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Tomaszewska A, Jagasia M, Beohou E, van der Werf S, Blaise D, Kanfer E, Milpied N, Reményi P, Ciceri F, Bourhis JH, Chevallier P, Solano C, Socié G, Bruno B, Rambaldi A, Castagna L, Kröger N, Corradini P, Afanasyev B, Ladetto M, Niederwieser D, Scheid C, Sengeloev H, Kroschinsky F, Yakoub-Agha I, Schoemans H, Koenecke C, Penack O, Perić Z, Greinix H, Duarte RF, Basak GW. Addition of Rituximab in Reduced Intensity Conditioning Regimens for B-Cell Malignancies Does Not Influence Transplant Outcomes: EBMT Registry Analyses Following Allogeneic Stem Cell Transplantation for B-Cell Malignancies. Front Immunol 2021; 11:613954. [PMID: 33603743 PMCID: PMC7884746 DOI: 10.3389/fimmu.2020.613954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022] Open
Abstract
Rituximab (R) is increasingly incorporated in reduced intensity conditioning (RIC) regimens for allogeneic hematopoietic cell transplantation (alloHCT) in patients with B-cell malignancies, not only to improve disease control, but also to prevent graft-versus-host disease (GVHD). There are no randomized prospective data to validate this practice, although single center data and the CIBMTR analysis have shown promising results. We aimed at validation of these findings in a large registry study. We conducted a retrospective analysis using the EBMT registry of 3,803 adult patients with B-cell malignancies undergoing alloHCT (2001-2013) with either rituximab (R-RIC-9%) or non-rituximab (RIC-91%) reduced intensity regimens respectively. Median age and median follow up were 55 years (range 19.1-77.3) and 43.2 months (range 0.3-179.8), respectively. There was no difference in transplant outcomes (R-RIC vs RIC), including 1-year overall survival (69.9% vs 70.7%), 1-year disease-free survival (64.4% vs 62.2%), 1-year non-relapse mortality (21% vs 22%), and day-100 incidence of acute GVHD 2-4° (12% vs 12%). In summary, we found that addition of rituximab in RIC regimens for B-cell malignancies had no significant impact on major transplant outcome variables. Of note, data on chronic GVHD was not available, limiting the conclusions that can be drawn from the present study.
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Affiliation(s)
- Agnieszka Tomaszewska
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Madan Jagasia
- Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, United States
| | | | | | | | - Edward Kanfer
- Hammersmith Hospital, Imperial College Healthcare, London, United Kingdom
| | | | | | | | - Jean H Bourhis
- Gustave Roussy Institute de Cancérologie, Val de Marne, France
| | | | | | | | - Benedetto Bruno
- A.O.U. Citta della Salute e della Scienza di Torino, Universita di Torino, Turin, Italy
| | | | | | | | - Paolo Corradini
- Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano, Milan, Italy
| | - Boris Afanasyev
- First State Pavlov Medical University of St. Petersburg, St. Petersburg, Russia
| | | | | | | | | | | | | | | | | | - Olaf Penack
- Department of Hematology, Oncology, and Tumor Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Hildegard Greinix
- Department of Hematology and Oncology, Medical University of Graz, Graz, Austria
| | - Rafael F Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Grzegorz W Basak
- Department of Hematology, Transplantology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Tichelli A, Beohou E, Labopin M, Socié G, Rovó A, Badoglio M, van Biezen A, Bader P, Duarte RF, Basak G, Salooja N. Evaluation of Second Solid Cancers After Hematopoietic Stem Cell Transplantation in European Patients. JAMA Oncol 2019; 5:229-235. [PMID: 30476975 DOI: 10.1001/jamaoncol.2018.4934] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Importance Incidence and risk factors of second solid cancers (SSCs) that occur after hematopoietic stem cell transplantation (HSCT) are well documented. However, clinical outcome data of patients who developed an SSC after HSCT are limited. Objective To assess the outcome of patients with an SSC occurring after HSCT from the time of SSC diagnosis. Design, Setting, and Participants This cohort study used data of 4065 patients from 26 countries registered with the European Society for Blood and Marrow Transplantation, which has maintained clinical data since 1977 of patients who received a transplant. Information from all patients who underwent a transplant in Europe and had an SSC diagnosis between January 1, 2000, and December 31, 2014, was extracted. The cohort included patients with 18 different cancers. Data analysis was conducted from September 3, 2017, to March 17, 2018. Main Outcomes and Measures Median and 5-year age-standardized overall survival, causes of death, risk factor multivariate analysis using a clustered Cox proportional hazard regression model, and standardized mortality ratio were calculated for each of the 18 types of SSC. Results In total, 220 617 patients underwent a transplant, of whom only 4065 (1.8%) patients with a second solid cancer after HSCT were included in the study. Among the 4065 patients, 2321 (57.1%) were men and 1744 (42.9%) were women, with a mean (range) age of 59.1 (3.2-82.3) years at diagnosis of second solid cancer. The 5-year age-standardized overall survival was 47% (95% CI, 45%-49%). The 5-year overall survival rate after SSC diagnosis was poor for pancreas, lung, hepatobiliary, esophageal, brain, and gastric cancers, with a median survival between 0.6 and 1 year. The 5-year overall survival was intermediate for endometrial, colorectal, sarcomas, ovarian, bladder, oropharyngeal, and kidney cancers, with a median survival between 2 and 10 years. The 5-year overall survival was more favorable for melanoma, breast, prostate, cervix, and thyroid cancers, with a median survival of 10 or more years. Additional transplant-associated factors for mortality for patients treated with allogeneic HSCT were age at transplant, donor type, conditioning regimen, and graft-vs-host disease. In total, 1777 patients (43.7%) died, of which 1256 (74.8%) were from SSC, 344 (20.5%) from primary disease, and 79 (4.7%) from other causes. Standardized mortality ratio was higher, compared with de novo solid cancers, for melanoma, prostate, breast, kidney, bladder, colorectal, and endometrial cancers but not for the other cancers. Conclusions and Relevance The outcome of SSC is mainly dependent on the type of second cancer; thus, future studies should investigate the reasons the standardized mortality ratio is higher for some cancers to identify whether patients with these cancers should be treated differently and to help in screening and counseling patients who developed an SSC after HSCT.
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Affiliation(s)
| | - Eric Beohou
- EBMT Paris Study Office/CEREST-TC, Hôpital Saint Antoine, Paris, France
| | - Myriam Labopin
- EBMT Paris Study Office/CEREST-TC, Hôpital Saint Antoine, Paris, France
| | - Gérard Socié
- Department of Hematology-BMT, Hôpital St Louis, Paris, France
| | - Alicia Rovó
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuela Badoglio
- EBMT Paris Study Office/CEREST-TC, Hôpital Saint Antoine, Paris, France
| | - Anja van Biezen
- EBMT Data Office Leiden, Leiden University Medical Center, Leiden, the Netherlands
| | - Peter Bader
- Stem Cell Transplantation and Immunology, Hospital for Children and Adolescents, Frankfurt, Germany
| | - Rafael F Duarte
- Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Grzegorz Basak
- Department of Hematology, Oncology and Internal Medicine, Central Clinical Hospital, the Medical University of Warsaw, Warsaw, Poland
| | - Nina Salooja
- Center for Haematology, Imperial College, London, United Kingdom
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3
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Baron F, Labopin M, Savani BN, Beohou E, Niederwieser D, Eder M, Potter V, Kröger N, Beelen D, Socié G, Itälä‐Remes M, Bornhäuser M, Mohty M, Nagler A. Graft‐versus‐host disease and graft‐versus‐leukaemia effects in secondary acute myeloid leukaemia: a retrospective, multicentre registry analysis from the Acute Leukaemia Working Party of the EBMT. Br J Haematol 2019; 188:428-437. [DOI: 10.1111/bjh.16185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/26/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Frédéric Baron
- Laboratory of Haematology GIGA‐I3 University of Liege Liege Belgium
| | - Myriam Labopin
- EBMT Paris Office Hospital Saint Antoine Paris France
- AP‐HP Hématologie Clinique et Thérapie Cellulaire Hôpital Saint‐Antoine Paris France
- Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint‐Antoine Université Pierre & Marie Curie and INSERM UMRs U938 Paris France
| | | | - Eric Beohou
- EBMT Paris Office Hospital Saint Antoine Paris France
| | | | - Matthias Eder
- Department of Haematology Haemostasis, Oncology and Stem Cell Transplantation Hannover Medical School Hannover Germany
| | - Victoria Potter
- Department of Haematological Medicine GKT School of Medicine London UK
| | - Nicolaus Kröger
- Bone Marrow Transplantation Centre University Hospital Eppendorf Hamburg Germany
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation West German Cancer CenterUniversity Hospital of Essen Essen Germany
| | - Gerard Socié
- Department of Haematology – BMT Hopital St. Louis Paris France
| | - Maija Itälä‐Remes
- Stem Cell Transplantation Unit HUCH Comprehensive Cancer Centre Helsinki Finland
| | - Martin Bornhäuser
- Medizinische Klinik und Poliklinik I Universitaetsklinikum TU Dresden Dresden Germany
| | - Mohamad Mohty
- EBMT Paris Office Hospital Saint Antoine Paris France
- AP‐HP Hématologie Clinique et Thérapie Cellulaire Hôpital Saint‐Antoine Paris France
- Service d'Hématologie Clinique et Thérapie Cellulaire Hôpital Saint‐Antoine Université Pierre & Marie Curie and INSERM UMRs U938 Paris France
| | - Arnon Nagler
- EBMT Paris Office Hospital Saint Antoine Paris France
- Division of Haematology and Bone Marrow Transplantation The Chaim Sheba Medical Centre Tel‐Hashomer Ramat‐Gan Israel
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Faraci M, Bertaina A, Dalissier A, Ifversen M, Schulz A, Gennery A, Burkhardt B, Badell Serra I, Diaz-de-Heredia C, Lanino E, Lankester AC, Gruhn B, Matthes-Martin S, Kühl JS, Varotto S, Paillard C, Guilmatre A, Sastre A, Abecasis M, Garwer B, Sedlacek P, Boelens JJ, Beohou E, Bader P. Solid organ transplantation after hematopoietic stem cell transplantation in childhood: A multicentric retrospective survey. Am J Transplant 2019; 19:1798-1805. [PMID: 30586230 DOI: 10.1111/ajt.15240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 09/13/2018] [Revised: 11/24/2018] [Accepted: 12/14/2018] [Indexed: 01/25/2023]
Abstract
We report data obtained from a retrospective multicenter pediatric survey on behalf of the European Society for Blood and Marrow Transplantation (EBMT). Information on solid organ transplantation (SOT) performed in pediatric recipients of either autologous or allogeneic hematopoietic stem cell transplantation (HSCT) between 1984 and 2016 was collected in 20 pediatric EBMT Centers (25.6%). Overall, we evaluated data on 44 SOTs following HSCT including 20 liver (LTx), 12 lung (LuTx), 6 heart (HTx), and 6 kidney (KTx) transplantations. The indication for SOT was organ failure related to intractable graft-vs-host disease in 16 children (36.3%), acute or chronic HSCT-related toxicity in 18 (40.9%), and organ dysfunction related to the underlying disease in 10 (22.8%). The median follow-up was 10.9 years (95% confidence interval: 1.7-29.5). The overall survival rate at 1 and 5 years after SOT was 85.7% and 80.4%, respectively: it was 74% and 63.2% after LTx, 83.2% after HTx, and 100% equally after LuTx and KTx. This multicenter survey confirms that SOT represents a promising option in children with severe organ failure occurring after HSCT. Additional studies are needed to further establish the effectiveness of SOT after HSCT and to better understand the mechanism underlying this encouraging success.
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Affiliation(s)
- Maura Faraci
- Hematopoietic Stem Cell Transplantation Unit, Hematology-Oncology, Istituto G Gaslini, Genova, Italy
| | - Alice Bertaina
- Dipartimento di Onco-Ematologia Pediatrica, IRCSS Ospedale Pediatrico Bambino Gesù, Rome, Italy.,Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Arnaud Dalissier
- European Society for Blood and Marrow Transplantation Pediatric Disease Working Party, Paris, France
| | - Marianne Ifversen
- Department for Children and Adolescents, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ansgar Schulz
- Department of Pediatrics, University Medical Center, Ulm, Germany
| | - Andrew Gennery
- Institute of Cellular Medicine, Pediatric Immunology Department, Newcastle University, Great North Children's Hospital, Newcastle-upon-Tyne, UK
| | - Birgit Burkhardt
- Pediatric Hematology and Oncology, University Hospital Münster, Muenster, Germany
| | - Isabel Badell Serra
- Pediatric Hematopoietic Transplant Unit, Sant Pau Hospital, Barcelona, Spain
| | - Cristina Diaz-de-Heredia
- Department of Pediatric Oncology and Hematology, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Edoardo Lanino
- Hematopoietic Stem Cell Transplantation Unit, Hematology-Oncology, Istituto G Gaslini, Genova, Italy
| | - Arjan C Lankester
- Department of Pediatrics Stem Cell Transplantation Program, Leiden University Medical Center, Leiden, The Netherlands
| | - Bernd Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | | | - Joern S Kühl
- Department Pediatric Hematology, Oncology, Hemostaseology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Stefania Varotto
- Clinic of Pediatric Hemato-Oncology, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Catherine Paillard
- Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, Hôpital Hautepierre, Strasbourg, France
| | - Audrey Guilmatre
- Service of Pediatric Hematology-Oncology, Hôpital Armand Trousseau, Paris, France
| | - Ana Sastre
- Unidad de Hematología y Oncología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | - Jaap J Boelens
- Pediatric Blood and Marrow Transplantation Program, Laboratory for Translational Immunology Tumor-immunology, University Medical Center, Utrecht, The Netherlands.,Stem Cell Transplant and Cellular Therapies Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric Beohou
- European Society for Blood and Marrow Transplantation Pediatric Disease Working Party, Paris, France
| | - Peter Bader
- Department for Children and Adolescents, Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt am Main, Germany
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5
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Canaani J, Beohou E, Labopin M, Ghavamzadeh A, Beelen D, Hamladji RM, Niederwieser D, Volin L, Markiewicz M, Arnold R, Mufti G, Ehninger G, Socié G, Kröger N, Mohty M, Nagler A. Trends in patient outcome over the past two decades following allogeneic stem cell transplantation for acute myeloid leukaemia: an ALWP/EBMT analysis. J Intern Med 2019; 285:407-418. [PMID: 30372796 DOI: 10.1111/joim.12854] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Outcomes for patients with acute myeloid leukaemia (AML) undergoing allogeneic stem cell transplantation (allo-SCT) have significantly improved in recent years. OBJECTIVES To assess the incremental improvement of transplanted AML patients in the last two decades. METHODS Patients included in this analysis were adult AML patients who underwent allo-SCT from an HLA-matched sibling donor (MSD) or HLA-matched unrelated donor (MUD) in first remission. Patient outcomes were assessed between three cohorts according to the year of transplant (1993-2002, 2003-2007 and 2008-2012). RESULTS The analysis comprised a total of 20 187 patients of whom 4763 were transplanted between 1993 and 2002, 5835 in 2003 and 2007, and 9589 in 2008 and 2012. In multivariate analysis, leukaemia-free survival (LFS) rates were significantly improved in more recently transplanted patients compared to patients transplanted in 1993-2002 [Hazard ratio (HR) = 0.84, confidence interval (CI) 95%, 0.77-0.92; P = 0.003], a benefit which also extended to improved overall survival (OS; HR = 0.8, CI 95%, 0.73-0.89; P < 0.0001), and decreased nonrelapse mortality (NRM) rates (HR = 0.65, CI 95%, 0.56-0.75; P < 0.0001). Subset analysis revealed that in MSD, the rates of LFS, NRM and OS significantly improved in patients in the more recent cohort with similar results also seen in MUD. Finally, the incidence of acute graft-versus-host disease (GVHD) was significantly reduced leading to improved GVHD-free/relapse-free survival (GRFS) rates in more recently transplanted patients. CONCLUSION Outcome of allo-SCT for AML patients has markedly improved in the last two decades owing to decreased nonrelapse mortality and improved rates of leukaemia-free survival resulting in significantly longer survival.
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Affiliation(s)
- J Canaani
- Hematology Division, Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | - E Beohou
- Acute Leukemia Working Party -EBMT and Department of Hematology and Cell Therapy, Hȏpital Saint-Antoine, Paris, France
| | - M Labopin
- Acute Leukemia Working Party -EBMT and Department of Hematology and Cell Therapy, Hȏpital Saint-Antoine, Paris, France
| | - A Ghavamzadeh
- Hematology-Oncology and BMT Research, Shariati Hospital, Teheran, Iran
| | - D Beelen
- Department of Bone Marrow Transplantation, University Hospital, Essen, Germany
| | - R-M Hamladji
- Service Hématologie Greffe de Moëlle, Centre Pierre et Marie Curie, Alger, Algeria
| | - D Niederwieser
- Division of Haematology & Oncology, University Hospital Leipzig, Leipzig, Germany
| | - L Volin
- Stem Cell Transplantation Unit, Comprehensive Cancer Centre, Helsinki University Hospital, Helsinki, Finland
| | - M Markiewicz
- Department of Haematology and BMT, Medical University of Silesia, Katowice, Poland
| | - R Arnold
- Medizinische Klinik m. S. Hämatologie/Onkologie, Charité Universitaetsmedizin Berlin, Berlin, Germany
| | - G Mufti
- Department of Haematological Medicine, GKT School of Medicine, London, UK
| | - G Ehninger
- Universitaetsklinikum Dresden Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - G Socié
- Department of Hematology - BMT, Hȏpital St. Louis, Paris, France
| | - N Kröger
- Bone Marrow Transplantation Centre, University Hospital Eppendorf, Hamburg, Germany
| | - M Mohty
- Acute Leukemia Working Party -EBMT and Department of Hematology and Cell Therapy, Hȏpital Saint-Antoine, Paris, France
| | - A Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel.,Acute Leukemia Working Party -EBMT and Department of Hematology and Cell Therapy, Hȏpital Saint-Antoine, Paris, France
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6
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Saraceni F, Beohou E, Labopin M, Arcese W, Bonifazi F, Stepensky P, Aljurf M, Bruno B, Pioltelli P, Passweg J, Sociè G, Santarone S, Yakoub-Agha I, Lanza F, Savani BN, Mohty M, Nagler A. Thiotepa, busulfan and fludarabine compared to busulfan and cyclophosphamide as conditioning regimen for allogeneic stem cell transplant from matched siblings and unrelated donors for acute myeloid leukemia. Am J Hematol 2018; 93:1211-1219. [PMID: 30033639 DOI: 10.1002/ajh.25225] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/11/2018] [Accepted: 07/16/2018] [Indexed: 11/09/2022]
Abstract
Busulfan plus cyclophosphamide (BuCy) is the traditional conditioning regimen for allogeneic stem cell transplant (allo-SCT) for young, fit patients with acute myeloid leukemia (AML). The thiotepa-busulfan-fludarabine (TBF) protocol has recently demonstrated promising outcome in cord blood and haploidentical SCT; however, there is limited evidence about this regimen in transplant from matched siblings (MSD) and unrelated donors (UD). We retrospectively compared outcomes of 2523 patients aged 18-50 with AML in remission, undergoing transplant from MSD or UD prepared with either TBF or BuCy conditioning. A 1:3 pair-matched analysis was performed: 146 patients receiving TBF were compared with 438 patients receiving BuCy. Relapse risk was significantly lower in the TBF when compared with BuCy group (HR 0.6, P = .02), while NRM did not differ. No significant difference was observed in LFS and OS between the two regimens. TBF was associated with a trend towards higher risk of grades III-IV aGVHD (HR 1.8, P = .06) and inferior cGVHD (HR 0.7, P = .04) when compared with BuCy. In patients undergoing transplant in first remission, the advantage for TBF in terms of relapse was more evident (HR 0.4, P = .02), leading to a trend for better LFS in favor of TBF (HR 0.7, P = .10), while OS did not differ between the two cohorts. In conclusion, TBF represents a valid myeloablative conditioning regimen providing significantly lower relapse and similar survival when compared with BuCy. Patients in first remission appear to gain the most from this protocol, as in this subgroup a tendency for better LFS was observed when compared with BuCy.
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Affiliation(s)
- Francesco Saraceni
- Hematology and Stem Cell Transplant, Romagna Transplant Network; Ravenna Italy
| | - Eric Beohou
- EBMT Paris Study Office, Saint Antoine Hospital; Paris France
| | - Myriam Labopin
- EBMT Paris Study Office, Saint Antoine Hospital; Paris France
| | - William Arcese
- Tor Vergata University of Rome, Stem Cell Transplant Unit, Policlinico Universitario Tor Vergata; Rome Italy
| | - Francesca Bonifazi
- Bologna University, S. Orsola-Malpighi Hospital, Institute of Hematology L and A Seràgnoli; Bologna Italy
| | - Polina Stepensky
- Department of Bone Marrow Transplantation; Hadassah University Hospital; Jerusalem Israel
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Centre, Oncology (Section of Adult Haematolgy/BMT); Riyadh Saudi Arabia
| | - Benedetto Bruno
- S.S.C.V.D Trapianto di Cellule Staminali, A.O.U Citta della Salute e della Scienza di Torino; Torino Italy
| | - Pietro Pioltelli
- Ospedale San Gerardo, Clinica Ematologica dell'Universita Milano-Bicocca; Monza Italy
| | - Jakob Passweg
- Department of Hematology; University Hospital; Basel Switzerland
| | - Gerard Sociè
- Department of Hematology; BMT, Hospital St. Louis; Paris France
| | - Stella Santarone
- Ospedale Civile, Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie; Pescara Italy
| | | | - Francesco Lanza
- Hematology and Stem Cell Transplant, Romagna Transplant Network; Ravenna Italy
| | | | - Mohamad Mohty
- Department of Haematology; Saint Antoine Hospital; Paris France
| | - Arnon Nagler
- EBMT Paris Study Office, Saint Antoine Hospital; Paris France
- Department of Bone Marrow Transplantation; Chaim Sheba Medical Center; Tel-Hashomer Israel
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7
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Flouzat-Lachaniette CH, Jullien N, Bouthors C, Beohou E, Laurent B, Bierling P, Dubory A, Rouard H. A novel in vivo porcine model of intervertebral disc degeneration induced by cryoinjury. International Orthopaedics (SICOT) 2018; 42:2263-2272. [DOI: 10.1007/s00264-018-3971-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/01/2018] [Indexed: 01/07/2023]
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8
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Yaniv I, Krauss AC, Beohou E, Dalissier A, Corbacioglu S, Zecca M, Afanasyev BV, Berger M, Diaz MA, Kalwak K, Sedlacek P, Varotto S, Peters C, Bader P. Second Hematopoietic Stem Cell Transplantation for Post-Transplantation Relapsed Acute Leukemia in Children: A Retrospective EBMT-PDWP Study. Biol Blood Marrow Transplant 2018; 24:1629-1642. [PMID: 29548831 DOI: 10.1016/j.bbmt.2018.03.002] [Citation(s) in RCA: 37] [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: 12/31/2017] [Accepted: 03/06/2018] [Indexed: 02/05/2023]
Abstract
Outcome data were collected from the European Society for Blood and Marrow Transplantation registry on 373 children from 120 centers with relapsed leukemia (214 with acute lymphoblastic leukemia [ALL] and 159 with acute myelogenous leukemia [AML]) who underwent second allogeneic hematopoietic stem cell transplantation (HSCT) between 2004 and 2013. Overall survival (OS) was 38% at 2 years and 29% at 5 years, and leukemia-free survival (LFS) was 30% at 2 years and 25% at 5 years. Median follow-up after second HSCT was 36.4 months in the ALL group and 50.2 months in the AML group. In the ALL group, OS was 43% at 2 years and 33% at 5 years, and LFS was 34% at 2 years and 31% at 5 years. In the AML group, OS was 32% at 2 years and 24% at 5 years, and LFS was 24% at 2 years and 17% at 5 years. The 2-year nonrelapse mortality (NRM) rate was 22% in the ALL group and 18% in the AML group. Favorable prognostic factors (P < .05) for OS and LFS included >12 months between transplantations and chronic graft-versus-host disease after the first HSCT (in both groups), complete response before the second HSCT (ALL group only), and age >12 years (AML group only). Findings were more consistent over time in the ALL group, with no significant differences between 2-year and 5-year rates of relapse, NRM, and LFS. Children with relapsed acute leukemias have a substantial likelihood of long-term survival following second HSCT. Given the many novel targeted and immunomodulation therapies currently under development, it is important to identify specific patient subpopulations that may benefit from a second HSCT compared with those better suited to new approaches.
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Affiliation(s)
- Isaac Yaniv
- Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aviva C Krauss
- Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Eric Beohou
- EBMT Paris study office/CEREST-TC, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Paris, France
| | - Arnaud Dalissier
- EBMT Paris study office/CEREST-TC, Department of Haematology, Saint Antoine Hospital, INSERM UMR 938, Paris, France
| | - Selim Corbacioglu
- Pediatric Hematology, Oncology and Stem Cell Transplantation, University of Regensburg, Regensburg, Germany
| | - Marco Zecca
- Pediatric Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Boris V Afanasyev
- Hematology and Transplantation Department, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russian Federation
| | - Massimo Berger
- Pediatric Onco-Hematology, Regina Margherita Children Hospital, Torino, Italy
| | - Miguel Angel Diaz
- Division of Hematopoietic Stem Cell Transplantation, "Nino Jesus" Children Hospital, Madrid, Spain
| | - Krzysztof Kalwak
- Department of Pediatric Hematology/Oncology and Bone Marrow Transplantation, Cape of Hope Wroclaw Medical University, Wroclaw, Poland
| | - Petr Sedlacek
- Pediatric Hematology-Oncology, University Hospital Motol, Prague, Czech Republic
| | - Stefania Varotto
- Oncoematologia Pediatrica, Azienda Ospedaliera-Universita, Padova, Italy
| | - Christina Peters
- AustriaStem Cell Transplantation Unit, St. Anna Children's Hospital, Vienna, Austria
| | - Peter Bader
- Department for Children and Adolescents; Division for Stem Cell Transplantation and Immunology, University Hospital Frankfurt, Frankfurt, Germany
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9
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Ofran Y, Beohou E, Labopin M, Blaise D, Cornelissen JJ, de Groot MR, Socié G, Huynh A, Maertens J, Baron F, Mohty M, Nagler A. Anti-thymocyte globulin for graft-versus-host disease prophylaxis in patients with intermediate- or high-risk acute myeloid leukaemia undergoing reduced-intensity conditioning allogeneic stem cell transplantation in first complete remission - a survey on behalf of the Acute Leukaemia Working Party of the European Society for Blood and Marrow Transplantation. Br J Haematol 2018; 184:643-646. [PMID: 29468648 DOI: 10.1111/bjh.15131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yishai Ofran
- Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel
| | - Eric Beohou
- EBMT Paris Study Office/CEREST-TC, Paris, France.,Department of Haematology, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Myriam Labopin
- EBMT Paris Study Office/CEREST-TC, Paris, France.,Department of Haematology, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Jan J Cornelissen
- Department of Haematology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - Marco R de Groot
- Department of Haematology, University Medical Centre Groningen (UMCG), Groningen, the Netherlands
| | - Gerard Socié
- APHP Haematology Transplantation, University Paris 7, Paris, France.,INSERM UMR 1160, Paris, France
| | - Anne Huynh
- Institut Universitaire du Cancer Toulouse, Oncopole, Toulouse, France
| | - Johan Maertens
- Department of Haematology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Mohamad Mohty
- EBMT Paris Study Office/CEREST-TC, Paris, France.,Department of Haematology, Saint Antoine Hospital, Paris, France.,INSERM UMR 938, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Arnon Nagler
- EBMT Paris Study Office/CEREST-TC, Paris, France.,Division of Haematology and Bone Marrow Transplantation, Chaim Sheba Medical Centre, Ramat-Gan, Israel
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10
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Baron F, Ruggeri A, Beohou E, Labopin M, Mohty M, Sanz J, Vigouroux S, Furst S, Bosi A, Chevallier P, Cornelissen JJ, Michallet M, Sierra J, Karakasis D, Savani BN, Gluckman E, Nagler A. Occurrence of graft-versus-host disease increases mortality after umbilical cord blood transplantation for acute myeloid leukaemia: a report from Eurocord and the ALWP of the EBMT. J Intern Med 2018; 283:178-189. [PMID: 28977716 DOI: 10.1111/joim.12696] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The efficacy of umbilical cord blood transplantation (UCBT) as treatment for acute myeloid leukaemia (AML) relies on immune-mediated graft-versus-leukaemia effects. Previous studies have suggested a strong association between graft-versus-host disease (GVHD) occurrence and graft-versus-leukaemia effects after allogeneic hematopoietic cell transplantation. METHODS Here, we evaluated the kinetics of relapse rate in correlation with GVHD occurrence after UCBT. The kinetics of relapse rate over time in correlation to GVHD occurrence were assessed by calculating the relapse rate per patient-year within sequential 90-day intervals. The impact of GVHD on relapse and mortality was further studied in multivariate Cox models handling GVHD as a time-dependent covariate. RESULTS The study included data from 1068 patients given single (n = 567) or double (n = 501) UCBT. The proportion of patients with grade II, III and IV acute GVHD was 20%, 7% and 4%, respectively. At 2 years, the cumulative incidence of chronic GVHD was 42%, the cumulative incidence of relapse was 32%, and overall survival was 32% as well. Relapse rates declined gradually over time during the first 30 months after transplantation. There was a possible suggestion that grade II-IV acute (HR = 0.8, P = 0.1) and chronic (HR = 0.65, P = 0.1) GVHD decreased relapse risk. However, grade II-IV acute GVHD significantly increased early (the first 18 months after UCBT) mortality (HR = 1.3, P = 0.02), whilst chronic GVHD increased each early (HR = 2.7, P < 0.001) and late (HR = 4.9, P < 0.001) mortality after UCBT. CONCLUSIONS The occurrence of grade II-IV acute or chronic GVHD each increases overall mortality after UCBT for AML mitigating the possible graft-versus-leukemia effect of GVHD.
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Affiliation(s)
- F Baron
- Laboratory of Hematology, GIGA-I3, University of Liege, Liege, Belgium
| | - A Ruggeri
- Eurocord, Hospital Saint Louis, AP-HP, IUH University Paris VII, Paris, France.,Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Université Pierre & Marie Curie and INSERM UMRs U938
| | - E Beohou
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - M Labopin
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - M Mohty
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Université Pierre & Marie Curie and INSERM UMRs U938
| | - J Sanz
- Servicio de Hematologia, Hospital Universitario La Fe, Valencia, Spain
| | - S Vigouroux
- Department of Hematology, University Hospital of Bordeaux, Bordeaux, France
| | - S Furst
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - A Bosi
- Hematology Unit, AOU Careggi, Florence, Italy
| | - P Chevallier
- Department of Hematology, CHU Nantes, Nantes, France
| | - J J Cornelissen
- Erasmus MC Cancer Institute, Department of Hematology, Rotterdam, The Netherlands
| | - M Michallet
- Department of Hematology, Centre Hospitalier Lyon-Sud, Lyon, France
| | - J Sierra
- Hematology Department, IIB Sant Pau and Josep Carreras Leukemia Research Institutes, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - D Karakasis
- Department of Hematology and Lymphomas, Evangelismos Hospital, Athens, Greece
| | - B N Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - E Gluckman
- Eurocord, Hospital Saint Louis, AP-HP, France Monacord, Centre Scientifique de Monaco, IUH University Paris VII, Monaco city, Monaco
| | - A Nagler
- EBMT Paris Office, Hospital Saint Antoine, Paris, France.,Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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11
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Baron F, Ruggeri A, Beohou E, Labopin M, Sanz G, Milpied N, Michallet M, Bacigalupo A, Blaise D, Sierra J, Socié G, Cornelissen JJ, Schmid C, Giebel S, Gorin NC, Esteve J, Ciceri F, Savani BN, Mohty M, Gluckman E, Nagler A. RIC versus MAC UCBT in adults with AML: A report from Eurocord, the ALWP and the CTIWP of the EBMT. Oncotarget 2018; 7:43027-43038. [PMID: 27250025 PMCID: PMC5190005 DOI: 10.18632/oncotarget.9599] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/14/2016] [Indexed: 01/08/2023] Open
Abstract
Nonrelapse mortality (NRM) is the first cause of treatment failure after unrelated cord blood transplantation (UCBT) following myeloablative conditioning (MAC). In the last decade, reduced-intensity conditioning (RIC) regimens have been developed with the aim of reducing NRM and allowing older patients and those with medical comorbidities to benefit from UCBT. The aim of the current retrospective study was to compare transplantation outcomes of acute myeloid leukemia (AML) patients given UCBT after either RIC or MAC. Data from 894 adults with AML receiving a single or double UCBT as first allograft from 2004 to 2013 at EBMT centers were included in this study. 415 patients were given UCBT after RIC while 479 patients following a MAC. In comparison to MAC recipients, RIC recipients had a similar incidence of neutrophil engraftment and of acute and chronic graft-versus-host disease (GVHD). However, RIC recipients had a higher incidence of disease relapse and a lower NRM, translating to comparable leukemia-free (LFS), GVHD-free, relapse-free survival (GRFS) and overall survival (OS). These observations remained qualitatively similar after adjusting for differences between groups in multivariate analyses. In conclusion, these data suggest that LFS and OS are similar with RIC or with MAC in adults AML patients transplanted with UCBT. These observations could serve as basis for a future prospective randomized study.
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Affiliation(s)
| | - Annalisa Ruggeri
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France.,AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Eric Beohou
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Myriam Labopin
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Guillermo Sanz
- Hospital Universitario La Fe, Servicio de Hematologia, Valencia, Spain
| | - Noel Milpied
- CHU Bordeaux, Hématologie Clinique et Thérapie Cellulaire-Hôpital Haut-leveque, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | | | | | - Didier Blaise
- Institut Paoli Calmettes (IPC), Aix Marseille University (AMU), UM105, Centre de Recherche en Cancerologie (CRCM), Inserm U1068, CNRS UMR7258 Marseille, Marseille, France
| | - Jorge Sierra
- Hospital Santa Creu i Sant Pau, Hematology Department, Barcelona, Spain
| | - Gérard Socié
- AP-HP, Hematology Transplantation, Hospital Saint-Louis, Paris, France
| | - Jan J Cornelissen
- Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - Christoph Schmid
- Klinikum Augsburg, Department of Hematology and Oncology, University of Munich, Augsburg, Germany
| | - Sebastian Giebel
- Maria Sklodowska-Curie Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Norbert-Claude Gorin
- AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.,EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Jordi Esteve
- Deptartment of Hematology, Hospital Clinic, Barcelona, Spain
| | - Fabio Ciceri
- Department of Hematology, Ospedale San Raffaele, Università degli Studi, Milano, Italy
| | - Bipin N Savani
- Long Term Transplant Clinic, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohamad Mohty
- AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France.,Universite Pierre & Marie Curie, Paris, France.,INSERM, UMRS 938, Paris, France
| | - Eliane Gluckman
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, France Monacord, Centre Scientifique de Monaco, Monaco
| | - Arnon Nagler
- EBMT Paris Office, Hospital Saint Antoine, Paris, France.,Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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12
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Eder S, Canaani J, Beohou E, Labopin M, Sanz J, Arcese W, Or R, Finke J, Cortelezzi A, Beelen D, Passweg J, Socié G, Gurman G, Aljurf M, Stelljes M, Giebel S, Mohty M, Nagler A. Thiotepa-based conditioning versus total body irradiation as myeloablative conditioning prior to allogeneic stem cell transplantation for acute lymphoblastic leukemia: A matched-pair analysis from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Am J Hematol 2017; 92:997-1003. [PMID: 28614903 DOI: 10.1002/ajh.24823] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/06/2017] [Accepted: 06/12/2017] [Indexed: 12/13/2022]
Abstract
The optimal conditioning regimen to employ before hematopoietic stem cell transplantation in acute lymphoblastic leukemia (ALL) is still undecided, and while cyclophosphamide/total body irradiation (Cy/TBI) is the most commonly used myeloablative regimen, there are concerns regarding long-term toxicity for patients conditioned with this regimen. Thiotepa-based conditioning is an emerging radiation-free regimen with recent publications indicative of comparable clinical outcomes to TBI-based conditioning. In this analysis of the acute leukemia working party of the EBMT, we performed a retrospective matched-pair analysis, evaluating the outcome of adult patients with ALL who received thiotepa-based conditioning (n = 180) with those receiving Cy/TBI conditioning (n = 540). The 2-year leukemia-free survival and overall survival (OS) rates of both conditioning regimens were comparable, 33% for thiotepa [95% confidence interval (CI): 26.4-42.8] versus 39% for Cy/TBI (95% CI: 34.8-44.5] (P = .33) and 46.5% [95% CI: 38.6-56.1] versus 48.8% [95% CI: 44.2-54] (P = .9), respectively. There was no significant difference between the two regimens in the incidence of either acute graft versus host disease (GVHD) or chronic GVHD. Multivariate analysis demonstrated increased relapse incidence for thiotepa conditioning compared to Cy/TBI (HR = 1.78, 95% CI, 1.07-2.95; P = .03) which did not affect OS. Our results indicate that thiotepa-based conditioning may not be inferior to Cy/TBI for adult patients with ALL.
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Affiliation(s)
- Sandra Eder
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
| | - Jonathan Canaani
- Hematology Division, Chaim Sheba Medical Center; Tel Aviv University; Tel-Hashomer Israel
| | - Eric Beohou
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
| | | | - Jaime Sanz
- Hospital Universitario La Fe, Servicio de Hematologia; Valencia Spain
| | - William Arcese
- Stem Cell Transplant Unit; Tor Vergata University of Rome, Policlinico Universitario Tor Vergata; Rome Italy
| | - Reuven Or
- Department of Bone Marrow Transplantation; Hadassah University Hospital; Jerusalem Israel
| | - Juergen Finke
- Department of Medicine; Hematology, Oncology, University of Freiburg; Freiburg Germany
| | - Agostino Cortelezzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico IRCCS; Milano Italy
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation; University Hospital; Essen Germany
| | - Jakob Passweg
- Department of Hematology; University Hospital, Hematology; Basel Switzerland
| | - Gerard Socié
- Department of Hematology-BMT; Hopital St. Louis; Paris France
| | - Gunhan Gurman
- Transplantation Unit; Department of Hematology Adult Stem Cell, Ankara University Faculty of Medicine; Ankara Turkey
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Centre, Oncology (Section of Adult Haematolgy/BMT); Riyadh Saudi Arabia
| | - Matthias Stelljes
- Department of Hematology/Oncology; University of Münster; Münster Germany
| | - Sebastian Giebel
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology; Gliwice Poland
| | - Mohamad Mohty
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
| | - Arnon Nagler
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
- Hematology Division, Chaim Sheba Medical Center; Tel Aviv University; Tel-Hashomer Israel
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13
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Balduzzi A, Dalle JH, Jahnukainen K, von Wolff M, Lucchini G, Ifversen M, Macklon KT, Poirot C, Diesch T, Jarisch A, Bresters D, Yaniv I, Gibson B, Willasch AM, Fadini R, Ferrari L, Lawitschka A, Ahler A, Sänger N, Corbacioglu S, Ansari M, Moffat R, Dalissier A, Beohou E, Sedlacek P, Lankester A, De Heredia Rubio CD, Vettenranta K, Wachowiak J, Yesilipek A, Trigoso E, Klingebiel T, Peters C, Bader P. Fertility preservation issues in pediatric hematopoietic stem cell transplantation: practical approaches from the consensus of the Pediatric Diseases Working Party of the EBMT and the International BFM Study Group. Bone Marrow Transplant 2017; 52:1406-1415. [PMID: 28737775 DOI: 10.1038/bmt.2017.147] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/31/2017] [Accepted: 06/04/2017] [Indexed: 12/14/2022]
Abstract
Fertility preservation is an urgent challenge in the transplant setting. A panel of transplanters and fertility specialists within the Pediatric Diseases Working Party of the European Society for Blood and Marrow Transplantation (EBMT) and the International BFM Study Group provides specific guidelines. Patients and families should be informed of possible gender- and age-specific cryopreservation strategies that should be tailored according to the underlying disease, clinical condition and previous exposure to chemotherapy. Semen collection should be routinely offered to all postpubertal boys at the diagnosis of any disease requiring therapy that could potentially impair fertility. Testicular tissue collection might be offered to postpubertal boys; nevertheless, its use has been unsuccessful to date. Oocyte collection after hormonal hyperstimulation should be offered to postpubertal girls facing gonadotoxic therapies that could be delayed for the 2 weeks required for the procedure. Ovarian tissue collection could be offered to pre-/post-pubertal girls. Pregnancies have been reported after postpubertal ovarian tissue reimplantation; however, to date, no pregnancy has been reported after the reimplantation of prepubertal ovarian tissue or in vitro maturation of pre-/post-pubertal ovarian tissue. Possible future advances in reproductive medicine could change this scenario. Health authorities should prioritize fertility preservation projects in pediatric transplantation to improve patient care and quality of life.
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Affiliation(s)
- A Balduzzi
- Clinica Pediatrica, Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - J-H Dalle
- Hemato-Immunology Department, Robert-Debre Hospital, APHP and Paris-Diderot University, Paris, France
| | - K Jahnukainen
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M von Wolff
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynecology, Inselspital Bern, University Hospital, Bern, Switzerland
| | - G Lucchini
- Bone Marrow Transplant Department, Great Ormond Street Hospital, London, UK
| | - M Ifversen
- Department of Pediatric and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - K T Macklon
- The Fertility Clinic, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Poirot
- Adolescent and Young Adult Hematology Unit, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie, Paris, France
| | - T Diesch
- Department of Pediatric Hematology/Oncology, University Children's Hospital of Basel, Basel, Switzerland
| | - A Jarisch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - D Bresters
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - I Yaniv
- Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - B Gibson
- Department of Paediatric Haematology, Royal Hospital for Children, Scotland, UK
| | - A M Willasch
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - R Fadini
- Centro di Medicina della Riproduzione Biogenesi, Istituti Clinici Zucchi, Monza, Italy
| | - L Ferrari
- Department of Gynecology and Obstetrics, Ospedale San Gerardo di Monza, Monza, Italy
| | - A Lawitschka
- St Anna Children's Hospital, UKKJ, MUW, Vienna, Austria
| | - A Ahler
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynaecology, University Hospital, Basel, Switzerland
| | - N Sänger
- Division of Reproductive Medicine, Endocrinology and Infertility, Department of Obstetrics and Gynecology, University Hospital, JW Goethe University, Frankfurt, Germany
| | - S Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital, University of Regensburg, Regensburg, Germany
| | - M Ansari
- Department of Pediatrics, Hémato-Oncologie Pédiatrique, CANSEARCH Research Laboratory, Université de Médecine de Genève, Geneva, Switzerland
| | - R Moffat
- Division of Reproductive Medicine and Endocrinology, Department of Obstetrics and Gynaecology, University Hospital, Basel, Switzerland
| | - A Dalissier
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - E Beohou
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - P Sedlacek
- Department of Pediatric Hematology and Oncology, University Hospital Motol, Prague, Czech Republic
| | - A Lankester
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - C D De Heredia Rubio
- Pediatric Oncology and Hematology Department, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - K Vettenranta
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J Wachowiak
- Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, Poznan, Poland
| | - A Yesilipek
- Bahcesehir University School of Medicine, Department of Pediatrics, Pediatric Stem Cell Transplantation Unit, Istanbul, Turkey
| | - E Trigoso
- Paediatric Oncology Unit, Paediatric Transplant Unit, Polytechnic and University Hospital 'LA FE', Valencia, Spain
| | - T Klingebiel
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
| | - C Peters
- St Anna Children's Hospital, UKKJ, MUW, Vienna, Austria
| | - P Bader
- Division for Stem Cell Transplantation and Immunology, Department for Children and Adolescents, University Hospital, Goethe University Frankfurt am Main, Frankfurt, Germany
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14
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Baron F, Ruggeri A, Beohou E, Labopin M, Mohty M, Blaise D, Cornelissen JJ, Chevallier P, Sanz G, Petersen E, Savani BN, Gluckman E, Nagler A. Single- or double-unit UCBT following RIC in adults with AL: a report from Eurocord, the ALWP and the CTIWP of the EBMT. J Hematol Oncol 2017. [PMID: 28637512 PMCID: PMC5479038 DOI: 10.1186/s13045-017-0497-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background The feasibility of cord blood transplantation (CBT) in adults is limited by the relatively low number of hematopoietic stem/progenitor cells contained in one single CB unit. The infusion of two CB units from different partially HLA-matched donors (double CBT) is frequently performed in patients who lack a sufficiently rich single CB unit. Methods We compared CBT outcomes in patients given single or double CBT following reduced-intensity conditioning (RIC) in a retrospective multicenter registry-based study. Inclusion criteria included adult (≥18 years) patients, acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), complete remission (CR) at the time of transplantation, first single (with a cryopreserved TNC ≥ 2.5 × 107/kg) or double CBT between 2004 and 2014, and RIC conditioning. Results Data from 534 patients with AML (n = 408) or ALL (n = 126) receiving a first single (n = 172) or double (n = 362) CBT were included in the analyses. In univariate analysis, in comparison to patients transplanted with a single CB, double CB recipients had a similar incidence of neutrophil engraftment but a suggestion for a higher incidence of grade II–IV acute GVHD (36 versus 28%, P = 0.08). In multivariate analyses, in comparison to single CBT recipients, double CBT patients had a comparable incidence of relapse (HR = 0.9, P = 0.5) and of nonrelapse mortality (HR = 0.8, P = 0.3), as well as comparable overall (HR = 0.8, P = 0.17), leukemia-free (HR = 0.8, P = 0.2) and GVHD-free, relapse-free (HR = 1.0, P = 0.3) survival. Conclusions These data failed to demonstrate better transplantation outcomes in adult patients receiving double CBT in comparison to those receiving single CBT with adequate TNC after RIC. Electronic supplementary material The online version of this article (doi:10.1186/s13045-017-0497-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frédéric Baron
- Department of Hematology, University of Liege, CHU Sart-Tilman, 4000, Liege, Belgium.
| | - Annalisa Ruggeri
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, Paris, France.,AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Eric Beohou
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Myriam Labopin
- EBMT Paris Office, Hospital Saint Antoine, Paris, France
| | - Mohamad Mohty
- AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - Didier Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, France
| | - Jan J Cornelissen
- Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | | | - Guillermo Sanz
- Servicio de Hematologia, Hospital Universitario La Fe, Valencia, Spain
| | - Eefke Petersen
- Department of Hematology, University Medical Centre, Utrecht, The Netherlands
| | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eliane Gluckman
- Eurocord, Hospital Saint Louis, AP-HP, and IUH University Paris VII, France Monacord, Centre Scientifique de Monaco, Monaco, Monaco
| | - Arnon Nagler
- EBMT Paris Office, Hospital Saint Antoine, Paris, France.,Division of Hematology and Bone Marrow Transplantation, The Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel and the EBMT Paris Office, Hospital Saint Antoine, Paris, France
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15
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Canaani J, Beohou E, Labopin M, Socié G, Huynh A, Volin L, Cornelissen J, Milpied N, Gedde-Dahl T, Deconinck E, Fegueux N, Blaise D, Mohty M, Nagler A. Impact of FAB classification on predicting outcome in acute myeloid leukemia, not otherwise specified, patients undergoing allogeneic stem cell transplantation in CR1: An analysis of 1690 patients from the acute leukemia working party of EBMT. Am J Hematol 2017; 92:344-350. [PMID: 28052366 DOI: 10.1002/ajh.24640] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/15/2016] [Accepted: 01/03/2017] [Indexed: 12/13/2022]
Abstract
The French, American, and British (FAB) classification system for acute myeloid leukemia (AML) is extensively used and is incorporated into the AML, not otherwise specified (NOS) category in the 2016 WHO edition of myeloid neoplasm classification. While recent data proposes that FAB classification does not provide additional prognostic information for patients for whom NPM1 status is available, it is unknown whether FAB still retains a current prognostic role in predicting outcome of AML patients undergoing allogeneic stem cell transplantation. Using the European Society of Blood and Bone Marrow Transplantation registry we analyzed outcome of 1690 patients transplanted in CR1 to determine if FAB classification provides additional prognostic value. Multivariate analysis revealed that M6/M7 patients had decreased leukemia free survival (hazard ratio (HR) of 1.41, 95% confidence interval (CI), 1.01-1.99; P = .046) in addition to increased nonrelapse mortality (NRM) rates (HR, 1.79; 95% CI, 1.06-3.01; P = .028) compared with other FAB types. In the NPM1wt AML, NOS cohort, FAB M6/M7 was also associated with increased NRM (HR, 2.17; 95% CI, 1.14-4.16; P = .019). Finally, in FLT3-ITD+ patients, multivariate analyses revealed that specific FAB types were tightly associated with adverse outcome. In conclusion, FAB classification may predict outcome following transplantation in AML, NOS patients.
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Affiliation(s)
- Jonathan Canaani
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer; Tel Aviv University; Israel
| | - Eric Beohou
- Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Universite Pierre & Marie Curie; Paris France
- EBMT Acute Leukemia Working Party office, Hôpital Saint-Antoine; Paris France
| | - Myriam Labopin
- Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Universite Pierre & Marie Curie; Paris France
- EBMT Acute Leukemia Working Party office, Hôpital Saint-Antoine; Paris France
| | - Gerard Socié
- EBMT Acute Leukemia Working Party office, Hôpital Saint-Antoine; Paris France
| | - Anne Huynh
- Institut Universitaire du Cancer Toulouse, Oncopole; Toulouse France
| | - Liisa Volin
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit; Helsinki Finland
| | - Jan Cornelissen
- Department of Hematology; Erasmus MC Cancer Institute, University Medical Center Rotterdam; Rotterdam The Netherlands
| | - Noel Milpied
- CHU Bordeaux, Hôpital Haut-leveque; Pessac France
| | - Tobias Gedde-Dahl
- Department of Hematology, Clinic for Cancer, Surgery and Transplantation; Oslo University Hospital, Rikshospitalet; Oslo Norway
| | - Eric Deconinck
- Service d`Hématologie; Hopital Jean Minjoz; Besancon France
| | - Nathalie Fegueux
- Département d`Hématologie Clinique; CHU Lapeyronie; Montpellier France
| | - Didier Blaise
- Centre de Recherche en Cancérologie de Marseille; Programme de Transplantation & Therapie Cellulaire; Marseille France
| | - Mohamad Mohty
- Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Universite Pierre & Marie Curie; Paris France
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer; Tel Aviv University; Israel
- EBMT Acute Leukemia Working Party office, Hôpital Saint-Antoine; Paris France
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16
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Eder S, Beohou E, Labopin M, Sanz J, Finke J, Arcese W, Or R, Bonifazi F, Aljurf M, Socié G, Passweg J, Giebel S, Mohty M, Nagler A. Thiotepa-based conditioning for allogeneic stem cell transplantation in acute lymphoblastic leukemia-A survey from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Am J Hematol 2017; 92:18-22. [PMID: 27673280 DOI: 10.1002/ajh.24567] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/14/2016] [Accepted: 09/21/2016] [Indexed: 11/12/2022]
Abstract
In this study, we analyzed a thiotepa-based conditioning regimen for allogeneic stem cell transplantation in adults with acute lymphoblastic leukemia, using the EBMT database. A total of 323 patients were identified. The median age was 43 years. Disease status at transplant was first complete remission (CR1) in 48.9%, CR2 in 21.7%, CR3 in 6.2%, while 23.2% of the patients had an active disease at the time of transplant. This was performed from a HLA-matched sibling (49.8%) or a matched-unrelated donor (51.2%). The incidence of acute graft-vs.-host disease (GvHD) (grade > II) was 26.6%, while chronic GvHD occurred in 35.9% of the patients at 1 year (24.6% with extensive disease). With a median follow-up of 16.8 months, the nonrelapse mortality was 12.4 and 25.3% at 100 days and 1 year, respectively. The relapse incidence at 1 year was 33.3% with no difference for patients in CR1 (27%). The one-year leukemia-free survival (LFS) and overall survival (OS) were 57 and 66%, respectively for the entire cohort and 50 and 66%, respectively in patients in CR1. Thiotepa/busulfan ± melphalan (n = 213) in comparison to thiotepa/other (n = 110) conditioning regimen resulted in higher relapse incidence at 1 year (34.9 vs. 30.3%, P = 0.016) and lower LFS (38.8 vs. 45.9%, P = 0.0203), while nonrelapse mortality (23.8 vs. 26.3%, n.s.) and OS (59.6 vs. 51.1%, P = 0.109) did not differ. This large study suggests that a thiotepa-based conditioning for allogeneic transplantation in acute lymphoblastic leukemia is feasible and effective, with the main outcomes being comparable to those achieved with other regimens. Am. J. Hematol. 92:18-22, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sandra Eder
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine; Paris France
| | - Eric Beohou
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
| | | | - Jaime Sanz
- Servicio de Hematología; Hospital Universitari i politècnic La Fe; Valencia Spain
| | - Jürgen Finke
- Hematology/Oncology; University Medical Center Freiburg; Freiburg Germany
| | - William Arcese
- Department of Hematology and Transplant; University of Rome ‘Tor Vergata’; Rome Italy
| | - Reuven Or
- Bone Marrow Transplantation; Hadassah University Hospital; Jerusalem Israel
| | - Francesca Bonifazi
- S.Orsola-Malpighi Hospital Institute of Hematology and Medical, Oncology L and A Seràgnoli, Bologna University; Bologna Italy
| | - Mahmoud Aljurf
- Oncology (Section of Adult Haematolgy/BMT), King Faisal Specialist Hospital and Research Centre; Riyadh Saudi Arabia
| | - Gerard Socié
- Department of Hematology, BMT; Hospital St. Louis; Paris France
| | | | - Sebastian Giebel
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
- Gliwice Branch; Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology; Gliwice Poland
| | - Mohamad Mohty
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint-Antoine; Paris France
| | - Arnon Nagler
- EBMT Office Paris, Hôpital Saint-Antoine; Paris France
- Hematology Division; Chaim Sheba Medical Center and Tel Aviv University; Tel-Hashomer Ramat-Gan Israel
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17
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Lucchini G, Labopin M, Beohou E, Dalissier A, Dalle JH, Cornish J, Zecca M, Samarasinghe S, Gibson B, Locatelli F, Bertrand Y, Abdel-Rahman F, Socie G, Sundin M, Lankester A, Sedlacek P, Hamladji RM, Heilmann C, Afanasyev B, Hough R, Peters C, Bader P, Veys P. Impact of Conditioning Regimen on Outcomes for Children with Acute Myeloid Leukemia Undergoing Transplantation in First Complete Remission. An Analysis on Behalf of the Pediatric Disease Working Party of the European Group for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 2016; 23:467-474. [PMID: 27916512 DOI: 10.1016/j.bbmt.2016.11.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 11/29/2016] [Indexed: 01/26/2023]
Abstract
Hematopoietic stem cell transplantation (HSCT) represents the cornerstone of treatment in pediatric high-risk and relapsed acute myeloid leukemia (AML). The aim of the present study was to compare outcomes of pediatric patients with AML undergoing HSCT using 3 different conditioning regimens: total body irradiation (TBI) and cyclophosphamide (Cy); busulfan (Bu) and Cy; or Bu, Cy, and melphalan (Mel). In this retrospective study, registry data for patients > 2 and <18 years age undergoing matched allogeneic HSCT for AML in first complete remission (CR1) in 204 European Group for Blood and Marrow Transplantation centers between 2000 and 2010 were analyzed. Data were available for 631 patients; 458 patients received stem cells from a matched sibling donor and 173 from a matched unrelated donor. For 440 patients, bone marrow was used as stem cell source, and 191 patients received peripheral blood stem cells. One hundred nine patients received TBICy, 389 received BuCy, and 133 received BuCyMel as their preparatory regimen. Median follow-up was 55 months. Patients receiving BuCyMel showed a lower incidence of relapse at 5 years (14.7% versus 31.5% in BuCy versus 30% in TBICy, P < .01) and higher overall survival (OS) (76.6% versus 64% versus 64.5%, P = .04) and leukemia-free survival (LFS) (74.5% versus 58% versus 61.9%, P < .01), with a comparable nonrelapse mortality (NRM) (10.8% versus 10.5% versus 8.1%, P = .79). Acute graft-versus-host disease (GVHD) grades III and IV but not chronic GVHD, was higher in patients receiving BuCyMel. Older age at HSCT had an adverse impact on NRM and the use of peripheral blood as stem cell source was associated with increased chronic GVHD and NRM as well as lower LFS and OS. Among pediatric patients receiving HSCT for AML in CR1, the use of BuCyMel conditioning proved superior to TBICy and BuCy in reducing relapse and improving LFS.
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Affiliation(s)
- Giovanna Lucchini
- Bone Marrow Transplant Department, Great Ormond Street Hospital, London, United Kingdom.
| | - Myriam Labopin
- BMT Statistical Unit, European Group for Blood and Marrow Transplantation Office, Universite' Pierre et Marie Curie, Paris, France
| | - Eric Beohou
- BMT Statistical Unit, European Group for Blood and Marrow Transplantation Office, Universite' Pierre et Marie Curie, Paris, France
| | - Arnauld Dalissier
- BMT Statistical Unit, European Group for Blood and Marrow Transplantation Office, Universite' Pierre et Marie Curie, Paris, France
| | | | - Jacqueline Cornish
- Paediatric Haematology/Oncology Department, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Marco Zecca
- Pediatric Hematology-Oncology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sujith Samarasinghe
- Bone Marrow Transplant Department, Great Ormond Street Hospital, London, United Kingdom
| | - Brenda Gibson
- Haematology Department, Royal Hospital for Sick Children, Glasgow, United Kingdom
| | - Franco Locatelli
- Pediatric Hematology-Oncology Department, IRCCS Bambino Gesu' Children Hospital, Rome, Italy
| | - Yves Bertrand
- Pediatric Hematology and Oncology Department, Institut d'Hématologie et d'Oncologie Pédiatriqu, Lyon, France
| | - Fawzi Abdel-Rahman
- Bone Marrow and Stem Cell Transplantation Department, King Hussein Cancer Centre, Amman, Jordan
| | - Gerald Socie
- Hematology/Transplantation Department, Hôpital St. Louis, Paris, France
| | - Mikael Sundin
- Hematology/Immunology/SCT Department, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Arjan Lankester
- Pediatrics Department, Division of Immuno-Hematology and Stem Cell Transplantation Leiden University Hospital, The Netherlands
| | - Peter Sedlacek
- Paediatric Haematology & Oncology Department, University Hospital Motol, Prague, Czech Republic
| | | | - Carsten Heilmann
- Paediatrics and Adolescent Medicine Department, Rigshospitalet, Copenhagen, Denmark
| | - Boris Afanasyev
- Hematology and Transplantology Department, Saint Petersburg State Medical Pavlov University, Ratsa Gorbacheva Memorial Children's Institute, St. Petersburg, Russia
| | - Rachel Hough
- Stem Cell Transplantation Department, University College Hospital, London, United Kingdom
| | - Cristina Peters
- Stem Cell Transplantation Department, St. Anna Kinderspital, Vienna, Austria
| | - Peter Bader
- Stem Cell Transplantation and Immunology Department, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt am Main, Germany
| | - Paul Veys
- Bone Marrow Transplant Department, Great Ormond Street Hospital, London, United Kingdom
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18
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Garderet L, Beohou E, Caillot D, Stoppa AM, Touzeau C, Chretien ML, Karlin L, Moreau P, Fontan J, Blaise D, Polge E, Gueye MS, Ikhlef S, Marjanovic Z, Labopin M, Mohty M. Upfront autologous stem cell transplantation for newly diagnosed elderly multiple myeloma patients: a prospective multicenter study. Haematologica 2016; 101:1390-1397. [PMID: 27612987 DOI: 10.3324/haematol.2016.150334] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/06/2016] [Indexed: 11/09/2022] Open
Abstract
The feasibility and efficacy of high-dose melphalan followed by autologous hematopoietic stem cell transplantation in newly diagnosed elderly patients with multiple myeloma was analyzed prospectively. Fifty-six multiple myeloma patients, aged 65 years or over, from 6 French centers were studied. The induction therapy was bortezomib-based in combination with dexamethasone and either thalidomide, cyclophosphamide or lenalidomide, for 4-6 cycles. Peripheral blood stem cells were collected after high-dose cyclophosphamide plus G-CSF or G-CSF alone, with plerixafor if needed. The conditioning regimen consisted of melphalan at 140 mg/m2 in 18 patients (36%) and 200 mg/m2 in 32 (64%). Three months post autologous hematopoietic stem cell transplantation, a 2-month consolidation phase with either lenalidomide plus dexamethasone or bortezomib-based combination therapy was allowed, but maintenance treatment was not given. All but 6 patients underwent autologous hematopoietic stem cell transplantation and 3 had tandem transplantations. The treatment-related mortality was 0% at 100 days post transplantation. Sixty-eight percent received consolidation therapy following transplantation. The best response achieved was 40% complete response, 36% very good partial response, and 18% partial response. After a median follow up of 21 months (range 6-31), the estimated progression-free and overall survival rates at two years were 76% [95%CI: (61.6-94.1)] and 88% [95%CI: (76.7-100)], respectively. The higher dose of melphalan (200 mg/m2) afforded superior progression-free and overall survival rates. This prospective study provides evidence for the safety and efficacy of autologous hematopoietic stem cell transplantation as a first-line treatment approach in elderly multiple myeloma patients. (clinicaltrials.gov identifier: 01671826).
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Affiliation(s)
- Laurent Garderet
- INSERM, UMR_S 938, Proliferation and Differentiation of Stem Cells, AP-HP, Hôpital Saint Antoine, Département d'Hématologie et de Thérapie Cellulaire, F-75012, Paris, Université Pierre et Marie Curie-Paris 6, Paris, France
| | | | | | - Anne Marie Stoppa
- Department of Hematology, Institut Paoli Calmettes, Marseille, Paris, France
| | - Cyrille Touzeau
- Department of hematology, University Hospital Hotel Dieu, Nantes, Paris, France
| | | | - Lionel Karlin
- Department of Hematology, CHU Lyon Sud, Pierre Bénite, Paris, France
| | - Philippe Moreau
- Department of hematology, University Hospital Hotel Dieu, Nantes, Paris, France
| | - Jean Fontan
- Department of Hematology, CHU Besançon, Paris, France
| | - Didier Blaise
- Department of Hematology, Institut Paoli Calmettes, Marseille, Paris, France
| | | | - Mor Seny Gueye
- Hôpital Saint Antoine, Département d'Hématologie et de Thérapie Cellulaire, F-75012, Paris, France
| | - Souhila Ikhlef
- Hôpital Saint Antoine, Département d'Hématologie et de Thérapie Cellulaire, F-75012, Paris, France
| | - Zora Marjanovic
- Hôpital Saint Antoine, Département d'Hématologie et de Thérapie Cellulaire, F-75012, Paris, France
| | | | - Mohamad Mohty
- INSERM, UMR_S 938, Proliferation and Differentiation of Stem Cells, AP-HP, Hôpital Saint Antoine, Département d'Hématologie et de Thérapie Cellulaire, F-75012, Paris, Université Pierre et Marie Curie-Paris 6, Paris, France
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19
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Sun Y, Beohou E, Labopin M, Volin L, Milpied N, Yakoub-Agha I, Piemontese S, Polge E, Houhou M, Huang XJ, Mohty M, Nagler A, Gorin NC. Unmanipulated haploidentical versus matched unrelated donor allogeneic stem cell transplantation in adult patients with acute myelogenous leukemia in first remission: a retrospective pair-matched comparative study of the Beijing approach with the EBMT database. Haematologica 2016; 101:e352-4. [PMID: 27081180 DOI: 10.3324/haematol.2015.140509] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Yuqian Sun
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China
| | - Eric Beohou
- Acute Leukemia Working Party of the EBMT, Paris, France
| | - Myriam Labopin
- Acute Leukemia Working Party of the EBMT, Paris, France Hospital Saint-Antoine, Paris University UPMC, INSERM U938, France
| | | | - Noel Milpied
- Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France; Université Bordeaux Segalen, Bordeaux, France
| | | | - Simona Piemontese
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China Peking-Tsinghua Center for Life Sciences, Beijing, China
| | - Mohamad Mohty
- Acute Leukemia Working Party of the EBMT, Paris, France Department of Hematology and Cell therapy, Hospital Saint-Antoine APHP, Paris University UPMC, INSERM U938, Paris, France
| | - Arnon Nagler
- EBMT Acute Leukemia Working Party and Registry, Hematology Division, BMT and Cord Blood Bank, Tel-Aviv University, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Norbert-Claude Gorin
- Acute Leukemia Working Party of the EBMT, Paris, France Department of Hematology and Cell therapy, Hospital Saint-Antoine APHP, Paris University UPMC, INSERM U938, Paris, France
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20
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Czerw T, Labopin M, Gorin NC, Giebel S, Blaise D, Meloni G, Pigneux A, Bosi A, Veelken J, Ferrara F, Schaap N, Lemoli RM, Cornelissen JJ, Beohou E, Nagler A, Mohty M. Long-term follow-up of patients with acute myeloid leukemia surviving and free of disease recurrence for at least 2 years after autologous stem cell transplantation: A report from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Cancer 2016; 122:1880-7. [PMID: 27018549 DOI: 10.1002/cncr.29990] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 01/14/2016] [Revised: 02/14/2016] [Accepted: 02/17/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Leukemia recurrence is a major cause of treatment failure after autologous stem cell transplantation for acute myeloid leukemia (AML). It usually occurs within the first 2 years after transplantation. The goal of the current retrospective study was to assess the follow-up of and characterize risk factors for outcome among patients who survived free of disease recurrence after this period. METHODS The analysis included 3567 adults (median age, 45 years) with AML who underwent autografting during the first (86% of patients) or second (14% of patients) complete remission between 1990 and 2008. The stem cell source was the bone marrow in 32% of patients or the peripheral blood in 68% of patients. The median follow-up was 6.9 years. RESULTS At 5 years and 10 years after transplantation, the probability of leukemia-free survival was 86% and 76%, respectively; the recurrence incidence was 11% and 16%, respectively; and the nonrecurrence mortality rate was 3% and 8%, respectively. The observed survival was decreased compared with the expected survival of the general European population. In a multivariate analysis, decreased probability of leukemia-free survival was demonstrated for patients who underwent peripheral blood autologous stem cell transplantation; had French-American-British subtypes M0, M6, or M7; and were of an older age. The same factors were found to be associated with an increased risk of disease recurrence. Nonrecurrence mortality was found to be affected by older age. CONCLUSIONS The results of the current analysis indicate that late recurrences remain a major concern after autologous stem cell transplantation among patients with AML, indicating the need for close monitoring of minimal residual disease and additional leukemic control measures after transplantation. Cancer 2016;122:1880-7. © 2016 American Cancer Society.
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Affiliation(s)
- Tomasz Czerw
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Myriam Labopin
- Clinical Hematology and Cellular Therapy Department, The Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation Office, Hopital Saint-Antoine APHP, Paris, France.,INSERM UMRs 938, Paris, France.,Pierre and Marie Curie University, Paris, France
| | - Norbert-Claude Gorin
- Clinical Hematology and Cellular Therapy Department, The Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation Office, Hopital Saint-Antoine APHP, Paris, France.,INSERM UMRs 938, Paris, France.,Pierre and Marie Curie University, Paris, France
| | - Sebastian Giebel
- Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Didier Blaise
- Department of Transplantation and Cellular Therapy, Paoli Calmettes Institute, Marseille, France
| | - Giovanna Meloni
- Department of Cellular Biotechnology and Hematology, "LaSapienza" University, Rome, Italy
| | - Arnaud Pigneux
- Department of Hematology and Cellular Therapy, University Hospital of Bordeaux, Bordeaux, France
| | - Alberto Bosi
- Bone Marrow Transplantation Unit, Department of Hematology, di Careggi Hospital, Florence, Italy
| | - Joan Veelken
- Bone Marrow Transplantation Centre Leiden, Leiden University Hospital, Leiden, The Netherlands
| | - Felicetto Ferrara
- Division of Hematology and Stem Cell Transplantation Unit, Cardarelli Hospital, Naples, Italy
| | - Nicolaas Schaap
- Department of Hematology, Radboud University-Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Roberto M Lemoli
- Institute of Hematology and Medical Oncology, "L & A Seragnoli," St.Orsola-Malpighi University Hospital, Bologna University, Bologna, Italy.,Roberto M. Lemoli's current address: Division of Hematology, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Jan J Cornelissen
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | | | - Arnon Nagler
- Clinical Hematology and Cellular Therapy Department, The Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation Office, Hopital Saint-Antoine APHP, Paris, France.,Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mohamad Mohty
- Clinical Hematology and Cellular Therapy Department, The Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation Office, Hopital Saint-Antoine APHP, Paris, France.,INSERM UMRs 938, Paris, France.,Pierre and Marie Curie University, Paris, France
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21
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Fiteni F, Jary M, Monnien F, Nguyen T, Beohou E, Demarchi M, Dobi E, Fein F, Cleau D, Fratté S, Nerich V, Bonnetain F, Pivot X, Borg C, Kim S. Advanced biliary tract carcinomas: a retrospective multicenter analysis of first and second-line chemotherapy. BMC Gastroenterol 2014; 14:143. [PMID: 25117717 PMCID: PMC4236575 DOI: 10.1186/1471-230x-14-143] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 08/05/2014] [Indexed: 12/12/2022] Open
Abstract
Background Gemcitabine/Cisplatin (Gem/CDDP) combination has demonstrated a clear survival advantage over gemcitabine alone and has become a new standard in advanced Biliary Tract Carcinoma (aBTC). However, Gemcitabine/Oxaliplatin (GEMOX) combination and Gemcitabine/Carboplatin (Gem/Carb) combination regimens have shown efficacy in phase II trials and there is no comparative study between different platinum salts. We assessed the efficacy and safety of different platinum-based chemotherapies at first line in aBTC patients. We also analysed the second-line chemotherapy. Methods Sixty-four consecutive patients with aBTC diagnosed between 1998 and 2010 were included for analysis. At first line chemotherapy, 44 patients received one day GEMOX regimen (gemcitabine 1000 mg/m2 and oxaliplatin 100 mg/m2 Day 1, every 2 weeks), and 20 patients received Gem/Carb regimen (gemcitabine at 1000 mg/m2 Days 1 and 8 with carboplatin delivered according to an area-under-the-curve (AUC) 5 at day 1, every 3 weeks). At second line, a total of 16 patients received a fluoropyrimidine-based chemotherapy. Results With GEMOX regimen, median progression-free survival (PFS) was 3.7 months (95%CI, 2.4 to 5) and median overall survival (OS) was 10.5 months (95%CI, 6.4 to14.7). The main toxicity was peripheral neuropathy (20% grade 2 and 7% grade 3). Grade 3/4 haematological toxicities were rare. With Gem/Carb regimen, PFS was 2.5 months (95%CI, 2.1 to 3.7) and OS was 4.8 months (95%CI, 3.7 to 5.8). The main grade 3/4 toxicities were haematological: anaemia (45%), thrombocytopenia (45%), and neutropenia (40%). At second-line, fluoropyrimidine-based chemotherapy was feasible in only a fourth of the patients. The median OS was 5.3 months (95%CI, 4.1 to 6.6), and median PFS was 4.0 months (95%CI, 2.6 to 5.5). Conclusions One day GEMOX regimen has a favourable toxicity profile and could be an alternative to standard Gem/CDDP regimen, in particular in unfit patients for CDDP. At second-line, selective patients may benefit from fluoropyrimidine-based chemotherapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Stefano Kim
- Department of Medical Oncology, Jean Minjoz University Teaching Hospital, 3 Boulevard Alexander Fleming, Besançon F-25030, France.
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Aparicio T, Svrcek M, Zaanan A, Beohou E, Laforest A, Afchain P, Mitry E, Taieb J, Di Fiore F, Gornet JM, Thirot-Bidault A, Sobhani I, Malka D, Lecomte T, Locher C, Bonnetain F, Laurent-Puig P. Small bowel adenocarcinoma phenotyping, a clinicobiological prognostic study. Br J Cancer 2013; 109:3057-66. [PMID: 24196786 PMCID: PMC3859950 DOI: 10.1038/bjc.2013.677] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Small bowel adenocarcinoma (SBA) is a rare tumour with a poor prognosis. Molecular biology data on SBA carcinogenesis are lacking. METHODS Expression of HER2, β-catenin, p53 and mismatch repair (MMR) protein was assessed by immunohistochemistry. KRAS, V600E BRAF mutations and microsatellite instability were investigated. RESULTS We obtained samples from 63 SBA patients (tumour stages: I-II: 30%; III: 35%; IV: 32%; locally advanced: 3%). HER2 overexpression (3+) was observed in 2 out of 62 patients, overexpression of p53 in 26 out of 62, abnormal expression of β-catenin in 12 out of 61, KRAS mutation in 21 out of 49, BRAF V600E mutation in 1 out of 40 patients, MMR deficiency (dMMR) in 14 out of 61 and was consistent with Lynch syndrome in 9 out of 14 patients. All of the dMMR tumours were in the duodenum or jejunum and only one was stage IV. Median overall survival (OS) was 36.6 months (95% CI, 26.9-72.2). For all patients, in univariate analysis, stages I-II (P<0.001), WHO PS 0-1 (P=0.01) and dMMR phenotype (P=0.02) were significantly associated with longer OS. In multivariate analysis, disease stage (P=0.01) and WHO PS 0-1 (P=0.001) independently predicted longer OS. For stage IV patients, median OS was 20.5 months (95% CI: 14.6; 36.6 months). In multivariate analysis, WHO PS 0-1 (P=0.0001) and mutated KRAS status (P=0.02) independently predicted longer OS. CONCLUSION This large study suggests that molecular alterations in SBA are closer to those in colorectal cancer (CRC) than those in gastric cancer, with low levels of HER 2 overexpression and high frequencies of KRAS mutations. The seemingly higher frequency of dMMR than in CRC may be explained by the higher frequency of Lynch syndrome in SBA patients. A dMMR phenotype was significantly associated with a non-metastatic tumour (P=0.02). A trend for a good prognosis and a duodenum or jejunum primary site was associated with dMMR.
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Affiliation(s)
- T Aparicio
- Gastroenterology and Digestive Oncology, APHP, Hôpitaux Universitaires de Seine Saint Denis, Avicenne Hospital, University Paris 13, Paris Sorbonne Cité, 125 rue de Stalingrad, Bobigny 93000, France
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