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Xhaard A, Villate A, Hamane S, Michonneau D, Menotti J, Robin M, Sicre de Fontbrune F, Dhédin N, Peffault de la Tour R, Socié G, Bretagne S. A 10-year retrospective analysis of Toxoplasma gondii qPCR screening in allogeneic hematopoietic stem cell transplantation recipients. Bone Marrow Transplant 2023; 58:152-159. [PMID: 36335254 DOI: 10.1038/s41409-022-01861-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 11/08/2022]
Abstract
Weekly blood Toxoplasma gondii DNA screening using real-time quantitative polymerase chain reaction (qPCR) has been implemented in all allogeneic hematopoietic stem cell transplantation (alloHSCT) recipients at our hospital. We retrospectively analyzed the consequences of a positive blood qPCR in the management of Toxoplasma infection (TI) and disease (TD).From 2011 to 2020, 52 (4.13%) of 1 257 alloHSCT recipients had at least one positive qPCR, 45 (3.5%) with TI and seven (0.56%) with TD (central nervous system involvement). Forty-four patients were qPCR-positive before day 100, 30 without and 14 with anti-Toxoplasma prophylaxis. Twenty-five of them (56.8%) started or continued prophylactic dosage treatment: all became qPCR-negative, including 20 (80%) receiving only prophylactic dosage treatment. Twenty-four of them (54.5%) received non-prophylactic dosage treatment: qPCR became negative in 22/24 (91.7%), while TI contributed to death in two cases. Six of the eight patients diagnosed after D100 had breakthrough TI or TD. No death was attributable to TI or TD. qPCR kinetics available for 24 patients increased until anti-Toxoplasma treatment began, then decreased with all treatment regimens.Clinical follow-up and qPCR monitoring with quantification of the parasitic load appears a reasonable strategy to avoid TD and to use minimal effective dosage of anti-Toxoplasma treatments.
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Affiliation(s)
- Alienor Xhaard
- Service d'hématologie-greffe, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France.
| | - Alban Villate
- Service d'hématologie et thérapie cellulaire, CHRU Tours, Tours, France
| | - Samia Hamane
- Laboratoire de mycologie-parasitologie, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - David Michonneau
- Service d'hématologie-greffe, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France.,INSERM UMR 976 (Team Insights), Université Paris Diderot, Paris, France.,Université Paris Cité, Paris, France
| | - Jean Menotti
- Laboratoire de mycologie-parasitologie, Hospices Civils de Lyon, Lyon, France
| | - Marie Robin
- Service d'hématologie-greffe, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Flore Sicre de Fontbrune
- Service d'hématologie-greffe, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Nathalie Dhédin
- Service d'hématologie adolescents jeunes adultes, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Régis Peffault de la Tour
- Service d'hématologie-greffe, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France.,Université Paris Cité, Paris, France
| | - Gérard Socié
- Service d'hématologie-greffe, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France.,INSERM UMR 976 (Team Insights), Université Paris Diderot, Paris, France.,Université Paris Cité, Paris, France
| | - Stéphane Bretagne
- Laboratoire de mycologie-parasitologie, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France.,Université Paris Cité, Paris, France
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Alanio A, Menotti J, Gits-Muselli M, Hamane S, Denis B, Rafoux E, Peffault de la Tour R, Touratier S, Bergeron A, Guigue N, Bretagne S. Circulating Aspergillus fumigatus DNA Is Quantitatively Correlated to Galactomannan in Serum. Front Microbiol 2017; 8:2040. [PMID: 29163378 PMCID: PMC5671575 DOI: 10.3389/fmicb.2017.02040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/05/2017] [Indexed: 12/20/2022] Open
Abstract
The performance of antigen galactomannan (GM) for diagnosing invasive aspergillosis (IA) is hampered by the occurrence of false-positive results. Quantitative PCR has been proposed to improve the diagnosis of IA. Therefore, we analyzed the value of performing a PCR test to the GM-positive serum sample. Using a quantitative PCR assay specific for Aspergillus fumigatus 28S ribosomal DNA, we retrospectively tested 422 GM-positive (Platelia Bio-Rad kit) serum samples collected over 1 year from 147 patients. The cases were classified based on EORTC criteria as “proven,” “probable,” and “no–IA” before availability of the PCR results. After exclusion of 65 samples for non-reproducibility of GM positivity (n = 62) or PCR inhibition (n = 3), 75 (21.0%) of the remaining 357 samples were PCR-positive. GM and fungal DNA showed a significantly positive correlation (p < 0.0001, R2 = 0.27, slope = 0.98 ± 0.19). At least one PCR-positive result was observed in 63.3% (31/49) of IA patients and in 13.2% (13/98) of non-IA patients (p < 0.0001). The PCR positivity was also associated with the presence of other microbiological criteria among the 44 patients with IA and complete mycological workup (p = 0.014), as well as a higher mortality rate at six months among the 135 patients with hematological conditions (p = 0.0198). Overall, we found a quantitative correlation between serum GM and circulating DNA with an increased likelihood of IA when both were positive. A PCR-positive result also supported a higher fungal load when GM was already positive. We advocate adding a PCR test for every confirmed GM-positive serum sample.
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Affiliation(s)
- Alexandre Alanio
- Laboratoire de Parasitologie-Mycologie, APHP, Paris, France.,Université Paris-Diderot, Université Sorbonne Paris Cité, Paris, France.,Unité de Mycologie Moléculaire, Institut Pasteur, CNRS URA 3012, Centre National de Référence des Mycoses Invasives et des Antifongiques, URA 3012, Paris, France
| | - Jean Menotti
- Laboratoire de Parasitologie-Mycologie, APHP, Paris, France.,Université Paris-Diderot, Université Sorbonne Paris Cité, Paris, France
| | - Maud Gits-Muselli
- Laboratoire de Parasitologie-Mycologie, APHP, Paris, France.,Université Paris-Diderot, Université Sorbonne Paris Cité, Paris, France
| | - Samia Hamane
- Laboratoire de Parasitologie-Mycologie, APHP, Paris, France
| | - Blandine Denis
- Service de Maladie Infectieuses et Tropicales, AP-HP, Paris, France
| | | | - Régis Peffault de la Tour
- Université Paris-Diderot, Université Sorbonne Paris Cité, Paris, France.,Service d'Hématologie-Greffe de Moelle, APHP, Paris, France
| | | | - Anne Bergeron
- Université Paris-Diderot, Université Sorbonne Paris Cité, Paris, France.,Service de Pneumologie, APHP, Paris, France
| | - Nicolas Guigue
- Laboratoire de Parasitologie-Mycologie, APHP, Paris, France
| | - Stéphane Bretagne
- Laboratoire de Parasitologie-Mycologie, APHP, Paris, France.,Université Paris-Diderot, Université Sorbonne Paris Cité, Paris, France.,Unité de Mycologie Moléculaire, Institut Pasteur, CNRS URA 3012, Centre National de Référence des Mycoses Invasives et des Antifongiques, URA 3012, Paris, France
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Alanio A, Denis B, Hamane S, Raffoux E, Peffault de la Tour R, Touratier S, Bergeron A, Bretagne S. New therapeutic strategies for invasive aspergillosis in the era of azole resistance: how should the prevalence of azole resistance be defined? J Antimicrob Chemother 2017; 71:2075-8. [PMID: 27494830 DOI: 10.1093/jac/dkw036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Given reports showing a high prevalence of azole resistance in Aspergillus fumigatus, alternatives to azole therapy are discussed when a threshold of 10% of azole-resistant environmental isolates is reached. This raises the issue of calculation of this threshold, either on the prevalence of azole-resistant isolates as a whole or on the prevalence of azole-resistant cases in populations at risk of invasive aspergillosis (IA). For isolate evaluation, there are high disparities in routine microbiological procedures for the isolation of A. fumigatus and azole resistance detection. There are also huge differences between the microbiological work-up for diagnosing IA. Some centres rely on galactomannan detection alone without actively trying to culture appropriate samples, which affects reliability of the figures on the prevalence of resistance and thus the threshold of resistance. Moreover, reports from the laboratory could mix up figures from completely different patient populations: frequent azole-resistant isolates from pneumology patients and rare azole-resistant isolates from haematology patients. Therefore, to sum isolates from different specimens and different wards can lead to erroneous calculations for the restricted populations at risk of developing IA. In conclusion, assessing the incidence of azole resistance in A. fumigatus should be based on harmonized consensual microbiological methods and reports should be restricted to IA episodes in identified populations at risk of IA when the issue is to define an operational threshold for modifying recommendations.
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Affiliation(s)
- Alexandre Alanio
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France Paris Diderot, Sorbonne Paris Cité University, Paris, France Institut Pasteur, Molecular Mycology Unit, National Reference Centre of Invasive Mycoses and Antifungals, CNRS URA 3012, Paris, France
| | - Blandine Denis
- Service de Maladie Infectieuses et tropicales, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Samia Hamane
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Emmanuel Raffoux
- Service d'Hématologie adulte, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Régis Peffault de la Tour
- Paris Diderot, Sorbonne Paris Cité University, Paris, France Service d'Hématologie-Greffe de Moelle, AP-HP, Groupe hospitalier Lariboisière-Saint Louis, Paris, France
| | - Sophie Touratier
- Service de Pharmacie, AP-HP, Groupe hospitalier Lariboisière-Saint Louis, Paris, France
| | - Anne Bergeron
- Paris Diderot, Sorbonne Paris Cité University, Paris, France Service de Pneumologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France
| | - Stéphane Bretagne
- Laboratoire de Parasitologie-Mycologie, AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France Paris Diderot, Sorbonne Paris Cité University, Paris, France Institut Pasteur, Molecular Mycology Unit, National Reference Centre of Invasive Mycoses and Antifungals, CNRS URA 3012, Paris, France
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Wang L, Raffoux E, Thomas X, Yakoub-Agha I, Bouhris JH, de Botton S, Michallet M, Quoc SN, Chantepie S, Deconinck E, Caillot D, Turlure P, Vigouroux S, Pigneux A, Huynh A, Malfuson JV, Loschi M, Socie G, Dombret H, de la Tour RP, Cluzeau T. Immune stimulation during chemotherapy increases incidence of acute graft versus host disease in acute myeloid leukemia: A study on behalf of SFGM-TC and ALFA. Leuk Res 2017; 54:12-16. [PMID: 28088653 DOI: 10.1016/j.leukres.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 10/20/2022]
Abstract
60-70% of AML patients have an indication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) during their treatment. Graft versus host disease (GvHD), the major cause of mortality and comorbidities post-transplantation, develops by immunological mechanism and decides greatly prognosis and quality of life (QoL) of graft recipient. Current GvHD prophylaxis is not personalized. Infections, toxicities and leukemic infiltration complicate the first chemotherapy phases prior to allo-HSCT. They, to certain extent, induce local immune stimulation. Impact of immune stimulation of this period on incidence of GvHD has not been evaluated. We retrospectively studied 238 AML patients transplanted at first remission from 21 French centers in the ALFA-0702 protocol and found that cutaneous and digestive immune stimulation during induction increases the incidence of skin and gut aGVHD, respectively. Furthermore, prolonged febrile duration correlates with elevated incidence of grade II-IV aGvHD. Thus, we identified a group of patients with higher risk of aGvHD. The benefit of personalized GvHD prophylaxis should be explored in a prospective cohort to decrease incidence of aGvHD in these patients and improve their QoLs.
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Affiliation(s)
- Lining Wang
- Saint Louis Hospital, Hematology Department, Paris, France; Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Saint Louis Hospital, Stem Cell Transplantation Unit, Paris, France
| | | | - Xavier Thomas
- Centre hospitalier Lyon Sud, Hematology Department, Lyon, France
| | | | | | | | | | | | - Sylvain Chantepie
- Institut d'Hématologie de Basse-Normandie, Bâtiment Sud Avenue Côte de Nacre, Caen, France
| | | | | | | | - Stéphane Vigouroux
- CHU Bordeaux, Haut Leveque Hospital, Hematology Department, Pessac, France
| | - Arnaud Pigneux
- CHU Bordeaux, Haut Leveque Hospital, Hematology Department, Pessac, France
| | - Anne Huynh
- CHU Toulouse, Hematology Department, Toulouse, France
| | | | - Michael Loschi
- Centre Henri Becquerel, Hematology Department, Rouen, France
| | - Gerard Socie
- Saint Louis Hospital, Stem Cell Transplantation Unit, Paris, France
| | - Hervé Dombret
- Saint Louis Hospital, Hematology Department, Paris, France
| | | | - Thomas Cluzeau
- Saint Louis Hospital, Hematology Department, Paris, France; Mediterranean Center of Molecular Medicine, INSERM U1065, Nice, France.
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Borie R, Kannengiesser C, Hirschi S, Le Pavec J, Mal H, Bergot E, Jouneau S, Naccache JM, Revy P, Boutboul D, Peffault de la Tour R, Wemeau-Stervinou L, Philit F, Cordier JF, Thabut G, Crestani B, Cottin V. Severe hematologic complications after lung transplantation in patients with telomerase complex mutations. J Heart Lung Transplant 2014; 34:538-46. [PMID: 25612863 DOI: 10.1016/j.healun.2014.11.010] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 10/29/2014] [Accepted: 11/04/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Mutations in the telomerase complex (TERT and TR) are associated with pulmonary fibrosis and frequent hematologic manifestations. The aim of this study was to characterize the prognosis of lung transplantation in patients with TERT or TR mutations. METHODS Patients with documented TERT or TR mutations who received a lung transplant between 2007 and 2013 in France were identified via an exhaustive search of the lung transplantation network, one expert genetic laboratory, and the clinical research network on rare pulmonary diseases. RESULTS There were 9 patients (7 men) with TERT (n = 6) or TR (n = 3) mutations who received a single (n = 8) or a double (n = 1) lung transplant for pulmonary fibrosis. Median age was 50 years (range, 35-61 years) at diagnosis and 52 years (range, 37-62 years) at the time of lung transplantation. Thrombocytopenia was present in 7 patients before lung transplantation. After lung transplantation, 6 patients developed myelodysplasia and/or bone marrow failure, directly contributing to death in 4 cases. Anemia was observed in 9 patients, and neutropenia was observed in 3 patients. The median survival after lung transplantation was 214 days (range, 59-1,709 days). CONCLUSIONS Patients with mutations of the telomerase complex are at high risk of severe hematologic complications after lung transplantation, in particular, bone marrow failure. Specific recommendations should be developed for appropriate guidance regarding hematologic risk assessment before transplantation and management of the post-transplantation immunosuppressive regimen.
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Affiliation(s)
- Raphael Borie
- APHP, Hôpital Bichat, DHU FIRE Service de Pneumologie A, Centre de compétence des maladies pulmonaires rares, INSERM, Unité 1152, Université Paris Diderot, Paris, France
| | | | - Sandrine Hirschi
- Service de Pneumologie, Centre de compétence des maladies pulmonaires rares, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jérôme Le Pavec
- Service de chirurgie thoracique et de transplantation pulmonaire, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Hervé Mal
- Service de Pneumologie B, APHP, Hôpital Bichat, Paris, France
| | | | - Stéphane Jouneau
- Service de Pneumologie, Centre de compétence des maladies pulmonaires rares, Hôpital Pontchaillou, IRSET UMR 1085, Université de Rennes 1, Rennes, France
| | - Jean-Marc Naccache
- Service de Pneumologie, Centre de compétence des maladies pulmonaires rares, Hôpital Tenon, Paris, France
| | - Patrick Revy
- INSERM UMR 1163, Laboratory of Genome Dynamics in the Immune System, Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France
| | - David Boutboul
- Service d'Immunopathologie clinique, APHP, Hôpital St Louis, Paris, France
| | - Régis Peffault de la Tour
- Service d'Hématologie greffe, centre de référence maladie rare aplasie médullaire, APHP, Hôpital St Louis, Paris, France
| | - Lidwine Wemeau-Stervinou
- Service de Pneumologie, Centre de compétence des maladies pulmonaires rares, CHRU de Lille, Lille, France
| | - Francois Philit
- Service de Pneumologie, Centre national de référence des maladies pulmonaires rares, Hôpital Louis Pradel, Université Claude Bernard Lyon 1, Lyon, France
| | - Jean-François Cordier
- Service de Pneumologie, Centre national de référence des maladies pulmonaires rares, Hôpital Louis Pradel, Université Claude Bernard Lyon 1, Lyon, France
| | - Gabriel Thabut
- Service de chirurgie thoracique et de transplantation pulmonaire, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France
| | - Bruno Crestani
- APHP, Hôpital Bichat, DHU FIRE Service de Pneumologie A, Centre de compétence des maladies pulmonaires rares, INSERM, Unité 1152, Université Paris Diderot, Paris, France.
| | - Vincent Cottin
- Service de Pneumologie, Centre national de référence des maladies pulmonaires rares, Hôpital Louis Pradel, Université Claude Bernard Lyon 1, Lyon, France
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