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Decaux O, Fontan J, Perrot A, Karlin L, Touzeau C, Schulmann S, Manier S, Belhadj K, Trebouet A, Zunic P, Schiano De Colella JM, Castel B, Van De Wyngaert Z, Pica GM, Tiab M, Kuhnowski F, Bouketouche M, Rigaudeau S, Benramdane R, Tekle C, Lafore R, Gaucher M, Corre J, Leleu X. Isatuximab plus pomalidomide and dexamethasone in patients with relapsed/refractory multiple myeloma in real-world: The retrospective IMAGE study. Eur J Haematol 2024. [PMID: 38712850 DOI: 10.1111/ejh.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND IMAGE is a retrospective cohort study of patients enrolled in early access programs (EAPs) in France with relapsed/refractory multiple myeloma (RRMM) receiving isatuximab with pomalidomide and dexamethasone (Isa-Pd). METHODS Patients aged ≥18 years with RRMM who received ≥1 dose of Isa under the EAPs between July 29, 2019 and August 30, 2020 were included. Effectiveness endpoints included progression-free survival (PFS) and response rates. Verbatim terms for adverse events (AEs) were coded using the Medical Dictionary for Regulatory Activities and not graded for severity. RESULTS A total of 294 and 299 patients were included in the effectiveness and safety populations, respectively. IMAGE included patients who received one prior line of treatment (10.2%) and were daratumumab-refractory (19.1%). At median follow-up of 14.2 months, median PFS in the effectiveness population was 12.4 months (95% CI 9.0-15.0). Overall response and very good partial response rates were 46.3% and 27.9%, respectively. Subgroup analyses reflected similar results. In the safety population, 26.4% of patients reported at least one AE; the most common any-grade AE was neutropenia (9.4%). CONCLUSION IMAGE demonstrated Isa-Pd had meaningful effectiveness in median PFS and depth of response and no new safety signals in a real-world context, consistent with clinical trial results.
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Affiliation(s)
- Olivier Decaux
- INSERM, Établissement Français du Sang de Bretagne, Unité Mixte de Recherche (UMR) S1236, Université de Rennes 1, Rennes, France
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire, Rennes, France
| | - Jean Fontan
- Department of Hematology, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France
| | - Aurore Perrot
- CHU de Toulouse, IUCT-O, Service d'Hématologie, UPS, Université de Toulouse, Toulouse, France
| | - Lionel Karlin
- Hematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Benite, France
| | - Cyrille Touzeau
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | | | - Salomon Manier
- Maladie du sang, CHRU Hôpital Claude Huriez, Lille, France
| | - Karim Belhadj
- Unité Hémopathies Lymphoïdes, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
| | - Adrien Trebouet
- Department of Haematology, Bretagne Sud Hospital Centre, Lorient, France
| | - Patricia Zunic
- Department of Haematology, University Hospital Centre, Saint-Pierre, France
| | | | - Brice Castel
- Service de Médecine Interne, Centre Hospitalier de Bigorre, Tarbes, France
| | - Zoé Van De Wyngaert
- Sorbonne Université, AP-HP, Centre de Recherche Saint-Antoine INSERM UMRs938, Service D'Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Gian Matteo Pica
- Hématologie, Centre Hospitalier Métropole Savoie, Chambéry, France
| | - Mourad Tiab
- Médecine Interne, CHU Vendée, La Roche sur Yon, France
| | | | - Malek Bouketouche
- Oncologie et hématologie, Centre Hospitalier de Saint-Quentin, Saint-Quentin, France
| | - Sophia Rigaudeau
- Service d'Hématologie Clinique, Centre Hospitalier de Versailles André Mignot, Faculté de Médecine Xavier Bichat, Université Paris Diderot, Paris, France
| | - Riad Benramdane
- Department of Hematology, Centre Hospitalier Pontoise René Dubos, Pontoise, France
| | | | | | | | - Jill Corre
- IUC-T Oncopole, Unité de Génomique du Myélome, Toulouse, France
| | - Xavier Leleu
- Faculte de médecine, INSERM CIC 1402 and U 1313, Centre Hospitalier Universitaire (CHU), Poitiers, France
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2
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Romero P, Richart L, Aflaki S, Petitalot A, Burton M, Michaud A, Masliah-Planchon J, Kuhnowski F, Le Cam S, Baliñas-Gavira C, Méaudre C, Luscan A, Hamza A, Legoix P, Vincent-Salomon A, Wassef M, Holoch D, Margueron R. EZH2 mutations in follicular lymphoma distort H3K27me3 profiles and alter transcriptional responses to PRC2 inhibition. Nat Commun 2024; 15:3452. [PMID: 38658543 PMCID: PMC11043461 DOI: 10.1038/s41467-024-47701-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
Mutations in chromatin regulators are widespread in cancer. Among them, the histone H3 lysine 27 methyltransferase Polycomb Repressive Complex 2 (PRC2) shows distinct alterations according to tumor type. This specificity is poorly understood. Here, we model several PRC2 alterations in one isogenic system to reveal their comparative effects. Focusing then on lymphoma-associated EZH2 mutations, we show that Ezh2Y641F induces aberrant H3K27 methylation patterns even without wild-type Ezh2, which are alleviated by partial PRC2 inhibition. Remarkably, Ezh2Y641F rewires the response to PRC2 inhibition, leading to induction of antigen presentation genes. Using a unique longitudinal follicular lymphoma cohort, we further link EZH2 status to abnormal H3K27 methylation. We also uncover unexpected variability in the mutational landscape of successive biopsies, pointing to frequent co-existence of different clones and cautioning against stratifying patients based on single sampling. Our results clarify how oncogenic PRC2 mutations disrupt chromatin and transcription, and the therapeutic vulnerabilities this creates.
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Affiliation(s)
- Pierre Romero
- Institut Curie, INSERM U934/CNRS UMR 3215, Paris Sciences et Lettres Research University, Sorbonne University, Paris, France
- Institut Curie, Department of Pathology, Paris Sciences et Lettres Research University, Paris, France
| | - Laia Richart
- Institut Curie, INSERM U934/CNRS UMR 3215, Paris Sciences et Lettres Research University, Sorbonne University, Paris, France
| | - Setareh Aflaki
- Institut Curie, INSERM U934/CNRS UMR 3215, Paris Sciences et Lettres Research University, Sorbonne University, Paris, France
| | - Ambre Petitalot
- Institut Curie, INSERM U934/CNRS UMR 3215, Paris Sciences et Lettres Research University, Sorbonne University, Paris, France
| | - Megan Burton
- Institut Curie, INSERM U934/CNRS UMR 3215, Paris Sciences et Lettres Research University, Sorbonne University, Paris, France
| | - Audrey Michaud
- Institut Curie, INSERM U934/CNRS UMR 3215, Paris Sciences et Lettres Research University, Sorbonne University, Paris, France
| | - Julien Masliah-Planchon
- Institut Curie, Pharmacogenetics Unit, Department of Genetics, Paris Sciences et Lettres Research University, Paris, France
| | - Frédérique Kuhnowski
- Institut Curie, Department of Clinical Hematology, Paris Sciences et Lettres Research University, Paris, France
| | - Samuel Le Cam
- Institut Curie, INSERM U934/CNRS UMR 3215, Paris Sciences et Lettres Research University, Sorbonne University, Paris, France
| | - Carlos Baliñas-Gavira
- Institut Curie, INSERM U934/CNRS UMR 3215, Paris Sciences et Lettres Research University, Sorbonne University, Paris, France
| | - Céline Méaudre
- Institut Curie, Department of Pathology, Paris Sciences et Lettres Research University, Paris, France
| | - Armelle Luscan
- Institut Curie, INSERM U934/CNRS UMR 3215, Paris Sciences et Lettres Research University, Sorbonne University, Paris, France
| | - Abderaouf Hamza
- Institut Curie, Pharmacogenetics Unit, Department of Genetics, Paris Sciences et Lettres Research University, Paris, France
| | - Patricia Legoix
- Institut Curie, Genomics of Excellence (ICGex) Platform, Paris Sciences et Lettres Research University, Paris, France
| | - Anne Vincent-Salomon
- Institut Curie, Department of Pathology, Paris Sciences et Lettres Research University, Paris, France
| | - Michel Wassef
- Institut Curie, INSERM U934/CNRS UMR 3215, Paris Sciences et Lettres Research University, Sorbonne University, Paris, France
| | - Daniel Holoch
- Institut Curie, INSERM U934/CNRS UMR 3215, Paris Sciences et Lettres Research University, Sorbonne University, Paris, France.
| | - Raphaël Margueron
- Institut Curie, INSERM U934/CNRS UMR 3215, Paris Sciences et Lettres Research University, Sorbonne University, Paris, France.
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3
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Bobin A, Kyheng M, Guidez S, Gruchet-Merouze C, Richez V, Duhamel A, Karlin L, Kolb B, Tiab M, Araujo C, Meuleman N, Malfuson JV, Bourquard P, Lenain P, Perrot A, Roussel M, Jaccard A, Petillon MO, Belhadj-Merzoug K, Chretien ML, Fontan J, Rodon P, Schmitt A, Offner F, Voillat L, Cereja S, Kuhnowski F, Rigaudeau S, Decaux O, Humbrecht-Kraut C, Frayfer J, Fitoussi O, Roos-Weil D, Eisenmann JC, Dorvaux V, Voog EG, Moreau P, Avet-Loiseau H, Hulin C, Facon T, Leleu X. Carfilzomib maintenance in newly diagnosed non-transplant eligible multiple myeloma. Leukemia 2021; 36:881-884. [PMID: 34650225 DOI: 10.1038/s41375-021-01415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Arthur Bobin
- Service d'onco-hématologie, and Inserm 1402, CHU, Poitiers, France
| | - Maéva Kyheng
- Univ., ULR 2694-METRICS, CHRU, Lille, France.,Département de Biostatistiques, CHRU, Lille, France
| | - Stéphanie Guidez
- Service d'onco-hématologie, and Inserm 1402, CHU, Poitiers, France
| | | | - Valentine Richez
- Service d'Hématologie Clinique-Greffe de Moelle, CHU, Nice, France
| | - Alain Duhamel
- Univ., ULR 2694-METRICS, CHRU, Lille, France.,Département de Biostatistiques, CHRU, Lille, France
| | | | - Brigitte Kolb
- Service d'Hématologie, Hôpital Robert Debré, CHU, Reims, France
| | - Mourad Tiab
- Service d'Hématologie, CH, La Roche sur Yon, France
| | | | - Nathalie Meuleman
- Service d'Hématologie, Institut Jules Bordet, Université Libre, Bruxelles, Belgium
| | | | | | - Pascal Lenain
- Service d'Hématologie, Centre Henri Becquerel, CNLCC, Rouen, France
| | | | | | | | | | | | | | | | | | - Anna Schmitt
- Service d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Fritz Offner
- Department Clinical Hematology, University Hospital, Ghent, Belgium
| | | | | | | | | | | | | | | | | | - Damien Roos-Weil
- Service d'Hématologie, Hôpital de la Pitié Salpétrière, Paris, France
| | | | | | | | | | | | - Cyrille Hulin
- Service d'Hématologie, Hôpital Haut Leveque, CHU, Bordeaux, France
| | | | | | - Xavier Leleu
- Service d'onco-hématologie, and Inserm 1402, CHU, Poitiers, France.
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Moreau P, Hulin C, Perrot A, Arnulf B, Belhadj K, Benboubker L, Béné MC, Zweegman S, Caillon H, Caillot D, Corre J, Delforge M, Dejoie T, Doyen C, Facon T, Sonntag C, Fontan J, Mohty M, Jie KS, Karlin L, Kuhnowski F, Lambert J, Leleu X, Macro M, Orsini-Piocelle F, Roussel M, Stoppa AM, van de Donk NWCJ, Wuillème S, Broijl A, Touzeau C, Tiab M, Marolleau JP, Meuleman N, Vekemans MC, Westerman M, Klein SK, Levin MD, Offner F, Escoffre-Barbe M, Eveillard JR, Garidi R, Ahmadi T, Krevvata M, Zhang K, de Boer C, Vara S, Kampfenkel T, Vanquickelberghe V, Vermeulen J, Avet-Loiseau H, Sonneveld P. Maintenance with daratumumab or observation following treatment with bortezomib, thalidomide, and dexamethasone with or without daratumumab and autologous stem-cell transplant in patients with newly diagnosed multiple myeloma (CASSIOPEIA): an open-label, randomised, phase 3 trial. Lancet Oncol 2021; 22:1378-1390. [PMID: 34529931 DOI: 10.1016/s1470-2045(21)00428-9] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND CASSIOPEIA part 1 showed superior depth of response and significantly improved progression-free survival with daratumumab, bortezomib, thalidomide, and dexamethasone (D-VTd) versus bortezomib, thalidomide, and dexamethasone (VTd) as induction and consolidation in patients with autologous stem-cell transplant (ASCT)-eligible newly diagnosed multiple myeloma. In part 2, we compared daratumumab maintenance versus observation only. METHODS CASSIOPEIA is a two-part, open-label, randomised, phase 3 trial of patients aged 18-65 years with newly diagnosed multiple myeloma and Eastern Cooperative Oncology Group performance status 0-2, done in 111 European academic and community practice centres. In part 1, patients were randomly assigned (1:1) to induction and consolidation with D-VTd or VTd. Patients still on study who had a partial response or better were randomly assigned (1:1) by an interactive web-response system to daratumumab 16 mg/kg intravenously every 8 weeks (a reduced frequency compared with standard daratumumab long-term dosing) or observation only for up to 2 years. Stratification factors were induction treatment and depth of response in part 1. The part 2 primary endpoint was progression-free survival from second randomisation. This preplanned interim analysis of progression-free survival was done after 281 events and shall be considered the primary analysis of progression-free survival. Sponsor personnel and designees who were involved in the analysis were masked to treatment group until the independent data monitoring committee recommended that the preplanned interim analysis be considered the main analysis of progression-free survival in part 2. Otherwise, treatment assignments were unmasked. The interaction between induction and consolidation and maintenance was tested at a two-sided significance level of 0·05 by a stratified Cox regression model that included the interaction term between maintenance treatment and induction and consolidation treatment. Efficacy analyses were done in the maintenance-specific intention-to-treat population, which comprised all patients who underwent second randomisation. Safety was analysed in all patients in the daratumumab group who received at least one dose and all patients randomly assigned to observation only. This trial is registered with ClinicalTrials.gov, NCT02541383. Long-term follow-up is ongoing and the trial is closed to new participants. FINDINGS Between May 30, 2016, and June 18, 2018, 886 patients (458 [84%] of 543 in the D-VTd group and 428 [79%] of 542 in the VTd group) were randomly assigned to daratumumab maintenance (n=442) or observation only (n=444). At a median follow-up of 35·4 months (IQR 30·2-39·9) from second randomisation, median progression-free survival was not reached (95% CI not evaluable [NE]-NE) with daratumumab versus 46·7 months (40·0-NE) with observation only (hazard ratio 0·53, 95% CI 0·42-0·68, p<0·0001). A prespecified analysis of progression-free survival results showed a significant interaction between maintenance and induction and consolidation therapy (p<0·0001). The most common grade 3 or 4 adverse events were lymphopenia (16 [4%] of 440 patients in the daratumumab group vs eight [2%] of 444 patients in the observation-only group), hypertension (13 [3%] vs seven [2%]), and neutropenia (nine [2%] vs ten [2%]). Serious adverse events occurred in 100 (23%) patients in the daratumumab group and 84 (19%) patients in the observation-only group. In the daratumumab group, two adverse events led to death (septic shock and natural killer-cell lymphoblastic lymphoma); both were related to treatment. INTERPRETATION Daratumumab maintenance every 8 weeks for 2 years significantly reduced the risk of disease progression or death compared with observation only. Longer follow-up and other ongoing studies will shed further light on the optimal daratumumab-containing post-ASCT maintenance treatment strategy. FUNDING Janssen Research & Development, the Intergroupe Francophone du Myélome, and the Dutch-Belgian Cooperative Trial Group for Hematology Oncology.
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Affiliation(s)
- Philippe Moreau
- Hematology Clinic, University Hospital Hôtel-Dieu, Nantes, France.
| | - Cyrille Hulin
- Bordeaux University Hospital Center, Bordeaux, France
| | - Aurore Perrot
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Bertrand Arnulf
- Hematology and Oncology, Hôpital Saint Louis, APHP, Paris, France
| | | | | | - Marie C Béné
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Sonja Zweegman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hélène Caillon
- Biochemistry Laboratory, Nantes University Hospital, Nantes, France
| | - Denis Caillot
- Dijon University Hospital, Hôpital du Bocage, Dijon, France
| | - Jill Corre
- Unité de Genomique du Myélome, IUC-T Oncopole, Toulouse, France
| | - Michel Delforge
- Department of Hematology, University Hospital Leuven, Leuven, Belgium
| | - Thomas Dejoie
- Biochemistry Laboratory, Nantes University Hospital, Nantes, France
| | - Chantal Doyen
- Université Catholique de Louvain, CHU UCL Namur, Yvoir, Belgium
| | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | - Cécile Sonntag
- University Hospital, Hôpital Hautepierre, Strasbourg, France
| | - Jean Fontan
- University Hospital Jean Minjoz, Besancon, France
| | - Mohamad Mohty
- Hematology and Cellular Therapy Department of Saint-Antoine Hospital, Sorbonne University, Paris, France
| | | | - Lionel Karlin
- Lyon University Hospital, Hematology Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | | | | | - Xavier Leleu
- Poitiers University Hospital, CHU la Milétrie, Poitiers, France
| | | | | | | | | | | | - Soraya Wuillème
- Hematology Biology, Nantes University Hospital, Nantes, France
| | | | - Cyrille Touzeau
- Hematology Clinic, University Hospital Hôtel-Dieu, Nantes, France
| | - Mourad Tiab
- Centre Hospitalier Départemental Vendée, La Roche sur Yon, France
| | | | - Nathalie Meuleman
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | | | | | | | - Réda Garidi
- Saint-Quentin Hospital Center, Saint Quentin, France
| | | | | | - Ke Zhang
- Janssen Research & Development, La Jolla, CA, USA
| | - Carla de Boer
- Janssen Research & Development, LLC, Leiden, Netherlands
| | - Sanjay Vara
- Janssen Research & Development, High Wycombe, UK
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5
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Hulin C, Offner F, Moreau P, Roussel M, Belhadj K, Benboubker L, Caillot D, Facon T, Garderet L, Kuhnowski F, Stoppa AM, Kolb B, Tiab M, Jie KS, Westerman M, Lambert J, Pei L, Vanquickelberghe V, De Boer C, Vermeulen J, Kampfenkel T, Sonneveld P, Van de Donk NWCJ. Stem cell yield and transplantation in transplant-eligible newly diagnosed multiple myeloma patients receiving daratumumab + bortezomib/thalidomide/dexamethasone in the phase 3 CASSIOPEIA study. Haematologica 2021; 106:2257-2260. [PMID: 33657786 PMCID: PMC8327738 DOI: 10.3324/haematol.2020.261842] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Indexed: 01/16/2023] Open
Affiliation(s)
- Cyrille Hulin
- Department of Hematology, Hôpital Haut-Lévêque, University Hospital Bordeaux, Pessac.
| | | | - Philippe Moreau
- Service d'Hématologie Clinique, University Hospital Hôtel-Dieu, Nantes
| | | | - Karim Belhadj
- Hémopathies Lymphoïdes, Hôpital Henri Mondor, Creteil
| | | | | | - Thierry Facon
- University of Lille, CHU Lille, Service des Maladies du Sang, Lille
| | - Laurent Garderet
- Sorbonne Université, INSERM, UMR_S 938, Centre de Recherche Saint-Antoine, Team Proliferation and Differentiation of Stem Cells, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpetrière, Département d'Hématologie, Paris
| | | | | | | | | | | | | | | | - Lixia Pei
- Janssen Research and Development, LLC, Raritan, NJ
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Boilève A, Kuhnowski F, Cassou-Mounat T, Jehanno N, Kirova Y. Hodkgin lymphoma concomitant of tuberculosis, a therapeutic challenge for multidisciplinary management. Cancer Radiother 2020; 24:335-339. [PMID: 32444284 DOI: 10.1016/j.canrad.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/12/2020] [Accepted: 02/19/2020] [Indexed: 11/18/2022]
Abstract
Hodgkin lymphoma (HL) is a disease characterized by a high curability rate, and the treatment benefit-risk balance must be carefully addressed to achieve complete disease control with low risk of long-term toxicities. Most patients are treated with a combination of chemotherapy and radiotherapy, after disease staging and response to treatment evaluated by FDG PET/CT. We report the case of a 28-year-old patient concomitantly diagnosed of a Hodgkin lymphoma and active tuberculosis. Initial staging was difficult due to pulmonary and abdominal tuberculosis localization that induced FDG PET/CT hypermetabolism. Anti-tuberculosis treatment was first started, allowing secondary an early accurate Hodgkin lymphoma staging by FDG PET/CT. The patient was then treated by chemotherapy and radiotherapy. Helical TomoTherapy® was used with involved site (IS) irradiation volume was performed to decrease the high doses to organs-at-risk (OAR), especially lungs in this context of tuberculosis.
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Affiliation(s)
- A Boilève
- Department of Radiation Oncology, Institut Curie, 25, rue d'Ulm, 75005 Paris, France.
| | - F Kuhnowski
- Department of Hematology, Institut Curie, Paris, France
| | - T Cassou-Mounat
- Department of Nuclear Medicine, Institut Curie, Paris, France
| | - N Jehanno
- Department of Nuclear Medicine, Institut Curie, Paris, France
| | - Y Kirova
- Department of Radiation Oncology, Institut Curie, 25, rue d'Ulm, 75005 Paris, France; University of Versailles, St Quentin, France
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7
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Moreau P, Attal M, Hulin C, Arnulf B, Belhadj K, Benboubker L, Béné MC, Broijl A, Caillon H, Caillot D, Corre J, Delforge M, Dejoie T, Doyen C, Facon T, Sonntag C, Fontan J, Garderet L, Jie KS, Karlin L, Kuhnowski F, Lambert J, Leleu X, Lenain P, Macro M, Mathiot C, Orsini-Piocelle F, Perrot A, Stoppa AM, van de Donk NW, Wuilleme S, Zweegman S, Kolb B, Touzeau C, Roussel M, Tiab M, Marolleau JP, Meuleman N, Vekemans MC, Westerman M, Klein SK, Levin MD, Fermand JP, Escoffre-Barbe M, Eveillard JR, Garidi R, Ahmadi T, Zhuang S, Chiu C, Pei L, de Boer C, Smith E, Deraedt W, Kampfenkel T, Schecter J, Vermeulen J, Avet-Loiseau H, Sonneveld P. Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): a randomised, open-label, phase 3 study. Lancet 2019; 394:29-38. [PMID: 31171419 DOI: 10.1016/s0140-6736(19)31240-1] [Citation(s) in RCA: 588] [Impact Index Per Article: 117.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/13/2019] [Accepted: 05/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bortezomib, thalidomide, and dexamethasone (VTd) plus autologous stem-cell transplantation is standard treatment in Europe for transplant-eligible patients with newly diagnosed multiple myeloma. We evaluated whether the addition of daratumumab to VTd before and after autologous stem-cell transplantation would improve stringent complete response rate in patients with newly diagnosed multiple myeloma. METHODS In this two-part, randomised, open-label, phase 3 CASSIOPEIA trial, we recruited transplant-eligible patients with newly diagnosed multiple myeloma at 111 European sites. Patients were randomly assigned (1:1) to receive four pre-transplant induction and two post-transplant consolidation cycles of VTd alone (VTd group) or in combination with daratumumab (D-VTd group). The primary endpoint of part 1 was stringent complete response assessed 100 days after transplantation. Part 2 (maintenance) is ongoing. The trial is registered with ClinicalTrials.gov, number NCT02541383. FINDINGS Between Sept 22, 2015, and Aug 1, 2017, 1085 patients were enrolled at 111 European sites and were randomly assigned to the D-VTd group (n=543) or the VTd group (n=542). At day 100 after transplantation, 157 (29%) of 543 patients in the D-VTd group and 110 (20%) of 542 patients in the VTd group in the intention-to-treat population had achieved a stringent complete response (odds ratio 1·60, 95% CI 1·21-2·12, p=0·0010). 211 (39%) patients in the D-VTd group versus 141 (26%) in the VTd group achieved a complete response or better, and 346 (64%) of 543 versus 236 (44%) of 542 achieved minimal residual disease-negativity (10-5 sensitivity threshold, assessed by multiparametric flow cytometry; both p<0·0001). Median progression-free survival from first randomisation was not reached in either group (hazard ratio 0·47, 95% CI 0·33-0·67, p<0·0001). 46 deaths on study were observed (14 vs 32, 0·43, 95% CI 0·23-0·80). The most common grade 3 or 4 adverse events were neutropenia (28% vs 15%), lymphopenia (17% vs 10%), and stomatitis (13% vs 16%). INTERPRETATION D-VTd before and after autologous stem-cell transplantation improved depth of response and progression-free survival with acceptable safety. CASSIOPEIA is the first study showing the clinical benefit of daratumumab plus standard of care in transplant-eligible patients with newly diagnosed multiple myeloma. FUNDING The Intergroupe Francophone du Myélome and Dutch-Belgian Cooperative Trial Group for Hematology Oncology.
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Affiliation(s)
| | - Michel Attal
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Cyrille Hulin
- Department of Hematology, Hopital Haut Leveque, University Hospital Bordeaux, Bordeaux, France
| | | | | | - Lotfi Benboubker
- Hôpital de Bretonneau, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Marie C Béné
- Hematology Biology, University Hospital Hôtel Dieu, Nantes, France
| | - Annemiek Broijl
- Erasmus University Medical Center Cancer Institute, Rotterdam, Netherlands
| | - Hélène Caillon
- Biochemistry Laboratory, Hospital of Nantes, Nantes, France
| | - Denis Caillot
- Hôpital Du Bocage, Centre Hospitalier Universitaire Dijon, Dijon, France
| | - Jill Corre
- Unite de Genomique du Myelome, Institut universitaire du cancer de Toulouse Oncopole, Toulouse, France
| | | | - Thomas Dejoie
- Biochemistry Laboratory, Hospital of Nantes, Nantes, France
| | - Chantal Doyen
- Centre Hospitalier Universitaire UCL Namur-site Godinne, Yvoir, Belgium
| | - Thierry Facon
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | | | - Laurent Garderet
- Team Proliferation and Differentiation of Stem Cells, Centre de Recherche Saint-Antoine, Inserm, Sorbonne Université, Paris, France; Département d'Hématologie et de Thérapie Cellulaire, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Lionel Karlin
- Service d'Hématologie Clinique, Centre Hospitalier Lyon-Sud, Lyon, France
| | | | - Jérôme Lambert
- Biostatistical Department, Hôpital Saint Louis, Paris, France
| | - Xavier Leleu
- Hôpital la Milétrie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Pascal Lenain
- Centre de Lutte Contre le Cancer-Centre Henri Becquerel, Rouen, France
| | | | | | | | - Aurore Perrot
- Hematology Department, Vandoeuvre Les Nancy, University Hospitals Nancy, France
| | | | - Niels Wcj van de Donk
- Department of Hematology, University Medical Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Soraya Wuilleme
- Hematology Biology, University Hospital Hôtel Dieu, Nantes, France
| | - Sonja Zweegman
- Department of Hematology, University Medical Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Brigitte Kolb
- Hôpital Robert Debré, Centre Hospitalier Universitaire de Reims, Reims, France
| | | | - Murielle Roussel
- Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Mourad Tiab
- Centre Hospitalier Départemental Vendée, La Roche sur Yon, France
| | | | - Nathalie Meuleman
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | - Jean Paul Fermand
- Service d'Immuno-Hématologie, Département d'Immunologie Clinique, Inserm and Intergroupe Francophone du Myélome, Hôpital Saint-Louis, Paris, France
| | | | | | - Reda Garidi
- Hospital Center de Saint-Quentin, Saint Quentin, France
| | | | - Sen Zhuang
- Janssen Research & Development, Raritan, NJ, USA
| | | | - Lixia Pei
- Janssen Research & Development, Raritan, NJ, USA
| | - Carla de Boer
- Janssen Research & Development, LLC, Leiden, Netherlands
| | - Elena Smith
- Janssen Research & Development, LLC, High Wycombe, UK
| | | | | | | | | | - Hervé Avet-Loiseau
- Unite de Genomique du Myelome, Institut universitaire du cancer de Toulouse Oncopole, Toulouse, France
| | - Pieter Sonneveld
- Erasmus University Medical Center Cancer Institute, Rotterdam, Netherlands
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Leleu X, Fouquet G, Richez V, Guidez S, Duhamel A, Machuron F, Karlin L, Kolb B, Tiab M, Araujo C, Meuleman N, Malfuson JV, Bourquard P, Lenain P, Roussel M, Jaccard A, Pétillon MO, Belhadj-Merzoug K, Lepeu G, Chrétien ML, Fontan J, Rodon P, Schmitt A, Offner F, Voillat L, Cereja S, Kuhnowski F, Rigaudeau S, Decaux O, Humbrecht-Kraut C, Frayfer J, Fitoussi O, Roos-Weil D, Eisenmann JC, Dorvaux V, Voog EG, Attal M, Moreau P, Avet-Loiseau H, Hulin C, Facon T. Carfilzomib Weekly plus Melphalan and Prednisone in Newly Diagnosed Transplant-Ineligible Multiple Myeloma (IFM 2012-03): A Phase I Trial. Clin Cancer Res 2019; 25:4224-4230. [PMID: 31053600 DOI: 10.1158/1078-0432.ccr-18-3642] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/18/2019] [Accepted: 04/29/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Carfilzomib is a novel generation proteasome inhibitor. The Carmysap trial demonstrated that twice-weekly KMP (carfilzomib, melphalan, prednisone) might challenge the MPV (melphalan, prednisone, bortezomib) standard. We sought to study KMP weekly, allowing to increase carfilzomib's dose with maintained efficacy and improved safety profile. PATIENTS AND METHODS IFM2012-03, a phase I multicenter study of KMP weekly in elderly patients with newly diagnosed multiple myeloma (eNDMM), aimed to determine the MTD of carfilzomib. Carfilzomib was given intravenously at 36, 45, 56, and 70 mg/m2/day on days 1, 8, 15, and 22 with melphalan and prednisone, for nine 35-day induction cycles, followed by carfilzomib maintenance for 1 year. Three dose-limiting toxicities (DLT) determined MTD at the lower dose. RESULTS Thirty eNDMMs were treated, 6 per cohort at 36, 45, and 56 mg/m2 and 12 at 70 mg/m². There was one DLT at 36 mg/m2 (lymphopenia), one at 45 mg/m2 (lysis syndrome), two at 56 mg/m2 (cardiac insufficiency and febrile neutropenia), and two at 70 mg/m2 (vomiting and elevated liver enzymes). The safety profile was acceptable; however, specific attention must be paid to the risk of cardiovascular events, especially for elderly patients. The overall response rate was 93.3%, with 46.6% complete response. CONCLUSIONS The MTD dose of carfilzomib was 70 mg/m2 in this KMP weekly study in eNDMM. Response rates, and especially CR rate, were remarkable in this population, and would benefit from being assessed in a larger-scale study. The IFM2012-03 study demonstrated that the MTD of carfilzomib weekly is 70 mg/m2 in eNDMM, and 56 mg/m2 for patients older than 75 years. Carfilzomib used weekly in combination has a good efficacy and safety profile in eNDMM.
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Affiliation(s)
- Xavier Leleu
- Hematology and Inserm CIC 1402, CHU Poitiers, France.
| | - Guillemette Fouquet
- Institut Imagine, Inserm U1163 - CNRS ERL8254, Hôpital Necker, Paris, France
| | | | | | - Alain Duhamel
- Université de Lille, CHRU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
| | - François Machuron
- Université de Lille, CHRU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
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Jehanno N, Cassou-Mounat T, Vincent-Salomon A, Luporsi M, Bedoui M, Kuhnowski F. PET/CT imaging in management of concomitant Hodgkin lymphoma and tuberculosis - a problem solver tool. Clin Case Rep 2017; 6:232-234. [PMID: 29375875 PMCID: PMC5771937 DOI: 10.1002/ccr3.1248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 02/06/2017] [Revised: 09/18/2017] [Accepted: 09/26/2017] [Indexed: 12/19/2022] Open
Abstract
Infectious lymph nodes mimicking lymphoma is challenging for accurate staging. Although 18F-FDG is a nonspecific tracer accumulating not only in tumor cells but also in inflammatory tissues, the metabolic features and uptake kinetics give valuable information: 18F-FDG PET/CT appears as a useful problem solver tool in ambiguous situation.
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Affiliation(s)
- Nina Jehanno
- Department of Nuclear Medicine Institut Curie Paris France
| | | | | | - Marie Luporsi
- Department of Nuclear Medicine Institut Curie Paris France
| | - Manel Bedoui
- Department of Hematology Institut Curie Paris France
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Mahdjoubi A, Salah S, Dendale R, Kuhnowski F, Brézin A, Farkhondeh F, Cassoux N. [Low-grade primary choroidal lymphoma: Case report]. J Fr Ophtalmol 2017; 40:e241-e243. [PMID: 28478015 DOI: 10.1016/j.jfo.2016.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/10/2016] [Accepted: 09/16/2016] [Indexed: 11/15/2022]
Affiliation(s)
- A Mahdjoubi
- Service ophtalmologie, institut Curie, 26, rue d'ULM, 75248 Paris, France.
| | - S Salah
- Service ophtalmologie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - R Dendale
- Service radiothérapie, institut Curie, 26, rue d'ULM, 75248 Paris, France
| | - F Kuhnowski
- Service hématologie, institut Curie, 26, rue d'ULM, 75248 Paris, France
| | - A Brézin
- Service ophtalmologie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - F Farkhondeh
- Service d'anatomie pathologique, institut Curie, 26, rue d'ULM, 75248 Paris, France
| | - N Cassoux
- Service ophtalmologie, institut Curie, 26, rue d'ULM, 75248 Paris, France
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11
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Leleu X, Fouquet G, Karlin L, Kolb B, Tiab M, Araujo C, Bourquard P, Lenain P, Roussel M, Jaccard A, Petillon MO, Belhadj-Merzoug K, Lepeu G, Chretien ML, Fontan J, Rodon P, Schmitt A, Voillat L, Cereja S, Kuhnowski F, Rigaudeau S, Decaux O, Frayfer J, Fitoussi O, Roos Weil D, Eisenmann JC, Dorvaux V, Voog E, Hulin C, Attal M. Carfilzomib Weekly Plus Melphalan and Prednisone in Newly Diagnosed Elderly Multiple Myeloma (IFM 2012-03). Clinical Lymphoma Myeloma and Leukemia 2017. [DOI: 10.1016/j.clml.2017.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Alvarez R, Dupuis J, Plonquet A, Christov C, Copie-Bergman C, Hemery F, Gaillard I, El Gnaoui T, Kuhnowski F, Bedoui M, Belhadj K, Brugières P, Haioun C. Clinical relevance of flow cytometric immunophenotyping of the cerebrospinal fluid in patients with diffuse large B-cell lymphoma. Ann Oncol 2012; 23:1274-1279. [PMID: 21965472 DOI: 10.1093/annonc/mdr436] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Central nervous system (CNS) relapse is an uncommon but dramatic complication of diffuse large B-cell lymphoma (DLBCL). Several studies have demonstrated the superiority of cerebrospinal fluid (CSF) flow cytometry (FCM), as compared with conventional cytology (CC), in detecting occult leptomeningeal disease. The clinical relevance of a positive FCM still has to be clarified. PATIENTS AND METHODS We analyzed CSF from 114 DLBCL patients at diagnosis (n = 95) or at relapse (n = 19) by FCM and CC. Most patients received meningeal prophylaxis. FCM results did not influence treatment strategies. RESULTS Fourteen samples were FCM+, versus one CC+ (also FCM+). Within all patients without neurological symptoms (n = 101), four (4%) relapsed in the CNS, with a median time to relapse of 5.2 months. Only one-fourth (25%) was FCM+ before relapse. More than one extranodal disease site and elevated lactate dehydrogenase levels were associated with an increased risk of CNS relapse. CONCLUSIONS FCM gives far more positive results than CC. However, a positive FCM result did not translate into a significant increase in CNS relapse rate in this histologically uniform population receiving CNS prophylaxis.
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Affiliation(s)
| | | | - A Plonquet
- Immunology Laboratory, Centre Hospitalo-Universitaire Henri Mondor, Assistance Publique - Hôpitaux de Paris, Paris; Université Paris-Est Créteil, Créteil
| | | | - C Copie-Bergman
- Université Paris-Est Créteil, Créteil; Department of Pathology
| | | | | | | | | | | | | | - P Brugières
- Department of Neuroradiology, Centre Hospitalo-Universitaire Henri Mondor, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - C Haioun
- Lymphoid Malignancies Unit; Université Paris-Est Créteil, Créteil
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Kuhnowski F, Thieblemont C, Jardin F, Broussais-Guillemot F, Meignan M, Cabecadas J, Gaulard P, Tilly H, Oprea C, Haioun C. A phase I study of IV aflibercept (Afl) in combination with R-CHOP in untreated patients (pts) with B-cell lymphoma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Belhadj K, Lin C, Luciani A, EL Gnaoui T, Gaillard I, Dupuis J, Kuhnowski F, Bedoui M, Rahmouni A, Haioun C. Multiple myeloma treatment response assessment with whole-body dynamic contrast-enhanced MR imaging. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lin C, Luciani A, Belhadj K, Deux JF, Kuhnowski F, Maatouk M, Beaussart P, Cuenod CA, Haioun C, Rahmouni A. Multiple myeloma treatment response assessment with whole-body dynamic contrast-enhanced MR imaging. Radiology 2010; 254:521-31. [PMID: 20093523 DOI: 10.1148/radiol.09090629] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To compare posttreatment bone marrow changes at whole-body dynamic contrast material-enhanced magnetic resonance (MR) imaging with clinical response in patients with multiple myeloma (MM) and to determine if this technique can be used to assess treatment response in patients with MM. MATERIALS AND METHODS This study was approved by an institutional review board; all patients gave informed written consent. Thirty patients (21 men, nine women; mean age, 58 years +/- 10 [standard deviation]) underwent whole-body dynamic contrast-enhanced MR imaging before treatment, after induction chemotherapy (n = 30), and after autologous stem cell transplantation (ASCT) (n = 20). Maximal percentages of bone marrow (BME(max)) and focal lesion (FLE(max)) enhancement were assessed at each MR imaging examination. Clinical responses were determined on the basis of international uniform response criteria. Posttreatment changes in BME(max)and FLE(max)were compared with clinical response to therapy by using the Mann-Whitney U test. Receiver operating characteristic (ROC) analysis of posttreatment BME(max)was used to identify poor responders. RESULTS Eleven of 30 patients were good responders to induction chemotherapy; 16 of 20 patients were good responders to ASCT. After induction chemotherapy, mean BME(max)differed between good and poor responders (94.3% vs 138.4%, respectively; P = .02). With the exclusion of results from six examinations with focal lesions in which a poor clinical response was classified but BME(max)had normalized, a posttreatment BME(max)of more than 96.8% had 100% sensitivity for the identification of poor responders (specificity, 76.9%; area under the ROC curve, 0.90; P = .0001). Mean FLE(max)after induction chemotherapy did not differ between good and poor responders. Mean timing (ie, the number of postcontrast dynamic acquisitions where FLE(max)was observed) was significantly delayed in good responders compared with poor responders (4.7 vs 2.9, P < .0001). Post-ASCT MR imaging results correctly depicted all four clinically good responders whose disease subsequently progressed. CONCLUSION With quantitative analysis of BME(max)and the timing of FLE(max), whole-body dynamic contrast-enhanced MR imaging can be used to assess treatment response in patients with MM.
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Affiliation(s)
- Chieh Lin
- Department of Medical Imaging, AP-HP, Groupe Henri-Mondor Albert-Chenevier, 51 Avenue du Malréchal de Lattre de Tassigny, 94010 Créteil, France
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Haioun C, Dupuis J, Itti E, Belhadj K, Gaillard I, El Gnaoui T, Kuhnowski F, Meignan M. 96 PET imaging of non-Hodgkin lymphoma: defining methodologies for early prediction of response. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70089-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Damaj G, Kuhnowski F, Marolleau JP, Bauters F, Leleu X, Yakoub-Agha I. Risk factors for severe infection in patients with hairy cell leukemia: a long-term study of 73 patients. Eur J Haematol 2009; 83:246-50. [DOI: 10.1111/j.1600-0609.2009.01259.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cordonnier C, Pautas C, Maury S, Vekhoff A, Farhat H, Suarez F, Dhédin N, Isnard F, Ades L, Kuhnowski F, Foulet F, Kuentz M, Maison P, Bretagne S, Schwarzinger M. Empirical versus Preemptive Antifungal Therapy for High‐Risk, Febrile, Neutropenic Patients: A Randomized, Controlled Trial. Clin Infect Dis 2009; 48:1042-51. [DOI: 10.1086/597395] [Citation(s) in RCA: 301] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Dupuis J, Itti E, Rahmouni A, Hemery F, Gisselbrecht C, Lin C, Copie-Bergman C, Belhadj K, El Gnaoui T, Gaillard I, Kuhnowski F, Meignan M, Haioun C. Response assessment after an inductive CHOP or CHOP-like regimen with or without rituximab in 103 patients with diffuse large B-cell lymphoma: integrating 18fluorodeoxyglucose positron emission tomography to the International Workshop Criteria. Ann Oncol 2009; 20:503-7. [DOI: 10.1093/annonc/mdn671] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lionne-Huyghe P, Kuhnowski F, Coiteux V, Bauters F, Morschhauser F. [Indications of G-CSF administration in hematologic disorders]. Bull Cancer 2006; 93:453-62. [PMID: 16777623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Accepted: 08/03/2005] [Indexed: 05/10/2023]
Abstract
Granulocyte colony stimulating factors (G-CSF) are largely used in the treatment of hematologic disorders to improve both the myelosuppression which might directly result from the disease or indirectly induced by the numerous chemotherapy regimen. G-CSF reduces the depth and duration of neutropenia in lymphoma patients and thus allows the design of more dose intense chemotherapy regimen which were shown to improve outcome particularly in patients with diffuse large B-cell and Hodgkin's lymphoma. G-CSF has been studied in patients with acute leukemias (ALL and AML) both concomitantly to induction chemotherapy to sensitize leukemic cells and after chemotherapy to reduce the duration of neutropenia and incidence of severe infection but it's benefit in these settings is still controversial. Myelodysplastic syndromes (MDS) can benefit from G-CSF in association with erythropoietin, particularly for patients with relative good prognosis according to the IPSS score at diagnosis. Still, an improvement of Quality of life needs to be demonstrated in the vue of the cost of these strategies. In aplastic anemia (AA), G-CSF has been used as a support during infection or in association with immunosuppressive treatments but caution is needed regarding the risk of clonal evolution in AA. The benefit of low dose G-CSF in chronic severe neutropenia is well established but the long term consequences of continuous G-CSF support are not known. Finally, G-CSF given alone or after chemotherapy as become one of the key components of hematopoietic stem cell mobilization allowing the use of high dose therapies with autologous or allogeneic stem cell support.
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Affiliation(s)
- Pauline Lionne-Huyghe
- Service des maladies du sang, Hôpital Huriez, CHRU, rue Michel Polonowski, 59037 Lille Cedex
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Kuhnowski F, Bauters F. [Management of drug-induced agranulocytosis]. Rev Prat 2005; 55:671-5. [PMID: 15913122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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