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Alsuliman T, Aubrun C, Bay JO, Beguin Y, Bigenwald C, Brissot E, Chalandon Y, Chevallier P, Pagliuca S, Magro L, Srour M. [Hematological toxicities post-CAR-T cells: Recommendations of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2024:S0007-4551(24)00119-X. [PMID: 38631984 DOI: 10.1016/j.bulcan.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 04/19/2024]
Abstract
Chimeric antigen receptor T cell (CAR-T cell) therapy has become a standard-of-care for several hematological and a promising treatment for solid malignancies or for selected non-malignant autoimmune disorders. Hematological complications following this treatment are very common with the majority of patients experiencing at least one cytopenia after CAR-T cell injections. The management of these adverse events is not standardized and represents an area of active research and unmet clinical needs. This harmonization workshop, gathering a group of experts who analyzed this topic, has been conceived for the optimization of the management of patients presenting with post-CAR-T cell hematological toxicities. Based on the data present in the literature, these practical recommendations were made to harmonize the practices of Francophone centers involved in the management of these patients.
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Affiliation(s)
- Tamim Alsuliman
- Service d'hématologie et de thérapie cellulaire, hôpital Saint-Antoine, AP-HP Sorbonne université, 184, Faubourg-Saint-Antoine, 75012 Paris, France.
| | - Clotilde Aubrun
- Coordination greffe-hémato, CHU Ambroise-Paré, 2, boulevard Kennedy, 7000 Mons, Belgique.
| | - Jacques Olivier Bay
- Service de thérapie cellulaire et d'hématologie clinique adulte, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
| | - Yves Beguin
- Department of Hematology and GIGA Laboratory of Hematology, University Hospital of Liège and ULiège, Liège, Belgique.
| | - Camille Bigenwald
- Département d'hématologie, Gustave-Roussy, université Paris Saclay, Villejuif, France.
| | - Eolia Brissot
- Service d'hématologie et de thérapie cellulaire, hôpital Saint-Antoine, AP-HP Sorbonne université, 184, Faubourg-Saint-Antoine, 75012 Paris, France.
| | - Yves Chalandon
- Service d'hématologie, département d'oncologie, hôpitaux universitaire Genève (HUG) et faculté de médecine, université de Genève, Genève, Suisse.
| | | | - Simona Pagliuca
- Service d'hématologie, UMR 7365, IMoPA, CNRS, campus Brabois Santé, hôpitaux de Brabois, CHRU de Nancy, université de Lorraine, Vandœuvre-lès-Nancy, France.
| | - Léonardo Magro
- Maladies du sang, hôpital Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France.
| | - Micha Srour
- Maladies du sang, hôpital Huriez, CHRU de Lille, rue Michel-Polonowski, 59000 Lille, France.
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Yakoub-Agha I, Greco R, Onida F, de la Cámara R, Ciceri F, Corbacioglu S, Dolstra H, Glass B, Kenyon M, McLornan DP, Neven B, de Latour RP, Peric Z, Ruggeri A, Snowden JA, Sureda A, Sánchez-Ortega I. Practice harmonization workshops of EBMT: an expert-based approach to generate practical and contemporary guidelines within the arena of hematopoietic cell transplantation and cellular therapy. Bone Marrow Transplant 2023:10.1038/s41409-023-01958-w. [PMID: 36973515 DOI: 10.1038/s41409-023-01958-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/21/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
AbstractFor hematopoietic cell transplantation (HCT) and cellular therapy (CT), clinical patient care is localized, and practices may differ between countries and from center to center even within the same country. Historically, international guidelines were not always adapted to the changing daily clinical practice and practical topics there were not always addressed. In the absence of well-established guidelines, centers tended to develop local procedures/policies, frequently with limited communication with other centers. To try to harmonize localized clinical practices for malignant and non-malignant hematological disorders within EBMT scope, the practice harmonization and guidelines (PH&G) committee of the EBMT will co-ordinate workshops with topic-specific experts from interested centers. Each workshop will discuss a specific issue and write guidelines/recommendations that practically addresses the topic under review. To provide clear, practical and user-friendly guidelines when international consensus is lacking, the EBMT PH&G committee plans to develop European guidelines by HCT and CT physicians for peers’ use. Here, we define how workshops will be conducted and guidelines/recommendations produced, approved and published. Ultimately, there is an aspiration for some topics, where there is sufficient evidence base to be considered for systematic reviews, which are a more robust and future-proofed basis for guidelines/recommendations than consensus opinion.
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Lebon D, Dujardin A, Caulier A, Joris M, Charbonnier A, Gruson B, Quint M, Castelain S, François C, Lacassagne MN, Guillaume N, Marolleau JP, Morel P. Ruxolitinib-induced reactivation of cytomegalovirus and Epstein-Barr virus in graft-versus-host disease. Leuk Res 2023; 125:107005. [PMID: 36580876 DOI: 10.1016/j.leukres.2022.107005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/17/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Steroid-refractory graft-versus-host disease (SR-GVHD) is a challenging complication of allogeneic hematopoietic stem cell transplantation, and leads to high morbidity and mortality rates. The orally administered, selective Janus-associated kinase 1/2 inhibitor ruxolitinib gives overall response rates (ORR) of more than 70 % in acute and chronic SR-GVHD. However, several studies have highlighted an elevated risk of cytomegalovirus (CMV) reactivation in patients with ruxolitinib-treated SR-GVHD. METHODS We therefore analyzed risk of CMV and Epstein-Barr virus (EBV) primary infection or reactivation in 57 patients with ruxolitinib-treated GVHD, while taking account of the competing risk (CR) of death prior to the first reactivation. RESULTS Initiation of ruxolitinib treatment was a significant adverse prognostic factor for the CR of first CMV reactivation (hazard ratio (HR)= 1.747, 95 % confidence interval (CI): 1.33-2.92, p < 0.0001) and first EBV reactivation (HR=2.657, 95 % CI: 1.82-3.87, p < 0.0001) during GVHD. In our cohort of ruxolitinib-treated patients, the ORR (48 % and 58 % for acute and chronic GVHD, respectively) and the toxicity profile (haematological adverse events in 29.8 % of the patients) were similar to the literature values. CONCLUSION Given ruxolitinib's efficacy in SR-GVHD, use of this drug should not be limited by the fear of viral reactivation; however, our present results emphasize the importance of monitoring the viral load.
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Affiliation(s)
- Delphine Lebon
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Amiens, Amiens, France; EA 4666, HEMATIM, Université de Picardie Jules Verne, Amiens, France.
| | - Adèle Dujardin
- Unité de Pharmacie Clinique Oncologique, CHU Amiens, Amiens, France
| | - Alexis Caulier
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Amiens, Amiens, France; EA 4666, HEMATIM, Université de Picardie Jules Verne, Amiens, France
| | - Magalie Joris
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Amiens, Amiens, France
| | - Amandine Charbonnier
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Amiens, Amiens, France
| | - Bérengère Gruson
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Amiens, Amiens, France
| | - Marine Quint
- Service de Recherche Clinique, CHU Amiens, Amiens, France
| | - Sandrine Castelain
- Laboratoire de Virologie, CHU Amiens, Amiens, France; UR 4294, UCVF, Université de Picardie Jules Verne, Amiens, France
| | - Catherine François
- Laboratoire de Virologie, CHU Amiens, Amiens, France; UR 4294, UCVF, Université de Picardie Jules Verne, Amiens, France
| | | | - Nicolas Guillaume
- EA 4666, HEMATIM, Université de Picardie Jules Verne, Amiens, France; Laboratoire d'Histocompatibilité, CHU Amiens, Amiens, France
| | - Jean-Pierre Marolleau
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Amiens, Amiens, France; EA 4666, HEMATIM, Université de Picardie Jules Verne, Amiens, France
| | - Pierre Morel
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU Amiens, Amiens, France; Département de Biostatistiques, EA 2694-Santé publique, Université de Lille, Centre Hospitalier Universitaire de Lille, Lille, France
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Srour M, Fayard A, Giannotti F, Giltat A, Guenounou S, Roy J, Schmitt J, Servais S, Alsuliman T, Agha IY, Guillerm G. [Graft failure, poor graft function erythroblastopenia: Actualization of definitions, diagnosis and treatment: Guidelines from the SFGM-TC]. Bull Cancer 2023; 110:S67-S78. [PMID: 36307323 DOI: 10.1016/j.bulcan.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
In this article, we discuss again the definition, the risk factor and guideline to treat the graft failure, the poor graft function and erythrobalstopenia. Graft failure is a severe but rare complication after hematopoietic cell transplantation (HCT). Despite disparity in the literature, we defined this complication and discussed the factor risks and recommendation for treatment based on new studies. Poor graft function is also a more frequent complication after HCT. New studies will soon be available to prove or not the current recommendation suggested in this article based on therapeutics medicine or cellular therapy. Erythroblastopenia, is a rarer complication post HCT. Despite anticipation for a better choice of compatibility donor/recipient, some patients still suffer from this complication.
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Affiliation(s)
- Micha Srour
- Hôpital Huriez, CHRU Lille, maladies du sang, rue Michel-Polonowski, 59000 Lille, France
| | - Amandine Fayard
- CHU de Clermont-Ferrand, service hématologie, 1, rue Lucie- et Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - Federica Giannotti
- HUG, service hématologie, rue Gabrielle-Perret-Gentil, 4, 1205 Genève, Suisse
| | - Aurelien Giltat
- CHU d'Angers, service hématologie, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Sarah Guenounou
- Institut universitaire du cancer de Toulouse-Oncopole, service d'hématologie, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex, France
| | - Jean Roy
- Hématologie, 5415, boulevard de l'assomption, QC H1T 2M4 Montréal, Canada
| | - Justine Schmitt
- CHU de Liège, service d'hématologie biologique et d'immuno-hématologie, Liège, Belgique
| | - Sophie Servais
- CHU de Liège, service d'hématologie clinique, Liège, Belgique
| | - Tamim Alsuliman
- AP-HP, hôpital Saint-Antoine, Sorbonne université, service d'hématologie, Paris, France.
| | - Ibrahim Yakoub Agha
- Université Lille, CHU de Lille, Infininite, Inserm U1286, 59000 Lille, France
| | - Gaelle Guillerm
- Hôpital Morvan, CHRU Brest, service d'hématologie, 2, avenue Foch, 29609 Brest cedex, France
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Beauvais D, Robin C, Thiebaut A, Alain S, Coiteux V, Ducastelle-Lepretre S, Marçais A, Ceballos P, Xhaard A, Redjoul R, Nguyen S, Brissot E, Joris M, Turlure P, Rubio MT, Chevallier P, Bénard N, Liautard C, Yakoub-Agha I. Effective Letermovir Prophylaxis of CMV infection post allogeneic hematopoietic cell transplantation: Results from the French temporary authorization of use compassionate program. J Clin Virol 2022; 148:105106. [PMID: 35182958 DOI: 10.1016/j.jcv.2022.105106] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
Abstract
We report the results of the French Temporary Authorization of Use (ATU) compassionate program of letermovir for primary prophylaxis conducted in 21 transplant centers. Patients were CMV seropositive allogeneic hematopoietic cell transplantation recipients and at high risk for CMV infection. Primary prophylaxis was defined as initiation of letermovir between day 0 and day +28 post-transplant. Between November 2017 and January 2019, 96 patients with a median age of 56 years received letermovir and follow-up data were available for 78 patients. The median time from transplant to letermovir initiation was 4 days, and the median duration of exposure to letermovir was 78 days, with 57 patients still on treatment at the cutoff date. Letermovir was temporarily discontinued in 4 patients (5.1%) and stopped in 39 patients (50.0%), in most cases due to planned end of treatment (n = 16, 20.5%). Fifteen patients (19.2%) each presented one positive CMV PCR, in median 13 days after letermovir initiation. Clinically significant CMV infection was reported in 5 patients (6.4%). No CMV disease was reported. At least one adverse drug reaction was reported for 12 patients (15.4%). In this early access program, letermovir was effective with comparable results of the phase 3 study with a low rate of clinically significant CMV infection, including in patients who were at high-risk for CMV infection.
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Affiliation(s)
- David Beauvais
- Univ Lille, CHU Lille, Hematology Department, Inserm, Infinite U1286, Lille, France.
| | - Christine Robin
- University Paris-Est-Créteil, Hematology Department, Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France
| | - Anne Thiebaut
- Hematology Department, CHU Grenoble, Grenoble, France
| | - Sophie Alain
- INSERM, CHU Limoges, RESINFIT, U1092, National Reference Center for Herpesviruses, Limoges University, Limoges, France
| | - Valérie Coiteux
- Univ Lille, CHU Lille, Hematology Department, Inserm, Infinite U1286, Lille, France
| | | | - Ambroise Marçais
- Department of adult hematology, Assistance Publique-Hôpitaux de Paris, university hospital Necker, Paris, France
| | - Patrice Ceballos
- Hematology Department, Saint-Eloi University Hospital, Montpellier, France
| | - Alienor Xhaard
- Hematology and transplantation unit, Saint Louis Hospital, APHP, Paris, France
| | - Rabah Redjoul
- University Paris-Est-Créteil, Hematology Department, Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France
| | - Stéphanie Nguyen
- Department of Hematology, AP-HP, Hôpital Pitié-Salpétrière, Sorbonne Université, Paris, France
| | - Eolia Brissot
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Magalie Joris
- Department of Haematology, Amiens University Medical Center, Amiens, France
| | - Pascal Turlure
- CHU Limoges, Univ. Limoges, Department of Hematology, Limoges, France
| | | | | | | | | | - Ibrahim Yakoub-Agha
- Univ Lille, CHU Lille, Hematology Department, Inserm, Infinite U1286, Lille, France
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Thevenet U, Daguenet E, Beszera SM, Cornillon J, Tavernier E, Schein F, Honeyman F, Guyotat D. Infectious risks in patients treated with extracorporeal photopheresis for graft-versus-host disease: A retrospective cohort study. J Clin Apher 2021; 37:106-116. [PMID: 34967023 DOI: 10.1002/jca.21957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/08/2021] [Accepted: 12/10/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Infections are common with significant mortality and morbidity in patients with graft-versus-host disease (GvHD). Extracorporeal photopheresis (ECP) is an advantageous treatment option for patients with GvHD because it is not immunosuppressive. The objective of this study was to assess the rate of infections and to determine risk factors in patients with GvHD. MATERIALS AND METHODS In a single-center cohort, we retrospectively collected data on infectious episodes by evaluating the clinical records of patients with GvHD treated by ECP since 2011. RESULTS A total of 47 patients were included in this study. At ECP initiation, there were 10 patients with acute GvHD and 37 with chronic GvHD. At the final follow-up, 200 infectious episodes were diagnosed in 91.5% of patients with an average follow-up of 25.9 months (ie, 1.97 infections per patient per year). Most episodes had positive outcomes as there was no death related to infections, and only six infections required long-term treatment. Higher dose of corticosteroids at the initiation of ECP was significantly associated with a shorter onset of the first infection (hazard ratio [HR] = 2.05; 95% confidence interval [CI] [1.17, 3.57]; P = .013). Unrelated donor transplants were significantly associated with a lower rate of infection (HR = 0.61; 95% CI [0.39, 0.95]; P = .028). CONCLUSION The results of our study suggest that ECP is associated with a low infection rate and an optimal clinical efficacy. Thus, ECP is still a suitable treatment for GvHD. Yet, a future study with a larger cohort will be necessary to deepen the identification of risk factors for infection.
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Affiliation(s)
- Ugo Thevenet
- Department of Clinical Hematology and Cellular Therapy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Elisabeth Daguenet
- Department of Clinical Hematology and Cellular Therapy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Silvia-Maria Beszera
- Department of Clinical Hematology and Cellular Therapy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Jérôme Cornillon
- Department of Clinical Hematology and Cellular Therapy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Emmanuelle Tavernier
- Department of Clinical Hematology and Cellular Therapy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Flora Schein
- Department of Internal Medicine, CHU de Saint-Étienne, Saint-Étienne, France
| | - Fressia Honeyman
- Department of Clinical Hematology and Cellular Therapy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Denis Guyotat
- Department of Clinical Hematology and Cellular Therapy, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
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Scoring system for clinically significant CMV infection in seropositive recipients following allogenic hematopoietic cell transplant: an SFGM-TC study. Bone Marrow Transplant 2020; 56:1305-1315. [PMID: 33339900 DOI: 10.1038/s41409-020-01178-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/06/2020] [Accepted: 11/25/2020] [Indexed: 11/08/2022]
Abstract
In order to identify cytomegalovirus (CMV)-seropositive patients who are at risk of developing CMV infection following first allogeneic hematopoietic cell transplantation (allo-HCT), we built up a scoring system based on patient/donor characteristics and transplantation modalities. To this end, 3690 consecutive patients were chronologically divided into a derivation cohort (2010-2012, n = 2180) and a validation cohort (2013-2014, n = 1490). Haploidentical donors were excluded. The incidence of first clinically significant CMV infection (CMV disease or CMV viremia leading to preemptive treatment) at 1, 3, and 6 months in the derivation cohort was 13.8%, 38.5%, and 39.6%, respectively. CMV-seropositive donor, unrelated donor (HLA matched 10/10 or HLA mismatched 9/10), myeloablative conditioning, total body irradiation, antithymocyte globulin, and mycophenolate mofetil significantly and independently affected the incidence of 3-month infection. These six factors were selected to build up the prognostic model. Four risk groups were defined: low, intermediate-low, intermediate-high, and high-risk categories, with a 3-month predicted incidence of first clinically significant CMV infection in the derivation cohort of 22.2%, 31.1%, 45.4%, and 56.9%, respectively. This score represents a framework for the evaluation of patients who are at risk of developing clinically significant CMV infection following allo-HCT. Prospective studies using this score may be of benefit in assessing the value of anti-CMV prophylaxis in well-defined patient cohorts.
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8
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Peffault De Latour R, Chevallier P, Blaise D, Alami S, Lévy-Bachelot L, Allavoine T, Tadmouri A, Blomkvist J, Duhamel A, Srour M, Beauvais D, Yakoub-Agha I. Clinical and economic impact of treated CMV infection in adult CMV-seropositive patients after allogeneic hematopoietic cell transplantation. J Med Virol 2020; 92:3665-3673. [PMID: 32297984 DOI: 10.1002/jmv.25895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 03/31/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Recipients of allogeneic hematopoietic stem cell transplantation (allo-HCT) with positive cytomegalovirus (CMV) serology are at increased risk of morbidity and mortality. The primary objective of this study was to assess the association between treated CMV infection and overall mortality within 1 year after allo-HCT in adult CMV-seropositive Recipients (R+). Secondary objectives included overall 5-year mortality after allo-HCT, risk factors for treated CMV infection, associations between treated CMV infection and allo-HCT complications and medical costs. METHODS A multicenter retrospective cohort study was conducted in adult CMV-seropositive recipients (R+) who underwent to allo-HCT between 1st January 2010 and 31st December 2014. RESULTS Five hundred seventy two CMV-seropositive patients (mean age, 50.2 years) undergoing allo-HCT between 2010 and 2014 were included; 55.9% of donors were CMV seropositive. CMV infection treated with antiviral therapy was reported in 227 patients (39.7%) after transplantation. One-year overall mortality was significantly increased in patients with treated CMV infections (hazard ratio, 1.86; 95% CI, 1.16-3.00; P = .011). Mean medical costs during the first post-HCT year were higher in patients with CMV infection (€46 853 vs €31 318; P < .0001). CONCLUSION In this large cohort of CMV-seropositive patients undergoing allo-HCT, treated CMV infection was significantly associated with an increased 1-year risk of overall mortality, with increased length of stay and with hospitalization cost. The burden of CMV disease in allo-HCT could be reduced in the future by appropriate prophylactic strategies.
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Affiliation(s)
| | | | - Didier Blaise
- Institut Paoli Calmettes, Department of Hematology, Centre de Recherche en Cancérologie de Marseille (CRCM), Marseille, France
| | | | | | | | | | | | - Alain Duhamel
- Université de Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
| | - Micha Srour
- Hematology Department, Claude Huriez Hospital, Lille, France
| | - David Beauvais
- Hematology Department, Claude Huriez Hospital, Lille, France
- Lille University Hospital, Lille, France
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9
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Brissot E, Alsuliman T, Beauvais D, Bonnin A, Mear JB, Souchet L, Villate A, Yakoub-Agha I, Bazarbachi A. [Antiviral prophylaxis for CMV, HSV/VZV and HBV in allogeneic hematopoietic cell transplantation in adult patients: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2019; 107:S1-S6. [PMID: 31627903 DOI: 10.1016/j.bulcan.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/14/2019] [Accepted: 09/04/2019] [Indexed: 02/08/2023]
Abstract
The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) organizes annual workshops in the attempt to harmonize clinical practices among different francophone transplantation centers. Here, we report our recommendations regarding the prophylaxis of cytomegalovirus (CMV), herpes simplex virus (HSV), varicella zoster virus (VZV) and hepatitis B virus infection after allogeneic hematopoietic cell transplantation in adult patients.
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Affiliation(s)
- Eolia Brissot
- Hôpital Saint-Antoine, Sorbonne université, service d'hématologie clinique et thérapie cellulaire, Inserm, UMRs 938, 75012 Paris, France.
| | - Tamim Alsuliman
- Hôpital Saint-Antoine, Sorbonne université, service d'hématologie clinique et thérapie cellulaire, Inserm, UMRs 938, 75012 Paris, France
| | - David Beauvais
- Université de Lille, CHU de Lille, LIRIC, Inserm U995, 59000 Lille, France
| | - Agnès Bonnin
- Hôpital Saint-Antoine, Sorbonne université, service d'hématologie clinique et thérapie cellulaire, Inserm, UMRs 938, 75012 Paris, France
| | | | - Laetitia Souchet
- Hôpital La Pitié-Salpétrière, Sorbonne université, service d'hématologie clinique, 75013 Paris, France
| | - Alban Villate
- CHRU de Tours, service d'hématologie clinique, 37000 Tours, France
| | | | - Ali Bazarbachi
- American university of Beirut, department of internal medicine, Beyrouth, Liban
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10
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Detrait M, de Berranger E, Dulery R, Ménard AL, Thépot S, Toprak SK, Turlure P, Yakoub-Agha I, Guillaume T. [Hepatobiliary complications following allogeneic hematopoietic cell transplantation: Recommendations of the Francophone Society of Bone Marrow transplantation and cellular Therapy (SFGM-TC)]. Bull Cancer 2019; 107:S18-S27. [PMID: 30952358 DOI: 10.1016/j.bulcan.2019.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
Hepatobiliary complications are frequent in the context of allogeneic hematopoietic cell transplantation (allo-HCT) and contribute largely to the morbidity and mortality after transplantation. Within the framework of the ninth workshops of practice harmonization of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) held in Lille in September 2018, diagnostic approaches and treatments of hepatobiliary dysfunctions prior to and following transplantation were reviewed according to the analysis of published studies.
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Affiliation(s)
- Marie Detrait
- CHU de Nancy, hôpitaux de Brabois, service d'hématologie, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - Eva de Berranger
- CHRU de Lille, hôpital Jeanne-de-Flandres, service d'hématologie pédiatrique, avenue Eugène-Aviné, 59037 Lille cedex, France
| | - Remy Dulery
- Hôpital Saint-Antoine, service d'hématologie clinique, 184, rue de Faubourg-Saint-Antoine, 75012 Paris, France
| | - Anne-Lise Ménard
- Centre Henri-Becquerel, département d'hématologie clinique, rue d'Amiens, 76038 Rouen, France
| | - Sylvain Thépot
- CHU d'Angers, service d'hématologie, 4, rue Larrey, 49033 Angers, France
| | - Selami Kocak Toprak
- Hôpital Cebeci, université d'Ankara, faculté de médecine, service d'hématologie, Tip Fakultesi Caddesi, Dikimevi, 06620 Ankara, Turquie
| | - Pascal Turlure
- CHU de Limoges, service d'hématologie, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - Ibrahim Yakoub-Agha
- CHU de Lille, LIRIC, Inserm U995, université de Lille, service d'hématologie, 59000 Lille, France
| | - Thierry Guillaume
- Hôtel-Dieu, CHU de Nantes, service d'hématologie clinique, 1, place Ricordeau, 44000 Nantes, France.
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11
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Delapierre B, Reman O, Dina J, Breuil C, Bellal M, Johnson-Ansah H, Gac AC, Damaj G, Chantepie S. Low dose Rituximab for pre-emptive treatment of Epstein Barr virus reactivation after allogenic hematopoietic stem cell transplantation. Curr Res Transl Med 2019; 67:145-148. [PMID: 30871955 DOI: 10.1016/j.retram.2019.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The most used preemptive therapy for Epstein Barr virus reactivation post allogeneic hematopoietic stem cell (HSCT) transplant is Rituximab, 375 mg/m2, once weekly until EBV viremia negativity. There is no data suggesting such a high dose. OBJECTIVE We hypothesized that a lower dose of Rituximab would be as efficient with less toxicity. PATIENTS In a retrospective, monocentric study, we analyzed 16 consecutive patients treated preemptively with low dose Rituximab for EBV reactivation post HSCT. Patients were treated with low Rituximab dose of 100 mg/m² weekly. Success was defined by a decrease of EBV viremia of 1 log10 and below 1000 UI/ml, and the absence of post-transplant lymphoproliferative disorder (PTLD). RESULTS Success rate was 93.4% (15/16). One (1/16, 6%) PTLD was diagnosed after preemptive therapy, despite a negative viremia. CONCLUSION A low dose of Rituximab of 100 mg/m² per injection for pre-emptive therapy of EBV reactivation post HSCT is safe and effective for preventing PTLD. Prospective, randomized, multicentric trials with larger number of patient are needed to determine the best rituximab dose.
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Affiliation(s)
- B Delapierre
- Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - O Reman
- Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - J Dina
- CHU de Caen, Department of Virology, Normandie Univ, 1400 Caen, France
| | - C Breuil
- Pharmacie du Centre Hospitalo-universitaire (CHU) de Caen, 14000, Caen, France
| | - M Bellal
- Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - H Johnson-Ansah
- Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - A C Gac
- Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - G Damaj
- Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France
| | - S Chantepie
- Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000 Caen, France.
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12
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Evaluation of infectious complications after haploidentical hematopoietic stem cell transplantation with post-transplant cyclophosphamide following reduced-intensity and myeloablative conditioning: a study on behalf of the Francophone Society of Stem Cell Transplantation and Cellular Therapy (SFGM-TC). Bone Marrow Transplant 2019; 54:1586-1594. [PMID: 30770870 DOI: 10.1038/s41409-019-0475-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/25/2019] [Accepted: 02/03/2019] [Indexed: 01/16/2023]
Abstract
Several approaches have been developed to overcome historical barriers associated with poor outcomes in the setting of HLA-haploidentical allogeneic transplantation (HaploSCT). Here, we examine the outcome of patients with various hematological disorders undergoing HaploSCT with high-dose, post-transplantation cyclophosphamide. We performed a retrospective study on 381 patients from 30 centers between January 2013 and December 2015. At the last follow-up, a total of 1058 infectious episodes were diagnosed, affecting 90.3% of the cohort. Median time to first infection was 13 days for bacterial, 32 days for viral and 20 days for fungal infections. Around 41% of these infections were of bacterial origin and 35% of viral origin, among which 48.8% of patients presented CMV reactivation. Median of GVHD relapse-free survival, progression-free survival and overall survival were 7.1 months, 19.9 months and 33.5 months, respectively. HSCT procedure was the primary or contributing cause of death (55.6%), followed by relapse of the original disease (34.2%). Infections accounted for 45.7% of the HSCT-related deaths. The present multicenter data on a large cohort of patients receiving HaploSCT with PTCy confirmed the feasibility of the procedure with an acceptable incidence of infectious complications, not different as compared to other haploidentical platforms or HLA-matched transplantation.
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13
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Hakimi Z, Ferchichi S, Aballea S, Odeyemi I, Toumi M, English M, Yakoub-Agha I. Burden of cytomegalovirus disease in allogeneic hematopoietic cell transplant recipients: a national, matched cohort study in an inpatient setting. Curr Res Transl Med 2018; 66:95-101. [PMID: 30274738 DOI: 10.1016/j.retram.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE OF THE STUDY No studies have compared the risk of mortality or graft-versus-host disease, in an inpatient setting in France, in allogeneic hematopoietic cell transplant recipients who develop cytomegalovirus disease with those who do not. This study assessed the impact of cytomegalovirus disease on clinical outcomes and healthcare resource utilization in allogeneic hematopoietic cell transplant recipients using the French Programme de Médicalisation des Systèmes d'Information database. PATIENTS AND METHODS Recipients who had undergone allogeneic hematopoietic cell transplant in French hospitals between 2008 and 2011 were included in this retrospective, matched cohort study. Those with cytomegalovirus disease were each matched with two allogeneic hematopoietic cell transplant recipients without cytomegalovirus disease according to demographic and clinical characteristics. Probabilities of in-hospital mortality, graft rejection and/or graft-versus-host disease, and healthcare resource utilization were compared up to 12 months after cytomegalovirus disease diagnosis. RESULTS Overall, 4884 transplant recipients were enrolled, of which 194 had cytomegalovirus disease. Of these, 165 recipients with cytomegalovirus disease were matched to 330 without cytomegalovirus disease (1:2 ratio). The development of cytomegalovirus disease was associated with a significantly higher risk of in-hospital mortality (relative risk = 1.7, p = 0.0005) and higher cumulative number of inpatient days (p < 0.0001), but was not associated with a significantly higher risk of graft rejection and/or graft-versus-host disease or healthcare costs. CONCLUSIONS Due to the increased risk of in-hospital mortality and higher cumulative number of inpatient days in allogeneic hematopoietic cell transplant recipients with cytomegalovirus disease versus those without, new strategies to prevent and manage cytomegalovirus disease are warranted.
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Affiliation(s)
- Z Hakimi
- Astellas Pharma Europe B.V., Sylviusweg 62, PO Box 344, Leiden, 2300 AH, The Netherlands
| | - S Ferchichi
- Health Economics & Outcomes Research, Creativ-Ceutical, 215 rue du Faubourg Saint-Honoré, Paris, 750086, France
| | - S Aballea
- Health Economics & Outcomes Research, Creativ-Ceutical, 215 rue du Faubourg Saint-Honoré, Paris, 750086, France
| | - I Odeyemi
- Astellas Pharma Europe Ltd., 2000 Hillswood Drive, Chertsey, KT16 0RS, UK
| | - M Toumi
- University Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, Lyon, 69622, France
| | - M English
- Astellas Pharma Global Development, Inc., Northbrook, 60062, IL, USA.
| | - I Yakoub-Agha
- CHU de Lille, LIRIC, INSERM U995, Université de Lille, 59000, France
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