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Roders N, Nakid-Cordero C, Raineri F, Fayon M, Abecassis A, Choisy C, Nelson E, Maillard C, Garrick D, Talbot A, Fermand JP, Arnulf B, Bories JC. Dual Chimeric Antigen Receptor T Cells Targeting CD38 and SLAMF7 with Independent Signaling Demonstrate Preclinical Efficacy and Safety in Multiple Myeloma. Cancer Immunol Res 2024; 12:478-490. [PMID: 38289260 DOI: 10.1158/2326-6066.cir-23-0839] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/29/2023] [Accepted: 01/26/2024] [Indexed: 04/04/2024]
Abstract
Chimeric antigen receptor (CAR) T-cell therapy for multiple myeloma targeting B-cell maturation antigen (BCMA) induces high overall response rates. However, relapse still occurs and novel strategies for targeting multiple myeloma cells using CAR T-cell therapy are needed. SLAMF7 (also known as CS1) and CD38 on tumor plasma cells represent potential alternative targets for CAR T-cell therapy in multiple myeloma, but their expression on activated T cells and other hematopoietic cells raises concerns about the efficacy and safety of such treatments. Here, we used CRISPR/Cas9 deletion of the CD38 gene in T cells and developed DCAR, a double CAR system targeting CD38 and CS1 through activation and costimulation receptors, respectively. Inactivation of CD38 enhanced the anti-multiple myeloma activity of DCAR T in vitro. Edited DCAR T cells showed strong in vitro and in vivo responses specifically against target cells expressing both CD38 and CS1. Furthermore, we provide evidence that, unlike anti-CD38 CAR T-cell therapy, which elicited a rapid immune reaction against hematopoietic cells in a humanized mouse model, DCAR T cells showed no signs of toxicity. Thus, DCAR T cells could provide a safe and efficient alternative to anti-BCMA CAR T-cell therapy to treat patients with multiple myeloma.
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Affiliation(s)
- Nathalie Roders
- INSERM, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis, Université de Paris-Cité, Paris, France
| | - Cecilia Nakid-Cordero
- INSERM, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis, Université de Paris-Cité, Paris, France
| | - Fabio Raineri
- INSERM, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis, Université de Paris-Cité, Paris, France
| | - Maxime Fayon
- INSERM, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis, Université de Paris-Cité, Paris, France
| | - Audrey Abecassis
- INSERM, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis, Université de Paris-Cité, Paris, France
| | - Caroline Choisy
- INSERM, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis, Université de Paris-Cité, Paris, France
| | - Elisabeth Nelson
- INSERM, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis, Université de Paris-Cité, Paris, France
| | | | - David Garrick
- INSERM, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis, Université de Paris-Cité, Paris, France
| | - Alexis Talbot
- INSERM, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis, Université de Paris-Cité, Paris, France
- Immuno-Hematology, Saint-Louis Hospital, Paris, France
| | - Jean-Paul Fermand
- INSERM, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis, Université de Paris-Cité, Paris, France
- Immuno-Hematology, Saint-Louis Hospital, Paris, France
| | - Bertrand Arnulf
- INSERM, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis, Université de Paris-Cité, Paris, France
- Immuno-Hematology, Saint-Louis Hospital, Paris, France
| | - Jean-Christophe Bories
- INSERM, Human Immunology, Pathophysiology, Immunotherapy (HIPI), Institut de Recherche Saint-Louis, Université de Paris-Cité, Paris, France
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Bridoux F, Joly F, Belmouaz M, Fermand JP. Place de l’épuration des chaînes légères dans l’insuffisance rénale aiguë du myélome multiple. Méd Intensive Réa 2021. [DOI: 10.37051/mir-00080] [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: 01/13/2023]
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Fayon M, Martinez-Cingolani C, Abecassis A, Roders N, Nelson E, Choisy C, Talbot A, Bensussan A, Fermand JP, Arnulf B, Bories JC. Bi38-3 is a novel CD38/CD3 bispecific T-cell engager with low toxicity for the treatment of multiple myeloma. Haematologica 2021; 106:1193-1197. [PMID: 32675220 PMCID: PMC8018129 DOI: 10.3324/haematol.2019.242453] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Alexis Talbot
- Immunology-Haematology department, Hôpital Saint-Louis, AP-HP
| | | | | | - Bertrand Arnulf
- Immunology-Haematology department, Hôpital Saint-Louis, AP-HP
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Cohen C, Joly F, Sibille A, Javaugue V, Desport E, Goujon JM, Touchard G, Fermand JP, Sirac C, Bridoux F. Randall-Type Monoclonal Immunoglobulin Deposition Disease: New Insights into the Pathogenesis, Diagnosis and Management. Diagnostics (Basel) 2021; 11:diagnostics11030420. [PMID: 33801393 PMCID: PMC7999117 DOI: 10.3390/diagnostics11030420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022] Open
Abstract
Randall-type monoclonal immunoglobulin deposition disease (MIDD) is a rare disease that belongs to the spectrum of monoclonal gammopathy of renal significance (MGRS). Renal involvement is prominent in MIDD, but extra-renal manifestations can be present and may affect global prognosis. Recent data highlighted the central role of molecular characteristics of nephrotoxic monoclonal immunoglobulins in the pathophysiology of MIDD, and the importance of serum free light chain monitoring in the diagnosis and follow-up disease. Clone-targeted therapy is required to improve the overall and renal survival, and the achievement of a rapid and deep hematological response is the goal of therapy. This review will focus on the recent progress in the pathogenesis and management of this rare disease.
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Affiliation(s)
- Camille Cohen
- Department of Nephrology Hôpital Necker, and INSERM U830 “Stress and Cancer” Laboratory, Institut Curie, 75015 Paris, France
- Correspondence:
| | - Florent Joly
- Department of Nephrology, CHU Poitiers, 86000 Poitiers, France; (F.J.); (A.S.); (V.J.); (E.D.); (G.T.); (F.B.)
- Centre National de Référence Maladies Rares: Amylose AL et Autres Maladies à Dépôts d’Immunoglobulines Monoclonales, 86000 Poitiers, France
| | - Audrey Sibille
- Department of Nephrology, CHU Poitiers, 86000 Poitiers, France; (F.J.); (A.S.); (V.J.); (E.D.); (G.T.); (F.B.)
- Centre National de Référence Maladies Rares: Amylose AL et Autres Maladies à Dépôts d’Immunoglobulines Monoclonales, 86000 Poitiers, France
| | - Vincent Javaugue
- Department of Nephrology, CHU Poitiers, 86000 Poitiers, France; (F.J.); (A.S.); (V.J.); (E.D.); (G.T.); (F.B.)
- Centre National de Référence Maladies Rares: Amylose AL et Autres Maladies à Dépôts d’Immunoglobulines Monoclonales, 86000 Poitiers, France
- INSERM CIC 1402, 86000 Poitiers, France
- CNRS UMR 7276-CRIBL, University of Limoges, 87000 Limoges, France;
| | - Estelle Desport
- Department of Nephrology, CHU Poitiers, 86000 Poitiers, France; (F.J.); (A.S.); (V.J.); (E.D.); (G.T.); (F.B.)
- Centre National de Référence Maladies Rares: Amylose AL et Autres Maladies à Dépôts d’Immunoglobulines Monoclonales, 86000 Poitiers, France
| | | | - Guy Touchard
- Department of Nephrology, CHU Poitiers, 86000 Poitiers, France; (F.J.); (A.S.); (V.J.); (E.D.); (G.T.); (F.B.)
- Department of Pathology, CHU Poitiers, 86000 Poitiers, France;
| | - Jean-Paul Fermand
- Department of Immunology and Hematology, Hôpital Saint Louis, 75010 Paris, France;
| | - Christophe Sirac
- CNRS UMR 7276-CRIBL, University of Limoges, 87000 Limoges, France;
| | - Frank Bridoux
- Department of Nephrology, CHU Poitiers, 86000 Poitiers, France; (F.J.); (A.S.); (V.J.); (E.D.); (G.T.); (F.B.)
- Centre National de Référence Maladies Rares: Amylose AL et Autres Maladies à Dépôts d’Immunoglobulines Monoclonales, 86000 Poitiers, France
- INSERM CIC 1402, 86000 Poitiers, France
- CNRS UMR 7276-CRIBL, University of Limoges, 87000 Limoges, France;
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5
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Javaugue V, Dufour-Nourigat L, Desport E, Sibille A, Moulin B, Bataille P, Bindi P, Garrouste C, Mariat C, Karlin L, Nouvier M, Goujon JM, Gnemmi V, Fermand JP, Touchard G, Bridoux F. Results of a nation-wide cohort study suggest favorable long-term outcomes of clone-targeted chemotherapy in immunotactoid glomerulopathy. Kidney Int 2020; 99:421-430. [PMID: 32739419 DOI: 10.1016/j.kint.2020.06.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 12/12/2022]
Abstract
Immunotactoid glomerulopathy is a rare disease defined by glomerular microtubular immunoglobulin deposits. Since management and long-term outcomes remain poorly described, we retrospectively analyzed results of 27 adults from 21 departments of nephrology in France accrued over 19 years. Inclusion criteria were presence of glomerular Congo red-negative monotypic immunoglobulin deposits with ultrastructural microtubular organization, without evidence for cryoglobulinemic glomerulonephritis. Baseline manifestations of this cohort included: proteinuria (median 6.0 g/day), nephrotic syndrome (70%), microscopic hematuria (74%) and hypertension (56%) with a median serum creatinine of 1.5 mg/dL. Nineteen patients had detectable serum and/or urine monoclonal gammopathy. A bone marrow and/or peripheral blood clonal disorder was identified in 18 cases (16 lymphocytic and 2 plasmacytic disorders). Hematologic diagnosis was chronic/small lymphocytic lymphoma in 13, and monoclonal gammopathy of renal significance in 14 cases. Kidney biopsy showed atypical membranous in 16 or membranoproliferative glomerulonephritis in 11 cases, with microtubular monotypic IgG deposits (kappa in 17 of 27 cases), most commonly IgG1. Identical intracytoplasmic microtubules were observed in clonal lymphocytes from 5 of 10 tested patients. Among 21 patients who received alkylating agents, rituximab-based or bortezomib-based chemotherapy, 18 achieved a kidney response. After a median follow-up of 40 months, 16 patients had sustained kidney response, 7 had reached end-stage kidney disease, and 6 died. Chronic/small lymphocytic lymphoma appears as a common underlying condition in immunotactoid glomerulopathy, but clonal detection remains inconstant with routine techniques in patients with monoclonal gammopathy of renal significance. Thus, early diagnosis and hematological response after clone-targeted chemotherapy was associated with favorable outcomes. Hence, thorough pathologic and hematologic workup is key to the management of immunotactoid glomerulopathy.
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Affiliation(s)
- Vincent Javaugue
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Centre National de la Recherche Scientifique UMR 7276, Institut National de la Santé et de la Recherche Médicale UMR 1262, Contrôle de la réponse immune B et lymphoproliférations, Limoges, France; Department of Nephrology, Centre National de Reference "Amylose AL et autres maladies à dépôt d'immunoglobulines monoclonales," Poitiers, France; Institut National de la Santé et de la Recherche Médicale CIC 1402, Centre Hospitalier Universitaire, Poitiers, France.
| | - Léa Dufour-Nourigat
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Estelle Desport
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Department of Nephrology, Centre National de Reference "Amylose AL et autres maladies à dépôt d'immunoglobulines monoclonales," Poitiers, France
| | - Audrey Sibille
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Department of Nephrology, Centre National de Reference "Amylose AL et autres maladies à dépôt d'immunoglobulines monoclonales," Poitiers, France
| | - Bruno Moulin
- Department of Nephrology, Centre Hospitalier Universitaire, Strasbourg, France
| | - Pierre Bataille
- Department of Nephrology, Centre Hospitalier Général, Boulogne-sur-Mer, France
| | - Pascal Bindi
- Department of Nephrology, Centre Hospitalier Général, Verdun, France
| | - Cyril Garrouste
- Department of Nephrology, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Christophe Mariat
- Department of Nephrology, Centre Hospitalier Universitaire, Saint-Etienne, France
| | - Lionel Karlin
- Department of Clinical Hematology, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre-Benite, France
| | - Mathilde Nouvier
- Department of Nephrology, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre-Benite, France
| | - Jean-Michel Goujon
- Department of Nephrology, Centre National de Reference "Amylose AL et autres maladies à dépôt d'immunoglobulines monoclonales," Poitiers, France; Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Viviane Gnemmi
- Department of Pathology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Jean-Paul Fermand
- Department of Immunology and Hematology, Hôpital Saint Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Guy Touchard
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Department of Nephrology, Centre National de Reference "Amylose AL et autres maladies à dépôt d'immunoglobulines monoclonales," Poitiers, France
| | - Frank Bridoux
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Centre National de la Recherche Scientifique UMR 7276, Institut National de la Santé et de la Recherche Médicale UMR 1262, Contrôle de la réponse immune B et lymphoproliférations, Limoges, France; Department of Nephrology, Centre National de Reference "Amylose AL et autres maladies à dépôt d'immunoglobulines monoclonales," Poitiers, France; Institut National de la Santé et de la Recherche Médicale CIC 1402, Centre Hospitalier Universitaire, Poitiers, France
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6
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Kastritis E, Leleu X, Arnulf B, Zamagni E, Cibeira MT, Kwok F, Mollee P, Hájek R, Moreau P, Jaccard A, Schönland SO, Filshie R, Nicolas-Virelizier E, Augustson B, Mateos MV, Wechalekar A, Hachulla E, Milani P, Dimopoulos MA, Fermand JP, Foli A, Gavriatopoulou M, Klersy C, Palumbo A, Sonneveld P, Johnsen HE, Merlini G, Palladini G. Bortezomib, Melphalan, and Dexamethasone for Light-Chain Amyloidosis. J Clin Oncol 2020; 38:3252-3260. [PMID: 32730181 DOI: 10.1200/jco.20.01285] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [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] Open
Abstract
PURPOSE Oral melphalan and dexamethasone (MDex) were considered a standard of care in light-chain (AL) amyloidosis. In the past decade, bortezomib has been increasingly used in combination with alkylating agents and dexamethasone. We prospectively compared the efficacy and safety of MDex and MDex with the addition of bortezomib (BMDex). METHODS This was a phase III, multicenter, randomized, open-label trial. Patients were stratified according to cardiac stage. Patients with advanced cardiac stage (stage IIIb) amyloidosis were not eligible. The primary end point was hematologic response rate at 3 months. This trial is registered with ClinicalTrials.gov identifier NCT01277016. RESULTS A total of 109 patients, 53 in the BMDex and 56 in the MDex group, received ≥ 1 dose of therapy (from January 2011 to February 2016). Hematologic response rate at 3 months was higher in the BMDex arm (79% v 52%; P = .002). Higher rates of very good partial or complete response rates (64% v 39%; hazard ratio [HR], 2.47; 95% CI, 1.30 to 4.71) and improved overall survival, with a 2-fold decrease in mortality rate (HR, 0.50; 95% CI, 0.27 to 0.90), were observed in the BMDex arm. Grade 3 and 4 adverse events (the most common being cytopenia, peripheral neuropathy, and heart failure) were more common in the BMDex arm, occurring in 20% versus 10% of cycles performed. CONCLUSION BMDex improved hematologic response rate and overall survival. To our knowledge, this is the first time a controlled study has demonstrated a survival advantage in AL amyloidosis. BMDex should be considered a new standard of care for AL amyloidosis.
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Affiliation(s)
- Efstathios Kastritis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Xavier Leleu
- Hopital Huriez Centre Hospitalier Régional Universitaire, Lille, France
| | - Bertrand Arnulf
- Immunohematology Unit, Hospital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Elena Zamagni
- Bologna University School of Medicine, Bologna, Italy
| | - María Teresa Cibeira
- Amyloidosis and Myeloma Unit, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Fiona Kwok
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Peter Mollee
- Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Roman Hájek
- Department of Hemato-oncology, University Hospital, Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | | | | | - Stefan O Schönland
- Medical Department V, Amyloidosis Centre, University Hospital, Heidelberg, Germany
| | - Robin Filshie
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | | | | | - María-Victoria Mateos
- University Hospital of Salamanca, Instituto de Investigación Biosanitaria de Salamanc, Institute of Cancer Molecular and Cellular Biology, Salamanca, Spain
| | - Ashutosh Wechalekar
- University College London Medical School, Royal Free Hospital Campus, London, United Kingdom
| | - Eric Hachulla
- Hopital Huriez Centre Hospitalier Régional Universitaire, Lille, France
| | - Paolo Milani
- Amyloidosis Research and Treatment Center "Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo," Pavia, Italy
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Jean-Paul Fermand
- Immunohematology Unit, Hospital Saint-Louis, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Andrea Foli
- Amyloidosis Research and Treatment Center "Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo," Pavia, Italy
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Catherine Klersy
- Clinical Epidemiology and Biometry Service, "Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo," Pavia, Italy
| | | | | | | | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center "Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo," Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Center "Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo," Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
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7
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Leung N, Bridoux F, Batuman V, Chaidos A, Cockwell P, D'Agati VD, Dispenzieri A, Fervenza FC, Fermand JP, Gibbs S, Gillmore JD, Herrera GA, Jaccard A, Jevremovic D, Kastritis E, Kukreti V, Kyle RA, Lachmann HJ, Larsen CP, Ludwig H, Markowitz GS, Merlini G, Mollee P, Picken MM, Rajkumar VS, Royal V, Sanders PW, Sethi S, Venner CP, Voorhees PM, Wechalekar AD, Weiss BM, Nasr SH. The evaluation of monoclonal gammopathy of renal significance: a consensus report of the International Kidney and Monoclonal Gammopathy Research Group. Nat Rev Nephrol 2019; 15:45-59. [PMID: 30510265 PMCID: PMC7136169 DOI: 10.1038/s41581-018-0077-4] [Citation(s) in RCA: 266] [Impact Index Per Article: 53.2] [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] [Indexed: 02/07/2023]
Abstract
The term monoclonal gammopathy of renal significance (MGRS) was introduced by the International Kidney and Monoclonal Gammopathy Research Group (IKMG) in 2012. The IKMG met in April 2017 to refine the definition of MGRS and to update the diagnostic criteria for MGRS-related diseases. Accordingly, in this Expert Consensus Document, the IKMG redefines MGRS as a clonal proliferative disorder that produces a nephrotoxic monoclonal immunoglobulin and does not meet previously defined haematological criteria for treatment of a specific malignancy. The diagnosis of MGRS-related disease is established by kidney biopsy and immunofluorescence studies to identify the monotypic immunoglobulin deposits (although these deposits are minimal in patients with either C3 glomerulopathy or thrombotic microangiopathy). Accordingly, the IKMG recommends a kidney biopsy in patients suspected of having MGRS to maximize the chance of correct diagnosis. Serum and urine protein electrophoresis and immunofixation, as well as analyses of serum free light chains, should also be performed to identify the monoclonal immunoglobulin, which helps to establish the diagnosis of MGRS and might also be useful for assessing responses to treatment. Finally, bone marrow aspiration and biopsy should be conducted to identify the lymphoproliferative clone. Flow cytometry can be helpful in identifying small clones. Additional genetic tests and fluorescent in situ hybridization studies are helpful for clonal identification and for generating treatment recommendations. Treatment of MGRS was not addressed at the 2017 IKMG meeting; consequently, this Expert Consensus Document does not include any recommendations for the treatment of patients with MGRS. This Expert Consensus Document from the International Kidney and Monoclonal Gammopathy Research Group includes an updated definition of monoclonal gammopathy of renal significance (MGRS) and recommendations for the use of kidney biopsy and other modalities for evaluating suspected MGRS
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Affiliation(s)
- Nelson Leung
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Frank Bridoux
- Department of Nephrology, Centre Hospitalier Universitaire et Université de Poitiers, Poitiers, France; CNRS UMR7276, Limoges, France; and Centre de Référence Amylose AL et Autres Maladies par Dépôt d'Immunoglobulines Monoclonales, Poitiers, France
| | - Vecihi Batuman
- Veterans Administration Medical Center, New Orleans, LA, USA and Tulane University Medical School, Tulane, LA, USA
| | - Aristeidis Chaidos
- Centre for Haematology, Department of Medicine, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Paul Cockwell
- Department of Nephrology, Renal Medicine - University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Vivette D D'Agati
- Department of Pathology, Renal Pathology Laboratory, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Angela Dispenzieri
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Fernando C Fervenza
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jean-Paul Fermand
- Department of Haematology and Immunology, University Hospital St Louis, Paris, France
| | - Simon Gibbs
- The Victorian and Tasmanian Amyloidosis Service, Department of Haematology, Monash Univerity Easter Health Clinical School, Melbourne, Victoria, Australia
| | - Julian D Gillmore
- National Amyloidosis Centre, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Guillermo A Herrera
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Arnaud Jaccard
- Service d'Hématologie et de Thérapie Cellulaire, Centre de Référence des Amyloses Primitives et des Autres Maladies par Dépôts d'Immunoglobuline, CHU Limoges, Limoges, France
| | - Dragan Jevremovic
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine National and Kapodistrian University of Athens Alexandra Hospital, Athens, Greece
| | - Vishal Kukreti
- University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Robert A Kyle
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Helen J Lachmann
- National Amyloidosis Centre, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, Royal Free Campus, University College London, London, UK
| | | | - Heinz Ludwig
- Wilhelminen Cancer Research Institute, Wilhelminenspital, Vienna, Austria
| | - Glen S Markowitz
- Department of Pathology, Renal Pathology Laboratory, Columbia University, College of Physicians and Surgeons, New York, NY, USA
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Peter Mollee
- Haematology Department, Princess Alexandra Hospital and School of Medicine, University of Queensland, Brisbane, Australia
| | - Maria M Picken
- Department of Pathology, Loyola University Medical Center, Maywood, IL, USA
| | - Vincent S Rajkumar
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Virginie Royal
- Department of Pathology, Hôpital Maisonneuve-Rosemont, Université de Montreal, Montreal, Quebec, Canada
| | - Paul W Sanders
- Department of Medicine, University of Alabama at Birmingham and Department of Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Sanjeev Sethi
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Peter M Voorhees
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium System, Charlotte, NC, USA
| | - Ashutosh D Wechalekar
- National Amyloidosis Centre, Centre for Amyloidosis and Acute Phase Proteins, Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Brendan M Weiss
- Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Samih H Nasr
- Division of Nephrology, Hematology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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8
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Jaccard A, Karlin L, Hebraud B, Frenzel L, Choquet S, Mohty M, Dib M, Vincent L, Slama B, Galicier L, Tournilhac O, Belhadj-Merzoug K, Moreau P, Decaux O, Benboubker L, Caillot D, Fontan J, Maisonneuve H, Bender S, Musset L, Fermand JP. A Prospective Phase II Trial of Lenalidomide and Dexamethasone in POEMS Syndrome. Clinical Lymphoma Myeloma and Leukemia 2019. [DOI: 10.1016/j.clml.2019.09.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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Bridoux F, Chevret S, Fermand JP. High cutoff haemodialysis in myeloma cast nephropathy: further investigation is needed. Lancet Haematol 2019; 6:e347. [PMID: 31244474 DOI: 10.1016/s2352-3026(19)30090-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/25/2019] [Indexed: 01/13/2023]
Affiliation(s)
| | - Sylvie Chevret
- Department of Biostatistics and Medical Information, Unite Mixte de Recherche 1153 (ECSTRA Team), Paris Diderot University, Hôpital Saint Louis, Paris, France
| | - Jean-Paul Fermand
- Department of Hematology and Immunology, Hôpital Saint Louis, Paris, France
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10
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Javaugue V, Debiais-Delpech C, Nouvier M, Gand E, Chauvet S, Ecotiere L, Desport E, Goujon JM, Delwail V, Guidez S, Tomowiak C, Leleu X, Jaccard A, Rioux-Leclerc N, Vigneau C, Fermand JP, Touchard G, Thierry A, Bridoux F. Clinicopathological spectrum of renal parenchymal involvement in B-cell lymphoproliferative disorders. Kidney Int 2019; 96:94-103. [PMID: 30987838 DOI: 10.1016/j.kint.2019.01.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/20/2018] [Accepted: 01/04/2019] [Indexed: 01/25/2023]
Abstract
The clinicopathological characteristics of kidney infiltration in B-cell lymphoproliferative disorders remain poorly described. We retrospectively studied 52 adults with biopsy-proven malignant B-cell kidney infiltration, including Waldenström's macroglobulinemia (n=21), chronic lymphocytic leukemia (n=11), diffuse large B-cell lymphoma (DLBCL) (n=8), other lymphoma (n=11), and multiple myeloma (n=1). Kidney disease varied according to the underlying lymphoproliferative disorder. In DLBCL, malignant kidney infiltration was prominent, resulting in acute kidney injury (AKI, 75%) and kidney enlargement (88%). In the other types, associated immunoglobulin-related nephropathy (most commonly AL amyloidosis) was more common (45%), and chronic kidney disease with proteinuria was the primary presentation. All patients received chemotherapy. Over a median follow-up of 31 months, 20 patients died and 21 reached end-stage kidney disease. Renal response, achieved in 25 patients (48%), was associated with higher overall survival (97 vs. 37 months in non-renal responders). In univariate analysis, percentage of sclerotic glomeruli, kidney enlargement, and complete hematological response at 6 months were predictive of renal response. In multivariate analysis, concomitant immunoglobulin-related nephropathy was the sole independent predictor of poor renal outcome. In conclusion, clinical presentation of renal lymphomatous infiltration depends on the nature of the underlying lymphoproliferative disorder. In DLBCL, massive renal infiltration manifests with enlarged kidneys and AKI, and the diagnosis primarily relies on lymph node biopsy. In other B-cell lymphoproliferative disorders, the clinicopathological spectrum is more heterogeneous, with a high frequency of immunoglobulin-related nephropathy that may affect renal outcome; thus kidney biopsy is required for early diagnosis and prognostic assessment.
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Affiliation(s)
- Vincent Javaugue
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; CNRS UMR 7276, INSERM UMR 1262, Université de Limoges, Limoges, France; INSERM CIC 1402, Centre Hospitalier Universitaire, Poitiers, France.
| | - Céline Debiais-Delpech
- Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Mathilde Nouvier
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Elise Gand
- INSERM CIC 1402, Centre Hospitalier Universitaire, Poitiers, France
| | - Sophie Chauvet
- INSERM UMR 1138, Centre de Recherche des Cordeliers, Complement and Diseases Team, Paris, France; Assistance Publique Hôpitaux de Paris, Department of Nephrology, Hôpital Européen Georges Pompidou, Paris, France
| | - Laure Ecotiere
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Estelle Desport
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Jean-Michel Goujon
- Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Vincent Delwail
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Stéphanie Guidez
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Cécile Tomowiak
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Xavier Leleu
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Arnaud Jaccard
- Department of Hematology, Centre Hospitalier Universitaire, Université de Limoges, Limoges, France
| | | | - Cécile Vigneau
- Department of Nephrology, Centre Hospitalier Universitaire, Rennes, France; CNRS UMR 6290, Université Rennes 1, France
| | | | - Guy Touchard
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Antoine Thierry
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; INSERM UMR 1082, Centre Hospitalier Universitaire, Poitiers, France
| | - Frank Bridoux
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; CNRS UMR 7276, INSERM UMR 1262, Université de Limoges, Limoges, France; INSERM CIC 1402, Centre Hospitalier Universitaire, Poitiers, France
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11
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Roupie AL, Battistella M, Talbot A, Jachiet M, Bouaziz JD, Vignon-Pennamen MD, Royer B, Fermand JP, Arnulf B, Harel S. Coexisting cutaneous macroglobulinosis and scleredema of Buschke in a patient with a Waldenström Macroglobulinemia. J Eur Acad Dermatol Venereol 2018; 33:e104-e106. [PMID: 30267590 DOI: 10.1111/jdv.15268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A L Roupie
- Department of Immuno-Hematology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - M Battistella
- Department of Pathology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - A Talbot
- Department of Immuno-Hematology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - M Jachiet
- Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Department of Dermatology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - J D Bouaziz
- Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Department of Dermatology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - M D Vignon-Pennamen
- Department of Pathology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - B Royer
- Department of Immuno-Hematology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - J P Fermand
- Department of Immuno-Hematology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - B Arnulf
- Department of Immuno-Hematology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - S Harel
- Department of Immuno-Hematology, Saint-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale (GEDIM), Hôpital Saint-Louis, 1 avenue Claude Vellefaux, 75010, Paris, France
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12
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Vignon M, Bridoux F, Fermand JP. [Monoclonal gammopathy related disorders]. Rev Prat 2018; 68:792-796. [PMID: 30869335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Monoclonal gammopathy related disorders. The presence of a monoclonal immunoglobulin in serum or urine reflects the existence of an abnormal clone of B cells. In case of large tumor mass, patient need treatment. Sometimes, the clone is nearly undetectable, but gammopathy is associated with complications not directly related to tumor cells but to the presence of the monoclonal immunoglobulin. Most often, lesions result from the deposit of monoclonal immunoglobulin, organized or not. Other mechanisms include autoantibody activity, immune complex formation or deregulation of the complement system. Finally, in some cases, the physiopathology remains to be determined. The downstream complications of gammopathies are protean and can affect various organs, mainly the kidney, the skin and the peripheral nervous system. A delayed diagnosis may be life-threatening or functional. A rigorous clinical examination, and appropriate explorations are therefore necessary in order to put in place a suitable therapy, targeting most often the underlying clone.
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Affiliation(s)
- Marguerite Vignon
- Service d'immunologiehématologie, hôpital Saint-Louis, Paris, France
| | | | - Jean-Paul Fermand
- Service d'immunologiehématologie, hôpital Saint-Louis, Paris, France
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13
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Fermand JP. [Myeloma and other monoclonal gammopathies: a lot of progress and a lot of hopes]. Rev Prat 2018; 68:775-776. [PMID: 30869331] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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14
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Jachiet M, Harel S, Saussine A, Battistella M, Rybojad M, Asli B, Bengoufa D, Mahevas T, Bessis D, Galicier L, Schmutz JL, Hadj-Rabia S, Boutboul D, Lebbé C, Bagot M, Malphettes M, Lipsker D, Fermand JP, Bouaziz JD, Arnulf B. Cutis laxa associated with monoclonal gammopathy: 14 new cases and review of the literature. J Am Acad Dermatol 2018; 79:945-947. [PMID: 29621555 DOI: 10.1016/j.jaad.2018.03.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/22/2018] [Accepted: 03/26/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Marie Jachiet
- Dermatology Department, Assistance Publique Hôpitaux de Paris, Saint-Louis Hospital, Paris, France.
| | - Stéphanie Harel
- Immuno-hematology Department, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Anne Saussine
- Dermatology Department, Assistance Publique Hôpitaux de Paris, Saint-Louis Hospital, Paris, France
| | - Maxime Battistella
- Pathology Department, Saint-Louis Hospital, Paris, France; Université Paris Diderot-Paris VII, Sorbonne Paris Cité, France
| | - Michel Rybojad
- Dermatology Department, Assistance Publique Hôpitaux de Paris, Saint-Louis Hospital, Paris, France
| | - Bouchra Asli
- Immuno-hematology Department, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Thibault Mahevas
- Dermatology Department, Assistance Publique Hôpitaux de Paris, Saint-Louis Hospital, Paris, France
| | - Didier Bessis
- Dermatology Department, Saint-Eloi Hospital, University Hospital of Montpellier, France
| | - Lionel Galicier
- Clinical Immunology Department, Saint-Louis Hospital, Paris, France
| | | | | | - David Boutboul
- Clinical Immunology Department, Saint-Louis Hospital, Paris, France
| | - Céleste Lebbé
- Dermatology Department, Assistance Publique Hôpitaux de Paris, Saint-Louis Hospital, Paris, France; Université Paris Diderot-Paris VII, Sorbonne Paris Cité, France
| | - Martine Bagot
- Dermatology Department, Assistance Publique Hôpitaux de Paris, Saint-Louis Hospital, Paris, France; Université Paris Diderot-Paris VII, Sorbonne Paris Cité, France
| | | | - Dan Lipsker
- Dermatology Department, Strasbourg University Hospital, France
| | - Jean-Paul Fermand
- Immuno-hematology Department, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean-David Bouaziz
- Dermatology Department, Assistance Publique Hôpitaux de Paris, Saint-Louis Hospital, Paris, France; Université Paris Diderot-Paris VII, Sorbonne Paris Cité, France
| | - Bertrand Arnulf
- Immuno-hematology Department, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université Paris Diderot-Paris VII, Sorbonne Paris Cité, France
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15
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Bridoux F, Carron PL, Pegourie B, Alamartine E, Augeul-Meunier K, Karras A, Joly B, Peraldi MN, Arnulf B, Vigneau C, Lamy T, Wynckel A, Kolb B, Royer B, Rabot N, Benboubker L, Combe C, Jaccard A, Moulin B, Knebelmann B, Chevret S, Fermand JP. Effect of High-Cutoff Hemodialysis vs Conventional Hemodialysis on Hemodialysis Independence Among Patients With Myeloma Cast Nephropathy: A Randomized Clinical Trial. JAMA 2017; 318:2099-2110. [PMID: 29209721 PMCID: PMC5820717 DOI: 10.1001/jama.2017.17924] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/06/2017] [Indexed: 11/14/2022]
Abstract
Importance Cast nephropathy is the main cause of acute kidney injury in multiple myeloma and persistent reduction in kidney function strongly affects prognosis. Strategies to rapidly remove nephrotoxic serum-free light chains combined with novel antimyeloma agents have not been evaluated prospectively. Objective To compare the hemodialysis independence rate among patients newly diagnosed with myeloma cast nephropathy treated with hemodialysis using a high-cutoff dialyzer (with very large membrane pores and high permeability to immunoglobulin light chains) or a conventional high-flux dialyzer (with small pores and lower permeability). Design, Setting, and Participants Randomized clinical trial involving 98 patients with biopsy-proven myeloma cast nephropathy requiring hemodialysis treated at 48 French centers between July 2011 and June 2016; the final date of follow-up was June 29, 2016. Interventions Intensive hemodialysis (eight 5-hour sessions over 10 days) with either a high-cutoff dialyzer (46 patients) or a conventional high-flux dialyzer (48 patients). All patients received the same chemotherapy regimen of bortezomib and dexamethasone. Main Outcomes and Measures Primary end point was hemodialysis independence at 3 months; secondary end points: hemodialysis independence rates at 6 and 12 months, hemodialysis- and chemotherapy-related adverse events, and death. Results Among 98 randomized patients, 94 (96%) (median age, 68.8 years [interquartile range, 61.2-75.3 years]; 45% women) were included in the modified intent-to-treat analysis. The hemodialysis independence rate at 3 months was 41.3% (n = 19) in the high-cutoff hemodialysis group vs 33.3% (n = 16) in the conventional hemodialysis group (between-group difference, 8.0% [95% CI, -12.0% to 27.9%], P = .42); at 6 months, the rate was 56.5% (n = 26) vs 35.4% (n = 17), respectively (between-group difference, 21.1% [95% CI, 0.9% to 41.3%], P = .04); and at 12 months, the rate was 60.9% (n = 28) vs 37.5% (n = 18) (between-group difference, 23.4% [95% CI, 3.2% to 43.5%], P = .02). The incidence of hemodialysis-related adverse events was 43% in the high-cutoff hemodialysis group vs 39% in the conventional hemodialysis group; chemotherapy-related serious adverse events, 39% vs 37%, respectively; and at 12 months, 9 patients vs 10 patients died. Conclusions and Relevance Among patients with myeloma cast nephropathy treated with a bortezomib-based chemotherapy regimen, the use of high-cutoff hemodialysis compared with conventional hemodialysis did not result in a statistically significant difference in hemodialysis independence at 3 months. However, the study may have been underpowered to identify an early clinically important difference. Trial Registration clinicaltrials.gov Identifier: NCT01208818.
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Affiliation(s)
- Frank Bridoux
- Department of Nephrology, Institut National de la Santé et de la Recherche Médicale, Centre d’Investigation Clinique 1402, Centre Hospitalier Universitaire, Poitiers, France
- Centre de Référence Maladies Rares, Poitiers, France
- Centre National de la Recherche Scientifique, Unite Mixte de Recherche 7276, Université de Limoges, Limoges, France
| | - Pierre-Louis Carron
- Department of Nephrology, Centre Hospitalier Universitaire, Grenoble, France
| | - Brigitte Pegourie
- Department of Hematology, Centre Hospitalier Universitaire, Grenoble, France
| | - Eric Alamartine
- Department of Nephrology, Centre Hospitalier Universitaire, Saint-Etienne, France
| | | | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Bertrand Joly
- Department of Hematology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Marie-Noëlle Peraldi
- Department of Nephrology, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Bertrand Arnulf
- Department of Hematology and Immunology, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1126, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Cécile Vigneau
- Department of Nephrology, Centre Hospitalier Universitaire, Rennes, France
| | - Thierry Lamy
- Department of Hematology, Centre Hospitalier Universitaire, Rennes, France
| | - Alain Wynckel
- Department of Nephrology, Centre Hospitalier Universitaire, Reims, France
| | - Brigitte Kolb
- Department of Hematology, Centre Hospitalier Universitaire, Reims, France
| | - Bruno Royer
- Department of Hematology, Centre Hospitalier Universitaire, Amiens, France
| | - Nolwenn Rabot
- Department of Nephrology, Centre Hospitalier Universitaire, Tours, France
| | - Lotfi Benboubker
- Department of Hematology, Centre Hospitalier Universitaire, Tours, France
| | - Christian Combe
- Department of Nephrology, Centre Hospitalier Universitaire, Bordeaux, France
| | - Arnaud Jaccard
- Centre de Référence Maladies Rares, Poitiers, France
- Centre National de la Recherche Scientifique, Unite Mixte de Recherche 7276, Université de Limoges, Limoges, France
- Department of Hematology, Centre Hospitalier Universitaire, Limoges, France
| | - Bruno Moulin
- Department of Nephrology, Centre Hospitalier Universitaire, Strasbourg, France
| | - Bertrand Knebelmann
- Department of Nephrology, Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Sylvie Chevret
- Department of Biostatistics and Medical Information, Institut National de la Santé et de la Recherche Médicale, Unite Mixte de Recherche 1153 (ECSTRA Team), Paris Diderot University, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean-Paul Fermand
- Department of Hematology and Immunology, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1126, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France
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16
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Rodon P, Hulin C, Daley L, Dauriac C, Hacini M, Decaux O, Eisemann JC, Fitoussi O, Lioure B, Voillat L, Slama B, Al Jijakli A, Benramdane R, Chaleteix C, Costello R, Thyss A, Mathiot C, Eileen B, Maloisel F, Stoppa AM, Kolb B, Michallet M, Lamblin A, Natta P, Facon T, Elalamy I, Fermand JP, Moreau P, Leleu X. MELISSE, a large multicentric observational study to determine risk factors of venous thromboembolism in patients with multiple myeloma treated with immunomodulatory drugs. Thromb Haemost 2017; 110:844-51. [DOI: 10.1160/th13-02-0140] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/22/2013] [Indexed: 01/06/2023]
Abstract
SummaryImmunomodulatory drugs (IMiDs) are associated with an increased risk of venous thromboembolism (VTE) in multiple myeloma (MM) patients. We designed MELISSE, a multicentre prospective observational study, to evaluate VTE incidence and identify risk factors in IMiDstreated MM. Our objective was to determine the real-life practice of VTE prophylaxis strategy. A total of 524 MM patients were included, and we planned to collect information at baseline, at four and at 12 months, on MM therapy, on VTE risk factors and management. VTE incidence was 7% (n=31), including 2.5% pulmonary embolism (PE) (n=11), similar at four or 12 months. VTE was observed at all risk assessment levels, although the increased risk assessment level correlated to a lower rate of VTE, maybe due to the implemented thromboprophylaxis strategy. VTE occurred in 7% on aspirin vs 3% on lowmolecular- weight heparin (LMWH) prophylaxis, and none on vitamin K antagonists (VKA). New risk factors for VTE in IMiDs-treated MM were identified. In conclusion, VTE prophylaxis is compulsory in IMiDstreated MM, based on individualised VTE risk assessment. Anticoagulation prophylaxis with LMWH should clearly be prioritised in MM patients with high VTE risk, along with VKA. Further prospective studies will identify most relevant VTE risk factors in IMiDs-treated MM to select accurately which MM patients should receive LMWH prophylaxis and for which duration to optimise VTE risk reduction.
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17
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Bahuaud M, Bodilis H, Malphettes M, Maugard Landre A, Matondo C, Bouscary D, Batteux F, Launay O, Fermand JP. Immunogenicity and persistence of the 13-valent Pneumococcal Conjugate Vaccine (PCV13) in patients with untreated Smoldering Multiple Myeloma (SMM): A pilot study. Heliyon 2017; 3:e00441. [PMID: 29159320 PMCID: PMC5681344 DOI: 10.1016/j.heliyon.2017.e00441] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/27/2017] [Accepted: 10/26/2017] [Indexed: 11/24/2022] Open
Abstract
Smoldering multiple myeloma (SMM) is an asymptomatic clonal plasma cell disorder that frequently progress to multiple myeloma (MM), a disease at high risk of pneumococcal infections. Moreover, if the polysaccharide vaccine is poorly immunogenic in MM, the 13-valent conjugated vaccine has never been tested in clonal plasma cell disorders. We evaluated its immunogenicity for 7 serotypes in 20 patients ≥ 50 years of age with smoldering multiple myeloma (SMM) pre and post routine-vaccination with PCV13. Concentrations of IgG specific for 7 serotypes were measured at baseline, 1, 6, and 12 months after vaccination by standardized ELISA and an Opsonophagocytic Assay (OPA). The primary endpoint was the proportion of patients responding to at least 5 of the 7 serotypes by ELISA at one month. At 1 month post vaccination, 12 patients (60%) were responders by ELISA, among whom 8 were also responders by OPA. At 6 months, 6 (30% of total) of the 12 responders had persistent immunity, and only 2 (10% of total) at 12 months. These results suggested a partial response in this population and a rapid decrease in antibody levels in the first months of vaccination. Although one injection of the 13-valent pneumococcal conjugate vaccine is immunogenic in some patients with SMM, the response is transient. Repeated injections are likely to be needed for effective and sustained protection.
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Affiliation(s)
- Mathilde Bahuaud
- Plateforme d'Immunomonotoring Vaccinal, Laboratoire d'Immunologie, Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Hélène Bodilis
- Centre d'Investigation Clinique Cochin-Pasteur (CIC1417), Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Marion Malphettes
- Service d'Immuno-Hématologie clinique, Groupe hospitalier Saint-Louis-Lariboisière-Fernand Widal, APHP, Paris, France
| | - Anaïs Maugard Landre
- Centre d'Investigation Clinique Cochin-Pasteur (CIC1417), Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Caroline Matondo
- Plateforme d'Immunomonotoring Vaccinal, Laboratoire d'Immunologie, Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Didier Bouscary
- Service d'Hématologie clinique, Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Frédéric Batteux
- Plateforme d'Immunomonotoring Vaccinal, Laboratoire d'Immunologie, Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Odile Launay
- Centre d'Investigation Clinique Cochin-Pasteur (CIC1417), Groupe hospitalier Cochin-Broca-Hôtel Dieu, AP-HP, Paris, France
| | - Jean-Paul Fermand
- Service d'Immuno-Hématologie clinique, Groupe hospitalier Saint-Louis-Lariboisière-Fernand Widal, APHP, Paris, France
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18
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Vignon M, Placais L, Malphettes M, Bouaziz JD, Asli B, Bedossa P, Rivet J, Szalat R, Zagdanski AM, Rybojad M, Fermand JP, Baron M, Rautou PE, Arnulf B. Non-cirrhotic portal hypertension in necrobiotic xanthogranuloma associated with monoclonal gammopathy. J Eur Acad Dermatol Venereol 2017; 31:e403-e405. [PMID: 28295661 DOI: 10.1111/jdv.14213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- M Vignon
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, 75010, Paris, France
| | - L Placais
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France
| | - M Malphettes
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, 75010, Paris, France
| | - J D Bouaziz
- Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, 75010, Paris, France.,Department of Dermatology, Saint-Louis Hospital, 75010, Paris, France
| | - B Asli
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France.,Department of Dermatology, Saint-Louis Hospital, 75010, Paris, France
| | - P Bedossa
- Department of Pathology, Beaujon Hospital, 75010, Paris, France
| | - J Rivet
- Department of Pathology, Saint-Louis Hospital, 75010, Paris, France
| | - R Szalat
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, 75010, Paris, France
| | - A M Zagdanski
- Department of Radiology, Saint Louis Hospital, 75010, Paris, France
| | - M Rybojad
- Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, 75010, Paris, France.,Department of Dermatology, Saint-Louis Hospital, 75010, Paris, France
| | - J P Fermand
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France
| | - M Baron
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France
| | - P E Rautou
- Department of Hepatology, Beaujon Hospital, 92110, Clichy, France
| | - B Arnulf
- Department of Clinical Immunology, Saint-Louis Hospital, 75010, Paris, France.,Groupe d'Etude des Dermatoses associées à une Immunoglobuline Monoclonale, 75010, Paris, France
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19
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Javaugue V, Debiaisdelpech C, Desport É, Écotière L, Fermand JP, Touchard G, Jaccard A, Bridoux F. [Monoclonal gammopathy of renal significance]. Rev Prat 2017; 67:71-75. [PMID: 30512440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Monoclonal gammopathy of renal significance. The term "monoclonal gammopathy of renal significance" regroups all renal disorders caused by a monoclonal immunoglobulin (Ig) secreted by a nonmalignant B-cell clone. However, a small clone can synthesize a very toxic protein, producing devastating renal and sometimes systemic damages. The spectrum of renal diseases in MGRS is wide. Renal lesions are classified according to the localization, either glomerular or tubular, and to the pattern of ultrastructural organization of Ig deposits. Physico-chemical characteristics of pathogenic monoclonal Ig are probably involved in their propensity to deposit or precipitate in the kidney, as illustrated by the high rate of recurrence of renal lesions after kidney transplantation if the underlying clone is not suppressed. Early diagnosis and efficient chemotherapy are mandatory to improve renal prognosis and patient survival, particularly in patients with systemic lesions such as AL amyloidosis.
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Affiliation(s)
- Vincent Javaugue
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Poitiers, Poitiers, France
| | - Céline Debiaisdelpech
- Laboratoire d'anatomo-pathologie et de pathologie ultra-structurale, CHU de Poitiers, Poitiers, France
| | - Éstelle Desport
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Poitiers, Poitiers, France
| | - Laure Écotière
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Poitiers, Poitiers, France
| | - Jean-Paul Fermand
- Service d'immunologie et d'hématologie, hôpital Saint-Louis, Paris, France
| | - Guy Touchard
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Poitiers, Poitiers, France
- Laboratoire d'anatomo-pathologie et de pathologie ultra-structurale, CHU de Poitiers, Poitiers, France
| | - Arnaud Jaccard
- Service d'hématologie clinique, CHU de Limoges, Limoges, France
| | - Frank Bridoux
- Service de néphrologie, hémodialyse et transplantation rénale, CHU de Poitiers, Poitiers, France
- CNRS UMR 7276, Limoges, France
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20
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Bridoux F, Javaugue V, Bender S, Leroy F, Aucouturier P, Debiais-Delpech C, Goujon JM, Quellard N, Bonaud A, Clavel M, Trouillas P, Di Meo F, Gombert JM, Fermand JP, Jaccard A, Cogné M, Touchard G, Sirac C. Unravelling the immunopathological mechanisms of heavy chain deposition disease with implications for clinical management. Kidney Int 2016; 91:423-434. [PMID: 27773425 DOI: 10.1016/j.kint.2016.09.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 06/19/2016] [Revised: 08/11/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022]
Abstract
Randall-type heavy chain deposition disease (HCDD) is a rare disorder characterized by tissue deposition of a truncated monoclonal immunoglobulin heavy chain lacking the first constant domain. Pathophysiological mechanisms are unclear and management remains to be defined. Here we retrospectively studied 15 patients with biopsy-proven HCDD of whom 14 presented with stage 3 or higher chronic kidney disease, with nephrotic syndrome in 9. Renal lesions were characterized by nodular glomerulosclerosis, with linear peritubular and glomerular deposits of γ-heavy chain in 12 patients or α-heavy chain in 3 patients, without concurrent light chain staining. Only 2 patients had symptomatic myeloma. By serum protein electrophoresis/immunofixation, 13 patients had detectable monoclonal gammopathy. However, none of these techniques allowed detection of the nephrotoxic truncated heavy chain, which was achieved by immunoblot and/or bone marrow heavy chain sequencing in 14 of 15 patients. Serum-free kappa to lambda light chain ratio was abnormal in 11 of 11 patients so examined. Immunofluorescence studies of bone marrow plasma cells showed coexpression of the pathogenic heavy chain with light chain matching the abnormal serum-free light chain in all 3 tested patients. Heavy chain sequencing showed first constant domain deletion in 11 of 11 patients, with high isoelectric point values of the variable domain in 10 of 11 patients. All patients received chemotherapy, including bortezomib in 10 cases. Renal parameters improved in 11 patients who achieved a hematological response, as assessed by normalization of the free light chain ratio in 8 cases. Tissue deposition in HCDD relates to physicochemical peculiarities of both variable and constant heavy chain domains. Early diagnosis and treatment with bortezomib-based combinations appear important to preserve renal prognosis. Thus, monitoring of serum-free light chain is an indirect but useful method to evaluate the hematological response.
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Affiliation(s)
- Frank Bridoux
- Department of Nephrology, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France; Department of Immunology, National Center for Scientific Research, Joint Research Unit 7276, University of Limoges, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Limoges, France.
| | - Vincent Javaugue
- Department of Nephrology, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Sébastien Bender
- Department of Immunology, National Center for Scientific Research, Joint Research Unit 7276, University of Limoges, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Limoges, France
| | - Fannie Leroy
- Department of Nephrology, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Pierre Aucouturier
- Department of Immunology, Inserm UMRS 938, Saint Antoine Hospital; Université Pierre et Marie Curie - Paris6, Paris, France
| | - Céline Debiais-Delpech
- Department of Pathology and Ultrastructural Pathology, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Jean-Michel Goujon
- Department of Pathology and Ultrastructural Pathology, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Nathalie Quellard
- Department of Pathology and Ultrastructural Pathology, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Amélie Bonaud
- Department of Immunology, National Center for Scientific Research, Joint Research Unit 7276, University of Limoges, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Limoges, France
| | - Marie Clavel
- Department of Immunology, National Center for Scientific Research, Joint Research Unit 7276, University of Limoges, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Limoges, France
| | - Patrick Trouillas
- INSERM UMR 850, University of Limoges, School of Pharmacy, Limoges, France; Regional Centre of Advanced Technologies and Materials, Department of Physical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| | - Florent Di Meo
- INSERM UMR 850, University of Limoges, School of Pharmacy, Limoges, France
| | - Jean-Marc Gombert
- Department of Immunology, University Hospital of Poitiers, Poitiers, France
| | - Jean-Paul Fermand
- Department of Hematology and Clinical Immunology, Saint Louis University Hospital, Paris, France
| | - Arnaud Jaccard
- Department of Hematology, University Hospital of Limoges, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Limoges, France
| | - Michel Cogné
- Department of Immunology, National Center for Scientific Research, Joint Research Unit 7276, University of Limoges, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Limoges, France
| | - Guy Touchard
- Department of Nephrology, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Christophe Sirac
- Department of Immunology, National Center for Scientific Research, Joint Research Unit 7276, University of Limoges, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Limoges, France
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21
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Cohen C, Javaugue V, Joly F, Arnulf B, Fermand JP, Jaccard A, Sirac C, Knebelmann B, Bridoux F, Touchard G. Maladie de dépôts d’immunoglobulines monoclonales de type Randall : du diagnostic au traitement. Nephrol Ther 2016; 12:131-9. [DOI: 10.1016/j.nephro.2015.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/02/2015] [Accepted: 12/02/2015] [Indexed: 11/17/2022]
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22
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Ecotière L, Thierry A, Debiais-Delpech C, Chevret S, Javaugue V, Desport E, Belmouaz S, Quellard N, Kaaki S, Michel Goujon J, Fermand JP, Touchard G, Bridoux F. Prognostic value of kidney biopsy in myeloma cast nephropathy: a retrospective study of 70 patients. Nephrol Dial Transplant 2016; 31:850. [PMID: 26968198 DOI: 10.1093/ndt/gfw056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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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23
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Fouquet G, Pegourie B, Macro M, Petillon MO, Karlin L, Caillot D, Roussel M, Arnulf B, Mathiot C, Marit G, Kolb B, Stoppa AM, Brechiniac S, Richez V, Rodon P, Banos A, Wetterwald M, Garderet L, Royer B, Hulin C, Benbouker L, Decaux O, Escoffre-Barbe M, Fermand JP, Attal M, Avet-Loiseau H, Moreau P, Facon T, Leleu X. Safe and prolonged survival with long-term exposure to pomalidomide in relapsed/refractory myeloma. Ann Oncol 2016; 27:902-7. [PMID: 26787238 DOI: 10.1093/annonc/mdw017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 11/11/2015] [Accepted: 01/07/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The IFM2009-02 trial studied pomalidomide (4 mg daily, 21/28 versus 28/28) and dexamethasone in very advanced relapsed or refractory multiple myeloma (RRMM). We observed that 40% of patients had a prolonged progression-free survival (PFS) and subsequently overall survival (OS). We sought to analyze the characteristics of these patients and study the effect of long exposure to pomalidomide. DESIGN We separated the studied population into two groups: 3 months to 1 year (<1 year) and more than 1 year (≥1 year) of treatment with pomalidomide and dexamethasone based on clinical judgment and historical control studies. We then analyzed the characteristics of patients according to duration of treatment. RESULTS The overall response rate (ORR) for the <1-year group was 43%, the median PFS 4.6 months [95% confidence interval (95% CI) 3.8-6.4] with only 6% at 12 months, and the median OS was 15 months (11.7-20.3) and 40% at 18 months. For the ≥1-year group, the response rate and survival were strikingly different, ORR at 83%, median PFS 20.7 months (14.7-35.4), median OS not reached, and 91% at 18 months. CONCLUSION Pomalidomide and dexamethasone favored prolonged and safe exposure to treatment in 40% of heavily treated and end-stage RRMM, a paradigm shift in the natural history of RRMM characterized with a succession of shorter disease-free intervals and ultimately shorter survival. Although an optimization of pomalidomide-dexamethasone regimen is warranted in advanced RRMM, we claim that pomalidomide has proven once more to change the natural history of myeloma in this series, which should be confirmed in a larger study.
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Affiliation(s)
- G Fouquet
- Department of Blood Diseases, Hôpital Huriez, CHRU Lille, Lille
| | - B Pegourie
- Department of Hematology, Hôpital A.Michallon, CHU Grenoble, Grenoble
| | - M Macro
- Department of Hematology, Hôpital Côte de Nacre, CHU Caen, Caen
| | - M O Petillon
- Department of Blood Diseases, Hôpital Huriez, CHRU Lille, Lille
| | - L Karlin
- Department of Hematology, Centre Hospitalier Lyon-Sud, Lyon
| | - D Caillot
- Department of Hematology, CHU de Dijon, Dijon
| | - M Roussel
- Department of Hematology, CHU de Toulouse, Toulouse
| | - B Arnulf
- Department of Hematology, Hôpital Saint Louis, APHP, Paris
| | - C Mathiot
- Intergroupe Francophone du Myélome (IFM)
| | - G Marit
- Department of Hematology and Cell Therapy Service, CHU de Bordeaux, Pessac, France
| | - B Kolb
- Department of Hematology, Hôpital Robert Debré, CHU Reims, Reims
| | - A M Stoppa
- Department of Hematology, Institut Paoli Calmettes, Marseille
| | - S Brechiniac
- Department of Hematology, CHU Avicennes, APHP, Paris
| | - V Richez
- Department of Hematology, CHU Nice, Nice
| | - P Rodon
- Department of Hematology, CH de Périgueux, Périgueux
| | - A Banos
- Department of Hematology, CH de la Côte Basque, Bayonne
| | - M Wetterwald
- Department of Hematology, CH de Dunkerque, Dunkerque
| | - L Garderet
- Department of Hematology, CHU St-Antoine, Paris
| | - B Royer
- Department of Hematology, Hôpital Sud, CHU Amiens, Amiens
| | - C Hulin
- Department of Hematology, Hôpital de Nancy, Nancy
| | - L Benbouker
- Department of Hematology, Hôpital de Tours, Tours
| | - O Decaux
- Department of Hematology, CHU Rennes, Rennes
| | | | - J P Fermand
- Department of Hematology, Hôpital Saint Louis, APHP, Paris
| | - M Attal
- Department of Hematology, CHU de Toulouse, Toulouse
| | | | - P Moreau
- Department of Hematology, CHU Nantes, Nantes
| | - T Facon
- Department of Blood Diseases, Hôpital Huriez, CHRU Lille, Lille
| | - X Leleu
- Department of Hematology, CHU Poitiers, Poitiers
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24
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Szalat R, Monsel G, Le Goff W, Battistella M, Bengouffa D, Schlageter MH, Bouaziz JD, Arnulf B, Vignon M, Lesnik P, Saussine A, Malphettes M, Lazareth A, Vignon-Pennamen MD, Bagot M, Brouet JC, Fermand JP, Rybojad M, Asli B. The spectrum of neutrophilic dermatoses associated with monoclonal gammopathy: Association with IgA isotype and inflammatory profile. J Am Acad Dermatol 2015; 73:809-20. [DOI: 10.1016/j.jaad.2015.07.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/21/2015] [Accepted: 07/26/2015] [Indexed: 01/31/2023]
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25
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Ecotière L, Thierry A, Debiais-Delpech C, Chevret S, Javaugue V, Desport E, Belmouaz S, Quellard N, Kaaki S, Goujon JM, Fermand JP, Touchard G, Bridoux F. Prognostic value of kidney biopsy in myeloma cast nephropathy: a retrospective study of 70 patients. Nephrol Dial Transplant 2015; 31:64-72. [PMID: 26289418 DOI: 10.1093/ndt/gfv283] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/25/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Light chain myeloma cast nephropathy (MCN) is the major cause of renal failure in multiple myeloma and strongly impacts patient survival. The role of kidney biopsy in the management of MCN is unclear. METHODS Renal pathological findings were retrospectively studied in 70 patients with multiple myeloma and MCN. Patients were categorized according to the achievement or not of renal response, as defined by estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m(2) and/or dialysis independence at 3 months. RESULTS Thirty-two patients (46%) achieved a renal response. In the whole study population, the following parameters differed significantly between patients with and without renal response, respectively: baseline median eGFR (13.3 versus 9.3 mL/min/1.73 m(2), P = 0.017), Acute Kidney Injury Network Stage 3 (68.8 versus 92.1%, P = 0.019), haematological response rate (94 versus 34%, P < 0.0001), median percentage of free light chain (FLC) reduction at Day 21 (92 versus 24%, P = 0.006) and median number of casts/10 fields (14 versus 25, P = 0.005). The extent of interstitial fibrosis and tubular atrophy was similar. In multivariate analysis, only FLC reduction at Day 21 was significantly associated with renal response. However, when considering only the subgroup of haematological responders, both median number of casts [odds ratio (OR) = 0.93, 95% confidence interval (95% CI): 0.88-0.98, P = 0.01] and extent of tubular atrophy (OR = 0.03, 95% CI: 0.00-0.52, P = 0.02) were independent predictors of renal response. CONCLUSIONS In MCN, the presence of numerous casts and diffuse tubular atrophy is associated with poor renal prognosis. These data suggest that additional strategies to reduce FLC burden should be considered in patients with extensive cast formation.
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Affiliation(s)
- Laure Ecotière
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Antoine Thierry
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | | | - Sylvie Chevret
- Department of Biostatistics, Saint Louis University Hospital, Paris, France
| | - Vincent Javaugue
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Estelle Desport
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Simohamed Belmouaz
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Nathalie Quellard
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
| | - Sihem Kaaki
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
| | - Jean Michel Goujon
- Department of Pathology, University Hospital of Poitiers, Poitiers, France
| | - Jean-Paul Fermand
- Department of Hematology and Clinical Immunology, Saint Louis University Hospital, Paris, France
| | - Guy Touchard
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
| | - Frank Bridoux
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospital of Poitiers, Centre de référence de l'amylose AL et des autres maladies par dépôts d'immunoglobuline monoclonale, Poitiers, France
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26
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Chauvet S, Bridoux F, Ecotière L, Javaugue V, Sirac C, Arnulf B, Thierry A, Quellard N, Milin S, Bender S, Goujon JM, Jaccard A, Fermand JP, Touchard G. Kidney diseases associated with monoclonal immunoglobulin M-secreting B-cell lymphoproliferative disorders: a case series of 35 patients. Am J Kidney Dis 2015; 66:756-67. [PMID: 25987261 DOI: 10.1053/j.ajkd.2015.03.035] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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: 10/24/2014] [Accepted: 03/27/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Kidney diseases associated with immunoglobulin M (IgM) monoclonal gammopathy are poorly described, with few data for patient outcomes and renal response. STUDY DESIGN Case series. SETTING & PARTICIPANTS 35 patients from 8 French departments of nephrology were retrospectively studied. Inclusion criteria were: (1) detectable serum monoclonal IgM, (2) estimated glomerular filtration rate (eGFR) < 60mL/min/1.73m(2) and/or proteinuria with protein excretion > 0.5g/d and/or microscopic hematuria, and (3) kidney biopsy showing monoclonal immunoglobulin deposits and/or lymphomatous B-cell renal infiltration. All patients received chemotherapy, including rituximab-based regimens in 8 cases. PREDICTORS Patients were classified into 3 groups according to renal pathology: glomerular AL amyloidosis (group 1; n=11), nonamyloid glomerulopathies (group 2; n=15, including 9 patients with membranoproliferative glomerulonephritis), and tubulointerstitial nephropathies (group 3; n=9, including cast nephropathy in 5, light-chain Fanconi syndrome in 3, and isolated tumor infiltration in 1). OUTCOMES Posttreatment hematologic response (≥50% reduction in serum monoclonal IgM and/or free light chain level) and renal response (≥50% reduction in 24-hour proteinuria or eGFR≥30mL/min/1.73m(2) in patients with glomerular and tubulointerstitial disorders, respectively). RESULTS Nephrotic syndrome was observed in 11 and 6 patients in groups 1 and 2, respectively. Patients in group 3 presented with acute kidney injury (n=7) and/or proximal tubular dysfunction (n=3). Waldenström macroglobulinemia was present in 26 patients (8, 12, and 6 in groups 1, 2, and 3, respectively). Significant lymphomatous interstitial infiltration was observed in 18 patients (4, 9, and 5 patients, respectively). Only 9 of 29 evaluable patients had systemic signs of symptomatic hematologic disease (2, 5, and 2, respectively). In groups 1, 2, and 3, respectively, hematologic response was achieved after first-line treatment in 3 of 9, 9 of 10, and 5 of 6 evaluable patients, while renal response occurred in 5 of 10, 9 of 15, and 5 of 8 evaluable patients. LIMITATIONS Retrospective study; insufficient population to establish the impact of chemotherapy. CONCLUSIONS IgM monoclonal gammopathy is associated with a wide spectrum of renal manifestations, with an under-recognized frequency of tubulointerstitial disorders.
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Affiliation(s)
- Sophie Chauvet
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Nephrology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Frank Bridoux
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Nephrology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France; CNRS UMR 6101, Université de Limoges, Limoges, France.
| | - Laure Ecotière
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Nephrology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Vincent Javaugue
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Nephrology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Christophe Sirac
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; CNRS UMR 6101, Université de Limoges, Limoges, France
| | - Bertrand Arnulf
- Department of Immunology and Hematology, Hôpital Saint-Louis AP-HP, Paris, France
| | - Antoine Thierry
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Nephrology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Nathalie Quellard
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Pathology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Serge Milin
- Department of Pathology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Sébastien Bender
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; CNRS UMR 6101, Université de Limoges, Limoges, France
| | - Jean-Michel Goujon
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Pathology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
| | - Arnaud Jaccard
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; CNRS UMR 6101, Université de Limoges, Limoges, France; Department of Hematology, CHU Limoges, Université de Limoges, Limoges, France
| | - Jean-Paul Fermand
- Department of Immunology and Hematology, Hôpital Saint-Louis AP-HP, Paris, France
| | - Guy Touchard
- Centre national de référence maladies rares amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, CHU Poitiers, Université de Poitiers, Poitiers, France; Department of Nephrology, Hôpital Jean Bernard, CHU Poitiers, Université de Poitiers, Poitiers, France
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Harel S, Mohr M, Jahn I, Aucouturier F, Galicier L, Asli B, Malphettes M, Szalat R, Brouet JC, Lipsker D, Fermand JP. Clinico-biological characteristics and treatment of type I monoclonal cryoglobulinaemia: a study of 64 cases. Br J Haematol 2014; 168:671-8. [PMID: 25363150 DOI: 10.1111/bjh.13196] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 08/15/2014] [Indexed: 11/27/2022]
Abstract
This retrospective analysis was conducted in 64 patients diagnosed with type I cryoglobulinaemia (CG) followed at two French centres. Median follow-up was 6·75 years. CG was IgG in 60% and IgM in 40% of all cases and was asymptomatic in 16 patients (25%). Cold-triggered ischaemic skin manifestations were observed in 33 patients (51%). Neurological manifestations were observed in 15 patients and renal manifestations in 13. Most of the patients with necrotic purpura (14/16, P = 0·009) and renal manifestations (11/13, P = 0·057) had IgG CG. IgG CG was associated with monoclonal gammopathy of undetermined significance (MGUS), myeloma, chronic lymphocytic leukaemia and lymphoplasmocytic lymphoma in 18, 13, 5 and 2 patients, respectively. IgM CG was associated with MGUS and Waldenström macroglobulinaemia in 8 and 18 cases, respectively. One third of patients did not receive any specific treatment. Various treatments, including rituximab, were administered to 25/31 patients with IgG CG and 6/25 patients with IgM CG due to CG-related symptoms. Rituximab was ineffective in all cases associated with a predominantly plasmacytic proliferation. To conclude, type I CG has specific clinico-biological characteristics compared to type II CG. Furthermore, there are differences in terms of related manifestations between type I IgG and type I IgM CG.
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Affiliation(s)
- Stephanie Harel
- Département d'Immuno-Hématologie, Hôpital Saint-Louis, Paris, France
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Reece DE, Hegenbart U, Sanchorawala V, Merlini G, Palladini G, Bladé J, Fermand JP, Hassoun H, Heffner L, Kukreti V, Vescio RA, Pei L, Enny C, Esseltine DL, van de Velde H, Cakana A, Comenzo RL. Long-term follow-up from a phase 1/2 study of single-agent bortezomib in relapsed systemic AL amyloidosis. Blood 2014; 124:2498-506. [PMID: 25202139 PMCID: PMC4199951 DOI: 10.1182/blood-2014-04-568329] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 08/11/2014] [Indexed: 01/26/2023] Open
Abstract
CAN2007 was a phase 1/2 study of once- and twice-weekly single-agent bortezomib in relapsed primary systemic amyloid light chain amyloidosis (AL) amyloidosis. Seventy patients were treated, including 18 and 34 patients at the maximum planned doses on the once- and twice-weekly schedules. This prespecified final analysis provides mature response and long-term outcomes data after 3-year additional follow-up since the last report. In the once-weekly 1.6 mg/m(2) and twice-weekly 1.3 mg/m(2) bortezomib groups, final hematologic response rates were 68.8% and 66.7%; 80% of patients in each group sustained their response for ≥1 year. One-year progression-free rates were 72.2% and 76.8%. Median overall survival (OS) was 62.1 months and not reached; 4-year OS rates were 75.0% and 63.0%. Low baseline difference in κ/λ free light-chain level was associated with higher hematologic complete response rates and longer OS. At data cutoff, 40 (57%) patients had received subsequent therapy, including 19 (27%) retreated with bortezomib, 11 (58%) of whom achieved complete or partial hematologic responses. Four patients received prolonged bortezomib for between 3.5 and 5.6 years, with no new safety concerns, highlighting the feasibility of long-term therapy. Single-agent bortezomib produced durable hematologic responses and promising long-term OS in relapsed AL amyloidosis. This trial was registered at www.clinicaltrials.gov as #NCT00298766.
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Affiliation(s)
- Donna E Reece
- Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Ute Hegenbart
- Amyloidosis Center, University of Heidelberg, Heidelberg, Germany
| | | | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Joan Bladé
- Hematology Department, Institute of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Hani Hassoun
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Leonard Heffner
- Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | | | | | - Lixia Pei
- Janssen Research and Development, LLC, Raritan, NJ
| | | | | | - Helgi van de Velde
- Janssen Research and Development, Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Andrew Cakana
- Janssen Research and Development, High Wycombe, United Kingdom; and
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Benboubker L, Dimopoulos MA, Dispenzieri A, Catalano J, Belch AR, Cavo M, Pinto A, Weisel K, Ludwig H, Bahlis N, Banos A, Tiab M, Delforge M, Cavenagh J, Geraldes C, Lee JJ, Chen C, Oriol A, de la Rubia J, Qiu L, White DJ, Binder D, Anderson K, Fermand JP, Moreau P, Attal M, Knight R, Chen G, Van Oostendorp J, Jacques C, Ervin-Haynes A, Avet-Loiseau H, Hulin C, Facon T. Lenalidomide and dexamethasone in transplant-ineligible patients with myeloma. N Engl J Med 2014; 371:906-17. [PMID: 25184863 DOI: 10.1056/nejmoa1402551] [Citation(s) in RCA: 583] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The combination melphalan-prednisone-thalidomide (MPT) is considered a standard therapy for patients with myeloma who are ineligible for stem-cell transplantation. However, emerging data on the use of lenalidomide and low-dose dexamethasone warrant a prospective comparison of the two approaches. METHODS We randomly assigned 1623 patients to lenalidomide and dexamethasone in 28-day cycles until disease progression (535 patients), to the same combination for 72 weeks (18 cycles; 541 patients), or to MPT for 72 weeks (547 patients). The primary end point was progression-free survival with continuous lenalidomide-dexamethasone versus MPT. RESULTS The median progression-free survival was 25.5 months with continuous lenalidomide-dexamethasone, 20.7 months with 18 cycles of lenalidomide-dexamethasone, and 21.2 months with MPT (hazard ratio for the risk of progression or death, 0.72 for continuous lenalidomide-dexamethasone vs. MPT and 0.70 for continuous lenalidomide-dexamethasone vs. 18 cycles of lenalidomide-dexamethasone; P<0.001 for both comparisons). Continuous lenalidomide-dexamethasone was superior to MPT for all secondary efficacy end points, including overall survival (at the interim analysis). Overall survival at 4 years was 59% with continuous lenalidomide-dexamethasone, 56% with 18 cycles of lenalidomide-dexamethasone, and 51% with MPT. Grade 3 or 4 adverse events were somewhat less frequent with continuous lenalidomide-dexamethasone than with MPT (70% vs. 78%). As compared with MPT, continuous lenalidomide-dexamethasone was associated with fewer hematologic and neurologic toxic events, a moderate increase in infections, and fewer second primary hematologic cancers. CONCLUSIONS As compared with MPT, continuous lenalidomide-dexamethasone given until disease progression was associated with a significant improvement in progression-free survival, with an overall survival benefit at the interim analysis, among patients with newly diagnosed multiple myeloma who were ineligible for stem-cell transplantation. (Funded by Intergroupe, Francophone du Myélome and Celgene; FIRST ClinicalTrials.gov number, NCT00689936; European Union Drug Regulating Authorities Clinical Trials number, 2007-004823-39.).
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Fermand JP. Treatment of smoldering myeloma: early or delayed? Clin Lymphoma Myeloma Leuk 2014; 14:5-7. [PMID: 24461801 DOI: 10.1016/j.clml.2013.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Jean-Paul Fermand
- Professor of Clinical Immunology, Head of Immuno-Hematology Unit, Hôpital Saint Louis, Paris, France.
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Fourrier-Réglat A, Noize P, Facon T, Fermand JP, Fitoussi O, Marit G, Thomaré P, Robinson P, Bignon E, Jové J, Lassalle R, Rouyer M, Grelaud A, Moore N. Real-life patterns of use and effectiveness of bortezomib: the VESUVE cohort study. Leuk Lymphoma 2013; 55:848-54. [DOI: 10.3109/10428194.2013.806801] [Citation(s) in RCA: 9] [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: 11/13/2022]
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Reece DE, Hegenbart U, Sanchorawala V, Merlini G, Palladini G, Blade J, Fermand JP, Hassoun H, Heffner L, Pei L, Enny C, Esseltine D, Van De Velde H, Cakana A, Comenzo R. Results after long-term follow-up from the CAN2007 phase I/II study of weekly or twice-weekly bortezomib in patients (pts) with relapsed systemic light-chain (AL) amyloidosis. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.8545] [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
8545 Background: Data from multiple studies suggest that bortezomib alone or in combination regimens is active in newly diagnosed and relapsed AL. CAN2007 (NCT00298766) was the first prospective study of single-agent bortezomib in relapsed AL. Here we report outcome data at study closure after a median follow-up of 51.8 mos (median 46.1–66.1 mos). Methods: 70 pts received bortezomib 0.7, 1.0, 1.3, or 1.6 mg/m2 on days 1, 8, 15, and 22 of 35-day cycles (QW) or 0.7, 1.0, or 1.3 mg/m2 on days 1, 4, 8, and 11 of 21-day cycles (BIW) for up to 8 cycles (or longer in pts with evidence of ongoing clinical benefit). The maximum tolerated dose was not reached on either schedule; 18 and 34 pts were treated at the maximum planned doses of 1.6 mg/m2 QW and 1.3 mg/m2BIW, respectively, and 18 pts were treated at lower doses. Post-treatment, pts were followed every 6 weeks until disease progression, and then every 3 mos for survival during the long-term follow-up phase. Results: Pts received a median (range) of 8 (1–39), 6 (1–57), and 8 (3–57) cycles of bortezomib in the 1.6 mg/m2 QW, 1.3 mg/m2 BIW, and lower-dose groups, respectively; overall, 32 (46%) pts received ≥8 cycles, and 4 pts were still on treatment and had received ≥39 cycles at study closure. Hematologic responses and outcomes are summarized below. Median (range) follow-up for survival was 51.8 (1–68), 46.1 (1–61), and 66.1 (2–80) mos, and 7, 12, and 9 pts have died, in the 1.6 mg/m2 QW, 1.3 mg/m2BIW, and lower-dose groups, respectively. Median overall survival (OS) in all 70 pts was 62.7 mos, and 4-yr OS rate was 67.3%; data by dose group are shown below. Conclusions: Single-agent bortezomib produces durable hematologic responses and promising long-term OS data in pts with relapsed AL. Clinical trial information: NCT00298766. [Table: see text]
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Affiliation(s)
| | - Ute Hegenbart
- Amyloidosis Center, University of Heidelberg, Heidelberg, Germany
| | | | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Center, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Joan Blade
- Hematology Department, Institute of Hematology and Oncology, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Hani Hassoun
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Leonard Heffner
- Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - Lixia Pei
- Janssen Research & Development, LLC, Raritan, NJ
| | | | | | | | - Andrew Cakana
- Janssen Research & Development, LLC, High Wycombe, United Kingdom
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Bridoux F, Fermand JP. Optimizing treatment strategies in myeloma cast nephropathy: rationale for a randomized prospective trial. Adv Chronic Kidney Dis 2012; 19:333-41. [PMID: 22920644 DOI: 10.1053/j.ackd.2012.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Revised: 07/10/2012] [Accepted: 07/10/2012] [Indexed: 11/11/2022]
Abstract
Renal failure is a frequent complication of multiple myeloma (MM) that strongly affects patient survival. Although a variety of renal diseases may be observed in MM, myeloma cast nephropathy (MCN), a tubulo-interstitial disorder related to precipitation of a monoclonal light chain (LC) within tubular distal lumens, is the main cause of severe and persistent renal failure. To date, the respective frequency and initial evolution of renal disorders associated with monoclonal LC in MM remain poorly defined. Treatment of MCN relies on urgent symptomatic measures and rapid introduction of chemotherapy to reduce the production of monoclonal LC. The introduction of novel chemotherapy regimens based on the association of bortezomib with dexamethasone is likely to have improved the prognosis of MM patients with renal failure. In addition, the combination of novel agents with efficient removal of circulating LC through high cut-off hemodialysis membrane may further increase renal response rate. However, the impact on patient and renal outcomes of these potential therapeutic advances has not been evaluated in prospective studies. The randomized trials EuLITE in the UK and Germany and MYRE in France should help to answer these issues. MYRE is a randomized controlled phase III trial (NCT01208818) that aims to better define the epidemiology and typology of inaugural renal failure in MM and to optimize therapy of MCN patients with and without dialysis-dependent renal failure.
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Desport E, Bridoux F, Sirac C, Delbes S, Bender S, Fernandez B, Quellard N, Lacombe C, Goujon JM, Lavergne D, Abraham J, Touchard G, Fermand JP, Jaccard A. Al amyloidosis. Orphanet J Rare Dis 2012; 7:54. [PMID: 22909024 PMCID: PMC3495844 DOI: 10.1186/1750-1172-7-54] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [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: 05/04/2010] [Accepted: 08/05/2012] [Indexed: 11/10/2022] Open
Abstract
Definition of the disease AL amyloidosis results from extra-cellular deposition of fibril-forming monoclonal immunoglobulin (Ig) light chains (LC) (most commonly of lambda isotype) usually secreted by a small plasma cell clone. Most patients have evidence of isolated monoclonal gammopathy or smoldering myeloma, and the occurrence of AL amyloidosis in patients with symptomatic multiple myeloma or other B-cell lymphoproliferative disorders is unusual. The key event in the development of AL amyloidosis is the change in the secondary or tertiary structure of an abnormal monoclonal LC, which results in instable conformation. This conformational change is responsible for abnormal folding of the LC, rich in β leaves, which assemble into monomers that stack together to form amyloid fibrils. Epidemiology AL amyloidosis is the most common type of systemic amyloidois in developed countries with an estimated incidence of 9 cases/million inhabitant/year. The average age of diagnosed patients is 65 years and less than 10% of patients are under 50. Clinical description The clinical presentation is protean, because of the wide number of tissues or organs that may be affected. The most common presenting symptoms are asthenia and dyspnoea, which are poorly specific and may account for delayed diagnosis. Renal manifestations are the most frequent, affecting two thirds of patients at presentation. They are characterized by heavy proteinuria, with nephrotic syndrome and impaired renal function in half of the patients. Heart involvement, which is present at diagnosis in more than 50% of patients, leading to restrictive cardiopathy, is the most serious complication and engages prognosis. Diagnostic methods The diagnosis relies on pathological examination of an involved site showing Congo red-positive amyloid deposits, with typical apple-green birefringence under polarized light, that stain positive with an anti-LC antibody by immunohistochemistry and/or immunofluorescence. Due to the systemic nature of the disease, non-invasive biopsies such as abdominal fat aspiration should be considered before taking biopsies from involved organs, in order to reduce the risk of bleeding complications. Differential diagnosis Systemic AL amyloidosis should be distinguished from other diseases related to deposition of monoclonal LC, and from other forms of systemic amyloidosis. When pathological studies have failed to identify the nature of amyloid deposits, genetic studies should be performed to diagnose hereditary amyloidosis. Management Treatment of AL amyloidosis is based on chemotherapy, aimed at controlling the underlying plasma clone that produces amyloidogenic LC. The hematological response should be carefully checked by serial measurements of serum free LC. The association of an alkylating agent with high-dose dexamethasone has proven to be effective in two thirds of patients and is considered as the current reference treatment. New agents used in the treatment of multiple myeloma are under investigation and appear to increase hematological response rates. Symptomatic measures and supportive care is necessary in patients with organ failure. Noticeably, usual treatments for cardiac failure (i.e. calcium inhibitors, β-blockers, angiotensin converting enzyme inhibitors) are inefficient or even dangerous in patients with amyloid heart disease, that should be managed using diuretics. Amiodarone and pace maker implantation should be considered in patients with rhythm or conduction abnormalities. In selected cases, heart and kidney transplantation may be associated with prolonged patient and graft survival. Prognosis Survival in AL amyloidosis depends on the spectrum of organ involvement (amyloid heart disease being the main prognosis factor), the severity of individual organs involved and haematological response to treatment.
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Affiliation(s)
- Estelle Desport
- Service d'Hématologie et de Thérapie Cellulaire, Cedex, France
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Resche-Rigon M, Pirracchio R, Robin M, De Latour RP, Sibon D, Ades L, Ribaud P, Fermand JP, Thieblemont C, Socié G, Chevret S. Estimating the treatment effect from non-randomized studies: The example of reduced intensity conditioning allogeneic stem cell transplantation in hematological diseases. BMC Blood Disord 2012; 12:10. [PMID: 22898556 PMCID: PMC3532369 DOI: 10.1186/1471-2326-12-10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 08/09/2012] [Indexed: 01/27/2023]
Abstract
Background In some clinical situations, for which RCT are rare or impossible, the majority of the evidence comes from observational studies, but standard estimations could be biased because they ignore covariates that confound treatment decisions and outcomes. Methods Three observational studies were conducted to assess the benefit of Allo-SCT in hematological malignancies of multiple myeloma, follicular lymphoma and Hodgkin’s disease. Two statistical analyses were performed: the propensity score (PS) matching approach and the inverse probability weighting (IPW) approach. Results Based on PS-matched samples, a survival benefit in MM patients treated by Allo-SCT, as compared to similar non-allo treated patients, was observed with an HR of death at 0.35 (95%CI: 0.14-0.88). Similar results were observed in HD, 0.23 (0.07-0.80) but not in FL, 1.28 (0.43-3.77). Estimated benefits of Allo-SCT for the original population using IPW were erased in HR for death at 0.72 (0.37-1.39) for MM patients, 0.60 (0.19-1.89) for HD patients, and 2.02 (0.88-4.66) for FL patients. Conclusion Differences in estimated benefits rely on whether the underlying population to which they apply is an ideal randomized experimental population (PS) or the original population (IPW). These useful methods should be employed when assessing the effects of innovative treatment in non-randomized experiments.
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Affiliation(s)
- Matthieu Resche-Rigon
- Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, AP-HP, Paris 75010, France.
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Hutchison CA, Bladé J, Cockwell P, Cook M, Drayson M, Fermand JP, Kastritis E, Kyle R, Leung N, Pasquali S, Winearls C. Novel approaches for reducing free light chains in patients with myeloma kidney. Nat Rev Nephrol 2012; 8:234-43. [PMID: 22349488 DOI: 10.1038/nrneph.2012.14] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Myeloma kidney is a tubulointerstitial pathology that accounts for approximately 80-90% of severe acute kidney injury in patients with multiple myeloma. Unless there is rapid intervention, progressive irreversible damage from interstitial fibrosis and tubular atrophy occurs. Work over the past decade has demonstrated that an early sustained reduction in serum concentrations of pathogenic monoclonal free light chains (FLCs) leads to improved renal recovery rates. In turn, an early improvement in renal function is associated with improved patient survival. An early reduction in FLC levels should therefore become standard of care, although the optimum mechanisms to achieve this depletion of FLCs remain to be determined. To provide a coordinated, cross-disciplinary approach to research in this disease, the International Kidney and Monoclonal Gammopathy Research Group was formed. In this Review, we address the current state of knowledge in the management of myeloma kidney.
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Affiliation(s)
- Colin A Hutchison
- Renal Institute of Birmingham, University Hospital Birmingham and University of Birmingham, Birmingham, UK. c.a.hutchison@ bham.ac.uk
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Bono C, Karlin L, Harel S, Mouly E, Labaume S, Galicier L, Apcher S, Sauvageon H, Fermand JP, Bories JC, Arnulf B. The human immunodeficiency virus-1 protease inhibitor nelfinavir impairs proteasome activity and inhibits the proliferation of multiple myeloma cells in vitro and in vivo. Haematologica 2012; 97:1101-9. [PMID: 22271897 DOI: 10.3324/haematol.2011.049981] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Multiple myeloma is characterized by the accumulation of tumor plasma cells in the bone marrow. Despite therapeutic improvements brought by proteasome inhibitors such as bortezomib, myeloma remains an incurable disease. In a variety of human cancers, human immunodeficiency virus protease inhibitors (e.g. nelfinavir) effectively inhibit tumor progression, but their impact on myeloma is unknown. We assessed the in vitro and in vivo effects of nelfinavir on multiple myeloma. DESIGN AND METHODS The effects of nelfinavir (1-10 μM) on proteasome activity, proliferation and viability of myeloma cell lines and plasma cells from patients were assessed by measuring PERK, AKT, STAT3 and ERK1/2 phosphorylation and CHOP expression with immunoblotting or flow cytometry. The in vivo effect was assessed in NOD/SCID mice injected with luciferase expressing human myeloma cell lines and treated with nelfinavir at a dose of 75 mg/kg/day. Tumor progression was evaluated using a bioluminescent system. RESULTS Nelfinavir inhibited 26S chymotrypsin-like proteasome activity, impaired proliferation and triggered apoptosis of the myeloma cell lines and fresh plasma cells. It activated the pro-apoptotic unfolded protein response pathway by inducing PERK phosphorylation and CHOP expression. Cell death triggered by nelfinavir treatment correlated with decreased phosphorylation of AKT, STAT3 and ERK1/2. Nelfinavir enhanced the anti-proliferative activity of bortezomib, dexamethasone and histone deacetylase inhibitors and delayed tumor growth in a myeloma mouse model. CONCLUSIONS These results suggest that nelfinavir, used at a pharmacological dosage, alone or in combination, may be useful in the treatment of myeloma. Our data provide a preclinical basis for clinical trials using nelfinavir in patients with myeloma.
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Affiliation(s)
- Camille Bono
- EA 3963, Univ Paris Diderot, Sorbonne Paris Cité, Institut Universitaire d’Hématologie, Paris, France
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Roos-Weil D, Moreau P, Avet-Loiseau H, Golmard JL, Kuentz M, Vigouroux S, Socié G, Furst S, Soulier J, Le Gouill S, François S, Thiebaut A, Buzyn A, Maillard N, Yakoub-Agha I, Raus N, Fermand JP, Michallet M, Blaise D, Dhédin N. Impact of genetic abnormalities after allogeneic stem cell transplantation in multiple myeloma: a report of the Société Française de Greffe de Moelle et de Thérapie Cellulaire. Haematologica 2011; 96:1504-11. [PMID: 21685472 DOI: 10.3324/haematol.2011.042713] [Citation(s) in RCA: 46] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The impact of cytogenetic abnormalities in multiple myeloma after allogeneic stem cell transplantation has not been clearly defined. This study examines whether allogeneic stem cell transplantation could be of benefit for myeloma patients with high-risk cytogenetic abnormalities. DESIGN AND METHODS This is a retrospective multicenter analysis of the registry of the Société Française de Greffe de Moelle et de Thérapie Cellulaire, including 143 myeloma patients transplanted between 1999 and 2008. RESULTS The incidences of cytogenetic abnormalities were 59% for del(13q), 25% for t(4;14), 25% for del(17p) and 4% for t(14;16). When comparing the population carrying an abnormality to that without the same abnormality, no significant difference was found in progression-free survival, overall survival or progression rate. Patients were grouped according to the presence of any of the poor prognosis cytogenetic abnormalities t(4;14), del(17p) or t(14;16) (n=53) or their absence (n=32). No difference in outcomes was observed between these two groups: the 3-year progression-free survival, overall survival and progression rates were 30% versus 17% (P=0.9), 45% versus 39% (P=0.8) and 53% versus 75% (P=0.9), respectively. CONCLUSIONS These data indicate that allogeneic stem cell transplantation could potentially be of benefit to high-risk myeloma patients.
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Affiliation(s)
- Damien Roos-Weil
- Hematology Department, University Hospital Pitié-Salpêtrière, Paris, France.
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Armoiry X, Fagnani F, Benboubker L, Facon T, Fermand JP, Hulin C, Moreau P, Aulagner G. Management of relapsed or refractory multiple myeloma in French hospitals and estimation of associated direct costs: a multi-centre retrospective cohort study. J Clin Pharm Ther 2011; 36:19-26. [PMID: 21198717 DOI: 10.1111/j.1365-2710.2009.01153.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND BACKGROUND For relapsed or refractory multiple myeloma (RRMM), a series of novel agents (thalidomide, bortezomib and lenalidomide) has emerged during the latest decade, but their use in routine clinical practice is not well documented as well as the cost of RRMM. OBJECTIVE Our aim is to review the therapeutic management of such patients in France and to estimate the associated costs. METHODS A retrospective cohort study, based on chart reviews, was conducted in French Haematology Departments over the period 2004-2007 and the associated direct costs estimated. RESULTS One hundred and two patients with a relapse after first-line therapy were selected from five centres. The average follow-up from diagnosis or the date of first relapse to death or to the latest news was respectively 56.25 and 23.53 months. Novel agents were used in 73% of all cases, and in all cases of first relapse. Thalidomide and bortezomib were respectively the most frequently used second-line (57%) and third-line treatments (44%). The average number of lines of treatment received per patient as from first relapse was 2.75 (min 1; max 8) and the mean direct cost per month was estimated at 3130 € after the first relapse. This cost was represented in greater part by the cost of chemotherapy drugs (66%). WHAT IS NEW AND CONCLUSION The use of novel agents such as thalidomide, bortezomib and lenalidomide for RRMM is highly prevalent in France from the first relapse. The associated medical cost is substantial mainly due to the cost of the new agents.
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Affiliation(s)
- X Armoiry
- Hospices Civils de Lyon, Groupement Hospitalier Est, Pharmacy Department/Délégation à la Recherche Clinique et à l'Innovation, Cellule Innovation, Bron, France.
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Penot A, Abraham J, Debarri H, Desport E, Aguilar C, Lavergne D, Auroy F, Leleu X, Goldstein A, Kolb B, Bridoux F, Fermand JP, Leblond V, Jaccard A. Effectiveness of second-line treatment in AL amyloidosis patient's refractory to M-Dex. Amyloid 2011; 18 Suppl 1:145-7. [PMID: 21838466 DOI: 10.3109/13506129.2011.574354054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Penot
- Service d'Hématologie, CHU, Limoges, France
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Moumas E, Hanf W, Desport E, Abraham J, Delbès S, Debiais C, Lacotte-Thierry L, Touchard G, Jaccard A, Fermand JP, Bridoux F. [New insights in the treatment of myeloma with renal failure]. Nephrol Ther 2011; 7:457-66. [PMID: 21515102 DOI: 10.1016/j.nephro.2011.03.002] [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] [Received: 01/07/2011] [Accepted: 03/14/2011] [Indexed: 01/01/2023]
Abstract
Renal failure, mostly related to myeloma cast nephropathy (MCN), is a frequent complication of multiple myeloma (MM), which occurs in up to 50% of patients during the course of the disease. Persistent renal failure in MM is associated with poor survival. Treatment of MCN relies on urgent symptomatic measures (alkalinisation, rehydration, correction of hypercalcemia, and withdrawal of nephrotoxic drugs), with rapid introduction of chemotherapy to efficiently reduce the production of monoclonal light chains (LC). Recent studies suggest that, in patients with MM and severe renal failure due to MCN, rapid removal of circulating LC, through intensive hemodialysis sessions using a new generation high cut-off dialysis membrane, might result in dialysis withdrawal in most patients. If the development of intensive therapy and new efficient chemotherapy agents (thalidomide, bortezomib, lenalidomide) has transformed the care and prognosis of MM, the modalities and safety of these therapeutic regimens in patients with renal failure remain to be defined. The association of bortezomib with dexamethasone should be considered currently as first-line treatment in patients with MM and impaired renal function.
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Affiliation(s)
- Eric Moumas
- Service de néphrologie, centre hospitalier de Niort, 79021 Niort, France
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Desport E, Moumas E, Abraham J, Delbès S, Lacotte-Thierry L, Touchard G, Fermand JP, Bridoux F, Jaccard A. [Current treatment of AL amyloidosis]. Nephrol Ther 2011; 7:467-73. [PMID: 21497573 DOI: 10.1016/j.nephro.2011.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 02/09/2011] [Indexed: 10/28/2022]
Abstract
Systemic AL amyloidosis is a rare complication of monoclonal gammopathies. Renal manifestations are frequent, mostly characterized by heavy proteinuria, with nephrotic syndrome and renal failure in more than half of the patients at diagnosis. Without treatment, median survival does not exceed 12 months. Amyloid heart disease and diffusion of amyloid deposits are associated with reduced survival. Treatment of systemic AL amyloidosis has been profoundly modified with the introduction of international criteria for the definition of organ involvement and hematologic response, and with the use of sensitive tests for the measurement of serum-free light chain levels. Melphalan plus dexamethasone is now established as the gold standard for first line treatment of systemic AL, with similar efficacy and reduced treatment-related mortality compared to high-dose therapy. Modern chemotherapy regimens, based on the use of novel agents such as bortezomib and lenalidomide, might further improve patient survival.
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Affiliation(s)
- Estelle Desport
- Service de néphrologie et transplantation rénale, hôpital Jean-Bernard, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Dimopoulos MA, Terpos E, Chanan-Khan A, Leung N, Ludwig H, Jagannath S, Niesvizky R, Giralt S, Fermand JP, Bladé J, Comenzo RL, Sezer O, Palumbo A, Harousseau JL, Richardson PG, Barlogie B, Anderson KC, Sonneveld P, Tosi P, Cavo M, Rajkumar SV, Durie BG, San Miguel J. Renal Impairment in Patients With Multiple Myeloma: A Consensus Statement on Behalf of the International Myeloma Working Group. J Clin Oncol 2010; 28:4976-84. [DOI: 10.1200/jco.2010.30.8791] [Citation(s) in RCA: 302] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Renal impairment is a common complication of multiple myeloma (MM). The estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease formula is the recommended method for the assessment of renal function in patients with MM with stabilized serum creatinine. In acute renal injury, the RIFLE (risk, injury, failure, loss and end-stage kidney disease) and Acute Renal Injury Network criteria seem to be appropriate to define the severity of renal impairment. Novel criteria based on eGFR measurements are recommended for the definition of the reversibility of renal impairment. Rapid intervention to reverse renal dysfunction is critical for the management of these patients, especially for those with light chain cast nephropathy. Bortezomib with high-dose dexamethasone is considered as the treatment of choice for such patients. There is limited experience with thalidomide in patients with myeloma with renal impairment. Thus, thalidomide can be carefully administered, mainly in the context of well-designed clinical trials, to evaluate if it can improve the rapidity and probability of response that is produced by the combination with bortezomib and high-dose dexamethasone. Lenalidomide is effective in this setting and can reverse renal insufficiency in a significant subset of patients, when it is given at reduced doses, according to renal function. The role of plasma exchange in patients with suspected light chain cast nephropathy and renal impairment is controversial. High-dose melphalan (140 mg/m2) and autologous stem-cell transplantation should be limited to younger patients with chemosensitive disease.
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Affiliation(s)
- Meletios A. Dimopoulos
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Evangelos Terpos
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Asher Chanan-Khan
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Nelson Leung
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Heinz Ludwig
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Sundar Jagannath
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Ruben Niesvizky
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Sergio Giralt
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Jean-Paul Fermand
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Joan Bladé
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Raymond L. Comenzo
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Orhan Sezer
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Antonio Palumbo
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Jean-Luc Harousseau
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Paul G. Richardson
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Bart Barlogie
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Kenneth C. Anderson
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Pieter Sonneveld
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Patrizia Tosi
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Michele Cavo
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - S. Vincent Rajkumar
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Brian G.M. Durie
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
| | - Jésus San Miguel
- From the University of Athens School of Medicine, Athens, Greece; Roswell Park Cancer Institute, Buffalo; St Vincents Catholic Medical Center; Weill Medical College of Cornell University; Adult Bone Marrow Transplantation Service, Memorial Sloan-Kettering Cancer Center, New York, NY; Mayo Clinic, Rochester, MN; Wilhelminenspital, Vienna, Austria; Service d'Immuno-Hématologie, Hopital Saint-Louis, Paris, France; Hospital Clinic, Barcelona; the University Hospital of Salamanca, Salamanca, Spain; Tufts
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Lepelletier Y, Lecourt S, Renand A, Arnulf B, Vanneaux V, Fermand JP, Menasché P, Domet T, Marolleau JP, Hermine O, Larghero J. Galectin-1 and semaphorin-3A are two soluble factors conferring T-cell immunosuppression to bone marrow mesenchymal stem cell. Stem Cells Dev 2010; 19:1075-9. [PMID: 19886821 DOI: 10.1089/scd.2009.0212] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
In human physiology and animal models, bone marrow mesenchymal stem cells (MSCs) exert an immunosuppressive role in both in vitro and in vivo experiments. However, cellular and molecular mechanisms involved in this process are not clear and remain largely elusive. Several studies have suggested the implication of cell-cell contacts or soluble factors including transforming growth factor-b1 (TGF-b1), interleukin-10 (IL-10), indoleamine 2,3-dioxygenase (IDO), or human leukocyte antigen-G (HLA-G). Here, we show that both Galectin-1 and Semaphorin-3A (Sema-3A), 2 soluble factors capable to inhibit T-cell proliferation through neuropilin-1 (NP-1) binding, are highly expressed by MSCs and may account for their known suppressive activities. Furthermore, MSCs suppressive functions are completely reverted by soluble recombinant NP-1, the main receptor of both Galectin-1 and Sema-3A. Similar results were obtained by using blocking antibodies against Galectin-1 or Sema-3A. Taken together, these results demonstrate the critical role of Galectin-1 and Sema-3A in MSCs functions and may open new perspectives in the understanding and treatment of various immune and neoplastic disorders.
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Affiliation(s)
- Yves Lepelletier
- CNRS UMR 8147, Université Paris Descartes , Hôpital Necker, Paris, 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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Malphettes M, Gérard L, Carmagnat M, Mouillot G, Vince N, Boutboul D, Bérezné A, Nove-Josserand R, Lemoing V, Tetu L, Viallard JF, Bonnotte B, Pavic M, Haroche J, Larroche C, Brouet JC, Fermand JP, Rabian C, Fieschi C, Oksenhendler E. Late-onset combined immune deficiency: a subset of common variable immunodeficiency with severe T cell defect. Clin Infect Dis 2009; 49:1329-38. [PMID: 19807277 DOI: 10.1086/606059] [Citation(s) in RCA: 153] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Common variable immunodeficiency (CVID) is a primary immune deficiency defined by defective antibody production. In most series, a small proportion of patients present with opportunistic infections (OIs). METHODS The French DEFI study has enrolled patients with primary hypogammaglobulinemia and allows a detailed clinical and immunologic description of patients with previous OIs and/or at risk for OIs. RESULTS Among 313 patients with CVID, 28 patients (8.9%) presented with late-onset combined immune deficiency (LOCID), defined by the occurrence of an OI and/or a CD4(+) T cell count <200 x 10(6) cells/L, and were compared with the remaining 285 patients with CVID. The patients with LOCID more frequently belonged to consanguineous families (29% vs 8%; P = .004). They differed from patients with CVID with a higher prevalence of splenomegaly (64% vs 31%), granuloma (43% vs 10%), gastrointestinal disease (75% vs 42%), and lymphoma (29% vs 4%). Even on immunoglobulin substitution, they required more frequent antibiotics administration and hospitalization. Lymphocyte counts were lower, with a marked decrease in CD4(+) T cell counts (158 x 10(6) vs 604 x 10(6) cells/L; P < .001) and a severe defect in naive CD45RA(+)CCR7(+)CD4(+) T cell counts (<20% of total CD4(+) T cells in 71% of patients with LOCID vs 37% of patients with CVID; P = .001). The CD19(+) B cell compartment was also significantly decreased (20 x 10(6) vs 102 x 10(6) cells/L; P < .001). CONCLUSIONS LOCID differs from classic CVID in its clinical and immunologic characteristics. Systematic T cell phenotype may help to discriminate such patients from those with CVID. Identification of this phenotype should result in a more fitted diagnostic and therapeutic approach of infections and could provide insights for genetic diagnosis.
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Affiliation(s)
- Marion Malphettes
- Département d'Immunologie, Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris, Paris, France.
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Matignon M, Cacoub P, Colombat M, Saadoun D, Brocheriou I, Mougenot B, Roudot-Thoraval F, Vanhille P, Moranne O, Hachulla E, Hatron PY, Fermand JP, Fakhouri F, Ronco P, Plaisier E, Grimbert P. Clinical and morphologic spectrum of renal involvement in patients with mixed cryoglobulinemia without evidence of hepatitis C virus infection. Medicine (Baltimore) 2009; 88:341-348. [PMID: 19910748 DOI: 10.1097/md.0b013e3181c1750f] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Hepatitis C virus (HCV) infection represents, by far, the major cause of mixed cryoglobulinemia (MC). The renal disease associated with this pathological condition is now well described. By contrast, renal involvement in patients with MC not associated with HCV has been only poorly described, and few cases have been reported. We analyzed the demographic, clinical, and laboratory features and outcome in patients presenting with renal disease associated with MC not related to HCV infection. Records of 20 patients with MC and renal disease, with no evidence of HCV by serology and polymerase chain reaction analysis, were retrospectively analyzed. Renal biopsies and extensive searches for lymphoproliferative disorder were performed in all patients at presentation. MC was related to primary Sjögren Syndrome (pSS) in 9 patients, and to non-Hodgkin lymphoma in 1 patient, while MC was classified as essential in the remaining 10 cases. Renal involvement was characterized by microscopic hematuria in all patients, nephrotic range proteinuria in 75% of patients, hypertension in 80% of patients, and renal failure in 85% of patients (mean glomerular filtration rate, 46 mL/min per 1.73 m). Membranoproliferative glomerulonephritis with subendothelial deposits was observed in all kidney specimens. Skin vasculitis was the main extrarenal manifestation. In all patients, cryoglobulinemia was classified as type II MC, characterized by monoclonal IgMkappa and polyclonal IgG. Most patients (17/20) were treated with steroids or immunosuppressive agents, or both. Initial renal remission was observed in 94% of patients. However, renal relapse occurred in most patients, with 10% reaching end-stage renal disease. Three patients with essential MC developed B-cell lymphoma 36-48 months after the diagnosis of MC. Unexpectedly, B-cell lymphoma induced by Epstein-Barr virus infection occurred in only 1 of the 9 pSS patients. Forty percent of patients died as a result of extrarenal causes.Renal disease associated with MC unrelated to HCV is characterized by the high prevalence of pSS (45%), the finding of CD20+ B-lymphocyte nodular infiltrates in the kidney interstitium, and a high incidence of overt B-cell lymphoma during follow-up. These findings emphasize the need for repetitive clinical evaluation in those patients.
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Affiliation(s)
- Marie Matignon
- From Nephrology and Transplantation Department (MM, PG), Henri Mondor Hospital, AP-HP, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), and Paris XII University, Créteil; Internal Medicine Department (PC, DS), Pitié Salpêtrière Hospital, AP-HP, Paris, and CNRS UMR 7087, Université Pierre et Marie Curie, Paris VI; Pathology Department (MC, BM), Tenon Hospital, AP-HP, Paris; Pathology Department (IB), Pitié Salpêtrière Hospital, AP-HP, Paris; Public Health and Biostatistics Department (FRT), Henri Mondor Hospital, AP-HP and Paris XII University, Créteil; Nephrology Department (PV), Valenciennes Hospital, Valenciennes; Nephrology Unit (OM), Nice University Hospital, Nice; Internal Medicine Department (EH, PYH), CHRU, Lille; Hematology Department (JPF), Saint-Louis Hospital, AP-HP, Paris; Nephrology and Dialysis Department (FF), Necker Hospital, AP-HP, Paris; and Nephrology and Dialysis Department (PR, EP), Tenon Hospital, AP-HP, Paris, France
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Dimopoulos MA, Gertz MA, Kastritis E, Garcia-Sanz R, Kimby EK, LeBlond V, Fermand JP, Merlini G, Morel P, Morra E, Ocio EM, Owen R, Ghobrial IM, Seymour J, Kyle RA, Treon SP. Update on Treatment Recommendations From the Fourth International Workshop on Waldenström's Macroglobulinemia. J Clin Oncol 2009; 27:120-6. [DOI: 10.1200/jco.2008.17.7865] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [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
Waldenström macroglobulinemia (WM) is a distinct B-cell lymphoproliferative disorder characterized by lymphoplasmacytic bone marrow infiltration along with an immunoglobulin M (IgM) monoclonal gammopathy. Patients with disease-related cytopenias, bulky adenopathy or organomegaly, symptomatic hyperviscosity, severe neuropathy, amyloidosis, cryoglobulinemia, cold agglutinin disease, or evidence of disease transformation should be considered for immediate therapy. Initiation of therapy should not be based on serum IgM levels alone, and asymptomatic patients should be observed. Individual patient considerations should be considered when deciding on a first-line agent including the presence of cytopenias, need for rapid disease control, age, and candidacy for autologous transplantation. Therapeutic outcomes should be evaluated using updated criteria. As part of the Fourth International Workshop on Waldenström's Macroglobulinemia, a consensus panel updated its recommendations on both first-line and salvage therapy in view of recently published and ongoing clinical trials. The panel considered encouraging results from recent studies of first-line combinations such as rituximab with nucleoside analogs with or without alkylating agents or with cyclophosphamide-based therapies (eg, cyclophosphamide, doxorubicin, vincristine, and prednisone or cyclophosphamide and dexamethasone) or the combination of rituximab with thalidomide. Such therapeutic approaches are likely to yield responses at least as good as, if not better than, monotherapy with any of the alkylating agents, nucleoside analogs, or rituximab. In the salvage setting, reuse of a first-line regimen or use of a different regimen should be considered along with bortezomib, alemtuzumab, autologous transplantation, and, in selected circumstances, allogeneic transplantation. Finally, the panel reaffirmed its encouragement of the active enrollment of patients with WM onto innovative clinical trials whenever possible.
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Affiliation(s)
- Meletios Athanasios Dimopoulos
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Morie A. Gertz
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Efstathios Kastritis
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Ramon Garcia-Sanz
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Eva K. Kimby
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Veronique LeBlond
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Jean-Paul Fermand
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Giampaolo Merlini
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Pierre Morel
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Enrica Morra
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Enrique M. Ocio
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Roger Owen
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Irene M. Ghobrial
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - John Seymour
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Robert A. Kyle
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
| | - Steven P. Treon
- From the University of Athens School of Medicine, Athens, Greece; Hospital Universitario de Salamanca, Salamanca, Spain; Karolinska Institute, Stockholm, Sweden; Hopital Pitie Salpetriere; Hopital Saint Louis, Paris; Hospitalier Schaffner, Lens, France; Scientific Institute Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia; Niguarda Ca'Granda Hospital, Milano, Italy; Leeds General Infirmary, Leeds, United Kingdom; Department of Hematology, Mayo School of Medicine,
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Peigne V, Rusinová K, Karlin L, Darmon M, Fermand JP, Schlemmer B, Azoulay É. Continued survival gains in recent years among critically ill myeloma patients. Intensive Care Med 2008; 35:512-8. [DOI: 10.1007/s00134-008-1320-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 09/08/2008] [Indexed: 12/19/2022]
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Terrier B, Jaccard A, Harousseau JL, Delarue R, Tournilhac O, Hunault-Berger M, Hamidou M, Dantal J, Bernard M, Grosbois B, Morel P, Coiteux V, Gisserot O, Rodon P, Hot A, Elie C, Leblond V, Fermand JP, Fakhouri F. The clinical spectrum of IgM-related amyloidosis: a French nationwide retrospective study of 72 patients. Medicine (Baltimore) 2008; 87:99-109. [PMID: 18344807 DOI: 10.1097/md.0b13e31816c43b6] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Immunoglobulin M (IgM)-related amyloidosis remains a rare and little-known complication of monoclonal IgM-associated disorders. We sought to determine the clinical and laboratory presentation, response to treatment, and outcome of patients with IgM-related amyloidosis in the era of new therapeutic approaches. We conducted a retrospective study in 29 French centers to identify patients with monoclonal IgM and biopsy-proven amyloidosis; we reviewed patients' records and collected relevant clinical and laboratory data. We identified 72 patients with IgM-related amyloidosis. Systemic primary amyloidosis (AL) was present in 64, peritumoral AL in 5, and systemic secondary amyloidosis (AA) in 3 patients. A peculiar pattern of relatively frequent lymph node (31%) and lung (17%) involvement was noted in patients with systemic AL amyloidosis. Response to alkylating agents was poor, with a hematologic response in 37%, a complete remission in 0%, and an organ response in 21%. Response to hematopoietic stem cell transplantation showed a hematologic response in 100% with complete remission in 75% and an organ response in 75%. Purine analogs and rituximab induced a hematologic response in 73% and 60%, respectively, with complete remission in 9% and 0% and an organ response in 55% and 0%, respectively. In multivariate analysis, prognostic factors for survival were serum albumin level < or =3.5 g/dL (p = 0.018) and heart involvement (p = 0.0034). Further prospective studies are needed in patients with IgM-related amyloidosis, with special emphasis on treatment options: hematopoietic stem cell transplantation and purine analogs could represent the most effective therapies. The identification of adverse prognostic factors of survival could be useful for those managing and making treatment decisions for these patients.
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Affiliation(s)
- Benjamin Terrier
- From Service de Néphrologie et d'Hématologie (BT, RD, FF), and Service de Biostatistiques (CE), CHU Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris; Service d'Hématologie Clinique (AJ), Centre de Référence des Amyloses Primitives et des Autres Maladies de Dépô t d'Immunoglobuline, CHU, Limoges; Service d'Hématologie (JLH), Service de Médecine Interne (MH), and Service de Néphrologie (JD), CHU Hôtel-Dieu, Nantes; Service d'Hématologie (OT), CHU, Clermont-Ferrand; Service d'Hématologie (MHB), CHU, Angers; Service d'Hématologie (MB) and Service de Médecine Interne (BG), CHU, Rennes; Service d'Hématologie (PM), Hôpital, Lens; Service d'Hématologie (VC), CHRU Claude Huriez, Lille; Service d'Hématologie et Médecine Interne (OG), Hôpital Saint-Anne, Toulon; Service d'Hématologie (PR), Hôpital, Blois; Service de Médecine Interne (AH), CHU, Lyon; Service d'Hématologie (VL), CHU Pitié- Salpétrière, Paris; and Service d'Immuno-Hématologie (JPF), CHU Saint-Louis, Paris, France
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