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Müller F, Taubmann J, Bucci L, Wilhelm A, Bergmann C, Völkl S, Aigner M, Rothe T, Minopoulou I, Tur C, Knitza J, Kharboutli S, Kretschmann S, Vasova I, Spoerl S, Reimann H, Munoz L, Gerlach RG, Schäfer S, Grieshaber-Bouyer R, Korganow AS, Farge-Bancel D, Mougiakakos D, Bozec A, Winkler T, Krönke G, Mackensen A, Schett G. CD19 CAR T-Cell Therapy in Autoimmune Disease - A Case Series with Follow-up. N Engl J Med 2024; 390:687-700. [PMID: 38381673 DOI: 10.1056/nejmoa2308917] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Treatment for autoimmune diseases such as systemic lupus erythematosus (SLE), idiopathic inflammatory myositis, and systemic sclerosis often involves long-term immune suppression. Resetting aberrant autoimmunity in these diseases through deep depletion of B cells is a potential strategy for achieving sustained drug-free remission. METHODS We evaluated 15 patients with severe SLE (8 patients), idiopathic inflammatory myositis (3 patients), or systemic sclerosis (4 patients) who received a single infusion of CD19 chimeric antigen receptor (CAR) T cells after preconditioning with fludarabine and cyclophosphamide. Efficacy up to 2 years after CAR T-cell infusion was assessed by means of Definition of Remission in SLE (DORIS) remission criteria, American College of Rheumatology-European League against Rheumatism (ACR-EULAR) major clinical response, and the score on the European Scleroderma Trials and Research Group (EUSTAR) activity index (with higher scores indicating greater disease activity), among others. Safety variables, including cytokine release syndrome and infections, were recorded. RESULTS The median follow-up was 15 months (range, 4 to 29). The mean (±SD) duration of B-cell aplasia was 112±47 days. All the patients with SLE had DORIS remission, all the patients with idiopathic inflammatory myositis had an ACR-EULAR major clinical response, and all the patients with systemic sclerosis had a decrease in the score on the EUSTAR activity index. Immunosuppressive therapy was completely stopped in all the patients. Grade 1 cytokine release syndrome occurred in 10 patients. One patient each had grade 2 cytokine release syndrome, grade 1 immune effector cell-associated neurotoxicity syndrome, and pneumonia that resulted in hospitalization. CONCLUSIONS In this case series, CD19 CAR T-cell transfer appeared to be feasible, safe, and efficacious in three different autoimmune diseases, providing rationale for further controlled clinical trials. (Funded by Deutsche Forschungsgemeinschaft and others.).
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Affiliation(s)
- Fabian Müller
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Jule Taubmann
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Laura Bucci
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Artur Wilhelm
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Christina Bergmann
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Simon Völkl
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Michael Aigner
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Tobias Rothe
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Ioanna Minopoulou
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Carlo Tur
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Johannes Knitza
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Soraya Kharboutli
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Sascha Kretschmann
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Ingrid Vasova
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Silvia Spoerl
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Hannah Reimann
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Luis Munoz
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Roman G Gerlach
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Simon Schäfer
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Ricardo Grieshaber-Bouyer
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Anne-Sophie Korganow
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Dominique Farge-Bancel
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Dimitrios Mougiakakos
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Aline Bozec
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Thomas Winkler
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Gerhard Krönke
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Andreas Mackensen
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
| | - Georg Schett
- From the Departments of Internal Medicine 5-Hematology and Oncology (F.M., S.V., M.A., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., A.M.) and Internal Medicine 3-Rheumatology and Immunology (J.T., L.B., A.W., C.B., T.R., I.M., C.T., J.K., L.M., R.G.-B., A.B., G.K., G.S.), Deutsches Zentrum Immuntherapie (F.M., J.T., L.B., A.W., C.B., S.V., M.A., T.R., I.M., C.T., J.K., S. Kharboutli, S. Kretschmann, I.V., S. Spoerl, H.R., L.M., R.G.-B., A.B., G.K., A.M., G.S.), and the Institute of Clinical Microbiology, Immunology, and Hygiene (R.G.G.), Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, and the Department of Biology, Division of Genetics, Nikolaus-Fiebiger Center for Molecular Medicine, FAU Erlangen-Nürnberg (S. Schäfer, T.W.), Erlangen, the Department of Hematology and Oncology and Health Campus Immunology, Infectiology, and Inflammation, Medical Center, Otto-von-Guericke University, Magdeburg (D.M.), and the Department of Rheumatology, Charité-Universitätsmedizin Berlin, Berlin (G.K.) - all in Germany; the Department of Rheumatology, Catholic University of the Sacred Heart, Rome (C.T., G.S.); the Department of Clinical Immunology, Nouvel Hôpital Civil, Strasbourg University, Strasbourg (A.-S.K.), and Centre de Référence des Maladies Auto-immunes Systémiques Rares d'Ile-de-France, Hôpital Saint-Louis and Université Paris Cité, Paris (D.F.-B.) - both in France; and Karolinska Institutet, Stockholm (G.S.)
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2
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Bonnin A, Terriou L, Beuvon C, Tudesq JJ, Puyade M, Pugnet G, Maria A, Llorente CC, Lansiaux P, Cacciatore C, Badoglio M, Yakoub-Agha I, Farge-Bancel D, Marjanovic Z. [Mobilization and conditioning protocols actualization for autologous stem cell transplantation for autoimmune diseases: Guidelines from MATHEC-SFGM-TC]. Bull Cancer 2024; 111:S84-S95. [PMID: 37845095 DOI: 10.1016/j.bulcan.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/25/2023] [Accepted: 09/01/2023] [Indexed: 10/18/2023]
Abstract
The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) organized the 13th workshop on hematopoietic stem cell transplantation clinical practices harmonization procedures in September 2022 in Lille, France. The aim of this workshop is to update the mobilization and conditioning protocols for autologous hematopoietic stem cell transplantation for autoimmune diseases, and to specify contraindications for transplant, conditioning regimen selection, immunosuppressive treatment discontinuation before mobilization and disease-specific surveillance.
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Affiliation(s)
- Agnès Bonnin
- AP-HP, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Louis Terriou
- CHU de Lille, département de médecine interne et immunologie clinique, 59000 Lille, France; Centre de référence des maladies auto-immunes et auto-inflammatoires rares (CERAINO), 59000 Lille, France
| | - Clément Beuvon
- CHU de Poitiers, service de médecine interne, 2, rue de La Miletrie, 86021 Poitiers, France
| | - Jean-Jacques Tudesq
- Université de Montpellier, CHU de Montpellier, service d'hématologie clinique, 80, avenue Augustin-Fliche, 34295 Montpellier, France
| | - Mathieu Puyade
- CHU de Poitiers, service de médecine interne, 2, rue de La Miletrie, 86021 Poitiers, France
| | - Grégory Pugnet
- CHU de Toulouse Rangueil, service de médecine interne et immunologie clinique, 2, rue Viguerie, 31059 Toulouse, France
| | - Alexandre Maria
- CHU de Montpellier, hôpital Saint-Eloi, Université de Montpellier, Institute for Regenerative Medicine and Biotherapy (IRMB), médecine interne et immuno-oncologie (MedI20), 80, avenue Augustin-Fliche, 34295 Montpellier, France
| | - Cristina Castilla Llorente
- Gustave-Roussy Cancer Campus, département d'hématologie, 114, rue Edouard-Vaillant, 94805 Villejuif, France
| | - Pauline Lansiaux
- AP-HP, hôpital St-Louis, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France MATHEC (FAI2R), unité de médecine interne : maladies auto-immunes et pathologie vasculaire (UF 04), 1, avenue Claude-Vellefaux, 75010 Paris, France; Université de Paris Cité, institut de recherche Saint-Louis, recherche clinique appliquée à l'hématologie, EA3518, 75010 Paris, France
| | - Carlotta Cacciatore
- AP-HP, hôpital St-Louis, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France MATHEC (FAI2R), unité de médecine interne : maladies auto-immunes et pathologie vasculaire (UF 04), 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Manuela Badoglio
- Hôpital Saint-Antoine, EBMT Office, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | | | - Dominique Farge-Bancel
- AP-HP, hôpital St-Louis, centre de référence des maladies auto-immunes systémiques rares d'Île-de-France MATHEC (FAI2R), unité de médecine interne : maladies auto-immunes et pathologie vasculaire (UF 04), 1, avenue Claude-Vellefaux, 75010 Paris, France; Université de Paris Cité, institut de recherche Saint-Louis, recherche clinique appliquée à l'hématologie, EA3518, 75010 Paris, France; McGill University, H3A 1A1, Department of Medicine, Montreal, Canada
| | - Zora Marjanovic
- AP-HP, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France.
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3
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Trujillo-Santos J, Farge-Bancel D, Pedrajas JM, Gómez-Cuervo C, Ballaz A, Braester A, Mahé I, Villalobos A, Porras JA, Monreal M. Enoxaparin versus dalteparin or tinzaparin in patients with cancer and venous thromboembolism: The RIETECAT study. Res Pract Thromb Haemost 2022; 6:e12736. [PMID: 35664535 PMCID: PMC9164243 DOI: 10.1002/rth2.12736] [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: 05/24/2021] [Revised: 04/06/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Venous thromboembolism (VTE) is a frequent complication in patients with cancer and a leading cause of morbidity and death. Objectives The objective of the RIETECAT study was to compare the long‐term effectiveness and safety of enoxaparin versus dalteparin or tinzaparin for the secondary prevention of VTE in adults with active cancer. Methods We used the data from the multicenter, multinational RIETE registry to compare the rates of VTE recurrences, major bleeding, or death over 6 months in patients with active cancer and acute VTE using full doses of enoxaparin versus dalteparin or tinzaparin, and a multivariable Cox proportional hazard model was used to analyze the primary end point. Results From January 2009 to June 2018, 4451 patients with active cancer received full doses of the study drugs: enoxaparin, 3526 patients; and dalteparin or tinzaparin, 925 (754 + 171) patients. There was limited difference in VTE recurrences (2.0% vs 2.5%) and mortality rate (19% vs 17%) between the enoxaparin and dalteparin or tinzaparin subgroups. However, there was a slight numerical increase in major bleeding (3.1% vs 1.9%). Propensity score matching confirmed that there were no differences in the risk for VTE recurrences (adjusted hazard ratio [aHR], 0.81; 95% confidence interval [CI], 0.48‐1.38), major bleeding (aHR, 1.40; 95% CI, 0.80‐2.46), or death (aHR, 1.07; 95% CI, 0.88‐1.30) between subgroups. Conclusions In RIETECAT, in patients with cancer and VTE receiving full‐dose enoxaparin or dalteparin or tinzaparin, no statistically significant differences were observed regarding effectiveness and safety outcomes over a 6‐month period.
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Affiliation(s)
- Javier Trujillo-Santos
- Department of Internal Medicine Hospital General Universitario Santa Lucía Universidad Católica de Murcia Murcia Spain
| | - Dominique Farge-Bancel
- Unité de Médecine Interne Maladies Auto-immunes et Pathologie Vasculaire (UF 04) IRSL EA-3518 Université de Paris Paris France
| | | | | | - Aitor Ballaz
- Department of Pneumonology Hospital de Galdakao Vizcaya Spain
| | - Andrei Braester
- Department of Haematology Azrieli Faculty of Medicine Bar-Ilan University Safed Israel
| | - Isabelle Mahé
- Department of Internal Medicine Hôpital Louis Mourier Colombes (APHP) University Paris France
| | - Aurora Villalobos
- Department of Internal Medicine Hospital Regional Universitario de Málaga Málaga Spain
| | - José Antonio Porras
- Department of Internal Medicine Hospital Universitario Joan XXIII de Tarragona Tarragona Spain
| | - Manuel Monreal
- Department of Internal Medicine Hospital Germans Trias i Pujol, Badalona Universidad Católica de Murcia Universidad Autónoma de Barcelona Badalona Spain
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Alsuliman T, Stocker N, de Wyngaert ZV, Ikhlef S, Ellouz C, Corre E, Banet A, Ricard L, Dulery R, Meynard JL, Malard F, Stankoff B, Farge-Bancel D, Brissot E, Mohty M, Marjanovic Z. COVID-19 in the context of autologous hematopoietic stem cell transplantation for a patient with autoimmune disease. Curr Res Transl Med 2021; 70:103332. [PMID: 34979485 PMCID: PMC8702398 DOI: 10.1016/j.retram.2021.103332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/21/2021] [Indexed: 01/27/2023]
Affiliation(s)
- Tamim Alsuliman
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France.
| | - Nicolas Stocker
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France
| | - Zoé Van de Wyngaert
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France
| | - Souhila Ikhlef
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France
| | - Cyrine Ellouz
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France
| | - Elise Corre
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France
| | - Anne Banet
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France
| | - Laure Ricard
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France
| | - Rémy Dulery
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France
| | - Jean-Luc Meynard
- Service des maladies infectieuses et tropicales, Hôpital Saint Antoine, AP-HP Sorbonne Université, F-75012 Paris, France
| | - Florent Malard
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France
| | - Bruno Stankoff
- Service de neurologie, Hôpital Saint Antoine, AP-HP Sorbonne Université, F-75012 Paris, France
| | - Dominique Farge-Bancel
- Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France, AP-HP, Hôpital St-Louis, F-75010 Paris, France; Université de Paris, IRSL, Recherche clinique appliquée à l'hématologie, EA3518, F-75010 Paris, France
| | - Eolia Brissot
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France
| | - Mohamad Mohty
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France
| | - Zora Marjanovic
- Sorbonne University, Paris, France; Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, Paris, France; INSERM, UMRs 938, Paris, France
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5
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Urbain F, Puyade M, Labeyrie C, Maubeuge N, Puma A, Cintas P, Pugnet G, Castilla-Llorente C, Adams D, Farge-Bancel D. Hematopoietic stem cell transplantation in chronic inflammatory demyelinating polyneuropathy: French experience about four patients, under the behalf of French society for bone marrow transplantation. J Neurol 2021; 268:1536-1539. [PMID: 33655343 DOI: 10.1007/s00415-021-10452-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Fanny Urbain
- Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France MATHEC (FAI2R), Assistance Publique-Hôpitaux de Paris, 75010, Paris, France.
| | - Mathieu Puyade
- Service de Médecine Interne et Maladies Infectieuses, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers cedex, France.,CIC-1402, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers cedex, France
| | - Céline Labeyrie
- Service de Neurologie, National Reference Center for Familial Amyloid Polyneuropathy and Other Rare Neuropathies, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France.,U1195, INSERM, Université Paris-Saclay, 94276, Le Kremlin Bicêtre, France
| | - Nicolas Maubeuge
- Service de Neurologie, CHU de Poitiers, 2, rue de la Milétrie, 86021, Poitiers cedex, France
| | - Angela Puma
- Centre Hospitalier Universitaire de Nice, Système Nerveux Périphérique et Muscle, Université Côte D'Azur, Hôpital Pasteur, 2, 30 voie Romaine, CS 51069, 06001, Nice Cedex 1, France
| | - Pascal Cintas
- Service de Neurologie, Hôpital Rangueil, CHU Toulouse, Avenue Jean Poulhes, 31300, Toulouse, France
| | - Gregory Pugnet
- Service de Médecine Interne, Hôpital Purpan, CHU Toulouse, Place du Docteur Joseph Baylac, 31300, Toulouse, France.,Faculté de Médecine de Toulouse, 37 Allée Jules Guesde, 31000, Toulouse, France
| | | | - David Adams
- Service de Neurologie, National Reference Center for Familial Amyloid Polyneuropathy and Other Rare Neuropathies, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, 94275, Le Kremlin-Bicêtre, France.,U1195, INSERM, Université Paris-Saclay, 94276, Le Kremlin Bicêtre, France
| | - Dominique Farge-Bancel
- Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France MATHEC (FAI2R), Assistance Publique-Hôpitaux de Paris, 75010, Paris, France.,IRSL, Recherche Clinique Appliquée à l'Hématologie, EA3518, Université de Paris, Paris, France.,Department of Medicine, H3A 1A1, McGill University, Montreal, QC, Canada
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6
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Gay MHP, Baldomero H, Farge-Bancel D, Robey PG, Rodeo S, Passweg J, Müller-Gerbl M, Martin I. The Survey on Cellular and Tissue-Engineered Therapies in Europe in 2016 and 2017. Tissue Eng Part A 2020; 27:336-350. [PMID: 32680446 DOI: 10.1089/ten.tea.2020.0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This report describes activity in Europe for the years 2016 and 2017 in the area of cellular and tissue-engineered therapies, excluding hematopoietic stem cell treatments for the reconstitution of hematopoiesis. It is the eighth of its kind and is supported by five established scientific organizations. In 2016 and 2017, a combined 234 teams from 29 countries responded to the cellular and engineered tissue therapy survey; 227 teams reported treating 8236 patients in these 2 years. Indications were categorized in hematology/oncology (40%; predominantly prevention or treatment of graft vs. host disease and hematopoietic graft enhancement), musculoskeletal/rheumatological disorders (29%), cardiovascular disorders (6%), neurological disorders (4%), gastrointestinal disorders (<1%), as well as miscellaneous disorders (20%), which were not assigned to the previous indications. The predominantly used cells were autologous (61%). The majority of autologous cells were used to treat musculoskeletal/rheumatological (44%) disorders, whereas allogeneic cells were mainly used for hematology/oncology (78%). The reported cell types were mesenchymal stem/stromal cells (MSCs) (56%), hematopoietic cells (21%), keratinocytes (7%), chondrocytes (6%) dermal fibroblasts (4%), dendritic cells (2%), and other cell types (4%). Cells were expanded in vitro in 62% of the treatments, sorted in 11% of the cases, and rarely transduced (2%). The processing of cells was outsourced to external facilities in 30% of the cases. Cells were delivered predominantly intravenously or intra-arterially [47%], as suspension [36%], or using a membrane/scaffold (16%). The data are compared with those from previous years to identify trends in a rapidly evolving field. In this edition, the report includes a critical discussion of data collected in the space of orthopedics and the use of MSCs.
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Affiliation(s)
- Max H P Gay
- Department of Biomedicine, Institute of Anatomy, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Helen Baldomero
- EBMT Activity Survey Office, Division of Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Dominique Farge-Bancel
- Unité de Médecine Interne, Maladies Auto-immunes et Pathologie Vasculaire, Université de Paris, Paris, France.,MATHEC, Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France, Hôpital St-Louis, Paris, France
| | - Pamela G Robey
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
| | - Scott Rodeo
- Orthopaedic Surgery, Weill Medical College of Cornell University, New York, New York, USA.,The Hospital for Special Surgery, New York, New York, USA
| | - Jakob Passweg
- EBMT Activity Survey Office, Division of Hematology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Magdalena Müller-Gerbl
- Department of Biomedicine, Institute of Anatomy, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ivan Martin
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
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7
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Siniscalchi C, Suriñach JM, Visonà A, Fernández-Reyes JL, Gómez-Cuervo C, Verhamme P, Marchena PJ, Farge-Bancel D, Moisés J, Monreal M. Different Types of Statins and All-Cause Mortality during Anticoagulation for Venous Thromboembolism: Validation Study from RIETE Registry. TH Open 2020; 4:e236-e244. [PMID: 32964178 PMCID: PMC7498305 DOI: 10.1055/s-0040-1716734] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/11/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction
We previously reported that during the course of anticoagulation for venous thromboembolism (VTE) patients using statins were at a lower risk to die than nonusers.
Methods
We used the
R
egistro
I
nformatizado
E
nfermedad
T
rombo
E
mbólica (RIETE) registry to validate our previous findings in a subsequent cohort of patients and to compare the risk of death according to the use of different types of statins.
Results
From January 2018 to December 2019, 19,557 patients with VTE were recruited in RIETE. Of them, 4,065 (21%) were using statins (simvastatin, 1,406; atorvastatin, 1,328; rosuvastatin, 246; and others, 1,085). During anticoagulation (192 vs.182 days, for statin and no statin users respectively), 500 patients developed a VTE recurrence, 519 suffered major bleeding, and 1,632 died (fatal pulmonary embolism [PE], 88 and fatal bleeding, 78). On multivariable analysis, statin users were at a lower risk to die (hazard ratio [HR] = 0.68; 95% confidence interval [CI]: 0.59–0.79) than nonusers. When separately analyzing the drugs, on multivariable analysis, patients using simvastatin (HR = 0.64; 95% CI: 0.52–0.80), atorvastatin (HR 0.72; 95% CI: 0.58–0.89), or other statins (HR = 0.67; 95% CI: 0.52–0.87) were at a lower risk to die than nonusers. For those using rosuvastatin, difference was not statistically significant (HR = 0.77; 95% CI: 0.50–1.19), maybe due to the sample size.
Conclusion
Our data validate previous findings and confirm that VTE patients using statins at baseline are at a lower risk to die than nonusers. No statistically differences were found according to type of statins.
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Affiliation(s)
- Carmine Siniscalchi
- Department of Internal and Emergency Medicine, Angiology Unit, Parma University Hospital, Parma, Italy
| | - José M Suriñach
- Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Adriana Visonà
- Department of Vascular Medicine, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
| | | | | | - Peter Verhamme
- Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium
| | - Pablo J Marchena
- Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Déu-Hospital General, Barcelona, Spain
| | | | - Jorge Moisés
- Department of Pneumonology, Hospital Universitario Clínic de Barcelona, Barcelona, Spain
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona, Universidad Católica de Murcia, Spain
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Mehdipoor G, Jimenez D, Bertoletti L, Fidalgo Á, Sanchez Muñoz-Torrero JF, Gonzalez-Martinez JP, Blanco-Molina Á, Ángel Aibar M, Bonnefoy PB, Khorasani R, Prince MR, Bikdeli B, Monreal M, Adarraga MD, Agud M, Azcarate-Agüero P, Aibar J, Alfonso J, Amado C, Ignacio Arcelus J, Ballaz A, Barba R, Barrón CBM, Barrón-Andrés B, Camon AM, Cañas I, Criado J, Ancos CD, Miguel JD, del Toro J, Demelo-Rodríguez P, Díaz-Pedroche C, Díaz-Peromingo JA, Díaz-Simón R, Díez-Sierra J, Milagros Domínguez I, Escribano JC, Farfán AI, Fernández-Capitán C, Fernández-Reyes JL, Flores K, Font C, Font L, Francisco I, Gabara C, Galeano-Valle F, Ángeles García M, García-Bragado F, García-García M, García-Raso A, Gavín-Blanco O, Gavín-Sebastián O, Carmen Gayol M, Gil-Díaz A, Gómez-Cuervo C, Grau E, Gutiérrez-Guisado J, Hernández-Blasco L, Iglesias M, Jara-Palomares L, Jesús Jaras M, Joya MD, Jou I, Lacruz B, Lalueza A, Lecumberri R, Lima J, Llamas P, Luis Lobo J, López-Jiménez L, López-Miguel P, José López-Núñez J, López-Reyes R, Bosco López-Sáez J, Alejandro Lorente M, Lorenzo A, Loring M, Lumbierres M, Madridano O, Maestre A, Javier Marchena P, Martín-Fernández M, Miguel Martín-Guerra J, Martín-Martos F, Mellado M, Mercado MI, Moisés J, del Valle Morales M, Muñoz-Blanco A, Muñoz-Guglielmetti D, Antonio Nieto J, Jesús Núñez M, Ortega-Michel MCOC, Dolores Ortega-Recio M, Osorio J, Otero R, Paredes D, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez-Ductor C, Asunción Pérez-Jacoíste M, Pesántez D, Porras JA, Portillo J, Reig L, Riera-Mestre A, Rivas A, Rodríguez-Cobo A, Rodríguez-Galán I, Rodríguez-Matute C, Rosa V, María Rubio C, Ruiz-Artacho P, Ruiz-Giménez N, Ruiz-Ruiz J, Ruiz-Sada P, Ruiz-Torregrosa P, Carles Sahuquillo J, Salgueiro G, Sampériz Á, Sancho T, Soler S, Suárez S, María Suriñach J, Tiberio G, Isabel Torres M, Tolosa C, Trujillo-Santos J, Uresandi F, Usandizaga E, Valle R, Ramón Vela J, Vidal G, Villares P, Zamora C, Gutiérrez P, Javier Vázquez F, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Salgado E, Benzidia I, Bura-Riviere A, Crichi B, Debourdeau P, Farge-Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G, Schellong S, Braester A, Brenner B, Tzoran I, Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Bucherini E, Ciammaichella M, Colaizzo D, Dentali F, Micco PD, Giammarino E, Grandone E, Maggi F, Mangiacapra S, Mastroiacovo D, Maida R, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tiraferri E, Tufano A, Visonà A, Hong NV, Zalunardo B, Kalejs RV, Kigitovica D, Skride A, Ferreira M, Meireles J, Reis A, Bosevski M, Krstevski G, Zdraveska M, Bounameaux H, Mazzolai L, Caprini JA, Tafur AJ, Weinberg I, Wilkins H, My Bui H. Patient-Level, Institutional, and Temporal Variations in Use of Imaging Modalities to Confirm Pulmonary Embolism. Circ Cardiovasc Imaging 2020; 13:e010651. [DOI: 10.1161/circimaging.120.010651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The choice of the imaging modality for diagnosis of pulmonary embolism (PE) could be influenced by provider, patient or hospital characteristics, or over time. However, little is known about the choice of the diagnostic modalities in practice. The aim of this study was to evaluate the variations in the use of imaging modalities for patients with acute PE.
Methods:
Using the data from Registro Informatizado Enfermedad TromboEmbolica (RIETE), a prospective international registry of patients with venous thromboembolism (March 2001–January 2019), we explored the imaging modalities used in patients with acute PE. The imaging modalities included computed tomography pulmonary angiography, ventilation/perfusion scanning, pulmonary angiography, a combination of these tests, or PE signs and symptoms plus imaging-confirmed proximal deep vein thrombosis but no chest imaging.
Results:
Among 38 025 patients with confirmed PE (53.1% female, age: 67.3±17 years), computed tomography pulmonary angiography was the dominant modality of diagnosis in all RIETE enrollees (78.2% [99% CI, 77.6–78.7]); including pregnant patients (58.9% [99% CI, 47.7%–69.4%]) and patients with severe renal insufficiency (62.5% [99% CI, 59.9–65.0]). A greater proportion of patients underwent ventilation/perfusion scanning in larger hospitals compared with smaller hospitals (13.1% versus 7.3%,
P
<0.001). The use of computed tomography pulmonary angiography varied between 13.3% and 98.3% across the countries, and its use increased over time (46.5% in 2002 to 91.7% in 2018,
P
<0.001).
Conclusions:
In a large multinational PE registry, variations were observed in the use of imaging modalities according to patient or institutional factors and over time. However, computed tomography pulmonary angiography was the dominant modality of diagnosis, even in pregnancy and severe renal insufficiency. The safety, costs, and downstream effects of these tests on PE-related and non-PE-related outcomes warrant further investigation.
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Affiliation(s)
| | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain (D.J.)
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, Hôpital Nord, CHU de Saint-Etienne and INSERM U1059 SAINBIOSE - CIC 1408, Université Jean-Monnet, Saint-Etienne, France (L.B.)
| | - Ángeles Fidalgo
- Department of Internal Medicine, Hospital Universitario de Salamanca, Spain (A.F.)
| | | | - José Pedro Gonzalez-Martinez
- Department of Internal Medicine, Hospital Universitari St Joan de Deu Manresa (Barcelona) Fundació Althaia (J.P.G.-M.)
| | - Ángeles Blanco-Molina
- Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain (A.B.-M.)
| | - Miguel Ángel Aibar
- Internal Medicine Department and IIS Aragón, Hospital Clínico Universitario, Zaragoza, Spain (M.A.A.)
| | - Pierre-Benoît Bonnefoy
- Service de médecine nucléaire, Hôpital Nord, CHU de St-Etienne, Saint-Etienne, France (P.-B.B.)
| | - Ramin Khorasani
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (R.K.)
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital (M.R.P.)
- Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - Behnood Bikdeli
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital (B.B.)
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (B.B.)
- Cardiovascular Research Foundation (CRF), New York, NY (B.B.)
| | - Manuel Monreal
- Department of Internal Medicine, Hospital de Badalona Germans Trias i Pujol, Universitat Autònoma de Barcelona, Spain (M.M.)
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9
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Connors JM, Farge-Bancel D. New progress in the treatment and prophylaxis of venous thrombo-embolism in cancer patients. J Med Vasc 2020; 45:2. [PMID: 32057321 DOI: 10.1016/j.jdmv.2019.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Affiliation(s)
- J M Connors
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - D Farge-Bancel
- Unité clinique de médecine interne, maladies auto-immunes et pathologie vasculaire, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France.
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10
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Fuentes HE, Tafur AJ, Caprini JA, Alatri A, Trujillo-Santos J, Farge-Bancel D, Rosa V, Font L, Vilaseca A, Monreal M. Prediction of early mortality in patients with cancer-associated thrombosis in the RIETE Database. INT ANGIOL 2019; 38:173-184. [PMID: 31112023 DOI: 10.23736/s0392-9590.19.04110-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Proper risk stratification of patients for early mortality after cancer-associated thrombosis may lead to personalized anticoagulation protocols. Therefore, we aimed to derive and validate a scoring system to predict early mortality in this population. To this end, we selected patients with active cancer and thrombosis from the Computerized Registry of Patients with Venous Thromboembolism database. METHODS The main outcome was all cause mortality within the month following a thrombotic event. We used a simple random selection to split are data in a derivation and a validation cohort. In the derivation cohort, we used recursive partitioning and binary logistic regression to identify groups at risk and to determine the likelihood of the primary outcome. The risk score was developed based on odds ratios from the final multivariate model, and then tested in the validation cohort. RESULTS In 10,025 eligible patients, we identified 6 predictors of 30-day mortality: leukocytosis ≥11.5x109/L; platelet count ≤160x109/L, metastasis, recent immobility, initial presentation as pulmonary embolism and Body Mass Index <18.5. The model divided the population into 3 risk categories: low (score 0-3), moderate (score 4-6), and high (score ≥7). The AUC for the overall score was 0.74, and using a cutoff ≥7 points, the model had a negative predictive value of 94.4%, a positive predictive value of 23.1%, a sensitivity of 73.3%, and a specificity of 64.6% in the validation cohort. CONCLUSIONS Our validated risk model may assist physicians in the selection of patients for outpatient management, and perhaps anticoagulant, considering expanding anticoagulation options.
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Affiliation(s)
- Harry E Fuentes
- Department of Hematology Oncology, Mayo Clinic, Rochester, MN, USA -
| | - Alfonso J Tafur
- Division of Vascular Medicine, Department of Internal Medicine Cardiology, NorthShore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Joseph A Caprini
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.,NorthShore University, HealthSystem-Emeritus, Evanston, IL, USA
| | - Adriano Alatri
- Division of Angiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Javier Trujillo-Santos
- Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain
| | | | - Vladimir Rosa
- Department of Internal Medicine, Virgen de Arrixaca University Hospital, Murcia, Spain
| | - Llorenç Font
- Department of Hematology, Tortosa Verge de la Cinta Hospital, Tarragona, Spain
| | - Alicia Vilaseca
- Department of Hematology and Hemostasis, San Camilo Clinic, Buenos Aires, Argentina
| | - Manuel Monreal
- Department of Internal Medicine, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
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11
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Di Cristofaro J, Karlmark KR, Kanaan SB, Azzouz DF, El Haddad M, Hubert L, Farge-Bancel D, Granel B, Harlé JR, Hachulla E, Pardoux E, Roudier J, Picard C, Lambert NC. Soluble HLA-G Expression Inversely Correlates With Fetal Microchimerism Levels in Peripheral Blood From Women With Scleroderma. Front Immunol 2018; 9:1685. [PMID: 30158921 PMCID: PMC6104483 DOI: 10.3389/fimmu.2018.01685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 04/26/2018] [Accepted: 07/09/2018] [Indexed: 01/22/2023] Open
Abstract
Women with scleroderma (SSc) maintain significantly higher quantities of persisting fetal microchimerism (FMc) from complete or incomplete pregnancies in their peripheral blood compared to healthy women. The non-classical class-I human leukocyte antigen (HLA) molecule HLA-G plays a pivotal role for the implantation and maintenance of pregnancy and has often been investigated in offspring from women with pregnancy complications. However data show that maternal HLA-G polymorphisms as well as maternal soluble HLA-G (sHLA-G) expression could influence pregnancy outcome. Here, we aimed to investigate the underlying role of maternal sHLA-G expression and HLA-G polymorphisms on the persistence of FMc. We measured sHLA-G levels by enzyme linked immunosorbent assay in plasma samples from 88 healthy women and 74 women with SSc. Male Mc was quantified by DYS14 real-time PCR in blood samples from 58 women who had previously given birth to at least one male child. Furthermore, eight HLA-G 5'URR/3'UTR polymorphisms, previously described as influencing HLA-G expression, were performed on DNA samples from 96 healthy women and 106 women with SSc. Peripheral sHLA-G was at lower concentration in plasma from SSc (76.2 ± 48.3 IU/mL) compared to healthy women (117.5 ± 60.1 IU/mL, p < 0.0001), independently of clinical subtypes, autoantibody profiles, disease duration, or treatments. Moreover, sHLA-G levels were inversely correlated to FMc quantities (Spearman correlation, p < 0.01). Finally, women with SSc had lower sHLA-G independently of the eight HLA-G 5'URR/3'UTR polymorphisms, although they were statistically more often homozygous than heterozygous for HLA-G polymorphism genotypes -716 (G/T), -201 (G/A), 14 bp (ins/del), and +3,142 (G/A) than healthy women. In conclusion, women with SSc display less sHLA-G expression independently of the eight HLA-G polymorphisms tested. This decreased production correlates with higher quantities of persisting FMc commonly observed in blood from SSc women. These results shed some lights on the contribution of the maternal HLA-G protein to long-term persistent fetal Mc and initiate new perspectives in this field.
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Affiliation(s)
- Julie Di Cristofaro
- Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguins", Marseille, France
| | - Karlin R Karlmark
- Aix Marseille Univ, INSERM, Autoimmune Arthritis (AA), Marseille, France
| | - Sami B Kanaan
- Aix Marseille Univ, INSERM, Autoimmune Arthritis (AA), Marseille, France
| | - Doua F Azzouz
- Aix Marseille Univ, INSERM, Autoimmune Arthritis (AA), Marseille, France
| | - Marina El Haddad
- Aix Marseille Univ, INSERM, Autoimmune Arthritis (AA), Marseille, France
| | - Lucas Hubert
- Immunogenetics Laboratory, EFS-Alpes Méditerranée, Marseille, France.,Antibody Therapeutics and Immunotargeting, CRCM, INSERM U1068, Institut Paoli Calmettes, Aix-Marseille Université, Marseille, France.,UM 105, CNRS UMR7258, Marseille, France
| | - Dominique Farge-Bancel
- Unité de Médecine Interne Maladies Auto-immunes et Pathologie Vasculaire (UF 04) Hôpital Saint Louis, AP-HP, Centre de Référence des Maladies auto-immunes systémiques Rares d'Île-de-France, FAI2R, EA 3518, Institut Universitaire d'Hématologie, Paris, France
| | - Brigitte Granel
- UMR-S 1076 Endothélium, Pathologies Vasculaires et Cibles Thérapeutiques - Faculté de Pharmacie, Marseille, France.,AP-HM, Pôle de Médecine Interne, Centre de Compétence PACA Ouest pour la prise en charge des maladies autoimmunes systémiques, Marseille, France
| | - Jean Robert Harlé
- AP-HM, Pôle de Médecine Interne, Centre de Compétence PACA Ouest pour la prise en charge des maladies autoimmunes systémiques, Marseille, France
| | - Eric Hachulla
- Service de Médecine Interne, Centre National de Référence de la Sclérodermie Systémique, Hôpital Claude Huriez, Lille, France
| | - Etienne Pardoux
- Aix Marseille Univ, CNRS, Centrale Marseille, I2M, Marseille, France
| | - Jean Roudier
- Aix Marseille Univ, INSERM, Autoimmune Arthritis (AA), Marseille, France.,Rhumatologie, IML, AP-HM, Hôpital Sainte Marguerite, Marseille, France
| | - Christophe Picard
- Aix Marseille Univ, CNRS, EFS, ADES, "Biologie des Groupes Sanguins", Marseille, France.,Immunogenetics Laboratory, EFS-Alpes Méditerranée, Marseille, France
| | - Nathalie C Lambert
- Aix Marseille Univ, INSERM, Autoimmune Arthritis (AA), Marseille, France
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12
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Gaudemer A, Sauvet G, Hij A, Stanciu R, Farge-Bancel D, Algayres JP. [Splenic sarcoidosis diagnosed by US-guided biopsy: About a case]. Rev Med Interne 2017; 39:200-202. [PMID: 29274795 DOI: 10.1016/j.revmed.2017.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 10/30/2017] [Accepted: 11/30/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Splenic localisation of sarcoidosis is common but rare as unique location. We report a case diagnosed by US-guided biopsy. OBSERVATION A 42-year-old woman presented atypic and recidivant epigastric pain. Abdominal ultrasound showed splenic hypoechoic nodules not characterizable with CT or MRI. PET-CT revealed hypermetabolism without any other abnormal metabolic activity. US-guided biopsy with small needle achieved diagnosis of isolated splenic sarcoidosis. CONCLUSION Diagnosis of splenic nodular sarcoidosis can be challenging without any other localization. Splenic biopsy achieved diagnosis. This procedure is associated with a low risk of complications - in particular hemorragic ones. Diagnostic splenectomy should be an exceptional intervention.
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Affiliation(s)
- A Gaudemer
- Service de médecine interne et pathologie vasculaire, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - G Sauvet
- Service de médecine interne et pathologie vasculaire, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - A Hij
- Service de médecine interne et pathologie vasculaire, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - R Stanciu
- Service de médecine interne et pathologie vasculaire, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - D Farge-Bancel
- Service de médecine interne et pathologie vasculaire, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - J-P Algayres
- Service de clinique médicale, hôpital d'instruction des armées du Val-de-Grâce, 74, boulevard de Port-Royal, 75005 Paris, France
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13
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Mahé I, Chidiac J, Bertoletti L, Font C, Trujillo-Santos J, Peris M, Pérez Ductor C, Nieto S, Grandone E, Monreal M, Arcelus J, Ballaz A, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina A, Bueso T, Casado I, Culla A, de Miguel J, del Toro J, Díaz-Peromingo J, Falgá C, Fernández-Capitán C, Font C, Font L, Gallego P, García-Bragado F, García-Brotons P, Gómez V, González J, Grau E, Grimón A, Guirado L, Gutiérrez J, Hernández G, Hernández-Blasco L, Isern V, Jara-Palomares L, Jaras M, Jiménez D, Lacruz B, Lecumberri R, Lobo J, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Madridano O, Marchena P, Martín-Antorán J, Martín-Martos F, Monreal M, Morales M, Nauffal D, Nieto J, Nieto S, Núñez M, Otalora S, Otero R, Pagán B, Pedrajas J, Pérez C, Pérez G, Peris M, Porras J, Ramírez L, Reig O, Riera A, Rivas A, Rodríguez-Dávila M, Rosa V, Ruiz-Artacho P, Ruiz-Giménez N, Ruiz-Martínez C, Sampériz A, Sala C, Sanz O, Soler S, Sopeña B, Suarez I, Suriñach J, Tiberio G, Tolosa C, Trujillo-Santos J, Uresandi F, Valle R, Vela J, Villalta J, Malfante P, Verhamme P, Wells P, Hirmerova J, Malý R, Tomko T, Salgado E, Bertoletti L, Bura-Riviere A, Farge-Bancel D, Hij A, Mahé I, Merah A, Papadakis M, Braester A, Brenner B, Tzoran I, Apollonio A, Barillari G, Candeloro G, Ciammaichella M, Di Micco P, Ferrazzi P, Grandone E, Lessiani G, Lodigiani C, Mastroiacovo D, Pace F, Pinelli M, Prandoni P, Rota L, Tiraferri E, Tufano A, Visonà A, Belovs A, Skride A, Moreira M, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Alatri A, Bounameaux H, Calanca L, Mazzolai L, Serrano J, Decousus H, Reis A. The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site. Am J Med 2017; 130:337-347. [PMID: 27884650 DOI: 10.1016/j.amjmed.2016.10.017] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 09/21/2016] [Accepted: 10/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND We hypothesized that the clinical course of venous thromboembolism in patients with active cancer may differ according to the specificities of primary tumor site. AIM AND METHODS We used data from RIETE (international registry of patients with venous thromboembolism) to compare the clinical venous thromboembolism-related outcomes during the course of anticoagulation in patients with one of the 4 more frequent cancers (breast, prostate, colorectal, or lung cancer). RESULTS As of September 2014, 3947 cancer patients were recruited, of whom 938 had breast, 629 prostate, 1189 colorectal, and 1191 lung cancer. Overall, 55% had metastatic disease (42%, 36%, 53%, and 72%, respectively). During the course of anticoagulant therapy (mean duration, 139 days), the rate of thromboembolic recurrences was similar to the rate of major bleeding in patients with breast (5.6 [95% confidence interval (CI), 3.8-8.1] vs 4.1 [95% CI, 2.7-5.9] events per 100 patient-years) or colorectal cancer (10 [95% CI, 7.6-13] vs 12 [95% CI, 9.4-15] per 100 patient-years). In contrast, in patients with prostate cancer, the rate of venous thromboembolic recurrences was half the rate of major bleeding (6.9 [95% CI, 4.4-10] vs 13 [95% CI, 9.2-17] events per 100 patient-years), whereas in those with lung cancer, the rate of thromboembolic recurrences was twofold higher than the rate of major bleeding (27 [95% CI, 22-23] vs 11 [95% CI, 8.6-15] per 100 patient-years). CONCLUSIONS Significant differences in the clinical profile of venous thromboembolic-related outcomes were observed according to the site of cancer. These findings suggest the development of cancer-specific anticoagulant strategies as an area for further research.
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Affiliation(s)
- Isabelle Mahé
- Department of Internal Medicine, Hôpital Louis Mourier, Investigation Network on Venous Thrombo-embolism (INNOVTE), Colombes (APHP), University Paris 7, EA REMES 7334 France.
| | - Jean Chidiac
- Department of Internal Medicine, Hôpital Louis Mourier, Investigation Network on Venous Thrombo-embolism (INNOVTE), Colombes (APHP), University Paris 7, EA REMES 7334 France
| | - Laurent Bertoletti
- Department of Vascular and Therapeutic Medicine, CHU Saint-Etienne, Hôpital Nord, French Clinical Research Infrastructure Network (F-CRIN), INNOVTE
| | - Carme Font
- Department of Medical Oncology, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Clinic de Barcelona, Spain
| | - Javier Trujillo-Santos
- Department of Internal Medicine, Complejo Hospitalario Universitario de Cartagena, Murcia, Spain
| | - Marisa Peris
- Department of Internal Medicine, Hospital Provincial Castellon; CEU Cardenal Herrero University, Spain
| | - Cristina Pérez Ductor
- Department of Emergency Medicine, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Santiago Nieto
- Department of Haematology, Hospital de la Vega Lorenzo Guirao, Murcia, Spain
| | - Elvira Grandone
- Atherosclerosis and Thrombosis Unit, Casa Sollievo Della Sofferenza, Foggia, Italy
| | - Manuel Monreal
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Católica de Murcia, Spain
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Farge-Bancel D, Verrecchia F. Tribute to Frédéric Morinet. Curr Res Transl Med 2017. [DOI: 10.1016/j.retram.2017.02.003] [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: 12/01/2022]
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Newton DH, Monreal Bosch M, Amendola M, Wolfe L, Perez Ductor C, Lecumberri R, Levy MM, Monreal M, Decousus H, Prandoni P, Brenner B, Barba R, Di Micco P, Bertoletti L, Tzoran I, Reis A, Bosevski M, Bounameaux H, Malý R, Wells P, Papadakis M, Agüero R, Aibar M, Alfonso M, Aranda R, Arcelus J, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Binetti J, Blanco-Molina A, Bueso T, Cañas I, Carmona F, Chic N, Culla A, del Pozo R, del Toro J, Díaz-Pedroche M, Díaz-Peromingo J, Falgá C, Fernández-Aracil C, Fernández-Capitán C, Fidalgo M, Font C, Font L, Gallego P, García M, García-Bragado F, Gómez V, González J, Grau E, Grimón A, Guirado L, Gutiérrez J, Hernández-Comes G, Hernández-Blasco L, Jara-Palomares L, Jaras M, Jiménez D, Joya M, Lecumberri R, Lobo J, López-Jiménez L, López-Reyes R, López-Sáez J, Lorente M, Lorenzo A, Manrique-Abos I, Marchena P, Martín M, Martín-Antorán J, Martín-Martos F, Monreal M, Nieto J, Nieto S, Núñez A, Núñez M, Otalora S, Otero R, Pagán B, Pedrajas J, Pérez G, Pérez I, Pérez-Ductor C, Peris M, Porras J, Reig O, Riera-Mestre A, Riesco D, Rivas A, Rodríguez-Dávila M, Rosa V, Rosillo-Hernández E, Ruiz-Artacho P, Ruiz-Giménez N, Sahuquillo J, Sala-Sainz M, Sampériz A, Sánchez R, Sanz O, Soler S, Sopeña B, Suriñach J, Tolosa C, Trujillo-Santos J, Uresandi F, Valero B, Valle R, Vela J, Vidal G, Villalta J, Vanassche T, Verhamme P, Wells P, Hirmerova J, Malý R, Salgado E, Bertoletti L, Bura-Riviere A, Champion K, Farge-Bancel D, Hij A, Mahé I, Merah A, Papadakis M, Braester A, Brenner B, Tzoran I, Antonucci G, Barillari G, Bilora F, Ciammaichella M, Dentali F, Di Micco P, Duce R, Ferrazzi P, Grandone E, Lodigiani C, Maida R, Pace F, Pesavento R, Poggio R, Prandoni P, Rota L, Tiraferri E, Tonello D, Tufano A, Visonà A, Zalunardo B, Drucka E, Kigitovica D, Skride A, Ramos A, Ribeiro J, Sousa M, Bosevski M, Zdraveska M, Bounameaux H, Erdmann A, Mazzolai L, Ney B. Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry. J Vasc Surg Venous Lymphat Disord 2017; 5:18-24.e1. [DOI: 10.1016/j.jvsv.2016.08.002] [Citation(s) in RCA: 10] [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: 04/24/2016] [Accepted: 08/12/2016] [Indexed: 11/25/2022]
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Passweg JR, Baldomero H, Bader P, Bonini C, Cesaro S, Dreger P, Duarte RF, Dufour C, Kuball J, Farge-Bancel D, Gennery A, Kröger N, Lanza F, Nagler A, Sureda A, Mohty M. Impact of drug development on the use of stem cell transplantation: a report by the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 2016; 52:191-196. [PMID: 27819687 DOI: 10.1038/bmt.2016.258] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 05/30/2016] [Accepted: 06/01/2016] [Indexed: 11/09/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) is used with increasing frequency in Europe with 40 000 transplants reported in 2014. Transplant-related mortality remains high in allogeneic HSCT (10-20%); high-dose chemotherapy is toxic and demanding for patients. Drug development is accelerating and with limited toxicity of some targeted drugs may replace HSCT, whereas others may function as a 'bridge to transplant'. We analyzed HSCT reported to the activity survey for selected diseases in which major advances in drug development have been made. Tyrosine kinase inhibitors markedly changed the number of allogeneic HSCT in early CML. In myelodysplastic syndromes, hypomethylating agents show no effect on HSCT activity and Janus kinase inhibitors for myeloproliferative neoplasm appear to have only a temporary effect. For CLL autologous HSCT decreased after publication of trials showing improved PFS but no overall survival advantage and allogeneic rates are dropping after the introduction of Bruton kinase and PI3K Inhibitors. Whether these are 'game changers' as was imatinib for CML requires additional follow-up. For myeloma, proteasome inhibitors and new immunomodulatory drugs do not appear to impact transplant rates. Drug development data show different effects on HSCT use; highly effective drugs may replace HSCT, whereas other drugs may improve the patient's condition to allow for HSCT.
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Affiliation(s)
- J R Passweg
- EBMT Activity Survey Office, Division of Hematology, Department of Medicine, University Hospital, Basel, Switzerland
| | - H Baldomero
- EBMT Activity Survey Office, Division of Hematology, Department of Medicine, University Hospital, Basel, Switzerland
| | - P Bader
- Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Germany
| | - C Bonini
- Università Vita-Salute San Raffaele, Milan, Italy
| | - S Cesaro
- Pediatric Haematology and Oncology, Policlinico GB Rossi, Verona, Italy
| | - P Dreger
- Medizinische Klinik V, University of Heidelberg, Heidelberg, Germany
| | - R F Duarte
- Hematology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - C Dufour
- Hematology Unit, G Gaslini Children's Institute, Genova, Italy
| | - J Kuball
- Department of Hematology, University Medical Centre, Utrecht, The Netherlands
| | - D Farge-Bancel
- Service de Médecine Interne, Maladies auto-immunes et pathologie vasculaire, Hôpital St Louis, Paris, France
| | - A Gennery
- Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK
| | - N Kröger
- University Hospital Eppendorf, Hamburg, Germany
| | - F Lanza
- Hematology and BMT Unit, University Hospital of Ravenna, Ravenna, Italy
| | - A Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - A Sureda
- Hematology Department, Institut Català d'Oncologia-Hospital Duran I Reynals, Barcelona, Spain
| | - M Mohty
- Hospital Saint Antoine, Paris, France
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Deville L, Konan M, Hij A, Goldwirt L, Peyrony O, Fieux F, Faure P, Madelaine I, Villiers S, Farge-Bancel D, Frère C. Major bleeding complications in patients treated with direct oral anticoagulants: One-year observational study in a Paris Hospital. Curr Res Transl Med 2016; 64:129-133. [PMID: 27765272 DOI: 10.1016/j.retram.2016.02.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/10/2016] [Accepted: 02/12/2016] [Indexed: 12/17/2022]
Abstract
Direct oral anticoagulants (DAOC) are indicated for the treatment of venous thromboembolism and the prevention of stroke or systemic embolism in patients with non-valvular atrial fibrillation. Given their advantages and friendly use for patient, the prescription of long term DOAC therapy has rapidly increased both as first line treatment while initiating anticoagulation and as a substitute to vitamins K antagonist (VKA) in poorly controlled patients. However, DOAC therapy can also be associated with significant bleeding complications, and in the absence of specific antidote at disposal, treatment of serious hemorrhagic complications under DOAC remains complex. We report and discuss herein five cases of major hemorrhagic complications under DOAC, which were reported to the pharmacological surveillance department over one year at Saint-Louis University Hospital (Paris, France). We further discuss the need for careful assessment of the risk/benefit ratio at time of starting DOAC therapy in daily clinical practice.
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Affiliation(s)
- L Deville
- Service de pharmacie, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - M Konan
- Unité de médecine interne et pathologie vasculaire, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France; Service de médecine interne, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - A Hij
- Unité de médecine interne et pathologie vasculaire, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - L Goldwirt
- Unité de pharmacologie, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - O Peyrony
- Service des urgences, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - F Fieux
- Service de réanimation chirurgicale, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - P Faure
- Service de pharmacie, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - I Madelaine
- Service de pharmacie, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - S Villiers
- Service d'anesthésie réanimation, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - D Farge-Bancel
- Unité de médecine interne et pathologie vasculaire, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - C Frère
- Service d'hématologie biologique, CHU Timone, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13385 Marseille, France; Inserm UMRS 1076, VRCM, Aix-Marseille université, 13385 Marseille, France.
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18
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Barrios D, Rosa-Salazar V, Jiménez D, Morillo R, Muriel A, Del Toro J, López-Jiménez L, Farge-Bancel D, Yusen R, Monreal M. Right heart thrombi in pulmonary embolism. Eur Respir J 2016; 48:1377-1385. [PMID: 27799388 DOI: 10.1183/13993003.01044-2016] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/19/2016] [Indexed: 01/01/2023]
Abstract
There is a lack of comprehensive data on the prevalence, predictors and prognostic significance of right heart thrombi (RHT) in pulmonary embolism.In this study of patients with pulmonary embolism from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry, we assessed the prevalence and predictors of RHT, and the association between the presence of RHT and the outcomes of all-cause mortality, pulmonary embolism-related mortality, recurrences, and major bleeding through 30 days after initiation of pulmonary embolism treatment.Of 12 441 patients with pulmonary embolism and baseline echocardiographic data, 2.6% had RHT. The following increased the risk of RHT: younger age, previous bleeding, congestive heart failure, cancer, syncope, systolic blood pressure <100 mmHg, and arterial oxyhaemoglobin saturation <90%. Patients with RHT were significantly more likely to die from any cause (adjusted OR 2.50 (95% CI 1.62-3.84); p<0.001) and from pulmonary embolism (adjusted OR 4.29 (95% CI 2.45-7.48); p<0.001) during follow-up. RHT was associated with an increased risk of recurrence during follow-up (1.8% versus 0.7%; p=0.04). Major bleeding was similar in patients with and without RHT.In patients presenting with pulmonary embolism, RHT is relatively infrequent. Patients with RHT had a worse outcome when compared with those without RHT.
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Affiliation(s)
- Deisy Barrios
- Respiratory Dept, Ramón y Cajal Hospital and Universidad de Alcala (IRYCIS), Madrid, Spain.,Both authors contributed equally to the manuscript
| | - Vladimir Rosa-Salazar
- Dept of Internal Medicine, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain.,Both authors contributed equally to the manuscript
| | - David Jiménez
- Respiratory Dept, Ramón y Cajal Hospital and Universidad de Alcala (IRYCIS), Madrid, Spain
| | - Raquel Morillo
- Respiratory Dept, Ramón y Cajal Hospital and Universidad de Alcala (IRYCIS), Madrid, Spain
| | - Alfonso Muriel
- Respiratory Dept, Ramón y Cajal Hospital and Universidad de Alcala (IRYCIS), Madrid, Spain
| | - Jorge Del Toro
- Dept of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Roger Yusen
- Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, MO, USA
| | - Manuel Monreal
- Dept of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Católica de Murcia, Spain
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Azzouz DF, Martin GV, Arnoux F, Balandraud N, Martin T, Dubucquoi S, Hachulla E, Farge-Bancel D, Tiev K, Cabane J, Bardin N, Chiche L, Martin M, Caillet EC, Kanaan SB, Harlé JR, Granel B, Diot E, Roudier J, Auger I, Lambert NC. Anti-Ephrin Type-B Receptor 2 (EphB2) and Anti-Three Prime Histone mRNA EXonuclease 1 (THEX1) Autoantibodies in Scleroderma and Lupus. PLoS One 2016; 11:e0160283. [PMID: 27617966 PMCID: PMC5019431 DOI: 10.1371/journal.pone.0160283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/15/2016] [Indexed: 11/19/2022] Open
Abstract
In a pilot ProtoArray analysis, we identified 6 proteins out of 9483 recognized by autoantibodies (AAb) from patients with systemic sclerosis (SSc). We further investigated the 6 candidates by ELISA on hundreds of controls and patients, including patients with Systemic Lupus Erythematosus (SLE), known for high sera reactivity and overlapping AAb with SSc. Only 2 of the 6 candidates, Ephrin type-B receptor 2 (EphB2) and Three prime Histone mRNA EXonuclease 1 (THEX1), remained significantly recognized by sera samples from SSc compared to controls (healthy or with rheumatic diseases) with, respectively, 34% versus 14% (P = 2.10−4) and 60% versus 28% (P = 3.10−8). Above all, EphB2 and THEX1 revealed to be mainly recognized by SLE sera samples with respectively 56%, (P = 2.10−10) and 82% (P = 5.10−13). As anti-EphB2 and anti-THEX1 AAb were found in both diseases, an epitope mapping was realized on each protein to refine SSc and SLE diagnosis. A 15-mer peptide from EphB2 allowed to identify 35% of SLE sera samples (N = 48) versus only 5% of any other sera samples (N = 157), including SSc sera samples. AAb titers were significantly higher in SLE sera (P<0.0001) and correlated with disease activity (p<0.02). We could not find an epitope on EphB2 protein for SSc neither on THEX1 for SSc or SLE. We showed that patients with SSc or SLE have AAb against EphB2, a protein involved in angiogenesis, and THEX1, a 3’-5’ exoribonuclease involved in histone mRNA degradation. We have further identified a peptide from EphB2 as a specific and sensitive tool for SLE diagnosis.
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Affiliation(s)
- Doua F. Azzouz
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
| | - Gabriel V. Martin
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
| | - Fanny Arnoux
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
| | - Nathalie Balandraud
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Rhumatologie, IML, AP-HM, Hôpital Sainte Marguerite, Marseille, France
| | - Thierry Martin
- Service d'Immunologie Clinique, Hôpitaux universitaires de Strasbourg, Strasbourg, France
- UPR CNRS 3572, Strasbourg, France
| | - Sylvain Dubucquoi
- Institut d’Immunologie Centre Hospitalier Régional et Universitaire de Lille, Lille, France
- EA 2686, Université de Lille, Lille, France
| | - Eric Hachulla
- Service de Médecine Interne, Centre National de Référence de la Sclérodermie Systémique, Hôpital Claude Huriez, Lille, France
| | - Dominique Farge-Bancel
- Service de Médecine Interne et Pathologie Vasculaire, Hôpital St Louis, Paris, France
- INSERM U697, Hôpital St Louis, Paris, France
| | - Kiet Tiev
- Service de Médecine Interne, Hôpital St Antoine, Paris, France
| | - Jean Cabane
- Service de Médecine Interne, Hôpital St Antoine, Paris, France
| | - Nathalie Bardin
- UMR-S 1076 Endothélium, Pathologies Vasculaires et Cibles Thérapeutiques - Faculté de Pharmacie, Marseille, France
| | - Laurent Chiche
- AP-HM, Pôle de Médecine Interne, Centre de Compétence PACA Ouest pour la prise en charge des maladies auto-immunes systémiques, Marseille, France
- Aix-Marseille Université, Centre d'Immunologie de Marseille-Luminy (CIML), INSERM, CNRS UMR7280, Marseille, France
| | - Marielle Martin
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
| | - Eléonore C. Caillet
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
| | - Sami B. Kanaan
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
| | - Jean Robert Harlé
- AP-HM, Pôle de Médecine Interne, Centre de Compétence PACA Ouest pour la prise en charge des maladies auto-immunes systémiques, Marseille, France
| | - Brigitte Granel
- Aix Marseille Université, Marseille, France
- UMR-S 1076 Endothélium, Pathologies Vasculaires et Cibles Thérapeutiques - Faculté de Pharmacie, Marseille, France
- AP-HM, Pôle de Médecine Interne, Centre de Compétence PACA Ouest pour la prise en charge des maladies auto-immunes systémiques, Marseille, France
| | - Elisabeth Diot
- Service de Médecine Interne, CHU Bretonneau, Tours, France
| | - Jean Roudier
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Rhumatologie, IML, AP-HM, Hôpital Sainte Marguerite, Marseille, France
| | - Isabelle Auger
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Rhumatologie, IML, AP-HM, Hôpital Sainte Marguerite, Marseille, France
| | - Nathalie C. Lambert
- INSERM UMRs 1097, Parc Scientifique de Luminy, Marseille, France
- Aix Marseille Université, Marseille, France
- * E-mail:
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Cajfinger F, Debourdeau P, Lamblin A, Benatar V, Falvo N, Benhamou Y, Sevestre MA, Farge-Bancel D. Low-molecular-weight heparins for cancer-associated thrombosis: Adherence to clinical practice guidelines and patient perception in TROPIQUE, a 409-patient prospective observational study. Thromb Res 2016; 144:85-92. [PMID: 27318244 DOI: 10.1016/j.thromres.2016.06.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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: 01/19/2016] [Revised: 05/18/2016] [Accepted: 06/07/2016] [Indexed: 02/01/2023]
Abstract
PURPOSE Data on long-term treatment with low-molecular-weight heparins (LMWH) in cancer patients treated for venous thromboembolism are scarce. Study objectives were to document the long-term clinical use of LMWH and patient perception in this setting. METHODS Adult cancer patients receiving antineoplastic treatment or palliative care and LMWH for cancer associated venous thromboembolism (CAT) were eligible to participate in this prospective observational study. Main outcome was adherence to clinical practice guidelines based on recommended LMWH treatment doses for at least 3months in the absence of severe renal insufficiency. Patients' perception of the treatment was assessed in an ancillary study using the Perception Anticoagulant Treatment Questionnaire (PACT-Q). RESULTS Among 409 included cancer patients aged 65±12.1years, overall adherence to practice guidelines as defined in the protocol was 55.3% (226 patients). However, 98.0% of patients received a prescription for 3months or more and mean LMWH treatment duration for VTE was 6.27±0.15months which meets guidelines recommendations. Main patients' expectations scored on a 1-5 scale were blood clots prevention (mean 3.94±0.75), symptom relief (mean 3.98±1.04) and ease of use (mean 4.22±0.9). LMWH treatment appeared convenient (global score 79.7±17.1 on a 0 to 100 scale) and 69.1% of patients were satisfied or very satisfied. CONCLUSION Despite incomplete strict adherence to guidelines, treatment duration with LMWH was adequate showing substantial progress in the management of CAT patients. Patients expectations were high while treatment was perceived convenient with a high degree of satisfaction.
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Affiliation(s)
- F Cajfinger
- Oncologie Médicale, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France
| | - P Debourdeau
- Oncologie, Institut Sainte Catherine, 250 Chemin de Baigne-pieds CS 800005, 84918 Avignon Cedex 9, , France
| | - A Lamblin
- LEO Pharma France, 2 rue René Caudron, F-78960, Voisins-le-Bretonneux, France
| | - V Benatar
- HEATHICS Clinical Consultants, 111, rue des Tennerolles, 92210 Saint-Cloud, France.
| | - N Falvo
- Département de Pathologie Vasculaire, CHU Dijon, 14 rue Gaffarel, 21079 Dijon cedex, France
| | - Y Benhamou
- Département de Médecine Interne, INSERM U1096, Centre Hospitalier Universitaire de Rouen, 1 rue de Germont, 76000 Rouen, France
| | - M A Sevestre
- Service de Médecine Vasculaire, CHU Amiens-Picardie- Site Sud, 80054 Amiens cedex, France
| | - D Farge-Bancel
- Unité de Médecine Interne et Pathologie Vasculaire, INSERM UMRS 1160, Hopital St Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
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Audemard-Verger A, Martin Silva N, Verstuyft C, Costedoat-Chalumeau N, Hummel A, Le Guern V, Sacré K, Meyer O, Daugas E, Goujard C, Sultan A, Lobbedez T, Galicier L, Pourrat J, Le Hello C, Godin M, Morello R, Lambert M, Hachulla E, Vanhille P, Queffeulou G, Potier J, Dion JJ, Bataille P, Chauveau D, Moulis G, Farge-Bancel D, Duhaut P, Saint-Marcoux B, Deroux A, Manuzak J, Francès C, Aumaitre O, Bezanahary H, Becquemont L, Bienvenu B. Glutathione S Transferases Polymorphisms Are Independent Prognostic Factors in Lupus Nephritis Treated with Cyclophosphamide. PLoS One 2016; 11:e0151696. [PMID: 27002825 PMCID: PMC4803192 DOI: 10.1371/journal.pone.0151696] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/02/2016] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To investigate association between genetic polymorphisms of GST, CYP and renal outcome or occurrence of adverse drug reactions (ADRs) in lupus nephritis (LN) treated with cyclophosphamide (CYC). CYC, as a pro-drug, requires bioactivation through multiple hepatic cytochrome P450s and glutathione S transferases (GST). METHODS We carried out a multicentric retrospective study including 70 patients with proliferative LN treated with CYC. Patients were genotyped for polymorphisms of the CYP2B6, CYP2C19, GSTP1, GSTM1 and GSTT1 genes. Complete remission (CR) was defined as proteinuria ≤0.33g/day and serum creatinine ≤124 µmol/l. Partial remission (PR) was defined as proteinuria ≤1.5g/day with a 50% decrease of the baseline proteinuria value and serum creatinine no greater than 25% above baseline. RESULTS Most patients were women (84%) and 77% were Caucasian. The mean age at LN diagnosis was 41 ± 10 years. The frequency of patients carrying the GST null genotype GSTT1-, GSTM1-, and the Ile→105Val GSTP1 genotype were respectively 38%, 60% and 44%. In multivariate analysis, the Ile→105Val GSTP1 genotype was an independent factor of poor renal outcome (achievement of CR or PR) (OR = 5.01 95% CI [1.02-24.51]) and the sole factor that influenced occurrence of ADRs was the GSTM1 null genotype (OR = 3.34 95% CI [1.064-10.58]). No association between polymorphisms of cytochrome P450s gene and efficacy or ADRs was observed. CONCLUSION This study suggests that GST polymorphisms highly impact renal outcome and occurrence of ADRs related to CYC in LN patients.
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Affiliation(s)
| | | | - Céline Verstuyft
- Department of Pharmacology, Hôpital Kremlin Bicêtre, Kremlin Bicêtre, France
| | | | | | - Véronique Le Guern
- Department of Internal Medicine, Hôpital Cochin, APHP, Université Paris V, Paris, France
| | - Karim Sacré
- Department of Internal Medicine, Hôpital Bichat, Paris, France
| | - Olivier Meyer
- Department of Rheumatology, Hôpital Bichat, Paris, France
| | - Eric Daugas
- Department of Nephrology, Hôpital Bichat, Paris, France
| | - Cécile Goujard
- Department of Internal Medicine, Hôpital Kremlin Bicêtre, Kremlin Bicêtre, France
| | - Audrey Sultan
- Department of Internal Medicine, CHU Caen, Caen, France
| | | | - Lionel Galicier
- Department of Clinical Immuno-pathology, Hôpital Saint Louis, Paris, France
| | - Jacques Pourrat
- Department of Nephrology and Clinical Immunology, CHU Toulouse, Toulouse, France
| | | | - Michel Godin
- Department of Nephrology, CHU Rouen, Rouen, France
| | | | - Marc Lambert
- Department of Internal Medicine, CHU Lille, Lille, France
| | - Eric Hachulla
- Department of Internal Medicine, CHU Lille, Lille, France
| | | | | | - Jacky Potier
- Department of Nephrology, CH Cherbourg, Cherbourg, France
| | - Jean-Jacques Dion
- Department of Nephrology, CH Charleville Mézière, Charleville Mézière, France
| | - Pierre Bataille
- Department of Nephrology, CH Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Dominique Chauveau
- Department of Nephrology and Clinical Immunology, CHU Toulouse, Toulouse, France
| | - Guillaume Moulis
- Department of Internal Medicine, CHU Toulouse, France; UMR 1027 Inserm-Univeristy of Toulouse, France; CIC 1436, Toulouse, France
| | | | - Pierre Duhaut
- Department of Internal Medicine, CHU Amiens, Amiens, France
| | | | - Alban Deroux
- Department of Internal Medicine, CHU Grenoble, Grenoble, France
| | | | | | - Olivier Aumaitre
- Department of Internal Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Holy Bezanahary
- Department of Internal Medicine, CHU Limoges, Limoges, France
| | - Laurent Becquemont
- Department of Pharmacology, Hôpital Kremlin Bicêtre, Kremlin Bicêtre, France
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22
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Passweg JR, Baldomero H, Bader P, Bonini C, Cesaro S, Dreger P, Duarte RF, Dufour C, Kuball J, Farge-Bancel D, Gennery A, Kröger N, Lanza F, Nagler A, Sureda A, Mohty M. Hematopoietic stem cell transplantation in Europe 2014: more than 40 000 transplants annually. Bone Marrow Transplant 2016; 51:786-92. [PMID: 26901709 PMCID: PMC4895175 DOI: 10.1038/bmt.2016.20] [Citation(s) in RCA: 278] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/06/2016] [Indexed: 12/30/2022]
Abstract
A record number of 40 829 hematopoietic stem cell transplantation (HSCT) in 36 469 patients (15 765 allogeneic (43%), 20 704 autologous (57%)) were reported by 656 centers in 47 countries to the 2014 survey. Trends include: continued growth in transplant activity, more so in Eastern European countries than in the west; a continued increase in the use of haploidentical family donors (by 25%) and slower growth for unrelated donor HSCT. The use of cord blood as a stem cell source has decreased again in 2014. Main indications for HSCT were leukemias: 11 853 (33% 96% allogeneic); lymphoid neoplasias; 20 802 (57% 11% allogeneic); solid tumors; 1458 (4% 3% allogeneic) and non-malignant disorders; 2203 (6% 88% allogeneic). Changes in transplant activity include more allogeneic HSCT for AML in CR1, myeloproliferative neoplasm (MPN) and aplastic anemia and decreasing use in CLL; and more autologous HSCT for plasma cell disorders and in particular for amyloidosis. In addition, data on numbers of teams doing alternative donor transplants, allogeneic after autologous HSCT, autologous cord blood transplants are presented.
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Affiliation(s)
- J R Passweg
- EBMT Activity Survey Office, Division of Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - H Baldomero
- EBMT Activity Survey Office, Division of Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - P Bader
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Germany
| | - C Bonini
- Università Vita-Salute San Raffaele, Milan, Italy
| | - S Cesaro
- Paediatric Haematology Oncology, Policlinico G.B. Rossi, Verona, Italy
| | - P Dreger
- Medizinische Klinik V, University of Heidelberg, Heidelberg, Germany
| | - R F Duarte
- Hematology Department, Institut Català d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain
| | - C Dufour
- Hematology Unit, G.Gaslini Children's Institute, Genova, Italy
| | - J Kuball
- Department of Haematology, University Medical Centre, Utrecht, The Netherlands
| | - D Farge-Bancel
- Service de Médecine Interne, Maladies Autoimmunes et Pathologie Vasculaire, Hôpital St Louis, Paris, France
| | - A Gennery
- Paediatric Team Children's BMT Unit, Great North Children's Hospital, Royal Victoria Infirmary, Newcastle University, Newcastle-Upon-Tyne, UK
| | - N Kröger
- Department of Stem cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - F Lanza
- Hematology and BMT Unit, Cremona, Italy
| | - A Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - A Sureda
- Hematology Department, Institut Català d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain
| | - M Mohty
- Department of Hematology, Hôpital Saint Antoine, Paris, France
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Cajfinger F, Farge-Bancel D, Falvo N, Sevestre MA, Lamblin A. Patients’ perception of long-term, low-molecular weight heparins for cancer-associated thrombosis (CAT): Treatment expectations, convenience, and satisfaction related to patient profile. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.29_suppl.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
88 Background: In the TROPIQUE study CAT pts had high expectations for anticoagulant treatment & long-term LMWH was perceived as convenient with high degree of treatment satisfaction. In this study, using the Perception of Anti-Coagulant Treatment Questionnaires (PACT-Q), we assessed the inpact of patient profile on treatment expectations, convenience and satisfaction. Methods: PACT-Q (1&2) were proposed on a voluntarily basis to cancer pts recently diagnosed with symptomatic venous thromboembolism; the global mean scores±SD was correlated to pts characteristics. Results: 269 PACT-Q1 & 139 PACT-Q2 were analysed &135 pts done both of them. In all pts, the highest mean scores were for expectations of symptom relief (4.22±0.9), confidence in preventing clots (3.98±1.04) & importance of simplicity of use (3.94±0.75). For clot prevention men were more confident (4.06±0.81) vs women (3.85±0.88). Expectations of symptom relief was higher in women (4.07±0.98) vs men (3.89±1.09). Importance of ease of use was higher in treated pts (4.27±0.89) vs no therapy (4.00±0.99) & pts with age ≥ 49 (4.46±0.59) vs < 49 years (3.98±1.07). At the end of the study, PACT-Q2 answers showed, an Anticoagulant Treatment Satisfaction scores of 62.9±16.7. 67.2% of pts felt strongly reassured & 48.5% were satisfied with symptom decrease. 69.1% of pts were satisfied / very satisfied with their anticoagulant treatment. Treatment-related side effects were as expected (41.7%), better/much better than expected (45.5%). 80.6% of pts reported higher ease with tinzaparin and 76.2% with other LMWH. According to pts characteristics, satisfaction was higher in men (64.4±17.7) vs women (61.0±15.0), in non-metastatic (64.6±16.9) vs metastatic (61.1±16.2). ECOG (3-4) pts reported lower treatment convenience with higher satisfaction vs ECOG (0-1); 80.0% of ECOG (3-4) pts were satisfied/very satisfied with anticoagulant treatment. 70.0% of ECOG (1-0) patients stated symptom decrease & 80.0 % a feeling of reassurance. Conclusions: pt’s profile influenced positively the perception of long-term LMWH treatment but not the convenience & treatment satisfaction.
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Hachulla E, Hatron PY, Carpentier P, Agard C, Chatelus E, Jego P, Mouthon L, Queyrel V, Fauchais AL, Michon-Pasturel U, Jaussaud R, Mathian A, Granel B, Diot E, Farge-Bancel D, Mekinian A, Avouac J, Desmur-Clavel H, Clerson P. OP0058 Efficacy of Sildenafil on Ischaemic Digital Ulcer Healing in Systemic Sclerosis: The Placebo-Controlled Seduce Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Hachulla E, Hatron PY, Carpentier P, Agard C, Chatelus E, Jego P, Mouthon L, Queyrel V, Fauchais AL, Michon-Pasturel U, Jaussaud R, Mathian A, Granel B, Diot E, Farge-Bancel D, Mekinian A, Avouac J, Desmurs-Clavel H, Clerson P. Efficacy of sildenafil on ischaemic digital ulcer healing in systemic sclerosis: the placebo-controlled SEDUCE study. Ann Rheum Dis 2015; 75:1009-15. [PMID: 25995322 PMCID: PMC4893100 DOI: 10.1136/annrheumdis-2014-207001] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [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: 11/15/2014] [Accepted: 04/23/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the effect of sildenafil, a phosphodiesterase type 5 inhibitor, on digital ulcer (DU) healing in systemic sclerosis (SSc). METHODS Randomised, placebo-controlled study in patients with SSc to assess the effect of sildenafil 20 mg or placebo, three times daily for 12 weeks, on ischaemic DU healing. The primary end point was the time to healing for each DU. Time to healing was compared between groups using Cox models for clustered data (two-sided tests, p=0.05). RESULTS Intention-to-treat analysis involved 83 patients with a total of 192 DUs (89 in the sildenafil group and 103 in the placebo group). The HR for DU healing was 1.33 (0.88 to 2.00) (p=0.18) and 1.27 (0.85 to 1.89) (p=0.25) when adjusted for the number of DUs at entry, in favour of sildenafil. In the per protocol population, the HRs were 1.49 (0.98 to 2.28) (p=0.06) and 1.43 (0.93 to 2.19) p=0.10. The mean number of DUs per patient was lower in the sildenafil group compared with the placebo group at week (W) 8 (1.23±1.61 vs 1.79±2.40 p=0.04) and W12 (0.86±1.62 vs 1.51±2.68, p=0.01) resulting from a greater healing rate (p=0.01 at W8 and p=0.03 at W12). CONCLUSIONS The primary end point was not reached in intention-to-treat, partly because of an unexpectedly high healing rate in the placebo group. We found a significant decrease in the number of DUs in favour of sildenafil compared with placebo at W8 and W12, confirming a sildenafil benefit. TRIAL REGISTRATION NUMBER NCT01295736.
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Affiliation(s)
- Eric Hachulla
- Médecine Interne, Hopital Huriez, Université de Lille, Lille, France
| | | | | | | | | | - Patrick Jego
- Médecine Interne, CHR Rennes Sud, Rennes, France
| | - Luc Mouthon
- Médecine Interne, AP-HP, Hôpital Cochin, Université Paris Descartes, Paris, France
| | | | | | | | | | - Alexis Mathian
- Médecine Interne 2, Hôpital Pitié-Salpêtrière, Paris, France
| | - Brigitte Granel
- Médecine Interne, Hôpital Nord, Aix Marseille Université, Marseille, France
| | | | | | - Arsène Mekinian
- Medicine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), AP-HP, Hôpital Saint Antoine, Paris, France
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26
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Passweg JR, Baldomero H, Bader P, Bonini C, Cesaro S, Dreger P, Duarte RF, Dufour C, Falkenburg JHF, Farge-Bancel D, Gennery A, Kröger N, Lanza F, Nagler A, Sureda A, Mohty M. Hematopoietic SCT in Europe 2013: recent trends in the use of alternative donors showing more haploidentical donors but fewer cord blood transplants. Bone Marrow Transplant 2015; 50:476-82. [PMID: 25642761 PMCID: PMC4387247 DOI: 10.1038/bmt.2014.312] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 12/04/2014] [Indexed: 12/18/2022]
Abstract
A record number of 39,209 HSCT in 34,809 patients (14,950 allogeneic (43%) and 19,859 autologous (57%)) were reported by 658 centers in 48 countries to the 2013 survey. Trends include: more growth in allogeneic than in autologous HSCT, increasing use of sibling and unrelated donors and a pronounced increase in haploidentical family donors when compared with cord blood donors for those patients without a matched related or unrelated donor. Main indications were leukemias, 11,190 (32%; 96% allogeneic); lymphoid neoplasias, 19,958 (57%; 11% allogeneic); solid tumors, 1543 (4%; 4% allogeneic); and nonmalignant disorders, 1975 (6%; 91% allogeneic). In patients without a matched sibling or unrelated donor, alternative donors are used. Since 2010 there has been a marked increase of 96% in the number of transplants performed from haploidentical relatives (802 in 2010 to 1571 in 2013), whereas the number of unrelated cord blood transplants has slightly decreased (789 in 2010 to 666 in 2013). The use of donor type varies greatly throughout Europe.
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Affiliation(s)
- J R Passweg
- EBMT Activity Survey Office, Hematology, Department of Medicine, University Hospital, Basel, Switzerland
| | - H Baldomero
- EBMT Activity Survey Office, Hematology, Department of Medicine, University Hospital, Basel, Switzerland
| | - P Bader
- Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Germany
| | - C Bonini
- Ospedale San Raffaele, Milan, Italy
| | - S Cesaro
- Paediatric Haematology Oncology, Policlinico G.B. Rossi, Verona, Italy
| | - P Dreger
- Medizinische Klinik V, University of Heidelberg, Heidelberg, Germany
| | - R F Duarte
- Hospital Duran i Reynals, Barcelona, Spain
| | - C Dufour
- Institute G. Gaslini, Genova, Italy
| | - J H F Falkenburg
- Department of Hematology, University Medical Center, Leiden, The Netherlands
| | - D Farge-Bancel
- Service de Médecine Interne, Hopital St Louis, Paris, France
| | - A Gennery
- Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne, UK
| | - N Kröger
- University Hospital Eppendorf, Hamburg, Germany
| | - F Lanza
- Hematology and BMT Unit, Cremona, Italy
| | - A Nagler
- Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - A Sureda
- Hospital Duran i Reynals, Barcelona, Spain
| | - M Mohty
- Hospital Saint Antoine, Paris, France
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27
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Sureda A, Bader P, Cesaro S, Dreger P, Duarte RF, Dufour C, Falkenburg JHF, Farge-Bancel D, Gennery A, Kröger N, Lanza F, Marsh JC, Nagler A, Peters C, Velardi A, Mohty M, Madrigal A. Indications for allo- and auto-SCT for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2015. Bone Marrow Transplant 2015; 50:1037-56. [PMID: 25798672 DOI: 10.1038/bmt.2015.6] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 01/09/2015] [Indexed: 12/17/2022]
Abstract
This is the sixth special report that the European Society for Blood and Marrow Transplantation regularly publishes on the current practice and indications for haematopoietic SCT for haematological diseases, solid tumours and immune disorders in Europe. Major changes have occurred in the field of haematopoietic SCT over the last years. Cord blood units as well as haploidentical donors have been increasingly used as stem cell sources for allo-SCT, thus, augmenting the possibility of finding a suitable donor for a patient. Continuous refinement of conditioning strategies has also expanded not only the number of potential indications but also has permitted consideration of older patients or those with co-morbidity for a transplant. There is accumulating evidence of the role of haematopoietic SCT in non-haematological disorders such as autoimmune diseases. On the other hand, the advent of new drugs and very effective targeted therapy has challenged the role of SCT in some instances or at least, modified its position in the treatment armamentarium of a given patient. An updated report with revised tables and operating definitions is presented.
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Affiliation(s)
- A Sureda
- Department of Haematology, Institut Catala d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain
| | - P Bader
- Universitätsklinikum Frankfurt, Goethe-Universität, Klinik für Kinder- und Jugendmedizin, Frankfurt, Germany
| | - S Cesaro
- Paediatric Haematology Oncology, Policlinico G.B. Rossi, Verona, Italy
| | - P Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - R F Duarte
- Department of Haematology, Institut Catala d'Oncologia, Hospital Duran I Reynals, Barcelona, Spain
| | - C Dufour
- Clinical And Experimental Hematology Unit. Institute G. Gaslini, Genoa, Italy
| | - J H F Falkenburg
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - D Farge-Bancel
- Department of Haematology-BMT, Hopital St Louis, Paris, France
| | - A Gennery
- Children's BMT Unit, Great North Children's Hospital, Newcastle-Upon-Tyne, UK
| | - N Kröger
- Department of Stem Cell Transplantation, University hospital Eppendorf, Hamburg, Germany
| | - F Lanza
- Haematology and BMT Unit, Cremona, Italy
| | - J C Marsh
- Department of Haematological Medicine, King's College Hospital/King's College London, London, UK
| | - A Nagler
- Chaim Sheva Medical Center, Tel-Hashomer, Israel
| | - C Peters
- Stem Cell Transplantation Unit, St Anna Kinderspital, Vienna, Austria
| | - A Velardi
- Sezione di Ematologia, Dipartimento di Medicina Clinica e Sperimentale, Università di Perugia, Perugia, Italy
| | - M Mohty
- Department of Haematology, H. Saint Antoine, Paris, France
| | - A Madrigal
- Anthony Nolan Research Institute, Royal Free and University College, London, UK
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28
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Farge-Bancel D, Bounameaux H, Brenner B, Büller HR, Kakkar A, Pabinger I, Streiff M, Debourdeau P. Implementing thrombosis guidelines in cancer patients: a review. Rambam Maimonides Med J 2014; 5:e0041. [PMID: 25386357 PMCID: PMC4222430 DOI: 10.5041/rmmj.10175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Venous thromboembolism is a frequent and serious complication in patients with cancer. It is an independent prognostic factor of death in cancer patients and the second leading cause of death, but physicians often underestimate its importance, as well as the need for adequate prevention and treatment. Management of venous thromboembolism in patients with cancer requires the coordinated efforts of a wide range of clinicians, highlighting the importance of a multidisciplinary approach. However, a lack of consensus among various national and international clinical practice guidelines has contributed to knowledge and practice gaps among practitioners, and inconsistent approaches to venous thromboembolism. The 2013 international guidelines for thrombosis in cancer have sought to address these gaps by critically re-evaluating the evidence coming from clinical trials and synthesizing a number of guidelines documents. An individualized approach to prophylaxis is recommended for all patients.
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Affiliation(s)
- Dominique Farge-Bancel
- Assistance Publique-Hôpitaux de Paris, Internal Medicine and Vascular Disease Unit, Saint-Louis Hospital; Sorbonne Paris Cité, Paris 7 Diderot University, Paris, France
| | - Henri Bounameaux
- Division of Angiology and Hemostasis, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Benjamin Brenner
- Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Harry R Büller
- Department of Vascular Medicine, Academic Medical Centre, Amsterdam, the Netherlands
| | - Ajay Kakkar
- Thrombosis Research Institute and Queen Mary University of London, London, UK
| | - Ingrid Pabinger
- Division of Hematology and Hemostaseology, Department of Internal Medicine, Medical University Vienna, Vienna, Austria
| | - Michael Streiff
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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29
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Secchi F, Cannao P, Pluchinotta F, Butera G, Carminati M, Sardanelli F, Lombardi M, Monney P, Piccini D, Rutz T, Vincenti G, Coppo S, Koestner S, Stuber M, Schwitter J, Romana P, Francesco S, Gianfranco B, Mario C, Francesco S, Massimo L, Alizadeh Sani Z, Vojdan-Parast M, Alimohammadi M, Sarafan-Sadeghi S, Seifi A, Fallahabadi H, Karami Tanha F, Jamshidi M, Hesamy M, Bonello B, Sorensen C, Fouilloux V, Gorincour G, Mace L, Fraisse A, Jacquier A, de Meester C, Amzulescu M, Bouzin C, Boileau L, Melchior J, Boulif J, Lazam S, Pasquet A, Vancrayenest D, Vanoverschelde J, Gerber B, Loudon M, Bull S, Bissell M, Joseph J, Neubauer S, Myerson S, Dorniak K, Hellmann M, Rawicz-Zegrzda D, W sierska M, Sabisz A, Szurowska E, Heiberg E, Dudziak M, Kwok T, Chin C, Dweck M, Hadamitzky M, Nadjiri J, Hendrich E, Pankalla C, Will A, Schunkert H, Martinoff S, Sonne C, Pepe A, Meloni A, Terrazzino F, Spasiano A, Filosa A, Bitti P, Tangari C, Restaino G, Resta M, Ricchi P, Meloni A, Tudisca C, Grassedonio E, Positano V, Piraino B, Romano N, Keilberg P, Midiri M, Pepe A, Meloni A, Positano V, Macchi S, Ambrosio D, De Marchi D, Chiodi E, Resta M, Salvatori C, Pepe A, Artang R, Bogachkov A, Botelho M, Bou-Ayache J, Vazquez M, Carr J, Collins J, Maret E, Ahlander B, Bjorklund P, Engvall J, Cimermancic R, Inage A, Mizuno N, Positano V, Meloni A, Santarelli M, Izzi G, Maddaloni D, De Marchi D, Salvatori C, Landini L, Pepe A, Pepe A, Meloni A, Carulli G, Oliva E, Arcioni F, Fraticelli V, Toia P, Renne S, Restaino G, Salvatori C, Rizzo M, Reinstadler S, Klug G, Feistritzer H, Aschauer A, Schocke M, Franz W, Metzler B, Melonil A, Positanol V, Roccamo G, Argento C, Benni M, De Marchil D, Missere M, Prezios P, Salvatoril C, Pepel A, Meloni A, Rossi G, Positano V, Cirotto C, Filati G, Toia P, Preziosi P, De Marchi D, Pepe A, Mongeon F, Fischer K, Teixeira T, Friedrich M, Marcotte F, Vincenti G, Monney P, Rutz T, Zenge M, Schmidt M, Nadar M, Chevre P, Rohner C, Schwitter J, Mouratoglou S, Kallifatidis A, Giannakoulas G, Grapsa J, Kamperidis V, Pitsiou G, Stanopoulos I, Hadjimiltiades S, Karvounis H, Ahmed N, Lawton C, Ghosh Dastidar A, Frontera A, Jackson A, Cripps T, Diab I, Duncan E, Thomas G, Bucciarelli-Ducci C, Kannoly S, Gosling O, Ninan T, Fulford J, Dalrymple-Haym M, Shore A, Bellenger N, Alegret J, Beltran R, Martin M, Mendoza M, Elisabetta C, Teresa C, Zairo F, Marcello N, Clorinda M, Bruna M, Vincenzo P, Alessia P, Giorgio B, Klug G, Feistritzer H, Reinstadler S, Mair J, Schocke M, Kremser C, Franz W, Metzler B, Aschauer S, Tufaro C, Kammerlander A, Pfaffenberger S, Marzluf B, Bonderman D, Mascherbauer J, Kliegel A, Sailer A, Brustbauer R, Sedivy R, Mayr H, Manessi M, Castelvecchio S, Votta E, Stevanella M, Menicanti L, Secchi F, Sardanelli F, Lombardi M, Redaelli A, Reiter U, Reiter G, Kovacs G, Greiser A, Olschewski H, Fuchsjager M, Kammerlander A, Tufaro C, Pfaffenberger S, Marzluf B, Aschauer S, Babayev J, Bonderman D, Mascherbauer J, Mlynarski R, Mlynarska A, Sosnowski M, Pontone G, Bertella E, Petulla M, Russo E, Innocenti E, Baggiano A, Mushtaq S, Gripari P, Andreini D, Tondo C, Nyktari E, Izgi C, Haidar S, Wage R, Keegan J, Wong T, Mohiaddin R, Durante A, Rimoldi O, Laforgia P, Gianni U, Benedetti G, Cava M, Damascelli A, Laricchia A, Ancona M, Aurelio A, Pizzetti G, Esposito A, Margonato A, Colombo A, De Cobelli F, Camici P, Zvaigzne L, Sergejenko S, Kal js O, Kannoly S, Ripley D, Swarbrick D, Gosling O, Hossain E, Chawner R, Moore J, Shore A, Bellenger N, Aquaro G, Barison A, Masci P, Todiere G, Strata E, Barison A, Di Bella G, Monasterio F, Feistritzer H, Reinstadler S, Klug G, Kremser C, Schocke M, Franz W, Metzler B, Levelt E, Mahmod M, Ntusi N, Ariga R, Upton R, Piechnick S, Francis J, Schneider J, Stoll V, Davis A, Karamitsos T, Leeson P, Holloway C, Clarke K, Neubauer S, Karwat K, Tomala M, Miszalski-Jamka K, Mrozi ska S, Kowalczyk M, Mazur W, Kereiakes D, Nessler J, Zmudka K, Ja wiec P, Miszalski-Jamka T, Ben Yaacoub-Kzadri I, Harguem S, Bennaceur R, Ganzoui I, Ben Miled A, Mnif N, Rodriguez Palomares J, Ortiz J, Bucciarelli-Ducci C, Tejedor P, Lee D, Wu E, Bonow R, Khanji M, Castiello T, Westwood M, Petersen S, Pepe A, Meloni A, Carulli G, Oliva E, Arcioni F, Storti S, Grassedonio E, Renne S, Missere M, Positano V, Rizzo M, Meloni A, Quota A, Smacchia M, Paci C, Positano V, Vallone A, Valeri G, Chiodi E, keilberg P, Pepe A, Barison A, De Marchi D, Gargani L, Aquaro G, Guiducci S, Pugliese N, Lombardi M, Pingitore A, Cole B, Douglas H, Rodden S, Horan P, Harbinson M, Johnston N, Dixon L, Choudhary P, Hsu C, Grieve S, Semsarian C, Richmond D, Celermajer D, Puranik R, Hinojar Baydes R, Varma N, Goodman B, Khan S, Arroyo Ucar E, Dabir D, Schaeffter T, Nagel E, Puntmann V, Hinojar R, Ucar E, Ngah N, Kuo N, D'Cruz D, Gaddum N, Schaeffter T, Nagel E, Puntmann V, Hinojar R, Foote L, Arroyo Ucar E, Dabir D, Schnackenburg B, Higgins D, Schaeffter T, Nagel E, Puntmann V, Nucifora G, Muser D, Morocutti G, Gianfagna P, Zanuttini D, Piccoli G, Proclemer A, Nucifora G, Prati G, Vitrella G, Allocca G, Buttignoni S, Muser D, Morocutti G, Delise P, Proclemer A, Sinagra G, Silva G, Almeida A, David C, Francisco A, Magalhaes A, Placido R, Menezes M, Guimaraes T, Mendes A, Nunes Diogo A, Aneq M, Maret E, Engvall J, Douglas H, Cole B, Rodden S, Horan P, Harbinson M, Dixon L, Johnston N, Papavassiliu T, Sandberg R, Schimpf R, Schoenberg S, Borggrefe M, Doesch C, Khan S, Tamin S, Tan L, Joshi S, Khan S, Memon S, Tamin S, Tan L, Joshi S, Tangcharoen T, Prasertkulchai W, Yamwong S, Sritara P, Hinojar R, Foote L, Arroyo Ucar E, Binti Ngah N, Cruz D, Schnackenburg B, Higgins D, Schaeffter T, Nagel E, Puntmann V, Nucifora G, Muser D, Masci P, Barison A, Rebellato L, Piccoli G, Daleffe E, Zanuttini D, Facchin D, Lombardi M, Proclemer A, Melao F, Paiva M, Pinho T, Martins E, Vasconcelos M, Madureira A, Macedo F, Ramos I, Maciel M, Agoston-Coldea L, Marjanovic Z, Hadj Khelifa S, Kachenoura N, Lupu S, Soulat G, Farge-Bancel D, Mousseaux E, Ben Yaacoub-Kzadri I, Harguem S, Bennaceur R, Ben Miled A, Mnif N, Dastidar A, Ahmed N, Frontera A, Lawton C, Augustine D, McAlindon E, Bucciarelli-Ducci C, Vasconcelos M, Leite S, Sousa C, Pinho T, Rangel I, Madureira A, Ramos I, Maciel M, El ghannudi S, Lefoulon A, Noel E, Germain P, Doutreleau S, Jeung M, Gangi A, Roy C, Todiere G, Pisciella L, Barison A, Zachara E, Federica R, Emdin M, Aquaro G, El ghannudi S, Lefoulon A, Noel E, Germain P, Doutreleau S, Jeung M, Gangi A, Roy C, Baydes R, Ucar E, Foote L, Dabir D, Mahmoud I, Jackson T, Schaeffter T, Higgins D, Nagel E, Puntmann V, Melao F, Paiva M, Pinho T, Martins E, Vasconcelos M, Madureira A, Macedo F, Ramos I, Maciel M. These abstracts have been selected for VIEWING only as ePosters and in print. ePosters will be available on Screen A & B throughout the meeting, Print Posters at the times indicated below. Please refer to the PROGRAM for more details. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu085] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Farge-Bancel D, Verrecchia F, Robert L, Morinet F. [Sixty years of Pathologie Biologie]. ACTA ACUST UNITED AC 2014; 62:59. [PMID: 24656440 DOI: 10.1016/j.patbio.2014.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 02/17/2014] [Indexed: 11/16/2022]
Affiliation(s)
- D Farge-Bancel
- Service de médecine interne et pathologie vasculaire, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
| | - F Verrecchia
- U957, laboratoire de physiopathologie de la résorption osseuse et thérapie des tumeurs osseuses primitives, faculté de médecine, 1, rue Gaston-Veil, 44000 Nantes, France
| | - L Robert
- Laboratoire de recherche ophtalmologique, université Paris 5, hôpital Hôtel-Dieu, 1, place du Parvis-Notre-Dame, 75004 Paris, France.
| | - F Morinet
- Centre d'innovations thérapeutiques en onco-hématologie (CITOH), hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris cedex 10, France
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Passweg JR, Baldomero H, Bregni M, Cesaro S, Dreger P, Duarte RF, Falkenburg JHF, Kröger N, Farge-Bancel D, Bobby Gaspar H, Marsh J, Mohty M, Peters C, Sureda A, Velardi A, Ruiz de Elvira C, Madrigal A. Hematopoietic SCT in Europe: data and trends in 2011. Bone Marrow Transplant 2013; 48:1161-7. [PMID: 23584439 PMCID: PMC3763517 DOI: 10.1038/bmt.2013.51] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/01/2013] [Accepted: 03/08/2013] [Indexed: 11/20/2022]
Abstract
In all, 651 from 680 centers in 48 countries reported 35 660 hematopoietic SCT (HSCT) in 32 075 patients (13 470 allogeneic (42%), 18 605 autologous (58%)) to the 2011 survey. Main indications were: leukemias; 10 113 (32%; 94% allogeneic); lymphoid neoplasias; non-Hodgkin's lymphoma, Hodgkin's lymphoma, plasma cell disorders; 18 433 (57%; 12% allogeneic); solid tumours; 1573 (5%; 5% allogeneic); and non-malignant disorders; 1830 (6%; 92% allogeneic). There were more unrelated donors than HLA identical sibling donors (54% versus 39%); proportion of peripheral blood as stem cell source was 99% for autologous and 73% for allogeneic HSCT. Cord blood was only used in allogeneic transplants (6% of total). In the past 10 years, the overall number of transplants has increased by 53%. Allogeneic HSCT have doubled (from 7272 to 14 549) while, autologous have increased by 32% and continue to increase by about 1100 HSCT per year since 2001. In the past 2 years, an increase of >2000 HSCT per year was seen. Transplant activity is shown by team size. For allogeneic HSCT, we show use of reduced-intensity conditioning versus myeloablative conditioning across Europe and use of post-transplant donor lymphocyte infusions with considerable variation across different countries.
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Affiliation(s)
- J R Passweg
- EBMT Activity Survey Office, Division of Hematology, Department of Medicine, University Hospital, Basel, Switzerland
| | - H Baldomero
- EBMT Activity Survey Office, Division of Hematology, Department of Medicine, University Hospital, Basel, Switzerland
| | - M Bregni
- Department of Oncology, Scientific Institute San Raffaele, Milan, Italy
| | - S Cesaro
- Paediatric Haematology Oncology, Policlinico G.B. Rossi, Verona, Italy
| | - P Dreger
- University of Heidelberg, Medizinische Klinik u. Poliklinik V, Heidelberg, Germany
| | - R F Duarte
- Institut Català d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain
| | | | - N Kröger
- University Hospital Eppendorf, Hamburg, Germany
| | - D Farge-Bancel
- Service de Médecine Interne, Hopital St Louis, Paris, France
| | - H Bobby Gaspar
- Molecular Immunology Unit, UCL Institute of Child Health, London, UK
| | - J Marsh
- GKT School of Medicine, Department of Haematological Medicine, King's Denmark Hill Campus, London, UK
| | - M Mohty
- Universite Pierre and Maris Curie, INSERM UMRs 938, Hôpital Saint Antoine, Paris, France
| | - C Peters
- St Anna Kinderspital, BMT Unit, Vienna, Austria
| | - A Sureda
- Addenbrookes Hospital, Cambridge, UK
| | - A Velardi
- Ospedale Santa Maria della Misericordia - Sezione di Ematologia, Localitá Sant Andrea delle Fratte, Perugia, Italy
| | | | - A Madrigal
- Anthony Nolan Research Institute Royal Free Hospital, London, UK
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Gesundheit B, Rosenzweig JP, Naor D, Lerer B, Zachor DA, Procházka V, Melamed M, Kristt DA, Steinberg A, Shulman C, Hwang P, Koren G, Walfisch A, Passweg JR, Snowden JA, Tamouza R, Leboyer M, Farge-Bancel D, Ashwood P. Immunological and autoimmune considerations of Autism Spectrum Disorders. J Autoimmun 2013; 44:1-7. [PMID: 23867105 DOI: 10.1016/j.jaut.2013.05.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 05/26/2013] [Accepted: 05/30/2013] [Indexed: 12/22/2022]
Abstract
Autism Spectrum Disorders (ASD) are a group of heterogeneous neurodevelopmental conditions presenting in early childhood with a prevalence ranging from 0.7% to 2.64%. Social interaction and communication skills are impaired and children often present with unusual repetitive behavior. The condition persists for life with major implications for the individual, the family and the entire health care system. While the etiology of ASD remains unknown, various clues suggest a possible association with altered immune responses and ASD. Inflammation in the brain and CNS has been reported by several groups with notable microglia activation and increased cytokine production in postmortem brain specimens of young and old individuals with ASD. Moreover several laboratories have isolated distinctive brain and CNS reactive antibodies from individuals with ASD. Large population based epidemiological studies have established a correlation between ASD and a family history of autoimmune diseases, associations with MHC complex haplotypes, and abnormal levels of various inflammatory cytokines and immunological markers in the blood. In addition, there is evidence that antibodies that are only present in some mothers of children with ASD bind to fetal brain proteins and may be a marker or risk factor for ASD. Studies involving the injection of these ASD specific maternal serum antibodies into pregnant mice during gestation, or gestational exposure of Rhesus monkeys to IgG subclass of these antibodies, have consistently elicited behavioral changes in offspring that have relevance to ASD. We will summarize the various types of studies associating ASD with the immune system, critically evaluate the quality of these studies, and attempt to integrate them in a way that clarifies the areas of immune and autoimmune phenomena in ASD research that will be important indicators for future research.
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Mihai C, Landewé R, van der Heijde D, Walker U, Constantin PI, Ionescu RM, Rednic S, Gherghe AM, Sfrent-Cornăteanu R, Allanore Y, Avouac J, Czirjak L, Farge-Bancel D, Damjanov N, Kowal-Bielecka O, van den Hoogen F, Tyndall A, Cutolo M, Müller-Ladner U, Matucci Cerinic M. FRI0393 Predictive value of history of digital ulcers in a eustar cohort of patients with systemic sclerosis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1520] [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: 11/03/2022]
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Vanneaux V, Farge-Bancel D, Lecourt S, Baraut J, Cras A, Jean-Louis F, Brun C, Verrecchia F, Larghero J, Michel L. Expression of transforming growth factor β receptor II in mesenchymal stem cells from systemic sclerosis patients. BMJ Open 2013; 3:bmjopen-2012-001890. [PMID: 23299111 PMCID: PMC3549232 DOI: 10.1136/bmjopen-2012-001890] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The present work aimed to evaluate the expression of transforming growth factor-β (TGF-β) receptors on bone marrow-derived multipotent mesenchymal stromal cells (MSCs) in patients with systemic sclerosis (SSc) and the consequences of TGF-β activation in these cells, since MSC have potential therapeutic interest for SSc patients and knowing that TGF-β plays a critical role during the development of fibrosis in SSc. DESIGN This is a prospective research study using MSC samples obtained from SSc patients and compared with MSC from healthy donors. SETTING One medical hospital involving collaboration between an internal medicine department for initial patient recruitment, a clinical biotherapeutic unit for MSC preparation and an academic laboratory for research. PARTICIPANTS 9 patients with diffuse SSc for which bone marrow (BM) aspiration was prescribed by sternum aspiration before haematopoietic stem cell transplantation, versus nine healthy donors for normal BM. PRIMARY AND SECONDARY OUTCOME MEASURES TGF-β, TGF-β receptor types I (TBRI) and II (TBRII) mRNA and protein expression were assessed by quantitative PCR and flow cytometry, respectively, in MSC from both SSc patients and healthy donors. MSC were exposed to TGF-β and assessed for collagen 1α2 synthesis and Smad expression. As positive controls, primary cultures of dermal fibroblasts were also analysed. RESULTS Compared with nine controls, MSC from nine SSc patients showed significant increase in mRNA levels (p<0.002) and in membrane expression (p<0.0001) of TBRII. In response to TGF-β activation, a significant increase in collagen 1α synthesis (p<0.05) and Smad-3 phosphorylation was upregulated in SSc MSC. Similar results were obtained on eight SSc-derived dermal fibroblasts compared to six healthy controls. CONCLUSIONS TBRII gene and protein expression defect in MSC derived from SSc patients may have pathological significance. These findings should be taken into account when considering the use of MSC-based therapies in an autologous setting.
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Affiliation(s)
- Valérie Vanneaux
- Unité de Thérapie Cellulaire et Centre d'Investigation Clinique en Biothérapies CIC-BT501,Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
- INSERM UMR940, Institut Universitaire d'Hématologie, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Dominique Farge-Bancel
- Unité de Médecine Interne et Pathologie Vasculaire, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
- INSERM UMR976 Skin Research Center and Université Paris Diderot, Sorbonne Paris Cité, Hôpital Saint-Louis, Paris, France
| | - Séverine Lecourt
- Unité de Thérapie Cellulaire et Centre d'Investigation Clinique en Biothérapies CIC-BT501,Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
- INSERM UMR940, Institut Universitaire d'Hématologie, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Julie Baraut
- INSERM UMR976 Skin Research Center and Université Paris Diderot, Sorbonne Paris Cité, Hôpital Saint-Louis, Paris, France
| | - Audrey Cras
- Unité de Thérapie Cellulaire et Centre d'Investigation Clinique en Biothérapies CIC-BT501,Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
- INSERM UMR940, Institut Universitaire d'Hématologie, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Francette Jean-Louis
- INSERM UMR976 Skin Research Center and Université Paris Diderot, Sorbonne Paris Cité, Hôpital Saint-Louis, Paris, France
| | - Cécilia Brun
- INSERM UMR976 Skin Research Center and Université Paris Diderot, Sorbonne Paris Cité, Hôpital Saint-Louis, Paris, France
| | | | - Jérôme Larghero
- Unité de Thérapie Cellulaire et Centre d'Investigation Clinique en Biothérapies CIC-BT501,Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
- INSERM UMR940, Institut Universitaire d'Hématologie, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Laurence Michel
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Unité de Médecine Interne et Pathologie Vasculaire, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Paris, France
- INSERM UMR976 Skin Research Center and Université Paris Diderot, Sorbonne Paris Cité, Hôpital Saint-Louis, Paris, France
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Verrecchia F, Farge-Bancel D. [ Gap junctional intercellular communication]. ACTA ACUST UNITED AC 2012. [PMID: 23206435 DOI: 10.1016/j.patbio.2012.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Farge-Bancel D, Van Laar J, Tyndall A. L’essai européen ASTIS (Autologous Stem Cell Transplantation International Scleroderma Trial). Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.027] [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: 11/29/2022]
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Farge-Bancel D, Debourdeau P, Beckers M, Bounameaux H, Buller H. Recommandations internationales de bonnes pratiques cliniques pour le traitement de la maladie thromboembolique chez les patients cancéreux. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Farge-Bancel D, Debourdeau P. Recommandations internationales pour le traitement de la maladie thromboembolique veineuse chez les patients atteints de cancer. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.03.065] [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: 11/30/2022]
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Azzouz DF, Rak JM, Fajardy I, Allanore Y, Tiev KP, Farge-Bancel D, Martin M, Kanaan SB, Pagni PP, Hachulla E, Harlé JR, Didelot R, Granel B, Cabane J, Roudier J, Lambert NC. Comparing HLA shared epitopes in French Caucasian patients with scleroderma. PLoS One 2012; 7:e36870. [PMID: 22615829 PMCID: PMC3352938 DOI: 10.1371/journal.pone.0036870] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 04/09/2012] [Indexed: 11/19/2022] Open
Abstract
Although many studies have analyzed HLA allele frequencies in several ethnic groups in patients with scleroderma (SSc), none has been done in French Caucasian patients and none has evaluated which one of the common amino acid sequences, 67FLEDR71, shared by HLA-DRB susceptibility alleles, or 71TRAELDT77, shared by HLA-DQB1 susceptibility alleles in SSc, was the most important to develop the disease. HLA-DRB and DQB typing was performed for a total of 468 healthy controls and 282 patients with SSc allowing FLEDR and TRAELDT analyses. Results were stratified according to patient’s clinical subtypes and autoantibody status. Moreover, standardized HLA-DRß1 and DRß5 reverse transcriptase Taqman PCR assays were developed to quantify ß1 and ß5 mRNA in 20 subjects with HLA-DRB1*15 and/or DRB1*11 haplotypes. FLEDR motif is highly associated with diffuse SSc (χ2 = 28.4, p<10−6) and with anti-topoisomerase antibody (ATA) production (χ2 = 43.9, p<10−9) whereas TRAELDT association is weaker in both subgroups (χ2 = 7.2, p = 0.027 and χ2 = 14.6, p = 0.0007 respectively). Moreover, FLEDR motif- association among patients with diffuse SSc remains significant only in ATA subgroup. The risk to develop ATA positive SSc is higher with double dose FLEDR than single dose with respectively, adjusted standardised residuals of 5.1 and 2.6. The increase in FLEDR motif is mostly due to the higher frequency of HLA-DRB1*11 and DRB1*15 haplotypes. Furthermore, FLEDR is always carried by the most abundantly expressed ß chain: ß1 in HLA DRB1*11 haplotypes and ß5 in HLA-DRB1*15 haplotypes. In French Caucasian patients with SSc, FLEDR is the main presenting motif influencing ATA production in dcSSc. These results open a new field of potential therapeutic applications to interact with the FLEDR peptide binding groove and prevent ATA production, a hallmark of severity in SSc.
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Affiliation(s)
- Doua F. Azzouz
- Laboratoire d’Immunogénétique de la Polyarthrite Rhumatoïde, INSERM UMRs1097, Marseille, France
| | - Justyna M. Rak
- Laboratoire d’Immunogénétique de la Polyarthrite Rhumatoïde, INSERM UMRs1097, Marseille, France
| | - Isabelle Fajardy
- Service de Médecine Interne, Centre National de Référence de la Sclérodermie Systémique, Hôpital Claude Huriez, Lille, France
| | - Yannick Allanore
- Université Paris Descartes, Service de Rhumatologie A, Hôpital Cochin, Paris, France
- Hôpital Cochin, Paris, France
| | - Kiet Phong Tiev
- Service de Médecine Interne, Hôpital St Antoine, Paris, France
| | - Dominique Farge-Bancel
- Service de Médecine Interne et Pathologie Vasculaire, Hôpital St Louis, Paris, France
- Hôpital St Louis, Paris, France
| | - Marielle Martin
- Laboratoire d’Immunogénétique de la Polyarthrite Rhumatoïde, INSERM UMRs1097, Marseille, France
| | - Sami B. Kanaan
- Laboratoire d’Immunogénétique de la Polyarthrite Rhumatoïde, INSERM UMRs1097, Marseille, France
| | - Philippe P. Pagni
- Laboratoire d’Immunogénétique de la Polyarthrite Rhumatoïde, INSERM UMRs1097, Marseille, France
| | - Eric Hachulla
- Service de Médecine Interne, Centre National de Référence de la Sclérodermie Systémique, Hôpital Claude Huriez, Lille, France
| | - Jean Robert Harlé
- Service de Médecine Interne, Hôpital La Conception, Marseille, France
| | - Rémi Didelot
- Centre d’Examen de Santé Assurance Maladie, Marseille, France
| | - Brigitte Granel
- Service de Médecine Interne, Hôpital Nord, Marseille, France
| | | | - Jean Roudier
- Laboratoire d’Immunogénétique de la Polyarthrite Rhumatoïde, INSERM UMRs1097, Marseille, France
- Service de Rhumatologie, Hôpital Ste Marguerite, Marseille, France
| | - Nathalie C. Lambert
- Laboratoire d’Immunogénétique de la Polyarthrite Rhumatoïde, INSERM UMRs1097, Marseille, France
- * E-mail:
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Passweg JR, Baldomero H, Gratwohl A, Bregni M, Cesaro S, Dreger P, de Witte T, Farge-Bancel D, Gaspar B, Marsh J, Mohty M, Peters C, Tichelli A, Velardi A, de Elvira CR, Falkenburg F, Sureda A, Madrigal A. The EBMT activity survey: 1990-2010. Bone Marrow Transplant 2012; 47:906-23. [PMID: 22543746 DOI: 10.1038/bmt.2012.66] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A total of 654 centers from 48 countries were contacted for the 2010 survey. In all, 634 centers reported a total of 33 362 hematopoietic SCT (HSCT) with 30 012 patients receiving their first transplant (12 276 allogeneic (41%) and 17 736 autologous (59%)). Main indications were leukemias: 9355 (31%; 93% allogeneic), lymphoid neoplasias specifically Non Hodgkin's lymphoma, Hodgkin's lymphoma and plasma cell disorders: 17 362 (58%; 12% allogeneic), solid tumors: 1585 (5%; 6% allogeneic) and non-malignant disorders: 1609 (6%; 88% allogeneic). There were more unrelated donors than HLA-identical sibling donors (53% versus 41%); the proportion of peripheral blood as stem cell source was 99% for autologous and 71% for allogeneic HSCT. Cord blood was primarily used in allogeneic transplants (6% of total) with three autologous cord blood HSCT being reported. The number of transplants has increased by 19% since 2005 (allogeneic 37% and autologous 9%) and continued to increase by about 1100 HSCT per year since 2000. Patterns of increase were distinct and different. The data show the development of transplantation in Europe since 1990, with the number of patients receiving a HSCT increasing from 4200 to over 30 000 annually. The most impressive trend seen is the steady increase of unrelated donor transplantation, in parallel to the availability of unrelated donors through donor registries.
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Affiliation(s)
- J R Passweg
- EBMT Activity Survey Office, Department of Medicine, Division of Hematology, University Hospital Basel, Basel, Switzerland.
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Darbousset R, Mezouar S, Bonier R, Sbarra V, Farge-Bancel D, Frère C, Dubois C, Panicot-Dubois L. On the use of anti-platelet drugs to diminish both tumor growth and thrombosis. Thromb Res 2012. [DOI: 10.1016/s0049-3848(12)70048-8] [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: 11/24/2022]
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Farge-Bancel D, Debourdeau P, Beckers M, Baglin C, Bauersachs R, Brenner B, Brilhante D, Falanga A, Gerotziafas G, Kakkar A, Khorana A, Lecumberri R, Mandalà M, Marty M, Monréal M, Mousa S, Nissim H, Noble S, Pabinger I, Prins M, Qari M, Streiff M, Bounameaux H, Büller H. Abstract related to PL-22 Guidelines for antithrombotics in cancer patients. Thromb Res 2012. [DOI: 10.1016/s0049-3848(12)70141-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Foocharoen C, Tyndall A, Hachulla E, Rosato E, Allanore Y, Farge-Bancel D, Caramaschi P, Airó P, Nikolaevna SM, Pereira da Silva JA, Stamenkovic B, Riemekasten G, Rednic S, Sibilia J, Wiland P, Tarner I, Smith V, Onken AT, Abdel Atty Mohamed WA, Distler O, Morović-Vergles J, Himsel A, de la Peña Lefebvre PG, Hügle T, Walker UA. Erectile dysfunction is frequent in systemic sclerosis and associated with severe disease: a study of the EULAR Scleroderma Trial and Research group. Arthritis Res Ther 2012; 14:R37. [PMID: 22348608 PMCID: PMC3392836 DOI: 10.1186/ar3748] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 12/11/2011] [Accepted: 02/20/2012] [Indexed: 02/05/2023] Open
Abstract
Introduction Erectile dysfunction (ED) is common in men with systemic sclerosis (SSc) but the demographics, risk factors and treatment coverage for ED are not well known. Method This study was carried out prospectively in the multinational EULAR Scleroderma Trial and Research database by amending the electronic data-entry system with the International Index of Erectile Function-5 and items related to ED risk factors and treatment. Centres participating in this EULAR Scleroderma Trial and Research substudy were asked to recruit patients consecutively. Results Of the 130 men studied, only 23 (17.7%) had a normal International Index of Erectile Function-5 score. Thirty-eight per cent of all participants had severe ED (International Index of Erectile Function-5 score ≤ 7). Men with ED were significantly older than subjects without ED (54.8 years vs. 43.3 years, P < 0.001) and more frequently had simultaneous non-SSc-related risk factors such as alcohol consumption. In 82% of SSc patients, the onset of ED was after the manifestation of the first non-Raynaud's symptom (median delay 4.1 years). ED was associated with severe cutaneous, muscular or renal involvement of SSc, elevated pulmonary pressures and restrictive lung disease. ED was treated in only 27.8% of men. The most common treatment was sildenafil, whose efficacy is not established in ED of SSc patients. Conclusions Severe ED is a common and early problem in men with SSc. Physicians should address modifiable risk factors actively. More research into the pathophysiology, longitudinal development, treatment and psychosocial impact of ED is needed.
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Affiliation(s)
- Chingching Foocharoen
- Department of Rheumatology, Basel University, Burgfelderstrasse 101, Basel 4012, Switzerland
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Farge-Bancel D, Lefort A, Mahé I, Algayres JP, Durant C, Roux X, Rapp C. Bienvenue au 64e congrès de la Société nationale française de médecine interne. Rev Med Interne 2011; 32 Suppl 2:S201-2. [DOI: 10.1016/j.revmed.2011.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Cajfinger F, Debourdeau P, Drouet L, Durant C, Elalamy I, Farge-Bancel D. Risque thromboembolique et prise en charge du cancer du sein. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-2089-6] [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: 11/28/2022]
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Farge-Bancel D. [Cell therapy in autoimmune diseases]. Rev Med Interne 2011; 32 Suppl 2:S204-7. [PMID: 22056080 DOI: 10.1016/j.revmed.2011.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- D Farge-Bancel
- Unité de médecine interne et de pathologie vasculaire, Inserm U976, hôpital Saint-Louis, université Paris-Diderot, Sorbonne Paris-cité, 1, avenue Claude-Vellefaux, 75010 Paris, France.
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Lobo JL, Nieto JA, Zorrilla V, Garrido N, Madridano O, Ruiz J, Farge-Bancel D, Tiberio G, Uresandi F, Monreal M. Venous thromboembolism in patients with intracranial haemorrhage. Thromb Haemost 2011; 106:750-2. [PMID: 21901229 DOI: 10.1160/th11-02-0136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 07/15/2011] [Indexed: 11/05/2022]
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Distler JHW, Jordan S, Airo P, Alegre-Sancho JJ, Allanore Y, Balbir Gurman A, Caporali R, Caramaschi P, Carreira PE, Chizzolini C, Cutolo M, Tuncay Duruöz M, Farge-Bancel D, Hesselstrand R, Iannone F, De Keyser F, Kucharz EJ, Launay D, García de la Peña Lefebvre P, Lukacova O, Marasini B, Martinovic D, Marques Neto JF, Radic M, Rednic S, Riemekasten G, Rovensky J, Seidel MF, Senel S, Smith V, Sunderkötter C, Ton E, van Laar JM, Matucci-Cerinic M, Müller Ladner U, Distler O. Is there a role for TNFα antagonists in the treatment of SSc? EUSTAR expert consensus development using the Delphi technique. Clin Exp Rheumatol 2011; 29:S40-S45. [PMID: 21586217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 04/21/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To obtain experiences and expert opinion on treatment of SSc patients with TNF-α antagonists. METHODS An investigation was carried out among the EUSTAR centres into their expertise on use of TNF-α antagonists. Assessment forms on the frequency of TNF-α inhibitor use were distributed to EULAR Scleroderma Trials and Research Group (EUSTAR) centres. Afterwards, a three round Delphi exercise was performed to obtain expert consensus on the use of TNF-α inhibitors in SSc. RESULTS Seventy-nine centres returned information on use of TNF-α antagonists in SSc patients. A total of 65 patients were treated with TNF-α inhibitors in 14 different centres. Forty-eight of the 65 patients treated with TNF-α inhibitors improved. Improvement was mainly seen in patients with arthritis, whereas the effects on fibrosis varied. In the first round of the subsequent Delphi approach, 71 out of 79 experts stated that they would use TNF-α antagonists in SSc. Arthritis was suggested as an indication for TNF-α antagonists by 75% of the experts. However, after the third stage of the Delphi exercise, the acceptance for the off-label use of TNF-α antagonists decreased and 59% recommended that TNF-α antagonists should not be used or only used in clinical trials in SSc patients, while 38% of the experts suggested the use of TNF-α antagonists for arthritis associated with SSc. CONCLUSIONS Most of the experts do not recommend the routine use of TNF-α antagonists in systemic sclerosis. Arthritis might be a potential indication in SSc, although controlled clinical trials with TNF-α antagonists are needed before general recommendations can be given.
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Affiliation(s)
- Joerg H W Distler
- Department of Rheumatology, University of Erlangen-Nuremberg, Germany.
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Durant C, Farge-Bancel D. Clinical images: Voluminous ectopic tumoral calcinosis of the spine in systemic sclerosis. ACTA ACUST UNITED AC 2011; 63:411. [DOI: 10.1002/art.27768] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Burt RK, Abinun M, Farge-Bancel D, Fassas A, Hiepe F, Havrdova E, Ikehara S, Loh Y, Marmont du Haut Champ A, Voltarelli JC, Snowden J, Slavin S. Risks of Immune System Treatments. Science 2010; 328:825-6. [DOI: 10.1126/science.328.5980.825-e] [Citation(s) in RCA: 20] [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] [Indexed: 11/02/2022]
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