1
|
Pincez T, Fernandes H, Fahd M, Pasquet M, Chahla WA, Granel J, Ducassou S, Thomas C, Garnier N, Jeziorski E, Bayart S, Chastagner P, Cheikh N, Guitton C, Paillard C, Lejeune J, Millot F, Li-Thiao Te V, Mallebranche C, Pellier I, Castelle M, Armari-Alla C, Carausu L, Piguet C, Benadiba J, Pluchart C, Stephan JL, Deparis M, Briandet C, Doré E, Marie-Cardine A, Barlogis V, Leverger G, Héritier S, Aladjidi N, Leblanc T. Pediatric refractory chronic immune thrombocytopenia: Identification, patients' characteristics, and outcome. Am J Hematol 2024. [PMID: 38651646 DOI: 10.1002/ajh.27337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/06/2024] [Indexed: 04/25/2024]
Abstract
Refractory chronic immune thrombocytopenia (r-cITP) is one of the most challenging situations in chronic immune thrombocytopenia (cITP). Pediatric r-cITP is inconsistently defined in literature, contributing to the scarcity of data. Moreover, no evidence is available to guide the choice of treatment. We compared seven definitions of r-cITP including five pediatric definitions in 886 patients with cITP (median [min-max] follow-up 5.3 [1.0-29.3] years). The pediatric definitions identified overlapping groups of various sizes (4%-20%) but with similar characteristics (higher proportion of immunopathological manifestations [IM] and systemic lupus erythematosus [SLE]), suggesting that they adequately captured the population of interest. Based on the 79 patients with r-cITP (median follow-up 3.1 [0-18.2] years) according to the CEREVANCE definition (≥3 second-line treatments), we showed that r-cITP occurred at a rate of 1.15% new patients per year and did not plateau over time. In multivariate analysis, older age was associated with r-cITP. One patient (1%) experienced two grade five bleeding events after meeting r-cITP criteria and while not receiving second-line treatment. The cumulative incidence of continuous complete remission (CCR) at 2 years after r-cITP diagnosis was 9%. In this analysis, splenectomy was associated with a higher cumulative incidence of CCR (hazard ratio: 5.43, 95% confidence interval: 1.48-19.84, p = 7.8 × 10-4). In sum, children with cITP may be diagnosed with r-cITP at any time point of the follow-up and are at increased risk of IM and SLE. Second-line treatments seem to be effective for preventing grade 5 bleeding. Splenectomy may be considered to achieve CCR.
Collapse
Affiliation(s)
- Thomas Pincez
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux and Paris, France
- Division of Hematology-Oncology, Charles-Bruneau Cancer Center, Department of Pediatrics, Sainte-Justine University Hospital, Université de Montréal, Montréal, Québec, Canada
| | - Helder Fernandes
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux and Paris, France
- Pediatric Haemato-Immunology, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| | - Mony Fahd
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux and Paris, France
- Pediatric Hematology Unit, Robert-Debré University Hospital, AP-HP, Paris, France
| | - Marlène Pasquet
- Pediatric Oncology Immunology Hematology Unit, Children's University Hospital, Toulouse, France
| | - Wadih Abou Chahla
- Department of Pediatric Hematology, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - Jérome Granel
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux and Paris, France
- Pediatric Haemato-Immunology, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| | - Stéphane Ducassou
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux and Paris, France
- Pediatric Haemato-Immunology, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| | - Caroline Thomas
- Pediatric Hematology Unit, Nantes University Hospital, Nantes, France
| | - Nathalie Garnier
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Lyon, France
| | - Eric Jeziorski
- Pediatric Oncology Hematology Unit, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Sophie Bayart
- Pediatric Hematology Unit, Rennes University Hospital, Rennes, France
| | - Pascal Chastagner
- Department of Pediatric Hematology and Oncology, Children's University Hospital, Nancy, France
| | - Nathalie Cheikh
- Department of Pediatric Hematology-Oncology, Besançon University Hospital, Besançon, France
| | - Corinne Guitton
- Department of Pediatrics, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Catherine Paillard
- Department of Pediatric Hematology and Oncology, Hautepierre University Hospital, Strasbourg, France
| | - Julien Lejeune
- Department of Pediatric Hematology-Oncology, Clocheville Hospital, Tours University Hospital, Tours, France
| | - Frédéric Millot
- Department of Pediatric Hematology, Poitiers University Hospital, Poitiers, France
| | - Valérie Li-Thiao Te
- Department of Pediatric Hematology/Oncology, Amiens University Hospital, Amiens, France
| | - Coralie Mallebranche
- Pediatric Immuno-Hemato-Oncology, Angers University Hospital, CRCI2NA, UMR Inserm CNRS, Université d'Angers, Université de Nantes, Angers, France
| | - Isabelle Pellier
- Pediatric Immuno-Hemato-Oncology, Angers University Hospital, CRCI2NA, UMR Inserm CNRS, Université d'Angers, Université de Nantes, Angers, France
| | - Martin Castelle
- Pediatric Hematology-Immunology and Rheumatology Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Corinne Armari-Alla
- Pediatric Hematology-Oncology Department, Grenoble University Hospital, Grenoble, France
| | - Liana Carausu
- Department of Pediatric Hematology, CHU de Brest, Brest, France
| | - Christophe Piguet
- Pediatric Oncology Hematology Unit, Limoges University Hospital, Limoges, France
| | - Joy Benadiba
- Department of Hematology-Oncology Pediatrics, Nice University Hospital, Nice, France
| | - Claire Pluchart
- Pediatric Hematology-Oncology Unit, Institut Jean Godinot, Reims University Hospital, Reims, France
| | - Jean-Louis Stephan
- Department of Pediatric Oncology, University Hospital of Saint Etienne, North Hospital, Saint Etienne, France
| | - Marianna Deparis
- Pediatric Oncology-Hematology Unit Department, Caen University Hospital, Caen, France
| | - Claire Briandet
- Department of Pediatrics, Dijon University Hospital, Dijon, France
| | - Eric Doré
- Pediatric Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Aude Marie-Cardine
- Department of Pediatric Hematology and Oncology, Rouen University Hospital, Rouen, France
| | - Vincent Barlogis
- Department of Pediatric Hematology, La Timone Hospital, Marseille University Hospital, Marseille, France
| | - Guy Leverger
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux and Paris, France
- Pediatric Hematology Oncology Unit, Hôpital Armand Trousseau, AP-HP, Sorbonne Université Paris, Paris, France
| | - Sébastien Héritier
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux and Paris, France
- Pediatric Hematology Oncology Unit, Hôpital Armand Trousseau, AP-HP, Sorbonne Université Paris, Paris, France
| | - Nathalie Aladjidi
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux and Paris, France
- Pediatric Haemato-Immunology, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| | - Thierry Leblanc
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux and Paris, France
- Pediatric Hematology Unit, Robert-Debré University Hospital, AP-HP, Paris, France
- Université Paris-Cité, Paris, France
| |
Collapse
|
2
|
Granel J, Fernandes H, Bader-Meunier B, Guth A, Richer O, Pillet P, Leverger G, Ducassou S, Fahd M, Pasquet M, Garnier N, Barlogis V, Guitton C, Jeziorski E, Thomas C, Bayart S, Cheikh N, Paillard C, Abou Chahla W, Chastagner P, Neven B, Millot F, Lejeune J, Li-Thiao Te V, Armari-Alla C, Briandet C, Carausu L, Deparis M, Piguet C, Benadiba J, Marie-Cardine A, Stephan JL, Pellier I, Pluchart C, Doré E, Michaux K, Héritier S, Leblanc T, Aladjidi N. Antinuclear antibody-associated autoimmune cytopenia in childhood is a risk factor for systemic lupus erythematosus. Blood 2024; 143:1576-1585. [PMID: 38227934 DOI: 10.1182/blood.2023021884] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024] Open
Abstract
ABSTRACT Autoimmune cytopenia (AIC) in children may be associated with positive antinuclear antibodies (ANA) and may progress to systemic lupus erythematosus (SLE). We evaluated the risk of progression to SLE of childhood-onset ANA-associated AIC. In the French national prospective OBS'CEREVANCE cohort, the long-term outcome of children with ANA-associated AIC (ANA titer ≥1/160) and a subgroup of children who developed SLE were described. ANA were positive in 355 of 1803 (20%) children with AIC. With a median follow-up of 5.8 (range, 0.1-29.6) years, 79 of 355 (22%) patients developed SLE at a median age of 14.5 (1.1-21.4) years; 20% of chronic immune thrombocytopenic purpura, 19% of autoimmune hemolytic anemia, and 45% of Evans syndrome. None of the patients with ANA-negative test developed SLE. Severe manifestations of SLE were observed in 21 patients, and 2 patients died. In multivariate analysis including patients with positive ANA within the first 3 months after AIC diagnosis, age >10 years at AIC diagnosis (relative risk [RR], 3.67; 95% confidence interval [CI], 1.18-11.4; P = .024) and ANA titer >1/160 (RR, 5.28; 95% CI, 1.20-23.17; P = .027) were associated with the occurrence of SLE after AIC diagnosis. ANA-associated AIC is a risk factor for progression to SLE, especially in children with an initial ANA titer >1/160 and an age >10 years at AIC diagnosis. ANA screening should be recommended in children with AIC, and patients with ANA should be monitored long-term for SLE, with special attention to the transition period. This trial was registered at www.ClinicalTrials.gov as #NCT05937828.
Collapse
Affiliation(s)
- Jérôme Granel
- Paediatric Clinical Immunology, Pellegrin Hospital, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
| | - Helder Fernandes
- Paediatric Clinical Immunology, Pellegrin Hospital, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| | - Brigitte Bader-Meunier
- Paediatric Haematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Amandine Guth
- Paediatric Department, Pontarlier Hospital, Pontarlier, France
| | - Olivier Richer
- Paediatric Clinical Immunology, Pellegrin Hospital, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| | - Pascal Pillet
- Paediatric Clinical Immunology, Pellegrin Hospital, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| | - Guy Leverger
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
- Paediatric Oncology Immunology Haematology Unit, Armand-Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Ducassou
- Paediatric Clinical Immunology, Pellegrin Hospital, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
| | - Mony Fahd
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
- Paediatric Haematology and Immunology Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marlène Pasquet
- Paediatric Oncology Immunology Haematology Unit, Children's University Hospital, Toulouse, France
| | - Nathalie Garnier
- Institute of Paediatric Haematology and Oncology, Hospices Civils de Lyon, Lyon, France
| | - Vincent Barlogis
- Department of Paediatric Haematology, La Timone Hospital, Marseille University Hospital, Marseille, France
| | - Corinne Guitton
- Department of Paediatrics, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Eric Jeziorski
- Paediatric Oncology Haematology Unit, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Caroline Thomas
- Paediatric Haematology Unit, Nantes University Hospital, Nantes, France
| | - Sophie Bayart
- Paediatric Haematology Unit, Rennes University Hospital, Rennes, France
| | - Nathalie Cheikh
- Department of Paediatric Haematology-Oncology, Besançon University Hospital, Besançon, France
| | - Catherine Paillard
- Department of Paediatric Haematology and Oncology, Hautepierre University Hospital, Strasbourg, France
| | - Wadih Abou Chahla
- Department of Paediatric Haematology, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - Pascal Chastagner
- Department of Paediatric Haematology and Oncology, Children's University Hospital, Nancy, France
| | - Bénédicte Neven
- Paediatric Haematology-Immunology and Rheumatology Department, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frédéric Millot
- Department of Paediatric Haematology, Poitiers University Hospital, Poitiers, France
| | - Julien Lejeune
- Department of Paediatric Haematology-Oncology, Clocheville Hospital, Tours University Hospital, Tours, France
| | - Valérie Li-Thiao Te
- Department of Paediatric Haematology/Oncology, Amiens University Hospital, Amiens, France
| | - Corinne Armari-Alla
- Paediatric Haematology-Oncology Department, Grenoble University Hospital, Grenoble, France
| | - Claire Briandet
- Department of Paediatrics, Dijon University Hospital, Dijon, France
| | - Liana Carausu
- Department of Paediatric Hematology, CHU de Brest, Brest, France
| | - Marianna Deparis
- Paediatric Oncology- Haematology Unit Department, Caen University Hospital, Caen, France
| | - Christophe Piguet
- Paediatric Oncology Hematology Unit, Limoges University Hospital, Limoges, France
| | - Joy Benadiba
- Department of Haematology-Oncology Paediatrics, Nice University Hospital, Nice, France
| | - Aude Marie-Cardine
- Department of Paediatric Haematology and Oncology, Rouen University Hospital, Rouen, France
| | - Jean-Louis Stephan
- University Hospital of Saint Etienne, North Hospital, Department of Paediatric Oncology, Saint Etienne, France
| | | | - Claire Pluchart
- Paediatric Haematology-Oncology Unit, Institut Jean Godinot, Reims University Hospital, Reims, France
| | - Eric Doré
- Paediatric Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Katell Michaux
- Paediatric Unit, Martinique University Hospital, Fort-de-France, France
| | - Sébastien Héritier
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
- Paediatric Oncology Immunology Haematology Unit, Armand-Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thierry Leblanc
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
- Paediatric Haematology and Immunology Unit, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie Aladjidi
- Paediatric Clinical Immunology, Pellegrin Hospital, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant, Bordeaux, France
| |
Collapse
|
3
|
Demoor-Goldschmidt C, Veillon P, Esvan M, Leonard M, Chauvet S, Bertrand A, Carausu L, Delehaye F, Lejeune J, Rouger J, Schneider P, Thomas C, Millot F, Claude L, Leseur J, Missohou F, Supiot S, Bihannic N, Debroise I, Jeanneaud C, Lebreton E, Roumy M, Aguerris L, Chrétien JM, Gandemer V, Pellier I. A software tool to support follow-up care in a French childhood cancer cohort: construction and feasibility. BMC Cancer 2024; 24:130. [PMID: 38267891 PMCID: PMC10809785 DOI: 10.1186/s12885-024-11857-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Treatment summaries and a personalized survivorship care plans based on internationally approved, organ-specific follow-up care recommendations are essential in preserving the health and quality of life for cancer survivors. Cohorts made up of survivors of childhood cancer have made significant contributions to the understanding of early mortality, somatic late complications, and psychosocial outcomes among former patients. New treatment protocols are needed to enhance survival and reduce the potential risk and severity of late effects, and working with treatment databases is crucial in doing so. CONSTRUCTION AND CONTENT In the GOCE (Grand Ouest Cancer de l'Enfant [Western Region Childhood Cancer]) network, in a participative approach, we developed the LOG-after medical tool, on which health data are registered and can be extracted for analysis. Its name emphasizes the tool's goal, referring to 'logiciel' (the French word for software) that focuses on the period "after" the acute phase. This tool is hosted on a certified health data server. Several interfaces have been developed that can be used depending on the user's profile. Here we present this innovative co-constructed tool that takes national aspects into account, including the results of the feasibility/satisfaction study and its perspective. UTILITY AND DISCUSSION The database contains data relating to 2558 patients, with samples from 1702 of these (66.54%) being held in a tumor bank. The average year in which treatment started was 2015 (ranging from December 1967 to November 2022: 118 patients were treated before 2012 and registered retrospectively when seen in long-term follow-up consultations or for another cancer since November 2021). A short questionnaire was distributed to healthcare professionals using the tool (physicians and research associates or technicians, n = 14), of whom 11 answered and were all satisfied. Access to the patient interface is currently open to 124 former patients. This was initially offered to 30 former patients who were over 15 years old, affected by the disease within the last 5 years, and had agreed to test it. Their opinions were collected by their doctor by e-mail, telephone, or during a consultation in an open-ended question and a non-directive interview. All patients were satisfied with the tool, with interest in testing it in the long term. Some former patients found that the tool provided them with some ease of mind; one, for instance, commented: "I feel lighter. I allow myself to forget. I know I will get a notification when the time comes." CONCLUSIONS Freely available to all users, LOG-after: (1) provides help with determining personalized survivorship care plans for follow-up; (2) builds links with general practitioners; (3) empowers the patient; and (4) enables health data to be exported for analysis. Database URL for presentation: https://youtu.be/2Ga64iausJE.
Collapse
Affiliation(s)
- Charlotte Demoor-Goldschmidt
- Department of Oncohematopediatrics, University Hospital of Angers, University of Angers, Angers, France.
- Department of Radiotherapy, Centre François Baclesse, University of Caen, Caen, France.
- Department of Supportive Care, Centre François Baclesse, University of Caen, Caen, France.
- Inserm U 1018, Epidemiology of Radiation, Gustave Roussy, Villejuif, France.
| | - Pascal Veillon
- Department of Oncohematopediatrics, University Hospital of Angers, University of Angers, Angers, France
| | - Maxime Esvan
- Department of Biostatitics, University Hospital of Rennes, Rennes, France
| | - Mathilde Leonard
- Department of Biostatitics, University Hospital of Rennes, Rennes, France
| | - Sophie Chauvet
- Department of Oncohematopediatrics, University Hospital of Nantes, Nantes, France
| | | | - Liana Carausu
- Department of Oncohematopediatrics, University Hospital of Brest, Brest, France
| | - Fanny Delehaye
- Department of Oncohematopediatrics, University Hospital of Caen, Caen, France
| | - Julien Lejeune
- Department of Oncohematopediatrics, University Hospital of Tours, Tours, France
| | - Jérémie Rouger
- Department of Oncohematopediatrics, University Hospital of Caen, Caen, France
| | - Pascale Schneider
- Department of Oncohematopediatrics, University Hospital of Rouen, Rouen, France
| | - Caroline Thomas
- Department of Oncohematopediatrics, University Hospital of Nantes, Nantes, France
| | - Frédéric Millot
- Department of Oncohematopediatrics, University Hospital of Poitiers, Poitiers, France
| | - Line Claude
- Department of Radiotherapy, Centre Leon Berard, Lyon, France
| | - Julie Leseur
- Department of Radiotherapy, Centre Eugène Marquis, Rennes, France
| | - Fernand Missohou
- Department of Radiotherapy, Centre François Baclesse, University of Caen, Caen, France
| | - Stéphane Supiot
- Department of Radiotherapy, Institut de Cancérologie de L'Ouest, Nantes, France
| | - Nathalie Bihannic
- Department of Oncohematopediatrics, University Hospital of Brest, Brest, France
| | | | - Carole Jeanneaud
- Department of Oncohematopediatrics, University Hospital of Tours, Tours, France
| | - Esther Lebreton
- Department of Oncohematopediatrics, University Hospital of Caen, Caen, France
| | - Marianne Roumy
- Department of Oncohematopediatrics, University Hospital of Angers, University of Angers, Angers, France
| | | | - Jean-Marie Chrétien
- Data Science Department, Clinical and Innovation Direction, CHU Angers, Angers, France
| | - Virginie Gandemer
- Department of Oncohematopediatrics, University Hospital of Rennes, Rennes, France
| | - Isabelle Pellier
- Department of Oncohematopediatrics, University Hospital of Angers, University of Angers, Angers, France
| |
Collapse
|
4
|
Hélias-Rodzewicz Z, Donadieu J, Terrones N, Barkaoui MA, Lambilliotte A, Moshous D, Thomas C, Azarnoush S, Pasquet M, Mansuy L, Aladjidi N, Jeziorski E, Marec-Berard P, Gilibert-Yvert M, Spiegel A, Saultier P, Pellier I, Pagnier A, Pertuisel S, Poiree M, Bodet D, Millot F, Isfan F, Stephan JL, Leruste A, Rigaud C, Filhon B, Carausu L, Reguerre Y, Kieffer I, Brichard B, Ben Jannet R, Bakari M, Idbaih A, Bodemer C, Cohen-Aubart F, Haroche J, Tazi A, Boudjemaa S, Fraitag S, Emile JF, Heritier S. Molecular and clinicopathologic characterization of pediatric histiocytoses. Am J Hematol 2023; 98:1058-1069. [PMID: 37115038 DOI: 10.1002/ajh.26938] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 01/06/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023]
Abstract
The spectrum of somatic mutations in pediatric histiocytoses and their clinical implications are not fully characterized, especially for non-Langerhans cell histiocytosis (-LCH) subtypes. A cohort of 415 children with histiocytosis from the French histiocytosis registry was reviewed and analyzed for BRAFV600E . Most BRAFWT samples were analyzed by next-generation sequencing (NGS) with a custom panel of genes for histiocytosis and myeloid neoplasia. Of 415 case samples, there were 366 LCH, 1 Erdheim-Chester disease, 21 Rosai-Dorfman disease (RDD), 21 juvenile xanthogranuloma (JXG, mostly with severe presentation), and 6 malignant histiocytosis (MH). BRAFV600E was the most common mutation found in LCH (50.3%, n = 184). Among 105 non-BRAFV600E -mutated LCH case samples, NGS revealed mutations as follows: MAP2K1 (n = 44), BRAF exon 12 deletions (n = 26), and duplications (n = 8), other BRAF V600 codon mutation (n = 4), and non-MAP-kinase pathway genes (n = 5). Wild-type sequences were identified in 17.1% of samples. BRAFV600E was the only variant significantly correlated with critical presentations: organ-risk involvement and neurodegeneration. MAP-kinase pathway mutations were identified in seven RDD (mostly MAP2K1) and three JXG samples, but most samples were wild-type on NGS. Finally, two MH samples had KRAS mutations, and one had a novel BRAFG469R mutation. Rarely, we identified mutations unrelated to MAP-kinase pathway genes. In conclusion, we characterized the mutational spectrum of childhood LCH and clinical correlations of variants and subtypes. Variants responsible for JXG and RDD were not elucidated in more than half of the cases, calling for other sequencing approaches.
Collapse
Affiliation(s)
- Zofia Hélias-Rodzewicz
- EA4340 BECCOH, Pathology Department, Ambroise Paré Hospital, AP-HP, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Jean Donadieu
- French Reference Center for Histiocytosis, Department of Pediatric Hematology and Oncology, Trousseau Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Nathalie Terrones
- EA4340 BECCOH, Pathology Department, Ambroise Paré Hospital, AP-HP, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Mohamed-Aziz Barkaoui
- French Reference Center for Histiocytosis, Department of Pediatric Hematology and Oncology, Trousseau Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Anne Lambilliotte
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Lille, Lille, France
| | - Despina Moshous
- Department of Pediatric Immunology, Hematology and Rheumatology, Necker Hospital, AP-HP, Centre-Université Paris Cité, Institut Imagine, Paris, France
| | - Caroline Thomas
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - Saba Azarnoush
- Department of Pediatric Immunology and Hematology, Robert Debré Hospital, AP-HP, Nord-Université Paris Cité, Paris, France
| | - Marlène Pasquet
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Ludovic Mansuy
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Nancy, Vandœuvre-lès-Nancy, France
| | - Nathalie Aladjidi
- Department of Pediatric Hematology and Oncology, Centre d'Investigation Clinique (CIC) 1401, INSERM, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
| | - Eric Jeziorski
- Department of Paediatric, Hôpital Arnaud de Villeneuve, Centre Hospitalo-Universitaire de Montpellier, Montpellier, France
| | - Perrine Marec-Berard
- Department of Paediatric Oncology, Institut d'Hémato-Oncologie Pediatrique, Lyon, France
| | - Marion Gilibert-Yvert
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Tours, Tours, France
| | - Alexandra Spiegel
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Strasbourg, Strasbourg, France
| | - Paul Saultier
- Department of Pediatric Hematology, Immunology and Oncology, Aix Marseille, APHM University, INSERM, INRAe, C2VN, La Timone Children's Hospital, Marseille, France
| | - Isabelle Pellier
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Angers, Angers, France
| | - Anne Pagnier
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Grenoble, Grenoble, France
| | - Sophie Pertuisel
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Rennes, Rennes, France
| | - Maryline Poiree
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Nice, Nice, France
| | - Damien Bodet
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Cean, Cean, France
| | - Frédéric Millot
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France
| | - Florentina Isfan
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Louis Stephan
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Saint Etienne, Saint-Étienne, France
| | - Amaury Leruste
- Pediatric, Adolescent and Young Adult Oncology Department, Institut Curie Medical Center, Paris, France
| | - Charlotte Rigaud
- Department of Paediatric and Adolescent Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Bruno Filhon
- Department of Pediatric Hematology and Oncology, Groupe Hospitalier du Havre, Montivilliers, France
| | - Liana Carausu
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire de Brest, Brest, France
| | - Yves Reguerre
- Department of Pediatric Hematology and Oncology, Centre Hospitalo-Universitaire Saint Denis de la Réunion, Saint-Denis, Réunion, France
| | - Isabelle Kieffer
- Service National d'Onco-Hematologie Pediatrique (SNOHP), Kannerklinik, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Bénédicte Brichard
- Department of Pediatric Hematology and Oncology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Rim Ben Jannet
- EA4340 BECCOH, Pathology Department, Ambroise Paré Hospital, AP-HP, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Mariama Bakari
- EA4340 BECCOH, Pathology Department, Ambroise Paré Hospital, AP-HP, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Ahmed Idbaih
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, AP-HP, Hôpital Universitaire La Pitié Salpêtrière, DMU Neurosciences, Paris, France
| | - Christine Bodemer
- Department of Dermatology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fleur Cohen-Aubart
- Department of Internal Medicine, La Pitié Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Julien Haroche
- Department of Internal Medicine, La Pitié Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Abdellatif Tazi
- Université Paris Cité, INSEM U976, AP-HP Pulmonary Department, Saint-Louis Hospital, Paris, France
| | - Sabah Boudjemaa
- Pathology Department, Trousseau Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Sylvie Fraitag
- Pathology Department, Necker Hospital, AP-HP, Centre-Université Paris Cité, Institut Imagine, Paris, France
| | - Jean-François Emile
- EA4340 BECCOH, Pathology Department, Ambroise Paré Hospital, AP-HP, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Sébastien Heritier
- French Reference Center for Histiocytosis, Department of Pediatric Hematology and Oncology, Trousseau Hospital, AP-HP, Sorbonne Université, Paris, France
| |
Collapse
|
5
|
Pincez T, Fernandes H, Pasquet M, Abou Chahla W, Granel J, Héritier S, Fahd M, Ducassou S, Thomas C, Garnier N, Barlogis V, Jeziorski E, Bayart S, Chastagner P, Cheikh N, Guitton C, Paillard C, Lejeune J, Millot F, Li-Thiao Te V, Mallebranche C, Pellier I, Neven B, Armari-Alla C, Carausu L, Piguet C, Benadiba J, Pluchart C, Stephan JL, Deparis M, Briandet C, Doré E, Marie-Cardine A, Leblanc T, Leverger G, Aladjidi N. Impact of age at diagnosis, sex, and immunopathological manifestations in 886 patients with pediatric chronic immune thrombocytopenia. Am J Hematol 2023; 98:857-868. [PMID: 36882195 DOI: 10.1002/ajh.26900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
Pediatric chronic immune thrombocytopenia (cITP) is a heterogeneous condition in terms of bleeding severity, second-line treatment use, association with clinical and/or biological immunopathological manifestations (IMs), and progression to systemic lupus erythematosus (SLE). No risk factors for these outcomes are known. Specifically, whether age at ITP diagnosis, sex, or IMs impact cITP outcomes is unknown. We report the outcomes of patients with pediatric cITP from the French nationwide prospective cohort OBS'CEREVANCE. We used multivariate analyses to investigate the effect of age at ITP diagnosis, sex, and IMs on cITP outcomes. We included 886 patients with a median (min-max) follow-up duration of 5.3 (1.0-29.3) years. We identified an age cutoff that dichotomized the risk of the outcomes and defined two risk groups: patients with ITP diagnosed <10 years (children) and ≥ 10 years (adolescents). Adolescents had a two to four-fold higher risk of grade ≥3 bleeding, second-line treatment use, clinical and biological IMs, and SLE diagnosis. Moreover, female sex and biological IMs were independently associated with higher risks of biological IMs and SLE diagnosis, second-line treatment use, and SLE diagnosis, respectively. The combination of these three risk factors defined outcome-specific risk groups. Finally, we showed that patients clustered in mild and severe phenotypes, more frequent in children and adolescents, respectively. In conclusion, we identified that age at ITP diagnosis, sex, and biological IMs impacted the long-term outcomes of pediatric cITP. We defined risk groups for each outcome, which will help clinical management and further studies.
Collapse
Affiliation(s)
- Thomas Pincez
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux, France
- Division of Pediatric Hematology-Oncology, Charles-Bruneau Cancer Center, Department of Pediatrics, Sainte-Justine University Hospital, Université de Montréal, Montréal, Québec, Canada
| | - Helder Fernandes
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux, France
- Pediatric Hemato-Immunology, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| | - Marlène Pasquet
- Pediatric Oncology Immunology Hematology Unit, Children's University Hospital, Toulouse, France
| | - Wadih Abou Chahla
- Department of Pediatric Hematology, Jeanne de Flandre Hospital, Lille University Hospital, Lille, France
| | - Jérome Granel
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux, France
- Pediatric Hemato-Immunology, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| | - Sébastien Héritier
- Sorbonne Université, AP-HP, Armand Trousseau University Hospital, Pediatric Hematology Oncology Unit, Paris, France
| | - Mony Fahd
- Pediatric Hematology Unit, Robert-Debré University Hospital AP-HP, Paris, France
| | - Stéphane Ducassou
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux, France
- Pediatric Hemato-Immunology, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| | - Caroline Thomas
- Pediatric Hematology Unit, Nantes University Hospital, Nantes, France
| | - Nathalie Garnier
- Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Lyon, France
| | - Vincent Barlogis
- Department of Pediatric Hematology, La Timone Hospital, Marseille University Hospital, Marseille, France
| | - Eric Jeziorski
- Pediatric Oncology Hematology Unit, Arnaud de Villeneuve University Hospital, Montpellier, France
| | - Sophie Bayart
- Pediatric Hematology Unit, Rennes University Hospital, Rennes, France
| | - Pascal Chastagner
- Department of Pediatric Hematology and Oncology, Children's University Hospital, Nancy, France
| | - Nathalie Cheikh
- Department of Pediatric Hematology-Oncology, Besançon University Hospital, Besançon, France
| | - Corinne Guitton
- Department of Pediatrics, Bicêtre University Hospital, AP-HP, Le Kremlin-Bicêtre, France
| | - Catherine Paillard
- Department of Pediatric Hematology and Oncology, Hautepierre University Hospital, Strasbourg, France
| | - Julien Lejeune
- Department of Pediatric Hematology-Oncology, Clocheville Hospital, Tours University Hospital, Tours, France
| | - Frédéric Millot
- Department of Pediatric Hematology, Poitiers University Hospital, Poitiers, France
| | - Valérie Li-Thiao Te
- Department of Pediatric Hematology/Oncology, Amiens University Hospital, Amiens, France
| | | | | | - Bénédicte Neven
- Pediatric Hematology-Immunology and Rheumatology Department, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Corinne Armari-Alla
- Pediatric Hematology-Oncology Department, Grenoble University Hospital, Grenoble, France
| | - Liana Carausu
- Department of Pediatric Hematology, CHU de Brest, Brest, France
| | - Christophe Piguet
- Pediatric Oncology Hematology Unit, Limoges University Hospital, Limoges, France
| | - Joy Benadiba
- Department of Hematology-Oncology Pediatrics, Nice University Hospital, Nice, France
| | - Claire Pluchart
- Pediatric Hematology-Oncology Unit, Institut Jean Godinot, Reims University Hospital, Reims, France
| | - Jean-Louis Stephan
- Department of Pediatric Oncology, North Hospital, University Hospital of Saint Etienne, Saint Etienne, France
| | - Marianna Deparis
- Pediatric Oncology- Hematology Unit Department, Caen University Hospital, Caen, France
| | - Claire Briandet
- Department of Pediatrics, Dijon University Hospital, Dijon, France
| | - Eric Doré
- Pediatric Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Aude Marie-Cardine
- Department of Pediatric Hematology and Oncology, Rouen University Hospital, Rouen, France
| | - Thierry Leblanc
- Pediatric Hematology Unit, Robert-Debré University Hospital AP-HP, Paris, France
| | - Guy Leverger
- Sorbonne Université, AP-HP, Armand Trousseau University Hospital, Pediatric Hematology Oncology Unit, Paris, France
| | - Nathalie Aladjidi
- Centre de Référence National des Cytopénies Auto-immunes de l'Enfant (CEREVANCE), Bordeaux, France
- Pediatric Hemato-Immunology, CIC1401, INSERM CICP, Bordeaux University Hospital, Bordeaux, France
| |
Collapse
|
6
|
Le Louet S, Icart V, Strullu M, Petit A, Freycon C, Blouin P, Serre J, Rama N, Reguerre Y, Piguet C, Pasquet M, David A, Simon P, Poiree M, Carausu L, Rialland F, Abouchahla W, Saultier P, Ducassou S, Valduga J, Baruchel A, Bertrand Y, Domenech C. Novel Insights into Pediatric Acute Lymphoblastic Leukemia Ophthalmic Relapses from a Nationwide Cohort Study. J Cancer 2022; 13:1272-1281. [PMID: 35281861 PMCID: PMC8899370 DOI: 10.7150/jca.64996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Ten to fifteen percent of children with acute lymphoblastic leukemia (ALL) relapse following treatment. Of these, less than 2% display ophthalmic relapses, which owing to their scarcity, are largely undocumented, leaving clinicians with few diagnostic and therapeutic recommendations, despite serious functional sequelae. We conducted a French multicenter retrospective study to collect all clinical, radiological, biological, and therapeutic data, and outcomes for children with ALL ophthalmic relapses. From 2000 to 2020, 20 ophthalmic relapses occurring after first-line therapy performed before January 1st, 2017 were included in our study: 14 B-ALL and 6 T-ALL. Fifteen patients (75%) had concomitant involvement of the central nervous system, and 11 (55%) a combined bone marrow relapse. Only 1 had an isolated ophthalmic relapse. Eight children (40%) died, 7 from a refractory disease and 1 from toxic death, and 4 patients relapsed. With a median follow-up of 63.1 months, 8 patients are currently alive in continuous complete remission with only 2 displaying severe ophthalmic sequelae. Although rare, ophthalmic relapse could have a significant impact on the functional prognosis of survivors. Their management must be multidisciplinary, with a central role given to ophthalmologists.
Collapse
|
7
|
Flatrès C, Roué JM, Picard C, Carausu L, Thomas C, Pellier I, Millot F, Gandemer V, Chantreuil J, Lorton F, Gras Le Guen C, Launay E. Investigation of primary immune deficiency after severe bacterial infection in children: A population-based study in western France. Arch Pediatr 2021; 28:398-404. [PMID: 33903000 DOI: 10.1016/j.arcped.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/30/2020] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Infectious diseases are still an important cause of morbidity and mortality in high-income countries and may preferentially affect predisposed children, especially immunocompromised children. We aimed to evaluate the frequency of recommended immunological tests in children with community-onset severe bacterial infection (COSBI) admitted to a pediatric intensive care unit. We also assessed the frequency and described the typology of diagnosed primary immune deficiency (PID). METHODS We conducted a retrospective observational epidemiological study in six university hospitals in western France. All children from 1 month to 16 years of age admitted to hospital for bacterial meningitis, purpura fulminans, or meningococcal disease between August 2009 and January 2014 were included. We analyzed the frequency, type, and results of the immunological tests performed on children with meningitis, purpura fulminans, or a meningococcemia episode. RESULTS Among the 143 children included (144 episodes), 84 (59%) and 60 (41%) had bacterial meningitis and purpura fulminans or meningococcemia, respectively: 72 (50%) had immunological tests and 8% had a complete immunological investigation as recommended. Among the 72 children examined for PID, 11 (15%) had at least one anomaly in the immunological test results. Two children had a diagnosis of PID (one with C2 deficit and the other with C8 deficit) and seven other children had possible PID. Thus, the prevalence of a definite or possible diagnosis of PID was 12% among the children examined. CONCLUSION PID is rarely investigated after COSBI. We raise awareness of the need for immunological investigations after a severe infection requiring PICU admission.
Collapse
Affiliation(s)
- C Flatrès
- Brest University Hospital, Pediatrics Department, Brest, France.
| | - J M Roué
- Brest University Hospital, neonatal Intensive Care Unit, Brest, France
| | - C Picard
- Laboratory of Lymphocyte Activation and Susceptibility to EBV infection, Inserm UMR 1163, Paris, University Paris Descartes Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - L Carausu
- Brest University Hospital, Pediatrics Department, Brest, France
| | - C Thomas
- CHU de Nantes, Pediatric Hematology-Oncology Unit, Nantes, France
| | - I Pellier
- University Hospital of Angers, Department of Pediatric Onco-hematology, Angers, France
| | - F Millot
- Department of Pediatric Onco-Hematology, Poitiers University Hospital, Poitiers, France
| | - V Gandemer
- Department of Pediatric Hematology/Oncology, University Hospital of Rennes, Rennes, France
| | - J Chantreuil
- Centre Hospitalo-universitaire de Tours, Service de réanimation pédiatrique, Tours, France
| | - F Lorton
- CHU de Nantes, Department of Pediatric Emergency, Nantes, France
| | - C Gras Le Guen
- CHU de Nantes, Department of Pediatric Emergency, Nantes, France; CHU de Nantes, Department of Pediatrics, Nantes, France
| | - E Launay
- CHU de Nantes, Department of Pediatrics, Nantes, France
| |
Collapse
|
8
|
Rouger-Gaudichon J, Gariazzo L, Thébault E, Brethon B, Fenwarth L, Gambart M, Alimi A, Réguerre Y, Piguet C, Jubert C, Gouache E, Thébaud E, Plantaz D, Paillard C, Raimbault S, Haouy S, Schneider P, Phulpin A, Mallebranche C, Dubrasquet M, de Berranger E, Devoldere C, Laithier V, Poirée M, Thouvenin S, Carausu L, Dupraz C, Bouttefroy S, André N, Gandemer V. Impact of COVID-19 on cancer care: A survey from the French Society of Pediatric Oncology (SFCE). Pediatr Blood Cancer 2021; 68:e28554. [PMID: 32893961 DOI: 10.1002/pbc.28554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Jérémie Rouger-Gaudichon
- Pediatric Oncology and Hematology Department, University Hospital of Caen (CHU Caen), Caen, France
| | - Luisa Gariazzo
- Pediatric Oncology and Hematology Department, University Hospital of Caen (CHU Caen), Caen, France
| | - Eric Thébault
- Department of Oncology for Child and Adolescent, Gustave Roussy, Villejuif, France
| | - Benoît Brethon
- Department of Pediatric Hematology, Robert Debre Hospital, APHP, Paris, France
| | | | - Marion Gambart
- Hémato-Immuno-Oncologie, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Aurélia Alimi
- Pediatric, Adolescent, Young Adult Department, Institut Curie, Paris, France
| | - Yves Réguerre
- Pediatric Oncology and Hematology Department, University Hospital of Saint Denis de La Réunion, Réunion, France
| | - Christophe Piguet
- Unité d'Onco-Hématologie Pédiatrique, Hôpital Mère-Enfant, CHU Limoges, Limoges, France
| | - Charlotte Jubert
- Department of Pediatric Hematology, Bordeaux Hospital, Bordeaux, France
| | - Elodie Gouache
- Department of Pediatric Hemato-Oncology, Hospital Armand Trousseau, Paris, France
| | - Estelle Thébaud
- Service d'Oncologie Pédiatrique, Hôpital de la Mère et l'Enfant, Nantes, France
| | - Dominique Plantaz
- Pediatric Department, University Hospital Centre of Grenoble, Grenoble, France
| | - Catherine Paillard
- Pediatric Hematology and Oncology Department, Hôpital Hautepierre, Strasbourg, France
| | | | - Stéphanie Haouy
- Department of Pediatric Oncology and Haematology, University Hospital of Montpellier, Montpellier, France
| | - Pascale Schneider
- Pediatric Hemato-Oncology Department, University Hospital, Rouen, France
| | - Aurélie Phulpin
- Pediatric Oncology and Hematology Department, University Hospital of Nancy (CHRU Nancy), Nancy, France
| | | | | | - Eva de Berranger
- Pediatric Hematology Department, University Hospital of Lille (CHU Lille), Lille, France
| | | | - Véronique Laithier
- Pediatric Hematology and Oncology, Hôpital Universitaire, Besançon, France
| | - Maryline Poirée
- Pediatric Oncology and Hematology Department, University Hospital of Nice, Nice, France
| | - Sandrine Thouvenin
- Department of Hematology and Pediatric Oncology, University Hospital Center, Saint-Etienne, France
| | - Liana Carausu
- Department of Pediatric Hematology and Oncology, CHU, Brest, France
| | - Chrystelle Dupraz
- Pediatric Oncology Department, Centre Hospitalier Universitaire Poitiers, Poitiers, France
| | - Séverine Bouttefroy
- Institute of Pediatric Hematology and Oncology IHOPE, Centre Leon Berard, Hospices Civils de Lyon, Lyon, France
| | - Nicolas André
- Pediatric Oncology and Hematology Department, Hôpital pour Enfant de La Timone, AP-HM, Marseille, France
| | - Virginie Gandemer
- Pediatric Oncology and Hematology Department, University Hospital of Rennes, Rennes, France
| |
Collapse
|
9
|
Hoffmann C, Guillerm G, Le Pape P, Carausu L, Lavergne RA, Nevez G, Le Gal S. Mucorales DNA detection in serum specimens for early diagnosis of mucormycosis. Diagn Microbiol Infect Dis 2020; 97:115004. [PMID: 32156450 DOI: 10.1016/j.diagmicrobio.2020.115004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/13/2020] [Accepted: 01/26/2020] [Indexed: 10/25/2022]
Abstract
We report a case of pulmonary mucormycosis in a patient with T-cell acute lymphoblastic leukemia. The diagnosis of mucormycosis was initially based on mycological examination of a pulmonary specimen. However, we describe how it could have been made 2 months earlier using polymerase chain reaction assays targeting Mucorales species on serum specimens.
Collapse
Affiliation(s)
- Claire Hoffmann
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France; Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP; EA 3142), Université de Bretagne Occidentale-Université d'Angers, Brest, France
| | - Gaëlle Guillerm
- Service d'Hématologie Clinique, Hôpital Morvan, CHU de Brest, Brest, France
| | - Patrice Le Pape
- Laboratoire de Parasitologie-Mycologie, Institut de Biologie, CHU de Nantes, France; Département de Parasitologie et Mycologie Médicale, Université de Nantes, Nantes Atlantique Universités, EA1155-IICiMed, Faculté de Pharmacie, Nantes, France
| | - Liana Carausu
- Service d'Hématologie Clinique, Hôpital Morvan, CHU de Brest, Brest, France
| | - Rose-Anne Lavergne
- Laboratoire de Parasitologie-Mycologie, Institut de Biologie, CHU de Nantes, France; Département de Parasitologie et Mycologie Médicale, Université de Nantes, Nantes Atlantique Universités, EA1155-IICiMed, Faculté de Pharmacie, Nantes, France
| | - Gilles Nevez
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France; Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP; EA 3142), Université de Bretagne Occidentale-Université d'Angers, Brest, France
| | - Solène Le Gal
- Laboratoire de Parasitologie et Mycologie, Hôpital de La Cavale Blanche, CHU de Brest, Brest, France; Groupe d'Etude des Interactions Hôte-Pathogène (GEIHP; EA 3142), Université de Bretagne Occidentale-Université d'Angers, Brest, France.
| |
Collapse
|
10
|
Ducassou S, Gourdonneau A, Fernandes H, Leverger G, Pasquet M, Fouyssac F, Bayart S, Bertrand Y, Michel G, Jeziorski E, Thomas C, Abouchallah W, Viard F, Guitton C, Cheikh N, Pellier I, Carausu L, Droz C, Leblanc T, Aladjidi N. Second-line treatment trends and long-term outcomes of 392 children with chronic immune thrombocytopenic purpura: the French experience over the past 25 years. Br J Haematol 2020; 189:931-942. [PMID: 32130726 DOI: 10.1111/bjh.16448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/22/2019] [Indexed: 01/19/2023]
Abstract
Childhood chronic immune thrombocytopenic purpura (cITP) is a rare disease. In severe cases, there is no evidence for the optimal therapeutic strategy. Our aim was to describe the real-life management of non-selected children with cITP at diagnosis. Since 2004, patients less than 18 years old with cITP have been enrolled in the national prospective cohort, OBS'CEREVANCE. From 1990 to 2014, in 29 centres, 392 children were diagnosed with cITP. With a median follow-up of six years (2·0-25), 45% did not need second-line therapy, and 55% (n = 217) received one or more second lines, mainly splenectomy (n = 108), hydroxychloroquine (n = 61), rituximab (n = 61) or azathioprine (n = 40). The overall five-year further second-line treatment-free survival was 56% [95% CI 49·5-64.1]. The use of splenectomy significantly decreased over time. Hydroxychloroquine was administered to children with positive antinuclear antibodies, more frequently older and girls, and reached 55% efficacy. None of the patients died. Ten years after the initial diagnosis, 55% of the 56 followed children had achieved complete remission. Children with cITP do not need second-line treatments in 45% of cases. Basing the treatment decision on the pathophysiological pathways is challenging, as illustrated by ITP patients with positive antinuclear antibodies treated with hydroxychloroquine.
Collapse
Affiliation(s)
- Stéphane Ducassou
- Pediatric Hematology Unit, CIC1401, INSERM CICP, University Hospital of Bordeaux, Bordeaux, France.,Centre de Référence National des Cytopénies Autoimmunes de l'enfant (CEREVANCE), University Hospital of Bordeaux, Bordeaux, France.,University of Bordeaux, INSERM U1218, Bordeaux, France
| | - Anne Gourdonneau
- Pediatric Hematology Unit, CIC1401, INSERM CICP, University Hospital of Bordeaux, Bordeaux, France
| | - Helder Fernandes
- Centre de Référence National des Cytopénies Autoimmunes de l'enfant (CEREVANCE), University Hospital of Bordeaux, Bordeaux, France
| | - Guy Leverger
- Centre de Recherche Saint Antoine UMR_S 938, Service d'Hématologie Oncologie Pédiatrique, Centre de Référence National des Cytopénies Auto-immunes de l'enfant (CEREVANCE), AP-HP, Hôpital Armand Trousseau, Sorbonne Université, Paris, France
| | - Marlène Pasquet
- Pediatric Hematology Unit, University Hospital of Toulouse, Toulouse, France
| | - Fanny Fouyssac
- Pediatric Hematology Unit, University Hospital of Nancy, Nancy, France
| | - Sophie Bayart
- Pediatric Hematology Unit, University Hospital of Rennes, Rennes, France
| | - Yves Bertrand
- Pediatric Hematology Unit, Institute of Pediatric Hematology and Oncology, Claude Bernard University Lyon, Lyon, France
| | - Gérard Michel
- Pediatric Hematology Unit, University Hospital Timone Enfants, Marseille, France
| | - Eric Jeziorski
- Department of Pediatrics, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Caroline Thomas
- Pediatric Hematology Unit, University Hospital of Nantes, Nantes, France
| | - Wadih Abouchallah
- Pediatric Hematology Unit, University Hospital of Lille, Lille, France
| | - Florence Viard
- Centre de Référence National des Cytopénies Autoimmunes de l'enfant (CEREVANCE), University Hospital of Bordeaux, Bordeaux, France
| | - Corinne Guitton
- Department of Pediatrics, University Hospital of Bicêtre, Le Kremlin-Bicêtre, France
| | - Nathalie Cheikh
- Pediatric Hematology Unit, University Hospital of Besançon, Besançon, France
| | - Isabelle Pellier
- Pediatric Hematology Unit, University Hospital of Angers, Angers, France
| | - Liana Carausu
- Pediatric Hematology Unit, University Hospital of Brest, Brest, France
| | - Cécile Droz
- Inserm CIC1401, Bordeaux PharmacoEpi, University of Bordeaux, Bordeaux, France
| | - Thierry Leblanc
- Hematology Unit, Centre de référeNce National des Cytopénies Auto-Immunes de l'enfant (CEREVANCE), APHP - Hôpital Robert Debré, Paris, France
| | - Nathalie Aladjidi
- Pediatric Hematology Unit, CIC1401, INSERM CICP, University Hospital of Bordeaux, Bordeaux, France.,Centre de Référence National des Cytopénies Autoimmunes de l'enfant (CEREVANCE), University Hospital of Bordeaux, Bordeaux, France
| | | |
Collapse
|
11
|
Garcia Spezza E, Brethon B, Petit A, Mazingue F, Gandemer V, Boissel N, Carausu L, Reguerre Y, Leverger G, Ducassou S. Tolerance to arsenic trioxide combined with all-trans-retinoic acid in children with acute promyelocytic leukaemia in France. Br J Haematol 2019; 188:170-173. [PMID: 31808943 DOI: 10.1111/bjh.16364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Emmanuel Garcia Spezza
- Department of Pediatric Hematology and Oncology, Félix Guyon Hospital, Réunion Island, France
| | - Benoit Brethon
- Department of Pediatric Hematology, Robert Debre Hospital, APHP, Paris, France
| | - Arnaud Petit
- Department of Pediatric Hematology Oncology, Inserm, Centre de Recherche Saint Antoine, CRSA, AP-HP, Hôpital Trousseau, Sorbone Université, Paris, France
| | | | - Virginie Gandemer
- Department of Pediatric Hematology and Oncology, University Hospital of Rennes, Rennes, France
| | - Nicolas Boissel
- Adolescent and Young Adult Hematology Unit, APHP, Saint-Louis Hospital, Paris, France
| | - Liana Carausu
- Department of Pediatric Hematology and Oncology, CHRU, Brest, France
| | - Yves Reguerre
- Department of Pediatric Hematology and Oncology, Félix Guyon Hospital, Réunion Island, France
| | - Guy Leverger
- Department of Pediatric Hematology Oncology, Inserm, Centre de Recherche Saint Antoine, CRSA, AP-HP, Hôpital Trousseau, Sorbone Université, Paris, France
| | - Stephane Ducassou
- Unité Inserm U1218, University of Bordeaux, Bordeaux, France.,Department of Pediatric Hematology and Oncology, Children's Hospital, CHU Bordeaux, Bordeaux, France
| |
Collapse
|
12
|
Demirtas S, Plantin P, Carausu L, Le Masson G, Quintin-Roué I, Misery L, Abasq-Thomas C. Éruption fluctuante du visage révélant un lymphome lymphoblastique cutané chez un nourrisson. Ann Dermatol Venereol 2017. [DOI: 10.1016/j.annder.2017.09.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
13
|
Henry C, Dumoucel S, Taque S, Esvan M, Pellier I, Minckes O, Blouin P, Carausu L, Gandemer V. Évaluation de la gastrostomie précoce dans la prise en charge des tumeurs osseuses primitives malignes de l’enfant. Expérience du groupe Grand Ouest Cancer de l’Enfant (GOCE) sur 10 ans. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.oncohp.2017.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
14
|
Ghesquières H, Ferlay C, Sebban C, Chassagne C, Carausu L, Gargi T, Favier B, Philip I, Blay JY, Biron P. Combination of rituximab with chemotherapy in diffuse large B-cell lymphoma. Evaluation in daily practice before and after approval of rituximab in this indication. Hematol Oncol 2008; 26:139-47. [PMID: 18383186 DOI: 10.1002/hon.850] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Randomized trials have demonstrated improved outcome from adding rituximab to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) for patients with diffuse large B-cell lymphoma (DLBCL). This retrospective study compared the outcomes of 224 patients with DLBCL treated in our institution before (Period 1, 1996-2002) and after (Period 2, 2002-2005) approval of rituximab in this indication to evaluate the impact of the drug in daily practice in unselected patients receiving different types of chemotherapy. We treated 131 patients in Period 1 versus 93 in Period 2 (median follow-up, 75 and 29 months, respectively) with no difference in patient characteristics between the two periods. Event-free and overall survivals (EFS and OS) were significantly improved in Period 2 for elderly patients and a significant shift in the selection of regimens was observed at the time when rituximab became available. More patients received the CHOP regimen in Period 2 than in Period 1 (82 vs. 57%, p < 0.007) with CHOP being substituted for epirubicin-based regimens. In younger patients treated mostly with the ACVBP regimen (doxorubicin, cyclophosphamide, vindesine, bleomycin, prednisone) these differences were not observed, suggesting that combination of rituximab with dose-dense chemotherapy may deserve further evaluation in this age group.
Collapse
|
15
|
Carausu L, Clapisson G, Philip I, Sebban H, Marec-Bérard P. Use of totally implantable catheters for peripheral blood stem cell apheresis. Bone Marrow Transplant 2007; 40:417-22. [PMID: 17603515 DOI: 10.1038/sj.bmt.1705756] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Collection of PBSC by leukapheresis requires one venous access (VA) for inflow and one for outflow. The use of implantable venous access devices (IVAD) has never been reported in this setting. We retrospectively analyzed the use of IVAD for performing apheresis. The study was conducted between January 2000 and June 2005 on 64 patients (41 children) requiring intensification for treatment of a solid tumor. Mean body weight was 26 kg (range 8-91 kg) for a median age of 8.5 years (range 0.7-66 years). A total of 121 aphereses were performed (mean 1.89 apheresis/patient). The second VA was in a cubital vein in 84 procedures and was a temporary central VA in 31. Mean duration of apheresis was 3 h (range 30-274 min). Mean flow rate was 41.3 ml/min (range 12-85 ml/min). Mean collection rate was 59.2% for CD34+ cells and 70% for mononuclear cells. The total number of CD34+ cells collected was 2.5 x 10(6)/kg per apheresis, and 5.9 x 10(6)/kg per patient. Several complications occurred: one catheter-related sepsis (0.86%), four catheter occlusions (3.47%) and eight hemodynamic instabilities related to extracorporeal volume. Weight <10 kg is a risk factor for complication (P=0.0006). IVAD are effective and safe for PBSC collection. Placement of a second central VA (requiring general anesthesia for children) could be avoided.
Collapse
Affiliation(s)
- L Carausu
- Pediatric Oncology Unit, Centre Léon-Bérard, Lyon, France
| | | | | | | | | |
Collapse
|
16
|
Conter C, Carausu L, Martin E, Rubie H, Castex MP, Marec-Berard P. Utilisation des sites veineux implantables dans les chimiothérapies massives en pédiatrie. Arch Pediatr 2006; 13:256-61. [PMID: 16469486 DOI: 10.1016/j.arcped.2005.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 08/01/2005] [Accepted: 12/16/2005] [Indexed: 11/23/2022]
Abstract
BACKGROUND The feasibility and complication rate of central venous totally implantable access ports (TIAP), used for delivering high-dose chemotherapy (HDC) with autologous stem cell transplantation, have not been fully investigated to date, due to the almost exclusive use of external catheters (EC) in this clinical setting. PATIENTS AND METHODS We retrospectively studied infectious and mechanical complications of 45 TIAP and 19 EC, in 64 children receiving HDC and autologous stem cell transplantation at the Centre Leon-Berard (Lyon) or at the oncology unit of Toulouse children hospital between January 1999 and December 2003. RESULTS From the beginning of intensification to 60 days after bone marrow transplantation, 7 catheter-related bloodstream infections (3/19 EC or 15.8% corresponding to 2.69 infections for 1000 days of observation; 4/45 TIAP or 8.9% corresponding to 1.38 infections for 1000 days of observation) and 2 local infections (1/45 TIAP; 1/19 EC) were reported. Seven cases of reversible obstruction (6/7 with TIAP) and no deep venous thrombosis were detected. In 7 cases, another venous access was required either for accidental removal (2 EC), catheter infection (2 TIAP), or admission to intensive care (2 TIAP, 1 EC). TIAP complication rate does not seem to be influenced by factors such as low weight, massive blood product transfusion or prolonged parenteral nutrition. In 8 children, TIAP were used for collection of hematopoietic progenitor cells. CONCLUSIONS The use of TIAPs appears as a safe and effective option for HDC. We found more mechanical complications but less infectious complications with TIAP than with EC. Nevertheless, results need to be validated prospectively in a larger study cohort.
Collapse
Affiliation(s)
- C Conter
- Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France.
| | | | | | | | | | | |
Collapse
|