Evolution of patients with Sézary syndrome after mogamulizumab discontinuation for any cause except progression: a multicenter retrospective study (Moga-stop study)

The results of this study suggest that a progressive discontinuation of mogamulizumab should be considered once response is obtained in Sezary syndrome patients, even after a treatment of short-duration. This may possibly minimize the risk of adverse effects, costs, and resistance to mogamulizumab. Additionally, our study emphasizes that mogamulizumab rechallenge should be encouraged as first-choice for relapsing patients.

Genomic profiling of Mycosis Fungoides identifies patients at high risk of disease progression

Mycosis fungoides (MF) is the most prevalent primary cutaneous T-cell lymphoma, with an indolent or aggressive course and poor survival. The pathogenesis of MF remains unclear, and prognostic factors in the early stages are not well-established. Here, we characterized the most recurrent genomic alterations using whole-exome sequencing of 67 samples from 48 patients from Lille University Hospital (France), including 18 sequential samples drawn across stages of the malignancy. Genomic data were analyzed on the Broad Institute's Terra bioinformatics platform. We found that gain7q, gain10p15.1 (IL2RA and IL15RA), del10p11.22 (ZEB1), or mutations in JUNB and TET2 are associated with high-risk disease stages. Furthermore, gain7q, gain10p15.1 (IL2RA and IL15RA), del10p11.22 (ZEB1), and del6q16.3 (TNFAIP3) are coupled with shorter survival. Del6q16.3 (TNFAIP3) was a risk factor for progression in low-risk patients. By analyzing the clonal heterogeneity and the clonal evolution of the cohort, we defined different phylogenetic pathways of the disease with acquisition of JUNB, gain10p15.1 (IL2RA and IL15RA), or del12p13.1 (CDKN1B) at progression. These results establish the genomics and clonality of MF and identify potential patients at risk of progression, independent of their clinical stage.

Real-life use of apremilast for the treatment of psoriasis in patients with oncological comorbidities: a retrospective descriptive multicentre study in France

BACKGROUND

Systemic treatment options for psoriasis are limited for patients with recent neoplasia.

OBJECTIVES

We report the real-life use of apremilast (APR) in patients with psoriasis and recent cancer.

MATERIALS & METHODS

We conducted a retrospective, multicentre study in five hospitals and among 120 private dermatologists in the north of France from January 2015 to May 2021. We included patients treated with APR for psoriasis and suffering from an active cancer or who had been diagnosed with a cancer or treated for a cancer within the last five years.

RESULTS

We included 23 patients diagnosed with a cancer, on average 2.6 years before the introduction of APR for psoriasis. In most patients, APR was specifically chosen due to oncological history. At 16±8 weeks, 55% (n=11/20) of patients had achieved PASI 50 score, 30% (n=6/20) PASI 75, 5% (n=3/20) PASI 90 and 37.5% (n=3/8) of them had a significant improvement in quality of life. Non-serious adverse events were observed in 65.2% (n=15/23) of patients (diarrhoea in 39%), resulting in discontinuation of treatment for 27.8%. The average duration of treatment was 303.8±252.4 days. For four patients, a recurrence or a progression of cancer was recorded during APR treatment.

CONCLUSION

In our patients with both psoriasis and cancer, APR improved quality of life, with a good safety profile. A larger study, matched for type, stage and treatment of underlying cancer, would be necessary to draw further conclusions about the oncological safety of APR.

Réactions cutanées aux vaccins anti-COVID-19 : cohorte prospective descriptive régionale

Introduction

Les manifestations cutanées possiblement liées à la Coronavirus Disease 19 (COVID-19) ont été rapportées dès printemps 2020. Nous observons désormais des réactions cutanées aux vaccins anti-COVID-19, impliquant les dermatologues dans le processus de vaccination. L’objectif de cette étude était de rapporter et caractériser ces réactions cutanées aux vaccins anti-COVID-19 dans la région des Hauts-de-France.

Matériel et méthodes

Il s’agit d’un recueil multicentrique prospectif anonyme, sur appel à cas auprès des dermatologues hospitaliers des départements du Nord et du Pas-de-Calais entre janvier et juin 2021, des réactions cutanées suite à tout vaccin anti-COVID-19 réalisé au sein de structures munies d’un centre de vaccination. Au CHU de Lille, en plus du recueil prospectif, les fiches de suivi inter-dose ont été recueillies rétrospectivement de janvier à février 2021 afin d’identifier les effets indésirables cutanés.

Résultats

143 patients ont été inclus dont 108 femmes et 35 hommes. L’âge moyen était de 53 ans. 60 patients ont été examinés par un dermatologue sénior, tandis que 83 ont rempli un formulaire de suivi inter-dose au CHU de Lille. Le vaccin le plus souvent réalisé était le vaccin Pfizer/BioNtech (n = 115/143, 80,4 %), suivi par le vaccin AstraZeneca (n = 23/143, 16,1 %), et le vaccin Moderna (n = 5/143, 3,5 %). Peu de patients avait été infectés par la COVID-19 (n = 14/145, 9,8 %). L’essentiel des réactions recueillies est survenu après la première injection (n = 135/143, 94,4 %). La réaction cutanée la plus fréquente était une réaction érythémateuse au point d’injection (n = 80/143, 55,9 %), un prurit (n = 13/143, 9,1 %), un zona (n = 10/143, 7 %), une poussée d’urticaire typique (n = 7/143, 9 %), des éruptions eczématiformes (n = 6/143, 4,2 %), des éruptions pseudo-urticariennes (n = 5/143, 3,5 %), des exanthèmes (n = 4/143, 2,8 %). Nous rapportons aussi 2 éruptions purpuriques (1,4 %), un pityriasis rosé de Gibert, et une poussée d’herpès labial. Le délai médian de survenue après vaccination était de 2 jours (IIQ, 1–5,5 jours). Six patients (4,9 %) ont eu une poussée d’une dermatose préexistante, dont 5 (3,4 %) étaient des maladies bulleuses auto-immunes. Concernant les 60 patients (41,9 %) ayant été évalués par un dermatologue sénior, la prise en charge consistait principalement en une surveillance seule (n = 27/60, 45 %), une prescription d’émollient (n = 22/60, 36,1 %), ou d’antihistaminique (n = 21/60, 35,6 %). La seconde injection a toujours été autorisée. Nous ignorons cependant la fréquence de la récidive lors de la seconde injection.

Discussion

Notre série rapporte diverses réactions aux vaccins anti-COVID-19, dont aucune grave, ne contre-indiquant pas la réalisation de la seconde injection en cas de survenue lors de la première injection. Le service médical rendu de la vaccination anti-COVID-19 demeure important.

Effectiveness and safety of dupilumab for the treatment of atopic dermatitis in a real-life French multicenter adult cohort

BACKGROUND

Dupilumab is the first biologic available to treat atopic dermatitis (AD). Its effectiveness and safety were demonstrated in clinical trials.

OBJECTIVE

We sought to assess the effectiveness and safety of dupilumab in adults with AD in a real-life French multicenter retrospective cohort.

METHODS

We included patients treated during March 2017-April 2018. Efficacy outcomes, including Scoring Atopic Dermatitis (SCORAD) and Eczema Area and Severity Index (EASI) scores, were collected at baseline and 3 months when available. Adverse events (AEs) were recorded at follow-up.

RESULTS

We included 241 patients. The median ± interquartile range (IQR) follow-up time was 3.8 ± 3.7 months. A ≥75% improvement in SCORAD was achieved in 27 of 163 (16.6%) patients, and a ≥75% improvement in EASI was achieved in 40 of 82 (48.8%) patients. The median SCORAD and EASI scores at 3 months were significantly lower than those at baseline (SCORAD ± IQR, 25 ± 21 vs 56 ± 27.4, P < 10^-9 and EASI ± IQR, 4.1 ± 6.8 vs 17.9 ± 15.4, P < 10^-9, respectively). Conjunctivitis was reported in 84 of 241 (38.2%) patients. The proportion with eosinophilia (>500 cells/mm³) during follow-up (57%) was higher than that at baseline (33.7%) (n = 172, P < 10^-6). Dupilumab was stopped in 42 cases; 27 patients stopped because of AEs.

LIMITATIONS

No control group, missing data.

CONCLUSION

This real-life study demonstrated a similar dupilumab effectiveness as that seen in clinical trials, but it also revealed a higher frequency of conjunctivitis and eosinophilia.

Blood pressure monitoring during arrhythmia: agreement between automated brachial cuff and intra-arterial measurements

BACKGROUND

Since arrhythmia induces irregular pulse waves, it is widely considered to cause flawed oscillometric brachial cuff measurements of blood pressure (BP). However, strong data are lacking. We assessed whether the agreement of oscillometric measurements with intra-arterial measurements is worse during arrhythmia than during regular rhythm.

METHODS

Among patients of three intensive care units (ICUs), a prospective comparison of three pairs of intra-arterial and oscillometric BP readings was performed among patients with arrhythmia and an arterial line already present. After each inclusion in the arrhythmia group, one patient with regular rhythm was included as a control. International Organization for Standardization (ISO) standard validation required a mean bias <5 (sd 8) mm Hg.

RESULTS

In 135 patients with arrhythmia, the agreement between oscillometric and intra-arterial measurements of systolic, diastolic and mean BP was similar to that observed in 136 patients with regular rhythm: for mean BP, similar mean bias [-0.1 (sd 5.2) and 1.9 (sd 5.9) mm Hg]. In both groups, the ISO standard was satisfied for mean and diastolic BP, but not for systolic BP (sd >10 mm Hg) in our ICU population. The ability of oscillometry to detect hypotension (systolic BP <90 mm Hg or mean BP <65 mm Hg), response to therapy (>10% increase in mean BP after cardiovascular intervention) and hypertension (systolic BP >140 mm Hg) was good and similar during arrhythmia and regular rhythm (respective areas under the receiver operating characteristic curves ranging from 0.89 to 0.96, arrhythmia vs regular rhythm between-group comparisons all associated with P>0.3).

CONCLUSIONS

Contrary to widespread belief, arrhythmia did not cause flawed automated brachial cuff measurements.

Risk factors for native kidney dysfunction in patients with abdominal multivisceral/small bowel transplantation

Kidney dysfunction is a recognized complication after non-renal solid organ transplantation, particularly after intestinal transplant. In our study, we reviewed data on 33 multivisceral transplant (MVT)- and 15 isolated small bowel (ISB)-transplant patients to determine risk factors for kidney dysfunction. Kidney function was estimated by modified diet in renal disease (MDRD) and Schwartz formula for adults and children, respectively. Acute kidney injury (AKI) was defined as an increase in the serum Cr (sCr) greater than twofold. Kidney function declined significantly at one yr after transplantation with 46% of subjects showing an estimated GFR (eGFR) <60 mL/min. Patients with an episode of AKI were more likely to have reduced eGFR than those without AKI (p < 0.025). In linear regression analyses, age, pre-transplant sCr, eGFR at postoperative day (POD) 30, 90, 180, 270, and tacrolimus level at POD 7 showed significant correlation with one yr post-transplant eGFR (p < 0.05). Pediatric patients and patients with MVT had lesser decline in kidney function compared with adults or patients with ISB. In conclusion, risk factors for post-transplant kidney dysfunction in intestinal transplantation included age, pre-transplant sCr, AKI episode, eGFR at POD 30, 90, 180, 270, and tacrolimus level at POD 7.

Sleep Disorders in Patients with Breast Cancer Based on Polysomnographic Data

Background. Complaints of sleep disturbances are common in patients with breast cancer and may affect their quality of life. Insomnia, fatigue, and sleep fragmentation were previously reported in these patients. However, no studies reported polysomnographic data to elucidate the etiology of these symptoms. We hypothesized that patients with breast cancer will have considerable abnormalities on their monitored overnight sleep studies including sleep disordered breathing, periodic leg movement, and spontaneous arousals.Methods. Data from sleep studies were prospectively collected from cancer patients who undergo a sleep study at the MD Anderson Sleep Center and who consented to participate. All breast cancer patients who underwent a poylsomnogram between 1/30/2007 and 4/1/2009 and signed informed consent were identified. The prospectively collected data included demographics, breast cancer clinical data and treatment, as well as polysomnographic data.Results. Sixty-nine patients (68 female, 1 male) were identified with breast cancer. All patients underwent a formal sleep consultation. The median age was 56 (range: 38 to 75 years), and the median body mass index (BMI) was 33 kg/m2 (21 to 52).Tumor characteristics were as follows: 55 patients (80%) had invasive ductal carcinoma, 8 (12%) had invasive lobular carcinoma, 5 with ductal carcinoma in situ (7%), and 1 unknown (1%). ER/PR was positive in 44 patients (64%), and HER-2 positive in 9 patients (13%). Five patients (7%) had stage 0, 12 (17%) had stage I, 30 (44%) had stage II, 12 (17%) had stage III, and 10 (15%) had stage IV disease. Twenty-four patients (35%) had completed treatment, 10 patients (15%) were receiving chemotherapy, and 34 patients (50%) were receiving hormonal therapy.Fifty-one patients (74%) were referred for daytime sleepiness and fatigue, 11 (16%) for sleep apnea symptoms, 1 (1%) for pulmonary hypertension and 6 (9%) for insomnia. In 55 patients (81%), the median Epworth Sleepiness Score 12 (4 to 21) was consistent with excessive daytime sleepiness.Sleep fragmentation was noted in all patients with a median sleep efficiency of 86% (36% to 98%) and a median Arousal Index of 33 arousals/hour of sleep (7 to 118). Furthermore, the median percentages of delta sleep (deep sleep) and REM sleep were notably diminished at 1% and 13% respectively. Sleep disordered breathing was noted with a median Apnea Hypopnea Index (AHI) of 10 apneas and hypopneas/hour of sleep (0 to 68). Only 2 patients were noted to have significant periodic limb movements with arousals. There was no difference in these abnormalities between treatment groups (chemotherapy, hormonal therapy, or no treatment).Conclusions. This is the first report of polysomnographic data in breast cancer patients. Our data show that sleep disordered breathing (obstructive sleep apnea) is a cause of sleep disturbance in a number of these patients. Conversely, periodic leg movement was not common among these patients. Of interest, the high Arousal Index indicates a high frequency of spontaneous arousals not explained by apnea or hypopnea and these findings did not vary across treatment types. These findings show unique abnormalities in the sleep architecture of breast cancer patients that are provoking and warrant further study.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5036.

[Pregnancy and delivery in a patient with Willebrand's disease. Apropos of a case]

Willebrand's disease is the most frequent inborn coagulopathy and type 3 is its most severe form. Pregnancy and delivery are critical events in women with Willebrand's disease of type 3. Prophylactic treatment for delivery and early postpartum period is recommended. We report the management of pregnancy and successful delivery of a 32-year-old woman with type 3. Prophylactic treatment with 2000 IU of Willebrand's disease factor (WdF) was given twice a day during the delivery day and the day after, and 1000 IU per day during the next three days. The patient did not show any spontaneous metrorrhagia but anemia. No bleeding was observed in the newborn.