1
|
Yaman S, Başci S, Bozan E, Seçilmiş S, Candir BA, Yiğenoğlu TN, Çakar MK, Dal MS, Altuntaş F. Early Tapering of Cyclosporine Is Feasible in Haploidentical Stem Cell Transplantation: A Single Center Experience. Clin Transplant 2024; 38:e15376. [PMID: 39031699 DOI: 10.1111/ctr.15376] [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: 12/28/2023] [Revised: 04/28/2024] [Accepted: 05/30/2024] [Indexed: 07/22/2024]
Abstract
INTRODUCTION Cyclosporine-A (CsA) and post transplantation cyclophosphamide (PTCy) are common agents used for graft versus host disease (GVHD) prophylaxis in Haploidentical hematopoietic cell transplantation (haplo-HCT). However, the impact of CsA cessation timing in the posttransplant setting on clinical outcomes is uncertain. We aimed to investigate the impact of a novel approach that integrated early CsA cessation with PTCy utilization. PATIENTS AND METHODS This study was a single arm retrospective study carried out at a tertiary referral hospital hematology and bone marrow transplantation center between 2009 and 2022. The patients who received haplo-HCT with ATG, PTCy and CsA as GVHD prophylaxis were included. CsA was planned for cessation starting at day 45 to day 60. Acute and chronic GVHD were evaluated and graded. CsA blood concentrations and its impact on acute and chronic GVHD was evaluated. RESULTS Thirty-one patients composed of 19 (61.3%) male and 12 (38.7%) female patients with a median age of 31 years (20-58). Busulfan and TBI based conditioning regimens were the most utilized regimens. The majority of donors were first degree relatives. Stem cell origin was peripheral blood for all patients. GVHD prophylaxis consisted of ATG, CsA and PTCy. Acute GVHD was observed in 9 (29%) cases, whereas chronic GVHD was seen in 3 (9.7%) cases, with 2 of them having overlapping GVHD. Age, gender, number of chemotherapy lines, transplant characteristics, infused CD34 cell count, and engraftment durations were similar among patients with and without GVHD. Patients with GVHD had similar 1st, 2nd, 3rd and 4th week CsA concentrations compared to patients without GVHD (p > 0.05). The presence of GVHD was not associated with worse progression free survival and overall survival (p = 0.6, p = 0.5, respectively). CMV reactivation was more common in the GVHD group. CONCLUSION In the current study, we did not find an impact of CsA concentration on GVHD and post-transplant outcomes in Haplo-HCT setting. Therefore, together with the use of PTCy, early CsA cessation can be an option; further studies are needed to understand all aspects of this approach.
Collapse
Affiliation(s)
- Samet Yaman
- Ankara Oncology Training and Research Hospital, Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Semih Başci
- Ankara Oncology Training and Research Hospital, Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Ersin Bozan
- Ankara Oncology Training and Research Hospital, Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Sema Seçilmiş
- Ankara Oncology Training and Research Hospital, Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Burcu Aslan Candir
- Ankara Oncology Training and Research Hospital, Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Tuğçe Nur Yiğenoğlu
- Ankara Oncology Training and Research Hospital, Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Merih Kızıl Çakar
- Ankara Oncology Training and Research Hospital, Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Mehmet Sinan Dal
- Ankara Oncology Training and Research Hospital, Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Fevzi Altuntaş
- Ankara Oncology Training and Research Hospital, Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey
| |
Collapse
|
2
|
Zhang Y, Fang H, Wang G, Yuan G, Dong R, Luo J, Lyu Y, Wang Y, Li P, Zhou C, Yin W, Xiao H, Sun J, Zeng X. Cyclosporine A-resistant CAR-T cells mediate antitumour immunity in the presence of allogeneic cells. Nat Commun 2023; 14:8491. [PMID: 38123592 PMCID: PMC10733396 DOI: 10.1038/s41467-023-44176-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/04/2023] [Indexed: 12/23/2023] Open
Abstract
Chimeric antigen receptor (CAR)-T therapy requires autologous T lymphocytes from cancer patients, a process that is both costly and complex. Universal CAR-T cell treatment from allogeneic sources can overcome this limitation but is impeded by graft-versus-host disease (GvHD) and host versus-graft rejection (HvGR). Here, we introduce a mutated calcineurin subunit A (CNA) and a CD19-specific CAR into the T cell receptor α constant (TRAC) locus to generate cells that are resistant to the widely used immunosuppressant, cyclosporine A (CsA). These immunosuppressant-resistant universal (IRU) CAR-T cells display improved effector function in vitro and anti-tumour efficacy in a leukemia xenograft mouse model in the presence of CsA, compared with CAR-T cells carrying wild-type CNA. Moreover, IRU CAR-T cells retain effector function in vitro and in vivo in the presence of both allogeneic T cells and CsA. Lastly, CsA withdrawal restores HvGR, acting as a safety switch that can eliminate IRU CAR-T cells. These findings demonstrate the efficacy of CsA-resistant CAR-T cells as a universal, 'off-the-shelf' treatment option.
Collapse
Affiliation(s)
- Yixi Zhang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Research Units of Infectious disease and Microecology, Chinese Academy of Medical Sciences, Hangzhou, 310003, China
| | - Hongyu Fang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Research Units of Infectious disease and Microecology, Chinese Academy of Medical Sciences, Hangzhou, 310003, China
| | - Guocan Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Research Units of Infectious disease and Microecology, Chinese Academy of Medical Sciences, Hangzhou, 310003, China
| | - Guangxun Yuan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Research Units of Infectious disease and Microecology, Chinese Academy of Medical Sciences, Hangzhou, 310003, China
| | - Ruoyu Dong
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Jijun Luo
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Research Units of Infectious disease and Microecology, Chinese Academy of Medical Sciences, Hangzhou, 310003, China
| | - Yu Lyu
- Zhejiang University-University of Edinburgh Institute (ZJU-UoE Institute), Zhejiang University School of Medicine, International Campus, Zhejiang University, Hangzhou, 310058, China
| | - Yajie Wang
- Bone Marrow Transplantation Center of the First Affiliated Hospital and Department of Cell Biology, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, China
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China
| | - Peng Li
- Puluoting Health Technology Co., Ltd, Hangzhou, 310003, China
| | - Chun Zhou
- School of Public Health & Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Weiwei Yin
- Key Laboratory for Biomedical Engineering of the Ministry of Education, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, 310058, China
- Department of Thoracic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China
| | - Haowen Xiao
- Department of Hematology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China.
| | - Jie Sun
- Bone Marrow Transplantation Center of the First Affiliated Hospital and Department of Cell Biology, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, China.
- Liangzhu Laboratory, Zhejiang University Medical Center, Hangzhou, 311121, China.
| | - Xun Zeng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
- Research Units of Infectious disease and Microecology, Chinese Academy of Medical Sciences, Hangzhou, 310003, China.
| |
Collapse
|
3
|
Fan Q, Hui X, Li X, Li Q, Yang D, Wang Y. Reaching the cyclosporine a level target slowly in four weeks correlates with better prognosis for Chinese patients after allogeneic haematopoietic cell transplantation. Hematology 2023; 28:2275893. [PMID: 37975575 DOI: 10.1080/16078454.2023.2275893] [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: 11/23/2022] [Accepted: 10/12/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study investigated the impact of early cyclosporin A (CsA) initiation (day -5) on the risk of acute graft versus host disease (aGvHD) after allogeneic haematopoietic cell transplantation (allo-HSCT). METHODS Sixty-seven leukaemia patients who underwent allo-HSCT were investigated. The correlation between the CsA level in the first four weeks and the following indices was examined: GvHD, cumulative incidence (CI) of GvHD, CI of relapse at month 18, and non-relapse mortality (NRM) at month 18. RESULTS A significant association between aGvHD and CsA level in the fourth week after allo-HSCT was observed, with the incidence of aGvHD in the fourth week in the lower level group being higher than that in the higher level group (p = 0.044). The CI of aGvHD was 30.1% and 9.8% at day +90 and 42.3% and 17.1% at day +180 in the lower level and higher level groups, respectively. CONCLUSION For Chinese patients, early introduction and reaching the target CsA concentration within four weeks after allo-HSCT have a positive effect on preventing GvHD, especially in the fourth week after HSCT. Compared to the Western population, the target CsA concentration is lower and the time required to reach the target (within 4 weeks) is longer in the Chinese population (274.75 ng/mL).
Collapse
Affiliation(s)
- Qingqing Fan
- Department of Pharmacy, Jiangsu Province Hospital (The First Affiliated Hospital with Nanjing Medical University), Nanjing, People's Republic of China
| | - Xiang Hui
- Department of Pharmacy, Jiangsu Province Hospital (The First Affiliated Hospital with Nanjing Medical University), Nanjing, People's Republic of China
| | - Xiang Li
- Department of Pharmacy, Jiangsu Province Hospital (The First Affiliated Hospital with Nanjing Medical University), Nanjing, People's Republic of China
| | - Qian Li
- Department of Pharmacy, Jiangsu Province Hospital (The First Affiliated Hospital with Nanjing Medical University), Nanjing, People's Republic of China
| | - Dihong Yang
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, People's Republic of China
| | - Yongqing Wang
- Department of Pharmacy, Jiangsu Province Hospital (The First Affiliated Hospital with Nanjing Medical University), Nanjing, People's Republic of China
| |
Collapse
|
4
|
Vergara-Cadavid J, Connor Johnson P, Kim HT, Yi A, Sise ME, Leaf DE, Hanna PE, Ho VT, Cutler CS, Antin JH, Gooptu M, Kelkar A, Wells SL, Nikiforow S, Koreth J, Romee R, Soiffer RJ, Shapiro RM, Gupta S. Clinical Features of Acute Kidney Injury in the Early Post-Transplantation Period Following Reduced-Intensity Conditioning Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2023; 29:455.e1-455.e9. [PMID: 37015320 PMCID: PMC10330095 DOI: 10.1016/j.jtct.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 03/04/2023] [Accepted: 03/23/2023] [Indexed: 04/06/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (HCT) is a potentially curative therapy for patients with hematologic malignancies but is associated with acute kidney injury (AKI). To date, few studies have examined risk factors for AKI at engraftment, or the relationship between AKI and clinical outcomes. This study examined the incidence and risk factors for periengraftment AKI, as well as the association between AKI and overall survival (OS) and nonrelapse mortality (NRM). We conducted a retrospective analysis of adult patients undergoing reduced-intensity conditioning (RIC) allogeneic HCT at the Dana-Farber Cancer Institute between 2012 and 2019. Periengraftment (day 0 to day 30) AKI incidence and severity were defined using modified KDIGO (Kidney Disease: Improving Global Outcomes) criteria. Factors associated with periengraftment AKI risk were examined using Cox regression analysis. The impact of periengraftment AKI on OS and NRM (defined as death without recurrent disease after HCT), was evaluated using Cox regression and the Fine and Gray competing risks model, respectively. Kidney recovery, defined as a return of serum creatinine (SCr) to within 25% of baseline or liberation from kidney replacement therapy (KRT), was examined at day 90 post-HCT. Periengraftment AKI occurred in 330 of 987 patients (33.4%) at a median of 13 days (interquartile range, 4 to 30 days) post-transplantation. Factors associated with a higher multivariable-adjusted risk of AKI were supratherapeutic rapamycin (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.20 to 2.03; P < .001), fludarabine/melphalan conditioning (HR, 1.35, 95% CI, 1.01 to 1.81; P = .05, compared to fludarabine/busulfan and fludarabine, cyclophosphamide, and total body irradiation), HCT Comorbidity Index ≥4 (HR, 1.43; 95% CI, 1.14 to 1.79; P = .002), albumin <3.4 g/dL (HR, 2.04; 95% CI, 1.33 to 3.12; P = .001), hemoglobin ≤12 (HR, 1.96; 95% CI, 1.38 to 2.78; P < .001), supratherapeutic tacrolimus (HR, 1.45; 95% CI, 1.07 to 1.95; P = .02), and baseline SCr >1.1 mg/dL (HR, 1.87; 95% CI, 1.48 to 2.35; P < .001). Periengraftment AKI was associated with worse OS (HR, 1.40; 95% CI, 1.16 to 1.71; P < .001) and NRM (subdistribution HR, 2.10; 95% CI, 1.52 to 2.89; P < .001). Kidney recovery occurred in 18%, 15%, and 30% of patients with stage 1, stage 2, and stage 3 AKI without KRT, respectively, and 4 of 16 patients (25%) were liberated from KRT. Periengraftment AKI is common among RIC allogeneic HCT recipients. We identified several important risk factors for periengraftment AKI. Its association with worse OS and NRM underscores the importance of timely recognition and management.
Collapse
Affiliation(s)
| | - P. Connor Johnson
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Haesook T. Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard School of Public Health, Boston, MA
| | - Alisha Yi
- Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, Boston, Massachusetts, USA
| | - Meghan E. Sise
- Division of Nephrology, Massachusetts General Hospital, MA
| | - David E. Leaf
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Paul E. Hanna
- Division of Nephrology, Massachusetts General Hospital, MA
| | - Vincent T. Ho
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Corey S. Cutler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Joseph H. Antin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Mahasweta Gooptu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Amar Kelkar
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Sophia L. Wells
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Sarah Nikiforow
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - John Koreth
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Rizwan Romee
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Robert J. Soiffer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Roman M. Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Shruti Gupta
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Division of Renal Medicine, Brigham and Women’s Hospital, Boston, MA
| |
Collapse
|
5
|
El Cheikh J, Sharrouf L, Hamade M, Terro K, Bidaoui G, Charafeddine M, Ismail F, Zahreddine A, Moukalled N, Abou Dalle I, Bazarbachi A. Timing of cyclosporine administration for GvHD prophylaxis in haploidentical stem cell transplantation setting: Single center experience. Curr Res Transl Med 2023; 71:103387. [PMID: 36966546 DOI: 10.1016/j.retram.2023.103387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/28/2023]
Affiliation(s)
- Jean El Cheikh
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Layal Sharrouf
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mahdi Hamade
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Khodr Terro
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghassan Bidaoui
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Charafeddine
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fatima Ismail
- Department of Pharmacy, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ammar Zahreddine
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour Moukalled
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imane Abou Dalle
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Bazarbachi
- Division of Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
6
|
Stocker N, Duléry R, Battipaglia G, Brissot E, Médiavilla C, Sestili S, Paviglianiti A, Ledraa T, Mohty R, Bazarbachi A, Belhocine R, Vekhoff A, Ruggeri A, Mohty M, Malard F. Impact of cyclosporine A concentration on acute graft‐vs‐host disease incidence after haploidentical hematopoietic cell transplantation. Eur J Haematol 2019; 103:10-17. [DOI: 10.1111/ejh.13233] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/01/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Nicolas Stocker
- INSERM, Centre de Recherche Saint‐Antoine (CRSA) Sorbonne Université Paris France
| | - Remy Duléry
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | | | - Eolia Brissot
- INSERM, Centre de Recherche Saint‐Antoine (CRSA) Sorbonne Université Paris France
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Clémence Médiavilla
- INSERM, Centre de Recherche Saint‐Antoine (CRSA) Sorbonne Université Paris France
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Simona Sestili
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | | | - Tounes Ledraa
- INSERM, Centre de Recherche Saint‐Antoine (CRSA) Sorbonne Université Paris France
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Razan Mohty
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | | | - Ramdane Belhocine
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Anne Vekhoff
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Annalisa Ruggeri
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Mohamad Mohty
- INSERM, Centre de Recherche Saint‐Antoine (CRSA) Sorbonne Université Paris France
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| | - Florent Malard
- INSERM, Centre de Recherche Saint‐Antoine (CRSA) Sorbonne Université Paris France
- Service d'Hématologie Clinique AP‐HP, Hôpital Saint‐Antoine Paris France
| |
Collapse
|