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Houot R, Bachy E, Cartron G, Gros FX, Morschhauser F, Oberic L, Gastinne T, Feugier P, Duléry R, Thieblemont C, Joris M, Jardin F, Choquet S, Casasnovas O, Brisou G, Cheminant M, Bay JO, Gutierrez FL, Menard C, Tarte K, Delfau MH, Portugues C, Itti E, Palard-Novello X, Blanc-Durand P, Al Tabaa Y, Bailly C, Laurent C, Lemonnier F. Author Correction: Axicabtagene ciloleucel as second-line therapy in large B cell lymphoma ineligible for autologous stem cell transplantation: a phase 2 trial. Nat Med 2024:10.1038/s41591-024-03053-z. [PMID: 38745012 DOI: 10.1038/s41591-024-03053-z] [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: 05/16/2024]
Affiliation(s)
- Roch Houot
- Department of Hematology, University Hospital of Rennes, UMR U1236, INSERM, University of Rennes, French Blood Establishment, Rennes, France.
| | - Emmanuel Bachy
- Department of Hematology, Lyon Sud Hospital Center, INSERM U1111, Lyon, France
| | - Guillaume Cartron
- Department of Hematology, University Hospital of Montpellier, UMR-CNRS 5535, Montpellier, France
| | - François-Xavier Gros
- Department of Clinical Hematology and Cellular Therapy, University Hospital of Bordeaux, Bordeaux, France
| | | | - Lucie Oberic
- Department of Hematology, Cancer University Institute of Toulouse Oncopole, Toulouse, France
| | - Thomas Gastinne
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Pierre Feugier
- Department of Hematology, University Hospital of Nancy, INSERM 1256, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Rémy Duléry
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, AP-HP, INSERM UMR938, Paris, France
| | | | - Magalie Joris
- Department of Hematology, University Hospital of Amiens, Amiens, France
| | - Fabrice Jardin
- Department of Clinical Hematology, Henri Becquerel Center, INSERM U1245, Rouen, France
| | - Sylvain Choquet
- Department of Hematology, University Hospital Pitié Salpêtrière, AP-HP, Sorbonne University, Paris, France
| | - Olivier Casasnovas
- Department of Clinical Hematology, Dijon University Hospital, INSERM UMR1231, Dijon, France
| | - Gabriel Brisou
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Morgane Cheminant
- Department of Clinical Hematology, Necker-Enfants Malades University Hospital, AP-HP, INSERM UMR1163, Paris, France
| | - Jacques-Olivier Bay
- Department of Clinical Hematology and Cellular Therapy, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | | | - Cédric Menard
- French Blood Establishment and SITI Laboratory, UMR U1236, INSERM, University of Rennes, University Hospital Center of Rennes, Rennes, France
| | - Karin Tarte
- French Blood Establishment and SITI Laboratory, UMR U1236, INSERM, University of Rennes, University Hospital Center of Rennes, Rennes, France
| | | | - Cédric Portugues
- Department of Biostatistics, LYSARC, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Henri Mondor Hospital, Créteil, France
| | - Xavier Palard-Novello
- Department of Nuclear Medicine, University of Rennes, CLCC Eugène Marquis, INSERM, Rennes, France
| | - Paul Blanc-Durand
- Department of Nuclear Medicine, CHU H. Mondor, U-PEC, AP-HP, Créteil, France
| | - Yassine Al Tabaa
- Scintidoc Nuclear Medicine Center, Clinique Clémentville, Montpellier, France
| | - Clément Bailly
- Nantes-Angers Cancer Research Center CRCI2NA, University of Nantes, INSERM UMR1307, CNRS-ERL6075, Nantes, France
| | - Camille Laurent
- Department of Pathology, Cancer University Institute of Toulouse Oncopole, CHU Toulouse, CRCT INSERM U1037, Toulouse, France
| | - François Lemonnier
- Lymphoid Malignancies Unit, Henri Mondor Hospital, Mondor Institute for Biomedical Research, INSERM U955, University Paris-Est, Créteil, France
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2
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Durot E, Roosweil D, Chauchet A, Decroocq J, Di Blasi R, Gastinne T, Bensaber H, Cheminant M, Jacquet C, Guidez S, Gros FX, Bachy E, Coste A, Cony-Makhoul P, Treon SP, Delmer AJ, Reshef R, Le Gouill S, Castillo JJ, Houot R. High efficacy of CD19 CAR T-cells in patients with transformed Waldenström macroglobulinemia. Blood 2024:blood.2024024452. [PMID: 38669635 DOI: 10.1182/blood.2024024452] [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: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Histological transformation of Waldenström macroglobulinemia (HT-WM) carries a poor prognosis with standard treatments. Here, we report the first series of HT-WM treated with CAR T-cells showing a high efficacy and no unexpected toxicity.
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Affiliation(s)
- Eric Durot
- Hôpital Robert Debré CHU de Reims, Reims cedex, France
| | - Damien Roosweil
- Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Justine Decroocq
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016, F-75014 Paris, France, Paris, France
| | | | | | - Hedi Bensaber
- University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | | | | | - Arthur Coste
- Hopital Robert Debre CHU de Reims, Reims cedex, France
| | | | - Steven P Treon
- Dana Farber Cancer Institute, Boston, Massachusetts, United States
| | | | - Ran Reshef
- Columbia University Medical Center, New York, New York, United States
| | | | - Jorge J Castillo
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States
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3
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Crochet G, Iacoboni G, Couturier A, Bachy E, Iraola-Truchuelo J, Gastinne T, Cartron G, Fradon T, Lesne B, Kwon M, Gounot R, Martínez-Cibrian N, Castilla-Llorente C, Abrisqueta P, Guerreiro M, Sarkozy C, Aspa-Cilleruelo JM, Camus V, Guidez S, Chauchet A, Deconinck E, Bouabdallah K, Bosch F, Barba P, Morschhauser F, Houot R. Efficacy of CAR T-Cell Therapy is Not Impaired by Previous Bispecific Antibody Treatment in Large B-Cell Lymphoma. Blood 2024:blood.2024024526. [PMID: 38657242 DOI: 10.1182/blood.2024024526] [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: 03/05/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
In this retrospective study, CAR T-cells remained effective in relapsed/refractory LBCL patients after prior exposure to bispecific antibodies (BsAbs) targeting different antigens. These results are relevant to clinical practice, particularly given the increasing use of BsAbs in earlier treatment lines.
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Affiliation(s)
| | - Gloria Iacoboni
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain, Barcelona, Spain
| | | | | | - Josu Iraola-Truchuelo
- Vall d'Hebron University Hospital-Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Tom Fradon
- LYSARC, The Lymphoma Academic Research Organization, Pierre-Bénite, France
| | - Bastien Lesne
- LYSARC, The Lymphoma Academic Research Organization, Pierre-Bénite, France
| | - Mi Kwon
- Hospital G. Univ. Gregorio Marañon, Institute of Health Research Hospital Gregorio Marañon, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Eric Deconinck
- Centre Hospitalier Universitaire Besancon, Besancon, France
| | - Krimo Bouabdallah
- Service d'Hématologie clinique et Thérapie cellulaire, PESSAC, France
| | - Francesc Bosch
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-1, Barcelona, Spain
| | - Pere Barba
- Hospital Vall d'Hebron, barcelona, Spain
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4
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Vic S, Thibert JB, Bachy E, Cartron G, Gastinne T, Morschhauser F, Le Bras F, Bouabdallah K, Despas F, Bay JO, Rubio MT, Mohty M, Casasnovas O, Choquet S, Castilla-Llorente C, Guidez S, Loschi M, Guffroy B, Carras S, Drieu La Rochelle L, Guillet M, Houot R. Transfusion needs after CAR T-cell therapy for large B-cell lymphoma: predictive factors and outcome (a DESCAR-T study). Blood Adv 2024; 8:1573-1585. [PMID: 38181767 PMCID: PMC10982963 DOI: 10.1182/bloodadvances.2023011727] [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: 09/19/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024] Open
Abstract
ABSTRACT Chimeric antigen receptor (CAR) T-cells targeting CD19 have been approved for the treatment of relapse/refractory large B-cell lymphoma. Hematotoxicity is the most frequent CAR T-cell-related adverse event. Transfusion support is a surrogate marker of severe cytopenias. Transfusion affects patients' quality of life, presents specific toxicities, and is known to affect immunity through the so-called transfusion-related immunomodulation that may affect CAR T-cell efficacy. We analyzed data from 671 patients from the French DESCAR-T registry for whom exhaustive transfusion data were available. Overall, 401 (59.8%) and 378 (56.3%) patients received transfusion in the 6-month period before and after CAR T-cell infusion, respectively. The number of patients receiving transfusion and the mean number of transfused products increased during the 6-month period before CAR T-cell infusion, peaked during the first month after infusion (early phase), and decreased over time. Predictive factors for transfusion at the early phase were age >60 years, ECOG PS ≥2, treatment with axicabtagene ciloleucel, pre-CAR T-cell transfusions, and CAR-HEMATOTOX score ≥2. Predictive factors for late transfusion (between 1 and 6 months after infusion) were pre-CAR T-cell transfusions, CAR-HEMATOTOX score ≥2, ICANS ≥3 (for red blood cells [RBC] transfusion), and tocilizumab use (for platelets transfusion). Early transfusions and late platelets (but not RBC) transfusions were associated with a shorter progression-free survival and overall survival. Lymphoma-related mortality and nonrelapse mortality were both increased in the transfused population. Our data shed light on the mechanisms of early and late cytopenia and on the potential impact of transfusions on CAR T-cell efficacy and toxicity.
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Affiliation(s)
- Samuel Vic
- Department of Hematology, CHU de Rennes, Rennes, France
| | | | - Emmanuel Bachy
- Hematology Department, CHU Lyon Sud, Pierre Bénite, Lyon, France
| | | | | | | | - Fabien Le Bras
- Department of Hematology, Lymphoid Malignancies Unit, CHU Henri Mondor, Créteil, France
| | - Kamal Bouabdallah
- Hematology and Cellular Therapy Department, CHU Bordeaux, Bordeaux, France
| | - Fabien Despas
- Hematology and Internal Medicine Department, Institut Universitaire du Cancer-Oncopole, CHU de Toulouse, Toulouse, France
| | - Jacques-Olivier Bay
- Hematology and Cellular Therapy Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Thérèse Rubio
- Department of Hematology CHRU Nancy, biopole de l'Université de Lorraine, Nancy, France
| | - Mohamad Mohty
- Hematology Department Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Olivier Casasnovas
- Department of Hematology and INSERM 1231, CHU Dijon Bourgogne, Dijon, France
| | - Sylvain Choquet
- Hematology Department, hôpital de la Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | | | - Stéphanie Guidez
- Hematology and Cellular Therapy Department, CHU de Poitiers, Poitiers, France
| | - Michaël Loschi
- Hematology Department CHU de Nice, Université Cote d’Azur, Nice, France
| | - Blandine Guffroy
- Department of Hematology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Sylvain Carras
- Institute for Advanced Biosciences, Hematology Department CHU Grenoble-Alpes, University Grenoble-Alpes, Grenoble, France
| | | | - Mathilde Guillet
- The Lymphoma Academic Research Organization, Statistics, Pierre-Bénite, France
| | - Roch Houot
- Department of Hematology, University Hospital of Rennes, UMR U1236 INSERM, University of Rennes, French Blood Establishment, Rennes, France
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Jullien M, Guillaume T, Le Bourgeois A, Peterlin P, Garnier A, Eveillard M, Le Bris Y, Bouzy S, Tessoulin B, Gastinne T, Dubruille V, Touzeau C, Mahé B, Blin N, Lok A, Vantyghem S, Sortais C, Antier C, Moreau P, Scotet E, Béné MC, Chevallier P. Phase I study of zoledronic acid combined with escalated doses of interleukine-2 for early in vivo generation of Vγ9Vδ2 T-cells after haploidentical stem cell transplant with posttransplant cyclophosphamide. Am J Hematol 2024; 99:350-359. [PMID: 38165016 DOI: 10.1002/ajh.27191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024]
Abstract
The presence of donor Vγ9Vδ2 T-cells after haploidentical hematopoietic stem cell transplant (h-HSCT) has been associated with improved disease-free survival. These cells kill tumor cells in a non-MHC restricted manner, do not induce graft-versus-host disease (GVHD), and can be generated by stimulation with zoledronic acid (ZA) in combination with interleukin-2 (IL-2). This monocentric phase I, open-label, dose-escalating study (ClinicalTrials.gov: NCT03862833) aimed at evaluating the safety and possibility to generate Vγ9Vδ2 T-cells early after h-HSCT. It applied a standard 3 + 3 protocol to determine the maximum tolerated dose (MTD) of increasing low-doses of IL-2 (5 days [d] per week, 4 weeks) in combination with a single dose of ZA, starting both the first Monday after d + 15 posttransplant. Vγ9Vδ2 T-cell monitoring was performed by multiparameter flow cytometry on blood samples and compared with a control cohort of h-HSCT recipients. Twenty-six patients were included between April 2019 and September 2022, 16 of whom being ultimately treated and seven being controls who received h-HSCT only. At the three dose levels tested, 1, 0, and 1 dose-limiting toxicities were observed. MTD was not reached. A significantly higher number of Vγ9Vδ2 T-cells was observed during IL-2 treatment compared with controls. In conclusion, early in vivo generation of Vγ9Vδ2 T-cells is feasible after h-HSCT by using a combination of ZA and repeated IL-2 infusions. This study paves the way to a future phase 2 study, with the hope to document lesser posttransplant relapse with this particular adaptive immunotherapy.
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Affiliation(s)
- Maxime Jullien
- Hematology Department, Nantes University Hospital, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
- LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
| | - Thierry Guillaume
- Hematology Department, Nantes University Hospital, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
- LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
| | | | - Pierre Peterlin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Alice Garnier
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Marion Eveillard
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
- LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Yannick Le Bris
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
- LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Simon Bouzy
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Benoît Tessoulin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Thomas Gastinne
- Hematology Department, Nantes University Hospital, Nantes, France
| | | | - Cyrille Touzeau
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Béatrice Mahé
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Nicolas Blin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Anne Lok
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Sophie Vantyghem
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Clara Sortais
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Chloé Antier
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Philippe Moreau
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Emmanuel Scotet
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
- LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
| | - Marie C Béné
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
- LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Patrice Chevallier
- Hematology Department, Nantes University Hospital, Nantes, France
- Nantes Université, Inserm UMR 1307, CNRS UMR 6075, Université d'Angers, CRCI2NA, Nantes, France
- LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
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6
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Sarkozy C, Thieblemont C, Oberic L, Moreau A, Bouabdallah K, Damaj G, Gastinne T, Tessoulin B, Ribrag V, Casasnovas O, Haioun C, Houot R, Jardin F, Van Den Neste E, Cheminant M, Morschhauser F, Callanan M, Safar V, Gressin R, Hermine O, Le Gouill S. Long-Term Follow-Up of Rituximab Maintenance in Young Patients With Mantle-Cell Lymphoma Included in the LYMA Trial: A LYSA Study. J Clin Oncol 2024; 42:769-773. [PMID: 38109684 DOI: 10.1200/jco.23.01586] [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: 07/26/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 12/20/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned coprimary or secondary analyses are not yet available. Clinical trial updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The LYMA trial demonstrated the benefit of rituximab maintenance (RM) in first-line young patients with mantle-cell lymphoma. In this prolonged follow-up of 7.5 years (95% CI, 7.4 to 7.7) from inclusion, the median progression-free survival (PFS) and overall survival (OS) for the full population were not reached (NR) with a 7-year PFS of 55.5% (95% CI, 49.5 to 61) and OS of 69.5% (95% CI, 63.8 to 74.5). The EFS remained statistically superior in favor of RM (median NR v 5.8 years, P < .0001; HR, 0.39 [95% CI, 0.52 to 0.6] and 7-year estimate, 76.2% versus 46% for RM and observation, respectively). Similarly, RM prolonged PFS (estimated PFS at 7 years, 78.5% v 47.4% and HR, 0.36 [95% CI, 0.23 to 0.56] for RM and observation, respectively, P < .0001). The 7-year OS estimate was 83.2% versus 72.2%, respectively (P = .088, HR, 0.63 [95% CI, 0.37 to 1.08]). Cause of death was not significantly distinct between the two groups, with lymphoma being the leading cause with a very low rate of infection-related death. Overall, the PFS benefit of RM after autologous stem cell transplantation remains after 7-year follow-up, and RM was not associated with an increase in infection-related mortality, making this strategy a safe standard of care with long-term follow-up.
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Affiliation(s)
- Clémentine Sarkozy
- Service d'hématologie, Institut Curie, Saint Cloud, France
- Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Inserm/Institut Curie centre de recherche, Paris cedex, France
| | | | - Lucie Oberic
- Service d'hématologie, Institut Universitaire du Cancer Toulouse, Oncopole, Toulouse, France
| | - Anne Moreau
- Service d'anatomopathologie, CHU Nantes, Nantes, France
| | | | - Gandhi Damaj
- Service d'hématologie, CHU de Caen, Caen, France
| | | | | | - Vincent Ribrag
- département d'hématologie, Institut Gustave Roussy, Villejuif, France
| | | | - Corinne Haioun
- Service d'hématologie, Hôpital Henri Mondor, APHP, Créteil, France
| | - Roch Houot
- Service d'hématologie, CHU Rennes, Rennes, France
| | - Fabrice Jardin
- Service d'hématologie, Centre Henri Becquerel, Rouen, France
| | - Eric Van Den Neste
- Service d'hématologie, Clinique universitaire UCL Saint Luc, Bruxelles, Belgique
| | | | | | | | - Violaine Safar
- Service d'hématologie, Hôpital Lyon Sud, Pierre Bénite, France
| | - Remy Gressin
- Service d'hématologie, Hôpital Necker, Paris, France
| | | | - Steven Le Gouill
- Service d'hématologie, Institut Curie, Saint Cloud, France
- Laboratoire d'Imagerie Translationnelle en Oncologie (LITO), U1288 Inserm/Institut Curie centre de recherche, Paris cedex, France
- université Versailles Saint-Quentin (UVSQ), France
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7
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Le Cacheux C, Couturier A, Sortais C, Houot R, Péré M, Gastinne T, Seguin A, Reignier J, Lascarrou JB, Tadié JM, Quelven Q, Canet E. Features and outcomes of patients admitted to the ICU for chimeric antigen receptor T cell-related toxicity: a French multicentre cohort. Ann Intensive Care 2024; 14:20. [PMID: 38291184 PMCID: PMC10828176 DOI: 10.1186/s13613-024-01247-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/09/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Chimeric antigen receptor T-cell (CAR-T) therapy is increasingly used in patients with refractory haematological malignancies but can induce severe adverse events. We aimed to describe the clinical features and outcomes of patients admitted to the intensive care unit (ICU) after CAR-T therapy. METHODS This retrospective observational cohort study included consecutive adults admitted to either of two French ICUs in 2018-2022 within 3 months after CAR-T therapy. RESULTS Among 238 patients given CAR-T therapy, 84 (35.3%) required ICU admission and were included in the study, a median of 5 [0-7] days after CAR-T infusion. Median SOFA and SAPSII scores were 3 [2-6] and 39 [30-48], respectively. Criteria for cytokine release syndrome were met in 80/84 (95.2%) patients, including 18/80 (22.5%) with grade 3-4 toxicity. Immune effector cell-associated neurotoxicity syndrome (ICANS) occurred in 46/84 (54.8%) patients, including 29/46 (63%) with grade 3-4 toxicity. Haemophagocytic lymphohistiocytosis was diagnosed in 15/84 (17.9%) patients. Tocilizumab was used in 73/84 (86.9%) patients, with a median of 2 [1-4] doses. Steroids were given to 55/84 (65.5%) patients, including 21/55 (38.2%) given high-dose pulse therapy. Overall, 23/84 (27.4%) patients had bacterial infections, 3/84 (3.6%) had fungal infections (1 invasive pulmonary aspergillosis and 2 Mucorales), and 2 (2.4%) had cytomegalovirus infection. Vasopressors were required in 23/84 (27.4%), invasive mechanical ventilation in 12/84 (14.3%), and dialysis in 4/84 (4.8%) patients. Four patients died in the ICU (including 2 after ICU readmission, i.e., overall mortality was 4.8% of patients). One year after CAR-T therapy, 41/84 (48.9%) patients were alive and in complete remission, 14/84 (16.7%) were alive and in relapse, and 29/84 (34.5%) had died. These outcomes were similar to those of patients never admitted to the ICU. CONCLUSION ICU admission is common after CAR-T therapy and is usually performed to manage specific toxicities. Our experience is encouraging, with low ICU mortality despite a high rate of grade 3-4 toxicities, and half of patients being alive and in complete remission at one year.
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Affiliation(s)
- Corentin Le Cacheux
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France.
| | - Audrey Couturier
- Clinical Haematology Department, Rennes University Hospital, Rennes University, INSERM U1236, Rennes, France
| | - Clara Sortais
- Haematology Department, Nantes University Hospital, Nantes University, Nantes, France
| | - Roch Houot
- Clinical Haematology Department, Rennes University Hospital, Rennes University, INSERM U1236, Rennes, France
| | - Morgane Péré
- Biostatistics Department, Nantes University Hospital, Nantes University, Nantes, France
| | - Thomas Gastinne
- Haematology Department, Nantes University Hospital, Nantes University, Nantes, France
| | - Amélie Seguin
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France
- ICU, Nantes University, Nantes University Hospital,-Interactions-Performance Research Unit (MIP, UR 4334), Nantes, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France
| | - Jean-Marc Tadié
- ICU, Rennes University Hospital, Rennes University, Rennes, France
| | - Quentin Quelven
- ICU, Rennes University Hospital, Rennes University, Rennes, France
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, 30 Bd. Jean Monnet, 44093, Nantes Cedex 1, France
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8
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Piron B, Costes-Tertrais D, Gastinne T, Fourmont AM, Dubruille V, Blin N, Moreau P, Touzeau C, Tessoulin B. Quad-class exposed/refractory myeloma is associated with short survival. Br J Haematol 2024; 204:186-190. [PMID: 37833834 DOI: 10.1111/bjh.19148] [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: 07/31/2023] [Revised: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023]
Abstract
Very scarce data exist about outcomes of relapsed multiple myeloma patients who have failed proteasome inhibitor, immunomodulatory drug, anti-CD38 monoclonal antibody and therapies targeting B-cell maturation antigen (BCMA) (Quad-class exposed [QCE]). In this retrospective single-centre study, we determined progression-free survival (PFS) and overall survival (OS) from anti-BCMA failure in 45 QCE patients. Seven (16%) patients received antibody-drug conjugate, 20 (44%) bispecific antibodies and 18 (40%) CAR-T cell. Thirty patients (67%) received ≥1 subsequent line of treatment. PFS was 4.4 months (95% CI = 2.4-12.5) and OS 6.3 months (95% CI = 3.9-14.4). Having an adverse prognosis, QCE myeloma patients remain an unmet medical need.
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Affiliation(s)
- Bénédicte Piron
- Department of Hematology, University Hospital, Nantes, France
| | | | - Thomas Gastinne
- Department of Hematology, University Hospital, Nantes, France
| | | | | | - Nicolas Blin
- Department of Hematology, University Hospital, Nantes, France
| | - Philippe Moreau
- Department of Hematology, University Hospital, Nantes, France
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
- Site de Recherche Intégrée sur le Cancer (SIRIC) «ILIAD», INCA-DGOS-Inserm_12558, Nantes, France
| | - Cyrille Touzeau
- Department of Hematology, University Hospital, Nantes, France
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
- Site de Recherche Intégrée sur le Cancer (SIRIC) «ILIAD», INCA-DGOS-Inserm_12558, Nantes, France
| | - Benoit Tessoulin
- Department of Hematology, University Hospital, Nantes, France
- CRCINA, INSERM, CNRS, Université d'Angers, Université de Nantes, Nantes, France
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9
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Piron B, Bastien M, Antier C, Dalla-Torre R, Jamet B, Gastinne T, Dubruille V, Moreau P, Martin J, Bénichou A, Touzeau C, Tessoulin B. Immune-related adverse events with bispecific T-cell engager therapy targeting B-cell maturation antigen. Haematologica 2024; 109:357-361. [PMID: 37470151 PMCID: PMC10772518 DOI: 10.3324/haematol.2023.282919] [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: 03/15/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
Not available.
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Affiliation(s)
| | | | - Chloé Antier
- Department of hematology, University hospital, Nantes
| | | | - Bastien Jamet
- Department of nuclear medicine, University hospital, Nantes
| | | | | | - Philippe Moreau
- Department of hematology, University hospital, Nantes, France; Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers, INSERM UMR 1307, CNRS UMR 6075, Nantes, France; Site de Recherche Intégrée sur le Cancer (SIRIC), Imaging and Longitudinal Investigations to Ameliorate Decision-Making (ILIAD), INCA-DGOS-Inserm 12558, Nantes, France Immunology Laboratory, CIMNA, Nantes
| | | | - Antoine Bénichou
- Department of Internal and Vascular Medicine, University hospital, Nantes
| | - Cyrille Touzeau
- Department of hematology, University hospital, Nantes, France; Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers, INSERM UMR 1307, CNRS UMR 6075, Nantes, France; Site de Recherche Intégrée sur le Cancer (SIRIC), Imaging and Longitudinal Investigations to Ameliorate Decision-Making (ILIAD), INCA-DGOS-Inserm 12558, Nantes, France Immunology Laboratory, CIMNA, Nantes
| | - Benoît Tessoulin
- Department of hematology, University hospital, Nantes, France; Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers, INSERM UMR 1307, CNRS UMR 6075, Nantes.
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10
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Vély A, Couturier MA, Delepine P, Le Calloch R, Ertault M, Gastinne T, Plichon C, Lebreton A, Lester MA, Larhantec G, Cormier N, Fouquet S, Houot R, Tanguy-Schmidt A, Hunault-Berger M, Orvain C. Comparison of efficacy and toxicity according to etoposide and cytarabine dosing in BEAM conditioning followed by autologous stem cell transplantation in Hodgkin lymphoma. Leuk Lymphoma 2023; 64:2178-2187. [PMID: 37615123 DOI: 10.1080/10428194.2023.2251073] [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: 05/04/2023] [Revised: 06/26/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
The combination of carmustine, etoposide, cytarabine, and melphalan (BEAM) followed by autologous stem cell transplantation (ASCT) is a commonly used intensification regimen for patients with Hodgkin lymphoma. As etoposide and cytarabine dosing are not defined, we conducted a retrospective, multicenter study, to compare efficacy and toxicity in 130 patients with Hodgkin lymphoma receiving etoposide and cytarabine at either 200 mg/m2/d (n = 50), 400 mg/m2/d (n = 35), or etoposide 200 mg/m2/d and cytarabine 400 mg/m2/d (n = 45). Progression-free survival and overall survival were not associated with the intensity of conditioning. Increased conditioning intensity was associated with longer duration of thrombocytopenia, a higher number of transfused RBC and platelet units and a higher frequency of mucositis, but serious adverse events or infectious complications were not increased. The intensity of BEAM regimen was not associated with survival but with the rate of cytopenia and mucositis advocating for the use of lower dosing in frail patients.
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Affiliation(s)
- Agathe Vély
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Angers, Angers, France
| | - Marie-Anne Couturier
- Service d'Hématologie Clinique, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | | | - Ronan Le Calloch
- Service d'Hématologie Clinique, Centre Hospitalier de Cornouaille, Quimper, France
| | - Marjan Ertault
- Service d'Hématologie et thérapie cellulaire, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Thomas Gastinne
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Chloé Plichon
- Service de Pharmacie, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Anne Lebreton
- Service de Pharmacie, Centre Hospitalier Universitaire de Angers, Angers, France
| | | | - Gaelle Larhantec
- Service de Pharmacie, Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | - Nicolas Cormier
- Service de Pharmacie, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | | | - Roch Houot
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Aline Tanguy-Schmidt
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Angers, Angers, France
- Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, Angers
- Federation hospitalo-universitaire « Grand Ouest against Leukemia »
| | - Mathilde Hunault-Berger
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Angers, Angers, France
- Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, Angers
- Federation hospitalo-universitaire « Grand Ouest against Leukemia »
| | - Corentin Orvain
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Angers, Angers, France
- Université d'Angers, Inserm UMR 1307, CNRS UMR 6075, Nantes Université, Angers
- Federation hospitalo-universitaire « Grand Ouest against Leukemia »
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11
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Lemoine J, Bachy E, Cartron G, Beauvais D, Gastinne T, Di Blasi R, Rubio MT, Guidez S, Mohty M, Casasnovas RO, Joris M, Castilla-Llorente C, Haioun C, Hermine O, Loschi M, Carras S, Bories P, Fradon T, Herbaux C, Sesques P, Le Gouill S, Morschhauser F, Thieblemont C, Houot R. Nonrelapse mortality after CAR T-cell therapy for large B-cell lymphoma: a LYSA study from the DESCAR-T registry. Blood Adv 2023; 7:6589-6598. [PMID: 37672383 PMCID: PMC10641092 DOI: 10.1182/bloodadvances.2023010624] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 05/03/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023] Open
Abstract
CD19 chimeric antigen receptor (CAR) T cells can induce prolonged remissions and potentially cure a significant proportion of patients with relapsed/refractory large B-cell lymphomas. However, some patients may die of causes unrelated to lymphoma after CAR T-cell therapy. To date, little is known about the nonrelapse mortality (NRM) after CAR T-cell therapy. Using the French DESCAR-T registry, we analyzed the incidence and causes of NRM and identified risk factors of NRM. We report on 957 patients who received standard-of-care axicabtagene ciloleucel (n = 598) or tisagenlecleucel (n = 359) between July 2018 and April 2022, in 27 French centers. With a median follow-up of 12.4 months, overall NRM occurred in 48 patients (5.0% of all patients): early (before day 28 after infusion) in 9 patients (0.9% of all patients and 19% of overall NRM), and late (on/after day 28 after infusion) in 39 patients (4.1% of all patients and 81% of overall NRM). Causes of overall NRM were distributed as follows: 56% infections (29% with non-COVID-19 and 27% with COVID-19), 10% cytokine release syndromes, 6% stroke, 6% cerebral hemorrhage, 6% second malignancies, 4% immune effector cell associated neurotoxicities, and 10% deaths from other causes. We report risk factors of early NRM and overall NRM. In multivariate analysis, both diabetes and elevated ferritin level at lymphodepletion were associated with an increased risk of overall NRM. Our results may help physicians in patient selection and management in order to reduce the NRM after CAR T-cell therapy.
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Affiliation(s)
- Jean Lemoine
- Department of Hematology, CHU de Rennes, Rennes, France
| | - Emmanuel Bachy
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Benite, France
| | | | | | | | - Roberta Di Blasi
- Department of Hemato-Oncology, Saint Louis Hospital, Paris, France
| | | | | | - Mohamad Mohty
- Department of Hematology, Saint Antoine Hospital, Paris, France
| | | | - Magalie Joris
- Department of Hematology, CHU d’Amiens, Amiens, France
| | - Cristina Castilla-Llorente
- Department of Hematology and INSERM, UMR 1030, Université Paris-Saclay, Gustave Roussy Cancer Campus Grand Paris, Paris, France
| | - Corinne Haioun
- Lymphoid Malignancies, Henri Mondor Hospital, Créteil, France
| | | | | | - Sylvain Carras
- Department of Hematology, CHU de Grenoble, Grenoble, France
| | - Pierre Bories
- Hematology Laboratory, Onco-occitanie Network, Toulouse University Institute of Cancer-Oncopole, Toulouse, France
| | - Tom Fradon
- LYSARC, The Lymphoma Academic Research Organisation, Lyon-Sud Hospital, Pierre-Benite, France
| | - Charles Herbaux
- Department of Hematology, CHU de Montpellier, Montpellier, France
| | - Pierre Sesques
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Benite, France
| | | | | | | | - Roch Houot
- Department of Hematology, CHU de Rennes, Rennes, France
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12
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Coste A, Conrad A, Porcher R, Poirée S, Peterlin P, Defrance C, Letscher-Bru V, Morio F, Gastinne T, Bougnoux ME, Suarez F, Nevez G, Dupont D, Ader F, Halfon-Domenech C, Ducastelle-Leprêtre S, Botterel F, Millon L, Guillerm G, Ansart S, Boutoille D, Ledoux MP, Herbrecht JE, Robin C, Melica G, Danion F, Blanchard E, Paccoud O, Garcia-Hermoso D, Lortholary O, Herbrecht R, Lanternier F. Improving Diagnosis of Pulmonary Mucormycosis: Leads From a Contemporary National Study of 114 Cases. Chest 2023; 164:1097-1107. [PMID: 37419276 DOI: 10.1016/j.chest.2023.06.039] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/04/2023] [Accepted: 06/29/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Pulmonary mucormycosis (PM) is a life-threatening invasive mold infection. Diagnosis of mucormycosis is challenging and often delayed, resulting in higher mortality. RESEARCH QUESTION Are the disease presentation of PM and contribution of diagnosis tools influenced by the patient's underlying condition? STUDY DESIGN AND METHODS All PM cases from six French teaching hospitals between 2008 and 2019 were retrospectively reviewed. Cases were defined according to updated European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria with the addition of diabetes and trauma as host factors and positive serum or tissue PCR as mycologic evidence. Thoracic CT scans were reviewed centrally. RESULTS A total of 114 cases of PM were recorded, including 40% with disseminated forms. Main underlying conditions were hematologic malignancy (49%), allogeneic hematopoietic stem cell transplantation (21%), and solid organ transplantation (17%). When disseminated, main dissemination sites were the liver (48%), spleen (48%), brain (44%), and kidneys (37%). Radiologic presentation included consolidation (58%), pleural effusion (52%), reversed halo sign (26%), halo sign (24%), vascular abnormalities (26%), and cavity (23%). Serum quantitative polymerase chain reaction (qPCR) was positive in 42 (79%) of 53 patients and BAL in 46 (50%) of 96 patients. Results of transthoracic lung biopsy were diagnostic in 8 (73%) of 11 patients with noncontributive BAL. Overall 90-day mortality was 59%. Patients with neutropenia more frequently displayed an angioinvasive presentation, including reversed halo sign and disseminated disease (P < .05). Serum qPCR was more contributive in patients with neutropenia (91% vs 62%; P = .02), and BAL was more contributive in patients without neutropenia (69% vs 41%; P = .02). Serum qPCR was more frequently positive in patients with a > 3 cm main lesion (91% vs 62%; P = .02). Overall, positive qPCR was associated with an early diagnosis (P = .03) and treatment onset (P = .01). INTERPRETATION Neutropenia and radiologic findings influence disease presentation and contribution of diagnostic tools during PM. Serum qPCR is more contributive in patients with neutropenia and BAL examination in patients without neutropenia. Results of lung biopsies are highly contributive in cases of noncontributive BAL.
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Affiliation(s)
- Anne Coste
- Infectious Diseases Department, La Cavale Blanche Hospital, Brest University Hospital, Brest, France; UMR 1101, Laboratoire de Traitement de l'Information Médicale, Université de Bretagne Occidentale, Brest, France
| | - Anne Conrad
- Infectious Diseases Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Raphaël Porcher
- Centre d'Epidémiologie Clinique, Hôtel-Dieu Hospital, AP-HP, Paris, France
| | - Sylvain Poirée
- Radiology Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Pierre Peterlin
- Clinical Hematology Department, Nantes University Hospital, Nantes, France
| | - Claire Defrance
- Radiology Department, Nantes University Hospital, Nantes, France
| | - Valérie Letscher-Bru
- Parasitology and Medical Mycology Laboratory, Strasbourg University Hospital, Strasbourg, France; Institut de Parasitologie et Pathologie Tropicale, UR 7292, Strasbourg University, Strasbourg, France
| | - Florent Morio
- Parasitology and Mycology Laboratory, Nantes University Hospital, Nantes, France; UR 1155 IICiMed, Nantes University, Nantes, France
| | - Thomas Gastinne
- Clinical Hematology Department, Nantes University Hospital, Nantes, France
| | - Marie-Elisabeth Bougnoux
- Mycology and Parasitology Laboratory, Necker-Enfants Malades Hospital, AP-HP, Paris, France; Unité Biologie et Pathogénicité Fongiques, Institut Pasteur, Paris, France
| | - Felipe Suarez
- Hematology Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Gilles Nevez
- Mycology and Parasitology Department, La Cavale Blanche University Hospital, Brest, France
| | - Damien Dupont
- Medical Mycology and Parasitology Department, Institut des Agents Infectieux, Hospices Civils de Lyon, Lyon, France
| | - Florence Ader
- Infectious Diseases Department, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, Université Claude Bernard Lyon 1, CNRS, UMR 5308, Ecole Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | | | | | - Françoise Botterel
- Mycology and Parasitology Unit, Henri Mondor University Hospital, AP-HP, Créteil, France; EA DYNAMYC 1380, Université Paris-Est Créteil, Créteil, France
| | - Laurence Millon
- Mycology and Parasitology Laboratory, Besançon University Hospital, Besançon, France; UMR 6249, CNRS Chrono-Environnement, Université de Bourgonne Franche-Comté, Besançon, France
| | - Gaelle Guillerm
- Hematology Department, Morvan Hospital, Brest University Hospital, Brest, France
| | - Séverine Ansart
- Infectious Diseases Department, La Cavale Blanche Hospital, Brest University Hospital, Brest, France; UMR 1101, Laboratoire de Traitement de l'Information Médicale, Université de Bretagne Occidentale, Brest, France
| | - David Boutoille
- Infectious Diseases Department, Nantes University Hospital, Nantes, France; Centre d'Investigation Clinique, INSERM 1413, Nantes University Hospital, Nantes, France
| | - Marie-Pierre Ledoux
- Hematology Department, European Strasbourg Cancer Institute, Strasbourg, France
| | | | - Christine Robin
- Hematology Department, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Giovanna Melica
- Infectious Diseases Department, Henri Mondor Hospital, AP-HP, Créteil, France
| | - François Danion
- Infectious Diseases Department, Strasbourg University Hospital, Strasbourg, France; UMR_S 1109, INSERM, ImmunoRhumatologie Moléculaire, Strasbourg University, Strasbourg, France
| | - Elodie Blanchard
- Pneumology Department, Bordeaux University Hospital, Bordeaux, France
| | - Olivier Paccoud
- Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris-Cité University, AP-HP, Paris, France
| | - Dea Garcia-Hermoso
- Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France
| | - Olivier Lortholary
- Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris-Cité University, AP-HP, Paris, France; Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France
| | - Raoul Herbrecht
- Hematology Department, European Strasbourg Cancer Institute, Strasbourg, France
| | - Fanny Lanternier
- Infectious Diseases Department, Necker-Enfants Malades Hospital, Paris-Cité University, AP-HP, Paris, France; Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France.
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13
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Houot R, Bachy E, Cartron G, Gros FX, Morschhauser F, Oberic L, Gastinne T, Feugier P, Duléry R, Thieblemont C, Joris M, Jardin F, Choquet S, Casasnovas O, Brisou G, Cheminant M, Bay JO, Gutierrez FL, Menard C, Tarte K, Delfau MH, Portugues C, Itti E, Palard-Novello X, Blanc-Durand P, Al Tabaa Y, Bailly C, Laurent C, Lemonnier F. Publisher Correction: Axicabtagene ciloleucel as second-line therapy in large B cell lymphoma ineligible for autologous stem cell transplantation: a phase 2 trial. Nat Med 2023; 29:2665. [PMID: 37814064 PMCID: PMC10579050 DOI: 10.1038/s41591-023-02624-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Roch Houot
- Department of Hematology, University Hospital of Rennes, UMR U1236, INSERM, University of Rennes, French Blood Establishment, Rennes, France.
| | - Emmanuel Bachy
- Department of Hematology, Lyon Sud Hospital Center, INSERM U1111, Lyon, France
| | - Guillaume Cartron
- Department of Hematology, University Hospital of Montpellier, UMR-CNRS 5535, Montpellier, France
| | - François-Xavier Gros
- Department of Clinical Hematology and Cellular Therapy, University Hospital of Bordeaux, Bordeaux, France
| | | | - Lucie Oberic
- Department of Hematology, Cancer University Institute of Toulouse Oncopole, Toulouse, France
| | - Thomas Gastinne
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Pierre Feugier
- Department of Hematology, University Hospital of Nancy, INSERM 1256, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Rémy Duléry
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, AP-HP, INSERM UMR938, Paris, France
| | | | - Magalie Joris
- Department of Hematology, University Hospital of Amiens, Amiens, France
| | - Fabrice Jardin
- Department of Clinical Hematology, Henri Becquerel Center, INSERM U1245, Rouen, France
| | - Sylvain Choquet
- Department of Hematology, University Hospital Pitié Salpêtrière, AP-HP, Sorbonne University, Paris, France
| | - Olivier Casasnovas
- Department of Clinical Hematology, Dijon University Hospital, INSERM UMR1231, Dijon, France
| | - Gabriel Brisou
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Morgane Cheminant
- Department of Clinical Hematology, Necker-Enfants Malades University Hospital, AP-HP, INSERM UMR1163, Paris, France
| | - Jacques-Olivier Bay
- Department of Clinical Hematology and Cellular Therapy, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | | | - Cédric Menard
- French Blood Establishment and SITI Laboratory, UMR U1236, INSERM, University of Rennes, University Hospital Center of Rennes, Rennes, France
| | - Karin Tarte
- French Blood Establishment and SITI Laboratory, UMR U1236, INSERM, University of Rennes, University Hospital Center of Rennes, Rennes, France
| | | | - Cédric Portugues
- Department of Biostatistics, LYSARC, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Henri Mondor Hospital, Créteil, France
| | - Xavier Palard-Novello
- Department of Nuclear Medicine, University of Rennes, CLCC Eugène Marquis, INSERM, Rennes, France
| | - Paul Blanc-Durand
- Department of Nuclear Medicine, CHU H. Mondor, U-PEC, AP-HP, Créteil, France
| | | | - Clément Bailly
- Nantes-Angers Cancer Research Center CRCI2NA, University of Nantes, INSERM UMR1307, CNRS-ERL6075, Nantes, France
| | - Camille Laurent
- Department of Pathology, Cancer University Institute of Toulouse Oncopole, CHU Toulouse, CRCT INSERM U1037, Toulouse, France
| | - François Lemonnier
- Lymphoid Malignancies Unit, Henri Mondor Hospital, Mondor Institute for Biomedical Research, INSERM U955, University Paris-Est, Créteil, France
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14
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Houot R, Bachy E, Cartron G, Gros FX, Morschhauser F, Oberic L, Gastinne T, Feugier P, Duléry R, Thieblemont C, Joris M, Jardin F, Choquet S, Casasnovas O, Brisou G, Cheminant M, Bay JO, Gutierrez FL, Menard C, Tarte K, Delfau MH, Portugues C, Itti E, Palard-Novello X, Blanc-Durand P, Al Tabaa Y, Bailly C, Laurent C, Lemonnier F. Axicabtagene ciloleucel as second-line therapy in large B cell lymphoma ineligible for autologous stem cell transplantation: a phase 2 trial. Nat Med 2023; 29:2593-2601. [PMID: 37710005 PMCID: PMC10579056 DOI: 10.1038/s41591-023-02572-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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] [Received: 05/25/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
Axicabtagene ciloleucel (axi-cel) demonstrated superior efficacy compared to standard of care as second-line therapy in patients with high-risk relapsed/refractory (R/R) large B cell lymphoma (LBCL) considered eligible for autologous stem cell transplantation (ASCT); however, in clinical practice, roughly half of patients with R/R LBCL are deemed unsuitable candidates for ASCT. The efficacy of axi-cel remains to be ascertained in transplant-ineligible patients. ALYCANTE, an open-label, phase 2 study, evaluated axi-cel as a second-line therapy in 62 patients with R/R LBCL who were considered ineligible for ASCT. The primary end point was investigator-assessed complete metabolic response at 3 months from the axi-cel infusion. Key secondary end points included progression-free survival, overall survival and safety. The study met its primary end point with a complete metabolic response of 71.0% (95% confidence interval, 58.1-81.8%) at 3 months. With a median follow-up of 12.0 months (range, 2.1-17.9), median progression-free survival was 11.8 months (95% confidence interval, 8.4-not reached) and overall survival was not reached. There was no unexpected toxicity. Grade 3-4 cytokine release syndrome and neurologic events occurred in 8.1% and 14.5% of patients, respectively. These results support axi-cel as second-line therapy in patients with R/R LBCL ineligible for ASCT. ClinicalTrials.gov Identifier: NCT04531046 .
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Affiliation(s)
- Roch Houot
- Department of Hematology, University Hospital of Rennes, UMR U1236, INSERM, University of Rennes, French Blood Establishment, Rennes, France.
| | - Emmanuel Bachy
- Department of Hematology, Lyon Sud Hospital Center, INSERM U1111, Lyon, France
| | - Guillaume Cartron
- Department of Hematology, University Hospital of Montpellier, UMR-CNRS 5535, Montpellier, France
| | - François-Xavier Gros
- Department of Clinical Hematology and Cellular Therapy, University Hospital of Bordeaux, Bordeaux, France
| | | | - Lucie Oberic
- Department of Hematology, Cancer University Institute of Toulouse Oncopole, Toulouse, France
| | - Thomas Gastinne
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Pierre Feugier
- Department of Hematology, University Hospital of Nancy, INSERM 1256, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Rémy Duléry
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, AP-HP, INSERM UMR938, Paris, France
| | | | - Magalie Joris
- Department of Hematology, University Hospital of Amiens, Amiens, France
| | - Fabrice Jardin
- Department of Clinical Hematology, Henri Becquerel Center, INSERM U1245, Rouen, France
| | - Sylvain Choquet
- Department of Hematology, University Hospital Pitié Salpêtrière, AP-HP, Sorbonne University, Paris, France
| | - Olivier Casasnovas
- Department of Clinical Hematology, Dijon University Hospital, INSERM UMR1231, Dijon, France
| | - Gabriel Brisou
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Morgane Cheminant
- Department of Clinical Hematology, Necker-Enfants Malades University Hospital, AP-HP, INSERM UMR1163, Paris, France
| | - Jacques-Olivier Bay
- Department of Clinical Hematology and Cellular Therapy, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | | | - Cédric Menard
- French Blood Establishment and SITI Laboratory, UMR U1236, INSERM, University of Rennes, University Hospital Center of Rennes, Rennes, France
| | - Karin Tarte
- French Blood Establishment and SITI Laboratory, UMR U1236, INSERM, University of Rennes, University Hospital Center of Rennes, Rennes, France
| | | | - Cédric Portugues
- Department of Biostatistics, LYSARC, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Henri Mondor Hospital, Créteil, France
| | - Xavier Palard-Novello
- Department of Nuclear Medicine, University of Rennes, CLCC Eugène Marquis, INSERM, Rennes, France
| | - Paul Blanc-Durand
- Department of Nuclear Medicine, CHU H. Mondor, U-PEC, AP-HP, Créteil, France
| | - Yassine Al Tabaa
- Scintidoc Nuclear Medicine Center, Clinique Clémentville, Montpellier, France
| | - Clément Bailly
- Nantes-Angers Cancer Research Center CRCI2NA, University of Nantes, INSERM UMR1307, CNRS-ERL6075, Nantes, France
| | - Camille Laurent
- Department of Pathology, Cancer University Institute of Toulouse Oncopole, CHU Toulouse, CRCT INSERM U1037, Toulouse, France
| | - François Lemonnier
- Lymphoid Malignancies Unit, Henri Mondor Hospital, Mondor Institute for Biomedical Research, INSERM U955, University Paris-Est, Créteil, France
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15
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Machet A, Poudou C, Tomowiak C, Gastinne T, Gardembas M, Systchenko T, Moya N, Debiais C, Levy A, Gruchet C, Sabirou F, Noel S, Bouyer S, Leleu X, Delwail V, Guidez S. Hodgkin lymphoma and female fertility: a multicenter study in women treated with doxorubicin, bleomycin, vinblastine, and dacarbazine. Blood Adv 2023; 7:3978-3983. [PMID: 36129842 PMCID: PMC10410126 DOI: 10.1182/bloodadvances.2021005557] [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: 06/17/2021] [Revised: 10/21/2021] [Accepted: 11/14/2021] [Indexed: 11/20/2022] Open
Abstract
Preservation of fertility has become a growing concern in young females with Hodgkin lymphoma (HL). However, the rate of pregnancy after the current most frequently prescribed ABVD (doxorubicin [Adriamycin], bleomycin, vinblastine, and darcarbazine) chemotherapy for HL has rarely been studied. In this study, we aim to determine the impact of ABVD on the fertility of women treated for HL. We conducted a noninterventional, multicenter study of female patients of childbearing age who were treated for HL. Two healthy apparied women nonexposed to chemotherapy (our controls) were assigned for each patient. Fertility was assessed by the number of pregnancies and births after HL treatment. Sixty-seven patients were included. The median age at diagnosis was 24.4 years (range, 16-43). HL was a localized disease for 68.7%. Of all the patients, 53.7% started at least 1 pregnancy after treatment vs 54.5% of the controls (P = .92). Of all the patients who desired children, 81% had at least 1 pregnancy. Patients treated with ABVD did not have a longer median time to pregnancy (4.8 years in the group of patients and 6.8 years for controls). Across patients, there were 58 pregnancies and 48 births (ratio, 1:2) and 136 pregnancies and 104 births (ratio, 1:3) for the control cohort. No increase in obstetric or neonatal complications has been reported in HL in our study. The number of pregnancies, births, and the time to start a pregnancy in young women treated with ABVD for HL is not different from that of controls. Therefore, females with HL treated with ABVD should be reassured regarding fertility.
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Affiliation(s)
- Antoine Machet
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Caroline Poudou
- Department of Medically Assisted Procreation, University Hospital of Poitiers, Poitiers, France
| | - Cécile Tomowiak
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Thomas Gastinne
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Martine Gardembas
- Department of Hematology, University Hospital of Angers, Angers, France
| | - Thomas Systchenko
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Niels Moya
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Celine Debiais
- Department of Anatomopathology, University Hospital of Poitiers, Poitiers, France
| | - Anthony Levy
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Cécile Gruchet
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Florence Sabirou
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Stéphanie Noel
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Sabrina Bouyer
- Department of Cytology, University Hospital of Poitiers, Poitiers, France
| | - Xavier Leleu
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Vincent Delwail
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Stéphanie Guidez
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
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16
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Cartron G, Bachy E, Tilly H, Daguindau N, Pica GM, Bijou F, Mounier C, Clavert A, Damaj GL, Slama B, Casasnovas O, Houot R, Bouabdallah K, Sibon D, Fitoussi O, Morineau N, Herbaux C, Gastinne T, Fornecker LM, Haioun C, Launay V, Araujo C, Benbrahim O, Sanhes L, Gressin R, Gonzalez H, Morschhauser F, Ternant D, Xerri L, Tarte K, Pranger D. Randomized Phase III Trial Evaluating Subcutaneous Rituximab for the First-Line Treatment of Low-Tumor Burden Follicular Lymphoma: Results of a LYSA Study. J Clin Oncol 2023:JCO2202327. [PMID: 37071836 DOI: 10.1200/jco.22.02327] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
PURPOSE Rituximab improves progression-free survival (PFS) and time to next treatment (TTNT) when compared with the watch and wait strategy for patients with low-tumor burden follicular lymphoma (FL). Prolonged rituximab maintenance did not prolong TTNT, whereas it raises concerns about resources use and patient adhesion. Our aim was then to investigate the use of short rituximab maintenance using the subcutaneous (SC) route in patients with low-tumor burden FL. METHODS Patients with histologically confirmed CD20+ low-tumor burden FL were randomly assigned to receive either rituximab, 375 mg/m2 once daily on D1, D8, D15, and D22, intravenous route (IV, control arm), or rituximab, 375 mg/m2, on day 1 (D1), IV followed by rituximab 1,400 mg total dose, SC once daily on D8, D15, and D22, with maintenance at months 3 (M3), M5, M7, and M9 (experimental arm). The primary end point was PFS. Secondary end points included safety, overall response rates, TTNT, and overall survival (OS). RESULTS Two hundred two patients with low-tumor burden FL were randomly assigned to the experimental (n = 100) or control arm (n = 102). The primary end point was met: the 4-year PFS was 58.1% (95% CI, 47.5 to 67.4) and 41.2% (95% CI, 30.6 to 51.6) in experimental and control arms, respectively (hazard ratio, 0.585 [0.393 to 0.871]; P = .0076). Complete response (CR) rates were 59.0% (95% CI, 48.7 to 68.7) in the experimental arm and 36.3% (95% CI, 27.0 to 46.4) in the control arm (P = .001). TTNT and OS were not significantly different. CR was associated with longer PFS and TTNT. High rituximab exposure during the first three months was independently associated with higher CR, PFS, and TTNT. CONCLUSION SC rituximab improves PFS for patients with low-tumor burden FL when used in induction followed by short maintenance. High rituximab exposure during the first 3 months after treatment initiation is, however, the only parameter influencing patient outcomes.
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Affiliation(s)
- Guillaume Cartron
- Department of Hematology, UMR CNRS 5535, University Hospital, Montpellier, France
| | - Emmanuel Bachy
- Department of Hematology, University Hospital, Lyon, France
| | - Hervé Tilly
- Department of Hematology, U1245, Henri Becquerel Institute, Rouen, France
| | - Nicolas Daguindau
- Departement of Hematology, Annecy-Genevois Hospital Centre, Annecy, France
| | | | - Fontanet Bijou
- Departement of Hematology, Bergonié Institute, Bordeaux, France
| | - Christiane Mounier
- Departement of Hematology, Oncology and Hematology Institute, Sainte-Etienne, France
| | - Aline Clavert
- Departement of Hematology, University Hospital, Angers, France
| | | | - Borhane Slama
- Departement of Hematology, Hospital Centre, Avignon, France
| | | | - Roch Houot
- Departement of Hematology, University Hospital, Rennes, France
| | | | - David Sibon
- Departement of Hematology, Necker Hospital, APHP, Paris, France
| | - Olivier Fitoussi
- Departement of Hematology, Polyclinic Bordeaux Nord, Bordeaux, France
| | - Nadine Morineau
- Departement of Hematology, Hospital Centre, La Roche-sur-Yon, France
| | - Charles Herbaux
- Department of Hematology, UMR CNRS 5535, University Hospital, Montpellier, France
| | - Thomas Gastinne
- Departement of Hematology, University Hospital, Nantes, France
| | | | - Corinne Haioun
- Departement of Hematology, Lymphoma Malignancies Unit, Henri Mondor Hospital, APHP, Créteil, France
| | - Vincent Launay
- Departement of Hematology, Hospital Centre, Saint-Brieuc, France
| | - Carla Araujo
- Departement of Hematology, Hospital Centre, Bayonne, France
| | - Omar Benbrahim
- Departement of Hematology, Hospital Centre, Orléans, France
| | - Laurence Sanhes
- Departement of Hematology, Hospital Centre, Perpignan, France
| | - Remy Gressin
- Departement of Hematology, University Hospital, Grenoble, France
| | - Hugo Gonzalez
- Departement of Hematology, Hospital Centre, Pontoise, France
| | - Franck Morschhauser
- Department of Hematology, ULR 7365 GRITA, University Hospital, Lille, France
| | - David Ternant
- UMR7292, University François-Rabelais, Tours, France
| | - Luc Xerri
- Department of Biopathology, Paoli-Calmettes Institue, Marseille, France
| | - Karin Tarte
- UMR1236, Department of Immunology, Rennes I University, Rennes, France
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17
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Kevork K, Gouin M, Letailleur V, Chevallier P, Touzeau C, Gastinne T, Piron B, Tessoulin B. Failure to bispecific-antibody therapy is associated with a short survival in highly pre-treated patients with aggressive B-Cell Lymphomas. Curr Res Transl Med 2023; 71:103388. [PMID: 37099834 DOI: 10.1016/j.retram.2023.103388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Kohar Kevork
- Nantes University Hospital, CRCI2NA, 1 Place Alexis Ricordeau, Nantes 44093, France
| | - Melanie Gouin
- Nantes University Hospital, CRCI2NA, 1 Place Alexis Ricordeau, Nantes 44093, France
| | - Valentin Letailleur
- Nantes University Hospital, CRCI2NA, 1 Place Alexis Ricordeau, Nantes 44093, France
| | - Patrice Chevallier
- Nantes University Hospital, CRCI2NA, 1 Place Alexis Ricordeau, Nantes 44093, France
| | - Cyrille Touzeau
- Nantes University Hospital, CRCI2NA, 1 Place Alexis Ricordeau, Nantes 44093, France
| | - Thomas Gastinne
- Nantes University Hospital, CRCI2NA, 1 Place Alexis Ricordeau, Nantes 44093, France
| | - Bénédicte Piron
- Nantes University Hospital, CRCI2NA, 1 Place Alexis Ricordeau, Nantes 44093, France
| | - Benoît Tessoulin
- Nantes University Hospital, CRCI2NA, 1 Place Alexis Ricordeau, Nantes 44093, France.
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18
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Driessen J, Kersten MJ, Visser L, van den Berg A, Tonino SH, Zijlstra JM, Lugtenburg PJ, Morschhauser F, Hutchings M, Amorim S, Gastinne T, Nijland M, Zwezerijnen GJC, Boellaard R, de Vet HCW, Arens AIJ, Valkema R, Liu RDK, Drees EEE, de Jong D, Plattel WJ, Diepstra A. Prognostic value of TARC and quantitative PET parameters in relapsed or refractory Hodgkin lymphoma patients treated with brentuximab vedotin and DHAP. Leukemia 2022; 36:2853-2862. [PMID: 36241696 DOI: 10.1038/s41375-022-01717-8] [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: 02/17/2022] [Revised: 08/20/2022] [Accepted: 09/26/2022] [Indexed: 11/08/2022]
Abstract
Risk-stratified treatment strategies have the potential to increase survival and lower toxicity in relapsed/refractory classical Hodgkin lymphoma (R/R cHL) patients. This study investigated the prognostic value of serum (s)TARC, vitamin D and lactate dehydrogenase (LDH), TARC immunohistochemistry and quantitative PET parameters in 65 R/R cHL patients who were treated with brentuximab vedotin (BV) and DHAP followed by autologous stem-cell transplantation (ASCT) within the Transplant BRaVE study (NCT02280993). At a median follow-up of 40 months, the 3-year progression free survival (PFS) was 77% (95% CI: 67-88%) and the overall survival was 95% (90-100%). Significant adverse prognostic markers for progression were weak/negative TARC staining of Hodgkin Reed-Sternberg cells in the baseline biopsy, and a high standard uptake value (SUV)mean or SUVpeak on the baseline PET scan. After one cycle of BV-DHAP, sTARC levels were strongly associated with the risk of progression using a cutoff of 500 pg/ml. On the pre-ASCT PET scan, SUVpeak was highly prognostic for progression post-ASCT. Vitamin D, LDH and metabolic tumor volume had low prognostic value. In conclusion, we established the prognostic impact of sTARC, TARC staining, and quantitative PET parameters for R/R cHL, allowing the use of these parameters in prospective risk-stratified clinical trials. Trial registration: NCT02280993.
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Affiliation(s)
- Julia Driessen
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Lydia Visser
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anke van den Berg
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne H Tonino
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Josée M Zijlstra
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Pieternella J Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | | | | | - Sandy Amorim
- Department of Hematology, Hopital Saint Louis, Paris, France
| | - Thomas Gastinne
- Department of Hematology, Centre Hospitalier Universitaire, Nantes, France
| | - Marcel Nijland
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerben J C Zwezerijnen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anne I J Arens
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roelf Valkema
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Roberto D K Liu
- Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Esther E E Drees
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Daphne de Jong
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Plattel
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Diepstra
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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19
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Stamatoullas A, Ghesquières H, Feugier P, André M, Le Bras F, Gac AC, Borel C, Gastinne T, Quittet P, Morschhauser F, Ribrag V, Guidez S, Nicolas-Virelizier E, Berriolo-Riedinger A, Vander Borght T, Edeline V, Brice P. Final results of brentuximab vedotin combined with ifosfamide-carboplatin-etoposide in first refractory/relapsed Hodgkin lymphoma: a lymphoma study association phase I/II study. Leuk Lymphoma 2022; 63:3063-3071. [PMID: 35975738 DOI: 10.1080/10428194.2022.2107204] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
This phase I/II study assessed the combination of brentuximab vedotin (BV) with ifosfamide-carboplatin-etoposide (ICE) as a second-line therapy in refractory/relapsed (R/R) classical Hodgkin lymphoma (cHL) patients. Phase I study was designed to determine the maximum tolerated dose (MTD) of BV (10 patients) and phase II evaluated the rate of complete metabolic response (CMR) after 2 cycles of BV-ICE (42 patients). There were no dose-limiting toxicities (DLT) during phase I recommending BV 1.8 mg/kg for phase II. Twenty-six patients (61.9%) achieved CMR after 2 cycles of BV-ICE and 37 patients (88%) were transplanted. With a median follow-up of 38 months, the 3-year progression free survival (PFS) and overall survival (OS) rate were 64.3% and 100%, respectively. Hematological toxicities (81%) and infections (21%) were the most frequent adverse event encountered BV-ICE regimen is feasible with manageable toxicities and could be an alternative to other salvage treatments. Trial Registration: ClinicalTrials.gov identifier: NCT02686346.
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Affiliation(s)
| | | | | | - Marc André
- Département d'Hématologie, CHU UCL, Namur, Belgique
| | - Fabien Le Bras
- Unité Hémopathies Lymphoïdes, Hôpital Henri Mondor, Créteil, France
| | | | - Cécile Borel
- Département d'Hématologie, IUCT Oncopole, Toulouse, France
| | | | | | | | - Vincent Ribrag
- Département of Hématologie, Institut Gustave Roussy, Paris, France
| | - Stephanie Guidez
- Service d'Oncologie Hématologique et Thérapie Cellulaire, CHU Poitiers, Poitiers, France
| | | | | | | | - Véronique Edeline
- Service de Médecine Nucléaire, Institut Curie, Hôpital R Huguenin, Saint-Cloud, France
| | - Pauline Brice
- Département d'Hématologie, Hôpital Saint Louis, APHP Paris, Paris, France
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20
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Bachy E, Le Gouill S, Di Blasi R, Sesques P, Manson G, Cartron G, Beauvais D, Roulin L, Gros FX, Rubio MT, Bories P, Bay JO, Llorente CC, Choquet S, Casasnovas RO, Mohty M, Guidez S, Joris M, Loschi M, Carras S, Abraham J, Chauchet A, Drieu La Rochelle L, Deau-Fischer B, Hermine O, Gastinne T, Tudesq JJ, Gat E, Broussais F, Thieblemont C, Houot R, Morschhauser F. A real-world comparison of tisagenlecleucel and axicabtagene ciloleucel CAR T cells in relapsed or refractory diffuse large B cell lymphoma. Nat Med 2022; 28:2145-2154. [PMID: 36138152 PMCID: PMC9556323 DOI: 10.1038/s41591-022-01969-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022]
Abstract
Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) have both demonstrated impressive clinical activity in relapsed/refractory (R/R) diffuse large B cell lymphoma (DLBCL). In this study, we analyzed the outcome of 809 patients with R/R DLBCL after two or more previous lines of treatment who had a commercial chimeric antigen receptor (CAR) T cells order for axi-cel or tisa-cel and were registered in the retrospective French DESCAR-T registry study ( NCT04328298 ). After 1:1 propensity score matching (n = 418), the best overall response rate/complete response rate (ORR/CRR) was 80%/60% versus 66%/42% for patients treated with axi-cel compared to tisa-cel, respectively (P < 0.001 for both ORR and CRR comparisons). After a median follow-up of 11.7 months, the 1-year progression-free survival was 46.6% for axi-cel and 33.2% for tisa-cel (hazard ratio (HR) = 0.61; 95% confidence interval (CI), 0.46-0.79; P = 0.0003). Overall survival (OS) was also significantly improved after axi-cel infusion compared to after tisa-cel infusion (1-year OS 63.5% versus 48.8%; HR = 0.63; 95% CI, 0.45-0.88; P = 0.0072). Similar findings were observed using the inverse probability of treatment weighting statistical approach. Grade 1-2 cytokine release syndrome was significantly more frequent with axi-cel than with tisa-cel, but no significant difference was observed for grade ≥3. Regarding immune effector cell-associated neurotoxicity syndrome (ICANS), both grade 1-2 and grade ≥3 ICANS were significantly more frequent with axi-cel than with tisa-cel. In conclusion, our matched comparison study supports a higher efficacy and also a higher toxicity of axi-cel compared to tisa-cel in the third or more treatment line for R/R DLBCL.
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Affiliation(s)
- Emmanuel Bachy
- Hematology Department, Hospices Civils de Lyon, Pierre Bénite, Lyon, France.
- International Center for Infectiology Research (CIRI), Inserm U1111, Lyon, France.
| | | | | | - Pierre Sesques
- Hematology Department, Hospices Civils de Lyon, Pierre Bénite, Lyon, France
| | | | - Guillaume Cartron
- Hematology Department, CHU de Montpellier & UMR-CNRS, Montpellier, France
| | | | - Louise Roulin
- Hematology Department, Hôpital Henri Mondor, Créteil, France
| | | | | | - Pierre Bories
- Hematology Department, CHU de Toulouse, Toulouse, France
| | | | | | - Sylvain Choquet
- Hematology Department, Hôpital de la Pitié Salpêtrière & AP-HP Sorbonne Université, Paris, France
| | | | - Mohamad Mohty
- Hematology Department, Hôpital Saint Antoine & Sorbonne University & Inserm UMRs 938, Paris, France
| | | | | | | | - Sylvain Carras
- Hematology Department, CHU de Grenoble & University Grenoble-Alpes, Institute for Advanced Biosciences, La Tronche, France
| | - Julie Abraham
- Hematology Department, CHU de Limoges, Limoges, France
| | | | | | | | | | | | | | - Elodie Gat
- Biostatistics Department, LYSARC, Lyon, France
| | | | | | - Roch Houot
- Hematology Department, CHU de Rennes, Rennes, France
| | - Franck Morschhauser
- Hematology Department, CHU de Lille, Lille, France
- Lille University, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
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21
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Coste A, Conrad A, Porcher R, Poirée S, Peterlin P, Defrance C, Letscher-Bru V, Morio F, Gastinne T, Bougnoux ME, Suarez F, Nevez G, Dupont D, Ader F, Halfon-Domenech C, Ducastelle-Duprêtre S, Botterel F, Millon L, Guillerm G, Ansart S, Boutoille D, Ledoux MP, Robin C, Herbrecht JE, Melica G, Danion F, Paccoud O, Lortholary O, Herbrecht R, Lanternier F. P397 Influence of underlying conditions on disease presentation and diagnostic strategy during pulmonary mucormycosis: Anational study of 114 cases. Med Mycol 2022. [PMCID: PMC9509859 DOI: 10.1093/mmy/myac072.p397] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Objectives Pulmonary mucormycosis (PM) is a life-threatening invasive fungal infection mostly affecting immunocompromised patients. We aimed to study the influence of underlying conditions on disease presentation and diagnostic strategy during PM. Methods All PM cases from six French teaching hospitals between 2008 and 2019 were retrospectively reviewed. Cases were defined according to EORTC/MSG 2019 criteria with the addition of diabetes and traumatism as host factors and positive serum or tissue PCR as mycological evidence. Thoracic CT scans were reviewed centrally. Results Among 114 cases of PM, 52 (46%) were proven and 62 (54%) were probable, including 12 cases with a positive serum qPCR as the sole mycological criterion. Hematological malignancy was the most common risk factor (49%), followed by allogeneic hematopoietic stem-cell transplantation (21%), and solid organ transplantation (SOT, 17%). Fever was the first symptom for 66% patients and was more frequent in patients with neutropenia than in those without (97% vs 52%, P <.01). A total of 46 (40%) patients had a disseminated infection, which was more frequently reported in neutropenic patients (50% vs 25%, P <.01). Main dissemination sites were the liver (48%), spleen (48%), brain (44%), and kidneys (37%). Sinusitis was present in 13% of cases. Chest radiological presentation included consolidation (58%), pleural effusion (52%), reversed halo sign (26%), halo sign (24%), vascular abnormalities (26%), and excavation (23%). The excavation was more frequently reported in SOT patients (64%, P <.01) compared with other groups. Vascular involvement was associated with reversed halo sign and Rhizomucor infection. Neutropenic patients presented more frequently than non-neutropenic patients with ground-glass opacities (75 vs 49%, P = .01), halo sign (32% vs 10%, P = .02), and reversed halo sign (35 vs 10%, P <.01). A total of 83 (73%) patients had a positive fungal culture from any type of respiratory sample. Serum qPCR was positive for 42/53 patients (79%) and respiratory fluid qPCR for 16/21 (76%) patients. In neutropenic patients, BAL culture was less often positive (30% vs 66%, P <.01), and serum qPCR was more frequently positive (91% vs 62%, P = .02). A transthoracic lung biopsy was contributive in 8/11 (73%) patients with negative bronchoalveolar lavage (BAL). Serum qPCR was more frequently positive in patients with the main lesion of >3 cm in diameter (91% vs 62%, P = .02). Rhizomucor spp. Was identified in 31 patients (32%), Rhizopus spp. In 29 patients (30%), Lichtheimia spp. In 24 patients (25%), Mucor spp. In 10 patients (10%) and Cunninghamella spp. In 4 patients (4%). Neutropenic patients were more frequently infected with Rhizomucor (43% vs 13%, P <.01) and less frequently with Rhizopus (17% vs 50%, P <.01). Histopathological specimens were available for 48 patients (42%) and revealed Mucorales hyphae in 85% of cases. Patients with a disseminated infection and neutropenia presented more often with angioinvasion than patients with localized disease (50% vs 9%, P <.01 and 38% vs 13%, P = .10). Overall, 90-day mortality was 59%. Conclusion Underlying conditions significantly influenced clinical and radiological presentation and diagnostic tools’ contribution. Neutropenic patients present more frequently with dissemination, fever, reversed halo sign, pathological angioinvasion, the negativity of BAL culture, the positivity of serum qPCR, and Rhizomucor infection.
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Affiliation(s)
- Anne Coste
- Brest University Hospital , Brest , France
| | | | | | | | | | | | | | - Florent Morio
- Strasbourg University Hospital , Strasbourg , France
| | | | | | - Felipe Suarez
- Assistante Public - Hôpitaux de Paris , Paris , France
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22
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Houillier C, Dureau S, Taillandier L, Houot R, Chinot O, Moluçon-Chabrot C, Schmitt A, Gressin R, Choquet S, Damaj G, Peyrade F, Abraham J, Delwail V, Gyan E, Sanhes L, Cornillon J, Garidi R, Delmer A, Al Jijakli A, Morel P, Waultier A, Paillassa J, Chauchet A, Gastinne T, Laadhari M, Plissonnier AS, Feuvret L, Cassoux N, Touitou V, Ricard D, Hoang-Xuan K, Soussain C. Radiotherapy or Autologous Stem-Cell Transplantation for Primary CNS Lymphoma in Patients Age 60 Years and Younger: Long-Term Results of the Randomized Phase II PRECIS Study. J Clin Oncol 2022; 40:3692-3698. [PMID: 35834762 DOI: 10.1200/jco.22.00491] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [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
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.We previously reported the results of a randomized phase II study in patients with newly diagnosed primary CNS lymphoma (age 18-60 years). Patients were treated with high-dose methotrexate-based induction chemotherapy followed by whole-brain radiotherapy (WBRT) or high-dose chemotherapy (thiotepa-busulfan-cyclophosphamide) with autologous stem-cell transplantation (ASCT). The median follow-up was 33 months. In this report, we provide long-term data (median follow-up, 8 years) regarding the outcomes and toxicities. Fifty-three and 44 patients received induction chemotherapy followed by WBRT or ASCT, respectively. Their 8-year event-free survival from random assignment was 67% and 39% in the ASCT and WBRT arms, respectively (P = .03), with a significantly lower risk of relapse after ASCT (hazard ratio = 0.13, P < .001). One third of patients who relapsed after WBRT were alive after salvage treatment. Five and four patients died of ASCT and WBRT-related toxicities, respectively. The 8-year overall survival was 69% and 65% in the ASCT and WBRT arms, respectively (not significant). Balance (52% v 10%, P ≤ 0.001) and neurocognition (64% v 13%, P < .001) significantly deteriorated after WBRT compared with ASCT during the follow-up. This study shows that 40 Gy WBRT should be avoided in first-line treatment because of its neurotoxicity and suboptimal efficacy in reducing relapses while ASCT appears to be highly efficient in preventing relapses.
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Affiliation(s)
- Caroline Houillier
- APHP, Sorbonne Université, IHU, ICM, Service de Neurologie-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | | | - Roch Houot
- Service d'Hématologie, CHU de Rennes, Inserm U1236 Université de Rennes 1, France
| | - Olivier Chinot
- Aix-Marseille Université, CNRS, INP, AP-HM, Service de Neuro-Oncologie, CHU de la Timone, France
| | | | - Anna Schmitt
- Service d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Rémy Gressin
- Onco-Haematology Department, CHU de Grenoble, France
| | - Sylvain Choquet
- Service d'Hématologie Clinique, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Gandhi Damaj
- Service d'Hématologie, CHU d'Amiens, France.,Current address: Hematology Institute, University Hospital Normandy, Caen, France
| | | | - Julie Abraham
- Service d'Hématologie et de Thérapie cellulaire, CHU de Limoges, France
| | - Vincent Delwail
- Service d'Oncologie Hématologique et de Thérapie Cellulaire, CHU de Poitiers, INSERM, CIC 1402, Poitiers, Centre d'Investigation Clinique, Université de Poitiers, Poitiers, France
| | - Emmanuel Gyan
- Service d'Hématologie et thérapie cellulaire, Centre d'Investigations Cliniques INSERM U1517, Centre hospitalier universitaire, Université de Tours, France
| | - Laurence Sanhes
- Service d'Hématologie, Centre Hospitalier de Perpignan, France
| | - Jérôme Cornillon
- Service d'Hématologie, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France.,Current affiliation: Département d'Hématologie Clinique, CHU de ST-Etienne, France
| | - Reda Garidi
- Service d'Hématologie, Centre Hospitalier de Saint Quentin, France
| | | | | | - Pierre Morel
- Service d'Hématologie, Centre Hospitalier de Lens, France.,Current affiliation: Service d'Hématologie, CHU d'Amiens, France
| | | | | | | | | | - Mouna Laadhari
- Département d'Imagerie Médicale, Institut Curie, Site Saint-Cloud, France
| | | | - Loïc Feuvret
- Service de Radiothérapie, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Nathalie Cassoux
- Service d'Ophtalmologie, Institut Curie, site de Paris, et Université Paris V Descartes et PSL (Paris Science et Lettre), Paris, France
| | - Valérie Touitou
- Service d'Ophtalmologie, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Damien Ricard
- Service de Neurologie, Hôpital d'Instruction des Armées Percy, Ecole du Val-de-Grâce, Service de Santé des Armées, Clamart, France
| | - Khê Hoang-Xuan
- APHP, Sorbonne Université, IHU, ICM, Service de Neurologie-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Carole Soussain
- Service d'Hématologie, Institut Curie, site de Saint-Cloud et INSERM U932 Institut Curie, PSL Research University, Paris, France
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23
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Paret R, Le Bourgeois A, Guillerm G, Tessoulin B, Rezig S, Gastinne T, Couturier MA, Boutoille D, Lecomte R, Ader F, Le Gouill S, Ansart S, Talarmin JP, Gaborit B. Safety and risk of febrile recurrence after early antibiotic discontinuation in high-risk neutropenic patients with haematological malignancies: a multicentre observational study. J Antimicrob Chemother 2022; 77:2546-2556. [PMID: 35748614 DOI: 10.1093/jac/dkac190] [Citation(s) in RCA: 3] [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: 01/04/2022] [Accepted: 05/16/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Early antibiotic discontinuation according to the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendations is not systematically applied in high-risk neutropenic patients with haematological malignancies. METHODS A retrospective multicentre observational study was conducted over 2 years to evaluate the safety of early antibiotic discontinuation for fever of unknown origin (FUO) during neutropenia after induction chemotherapy or HSCT, in comparison with a historical cohort. We used Cox proportional hazards models, censored on neutropenia resolution, to analyse factors associated with febrile recurrence. RESULTS Among 147 included patients in the ECIL-4 cohort, mainly diagnosed with acute leukaemia (n = 104, 71%), antibiotics were discontinued during 170 post-chemotherapy neutropenic episodes. In comparison with the historical cohort of 178 episodes of neutropenia without antibiotic discontinuation, no significant differences were observed regarding febrile recurrences [71.2% (121/170) versus 71.3% (127/178), P = 0.97], admission in ICUs [6.5% (11/170) versus 11.2% (20/178), P = 0.17], septic shock [0.6% (1/170) versus 3.9% (7/178), P = 0.07] and 30 day mortality [1.4% (2/147) versus 2.7% (4/150), P = 0.084]. In the ECIL-4 cohort, the rate of bacteraemia in case of febrile recurrence was higher [27.1% (46/170) versus 11.8% (21/178), P < 0.01] and antibiotic consumption was significantly lower (15.5 versus 19.9 days, P < 0.001). After early antibiotic discontinuation according to ECIL-4 recommendations, enterocolitis was associated with febrile recurrence [HR = 2.31 (95% CI = 1.4-3.8), P < 0.001] and stage III-IV oral mucositis with bacteraemia [HR = 2.26 (95% CI = 1.22-4.2), P = 0.01]. CONCLUSIONS After an FUO episode in high-risk neutropenia, compliance with ECIL-4 recommendations for early antibiotic discontinuation appears to be safe and mucosal damage was associated with febrile recurrence and bacteraemia. Prospective interventional studies are warranted to assess this strategy in high-risk neutropenic patients.
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Affiliation(s)
- Raphael Paret
- Department of Infectious Diseases, University Hospital of Brest, Brest, France
| | - Amandine Le Bourgeois
- Department of Haematology, University Hospital of Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Gaëlle Guillerm
- Department of Haematology, University Hospital of Brest, Brest, France
| | - Benoit Tessoulin
- Department of Haematology, University Hospital of Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Schéhérazade Rezig
- Department of Infectious Diseases, University Hospital of Brest, Brest, France
| | - Thomas Gastinne
- Department of Haematology, University Hospital of Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | | | - David Boutoille
- Department of Infectious Diseases, University Hospital of Nantes and CIC 1413, Nantes, France.,Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000 Nantes, France
| | - Raphael Lecomte
- Department of Infectious Diseases, University Hospital of Nantes and CIC 1413, Nantes, France
| | - Florence Ader
- Department of Infectious Diseases, University Hospital of Lyon, Lyon, France
| | - Steven Le Gouill
- Department of Haematology, University Hospital of Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Séverine Ansart
- Department of Infectious Diseases, University Hospital of Brest, Brest, France
| | - Jean Philippe Talarmin
- Department of Internal Medicine, Infectious Diseases and Haematology, Cornouaille Hospital Quimper, Quimper, France
| | - Benjamin Gaborit
- Department of Infectious Diseases, University Hospital of Nantes and CIC 1413, Nantes, France.,Nantes Université, CHU Nantes, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, F-44000 Nantes, France
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24
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Bachy E, Le Gouill S, Sesques P, Di Blasi R, Guillaume M, Cartron G, Beauvais D, Roulin L, Gros FX, Rubio MT, Bories P, Bay JO, Castilla Llorente C, Choquet S, Casasnovas RO, Mothy M, Guidez S, Joris M, Loschi M, Carras S, Abraham J, Chauchet A, Drieu La Rochelle L, Zerbit J, Hermine O, Gastinne T, Tudesq JJ, Gat E, Broussais F, Thieblemont C, Houot R, Morschhauser F. S260: A MATCHED COMPARISON OF TISAGENLECLEUCEL AND AXICABTAGENE CILOLEUCEL CAR T CELLS IN RELAPSED OR REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA: A REAL-LIFE LYSA STUDY FROM THE FRENCH DESCAR-T REGISTRY. Hemasphere 2022. [DOI: 10.1097/01.hs9.0000843932.28141.4d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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25
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Bonnet A, Bossard C, Gabellier L, Rohmer J, Laghmari O, Parrens M, Sarkozy C, Dulery R, Roland V, Llamas-Gutierrez F, Oberic L, Fornecker LM, Bounaix L, Villemagne B, Szablewski V, Choquet S, Bouabdallah K, Traverse-Glehen A, Mohty M, Sanhes L, Houot R, Gastinne T, Leux C, Le Gouill S. Clinical presentation, outcome, and prognostic markers in patients with intravascular large B-cell lymphoma, a lymphoma study association (LYSA) retrospective study. Cancer Med 2022; 11:3602-3611. [PMID: 35538643 PMCID: PMC9554445 DOI: 10.1002/cam4.4742] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/03/2021] [Accepted: 12/23/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Intravascular large B-cell lymphoma (lVLBCL) is a very rare type of large B-cell lymphoma. METHODS We conducted a retrospective study on IVLBCL patients treated from 2000 to 2016 in LYSA cooperative group centers. RESULTS Sixty-five patients were identified in 23 centers. Median age at diagnosis was 69 years (range 23-92). Thirty-four patients (64%) had an IPI score >3 and 40 patients (67%) had a performance status ≥2. The most frequent extra-nodal locations were bone marrow (n = 34; 52%), central nervous system (n = 25; 39%), and skin (n = 21; 33%). Nodal involvement and endocrine system were observed in 34% (n = 22) and 18% (n = 12) of all cases, respectively. Twenty-six patients (41%) had macrophage activation syndrome. Tumor cells were frequently CD5 positive (52%) with a non-germinal center origin (86%). BCL2 was expressed in 87% of all samples analyzed (n = 20) and 43% of patients had a MYC/BCL2 double expression. Fifty-six patients were treated with a regimen of chemotherapy containing rituximab, among whom 73% reached complete remission. The median progression-free survival (PFS) and median overall survival (OS) were 29.4 months and 63.8 months, respectively. History of autoimmune disorder (Hazard ratio [HR] 3.3 [1.4-7.8]; p < 0.01), nodal involvement (HR 2.6 [1.4-5.1]; p < 0.01), lack of anthracycline (HR 0.1 [0-0.4] for use; p < 0.001), or no intensification at first-line regimen (p = 0.02) were associated with worse PFS. High-dose methotrexate use was not associated with better PFS or OS. CONCLUSIONS Our study highlights the aggressive clinical picture of IVLBCL, in particular the frequency of macrophage activation syndrome, and the need for new therapies despite a response to R-CHOP-like regimen similar to non-intravascular diffuse large B-cell lymphomas.
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Affiliation(s)
| | - Céline Bossard
- Service d'anatomie et cytologie pathologique, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Ludovic Gabellier
- Service d'hématologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Julien Rohmer
- Service d'hématologie, Hôpital Pitié - Salpêtrière - APHP, Sorbonne Université, Paris, France
| | - Othman Laghmari
- Service d'anatomie et cytologie pathologique, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Marie Parrens
- Département de pathologie, Hôpital Haut-Lévêque, CHU et université de Bordeaux, Bordeaux, France
| | | | - Rémy Dulery
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, AP-HP, Université Sorbonne, INSERM, Centre de recherche Saint-Antoine, Paris, France
| | - Virginie Roland
- Centre Hospitalier de Perpignan, Service d'hématologie, Perpignan, France
| | | | - Lucie Oberic
- Service d'hématologie, Centre Hospitalier Universitaire Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Luc-Matthieu Fornecker
- Service d'hématologie, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Laura Bounaix
- Service de thérapie cellulaire et d'hématologie clinique adulte, Centre Hospitalier Universitaire Clermont-Ferrand, site Estaing, Clermont-Ferrand, France
| | - Bruno Villemagne
- Service d'onco-hématologie médecine interne, Centre Hospitalier Départemental Vendée, La Roche sur Yon, France
| | - Vanessa Szablewski
- Service d'anatomopathologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Sylvain Choquet
- Service d'hématologie, Hôpital Pitié - Salpêtrière - APHP, Sorbonne Université, Paris, France
| | - Krimo Bouabdallah
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Haut-Lévèque, CHU Bordeaux, Bordeaux, France
| | | | - Mohamad Mohty
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, AP-HP, Université Sorbonne, INSERM, Centre de recherche Saint-Antoine, Paris, France
| | - Laurence Sanhes
- Centre Hospitalier de Perpignan, Service d'hématologie, Perpignan, France
| | - Roch Houot
- Service d'hématologie, CHU Rennes, University of Rennes, INSERM U1236, Rennes, France
| | | | - Christophe Leux
- Service d'information médicale, Centre Hospitalier Universitaire Nantes, Nantes, France
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26
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Le Calvez B, Eveillard M, Decamps P, Aguilar J, Seguin A, Canet E, Grain A, Touzeau C, Tessoulin B, Gastinne T. Extensive myelitis with eosinophilic meningitis after Chimeric antigen receptor T cells therapy. eJHaem 2022; 3:533-536. [PMID: 35846023 PMCID: PMC9175988 DOI: 10.1002/jha2.381] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/26/2022]
Abstract
Immune effector cell‐associated neurotoxicity syndrome (ICANS) is a frequent adverse event after Chimeric antigen receptor T cells (CAR‐T cells). A patient treated with anti‐CD19 CAR‐T cells for a refractory mantle cell lymphoma presented at Day 8 post‐infusion with extensive myelitis. Unusual eosinophilia was disclosed in the patient's cerebrospinal fluid. After treatment with methylprednisolone and siltuximab, a decrease in clinical symptoms and magnetic resonance imaging lesions were obtained. This unprecedented presentation of eosinophilic meningitis after CAR‐T cells therapy highlights the need for a better understanding of the physiopathology of ICANS, especially to identify potentially targetable pathways.
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Affiliation(s)
- Baptiste Le Calvez
- Department of Hematology Nantes University hospital Nantes France
- Pediatric Oncology Nantes University Hospital Nantes France
| | - Marion Eveillard
- Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA Nantes France
- Hematology Biology Nantes University Hospital Nantes France
| | - Paul Decamps
- Intensive Care Unit Nantes University Hospital Nantes France
| | - Jesus Aguilar
- Medical Imaging Unit Nantes University Hospital Nantes France
| | - Amélie Seguin
- Intensive Care Unit Nantes University Hospital Nantes France
| | - Emmanuel Canet
- Intensive Care Unit Nantes University Hospital Nantes France
| | - Audrey Grain
- Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA Nantes France
- Pediatric Oncology Nantes University Hospital Nantes France
| | - Cyrille Touzeau
- Department of Hematology Nantes University hospital Nantes France
- Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA Nantes France
- Site de Recherche Intégrée sur le Cancer, ILIAD INCA‐DGOS‐Inserm U12558 Nantes France
| | - Benoît Tessoulin
- Department of Hematology Nantes University hospital Nantes France
- Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA Nantes France
- Site de Recherche Intégrée sur le Cancer, ILIAD INCA‐DGOS‐Inserm U12558 Nantes France
| | - Thomas Gastinne
- Department of Hematology Nantes University hospital Nantes France
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27
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Jullien M, Le Bourgeois A, Coste-Burel M, Peterlin P, Garnier A, Rimbert M, Imbert BM, Le Gouill S, Moreau P, Mahe B, Dubruille V, Blin N, Lok A, Touzeau C, Gastinne T, Tessoulin B, Vantyghem S, Béné MC, Guillaume T, Chevallier P. B Cell Aplasia Is the Most Powerful Predictive Marker for Poor Humoral Response after BNT162b2 mRNA SARS-CoV-2 Vaccination in Recipients of Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2022; 28:279.e1-279.e4. [PMID: 35218998 PMCID: PMC8865956 DOI: 10.1016/j.jtct.2022.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 09/25/2021] [Revised: 01/14/2022] [Accepted: 02/17/2022] [Indexed: 12/14/2022]
Abstract
Little is known about the immune response to SARS-CoV-2 vaccination in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, several studies have reported that adequate protection could be provided to this population. The purpose of this study was to evaluate which factors can predict the efficacy of SARS-CoV-2 vaccination in these specifically immunosuppressed patients. Specific anti-Spike (S) antibody responses were assessed in a cohort of 117 allo-HSCT recipients after 2 injections of BNT162b2 mRNA SARS-CoV-2 vaccine (V1 and V2). Factors considered liable to influence the antibody response and analyzed in this series were the interval between allo-HSCT and V1, donor source, recipient and donor age, current immunosuppressive/chemotherapy (I/C) treatment, and levels of CD4+and CD8+ T cells, B cells, and natural killer cells at the time of V1. Overall, the S-antibody response rate, evaluated at a median of 35 days after V2, was 82.9% for the entire cohort, with 71 patients (61%) reaching the highest titer. In univariate analysis, a lower pre-V1 median total lymphocyte count, lower CD4+ T cell and B cell counts, ongoing I/C treatment, and a haploidentical donor were characteristic of nonhumoral responders. However, multiparameter analysis showed that B cell aplasia was the sole factor predicting the absence of a specific immune response (odds ratio, 0.01; 95% confidence interval, 0.00 to 0.10; P < 10-3). Indeed, the rate of humoral response was 9.1% in patients with B cell aplasia versus 95.9% in patients with a B cell count >0 (P < 10-9). These results advocate for the administration of anti-SARS-CoV-2 vaccination in allo-HSCT recipients as early as peripheral B cell levels can be detected, and also suggest the need for close monitoring of B-cell reconstitution after Allo-HSCT.
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Affiliation(s)
- Maxime Jullien
- Hematology Department, Nantes University Hospital, Nantes, France
| | | | | | - Pierre Peterlin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Alice Garnier
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Marie Rimbert
- Immunology Department, Nantes University Hospital, Nantes, France
| | | | - Steven Le Gouill
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Philippe Moreau
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Beatrice Mahe
- Hematology Department, Nantes University Hospital, Nantes, France
| | | | - Nicolas Blin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Anne Lok
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Cyrille Touzeau
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Thomas Gastinne
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Benoit Tessoulin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Sophie Vantyghem
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Marie C. Béné
- INSERM UMR1232, CRCINA IRS-UN, University of Nantes, University Hospital, Nantes, France,Hematology Biology Department, Nantes University Hospital, Nantes, France
| | - Thierry Guillaume
- Hematology Department, Nantes University Hospital, Nantes, France,INSERM UMR1232, CRCINA IRS-UN, University of Nantes, University Hospital, Nantes, France
| | - Patrice Chevallier
- Hematology Department, Nantes University Hospital, Nantes, France,INSERM UMR1232, CRCINA IRS-UN, University of Nantes, University Hospital, Nantes, France,Correspondence and reprint requests: Patrice Chevallier, Service d'Hématologie Clinique, CHU Hotel-Dieu, Place A. Ricordeau, 44093 Nantes Cedex, France
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28
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Casasnovas RO, Bouabdallah R, Brice P, Lazarovici J, Ghesquieres H, Stamatoullas A, Dupuis J, Gac AC, Gastinne T, Joly B, Bouabdallah K, Nicolas-Virelizier E, Feugier P, Morschhauser F, Sibon D, Bonnet C, Berriolo-Riedinger A, Edeline V, Parrens M, Damotte D, Coso D, André M, Meignan M, Rossi C. Positron Emission Tomography-Driven Strategy in Advanced Hodgkin Lymphoma: Prolonged Follow-Up of the AHL2011 Phase III Lymphoma Study Association Study. J Clin Oncol 2022; 40:1091-1101. [PMID: 34990281 DOI: 10.1200/jco.21.01777] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The AHL2011 study (ClinicalTrials.gov identifier: NCT01358747) demonstrated that a positron emission tomography (PET)-driven de-escalation strategy after two cycles of bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) provides similar progression-free survival (PFS) and overall survival (OS) and reduces early toxicity compared with a nonmonitored standard treatment. Here, we report, with a prolonged follow-up, the final study results. METHODS Patients with advanced Hodgkin lymphoma (stage III, IV, or IIB with mediastinum/thorax ratio > 0.33 or extranodal involvement) age 16-60 years were prospectively randomly assigned between 6 × BEACOPP and a PET-driven arm after 2 × BEACOPP delivering 4 × ABVD (doxorubicin, bleomycin, vinblastine, and dacarbazine) in PET2- and 4 × BEACOPP in PET2+ patients. PET performed after four cycles of chemotherapy had to be negative to complete the planned treatment. RESULTS In total, 823 patients were enrolled including 413 in the standard arm and 410 in the PET-driven arm. With a 67.2-month median follow-up, 5-year PFS (87.5% v 86.7%; hazard ratio [HR] = 1.07; 95% CI, 0.74 to 1.57; P = .67) and OS (97.7% in both arms; HR = 1.012; 95% CI, 0.50 to 2.10; P = .53) were similar in both randomization arms. In the whole cohort, full interim PET assessment predicted patients' 5-year PFS (92.3% in PET2-/PET4-, 75.4% [HR = 3.26; 95% CI, 18.3 to 5.77] in PET2+/PET4- and 46.5% [HR = 12.4; 95% CI, 7.31 to 19.51] in PET4+ patients, respectively; P < .0001) independent of international prognosis score. Five-year OS was also affected by interim PET results, and PET2+/PET4- patients (93.5%; HR = 3.3; 95% CI, 1.07 to 10.1; P = .036) and PET4+ patients (91.9%; HR = 3.756; 95% CI, 1.07 to 13.18; P = .038) had a significant lower OS than PET2-/PET4- patients (98.2%). Twenty-two patients (2.7%) developed a second primary malignancy, 13 (3.2%) and 9 (2.2%) in the standard and experimental arms, respectively. CONCLUSION The extended follow-up confirms the continued efficacy and favorable safety of AHL2011 PET-driven strategy, which is noninferior to standard six cycles of BEACOPP. PET4 provides additional prognostic information to PET2 and allows identifying patients with particularly poor prognosis.
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Affiliation(s)
- René-Olivier Casasnovas
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France
| | - Reda Bouabdallah
- Department of Hematology, Institut P. Calmette, Marseille, France.,Department of Hematology, Hopital privé de Provence, Aix en Provence, France
| | - Pauline Brice
- Department of Hematology, APHP, Hopital Saint Louis, Paris, France
| | | | - Hervé Ghesquieres
- Department of Hematology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, et Université Claude Bernard Lyon-1, Pierre Bénite, France
| | | | - Jehan Dupuis
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, Créteil, France
| | - Anne-Claire Gac
- Department of Hematology, Institut d'hématologie de basse normandie, Caen, France
| | - Thomas Gastinne
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Bertrand Joly
- Department of Hematology, Hospital Sud Francilien, Corbeille-Essonnes, France
| | - Krimo Bouabdallah
- Department of Hematology, University Hospital of Bordeaux, Bordeaux, France
| | | | - Pierre Feugier
- Department of Hematology, University Hospital of Nancy, Vandoeuvre les Nancy, France
| | - Franck Morschhauser
- Department of Hematology, CHU Lille, Unité GRITA, Université de Lille 2, Lille, France
| | - David Sibon
- Department of Hematology, Hopital Necker, Paris, France
| | | | | | - Véronique Edeline
- Department of Nuclear Medicine, Hopital R. Huguenin, Institut Curie, St-Cloud, France
| | - Marie Parrens
- Department of Pathology, University Hospital of Bordeaux and Inserm UMR 1053, Bordeaux, France
| | - Diane Damotte
- Department of Pathology, Université de Paris et GH Paris Centre APHP, Paris, France
| | - Diane Coso
- Department of Hematology, Institut P. Calmette, Marseille, France
| | - Marc André
- Department of Hematology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium.,Pole Mont, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Michel Meignan
- Department of Nuclear Medicine, University Hospital H. Mondor, Creteil, France
| | - Cédric Rossi
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France
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29
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Bouard L, Tessoulin B, Thieblemont C, Bouabdallah K, Gastinne T, Oberic L, Carras S, Delette C, Casasnovas O, Dartigeas C, Cacheux V, Masse S, Hermine O, Le Gouill S. Humoral immune-depression following autologous stem cell transplantation is a marker of prolonged response duration in patients with mantle cell lymphoma. Haematologica 2022; 107:2163-2172. [PMID: 35172560 PMCID: PMC9425317 DOI: 10.3324/haematol.2021.279561] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Indexed: 12/02/2022] Open
Abstract
Rituximab maintenance (RM) after autologous stem cell transplantation (ASCT) is standard-of-care for young patients with mantle cell lymphoma (MCL). RM may enhance post-transplantation immune depression and risk of infections. We compared infection incidence and immune consequences of RM versus observation in transplanted MCL patients. All randomized patients included in the LyMa trial were eligible. The following parameters were collected prospectively: occurrence of fever, infection, hospitalization, neutropenia, hypogammaglobulinemia, CD4 lymphopenia and γ globulin (Ig) substitution. The post-ASCT period was divided into four periods in order to assess the possible effects of RM or ASCT on immune status. Each arm included 120 patients. Concerning infection incidence and all biological parameters, there was no difference between the two arms during the first year post ASCT. After this period, RM patients were more exposed to fever (P=0.03), infections (P=0.001), hypogammaglobulinemia (P=0.0001) and Ig substitution (P<0.0001). Incidences of hospitalization, neutropenia and CD4 lymphopenia were not different between the two arms. The number of rituximab injections was correlated with infections and hypogammaglobulinemia, P<0.0001 and P=0.001; but was not correlated with neutropenia and CD4 lymphopenia. Ig substitution did not modify infection incidence. Patients who presented hypogammaglobulinemia <6 g/L or <4 g/L had longer 3-years progression-free survival (PFS), this applies to RM patients (P=0.012 and P=0.03) and to the global cohort (P=0.008 and P=0.003). Hypogammaglobulinemia did not influence overall survival. Occurrence of infectious event, neutropenia and CD4 lymphopenia did neither influence PFS nor overall survival. Post-ASCT RM in MCL patients causes sustained hypogammaglobulinemia, which is independently correlated with improved PFS.
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Affiliation(s)
| | - Benoit Tessoulin
- Department of hematology CHU Nantes, INSERM CRCINA Nantes-Angers, NeXT, Nantes University, Nantes
| | | | | | | | - Lucie Oberic
- Department of hematology, IUC Toulouse Oncopole, Toulouse
| | | | | | | | | | - Victoria Cacheux
- Department of hematology, CHU Clermont-Ferrand, Clermont-Ferrand
| | - Sibylle Masse
- Lysarc Institut Carnot CALYM, Lyon-Sud Hospital, Lyon
| | | | - Steven Le Gouill
- Department of hematology CHU Nantes, INSERM CRCINA Nantes-Angers, NeXT, Nantes University, Nantes, France; Institut Curie, Paris.
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30
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Costes-Tertrais D, Hueso T, Gastinne T, Thieblemont C, Oberic L, Bouabdallah K, Garciaz S, Tchernonog E, Dartigeas C, Ribrag V, Fogarty P, Casasnovas RO, Houot R, Delette C, Malak S, Fornecker LM, Gressin R, Damaj G, Le Gouill S. Bendamustine-EAM versus R-BEAM after high-dose cytarabine-based induction in newly diagnosed patients with mantle cell lymphoma, a LYSA retrospective study. Bone Marrow Transplant 2022; 57:627-632. [PMID: 35149851 DOI: 10.1038/s41409-022-01596-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 11/09/2022]
Abstract
Cytarabine-based immuno-chemotherapy followed by autologous stem cell transplantation (ASCT) consolidation is standard of care for fit patients with Mantle Cell Lymphoma (MCL). BEAM (Carmustine, Etoposide, Aracytine, Melphalan) is among the most frequently used conditioning regimen. Studies comparing BEAM with Bendamustine-EAM (BeEAM) have suggested that patients treated with BeEAM have a better progression-free survival (PFS). We performed a cross-study analysis to better evaluate BeEAM. Thirty-five patients from a retrospective study who received R-DHAP/BeEAM were compared to 245 patients from the LyMa trial (NCT00921414) who all received R-DHAP followed by R-BEAM. PFS and Overall Survival (OS) were estimated using Kaplan-Meier methods. At 2 years there was no difference between R-BEAM and BeEAM in either PFS (84.9% versus 87.9%; p = 0.95) or OS (91.8% versus 94.2%; p = 0.30). Analyses were repeated on a propensity score to reduce biases. Each patient from the BeEAM cohort (n = 30) was matched to three patients from the R-BEAM cohort (n = 90) for age, sex, MIPI score, pre-transplant status disease and rituximab maintenance (RM). PFS and OS at 2 years remained similar between R-BEAM and BeEAM with more renal toxicity in BeEAM group. MCL patients who received R-DHAP induction before ASCT have similar outcome after R-BEAM or BeEAM conditioning regimen.
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Affiliation(s)
- Domitille Costes-Tertrais
- Department of Hematology, CHU de Nantes, University Hospital of Nantes, Nantes, France.,School of Medicine, Nantes University, Nantes, France
| | - Thomas Hueso
- Department of Hematology, APHP-Avicenne Hospital, Paris, France.,Sorbonne University Paris Nord, Bobigny, France
| | - Thomas Gastinne
- Department of Hematology, CHU de Nantes, University Hospital of Nantes, Nantes, France
| | - Catherine Thieblemont
- Department of Hemato-oncology, APHP-Saint-Louis Hospital, Paris, France.,Diderot Sorbonne Paris-Cité University, Paris, France.,Descartes University, Paris, France
| | - Lucie Oberic
- Department of Clinical Hematology, Toulouse Oncopole, Toulouse, France
| | - Krimo Bouabdallah
- Department of Clinical Hematology, Bordeaux University Hospital, Bordeaux, France
| | - Sylvain Garciaz
- Department of Clinical Hematology, Paoli Calmettes Institute, Marseille, France
| | - Emmanuelle Tchernonog
- Department of Clinical Hematology, Montpellier University Hospital, Montpellier, France
| | - Caroline Dartigeas
- Department of Clinical Hematology, Tours University Hospital, Tours, France
| | | | | | - René-Olivier Casasnovas
- Department of Clinical Hematology, François Mitterrand University Hospital, Dijon, France.,Inserm UMR 1231, Dijon, France
| | - Roch Houot
- Department of Clinical Hematology, Rennes University Hospital, F-35033, Rennes, France.,MICMAC-Inserm UMR 1236, Rennes University, F-35000, Rennes, France
| | - Caroline Delette
- Department of Clinical Hematology, Amiens University Hospital, Amiens, France
| | - Sandra Malak
- Department of Clinical Hematology, Curie Institute, René Huguenin Hospital, Saint-Cloud, France
| | | | - Remy Gressin
- Department of Clinical Hematology, Grenoble University Hospital, Grenoble, France
| | - Gandhi Damaj
- Department of Clinical Hematology, Caen University Hospital, F-14000, Caen, France.,School of Medicine, Normandy University, F-14000, Caen, France
| | - Steven Le Gouill
- Department of Hematology, CHU de Nantes, University Hospital of Nantes, Nantes, France. .,Now at Curie Insitute, Paris, France.
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31
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Bailly C, Carlier T, Tessoulin B, Gastinne T, Kraeber-Bodere F, Le Gouill S, Bodet-Milin C. Prognostic value of FDG-PET response for patient selection before CAR-T-cells therapy in non-Hodgkin lymphoma. Hematol Oncol 2022; 40:796-800. [PMID: 35044695 DOI: 10.1002/hon.2965] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
CD19-targeting chimeric antigen receptor (CAR)-T-cells have changed the landscape of immunotherapy in relapsed or refractory (R/R) B-cell non-Hodgkin's lymphoma (NHL). The selection of candidates for this therapy remains essential and 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (FDG-PET/CT) role is still to be defined. Forty patients with R/R NHL treated with CAR-T-cells, who underwent FDG-PET/CT imaging, at the time of enrollment, showing R/R disease (FDG-PET/CTbaseline ) and before CAR-T-cells injection (FDG-PET/CTpre-infusion ) were retrospectively reviewed. All patients had active disease on FDG-PET/CTbaseline . Patients achieving objective response (complete or partial response) according to Lugano Criteria on FDG-PET/CTpre-infusion had significantly longer Event Free Survival (EFS) in comparison to other patients (median EFS: not reached vs 2.1 months; p=0.0001). Although significant higher SUVmax, whole-body functional volume (MTV) and whole-body total lesion glycolysis (TLG) were observed in non-responding patients, FDG-PET/CTpre-infusion response appeared as the main prognostic factor on multivariate logistic regression outweighing PET metrics or clinico-biological biomarkers. These results underlie the need to integrate FDG-PET/CT results into patient selection for CAR-T-cells treatment to improve disease management in identifying patients who might not benefit from this therapy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Clément Bailly
- Université de Nantes, CHU Nantes, CNRS, Inserm, CRCINA, F-44000 Nantes, France.,Nuclear Medicine Unit, University Hospital, 44093, Nantes, France
| | - Thomas Carlier
- Université de Nantes, CHU Nantes, CNRS, Inserm, CRCINA, F-44000 Nantes, France.,Nuclear Medicine Unit, University Hospital, 44093, Nantes, France
| | - Benoit Tessoulin
- Université de Nantes, CHU Nantes, CNRS, Inserm, CRCINA, F-44000 Nantes, France.,Haematology Department, University Hospital, 44093, Nantes, France
| | - Thomas Gastinne
- Haematology Department, University Hospital, 44093, Nantes, France
| | - Françoise Kraeber-Bodere
- Université de Nantes, CHU Nantes, CNRS, Inserm, CRCINA, F-44000 Nantes, France.,Nuclear Medicine Unit, University Hospital, 44093, Nantes, France
| | - Steven Le Gouill
- Université de Nantes, CHU Nantes, CNRS, Inserm, CRCINA, F-44000 Nantes, France.,Haematology Department, University Hospital, 44093, Nantes, France
| | - Caroline Bodet-Milin
- Université de Nantes, CHU Nantes, CNRS, Inserm, CRCINA, F-44000 Nantes, France.,Nuclear Medicine Unit, University Hospital, 44093, Nantes, France
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32
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Marouf A, Cottereau AS, Kanoun S, Deschamps P, Meignan M, Franchi P, Sibon D, Antoine C, Gastinne T, Borel C, Hammoud M, Sicard G, Gille R, Cavalieri D, Stamatoullas A, Filliatre-Clement L, Lazarovici J, Chauchet A, Fornecker LM, Amorin S, Rocquet M, Raus N, Burroni B, Rubio MT, Bouscary D, Quittet P, Casasnovas RO, Brice P, Ghesquieres H, Tamburini J, Deau B. Outcomes of refractory or relapsed Hodgkin lymphoma patients with post autologous stem cell transplantation brentuximab vedotin maintenance : a French multicenter observational cohort study. Haematologica 2021; 107:1681-1686. [PMID: 34965701 PMCID: PMC9244814 DOI: 10.3324/haematol.2021.279564] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Amira Marouf
- Department of Hematology, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Université de Paris, France; INSERM UMR 1163, Institut Imagine, Paris
| | - Anne Segolene Cottereau
- Université de Paris, France; Department of Nuclear Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris
| | - Salim Kanoun
- Cancer Research Center of Toulouse (CRCT), Team 9, INSERM UMR 1037, Toulouse
| | - Paul Deschamps
- Department of Hematology, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Université de Paris
| | - Michel Meignan
- Lymphoma Academic Research Organization (LYSARC) Lymphoma Study Association Imaging, Hôpital Henri Mondor, Créteil, France; Paris Est University, Créteil
| | - Patricia Franchi
- Department of Hematology, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Université de Paris
| | - David Sibon
- Hematology Department and INSERM U1151, Institut Necker Enfants Malades, Necker University Hospital, AP-HP, Paris
| | - Clara Antoine
- Lymphoma Academic Research Organization (LYSARC) Lymphoma Study Association Imaging, Hôpital Henri Mondor, Créteil
| | - Thomas Gastinne
- Department of Hematology, Nantes University Hospital, Nantes
| | - Cecile Borel
- Department of Hematology, Institut universitaire du cancer Toulouse- Oncopole, Toulouse
| | | | | | - Romane Gille
- Department of Medical Oncology, Centre Léon Bérard, Lyon
| | - Doriane Cavalieri
- Department of Haematology, Centre Hospitalier Universitaire Estaing, Clermont-Ferrand
| | | | | | | | | | - Luc-Matthieu Fornecker
- Strasbourg University Hospital, Strasbourg, France; INSERM S-1113, Strasbourg, France; Strasbourg University, Faculty of medicine, Strasbourg
| | - Sandy Amorin
- Department of Hematology, Hôpital Saint Vincent de Paul, Lille
| | - Mathieu Rocquet
- Department of Hematology, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris
| | - Nicole Raus
- Department of Hematology, Hôpital Lyon Sud, Pierre-Bénite, France; Société francophone de greffe de moelle et de thérapie cellulaire
| | - Barbara Burroni
- Service de pathologie, Hôpital Cochin, APHP, France; Centre de recherche des Cordeliers, Sorbonne University, INSERM, Paris University
| | - Marie Therese Rubio
- Société francophone de greffe de moelle et de thérapie cellulaire, France; Department of Hematology, CHRU Nancy, Hôpital Brabois; CNRS UMR 7365, Équipe 6, Biopôle de L'Université de Lorraine, Vandoeuvre-les-Nancy
| | - Didier Bouscary
- Department of Hematology, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Université de Paris, France; Institut Cochin, INSERM U1016, Paris
| | - Philippe Quittet
- Department of Hematology, University of Montpellier, Montpellier
| | - Rene Olivier Casasnovas
- Department of Hematology, Dijon University Hospital, Dijon, France; INSERM UMR 1231 CHU Dijon
| | - Pauline Brice
- Department of Hematology, CHU Paris-GH St-Louis Lariboisière F-Widal - Hôpital Saint-Louis, Paris
| | - Herve Ghesquieres
- Department of Hematology, Centre Hospitalier Lyon Sud, Pierre-Bénite
| | - Jérôme Tamburini
- Department of Hematology, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Université de Paris, France; Institut Cochin, INSERM U1016, Paris, France; Translational Research Centre in Onco-hematology, Faculty of Medicine, University of Geneva, 1211, Geneva 4
| | - Benedicte Deau
- Department of Hematology, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Université de Paris.
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33
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Le Bourgeois A, Coste-Burel M, Guillaume T, Peterlin P, Garnier A, Imbert BM, Drumel T, Mahé B, Dubruille V, Blin N, Lok A, Touzeau C, Gastinne T, Tessoulin B, Jullien M, Vantyghem S, Moreau P, Le Gouill S, Béné MC, Chevallier P. Interest of a third dose of BNT162b2 anti-SARS-CoV-2 messenger RNA vaccine after allotransplant. Br J Haematol 2021; 196:e38-e40. [PMID: 34671982 PMCID: PMC8653164 DOI: 10.1111/bjh.17911] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 01/11/2023]
Affiliation(s)
| | | | | | - Pierre Peterlin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Alice Garnier
- Hematology Department, Nantes University Hospital, Nantes, France
| | | | - Thomas Drumel
- Virology Department, Nantes University Hospital, Nantes, France
| | - Beatrice Mahé
- Hematology Department, Nantes University Hospital, Nantes, France
| | | | - Nicolas Blin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Anne Lok
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Cyrille Touzeau
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Thomas Gastinne
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Benoît Tessoulin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Maxime Jullien
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Sophie Vantyghem
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Philippe Moreau
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Steven Le Gouill
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Marie C Béné
- INSERM UMR1232, CRCINA IRS-UN, Nantes University, Nantes, France.,Hematology Biology, Nantes University Hospital, Nantes, France
| | - Patrice Chevallier
- Hematology Department, Nantes University Hospital, Nantes, France.,INSERM UMR1232, CRCINA IRS-UN, Nantes University, Nantes, France
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Gastinne T, Le Bourgeois A, Coste-Burel M, Guillaume T, Peterlin P, Garnier A, Imbert BM, Drumel T, Mahe B, Dubruille V, Blin N, Lok A, Touzeau C, Tessoulin B, Jullien M, Vanthygem S, Béné MC, Moreau P, Le Gouill S, Chevallier P. Safety and antibody response after one and/or two doses of BNT162b2 Anti-SARS-CoV-2 mRNA vaccine in patients treated by CAR T cells therapy. Br J Haematol 2021; 196:360-362. [PMID: 34476803 PMCID: PMC8653317 DOI: 10.1111/bjh.17818] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Thomas Gastinne
- Hematology Department, Nantes University Hospital, Nantes, France
| | | | | | - Thierry Guillaume
- Hematology Department, Nantes University Hospital, Nantes, France.,INSERM UMR1232, CRCINA IRS-UN, University of Nantes, Nantes, France
| | - Pierre Peterlin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Alice Garnier
- Hematology Department, Nantes University Hospital, Nantes, France
| | | | - Thomas Drumel
- Virology Department, Nantes University Hospital, Nantes, France
| | - Beatrice Mahe
- Hematology Department, Nantes University Hospital, Nantes, France
| | | | - Nicolas Blin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Anne Lok
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Cyrille Touzeau
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Benoit Tessoulin
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Maxime Jullien
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Sophie Vanthygem
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Marie C Béné
- INSERM UMR1232, CRCINA IRS-UN, University of Nantes, Nantes, France.,Hematology Biology, Nantes University Hospital, Nantes, France
| | - Philippe Moreau
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Steven Le Gouill
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Patrice Chevallier
- Hematology Department, Nantes University Hospital, Nantes, France.,INSERM UMR1232, CRCINA IRS-UN, University of Nantes, Nantes, France
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35
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Garnier A, Jullien M, Guillaume T, Peterlin P, Le Bourgeois A, Mahe B, Dubruille V, Blin N, Touzeau C, Gastinne T, Lok A, Vantyghem S, Moreau P, Bene M, Le Gouill S, Chevallier P. Topic: AS08-Treatment/AS08h-Allogeneic hematopoietic cell transplantation -Bridging to transplantation. Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106681.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Gouill S, Bachy E, Blasi R, Cartron G, Beauvais D, Bras F, Gros F, Choquet S, Bories P, Rubio M, Casasnovas R, Bounaix L, Mohty M, Joris M, Gastinne T, Sesques P, Tudesq JJ, Morschhauser F, Gat E, Broussais F, Thieblemont C, Houot R. FIRST RESULTS OF DLBCL PATIENTS TREATED WITH CAR‐T CELLS AND ENROLLED IN DESCAR‐T REGISTRY, A FRENCH REAL‐LIFE DATABASE FOR CAR‐T CELLS IN HEMATOLOGIC MALIGNANCIES. Hematol Oncol 2021. [DOI: 10.1002/hon.84_2879] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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]
Affiliation(s)
- S. Gouill
- CHU de Nantes Hematology Nantes France
| | | | - R. Blasi
- Höpital Saint‐Louis APHP Hematology PAris France
| | - G. Cartron
- CHU de Montpellier Hematology Montpellier France
| | | | - F. Bras
- CHU Creteil Hematology Creteil France
| | | | - S. Choquet
- Hôpital La Pitié‐Salpetrière ‐ APHP Hematology Paris France
| | - P. Bories
- Oncopole de Toulouse Hematology Toulouse France
| | | | | | - L. Bounaix
- CHU de Clermont‐Ferrand Hematology Clermont‐Ferrand France
| | - M. Mohty
- Hôpital Saint‐Antoine Hematology Paris France
| | - M. Joris
- CHU Amiens Hematology Amiens France
| | | | | | - J. J. Tudesq
- CHU de Montpellier Hematology Montpellier France
| | | | - E. Gat
- LYSARC DESCAR‐T LYON France
| | | | | | - R. Houot
- CHU de Rennes Hematology Rennes France
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37
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Makanga DR, Jullien M, David G, Legrand N, Willem C, Dubreuil L, Walencik A, Touzeau C, Gastinne T, Tessoulin B, Le Gouill S, Mahé B, Gagne K, Chevallier P, Clemenceau B, Retière C. Low number of KIR ligands in lymphoma patients favors a good rituximab-dependent NK cell response. Oncoimmunology 2021; 10:1936392. [PMID: 34178429 PMCID: PMC8204974 DOI: 10.1080/2162402x.2021.1936392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The antibody-dependent cellular cytotoxicity (ADCC) effector function of natural killer (NK) cells is one of the known mechanisms of action for rituximab-based anti-cancer immunotherapy. Inhibition of the ADCC function of NK cells through interactions between inhibitory killer cell immunoglobulin-like receptors (KIRs) and HLA class I ligands is associated with resistance of cancers to rituximab. In this study, we deeply investigated the impact of KIR, HLA class I, and CD16 genotypes on rituximab-dependent NK cell responses in both an in vitro cellular model from healthy blood donors and ex vivo rituximab-treated non-Hodgkin lymphoma (NHL) patients. We highlight that an HLA environment with limited KIR ligands is beneficial to promoting a higher frequency of KIR+ NK cells including both educated and uneducated NK cells, two NK cell compartments that demonstrate higher rituximab-dependent degranulation than KIR− NK cells. In contrast, a substantial KIR ligand environment favors a higher frequency of poorly effective KIR− NK cells and numerous functional KIR/HLA inhibitions of educated KIR+ NK cells. These phenomena explain why NHL patients with limited KIR ligands respond better to rituximab. In this HLA environment, CD16 polymorphism appears to have a collateral effect. Furthermore, we show the synergic effect of KIR2DS1, which strongly potentiates NK cell ADCC from C2− blood donors against C2+ target cells. Taken together, these results pave the way for stronger prediction of rituximab responses for NHL patients. HLA class I typing and peripheral blood KIR+ NK cell frequency could be simple and useful markers for predicting rituximab response.
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Affiliation(s)
- Dhon Roméo Makanga
- Etablissement Français Du Sang, Nantes, Nantes, France.,Université De Nantes, INSERM U1232 CNRS, CRCINA, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
| | | | - Gaëlle David
- Etablissement Français Du Sang, Nantes, Nantes, France.,Université De Nantes, INSERM U1232 CNRS, CRCINA, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
| | - Nolwenn Legrand
- Etablissement Français Du Sang, Nantes, Nantes, France.,Université De Nantes, INSERM U1232 CNRS, CRCINA, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
| | - Catherine Willem
- Etablissement Français Du Sang, Nantes, Nantes, France.,Université De Nantes, INSERM U1232 CNRS, CRCINA, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
| | - Léa Dubreuil
- Etablissement Français Du Sang, Nantes, Nantes, France.,Université De Nantes, INSERM U1232 CNRS, CRCINA, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
| | | | | | | | | | | | | | - Katia Gagne
- Etablissement Français Du Sang, Nantes, Nantes, France.,Université De Nantes, INSERM U1232 CNRS, CRCINA, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France.,LabEx Transplantex, Université De Strasbourg, Strasbourg, France
| | - Patrice Chevallier
- Université De Nantes, INSERM U1232 CNRS, CRCINA, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France.,Hematology Clinic, CHU, Nantes, France
| | - Béatrice Clemenceau
- Université De Nantes, INSERM U1232 CNRS, CRCINA, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
| | - Christelle Retière
- Etablissement Français Du Sang, Nantes, Nantes, France.,Université De Nantes, INSERM U1232 CNRS, CRCINA, Nantes, France.,LabEx IGO "Immunotherapy, Graft, Oncology", Nantes, France
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38
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Driessen J, Kersten MJ, Visser L, den Berg A, Zijlstra JM, Tonino SH, Zwezerijnen GJ, Boellaard R, Lugtenburg PJ, Hutchings M, Nijland M, Liu RD, Morschhauser F, Brice P, Gastinne T, Jong D, Hagenbeek A, Plattel WJ, Diepstra A. LONG‐TERM FOLLOW‐UP AND BIOMARKER ANALYSES OF BRENTUXIMAB VEDOTIN AND DHAP IN RELAPSED/REFRACTORY HODGKIN LYMPHOMA PATIENTS: THE HOVON/LLPC TRANSPLANT BRAVE STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.102_2880] [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: 11/08/2022]
Affiliation(s)
- J. Driessen
- Amsterdam UMC University of Amsterdam LYMMCARE Cancer Center Amsterdam Department of Hematology Amsterdam Netherlands
| | - M. J. Kersten
- Amsterdam UMC University of Amsterdam LYMMCARE Cancer Center Amsterdam Department of Hematology Amsterdam Netherlands
| | - L. Visser
- University of Groningen University Medical Center Groningen Department of Pathology and Medical Biology Groningen Netherlands
| | - A. den Berg
- University of Groningen University Medical Center Groningen Department of Pathology and Medical Biology Groningen Netherlands
| | - J. M. Zijlstra
- Amsterdam UMC Vrije Universiteit Amsterdam Cancer Center Amsterdam Department of Hematology Amsterdam Netherlands
| | - S. H. Tonino
- Amsterdam UMC University of Amsterdam LYMMCARE Cancer Center Amsterdam Department of Hematology Amsterdam Netherlands
| | - G. J. Zwezerijnen
- Amsterdam UMC Vrije Universiteit Amsterdam Cancer Center Amsterdam Department of Radiology and Nuclear Medicine Amsterdam Netherlands
| | - R. Boellaard
- Amsterdam UMC Vrije Universiteit Amsterdam Cancer Center Amsterdam Department of Radiology and Nuclear Medicine Amsterdam Netherlands
| | - P. J. Lugtenburg
- Erasmus MC Cancer Institute University Medical Center Department of Hematology Rotterdam Netherlands
| | - M. Hutchings
- Rigshospitalet Department of Hematology Copenhagen Denmark
| | - M. Nijland
- University of Groningen University Medical Center Groningen Department of Hematology Groningen Netherlands
| | - R. D. Liu
- Amsterdam UMC University of Amsterdam LYMMCARE Cancer Center Amsterdam Department of Hematology Amsterdam Netherlands
| | - F. Morschhauser
- Centre Hospitalier Universitaire Department of Hematology Lille France
| | - P. Brice
- Hopital Saint Louis Department of Hematology Paris France
| | - T. Gastinne
- Centre Hospitalier Universitaire Department of Hematology Nantes France
| | - D. Jong
- msterdam UMC Vrije Universiteit Amsterdam Cancer Center Amsterdam Department of Pathology Amsterdam Netherlands
| | - A. Hagenbeek
- Amsterdam UMC University of Amsterdam LYMMCARE Cancer Center Amsterdam Department of Hematology Amsterdam Netherlands
| | - W. J. Plattel
- University of Groningen University Medical Center Groningen Department of Hematology Groningen Netherlands
| | - A. Diepstra
- University of Groningen University Medical Center Groningen Department of Pathology and Medical Biology Groningen Netherlands
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Marouf A, Cottereau AS, Kanoun S, Deschamps P, Franchi P, Meignan M, Sibon D, Gastinne T, Borel C, Hammoud M, Sicard G, Gille R, Cavalieri D, Stamatoullas A, Clement L, Lazarovici J, Chauchet A, Fornecker LM, Amorin S, Rocquet M, Raus N, Burroni B, Rubio MT, Casasnovas O, Cartron G, Bouscary D, Brice P, Ghesquieres H, Tamburini J, Deau B. AMAHRELIS : ADCETRIS MAINTENANCE AFTER AUTOLOGOUS STEM CELL TRANSPLANTATION IN HODGKIN LYMPHOMA : A REAL LIFE STUDY FROM SFGMTC AND LYSA GROUPS. Hematol Oncol 2021. [DOI: 10.1002/hon.101_2880] [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: 11/08/2022]
Affiliation(s)
- A. Marouf
- Cochin Hospital Paris University Hematology Unit Paris France
| | - A. S. Cottereau
- Cochin Hospital Assistance Publique‐Hôpitaux de Paris (AP‐HP) Paris Descartes University Department of Nuclear Medicine Paris France
| | - S. Kanoun
- Institut universitaire du cancer Toulouse‐Oncopole Nuclear Medecine Unit, Toulouse France
| | - P. Deschamps
- Cochin Hospital Paris University Hematology Unit Paris France
| | - P. Franchi
- Cochin Hospital Paris University Hematology Unit Paris France
| | - M. Meignan
- Hôpital Henri Mondor Paris Est University Lymphoma Study Association Imaging Créteil France
| | - D. Sibon
- Necker Hospital Paris University Department of Hematology Paris France
| | - T. Gastinne
- Nantes University Hospital Department of Hematology Nantes France
| | - C. Borel
- Institut universitaire du cancer Toulouse‐ Oncopole Hematology Toulouse France
| | - M. Hammoud
- Lymphoid Malignancies Unit Hôpital Henri Mondor Hematology Creteil France
| | - G. Sicard
- Aix‐Marseille University Hematology Marseille France
| | - R. Gille
- Centre Léon Berard Hematology Lyon France
| | - D. Cavalieri
- Centre Hospitalier Universitaire Estaing Hematology Clermont Ferrand France
| | | | - L. Clement
- CHRU Nancy Brabois Hematology Vandoeuvre Les Nancy France
| | | | | | - L. M. Fornecker
- Strasbourg University Hospital INSERM S‐1113 Hematology Strasbourg France
| | - S. Amorin
- Hopital Saint Vincent de Paul Hematology Lille France
| | - M. Rocquet
- Cochin Hospital Paris University Hematology Unit Paris France
| | - N. Raus
- Hopital Lyon Sud Hematology Pierre Benite France
| | - B. Burroni
- Cochin Hospital APHP, Centre de recherche des Cordeliers Sorbonne University INSERM, Paris University Pathology Paris France
| | - M. T. Rubio
- CHRU Nancy CNRS UMR 7365 Équipe 6 Biopôle de L'Université de Lorraine Hematology Vandoeuvre Les Nancy France
| | - O. Casasnovas
- Dijon University Hospital INSERM UMR 1231 Hematology Dijon France
| | - G. Cartron
- University of Montpellier Hematology Montpellier France
| | - D. Bouscary
- Cochin Hospital Paris University Hematology Unit Paris France
| | - P. Brice
- Saint Louis Hospital Paris university Hematology Paris France
| | | | - J. Tamburini
- Université de Paris Institut Cochin INSERM U1016, F‐75014 Paris Translational Research Centre in Onco‐hematology Faculty of Medicine University of Geneva Hematology 1211 Geneva Switzerland
| | - B. Deau
- Cochin Hospital Paris University Hematology Unit Paris France
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Gastinne T, Bouabdallah K, Moatti H, Tessoulin B, Shiano del colella JM, Lamy T, Casasnovas O, Borel C, Stamatoullas A, Gac AC, Chaoui D, Feugier P, Delmer A, Bonnet C, Fornecker L, Lazarovici J, Bras F, Ghesquieres H, Meignan M, Traverse Glehen A, Brice P. BRENTUXIMAB VEDOTIN AS CONSOLIDATION TREATMENT IN PATIENTS WITH STAGE I/II CLASSICAL HODGKIN'S LYMPHOMA AND A POSITIVE FDG‐PET AFTER 2 CYCLES OF ABVD: A LYSA PHASE 2 STUDY. Hematol Oncol 2021. [DOI: 10.1002/hon.111_2880] [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: 11/08/2022]
Affiliation(s)
- T. Gastinne
- University Hospital of Nantes Hematology Nantes France
| | - K. Bouabdallah
- Hopital Haut‐Levêque Centre Hospitalier Regional Universitaire de Bordeaux Department of Hematology Pessac France
| | - H. Moatti
- Hôpital saint Louis APHP Université Paris 7 Department of Oncohaematology Paris France
| | - B. Tessoulin
- University Hospital of Nantes Hematology Nantes France
| | | | - T. Lamy
- Rennes University Hospital Department of Clinical Hematology MICA Research Unit Rennes France
| | - O. Casasnovas
- University Hospital F Mitterrand and INSERM 1231 Department of Haematology Dijon France
| | - C. Borel
- IUCT‐Oncopole CHU Toulouse Department of Haematology Toulouse France
| | - A. Stamatoullas
- Centre Henri Becquerel Department of Haematology U918 Rouen France
| | - A. C. Gac
- Centre Hospitalier Universitaire de Caen Institut d'hématologie de Basse‐Normandie Caen France
| | - D. Chaoui
- Centre Hospitalier d'Argenteuil Department of Hematology Argenteuil France
| | - P. Feugier
- Nancy University Hospital Department of Clinical Hematology INSERM 1256 Nancy France
| | - A. Delmer
- University Hospital of Reims Department of Haematology Reims France
| | - C. Bonnet
- CHU Liège, Liège Université Campus Universitaire de Sart Tilman Clinical Hematology Unit Liège Belgium
| | - Luc‐M. Fornecker
- Strasbourg University Hospital Department of Clinical Hematology Strasbourg France
| | - J. Lazarovici
- Institut Gustave Roussy Département des Innovations Thérapeutiques et Essais Précoces Villejuif France
| | - F. Bras
- CHU Henri Mondor Department of Hematology Creteil France
| | - H. Ghesquieres
- Hospices Civils de Lyon Centre Hospitalier Lyon‐Sud and Université Claude Bernard Lyon‐1 Department of Haematology Lyon France
| | - M. Meignan
- Hôpital H Mondor LYSA Imaging Creteil France
| | - A. Traverse Glehen
- Centre Hospitalier Lyon‐Sud Hospices Civils de Lyon Pathology Department cedex, France, Lyon France
| | - P. Brice
- Hôpital saint Louis APHP Université Paris 7 Department of Oncohaematology Paris France
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Chevallier P, Coste-Burel M, Le Bourgeois A, Peterlin P, Garnier A, Béné MC, Imbert BM, Drumel T, Le Gouill S, Moreau P, Mahe B, Dubruille V, Blin N, Lok A, Touzeau C, Gastinne T, Jullien M, Vanthygem S, Guillaume T. Safety and immunogenicity of a first dose of SARS-CoV-2 mRNA vaccine in allogeneic hematopoietic stem-cells recipients. ACTA ACUST UNITED AC 2021; 2:520-524. [PMID: 34226903 PMCID: PMC8242867 DOI: 10.1002/jha2.242] [Citation(s) in RCA: 21] [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: 05/04/2021] [Revised: 05/18/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022]
Abstract
This was a monocentric prospective study testing the efficacy and safety of a first injection of BNT162b2 (Pfizer‐BioNTech) in 112 Allo‐HSCT patients. Antibody response to SARS‐CoV‐2 spike protein receptor‐binding domain was tested at the time of the second injection (Roche Elecsys). The study also included a non‐randomized control arm of 26 healthy controls. This study shows that a first dose of SARS‐CoV‐2 messenger RNA vaccine is safe and provides a 55% rate of seroconversion in allotransplanted patients compared to 100% for the controls (p < 0.001). Factors influencing the absence of response in patients were recent transplantation (<2 years), lymphopenia (<1 × 109/L) and immunosuppressive treatment or chemotherapy at the time of vaccination.
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Affiliation(s)
- Patrice Chevallier
- Department of Hematology Nantes University Hospital Nantes France.,INSERM UMR1232 CRCINA IRS-UN University of Nantes Nantes France
| | | | | | - Pierre Peterlin
- Department of Hematology Nantes University Hospital Nantes France
| | - Alice Garnier
- Department of Hematology Nantes University Hospital Nantes France
| | - Marie C Béné
- INSERM UMR1232 CRCINA IRS-UN University of Nantes Nantes France.,Department of Hematology Biology Nantes University Hospital Nantes France
| | | | - Thomas Drumel
- Department of Virology Nantes University Hospital Nantes France
| | - Steven Le Gouill
- Department of Hematology Nantes University Hospital Nantes France
| | - Philippe Moreau
- Department of Hematology Nantes University Hospital Nantes France
| | - Beatrice Mahe
- Department of Hematology Nantes University Hospital Nantes France
| | | | - Nicolas Blin
- Department of Hematology Nantes University Hospital Nantes France
| | - Anne Lok
- Department of Hematology Nantes University Hospital Nantes France
| | - Cyrille Touzeau
- Department of Hematology Nantes University Hospital Nantes France
| | - Thomas Gastinne
- Department of Hematology Nantes University Hospital Nantes France
| | - Maxime Jullien
- Department of Hematology Nantes University Hospital Nantes France
| | - Sophie Vanthygem
- Department of Hematology Nantes University Hospital Nantes France
| | - Thierry Guillaume
- Department of Hematology Nantes University Hospital Nantes France.,INSERM UMR1232 CRCINA IRS-UN University of Nantes Nantes France
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42
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Chevallier P, Berceanu A, Peterlin P, Garnier A, Le Bourgeois A, Imbert BM, Daguindau E, Mahé B, Dubruille V, Blin N, Touzeau C, Gastinne T, Lok A, Tessoulin B, Vantyghem S, Desbrosses Y, Bressollette C, Duquesne A, Eveillard M, Le Bris Y, Dormoy A, Malugani C, Deconinck E, Moreau P, Le Gouill S, Béné MC, Guillaume T. Grade 2 acute GVHD is a factor of good prognosis in patients receiving peripheral blood stem cells haplo-transplant with post-transplant cyclophosphamide. Acta Oncol 2021; 60:466-474. [PMID: 33112687 DOI: 10.1080/0284186x.2020.1837947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The impact of acute graft versus host disease (GVHD) on survivals for patients receiving a haploidentical allogeneic stem-cell transplant (Allo-SCT) with peripheral blood stem-cells (PBSC) complemented by post-transplant cyclophosphamide (PTCY) is ill-known. MATERIAL AND METHODS This retrospective study included 131 patients who received a PBSC haplograft in order to precise the impact of acute GVHD on outcomes. There were 78 males and 53 females and the median age for the whole cohort was 59 years (range: 20-71). Thirty-five patients were allografted for a lymphoid disease and 96 for a myeloid malignancy, including 67 patients with acute myeloid leukemia (AML). RESULTS The cumulative incidence (CI) of day 100 grade 2-4 and 3-4 acute GVHD was 43.4 + 4.6% and 16.7 + 3.4%, respectively. The 2-year CI of moderate/severe chronic GVHD was 10.1 + 2.8%. The only factor affecting the occurrence of GVHD was GVHD prophylaxis. Indeed, CI of day 100 grade 2-4 (but not grade 3-4) acute GVHD was significantly reduced when adding anti-thymoglobulin (ATG) to PTCY. However, in multivariate analysis, grade 2 acute GVHD was significantly associated with better disease-free (HR: 0.36; 95%CI: 0.19-0.69, p = .002) and overall (HR: 0.35; 95%CI: 0.1-0.70, p = .003) survivals. The same results were observed when considering only AML patients. CONCLUSION Acute grade 2 GVHD is a factor of good prognosis after PBSC haplotransplant with PTCY. Further and larger studies are needed to clarify the complex question of GVHD prophylaxis in the setting of haplo-transplant, especially that of combining ATG and PTCY.
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Affiliation(s)
| | | | | | - Alice Garnier
- Hematology Department, CHU Hotel-Dieu, Nantes, France
| | | | | | | | - Béatrice Mahé
- Hematology Department, CHU Hotel-Dieu, Nantes, France
| | | | - Nicolas Blin
- Hematology Department, CHU Hotel-Dieu, Nantes, France
| | | | | | - Anne Lok
- Hematology Department, CHU Hotel-Dieu, Nantes, France
| | | | | | | | | | - Alix Duquesne
- Cellular Engineering Unit, EFS Pays de la Loire, Nantes, France
| | | | - Yannick Le Bris
- Hematology/Biology Department, CHU Hotel-Dieu, Nantes, France
| | - Anne Dormoy
- EFS Bourgogne Franche-Comté, Besançon, France
| | | | - Eric Deconinck
- Hematology Department, CHU, Besançon, France
- Université de Franche-Comté, Inserm UMR1098 RIGHT, Besançon, France
| | | | | | - Marie C. Béné
- Hematology/Biology Department, CHU Hotel-Dieu, Nantes, France
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43
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Kersten MJ, Driessen J, Zijlstra JM, Plattel WJ, Morschhauser F, Lugtenburg PJ, Brice P, Hutchings M, Gastinne T, Liu R, Burggraaff CN, Nijland M, Tonino SH, Arens AIJ, Valkema R, van Tinteren H, Lopez-Yurda M, Diepstra A, De Jong D, Hagenbeek A. Combining brentuximab vedotin with dexamethasone, high-dose cytarabine and cisplatin as salvage treatment in relapsed or refractory Hodgkin lymphoma: the phase II HOVON/LLPC Transplant BRaVE study. Haematologica 2021; 106:1129-1137. [PMID: 32273476 PMCID: PMC8018114 DOI: 10.3324/haematol.2019.243238] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/19/2020] [Indexed: 12/13/2022] Open
Abstract
Achieving a metabolic complete response (mCR) before high-dose chemotherapy (HDC) and autologous peripheral blood stem-cell transplant (auto-PBSCT) predicts progression free survival (PFS) in relapsed/refractory classical Hodgkin lymphoma (R/R cHL). We added brentuximab vedotin (BV) to DHAP to improve the mCR rate. In a Phase I dose-escalation part in 12 patients, we showed that BV-DHAP is feasible. This Phase II study included 55 R/R cHL patients (23 primary refractory). Treatment consisted of three 21-day cycles of BV 1.8 mg/kg on day 1, and DHAP (dexamethasone 40mg days 1-4, cisplatin 100mg/m2; day 1 and cytarabine 2x2g/m2; day 2). Patients with a metabolic partial response (mPR) or mCR proceeded to HDC/auto-PBSCT. Based on independent central FDG-PET-CT review, 42 of 52 evaluable patients (81% [95% CI: 67-90]) achieved an mCR before HDC/auto-PBSCT, five had an mPR and five had progressive disease (three were not evaluable). After HDC/auto-PBSCT, four patients with an mPR converted to an mCR. The 2-year PFS was 74% [95% CI: 63-86], and the overall survival 95% [95% CI: 90-100]. Toxicity was manageable and mainly consisted of grade 3/4 hematological toxicity, fever, nephrotoxicity, ototoxicity (grade 1/2) and transiently elevated liver enzymes during BV-DHAP. Eighteen patients developed new onset peripheral neuropathy (maximum grade 1/2) and all recovered. In conclusion, BV-DHAP is a very effective salvage regimen in R/R cHL patients, but patients should be monitored closely for toxicity. ClinicalTrials.gov identifier: NCT02280993.
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Affiliation(s)
- Marie José Kersten
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
| | - Julia Driessen
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
| | - Josée M Zijlstra
- Dept of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Plattel
- Dept of Hematology, University of Groningen, UMC Groningen, Groningen, The Netherlands
| | | | | | - Pauline Brice
- Dept of Hematology, Hopital Saint Louis, Paris, France
| | | | - Thomas Gastinne
- Dept of Hematology, Centre Hospitalier Universitaire, Nantes, France
| | - Roberto Liu
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Coreline N Burggraaff
- Dept of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marcel Nijland
- Dept of Hematology, University of Groningen, UMC Groningen, Groningen, The Netherlands
| | - Sanne H Tonino
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
| | - Anne I J Arens
- Dept of Radiology and Nuclear Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Roelf Valkema
- Dept of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Harm van Tinteren
- Dept of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marta Lopez-Yurda
- Dept of Biometrics, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arjan Diepstra
- Dept. of Pathology and Medical Biology, UMC Groningen, University of Groningen, the Netherlands
| | - Daphne De Jong
- Dept of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anton Hagenbeek
- Dept of Hematology, Amsterdam UMC, University of Amsterdam, and LYMMCARE, Amsterdam, The Netherlands
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44
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Peterlin P, Gaschet J, Guillaume T, Garnier A, Eveillard M, Le Bourgeois A, Cherel M, Debord C, Le Bris Y, Theisen O, Godon C, Mahé B, Dubruille V, Wuilleme S, Touzeau C, Gastinne T, Blin N, Lok A, Tessoulin B, Le Gouill S, Moreau P, Béné MC, Chevallier P. A new cytokine-based dynamic stratification during induction is highly predictive of survivals in acute myeloid leukemia. Cancer Med 2020; 10:642-648. [PMID: 33369136 PMCID: PMC7877358 DOI: 10.1002/cam4.3648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/17/2020] [Revised: 10/29/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022] Open
Abstract
The aim of this study was to assess the potential impact of the kinetics of serum levels of seven cytokines during induction in acute myeloid leukemia (AML) patients. Indeed, the role of cytokines, in the pathophysiology and response to therapy of AML patients, remains under investigation. Here, we report on the impact of peripheral levels of two cytokines, the Fms‐like tyrosine kinase 3 ligand (FL) and interleukin‐6 (IL‐6), evaluated during first‐line intensive induction. A new risk stratification can be proposed, which supersedes the ELN 2017 classification to predict survivals in AML patients by examining the kinetic profile of these cytokines during the induction phase. It segregates three groups of, respectively, high‐risk, characterized by a stagnation of low FL levels, intermediate risk, with dynamic increasing FL levels and high IL‐6 at day 22, and favorable risk with increasing FL levels but low IL‐6 at day 22.
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Affiliation(s)
- Pierre Peterlin
- Hematology Clinic, CHU, Nantes, France.,CRCINA, INSERM, Université d'Angers, Université de Nantes, Nantes, France
| | - Joelle Gaschet
- CRCINA, INSERM, Université d'Angers, Université de Nantes, Nantes, France
| | - Thierry Guillaume
- Hematology Clinic, CHU, Nantes, France.,CRCINA, INSERM, Université d'Angers, Université de Nantes, Nantes, France
| | | | - Marion Eveillard
- CRCINA, INSERM, Université d'Angers, Université de Nantes, Nantes, France.,Hematology Biology, CHU, Nantes, France
| | | | - Michel Cherel
- CRCINA, INSERM, Université d'Angers, Université de Nantes, Nantes, France.,Nuclear Medicine Unit, ICO Cancer Center Gauducheau, Saint Herblain, France
| | | | - Yannick Le Bris
- CRCINA, INSERM, Université d'Angers, Université de Nantes, Nantes, France.,Hematology Biology, CHU, Nantes, France
| | | | | | | | | | | | | | | | | | - Anne Lok
- Hematology Clinic, CHU, Nantes, France
| | | | - Steven Le Gouill
- Hematology Clinic, CHU, Nantes, France.,CRCINA, INSERM, Université d'Angers, Université de Nantes, Nantes, France
| | - Philippe Moreau
- Hematology Clinic, CHU, Nantes, France.,CRCINA, INSERM, Université d'Angers, Université de Nantes, Nantes, France
| | - Marie-C Béné
- CRCINA, INSERM, Université d'Angers, Université de Nantes, Nantes, France.,Hematology Biology, CHU, Nantes, France
| | - Patrice Chevallier
- Hematology Clinic, CHU, Nantes, France.,CRCINA, INSERM, Université d'Angers, Université de Nantes, Nantes, France
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45
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Gangneux JP, Padoin C, Michallet M, Saillio E, Kumichel A, Peffault de La Tour R, Ceballos P, Gastinne T, Pigneux A. Outcomes of Antifungal Prophylaxis in High-Risk Haematological Patients (AML under Intensive Chemotherapy): The SAPHIR Prospective Multicentre Study. J Fungi (Basel) 2020; 6:jof6040281. [PMID: 33198192 PMCID: PMC7712136 DOI: 10.3390/jof6040281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/15/2022] Open
Abstract
Antifungal prophylaxis (AFP) is recommended by international guidelines for patients with acute myeloid leukaemia (AML) undergoing induction chemotherapy and allogeneic hematopoietic cell transplantation. Nonetheless, treatment of breakthrough fungal infections remains challenging. This observational, prospective, multicentre, non-comparative study of patients undergoing myelosuppressive and intensive chemotherapy for AML who are at high-risk of invasive fungal diseases (IFDs), describes AFP management and outcomes for 404 patients (65.6% newly diagnosed and 73.3% chemotherapy naïve). Ongoing chemotherapy started 1.0 ± 4.5 days before inclusion and represented induction therapy for 79% of participants. In 92.3% of patients, posaconazole was initially prescribed, and 8.2% of all patients underwent at least one treatment change after 17 ± 24 days, mainly due to medical conditions influencing AFP absorption (65%). The mean AFP period was 24 ± 32 days, 66.8% stopped their prophylaxis after the high-risk period and 31.2% switched to a non-prophylactic treatment (2/3 empirical, 1/3 pre-emptive/curative). Overall, 9/404 patients (2.2%) were diagnosed with probable or proven IFDs. During the follow-up, 94.3% showed no signs of infection. Altogether, 20 patients (5%) died, and three deaths (0.7%) were IFD-related. In conclusion, AFP was frequently prescribed and well tolerated by these AML patients, breakthrough infections incidence and IFD mortality were low and very few treatment changes were required.
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Affiliation(s)
- Jean-Pierre Gangneux
- Mycology Department, Centre Hospitalier Universitaire de Rennes, University Rennes, INSERM, Irset (Institut de Recherche en Santé, Environnement et Travail), UMR S_1085, 35000 Rennes, France
- Correspondence: ; Tel.: +33-299-283-731
| | - Christophe Padoin
- Pharmacy Department, CHU Martinique Site P. Zobda Quitman, 97261 Fort de France, Martinique, France;
| | - Mauricette Michallet
- Clinical Haematology Department, Centre Léon Bérard (Anticancer Center), 28 Rue Laennec, 69373 Lyon, France;
| | - Emeline Saillio
- Department of Medical Affairs, MSD France, 10-12 cours Michelet, 92800 Puteaux, France;
| | - Alexandra Kumichel
- Scientific Department, ClinSearch, 110 Avenue Pierre Brossolette, 92240 Malakoff, France;
| | - Régis Peffault de La Tour
- Haematology-Bone Marrow Transplant Department, Saint-Louis Hospital APHP, 1 Avenue Claude-Vellefaux, 75010 Paris, France;
| | - Patrice Ceballos
- Clinical Haematology Department, CHRU Lapeyronie, 371 Avenue Doyen Gaston Giraud, 34295 Montpellier, France;
| | - Thomas Gastinne
- Clinical Haematology Department, CHU Nantes, 1 Place Alexis-Ricordeau, 44093 Nantes, France;
| | - Arnaud Pigneux
- Blood Diseases Department, Hospital Group Haut Leveque, Avenue de Magellan, 33604 Pessac, France;
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46
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Belin C, Devic P, Ayrignac X, Dos Santos A, Paix A, Sirven-Villaros L, Simard C, Lamure S, Gastinne T, Ursu R, Berger C, Platon L, Tessoulin B, Azoulay E, Wallet F, Thieblemont C, Bachy E, Cartron G, Laplaud DA, Carpentier AF. Description of neurotoxicity in a series of patients treated with CAR T-cell therapy. Sci Rep 2020; 10:18997. [PMID: 33149178 PMCID: PMC7642402 DOI: 10.1038/s41598-020-76055-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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: 07/10/2020] [Accepted: 10/20/2020] [Indexed: 12/25/2022] Open
Abstract
Chimeric antigen receptor-modified T (CAR T) cell therapy is a highly promising treatment for haematological malignancies but is frequently associated with cytokine release syndrome and neurotoxicity. Between July 2018 and July 2019, all patients treated with CD19-targeted CAR T-cell therapy for relapsing lymphoma were followed-up longitudinally to describe neurological symptoms and their evolution over time. Four different French centres participated and 84 patients (median age 59 years, 31% females) were included. Neurotoxicity, defined as the presence of at least one neurological symptom appearing after treatment infusion, was reported in 43% of the patients. The median time to onset was 7 days after infusion with a median duration of 6 days. More than half of the patients (64%) had grade 1–2 severity and 34% had grade 3–4. CRS was observed in 80% of all patients. The most frequent neurological symptoms were cognitive signs, being severe in 36%, and were equally distributed between language disorders and cognitive disorders without language impairment. Non-pyramidal motor disorders, severe in 11%, were reported in 42% of the patients. Elevation of C-reactive protein (CRP) within 4 days after treatment was significantly correlated with the occurrence of grade 3–4 neurotoxicity. Although sometimes severe, neurotoxicity was almost always reversible. The efficacy of steroids and antiepileptic drugs remains unproven in the management of neurotoxicity. Neurotoxicity associated with CAR T-cell therapies occurs in more than 40% of patients. The clinical pattern is heterogeneous but cognitive disorders (not limited to language disorders) and, to a minor degree, non-pyramidal motor disorders, appeared as a signature of severe neurotoxicity.
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Affiliation(s)
- Catherine Belin
- Department of Neurology, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France.
| | - Perrine Devic
- Department of Clinical and Functional Neurology, Hospices Civils de Lyon, CHU Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - Xavier Ayrignac
- Department of Neurology, Centre Hospitalier Universitaire de Montpellier, INSERM, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Amélie Dos Santos
- Department of Neurology, CRTI-InsermU1064, CIC 1413, Centre Hospitalier Universitaire de Nantes, 5 Allée de l'île Gloriette, 44093, Nantes, France
| | - Adrien Paix
- Institut de Radiothérapie de Bobigny, Ramsay Générale de Santé, Rue Lautréamont, 93000, Bobigny, France
| | - Lila Sirven-Villaros
- Department of Neurology, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Université de Paris, Paris-Diderot, 75010, Paris, France
| | - Claire Simard
- Department of Clinical and Functional Neurology, Hospices Civils de Lyon, CHU Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - Sylvain Lamure
- Department of Clinical Haematology, Centre Hospitalier Universitaire de Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Thomas Gastinne
- Department of Clinical Haematology, Centre Hospitalier Universitaire de Nantes, 5 Allée de l'île gloriette, 44093, Nantes, France
| | - Renata Ursu
- Department of Neurology, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Colette Berger
- Department of Clinical and Functional Neurology, Hospices Civils de Lyon, CHU Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - Laura Platon
- Intensive Care Medicine Department, Lapeyronie Hospital, Centre Hospitalier Universitaire de Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - Benoît Tessoulin
- Department of Clinical Haematology, Centre Hospitalier Universitaire de Nantes, 5 Allée de l'île gloriette, 44093, Nantes, France
| | - Elie Azoulay
- Université de Paris, Paris-Diderot, 75010, Paris, France.,Intensive Care Medicine Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 75010, Paris, France
| | - Florent Wallet
- Intensive Care Medicine Department, Hospices Civils de Lyon, CHU Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - Catherine Thieblemont
- Université de Paris, Paris-Diderot, 75010, Paris, France.,Department of Haemato-Oncology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 75010, Paris, France
| | - Emmanuel Bachy
- Department of Clinical Haematology, Hospices Civils de Lyon, CHU Lyon Sud, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.,INSERM U1052 CNRS, UMR5286, Centre de Recherche en Cancérologie de Lyon &, Université Claude Bernard, Lyon 1, France
| | - Guillaume Cartron
- Department of Clinical Haematology, Centre Hospitalier Universitaire de Montpellier, 80 Avenue Augustin Fliche, 34295, Montpellier, France
| | - David A Laplaud
- Department of Neurology, CRTI-InsermU1064, CIC 1413, Centre Hospitalier Universitaire de Nantes, 5 Allée de l'île Gloriette, 44093, Nantes, France
| | - Antoine F Carpentier
- Department of Neurology, Hôpital Saint-Louis, Assistance Publique - Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Université de Paris, Paris-Diderot, 75010, Paris, France
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47
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Jullien M, Guillaume T, Peterlin P, Garnier A, Le Bourgeois A, Debord C, Mahe B, Dubruille V, Wuilleme S, Blin N, Touzeau C, Gastinne T, Tessoulin B, Le Bris Y, Eveillard M, Duquesne A, Moreau P, Le Gouill S, Bene MC, Chevallier P. Antithymocyte globulin administration in patients with profound lymphopenia receiving a PBSC purine analog/busulfan-based conditioning regimen allograft. Sci Rep 2020; 10:15399. [PMID: 32958816 PMCID: PMC7505958 DOI: 10.1038/s41598-020-72415-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/01/2020] [Indexed: 11/09/2022] Open
Abstract
Graft-versus host disease (GVHD) remains one of the main causes of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (ASCT). Prophylactic T cell depletion via antithymocyte globulin (ATG) during ASCT conditioning is one of the standards of care for GVHD prophylaxis, although the optimal dosing strategy is still unclear. Recent studies have reported that absolute lymphocyte count at the time of ATG administration could predict survivals in ASCT from unrelated donors. Here this issue was examined in 116 patients receiving peripheral blood stem cells (PBSC) ASCT with purine analog/busulfan-based conditioning regimens between 2009 and 2019 in our department. The impact of lymphopenia at the time of ATG administration was evaluated in terms of overall survival, disease-free survival and GVHD-free/relapse-free survival. After a median follow-up of 4 years, no adverse effect of a profound lymphopenia was observed on patients' outcome. Notably, a reduced dose of ATG in patients with profound lymphopenia did not translate into better survivals. This study indicates that ATG can be administered whatever the recipient's lymphocyte counts in patients receiving a PBSC purine analog/busulfan-based conditioning regimen ASCT.
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Affiliation(s)
- Maxime Jullien
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France.
| | - Thierry Guillaume
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Pierre Peterlin
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Alice Garnier
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Amandine Le Bourgeois
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Camille Debord
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Beatrice Mahe
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Viviane Dubruille
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Soraya Wuilleme
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Nicolas Blin
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Cyrille Touzeau
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Thomas Gastinne
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Benoit Tessoulin
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Yannick Le Bris
- Hematology Biology, Nantes University Hospital, Nantes, France
| | | | | | - Philippe Moreau
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Steven Le Gouill
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
| | - Marie C Bene
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Patrice Chevallier
- Clinical Hematology, Nantes University Hospital, CHU de Nantes, 1 Place Alexis Ricordeau, 44000, Nantes, France
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48
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Le Gouill S, Beldi-Ferchiou A, Alcantara M, Cacheux V, Safar V, Burroni B, Guidez S, Gastinne T, Canioni D, Thieblemont C, Maisonneuve H, Bodet-Milin C, Houot R, Oberic L, Bouabdallah K, Bescond C, Damaj G, Jaccard A, Daguindau N, Moreau A, Tilly H, Ribrag V, Delfau-Larue MH, Hermine O, Macintyre E. Molecular response after obinutuzumab plus high-dose cytarabine induction for transplant-eligible patients with untreated mantle cell lymphoma (LyMa-101): a phase 2 trial of the LYSA group. Lancet Haematol 2020; 7:e798-e807. [PMID: 32971036 DOI: 10.1016/s2352-3026(20)30291-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Obinutuzumab monotherapy has shown promising efficacy in mantle cell lymphoma. We aimed to investigate the activity of obinutuzumab plus DHAP (dexamethasone, high-dose cytarabine, and cisplatin), measured by minimal residual disease quantitative (q)PCR status in the bone marrow after four cycles. METHODS LyMa-101 was a prospective, open-label, single-arm, phase 2 trial. Participants were enrolled from 28 hospitals in France. Newly diagnosed patients with mantle cell lymphoma (aged 18 to <66 years) who were eligible for autologous stem-cell transplantation received four cycles of obinutuzumab plus DHAP (obinutuzumab 1000 mg/m2 intravenously on days 1, 8, and 15 at cycle 1 and day 1 at cycles 2, 3, and 4; dexamethasone 40 mg intravenously on days 1-4, cytarabine 2 g/m2 intravenously every 12 h on day 1, and according to local investigator, cisplatin 100 mg/m2 by continuous infusion over 24 h on day 1 or carboplatin area under the curve 5 or oxaliplatin 130 mg/m2) every 21 days before transplantation, and 3 years of obinutuzumab (1000 mg/m2 every 2 months) maintenance followed by minimal residual disease-based obinutuzumab on-demand maintenance. The primary outcome was minimal residual disease negativity in the bone marrow after four cycles of obinutuzumab plus DHAP at the end of induction, measured in the efficacy set (all minimal residual disease-informative [bone marrow or peripheral blood] patients who received at least one dose of obinutuzumab). Obinutuzumab plus DHAP was considered effective if bone marrow minimal residual disease negativity was 70% or more by intention to treat. The trial is closed to recruitment and registered with ClinicalTrials.gov, NCT02896582. FINDINGS 86 patients were enrolled between Nov 29, 2016, and May 2, 2018. 81 patients completed induction, 73 underwent autologous stem-cell transplantation, and 69 started maintenance therapy. 55 (75%) of 73 patients in the efficacy set reached minimal residual disease negativity in bone marrow at end of induction. According to the protocol definition, 18 (25%) of 73 patients in the efficacy set were minimal residual disease-positive: 12 patients who were minimal residual disease-positive in the bone marrow, plus two patients who progressed during induction, and four patients who did not have minimal residual disease assessment. The most common grade 3-4 treatment-emergent adverse events were anaemia (grade 3, 26 [31%] of 85 patients; grade 4, three [4%] of 85 patients) and neutropenia (grade 3, 13 [15%] of 85 patients; grade 4, 32 [38%] of 85 patients). 58 serious adverse events occurred during the induction phase. There were no treatment-related deaths. INTERPRETATION Obinutuzumab plus DHAP is a well tolerated regimen and has good activity for inducing minimal residual disease negativity in the bone marrow of transplant-eligible patients with mantle cell lymphoma. Obinutuzumab plus DHAP has potential activity as induction chemotherapy, with bone marrow minimal residual disease negativity potentially predicting long-term disease control. FUNDING Roche SAS.
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Affiliation(s)
- Steven Le Gouill
- Service d'hématologie clinique, CHU de Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France.
| | - Asma Beldi-Ferchiou
- Biological Haematology and Immunology Department, Groupe Hospitalier Mondor, Assistance Publique Hôpitaux de Paris, INSERM U955, Paris, France
| | - Marion Alcantara
- Onco-Haematology, Université de Paris, Hôpital and Institut Necker-Enfants Malades, Assistance-Publique-Hôpitaux de Paris, INSERM U1151, Paris, France
| | - Victoria Cacheux
- Service d'hématologie clinique du CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Violaine Safar
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | | | - Stéphanie Guidez
- Service d'hématologie clinique du CHU de Poitiers, Poitiers, France
| | - Thomas Gastinne
- Service d'hématologie clinique, CHU de Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Danielle Canioni
- Onco-Haematology, Université de Paris, Hôpital and Institut Necker-Enfants Malades, Assistance-Publique-Hôpitaux de Paris, INSERM U1151, Paris, France
| | - Catherine Thieblemont
- Service d'hémato-oncologie, L'hôpital Saint-Louis AP-HP, Université de Paris, Paris, France
| | | | - Caroline Bodet-Milin
- Service de médecine nucléaire, CHU de Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Roch Houot
- Service d'Hématologie Clinique, CHU de Rennes, Université de Rennes, INSERM U1236, Rennes, France
| | - Lucie Oberic
- Service d'hématologie, IUC Toulouse Oncopole, Toulouse, France
| | | | | | - Ghandi Damaj
- Haematology Institute, Normandy University School of Medicine, Caen, France
| | | | | | - Anne Moreau
- Service d'anatomo-pathologie, CHU de Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Hervé Tilly
- Département d'Hématologie and U1245, Centre Henri Becquerel, Université de Rouen, Rouen, France
| | - Vincent Ribrag
- Département des Innovations Thérapeutiques et Essais Précoces, Université Paris-Saclay, Département d'Hématologie, Gustave Roussy, Université Paris-Saclay, Paris, France
| | - Marie-Hélène Delfau-Larue
- Biological Haematology and Immunology Department, Groupe Hospitalier Mondor, Assistance Publique Hôpitaux de Paris, INSERM U955, Paris, France
| | - Olivier Hermine
- Department of Adult Haematology, Université de Paris, Hôpital Necker-Enfants Malades, Assistance-Publique, Hôpitaux de Paris, Imagine Institute, INSERM U1153, Paris, France
| | - Elizabeth Macintyre
- Onco-Haematology, Université de Paris, Hôpital and Institut Necker-Enfants Malades, Assistance-Publique-Hôpitaux de Paris, INSERM U1151, Paris, France
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Paret R, Talarmin J, Le Bourgeois A, Guillerm G, Gastinne T, Couturier M, Boutoille D, Ansart S, Gaborit B. Arrêt de l’antibiothérapie en cours de neutropénie pour fièvre d’origine indéterminée en hématologie stérile : RELAPS, une étude de cohorte bicentrique descriptive. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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50
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Le Calvez B, Le Bris Y, Herbreteau G, Jamet B, Bossard C, Tessoulin B, Gastinne T, Mahé B, Dubruille V, Blin N, Antier C, Theisen O, Kraeber‐Bodéré F, Le Gouill S, Béné MC, Moreau P, Touzeau C. RAS mutation leading to acquired resistance to dabrafenib and trametinib therapy in a multiple myeloma patient harboring BRAF mutation. eJHaem 2020; 1:318-322. [PMID: 35847743 PMCID: PMC9175793 DOI: 10.1002/jha2.8] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/25/2022]
Abstract
Multiple myeloma (MM) is still considered incurable and new therapeutic approaches are therefore needed. Deep‐sequencing analysis revealed the presence of BRAF mutations in up to 15% of patients. The clinical experience of BRAF‐targeted therapy in myeloma patients harboring BRAF mutation is still limited. We here report the case of a patient with penta‐refractory (bortezomib, lenalidomide, carfilzomib, pomalidomide, and daratumumab) MM with extramedullary BRAF‐mutated disease that achieved clinical response to dual BRAF and MEK inhibition. At the time of disease progression, gene sequencing analysis of the tumor at the time of progression demonstrated a clonal evolution with emergence of a NRAS mutation and persistence of BRAF and TP53 mutations. Backtracking of the NRAS mutation was performed by digital polymerase chain reaction on the baseline biopsy and identified the pre‐existence of the NRAS at a subclonal level. This observation is the first report of acquired NRAS mutation leading to resistance to dual BRAF/MEK inhibitors in MM. These data suggest that a systematic search for RAS mutations using highly sensitive techniques should be performed before considering targeted therapy in relapsed myeloma with BRAF mutation.
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Affiliation(s)
| | - Yannick Le Bris
- Hematology BiologyUniversity Hospital Nantes France
- CRCINA, INSERM, CNRSUniversité d'AngersUniversité de Nantes Nantes France
- Site de Recherche Intégrée sur le Cancer (SIRIC) « ILIAD »INCA‐DGOS‐Inserm_12558 Nantes France
| | | | - Bastien Jamet
- Department of Nuclear MedicineUniversity Hospital Nantes France
- Site de Recherche Intégrée sur le Cancer (SIRIC) « ILIAD »INCA‐DGOS‐Inserm_12558 Nantes France
| | - Céline Bossard
- Service d'Anatomie et Cytologie Pathologiques, INSERM, CRCINAUniversité de Nantes, CHU Nantes Nantes F44000 France
| | - Benoit Tessoulin
- Department of HematologyUniversity Hospital Nantes France
- CRCINA, INSERM, CNRSUniversité d'AngersUniversité de Nantes Nantes France
| | | | - Béatrice Mahé
- Department of HematologyUniversity Hospital Nantes France
| | | | - Nicolas Blin
- Department of HematologyUniversity Hospital Nantes France
| | - Chloé Antier
- Department of HematologyUniversity Hospital Nantes France
| | | | - Françoise Kraeber‐Bodéré
- Department of Nuclear MedicineUniversity Hospital Nantes France
- CRCINA, INSERM, CNRSUniversité d'AngersUniversité de Nantes Nantes France
- Site de Recherche Intégrée sur le Cancer (SIRIC) « ILIAD »INCA‐DGOS‐Inserm_12558 Nantes France
| | - Steven Le Gouill
- Department of HematologyUniversity Hospital Nantes France
- CRCINA, INSERM, CNRSUniversité d'AngersUniversité de Nantes Nantes France
- Site de Recherche Intégrée sur le Cancer (SIRIC) « ILIAD »INCA‐DGOS‐Inserm_12558 Nantes France
| | - Marie C. Béné
- Hematology BiologyUniversity Hospital Nantes France
- CRCINA, INSERM, CNRSUniversité d'AngersUniversité de Nantes Nantes France
| | - Philippe Moreau
- Department of HematologyUniversity Hospital Nantes France
- CRCINA, INSERM, CNRSUniversité d'AngersUniversité de Nantes Nantes France
- Site de Recherche Intégrée sur le Cancer (SIRIC) « ILIAD »INCA‐DGOS‐Inserm_12558 Nantes France
| | - Cyrille Touzeau
- Department of HematologyUniversity Hospital Nantes France
- CRCINA, INSERM, CNRSUniversité d'AngersUniversité de Nantes Nantes France
- Site de Recherche Intégrée sur le Cancer (SIRIC) « ILIAD »INCA‐DGOS‐Inserm_12558 Nantes France
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