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Moraly J, Rossignol J, Rouzaud C, Gabas T, Bouktit H, Lhermitte L, Canioni D, Fraitag S, Bruneau J, Barete S, Suarez F, Ballul T, Meni C, Polivka L, Terriou L, Launay D, Bouillet L, Gaudy-Marqueste C, Gousseff M, Le Mouel E, Neel A, Ranta D, Jaussaud R, Guilpain P, Frenzel L, Agopian J, Dubreuil P, Greco C, Dimicoli-Salazar S, Heiblig M, Gourguechon C, Tournilhac O, Javier RM, Castelain F, Cabrera Q, Gourin MP, Wierzbicka-Hainaut E, Torregrosa-Diaz JM, Bulai C, Lavigne C, Hoarau C, Arock M, Damaj G, Lortholary O, Hermine O. Efficacy and safety of mammalian target of rapamycin inhibitors in systemic mastocytosis: A nationwide French pilot study. Am J Hematol 2024. [PMID: 38581211 DOI: 10.1002/ajh.27323] [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] [Received: 12/15/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 04/08/2024]
Abstract
Systemic mastocytosis (SM) corresponds to a rare and heterogeneous spectrum of diseases characterized by the accumulation of atypical mast cells (MCs). Advanced mastocytosis (Adv-SM) is associated with poor survival; in contrast, patients with non-advanced SM (non-Adv-SM) usually have a normal life expectancy but may experience poor quality of life. Despite recent therapeutic progress including tyrosine kinase inhibitors, new treatment options are needed for refractory and/or intolerant patients with both severely symptomatic and Adv-SM. In vitro, the mTOR pathway is activated in MCs from patients bearing the KIT D816V mutation. Furthermore, rapamycin induces the apoptosis of KIT D816V MCs selectively. In this nationwide study, we report the outcomes of patients diagnosed with SM and treated with a mammalian target of rapamycin inhibitor (imTOR) within the French National Reference Center for mastocytosis (CEREMAST). All patients registered were relapsing, treatment-refractory, or ineligible for other cytoreductive therapy. Non-Adv-SM patients received imTOR as a monotherapy (rapamycin/everolimus), and Adv-SM patients received imTOR as a monotherapy or in combination with cytarabine. The objective response rate (ORR) in non-Adv-SM was 60% (partial response in 40% and major response in 20%), including reductions in skin involvement, mediator release symptoms, and serum tryptase. In the Adv-SM group, the ORR was 20% (including one major response and one partial response, both in patients with a KIT D816V mutation), which enabled a successful bridge to allogeneic stem cell transplantation in one patient. Our results suggest that imTOR treatment has potential benefits in patients with SM harboring a KIT D816V mutation.
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Affiliation(s)
- Josquin Moraly
- Infectious and Tropical Diseases Department, Necker-Pasteur Infectiology Center, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Julien Rossignol
- Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades Hospital, AP-HP, Paris, France
- INSERM U1163, Imagine Institute, Paris-Cite University, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Department of Hematology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Claire Rouzaud
- Infectious and Tropical Diseases Department, Necker-Pasteur Infectiology Center, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Thomas Gabas
- Infectious and Tropical Diseases Department, Necker-Pasteur Infectiology Center, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Hassiba Bouktit
- Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Ludovic Lhermitte
- Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Laboratory of Onco-Hematology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Danielle Canioni
- Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Department of Pathology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Sylvie Fraitag
- Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Department of Pathology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Julie Bruneau
- Department of Pathology, Necker-Children's Hospital, AP-HP, Paris Centre University, Paris, France
| | - Stéphane Barete
- Department of Dermatology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Felipe Suarez
- Department of Hematology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Thomas Ballul
- Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades Hospital, AP-HP, Paris, France
- INSERM U1163, Imagine Institute, Paris-Cite University, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Department of Hematology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Cécile Meni
- Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Department of Dermatology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Laura Polivka
- Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades Hospital, AP-HP, Paris, France
- INSERM U1163, Imagine Institute, Paris-Cite University, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Department of Dermatology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Louis Terriou
- Department of Internal Medicine and Clinical Immunology, Claude Huriez Hospital, CHRU Lille, Lille, France
| | - David Launay
- Department of Internal Medicine and Clinical Immunology, Claude Huriez Hospital, CHRU Lille, Lille, France
| | - Laurence Bouillet
- Clinical Immunology/Internal Medicine Department, National Reference Center for Angioedema, Grenoble University Hospital, Grenoble, France
| | | | - Marie Gousseff
- Department of Internal Medicine, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Edwige Le Mouel
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Antoine Neel
- Department of Internal Medicine, Hôtel-Dieu University Hospital, Nantes, France
| | - Dana Ranta
- Department of Hematology, Nancy University Hospital, Nancy, France
| | - Roland Jaussaud
- Department of Internal Medicine and Clinical Immunology, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Philippe Guilpain
- Department of Internal Medicine-Multi-Organ Diseases, Saint-Eloi University Hospital, Montpellier University, Montpellier, France
| | - Laurent Frenzel
- Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades Hospital, AP-HP, Paris, France
- INSERM U1163, Imagine Institute, Paris-Cite University, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Department of Hematology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Julie Agopian
- INSERM, U1068, Centre de Recherche en Cancerologie de Marseille (CRCM), Paoli-Calmettes Institute, Marseille, France
| | - Patrice Dubreuil
- INSERM, U1068, Centre de Recherche en Cancerologie de Marseille (CRCM), Paoli-Calmettes Institute, Marseille, France
| | - Céline Greco
- Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Department of Pain and Palliative Care Unit, Necker-Children's Hospital, AP-HP, Paris Centre University, Paris, France
| | | | - Mael Heiblig
- Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | | | - Olivier Tournilhac
- Adult Clinical Hematology, CHU Clermont-Ferrand, INSERM CIC501, EA 7453 - Clermont Auvergne University, Clermont-Ferrand, France
| | - Rose-Marie Javier
- Department of Rheumatology, Strasbourg University Hospital, Strasbourg, France
| | - Florence Castelain
- Department of Dermatology, Allergology Unit, University Hospital of Besançon, Besançon, France
| | - Quentin Cabrera
- Department of Hematology, Sud Reunion University Hospital, Saint Pierre, La Réunion, France
| | | | | | | | - Cristina Bulai
- Department of Dermatology, Hôpital Larrey, CHU Toulouse, Toulouse, France
| | - Christian Lavigne
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
| | - Cyrille Hoarau
- Department of Clinical Immunology and Allergology, Centre Hospitalier Régional Universitaire, Tours, France
| | - Michel Arock
- Laboratory of Hematology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Gandhi Damaj
- Hematology Institute, Normandy University School of Medicine, Caen, France
| | - Olivier Lortholary
- Infectious and Tropical Diseases Department, Necker-Pasteur Infectiology Center, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Olivier Hermine
- Reference Center for Mastocytosis (CEREMAST), Necker-Enfants Malades Hospital, AP-HP, Paris, France
- INSERM U1163, Imagine Institute, Paris-Cite University, Necker-Enfants Malades Hospital, AP-HP, Paris, France
- Department of Hematology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
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Gurnari C, Koster L, Baaij L, Heiblig M, Yakoub-Agha I, Collin M, Passweg J, Bulabois CE, Khan A, Loschi M, Carnevale-Schianca F, Crisà E, Caravelli D, Kuball J, Saraceni F, Olivieri A, Rambaldi A, Kulasekararaj AG, Hayden PJ, Badoglio M, Onida F, Scheid C, Franceschini F, Mekinian A, Savic S, Voso MT, Drozd-Sokolowska J, Snowden JA, Raj K, Alexander T, Robin M, Greco R, McLornan DP. Allogeneic hematopoietic cell transplantation for VEXAS syndrome: results of a multicenter study of the EBMT. Blood Adv 2024; 8:1444-1448. [PMID: 38330178 PMCID: PMC10955646 DOI: 10.1182/bloodadvances.2023012478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Affiliation(s)
- Carmelo Gurnari
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
- Translational Hematology and Oncology Research Department, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
| | | | | | - Mael Heiblig
- Department of Hematology, Centre Hospitalier Lyon Sud, Lyon, France
| | | | | | | | | | - Anjum Khan
- Yorkshire Blood & Marrow Transplant Program, Leeds, United Kingdom
| | | | | | - Elena Crisà
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | | | - Jürgen Kuball
- Department of Haematology, University Medical Centre, Utrecht, The Netherlands
| | | | | | - Alessandro Rambaldi
- Department of Oncology and Hematology, University of Milan and Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Patrick J. Hayden
- Department of Haematology, Trinity College Dublin, St. James’s Hospital, Dublin, Ireland
| | | | - Francesco Onida
- ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy
| | | | - Franco Franceschini
- Rheumatology and Clinical Immunology, ASST Spedali Civili of Brescia and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Arsène Mekinian
- Sorbonne Université, Assistance Publique–Hôpitaux de Paris, Hôpital Saint Antoine, Service de médecine interne et Inflammation-Immunopathology-Biotherapy Department, Paris, France
| | - Sinisa Savic
- Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals, NHS Trust, Leeds, United Kingdom
| | - Maria Teresa Voso
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | | | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Kavita Raj
- University College London Hospitals NHS Trust, London, United Kingdom
| | - Tobias Alexander
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Rheumatology and Clinical Immunology, Berlin, Germany
| | | | - Raffaella Greco
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Donal P. McLornan
- University College London Hospitals NHS Trust, London, United Kingdom
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de Valence B, Delaune M, Nguyen Y, Jachiet V, Heiblig M, Jean A, Riescher Tuczkiewicz S, Henneton P, Guilpain P, Schleinitz N, Le Guenno G, Lobbes H, Lacombe V, Ardois S, Lazaro E, Langlois V, Outh R, Vinit J, Martellosio JP, Decker P, Moulinet T, Dieudonné Y, Bigot A, Terriou L, Vlakos A, de Maleprade B, Denis G, Broner J, Kostine M, Humbert S, Lifermann F, Samson M, Pechuzal S, Aouba A, Kosmider O, Dion J, Grosleron S, Bourguiba R, Terrier B, Georgin-Lavialle S, Fain O, Mekinian A, Morgand M, Comont T, Hadjadj J. Serious infections in patients with VEXAS syndrome: data from the French VEXAS registry. Ann Rheum Dis 2024; 83:372-381. [PMID: 38071510 DOI: 10.1136/ard-2023-224819] [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: 08/07/2023] [Accepted: 10/22/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is an acquired autoinflammatory monogenic disease with a poor prognosis whose determinants are not well understood. We aimed to describe serious infectious complications and their potential risk factors. METHODS Retrospective multicentre study including patients with VEXAS syndrome from the French VEXAS Registry. Episodes of serious infections were described, and their risk factors were analysed using multivariable Cox proportional hazards models. RESULTS Seventy-four patients with 133 serious infections were included. The most common sites of infection were lung (59%), skin (10%) and urinary tract (9%). Microbiological confirmation was obtained in 76%: 52% bacterial, 30% viral, 15% fungal and 3% mycobacterial. Among the pulmonary infections, the main pathogens were SARS-CoV-2 (28%), Legionella pneumophila (21%) and Pneumocystis jirovecii (19%). Sixteen per cent of severe infections occurred without any immunosuppressive treatment and with a daily glucocorticoid dose ≤10 mg. In multivariate analysis, age >75 years (HR (95% CI) 1.81 (1.02 to 3.24)), p.Met41Val mutation (2.29 (1.10 to 5.10)) and arthralgia (2.14 (1.18 to 3.52)) were associated with the risk of serious infections. JAK inhibitors were most associated with serious infections (3.84 (1.89 to 7.81)) compared with biologics and azacitidine. After a median follow-up of 4.4 (2.5-7.7) years, 27 (36%) patients died, including 15 (56%) due to serious infections. CONCLUSION VEXAS syndrome is associated with a high incidence of serious infections, especially in older patients carrying the p.Met41Val mutation and treated with JAK inhibitors. The high frequency of atypical infections, especially in patients without treatment, may indicate an intrinsic immunodeficiency.
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Affiliation(s)
| | - Marion Delaune
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | - Yann Nguyen
- Médecine interne, Université Paris Cité, Hôpital Beaujon, Clichy, France
| | - Vincent Jachiet
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Mael Heiblig
- Hématologie clinique, Université Claude Bernard Lyon 1, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
| | - Alexis Jean
- Médecine interne, CHU de Bordeaux, Bordeaux, France
| | | | - Pierrick Henneton
- Service de Médecine Interne A, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier, France
| | - Philippe Guilpain
- Service de Médecine Interne A, Hôpital Saint Eloi, CHRU de Montpellier, Montpellier, France
| | - Nicolas Schleinitz
- Médecine interne, Aix-Marseille Universite, Hôpital de la Timone, Marseille, France
| | | | - Hervé Lobbes
- Médecine interne, CHU Estaing, Clermont-Ferrand, France
| | - Valentin Lacombe
- Médecine interne et immunologique clinique, CHU Angers, Angers, France
| | | | | | - Vincent Langlois
- Médecine interne et infectieuse, Hospital Group Le Havre, Le Havre, France
| | - Roderau Outh
- Service de médecine interne et générale, CH Perpignan, Perpignan, France
| | - Julien Vinit
- Médecine interne, Hospital Centre Chalon-sur-Saon, Chalon-sur-Saone, France
| | | | - Paul Decker
- Médecine interne et immunologie clinique, CHU de Nancy, Nancy, France
| | - Thomas Moulinet
- Médecine interne et immunologie clinique, CHU de Nancy, Nancy, France
| | - Yannick Dieudonné
- Immunologie Clinique et Médecine Interne, CHU de Strasbourg, Strasbourg, France
| | | | - Louis Terriou
- Médecine interne - hématologie, CHU Lille, Lille, France
| | - Alexandre Vlakos
- Médecine interne, Haute-Saône Hospital Group Vesoul Site, Vesoul, France
| | | | - Guillaume Denis
- Médecine interne et hématologie, Centre Hospitalier de Rochefort, Rochefort, France
| | | | - Marie Kostine
- Rhumatologie, Centre Hospitalier Universitaire de Bordeaux Groupe hospitalier Pellegrin, Bordeaux, France
| | - Sebastien Humbert
- Hématologie, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | | | | | - Susann Pechuzal
- Médecine interne-polyvalente, Hôpitaux Drôme Nord, Romans, France
| | | | - Olivier Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen, APHP, Paris, France
| | - Jeremie Dion
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | | | - Rim Bourguiba
- Médecine interne, CEREMAIA, Sorbonne Université, Hospital Tenon, Paris, France
| | - Benjamin Terrier
- Médecine interne, Université Paris Cité, Hospital Cochin, Paris, France
| | | | - Olivier Fain
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Arsène Mekinian
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Marjolaine Morgand
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
| | - Thibault Comont
- Médecine interne, Université Toulouse III-Paul Sabatier Faculté de santé, Centre Hospitalier Universitaire de Toulouse Pole IUC de Toulouse Oncopole CHU, Toulouse, France
| | - Jerome Hadjadj
- Médecine Interne, Sorbonne université, Hopital Saint-Antoine, Paris, France
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Stein EM, de Botton S, Cluzeau T, Pigneux A, Liesveld JL, Cook RJ, Rousselot P, Rizzieri DA, Braun T, Roboz GJ, Lebon D, Heiblig M, Baker K, Volkert A, Paul S, Rajagopal N, Roth DA, Kelly M, Peterlin P. Use of tamibarotene, a potent and selective RARα agonist, in combination with azacitidine in patients with relapsed and refractory AML with RARA gene overexpression. Leuk Lymphoma 2023; 64:1992-2001. [PMID: 37571998 DOI: 10.1080/10428194.2023.2243356] [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: 04/06/2023] [Revised: 07/17/2023] [Accepted: 07/25/2023] [Indexed: 08/14/2023]
Abstract
Tamibarotene-based therapy is a novel targeted approach for the treatment of relapsed/refractory (R/R) acute myeloid leukemia (AML) with retinoic acid receptor alpha (RARA) gene overexpression. Approximately, 50% of higher-risk myelodysplastic syndrome (MDS) patients and approximately 30% of AML patients are positive for RARA overexpression using a blood-based biomarker test that measures RARA expression in peripheral blasts. A phase 2 study investigating the activity of tamibarotene in patients with RARA overexpression was conducted in patients with AML and MDS (NCT02807558). In 28 patients with R/R AML and RARA overexpression treated with tamibarotene in combination with azacitidine, the median overall survival was 5.9 months. In 21 response-evaluable patients, the complete remission/complete remission with incomplete hematologic recovery (CR/CRi) rate was 19%, and median time to initial CR/CRi was 1.2 months. The favorable safety profile and preliminary clinical activity support the development of combination therapies with tamibarotene in myeloid malignancies with RARA overexpression.
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Affiliation(s)
- Eytan M Stein
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Thomas Cluzeau
- Côte d'Azur University, CHU de Nice Hôpital, Nice, France
| | - Arnaud Pigneux
- Hematology Clinic, Bordeaux University Hospital, Bordeaux University, Bordeaux, France
| | | | - Rachel J Cook
- Division of Hematology/Medical Oncology, Oregon Health and Science University, Portland, OR
| | - Philippe Rousselot
- Centre Hospitalier de Versailles, Université Paris-Saclay, Versailles, France
| | | | - Thorsten Braun
- Centre Hospitalier Universitiaire Hôpital Avicenne, Bobigny, France
| | - Gail J Roboz
- Weill Cornell Medicine and the New York Presbyterian Hospital, New York, NY, USA
| | | | - Mael Heiblig
- Centre Hospitalier Lyon Sud, Pierre-Bénite, France
| | | | | | - Sofia Paul
- Syros Pharmaceuticals, Cambridge, MA, USA
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5
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Belhabri A, Heiblig M, Morisset S, Vila L, Santana C, Nicolas‐Virelizier E, Hayette S, Tigaud I, Plesa A, Labussiere‐Wallet H, Sobh M, Michallet A, Marie B, Nicolini F, Guillermin Y, Gaëlle F, Lebras L, Rey P, Jauffret‐Bertholon L, Laude M, Sandrine L, Michallet M. Clinical outcome of therapy-related acute myeloid leukemia patients. Real-life experience in a University Hospital and a Cancer Center in France. Cancer Med 2023; 12:16929-16944. [PMID: 37548369 PMCID: PMC10501294 DOI: 10.1002/cam4.6322] [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: 01/13/2023] [Revised: 06/17/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND t-AML occurs after a primary malignancy treatment and retains a poor prognosis. AIMS To determine the impact of primary malignancies, therapeutic strategies, and prognostic factors on clinical outcomes of t-AML. RESULTS A total of 112 adult patients were included in this study. Fifty-Five patients received intensive chemotherapy (IC), 33 non-IC, and 24 best supportive care. At t-AML diagnosis, 42% and 44% of patients presented an unfavorable karyotype and unfavorable 2010 ELN risk profile, respectively. Among treated patients (n = 88), 43 (49%) achieved complete remission: four out of 33 (12%) and 39 out of 55 (71%) in non-IC and IC groups, respectively. With a median follow-up of 5.5 months, the median overall survival (OS) and disease-free survival (DFS) for the whole population were 9 months and 6.3 months, respectively, and for the 88 treated patients 13.5 months and 8.2 months, respectively. Univariate analysis on OS and DFS showed a significant impact of high white blood cells (WBC) and blast counts at diagnosis, unfavorable karyotype and ELN classification. Multivariate analysis showed a negative impact of WBC count at diagnosis and a positive impact of chemotherapy on OS and DFS in the whole population. It also showed a negative impact of previous auto-HCT and high WBC count on OS and DFS and of IC on OS in treated patients which disappeared when we considered only confounding variables (age, previous cancers, marrow blasts, and 2010 ELN classification). In a pair-matched analysis comparing IC treated t-AML with de novo AML, there was no difference of OS and DFS between the two populations. CONCLUSION We showed, in this study that t-AML patients with unfavorable features represented almost half of the population. Best outcomes obtained in patients receiving IC must be balanced by known confounding variables and should be improved by using new innovative agents and therapeutic strategies.
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Affiliation(s)
- Amine Belhabri
- Department of HematologyLeon Berard Cancer CenterLyonFrance
| | - Mael Heiblig
- Department of HematologyUniversity Hospital Lyon SudPierre BeniteFrance
| | | | - Liliana Vila
- Department of HematologyLeon Berard Cancer CenterLyonFrance
| | | | | | - Sandrine Hayette
- Department of biology – GHSUniversity Hospital Lyon SudPierre BeniteFrance
| | - Isabelle Tigaud
- Department of biology – GHSUniversity Hospital Lyon SudPierre BeniteFrance
| | - Adriana Plesa
- Department of biology – GHSUniversity Hospital Lyon SudPierre BeniteFrance
| | | | - Mohamad Sobh
- Research Advisor, Faculty of MedicineUniversity of OttawaOttawaCanada
| | | | - Balsat Marie
- Department of HematologyUniversity Hospital Lyon SudPierre BeniteFrance
| | | | | | - Fossard Gaëlle
- Department of HematologyUniversity Hospital Lyon SudPierre BeniteFrance
| | - Laure Lebras
- Department of HematologyLeon Berard Cancer CenterLyonFrance
| | - Philippe Rey
- Department of HematologyLeon Berard Cancer CenterLyonFrance
| | | | | | - Loron Sandrine
- Department of HematologyUniversity Hospital Lyon SudPierre BeniteFrance
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Borie R, Debray MP, Guedon AF, Mekinian A, Terriou L, Lacombe V, Lazaro E, Meyer A, Mathian A, Ardois S, Vial G, Moulinet T, Terrier B, Jamilloux Y, Heiblig M, Bouaziz JD, Zakine E, Outh R, Groslerons S, Bigot A, Flamarion E, Kostine M, Henneton P, Humbert S, Constantin A, Samson M, Bertrand NM, Biscay P, Dieval C, Lobbes H, Jeannel J, Servettaz A, Adelaide L, Graveleau J, de Sainte-Marie B, Galland J, Guillotin V, Duroyon E, Templé M, Bourguiba R, Georgin Lavialle S, Kosmider O, Audemard-Verger A, Pha M, Hie M, Meghit K, Rondeau-Lutz M, Weber JC. Pleuropulmonary Manifestations of Vacuoles, E1 Enzyme, X-Linked, Autoinflammatory, Somatic (VEXAS) Syndrome. Chest 2023; 163:575-585. [PMID: 36272567 DOI: 10.1016/j.chest.2022.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [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: 06/03/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is a newly identified autoinflammatory disorder related to somatic UBA1 mutations. Up to 72% of patients may show lung involvement. RESEARCH QUESTION What are the pleuropulmonary manifestations in VEXAS syndrome? STUDY DESIGN AND METHODS One hundred fourteen patients were included in the French cohort of VEXAS syndrome between November 2020 and May 2021. Each patient included in the study who had an available chest CT scan was discussed in an adjudication multidisciplinary team and classified as showing potentially pleuropulmonary-specific involvement of VEXAS syndrome or others. RESULTS Fifty-one patients had a CT scan available for review and 45 patients (39%) showed pleuropulmonary abnormalities on chest CT scan that were considered related to VEXAS syndrome after adjudication. Most patients were men (95%) with a median age 67.0 years at the onset of symptoms. Among these 45 patients, 44% reported dyspnea and 40% reported cough. All 45 patients showed lung opacities on chest CT scan (including ground-glass opacities [87%], consolidations [49%], reticulation [38%], and septal lines [51%]) and 53% of patients showed pleural effusion. Most patients showed improvement with prednisone, but usually required > 20 mg/d. The main clinical and biological features as well the median survival did not differ between the 45 patients with pleuropulmonary involvement and the rest of the cohort, suggesting that the prevalence of pleuropulmonary involvement might have been underdiagnosed in the rest of the cohort. INTERPRETATION Pulmonary manifestations are frequent in VEXAS syndrome, but rarely are at the forefront. The initial outcome is favorable with prednisone and does not seem to lead to pulmonary fibrosis.
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Affiliation(s)
- Raphael Borie
- Service de Pneumologie A, Hôpital Bichat, APHP, Paris, France; INSERM, Unité 1152, Université de Paris, Paris, France.
| | - Marie Pierre Debray
- Service de Radiologie, Hôpital Bichat, APHP, Paris, France; INSERM, Unité 1152, Université de Paris, Paris, France
| | - Alexis F Guedon
- Service de Médecine Interne, Hôpital St. Antoine, APHP, Paris, France
| | - Arsene Mekinian
- Service de Médecine Interne, Hôpital St. Antoine, APHP, Paris, France
| | | | - Valentin Lacombe
- Service de Médecine Interne et Immunologie Clinique, CHU d'Angers, Angers, France
| | - Estibaliz Lazaro
- Médecine Interne et Maladies Infectieuses, Hôpital Haut l'Evêque, CHU de Bordeaux, Pessac, France
| | - Aurore Meyer
- Service d'Immunologie Clinique et Médecine Interne, Nouvel Hôpital Civil, CHU Strasbourg, Strasbourg, France
| | - Alexis Mathian
- Service de Médicine Interne 2, Hôpital de la Pitié Salpêtrière, APHP, Paris, France
| | - Samuel Ardois
- Service de Médecine Interne et Immunologie Clinique, Hôpital Pontchaillou, Renne, France
| | - Guillaume Vial
- Médecine Interne et Immunologie Clinique, Hôpital Saint André, CHU Bordeaux, Bordeaux, France
| | - Thomas Moulinet
- Département de Médecine Interne et Immunologie Clinique, CHU Nancy, UMR 7365, IMoPA, University of Lorraine, CNRS, Nancy, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, APHP, Paris, France
| | - Yvan Jamilloux
- Service de Médecine Interne, Hôpital de la Croix Rousse, Hématologie, Centre Hospitalier de Lyon Sud, Pierre Bénite, Lyon, France
| | - Mael Heiblig
- Service de Médecine Interne, Hôpital de la Croix Rousse, Hématologie, Centre Hospitalier de Lyon Sud, Pierre Bénite, Lyon, France
| | | | - Eve Zakine
- Service de Dermatologie, Hopital St. Louis, APHP, Paris, France
| | - Roderau Outh
- Service de Médecine Interne, CHG Perpignan, Perpignan, France
| | | | - Adrien Bigot
- Service de Médecine Interne et Immunologie Clinique, CHU Bretonneau, Tours, France
| | - Edouard Flamarion
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, APHP-Centre, Université de Paris Cité, Paris, France
| | - Marie Kostine
- Service de Rhumatologie, CHU Bordeaux, Bordeaux, France
| | - Pierrick Henneton
- Service de Médecine Vasculaire, CHU de Montpellier, Montpellier, France
| | | | - Arnaud Constantin
- Department of Rheumatology, Pierre-Paul Riquet University Hospital, and Toulouse III-Paul Sabatier University, Toulouse, France
| | - Maxime Samson
- Service de Médecine Interne et Immunologie Clinique, CHU de Dijon, Dijon, France
| | | | - Pascal Biscay
- Clinique Mutualiste Pessac Médecine Interne, Pessac, France
| | - Celine Dieval
- Service de Médecine Interne, CHU Rochefort, Rochefort, France
| | - Herve Lobbes
- Service de Médecine Interne, CHU de Clermont-Ferrand, Hôpital Estaing, Clermont-Ferrand, France
| | - Juliette Jeannel
- Service de Médecine Interne, Nouvel Hôpital Civil, CHU Strasbourg, Strasbourg, France
| | - Amelie Servettaz
- Service de Médecine Interne, Maladies Infectieuses, Immunologie Clinique, CHU de Reims, Reims, France
| | - Leo Adelaide
- Service de Médecine Interne, CHU Lucien Hussel, Vienne, France
| | - Julie Graveleau
- Service de Médecine Interne, CHU Saint-Nazaire, Saint-Nazaire, France
| | | | - Joris Galland
- Service de Médecine Interne, Centre Hospitalier de Bourg-en-Bresse, Bourg-en-Bresse, France
| | - Vivien Guillotin
- Médecine Interne et Maladies Infectieuses, Hôpital Haut l'Evêque, CHU de Bordeaux, Pessac, France
| | - Eugénie Duroyon
- Laboratoire d'Hématologie, Hôpital Cochin, APHP, Paris, France
| | - Marie Templé
- Laboratoire d'Hématologie, Hôpital Cochin, APHP, Paris, France
| | - Rim Bourguiba
- Service de Médecine Interne, Hôpital Tenon, APHP, Paris, France
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Comont T, Heiblig M, Riviere E, Terriou L, Rossignol J, Bouscary D, Rieu V, Le Guenno G, Mathian A, Aouba A, Vinit J, Dion J, Kosmider O, Terrier B, Georgin-Lavialle S, Fenaux P, Mekinian A. Utilisation de l’azacitidine dans le VEXAS chez des patients porteurs d’un syndrome myélodysplasique : données du registre Français VEXAS. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Georgin-Lavialle S, Terrier B, Guedon A, Estibaliz L, Heiblig M, Comont T, Louis T, Lacombe V, Fenaux P, Ardois S, Kosmider O, Mekinian A. Observatoire français de 116 patients avec un syndrome VEXAS : corrélation phénotype–génotype et prise en charge. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.249] [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: 11/27/2022]
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Comont T, Heiblig M, Rivière E, Terriou L, Rossignol J, Bouscary D, Rieu V, Le Guenno G, Mathian A, Aouba A, Vinit J, Dion J, Kosmider O, Terrier B, Georgin-Lavialle S, Fenaux P, Mekinian A. Azacitidine for patients with Vacuoles, E1 Enzyme, X-linked, Autoinflammatory, Somatic syndrome (VEXAS) and myelodysplastic syndrome: data from the French VEXAS registry. Br J Haematol 2021; 196:969-974. [PMID: 34651299 DOI: 10.1111/bjh.17893] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [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: 08/24/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/12/2022]
Abstract
Azacitidine can be effective in myelodysplastic syndromes (MDS) associated with inflammatory/autoimmune diseases. Vacuoles, E1 Enzyme, X-linked, Autoinflammatory, Somatic syndrome (VEXAS) is a new monogenic autoinflammatory syndrome caused by somatic ubiquitin-like modifier-activating enzyme 1 (UBA1) mutation, often associated with MDS, whose treatment is difficult and not yet codified. Based on a French nationwide registry of 116 patients with VEXAS, we report the efficacy and safety of azacitidine treatment in 11 patients with VEXAS with MDS. Clinical response of VEXAS to azacitidine was achieved in five patients (46%), during 6, 8+, 12, 21, 27+ months respectively, suggesting that azacitidine can be effective in selected patients with VEXAS and associated MDS.
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Affiliation(s)
- Thibault Comont
- Department of Internal Medicine, IUCT-Oncopole, University Hospital of Toulouse, Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Mael Heiblig
- Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, Université Lyon Sud, Pierre Bénite, France
| | - Etienne Rivière
- Department of Internal Medicine, University of Bordeaux, Haut-Lévêque Hospital, Pessac, France
| | - Louis Terriou
- Department of Internal Medicine and Clinical Immunology, University of Lille, CHU Lille, Lille, France
| | - Julien Rossignol
- French Reference Center for Mastocytosis (CEREMAST), Hôpital Necker, Assistance Publique-Hôpitaux de Paris (APH-HP), Université de Paris, Paris, France
| | - Didier Bouscary
- Departement of Hematology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APH-HP), Université de Paris, Paris, France
| | - Virginie Rieu
- Department of Internal Medicine, University Hospital Estaing, Université de Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Le Guenno
- Department of Internal Medicine, University Hospital Estaing, Université de Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexis Mathian
- Department of Internal Medicine, Pitie-Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Achille Aouba
- Department of Clinical Immunology and Internal Medicine, CHU of Caen Normandie, Université de Caen, Caen, France
| | - Julien Vinit
- Department of Internal Medicine, CHWM, Chalon-sur-Saône, France
| | - Jeremie Dion
- Department of Internal Medicine, IUCT-Oncopole, University Hospital of Toulouse, Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Olivier Kosmider
- Hematology laboratory, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APH-HP), Université de Paris, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Sophie Georgin-Lavialle
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris (AP-HP), Tenon Hospital, National reference center for autoinflammatory diseases and AA amyloidosis (CEREMAIA), Sorbonne University, Université de Paris, Paris, France
| | - Pierre Fenaux
- Department of Hematology, Hopital Saint-Louis, Assistance Publique Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Arsène Mekinian
- Department of Internal Medicine, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Sorbonne University, Paris, France
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10
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Georgin-Lavialle S, Terrier B, Guedon AF, Heiblig M, Comont T, Lazaro E, Lacombe V, Terriou L, Ardois S, Bouaziz JD, Mathian A, Le Guenno G, Aouba A, Outh R, Meyer A, Roux-Sauvat M, Ebbo M, Zhao LP, Bigot A, Jamilloux Y, Guillotin V, Flamarion E, Henneton P, Vial G, Jachiet V, Rossignol J, Vinzio S, Weitten T, Vinit J, Deligny C, Humbert S, Samson M, Magy-Bertrand N, Moulinet T, Bourguiba R, Hanslik T, Bachmeyer C, Sebert M, Kostine M, Bienvenu B, Biscay P, Liozon E, Sailler L, Chasset F, Audemard-Verger A, Duroyon E, Sarrabay G, Borlot F, Dieval C, Cluzeau T, Marianetti P, Lobbes H, Boursier G, Gerfaud-Valentin M, Jeannel J, Servettaz A, Audia S, Larue M, Henriot B, Faucher B, Graveleau J, de Sainte Marie B, Galland J, Bouillet L, Arnaud C, Ades L, Carrat F, Hirsch P, Fenaux P, Fain O, Sujobert P, Kosmider O, Mekinian A. Further characterization of clinical and laboratory features occurring in VEXAS syndrome in a large-scale analysis of multicenter case-series of 116 French patients. Br J Dermatol 2021; 186:564-574. [PMID: 34632574 DOI: 10.1111/bjd.20805] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A new autoinflammatory syndrome related to somatic mutations of UBA1 was recently described and called VEXAS syndrome. OBJECTIVE To describe clinical characteristics, laboratory findings and outcomes of VEXAS syndrome. DESIGN Case-series. SETTING Patients referred to a French multicenter registry between November 2020 and May 2021. PATIENTS 116 patients with VEXAS syndrome. MEASUREMENTS Frequency and median of parameters and vital status, from diagnosis to the end of the follow-up. RESULTS Main clinical features were skin lesions (83.5%), non-infectious fever (63.6%), weight loss (62%), lung involvement (49.6%), ocular symptoms (38.8%), relapsing chondritis (36.4%), venous thrombosis (34.7%), lymph nodes (33.9%), and arthralgia (27.3%). Hematological disease was present in 58 cases (50%), considered as myelodysplastic syndrome (MDS, n= 58) and monoclonal gammapathy of unknown significance (n=12).UBA1 mutations included p.M41T (44.8%), p.M41V (30.2%), p.M41L (18.1%), and splice mutations (6.9%). After a median follow-up of 3.0 years, 18 patients died (15.5%), from infectious origin (n=9) and MDS progression (n=3). Unsupervised analysis identified 3 clusters: cluster 1 (47%) with mild-to-moderate disease; cluster 2 (16%) with underlying MDS and higher mortality rates; cluster 3 (37%) with constitutional manifestations, higher C-reactive protein levels and less frequent chondritis. Five-year probability of survival was 84.2% in cluster 1, 50.5 % in cluster 2, and 89.6% in cluster 3. UBA1 p.Met41Leu mutation was associated with a better prognosis. CONCLUSION VEXAS syndrome displays a large spectrum of organ manifestations and shows different clinical and prognostic profiles. It also raises a potential impact of the identified UBA1 mutation.
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Affiliation(s)
- S Georgin-Lavialle
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - B Terrier
- University of Paris, AP-HP, Cochin Hospital, Department of Internal Medicine, F-75014, Paris, France
| | - A F Guedon
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Hôpital Saint-Antoine, APHP, Paris
| | | | - T Comont
- University Hospital of Toulouse, Department of Internal Medicine and Clinical Immunology, Toulouse, France
| | - E Lazaro
- Department of Internal Medicine and Infectious Diseases, Hôpital Haut-Lévêque, Bordeaux, France
| | - V Lacombe
- Department of Internal Medicine, Angers University Hospital, Angers, France
| | - L Terriou
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - S Ardois
- Service de médecine interne, CHU de Rennes, Rennes, France
| | - J-D Bouaziz
- Université de Paris, Service de dermatologie, Hôpital Saint Louis, APHP, INSERM U944, Paris, France
| | - A Mathian
- Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - G Le Guenno
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - A Aouba
- Caen Université, Hôpital de Caen, Department of Internal Medicine, Caen, France
| | - R Outh
- Service de médecine interne et générale, Centre Hospitalier de Perpignan, Perpignan, France
| | - A Meyer
- Service d'immunologie clinique et médecine interne, Nouvel Hôpital Civil, CHU Strasbourg
| | - M Roux-Sauvat
- GHND, Centre Hospitalier Pierre Oudot, 30 avenue du Médipôle, BP 40348, 38302 Bourgoin-Jallieu Cedex
| | - M Ebbo
- Aix Marseille Université, AP-HM, Hôpital de la Timone, Department of Internal Medicine, Marseille, France
| | - L P Zhao
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - A Bigot
- 19University of Tours, Tours, France, Department of Internal Medicine and Clinical
| | - Y Jamilloux
- University Hospital of Lyon, Hospices Civils de Lyon, Department of Internal Medicine and Clinical Immunology, Lyon, France
| | - V Guillotin
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - E Flamarion
- Université de Paris, Service de médecine interne, HEGP Paris, France
| | - P Henneton
- Service de Médecine Vasculaire, CHU Montpellier, 80 Av Augustin Fliche, Montpellier, 34090
| | - G Vial
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - V Jachiet
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
| | - J Rossignol
- Université de Paris, Service d'hématologie, Necker Enfants Malades, Paris, France
| | - S Vinzio
- Univ. Grenoble Alpes, Inserm, U1036, CHU Grenoble Alpes, CEA, IRIG-BCI, 38000, Grenoble, France
| | - T Weitten
- Service de médecine interne, Centre Hospitalier (CHICAS), GAP, France
| | - J Vinit
- Service de médecine interne, Centre Hospitalier, Chalons, France
| | - C Deligny
- Service de Rhumatologie - Médecine Interne 5D · CHU de Martinique - Hôpital P. Zobda-Quitman, France
| | - S Humbert
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - M Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - N Magy-Bertrand
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - T Moulinet
- Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Systemic and Autoimmune Rare Diseases, Nancy University Hospital, UMR 7365, IMoPA, Lorraine University, CNRS, Vandoeuvre-lès-Nancy, France
| | - R Bourguiba
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - T Hanslik
- AP-HP, Hôpital Ambroise Paris, service de médecine interne, Paris, France
| | - C Bachmeyer
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - M Sebert
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - M Kostine
- Department of Rheumatology, Hôpital Haut-Lévesque, Bordeaux, France
| | - B Bienvenu
- Hôpital Saint Joseph, service de médecine interne, Marseille, France
| | - P Biscay
- Clinique Mutualiste Pessac Médecine Interne, Pessac, France
| | - E Liozon
- Service de Médecine Interne, CHU Dupuytren, Limoges, France
| | - L Sailler
- University Hospital of Toulouse, Department of Internal Medicine, Toulouse, France
| | - F Chasset
- Sorbonne Université, Hôpital Tenon, service de dermatologie et allergologie et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75020, Paris, France
| | - A Audemard-Verger
- 19University of Tours, Tours, France, Department of Internal Medicine and Clinical
| | - E Duroyon
- Service d'Hématologie Biologique, DMU BioPhyGen GH AP-HP. Centre-University de Paris
| | - G Sarrabay
- Laboratory of Rare and Autoinflammatory Genetic Diseases and Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), CHU Montpellier, University of Montpellier, Montpellier, France
| | - F Borlot
- Service de médecine Interne, CH Béziers, France
| | - C Dieval
- Service de médecine interne et hématologie, CH régional, Rochefort, France
| | - T Cluzeau
- Hematology department, CHU of Nice, Cote d'Azur University, Nice, France
| | - P Marianetti
- CHU de REIMS, Service de médecine interne, maladies infectieuses, immunologie clinique
| | - H Lobbes
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - G Boursier
- Laboratory of Rare and Autoinflammatory Genetic Diseases and Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), CHU Montpellier, University of Montpellier, Montpellier, France
| | - M Gerfaud-Valentin
- University Hospital of Lyon, Hospices Civils de Lyon, Department of Haematology, Lyon, France
| | - J Jeannel
- Université de Paris, Service de médecine interne, HEGP Paris, France
| | - A Servettaz
- CHU de REIMS, Service de médecine interne, maladies infectieuses, immunologie clinique
| | - S Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - M Larue
- APHP, Service de rhumatologie, Hôpital Henri Mondor, Créteil, France
| | - B Henriot
- Service de médecine interne, Centre Hospitalier René Pleven, Dinan, France
| | - B Faucher
- Aix Marseille Université, AP-HM, Hôpital de la Timone, Department of Internal Medicine, Marseille, France
| | - J Graveleau
- CHU de Nantes Hôtel Dieu, Service de Médecine Interne, Nantes, France
| | - B de Sainte Marie
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - J Galland
- Service de médecine interne, hôpital Fleyriat, Centre hospitalier Bourg-en-Bresse, France
| | - L Bouillet
- Univ. Grenoble Alpes, Inserm, U1036, CHU Grenoble Alpes, CEA, IRIG-BCI, 38000, Grenoble, France
| | - C Arnaud
- University Hospital of Toulouse, Department of Internal Medicine, Toulouse, France
| | - L Ades
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - F Carrat
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Hôpital Saint-Antoine, APHP, Paris
| | - P Hirsch
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service d'hématologie biologique, F-75012, Paris, France
| | - P Fenaux
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - O Fain
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
| | - P Sujobert
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - O Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen GH AP-HP. Centre-University de Paris
| | - A Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
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Ribereau-Gayon E, Heiblig M, Bourbon E, Sujobert P, Harou O, Theillac C, Poulalhon N, Balme B, Dalle S, Debarbieux S. Atypical extensive lupus tumidus-like eruption as an early presentation of VEXAS syndrome. Int J Dermatol 2021; 61:e89-e91. [PMID: 34587282 DOI: 10.1111/ijd.15916] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/11/2021] [Revised: 08/22/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Emmanuel Ribereau-Gayon
- Dermatology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Mael Heiblig
- Haematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Estelle Bourbon
- Biological Haematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Pierre Sujobert
- Biological Haematology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Olivier Harou
- Pathology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Claire Theillac
- Dermatology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Nicolas Poulalhon
- Dermatology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Brigitte Balme
- Pathology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Stéphane Dalle
- Dermatology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - Sébastien Debarbieux
- Dermatology Department, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
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12
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Antherieu G, Bidet A, Huet S, Hayette S, Migeon M, Boureau L, Sujobert P, Thomas X, Ghesquières H, Pigneux A, Heiblig M. Allogenic Stem Cell Transplantation Abrogates Negative Impact on Outcome of AML Patients with KMT2A Partial Tandem Duplication. Cancers (Basel) 2021; 13:cancers13092272. [PMID: 34068470 PMCID: PMC8126020 DOI: 10.3390/cancers13092272] [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: 03/06/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 01/22/2023] Open
Abstract
Recently, a new subset of acute myeloid leukemia (AML) presenting a direct partial tandem duplication (PTD) of the KMT2A gene was described. The consequences of this alteration in terms of outcome and response to treatment remain unclear. We analyzed retrospectively a cohort of KMT2A-PTD-mutated patients with newly diagnosed AML. With a median follow-up of 3.6 years, the median overall survival was 12.1 months. KMT2A-PTD-mutated patients were highly enriched in mutations affecting epigenetic actors and the RTK/RAS signaling pathway. Integrating KMT2A-PTD in ELN classification abrogates its predictive value on survival suggesting that this mutation may overcome other genomic marker effects. In patients receiving intensive chemotherapy, hematopoietic stem cell transplantation (HSCT) significantly improved the outcome compared to non-transplanted patients. In the multivariate analysis, only HSCT at any time in complete remission (HR = 2.35; p = 0.034) and FLT3-ITD status (HR = 0.29; p = 0.014) were independent variables associated with overall survival, whereas age was not. In conclusion, our results emphasize that KMT2A-PTD should be considered as a potential adverse prognostic factor. However, as KMT2A-PTD-mutated patients are usually considered an intermediate risk group, upfront HSCT should be considered in first CR due to the high relapse rate observed in this subset of patients.
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Affiliation(s)
- Gabriel Antherieu
- Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France; (G.A.); (X.T.); (H.G.)
| | - Audrey Bidet
- Hematology Biology, Molecular Hematology, Bordeaux University Hospital, 33600 Pessac, France; (A.B.); (M.M.); (L.B.)
| | - Sarah Huet
- Department of Molecular Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France; (S.H.); (S.H.); (P.S.)
| | - Sandrine Hayette
- Department of Molecular Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France; (S.H.); (S.H.); (P.S.)
| | - Marina Migeon
- Hematology Biology, Molecular Hematology, Bordeaux University Hospital, 33600 Pessac, France; (A.B.); (M.M.); (L.B.)
| | - Lisa Boureau
- Hematology Biology, Molecular Hematology, Bordeaux University Hospital, 33600 Pessac, France; (A.B.); (M.M.); (L.B.)
| | - Pierre Sujobert
- Department of Molecular Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France; (S.H.); (S.H.); (P.S.)
| | - Xavier Thomas
- Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France; (G.A.); (X.T.); (H.G.)
| | - Hervé Ghesquières
- Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France; (G.A.); (X.T.); (H.G.)
| | - Arnaud Pigneux
- Hematology and Cell Therapy, Bordeaux University Hospital, 33600 Pessac, France;
| | - Mael Heiblig
- Department of Hematology, Lyon-Sud Hospital, Hospices Civils de Lyon, 69495 Pierre Bénite, France; (G.A.); (X.T.); (H.G.)
- Correspondence: ; Tel.: +33-478-862-240; Fax: +33-472-678-880
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13
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Heiblig M, Hachem-Khalife S, Willekens C, Micol JB, Paci A, Penard-Lacronique V, de Botton S. Enasidenib for the treatment of relapsed or refractory acute myeloid leukemia with an isocitrate dehydrogenase 2 mutation. Expert Review of Precision Medicine and Drug Development 2020. [DOI: 10.1080/23808993.2020.1831909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Mael Heiblig
- Inserm U1170, Gustave Roussy Cancer Campus, Université Paris-Sud, Villejuif, France
| | | | | | - Jean-Baptiste Micol
- Service d’Hématologie Clinique, Gustave Roussy Cancer Campus, Villejuif, France
| | - Angelo Paci
- Service De Pharmacologie, Département De Biologie Et Pathologie Médicales, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | | | - Stéphane de Botton
- Inserm U1170, Gustave Roussy Cancer Campus, Université Paris-Sud, Villejuif, France
- Service d’Hématologie Clinique, Gustave Roussy Cancer Campus, Villejuif, France
- Département d’Innovation Thérapeutique Et d’Essais Précoces (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Faculté De Médecine Paris-Sud, Université Paris-Saclay, Kremlin-Bicêtre, France
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14
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Nicolini FE, Alcazer V, Huguet F, Cony-Makhoul P, Heiblig M, Fort MP, Morisset S, Guerci-Bresler A, Soula V, Sobh M, d'Estaing SG, Daudin M, Etienne G. CML patients show sperm alterations at diagnosis that are not improved with imatinib treatment. Leuk Res 2016; 48:80-3. [PMID: 27501271 DOI: 10.1016/j.leukres.2016.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/12/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Franck-Emmanuel Nicolini
- Hematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France; INSERM U1052, Centre de Recherche en Cancérologie de Lyon, Lyon, France; French Group of CML (Fi-LMC Group), Bordeaux, France.
| | - Vincent Alcazer
- Hematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Françoise Huguet
- Hematology Department, Hôpital Purpan, Toulouse, France; French Group of CML (Fi-LMC Group), Bordeaux, France
| | - Pascale Cony-Makhoul
- Hematology Department, Centre Hospitalier d'Annecy-Genevois, Metz-Tessy, France; French group of CML (Fi-LMC group), Bordeaux, France
| | - Mael Heiblig
- Hematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | | | - Stéphane Morisset
- Hematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Agnès Guerci-Bresler
- Hematology Department, Hôpital de Brabois, Vandoeuvre-lès-Nancy, France; French Group of CML (Fi-LMC Group), Bordeaux, France
| | - Volcy Soula
- CECOS & service de biologie de la reproduction, Hôpital Pellegrin, Bordeaux, France
| | - Mohamad Sobh
- Hematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | | | - Myriam Daudin
- CECOS, Groupe d'Activité de Médecine de la Reproduction, Hôpital Paule de Viguier, Toulouse, France
| | - Gabriel Etienne
- Hematology Department, Institut Bergonié, Bordeaux, France; French Group of CML (Fi-LMC Group), Bordeaux, France
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15
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Heiblig M, Bozzoli V, Saison J, Thomas X, De Croze D, Traverse-Glehen A, Cosmidis A, Chidiac C, Ferry T, Alanio A, Bienvenu AL, Dupont D, Ducastelle-Lepretre S, Michallet M, Ader F. Combined medico-surgical strategy for invasive sino-orbito-cerebral breakthrough fungal infection withHormographiella aspergillatain an acute leukaemia patient. Mycoses 2015; 58:308-12. [DOI: 10.1111/myc.12305] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 01/26/2015] [Accepted: 01/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- M. Heiblig
- Service d'Hématologie 1G; Centre Hospitalier Lyon Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - V. Bozzoli
- Service d'Hématologie 1G; Centre Hospitalier Lyon Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - J. Saison
- Service de Maladies Infectieuses et Tropicales; Hôpital de la Croix-Rousse; Hospices Civils de Lyon; Lyon France
| | - X. Thomas
- Service d'Hématologie 1G; Centre Hospitalier Lyon Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - D. De Croze
- Laboratoire d'Anatomie et de cytopathologie; Centre Hospitalier Lyon Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - A. Traverse-Glehen
- Laboratoire d'Anatomie et de cytopathologie; Centre Hospitalier Lyon Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - A. Cosmidis
- Service d'Otorhinolaryngologie; Centre Hospitalier Lyon Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - C. Chidiac
- Service de Maladies Infectieuses et Tropicales; Hôpital de la Croix-Rousse; Hospices Civils de Lyon; Lyon France
| | - T. Ferry
- Service de Maladies Infectieuses et Tropicales; Hôpital de la Croix-Rousse; Hospices Civils de Lyon; Lyon France
- Inserm U1111 Centre International de Recherche en Infectiologie (CIRI); Université Claude Bernard Lyon 1; Lyon France
| | - A. Alanio
- Service de Parasitologie-Mycologie; Groupe Hospitalier Lariboisière; Saint Louis Fernand Widal; Université Paris Diderot; Sorbonne Paris Cité; Paris France
- Institut Pasteur; Unité de Mycologie moléculaire; CNRS URA3012; Paris France
| | - A. L. Bienvenu
- Institut de Parasitologie et Mycologie Médicale; Hospices Civils de Lyon; Lyon France
- Malaria Research Unit; ICBMS; CNRS UMR 5246; Lyon 1 University; Lyon France
| | - D. Dupont
- Institut de Parasitologie et Mycologie Médicale; Hospices Civils de Lyon; Lyon France
| | - S. Ducastelle-Lepretre
- Service d'Hématologie 1G; Centre Hospitalier Lyon Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - M. Michallet
- Service d'Hématologie 1G; Centre Hospitalier Lyon Sud; Hospices Civils de Lyon; Pierre Bénite France
| | - F. Ader
- Service de Maladies Infectieuses et Tropicales; Hôpital de la Croix-Rousse; Hospices Civils de Lyon; Lyon France
- Inserm U1111 Centre International de Recherche en Infectiologie (CIRI); Université Claude Bernard Lyon 1; Lyon France
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Thomas X, Heiblig M, Bozzoli V, Elhamri M. Decitabine for the treatment of adult patients (age ≥65 years) with newly diagnosed de novoor secondary acute myeloid leukemia. Int J Hematol Oncol 2013. [DOI: 10.2217/ijh.13.36] [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: 11/21/2022] Open
Abstract
>SUMMARY Decitabine is a deoxynucleoside analogue of cytidine. Its use for the treatment of acute myeloid leukemia (AML) has been recently refined. It selectively inhibits DNA methyltransferases when administered at a dose of 20 mg/m2by a 1-h intravenous infusion for 5 consecutive days of a 4-week cycle in the AML study. This schedule has recently been approved by the EMA as a well-tolerated alternative treatment to cytarabine or supportive care in patients aged ≥65 years with de novo or secondary AML who are not candidates for intensive chemotherapy.
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Affiliation(s)
- Xavier Thomas
- Hospices Civils de Lyon, Lyon-Sud Hospital, Hematology Department, Pavillon Marcel Bérard, Bat.1G, 69495 Pierre-Bénite, France
| | - Mael Heiblig
- Hospices Civils de Lyon, Lyon-Sud Hospital, Hematology Department, Pavillon Marcel Bérard, Bat.1G, 69495 Pierre-Bénite, France
| | - Valentina Bozzoli
- Hospices Civils de Lyon, Lyon-Sud Hospital, Hematology Department, Pavillon Marcel Bérard, Bat.1G, 69495 Pierre-Bénite, France
| | - Mohamed Elhamri
- Hospices Civils de Lyon, Lyon-Sud Hospital, Hematology Department, Pavillon Marcel Bérard, Bat.1G, 69495 Pierre-Bénite, France
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