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Benjamin R, Jain N, Maus MV, Boissel N, Graham C, Jozwik A, Yallop D, Konopleva M, Frigault MJ, Teshima T, Kato K, Boucaud F, Balandraud S, Gianella-Borradori A, Binlich F, Marchiq I, Dupouy S, Almena-Carrasco M, Pannaux M, Fouliard S, Brissot E, Mohty M, Benjamin R, Graham C, Jozwik A, Yallop D, Bonganay L, Catt L, Chappell J, Cheung G, Chu V, Cuthill K, Devereux S, Dunlop A, Ellard R, Farzeneh F, Folarin N, Giemza E, Kassam S, Kazmi M, Kuhnl A, Lewis J, Liskova M, Mason A, Metaxa V, Mufti G, Munro H, Pagliuca A, Patten P, Potter V, Rice C, Saleem A, Sanderson R, Stewart O, Jabbour E, Jain N, Jones E, Kantarjian H, Kebriaei P, Konopleva M, McGee K, Wierda W, Brown J, Casey K, Frigault M, Hock H, Mathews R, Maus M, McKeown MA, Spitzer T, Toncheva V, Azoulay E, Boissel N, Caillat-Zucman S, Celli-Lebras K, Clappier E, Itzykson R, Larghero J, Lengliné E, Madelaine I, Meunier M, Rabian F, Raffoux E, Tremorin MT, Bonnin A, Brissot E, Daguenel-Nguyen A, Dulery R, Ledraa T, Malard F, Mediavilla C, Mohty M, Vekhoff A, Teshima T, Kato K. UCART19, a first-in-class allogeneic anti-CD19 chimeric antigen receptor T-cell therapy for adults with relapsed or refractory B-cell acute lymphoblastic leukaemia (CALM): a phase 1, dose-escalation trial. The Lancet Haematology 2022; 9:e833-e843. [DOI: 10.1016/s2352-3026(22)00245-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/18/2022] [Accepted: 07/19/2022] [Indexed: 12/16/2022]
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Jachiet V, Ricard L, Hirsch P, Malard F, Pascal L, Beyne-Rauzy O, Peterlin P, Maria ATJ, Vey N, D'Aveni M, Gourin MP, Dimicoli-Salazar S, Banos A, Wickenhauser S, Terriou L, De Renzis B, Durot E, Natarajan-Ame S, Vekhoff A, Voillat L, Park S, Vinit J, Dieval C, Dellal A, Grobost V, Willems L, Rossignol J, Solary E, Kosmider O, Dulphy N, Zhao LP, Adès L, Fenaux P, Fain O, Mohty M, Gaugler B, Mekinian A. Reduced peripheral blood dendritic cell and monocyte subsets in MDS patients with systemic inflammatory or dysimmune diseases. Clin Exp Med 2022:10.1007/s10238-022-00866-5. [PMID: 35953763 DOI: 10.1007/s10238-022-00866-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/10/2022] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systemic inflammatory and autoimmune diseases (SIADs) occur in 10-20% of patients with myelodysplastic syndrome (MDS). Recently identified VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome, associated with somatic mutations in UBA1 (Ubiquitin-like modifier-activating enzyme 1), encompasses a range of severe inflammatory conditions along with hematological abnormalities, including MDS. The pathophysiological mechanisms underlying the association between MDS and SIADs remain largely unknown, especially the roles of different myeloid immune cell subsets. The aim of this study was to quantitatively evaluate peripheral blood myeloid immune cells (dendritic cells (DC) and monocytes) by flow cytometry in MDS patients with associated SIAD (n = 14, most often including relapsing polychondritis or neutrophilic dermatoses) and to compare their distribution in MDS patients without SIAD (n = 23) and healthy controls (n = 7). Most MDS and MDS/SIAD patients had low-risk MDS. Eight of 14 (57%) MDS/SIAD patients carried UBA1 somatic mutations, defining VEXAS syndrome.Compared with MDS patients, most DC and monocyte subsets were significantly decreased in MDS/SIAD patients, especially in MDS patients with VEXAS syndrome. Our study provides the first overview of the peripheral blood immune myeloid cell distribution in MDS patients with associated SIADs and raises several hypotheses: possible redistribution to inflammation sites, increased apoptosis, or impaired development in the bone marrow.
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Affiliation(s)
- Vincent Jachiet
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France. .,Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France.
| | - Laure Ricard
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Pierre Hirsch
- Service d'Hématologie Biologique, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Florent Malard
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Laurent Pascal
- Service d'Oncologie et d'Hématologie, Hôpital Saint Vincent de Paul, Université Catholique de Lille, Lille, France
| | - Odile Beyne-Rauzy
- Service de Médecine Interne, CHU de Toulouse, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Pierre Peterlin
- Service d'Hématologie Clinique, CHU de Nantes, Nantes, France
| | - Alexandre Thibault Jacques Maria
- Service de Médecine Interne, maladies multi-organiques de l'adulte, Hôpital Saint-Éloi, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Norbert Vey
- Institut Paoli-Calmettes, CRCM, Aix-Marseille Univ, Inserm, CNRS, Marseille, France
| | - Maud D'Aveni
- Service d'Hématologie et de Médecine Interne, Hôpital Brabois, CHRU Nancy, Nancy, France
| | - Marie-Pierre Gourin
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Dupuytren, CHU de Limoges, Limoges, France
| | | | - Anne Banos
- Service d'Hématologie Clinique, Centre Hospitalier Côte Basque, Bayonne, France
| | - Stefan Wickenhauser
- Service d'Hématologie Clinique, Hôpital Universitaire Carémeau, Institut de Cancérologie du Gard, Nîmes, France
| | - Louis Terriou
- Service de Médecine Interne et Immunologie Clinique, CHU Lille, 59000, Lille, France
| | - Benoit De Renzis
- Service d'Hématologie Clinique, Hôpital Estaing, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Eric Durot
- Service d'Hématologie Clinique, Hôpital Robert Debré, CHU de Reims, Reims, France
| | - Shanti Natarajan-Ame
- Service d'Hématologie, Institut de Cancérologie Strasbourg Europe (ICANS), 17 rue Albert Calmette, Strasbourg, France
| | - Anne Vekhoff
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Laurent Voillat
- Service d'Hématologie et Oncologie, CH William Morey, Chalon sur Saône, France
| | - Sophie Park
- Service d'Hématologie, Université Grenoble Alpes Et CHU Grenoble Alpes, Grenoble, France
| | - Julien Vinit
- Service de Médecine Interne, CH William Morey, Chalon sur Saône, France
| | - Céline Dieval
- Service de Médecine Interne et Hématologie, GHLA, CH de Rochefort, Rochefort, France
| | - Azeddine Dellal
- Service de Rhumatologie, Hôpital Montfermeil, Montfermeil, France
| | - Vincent Grobost
- Service de Médecine Interne, CHU Estaing, Clermont-Ferrand, France
| | - Lise Willems
- Service d'Hématologie, AP-HP, Hôpital Cochin, Paris, France
| | - Julien Rossignol
- Service d'Hématologie Adultes, AP-HP, Hôpital Necker-Enfants Malades, 75015, Paris, France
| | - Eric Solary
- Département d'Hématologie, Institut Gustave Roussy, Villejuif, France
| | - Olivier Kosmider
- Service d'Hématologie Biologique, Université de Paris, AP-HP, Hôpital Cochin, 75014, Paris, France
| | - Nicolas Dulphy
- Institut de Recherche Saint Louis, Hôpital Saint Louis, Université de Paris, INSERM U1160, Paris, France
| | - Lin Pierre Zhao
- Département d'Hématologie, Université de Paris, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Lionel Adès
- Département d'Hématologie, Université de Paris, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Pierre Fenaux
- Département d'Hématologie, Université de Paris, AP-HP, Hôpital Saint Louis, 75010, Paris, France
| | - Olivier Fain
- Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Mohamad Mohty
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Béatrice Gaugler
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service d'Hématologie Clinique et de Thérapie Cellulaire, Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Arsène Mekinian
- Sorbonne Université, INSERM UMR938, Centre de Recherche Saint-Antoine (CRSA), 75012, Paris, France.,Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Sorbonne Université, AP-HP, Hôpital Saint Antoine, Paris, France
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3
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Genthon A, Dragoi D, Memoli M, Hirsch P, Favale F, Suner L, Chaquin M, Boncoeur P, Marjanovic Z, Bonnin A, Sestili S, Dulery R, Malard F, Brissot E, Banet A, van de Wyngaert Z, Vekhoff A, Delhommeau F, Mohty M, Legrand O. Isocitrate dehydrogenase inhibitors as a bridge to allogeneic stem cell transplant in relapsed or refractory acute myeloid leukaemia. Br J Haematol 2022; 198:780-784. [PMID: 35615877 DOI: 10.1111/bjh.18290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Alexis Genthon
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
| | - Diana Dragoi
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
| | - Mara Memoli
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
| | - Pierre Hirsch
- Service d'Hématologie Biologique, Hôpital Saint Antoine, AP-HP, Centre de Recherche Saint-Antoine (CRSA), INSERM UMR938, Sorbonne Université, Paris, France
| | - Fabrizia Favale
- Service d'Hématologie Biologique, Hôpital Saint Antoine, AP-HP, Centre de Recherche Saint-Antoine (CRSA), INSERM UMR938, Sorbonne Université, Paris, France
| | - Ludovic Suner
- Service d'Hématologie Biologique, Hôpital Saint Antoine, AP-HP, Centre de Recherche Saint-Antoine (CRSA), INSERM UMR938, Sorbonne Université, Paris, France
| | - Michael Chaquin
- Service d'Hématologie Biologique, Hôpital Saint Antoine, AP-HP, Centre de Recherche Saint-Antoine (CRSA), INSERM UMR938, Sorbonne Université, Paris, France
| | - Pierre Boncoeur
- Service d'Hématologie Biologique, Hôpital Saint Antoine, AP-HP, Centre de Recherche Saint-Antoine (CRSA), INSERM UMR938, Sorbonne Université, Paris, France
| | - Zora Marjanovic
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
| | - Agnès Bonnin
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
| | - Simona Sestili
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
| | - Remy Dulery
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
| | - Florent Malard
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
| | - Eolia Brissot
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
| | - Anne Banet
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
| | - Zoe van de Wyngaert
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
| | - Anne Vekhoff
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
| | - Francois Delhommeau
- Service d'Hématologie Biologique, Hôpital Saint Antoine, AP-HP, Centre de Recherche Saint-Antoine (CRSA), INSERM UMR938, Sorbonne Université, Paris, France
| | - Mohamad Mohty
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
| | - Ollivier Legrand
- Service d'hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine, AP-HP, INSERM UMRs 938, Sorbonne Université, Paris, France
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Guilhot F, Rigal-Huguet F, Guilhot J, Guerci-Bresler AP, Maloisel F, Rea D, Coiteux V, Gardembas M, Berthou C, Vekhoff A, Jourdan E, Berger M, Fouillard L, Alexis M, Legros L, Rousselot P, Delmer A, Lenain P, Escoffre Barbe M, Gyan E, Bulabois CE, Dubruille V, Joly B, Pollet B, Cony-Makhoul P, Johnson-Ansah H, Mercier M, Caillot D, Charbonnier A, Kiladjian JJ, Chapiro J, Penot A, Dorvaux V, Vaida I, Santagostino A, Roy L, Zerazhi H, Deconinck E, Maisonneuve H, Plantier I, Lebon D, Arkam Y, Cambier N, Ghomari K, Miclea JM, Glaisner S, Cayuela JM, Chomel JC, Muller M, Lhermitte L, Delord M, Preudhomme C, Etienne G, Mahon FX, Nicolini FE. Long-term outcome of imatinib 400 mg compared to imatinib 600 mg or imatinib 400 mg daily in combination with cytarabine or pegylated interferon alpha 2a for chronic myeloid leukaemia: results from the French SPIRIT phase III randomised trial. Leukemia 2021; 35:2332-2345. [PMID: 33483613 DOI: 10.1038/s41375-020-01117-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 11/20/2020] [Accepted: 12/15/2020] [Indexed: 01/29/2023]
Abstract
The STI571 prospective randomised trial (SPIRIT) French trial is a four-arm study comparing imatinib (IM) 400 mg versus IM 600 mg, IM 400 mg + cytarabine (AraC), and IM 400 mg + pegylated interferon alpha2a (PegIFN-α2a) for the front-line treatment of chronic-phase chronic myeloid leukaemia (CML). Long-term analyses included overall and progression-free survival, molecular responses to treatment, and severe adverse events. Starting in 2003, the trial included 787 evaluable patients. The median overall follow-up of the patients was 13.5 years (range 3 months to 16.7 years). Based on intention-to-treat analyses, at 15 years, overall and progression-free survival were similar across arms: 85%, 83%, 80%, and 82% and 84%, 87%, 79%, and 79% for the IM 400 mg (N = 223), IM 600 mg (N = 171), IM 400 mg + AraC (N = 172), and IM 400 mg + PegIFN-α2a (N = 221) arms, respectively. The rate of major molecular response at 12 months and deep molecular response (MR4) over time were significantly higher with the combination IM 400 mg + PegIFN-α2a than with IM 400 mg: p = 0.0001 and p = 0.0035, respectively. Progression to advanced phases and secondary malignancies were the most frequent causes of death. Toxicity was the main reason for stopping AraC or PegIFN-α2a treatment.
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Affiliation(s)
| | | | | | | | | | - Delphine Rea
- Department of Hematology, Hopital Saint-Louis, APHP, Paris, France
| | - Valérie Coiteux
- Clinical Hematology Department, Hospital Claude Huriez, CHRU, Lille, France
| | | | | | - Anne Vekhoff
- Clinical Hematology Department, Hospital St Antoine, APHP. Sorbonne Université, Paris, France
| | - Eric Jourdan
- Hématologie Clinique, Institut de Cancérologie du Gard, CHU de Nîmes, Nîmes, France
| | - Marc Berger
- Hematologie Biologique, CHU Estaing, Clermont Ferrand, France
| | | | - Magda Alexis
- Hématologie et Thérapie Cellulaire, Grand Hôpital de l'EST Francilien, Meaux, France
| | - Laurence Legros
- Department of Haematology, Hopital Paul Brousse, AP-HP, INSERM UMRS-MD1197, Villejuif, France
| | - Philippe Rousselot
- Hematology Department, Division of Innovative Therapies, Centre Hospitalier de Versailles, Versailles and Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IMVA-HB/IDMIT), Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Alain Delmer
- Clinical Hematology Department, CHU, Reims, France
| | - Pascal Lenain
- Clinical Hematology Department, Centre Henri Becquerel, Rouen, France
| | | | - Emmanuel Gyan
- Hematology and Cell Therapy Department, University of Tours, Tours, France
| | | | | | - Bertrand Joly
- Hématologie Clinique, CH Sud Francilien, Corbeil-Essonnes, France
| | - Bertrand Pollet
- Hématologie Clinique, CH Boulogne sur mer, Boulogne sur mer, France
| | | | | | - Melanie Mercier
- Service d'Dématologie Médecine Interne Maladies Infectieuses, Centre Hospitalier Bretagne Atlantique Vannes, Vannes, France
| | - Denis Caillot
- Hématologie Clinique, CHU Dijon Bourgogne, Dijon, France
| | - Aude Charbonnier
- Clinical Hematology Department, Institut Paoli Calmettes, Marseille, France
| | | | - Jacques Chapiro
- Service Hématologie Clinique, Hopitaux Civiles de Colmar, Colmar, France
| | - Amélie Penot
- Service Hématologie et Thérapie Cellulaire, CHU Limoges, Limoges, France
| | | | - Iona Vaida
- Hématologie Clinique, Centre Hospitalier René-Dubois, Cergy-Pontoise, France
| | | | - Lydia Roy
- Clinical Hematology Department, Hop Henri Mondor, APHP, UPEC, Créteil, France
| | - Hacene Zerazhi
- Service Oncologie Médicale et Hématologie Clinique, Centre Hospitalier Henri Duffaut, Avignon, France
| | | | | | | | - Delphine Lebon
- Service d'Hématologie Clinique CHU Amiens-Picardie, Amiens-Picardie, France
| | - Yazid Arkam
- Service d'Hématologie GHR Mulhouse, Mulhouse, France
| | | | - Kamel Ghomari
- Service d'Hématologie-Oncologie CH Beauvais, Beauvais, France
| | | | | | | | | | - Marc Muller
- Laboratoire de Génétique, CHRU Nancy, Nancy, France
| | - Ludovic Lhermitte
- Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Marc Delord
- Clinical Research Department, Hôpital André Mignot, Versailles, France
| | | | - Gabriel Etienne
- Clinical Hematology Department, Institut Bergonié, Bordeaux, France
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5
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Malard F, Vekhoff A, Lapusan S, Isnard F, D'incan-Corda E, Rey J, Saillard C, Thomas X, Ducastelle-Lepretre S, Paubelle E, Larcher MV, Rocher C, Recher C, Tavitian S, Bertoli S, Michallet AS, Gilis L, Peterlin P, Chevallier P, Nguyen S, Plantamura E, Boucinha L, Gasc C, Michallet M, Dore J, Legrand O, Mohty M. Gut microbiota diversity after autologous fecal microbiota transfer in acute myeloid leukemia patients. Nat Commun 2021; 12:3084. [PMID: 34035290 PMCID: PMC8149453 DOI: 10.1038/s41467-021-23376-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 09/25/2020] [Accepted: 04/22/2021] [Indexed: 12/20/2022] Open
Abstract
Acute myeloid leukemia (AML) intensive chemotherapy combined with broad-spectrum antibiotics, leads to gut microbiota dysbiosis promoting pathological conditions and an increased incidence of complications. Here we report findings from a phase II single-arm, multicenter study evaluating autologous fecal microbiota transfer (AFMT) in 25 AML patients treated with intensive chemotherapy and antibiotics (ClinicalTrials.gov number: NCT02928523). The co-primary outcomes of the study are to evaluate the efficacy of AFMT in dysbiosis correction and multidrug-resistant bacteria eradication. The main secondary outcomes are to define a dysbiosis biosignature, to evaluate the effect of dysbiosis correction on patient clinical status, to assess the short and mid-term safety of AFMT in this immunocompromised population, and to evaluate the feasibility of the AFMT procedure and acceptability by the patient. Intensive induction chemotherapy induces a dramatic decrease of α-diversity indices, and a microbial dysbiosis with a significant shift of the microbial communities and domination of pro-inflammatory families. After AFMT treatment, α-diversity indices return to their initial mean levels and the similarity index shows the restoration of microbial communities. The trial meets pre-specified endpoints. AFMT appears to be safe and may be effective for gut microbiota restoration in AML patients receiving intensive chemotherapy and antibiotics, with an excellent gut microbiota reconstruction based on both richness and diversity indices at the species level. The combination of chemotherapy and broad-spectrum antibiotics induces gut microbiota (GM) dysbiosis in acute myeloid leukaemia (AML) leading to additional complications. Here, the authors report the efficacy in GM restoration and safety of autologous faecal microbiota transfer in treated AML patients in a phase II clinical trial.
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Affiliation(s)
- Florent Malard
- Service d'hématologie clinique et de thérapie cellulaire, Hôpital Saint Antoine, APHP, Sorbonne Université, INSERM UMRs 938, Paris, France.
| | - Anne Vekhoff
- Service d'hématologie clinique et de thérapie cellulaire, Hôpital Saint Antoine, APHP, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Simona Lapusan
- Service d'hématologie clinique et de thérapie cellulaire, Hôpital Saint Antoine, APHP, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Francoise Isnard
- Service d'hématologie clinique et de thérapie cellulaire, Hôpital Saint Antoine, APHP, Sorbonne Université, INSERM UMRs 938, Paris, France
| | | | - Jérôme Rey
- Service d'hématologie, Institut Paoli Calmettes, Marseille, France
| | - Colombe Saillard
- Service d'hématologie, Institut Paoli Calmettes, Marseille, France
| | - Xavier Thomas
- Service d'hématologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | | | - Etienne Paubelle
- Service d'hématologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Marie-Virginie Larcher
- Service d'hématologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Clément Rocher
- Service d'hématologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Christian Recher
- CHU de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université de Toulouse III Paul Sabatier, Service d'hématologie, Toulouse, France
| | - Suzanne Tavitian
- CHU de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université de Toulouse III Paul Sabatier, Service d'hématologie, Toulouse, France
| | - Sarah Bertoli
- CHU de Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Université de Toulouse III Paul Sabatier, Service d'hématologie, Toulouse, France
| | | | - Lila Gilis
- Service d'hématologie, Centre Léon Bérard, Lyon, France
| | | | | | - Stéphanie Nguyen
- Service d'hématologie clinique, Hôpital de la Pitié Salpétrière, APHP, Sorbonne Université, Paris, France
| | | | | | | | | | - Joel Dore
- Université Paris-Saclay, INRAE, MetaGenoPolis, AgroParisTech, MICALIS, Jouy-en-Josas, France
| | - Ollivier Legrand
- Service d'hématologie clinique et de thérapie cellulaire, Hôpital Saint Antoine, APHP, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Mohamad Mohty
- Service d'hématologie clinique et de thérapie cellulaire, Hôpital Saint Antoine, APHP, Sorbonne Université, INSERM UMRs 938, Paris, France
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6
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Memoli M, Paviglianiti A, Malard F, Battipaglia G, Brissot E, Médiavilla C, Bianchessi A, Banet A, Van de Wyngaert Z, Ledraa T, Belhocine R, Sestili S, Lapusan S, Hirsch P, Favale F, Boussaroque A, Bonnin A, Vekhoff A, Legrand O, Mohty M, Duléry R. Thiotepa-busulfan-fludarabine as a conditioning regimen for patients with myelofibrosis undergoing allogeneic hematopoietic transplantation: a single center experience. Leuk Lymphoma 2020; 62:419-427. [DOI: 10.1080/10428194.2020.1827246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Mara Memoli
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- Department of Medicine and Surgery, Hematology and Hematopoietic Stem Cell Transplant Center, University of Naples Federico II, Naples, Italy
| | - Annalisa Paviglianiti
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Florent Malard
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Giorgia Battipaglia
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Eolia Brissot
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Clémence Médiavilla
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Antonio Bianchessi
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Anne Banet
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Zoé Van de Wyngaert
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Tounes Ledraa
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Ramdane Belhocine
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Simona Sestili
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Simona Lapusan
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Pierre Hirsch
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
- AP-HP, Service d'Hématologie biologique, Hôpital Saint Antoine, Paris, France
| | - Fabrizia Favale
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
- AP-HP, Service d'Hématologie biologique, Hôpital Saint Antoine, Paris, France
| | - Agathe Boussaroque
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
- AP-HP, Service d'Hématologie biologique, Hôpital Saint Antoine, Paris, France
| | - Agnès Bonnin
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Anne Vekhoff
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Ollivier Legrand
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Mohamad Mohty
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Rémy Duléry
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
- INSERM, UMRs 938, Paris, France
- Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
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7
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Marini C, Brissot E, Bazarbachi A, Duléry R, Sestili S, Battipaglia G, Médiavilla C, Paviglianiti A, Belhocine R, Isnard F, Lapusan S, Adaeva R, Bannet A, van de Wiegert Z, Vekhoff A, Ledraa T, Legrand O, Labopin M, Bonnin A, Ruggeri A, Malard F, Mohty M. Tolerability and Efficacy of Treatment With Azacytidine as Prophylactic or Preemptive Therapy for Myeloid Neoplasms After Allogeneic Stem Cell Transplantation. Clinical Lymphoma Myeloma and Leukemia 2020; 20:377-382. [DOI: 10.1016/j.clml.2019.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 12/28/2022]
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8
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Mohty R, Brissot E, Battipaglia G, Ruggeri A, Dulery R, Bonnin A, Médiavilla C, Sestili S, Belhocine R, Vekhoff A, Ledraa T, Lapusan CS, Adaeva R, Isnard F, Legrand O, Mohty M, Malard F. Infectious complications after post-transplantation cyclophosphamide and anti-thymocyte globulin-based haploidentical stem cell transplantation. Br J Haematol 2019; 187:e64-e68. [PMID: 31487392 DOI: 10.1111/bjh.16189] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Razan Mohty
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Eolia Brissot
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France.,Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Giorgia Battipaglia
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Annalisa Ruggeri
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Rémy Dulery
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Agnès Bonnin
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Clémence Médiavilla
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Simona Sestili
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Ramdane Belhocine
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Anne Vekhoff
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Tounes Ledraa
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Camelia Simona Lapusan
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Rosa Adaeva
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Françoise Isnard
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Olivier Legrand
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France
| | - Mohamad Mohty
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France.,Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Florent Malard
- Service d'Hématologie Clinique et de Thérapie cellulaire, APHP, Hôpital Saint Antoine, Paris, France.,Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Paris, France
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9
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Bachy E, Seymour JF, Feugier P, Offner F, López-Guillermo A, Belada D, Xerri L, Catalano JV, Brice P, Lemonnier F, Martin A, Casasnovas O, Pedersen LM, Dorvaux V, Simpson D, Leppa S, Gabarre J, da Silva MG, Glaisner S, Ysebaert L, Vekhoff A, Intragumtornchai T, Le Gouill S, Lister A, Estell JA, Milone G, Sonet A, Farhi J, Zeuner H, Tilly H, Salles G. Sustained Progression-Free Survival Benefit of Rituximab Maintenance in Patients With Follicular Lymphoma: Long-Term Results of the PRIMA Study. J Clin Oncol 2019; 37:2815-2824. [PMID: 31339826 PMCID: PMC6823890 DOI: 10.1200/jco.19.01073] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [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] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The PRIMA study (ClinicalTrials.gov identifier: NCT00140582) established that 2 years of rituximab maintenance after first-line immunochemotherapy significantly improved progression-free survival (PFS) in patients with follicular lymphoma compared with observation. Here, we report the final PFS and overall survival (OS) results from the PRIMA study after 9 years of follow-up and provide a final overview of safety. METHODS Patients (> 18 years of age) with previously untreated high-tumor-burden follicular lymphoma were nonrandomly assigned to receive one of three immunochemotherapy induction regimens. Responding patients were randomly assigned (stratified by induction regimen, response to induction treatment, treatment center, and geographic region) 1:1 to receive 2 years of rituximab maintenance (375 mg/m2, once every 8 weeks), starting 8 weeks after the last induction treatment, or observation (no additional treatment). All patients in the extended follow-up provided their written informed consent (data cutoff: December 31, 2016). RESULTS In total, 1,018 patients completed induction treatment and were randomly assigned to rituximab maintenance (n = 505) or observation (n = 513). Consent for the extended follow-up was provided by 607 patients (59.6%) of 1,018 (rituximab maintenance, n = 309; observation, n = 298). After data cutoff, median PFS was 10.5 years in the rituximab maintenance arm compared with 4.1 years in the observation arm (hazard ratio, 0.61; 95% CI, 0.52 to 0.73; P < .001). No OS difference was seen in patients randomly assigned to rituximab maintenance or observation (hazard ratio, 1.04; 95% CI, 0.77 to 1.40; P = .7948); 10-year OS estimates were approximately 80% in both study arms. No new safety signals were observed. CONCLUSION Rituximab maintenance after induction immunochemotherapy provides a significant long-term PFS, but not OS, benefit over observation.
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Affiliation(s)
- Emmanuel Bachy
- Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Institut National de la Santé et de la Recherche Médicale (INSERM) 1052, Pierre-Bénite, France
| | - John F Seymour
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Pierre Feugier
- Centre Hospitalier Régional Universitaire de Nancy, Université de Lorraine, INSERM 1256, Nancy, France
| | | | | | - David Belada
- Charles University, Hradec Králové, Czech Republic
| | - Luc Xerri
- Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - John V Catalano
- Frankston Hospital and Monash University, Frankston, Victoria, Australia
| | - Pauline Brice
- Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Lemonnier
- Hôpitaux Universitaires Henri Mondor, Université Paris-Est Créteil, INSERM U955, Créteil, France
| | - Alejandro Martin
- Hospital Universitario de Salamanca-Institute for Biomedical Research of Salamanca, Centro de Investigación Biomédica en Red de Cáncer, Salamanca, Spain
| | - Olivier Casasnovas
- Department of Haematology and INSERM 1231, University Hospital F. Mitterrand, Dijon, France
| | | | - Véronique Dorvaux
- Hôpital de Mercy Centre Hospitalier Régional Metz-Thionville, Metz, France
| | | | - Sirpa Leppa
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | | | | | - Loic Ysebaert
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Anne Vekhoff
- Saint Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Steven Le Gouill
- Centre Hospitalier Universitaire de Nantes, Centre de Recherche en Cancérologie et Immunologie Nantes Angers, INSERM, Université de Nantes, Nantes, France
| | - Andrew Lister
- Queen Mary University of London, London, United Kingdom
| | - Jane A Estell
- Concord Hospital, Concord, University of Sydney, New South Wales, Australia
| | | | | | - Jonathan Farhi
- Centre Hospitalier Universitaire d'Angers, Angers, France
| | | | | | - Gilles Salles
- Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Institut National de la Santé et de la Recherche Médicale (INSERM) 1052, Pierre-Bénite, France
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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
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11
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Picod A, Bonnin A, Battipaglia G, Giannotti F, Ruggeri A, Brissot E, Malard F, Médiavilla C, Belhocine R, Vekhoff A, Gueye MS, Lapusan S, Adaeva R, Isnard F, Legrand O, Baylatry MT, Joly AC, Labopin M, Duléry R, Mohty M. Defibrotide for Sinusoidal Obstruction Syndrome/Veno-Occlusive Disease Prophylaxis in High-Risk Adult Patients: A Single-Center Experience Study. Biol Blood Marrow Transplant 2018; 24:1471-1475. [PMID: 29477779 DOI: 10.1016/j.bbmt.2018.02.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 02/14/2018] [Indexed: 10/17/2022]
Abstract
Sinusoidal obstruction syndrome (SOS), also known as hepatic veno-occlusive disease (VOD), is a serious complication after hematopoietic stem cell transplantation (HSCT). SOS/VOD usually occurs within 3 weeks of HSCT, but the 2016 European Society for Blood and Marrow Transplantation diagnosis criteria have been revised to include late forms. Prophylactic use of defibrotide is recommended in the pediatric setting, but its value remains uncertain in the adult population. We report here a single-center series of 63 adult patients considered at high risk for SOS/VOD who received defibrotide prophylaxis in combination with ursodeoxycholic acid between May 2012 and August 2016. The median duration of defibrotide therapy was 23 days. Bleeding occurred in 14 patients (21.5%). Defibrotide prophylaxis was discontinued in 7 patients (10.8%): 4 cases (6.3%) due to bleeding and 3 cases (4.6%) because of the need for antithrombotic therapy. Overall, SOS/VOD occurred in 4 cases (6.3%) within 21 days after HSCT (days 13 and 14) in 2 cases and late-onset SOS/VOD (days 57 and 58) in the other 2 cases. SOS/VOD was moderate in 1 case, very severe in 3 cases, with 2 deaths related to SOS/VOD. Cumulative incidence of grades II to IV acute graft-versus-host disease and transplant-associated thrombotic microangiopathy were 22.2% and 3.2%, respectively. With a median follow-up of 31 months (range, 10.7 to 60.3), the rates of 2-year overall survival, progression-free survival, incidence of relapse, and nonrelapse mortality were 56.5%, 49%, 28.7%, and 22.3%, respectively. In our experience defibrotide prophylaxis is associated with a low incidence of SOS/VOD after allogeneic HSCT in a high-risk adult population with an acceptable safety profile.
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Affiliation(s)
- Adrien Picod
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Agnès Bonnin
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Giorgia Battipaglia
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France; Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France
| | - Federica Giannotti
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Annalisa Ruggeri
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Eolia Brissot
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France; Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France; INSERM, UMRs 938, Paris, France
| | - Florent Malard
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France; Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France; INSERM, UMRs 938, Paris, France
| | - Clémence Médiavilla
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France; Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France
| | - Ramdane Belhocine
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Anne Vekhoff
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Mor Sény Gueye
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Simona Lapusan
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Rosa Adaeva
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Françoise Isnard
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Ollivier Legrand
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France; Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France
| | - Minh-Tam Baylatry
- UPAC & C (Unité de préparation des anticancéreux et contrôle), Saint Antoine Hospital, AP-HP, Paris, France
| | - Anne-Christine Joly
- UPAC & C (Unité de préparation des anticancéreux et contrôle), Saint Antoine Hospital, AP-HP, Paris, France
| | - Myriam Labopin
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France; Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France
| | - Rémy Duléry
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France; Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France; INSERM, UMRs 938, Paris, France
| | - Mohamad Mohty
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France; Université Pierre et Marie Curie (UPMC), Sorbonne Universités, Paris, France; INSERM, UMRs 938, Paris, France.
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12
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Duléry R, Ménard AL, Chantepie S, El-Cheikh J, François S, Delage J, Giannotti F, Ruggeri A, Brissot E, Battipaglia G, Malard F, Belhocine R, Sestili S, Vekhoff A, Delhommeau F, Reman O, Legrand O, Labopin M, Rubio MT, Mohty M. Sequential Conditioning with Thiotepa in T Cell- Replete Hematopoietic Stem Cell Transplantation for the Treatment of Refractory Hematologic Malignancies: Comparison with Matched Related, Haplo-Mismatched, and Unrelated Donors. Biol Blood Marrow Transplant 2018; 24:1013-1021. [PMID: 29337223 DOI: 10.1016/j.bbmt.2018.01.005] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 10/04/2017] [Accepted: 01/02/2018] [Indexed: 11/19/2022]
Abstract
The results of conventional allogeneic stem cell transplantation (SCT) in refractory hematologic malignancies are poor. Sequential strategies have shown promising results in refractory acute myelogenous leukemia (AML), but have not been validated in a haploidentical (Haplo) transplant setting. We have developed a new sequential approach combining chemotherapy with broad antitumor activity (thiotepa 10 mg/kg, etoposide 400 mg/m2, and cyclophosphamide 1600 mg/m2 from day -15 to day -10), followed after 3 days of rest by a reduced-intensity conditioning regimen (fludarabine 150 mg/m2, i.v. busulfan 6.4 mg/kg, and thymoglobulin 5 mg/kg from day -6 to day -2). High-dose post-transplantation cyclophosphamide was added in cases with Haplo donors. Seventy-two patients (median age, 54 years) with a refractory hematologic malignancy (44 with acute myelogenous leukemia, 7 with acute lymphoblastic leukemia, 15 with myelodysplastic syndrome/myeloproliferative neoplasms, and 6 with lymphomas) were included in this retrospective multicenter study. Donors were Haplo (n = 27), matched related (MRD; n = 16), and unrelated (UD; n = 29). With a median follow-up of 21 months, the 2-year overall survival (OS) and event-free survival (EFS) were 54.7% and 49.3%, respectively, in recipients of Haplo transplants, 49.2% and 43.8%, respectively, in recipients of MRD transplants, and 37.9% and 28%, respectively, in recipients of UD transplants. Compared with UD, the outcomes were improved in Haplo in terms of the incidences of acute grade II-IV graft-versus-host disease (GVHD) (11.1% versus 41.4%; P < .001) and GVHD-free, relapse-free survival (44.4 versus 10.3%; P = .022). These results support the safety and efficacy of a thiotepa-based sequential approach in allogeneic SCT with a Haplo donor with post-transplantation immune modulation. Thus, in patients with refractory hematologic malignancies, there seems to be no benefit in searching for a UD when a Haplo donor is readily available.
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Affiliation(s)
- Rémy Duléry
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France; UMRS 938, Inserm, Paris, France; Université Pierre et Marie Curie Paris VI, Sorbonne University, Paris, France
| | | | | | - Jean El-Cheikh
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sylvie François
- Department of Hematology, Angers University Hospital, Angers, France
| | - Jérémy Delage
- Department of Hematology, University Hospital of Montpellier, Montpellier, France
| | - Federica Giannotti
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France; Université Pierre et Marie Curie Paris VI, Sorbonne University, Paris, France
| | - Annalisa Ruggeri
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Eolia Brissot
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France; UMRS 938, Inserm, Paris, France; Université Pierre et Marie Curie Paris VI, Sorbonne University, Paris, France
| | - Giorgia Battipaglia
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France; Department of Hematology and Marrow Transplantation, Federico II University, Naples, Italy
| | - Florent Malard
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France; UMRS 938, Inserm, Paris, France; Université Pierre et Marie Curie Paris VI, Sorbonne University, Paris, France
| | - Ramdane Belhocine
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Simona Sestili
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Anne Vekhoff
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - François Delhommeau
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France; UMRS 938, Inserm, Paris, France; Université Pierre et Marie Curie Paris VI, Sorbonne University, Paris, France; Department of Biological Hematology, Saint Antoine and Armand-Trousseau Hospitals, AP-HP, Paris, France
| | - Oumédaly Reman
- Department of Hematology, Caen University Hospital, Caen, France
| | - Ollivier Legrand
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France; UMRS 938, Inserm, Paris, France; Université Pierre et Marie Curie Paris VI, Sorbonne University, Paris, France
| | - Myriam Labopin
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France; UMRS 938, Inserm, Paris, France; Université Pierre et Marie Curie Paris VI, Sorbonne University, Paris, France; Paris Study Office/CEREST-TC, European Group for Blood and Marrow Transplantation, Paris, France
| | - Marie-Thérèse Rubio
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France
| | - Mohamad Mohty
- Department of Hematology and Cellular Therapy, Saint Antoine Hospital, AP-HP, Paris, France; UMRS 938, Inserm, Paris, France; Université Pierre et Marie Curie Paris VI, Sorbonne University, Paris, France.
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13
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Leblond V, Morel P, Dilhuidy MS, Leleu X, Soussain C, Leprête S, Dreyfus B, Dartigeas C, Mahé B, Anglaret B, Pégourié B, Besson C, Aurran T, Vekhoff A, Tournilhac O, Banos A, Oya H, Lejeune J, Ouzegdouh M, Chevret S. A phase II Bayesian sequential clinical trial in advanced Waldenström macroglobulinemia patients treated with bortezomib: interest of addition of dexamethasone. Leuk Lymphoma 2017; 58:2615-2623. [PMID: 28395585 DOI: 10.1080/10428194.2017.1307357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In patients with advanced Waldenström macroglobulinemia (WM), overall response rate (ORR) and median progression-free survival (PFS) achieved with bortezomib alone and bortezomib rituximab combination were 27-85% and 7.9 months, and 81% and 16.4 months, respectively. We checked the role of dexamethasone in combination with bortezomib by enrolling in a phase II trial 34 patients with relapsed/refractory WM. Bortezomib (1.3 mg/m2 IV D1, 4, 8, and 11 every 21 days) was used for six cycles. In non-responding patients, dexamethasone (20 mg daily for two days) was added to each infusion after the second cycle. After two cycles, the Bayes estimated ORR was 43.2 (95% Credible Interval: 28.0-59.1%) using the informative prior. Two-year survival rate was 84.0% and the median PFS 15.3 months without difference between patients treated with or without dexamethasone. We conclude that dexamethasone must be associated to bortezomib-based regimen.
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Affiliation(s)
- Véronique Leblond
- a Service d?Hematologie, Hôpital Pitié Salpêtrière APHP GRC-11 UPMC , Paris , France
| | - Pierre Morel
- b Service d'Hématologie Clinique , Centre Hospitalier Schaffner , Lens , France.,c Service d'Hématologie Clinique Thérapie Cellulaire , Centre Hospitalier Universitaire Amiens Picardie , Amiens , France.,d Centre d'Etude et de Recherche en Informatique Medicale , Faculté de Médecine pole Recherche , Lille , France
| | - Marie-Sarah Dilhuidy
- e Service d'hématologie et de thérapie cellulaire , Centre François Magendie Hôpital Haut Lévêque , Pessac , France
| | - Xavier Leleu
- f Service des maladies du sang , Hopital Huriez CHRU , Lille , France
| | - Carole Soussain
- g Hôpital René Huguenin-Institut Curie, Service d'Hématologie , Saint-Cloud , France.,h Collège de France, CNRS UMR 7241/INSERM U1050 , Paris , France
| | - Stéphane Leprête
- i Département d'Hématologie , Centre Henri Becquerel , Rouen , France
| | - Brigitte Dreyfus
- j CHU, Service d'Oncologie Hématologie et Thérapie cellulaire , Centre d'investigation clinique Inserm , Poitiers , France
| | - Caroline Dartigeas
- k Service Hématologie et Thérapie Cellulaire, Pole Henry Kaplan , Hopital Bretonneau , Tours , France
| | - Béatrice Mahé
- l Service d?Hématologie clinique, CHU Hotel Dieu , Nantes , France
| | | | - Brigitte Pégourié
- n Service d?Hématologie Clinique , CHU de Grenoble, Grenoble , France
| | - Caroline Besson
- o Laboratoire d'hématologie , CHU Bicêtre APHP, Le Kremlin-Bicêtre , France
| | | | - Anne Vekhoff
- q Département d'Hématologie Clinique et de Thérapie Cellulaire , Hôpital Saint-Antoine APHP , Paris , France
| | - Olivier Tournilhac
- r Service d'Hématologie Clinique Adultes de Thérapie Cellulaire , Hôpital Estaing, Université d'Auvergne EA7283, Inserm CIC-501, CHU Clermont-Ferrand , Clermont-Ferrand , France
| | - Anne Banos
- s Service hématologie , Centre hospitalier de la Côte Basque , Bayonne , France
| | - Hervé Oya
- t Unité de Recherche Clinique Groupe Hospitalier Pitié-Salpêtrière - Charles Foix APHP , Paris , France
| | - Julie Lejeune
- u Service de Biostatistique et Informatique Médicale Hôpital Saint Louis APHP , Paris Cedex , France
| | - Maya Ouzegdouh
- a Service d?Hematologie, Hôpital Pitié Salpêtrière APHP GRC-11 UPMC , Paris , France
| | - Sylvie Chevret
- u Service de Biostatistique et Informatique Médicale Hôpital Saint Louis APHP , Paris Cedex , France
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14
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Battipaglia G, Ruggeri A, Massoud R, El Cheikh J, Jestin M, Antar A, Ahmed SO, Rasheed W, Shaheen M, Belhocine R, Brissot E, Dulery R, Eder S, Giannotti F, Isnard F, Lapusan S, Rubio MT, Vekhoff A, Aljurf M, Legrand O, Mohty M, Bazarbachi A. Efficacy and feasibility of sorafenib as a maintenance agent after allogeneic hematopoietic stem cell transplantation for Fms-like tyrosine kinase 3-mutated acute myeloid leukemia. Cancer 2017; 123:2867-2874. [PMID: 28387928 DOI: 10.1002/cncr.30680] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [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: 11/22/2016] [Revised: 02/02/2017] [Accepted: 02/09/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sorafenib has shown encouraging results in patients with Fms-like tyrosine kinase 3 (FLT3)-positive acute myeloid leukemia. Its role after allogeneic stem cell transplantation (HSCT) has been reported in a few cases with encouraging results. METHODS The authors describe the use of sorafenib as a maintenance agent after HSCT in 27 patients with FLT3-positive acute myeloid leukemia. RESULTS The median age of the patients was 46 years (range, 15-57 years). Sorafenib was introduced at a median of 70 days (range, 29-337 days) after HSCT. The median treatment duration was 8.4 months (range, 0.2-46 months). Eleven patients experienced treatment toxicities, mainly of grade 1 to 2 (graded according to the National Cancer Institute Common Toxicity Criteria [version 4.0]). Dose reduction or withdrawal was required in 4 patients and 4 patients, respectively. The persistence of toxicity prompted treatment withdrawal in 1 patient. Clinical improvement followed dose modifications. Thirteen patients experienced chronic graft-versus-host disease (limited in 9 patients and extensive in 4 patients), resulting in dose reduction in 5 patients followed by withdrawal in 1 of these individuals. At a median follow-up of 18 months (range, 4-48 months), 25 patients were alive (all of whom were in complete molecular remission) and 18 were still receiving treatment, with 1-year overall survival and progression-free survival rates of 92% ± 6% and 92% ± 5%, respectively. CONCLUSIONS Sorafenib treatment after HSCT appears to be feasible and highly effective with dose individualization according to patient tolerability. Further analysis is needed to evaluate the immunomodulating role of sorafenib after HSCT. The data from the current support prospective controlled trials of sorafenib after HSCT. Cancer 2017;123:2867-74. © 2017 American Cancer Society.
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Affiliation(s)
- Giorgia Battipaglia
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France.,Department of Hematology and Marrow Transplantation, Federico II University, Naples, Italy
| | - Annalisa Ruggeri
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Radwan Massoud
- Bone Marrow Transplantation Program, Department of Internal Medicine, American Universit6y of Beirut Medical Center, Beirut, Lebanon
| | - Jean El Cheikh
- Bone Marrow Transplantation Program, Department of Internal Medicine, American Universit6y of Beirut Medical Center, Beirut, Lebanon
| | - Matthieu Jestin
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Ahmad Antar
- Bone Marrow Transplantation Program, Department of Internal Medicine, American Universit6y of Beirut Medical Center, Beirut, Lebanon
| | - Syed Osman Ahmed
- Adult Hematology/HSCT Section, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Walid Rasheed
- Adult Hematology/HSCT Section, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Marwan Shaheen
- Adult Hematology/HSCT Section, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ramdane Belhocine
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Eolia Brissot
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Remy Dulery
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Sandra Eder
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Federica Giannotti
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Francoise Isnard
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Simona Lapusan
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Marie-Therese Rubio
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Anne Vekhoff
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Mahmoud Aljurf
- Adult Hematology/HSCT Section, Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ollivier Legrand
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France
| | - Mohamad Mohty
- Hematology and Cellular Therapy Service, Saint Antoine Hospital, AP-HP, Paris, France.,Hospital Saint-Antoine, Paris University UPMC, Paris, France.,INSERM, Paris, France
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American Universit6y of Beirut Medical Center, Beirut, Lebanon.,Department of Cell Biology, Anatomy and Physiological Sciences, American University of Beirut, Beirut, Lebanon
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15
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Ruggeri A, Roth-Guepin G, Battipaglia G, Mamez AC, Malard F, Gomez A, Brissot E, Belhocine R, Vekhoff A, Lapusan S, Isnard F, Legrand O, Gozlan J, Boutolleau D, Ledraa T, Labopin M, Rubio MT, Mohty M. Incidence and risk factors for hemorrhagic cystitis in unmanipulated haploidentical transplant recipients. Transpl Infect Dis 2015; 17:822-30. [PMID: 26354178 DOI: 10.1111/tid.12455] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [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: 07/20/2015] [Revised: 08/13/2015] [Accepted: 08/18/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hemorrhagic cystitis (HC) is a common complication after hematopoietic allogeneic stem cell transplantation (HSCT) associated with intensity of the conditioning regimen, cyclophosphamide (Cy) therapy, and BK polyomavirus (BKPyV) infection. METHODS We analyzed 33 consecutive haploidentical (haplo) HSCT recipients transplanted for hematologic diseases. Eleven patients had a previous transplant. Median follow-up was 11 months. Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine + mycophenolate mofetil and post-HSCT Cy. RESULTS Thirty-two of 33 patients achieved neutrophil recovery. Cumulative incidence (CI) of platelet recovery was 65%. CI grade II-IV acute GVHD was 44%. Twenty patients developed HC in a median time of 38 days. CI of HC at day 180 was 62%. BKPyV was positive in blood and urine of 91% of patients at HC onset. HC resolved in 18/20 patients. Factors associated with HC were previous transplant (P = 0.01) and occurrence of cytomegalovirus reactivation before HC (P = 0.05). Grade II-IV acute GVHD was not associated with HC (P = 0.62). CI of day 180 viral infections was 73%. Two-year overall survival (OS) was 50%; HC did not impact OS (P = 0.29). CONCLUSION The incidence of HC after haplo with post-HSCT Cy is high and is associated with morbidity, especially in high-risk patients such as those with a previous transplant history and with impaired immune reconstitution.
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Affiliation(s)
- A Ruggeri
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.,INSERM, UMRs 938, Paris, France
| | - G Roth-Guepin
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.,Service d'Hématologie, CHU Nancy, Nancy, France
| | - G Battipaglia
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.,Ematologia, Università Federico II di Napoli, Naples, Italy
| | - A-C Mamez
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - F Malard
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.,INSERM, UMRs 938, Paris, France
| | - A Gomez
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - E Brissot
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.,INSERM, UMRs 938, Paris, France.,Université Pierre & Marie Curie, Paris, France
| | - R Belhocine
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - A Vekhoff
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - S Lapusan
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - F Isnard
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - O Legrand
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - J Gozlan
- Service de Virologie, Hôpital Saint Antoine, AP-HP, Paris, France
| | - D Boutolleau
- Service de Virologie, Hôpitaux Universitaires Pitié-Salpêtrière, AP-HP, Paris, France
| | - T Ledraa
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - M Labopin
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.,Université Pierre & Marie Curie, Paris, France
| | - M-T Rubio
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.,INSERM, UMRs 938, Paris, France
| | - M Mohty
- Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France.,INSERM, UMRs 938, Paris, France.,Université Pierre & Marie Curie, Paris, France
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16
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Guitard J, Angoulvant A, Letscher-Bru V, L’Ollivier C, Cornet M, Dalle F, Grenouillet F, Lacroix C, Vekhoff A, Maury E, Caillot D, Charles PE, Pili-Floury S, Herbrecht R, Raffoux E, Brethon B, Hennequin C. Invasive infections due toCandida norvegensisandCandida inconspicua: report of 12 cases and review of the literature. Med Mycol 2013; 51:795-9. [DOI: 10.3109/13693786.2013.807444] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Adès L, Chevret S, Raffoux E, Guerci-Bresler A, Pigneux A, Vey N, Lamy T, Huguet F, Vekhoff A, Lambert JF, Lioure B, de Botton S, Deconinck E, Ferrant A, Thomas X, Quesnel B, Cassinat B, Chomienne C, Dombret H, Degos L, Fenaux P. Long-term follow-up of European APL 2000 trial, evaluating the role of cytarabine combined with ATRA and Daunorubicin in the treatment of nonelderly APL patients. Am J Hematol 2013; 88:556-9. [PMID: 23564205 DOI: 10.1002/ajh.23451] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 03/22/2013] [Accepted: 04/01/2013] [Indexed: 11/11/2022]
Abstract
All-trans retinoic acid (ATRA) combined to anthracycline-based chemotherapy is the reference treatment of acute promyelocytic leukemia (APL). Whereas, in high-risk patients, cytarabine (AraC) is often considered useful in combination with anthracycline to prevent relapse, its usefulness in standard-risk APL is uncertain. In APL 2000 trial, patients with standard-risk APL [i.e., with baseline white blood cell (WBC) count <10,000/mm(3) ] were randomized between treatment with ATRA with Daunorubicin (DNR) and AraC (AraC group) and ATRA with DNR but without AraC (no AraC group). All patients subsequently received combined maintenance treatment. The trial had been prematurely terminated due to significantly more relapses in the no AraC group (J Clin Oncol, (24) 2006, 5703-10), but follow-up was still relatively short. With long-term follow-up (median 103 months), the 7-year cumulative incidence of relapses was 28.6% in the no AraC group, compared to 12.9% in the AraC group (P = 0.0065). In standard-risk APL, at least when the anthracycline used is DNR, avoiding AraC may lead to an increased risk of relapse suggesting that the need for AraC is regimen-dependent.
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Affiliation(s)
- Lionel Adès
- Hopital Avicenne, université paris 13; Bobigny France
| | | | | | | | | | - Nobert Vey
- Institut Paoli Calmettes; Marseille France
| | - Thierry Lamy
- Centre hospitalo universitaire de Rennes; France
| | | | | | | | - Bruno Lioure
- Centre hospitalo universitaire Strasbourg; France
| | | | | | | | | | | | | | | | - Hervé Dombret
- Hopital Saint Louis, univertsité paris 5; Paris France
| | - Laurent Degos
- Hopital Saint Louis, univertsité paris 5; Paris France
| | - Pierre Fenaux
- Hopital Avicenne, université paris 13; Bobigny France
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18
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Levy R, Mahevas M, Galicier L, Boutboul D, Fain O, Khellaf M, Limal N, Fieschi C, Vekhoff A, Ebbo M, Michel M, Godeau B. Survenue d’une hypogammaglobulinémie symptomatique à distance d’un traitement par rituximab dans le cadre d’un purpura thrombopénique immunologique : une complication potentiellement grave qui doit être recherchée. À propos de trois observations. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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Corre E, Marjanovic Z, Lapusan S, Vekhoff A, Hirsch P, Marie JP, Legrand O. Double-delayed intensification paediatric protocol without radiotherapy is an efficient treatment in adult lymphoblastic lymphoma. Hematol Oncol 2012; 30:206-9. [PMID: 22271176 DOI: 10.1002/hon.2007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 12/16/2011] [Accepted: 12/23/2011] [Indexed: 11/12/2022]
Abstract
Lymphoblastic lymphoma (LBL) is a rare disease associated with favourable prognosis in childhood but with poor prognosis in adults when treated with conventional non-Hodgkin lymphoma regimens. Improvements in long-term outcome have been made since the use of acute lymphoblastic leukaemia (ALL) regimens. We report here the feasibility of a double-delayed intensification paediatric protocol in 12 adult LBL patients. There were no relapses and no deaths, with a median follow-up of 4.7 years. Using the same protocol, overall survival was significantly longer in LBL patients versus ALL patients (100% vs 75%, p = 0.05). Overall tolerance was acceptable and better in ALL patients. We have shown the feasibility and the good results of using this paediatric protocol in LBL.
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Affiliation(s)
- Elise Corre
- Département d'Hématologie, Hôpital Saint-Antoine, APHP and Université Pierre et Marie Curie, Paris, France
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20
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Bardin C, Decleves X, Vekhoff A, Labat L, Chast F. 9233 POSTER Pharmacokinetic Intra-individual Variability of Imatinib -Consequences for Therapeutic Drug Monitoring in Chronic Myeloid Leukaemia. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72498-4] [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: 11/25/2022]
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21
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Kazan E, Maertens J, Herbrecht R, Weisser M, Gachot B, Vekhoff A, Caillot D, Raffoux E, Fagot T, Reman O, Isnard F, Thiebaut A, Bretagne S, Cordonnier C. A retrospective series of gut aspergillosis in haematology patients. Clin Microbiol Infect 2011; 17:588-94. [PMID: 20636423 DOI: 10.1111/j.1469-0691.2010.03310.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Gut invasive aspergillosis is an extremely rare infection in immunocompromised patients. The goal of this retrospective multicentre study is to report on cases of gut aspergillosis in haematology patients, including clinical presentation, risk factors, and outcome. Twenty-one patients from nine centres were identified. Eight had isolated gut aspergillosis, with no evidence of other infected sites, and 13 had disseminated aspergillosis. Thirteen patients had acute leukaemia. Nine were allogeneic stem cell transplant recipients. Clinical symptoms and imaging were poorly specific. The galactomannan antigenaemia test result was positive in 16/25 (64%) patients, including in four of the eight cases of isolated gut aspergillosis. Five of 21 patients had a dietary regimen rich in spices, suggesting that, in these cases, food could have been the source of gut colonization, and then of a primary gut Aspergillus lesion. The diagnosis was made post-mortem in six patients. The mortality rate in the remaining patients at 12 weeks was 7/15 (47%). Gut aspergillosis is probably misdiagnosed and underestimated in haematology patients, owing to the poor specificity of symptoms and imaging. Patients with a persistently positive galactomannan antigenaemia finding that is unexplained by respiratory lesions should be suspected of having gut aspergillosis in the presence of abdominal symptoms, and be quickly investigated. In the absence of severe abdominal complications leading to surgery and resection of the lesions, the optimal treatment is not yet defined.
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Affiliation(s)
- E Kazan
- Haematology Department, Henri Mondor Teaching Hospital, Assistance Publique-Hôpitaux de Paris and Paris 12 University, Créteil, France.
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22
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Lapusan S, Vidriales MB, Thomas X, de Botton S, Vekhoff A, Tang R, Dumontet C, Morariu-Zamfir R, Lambert JM, Ozoux ML, Poncelet P, San Miguel JF, Legrand O, DeAngelo DJ, Giles FJ, Marie JP. Phase I studies of AVE9633, an anti-CD33 antibody-maytansinoid conjugate, in adult patients with relapsed/refractory acute myeloid leukemia. Invest New Drugs 2011; 30:1121-31. [PMID: 21519855 DOI: 10.1007/s10637-011-9670-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 04/05/2011] [Indexed: 10/18/2022]
Abstract
The efficacy of anti-CD33 immunoconjugates had been previously demonstrated for gemtuzumab-ozogamicin. AVE9633 is an anti-CD33-maytansine conjugate created by ImmunoGen Inc. Phase I trials of AVE9633 were performed in patients with AML to evaluate tolerability, pharmacokinetics and pharmacodynamics. Three phase I studies of AVE9633 were performed in 54 patients with refractory/relapsed AML, evaluating drug infusion on day 1 of a 21-day cycle (Day 1 study), day 1 and 8 (Day 1/8 study) and day 1, 4 and 7 (Day 1/4/7 study) of a 28-day cycle. Toxicity was mainly allergic reaction during infusion (3 grade 3 bronchospasms). DLT was reached for the D1-D7 schedule at 150 mg/sqm (1 keratitis, 1 liver toxicity), and the MTD was set at 130 mg/sqm for this schedule. In the two other phases I, the DLT was not reached. In the Day 1/8 study, CD33 on peripheral blasts was saturated and down-modulated for doses of 75 mg/m(2) × 2 or higher, which was correlated with WBC kinetics and plasma levels of AVE9633. Decrease of DM4/CD33 ratio on the blasts surface between day 1 and 8 was the rational for evaluating day 1/4/7 schedule. This induced relatively constant DM4/CD33 levels over the first 8 days, however no activity was noted. One CRp, one PR and biological activity in five other patients were observed in this study. The Day 1 and Day 1/4/7 studies were early discontinued because of drug inactivity at doses significantly higher than CD33 -saturating doses. No myelossuppression was observed at any trial of AVE9633. The pharmacokinetics/pharmacodynamics data obtained in these studies will provide very useful information for the design of the next generation of immunoconjugates.
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Affiliation(s)
- Simona Lapusan
- Hematology and Oncology Department, Saint-Antoine Hospital, AP-HP, Paris, France
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Hivert B, Tamburini J, Vekhoff A, Tournilhac O, Leblond V, Morel P. Prognostic value of the International Scoring System and response in patients with advanced Waldenstrom macroglobulinemia. Haematologica 2011; 96:785-8. [PMID: 21393333 DOI: 10.3324/haematol.2010.029140] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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24
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Haïat S, Marjanovic Z, Lapusan S, Vekhoff A, Rio B, Corre E, Dimicoli S, Hirsch P, Marie JP, Legrand O. Outcome of 40 adults aged from 18 to 55 years with acute lymphoblastic leukemia treated with double-delayed intensification pediatric protocol. Leuk Res 2011; 35:66-72. [DOI: 10.1016/j.leukres.2010.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 03/20/2010] [Accepted: 04/06/2010] [Indexed: 10/19/2022]
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Preudhomme C, Guilhot J, Nicolini FE, Guerci-Bresler A, Rigal-Huguet F, Maloisel F, Coiteux V, Gardembas M, Berthou C, Vekhoff A, Rea D, Jourdan E, Allard C, Delmer A, Rousselot P, Legros L, Berger M, Corm S, Etienne G, Roche-Lestienne C, Eclache V, Mahon FX, Guilhot F. Imatinib plus peginterferon alfa-2a in chronic myeloid leukemia. N Engl J Med 2010; 363:2511-21. [PMID: 21175313 DOI: 10.1056/nejmoa1004095] [Citation(s) in RCA: 282] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Imatinib (400 mg daily) is considered the best initial therapy for patients with newly diagnosed chronic myeloid leukemia (CML) in the chronic phase. However, only a minority of patients treated with imatinib have a complete molecular remission. METHODS We randomly assigned 636 patients with untreated chronic-phase CML to receive imatinib alone at a dose of 400 mg daily, imatinib (400 mg daily) plus cytarabine (20 mg per square meter of body-surface area per day on days 15 through 28 of each 28-day cycle) or pegylated interferon (peginterferon) alfa-2a (90 μg weekly), or imatinib alone at a dose of 600 mg daily. Molecular and cytogenetic responses, time to treatment failure, overall and event-free survival, and adverse events were assessed. An analysis of molecular response at 12 months was planned. A superior molecular response was defined as a decrease in the ratio of transcripts of the tyrosine kinase gene BCR-ABL to transcripts of ABL of 0.01% or less, corresponding to a reduction of 4 log(10) units or more from the baseline level, as assessed by means of a real-time quantitative polymerase-chain-reaction assay. RESULTS At 12 months, the rates of cytogenetic response were similar among the four groups. The rate of a superior molecular response was significantly higher among patients receiving imatinib and peginterferon alfa-2a (30%) than among patients receiving 400 mg of imatinib alone (14%) (P=0.001). The rate was significantly higher among patients treated for more than 12 months than among those treated for 12 months or less. Gastrointestinal events were more frequent among patients receiving cytarabine, whereas rash and depression were more frequent among patients receiving peginterferon alfa-2a. CONCLUSIONS As compared with other treatments, the addition of peginterferon alfa-2a to imatinib therapy resulted in significantly higher rates of molecular response in patients with chronic-phase CML. (Funded by the French Ministry of Health and others; ClinicalTrials.gov number, NCT00219739.).
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MESH Headings
- Adult
- Anemia/chemically induced
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Benzamides
- Cytarabine/administration & dosage
- Cytarabine/adverse effects
- Female
- Fusion Proteins, bcr-abl/analysis
- Fusion Proteins, bcr-abl/genetics
- Humans
- Imatinib Mesylate
- Interferon alpha-2
- Interferon-alpha/administration & dosage
- Interferon-alpha/adverse effects
- Leukemia, Myeloid, Chronic-Phase/drug therapy
- Leukemia, Myeloid, Chronic-Phase/mortality
- Leukemia, Myeloid, Chronic-Phase/pathology
- Male
- Middle Aged
- Neutropenia/chemically induced
- Piperazines/administration & dosage
- Piperazines/adverse effects
- Polyethylene Glycols/administration & dosage
- Polyethylene Glycols/adverse effects
- Proto-Oncogene Proteins c-abl/analysis
- Proto-Oncogene Proteins c-abl/genetics
- Pyrimidines/administration & dosage
- Pyrimidines/adverse effects
- RNA, Neoplasm/analysis
- Recombinant Proteins
- Remission Induction
- Stem Cells/drug effects
- Survival Analysis
- Thrombocytopenia/chemically induced
- Transcription, Genetic
- Treatment Outcome
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Affiliation(s)
- Claude Preudhomme
- Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Lille, and INSERM Unité 837, Lille, France
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Michallet M, Tulliez M, Corm S, Gardembas M, Huguet F, Oukessou A, Bregman B, Vekhoff A, Ghomari K, Cambier N, Guerci-Bresler A. Management of chronic myeloid leukaemia in clinical practice in France: results of the French subset of patients from the UNIC study. Curr Med Res Opin 2010; 26:307-17. [PMID: 19961284 DOI: 10.1185/03007990903479299] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess real-life treatment practices with imatinib for chronic-phase chronic myeloid leukaemia (CP-CML) in France. RESEARCH DESIGN AND METHODS In the observational 'Unmet Needs in CML' (UNIC) study of CML management in Europe, case report forms were completed retrospectively for eligible patients (> or =18 years of age, currently treated for CML) during enrolment (September 2006-March 2007). Results from the subset of patients from France are presented. MAIN OUTCOME MEASURES Primary objectives were to estimate from the collected data the proportions of patients ever treated with imatinib and those experiencing imatinib resistance and/or intolerance as determined by physicians' diagnoses of resistance/intolerance leading to a change in imatinib use. Collected data were analysed descriptively. Secondary descriptive measures included imatinib dose modifications and methods for treatment response monitoring. RESULTS Of the 654 French CP-CML patients, 95.9% had received imatinib. Of these, 15% were judged by physicians as imatinib-resistant and 31% as imatinib-intolerant (not mutually exclusive) during treatment, 44% required dose modification and 23% discontinued imatinib. In the 12 months preceding the last observation, 65% had a cytogenetic features analysis and 93% had a polymerase chain reaction (PCR) assessment of molecular response. Importantly, and contrasting with European recommendations, 46% of imatinib-resistant patients had never been assessed for BCR-ABL mutations. LIMITATIONS The observational study design limits data collection and interpretation. The findings are specific to the French healthcare system and may not apply to other countries. CONCLUSION This observational study of CP-CML management in France confirmed that most patients are treated with imatinib, a treatment widely recognised as efficacious. The study highlights opportunities for optimising CML management, as a proportion of patients may require alternative treatment strategies due to imatinib resistance/intolerance. Response monitoring rates differ from recommendations, representing another opportunity for improving care for CP-CML patients through early identification of patients failing current therapy.
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Thomas X, Le Q, Botton SD, Raffoux E, Chelghoum Y, Pautas C, Dreyfus F, Dhedin N, Vekhoff A, Troncy J, Pigneux A, Revel TD, Reman O, Travade P, Thiebaut A, Guerci A, Elhamri M, Fenaux P, Dombret H, Michallet M. Autologous or allogeneic stem cell transplantation as post-remission therapy in refractory or relapsed acute myeloid leukemia after highly intensive chemotherapy. Leuk Lymphoma 2009; 46:1007-16. [PMID: 16019551 DOI: 10.1080/10428190500084837] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Post-remission options were compared in a population of 262 relapsing and refractory acute myeloid leukemia patients achieving complete remission (CR) after the same re-induction according to etoposide - mitoxantrone - cytarabine (EMA) trials. The selection of post-remission therapy depended on trial recommendations, age, performance status, and availability of an HLA-identical sibling. One hundred and thirty patients received chemotherapy consolidation courses, 50 received autologous stem cell transplantation (SCT), and 43 underwent allogeneic bone marrow transplantation (BMT), while 39 did not receive any additional therapy. The preliminary analysis identified 3 favorable prognostic factors correlated with event-free survival (EFS): M3 subtype, previous CR duration > 1 year, and transplantation. Three year EFS was 68 vs. 23% with autologous SCT and allogeneic BMT in M3 patients and, respectively, 41 vs. 20% in non-M3 patients. Three year probabilities of treatment-related mortality were 11 and 47%, respectively. A statistical model was conceived with adjustment on prognostic factors and post-remission option. In the multivariate analysis, autologous SCT appeared significantly better than allogeneic BMT (P < 0.01) or chemotherapy (P = 0.001), while allogeneic BMT was not statistically different than chemotherapy. This indicates a high treatment-related toxicity with allogeneic BMT in patients re-induced by highly intensive chemotherapy, and therefore a tendency for a better outcome with autologous SCT as post-remission treatment in those patients.
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Affiliation(s)
- X Thomas
- Department of Hematology, Hôpital Edouard Herriot, Lyon, France.
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Cordonnier C, Pautas C, Maury S, Vekhoff A, Farhat H, Suarez F, Dhédin N, Isnard F, Ades L, Kuhnowski F, Foulet F, Kuentz M, Maison P, Bretagne S, Schwarzinger M. Empirical versus Preemptive Antifungal Therapy for High‐Risk, Febrile, Neutropenic Patients: A Randomized, Controlled Trial. Clin Infect Dis 2009; 48:1042-51. [DOI: 10.1086/597395] [Citation(s) in RCA: 301] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Tamburini J, Elie C, Park S, Beyne-Rauzy O, Gardembas M, Berthou C, Mahe B, Sanhes L, Stamatoullas A, Vey N, Aouba A, Slama B, Quesnel B, Vekhoff A, Sotto J, Vassilief D, Al-Nawakil C, Fenaux P, Dreyfus F, Bouscary D. Effectiveness and tolerance of low to very low dose thalidomide in low-risk myelodysplastic syndromes. Leuk Res 2009; 33:547-50. [DOI: 10.1016/j.leukres.2008.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Revised: 06/02/2008] [Accepted: 06/03/2008] [Indexed: 12/01/2022]
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Adès L, Chevret S, Raffoux E, de Botton S, Guerci A, Pigneux A, Stoppa AM, Lamy T, Rigal-Huguet F, Vekhoff A, Meyer-Monard S, Maloisel F, Deconinck E, Ferrant A, Thomas X, Fegueux N, Chomienne C, Dombret H, Degos L, Fenaux P. Is Cytarabine Useful in the Treatment of Acute Promyelocytic Leukemia? Results of a Randomized Trial From the European Acute Promyelocytic Leukemia Group. J Clin Oncol 2006; 24:5703-10. [PMID: 17116939 DOI: 10.1200/jco.2006.08.1596] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Several phase II studies have suggested that cytarabine (AraC) was not required in the treatment of newly diagnosed acute promyelocytic leukemia (APL) patients receiving all-trans-retinoic acid (ATRA), an anthracycline, and maintenance therapy, and we aimed at confirming this finding in a randomized trial. Patients and Methods Newly diagnosed APL patients younger than age 60 years with a WBC count of less than 10,000/μL were randomly assigned to receive either ATRA combined with and followed by three daunorubicin (DNR) plus AraC courses and a 2-year maintenance regimen (AraC group) or the same treatment but without AraC (no AraC group). Patients older than age 60 years and patients with initial WBC count of more than 10,000/μL were not randomly assigned but received risk-adapted treatment, with higher dose of AraC and CNS prophylaxis in patients with WBC counts more than 10,000/μL. Results Overall, 328 (96.5%) of 340 patients achieved complete remission (CR). In the AraC and the no AraC groups, the CR rates were 99% and 94% (P = .12), the 2-year cumulative incidence of relapse (CIR) rates were 4.7% and 15.9% (P = .011), the event-free survival (EFS) rates were 93.3% and 77.2% (P = .0021), and survival rates were 97.9% and 89.6% (P = .0066), respectively. In patients younger than age 60 years with WBC counts more than 10,000/μL, the CR, 2-year CIR, EFS, and survival rates were 97.3%, 2.9%, 89%, and 91.9%, respectively. Conclusion These results support a role for AraC in addition to ATRA and anthracyclines in the treatment of newly diagnosed APL, at least using DNR at the cumulative dose we used and with the consolidation and maintenance regimens we used.
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Affiliation(s)
- Lionel Adès
- Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, Service d'Hématologie Clinique, Paris 13 University, Bobigny, France
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Kelaidi C, Ades L, Chevret S, Sanz M, Guerci A, Thomas X, de Botton S, Raffoux E, Rayon C, Fegueux N, Bordessoule D, Rigal-Huguet F, Link H, Stoppa A, Vekhoff A, Meyer-Monard S, Castaigne S, Dombret H, Degos L, Fenaux P. Late first relapses in APL treated with all-trans-retinoic acid- and anthracycline- based chemotherapy: the European APL group experience (APL 91 and APL 93 trials). Leukemia 2006; 20:905-7. [PMID: 16541143 DOI: 10.1038/sj.leu.2404158] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lévy V, Zohar S, Bardin C, Vekhoff A, Chaoui D, Rio B, Legrand O, Sentenac S, Rousselot P, Raffoux E, Chast F, Chevret S, Marie JP. A phase I dose-finding and pharmacokinetic study of subcutaneous semisynthetic homoharringtonine (ssHHT) in patients with advanced acute myeloid leukaemia. Br J Cancer 2006; 95:253-9. [PMID: 16847470 PMCID: PMC2360653 DOI: 10.1038/sj.bjc.6603265] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To determine the maximum-tolerated dose (MTD), dose-limiting toxicities and pharmacokinetic of semisynthetic homoharringtonine (ssHHT), given as a twice daily subcutaneous (s.c.) injections for 9 days, in patients with advanced acute leukaemia, 18 patients with advanced acute myeloid leukaemia were included in this sequential Bayesian phase I dose-finding trial. A starting dose of 0.5 mg m−2 day−1 was explored with subsequent dose escalations of 1, 3, 5 and 6 mg m−2 day−1. Myelosuppression was constant. The MTD was estimated as the dose level of 5 mg m−2 day−1 for 9 consecutive days by s.c. route. Dose-limiting toxicities were hyperglycaemia with hyperosmolar coma at 3 mg m−2, and (i) one anasarque and haematemesis, (ii) one life-threatening pulmonary aspergillosis, (iii) one skin rash and (iv) one scalp pain at dose level of 5 mg m−2 day−1. The mean half-life of ssHHT was 11.01±3.4 h, the volume of distribution at steady state was 2±1.4 l kg−1 and the plasma clearance was 11.6±10.4 l h−1. Eleven of the 12 patients with circulating leukaemic cells had blood blast clearance, two achieved complete remission and one with blast crisis of CMML returned in chronic phase. The recommended daily dose of ssHHT on the 9-day schedule is 5 mg m−2 day−1.
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Affiliation(s)
- V Lévy
- Inserm CIC 9504, Centre d'Investigations Cliniques, Hôpital Saint Louis, AP-HP, 1 Avenue Claude Vellefaux, Paris 75475, France
- Inserm U717, Hôpital Saint Louis, Paris, France
- E-mail:
| | - S Zohar
- Inserm CIC 9504, Centre d'Investigations Cliniques, Hôpital Saint Louis, AP-HP, 1 Avenue Claude Vellefaux, Paris 75475, France
- Inserm U717, Hôpital Saint Louis, Paris, France
- Inserm U717, Département de Biostatistique et Infomatique Médicale, Hôpital Saint Louis, AP-HP, Paris, France
| | - C Bardin
- Service de Pharmacie Pharmacologie Toxicologie, Hôtel Dieu de Paris, AP-HP, Paris, France
| | - A Vekhoff
- Département d'Hématologie et d'Oncologie Médicale, Hôtel Dieu, AP-HP, Paris, France
| | - D Chaoui
- Département d'Hématologie et d'Oncologie Médicale, Hôtel Dieu, AP-HP, Paris, France
| | - B Rio
- Département d'Hématologie et d'Oncologie Médicale, Hôtel Dieu, AP-HP, Paris, France
| | - O Legrand
- Département d'Hématologie et d'Oncologie Médicale, Hôtel Dieu, AP-HP, Paris, France
| | - S Sentenac
- Service de Pharmacie Pharmacologie Toxicologie, Hôtel Dieu de Paris, AP-HP, Paris, France
| | - P Rousselot
- Service d'Hématologie Clinique, Hôpital Saint Louis, AP-HP, Paris France
| | - E Raffoux
- Service d'Hématologie Clinique, Hôpital Saint Louis, AP-HP, Paris France
| | - F Chast
- Service de Pharmacie Pharmacologie Toxicologie, Hôtel Dieu de Paris, AP-HP, Paris, France
| | - S Chevret
- Inserm U717, Hôpital Saint Louis, Paris, France
- Inserm U717, Département de Biostatistique et Infomatique Médicale, Hôpital Saint Louis, AP-HP, Paris, France
| | - J P Marie
- Département d'Hématologie et d'Oncologie Médicale, Hôtel Dieu, AP-HP, Paris, France
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Florent M, Katsahian S, Vekhoff A, Levy V, Rio B, Marie JP, Bouvet A, Cornet M. Prospective Evaluation of a Polymerase Chain Reaction–ELISA Targeted toAspergillus fumigatusandAspergillus flavusfor the Early Diagnosis of Invasive Aspergillosis in Patients with Hematological Malignancies. J Infect Dis 2006; 193:741-7. [PMID: 16453271 DOI: 10.1086/500466] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 10/04/2005] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Current laboratory and radiological methods for diagnosis of invasive aspergillosis (IA) lack sensitivity and specificity. METHODS We prospectively evaluated the diagnostic value of twice-weekly screening for circulating Aspergillus fumigatus and A. flavus DNA with a polymerase chain reaction-enzyme-linked immunosorbent assay (PCR-ELISA). RESULTS Among the 201 adult patients with hematological malignancies who were included in the study, 55 IA cases were diagnosed. On the basis of the analysis of 1205 serum samples from 167 patients, the sensitivity, specificity, and positive and negative predictive values of the PCR-ELISA for proven and probable IA cases were 63.6%, 89.7%, 63.6%, and 89.7%, respectively, when samples with 2 consecutive positive results were used. The use of a combination of the PCR-ELISA and a galactomannan (GM) assay increased the sensitivity to 83.3%, increased the negative predictive value to 97.6%, and decreased the specificity to 69.8%. In most patients with IA, PCR-ELISA positivity anticipated or was simultaneous with the initiation of antifungal therapy, the abnormalities found by computed tomography, the mycological/histological diagnosis, and the GM positivity. Overall, 56.3% of the patients had at least 1 positive sample, and the false single-positive rate was 44.8%. CONCLUSIONS In addition to serial screening for GM antigenemia and radiological surveillance, PCR-ELISA may improve the rates of early diagnosis of IA and the management of patients with hematological malignancies.
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Affiliation(s)
- Martine Florent
- Service de Microbiologie, Hotel-Dieu, Assistance Publique-Hopitaux de Paris (AP-HP), Universite Paris Descartes, Paris, France
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Callens C, Chevret S, Cayuela JM, Cassinat B, Raffoux E, de Botton S, Thomas X, Guerci A, Fegueux N, Pigneux A, Stoppa AM, Lamy T, Rigal-Huguet F, Vekhoff A, Meyer-Monard S, Ferrand A, Sanz M, Chomienne C, Fenaux P, Dombret H. Prognostic implication of FLT3 and Ras gene mutations in patients with acute promyelocytic leukemia (APL): a retrospective study from the European APL Group. Leukemia 2005; 19:1153-60. [PMID: 15889156 DOI: 10.1038/sj.leu.2403790] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Internal tandem duplications (ITDs) of the FLT3 gene have been observed in about 35% of APL cases. If FLT3-ITD is associated with a worse outcome in patients with acute myeloid leukemia (AML) in general, its prognostic value in acute promyelocytic leukemia (APL) is still a matter of debate. We investigated incidence, associated clinical features, and prognostic implication of FLT3-ITD, but also FLT3-D835 point mutation and N-Ras or K-Ras mutations in 119 APL patients, all prospectively enrolled in the two consecutive APL-93 and APL-2000 trials. Mutation incidences were 38, 20, and 4%, for FLT3-ITD, FLT3-D835, and Ras, respectively. The presence of FLT3-ITD was associated with high white blood cell count, high Sanz index, M3-variant subtype, and V/S PML-RAR alpha isoforms. Complete remission (CR), induction death, and death in CR rates were not affected by FLT3 or Ras mutations, as well as cumulative incidence of relapse. However, a trend for a shorter overall survival (P=0.09) was observed in FLT3-ITD patients, because of a very poor postrelapse survival (P=0.02). This feature, which has been also reported in patients with AML in general, is suggestive of an underlying genetic instability in FLT3-ITD patients, leading to the acquisition of additional unknown bad-prognosis gene mutations at relapse.
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Affiliation(s)
- C Callens
- Department of Hematology, Hôpital Saint-Louis, Paris, France
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Casadevall N, Durieux P, Dubois S, Hemery F, Lepage E, Quarré MC, Damaj G, Giraudier S, Guerci A, Laurent G, Dombret H, Chomienne C, Ribrag V, Stamatoullas A, Marie JP, Vekhoff A, Maloisel F, Navarro R, Dreyfus F, Fenaux P. Health, economic, and quality-of-life effects of erythropoietin and granulocyte colony-stimulating factor for the treatment of myelodysplastic syndromes: a randomized, controlled trial. Blood 2004; 104:321-7. [PMID: 15054036 DOI: 10.1182/blood-2003-07-2252] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In myelodysplastic syndromes (MDS), anemia responds to recombinant human erythropoietin (rHuEPO) alone and in combination with recombinant human granulocyte-colony-stimulating factor (rHuGCSF) in 10% to 20% and in 35% to 40% of patients, respectively. We randomly divided 60 patients with low-grade anemic MDS and serum EPO levels lower than 500 IU/L (500 mU/mL) into 2 groups: rHuEPO + rHuG-CSF (arm A) and supportive care (arm B). After 12 weeks, those who had erythroid responses were given rHuEPO alone for 40 additional weeks. They were also given rHuG-CSF if they had relapses. A response was considered major if the hemoglobin (Hb) level was 115 g/L (11.5 g/dL) or higher and minor Hb increase was 15 g/L (1.5 g/dL) or more or if it remained stable without transfusion. Ten of 24 patients responded in arm A, and 0 of 26 responded in arm B (P =.01). Eight patients in arm A continued rHuEPO therapy alone, and 6 had relapses. Responses were always restored when rHuG-CSF was reintroduced. Mean direct costs per patient were 26,723 euros (arm A) and 8,746 euros (arm B). Quality of life was assessed with a Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale. Similar percentages of patients from both arms showed significant clinical improvement. rHuEPO plus rHuG-CSF led to responses in 41.7% of MDS patients. This treatment was expensive. No effect on quality of life was demonstrated.
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Affiliation(s)
- Nicole Casadevall
- Hôtel Dieu, Service d'Hématologie Biologique, 1 place du parvis Notre Dame, 75004 Paris, France.
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Lobe I, Rigal-Huguet F, Vekhoff A, Desablens B, Bordessoule D, Mounier C, Ferrant A, Sanz M, Fey M, Chomienne C, Chevret S, Degos L, Fenaux P. Myelodysplastic syndrome after acute promyelocytic leukemia: the European APL group experience. Leukemia 2003; 17:1600-4. [PMID: 12886249 DOI: 10.1038/sj.leu.2403034] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
With improved treatment of acute promyelocytic leukemia (APL) by all trans retinoic acid (ATRA) combined to anthracycline-aracytin chemotherapy (CT), a larger number of those patients may be at risk of late complications. Recently, the Rome group reported five cases of myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML, non-APL) occurring during the course of 77 APL patients (6.5%) in complete remission (CR). From 1991 to 1998, we treated 677 newly diagnosed cases of APL, and 617 of them achieved CR with ATRA combined to CT (n=579) or CT alone (n=38); 246 of them received subsequent maintenance CT with 6 mercaptopurine and methotrexate. With a median follow-up of 51 months, 6 patients (0.97%) developed MDS, 13-74 months after the diagnosis of APL. In all six cases, t(15;17) and PML-RARalpha rearrangement were absent at the time of MDS diagnosis, and karyotype mainly showed complex cytogenetic abnormalities involving chromosomes 5 and/or 7, typical of MDS observed after treatment with alkylating agents, although none of the six patients had received such agents for the treatment of APL. Our findings suggest that MDS can indeed be a long-term complication in APL, although probably at lower incidence than that previously reported.
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Affiliation(s)
- I Lobe
- Service des Maladies du Sang, CHU Lille, France
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Belhabri A, Thomas X, Wattel E, Chelghoum Y, Anglaret B, Vekhoff A, Reman O, Dombret H, Dhedin N, Michallet M, Fière D, Archimbaud E. All trans retinoic acid in combination with intermediate-dose cytarabine and idarubicin in patients with relapsed or refractory non promyelocytic acute myeloid leukemia: a phase II randomized trial. Hematol J 2003; 3:49-55. [PMID: 11960396 DOI: 10.1038/sj.thj.6200141] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2001] [Accepted: 10/15/2001] [Indexed: 11/09/2022]
Abstract
INTRODUCTION All trans retinoic acid has shown a remarkable effectiveness in acute promyelocytic leukemia. These results have encouraged studies of treatment with ATRA in other acute myeloid leukemia subtypes. PATIENTS AND METHODS In order to evaluate toxicity and antileukemic efficacy of all ATRA in patients with relapsed or refractory non promyelocytic AML, 95 patients (median age, 58 years; range, 20 to 80 years), with unclassified AML according to the FAB classification or secondary AML at diagnosis, or refractory or relapsing AML, received induction therapy with Idarubicin, 10 mg/m(2)/day, for 3 days and cytarabine, 1000 mg/m(2)/12 h, for 6 days, alone or combined, on a randomized basis, with ATRA, 45 mg/m(2)/day, from day 1 to complete remission. Patients in CR received maintenance therapy with 6 monthly courses combining Ida, 10 mg/m(2)/day, intravenously, on day 1 with Ara-C100 mg/m(2)/day, subcutaneously, from day 1 to day 5. RESULTS Results were evaluated after one induction course. Overall 54 patients (57%, 26 with ATRA and 28 without ATRA) achieved CR including five patients treated at time of initial diagnosis, seven previously resistant, 38 in first relapse and four in further relapse. Thirty patients (31%) had resistant disease and 11 (12%) died from toxicity. Median time for neutrophil recovery to 0.5 x 10(9)/l and platelets to 20 x 10(9)/l was 31 and 21 days respectively. Severe toxicity (WHO grade >or=3) included infections (37%), diarrhea (9%), bleeding (3%), vomiting (16%), hyperbilirubinemia (5%), mucositis (6%) and hypercreatininemia (2%). No ATRA syndrome was noted in the ATRA arm. Median overall survival for the entire cohort was 6.3 months and median disease-free survival was 4.7 months. There were no statistical differences in terms of CR, DFS, and OS between the two arms. CONCLUSION We conclude that ATRA in combination with Ida and Ara-C can be administered safely to high-risk AML patients. However, in this setting, ATRA did not offer any advantage when compared to chemotherapy alone.
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Affiliation(s)
- Amine Belhabri
- Service d'Hématologie, Hôpital Edouard Herriot, Lyon, France
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de Botton S, Chevret S, Coiteux V, Dombret H, Sanz M, San Miguel J, Caillot D, Vekhoff A, Gardembas M, Stamatoulas A, Conde E, Guerci A, Gardin C, Fey M, Cony Makhoul D, Reman O, de la Serna J, Lefrere F, Chomienne C, Degos L, Fenaux P. Early onset of chemotherapy can reduce the incidence of ATRA syndrome in newly diagnosed acute promyelocytic leukemia (APL) with low white blood cell counts: results from APL 93 trial. Leukemia 2003; 17:339-42. [PMID: 12592333 DOI: 10.1038/sj.leu.2402807] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2002] [Accepted: 08/30/2002] [Indexed: 11/09/2022]
Abstract
Treatment combining ATRA and chemotherapy (CT) has improved the outcome of APL patients, by comparison with CT alone. ATRA syndrome is a life-threatening complication of ATRA treatment whose prophylaxis remains somewhat controversial. In APL93 trial, newly diagnosed APL patients </=65 years and with initial WBC counts below 5000/mm(3) were randomized between ATRA until CR achievement followed by CT (ATRA --> CT) and ATRA with early addition of CT, on day 3 of ATRA treatment (ATRA + CT). The incidence of ATRA syndrome in the ATRA --> CT arm was 18% (22/122) as compared to 9.2% (17/184) in the ATRA + CT arm (P = 0.035). In the ATRA --> CT arm, three (2.5%) patients died from ATRA syndrome, as compared to one (0.5%) in the ATRA + CT group. Early addition of chemotherapy to ATRA in newly diagnosed APL with low WBC counts significantly reduced the incidence of ATRA syndrome.
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Ombandza-Moussa E, Schlegel L, Vekhoff A, Gerbal R, Marie JP, Bouvet A. [Therapeutic impact of streptococcal and enterococcal bacteremia in hematology patients]. Pathol Biol (Paris) 2002; 50:169-77. [PMID: 11980330 DOI: 10.1016/s0369-8114(02)00284-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
From January 1999 to May 2000 (17 months), 21 strains of streptococci and four strains of enterococci have been isolated from 74 blood cultures in 25 infectious episodes in hematologic patients. They concerned 21 patients, of 21 to 77 years old. These patients suffered from acute leukaemia (14 cases), chronic lymphoid leukaemia (two cases), non-Hodgkin's lymphoma (two cases) or myeloma (three cases). Seventeen patients displayed a single streptococcal or enterococcal episode, two had two episodes in the course of a single stay in the hospital, two others in the course of two different stays. During 16 episodes (64%), the bacteremia occurred within 15 days after the onset of neutropenia consecutive to antimitotic chemotherapy, and in nine episodes (36%) it has occurred after a period exceeding 15 days. In six cases the patients had already received antibiotics with a large antibacterial activity (beta-lactam, fluoroquinolone and/or glycopeptide +/- aminoside) and in four cases a single antibiotic (synergistine or cotrimoxazole). Most streptococci (20/21) were oral streptococci (ten Streptococcus mitis, five S. oralis, two S. sanguis, three S. pneumoniae). A single strain of beta-hemolytic streptococci has been identified as S. dysgalactiae subsp. equisimilis. The enterococci were one strain of Enterococcus faecalis and three E. faecium. Ten streptococci were susceptible to 0.25 mg/L of penicillin G, ten were less susceptible (0.5 < or = MIC < 32 mg/L), and a strain was resistant (MIC = 32 mg/L). Eighteen strains were susceptible to amoxicillin and cefotaxime. For three strains, the MICs of amoxicillin and cefotaxime (8-16 mg/L and 8-32 mg/L, respectively) were higher. Levels of resistance of the enterococci to the beta-lactam (penicillin, amoxicillin, and piperacillin) were variable. All species were susceptible to glycopeptides. Three patients were transferred in intensive care unit for respiratory distress or shock syndrome. Their evolution has remained severe under antibiotherapy comprising beta-lactam or vancomycin associated with an aminoside. This results demonstrate the interest of species identification to adapt the antibiotic treatment and confirms the frequency of oral streptococci in severe bacteremia in neutropenic patients.
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Affiliation(s)
- E Ombandza-Moussa
- Service de microbiologie, Centre National de Référence des Streptocoques, Hôtel Dieu, université Paris VI, France
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Cornet M, Ugo V, Lefort E, Molina T, James JM, Vekhoff A, Audouin J, Marie JP, Bouvet A. Eur J Clin Microbiol Infect Dis 2001; 20:0358-0359. [DOI: 10.1007/s10096-001-8121-9] [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: 10/27/2022]
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41
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Cornet M, Ugo V, Lefort E, Molina T, James JM, Vekhoff A, Audouin J, Marie JP, Bouvet A. A case of disseminated aspergillosis with thyroid involvement. Eur J Clin Microbiol Infect Dis 2001; 20:358-9. [PMID: 11453600 DOI: 10.1007/s100960100501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M Cornet
- Service de Microbiologie, Hótel-Dieu, Université Paris VI, Paris, France.
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Thomas X, Cambier N, Taksin AL, Reman O, Vekhoff A, Pautas C, Leblond V, Soler-Michel P, Ecstein-Fraïssé E, Archimbaud E. Dose-escalation study of single dose mitoxantrone in combination with timed sequential chemotherapy in patients with refractory or relapsing acute myelogenous leukemia. Leuk Res 2000; 24:957-63. [PMID: 11086179 DOI: 10.1016/s0145-2126(00)00075-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A dose-escalation study was realized in order to assess the maximally tolerated dose (MTD) of high-dose mitoxantrone in a single injection combined with cytarabine and etoposide (EMA regimen) in refractory or relapsed acute myelogenous leukemia (AML). Between July 1997 and June 1998, 24 patients with relapsed or refractory AML entered the study. All but one patient had normal left ventricular ejection fraction (LVEF) at baseline. Performance status according to World Health Organization (WHO) criteria was less than two in all cases. All patients have been previously treated by mitoxantrone or anthracyclines. Four cohort of ten patients were scheduled with the following doses: (1) mitoxantrone 36 mg/m2 on day 1; (2) mitoxantrone 45 mg/m2 on day 1; (3) mitoxantrone 60 mg/m2 on day 1; (4) mitoxantrone 75 mg/m2 on day 1 in combination with cytarabine 500 mg/m2 per day (days 1-3, and days 8-10), and etoposide 200 mg/m2 per day (days 8-10). All patients received the full doses of the three drugs. The limiting toxicity was defined as WHO grade 4 nonhematologic toxicity and for impairment of cardiac function by Alexander's criteria (moderate or severe toxicity). The occurrence of limiting toxicity in at least three patients from the same dose level determined the MDT. No limiting toxicity was observed in mitoxantrone dose level 1. Two limiting toxicities were observed in mitoxantrone dose level 2 (one mucositis, one moderate cardiac toxicity), and three limiting toxicities in mitoxantrone dose level 3 (1 high transaminase levels, two moderate cardiac toxicities) ending the assay. Overall, 16 patients (67%) achieved complete remission (CR). One drug-addict patient died from cerebral hemorrhage due to severe aspergillosis and was not considered as a limiting toxicity. After EMA chemotherapy, 13 patients received subsequent chemotherapy courses involving anthracyclines or their derivatives. Six patients underwent allogeneic bone marrow transplantation. No late toxicity occurred. The median survival of the entire cohort was 41.4 weeks. We conclude that (i) EMA chemotherapy using a single injection of mitoxantrone is effective in the treatment of refractory or relapsing AML; (ii) the recommended phase II dose of mitoxantrone is 45 mg/m2 administered over 30 min as a single dose in combination with cytarabine and etoposide.
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Affiliation(s)
- X Thomas
- Service d'Hematologie, Hôpital Edouard Herriot, Lyon, France.
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43
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Lévy V, Marjanovic Z, Vekhoff A, Belhocine R, Marie JP, Delmer A, Ajchenbaum-Cymbalista F, Zittoun R, Rio B. Relapse after autologous hematopoietic stem cell transplantation in acute myeloid leukemia, a single center experience over 13 years. Am J Hematol 2000; 64:232-3. [PMID: 10861826 DOI: 10.1002/1096-8652(200007)64:3<232::aid-ajh20>3.0.co;2-#] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Thomas X, Dombret H, Cordonnier C, Pigneux A, Gardin C, Guerci A, Vekhoff A, Sadoun A, Stamatoullas A, Fegueux N, Maloisel F, Cahn JY, Reman O, Gratecos N, Berthou C, Huguet F, Kotoucek P, Travade P, Buzyn A, de Revel T, Vilque JP, Naccache P, Chomienne C, Degos L, Fenaux P. Treatment of relapsing acute promyelocytic leukemia by all-trans retinoic acid therapy followed by timed sequential chemotherapy and stem cell transplantation. APL Study Group. Acute promyelocytic leukemia. Leukemia 2000; 14:1006-13. [PMID: 10865965 DOI: 10.1038/sj.leu.2401800] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of this study was to assess the safety and efficacy of stem cell transplantation (SCT) mainly autologous SCT as consolidation therapy in APL patients who relapsed and achieved a second complete remission (CR2). Fifty adult patients with a first relapsed APL, of whom 39 had been previously treated with ATRA, entered a multicenter trial of oral ATRA until complete remission (CR) achievement followed by timed sequential chemotherapy (EMA combining etoposide 200 mg/m2/day for 3 days, mitoxantrone 12 mg/m2/day for 3 days, and cytarabine 500 mg/m2/day for two sequences of 3 days). EMA was started either after CR achievement, or on day 1 of ATRA because of initial white blood cell (WBC) counts >5 x 10(9)/l, or rapidly added to ATRA in order to prevent ATRA syndrome because WBC count increased under ATRA. Forty-five patients (90%, 95% CI 78%-97%) were in CR after induction therapy. Five patients died from infection during aplasia following EMA chemotherapy. Eleven patients who achieved CR had a familial HLA-identical donor and were allografted. The median disease-free survival (DFS) of allografted patients was 8.2 months. The 34 other CR patients were scheduled for autologous peripheral blood (PB) SCT (intent-to-treat group). Actually, autologous transplantation was only carried out in 22 patients (65%) (17 PBSCT and five autologous bone marrow transplantation (BMT)). Reasons for not autografting were early relapse (three patients), severe toxicity of EMA chemotherapy (six patients), and refusal or failure of stem cell harvest (three patients). The 3-year DFS rate of patients actually autografted was 77%. Among the 17 autografted patients still in CR2, nine patients have already reached a longer CR2 than first CR (CR1). Results of detection of PML/RARalpha by RT-PCR after autologous transplantation show negative findings in eight of the nine patients tested. We conclude that (1) ATRA combined to EMA chemotherapy is effective in the treatment of relapsed APL; (2) allogeneic BMT may be too toxic after salvage treatment including EMA intensive chemotherapy; (3) clinical outcome of autografted patients and preliminary molecular results regarding detection of PML/RARalpha after autologous PBSCT are encouraging.
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Affiliation(s)
- X Thomas
- Department of Hematology, Hôpital Edouard Herriot, Lyon, France
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Thomas X, Fenaux P, Dombret H, Delair S, Dreyfus F, Tilly H, Vekhoff A, Cony-Makhoul P, Leblond V, Troussard X, Cordonnier C, de Revel T, Simon M, Nicolini F, Stoppa AM, Janvier M, Bordessoule D, Rousselot P, Ffrench M, Marie JP, Archimbaud E. Granulocyte-macrophage colony-stimulating factor (GM-CSF) to increase efficacy of intensive sequential chemotherapy with etoposide, mitoxantrone and cytarabine (EMA) in previously treated acute myeloid leukemia: a multicenter randomized placebo-controlled trial (EMA91 Trial). Leukemia 1999; 13:1214-20. [PMID: 10450749 DOI: 10.1038/sj.leu.2401474] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The EMA86 study showed efficacy of intensive sequential chemotherapy with mitoxantrone, 12 mg/m2 day on days 1-3, etoposide, 200 mg/m2/day as a continuous infusion on days 8-10 and cytarabine (araC), 500 mg/m2/day as continuous infusion on days 1-3 and 8-10 (EMA regimen) in previously treated patients with AML. The goal of the EMA91 study was to determine whether administration of GM-CSF between the two sequences of EMA chemotherapy and during the second sequence could increase therapeutic efficacy by potentially increasing leukemic cell recruitment into the S phase of cell cycle before the second sequence. One hundred and ninety-two patients aged less than 65 years with previously treated AML received GM-CSF, 5 microg/kg/day or placebo from day 4 to day 8 of EMA chemotherapy. One hundred and twenty were refractory and 72 were in first relapse after a complete remission (CR) of more than 6 months duration. CR rates after one course of chemotherapy were 65% in the GM-CSF group (refractory: 51%; first relapse: 89%), not significantly different from the 59% CR rate (refractory: 46%; first relapse: 81%) in the placebo group. Median time to recovery of neutrophils was 38 and 37 days and median time to last platelet transfusion 32 and 32 days respectively in the GM-CSF and placebo groups. WHO grade > or = 3 non-hematologic toxicities were mainly sepsis (45% and 51%, respectively) and mucositis (34% and 31%) and did not differ between the two groups. Toxic death rate was 5% and 8%, respectively, in the GM-CSF and placebo groups. Patients achieving CR were scheduled to receive six courses of maintenance with reduced-dose EMA. Time to progression tended to be longer in the GM-CSF group (median 154 vs 115 days, progression-free rate at 18 months 33% vs 19%, P = 0.08), particularly in refractory patients (P = 0.06). However, at the current follow-up, this did not translate into a significantly longer disease-free survival and survival. Cell cycle studies showed increased recruitment of cells in the S phase between day 4 and day 8 in the GM-CSF group compared to placebo (P = 0.006). However, this did not significantly relate to prognosis in this cohort of patients. GM-CSF might marginally increase efficacy of sequential chemotherapy without increasing its toxicity in the absence of any detected relationship between this effect and observed leukemic cell recruitment into the cell cycle.
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Affiliation(s)
- X Thomas
- Department of Hematology, Hôpital Edouard Herriot, Lyon, France
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Marie JP, Marjanovic Z, Vekhoff A, Bouvet A, Chast F, Levy V, Baudard M, Legrand O, Rio B, Delmer A, Zittoun R. Piperacillin/tazobactam plus tobramycin versus ceftazidime plus tobramycin as empiric therapy for fever in severely neutropenic patients. Support Care Cancer 1999; 7:89-94. [PMID: 10089089 DOI: 10.1007/s005200050233] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objective of this trial was to evaluate the potential advantages of the combination of piperacillin and tazobactam in the control of fever in neutropenic patients. In this single-center study, patients who experienced a total of 247 febrile episodes were prospectively randomized to receive either our standard regimen, ceftazidime 3 g/day (1 g t.i.d.) plus tobramycin 3 mg/kg per day (1.5 mg/kg b.i.d.), or piperacillin 12 g/day plus tazobactam 1.5 g/day (4 g+0.5 g t.i.d.) plus tobramycin 3 mg/kg per day (1.5 mg/kg b.i.d.). Vancomycin was added in all cases of persistent fever in the ceftazidime arm, but only when there was microbiologically documented resistance in the piperacillin/tazobactam arm. All 247 episodes were evaluable by "intent-to-treat" analysis. The two populations were well matched in terms of age, gender, underlying disease, chemotherapy received, oral decontamination, clinical and bacterial documentation, and severity and duration of neutropenia. Initial antibacterial therapy was successful (apyrexia at 72 h, without antibiotic change) more frequently (P = 0.008) with the regimen containing piperacillin/tazobactam (54.4%) than with the one including ceftazidime (37.6%). Fewer (P = 0.02) major infectious events (infectious death or delay in treatment of underlying disease due to infection) were observed during piperacillin/ tazobactam treatment (2.6%) than with the ceftazidime regimen (11.3%), despite a lower frequency of glycopeptide addition when piperacillin/tazobactam was used (54.4% versus 77.4%) according to the rules adopted. This trial confirmed the efficacy of the piperacillin/tazobactam combination for empirical treatment of febrile neutropenic patients. This antibiotic combination permitted a dramatic decrease in empiric glycopeptide antibiotic administration in such patients.
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Affiliation(s)
- J P Marie
- Department of Hematology, Hôtel-Dieu of Paris, France.
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Marie JP, Vekhoff A, Pico JL, Guy H, Andremont A, Richet H. Neutropenic infections: a review of the French Febrile Aplasia Study Group trials in 608 febrile neutropenic patients. J Antimicrob Chemother 1998; 41 Suppl D:57-64. [PMID: 9688452 DOI: 10.1093/jac/41.suppl_4.57] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
From 1986 to 1992, the Febrile Aplasia Study Group conducted a series of studies involving severely neutropenic patients. The average duration of neutropenia was 21 days, following chemotherapy for leukaemia, or chemotherapy/radiotherapy as part of a conditioning regimen for autologous or allogeneic bone marrow transplantation. A total of 591 evaluable febrile episodes were randomized to treatment with either ceftazidime 3 g daily + amikacin (the reference regimen; n=246), ceftazidime alone (n=98), ceftazidime + vancomycin (n=77), ceftazidime + ciprofloxacin (n=64) or piperacillin/tazobactam + amikacin (n=106). Only three patients treated with the reference dose of ceftazidime died or suffered serious morbidity from infections caused by Gram-negative bacteria. Piperacillin/tazobactam + amikacin was the only antibiotic regimen to have an effect significantly different from the reference regimen. Piperacillin/tazobactam + amikacin produced a higher rate of defervescence at 72 h (P=0.003), fewer days of fever (P < 0.001), fewer superinfections (P=0.018), a less frequent requirement for addition of vancomycin (P=0.01) and a higher incidence of treatment judged to be a 'complete success' (enduring defervescence without a change in antibiotics) (P=0.04). Despite the improved control of Gram-positive microorganisms, the infection-related death rate remained unchanged from 1987 to 1992. An increase in disseminated aspergillosis compensated for the reduction in lethal Gram-positive septicaemia.
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Affiliation(s)
- J P Marie
- Service d'Hématologie Biologique, Hôtel-Dieu, Paris, France.
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Legrand O, Vekhoff A, Marie JP, Zittoun R, Delmer A. Treatment of hairy cell leukaemia (HCL) with 2-chlorodeoxyadenosine (2-CdA): identification of parameters predictive of adverse effects. Br J Haematol 1997; 99:165-7. [PMID: 9359518 DOI: 10.1046/j.1365-2141.1997.3483162.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
2-chlorodeoxyadenosine (2-CdA) induces high complete remission (CR) rates in hairy cell leukaemia (HCL), but is associated with serious toxicities. Therefore we reviewed our experience with 2-CdA in 16 HCL patients, with special attention to adverse effects. One-third of patients presented severe neutropenic infections and/or required prolonged blood support. Patients with low tumour mass and moderate cytopenias were more likely to achieve CR, whereas those with high tumour burden and severe bone marrow impairment were at increased risk of severe infection and blood product requirements. All these unfavourable parameters may be corrected by short-term alpha-interferon (IFN) therapy. Therefore we suggest that patients with unfavourable presenting features might benefit from IFN therapy before 2-CdA.
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Affiliation(s)
- O Legrand
- Service d'Hématologie Clinique, Hôpital Hôtel-Dieu, Paris, France
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Sonneveld P, Marie JP, Huisman C, Vekhoff A, Schoester M, Faussat AM, van Kapel J, Groenewegen A, Charnick S, Zittoun R, Löwenberg B. Reversal of multidrug resistance by SDZ PSC 833, combined with VAD (vincristine, doxorubicin, dexamethasone) in refractory multiple myeloma. A phase I study. Leukemia 1996; 10:1741-50. [PMID: 8892677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
SDZ PSC 833, a non-immunosuppressive cyclosporin analogue reverses multidrug resistance (MDR) in vitro by inhibiting P-glycoprotein (P-gp) mediated drug efflux. We performed a dose escalation study of SDZ PSC 833 combined with VAD chemotherapy in refractory multiple myeloma (MM). Twenty-two MM patients who were refractory to doxorubicin/vincristine/dexamethasone (VADr, n=11) or had failed multiple regimens (n=6) or were melphalan-refractory (MELr, n=5), were treated with one to three cycles of VAD combined with oral SDZ PSC 833, which was administered at escalating dosages starting at 5 mg/kg/day to 15 mg/kg/day for 7 days. The median trough and peak blood levels of SDZ PSC 833 ranged from 461/1134 ng/ml at 5 mg/kg/day to 821/2663 ng/ml at 15 mg/kg, respectively. With addition of SDZ PSC 833 (5 mg/kg) the mean plasma AUC 0-->96 h of doxorubicin as compared with control patients treated with VAD increased from 779 to 1510 ng/ml/h (P=0.0071), while the doxorubicin clearance was reduced from 47.6 to 27.8 l/h/m2 (P=0.0002). The clearance of doxorubicinol was reduced accordingly. Because of the increased plasma AUC, the dose of doxorubicin and vincristine had to be reduced in 13 patients to 50% (n=1) or 75% (n=12). A further dose-escalation of SDZ PSC 833 did not lead to a proportional increase of doxorubicin AUC. Toxicity WHO CTC grade 2 or 3 included hypoplasia (18/22), constipation (10/22), hyponatremia (3/22) and infections (6/22). A partial response or stable disease was achieved in eight and six patients, respectively. In 17 evaluable patients the mean percentage of pretreatment bone marrow plasma cells which expressed P-glycoprotein was 40%. The pretreatment in vitro rhodamin retention in CD38++ myeloma cells was reversible by 2 microM SDZ PSC 833 with 15-98% in 7/9 tested patients. In 4/5 responding patients analyzed before and after treatment with VAD + SDZ PSC 833, a reduction of P-gp + plasma cells was observed. It is concluded, that the blood concentrations of SDZ PSC 833 attained in MM patients increase with dose after oral administration. It can be safely combined with VAD chemotherapy. SDZ PSC 833 diminishes the clearance of doxorubicin, leading to an increase of the plasma AUC of doxorubicin. In addition, it is an effective inhibitor of P-gp mediated efflux of doxorubicin in myeloma tumor cells in vitro. Therefore, a proportional dose-reduction of doxorubicin and vincristine is warranted. Phase II/III studies in refractory MM are in progress to evaluate the therapeutic efficacy of SDZ PSC 833 with VAD.
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Affiliation(s)
- P Sonneveld
- University Hospital Rotterdam Dijkzigt/Erasmus University, The Netherlands
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Keating S, Suciu S, de Witte T, Mandelli F, Willemze R, Resegotti L, Broccia G, Thaler J, Labar B, Damasio E, Bizzi B, Rotoli B, Vekhoff A, Muus P, Petti MC, Dardenne M, Solbu G, Vegna ML, Zittoun RA. Prognostic factors of patients with acute myeloid leukemia (AML) allografted in first complete remission: an analysis of the EORTC-GIMEMA AML 8A trial. The European Organization for Research and Treatment of Cancer (EORTC) and the Gruppo Italiano Malattie Ematologiche Maligne dell' Adulto (GIMEMA) Leukemia Cooperative Groups. Bone Marrow Transplant 1996; 17:993-1001. [PMID: 8807105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The Leukemia Cooperative Groups of the EORTC and the GIMEMA conducted a prospective randomized phase III trial, in order to assess the value of autologous BMT (ABMT) vs a second intensive consolidation course (IC2), following a common intensive consolidation course (IC1) for patients with AML. Patients with an HLA-identical sibling donor were not randomized, but were included in an allogeneic BMT (alloBMT) program. This is an analysis of prognostic factors which influence the outcome of treatment after alloBMT in first complete remission (CR). The study included 730 patients < 46 years of age in CR, 270 having a histocompatible sibling donor. In 169 of these patients alloBMT was performed in first CR. Early remitters (122 patients achieving CR with one course of treatment) had a DFS at 3 years of 67%, significantly longer than that of 44% for late remitters (47 patients achieving CR after more than one course of treatment) (P = 0.006). The relapse risk for early vs late remitters was 16 and 40% at 3 years (P = 0.001) and the treatment-related mortality (TRM) at 2 years was 21 vs 27%. Age appeared to be a prognostic factor for TRM, WBC for DFS, whereas the FAB classification was not of prognostic importance. Patients with poor risk cytogenetic abnormalities showed a trend towards a higher relapse risk. Patients transplanted shortly after achieving CR appeared to have a worse prognosis than those transplanted further into remission. Overall, the number of courses of induction therapy needed to achieve CR was the most important prognostic factor for outcome after allogeneic BMT.
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Affiliation(s)
- S Keating
- Department of Hematology of 12Hôtel-Dieu, Paris, France
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