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Loirat M, Chevallier P, Leux C, Moreau A, Bossard C, Guillaume T, Gastinne T, Delaunay J, Blin N, Mahé B, Dubruille V, Augeul-Meunier K, Peterlin P, Maisonneuve H, Moreau P, Juge-Morineau N, Jardel H, Mohty M, Moreau P, Le Gouill S. Upfront allogeneic stem-cell transplantation for patients with nonlocalized untreated peripheral T-cell lymphoma: an intention-to-treat analysis from a single center. Ann Oncol 2014; 26:386-92. [PMID: 25392158 DOI: 10.1093/annonc/mdu515] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Peripheral T-cell lymphomas (PTCLs) are rare and heterogeneous diseases with dismal outcome when treated with chemotherapy alone. Because allogeneic stem-cell transplantation (allo-SCT) can cure relapse/refractory patients, we hypothesized that upfront allo-SCT may provide a better outcome. Therefore, all patients that presented with advanced PTCL in our institution at diagnosis were scheduled to undergo upfront allo-SCT after induction chemotherapy. PATIENTS AND METHODS The aim of the present work was to assess the feasibility and toxicity of upfront allo-SCT. From 2004 to 2012, 49 newly diagnosed PTCL patients were scheduled to receive upfront allo-SCT. A human leukocyte antigen-matched donor was found for 42 patients: related to the patient in 15 cases, unrelated in 20 cases, and suitable cord blood units were used in 7 cases. RESULTS After induction chemotherapy, 17 patients reached complete remission and 29 (60%) proceeded to upfront allo-SCT. For all patients, the 1 and 2-year overall survival (OS) rates were 59% [95% confidence interval (CI) 47-75] and 55% (95% CI 43-71), respectively. The most frequent reason we did not proceed to allo-SCT was disease progression or insufficient response after induction. For transplanted patients, the 1- and 2-year OS were 76% (95% CI 62-93) and 72.5% (95% CI 58-91), respectively. Toxicity-related mortality (TRM) 1 year after allo-SCT was only 8.2% (95% CI 0-18.5). The 2-year progression-free survival (PFS) rate of patients who did not proceed to allo-SCT (n = 20) was below 30%. The disease status at the time of transplantation was a strong predictive marker for both PFS and OS in transplant patients. CONCLUSIONS Upfront allo-SCT in PTCLs is feasible with low TRM, and it provides long-term disease control. However, one-third of patients remain chemo-refractory and, thus, new therapeutic approaches are warranted. The role of upfront allo-SCT compared with other therapeutic approaches in PTCLs requires investigation in randomized studies.
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Affiliation(s)
| | | | - C Leux
- Department of Epidemiology
| | - A Moreau
- Department of Pathology, University Hospital of Nantes, Nantes
| | - C Bossard
- Department of Pathology, University Hospital of Nantes, Nantes
| | | | | | | | | | | | | | | | | | | | - P Moreau
- Department of Hematology, CH de Lorient, La Roche-Sur-Yon
| | | | - H Jardel
- Department of Hematology, CH de Vannes, Vannes
| | - M Mohty
- Department of Hematology, Saint-antoine, APHP, Paris
| | | | - S Le Gouill
- Department of Hematology INSERM, UMR892, Equipe 10, Nantes INSERM, CIC 004, Nantes University Hospital, Nantes, France
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Peric Z, Cahu X, Chevallier P, Brissot E, Malard F, Guillaume T, Delaunay J, Ayari S, Dubruille V, Le Gouill S, Mahé B, Gastinne T, Blin N, Saulquin B, Harousseau JL, Moreau P, Coste-Burel M, Imbert-Marcille BM, Mohty M. Features of EBV reactivation after reduced intensity conditioning unrelated umbilical cord blood transplantation. Bone Marrow Transplant 2011; 47:251-7. [PMID: 21441959 DOI: 10.1038/bmt.2011.64] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This single centre study assessed the incidence, kinetics and predictive factors of EBV reactivation and EBV-related lymphoproliferative diseases (LPD) in 33 consecutive patients who received a reduced intensity conditioning (RIC) before umbilical cord blood transplantation (UCBT). During the first 6 months after UCBT, weekly all patients were DNA-PCR screened in the peripheral blood for EBV reactivation and were clinically monitored for clinical features attributable to EBV. The cumulative incidences of EBV reactivation (defined as an EBV load >1000 EBV copies per 10(5) cells measured at least once during follow-up) at 6 months and 2 years after UCBT were 9 (95% confidence interval (CI), 2-22%) and 17% (95% CI, 6-33%), respectively. In 28 patients (85%), the EBV load remained negative at all times, and none of these patients experienced any sign of LPD. Five patients (15%) experienced at least one EBV reactivation episode. EBV reactivation was observed at a median of 132 days (range, 85-438) after UCBT. Two patients developed EBV-related LPD (cumulative incidence, 6% at 3 years). With a median follow-up of 468 days (range, 92-1277) post UCBT, the OS was 62% at 3 years. Five patients died of disease progression and seven patients died of transplant-related complications, including one case of EBV-related LPD. Univariate analysis did not identify any significant risk factor associated with EBV reactivation. We conclude that patients undergoing RIC UCBT are at risk for EBV reactivation, with the need for close EBV monitoring and the use of preemptive rituximab treatment as some cases may progress to life-threatening LPD.
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Affiliation(s)
- Z Peric
- Service d'Hématologie Clinique, Centre Hospitalier et Universitaire (CHU) de Nantes, Nantes, France
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Maloisel F, Dubruille V, Varet B, Escoffre-Barbe M, Berthaud P, Meresse V, Mahon F, Preudhomme C, Guilhot J, Guilhot F. Design and first interim analysis of a randomized phase III trial comparing imatinib versus imatinib (IM) based combination therapies in newly diagnosed chronic myelogenous leukemia patients in chronic phase. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6589 Background: Despite impressive results achieved with IM 400 mg/day alone, only a minority of pts reached a complete molecular remission at 12-month. Higher dose of IM or its combination with other therapies might improve molecular remission. Design of the trial: the 3 experimental arms are IM 400mg daily in combination with Peg-IFN-α2a (Peg-IFNα2a, 90 μg weekly) or with Ara-C (20 mg/m2/day, days 15–28 of 28-day cycles) or IM 600mg daily. The reference arm is IM 400mg daily. All pts (over 18 years of age with Bcr-Abl positive CML) receive IM 400 mg/day as monotherapy days 1–14 and then start the assigned regimen for at least 12 months. The endpoints are overall survival (primary), rate and duration of hematologic, cytogenetic and molecular responses and tolerability. An interim analysis of the first 636 pts at 1 year from randomization will allow evaluation of molecular response rates, one of the experimental arm being selected for further comparison with IM 400. An experimental arm would be selected if it increased the 4 log reduction response rate at 12-month by at least 20 percentage points, (15% to 35%), with an acceptable tolerability. Results: This evaluation is based on a cohort of 370 pts with a median time of observation of 16 months, recruited between 9/2003 and 9/2005. [median age 53 yrs (18–81); Sokal distribution: 38% of pts low, 38% intermediate, and 24% high]. At 1 month 80% of pts achieved complete hematologic response. At 12 months, 138 pts (72%) achieved a major cytogenetic response, being complete in 120 pts (63%). Grade 3/4 hematologic toxicity occurred in 8% of IM400 pts, 9% of IM600 pts, 41% of IM+IFN pts and 33% of IM+Ara-c pts respectively. Dose of Peg IFN was reduced in 16% of pts, 45 μg per week being well tolerated. Grade 3/4 non hematological toxicity occurred in 11% of IM400 pts, 16% of IM600 pts, 10% of IM+IFN pts (maily skin rash) and 11% of IM+Ara-c pts. Discontinuation of experimental treatment occurred in 17% of IM600 pts, 36% of IM+IFN pts and 16% of IM+Ara-c pts. Conclusion: This first analysis confirmed both feasibility of IM combinations and high response rates. However a substantial hematological toxicity requires a careful assessment of pts. [Table: see text]
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Affiliation(s)
- F. Maloisel
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - V. Dubruille
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - B. Varet
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - M. Escoffre-Barbe
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - P. Berthaud
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - V. Meresse
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - F. Mahon
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - C. Preudhomme
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - J. Guilhot
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
| | - F. Guilhot
- Fi-Lmc; Department of Hematology, Strasbourg, France; Department of Hematology, Nantes, France; Department of Hematology, Paris, France; Department of Hematology, Rennes, France; Novartis Pharma France, Rueil-Malmaison, France; Roche Pharma, Paris, France; Laboratory of Hematology, Bordeaux, France; Laboratory of Hematology, Lille, France; Clinical Research Centre, Poitiers, France; Department of Hematology, Poitiers, France
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