1
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Rafii H, Volt F, Bierings M, Dalle JH, Ayas M, Rihani R, Faraci M, de Simone G, Sengeloev H, Passweg J, Cavazzana M, Costello R, Maertens J, Biffi A, Johansson JE, Montoro J, Guepin GR, Diaz MA, Sirvent A, Kenzey C, Rivera Franco MM, Cappelli B, Scigliuolo GM, Rocha V, Ruggeri A, Risitano A, De Latour RP, Gluckman E. Umbilical Cord Blood Transplantation for Fanconi Anemia With a Special Focus on Late Complications: a Study on Behalf of Eurocord and SAAWP-EBMT. Transplant Cell Ther 2024; 30:532.e1-532.e16. [PMID: 38452872 DOI: 10.1016/j.jtct.2024.02.024] [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: 01/18/2024] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024]
Abstract
Hematopoietic cell transplantation (HCT) remains the sole available curative treatment for Fanconi anemia (FA), with particularly favorable outcomes reported after matched sibling donor (MSD) HCT. This study aimed to describe outcomes, with a special focus on late complications, of FA patients who underwent umbilical cord blood transplantation (UCBT). In this retrospective analysis of allogeneic UCBT for FA performed between 1988 and 2021 in European Society for Blood and Marrow Transplantation (EBMT)-affiliated centers, a total of 205 FA patients underwent UCBT (55 related and 150 unrelated) across 77 transplant centers. Indications for UCBT were bone marrow failure in 190 patients and acute leukemia/myelodysplasia in 15 patients. The median age at transplantation was 9 years (range, 1.2 to 43 years), with only 20 patients aged >18 years. Among the donor-recipient pairs, 56% (n = 116) had a 0 to 1/6 HLA mismatch. Limited-field radiotherapy was administered to 28% (n = 58) and 78% (n = 160) received a fludarabine (Flu)-based conditioning regimen. Serotherapy consisted of antithymocyte globulin (n = 159; 78%) or alemtuzumab (n = 12; 6%). The median follow-up was 10 years for related UCBT and 7 years for unrelated UCBT. Excellent outcomes were observed in the setting of related UCBT, including a 60-day cumulative incidence (CuI) of neutrophil recovery of 98.1% (95% confidence interval [CI], 93.9% to 100%), a 100-day CuI of grade II-IV acute graft-versus-host disease (GVHD) of 17.3% (95% CI, 9.5% to 31.6%), and a 5-year CuI of chronic GVHD (cGVHD) of 22.7% (95% CI, 13.3% to 38.7%; 13% extensive). Five-year overall survival (OS) was 88%. In multivariate analysis, none of the factors included in the model predicted a better OS. In unrelated UCBT, the 60-day CuI of neutrophil recovery was 78.7% (95% CI, 71.9% to 86.3%), the 100-day CuI of grade II-IV aGVHD was 31.4% (95% CI, 24.6% to 40.2%), and the 5-year CuI of cGVHD was 24.3% (95% CI, 17.8% to 32.2%; 12% extensive). Five-year OS was 44%. In multivariate analysis, negative recipient cytomegalovirus serology, Flu-based conditioning, age <9 years at UCBT, and 0 to 1/6 HLA mismatch were associated with improved OS. A total of 106 patients, including 5 with acute leukemia/myelodysplasia, survived for >2 years after UCBT. Nine of these patients developed subsequent neoplasms (SNs), including 1 donor-derived acute myelogenous leukemia and 8 solid tumors, at a median of 9.7 years (range, 2.3 to 21.8 years) post-UCBT (1 related and 8 unrelated UCBT). In a subset of 49 patients with available data, late nonmalignant complications affecting various organ systems were observed at a median of 8.7 years (range, 2.7 to 28.8 years) post-UCBT. UCB is a valid source of stem cells for transplantation in patients with FA, with the best results observed after related UCBT. After unrelated UCBT, improved survival was observed in patients who underwent transplantation at a younger age, with Flu-based conditioning, and with better HLA parity. The incidence of organ-specific complications and SNs was relatively low. The incidence of SNs, mostly squamous cell carcinoma, increases with time. Rigorous follow-up and lifelong screening are crucial in survivors of UCBT for FA.
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Affiliation(s)
- Hanadi Rafii
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Fernanda Volt
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Marc Bierings
- Princess Maxima Center, University Hospital for Children, Utrecht, Netherlands
| | - Jean-Hugues Dalle
- Pediatric Hematology and Immunology Department, Robert Debré Hospital, Université Paris Cité, APHP, Paris, France
| | - Mouhab Ayas
- Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Rawad Rihani
- Pediatric Blood, Marrow and Cellular Therapy Program, King Hussein Cancer Centre, Amman, Jordan
| | - Maura Faraci
- Hematopoetic Stem Cell Unit, Department of Hematology-Oncology, IRCCS Istituto G. Gaslini, Genova, Italy
| | - Giuseppina de Simone
- Hematology and Stem Cell Transplant Unit, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon, Napoli, Italy
| | - Henrik Sengeloev
- Bone Marrow Transplant Unit L 4043, National University Hospital, Copenhagen, Denmark
| | - Jakob Passweg
- Hematology Department, University Hospital of Basel, Basel, Switzerland
| | | | - Regis Costello
- Centre Hospitalier Universitaire La Conception, Marseille, France
| | - Johan Maertens
- Departement of Hematology,University Hospital Gasthuisberg, Leuven, Belgium
| | - Alessandra Biffi
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Padua University Hospital, Padua, Italy
| | | | | | | | | | - Anne Sirvent
- Pediatric Onco-Hematology Unit, CHU A de Villeneuve, Montpellier, France
| | - Chantal Kenzey
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Monica M Rivera Franco
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France
| | - Barbara Cappelli
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Graziana Maria Scigliuolo
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco
| | - Vanderson Rocha
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Hematology, Transfusion, and Cell Therapy Service and Laboratory of Medical Investigation in Pathogenesis and Directed Therapy in Onco-Immuno-Hematology (LIM-31), Hospital das Clínicas, Faculty of Medicine, São Paulo University, São Paulo, Brazil
| | - Annalisa Ruggeri
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Risitano
- University of Naples, Avellino, Italy; AORN San Giuseppe Moscati, Avellino, Italy
| | - Regis Peffault De Latour
- Bone Marrow Transplant Unit, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Eliane Gluckman
- Eurocord, Institut de Recherche de Saint-Louis (IRSL) EA3518, Hôpital Saint-Louis, Université Paris Cité, Paris, France; Monacord, Centre Scientifique de Monaco, Monaco.
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2
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Chalandon Y, Rousselot P, Chevret S, Cayuela JM, Kim R, Huguet F, Chevallier P, Graux C, Thiebaut-Bertrand A, Chantepie SP, Thomas X, Vincent L, Berthon C, Hicheri Y, Raffoux E, Escoffre-Barbe M, Plantier I, Joris M, Turlure P, Pasquier F, Belhabri A, Roth Guepin G, Blum S, Gregor M, Lafage-Pochitaloff M, Quessada J, Lheritier V, Clappier E, Boissel N, Dombret H. Nilotinib with or without cytarabine for Philadelphia positive acute lymphoblastic leukemia. Blood 2024:blood.2023023502. [PMID: 38452207 DOI: 10.1182/blood.2023023502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/15/2024] [Accepted: 02/27/2024] [Indexed: 03/09/2024] Open
Abstract
We previously demonstrated that a reduced-intensity chemotherapy schedule can safely replace Hyper-CVAD cycle 1 when combined with imatinib in adults with Philadelphia-positive (Ph+) acute lymphoblastic leukemia (ALL). In the present randomized GRAAPH-2014 trial, we used nilotinib and addressed the omission of cytarabine (Ara-C) in consolidation. The primary objective was the major molecular response (MMR) rate measured by BCR::ABL1 quantification after cycle 4 (end of consolidation). All patients were eligible for allogeneic stem cell transplant (SCT), whereas those in MMR could receive autologous SCT, followed by 2-year imatinib maintenance in both cases. After the enrollment of 156 out of 265 planed patients, the data and safety monitoring board decided to hold the randomization due to an excess of relapse in the investigational arm. Among the 155 evaluable patients, 77 received Ara-C during consolidation (arm A) and 78 did not (arm B). Overall, 133 (85%) patients underwent SCT, 93 allogeneic, 40 autologous. The non-inferiority endpoint regarding MMR was reached with 71.1% (arm A) and 77.2% (arm B) of patients reaching MMR. However, the 4-year cumulative incidence of relapse was higher in arm B as compared to arm A (31.3% [95% CI, 21.1-41.9%] versus 13.2% [95% CI, 6.7-21.9%]; p=0.017), which translated in a lower relapse-free survival. With a median follow-up of 3.8 years, 4-year overall survival (OS) was 79.0% (95% CI, 70.6-89.3%) in arm A versus 73.4% (95% CI, 63.9-84.4%) in arm B (p=0.35). Despite a non-inferior rate of MMR, more relapses were observed when ARA-C was omitted without impact on survival. ClinicalTrials.gov ID, NCT02611492.
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Affiliation(s)
| | - Philippe Rousselot
- Centre Hospitalier de Versailles, Université Paris-Saclay, Versailles, France
| | - Sylvie Chevret
- 4 APHP, Hôpital Saint-Louis, Service de médecine nucléaire, Paris, France ;, Paris, France
| | - Jean-Michel Cayuela
- University Hospital Saint-Louis, APHP and Université Paris Cité, Paris, France
| | - Rathana Kim
- Université Paris Cité - Hopital Saint-Louis APHP - INSERM U944, PARIS, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sabine Blum
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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3
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Jandin A, Pochon C, Campidelli A, D'Aveni M, Kicki C, Notarantonio AB, Roth Guepin G, Mbuyi TA, Feugier P, Chastagner P, Schweitzer C, de Carvalho Bittencourt M, Rubio MT, Pagliuca S. Age-related immune cell dynamics influence outcomes after allogeneic haematopoietic cell transplantation. Br J Haematol 2023. [PMID: 37092504 DOI: 10.1111/bjh.18822] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/29/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
An efficient immunological reconstitution construes the pillar for the success of allogeneic haematopoietic cell transplantation (HCT) in haematological disorders. Factors influencing post-transplant immune recovery have been largely investigated across multiple cohorts issuing heterogeneous results. Differences in outcomes in adult and paediatric populations suggest an age-related contribution to post-transplant immune reconstitution; however, it is unclear how recipient and donor age may affect the dynamics of single immune cells. Here, we retrospectively collected and analysed immunological data of 174 patients (58 children and 116 adults) consecutively transplanted for haematological disorders in our centre. We show that trajectories of specific immune cells were strictly dependent on recipient age and pretransplant virus exposure, with the strongest effect seen on T CD4+ and B-cell counterparts, while donor age and transplant platforms had a minimal impact. This mirrored different kinetics of immune reconstitution in adult and paediatric patients, with major divergences in immune cell composition in late post-transplant phases, featuring better survival, relapse-free survival and cumulative incidence of pathogen-specific infections in younger patients. Altogether, these findings underpin the importance of recipient age on post-transplant immune cell recovery and define the basic dynamics of the immune reconstitution in paediatric and adult populations as a benchmark for future studies.
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Affiliation(s)
- Alizée Jandin
- Onco-Haematology Paediatric Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Cécile Pochon
- Onco-Haematology Paediatric Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Arnaud Campidelli
- Haematology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Maud D'Aveni
- Haematology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- CNRS UMR 7365 IMoPa, Biopole de l'Université de Lorraine, Vandoeuvre les Nancy, France
| | - Céline Kicki
- Haematology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Anne-Béatrice Notarantonio
- Haematology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- CNRS UMR 7365 IMoPa, Biopole de l'Université de Lorraine, Vandoeuvre les Nancy, France
| | | | | | - Pierre Feugier
- Haematology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- INSERM U1256 Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Pascal Chastagner
- Onco-Haematology Paediatric Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Cyril Schweitzer
- Paediatric Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Marcelo de Carvalho Bittencourt
- CNRS UMR 7365 IMoPa, Biopole de l'Université de Lorraine, Vandoeuvre les Nancy, France
- Laboratory of Immunology, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Marie Thérèse Rubio
- Haematology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- CNRS UMR 7365 IMoPa, Biopole de l'Université de Lorraine, Vandoeuvre les Nancy, France
| | - Simona Pagliuca
- Haematology Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
- CNRS UMR 7365 IMoPa, Biopole de l'Université de Lorraine, Vandoeuvre les Nancy, France
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4
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Laloi L, Billotey NC, Dumas P, Paul F, Villate A, Simand C, Fornecker L, Puisset F, Bertoli S, Simonet MB, Laribi K, Houyou D, Santagostino A, Michel C, Guepin GR, Guerineau E, Tabrizi R, Hunault M, Giltat A, Kaphan E, Bulabois C, Cartet E, Rocher C, Lachenal F, Morisset S, Récher C, Pigneux A, Belhabri A, Michallet M, Michallet A. Retrospective, real‐life study of venetoclax plus azacitidine or low‐dose cytarabine in French patients with acute myeloid leukemia ineligible for intensive chemotherapy. Cancer Med 2022; 12:7175-7181. [PMID: 36482507 PMCID: PMC10067034 DOI: 10.1002/cam4.5459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recently, the combination of venetoclax plus a hypomethylating agent (HMA; azacitidine ordecitabine) or low-dose cytarabine (LDAC) showed promise in Phase III trials in previously untreated AML. In France at the time of this study, venetoclax was not yet approved for AML and there were therefore no formal usage recommendations. Here we report the first study in a French cohort that assessed venetoclax in combination with existing treatments for AML under real-life conditions. METHOD This retrospective, real-life study collected data on venetoclax use and management in a French cohort with acute myeloid leukemia (AML) ineligible for intensive chemotherapy. RESULT Of 118 patients, 81 were in second line/beyond (71.6% also hypomethylating agent [HMA]; 23.5% lowdose cytarabine [LDAC]) and 37 in first line. For venetoclax initiation, 57.3% underwent ramp up and 74.6% were hospitalized. Median venetoclax duration was 2.5 months (range 0.03-16.2). With all treatment lines and regimens, most common grade 3/4 adverse events were hematologic (overall 96.4% of patients) and infections (57.1%). Dosage adjustments for drug interactions and safety varied between centers. In second-line/beyond, median progression-free survival was 4.0 months (95% confidence interval [CI] 2.7-12.8) with venetoclax-HMA and 3.4 months (1.3-8.9) with venetoclax-LDAC; overall response rate was 51.9% and 41.2%, respectively. Thus, we showed that venetoclax-based treatment yields promising findings in patients with AML, but to address treatment complexity, practice harmonization is needed.
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Affiliation(s)
- Louise Laloi
- Department of Pharmacy Centre Léon Bérard Lyon France
| | | | - Pierre‐Yves Dumas
- Department of Hematology University Hospital of Bordeaux Bordeaux France
| | - Franciane Paul
- Department of Hematology University Hospital of Montpellier Montpellier France
| | - Alban Villate
- Department of Hematology University Hospital of Tours Tours France
| | - Célestine Simand
- Department of Hematology University Hospital of Strasbourg Strasbourg France
| | - Luc Fornecker
- Department of Hematology University Hospital of Strasbourg Strasbourg France
| | - Florent Puisset
- Department of Pharmacy Institut Universitaire du Cancer Oncopole Toulouse France
| | - Sarah Bertoli
- Department of Hematology Institut Universitaire du Cancer Oncopole Toulouse France
| | | | - Kamel Laribi
- Department of Hematology Hospital of Le Mans Le Mans France
| | - Dyhia Houyou
- Department of Clinical Research Hospital of Troyes Troyes France
| | | | - Claire Michel
- Department of Hematology University Hospital of Nancy Nancy France
| | | | - Elodie Guerineau
- Department of Clinical Research Hospital of Mont de Marsan Mont de Marsan France
| | - Reza Tabrizi
- Department of Hematology Hospital of Mont de Marsan Mont de Marsan France
| | - Mathilde Hunault
- Department of Hematology University Hospital of Angers Angers France
| | - Aurélien Giltat
- Department of Hematology University Hospital of Angers Angers France
| | - Eléonore Kaphan
- Department of Hematology University Hospital of Grenoble Grenoble France
| | - Claude Bulabois
- Department of Hematology University Hospital of Grenoble Grenoble France
| | - Elodie Cartet
- Department of Pharmacy Hospital of Bourgoin‐Jallieu Bourgoin‐Jallieu France
| | - Clément Rocher
- Department of Hematology Hospital of Bourgoin‐Jallieu Bourgoin‐Jallieu France
| | - Florence Lachenal
- Department of Hematology Hospital of Bourgoin‐Jallieu Bourgoin‐Jallieu France
| | | | - Christian Récher
- Department of Hematology Institut Universitaire du Cancer Oncopole Toulouse France
| | - Arnaud Pigneux
- Department of Hematology University Hospital of Bordeaux Bordeaux France
| | - Amine Belhabri
- Department of Hematology and Medical Oncology Centre Léon Bérard Lyon France
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5
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Broussais F, Bay JO, Boissel N, Baruchel A, Arnulf B, Morschhauser F, Robin M, Guepin GR, Moreau P, Gandemer V, Manier S, Leguay T, Nguyen Quoc S, Schwartzmann A, Houot R, Le Gouill S. [DESCAR-T, a nationwide registry for patient treated by CAR-T Cells in France]. Bull Cancer 2021; 108:S143-S154. [PMID: 34920797 DOI: 10.1016/j.bulcan.2021.07.002] [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: 05/07/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
CAR-T Cells have opened new doors for cellular immunotherapies and provides new therapeutic options for patients with refractory B-cell malignancies, B-cell acute lymphoblastic leukemia and diffuse large B-cel lymphoma. CAR-T Cells have benefited from an accelerated approval procedure in many countries. Indeed, The French health authorities have approved the specialties Tisacel ® and Axicel ®, but additional data including the use of CAR-T Cells in real life were also mandatory. In regard to the scientific interest of the project, LYSA-LYSARC committed itself to prospectively and retrospectively collect information on patients eligible for CAR-T Cells as required by French health authorities. Other academic cooperating groups (GRAALL, IFM, SFCE, FILO and the scientific society SFGM-TC) were associated to this initiative which aims to build a nationwide CAR-T Cells devoted registry, so-called DESCART (Dispositif d'Enregistrement et Suivi des patients traités par CAR-T cells). DESCAR-T is a real-life multicentric registry set up in French sites qualified for CAR-T Cells treatment. DESCAR-T objective is to describe the use of CAR-T Cells in real life. All paediatric and adult patients with hematological malignancy fulfilling CAR-T Cells approval criteria and for whom a CAR-T Cells therapy has been discussed are included from 1 July 2018. Clinical data are directly collected from medical records and patients are treated according to the centers' routine practices. One of the distinctive features of DESCAR-T is its link with HTA for CAR-T Cells s reimbursement by the French public health system. DESCAR-T is the first national registry promoted by an academic group allowing centralized data collection for both academic and HTA/health authorities' purposes.
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Affiliation(s)
- Florence Broussais
- LYSARC : Centre Hospitalier Lyon-Sud Batiment 2D, 69495 Pierre-Bénite Cedex, France.
| | - Jacques Olivier Bay
- CHU ESTAING Service d'hématologie clinique et de thérapie cellulaire adulte, 1, place Lucie Aubrac, 63003 Clermont-Ferrand Cedex, France.
| | - Nicolas Boissel
- Hôpital Saint-Louis, AP-HP, service d'hématologie adolescents et jeunes adultes, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - André Baruchel
- Hôpital Robert-Debré, service d'hémato-immunologie, 48, boulevard Sérurier, 79395 Paris cedex 19, France.
| | - Bertrand Arnulf
- Hôpital Saint-Louis, Service d'immunohématologie, UMR Inserm 1126, Paris, France.
| | - Franck Morschhauser
- CHU de Lille, Hôpital Huriez, service des maladies du sang, 1, rue Michel-Polonowski, 59037 Lille Cedex, France.
| | - Marie Robin
- Hôpital Saint-Louis, Inserm 1131, université Paris 7, Service d'hématologie-allogreffe, Paris, France.
| | - Gabrielle Roth Guepin
- Hôpitaux de Brabois, Service d'Hématologie du CHRU de Nancy, 8, rue Du Morvan, 54500 Vandoeuvre Les Nancy, France.
| | - Philippe Moreau
- Service d'hématologie clinique, CHU Hôtel Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - Virginie Gandemer
- Service d'hémato-oncologie pédiatrique, Centre hospitalier universitaire de Rennes, 2 rue Henri Le Guilloux, 35033 Rennes cedex 9, France.
| | - Salomon Manier
- CHU de Lille, Hôpital Huriez, service des maladies du sang, 1, rue Michel-Polonowski, 59037 Lille Cedex, France.
| | - Thibaut Leguay
- Hopital Haut-Leveque -CHU, Service d'hématologie et de thérapie cellulaire, avenue de Magellan, 33600 Pessac, France.
| | - Stéphanie Nguyen Quoc
- Assistance publique-Hôpitaux de Paris, service d'hématologie clinique, groupe hospitalier Pitié-Salpêtrière, Paris, France.
| | - Alexia Schwartzmann
- LYSARC : Centre Hospitalier Lyon-Sud Batiment 2D, 69495 Pierre-Bénite Cedex, France.
| | - Roch Houot
- Service d'Hématologie, centre hospitalier universitaire de Rennes, 2 rue Henri Le Guilloux, 35033 Rennes cedex 9, France.
| | - Steven Le Gouill
- Service d'hématologie clinique, CHU Hôtel Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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6
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Bouvier A, Hamel JF, Delaunay J, Delabesse E, Dumas PY, Ledoux MP, Peterlin P, Luquet I, Roth Guepin G, Bulabois CE, Gallego Hernanz MP, Guillerm G, Guieze R, Hicheri Y, Simand C, Himberlin C, Hunault-Berger M, Bernard M, Jourdan E, Caillot D, Dorvaux V, Tavernier E, Daguindau E, Banos A, Ojeda-Uribe M, Gyan E, Alexis M, Marolleau JP, Turlure P, Bouscary D, Humbrecht C, Zerazhi H, Béné MC, Pigneux A, Carre M, Ifrah N, Blanchet O, Vey N, Récher C, Cornillet-Lefèbvre P. Molecular classification and prognosis in younger adults with acute myeloid leukemia and intermediate-risk cytogenetics treated or not by gemtuzumab ozogamycin: Final results of the GOELAMS/FILO acute myeloid leukemia 2006-intermediate-risk trial. Eur J Haematol 2021; 107:111-121. [PMID: 33765335 DOI: 10.1111/ejh.13626] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/12/2022]
Abstract
In this randomized phase 3 study, the FILO group tested whether the addition of 6 mg/m2 of gemtuzumab ozogamycin (GO) to standard chemotherapy could improve outcome of younger patients with de novo acute myeloid leukemia (AML) and intermediate-risk cytogenetics. GO arm was prematurely closed after 254 inclusions because of toxicity. A similar complete remission rate was observed in both arms. Neither event-free survival nor overall survival were improved by GO in younger AML patients (<60 years) ineligible for allogeneic stem-cell transplantation. (P = .086; P = .149, respectively). Using unsupervised hierarchical clustering based on mutational analysis of seven genes (NPM1, FLT3-ITD, CEBPA, DNMT3A, IDH1, IDH2, and ASXL1), six clusters of patients with significant different outcome were identified. Five clusters were based on FLT3-ITD, NPM1, and CEBPA mutations as well as epigenetic modifiers (DNMT3A, IDH1/2, ASXL1), whereas the last cluster, representing 25% of patients, had no mutation and intermediate risk. One cluster isolated FLT3-ITD mutations with higher allelic ratio and a very poor outcome. The addition of GO had no impact in these molecular clusters. Although not conclusive for GO impact in AML patients <60 years, this study provides a molecular classification that distinguishes six AML clusters influencing prognosis in younger AML patients with intermediate-risk cytogenetic.
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Affiliation(s)
- Anne Bouvier
- Hématologie Biologique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Jean-François Hamel
- Departement de Biostatistiques, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Jacques Delaunay
- Hématologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Eric Delabesse
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopôle, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Pierre-Yves Dumas
- Hématologie Clinique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Marie-Pierre Ledoux
- Hématologie Clinique, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Pierre Peterlin
- Hématologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Isabelle Luquet
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopôle, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Claude Eric Bulabois
- Hématologie Clinique, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | | | - Gaëlle Guillerm
- Hématologie Clinique, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Romain Guieze
- Hématologie Clinique, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Yosr Hicheri
- Hématologie Clinique, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Célestine Simand
- Hématologie Clinique, Institut cancérologique de Strasbourg Europe, Strasbourg, France
| | - Chantal Himberlin
- Hématologie Clinique, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Mathilde Hunault-Berger
- Hématologie clinique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Inserm, CRCINA, Angers, France
| | - Marc Bernard
- Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Eric Jourdan
- Hématologie Clinique, Centre Hospitalier Universitaire de Nîmes, Nîmes, France
| | - Denis Caillot
- Hématologie Clinique, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Véronique Dorvaux
- Hématologie Clinique, Centre Hospitalier Régional de Metz, Metz, France
| | | | - Etienne Daguindau
- Hématologie Clinique, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Anne Banos
- Hématologie Clinique, Centre Hospitalier Côte Basque, Bayonne, France
| | - Mario Ojeda-Uribe
- Hématologie Clinique, Centre Hospitalier Regional de Mulhouse, Mulhouse, France
| | - Emmanuel Gyan
- Service d'Hématologie et thérapie cellulaire, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Magda Alexis
- Hématologie Clinique, Centre Hospitalier Régional Orléans, Orléans, France
| | | | - Pascal Turlure
- Hématologie Clinique, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | | | | | - Hacène Zerazhi
- Hématologie Clinique, Centre Hospitalier d'Avignon, Avignon, France
| | - Marie-Christine Béné
- Hématologie Biologique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Arnaud Pigneux
- Hématologie Clinique, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Martin Carre
- Hématologie Clinique, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Norbert Ifrah
- Hématologie clinique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Inserm, CRCINA, Angers, France
| | - Odile Blanchet
- Hématologie Biologique, Centre Hospitalier Universitaire d'Angers, Université d'Angers, Angers, France
| | - Norbert Vey
- Hématologie Clinique, Institut Paoli-Calmettes, Marseille, France
| | - Christian Récher
- Service d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopôle, Université Toulouse III Paul Sabatier, Toulouse, France
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