trial (NCT03276468) evaluate the combination of ATE, OBI and VEN in R/R B lymphomas, we present here primary efficacy and safety data fromthe DLBCL cohort. Methods: Patients ≥18 years with biopsy-confirmed R/R DLBCL who failed at least one line of therapy were eligible. OBI was given IV at the dose of 1 g on day (D) 1, 8 and 15 of cycle (C) 1 and on D1 from C2 to C8 every 3 weeks. ATE was given IV, 1.2 g every 3 weeks, started at D2 of C1, then administered at D2 of each cycle for 24 cycles. VEN was given orally at 800 mg/D at full dose, started on D8C1 for 24 cycles. The primary endpoint wasthe Overall Metabolic Response Rate (OMRR) by Lugano criteria at the end of induction (EOI) after 8 cycles of ATE, OBI and VEN (M6) or at premature treatment discontinuation. Results: At the time of the primary analysis (03 Jan 2020), 58 pts were enrolled and the median follow-up was 9 months [6.9-11.8]. Baseline characteristics were: median age, 70 years; male, 53.4%; Ann Arbor Stage IV, 84.5%; aaIPI (≥2), 63.2%; > 2 prior lines of therapy, 83.6%; and refractory to last line of prior regimen, 63.6%. The OMRR at EOI was measured at 23.6% [14.58%-34.93%], including 18% of CMR. To date, these responses seem durable with only 3 reported relapses. According to the highest diameter mass, OMRR was 38.5% versus 10.3%, < 5cm and > 5cm respectively; P = 0,02. All three treatments were stopped in 78% of patients, mostly for progressive disease. At the time of analysis, a median of 4 cycles [1-8] has been administered. A total of 48 (84.2%) pts experienced grade 3–4 adverse event (AE) and 6 (10.5%) had an AE that led to discontinuation of any drug.AE of grade 3 or more reported in at least 20% of patients were neutropenia (33.3%) and lymphopenia (35.1%). Of note, a grade 3 autoimmune colitis and a grade 1 hypothyroidism were reported during induction. Conclusions: The ATE, OBI and VEN combinationappears to be well tolerated. The OMRR rate at EOI is comparable with currently available treatment options in this population, with durable responses. The OMRR seems better in patients with a low tumor burden. Clinical trial information: NCT03276468 .
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Affiliation(s)
- Charles Herbaux
- Centre Hospitalier Régional Universitaire de Lille, Institute of Hematolog-Tranfusion, Lille, France
| | | | | | - Gandhi Damaj
- Department of Hematology, University Hospital, School of Medicine, Caen, France
| | | | | | - Loic Ysebaert
- Department of Haematology, Institut Universitaire du Cancer de Toulouse— Oncopôle, Toulouse, France
| | - Herve Tilly
- Department of Hematology, Centre Henri Becquerel, University of Rouen, Rouen, France
| | | | - Luc Fornecker
- University Hospital of Strasbourg, Strasbourg, France
| | | | | | - Corinne Haioun
- Henri Mondor University Hospital, University Hospital, Créteil, France
| | - Emmanuel Gyan
- CHU de Tours-Hôpital Bretonneau, Tours Cedex, France
| | - David Sibon
- Hôpital Necker-Enfants Malades Hematology, Paris, France
| | - Rémy Gressin
- Université Grenoble Alpes, Institut Albert Bonniot, Departement d’Hématologie Clinique, Centre Hospitalier et Universitaire de Grenoble-Alpes, Grenoble, France
| | - Roch Houot
- Centre Hospitalier Universitaire Pontchaillou, Rennes, France
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Gressin R, Daguindau N, Tempescul A, Moreau A, Carras S, Tchernonog E, Schmitt A, Houot R, Dartigeas C, Pignon JM, Corm S, Banos A, Mounier C, Dupuis J, Macro M, Fleury J, Jardin F, Sarkozy C, Damaj G, Feugier P, Fornecker LM, Chabrot C, Dorvaux V, Bouadallah K, Amorin S, Garidi R, Voillat L, Joly B, Celigny PS, Morineau N, Moles MP, Zerazhi H, Fontan J, Arkam Y, Alexis M, Delwail V, Vilque JP, Ysebaert L, Le Gouill S, Callanan MB. A phase 2 study of rituximab, bendamustine, bortezomib and dexamethasone for first-line treatment of older patients with mantle cell lymphoma. Haematologica 2018; 104:138-146. [PMID: 30171024 PMCID: PMC6312036 DOI: 10.3324/haematol.2018.191429] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/23/2018] [Indexed: 01/30/2023] Open
Abstract
We present results of a prospective, multicenter, phase II study evaluating rituximab, bendamustine, bortezomib and dexamethasone as first-line treatment for patients with mantle cell lymphoma aged 65 years or older. A total of 74 patients were enrolled (median age, 73 years). Patients received a maximum of six cycles of treatment at 28-day intervals. The primary objective was to achieve an 18-month progression-free survival rate of 65% or higher. Secondary objectives were to evaluate toxicity and the prognostic impact of mantle cell lymphoma prognostic index, Ki67 expression, [18F]fluorodeoxyglucose-positron emission tomography and molecular minimal residual disease, in peripheral blood or bone marrow. With a median follow-up of 52 months, the 24-month progression-free survival rate was 70%, hence the primary objective was reached. After six cycles of treatment, 91% (54/59) of responding patients were analyzed for peripheral blood residual disease and 87% of these (47/54) were negative. Four-year overall survival rates of the patients who did not have or had detectable molecular residual disease in the blood at completion of treatment were 86.6% and 28.6%, respectively (P<0.0001). Neither the mantle cell lymphoma index, nor fluorodeoxyglucose-positron emission tomography nor Ki67 positivity (cut off of ≥30%) showed a prognostic impact for survival. Hematologic grade 3-4 toxicities were mainly neutropenia (51%), thrombocytopenia (35%) and lymphopenia (65%). Grade 3-4 non-hematologic toxicities were mainly fatigue (18.5%), neuropathy (15%) and infections. In conclusion, the tested treatment regimen is active as frontline therapy in older patients with mantle cell lymphoma, with manageable toxicity. Minimal residual disease status after induction could serve as an early predictor of survival in mantle cell lymphoma. ClinicalTrials.gov: NCT 01457144.
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Affiliation(s)
- Rémy Gressin
- Onco-Hematology Department, Grenoble University Hospital .,INSERM 1209, CNRS UMR 5309, Faculté de Médecine, Université Grenoble-Alpes, Institute for Advanced Biosciences, Grenoble
| | | | | | - Anne Moreau
- Pathology Department, Nantes University Hospital
| | - Sylvain Carras
- Onco-Hematology Department, Grenoble University Hospital
| | | | - Anna Schmitt
- Hematology Department, Cancer Institute Bergonie Bordeaux
| | - Roch Houot
- Hematology Department, Rennes University Hospital
| | | | | | - Selim Corm
- Hematology Department, Chambery Hospital
| | | | | | - Jehan Dupuis
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil
| | | | - Joel Fleury
- Hematology Department, Clermont-Ferrand Cancer Institute
| | | | - Clementine Sarkozy
- Hematology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud. INSERM 1052
| | - Ghandi Damaj
- Hematology Department, Amiens University Hospital
| | | | | | - Cecile Chabrot
- Hematology Department, University Clermont-Ferrand Hospital
| | | | | | - Sandy Amorin
- Hematology Department, University Hospital Paris Saint-Louis
| | - Reda Garidi
- Hematology Department, Saint Quentin Hospital
| | | | | | | | | | | | | | - Jean Fontan
- Hematology Department, Besançon University Hospital
| | | | | | - Vincent Delwail
- Onco-Hematology Department, University Hospital Poitiers and INSERM, CIC 1402, Poitiers University
| | | | | | | | - Mary B Callanan
- INSERM 1209, CNRS UMR 5309, Faculté de Médecine, Université Grenoble-Alpes, Institute for Advanced Biosciences, Grenoble .,Unit for Innovation in Genetics and Epigenetics in Oncology, Dijon University Hospital, France
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15
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Gyan E, Sonet A, Brice P, Anglaret B, Laribi K, Fruchart C, Tilly H, Araujo C, Soubeyran P, Gonzalez H, Morineau N, Nicolas-Virelizier E, Ghesquières H, Salles B, Bouabdallah R, Orfeuvre H, Fahri J, Couturier O, Xerri L, Feugier P. Bendamustine and rituximab in elderly patients with low-tumour burden follicular lymphoma. Results of the LYSA phase II BRIEF study. Br J Haematol 2018; 183:76-86. [DOI: 10.1111/bjh.15513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/07/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Emmanuel Gyan
- Department of Haematology and Cell Therapy; University Hospital; Tours France
- Clinical Investigation Centre; INSERM U1415, University Hospital; Tours France
| | - Anne Sonet
- Department of Haematology; Mont-Godinne University; Université Catholique de Louvain; CHU UCL Namur; Yvoir Belgium
| | - Pauline Brice
- Department of Haematology; Saint-Louis Hospital; AP-HP; Paris France
| | - Bruno Anglaret
- Department of Haematology; Valence Hospital; Valence France
| | - Kamel Laribi
- Department of Haematology; Le Mans Hospital; Le Mans France
| | | | - Hervé Tilly
- Department of Haematology; Centre Henri Becquerel; Rouen France
| | - Carla Araujo
- Department of Haematology; Bayonne Hospital; Bayonne France
| | | | - Hugo Gonzalez
- Department of Haematology; René Dubos Hospital; Pontoise France
| | - Nadine Morineau
- Department of Haematology; Catherine de Sienne Centre; Nantes France
| | | | | | - Bruno Salles
- Department of Haematology; Châlon Hospital; Châlon-sur-Saône France
| | - Réda Bouabdallah
- Department of Haematology; Paoli-Calmettes Institute; Marseille France
| | - Hubert Orfeuvre
- Department of Haematology; Bourg-en-Bresse Hospital; Bourg-en-Bresse France
| | - Jonathan Fahri
- Department of Haematology; Angers University Hospital; Angers France
| | - Olivier Couturier
- Lysa Pathology Department; Mondor University Hospital; Créteil France
| | - Luc Xerri
- Lysa Imaging Department; Mondor University Hospital; Créteil France
| | - Pierre Feugier
- Department of Haematology; University Hospital, and INSERM U954; Nancy France
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16
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Kraeber-Bodere F, Pallardy A, Maisonneuve H, Campion L, Moreau A, Soubeyran I, Le Gouill S, Tournilhac O, Daguindau E, Jardel H, Morineau N, Bouabdallah K, Gyan E, Moles MP, Gressin R, Berthou C, Sadot S, Moreau P, Deau B, Bodet-Milin C, Cazeau AL, Garin E, Salaun PY, Vuillez JP, Gouilleux-Gruart V, Barbet J, Wegener WA, Goldenberg DM, Lamy T, Soubeyran P. Consolidation anti-CD22 fractionated radioimmunotherapy with 90Y-epratuzumab tetraxetan following R-CHOP in elderly patients with diffuse large B-cell lymphoma: a prospective, single group, phase 2 trial. Lancet Haematol 2016; 4:e35-e45. [PMID: 27964867 DOI: 10.1016/s2352-3026(16)30168-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/03/2016] [Accepted: 10/27/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Radioimmunotherapy represents a potential option as consolidation after chemoimmunotherapy in patients with diffuse large B-cell lymphoma who are not candidates for transplantation. We aimed to assess activity and toxicity of fractionated radioimmunotherapy using anti-CD22 90Y-epratuzumab tetraxetan as consolidation after front-line induction chemoimmunotherapy in untreated elderly patients with diffuse large B-cell lymphoma. METHODS We did a prospective, single-group, phase 2 trial at 28 hospitals in France, with patients recruited from 17 hospitals. Eligible patients were aged 60-80 years with bulky stage 2-3 or stage 3-4 CD20-positive diffuse large B-cell lymphoma, previously untreated, and not eligible for transplantation. Patients received six cycles of R-CHOP (rituximab [375 mg/m2], cyclophosphamide [750 mg/m2], doxorubicin [50 mg/m2], and vincristine [1·4 mg/m2, up to 2 mg] all on day 1, and prednisone [40 mg/m2] daily for 5 days), administered every 14 days. 6-8 weeks after R-CHOP, responders received two doses of 15 mCi/m2 (555 MBq/m2) 90Y-epratuzumab tetraxetan administered 1 week apart. The primary endpoint was 2 year event-free survival in all registered eligible patients who received at least 1 day of study treatment; the safety analysis was done in the same population. This trial is registered with ClinicalTrials.gov, number NCT00906841. FINDINGS Between Oct 22, 2008, and Dec 16, 2010, we recruited 75 patients, of whom four (5%) were excluded after central pathology review; hence, 71 (95%) patients were included in the analysis. All patients started induction treatment; 57 (80%) received radioimmunotherapy. With a median follow-up of 37 months (IQR 30-44), the estimated 2 year event-free survival was 75% (95% CI 63-84). Radioimmunotherapy toxicity consisted of grade 3-4 thrombocytopenia in 48 (84%) of 57 patients and neutropenia in 45 (79%) of 57 patients. One patient developed myelodysplastic syndrome 28 months after receiving radioimmunotherapy and one patient developed acute myeloid leukaemia 5 months after receiving radioimmunotherapy. INTERPRETATION Fractionated radioimmunotherapy with 90Y-epratuzumab tetraxetan might be appropriate for response consolidation after induction chemotherapy in older patients with advanced diffuse large B-cell lymphoma, but further comparative studies are needed. FUNDING Immunomedics, Amgen, Canceropôle Grand Ouest, the GOELAMS/LYSA group and the French National Agency for Research (Investissements d'Avenir).
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Affiliation(s)
- Françoise Kraeber-Bodere
- University Hospital, Nantes, France; Institut de Cancérologie de l'Ouest Cancer Center, Saint-Herblain, France.
| | | | | | - Loïc Campion
- Institut de Cancérologie de l'Ouest Cancer Center, Saint-Herblain, France
| | | | - Isabelle Soubeyran
- Institut Bergonié, Cancer Centre, and University of Bordeaux, Bordeaux, France
| | | | | | | | - Henry Jardel
- Centre Hospitalier Bretagne-Atlantique, Vannes, France
| | | | | | - Emmanuel Gyan
- Hematology and Cell Therapy Department, Clinical Investigation Center INSERM U1415, GICC UMR CNRS 7292, University Hospital, Tours, France
| | | | | | | | - Sophie Sadot
- Institut de Cancérologie de l'Ouest Cancer Center, Saint-Herblain, France
| | | | - Bénédicte Deau
- Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Anne-Laure Cazeau
- Institut Bergonié, Cancer Centre, and University of Bordeaux, Bordeaux, France
| | | | | | | | - Valérie Gouilleux-Gruart
- Hematology and Cell Therapy Department, Clinical Investigation Center INSERM U1415, GICC UMR CNRS 7292, University Hospital, Tours, France
| | - Jacques Barbet
- Groupement d'Intêret Publique Arronax, Arronax, Saint-Herblain, France
| | | | | | | | - Pierre Soubeyran
- Institut Bergonié, Cancer Centre, and University of Bordeaux, Bordeaux, France
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Katchakourian L, Durant C, Graveleau J, Lestang E, Penhoat M, Masseau A, Néel A, Toquet C, Agard C, Morineau N, Hamidou M. Artérite temporale avec aortite malgré traitement par anti-CD52 (alemtuzumab) pour une leucémie lymphoïde chronique. Intérêt du TEP scan. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.252] [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: 10/26/2022]
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18
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Damaj G, Malard F, Hulin C, Caillot D, Garidi R, Royer B, Marit G, Stoppa A, Banos A, Morineau N, Moreau P, Fitoussi O, Tiab M, Moreau P. Efficacy of bendamustine in relapsed/refractory myeloma patients: results from the French compassionate use program. Leuk Lymphoma 2012; 53:632-4. [DOI: 10.3109/10428194.2011.622422] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Le Gouill S, Milpied NJ, Lamy T, Delwail V, Gressin R, Guyotat D, Damaj GL, Foussard C, Cartron G, Maisonneuve H, Deconinck E, Dreyfus F, Gyan E, Sutton L, Morineau N, Alexis M, Perry F, Sauvezie M. First-line rituximab (R) high-dose therapy (R-HDT) versus R-CHOP14 for young adults with diffuse large B-cell lymphoma: Preliminary results of the GOELAMS 075 prospective multicenter randomized trial. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cahu X, Bodet-Milin C, Brissot E, Maisonneuve H, Houot R, Morineau N, Solal-Celigny P, Godmer P, Gastinne T, Moreau P, Moreau A, Lamy T, Kraber-Bodere F, Le Gouill S. 18F-fluorodeoxyglucose-positron emission tomography before, during and after treatment in mature T/NK lymphomas: a study from the GOELAMS group. Ann Oncol 2010; 22:705-711. [PMID: 20739714 DOI: 10.1093/annonc/mdq415] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In non-cutaneous T-cell/natural killer (T/NK) lymphomas, the prognostic value of (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) during or after therapy is unknown. PATIENTS AND METHODS In this retrospective study, 54 T/NK lymphoma patients were assessed using FDG-PET before (n = 40), during (n = 44) and/or after therapy (n = 31). RESULTS FDG-PET showed an abnormal FDG uptake in all cases. Interim FDG-PET was negative in 25 of 44 cases. After completion of therapy, 19 of 31 patients reached complete remission with negative FDG-PET. In ALK+ anaplastic large cell lymphomas, the 4-year progression-free survival (PFS) was 80% and the negative predictive value of post-therapy FDG-PET was 83% (n = 9). In ALK- T/NK lymphomas, the 4-year PFS was 59% for patients with a negative interim FDG-PET versus 46% for patients with a positive interim FDG-PET (P = 0.28, n = 35). Similarly, there was no statistical difference in 4-year PFS between negative and positive post-therapy FDG-PET in these lymphomas (51% and 67%, respectively, P = 0.96). The 4-year cumulative incidence of relapse from a negative post-therapy FDG-PET was 53% in ALK- T/NK lymphomas. CONCLUSIONS Although T/NK lymphomas are FDG-avid at diagnosis, a negative interim or post-therapy FDG-PET does not translate into an improved PFS in ALK- T/NK lymphomas.
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Affiliation(s)
| | - C Bodet-Milin
- Department of Nuclear Medicine, Centre Hospitalier Universitaire Nantes
| | | | - H Maisonneuve
- Department of Hematology, Centre Hospitalier Départemental La Roche-sur-Yon
| | - R Houot
- Department of Hematology, Hôpital Pontchaillou, Centre Hospitalier Universitaire Rennes, Rennes
| | - N Morineau
- Department of Hematology, Centre Catherine de Sienne, Nantes
| | - P Solal-Celigny
- Department of Hematology and Oncology, Centre Jean Bernard, Clinique Victor Hugo, Le Mans
| | - P Godmer
- Department of Hematology, Centre Hospitalier Départemental Vannes, Vannes
| | | | | | - A Moreau
- Department of Pathology, Centre Hospitalier Universitaire Nantes, Nantes
| | - T Lamy
- Department of Hematology, Hôpital Pontchaillou, Centre Hospitalier Universitaire Rennes, Rennes; Research Unit, Inserm U917, Université de Rennes I, Rennes
| | - F Kraber-Bodere
- Department of Nuclear Medicine, Centre Hospitalier Universitaire Nantes; Center for Oncology Research Nantes/Angers, Inserm UMR 892, Nantes; Department of Nuclear Medicine, Centre René Gauducheau, Saint-Herblain
| | - S Le Gouill
- Department of Hematology; Center for Oncology Research Nantes/Angers, Inserm UMR 892, Nantes; Center for Clinical Investigation in Oncology (CI2C), Centre Hospitalier Universitaire Nantes, France.
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Bodet-Milin C, Touzeau C, Leux C, Sahin M, Moreau A, Maisonneuve H, Morineau N, Jardel H, Moreau P, Gallazini-Crépin C, Gries P, Gressin R, Harousseau JL, Mohty M, Moreau P, Kraeber-Bodere F, Le Gouill S. Prognostic impact of 18F-fluoro-deoxyglucose positron emission tomography in untreated mantle cell lymphoma: a retrospective study from the GOELAMS group. Eur J Nucl Med Mol Imaging 2010; 37:1633-42. [PMID: 20428863 DOI: 10.1007/s00259-010-1469-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 04/06/2010] [Indexed: 12/20/2022]
Abstract
PURPOSE (18)F-fluorodeoxyglucose (FDG) PET is a non-invasive imaging technique recommended for the management of both diffuse large B-cell and Hodgkin's lymphomas. This retrospective study investigated the value of FDG PET for initial staging and its prognostic impact on patients with mantle cell lymphoma (MCL). METHODS A total of 44 untreated MCL patients assessed by both conventional evaluations (CE) and FDG PET for initial staging were included. The maximum standardized uptake value (SUV(max)) in the most intense pathological area was recorded for each patient. Disease status after chemotherapy completion was assessed according to the International Workshop Criteria (IWC) for non-Hodgkin's lymphoma (NHL) response and IWC+PET. RESULTS FDG PET uptakes at diagnosis were abnormal in all cases. Compared to CT scan, nodal and extranodal sites were only detected by FDG PET. Due to insufficient sensibility for bone marrow (BM) and gastrointestinal (GI) involvement, FDG PET did not modify initial staging. Positive and negative predictive values of IWC+PET for relapse at 1 year were 62.5 and 100%. With a median follow-up of 21 months, only the International Prognostic Index (IPI) and IWC+PET modified both event-free survival (EFS) (p = .02 and .0001, respectively) and overall survival (p = .03 and .05, respectively) duration. When combining IPI and SUV(max) at diagnosis, we were able to identify patients with low (29%; no relapse/progression), intermediate (42%; median EFS: 37 months) and high risk (29%, median EFS: 22 months) (p = .004). CONCLUSION In MCL, FDG PET at diagnosis is complementary to CE, but BM and GI biopsies remain mandatory. IWC+PET criteria are highly efficient to identify patients with high risk for early relapse. Combining IPI and SUV(max) may predict patient outcome and warrant further prospective investigations towards designing risk-adapted strategies.
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Blin N, Morineau N, Gaillard F, Morin O, Milpied N, Harousseau JL, Moreau P. Disseminated mucormycosis associated with invasive pulmonary aspergillosis in a patient treated for post-transplant high-grade non-Hodgkin's lymphoma. Leuk Lymphoma 2009; 45:2161-3. [PMID: 15370266 DOI: 10.1080/10428190410001700803] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The incidence of mucormycosis, defined as systemic infection caused by fungi of the class Phycomycetes has been increasing over the past 2 decades, especially in profoundly immunocompromised hosts. We report a new case in a patient presenting with post-transplant high-grade non-Hodgkin's lymphoma who received a prolonged treatment with voriconazole and caspofungin for an invasive pulmonary aspergillosis. Definite diagnosis of mucormycosis was made by liver biopsy of nodules mimicking progressive lymphoma. The patient died 1 week after the diagnosis of mucormycosis despite the administration of liposomal amphotericin B. The role of voriconazole and caspofungin in the emergence of mucormycosis is discussed.
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Affiliation(s)
- Nicolas Blin
- Haematology Department, University Hospital Hôtel-Dieu, Place Alexis Ricordeau, Nantes Cedex, France
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Lortholary A, Cary-Ten Have Dallinga M, El Kouri C, Morineau N, Ramée JF. Lupus induit par le paclitaxel. Presse Med 2007; 36:1207-8. [PMID: 17521858 DOI: 10.1016/j.lpm.2007.02.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/13/2006] [Revised: 12/15/2006] [Accepted: 02/04/2007] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Paclitaxel (Taxol) is a drug derived from the bark of the Pacific yew tree and is widely used in cancer treatment, especially for breast, ovarian, and lung cancers. It has not previously been reported to induce lupus. CASE We report the case of a woman with ovarian cancer who developed paclitaxel-induced lupus on two occasions. Both times, the paclitaxel dramatically improved the ovarian cancer. DISCUSSION The diagnosis of lupus was confirmed by the initial skin appearance, elevated levels of antinuclear antibodies, recurrence on reintroduction, and biopsy results. To our knowledge, it is the first case reported of paclitaxel-induced lupus.
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Vigouroux S, Morin O, Moreau P, Méchinaud F, Morineau N, Mahé B, Chevallier P, Guillaume T, Dubruille V, Harousseau JL, Milpied N. Zygomycosis after prolonged use of voriconazole in immunocompromised patients with hematologic disease: attention required. Clin Infect Dis 2005; 40:e35-7. [PMID: 15712069 DOI: 10.1086/427752] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2004] [Accepted: 10/11/2004] [Indexed: 01/24/2023] Open
Abstract
We describe 4 cases of zygomycosis that occurred after prolonged use of voriconazole in severely immunocompromised patients with hematologic disease. An invasive infection was present in 3 patients who died soon after the diagnosis at 12, 13, and 45 days. Physicians should be mindful of this potential risk after treatment with voriconazole.
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Wallon-Dumont G, Milpied-Homsi B, Morineau N, Harousseau J, Stalder J. Effets secondaires cutanéo-muqueux de l’hydroxyurée : étude prospective sur trois ans avec collaboration hémato-dermatologique. Ann Dermatol Venereol 2004. [DOI: 10.1016/s0151-9638(04)93873-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Moreau P, Robillard N, Avet-Loiseau H, Pineau D, Morineau N, Milpied N, Harousseau JL, Bataille R. Patients with CD45 negative multiple myeloma receiving high-dose therapy have a shorter survival than those with CD45 positive multiple myeloma. Haematologica 2004; 89:547-51. [PMID: 15136217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES CD45 is a critical regulator of signaling threshold in immune cells. There are clinical and animal studies suggesting that the CD45-negative phenotype is the phenotype of progressive multiple myeloma (MM). The aims of this study were to confirm this hypothesis and to test the prognostic value of CD45 expression in newly diagnosed MM patients. DESIGN AND METHODS In a retrospective study of 95 newly diagnosed MM patients treated with high dose therapy we used 4-color flow cytometry to determine CD45 expression and correlated the immunophenotipic data with clinical data. RESULTS Thirty of 95 patients (31.5%) lacked CD45 expression at diagnosis. The CD45 phenotype significantly affected the overall survival (OS) of the patients, like the most common presenting prognostic parameters analyzed including b-2-microglobulin, age and 14q32 translocations. CD45 negative MM patients had a significantly worse OS than did CD45 positive cases of MM: 28.7% cumulative survival at 4 years, median 42 months vs not reached; p = 0.004. Furthermore, CD45 remained the only parameter adversely affecting OS in multivariate analysis. INTERPRETATION AND CONCLUSIONS The CD45 negative phenotype could reflect the phenotype of progressive disease in relation to the intrinsic malignancy of the MM clone. Indeed, CD45 negative myeloma cells appear to have a greater capacity to circulate, disseminate and clone as well as being less sensitive to apoptosis.
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Affiliation(s)
- Philippe Moreau
- Department of Clinical Hematology, University Hospital, Nantes, France
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27
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Mahé B, Milpied N, Mellerin MP, Moreau P, Morineau N, Vigier M, Harousseau JL. PCR detection of residual Bcl-2/IgH-positive cells after high-dose therapy with autologous stem cell transplantation is a prognostic factor for event-free survival in patients with low-grade follicular non-Hodgkin's lymphoma. Bone Marrow Transplant 2003; 31:467-73. [PMID: 12665842 DOI: 10.1038/sj.bmt.1703829] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This study was designed to evaluate the results of high-dose therapy followed by purged autologous stem cell transplantation (ASCT) for patients with low-grade follicular non Hodgkin's lymphoma (LGFL), and the prognostic significance of PCR detection of residual Bcl-2/IgH-positive cells after ASCT. Between 1992 and 1998, 49 patients with LGFL received total body irradiation and high-dose cyclophosphamide followed by purged ASCT. PCR amplification of the Bcl-2/IgH rearrangement was performed at diagnosis, on stem cell collections before and after purging and on bone marrow and blood samples after ASCT. With a median follow-up of 76 months (37-103) 34 patients remain alive and event-free. A total of 20 patients had disease recurrence, three patients developed secondary myelodysplastic syndrome (MDS). In all, 11 patients died; 10 deaths were because of recurrent disease, one because of MDS. Kaplan-Meier estimates of event-free survival (EFS) and overall survival (OS) at 5 years were 65% (+/-7%) and 77% (+/-6%), respectively. Patients who achieved a sustained molecular complete response (CR) had a lower risk of disease recurrence and experienced significantly longer EFS (93% (+/-6%) vs 11% (+/-7%) P=0.0008) and OS (100 vs 55% (+/-12%) P=0.0057). In conclusion, myeloablative therapy followed by purged ASCT may induce long EFS in patients with LGFL. The achievement of sustained molecular CR after ASCT improves EFS and OS.
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Affiliation(s)
- B Mahé
- Service d'Hématologie, Centre Hospitalier Universitaire Nantes, France
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28
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Moreau P, Facon T, Leleu X, Morineau N, Huyghe P, Harousseau JL, Bataille R, Avet-Loiseau H. Recurrent 14q32 translocations determine the prognosis of multiple myeloma, especially in patients receiving intensive chemotherapy. Blood 2002; 100:1579-83. [PMID: 12176874 DOI: 10.1182/blood-2002-03-0749] [Citation(s) in RCA: 224] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recently, we have described the biological correlations associated with the main translocations involving the 14q32 chromosomal region, that is, t(14q32), in patients with multiple myeloma (MM). We have now extended the analysis to the prognostic value of these chromosomal rearrangements in 168 consecutive patients with newly diagnosed MM receiving intensive chemotherapy within clinical trials of the Intergroupe Francophone du Myelome (IFM). Patients with t(4;14) displayed a poor outcome (short event-free survival and short overall survival), whereas those with t(11;14) displayed long survival. On the other hand, patients with neither t(4;14) nor t(11;14) presented an intermediate outcome. Importantly, chromosome 13 abnormalities (C13As) significantly influence the prognosis of this latter group. In contrast, C13As affected the outcome of the other patients to a much lesser extent, either because of an almost constant association (in the t(4;14) group) or because of a lack of any significant prognostic impact (in the t(11;14) group; only one event occurred in the 10 patients with t(11;14) and C13As). Considering that t(4;14) and t(11;14) (1) are the only (so far recognized) true, recurrent t(14q32)'s, (2) are linked to specific immunoglobulin isotypes, and (3) display specific outcomes, they represent distinct entities corresponding to a specific oncogenesis and prognosis. These data emphasized the interest in analyzing these two translocations by fluorescence in situ hybridization in prospective therapeutic trials in order to consider these translocations as distinct entities.
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Affiliation(s)
- Philippe Moreau
- Clinical Hematology Department and the Hematology Laboratory, University Hospital, Nantes, France
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29
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Moreau P, Misbahi R, Milpied N, Morineau N, Mahé B, Vigier M, Rapp MJ, Bataille R, Harousseau JL. Long-term results (12 years) of high-dose therapy in 127 patients with de novo multiple myeloma. Leukemia 2002; 16:1838-43. [PMID: 12200701 DOI: 10.1038/sj.leu.2402613] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 10/31/2001] [Accepted: 04/11/2002] [Indexed: 11/10/2022]
Abstract
This report describes the long-term outcome of a cohort of 127 de novo multiple myeloma patients treated with at least one course of high-dose therapy (HDT) in a single institution between June 1985 and December 1995, for whom the minimum follow-up duration for survivors is 6 years. The 12-year overall survival (OS) and event-free survival (EFS) rates are 24.9% and 3.1%, respectively, and the median survival and EFS are 49 and 17 months, respectively. Only four patients are alive and disease-free 79, 90, 132 and 153 after the first HDT, respectively. Three of them received a subsequent allogeneic bone marrow transplantation. Three factors significantly influence OS in this series: B2M at diagnosis, age, and the completion of a second HDT. The 10-year survival is 18.9% for the group of patients with B2M level >3 mg/l at diagnosis as compared with 41% for patients with B2M < or =3, with a median survival of 31 months vs 73 (P = 0.01). The 10-year survival is 23.4% for the group of patients aged >55 years as compared with 36.5% for patients aged <55 years, with a median survival of 34.5 months vs 70.5 (P = 0.04). The 10-year survival is 20.4% for the group of patients who did not receive a second HDT as compared with 35.2% for patients who completed a second HDT, with a median survival of 29 months vs 70 (P = 0.02). In this study we show that some patients treated with HDT experience durable remission and prolonged survival. This survival is significantly influenced by age (< or =55 years), B2M at diagnosis (< or =3 mg/l) and by the completion of two cycles of HDT.
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Affiliation(s)
- P Moreau
- Department of Hematology, University Hospital, Nantes, France
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30
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Spisek R, Chevallier P, Morineau N, Milpied N, Avet-Loiseau H, Harousseau JL, Meflah K, Gregoire M. Induction of leukemia-specific cytotoxic response by cross-presentation of late-apoptotic leukemic blasts by autologous dendritic cells of nonleukemic origin. Cancer Res 2002; 62:2861-8. [PMID: 12019165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Acute myeloid leukemias (AMLs) are monoclonal proliferations of undifferentiated myeloid progenitors in blood and bone marrow. Long-term remissions are achieved in <50% of patients. There is hope that activation of specific antileukemic immune responses could efficiently eliminate minimal residual disease at the end of chemotherapy and decrease the frequency of relapses. It was demonstrated that AML leukemic blasts can acquire the morphology and phenotype of dendritic cells (DCs), i.e., differentiate into leukemic DCs. However, this method has limitations as a potential immunotherapy. The alternative approach for the induction of leukemia-specific cytotoxicity we explored in this study consisted of using DCs of nonleukemic origin, pulsed with autologous apoptotic leukemic blasts. We show that mature pulsed nonleukemic DCs were successfully generated from remission samples of all tested patients with minimal interindividual differences. Mature pulsed DCs were used as antigen-presenting cells for leukemia-specific CTL induction. Specific cytotoxic activity against autologous AML blasts was demonstrated. Tumor lysis was autologous blast specific, with no killing activity against allogeneic leukemic cells or autologous mature unpulsed DCs and was MHC class I and class II restricted. In one patient, autologous CTLs stimulated by leukemic DCs or pulsed nonleukemic DCs showed similar significant cytotoxic activity against autologous AML cells. These findings demonstrate the induction of leukemia-specific cytotoxic response by nonleukemic mature DCs cross-presenting apoptotic leukemic blasts and offer a complementary approach to the use of leukemic DCs. We believe that this strategy permits the generation of DC vaccines for the majority of patients with hematological malignancies.
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Affiliation(s)
- Radek Spisek
- INSERM U419, Institut de Biologie, 9 Quai Moncousu, 44093 Nantes Cedex 01, France
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31
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Vigouroux S, Milpied N, Andrieu JM, Colonna P, Ifrah N, Colombat P, Desablens B, Abgrall JF, Casassus P, Guilhot F, Briere J, Le Mevel A, Moreau P, Mechinaud F, Mahe B, Morineau N, Vigier M, Rapp MJ, Harousseau JL. Front-line high-dose therapy with autologous stem cell transplantation for high risk Hodgkin's disease: comparison with combined-modality therapy. Bone Marrow Transplant 2002; 29:833-42. [PMID: 12058233 DOI: 10.1038/sj.bmt.1703547] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2001] [Accepted: 02/08/2002] [Indexed: 11/09/2022]
Abstract
This retrospective study compares high-dose therapy (HDT) with autologous stem cell transplantation and combined-modality treatment (CT) as a first-line therapy for Hodgkin's disease (HD) for patients with both a clinical stage (CS) IV and/or a mediastinal mass > or =0.45 of the thoracic diameter (MM > or =0.45) at diagnosis, and an incomplete response after the first-line chemotherapy. Data on 42 grafted patients (GP) in Nantes Hospital, France and on 108 combined-modality treated patients (CTP) from two protocols of the GOELAMS group, France (POF 81 and H90) was analyzed. Both groups were comparable except for pulmonary disease in excess in the grafted group (P = 0.01). Among GP, 95% were in complete response at the end of first-line treatment and 77% among CTP. Median follow-up was 53 months (range, 7 to 128 months) for GP and 88 months (range, 25 to 181 months) for CTP. The 5-year freedom from progression (FFP) and event-free survival (EFS) rates were better for GP (87% vs 55% for FFP: P = 0.0004 and 81% vs 51% for EFS: P = 0.0004) whereas the overall survival (OS) rates did not differ significantly (85% for GP vs 71% for CTP: P = 0.06). Similar results were obtained for the groups with a response > or =50% after initial chemotherapy: 91% vs 65% for FFP, P = 0.01; 87% vs 61% for EFS, P = 0.02; and 92% vs 77% for OS, P = 0.2; and for the groups with a response <50%: 80% vs 22% for FFP, P = 0.0003; 72% vs 13% for EFS, P = 0.0001; and 76% vs 46% for OS, P = 0.04. This study shows a better control of the disease with HDT.
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32
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Le Gouill S, Moreau P, Morineau N, Harousseau JL, Milpied N. Tandem high-dose therapy followed by autologous stem-cell transplantation for refractory or relapsed high grade non-Hodgkin's lymphoma with poor prognosis factors: a prospective pilot study. Haematologica 2002; 87:333-4. [PMID: 11869953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
We conducted a tandem autologous stem cell transplantation procedure for patients with relapsed or refractory high-grade non-Hodgkin's lymphoma (HGNHL) or with transformation of indolent lymphoma (n=15). These patients had poor prognosis factors. The procedure was well tolerated, ten patients were in complete remission. Overall survival rate is 67%.
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33
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Tang X, Morineau N, Milpied N, Moreau P, Bataille R, Harousseau JL. [Autologous peripheral blood selected CD34+ cell transplantation in the treatment of multiple myeloma]. Zhonghua Xue Ye Xue Za Zhi 2001; 22:370-3. [PMID: 11877101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To investigate the clinical impact of CD(34)(+) cell selected autologous peripheral blood stem cell transplantation (APBSCT) in multiple myeloma (MM). METHODS The hematopoietic recovery time, treatment efficacy, survival rate, transplantation related morbidity and the cost were compared between 21 MM patients receiving CD(34)(+) APBSCT and 21 MM patients receiving unselected APBSCT. The age and beta(2) microglobulin level at diagnosis and disease status at the time of transplantation were similar in the two groups. The induction treatment and conditioning regimen were the same. RESULTS Significantly lower CD(34)(+) cells were infused in the selected group as compared with the control group: 2.2 (0.5 - 14.3) x 10(6)/kg vs 9.4 (1.1 - 15.0) x 10(6)/kg, (P < 0.001). The median times to neutrophil >or= 0.5 x 10(9)/L and platelet >or= 20 x 10(9)/L were 10 and 9 days for the selected group, and 9.5 (P = 0.357) and 4.5 days (P = 0.005) for the control group, respectively. Response rates were similar in both groups (85.7% for the selected group vs 90.4% for the control group). Three year disease-free survival (32% for the selected group vs 39% for the control group) and overall survival rates (85% for the selected group vs 79% for the control group) were not significantly different. Furthermore, unselected APBSCT could reduce the cost for the transplantation. CONCLUSION It shows that CD(34)(+) cell selected autologous transplantation is more expensive and does not improve the clinical outcome of patients with MM.
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Affiliation(s)
- X Tang
- First Affiliated Hospital of Suzhou University, Suzhou 215006, China
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34
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Ninin E, Milpied N, Moreau P, André-Richet B, Morineau N, Mahé B, Vigier M, Imbert BM, Morin O, Harousseau JL, Richet H. Longitudinal study of bacterial, viral, and fungal infections in adult recipients of bone marrow transplants. Clin Infect Dis 2001; 33:41-7. [PMID: 11389493 DOI: 10.1086/320871] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2000] [Revised: 11/09/2000] [Indexed: 11/03/2022] Open
Abstract
The epidemiology of infections was studied in a retrospective cohort of 446 recipients of bone marrow transplants (BMTs; 92 of which were allogeneic and 354 of which were autologous) during 1993--1996. Infections that were microbiologically documented in 274 recipients included bacteremia, urinary tract infections, cytomegalovirus viremia, fungemia, invasive aspergillosis, and catheter-related infections. During the period of neutropenia, no differences were found between recipients of allogeneic BMTs and recipients of autologous BMTs with regard to the incidence and the nature of infection. After patients underwent engraftment, bacteremia, cytomegalovirus viremia, and invasive aspergillosis were significantly more common in recipients of allogeneic BMTs than in recipients of autologous BMTs. Deaths caused by infection were uncommon and were mainly the result of invasive aspergillosis. Therefore, empirical antimicrobial therapy should be the same for recipients of both allogeneic and autologous BMTs during the period of neutropenia; after engraftment, more attention should be paid to the risk of infection in allogeneic BMT recipients, particularly with regard to detection and prevention of invasive aspergillosis.
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Affiliation(s)
- E Ninin
- Laboratoire de Bactériologie-Virologie-Hygiène Hospitalière, Institut de Biologie des Hôpitaux de Nantes, Nantes, France.
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35
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Morineau N, Tang XW, Moreau P, Milpied N, Mahé B, Bataille R, Harousseau JL. Lack of benefit of CD34+ cell selected over non-selected peripheral blood stem cell transplantation in multiple myeloma: results of a single center study. Leukemia 2000; 14:1815-20. [PMID: 11021757 DOI: 10.1038/sj.leu.2401883] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In order to determine the clinical impact of CD34+ cell selected autologous transplantation in multiple myeloma (MM), we have performed a retrospective case-controlled analysis comparing 21 MM patients receiving high-dose melphalan and autologous transplantation with CD34+ peripheral blood stem cells (PBSC) as front-line therapy to 21 control patients receiving unselected products. Case matching was performed using the following criteria: age and beta2-microglobulin at diagnosis and disease status at the time of transplantation. Both cohorts were homogeneous in term of induction treatment and conditioning regimen. Patients were collected for CD34+ selection after priming with G-CSF alone. Significantly fewer CD34+ cells/kg were infused to patients in the selected group as compared to patients in the control group: 2.2 (range 0.5-14.3) vs 9.4 (range 1.1-15) (P < 0.001). The median time to neutrophil recovery > or =0.05 x 10(9)/l was 10 days for the CD34+ group and 9.5 days for the control group (P = 0.357). The median time to platelet recovery > or = 20 x 10(9)/l was 9 days for the CD34+ group and 4.5 days for the control group (P = 0.005). Response rates were comparable in both groups (85.7% in the CD34+ group vs 90.4% in the control group). At 3 years, event-free survival (32% in the CD34+ group vs 39% in the control group) and overall survival (85% in the CD34+ group vs 79% in the control group) were not significantly different. Finally, use of unselected products dramatically reduced the cost of the transplantation procedure. This study shows that CD34+ cell selected autologous transplantation is more expensive than transplantation with unselected products and does not improve the clinical outcome of patients with MM.
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Affiliation(s)
- N Morineau
- Department of Hematology, CHU Hôtel-Dieu, Nantes, France
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36
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Moreau P, Harousseau JL, Wijdenes J, Morineau N, Milpied N, Bataille R. A combination of anti-interleukin 6 murine monoclonal antibody with dexamethasone and high-dose melphalan induces high complete response rates in advanced multiple myeloma. Br J Haematol 2000; 109:661-4. [PMID: 10886221 DOI: 10.1046/j.1365-2141.2000.02093.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To improve the complete response (CR) rate in advanced multiple myeloma (MM) without increasing the toxicity of high-dose therapy, we have used a new conditioning regimen. A combination of BE-8 [an anti-interleukin 6 (IL-6) murine monoclonal antibody] and dexamethasone followed by high-dose melphalan (220 mg/m2) and autologous stem cell transplantation was used to treat a series of 16 patients with advanced multiple myeloma. A strong inhibition of IL-6 activity evaluated by quantification of C-reactive protein was observed in all patients and was correlated with the high CR rate achieved with this combination therapy.
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Affiliation(s)
- P Moreau
- Haematology Department, CHU Hôtel-Dieu, Nantes, and Diaclone Research, Besançon, France.
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37
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Avet-Loiseau H, Li JY, Morineau N, Facon T, Brigaudeau C, Harousseau JL, Grosbois B, Bataille R. Monosomy 13 is associated with the transition of monoclonal gammopathy of undetermined significance to multiple myeloma. Intergroupe Francophone du Myélome. Blood 1999; 94:2583-9. [PMID: 10515861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Chromosomal abnormalities are present in most (if not all) patients with multiple myeloma (MM) and primary plasma cell leukemia (PCL). Furthermore, recent data have shown that numerical chromosomal changes are present in most individuals with monoclonal gammopathy of undetermined significance (MGUS). Epidemiological studies have shown that up to one third of MM may emerge from pre-existing MGUS. To clarify further possible stepwise chromosomal aberrations on a pathway between MGUS and MM, we have analyzed 158 patients with either MM or primary PCL and 19 individuals with MGUS using fluorescence in situ hybridization (FISH). Our FISH analyses were designed to detect illegitimate IGH rearrangements at 14q32 or monosomy 13. Whereas translocations involving the 14q32 region were observed with a similar incidence (60%) in both conditions, a significant difference was found in the incidence of monosomy 13 in MGUS versus MM or primary PCL. It was present in 40% of MM/PCL patients, but in only 4 of 19 MGUS individuals. Moreover, whereas monosomy 13 was found in the majority of plasma cells in MM, it was observed only in cell subpopulations in MGUS. It is noteworthy that, in a group of 20 patients with MM and a previous MGUS history, incidence of monosomy 13 was 70% versus 31% in MM patients without a known history of MGUS (P =.002). Thus, this study highlights monosomy 13 as correlated with the transformation of MGUS to overt MM and may define 2 groups of MM with possible different natural history and outcome, ie, post-MGUS MM with a very high incidence of monosomy 13 and de novo MM in which other genetic events might be involved. Serial analyses of individuals with MGUS will be needed to validate this model.
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MESH Headings
- Aged
- Aged, 80 and over
- Cell Transformation, Neoplastic/genetics
- Chromosomes, Human, Pair 13/genetics
- Chromosomes, Human, Pair 14/genetics
- Disease Progression
- Female
- Genes, Immunoglobulin
- Humans
- Immunoglobulin Heavy Chains/genetics
- In Situ Hybridization, Fluorescence
- Leukemia, Plasma Cell/genetics
- Leukemia, Plasma Cell/pathology
- Male
- Middle Aged
- Monosomy
- Multiple Myeloma/genetics
- Multiple Myeloma/pathology
- Paraproteinemias/genetics
- Paraproteinemias/pathology
- Precancerous Conditions/genetics
- Precancerous Conditions/pathology
- Prognosis
- Recombination, Genetic
- Translocation, Genetic
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Affiliation(s)
- H Avet-Loiseau
- Laboratory of Hematology, the Clinical Hematology Department, Centre Hospitalier Universitaire, Nantes, France.
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38
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Abstract
Recently a high incidence of interstitial deletion of the P53 locus has been reported in multiple myeloma (MM) patients. Considering the importance of such an event, we analysed 79 patients with advanced-stage disease using fluorescence in situ hybridization (FISH). Strikingly, we found only 7/79 patients with a P53 deletion. In order to rule out any differences in probe selection, we reanalysed all the patients with the same probe as that used in a previous study, and confirmed the low incidence of P53 deletion (7/79, 9%). The only explanation is a difference in hybridization efficiency. Since hybridization is far less efficient on malignant plasma cells than on other bone marrow cells we suggest that this poor hybridization efficiency may lead to a false P53 deletion.
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Affiliation(s)
- H Avet-Loiseau
- Laboratory of Haematology, University Hospital, Lille, France
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39
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Le Gouill SL, Morineau N, Miégeville M, Milpied N, Harousseau JL, Moreau P. [Pseudallescheria boydii osteoarthritis in a patient with acute lymphoblastic leukemia: a case report]. Rev Med Interne 1999; 20:434-8. [PMID: 10365416 DOI: 10.1016/s0248-8663(99)83097-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The outcome of neutropenic patients with Pseudallescheria boydii infection is poor. EXEGESIS We report the first case of Pseudallescheria boydii hip arthritis in a patient treated for acute lymphoblastic leukemia. In vitro susceptibility testing showed that the strain was resistant to amphotericin B, fluorocytosine and nystatin, but susceptible to itraconazole. The patient received oral itraconazole (600 mg/day) and clinical symptoms initially resolved. Two months later, after a course of chemotherapy and high-dose steroids while receiving oral itraconazole treatment, the patient developed fever, skin lesions and disseminated lung infiltrates due to Pseudallescheria boydii and finally died. CONCLUSION This case illustrates the severity of fungal infections due to Pseudallescheria boydii despite a presumably well-conducted antifungal therapy.
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Affiliation(s)
- S L Le Gouill
- Service d'hématologie clinique, Hôtel-Dieu, CHU, Nantes, France
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Avet-Loiseau H, Brigaudeau C, Morineau N, Talmant P, Laï JL, Daviet A, Li JY, Praloran V, Rapp MJ, Harousseau JL, Facon T, Bataille R. High incidence of cryptic translocations involving the Ig heavy chain gene in multiple myeloma, as shown by fluorescence in situ hybridization. Genes Chromosomes Cancer 1999; 24:9-15. [PMID: 9892103 DOI: 10.1002/(sici)1098-2264(199901)24:1<9::aid-gcc2>3.0.co;2-k] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Cytogenetic studies have shown rearrangements of the Ig heavy chain (IGH) gene at 14q32 in 10-60% of patients with multiple myeloma (MM) or primary plasma cell leukemia (PCL). Analysis of MM patients and human myeloma cell lines (HMCL) using interphase fluorescence in situ hybridization (FISH) and molecular techniques has shown IGH rearrangements in 75% of MM cases and in up to 100% of HMCL. A review of the literature revealed at least 18 different partner chromosomal regions. To investigate whether some of these translocations were recurrent and possibly to identify new partner regions, we developed a set of FISH probes to detect every IGH recombination. We analyzed 28 MM and 4 primary PCL patients with abnormal karyotypes and 12 HMCL. Whereas conventional cytogenetics detected a 14q32 abnormality in only 15% of the patients, FISH detected it in 47% of patients and in 75% of HMCL. The partner chromosome was identified in 10 of 15 patients with a 14q32 rearrangement. Interestingly, the same t(4; 14)(p16;q32) was detected in five patients and three HMCL, i.e., 33% of patients and HMCL with an IGH rearrangement. New partner chromosomal regions have also been identified, i.e., 9p13, 12p11, 12p13, and Xq28, besides the previously reported 8q24, 11q13, 12q24, and 16q24 rearrangements. The genes involved in these new translocations are not known, except for 9p13, where PAX5 was shown to be the partner gene. We conclude that: I) IGH recombinations are frequent but not constant in MM, 2) these rearrangements often occur through cryptic translocations, and 3) the t(4;14)(p16;q32) is one of the most frequent translocations, but many other chromosomal regions may be involved.
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Affiliation(s)
- H Avet-Loiseau
- Laboratory of Hematology, University Hospital, Nantes, France
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Avet-Loiseau H, Li JY, Facon T, Brigaudeau C, Morineau N, Maloisel F, Rapp MJ, Talmant P, Trimoreau F, Jaccard A, Harousseau JL, Bataille R. High incidence of translocations t(11;14)(q13;q32) and t(4;14)(p16;q32) in patients with plasma cell malignancies. Cancer Res 1998; 58:5640-5. [PMID: 9865713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Abnormalities involving the 14q32 region are recurrent chromosomal changes in plasma cell malignancies. Recent preliminary molecular analyses found IGH rearrangements in almost 100% of human myeloma cell lines and in 75% of patients. However, no systematic study analyzing the nature of the partner chromosomal regions have been reported thus far. To define the exact incidence of illegitimate IGH rearrangements and the respective incidence of partner genes cloned to date, we analyzed 141 patients with either multiple myeloma (MM, n = 127) or primary plasma cell leukemia (PCL, n = 14) using fluorescence in situ hybridization. The overall incidence of illegitimate recombinations was 57% (80 of 141 patients). Analysis of this incidence according to Durie and Salmon stage, patients' status, i.e., MM versus primary PCL and diagnosis versus relapse, immunoglobulin type and subtype, and beta2-microglobulin value, did not show any correlation. To analyze the nature of the partner chromosomal region, we selected probes specific for the following genes: FGFR3 (4p16), MYC (8q24), CCND1 (11q13), MAF (16q23), and BCL2 (18q21). These probes, combined with differentially labeled 14q32 probes, were used for dual-color fluorescence in situ hybridization on interphase plasma cells. Among the 80 patients with illegitimate IGH rearrangement, we identified 23 IGH-CCND1 fusion cases [i.e., t(11;14)], 17 IGH-FGFR3 fusion cases [i.e., t(4;14)], 3 IGH-MYC fusion cases [i.e., t(8;14)], and only one IGH-MAF fusion case. No IGH-BCL2 fusion case was detected. In 37 of 80 patients, none of these partner genes was involved. Analysis of cases with specific translocations according to their bioclinical features at diagnosis did not show any correlation. This study demonstrated that CCND1 and FGFR3 genes are involved together in about 50% of MM and primary PCL patients with illegitimate IGH rearrangements.
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Affiliation(s)
- H Avet-Loiseau
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire, Nantes, France
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Milpied N, Gaillard F, Moreau P, Mahé B, Souchet J, Rapp MJ, Bulabois CE, Morineau N, Harousseau JL. High-dose therapy with stem cell transplantation for mantle cell lymphoma: results and prognostic factors, a single center experience. Bone Marrow Transplant 1998; 22:645-50. [PMID: 9818691 DOI: 10.1038/sj.bmt.1701400] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
From 1991 to 1997 18 consecutive patients with well-defined mantle cell lymphoma (MCL) underwent high-dose therapy with unpurged autologous (17 patients) or allogeneic (one patient) stem cell transplantation. Tissue sections were reviewed for morphology, immunophenotype, cyclin D1 and P53 expression as well as proliferation index (PI). Median age of patients was 47 years (range 40-60). Sixteen had stage IV disease with bone marrow involvement in 12 and performance status was > or =1 in 12 patients. At the time of high-dose therapy 10 patients were in first partial response (PR), one was in second complete remission (CR), four were in second PR and three were refractory to conventional anthracycline-containing chemotherapy. The conditioning regimen consisted of TBI plus chemotherapy in 13 patients and chemotherapy only (BEAM) in five patients. No treatment-related deaths were observed. With a median follow-up of 36 months (range 13-80) after transplant, disease-free survival (DFS) and overall survival (OS) are estimated to be 48 and 80% at 4 years, respectively. Significantly better results are achieved for patients transplanted after a TBI containing regimen with a 4 year OS and DFS estimated at 89 and 71%, respectively compared to 60 and 0% respectively for patients who were conditioned without TBI (P = 0.07 for OS and P < 0.0001 for DFS). There is a trend towards better DFS when the transplant is performed in PR1 (4 year DFS: 80% with eight patients out of 10 in continuous CR 13 to 80 months, median 36 months after transplant) compared to more advanced stages (4 year DFS: 18% with only three patients out of eight in continuous CR 16, 17 and 58 months after transplant). Blastic histology and P53 overexpression are also associated with a trend towards a worst prognosis.
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Affiliation(s)
- N Milpied
- Department of Hematology, University Hospital, Nantes, France
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Moreau P, Milpied N, Rapp MJ, Moreau A, Bourdin S, Mahe MA, Dupas B, Le Tortorec S, Hamidou M, Maisoneuve H, Mahe B, Bulabois CE, Morineau N, Jardel H, Harousseau JL. Early intensive therapy with autologous stem cell transplantation in high-risk Hodgkin's disease: long-term follow-up in 35 cases. Leuk Lymphoma 1998; 30:313-24. [PMID: 9713963 DOI: 10.3109/10428199809057544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Thirty-five adult patients with high-risk HD (HD) defined by (1) Ann Arbor stage IV or bulky nodal disease (tumor/thorax ratio > 0.45) and (2) no or partial response (PR) (< 75%) to the initial 3 courses of ABVD, received an early intensive therapy with autologous stem cell transplantation (ASCT). Thirty patients were considered as partial responders and 5 as refractory to initial chemotherapy. Conditioning regimen consisted of chemotherapy alone (CBV in 11 patients before 1993, BEAM in 13 patients since 1993) followed by adjuvant radiotherapy: 40 Gy) on the initial sites of bulky disease, or 12 Gy total body irradiation plus 120 mg/kg cyclophosphamide in 11 patients with disseminated extra-nodal disease. All 30 patients in PR at the time of ASCT experienced prolonged complete remission (CR). One patient died in CR from an acute myocardial infarction 48 months after ASCT. Four out of the 5 patients with refractory disease at the time of ASCT experienced rapid progression of HD leading to death in 3 cases. After 6 years of CR post-ASCT, the last refractory patient died of myelodysplastic syndrome diagnosed 2 years after intensive therapy. With a median follow-up for surviving patients of 51 months (range: 11-111), the cumulative probability of 8-year overall survival is 75.6% for the entire group of patients, 94.1% for the chemosensitive ones, and 0% for the primary refractory (P < .0001). The cumulative probability of 8-year event-free survival is 79.9% for the entire group of patients, 94.1% for the chemosensitive ones, and 0% for the primary refractory (P < .0001). We conclude that early intensive therapy with ASCT is feasible in patients with high-risk HD and induces a high cure rate in chemosensitive patients. In primary refractory patients, new therapeutic approaches are warranted.
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Affiliation(s)
- P Moreau
- Department of Hematology, CHU Hôtel-Dieu, Nantes, France
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