1
|
Gruchet C, Richez V, Guidez S, Fouquet G, Azais I, Durand G, Javaugue V, Plasse F, Machet A, Moya N, Gardeney H, Bobin A, Levy A, Sabirou F, Bonnin A, Dieval C, Primault S, Bridoux F, Avet-Loiseau H, Leleu X. Weekly 20/56 mg/m² carfilzomib, lenalidomide, and dexamethasone until progression in early relapsed refractory multiple myeloma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.8041] [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
8041 Background: Triplet-based Carfilzomib (K), Lenalidomide and Dexamethasone combination (KRd) has led to approval in early RRMM based on ASPIRE International phase 3 study. However, K was used on a twice a week basis at 27mg/m2 and limited to 18 months exposure. We have reported already that KRd on a weekly basis at 56 mg/m2 was active similar to ASPIRE KRd and safe. We report herein the long-term exposure data on KRd weekly given until progression. We aimed to evaluate the efficacy of KRd given on a prolong duration beyond 18months, and to validate the safety profile of continuous exposure to K. Methods: 28 patients were prospectively recruited. Carfilzomib 20/56mg/m2 was administered on days 1,8,15, Lenalidomide 25mg/day was given 21/28 days and Dexamethasone was administered weekly on 28 days cycles until progression. Results: With a median follow-up at start of KRd of 30 months, 50% of patients relapsed and 39% died. 24/28 patients received 1 prior line of treatment. 8/28 patients are still on treatment with duration > 24 month and 6/28 with duration > 30 months. The median number of cycles was 15. ORR and CBR was 85.7% and 89.3%, whom 46% ≥ CR ; with a median DOR of 13 months and 43% having more than 18 months. 6 patients had negative MRD at 10-6 and normalized PET CT. Median of OS is not reached, and the 30 month-expected OS from the start of KRd was 56%. The median PFS and EFS was at 29 months, and the 30 month-expected PFS and EFS was 45%. PFS and EFS being superimposable speaks to that there was no safety concern related to prolonged exposure to K. Only 4 patients stopped KRd for safety issues. Hematologic and non-hematologic adverse events ≥ grade 3 were reported in 16/28 and 10/28 patients. Adverse events ≥ grade 3 seen in ≥10% of patients were neutropenia, thrombocytopenia, vomiting and pyrexia. Of note, 5 patients (18%) were ≥ 65 years old and showed similar data compared to the cohort. Conclusions: KRd weekly is effective and safe to early in RRMM patients, provides improved safety profile to patients allowing treating patients until progression. Further studies are warranted to confirm this data on a larger early RRMM population and validate the concept of long duration of treatment using Carfilzomib combination.
Collapse
Affiliation(s)
| | | | - Stephanie Guidez
- Poitiers University Hospital / INSERM CIC 1402, Poitiers, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xavier Leleu
- Department of Hematology, CHU la Miletrie and Inserm CIC 1402, Poitiers, France
| |
Collapse
|
2
|
Richez V, Gruchet C, Guidez S, Fouquet G, Azais I, Durand G, Javaugue V, Brigaud A, Plasse F, Diolez J, Machet A, Moya N, Gardeney H, Franques P, Bobin A, Levy A, Sabirou F, Bonnin A, Dieval C, Primault S, Barrier J, Fleck E, Bouyier S, Daras C, Princet I, Bauwens D, Legros L, Fuzibet JG, Gil A, Bridoux F, Avet-Loiseau H, Leleu X. Carfilzomib weekly 20/56 mg/m 2 , lenalidomide and dexamethasone for early relapsed refractory multiple myeloma. Am J Hematol 2019; 94:E17-E20. [PMID: 30358902 DOI: 10.1002/ajh.25327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Niels Moya
- Hématologie et Inserm CIC 1402; Poitiers France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Labrousse J, Plasse F, Aucher P, Augereau P, Bertin A, Carrere F, Cognée AS, Vignon G, Violette J, Lellouche F. [IgM Myeloma: case report and literature review]. Ann Biol Clin (Paris) 2018; 76:575-578. [PMID: 30226197 DOI: 10.1684/abc.2018.1380] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The presence of serum monoclonal IgM is often associated with the diagnosis of Waldenström macroglobulinemia (WM) or other chronic lymphoproliferative disorders. IgM myeloma is a rare entity (0.5%). We report the case of an IgM myeloma complicated by systemic amyloidosis AL, with an impure nephrotic syndrome and a factor FX deficiency.
Collapse
Affiliation(s)
- Julien Labrousse
- GCS de Saintonge, Centres hospitaliers de Saint-Jean-d'Angély, Jonzac, Saintes et Royan, Saint-Jean-d'Angély, France
| | - Florent Plasse
- Service de néphrologie, Centre hospitalier de Saintes, Saintes, France
| | - Philippe Aucher
- GCS de Saintonge, Centres hospitaliers de Saint-Jean-d'Angély, Jonzac, Saintes et Royan, Saint-Jean-d'Angély, France
| | - Pierre Augereau
- GCS de Saintonge, Centres hospitaliers de Saint-Jean-d'Angély, Jonzac, Saintes et Royan, Saint-Jean-d'Angély, France
| | - Anne Bertin
- GCS de Saintonge, Centres hospitaliers de Saint-Jean-d'Angély, Jonzac, Saintes et Royan, Saint-Jean-d'Angély, France
| | - François Carrere
- GCS de Saintonge, Centres hospitaliers de Saint-Jean-d'Angély, Jonzac, Saintes et Royan, Saint-Jean-d'Angély, France
| | - Anne-Sophie Cognée
- GCS de Saintonge, Centres hospitaliers de Saint-Jean-d'Angély, Jonzac, Saintes et Royan, Saint-Jean-d'Angély, France
| | - Guillaume Vignon
- GCS de Saintonge, Centres hospitaliers de Saint-Jean-d'Angély, Jonzac, Saintes et Royan, Saint-Jean-d'Angély, France
| | - Jérémie Violette
- GCS de Saintonge, Centres hospitaliers de Saint-Jean-d'Angély, Jonzac, Saintes et Royan, Saint-Jean-d'Angély, France
| | - Franck Lellouche
- GCS de Saintonge, Centres hospitaliers de Saint-Jean-d'Angély, Jonzac, Saintes et Royan, Saint-Jean-d'Angély, France
| |
Collapse
|
4
|
Zaidan M, Plasse F, Rabant M, Javaugue V, Knebelmann B, Alyanakian MA, Joly D, Nochy D, Bridoux F. [Renal involvement during type 1 cryoglobulinemia]. Nephrol Ther 2016; 12 Suppl 1:S71-81. [PMID: 26972092 DOI: 10.1016/j.nephro.2016.01.010] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cryoglobulins are circulating immunoglobulins that precipitate with cold temperature and dissolve with rewarming. Type 1 cryoglobulinemia is composed of a single monoclonal immunoglobulin and is associated with renal involvement in up to 40% of cases. Type 1 cryoglobulinemia is related to an underlying B-cell haematological malignancy in 60% of patients. In the remaining cases, in the absence of criteria for malignancy, the diagnosis of monoclonal gammopathy of renal significance should be established. The clinical and biological setting and histological features of type 1 cryoglobulinemia are globally similar to those of mixed cryoglobulinemia. In case of haematological malignancy, the treatment is guided by the nature of the underlying disease, and aims at inducing haematological remission, which is necessary for the renal response. The management of monoclonal gammopathy of renal significance has been clarified by an international consensus group and is based on the nature of the underlying clone. In case of monoclonal cryoglobulinemia associated with a plasma-cell clone (IgG or IgA), the treatment is based on the combination of bortezomib, cyclophosphamide and dexamethasone. In case of IgM monoclonal cryoglobulinemia, the treatment is similar to that of Waldenström macroglobulinemia, and is based on rituximab. The clinical course of renal monoclonal cryoglobulinemia is intimately associated with the haematological response, and is usually favourable.
Collapse
Affiliation(s)
- Mohamad Zaidan
- Service de néphrologie-transplantation adultes, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France.
| | - Florent Plasse
- Service de néphrologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Centre national de référence amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - Marion Rabant
- Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France; Service d'anatomie pathologique, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Vincent Javaugue
- Service de néphrologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Centre national de référence amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - Bertrand Knebelmann
- Service de néphrologie-transplantation adultes, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - Marie-Alexandra Alyanakian
- Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France; Service d'immunologie biologique, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - Dominique Joly
- Service de néphrologie-transplantation adultes, hôpital Necker, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - Dominique Nochy
- Université Paris Descartes, 12, rue de l'École-de-Médecine, 75006 Paris, France; Service d'anatomie pathologique, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - Frank Bridoux
- Service de néphrologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Centre national de référence amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| |
Collapse
|
5
|
Lesieur O, Leloup M, Gonzalez F, Plasse F, Mamzer-Bruneel M. Prélèvement d’organes après arrêt des techniques de suppléance vitale en réanimation : une étude épidémiologique de faisabilité réalisée par le groupe EPILAT. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.331] [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: 11/27/2022]
|
6
|
Plasse F, Belmouaz S, Bridoux F, Bauwens M. Détermination de la dose normalisée de dialyse par modèle multi-séances de cinétique de l’urée : avantages et inconvénients. Nephrol Ther 2014. [DOI: 10.1016/j.nephro.2014.07.076] [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: 11/26/2022]
|
7
|
Pourreau F, Pinsard M, Goyffon M, Plasse F, Desport E, Thierry A, Touchard G, Bridoux F. Bilateral renal cortical necrosis with end-stage renal failure following envenoming by Proatheris superciliaris: a case report. Toxicon 2014; 84:36-40. [PMID: 24709757 DOI: 10.1016/j.toxicon.2014.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 01/09/2014] [Revised: 03/10/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
Acute bilateral renal cortical necrosis (BRCN) has been reported following envenoming by exotic venomous snakes. Proatheris superciliaris is a rare viper with restricted distribution in east Africa. Very little information is available on envenoming by this species. We herein describe the case of a 60-year-old professional wildlife photographer who was bitten on his thumb while photographing an adult specimen of P. superciliaris that he held at home in France. On admission, physical examination revealed severe hypertension and bruising with edema at the bite site. Within the following 24 h, he developed vomiting, diarrhea, acute lumbar pain and anuria. Laboratory tests showed acute kidney injury (serum creatinine 4.6 mg/dL), with thrombocytopenia, anemia and severe coagulopathy. Contrast-enhanced computed tomography scan revealed hypodense areas in the cortex of both kidneys consistent with diffuse BRCN. As no appropriate antivenom existed, only symptomatic care was given to the patient. Coagulation tests returned to normal within 48 h. The patient was placed on chronic hemodialysis, until he underwent successful kidney transplantation 18 months later. In developed countries, severe complications provoked by snake bites tend to be more frequent with the number of trendy exotic pets. Acute kidney injury, including BRCN, is a classic complication of viper bites. The present case of end-stage renal failure related to diffuse BRCN illustrates the potentially devastating effects of envenoming by P. superciliaris. Clinicians in developed countries should be informed about renal disorders and other potentially fatal complications of venomous snake bites and seek urgent expert advice for optimizing clinical management. Education and coaching of envenomed patients and exotic snake owners is mandatory to prevent dramatic accidents.
Collapse
Affiliation(s)
- François Pourreau
- Department of Nephrology and Renal Transplantation, University Hospital and University of Poitiers, France
| | - Michel Pinsard
- Department of Intensive Care Unit, University Hospital and University of Poitiers, France
| | - Max Goyffon
- Museum National d'Histoire Naturelle, Paris, France
| | - Florent Plasse
- Department of Nephrology and Renal Transplantation, University Hospital and University of Poitiers, France
| | - Estelle Desport
- Department of Nephrology and Renal Transplantation, University Hospital and University of Poitiers, France
| | - Antoine Thierry
- Department of Nephrology and Renal Transplantation, University Hospital and University of Poitiers, France
| | - Guy Touchard
- Department of Nephrology and Renal Transplantation, University Hospital and University of Poitiers, France
| | - Frank Bridoux
- Department of Nephrology and Renal Transplantation, University Hospital and University of Poitiers, France.
| |
Collapse
|