1
|
Mauget M, Lemercier S, Quelven Q, Maamar A, Lhomme F, de Guibert S, Houot R, Manson G. Impact of diagnostic investigations in the management of CAR T-cell-associated neurotoxicity. Blood Adv 2024:bloodadvances.2023011669. [PMID: 38501964 DOI: 10.1182/bloodadvances.2023011669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 03/20/2024] Open
Abstract
International guidelines regarding the management of immune effector cell-associated neurotoxicity syndrome (ICANS) recommend several diagnostic investigations, including MRI, lumbar puncture (LP) and EEG based on ICANS grade. However, the impact of these investigations has not yet been evaluated. Here, we aimed to describe the role of MRI, LP and EEG in the management of ICANS in a cohort of real-life patients treated with CAR T-cells at the University Hospital of Rennes, France. Between August 2018 and January 2023, 190 consecutive patients were treated with CAR T-cells. Among those, 91 (48%) patients developed ICANS. MRI was performed in 71 (78%) patients with ICANS, with a therapeutic impact in 4% of patients, despite frequent abnormal findings. Lumbar puncture was performed in 43 (47%) patients which led to preemptive antimicrobial agents in 7% of patients although no infection was eventually detected. Systematic EEG was performed in 51 (56%) patients which led to therapeutic modifications in 16% of patients. Our study shows that EEG is the diagnostic investigation with the greatest therapeutic impact while MRI and LP appear to have a limited therapeutic impact. Our results emphasize the role of EEG in the current guidelines, but questions the need for systematic MRI and LP, which might be left to the discretion of the treating physician.
Collapse
|
2
|
Oluwole OO, Forcade E, Muñoz J, de Guibert S, Vose JM, Bartlett NL, Lin Y, Deol A, McSweeney P, Goy AH, Kersten MJ, Jacobson CA, Farooq U, Minnema MC, Thieblemont C, Timmerman JM, Stiff P, Avivi I, Tzachanis D, Zheng Y, Vardhanabhuti S, Nater J, Shen RR, Miao H, Kim JJ, van Meerten T. Long-term outcomes of patients with large B-cell lymphoma treated with axicabtagene ciloleucel and prophylactic corticosteroids. Bone Marrow Transplant 2024; 59:366-372. [PMID: 38177222 PMCID: PMC10920180 DOI: 10.1038/s41409-023-02169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
ZUMA-1 safety management cohort 6 investigated the impact of prophylactic corticosteroids and earlier corticosteroids and/or tocilizumab on the incidence and severity of cytokine release syndrome (CRS) and neurologic events (NEs) following axicabtagene ciloleucel (axi-cel) in patients with relapsed/refractory large B-cell lymphoma (R/R LBCL). Prior analyses of cohort 6 with limited follow-up demonstrated no Grade ≥3 CRS, a low rate of NEs, and high response rates, without negatively impacting axi-cel pharmacokinetics. Herein, long-term outcomes of cohort 6 (N = 40) are reported (median follow-up, 26.9 months). Since the 1-year analysis (Oluwole, et al. Blood. 2022;138[suppl 1]:2832), no new CRS was reported. Two new NEs occurred in two patients (Grade 2 dementia unrelated to axi-cel; Grade 5 axi-cel-related leukoencephalopathy). Six new infections and eight deaths (five progressive disease; one leukoencephalopathy; two COVID-19) occurred. Objective and complete response rates remained at 95% and 80%, respectively. Median duration of response and progression-free survival were reached at 25.9 and 26.8 months, respectively. Median overall survival has not yet been reached. Eighteen patients (45%) remained in ongoing response at data cutoff. With ≥2 years of follow-up, prophylactic corticosteroids and earlier corticosteroids and/or tocilizumab continued to demonstrate CRS improvement without compromising efficacy outcomes, which remained high and durable.
Collapse
Affiliation(s)
| | - Edouard Forcade
- Service d'Hématologie Clinique et Thérapie Cellulaire, Centre Hospitalier Universitaire de Bordeaux, F-33000, Bordeaux, France
| | - Javier Muñoz
- Banner MD Anderson Cancer Center, Gilbert, AZ, USA
| | - Sophie de Guibert
- Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Julie M Vose
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Nancy L Bartlett
- Washington University School of Medicine and Siteman Cancer Center, St Louis, MO, USA
| | - Yi Lin
- Mayo Clinic, Rochester, MN, USA
| | - Abhinav Deol
- Karmanos Cancer Center, Wayne State University, Detroit, MI, USA
| | | | - Andre H Goy
- John Theurer Cancer Center, Hackensack, NJ, USA
| | - Marie José Kersten
- Amsterdam UMC, Location University of Amsterdam, Cancer Center Amsterdam, Amsterdam (on behalf of HOVON/LLPC), The Netherlands
| | | | | | - Monique C Minnema
- University Medical Center Utrecht (on behalf of HOVON/LLPC), Utrecht, The Netherlands
| | - Catherine Thieblemont
- Paris University, Assistance publique-Hôpitaux de Paris, Hemato-oncology, F-75010, Paris, France
| | - John M Timmerman
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Patrick Stiff
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Irit Avivi
- Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Yan Zheng
- Kite, a Gilead Company, Santa Monica, CA, USA
| | | | - Jenny Nater
- Kite, a Gilead Company, Santa Monica, CA, USA
| | | | - Harry Miao
- Kite, a Gilead Company, Santa Monica, CA, USA
| | - Jenny J Kim
- Kite, a Gilead Company, Santa Monica, CA, USA
| | - Tom van Meerten
- University Medical Center Groningen, Groningen (on behalf of HOVON/LLPC), The Netherlands
| |
Collapse
|
3
|
Michallet AS, Letestu R, Le Garff-Tavernier M, Campos L, Ticchioni M, Dilhuydy MS, Morisset S, Rouille V, Mahé B, Laribi K, Villemagne B, Ferrant E, Tournilhac O, Delmer A, Molina L, Leblond V, Tomowiak C, de Guibert S, Orsini-Piocelle F, Banos A, Carassou P, Cartron G, Fornecker LM, Ysebaert L, Dartigeas C, Truchan-Graczyk M, Vilque JP, Schleinitz TA, Cymbalista F, Leprêtre S, Lévy V, Nguyen-Khac F, Feugier P. A fixed-duration immunochemotherapy approach in CLL: 5.5-year results from the phase 2 ICLL-07 FILO trial. Blood Adv 2023; 7:3936-3945. [PMID: 37026799 PMCID: PMC10410135 DOI: 10.1182/bloodadvances.2022009594] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
In previously untreated, medically fit patients with chronic lymphocytic leukemia (CLL), research is focused on developing fixed-duration strategies to improve long-term outcomes while sparing patients from serious toxicities. The ICLL-07 trial evaluated a fixed-duration (15-month) immunochemotherapy approach in which after obinutuzumab-ibrutinib induction for 9 months, patients (n = 10) in complete remission (CR) with bone marrow (BM) measurable residual disease (MRD) <0.01% continued only ibrutinib 420 mg/day for 6 additional months (I arm), whereas the majority (n = 115) received up to 4 cycles of fludarabine/cyclophosphamide-obinutuzumab 1000 mg alongside the ibrutinib (I-FCG arm). Primary analysis at month 16 showed that 84 of 135 (62.2%) patients enrolled achieved CR with a BM MRD <0.01%. Here, we report follow-up at median 63 months. Peripheral blood (PB) MRD was assessed 6 monthly beyond the end of treatment using a highly sensitive (10-6) flow cytometry technique. In the I-FCG arm, the PB MRD <0.01% rate (low-level positive <0.01% or undetectable with limit of detection ≤10-4) in evaluable patients was still 92.5% (74/80) at month 40 and 80.6% (50/62) at month 64. No differences in the PB MRD status were apparent per to the IGHV mutational status. In the overall population, 4-year progression-free and overall survival rates were 95.5% and 96.2%, respectively. Twelve deaths occurred overall. Fourteen serious adverse events occurred beyond the end of treatment. Thus, our fixed-duration immunochemotherapy approach produced deep and sustained PB MRD responses, high survival rates, and low long-term toxicity. A randomized trial is needed to compare our immunochemotherapy approach with a chemotherapy-free strategy. This trial was registered at www.clinicaltrials.gov as #NCT02666898.
Collapse
Affiliation(s)
| | - Rémi Letestu
- Hematology Laboratory, Avicenne Hospital, Hôpitaux universitaires Paris Seine Saint-Denis (HUPSSD), Assistance Publique–Hôpitaux de Paris (AP-HP), Bobigny, France
| | | | - Lydia Campos
- Department of Hematology Biology, Le Centre Hospitalier Universitaire (CHU) Saint Etienne, Saint Etienne, France
| | | | | | | | - Valérie Rouille
- Department of Hematology, CHU Montpellier, Montpellier, France
| | - Béatrice Mahé
- Department of Hematology, Nantes University Hospital, Nantes, France
| | - Kamel Laribi
- Department of Hematology, CH Le Mans, Le Mans, France
| | | | - Emmanuelle Ferrant
- Department of Hematology and Oncology, CH Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard, Pierre-Benite, Lyon, France
| | - Olivier Tournilhac
- Department of Hematology and Cellular Therapy, CHU Hotel Dieu Hématologie, Clermont-Ferrand, France
| | - Alain Delmer
- Department of Hematology, CHU Reims, Reims, France
| | - Lysiane Molina
- Department of Hematology, CHU Grenoble, La Tronche, France
| | - Véronique Leblond
- Department of Hematology, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | | | | | | | - Anne Banos
- Department of Hematology, CH Côte Basque, Bayonne, France
| | | | - Guillaume Cartron
- Department of Hematology, CHU Montpellier, Montpellier, France
- Department of Hematology, Montpellier University Hospital, Montpelllier, France
| | | | - Loic Ysebaert
- Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | | | | | - Jean-Pierre Vilque
- Institut d'Hématologie de Basse-Normandie, Centre François Baclesse, Caen, France
| | | | | | - Stéphane Leprêtre
- Inserm U1245 and Department of Hematology, Centre Centre Henri-Becquerel and Normandie University UNIROUEN, Rouen, France
| | - Vincent Lévy
- Department of Clinical Research, Avicenne Hospital, HUPSSD, AP-HP, Bobigny, France
| | | | - Pierre Feugier
- Department of Hematology, Centre Hospitalier Régional Universitaire de Nancy, Hôpitaux de Brabois, Vandoeuvre-lès-Nancy, France
| | - French Innovative Leukemia Organization (FILO) CLL group
- Department of Hematology, Centre Léon Bérard, Lyon, France
- Hematology Laboratory, Avicenne Hospital, Hôpitaux universitaires Paris Seine Saint-Denis (HUPSSD), Assistance Publique–Hôpitaux de Paris (AP-HP), Bobigny, France
- Department of Hematology Biology, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
- Department of Hematology Biology, Le Centre Hospitalier Universitaire (CHU) Saint Etienne, Saint Etienne, France
- Department of Immunology, CHU Nice, Nice, France
- Department of Hematology, CHU Bordeaux, Pessac, France
- Department of Hematology, CHU Montpellier, Montpellier, France
- Department of Hematology, Nantes University Hospital, Nantes, France
- Department of Hematology, CH Le Mans, Le Mans, France
- Department of Hematology, CHD Vendée, La Roche-sur-Yon, France
- Department of Hematology and Oncology, CH Lyon-Sud, Hospices Civils de Lyon, Université Claude Bernard, Pierre-Benite, Lyon, France
- Department of Hematology and Cellular Therapy, CHU Hotel Dieu Hématologie, Clermont-Ferrand, France
- Department of Hematology, CHU Reims, Reims, France
- Department of Hematology, CHU Grenoble, La Tronche, France
- Department of Hematology, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
- Department of Hematology, CHU Poitiers, Poitiers, France
- Department of Hematology, CHU Rennes, Rennes, France
- Hematology Service, CH Annecy, Annecy, France
- Department of Hematology, CH Côte Basque, Bayonne, France
- Department of Hematology, CH Metz, Metz, France
- Department of Hematology, Montpellier University Hospital, Montpelllier, France
- Department of Hematology, Strasbourg University Hospital, Strasbourg, France
- Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
- Department of Hematology, CHU Tours, Hôpital Bretonneau, Tours, France
- Department of Hematology, CHU Angers, Angers, France
- Institut d'Hématologie de Basse-Normandie, Centre François Baclesse, Caen, France
- Department of Hematology, Institut Paoli Calmettes, Marseille, Marseille France
- Department of Hematology, Avicenne Hospital, HUPSSD, AP-HP, Bobigny, France
- Inserm U1245 and Department of Hematology, Centre Centre Henri-Becquerel and Normandie University UNIROUEN, Rouen, France
- Department of Clinical Research, Avicenne Hospital, HUPSSD, AP-HP, Bobigny, France
- Department of Hematology, Centre Hospitalier Régional Universitaire de Nancy, Hôpitaux de Brabois, Vandoeuvre-lès-Nancy, France
| |
Collapse
|
4
|
Buske C, Dimopoulos MA, Grunenberg A, Kastritis E, Tomowiak C, Mahé B, Troussard X, Hajek R, Viardot A, Tournilhac O, Aurran T, Lepretre S, Zerazhi H, Hivert B, Leblond V, de Guibert S, Brandefors L, Garcia-Sanz R, Gomes da Silva M, Kimby E, Schmelzle B, Kaszynski D, Dreyhaupt J, Muche R, Morel P. Bortezomib-Dexamethasone, Rituximab, and Cyclophosphamide as First-Line Treatment for Waldenström's Macroglobulinemia: A Prospectively Randomized Trial of the European Consortium for Waldenström's Macroglobulinemia. J Clin Oncol 2023; 41:2607-2616. [PMID: 36763945 DOI: 10.1200/jco.22.01805] [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: 08/08/2022] [Revised: 10/26/2022] [Accepted: 12/20/2022] [Indexed: 02/12/2023] Open
Abstract
PURPOSE Rituximab/chemotherapy is a cornerstone of treatment for Waldenström's macroglobulinemia (WM). In addition, bortezomib has shown significant activity in WM. This study evaluated the efficacy and safety of dexamethasone, rituximab, and cyclophosphamide (DRC) as first-line treatment in WM. METHODS In this European study, treatment-naïve patients were randomly assigned to DRC or bortezomib-DRC B-DRC for six cycles. The primary end point was progression-free survival. Secondary end points included response rates, overall survival, and safety. RESULTS Two hundred four patients were registered. After a median follow-up of 27.5 months, the estimated 24-month progression-free survival was 80.6% (95% CI, 69.5 to 88.0) for B-DRC and 72.8% (95% CI, 61.3 to 81.3) for DRC (P = .32). At the end of treatment, B-DRC and DRC induced major responses in 80.6% versus 69.9% and a complete response/very good partial response in 17.2% versus 9.6% of patients, respectively. The median time to first response was shorter for B-DRC with 3.0 (95% CI, 2.8 to 3.2) versus 5.5 (95% CI, 2.9 to 5.8) months for DRC. This resulted in higher major response rates (57.0% v 32.5%; P < .01) after three cycles of B-DRC compared with DRC. At best response, the complete response/very good partial response increased to 32.6% for B-DRC. Both treatments were well tolerated: grade ≥ 3 adverse events occurred in 49.2% of all patients (B-DRC, 49.5%; DRC, 49.0%). Peripheral sensory neuropathy grade 3 occurred in two patients treated with B-DRC and in none with DRC. CONCLUSION This large randomized study illustrates that B-DRC is highly effective and well tolerated in WM. The data demonstrate that fixed duration immunochemotherapy remains an important pillar in the clinical management of WM.
Collapse
Affiliation(s)
- Christian Buske
- Institute of Experimental Cancer Research, University Hospital of Ulm, Ulm, Germany
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Cecile Tomowiak
- Hematology Department and CIC1402 INSERM, CHU Poitiers, Poitiers, France
| | | | | | - Roman Hajek
- Department of Haematooncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Andreas Viardot
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | | | - Therese Aurran
- Hematology Department, Institut Paoli-Calmettes, Marseille France
| | - Stephane Lepretre
- Inserm U1245 and Department of Hematology, Centre Henri Becquerel and Normandie Univ UNIROUEN, Rouen, France
| | | | | | - Veronique Leblond
- Sorbonne Université. Hématologie clinique Hôpital Pitié Salpêtrière. APHP, Paris, France
| | | | | | | | | | - Eva Kimby
- Department of Medicine Huddinge, Karolinska Institutet, Unit for Hematology, Stockholm, Sweden
| | - Birgit Schmelzle
- Institute of Experimental Cancer Research, University Hospital of Ulm, Ulm, Germany
| | - Dajana Kaszynski
- Institute of Experimental Cancer Research, University Hospital of Ulm, Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Rainer Muche
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | | |
Collapse
|
5
|
Oluwole OO, Forcade E, Muñoz J, de Guibert S, Vose JM, Bartlett NL, Lin Y, Deol A, McSweeney PA, Goy AH, Kersten MJ, Jacobson CA, Farooq U, Minnema MC, Thieblemont C, Timmerman JM, Stiff P, Avivi I, Tzachanis D, Zheng Y, Vardhanabhuti S, Nater J, Shen RR, Miao H, Kim JJ, van Meerten T. Prophylactic Corticosteroid Use with Axicabtagene Ciloleucel (Axi-Cel) in Patients (Pts) with Relapsed/ Refractory Large B-Cell Lymphoma (R/R LBCL): 2-Year Follow-up of Zuma-1 Cohort 6. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00575-4] [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: 02/07/2023]
|
6
|
Boulland ML, Vic S, Thonier F, Ganard M, Lamy T, Fest T, Guibert SD, Pastoret C. Reliable IGHV status assessment by next generation sequencing in routine practice for chronic lymphocytic leukemia. Leuk Lymphoma 2021; 62:2800-2803. [PMID: 34060965 DOI: 10.1080/10428194.2021.1933476] [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: 10/21/2022]
Affiliation(s)
- Marie-Laure Boulland
- Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, Rennes, France.,INSERM, UMR1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | - Samuel Vic
- Service d'Hématologie Clinique, CHU de Rennes, Rennes, France
| | | | - Michel Ganard
- Service d'Hématologie Clinique, CHU de Rennes, Rennes, France
| | - Thierry Lamy
- INSERM, UMR1236, Equipe labellisée Ligue contre le Cancer, Rennes, France.,Service d'Hématologie Clinique, CHU de Rennes, Rennes, France
| | - Thierry Fest
- Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, Rennes, France.,INSERM, UMR1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | | | - Cédric Pastoret
- Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, Rennes, France.,INSERM, UMR1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| |
Collapse
|
7
|
Morschhauser F, Bouabdallah K, Stilgenbauer S, Thieblemont C, de Guibert S, Zettl F, Gelbert LM, Turner KP, Prasad Kambhampati SR, Li L, Li LQ, Buchanan S, Barriga S, Bear MM, Wilhelm M, Hess G. Clinical activity of abemaciclib in patients with relapsed or refractory mantle cell lymphoma - a phase II study. Haematologica 2021; 106:859-862. [PMID: 32381571 PMCID: PMC7927997 DOI: 10.3324/haematol.2019.224535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Indexed: 12/31/2022] Open
Affiliation(s)
- Franck Morschhauser
- Hôpital Claude Huriez, Centre Hospitalier Regional Universitaire, Lille, France
| | - Kamal Bouabdallah
- Hopital Haut-Levêque, Centre Hospitalier Regional Universitaire de Bordeaux, Pessac, France
| | | | - Catherine Thieblemont
- Hemato-Oncology Department, Hôpital Saint-Louis and Diderot University, Paris, France
| | | | | | | | | | | | - Li Li
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Lily Q Li
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | | | | | | | - Georg Hess
- Universitätsmedizin Mainz, Mainz, Germany
| |
Collapse
|
8
|
Bouclet F, Calleja A, Dilhuydy MS, Véronèse L, Pereira B, Amorim S, Cymbalista F, Herbaux C, de Guibert S, Roos-Weil D, Hivert B, Aurran T, Dupuis J, Blouet A, Tchernonog E, Laribi K, Dmytruck N, Morel P, Michallet AS, Dartigeas C, Tournilhac O, Nguyen-Khac F, Delmer A, Feugier P, Ysebaert L, Guièze R. Real-world outcomes following venetoclax therapy in patients with chronic lymphocytic leukemia or Richter syndrome: a FILO study of the French compassionate use cohort. Ann Hematol 2021; 100:987-993. [PMID: 33495922 DOI: 10.1007/s00277-021-04419-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/11/2021] [Indexed: 12/01/2022]
Abstract
The BCL2 inhibitor venetoclax is transforming the management of patients with chronic lymphocytic leukemia (CLL), given its high efficacy in relapsed/refractory CLL as observed in both early-phase and randomized clinical trials. The present study aimed to determine whether venetoclax is effective and well tolerated in patients with CLL or Richter's syndrome (RS) in a real-world setting and to highlight factors impacting survival. Data from a venetoclax French compassionate use program were collected for 67 patients (60 with CLL and 7 with RS). Most patients presented adverse genetic features, such as TP53 disruption (74%) or complex karyotype (58%). Tumor lysis syndrome was observed in 14 (22%) patients, and 16 (24%) patients were hospitalized for grade III/IV infection. In the CLL cohort, ORR was 75 %, 1-year PFS was 61% (95% CI = 47-72%) and 1-year OS 70% (95% CI = 56-80%). No impact of TP53 disruption was noted while complex karyotype was identified as a predictor of both inferior PFS (HR = 3.46; 95% CI = 1-12; log-rank p = 0.03) and OS (HR = 3.2; 95% CI = 0.9-11.4, log-rank p = 0.047). Among the seven patients with RS, two achieved an objective response to venetoclax; however, the median OS was only 1.1 month. The well-balanced safety/efficacy profile of venetoclax is confirmed in this real-world setting. Complex karyotype should be evaluated as a predictive factor of survival for patients treated by venetoclax.
Collapse
Affiliation(s)
- Florian Bouclet
- Service d'Hématologie clinique adultes et thérapie cellulaire, Hôpital Estaing, CHU Clermont-Ferrand, 1 place Lucie Aubrac, 63000, Clermont-Ferrand, France
| | - Anne Calleja
- Hématologie clinique, Hôpital L'Archet, CHU Nice, Nice, France
| | | | - Lauren Véronèse
- Laboratoire de cytogénétique, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Département de Biostatistiques, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Sandy Amorim
- Hématologie clinique, APHP Saint-Louis, Paris, France
| | | | | | | | - Damien Roos-Weil
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Bénédicte Hivert
- Hématologie clinique, Hôpital Saint-Vincent de Paul, Lille, France
| | - Thérèse Aurran
- Hématologie clinique, Institut Paoli-Calmettes, Marseille, France
| | - Jehan Dupuis
- Hématologie clinique, APHP Henri Mondor, Créteil, France
| | | | | | - Kamel Laribi
- Hématologie clinique, CH Le Mans, Le Mans, France
| | - Nataliya Dmytruck
- Hématologie clinique et thérapie cellulaire, CHU Limoges, Limoges, France
| | - Pierre Morel
- Hématologie Clinique et thérapie cellulaire, CHU Amiens, Amiens, France
| | | | | | - Olivier Tournilhac
- Service d'Hématologie clinique adultes et thérapie cellulaire, Hôpital Estaing, CHU Clermont-Ferrand, 1 place Lucie Aubrac, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, Clermont-Ferrand, France
| | - Florence Nguyen-Khac
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | | | | | - Loïc Ysebaert
- Hématologie clinique, IUCT Oncopole, Toulouse, France
| | - Romain Guièze
- Service d'Hématologie clinique adultes et thérapie cellulaire, Hôpital Estaing, CHU Clermont-Ferrand, 1 place Lucie Aubrac, 63000, Clermont-Ferrand, France. .,Université Clermont Auvergne, Clermont-Ferrand, France.
| |
Collapse
|
9
|
Moro-Sibilot D, Cozic N, Pérol M, Mazières J, Otto J, Souquet PJ, Bahleda R, Wislez M, Zalcman G, Guibert SD, Barlési F, Mennecier B, Monnet I, Sabatier R, Bota S, Dubos C, Verriele V, Haddad V, Ferretti G, Cortot A, De Fraipont F, Jimenez M, Hoog-Labouret N, Vassal G. Crizotinib in c-MET- or ROS1-positive NSCLC: results of the AcSé phase II trial. Ann Oncol 2019; 30:1985-1991. [PMID: 31584608 DOI: 10.1093/annonc/mdz407] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In 2013, the French National Cancer Institute initiated the AcSé program to provide patients with secure access to targeted therapies outside of their marketed approvals. Efficacy and safety was then assessed using a two-stage Simon phase II trial design. When the study design was designed, crizotinib was approved only as monotherapy for adults with anaplastic lymphoma kinase plus non-small-cell lung cancers (NSCLC). PATIENTS AND METHODS Advanced NSCLC patients with c-MET ≥6 copies, c-MET-mutated, or ROS-1-translocated tumours were enrolled in one of the three cohorts. Patients were treated with crizotinib 250 mg twice daily. Efficacy was assessed using the objective response rate (ORR) after two cycles of crizotinib as primary outcome. Secondary outcomes included disease control rate at four cycles, best ORR, progression-free survival, overall survival, and drug tolerance. RESULTS From August 2013 to March 2018, 5606 patients had their tumour tested for crizotinib targeted molecular alterations: 252 patients had c-MET ≥6 copies, 74 c-MET-mutation, and 78 ROS-1-translocated tumour. Finally, 25 patients in the c-MET ≥6 copies cohort, 28 in the c-MET-mutation cohort, and 37 in the ROS-1-translocation cohort were treated in the phase II trial. The ORR was 16% in the c-MET ≥6 copies cohort, 10.7% in the mutated, and 47.2% in the ROS-1 cohort. The best ORR during treatment was 32% in the c-MET-≥6 copies cohort, 36% in the c-MET-mutated, and 69.4% in the ROS-1-translocation cohort. Safety data were consistent with that previously reported. CONCLUSIONS Crizotinib activity in patients with ROS1-translocated tumours was confirmed. In the c-MET-mutation and c-MET ≥6 copies cohorts, despite insufficient ORR after two cycles of crizotinib, there are signs of late response not sufficient to justify the development of crizotinib in this indication. The continued targeting of c-MET with innovative therapies appears justified. CLINICAL TRIAL NUMBER NCT02034981.
Collapse
Affiliation(s)
- D Moro-Sibilot
- Thoracic Oncology Unit, Grenoble-Alpes University Hospital, Grenoble; Intergroupe Francophone de Cancérologie Thoracique (IFCT), Paris.
| | - N Cozic
- Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, INSERM U1018, ESP, Paris-Saclay and Paris-Sud Universities, Villejuif
| | - M Pérol
- Department of Medical Oncology, Léon Bérard Cancer Centre, Lyon
| | - J Mazières
- Pneumology Department, Toulouse University Hospital and Paul Sabatier University, Toulouse
| | - J Otto
- Department of Medicine, Antoine Lacassagne Cancer Centre, Nice
| | - P J Souquet
- Department of Pneumology and Thoracic Oncology, Lyon Sud Hospital Center, Hospices Civils de Lyon, Pierre Bénite
| | - R Bahleda
- Drug Development Department (DITEP), Gustave Roussy Cancer Campus, Villejuif
| | - M Wislez
- Pneumology Department, Tenon Hospital, AP-HP and "Pierre and Marie Curie" University, Paris
| | - G Zalcman
- Thoracic Oncology Department-CIC INSERM 1425, Bichat University Hospital, AP-HP, Paris; Paris-Diderot University, Paris
| | | | - F Barlési
- Multidisciplinary Oncology & Therapeutic Innovations Department, APHM and Aix Marseille University, INSERM, CNRS, CRCM, Marseille
| | - B Mennecier
- Pneumology Department, Strasbourg University Hospital, Strasbourg
| | - I Monnet
- Pneumology Department, CHIC Creteil, Créteil
| | - R Sabatier
- Department of Medical Oncology, Inserm 1068, CNRS UMR7258, CRCM, Paoli-Calmettes Institute and Aix-Marseille University, Marseille
| | - S Bota
- Pneumology Department, Charles Nicolle Hospital, Rouen University Hospital, Rouen
| | - C Dubos
- Pneumology Department, François Baclesse Cancer Centre, Caen
| | - V Verriele
- Anatomy and Pathological Cytologies Department, Paul Papin Cancer Centre, ICO, Angers
| | - V Haddad
- Department of Tumour Biology, Léon Bérard Cancer Centre, Lyon
| | - G Ferretti
- Radiology and Medical Imaging Department, Grenoble-Alpes University Hospital, Grenoble
| | - A Cortot
- Department of Thoracic Oncology, Lille University Hospital and University of Lille, Lille
| | - F De Fraipont
- Molecular Genetic Unit: Hereditary Diseases and Oncology, Grenoble-Alpes University Hospital, Grenoble
| | - M Jimenez
- Research and Development UNICANCER, Paris
| | | | - G Vassal
- Clinical Research Division, Gustave Roussy Cancer Campus, Villejuif, France
| |
Collapse
|
10
|
Michallet AS, Dilhuydy MS, Subtil F, Rouille V, Mahe B, Laribi K, Villemagne B, Salles G, Tournilhac O, Delmer A, Portois C, Pegourie B, Leblond V, Tomowiak C, de Guibert S, Orsini F, Banos A, Carassou P, Cartron G, Fornecker LM, Ysebaert L, Dartigeas C, Truchan Graczyk M, Vilque JP, Aurran T, Cymbalista F, Lepretre S, Lévy V, Nguyen-Khac F, Le Garff-Tavernier M, Aanei C, Ticchioni M, Letestu R, Feugier P. Obinutuzumab and ibrutinib induction therapy followed by a minimal residual disease-driven strategy in patients with chronic lymphocytic leukaemia (ICLL07 FILO): a single-arm, multicentre, phase 2 trial. Lancet Haematol 2019; 6:e470-e479. [PMID: 31324600 DOI: 10.1016/s2352-3026(19)30113-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/17/2019] [Accepted: 05/24/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND In patients with chronic lymphocytic leukaemia, achievement of a complete response with minimal residual disease of less than 0·01% (ie, <1 chronic lymphocytic leukaemia cell per 10 000 leukocytes) in bone marrow has been associated with improved progression-free survival. We aimed to explore the activity of induction therapy for 9 months with obinutuzumab and ibrutinib, followed up with a minimal residual disease-driven therapeutic strategy for 6 additional months, in previously untreated patients. METHODS We did a single-arm, phase 2 trial in 27 university hospitals, general hospitals, and specialist cancer centres in France. Eligible patients were at least 18 years old and previously untreated, and had immunophenotypically confirmed B-cell chronic lymphocytic leukaemia; an Eastern Cooperative Oncology Group (ECOG) performance status score of less than 2; a Binet stage C according to IWCLL 2008 criteria or Binet stage A and B with active disease; no 17p deletion or absence of p53 mutation; and were considered medically fit. In the first part of the study (induction phase), all participants received eight intravenous infusions of obinutuzumab 1000 mg over six 4-weekly cycles and oral ibrutinib 420 mg once per day for 9 months. In part 2, after assessment on day 1 of month 9, patients with a complete response and bone marrow minimal residual disease of less than 0·01% received only oral ibrutinib 420 mg once per day for 6 additional months. Patients with a partial response, or with a complete response and bone marrow minimal residual disease of 0·01% or more, received 6 months of four 4-weekly cycles of intravenous fludarabine, cyclophosphamide, and obinutuzumab 1000 mg, alongside continuing ibrutinib 420 mg once per day. The primary endpoint was the proportion of patients achieving a complete response with bone marrow minimal residual disease less than 0·01% on day 1 of month 16 assessed by intention to treat (ITT). This trial is registered with ClinicalTrials.gov (number NCT02666898) and is still open for follow-up. FINDINGS Between Oct 27, 2015, and May 16, 2017, 135 patients were enrolled. After induction treatment (day 1 of month 9), 130 patients were evaluable, of which ten (8%) achieved a complete response with bone marrow minimal residual disease of less than 0·01% and were assigned to ibrutinib, and 120 (92%) were assigned to ibrutinib plus fludarabine, cyclophosphamide, and obinutuzumab. After minimal residual disease-guided treatment (day 1 of month 16), 84 (62%, 90% CI 55-69) of 135 patients (ITT population) achieved a complete response with bone marrow minimal residual disease of less than 0·01%. The most common haematological adverse event was thrombocytopenia (in 45 [34%] of 133 patients at grade 1-2 in months 1-9 and in 43 [33%] of 130 patients at grade 1-2 in months 9-15). The most common non-haematological adverse events were infusion-related reactions (in 83 [62%] patients at grade 1-2 in months 1-9) and gastrointestinal disorders (in 62 [48%] patients at grades 1 and 2 in months 9-15). 49 serious adverse events occurred, most frequently infections (ten), cardiac events (eight), and haematological events (eight). No treatment-related deaths occurred. INTERPRETATION Obinutuzumab and ibrutinib induction therapy followed by a minimal residual disease driven strategy is safe and active in patients with previously untreated chronic lymphocytic leukaemia. With longer follow-up, including assessing the evolution of minimal residual disease, if response is maintained, this strategy could be an option in the first-line setting in patients with chronic lymphocytic leukaemia, although randomised evidence is needed. FUNDING Roche, Janssen.
Collapse
MESH Headings
- Adenine/analogs & derivatives
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Drug Administration Schedule
- Female
- Gastrointestinal Diseases/etiology
- Humans
- Immunoglobulin Heavy Chains/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Mutation
- Neoplasm, Residual
- Piperidines
- Pyrazoles/administration & dosage
- Pyrazoles/adverse effects
- Pyrimidines/administration & dosage
- Pyrimidines/adverse effects
- Survival Rate
- Thrombocytopenia/etiology
- Treatment Outcome
- Tumor Suppressor Protein p53/genetics
Collapse
Affiliation(s)
| | | | - Fabien Subtil
- Department of Biostatistics, Hospices Civils de Lyon, Lyon, France
| | - Valerie Rouille
- Department of Hematology, CHU Montpellier, Montpellier, France
| | - Beatrice Mahe
- Department of Hematology, CHU Nantes, Nantes, France
| | - Kamel Laribi
- Department of Clinical Hematology, Centre Hospitalier du Mans, Le Mans, France
| | - Bruno Villemagne
- Department of Clinical Hematology, CHD Vendee, La Roche sur Yon, France
| | - Gilles Salles
- Department of Hematology, Hospices Civils de Lyon, Lyon, France
| | - Olivier Tournilhac
- Department of Hematology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alain Delmer
- Department of Hematology, CHU Reims, Reims, France
| | | | | | - Veronique Leblond
- Department of Hematology, Assistance Publique Hopitaux de Paris, PitiéSalpêtrière Hospital, Université Paris Sorbonne, Paris, France
| | | | | | - Frederique Orsini
- Department of Clinical Hematology, Centre Hospitalier Annecy Genevois, Annecy Genevois, France
| | - Anne Banos
- Department of Clinical Hematology, Centre Hospitalier Bayonne, Bayonne, France
| | | | | | | | - Loic Ysebaert
- Department of Hematology, CHU Toulouse, Toulouse, France
| | | | | | | | - Thérèse Aurran
- Department of Hematology, Institut Paoli Calmettes, Marseille, Marseille, France
| | - Florence Cymbalista
- Department of Hematology, Avicenne Hospital, Assistance Publique Hopitaux de Paris, Bobigny, France
| | - Stéphane Lepretre
- Department of Hematology, Centres de Lutte Contre le Cancer Centre Henri-Becquerel, Haute Normandie, Rouen, France
| | - Vincent Lévy
- URC/CRC, Avicenne Hospital, Assistance Publique Hopitaux de Paris, Bobigny, France
| | - Florence Nguyen-Khac
- Department of Hematology, Assistance Publique Hopitaux de Paris, PitiéSalpêtrière Hospital, Université Paris Sorbonne, Paris, France
| | - Magali Le Garff-Tavernier
- Department of Hematology Biology, Assistance Publique Hopitaux de Paris, Pitié Salpêtrière, Paris, France
| | - Carmen Aanei
- Department of Hematology Biology, CHU Saint Etienne, Saint Etienne, France
| | | | - Rémi Letestu
- Department of Hematology Biology, Avicenne Hospital, Assistance Publique Hopitaux de Paris, Bobigny, France
| | | |
Collapse
|
11
|
Houot R, Cartron G, Bijou F, de Guibert S, Salles GA, Fruchart C, Bouabdallah K, Maerevoet M, Feugier P, Le Gouill S, Tilly H, Casasnovas RO, Moluçon-Chabrot C, Van Den Neste E, Zachee P, Andre M, Bonnet C, Haioun C, Van Hoof A, Van Eygen K, Molina L, Nicolas-Virelizier E, Ruminy P, Morschhauser F. Obinutuzumab plus Lenalidomide (GALEN) for the treatment of relapse/refractory aggressive lymphoma: a phase II LYSA study. Leukemia 2018; 33:776-780. [PMID: 30291335 DOI: 10.1038/s41375-018-0282-y] [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: 07/06/2018] [Revised: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Roch Houot
- Department of Clinical Hematology, University Hospital of Rennes, Inserm 0203, University of Rennes, Rennes, France
| | - Guillaume Cartron
- Department of Clinical Hematology, University Hospital of Montpellier, UMR CNRS 5235, University of Montpellier, Montpellier, France
| | | | - Sophie de Guibert
- Department of Clinical Hematology, University Hospital of Rennes, Inserm 0203, University of Rennes, Rennes, France
| | - Gilles A Salles
- Department of Hematology, Centre Hospitalier Lyon-Sud, Pierre Benite, France
| | | | | | | | - Pierre Feugier
- CHU et INSERM 954, Nancy Université, Vandoeuvre Les Nancy, France
| | - Steven Le Gouill
- Department of Hematology, Nantes University Hospital and UMR892 INSERM, Nantes, France
| | - Hervé Tilly
- Centre Henri Becquerel, Inserm U918, Université de Rouen, IRIB, Rouen, France
| | | | | | - Eric Van Den Neste
- Department of Hematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Marc Andre
- Hematology Department, CHU UCL NAMUR, Yvoir, Belgium
| | | | - Corinne Haioun
- Hôpital Henri Mondor, Unité Hémopathies Lymphoide, Créteil, France
| | | | | | | | | | - Philippe Ruminy
- Centre Henri Becquerel, Inserm U918, Université de Rouen, IRIB, Rouen, France
| | | |
Collapse
|
12
|
Cartron G, Letestu R, Dartigeas C, Tout M, Mahé B, Gagez AL, Ferrant E, Guiu B, Villemagne B, Letuan P, Aurran T, Orsini-Piocelle F, Banos A, Feugier P, Leblond V, de Guibert S, Tournilhac O, Dupuis J, Delmer A, Rouillé V, Ternant D, Leprêtre S. Increased rituximab exposure does not improve response and outcome of patients with chronic lymphocytic leukemia after fludarabine, cyclophosphamide, rituximab. A French Innovative Leukemia Organization (FILO) study. Haematologica 2018. [PMID: 29519866 DOI: 10.3324/haematol.2017.182352] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Guillaume Cartron
- Department of clinical hematology, University hospital of Montpellier, France .,CNRS UMR 5235, University of Montpellier, France
| | - Rémi Letestu
- APHP, HUPSSD, Hospital Avicenne, Department of biological hematology, Bobigny, France
| | | | - Mira Tout
- CNRS UMR 7292, François Rabelais University, University hospital of Tours, France
| | - Béatrice Mahé
- Department of clinical hematology, University hospital of Nantes, France
| | - Anne-Laure Gagez
- Department of clinical hematology, University hospital of Montpellier, France
| | | | - Boris Guiu
- Department of Radiology, University hospital of Montpellier, France
| | - Bruno Villemagne
- Department of hematology-oncology, Departmental Hospital La Roche-sur-Yon, France
| | - Phan Letuan
- Laboratory of Biostatistics, University institute of Clinical Research, Montpellier, France
| | | | | | - Anne Banos
- Department of clinical hematology, Hospital Côte Basque, Bayonne, France
| | - Pierre Feugier
- Department of clinical hematology, University hospital of Nancy, France
| | - Véronique Leblond
- Department of clinical hematology, UPMC University of Paris 6, GRC11, Hospital La Pitié Salpêtrière, France
| | - Sophie de Guibert
- Department of clinical hematology, University hospital of Rennes, France
| | - Olivier Tournilhac
- Department of clinical hematology, University hospital of Clermont-Ferrand, France
| | - Jehan Dupuis
- Fonctional unit Lymphoid malignancies, University hospital Henri Mondor, Créteil, France
| | - Alain Delmer
- Department of clinical hematology, University hospital of Reims, Rouen, France
| | - Valérie Rouillé
- Department of clinical hematology, University hospital of Montpellier, France
| | - David Ternant
- CNRS UMR 7292, François Rabelais University, University hospital of Tours, France.,Laboratory of Pharmacology-Toxicology, CNRS, UMR7292, University hospital of Tours, Rouen, France
| | - Stéphane Leprêtre
- Inserm U1245 and department of hematology, Henri Becquerel Center and university of Normandy UNIROUEN, Rouen, France
| |
Collapse
|
13
|
Godet S, Protin C, Dupuis J, Dartigeas C, Bastie JN, Herbaux C, Leblond V, de Guibert S, Ghez D, Brion A, Ysebaert L, Delmer A, Quinquenel A. Outcome of chronic lymphocytic leukemia patients who switched from either ibrutinib or idelalisib to alternate kinase inhibitor: A retrospective study of the French innovative leukemia organization (FILO). Am J Hematol 2018; 93:E52-E54. [PMID: 29164674 DOI: 10.1002/ajh.24981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Sophie Godet
- CHU Reims, Hôpital Robert Debré, Service d'Hématologie Clinique; Reims France
| | | | | | | | | | | | | | | | - David Ghez
- Institut Gustave Roussy; Villejuif France
| | | | | | - Alain Delmer
- CHU Reims, Hôpital Robert Debré, Service d'Hématologie Clinique; Reims France
- Université Reims Champagne Ardenne, UFR Médecine; Reims France
| | - Anne Quinquenel
- CHU Reims, Hôpital Robert Debré, Service d'Hématologie Clinique; Reims France
- Université Reims Champagne Ardenne, UFR Médecine; Reims France
| |
Collapse
|
14
|
Allain JS, Thonier F, Pihan M, Boulland ML, de Guibert S, Launay V, Doncker AV, Ganard M, Aliouat A, Pangault C, Houot R, De Tayrac M, Lamy T, Roussel M, Fest T, Decaux O, Pastoret C. IGHV segment utilization in immunoglobulin gene rearrangement differentiates patients with anti-myelin-associated glycoprotein neuropathy from others immunoglobulin M-gammopathies. Haematologica 2018; 103:e207-e210. [PMID: 29371323 DOI: 10.3324/haematol.2017.177444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Florian Thonier
- Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, France
| | | | | | | | | | | | - Michel Ganard
- Université de Rennes 1, France.,Service d'Hématologie Clinique, CHU de Rennes, France
| | - Amyra Aliouat
- Laboratoire de Bioinformatique Médicale, Pôle de Biologie, CHU Rennes, France
| | - Céline Pangault
- Université de Rennes 1, France.,Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | - Roch Houot
- Université de Rennes 1, France.,Service d'Hématologie Clinique, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | - Marie De Tayrac
- Université de Rennes 1, France.,Laboratoire de Bioinformatique Médicale, Pôle de Biologie, CHU Rennes, France
| | - Thierry Lamy
- Université de Rennes 1, France.,Service d'Hématologie Clinique, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | - Mikael Roussel
- Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | - Thierry Fest
- Université de Rennes 1, France.,Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | - Olivier Decaux
- Service de Médecine Interne, CHU de Rennes, France.,Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | - Cedric Pastoret
- Université de Rennes 1, France .,Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| |
Collapse
|
15
|
Loschi M, Porcher R, Barraco F, Terriou L, Mohty M, de Guibert S, Mahe B, Lemal R, Dumas PY, Etienne G, Jardin F, Royer B, Bordessoule D, Rohrlich PS, Fornecker LM, Salanoubat C, Maury S, Cahn JY, Vincent L, Sene T, Rigaudeau S, Nguyen S, Lepretre AC, Mary JY, Corront B, Socie G, Peffault de Latour R. Impact of eculizumab treatment on paroxysmal nocturnal hemoglobinuria: a treatment versus no-treatment study. Am J Hematol 2016; 91:366-70. [PMID: 26689746 DOI: 10.1002/ajh.24278] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 12/10/2015] [Accepted: 12/15/2015] [Indexed: 12/21/2022]
Abstract
Intravascular hemolysis in Paroxysmal nocturnal hemoglobinuria (PNH) can effectively be controlled with eculizumab, a humanized monoclonal antibody that binds complement protein C5. We report here a retrospective comparison study between 123 patients treated with eculizumab in the recent period (>2005) and 191 historical controls (from the French registry). Overall survival (OS) at 6 years was 92% (95%CI, 87 to 98) in the eculizumab cohort versus 80% (95%CI 70 to 91) in historical controls diagnosed after 1985 (HR 0.38 [0.15 to 0.94], P = 0.037). There were significantly fewer thrombotic events (TEs) in the group of patients treated with eculizumab (4% [1-10]) as compared to the historical cohort (27% [20-34]). However, we found that TEs may still occur after the initiation of eculizumab treatment and that previous TEs still have a negative impact on survival. Evolutions to myelodysplastic syndrome or acute leukemia were similar in both cohorts. There was less evolution to aplastic anemia in the treatment group. In multivariate analysis, absence of a previous TE and treatment with eculizumab were associated with a better OS. Treatment with eculizumab improves overall survival in classic PNH patients without increasing the risk of clonal evolution.
Collapse
Affiliation(s)
- Michael Loschi
- Hematology-Transplantation Department; AP-HP, Saint-Louis Hospital; Paris France
- Hematology Department; Centre Henri BECQUEREL; Rouen France
| | - Raphael Porcher
- Center for Clinical Epidemiology; AP-HP, Hotel-Dieu Hospital, Inserm U1153, University Paris Descartes; Paris France
| | - Fiorenza Barraco
- Hematology Department; Centre Hospitalier Lyon Sud; Pierre Bénite France
| | - Louis Terriou
- Hematology Department; Hôpital Claude Huriez; Lille France
| | - Mohamad Mohty
- Hematology Department; AP-HP, Saint Antoine Hospital; Paris France
| | - Sophie de Guibert
- Hematology Department; University Hospital Pontchaillou; Rennes France
| | - Beatrice Mahe
- Hematology Department; University Hospital; Nantes France
| | - Richard Lemal
- Hematology Department; University Hospital; Clermont Ferrand France
| | | | - Gabriel Etienne
- Hematology Department; Groupe Hospitalier Sud; Pessac France
| | - Fabrice Jardin
- Hematology Department; Centre Henri BECQUEREL; Rouen France
| | - Bruno Royer
- Hematology Department; University Hospital Amiens Sud; Amiens France
| | | | | | | | | | - Sebastien Maury
- Hematology Department; AP-HP, Henri-Mondor Hospital; Créteil France
| | - Jean-Yves Cahn
- Hematology Department; University Hospital; Grenoble France
| | - Laure Vincent
- Hematology Department; University Hospital; Montpellier France
| | - Thomas Sene
- Internal Medicine Department; Foch Hospital; Paris France
| | | | - Stephanie Nguyen
- Hematology Department; AP-HP, Pitié Salpetriere Hospital; Paris France
| | - Anne-Claire Lepretre
- Transfusion Department; Etablissement Français Du Sang, Site Saint-Louis; Paris France
| | - Jean-Yves Mary
- Statistics; AP-HP, Saint-Louis Hospital, Inserm U1153; Paris France
- Sorbonne Paris Cité; University Paris Diderot; Paris France
| | | | - Gerard Socie
- Hematology-Transplantation Department; AP-HP, Saint-Louis Hospital; Paris France
- Sorbonne Paris Cité; University Paris Diderot; Paris France
| | - Regis Peffault de Latour
- Hematology-Transplantation Department; AP-HP, Saint-Louis Hospital; Paris France
- Sorbonne Paris Cité; University Paris Diderot; Paris France
| |
Collapse
|
16
|
Coiffier B, Thieblemont C, de Guibert S, Dupuis J, Ribrag V, Bouabdallah R, Morschhauser F, Navarro R, Le Gouill S, Haioun C, Houot R, Casasnovas O, Holte H, Lamy T, Broussais F, Payrard S, Hatteville L, Tilly H. A phase II, single-arm, multicentre study of coltuximab ravtansine (SAR3419) and rituximab in patients with relapsed or refractory diffuse large B-cell lymphoma. Br J Haematol 2016; 173:722-30. [DOI: 10.1111/bjh.13992] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Catherine Thieblemont
- Department of Hemato-oncology - Paris Diderot 7 University; APHP - Hôpital Saint-Louis; Paris France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Hervé Tilly
- Centre Henri Becquerel; UMR918; Université de Rouen; Rouen France
| |
Collapse
|
17
|
Kelly RJ, Höchsmann B, Szer J, Kulasekararaj A, de Guibert S, Röth A, Weitz IC, Armstrong E, Risitano AM, Patriquin CJ, Terriou L, Muus P, Hill A, Turner MP, Schrezenmeier H, Peffault de Latour R. Eculizumab in Pregnant Patients with Paroxysmal Nocturnal Hemoglobinuria. N Engl J Med 2015; 373:1032-9. [PMID: 26352814 DOI: 10.1056/nejmoa1502950] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Eculizumab, a humanized monoclonal antibody against complement protein C5 that inhibits terminal complement activation, has been shown to prevent complications of paroxysmal nocturnal hemoglobinuria (PNH) and improve quality of life and overall survival, but data on the use of eculizumab in women during pregnancy are scarce. METHODS We designed a questionnaire to solicit data on pregnancies in women with PNH and sent it to the members of the International PNH Interest Group and to the physicians participating in the International PNH Registry. We assessed the safety and efficacy of eculizumab in pregnant patients with PNH by examining the birth and developmental records of the children born and adverse events in the mothers. RESULTS Of the 94 questionnaires that were sent out, 75 were returned, representing a response rate of 80%. Data on 75 pregnancies in 61 women with PNH were evaluated. There were no maternal deaths and three fetal deaths (4%). Six miscarriages (8%) occurred during the first trimester. Requirements for transfusion of red cells increased during pregnancy, from a mean of 0.14 units per month in the 6 months before pregnancy to 0.92 units per month during pregnancy. Platelet transfusions were given in 16 pregnancies. In 54% of pregnancies that progressed past the first trimester, the dose or the frequency of use of eculizumab had to be increased. Low-molecular-weight heparin was used in 88% of the pregnancies. Ten hemorrhagic events and 2 thrombotic events were documented; both thrombotic events occurred during the postpartum period. A total of 22 births (29%) were premature. Twenty cord-blood samples were examined for the presence of eculizumab; the drug was detected in 7 of the samples. A total of 25 babies were breast-fed, and in 10 of these cases, breast milk was examined for the presence of eculizumab; the drug was not detected in any of the 10 breast-milk samples. CONCLUSIONS Eculizumab provided benefit for women with PNH during pregnancy, as evidenced by a high rate of fetal survival and a low rate of maternal complications. (ClinicalTrials.gov number, NCT01374360.).
Collapse
Affiliation(s)
- Richard J Kelly
- From Department of Haematology, St. James's University Hospital, Leeds (R.J.K., A.H.), and Haematological Medicine, Kings College Hospital, London (A.K.) - both in the United Kingdom; University of Ulm and German Red Cross Blood Transfusion Service Baden-Württemberg-Hessen, Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, Ulm (B.H., H.S.), and Department of Hematology, University Hospital of Essen, Essen (A.R.) - both in Germany; PNH Subcommittee of the Severe Aplastic Anemia Working Party of the European Group for Blood and Marrow Transplantation, Leiden (B.H., A.K., A.M.R., L.T., H.S., R.P.L.), and Radboud University Medical Center, Nijmegen (P.M.) - both in the Netherlands; Department of Clinical Haematology, the Royal Melbourne Hospital and University of Melbourne, Parkville, VIC, Australia (J.S.); Department of Hematology, University Hospital, Rennes (S.G.), Clinical Immunology, Department of Internal Medicine, University Hospital of Lille, Lille (L.T.), and Assistance Publique-Hôpitaux de Paris, Service d'Hématologie-Greffe, Hôpital Saint-Louis, University Paris Diderot, Sorbonne Paris Cité, Centre de Référence Aplasie Médullaire-HPN, and Filière de Santé Maladie Rare Immuno-Hématologique (MARIH), Paris (R.P.L.) - all in France; Jane Anne Nohl Division of Hematology, Keck School of Medicine of University of Southern California, Los Angeles (I.C.W.); Department of Hematology, Helsinki University Central Hospital, Helsinki (E.A.); Hematology, Department of Clinical Medicine and Surgery, Federico II, University of Naples, Naples, Italy (A.M.R.); Hematology and Thromboembolism, McMaster University, Hamilton, ON, Canada (C.J.P.); and ICON Clinical Research, San Francisco (M.P.T.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Hasseine L, Cassaing S, Robert-Gangneux F, Fillaux J, Marty P, Gangneux JP, Sirvent A, Mondain V, Hyvernat H, Rosenthal E, Cointault O, Lavayssière L, Georges B, Berry A, de Guibert S, Nimubona S, Revest M, Tattevin P. High negative predictive value diagnostic strategies for the reevaluation of early antifungal treatment: A multicenter prospective trial in patients at risk for invasive fungal infections. J Infect 2015; 71:258-65. [DOI: 10.1016/j.jinf.2015.04.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 03/09/2015] [Accepted: 04/10/2015] [Indexed: 11/25/2022]
|
19
|
Meppiel E, Crassard I, Latour RPD, de Guibert S, Terriou L, Chabriat H, Socié G, Bousser MG. Cerebral venous thrombosis in paroxysmal nocturnal hemoglobinuria: a series of 15 cases and review of the literature. Medicine (Baltimore) 2015; 94:e362. [PMID: 25569655 PMCID: PMC4602837 DOI: 10.1097/md.0000000000000362] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired disorder of hematopoietic stem cells characterized by hemolytic anemia, marrow failure, and a high incidence of life-threatening venous thrombosis. Cerebral venous system is the second most frequent location of thrombosis after hepatic veins. However, data about PNH-related cerebral venous thrombosis (CVT) are very scarce because of the rarity of both the disorders.We report a French study about PNH patients with CVT. Patients were recruited retrospectively, from the Société Française d'Hématologie (SFH) registry of 465 patients with PNH; the Lariboisière registry of 399 patients with CVT; and a direct contact with 26 French Hematology Units. We review cases reported since 1938 in the English and French language literature. We then compared patients of our series with cases from the literature, with non-PNH-related CVT cases from Lariboisière registry, and with PNH patients without CVT from SFH registry.Fifteen patients were included between 1990 and 2012. Most patients were women (12/15) and half of them presented associated hormonal venous thrombosis risk factors. Three patients had concomitant hepatic vein thrombosis. CVT was the first manifestation of PNH in 4 patients. No major difference in CVT characteristics was found compared with non-PNH-related CVT cases, except for a younger age at diagnosis in PNH patients (P < 0.001). All patients were treated with anticoagulation therapy. One death occurred in acute stage. All surviving patients were independent 1 year after. Median survival time was 9 years. Recurrent thrombosis rate was 50% at 6 years, occurring in patients that did not have bone marrow transplantation or eculizumab therapy. Cases of death were mainly related to hepatic vein thrombosis.Prognosis of CVT was good in our series. However, these patients have a poor long-term prognosis due to PNH disease by itself. PNH treatment should be proposed as soon as possible to avoid recurrent thrombosis. Besides, inaugural CVT events encourage investigating PNH in case of cytopenia, hemolysis, abdominal veins thrombosis, or aplastic anemia history associated with the neurological complication.
Collapse
Affiliation(s)
- Elodie Meppiel
- From the AP-HP, Hôpital Lariboisière (EM, IC, HC, M-GB), Service de Neurologie; AP-HP, Hôpital Saint Louis (RPL, GS), Service d'Hématologie Greffe, Paris; Centre Hospitalier Pontchaillou (SG), Service d'Hématologie Clinique, Rennes; Hôpital Claude Huriez (LT), Service des Maladies du Sang, Lille; and INSERM 728 (GS), Université Paris 7 Denis Diderot, Paris, France
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Peffault de Latour R, Schrezenmeier H, Bacigalupo A, Blaise D, de Souza CA, Vigouroux S, Willemze R, Terriou L, Tichelli A, Mohty M, de Guibert S, Marsh JC, Passweg J, Yves Mary J, Socié G. Allogeneic stem cell transplantation in paroxysmal nocturnal hemoglobinuria. Haematologica 2012; 97:1666-73. [PMID: 22689687 DOI: 10.3324/haematol.2012.062828] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In the era of eculizumab, identifying patients with paroxysmal nocturnal hemoglobinuria who may benefit from allogeneic stem cell transplantation is challenging. DESIGN AND METHODS We describe the characteristics and overall survival of 211 patients transplanted for paroxysmal nocturnal hemoglobinuria in 83 EBMT centers from 1978 to 2007. Next, we conducted a comparison with a cohort of 402 non-transplanted patients with paroxysmal nocturnal hemoglobinuria diagnosed between 1950 and 2005 in 92 French centers. We compared the occurrence of complications (i.e. thromboembolism and aplastic anemia) using either an individual or a stratum-matching procedure. RESULTS After a median follow-up of 5 years, the 5-year overall survival rate ± standard error (%) was 68 ± 3 in the transplanted group (54 ± 7 in the case of thromboembolism, 69 ± 5 in the case of aplastic anemia without thromboembolism and 86 ± 6 in the case of recurrent hemolytic anemia without thromboembolism or aplastic anemia). Only thromboembolism as the indication for transplantation was associated with worse outcome (P=0.03). We identified 24 pairs of transplanted and non-transplanted patients with thromboembolism for the matched comparison, with worse overall survival for the transplanted patients (hazard ratio=10.0; 95% confidence interval, 1.3-78.1; P=0.007). This was confirmed by the global matching procedure (P=0.03). As regards aplastic anemia without thromboembolism, 30 pairs were identified for the matched comparison. It was not observed that transplanted patients had a significantly worse overall survival (hazard ratio=4.0; 95% confidence interval, 0.9-18.9; P=0.06). A global matching procedure was not feasible. CONCLUSIONS Allogeneic stem cell transplantation is probably not a suitable treatment option for life-threatening thromboembolism in paroxysmal nocturnal hemoglobinuria.
Collapse
|
21
|
de Guibert S, Peffault de Latour R, Varoqueaux N, Labussière H, Rio B, Jaulmes D, Eveillard JR, Dulucq S, Stoppa AM, Bouscary D, Girodon F, Bonnotte B, Laskri D, Socié G, Lamy T. Paroxysmal nocturnal hemoglobinuria and pregnancy before the eculizumab era: the French experience. Haematologica 2011; 96:1276-83. [PMID: 21606169 DOI: 10.3324/haematol.2010.037531] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pregnancy in women with paroxysmal nocturnal hemoglobinuria is rare, with few reports on maternal and fetal mortality rates. DESIGN AND METHODS A specific questionnaire designed to solicit data on pregnancies in women with paroxysmal nocturnal hemoglobinuria was sent to all members of the French Society of Hematology in January 2008. RESULTS We identified 27 pregnancies in 22 women at 10 French Society of Hematology centers between 1978 and 2008. The median age was 21.5 years at diagnosis of paroxysmal nocturnal hemoglobinuria and 27 years at pregnancy. None of these women had received eculizumab during their pregnancy. Maternal complications, consisting mostly of cytopenias requiring transfusions, occurred in 95% of cases. Two cases of severe aplastic anemia (de novo in one case and relapse in the other) were recorded. No thrombotic events occurred during pregnancy, whereas 4 postpartum thromboses (16%) were recorded, 2 of which were fatal (maternal mortality rate 8%). Most patients received antithrombotic prophylaxis during pregnancy and postpartum (n=16; 64%). Delivery was preterm in 29% of cases, and birth weight was less than 3 kg in 53% of cases. Fetal mortality rate was 4%. CONCLUSIONS Pregnancy during paroxysmal nocturnal hemoglobinuria is associated with increased maternal and fetal mortality rates (8% and 4%, respectively, in this series). Maternal mortality is related to postpartum thromboses. Prophylactic anticoagulation is recommended during pregnancy and for six weeks postpartum.
Collapse
Affiliation(s)
- Sophie de Guibert
- Hématologie Clinique, Centre Hospitalier Pontchaillou, Rennes, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Arakelyan N, Berthou C, Desablens B, de Guibert S, Delwail V, Moles MP, Quittet P, Jais JP, Colonna P, Andrieu JM. Early versus late intensification for patients with high-risk Hodgkin lymphoma-3 Cycles of intensive chemotherapy plus low-dose lymph node radiation therapy versus 4 cycles of combined doxorubicin, bleomycin, vinblastine, and dacarbazine plus myeloablative chemotherapy with autologous stem cell transplantation. Cancer 2008; 113:3323-30. [DOI: 10.1002/cncr.23979] [Citation(s) in RCA: 29] [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: 11/12/2022]
|
23
|
Ansquer C, Hervouët T, Devillers A, de Guibert S, Gastinne T, Le Gouill S, Garin E, Moreau A, Kraeber-Bodéré F, Lamy T. 18-F FDG-PET in the staging of lymphocyte-predominant Hodgkin's disease. Haematologica 2008; 93:128-31. [PMID: 18166797 DOI: 10.3324/haematol.11661] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This bicentric study assessed retrospectively the usefulness of 18 F-FDG-PET in the staging of 31 patients with lymphocyte-predominant Hodgkin's disease (LPHD). FDG-PET and conventional explorations (CE) were performed for initial disease (n=25) or recurrence (n= 6). All the 68 involved sites were detected by PET including 5 extra-nodal lesions. Only 43 nodal sites (68%) and one splenic focus were detected by CE. PET changed staging in 9 patients (7 upstaged, 2 downstaged) and radiation fields in 3 patients. These results showed the potential role of PET in the staging of LPHD.
Collapse
|
24
|
Gros F, Sebti Y, de Guibert S, Branger B, Bernard M, Fauchet R, Amiot L. Soluble HLA-G molecules increase during acute leukemia, especially in subtypes affecting monocytic and lymphoid lineages. Neoplasia 2006; 8:223-30. [PMID: 16611416 PMCID: PMC1578523 DOI: 10.1593/neo.05703] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [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: 11/18/2022] Open
Abstract
Human leukocyte antigen G (HLA-G) molecules exhibit immunomodulatory properties corresponding to nonclassic class I genes of the major histocompatibility complex. They are either membrane-bound or solubly expressed during certain tumoral malignancies. Soluble human leukocyte antigen G (sHLA-G) molecules seem more frequently expressed than membrane-bound isoforms during hematologic malignancies, such as lymphoproliferative disorders. Assay of these molecules by enzyme-linked immunosorbent assay in patients suffering from another hematologic disorder (acute leukemia) highlights increased sHLA-G secretion. This increased secretion seems more marked in acute leukemia subtypes affecting monocytic and lymphoid lineages such as FABM4 and FABM5, as well as both B and T acute lymphoblastic leukemia (ALL). Moreover, this study uses in vitro cytokine stimulations and reveals the respective potential roles of granulocyte-macrophage colony-stimulating factor and interferon-gamma in increasing this secretion in FABM4 and ALL. Correlations between sHLA-G plasma level and clinical biologic features suggest a link between elevated sHLA-G level and 1) the absence of anterior myelodysplasia and 2) high-level leukocytosis. All these findings suggest that sHLA-G molecules could be a factor in tumoral escape from immune survey during acute leukemia.
Collapse
MESH Headings
- Acute Disease
- Antigens, Neoplasm/biosynthesis
- Antigens, Neoplasm/blood
- Antigens, Neoplasm/genetics
- Biomarkers, Tumor/blood
- Burkitt Lymphoma/blood
- Burkitt Lymphoma/genetics
- Burkitt Lymphoma/metabolism
- Burkitt Lymphoma/pathology
- Cell Line, Tumor/chemistry
- Cell Line, Tumor/drug effects
- Cell Line, Tumor/metabolism
- Cytokines/blood
- Cytokines/pharmacology
- Enzyme-Linked Immunosorbent Assay
- Gene Expression Regulation, Leukemic/drug effects
- HLA Antigens/biosynthesis
- HLA Antigens/blood
- HLA Antigens/genetics
- HLA-G Antigens
- Histocompatibility Antigens Class I/biosynthesis
- Histocompatibility Antigens Class I/blood
- Histocompatibility Antigens Class I/genetics
- Humans
- Leukemia/blood
- Leukemia/classification
- Leukemia/genetics
- Leukemia/metabolism
- Leukemia, Myeloid/blood
- Leukemia, Myeloid/classification
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/metabolism
- Leukemia, Myeloid/pathology
- Leukemia-Lymphoma, Adult T-Cell/blood
- Leukemia-Lymphoma, Adult T-Cell/genetics
- Leukemia-Lymphoma, Adult T-Cell/metabolism
- Leukemia-Lymphoma, Adult T-Cell/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/blood
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/genetics
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/metabolism
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Retrospective Studies
- Solubility
- Tumor Escape
Collapse
Affiliation(s)
- Frédéric Gros
- UPRES EA 3889, Immunologie/Hématologie, Université de Rennes 1, Rennes Cedex, France
| | - Yasmine Sebti
- UPRES EA 3889, Immunologie/Hématologie, Université de Rennes 1, Rennes Cedex, France
| | - Sophie de Guibert
- Service d'Hématologie Clinique, CHU Pontchaillou, Rennes Cedex, France
| | | | - Marc Bernard
- Service d'Hématologie Clinique, CHU Pontchaillou, Rennes Cedex, France
| | - Renée Fauchet
- UPRES EA 3889, Immunologie/Hématologie, Université de Rennes 1, Rennes Cedex, France
| | - Laurence Amiot
- UPRES EA 3889, Immunologie/Hématologie, Université de Rennes 1, Rennes Cedex, France
| |
Collapse
|
25
|
de Guibert S, Bernard M. [Superficial adenopathy]. Rev Prat 2006; 56:1129-34. [PMID: 16836211] [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] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
|
26
|
de Guibert S, Jaccard A, Bernard M, Turlure P, Bordessoule D, Lamy T. Rituximab and DHAP followed by intensive therapy with autologous stem-cell transplantation as first-line therapy for mantle cell lymphoma. Haematologica 2006; 91:425-6. [PMID: 16531272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
We report on a series of 24 patients with newly diagnosed mantle cell lymphoma treated with four to six courses of DHAP-rituximab followed by autologous stem cell transplantation for patients <65 years. Three-year overall survival (OS) and event free survival (EFS) rates were 69% and 65% respectively, for the 24 patients. In intent-to-treat analysis, 3-year OS and EFS were 75% and 76% for the 17 patients < 65 years old. This treatment is quite feasible and compares favourably with other regimens.
Collapse
|
27
|
Birebent B, Lorho R, Lechartier H, de Guibert S, Alizadeh M, Vu N, Beauplet A, Robillard N, Semana G. Suppressive properties of human CD4+CD25+ regulatory T cells are dependent on CTLA-4 expression. Eur J Immunol 2005; 34:3485-96. [PMID: 15484187 DOI: 10.1002/eji.200324632] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
It has been demonstrated that T cells with regulatory properties are present within the peripheral blood CD4(+)CD25(+) T cell compartment. Here, we describe an original method to purify human CD4(+)CD25(+)CD152(+) T lymphocytes as living cells by forcing the exportation of CTLA-4 molecules stored in intracellular vesicules at the cell surface. By doing so, we demonstrate that CD4(+)CD25(+) T cells contain a smaller and more homogeneous population enriched in cells with in vitro regulatory activity. Moreover, we show that this enrichment in regulatory T cells is associated with an increased expression of Foxp3 and that CD4(+)CD25(+)CD152(+) T lymphocytes display a much stronger suppressive activity in controlling in vitro proliferation of alloantigen-specific T cells than CD4(+)CD25(+)CD152(-) T lymphocytes purified in parallel. Lastly, by purifying such cells expressing CTLA-4, we demonstrate that indeed CTLA-4 is involved in CD4(+)CD25(+)CD152(+) T cell regulatory activity, while suppressive cytokines are not.
Collapse
Affiliation(s)
- Brigitte Birebent
- Laboratoire d'Immunologie (UPRES EA 1257-IFR97), Faculté de Médecine de Rennes1, Rennes, France
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Egreteau J, Boucher E, de Guibert S, Jacquelinet C, Meunier B, Boudjema K, Raoul JL. New Drugs for Colorectal Cancer (Irinotecan, Oxaliplatin, Raltitrexed) Meet Expectations in Routine Practice: A Single Center's Experience Before and After Their Introduction. ACTA ACUST UNITED AC 2005; 35:69-76. [PMID: 15722576 DOI: 10.1385/ijgc:35:1:069] [Citation(s) in RCA: 2] [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: 11/11/2022]
Abstract
BACKGROUND AND AIMS Treatment of metastatic colorectal cancer with new drugs (NDs) as oxaliplatin and irinotecan had improved response and survival. In order to check whether the promising achievements of the trials are obtained in routine clinical practice, we have reviewed retrospectively our results for two periods, before (period A: 1993-1995, n=63) and after (period B:1998-2000 n=103) the introduction of these NDs. Patients characteristics, treatment modalities, survival, and prognostic factors were compared. PATIENTS There were 74 women and 92 men, aged 60.8+/-11.6 yr, 7 patients received best supportive care only, 91 had synchronous metastasis. RESULTS Period B patients were older, with WHO score>1 more often, more adjuvant treatment, more metachronous metastasis, and NDs used more frequently (24% vs 59%). Median survival was similar (16 vs 15 mo). But when looking at the population aged<75 years with WHO score<2, median survival was 13 mo (period A) vs 21 mo (period B); survival at 1, 2, and 3 yr were respectively 59.5+/-8%, 16.2+/-6 %, 13.5+/-6 % vs 69.8+/-6%, 49.6+/-7%, 29.8+/-7%, p<0.01). In multiparametric analysis, factors correlated with survival were the absence of elevated serum alkaline phosphatase, a unique metastatic organ, and administration of NDs. CONCLUSION In our routine clinical experience the use of NDs for metastatic CRC has allowed a significant improvement in survival among patients with unresectable tumors.
Collapse
Affiliation(s)
- Joëlle Egreteau
- Oncologie Médicale, Centre Eugène Marquis, 35042 - Rennes France
| | | | | | | | | | | | | |
Collapse
|