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Ducassou S, Leverger G, Fernandes H, Chambost H, Bertrand Y, Armari-Alla C, Nelken B, Monpoux F, Guitton C, Leblanc T, Fisher A, Lejars O, Jeziorski E, Fouissac F, Lutz P, Pasquet M, Pellier I, Piguet C, Vic P, Bayart S, Marie-Cardine A, Michel M, Perel Y, Aladjidi N. Benefits of rituximab as a second-line treatment for autoimmune haemolytic anaemia in children: a prospective French cohort study. Br J Haematol 2017; 177:751-758. [PMID: 28444729 DOI: 10.1111/bjh.14627] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/31/2016] [Indexed: 11/28/2022]
Abstract
Childhood autoimmune haemolytic anaemia (AIHA) requires second-line immunosuppressive therapy in 30-50% of cases. It appears that rituximab is indicated in such circumstances. This prospective national study reports the practice, efficacy and tolerance of rituximab in children with isolated AIHA and AIHA in the setting of Evans syndrome (ES). Sixty-one children were given rituximab between 2000 and 2014. The median interval from diagnosis to rituximab was 9·9 [interquartile range (IQR) 1·6-28·5] months. Forty-six patients responded (75%) and the 6-year relapse-free survival (RFS) was 48%. Twenty patients relapsed at a median interval of 10·8 (IQR 3·9-18·7) months, rituximab allowed steroid withdrawal in 44/61 (72%) of children. In isolated AIHA, complete response and 6-year RFS were significantly higher than in ES (P < 0·05). Ten out of 61 patients were infants, seven of who responded with a 6-year RFS of 71%. Among patients without immunoglobulin substitution before rituximab, 4 are still receiving substitutions. Five patients died, including one potentially attributable to rituximab. This large observational series of childhood AIHA established the rituximab benefit-risk ratio, allowing steroid withdrawal, with 37% of long-term responders, mainly in isolated AIHA. All subgroups of patients drew benefit. Our long-term results indicate the baseline to be challenged by new treatment approaches.
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Affiliation(s)
- Stéphane Ducassou
- Paediatric Oncology Haematology Unit/CEREVANCE/CIC 1401, Inserm CICP, University Hospital of Bordeaux, Paediatric Hospital, Bordeaux, France
| | - Guy Leverger
- Paediatric Onco-Haematology Unit, Hôpital Trousseau, APHP, Paris, France
| | - Helder Fernandes
- Paediatric Oncology Haematology Unit/CEREVANCE/CIC 1401, Inserm CICP, University Hospital of Bordeaux, Paediatric Hospital, Bordeaux, France
| | - Hervé Chambost
- Paediatric Haematology Unit, Hôpital La Timone Enfants - APHM, Marseille, France
| | - Yves Bertrand
- Paediatric Immuno-Haematology Unit, Institut d'Hématologie et d'Oncologie Pédiatrique (IHOP), Lyon, France
| | | | - Brigitte Nelken
- Paediatrics Unit, University Hospital of Lille, Lille, France
| | - Fabrice Monpoux
- Paediatric Onco-Haematology Unit, University Hospital of Nice, Nice, France
| | - Corinne Guitton
- Paediatrics Unit, University Hospital Bicêtre - APHP, Le Kremlin-Bicêtre, France
| | - Thierry Leblanc
- Haematology Unit, Hôpital Robert Debré - APHP, Paris, France
| | - Alain Fisher
- Immuno-Haematology Unit, Hôpital Necker - APHP, Paris, France
| | - Odile Lejars
- Paediatric Onco-Haematology Unit, University Hospital of Tours, Tours, France
| | - Eric Jeziorski
- Paediatric Onco-Haematology Unit, University Hospital of Montpellier, Montpellier, France
| | - Fanny Fouissac
- Paediatric Onco-Haematology Unit, University Hospital of Nancy, Nancy, France
| | - Patrick Lutz
- Paediatric Onco-Haematology Unit, University Hospital of Strasbourg, Strasbourg, France
| | - Marlène Pasquet
- Paediatric Onco-Haematology Unit, University Hospital of Toulouse, Toulouse, France
| | - Isabelle Pellier
- Paediatric Onco-Haematology Unit, University Hospital of Angers, Angers, France
| | - Christophe Piguet
- Paediatric Onco-Haematology Unit, University Hospital of Limoges, Limoges, France
| | - Philippe Vic
- Paediatric Unit, General Hospital of Quimper, Quimper, France
| | - Sophie Bayart
- Paediatric Onco-Haematology Unit, University Hospital of Rennes, Rennes, France
| | - Aude Marie-Cardine
- Paediatric Onco-Haematology Unit, University Hospital of Rouen, Rouen, France
| | - Marc Michel
- Department of Internal Medicine, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil, Créteil, France
| | - Yves Perel
- Paediatric Oncology Haematology Unit/CEREVANCE/CIC 1401, Inserm CICP, University Hospital of Bordeaux, Paediatric Hospital, Bordeaux, France
| | - Nathalie Aladjidi
- Paediatric Oncology Haematology Unit/CEREVANCE/CIC 1401, Inserm CICP, University Hospital of Bordeaux, Paediatric Hospital, Bordeaux, France
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Dufour C, Geoffray A, Faivre L, Bourdeaut F, Planchon JM, Figarella-Branger D, Faure-Conter C, Icher C, Bertozzi AI, Leblond P, Sirvent N, Doz F, André N, De Carli E, Chappe C, Lejars O, Chastagner P, Soler C, Berger C, Entz-Werlé N, Delisle MB. MB-106PROGNOSTIC RELEVANCE OF CLINICAL AND MOLECULAR RISK FACTORS IN CHILDREN WITH HIGH-RISK MEDULLOBLASTOMA TREATED IN THE FRENCH PROSPECTIVE TRIAL PNET HR + 5. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now076.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Aladjidi N, Fernandes H, Leblanc T, Vareliette A, Rieux-Laucat F, Bertrand Y, Chambost H, Pasquet M, Mazingue F, Guitton C, Pellier I, Roqueplan-Bellmann F, Armari-Alla C, Thomas C, Marie-Cardine A, Lejars O, Fouyssac F, Bayart S, Lutz P, Piguet C, Jeziorski E, Rohrlich P, Lemoine P, Bodet D, Paillard C, Couillault G, Millot F, Fischer A, Pérel Y, Leverger G. Evans Syndrome in Children: Long-Term Outcome in a Prospective French National Observational Cohort. Front Pediatr 2015; 3:79. [PMID: 26484337 PMCID: PMC4586429 DOI: 10.3389/fped.2015.00079] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 09/14/2015] [Indexed: 12/11/2022] Open
Abstract
Evans syndrome (ES) is a rare autoimmune disorder whose long-term outcome is not well known. In France, a collaborative pediatric network set up via the National Rare Disease Plan now provides comprehensive clinical data in children with this disease. Patients aged less than 18 years at the initial presentation of autoimmune cytopenia have been prospectively included into a national observational cohort since 2004. The definition of ES was restricted to the simultaneous or sequential association of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenic purpura (ITP). Cases were deemed secondary if associated with a primitive immunodeficiency or systemic lupus erythematosus. In December 2014, we analyzed the data pertaining to 156 children from 26 centers with ES whose diagnosis was made between 1981 and 2014. Median age (range) at the onset of cytopenia was 5.4 years (0.2-17.2). In 85 sequential cases, the time lapse between the first episodes of AIHA and ITP was 2.4 years (0.1-16.3). The follow-up period as from ES diagnosis was 6.5 years (0.1-28.8). ES was secondary, revealing another underlying disease, in 10% of cases; various associated immune manifestations (mainly lymphoproliferation, other autoimmune diseases, and hypogammaglobulinemia) were observed in 60% of cases; and ES remained primary in 30% of cases. Five-year ITP and AIHA relapse-free survival were 25 and 61%, respectively. Overall, 69% of children required one or more second-line immune treatments, and 15 patients (10%) died at the age of 14.3 years (1.7-28.1). To our knowledge, this is the first consistent long-term clinical description of this rare syndrome. It underscores the high rate of associated immune manifestations and the burden of long-term complications and treatment toxicity. Future challenges include (1) the identification of the underlying genetic defects inducing immune dysregulation and (2) the need to better characterize patient subgroups and second-line treatment strategies.
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Affiliation(s)
- Nathalie Aladjidi
- Department of Pediatric Hematology, University Hospital of Bordeaux , Bordeaux , France ; Centre de Référence National des Cytopénies Autoimmunes de l'Enfant (CEREVANCE), University Hospital of Bordeaux , Bordeaux , France ; CIC 0005, INSERM CICP, University Hospital of Bordeaux , Bordeaux , France
| | - Helder Fernandes
- Centre de Référence National des Cytopénies Autoimmunes de l'Enfant (CEREVANCE), University Hospital of Bordeaux , Bordeaux , France ; CIC 0005, INSERM CICP, University Hospital of Bordeaux , Bordeaux , France
| | - Thierry Leblanc
- Department of Hematology, APHP - Hôpital Robert Debré , Paris , France ; Centre de Référence National des Cytopénies Autoimmunes de l'Enfant (CEREVANCE), APHP - Hôpital Robert Debré , Paris , France
| | - Amélie Vareliette
- Centre de Référence National des Cytopénies Autoimmunes de l'Enfant (CEREVANCE), University Hospital of Bordeaux , Bordeaux , France
| | - Frédéric Rieux-Laucat
- Immunogenetics of Pediatric Autoimmune Diseases, Institut Imagine, INSERM UMR_S1163, Université Paris Descartes , Paris , France
| | - Yves Bertrand
- Pediatric Immuno-Hematology Unit, University Hospital of Lyon - IHOP , Lyon , France
| | - Hervé Chambost
- Department of Pediatric Hematology, University Hospital Timone Enfants , Marseille , France
| | - Marlène Pasquet
- Hôpital des Enfants, University Hospital of Toulouse , Toulouse , France
| | - Françoise Mazingue
- Department of Pediatrics, Hôpital Jeanne de Flandre, University Hospital of Lille , Lille , France
| | - Corinne Guitton
- Department of Pediatrics, APHP - Hôpital Bicêtre , Le Kremlin-Bicêtre , France
| | - Isabelle Pellier
- Pediatric Hemato-Oncology Unit, University Hospital of Angers , Angers , France
| | | | - Corinne Armari-Alla
- Department of Pediatrics, University Hospital of Grenoble , Grenoble , France
| | - Caroline Thomas
- Pediatric Hemato-Oncology Unit, Hôpital Mère Enfant, University Hospital of Nantes , Nantes , France
| | - Aude Marie-Cardine
- Pediatric Immuno-Hematology-Oncology Unit, University Hospital of Rouen , Rouen , France
| | - Odile Lejars
- Pediatric Hemato-Oncology Unit, Centre de Pédiatrie Gatien De Clocheville, University Hospital of Tours , Tours , France
| | - Fanny Fouyssac
- Service de Médecine Infantile II, Hôpital d'Enfants, University Hospital of Nancy , Vandoeuvre-lès-Nancy , France
| | - Sophie Bayart
- Department of Pediatric Hematology, Hôpital Sud, University Hospital of Rennes , Rennes , France
| | - Patrick Lutz
- Pediatric Hemato-Oncology Unit, Hôpital de Hautepierre, University Hospital of Strasbourg , Strasbourg , France
| | - Christophe Piguet
- Pediatric Hemato-Oncology Unit, Hôpital Mère Enfants, University Hospital of Limoges , Limoges , France
| | - Eric Jeziorski
- Department of Pediatric Hematology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier , Montpellier , France ; Centre de Référence National des Cytopénies Autoimmunes de l'Enfant (CEREVANCE), Hôpital Arnaud de Villeneuve, University Hospital of Montpellier , Montpellier , France
| | - Pierre Rohrlich
- Pediatric Hemato-Oncology Unit 1, University Hospital of Besançon , Besançon , France
| | - Philippe Lemoine
- Onco-Hematology Unit, Hôpital Morvan, University Hospital of Brest , Brest , France
| | - Damien Bodet
- Onco-Hematology Unit, University Hospital of Caen , Caen , France
| | - Catherine Paillard
- Pediatric Hemato-Oncology Unit, Hôtel-Dieu, University Hospital of Clermont-Ferrand , Clermont-Ferrand , France
| | - Gérard Couillault
- Pediatric Hemato-Oncology Unit, Hôpital d'Enfants, University Hospital of Dijon , Dijon , France
| | - Frédéric Millot
- Pediatric Hemato-Oncology Unit, University Hospital of Poitiers , Poitiers , France
| | - Alain Fischer
- Department of Immuno-Hematology, APHP - Hôpital Necker-Enfants Malades , Paris , France ; Centre de Référence National des Cytopénies Autoimmunes de l'Enfant (CEREVANCE), APHP - Hôpital Necker-Enfants Malades , Paris , France
| | - Yves Pérel
- Department of Pediatric Hematology, University Hospital of Bordeaux , Bordeaux , France ; Centre de Référence National des Cytopénies Autoimmunes de l'Enfant (CEREVANCE), University Hospital of Bordeaux , Bordeaux , France ; CIC 0005, INSERM CICP, University Hospital of Bordeaux , Bordeaux , France
| | - Guy Leverger
- Department of Onco-Hematologie, APHP - Hôpital Trousseau , Paris , France ; Centre de Référence National des Cytopénies Autoimmunes de l'Enfant (CEREVANCE), APHP - Hôpital Trousseau , Paris , France
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Tippelt S, Mikasch R, Warmuth-Metz M, Pietsch T, Hilger RA, Kwiecien R, Faldum A, Rutkowski S, Bode U, Siegler N, Fleischhack G, Dufour C, Delisle MB, Geoffray A, Laplanche A, Frappaz D, Icher C, Bertozzi AI, Leblond P, Doz F, Andre N, Schneider P, De Carli E, Berger C, Lejars O, Chastagner P, Soler C, Entz-Werle N, Valteau-Couanet D, Burzynski S, Janicki T, Burzynski G, Marszalek A, Deiss A, Korshunov A, Capper D, Witt H, van Tilburg C, von Deimling A, Kulozik AE, Pfister SM, Witt O, Milde T, Dhall G, Haley K, Finlay J, Rushing T, Sposto R, Seeger R, Lulla RR, Goldman S, Beattie C, DasGupta TK, Pollack I, Fisher PG, Wu S, Boyett JM, Fouladi M, Meijer L, Veal G, Walker D, Grundy R, Meijer L, Veal G, Grundy R, Konczalik W, Ivanov D, Garnett M, Parker T, Kearns P, Walker D, Grundy R, Garnett M, Rahman R, Smith S, Meijer L, Walker D, Kimpo M, Yan B, Ning C, Villegas M, Alcasabas AP, Juh YE, Chong QT, Lin TP, Dewire M, Fouladi M, Drissi R, Chow L, Goldman S, Pai A, Leach J, Lane A, Backus L, Grimme L, Tabares J, Kumar S, Sobo M, Hummel TR, Alharbi M, Abdullah S, Alharbi Q, Alshahrani M, Mosleh O, Balbaid A, Alkofide A, Alkhayat N, AlFar K, Banyhamdan A, Ahmed O, El-Badawy S, Bouffet E, Jiang MW, Zhou RH, Zhou Q, Yuan XJ, Ma J, Turner D, Wright K, Broniscer A, Robinson G, Qaddoumi I, Armstrong G, Gajjar A, Stewart C, Misra SN, Misra AK, Michalski A, Stiller C. CLINICAL TRIALS. Neuro Oncol 2014; 16:i10-i13. [PMCID: PMC4046282 DOI: 10.1093/neuonc/nou066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
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5
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Dufour C, Delisle MB, Geoffray A, Laplanche A, Frappaz D, Icher C, Bertozzi AI, Leblond P, Doz FP, Andre N, Schneider P, De Carli E, Berger C, Lejars O, Chastagner PB, Pagnier A, Soler C, Entz-Werle N, Valteau-Couanet D. Tandem high-dose chemotherapy with stem cell rescue followed by risk-adapted radiation in children with high-risk cerebral primitive neuroectodermal tumor: Results of the prospective SFCE-trial PNET HR+5. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.10007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Francois P. Doz
- Institut Curie, Pediatric Oncology Department, Paris, France
| | | | | | | | - Claire Berger
- Childhood Cancer Registry of Rhone-Alpes, CHU Saint-Etienne, Saint-Etienne, France
| | | | | | | | | | | | - Dominique Valteau-Couanet
- Pediatric and Adolescent Oncology, Gustave Roussy Institute, Universite Paris-Sud, Villejuif, France
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Ducassou S, Fernandes H, Leverger G, Bertrand Y, Chambost H, Nelken B, Guitton C, Plantaz D, Monpoux F, Lejars O, Aladjidi N, Perel Y. SFP CO-01 - Efficacité du rituximab dans les anémies hémolytiques auto-immmunes (AHAI) pédiatriques. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71914-1] [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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Gaspar N, Rey A, Bérard PM, Michon J, Gentet JC, Tabone MD, Roché H, Defachelles AS, Lejars O, Plouvier E, Schmitt C, Bui B, Boutard P, Taque S, Munzer M, Vannier JP, Plantaz D, Entz-Werle N, Oberlin O. Corrigendum to “Risk adapted chemotherapy for localised Ewing’s sarcoma of bone: The French EW93 study” [Eur. J. Cancer 48 (9) (2012) 1376–1385]. Eur J Cancer 2013. [DOI: 10.1016/j.ejca.2013.03.025] [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: 10/26/2022]
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Gandemer V, Chevret S, Petit A, Vermylen C, Leblanc T, Michel G, Schmitt C, Lejars O, Schneider P, Demeocq F, Bader-Meunier B, Bernaudin F, Perel Y, Auclerc MF, Cayuela JM, Leverger G, Baruchel A. Excellent prognosis of late relapses of ETV6/RUNX1-positive childhood acute lymphoblastic leukemia: lessons from the FRALLE 93 protocol. Haematologica 2012; 97:1743-50. [PMID: 22580999 DOI: 10.3324/haematol.2011.059584] [Citation(s) in RCA: 38] [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: 11/09/2022] Open
Abstract
BACKGROUND The prognosis of patients with relapses of ETV6/RUNX1-positive acute lymphoblastic leukemia remains to be evaluated, particularly with regards to the frequency of late relapses. We performed a long-term, follow-up retrospective study to address the outcome of patients with ETV6/RUNX1-positive leukemia relapses. DESIGN AND METHODS Among the 713 children tested for ETV6/RUNX1 enrolled into the FRALLE 93 protocol, 43 ETV6/RUNX1-positive patients relapsed (19.4%). Most were initially stratified in the low or intermediate risk groups. The median follow-up after relapse was 54.2 months. All but three received second-line salvage therapy and 16 underwent allogeneic transplantation. RESULTS ETV6/RUNX1 had a strong effect on overall survival after relapse (3-year survival= 64.7% for positive cases versus 46.5% for negative cases) (P=0.007). The 5-year cumulative incidence of relapse was 19.4% and testes were more frequently involved in ETV6/RUNX1-positive relapses (P=0.04). In 81.4% of cases the relapses were late, early combined or isolated extramedullary relapses. The 5-year survival rate of patients with ETV6-RUNX1-positive acute lymphoblastic leukemia relapses reached 80.8% when the relapse occurred after 36 months (versus 31.2% when the relapse occurred earlier). In univariate analysis, female gender was associated with a poor survival, whereas site of relapse, age at diagnosis, leukocytosis and consolidation strategy had no effect. In multivariate analysis, only the duration of first remission remained associated with outcome. CONCLUSIONS We found an excellent outcome for patients with ETV6/RUNX1-positive leukemia relapses that occurred more than 36 months after diagnosis. The duration of first complete remission may, therefore, be a guide to define the treatment strategy for patients with relapsed ETV6/RUNX1- positive leukemia.
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Affiliation(s)
- Virginie Gandemer
- Department of Pediatric Hematology/Oncology, University Hospital of Rennes, France.
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Gaspar N, Rey A, Bérard PM, Michon J, Gentet JC, Tabone MD, Roché H, Defachelles AS, Lejars O, Plouvier E, Schmitt C, Bui B, Boutard P, Taque S, Munzer M, Vannier JP, Plantaz D, Entz-Werle N, Enz-Werlé N, Oberlin O. Risk adapted chemotherapy for localised Ewing's sarcoma of bone: the French EW93 study. Eur J Cancer 2012; 48:1376-85. [PMID: 22516209 DOI: 10.1016/j.ejca.2012.03.017] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 02/27/2012] [Accepted: 03/19/2012] [Indexed: 12/19/2022]
Abstract
AIM OF THE STUDY To determine whether a risk factor adapted chemotherapy would improve the outcome of non-metastatic bone Ewing's sarcoma. METHODS Standard risk tumours (SR, good histological response to chemotherapy or small unresected tumours) received the previous EW88 chemotherapy. Ifosfamide/etoposide (IE) were introduced after 3 courses of cyclophosphamide/doxorubicine when tumour regression was <50% or during consolidation therapy for the intermediate risk tumours (IR, intermediate histological response 5-30% residual cells or large unresected tumours >100ml). High risk tumours (HR, histological poor response >30% residual cells or clinical poor response <50% for unresectable tumours), received IE prior high dose busulfan/melphalan with stem cell rescue. RESULTS From 1993 to 1999, 214 patients were enrolled. 5 y-EFS and OS were 60% (95% confidence interval (CI), 53-66) and 69% (95% CI, 63-75), respectively. 116 (54%), 46 (21%), 48 (22%) patients were considered as SR, IR and HR of relapse, respectively. No advantage to IE was observed in the IR group. As compared to previous study, tumour with poor histological response to induction chemotherapy seemed to benefit from the consolidation strategy including busulfan/melphalan: EFS were 45% (95% CI, 30-60) and 20% (95% CI, 7-43) for EW93 and EW88, respectively. Despite a risk-adapted strategy, histological response to chemotherapy remains the main prognostic factor in resected tumours, while initial tumour volume is the main prognostic factor for unresected tumours. CONCLUSION These results showing a potential benefit of a consolidation strategy including busulfan/melphalan as compared to conventional chemotherapy needed confirmation by a randomised trial and were one of the bases of the ongoing EuroEwing99.
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Affiliation(s)
- Nathalie Gaspar
- Department of Paediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France.
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Shankar A, Hall GW, Gorde-Grosjean S, Hasenclever D, Leblanc T, Hayward J, Lambilliotte A, Daw S, Perel Y, McCarthy K, Lejars O, Coulomb A, Oberlin WO, Wallace WH, Landman-Parker J. Treatment outcome after low intensity chemotherapy [CVP] in children and adolescents with early stage nodular lymphocyte predominant Hodgkin's lymphoma - an Anglo-French collaborative report. Eur J Cancer 2011; 48:1700-6. [PMID: 22093944 DOI: 10.1016/j.ejca.2011.10.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/26/2011] [Accepted: 10/14/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE To examine whether three cycles of a low-intensity chemotherapy consisting of cyclophosphamide [500 mg/m(2) - day 1], vinblastine [6 mg/m(2) - days 1 and 8] and prednisolone [40 mg/m(2) - days 1-7] (CVP) is safe and therapeutically effective in children and adolescents with early stage nodular lymphocyte predominant Hodgkin lymphoma [nLPHL]. PATIENTS AND METHODS Fifty-five children and adolescents with early stage nLPHL [median age 13 years, range 4-17 years] diagnosed between June 2005 and October 2010 in the UK and France are the subjects of this report. Staging investigations included conventional cross sectional as well as 18 fluro-deoxyglucose [FDG] PET imaging. Histology was confirmed as nLPHL by an expert pathology panel. RESULTS Of the 45 patients, who received CVP as first line treatment, 36 [80%, 95% Confidence Interval [CI]: (68; 92)] either achieved a complete remission [CR] or CR unconfirmed [CRu], the remaining nine patients achieved a partial response. All nine subsequently achieved CR with salvage chemotherapy [n=7] or radiotherapy [n=2]. Ten patients received CVP at relapse after primary treatment that consisted of surgery alone and all achieved CR. To date, only three patients have relapsed after CVP chemotherapy and all had received CVP as first line treatment at initial diagnosis. The 40-month freedom from treatment failure and overall survival for the entire cohort were 75.4% (SE ± 6%) and 100%, respectively. No significant early toxicity was observed. CONCLUSIONS Our results show that CVP is an effective chemotherapy regimen in children and adolescents with early stage nLPHL that is well tolerated with minimal acute toxicity.
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Gaspar N, Le Teuff G, Defachelles AS, Schmitt C, Levy D, Castex MP, Lejars O, Verite C, Plouvier E, Claude L, Oberlin O. Ewing sarcoma prognostic score (ESPS) at diagnosis, based on fever and metastatic status. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9539] [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: 11/20/2022] Open
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Le Bidre E, Delage M, Lejars O, Machet MC, Lorette G, Maruani A. [Xanthelasma and juvenile xanthogranuloma in a 7-year-old boy]. Ann Dermatol Venereol 2009; 136:723-6. [PMID: 19801258 DOI: 10.1016/j.annder.2009.01.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 01/09/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Palpebrum xanthelasma is the most common type of xanthoma seen in adults but it is extremely rare in children. We report an original case of bilateral xanthelasma palpebrarum associated with juvenile xanthogranuloma (JXG) in a 7-year-old child. Only two cases of xanthelasma in children have been described to date. The association of xanthelasma and JXG has never been described. PATIENTS AND METHODS A 7-year-old boy presented xanthelasmas on both eyelids. At the same time, pinkish JXG papules appeared on the child's trunk. The boy had been diagnosed at the age of 10 months with myelogenous leukaemia, which was in remission. He also had a familial history of hypercholesterolaemia. The skin lesions were removed and microscopic examination confirmed the diagnosis of xanthelasmas and JXG. DISCUSSION This patient's presentation is unusual in several respects: the presence of xanthelasma in a child, appearance of JXG at an advanced age, and the association of these two diseases in a child with a past history of leukaemia. The occurrence of these skin lesions did not appear to be linked to the history of malignant blood disease in this patient.
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Affiliation(s)
- E Le Bidre
- Université François-Rabelais, Tours, France.
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Gandemer V, Auclerc MF, Perel Y, Vannier JP, Le Gall E, Demeocq F, Schmitt C, Piguet C, Stephan JL, Lejars O, Debre M, Jonveaux P, Cayuela JM, Chevret S, Leverger G, Baruchel A. Impact of age, leukocyte count and day 21-bone marrow response to chemotherapy on the long-term outcome of children with philadelphia chromosome-positive acute lymphoblastic leukemia in the pre-imatinib era: results of the FRALLE 93 study. BMC Cancer 2009; 9:14. [PMID: 19144139 PMCID: PMC2629767 DOI: 10.1186/1471-2407-9-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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: 09/15/2008] [Accepted: 01/13/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We explored the heterogeneity of philadelphia chromosome-positive acute lymphoblastic leukemia (Ph1-ALL) in a study of the effect of early features on prognosis in children. Here we report the long-term results of the FRALLE 93 study conducted in the era before the use of tyrosine kinase inhibitors. METHODS Between 1993 and 1999, 36 children with Ph1-ALL were enrolled into the FRALLE 93 protocol. After conventional four-drug induction, children were stratified by availability of an HLA-matched sibling. RESULTS Complete remission (CR) was observed in 26 children (72%), of which 13 underwent allogeneic bone marrow transplantation (BMT). Thirty-one children were good responders to prednisone, defined on day 8, and 21 were good responders to chemotherapy, defined by day-21 bone marrow (M1). Overall five-year disease-free survival (DFS) was 42 +/- 9.7%. Based on multivariate analysis, two groups showed marked differences in five-year outcome: children with age<10, leukocyte count <100,000/mm3 and day-21 M1 marrow had a more favorable prognosis (14 pts: 100% CR, event free survival [EFS]: 57%, overall survival [OS]: 79%), than the high-risk group (22 patients: 55% CR, EFS: 18%, OS: 27%) (p < 0.005). We also observed a non statistically significant difference (p = 0.14) in outcome between these groups for transplanted patients (5-year DFS: 83 +/- 14% and 33 +/- 15%, respectively). CONCLUSION Age, leukocyte count and early response to treatment defined by the D21 bone marrow response provide an accurate model for outcome prediction. The combination of available tools such as minimal residual disease assessment with determination of these simple factors could be useful for refining indications for BMT in the current era of tyrosine-kinase inhibitor-based therapy.
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Affiliation(s)
- Virginie Gandemer
- Department of Pediatric Hematology, University Hospital of Rennes, Rennes, France.
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Cissé M, Machet L, Le Touze A, Machet M, Lejars O, Lorette G. Fibrosarcome infantile simulant un hémangiome type rapidly involuting congenital hemangioma (RICH). Ann Dermatol Venereol 2008; 135:53-7. [DOI: 10.1016/j.annder.2007.01.002] [Citation(s) in RCA: 6] [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] [Received: 12/01/2006] [Accepted: 01/12/2007] [Indexed: 11/15/2022]
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15
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Vermeulen J, Ballet S, Oberlin O, Peter M, Pierron G, Longavenne E, Laurence V, Kanold J, Chastagner P, Lejars O, Blay JY, Marec-Berard P, Michon J, Delattre O, Schleiermacher G. Incidence and prognostic value of tumour cells detected by RT-PCR in peripheral blood stem cell collections from patients with Ewing tumour. Br J Cancer 2006; 95:1326-33. [PMID: 17088915 PMCID: PMC2360590 DOI: 10.1038/sj.bjc.6603438] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [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] [Indexed: 11/27/2022] Open
Abstract
To retrospectively evaluate the incidence of tumour cell contamination of peripheral blood stem cell (PBSC) collections and to correlate these data with the clinical outcome after high-dose chemotherapy (HDCT) with stem cell rescue in patients with a high-risk Ewing tumour. Peripheral blood stem cell collections obtained from 171 patients were analysed. Tumour contamination was assessed by reverse transcriptase–polymerase chain reaction (RT–PCR). The files of 88 patients who underwent HDCT followed by PBSC reinfusion were reviewed in detail, and their outcome compared to the PBSC RT–PCR results. Seven of 88 PBSC collections (8%) contained tumour cells as detected by RT–PCR. Peripheral blood stem cells were collected after a median of five cycles of chemotherapy. No clinical factor predictive of tumour cell contamination of PBSC harvest could be identified. Event-free survival (EFS) and overall survival (OS) of the whole study population were 45.3 % and 51.8 % at 3 years from the date of the graft, respectively. Forty-five patients relapsed with a median time of 15 months after graft, only four of whom had tumour cell contamination of the PBSC harvest. Tumour cell contamination of PBSC collection is rare and does not seem to be associated with a significantly poorer EFS or OS in this high-risk population.
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Affiliation(s)
- J Vermeulen
- Département d'Oncologie Pédiatrique, Institut Curie, Paris, France
| | - S Ballet
- Unité de Génétique Somatique, Institut Curie, Paris, France
| | - O Oberlin
- Département d'Oncologie Pédiatrique, Institut Gustave Roussy, Villejuif, France
| | - M Peter
- Unité de Génétique Somatique, Institut Curie, Paris, France
| | - G Pierron
- Unité de Génétique Somatique, Institut Curie, Paris, France
| | - E Longavenne
- Unité de Génétique Somatique, Institut Curie, Paris, France
| | - V Laurence
- Département d'Oncologie Médicale, Institut Curie, Paris, France
| | - J Kanold
- Centre de Cancérologie Pédiatrique, INSERM CIC 501, Clermont-Ferrand, France
| | - P Chastagner
- Département d'Oncologie Pédiatrique, Hôpital d'Enfants, Nancy, France
| | - O Lejars
- Département d'Oncologie Pédiatrique, Hôpital Clocheville, Tours, France
| | - J-Y Blay
- Département d'Oncologie Médicale, Hôpital Edouard-Herriot, Lyon, France
| | - P Marec-Berard
- Département d'Oncologie Pédiatrique, Centre Léon Bérard, Lyon, France
| | - J Michon
- Département d'Oncologie Pédiatrique, Institut Curie, Paris, France
| | - O Delattre
- Unité de Génétique Somatique, Institut Curie, Paris, France
- INSERM U509, Institut Curie, Paris, France
| | - G Schleiermacher
- Département d'Oncologie Pédiatrique, Institut Curie, Paris, France
- INSERM U509, Institut Curie, Paris, France
- Department of Pediatric Oncology, Institut Curie, 26 rue d'Ulm, 75 248 Paris Cedex 05, France. E-mail:
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Oberlin O, Rey A, Desfachelles AS, Philip T, Plantaz D, Schmitt C, Plouvier E, Lejars O, Rubie H, Terrier P, Michon J. Impact of high-dose busulfan plus melphalan as consolidation in metastatic Ewing tumors: a study by the Société Française des Cancers de l'Enfant. J Clin Oncol 2006; 24:3997-4002. [PMID: 16921053 DOI: 10.1200/jco.2006.05.7059] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To improve the prognosis for patients with metastatic Ewing sarcoma/primitive neuroectodermal tumors (ES/PNET) using conventional chemotherapy and consolidation high-dose chemotherapy (HDCT) containing busulfan and melphalan. PATIENTS AND METHODS Ninety-seven unselected patients with newly diagnosed metastatic ES/PNET received induction chemotherapy that included five cycles of cyclophosphamide 150 mg/m2/d for 7 days, doxorubicin 35 mg/m2/d once, followed by two cycles of ifosfamide 1.8 g/m2/d for 5 days, and etoposide 100 mg/m2/d for 5 days. Patients in complete or very good partial remission received HDCT with busulfan total dose 600 mg/m2 and melphalan 140 mg/m2 followed by autologous blood stem cells. Local therapy (surgery and/or radiation therapy) was performed before or after HDCT. RESULTS Ninety-seven patients were enrolled from 1991 to 1999 (median age, 12.3 years; range, 0.2 to 25 years). Among them, 75 received HDCT. The 5-year event-free survival (EFS) rate for all 97 patients was 37% and the overall survival (OS) rate was 38%. The EFS after HDCT was 47%. The EFS for the 44 patients with lung-only metastases was 52%, whereas it was 36% for patients with bone metastases without bone marrow involvement. Among the 23 patients with bone marrow metastases, only one survived. The multivariate analysis for both EFS and for OS identified three independent prognostic factors: age, fever at diagnosis, and bone marrow involvement. CONCLUSION Compared with conventional chemotherapy, HDCT may yield benefits for patients with lung-only metastases or bone metastases. These results warrant confirmation in a randomized trial and provide part of the background data for the ongoing Euro-Ewing study.
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Affiliation(s)
- Odile Oberlin
- Department of Paediatric Oncology, Institut Gustave-Roussy, Rue Camille Desmoulins, Villejuif, France.
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Perel Y, Auvrignon A, Leblanc T, Michel G, Reguerre Y, Vannier JP, Dalle JH, Gandemer V, Schmitt C, Méchinaud F, Lejars O, Piguet C, Couillaud G, Pautard B, Landman-Parker J, Thuret I, Aladjidi N, Baruchel A, Leverger G. Treatment of childhood acute myeloblastic leukemia: dose intensification improves outcome and maintenance therapy is of no benefit--multicenter studies of the French LAME (Leucémie Aiguë Myéloblastique Enfant) Cooperative Group. Leukemia 2006; 19:2082-9. [PMID: 16121218 DOI: 10.1038/sj.leu.2403867] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
From 1989 to 1998, 341 children were included in the French multicentric LAME (Leucémie Aiguë Myéloblastique Enfant) trials. A total of 309 children were registered in the LAME 89/91 protocol. This intensive regimen included an induction phase (mitoxantrone plus cytarabine), two consolidation courses, one containing timed-sequential high-dose cytarabine, asparaginase and amsacrine; 276 (90%) achieved a CR. The 5-year overall survival (OS) and event-free survival (EFS) were 60+/-4 and 48+/-4%, respectively. From 1997, timed-sequencing of the LAME SP induction chemotherapy led to an unacceptable frequency of consolidation delay; future improvements are unlikely to come from further increases in intensity. The role of allogenic bone-marrow transplantation from an HLA-identical sibling in CR1 was examined. The disease-free survival (DFS) was 52+/-4% for non-allografted patients and 57+/-7% for allografted patients (P=NS); a better OS for allografted patients was shown and could be related either to allo-BMT early in CR1 or to a second allo-BMT in CR2. For the complete responders after consolidation therapy, the 5-year OS was significantly better in patients randomized for no maintenance therapy (MT-) than in patients randomized for MT (77.6+/-8 vs 59+/-8%; P=0.05), while the 5-year DFS was not significantly different. Exposure to low-dose MT might contribute to clinical drug resistance and treatment failure in relapsing patients.
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Affiliation(s)
- Y Perel
- Pediatric Onco-Hematology Unit, University Hospital, Bordeaux, France.
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18
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Bernier-Chastagner V, Grill J, Doz F, Bracard S, Gentet JC, Marie-Cardine A, Luporsi E, Margueritte G, Lejars O, Laithier V, Mechinaud F, Millot F, Kalifa C, Chastagner P. Topotecan as a radiosensitizer in the treatment of children with malignant diffuse brainstem gliomas: results of a French Society of Paediatric Oncology Phase II Study. Cancer 2006; 104:2792-7. [PMID: 16265674 DOI: 10.1002/cncr.21534] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The current Phase II study was conducted to evaluate the survival and toxicity observed in children with newly diagnosed brainstem gliomas who were treated with the daily radiotherapy with topotecan used as a radiosensitizer. METHODS Eligible patients were those ages 3-18 years with previously untreated tumors arising in the pons diagnosed within the previous 6 months. Histologic confirmation was not mandatory provided that the clinical and magnetic resonance imaging findings were typical for a diffusely infiltrating brainstem lesion. Treatment was comprised of a 6-week course of topotecan administered intravenously at a dose of 0.4 mg/m(2)/day over 30 minutes within 1 hour before irradiation. Radiotherapy was comprised of a once-daily treatment of 1.8 grays (Gy) per fraction to a total dose of 54 Gy. RESULTS Thirty-two patients were included in the current study between August 2000 and October 2002. All patients completed the combined treatment in accordance with the treatment design. Only partial responses were observed, occurring in 40% of the patients. The 9-month and 12-month survival rates were 34.4% +/- 8% and 25.5% +/- 8%, respectively. The median duration of survival for these 32 patients was 8.3 months. An intratumoral cystic/necrotic change was observed in five patients, with clinical impairment noted in two patients. One intratumoral hemorrhage occurred during radiotherapy, and was associated with transitory neurologic impairment. CONCLUSIONS The findings of the current study regarding newly diagnosed brainstem glioma patients treated with topotecan given as a radiosensitizing agent did not reproduce the encouraging results obtained in preclinical studies. Therefore, the concomitant combination of topotecan and radiotherapy at this schedule and these doses cannot be recommended for the treatment of patients with brainstem gliomas.
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Grill J, Sainte-Rose C, Jouvet A, Gentet JC, Lejars O, Frappaz D, Doz F, Rialland X, Pichon F, Bertozzi AI, Chastagner P, Couanet D, Habrand JL, Raquin MA, Le Deley MC, Kalifa C. Treatment of medulloblastoma with postoperative chemotherapy alone: an SFOP prospective trial in young children. Lancet Oncol 2005; 6:573-80. [PMID: 16054568 DOI: 10.1016/s1470-2045(05)70252-7] [Citation(s) in RCA: 195] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Morbidity and mortality are high in young children with medulloblastoma who receive craniospinal radiotherapy. We aimed to assess whether adjuvant treatment with protracted chemotherapy alone could replace radiotherapy. METHODS We enrolled 79 children aged younger than 5 years who had had surgical resection of medulloblastoma onto a multicentre trial. Patients were treated with combination chemotherapy, which did not include methotrexate, for more than 16 months irrespective of the extent of disease. Early postoperative imaging defined three groups: R0M0 (no residual disease, no metastasis), R1M0 (radiological residual disease alone), and RXM+ (presence of metastases). Patients who did not relapse did not receive radiotherapy. Patients who relapsed or had disease progression received salvage treatment, which consisted of high-dose chemotherapy and stem-cell transplantation followed by local or craniospinal radiotherapy. For children classified as R0M0, the primary endpoint was 5-year overall survival and the secondary endpoint was 5-year progression-free survival. For children classified as R1M0 or RXM+, the primary endpoint was best radiological response and the secondary endpoints were 5-year overall survival and 5-year progression-free survival. Analyses were done by intention to treat. FINDINGS Two of 15 patients classified as RXM+ and four of 17 patients classified as R1M0 had a complete radiological response. 5-year progression-free survival was 29% (95% CI 18-44) in the R0M0 group, 6% (1-27) in the R1M0 group, and 13% (4-38) in the RXM+ group. 5-year overall survival was 73% (59-84) in the R0M0 group, 41% (22-64) in the R1M0 group, and 13% (4-38) in the RXM+ group. In the R0M0 group, 5-year progression-free survival was 41% (26-58) for the 34 patients who underwent gross total resection compared with 0% for the 13 patients who had subtotal resection (relative risk 2.7 [1.3-5.6], p=0.0065). INTERPRETATION Conventional chemotherapy alone can be used to cure children with non-metastatic medulloblastoma who have gross total resection confirmed by early radiological assessment, but is not sufficient for treatment of those with metastatic or incompletely resected medulloblastoma. Salvage treatment followed by posterior-fossa radiotherapy can effectively treat local relapses or progression.
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Affiliation(s)
- Jacques Grill
- Department of Paediatric and Adolescent Oncology, Institute Gustave Roussy, Villejuif, France.
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Piram M, Lejars O, Grosjean-Cornuault MF, Lorette G. [Chronic pruritus]. Ann Dermatol Venereol 2003; 130:217-8. [PMID: 12671591] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Affiliation(s)
- M Piram
- Consultation de Dermatologie, Service d'Oncologie, Hôpital Pédiatrique de Clocheville, CHU, 37044 Tours Cedex 01
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Oberlin O, Hartmann O, Bergeron C, Rubie H, Baranzelli M, Boutard P, Lejars O, Michon J. Does myeloablative BuMel therapy improve survival of poor-risk localized tumor of the Ewing family (ET)? Experience of the French Society of Pediatric Oncology (SFOP). Eur J Cancer 2001. [DOI: 10.1016/s0959-8049(01)81743-3] [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: 10/26/2022]
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Minard V, Hartmann O, Peyroulet MC, Michon J, Coze C, Defachelle AS, Lejars O, Perel Y, Bergeron C, Boutard P, Leverger G, Stephan JL, Thyss A, Chastagner P, Couillault G, Devalck C, Lutz P, Mechinaud F, Millot F, Plantaz D, Rialland X, Rubie H. Adverse outcome of infants with metastatic neuroblastoma, MYCN amplification and/or bone lesions: results of the French society of pediatric oncology. Br J Cancer 2000; 83:973-9. [PMID: 10993641 PMCID: PMC2363565 DOI: 10.1054/bjoc.2000.1412] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To assess the relevance of MYCN amplification and bone lesions in stage 4 neuroblastoma (NB) in infants aged <1 year, 51 infants with stage 4 NB were enrolled. Three groups of patients were defined according to the type of metastases and the resectability of the primary tumour. Group I comprised 21 infants with radiologically detectable bone lesions, Group II 22 patients with an unresectable primary tumour and Group III eight patients with only metaiodobenzylguanidine (MIBG) skeletal uptake. MYCN oncogene content was assayed in 47/51 tumours and found to be amplified in 17 (37%). The 5-year event-free survival (EFS) rate of these 51 infants was 64.1% (+/- 7.1%). In a univariate analysis, bone lesions, MYCN amplification, urinary vanillylmandelic/homovanillic acid ratio and serum ferritin levels adversely influenced outcome. In the multivariate analysis, radiologically detectable bone lesions were the most powerful unfavourable prognostic indicator: the EFS rate was 27.2% for these infants compared to 90% for infants without bone lesions (P<0.0001). Our data emphasize the poor prognosis of infants affected by stage 4 NB with bone lesions, especially when associated with MYCN amplification. Given the poor results in this group whatever the treatment, new therapeutic approaches need to be investigated in the future.
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Affiliation(s)
- V Minard
- Department of Pediatrics, Institut Gustave Roussy, 39 rue Camille Desmoulins, Villejuif Cedex, 94805, France
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Bouffet E, Doz F, Demaille MC, Tron P, Roche H, Plantaz D, Thyss A, Stephan JL, Lejars O, Sariban E, Buclon M, Zücker JM, Brunat-Mentigny M, Bernard JL, Gentet JC. Improving survival in recurrent medulloblastoma: earlier detection, better treatment or still an impasse? Br J Cancer 1998; 77:1321-6. [PMID: 9579840 PMCID: PMC2150165 DOI: 10.1038/bjc.1998.220] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [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] [Indexed: 02/07/2023] Open
Abstract
Early detection of relapse has been advocated to improve survival in children with recurrent medulloblastoma. However, the prognostic factors and the longer term outcome of these patients remains unclear. Pattern of recurrences were analysed in three consecutive protocols of the Société Française d'Oncologie Pédiatrique (1985-91). A uniform surveillance programme including repeated lumbar puncture combined with computerized tomography (CT) or magnetic resonance imaging (MRI) scan was applied for all registered patients. Forty-six out of 116 patients had progressive or recurrent disease. The median time from diagnosis to recurrence was 10.5 months and 76% relapses occurred during the first 2 years. Seventeen patients had asymptomatic relapses that were detected by the surveillance protocol. Forty-one patients were treated at time of progression. Twenty-three responded to salvage therapy and 11 achieved a second complete remission. The median survival time after progression was 5 months (<1-41 months), and only two patients remained alive at time of follow-up. Length of survival is primarily related to some specific patterns of relapse (time from diagnosis to recurrence, circumstances of relapse, extent of relapse) and to the response to salvage therapy. No evidence of long-term benefit appeared from any form of treatment.
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Affiliation(s)
- E Bouffet
- Department of Paediatric Oncology, Centre Leon Bérard, Lyon, France
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Baranzelli MC, Patte C, Bouffet E, Couanet D, Habrand JL, Portas M, Lejars O, Lutz P, Le Gall E, Kalifa C. Nonmetastatic intracranial germinoma: the experience of the French Society of Pediatric Oncology. Cancer 1997; 80:1792-7. [PMID: 9351549] [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] [Indexed: 02/05/2023]
Abstract
BACKGROUND Standard treatment of localized intracranial germinoma is focal irradiation of the primary tumor (45-50 grays [Gy]) combined with craniospinal radiotherapy (RT). To decrease late effects related to extensive fields of RT, the French Society of Pediatric Oncology decided in 1990 to replace prophylactic RT with chemotherapy (CT) and to deliver focal RT at 40 Gy. METHODS Twenty-nine patients with localized, biopsy proven germinoma were included in this study between January 1990 and December 1994. CT consisted of 2 cycles of carboplatin 600 mg/m2 on Day 1, etoposide 150 mg/m2 on Days 1-3, ifosfamide 1.8 g/m2 on Days 22-26, and etoposide 150 mg2 on Days 22-24, followed by RT delivered to the initial tumor volume (40 Gy). RESULTS The median age of the 19 boys and 10 girls was 12.8 years; 25 patients had a unifocal tumor in the pineal (13), suprasellar (10), or thalamic (2) area, and 4 patients had a bifocal tumor. Three patients initially had complete surgery. Of the 26 patients evaluable for CT response, 11 had a small amount of tumor residue and 15 no residue; no patient underwent surgery after CT or RT. One patient recurred 3 years after diagnosis and is in his second complete remission. Twenty-eight patients are in their first complete remission after a median follow-up of 32 months (range, 7-68 months); 9 of the 28 have a small amount of tumor residue that is considered nonevolving. Overall survival at 4 years is 100% and event free survival is 93.3% (+/- 6%) after a median follow-up of 32 months. CONCLUSIONS This treatment strategy avoids craniospinal RT and reduces focal RT, with results equivalent to those achieved with extensive RT. Thus, the authors consider it a valid treatment of nonmetastatic germinoma.
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Affiliation(s)
- M C Baranzelli
- Service d'Oncologie Médicale A, Centre Oscar Lambret, Lille, France
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26
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Stéphan JL, Deschênes G, Pérel Y, Bader-Meunier B, Brunat-Mentigny M, Lejars O, Lamagnères JP. Nephrotic syndrome and Hodgkin disease in children: a report of five cases. Eur J Pediatr 1997; 156:239-42. [PMID: 9083769 DOI: 10.1007/s004310050592] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED This report documents the occurrence of a nephrotic syndrome in five children with Hodgkin disease. In two cases the nephrotic syndrome predated the diagnosis of lymphoma by 6 months and 12 months respectively, while in the other three, the two disorders occurred simultaneously. The nephrotic syndrome resolved in four cases during effective treatment for active Hodgkin disease, while proteinuria remained unchanged in the fifth case with partial control of the lymphoma. The occurrence of a nephrotic syndrome as a manifestation of active Hodgkin disease suggests that some immunological abnormalities play a role in the pathogenesis of the association. CONCLUSION The possibility of glomerular dysfunction although rare must be considered and actively looked for in all cases of Hodgkin disease. Similarly, any unusual sign or symptom noted in patients with nephrotic syndrome, particularly receiving or having received immunosuppressants, requires thorough investigation to determine the presence or absence of lymphoma.
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Affiliation(s)
- J L Stéphan
- Unité d' Oncologie Pédiatrique, St Etienne, France
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27
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Deschênes G, Allard C, Benoit S, Lejars O, Lamagnére JP, Nivet H. Hodgkin's disease following steroid-resistant idiopathic nephrotic syndrome. Pediatr Nephrol 1994; 8:395-6. [PMID: 7917876 DOI: 10.1007/bf00866377] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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28
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Baranzelli MC, Flamant F, De Lumley L, Le Gall E, Lejars O. Treatment of non-metastatic, non-seminomatous malignant germ-cell tumours in childhood: experience of the "Société Française d'Oncologie Pédiatrique" MGCT 1985-1989 study. Med Pediatr Oncol 1993; 21:395-401. [PMID: 8390599 DOI: 10.1002/mpo.2950210602] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The members of the French Society of Pediatric Oncology treated, between January 1985 and June 1989, 67 cases of non-metastatic, non-seminomatous malignant germ cell tumours (nSGCT) in sites other than the brain. They used a clinical pre- and postsurgical TNM-type classification in order to standardize the treatment regardless of tumour site. The intensity of the treatment was decreased in comparison with the previous regimen (elimination of adriamycin, reduction in the length of treatment). The actuarial 2-year disease-free survival rate is 80%; results are excellent for patients with clinical stage I and II tumours and permit cure with moderate chemotherapy, avoiding undesirable late effects. On the other hand it is inadequate for patients with stage III suggesting that the initial chemotherapy should be intensified for these latter patients in future protocols.
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Affiliation(s)
- M C Baranzelli
- Service d'Oncologie Pédiatrique, Centre Oscar Lambret, Lille, France
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29
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Frappaz D, Michon J, Hartmann O, Bouffet E, Lejars O, Rubie H, Gentet JC, Chastagner P, Sariban E, Brugiere L. Etoposide and carboplatin in neuroblastoma: a French Society of Pediatric Oncology phase II study. J Clin Oncol 1992; 10:1592-601. [PMID: 1403039 DOI: 10.1200/jco.1992.10.10.1592] [Citation(s) in RCA: 44] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE A phase II study of etoposide (VP 16) and carboplatin (CBDCA) was performed in patients with metastatic neuroblastoma (NB). The aim of the study was to find an alternative treatment for induction with different toxicities than the VP 16/cisplatin (CDDP) combination. PATIENTS AND METHODS Forty-seven patients who were from 6 months to 16 years of age, with either relapsed (29) or primary resistant (18) NB, were included in a cooperative multicenter phase II study of the French Society of Pediatric Oncology (SFOP). The schedule consisted of 5 consecutive days of VP 16 100 mg/m2/d and CBDCA 160 mg/m2/d. RESULTS The response rate for the 39 assessable patients was 43%; there were four complete remissions and 13 partial remissions. Neither the status of the patients nor the total dose of CDDP that was received previously influenced response. Hematologic toxicity was marked and caused considerable delay between courses (median interval, 39 days). In these heavily pretreated patients, 16% had a more than 50% decrease in creatinine clearance and a 22% World Health Organization (WHO) grade 2 ototoxicity. CONCLUSION This VP 16/CBDCA combination deserves further evaluation for efficacy and toxicity in newly diagnosed patients, and the combination of both drugs should be considered for high-dose therapy with bone marrow transplantation.
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Affiliation(s)
- D Frappaz
- Department of Pediatric Oncology, Centre Léon Bérard, Lyon, France
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30
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Barin C, Valtat C, Briault S, Bremond JL, Petit A, Lejars O, Linassier C, Gaschard P, Moraine C. Structural rearrangements of chromosome 13 as additional abnormalities in Burkitt lymphoma and type 3 acute lymphoblastic leukemia. Cancer Genet Cytogenet 1992; 60:206-9. [PMID: 1606568 DOI: 10.1016/0165-4608(92)90021-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report three cases of chromosome 13 rearrangements as additional abnormalities in two patients with Burkitt lymphoma (BL) and one with type 3 acute lymphoblastic leukemia (ALL). Involvement of chromosome 13 has been reported most often as 13q+, without identification of the supplementary chromosomal material; in our three cases with 13q+, we identified two duplications: dup(13)(q13q22) and dup(13)(q21q22).
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Affiliation(s)
- C Barin
- Unité de Génétique, CHUR Bretonneau, Tours, France
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31
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Tournade MF, Lemerle J, Brunat-Mentigny M, Bachelot C, Roche H, Taboureau O, Olive D, Lejars O, Boilletot A, Demeocq F. Ifosfamide is an active drug in Wilms' tumor: a phase II study conducted by the French Society of Pediatric Oncology. J Clin Oncol 1988; 6:793-6. [PMID: 2835442 DOI: 10.1200/jco.1988.6.5.793] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Twenty-one patients with advanced Wilms' tumor entered a phase II study with high-dose ifosfamide (3 g/m2 over two days every 15 days). Mesna and hyperhydration were associated with minimal bladder toxicity. After two courses, five partial responses and six complete responses were observed. Ten patients did not respond. The median duration of response was 2 months (range, 1 to 7). Therapy was delayed because of leukopenia for 1 or 2 weeks in only three cases. Fever and infection were not observed. Seven patients presented with hematuria, three of whom were among the 17 patients coadministered mesna, which did not interfere with subsequent therapy.
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32
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Hartmann O, Benhamou E, Beaujean F, Kalifa C, Lejars O, Patte C, Behard C, Flamant F, Thyss A, Deville A. Repeated high-dose chemotherapy followed by purged autologous bone marrow transplantation as consolidation therapy in metastatic neuroblastoma. J Clin Oncol 1987; 5:1205-11. [PMID: 3305792 DOI: 10.1200/jco.1987.5.8.1205] [Citation(s) in RCA: 70] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Among 62 children over 1 year of age at diagnosis, who were treated for stage IV neuroblastoma, 33 entered complete remission (CR) or good partial remission (GPR) after conventional therapy and received high-dose chemotherapy (HDC) with in vitro purged autologous bone marrow transplantation (ABMT) as consolidation therapy. The HDC was a combination of carmustine (BCNU), teniposide (VM-26), and melphalan. Thirty-three patients received one course of this regimen, and 18 received two courses. At present, 16 of the 33 grafted patients are alive in continuous CR, with a median follow-up of 28 months. Toxicity of this regimen was tolerable, principally marked by bone marrow depression and gastrointestinal (GI) tract complications. Four complication-related deaths were observed. Relapse post-ABMT occurred most often in the bone marrow. Under this treatment, actuarial disease-free survival is improved compared with that observed under conventional therapy.
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33
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Despert F, Lamagnere JP, Chantepie A, Grangeponte MC, Lejars O, Combe P. [Fanconi's disease associated with hepato-splenic peliosis (author's transl)]. Arch Fr Pediatr 1981; 38:29-33. [PMID: 7224798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The authors report a case of Fanconi's disease equilibrated for a period of 8 years by androgen therapy. The patient died after interruption of treatment; the clinical picture comprised hepatomegaly, jaundice, pancytopenia. The autopsy showed hepato-splenic peliosis and acute tuberculosis. The subject of peliosis is brought up to date by a thorough review of current literature and the relationships between steroid treatment and hepatic complications are discussed.
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34
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Rolland JC, Thibert M, Lebranchu Y, Lemoine G, Lejars O. [Fistula between right pulmonary artery and left atrium. A case report and review of the literature (author's transl)]. Sem Hop 1980; 56:853-61. [PMID: 6248969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The communication between right pulmonary artery and left atrium is a very uncommon cause of right to left shunt. The 18th case in the world literature and the first case in France is reported here. Normal pressure in the right cavities and in pulmonary artery is evocative. Angiography assesses the diagnosis and precises the place and connections of the fistula. Surgical closing of the fistula must be promptly achieved in order to obviate embolic complications.
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35
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Lebranchu Y, Drucker J, Nivet H, Rolland JC, Grenier B, Lejars O, Lamagnere JP, Buriot D. Acute monoblastic leukaemia in child receiving chlorambucil for juvenile rheumatoid arthritis. Lancet 1980; 1:649. [PMID: 6102646 DOI: 10.1016/s0140-6736(80)91138-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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36
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Rolland JC, Thibert M, Lebranchu Y, Lemoine G, Lejars O. [Fistula between right pulmonary artery and left atrium. A case report and review of the literature (author's transl)]. Ann Pediatr (Paris) 1979; 26:603-11. [PMID: 555633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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