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Leroy H, Gadaud N, Bérard E, Klein E, Luquet I, Vial J, Rieu J, Lechevalier N, Tavitian S, Leguay T, Largeaud L, Bidet A, Delabesse E, Sarry A, de Grande A, Récher C, Pigneux A, Bertoli S, Dumas P. Dismal outcome of refractory or relapsing patients with myelodysplasia-related acute myeloid leukemia partially alleviated by intensive chemotherapy. Cancer Med 2024; 13:e7003. [PMID: 38400682 PMCID: PMC10891460 DOI: 10.1002/cam4.7003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 01/08/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Acute myeloid leukemia (AML) with myelodysplasia-related characteristics is a heterogeneous subset of AML that has been challenged throughout the history of myeloid malignancies classifications, considered to have similar outcomes as intermediate- or adverse-risk AML depending on the subgroup. However, little is known about the fate of these patients in refractory or relapsed situation (R/R) after first line therapy. METHODS A large series of R/R AML patients, recorded in the French DATAML registry, have received either intensive chemotherapy (ICT), azacitidine (AZA) as single agent, or best supportive care (BSC). A cohort of 183 patients (median age 63-year-old) with what was called at the time AML-MRC has been explored, and data are reported here. RESULTS Patient status was refractory for 93, while 90 had relapsed. Respectively, 88, 34, and 61 were included in the three treatment arms. The median OS of the whole cohort was 4.2 months (95%CI: 3.1-5.6) with a mean 1-year overall survival of 24% ± 3.2%. There was no significant survival difference between refractory and relapsed patients. The BSC group had overall a significantly worse outcome (p = 0.0001), and this remained true in both refractory (p = 0.01) and relapsed (p = 0.002) patients. Similar survivals were observed in both groups comparing ICT and AZA. CONCLUSIONS These data, reporting about an ill-explored population, indicate the poor prognosis of this condition where both ICT and AZA can be proposed. The latter, which was demonstrated here to be a feasible option, should be added to new targeted therapies.
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Affiliation(s)
- Harmony Leroy
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie CellulaireBordeauxFrance
| | - Noémie Gadaud
- Service d'HématologieCentre Hospitalier Universitaire de ToulouseInstitut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
| | - Emilie Bérard
- Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, CERPOP, Inserm, Université Toulouse III Paul SabatierToulouseFrance
| | - Emilie Klein
- CHU Bordeaux, Laboratoire d'Hématologie BiologiqueBordeauxFrance
| | - Isabelle Luquet
- Laboratoire d'HématologieCentre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
| | | | - Jean‐Baptiste Rieu
- Laboratoire d'HématologieCentre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
| | | | - Suzanne Tavitian
- Service d'HématologieCentre Hospitalier Universitaire de ToulouseInstitut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
| | - Thibaut Leguay
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie CellulaireBordeauxFrance
| | - Laetitia Largeaud
- Laboratoire d'HématologieCentre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
| | - Audrey Bidet
- CHU Bordeaux, Laboratoire d'Hématologie BiologiqueBordeauxFrance
| | - Eric Delabesse
- Laboratoire d'HématologieCentre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
| | - Audrey Sarry
- Service d'HématologieCentre Hospitalier Universitaire de ToulouseInstitut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
| | | | - Christian Récher
- Service d'HématologieCentre Hospitalier Universitaire de ToulouseInstitut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
| | - Arnaud Pigneux
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie CellulaireBordeauxFrance
- Université de Bordeaux, Bordeaux, Institut National de la Santé et de la Recherche MédicaleBordeauxFrance
| | - Sarah Bertoli
- Service d'HématologieCentre Hospitalier Universitaire de ToulouseInstitut Universitaire du Cancer de Toulouse‐OncopoleToulouseFrance
| | - Pierre‐Yves Dumas
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie CellulaireBordeauxFrance
- Université de Bordeaux, Bordeaux, Institut National de la Santé et de la Recherche MédicaleBordeauxFrance
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2
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Row C, Lechevalier N, Vial JP, Mimoun A, Bastie JN, Lafon I, Pigneux A, Leguay T, Callanan M, Maynadie M, Béné MC, Dumas PY, Guy J. Prognostic value of postinduction medullary myeloid recovery by flow cytometry in acute myeloid leukemia. EJHaem 2024; 5:84-92. [PMID: 38406512 PMCID: PMC10887270 DOI: 10.1002/jha2.822] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 02/27/2024]
Abstract
Risk stratification and treatment response evaluation are key features in acute myeloid leukemia (AML) management. Immunophenotypic and molecular approaches all rely on the detection of persisting leukemic cells by measurable residual disease techniques. A new approach is proposed here by assessing medullary myeloid maturation by flow cytometry through a myeloid progenitor ratio (MPR). The normal MPR range was defined using reference normal bone marrows (n = 48). MPR was considered balanced if between 1 and 4 and unbalanced if < 1 or > 4. MPR was retrospectively assessed at baseline and post-induction for 206 newly diagnosed AML patients eligible for intensive treatment from two different French centers. All AML baseline MPR were unbalanced and thus significantly different from normal MPR (p < 0.0001). Patients with an unbalanced MPR after induction had worse 3-year overall survival (OS) (44.4% vs. 80.2%, HR, 2.96; 95% CI, 1.81-4.84, p < 0.0001) and 3-year relapse free survival (RFS) (38.7% vs. 64.4%, HR, 2.11; 95% CI, 1.39-3.18, p < 0.001). In multivariate analysis, postinduction unbalanced MPR was significantly associated with shorter OS and RFS regardless of the European LeukemiaNet 2010 risk stratification or NPM1/FLT3-ITD status. A balanced postinduction MPR conversely conferred favorable outcomes and reflects medullary myeloid recovery.
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Affiliation(s)
- Céline Row
- Service d'Hématologie BiologiqueCHU de DijonDijonFrance
- University of Burgundy‐ISITE‐BFC‐Institut National de la Santé et de la Recherche Médicale (Inserm) UMR1231Faculty of MedicineDijonFrance
| | | | | | - Aguirre Mimoun
- Service d'Hématologie BiologiqueCHU de BordeauxBordeauxFrance
| | - Jean Noel Bastie
- University of Burgundy‐ISITE‐BFC‐Institut National de la Santé et de la Recherche Médicale (Inserm) UMR1231Faculty of MedicineDijonFrance
- Service d'Hématologie CliniqueCHU de DijonDijonFrance
| | - Ingrid Lafon
- Service d'Hématologie BiologiqueCHU de BordeauxBordeauxFrance
| | - Arnaud Pigneux
- Service d'Hématologie Clinique et de Thérapie CellulaireCHU de BordeauxBordeauxFrance
| | - Thibaut Leguay
- Service d'Hématologie Clinique et de Thérapie CellulaireCHU de BordeauxBordeauxFrance
| | - Mary Callanan
- University of Burgundy‐ISITE‐BFC‐Institut National de la Santé et de la Recherche Médicale (Inserm) UMR1231Faculty of MedicineDijonFrance
| | - Marc Maynadie
- Service d'Hématologie BiologiqueCHU de DijonDijonFrance
- University of Burgundy‐ISITE‐BFC‐Institut National de la Santé et de la Recherche Médicale (Inserm) UMR1231Faculty of MedicineDijonFrance
| | - Marie C. Béné
- CRCI2NA INSERM UMR 1307 & CNRS UMR 6075 Université de NantesNantesFrance
| | | | - Julien Guy
- Service d'Hématologie BiologiqueCHU de DijonDijonFrance
- University of Burgundy‐ISITE‐BFC‐Institut National de la Santé et de la Recherche Médicale (Inserm) UMR1231Faculty of MedicineDijonFrance
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3
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Orvain C, Chantepie S, Thomas X, Escofrre-Barbe M, Huguet F, Desbrosses Y, Guillerm G, Uzunov M, Leguay T, Barbieux S, Vey N, Chevallier P, Malfuson JV, Lepretre S, Baumann M, Aykut M, Chaib A, Joris M, Zerazhi H, Stussi G, Chapiro J, Berthon C, Bonmati C, Jourdan E, Carp D, Marcais AR, Gallego-Hernanz MP, Vaida I, Bilger K, Villate A, Pasquier F, Chalandon Y, Maury S, Lheritier V, Ifrah N, Dombret H, Boissel N, Hunault-Berger M. Impact of central nervous system involvement in adult patients with Philadelphia-negative acute lymphoblastic leukemia: a GRAALL-2005 study. Haematologica 2023; 108:3287-3297. [PMID: 36891751 PMCID: PMC10690907 DOI: 10.3324/haematol.2022.282332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/25/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
Whereas the prognosis of adult patients with Philadelphia-negative acute lymphoblastic leukemia (ALL) has greatly improved since the advent of pediatric-inspired regimens, the impact of initial central nervous system (CNS) involvement has not been formerly re-evaluated. We report here the outcome of patients with initial CNS involvement included in the pediatric-inspired prospective randomized GRAALL-2005 study. Between 2006 and 2014, 784 adult patients (aged 18-59 years) with newly diagnosed Philadelphia-negative ALL were included, of whom 55 (7%) had CNS involvement. In CNSpositive patients, overall survival was shorter (median 1.9 years vs. not reached, HR=1.8 [1.3-2.6], P<0.001). While there was no statistical difference in cumulative incidence of relapse between CNS+ and CNS- patients (HR=1.5 [0.9-2.5], P=0.11), non-relapse mortality was significantly higher in those with initial CNS disease (HR=2.1 [1.2-3.5], P=0.01). This increase in toxicity was mostly observed in patients randomized to the high-dose cyclophosphamide arm and in those who received allogeneic stem cell transplantation. Exploratory landmark analyses did not show any association between either cranial irradiation or allogeneic stem cell transplantation and outcome. Despite improved outcome in young adult ALL patients with pediatric-inspired protocols, CNS involvement is associated with a worse outcome mainly due to excess toxicity, without improved outcome with allogeneic SCT.
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Affiliation(s)
- Corentin Orvain
- Maladies du Sang, CHU d'Angers, Angers, France; Federation Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL; Universite d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Universite, CRCI2NA, F-49000 Angers
| | | | - Xavier Thomas
- Hematologie Clinique, HCL, Centre Hospitalier Lyon Sud, Pierre Benite
| | | | - Francoise Huguet
- Hematologie, Centre Hospitalo-Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole
| | | | | | | | - Thibaut Leguay
- Hematologie Clinique, Hopital du Haut-Leveque, CHU de Bordeaux, Pessac
| | - Sarah Barbieux
- Hematologie Clinique, Centre Hospitalier de Dunkerque, Dunkerque
| | - Norbert Vey
- Hematologie Clinique, Institut Paoli-Calmettes, Marseille
| | | | | | | | - Michael Baumann
- Klinik fur Med. Onkologie und Hamatologie, Kantonsspital St. Gallen, St. Gallen, Switzerland; Swiss Group for Clinical Cancer Research (SAKK), Bern
| | - Murat Aykut
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Klinik fur Medizinische Onkologie und Hamatologie, Universitatsspital Zurich, Zurich
| | - Abdelaziz Chaib
- Hemato-Oncologie et Medecine Interne, Centre Hospitalier du Pays d'Aix, Aix-en-Provence
| | | | - Hacene Zerazhi
- Hematologie Clinique, Centre Hospitalier Henri Duffaut, Avignon
| | - Georg Stussi
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Clinica di Ematologia, Istituto oncologico della Svizzera Italiana, Bellinzona
| | | | | | | | | | - Diana Carp
- Oncologie Medicale, Centre Hospitalier d'Orleans, Orleans
| | | | | | - Iona Vaida
- Onco-Hematologie, Centre Hospitalier Rene-Dubos, Pontoise
| | - Karin Bilger
- Oncologie et Hematologie, Institut de Cancerologie Strasbourg Europe (ICANS), Strasbourg
| | - Alban Villate
- Hematologie et Therapie Cellulaire, CHRU de Tours, Tours
| | - Florence Pasquier
- Departement d'Hematologie, Gustave Roussy, Universite Paris-Saclay, Villejuif
| | - Yves Chalandon
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Department of Oncology, Hematology Division, University Hospital of Geneva and Faculty of Medicine of Geneva, Geneva
| | - Sebastien Maury
- Departement d'Hematologie, Assistance Publique-Hopitaux de Paris (AP-HP), Hopital Henri Mondor, Creteil
| | | | - Norbert Ifrah
- Maladies du Sang, CHU d'Angers, Angers, France; Federation Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL; Universite d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Universite, CRCI2NA, F-49000 Angers
| | - Herve Dombret
- Hematologie Adulte, Hopital Saint-Louis, AP-HP, Paris
| | | | - Mathilde Hunault-Berger
- Maladies du Sang, CHU d'Angers, Angers, France; Federation Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL; Universite d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Universite, CRCI2NA, F-49000 Angers.
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4
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Kim R, Bergugnat H, Pastoret C, Pasquier F, Raffoux E, Larcher L, Passet M, Grardel N, Delabesse E, Kubetzko S, Caye-Eude A, Meyer C, Marschalek R, Lafage-Pochitaloff M, Thiebaut-Bertrand A, Balsat M, Escoffre-Barbe M, Blum S, Baumann M, Banos A, Straetmans N, Gallego-Hernanz MP, Chalandon Y, Graux C, Soulier J, Leguay T, Hunault M, Huguet F, Lhéritier V, Dombret H, Boissel N, Clappier E. Genetic alterations and MRD refine risk assessment for KMT2A-rearranged B-cell precursor ALL in adults: a GRAALL study. Blood 2023; 142:1806-1817. [PMID: 37595275 DOI: 10.1182/blood.2023021501] [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: 06/13/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 08/20/2023] Open
Abstract
KMT2A-rearranged (KMT2A-r) B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is widely recognized as a high-risk leukemia in both children and adults. However, there is a paucity of data on adults treated in recent protocols, and the optimal treatment strategy for these patients is still a matter of debate. In this study, we set out to refine the prognosis of adult KMT2A-r BCP-ALL treated with modern chemotherapy regimen and investigate the prognostic impact of comutations and minimal residual disease (MRD). Of 1091 adult patients with Philadelphia-negative BCP-ALL enrolled in 3 consecutive trials from the Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL), 141 (12.9%) had KMT2A-r, with 5-year cumulative incidence of relapse (CIR) and overall survival (OS) rates of 40.7% and 53.3%, respectively. Molecular profiling highlighted a low mutational burden in this subtype, reminiscent of infant BCP-ALL. However, the presence of TP53 and/or IKZF1 alterations defined a subset of patients with significantly poorer CIR (69.3% vs 36.2%; P = .001) and OS (28.1% vs 60.7%; P = .006) rates. Next, we analyzed the prognostic implication of MRD measured after induction and first consolidation, using both immunoglobulin (IG) or T-cell receptor (TR) gene rearrangements and KMT2A genomic fusion as markers. In approximately one-third of patients, IG/TR rearrangements were absent or displayed clonal evolution during the disease course, compromising MRD monitoring. In contrast, KMT2A-based MRD was highly reliable and strongly associated with outcome, with early good responders having an excellent outcome (3-year CIR, 7.1%; OS, 92.9%). Altogether, our study reveals striking heterogeneity in outcomes within adults with KMT2A-r BCP-ALL and provides new biomarkers to guide risk-based therapeutic stratification.
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Affiliation(s)
- Rathana Kim
- Hematology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM U944, CNRS UMR 7212 GenCellDis, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
| | - Hugo Bergugnat
- INSERM U944, CNRS UMR 7212 GenCellDis, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
| | - Cédric Pastoret
- Hematology Laboratory, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Florence Pasquier
- Department of Hematology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Emmanuel Raffoux
- Hematology Department, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Lise Larcher
- Hematology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM U944, CNRS UMR 7212 GenCellDis, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
| | - Marie Passet
- Hematology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie Grardel
- Hematology Laboratory, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Eric Delabesse
- Hematology Laboratory, Institut Universitaire de Cancer Toulouse-Oncopole, INSERM 1037, CNRS, Université Toulouse III-Paul Sabatier, Toulouse, France
| | - Susanne Kubetzko
- Department of Hematology, University Hospital of Zürich, Zürich, Switzerland
| | - Aurélie Caye-Eude
- Genetics Department, Molecular Genetics Unit, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, INSERM UMR_S1131, Institut de Recherche Saint-Louis, Université de Paris-Cité, Paris, France
| | - Claus Meyer
- Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia, Goethe University, Frankfurt/Main, Germany
| | - Rolf Marschalek
- Institute of Pharmaceutical Biology/Diagnostic Center of Acute Leukemia, Goethe University, Frankfurt/Main, Germany
| | - Marine Lafage-Pochitaloff
- Laboratoire de Cytogénétique Hématologique, Hôpital Timone Enfant, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Marseille, France
| | | | - Marie Balsat
- Department of Hematology, Hôpital Lyon Sud, Pierre Benite, France
| | | | - Sabine Blum
- Department of Hematology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Michael Baumann
- Klinik für Medizinische Onkologie und Hämatologie, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Anne Banos
- Department of Hematology, Centre Hospitalier de la Côte Basque, Bayonne, France
| | - Nicole Straetmans
- Department of Hematology, University Hospital Saint-Luc, Brussels, Belgium
| | | | - Yves Chalandon
- Division of Hematology, Department of Oncology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland, for the Swiss Group for Clinical Cancer Research
- Swiss Group for Clinical Cancer Research
| | - Carlos Graux
- Department of Hematology, Université Catholique de Louvain, Centre Hospitalier Universitaire UCLouvain Namur-Godinne, Yvoir, Belgium
| | - Jean Soulier
- Hematology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM U944, CNRS UMR 7212 GenCellDis, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
| | - Thibaut Leguay
- Department of Hematology, Centre Hospitalier Universitaire de Bordeaux, Hôpital du Haut-Levêque, Pessac, France
| | - Mathilde Hunault
- Département des Maladies du Sang, Centre Hospitalier Universitaire Angers, INSERM, CNRS, CRCI2NA, Fédération Hospitalo-Universitaire Grand Ouest Against Leukemia, Université d'Angers, Université de Nantes, Angers, France
| | - Françoise Huguet
- Department of Hematology, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire de Cancer Toulouse-Oncopole, Toulouse, France
| | - Véronique Lhéritier
- Coordination du Groupe Group for Research on Adult Acute Lymphoblastic Leukemia, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre Benite, France
| | - Hervé Dombret
- Hematology Department, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Nicolas Boissel
- Hematology Department, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Emmanuelle Clappier
- Hematology Laboratory, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM U944, CNRS UMR 7212 GenCellDis, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
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5
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Shah BD, Cassaday RD, Park JH, Houot R, Oluwole OO, Logan AC, Boissel N, Leguay T, Bishop MR, Topp MS, Tzachanis D, O'Dwyer KM, Arellano ML, Lin Y, Baer MR, Schiller GJ, Subklewe M, Abedi M, Minnema MC, Wierda WG, DeAngelo DJ, Stiff PJ, Jeyakumar D, Mao D, Adhikary S, Zhou L, Schuberth PC, Damico Khalid R, Ghobadia A. Impact of prior therapies and subsequent transplantation on outcomes in adult patients with relapsed or refractory B-cell acute lymphoblastic leukemia treated with brexucabtagene autoleucel in ZUMA-3. J Immunother Cancer 2023; 11:e007118. [PMID: 37648261 PMCID: PMC10471850 DOI: 10.1136/jitc-2023-007118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Brexucabtagene autoleucel (brexu-cel) is an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy approved in the USA for adults with relapsed or refractory (R/R) B-cell acute lymphoblastic leukemia (B-ALL) and in the European Union for patients ≥26 years with R/R B-ALL. After 2 years of follow-up in ZUMA-3, the overall complete remission (CR) rate (CR+CR with incomplete hematological recovery (CRi)) was 73%, and the median overall survival (OS) was 25.4 months in 78 Phase 1 and 2 patients with R/R B-ALL who received the pivotal dose of brexu-cel. Outcomes by prior therapies and subsequent allogeneic stem cell transplantation (alloSCT) are reported. METHODS Eligible adults had R/R B-ALL and received one infusion of brexu-cel (1×10⁶ CAR T cells/kg) following conditioning chemotherapy. The primary endpoint was the CR/CRi rate per central review. Post hoc subgroup analyses were exploratory with descriptive statistics provided. RESULTS Phase 1 and 2 patients (N=78) were included with median follow-up of 29.7 months (range, 20.7-58.3). High CR/CRi rates were observed across all prior therapy subgroups examined: 1 prior line of therapy (87%, n=15) and ≥2 prior lines (70%, n=63); prior blinatumomab (63%, n=38) and no prior blinatumomab (83%, n=40); prior inotuzumab (59%, n=17) and no prior inotuzumab (77%, n=61); and prior alloSCT (76%, n=29) and no prior alloSCT (71%, n=49). The frequency of Grade ≥3 cytokine release syndrome, neurological events, and treatment-related Grade 5 adverse events were largely similar among prior therapy subgroups.Median duration of remission (DOR) in responders with (n=14) and without (n=43) subsequent alloSCT was 44.2 (95% CI, 8.1 to not estimable (NE)) and 18.6 months (95% CI, 9.4 to NE); median OS was 47.0 months (95% CI, 10.2 to NE) and not reached (95% CI, 23.2 to NE), respectively. Median DOR and OS were not reached in responders without prior or subsequent alloSCT (n=22). CONCLUSIONS In ZUMA-3, adults with R/R B-ALL benefited from brexu-cel, regardless of prior therapies and subsequent alloSCT status, though survival appeared better in patients without certain prior therapies and in earlier lines of therapy. Additional studies are needed to determine the impact prior therapies and subsequent alloSCT have on outcomes of patients who receive brexu-cel.
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Affiliation(s)
- Bijal D Shah
- Division of Hematology/Oncology, Department of Malignant Hematology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Ryan D Cassaday
- Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington, USA
| | - Jae H Park
- Department of Medicine, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Roch Houot
- Department of Hematology, CHU Rennes, University Hospital Rennes, Inserm & EFS, Rennes, France
| | - Olalekan O Oluwole
- Vanderbilt-Ingram Cancer Center, Division of Hematology and Oncology, Vanderbilt University, Nashville, Tennessee, USA
| | - Aaron C Logan
- Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Nicolas Boissel
- Département d'Hématologie Clinique, Hôpital Saint-Louis, Paris, France
| | - Thibaut Leguay
- Department of Hematology, Service d'hématologie clinique et thérapie cellulaire Hôpital du Haut-Leveque CHU de Bordeaux, Bordeaux, France
| | - Michael R Bishop
- The David and Etta Jonas Center for Cellular Therapy, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Max S Topp
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Würzburg, Wurzburg, Germany
| | - Dimitrios Tzachanis
- Moores Cancer Center, University of California San Diego, San Diego, California, USA
| | - Kristen M O'Dwyer
- Wilmot Cancer Institute, University of Rochester, Rochester, New York, USA
| | | | - Yi Lin
- Department of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria R Baer
- Marlene and Stewart Greenebaum Cancer Center, University of Maryland, Baltimore, Maryland, USA
| | - Gary J Schiller
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Marion Subklewe
- Department of Medicine III, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mehrdad Abedi
- Davis Comprehensive Cancer Center, University of California, Sacramento, California, USA
| | - Monique C Minnema
- Department of Hematology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - William G Wierda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Daniel J DeAngelo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Patrick J Stiff
- Department of Hematology/Oncology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Deepa Jeyakumar
- Chao Comprehensive Cancer Center, University of California Irvine Medical Center, Irvine, California, USA
| | - Daqin Mao
- Kite, a Gilead Company, Santa Monica, California, USA
| | | | - Lang Zhou
- Kite, a Gilead Company, Santa Monica, California, USA
| | | | | | - Armin Ghobadia
- Division of Medical Oncology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
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6
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Kim R, Bergugnat H, Larcher L, Duchmann M, Passet M, Gachet S, Cuccuini W, Lafage-Pochitaloff M, Pastoret C, Grardel N, Asnafi V, Schäfer BW, Delabesse E, Itzykson R, Adès L, Hicheri Y, Chalandon Y, Graux C, Chevallier P, Hunault M, Leguay T, Huguet F, Lhéritier V, Dombret H, Soulier J, Rousselot P, Boissel N, Clappier E. Adult Low-Hypodiploid Acute Lymphoblastic Leukemia Emerges from Preleukemic TP53-Mutant Clonal Hematopoiesis. Blood Cancer Discov 2023; 4:134-149. [PMID: 36630200 PMCID: PMC9975768 DOI: 10.1158/2643-3230.bcd-22-0154] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/29/2022] [Accepted: 01/10/2023] [Indexed: 01/12/2023] Open
Abstract
Low hypodiploidy defines a rare subtype of B-cell acute lymphoblastic leukemia (B-ALL) with a dismal outcome. To investigate the genomic basis of low-hypodiploid ALL (LH-ALL) in adults, we analyzed copy-number aberrations, loss of heterozygosity, mutations, and cytogenetics data in a prospective cohort of Philadelphia (Ph)-negative B-ALL patients (n = 591, ages 18-84 years), allowing us to identify 80 LH-ALL cases (14%). Genomic analysis was critical for evidencing low hypodiploidy in many cases missed by cytogenetics. The proportion of LH-ALL within Ph-negative B-ALL dramatically increased with age, from 3% in the youngest patients (under 40 years old) to 32% in the oldest (over 55 years old). Somatic TP53 biallelic inactivation was the hallmark of adult LH-ALL, present in virtually all cases (98%). Strikingly, we detected TP53 mutations in posttreatment remission samples in 34% of patients. Single-cell proteogenomics of diagnosis and remission bone marrow samples evidenced a preleukemic, multilineage, TP53-mutant clone, reminiscent of age-related clonal hematopoiesis. SIGNIFICANCE We show that low-hypodiploid ALL is a frequent entity within B-ALL in older adults, relying on somatic TP53 biallelic alteration. Our study unveils a link between aging and low-hypodiploid ALL, with TP53-mutant clonal hematopoiesis representing a preleukemic reservoir that can give rise to aneuploidy and B-ALL. See related commentary by Saiki and Ogawa, p. 102. This article is highlighted in the In This Issue feature, p. 101.
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Affiliation(s)
- Rathana Kim
- Université Paris Cité, Institut de Recherche Saint-Louis (IRSL), Institut National de la Santé et de la Recherche Médicale (INSERM) U944, Centre National de la Recherche Scientifique (CNRS) UMR 7212 GenCellDis, Paris, France
- Laboratoire d'Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Hugo Bergugnat
- Laboratoire d'Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Lise Larcher
- Université Paris Cité, Institut de Recherche Saint-Louis (IRSL), Institut National de la Santé et de la Recherche Médicale (INSERM) U944, Centre National de la Recherche Scientifique (CNRS) UMR 7212 GenCellDis, Paris, France
- Laboratoire d'Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Matthieu Duchmann
- Université Paris Cité, Institut de Recherche Saint-Louis (IRSL), Institut National de la Santé et de la Recherche Médicale (INSERM) U944, Centre National de la Recherche Scientifique (CNRS) UMR 7212 GenCellDis, Paris, France
| | - Marie Passet
- Université Paris Cité, Institut de Recherche Saint-Louis (IRSL), Institut National de la Santé et de la Recherche Médicale (INSERM) U944, Centre National de la Recherche Scientifique (CNRS) UMR 7212 GenCellDis, Paris, France
- Laboratoire d'Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Stéphanie Gachet
- Université Paris Cité, Institut de Recherche Saint-Louis (IRSL), Institut National de la Santé et de la Recherche Médicale (INSERM) U944, Centre National de la Recherche Scientifique (CNRS) UMR 7212 GenCellDis, Paris, France
| | - Wendy Cuccuini
- Laboratoire d'Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Groupe Francophone de Cytogénétique Hématologique (GFCH), Paris, France
| | - Marina Lafage-Pochitaloff
- Groupe Francophone de Cytogénétique Hématologique (GFCH), Paris, France
- Laboratoire de Cytogénétique Hématologique, Hôpital Timone Enfant, AP-HM, Aix-Marseille Université, Marseille, France
| | - Cédric Pastoret
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Nathalie Grardel
- Laboratoire d'Hématologie, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - Vahid Asnafi
- Laboratoire d'Onco-hématologie, Hôpital Necker Enfants-Malades, AP-HP, Paris, France
| | - Beat W. Schäfer
- Department of Hematology, University Hospital, Zürich, Switzerland
| | - Eric Delabesse
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Raphaël Itzykson
- Université Paris Cité, Institut de Recherche Saint-Louis (IRSL), Institut National de la Santé et de la Recherche Médicale (INSERM) U944, Centre National de la Recherche Scientifique (CNRS) UMR 7212 GenCellDis, Paris, France
- Département d'Hématologie Clinique, Hôpital Saint-Louis, AP-HP, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
| | - Lionel Adès
- Université Paris Cité, Institut de Recherche Saint-Louis (IRSL), Institut National de la Santé et de la Recherche Médicale (INSERM) U944, Centre National de la Recherche Scientifique (CNRS) UMR 7212 GenCellDis, Paris, France
- Département d'Hématologie Clinique, Hôpital Saint-Louis, AP-HP, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
| | - Yosr Hicheri
- Hematology Department, Institut Paoli-Calmettes, Aix Marseille Univ, CNRS, INSERM, CRCM, Marseille, France
| | - Yves Chalandon
- Hématologie, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Carlos Graux
- Université Catholique de Louvain, Centre Hospitalier Universitaire UCLouvaine Namur-Godinne, Service d'Hématologie, Yvoir, Belgium
| | - Patrice Chevallier
- Department of Hematology, CHU Nantes, INSERM UMR1232 and CNRS ERL6001 CRCINA IRS-UN, Nantes, France
| | - Mathilde Hunault
- Département des Maladies du sang, CHU Angers, FHU GOAL, Université d'Angers, Université de Nantes, INSERM, CNRS, CRCI2NA, SFR ICAT, Angers, France
| | - Thibaut Leguay
- Department of Hematology, CHU de Bordeaux, Hôpital du Haut-Levêque, Pessac, France
| | - Françoise Huguet
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | | | - Hervé Dombret
- Département d'Hématologie Clinique, Hôpital Saint-Louis, AP-HP, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
| | - Jean Soulier
- Université Paris Cité, Institut de Recherche Saint-Louis (IRSL), Institut National de la Santé et de la Recherche Médicale (INSERM) U944, Centre National de la Recherche Scientifique (CNRS) UMR 7212 GenCellDis, Paris, France
- Laboratoire d'Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Philippe Rousselot
- Hematology Department, Centre Hospitalier de Versailles, UMR 1184 CEA, University Paris-Saclay, Le Chesnay, France
| | - Nicolas Boissel
- Département d'Hématologie Clinique, Hôpital Saint-Louis, AP-HP, Institut de Recherche Saint-Louis, Université Paris Cité, Paris, France
| | - Emmanuelle Clappier
- Université Paris Cité, Institut de Recherche Saint-Louis (IRSL), Institut National de la Santé et de la Recherche Médicale (INSERM) U944, Centre National de la Recherche Scientifique (CNRS) UMR 7212 GenCellDis, Paris, France
- Laboratoire d'Hématologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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7
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Galtier J, Dimicoli-Salazar S, Trimouille A, Lainey E, Revy P, Bidet A, Vial Y, Forcade E, Negrier-Leibreich ML, Rivière E, Tinat J, Le Meur N, Ménard C, Pigneux A, Leguay T, Dumas PY, Ibrahima B, Kannengiesser C. First clinical description of a pedigree with complete NAF1 deletion. Leuk Lymphoma 2023; 64:487-490. [PMID: 36416722 DOI: 10.1080/10428194.2022.2148377] [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] [Indexed: 11/24/2022]
Affiliation(s)
- Jean Galtier
- Service D'Hématologie et Thérapie Cellulaire, CHU de Bordeaux, Pessac, France
| | | | - Aurélien Trimouille
- Département d'Anatomopathologie, CHU de Bordeaux, Bordeaux, France.,Maladies Rares: Génétique et Métabolisme (MRGM), U1211 INSERM, CHU Bordeaux, Bordeaux, France
| | - Elodie Lainey
- Hématologie Biologique, Hôpital Robert-Debré, APHP, Paris, France
| | - Patrick Revy
- Laboratory of Genome Dynamics in the Immune System, Equipe Labellisée Ligue contre le Cancer, INSERM UMR 1163, Imagine Institute, Université de Paris, Paris, France
| | - Audrey Bidet
- Service d'Hématologie Biologique, CHU de Bordeaux, Pessac, France
| | - Yoann Vial
- Génétique Moléculaire, Hôpital Robert-Debré, APHP, Paris, France
| | - Edouard Forcade
- Service D'Hématologie et Thérapie Cellulaire, CHU de Bordeaux, Pessac, France
| | | | - Etienne Rivière
- Service de Médecine Interne et Maladie Infectieuse, CHU de Bordeaux, Pessac, France
| | - Julie Tinat
- Service de Génétique Médicale, CHU de Bordeaux, Bordeaux, France
| | | | - Christelle Ménard
- Département de Génétique, Hôpital Xavier Bichat-Claude Bernard, APHP, Paris, France
| | - Arnaud Pigneux
- Service D'Hématologie et Thérapie Cellulaire, CHU de Bordeaux, Pessac, France
| | - Thibaut Leguay
- Service D'Hématologie et Thérapie Cellulaire, CHU de Bordeaux, Pessac, France
| | - Pierre-Yves Dumas
- Service D'Hématologie et Thérapie Cellulaire, CHU de Bordeaux, Pessac, France
| | - Ba Ibrahima
- Département de Génétique, Hôpital Xavier Bichat-Claude Bernard, APHP, Paris, France
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8
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Shah BD, Cassaday RD, Park JH, Houot R, Oluwole OO, Logan AC, Boissel N, Leguay T, Bishop MR, Topp MS, Tzachanis D, O’Dwyer KM, Arellano ML, Lin Y, Baer MR, Schiller GJ, Subklewe M, Abedi M, Minnema MC, Wierda WG, DeAngelo DJ, Stiff P, Jeyakumar D, Dong J, Adhikary S, Zhou L, Schuberth PC, Masouleh BK, Ghobadi A. Subgroup Analyses of Kte-X19, an Anti-CD19 Chimeric Antigen Receptor (CAR) T-Cell Therapy, in Adult Patients (Pts) with Relapsed/Refractory B-Cell Acute Lymphoblastic Leukemia (R/R B-ALL) in Zuma-3. Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00078-7] [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: 02/07/2023]
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9
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Shah BD, Ghobadi A, Oluwole OO, Logan AC, Boissel N, Cassaday RD, Leguay T, Bishop MR, Topp MS, Tzachanis D, O’Dwyer KM, Arellano ML, Lin Y, Baer MR, Schiller GJ, Park JH, Subklewe M, Abedi M, Minnema MC, Wierda WG, DeAngelo DJ, Stiff P, Jeyakumar D, Dong J, Adhikary S, Zhou L, Schuberth PC, Faghmous I, Masouleh BK, Houot R. Two-year follow-up of KTE-X19 in patients with relapsed or refractory adult B-cell acute lymphoblastic leukemia in ZUMA-3 and its contextualization with SCHOLAR-3, an external historical control study. J Hematol Oncol 2022; 15:170. [PMID: 36494725 PMCID: PMC9734710 DOI: 10.1186/s13045-022-01379-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/05/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Brexucabtagene autoleucel (KTE-X19) is an autologous anti-CD19 CAR T-cell therapy approved in the USA to treat adult patients with relapsed or refractory B-precursor acute lymphoblastic leukemia (R/R B-ALL) based on ZUMA-3 study results. We report updated ZUMA-3 outcomes with longer follow-up and an extended data set along with contextualization of outcomes to historical standard of care. METHODS Adults with R/R B-ALL received a single infusion of KTE-X19 (1 × 106 CAR T cells/kg). Long-term post hoc subgroup assessments of ZUMA-3 were conducted. Outcomes from matched patients between historical clinical trials and ZUMA-3 patients were assessed in the retrospective historical control study SCHOLAR-3. RESULTS After 26.8-months median follow-up, the overall complete remission (CR) rate (CR + CR with incomplete hematological recovery) among treated patients (N = 55) in phase 2 was 71% (56% CR rate); medians for duration of remission and overall survival (OS) were 14.6 and 25.4 months, respectively. Most patients responded to KTE-X19 regardless of age or baseline bone marrow blast percentage, but less so in patients with > 75% blasts. No new safety signals were observed. Similar outcomes were observed in a pooled analysis of phase 1 and 2 patients (N = 78). In SCHOLAR-3, the median OS for treated patients from ZUMA-3 (N = 49) and matched historical controls (N = 40) was 25.4 and 5.5 months, respectively. CONCLUSIONS These data, representing the longest follow-up of CAR T-cell therapy in a multicenter study of adult R/R B-ALL, suggest that KTE-X19 provides a clinically meaningful survival benefit with manageable toxicity in this population. TRIAL REGISTRATION NCT02614066.
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Affiliation(s)
- Bijal D. Shah
- grid.468198.a0000 0000 9891 5233Moffitt Cancer Center, Tampa, FL 33612 USA
| | - Armin Ghobadi
- grid.4367.60000 0001 2355 7002Washington University School of Medicine, St Louis, MO USA
| | - Olalekan O. Oluwole
- grid.152326.10000 0001 2264 7217Vanderbilt University Cancer Center, Nashville, TN USA
| | - Aaron C. Logan
- grid.413077.60000 0004 0434 9023UCSF Medical Center, San Francisco, CA USA
| | - Nicolas Boissel
- grid.413328.f0000 0001 2300 6614Hôpital Saint-Louis, Paris, France
| | - Ryan D. Cassaday
- grid.34477.330000000122986657University of Washington, Fred Hutchinson Cancer Center, Seattle, WA USA
| | - Thibaut Leguay
- grid.42399.350000 0004 0593 7118Service d’hématologie Clinique Et Thérapie Cellulaire, Hopital du Haut-Leveque CHU de Bordeaux, Bordeaux, France
| | - Michael R. Bishop
- grid.170205.10000 0004 1936 7822The University of Chicago Medicine, Chicago, IL USA
| | - Max S. Topp
- grid.411760.50000 0001 1378 7891Medizinische Klinik Und Poliklinik II, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Dimitrios Tzachanis
- grid.266100.30000 0001 2107 4242University of California San Diego, San Diego, CA USA
| | - Kristen M. O’Dwyer
- grid.16416.340000 0004 1936 9174Wilmot Cancer Institute of University of Rochester, Rochester, NY USA
| | - Martha L. Arellano
- grid.189967.80000 0001 0941 6502Winship Cancer Institute of Emory University, Atlanta, GA USA
| | - Yi Lin
- grid.66875.3a0000 0004 0459 167XMayo Clinic, Rochester, MN USA
| | - Maria R. Baer
- grid.411024.20000 0001 2175 4264University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD USA
| | - Gary J. Schiller
- grid.19006.3e0000 0000 9632 6718David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Jae H. Park
- grid.51462.340000 0001 2171 9952Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Marion Subklewe
- grid.5252.00000 0004 1936 973XLudwig-Maximilians-Universität München, Munich, Germany
| | - Mehrdad Abedi
- grid.27860.3b0000 0004 1936 9684University of California Davis Comprehensive Cancer Center, Sacramento, CA USA
| | - Monique C. Minnema
- grid.7692.a0000000090126352University Medical Center Utrecht (on behalf of HOVON/LLPC), Utrecht, The Netherlands
| | - William G. Wierda
- grid.240145.60000 0001 2291 4776The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Daniel J. DeAngelo
- grid.65499.370000 0001 2106 9910Dana-Farber Cancer Institute, Boston, MA USA
| | - Patrick Stiff
- grid.164971.c0000 0001 1089 6558Loyola University Chicago Stritch School of Medicine, Maywood, IL USA
| | - Deepa Jeyakumar
- grid.417319.90000 0004 0434 883XUniversity of California Irvine Medical Center, Orange, CA USA
| | - Jinghui Dong
- grid.504964.aKite, a Gilead Company, Santa Monica, CA USA
| | | | - Lang Zhou
- grid.504964.aKite, a Gilead Company, Santa Monica, CA USA
| | | | - Imi Faghmous
- grid.504964.aKite, a Gilead Company, Santa Monica, CA USA
| | | | - Roch Houot
- grid.411154.40000 0001 2175 0984CHU Rennes, Univ Rennes, Inserm & EFS, Rennes, France
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10
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Heraudet L, Galtier J, Favre S, Peyraud F, Cazaubiel T, Leroy H, Mottal N, Gros FX, Forcade E, Clément L, Dumas PY, Pigneux A, Leguay T. VANDA regimen followed by blinatumomab leads to favourable outcome in patients with Philadelphia chromosome-negative B-precursor acute lymphoblastic leukaemia in first relapse. Br J Haematol 2022; 198:523-527. [PMID: 35524489 DOI: 10.1111/bjh.18218] [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: 03/19/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/28/2022]
Abstract
Adults with relapsed or refractory B-precursor acute lymphoblastic leukaemia (R/R BCP-ALL) have very poor outcome. Blinatumomab as single agent has shown activity in R/R BCP-ALL. We aimed to assess the activity of blinatumomab in concomitant association with intensive chemotherapy. Seventeen patients with R/R BCP-ALL were treated with combination of blinatumomab and VANDA (etoposide, cytarabine, mitoxantrone, dexamethasone and asparaginase) regimen. Complete remission (CR) was achieved in 14/17 patient (82%) and 11/17 (65%) were transplanted. One-year leukaemia-free survival was 58.8% for the whole cohort and 90.9% for transplanted patients. These preliminary data suggest that the VANDA-blinatumomab salvage regimen leads to a very high rate of CR and HSCT in suitable patients.
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Affiliation(s)
- Luc Heraudet
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Jean Galtier
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Simon Favre
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Florent Peyraud
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Titouan Cazaubiel
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Harmony Leroy
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Nathan Mottal
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - François-Xavier Gros
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Edouard Forcade
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Laurence Clément
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Pierre-Yves Dumas
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Arnaud Pigneux
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Thibaut Leguay
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
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11
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Michallet M, Sobh M, Morisset S, Deloire A, Raffoux E, de Botton S, Caillot D, Chantepie S, Girault S, Berthon C, Bertoli S, Lepretre S, Leguay T, Castaigne S, Marolleau JP, Pautas C, Malfuson JV, Veyn N, Braun T, Gastaud L, Suarez F, Schmidt A, Gressin R, Bonmati C, Celli-Lebras K, El-Hamri M, Ribaud P, Dombret H, Thomas X, Bergeron A. Antifungal Prophylaxis in AML Patients Receiving Intensive Induction Chemotherapy: A Prospective Observational Study From the Acute Leukaemia French Association (ALFA) Group. Clin Lymphoma Myeloma Leuk 2022; 22:311-318. [PMID: 34895843 DOI: 10.1016/j.clml.2021.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Although recommended in patients with acute myeloblastic leukaemia (AML) after induction chemotherapy, real-life use of antifungal prophylaxis (AFP) is different among centres. MATERIALS AND METHODS This is an ancillary study to a randomized trial on intensive induction chemotherapy in AML patients (ALFA-0702/NCT00932412), where AFP with posaconazole was recommended. IFIs were graded by investigators and by central reviewers according to the revised EORTC definitions. Experts conclusions were compared to the investigators' ones. RESULTS A total of 677 patients were included. Four AFP strategies were reported: Group-1: no AFP (n = 203, 30%), Group-2: posaconazole (n = 241, 36%), Group-3: posaconazole with other AFP (n = 142, 21%), Group-4: other AFP (n = 91, 13%). Experts graded more IFI than investigators: proven/probable IFI, 9.0% (n = 61) versus 6.2% (n = 42). The cumulative incidence at day60 of probable/proven IFI was 13.9% (Group-1); 7.9% (Group-2); 5.6% (Group-3); and 6.6% (Group-4). IFI onset was 26 (19-31) days after induction in Groups 2-3, versus 16 (9-25) days in Group 1 and 20 (12-24) days in Group 4 (P< .001). After a median follow-up of 27.5 months (0.4-73.4), the mortality rate was 38.3%, with 5.4% attributed to IFI. In multivariate analysis, IFI occurrence was an independent risk of death (HR5.63, 95%-CI 2.62-12.08, P< .001). EORTC recommendations were applied in only 57% of patients. In patients without IFI, the rate of AML complete remission was higher. CONCLUSIONS In AML patients, AFP delayed the onset of IFI in addition of decreasing their rate. The frequent misidentification of IFI impacts their appropriate management according to recommendations. hematological remission was more frequent in patients without IFI.
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Affiliation(s)
| | - Mohamad Sobh
- Hematology department, Anticancer Centre Léon Bérard, Lyon, France
| | | | | | | | | | - Denis Caillot
- Hématologie Clinique, Dijon University Hospital, Dijon, France
| | | | | | | | - Sarah Bertoli
- Service d'hématologie, Institut Universitaire du Cancer de Toulouse - Oncopole, CHU de Toulouse, Toulouse, France
| | - Stephane Lepretre
- Inserm U1245 and Department of Hematology, Centre Henri Becquerel and Normandie Univ UNIROUEN, Rouen, France
| | | | | | | | | | | | - Norbert Veyn
- Hematology, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Felipe Suarez
- Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | | | | | | | | | - Mohamed El-Hamri
- Haematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | | | - Herve Dombret
- Hematology Department, Saint Louis Hospital, Paris, France
| | - Xavier Thomas
- Haematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Anne Bergeron
- Pneumology department, Saint Louis Hospital, AP-HP, Paris, France
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12
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Cabannes-Hamy A, Brissot E, Leguay T, Huguet F, Chevallier P, Hunault M, Escoffre-Barbe M, Cluzeau T, Balsat M, Nguyen S, Pasquier F, Alexis M, Lheritier V, Pastoret C, Delabesse E, Clappier E, Dombret H, Boissel N. High tumor burden before blinatumomab has a negative impact on the outcome of adult patients with B-cell precursor acute lymphoblastic leukemia. A real-world study by the GRAALL. Haematologica 2022; 107:2072-2080. [PMID: 35263986 PMCID: PMC9425331 DOI: 10.3324/haematol.2021.280078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Indexed: 11/25/2022] Open
Abstract
Blinatumomab is a bispecific T-cell engager approved for B-cell precursor acute lymphoblastic leukemia (B-ALL) with persistent minimal residual disease (MRD) or in relapse. The prognostic impact of tumor load has been suggested before other immunotherapies but remains poorly explored before blinatumomab. We retrospectively analyzed the outcome of 73 patients who received blinatumomab either in first complete remission (CR) with MRD (n=35) or at relapse (n=38). Among MRD patients, 91% had MRD >0.01% before blinatumomab, and 89% achieved complete MRD response after blinatumomab. High pre-blinatumomab MRD levels were associated with shorter relapse-free survival (P=0.049) and overall survival (OS) (P=0.011). At 3 years, OS was 33%, 58% and 86% for pre-blinatumomab MRD >1%, between MRD 0.1-1% and <0.1% respectively. Among relapsed patients, 23 received blinatumomab with overt relapse and 15 were in complete response (CR) after bridging chemotherapy. At 3 years, overall CR rate was 68% and complete MRD response rate was 84%. Patients who directly received blinatumomab had shorter relapse-free survival (P=0.033) and OS (P=0.003) than patients bridged to blinatumomab. Three-year OS was 66% in the latter group compared to 16% in the former group. Our observations suggest that pre-blinatumomab tumor burden should help to design more tailored strategies including tumor load reduction in relapsed patients.
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Affiliation(s)
| | - Eolia Brissot
- Sorbonne Université, AP-HP, Saint-Antoine Hospital, Hematology Department, UMRS 938, INSERM,Paris
| | | | | | | | | | | | | | - Marie Balsat
- Hematology Departement, Lyon Sud Hospital, Pierre Benite
| | | | | | - Magda Alexis
- Hematology Departement, Orléans Hospital, Orléans
| | | | | | | | | | - Herve Dombret
- Adult Hematology Department, Saint-Louis Hospital, APHP, URP3518, Institut de Recherche Saint-Louis, Université de Paris, Paris
| | - Nicolas Boissel
- Hematology Adolescent and Young Adult Unit, Saint-Louis Hospital, APHP, URP3518, Institut de Recherche Saint-Louis, Université de Paris, Paris.
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13
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Gadaud N, Leroy H, Bérard E, Tavitian S, Leguay T, Dimicoli-Salazar S, Rieu JB, Luquet I, Largeaud L, Bidet A, Delabesse E, Klein E, Sarry A, de Grande AC, Bories P, Pigneux A, Récher C, Dumas PY, Bertoli S. Azacitidine, intensive chemotherapy or best supportive care in relapsed or refractory acute myeloid leukemia, a DATAML registry study. Leuk Lymphoma 2022; 63:1398-1406. [DOI: 10.1080/10428194.2021.2022140] [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] [Indexed: 10/19/2022]
Affiliation(s)
- Noémie Gadaud
- Service d’Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Harmony Leroy
- Centre Hospitalier Universitaire de Bordeaux, Service d’Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Emilie Bérard
- Service d’Epidémiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Suzanne Tavitian
- Service d’Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Thibaut Leguay
- Centre Hospitalier Universitaire de Bordeaux, Service d’Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Sophie Dimicoli-Salazar
- Centre Hospitalier Universitaire de Bordeaux, Service d’Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Jean-Baptiste Rieu
- Laboratoire d’Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Isabelle Luquet
- Laboratoire d’Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Laetitia Largeaud
- Laboratoire d’Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, Toulouse, France
| | - Audrey Bidet
- Laboratoire d’Hématologie Biologique, CHU Bordeaux, Bordeaux, France
| | - Eric Delabesse
- Laboratoire d’Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, Toulouse, France
| | - Emilie Klein
- Laboratoire d’Hématologie Biologique, CHU Bordeaux, Bordeaux, France
| | - Audrey Sarry
- Service d’Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Anne-Charlotte de Grande
- Centre Hospitalier Universitaire de Bordeaux, Service d’Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Pierre Bories
- Service d’Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Arnaud Pigneux
- Centre Hospitalier Universitaire de Bordeaux, Service d’Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
- Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
| | - Christian Récher
- Service d’Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, Toulouse, France
| | - Pierre-Yves Dumas
- Centre Hospitalier Universitaire de Bordeaux, Service d’Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
- Institut National de la Santé et de la Recherche Médicale, Bordeaux, France
| | - Sarah Bertoli
- Service d’Hématologie, Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, Toulouse, France
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14
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Brett VE, Menguy S, Arcourt A, Bidet A, Lechevalier N, Leguay T, Klein E, Garnache-Ottou F, Vial JP. An unusual case of cytoplasmic CD3 expressing BPDCN supporting the T-lineage origin of plasmacytoid dendritic cells. Cytometry B Clin Cytom 2021; 102:175-177. [PMID: 34787365 DOI: 10.1002/cyto.b.22039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/08/2022]
Affiliation(s)
| | - Sarah Menguy
- Laboratoire d'Anathomo-pathologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Agathe Arcourt
- Service des maladies du sang et de thérapie cellulaire, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Audrey Bidet
- Laboratoire d'Hématologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Nicolas Lechevalier
- Laboratoire d'Hématologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Thibaut Leguay
- Service des maladies du sang et de thérapie cellulaire, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Emilie Klein
- Laboratoire d'Hématologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Francine Garnache-Ottou
- INSERM UMR 1098, RIGHT (Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique), Établissement Français du Sang et Université de Bourgogne Franche-Comté, Besançon, France
| | - Jean-Philippe Vial
- Laboratoire d'Hématologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
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15
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Dumas PY, Villacreces A, Guitart AV, El-Habhab A, Massara L, Mansier O, Bidet A, Martineau D, Fernandez S, Leguay T, Pigneux A, Vigon I, Pasquet JM, Desplat V. Dual Inhibition of FLT3 and AXL by Gilteritinib Overcomes Hematopoietic Niche-Driven Resistance Mechanisms in FLT3-ITD Acute Myeloid Leukemia. Clin Cancer Res 2021; 27:6012-6025. [PMID: 34400415 DOI: 10.1158/1078-0432.ccr-20-3114] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 06/14/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE AXL has been shown to play a pivotal role in the selective response of FLT3-ITD acute myeloid leukemia (AML) cells to FLT3 tyrosine kinase inhibitors (TKI), particularly within the bone marrow microenvironment. EXPERIMENTAL DESIGN Herein, we compared the effect of dual FLT3/AXL-TKI gilteritinib with quizartinib through in vitro models mimicking hematopoietic niche conditions, ex vivo in primary AML blasts, and in vivo with dosing regimens allowing plasma concentration close to those used in clinical trials. RESULTS We observed that gilteritinib maintained a stronger proapoptotic effect in hypoxia and coculture with bone marrow stromal cells compared with quizartinib, linked to a dose-dependent inhibition of AXL phosphorylation. In vivo, use of the MV4-11 cell line with hematopoietic engraftment demonstrated that gilteritinib was more effective than quizartinib at targeting leukemic cells in bone marrow. Finally, FLT3-ITD AML patient-derived xenografts revealed that this effect was particularly reproducible in FLT3-ITD AML with high allelic ratio in primary and secondary xenograft. Moreover, gilteritinib and quizartinib displayed close toxicity profile on normal murine hematopoiesis, particularly at steady state. CONCLUSIONS Overall, these findings suggest that gilteritinib as a single agent, compared with quizartinib, is more likely to reach leukemic cells in their protective microenvironment, particularly AML clones highly dependent on FLT3-ITD signaling.
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Affiliation(s)
- Pierre-Yves Dumas
- Service d'Hématologie et Thérapie Cellulaire, CHU Bordeaux, Bordeaux, France.
- BMGIC, U1035 INSERM, University of Bordeaux, Bordeaux, France
| | | | | | - Ali El-Habhab
- BMGIC, U1035 INSERM, University of Bordeaux, Bordeaux, France
| | - Layal Massara
- BMGIC, U1035 INSERM, University of Bordeaux, Bordeaux, France
| | - Olivier Mansier
- INSERM U1034, Institut National de la Santé et de la Recherche Médicale, University of Bordeaux, Bordeaux, France
- Service d'Hématologie Biologique, CHU Bordeaux, Bordeaux, France
| | - Audrey Bidet
- Service d'Hématologie Biologique, CHU Bordeaux, Bordeaux, France
| | - Delphine Martineau
- Service d'Hématologie et Thérapie Cellulaire, CHU Bordeaux, Bordeaux, France
- BMGIC, U1035 INSERM, University of Bordeaux, Bordeaux, France
| | | | - Thibaut Leguay
- Service d'Hématologie et Thérapie Cellulaire, CHU Bordeaux, Bordeaux, France
| | - Arnaud Pigneux
- Service d'Hématologie et Thérapie Cellulaire, CHU Bordeaux, Bordeaux, France
- BMGIC, U1035 INSERM, University of Bordeaux, Bordeaux, France
| | - Isabelle Vigon
- BMGIC, U1035 INSERM, University of Bordeaux, Bordeaux, France
| | | | - Vanessa Desplat
- BMGIC, U1035 INSERM, University of Bordeaux, Bordeaux, France.
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16
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Broussais F, Bay JO, Boissel N, Baruchel A, Arnulf B, Morschhauser F, Robin M, Guepin GR, Moreau P, Gandemer V, Manier S, Leguay T, Nguyen Quoc S, Schwartzmann A, Houot R, Le Gouill S. [DESCAR-T, a nationwide registry for patient treated by CAR-T Cells in France]. Bull Cancer 2021; 108:S143-S154. [PMID: 34920797 DOI: 10.1016/j.bulcan.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/29/2022]
Abstract
CAR-T Cells have opened new doors for cellular immunotherapies and provides new therapeutic options for patients with refractory B-cell malignancies, B-cell acute lymphoblastic leukemia and diffuse large B-cel lymphoma. CAR-T Cells have benefited from an accelerated approval procedure in many countries. Indeed, The French health authorities have approved the specialties Tisacel ® and Axicel ®, but additional data including the use of CAR-T Cells in real life were also mandatory. In regard to the scientific interest of the project, LYSA-LYSARC committed itself to prospectively and retrospectively collect information on patients eligible for CAR-T Cells as required by French health authorities. Other academic cooperating groups (GRAALL, IFM, SFCE, FILO and the scientific society SFGM-TC) were associated to this initiative which aims to build a nationwide CAR-T Cells devoted registry, so-called DESCART (Dispositif d'Enregistrement et Suivi des patients traités par CAR-T cells). DESCAR-T is a real-life multicentric registry set up in French sites qualified for CAR-T Cells treatment. DESCAR-T objective is to describe the use of CAR-T Cells in real life. All paediatric and adult patients with hematological malignancy fulfilling CAR-T Cells approval criteria and for whom a CAR-T Cells therapy has been discussed are included from 1 July 2018. Clinical data are directly collected from medical records and patients are treated according to the centers' routine practices. One of the distinctive features of DESCAR-T is its link with HTA for CAR-T Cells s reimbursement by the French public health system. DESCAR-T is the first national registry promoted by an academic group allowing centralized data collection for both academic and HTA/health authorities' purposes.
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Affiliation(s)
- Florence Broussais
- LYSARC : Centre Hospitalier Lyon-Sud Batiment 2D, 69495 Pierre-Bénite Cedex, France.
| | - Jacques Olivier Bay
- CHU ESTAING Service d'hématologie clinique et de thérapie cellulaire adulte, 1, place Lucie Aubrac, 63003 Clermont-Ferrand Cedex, France.
| | - Nicolas Boissel
- Hôpital Saint-Louis, AP-HP, service d'hématologie adolescents et jeunes adultes, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - André Baruchel
- Hôpital Robert-Debré, service d'hémato-immunologie, 48, boulevard Sérurier, 79395 Paris cedex 19, France.
| | - Bertrand Arnulf
- Hôpital Saint-Louis, Service d'immunohématologie, UMR Inserm 1126, Paris, France.
| | - Franck Morschhauser
- CHU de Lille, Hôpital Huriez, service des maladies du sang, 1, rue Michel-Polonowski, 59037 Lille Cedex, France.
| | - Marie Robin
- Hôpital Saint-Louis, Inserm 1131, université Paris 7, Service d'hématologie-allogreffe, Paris, France.
| | - Gabrielle Roth Guepin
- Hôpitaux de Brabois, Service d'Hématologie du CHRU de Nancy, 8, rue Du Morvan, 54500 Vandoeuvre Les Nancy, France.
| | - Philippe Moreau
- Service d'hématologie clinique, CHU Hôtel Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - Virginie Gandemer
- Service d'hémato-oncologie pédiatrique, Centre hospitalier universitaire de Rennes, 2 rue Henri Le Guilloux, 35033 Rennes cedex 9, France.
| | - Salomon Manier
- CHU de Lille, Hôpital Huriez, service des maladies du sang, 1, rue Michel-Polonowski, 59037 Lille Cedex, France.
| | - Thibaut Leguay
- Hopital Haut-Leveque -CHU, Service d'hématologie et de thérapie cellulaire, avenue de Magellan, 33600 Pessac, France.
| | - Stéphanie Nguyen Quoc
- Assistance publique-Hôpitaux de Paris, service d'hématologie clinique, groupe hospitalier Pitié-Salpêtrière, Paris, France.
| | - Alexia Schwartzmann
- LYSARC : Centre Hospitalier Lyon-Sud Batiment 2D, 69495 Pierre-Bénite Cedex, France.
| | - Roch Houot
- Service d'Hématologie, centre hospitalier universitaire de Rennes, 2 rue Henri Le Guilloux, 35033 Rennes cedex 9, France.
| | - Steven Le Gouill
- Service d'hématologie clinique, CHU Hôtel Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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17
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Shah BD, Ghobadi A, Oluwole OO, Logan AC, Boissel N, Cassaday RD, Leguay T, Bishop MR, Topp MS, Tzachanis D, O'Dwyer KM, Arellano ML, Lin Y, Baer MR, Schiller GJ, Park JH, Subklewe M, Abedi M, Minnema MC, Wierda WG, DeAngelo DJ, Stiff P, Jeyakumar D, Feng C, Dong J, Shen T, Milletti F, Rossi JM, Vezan R, Masouleh BK, Houot R. KTE-X19 for relapsed or refractory adult B-cell acute lymphoblastic leukaemia: phase 2 results of the single-arm, open-label, multicentre ZUMA-3 study. Lancet 2021; 398:491-502. [PMID: 34097852 DOI: 10.1016/s0140-6736(21)01222-8] [Citation(s) in RCA: 289] [Impact Index Per Article: 96.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite treatment with novel therapies and allogeneic stem-cell transplant (allo-SCT) consolidation, outcomes in adult patients with relapsed or refractory B-precursor acute lymphoblastic leukaemia remain poor, underlining the need for more effective therapies. METHODS We report the pivotal phase 2 results of ZUMA-3, an international, multicentre, single-arm, open-label study evaluating the efficacy and safety of the autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy KTE-X19 in adult patients with relapsed or refractory B-precursor acute lymphoblastic leukaemia. Patients were enrolled at 25 sites in the USA, Canada, and Europe. Eligible patients were aged 18 years or older, with Eastern Cooperative Oncology Group performance status of 0-1, and morphological disease in the bone marrow (>5% blasts). After leukapheresis and conditioning chemotherapy, patients received a single KTE-X19 infusion (1 × 106 CAR T cells per kg bodyweight). The primary endpoint was the rate of overall complete remission or complete remission with incomplete haematological recovery by central assessment. Duration of remission and relapse-free survival, overall survival, minimal residual disease (MRD) negativity rate, and allo-SCT rate were assessed as secondary endpoints. Efficacy and safety analyses were done in the treated population (all patients who received a dose of KTE-X19). This study is registered with ClinicalTrials.gov, NCT02614066. FINDINGS Between Oct 1, 2018, and Oct 9, 2019, 71 patients were enrolled and underwent leukapheresis. KTE-X19 was successfully manufactured for 65 (92%) patients and administered to 55 (77%). The median age of treated patients was 40 years (IQR 28-52). At the median follow-up of 16·4 months (13·8-19·6), 39 patients (71%; 95% CI 57-82, p<0·0001) had complete remission or complete remission with incomplete haematological recovery, with 31 (56%) patients reaching complete remission. Median duration of remission was 12·8 months (95% CI 8·7-not estimable), median relapse-free survival was 11·6 months (2·7-15·5), and median overall survival was 18·2 months (15·9-not estimable). Among responders, the median overall survival was not reached, and 38 (97%) patients had MRD negativity. Ten (18%) patients received allo-SCT consolidation after KTE-X19 infusion. The most common adverse events of grade 3 or higher were anaemia (27 [49%] patients) and pyrexia (20 [36%] patients). 14 (25%) patients had infections of grade 3 or higher. Two grade 5 KTE-X19-related events occurred (brain herniation and septic shock). Cytokine release syndrome of grade 3 or higher occurred in 13 (24%) patients and neurological events of grade 3 or higher occurred in 14 (25%) patients. INTERPRETATION KTE-X19 showed a high rate of complete remission or complete remission with incomplete haematological recovery in adult patients with relapsed or refractory B-precursor acute lymphoblastic leukaemia, with the median overall survival not reached in responding patients, and a manageable safety profile. These findings indicate that KTE-X19 has the potential to confer long-term clinical benefit to these patients. FUNDING Kite, a Gilead Company.
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Affiliation(s)
| | - Armin Ghobadi
- Washington University School of Medicine and Siteman Cancer Center, St Louis, MO, USA
| | | | - Aaron C Logan
- Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | | | - Ryan D Cassaday
- University of Washington School of Medicine, Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Thibaut Leguay
- Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | | | - Max S Topp
- Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Kristen M O'Dwyer
- Wilmot Cancer Institute of University of Rochester, Rochester, NY, USA
| | | | - Yi Lin
- Mayo Clinic, Rochester, MN, USA
| | - Maria R Baer
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
| | - Gary J Schiller
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jae H Park
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Mehrdad Abedi
- University of California-Davis Medical Center, Sacramento, CA, USA
| | | | - William G Wierda
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Patrick Stiff
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA
| | - Deepa Jeyakumar
- University of California Irvine Medical Center, Irvine, CA, USA
| | | | | | - Tong Shen
- Kite, a Gilead Company, Santa Monica, CA, USA
| | | | | | - Remus Vezan
- Kite, a Gilead Company, Santa Monica, CA, USA
| | | | - Roch Houot
- CHU Rennes, University of Rennes, INSERM U1236, EFS, Rennes, France
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18
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Vial JP, Lechevalier N, Lacombe F, Dumas PY, Bidet A, Leguay T, Vergez F, Pigneux A, Béné MC. Unsupervised Flow Cytometry Analysis Allows for an Accurate Identification of Minimal Residual Disease Assessment in Acute Myeloid Leukemia. Cancers (Basel) 2021; 13:cancers13040629. [PMID: 33562525 PMCID: PMC7914957 DOI: 10.3390/cancers13040629] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 01/12/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/16/2022] Open
Abstract
The assessment of minimal residual disease (MRD) is increasingly considered to monitor response to therapy in hematological malignancies. In acute myeloblastic leukemia (AML), molecular MRD (mMRD) is possible for about half the patients while multiparameter flow cytometry (MFC) is more broadly available. However, MFC analysis strategies are highly operator-dependent. Recently, new tools have been designed for unsupervised MFC analysis, segregating cell-clusters with the same immunophenotypic characteristics. Here, the Flow-Self-Organizing-Maps (FlowSOM) tool was applied to assess MFC-MRD in 96 bone marrow (BM) follow-up (FU) time-points from 40 AML patients with available mMRD. A reference FlowSOM display was built from 19 healthy/normal BM samples (NBM), then simultaneously compared to the patient's diagnosis and FU samples at each time-point. MRD clusters were characterized individually in terms of cell numbers and immunophenotype. This strategy disclosed subclones with varying immunophenotype within single diagnosis and FU samples including populations absent from NBM. Detectable MRD was as low as 0.09% in MFC and 0.051% for mMRD. The concordance between mMRD and MFC-MRD was 80.2%. MFC yielded 85% specificity and 69% sensitivity compared to mMRD. Unsupervised MFC is shown here to allow for an easy and robust assessment of MRD, applicable also to AML patients without molecular markers.
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Affiliation(s)
- Jean Philippe Vial
- Hematology Biology, Flow Cytometry, Bordeaux University Hospital, 33600 Pessac, France; (J.P.V.); (N.L.); (F.L.)
| | - Nicolas Lechevalier
- Hematology Biology, Flow Cytometry, Bordeaux University Hospital, 33600 Pessac, France; (J.P.V.); (N.L.); (F.L.)
| | - Francis Lacombe
- Hematology Biology, Flow Cytometry, Bordeaux University Hospital, 33600 Pessac, France; (J.P.V.); (N.L.); (F.L.)
| | - Pierre-Yves Dumas
- Service d’Hématologie Clinique et de Thérapie Cellulaire, Bordeaux University Hospital, 33600 Pessac, France; (P.-Y.D.); (T.L.); (A.P.)
| | - Audrey Bidet
- Hematology Biology, Molecular Hematology, Bordeaux University Hospital, 33600 Pessac, France;
| | - Thibaut Leguay
- Service d’Hématologie Clinique et de Thérapie Cellulaire, Bordeaux University Hospital, 33600 Pessac, France; (P.-Y.D.); (T.L.); (A.P.)
| | - François Vergez
- Hematology Biology, IUCT Oncopôle, Toulouse University Hospital, 31000 Toulouse, France;
| | - Arnaud Pigneux
- Service d’Hématologie Clinique et de Thérapie Cellulaire, Bordeaux University Hospital, 33600 Pessac, France; (P.-Y.D.); (T.L.); (A.P.)
| | - Marie C. Béné
- Hematology Biology, Nantes University Hospital, 44000 Nantes, France
- Correspondence:
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Couturier MA, Thomas X, Raffoux E, Huguet F, Berthon C, Simand C, Gallego-Hernanz MP, Hicheri Y, Hunault Berger M, Saillard C, Leguay T, Loiseau C, Béné MC, Chevallier P. Blinatumomab + ponatinib for relapsed/refractory Philadelphia chromosome-positive acute lymphoblastic leukemia in adults. Leuk Lymphoma 2020; 62:620-629. [DOI: 10.1080/10428194.2020.1844198] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | - Xavier Thomas
- Department of Hematology, Hôpital Lyon-Sud, Lyon, France
| | | | - Françoise Huguet
- Department of Hematology, CHRU – Institut Universitaire de Cancer Toulouse – Oncopole, Toulouse, France
| | - Céline Berthon
- Department of Hematology, Hôpital Claude Huriez, CHRU Lille, Lille cedex, France
| | - Célestine Simand
- Department of Hematology, CHU de Hautepierre, Strasbourg, France
| | | | - Yosr Hicheri
- Department of Hematology, Hôpital Saint Eloi, CHRU Montpellier, Montpellier, France
| | | | - Colombe Saillard
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Thibaut Leguay
- Department of Hematology, Hôpital Haut-Leveque, CHU Bordeaux, Bordeaux, France
| | - Clémence Loiseau
- Department of Hematology Oncology, CH de Versailles, Hôpital André Mignot, Le Chesnay, France
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Mottal N, Issa N, Dumas PY, Camou F, Sauvezie M, Gros FX, Cazaubiel T, Mourissoux G, Leroy H, Pigneux A, Guisset O, Leguay T. Reduce Mortality and Morbidity in Acute Myeloid Leukemia With Hyperleukocytosis With Early Admission in Intensive Care Unit: A Retrospective Analysis. J Hematol 2020; 9:109-115. [PMID: 33224390 PMCID: PMC7665861 DOI: 10.14740/jh691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/18/2020] [Accepted: 08/04/2020] [Indexed: 01/25/2023] Open
Abstract
Background Patients presenting with acute myeloid leukemia (AML) at diagnosis are at high risk of severe complications and death, particularly with high white blood cell (WBC) count. In this retrospective study, we evaluate interest of early and systematic support in the intensive care unit (ICU) for AML with hyperleukocytosis (AML-HL) at diagnosis. Methods Patients with AML-HL, defined by WBC > 50 × 109/L, primary referred in ICU (“Early ICU”) without organ failure and before initiating chemotherapy induction were compared to patients first admitted in the Hematology Department who required a secondary transfer in ICU (“Late ICU”) or not (“No ICU”). Primary end point was mortality during the first month, and secondary end points were the use of life-sustaining therapies in ICU and risk factors for ICU transfer and mortality. Results One hundred fifty-four patients were included: 77 (50%) to the group “No ICU”, 18 (12%) to “Late ICU” and 59 (38%) to “Early ICU”. Mortality at day 30 was higher in “Late ICU” than in “Early ICU” and “No ICU”, with 27.8%; 16.9% and 2.6% respectively (P < 0.001). “Late ICU” patients had an increased use of life-sustaining therapy comparing to “Early ICU” patients (56% vs. 29%, P = 0.04). Conclusions Early referral to ICU reduces morbidity and seems an effective strategy to reduce short-term mortality in AML-HL at diagnosis.
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Affiliation(s)
- Nathan Mottal
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Nahema Issa
- CHU de Bordeaux, Hopital Saint Andre, Service de Reanimation medicale, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Pierre-Yves Dumas
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Fabrice Camou
- CHU de Bordeaux, Hopital Saint Andre, Service de Reanimation medicale, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Mathieu Sauvezie
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Francois-Xavier Gros
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Titouan Cazaubiel
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Gaelle Mourissoux
- CHU de Bordeaux, Hopital Saint Andre, Service de Reanimation medicale, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Harmony Leroy
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Arnaud Pigneux
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Olivier Guisset
- CHU de Bordeaux, Hopital Saint Andre, Service de Reanimation medicale, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Thibaut Leguay
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
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21
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Dumas PY, Bertoli S, Bérard E, Largeaud L, Bidet A, Delabesse E, Leguay T, Leroy H, Gadaud N, Rieu JB, Vial JP, Vergez F, Lechevalier N, Luquet I, Klein E, Sarry A, de Grande AC, Pigneux A, Récher C. Real-World Outcomes of Patients with Refractory or Relapsed FLT3-ITD Acute Myeloid Leukemia: A Toulouse-Bordeaux DATAML Registry Study. Cancers (Basel) 2020; 12:cancers12082044. [PMID: 32722211 PMCID: PMC7465142 DOI: 10.3390/cancers12082044] [Citation(s) in RCA: 8] [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: 06/08/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/15/2022] Open
Abstract
Two recent phase 3 trials showed that outcomes for relapsed/refractory (R/R) FLT3-mutated acute myeloid leukemia (AML) patients may be improved by a single-agent tyrosine kinase inhibitor (TKI) (i.e., quizartinib or gilteritinib). In the current study, we retrospectively investigated the characteristics and real-world outcomes of R/R FLT3-internal tandem duplication (ITD) acute myeloid leukemia (AML) patients in the Toulouse-Bordeaux DATAML registry. In the study, we included 316 patients with FLT3-ITD AML that received intensive chemotherapy as a first-line treatment. The rate of complete remission (CR) or CR without hematological recovery (CRi) was 75.2%, and 160 patients were R/R after a first-line TKI-free treatment (n = 294). Within the subgroup of R/R patients that fulfilled the main criteria of the QUANTUM-R study, 48.9% received an intensive salvage regimen; none received hypomethylating agents or low-dose cytarabine. Among the R/R FLT3-ITD AML patients with CR1 durations < 6 months who received intensive TKI-free treatment, the rate of CR or CRi after salvage chemotherapy was 52.8%, and these results allowed a bridge to be transplanted in 39.6% of cases. Finally, in this QUANTUM-R standard arm-matched cohort, the median overall survival (OS) was 7.0 months and 1-, 3- and 5-year OS were 30.2%, 23.7% and 21.4%, respectively. To conclude, these real-world data show that the intensity of the second-line treatment likely affects response and transplantation rates. Furthermore, the results indicate that including patients with low-intensity regimens, such as low-dose cytarabine or hypomethylating agents, in the control arm of a phase 3 trial may be counterproductive and could compromise the results of the study.
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Affiliation(s)
- Pierre-Yves Dumas
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Bordeaux, F-33000 Bordeaux, France; (T.L.); (H.L.); (A.-C.d.G.); (A.P.)
- Université de Bordeaux, 33076 Bordeaux, France
- Institut National de la Santé et de la Recherche Médicale, U1035, 33000 Bordeaux, France
- Correspondence: ; Tel.: +33-557-656-511; Fax: +33-557-656-514
| | - Sarah Bertoli
- Service d’Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France; (S.B.); (L.L.); (N.G.); (A.S.); (C.R.)
- Université Toulouse III Paul Sabatier, 31000 Toulouse, France; (E.D.); (F.V.)
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, 31000 Toulouse, France
| | - Emilie Bérard
- Service d’Epidémiologie, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France;
- INSERM-Université de Toulouse III, UMR 1027, 31000 Toulouse, France
| | - Laetitia Largeaud
- Service d’Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France; (S.B.); (L.L.); (N.G.); (A.S.); (C.R.)
- Université Toulouse III Paul Sabatier, 31000 Toulouse, France; (E.D.); (F.V.)
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, 31000 Toulouse, France
- Laboratoire d’Hématologie Biologique, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France; (J.B.R.); (I.L.)
| | - Audrey Bidet
- Laboratoire d’Hématologie Biologique, CHU Bordeaux, F-33000 Bordeaux, France; (A.B.); (J.-P.V.); (N.L.); (E.K.)
| | - Eric Delabesse
- Université Toulouse III Paul Sabatier, 31000 Toulouse, France; (E.D.); (F.V.)
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, 31000 Toulouse, France
- Laboratoire d’Hématologie Biologique, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France; (J.B.R.); (I.L.)
| | - Thibaut Leguay
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Bordeaux, F-33000 Bordeaux, France; (T.L.); (H.L.); (A.-C.d.G.); (A.P.)
| | - Harmony Leroy
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Bordeaux, F-33000 Bordeaux, France; (T.L.); (H.L.); (A.-C.d.G.); (A.P.)
| | - Noémie Gadaud
- Service d’Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France; (S.B.); (L.L.); (N.G.); (A.S.); (C.R.)
| | - Jean Baptiste Rieu
- Laboratoire d’Hématologie Biologique, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France; (J.B.R.); (I.L.)
| | - Jean-Philippe Vial
- Laboratoire d’Hématologie Biologique, CHU Bordeaux, F-33000 Bordeaux, France; (A.B.); (J.-P.V.); (N.L.); (E.K.)
| | - François Vergez
- Université Toulouse III Paul Sabatier, 31000 Toulouse, France; (E.D.); (F.V.)
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, 31000 Toulouse, France
- Laboratoire d’Hématologie Biologique, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France; (J.B.R.); (I.L.)
| | - Nicolas Lechevalier
- Laboratoire d’Hématologie Biologique, CHU Bordeaux, F-33000 Bordeaux, France; (A.B.); (J.-P.V.); (N.L.); (E.K.)
| | - Isabelle Luquet
- Laboratoire d’Hématologie Biologique, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France; (J.B.R.); (I.L.)
| | - Emilie Klein
- Laboratoire d’Hématologie Biologique, CHU Bordeaux, F-33000 Bordeaux, France; (A.B.); (J.-P.V.); (N.L.); (E.K.)
| | - Audrey Sarry
- Service d’Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France; (S.B.); (L.L.); (N.G.); (A.S.); (C.R.)
| | - Anne-Charlotte de Grande
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Bordeaux, F-33000 Bordeaux, France; (T.L.); (H.L.); (A.-C.d.G.); (A.P.)
| | - Arnaud Pigneux
- Service d’Hématologie Clinique et de Thérapie Cellulaire, CHU Bordeaux, F-33000 Bordeaux, France; (T.L.); (H.L.); (A.-C.d.G.); (A.P.)
- Université de Bordeaux, 33076 Bordeaux, France
- Institut National de la Santé et de la Recherche Médicale, U1035, 33000 Bordeaux, France
| | - Christian Récher
- Service d’Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Centre Hospitalier Universitaire de Toulouse, 31000 Toulouse, France; (S.B.); (L.L.); (N.G.); (A.S.); (C.R.)
- Université Toulouse III Paul Sabatier, 31000 Toulouse, France; (E.D.); (F.V.)
- Cancer Research Center of Toulouse, UMR1037 INSERM, ERL5294 CNRS, 31000 Toulouse, France
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Tavitian S, Uzunov M, Bérard E, Bouscary D, Thomas X, Raffoux E, Leguay T, Gallego Hernanz MP, Berceanu A, Leprêtre S, Hicheri Y, Chevallier P, Bertoli S, Lhéritier V, Dombret H, Huguet F. Ponatinib-based therapy in adults with relapsed or refractory Philadelphia chromosome-positive acute lymphoblastic leukemia: results of the real-life OPAL study. Leuk Lymphoma 2020; 61:2161-2167. [DOI: 10.1080/10428194.2020.1762876] [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] [Indexed: 10/24/2022]
Affiliation(s)
- Suzanne Tavitian
- Department of Hematology, Institut Universitaire du Cancer Toulouse-Oncopole, CHU de Toulouse, Toulouse, France
| | - Madalina Uzunov
- Department of Hematology, Assistance Publique – Hôpitaux de Paris, Paris, France
| | - Emilie Bérard
- CHU de Toulouse, UMR 1027, INSERM-Université Toulouse III, Toulouse, France
| | | | - Xavier Thomas
- Department of Hematology, CHU de Lyon Sud, Pierre-Bénite, France
| | - Emmanuel Raffoux
- AP-HP, Hopital Saint-Louis, Service Hematologie Adulte, Paris, France
| | - Thibaut Leguay
- Service d'hématologie clinique et thérapie cellulaire, Hôpital du Haut-Lévèque, CHU de Bordeaux, Bordeaux, France
| | | | - Ana Berceanu
- Department of Hematology, CHU Besancon, Besancon, France
| | | | | | | | - Sarah Bertoli
- Department of Hematology, Institut Universitaire du Cancer Toulouse-Oncopole, CHU de Toulouse, Toulouse, France
| | - Véronique Lhéritier
- Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL), Lyon, France
| | - Hervé Dombret
- Hospital Saint-Louis, Hématologie Adulte, Paris, France
| | - Françoise Huguet
- Department of Hematology, Institut Universitaire du Cancer Toulouse-Oncopole, CHU de Toulouse, Toulouse, France
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Camou F, Didier M, Leguay T, Milpied N, Daste A, Ravaud A, Mourissoux G, Guisset O, Issa N. Long-term prognosis of septic shock in cancer patients. Support Care Cancer 2019; 28:1325-1333. [PMID: 31243586 DOI: 10.1007/s00520-019-04937-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 06/11/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES In the last decades, the number of cancer patients admitted in intensive care units (ICUs) for septic shock has dramatically increased. However, prognosis data remain scarce. METHODS To assess the 180-day mortality rate in cancer patients admitted to the ICU for septic shock, a 5-year prospective study was performed. All adult patients admitted for septic shock were included and categorized into the following two groups and four subgroups: cancer patients (solid tumor or hematological malignancy) and non-cancer patients (immunocompromised or not). Data were collected and compared between the groups. Upon early ICU admission, the decision to forgo life-sustaining therapy (DFLST) or not was made by consultation among hematologists, oncologists, and the patients or their relatives. RESULTS During the study period, 496 patients were admitted for septic shock: 252 cancer patients (119 hematological malignancies and 133 solid tumors) and 244 non-cancer patients. A DFLST was made for 39% of the non-cancer patients and 52% of the cancer patients. The 180-day mortality rate among the cancer patients was 51% and 68% for those with hematological malignancies and solid cancers, respectively. The mortality rate among the non-cancer patients was 44%. In a multivariate analysis, the performance status, Charlson comorbidity index, simplified acute physiology score 2, sequential organ failure assessment score, and DFLST were independent predictors of 180-day mortality. CONCLUSIONS Despite early admission to the ICU, the 180-day mortality rate due to septic shock was higher in cancer patients compared with non-cancer patients, due to excess mortality in the patients with solid tumors. The long-term prognosis of cancer patients with septic shock is modulated by their general state, severity of organ failure, and DFLST.
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Affiliation(s)
- Fabrice Camou
- Intensive Care and Infectious Disease Unit, CHU Bordeaux, 33000, Bordeaux, France
| | - Marion Didier
- Intensive Care and Infectious Disease Unit, CHU Bordeaux, 33000, Bordeaux, France
| | | | - Noël Milpied
- Hematology, CHU Bordeaux, 33000, Bordeaux, France
| | | | | | - Gaëlle Mourissoux
- Intensive Care and Infectious Disease Unit, CHU Bordeaux, 33000, Bordeaux, France
| | - Olivier Guisset
- Intensive Care and Infectious Disease Unit, CHU Bordeaux, 33000, Bordeaux, France
| | - Nahéma Issa
- Intensive Care and Infectious Disease Unit, CHU Bordeaux, 33000, Bordeaux, France. .,Hôpital Saint-André, 1 rue Jean Burguet, 33075, Bordeaux, France.
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24
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Touzart A, Lengliné E, Latiri M, Belhocine M, Smith C, Thomas X, Spicuglia S, Puthier D, Pflumio F, Leguay T, Graux C, Chalandon Y, Huguet F, Leprêtre S, Ifrah N, Dombret H, Macintyre E, Hunault M, Boissel N, Asnafi V. Epigenetic Silencing Affects l-Asparaginase Sensitivity and Predicts Outcome in T-ALL. Clin Cancer Res 2019; 25:2483-2493. [PMID: 30659025 DOI: 10.1158/1078-0432.ccr-18-1844] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/29/2018] [Accepted: 01/15/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Biological explanation for discrepancies in patient-related response to chemotherapy depending on the underlying oncogenic events is a promising research area. TLX1- or TLX3-deregulated T-cell acute lymphoblastic leukemias (T-ALL; TLX1/3+) share an immature cortical phenotype and similar transcriptional signatures. However, their prognostic impacts differ, and inconsistent clinical outcome has been reported for TLX3. We therefore hypothesized that the overlapping transcriptional profiles of TLX1+ and TLX3+ T-ALLs would allow identification of candidate genes, which might determine their distinct clinical outcomes. EXPERIMENTAL DESIGN We compared TLX1+ and TLX3+ adult T-ALL outcome in the successive French national LALA-94 and GRAALL-2003/2005 multicentric trials and analyzed transcriptomic data to identify differentially expressed genes. Epigenetic regulation of asparagine synthetase (ASNS) and in vitro l-asparaginase sensitivity were evaluated for T-ALL cell lines and primary samples. RESULTS We show that TLX1+ patients expressed low levels of ASNS when compared with TLX3+ and TLX-negative patients, due to epigenetic silencing of ASNS by both DNA methylation and a decrease of active histone marks. Promoter methylation of the ASNS gene correlated with l-asparaginase sensitivity in both T-ALL cell lines and patient-derived xenografts. Finally, ASNS promoter methylation was an independent prognostic factor for both event-free survival [HR, 0.42; 95% confidence interval (CI), 0.24-0.71; P = 0.001] and overall survival (HR, 0.40; 95% CI, 0.23-0.70; P = 0.02) in 160 GRAALL-2003/2005 T-ALL patients and also in an independent series of 47 LL03-treated T lymphoblastic lymphomas (P = 0.012). CONCLUSIONS We conclude that ASNS methylation status at diagnosis may allow individual adaptation of l-asparaginase dose.
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Affiliation(s)
- Aurore Touzart
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de recherche Médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - Etienne Lengliné
- Université Paris Diderot, Institut Universitaire d'Hématologie, EA-3518, Assistance Publique-Hôpitaux de Paris, University Hospital Saint-Louis, Paris, France
| | - Mehdi Latiri
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de recherche Médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - Mohamed Belhocine
- Aix-Marseille University, Inserm, TAGC, UMR1090, Marseille, France; Equipe Labélisée Ligue Contre le Cancer, Marseille, France
| | - Charlotte Smith
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de recherche Médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - Xavier Thomas
- Division of Hematology, Hospices Civils de Lyon, INSERM U1052-Centre National de la Recherche Scientifique UMR 5286, Centre Hospitalier Lyon Sud, Pierre Benite, France
| | - Salvatore Spicuglia
- Aix-Marseille University, Inserm, TAGC, UMR1090, Marseille, France; Equipe Labélisée Ligue Contre le Cancer, Marseille, France
| | - Denis Puthier
- Aix-Marseille University, Inserm, TAGC, UMR1090, Marseille, France; Equipe Labélisée Ligue Contre le Cancer, Marseille, France
| | - Françoise Pflumio
- INSERM UMR967, CEA/DSV/iRCM, Laboratory of Hematopoietic Stem Cells and Leukemic Cells, Equipe labellisée par la Ligue Nationale Contre le Cancer, Université Paris Diderot, Université Paris-Saclay, Commissariat à l'Energie Atomique et aux Energies Alternatives, Fontenay-aux-Roses, France
| | - Thibaut Leguay
- Division of Hematology, Hôpital du Haut-Levêque, Pessac, France
| | - Carlos Graux
- Department of Hematology, Mont-Godinne University Hospital, Yvoir, Belgium
| | - Yves Chalandon
- Hematology Division, Department of Oncology, University Hospital, Genève, Switzerland; Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Françoise Huguet
- Centre Hospitalier Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Stéphane Leprêtre
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1245, Department of Hematology, Centre Henri-Becquerel and Normandie Univ UNIROUEN, Rouen, France
| | - Norbert Ifrah
- PRES LUNAM, CHU Angers Service des Maladies du Sang et INSERM U 892, Angers, France
| | - Hervé Dombret
- Université Paris Diderot, Institut Universitaire d'Hématologie, EA-3518, Assistance Publique-Hôpitaux de Paris, University Hospital Saint-Louis, Paris, France
| | - Elizabeth Macintyre
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de recherche Médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - Mathilde Hunault
- Division of Hematology, Centre Hospitalier Universitaire d'Angers, Angers, France; INSERM U892/Centre National de la Recherche Scientifique 6299, Angers, CRCINA, INSERM, Université de Nantes, Université d'Angers, Angers, France
| | - Nicolas Boissel
- Université Paris Diderot, Institut Universitaire d'Hématologie, EA-3518, Assistance Publique-Hôpitaux de Paris, University Hospital Saint-Louis, Paris, France
| | - Vahid Asnafi
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de recherche Médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France.
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Bond J, Touzart A, Leprêtre S, Graux C, Bargetzi M, Lhermitte L, Hypolite G, Leguay T, Hicheri Y, Guillerm G, Bilger K, Lhéritier V, Hunault M, Huguet F, Chalandon Y, Ifrah N, Macintyre E, Dombret H, Asnafi V, Boissel N. DNMT3A mutation is associated with increased age and adverse outcome in adult T-cell acute lymphoblastic leukemia. Haematologica 2019; 104:1617-1625. [PMID: 30655366 PMCID: PMC6669163 DOI: 10.3324/haematol.2018.197848] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [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: 05/24/2018] [Accepted: 01/10/2019] [Indexed: 11/26/2022] Open
Abstract
The prognostic implications of DNMT3A genotype in T-cell acute lymphoblastic leukemia are incompletely understood. We performed comprehensive genetic and clinico-biological analyses of T-cell acute lymphoblastic leukemia patients with DNMT3A mutations treated during the GRAALL-2003 and -2005 studies. Eighteen of 198 cases (9.1%) had DNMT3A alterations. Two patients also had DNMT3A mutations in non-leukemic cell DNA, providing the first potential evidence of age-related clonal hematopoiesis in T-cell acute lymphoblastic leukemia. DNMT3A mutation was associated with older age (median 43.9 years vs. 29.4 years, P<0.001), immature T-cell receptor genotype (53.3% vs. 24.4%, P=0.016) and lower remission rates (72.2% mutated vs. 94.4% non-mutated, P=0.006). DNMT3A alterations were significantly associated with worse clinical outcome, with higher cumulative incidence of relapse (HR 2.33, 95% CI: 1.05-5.16, P=0.037) and markedly poorer event-free survival (HR 3.22, 95% CI: 1.81-5.72, P<0.001) and overall survival (HR 2.91, 95% CI: 1.56-5.43, P=0.001). Adjusting for age as a covariate, or restricting the analysis to patients over 40 years, who account for almost 90% of DNMT3A-mutated cases, did not modify these observations. In multivariate analysis using the risk factors that were used to stratify treatment during the GRAALL studies, DNMT3A mutation was significantly associated with shorter event-free survival (HR 2.33, 95% CI: 1.06 – 4.04, P=0.02). Altogether, these results identify DNMT3A genotype as a predictor of aggressive T-cell acute lymphoblastic leukemia biology. The GRAALL-2003 and -2005 studies were registered at http://www.ClinicalTrials.gov as #NCT00222027 and #NCT00327678, respectively.
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Affiliation(s)
- Jonathan Bond
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France.,Systems Biology Ireland, School of Medicine, University College Dublin, Ireland.,National Children's Research Centre, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Aurore Touzart
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - Stéphane Leprêtre
- INSERM U1245 and Department of Hematology, Centre Henri Becquerel and Normandie Université UNIROUEN, Rouen, France
| | - Carlos Graux
- Department of Hematology, Université Catholique de Louvain (UCL), Centre Hospitalier Universitaire (CHU) Namur - Godinne site, Yvoir, Belgium
| | - Mario Bargetzi
- University Medical Department, Division of Oncology, Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Swiss Group for Clinical Cancer Research (SAKK), Bern, Switerland
| | - Ludovic Lhermitte
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - Guillaume Hypolite
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | | | - Yosr Hicheri
- Hematology Service, Hôpital St Eloi, Montpellier, France
| | | | - Karin Bilger
- Hematology Service, CHU Hautepierre, Strasbourg, France
| | - Véronique Lhéritier
- Group for Research on Adult Acute Lymphoblastic Leukemia, Coordination Office, Centre Hospitalier Lyon Sud, Lyon, France
| | - Mathilde Hunault
- PRES LUNAM, CHU Angers Service des Maladies du Sang and CRCINA INSERM, Angers, France
| | - Françoise Huguet
- Department of Hematology, CHU de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Yves Chalandon
- University Medical Department, Division of Oncology, Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland.,Department of Oncology, Hematology Division, University Hospital, Geneva, Switzerland
| | - Norbert Ifrah
- PRES LUNAM, CHU Angers Service des Maladies du Sang and CRCINA INSERM, Angers, France
| | - Elizabeth Macintyre
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - Hervé Dombret
- Université Paris Diderot, Institut Universitaire d'Hématologie, EA-3518, AP-HP, University Hospital Saint-Louis, Paris, France
| | - Vahid Asnafi
- Université Paris Descartes Sorbonne Cité, Institut Necker-Enfants Malades (INEM), Institut National de Recherche Médicale (INSERM) U1151, and Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants-Malades, Paris, France
| | - Nicolas Boissel
- Université Paris Diderot, Institut Universitaire d'Hématologie, EA-3518, AP-HP, University Hospital Saint-Louis, Paris, France
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Huguet F, Chevret S, Leguay T, Thomas X, Boissel N, Escoffre-Barbe M, Chevallier P, Hunault M, Vey N, Bonmati C, Lepretre S, Marolleau JP, Pabst T, Rousselot P, Buzyn A, Cahn JY, Lhéritier V, Béné MC, Asnafi V, Delabesse E, Macintyre E, Chalandon Y, Ifrah N, Dombret H. Intensified Therapy of Acute Lymphoblastic Leukemia in Adults: Report of the Randomized GRAALL-2005 Clinical Trial. J Clin Oncol 2018; 36:2514-2523. [DOI: 10.1200/jco.2017.76.8192] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose To evaluate randomly the role of hyperfractionated cyclophosphamide (hyper-C) dose intensification in adults with newly diagnosed Philadelphia chromosome–negative acute lymphoblastic leukemia treated with a pediatric-inspired protocol and to determine the upper age limit for treatment tolerability in this context. Patients and Methods A total of 787 evaluable patients (B/T lineage, 525 and 262, respectively; median age, 36.1 years) were randomly assigned to receive a standard dose of cyclophosphamide or hyper-C during first induction and late intensification. Compliance with chemotherapy was assessed by median doses actually received during each treatment phase by patients potentially exposed to the full planned doses. Results Overall complete remission (CR) rate was 91.9%. With a median follow-up of 5.2 years, the 5-year rate of event-free survival (EFS) and overall survival (OS) was 52.2% (95% CI, 48.5% to 55.7%) and 58.5% (95% CI, 54.8% to 61.9%), respectively. Randomization to the hyper-C arm did not increase the CR rate or prolong EFS or OS. As a result of worse treatment tolerance, advanced age continuously affected CR rate, EFS, and OS, with 55 years as the best age cutoff. At 5 years, EFS was 55.7% (95% CI, 51.8% to 59.4%) for patients younger than 55 years of age versus 25.8% (95% CI, 19.9% to 35.6%) in older patients (hazard ratio, 2.16; P < .001). Patients ≥ 55 years of age, in whom a lower compliance to the whole planned chemotherapy was observed, benefited significantly from hyper-C, whereas younger patients did not. Conclusion No significant benefit was associated with the introduction of a hyper-C sequence into a frontline pediatric-like adult acute lymphoblastic leukemia therapy. Overall, tolerability of an intensive pediatric-derived treatment was poor in patients ≥ 55 years of age.
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Affiliation(s)
- Françoise Huguet
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Sylvie Chevret
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Thibaut Leguay
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Xavier Thomas
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Nicolas Boissel
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Martine Escoffre-Barbe
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Patrice Chevallier
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Mathilde Hunault
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Norbert Vey
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Caroline Bonmati
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Stéphane Lepretre
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Jean-Pierre Marolleau
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Thomas Pabst
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Philippe Rousselot
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Agnès Buzyn
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Jean-Yves Cahn
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Véronique Lhéritier
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Marie C. Béné
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Vahid Asnafi
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Eric Delabesse
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Elizabeth Macintyre
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Yves Chalandon
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Norbert Ifrah
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
| | - Hervé Dombret
- Françoise Huguet, Eric Delabesse, Institut Universitaire du Cancer, Toulouse; Sylvie Chevret, Nicolas Boissel, Hervé Dombret, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Diderot; Agnès Buzyn, Vahid Asnafi, Elizabeth Macintyre, Hôpital Necker, AP-HP; Université Paris Descartes, Paris; Thibaut Leguay, Centre Hospitalier Universitaire, Pessac; Xavier Thomas, Véronique Lhéritier, Hôpital Lyon-Sud, Pierre Bénite; Martine Escoffre-Barbe, Centre Hospitalier Universitaire
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Cornely OA, Leguay T, Maertens J, Vehreschild MJGT, Anagnostopoulos A, Castagnola C, Verga L, Rieger C, Kondakci M, Härter G, Duarte RF, Allione B, Cordonnier C, Heussel CP, Morrissey CO, Agrawal SG, Donnelly JP, Bresnik M, Hawkins MJ, Garner W, Gökbuget N. Randomized comparison of liposomal amphotericin B versus placebo to prevent invasive mycoses in acute lymphoblastic leukaemia. J Antimicrob Chemother 2018; 72:2359-2367. [PMID: 28575414 DOI: 10.1093/jac/dkx133] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/07/2017] [Indexed: 02/07/2023] Open
Abstract
Objectives To prevent invasive fungal disease (IFD) in adult patients undergoing remission-induction chemotherapy for newly diagnosed acute lymphoblastic leukaemia (ALL). Patients and methods In a double-blind multicentre Phase 3 study, patients received prophylactic liposomal amphotericin B (L-AMB) at 5 mg/kg intravenously or placebo twice weekly in a 2:1 random allocation during remission-induction treatment. The primary endpoint was the development of proven or probable IFD. Secondary endpoints included those focused on the safety and tolerability of prophylactic L-AMB. Results Three hundred and fifty-five patients from 86 centres in Europe and South America received at least one dose of L-AMB ( n = 237) or placebo ( n = 118). Rates of proven and probable IFD assessed independently were 7.9% (18/228) in the L-AMB group and 11.7% (13/111) in the placebo group ( P = 0.24). Rates of possible IFD were 4.8% (11/228) in the L-AMB and 5.4% (6/111) in the placebo group ( P = 0.82). The remission-induction phase was a median of 22 days for both groups. Overall mortality was similar between the groups: 7.2% (17/237) for L-AMB and 6.8% (8/118) for placebo ( P = 1.00). Hypokalaemia and creatinine increase were significantly more frequent with L-AMB. Conclusions The IFD rate among adult patients undergoing remission-induction chemotherapy for newly diagnosed ALL was 11.7% in the placebo group, and was not significantly different in patients receiving L-AMB, suggesting that the L-AMB regimen studied is not effective as prophylaxis against IFD. The IFD rate appears higher than previously reported, warranting further investigation. Tolerability of L-AMB was what might be expected. Further studies are needed to determine the optimal antifungal strategy during remission-induction chemotherapy of ALL.
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Affiliation(s)
- Oliver A Cornely
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Department I of Internal Medicine, Clinical Trials Centre Cologne (ZKS), Center for Integrated Oncology (CIO KölnBonn), German Centre for Infection Research (DZIF), partner site Bonn-Cologne, University of Cologne, Cologne, Germany
| | - Thibaut Leguay
- Service d'hématologie clinique et Thérapie cellulaire, Hôpital du Haut-Lévèque, CHU de Bordeaux, France
| | - Johan Maertens
- KU Leuven-University of Leuven, Department of Microbiology and Immunology, University Hospitals Leuven, Department of Hematology, B-3000 Leuven, Belgium
| | | | | | - Carlo Castagnola
- Department of Hematology Oncology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | - Christina Rieger
- Medizinische Klinik und Poliklinik III, Klinikum der Universität München, Munich, Germany
| | - Mustafa Kondakci
- Klinik für Hämatologie, Onkologie und klin. Immunologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Georg Härter
- Zentrum für Hormon- und Stoffwechselerkrankungen und Infektiologie, MVZ Endokrinologikum Ulm, and Department of Internal Medicine III, Ulm University Hospital Medical Center, Ulm, Germany
| | - Rafael F Duarte
- Department of Hematology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid 28222, Spain
| | | | - Catherine Cordonnier
- AP-HP-Henri Mondor, Hematology Department and University Paris-Est Creteil, F-94010 Créteil, France
| | | | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
| | - Samir G Agrawal
- Division of Haemato-Oncology, St Bartholomew's Hospital, Barts Cancer Institute, Queen Mary University, London, UK
| | - J Peter Donnelly
- Department of Haematology, Radboud UMC, Nijmegen, the Netherlands
| | | | | | | | - Nicola Gökbuget
- Department of Medicine II, University Hospital, Goethe University, Frankfurt, Germany
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Bond J, Graux C, Lhermitte L, Lara D, Cluzeau T, Leguay T, Cieslak A, Trinquand A, Pastoret C, Belhocine M, Spicuglia S, Lheritier V, Leprêtre S, Thomas X, Huguet F, Ifrah N, Dombret H, Macintyre E, Boissel N, Asnafi V. Early Response-Based Therapy Stratification Improves Survival in Adult Early Thymic Precursor Acute Lymphoblastic Leukemia: A Group for Research on Adult Acute Lymphoblastic Leukemia Study. J Clin Oncol 2017; 35:2683-2691. [PMID: 28605290 DOI: 10.1200/jco.2016.71.8585] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose Early thymic precursor (ETP) acute lymphoblastic leukemia (ALL) is an immunophenotypically defined subgroup of T-cell ALL (T-ALL) associated with high rates of intrinsic treatment resistance. Studies in children have shown that the negative prognostic impact of chemotherapy resistance is abrogated by the implementation of early response-based intensification strategies. Comparable data in adults are lacking. Patients and Methods We performed comprehensive clinicobiologic, genetic, and survival analyses of a large cohort of 213 adult patients with T-ALL, including 47 patients with ETP-ALL, treated in the GRAALL (Group for Research on Adult Acute Lymphoblastic Leukemia) -2003 and -2005 studies. Results Targeted next-generation sequencing revealed that the genotype of immunophenotypically defined adult T-ALL is similar to the pediatric equivalent, with high rates of mutations in factors involved in cytokine receptor and RAS signaling (62.2%), hematopoietic development (29.7%), and chemical modification of histones (48.6%). In contrast to pediatric cases, mutations in DNA methylation factor genes were also common (32.4%). We found that despite expected high levels of early bone marrow chemotherapy resistance (87%), the overall prognosis for adults with ETP-ALL treated using the GRAALL protocols was not inferior to that of the non-ETP-ALL group (5-year overall survival: ETP, 59.6%; 95% CI, 44.2% to 72.0% v non-ETP, 66.5%; 95% CI, 58.7% to 73.2%; P = 0.33) and that allogeneic stem-cell transplantation had a beneficial effect in a large proportion of patients with ETP-ALL. Conclusion Our results suggest that the use of response-based risk stratification and therapy intensification abrogates the poor prognosis of adult ETP-ALL.
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Affiliation(s)
- Jonathan Bond
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Carlos Graux
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Ludovic Lhermitte
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Diane Lara
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Thomas Cluzeau
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Thibaut Leguay
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Agata Cieslak
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Amélie Trinquand
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Cedric Pastoret
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Mohamed Belhocine
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Salvatore Spicuglia
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Véronique Lheritier
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Stéphane Leprêtre
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Xavier Thomas
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Françoise Huguet
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Norbert Ifrah
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Hervé Dombret
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Elizabeth Macintyre
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Nicolas Boissel
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
| | - Vahid Asnafi
- Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Hôpital Necker-Enfants Malades; Jonathan Bond, Ludovic Lhermitte, Agata Cieslak, Amélie Trinquand, Elizabeth Macintyre, and Vahid Asnafi, Institut National de la santé et de la recherche médicale (INSERM) U1151; Hervé Dombret and Nicolas Boissel, University Hospital Saint-Louis, Paris; Diane Lara, Hospitalier de Versailles, Le Chesnay; Thomas Cluzeau, Centre Hospitalier Universitaire (CHU) de Nice, Nice; Thibaut Leguay, CHU de Bordeaux, Bordeaux; Cedric Pastoret, CHU de Rennes, Rennes; Mohamed Belhocine and Salvatore Spicuglia, Aix-Marseille University, Marseille; Véronique Lheritier, Centre Hospitalier Lyon Sud; Xavier Thomas, CHU de Lyon, Lyon; Stéphane Leprêtre, Centre Henri Becquerel and Université de Rouen Normandie, Rouen; Françoise Huguet, CHU de Toulouse, Toulouse; Norbert Ifrah, CHU d'Angers, Angers, France; and Carlos Graux, Godinne University Hospital, Yvoir, Belgium
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Gros FX, Cazaubiel T, Forcade E, Lechevalier N, Leguay T, Servant V, Tabrizi R, Clement L, Dumas PY, Bidet A, Pigneux A, Vigouroux S, Milpied N. Severe acute GvHD following administration of ipilimumab for early relapse of AML after haploidentical stem cell transplantation. Bone Marrow Transplant 2017; 52:1047-1048. [DOI: 10.1038/bmt.2017.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Chevallier P, Chantepie S, Huguet F, Raffoux E, Thomas X, Leguay T, Marchand T, Isnard F, Charbonnier A, Maury S, Gallego-Hernanz MP, Robillard N, Guillaume T, Peterlin P, Garnier A, Rialland F, Le Houerou C, Goldenberg DM, Wegener WA, Béné MC, Dombret H. Hyper-CVAD + epratuzumab as a salvage regimen for younger patients with relapsed/refractory CD22-positive precursor B-cell acute lymphocytic leukemia. Haematologica 2017; 102:e184-e186. [PMID: 28154086 DOI: 10.3324/haematol.2016.159905] [Citation(s) in RCA: 5] [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: 11/09/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Aude Charbonnier
- Hematology Department, Institut Paoli-Calmette, Marseille, France
| | | | | | | | | | | | - Alice Garnier
- Hematology Department, CHU Hotel-Dieu, Nantes, France
| | | | | | | | | | - Marie-C Béné
- Hematology/Biology, CHU Hotel-Dieu, Nantes, France
| | - Hervé Dombret
- Hematology Department, Hôpital Saint-Louis, Paris, France
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Maury S, Chevret S, Thomas X, Heim D, Leguay T, Huguet F, Chevallier P, Hunault M, Boissel N, Escoffre-Barbe M, Hess U, Vey N, Pignon JM, Braun T, Marolleau JP, Cahn JY, Chalandon Y, Lhéritier V, Beldjord K, Béné MC, Ifrah N, Dombret H. Rituximab in B-Lineage Adult Acute Lymphoblastic Leukemia. N Engl J Med 2016; 375:1044-53. [PMID: 27626518 DOI: 10.1056/nejmoa1605085] [Citation(s) in RCA: 209] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Treatment with rituximab has improved the outcome for patients with non-Hodgkin's lymphoma. Patients with B-lineage acute lymphoblastic leukemia (ALL) may also have the CD20 antigen, which is targeted by rituximab. Although single-group studies suggest that adding rituximab to chemotherapy could improve the outcome in such patients, this hypothesis has not been tested in a randomized trial. METHODS We randomly assigned adults (18 to 59 years of age) with CD20-positive, Philadelphia chromosome (Ph)-negative ALL to receive chemotherapy with or without rituximab, with event-free survival as the primary end point. Rituximab was given during all treatment phases, for a total of 16 to 18 infusions. RESULTS From May 2006 through April 2014, a total of 209 patients were enrolled: 105 in the rituximab group and 104 in the control group. After a median follow-up of 30 months, event-free survival was longer in the rituximab group than in the control group (hazard ratio, 0.66; 95% confidence interval [CI], 0.45 to 0.98; P=0.04); the estimated 2-year event-free survival rates were 65% (95% CI, 56 to 75) and 52% (95% CI, 43 to 63), respectively. Treatment with rituximab remained associated with longer event-free survival in a multivariate analysis. The overall incidence rate of severe adverse events did not differ significantly between the two groups, but fewer allergic reactions to asparaginase were observed in the rituximab group. CONCLUSIONS Adding rituximab to the ALL chemotherapy protocol improved the outcome for younger adults with CD20-positive, Ph-negative ALL. (Funded by the Regional Clinical Research Office, Paris, and others; ClinicalTrials.gov number, NCT00327678 .).
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Affiliation(s)
- Sébastien Maury
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Sylvie Chevret
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Xavier Thomas
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Dominik Heim
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Thibaut Leguay
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Françoise Huguet
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Patrice Chevallier
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Mathilde Hunault
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Nicolas Boissel
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Martine Escoffre-Barbe
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Urs Hess
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Norbert Vey
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Jean-Michel Pignon
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Thorsten Braun
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Jean-Pierre Marolleau
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Jean-Yves Cahn
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Yves Chalandon
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Véronique Lhéritier
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Kheira Beldjord
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Marie C Béné
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Norbert Ifrah
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
| | - Hervé Dombret
- From the Département d'Hématologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Mondor de Recherche Biomédicale (équipe 21), Université Paris Est, Creteil (S.M.), Service de Biostatistique (S.C.) and Département d'Hématologie (N.B., K.B., H.D.), Hôpital Saint-Louis, AP-HP, Institut Universitaire d'Hématologie, Université Paris Diderot, Paris, Département d'Hématologie (X.T.) and Group for Research on Adult Acute Lymphoblastic Leukemia Coordination Office (V.L.), Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, Département d'Hématologie, Centre Hospitalier Universitaire (CHU) Haut-Lévêque, Pessac (T.L.), Département d'Hématologie, Institut Universitaire du Cancer, Toulouse (F.H.), Département d'Hématologie Clinique, CHU Hôtel Dieu (P.C.), and Service d'Hématologie Biologique, CHU (M.C.B.), Nantes, Département d'Hématologie, CHU, Angers (M.H., N.I.), Département d'Hématologie, CHU, Rennes (M.E.-B.), Département d'Hématologie, Institut Paoli-Calmettes, Marseille (N.V.), Département d'Hématologie, Centre Hospitalier de Dunkerque, Dunkirk (J.-M.P.), Département d'Hématologie, Hôpital Avicenne, AP-HP, Université Paris Nord, Bobigny (T.B.), Département d'Hématologie, CHU, Université Picardie Jules Verne, Amiens ( J.-P.M.), and Département d'Hématologie, CHU, Grenoble ( J.-Y.C.) - all in France; and the Klinik für Hämatologie, Universitätsspital, Basel (D.H.), Swiss Group for Clinical Cancer Research, Bern (D.H., U.H., Y.C.), Klinik für Onkologie-Hämatologie, Kantonsspital St. Gallen, St. Gallen (U.H.), and Division of Hematology, Department of Medical Specialties, University Hospital and University of Geneva, Geneva (Y.C.) - all in Switzerland
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Ribrag V, Koscielny S, Bosq J, Leguay T, Casasnovas O, Fornecker LM, Recher C, Ghesquieres H, Morschhauser F, Girault S, Le Gouill S, Ojeda-Uribe M, Mariette C, Cornillon J, Cartron G, Verge V, Chassagne-Clément C, Dombret H, Coiffier B, Lamy T, Tilly H, Salles G. Rituximab and dose-dense chemotherapy for adults with Burkitt's lymphoma: a randomised, controlled, open-label, phase 3 trial. Lancet 2016; 387:2402-11. [PMID: 27080498 DOI: 10.1016/s0140-6736(15)01317-3] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Short intensive chemotherapy is the standard of care for adult patients with Burkitt's leukaemia or lymphoma. Findings from single-arm studies suggest that addition of rituximab to these regimens could improve patient outcomes. Our objective was to test this possibility in a randomised trial. METHODS In this randomised, controlled, open-label, phase 3 trial, we recruited patients older than 18 years with untreated HIV-negative Burkitt's lymphoma (including Burkitt's leukaemia) from 45 haematological centres in France. Exclusion criteria were contraindications to any drug included in the chemotherapy regimens, any serious comorbidity, poor renal (creatinine concentration >150 μmol/L) or hepatic (cirrhosis or previous hepatitis B or C) function, pregnancy, and any history of cancer except for non-melanoma skin tumours or stage 0 (in situ) cervical carcinoma. Patients were stratified into two groups based on disease extension (absence [group B] or presence [group C] of bone marrow or central nervous system involvement). Patients were further stratified in group C according to age (<40 years, 40-60 years, and >60 years) and central nervous system involvement. Participants were randomly assigned in each group to either intravenous rituximab injections and chemotherapy (lymphome malin B [LMB]) or chemotherapy alone by the Groupe d'Etude des Lymphomes de l'Adulte datacentre. Randomisation was stratified by treatment group and centre using computer-assisted permuted-block randomisation (block size of four; allocation ratio 1:1). We gave rituximab (375 mg/m(2)) on day 1 and day 6 during the first two courses of chemotherapy (total of four infusions). The primary endpoint is 3 year event-free survival (EFS). We analysed all patients who had data available according to their originally assigned group. This trial is registered with ClinicalTrials.gov, number NCT00180882. RESULTS Between Oct 14, 2004, and Sept 7, 2010, we randomly allocated 260 patients to rituximab or no rituximab (group B 124 patients [64 no rituximab; 60 rituximab]; group C 136 patients [66 no rituximab; 70 rituximab]). With a median follow-up of 38 months (IQR 24-59), patients in the rituximab group achieved better 3 year EFS (75% [95% CI 66-82]) than did those in the no rituximab group (62% [53-70]; log-rank p stratified by treatment group=0·024). The hazard ratio estimated with a Cox model stratified by treatment group, assuming proportionality, was 0·59 for EFS (95% CI 0·38-0·94; p=0·025). Adverse events did not differ between the two treatment groups. The most common adverse events were infectious (grade 3-4 in 137 [17%] treatment cycles in the rituximab group vs 115 [15%] in the no rituximab group) and haematological (mean duration of grade 4 neutropenia of 3·31 days per cycle [95% CI 3·01-3·61] vs 3·38 days per cycle [3·05-3·70]) events. INTERPRETATION Addition of rituximab to a short intensive chemotherapy programme improves EFS in adults with Burkitt's leukaemia or lymphoma. FUNDING Gustave Roussy Cancer Campus, Roche, Chugai, Sanofi.
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Affiliation(s)
- Vincent Ribrag
- Department of Medicine, Gustave Roussy, Université Paris Saclay, Villejuif, France.
| | - Serge Koscielny
- Biostatistics and Epidemiology Unit, Gustave Roussy, Université Paris Saclay, Villejuif, France; Centre for Research in Epidemiology and Population Health, Institut national de la santé et de la recherche médicale U1018, Université Paris-Sud, Villejuif, France
| | - Jacques Bosq
- Department of Biopathology, Morphology Unit, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Thibaut Leguay
- Service d'hématologie clinique et thérapie cellulaire, Hôpital du Haut-Lévèque, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Olivier Casasnovas
- Service d'hématologie Clinique, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - Luc-Mathieu Fornecker
- Department of Oncology and Hematology, Hôpital de Hautepierre Université de Strasbourg, Strasbourg, France
| | - Christian Recher
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Hervé Ghesquieres
- Onco-Hematology, Centre Léon Bérard, Université Claude Bernard Lyon 1, Lyon, France
| | - Franck Morschhauser
- Service des Maladies du Sang, Hôpital Huriez, Université de Lille, Unité Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Stéphane Girault
- Hématologie Clinique et Thérapie Cellulaire, Centre Hospitalier Universitaire Limoges, Limoges, France
| | - Steven Le Gouill
- Department of Hematology, Institut national de la santé et de la recherche médicale, Unité Mixte de Recherche 892, Equipe 10, Nantes Institut national de la santé et de la recherche médicale, Centre d'Investigation Clinique 004, Nantes University Hospital, Nantes, France
| | - Mario Ojeda-Uribe
- Department of Hematology and Cellular Therapy Unit, Hôpital Emile Muller, Centre de Competences on Thrombotic Microangiopathies, Mulhouse, France
| | - Clara Mariette
- Department of Haematology, Grenoble University Hospital, Grenoble, France
| | - Jerome Cornillon
- Département d'Hématologie, Institut de Cancérologie Lucien Neuwirth, Saint-Priest en Jarez, France
| | - Guillaume Cartron
- Department of Hematology, Unité Mixte de Recherche Centre national de la recherche scientifique 5235, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Veronique Verge
- Haematology Unit, Gustave Roussy, Université Paris Saclay, Villejuif, France
| | | | - Hervé Dombret
- Service d'hématologie clinique, Centre Hospitalier Universitaire Paris, Groupe Hospitalier Saint-Louis, Lariboisière, Fernand-Widal, Hôpital Saint-Louis, Paris, France
| | - Bertrand Coiffier
- Hématologie Clinique, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Thierry Lamy
- Department of Clinical Hematology, Rennes University Hospital, Rennes, France; Institut national de la santé et de la recherche médicale Unité Mixte de Recherche 917, Faculté de médecine, Université Rennes 1, Rennes Department of Clinical Investigation, Rennes University Hospital, Rennes, France
| | - Hervé Tilly
- Centre Henri Becquerel, Université de Rouen, Rouen, France
| | - Gilles Salles
- Hospices Civils de Lyon, Université Lyon 1, Pierre Bénite, France
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Huguet F, Leguay T, Raffoux E, Rousselot P, Vey N, Pigneux A, Ifrah N, Dombret H. Clofarabine for the treatment of adult acute lymphoid leukemia: the Group for Research on Adult Acute Lymphoblastic Leukemia intergroup. Leuk Lymphoma 2016; 56:847-57. [PMID: 24996442 DOI: 10.3109/10428194.2014.887708] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Clofarabine, a second-generation purine analog displaying potent inhibition of DNA synthesis and favorable pharmacologic profile, is approved for the treatment of acute lymphoblastic leukemia (ALL) after failure of at least two previous regimens in patients up to 21 years of age at diagnosis. Good neurologic tolerance, synergy with alkylating agents, management guidelines defined through pediatric ALL and adult acute myeloid leukemia, have also prompted its administration in more than 100 adults with Philadelphia chromosome-positive and negative B lineage and T lineage ALL, as single agent (40 mg/m(2)/ day for 5 days), or in combination. In a Group for Research on Adult Acute Lympho- blastic Leukemia (GRAALL) retrospective study of two regimens (clofarabine ± cyclophosphamide + / - etoposide (ENDEVOL) ± mitoxantrone ± asparaginase ± dexamethasone (VANDEVOL)), remission was achieved in 50% of 55 relapsed/refractory patients, and 17-35% could proceed to allogeneic stem cell. Clofarabine warrants further exploration in advanced ALL treatment and bridge-to-transplant.
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Kantarjian HM, Lioure B, Kim SK, Atallah E, Leguay T, Kelly K, Marolleau JP, Escoffre-Barbe M, Thomas XG, Cortes J, Jabbour E, O'Brien S, Bories P, Oprea C, Hatteville L, Dombret H. A Phase II Study of Coltuximab Ravtansine (SAR3419) Monotherapy in Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia. Clin Lymphoma Myeloma Leuk 2015; 16:139-45. [PMID: 26775883 DOI: 10.1016/j.clml.2015.12.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/14/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Long-term disease-free survival in adult patients with acute lymphoblastic leukemia (ALL) remains unsatisfactory, and the treatment options are limited for those patients with relapse or a failure to respond after initial therapy. We conducted a dose-escalation/expansion phase II, multicenter, single-arm study to determine the optimal dose of coltuximab ravtansine (SAR3419), an anti-CD19 antibody-drug conjugate, in this setting. PATIENTS AND METHODS The dose-escalation part of the study determined the selected dose of coltuximab ravtansine for the evaluation of efficacy and safety in the dose-expansion phase. Patients received coltuximab ravtansine induction therapy (≤ 8 weekly doses). The responding patients were eligible for maintenance therapy (biweekly administration for ≤ 24 weeks). Three dose levels of coltuximab ravtansine were examined: 55, 70, and 90 mg/m(2). The primary endpoint was the objective response rate (ORR). The secondary endpoints included the duration of response (DOR) and safety. RESULTS A total of 36 patients were treated: 19 during dose escalation and 17 during dose expansion. One dose-limiting toxicity was observed at 90 mg/m(2) (grade 3 peripheral motor neuropathy); therefore, 70 mg/m(2) was selected for the dose-expansion phase. Five patients discontinued therapy because of adverse events (AEs). The most common AEs were pyrexia, diarrhea, and nausea. Of the 17 evaluable patients treated at the selected dose, 4 had a disease response (estimated ORR using the Bayesian method: 25.5% (80% confidence interval, 14.2%-39.6%). The DOR was 1.9 months (range, 1-5.6 months). Because of these results, the study was prematurely discontinued. CONCLUSION Coltuximab ravtansine was well tolerated but was associated with a low clinical response rate in patients with relapsed or refractory ALL.
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Affiliation(s)
| | | | - Stella K Kim
- University of Texas Health Medical School, The Robert Cizik Eye Clinic, Houston, TX
| | | | | | - Kevin Kelly
- Cancer Therapy & Research Center, University of Texas Health Science Center, San Antonio, TX
| | | | | | | | | | | | | | | | | | | | - Hervé Dombret
- Hospital Saint-Louis, University Institute of Hematology, University Paris Diderot, Paris, France
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35
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Hunault-Berger M, Leguay T, Huguet F, Leprêtre S, Deconinck E, Ojeda-Uribe M, Bonmati C, Escoffre-Barbe M, Bories P, Himberlin C, Chevallier P, Rousselot P, Reman O, Boulland ML, Lissandre S, Turlure P, Bouscary D, Sanhes L, Legrand O, Lafage-Pochitaloff M, Béné MC, Liens D, Godfrin Y, Ifrah N, Dombret H. A Phase 2 study of L-asparaginase encapsulated in erythrocytes in elderly patients with Philadelphia chromosome negative acute lymphoblastic leukemia: The GRASPALL/GRAALL-SA2-2008 study. Am J Hematol 2015; 90:811-8. [PMID: 26094614 DOI: 10.1002/ajh.24093] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 11/11/2022]
Abstract
PURPOSE The GRASPALL/GRAALL-SA2-2008 Phase II trial evaluated the safety and efficacy of L-asparaginase encapsulated within erythrocytes (GRASPA®) in patients ≥ 55 years with Philadelphia chromosome-negative acute lymphoblastic leukemia. FINDINGS Thirty patients received escalating doses of GRASPA® on Day 3 and 6 of induction Phases 1 and 2. The primary efficacy endpoint was asparagine depletion < 2 µmol/L for at least 7 days. This was reached in 85 and 71% of patients with 100 and 150 IU/kg respectively but not with 50 IU/kg. Grade 3/4 infection, hypertransaminasemia, hyperbilirubinemia and deep vein thrombosis occurred in 77, 20, 7, and 7% of patients, respectively. No allergic reaction or clinical pancreatitis was observed despite 17% of Grade 3/4 lipase elevation. Anti-asparaginase antibodies were detected in 50% of patients and related to a reduction in the duration of asparagine depletion during induction Phase 2 without decrease of encapsulated L-asparaginase activity. Complete remission rate was 70%. With a median follow-up of 42 months, median overall survival was 15.8 and 9.7 months, in the 100 and 150 IU/kg cohorts respectively. CONCLUSIONS The addition of GRASPA®, especially at the 100 IU/kg dose level, is feasible in elderly patients without excessive toxicity and associated with durable asparagine depletion. (clinicaltrials.gov identifier NCT01523782).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pierre Bories
- Haematology Department of Strasbourg; Strasbourg France
| | | | | | | | | | | | | | | | | | | | | | | | | | - David Liens
- Haematology Department of ERYTECH Pharma; France
| | - Yann Godfrin
- Haematology Department of ERYTECH Pharma; France
| | | | - Hervé Dombret
- Haematology Department of Saint-Louis AP-HP Paris; France
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36
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Calmettes C, Vigouroux S, Labopin M, Tabrizi R, Turlure P, Lafarge X, Marit G, Pigneux A, Leguay T, Bouabdallah K, Dilhuydy MS, Duclos C, Mohr C, Lascaux A, Dumas PY, Dimicoli-Salazar S, Saint-Lézer A, Milpied N. Risk Factors for Steroid-Refractory Acute Graft-versus-Host Disease after Allogeneic Stem Cell Transplantation from Matched Related or Unrelated Donors. Biol Blood Marrow Transplant 2015; 21:860-5. [DOI: 10.1016/j.bbmt.2015.01.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/14/2015] [Indexed: 11/24/2022]
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37
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Boissel N, Renneville A, Leguay T, Lefebvre PC, Recher C, Lecerf T, Delabesse E, Berthon C, Blanchet O, Prebet T, Pautas C, Chevallier P, Leprêtre S, Girault S, Bonmati C, Guièze R, Himberlin C, Randriamalala E, Preudhomme C, Jourdan E, Dombret H, Ifrah N. Dasatinib in high-risk core binding factor acute myeloid leukemia in first complete remission: a French Acute Myeloid Leukemia Intergroup trial. Haematologica 2015; 100:780-5. [PMID: 25715404 DOI: 10.3324/haematol.2014.114884] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 02/19/2015] [Indexed: 01/23/2023] Open
Abstract
Core-binding factor acute myeloid leukemia is a favorable acute myeloid leukemia subset cytogenetically defined by t(8;21) or inv(16)/t(16;16) rearrangements, disrupting RUNX1 (previously CBFA/AML1) or CBFB transcription factor functions. The receptor tyrosine kinase KIT is expressed in the vast majority of these acute myeloid leukemias and frequent activating KIT gene mutations have been associated with a higher risk of relapse. This phase II study aimed to evaluate dasatinib as maintenance therapy in patients with core-binding factor acute myeloid leukemia in first hematologic complete remission, but at higher risk of relapse due to molecular disease persistence or recurrence. A total of 26 patients aged 18-60 years old previously included in the CBF-2006 trial were eligible to receive dasatinib 140 mg daily if they had a poor initial molecular response (n=18) or a molecular recurrence (n=8). The tolerance of dasatinib as maintenance therapy was satisfactory. The 2-year disease-free survival in this high-risk population of patients was 25.7%. All but one patient with molecular recurrence presented subsequent hematologic relapse. Patients with slow initial molecular response had a similar disease-free survival when treated with dasatinib (40.2% at 2 years) or without any maintenance (50.0% at 2 years). The disappearance of KIT gene mutations at relapse suggests that clonal devolution may in part explain the absence of efficacy observed with single-agent dasatinib in these patients (n. EudraCT: 2006-006555-12).
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Affiliation(s)
- Nicolas Boissel
- Service d'Hématologie Adulte, Hôpital Saint-Louis, Paris EA-3518, Université Paris 7
| | - Aline Renneville
- Laboratoire d'hématologie, Centre de Biologie-Pathologie, CHRU de Lille Equipe 3 INSERM U837, JPARC Lille
| | | | | | | | - Thibaud Lecerf
- Service des Maladies du Sang, INSERM U892/CNRS 6299, CHU Angers
| | | | | | | | - Thomas Prebet
- Service d'Hématologie, Institut Paoli Calmettes, Marseille
| | | | | | | | | | | | | | | | | | - Claude Preudhomme
- Laboratoire d'hématologie, Centre de Biologie-Pathologie, CHRU de Lille Equipe 3 INSERM U837, JPARC Lille
| | - Eric Jourdan
- Hématologie Clinique et Oncologie Médicale, CHU de Nîmes, France
| | - Hervé Dombret
- Service d'Hématologie Adulte, Hôpital Saint-Louis, Paris EA-3518, Université Paris 7
| | - Norbert Ifrah
- Service des Maladies du Sang, INSERM U892/CNRS 6299, CHU Angers
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38
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Chevallier P, Huguet F, Raffoux E, Etienne A, Leguay T, Isnard F, Robillard N, Guillaume T, Delaunay J, Charbonnier A, Pigneux A, Peterlin P, Bené MC, Wegener WA, Goldenberg DM, Dombret H. Vincristine, dexamethasone and epratuzumab for older relapsed/refractory CD22+ B-acute lymphoblastic leukemia patients: a phase II study. Haematologica 2014; 100:e128-31. [PMID: 25552705 DOI: 10.3324/haematol.2014.120220] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
| | | | | | - Anne Etienne
- Hematology Department, Institut Paoli-Calmette, Marseille
| | | | | | - Nelly Robillard
- Hematology/Biology Department, CHU Hotel-Dieu, Nantes, France
| | | | | | | | | | | | - Marie C Bené
- Hematology/Biology Department, CHU Hotel-Dieu, Nantes, France
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Tabrizi R, Marit G, Mohr C, Lascaux A, Vigouroux S, Bouabdallah K, Pigneux A, Leguay T, Dilhuydy MS, Duclos C, Dimicoli-Salazar S, Milpied NJ. Outcome of patients with multiple myeloma (MM) relapsing after front-line autologous stem cell transplantation (ASCT): Impact of reduced intensity allogeneic transplantation (RICALLO). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e19564] [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] [Indexed: 11/20/2022] Open
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Giebel S, Labopin M, Gorin NC, Caillot D, Leguay T, Schaap N, Michallet M, Dombret H, Mohty M. Improving results of autologous stem cell transplantation for Philadelphia-positive acute lymphoblastic leukaemia in the era of tyrosine kinase inhibitors: a report from the Acute Leukaemia Working Party of the European Group for Blood and Marrow Transplantation. Eur J Cancer 2013; 50:411-7. [PMID: 24210524 DOI: 10.1016/j.ejca.2013.08.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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: 05/02/2013] [Revised: 08/12/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Outcome of Philadelphia-positive acute lymphoblastic leukaemia (Ph+ ALL) improved significantly with the introduction of tyrosine kinase inhibitors (TKIs). Autologous stem cell transplantation (ASCT) has never been considered a standard of care in this setting. The aim of our study was to analyse if results of ASCT improved in the era of TKIs. PATIENTS AND METHODS One-hundred and seventy-seven adults with Ph+ ALL treated with ASCT in first complete remission were analysed for the impact of year of transplantation on outcome. Additional analysis was performed including 32 patients for whom detailed data on the use of TKIs and the status of minimal residual disease were collected. RESULTS The probability of the overall survival (OS) at 3 years increased from 16% for transplants performed between 1996 and 2001 to 48% between 2002 and 2006 and 57% between 2007 and 2010 (P<.0001). Leukaemia-free survival (LFS) was 11%, 39% and 52%, respectively (P<.0001). Relapse incidence decreased from 70% to 45% and 45% (P=.01), respectively, while non-relapse mortality was 19%, 15% and 3% (P=.08). In a multivariate analysis, year of ASCT was the only independent factor influencing the risk of treatment failure (hazard ratio (HR)=0.37; P<.001). In a subgroup of 22 patients actually treated with TKIs and being in complete molecular remission at the time of ASCT, the LFS rate at 3 years was 65%. CONCLUSIONS Results of ASCT for Ph+ ALL improved significantly over time. Prospective, innovative studies are needed to verify the role of ASCT in this patient setting.
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Affiliation(s)
- Sebastian Giebel
- Dept. of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland.
| | - Myriam Labopin
- Clinical Haematology and Cellular Therapy Department, Hospital Saint-Antoine, APHP, Paris, France; EBMT ALWP Office, Hospital Saint-Antoine, Paris, France; Universite Pierre et Marie Curie, Paris, France; INSERM UMRs 938, Paris, France
| | - Norbert Claude Gorin
- Clinical Haematology and Cellular Therapy Department, Hospital Saint-Antoine, APHP, Paris, France; EBMT ALWP Office, Hospital Saint-Antoine, Paris, France; Universite Pierre et Marie Curie, Paris, France; INSERM UMRs 938, Paris, France
| | - Denis Caillot
- Centre Hospitalier Universitaire Le Bocage, Dijon, France
| | - Thibaut Leguay
- Centre Hospitalier Universitaire Bordeaux, Hôpital Haut-Leveque, Pessac, France
| | - Nicolaas Schaap
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | | | - Mohamad Mohty
- Clinical Haematology and Cellular Therapy Department, Hospital Saint-Antoine, APHP, Paris, France; EBMT ALWP Office, Hospital Saint-Antoine, Paris, France; Universite Pierre et Marie Curie, Paris, France; INSERM UMRs 938, Paris, France
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41
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Ben Abdelali R, Asnafi V, Petit A, Micol JB, Callens C, Villarese P, Delabesse E, Reman O, Lepretre S, Cahn JY, Guillerm G, Berthon C, Gardin C, Corront B, Leguay T, Béné MC, Ifrah N, Leverger G, Dombret H, Macintyre E. The prognosis of CALM-AF10-positive adult T-cell acute lymphoblastic leukemias depends on the stage of maturation arrest. Haematologica 2013; 98:1711-7. [PMID: 23831922 DOI: 10.3324/haematol.2013.086082] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
CALM-AF10 (also known as PICALM-MLLT10) is the commonest fusion protein in T-cell acute lymphoblastic leukemia, but its prognostic impact remains unclear. Molecular screening at diagnosis identified CALM-AF10 in 30/431 (7%) patients with T-cell acute lymphoblastic leukemia aged 16 years and over and in 15/234 (6%) of those aged up to 15 years. Adult CALM-AF10-positive patients were predominantly (72%) negative for surface (s)CD3/T-cell receptor, whereas children were predominantly (67%) positive for T-cell receptor. Among 22 adult CALM-AF10-positive patients treated according to the LALA94/GRAALL03-05 protocols, the poor prognosis for event-free survival (P=0.0017) and overall survival (P=0.0014) was restricted to the 15 T-cell receptor-negative cases. Among CALM-AF10-positive, T-cell receptor-negative patients, 82% had an early T-cell precursor phenotype, reported to be of poor prognosis in pediatric T-cell acute lymphoblastic leukemia. Early T-cell precursor acute lymphoblastic leukemia corresponded to 22% of adult LALA94/GRAALL03-05 T-cell acute lymphoblastic leukemias, but had no prognostic impact per se. CALM-AF10 fusion within early T-cell precursor acute lymphoblastic leukemia (21%) did, however, identify a group with a poor prognosis with regards to event-free survival (P=0.04). CALM-AF10 therefore identifies a poor prognostic group within sCD3/T-cell receptor negative adult T-cell acute lymphoblastic leukemias and is over-represented within early T-cell precursor acute lymphoblastic leukemias, in which it identifies patients in whom treatment is likely to fail. Its prognosis and overlap with early T-cell precursor acute lymphoblastic leukemia in pediatric T-cell acute lymphoblastic leukemia merits analysis. The clinical trial GRAALL was registered at Clinical Trials.gov number NCT00327678.
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42
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Forcade E, Leguay T, Vey N, Baruchel A, Delaunay J, Robin M, Socié G, Dombret H, Peffault de Latour R, Raffoux E. Nelarabine for T cell acute lymphoblastic leukemia relapsing after allogeneic hematopoietic stem cell transplantation: an opportunity to improve survival. Biol Blood Marrow Transplant 2013; 19:1124-6. [PMID: 23648236 DOI: 10.1016/j.bbmt.2013.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 04/06/2013] [Indexed: 11/30/2022]
Abstract
T-ALL relapsing after allogeneic stem cell transplantation is unusual but classically associated with poor outcome. Recently, encouraging results have been reported with Nelarabine in relapse or refractory cases. On behalf of the Group of Research in Adult ALL (GRAALL), we conducted a retrospective analysis of patients receiving Nelarabine following relapse after transplantation. Eleven patients received Nelarabine as salvage therapy in this situation. Most of them were transplanted in first Complete Remission (CR), and received a myeloablative conditioning regimen in 7 cases. Relapse occurred with a median time of 199 days. Nelarabine was given at 1.5 g/m(2)/day (Day 1, D3, D5) alone (N = 5) or in association (N = 6). The overall hematological response rate was 81%. Neurologic toxicity represents the main adverse event (N = 4), mainly grade I-II. Event free survival and overall survival at 1 year were 70 and 90% respectively. Nelarabine is a valuable option for salvage therapy in T-cell acute lymphoblastic leukemia relapsing after transplantation.
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Affiliation(s)
- Edouard Forcade
- Service d'Hématologie clinique et de Thérapie cellulaire, Bordeaux, Pessac, France.
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Labouré G, Dulucq S, Labopin M, Tabrizi R, Guérin E, Pigneux A, Lafarge X, Leguay T, Bouabdallah K, Dilhuydy MS, Duclos C, Lascaux A, Marit G, Mahon FX, Boiron JM, Milpied N, Vigouroux S. Potent Graft-versus-Leukemia Effect after Reduced-Intensity Allogeneic SCT for Intermediate-Risk AML with FLT3-ITD or Wild-Type NPM1 and CEBPA without FLT3-ITD. Biol Blood Marrow Transplant 2012; 18:1845-50. [DOI: 10.1016/j.bbmt.2012.06.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 06/18/2012] [Indexed: 11/30/2022]
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Vigouroux S, Tabrizi R, Melot C, Coiffard J, Lafarge X, Marit G, Bouabdallah K, Pigneux A, Leguay T, Dilhuydy MS, Schmitt A, Boiron JM, Milpied N. Comparable outcome after related or unrelated allogeneic stem cell transplant following reduced conditioning with fludarabine, busulfan and antithymocyte globulin. Leuk Lymphoma 2011; 53:162-5. [PMID: 21756024 DOI: 10.3109/10428194.2011.604754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vigouroux S, Tabrizi R, Melot C, Coiffard J, Lafarge X, Marit G, Bouabdallah K, Pigneux A, Leguay T, Dilhuydy MS, Schmitt A, Boiron JM, Milpied N. Methotrexate Reduces the Incidence of Severe Acute Graft-versus-Host Disease without Increasing the Risk of Relapse after Reduced-Intensity Allogeneic Stem Cell Transplantation from Unrelated Donors. Biol Blood Marrow Transplant 2011; 17:93-100. [DOI: 10.1016/j.bbmt.2010.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 06/14/2010] [Indexed: 10/19/2022]
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Hunault-Berger M, Leguay T, Thomas X, Legrand O, Huguet F, Bonmati C, Escoffre-Barbe M, Legros L, Turlure P, Chevallier P, Larosa F, Garban F, Reman O, Rousselot P, Dhédin N, Delannoy A, Lafage-Pochitaloff M, Béné MC, Ifrah N, Dombret H. A randomized study of pegylated liposomal doxorubicin versus continuous-infusion doxorubicin in elderly patients with acute lymphoblastic leukemia: the GRAALL-SA1 study. Haematologica 2010; 96:245-52. [PMID: 20971822 DOI: 10.3324/haematol.2010.027862] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The prognosis of acute lymphoblastic leukemia in the elderly is poor. The GRAALL-SA1 phase II, randomized trial compared the efficacy and toxicity of pegylated liposomal doxorubicin versus continuous-infusion doxorubicin in patients 55 years or older with Philadelphia chromosome-negative acute lymphoblastic leukemia. DESIGN AND METHODS Sixty patients received either continuous-infusion doxorubicin (12 mg/m(2)/day) and continuous-infusion vincristine (0.4 mg/day) on days 1-4 or pegylated liposomal doxorubicin (40 mg/m(2)) and standard vincristine (2 mg) on day 1, accompanied by dexamethasone, followed at day 28 by a second cycle, reinforced by cyclophosphamide. End-points were safety, outcome and prognostic factors. RESULTS Myelosuppression was reduced in the pegylated liposomal doxorubicin arm with shorter severe neutropenia (P=0.05), shorter severe thrombocytopenia (P=0.03), and fewer red blood cell transfusions (P=0.04). Grade 3/4 infections and Gram-negative bacteremia were reduced in the pegylated liposomal doxorubicin arm (P=0.04 and P=0.02, respectively). There was a trend towards fewer cardiac events among the patients who received pegylated liposomal doxorubicin (1/29 versus 6/31). The complete remission rate was 82% and, with a median follow-up of 4 years, median event-free survival and overall survival were 9 and 10 months, respectively. Despite the better tolerance of pegylated liposomal doxorubicin, no differences in survival were observed between the two arms, due to trends towards more induction refractoriness (17 versus 3%, P=0.10) and a higher cumulative incidence of relapse (52% versus 32% at 2 years, P=0.20) in the pegylated liposomal doxorubicin arm. CONCLUSIONS With the drug schedules used in this study, pegylated liposomal doxorubicin did not improve the outcome of elderly patients with acute lymphoblastic leukemia despite reduced toxicities.
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Maury S, Huguet F, Leguay T, Lacombe F, Maynadié M, Girard S, de Labarthe A, Kuhlein E, Raffoux E, Thomas X, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Rousselot P, Macintyre E, Ifrah N, Dombret H, Béné MC. Adverse prognostic significance of CD20 expression in adults with Philadelphia chromosome-negative B-cell precursor acute lymphoblastic leukemia. Haematologica 2009; 95:324-8. [PMID: 19773266 DOI: 10.3324/haematol.2009.010306] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The prognostic significance of CD20 expression in B-cell precursor acute lymphoblastic leukemia (BCP-ALL) has been mostly studied in children and yielded conflicting results. In 143 adults with Philadelphia chromosome-negative BCP-ALL treated in the multicentric GRAALL 2003 trial, CD20 positivity over 20% was observed in 32% of patients. While not influencing complete remission achievement, CD20 expression was associated with a higher cumulative incidence of relapse (CIR) at 42 months (P=0.04), independently of the ALL high-risk subset (P=0.025). Notably, the negative impact of CD20 expression on CIR was only observed in patients with a white blood cell count (WBC) over 30x10(9)/L (P=0.006), while not in those with a lower WBC. In the former subgroup, this impact translated into lower event-free survival (15% vs. 59% at 42 months, P=0.003). CD20 expression thus appears to be associated with a worse outcome, which reinforces the interest of evaluating rituximab combined to chemotherapy in CD20-positive adult BCP-ALL. ClinicalTrials.gov ID, NCT00222027.
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Affiliation(s)
- Sébastien Maury
- Service d'Hématologie Clinique, CHU Henri Mondor, 51 av du Mal de Lattre de Tassigny, 94010 Créteil cedex, France.
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Huguet F, Leguay T, Raffoux E, Thomas X, Beldjord K, Delabesse E, Chevallier P, Buzyn A, Delannoy A, Chalandon Y, Vernant JP, Lafage-Pochitaloff M, Chassevent A, Lhéritier V, Macintyre E, Béné MC, Ifrah N, Dombret H. Pediatric-Inspired Therapy in Adults With Philadelphia Chromosome–Negative Acute Lymphoblastic Leukemia: The GRAALL-2003 Study. J Clin Oncol 2009; 27:911-8. [DOI: 10.1200/jco.2008.18.6916] [Citation(s) in RCA: 431] [Impact Index Per Article: 28.7] [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
Purpose Retrospective comparisons have suggested that adolescents or teenagers with acute lymphoblastic leukemia (ALL) benefit from pediatric rather than adult chemotherapy regimens. Thus, the aim of the present phase II study was to test a pediatric-inspired treatment, including intensified doses of nonmyelotoxic drugs, such as prednisone, vincristine, or l-asparaginase, in adult patients with ALL up to the age of 60 years. Patients and Methods Between 2003 and 2005, 225 adult patients (median age, 31 years; range, 15 to 60 years) with Philadelphia chromosome–negative ALL were enrolled onto the Group for Research on Adult Acute Lymphoblastic Leukemia 2003 protocol, which included several pediatric options. Some adult options, such as allogeneic stem-cell transplantation for patients with high-risk ALL, were nevertheless retained. Results were retrospectively compared with the historical France-Belgium Group for Lymphoblastic Acute Leukemia in Adults 94 (LALA-94) trial experience in 712 patients age 15 to 55 years. Results Complete remission rate was 93.5%. At 42 months, event-free survival (EFS) and overall survival (OS) rates were 55% (95% CI, 48% to 52%) and 60% (95% CI, 53% to 66%), respectively. Age remained an important bad prognostic factor, with 45 years of age as best cutoff. In older versus younger patients, there was a higher cumulative incidence of chemotherapy-related deaths (23% v 5%, respectively; P < .001) and deaths in first CR (22% v 5%, respectively; P < .001), whereas the incidence of relapse remained stable (30% v 32%, respectively). Complete remission rate (P = .02), EFS (P < .001), and OS (P < .001) compared favorably with the previous LALA-94 experience. Conclusion These results suggest that pediatric-inspired therapy markedly improves the outcome of adult patients with ALL, at least until the age of 45 years.
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Affiliation(s)
- Françoise Huguet
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Thibaut Leguay
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Emmanuel Raffoux
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Xavier Thomas
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Kheira Beldjord
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Eric Delabesse
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Patrice Chevallier
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Agnes Buzyn
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - André Delannoy
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Yves Chalandon
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jean-Paul Vernant
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marina Lafage-Pochitaloff
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Agnès Chassevent
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Véronique Lhéritier
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Elizabeth Macintyre
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Marie-Christine Béné
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Norbert Ifrah
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Hervé Dombret
- From the Departments of Hematology, Hôpital Purpan, Toulouse; Hôpital Haut-Lévèque, Bordeaux; Hôpital Saint-Louis, Hôpital Necker, and Hôpital Pitié-Salpêtriere, Assistance Publique–Hôpitaux de Paris, Paris; Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon; Hotel Dieu, Nantes; Hôpital de la Timone, Marseille; Hôpital Larrey, Angers; Hôpital Brabois, Nancy, France; Hôpital Universitaire, Geneva, Switzerland; and Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Leguay T, Foucaud C, Parrens M, Fitoussi O, Bouabdallah K, Belaud-Rotureau M, Tabrizi R, Marit G, Pigneux A, Milpied N. EBV-positive lymphoproliferative disease with medullar, splenic and hepatic infiltration after imatinib mesylate therapy for chronic myeloid leukemia with two relapses and rituximab resistance. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.17536] [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
17536 Background: Imatinib mesylate has transformed the management of the patients with chronic myeloid leukemia (CML). Initially, few undesirable effects was described. In 2003, Bekkenk presented the first EBV-positive cutaneous B-cell lymphoproliferative disease during imatinib mesylate therapy with disappearance of the cutaneous tumor after interruption of the specific inhibitor of BCR-ABL. Methods: Results: We reported a case of first EBV-positive lymphoproliferative disease with diffuse infiltration. Our patient 59 years old female was treated with imatinib mesylate for CML in chronic phase. CML was diagnosed on 2003 and imatinib mesylate therapy (400 mg/day) was initiated. A CCR was achieved after six months and a major molecular response after eighteen months. EBV-positive lymphoproliferative disease was diagnosed on 2005 and interruption of imatinib mesylate have not demonstrated efficiency. A response was initially obtained after treatment with rituximab alone, but our patient relapsed after reintroduction of imatinib at the same dose. A retreatment with rituximab have permitted a second biological complete remission and disappearance of clinical abnormalities but during only few months. At the second relapse, the disease transformed into a CD20-negative diffuse large B cell lymphoma and became resistant to rituximab therapy. Nevertheless, the lymphoproliferative disease remained responsive to conventional chemotherapy with CHOP and Interferon-alpha. Conclusions: Imatinib mesylate has modified the evolution of CML with an improvement of overall survival. In vitro studies have shown that imatinib mesylate is able to inhibit the proliferation and the activation of T-cells, and to reduce significantly the antigen-triggered expansion of CD8+ T cells in response to immunodominant EBV peptides. We speculate that such an effect might have occurred in our patient. Despite a growing number of patient receiving this tyrosine kinase inhibitor, case reports of EBV-positive lymphoproliferation disease remain rare. No significant financial relationships to disclose.
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Affiliation(s)
- T. Leguay
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - C. Foucaud
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - M. Parrens
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - O. Fitoussi
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - K. Bouabdallah
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - M. Belaud-Rotureau
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - R. Tabrizi
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - G. Marit
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - A. Pigneux
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - N. Milpied
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
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Leguay T, Foucaud C, Parrens M, Fitoussi O, Bouabdallah K, Belaud-Rotureau MA, Tabrizi R, Marit G, Pigneux A, Milpied N. EBV-positive lymphoproliferative disease with medullary, splenic and hepatic infiltration after imatinib mesylate therapy for chronic myeloid leukemia. Leukemia 2007; 21:2208-10. [PMID: 17541400 DOI: 10.1038/sj.leu.2404758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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