1
|
Blaize M, Thizy G, Boissonnas A, Portalier A, Lanternier F, de La Porte des Vaux C, Suarez F, Bougnoux ME, Guitard J, Jabet A, Stocker N, Aoudjhane A, Roos-Weil D, Fekkar A. Invasive Aspergillosis with impaired neutrophil responses against Aspergillus fumigatus in patients treated with Acalabrutinib-findings from three cases. Int J Infect Dis 2024; 142:107000. [PMID: 38461932 DOI: 10.1016/j.ijid.2024.107000] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/19/2024] [Accepted: 03/04/2024] [Indexed: 03/12/2024] Open
Abstract
OBJECTIVES Ibrutinib, a first-generation covalent Bruton's tyrosine kinase inhibitor (BTKi) was found to be a risk factor for the occurrence of invasive fungal complications. Acalabrutinib is a second-generation covalent BTKi used to treat B-cell malignancies. Healthy donor neutrophils incubated ex vivo with acalabrutinib lose ability to control Aspergillus conidia germination. In patients receiving acalabrutinib, the potential effect on neutrophil antifungal activity is unknown. Furthermore, only two cases of invasive aspergillosis have been reported during treatment with acalabrutinib, outside of a few cases in a clinical trial. METHODS We describe three new cases of invasive aspergillosis occurring within the first months of acalabrutinib therapy in patients with chronic lymphocytic leukemia. We used videomicroscopy and flow cytometry approaches to investigate the basic functional responses against Aspergillus of neutrophils from acalabrutinib-treated patients. RESULTS We showed an alteration in the anti-Aspergillus response after 1 month of acalabrutinb therapy: neutrophils lost their capacities of killing Aspergillus fumigatus germinating conidia and decreased their reactive oxygen species production when stimulated by Aspergillus. CONCLUSIONS It is important to follow-up patients treated with acalabrutinib for the risk of aspergillosis as well as those treated with ibrutinib.
Collapse
Affiliation(s)
- Marion Blaize
- Sorbonne Université, INSERM, CNRS, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié, Salpêtrière, Service de Parasitologie-Mycologie, Paris, France.
| | - Guillaume Thizy
- Sorbonne Université, INSERM, CNRS, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), Paris, France
| | - Alexandre Boissonnas
- Sorbonne Université, INSERM, CNRS, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), Paris, France
| | - Anaïs Portalier
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié, Salpêtrière, Service d'Hématologie Clinique, Paris, France
| | - Fanny Lanternier
- Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Clémentine de La Porte des Vaux
- Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, Paris, France
| | - Felipe Suarez
- Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Département d'Hématologie, Paris, France
| | - Marie-Elisabeth Bougnoux
- Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Service de Parasitologie-Mycologie, Paris, France
| | - Juliette Guitard
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France
| | - Arnaud Jabet
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service de Parasitologie-Mycologie, Paris, France
| | - Nicolas Stocker
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service d'Hématologie Clinique, Paris, France
| | - Abdelmalek Aoudjhane
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Service d'Hématologie Clinique, Paris, France
| | - Damien Roos-Weil
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié, Salpêtrière, Service d'Hématologie Clinique, Paris, France
| | - Arnaud Fekkar
- Sorbonne Université, INSERM, CNRS, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié, Salpêtrière, Service de Parasitologie-Mycologie, Paris, France
| |
Collapse
|
2
|
Jourdes A, Cellerin E, Touzeau C, Harel S, Denis B, Escure G, Faure E, Jamard S, Danion F, Sonntag C, Ader F, Karlin L, Soueges S, Cazelles C, de La Porte des Vaux C, Frenzel L, Lanternier F, Brousse X, Cazaubiel T, Berger P, Collignon A, Blot M, Pieragostini A, Charles M, Chaleteix C, Redor A, Roland V, Cartau T, Macro M, Chalopin T, Vallet N, Perrot A, Martin-Blondel G. Characteristics and incidence of infections in patients with multiple myeloma treated by bispecific antibodies: a national retrospective study on the behalf of G2I and Intergroupe Francophone du Myélome. Clin Microbiol Infect 2024:S1198-743X(24)00098-3. [PMID: 38432433 DOI: 10.1016/j.cmi.2024.02.023] [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: 11/21/2023] [Revised: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Bispecific antibodies (BsAbs) are an effective treatment used in relapsed or refractory multiple myeloma. Despite a well-tolerated safety profile, infectious events appear to be frequent in clinical trials. Real-world data on epidemiology, characteristics, risk factors, and outcomes of infections in patients treated with BsAb are still needed. METHODS A retrospective, multicentre study in BsAb-treated patients with multiple myeloma was performed in 14 French centres from December 2020 to February 2023. The primary objective was to describe the incidence of infections that required hospitalization, specific treatment, or adaptation in BsAb administration. RESULTS Among 229 patients with multiple myeloma treated with BsAb, 153 (67%) received teclistamab, 47 (20%) received elranatamab, and 29 (13%) talquetamab. We reported a total of 234 infections, including 123 (53%) of grade of ≥3. Predominant infections affected the respiratory tract (n = 116, 50%) followed by bacteraemias (n = 36, 15%). The hospitalization rate was 56% (n = 131), and 20 (9%) infections resulted in death. Global cumulative incidence of the first infection was 70% in all patients, 73% in patients treated with B-cell maturation antigen-targeting, and 51% with GPRC5D-targeting BsAb. In univariate analyses, corticosteroids for cytokine release syndrome (CRS)/immune effector cell-associated neurotoxicity syndrome (ICANS) were associated with a higher risk of first infection (HR = 2.13; 95% CI, 1.38-3.28), whereas GPRC5D-targeting BsAb and anti-bacterial prophylaxis were associated with a lower risk (HR = 0.53; 95% CI, 0.3-0.94 and HR = 0.65; 95% CI, 0.46-0.9). Fine and Gray multivariate model found that only corticosteroids for CRS/ICANS were correlated with a higher risk of first infection (HR = 2.01; 95% CI, 1.27-3.19). DISCUSSIONS The implementation of preventive measures that aim to mitigate the risk of infection under BsAb is pivotal, notably in patients who received corticosteroids for CRS/ICANS.
Collapse
Affiliation(s)
- Aurélie Jourdes
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) de Toulouse, France
| | - Elise Cellerin
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Tours, France
| | - Cyrille Touzeau
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) Hôtel Dieu, Nantes, France
| | - Stéphanie Harel
- Service d'immuno-hématologie, Hôpital St-Louis, AP-HP, Paris, France
| | - Blandine Denis
- Service de Maladies Infectieuses et Tropicales, Hôpital St-Louis, AP-HP, Paris, France
| | - Guillaume Escure
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Lille, France
| | - Emmanuel Faure
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Lille, France; U1019-UMR 9017-Centre d'Infection et d'Immunité de Lille, INSERM, Centre National de la Recherche Scientifique, Institut Pasteur de Lille, Université de Lille, Lille, France
| | - Simon Jamard
- Service de Médecine Infectieuse et Tropicale, Centre Hospitalo-Universitaire (CHU) de Tours, France
| | - Francois Danion
- Service de Maladies Infectieuses et Tropicales, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, Grand Est, France; Laboratoire d'Immuno-rhumatologie Moléculaire UMR_S 1109, INSERM, Strasbourg, Grand Est, France
| | - Cécile Sonntag
- Service d'hématologie, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg, France
| | - Florence Ader
- Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie (CIRI), INSERM 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Lionel Karlin
- Service d'hématologie, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Sarah Soueges
- Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France
| | - Clarisse Cazelles
- Service d'hématologie, Hôpital Necker-Enfants Malades, AP-HP, Paris, France; Institut Cochin, Université de Paris, CNRS UMR8104, INSERM U1016, Paris, France
| | | | - Laurent Frenzel
- Service d'hématologie, Hôpital Necker-Enfants Malades, AP-HP, Paris, France; CEREMAST, Institut Imagine, INSERM U1163, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Centre, Paris, France
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, AP-HP, Paris, France; Institut Pasteur, Université Paris Cité, Centre National de Référence Mycoses Invasives et Antifongiques, Groupe de Recherche Translationnelle en Mycologie, Département de Mycologie, Paris, Île-de-France, France
| | - Xavier Brousse
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) de Bordeaux, France
| | - Titouan Cazaubiel
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Bordeaux, France; Equipe Génomique et Immunologie du Myélome Multiple, Centre de Recherche en Cancérologie de Toulouse INSERM U1037, Université Paul Sabatier, Toulouse, France
| | - Pierre Berger
- Infectiologie Transversale, Institut Paoli-Calmettes, Marseille, France
| | - Aude Collignon
- Service d'hématologie, Institut Paoli-Calmettes, Marseille, France
| | - Mathieu Blot
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) de Dijon-Bourgogne, France; INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France; Equipe Lipness, INSERM LNC-UMR1231 et LabEx LipSTIC, Université de Burgundy, Dijon, France
| | - Andrea Pieragostini
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Dijon-Bourgogne, France
| | - Morgane Charles
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) d'Estaing, Clermont-Ferrand, France
| | - Carine Chaleteix
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) d'Estaing, Clermont-Ferrand, France
| | - Alexis Redor
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Perpignan, France
| | - Virginie Roland
- Service d'hématologie, Centre Hospitalier de Perpignan, France
| | - Tom Cartau
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) Côte de Nacre, Caen, France
| | - Margaret Macro
- Service d'hématologie, Institut bas Normand d'Hématologie, CHU Caen Normandie, Caen, France
| | - Thomas Chalopin
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Tours, France
| | - Nicolas Vallet
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Tours, France; Equipe INSERM U1069 N2COx, Groupe LNOx, Université de Tours, France
| | - Aurore Perrot
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) de Bordeaux, France; Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Guillaume Martin-Blondel
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) de Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM, Université Toulouse III, Toulouse, France.
| |
Collapse
|
3
|
de La Porte des Vaux C, Sainte-Rose V, Le Turnier P, Djossou F, Nacher M, Zappa M, Epelboin L. Chest CT findings in community-acquired pneumonia due to Coxiella burnetii (Q fever) compared to Streptococcus pneumoniae, a cross sectional study in French Guiana, 2013-2017. Travel Med Infect Dis 2024; 57:102679. [PMID: 38135242 DOI: 10.1016/j.tmaid.2023.102679] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVES Few and small studies previously examined chest CT-scan characteristics of Coxiella burnetii (Cb) community-acquired pneumonia (CAP). Larger studies are needed to guide physicians towards diagnosis of Q fever in case of pneumonia. METHODS We conducted a single-center retrospective observational study between 2013 and 2017. All patients with Cb or Streptococcus pneumoniae (Sp) CAP who had a chest CT-scan on admission at Cayenne Hospital (French Guiana) were included. Chest CT-scan were all analyzed by the same expert radiologist. RESULTS We included 75 patients with Cb CAP and 36 with Sp CAP. Fifty-nine percent of all patients were men (n = 66) and median age was 52 [IQR = 38-62]. Chest CT-scans of Cb CAP patients revealed 67 alveolar condensations (89 %), 52 ground-glass opacities (69 %), 30 cases of lymphadenopathy(ies) (40 %) and 25 pleural effusions (33 %). Parenchyma lesions caused by Cb were predominantly unilateral (67 %). We found high numbers of alveolar condensations in both Cb and Sp CAP (89 % and 75 %; respectively), but the presence of ground-glass opacities was significantly associated with Cb CAP (69 % versus 30 %; p < 0.01). Cb CAP were associated with more lymphadenopathies (40 % vs 17 %; p = 0.01) while Sp CAP showed more bronchial thickening (19 % versus 3 %; p < 0.01) and (micro)nodule(s) ≤1 cm (25 % vs 3 %, p < 0.01). CONCLUSIONS This large study shows that the most typical aspect of chest CT-scan in case of Cb CAP in French Guiana is a unilateral alveolar consolidation associated with ground glass opacities and lymphadenopathies. C. burnetti and S. pneumoniae both most often cause alveolar consolidations, but present some significantly different CT-scan patterns. This could help physicians through therapeutic choices.
Collapse
Affiliation(s)
- Clémentine de La Porte des Vaux
- Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana; Department of Infectious and Tropical Diseases, Hôpital Universitaire Necker-Enfants malades, Paris, France.
| | - Vincent Sainte-Rose
- Department of Microbiology, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Paul Le Turnier
- Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Félix Djossou
- Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Mathieu Nacher
- CIC INSERM 1424, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Magaly Zappa
- Department of Radiology, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Loïc Epelboin
- Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana; CIC INSERM 1424, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| |
Collapse
|