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Decaux O, Fontan J, Perrot A, Karlin L, Touzeau C, Schulmann S, Manier S, Belhadj K, Trebouet A, Zunic P, Schiano De Colella JM, Castel B, Van De Wyngaert Z, Pica GM, Tiab M, Kuhnowski F, Bouketouche M, Rigaudeau S, Benramdane R, Tekle C, Lafore R, Gaucher M, Corre J, Leleu X. Isatuximab plus pomalidomide and dexamethasone in patients with relapsed/refractory multiple myeloma in real-world: The retrospective IMAGE study. Eur J Haematol 2024. [PMID: 38712850 DOI: 10.1111/ejh.14225] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND IMAGE is a retrospective cohort study of patients enrolled in early access programs (EAPs) in France with relapsed/refractory multiple myeloma (RRMM) receiving isatuximab with pomalidomide and dexamethasone (Isa-Pd). METHODS Patients aged ≥18 years with RRMM who received ≥1 dose of Isa under the EAPs between July 29, 2019 and August 30, 2020 were included. Effectiveness endpoints included progression-free survival (PFS) and response rates. Verbatim terms for adverse events (AEs) were coded using the Medical Dictionary for Regulatory Activities and not graded for severity. RESULTS A total of 294 and 299 patients were included in the effectiveness and safety populations, respectively. IMAGE included patients who received one prior line of treatment (10.2%) and were daratumumab-refractory (19.1%). At median follow-up of 14.2 months, median PFS in the effectiveness population was 12.4 months (95% CI 9.0-15.0). Overall response and very good partial response rates were 46.3% and 27.9%, respectively. Subgroup analyses reflected similar results. In the safety population, 26.4% of patients reported at least one AE; the most common any-grade AE was neutropenia (9.4%). CONCLUSION IMAGE demonstrated Isa-Pd had meaningful effectiveness in median PFS and depth of response and no new safety signals in a real-world context, consistent with clinical trial results.
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Affiliation(s)
- Olivier Decaux
- INSERM, Établissement Français du Sang de Bretagne, Unité Mixte de Recherche (UMR) S1236, Université de Rennes 1, Rennes, France
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire, Rennes, France
| | - Jean Fontan
- Department of Hematology, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France
| | - Aurore Perrot
- CHU de Toulouse, IUCT-O, Service d'Hématologie, UPS, Université de Toulouse, Toulouse, France
| | - Lionel Karlin
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Benite, France
| | - Cyrille Touzeau
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | | | - Salomon Manier
- Maladie du sang, CHRU Hôpital Claude Huriez, Lille, France
| | - Karim Belhadj
- Unité Hémopathies Lymphoïdes, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
| | - Adrien Trebouet
- Department of Haematology, Bretagne Sud Hospital Centre, Lorient, France
| | - Patricia Zunic
- Department of Haematology, University Hospital Centre, Saint-Pierre, France
| | | | - Brice Castel
- Service de Médecine Interne, Centre Hospitalier de Bigorre, Tarbes, France
| | - Zoé Van De Wyngaert
- Sorbonne Université, AP-HP, Centre de Recherche Saint-Antoine INSERM UMRs938, Service D'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Gian Matteo Pica
- Hématologie, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Mourad Tiab
- Médecine Interne, CHU Vendée, La Roche sur Yon, France
| | | | - Malek Bouketouche
- Oncologie et hématologie, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Sophia Rigaudeau
- Service d'Hématologie Clinique, Centre Hospitalier de Versailles André Mignot, Faculté de Médecine Xavier Bichat, Université Paris Diderot, Paris, France
| | - Riad Benramdane
- Department of Hematology, Centre Hospitalier Pontoise René Dubos, Pontoise, France
| | | | | | | | - Jill Corre
- IUC-T Oncopole, Unité de Génomique du Myélome, Toulouse, France
| | - Xavier Leleu
- Faculte de médecine, INSERM CIC 1402 and U 1313, Centre Hospitalier Universitaire (CHU), Poitiers, France
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Laribi K, Leleu X, Texier N, Germain R, Touzeau C, Hammoud M, Payssot A, Schulmann S, Le Calloch R, Trebouet A, Chaoui D, David S, Benbrahim O, Benramdane R, Charvet‐Rumpler A, Jadeau C, Rouanet E, Decaux O, Perrot A. Real-life effectiveness of carfilzomib in patients with relapsed multiple myeloma receiving treatment in the context of early access: The CARMYN study. EJHaem 2024; 5:55-60. [PMID: 38406520 PMCID: PMC10887228 DOI: 10.1002/jha2.828] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 02/27/2024]
Abstract
The real-life retrospective observational study CARMYN aimed at investigating the long-term efficacy and safety of carfilzomib in combination with dexamethasone and lenalidomide (KRd, 159 patients). These patients (62% in first and 38% in second relapse, median age 62 yo) were treated between 02/2014 and 02/2017. Most had been pre-exposed to bortezomib (98.2%) and to an IMID (75.4%). At the time of collection, 90% had permanently discontinued carfilzomib. Data collection was conducted from January to July 2021 in 27 participating sites, after a median of 39 months follow-up. For patients treated with KRd, an overall response rate of 78.4% translated in a median progression free survival (PFS) of 24.0 months (95% CI 18.8-27.6) and a median overall survival (OS) of 51.1 months (95% CI 41.3-not reached). Results were poorer but difficult to interpret in the small cohort of Kd recipients. The study is one of the longest real-life studies of carfilzomib treatment in patients in first or second relapse. CARMYN confirmed the real-life long-term efficacy of carfilzomib in combination with lenalidomide and dexamethasone with results similar to those of clinical trials. The KRd regimen is thus an option to consider for late relapses in the current context of MM management.
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Affiliation(s)
| | | | | | | | - Cyrille Touzeau
- Hématologie Clinique, CHU de Nantes, CRCINA, INSERM, CNRS, Université d'Angers, Université de NantesNantesFrance
| | | | | | | | - Ronan Le Calloch
- Médecine Interne, Maladies Infectieuses et Maladies du Sang, CH de CornouailleQuimperFrance
| | | | | | - Selva David
- Hématologie, Polyclinique Le LanguedocNarbonneFrance
| | - Omar Benbrahim
- Hématologie Clinique, Nouvel Hôpital d'OrléansOrléansFrance
| | | | | | | | | | | | - Aurore Perrot
- Hématologie, CHU de Toulouse, IUC T‐OncopoleToulouseFrance
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3
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Frenzel L, Decaux O, Macro M, Belhadj-Merzoug K, Manier S, Touzeau C, Leleu X, Frère C, Lecompte T, Perrot A, Avet-Loiseau H, Moreau P, Chalayer E. Venous thromboembolism prophylaxis and multiple myeloma patients in real-life: Results of a large survey and clinical guidance recommendations from the IFM group. Thromb Res 2024; 233:153-164. [PMID: 38064842 DOI: 10.1016/j.thromres.2023.11.021] [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: 08/31/2023] [Revised: 10/30/2023] [Accepted: 11/20/2023] [Indexed: 01/01/2024]
Abstract
Venous thromboembolism (VTE) remains a critical issue in the management of patients with multiple myeloma (MM), particularly when immunomodulatory drugs (IMiDs) combined with dexamethasone therapy are being prescribed as first-line and relapse therapy. One possible explanation for the persistent high rates of VTE, is the use of inappropriate thromboprophylaxis strategies for patients starting antimyeloma treatment. To tackle the issue, the Intergroupe francophone du myélome (IFM) offered convenient guidance for VTE thromboprophylaxis in MM patients initiating systemic therapy. This guidance is mainly supported by the results of a large survey on the clinical habits regarding VTE of physicians who are substantially involved in daily care of MM patients. VTE prophylaxis should be considered for all patients treated with IMiDs in combination with dexamethasone, in the absence of significant comorbidities, such as renal failure or bleeding risk. Anticoagulant should be preferred to antiplatelet agents for thromboprophylaxis. Despite the absence of large randomized controlled trials comparing those attitudes/options, available data on direct oral anticoagulants, which are already used in daily management of MM patients, are consistent with their potential usefulness for VTE prophylaxis in such patients. However, in order to implement a personalized continuous improvement strategy, clinicians must to be organized to collect all the data regarding this management. In other situations, thromboprophylaxis should be evaluated by using risk models and after careful evaluation of the risk/benefit ratio.
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Affiliation(s)
- Laurent Frenzel
- Service d'Hématologie Adulte et unité d'hémostase clinique, Hôpital Necker, Institut IMAGINE - INSERM U 1163/CNRS ERL 8254, Paris, France.
| | | | - Margaret Macro
- Institut d'Hématologie de Basse Normandie (IHBN), CHU Côte de Nacre, Caen, France
| | | | - Salomon Manier
- Hematology department, CHU Lille, Lille University, INSERM UMR-S1277, Lille, France
| | - Cyrille Touzeau
- Department of Hematology, University Hospital Hôtel-Dieu, 44093 Nantes, France; Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers, INSERM UMR 1307, CNRS UMR 6075, Nantes, France
| | - Xavier Leleu
- Hématologie Biologique, Hôpital Pontchaillou University Hospital of Rennes, Rennes, France
| | - Corinne Frère
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | | | - Aurore Perrot
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse, France
| | - Hervé Avet-Loiseau
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse, France
| | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, 44093 Nantes, France; Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers, INSERM UMR 1307, CNRS UMR 6075, Nantes, France
| | - Emilie Chalayer
- Hématologie clinique, Institut de Cancérologie Hématologie Universitaire, CHU St Etienne Unité INSERM SAINBIOSE, U1059, Université Jean Monnet, St-Etienne, France
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4
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Talbot A, Bobin A, Tabone L, Lambert J, Boccaccio C, Deal C, Petillon MO, Allangba O, Agape P, Arnautou P, Belkhir R, Cailleres S, Chaoui D, Chrétien ML, Decaux O, Schulmann S, Frenzel L, Gastaud L, Huart A, Hulin C, Karlin L, Laribi K, Le Calloch R, Lenain P, Macro M, Manier S, Montes L, Moreau S, Moreau P, Morel V, Norwood J, Piocelle FO, Perrot A, Pica GM, Rey P, Schmitt A, Stoppa AM, Tiab M, Touzeau C, Vidal V, Vignon M, Vincent L, Van De Wyngaert Z, Zarnitsky C, Kerbouche N, Paka P, Leleu X, Arnulf B, Avet-Loiseau H, Du Myélome IIF. Real-world study of the efficacy and safety of belantamab mafodotin (GSK2857916) in relapsed or refractory multiple myeloma based on data from the nominative ATU in France: the IFM 2020-04 study. Haematologica 2023; 108:2774-2782. [PMID: 37078253 PMCID: PMC10543185 DOI: 10.3324/haematol.2022.281772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/11/2023] [Indexed: 04/21/2023] Open
Abstract
Belantamab mafodotin (BM) is an anti-BCMA antibody-drug conjugate (GSK2857916) that represents an alternative option in multiple myeloma. We sought to assess the efficacy and safety of BM in a real-world setting in patients who benefited from an early access program. We conducted an observational, retrospective, multicenter study. Eligibility criteria were treatment of relapsed or refractory multiple myeloma (RRMM) in monotherapy in adult patients who have received at least three lines of therapy previously, including at least one immunomodulatory agent (IMiD), a proteasome inhibitor (PI) and an anti-CD38 monoclonal antibody, and whose disease progressed during the last treatment period. The primary endpoint of the study is to assess the overall survival (OS). Between November 2019 and December 2020, 106 patients were treated with BM; 97 were eligible for the efficacy evaluation and 104 for safety. The median age was 66 (range, 37-82) years. High-risk cytogenetics were identified in 40.9% of patients. Fifty-five (56.7%) patients were triple-class refractory and 11 (11.3%) were penta-class refractory. The median number of prior lines of treatment was five (range, 3-12). The median number of BM cycles administered was three (range, 1-22). The overall response rate at best response was 38.1% (37/97). The median OS was 9.3 months (95% confidence interval [CI]: 5.9-15.3), and median progression-free survival was 3.5 months (95% CI: 1.9-4.7). The median duration of response was 9 months (range, 4.65-10.4). Treatment was delayed for 55 (52.9%) patients including 36.5% for treatment-related toxicity. Ophthalmic adverse events, mainly grade ≤2, were the most common toxicity (48%). The occurrence of keratopathy was 37.5%. Overall, our data are concordant with the results from DREAMM-2 in terms of efficacy and safety on a non-biased population.
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Affiliation(s)
- Alexis Talbot
- Hôpital Saint Louis, APHP, Immuno-Hématologie, INSERM U976, équipe 5.
| | - Arthur Bobin
- CHU de Poitiers, Service d'Hématologie et Thérapie cellulaire, CIC U1402, Poitiers
| | | | - Jérôme Lambert
- ECSTRA, Centre de Recherche en Epidémiologie et Statistiques, INSERM UMR 1153
| | | | | | | | - Olivier Allangba
- Centre Hospitalier Yves Le Foll, Hématologie-Oncologie, Saint Brieuc
| | | | - Pierre Arnautou
- Hôpital d'Instruction des Armées Percy, Hématologie, Clamart
| | | | - Sylvie Cailleres
- Centre Hospitalier du Pays d'Aix, Service hématologie oncologie, Aix-enProvence
| | - Driss Chaoui
- Centre Hospitalier Victor Dupouy, Hématologie, Argenteuil
| | | | | | | | - Laurent Frenzel
- APHP, Hôpital Universitaire Necker Enfants Malades, Hématologie adultes
| | - Lauris Gastaud
- Centre Antoine Lacassagne, service onco-hématologie, Nice
| | - Antoine Huart
- CHU Toulouse - Hôpital de Rangueil, Néphrologie, Toulouse
| | - Cyrille Hulin
- CHU Bordeaux, Hématologie et thérapie cellulaire, Bordeaux
| | | | - Kamel Laribi
- Centre Hospitalier du Mans, Hématologie clinique, Le Mans
| | - Ronan Le Calloch
- Centre Hospitalier de Quimper Cornouaille, Service d'hématologie, Quimper
| | | | | | | | | | - Stéphane Moreau
- CHU de Limoges, Hématologie clinique et thérapie cellulaire, Limoges
| | | | | | | | | | - Aurore Perrot
- CHU de Toulouse, IUCT-O, Service Hématologie, Université de Toulouse UPS, Toulouse
| | | | | | | | | | - Mourad Tiab
- CHD Vendée, Médecine Interne, La Roche-sur-Yon
| | | | | | | | - Laure Vincent
- CHU Montpellier - Hôpital Saint Eloi, Hématologie, Montpellier
| | | | | | | | | | - Xavier Leleu
- CHU de Poitiers, Service d'Hématologie et Thérapie cellulaire, CIC U1402, Poitiers
| | - Bertrand Arnulf
- Hôpital Saint Louis, APHP, Immuno-Hématologie, INSERM U976, équipe 5
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Corenblit D, Decaux O, Delmotte S, Toumazet JP, Arrignon F, André MF, Darrozes J, Davies NS, Julien F, Otto T, Ramillien G, Roussel E, Steiger J, Viles H. Signatures of Life Detected in Images of Rocks Using Neural Network Analysis Demonstrate New Potential for Searching for Biosignatures on the Surface of Mars. Astrobiology 2023; 23:308-326. [PMID: 36668995 DOI: 10.1089/ast.2022.0034] [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] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Microorganisms play a role in the construction or modulation of various types of landforms. They are especially notable for forming microbially induced sedimentary structures (MISS). Such microbial structures have been considered to be among the most likely biosignatures that might be encountered on the martian surface. Twenty-nine algorithms have been tested with images taken during a laboratory experiment for testing their performance in discriminating mat cracks (MISS) from abiotic mud cracks. Among the algorithms, neural network types produced excellent predictions with similar precision of 0.99. Following that step, a convolutional neural network (CNN) approach has been tested to see whether it can conclusively detect MISS in images of rocks and sediment surfaces taken at different natural sites where present and ancient (fossil) microbial mat cracks and abiotic desiccation cracks were observed. The CNN approach showed excellent prediction of biotic and abiotic structures from the images (global precision, sensitivity, and specificity, respectively, 0.99, 0.99, and 0.97). The key areas of interest of the machine matched well with human expertise for distinguishing biotic and abiotic forms (in their geomorphological meaning). The images indicated clear differences between the abiotic and biotic situations expressed at three embedded scales: texture (size, shape, and arrangement of the grains constituting the surface of one form), form (outer shape of one form), and pattern of form arrangement (arrangement of the forms over a few square meters). The most discriminative components for biogenicity were the border of the mat cracks with their tortuous enlarged and blistered morphology more or less curved upward, sometimes with thin laminations. To apply this innovative biogeomorphological approach to the images obtained by rovers on Mars, the main physical and biological sources of variation in abiotic and biotic outcomes must now be further considered.
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Affiliation(s)
- Dov Corenblit
- Université Clermont Auvergne, CNRS, GEOLAB, Clermont-Ferrand, France
- CNRS, Laboratoire écologie fonctionnelle et environnement, Université Paul Sabatier, CNRS, INPT, UPS, Toulouse, France
| | | | | | | | | | | | - José Darrozes
- Université Paul Sabatier, CNRS/IRD, GET, Toulouse, France
| | - Neil S Davies
- Department of Earth Sciences, University of Cambridge, Cambridge, United Kingdom
| | - Frédéric Julien
- CNRS, Laboratoire écologie fonctionnelle et environnement, Université Paul Sabatier, CNRS, INPT, UPS, Toulouse, France
| | - Thierry Otto
- CNRS, Laboratoire écologie fonctionnelle et environnement, Université Paul Sabatier, CNRS, INPT, UPS, Toulouse, France
| | | | - Erwan Roussel
- Université Clermont Auvergne, CNRS, GEOLAB, Clermont-Ferrand, France
| | - Johannes Steiger
- Université Clermont Auvergne, CNRS, GEOLAB, Clermont-Ferrand, France
| | - Heather Viles
- School of Geography and the Environment, University of Oxford, Oxford, United Kingdom
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Dumontet C, Demangel D, Galia P, Karlin L, Roche L, Fauvernier M, Golfier C, Laude M, Leleu X, Rodon P, Roussel M, Azaïs I, Doyen C, Slama B, Manier S, Decaux O, Pertesi M, Beaumont M, Caillot D, Boyle EM, Cliquennois M, Cony‐Makhoul P, Doncker A, Dorvaux V, Petillon MO, Fontan J, Hivert B, Leduc I, Leyronnas C, Macro M, Maigre M, Mariette C, Mineur P, Rigaudeau S, Royer B, Vincent L, Mckay J, Perrial E, Garderet L. Clinical characteristics and outcome of 318 families with familial monoclonal gammopathy: A multicenter Intergroupe Francophone du Myélome study. Am J Hematol 2023; 98:264-271. [PMID: 36588407 PMCID: PMC10107808 DOI: 10.1002/ajh.26785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 01/03/2023]
Abstract
Familial forms of monoclonal gammopathy, defined as multiple myeloma (MM) or Monoclonal Gammopathy of Undetermined Significance (MGUS), are relatively infrequent and most series reported in the literature describe a limited number of families. MM rarely occurs in a familial context. MGUS is observed much more commonly, which can in some cases evolve toward full-blown MM. Although recurrent cytogenetic abnormalities have been described in tumor cells of sporadic cases of MM, the pathogenesis of familial MM remains largely unexplained. In order to identify genetic factors predisposing to familial monoclonal gammopathy, the Intergroupe Francophone du Myélome identified 318 families with at least two confirmed cases of monoclonal gammopathy. There were 169 families with parent/child pairs and 164 families with cases in at least two siblings, compatible with an autosomal transmission. These familial cases were compared with sporadic cases who were matched for age at diagnosis, sex and immunoglobulin isotype, with 10 sporadic cases for each familial case. The gender distribution, age and immunoglobulin subtypes of familial cases were unremarkable in comparison to sporadic cases. With a median follow-up of 7.4 years after diagnosis, the percentage of MGUS cases having evolved to MM was 3%. The median overall survival of the 148 familial MM cases was longer than that of matched sporadic cases, with projected values of 7.6 and 16.1 years in patients older and younger than 65 years, respectively. These data suggest that familial cases of monoclonal gammopathy are similar to sporadic cases in terms of clinical presentation and carry a better prognosis.
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Affiliation(s)
- Charles Dumontet
- Hospices Civils de LyonLyonFrance
- CRCL, UMR INSERM 1052/CNRS 5286/University of Lyon‐FranceLyonFrance
| | | | | | | | | | | | | | | | | | | | | | | | | | - Borhane Slama
- Clinical Hematology DepartmentCH AvignonAvignonFrance
| | | | - Olivier Decaux
- Hematology DepartmentCHU Rennes, Inserm UMR1236RennesFrance
| | - Maroulio Pertesi
- Genetic Cancer Susceptibility, International Agency for Research on CancerLyonFrance
- Department of Laboratory MedicineHematology and Transfusion MedicineLundSweden
| | | | - Denis Caillot
- Clinical Hematology DepartmentHôpital F. Mitterrand, CHU DijonDijonFrance
| | - Eileen M. Boyle
- Perlmutter Cancer CenterNYU Langone HealthNew YorkNew YorkUSA
| | | | | | | | - Véronique Dorvaux
- Clinical Hematology DepartmentCHR Metz‐ThionvilleMetz‐ThionvilleFrance
| | | | - Jean Fontan
- Hematology DepartmentCHU BesançonBesançonFrance
| | | | | | | | | | - Michel Maigre
- Internal Medicine DepartmentCH ChartresChartresFrance
| | | | - Philippe Mineur
- Clinical Hematology DepartmentGrand Hôpital de CharleroiCharleroiBelgium
| | | | - Bruno Royer
- Clinical Hematology and Cell Therapy DepartmentAmiensFrance
| | | | - James Mckay
- Genetic Cancer Susceptibility, International Agency for Research on CancerLyonFrance
| | - Emeline Perrial
- CRCL, UMR INSERM 1052/CNRS 5286/University of Lyon‐FranceLyonFrance
| | - Laurent Garderet
- HU PITIE SALPETRIERE APHPParisFrance
- Centre de Recherche Saint‐Antoine‐Team Hematopoietic and Leukemic DevelopmentSorbonne Université‐INSERM, UMR_S 938ParisFrance
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7
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Schavgoulidze A, Lauwers-Cances V, Perrot A, Cazaubiel T, Chretien ML, Moreau P, Facon T, Leleu X, Karlin L, Stoppa AM, Decaux O, Belhadj K, Arnulf B, Mohty M, Ariette CM, Fohrer-Sonntag C, Lenain P, Marolleau JP, Tiab M, Araujo C, Orsini-Piocelle F, Jaccard A, Roussel M, Benboubker L, Eveillard JR, Dib M, Divoux M, Attal M, Avet-Loiseau H, Corre J. Heterogeneity in long term outcomes for R-ISS stage II in newly diagnosed multiple myeloma patients. Haematologica 2022; 108:1374-1384. [PMID: 36172814 PMCID: PMC10153521 DOI: 10.3324/haematol.2021.280566] [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: 12/22/2021] [Indexed: 11/09/2022] Open
Abstract
In the era of personalized treatment in multiple myeloma, high-risk patients must be accurately defined. The International Myeloma Working Group recommends using the Revised International Staging System (R-ISS) to identify high-risk patients. The main purpose of our work was to explore the heterogeneity of outcome among R-ISS stage II patients assessing the impact of ISS, chromosomal abnormalities (CA) and LDH level in this subgroup. Data were issued from 1,343 newly diagnosed myeloma patients up to 65 years, enrolled in 3 clinical trials implemented by the Intergroupe Francophone du Myelome. All patients were eligible to an intensive treatment. Patients R-ISS stage II but ISS stage I had 1.6 times more risk of death than patients R-ISS stage I (adjusted HR 1.6; 95% CI, 1.1 to 2.2; P = .01) and patients R-ISS stage II but ISS stage III had a better overall survival than patients R-ISS stage III (adjusted HR 0.7; 95% CI, 0.4 to 0.9, P = .02). However, among patients classified in R-ISS II, ISS stage and CA (del(17p) and t(4;14)) were still relevant prognostic factors for death. Dividing R-ISS stage II into 3 subgroups: ISS I with standard risk CA, ISS II or III with standard risk CA and, high risk CA patients, median overall survivals were respectively not reached, 112 and 71 months (P < 0.001). In conclusion, stratification of patients in the R-ISS stage II group can be improved by taking into account CA and ISS. However, this does not improve predictive performance of survival models.
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Affiliation(s)
- Anais Schavgoulidze
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse
| | | | - Aurore Perrot
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse
| | | | | | | | | | - Xavier Leleu
- Centre Hospitalier Universitaire Poitiers, Poitiers
| | | | | | | | | | - Bertrand Arnulf
- Centre Hospitalier Universitaire, Hopital Saint Louis, Paris
| | - Mohamad Mohty
- Centre Hospitalier Universitaire, Hopital Saint-Antoine, Paris
| | | | | | - Pascal Lenain
- Centre de Lutte Contre le Cancer - Centre Henri Becquerel, Rouen
| | | | - Mourad Tiab
- Centre Hospitalier Departemental Vendee, La Roche-sur-Yon
| | | | | | | | - Murielle Roussel
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse
| | | | | | - Mamoun Dib
- Centre Hospitalier Universitaire Angers, Angers
| | - Marion Divoux
- Centre Hospitalier Regional Universitaire Nancy Vandoeuvre les Nancy, Nancy
| | - Michel Attal
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse
| | - Herve Avet-Loiseau
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse
| | - Jill Corre
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse.
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8
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Touzeau C, Perrot A, Hulin C, Manier S, Macro M, Caillot D, Karlin L, Decaux O, Jacquet C, Tiab M, Leleu X, Planche L, Avet-Loiseau H, Moreau P. Daratumumab carfilzomib lenalidomide and dexamethasone as induction therapy in high-risk, transplant-eligible patients with newly diagnosed myeloma: Results of the phase 2 study IFM 2018-04. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8002 Background: High-risk (HR) cytogenetic is associated with poor outcome in transplant eligible (TE) newly diagnosed myeloma multiple myeloma (NDMM). The triplet combination carfilzomib lenalidomide and dexamethasone (KRD) plus transplantation demonstrated high efficacy with favorable safety profile in TE-NDMM patients (FORTE). The addition of daratumumab (Dara) to frontline therapy also improved response rate and progression free-survival in TE-NDMM patients (CASSIOPEIA, GRIFFIN). Double transplant also improved outcome of HR TE NDMM patients (EMN02, STAMINA). The phase 2 trial 2018-04 from the Intergroupe Francophone du Myelome (IFM) is evaluating an intensive strategy with Dara-KRD induction and consolidation plus double transplant in HR TE NDMM (NCT03606577). Methods: HR MM was defined by the presence of del17p, t(4;14) and/or t(14;16). Stategy includes Dara-KRD induction (6 cycles), autologous stem cell transplantation (ASCT), Dara-KRD consolidation (4 cycles), second ASCT, Dara-lenalidomide maintenance. The primary endpoint was the feasibility of this intensive strategy. Here, we report efficacy and safety analysis of Dara-KRD induction. Results: Fifty patients with previously untreated NDMM were included from july 2019 to march 2021 in 11 IFM centers Median age was 57 (range 38 -65). ISS stage 3 was present in 12 (24%) patients. Based on inclusion criteria, all patients had HR cytogenetic, including 17p deletion (n = 20, 40%), t(4;14) (n = 26, 52%) or t(14;16) (n = 10,20%). Forty-six patients completed Dara-KRD induction. Two patients discontinued treatment due to severe adverse event (COVID-19 infection, n = 1 ; drug-induced hepatitis, n = 1) and 2 patients discontinued treatment due to disease progression. Grade 3-4 treatment related adverse event ( > 5% of patients) were neutropenia (38%), anemia (14%), thrombocytopenia (8%), infection (6%), renal insufficiency (6%) and deep-vein thrombosis (6%). Two patients (6%) experienced stem-cell collection failure. Overall response rate was 96%, including 92 % > very good partial response. Among 37 (/46) evaluable patients post induction, Minimal Residual Disease negativity rate (NGS, 10-5) was 62%. Conclusions: Dara-KRD as induction prior ASCT is safe and allows deep responses in TE NDMM patients with high-risk cytogenetic profile. IFM 2018-04 study is ongoing and longer follow-up is needed to evaluate safety and efficacy of the overall strategy with Dara-KRD induction and consolidation plus double transplant in this subset of HR patients. Clinical trial information: NCT03606577.
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Affiliation(s)
| | - Aurore Perrot
- Centre Hospitalier, Universitaire de Toulouse, Service d'Hematologie, Toulouse, France
| | - Cyrille Hulin
- Department of Hematology, Hôpital Haut Lévêque, University Hospital Bordeaux, Pessac, France
| | - Salomon Manier
- Centre Hospitalier Regional Universitaire de Lille, Lille, France
| | - Margaret Macro
- Centre Hospitalier Universitaire (CHU) de Caen, Caen, France
| | | | - Lionel Karlin
- Service d’Hématologie Clinique, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | | | - Caroline Jacquet
- Department of Hematology Centre Hospitalier Universitaire, Nancy, France
| | | | - Xavier Leleu
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Lucie Planche
- Département de recherche clinique, CHU Hotel Dieu, Nantes, France
| | - Herve Avet-Loiseau
- Unit for Genomics in Myeloma, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital & Centre de Recherche en Cancérologie de Toulouse, INSERM U1037, Toulouse, France
| | - Philippe Moreau
- Hematology Clinic, University Hospital Hôtel-Dieu, Nantes, France
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9
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Leleu X, Macro M, Touzeau C, Mariette C, Manier S, Brechignac S, Vincent L, Hebraud B, Decaux O, Schulmann S, Lenoir C, Godmer P, Farge A, Peyro Saint Paul L, Parienti JJ. Ixazomib and daratumumab without dexamethasone (I-Dara) in elderly frail RRMM patients: A multicenter phase 2 study (IFM 2018-02) of the Intergroupe Francophone du Myélome (IFM). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.8000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
8000 Background: Frail patients with multiple myeloma have an inferior outcome, especially in the relapse setting. This adverse prognosis is mainly related to a high discontinuation rate due to treatment (Tx) related adverse events. The aim of this phase 2 study is to evaluate efficacy and tolerability of Ixazomib-Daratumumab (I-Dara) without Dexamethasone in elderly frail patients with relapsed myeloma (RRMM) (NCT03757221). Methods: Ixa-Dara naïve RRMM patients received oral Ixazomib (4 mg: days 1, 8, 15), IV Daratumumab (16 mg/kg; days 1, 8, 15, 22, cycles 1-2; days 1, 15, cycles 3-6; days 1, cycles 7+) and IV Methylprednisolone before Daratumumab (100 mg at day 1, 8, cycle 1 and then 60 mg). They were enrolled after 1 or 2 prior therapy if their frailty score was ≥ 2 by IMWG score. The primary endpoint was ≥ very good partial response rate (VGPR) at one year. Secondary endpoints included ORR, PFS, OS & toxicity according to NCI-CTCAE version 5. Results: Sixty-three patients were screened and 55 enrolled between 03/2018 and 09/2021. Patient were at first (n = 36) or second relapse (n = 19). Thirty-three patients (60%) were previously exposed to bortezomib, 37 (67%) were previously exposed to lenalidomide (Len) and 20 (36 %) were refractory to Len. Median age was 82 (72-93). All patients had a frailty score ≥2 and 13 (24 %) had a 3 or 4 frailty score. In 41 patients ISS at diagnosis was stage I (n = 11), II (n = 18) or III (n = 12). Seventeen (36%) patients harbored high-risk (HR) cytogenetic, including t(4;14) (n = 8) or del17p (n = 10). The median duration of Tx among 28 pts with ongoing Tx was 10 months [5-32] at data cutoff (February, 2)]. The median duration of Tx among 27 pts who stopped Tx was 6 months [0-18]: 18 had progressive disease. Nine patients died during the study: Daratumumab-related bronchospasm (D1C1); Ixazomib-related overdose (C2); sepsis (n = 4), progressive disease (n = 3). Regarding toxicity, 27 pts had a ≥grade 3 AE (49%). The most common grade 3-4 toxicities were thrombocytopenia (n = 9), other cytopenias (n = 4), infection (n = 8), hypertension (n = 3) and gastrointestinal disorders (n = 3). Fourteen out of 28 were SAE including 5 infections, 1 bronchospasm, 1 acute respiratory failure and 2 ixazomib overdoses. Overall response rate, including minimal response, was 86 % with a ≥VGPR rate of 32 % in the whole group. In Len refractory patients the ORR was 82 % and ≥VGPR 41%, in HR cytogenetic patients ORR was 85 % and ≥VGPR 46%. With a median follow-up of 11.6 months median PFS is 16 months and median OS NR (76% estimated at one year). Conclusions: In this elderly frail population Ixa-Dara is a feasible combination with favorable efficacy profile even in Len refractory and HR cytogenetic patients. Early toxicity remains a concern in this population eventhough more manageable with Dara SC. Clinical trial information: NCT03757221.
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Affiliation(s)
- Xavier Leleu
- Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Margaret Macro
- Centre Hospitalier Universitaire (CHU) de Caen, Caen, France
| | | | | | | | | | - Laure Vincent
- Département d'hématologie Clinique, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | | | | | - Caroline Lenoir
- Polyclinique Bordeaux Nord Nord Acquitaine, Bordeaux, France
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10
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Pineton de Chambrun M, Moyon Q, Faguer S, Urbanski G, Mathian A, Zucman N, Werner M, Luyt CE, Verlicchi F, Amoura Z, Gousseff M, Mauhin W, Hot A, Lega JC, Lambert M, Riviere S, Dossier A, Ruivard M, Lhote F, Blaison G, Merceron S, Zapella N, Alric L, Agard C, Lacout M, Saadoun D, Graveleau J, Soubrier M, Haroche J, Boileau J, Lucchini-Lecomte MJ, Hanslik T, Christides C, Levesque H, Talasczka A, Bulte C, Hachulla E, Decaux O, Sonneville R, Ibouanga F, Arnulf B, Benedit M, Viallard JF, Tieulie N, Haddad F, Moulin B, Cohen-Aubert F, Lovey PY, le Moal S, Bibes B, Rivard GE, Rondeau E, Malizia G, Debourdeau P, Abgueguen P, Bosseray A, Devaquet J, Presne C, Liferman F, Limal N, Argaud L, Hernu R, de la Salle S, Faguer S, Urbanski G, Zucman N, Werner M, Luyt CE, Moyon Q, Verlicchi F, Troncoso JÁ, Harty J, Godmer P, Hie M, Papo T, Hatron PY, Mathian A, Amoura Z. The consequences of COVID-19 pandemic on patients with monoclonal gammopathy-associated systemic capillary leak syndrome (Clarkson disease). J Allergy Clin Immunol Pract 2022; 10:626-629. [PMID: 34890829 PMCID: PMC8648572 DOI: 10.1016/j.jaip.2021.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France,Institut de Cardiométabolisme et Nutrition (ICAN), INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France,Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France,Corresponding author: Marc Pineton de Chambrun, MD, MSc, Service de Médecine Intensive-Réanimation, Hôpital La Pitié-Salpêtrière, 47-83, boulevard de l’Hôpital, 75651 Paris Cedex 13, France
| | - Quentin Moyon
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France,Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'Organes, Centre de Référence Des Maladies Rénales Rares, INSERM U1297 (I2MC, Équipe 12), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Geoffrey Urbanski
- Service de Médecine Interne et d’Immunologie Clinique, Centre Hospitalier Universitaire, Angers, France
| | - Alexis Mathian
- Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Noémie Zucman
- Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, APHP, DMU ESPRIT, Université de Paris, Colombes, France
| | - Marie Werner
- Service de Réanimation Chirurgicale Adulte, AP-HP, Hôpital Bicêtre, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France,Institut de Cardiométabolisme et Nutrition (ICAN), INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
| | | | - Zahir Amoura
- Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
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11
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Ly KH, Costedoat-Chalumeau N, Liozon E, Dumonteil S, Ducroix JP, Sailler L, Lidove O, Bienvenu B, Decaux O, Hatron PY, Smail A, Astudillo L, Morel N, Boutemy J, Perlat A, Denes E, Lambert M, Papo T, Cypierre A, Vidal E, Preux PM, Monteil J, Fauchais AL. Diagnostic Value of 18F-FDG PET/CT vs. Chest-Abdomen-Pelvis CT Scan in Management of Patients with Fever of Unknown Origin, Inflammation of Unknown Origin or Episodic Fever of Unknown Origin: A Comparative Multicentre Prospective Study. J Clin Med 2022; 11:jcm11020386. [PMID: 35054081 PMCID: PMC8779072 DOI: 10.3390/jcm11020386] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 12/24/2022] Open
Abstract
Fluorodesoxyglucose Positron Emission Tomography (PET/CT) has never been compared to Chest-Abdomen-Pelvis CT (CAPCT) in patients with a fever of unknown origin (FUO), inflammation of unknown origin (IUO) and episodic fever of unknown origin (EFUO) through a prospective and multicentre study. In this study, we investigated the diagnostic value of PET/CT compared to CAPCT in these patients. The trial was performed between 1 May 2008 through 28 February 2013 with 7 French University Hospital centres. Patients who fulfilled the FUO, IUO or EFUO criteria were included. Diagnostic orientation (DO), diagnostic contribution (DC) and time for diagnosis of both imaging resources were evaluated. One hundred and three patients were included with 35 FUO, 35 IUO and 33 EFUO patients. PET/CT showed both a higher DO (28.2% vs. 7.8%, p < 0.001) and DC (19.4% vs. 5.8%, p < 0.001) than CAPCT and reduced the time for diagnosis in patients (3.8 vs. 17.6 months, p = 0.02). Arthralgia (OR 4.90, p = 0.0012), DO of PET/CT (OR 4.09, p = 0.016), CRP > 30 mg/L (OR 3.70, p = 0.033), and chills (OR 3.06, p = 0.0248) were associated with the achievement of a diagnosis (Se: 89.1%, Sp: 56.8%). PET/CT both orients and contributes to diagnoses at a higher rate than CAPCT, especially in patients with FUO and IUO, and reduces the time for diagnosis.
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Affiliation(s)
- Kim-Heang Ly
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
- Correspondence: ; Tel.: +33-55-5055-8076
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Cochin University Hospital, Internal Medicine Department, Referral Centre for Rare Autoimmune and Systemic Diseases, 75014 Paris, France; (N.C.-C.); (N.M.)
| | - Eric Liozon
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
| | - Stéphanie Dumonteil
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
| | - Jean-Pierre Ducroix
- Department of Internal Medicine, Amiens University Hospital, 80054 Amiens, France; (J.-P.D.); (A.S.)
| | - Laurent Sailler
- Department of Internal Medicine, CHU Toulouse-Purpan, CEDEX, 31059 Toulouse, France; (L.S.); (L.A.)
| | - Olivier Lidove
- Department of Internal Medicine, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 75020 Paris, France;
| | - Boris Bienvenu
- Department of Internal Medicine, Caen University Hospital, CEDEX 9, 14033 Caen, France; (B.B.); (J.B.)
| | - Olivier Decaux
- Department of Internal Medicine CHU de Rennes, 35000 Rennes, France; (O.D.); (A.P.)
| | - Pierre-Yves Hatron
- Department of Internal Medicine, CHU Claude Huriez, 59000 Lille, France; (P.-Y.H.); (M.L.)
| | - Amar Smail
- Department of Internal Medicine, Amiens University Hospital, 80054 Amiens, France; (J.-P.D.); (A.S.)
| | - Léonardo Astudillo
- Department of Internal Medicine, CHU Toulouse-Purpan, CEDEX, 31059 Toulouse, France; (L.S.); (L.A.)
| | - Nathalie Morel
- AP-HP, Cochin University Hospital, Internal Medicine Department, Referral Centre for Rare Autoimmune and Systemic Diseases, 75014 Paris, France; (N.C.-C.); (N.M.)
| | - Jonathan Boutemy
- Department of Internal Medicine, Caen University Hospital, CEDEX 9, 14033 Caen, France; (B.B.); (J.B.)
| | - Antoinette Perlat
- Department of Internal Medicine CHU de Rennes, 35000 Rennes, France; (O.D.); (A.P.)
| | - Eric Denes
- Department of Infectious Diseases, CHU Limoges, CEDEX, 87042 Limoges, France; (E.D.); (A.C.)
| | - Marc Lambert
- Department of Internal Medicine, CHU Claude Huriez, 59000 Lille, France; (P.-Y.H.); (M.L.)
| | - Thomas Papo
- Department of Internal Medicine, Paris Diderot University, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 75018 Paris, France;
| | - Anne Cypierre
- Department of Infectious Diseases, CHU Limoges, CEDEX, 87042 Limoges, France; (E.D.); (A.C.)
| | - Elisabeth Vidal
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
| | - Pierre-Marie Preux
- Centre d’Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges University Hospital, CEDEX, 87042 Limoges, France;
| | - Jacques Monteil
- Department of Nuclear Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France;
| | - Anne-Laure Fauchais
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
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12
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Facon T, Cook G, Usmani SZ, Hulin C, Kumar S, Plesner T, Touzeau C, Bahlis NJ, Basu S, Nahi H, Goldschmidt H, Quach H, Mohty M, Venner CP, Weisel K, Raje N, Hebraud B, Belhadj-Merzoug K, Benboubker L, Decaux O, Manier S, Caillot D, Ukropec J, Pei H, Van Rampelbergh R, Uhlar CM, Kobos R, Zweegman S. Daratumumab plus lenalidomide and dexamethasone in transplant-ineligible newly diagnosed multiple myeloma: frailty subgroup analysis of MAIA. Leukemia 2022; 36:1066-1077. [PMID: 34974527 PMCID: PMC8979809 DOI: 10.1038/s41375-021-01488-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 12/14/2022]
Abstract
In the phase 3 MAIA study of patients with transplant-ineligible newly diagnosed multiple myeloma (NDMM), daratumumab plus lenalidomide/dexamethasone (D-Rd) improved progression-free survival (PFS) versus lenalidomide/dexamethasone (Rd). We present a subgroup analysis of MAIA by frailty status. Frailty assessment was performed retrospectively using age, Charlson comorbidity index, and baseline Eastern Cooperative Oncology Group performance status score. Patients were classified as fit, intermediate, non-frail (fit + intermediate), or frail. Of the randomized patients (D-Rd, n = 368; Rd, n = 369), 396 patients were non-frail (D-Rd, 196 [53.3%]; Rd, 200 [54.2%]) and 341 patients were frail (172 [46.7%]; 169 [45.8%]). After a 36.4-month median follow-up, non-frail patients had longer PFS than frail patients, but the PFS benefit of D-Rd versus Rd was maintained across subgroups: non-frail (median, not reached [NR] vs 41.7 months; hazard ratio [HR], 0.48; P < 0.0001) and frail (NR vs 30.4 months; HR, 0.62; P = 0.003). Improved rates of complete response or better and minimal residual disease (10-5) negativity were observed for D-Rd across subgroups. The most common grade 3/4 treatment-emergent adverse event in non-frail and frail patients was neutropenia (non-frail, 45.4% [D-Rd] and 37.2% [Rd]; frail, 57.7% and 33.1%). These findings support the clinical benefit of D-Rd in transplant-ineligible NDMM patients enrolled in MAIA, regardless of frailty status.
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Affiliation(s)
- Thierry Facon
- grid.503422.20000 0001 2242 6780University of Lille, CHU Lille, Service des Maladies du Sang, Lille, France
| | - Gordon Cook
- grid.415967.80000 0000 9965 1030Leeds Cancer Centre, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Saad Z. Usmani
- grid.468189.aLevine Cancer Institute/Atrium Health, Charlotte, NC USA
| | - Cyrille Hulin
- grid.42399.350000 0004 0593 7118Department of Hematology, Hôpital Haut Lévêque, University Hospital, Pessac, France
| | - Shaji Kumar
- grid.66875.3a0000 0004 0459 167XDepartment of Hematology, Mayo Clinic Rochester, Rochester, MN USA
| | - Torben Plesner
- grid.417271.60000 0004 0512 5814Vejle Hospital and University of Southern Denmark, Vejle, Denmark
| | - Cyrille Touzeau
- grid.277151.70000 0004 0472 0371Centre Hospitalier Universitaire, Nantes, France
| | - Nizar J. Bahlis
- grid.22072.350000 0004 1936 7697University of Calgary, Arnie Charbonneau Cancer Research Institute, Calgary, AB Canada
| | - Supratik Basu
- grid.6374.60000000106935374The Royal Wolverhampton Hospitals NHS Trust, University of Wolverhampton, Wolverhampton, UK
| | - Hareth Nahi
- grid.24381.3c0000 0000 9241 5705Karolinska Institute, Department of Medicine, Division of Hematology, Karolinska University Hospital at Huddinge, Stockholm, Sweden
| | - Hartmut Goldschmidt
- grid.5253.10000 0001 0328 4908University Clinic Heidelberg, International Medicine V and National Center of Tumor Diseases (NCT), Heidelberg, Germany
| | - Hang Quach
- grid.1008.90000 0001 2179 088XUniversity of Melbourne, St. Vincent’s Hospital, Melbourne, VIC Australia
| | - Mohamad Mohty
- grid.412370.30000 0004 1937 1100Sorbonne University, Department of Hematology, Saint-Antoine Hospital, Paris, France
| | - Christopher P. Venner
- grid.17089.370000 0001 2190 316XCross Cancer Institute, University of Alberta, Edmonton, AB Canada
| | - Katja Weisel
- grid.13648.380000 0001 2180 3484Department of Oncology, Hematology and Bone Marrow Transplantation With Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Noopur Raje
- grid.32224.350000 0004 0386 9924Department of Hematology/Oncology, Massachusetts General Hospital, Boston, MA USA
| | - Benjamin Hebraud
- grid.411175.70000 0001 1457 2980Institut Universitaire du Cancer and University Hospital, Toulouse, France
| | - Karim Belhadj-Merzoug
- grid.412116.10000 0001 2292 1474Hémopathies Lymphoïdes, Hôpital Henri Mondor, Créteil, France
| | | | - Olivier Decaux
- grid.410368.80000 0001 2191 9284Clinical Haematology Department, University of Rennes, CHU Rennes, CIC INSERM 1414, Rennes, France
| | - Salomon Manier
- grid.503422.20000 0001 2242 6780University of Lille, CHU Lille, Service des Maladies du Sang, Lille, France
| | - Denis Caillot
- grid.31151.37CHU Dijon, Hôpital du Bocage, Dijon, France
| | - Jon Ukropec
- Janssen Global Medical Affairs, Horsham, PA USA
| | - Huiling Pei
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Titusville, NJ USA
| | | | - Clarissa M. Uhlar
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Spring House, PA USA
| | - Rachel Kobos
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, Raritan, NJ USA
| | - Sonja Zweegman
- grid.12380.380000 0004 1754 9227Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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13
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Nsiala L, Bobin A, Levy A, Gruchet C, Sabirou F, Gardeney H, Cailly L, Manier S, Moya N, Tomowiak C, Guidez S, Leleu X, Decaux O. Smoldering multiple myeloma: biology, clinical manifestations and management. Leuk Lymphoma 2021; 63:518-529. [PMID: 34672244 DOI: 10.1080/10428194.2021.1992615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Smoldering multiple myeloma (SMM) is a heterogeneous group of asymptomatic plasma cell disorder characterized by the presence of monoclonal protein ≥ 30 g/L and/or 10-60% of bone marrow plasma cells and no evidence of SLiM-CRAB criteria according to the 2014 International Myeloma Working Group (IMWG) recommendations. Once the effort to reclassify SMM with active disease as MM requiring treatment was completed, the need to redefine new high-risk SMM arose. The 20/2/20 and the IMWG risk model with the add-on high-risk cytogenetic abnormalities allow to identify high-risk SMM with 50% risk of progression to MM within 2 years, and therefore might help to propose a better therapeutic approach, either with the goal to « cure » by profoundly debulk the MM with aggressive therapies, or alternatively to restore the immune surveillance like a « delay » strategy with immune-based therapies. The debate is still ongoing but clearly challenges the watch-and-wait standard of care.
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Affiliation(s)
- Laly Nsiala
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Arthur Bobin
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Anthony Levy
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Cécile Gruchet
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Florence Sabirou
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Hélène Gardeney
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Laura Cailly
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Salomon Manier
- Service d'Hematologie Clinique, CHRU Lille, Lille 2 64 University, INSERM UMR-S1172, Lille, France
| | - Niels Moya
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Cécile Tomowiak
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Stephanie Guidez
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Xavier Leleu
- Service d'Hématologie et Thérapie cellulaire, CHU Poitiers, Poitiers, France
| | - Olivier Decaux
- Service d'Hématologie Clinique, CHU Rennes, INSERM U1236, Rennes 1 University, Rennes, France
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14
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Bobin A, Kyheng M, Guidez S, Gruchet-Merouze C, Richez V, Duhamel A, Karlin L, Kolb B, Tiab M, Araujo C, Meuleman N, Malfuson JV, Bourquard P, Lenain P, Perrot A, Roussel M, Jaccard A, Petillon MO, Belhadj-Merzoug K, Chretien ML, Fontan J, Rodon P, Schmitt A, Offner F, Voillat L, Cereja S, Kuhnowski F, Rigaudeau S, Decaux O, Humbrecht-Kraut C, Frayfer J, Fitoussi O, Roos-Weil D, Eisenmann JC, Dorvaux V, Voog EG, Moreau P, Avet-Loiseau H, Hulin C, Facon T, Leleu X. Carfilzomib maintenance in newly diagnosed non-transplant eligible multiple myeloma. Leukemia 2021; 36:881-884. [PMID: 34650225 DOI: 10.1038/s41375-021-01415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Arthur Bobin
- Service d'onco-hématologie, and Inserm 1402, CHU, Poitiers, France
| | - Maéva Kyheng
- Univ., ULR 2694-METRICS, CHRU, Lille, France.,Département de Biostatistiques, CHRU, Lille, France
| | - Stéphanie Guidez
- Service d'onco-hématologie, and Inserm 1402, CHU, Poitiers, France
| | | | - Valentine Richez
- Service d'Hématologie Clinique-Greffe de Moelle, CHU, Nice, France
| | - Alain Duhamel
- Univ., ULR 2694-METRICS, CHRU, Lille, France.,Département de Biostatistiques, CHRU, Lille, France
| | | | - Brigitte Kolb
- Service d'Hématologie, Hôpital Robert Debré, CHU, Reims, France
| | - Mourad Tiab
- Service d'Hématologie, CH, La Roche sur Yon, France
| | | | - Nathalie Meuleman
- Service d'Hématologie, Institut Jules Bordet, Université Libre, Bruxelles, Belgium
| | | | | | - Pascal Lenain
- Service d'Hématologie, Centre Henri Becquerel, CNLCC, Rouen, France
| | | | | | | | | | | | | | | | | | - Anna Schmitt
- Service d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Fritz Offner
- Department Clinical Hematology, University Hospital, Ghent, Belgium
| | | | | | | | | | | | | | | | | | - Damien Roos-Weil
- Service d'Hématologie, Hôpital de la Pitié Salpétrière, Paris, France
| | | | | | | | | | | | - Cyrille Hulin
- Service d'Hématologie, Hôpital Haut Leveque, CHU, Bordeaux, France
| | | | | | - Xavier Leleu
- Service d'onco-hématologie, and Inserm 1402, CHU, Poitiers, France.
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15
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Wahbi A, Tessoulin B, Bretonnière C, Boileau J, Carpentier D, Decaux O, Fardet L, Geri G, Godmer P, Goujard C, Maisonneuve H, Mari A, Pouchot J, Ziza JM, Georgin-Lavialle S, Hamidou M, Néel A. Catastrophic adult-onset Still's disease as a distinct life-threatening clinical subset: case-control study with dimension reduction analysis. Arthritis Res Ther 2021; 23:256. [PMID: 34635157 PMCID: PMC8504015 DOI: 10.1186/s13075-021-02631-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/16/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder. Diagnosing AOSD can be challenging, as disease presentation and clinical course are highly heterogeneous. For unclear reasons, a few patients develop life-threatening complications. Our objective was to determine whether these cases resulted from therapeutic delay or could represent a peculiar AOSD subset. Methods We conducted a multicentre retrospective study of 20 AOSD patients with organ failure requiring intensive care unit admission and 41 control AOSD patients without organ failure. Clinico-biological data at hospital admission were explored using supervised analyses and unsupervised dimension reduction analysis (factor analysis of mixed data, FAMD). Results Disease duration before admission was shorter in patients with life-threatening AOSD (median, 10 vs 20 days, p = 0.007). Disease duration before AOSD therapy initiation also tended to be shorter (median, 24 vs 32 days, p = 0.068). Despite this shorter disease duration, FAMD, hierarchical clustering and univariate analyses showed that these patients exhibited distinctive characteristics at first presentation, including younger age; higher frequency of splenomegaly, liver, cardiac and/or lung involvement; less frequent arthralgia; and higher ferritin level. In multivariate analysis, 3 parameters predicted life-threatening complications: lack of arthralgia, younger age and shorter time between fever onset and hospitalisation. Conclusion This study suggests that life-threatening complications of AOSD occur very early, in a peculiar subset, which we propose to name catastrophic adult-onset Still’s disease (CAOSD). Its exact burden may be underestimated and remains to be clarified through large multicentre cohorts. Further studies are needed to identify red flags and define the optimal therapeutic strategy.
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Affiliation(s)
- Anaïs Wahbi
- Service de Médecine Interne, PHU3, Centre Hospitalier Universitaire de Nantes - Hôtel-Dieu, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Benoît Tessoulin
- Service d'Hématologie, PHU1, CHU Hôtel-Dieu, 44093, Nantes, France
| | - Cédric Bretonnière
- Service de Pneumologie, PHU2, CHU de Nantes, 44093, Nantes, France.,UPRES EA 3826, Faculté de Médecine, Université de Nantes, 44035, Nantes, France
| | - Julien Boileau
- Service de Médecine, CH de Morlaix, 29672, Morlaix, France
| | | | - Olivier Decaux
- Service de Médecine Interne, CHU de Rennes, 35033, Rennes, France
| | - Laurence Fardet
- Service de Dermatologie, Hôpital Henri Mondor, 94000, Créteil, France
| | - Guillaume Geri
- Service de Réanimation Médicale, CHU Cochin, AP-HP, 75012, Paris, France
| | | | - Cécile Goujard
- Service de Médecine Interne, CHU Bicêtre, AP-HP, 94270, Kremlin-Bicêtre, France
| | - Hervé Maisonneuve
- Service de Médecine Interne, CHD Vendée, 85925, La Roche-sur-Yon, France
| | - Arnaud Mari
- Service de Réanimation, Hôpital Yves Le Foll, 22000, St Brieuc, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, AP-HP, 75908, Paris, France
| | - Jean-Marc Ziza
- Service de Médecine Interne-Rhumatologie, Groupe Hospitalier Diaconesses-Croix-Saint-Simon, 75020, Paris, France
| | | | - Mohamed Hamidou
- Service de Médecine Interne, PHU3, Centre Hospitalier Universitaire de Nantes - Hôtel-Dieu, 1 Place Alexis Ricordeau, 44093, Nantes, France
| | - Antoine Néel
- Service de Médecine Interne, PHU3, Centre Hospitalier Universitaire de Nantes - Hôtel-Dieu, 1 Place Alexis Ricordeau, 44093, Nantes, France.
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16
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Derrien J, Guérin-Charbonnel C, Gaborit V, Campion L, Devic M, Douillard E, Roi N, Avet-Loiseau H, Decaux O, Facon T, Mallm JP, Eils R, Munshi NC, Moreau P, Herrmann C, Magrangeas F, Minvielle S. The DNA methylation landscape of multiple myeloma shows extensive inter- and intrapatient heterogeneity that fuels transcriptomic variability. Genome Med 2021; 13:127. [PMID: 34372935 PMCID: PMC8351364 DOI: 10.1186/s13073-021-00938-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 07/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background Cancer evolution depends on epigenetic and genetic diversity. Historically, in multiple myeloma (MM), subclonal diversity and tumor evolution have been investigated mostly from a genetic perspective. Methods Here, we performed an analysis of 42 MM samples from 21 patients by using enhanced reduced representation bisulfite sequencing (eRRBS). We combined several metrics of epigenetic heterogeneity to analyze DNA methylation heterogeneity in MM patients. Results We show that MM is characterized by the continuous accumulation of stochastic methylation at the promoters of development-related genes. High combinatorial entropy change is associated with poor outcomes in our pilot study and depends predominantly on partially methylated domains (PMDs). These PMDs, which represent the major source of inter- and intrapatient DNA methylation heterogeneity in MM, are linked to other key epigenetic aberrations, such as CpG island (CGI)/transcription start site (TSS) hypermethylation and H3K27me3 redistribution as well as 3D organization alterations. In addition, transcriptome analysis revealed that intratumor methylation heterogeneity was associated with low-level expression and high variability. Conclusions We propose that disrupted DNA methylation in MM is responsible for high epigenetic and transcriptomic instability allowing tumor cells to adapt to environmental changes by tapping into a pool of evolutionary trajectories. Supplementary Information The online version contains supplementary material available at (10.1186/s13073-021-00938-3).
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Affiliation(s)
- Jennifer Derrien
- Université de Nantes, CNRS, INSERM, CRCINA, Nantes, F-44000, France
| | - Catherine Guérin-Charbonnel
- Université de Nantes, CNRS, INSERM, CRCINA, Nantes, F-44000, France.,Institut de Cancérologie de l'Ouest, Nantes-Saint Herblain, France
| | - Victor Gaborit
- Université de Nantes, CNRS, INSERM, CRCINA, Nantes, F-44000, France.,LS2N, CNRS, Université de Nantes, Nantes, France
| | - Loïc Campion
- Université de Nantes, CNRS, INSERM, CRCINA, Nantes, F-44000, France.,Institut de Cancérologie de l'Ouest, Nantes-Saint Herblain, France
| | - Magali Devic
- Université de Nantes, CNRS, INSERM, CRCINA, Nantes, F-44000, France.,Centre Hospitalier Universitaire, Nantes, France
| | - Elise Douillard
- Université de Nantes, CNRS, INSERM, CRCINA, Nantes, F-44000, France.,Centre Hospitalier Universitaire, Nantes, France
| | - Nathalie Roi
- Université de Nantes, CNRS, INSERM, CRCINA, Nantes, F-44000, France.,Centre Hospitalier Universitaire, Nantes, France
| | - Hervé Avet-Loiseau
- Institut Universitaire du Cancer, CHU, Centre de Recherche en Cancérologie de Toulouse, INSERM 1037, Toulouse, France
| | | | | | - Jan-Philipp Mallm
- Research Group Genome Organization & Function, DKFZ, and BioQuant Heidelberg, Heidelberg, 69120, Germany
| | - Roland Eils
- Health Data Science Unit, Medical Faculty Heidelberg and BioQuant, Heidelberg, 69120, Germany.,Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany.,Berlin Institute of Health (BIH), Center for Digital Health, Anna-Louisa-Karsch-Strasse 2, Berlin, 10178, Germany
| | - Nikhil C Munshi
- Dana-Farber Cancer Institute, Harvard Medical School, LeBow Institute for Myeloma Therapeutics and Jerome Lipper Center for Multiple Myeloma Research, Boston, MA, United States
| | - Philippe Moreau
- Université de Nantes, CNRS, INSERM, CRCINA, Nantes, F-44000, France.,Centre Hospitalier Universitaire, Nantes, France
| | - Carl Herrmann
- Health Data Science Unit, Medical Faculty Heidelberg and BioQuant, Heidelberg, 69120, Germany
| | - Florence Magrangeas
- Université de Nantes, CNRS, INSERM, CRCINA, Nantes, F-44000, France.,Centre Hospitalier Universitaire, Nantes, France
| | - Stéphane Minvielle
- Université de Nantes, CNRS, INSERM, CRCINA, Nantes, F-44000, France. .,Centre Hospitalier Universitaire, Nantes, France.
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17
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Iudici M, Pagnoux C, Courvoisier DS, Cohen P, Hamidou M, Aouba A, Lifermann F, Ruivard M, Aumaître O, Bonnotte B, Maurier F, Decaux O, Hachulla E, Karras A, Khouatra C, Jourde-Chiche N, Viallard JF, Blanchard-Delaunay C, Godmer P, Quellec AL, Quéméneur T, de Moreuil C, Régent A, Terrier B, Mouthon L, Guillevin L, Puéchal X. Granulomatosis with polyangiitis: Study of 795 patients from the French Vasculitis Study Group registry. Semin Arthritis Rheum 2021; 51:339-346. [PMID: 33601189 DOI: 10.1016/j.semarthrit.2021.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 02/06/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To describe the characteristics and long-term outcomes of patients with granulomatosis with polyangiitis (GPA) from the French Vasculitis Study Group database. METHODS Patients' clinical and laboratory characteristics, Birmingham Vasculitis Activity Score (BVAS)-assessed disease activity, malignancies, opportunistic infections, and vital status were collected at diagnosis and each visit. Estimated probabilities and predictors of overall (OS) and relapse-free survival (RFS) were analyzed by Cox regression. RESULTS We enrolled 795 newly diagnosed patients, followed for a median of 3.5 years. Initial clinical manifestations involved ear, nose & throat (ENT; 80%), lungs (68%) and kidneys (56%). Among the 728 available ELISA results, 75.0% were PR3-ANCA-positive, 16.5% MPO-ANCA-positive and 62 (8.5%) ANCA-negative. Relapses occurred in 394 (50%) patients, involving ≥1 organ(s) affected at onset in 179 (46%), mainly ENT, lungs and kidneys, with mean BVAS 10.2 points below that at diagnosis (p<0.001). Five- and 10-year RFS rates were 37% and 17%, respectively. PR3-ANCA-positivity independently predicted relapse (p = 0.05) and prolonged survival (p = 0.038). OS-but not RFS-improved significantly over time (p<0.001); 10-year OS reached 88.2% (95% CI 83.9 to 92.7) for the 660 patients diagnosed after 2000. Infections were the main causes of death. Malignancy or opportunistic infection each occurred in ≤5% of the patients. CONCLUSION Survival has improved dramatically over the last decades but the high relapse rate remains a major concern for GPA patients, once again stressing the need for therapeutic strategy optimization to lower it. PR3-ANCA-positivity was associated with increased probability of relapse and survival.
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Affiliation(s)
- Michele Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France; Division of Rheumatology, Department of Internal Medicine Specialties, Geneva University Hospitals, Switzerland
| | - Christian Pagnoux
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France; Present address: Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Delphine S Courvoisier
- Division of Rheumatology, Department of Internal Medicine Specialties, Geneva University Hospitals, Switzerland
| | - Pascal Cohen
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France
| | - Mohamed Hamidou
- Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Nantes, France
| | - Achille Aouba
- Department of Internal Medicine, CHU Côte-de-Nacre, Caen, France
| | | | - Marc Ruivard
- Department of Internal Medicine, CHU, Clermont-Ferrand, France
| | | | | | | | - Olivier Decaux
- Department of Internal Medicine, CHU Sud, Rennes, France
| | - Eric Hachulla
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine and Clinical Immunology, Claude-Huriez Hospital, University of Lille, Lille, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Chahéra Khouatra
- Department of Respiratory Medicine, CHU Louis-Pradel and UMR754, Université Claude-Bernard Lyon 1, Lyon, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM 1263, INRAE 1260, AP-HM, Department of Nephrology, CHU de la Conception, Marseille, France
| | | | | | - Pascal Godmer
- Department of Internal Medicine, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Alain Le Quellec
- Department of Internal Medicine, CHU Saint-Eloi, Montpellier, France
| | - Thomas Quéméneur
- Department of Nephrology and Internal Medicine, Centre Hospitalier, Valenciennes, France
| | - Claire de Moreuil
- Department of Internal Medicine, CHU La Cavale Blanche, Brest, France
| | - Alexis Régent
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France
| | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France
| | - Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France.
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18
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Puéchal X, Iudici M, Pagnoux C, Cohen P, Hamidou M, Aouba A, Lifermann F, Ruivard M, Aumaître O, Bonnotte B, Maurier F, Decaux O, Hachulla E, Karras A, Khouatra C, Jourde-Chiche N, Viallard J, Mouthon L, Terrier B, Guillevin L. Les granulomatoses avec polyangéite (GPA) sans ANCA ou avec ANCA anti-myéloperoxydase représentent des entités distinctes au sein des GPA. Analyse de 727 GPA du registre du Groupe Français d’Etude des Vascularites. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.038] [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: 11/17/2022]
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19
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Moreau C, Lefevre CR, Decaux O. How to quantify monoclonal free light chains in plasma cell disorders: which mass spectrometry technology? Ann Transl Med 2020; 8:973. [PMID: 32953773 PMCID: PMC7475393 DOI: 10.21037/atm.2020.03.200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Caroline Moreau
- Biochemistry Laboratory, Pontchaillou Hospital CHU Rennes, Rennes, France.,Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de Recherche en Santé, Environment et Travail) UMR_S 1085, Rennes, France
| | - Charles R Lefevre
- Biochemistry Laboratory, Pontchaillou Hospital CHU Rennes, Rennes, France.,Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de Recherche en Santé, Environment et Travail) UMR_S 1085, Rennes, France
| | - Olivier Decaux
- Internal Medicine, CHU Rennes, Rennes, France.,Hematology, Pontchaillou Hospital CHU Rennes, Rennes, France
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20
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Cherel B, Humbert M, LeBlanc FR, Zambello R, Hamidou M, Lifermann F, Montani D, Leoncin M, Decaux O, Pastoret C, Le Bourgeois A, Dominique S, Chabanne C, Loughran TP, Lamy T. Large Granular Lymphocyte Leukemia and Precapillary Pulmonary Hypertension. Chest 2020; 158:2602-2609. [PMID: 32919988 DOI: 10.1016/j.chest.2020.07.094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/30/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Brieuc Cherel
- Department of Hematology, Pontchaillou University Hospital, Rennes, France
| | - Marc Humbert
- Paris-Sud University, Faculty of Medicine, Paris-Saclay University, Le Kremlin-Bicêtre, Paris, France; Department of Pulmonary Medicine, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, Paris, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Paris, France
| | | | - Renato Zambello
- Department of Medicine, Hematology and Clinical Immunology, Padua School of Medicine, Padua, Italy
| | - Mohamed Hamidou
- Department of Internal Medicine, Hôtel-Dieu University Hospital, Nantes, France
| | | | - David Montani
- Department of Pulmonary Medicine, Hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, Paris, France
| | - Matteo Leoncin
- Department of Medicine, Hematology and Clinical Immunology, Padua School of Medicine, Padua, Italy
| | - Olivier Decaux
- Department of Hematology, Pontchaillou University Hospital, Rennes, France; Department of Internal Medicine, Hôpital Sud University Hospital, Rennes, France
| | - Cedric Pastoret
- Laboratory of Hematology, Pontchaillou University Hospital, Rennes, France
| | | | - Stéphane Dominique
- Department of Pulmonary Medicine, Charles-Nicolle University Hospital, Rouen, France
| | - Céline Chabanne
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, Rennes, France
| | | | - Thierry Lamy
- Department of Hematology, Pontchaillou University Hospital, Rennes, France; Clinical Investigation Center CIC14-14, Pontchaillou University Hospital, Rennes, France.
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21
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Bosseboeuf A, Mennesson N, Allain-Maillet S, Tallet A, Piver E, Decaux O, Moreau C, Moreau P, Lehours P, Mégraud F, Salle V, Bigot-Corbel E, Harb J, Hermouet S. Characteristics of MGUS and Multiple Myeloma According to the Target of Monoclonal Immunoglobulins, Glucosylsphingosine, or Epstein-Barr Virus EBNA-1. Cancers (Basel) 2020; 12:cancers12051254. [PMID: 32429322 PMCID: PMC7281552 DOI: 10.3390/cancers12051254] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 12/21/2022] Open
Abstract
Chronic stimulation by infectious or self-antigens initiates subsets of monoclonal gammopathies of undetermined significance (MGUS), smoldering multiple myeloma (SMM), or multiple myeloma (MM). Recently, glucosylsphingosine (GlcSph) was reported to be the target of one third of monoclonal immunoglobulins (Igs). In this study of 233 patients (137 MGUS, 6 SMM, 90 MM), we analyzed the GlcSph-reactivity of monoclonal Igs and non-clonal Igs. The presence of GlcSph-reactive Igs in serum was unexpectedly frequent, detected for 103/233 (44.2%) patients. However, GlcSph was targeted by the patient’s monoclonal Ig for only 37 patients (15.9%); for other patients (44 MGUS, 22 MM), the GlcSph-reactive Igs were non-clonal. Then, the characteristics of patients were examined: compared to MM with an Epstein-Barr virus EBNA-1-reactive monoclonal Ig, MM patients with a GlcSph-reactive monoclonal Ig had a mild presentation. The inflammation profiles of patients were similar except for moderately elevated levels of 4 cytokines for patients with GlcSph-reactive Igs. In summary, our study highlights the importance of analyzing clonal Igs separately from non-clonal Igs and shows that, if autoimmune responses to GlcSph are frequent in MGUS/SMM and MM, GlcSph presumably represents the initial pathogenic event for ~16% cases. Importantly, GlcSph-initiated MM appears to be a mild form of MM disease.
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Affiliation(s)
- Adrien Bosseboeuf
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Inserm, Université de Nantes, Université d’Angers, 44000 Nantes, France; (A.B.); (N.M.); (S.A.-M.); (E.B.-C.); (J.H.)
| | - Nicolas Mennesson
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Inserm, Université de Nantes, Université d’Angers, 44000 Nantes, France; (A.B.); (N.M.); (S.A.-M.); (E.B.-C.); (J.H.)
| | - Sophie Allain-Maillet
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Inserm, Université de Nantes, Université d’Angers, 44000 Nantes, France; (A.B.); (N.M.); (S.A.-M.); (E.B.-C.); (J.H.)
| | - Anne Tallet
- Laboratoire de Biochimie, Centre Hospitalier Universitaire (CHU) Tours, 37000 Tours, France; (A.T.); (E.P.)
| | - Eric Piver
- Laboratoire de Biochimie, Centre Hospitalier Universitaire (CHU) Tours, 37000 Tours, France; (A.T.); (E.P.)
- Inserm UMR966, 37000 Tours, France
| | | | | | | | - Philippe Lehours
- Laboratoire de Bactériologie, CHU Bordeaux, 33000 Bordeaux, France; (P.L.); (F.M.)
- Inserm U1053, Université de Bordeaux, 33000 Bordeaux, France
| | - Francis Mégraud
- Laboratoire de Bactériologie, CHU Bordeaux, 33000 Bordeaux, France; (P.L.); (F.M.)
- Inserm U1053, Université de Bordeaux, 33000 Bordeaux, France
| | - Valéry Salle
- Médecine Interne et Maladies Systémiques, CHU Amiens, 80000 Amiens, France;
| | - Edith Bigot-Corbel
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Inserm, Université de Nantes, Université d’Angers, 44000 Nantes, France; (A.B.); (N.M.); (S.A.-M.); (E.B.-C.); (J.H.)
- Laboratoire de Biochimie, CHU Nantes, 44000 Nantes, France
| | - Jean Harb
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Inserm, Université de Nantes, Université d’Angers, 44000 Nantes, France; (A.B.); (N.M.); (S.A.-M.); (E.B.-C.); (J.H.)
- Laboratoire de Biochimie, CHU Nantes, 44000 Nantes, France
- Centre de Recherche en Transplantation et Immunologie (CRTI), UMR1064, Inserm, Université de Nantes, 44000 Nantes, France
| | - Sylvie Hermouet
- Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Inserm, Université de Nantes, Université d’Angers, 44000 Nantes, France; (A.B.); (N.M.); (S.A.-M.); (E.B.-C.); (J.H.)
- Laboratoire d’Hématologie, CHU Nantes, 44000 Nantes, France
- Correspondence: ; Tel.: +33-2-28-08-03-55
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22
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Roupie AL, de Boysson H, Thietart S, Carrat F, Seguier J, Terriou L, Versini M, Queyrel V, Groh M, Benhamou Y, Maurier F, Decaux O, d'Aveni M, Rossignol J, Galland J, Solary E, Willems L, Schleinitz N, Ades L, Dellal A, Samson M, Aouba A, Fenaux P, Fain O, Mekinian A. Giant-cell arteritis associated with myelodysplastic syndrome: French multicenter case control study and literature review. Autoimmun Rev 2019; 19:102446. [PMID: 31838164 DOI: 10.1016/j.autrev.2019.102446] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 09/13/2019] [Accepted: 09/15/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Myelodysplastic syndromes (MDS) and MDS/myeloproliferative neoplasms (MDS/MPN) can be associated with giant cell arteritis (GCA). In this nationwide study by the "French Network of dysimmune disorders associated with hemopathies" (MINHEMON) the objective was to evaluate characteristics, treatment and outcome of GCA MDS-MDS/MPN. PATIENTS AND METHODS Retrospective analysis of patients that presented a MDS or MDS/MPN associated with GCA. Treatment efficiency, relapse-free and overall survival of GCA MDS-MDS/MPN were compared to GCA alone. RESULTS Twenty-one patients with GCA MDS-MDS/MPN were included with median age 76 [42-92], M/F ratio 2.5, 8 MDS with multilineage dysplasia (38%), 4 chronic myelomonocytic leukemia (19%), at low or intermediate risk according to IPPS and IPSS-R. The prevalence of headaches, jaw claudication and anterior ischemic optic neuropathy was significantly lower in patients with GCA MDS-MDS/MPN compared to idiopathic GCA (14.3%, 0% and 0% versus 30%, 25%, and 25%, respectively; p < .05). Other clinical and histology findings were similar. All GCA patients received steroid therapy as first-line treatment. Complete or partial response was observed in 14 GCA MDS-MDS/MPN patients (66.7%), of whom 6 (28.6%) received combined immunosuppressive therapies (versus 10% of idiopathic GCA; p = .07). Relapse incidence was similar in the two groups. Steroid dependence was more frequent among GCA MDS-MDS/MPN patients (12 (57%) versus 18 (22.5%); p < .05). Relapse-free and steroid-free survivals were significantly decreased in GCA MDS-MDS/MPN patients (log rank 0.002 and 0.049 respectively), but not overall survival. CONCLUSION Characteristics of GCA MDS-MDS/MPN seem different than idiopathic GCA, with a distinct clinical phenotype and poorer outcome with a higher risk of steroid dependence and relapse.
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Affiliation(s)
- Anne Laure Roupie
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Hubert de Boysson
- Department of Internal Medicine, CHU Caen, Avenue de la côte de nacre, 14033 Caen, France
| | - Sara Thietart
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, AP-HP, Hôpital Saint Antoine, F75012 Paris, France
| | - Julie Seguier
- Department of Internal Medicine, CHU Marseille, Marseille, France
| | - Louis Terriou
- Department of Internal Medicine, CHU Lille, Lille, France
| | | | | | - Matthieu Groh
- Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndromes (CEREO), Foch hospital, Suresnes, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Rouen, Rouen, France
| | - Francois Maurier
- Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France
| | - Olivier Decaux
- Department of Internal Medicine, CHU Rennes, Rennes, France
| | - Maud d'Aveni
- Department of Hematology, CHU Nancy, Nancy, France
| | - Julien Rossignol
- Department of Hematology, Gustave Roussy Cancer Center, 94805 Villejuif, France
| | - Joris Galland
- Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France
| | - Eric Solary
- Department of Hematology, Gustave Roussy Cancer Center, 94805 Villejuif, France
| | - Lise Willems
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, 75014 Paris, France
| | | | - Lionel Ades
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Azeddine Dellal
- Department of Rheumatology, Montfermeil Hospital, 93370 Montfermeil, France
| | - Maxime Samson
- Department of Internal Medicine, CHU Dijon, Dijon, France
| | - Achille Aouba
- Department of Internal Medicine, CHU Caen, Avenue de la côte de nacre, 14033 Caen, France
| | - Pierre Fenaux
- Department of Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
| | - Olivier Fain
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Arsène Mekinian
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France Sorbonne Université, France; Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), Paris, France.
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23
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Roupie A, Fain O, Mekinian A, Terrier B, Regent A, de Boysson H, Carrat F, Seguier J, Terriou L, Versini M, Queyrel V, Groh M, Benhamou Y, Maurier F, Decaux O, Le Clech L, d’Aveni M, Rossignol J, Gal J. Vascularites associées aux syndromes myélodysplasiques : étude de cas multicentrique française. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.074] [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: 11/25/2022]
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24
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Durham BH, Lopez Rodrigo E, Picarsic J, Abramson D, Rotemberg V, De Munck S, Pannecoucke E, Lu SX, Pastore A, Yoshimi A, Mandelker D, Ceyhan-Birsoy O, Ulaner GA, Walsh M, Yabe M, Petrova-Drus K, Arcila ME, Ladanyi M, Solit DB, Berger MF, Hyman DM, Lacouture ME, Erickson C, Saganty R, Ki M, Dunkel IJ, Santa-María López V, Mora J, Haroche J, Emile JF, Decaux O, Geissmann F, Savvides SN, Drilon A, Diamond EL, Abdel-Wahab O. Activating mutations in CSF1R and additional receptor tyrosine kinases in histiocytic neoplasms. Nat Med 2019; 25:1839-1842. [PMID: 31768065 PMCID: PMC6898787 DOI: 10.1038/s41591-019-0653-6] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [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: 05/28/2019] [Accepted: 10/17/2019] [Indexed: 12/14/2022]
Abstract
Histiocytoses are clonal hematopoietic disorders frequently driven by mutations in BRAF and MEK1/2 kinases. Currently, however, the developmental origins of histiocytoses in patients are not well understood, and clinically meaningful therapeutic targets outside of BRAF and MEK are undefined. Here we uncover activating mutations in CSF-1R, as well as rearrangements in RET and ALK which confer dramatic responses to selective inhibition of RET (selpercatinib) and crizotinib, respectively, in histiocytosis patients.
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Affiliation(s)
- Benjamin H Durham
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Estibaliz Lopez Rodrigo
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer Picarsic
- UPMC Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - David Abramson
- Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Veronica Rotemberg
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Steven De Munck
- Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Erwin Pannecoucke
- Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Sydney X Lu
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alessandro Pastore
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Akihide Yoshimi
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Diana Mandelker
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ozge Ceyhan-Birsoy
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gary A Ulaner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael Walsh
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mariko Yabe
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kseniya Petrova-Drus
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria E Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc Ladanyi
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David B Solit
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael F Berger
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David M Hyman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mario E Lacouture
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Caroline Erickson
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ruth Saganty
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Ki
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ira J Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Jaume Mora
- Division of Pediatric Oncology, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Julien Haroche
- Department of Internal Medicine, Assistance Publique-Hôpitaux de Paris, Centre de référence des histiocytosesUniversity Hospital La Pitié-Salpêtrière, Paris, France
| | - Jean-Francois Emile
- Department of Pathology, APHP, University Hospital Ambroise Paré, Boulogne, France
| | - Olivier Decaux
- Service d'Hématologie Clinique, Hôpital Pontchaillou CHU Rennes, Rennes, France
| | - Frederic Geissmann
- Immunology Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Savvas N Savvides
- Department of Biochemistry and Microbiology, Ghent University, Ghent, Belgium.,VIB-UGent Center for Inflammation Research, Ghent, Belgium
| | - Alexander Drilon
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Omar Abdel-Wahab
- Human Oncology and Pathogenesis Program, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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25
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Alix L, Néel A, Cador B, Smail A, Serratrice J, Closs-Prophette F, Jego P, Devillers A, Decaux O. Diagnostic value of 18-F fluorodeoxyglucose PET/CT and bone scan in Schnitzler syndrome. Autoimmunity 2019; 52:264-271. [PMID: 31646899 DOI: 10.1080/08916934.2019.1680649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: Schnitzler syndrome is an auto-inflammatory disease defined by chronic urticarial eruption and monoclonal gammopathy. 18F fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is often performed, but its utility in Schnitzler syndrome has not been specifically investigated. The aim of this study was to determine whether PET/CT is informative in the diagnosis and follow-up of Schnitzler syndrome relative to other imaging techniques, including bone scans.Patients and methods: Patients of this study were selected from the French cohort established by Néel et al. All patients with a diagnosis of Schnitzler syndrome (according to Strasbourg's and Lipsker's criteria) who had at least one PET/CT were included. Data were collected from medical records. PET/CT scans were all reviewed by a nuclear physician blinded to the clinical and imaging data.Results: Ten patients underwent at least one PET/CT scan and all had at least one 99mTechnetium bone scan during their follow-up. The most frequent PET/CT abnormalities were diffuse bone-marrow and/or increased femoral fluorodeoxyglucose uptake, but they did not correlate with disease activity. Conversely, bone-scan abnormalities, including mainly increased radiotracer uptake in long bones, appeared to strongly correlate with Schnitzler syndrome activity.Discussion: PET/CT does not appear to be useful for the diagnosis and follow-up of Schnitzler syndrome. However, bone scans appear to be more sensitive for diagnosis and may correlate with clinical activity. Bone scans may be well positioned to distinguish Schnitzler syndrome relapse from other aetiologies of bone, joint, or muscle pain.Conclusion: Bone scans may be favoured over PET/CT in Schnitzler syndrome.
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Affiliation(s)
- L Alix
- Internal Medicine Department, Rennes University Hospital, Rennes, France
| | - A Néel
- Internal Medicine Department, Nantes University Hospital, Nantes, France
| | - B Cador
- Internal Medicine Department, Rennes University Hospital, Rennes, France
| | - A Smail
- Internal Medicine Department, Amiens University Hospital, Amiens, France
| | - J Serratrice
- Internal Medicine Department, Geneva University Hospital, Geneva, Switzerland
| | | | - P Jego
- Internal Medicine Department, Rennes University Hospital, Rennes, France
| | - A Devillers
- Nuclear Medicine Department, Regional Center for the Fight against Cancer, Rennes, France
| | - O Decaux
- Internal Medicine Department, Rennes University Hospital, Rennes, France
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26
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Jaccard A, Karlin L, Hebraud B, Frenzel L, Choquet S, Mohty M, Dib M, Vincent L, Slama B, Galicier L, Tournilhac O, Belhadj-Merzoug K, Moreau P, Decaux O, Benboubker L, Caillot D, Fontan J, Maisonneuve H, Bender S, Musset L, Fermand JP. A Prospective Phase II Trial of Lenalidomide and Dexamethasone in POEMS Syndrome. Clinical Lymphoma Myeloma and Leukemia 2019. [DOI: 10.1016/j.clml.2019.09.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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27
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Pertesi M, Vallée M, Wei X, Revuelta MV, Galia P, Demangel D, Oliver J, Foll M, Chen S, Perrial E, Garderet L, Corre J, Leleu X, Boyle EM, Decaux O, Rodon P, Kolb B, Slama B, Mineur P, Voog E, Le Bris C, Fontan J, Maigre M, Beaumont M, Azais I, Sobol H, Vignon M, Royer B, Perrot A, Fuzibet JG, Dorvaux V, Anglaret B, Cony-Makhoul P, Berthou C, Desquesnes F, Pegourie B, Leyvraz S, Mosser L, Frenkiel N, Augeul-Meunier K, Leduc I, Leyronnas C, Voillat L, Casassus P, Mathiot C, Cheron N, Paubelle E, Moreau P, Bignon YJ, Joly B, Bourquard P, Caillot D, Naman H, Rigaudeau S, Marit G, Macro M, Lambrecht I, Cliquennois M, Vincent L, Helias P, Avet-Loiseau H, Moreno V, Reis RM, Varkonyi J, Kruszewski M, Vangsted AJ, Jurczyszyn A, Zaucha JM, Sainz J, Krawczyk-Kulis M, Wątek M, Pelosini M, Iskierka-Jażdżewska E, Grząśko N, Martinez-Lopez J, Jerez A, Campa D, Buda G, Lesueur F, Dudziński M, García-Sanz R, Nagler A, Rymko M, Jamroziak K, Butrym A, Canzian F, Obazee O, Nilsson B, Klein RJ, Lipkin SM, McKay JD, Dumontet C. Exome sequencing identifies germline variants in DIS3 in familial multiple myeloma. Leukemia 2019; 33:2324-2330. [PMID: 30967618 PMCID: PMC6756025 DOI: 10.1038/s41375-019-0452-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Maroulio Pertesi
- Genetic Cancer Susceptibility, International Agency for Research on Cancer, Lyon, France
- Department of Laboratory Medicine, Division of Hematology and Transfusion medicine, Lund University, Lund, Sweden
| | - Maxime Vallée
- Genetic Cancer Susceptibility, International Agency for Research on Cancer, Lyon, France
| | - Xiaomu Wei
- Biological Statistics and Computational Biology, Cornell University, Ithaca, NY, USA
| | | | - Perrine Galia
- ProfilExpert, Lyon, France
- Hospices Civils de Lyon, Lyon, France
| | | | - Javier Oliver
- Genetic Cancer Susceptibility, International Agency for Research on Cancer, Lyon, France
- Medical Oncology Service, Hospitales Universitarios Regional y Virgen de la Victoria; Institute of Biomedical Research in Malaga (IBIMA), CIMES, University of Málaga, Málaga, Spain
| | - Matthieu Foll
- Genetic Cancer Susceptibility, International Agency for Research on Cancer, Lyon, France
| | - Siwei Chen
- Biological Statistics and Computational Biology, Cornell University, Ithaca, NY, USA
| | - Emeline Perrial
- INSERM 1052, CNRS 5286, CRCL, Lyon, France
- University of Lyon, Lyon, France
| | - Laurent Garderet
- INSERM, UMR_S 938, Paris, France
- AP-HP, Hôpital Saint Antoine, Departement d'hematologie et de therapie cellulaire, Paris, France
- Sorbonne Universites, UPMC Univ Paris 06, UMR_S 938, Paris, France
| | - Jill Corre
- IUC-Oncopole and CRCT INSERM U1037, Toulouse, France
| | - Xavier Leleu
- Inserm CIC 1402 & Service d'Hématologie et Thérapie Cellulaire, CHU La Miletrie, Poitiers, France
| | | | - Olivier Decaux
- Service de Medecine Interne, CHU Rennes, Rennes, France
- Faculte de Medecine, Universite de Rennes 1, Rennes, France
- INSERM UMR U1236, Rennes, France
| | - Philippe Rodon
- Unite d'Hematologie et d'Oncologie, Centre Hospitalier, Perigueux, France
| | | | - Borhane Slama
- Service d'Onco hematologie, CH Avignon, Avignon, France
| | - Philippe Mineur
- Hematologie et pathologies de la coagulation, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Eric Voog
- Centre Jean Bernard, Institut Inter-regional de Cancerologie, Le Mans, France
| | - Catherine Le Bris
- Service post urgences, CHU de FORT DE FRANCE, pôle RASSUR, Martinique, France
| | - Jean Fontan
- Hopital Jean Minjoz, CHRU Besançon, Besançon, France
| | - Michel Maigre
- Service d'Hemato-Oncologie, CHU Chartres, Chartres, France
| | - Marie Beaumont
- Hematologie clinique et therapie cellulaire, CHU Amiens, Amiens, France
| | | | - Hagay Sobol
- Cancer Genetics Department, Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | | | - Bruno Royer
- Service d'Immuno-hematologie, Hôpital Saint Louis, Paris, France
| | - Aurore Perrot
- Service d'Hematologie, CHU de Nancy, Universite de Lorraine, Vandoeuvre les Nancy, Nancy, France
| | | | | | | | - Pascale Cony-Makhoul
- Service d'Hematologie, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France
| | | | | | | | - Serge Leyvraz
- Departement d'oncologie, CHUV, Lausanne, Switzerland
| | - Laurent Mosser
- Unite d'oncologie medicale, Pôle medical 2, Hôpital Jacques Puel, Rodez, France
| | | | - Karine Augeul-Meunier
- Service Hematologie, Institut de Cancerologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | | | - Cécile Leyronnas
- Institut Daniel Hollard, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Laurent Voillat
- Service hemato/oncologie, CH William Morey, Chalon sur Saône, France
| | | | - Claire Mathiot
- Intergroupe Francophone du Myelome (IFM), Bobigny, France
| | | | | | | | - Yves-Jean Bignon
- Laboratoire de Biologie Medicale OncoGènAuvergne; Departement d'oncogenetique, UMR INSERM 1240, Centre Jean Perrin, Clermont-Ferrand, France
| | - Bertrand Joly
- Service d'hematologie clinique, Pôle medecine de specialite, Centre Hospitalier Sud Francilien (CHSF), Corbeil-Essonnes, France
| | | | | | - Hervé Naman
- Hematologie - Oncologie medicale, Centre Azureen de Cancerologie, Mougins, France
| | - Sophie Rigaudeau
- Service d'Hematologie et d'Oncologie, CHU de Versailles, Le Chesnay, France
| | - Gérald Marit
- INSERM U1035, Universite de Bordeaux, Bordeaux, France
| | - Margaret Macro
- Hematologie Clinique, IHBN-CHU CAEN (University Hospital), Caen, France
| | - Isabelle Lambrecht
- Rheumatology Department, Maison Blanche Hospital, Reims University Hospitals, Reims, France
| | - Manuel Cliquennois
- Unite d'Hematologie clinique, Groupement des hôpitaux de l'Institut Catholique (GHICL), Universite Catholique de Lille, Lille, France
| | - Laure Vincent
- Departement d'hematologie clinique, CHU de Montpellier, Montpellier, France
| | - Philippe Helias
- Service d'Oncologie medicale, CHU de La Guadeloupe, Pointe-a-Pitre, Guadeloupe
| | - Hervé Avet-Loiseau
- Laboratory for Genomics in Myeloma, Institut Universitaire du Cancer and University Hospital, Centre de Recherche en Cancerologie de Toulouse, Toulouse, France
| | - Victor Moreno
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Unit of Biomarkers and Susceptibility, Cancer Prevention and Control Program, IDIBELL, Catalan Institute of Oncology; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Rui Manuel Reis
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Judit Varkonyi
- 3rd Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | | | - Annette Juul Vangsted
- Department of Haematology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Artur Jurczyszyn
- Jagiellonian University Medical College, Department of Hematology, Cracow, Poland
| | - Jan Maciej Zaucha
- Gdynia Oncology Center, Gdynia and Department of Oncological Propedeutics, Medical University of Gdańsk, Gdańsk, Poland
| | - Juan Sainz
- Genomic Oncology Area, GENYO. Centre for Genomics and Oncological Research: Pfizer/University of Granada/Andalusian Regional Government, PTS Granada, Granada, Spain
| | - Malgorzata Krawczyk-Kulis
- Department of Bone Marrow Transplantation and Hematology-Oncology M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Marzena Wątek
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
- Holycross Cancer Center of Kielce, Hematology Clinic, Kielce, Poland
| | - Matteo Pelosini
- Department of Oncology, Transplants and Advanced Technologies, Section of Hematology, Pisa University Hospital, Pisa, Italy
| | | | - Norbert Grząśko
- Department of Experimental Hemato-oncology, Medical University of Lubli, Poland; Department of Hematology, St. John's Cancer Centre, Polish Myeloma Study Group, Lublin, Poland
| | - Joaquin Martinez-Lopez
- Hematology Department, Hospital 12 de Octubre, Universidad Complutense; CNIO, Madrid, Spain
| | - Andrés Jerez
- Hematology and Medical Oncology Department, Hospital Morales Meseguer, IMIB, Murcia, Spain
| | - Daniele Campa
- Department of Biology, University of Pisa, Pisa, Italy
| | - Gabriele Buda
- Holycross Cancer Center of Kielce, Hematology Clinic, Kielce, Poland
| | - Fabienne Lesueur
- Inserm U900, Institut Curie, PSL Research University, Mines ParisTech, Paris, France
| | | | - Ramón García-Sanz
- Hematology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Marcin Rymko
- Department of Hematology, Copernicus Hospital, Torun, Poland
| | - Krzysztof Jamroziak
- Department of Hematology, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Federico Canzian
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ofure Obazee
- Genomic Epidemiology Group, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Björn Nilsson
- Department of Laboratory Medicine, Division of Hematology and Transfusion medicine, Lund University, Lund, Sweden
| | - Robert J Klein
- Department of Genetics and Genomic Sciences and Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - James D McKay
- Genetic Cancer Susceptibility, International Agency for Research on Cancer, Lyon, France.
| | - Charles Dumontet
- ProfilExpert, Lyon, France.
- Hospices Civils de Lyon, Lyon, France.
- INSERM 1052, CNRS 5286, CRCL, Lyon, France.
- University of Lyon, Lyon, France.
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Henriot B, Rouger E, Rousseau C, Escoffre M, Sébillot M, Bendavid C, Minvielle S, Avet-Loiseau H, Decaux O, Moreau C. Prognostic value of involved/uninvolved free light chain ratio determined by Freelite and N Latex FLC assays for identification of high-risk smoldering myeloma patients. ACTA ACUST UNITED AC 2019; 57:1397-1405. [DOI: 10.1515/cclm-2018-1369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/15/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Smoldering multiple myeloma (SMM) is an asymptomatic plasma cell disorder with a high risk of progression to symptomatic multiple myeloma (MM). The serum free light chain (sFLC) ratio is a powerful prognostic factor for SMM: an sFLC ratio ≥8 has been reported to be associated with a high risk of progression to MM, and an sFLC ratio ≥100 has been described as a criterion for ultra-high-risk SMM, and has been integrated into the definition criteria for MM since 2014. However, all recommendations were based on sFLC measured using the first commercialized assay, Freelite™, while other assays are now available. We aimed to evaluate the safety and accuracy of N-Latex sFLC to identify high-risk and ultra-high-risk SMM.
Methods
The sFLC ratio was measured at diagnosis with both Freelite and N-Latex assays in a cohort of 176 SMM patients on a BN Prospec nephelometer. Demographic, clinical, therapeutic and laboratory data were collected at the time of diagnosis and at follow-up.
Results
Sixty-two patients (35.2%) progressed to MM within 2 years. Compared to Freelite™ sFLC, N Latex sFLC ratios ≥8 and ≥100 provided similar performances for the identification of high-risk and ultra-high risk SMM patients.
Conclusions
Our results evidenced that the N-Latex assay could be used for SMM monitoring, like Freelite. However, an N-Latex sFLC ratio ≥70 appears to provide similar performances to a Freelite sFLC ratio ≥100, with a slightly better positive predictive value. Both assays provided accurate identification of high-risk and ultra-high risk SMM patients. These results should be confirmed in an independent study.
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Perrot A, Lauwers-Cances V, Tournay E, Hulin C, Chretien ML, Royer B, Dib M, Decaux O, Jaccard A, Belhadj K, Brechignac S, Fontan J, Voillat L, Demarquette H, Collet P, Rodon P, Sohn C, Lifermann F, Orsini-Piocelle F, Richez V, Mohty M, Macro M, Minvielle S, Moreau P, Leleu X, Facon T, Attal M, Avet-Loiseau H, Corre J. Development and Validation of a Cytogenetic Prognostic Index Predicting Survival in Multiple Myeloma. J Clin Oncol 2019; 37:1657-1665. [PMID: 31091136 PMCID: PMC6804890 DOI: 10.1200/jco.18.00776] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The wide heterogeneity in multiple myeloma (MM) outcome is driven mainly by cytogenetic abnormalities. The current definition of high-risk profile is restrictive and oversimplified. To adapt MM treatment to risk, we need to better define a cytogenetic risk classification. To address this issue, we simultaneously examined the prognostic impact of del(17p); t(4;14); del(1p32); 1q21 gain; and trisomies 3, 5, and 21 in a cohort of newly diagnosed patients with MM. METHODS Data were obtained from 1,635 patients enrolled in four trials implemented by the Intergroupe Francophone du Myélome. The oldest collection of data were used for model development and internal validation. For external validation, one of the two independent data sets was used to assess the performance of the model in patients treated with more current regimens. Six cytogenetic abnormalities were identified as clinically relevant, and a prognostic index (PI) that was based on the parameter estimates of the multivariable Cox model was computed for all patients. RESULTS In all data sets, a higher PI was consistently associated with a poor survival outcome. Dependent on the validation cohorts used, hazard ratios for patients in the high-risk category for death were between six and 15 times higher than those of patients in the low-risk category. Among patients with t(4;14) or del(17p), we observed a worse survival in those classified in the high-risk category than in those in the intermediate-risk category. The PI showed good performance for discriminating between patients who died and those who survived (Harrell's concordance index greater than 70%). CONCLUSION The cytogenetic PI improves the classification of newly diagnosed patients with MM in the high-risk group compared with current classifications. These findings may facilitate the development of risk-adapted treatment strategies.
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Affiliation(s)
- Aurore Perrot
- Centre Hospitalier Régional Universitaire Nancy, Nancy, France
| | | | - Elodie Tournay
- Centre Hospitalier Universitaire Toulouse, Toulouse, France
| | - Cyrille Hulin
- Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | | | - Bruno Royer
- Centre Hospitalier Universitaire Amiens, Amiens, France
| | - Mamoun Dib
- Centre Hospitalier Universitaire Angers, Angers, France
| | | | - Arnaud Jaccard
- Centre Hospitalier Universitaire Limoges, Limoges, France
| | - Karim Belhadj
- Centre Hospitalier Universitaire Créteil, Créteil, France
| | | | - Jean Fontan
- Centre Hospitalier Universitaire Besancon, Besançon, France
| | - Laurent Voillat
- Centre Hospitalier Chalon sur Saône William Morey, Chalon-sur-Saône, France
| | | | - Philippe Collet
- Centre Hospitalier Universitaire Saint-Étienne, Saint-Étienne, France
| | | | | | | | | | | | - Mohamad Mohty
- Centre Hospitalier Universitaire Paris, Paris, France
| | - Margaret Macro
- Centre Hospitalier Universitaire Caen Normandie, Caen, France
| | | | | | - Xavier Leleu
- Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Thierry Facon
- Centre Hospitalier Régional Universitaire Lille, Lille, France
| | - Michel Attal
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancérologie de Toulouse Institut National de la Santé et de la Recherche Médicale, Toulouse, France
| | - Hervé Avet-Loiseau
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancérologie de Toulouse Institut National de la Santé et de la Recherche Médicale, Toulouse, France
| | - Jill Corre
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancérologie de Toulouse Institut National de la Santé et de la Recherche Médicale, Toulouse, France
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Pegourie B, Karlin L, Benboubker L, Orsini‐Piocelle F, Tiab M, Auger‐Quittet S, Rodon P, Royer B, Leleu X, Bareau B, Cliquennois M, Fuzibet J, Voog E, Belhadj‐Merzoug K, Decaux O, Rey P, Slama B, Leyronnas C, Zarnitsky C, Boyle E, Bosson JL, Pernod G. Apixaban for the prevention of thromboembolism in immunomodulatory-treated myeloma patients: Myelaxat, a phase 2 pilot study. Am J Hematol 2019; 94:635-640. [PMID: 30859608 DOI: 10.1002/ajh.25459] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 01/06/2023]
Abstract
The risk of venous thromboembolism (VTE) is higher in myeloma patients receiving immunomodulatory compounds. A VTE prophylaxis using low-molecular-weight heparin or aspirin is therefore proposed. Apixaban is an oral direct anti-Xa. Several studies have shown the efficacy and safety of apixaban in VTE prophylaxis compared to enoxaparin. The objective of this prospective phase 2 pilot study was to assess the risk of VTE and bleeding in patients with myeloma treated with immunomodulatory compounds lenalidomide (len) or thalidomide (thal), using apixaban in a preventive scheme. Myeloma patients requiring Melphalan-Prednisone-Thalidomide in the first line, or Lenalidomide-Dexamethasone in the relapse setting received apixaban, 2.5 mg x 2/day for 6 months. Venous (pulmonary embolism-PE, or symptomatic proximal or distal deep vein thrombosis-DVT, or all proximal asymptomatic events detected by systematic proximal bilateral compression ultrasound) or arterial thrombotic events, and bleeding events (ISTH 2005) were registered. One hundred and four patients were enrolled (mean age 69.8 ± 7.8 years), 11 in first line and 93 in relapse. Two venous thrombotic events were observed, for example, an asymptomatic proximal DVT and a symptomatic distal DVT, in the context of apixaban stopped 14 days before, due to lenalidomide-induced thrombocytopenia. No PE or arterial cardiovascular events were reported. Only one major and 11 CRNM hemorrhages were reported. These data must now be confirmed on a randomized large study.
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Affiliation(s)
- Brigitte Pegourie
- Department of HematologyUniversity Hospital Grenoble‐Alpes Grenoble Auvergne‐Rhône‐Alpes France
| | - Lionel Karlin
- Department of HematologyUniversity Hospital Lyon Lyon Auvergne‐Rhône‐Alpes France
| | - Lotfi Benboubker
- Department of HematologyUniversity Hospital Tours Tours Centre‐Val de Loire France
| | | | - Mourad Tiab
- Department of Clinical HematologyHospital de Vendée La Roche sur Yon Pays de la Loire France
| | | | - Philippe Rodon
- Department of HematologyHospital Perigueux Perigueux Dordogne France
| | - Bruno Royer
- Department of HematologyUniversity Hospital Saint Louis Paris Île‐de‐France France
| | - Xavier Leleu
- Department of HematologyUniversity Hospital Poitiers Poitiers Nouvelle‐Aquitaine France
| | - Benoit Bareau
- Department of HematologyHôpital Privé Sévigné ‐ Pôle Santé Ouest Vivalto Cesson Sévigné Brittany France
| | - Manuel Cliquennois
- Department of HematologyHospital St Vincent de Paul Lille Hauts‐de‐France France
| | - Jean‐Gabriel Fuzibet
- Department of HematologyUniversity Hospital Nice Nice Provence‐Alpes‐Côte d'Azur France
| | - Eric Voog
- Department of OncologyCentre Jean Bernard Le Mans Pays de la Loire France
| | - Karim Belhadj‐Merzoug
- Department of HematologyUniversity Hospital Henri Mondor Créteil Île‐de‐France France
| | - Olivier Decaux
- Department of HematologyUniversity Hospital Rennes Brittany France
| | - Philippe Rey
- Department of HematologyCentre Léon Bérard Lyon Auvergne‐Rhône‐Alpes France
| | - Bohrane Slama
- Department of Clinical HematologyCH Avignon Avignon Provence‐Alpes‐Côte d'Azur France
| | - Cecile Leyronnas
- Department of Clinical HematologyInstitut Daniel Hollard Grenoble Auvergne‐Rhône‐Alpes France
| | - Charles Zarnitsky
- Department of Clinical HematologyHospital Le Havre Le Havre Normandy France
| | - Eileen Boyle
- Department of Clinical HematologyUniversity Hospital Lille Lille Hauts‐de‐France France
| | - Jean Luc Bosson
- Department of BiostatisticsUniversity Hospital Grenoble‐Alpes Grenoble Auvergne‐Rhône‐Alpes France
| | - Gilles Pernod
- Department of Vascular MedicineCNRS / TIMC‐IMAG UMR 5525/Themas and F‐CRIN InnoVTE Network Grenoble Auvergne‐Rhône‐Alpes France
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Leleu X, Fouquet G, Richez V, Guidez S, Duhamel A, Machuron F, Karlin L, Kolb B, Tiab M, Araujo C, Meuleman N, Malfuson JV, Bourquard P, Lenain P, Roussel M, Jaccard A, Pétillon MO, Belhadj-Merzoug K, Lepeu G, Chrétien ML, Fontan J, Rodon P, Schmitt A, Offner F, Voillat L, Cereja S, Kuhnowski F, Rigaudeau S, Decaux O, Humbrecht-Kraut C, Frayfer J, Fitoussi O, Roos-Weil D, Eisenmann JC, Dorvaux V, Voog EG, Attal M, Moreau P, Avet-Loiseau H, Hulin C, Facon T. Carfilzomib Weekly plus Melphalan and Prednisone in Newly Diagnosed Transplant-Ineligible Multiple Myeloma (IFM 2012-03): A Phase I Trial. Clin Cancer Res 2019; 25:4224-4230. [PMID: 31053600 DOI: 10.1158/1078-0432.ccr-18-3642] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/18/2019] [Accepted: 04/29/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Carfilzomib is a novel generation proteasome inhibitor. The Carmysap trial demonstrated that twice-weekly KMP (carfilzomib, melphalan, prednisone) might challenge the MPV (melphalan, prednisone, bortezomib) standard. We sought to study KMP weekly, allowing to increase carfilzomib's dose with maintained efficacy and improved safety profile. PATIENTS AND METHODS IFM2012-03, a phase I multicenter study of KMP weekly in elderly patients with newly diagnosed multiple myeloma (eNDMM), aimed to determine the MTD of carfilzomib. Carfilzomib was given intravenously at 36, 45, 56, and 70 mg/m2/day on days 1, 8, 15, and 22 with melphalan and prednisone, for nine 35-day induction cycles, followed by carfilzomib maintenance for 1 year. Three dose-limiting toxicities (DLT) determined MTD at the lower dose. RESULTS Thirty eNDMMs were treated, 6 per cohort at 36, 45, and 56 mg/m2 and 12 at 70 mg/m². There was one DLT at 36 mg/m2 (lymphopenia), one at 45 mg/m2 (lysis syndrome), two at 56 mg/m2 (cardiac insufficiency and febrile neutropenia), and two at 70 mg/m2 (vomiting and elevated liver enzymes). The safety profile was acceptable; however, specific attention must be paid to the risk of cardiovascular events, especially for elderly patients. The overall response rate was 93.3%, with 46.6% complete response. CONCLUSIONS The MTD dose of carfilzomib was 70 mg/m2 in this KMP weekly study in eNDMM. Response rates, and especially CR rate, were remarkable in this population, and would benefit from being assessed in a larger-scale study. The IFM2012-03 study demonstrated that the MTD of carfilzomib weekly is 70 mg/m2 in eNDMM, and 56 mg/m2 for patients older than 75 years. Carfilzomib used weekly in combination has a good efficacy and safety profile in eNDMM.
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Affiliation(s)
- Xavier Leleu
- Hematology and Inserm CIC 1402, CHU Poitiers, France.
| | - Guillemette Fouquet
- Institut Imagine, Inserm U1163 - CNRS ERL8254, Hôpital Necker, Paris, France
| | | | | | - Alain Duhamel
- Université de Lille, CHRU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
| | - François Machuron
- Université de Lille, CHRU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
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Caillon H, Avet-Loiseau H, Attal M, Moreau P, Decaux O, Dejoie T. Comparison of Sebia Free Light Chain Assay With Freelite Assay for the Clinical Management of Diagnosis, Response, and Relapse Assessment in Multiple Myeloma. Clinical Lymphoma Myeloma and Leukemia 2019; 19:e228-e237. [DOI: 10.1016/j.clml.2019.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/17/2019] [Indexed: 02/05/2023]
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Mheidly K, Lamy De La Chapelle T, Hunault M, Benboubker L, Benchalal M, Moreau P, Baugier de Materre A, Decaux O, Laribi K. New insights in the treatment of patients with solitary bone plasmacytoma. Leuk Lymphoma 2019; 60:2810-2813. [PMID: 31020888 DOI: 10.1080/10428194.2019.1605067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Kayane Mheidly
- Department of Hematology, Medical University Hospital, Pontchaillou, Rennes, France.,Department of Hematology, Centre Hospitalier Le Mans, Le Mans, France
| | | | - Mathilde Hunault
- Department of Hematology, Medical University Hospital, Angers, France
| | - Lotfi Benboubker
- Department of Hematology, Medical University Hospital, Tours, France
| | | | - Philippe Moreau
- Department of Hematology, Medical University Hospital, Nantes, France
| | - Alix Baugier de Materre
- Geriatric Department, Rothschild Hospital, Assistance Publique hôpitaux de Paris, Paris, France
| | - Olivier Decaux
- Department of Hematology, Medical University Hospital, Pontchaillou, Rennes, France
| | - Kamel Laribi
- Department of Hematology, Centre Hospitalier Le Mans, Le Mans, France
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Corlu L, Rioux-Leclercq N, Ganard M, Decaux O, Houot R, Vigneau C. Renal Dysfunction in Patients With Direct Infiltration by B-Cell Lymphoma. Kidney Int Rep 2019; 4:688-697. [PMID: 31080924 PMCID: PMC6506703 DOI: 10.1016/j.ekir.2019.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/28/2019] [Accepted: 02/04/2019] [Indexed: 12/29/2022] Open
Abstract
Background B-cell lymphoproliferative disorders with renal involvement are relatively frequent, but remain poorly described. A kidney biopsy is usually required to detect the renal lesions that are often missed using other diagnostic tools. Methods We retrospectively identified 34 patients with renal lymphoma diagnosed by percutaneous kidney biopsy (PKB) at Rennes University Hospital and its affiliated hospital centers between January 1, 2004, and May 1, 2016. Clinical, biological, radiological, and histological characteristics were collected at biopsy time. Results The included patients had Waldenström macroglobulinemia (n = 12; 35.3%), chronic lymphocytic leukemia/lymphocytic lymphoma (n = 10; 29.5%), high-grade B-cell lymphoma (n = 6; 17.6%), and low-grade B-cell lymphoma (n = 6; 17.6%). The median follow-up was 29 months. Renal involvement led to renal function impairment in 29 patients (85.3%), among whom 20 had acute kidney injury (70%), and to nephrotic syndrome in 4 patients (11.8%). Only 13 patients (38.2%) presented morphological kidney anomalies among whom 5 showed bilateral infiltration. Histologically, interstitial infiltrate (97.1%) was the most common kidney lesion, and 9 patients (26.5%) had specific lymphomatous intraglomerular lesions. After hematological treatment (n = 29), a renal response was observed only in 8 patients (27.6%). Conclusion Renal involvement in the context of B-cell lymphoproliferative disorders is not uncommon. PKB is the best method to confirm this diagnosis. It should be performed early to rapidly initiate the hematological treatment to preserve kidney function.
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Affiliation(s)
- Lea Corlu
- CHU de Rennes, Service de Néphrologie, Rennes, France
| | | | - Michel Ganard
- CHU de Rennes, Service d'Hématologie, Rennes, France
| | - Olivier Decaux
- CHU de Rennes, Service de Médecine Interne, Rennes, France
| | - Roch Houot
- CHU de Rennes, Service d'Hématologie, Rennes, France
| | - Cécile Vigneau
- CHU de Rennes, Service de Néphrologie, Rennes, France.,CHU de Rennes, Service d'Anatomo-cytopathologie, Rennes, France.,CHU de Rennes, Service d'Hématologie, Rennes, France.,CHU de Rennes, Service de Médecine Interne, Rennes, France.,IRSET, Rennes, France
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35
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Perrot A, Lauwers-Cances V, Corre J, Robillard N, Hulin C, Chretien ML, Dejoie T, Maheo S, Stoppa AM, Pegourie B, Karlin L, Garderet L, Arnulf B, Doyen C, Meuleman N, Royer B, Eveillard JR, Benboubker L, Dib M, Decaux O, Jaccard A, Belhadj K, Brechignac S, Kolb B, Fohrer C, Mohty M, Macro M, Richardson PG, Carlton V, Moorhead M, Willis T, Faham M, Anderson KC, Harousseau JL, Leleu X, Facon T, Moreau P, Attal M, Avet-Loiseau H, Munshi N. Minimal residual disease negativity using deep sequencing is a major prognostic factor in multiple myeloma. Blood 2018; 132:2456-2464. [PMID: 30249784 PMCID: PMC6284215 DOI: 10.1182/blood-2018-06-858613] [Citation(s) in RCA: 270] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/28/2018] [Indexed: 12/27/2022] Open
Abstract
The introduction of novel agents has led to major improvements in clinical outcomes for patients with multiple myeloma. To shorten evaluation times for new treatments, health agencies are currently examining minimal residual disease (MRD) as a surrogate end point in clinical trials. We assessed the prognostic value of MRD, measured during maintenance therapy by next-generation sequencing (NGS). MRD negativity was defined as the absence of tumor plasma cell within 1 000 000 bone marrow cells (<10-6). Data were analyzed from a recent clinical trial that evaluated the role of transplantation in newly diagnosed myeloma patients treated with lenalidomide, bortezomib, and dexamethasone (RVD). MRD negativity was achieved at least once during maintenance in 127 patients (25%). At the start of maintenance therapy, MRD was a strong prognostic factor for both progression-free survival (adjusted hazard ratio, 0.22; 95% confidence interval, 0.15-0.34; P < .001) and overall survival (adjusted hazard ratio, 0.24; 95% confidence interval, 0.11-0.54; P = .001). Patients who were MRD negative had a higher probability of prolonged progression-free survival than patients with detectable residual disease, regardless of treatment group (RVD vs transplant), cytogenetic risk profile, or International Staging System disease stage at diagnosis. These results were similar after completion of maintenance therapy. Our findings confirm the value of MRD status, as determined by NGS, as a prognostic biomarker in multiple myeloma, and suggest that this approach could be used to adapt treatment strategies in future clinical trials.
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Affiliation(s)
- Aurore Perrot
- Hematology Department, University Hospital, Nancy, France
| | | | - Jill Corre
- Myeloma Genomics Lab University Cancer Institute Toulouse (IUCT)-Oncopole, Cancer Research Center of Toulouse (CRCT), INSERM 1037, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | | | - Cyrille Hulin
- Hematology Department, University Hospital, Bordeaux, France
| | | | - Thomas Dejoie
- Biochemistry Laboratory, University Hospital, Nantes, France
| | - Sabrina Maheo
- Myeloma Genomics Lab University Cancer Institute Toulouse (IUCT)-Oncopole, Cancer Research Center of Toulouse (CRCT), INSERM 1037, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | | | | | - Lionel Karlin
- Hematology Department, University Hospital, Lyon, France
| | - Laurent Garderet
- Hematology Department, Saint-Antoine University Hospital, Paris, France
| | - Bertrand Arnulf
- Hematology Department, Saint-Louis University Hospital, Paris, France
| | - Chantal Doyen
- Hematology Department, Centre Hospitalier Universitaire (CHU) Université Catholique de Louvain (UCL) Namur, Yvoir, Belgium
| | - Nathalie Meuleman
- Hematology Department, Institut Jules Bordet (ULB), Brussels, Belgium
| | - Bruno Royer
- Hematology Department, University Hospital, Amiens, France
| | | | | | - Mamoun Dib
- Hematology Department, University Hospital, Angers, France
| | - Olivier Decaux
- Hematology Department, University Hospital, Rennes, France
| | - Arnaud Jaccard
- Hematology Department, University Hospital, Limoges, France
| | - Karim Belhadj
- Hematology Department, University Hospital, Creteil, France
| | | | - Brigitte Kolb
- Hematology Department, University Hospital, Reims, France
| | - Cecile Fohrer
- Hematology Department, University Hospital, Strasbourg, France
| | - Mohamad Mohty
- Hematology Department, Saint-Antoine University Hospital, Paris, France
| | - Margaret Macro
- Hematology Department, University Hospital, Caen, France
| | | | | | | | | | | | | | | | - Xavier Leleu
- Hematology Department, University Hospital, Poitiers, France
| | - Thierry Facon
- Hematology Department, University Hospital, Lille, France
| | - Philippe Moreau
- Hematology Department, University Hospital, Nantes, France; and
| | - Michel Attal
- Hematology Department, University Hospital, Toulouse, France
| | - Hervé Avet-Loiseau
- Myeloma Genomics Lab University Cancer Institute Toulouse (IUCT)-Oncopole, Cancer Research Center of Toulouse (CRCT), INSERM 1037, Toulouse, France
- Université Paul Sabatier, Toulouse, France
| | - Nikhil Munshi
- Hematology Department, Dana-Farber Cancer Institute, Boston, MA
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Engalenc X, Costedoat-Chalumeau N, Duhaut P, Sailler L, Papo T, Decaux O, Bienvenu B, Lambert M, Preux P, Monteil J, Fauchais A, Ly K. Caractéristiques des patients faux et vrais positifs pour une tomographie à émission de positons au 18FDG couplée au scanner à orientation diagnostique positive faite précocement explorant une fièvre prolongée inexpliquée ou un syndrome inflammatoire nu. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.353] [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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Benbrahim O, Viallard JF, Choquet S, Royer B, Bauduer F, Decaux O, Crave JC, Fardini Y, Clerson P, Lévy V. The use of octagam and gammanorm in immunodeficiency associated with hematological malignancies: a prospective study from 21 French hematology departments. Hematology 2018; 24:173-182. [DOI: 10.1080/10245332.2018.1538001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Omar Benbrahim
- Hôpital de La Source, Centre Hospitalier Régionale Orléans, Orléans, France
| | | | - Sylvain Choquet
- Hématologie, GH Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bruno Royer
- Hématologie Clinique, CHU Amiens – Sud, Amiens, France
| | | | | | | | | | | | - Vincent Lévy
- URC/CRC Groupe Hospitalier Paris Seine Saint Denis, APHP, Hôpital Avicenne, France
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Lescoat A, Dupuy A, Belhomme N, Stock N, Sebillot M, Decaux O, Jégo P, Droitcourt C. Atypical bortezomib-induced neutrophilic dermatosis. Ann Hematol 2018; 98:1315-1316. [PMID: 30315343 DOI: 10.1007/s00277-018-3519-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France. .,Univeristy of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France. .,Department of Internal Medicine, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes cedex 9, France.
| | - Alain Dupuy
- Department of Dermatology, CHU Rennes, University of Rennes 1, INSERM CIC1414, UPRES EA 7449 REPERES (Pharmacoepidemiology and access to health care), University Rennes 1 and French School of Public Health, Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France
| | - Nathalie Stock
- Department of Pathology, CHU Rennes, University of Rennes 1, Rennes, France
| | - Martine Sebillot
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France
| | - Olivier Decaux
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France
| | - Patrick Jégo
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France.,Univeristy of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Catherine Droitcourt
- Department of Dermatology, CHU Rennes, University of Rennes 1, INSERM CIC1414, UPRES EA 7449 REPERES (Pharmacoepidemiology and access to health care), University Rennes 1 and French School of Public Health, Rennes, France
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39
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Decaux O. [Conduct in case of monoclonal gammapathy ?]. Rev Prat 2018; 68:777-784. [PMID: 30869332] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Conduct in case of monoclonal gammapathy ? Monoclonal gammopathies are frequent in general population (about 3 % beyond 50 years) and their prevalence increases with age. They may be associated with malignant haemopathy (multiple myeloma for IgG and IgA, Waldenström disease for IgM). In absence of malignant haemopathy, the diagnosis is that of monoclonal gammopathy of indeterminate significance (MGUS). MGUS accounts for the majority (over 60 %) cases of monoclonal gammopathy. Only patients with multiple myeloma or Waldenström disease require treatment. For MGUS, smoldering myeloma and smoldering Waldenström disease, therapeutic abstention is recommended but regular and prolonged monitoring is necessary given the risk of progression to malignant hemopathy. Given the prevalence of monoclonal gammopathies in general population and the frequency of MGUS, it is rational to limit initial explorations in asymptomatic patients.
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Affiliation(s)
- Olivier Decaux
- CHU de Rennes, service de médecine interne, hôpital Sud, Rennes, France. Faculté de médecine de Rennes, université Rennes-1, Rennes, France
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40
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Decaux O. [Epidemiology of monoclonal gammopathies]. Rev Prat 2018; 68:785-786. [PMID: 30869333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Olivier Decaux
- CHU de Rennes, service de médecine interne, hôpital Sud, Rennes, France. Faculté de médecine de Rennes, université Rennes-1, Rennes, France
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41
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Benbrahim O, Viallard JF, Choquet S, Royer B, Bauduer F, Decaux O, Crave JC, Fardini Y, Clerson P, Lévy V. A French observational study describing the use of human polyvalent immunoglobulins in hematological malignancy-associated secondary immunodeficiency. Eur J Haematol 2018; 101:48-56. [DOI: 10.1111/ejh.13078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Omar Benbrahim
- Hématologie; Hôpital de La Source; CHR Orléans; Orléans France
| | | | - Sylvain Choquet
- Hématologie; GH Pitié Salpêtrière; Assistance Publique-Hôpitaux de Paris; Paris France
| | - Bruno Royer
- Hématologie Clinique; CHU Amiens - Sud; Amiens France
| | | | | | | | | | | | - Vincent Lévy
- URC/CRC Groupe Hospitalier Paris Seine Saint Denis; APHP, Hôpital Avicenne; Bobigny France
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42
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Terrier B, Pagnoux C, Perrodeau É, Karras A, Khouatra C, Aumaître O, Cohen P, Decaux O, Desmurs-Clavel H, Maurier F, Gobert P, Quémeneur T, Blanchard-Delaunay C, Bonnotte B, Carron PL, Daugas E, Ducret M, Godmer P, Hamidou M, Lidove O, Limal N, Puéchal X, Mouthon L, Ravaud P, Guillevin L. Long-term efficacy of remission-maintenance regimens for ANCA-associated vasculitides. Ann Rheum Dis 2018; 77:1150-1156. [DOI: 10.1136/annrheumdis-2017-212768] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 11/04/2022]
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Néel A, Wahbi A, Tessoulin B, Boileau J, Carpentier D, Decaux O, Fardet L, Geri G, Godmer P, Goujard C, Maisonneuve H, Mari A, Pouchot J, Ziza JM, Bretonnière C, Hamidou M. Diagnostic and management of life-threatening Adult-Onset Still Disease: a French nationwide multicenter study and systematic literature review. Crit Care 2018; 22:88. [PMID: 29642928 PMCID: PMC5896069 DOI: 10.1186/s13054-018-2012-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/12/2018] [Indexed: 11/18/2022] Open
Abstract
Background Adult-onset Still disease (AOSD) is a rare systemic inflammatory disorder. A few patients develop organ complications that can be life-threatening. Our objectives were to describe the disease course and phenotype of life-threatening AOSD, including response to therapy and long-term outcome. Methods A multicenter case series of intensive care medicine (ICU) patients with life-threatening AOSD and a systematic literature review. Results Twenty patients were included. ICU admission mostly occurred at disease onset (90%). Disease manifestations included fever (100%), sore throat (65%), skin rash (65%), and arthromyalgia (55%). Serum ferritin was markedly high (median: 29,110 ng/mL). Acute respiratory failure, shock and multiple organ failure occurred in 15 (75%), 10 (50%), and 7 (35%) cases, respectively. Hemophagocytosis was demonstrated in eight cases. Two patients died. Treatment delay was significant. All patients received corticosteroids. Response rate was 50%. As second-line, intravenous immunoglobulins were ineffective. Anakinra was highly effective. After ICU discharge, most patients required additional treatment. Literature analysis included 79 cases of AOSD with organ manifestations, which mainly included reactive hemophagocytic syndrome (42%), acute respiratory failure (34%), and cardiac complications (23%). Response rate to corticosteroids was 68%. Response rates to IVIgs, cyclosporin, and anakinra were 50%, 80%, and 100%, respectively. Conclusions AOSD should be recognized as a rare cause of sepsis mimic in patients with fever of unknown origin admitted to the ICU. The diagnosis relies on a few simple clinical clues. Early intensive treatment may be discussed. IVIgs should be abandoned. Long-term prognosis is favorable. Electronic supplementary material The online version of this article (10.1186/s13054-018-2012-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antoine Néel
- Service de Médecine Interne, PHU3, CHU Hôtel-Dieu, 44093, Nantes, France
| | - Anaïs Wahbi
- Service de Médecine Interne, PHU3, CHU Hôtel-Dieu, 44093, Nantes, France.
| | - Benoit Tessoulin
- Service d'Hématologie, PHU1, CHU Hôtel-Dieu, 44093, Nantes, France
| | - Julien Boileau
- Service de Médecine, CH de Morlaix, 29672, Morlaix, France
| | | | - Olivier Decaux
- Service de Médecine Interne, CHU de Rennes, 35033, Rennes, France
| | - Laurence Fardet
- Service de Dermatologie, Hôpital Henri Mondor, 94000, Créteil, France
| | - Guillaume Geri
- Service de Réanimation Médicale, CHU Cochin, AP-HP, 75012, Paris, France
| | | | - Cécile Goujard
- Service de Médecine Interne, CHU Bicêtre, AP-HP, 94270, Kremlin-Bicêtre, France
| | - Hervé Maisonneuve
- Service de Médecine Interne, CHD Vendée, 85925, La Roche-sur-Yon, France
| | - Arnaud Mari
- Service de Réanimation, Hôpital Yves Le Foll, 22000, St Brieuc, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, AP-HP, 75908, Paris, France
| | - Jean-Marc Ziza
- Service de Médecine Interne-Rhumatologie, groupe hospitalier Diaconesses-Croix-Saint-Simon, 75020, Paris, France
| | - Cédric Bretonnière
- Service de Réanimation Médicale, PHU3, CHU de Nantes, 44093, Nantes, France.,UPRES EA 3826, Faculté de Médecine, Université de Nantes, 44035, Nantes, France
| | - Mohamed Hamidou
- Service de Médecine Interne, PHU3, CHU Hôtel-Dieu, 44093, Nantes, France
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Belhomme N, Jouneau S, Bouzillé G, Decaux O, Lederlin M, Guillot S, Perlat A, Jégo P. Role of serum immunoglobulins for predicting sarcoidosis outcome: A cohort study. PLoS One 2018; 13:e0193122. [PMID: 29641520 PMCID: PMC5894960 DOI: 10.1371/journal.pone.0193122] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/05/2018] [Indexed: 12/18/2022] Open
Abstract
Background Sarcoidosis is a systemic granulomatous disease which carries variable outcomes. Serum protein electrophoresis is an easily accessible and routinely performed examination at diagnosis, in order to search for hypergammaglobulinemia, which is frequently found, and to rule out other granulomatous diseases such as common variable immunodeficiency. We aimed to assess the impact of baseline immunoglobulin level on the outcome of sarcoidosis. Methods We conducted a retrospective cohort-study, at Rennes University Hospital, in which all newly diagnosed patients for whom a serum protein electrophoresis had been performed at baseline were enrolled, from 2006 to 2014. The main outcome was the need for corticosteroid treatment within 2 years from diagnosis, the secondary outcome was the occurrence of relapse among treated patients. Results Eighty patients were included in the study, and 41.25% of them exhibited an elevated globulins rate. In univariate analysis, an elevated ACE level >70 U/l, Afro-Caribbean origin, and extra-pulmonary involvement, were associated with the need for corticosteroid treatment. In multivariate analysis, only ACE elevation (OR = 1.03, IC95% 1.01–1.05, p = 0.009) and extra-pulmonary involvement (OR = 5.8, IC95% 1.4–24, p = 0.015) were significant. Immunoglobulin level was not associated with the main outcome. Regarding the secondary outcome, none of the studied features were predictive of relapse among the 34 treated patients followed for two years. Conclusions There was no relation between the immunoglobulin level at diagnosis and the evolution of sarcoidosis. An elevated ACE level and the presence of initial extra-pulmonary involvement were both associated with a more severe course of the disease necessitating a corticosteroid treatment.
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Affiliation(s)
- Nicolas Belhomme
- Internal Medicine Department, Rennes University Hospital, Rennes, France
- University of Rennes 1, Rennes, France
- * E-mail:
| | - Stéphane Jouneau
- University of Rennes 1, Rennes, France
- Department of Respiratory Medicine, Rennes University Hospital, Rennes, France. University of Rennes 1, Rennes, France
- INSERM-IRSET UMR1085, Rennes, France
| | - Guillaume Bouzillé
- INSERM, U1099, Rennes, France
- Université de Rennes 1, LTSI, Rennes, France
- CHU Rennes, CIC Inserm 1414, Rennes, France
- CHU Rennes, Centre de Données Cliniques, Rennes, France
| | - Olivier Decaux
- Internal Medicine Department, Rennes University Hospital, Rennes, France
- University of Rennes 1, Rennes, France
| | - Mathieu Lederlin
- University of Rennes 1, Rennes, France
- INSERM, U1099, Rennes, France
- Department of Radiology, Rennes University Hospital, Rennes, France
| | - Stéphanie Guillot
- Department of Respiratory Physiology, Rennes University Hospital, Rennes, France
| | - Antoinette Perlat
- Internal Medicine Department, Rennes University Hospital, Rennes, France
| | - Patrick Jégo
- Internal Medicine Department, Rennes University Hospital, Rennes, France
- University of Rennes 1, Rennes, France
- INSERM-IRSET UMR1085, Rennes, France
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Allain JS, Thonier F, Pihan M, Boulland ML, de Guibert S, Launay V, Doncker AV, Ganard M, Aliouat A, Pangault C, Houot R, De Tayrac M, Lamy T, Roussel M, Fest T, Decaux O, Pastoret C. IGHV segment utilization in immunoglobulin gene rearrangement differentiates patients with anti-myelin-associated glycoprotein neuropathy from others immunoglobulin M-gammopathies. Haematologica 2018; 103:e207-e210. [PMID: 29371323 DOI: 10.3324/haematol.2017.177444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Florian Thonier
- Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, France
| | | | | | | | | | | | - Michel Ganard
- Université de Rennes 1, France.,Service d'Hématologie Clinique, CHU de Rennes, France
| | - Amyra Aliouat
- Laboratoire de Bioinformatique Médicale, Pôle de Biologie, CHU Rennes, France
| | - Céline Pangault
- Université de Rennes 1, France.,Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | - Roch Houot
- Université de Rennes 1, France.,Service d'Hématologie Clinique, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | - Marie De Tayrac
- Université de Rennes 1, France.,Laboratoire de Bioinformatique Médicale, Pôle de Biologie, CHU Rennes, France
| | - Thierry Lamy
- Université de Rennes 1, France.,Service d'Hématologie Clinique, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | - Mikael Roussel
- Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | - Thierry Fest
- Université de Rennes 1, France.,Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | - Olivier Decaux
- Service de Médecine Interne, CHU de Rennes, France.,Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
| | - Cedric Pastoret
- Université de Rennes 1, France .,Laboratoire d'Hématologie, Pôle de Biologie, CHU de Rennes, France.,INSERM, UMR U1236, Equipe labellisée Ligue contre le Cancer, Rennes, France
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Rodon P, Hulin C, Daley L, Dauriac C, Hacini M, Decaux O, Eisemann JC, Fitoussi O, Lioure B, Voillat L, Slama B, Al Jijakli A, Benramdane R, Chaleteix C, Costello R, Thyss A, Mathiot C, Eileen B, Maloisel F, Stoppa AM, Kolb B, Michallet M, Lamblin A, Natta P, Facon T, Elalamy I, Fermand JP, Moreau P, Leleu X. MELISSE, a large multicentric observational study to determine risk factors of venous thromboembolism in patients with multiple myeloma treated with immunomodulatory drugs. Thromb Haemost 2017; 110:844-51. [DOI: 10.1160/th13-02-0140] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/22/2013] [Indexed: 01/06/2023]
Abstract
SummaryImmunomodulatory drugs (IMiDs) are associated with an increased risk of venous thromboembolism (VTE) in multiple myeloma (MM) patients. We designed MELISSE, a multicentre prospective observational study, to evaluate VTE incidence and identify risk factors in IMiDstreated MM. Our objective was to determine the real-life practice of VTE prophylaxis strategy. A total of 524 MM patients were included, and we planned to collect information at baseline, at four and at 12 months, on MM therapy, on VTE risk factors and management. VTE incidence was 7% (n=31), including 2.5% pulmonary embolism (PE) (n=11), similar at four or 12 months. VTE was observed at all risk assessment levels, although the increased risk assessment level correlated to a lower rate of VTE, maybe due to the implemented thromboprophylaxis strategy. VTE occurred in 7% on aspirin vs 3% on lowmolecular- weight heparin (LMWH) prophylaxis, and none on vitamin K antagonists (VKA). New risk factors for VTE in IMiDs-treated MM were identified. In conclusion, VTE prophylaxis is compulsory in IMiDstreated MM, based on individualised VTE risk assessment. Anticoagulation prophylaxis with LMWH should clearly be prioritised in MM patients with high VTE risk, along with VKA. Further prospective studies will identify most relevant VTE risk factors in IMiDs-treated MM to select accurately which MM patients should receive LMWH prophylaxis and for which duration to optimise VTE risk reduction.
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Ly K, Costedoat-Chalumeau N, Duhaut P, Sailler L, Papo T, Decaux O, Bienvenu B, Liozon E, Dumonteil S, Preux P, Monteil J, Fauchais A. Place de la scintigraphie au 18-FDG couplée à une tomodensitométrie corps entier dans la stratégie diagnostique des fièvres prolongées, des fièvres intermittentes et des syndromes inflammatoires nus. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hudier L, Decaux O, Haddj-Elmrabet A, Lino M, Mandart L, Siohan P, Renaudineau E, Sawadogo T, Lamy De La Chapelle T, Oger E, Bridoux F, Vigneau C. Intensive haemodialysis using PMMA dialyser does not increase renal response rate in multiple myeloma patients with acute kidney injury. Clin Kidney J 2017; 11:230-235. [PMID: 29644064 PMCID: PMC5887381 DOI: 10.1093/ckj/sfx079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 06/19/2017] [Indexed: 02/02/2023] Open
Abstract
Background Intensive haemodialysis (IHD) in addition to bortezomib-based chemotherapy might be efficient to rapidly decrease serum immunoglobulin-free light chains removal in patients with multiple myeloma (MM) and to improve renal prognosis and survival. Methods The aim of this retrospective multi-centre study was to compare the efficacy (renal recovery rate) of IHD and of standard haemodialysis (SHD) in patients with MM and dialysis-dependent acute kidney injury (AKI), concomitantly treated with bortezomib-based chemotherapy. Results We selected 41 patients with MM and dialysis-dependent AKI, most likely due to myeloma cast nephropathy (MCN), and who were treated in eight French hospitals between January 2007 and June 2011. Patients were classified in two groups according to dialysis regimen: IHD [n = 21, with a mean of 11.3 dialysis sessions all with poly(methyl methacrylate) (PMMA) membranes for 13.2 days] and SHD (n = 20 patients, mostly three times per week, 31% with PMMA membrane). The main outcome was dialysis-independence at 3 months. At 3 months, 15 patients could stop dialysis: 8 (38.1%) in the IHD and 7 (35%) in the SHD group (P = 1). Moreover, 14 (56%) of the 25 patients who did show haematological response and only one of the 16 patients who did not were dialysis-independent (P = 0.002) at 3 months. Conclusions The results of this retrospective study did not show any clear renal benefit of IHD in patients with MM and MCN compared with SHD. Conversely, they underline the importance of the haematological response to chemotherapy for the renal response and patient prognosis.
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Affiliation(s)
- Laurent Hudier
- Centre hospitalier Broussais, Service de Néphrologie-Hémodialyse, Saint-Malo, France
| | - Olivier Decaux
- CHU Rennes, Service de Médecine Interne, Rennes, France
- CHU Rennes, Service de Néphrologie, Rennes, France
- CHU de Nantes, Service de Néphrologie et d'Immunologie Clinique, Nantes, France
- Centre Hospitalier Bretagne Atlantique, Service de Néphrologie-Hémodialyse, Vannes, France
- Centre Hospitalier de Cornouaille, Service de Néphrologie-Hémodialyse, Quimper, France
- Centre Hospitalier de Bretagne Sud, Service de Néphrologie-Hémodialyse, Lorient, France
- CHU Rennes, Service d'Hématologie clinique, Rennes, France
- CHU Rennes, Département de pharmacologie clinique, Rennes, France
- CHU Poitiers, Service de Néphrologie-Hémodialyse, Poitiers, France
- Université de Rennes 1, UMR CNRS 6290 IGDR, 35042 Rennes, France
| | | | - Marie Lino
- CHU de Nantes, Service de Néphrologie et d'Immunologie Clinique, Nantes, France
| | - Lise Mandart
- Centre Hospitalier Bretagne Atlantique, Service de Néphrologie-Hémodialyse, Vannes, France
| | - Pascale Siohan
- Centre Hospitalier de Cornouaille, Service de Néphrologie-Hémodialyse, Quimper, France
| | - Eric Renaudineau
- Centre hospitalier Broussais, Service de Néphrologie-Hémodialyse, Saint-Malo, France
| | - Theophile Sawadogo
- Centre Hospitalier de Bretagne Sud, Service de Néphrologie-Hémodialyse, Lorient, France
| | - Thierry Lamy De La Chapelle
- CHU Rennes, Service d'Hématologie clinique, Rennes, France
- CHU Rennes, Département de pharmacologie clinique, Rennes, France
- CHU Poitiers, Service de Néphrologie-Hémodialyse, Poitiers, France
- Université de Rennes 1, UMR CNRS 6290 IGDR, 35042 Rennes, France
- Université de Rennes 1, Inserm U917, Rennes, France
| | - Emmanuel Oger
- CHU Rennes, Département de pharmacologie clinique, Rennes, France
| | - Frank Bridoux
- CHU Poitiers, Service de Néphrologie-Hémodialyse, Poitiers, France
| | - Cécile Vigneau
- CHU Rennes, Service de Néphrologie, Rennes, France
- CHU de Nantes, Service de Néphrologie et d'Immunologie Clinique, Nantes, France
- Centre Hospitalier Bretagne Atlantique, Service de Néphrologie-Hémodialyse, Vannes, France
- Centre Hospitalier de Cornouaille, Service de Néphrologie-Hémodialyse, Quimper, France
- Centre Hospitalier de Bretagne Sud, Service de Néphrologie-Hémodialyse, Lorient, France
- CHU Rennes, Service d'Hématologie clinique, Rennes, France
- CHU Rennes, Département de pharmacologie clinique, Rennes, France
- CHU Poitiers, Service de Néphrologie-Hémodialyse, Poitiers, France
- Université de Rennes 1, UMR CNRS 6290 IGDR, 35042 Rennes, France
- Université de Rennes 1, Inserm U917, Rennes, France
- Université de Rennes 1, IRSET, Rennes, France
- Correspondence and offprint requests to: Cécile Vigneau; E-mail:
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Fouquet G, Snell KI, Guidez S, Schraen S, Boyle E, Renaud L, Desmier D, Machet A, Moya N, Systchenko T, Gruchet C, Decaux O, Arnulf B, Fohrer C, Richez V, Kolb B, Macro M, Karlin L, Royer B, Pegourie B, Hebraud B, Caillot D, Perrot A, Moreau P, Facon T, Avet-Loiseau H, Dejoie T, Hulin C, Harding S, Leleu X. Heavy + light chain analysis to assign myeloma response is analogous to the IMWG response criteria. Leuk Lymphoma 2017; 59:583-589. [PMID: 28697637 DOI: 10.1080/10428194.2017.1339876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Automated serum heavy + light chain (HLC) immunoassays can measure the intact immunoglobulins of each light chain type separately. We though to compare HLC assays with electrophoretic techniques in determining International Myeloma Working Group (IMWG) response criteria. 114 myeloma patients from 2 trials were included. HLC measurements were made utilizing archived sera and response assessments compared with those based on electrophoretic analysis at the time of the trials. Assessments at ∼90 days and maximal response were compared as was the power of the 2 techniques for predicting later responses, overall survival, and progression. The kappa statistic indicated good agreement between the 2 methods for determining IMWG response criteria, although HLC measurements might give better predictions of subsequent responses and frequently gave an earlier indication of change. HLC measurements could represent an alternative to electrophoretic techniques in determining IMWG response. Validation with a greater range of patient responses is needed for confirmation.
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Affiliation(s)
| | | | - Stéphanie Guidez
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | | | | | | | - Déborah Desmier
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | - Antoine Machet
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | - Niels Moya
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | | | - Cécile Gruchet
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | | | | | | | - Valentine Richez
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | | | | | - Lionel Karlin
- j Hôpital Lyon Sud, CHU , Lyon Pierre Bénite , France
| | | | | | | | | | | | | | | | | | | | - Cyrille Hulin
- q Hôpital Haut-Leveque, CHU , Pessac Bordeaux , France
| | | | - Xavier Leleu
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
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Leleu X, Fouquet G, Karlin L, Kolb B, Tiab M, Araujo C, Roussel M, Bourquard P, Lenain P, Humbrecht-Kraut C, Belhadj K, Petillon MO, Chretien ML, Rodon P, Decaux O, Jaccard A, Hulin C, Attal M, Moreau P, Facon T. Carfilzomib weekly-melphalan-prednisone in untreated elderly multiple myeloma: IFM2012-03. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.8004] [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] [Indexed: 11/20/2022] Open
Abstract
8004 Background: Melphalan-prednisone-bortezomib (MPV) is a standard of care upfront for newly diagnosed elderly myeloma (eNDMM). Despite significant improvements on MPV’s safety profile, toxicity issues remain. Carfilzomib (K) is a novel generation proteasome inhibitor with a different safety profile from Bortezomib. Carmysap phase I/II study (twice a week Carfilzomib+MP) demonstrated K at 36mg/m² safe and active in eNDMM. We thought to study the K weekly-MP combination in eNDMM. Methods: IFM2012-03 is a multicenter phase I/II study in eNDMM (65 and older) aimed to determine the maximum tolerated dose (MTD) of K weekly. 4 cohorts of 6 patients each were recruited at K 36, 45, 56 and 70 mg/m2 on days 1, 8, 15, 22 IV of 35-days cycles, with oral Melphalan and Prednisone from days 1 to 4 at usual doses. Patients received a 9-cycles induction followed by a K monotherapy maintenance at 36 mg/m2 IV every 2 weeks for 1 year. 3 dose-limiting toxicities (DLTs) defined MTD at the lower N-1 dose. Results: 24 patients were included at K 36, 45, 56 and 70 mg/m². One DLT occurred at 36 mg/m² (grade 4 lymphopenia), one at 45 mg/m² (tumor lysis syndrome with grade 4 renal insufficiency), two at 56 mg/m² (grade 3 cardiac insufficiency and grade 3 febrile neutropenia) and two at 70 mg/m² (grade 3 nausea/vomiting and grade 3 hepatic cytolysis). One patient died from cardiac dysfunction considered related to K at 56 mg/m². 3 patients stopped therapy and 3 others required dose reduction of K. Following DSMB’s request a second 6-patients cohort was recruited at 70 mg/m², with increased attention around hyperhydration and monitoring HTA. We observed no DLT and no grade 3/4 adverse event in this cohort. Median age was 75 years, 56% patients were R-ISS 2 or 3. For the whole cohort (N=30), the overall response rate was 87% including 67% very good partial responses and 44% complete responses. Conclusions: The MTD of weekly K in the KMP combination is 70 mg/m² upfront for eNDMM, but it seems reasonable to recommend 56mg/m² after 75 years-old for safety reasons. KMP offers high response rates and possibly greater CR rate. However, since the CLARION study (VMP vs KMP) will not allow KMP’s approval in eNDMM in Europe, IFM decided to stop IFM2012-03 after phase I without performing phase II. Clinical trial information: NCT02302495.
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Affiliation(s)
| | | | | | | | | | - Carla Araujo
- Centre Hospitalier de la Cote Basque, Bayonne, France
| | | | | | | | | | | | | | | | | | | | - Arnaud Jaccard
- Centre Hospitalier Universitaire de Limoges - Hôpital Dupuytren, Limoges, France
| | - Cyrille Hulin
- Bordeaux Hospital University Center (CHU), Bordeaux, France
| | | | | | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
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