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Rossignol J, Ouedrani A, Livideanu CB, Barete S, Terriou L, Launay D, Lemal R, Greco C, Frenzel L, Meni C, Bodemere-Skandalis C, Polivka L, Collange AF, Hachichi H, Bouzourine S, Messaoud DN, Negretto M, Vendrame L, Jambou M, Gousseff M, Durupt S, Lega JC, Durand JM, Gaudy C, Damaj G, Gourin MP, Hamidou M, Bouillet L, Le Mouel E, Maria A, Zunic P, Cabrera Q, Vincent D, Lavigne C, Riviere E, Gourguechon C, Courbebaisse M, Lebeaux D, Parfait B, Friedlander G, Brignier A, Lhermitte L, Molina TJ, Bruneau J, Agopian J, Dubreuil P, Ranta D, Mania A, Arock M, Staropoli I, Tournilhac O, Lortholary O, Schwartz O, Chatenoud L, Hermine O. Effective Anti-SARS-CoV-2 Immune Response in Patients With Clonal Mast Cell Disorders. J Allergy Clin Immunol Pract 2022; 10:1356-1364.e2. [PMID: 35074600 PMCID: PMC8780123 DOI: 10.1016/j.jaip.2021.12.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/05/2021] [Accepted: 12/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mast cells are key players in innate immunity and the TH2 adaptive immune response. The latter counterbalances the TH1 response, which is critical for antiviral immunity. Clonal mast cell activation disorders (cMCADs, such as mastocytosis and clonal mast cell activation syndrome) are characterized by abnormal mast cell accumulation and/or activation. No data on the antiviral immune response in patients with MCADs have been published. OBJECTIVE To study a comprehensive range of outcomes in patients with cMCAD with PCR- or serologically confirmed coronavirus disease 2019 and to characterize the specific anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immune response in this setting. METHODS Clinical follow-up and outcome data were collected prospectively over a 12-month period by members of the French Centre de Référence des Mastocytoses rare disease network. Anti-SARS-CoV-2-specific T-cell activity was measured with an ELISA, and humoral responses were evaluated by assaying circulating levels of specific IgG, IgA, and neutralizing antibodies. RESULTS Overall, 32 patients with cMCAD were evaluated. None required noninvasive or mechanical ventilation. Two patients were admitted to hospital for oxygen and steroid therapy. The SARS-CoV-2-specific immune response was characterized in 21 of the 32 patients. Most had high counts of circulating SARS-CoV-2-specific, IFN-γ-producing T cells and high titers of neutralizing antispike IgGs. The patients frequently showed spontaneous T-cell IFN-γ production in the absence of stimulation; this production was correlated with basal circulating tryptase levels (a marker of the mast cell burden). CONCLUSIONS Patients with cMCADs might not be at risk of severe coronavirus disease 2019, perhaps due to their spontaneous production of IFN-γ.
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Affiliation(s)
- Julien Rossignol
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Amani Ouedrani
- Paris University, Necker-Enfants Malades Institute, CNRS UMR 8253 and INSERM UMR1151, Necker-Enfants Malades University Hospital, Paris, France; Laboratory of Immunoregulation and Immunopathology, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Cristina Bulai Livideanu
- French Reference Center for Mastocytosis (CEREMAST), Department of Dermatology, Hôpital Larrey, Toulouse University Hospital, Toulouse, France
| | - Stéphane Barete
- French Reference Center for Mastocytosis (CEREMAST), Department of Dermatology, Pitié-Salpêtrière University Hospital, APHP, Paris, France
| | - Louis Terriou
- University Lille, INSERM, CHU Lille, Department of Internal Medicine and Clinical Immunology, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - David Launay
- University Lille, INSERM, CHU Lille, Department of Internal Medicine and Clinical Immunology, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Richard Lemal
- Adult Clinical Hematology, Clermont-Ferrand University Hospital, INSERM CIC501, EA 7453-Université Clermont Auvergne, Clermont-Ferrand, France
| | - Celine Greco
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Laurent Frenzel
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Cecile Meni
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Christine Bodemere-Skandalis
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Laura Polivka
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Anne-Florence Collange
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Hassiba Hachichi
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Sonia Bouzourine
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Djazira Nait Messaoud
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Mathilde Negretto
- French Reference Center for Mastocytosis (CEREMAST), Department of Dermatology, Hôpital Larrey, Toulouse University Hospital, Toulouse, France
| | - Laurence Vendrame
- Paris University, Necker-Enfants Malades Institute, CNRS UMR 8253 and INSERM UMR1151, Necker-Enfants Malades University Hospital, Paris, France
| | - Marguerite Jambou
- Paris University, Necker-Enfants Malades Institute, CNRS UMR 8253 and INSERM UMR1151, Necker-Enfants Malades University Hospital, Paris, France
| | - Marie Gousseff
- Department of Internal Medicine, Bretagne Atlantique Hospital, Vannes, France
| | - Stéphane Durupt
- Department of Internal Medicine, Adult Cystic Fibrosis Care Center, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Lega
- Department of Internal Medicine, Adult Cystic Fibrosis Care Center, Hospices Civils de Lyon, Lyon, France
| | - Jean-Marc Durand
- Department of Internal Medicine, Aix-Marseille University, Timone University Hospital, Marseille, France
| | - Caroline Gaudy
- Department of Internal Medicine, Aix-Marseille University, Timone University Hospital, Marseille, France
| | - Gandhi Damaj
- Haematology Institute, Normandy University School of Medicine, Caen, France
| | | | - Mohamed Hamidou
- Department of Internal Medicine, Hôtel-Dieu University Hospital, Nantes, France
| | - Laurence Bouillet
- Clinical Immunology/Internal Medicine Department, National Reference Center for Angioedema, Grenoble University Hospital, Grenoble, France
| | - Edwige Le Mouel
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Alexandre Maria
- Department of Internal Medicine, Montpellier University Hospital, Montpellier, France
| | - Patricia Zunic
- Department of Haematology, Sud Réunion University Hospital, Saint Pierre, La Réunion, France
| | - Quentin Cabrera
- Department of Haematology, Sud Réunion University Hospital, Saint Pierre, La Réunion, France
| | - Denis Vincent
- Department of Pneumology and Internal Medicine, Caremeau University Hospital, Nimes, France
| | - Christian Lavigne
- Department of Internal Medicine, Angers University Hospital, Angers, France
| | - Etienne Riviere
- Department of Internal Medicine, Bordeaux University Hospital, Haut-Lévêque Hospital, Pessac, France
| | | | - Marie Courbebaisse
- Paris University, Necker-Enfants Malades Institute, CNRS UMR 8253 and INSERM UMR1151, Necker-Enfants Malades University Hospital, Paris, France; Department of Physiology-Functional Renal Explorations, Hôpital Européen Georges Pompidou University Hospital, Paris, France
| | - David Lebeaux
- Service de Microbiologie, Unité Mobile d'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France; Université de Paris, Paris, France
| | - Béatrice Parfait
- Centre de Ressources Biologiques, Hôpital Cochin, Paris, France; Paris University, Institut Cochin INSERM UMR1016, Paris, France
| | - Gérard Friedlander
- Paris University, Necker-Enfants Malades Institute, CNRS UMR 8253 and INSERM UMR1151, Necker-Enfants Malades University Hospital, Paris, France
| | - Anne Brignier
- Therapeutic Apheresis Unit, Saint-Louis University Hospital, APHP, Paris, France
| | - Ludovic Lhermitte
- Laboratory of Onco-Hematology, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Thierry Jo Molina
- Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France; Pathology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Julie Bruneau
- Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France; Pathology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Julie Agopian
- CRCM, [Signaling, Hematopoiesis and Mechanism of Oncogenesis, CEREMAST, AFIRMM], INSERM U1068, Marseille, France; Institut Paoli-Calmettes, Marseille, France; Aix-Marseille Univ, UM105, Marseille, France; CNRS, UMR7258, Marseille, France
| | - Patrice Dubreuil
- CRCM, [Signaling, Hematopoiesis and Mechanism of Oncogenesis, CEREMAST, AFIRMM], INSERM U1068, Marseille, France; Institut Paoli-Calmettes, Marseille, France; Aix-Marseille Univ, UM105, Marseille, France; CNRS, UMR7258, Marseille, France
| | - Dana Ranta
- Department of Haematology, Nancy University Hospital, Nancy, France
| | - Alexandre Mania
- Adult Clinical Hematology, Clermont-Ferrand University Hospital, INSERM CIC501, EA 7453-Université Clermont Auvergne, Clermont-Ferrand, France
| | - Michel Arock
- Laboratory of Haematology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Isabelle Staropoli
- Virus & Immunity Unit, Department of Virology, Institut Pasteur, CNRS UMR3569, Paris, France
| | - Olivier Tournilhac
- Adult Clinical Hematology, Clermont-Ferrand University Hospital, INSERM CIC501, EA 7453-Université Clermont Auvergne, Clermont-Ferrand, France
| | - Olivier Lortholary
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France
| | - Olivier Schwartz
- Virus & Immunity Unit, Department of Virology, Institut Pasteur, CNRS UMR3569, Paris, France
| | - Lucienne Chatenoud
- Paris University, Necker-Enfants Malades Institute, CNRS UMR 8253 and INSERM UMR1151, Necker-Enfants Malades University Hospital, Paris, France; Laboratory of Immunoregulation and Immunopathology, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Olivier Hermine
- French Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades University Hospital, APHP, Paris, France; Paris University, Imagine Institute, INSERM U1163, Necker-Enfants Malades University Hospital, Paris, France.
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Dourthe ME, Rabian F, Yakouben K, Chevillon F, Cabannes-Hamy A, Méchinaud F, Grain A, Chaillou D, Rahal I, Caillat-Zucman S, Lesprit E, Naudin J, Roupret-Serzec J, Parquet N, Brignier A, Guérin-El Khourouj V, Lainey E, Caye-Eude A, Cavé H, Clappier E, Mathis S, Azoulay E, Dalle JH, Dhédin N, Madelaine I, Larghero J, Boissel N, Baruchel A. Determinants of CD19-positive vs CD19-negative relapse after tisagenlecleucel for B-cell acute lymphoblastic leukemia. Leukemia 2021; 35:3383-3393. [PMID: 34002027 DOI: 10.1038/s41375-021-01281-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 01/01/2023]
Abstract
Tisagenlecleucel therapy has shown promising efficacy for relapsed/refractory (R/R) B-cell precursor acute lymphoblastic leukemia (BCP-ALL). However, relapses occur in 30-50% of patients. Determinants for CD19pos versus CD19neg relapses are poorly characterized. We report on 51 patients with R/R BCP-ALL (median age 17 years) infused with tisagenlecleucel after lymphodepletion. Complete remission rate at D28 was 96%. Prior blinatumomab increased the risk of early failure at D28. The 18-month cumulative incidence of relapse (CIR), event-free survival (EFS), and overall survival (OS) were 51%, 44%, and 74%, respectively, at a median follow-up of 15.5 months. Factors associated with a high tumor burden (occurrence of cytokine release syndrome) and prior blinatumomab were associated with an increased CIR, and a shorter EFS and OS. Pre-lymphodepletion high disease burden (MRD ≥ 10-2, SHR 10.4, p = 0.03) and detectable MRD at D28 (SHR 7.2, p = 0.006) correlated with an increased risk of CD19neg relapse. Low disease burden (SHR 5.3, p = 0.03) and loss of B-cell aplasia (BCA) (SHR 21.7, p = 0.004) predicted an increased risk of CD19pos relapses. These data highlight the impact of prior therapy on patient outcome. Finally, detectable MRD at D28 and loss of BCA both define patients at high risk of relapse for whom additional interventions are needed.
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Affiliation(s)
- Marie-Emilie Dourthe
- Department of Pediatric Hematology and Immunology, AP-HP, Hôpital Universitaire Robert Debré, Paris, France.,Laboratory of Onco-Hematology, AP-HP, Hôpital Necker Enfants-Malades, Université de Paris, Institut Necker-Enfants Malades (INEM), INSERM U1151, Paris, France
| | - Florence Rabian
- Unité d'Hématologie Adolescents et Jeunes Adultes, AP-HP, Hôpital Saint Louis, Paris, France
| | - Karima Yakouben
- Department of Pediatric Hematology and Immunology, AP-HP, Hôpital Universitaire Robert Debré, Paris, France
| | - Florian Chevillon
- Unité d'Hématologie Adolescents et Jeunes Adultes, AP-HP, Hôpital Saint Louis, Paris, France
| | | | - Françoise Méchinaud
- Department of Pediatric Hematology and Immunology, AP-HP, Hôpital Universitaire Robert Debré, Paris, France
| | - Audrey Grain
- Department of Pediatric Hematology and Immunology, AP-HP, Hôpital Universitaire Robert Debré, Paris, France
| | - Delphine Chaillou
- Department of Pediatric Hematology and Immunology, AP-HP, Hôpital Universitaire Robert Debré, Paris, France
| | - Ilhem Rahal
- Hematology Unit, AP-HP, Hôpital Necker Enfants-Malades, Paris, France
| | - Sophie Caillat-Zucman
- Laboratory of Immunology, AP-HP, Hôpital Saint Louis, INSERM UMR1149, Université de Paris, Paris, France
| | - Emmanuelle Lesprit
- Etablissement Français du Sang, AP-HP, Hôpital Universitaire Robert Debré, Paris, France
| | - Jérôme Naudin
- Pediatric Intensive Care Unit, AP-HP, Hôpital Universitaire Robert Debré, Paris, France
| | - Julie Roupret-Serzec
- Department of Pediatric Hematology and Immunology, AP-HP, Hôpital Universitaire Robert Debré, Paris, France
| | - Nathalie Parquet
- Therapeutic Apheresis Unit, AP-HP, Hôpital Saint Louis, Paris, France
| | - Anne Brignier
- Therapeutic Apheresis Unit, AP-HP, Hôpital Saint Louis, Paris, France
| | | | - Elodie Lainey
- Laboratory of Hematology, AP-HP, Hôpital Universitaire Robert Debré, Université de Paris, Paris, France
| | - Aurélie Caye-Eude
- Department of Genetics, AP-HP, Hôpital Universitaire Robert Debré, Université de Paris, Paris, France
| | - Hélène Cavé
- Department of Genetics, AP-HP, Hôpital Universitaire Robert Debré, Université de Paris, Paris, France.,UMRS 1131, Institut de Recherche Saint-Louis, INSERM, Université de Paris, Paris, France
| | - Emmanuelle Clappier
- Hematology Laboratory, AP-HP, Hôpital Saint Louis, Paris, France.,INSERM U944/CNRS UMR7212, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - Stéphanie Mathis
- Hematology Laboratory, AP-HP, Hôpital Saint Louis, Paris, France
| | - Elie Azoulay
- Intensive Care Unit, AP-HP, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Jean Hugues Dalle
- Department of Pediatric Hematology and Immunology, AP-HP, Hôpital Universitaire Robert Debré, Paris, France
| | - Nathalie Dhédin
- Unité d'Hématologie Adolescents et Jeunes Adultes, AP-HP, Hôpital Saint Louis, Paris, France
| | | | - Jérôme Larghero
- Unité de Thérapie Cellulaire et Centre MEARY de Thérapie Cellulaire et Génique, Université de Paris, AP-HP, Hôpital Saint-Louis, U976 et CICBT, INSERM, Paris, France
| | - Nicolas Boissel
- Unité d'Hématologie Adolescents et Jeunes Adultes, AP-HP, Hôpital Saint Louis, Paris, France.,EA3518, Institut de Recherche Saint-Louis, Université de Paris, Paris, France
| | - André Baruchel
- Department of Pediatric Hematology and Immunology, AP-HP, Hôpital Universitaire Robert Debré, Paris, France. .,EA3518, Institut de Recherche Saint-Louis, Université de Paris, Paris, France.
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3
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Rohmer J, Couteau‐Chardon A, Trichereau J, Panel K, Gesquiere C, Ben Abdelali R, Bidet A, Bladé J, Cayuela J, Cony‐Makhoul P, Cottin V, Delabesse E, Ebbo M, Fain O, Flandrin P, Galicier L, Godon C, Grardel N, Guffroy A, Hamidou M, Hunault M, Lengline E, Lhomme F, Lhermitte L, Machelart I, Mauvieux L, Mohr C, Mozicconacci M, Naguib D, Nicolini FE, Rey J, Rousselot P, Tavitian S, Terriou L, Lefèvre G, Preudhomme C, Kahn J, Groh M, Ackermann F, Adiko D, Ahwij N, Baruchel A, Beal C, Bemba M, Beylot Barry M, Beyne Rauzy O, Bielefeld P, Boisseau M, Bonmati C, Bonnote B, Borel C, Bouredji D, Brignier A, Brouillard M, Campos F, Carre M, Chalayer E, Chomel JC, Coiteux V, Contejean A, Corby A, Darre S, Dubruille V, Durel CA, El Yamani A, Etancelin P, Etienne N, Evon P, Gyan E, Hachulla E, Hermet M, Huguet F, Ianotto JC, Inchiappa L, Jdid I, Jondeau K, Joubert M, Legrand F, Lejeune C, Le Pendu C, Lidove O, Lemal R, Limal N, Lopinet E, Maloisel F, Marfaing A, Marroun I, Maurier F, Muller E, Muron T, Ojeda M, Paule R, Pignon JM, Rossi C, Roumier M, Sene D, Sene T, Simon L, Slama B, Suarez F, Tcherakian C, Torregrosa JM, Toussaint E, Vatan R, Visanica S, Voilat L, Zini JM. Epidemiology, clinical picture and long-term outcomes of FIP1L1-PDGFRA-positive myeloid neoplasm with eosinophilia: Data from 151 patients. Am J Hematol 2020; 95:1314-1323. [PMID: 32720700 DOI: 10.1002/ajh.25945] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022]
Abstract
FIP1L1-PDGFRA-positive myeloid neoplasm with eosinophilia (F/P+ MN-eo) is a rare disease: robust epidemiological data are lacking and reported issues are scarce, of low sample-size and limited follow-up. Imatinib mesylate (IM) is highly efficient but no predictive factor of relapse after discontinuation has yet been identified. One hundred and fifty-one patients with F/P+ MN-eo (143 males; mean age at diagnosis 49 years; mean annual incidence: 0.18 case per million population) were included in this retrospective nationwide study involving all French laboratories who perform the search of F/P fusion gene (study period: 2003-2019). The main organs involved included the spleen (44%), skin (32%), lungs (30%), heart (19%) and central nervous system (9%). Serum vitamin B12 and tryptase levels were elevated in 74/79 (94%) and 45/57 (79%) patients, respectively, and none of the 31 patients initially treated with corticosteroids achieved complete hematologic remission. All 148 (98%) IM-treated patients achieved complete hematologic and molecular (when tested, n = 84) responses. Forty-six patients eventually discontinued IM, among whom 20 (57%) relapsed. In multivariate analysis, time to IM initiation (continuous HR: 1,01 [0.99-1,03]; P = .05) and duration of IM treatment (continuous HR: 0,97 [0,95-0,99]; P = .004) were independent factors of relapse after discontinuation of IM. After a mean follow-up of 80 (56) months, the 1, 5- and 10-year overall survival rates in IM-treated patients were 99%, 95% and 84% respectively. In F/P+ MN-eo, prompt initiation of IM and longer treatment durations may prevent relapses after discontinuation of IM.
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Affiliation(s)
- Julien Rohmer
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Internal Medicine Hôpital Foch Suresnes France
| | - Amélie Couteau‐Chardon
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Intensive Care medicine Centre Hospitalier Annecy Genevois Saint‐Julien‐en‐Genevois France
| | - Julie Trichereau
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Clinical Research Department Hôpital Foch Suresnes France
| | - Kewin Panel
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Clinical Research Department Hôpital Foch Suresnes France
| | - Cyrielle Gesquiere
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
| | - Raouf Ben Abdelali
- Pole Hématologie et Oncologie Laboratoire CERBA Saint‐Ouen‐l'Aumône France
| | - Audrey Bidet
- Laboratory of Hematology CHU de Bordeaux Pessac France
| | | | - Jean‐Michel Cayuela
- Laboratory of Hematology Saint‐Louis Hospital, University of Paris Paris France
| | - Pascale Cony‐Makhoul
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Hematology Department CH Annecy Genevois Annecy France
| | - Vincent Cottin
- National Coordinating Reference Center for Rare Pulmonary Diseases Louis Pradel Hospital Lyon France
- Hospices Civils de Lyon, UMR754, University Claude Bernard Lyon 1 Lyon France
| | - Eric Delabesse
- Laboratory of Hematology Institut Universitaire du Cancer de Toulouse Oncopole, CHU de Toulouse Toulouse France
| | - Mikaël Ebbo
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Aix Marseille University, Department of Internal Medicine Hôpital de la Timone, AP‐HM, CNRS, INSERM, CIML Marseille France
| | - Olivier Fain
- Department of Internal Medicine CHU Saint Antoine Paris France
| | - Pascale Flandrin
- Laboratory of Hematology Hôpital Nord, CHU de Saint‐Étienne Saint‐Étienne France
| | - Lionel Galicier
- Department of Clinical Immunology Saint Louis hospital Paris France
| | - Catherine Godon
- Laboratoire de cytogénétique hématologique CHU de Nantes Nantes France
| | | | - Aurélien Guffroy
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (RESO), Tertiary Center for Primary Immunodeficiency Strasbourg University Hospital Strasbourg France
| | - Mohamed Hamidou
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Internal Medicine CHU de Nantes Nantes France
| | | | | | | | - Ludovic Lhermitte
- University of Paris, Institut National de Recherche Médicale U1151 Laboratory of Onco‐Hematology, Hôpital Necker Enfants‐Malades Paris France
| | - Irène Machelart
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Internal Medicine CHU de Bordeaux Bordeaux France
| | - Laurent Mauvieux
- Université de Strasbourg, INSERM U1113 Interface de Recherche Fondamentale et Appliquée en Cancérologie, Laboratoire d'hématologie du CHRU Strasbourg, Faculté de Médecine de Strasbourg Strasbourg France
| | - Catherine Mohr
- Service d'Hématologie Oncologie, CHU Groupe Hospitalier Sud Réunion Saint Pierre, Reunion France
| | - Marie‐Joelle Mozicconacci
- Institut Paoli‐Calmettes, Centre de Recherche en Cancérologie de Marseille, Biopathologie Marseille France
| | - Dina Naguib
- Laboratory of Hematology CHU Caen Caen France
| | - Franck E. Nicolini
- Department of Hematology INSERM U 1052, CRCL, Centre Léon Bérard Lyon France
| | - Jerome Rey
- Department of Hematology Institut Paoli‐Calmettes Marseille France
| | - Philippe Rousselot
- Hematology Department Versailles André Mignot Hospital, University Paris‐Saclay Le Chesnay France
| | - Suzanne Tavitian
- Service d'Hématologie, Institut Universitaire du Cancer de Toulouse‐Oncopole Centre Hospitalier Universitaire de Toulouse Toulouse France
| | - Louis Terriou
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Université de Lille, CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto‐immunes Systémiques Rares du Nord et Nord‐Ouest de France (CeRAINO) Lille France
| | - Guillaume Lefèvre
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Université de Lille, CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto‐immunes Systémiques Rares du Nord et Nord‐Ouest de France (CeRAINO) Lille France
| | | | - Jean‐Emmanuel Kahn
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Université Paris‐Saclay, Department of Internal Medicine Ambroise Paré hospital, Boulogne Billancourt Cedex France
| | - Matthieu Groh
- National Reference Center for Hypereosinophilic syndromes (CEREO) Suresnes France
- Department of Internal Medicine Hôpital Foch Suresnes France
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4
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Talarmin C, Kerob S, Cartier F, Madelaine I, Mukenyi S, Schwartz E, Boissel N, Baruchel A, Thieblemont C, Parquet N, Brignier A, Lesprit E, Desproges A, Magdelonnette L, Larghero J, Mebarki M. Quality risk management of the chimeric antigen receptor T cell pharmaceutical circuit in one of the first qualified European centers. Cytotherapy 2020; 22:792-801. [PMID: 32732084 DOI: 10.1016/j.jcyt.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/18/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AIMS According to European Directive 2001/83/EC, chimeric antigen receptor T (CAR T) cells belong to a new class of medicines referred to as advanced therapy medicinal products (ATMPs). The specific features and complexity of these products require a total reorganization of the hospital circuit, from cell collection from the patient to administration of the final medicinal product. In France, at the cell stage, products are under the responsibility of a cell therapy unit (CTU) that controls, manipulates (if necessary) and ships cells to the manufacturing site. However, the final product is a medicinal product, and as with any other medicine, ATMPs have to be received, stored and further reconstituted for final distribution under the responsibility of the hospital pharmacy. The aim of our work was to perform a risk analysis of this circuit according to International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use Q9 guidelines on quality risk management. METHODS We evaluated the activities carried out by the Saint-Louis Hospital CTU and pharmacy. Process mapping was established to trace all the steps of the circuit and to identify potential risks or failures. The risk analysis was performed according to failure mode, effects and criticality analysis. The criticality of each risk (minor [Mi], moderate [Mo], significant [S] or major [Ma]) was scored, and corrective actions or preventive actions (CAPAs) for Mo, S and Ma risks were proposed. RESULTS We identified five Mo, six S and no Ma risks for the CTU part of the process. The most frequent risk was traceability failure. To reduce its frequency, we developed and validated software dedicated to ATMP activities. Another S risk was non-compliance of CAR T cell-specific steps due to the significant variability between companies. Our CAPA process was to implement procedures and design information sheets specific to each CAR T-cell program. In addition, critical steps were added to the ATMP software. Our CAPA process allowed us to reduce the criticality of identified risks to one Mi, seven Mo and three S. For the pharmacy part of the process, five Mo, two S and one Ma risk were identified. The most critical risk was compromised integrity of the CAR T-cell bag at the time of thawing. In case of unavailability of a backup bag, we designed and validated a degraded mode of operation allowing product recovery. In this exceptional circumstance, an agreement has to be signed between the physician, pharmacy, CTU and sponsor or marketing authorization holder. The implemented CAPA process allowed us to reduce the criticality of risks to three Mi and five Mo. CONCLUSIONS Our risk analysis identified several Mo and S risks but only one Ma risk. The implementation of the CAPA process allowed for controlling some risks by decreasing their frequency and/or criticality or by increasing their detectability. The close collaboration between the CTU and pharmacy allows complete traceability of the CAR T-cell circuit, which is essential to guarantee safe use.
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Affiliation(s)
- Chloé Talarmin
- AP-HP, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Paris, France
| | - Steven Kerob
- AP-HP, Hôpital Saint-Louis, Pharmacie à Usage Intérieur, Paris, France
| | - François Cartier
- AP-HP, Hôpital Saint-Louis, Pharmacie à Usage Intérieur, Paris, France
| | | | - Sarah Mukenyi
- AP-HP, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Paris, France
| | - Eden Schwartz
- AP-HP, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Paris, France
| | - Nicolas Boissel
- AP-HP, Hôpital Saint-Louis, Unité d'Hématologie Adolescents et Jeunes Adultes, Paris, France
| | - André Baruchel
- AP-HP, Hôpital Robert Debré, Service d'Hématologie Pédiatrique, Paris, France
| | | | - Nathalie Parquet
- AP-HP, Hôpital Saint-Louis, Unité d'Aphérèse Thérapeutique, Paris, France
| | - Anne Brignier
- AP-HP, Hôpital Saint-Louis, Unité d'Aphérèse Thérapeutique, Paris, France
| | - Emmanuelle Lesprit
- Etablissement Français du Sang, Hôpital Robert Debré, Unité de Médecine Transfusionnelle et Curative, Paris, France
| | - André Desproges
- AP-HP, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Paris, France
| | | | - Jérôme Larghero
- AP-HP, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Paris, France; Centre d'Investigation Clinique de Biothérapies et Inserm U976, Paris, France; Faculté de Médecine, Université de Paris, Paris, France
| | - Miryam Mebarki
- AP-HP, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, Paris, France; Centre d'Investigation Clinique de Biothérapies et Inserm U976, Paris, France; Faculté de Pharmacie, Université de Paris, Paris, France.
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5
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Pagliuca S, Prata PH, Xhaard A, Frieri C, Giannoni L, Sutra Del Galy A, Brignier A, Sicre de Fontbrune F, Michonneau D, Dhedin N, Peffault de Latour R, Socié G, Robin M. Long-term outcomes and risk factor analysis of steroid-refractory graft versus host disease after hematopoietic stem cell transplantation. Bone Marrow Transplant 2020; 56:38-49. [PMID: 32587336 DOI: 10.1038/s41409-020-0977-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/19/2020] [Accepted: 06/10/2020] [Indexed: 11/09/2022]
Abstract
Steroid-refractory graft versus host disease (GVHD) represents a fearsome complication after allogeneic hematopoietic stem cell transplantation (HSCT). We conducted a retrospective study on outcomes and risk factors associated with acute and chronic steroid-refractory GVHD in a large cohort of 1207 patients receiving HSCT in Saint Louis Hospital between 2007 and 2017. Among patients who developed an acute and/or a chronic GVHD, the cumulative incidences of acute and chronic steroid-refractory disease were 31% and 48%, respectively, at day +100 and 1-year post-HSCT. Through a multivariable analysis we selected several risk factors associated with the development of a steroid-refractory disease. For acute GVHD steroid refractoriness, we identified (1) a very high disease risk index, (2) an unrelated donor, (3) the absence of in vivo T-depletion as GVHD prophylaxis, and (4) a reduced intensity conditioning regimen. For chronic GVHD, (1) the use of peripheral blood stem cells, (2) unrelated donors, and (3) absence of in vivo T-depletion were more likely associated with a steroid-refractory disease. After the construction of a multistate dynamic model, we found that the probability of being alive without relapse after the resolution of all GVHD episodes was about 36% in the long term.
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Affiliation(s)
- Simona Pagliuca
- Assistance Publique Hôpitaux des Paris, Saint Louis Hospital, Hematology and Transplantation Unit, Paris, France. .,Université de Paris, Paris, France. .,Department of Translational Hematology and Oncology Research, Cleveland Clinic Foundation, Cleveland, Ohio, United States.
| | - Pedro Henrique Prata
- Assistance Publique Hôpitaux des Paris, Saint Louis Hospital, Hematology and Transplantation Unit, Paris, France
| | - Aliénor Xhaard
- Assistance Publique Hôpitaux des Paris, Saint Louis Hospital, Hematology and Transplantation Unit, Paris, France
| | - Camilla Frieri
- Assistance Publique Hôpitaux des Paris, Saint Louis Hospital, Hematology and Transplantation Unit, Paris, France.,Université de Paris, Paris, France.,Department of Hematology and Transplantation, Federico II University, Naples, Italy
| | - Livia Giannoni
- Assistance Publique Hôpitaux des Paris, Saint Louis Hospital, Hematology and Transplantation Unit, Paris, France
| | - Aurelien Sutra Del Galy
- Assistance Publique Hôpitaux des Paris, Saint Louis Hospital, Hematology and Transplantation Unit, Paris, France.,Université de Paris, Paris, France
| | - Anne Brignier
- Assistance Publique Hôpitaux des Paris, Saint Louis Hospital, Therapeutic Apheresis Unit, Paris, France
| | - Flore Sicre de Fontbrune
- Assistance Publique Hôpitaux des Paris, Saint Louis Hospital, Hematology and Transplantation Unit, Paris, France
| | - David Michonneau
- Assistance Publique Hôpitaux des Paris, Saint Louis Hospital, Hematology and Transplantation Unit, Paris, France.,Université de Paris, Paris, France.,INSERM UMR 976, Paris, France
| | - Nathalie Dhedin
- Assistance Publique Hôpitaux des Paris, Saint Louis Hospital, Hematology and Transplantation Unit, Paris, France
| | - Régis Peffault de Latour
- Assistance Publique Hôpitaux des Paris, Saint Louis Hospital, Hematology and Transplantation Unit, Paris, France.,Université de Paris, Paris, France
| | - Gérard Socié
- Assistance Publique Hôpitaux des Paris, Saint Louis Hospital, Hematology and Transplantation Unit, Paris, France.,Université de Paris, Paris, France.,INSERM UMR 976, Paris, France
| | - Marie Robin
- Assistance Publique Hôpitaux des Paris, Saint Louis Hospital, Hematology and Transplantation Unit, Paris, France
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6
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Brignier A, Ader V, Bellegarde K, Giraud C, Guerout-Verite MA, Hamzy F, Huynh TNP, Levavasseur A, Nacimento F, Rousseau Y, Vincent L, Yakoub-Agha I, De Vos J. Modalités de mobilisation des cellules souches hématopoïétiques autologues et objectifs cellulaires en cellules CD34 + : recommandations de la Société francophone de greffe de mœlle et de thérapie cellulaire (SFGM-TC). Bull Cancer 2020; 107:S44-S51. [DOI: 10.1016/j.bulcan.2019.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/22/2019] [Accepted: 08/29/2019] [Indexed: 01/08/2023]
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7
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Rabian F, Boissel N, Lafaurie M, Brignier A, Larghero J, Madelaine I, Azoulay E, Molina JM, Denis B. Infections compliquant l’immunothérapie par chimeric antigen receptor modified T cell (CAR-T) ciblant le CD19 : partage d’expérience française et nécessité d’un observatoire prospectif. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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8
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Baron M, Lozeron P, Harel S, Bengoufa D, Vignon M, Asli B, Malphettes M, Parquet N, Brignier A, Fermand JP, Kubis N, Arnulf B. Plasma exchanges for severe acute neurological deterioration in patients with IgM anti-myelin-associated glycoprotein (anti-MAG) neuropathy. J Neurol 2017; 264:1132-1135. [DOI: 10.1007/s00415-017-8502-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/20/2017] [Accepted: 04/18/2017] [Indexed: 12/14/2022]
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9
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Chasset F, De Masson A, Le-Buanec H, Xhaa A, Sicre de Fontbrune F, Robin M, Rybojad M, Parquet N, Brignier A, Coman T, Bengoufa D, Bergeron A, Peffault de Latour R, Bagot M, Bensussan A, Socié G, Bouaziz JD. Les taux d’APRIL sont associés à l’activité de la réaction chronique du greffon contre l’hôte chez l’homme. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Rubio MT, Bouillié M, Bouazza N, Coman T, Trebeden-Nègre H, Gomez A, Suarez F, Sibon D, Brignier A, Paubelle E, Nguyen-Khoc S, Cavazzana M, Lantz O, Mohty M, Urien S, Hermine O. Pre-transplant donor CD4 - invariant NKT cell expansion capacity predicts the occurrence of acute graft-versus-host disease. Leukemia 2016; 31:903-912. [PMID: 27740636 DOI: 10.1038/leu.2016.281] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/26/2016] [Accepted: 09/06/2016] [Indexed: 02/07/2023]
Abstract
Clinically useful pre-transplant predictive factors of acute graft-versus-host-disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-SCT) are lacking. We prospectively analyzed HSC graft content in CD34+, NK, conventional T, regulatory T and invariant natural killer T (iNKT) cells in 117 adult patients before allo-SCT. Results were correlated with occurrence of aGVHD and relapse. In univariate analysis, iNKT cells were the only graft cell populations associated with occurrence of aGVHD. In multivariate analysis, CD4- iNKT/T cell frequency could predict grade II-IV aGVHD in bone marrow and peripheral blood stem cell (PBSC) grafts, while CD4- iNKT expansion capacity was predictive in PBSC grafts. Receiver operating characteristic analyses determined the CD4- iNKT expansion factor as the best predictive factor of aGVHD. Incidence of grade II-IV aGVHD was reduced in patients receiving a graft with an expansion factor above versus below 6.83 (9.7 vs 80%, P<0.0001), while relapse incidence at two years was similar (P=0.5).The test reached 94% sensitivity and 100% specificity in the subgroup of patients transplanted with human leukocyte antigen 10/10 PBSCs without active disease. Analysis of this CD4- iNKT expansion capacity test may represent the first diagnostic tool allowing selection of the best donor to avoid severe aGVHD with preserved graft-versus-leukemia effect after peripheral blood allo-SCT.
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Affiliation(s)
- M-T Rubio
- INSERM UMR 1163 and CNRS ERL 8254, Laboratory of Cellular and Molecular Mechanisms of Hemathological Disorders and Therapeutic Implication, Hôpital Necker, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France.,INSERM UMRs 938, Centre de Recherche de l'hôpital Saint Antoine, Paris, France.,Université Pierre et Marie Curie, Paris VI, France.,Institut Hospitalo-Universitaire (IHU) Imagine, Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - M Bouillié
- INSERM UMR 1163 and CNRS ERL 8254, Laboratory of Cellular and Molecular Mechanisms of Hemathological Disorders and Therapeutic Implication, Hôpital Necker, Paris, France.,Institut Hospitalo-Universitaire (IHU) Imagine, Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - N Bouazza
- Unité de Recherche Clinique, Paris Centre Necker Cochin, Hôpital Tarnier, Paris, France
| | - T Coman
- INSERM UMR 1163 and CNRS ERL 8254, Laboratory of Cellular and Molecular Mechanisms of Hemathological Disorders and Therapeutic Implication, Hôpital Necker, Paris, France.,Institut Hospitalo-Universitaire (IHU) Imagine, Paris Descartes-Sorbonne Paris Cité University, Paris, France
| | - H Trebeden-Nègre
- Département de Biothérapie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - A Gomez
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France.,INSERM UMRs 938, Centre de Recherche de l'hôpital Saint Antoine, Paris, France.,Université Pierre et Marie Curie, Paris VI, France
| | - F Suarez
- INSERM UMR 1163 and CNRS ERL 8254, Laboratory of Cellular and Molecular Mechanisms of Hemathological Disorders and Therapeutic Implication, Hôpital Necker, Paris, France.,Institut Hospitalo-Universitaire (IHU) Imagine, Paris Descartes-Sorbonne Paris Cité University, Paris, France.,Service d'Hématologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - D Sibon
- INSERM UMR 1163 and CNRS ERL 8254, Laboratory of Cellular and Molecular Mechanisms of Hemathological Disorders and Therapeutic Implication, Hôpital Necker, Paris, France.,Service d'Hématologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - A Brignier
- Therapeutic Apheresis Unit, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - E Paubelle
- INSERM UMR 1163 and CNRS ERL 8254, Laboratory of Cellular and Molecular Mechanisms of Hemathological Disorders and Therapeutic Implication, Hôpital Necker, Paris, France.,Institut Hospitalo-Universitaire (IHU) Imagine, Paris Descartes-Sorbonne Paris Cité University, Paris, France.,Service d'Hématologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
| | - S Nguyen-Khoc
- Service d'Hématologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - M Cavazzana
- Institut Hospitalo-Universitaire (IHU) Imagine, Paris Descartes-Sorbonne Paris Cité University, Paris, France.,Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U1163, Laboratory of Human Lymphohematopoiesis, Paris, France
| | - O Lantz
- INSERM U932, Département de Biologie des Tumeurs, Institut Curie, Paris, France.,Centre d'Investigation Clinique, CICBT507 IGR/Curie, Paris, France
| | - M Mohty
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France.,INSERM UMRs 938, Centre de Recherche de l'hôpital Saint Antoine, Paris, France.,Université Pierre et Marie Curie, Paris VI, France
| | - S Urien
- Unité de Recherche Clinique, Paris Centre Necker Cochin, Hôpital Tarnier, Paris, France.,INSERM CIC 1419, EAU08 Université Paris Descartes, Paris, France
| | - O Hermine
- INSERM UMR 1163 and CNRS ERL 8254, Laboratory of Cellular and Molecular Mechanisms of Hemathological Disorders and Therapeutic Implication, Hôpital Necker, Paris, France.,Institut Hospitalo-Universitaire (IHU) Imagine, Paris Descartes-Sorbonne Paris Cité University, Paris, France.,Service d'Hématologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Necker, Paris, France
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11
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Awad F, Georgin-Lavialle S, Brignier A, Derrieux C, Aouba A, Stojanovic KS, Grateau G, Amselem S, Karabina SA. Chronic myelomonocytic leukemia as a cause of fatal uncontrolled inflammation in familial Mediterranean fever. Pediatr Rheumatol Online J 2015. [PMCID: PMC4599954 DOI: 10.1186/1546-0096-13-s1-p177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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12
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Fourgeaud C, El Nemer W, Michon Pasturel U, Bonhomme S, Brignier A, Lazareth I, Priollet P. [Vascular myeloproliferative neoplasm with normal cell blood count: Exploration and medical management]. ACTA ACUST UNITED AC 2015; 40:350-8. [PMID: 26362408 DOI: 10.1016/j.jmv.2015.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/12/2015] [Indexed: 02/06/2023]
Abstract
UNLABELLED Negative BCR ABL myeloproliferative neoplasm (MPN) such as polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (MFP) are clonal hematological malignancies and may lead to a high risk of venous, arterial or microcirculatory thrombosis. Atypical sites of thrombosis can sometimes reveal the neoplasm disorder. Their diagnoses are a major issue because of the propensity to develop acute myeloid leukemia and/or myelofibrosis. The acquired JAK2V617F variant (Janus kinase 2; 9p24) is a prevalent MPN and also a sensitive marker for PV diagnosis (95% positive mutation), but not specific since found in approximately 50% of patients with ET and MFP. PATIENT AND METHODS We present a diagnostic and a therapeutic approach based on one patient with microcirculatory ischemic manifestations in the toes, and who had strictly normal cell blood counts and was positive for JAK2V617F mutation: thrombotic risk factor evaluation; bone marrow biopsy; red cell adhesion assays. These experimental assays are promising for the development of new therapeutics in MPN; they assess red cell adherence to the vascular endothelium after the phosphorylation of Lu/BCAM subsequent to a positive JAK2V617F mutation. RESULTS Compared with controls, our patient exhibited increased Lu/BCAM receptor phosphorylation and red blood cell adhesion. CONCLUSION This development may lead to improved care for patients with thrombotic manifestations, normal blood cell counts, and a positive JAK2V617F mutation: multidisciplinary management, including regular hematological monitoring, could lead to the introduction of a cytoreductive treatment.
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Affiliation(s)
- C Fourgeaud
- Service de médecine vasculaire, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
| | - W El Nemer
- Institut national de la transfusion sanguine, Inserm U1134, 6, rue Alexandre-Cabanel, 75739 Paris cedex 15, France
| | - U Michon Pasturel
- Service de médecine vasculaire, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - S Bonhomme
- Service de médecine vasculaire, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Brignier
- Service d'hématologie A, hôpital Necker, 149, rue de Sèvres, 75015 Paris, France
| | - I Lazareth
- Service de médecine vasculaire, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Priollet
- Service de médecine vasculaire, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
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13
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Awad F, Georgin-Lavialle S, Brignier A, Derrieux C, Aouba A, Stankovic-Stojanovic K, Grateau G, Amselem S, Hermine O, Karabina SA. Chronic myelomonocytic leukemia as a cause of fatal uncontrolled inflammation in familial Mediterranean fever. Orphanet J Rare Dis 2015; 10:76. [PMID: 26076658 PMCID: PMC4485869 DOI: 10.1186/s13023-015-0295-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/09/2015] [Indexed: 12/31/2022] Open
Abstract
We report on a familial Mediterranean fever (FMF) patient homozygous for p.M694V in the MEFV gene who developed chronic myelomonocytic leukemia (CMML) leading to an uncontrolled and fatal inflammatory syndrome. Plasma levels of IL-6 and IL-18 were found to be very high, as compared to healthy controls and CMML-free FMF patients. Our study unveils the interplay between two different disorders involving the same target cells, suggesting that in myelodysplasia with inflammatory manifestations, mutations in genes causing autoinflammatory syndromes, like MEFV, can be present and thus could be sought. Early chemotherapy with interleukin inhibitors could be proposed in such unusual situations.
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Affiliation(s)
- Fawaz Awad
- Sorbonne Universités, UPMC University Paris 06, INSERM UMR_S933, Hôpital Armand-Trousseau, Paris, F-75012, France.
| | - Sophie Georgin-Lavialle
- Sorbonne Universités, UPMC University Paris 06, INSERM UMR_S933, Hôpital Armand-Trousseau, Paris, F-75012, France. .,Centre de référence de la fièvre méditerranéenne familiale, DHU I2B, Service de médecine interne, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
| | - Anne Brignier
- Service d'Hématologie clinique, AP-HP, Hôpital Necker, Université Paris Descartes - Sorbonne Paris Cité, Imagine Institute, INSERM UMR 1163 et CNRS ERL 8254, Paris, France.
| | - Coralie Derrieux
- Laboratoire d'hématologie biologique, Hôpital Necker, 149 rue de Sèvres, 75015, Paris, France.
| | - Achille Aouba
- Service d'Hématologie clinique, AP-HP, Hôpital Necker, Université Paris Descartes - Sorbonne Paris Cité, Imagine Institute, INSERM UMR 1163 et CNRS ERL 8254, Paris, France.
| | - Katia Stankovic-Stojanovic
- Centre de référence de la fièvre méditerranéenne familiale, DHU I2B, Service de médecine interne, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
| | - Gilles Grateau
- Sorbonne Universités, UPMC University Paris 06, INSERM UMR_S933, Hôpital Armand-Trousseau, Paris, F-75012, France. .,Centre de référence de la fièvre méditerranéenne familiale, DHU I2B, Service de médecine interne, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
| | - Serge Amselem
- Sorbonne Universités, UPMC University Paris 06, INSERM UMR_S933, Hôpital Armand-Trousseau, Paris, F-75012, France. .,Service de Génétique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Trousseau, F-75012, Paris, France.
| | - Olivier Hermine
- Service d'Hématologie clinique, AP-HP, Hôpital Necker, Université Paris Descartes - Sorbonne Paris Cité, Imagine Institute, INSERM UMR 1163 et CNRS ERL 8254, Paris, France.
| | - Sonia-Athina Karabina
- Sorbonne Universités, UPMC University Paris 06, INSERM UMR_S933, Hôpital Armand-Trousseau, Paris, F-75012, France.
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