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Dervin G, Mekinian A, Kahn J, Terriou L, Liozon E, Grignano E, Piette J, Beyne-Rauzy O, Geraldine F, Godmer P, Fenaux P, Fain O, Rossignol J, Launay D, Aouba A, Gillard J, Cardon T, Bouillet L, Broner T, Vinit J, Ades L, Salvado C, Toussirot E, Guilpain P, Groh M, Lapidus N, Carrat F. Efficacité des biothérapies dans les manifestations auto-immunes et systémiques des syndromes myélodysplasiques : étude multicentrique rétrospective de 29 patients. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soussan M, Hommada M, Abad S, Larroche C, Dhôte R, Fain O, Mekinian A. Comparaison du TEP au FDG et de l’angioscanner aortique pour la détection d’aortite au cours de l’artérite à cellules géantes. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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103
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Jachiet V, Mekinian A, Carrat F, Grignano E, Retbi A, Coppo P, Fain O. Manifestations auto-immunes et inflammatoires associées aux lymphomes : caractéristiques et pronostic d’une série rétrospective de 108 patients. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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104
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Mahévas T, Gobert D, Gatfossé M, Mekinian A, Fain O. [Insulin edema in hepatic glycogenosis]. Rev Med Interne 2016; 38:201-203. [PMID: 27745935 DOI: 10.1016/j.revmed.2016.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 03/06/2016] [Accepted: 05/02/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Hepatic glycogenosis is a rare syndrome, which includes poorly controlled diabetes mellitus, hepatomegaly, delayed puberty, and growth delay. Insulin edema is sometimes associated. CASE REPORT An 18-year-old woman presented with diffuse edema, hepatomegaly, amenorrhea, uncontrolled diabetes, and elevated transaminases and cholestasis. Hepatic ultrasonography and abdominal computed tomographic scan confirmed the hepatomegaly. The liver biopsy showed a massive glycogenosis and the diagnosis of hepatic glycogenosis was confirmed. Too large doses of insulin were responsible of diffuse edema. Diabetes equilibration and diminution of insulin intakes allow correction of this disorder. CONCLUSION Excess of insulin can lead to excessive hepatic glycogen storage by activation of glycogenosis enzymes. Biological manifestations consist on elevated liver enzymes and hyperlactatemia. There is a link between administration of high dose of insulin and edema. Hepatic glycogenosis should be suspected when diabetes is uncontrolled and be considered as a differential diagnosis of steatosis. It may be associated and revealed by insulin edema directly related to excessive insulin intakes.
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Bohelay G, Robert S, Bouges-Michel C, Gerin M, Levy A, Fain O, Caux F. Subcutaneous phaeohyphomycosis caused byExophiala spiniferain a European patient with lymphoma: a rare occurrence case report and literature review. Mycoses 2016; 59:691-696. [DOI: 10.1111/myc.12515] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 03/27/2016] [Accepted: 04/19/2016] [Indexed: 11/28/2022]
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106
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Urbina T, Adedjouma A, Maury E, Boffa J, Coppo P, Ronco P, Mekinian A, Fain O. Microangiopathie thrombotique (MAT) hématologique dans le cadre d’une vascularite associée aux ANCA. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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107
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Mekinian A, Bourrienne M, Carbillon L, Benbara A, Abisror N, Chollet-Martin S, Tigaizin A, Montestruc F, Fain O, Nicaise-Roland P. Anticorps non conventionnels chez les patientes avec des complications obstétricales : caractéristiques et efficacité du traitement. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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108
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Abisror N, Mekinian A, Gardano L, Dumoitier N, Dondi B, Cymbalista F, Leroy C, Fain O, Varin-Blank N. Lymphocytes B régulateurs dans le purpura thrombopénique immunologique de l’adulte. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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109
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Ricard L, Abisror N, Solary É, Willens C, Deligny C, Fain O, Ghrenassia E, Mekinian A. Fibrose rétropéritonéale associée à une leucémie myélomonocytaire chronique. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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110
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Jolly M, Galicier L, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Boutin DLTH, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Jallouli M, Leroux G, Cohen-Bittan J, Hulot JS, Arora S, Amoura Z, Piette JC, Costedoat-Chalumeau N. Quality of life in systemic lupus erythematosus: description in a cohort of French patients and association with blood hydroxychloroquine levels. Lupus 2016; 25:735-740. [DOI: 10.1177/0961203315627200] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Objectives Benefits of hydroxychloroquine (HCQ) use on physician reported outcomes are well documented in systemic lupus erythematosus (SLE). We assess for the first time the association and predictive value of blood HCQ levels towards health-related quality of life (HRQOL) in SLE. Methods Data from the PLUS study (a randomized, double-blind, placebo-controlled, multicentre study) were utilized. Blood HCQ levels were quantified by high-performance liquid chromatography along with HRQOL assessments (Medical Outcomes Study-SF-36) at baseline (V1) and month 7 (V2). Results 166 SLE patients’ data were analysed. Mean (SD) age and disease duration were 44.4 (10.7) and 9.3 (6.8) years. Eighty-seven per cent were women. Mean (SD, median, IQR) HCQ concentrations in the blood at V1 were 660 (314, 615, 424) ng/ml and increased to 1020 (632, 906, 781) ng/ml at V2 (mean difference 366 units, 95% confidence interval −472 to −260, p < 0.001). No significant correlations between HCQ concentrations with HRQOL domains at V1 or V2 were noted. There were no differences in HRQOL stratified by HCQ concentrations. HCQ concentrations at V1 or changes in HCQ concentration (V2-V1) were not predictive of HRQOL at V2 or changes in HRQOL (V2-V1). Conclusions No association of HCQ concentrations with current or longitudinal HRQOL were found in SLE.
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Mekinian A, Djelbani S, Viry F, Fain O, Soussan M. Place de l’imagerie dans l’évaluation des vascularites de gros vaisseaux. Rev Med Interne 2016; 37:245-55. [DOI: 10.1016/j.revmed.2015.10.353] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/08/2015] [Accepted: 10/27/2015] [Indexed: 12/13/2022]
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112
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Abbara S, Fain O, Saadoun D, Bachmeyer C, Mekininan A, Stankovic Stojanovic K, Mouthon L, Gilardin L, Amselem S, Grateau G, Georgin-Lavialle S. Vasculitis associated with familial Mediterranean fever: a study on 16 french adult cases. Pediatr Rheumatol Online J 2015. [PMCID: PMC4599869 DOI: 10.1186/1546-0096-13-s1-p128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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113
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Fraison J, Mekinian A, Braun T, Grignano E, Ades L, Brechignac S, Gardin C, Bourgarit-Durand A, Andres E, Fenaux P, Fain O. Hypervitaminémie B12 dans les syndromes myélodysplasiques : facteur de mauvais pronostic ? Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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114
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Vigneron C, Baudel J, Mekinian A, Gatfosse M, Guidet B, Maury E, Fain O. Le TRALI, une complication rare et sévère des immunoglobulines intraveineuses. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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115
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Bouillet L, Boccon-Gibod I, Launay D, Gompel A, Kanny G, Fabien V, Fain O. L’angiœdème héréditaire à C1-inhibiteur normal : caractéristiques cliniques et réponse au traitement par icatibant. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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116
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Abbara S, Saadoun D, Fain O, Bachmeyer C, Mekinian A, Stankovic K, Mouthon L, Terrier B, Gilardin L, Amselem S, Grateau G, Georgin-Lavialle S. Vascularites associées à la fièvre méditerranéenne familiale : étude de 17 cas. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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117
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Abisror N, Fain O, Mekinian A, Lefevre G, Berezne A, Morati-Hafsaoui C, Dufour J, Haroche J, Jeandel P, Noel N, Lhote F, Kahn J. Angiœdèmes épisodiques avec hyperéosinophilie ou syndrome de Gleich : à propos de 29 observations. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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118
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Ghrenassia E, Mekinian A, Chapelon-Abric C, Cosnes J, Lefevre G, Morell-Dubois S, Prendki V, Sève P, Dhôte R, Launay D, Valeyre D, Fain O. Sarcoïdoses avec atteinte du tube digestif. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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119
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Koné-Paut I, Quartier P, Fain O, Grateau G, Pillet P, Le Blay P, Bonnet F, Despert V, Stankovic K, Willemins L, Queré S, Reigneau O, Hachulla E. “Daily life of CAPS patients treated with canakinumab (Ilaris®) : data from the French observational study - ENVOL Study”. Pediatr Rheumatol Online J 2015. [PMCID: PMC4600039 DOI: 10.1186/1546-0096-13-s1-p162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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120
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Trad S, Venon M, Fain O, Hanslik T. Pseudo-entéro-Behçet associé aux hémopathies myéloprolifératives avec trisomie 8 : une indication potentielle de l’azacitidine ? Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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121
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Lageix F, Nicaise-Roland P, Houlier M, Zylberberg P, Dubrel M, Heulin M, Fain O, Lachassinne E, Héron B, Chollet-Martin S, Mekinian A, de Pontual L. Lien entre trouble du spectre autistique de l’enfant et anticorps antiphospholipides : une étude cas–témoin. Arch Pediatr 2015; 22:1140-6. [DOI: 10.1016/j.arcped.2015.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/24/2015] [Accepted: 08/18/2015] [Indexed: 12/18/2022]
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122
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Jallouli M, Galicier L, Zahr N, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Leroux G, Cohen-Bittan J, Sellam J, Mariette X, Blanchet B, Hulot JS, Amoura Z, Piette JC, Costedoat-Chalumeau N. Determinants of hydroxychloroquine blood concentration variations in systemic lupus erythematosus. Arthritis Rheumatol 2015; 67:2176-84. [PMID: 25989906 DOI: 10.1002/art.39194] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 05/05/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Blood concentrations of hydroxychloroquine (HCQ) vary widely among patients with systemic lupus erythematosus (SLE). A pharmacokinetic/pharmacodynamic relationship has been found in different situations, and a very low blood concentration of HCQ is a simple marker of nonadherence to treatment. Therefore, interest in blood HCQ concentration measurement has increased, but little is known about factors that influence blood HCQ concentration variability. This study was undertaken to analyze determinants of blood HCQ concentrations. METHODS We conducted a retrospective analysis of patient data, including data from the Plaquenil Lupus Systemic (PLUS) study, to determine the association of epidemiologic, clinical, and biologic factors with blood HCQ concentrations. Data for nonadherent patients (blood HCQ concentration <200 ng/ml) were excluded. RESULTS To examine homogeneous pharmacologic data, we restricted the analyses of the PLUS data to the 509 SLE patients receiving 400 mg/day. We found no association of ethnicity or smoking with blood HCQ concentrations and no pharmacokinetic drug-drug interaction with antacids or with inhibitors or inducers of cytochrome P450 enzymes. On multivariate analysis, high body mass index (P = 0.008), no treatment with corticosteroids (P = 0.04), increased time between the last tablet intake and measurement of blood HCQ concentrations (P = 0.017), low platelet count (P < 0.001), low neutrophil count (P < 0.001), and high estimated creatinine clearance (P < 0.001) were associated with low blood HCQ concentrations. In 22 SLE patients with chronic renal insufficiency (median serum creatinine clearance 52 ml/minute [range 23-58 ml/minute]) who received 400 mg/day HCQ, the median blood HCQ concentration was significantly higher than that in the 509 patients from the PLUS study (1,338 ng/ml [range 504-2,229 ng/ml] versus 917 ng/ml [range 208-3316 ng/ml]) (P < 0.001). CONCLUSION We provide a comprehensive analysis of determinants of blood HCQ concentrations. Because this measurement is increasingly being used, these data might be useful for clinicians.
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Vallet H, Riviere S, Sanna A, Deroux A, Moulis G, Addimanda O, Salvarani C, Lambert M, Bielefeld P, Seve P, Sibilia J, Pasquali J, Fraison J, Marie I, Perard L, Bouillet L, Cohen F, Sene D, Schoindre Y, Lidove O, Le Hoang P, Hachulla E, Fain O, Mariette X, Papo T, Wechsler B, Bodaghi B, Rigon MR, Cacoub P, Saadoun D. Efficacy of anti-TNF alpha in severe and/or refractory Behçet's disease: Multicenter study of 124 patients. J Autoimmun 2015; 62:67-74. [PMID: 26162757 DOI: 10.1016/j.jaut.2015.06.005] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/06/2015] [Accepted: 06/07/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To report the efficacy and safety of anti-TNF agents in patients with severe and/or refractory manifestations of Behçet's disease (BD). METHODS We performed a multicenter study of main characteristics and outcomes of anti-TNF alpha treatments [mainly infliximab (62%), and adalimumab (30%)] in 124 BD patients [48% of men; median age of 33.5 (28-40) years]. RESULTS Overall response (i.e. complete and partial) rate was 90.4%. Clinical responses were observed in 96.3%, 88%, 70%, 77.8%, 92.3% and 66.7% of patients with severe and/or refractory ocular, mucocutaneous, joint, gastro-intestinal manifestations, central nervous system manifestations and cardiovascular manifestations, respectively. No significant difference was found with respect to the efficacy of anti-TNF used as monotherapy or in association with an immunosuppressive agent. The incidence of BD flares/patient/year was significantly lower during anti-TNF treatment (0.2 ± 0.5 vs 1.7 ± 2.4 before the use of anti-TNF, p < 0.0001). The prednisone dose was significantly reduced at 6 and 12 months (p < 0.0001). In multivariate analysis, retinal vasculitis was negatively associated with complete response to anti-TNF (OR = 0.33 [0.12-0.89]; p = 0.03). The efficacy and relapse free survival were similar regardless of the type of anti-TNF agent used. After a median follow-up of 21 [7-36] months, side effects were reported in 28% of patients, including infections (16.3%) and hypersensitivity reactions (4.1%). Serious adverse events were reported in 13% of cases. CONCLUSION Anti-TNF alpha therapy is efficient in all severe and refractory BD manifestations. Efficacy appears to be similar regardless of the anti-TNF agent used (infliximab or adalimumab).
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Djelbani-Ahmed S, Chandesris MO, Mekinian A, Canioni D, Brouzes C, Hanssens K, Pop G, Durieu I, Durupt S, Grosbois B, Besnard S, Tournilhac O, Beyne-Rauzy O, Agapé P, Delmer A, Ranta D, Jeandel PY, Georgin-Lavialle S, Frenzel L, Damaj G, Eder V, Lortholary O, Hermine O, Fain O, Soussan M. FDG-PET/CT findings in systemic mastocytosis: a French multicentre study. Eur J Nucl Med Mol Imaging 2015; 42:2013-20. [PMID: 26140850 DOI: 10.1007/s00259-015-3117-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/10/2015] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Mastocytosis is a clonal haematological disease characterized by uncontrolled proliferation and the activation of mast cells. The value of FDG-PET/CT (FDG-PET) in mastocytosis has yet to be determined. METHODS We retrospectively identified patients with an established diagnosis of systemic mastocytosis (SM), according to the WHO criteria, who underwent PET using the French Reference Centre for Mastocytosis database. Semi-quantitative and visual analysis of FDG-PET was performed and compared to the clinico-biological data. RESULTS Our cohort included 19 adult patients, median age 65 years [range 58-74], including three with smouldering SM (SSM), three with aggressive SM (ASM), 10 with an associated clonal haematological non-mast-cell lineage disease (SM-AHNMD), and three with mast cell sarcoma (MCS). FDG-PET was performed at the time of the SM diagnosis (15/19), to evaluate lymph node (LN) activity (3/19) or the efficacy of therapy (1/19). FDG uptake was observed in the bone marrow (BM) (9/19, 47%), LN (6/19, 32%), spleen (12/19, 63%), or liver (1/19, 5%). No significant FDG uptake was observed in the SSM and ASM patients. A pathological FDG uptake was observed in the BM of 6/10 patients with SM-AHNMD, appearing as diffuse and homogeneous, and in the LN of 5/10 patients. All 3 MCS patients showed intense and multifocal BM pathological uptake, mimicking metastasis. No correlation was found between the FDG-PET findings and serum tryptase levels, BM mast cell infiltration percentage, and CD30 and CD2 expression by mast cells. CONCLUSIONS FDG uptake does not appear to be a sensitive marker of mast cell activation or proliferation because no significant FDG uptake was observed in most common forms of mastocytosis (notably purely aggressive SM). However, pathological FDG uptake was observed in the SM-AHNMD and in MCS cases, suggesting a role of FDG-PET in their early identification and as a tool of therapeutic assessment in this subgroup of patients.
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Salmon JH, Cacoub P, Combe B, Sibilia J, Pallot-Prades B, Fain O, Cantagrel A, Dougados M, Andres E, Meyer O, Carli P, Pertuiset E, Pane I, Maurier F, Ravaud P, Mariette X, Gottenberg JE. Late-onset neutropenia after treatment with rituximab for rheumatoid arthritis and other autoimmune diseases: data from the AutoImmunity and Rituximab registry. RMD Open 2015; 1:e000034. [PMID: 26509060 PMCID: PMC4612695 DOI: 10.1136/rmdopen-2014-000034] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 01/12/2023] Open
Abstract
Objectives To evaluate the prevalence of late-onset neutropenia and its complications in patients treated with rituximab (RTX) for rheumatoid arthritis (RA) and other autoimmune diseases (AIDs) in a prospective registry. Methods The AutoImmunity and Rituximab registry is an independent 7-year prospective registry promoted by the French Society of Rheumatology. For each episode of neutropenia, data were validated by the clinician in charge of the patient. Results Among 2624 patients treated with RTX for refractory AIDs, and at least 1 follow-up visit (a total follow-up of 4179 patient-years in RA and 987 patient-years in AIDs), late-onset neutropenia was observed in 40 patients (25 RA (1.3% of patients with RA, 0.6/100 patient-years), and AIDs in 15 (2.3% of patients with AIDs, 1.5/100 patient-years)). 6 patients (15%) had neutrophils <500/mm3, 8 (20%) had neutrophils between 500 and 1000/mm3, and 26 (65%) had neutrophils between 1000 and 1500/mm3. Neutropenia occurred after a median period of 4.5 (3–6.5) months after the last RTX infusion in patients with RA, and 5 (3–6.5) months in patients with AIDs. 5 patients (12.5%), 4 of them with neutrophils lower than 500/mm3, developed a non-opportunistic serious infection and required antibiotics and granulocyte colony-stimulating factor injections, with a favourable outcome. After resolution of their RTX-related neutropenia, 19 patients (47.5%) were re-treated, and neutropenia reoccurred in 3 of them. Conclusions Late-onset neutropenia might occur after RTX and may result in serious infections. Thus, monitoring of white cell count should be performed after RTX. However, in this large registry of patients with AIDs, the frequency of RTX-induced neutropenia was much lower than that previously reported in patients treated for blood malignancies or AIDs.
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