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Gressens SB, Cazals-Hatem D, Lloyd V, Plessier A, Payancé A, Lebrec D, Durand F, Socie G, Valla D, Paradis V, Michonneau D, Rautou PE. Hepatic venous pressure gradient in sinusoidal obstruction syndrome: diagnostic value and link with histological lesions. JHEP Rep 2022; 4:100558. [PMID: 36160755 PMCID: PMC9489746 DOI: 10.1016/j.jhepr.2022.100558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022]
Abstract
Background & Aims Liver sinusoidal obstruction syndrome (SOS) is a well-established complication of myeloablative conditioning regimens used in hematopoietic stem cell transplantation. Hepatic venous pressure gradient (HVPG) >10 mmHg was described as an accurate diagnostic tool for SOS in the 1990s. However, epidemiology and presentation of SOS have dramatically changed. Moreover, elementary histological lesions influencing HVPG are unknown. Methods We retrospectively analyzed the charts of all patients who underwent transjugular liver biopsy with HVPG measurement for a clinical suspicion of SOS at our center. Two expert pathologists unaware of the presence or absence of SOS reviewed all liver samples and graded elementary histological lesions according to a semi-quantitative scoring defined a priori. Results Out of the 77 included patients, the 30 patients with SOS had higher HVPG than the 47 patients without SOS (median 14 mmHg [IQR 10-18], vs. 6 mmHg [3-9], respectively p <0.001). HVPG >10 mmHg had a specificity of 78% and a positive predictive value of 66% for the diagnosis of SOS. However, almost 40% of the patients with SOS had an HVPG ≤10 mmHg. HVPG correlated with sinusoidal congestion (r = 0.57; p = 0.001) and hepatocyte necrosis (r = 0.42; p = 0.02), but not with other lesions. Conclusion Even though HVPG is higher in patients with SOS, low HVPG values do not rule out SOS. Thus, HVPG cannot be used alone, and should be combined with transjugular liver biopsy, for the diagnosis of SOS. Lay summary Hepatic venous pressure gradient >10 mmHg has been described as an accurate tool for the diagnosis of liver sinusoidal obstruction syndrome after hematopoietic stem cell transplantation. This study shows that the sensitivity and specificity of hepatic venous pressure gradient measurement for sinusoidal obstruction syndrome are insufficient, so that liver pressure measurement should be combined with a liver biopsy in this setting. HVPG is significantly higher in patients with sinusoidal obstruction syndrome than in those with other liver injuries. A 10 mmHg threshold is associated with low PPV (66%) and low sensitivity (63%). HVPG measurement should be combined with transjugular liver biopsy when sinusoidal obstruction syndrome is suspected.
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Affiliation(s)
- Simon B Gressens
- Université Paris-Cité, Inserm, Centre de recherche sur l'inflammation, UMR 1149, Paris, France.,AP-HP, Service d'Hépatologie, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France
| | - Dominique Cazals-Hatem
- Service d'Anatomie pathologique, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Virginie Lloyd
- AP-HP, Service d'Hépatologie, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France
| | - Aurélie Plessier
- Université Paris-Cité, Inserm, Centre de recherche sur l'inflammation, UMR 1149, Paris, France.,AP-HP, Service d'Hépatologie, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France
| | - Audrey Payancé
- Université Paris-Cité, Inserm, Centre de recherche sur l'inflammation, UMR 1149, Paris, France.,AP-HP, Service d'Hépatologie, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France
| | - Didier Lebrec
- Université Paris-Cité, Inserm, Centre de recherche sur l'inflammation, UMR 1149, Paris, France.,AP-HP, Service d'Hépatologie, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France
| | - François Durand
- Université Paris-Cité, Inserm, Centre de recherche sur l'inflammation, UMR 1149, Paris, France.,AP-HP, Service d'Hépatologie, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France
| | - Gérard Socie
- Service d'Hématologie Greffe, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Dominique Valla
- Université Paris-Cité, Inserm, Centre de recherche sur l'inflammation, UMR 1149, Paris, France.,AP-HP, Service d'Hépatologie, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France
| | - Valérie Paradis
- Service d'Anatomie pathologique, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - David Michonneau
- Service d'Hématologie Greffe, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Pierre-Emmanuel Rautou
- Université Paris-Cité, Inserm, Centre de recherche sur l'inflammation, UMR 1149, Paris, France.,AP-HP, Service d'Hépatologie, Hôpital Beaujon, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Clichy, France
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Abstract
The virome has been recently studied in hematology and mostly in the setting of allogeneic hematopoietic stem cell transplantation. However, in hematology (as in the setting of nonhematological disorders) the study of the microbiome (that indeed includes the virome) is a growing field. The overall field is moving beyond species catalogue to the understanding of the complex ecological relationship that microbes have with each other and with their host. Here we review the existing literature on the virome in transplant recipients and in other settings, and discuss potential applications of the virome study in hematology.
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Affiliation(s)
- Jérôme Legoff
- Université de Paris, INSERM U976, Paris, France; Microbiology department, Virology laboratory, Saint Louis Hospital, Paris, France
| | - David Michonneau
- Université de Paris, INSERM U976, Paris, France; Hematology-Transplantation, Saint Louis Hospital, Paris, France
| | - Gérard Socie
- Université de Paris, INSERM U976, Paris, France; Hematology-Transplantation, Saint Louis Hospital, Paris, France.
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3
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Friedrich C, Gay J, Alary AS, Arlet JB, Socie G, Fremaux-Bacchi V, Weiss IR, Kosmider O, Darnige L. Battle of the clones: paroxysmal nocturnal hemoglobinuria vs myelodysplastic syndrome. Ann Hematol 2020; 99:2459-2461. [PMID: 32533252 DOI: 10.1007/s00277-020-04134-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/06/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Chloé Friedrich
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris, Hematology Laboratory, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
| | - Juliette Gay
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris, Hematology Laboratory, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Anne-Sophie Alary
- Institut Paoli-Calmettes (IPC), Genetic Laboratory, Marseille, France
| | - Jean-Benoît Arlet
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris, Internal Medicine Department, Georges Pompidou European Hospital, Paris, France
| | - Gérard Socie
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris, Hematology Department, Saint Louis Hospital, INSERM U976, Université de Paris, Paris, France
| | - Véronique Fremaux-Bacchi
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris, Immunology Laboratory, Georges Pompidou European Hospital, Paris, France
| | - Isabelle Radford Weiss
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris, Cytogenetics Department, Necker Hospital, Paris, France
| | - Olivier Kosmider
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris, Hematology Laboratory, Cochin Hospital, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Luc Darnige
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires de Paris, Hematology Laboratory, Georges Pompidou European Hospital, INSERM UMR-S1140, Paris, France
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4
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Bonifazi F, Rubio MT, Bacigalupo A, Boelens JJ, Finke J, Greinix H, Mohty M, Nagler A, Passweg J, Rambaldi A, Socie G, Solano C, Walker I, Barosi G, Kröger N. Rabbit ATG/ATLG in preventing graft-versus-host disease after allogeneic stem cell transplantation: consensus-based recommendations by an international expert panel. Bone Marrow Transplant 2020; 55:1093-1102. [PMID: 31969678 PMCID: PMC7269907 DOI: 10.1038/s41409-020-0792-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/04/2019] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Abstract
This collaborative initiative aimed to provide recommendations on the use of polyclonal antithymocyte globulin (ATG) or anti-T lymphocyte globulin (ATLG) for the prevention of graft-versus-host disease (GvHD) after allogeneic hematopoietic stem cell transplantation (HSCT). A comprehensive review of articles released up to October, 2018 was performed as a source of scientific evidence. Fourteen clinically relevant key questions to the domains indication, administration, and post-transplant management were developed and recommendations were produced using the Delphi technique involving a Panel of 14 experts. ATG/ATLG was strongly recommended as part of myeloablative conditioning regimen prior to matched or mismatched unrelated bone marrow or peripheral blood allogeneic HSCT in malignant diseases to prevent severe acute and chronic GvHD. ATG/ATLG was also recommended prior to HLA-identical sibling peripheral HSCT with good but lesser bulk of evidence. In reduced intensity or nonmyeloablative conditioning regimens, ATG/ATLG was deemed appropriate to reduce the incidence of acute and chronic GvHD, but a higher risk of relapse should be taken into account. Recommendations regarding dose, application, and premedication were also provided as well as post-transplant infectious prophylaxis and vaccination. Overall, these recommendations can be used for a proper and safe application of polyclonal ATG/ATLG to prevent GvHD after allogeneic HSCT.
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Affiliation(s)
- Francesca Bonifazi
- Institute of Hematology "Seragnoli", University Hospital "S. Orsola Malpighi", Bologna, Italy.
| | - Marie-Thérèse Rubio
- Department of Hematology, Hôpital Brabois, CHRU Nancy and CNRS UMR 7365, Biopole del'Université del Lorraine, Vendoeuvre les Nancy, France
| | - Andrea Bacigalupo
- "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jaap Jan Boelens
- Stem Cell Transplantation and Cellular Therapies, MSK Kids, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jürgen Finke
- Freiburg University Medical Faculty and Medical Center, Department for Medicine, Hematology, Oncology and Stem Cell Transplantation, Freiburg, Germany
| | - Hildegard Greinix
- Division of Hematology, Medical University of Graz, Auenbruggerplatz 38, 8036, Graz, Austria
| | - Mohamad Mohty
- Service d'Hématologie clinique et Thérapie cellulaire, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, INSERM UMRs 938, Paris, France
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Jakob Passweg
- Division of Hematology, Department of Medicine, University Hospital Basel, Basel, Switzerland
| | - Alessandro Rambaldi
- Department of Oncology, University of Milano and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Gérard Socie
- Service d' Hématologie-greffe, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Inserm UMR 976, Paris, France
| | - Carlos Solano
- Hematology Service, Hospital Clínico Universitario-INCLIVA; Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Irwin Walker
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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5
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Lawitschka A, Schwarze P, Rovelli A, Badoglio M, Socie G, Tichelli A, Bauer D, Rovo A, Basak G, Schoemans H, Peters C, Salooja N. Management of growth failure and growth hormone deficiency after pediatric allogeneic HSCT: Endocrinologists are of importance for further guidelines and studies. Pediatr Hematol Oncol 2019; 36:494-503. [PMID: 31633441 DOI: 10.1080/08880018.2019.1670764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/25/2022]
Abstract
Growth failure (GF) is a frequent problem after pediatric allogeneic hematopoietic stem cell transplantation (HSCT). Growth hormone deficiency (GHD) occurs in 20 to 85%, but published data on the efficacy of growth hormone treatment (GHT) are conflicting. Currently, there are no recommendations on screening for and treatment of GHD after HSCT. We aimed to describe the management of endocrine follow-up (FU)and details of GHT within European Society for Blood and Marrow Transplantation (EBMT) centers.In a retrospective questionnaire study, all EBMT centers performing pediatric HSCT were invited. Results were evaluated in correlation with the structure of endocrine aftercare (HSCT-clinicians and endocrinologists).The majority of centers (80%) reported endocrine FU by an endocrinologist - either within the HSCT-center or in a separate endocrine clinic. Fifty-four percent reported FU outside of the HSCT-center. As diagnostic tests the insulin-like growth factor IGF-I and insulin-like growth factor binding protein IGFBP3, insulin tolerance test and arginine stimulation test were most frequently used. Sixty-four percent of centers performed GHT and endocrinologists were more likely to prescribe GH (74%) compared to HSCT-clinicians (33%). The most frequent indication for GHT was GHD in 60%, with a distinct different approach of endocrinologists in comparison with HSCT-clinicians.Our study reveals substantial variation in practice and emphasizes the need for endocrine aftercare performed by dedicated endocrinologists in close collaboration with the HSCT-center. Our results indicate that the management of GHT depends on the structure of endocrine aftercare, which is important for the future development and distribution of studies and guidelines.
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Affiliation(s)
- A Lawitschka
- St. Anna Children's Hospital, Vienna Medical University, Vienna, Austria
| | - P Schwarze
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital, Tuebingen, Germany
| | - A Rovelli
- MBBM Foundation, Bone Marrow Transplantation Unit, Pediatric Department of Milano-Bicocca University, Monza, Italy
| | - M Badoglio
- Department of Haematology, EBMT Paris Study Office, Saint Antoine Hospital, Paris, France
| | - G Socie
- Department of Hematology, Hôpital Saint Louis, Paris, France
| | - A Tichelli
- Department for Haematology, University Hospital Basel, Basel, Switzerland
| | - D Bauer
- St. Anna Children's Hospital, Vienna Medical University, Vienna, Austria
| | - A Rovo
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern
| | - G Basak
- Department of Hematology, Oncology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - H Schoemans
- Department of Hematology, University Hospital Leuven and KU Leuven, Leuven, Belgium
| | - C Peters
- St. Anna Children's Hospital, Vienna Medical University, Vienna, Austria
| | - N Salooja
- Centre for Haematology, Imperial College London, London, UK
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6
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Sonigo G, Battistella M, Beylot-Barry M, Oro S, Franck N, Barete S, Bouaziz J, Ram-Wolff C, Boulinguez S, Dereure O, Bachelez H, Bonnet N, Socie G, Brice P, Brunet-Possenti F, Dalle S, Suarez F, Marçais A, Boccara O, Bodemer C, Adamski H, D’Incan M, Fraitag S, Bagot M, Michonneau D, De Masson A. Lymphomes T sous-cutanés à type de panniculite : étude anatomoclinique rétrospective de 55 cas. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.074] [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: 11/28/2022]
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7
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Craddock C, Versluis J, Labopin M, Socie G, Huynh A, Deconinck E, Volin L, Milpied N, Bourhis JH, Rambaldi A, Chevallier P, Blaise D, Manz M, Vellenga E, Vekemans MC, Maertens J, Passweg J, Vyas P, Schmid C, Löwenberg B, Ossenkoppele G, Mohty M, Cornelissen JJ, Nagler A. Distinct factors determine the kinetics of disease relapse in adults transplanted for acute myeloid leukaemia. J Intern Med 2018; 283:371-379. [PMID: 29214689 DOI: 10.1111/joim.12720] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 01/16/2023]
Abstract
BACKGROUND Disease recurrence remains the major cause of death in adults with acute myeloid leukaemia (AML) treated using either intensive chemotherapy (IC) or allogenic stem cell transplantation (allo-SCT). AIMS The timely delivery of maintenance drug or cellular therapies represent emerging strategies with the potential to reduce relapse after both treatment modalities, but whilst the determinants of overall relapse risk have been extensively characterized the factors determining the timing of disease recurrence have not been characterized. MATERIALS AND METHODS We have therefore examined, using a series of sequential landmark analyses, relapse kinetics in a cohort of 2028 patients who received an allo-SCT for AML in CR1 and separately 570 patients treated with IC alone. RESULTS In the first 3 months after allo-SCT, the factors associated with an increased risk of relapse included the presence of the FLT3-ITD (P < 0.001), patient age (P = 0.012), time interval from CR1 to transplant (P < 0.001) and donor type (P = 0.03). Relapse from 3 to 6 months was associated with a higher white cell count at diagnosis (P = 0.001), adverse-risk cytogenetics (P < 0.001), presence of FLT3-ITD mutation (P < 0.001) and time interval to achieve first complete remission (P = 0.013). Later relapse was associated with adverse cytogenetics, mutated NPM1, absence of chronic graft-versus-host disease (GVHD) and the use of in vivo T-cell depletion. In patients treated with IC alone, the factors associated with relapse in the first 3 months were adverse-risk cytogenetics (P < 0.001) and FLT3-ITD status (P = 0.001). The factors predicting later relapse were the time interval from diagnosis to CR1 (P = 0.22) and time interval from CR1 to IC (P = 0.012). DISCUSSION AND CONCLUSION Taken together, these data provide novel insights into the biology of disease recurrence after both allo-SCT and IC and have the potential to inform the design of novel maintenance strategies in both clinical settings.
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Affiliation(s)
- C Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - J Versluis
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - M Labopin
- Department of Haematology, Hospital Saint Antoine, Paris, France
| | - G Socie
- Department of Hematology, Hospital Saint-Louis, Sorbonne University, Paris, France
| | - A Huynh
- Department of Haematology, CHU, Toulouse, France
| | - E Deconinck
- Department of Hematology, CHU, Besancon, France
| | - L Volin
- Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland
| | - N Milpied
- Department of Hamatology, CHU, Nantes, France
| | - J H Bourhis
- Department of Medical Oncology, Institute of Cancer, Villejuif, France
| | - A Rambaldi
- Department of Hematology, University of Milan, Milan, Italy
| | | | - D Blaise
- Department of Hematology, Centre of Cancer Research, Marseille, France
| | - M Manz
- Center for Hemato-Oncology, University Hospital Zurich, Zurich, Switzerland
| | - E Vellenga
- Department of Hematology, University Medical Center Groningen, Groningen, The Netherlands
| | - M-C Vekemans
- Department of Hematology, Saint-Luc University, Brussels, Belgium
| | - J Maertens
- Department of Haematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - J Passweg
- Department of Haematology, University of Basel, Basel, Switzerland
| | - P Vyas
- Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - C Schmid
- Stem Cell Transplantation Unit, Department of Medicine, University of Munich, Munich, Germany
| | - B Löwenberg
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - G Ossenkoppele
- Department of Haematology, University Medical Center, Amsterdam, The Netherlands
| | - M Mohty
- Hospital Saint-Antoine, University UPMC, Paris, France
| | - J J Cornelissen
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - A Nagler
- Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel.,ALWP office of the EBMT Hospital Saint Antoine, Paris, France
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Servais S, Hannon M, Peffault de Latour R, Socie G, Beguin Y. Reconstitution of adaptive immunity after umbilical cord blood transplantation: impact on infectious complications. Stem Cell Investig 2017; 4:40. [PMID: 28607914 DOI: 10.21037/sci.2017.05.03] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 03/18/2017] [Accepted: 05/04/2017] [Indexed: 01/07/2023]
Abstract
In comparison with allogeneic stem cell transplantation (alloHSCT) with other stem cell sources, umbilical cord blood transplantation (UCBT) was traditionally associated with increased risk of infections, particularly during the first 3 months after transplantation. Longitudinal studies of immune monitoring reported peculiar patterns of T- and B-cell recovery in the peripheral blood of UCB recipients during the first months post-transplantation. Overall, current data suggest delayed reconstitution of naive and memory CD4+ and CD8+ T-cell pools after UCBT. This is particularly true for adult recipients and for patients who received in vivo T-cell depleting approaches before the transplantation. Such delayed T-cell recovery may increase susceptibility of UCB recipients for developing opportunistic infections and viral reactivations. Regarding B-cell recovery, UCBT was associated with accelerated B-lymphopoiesis. Recent studies also reported evidence for faster functional memory B-cell recovery in UCB recipients. In this article, we briefly review T- and B-cell reconstitution after alloHSCT, with emphasis on peculiarities observed after UCBT. We further put these data in lines with risks of infections after UCBT.
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Affiliation(s)
- Sophie Servais
- Department of Hematology, CHU and University of Liège, Liège, Belgium.,GIGA I3, University of Liège, Liège, Belgium
| | | | - Régis Peffault de Latour
- Department of Hematology and Bone Marrow Transplantation, Hôpital Saint-Louis, APHP, University Paris VII, Paris, France.,INSERM UMR 1160, Hôpital Saint Louis, University Paris VII, Paris, France
| | - Gérard Socie
- Department of Hematology and Bone Marrow Transplantation, Hôpital Saint-Louis, APHP, University Paris VII, Paris, France.,INSERM UMR 1160, Hôpital Saint Louis, University Paris VII, Paris, France
| | - Yves Beguin
- Department of Hematology, CHU and University of Liège, Liège, Belgium.,GIGA I3, University of Liège, Liège, Belgium
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9
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Colombier MA, Lafaurie M, de Fontbrune FS, Resche-Rigon M, Donay JL, Pons JL, Molina JM, Socie G. Usefulness of daily surveillance blood cultures in allogeneic hematopoietic stem cell transplant recipients on steroids: a 1-year prospective study. Transpl Infect Dis 2016; 18:504-11. [PMID: 27218243 DOI: 10.1111/tid.12552] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/17/2016] [Accepted: 02/23/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Bloodstream infections (BSI) are frequent and potentially severe complications in allogeneic hematopoietic stem cell transplant (AHSCT) recipients. In patients on steroids, surveillance blood cultures (SBCs) are routinely performed to detect asymptomatic BSI but their usefulness remains controversial. METHODS We performed a 1-year, observational, prospective, single-center study to assess the utility of daily SBCs in AHSCT recipients on steroids and a case-control study to identify risk factors associated with positive SBCs. All blood cultures (BCs) obtained from adults hospitalized in the HSCT unit were prospectively studied throughout 1 year. Characteristics, treatments, and outcome of patients were retrieved from medical charts. RESULTS A total of 3594 BCs were obtained in 177 patients, including 1450 SBCs in 82 AHSCT recipients on steroids. In 33 patients, 103 SBCs (7%) were positive. Low-virulence bacteria were identified in 74% of episodes. When analyzing first episode of positive SBCs (28 patients), 6 (21%) true BSI were identified. CONCLUSIONS Patients with positive SBCs were receiving antibiotic treatment less frequently at the time of SBCs (P < 0.001) and had more frequently BCs obtained through central venous access (P < 0.04) when compared to patients with negative SBCs. Daily SBCs in AHSCT recipients on steroids only rarely identify BSI and clear benefit for patients could not be demonstrated.
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Affiliation(s)
- M-A Colombier
- Department of Infectious Diseases, Hôpital Saint Louis, APHP, Paris, France
| | - M Lafaurie
- Department of Infectious Diseases, Hôpital Saint Louis, APHP, Paris, France
| | - F S de Fontbrune
- Hematology, Immunology, Oncology Division (HOR), Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France
| | - M Resche-Rigon
- Biostatistic Unit, Hôpital Saint-Louis, AP-HP, Inserm 1153 ECSTRA Team, Université Paris 7 Diderot, Paris, France
| | - J-L Donay
- Microbiology Laboratory, Hôpital Saint-Louis, APHP, Paris, France
| | - J-L Pons
- Microbiology Laboratory, Hôpital Saint-Louis, APHP, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France
| | - J-M Molina
- Department of Infectious Diseases, Hôpital Saint Louis, APHP, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France
| | - G Socie
- Hematology, Immunology, Oncology Division (HOR), Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France.,Inserm UMR 1160, Paris, France
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10
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Tessoulin B, Ceballos P, Chevallier P, Blaise D, Tournilhac O, Gauthier J, Maillard N, Tabrizi R, Choquet S, Carras S, Ifrah N, Guillerm G, Mohty M, Tilly H, Socie G, Cornillon J, Hermine O, Daguindau É, Bachy E, Girault S, Marchand T, Oberic L, Reman O, Leux C, Le Gouill S. Allogeneic stem cell transplantation for patients with mantle cell lymphoma who failed autologous stem cell transplantation: a national survey of the SFGM-TC. Bone Marrow Transplant 2016; 51:1184-90. [PMID: 27111043 DOI: 10.1038/bmt.2016.102] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/06/2016] [Accepted: 03/08/2016] [Indexed: 11/09/2022]
Abstract
Poly-chemotherapy plus rituximab followed by autologous stem cell transplantation (auto-SCT) is standard care for untreated young patients with mantle cell lymphoma (MCL). Despite this intensive treatment, transplant patients remain highly susceptible to relapse over time. The French SFGM-TC performed a national survey on reduced-intensity conditioning allogeneic stem cell transplantation (RIC-allo-SCT) for fit relapsed/refractory patients who failed after auto-SCT (n=106). Median times of relapse after auto-SCT, and from auto-SCT to RIC-allo-SCT were 28 months and 3.6 years, respectively. Sixty per cent of patients received at least three lines of treatment before RIC-allo-SCT. Conditioning regimens for RIC-allo-SCT were heterogeneous. Twenty patients experienced grade III/IV aGvHD, extensive cGvHD was reported in 28 cases. Median follow-up after RIC-allo-SCT was 45 months. Median PFS after RIC-allo-SCT was 30.1 months and median overall survival was 62 months. Treatment-related mortality (TRM) at 1 year and 3 years were estimated at 28% and 32%, respectively. A total of 52 patients died; major causes of death were related to toxicity (n=34) and MCL (n=11). Patients in good response before RIC-allo-SCT experienced a better PFS and OS. Our work highlights the need for new RIC-allo-SCT MCL-tailored approaches to reduce TRM, and early and late relapse.
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Affiliation(s)
- B Tessoulin
- Department of Hematology, University Hospital, Nantes, France.,INSERM team 10 UMR 892, CRCNA, Nantes, France
| | - P Ceballos
- Department of Hematology, University Hospital, Montpellier, France
| | - P Chevallier
- Department of Hematology, University Hospital, Nantes, France
| | - D Blaise
- Department of Hematology, Paoli Calmettes, Marseille, France
| | - O Tournilhac
- Department of Hematology, University Hospital, Clermont-Ferrand, France
| | - J Gauthier
- Department of Hematology, University Hospital, Lille, France
| | - N Maillard
- Department of Hematology, University Hospital, Poitiers, France
| | - R Tabrizi
- Department of Hematology, University Hospital, Bordeaux, France
| | - S Choquet
- Department of Hematology, Pitie Salpetriere, Paris, France
| | - S Carras
- Department of Hematology, University Hospital, Grenoble, France
| | - N Ifrah
- Department of Hematology, University Hospital, Angers, France
| | - G Guillerm
- Department of Hematology, University Hospital, Brest, France
| | - M Mohty
- Department of Hematology, University Hospital-Saint Antoine, Paris, France
| | - H Tilly
- Department of Hematology, Centre Henri-Becquerel, Rouen, France
| | - G Socie
- Department of Hematology, Saint Louis Hospital, Paris, France
| | - J Cornillon
- Department of Hematology, Institut de Cancerologie de la Loire, Saint Etienne, France
| | - O Hermine
- Department of Hematology, Necker Hospital, Paris, France
| | - É Daguindau
- Department of Hematology, University Hospital, Besancon, France
| | - E Bachy
- Department of Hematology, University hospital, Lyon, France
| | - S Girault
- Department of Hematology, University Hospital, Limoges, France
| | - T Marchand
- Department of Hematology, University Hospital, Rennes, France
| | - L Oberic
- University Cancer Institute, Toulouse, France
| | - O Reman
- Department of Hematology, University Hospital, Caen, France
| | - C Leux
- Department of Epidemiology, University Hospital of Nantes, Nantes, France
| | - S Le Gouill
- Department of Hematology, University Hospital, Nantes, France.,INSERM team 10 UMR 892, CRCNA, Nantes, France.,Centre d'Investigation Clinique en Cancérologie (CI2C), CHU de Nantes, Nantes, France
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11
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Balavarca Y, Pearce K, Norden J, Collin M, Jackson G, Holler E, Dressel R, Kolb HJ, Greinix H, Socie G, Toubert A, Rocha V, Gluckman E, Hromadnikova I, Sedlacek P, Wolff D, Holtick U, Dickinson A, Bickeböller H. Predicting survival using clinical risk scores and non-HLA immunogenetics. Bone Marrow Transplant 2015. [PMID: 26214138 DOI: 10.1038/bmt.2015.173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Previous studies of non-histocompatibility leukocyte antigen (HLA) gene single-nucleotide polymorphisms (SNPs) on subgroups of patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) revealed an association with transplant outcome. This study further evaluated the association of non-HLA polymorphisms with overall survival in a cohort of 762 HSCT patients using data on 26 polymorphisms in 16 non-HLA genes. When viewed in addition to an already established clinical risk score (EBMT-score), three polymorphisms: rs8177374 in the gene for MyD88-adapter-like (MAL; P=0.026), rs9340799 in the oestrogen receptor gene (ESR; P=0.003) and rs1800795 in interleukin-6 (IL-6; P=0.007) were found to be associated with reduced overall survival, whereas the haplo-genotype (ACC/ACC) in IL-10 was protective (P=0.02). The addition of these non-HLA polymorphisms in a Cox regression model alongside the EBMT-score improved discrimination between risk groups and increased the level of prediction compared with the EBMT-score alone (gain in prediction capability for EBMT-genetic-score 10.8%). Results also demonstrated how changes in clinical practice through time have altered the effects of non-HLA analysis. The study illustrates the significance of non-HLA genotyping prior to HSCT and the importance of further investigation into non-HLA gene polymorphisms in risk prediction.
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Affiliation(s)
- Y Balavarca
- Department of Genetic Epidemiology, University Medical Center, Göttingen, Germany
| | - K Pearce
- Department of Haematological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - J Norden
- Department of Haematological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - M Collin
- Department of Haematological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - G Jackson
- Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - E Holler
- Department of Hematology and Oncology, University of Regensburg, Regensburg, Germany
| | - R Dressel
- Department of Cellular and Molecular Immunology, University Medical Center, Göttingen, Germany
| | - H-J Kolb
- Department of Haematology and Oncology, Klinikum Grosshadern, Medical Klinik III, Munich, Germany
| | - H Greinix
- Department of Haematology, Division of Haematology, Medical University of Graz, Graz, Austria
| | - G Socie
- Department of Haematology, Immunology and Oncology, AP-HP, Saint Louis Hospital, Hematology Transplantation, Paris, France
| | - A Toubert
- Departement d'Immunologie, Université Paris Diderot, INSERM UMRS-940, AP-HP, Paris, France
| | - V Rocha
- Department of Bone Marrow Transplantation, EUROCORD, St Louis Hospital, Paris, France
| | - E Gluckman
- Department of Bone Marrow Transplantation, EUROCORD, St Louis Hospital, Paris, France
| | - I Hromadnikova
- Department of Molecular Biology and Cell Pathology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - P Sedlacek
- Department of Pediatric Hematology and Oncology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - D Wolff
- Department of Hematology and Oncology, University of Regensburg, Regensburg, Germany
| | - U Holtick
- Department I of Internal Medicine, University of Cologne, Cologne, Germany
| | - A Dickinson
- Department of Haematological Sciences, Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - H Bickeböller
- Department of Genetic Epidemiology, University Medical Center, Göttingen, Germany
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12
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Denis B, Lafaurie M, Donay JL, Fontaine JP, Oksenhendler E, Raffoux E, Hennequin C, Allez M, Socie G, Maziers N, Porcher R, Molina JM. Prevalence, risk factors, and impact on clinical outcome of extended-spectrum beta-lactamase-producing Escherichia coli bacteraemia: a five-year study. Int J Infect Dis 2015; 39:1-6. [PMID: 26189774 DOI: 10.1016/j.ijid.2015.07.010] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [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: 03/17/2015] [Revised: 06/01/2015] [Accepted: 07/09/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The impact of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) bacteraemia on outcome remains controversial. METHODS A retrospective analysis of the prevalence, risk factors, clinical features, and outcomes of all ESBL-EC bacteraemia in one French hospital over a 5-year period was performed. A case-control study was undertaken: cases had at least one ESBL-EC bacteraemia and controls a positive non-ESBL-EC bacteraemia. RESULTS The prevalence of ESBL-EC bacteraemia increased from 5.2% of all positive E. coli blood cultures in 2005 to 13.5% in 2009 (p<0.003). CTX-M represented 70% of ESBL-EC bacteraemia strains, and strains were not clonally related. On adjusted analysis, the only significant risk factor for ESBL-EC bacteraemia was a previous ESBL-EC colonization (odds ratio 11.3, 95% confidence interval 1.2-107; p=0.003). Initial antimicrobial therapy was less frequently adequate in the ESBL-EC group (48% vs. 85%; p=0.003). The presence of ESBL-EC bacteraemia was not associated with a longer hospital stay (p=0.088). Day 30 mortality was high, but not significantly different in the two groups (30% vs. 27%; p=0. 82). CONCLUSION The prevalence of ESBL-EC bacteraemia has been increasing dramatically. Previous colonization with ESBL-EC was a strong risk factor for ESBL-EC bacteraemia. More inadequate initial antimicrobial therapy was noted in the ESBL-EC group, but mortality and length of hospital stay were not significantly different from those of patients with non-ESBL-EC bacteraemia.
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Affiliation(s)
- B Denis
- Department of Infectious Diseases, Hôpital Saint-Louis, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France; Inserm UMRS 1136, UPMC Université Paris 06, Paris, France.
| | - M Lafaurie
- Department of Infectious Diseases, Hôpital Saint-Louis, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - J-L Donay
- Department of Microbiology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - J-P Fontaine
- Emergency Department, Hôpital Saint-Louis, AP-HP, Paris, France
| | - E Oksenhendler
- Department of Clinical Immunology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - E Raffoux
- Department of Haematology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - C Hennequin
- Department of Oncology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - M Allez
- Department of Gastroenterology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - G Socie
- Department of Haematology-Bone Marrow Transplantation, Hôpital Saint-Louis, AP-HP, Paris, France
| | - N Maziers
- Department of Intensive Care, Hôpital Saint-Louis, AP-HP, Paris, France
| | - R Porcher
- Department of Biomedical Statistics and Methodology, Hôpital Saint-Louis, AP-HP, Paris, France
| | - J-M Molina
- Department of Infectious Diseases, Hôpital Saint-Louis, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
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13
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Lerolle N, Raffoux E, Socie G, Touratier S, Sauvageon H, Porcher R, Bretagne S, Bergeron A, Azoulay E, Molina JM, Lafaurie M. Breakthrough invasive fungal disease in patients receiving posaconazole primary prophylaxis: a 4-year study. Clin Microbiol Infect 2014; 20:O952-9. [DOI: 10.1111/1469-0691.12688] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/12/2014] [Accepted: 05/17/2014] [Indexed: 01/28/2023]
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14
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Ringdén O, Brazauskas R, Wang Z, Ahmed I, Atsuta Y, Buchbinder D, Burns LJ, Cahn JY, Duncan C, Hale GA, Halter J, Hayashi RJ, Hsu JW, Jacobsohn DA, Kamble RT, Kamani NR, Kasow KA, Khera N, Lazarus HM, Loren AW, Marks DI, Myers KC, Ramanathan M, Saber W, Savani BN, Schouten HC, Socie G, Sorror ML, Steinberg A, Popat U, Wingard JR, Mattsson J, Majhail NS. Second solid cancers after allogeneic hematopoietic cell transplantation using reduced-intensity conditioning. Biol Blood Marrow Transplant 2014; 20:1777-84. [PMID: 25042734 DOI: 10.1016/j.bbmt.2014.07.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/07/2014] [Indexed: 12/21/2022]
Abstract
We examined risk of second solid cancers after allogeneic hematopoietic cell transplantation (AHCT) using reduced-intensity/nonmyeloablative conditioning (RIC/NMC). RIC/NMC recipients with leukemia/myelodysplastic syndrome (MDS) (n = 2833) and lymphoma (n = 1436) between 1995 and 2006 were included. In addition, RIC/NMC recipients 40 to 60 years of age (n = 2138) were compared with patients of the same age receiving myeloablative conditioning (MAC, n = 6428). The cumulative incidence of solid cancers was 3.35% at 10 years. There was no increase in overall cancer risk compared with the general population (leukemia/MDS: standardized incidence ratio [SIR] .99, P = 1.00; lymphoma: SIR .92, P = .75). However, risks were significantly increased in leukemia/MDS patients for cancers of lip (SIR 14.28), tonsil (SIR 8.66), oropharynx (SIR 46.70), bone (SIR 23.53), soft tissue (SIR 12.92), and vulva (SIR 18.55) and skin melanoma (SIR 3.04). Lymphoma patients had significantly higher risks of oropharyngeal cancer (SIR 67.35) and skin melanoma (SIR 3.52). Among RIC/NMC recipients, age >50 years was the only independent risk factor for solid cancers (hazard ratio [HR] 3.02, P < .001). Among patients ages 40 to 60 years, when adjusted for other factors, there was no difference in cancer risks between RIC/NMC and MAC in leukemia/MDS patients (HR .98, P = .905). In lymphoma patients, risks were lower after RIC/NMC (HR .51, P = .047). In conclusion, the overall risks of second solid cancers in RIC/NMC recipients are similar to the general population, although there is an increased risk of cancer at some sites. Studies with longer follow-up are needed to realize the complete risks of solid cancers after RIC/NMC AHCT.
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Affiliation(s)
- Olle Ringdén
- Center for Allogeneic Stem Cell Transplantation, Karolinka University Hospital, Stockholm, Sweden
| | - Ruta Brazauskas
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Zhiwei Wang
- Center for International Bone and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ibrahim Ahmed
- Department of Pediatric Hematology & Oncology, University of New Mexico, Albuquerque, New Mexico
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - David Buchbinder
- Division of Pediatric Hematology, Children's Hospital of Orange County, Orange, California
| | - Linda J Burns
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Jean-Yves Cahn
- Clinique Universitaire d'Hématologie, University Hospital, Grenoble, France
| | - Christine Duncan
- Pediatric Stem Cell Transplantation Program, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Gregory A Hale
- Department of Hematology Oncology, All Children's Hospital, St. Petersburg, Florida
| | - Joerg Halter
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Robert J Hayashi
- Division of Pediatric Hematology/Oncology, Washington University, St. Louis Children's Hospital, St. Louis, Missouri
| | - Jack W Hsu
- Division of Hematology & Oncology, Shands HealthCare, University of Florida, Gainesville, Florida
| | - David A Jacobsohn
- Division of Blood and Marrow Transplantation, Children's National Medical Center, Washington, DC
| | - Rammurti T Kamble
- Center for Gene Therapy, Baylor College of Medicine Center for Cell and Gene Therapy, Houston, Texas
| | | | - Kimberly A Kasow
- Pediatric Bone Marrow Transplantation Program, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Nandita Khera
- Department of Hematology/Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Hillard M Lazarus
- Division of Hematology and Oncology, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Alison W Loren
- Division of Hematology/Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David I Marks
- Adult BMT Unit, Bristol Children's Hospital, Bristol, United Kingdom
| | - Kasiani C Myers
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Muthalagu Ramanathan
- Division of Hematology/Oncology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Wael Saber
- Center for International Bone and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Harry C Schouten
- Department of Medicine and Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | - Gérard Socie
- Service d'Hematologie-Greffe de Moelle, Hopital Saint Louis, Paris, France
| | - Mohamed L Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, and Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Amir Steinberg
- Department of Hematology and Medical Oncology, Mount Sinai Medical Center, Los Angeles, California
| | - Uday Popat
- Department of Stem Cell Transplantation, MD Anderson Cancer Center, Houston, Texas
| | - John R Wingard
- Division of Hematology & Oncology, Shands HealthCare, University of Florida, Gainesville, Florida
| | - Jonas Mattsson
- Center for Allogeneic Stem Cell Transplantation, Karolinka University Hospital, Stockholm, Sweden
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Cleveland Clinic, Cleveland, Ohio.
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15
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Versluis J, Labopin M, Niederwieser D, Socie G, Schlenk RF, Milpied N, Nagler A, Blaise D, Rocha V, Cornelissen JJ, Mohty M. Prediction of non-relapse mortality in recipients of reduced intensity conditioning allogeneic stem cell transplantation with AML in first complete remission. Leukemia 2014; 29:51-7. [PMID: 24913728 DOI: 10.1038/leu.2014.164] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/13/2014] [Accepted: 04/28/2014] [Indexed: 01/21/2023]
Abstract
Non-relapse mortality (NRM) after allogeneic hematopoietic stem cell transplantation (alloHSCT) can be predicted by the hematopoietic cell transplantation comorbidity index (HCT-CI) and the European Group for Blood and Marrow Transplantation (EBMT) score, which are composed of different parameters. We set out to integrate the parameters of both scores in patients with acute myeloid leukemia (AML) in first complete remission (CR1) receiving reduced intensity conditioning (RIC) alloHSCT. All parameters from the HCT-CI and the EBMT-score with the addition of patient and donor cytomegalovirus serology were evaluated in 812 patients by multivariable analysis with end-point NRM at 2 years. Subsequently, 16 parameters were selected based on hazard ratio >1.2, and were incorporated into a novel score, which was further internally validated by bootstrapping. Both the HCT-CI and the EBMT-score showed relatively weak predictive value, whereas the integrated score allowed to identify three clearly distinct risk groups with 2-year NRM estimates of 8±2% (low-risk), 17±2% (intermediate-risk) and 38±4% (high-risk), which also translated in prediction of overall survival. Collectively, integration of the most dominant parameters from the HCT-CI and the EBMT-score allowed to develop a simple and robust, integrated score with improved prediction of NRM for AML patients proceeding to RIC alloHSCT in CR1.
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Affiliation(s)
- J Versluis
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - M Labopin
- 1] Sorbonne Universités, Paris, France [2] Institut National de la Sante et de la Recherche Medicale (INSERM), Paris, France [3] AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
| | - D Niederwieser
- Department of Hematology and Oncology, University Leipzig, Leipzig, Germany
| | - G Socie
- 1] Institut National de la Sante et de la Recherche Medicale (INSERM), Paris, France [2] Department of Hematology/Transplantation, Hopital Saint-Louis, Sorbonne University, Paris, France
| | - R F Schlenk
- Department of Internal Medicine III, University Hospital of Ulm, Ulm, Germany
| | - N Milpied
- Department of Hematology, CHU de Bordeaux, Bordeaux, France
| | - A Nagler
- Division of Hematology and Bone Marrow Transplantation, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - D Blaise
- Department of Hematology and Transplant Program, Institut Paoli Calmettes, Marseille, France
| | - V Rocha
- Eurocord International Registry, Hopital Saint Louis, Sorbonne University, Paris, France
| | - J J Cornelissen
- Department of Hematology, Erasmus University Medical Center Cancer Institute, Rotterdam, The Netherlands
| | - M Mohty
- 1] Sorbonne Universités, Paris, France [2] Institut National de la Sante et de la Recherche Medicale (INSERM), Paris, France [3] AP-HP, Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Paris, France
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16
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McClune BL, Ahn KW, Wang HL, Antin JH, Artz AS, Cahn JY, Deol A, Freytes CO, Hamadani M, Holmberg LA, Jagasia MH, Jakubowski AA, Kharfan-Dabaja MA, Lazarus HM, Miller AM, Olsson R, Pedersen TL, Pidala J, Pulsipher MA, Rowe JM, Saber W, van Besien KW, Waller EK, Aljurf MD, Akpek G, Bacher U, Chao NJ, Chen YB, Cooper BW, Dehn J, de Lima MJ, Hsu JW, Lewis ID, Marks DI, McGuirk J, Cairo MS, Schouten HC, Szer J, Ramanathan M, Savani BN, Seftel M, Socie G, Vij R, Warlick ED, Weisdorf DJ. Allotransplantation for patients age ≥40 years with non-Hodgkin lymphoma: encouraging progression-free survival. Biol Blood Marrow Transplant 2014; 20:960-8. [PMID: 24641829 DOI: 10.1016/j.bbmt.2014.03.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 01/30/2014] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
Non-Hodgkin lymphoma (NHL) disproportionately affects older patients, who do not often undergo allogeneic hematopoietic cell transplantation (HCT). We analyzed Center for International Blood and Marrow Transplant Research data on 1248 patients age ≥40 years receiving reduced-intensity conditioning (RIC) or nonmyeloablative (NMA) conditioning HCT for aggressive (n = 668) or indolent (n = 580) NHL. Aggressive lymphoma was more frequent in the oldest cohort 49% for age 40 to 54 versus 57% for age 55 to 64 versus 67% for age ≥65; P = .0008). Fewer patients aged ≥65 had previous autografting (26% versus 24% versus 9%; P = .002). Rates of relapse, acute and chronic GVHD, and nonrelapse mortality (NRM) at 1 year post-HCT were similar in the 3 age cohorts (22% [95% confidence interval (CI), 19% to 26%] for age 40 to 54, 27% [95% CI, 23% to 31%] for age 55 to 64, and 34% [95% CI, 24% to 44%] for age ≥65. Progression-free survival (PFS) and overall survival (OS) at 3 years was slightly lower in the older cohorts (OS: 54% [95% CI, 50% to 58%] for age 40 to 54; 40% [95% CI, 36% to 44%] for age 55 to 64, and 39% [95% CI, 28% to 50%] for age ≥65; P < .0001). Multivariate analysis revealed no significant effect of age on the incidence of acute or chronic GVHD or relapse. Age ≥55 years, Karnofsky Performance Status <80, and HLA mismatch adversely affected NRM, PFS, and OS. Disease status at HCT, but not histological subtype, was associated with worse NRM, relapse, PFS, and OS. Even for patients age ≥55 years, OS still approached 40% at 3 years, suggesting that HCT affects long-term remission and remains underused in qualified older patients with NHL.
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Affiliation(s)
- Brian L McClune
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Kwang Woo Ahn
- Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Hai-Lin Wang
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Joseph H Antin
- Division of Hematologic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Andrew S Artz
- Section of Hematology/Oncology, University of Chicago School of Medicine, Chicago, Illinois
| | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Abhinav Deol
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - César O Freytes
- Department of Hematology, South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Madan H Jagasia
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Ann A Jakubowski
- Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH
| | - Alan M Miller
- Department of Oncology, Baylor University Medical Center, Dallas, TX
| | - Richard Olsson
- Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden
| | - Tanya L Pedersen
- Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Joseph Pidala
- Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL
| | - Michael A Pulsipher
- Primary Children's Hospital, Division of Hematology/Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jacob M Rowe
- Department of Hematology, Rambam Medical Center, Haifa, Israel
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Edmund K Waller
- Bone Marrow and Stem Cell Transplant Center, Winship Cancer Institute, Emory University Hospital, Atlanta, Georgia
| | - Mahmoud D Aljurf
- Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia
| | - Görgun Akpek
- Banner M.D. Anderson Cancer Center, Gilbert, Arizona
| | - Ulrike Bacher
- Department of Stem Cell Transplantation, University of Hamburg, Hamburg, Germany; MLL Munich Leukemia Laboratory, Munich, Germany
| | - Nelson J Chao
- Division of Cell Therapy, Duke University Medical Center, Durham, NC
| | - Yi-Bin Chen
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA
| | - Brenda W Cooper
- Division of Hematology/Oncology, University Hospitals Case Medical Center, Cleveland, OH
| | - Jason Dehn
- National Marrow Donor Program, Minneapolis, MN
| | - Marcos J de Lima
- Division of Hematology/Oncology, University Hospitals Case Medical Center, Cleveland, OH
| | - Jack W Hsu
- Division of Hematology/Oncology, Shands HealthCare, University of Florida, Gainesville, FL
| | - Ian D Lewis
- Haematology Clinical Trial Office, Royal Adelaide Hospital/SA Pathology, Adelaide, Australia
| | - David I Marks
- Avon Haematology Unit and BCH BMT Unit, Bristol Children's Hospital, Bristol, United Kingdom
| | - Joseph McGuirk
- Division of Hematology & Oncology, University of Kansas, Westwood, KS
| | - Mitchell S Cairo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, New York Medical College, Valhalla, NY
| | - Harry C Schouten
- Division of Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | - Jeffrey Szer
- Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital City Campus, Victoria, Australia
| | - Muthalagu Ramanathan
- Department of Hematologic Malignancies Bone Marrow Transplant, UMass Memorial Medical Center, Worcester, MA
| | - Bipin N Savani
- Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew Seftel
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Gérard Socie
- Department of Hematology, Hopital Saint Louis, Paris, France
| | - Ravi Vij
- Division of Medical Oncology, Barnes Jewish Hospital, St. Louis Children's Hospital, Washington University, St. Louis, MO
| | - Erica D Warlick
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota
| | - Daniel J Weisdorf
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota.
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17
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Warlick ED, Paulson K, Brazauskas R, Zhong X, Miller AM, Camitta BM, George B, Savani BN, Ustun C, Marks DI, Waller EK, Baron F, Freytes CO, Socie G, Akpek G, Schouten HC, Lazarus HM, Horwitz EM, Koreth J, Cahn JY, Bornhauser M, Seftel M, Cairo MS, Laughlin MJ, Sabloff M, Ringdén O, Gale RP, Kamble RT, Vij R, Gergis U, Mathews V, Saber W, Chen YB, Liesveld JL, Cutler CS, Ghobadi A, Uy GL, Eapen M, Weisdorf DJ, Litzow MR. Effect of postremission therapy before reduced-intensity conditioning allogeneic transplantation for acute myeloid leukemia in first complete remission. Biol Blood Marrow Transplant 2014; 20:202-8. [PMID: 24184335 PMCID: PMC3924751 DOI: 10.1016/j.bbmt.2013.10.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 08/19/2013] [Accepted: 10/28/2013] [Indexed: 11/23/2022]
Abstract
The impact of pretransplant (hematopoietic cell transplantation [HCT]) cytarabine consolidation therapy on post-HCT outcomes has yet to be evaluated after reduced-intensity or nonmyeloablative conditioning. We analyzed 604 adults with acute myeloid leukemia in first complete remission (CR1) reported to the Center for International Blood and Marrow Transplant Research who received a reduced-intensity or nonmyeloablative conditioning HCT from an HLA-identical sibling, HLA-matched unrelated donor, or umbilical cord blood donor from 2000 to 2010. We compared transplant outcomes based on exposure to cytarabine postremission consolidation. Three-year survival rates were 36% (95% confidence interval [CI], 29% to 43%) in the no consolidation arm and 42% (95% CI, 37% to 47%) in the cytarabine consolidation arm (P = .16). Disease-free survival was 34% (95% CI, 27% to 41%) and 41% (95% CI, 35% to 46%; P = .15), respectively. Three-year cumulative incidences of relapse were 37% (95% CI, 30% to 44%) and 38% (95% CI, 33% to 43%), respectively (P = .80). Multivariate regression confirmed no effect of consolidation on relapse, disease-free survival, and survival. Before reduced-intensity or nonmyeloablative conditioning HCT, these data suggest pre-HCT consolidation cytarabine does not significantly alter outcomes and support prompt transition to transplant as soon as morphologic CR1 is attained. If HCT is delayed while identifying a donor, our data suggest that consolidation does not increase transplant treatment-related mortality and is reasonable if required.
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Affiliation(s)
- Erica D Warlick
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
| | - Kristjan Paulson
- Department of Hematology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruta Brazauskas
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Xiaobo Zhong
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alan M Miller
- Department of Oncology, Baylor University Medical Center, Dallas, Texas
| | - Bruce M Camitta
- Department of Pediatrics, Midwest Center for Cancer and Blood Disorders, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Biju George
- Department of Hematology, Christian Medical College Hospital, Vellore, India
| | - Bipin N Savani
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Celalettin Ustun
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - David I Marks
- Bristol Adult BMT Unit, Bristol Children's Hospital, Bristol, United Kingdom
| | - Edmund K Waller
- Bone Marrow and Stem Cell Transplant Center, Emory University Hospital, Atlanta, Georgia
| | - Frédéric Baron
- Universitaire de Liege, Centre Hospitalier Universitaire - Sart-Tilman, Liege, Belgium
| | - César O Freytes
- Department of Hematopoietic Stem Cell Transplant Program, South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas
| | - Gérard Socie
- Service d'Hematologie, Hopital Saint Louis, Paris, France
| | - Gorgun Akpek
- SCTCT Program, Banner MD Anderson Cancer Center, Gilbert, Arizona
| | - Harry C Schouten
- Division of Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands
| | - Hillard M Lazarus
- Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio
| | - Edwin M Horwitz
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John Koreth
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Jean-Yves Cahn
- Department of Hematology, University Hospital, Grenoble, France
| | - Martin Bornhauser
- Medizinische Klinik und Poliklinik I, Universitatsklinikum Carl Gustav Carus, Dresden, Germany
| | - Matthew Seftel
- Department of Hematology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mitchell S Cairo
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York
| | - Mary J Laughlin
- Hematopoietic Cell Transplantation Program, University of Virginia, Charlottesville, Virginia
| | - Mitchell Sabloff
- Division of Hematology, Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Olle Ringdén
- Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Peter Gale
- Section of Hematology, Division of Experimental Medicine, Department of Medicine, Imperial College, London, United Kingdom
| | - Rammurti T Kamble
- Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas
| | - Ravi Vij
- Washington University School of Medicine, St. Louis, Missouri
| | - Usama Gergis
- Weill Cornell Medical College, New York, New York
| | - Vikram Mathews
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yi-Bin Chen
- Department of BMT, Massachusetts General Hospital, Boston, Massachusetts
| | - Jane L Liesveld
- Department of Hematology/Oncology, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, New York
| | - Corey S Cutler
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Armin Ghobadi
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, Texas
| | - Geoffrey L Uy
- Section of Hematology, Division of Experimental Medicine, Department of Medicine, Imperial College, London, United Kingdom
| | - Mary Eapen
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel J Weisdorf
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Mark R Litzow
- Department of Hematology and Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota
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18
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Servais S, Lengline E, Porcher R, Carmagnat M, Peffault de Latour R, Robin M, Sicre de Fontebrune F, Clave E, Maki G, Granier C, Xhaard A, Dhedin N, Molina JM, Toubert A, Moins-Teisserenc H, Socie G. Long-term immune reconstitution and infection burden after mismatched hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2014; 20:507-17. [PMID: 24406505 DOI: 10.1016/j.bbmt.2014.01.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/02/2014] [Indexed: 12/19/2022]
Abstract
Mismatched unrelated donor (MMUD) or umbilical cord blood (UCB) can be chosen as alternative donors for allogeneic stem cell transplantation but might be associated with long-lasting immune deficiency. Sixty-six patients who underwent a first transplantation from either UCB (n = 30) or 9/10 MMUD (n = 36) and who survived beyond 3 months were evaluated. Immune reconstitution was prospectively assessed at sequential time points after transplantation. NK, B, CD4(+), and CD8(+) T cells and their naïve and memory subsets, as well as regulatory T cells (Treg), were studied. Detailed analyses on infections occurring after 3 months were also assessed. The 18-month cumulative incidences of infection-related death were 8% and 3%, and of infections were 72% and 57% after MMUD and UCB transplantation, respectively. Rates of infection per 12 patient-month were roughly 2 overall (1 for bacterial, .9 for viral, and .3 for fungal infections). Memory, naïve CD4(+) and CD8(+)T cells, naïve B cells, and Treg cells reconstitution between the 2 sources were roughly similar. Absolute CD4(+)T cells hardly reached 500 per μL by 1 year after transplantation and most B cells were of naïve phenotype. Correlations between immune reconstitution and infection were then performed by multivariate analyses. Low CD4(+) and high CD8(+)T cells absolute counts at 3 months were linked to increased risks of overall and viral (but not bacterial) infections. When assessing for the naïve/memory phenotypes at 3 months among the CD4(+) T cell compartment, higher percentages of memory subsets were protective against late infections. Central memory CD4(+)T cells protected against overall and bacterial infections; late effector memory CD4(+)T cells protected against overall, bacterial, and viral infections. To the contrary, high percentage of effector- and late effector-memory subsets at 3 months among the CD8(+) T cell compartment predicted higher risks for viral infections. Patients who underwent transplantation from alternative donors represent a population with very high risk of infection. Detailed phenotypic analysis of immune reconstitution may help to evaluate infection risk and to adjust infection prophylaxis.
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Affiliation(s)
- Sophie Servais
- Service d'Hématologie Greffe, AP-HP Hôpital Saint Louis, Paris, France
| | - Etienne Lengline
- Service d'Hématologie Greffe, AP-HP Hôpital Saint Louis, Paris, France
| | | | | | | | - Marie Robin
- Service d'Hématologie Greffe, AP-HP Hôpital Saint Louis, Paris, France
| | | | - Emmanuel Clave
- Immunologie, AP-HP Hôpital Saint Louis, Paris, France; Inserm U 940, Hôpital Saint Louis, Paris, France
| | - Guitta Maki
- Immunologie, AP-HP Hôpital Saint Louis, Paris, France
| | | | - Alienor Xhaard
- Service d'Hématologie Greffe, AP-HP Hôpital Saint Louis, Paris, France
| | - Nathalie Dhedin
- Service d'Hématologie Greffe, AP-HP Hôpital Saint Louis, Paris, France
| | - Jean-Michel Molina
- Service des Maladies Infectieuses et Tropicales, AP-HP Hôpital Saint Louis, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, France
| | - Antoine Toubert
- Immunologie, AP-HP Hôpital Saint Louis, Paris, France; Inserm U 940, Hôpital Saint Louis, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, France
| | - Hélène Moins-Teisserenc
- Immunologie, AP-HP Hôpital Saint Louis, Paris, France; Inserm U 940, Hôpital Saint Louis, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, France
| | - Gérard Socie
- Service d'Hématologie Greffe, AP-HP Hôpital Saint Louis, Paris, France; Inserm U 940, Hôpital Saint Louis, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, France.
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19
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Loren AW, Brazauskas R, Chow EJ, Gilleece M, Halter J, Jacobsohn DA, Joshi S, Pidala J, Quinn GP, Wang Z, Apperley JF, Burns LJ, Hale GA, Hayes-Lattin BM, Kamble R, Lazarus H, McCarthy PL, Reddy V, Warwick AB, Bolwell BJ, Duncan C, Socie G, Sorror ML, Wingard JR, Majhail NS. Physician perceptions and practice patterns regarding fertility preservation in hematopoietic cell transplant recipients. Bone Marrow Transplant 2013; 48:1091-7. [PMID: 23419436 PMCID: PMC3914209 DOI: 10.1038/bmt.2013.13] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 01/02/2013] [Accepted: 01/15/2013] [Indexed: 11/09/2022]
Abstract
Physician practice variation may be a barrier to informing hematopoietic cell transplant (HCT) recipients about fertility preservation (FP) options. We surveyed HCT physicians in the United States to evaluate FP knowledge, practices, perceptions and barriers. Of the 1035 physicians invited, 185 completed a 29-item web-survey. Most respondents demonstrated knowledge of FP issues and discussed and felt comfortable discussing FP. However, only 55% referred patients to an infertility specialist. Most did not provide educational materials to patients and only 35% felt that available materials were relevant for HCT. Notable barriers to discussing FP included perception that patients were too ill to delay transplant (63%), patients were already infertile from prior therapy (92%) and time constraints (41%). Pediatric HCT physicians and physicians with access to an infertility specialist were more likely to discuss FP and to discuss FP even when prognosis was poor. On analyses that considered physician demographics, knowledge and perceptions as predictors of referral for FP, access to an infertility specialist and belief that patients were interested in FP were observed to be significant. We highlight variation in HCT physician perceptions and practices regarding FP. Physicians are generally interested in discussing fertility issues with their patients but lack educational materials.
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Affiliation(s)
- A W Loren
- Abramson Cancer Center University of Pennsylvania Medical Center, Philadelphia, PA, USA
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Meppiel E, Crassard I, De Latour RP, Chabriat H, Socie G, Bousser MG. C0165 Cerebral venous thrombosis and paroxysmal nocturnal hemoglobinuria: A series of 12 cases. Thromb Res 2012. [DOI: 10.1016/j.thromres.2012.08.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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21
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Majhail NS, Rizzo JD, Lee SJ, Aljurf M, Atsuta Y, Bonfim C, Burns LJ, Chaudhri N, Davies S, Okamoto S, Seber A, Socie G, Szer J, Van Lint MT, Wingard JR, Tichelli A. Recommended screening and preventive practices for long-term survivors after hematopoietic cell transplantation. Hematol Oncol Stem Cell Ther 2012; 5:1-30. [PMID: 22446607 DOI: 10.5144/1658-3876.2012.1] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (eg, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri-, and posttransplant exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplantation experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
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Affiliation(s)
- N S Majhail
- National Marrow Donor Program, Minneapolis, MN 55413-1753, USA.
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22
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Meppiel E, Crassard I, Peffault de Latour R, Socie G, Bousser MG. Cerebral Venous Thrombosis and Paroxysmal Nocturnal Hemoglobinuria: A Retrospective Study on Twelve Cases (P07.013). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.013] [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: 11/15/2022] Open
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23
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Giustiniani J, Sabour-Alaoui S, Bernard J, Olive D, Bos C, Razafindratsita A, Petropoulou A, de Latour R, Le Bouteiller P, Bagot M, Socie G, Bensussan A, Marie-Cardine A. Possible Pathogenic Role of the Transmembrane Isoform of CD160 NK Lymphocyte Receptor in Paroxysmal Nocturnal Hemoglobinuria. Curr Mol Med 2012; 12:188-98. [DOI: 10.2174/156652412798889081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/21/2011] [Accepted: 11/26/2011] [Indexed: 11/22/2022]
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24
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Spyridonidis A, Labopin M, Schmid C, Volin L, Yakoub-Agha I, Stadler M, Milpied N, Socie G, Browne P, Lenhoff S, Sanz MA, Aljurf M, Mohty M, Rocha V. Outcomes and prognostic factors of adults with acute lymphoblastic leukemia who relapse after allogeneic hematopoietic cell transplantation. An analysis on behalf of the Acute Leukemia Working Party of EBMT. Leukemia 2012; 26:1211-7. [PMID: 22290066 DOI: 10.1038/leu.2011.351] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To describe outcomes, treatment and prognostic factors that influence survival of adult patients with acute lymphoblastic leukemia (ALL), who relapsed after allogeneic hematopoietic cell transplantation (HCT), we retrospectively analyzed 465 ALL adult patients from European Group for Blood and Marrow Transplantation (EBMT) centers who relapsed after a first HCT performed in complete remission (CR1 65%, CR2/3 35%). Salvage treatments were: supportive care (13%), cytoreductive therapy (43%), donor lymphocyte infusion without or with prior chemotherapy (23%) and second HCT (20%). Median time from HCT to relapse was 6.9 months, median follow-up was 46 months and median survival after relapse was 5.5 months. Estimated 1-, 2- and 5-year post-relapse survival was 30 ± 2%, 16 ± 2% and 8 ± 1%, respectively. In a multivariate analysis, adverse factors for survival were: late CR (CR2/3) at transplant (P<0.012), early relapse after transplant (<6.9 months, P <0.0001) and peripheral blast percent at relapse (P <0.0001). On the basis of multivariate model for survival, three groups of patients were identified with estimated 2 year survival of 6 ± 2, 17 ± 3 and 30 ± 7%. Outcome of ALL patients relapsing after HCT is dismal and there is a need for new therapies. Our study provides the standard expectations in ALL relapse and may help in the decision of post-relapse therapy.
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Affiliation(s)
- A Spyridonidis
- Division of Hematology , BMT Unit, University of Patras, Patras, Greece.
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De Masson A, Bouaziz JD, Rybojad M, Peffault de Latour R, Robin M, Rodriguez-Otero P, Durant C, Socie G, Bagot M. EF/SSc overlap syndrome and aplastic anaemia resistant to immunosuppressive therapy. Rheumatology (Oxford) 2012; 51:762-4. [DOI: 10.1093/rheumatology/ker406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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26
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Konopacki J, Porcher R, Robin M, Bieri S, Cayuela JM, Larghero J, Xhaard A, Andreoli AL, Dhedin N, Petropoulou A, Rodriguez-Otero P, Ribaud P, Moins-Teisserenc H, Carmagnat M, Toubert A, Chalandon Y, Socie G, Peffault de Latour R. Long-term follow up after allogeneic stem cell transplantation in patients with severe aplastic anemia after cyclophosphamide plus antithymocyte globulin conditioning. Haematologica 2011; 97:710-6. [PMID: 22180425 DOI: 10.3324/haematol.2011.050096] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Due to increased rates of secondary solid organ cancer in patients with severe aplastic anemia who received an irradiation-based conditioning regimen, we decided some years ago to use the combination of cyclophosphamide and antithymocyte globulin. We report the long-term follow up of patients who underwent hematopoietic stem cell transplantation from an HLA-matched sibling donor after this conditioning regimen. DESIGN AND METHODS We analyzed 61 consecutive patients transplanted from June 1991 to February 2010, following conditioning with cyclophosphamide (200 mg/kg) and antithymocyte globulin (2.5 mg/kg/day × 5 days). RESULTS Median age was 21 years (range 4-43); 41 of the 61 patients were adults. Median duration of the disease before hematopoietic stem cell transplantation was 93 days. All but 2 patients received bone marrow as the source of stem cells and all but 2 engrafted. Cumulative incidence of acute grade II-IV graft-versus-host disease was 23% (95%CI 13-34) and 18 developed chronic graft-versus-host disease (cumulative incidence 32% at 72 months, 95% CI 20-46). In multivariate analysis, a higher number of infused CD3 cells was associated with an increased risk of developing chronic graft-versus-host disease (P = 0.017). With a median follow up of 73 months (range 8-233), the estimated 6-year overall survival was 87% (95% CI 78-97). At 72 months, the cumulative incidence of avascular necrosis was 21% and 12 patients presented with endocrine dysfunction (cumulative incidence of 19%). Only one patient developed a secondary malignancy (Hodgkin's lymphoma) during follow up. CONCLUSIONS Cyclophosphamide and antithymocyte globulin is an effective conditioning regimen for patients with severe aplastic anemia and is associated with low treatment-related mortality. Long-term complications include avascular necrosis and endocrine dysfunction.
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27
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Lorillon G, Robin M, Meignin V, Ribaud P, Lescoeur B, Gossot D, Socie G, Tazi A, Bergeron A. Rituximab in bronchiolitis obliterans after haematopoietic stem cell transplantation. Eur Respir J 2011; 38:470-2. [DOI: 10.1183/09031936.00003711] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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28
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Quentin S, Cuccuini W, Ceccaldi R, Nibourel O, Pondarre C, Pages MP, de Latour RP, Rocha V, Michallet M, Schneider P, Michel G, Baruchel A, Sigaux F, Gluckman E, Leblanc T, Stoppa-Lyonnet D, Preudhomme C, Socie G, Soulier J. 260 Myelodysplasia and leukemia of Fanconi anemia are associated with a specific pattern of genomic abnormalities that includes RUNX1/AML1 lesions. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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Ceccaldi R, Briot D, Larghero J, Vasquez N, Noguera ME, Waisfisz Q, Pondarre C, Leblanc T, Gluckman E, Joenje H, Stoppa-Lyonnet D, Socie G, Soulier J. 40 Spontaneous abrogation of a DNA damage checkpoint has clinical benefit but promotes MDS/AML in Fanconi anemia. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70042-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Michallet M, Sobh M, Morisset S, Mohty M, Socie G, Tabrizi R, Milpied N, Bordigoni P, Tedone N, Bay J, Blaise D. Rituximab in Allogeneic Hematopoietic Stem Cell Transplantation for Advanced Chronic Lymphocytic Leukemia With Fludarabine + Total Body Irradiation Conditioning: Results of a Phase II Prospective Multicenter Study (Itac 02-02). Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.440] [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: 11/30/2022]
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Finke J, Schmoor C, Bethge W, Ottinger H, Stelljes M, Zander A, Volin L, Heim D, Schwerdtfeger R, Bertz H, Grichina O, Socie G. Prognostic Factors in Allogeneic Hematopoietic Cell Transplantation From Matched Unrelated Donors: Lessons From Extended Follow Up of a Randomized Trial on GVHD Prophylaxis With or Without Anti T-Cell Globulin ATG-Fresenius (ATG-F). Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Majhail N, Quinn G, Brzauskas R, Wang Z, Chow E, Gilleece M, Halter J, Joshi S, Pidala J, Bolwell B, Jacobsohn D, Socie G, Sorror M, Wingard J, Rizzo J, Loren A. Transplant Physician Perceptions and Practice Patterns Regarding Fertility Preservation in Hematopoietic-Cell Transplant (HCT) Recipients. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lissandre S, Bay JO, Cahn JY, Porcher R, Cacheux V, Cabrespine A, Cornillon J, Cassinat B, Peffault de Latour R, Socie G, Robin M. Retrospective study of allogeneic haematopoietic stem-cell transplantation for myelofibrosis. Bone Marrow Transplant 2010; 46:557-61. [DOI: 10.1038/bmt.2010.276] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cavazzana-Calvo M, Payen E, Negre O, Wang G, Hehir K, Fusil F, Down J, Denaro M, Brady T, Westerman K, Cavallesco R, Gillet-Legrand B, Caccavelli L, Sgarra R, Maouche-Chrétien L, Bernaudin F, Girot R, Dorazio R, Mulder GJ, Polack A, Bank A, Soulier J, Larghero J, Kabbara N, Dalle B, Gourmel B, Socie G, Chrétien S, Cartier N, Aubourg P, Fischer A, Cornetta K, Galacteros F, Beuzard Y, Gluckman E, Bushman F, Hacein-Bey-Abina S, Leboulch P. Transfusion independence and HMGA2 activation after gene therapy of human β-thalassaemia. Nature 2010; 467:318-22. [PMID: 20844535 DOI: 10.1038/nature09328] [Citation(s) in RCA: 941] [Impact Index Per Article: 67.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 06/28/2010] [Indexed: 12/12/2022]
Abstract
The β-haemoglobinopathies are the most prevalent inherited disorders worldwide. Gene therapy of β-thalassaemia is particularly challenging given the requirement for massive haemoglobin production in a lineage-specific manner and the lack of selective advantage for corrected haematopoietic stem cells. Compound β(E)/β(0)-thalassaemia is the most common form of severe thalassaemia in southeast Asian countries and their diasporas. The β(E)-globin allele bears a point mutation that causes alternative splicing. The abnormally spliced form is non-coding, whereas the correctly spliced messenger RNA expresses a mutated β(E)-globin with partial instability. When this is compounded with a non-functional β(0) allele, a profound decrease in β-globin synthesis results, and approximately half of β(E)/β(0)-thalassaemia patients are transfusion-dependent. The only available curative therapy is allogeneic haematopoietic stem cell transplantation, although most patients do not have a human-leukocyte-antigen-matched, geno-identical donor, and those who do still risk rejection or graft-versus-host disease. Here we show that, 33 months after lentiviral β-globin gene transfer, an adult patient with severe β(E)/β(0)-thalassaemia dependent on monthly transfusions since early childhood has become transfusion independent for the past 21 months. Blood haemoglobin is maintained between 9 and 10 g dl(-1), of which one-third contains vector-encoded β-globin. Most of the therapeutic benefit results from a dominant, myeloid-biased cell clone, in which the integrated vector causes transcriptional activation of HMGA2 in erythroid cells with further increased expression of a truncated HMGA2 mRNA insensitive to degradation by let-7 microRNAs. The clonal dominance that accompanies therapeutic efficacy may be coincidental and stochastic or result from a hitherto benign cell expansion caused by dysregulation of the HMGA2 gene in stem/progenitor cells.
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Affiliation(s)
- Marina Cavazzana-Calvo
- Clinical Investigation Center in Biotherapy, Groupe Hospitalier Universitaire Ouest, Inserm/Assistance Publique-Hôpitaux de Paris, Paris 75015, France
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Karlin L, Arnulf B, Chevret S, Ades L, Robin M, De Latour RP, Malphettes M, Kabbara N, Asli B, Rocha V, Fermand JP, Socie G. Tandem autologous non-myeloablative allogeneic transplantation in patients with multiple myeloma relapsing after a first high dose therapy. Bone Marrow Transplant 2010; 46:250-6. [DOI: 10.1038/bmt.2010.90] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Mohty M, Blaise D, Milpied N, Michallet M, Vernant J, Fegueux N, Guilhot F, Rio B, Gratecos N, Cahn J, Socie G, Yakoub-Agha I, Huynh A, Francois S, Bay J, Cordonnier C, Buzyn A, Contentin N, Deconinck E, Chevallier P. Reduced-Intensity Conditioning (RIC) Allogeneic Stem Cell Transplantation (allo-SCT) For Patients Aged ≥60 Years: A Retrospective Analysis Of 629 Patients From The Societe Francaise de Greffe de Moelle et de Therapie Cellulaire (SFGM-TC). Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mohty M, Labopin M, Basara N, Cornelissen J, Tabrizi R, Malm C, Perez-Simon J, Nagler A, Kroger N, Rio B, Martino R, Eder M, Bilger K, Bunjes D, Socie G, Blaise D, Polge E, Rocha V. Association Between The Hematopoietic Cell Transplantation-Specific Comorbidity Index (CIn) And Non-Relapse Mortality (NRM) After Reduced Intensity Conditioning (RIC) Allogeneic Stem Cell Transplantation (Allo-SCT) For Acute Myeloid Leukemia (AML) In First Complete Remission (CR1). Biol Blood Marrow Transplant 2010. [DOI: 10.1016/j.bbmt.2009.12.375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mohty M, Balere M, Socie G, Milpied N, Ifrah N, Harousseau JL, Michallet M, Blaise D, Esperou H, Yakoub-Agha I. Effect of antithymocyte globulins (ATG) as part of the myeloablative conditioning (MAC) regimen on the risk of severe graft-versus-host disease (GVHD) after allogeneic stem cell transplantation (allo-SCT) from matched-unrelated donors (MUD). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7025 Here, we report the results of a multicenter retrospective study analyzing the effect of ATG, incorporated within the MAC regimen for MUD-transplants in leukemic patients. The purpose of the study was to compare the incidence and severity of acute and chronic GVHD as well as overall outcome. 171 adult patients with acute leukemia and MDS, for whom detailed allelic HLA typing (4 digits) was available, were included. 81% of patients were transplanted from 10/10 allelic MUD, and 19% from a MUD with at least one allelic difference. 120 patients (70%) did not receive ATG (no-ATG group), while 51 patients received ATG (ATG group; thymoglobuline* in all cases) as part of the MAC regimen. Except for a significantly higher number of allelic differences between recipient and donor (33% vs. 13%; p = 0.002), the no-ATG and ATG groups were strictly comparable. With a median follow-up of 30.3 (range, 2.6–68.1) months, grade 0–1 and 2–4 acute GVHD occurred in 74 (46%) and 88 patients (54%) respectively, with grade 3–4 acute GVHD being significantly lower in the ATG group (18% vs. 32%; p = 0.04). Extensive chronic GVHD was significantly lower in the ATG group (5% vs. 33%; p = 0.001). Patients from the ATG group had a higher incidence of limited chronic GVHD (33% vs. 18%; p = 0.06). Moreover, infection-related mortality was comparable between both groups (23% vs. 27%, p = NS). Also, NRM was comparable between both groups (30% vs. 29%; p = NS). In multivariate analysis, an HLA allelic mismatch and the non-use of ATG were associated with an increased risk of grade 3–4 acute GVHD (RR = 2.80, 95% CI, 1.5–5.3, p = 0.001; and RR = 2.4, 95% CI, 1.1–5.0, p = 0.02 respectively). Similarly, multivariate analysis showed that the absence of use of ATG was the unique parameter associated with an increased risk of extensive chronic GVHD (RR = 6.9; 95% CI, 1.7–29.0, p = 0.008). Finally, LFS and OS at 2 years were not significantly different between the no-ATG and ATG group (48.8% vs. 41.3%, p = NS; and 53.6% vs. 54.3%, p = NS; respectively). These results suggest a global long-term beneficial effect of ATG when used as part of the MAC regimen prior to allo-SCT from MUD (especially in the HLA mismatch setting). No significant financial relationships to disclose.
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Affiliation(s)
- M. Mohty
- CHU de Nantes, Nantes, France; Agence de Biomedecine, Paris, France; CHU St Louis, Paris, France; CHU de Bordeaux, Bordeaux, France; CHU d'Angers, Angers, France; CRLCC Gauducheau, Nantes, France; CHU de Lyon, Lyon, France; Institut Paoli-Calmettes, Marseille, France; CHRU, Lille, France
| | - M. Balere
- CHU de Nantes, Nantes, France; Agence de Biomedecine, Paris, France; CHU St Louis, Paris, France; CHU de Bordeaux, Bordeaux, France; CHU d'Angers, Angers, France; CRLCC Gauducheau, Nantes, France; CHU de Lyon, Lyon, France; Institut Paoli-Calmettes, Marseille, France; CHRU, Lille, France
| | - G. Socie
- CHU de Nantes, Nantes, France; Agence de Biomedecine, Paris, France; CHU St Louis, Paris, France; CHU de Bordeaux, Bordeaux, France; CHU d'Angers, Angers, France; CRLCC Gauducheau, Nantes, France; CHU de Lyon, Lyon, France; Institut Paoli-Calmettes, Marseille, France; CHRU, Lille, France
| | - N. Milpied
- CHU de Nantes, Nantes, France; Agence de Biomedecine, Paris, France; CHU St Louis, Paris, France; CHU de Bordeaux, Bordeaux, France; CHU d'Angers, Angers, France; CRLCC Gauducheau, Nantes, France; CHU de Lyon, Lyon, France; Institut Paoli-Calmettes, Marseille, France; CHRU, Lille, France
| | - N. Ifrah
- CHU de Nantes, Nantes, France; Agence de Biomedecine, Paris, France; CHU St Louis, Paris, France; CHU de Bordeaux, Bordeaux, France; CHU d'Angers, Angers, France; CRLCC Gauducheau, Nantes, France; CHU de Lyon, Lyon, France; Institut Paoli-Calmettes, Marseille, France; CHRU, Lille, France
| | - J. L. Harousseau
- CHU de Nantes, Nantes, France; Agence de Biomedecine, Paris, France; CHU St Louis, Paris, France; CHU de Bordeaux, Bordeaux, France; CHU d'Angers, Angers, France; CRLCC Gauducheau, Nantes, France; CHU de Lyon, Lyon, France; Institut Paoli-Calmettes, Marseille, France; CHRU, Lille, France
| | - M. Michallet
- CHU de Nantes, Nantes, France; Agence de Biomedecine, Paris, France; CHU St Louis, Paris, France; CHU de Bordeaux, Bordeaux, France; CHU d'Angers, Angers, France; CRLCC Gauducheau, Nantes, France; CHU de Lyon, Lyon, France; Institut Paoli-Calmettes, Marseille, France; CHRU, Lille, France
| | - D. Blaise
- CHU de Nantes, Nantes, France; Agence de Biomedecine, Paris, France; CHU St Louis, Paris, France; CHU de Bordeaux, Bordeaux, France; CHU d'Angers, Angers, France; CRLCC Gauducheau, Nantes, France; CHU de Lyon, Lyon, France; Institut Paoli-Calmettes, Marseille, France; CHRU, Lille, France
| | - H. Esperou
- CHU de Nantes, Nantes, France; Agence de Biomedecine, Paris, France; CHU St Louis, Paris, France; CHU de Bordeaux, Bordeaux, France; CHU d'Angers, Angers, France; CRLCC Gauducheau, Nantes, France; CHU de Lyon, Lyon, France; Institut Paoli-Calmettes, Marseille, France; CHRU, Lille, France
| | - I. Yakoub-Agha
- CHU de Nantes, Nantes, France; Agence de Biomedecine, Paris, France; CHU St Louis, Paris, France; CHU de Bordeaux, Bordeaux, France; CHU d'Angers, Angers, France; CRLCC Gauducheau, Nantes, France; CHU de Lyon, Lyon, France; Institut Paoli-Calmettes, Marseille, France; CHRU, Lille, France
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Holler E, Rogler G, Brenmoehl J, Hahn J, Greinix H, Dickinson AM, Socie G, Wolff D, Finke J, Fischer G, Jackson G, Rocha V, Hilgendorf I, Eissner G, Marienhagen J, Andreesen R. The role of genetic variants of NOD2/CARD15, a receptor of the innate immune system, in GvHD and complications following related and unrelated donor haematopoietic stem cell transplantation. Int J Immunogenet 2009; 35:381-4. [PMID: 18976442 DOI: 10.1111/j.1744-313x.2008.00795.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Previous studies from our group indicated a role of SNPs within the innate immunity receptor NOD2/CARD15 as a risk factor for GvHD and treatment-related mortality allogeneic stem cell transplantation from HLA-identical siblings. We now extended these studies to assess the role of NOD2/CARD15 SNPs in 342 unrelated donor transplants. Overall, presence of any SNPs in patients or donor resulted in an increased risk of severe GvHD (25% in wildtype versus 38% in recipients and donors with variants, P= 0.01), which did not translate in increased mortality. When the analysis was broken down to individual SNPs, the presence of a SNP13 in the donor turned out to be the only highly significant risk factor (GvHD III/IV 22% wt, 42% SNP13 donor, P < 0.004; TRM 33% wt versus 59% SNP13 donor, P= 0.01; overall survival 49% wt versus 26% SNP13 donor, P= 0.007). This association was confirmed in multivariate analysis. Analysis of clinical risk factors suggested that this effect was most prominent in patients receiving any form of T cell depletion. Thus our observation indicates that the presence of a defect in innate immunity signalling in donor monocytes and possibly antigen presenting cells is most prominent in patients having additional T cell deficiency.
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Affiliation(s)
- E Holler
- Department of Haematology/Oncology, University of Regensburg, Regensburg, Germany.
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Bacigalupo A, Locatelli F, Lanino E, Marsh J, Socie G, Passweg J. Fludarabine, Cyclophosphamide with or without Low Dose TBI for Alternative Donor Transplants in Acquired Aplastic Anemia (SAA): A Report From the EBMT-SAA Working Party. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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41
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Mohty M, Balere M, Socie G, Milpied N, Ifrah N, Kuentz M, Harousseau J, Vernant J, Michallet M, Buzyn A, Cahn J, Bourhis J, Blaise D, Raffoux C, Esperou H, Yakoub-Agha I. Antithymocyte Globulins (ATG) As Part Of The Myeloablative Conditioning (MAC) Regimen Can Reduce The Risk Of Severe Graft-Vs.-Host Disease (GVHD) After Allogeneic Stem Cell Transplantation (allo-SCT) From Matched-Unrelated Donors (MUD) [A SFGM-TC Study]. Biol Blood Marrow Transplant 2009. [DOI: 10.1016/j.bbmt.2008.12.369] [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]
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Rocha V, Porcher R, Fernandes JF, Filion A, Bittencourt H, Silva W, Vilela G, Zanette DL, Ferry C, Larghero J, Devergie A, Ribaud P, Skvortsova Y, Tamouza R, Gluckman E, Socie G, Zago MA. Association of drug metabolism gene polymorphisms with toxicities, graft-versus-host disease and survival after HLA-identical sibling hematopoietic stem cell transplantation for patients with leukemia. Leukemia 2008; 23:545-56. [DOI: 10.1038/leu.2008.323] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kabbara N, Lacroix C, Peffault de Latour R, Socie G, Ghannoum M, Ribaud P. Breakthrough C. parapsilosis and C. guilliermondii blood stream infections in allogeneic hematopoietic stem cell transplant recipients receiving long-term caspofungin therapy. Haematologica 2008; 93:639-40. [DOI: 10.3324/haematol.11149] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Oudot C, Auclerc MF, Levy V, Porcher R, Piguet C, Perel Y, Gandemer V, Debre M, Vermylen C, Pautard B, Berger C, Schmitt C, Leblanc T, Cayuela JM, Socie G, Michel G, Leverger G, Baruchel A. Prognostic factors for leukemic induction failure in children with acute lymphoblastic leukemia and outcome after salvage therapy: the FRALLE 93 study. J Clin Oncol 2008; 26:1496-503. [PMID: 18349402 DOI: 10.1200/jco.2007.12.2820] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To identify prognostic factors and to evaluate the outcome of children with acute lymphoblastic leukemia (ALL) failure after induction therapy. PATIENTS AND METHODS Between June 1993 and December 1999, 1,395 leukemic children were included in the French Acute Lymphoblastic Leukemia 93 study. RESULTS Fifty-three patients (3.8%) had a leukemic induction failure (LIF) after three- or four-drug induction therapy. In univariate analysis, high WBC count (P = .001), mediastinal mass (P = .017), T-cell phenotype (T-ALL; P = .001), t(9;22) translocation (P = .001), and a slow early response (at day 8 and/or on day 21, P = .001) were predictive of LIF. The following three prognostic groups for LIF were identified by multivariate analysis: a low-risk group with B-cell progenitor (BCP) ALL without t(9;22) (odds ratio [OR] = 1), an intermediate-risk group with T-ALL and a mediastinal mass (OR = 7.4, P < .0001), and a high-risk group with BCP-ALL and t(9;22) or T-ALL without a mediastinal mass (OR = 28.4, P < .0001). Complete remission (CR) was subsequently obtained in 43 patients (81%). The 5-year overall survival (OS) rate of the 53 patients was 30% +/- 6%. The 5-year OS rate among allogeneic graft recipients, autologous graft recipients, and after chemotherapy were 30.4% +/- 9.6% (50% +/- 26% after genoidentical transplantation), 50% +/- 17.7%, and 41.7% +/- 14.2%, respectively (P = .18). Fourteen patients (26%) were still in first CR after a median of 83 months (range, 53 to 117 months). CONCLUSION Three risk categories for LIF in children with ALL were identified. Approximately one third of patients with LIF can be successfully treated with salvage therapy overall. Subsequent CR after LIF is mandatory for cure.
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Affiliation(s)
- Caroline Oudot
- Service d'Hématologie et Oncologie Pédiatrique, Hôpital Mère-Enfant, Limoges, France
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Leitch E, Harrold J, Ironside A, Norden J, Jackson G, Holler E, Rocha V, Socie G, Hromadnikova I, Sedlacek P, Greinix H, Wolff D, Urbano-Ispizua A, Dickinson A. 28: IL13 +2044 (Arg130Gln) Associates with Acute and Chronic Graft-Versus-Host Disease Following Haematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2008. [DOI: 10.1016/j.bbmt.2007.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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46
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Bergeron A, Feuillet S, Meignin V, Socie G, Tazi A. Les complications pulmonaires tardives non infectieuses après allogreffe de cellules souches hématopoïétiques. Rev Mal Respir 2008; 25:173-83. [DOI: 10.1016/s0761-8425(08)71515-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Bernaudin F, Socie G, Kuentz M, Chevret S, Duval M, Bertrand Y, Vannier JP, Yakouben K, Thuret I, Bordigoni P, Fischer A, Lutz P, Stephan JL, Dhedin N, Plouvier E, Margueritte G, Bories D, Verlhac S, Esperou H, Coic L, Vernant JP, Gluckman E. Long-term results of related myeloablative stem-cell transplantation to cure sickle cell disease. Blood 2007; 110:2749-56. [PMID: 17606762 DOI: 10.1182/blood-2007-03-079665] [Citation(s) in RCA: 351] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Allogeneic hematopoietic stem-cell transplantation (HSCT) is the only curative treatment for sickle cell disease (SCD); nevertheless, its use has been limited by the risk of transplantation-related mortality (TRM). Between November 1988 and December 2004, 87 consecutive patients with severe SCD ranging from 2 to 22 years of age received transplants in France. Cerebral vasculopathy was the principal indication for transplantation (55 patients). All the patients received grafts from a sibling donor after a myeloablative conditioning regimen (CR). The only change in the CR during the study period was the introduction of antithymocyte globulin (ATG) in March 1992. The rejection rate was 22.6% before the use of ATG but 3% thereafter. With a median follow-up of 6 years (range, 2.0 to 17.9 years), the overall and event-free survival (EFS) rates were 93.1% and 86.1%, respectively. Graft versus host disease (GVHD) was the main cause of TRM. Importantly, cord blood transplant recipients did not develop GVHD. No new ischemic lesions were detected after engraftment, and cerebral velocities were significantly reduced. The outcome improved significantly with time: the EFS rate among the 44 patients receiving transplants after January 2000 was 95.3%. These results indicate that HLA-identical sibling HSCT after myeloablative conditioning with ATG should be considered as a standard of care for SCD children who are at high risk for stroke.
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Affiliation(s)
- Françoise Bernaudin
- Reference Center for Sickle Cell Disease, Intercommunal Hospital, Créteil, France.
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48
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Medeiros R, Rameix-Welti MA, Lorin V, Ribaud P, Manuguerra JC, Socie G, Scieux C, Naffakh N, Van Der Werf S. Failure of Zanamivir Therapy for Pneumonia in a Bone-Marrow Transplant Recipient Infected by a Zanamivir-Sensitive Influenza a (H1N1) Virus. Antivir Ther 2007. [DOI: 10.1177/135965350701200401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Influenza A viruses are responsible for significant morbidity and mortality after bone marrow transplantation. Here we report failure of inhaled zanamivir treatment in a bone-marrow transplant recipient with pneumonia caused by an influenza A (H1N1) virus, although the influenza viruses isolated from bronchoalveolar lavages before and after treatment were clearly found to be sensitive to zanamivir using cell-based and enzymatic assays. Subsequent oral treatment with oseltamivir allowed complete recovery. Poor bioavailability of zanamivir in the peripheral lungs might have been limiting treatment efficacy in such an immunocompromised patient.
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Affiliation(s)
- Rita Medeiros
- Unité de Génétique Moléculaire des Virus Respiratoires, URA CNRS 1966, Université Paris 7 EA302, Centre National de Référence du virus influenzae (Région Nord), Institut Pasteur, Paris, France
| | - Marie-Anne Rameix-Welti
- Unité de Génétique Moléculaire des Virus Respiratoires, URA CNRS 1966, Université Paris 7 EA302, Centre National de Référence du virus influenzae (Région Nord), Institut Pasteur, Paris, France
| | - Valérie Lorin
- Unité de Génétique Moléculaire des Virus Respiratoires, URA CNRS 1966, Université Paris 7 EA302, Centre National de Référence du virus influenzae (Région Nord), Institut Pasteur, Paris, France
| | - Patricia Ribaud
- Service d'Hématologie-Greffe de Moelle, AP-HP Hôpital Saint-Louis, Paris, France
| | - Jean-Claude Manuguerra
- Unité de Génétique Moléculaire des Virus Respiratoires, URA CNRS 1966, Université Paris 7 EA302, Centre National de Référence du virus influenzae (Région Nord), Institut Pasteur, Paris, France
| | - Gérard Socie
- Service d'Hématologie-Greffe de Moelle, AP-HP Hôpital Saint-Louis, Paris, France
| | - Catherine Scieux
- Laboratoire de Virologie, AP-HP Hôpital Saint-Louis, Paris, France
| | - Nadia Naffakh
- Unité de Génétique Moléculaire des Virus Respiratoires, URA CNRS 1966, Université Paris 7 EA302, Centre National de Référence du virus influenzae (Région Nord), Institut Pasteur, Paris, France
| | - Sylvie Van Der Werf
- Unité de Génétique Moléculaire des Virus Respiratoires, URA CNRS 1966, Université Paris 7 EA302, Centre National de Référence du virus influenzae (Région Nord), Institut Pasteur, Paris, France
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49
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Medeiros R, Rameix-Welti MA, Lorin V, Ribaud P, Manuguerra JC, Socie G, Scieux C, Naffakh N, van der Werf S. Failure of zanamivir therapy for pneumonia in a bone-marrow transplant recipient infected by a zanamivir-sensitive influenza A (H1N1) virus. Antivir Ther 2007; 12:571-6. [PMID: 17668567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Influenza A viruses are responsible for significant morbidity and mortality after bone marrow transplantation. Here we report failure of inhaled zanamivir treatment in a bone-marrow transplant recipient with pneumonia caused by an influenza A (H1N1) virus, although the influenza viruses isolated from bronchoalveolar lavages before and after treatment were clearly found to be sensitive to zanamivir using cell-based and enzymatic assays. Subsequent oral treatment with oseltamivir allowed complete recovery. Poor bioavailability of zanamivir in the peripheral lungs might have been limiting treatment efficacy in such an immunocompromised patient.
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Affiliation(s)
- Rita Medeiros
- Unité de Génétique Moléculaire des Virus Respiratoires, URA CNRS 1966, Université Paris 7 EA302, Centre National de Référence du virus influenzae (Région Nord), Institut Pasteur, Paris, France
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50
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Pavletic SZ, Lee SJ, Socie G, Vogelsang G. Chronic graft-versus-host disease: implications of the National Institutes of Health consensus development project on criteria for clinical trials. Bone Marrow Transplant 2006; 38:645-51. [PMID: 16980994 DOI: 10.1038/sj.bmt.1705490] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Chronic graft-versus-host disease (GVHD) has been a difficult problem to address and clinical research in this area lags behind other innovations in hematopoietic stem cell transplantation (HCT). Recently the international transplant community has focused more on chronic GVHD. This new focus is well represented by the development of the National Institutes of Health sponsored chronic GVHD consensus project, which has unified the transplant community's approach to chronic GVHD through the activities of focused working groups. From December 2005 through May 2006, a series of consensus documents have been published addressing the areas of diagnosis and staging, histopathology, strategies for the development and validation of biomarkers, response criteria, ancillary therapy and supportive care and the design of clinical trials. This paper summarizes and discusses these reports, focusing specifically on diagnosis and scoring and response criteria. Although these documents represent a huge effort by the research community, they must be prospectively implemented and validated. These new criteria should advance the standards and uniformity of chronic GVHD clinical research. The ultimate success of this project is dependent on whether these recommendations move the field forward. This is an opportunity for the transplant community to unite and make a significant impact in chronic GVHD.
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Affiliation(s)
- S Z Pavletic
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA.
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