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Dumas PY, Raffoux E, Bérard E, Bertoli S, Hospital MA, Heiblig M, Desbrosses Y, Bonmati C, Pautas C, Lambert J, Orvain C, Banos A, Pasquier F, Peterlin P, Marchand T, Uzunov M, Frayfer J, Turlure P, Cluzeau T, Jourdan E, Himberlin C, Tavernier E, Villate A, Haiat S, Chretien ML, Carre M, Chantepie S, Vaida I, Wemeau M, Chebrek S, Guillerm G, Guièze R, Debarri H, Gehlkopf E, Laribi K, Marcais A, Santagostino A, Béné MC, Mineur A, Pigneux A, Dombret H, Récher C. Gilteritinib activity in refractory or relapsed FLT3-mutated acute myeloid leukemia patients previously treated by intensive chemotherapy and midostaurin: a study from the French AML Intergroup ALFA/FILO. Leukemia 2023; 37:91-101. [PMID: 36376378 DOI: 10.1038/s41375-022-01742-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Abstract
The real-world efficacy and safety of gilteritinib was assessed in an ambispective study that included 167 R/R FLT3-mutated AML patients. Among them, 140 received gilteritinib as single agent (cohort B), including 67 previously treated by intensive chemotherapy and midostaurin (cohort C). The main differences in patient characteristics in this study compared to the ADMIRAL trial were ECOG ≥ 2 (83.6% vs. 16.6%), FLT3-TKD mutation (21.0% vs. 8.5%), primary induction failure (15.0% vs. 40.0%) and line of treatment (beyond 2nd in 37.1% vs. 0.0%). The rates of composite complete remission, excluding those that occurred after hematopoietic stem cell transplantation (HSCT), were similar at respectively 25.4% and 27.5% in cohorts B and C. Median overall survival (OS) for these two groups was also similar at respectively 6.4 and 7.8 months. Multivariate analyses for prognostic factors associated with OS identified female gender (HR 1.61), adverse cytogenetic risk (HR 2.52), and allogenic HSCT after gilteritinib (HR 0.13). Although these patients were more heavily pretreated, these real-world data reproduce the results of ADMIRAL and provide new insights into the course of patients previously treated by intensive chemotherapy and midostaurin and beyond the 2nd line of treatment who can benefit from treatment in an outpatient setting.
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Affiliation(s)
- Pierre-Yves Dumas
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, F-33000, Bordeaux, France.
| | - Emmanuel Raffoux
- Hôpital Saint Louis, APHP, service d'hématologie adultes, Paris, France
| | - Emilie Bérard
- Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, CERPOP, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Sarah Bertoli
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Maël Heiblig
- Hospices Civils de Lyon, Hôpital Lyon Sud, Service d'Hématologie clinique, Pierre Bénite, France
| | | | - Caroline Bonmati
- Service d'Hématologie, CHU Nancy Brabois, 54500, Vandoeuvre les Nancy, France
| | - Cécile Pautas
- CHU Henri-Mondor, Service d'Hématologie Clinique et de Thérapie Cellulaire; 1, rue Gustave Eiffel, 94010, Créteil, France
| | - Juliette Lambert
- Centre hospitalier de Versailles, Service Hématologie, Le Chesnay, France
| | - Corentin Orvain
- Service des maladies du sang, CHU d'Angers, France/Fédération hospitalo-universitaire « Grand Ouest against Leukemia »/Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, CRCI2NA, F-49000, Angers, France
| | - Anne Banos
- Service Hématologie, Centre Hospitalier de la Côte Basque, 64100, Bayonne, France
| | - Florence Pasquier
- Département d'Hématologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Pierre Peterlin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Tony Marchand
- Service d'hématologie Clinique, CHU de Rennes, 35000, Rennes, France
| | - Madalina Uzunov
- Hôpital Pitié Salpetrière, Service d'hématologie, Paris, France
| | | | - Pascal Turlure
- CHU limoges, Service d'Hématologie Clinique et de Thérapie Cellulaire, F-87000, Limoges, France
| | - Thomas Cluzeau
- Université Cote d'Azur, CHU de Nice, Département d'hématologie clinique, Nice, France
| | - Eric Jourdan
- Department of Hematology, Nîmes University Hospital, Nîmes, France
| | - Chantal Himberlin
- Centre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, France
| | - Emmanuelle Tavernier
- CHU Saint Etienne. Service d'hématologie clinique et thérapie cellulaire, 42 000, Saint Etienne, France
| | - Alban Villate
- Hématologie et thérapie cellulaire, CHRU de Tours, Tours, France
| | - Stephanie Haiat
- Centre hospitalier Sud francilien, Service d'hématologie clinique, Corbeil-Essonnes, France
| | | | | | | | - Ioana Vaida
- Centre Hospitalier René Dubos, Service d'hématologie et thérapie cellulaire, Cergy-Pontoise, France
| | - Mathieu Wemeau
- CH Roubaix, service d'hématologie, F-59100, Roubaix, France
| | - Safia Chebrek
- CH Avignon, service d'onco-hématologie, Avignon, France
| | - Gaelle Guillerm
- CHU Brest, Hôpital Morvan, Service de cancérologie-hématologie, Brest, France
| | - Romain Guièze
- Service d'hématologie clinique et de thérapie cellulaire, CHU de Clermont-Ferrand, Clermont-Ferrand, France; EA 7453 (CHELTER), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Houria Debarri
- CHR Metz-Thionville, Hôpital Mercy, service d'hématologie, Metz, France
| | - Eve Gehlkopf
- Hôpital Saint Eloi CHU Montpellier, Service d'Hématologie Clinique, 34295, Montpellier, France
| | - Kamel Laribi
- Department of Haematology, Centre hospitalier Le Mans, Le Mans, France
| | - Ambroise Marcais
- Service Hématologie Adultes, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Cité, Paris, France
| | | | | | - Ariane Mineur
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, F-33000, Bordeaux, France
| | - Arnaud Pigneux
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, F-33000, Bordeaux, France
| | - Hervé Dombret
- Hôpital Saint Louis, APHP, service d'hématologie adultes, Paris, France
| | - Christian Récher
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université Toulouse III Paul Sabatier, Toulouse, France
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Kayser S, Schlenk RF, Lebon D, Carre M, Götze KS, Stölzel F, Berceanu A, Schäfer-Eckart K, Peterlin P, Hicheri Y, Rahme R, Raffoux E, Chermat F, Krause SW, Aulitzky WE, Rigaudeau S, Noppeney R, Berthon C, Görner M, Jost E, Carassou P, Keller U, Orvain C, Braun T, Saillard C, Arar A, Kunzmann V, Wemeau M, De Wit M, Niemann D, Bonmati C, Schwänen C, Abraham J, Aljijakli A, Haiat S, Krämer A, Reichle A, Gnadler M, Willekens C, Spiekermann K, Hiddemann W, Müller-Tidow C, Thiede C, Röllig C, Serve H, Bornhäuser M, Baldus CD, Lengfelder E, Fenaux P, Platzbecker U, Adès L. Characteristics and outcome of patients with low-/intermediate-risk acute promyelocytic leukemia treated with arsenic trioxide - an international collaborative study. Haematologica 2021; 106:3100-3106. [PMID: 34047178 PMCID: PMC8634174 DOI: 10.3324/haematol.2021.278722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/06/2021] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to characterize a large series of 154 patients with acute promyelocytic leukemia (median age, 53 years; range, 18-90 years) and evaluate real-life outcome after up-front treatment with arsenic trioxide and all-trans retinoic acid. All patients were included in the prospective NAPOLEON registry (NCT02192619) between 2013 and 2019. The acute promyelocytic leukemia was de novo in 91% (n=140) and therapy-related in 9% (n=14); 13% (n=20) of the patients were older than 70 years. At diagnosis bleeding/hemorrhage was present in 38% and thrombosis in 3%. Complete remission was achieved in 152 patients (99%), whereas two patients (1%) experienced induction death within 18 days after starting therapy. With a median follow-up of 1.99 years (95% confidence interval: 1.61-2.30 years) 1-year and 2-year overall survival rates were 97% (95% confidence interval: 94-100%) and 95% (95% confidence interval: 91-99%), respectively. Age above 70 years was associated with a significantly shorter overall survival (P<0.001) compared to that of younger patients. So far no relapses have been observed. Six patients (4%) died in complete remission at a median of 0.95 years after diagnosis (range, 0.18-2.38 years). Our data confirm the efficiency and durability of arsenic trioxide and all-trans retinoic acid therapy in the primary management of adults with low-/intermediate-risk acute promyelocytic leukemia in the real-life setting, irrespective of age.
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Affiliation(s)
- Sabine Kayser
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany; NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg.
| | - Richard F Schlenk
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg; Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg
| | | | - Martin Carre
- 5HCE Grenoble, Service d'Oncologie et Hématologie Pédiatrique, Grenoble
| | | | - Friedrich Stölzel
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, TU Dresden
| | - Ana Berceanu
- Service d'Hématologie du Pr. Cahn Hopital Jean Minjoz, Besancon
| | | | | | - Yosr Hicheri
- Département d'Hématologie Clinique du Chu Saint Eloi Montpellier
| | - Ramy Rahme
- Hôpital Saint Louis, Université Paris Diderot, Paris
| | | | | | - Stefan W Krause
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen
| | | | - Sophie Rigaudeau
- Service d'Hémato-Oncologie du Pr. Castaigne Hopital Andre Mignot le Chesnay
| | | | - Celine Berthon
- Service des Maladies du Sang Chru, Hopital Claude Huriez, Lille
| | - Martin Görner
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum Bielefeld Mitte
| | | | - Philippe Carassou
- Service de Médecine interne, Hématologie du Pr. Christian Chr Metz Thionville, Hopital de Marcy, Metz
| | - Ulrich Keller
- Department of Hematology, Oncology and Tumor Immunology, Charité-University Medical Center, Campus Benjamin Franklin, Berlin
| | - Corentin Orvain
- Angers University Hospital, Maladies du Sang, Angers; Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL, France; Université d'Angers, Inserm, CRCINA, Angers
| | - Thorsten Braun
- Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris
| | | | - Ali Arar
- Service d' Oncologie Médicale Hopital de la Source, Orleans
| | | | | | | | - Dirk Niemann
- Gemeinschaftsklinikum Mittelrhein gGmbH, Koblenz
| | - Caroline Bonmati
- Division of Hematology, Hôpital de Brabois, Centre Hospitalier Universitaire de Nancy, Nancy
| | | | - Julie Abraham
- Service d' Hématologie, Thérapie Cellulaire du Pr. Bordessoule, Hopital Universitaire Dupuytren, Limoges
| | - Ahmad Aljijakli
- Service d'Hématologie du Dr. Sutton Centre Hospitalier v. Dupouy, Argenteuil
| | - Stephanie Haiat
- Service d'Hematologie Clinique, CH Sud Francilien, Corbeil Essonnes
| | - Alwin Krämer
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg; German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg
| | - Albrecht Reichle
- Department of Medicine III - Hematology and Internal Oncology, University Hospital Regensburg, Regensburg
| | - Martina Gnadler
- St. Vincentius Kliniken, Abteilung für Hämatologie, Onkologie, Immunologie und Palliativmedizin, Karlsruhe
| | - Christophe Willekens
- Département d'Hématologie, Gustave Roussy, Université Paris-Saclay, Villejuif; INSERM Unit 1170, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif
| | - Karsten Spiekermann
- Department of Medicine III, University Hospital, Ludwig-Maximilians University (LMU) Munich, Munich
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital, Ludwig-Maximilians University (LMU) Munich, Munich
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg
| | - Christian Thiede
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, TU Dresden
| | - Christoph Röllig
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, TU Dresden
| | - Hubert Serve
- Department of Internal Medicine II, University Hospital of Frankfurt Main
| | - Martin Bornhäuser
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, TU Dresden
| | | | - Eva Lengfelder
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim
| | - Pierre Fenaux
- Hôpital Saint Louis, Université Paris Diderot, Paris
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig
| | - Lionel Adès
- Hôpital Saint Louis, Université Paris Diderot, Paris
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Paillassa J, Cornet E, Noel S, Tomowiak C, Lepretre S, Vaudaux S, Dupuis J, Devidas A, Joly B, Petitdidier-Lionnet C, Haiat S, Mariette C, Thieblemont C, Decaudin D, Validire-Charpy P, Drenou B, Eisenmann JC, Uribe MO, Olivrie A, Touati M, Lambotte O, Hermine O, Karsenti JM, Feugier P, Vaillant W, Gutnecht J, Lippert E, Huysman F, Ghomari K, Boubaya M, Levy V, Riou J, Damaj G, Tanguy-Schmidt A, Hunault-Berger M, Troussard X. Analysis of a cohort of 279 patients with hairy-cell leukemia (HCL): 10 years of follow-up. Blood Cancer J 2020; 10:62. [PMID: 32461544 PMCID: PMC7253459 DOI: 10.1038/s41408-020-0328-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/02/2020] [Accepted: 05/12/2020] [Indexed: 11/12/2022] Open
Abstract
In total, 279 patients with hairy-cell leukemia (HCL) were analyzed, with a median follow-up of 10 years. Data were collected up to June 2018. We analyzed responses to treatment, relapses, survival, and the occurrence of second malignancies during follow-up. The median age was 59 years. In total, 208 patients (75%) were treated with purine analogs (PNAs), either cladribine (159) or pentosatin (49), as the first-line therapy. After a median follow-up of 127 months, the median overall survival was 27 years, and the median relapse-free survival (RFS) was 11 years. The cumulative 10-year relapse incidence was 39%. In patients receiving second-line therapy, the median RFS was 7 years. For the second-line therapy, using the same or another PNA was equivalent. We identified 68 second malignancies in 59 patients: 49 solid cancers and 19 hematological malignancies. The 10-year cumulative incidences of cancers, solid tumors, and hematological malignancies were 15%, 11%, and 5.0%, respectively, and the standardized incidence ratios were 2.22, 1.81, and 6.67, respectively. In multivariate analysis, PNA was not a risk factor for second malignancies. HCL patients have a good long-term prognosis. PNAs are the first-line treatment. HCL patients require long-term follow-up because of their relatively increased risk of second malignancies.
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Affiliation(s)
| | - Edouard Cornet
- Laboratoire d'Hematologie Biologique, CHU de Caen, Caen, France
| | - Stephanie Noel
- Service d'Oncologie Hematologique et Therapie Cellulaire, CHU de Poitiers, et CIC Inserm U1402, Poitiers, France
| | - Cecile Tomowiak
- Service d'Oncologie Hematologique et Therapie Cellulaire, CHU de Poitiers, et CIC Inserm U1402, Poitiers, France
| | - Stephane Lepretre
- Inserm U1245 et Service d'Hematologie, Centre Henri Becquerel et Normandie Univ UNIROUEN, Rouen, France
| | - Sandrine Vaudaux
- Inserm U1245 et Service d'Hematologie, Centre Henri Becquerel et Normandie Univ UNIROUEN, Rouen, France
| | - Jehan Dupuis
- Service d'Hematologie Clinique, CHU Henri Mondor, Assistance Publique des Hopitaux de Paris, Creteil, France
| | - Alain Devidas
- Service d'Hematologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | - Bertrand Joly
- Service d'Hematologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | | | - Stephanie Haiat
- Service d'Hematologie Clinique, CH Sud Francilien, Corbeil Essonnes, France
| | - Clara Mariette
- Service d'Hematologie, CHU de Grenoble, Grenoble, France
| | - Catherine Thieblemont
- Service Hemato-Oncologie, Hopital Saint Louis, Assistance Publique des Hopitaux de Paris, Paris, France
| | - Didier Decaudin
- Unite d'Investigation Clinique, Departement de Medecine Oncologique, Institut Curie, Paris, France
| | | | - Bernard Drenou
- Service d'Hematologie Clinique, Groupe Hospitalier Regional de Mulhouse, Mulhouse, France
| | - Jean-Claude Eisenmann
- Service d'Hematologie Clinique, Groupe Hospitalier Regional de Mulhouse, Mulhouse, France
| | - Mario Ojeda Uribe
- Service d'Hematologie Clinique, Groupe Hospitalier Regional de Mulhouse, Mulhouse, France
| | - Agnès Olivrie
- Service d'Hematologie Clinique et Therapie Cellulaire, CHU de Limoges, Limoges, France
| | - Mohamed Touati
- Service d'Hematologie Clinique et Therapie Cellulaire, CHU de Limoges, Limoges, France
| | - Olivier Lambotte
- Service de Medecine Interne et Immunologie Clinique, Hopital Bicêtre, Assistance Publique des Hopitaux de Paris, Paris, France
| | - Olivier Hermine
- Service d'Hematologie Adulte, Hopital Necker-Enfants Malades, Assistance Publique des Hopitaux de Paris, Paris, France
| | | | | | - Willy Vaillant
- Service de Medecine Interne, Maladies Infectieuses, Oncologie et Hematologie, CH d'Auch, Auch, France
| | - Jean Gutnecht
- Service de Medecine Interne, CHI Frejus Saint Raphaël, Frejus, France
| | - Eric Lippert
- Laboratoire d'Hematologie Biologique, CHU de Brest, Brest, France
| | - Fabienne Huysman
- Service d'Hematologie Oncologie, CH de Beauvais, Beauvais, France
| | - Kamel Ghomari
- Service d'Hematologie Oncologie, CH de Beauvais, Beauvais, France
| | - Marouane Boubaya
- Unite de Recherche Clinique, Hopital Avicenne, Assistance Publique des Hopitaux de Paris, Bobigny, France
| | - Vincent Levy
- Unite de Recherche Clinique, Hopital Avicenne, Assistance Publique des Hopitaux de Paris, Bobigny, France
| | - Jeremie Riou
- MINT UMR INSERM 1066, CNRS 6021, Universite d'Angers, Angers, France
| | - Gandhi Damaj
- Institut d'Hematologie de Basse-Normandie, CHU de Caen, Caen, France
| | - Aline Tanguy-Schmidt
- Service des Maladies du Sang, CHU d'Angers, Angers, France
- Federation Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), Angers, France
- UFR Sante, Universite d'Angers, Angers, France
- CRCINA, INSERM, Universite de Nantes, Universite d'Angers, Angers, France
| | - Mathilde Hunault-Berger
- Service des Maladies du Sang, CHU d'Angers, Angers, France
- Federation Hospitalo-Universitaire 'Grand Ouest Against Leukemia' (FHU GOAL), Angers, France
- UFR Sante, Universite d'Angers, Angers, France
- CRCINA, INSERM, Universite de Nantes, Universite d'Angers, Angers, France
| | - Xavier Troussard
- Laboratoire d'Hematologie Biologique, CHU de Caen, Caen, France.
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