1
|
Machet A, Poudou C, Tomowiak C, Gastinne T, Gardembas M, Systchenko T, Moya N, Debiais C, Levy A, Gruchet C, Sabirou F, Noel S, Bouyer S, Leleu X, Delwail V, Guidez S. Hodgkin lymphoma and female fertility: a multicenter study in women treated with doxorubicin, bleomycin, vinblastine, and dacarbazine. Blood Adv 2023; 7:3978-3983. [PMID: 36129842 PMCID: PMC10410126 DOI: 10.1182/bloodadvances.2021005557] [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: 06/17/2021] [Revised: 10/21/2021] [Accepted: 11/14/2021] [Indexed: 11/20/2022] Open
Abstract
Preservation of fertility has become a growing concern in young females with Hodgkin lymphoma (HL). However, the rate of pregnancy after the current most frequently prescribed ABVD (doxorubicin [Adriamycin], bleomycin, vinblastine, and darcarbazine) chemotherapy for HL has rarely been studied. In this study, we aim to determine the impact of ABVD on the fertility of women treated for HL. We conducted a noninterventional, multicenter study of female patients of childbearing age who were treated for HL. Two healthy apparied women nonexposed to chemotherapy (our controls) were assigned for each patient. Fertility was assessed by the number of pregnancies and births after HL treatment. Sixty-seven patients were included. The median age at diagnosis was 24.4 years (range, 16-43). HL was a localized disease for 68.7%. Of all the patients, 53.7% started at least 1 pregnancy after treatment vs 54.5% of the controls (P = .92). Of all the patients who desired children, 81% had at least 1 pregnancy. Patients treated with ABVD did not have a longer median time to pregnancy (4.8 years in the group of patients and 6.8 years for controls). Across patients, there were 58 pregnancies and 48 births (ratio, 1:2) and 136 pregnancies and 104 births (ratio, 1:3) for the control cohort. No increase in obstetric or neonatal complications has been reported in HL in our study. The number of pregnancies, births, and the time to start a pregnancy in young women treated with ABVD for HL is not different from that of controls. Therefore, females with HL treated with ABVD should be reassured regarding fertility.
Collapse
Affiliation(s)
- Antoine Machet
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Caroline Poudou
- Department of Medically Assisted Procreation, University Hospital of Poitiers, Poitiers, France
| | - Cécile Tomowiak
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Thomas Gastinne
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Martine Gardembas
- Department of Hematology, University Hospital of Angers, Angers, France
| | - Thomas Systchenko
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Niels Moya
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Celine Debiais
- Department of Anatomopathology, University Hospital of Poitiers, Poitiers, France
| | - Anthony Levy
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Cécile Gruchet
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Florence Sabirou
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Stéphanie Noel
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Sabrina Bouyer
- Department of Cytology, University Hospital of Poitiers, Poitiers, France
| | - Xavier Leleu
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Vincent Delwail
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Stéphanie Guidez
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| |
Collapse
|
2
|
Systchenko T, Chomel JC, Gallego-Hernanz P, Moya N, Desmier D, Maillard N, Bobin A, Vonfeld M, Gardeney H, Cayssials E E, Torregrosa J. Combination of azacitidine, venetoclax and ruxolitinib in blast phase myeloproliferative neoplasms. Br J Haematol 2023. [PMID: 37183377 DOI: 10.1111/bjh.18853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
Myeloproliferative neoplasms in blastic phase (MPN-BP) have a dreadful prognosis. We report the characteristics and outcomes of five MPN-BP patients treated with a never-before-described combination of azacytidine and venetoclax (to control BP transformation), added to ruxolitinib (needed to control constitutional symptoms). Median age was 76 years (range 72-84), and worst performance status was 2. The overall response rate was 80%, and the complete remission rate was 40%. With median follow-up of 10.0 months (range 4.2-13.4), median overall survival was 13.4 months (95% CI 4.2-13.4). We did not detect any unexpected treatment-related toxicity, and quality of life was improved.
Collapse
Affiliation(s)
| | - Jean-Claude Chomel
- Department of Cancer Biology, Onco-Hematology Unit, CHU de Poitiers, Poitiers, France
| | | | - Niels Moya
- Haematology Department, CHU de Poitiers, Poitiers, France
| | | | | | - Arthur Bobin
- Haematology Department, CHU de Poitiers, Poitiers, France
| | | | | | | | | |
Collapse
|
3
|
Cailly L, Gruchet C, Maitre E, Guidez S, Delwail V, Systchenko T, Moya N, Sabirou F, Levy A, Bobin A, Gardeney H, Nsiala L, Vonfeld M, Chacon A, Pichon A, Bouyer S, Baslé C, Dindinnaud E, Chomel J, Raimbault A, Borde‐Mougenot F, Troussard X, Tomowiak C. Hairy cell leukemia with isolated bone lesions. Clin Case Rep 2023; 11:e7343. [PMID: 37207087 PMCID: PMC10188895 DOI: 10.1002/ccr3.7343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/24/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023] Open
Abstract
Key Clinical Message 18F-FDG PET/CT has clinical relevance in HCL at diagnosis and for the follow-up of patients treated, especially in case of atypical presentations such as bone involvements (which are probably underestimated) and poor bone marrow infiltration. Abstract Bone lesions are rarely reported in Hairy Cell Leukemia (HCL). We report two BRAFV600E mutated HCL patients presented bone lesions at foreground, poor bone marrow involvement, and the important role 18F-FDG PET/CT played in their management. We discuss the crucial role that 18F-FDG PET/CT could play in HCL routine practice.
Collapse
Affiliation(s)
- Laura Cailly
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Cécile Gruchet
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Elsa Maitre
- Department of Hematology, CHU Cote de NacreUniversity HospitalCaenFrance
| | - Stephanie Guidez
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Vincent Delwail
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Thomas Systchenko
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Niels Moya
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Florence Sabirou
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Anthony Levy
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Arthur Bobin
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Hélène Gardeney
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Laly Nsiala
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Mathilde Vonfeld
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Aurélia Chacon
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Aurélien Pichon
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| | - Sabrina Bouyer
- Department of Biology, CHU La MiletrieUniversity HospitalPoitiersFrance
| | - Caroline Baslé
- Department of Biology, CHU La MiletrieUniversity HospitalPoitiersFrance
| | - Elodie Dindinnaud
- Department of Biology, CHU La MiletrieUniversity HospitalPoitiersFrance
| | | | - Anna Raimbault
- Department of Biology, CHU La MiletrieUniversity HospitalPoitiersFrance
| | | | - Xavier Troussard
- Department of Hematology, CHU Cote de NacreUniversity HospitalCaenFrance
| | - Cécile Tomowiak
- Department of Hematology and Cellular Therapy, and INSERM CIC1402CHU La Miletrie, University HospitalPoitiersFrance
| |
Collapse
|
4
|
Bobin A, Gruchet C, Guidez S, Gardeney H, Nsiala Makunza L, Vonfeld M, Lévy A, Cailly L, Sabirou F, Systchenko T, Moya N, Leleu X. Novel Non-Immunologic Agents for Relapsed and Refractory Multiple Myeloma: A Review Article. Cancers (Basel) 2021; 13:5210. [PMID: 34680358 PMCID: PMC8534104 DOI: 10.3390/cancers13205210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 12/28/2022] Open
Abstract
Novel treatments are needed to address the lack of options for patients with relapsed or refractory multiple myeloma. Even though immunotherapy-based treatments have revolutionized the field in recent years, offering new opportunities for patients, there is still no curative therapy. Thus, non-immunologic agents, which have proven effective for decades, are still central to the treatment of multiple myeloma, especially for advanced disease. Building on their efficacy in myeloma, the development of proteasome inhibitors and immunomodulatory drugs has been pursued, and has led to the emergence of a novel generation of agents (e.g., carfilzomib, ixazomib, pomalidomide). The use of alkylating agents is decreasing in most treatment regimens, but melflufen, a peptide-conjugated alkylator with a completely new mechanism of action, offers interesting opportunities. Moreover, with the identification of novel targets, new drug classes have entered the myeloma armamentarium, such as XPO1 inhibitors (selinexor), HDAC inhibitors (panobinostat), and anti-BCL-2 agents (venetoclax). New pathways are still being explored, especially the possibility of a mutation-driven strategy, as biomarkers and targeted treatments are increasing. Though multiple myeloma is still considered incurable, the treatment options are expanding and are progressively becoming more diverse, largely because of the continuous development of non-immunologic agents.
Collapse
Affiliation(s)
- Arthur Bobin
- Department of Hematology, CIC 1402, University Hospital, 86000 Poitiers, France; (C.G.); (S.G.); (H.G.); (L.N.M.); (M.V.); (A.L.); (L.C.); (F.S.); (T.S.); (N.M.); (X.L.)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Levy A, Guidez S, Debiais C, Princet I, Bouyer S, Dindinaud E, Delwail V, Systchenko T, Moya N, Gruchet C, Sabirou F, Bobin A, Gardeney H, Nsiala L, Cailly L, Olivier G, Motard C, Fleck E, Corby A, Roul C, Denis G, Dieval C, Leleu X, Tomowiak C. Waldenström macroglobulinemia and relationship to immune deficiency. Leuk Lymphoma 2021; 62:2665-2670. [PMID: 34085595 DOI: 10.1080/10428194.2021.1907379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Primary or secondary immune deficiency (ID) is a risk factor, although rare, to develop Waldenström macroglobulinemia (WM). We aimed to better understand the incidence of this occurrence in the real-life and the outcome of either entity. We conducted a review of 194 WM in the Poitou-Charentes registry and identified 7 (3.6%) with a prior history of ID. Across the 7 WM with ID, 4 progressed to active WM disease and required treatment for WM with a median time between WM diagnosis and the first treatment of 1.5 years (range 0-3). The median time from ID to WM occurrence was 8 years (1-18). WM could develop from ID, although a rare event. Our first action was to systematically decrease immunosuppression with long-term control of ID. Half of indolent WM remained indolent despite ID and for remaining WM none appeared of poor risk WM.
Collapse
Affiliation(s)
- Anthony Levy
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Stéphanie Guidez
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Céline Debiais
- Laboratoire d'Anatomie Pathologie, CHU, Poitiers, France
| | | | | | | | - Vincent Delwail
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Thomas Systchenko
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Niels Moya
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Cécile Gruchet
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Florence Sabirou
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Arthur Bobin
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Hélène Gardeney
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Laly Nsiala
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Laura Cailly
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | | | | | | | - Anne Corby
- Service d'Onco-Hématologie, La Rochelle, France
| | | | | | | | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Cécile Tomowiak
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| |
Collapse
|
6
|
Bobin A, Liuu E, Moya N, Gruchet C, Sabirou F, Lévy A, Gardeney H, Nsiala L, Cailly L, Guidez S, Tomowiak C, Systchenko T, Javaugue V, Durand G, Leleu X, Puyade M. Multiple Myeloma: An Overview of the Current and Novel Therapeutic Approaches in 2020. Cancers (Basel) 2020; 12:E2885. [PMID: 33050025 PMCID: PMC7600346 DOI: 10.3390/cancers12102885] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 08/31/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 01/06/2023] Open
Abstract
The survival rate of multiple myeloma (MM) patients has drastically increased recently as a result of the wide treatment options now available. Younger patients truly benefit from these innovations as they can support more intensive treatment, such as autologous stem cell transplant or multiple drug association (triplet, quadruplet). The emergence of immunotherapy allowed new combinations principally based on monoclonal anti-CD38 antibodies for these patients. Still, the optimal induction treatment has not been found yet. While consolidation is still debated, maintenance treatment is now well acknowledged to prolong survival. Lenalidomide monotherapy is the only drug approved in that setting, but many innovations are expected. Older patients, now logically named not transplant-eligible, also took advantage of these breakthrough innovations as most of the recent drugs have a more acceptable safety profile than previous cytotoxic agents. For this heterogenous subgroup, geriatric assessment has become an essential tool to identify frail patients and provide tailored strategies. At relapse, options are now numerous, especially for patients who were not treated with lenalidomide, or not refractory at least. Concerning lenalidomide refractory patients, approved combinations are lacking, but many trials are ongoing to fill that space. Moreover, innovative therapeutics are increasingly being developed with modern immunotherapy, such as chimeric antigen receptor T-cells (CAR-T cells), bispecific antibodies, or antibody-drug conjugates. For now, these treatments are usually reserved to heavily pre-treated patients with a poor outcome. MM drug classes have tremendously extended from historical alkylating agents to current dominant associations with proteasome inhibitors, immunomodulatory agents, and monoclonal anti-CD38/anti SLAMF7 antibodies. Plus, in only a couple of years, several new classes will enter the MM armamentarium, such as cereblon E3 ligase modulators (CELMoDs), selective inhibitors of nuclear export, and peptide-drug conjugates. Among the questions that will need to be answered in the years to come is the position of these new treatments in the therapeutic strategy, as well as the role of minimal residual disease-driven strategies which will be a key issue to elucidate. Through this review, we chose to enumerate and comment on the most recent advances in MM therapeutics which have undergone major transformations over the past decade.
Collapse
Affiliation(s)
- Arthur Bobin
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Evelyne Liuu
- Department of Geriatric Medicine, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France;
| | - Niels Moya
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Cécile Gruchet
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Florence Sabirou
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Anthony Lévy
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Hélène Gardeney
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Laly Nsiala
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Laura Cailly
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Stéphanie Guidez
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Cécile Tomowiak
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Thomas Systchenko
- Department of Internal Medicine, Châtellerault Hospital Center, 1 rue du Dr Luc Montagnier, 86106 Châtellerault, France;
| | - Vincent Javaugue
- Department of Nephrology, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France;
| | - Géraldine Durand
- Department of Rhumatology, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France;
| | - Xavier Leleu
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Mathieu Puyade
- Department of Internal Medicine, and CIC1402 INSERM unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France
| |
Collapse
|
7
|
Cayssials E, Torregrosa-Diaz J, Gallego-Hernanz P, Tartarin F, Systchenko T, Maillard N, Desmier D, Machet A, Fleck E, Corby A, Motard C, Denis G, Herbelin A, Gombert JM, Roy L, Ragot S, Leleu X, Guilhot F, Chomel JC. Low-dose tyrosine kinase inhibitors before treatment discontinuation do not impair treatment-free remission in chronic myeloid leukemia patients: Results of a retrospective study. Cancer 2020; 126:3438-3447. [PMID: 32459375 DOI: 10.1002/cncr.32940] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/17/2020] [Accepted: 04/03/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Long-term treatment-free remission (TFR) represents a new goal for chronic myeloid leukemia (CML). In clinical practice, tyrosine kinase inhibitor (TKI) dose reductions can be considered a means of preventing adverse effects and improving quality of life. We hypothesized that administration of low-dose TKIs before treatment discontinuation does not impair TFR in patients with CML who have a deep molecular response (DMR, ≥MR4 ). METHODS We conducted a retrospective analysis of 77 patients with CML who discontinued treatment with TKIs. Twenty-six patients had been managed with low-dose TKIs before stopping treatment. Patients were to be exposed to TKIs for ≥5 years and to low-dose TKIs for ≥1 year and in DMR for ≥2 years. The loss of major molecular response (MMR) was considered a trigger for restarting therapy. RESULTS In the low-dose group, 61.5% of patients received second-generation TKIs, and dose reduction was ≥50% for 65.4% of patients. With a median follow-up of 61.5 months, TFR at 12 months was 56.8% in the full-dose TKI group and 80.8% in the low-dose group, and TFR at 60 months was 47.5% and 58.8%, respectively. The median time to molecular recurrence (≥MMR) from TKI discontinuation in the entire cohort was 6.2 months. All patients quickly achieved MMR after resuming TKI therapy. Results appear independent of both dose reduction and potential pretreatment with interferon-α. CONCLUSION This retrospective study shows that TFR was not impaired by low-dose TKI regimens before TKI cessation in Patients with CML. Nevertheless, prospective randomized clinical trials must be undertaken to analyze the probability of successful TFR in patients managed with TKI dose de-escalation strategies before TKI discontinuation.
Collapse
Affiliation(s)
- Emilie Cayssials
- Service d'Oncologie Hématologique et Thérapie Cellulaire, CHU Poitiers, Poitiers, France.,INSERM CIC 1402, CHU Poitiers, Poitiers, France.,INSERM 1082, Poitiers, France
| | - Jose Torregrosa-Diaz
- Service d'Oncologie Hématologique et Thérapie Cellulaire, CHU Poitiers, Poitiers, France.,INSERM CIC 1402, CHU Poitiers, Poitiers, France
| | - Pilar Gallego-Hernanz
- Service d'Oncologie Hématologique et Thérapie Cellulaire, CHU Poitiers, Poitiers, France
| | | | - Thomas Systchenko
- Service d'Oncologie Hématologique et Thérapie Cellulaire, CHU Poitiers, Poitiers, France
| | - Natacha Maillard
- Service d'Oncologie Hématologique et Thérapie Cellulaire, CHU Poitiers, Poitiers, France
| | - Déborah Desmier
- Service d'Oncologie Hématologique et Thérapie Cellulaire, CHU Poitiers, Poitiers, France
| | - Antoine Machet
- Service d'Oncologie Hématologique et Thérapie Cellulaire, CHU Poitiers, Poitiers, France
| | - Emmanuel Fleck
- Service d'Oncologie Hématologique, CH La Rochelle, La Rochelle, France
| | - Anne Corby
- Service d'Oncologie Hématologique, CH La Rochelle, La Rochelle, France
| | | | | | | | | | - Lydia Roy
- Service Clinique d'Hématologie, Hôpital Henri-Mondor, Creteil, France
| | | | - Xavier Leleu
- Service d'Oncologie Hématologique et Thérapie Cellulaire, CHU Poitiers, Poitiers, France.,INSERM CIC 1402, CHU Poitiers, Poitiers, France
| | | | | |
Collapse
|
8
|
Systchenko T, Defossez G, Guidez S, Laurent C, Puyade M, Debiais-Delpech C, Dreyfus B, Machet A, Leleu X, Delwail V, Ingrand P. R-CHOP appears to be the best first-line treatment for second primary diffuse large B cell lymphoma: a cancer registry study. Ann Hematol 2020; 99:1605-1613. [PMID: 32451709 DOI: 10.1007/s00277-020-04100-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Abstract
Second primary diffuse large B cell lymphoma (spDLBCL) is defined as a metachronous tumor occurring after a first primary cancer. To date, while R-CHOP is the standard first-line treatment for de novo DLBCL, no available data show that R-CHOP is the optimal treatment for spDLBCL. This exploratory study aimed to investigate treatment of spDLBCL. From 2008 to 2015, the Poitou-Charentes general cancer registry recorded 68 cases of spDLBCL ≤ 80 years old, having received a first-line treatment with either R-CHOP (78%) or other regimens (22%). Patients without R-CHOP have worse overall survival in univariate (HR 2.89 [1.33-6.24], P = 0.007) and multivariate (HR 2.98 [1.34-6.67], P = 0.008) analyses. Patients without R-CHOP more frequently had PS > 1 (67% vs. 28%, P = 0.007) and prior chemotherapy (60% vs. 26%, P = 0.02), which suggests that both of these factors influence a clinician's decision to not use R-CHOP. Prior chemotherapy had no prognostic impact in univariate and multivariate analyses; this result could call into question the risk-benefit balance of not using R-CHOP to prevent toxicity. In our study, one DLBCL out of ten occurred after a first primary cancer, and as regards de novo DLBCL, R-CHOP appeared to be the best first-line treatment. Larger series are needed to confirm these results.
Collapse
Affiliation(s)
- T Systchenko
- Poitou-Charentes General Cancer Registry, Université de Poitiers, 6 rue de la Milétrie, 86073, Poitiers Cedex 9, France. .,INSERM CIC 1402, CHU de Poitiers, Poitiers, France. .,Haematology Department, CHU de Poitiers, Poitiers, France.
| | - G Defossez
- Poitou-Charentes General Cancer Registry, Université de Poitiers, 6 rue de la Milétrie, 86073, Poitiers Cedex 9, France.,INSERM CIC 1402, CHU de Poitiers, Poitiers, France
| | - S Guidez
- INSERM CIC 1402, CHU de Poitiers, Poitiers, France.,Haematology Department, CHU de Poitiers, Poitiers, France
| | - C Laurent
- Anatomy-pathology Department, CHU de Toulouse, Réseau Lymphopath, Toulouse, France
| | - M Puyade
- Poitou-Charentes General Cancer Registry, Université de Poitiers, 6 rue de la Milétrie, 86073, Poitiers Cedex 9, France.,INSERM CIC 1402, CHU de Poitiers, Poitiers, France
| | | | - B Dreyfus
- Haematology Department, CHU de Poitiers, Poitiers, France
| | - A Machet
- Haematology Department, CHU de Poitiers, Poitiers, France
| | - X Leleu
- INSERM CIC 1402, CHU de Poitiers, Poitiers, France.,Haematology Department, CHU de Poitiers, Poitiers, France
| | - V Delwail
- INSERM CIC 1402, CHU de Poitiers, Poitiers, France.,Haematology Department, CHU de Poitiers, Poitiers, France
| | - P Ingrand
- Poitou-Charentes General Cancer Registry, Université de Poitiers, 6 rue de la Milétrie, 86073, Poitiers Cedex 9, France.,INSERM CIC 1402, CHU de Poitiers, Poitiers, France
| |
Collapse
|
9
|
Van de Wyngaert Z, Nerich V, Fouquet G, Chrétien ML, Caillot D, Azar N, Garderet L, Lenain P, Macro M, Bourhis JH, Belhocine R, Jaccard A, Karlin L, Bobin A, Moya N, Systchenko T, Gruchet C, Giraud C, Guidez S, Darras C, Princet I, Touzeau C, Moreau P, Hulin C, Deconinck E, Limat S, Leleu X. Cost and efficacy of peripheral stem cell mobilization strategies in multiple myeloma. Bone Marrow Transplant 2020; 55:2254-2260. [PMID: 32447348 DOI: 10.1038/s41409-020-0940-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/09/2022]
Abstract
Mobilization of peripheral blood stem cells (PBSC) can be performed using plerixafor, which is expensive, or high-dose cyclophosphamide (HDCy). We hypothesized that the overall cost of mobilization with plerixafor might not be greater if the cost of complication management was considered. We performed a cost analysis of these two strategies. This multicentric observational study recruited patients with myeloma who underwent a first PBSC mobilization. We considered direct medical costs, including hospitalization, mobilization agents, apheresis, and supportive treatments. We included 111 patients, 54 and 57 in the HDCy and plerixafor groups, respectively. Cost of mobilization with HDCy was 5097 ± 2982€ vs. 10958 ± 1789€ for plerixafor (p < 0.0001). Cost of agents used was 1287 ± 779€ vs. 6552 ± 509€, respectively (p = 0.0009). The mean number of days of hospitalization was 2 and 2.1 days, respectively (p = 0.035). All patients achieved the minimum PBSC collection target (p = 1.0); however, ASCT was performed with HDCy in 67% patients and with plerixafor in 86% (p = 0.02). Plerixafor mobilization incurred a greater cost, mostly due to the greater cost of the drug. Hospitalization length in the two groups was similar in our series. Interestingly, plerixafor appeared to be a very effective and safe mobilizing approach translating into a greater ASCT success.
Collapse
Affiliation(s)
- Zoé Van de Wyngaert
- CHU Lille, Service des Maladies du Sang, F-59000, Lille, France.,Hématologie et thérapie cellulaire, Hôpital Saint Antoine, APHP, Université Paris-Sorbonne, INSERM UMRs 938, Paris, France
| | - Virginie Nerich
- Department of Pharmacy, University Hospital of Besançon, Univ. Bourgogne Franche-Comté, Besançon, France.,INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | | | | | | | - Nabih Azar
- Hôpital Pitié Salpêtrière, Service d'Hématologie, F-75013, Paris, France
| | - Laurent Garderet
- Hématologie et thérapie cellulaire, Hôpital Saint Antoine, APHP, Université Paris-Sorbonne, INSERM UMRs 938, Paris, France.,Hôpital Pitié Salpêtrière, Service d'Hématologie, F-75013, Paris, France
| | | | | | | | - Ramdane Belhocine
- Hématologie et thérapie cellulaire, Hôpital Saint Antoine, APHP, Université Paris-Sorbonne, INSERM UMRs 938, Paris, France
| | - Arnaud Jaccard
- Hématologie clinique et thérapie cellulaire, CHU, Limoges, France
| | - Lionel Karlin
- Service d'Hématologie, Hospices Civils de Lyon, Lyon Sud, France
| | - Arthur Bobin
- Hematology and Inserm CIC 1402, CHU, Poitiers, France
| | - Niels Moya
- Hematology and Inserm CIC 1402, CHU, Poitiers, France
| | | | | | | | | | - Claire Darras
- Hematology and Inserm CIC 1402, CHU, Poitiers, France
| | | | - Cyrille Touzeau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | - Philippe Moreau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | | | | | - Samuel Limat
- Department of Pharmacy, University Hospital of Besançon, Univ. Bourgogne Franche-Comté, Besançon, France.,INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Xavier Leleu
- Hematology and Inserm CIC 1402, CHU, Poitiers, France.
| | | |
Collapse
|
10
|
Renaud L, Schraen S, Fouquet G, Guidez S, Demarquette H, Nudel M, Cayssials E, Bories C, Herbaux C, Systchenko T, Faucompré JL, Machet A, Sabirou F, Levy A, Bobin A, Richez V, Moya N, Gruchet C, Desmier D, van de Wyngaert Z, Carpentier B, Manier S, Facon T, Harding S, Leleu X. Response to pneumococcal vaccination in multiple myeloma. Cancer Med 2019; 8:3822-3830. [PMID: 31145552 PMCID: PMC6639194 DOI: 10.1002/cam4.2253] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 12/05/2018] [Revised: 04/24/2019] [Accepted: 05/02/2019] [Indexed: 12/14/2022] Open
Abstract
Background Streptococcus pneumoniae infection causes morbidity and mortality in multiple myeloma patients. Pneumococcal vaccination is commonly given to immunocompromised myeloma patients; however response data are sparse. Here, we present longitudinal response data to pneumococcal vaccination in multiple myeloma patients. Method Twenty‐eight multiple myeloma patients were included, 25 of whom were newly diagnosed. All the patients received two vaccines Prevnar13® and Pneumo23®. Serotype‐specific IgG was measured by ELISA for all 23 vaccine serotypes at baseline, and then sequentially at different time points postvaccination until treatment ended. Response to vaccination is available for 20 patients. The primary endpoint was the incidence rate of patients who obtained an isotype response serum concentration after vaccination. Secondary endpoints included detailed isotype increase, time to first increase, further assessment of a decreased anti‐pneumococcal serum concentrations following treatment including autologous stem cell transplantation (ASCT), rate of infection with a special attention to pneumococcal infection. Results The median age was 66 years and the male to female ratio was 0.6. Anti‐pneumococcal capsular polysaccharide (anti‐PCP23) IgG, IgG2, IgA, and IgM responses were detected within 1 week postvaccination. Response to at least one subtype of antibody was obtained in 85% (n = 17) of patients, for at least two subtypes in 65% (n = 13), for at least three subtypes in 55% (n = 11), and 2 patients responded to all four subtypes. The median increase in the concentration of anti‐PCP23 isotypes was threefold following vaccination, with the highest increase observed when Pneumo23® was given more than 30 days after Prevnar13®. The anti‐pneumococcal geometric mean concentration decreased significantly for all subtypes over time independently of treatment approaches. Conclusion Myeloma has the ability to demonstrate a response to pneumococcal vaccine, independently of preexisting hypogammaglobulinemia and possibly of treatment‐induced immunodepression. We also observed a drop in the serum response overtime and following autologous transplantation. Further studies in larger sample are needed to understand the benefit of vaccination strategies in these patients.
Collapse
Affiliation(s)
- Loïc Renaud
- Department of Hematology, CHU Lille, Lille, France
| | | | | | - Stephanie Guidez
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | | | | | | | | | | | - Thomas Systchenko
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | | | - Antoine Machet
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Florence Sabirou
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Antony Levy
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Arthur Bobin
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | | | - Niels Moya
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Cécile Gruchet
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | - Deborah Desmier
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| | | | | | | | | | | | - Xavier Leleu
- Faculté de médecine, Hôpital de la Milétrie, and Inserm CIC 1402, CHU, Poitiers, France
| |
Collapse
|
11
|
Fouquet G, Snell KI, Guidez S, Schraen S, Boyle E, Renaud L, Desmier D, Machet A, Moya N, Systchenko T, Gruchet C, Decaux O, Arnulf B, Fohrer C, Richez V, Kolb B, Macro M, Karlin L, Royer B, Pegourie B, Hebraud B, Caillot D, Perrot A, Moreau P, Facon T, Avet-Loiseau H, Dejoie T, Hulin C, Harding S, Leleu X. Heavy + light chain analysis to assign myeloma response is analogous to the IMWG response criteria. Leuk Lymphoma 2017; 59:583-589. [PMID: 28697637 DOI: 10.1080/10428194.2017.1339876] [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] [Indexed: 10/19/2022]
Abstract
Automated serum heavy + light chain (HLC) immunoassays can measure the intact immunoglobulins of each light chain type separately. We though to compare HLC assays with electrophoretic techniques in determining International Myeloma Working Group (IMWG) response criteria. 114 myeloma patients from 2 trials were included. HLC measurements were made utilizing archived sera and response assessments compared with those based on electrophoretic analysis at the time of the trials. Assessments at ∼90 days and maximal response were compared as was the power of the 2 techniques for predicting later responses, overall survival, and progression. The kappa statistic indicated good agreement between the 2 methods for determining IMWG response criteria, although HLC measurements might give better predictions of subsequent responses and frequently gave an earlier indication of change. HLC measurements could represent an alternative to electrophoretic techniques in determining IMWG response. Validation with a greater range of patient responses is needed for confirmation.
Collapse
Affiliation(s)
| | | | - Stéphanie Guidez
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | | | | | | | - Déborah Desmier
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | - Antoine Machet
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | - Niels Moya
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | | | - Cécile Gruchet
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | | | | | | | - Valentine Richez
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | | | | | - Lionel Karlin
- j Hôpital Lyon Sud, CHU , Lyon Pierre Bénite , France
| | | | | | | | | | | | | | | | | | | | - Cyrille Hulin
- q Hôpital Haut-Leveque, CHU , Pessac Bordeaux , France
| | | | - Xavier Leleu
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| |
Collapse
|