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Yafour N, Hamzy F, Elkababri M, Yakoub-Agha I, Bekadja MA. [Acute lymphoblastic leukemia in developing countries: Management from the transplant indication (allo/auto) until post-transplant follow-up. Guidelines from the SFGM-TC]. Bull Cancer 2023; 110:S30-S38. [PMID: 35562231 DOI: 10.1016/j.bulcan.2022.02.011] [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: 02/06/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 11/26/2022]
Abstract
Management of acute lymphoblastic leukemia (ALL) patients in countries with limited resources depends on the means of prognostic stratification, available treatment and logistics. During the 12th annual harmonization workshops of the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC), a designated working group reviewed the literature in order to elaborate unified guidelines for allogeneic hematopoietic cell transplantation (Allo-HCT) in this disease. Conventional poor prognostic factors can be used to determine the indication of allo-HCT in first remission. Patients lacking a HLA-matched related donor can be allografted with a haploidentical donor allo-HCT if available. Chemotherapy based conditioning regimen can be used if TBI is not available, because the probability to find a radiotherapy department with the capacity for total body irradiation is low. For patients with Philadelphia chromosome positive (Phi+) ALL, post-transplantation tyrosine kinase inhibitors as a systematic maintenance strategy is recommended. Autologous HCT is optional for Phi+ ALL patients with negative minimal residual disease, who not eligible for allo-HCT. Patients with refractory/relapsed disease have a poor prognosis which highlights the importance of acquiring in the future new therapies such as: blinatumumab, inotuzumab, and CAR-T cells.
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Affiliation(s)
- Nabil Yafour
- Université d'Oran 1, Ahmed-Ben-Bella, établissement hospitalier et universitaire 1(er) Novembre 1954, faculté de médecine, service d'hématologie et de thérapie cellulaire, BP 4166 Ibn-Rochd, 31000 Oran, Algérie.
| | - Faty Hamzy
- Hôpital Cheikh-Zaïd universitaire international, service d'hématologie et greffe, cité Al-Irfane-Hay Ryad avenue Allal-al-Fassi, 10000 Rabat, Maroc
| | - Maria Elkababri
- Hôpital d'enfants de Rabat, université Mohammed V de Rabat, service d'hématologie et oncologie pédiatrique, Rabat, Maroc
| | | | - Mohamed Amine Bekadja
- Université d'Oran 1, Ahmed-Ben-Bella, établissement hospitalier et universitaire 1(er) Novembre 1954, faculté de médecine, service d'hématologie et de thérapie cellulaire, BP 4166 Ibn-Rochd, 31000 Oran, Algérie
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2
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Charra F, Philippe M, Herledan C, Caffin AG, Larbre V, Baudouin A, Schwiertz V, Vantard N, Labussiere-Wallet H, Ducastelle-Leprêtre S, Barraco F, Balsat M, Larcher MV, Salles G, Rioufol C, Ranchon F. Immunosuppression medication adherence after allogeneic hematopoietic stem cell transplant: Impact of a specialized clinical pharmacy program. J Oncol Pharm Pract 2021:10781552211000115. [PMID: 33683151 DOI: 10.1177/10781552211000115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aims to evaluate the impact of implementing a specialized clinical pharmacy program in patients with allogeneic hematopoietic stem cell transplant (HSCT) on their adherence to the immunosuppression treatment after discharge. A prospective open interventional design using a retrospective control group was used. The intervention was based on pharmaceutical consultations: the first was performed the day before discharge of HSCT unit and the next consultations during day-care follow-up (weeks 2 and 4 after discharge). Proactive medication reconciliation was implemented with a complete list of medications before the discharge prescription. The discharge prescription summarized on a personalized drug schedule was explained to the patient. The importance of optimal adherence and the potential problems related to self-medication were explained to the patient. Immunosuppression drug adherence was assessed by a direct method using serum levels of calcineurin inhibitors. The potential impact on acute GvHD, and infection was investigated. Twenty-six patients were included in the specialized clinical pharmacy program and 35 patients were in the control group. Seventy-nine pharmaceutical consultations were conducted in the intervention group, lasting a mean 25 min and 16 min for the first and following consultations, respectively. Serum levels in the therapeutic target range were higher in the intervention group (61.5% versus 53.0%, p = 0.07), with greater intra-individual variation (p = 0.005). There was no significant intergroup difference in acute GvHD (53.8% versus 50.3%, p = 0.85) or infection (26.9 versus 22.8%, p = 0.72). The implementation of a specialized clinical pharmacy program for patients who have received allogeneic HSCT seems to be beneficial for immunosuppression drug adherence; this now needs to be confirmed in a multicenter study involving a larger number of patients.
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Affiliation(s)
- Florent Charra
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Michael Philippe
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Chloé Herledan
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
- University Lyon 1, EA CICLY Centre pour l'innovation en cancérologie, Lyon, France
| | - Anne-Gaëlle Caffin
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Virginie Larbre
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
- University Lyon 1, EA CICLY Centre pour l'innovation en cancérologie, Lyon, France
| | - Amandine Baudouin
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Vérane Schwiertz
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Nicolas Vantard
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
| | - Hélène Labussiere-Wallet
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Sophie Ducastelle-Leprêtre
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Fiorenza Barraco
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Marie Balsat
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Marie Virginie Larcher
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Gilles Salles
- Hospices Civils de Lyon, Hematology Department, Blood and Marrow Transplantation Unit, Pierre Bénite, France
| | - Catherine Rioufol
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
- University Lyon 1, EA CICLY Centre pour l'innovation en cancérologie, Lyon, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Clinical Oncology Pharmacy Department, Groupement Hospitalier Sud, Pierre Bénite, France
- University Lyon 1, EA CICLY Centre pour l'innovation en cancérologie, Lyon, France
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3
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Belaiche S, Décaudin B, Caron A, Depas N, Vignaux C, Vigouroux S, Coiteux V, Magro L, Sirvent A, Huynh A, Turlure P, Farge D, Lioure B, Bruno B, De Berranger E, Maillard N, Bourhis JH, Bay JO, Bulabois CE, Ceballos P, Fegueux N, Hicheri Y, Vincent L, Rialland F, Gandemer V, Taque S, Cornillon J, Contentin N, Galambrun C, Plantaz D, Odou P, Yakoub-Agha I. Medication non-adherence after allogeneic hematopoietic cell transplantation in adult and pediatric recipients: a cross sectional study conducted by the Francophone Society of Bone Marrow Transplantation and Cellular Therapy. Fundam Clin Pharmacol 2020; 35:435-445. [PMID: 32740936 DOI: 10.1111/fcp.12593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 06/09/2020] [Accepted: 07/27/2020] [Indexed: 12/14/2022]
Abstract
Medication non-adherence (NA) after allogeneic hematopoietic cell transplantation (allo-HCT) can lead to serious complications. This study assesses NA in French adult and pediatric recipients and identifies factors associated with NA. In accordance with the EMERGE and STROBE guidelines, a cross sectional multicentric survey was conducted. We used a self-reported questionnaire that was adapted to adults and pediatrics and that could provide a picture of all three phases of medication adherence: initiation, implementation, persistence. We enrolled 242 patients, 203 adults (mean age: 51 years old, 50.7% male) and 39 children (mean age: 9 years old, 56.4% female). Reported NA was estimated at about 75% in both populations, adults and pediatrics. In adults, the univariate analysis showed that patients less than 50 years old (P = 0.041), (i) treated with cyclosporine (P = 0.02), (ii) treated with valacyclovir/acyclovir (P = 0.016), and (iii) experiencing side effects (P = 0.009), were significantly more non-adherent. In multivariate analysis, only recipient age was significantly associated to NA (P = 0.05). The limited size of the pediatric population did not allow us to draw any statistical conclusion about this population. To the best of our knowledge, this is the first study in France on NA in allo-HCT recipients. Our results highlight the age factor as the only factor related to NA. Further studies are needed to confirm our observations and refine results in pediatric populations, currently most at risk of medication NA.
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Affiliation(s)
| | | | - Alexandre Caron
- EA 2694 - Santé publique: épidémiologie et qualité des soins, CHU Lille, Univ. Lille, Lille, F-59000, France
| | - Nicolas Depas
- EA 2694 - Santé publique: épidémiologie et qualité des soins, CHU Lille, Univ. Lille, Lille, F-59000, France
| | - Claire Vignaux
- Service Hématologie Adulte, CHU Bordeaux, Bordeaux Cedex, F-33076, France
| | - Stephane Vigouroux
- Service Hématologie Adulte, CHU Bordeaux, Bordeaux Cedex, F-33076, France
| | | | | | - Anne Sirvent
- Service Hématologie Pédiatrique, CHU Montpellier, Montpellier, F-34090, France
| | - Anne Huynh
- Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse Cedex 9, F-31059, France
| | - Pascal Turlure
- Service Hématologie Adulte, CHU Dupuytren, Limoges Cedex, F-87042, France
| | - Dominique Farge
- Service Hématologie Adulte, APHP- Hopital Saint Louis, Paris, F-75010, France
| | - Bruno Lioure
- Service Hématologie Adulte, Hopital de Hautepierre, CHU de Strasbourg, Strasbourg, F-67200, France
| | - Bénédicte Bruno
- Service Hématologie Pédiatrique, CHU Lille, Lille, F-59000, France
| | - Eva De Berranger
- Service Hématologie Pédiatrique, CHU Lille, Lille, F-59000, France
| | - Natacha Maillard
- Service Hématologie Adulte, CHU Poitier, Poitier, F-86000, France
| | - Jean-Henri Bourhis
- Service Hématologie Adulte, Institut Gustave Roussy, Villejuif Cedex, F-94805, France
| | | | | | - Patrice Ceballos
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Nathalie Fegueux
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Yosr Hicheri
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Laure Vincent
- Service Hématologie Adulte, CHU Montpellier, Montpellier, F-34090, France
| | - Fanny Rialland
- Service Hématologie Pédiatrique, CHU Nantes, Nantes, F-44000, France
| | - Virginie Gandemer
- Service Hématologie Pédiatrique, CHU Rennes, Rennes Cedex 9, F-35033, France
| | - Sophie Taque
- Service Hématologie Pédiatrique, CHU Rennes, Rennes Cedex 9, F-35033, France
| | - Jérôme Cornillon
- Service Hématologie Adulte, Institut de Cancérologie Lucien Neuwirth, Saint Etienne, F-42000, France
| | - Nathalie Contentin
- Service Hématologie Adulte, Centre Henri Becquerel, Rouen Cedex, F 76038, France
| | - Claire Galambrun
- Service Hématologie Pédiatrique, APHM Hopital La Timone, Marseille, F-13005, France
| | - Dominique Plantaz
- Service Hématologie Pédiatrique, CHU Grenoble, La Tronche, F-38700, France
| | - Pascal Odou
- Institut de Pharmacie, CHU Lille, Lille, F-59000, France
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4
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Pharmacie clinique en unité de greffe de moelle osseuse et thérapie cellulaire – quelles activités mettre en place ? Recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC). Bull Cancer 2019; 106:S59-S70. [DOI: 10.1016/j.bulcan.2018.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/09/2018] [Indexed: 10/27/2022]
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5
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Alsuliman T, Kitel C, Dulery R, Guillaume T, Larosa F, Cornillon J, Labussière-Wallet H, Médiavilla C, Belaiche S, Delage J, Alain S, Yakoub-Agha I. Cytotect®CP as salvage therapy in patients with CMV infection following allogeneic hematopoietic cell transplantation: a multicenter retrospective study. Bone Marrow Transplant 2018; 53:1328-1335. [PMID: 29654288 DOI: 10.1038/s41409-018-0166-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/21/2018] [Accepted: 03/04/2018] [Indexed: 11/09/2022]
Abstract
Cytomegalovirus is one of the main contributing factors to high mortality rates in patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT). The main factors of treatment failure are both drug resistance and intolerance. In some cases, Cytotect®CP CMV-hyperimmune globulin is used as salvage therapy. This study aims to investigate the safety and efficacy of Cytotect®CP as a salvage therapy in patients with CMV infection after allo-HCT. Twenty-three consecutive patients received Cytotect®CP for CMV infection after prior CMV therapy. At the time of Cytotect®CP introduction, 17 patients (74%) had developed acute GVHD and 15 patients (64%) were receiving steroid treatment; Cytotect®CP was used as monotherapy (n = 7) and in combination (n = 16). Overall, response was observed in 18 patients (78%) with a median time of 15 days (range: 3-51). Of the 18 responders, 4 experienced CMV reactivation, while 5 responders died within 100 days of beginning treatment. Of these 5 deaths, 4 were due to causes unrelated to CMV. Estimated 100-day OS from the introduction of Cytotect®CP was 69.6%. No statistically significant difference was observed in 100-day OS between responders and non-responders (73.7% vs 50.0%, p = 0.258). Cytotect®CP as salvage therapy is effective and well-tolerated. Given its safety profile, early treatment use should be considered.
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Affiliation(s)
- Tamim Alsuliman
- Maladies du sang, CHRU de Lille, 59037, Lille, France.,Service d'Hématologie, CH de Boulogne, 62321, Boulogne sur mer, France
| | | | - Rémy Dulery
- Service d'Hématologie, Hôpital Saint-Antoine, AP-HP, Université Pierre et Marie Curie (UPMC), 75012, Paris, France
| | - Thierry Guillaume
- Service d'Hématologie, CHU de Nantes, 44093, Nantes, Cedex 1, France
| | - Fabrice Larosa
- Service d'Hématologie, CHU de Besançon, 25030, Besançon, France
| | - Jérôme Cornillon
- Service d'Hématologie, IC Loire, 42270, Saint-Priest-en-Jarez, France
| | | | | | | | - Jeremy Delage
- Service d'Hématologie, CHU de Montpellier, 34295, Montpellier, cedex 5, France
| | - Sophie Alain
- National Reference Center for Herpes viruses, Inserm U1092, Université de Limoges, Laboratoire de Bactériologie-Virologie-Hygiène, CHU de Limoges, Limoges, France
| | - Ibrahim Yakoub-Agha
- Maladies du sang, CHRU de Lille, 59037, Lille, France. .,CHU de Lille, LIRIC, INSERM U995, université de Lille2, 59000, Lille, France.
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6
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Duléry R, Nibourel O, Gauthier J, Elsermans V, Behal H, Coiteux V, Magro L, Renneville A, Marceau A, Boyer T, Quesnel B, Preudhomme C, Duhamel A, Yakoub-Agha I. Impact of Wilms' tumor 1 expression on outcome of patients undergoing allogeneic stem cell transplantation for AML. Bone Marrow Transplant 2017; 52:539-543. [PMID: 28067876 DOI: 10.1038/bmt.2016.318] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 09/22/2016] [Accepted: 10/05/2016] [Indexed: 11/09/2022]
Abstract
The monitoring of the minimal residual disease by Wilms' tumor 1 expression (MRDWT1) is a standardized test, which can be used in over 80% of patients with AML. To investigate the prognostic value of MRDWT1 in patients undergoing allogeneic stem cell transplantation (allo-SCT) for AML, MRDWT1 was monitored 3 months after transplantation in 139 patients. MRDWT1 positivity did not lead to any therapeutic intervention. Median follow-up was 39.3 (6.4-99.8) months. Patients with positive MRDWT1 at 3 months experienced more often post-transplant relapse (27/30, 90%) than those with negative MRDWT1 (16/109, 14.7%) (P<0.0001). Similarly, a shorter 3-year event-free survival (EFS) was observed in MRDWT1-positive patients (10% vs 72.3% in MRDWT1-negative patients, P<0.0001). The correlation between relapse and MRDWT1 was stronger in blood than in bone marrow samples. Multivariate analysis confirmed the detrimental role of 3-month positive MRDWT1 for relapse (hazard ratio (HR): 15.42; 95% confidence interval (CI): 7.53-31.59; P<0.0001) and EFS (HR: 10.71; 95% CI: 5.41-21.21; P<0.0001). Interestingly, 3-month chimerism was less predictive of relapse than positive MRDWT1. In conclusion, our results demonstrate the usefulness of peripheral blood MRDWT1 monitoring in identifying very high-risk patients, who could benefit from an early preemptive treatment, and those who do not need such an intervention.
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Affiliation(s)
- R Duléry
- Department of Hematology and Bone Marrow Transplantation, CHRU de Lille, Lille, France.,University of Lille Nord de France, Lille, France.,Inserm, UMRs 837, Team 3, Cancer Research Institute of Lille, Lille, France
| | - O Nibourel
- University of Lille Nord de France, Lille, France.,Inserm, UMRs 837, Team 3, Cancer Research Institute of Lille, Lille, France.,Laboratory of Hematology, Biology and Pathology Center, CHRU of Lille, Lille, France
| | - J Gauthier
- Department of Hematology and Bone Marrow Transplantation, CHRU de Lille, Lille, France.,University of Lille Nord de France, Lille, France
| | - V Elsermans
- University of Lille Nord de France, Lille, France.,Laboratory of Immunology, Biology and Pathology Center, CHRU of Lille, Lille, France
| | - H Behal
- University of Lille Nord de France, Lille, France.,Department of Biostatistics, CHRU Lille, Lille, France
| | - V Coiteux
- Department of Hematology and Bone Marrow Transplantation, CHRU de Lille, Lille, France.,University of Lille Nord de France, Lille, France
| | - L Magro
- Department of Hematology and Bone Marrow Transplantation, CHRU de Lille, Lille, France.,University of Lille Nord de France, Lille, France
| | - A Renneville
- University of Lille Nord de France, Lille, France.,Inserm, UMRs 837, Team 3, Cancer Research Institute of Lille, Lille, France.,Laboratory of Hematology, Biology and Pathology Center, CHRU of Lille, Lille, France
| | - A Marceau
- University of Lille Nord de France, Lille, France.,Inserm, UMRs 837, Team 3, Cancer Research Institute of Lille, Lille, France.,Laboratory of Hematology, Biology and Pathology Center, CHRU of Lille, Lille, France
| | - T Boyer
- University of Lille Nord de France, Lille, France.,Inserm, UMRs 837, Team 3, Cancer Research Institute of Lille, Lille, France.,Laboratory of Hematology, Biology and Pathology Center, CHRU of Lille, Lille, France
| | - B Quesnel
- Department of Hematology and Bone Marrow Transplantation, CHRU de Lille, Lille, France.,University of Lille Nord de France, Lille, France.,Inserm, UMRs 837, Team 3, Cancer Research Institute of Lille, Lille, France
| | - C Preudhomme
- University of Lille Nord de France, Lille, France.,Inserm, UMRs 837, Team 3, Cancer Research Institute of Lille, Lille, France.,Laboratory of Hematology, Biology and Pathology Center, CHRU of Lille, Lille, France
| | - A Duhamel
- University of Lille Nord de France, Lille, France.,Laboratory of Immunology, Biology and Pathology Center, CHRU of Lille, Lille, France
| | - I Yakoub-Agha
- Department of Hematology and Bone Marrow Transplantation, CHRU de Lille, Lille, France.,University of Lille Nord de France, Lille, France.,LIRC U995, Lille, France
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7
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Tipton R, Yakoub-Agha I. [How we harmonize HSCT clinical practices among the SFGM-TC centers]. Bull Cancer 2016; 103:S193-S197. [PMID: 27810144 DOI: 10.1016/j.bulcan.2016.09.006] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/01/2016] [Indexed: 12/21/2022]
Abstract
In hematopoietic transplantation, clinical patient care is localized and practices differ from one country to another and even from center to center. International guidelines are not always well adapted to the evolution of daily clinical practice, and they do not address all issues, especially practical ones. Therefore, in the absence of well-established guidelines, each center tends to make do by developing local procedures. In the attempt to harmonize localized clinical practices between different centers belonging to the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC), our society set up in 2010 what would become an annual workshop series, bringing together practitioners from all member centers. Each workshop group is responsible for discussing a specific issue and then drafting, in the form of an article, a set of guidelines that address the issue practically. With the aim of covering all practical issues and providing widely-usable guidelines when international consensus is lacking, the SFGM-TC has succeeded in establishing national guidelines by those who use them. So as to be easily localized by all centers, the guidelines are written in French. In this article, we set out the process by which the workshops are conducted and how the final guidelines produced are approved each year.
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Affiliation(s)
| | - Ibrahim Yakoub-Agha
- CHU de Lille, université de Lille 2, LIRIC Inserm U995, 59000 Lille, France.
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8
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Contribution of Revised International Prognostic Scoring System Cytogenetics to Predict Outcome After Allogeneic Stem Cell Transplantation for Myelodysplastic Syndromes: A Study From the French Society of Bone Marrow Transplantation and Cellular Therapy. Transplantation 2015; 99:1672-80. [PMID: 25769079 DOI: 10.1097/tp.0000000000000649] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prognosis of myelodysplastic syndromes (MDS) after allogeneic stem cell transplantation is critically determined by cytogenetic abnormalities, as previously defined by International Prognostic Scoring System (IPSS) cytogenetics. It has been shown that a new cytogenetic classification, included in the IPSS-R (cytogenetic-IPSS-R [C-IPSS-R]), can better predict the outcome of untreated MDS patients. METHODS In this study, we assessed the impact of the IPSS-R cytogenetic score (C-IPSS-R) on the outcome of 367 MDS patients transplanted from HLA-identical siblings or HLA allele-matched unrelated donors. RESULTS According to the C-IPSS-R, 178 patients (48%) fell in the good risk, 102 (28%) in the intermediate risk, 77 (21%) in the poor risk, and 10 (3%) in the very poor risk group. In multivariate analysis, after a median follow-up of 4 years, the poor and very poor-risk categories correlated with shorter overall survival (OS) (4-year OS, 32%; hazard ratio [HR], 1.59; P = 0.009 and OS, 10%; HR, 3.18; P = 0.002, respectively) and higher cumulative incidence of relapse (CIR) (CIR, 52%; HR, 1.82; P = 0.004 and CIR, 60%; HR, 2.44; P = 0.060, respectively). CONCLUSIONS Overall, the C-IPSS-R changed the IPSS cytogenetic risk only in 8% of cases but identified a new risk group, the very poor C-IPSS-R category, with dismal outcome after allogeneic stem cell transplantation (10% 4-year OS, 60% 4-year CIR). Posttransplantation maintenance therapy should be investigated in prospective trials for patients with high-risk C-IPSS-R karyotypes.
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