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Luterbacher F, Bernard F, Baleydier F, Ranza E, Jandus P, Blanchard-Rohner G. Case Report: Persistent Hypogammaglobulinemia More Than 10 Years After Rituximab Given Post-HSCT. Front Immunol 2021; 12:773853. [PMID: 35003091 PMCID: PMC8727997 DOI: 10.3389/fimmu.2021.773853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/26/2021] [Indexed: 12/14/2022] Open
Abstract
Rituximab (RTX) is an anti-CD20 monoclonal antibody that targets B cells-from the immature pre-B-cell stage in the bone marrow to mature circulating B cells-while preserving stem cells and plasma cells. It is used to treat autoimmune diseases, hematological malignancies, or complications after hematopoietic stem cell transplantation (HSCT). Its safety profile is acceptable; however, a subset of patients can develop persistent hypogammaglobulinemia and associated severe complications, especially in pediatric populations. We report the unrelated cases of two young men aged 17 and 22, presenting with persistent hypogammaglobulinemia more than 7 and 10 years after treatment with RTX, respectively, and administered after HSCT for hemolytic anemia and Epstein-Barr virus reactivation, respectively. Both patients' immunological workups showed low levels of total immunoglobulin, vaccine antibodies, and class switched-memory B cells but an increase in naive B cells, which can also be observed in primary immunodeficiencies such as those making up common variable immunodeficiency. Whole exome sequencing for one of the patients failed to detect a pathogenic variant causing a Mendelian immunological disorder. Annual assessments involving interruption of immunoglobulin replacement therapy each summer failed to demonstrate the recovery of endogenous immunoglobulin production or normal numbers of class switched-memory B cells 7 and 10 years after the patients' respective treatments with RTX. Although the factors that may lead to prolonged hypogammaglobulinemia after rituximab treatment (if necessary) remain unclear, a comprehensive immunological workup before treatment and long-term follow-up are mandatory to assess long-term complications, especially in children.
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Affiliation(s)
- Fanny Luterbacher
- The Children’s Hospital, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Fanette Bernard
- Pediatric Hematology/Oncology Unit, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Baleydier
- Pediatric Hematology/Oncology Unit, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Emmanuelle Ranza
- Genetic Medicine Division, Geneva University Hospitals, Geneva, Switzerland
- Medigenome, Swiss Institute of Genomic Medicine, Geneva, Switzerland
| | - Peter Jandus
- Immunology and Allergology Division, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Geraldine Blanchard-Rohner
- Pediatric Immunology and Vaccinology Unit, General Pediatrics Division, Department for Women, Children, and Teenagers, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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2
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Prader S, Ritz N, Baleydier F, Andre MC, Stähli N, Schmid K, Schmid H, Woerner A, Diesch T, Meyer Sauteur PM, Trück J, Gebistorf F, Opitz L, Killian MP, Marchetti T, Vavassori S, Blanchard-Rohner G, Mc Lin V, Grazioli S, Pachlopnik Schmid J. X-Linked Lymphoproliferative Disease Mimicking Multisystem Inflammatory Syndrome in Children-A Case Report. Front Pediatr 2021; 9:691024. [PMID: 34414143 PMCID: PMC8369030 DOI: 10.3389/fped.2021.691024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/02/2021] [Indexed: 12/03/2022] Open
Abstract
Most children with a SARS-CoV-2 infection are asymptomatic or exhibit mild symptoms. However, a small number of children develop features of substantial inflammation temporarily related to the COVID-19 also called multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS), clinically similar to Kawasaki disease, toxic shock syndrome and hemophagocytic lymphohistiocytosis (HLH). It is well-known that genetic pre-disposition plays an important role in virally-triggered diseases such as Epstein-Barr virus (EBV)-associated HLH, while this has not yet been established for patients with MIS-C. Here we describe a male patient fulfilling the diagnostic criteria of MIS-C, who was initially treated according to current consensus guidelines. Presence of hypofibrinogenemia, normal lymphocyte counts and C-reactive protein, but substantial hyperferritinemia distinguish this patient from others with MIS-C. The clinical course following initial presentation with acute respiratory distress syndrome was marked by fatal liver failure in the context of EBV-associated HLH despite treatment with steroids, intravenous immunoglobulins, interleukin (IL)-1 receptor blockade and eventually HLH-directed treatment. X-linked lymphoproliferative disease type 1 (XLP1), a subtype of primary HLH was diagnosed in this patient post-mortem. This case report highlights the importance of including HLH in the differential diagnosis in MIS-C with severe disease course to allow specific, risk-adapted treatment and genetic counseling.
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Affiliation(s)
- Seraina Prader
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicole Ritz
- Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital Basel, Basel, Switzerland.,Department of Pediatrics, The Royal Children's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | - Frédéric Baleydier
- Pediatric Hemato-Oncology Unit, Department for Women, Children, and Adolescents, University Hospitals Geneva, Geneva, Switzerland.,CANSEARCH Research Laboratory, Medical Faculty, Geneva University, Geneva, Switzerland
| | - Maya C Andre
- University Children's Hospital, Division of Respiratory and Critical Care Medicine, University of Basel, Basel, Switzerland
| | - Noémie Stähli
- Emergency Department, University Children's Hospital Zurich, Zurich, Switzerland
| | - Kevin Schmid
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Hanna Schmid
- Pediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital Basel, Basel, Switzerland
| | - Andreas Woerner
- Division of Pediatric Rheumatology, University of Basel Children's Hospital Basel, Basel, Switzerland
| | - Tamara Diesch
- Division of Pediatric Hematology/Oncology, University Children's Hospital of Basel, Basel, Switzerland
| | - Patrick M Meyer Sauteur
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Johannes Trück
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Fabienne Gebistorf
- Division of Neonatal and Pediatric Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Lennart Opitz
- Functional Genomic Center Zurich, University of Zurich and Swiss Federal Institute of Technology in Zurich, Zurich, Switzerland
| | - Michael P Killian
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Tommaso Marchetti
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Stefano Vavassori
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Géraldine Blanchard-Rohner
- Unit of Immunology and Vaccinology, Division of General Pediatrics, Department of Woman, Child, and Adolescent Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Valerie Mc Lin
- Swiss Pediatric Liver Center, Department for Women, Children, and Adolescents, University Hospitals Geneva, Geneva, Switzerland.,Medical Faculty, University of Geneva, Geneva, Switzerland
| | - Serge Grazioli
- Division of Neonatal and Pediatric Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
| | - Jana Pachlopnik Schmid
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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Granzotto A, Benadjaoud MA, Vogin G, Devic C, Ferlazzo ML, Bodgi L, Pereira S, Sonzogni L, Forcheron F, Viau M, Etaix A, Malek K, Mengue-Bindjeme L, Escoffier C, Rouvet I, Zabot MT, Joubert A, Vincent A, Venezia ND, Bourguignon M, Canat EP, d'Hombres A, Thébaud E, Orbach D, Stoppa-Lyonnet D, Radji A, Doré E, Pointreau Y, Bourgier C, Leblond P, Defachelles AS, Lervat C, Guey S, Feuvret L, Gilsoul F, Berger C, Moncharmont C, de Laroche G, Moreau-Claeys MV, Chavaudra N, Combemale P, Biston MC, Malet C, Martel-Lafay I, Laude C, Hau-Desbat NH, Ziouéche A, Tanguy R, Sunyach MP, Racadot S, Pommier P, Claude L, Baleydier F, Fleury B, de Crevoisier R, Simon JM, Verrelle P, Peiffert D, Belkacemi Y, Bourhis J, Lartigau E, Carrie C, De Vathaire F, Eschwege F, Puisieux A, Lagrange JL, Balosso J, Foray N. Influence of Nucleoshuttling of the ATM Protein in the Healthy Tissues Response to Radiation Therapy: Toward a Molecular Classification of Human Radiosensitivity. Int J Radiat Oncol Biol Phys 2016; 94:450-60. [DOI: 10.1016/j.ijrobp.2015.11.013] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/24/2015] [Accepted: 11/05/2015] [Indexed: 01/20/2023]
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Rohmer B, Valla FV, Baleydier F, Launay V, Dommange-Romero F, Pondarré C. Newly diagnosed immune thrombocytopenic purpura in childhood: successful implementation of a limited intervention strategy in the setting of pediatric emergency care. J Pediatr 2015; 166:480-2. [PMID: 25454932 DOI: 10.1016/j.jpeds.2014.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 08/21/2014] [Accepted: 10/01/2014] [Indexed: 01/19/2023]
Abstract
Immune thrombocytopenic purpura is a bleeding disorder for which management remains mainly guided by platelet counts. Pediatric hematologists and emergency physicians collaborated to set up a limited intervention strategy, focusing on clinical bleeding severity irrespective of platelet counts, starting in the emergency room. We report how this strategy was safely applied for 106 consecutive children admitted for newly diagnosed immune thrombocytopenic purpura.
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Affiliation(s)
| | - Frédéric V Valla
- Hospices Civils de Lyon, Lyon, France; Department of Pediatric Emergency and Critical Care, Hôpital-Femme-Mère-Enfant
| | - Frédéric Baleydier
- Hospices Civils de Lyon, Lyon, France; Institut d'hématologie et d'oncologie pédiatrique (Department of Pediatric Hematology and Oncology); Lyon I University, Lyon, France
| | - Valérie Launay
- Hospices Civils de Lyon, Lyon, France; Department of Pediatric Emergency and Critical Care, Hôpital-Femme-Mère-Enfant
| | - Florence Dommange-Romero
- Hospices Civils de Lyon, Lyon, France; Institut d'hématologie et d'oncologie pédiatrique (Department of Pediatric Hematology and Oncology)
| | - Corinne Pondarré
- Hospices Civils de Lyon, Lyon, France; Institut d'hématologie et d'oncologie pédiatrique (Department of Pediatric Hematology and Oncology); Lyon I University, Lyon, France; Referral Center for Thalassemia, Paris, France.
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Uzan B, Poglio S, Gerby B, Wu CL, Gross J, Armstrong F, Calvo J, Cahu X, Deswarte C, Dumont F, Passaro D, Besnard-Guérin C, Leblanc T, Baruchel A, Landman-Parker J, Ballerini P, Baud V, Ghysdael J, Baleydier F, Porteu F, Pflumio F. Interleukin-18 produced by bone marrow-derived stromal cells supports T-cell acute leukaemia progression. EMBO Mol Med 2014; 6:821-34. [PMID: 24778454 PMCID: PMC4203358 DOI: 10.1002/emmm.201303286] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 01/06/2023] Open
Abstract
Development of novel therapies is critical for T-cell acute leukaemia (T-ALL). Here, we investigated the effect of inhibiting the MAPK/MEK/ERK pathway on T-ALL cell growth. Unexpectedly, MEK inhibitors (MEKi) enhanced growth of 70% of human T-ALL cell samples cultured on stromal cells independently of NOTCH activation and maintained their ability to propagate in vivo. Similar results were obtained when T-ALL cells were cultured with ERK1/2-knockdown stromal cells or with conditioned medium from MEKi-treated stromal cells. Microarray analysis identified interleukin 18 (IL-18) as transcriptionally up-regulated in MEKi-treated MS5 cells. Recombinant IL-18 promoted T-ALL growth in vitro, whereas the loss of function of IL-18 receptor in T-ALL blast cells decreased blast proliferation in vitro and in NSG mice. The NFKB pathway that is downstream to IL-18R was activated by IL-18 in blast cells. IL-18 circulating levels were increased in T-ALL-xenografted mice and also in T-ALL patients in comparison with controls. This study uncovers a novel role of the pro-inflammatory cytokine IL-18 and outlines the microenvironment involvement in human T-ALL development.
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Affiliation(s)
- Benjamin Uzan
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) DSV-IRCM-SCSR-LSHL Equipe Labellisée Ligue Contre le Cancer UMR 967, Fontenay-aux-Roses, France INSERM U967, Fontenay-aux-Roses, France Université Paris Diderot Sorbonne Paris Cité UMR 967, Fontenay-aux-Roses, France Université Paris-Sud UMR 967, Fontenay-aux-Roses, France
| | - Sandrine Poglio
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) DSV-IRCM-SCSR-LSHL Equipe Labellisée Ligue Contre le Cancer UMR 967, Fontenay-aux-Roses, France INSERM U967, Fontenay-aux-Roses, France Université Paris Diderot Sorbonne Paris Cité UMR 967, Fontenay-aux-Roses, France Université Paris-Sud UMR 967, Fontenay-aux-Roses, France
| | - Bastien Gerby
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) DSV-IRCM-SCSR-LSHL Equipe Labellisée Ligue Contre le Cancer UMR 967, Fontenay-aux-Roses, France INSERM U967, Fontenay-aux-Roses, France Université Paris Diderot Sorbonne Paris Cité UMR 967, Fontenay-aux-Roses, France Université Paris-Sud UMR 967, Fontenay-aux-Roses, France
| | - Ching-Lien Wu
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) DSV-IRCM-SCSR-LSHL Equipe Labellisée Ligue Contre le Cancer UMR 967, Fontenay-aux-Roses, France INSERM U967, Fontenay-aux-Roses, France Université Paris Diderot Sorbonne Paris Cité UMR 967, Fontenay-aux-Roses, France Université Paris-Sud UMR 967, Fontenay-aux-Roses, France
| | - Julia Gross
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) DSV-IRCM-SCSR-LSHL Equipe Labellisée Ligue Contre le Cancer UMR 967, Fontenay-aux-Roses, France INSERM U967, Fontenay-aux-Roses, France Université Paris Diderot Sorbonne Paris Cité UMR 967, Fontenay-aux-Roses, France Université Paris-Sud UMR 967, Fontenay-aux-Roses, France
| | - Florence Armstrong
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) DSV-IRCM-SCSR-LSHL Equipe Labellisée Ligue Contre le Cancer UMR 967, Fontenay-aux-Roses, France INSERM U967, Fontenay-aux-Roses, France Université Paris Diderot Sorbonne Paris Cité UMR 967, Fontenay-aux-Roses, France Université Paris-Sud UMR 967, Fontenay-aux-Roses, France
| | - Julien Calvo
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) DSV-IRCM-SCSR-LSHL Equipe Labellisée Ligue Contre le Cancer UMR 967, Fontenay-aux-Roses, France INSERM U967, Fontenay-aux-Roses, France Université Paris Diderot Sorbonne Paris Cité UMR 967, Fontenay-aux-Roses, France Université Paris-Sud UMR 967, Fontenay-aux-Roses, France
| | - Xavier Cahu
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) DSV-IRCM-SCSR-LSHL Equipe Labellisée Ligue Contre le Cancer UMR 967, Fontenay-aux-Roses, France INSERM U967, Fontenay-aux-Roses, France Université Paris Diderot Sorbonne Paris Cité UMR 967, Fontenay-aux-Roses, France Université Paris-Sud UMR 967, Fontenay-aux-Roses, France
| | - Caroline Deswarte
- Service D'hématologie Pédiatrique, Assistance Publique - Hôpitaux de Paris Hôpital A. Trousseau, Paris, France
| | - Florent Dumont
- INSERM U1016 Institut Cochin, Paris, France CNRS UMR8104, Paris, France Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Diana Passaro
- Institut Curie Centre Universitaire, Orsay, France CNRS UMR 3306, Orsay, France Institut National de la Santé et de la Recherche Médicale U1005, Orsay, France
| | - Corinne Besnard-Guérin
- INSERM U1016 Institut Cochin, Paris, France CNRS UMR8104, Paris, France Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Thierry Leblanc
- Service D'hématologie Pédiatrique, Assistance Publique - Hôpitaux de Paris Hôpital Robert Debré, Paris, France
| | - André Baruchel
- Service D'hématologie Pédiatrique, Assistance Publique - Hôpitaux de Paris Hôpital Robert Debré, Paris, France
| | - Judith Landman-Parker
- Service D'hématologie Pédiatrique, Assistance Publique - Hôpitaux de Paris Hôpital A. Trousseau, Paris, France
| | - Paola Ballerini
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) DSV-IRCM-SCSR-LSHL Equipe Labellisée Ligue Contre le Cancer UMR 967, Fontenay-aux-Roses, France INSERM U967, Fontenay-aux-Roses, France Université Paris Diderot Sorbonne Paris Cité UMR 967, Fontenay-aux-Roses, France Université Paris-Sud UMR 967, Fontenay-aux-Roses, France Service D'hématologie Pédiatrique, Assistance Publique - Hôpitaux de Paris Hôpital A. Trousseau, Paris, France
| | - Véronique Baud
- INSERM U1016 Institut Cochin, Paris, France CNRS UMR8104, Paris, France Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Jacques Ghysdael
- Institut Curie Centre Universitaire, Orsay, France CNRS UMR 3306, Orsay, France Institut National de la Santé et de la Recherche Médicale U1005, Orsay, France
| | - Frédéric Baleydier
- Institut d'Hématologie et Oncologie Pédiatrique Hospices Civils de Lyon et Université Claude Bernard, Lyon, France
| | - Francoise Porteu
- INSERM U1016 Institut Cochin, Paris, France CNRS UMR8104, Paris, France Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Francoise Pflumio
- Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA) DSV-IRCM-SCSR-LSHL Equipe Labellisée Ligue Contre le Cancer UMR 967, Fontenay-aux-Roses, France INSERM U967, Fontenay-aux-Roses, France Université Paris Diderot Sorbonne Paris Cité UMR 967, Fontenay-aux-Roses, France Université Paris-Sud UMR 967, Fontenay-aux-Roses, France
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Baleydier F, Galambrun C, Manel AM, Guibaud L, Nicolino M, Bertrand Y. Primary lymphoma of the pituitary stalk in an immunocompetent 9-year-old child. Med Pediatr Oncol 2001; 36:392-5. [PMID: 11241445 DOI: 10.1002/mpo.1094] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- F Baleydier
- Department of Pediatric Hematology, Hôpital Debrousse, Lyon, France
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