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Bastard P, Cozic N, Brion R, Gaspar N, Piperno-Neumann S, Cordero C, Leculée-Thébaud E, Gomez-Mascard A, Rédini F, Marchais A, Ikonomova R, Cleirec M, Laurence V, Rigaud C, Abbas R, Verrecchia F, Brugières L, Minard-Colin V. Prognostic value of hemogram parameters in osteosarcoma: The French OS2006 experience. Pediatr Blood Cancer 2024:e31029. [PMID: 38679845 DOI: 10.1002/pbc.31029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Previous studies have shown that neutrophil-to-lymphocyte (NLR) ratio at diagnosis and early lymphocytes recovery on doxorubicin-based chemotherapy, may impact the outcome in patients with osteosarcoma (OST). This study aimed to evaluate the prognostic value of hemogram parameters in patients with OST treated with high-dose methotrexate and etoposide/ifosfamide (M-EI) chemotherapy. MATERIALS AND METHODS We retrospectively analyzed the prognostic value of various hemogram parameters at diagnosis and during therapy in a large consecutive cohort of patients with OST included in the French OS2006 trial and treated with M-EI chemotherapy. RESULTS A total of 164 patients were analyzed. The median age was 14.7 years (interquartile range [IQR]: 11.7-17). Median follow-up was 5.6 years (IQR: 3.3-7.7 years). Three-year event-free survival (EFS) and overall survival (OS) were 71.5% (95% confidence interval [CI]: 64%-78%) and 86.4% (95% CI: 80%-91%), respectively. In univariate analysis, blood count parameters at diagnosis and early lymphocyte recovery at Day 14 were not found prognostic of survival outcomes. By contrast, an increase of NLR ratio at Day 1 of the first EI chemotherapy (NLR-W4) was associated with reduced OS in univariate (p = .0044) and multivariate analysis (hazards ratio [HR] = 1.3, 95% CI: 1.1-1.5; p = .002), although not with EFS. After adjustment on histological response and metastatic status, an increase of the ratio NLR-W4 of 1 was associated with an increased risk of death of 30%. CONCLUSIONS We identified NLR-W4 as a potential early biomarker for survival in patients with OST treated with M-EI chemotherapy. Further studies are required to confirm the prognostic value of NLR and better identify immune mechanisms involved in disease surveillance.
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Affiliation(s)
- Paul Bastard
- Department of Oncology for Child and Adolescents, University Paris-Saclay, Gustave Roussy, Villejuif, France
| | | | - Régis Brion
- Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers (CRCI2NA), INSERM UMR 1307, CNRS UMR 6075, Université de NantesCHU de Nantes, Nantes, France
| | - Nathalie Gaspar
- Department of Oncology for Child and Adolescents, University Paris-Saclay, Gustave Roussy, Villejuif, France
- INSERM U1015, University Paris-Saclay, Gustave Roussy, Villejuif, France
| | | | - Camille Cordero
- Pediatric Oncology Department, CHU-Hôpital de la Mère et de l'Enfant, Nantes, France
| | | | - Anne Gomez-Mascard
- Department of Pathology, CHU, IUCT-Oncopole, University of Toulouse, Eq19. ONCOSARC CRCT, UMR 1037 Inserm/UT3, ERL 5294 CNRS, Toulouse, France
| | - Françoise Rédini
- Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers (CRCI2NA), INSERM UMR 1307, CNRS UMR 6075, Université de NantesCHU de Nantes, Nantes, France
| | - Antonin Marchais
- Department of Oncology for Child and Adolescents, University Paris-Saclay, Gustave Roussy, Villejuif, France
- INSERM U1015, University Paris-Saclay, Gustave Roussy, Villejuif, France
| | | | - Morgane Cleirec
- Pediatric Oncology Department, CHU-Hôpital de la Mère et de l'Enfant, Nantes, France
| | | | - Charlotte Rigaud
- Department of Oncology for Child and Adolescents, University Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Rachid Abbas
- Biostatistics Unit, Gustave Roussy, Villejuif, France
| | - Franck Verrecchia
- Centre de Recherche en Cancérologie et Immunologie Intégrée Nantes Angers (CRCI2NA), INSERM UMR 1307, CNRS UMR 6075, Université de NantesCHU de Nantes, Nantes, France
| | - Laurence Brugières
- Department of Oncology for Child and Adolescents, University Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Véronique Minard-Colin
- Department of Oncology for Child and Adolescents, University Paris-Saclay, Gustave Roussy, Villejuif, France
- INSERM U1015, University Paris-Saclay, Gustave Roussy, Villejuif, France
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Bateman RJ, Smith J, Donohue MC, Delmar P, Abbas R, Salloway S, Wojtowicz J, Blennow K, Bittner T, Black SE, Klein G, Boada M, Grimmer T, Tamaoka A, Perry RJ, Turner RS, Watson D, Woodward M, Thanasopoulou A, Lane C, Baudler M, Fox NC, Cummings JL, Fontoura P, Doody RS. Two Phase 3 Trials of Gantenerumab in Early Alzheimer's Disease. N Engl J Med 2023; 389:1862-1876. [PMID: 37966285 PMCID: PMC10794000 DOI: 10.1056/nejmoa2304430] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Monoclonal antibodies that target amyloid-beta (Aβ) have the potential to slow cognitive and functional decline in persons with early Alzheimer's disease. Gantenerumab is a subcutaneously administered, fully human, anti-Aβ IgG1 monoclonal antibody with highest affinity for aggregated Aβ that has been tested for the treatment of Alzheimer's disease. METHODS We conducted two phase 3 trials (GRADUATE I and II) involving participants 50 to 90 years of age with mild cognitive impairment or mild dementia due to Alzheimer's disease and evidence of amyloid plaques on positron-emission tomography (PET) or cerebrospinal fluid (CSF) testing. Participants were randomly assigned to receive gantenerumab or placebo every 2 weeks. The primary outcome was the change from baseline in the score on the Clinical Dementia Rating scale-Sum of Boxes (CDR-SB; range, 0 to 18, with higher scores indicating greater cognitive impairment) at week 116. RESULTS A total of 985 and 980 participants were enrolled in the GRADUATE I and II trials, respectively. The baseline CDR-SB score was 3.7 in the GRADUATE I trial and 3.6 in the GRADUATE II trial. The change from baseline in the CDR-SB score at week 116 was 3.35 with gantenerumab and 3.65 with placebo in the GRADUATE I trial (difference, -0.31; 95% confidence interval [CI], -0.66 to 0.05; P = 0.10) and was 2.82 with gantenerumab and 3.01 with placebo in the GRADUATE II trial (difference, -0.19; 95% CI, -0.55 to 0.17; P = 0.30). At week 116, the difference in the amyloid level on PET between the gantenerumab group and the placebo group was -66.44 and -56.46 centiloids in the GRADUATE I and II trials, respectively, and amyloid-negative status was attained in 28.0% and 26.8% of the participants receiving gantenerumab in the two trials. Across both trials, participants receiving gantenerumab had lower CSF levels of phosphorylated tau 181 and higher levels of Aβ42 than those receiving placebo; the accumulation of aggregated tau on PET was similar in the two groups. Amyloid-related imaging abnormalities with edema (ARIA-E) occurred in 24.9% of the participants receiving gantenerumab, and symptomatic ARIA-E occurred in 5.0%. CONCLUSIONS Among persons with early Alzheimer's disease, the use of gantenerumab led to a lower amyloid plaque burden than placebo at 116 weeks but was not associated with slower clinical decline. (Funded by F. Hoffmann-La Roche; GRADUATE I and II ClinicalTrials.gov numbers, NCT03444870 and NCT03443973, respectively.).
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Affiliation(s)
- Randall J Bateman
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Janice Smith
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Michael C Donohue
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Paul Delmar
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Rachid Abbas
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Stephen Salloway
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Jakub Wojtowicz
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Kaj Blennow
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Tobias Bittner
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Sandra E Black
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Gregory Klein
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Mercè Boada
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Timo Grimmer
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Akira Tamaoka
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Richard J Perry
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - R Scott Turner
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - David Watson
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Michael Woodward
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Angeliki Thanasopoulou
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Christopher Lane
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Monika Baudler
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Nick C Fox
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Jeffrey L Cummings
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Paulo Fontoura
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
| | - Rachelle S Doody
- From the Department of Neurology, Washington University School of Medicine, St. Louis (R.J.B.); Roche Products, Welwyn Garden City (J.S., C.L.), and the Department of Brain Sciences, Faculty of Medicine, Imperial College London (R.J.P.), and the Dementia Research Centre, Department of Neurodegenerative Disease, and the U.K. Dementia Research Institute, Queen Square Institute of Neurology, University College London (N.C.F.), London - all in the United Kingdom; the Alzheimer's Therapeutic Research Institute, Keck School of Medicine, University of Southern California, San Diego (M.C.D.), and Genentech, South San Francisco (T.B., R.S.D.) - both in California; F. Hoffmann-La Roche, Basel, Switzerland (P.D., R.A., J.W., T.B., G.K., A. Thanasopoulou, M. Baudler, P.F., R.S.D.); Butler Hospital and Warren Alpert Medical School, Brown University, Providence, RI (S.S.); the Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, and the Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital - both in Mölndal, Sweden (K.B.); the Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, and the L.C. Campbell Cognitive Neurology Research Unit, Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, University of Toronto - both in Toronto (S.E.B.); the Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, and the Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid - both in Spain (M. Boada); the Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany (T.G.); the Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (A. Tamaoka); the Department of Neurology, Georgetown University School of Medicine, Washington, DC (R.S.T.); the Alzheimer's Research and Treatment Center, Wellington, FL (D.W.); the Medical and Cognitive Research Unit, Heidelberg Repatriation Hospital, Austin Health, Melbourne, VIC, Australia (M.W.); and the Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Las Vegas (J.L.C.)
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Del Baldo G, Vennarini S, Toniutti M, Abbas R, Lorentini S, Piccirilli E, Cacchione A, Megaro G, Di Ruscio V, De Ioris MA, De Salvo A, Albino G, Rossi S, Colafati GS, Carai A, Mastronuzzi A. Unraveling the impact of upfront chemotherapy and proton beam therapy on treatment outcome and follow-up in central nervous system germ cell tumors: a single center experience. Front Oncol 2023; 13:1259403. [PMID: 37860194 PMCID: PMC10584321 DOI: 10.3389/fonc.2023.1259403] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 08/30/2023] [Indexed: 10/21/2023] Open
Abstract
Background Germ cell tumors (GCT) account for a minority of central nervous system (CNS) malignancies, highly prevalent in adolescents and young adults. Despite their aggressive biological behavior, prognosis is excellent in most cases with risk stratified treatment, consisting in a combination of chemotherapy and radiotherapy. Whole ventricular irradiation (WVI) and craniospinal irradiation, the treatment of choice for localized and metastatic disease, pose significant risk of collateral effects, therefore proton beam radiation (PBT) has been recently proposed for its steep dose fallout. Materials and methods We report our experience in a consecutive series of 17 patients treated for CNS GCT at our Institution from 2015 to 2021. Results Most frequent lesion location were sellar/suprasellar (35%) and bifocal germinoma (35%), followed by pineal (18%) and thalamic (12%). Two patients (12%), had evidence of disseminated disease at the time of diagnosis. At the latest follow-up all but one patient showed complete response to treatment. The only relapse was successfully rescued by additional chemotherapy and PBT. PBT was well tolerated in all cases. No visual, neurological or endocrinological worsening was documented during and after treatment. Neuropsychological evaluation demonstrated preservation of cognitive performance after PBT treatment. Conclusions Our data, albeit preliminary, strongly support the favourable therapeutic profile of PBT for the treatment of CNS germ cell tumors.
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Affiliation(s)
- Giada Del Baldo
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Sabina Vennarini
- Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maristella Toniutti
- Department of Medicine DAME-Division of Pediatrics, University of Udine, Udine, Italy
| | - Rachid Abbas
- CESP, INSERM, Université Paris Sud, Villejuif, France
| | - Stefano Lorentini
- Medical Physics Department, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Eleonora Piccirilli
- Department of Diagnostic Imaging Oncological Neuroradiology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti, Chieti, Italy
| | - Antonella Cacchione
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giacomina Megaro
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valentina Di Ruscio
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Maria Antonietta De Ioris
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Andrea De Salvo
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giulia Albino
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Sabrina Rossi
- Pathology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giovanna Stefania Colafati
- Department of Diagnostic Imaging Oncological Neuroradiology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti, Chieti, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Umar Z, Nassar M, Akbar U, Haseeb Ul Rasool M, Abbas R, Taimur M, Ilyas U, Trandafirescu T. Safety and Efficacy of Autologous Blood Patching for Persistent Air Leaks: A Systematic Review and Metanalysis. C21. "CUTTING" EDGE: CLINICAL STUDIES IN INTERVENTIONAL PULMONARY AND PLEURAL DISEASE 2023. [DOI: 10.1164/ajrccm-conference.2023.207.1_meetingabstracts.a4549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Affiliation(s)
- Z. Umar
- Internal medicine, ISMMS NYC H+H Queens/NY, Queens, NY, United States
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Del Bufalo F, De Angelis B, Caruana I, Del Baldo G, De Ioris MA, Serra A, Mastronuzzi A, Cefalo MG, Pagliara D, Amicucci M, Li Pira G, Leone G, Bertaina V, Sinibaldi M, Di Cecca S, Guercio M, Abbaszadeh Z, Iaffaldano L, Gunetti M, Iacovelli S, Bugianesi R, Macchia S, Algeri M, Merli P, Galaverna F, Abbas R, Garganese MC, Villani MF, Colafati GS, Bonetti F, Rabusin M, Perruccio K, Folsi V, Quintarelli C, Locatelli F. GD2-CART01 for Relapsed or Refractory High-Risk Neuroblastoma. N Engl J Med 2023; 388:1284-1295. [PMID: 37018492 DOI: 10.1056/nejmoa2210859] [Citation(s) in RCA: 94] [Impact Index Per Article: 94.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND Immunotherapy with chimeric antigen receptor (CAR)-expressing T cells that target the disialoganglioside GD2 expressed on tumor cells may be a therapeutic option for patients with high-risk neuroblastoma. METHODS In an academic, phase 1-2 clinical trial, we enrolled patients (1 to 25 years of age) with relapsed or refractory, high-risk neuroblastoma in order to test autologous, third-generation GD2-CAR T cells expressing the inducible caspase 9 suicide gene (GD2-CART01). RESULTS A total of 27 children with heavily pretreated neuroblastoma (12 with refractory disease, 14 with relapsed disease, and 1 with a complete response at the end of first-line therapy) were enrolled and received GD2-CART01. No failure to generate GD2-CART01 was observed. Three dose levels were tested (3-, 6-, and 10×106 CAR-positive T cells per kilogram of body weight) in the phase 1 portion of the trial, and no dose-limiting toxic effects were recorded; the recommended dose for the phase 2 portion of the trial was 10×106 CAR-positive T cells per kilogram. Cytokine release syndrome occurred in 20 of 27 patients (74%) and was mild in 19 of 20 (95%). In 1 patient, the suicide gene was activated, with rapid elimination of GD2-CART01. GD2-targeted CAR T cells expanded in vivo and were detectable in peripheral blood in 26 of 27 patients up to 30 months after infusion (median persistence, 3 months; range, 1 to 30). Seventeen children had a response to the treatment (overall response, 63%); 9 patients had a complete response, and 8 had a partial response. Among the patients who received the recommended dose, the 3-year overall survival and event-free survival were 60% and 36%, respectively. CONCLUSIONS The use of GD2-CART01 was feasible and safe in treating high-risk neuroblastoma. Treatment-related toxic effects developed, and the activation of the suicide gene controlled side effects. GD2-CART01 may have a sustained antitumor effect. (Funded by the Italian Medicines Agency and others; ClinicalTrials.gov number, NCT03373097.).
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Affiliation(s)
- Francesca Del Bufalo
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Biagio De Angelis
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Ignazio Caruana
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Giada Del Baldo
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Maria A De Ioris
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Annalisa Serra
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Angela Mastronuzzi
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Maria G Cefalo
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Daria Pagliara
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Matteo Amicucci
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Giuseppina Li Pira
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Giovanna Leone
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Valentina Bertaina
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Matilde Sinibaldi
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Stefano Di Cecca
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Marika Guercio
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Zeinab Abbaszadeh
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Laura Iaffaldano
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Monica Gunetti
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Stefano Iacovelli
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Rossana Bugianesi
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Stefania Macchia
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Mattia Algeri
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Pietro Merli
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Federica Galaverna
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Rachid Abbas
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Maria C Garganese
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Maria F Villani
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Giovanna S Colafati
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Federico Bonetti
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Marco Rabusin
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Katia Perruccio
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Veronica Folsi
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Concetta Quintarelli
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
| | - Franco Locatelli
- From the Department of Pediatric Hematology and Oncology and of Cell and Gene Therapy (F.D.B., B.D.A., I.C., G.D.B., M.A.D.I., A.S., A.M., M.G.C., D.P., M. Amicucci, G.L.P., V.B., M.S., S.D.C., M. Guercio, Z.A., L.I., M. Algeri, P.M., F.G., C.Q., F.L.), the Transfusion Unit, Department of Laboratories (G.L.), Officina Farmaceutica, Good Manufacturing Practice Facility (M. Gunetti, S.I., R.B., S.M.), and the Nuclear Medicine Unit (M.C.G., M.F.V.), Department of Imaging (G.S.C.), IRCCS Ospedale Pediatrico Bambino Gesù, and the Department of Life Sciences and Public Health, Catholic University of the Sacred Heart (F.L.), Rome, the Pediatric Hematology and Oncology Unit, IRCCS Policlinico San Matteo, Pavia (F.B.), the Pediatric Hematology-Oncology Unit, Institute for Maternal and Child Health, IRCCS "Burlo Garofolo," Trieste (M.R.), Pediatric Oncology Hematology, Mother and Child Health Department, Santa Maria della Misericordia Hospital, Perugia (K.P.), the Pediatric Hematology-Oncology Unit, Ospedale dei Bambini, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia (V.F.), and the Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples (C.Q.) - all in Italy; and INSERM, Centre d'Investigation Clinique 1418 (CIC1418) Epidémiologie Clinique, Paris (R.A.)
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Del Baldo G, Carai A, Abbas R, Cacchione A, Vinci M, Di Ruscio V, Colafati GS, Rossi S, Diomedi Camassei F, Maestro N, Temelso S, Pericoli G, De Billy E, Giovannoni I, Carboni A, Rinelli M, Agolini E, Mackay A, Jones C, Chiesa S, Balducci M, Locatelli F, Mastronuzzi A. Targeted therapy for pediatric diffuse intrinsic pontine glioma: a single-center experience. Ther Adv Med Oncol 2022; 14:17588359221113693. [PMID: 36090803 PMCID: PMC9459464 DOI: 10.1177/17588359221113693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/09/2021] [Accepted: 06/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Diffuse intrinsic pontine glioma (DIPG) is a fatal disease with a median
overall survival (OS) of less than 12 months after diagnosis. Radiotherapy
(RT) still remains the mainstay treatment. Several other therapeutic
strategies have been attempted in the last years without a significant
effect on OS. Although radiological imaging is the gold standard for DIPG
diagnosis, the urgent need to improve the survival has led to the
reconsideration of biopsy with the aim to better understand the molecular
profile of DIPG and support personalized treatment. Methods: In this study, we present a single-center experience in treating DIPG
patients at disease progression combining targeted therapies with standard
of care. Biopsy was proposed to all patients at diagnosis or disease
progression. First-line treatment included RT and nimotuzumab/vinorelbine or
temozolomide. Immunohistochemistry-targeted research included study of
mTOR/p-mTOR pathway and BRAFv600E. Molecular analyses
included polymerase chain reaction, followed by Sanger sequences and/or
next-generation sequencing. Results: Based on the molecular profile, targeted therapy was administered in 9 out of
25 patients, while the remaining 16 patients were treated with standard of
care. Personalized treatment included inhibition of the PI3K/AKT/mTOR
pathway (5/9), PI3K/AKT/mTOR pathway and BRAFv600E (1/9),
ACVR1 (2/9) and PDGFRA (1/9); no
severe side effects were reported during treatment. Response to treatment
was evaluated according to Response Assessment in Pediatric Neuro-Oncology
criteria, and the overall response rate within the cohort was 66%. Patients
treated with targeted therapies were compared with the control cohort of 16
patients. Clinical and pathological characteristics of the two cohorts were
homogeneous. Median OS in the personalized treatment and control cohort was
20.26 and 14.18 months, respectively (p = 0.032). In our
experience, the treatment associated with the best OS was everolimus. Conclusion: Despite the small simple size of our study, our data suggest a prognostic
advantage and a safe profile of targeted therapies in DIPG patients, and we
strongly advocate to reconsider the role of biopsy for these patients.
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Affiliation(s)
- Giada Del Baldo
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Rachid Abbas
- CESP, INSERM, Université Paris Sud, Villejuif, France
| | - Antonella Cacchione
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mara Vinci
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Di Ruscio
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanna Stefania Colafati
- Oncological Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sabrina Rossi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Nicola Maestro
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Temelso
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK.,Division of Cancer Therapeutics, The Institute of Cancer Research, London, UK
| | - Giulia Pericoli
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Emmanuel De Billy
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Isabella Giovannoni
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessia Carboni
- Oncological Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Martina Rinelli
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alan Mackay
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK.,Division of Cancer Therapeutics, The Institute of Cancer Research, London, UK
| | - Chris Jones
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK.,Division of Cancer Therapeutics, The Institute of Cancer Research, London, UK
| | - Silvia Chiesa
- Department of Radiotherapy, Fondazione Policlinico Universitario "A. Gemelli," Catholic University of Sacred Heart, Rome, Italy
| | - Mario Balducci
- Department of Radiotherapy, Fondazione Policlinico Universitario "A. Gemelli," Catholic University of Sacred Heart, Rome, Italy
| | - Franco Locatelli
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Department of Life Sciences and Public Health, Fondazione Policlinico Universitario "A. Gemelli," Catholic University of Sacred Heart, Rome, Italy
| | - Angela Mastronuzzi
- Department of Pediatric Haematology and Oncology, and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Marchais A, Marques Da Costa ME, Job B, Abbas R, Drubay D, Piperno-Neumann S, Fromigué O, Gomez-Brouchet A, Françoise R, Droit R, Lervat C, ENTZ-WERLE N, Pacquement H, Devoldere C, Cupissol D, Bodet D, GANDEMER V, Berger MG, Bérard PM, Jimenez M, Vassal G, Geoerger B, Brugieres L, Gaspar N. Immune infiltrate and tumor microenvironment transcriptional programs stratify pediatric osteosarcoma into prognostic groups at diagnosis. Cancer Res 2022; 82:974-985. [DOI: 10.1158/0008-5472.can-20-4189] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/26/2021] [Accepted: 01/18/2022] [Indexed: 11/16/2022]
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Abstract
Many people with chronic hepatitis C infection don't engage in treatment. To eliminate hepatitis C and avoid health inequalities therapy must be provided to everyone. In other diseases peers with lived experience of the condition have improved care but, for hepatitis C, studies have not shown unequivocal benefit. We completed a retrospective analysis of the English National Health Service treatment registry comparing treatment networks with and without peers using Bayesian Poisson (for count outcomes) or Bayesian Binomial (for proportion outcomes) mixed effects models with time fixed effects. For each outcome, we estimated relative ratio (RR-Poisson model) or odds ratio (Odds Ratio (OR)-Binomial model) between peer and non-peer networks. We analysed 30,729 patients within 20 operational delivery networks. In networks with peers there was an increase in the number of people initiating therapy (RR 1.12 95%, credible interval 1.02-1.21) and an increase in the proportion completing therapy (OR 2.45 95%, credible interval 1.49-3.84). However, we saw no change in proportions of people using drugs who initiated therapy nor any significant change in virological response (OR 1.14 95% credible interval 0.979-1.36). We repeated the analysis looking at the impact of peers two months after they had been introduced, when they had established networks of contacts, and saw an increase in the proportion of people treated in addiction services. In treating patients with chronic hepatitis C infection the inclusion of peer supporters may increase the number of people who initiate and complete antiviral therapy.
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Affiliation(s)
- Rachid Abbas
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Ligue contre le Cancer, Villejuif, France
| | - James Wason
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Stefan Michiels
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Ligue contre le Cancer, Villejuif, France
| | - Gwénaёl Le Teuff
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Ligue contre le Cancer, Villejuif, France
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9
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Abbas R, Wason J, Michiels S, Le Teuff G. A two-stage drop-the-losers design for time-to-event outcome using a historical control arm. Pharm Stat 2021; 21:268-288. [PMID: 34496117 DOI: 10.1002/pst.2168] [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: 05/12/2020] [Revised: 07/31/2021] [Accepted: 08/22/2021] [Indexed: 11/10/2022]
Abstract
Phase II immuno-oncology clinical trials screen for efficacy an increasing number of treatments. In rare cancers, using historical control data is a pragmatic approach for speeding up clinical trials. The drop-the-losers design allows dropping off ineffective arms at interim analyses. We extended the original drop-the-losers design for a time-to-event outcome using a historical control through the one-sample log-rank statistic. Simulated trials featured three arms at the first stage, one at the second stage, nine scenarios, eight sample sizes with 5%- and 10%- nominal family-wise error rate (FWER). A numerical algorithm is provided to solve power calculations at the design stage. Our design was compared with a group of three independent single-arm trials (fixed design) with and without correction for multiplicity. Our design allowed strict control of the FWER at nominal levels while the misspecification of survival distribution and fixed design inflated the FWER up to three times the nominal level. The empirical power of our design increased with the sample size, the treatment effect and the number of effective treatments and dropped when more patients were recruited at the second stage. The fixed design with correction showed comparable power, while our design advantageously included more patients to the most promising arm. Recommendations for future applications are given. By taking advantage of the use of historical control data and a time-to-event outcome, the drop-the-losers design is a promising tool to meet the challenge of improving phase II clinical trials in immuno-oncology.
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Affiliation(s)
- Rachid Abbas
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France.,Oncostat U1018, Inserm, Université Paris-Saclay, Ligue contre le Cancer, Villejuif, France
| | - James Wason
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.,MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Stefan Michiels
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France.,Oncostat U1018, Inserm, Université Paris-Saclay, Ligue contre le Cancer, Villejuif, France
| | - Gwénaël Le Teuff
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France.,Oncostat U1018, Inserm, Université Paris-Saclay, Ligue contre le Cancer, Villejuif, France
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10
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Rigaud C, Abbas R, Grand D, Minard-Colin V, Aladjidi N, Buchbinder N, Garnier N, Plat G, Couec ML, Duplan M, Lambilliotte A, Schmitt C, Leblanc T, Lamant L, Brugières L. Should treatment of ALK-positive anaplastic large cell lymphoma be stratified according to minimal residual disease? Pediatr Blood Cancer 2021; 68:e28982. [PMID: 33687135 DOI: 10.1002/pbc.28982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/30/2021] [Accepted: 02/12/2021] [Indexed: 11/09/2022]
Abstract
In anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma (ALK+ ALCL), positive minimal residual disease (MRD+) after the first chemotherapy course was proven of strong prognostic significance. We aimed to validate these results in 138 French patients. Eighty-seven patients had a detectable minimal disseminated disease at diagnosis (MDD+). Early MRD assessment was performed in 33 of 87 patients and was positive in 18 and negative in 15 (MRD-). Three-year progression-free survival was significantly correlated with the MDD/MRD status: 81.1% in MDD-, 69.6% in MDD+/MRD-, and 15.2% in MDD+/MRD+ patients. In conclusion, we confirmed on an independent cohort that the MDD/MRD status has strong prognosis significance in ALK+ ALCL.
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Affiliation(s)
- Charlotte Rigaud
- Children and Adolescent Oncology Department, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - Rachid Abbas
- Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | - David Grand
- Department of Pathology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Véronique Minard-Colin
- Children and Adolescent Oncology Department, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | | | | | | | - Geneviève Plat
- Pediatric Oncology, Toulouse University Hospital, Toulouse, France
| | | | - Mylène Duplan
- Pediatric Oncology, Angers University Hospital, Angers, France
| | | | | | - Thierry Leblanc
- Pediatric Hematology, Robert Debré Hospital-APHP, Paris, France
| | - Laurence Lamant
- Department of Pathology, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Laurence Brugières
- Children and Adolescent Oncology Department, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
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11
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Guerrini-Rousseau L, Abbas R, Huybrechts S, Kieffer-Renaux V, Puget S, Andreiuolo F, Beccaria K, Blauwblomme T, Bolle S, Dhermain F, Longaud Valès A, Roujeau T, Sainte-Rose C, Tauziede-Espariat A, Varlet P, Zerah M, Valteau-Couanet D, Dufour C, Grill J. Role of neoadjuvant chemotherapy in metastatic medulloblastoma: a comparative study in 92 children. Neuro Oncol 2021; 22:1686-1695. [PMID: 32267940 PMCID: PMC7846143 DOI: 10.1093/neuonc/noaa083] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Previous pilot studies have shown the feasibility of preoperative chemotherapy in patients with medulloblastoma, but benefits and risks compared with initial surgery have not been assessed. METHODS Two therapeutic strategies were retrospectively compared in 92 patients with metastatic medulloblastoma treated at Gustave Roussy between 2002 and 2015: surgery at diagnosis (n = 54, group A) and surgery delayed after carboplatin and etoposide-based neoadjuvant therapy (n = 38, group B). Treatment strategies were similar in both groups. RESULTS The rate of complete tumor excision was significantly higher in group B than in group A (93.3% vs 57.4%, P = 0.0013). Postoperative complications, chemotherapy-associated side effects, and local progressions were not increased in group B. Neoadjuvant chemotherapy led to a decrease in the primary tumor size in all patients; meanwhile 4/38 patients experienced a distant progression. The histological review of 19 matched tumor pairs (before and after chemotherapy) showed that proliferation was reduced and histological diagnosis feasible and accurate even after neoadjuvant chemotherapy. The 5-year progression-free and overall survival rates were comparable between groups. Comparison of the longitudinal neuropsychological data showed that intellectual outcome tended to be better in group B (the mean predicted intellectual quotient value was 6 points higher throughout the follow-up). CONCLUSION Preoperative chemotherapy is a safe and efficient strategy for metastatic medulloblastoma. It increases the rate of complete tumor excision and may improve the neuropsychological outcome without jeopardizing survival. KEY POINTS 1. Preoperative chemotherapy increases the rate of complete tumor removal.2. No additional risk (toxic or disease progression) is linked to the delayed surgery.3. Preoperative chemotherapy could have a positive impact on the neuropsychological outcome of patients.
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Affiliation(s)
- Léa Guerrini-Rousseau
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Paris-Saclay University, Villejuif, France.,Gustave Roussy Cancer Center, Combined Research Unit 8203, National Center of Scientific Research, Paris-Saclay University, Villejuif, France
| | - Rachid Abbas
- Gustave Roussy Cancer Center, Department of Biostatistics, Paris-Saclay University, Villejuif, France
| | - Sophie Huybrechts
- Hospital Center of Luxembourg, Department of Oncology and Hematology, Luxembourg City, Luxembourg
| | - Virginie Kieffer-Renaux
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Paris-Saclay University, Villejuif, France.,Saint Maurice Hospital, Monitoring and Integration Center for Children and Adolescents with Acquired Brain Injury, Saint Maurice, France
| | - Stéphanie Puget
- Necker Hospital, Department of Pediatric Neurosurgery, Paris Descartes University, Paris, France
| | - Felipe Andreiuolo
- Sainte Anne Hospital, Department of Neuropathology, Rene Descartes University, Paris, France
| | - Kévin Beccaria
- Necker Hospital, Department of Pediatric Neurosurgery, Paris Descartes University, Paris, France
| | - Thomas Blauwblomme
- Necker Hospital, Department of Pediatric Neurosurgery, Paris Descartes University, Paris, France
| | - Stéphanie Bolle
- Gustave Roussy Cancer Center, Department of Radiation Oncology, Paris-Saclay University, Villejuif, France
| | - Frédéric Dhermain
- Gustave Roussy Cancer Center, Department of Radiation Oncology, Paris-Saclay University, Villejuif, France
| | - Audrey Longaud Valès
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Paris-Saclay University, Villejuif, France
| | - Thomas Roujeau
- Gui-de-Chauliac Hospital, Department of Neurosurgery, Montpellier University Hospital, Montpellier, France
| | - Christian Sainte-Rose
- Necker Hospital, Department of Pediatric Neurosurgery, Paris Descartes University, Paris, France
| | | | - Pascale Varlet
- Sainte Anne Hospital, Department of Neuropathology, Rene Descartes University, Paris, France
| | - Michel Zerah
- Necker Hospital, Department of Pediatric Neurosurgery, Paris Descartes University, Paris, France
| | - Dominique Valteau-Couanet
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Paris-Saclay University, Villejuif, France
| | - Christelle Dufour
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Paris-Saclay University, Villejuif, France.,Gustave Roussy Cancer Center, Combined Research Unit 8203, National Center of Scientific Research, Paris-Saclay University, Villejuif, France
| | - Jacques Grill
- Gustave Roussy Cancer Center, Department of Pediatric and Adolescent Oncology, Paris-Saclay University, Villejuif, France.,Gustave Roussy Cancer Center, Combined Research Unit 8203, National Center of Scientific Research, Paris-Saclay University, Villejuif, France
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12
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Kueht M, Jindra P, Stevenson HL, Galvan TN, Murthy B, Goss J, Anton J, Abbas R, Cusick MF. Intra-operative kinetics of anti-HLA antibody in simultaneous liver-kidney transplantation. Mol Genet Metab Rep 2021; 26:100705. [PMID: 33489761 PMCID: PMC7811052 DOI: 10.1016/j.ymgmr.2020.100705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/05/2022] Open
Abstract
During simultaneous liver-kidney transplantation (SLK) in highly sensitized patients, donor specific anti-human leukocyte antigen antibodies (DSA, HLA) can be present prior to transplant leading to positive crossmatch, yet these recipients have relatively low incidences of acute rejection. The mechanisms and timing underlying immunologic changes that occur intra-operatively remain largely unknown. Therefore, we measured the intra- and peri-operative kinetics of anti-HLA antibodies in highly sensitized SLK recipients. In this study, pre- and post-operative blood samples were obtained from sensitized SLK candidates with documented DSA. Intra-operative samples were obtained from a sub-group of SLK recipients. Pretransplant anti-HLA antibody profiles were created and flow cytometry and anti-human globulin complement-dependent cytotoxic crossmatches were performed. Significant reductions in anti-HLA class I and II DSA were seen intra-operatively shortly after reperfusion of the liver allograft. This effect was most pronounced for anti-HLA class I DSA (mean change, −85%, p < 0.05); changes to anti-HLA class II DSA were less robust (mean change, −47%, p = 0.15). Importantly, non-DSA anti-HLA antibodies remained unchanged throughout the perioperative period, suggesting the mechanism(s) by which the liver lowers DSA levels are specific to the DSA. These data demonstrate the immunologic benefit of performing SLK is lasting and occurs very shortly after liver reperfusion.
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Affiliation(s)
- M Kueht
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, United States of America
| | - P Jindra
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM 504, Houston, TX 77030, United States of America
| | - H L Stevenson
- Department of Pathology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, United States of America
| | - T N Galvan
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM 504, Houston, TX 77030, United States of America
| | - B Murthy
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM 504, Houston, TX 77030, United States of America
| | - J Goss
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM 504, Houston, TX 77030, United States of America
| | - J Anton
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM 504, Houston, TX 77030, United States of America
| | - R Abbas
- Department of Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM 504, Houston, TX 77030, United States of America
| | - M F Cusick
- Department of Pathology, University of Michigan Medicine, 2800 Plymouth Rd., Building 36, Ann Arbor, MI 48109, United States of America
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13
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Huybrechts S, Le Teuff G, Tauziède-Espariat A, Rossoni C, Chivet A, Indersie É, Varlet P, Puget S, Abbas R, Ayrault O, Guerrini-Rousseau L, Grill J, Valteau-Couanet D, Dufour C. Prognostic Clinical and Biologic Features for Overall Survival after Relapse in Childhood Medulloblastoma. Cancers (Basel) 2020; 13:cancers13010053. [PMID: 33375523 PMCID: PMC7795432 DOI: 10.3390/cancers13010053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/06/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Despite progress in the biology and upfront treatment of childhood medulloblastoma, relapse is almost universally fatal. No standardized treatment has so far been established for these patients. By determining which characteristics are prognostic after relapse, treatment strategies may be optimized for each of these children. We demonstrated that molecular subgroup at diagnosis is a relevant prognostic factor of outcome after relapse. Moreover, we showed that time to relapse and the use of salvage radiotherapy at relapse might have a potential impact on post-relapse survival. Our data suggest that ongoing efforts toward a better understanding of the biology, timing and type of relapse would be important to understand the determinants of tumor behavior at relapse. This could help us address more specific questions on the best surveillance strategies after completion of the treatment and the introduction of risk-stratified second-line treatment strategies. Abstract Given the very poor prognosis for children with recurrent medulloblastoma, we aimed to identify prognostic factors for survival post-relapse in children with childhood medulloblastoma. We retrospectively collected clinico-biological data at diagnosis and main clinical characteristics at relapse of children newly diagnosed with a medulloblastoma between 2007 and 2017 at Gustave Roussy and Necker Hospital. At a median follow-up of 6.6 years (range, 0.4–12.3 years), relapse occurred in 48 out 155 patients (31%). The median time from diagnosis to relapse was 14.3 months (range, 1.2–87.2 months). Relapse was local in 9, metastatic in 22 and combined (local and metastatic) in 17 patients. Second-line treatment consisted of chemotherapy in 31 cases, radiotherapy in 9, SHH-inhibitor in four and no treatment in the remaining four. The 1-year overall survival rate post-relapse was 44.8% (CI 95%, 31.5% to 59.0%). While molecular subgrouping at diagnosis was significantly associated with survival post-relapse, the use of radiotherapy at relapse and time to first relapse (>12 months) might also have a potential impact on post-relapse survival.
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Affiliation(s)
- Sophie Huybrechts
- Service National d’Oncologie et Hématologie Pédiatrique, Centre Hospitalier de Luxembourg, L-1210 Luxembourg City, Luxembourg;
| | - Gwénaël Le Teuff
- Department of Biostatistics, Gustave Roussy Cancer Center, Paris-Saclay University, 94800 Villejuif, France; (G.L.T.); (C.R.); (R.A.)
| | - Arnault Tauziède-Espariat
- Department of Neuropathology, Sainte Anne Hospital, Rene Descartes University, 75014 Paris, France; (A.T.-E.); (P.V.)
| | - Caroline Rossoni
- Department of Biostatistics, Gustave Roussy Cancer Center, Paris-Saclay University, 94800 Villejuif, France; (G.L.T.); (C.R.); (R.A.)
| | - Anaïs Chivet
- Department of Pediatric Neurosurgery, Necker Hospital, Paris Descartes University, 75015 Paris, France; (A.C.); (S.P.)
| | - Émilie Indersie
- Institut Curie, PSL Research University, CNRS UMR, INSERM, 91400 Orsay, France; (É.I.); (O.A.)
- Paris Sud University, Paris-Saclay University, CNRS UMR 3347, INSERM U1021, 91400 Orsay, France
| | - Pascale Varlet
- Department of Neuropathology, Sainte Anne Hospital, Rene Descartes University, 75014 Paris, France; (A.T.-E.); (P.V.)
| | - Stéphanie Puget
- Department of Pediatric Neurosurgery, Necker Hospital, Paris Descartes University, 75015 Paris, France; (A.C.); (S.P.)
| | - Rachid Abbas
- Department of Biostatistics, Gustave Roussy Cancer Center, Paris-Saclay University, 94800 Villejuif, France; (G.L.T.); (C.R.); (R.A.)
| | - Olivier Ayrault
- Institut Curie, PSL Research University, CNRS UMR, INSERM, 91400 Orsay, France; (É.I.); (O.A.)
- Paris Sud University, Paris-Saclay University, CNRS UMR 3347, INSERM U1021, 91400 Orsay, France
| | - Léa Guerrini-Rousseau
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, 94800 Villejuif, France; (L.G.-R.); (J.G.); (D.V.-C.)
- INSERM, Molecular Predictors and New Targets in Oncology, Paris-Saclay University, 94800 Villejuif, France
| | - Jacques Grill
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, 94800 Villejuif, France; (L.G.-R.); (J.G.); (D.V.-C.)
- INSERM, Molecular Predictors and New Targets in Oncology, Paris-Saclay University, 94800 Villejuif, France
| | - Dominique Valteau-Couanet
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, 94800 Villejuif, France; (L.G.-R.); (J.G.); (D.V.-C.)
| | - Christelle Dufour
- Department of Pediatric and Adolescent Oncology, Gustave Roussy, 94800 Villejuif, France; (L.G.-R.); (J.G.); (D.V.-C.)
- INSERM, Molecular Predictors and New Targets in Oncology, Paris-Saclay University, 94800 Villejuif, France
- Correspondence: ; Tel.: +33-1-42114247
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14
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Guerrini-Rousseau L, Abbas R, Huybrechts S, Kieffer-Renaux V, Puget S, Andreiuolo F, Beccaria K, Blauwblomme T, Bolle S, Dhermain F, Longaud A, Roujeau T, Rose CS, Tauziede-Esperiat A, Varlet P, Zerah M, Valteau-Couanet D, Dufour C, Jacques G. MBCL-02. ROLE OF PREOPERATIVE CHEMOTHERAPY IN METASTATIC MEDULLOBLASTOMA: A COMPARATIVE STUDY IN 92 CHILDREN. Neuro Oncol 2020. [PMCID: PMC7715660 DOI: 10.1093/neuonc/noaa222.478] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Previous pilot studies have shown the feasibility of preoperative chemotherapy in patients with medulloblastoma, but benefits and risks compared with initial surgery have not been assessed. METHODS Two therapeutic strategies were retrospectively compared in 92 patients with metastatic medulloblastoma treated at Gustave Roussy, France, between 2002 and 2015: surgery at diagnosis (n=54; group A) and surgery delayed after carboplatin and etoposide-based preoperative therapy (n=38; group B). Treatment strategies were similar in both groups. RESULTS The rate of complete tumor excision was significantly higher in group B than in group A (93.3% versus 57.4%, p=0.0013). Post-operative complications, chemotherapy-associated side effects and local progressions were not increased in group B. Preoperative chemotherapy led to a decrease in the primary tumor size in all patients, 4/38 patients experiencing meanwhile a distant progression. The histological review of 19 matched tumor pairs (before and after chemotherapy) showed that proliferation was reduced and histological diagnosis feasible and accurate even after preoperative chemotherapy. The 5-year progression-free and overall survival rates were comparable between groups. Comparison of the longitudinal neuropsychological data showed that intellectual outcome tended to be better in group B (the mean predicted intellectual quotient value was 6 points higher throughout the follow-up). CONCLUSION Preoperative chemotherapy is a safe and efficient strategy for metastatic medulloblastoma. It increases the rate of complete tumor excision and may improve the neuropsychological outcome without jeopardizing survival.
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15
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Dufour C, Masliah-Planchon J, Delisle MB, Geoffray A, Abbas R, Bourdeaut F, Bertozzi AI, Faure-Conter C, Chappe C, De Carli E, Entz-Werle N, Fouyssac F, Andre N, Soler C, Pluchart C, Palenzuela G, Leblond P, Grill J. MBCL-29. PHASE I/II STUDY OF SEQUENTIAL HIGH-DOSE CHEMOTHERAPY WITH STEM CELL SUPPORT IN CHILDREN YOUNGER THAN 5 YEARS OF AGE WITH HIGH-RISK MEDULLOBLASTOMA. Neuro Oncol 2020. [PMCID: PMC7715253 DOI: 10.1093/neuonc/noaa222.505] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To assess the 3-year EFS rate of children younger than 5 years of age with high-risk medulloblastoma (MB) treated according to the prospective multicenter trial HR MB-5. PATIENTS AND METHODS After surgery, all children received 2 cycles of Etoposide- Carboplatine. If partial (PR) or complete response (CR) was achieved after induction chemotherapy, children received 2 courses of thiotepa (600mg/m²) with stem cell rescue. For patients in CR after high-dose chemotherapy, they received one course of Cyclophosphamide – Busilvex with stem cell rescue (Phase I part). The others patients (not in PR after induction or in CR after thiotepa) were treated with 2 cycles of Temozolomide-Irinotecan followed by age-adapted craniospinal irradiation and maintenance treatment. RESULTS 28 children (2 to 4 years; median: 3.0 years) were enrolled. Group 3 MB were most common (57%). The response rate to Etoposide-Carboplatine was 60.7%. Among 20 patients treated with Thiotepa, 13 children were in CR and received Cyclophosphamide – Busilvex without radiotherapy. Out of them, 9 patients (45%) are alive in CR without craniospinal irradiation (median follow-up 5 years). Among 15 patients treated with radiotherapy, 8 patients are alive (median follow-up 3.8 years). The study was prematurely stopped for an excess of events. The median follow-up was 4 years (range 1.5 - 6.1). The 3-year EFS and OS were 42.3% [25.9 - 60.6] and 71.3% [52.7 - 84.7], respectively. CONCLUSIONS This risk-adapted strategy did not improve EFS in young children with high-risk MB. However, the study shows that good responders to chemotherapy can be cured without recourse to irradiation.
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16
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Bertaud S, Skarbek Borowski E, Abbas R, Baudouin C, Labbé A. Influence of automated visual field testing on intraocular pressure. BMC Ophthalmol 2020; 20:363. [PMID: 32907553 PMCID: PMC7488059 DOI: 10.1186/s12886-020-01622-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the influence of automated visual field (VF) testing on intraocular pressure (IOP) in patients with ocular hypertension (OHT) or glaucoma. Methods We conducted a prospective observational study in the glaucoma department at Quinze-Vingts National Ophthalmology Hospital in Paris. Ninety-five right eyes of 95 patients followed for glaucoma or OHT were included. IOP was measured three times using a Nidek NT-510 non-contact tonometer within a maximum of 5 min before and after VF testing. Sub analyses using logistic regression analysis were performed to evaluate the impact of gender, age, central corneal thickness (CCT), mean deviation (MD) of the VF, VF test duration and filtration surgery on IOP fluctuations. Results There was no significant change in IOP after VF testing, with IOP’s 15.14 ± 4.00 mmHg before and 14.98 ± 3.33 mmHg after the VF (P = 0.4). The average change in IOP was 0.15 ± 1.82 mmHg. Using multivariate analysis, no effect of the VF test on IOP was found (global model fit R2 = 0.12), whether based on duration of the VF test (P = 0.18) or the MD (P = 0.7) after adjustment for age, gender, CCT and history of glaucoma surgery. Similarly, there was no significant difference within different types of glaucoma, including open-angle glaucoma (P = 0.36), chronic angle closure glaucoma (P = 0.85) and OHT (P = 0.42). The subgroup of patients with an IOP elevation ≥2 mmHg had a significantly higher VF test duration (P = 0.002). Conclusion VF testing does not influence IOP as measured with a non-contact tonometer.
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Affiliation(s)
- Samuel Bertaud
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France.
| | - Elisabeth Skarbek Borowski
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France
| | - Rachid Abbas
- Department of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France; INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, IHU FOReSIGHT, Université de Versailles Saint-Quentin en Yvelines, Université Paris Saclay, Versailles, France.,Sorbonne Université, INSERM, CNRS, Institut de la Vision, IHU FOReSIGHT, Paris, France
| | - Antoine Labbé
- Quinze-Vingts National Ophthalmology Hospital, INSERM-DGOS CIC 1423, IHU FOReSIGHT, 28 rue de Charenton, 75012, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, IHU FOReSIGHT, Université de Versailles Saint-Quentin en Yvelines, Université Paris Saclay, Versailles, France.,Sorbonne Université, INSERM, CNRS, Institut de la Vision, IHU FOReSIGHT, Paris, France
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17
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Del Baldo G, Abbas R, Woessmann W, Horibe K, Pillon M, Burke A, Beishuizen A, Rigaud C, Le Deley MC, Lamant L, Brugières L. Neuro-meningeal relapse in anaplastic large-cell lymphoma: incidence, risk factors and prognosis - a report from the European intergroup for childhood non-Hodgkin lymphoma. Br J Haematol 2020; 192:1039-1048. [PMID: 32648260 DOI: 10.1111/bjh.16755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/25/2020] [Indexed: 12/26/2022]
Abstract
Relapses involving the central nervous system (CNS) are rare in children and adolescents with ALK+ anaplastic large cell lymphoma (ALCL) treated with regimens including CNS prophylaxis. Early identification of patients at high-risk for CNS relapse would enable stratification and better adaptation of initial treatment especially in the light of the upcoming targeted therapies with limited CNS penetration. We analyzed clinical and histological data of all ALK+ALCL patients with CNS relapse registered in ALCL99-database with the aim to describe risk factors and outcome. Characteristics of patients with no relapse, relapse without CNS involvement and CNS relapse were compared. At a median follow-up of 8 years (0.05-18 years), a CNS involvement was reported at first or subsequent relapse in 26/618 patients. Median interval between initial diagnosis and first CNS relapse was 8 months (IQR 5.55-10.61/range 1.31-130.69). The 5-year cumulative risk of CNS relapse was 4% (95% CI 2.9-5.5). Bone marrow involvement, peripheral blasts and CNS involvement at diagnosis were more frequent in patients with CNS relapse than in patients with no relapse or with relapse with no CNS involvement. The treatment of CNS relapse was heterogeneous. The median survival after CNS relapse was 23.7 months. Eleven patients were alive at last follow-up. Three-year overall survival after CNS relapse was 48.70% (95% CI 30.52-67.23).
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Affiliation(s)
- Giada Del Baldo
- Department of Children and Adolescents Oncology, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France.,Department of Hematology/Oncology, Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rachid Abbas
- UVSQ, CESP, INSERM, Université Paris-Saclay, Université Paris-Sud, Villejuif, France
| | - Wilhelm Woessmann
- Department of Paediatric Haematology and Oncology, University Hospital, Hamburg-Eppendorf, Germany
| | - Keizo Horibe
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi, Japan
| | - Marta Pillon
- Department of Women's and Children's Health, Paediatric Haemato-Oncology, University Hospital of Padova, Padova, Italy
| | - Amos Burke
- Department of Paediatric Haematology, Oncology and Palliative Care, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Auke Beishuizen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Charlotte Rigaud
- Department of Children and Adolescents Oncology, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France
| | - Marie-Cécile Le Deley
- UVSQ, CESP, INSERM, Université Paris-Saclay, Université Paris-Sud, Villejuif, France.,Department of Methodology and Biostatistics, Centre Oscar Lambret, Lille, France
| | - Laurence Lamant
- Department of Pathology, Institut Universitaire du Cancer-Oncopole, Toulouse, France
| | - Laurence Brugières
- Department of Children and Adolescents Oncology, Gustave Roussy Cancer Center, Paris-Saclay University, Villejuif, France
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18
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Abbas R, Rossoni C, Jaki T, Paoletti X, Mozgunov P. A comparison of phase I dose-finding designs in clinical trials with monotonicity assumption violation. Clin Trials 2020; 17:522-534. [PMID: 32631095 DOI: 10.1177/1740774520932130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS In oncology, new combined treatments make it difficult to order dose levels according to monotonically increasing toxicity. New flexible dose-finding designs that take into account uncertainty in dose levels ordering were compared with classical designs through simulations in the setting of the monotonicity assumption violation. We give recommendations for the choice of dose-finding design. METHODS Motivated by a clinical trial for patients with high-risk neuroblastoma, we considered designs that require a monotonicity assumption, the Bayesian Continual Reassessment Method, the modified Toxicity Probability Interval, the Bayesian Optimal Interval design, and designs that relax monotonicity assumption, the Bayesian Partial Ordering Continual Reassessment Method and the No Monotonicity Assumption design. We considered 15 scenarios including monotonic and non-monotonic dose-toxicity relationships among six dose levels. RESULTS The No Monotonicity Assumption and Partial Ordering Continual Reassessment Method designs were robust to the violation of the monotonicity assumption. Under non-monotonic scenarios, the No Monotonicity Assumption design selected the correct dose level more often than alternative methods on average. Under the majority of monotonic scenarios, the Partial Ordering Continual Reassessment Method selected the correct dose level more often than the No Monotonicity Assumption design. Other designs were impacted by the violation of the monotonicity assumption with a proportion of correct selections below 20% in most scenarios. Under monotonic scenarios, the highest proportions of correct selections were achieved using the Continual Reassessment Method and the Bayesian Optimal Interval design (between 52.8% and 73.1%). The costs of relaxing the monotonicity assumption by the No Monotonicity Assumption design and Partial Ordering Continual Reassessment Method were decreases in the proportions of correct selections under monotonic scenarios ranging from 5.3% to 20.7% and from 1.4% to 16.1%, respectively, compared with the best performing design and were higher proportions of patients allocated to toxic dose levels during the trial. CONCLUSIONS Innovative oncology treatments may no longer follow monotonic dose levels ordering which makes standard phase I methods fail. In such a setting, appropriate designs, as the No Monotonicity Assumption or Partial Ordering Continual Reassessment Method designs, should be used to safely determine recommended for phase II dose.
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Affiliation(s)
- Rachid Abbas
- ONCOSTAT Team CESP INSERM U1018, Univ. Paris-Saclay and Biostatistics and Epidemiology department, Gustave Roussy Cancer Center, Villejuif, France
| | - Caroline Rossoni
- ONCOSTAT Team CESP INSERM U1018, Univ. Paris-Saclay and Biostatistics and Epidemiology department, Gustave Roussy Cancer Center, Villejuif, France
| | - Thomas Jaki
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK.,MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Xavier Paoletti
- Université Versailles St Quentin & INSERM U900 STAMPM, Institut Curie, Paris, France
| | - Pavel Mozgunov
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
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19
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de Tersant M, Généré L, Freyçon C, Villebasse S, Abbas R, Barlier A, Bodet D, Corradini N, Defachelles AS, Entz-Werle N, Fouquet C, Galmiche L, Gandemer V, Lacour B, Mansuy L, Orbach D, Pluchart C, Réguerre Y, Rigaud C, Sarnacki S, Sirvent N, Stephan JL, Thebaud E, Gimenez-Roqueplo AP, Brugières L. Pheochromocytoma and Paraganglioma in Children and Adolescents: Experience of the French Society of Pediatric Oncology (SFCE). J Endocr Soc 2020; 4:bvaa039. [PMID: 32432211 PMCID: PMC7217277 DOI: 10.1210/jendso/bvaa039] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 04/01/2020] [Indexed: 11/19/2022] Open
Abstract
Purpose The purpose of this work is to assess the clinical outcome of pediatric patients diagnosed with pheochromocytoma and paraganglioma (PPGL) detected in France since 2000. Methods A retrospective multicenter study was conducted that included all patients younger than 18 years with PPGL diagnosed in France between 2000 and 2016. Patients were identified from 4 different sources: the National Registry of Childhood Solid Tumors, the French Pediatric Rare Tumors Database, the French registry of succinate dehydrogenase (SDH)-related hereditary paraganglioma, and the nationwide TenGen network. Results Among 113 eligible patients, 81 children with available data were enrolled (41 with adrenal and 40 with extra-adrenal PPGL). At diagnosis, 11 had synchronous metastases. After a median follow-up of 53 months, 27 patients experienced a new event (n = 7 second PPGL, n = 1 second paraganglioma [PGL], n = 8 local recurrences, n = 10 metastatic relapses, n = 1 new tumor) and 2 patients died of their disease. The 3- and 10-year event-free survival rates were 80% (71%-90%) and 39% (20%-57%),respectively, whereas the overall survival rate was 97% (93%-100%)at 3 and 10 years. A germline mutation in one PPGL-susceptibility gene was identified in 53 of the 68 (77%) patients who underwent genetic testing (SDHB [n = 25], VHL [n = 21], RET [n = 2], HIF2A [n = 2], SDHC [n = 1], SDHD [n = 1], NF1 [n = 1]). Incomplete resection and synchronous metastases were associated with higher risk of events (P = .011, P = .004), but presence of a germline mutation was not (P = .11). Conclusions Most pediatric PPGLs are associated with germline mutations and require specific follow-up because of the high risk of tumor recurrence.
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Affiliation(s)
- Marie de Tersant
- Centre de Cancérologie Gustave Roussy, Département de Cancérologie de l'Enfant et de l'Adolescent, Paris-Saclay University Villejuif, France
| | - Lucile Généré
- Institut d'Hématologie et d'oncologie pédiatrique, Lyon, France
| | - Claire Freyçon
- Centre Hospitalier Universitaire Grenoble Alpes, Immuno-hémato-oncologie pédiatrique, La Tronche, France
| | - Sophie Villebasse
- Centre de Cancérologie Gustave Roussy, Département de Cancérologie de l'Enfant et de l'Adolescent, Paris-Saclay University Villejuif, France
| | - Rachid Abbas
- Centre de Cancérologie Gustave Roussy, Service de Biostatistique et d'Epidémiologie, Paris-Saclay University Villejuif, France
| | - Anne Barlier
- Aix Marseille Université, APHM, INSERM, MMG, Laboratory of Molecular Biology Hospital La Conception, Marseille Cedex 5, France
| | - Damien Bodet
- CHU de Caen, Hémato- Immuno-Oncologie Pédiatrique, Caen, France
| | | | | | - Natacha Entz-Werle
- Hôpitaux Universitaire de Strasbourg, Onco-Hématologie Pédiatrique, Strasbourg, France
| | - Cyrielle Fouquet
- Groupe Hospitalier Pellegrin, Unité d'Oncologie et Hématologie Pédiatriques, Bordeaux, France
| | - Louise Galmiche
- Assistance Publique Hôpitaux de Paris, Hôpital Necker Enfants Malades, Anatomie Pathologique, Paris, France
| | - Virginie Gandemer
- Hôpital Sud, CHU de Rennes, Hémato-Oncologie Pédiatrique, Rennes, France
| | - Brigitte Lacour
- Registre National des Tumeurs Solides de l'Enfant, CHU de Nancy, 54500 Vandoeuvre-Lès-Nancy, France; Inserm U1153, Centre de Recherche Epidémiolgie et StatistiqueS (CRESS), Université de Paris, Equipe d'Epidemiologie des cancers de l'enfant et de l'adolescent (EPICEA), Paris, France
| | - Ludovic Mansuy
- CHU de Nancy-Hôpital de Brabois, Service d'hémato-oncologie pédiatrique, Vandoeuvre-lès-Nancy Cedex, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Université PSL Paris, France, Paris, France.,Comité FRACTURE des tumeurs très rares pédiatriques de la SFCE
| | | | - Yves Réguerre
- CHU de Saint Denis, Service d'Oncologie et d'hématologie pédiatrique, La Réunion, France
| | - Charlotte Rigaud
- Centre de Cancérologie Gustave Roussy, Département de Cancérologie de l'Enfant et de l'Adolescent, Paris-Saclay University Villejuif, France
| | - Sabine Sarnacki
- Assistance Publique Hôpitaux de Paris, Hôpital Necker Enfants Malades, Chirurgie Pédiatrique, Paris, France
| | - Nicolas Sirvent
- CHU de Montpellier, Onco-Hématologie Pédiatrique, Montpellier, France
| | - Jean-Louis Stephan
- CHU de Saint-Etienne, Hématologie et Oncologie Pédiatrique, Hôpital Nord, Saint-Priest-en-Jarez, France
| | - Estelle Thebaud
- CHU de Nantes, Hématologie et Oncologie Pédiatrique, Nantes, France
| | - Anne-Paule Gimenez-Roqueplo
- Université de Paris, PARCC, INSERM, Paris, France.,Service de Génétique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Laurence Brugières
- Centre de Cancérologie Gustave Roussy, Département de Cancérologie de l'Enfant et de l'Adolescent, Paris-Saclay University Villejuif, France
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20
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Refaat M, El Khoury W, Rmeity N, Mahmasani A, Al Aaraj J, Akiki M, Gebran A, Abbas R, Hajjar M, Oweis G. P1863Establishing safe working parameters for radio frequency catheterization along with acoustic sensing. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0613] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Studies comparing angles of application in Radio Frequency (RF) catheter ablation other than 0 and 90 degrees are absent from the literature. Likewise, using acoustics to predict steam pop occurrences and prevent a catastrophic rupture of the myocardium has not been examined previously.
Purpose
Evaluate the effect of various parameters on the ablated volume and the probability of creating a boiling pop.
Methods
A low-cost testing and educational platform to work with generic RF catheters was set up. The in-vitro system allows controlling the blood flow surrogate over the cardiac tissue, the catheter contact force, electric power, and ablation time. Acoustic transducers have been employed with the setup to detect preliminary acoustic signals.
Results
Obtained results show a positive correlation between variations of the ablated surface geometry and power intensity changes. Generated figures provide percentages of a boiling pops for any given set of parameters fig1 (Top left: Probability of popping vs power and time). The probability of a boiling pop occurring increased if the ovine specimen is non-irrigated. The ratio of the burn correlates with the power and the angle of the catheter (30°, 45°, 60°, and 90°). However, the probability of the popping mostly depends on the power fig1 (Top right: Burn ratio vs power for 30°, 45°, 60°, and 90°) and fig1 (Bottom right: Cross sectional view of the corresponding lesions -same scale used for all images). Benign precursory bubbles detected by acoustics preceded the occurrence of catastrophic boiling pops fig1 (Bottom left: Acoustic signal showing a precursory pop before the major cavitation).
Figure 1
Conclusion
The established parameters for power intensity and exposure time should be respected to maintain a safe procedure. Acoustics can be further implemented to provide a warning for electrophysiologists before the occurrence of a boiling pop.
Acknowledgement/Funding
The funding for this project was provided from the URB and the MPP at the AUBMC and the AUB.
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Affiliation(s)
- M Refaat
- American University of Beirut Medical Center, Department of Cardiology, Beirut, Lebanon
| | - W El Khoury
- American University of Beirut AUB, Faculty of Medicine, Beirut, Lebanon
| | - N Rmeity
- American University of Beirut AUB, Department of Mechanical Engineering, Beirut, Lebanon
| | - A Mahmasani
- American University of Beirut AUB, Department of Mechanical Engineering, Beirut, Lebanon
| | - J Al Aaraj
- American University of Beirut AUB, Department of Mechanical Engineering, Beirut, Lebanon
| | - M Akiki
- American University of Beirut AUB, Department of Mechanical Engineering, Beirut, Lebanon
| | - A Gebran
- American University of Beirut AUB, Faculty of Medicine, Beirut, Lebanon
| | - R Abbas
- American University of Beirut AUB, Faculty of Medicine, Beirut, Lebanon
| | - M Hajjar
- American University of Beirut AUB, Faculty of Medicine, Beirut, Lebanon
| | - G Oweis
- American University of Beirut AUB, Department of Mechanical Engineering, Beirut, Lebanon
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21
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Huybrechts S, Chivet A, Tauziede-Espariat A, Rossoni C, Indersie E, Varlet P, Puget S, Abbas R, Ayrault O, Guerrini-Rousseau L, Grill J, Valteau-Couanet D, Dufour C. P14.99 Clinical and biologic features predictive of survival after relapse of childhood medulloblastoma. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.334] [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: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Salvage therapy for recurrent medulloblastoma (MB) is not standardized. Factors associated with survival after recurrence have not been reported.
MATERIAL AND METHODS
Medical records were reviewed for 155 consecutive patients with newly diagnosed MB between 2007 and 2017, treated at Gustave Roussy and Hospital Necker. The following variables were collected for all patients: age at diagnosis, stage, histology (central review according to WHO 2016 classification), molecular subgrouping (DNA methylation), first-line treatment modalities, time to relapse, pattern of recurrence and current status.
RESULTS
A disease recurrence was observed in 47 patients (30%) at a median time of 15 months (range, 1–88 months). The 1-year survival after recurrence was 44% (CI 95%,29.6 to 58.8). The pattern of recurrence was local in 9 patients, metastatic in 21 and combined local and metastatic in 17 patients. The time to first recurrence, less or more than 12 months from diagnosis, was a predictor of post-recurrence overall survival (p < 0.0001) after adjustment for age, treatment, MYC amplification and molecular subgroups. Twenty-seven patients (57%) experiencing recurrent or progressive disease more than 12 months after diagnosis, had an estimated 1-year survival after recurrence of 100% (CI 95%, 100.0 to 100.0) vs 30% (CI 95%, 12.2 to 50.1) with an earlier recurrence. Early relapse was more frequent in children younger than 5 years of age at diagnosis (75% vs 37%, p =0.009), anaplastic/large cell MB (30% vs 3.7%, p=0.046) and Group 3 tumours (76.5% vs 20.8%, p=0.003). Other factors influencing post-relapse survival were metastatic disease and treatment modalities at diagnosis. Multivariable analyses will be presented.
CONCLUSION
The overall prognosis after relapse remains poor. Time to relapse is a significant prognostic factor for postrelapse survival and may help in the design of clinical trials evaluating new agents.
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Affiliation(s)
- S Huybrechts
- Hospital Center of Luxembourg, Luxembourg, Luxembourg
| | | | | | - C Rossoni
- Gustave Roussy Cancer Center, Villejuif, France
| | | | - P Varlet
- Sainte Anne Hospital, Paris, France
| | - S Puget
- Necker Hospital, Paris, France
| | - R Abbas
- Gustave Roussy Cancer Center, Villejuif, France
| | | | | | - J Grill
- Gustave Roussy Cancer Center, Villejuif, France
| | | | - C Dufour
- Gustave Roussy Cancer Center, Villejuif, France
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22
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David C, Divard G, Abbas R, Escoubet B, Chezel J, Chauveheid MP, Rouzaud D, Boutten A, Papo T, Dehoux M, Sacre K. Soluble CD163 is a biomarker for accelerated atherosclerosis in systemic lupus erythematosus patients at apparent low risk for cardiovascular disease. Scand J Rheumatol 2019; 49:33-37. [PMID: 31161842 DOI: 10.1080/03009742.2019.1614213] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objective: This study aimed to determine whether sCD163, a soluble macrophage marker up-regulated in numerous inflammatory disorders, is predictive of accelerated atherosclerosis associated with systemic lupus erythematosus (SLE).Methods: Carotid ultrasound was prospectively performed, at baseline and during follow-up, in 63 consecutive SLE patients asymptomatic for cardiovascular disease (CVD) and 18 volunteer health workers. Serum sCD163 level was determined at baseline using enzyme-linked immunosorbent assay. The primary outcome was the presence of a carotid plaque. Factors associated with carotid plaques were identified through multivariate analysis.Results: Despite a low risk for cardiovascular events according to Framingham score in both groups (2.1 ± 3.8% in SLE vs 2.1 ± 2.9% in controls; p = 0.416), ultrasound at baseline showed a carotid plaque in 23 SLE patients (36.5%) and two controls (11.1%) (p = 0.039). Multivariate analysis showed that SLE status increased the risk for carotid plaque by a factor of 9 (p = 0.017). In SLE patients, sCD163 level was high (483.7 ± 260.8 ng/mL vs 282.1 ± 97.5 ng/mL in controls; p < 0.001) and independently associated with carotid plaques, as assessed by stratification based on sCD163 quartile values (p = 0.009), receiver operating characteristics (p = 0.001), and multivariate analysis (p = 0.015). sCD163 at baseline was associated with the onset of carotid plaque during follow-up (3 ± 1.4 years) in SLE patients who had no carotid plaque at the first evaluation (p = 0.041).Conclusion: sCD163 is associated with progressing carotid plaque in SLE and may be a useful biomarker for accelerated atherosclerosis in SLE patients at apparent low risk for CVD.
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Affiliation(s)
- C David
- Departement of Internal Medicine, Bichat Hospital, University of Paris Diderot, PRES Sorbonne Paris Cité, APHP, Public Hospitals of Paris, Paris, France
| | - G Divard
- Departement of Internal Medicine, Bichat Hospital, University of Paris Diderot, PRES Sorbonne Paris Cité, APHP, Public Hospitals of Paris, Paris, France
| | - R Abbas
- Department of Epidemiology and Clinical Research, Bichat Hospital, University of Paris Diderot, PRES Sorbonne Paris Cité, APHP, Public Hospitals of Paris, Paris, France
| | - B Escoubet
- Departement of Physiology, Bichat Hospital, University of Paris Diderot, PRES Sorbonne Paris Cité, APHP, Public Hospitals of Paris, INSERM, Paris, France
| | - J Chezel
- Departement of Internal Medicine, Bichat Hospital, University of Paris Diderot, PRES Sorbonne Paris Cité, APHP, Public Hospitals of Paris, Paris, France
| | - M P Chauveheid
- Departement of Internal Medicine, Bichat Hospital, University of Paris Diderot, PRES Sorbonne Paris Cité, APHP, Public Hospitals of Paris, Paris, France
| | - D Rouzaud
- Departement of Internal Medicine, Bichat Hospital, University of Paris Diderot, PRES Sorbonne Paris Cité, APHP, Public Hospitals of Paris, Paris, France
| | - A Boutten
- Department of Metabolic and Cellular Biochemistry, Bichat Hospital, University of Paris Diderot, PRES Sorbonne Paris Cité, APHP, Public Hospitals of Paris, Paris, France
| | - T Papo
- Departement of Internal Medicine, Bichat Hospital, University of Paris Diderot, PRES Sorbonne Paris Cité, APHP, Public Hospitals of Paris, Paris, France.,INSERM U1149 (French Institute of Health and Medical Research), University of Paris Diderot, Paris, France.,Hospital-University Department of Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases, FIRE, Paris, France
| | - M Dehoux
- Department of Metabolic and Cellular Biochemistry, Bichat Hospital, University of Paris Diderot, PRES Sorbonne Paris Cité, APHP, Public Hospitals of Paris, Paris, France
| | - K Sacre
- Departement of Internal Medicine, Bichat Hospital, University of Paris Diderot, PRES Sorbonne Paris Cité, APHP, Public Hospitals of Paris, Paris, France.,INSERM U1149 (French Institute of Health and Medical Research), University of Paris Diderot, Paris, France.,Hospital-University Department of Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases, FIRE, Paris, France
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23
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David C, Divard G, Abbas R, Escoubet B, Chezel J, Chauveheid M, Rouzaud D, Boutten A, Leçon-Malas V, Papo T, Dehoux M, Sacre K. Soluble CD163 is a biomarker for accelerated atherosclerosis in systemic lupus erythematosus patients at apparent low risk for cardiovascular disease. Clin Chim Acta 2019. [DOI: 10.1016/j.cca.2019.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Bertin C, Abbas R, Andrieu V, Michard F, Rioux C, Descamps V, Yazdanpanah Y, Bouscarat F. Illicit massive silicone injections always induce chronic and definitive silicone blood diffusion with dermatologic complications. Medicine (Baltimore) 2019; 98:e14143. [PMID: 30681578 PMCID: PMC6358378 DOI: 10.1097/md.0000000000014143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/18/2018] [Accepted: 12/23/2018] [Indexed: 12/03/2022] Open
Abstract
Male-to-female transgender (MtF TG) individuals often report using illegal subcutaneous silicone injections for body feminisation. It leads to silicone dissemination and various dermatologic complications.We report the long-term complications of these feminisation procedures with blood smear examination and dermatologic examination.Between July 2015 and December 2015, 77 MtF TG consulting at Bichat Hospital (Paris, France) were included in this cross-sectional study. Blood smear examinations were performed by a trained haematologist to quantify the presence of silicone vacuoles in monocytes.All patients reported a history of massive amounts of silicone injections (mean 4 L, range 0.5-15 L). Most patients were South American (75/77, 97%). Fifty-nine (59/75, 79%) were HIV-seropositive, mostly with undetectable HIV RNA plasma levels (46/58, 80%). Clinical examinations reported dermatologic complications for all patients: lymphatic or subcutaneous migration of silicone (59%), inflammation (50%), varicose veins (39%), post-inflammatory pigmentation (20%), infection (14%) and abscesses (4%). Blood smear examination showed intracytoplasmic vacuoles containing silicone in monocytes in all patients.We did not chemically prove the silicone nature of the vacuoles. The design of this study does not allow evaluation of short-term complications that should not be minimized.Illicit massive silicone injections always induced chronic and definitive silicone blood diffusion with dermatologic complications. This study highlights the dangers and the inefficiency of clandestine esthetic surgery. There is a need for targeted information campaigns with transgender populations about silicone injections. Otherwise, these practices may persist.
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Affiliation(s)
| | - Rachid Abbas
- Biostatistic and Epidemiology Department, Gustave Roussy Hospital, Villejuif
| | | | | | | | | | | | - Fabrice Bouscarat
- Dermatology and CeGIDD, Bichat Hospital, Assistance Publique Hopitaux De Paris, Paris, France
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David C, Escoubet B, Abbas R, Chezel J, Chauveheid M, Papo T, Dehoux M, Sacré K. CD163 soluble est un marqueur d’athérome accéléré chez les patients lupiques à faible risque cardiovasculaire apparent. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Guerrini-Rousseau L, Dufour C, Varlet P, Masliah-Planchon J, Bourdeaut F, Guillaud-Bataille M, Abbas R, Bertozzi AI, Fouyssac F, Huybrechts S, Puget S, Bressac-De Paillerets B, Caron O, Sevenet N, Dimaria M, Villebasse S, Delattre O, Valteau-Couanet D, Grill J, Brugières L. Germline SUFU mutation carriers and medulloblastoma: clinical characteristics, cancer risk, and prognosis. Neuro Oncol 2018; 20:1122-1132. [PMID: 29186568 PMCID: PMC6280147 DOI: 10.1093/neuonc/nox228] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Germline mutations of suppressor of fused homolog (SUFU) predispose to sonic hedgehog (SHH) medulloblastoma. Germline SUFU mutations have been reported in nevoid basal cell carcinoma syndrome (NBCCS), but little is known about the cancer risk and clinical spectrum. Methods We performed a retrospective review of all patients with medulloblastoma and a germline SUFU mutation in France. Results Twenty-two patients from 17 families were identified with medulloblastoma and a germline SUFU mutation (median age at diagnosis: 16.5 mo). Macrocrania was present in 20 patients, but only 5 met the diagnostic criteria for NBCCS. Despite treatment with surgery and chemotherapy, to avoid radiotherapy in all patients except one, the outcome was worse than expected for SHH medulloblastoma, due to the high incidence of local relapses (8/22 patients) and second malignancies (n = 6 in 4/22 patients). The 5-year progression-free survival and overall survival rates were 42% and 66%. Mutations were inherited in 79% of patients, and 34 additional SUFU mutation carriers were identified within 14 families. Medulloblastoma penetrance was incomplete, but higher than in Patched 1 (PTCH1) mutation carriers. Besides medulloblastoma, 19 other tumors were recorded among the 56 SUFU mutation carriers, including basal cell carcinoma (BCC) in 2 patients and meningioma in 3 patients. Conclusion Germline SUFU mutations strongly predispose to medulloblastoma in the first years of life, with worse prognosis than usually observed for SHH medulloblastoma. The clinical spectrum differs between SUFU and PTCH1 mutation carriers, and BCC incidence is much lower in SUFU mutation carriers. The optimal treatment of SUFU mutation-associated medulloblastoma has not been defined.
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Affiliation(s)
- Léa Guerrini-Rousseau
- Département de Cancérologie de l’Enfant et de l’Adolescent, Gustave Roussy, Université Paris-Saclay, Villejuif, France,Corresponding author: Léa Guerrini-Rousseau, Gustave Roussy, Département de Cancérologie de l’Enfant et de l’Adolescent, 114 rue Edouard Vaillant, 94805 Villejuif, France ()
| | - Christelle Dufour
- Département de Cancérologie de l’Enfant et de l’Adolescent, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Pascale Varlet
- Service de neuropathologie, Hôpital Sainte-Anne, Université Paris Descartes, Paris, France
| | - Julien Masliah-Planchon
- PSL Research University, INSERM U830 Génétique et Biologie des Cancers Institut Curie, Paris, France,Unité de génétique somatique, SIREDO pediatric oncology center, Institut Curie, Paris, France
| | - Franck Bourdeaut
- PSL Research University, INSERM U830 Génétique et Biologie des Cancers Institut Curie, Paris, France,Département d’oncologie Pédiatrique adolescents Jeunes Adultes, Institut Curie, Paris, France, SIREDO pediatric oncology center, Institut Curie, Paris, France,Institut Curie SIRIC - Laboratoire de Recherche Translationnelle en Oncologie Pédiatrique, Institut Curie, Paris, France
| | - Marine Guillaud-Bataille
- Département de Biologie et Pathologie Médicales, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Rachid Abbas
- INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France,Service de Biostatistique et d’Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | - Fanny Fouyssac
- Onco-hématologie pédiatrique, Hôpital d’Enfants, CHU Nancy, Nancy, France
| | - Sophie Huybrechts
- Hematology-Oncology Unit, Hôpital Universitaire des Enfants Reine Fabiola, ULB Université libre de Bruxelles, Brussels, Belgium
| | - Stéphanie Puget
- Service de neurochirurgie pédiatrique, Hôpital Necker-Enfants malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Olivier Caron
- PSL Research University, INSERM U830 Génétique et Biologie des Cancers Institut Curie, Paris, France,Unité de génétique somatique, SIREDO pediatric oncology center, Institut Curie, Paris, France,Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Nicolas Sevenet
- Laboratoire de génétique moléculaire, Département de bio-pathologie, Institut Bergonié, Bordeaux, France,INSERM U1218, Université de Bordeaux, Bordeaux, France,UFR des Sciences Pharmaceutiques, Université de Bordeaux, Bordeaux, France
| | - Marina Dimaria
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Sophie Villebasse
- Département de Médecine Oncologique, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Olivier Delattre
- Département de Cancérologie de l’Enfant et de l’Adolescent, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Dominique Valteau-Couanet
- Département de Cancérologie de l’Enfant et de l’Adolescent, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jacques Grill
- Unité Mixte de Recherche 8203 du Centre National de la Recherche Scientifique, Université Paris-Saclay, Villejuif, France
| | - Laurence Brugières
- Département de Cancérologie de l’Enfant et de l’Adolescent, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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Abbas R, Rossoni C, Jaki T, Paoletti X, Mozgunov P. A comparison of phase I dose-escalation designs in clinical trials with monotonicity assumption violation. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.03.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abbas R, Tanguy A, Bonnet-Zamponi D, Djedid R, Lounis A, Gaubert-Dahan ML. New Simplified Screening Method for Postprandial Hypotension in Older People. J Frailty Aging 2018; 7:28-33. [PMID: 29412439 DOI: 10.14283/jfa.2018.2] [Citation(s) in RCA: 2] [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] [Indexed: 11/11/2022]
Abstract
BACKGROUND Postprandial hypotension (PPH) is an important disorder in the older people that remain underdiagnosed. The reference PPH diagnostic method is too demanding, because blood pressure (BP) needs to be measured 8 times in 2 hours. OBJECTIVES Our primary objective was to define a new simplified PPH diagnostic method and to evaluate its performances. DESIGN We conducted a cross-sectional study. SETTING Two geriatric rehabilitation units in France. PARTICIPANTS 104 patients (70 women, 34 men) with high risk of PPH were included. MEASUREMENTS BP was measured twice before the midday meal in seated position at the table, and every 15 minutes for 90 minutes after the end of the meal. Receiver Operating Characteristic curves were plotted for each postprandial BP measure to determine the best postprandial measure in terms of sensitivity and specificity. The optimal diagnostic threshold was calculated with Youden's index according to BP difference before and after the meal. RESULTS A new simplified diagnostic method is proposed: a decrease of at least 10 mmHg systolic BP between BP measures before the meal and 75 minutes after the end of the meal. This new method had a sensitivity of 82% (95%CI 66 - 92) and a specificity of 91% (95%CI 81 - 97). CONCLUSION This new diagnostic method is fast, efficient and suitable for everyday use. It could improve PPH diagnosis in older people. Larger studies are needed to validate it.
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Affiliation(s)
- R Abbas
- Rachid Abbas, Département d'épidémiologie et recherche clinique, CIC-EC 1425, AP-HP, Hôpital Bichat, Paris France,
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Abstract
Acute meningitis can be the first manifestation of an underlying systemic inflammatory disorder (SID). In the current study, we aimed to identify clinical indicators for SIDs in patients admitted for acute aseptic meningitis. All patients hospitalised for acute aseptic meningitis over a 4-year period in a department of internal medicine were included retrospectively. Patients with neoplastic meningitis were excluded. Extraneurological signs were recorded using a systematic panel. Systemic inflammatory disorder diagnosis was made according to current international criteria. Forty-three (average age 46 years [range 19-82 years], 60% females) consecutive patients were analysed retrospectively. Of these, 23 patients had an SID (mostly sarcoidosis and Behçet's disease). -Multiple logistic regression analysis showed that the probability of an SID was 93.7% in patients with both neurological and extraneurological signs, but 14.9% in patients with neither neurological nor extraneurological signs. In conclusion, clinical sorting according to both neurological and extraneurological signs could help to identify patients with acute aseptic meningitis caused by an SID.
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Parkes JP, Wood L, Chadburn AJ, Garman E, Abbas R, Modupe A, Whitehead SJ, Ford C, Thomas OL, Chugh S, Deshpande S, Gama R. The effect of the acute phase response on routine laboratory markers of folate and vitamin B12 status. Int J Lab Hematol 2018; 40:e21-e23. [PMID: 29405641 DOI: 10.1111/ijlh.12778] [Citation(s) in RCA: 2] [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] [Received: 12/11/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Affiliation(s)
- J P Parkes
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - L Wood
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - A J Chadburn
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - E Garman
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - R Abbas
- Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - A Modupe
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - S J Whitehead
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - C Ford
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - O L Thomas
- Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - S Chugh
- Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - S Deshpande
- Orthopaedics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - R Gama
- Blood Sciences, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,Research Institute, Healthcare Sciences, Wolverhampton University, Wolverhampton, UK
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Assayag M, Abbas R, Chanson N, Perozziello A, Ducrocq G, Alexandra JF, Dossier A, Papo T, Sacre K. Diagnosis of systemic inflammatory diseases among patients admitted for acute pericarditis with pericardial effusion. J Cardiovasc Med (Hagerstown) 2017; 18:875-880. [PMID: 28937580 DOI: 10.2459/jcm.0000000000000576] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Acute pericarditis may be the heralding manifestation of various systemic inflammatory diseases (SIDs). The aim of this study was to identify clinical indicators for SIDs in patients admitted for acute pericarditis with pericardial effusion. METHODS All consecutive adult patients hospitalized in a Department of Internal Medicine over a 10-year period for acute pericarditis with pericardial effusion were retrospectively reviewed. Patients with cancer and tuberculosis were excluded. A structured clinical panel for extra-cardiac symptoms of SIDs was applied. SIDs were classified using current international criteria. RESULTS Ninety-nine patients were admitted for acute pericarditis with pericardial effusion. After exclusion, 74 (49.7 ± 19.7 years, 56.7% women) patients were analyzed. Among them, 23 (23.2%) patients had a SID that was revealed by pericarditis in 12 cases. Systemic lupus erythematosus, undifferentiated connective-tissue disease, and Sjogren's syndrome accounted for 75% of the SID. Patients with SIDs were younger (P < 0.001), more frequently of female sex (P = 0.025), and had a higher frequency of extra-cardiac symptoms (P < 0.001) including arthralgia, myalgia, Raynaud phenomenon, and skin rash, as compared with patients with idiopathic pericarditis (n = 51). Overall, after exclusion of neoplasm and tuberculosis, the probability of SIDs in patients admitted with an acute pericarditis with pericardial effusion was 89.7% in patients younger than 50 who had extra-cardiac symptoms. Conversely, the probability fell to 8.4% in patients older than 50 with no extra-cardiac symptoms. CONCLUSION Both age and extra-cardiac symptoms suggest an underlying SID as a possible cause of acute pericarditis.
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Affiliation(s)
- Maureen Assayag
- aDépartement de Médecine Interne bDépartement d'Epidémiologie et Recherche Clinique cDépartement d'Information Médicale dDépartement de Cardiologie, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris eINSERM U1149 fDépartement Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France
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Lammers P, Dank M, Masetti R, Abbas R, Hilton F, Coiro J, Jacobs I. A randomized, double-blind study of PF-05280014 (a potential biosimilar) vs trastuzumab, both given with docetaxel (D) and carboplatin (C), as neoadjuvant treatment for operable human epidermal growth factor receptor 2-positive (HER2+) breast cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gaubert-Dahan M, Bonnet-Zamponi D, Abbas R. NEW SIMPLIFIED DIAGNOSTIC METHOD TO SCREENING FOR POSTPRANDIAL HYPOTENSION IN OLDER PEOPLE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - D. Bonnet-Zamponi
- OMEDIT (Observatoire des MEdicaments Dispositifs médicaux et Innovations Thérapeutiques) Ile de France, Paris, France,
- Département d’épidémiologie et recherche clinique, CIC-EC 1425, Groupe Hospitalier Paris Nord Val de Seine, AP-HP, Hôpital Bichat, Paris, France
| | - R. Abbas
- Département d’épidémiologie et recherche clinique, CIC-EC 1425, Groupe Hospitalier Paris Nord Val de Seine, AP-HP, Hôpital Bichat, Paris, France
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Divard G, Abbas R, Chenevier-Gobeaux C, Chanson N, Escoubet B, Chauveheid MP, Dossier A, Papo T, Dehoux M, Sacre K. High-sensitivity cardiac troponin T is a biomarker for atherosclerosis in systemic lupus erythematous patients: a cross-sectional controlled study. Arthritis Res Ther 2017; 19:132. [PMID: 28610589 PMCID: PMC5470230 DOI: 10.1186/s13075-017-1352-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/26/2017] [Indexed: 11/24/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the main cause of death in systemic lupus erythematous (SLE) patients. The Framingham score underestimates the risk for CVD in this population. Our study aimed to determine whether serum high-sensitivity cardiac troponin T (HS-cTnT) might help to identify SLE patients at risk for CVD. Methods The presence of carotid plaques was prospectively assessed by ultrasound in 63 consecutive SLE patients asymptomatic for CVD and 18 controls. Serum HS-cTnT concentration was measured using the electrochemiluminescence method. Factors associated with carotid plaques were identified and multivariate analysis was performed. Results Framingham score was low in both SLE patients (median 1 (range 1–18%)) and controls (1 (1–13%)). Nevertheless, 23 (36.5%) SLE patients, but only 2 (11.1%) controls (p = 0.039), had carotid plaque detected by vascular ultrasound. In the multivariate analysis, only age (p = 0.006) and SLE status (p = 0.017) were independently associated with carotid plaques. Serum HS-cTnT concentration was detectable (i.e. >3 ng/L) in 37 (58.7%) SLE patients and 6 (33.3%) controls (p = 0.057). Interestingly, 87% of SLE patients with carotid plaques, but only 42.5% of SLE patients without plaques (p < 0.001), had detectable HS-cTnT. Conversely, 54.5% of SLE patients with detectable HS-cTnT, but only 11.5% with undetectable HS-cTnT (p < 0.001), had a carotid plaque. In the multivariate analysis, only body mass index (p = 0.006) and HS-cTnT (p = 0.033) were statistically associated with carotid plaques in SLE patients. Overall, the risk of having a carotid plaque was increased by 9 (odds ratio 9.26, 95% confidence interval 1.55–90.07) in SLE patients in whom HS-cTnT was detectable in serum. Conclusion Serum HS-cTnT level is high and associated with carotid plaques in SLE patients who are at an apparently low risk for CVD according to the Framingham score. HS-cTnT may be a useful biomarker for SLE-associated atherosclerosis.
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Affiliation(s)
- Gillian Divard
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France
| | - Rachid Abbas
- Département d'Epidémiologie et recherche clinique, CIC-EC 1425, Groupe Hospitalier Paris Nord Val de Seine, AP-HP, Hôpital Bichat, Paris France; Univ Paris Diderot, PRES Sorbonne Paris Cité, UMR 1123 ECEVE, Paris, France
| | - Camille Chenevier-Gobeaux
- Département de Biochimie, Hôpital Cochin, Université Paris Descartes, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Noémie Chanson
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France
| | - Brigitte Escoubet
- Département de Physiologie, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, INSERM U1138, Paris, France
| | - Marie-Paule Chauveheid
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France
| | - Antoine Dossier
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France
| | - Thomas Papo
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France.,INSERM U1149, Paris, France.,Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France
| | - Monique Dehoux
- Département de Biochimie Métabolique et Cellulaire, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Université Paris Diderot, PRES Sorbonne Paris Cité, Assistance Publique Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France. .,INSERM U1149, Paris, France. .,Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation and Remodelling in Renal and Respiratory Diseases), Paris, France.
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Bertin C, Abbas R, Andrieu V, Michard F, Rioux C, Descamps V, Yazdanpanah Y, Bouscarat F. Complications à long terme des injections massives de silicones non médicaux : étude clinique et cytologique chez 77 transgenres. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.184] [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: 10/20/2022]
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Divard G, Abbas R, Chenevier-Gobeaux C, Escoubet B, Chauveheid M, Dossier A, Dehoux M, Papo T, Sacré K. La troponine C ultrasensible est un biomarqueur d’athérosclérose accélérée chez les sujets lupiques. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.125] [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: 10/20/2022]
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Pemmaraju G, Bassett J, Abbas R, Nagra G, Chugh S, Mughal E. Outcomes of combined tibial tuberosity transfer and medial patellofemoral ligament reconstruction for recurrent patellar instability. Acta Orthop Belg 2016; 82:365-371. [PMID: 27682301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Patellofemoral instability is multifactorial and is associated with pathomechanics secondary to anatomical variance. Surgical management of this problem must be tailored to each patient and a thorough clinical and radiological assessment of the anatomical alignment should be carried out pre-operatively. The aim of this study is to assess the role of medial patellofemoral ligament reconstruction combined with tibial tuberosity transfer in patients with increased tibial tuberosity to trochlear groove (TT-TG) distance. Twenty-four patients (27 knees) over 2-years were operated on by a single surgeon, with standardised post-operative rehabilitation and follow up. Mean follow up was 31-months. Two patients had problems with recurrent instability, 1 had a -traumatic re-dislocation at 2 years and a total of 4 required further operation for complications. Mean post--operative Kujala scores were 87.4 (SD 9.8). Combined medial patellofemoral ligament reconstruction and tibial tuberosity transfer is an appropriate treatment for patients with increased TT-TG distance.
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Stadler N, Lehner J, Abbas R, Trieb K. Prospective mid-term results of a consecutive series of a short stem. Acta Orthop Belg 2016; 82:372-375. [PMID: 27682302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A large number of short stem prostheses for hip -arthroplasty have been introduced in the past years. Although there is a large increase of publications about short stems, there is still little data available about survival and revision rates. We report prospectively on the outcome of 84 consecutive NANOS® short stem prostheses in 81 patients. We have included 37 female patients and 44 male patients with an average age of 61.6 ± 9.2 years. The main diagnoses were osteoarthritis in 67 patients, dysplastic osteoarthritis in 8 patients and avascular necrosis of the femoral head in 6 patients. Along with demographic data and co-morbidities, the Harris Hip Score was recorded preoperatively and at follow-up. The Harris Hip Score increased from 36.6 ± 14.5 preoperatively to 94.5 ± 8.8 at the final follow-up. During the main follow-up time (27.7 months ± 5.7) none of the 84 stems were revised, intraoperatively three fissure fractures occurred.
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Lefebvre A, Manoha C, Bour JB, Abbas R, Fournel I, Tiv M, Pothier P, Astruc K, Aho-Glélé LS. Human metapneumovirus in patients hospitalized with acute respiratory infections: A meta-analysis. J Clin Virol 2016; 81:68-77. [PMID: 27337518 PMCID: PMC7106388 DOI: 10.1016/j.jcv.2016.05.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/26/2016] [Accepted: 05/30/2016] [Indexed: 12/31/2022]
Abstract
This meta-analysis aimed to estimate the prevalence of human metapneumovirus (hMPV) infections in patients hospitalized for acute respiratory infection (ARI) and to study factors associated with this prevalence. Medline and ScienceDirect databases were searched for prospective observational studies that screened hospitalized patients with ARI for hMPV by RT-PCR, with data available at December 27, 2014. The risk of bias was assessed regarding participation rate, definition of ARI, description of diagnostic technique, method of inclusion identical for all subjects, standardized and identical sampling method for all subjects, analysis performed according to the relevant subgroups, and presentation of data sources. Random-effect meta-analysis with arcsine transformation and meta-regressions was used. In the 75 articles included, the prevalence of hMPV among hospitalized ARI was 6.24% (95% CI 5.25-7.30). An effect of the duration of the inclusion period was observed (p=0.0114), with a higher prevalence of hMPV in studies conducted during periods of 7-11 months (10.56%, 95% CI 5.97-16.27) or complete years (7.55%, 95% CI 5.90-9.38) than in periods of 6 months or less (5.36%, 95% CI 4.29-6.54). A significant increase in the incidence with increasing distance from the equator was observed (p=0.0384). hMPV should be taken into account as a possible etiology in hospitalized ARI.
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Affiliation(s)
- Annick Lefebvre
- Epidemiology and infection control unit, Dijon University Hospital, France.
| | | | | | - Rachid Abbas
- Epidemiology and infection control unit, Dijon University Hospital, France
| | - Isabelle Fournel
- Epidemiology and infection control unit, Dijon University Hospital, France
| | - Michel Tiv
- Epidemiology and infection control unit, Dijon University Hospital, France
| | | | - Karine Astruc
- Epidemiology and infection control unit, Dijon University Hospital, France
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Randon M, Liang H, Abbas R, Michée S, Denoyer A, Baudouin C, Labbé A. [A new classification for meibomian gland diseases with in vivo confocal microscopy]. J Fr Ophtalmol 2016; 39:239-47. [PMID: 26896195 DOI: 10.1016/j.jfo.2015.07.015] [Citation(s) in RCA: 14] [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: 05/06/2015] [Revised: 07/10/2015] [Accepted: 07/20/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Meibomian gland dysfunction (MGD) is a frequent disorder often associated with dry eye disease. Slit-lamp examination with digital expression of the tarsal Meibomian glands allows examination of the contents of the distal Meibomian gland and the meatus. However, the Meibomian epithelium, interglandular space and proximal secretions cannot be clinically assessed. In vivo confocal microscopy (IVCM) is a rapid and non-invasive imaging technique that provides high-resolution images of the ocular surface and eyelids. The primary objective of the present study was to establish a classification of MGD with IVCM. Secondary objectives were to evaluate this scoring system by analyzing the correlation with OSDI, infrared (IR) meibography and Demodex infestation. MATERIAL AND METHODS Forty-six dry eye patients (Ocular Surface Disease Index [OSDI] >13) associated with MGD were enrolled. Ten healthy subjects without dry eye disease or blepharitis were also included as controls. An OSDI questionnaire, clinical examination, IVCM and infrared meibography of the lower lid were performed in all subjects by the same examiner. RESULTS A new MGD score was established based on IVCM findings: the first stage was Meibomian obstruction with a clear epithelium, the second stage was an inflammatory state with Meibomian gland obstruction, epithelial and interglandular inflammation, and the last stage was glandular fibrosis. This score was significantly correlated with the meiboscore obtained with infrared meibography (correlation coefficient 0.47, CI95% [0.22-0.66]). CONCLUSION IVCM of the Meibomian gland complex complements the clinical examination by determining the stage of dysfunction and may help clinicians evaluate and treat MGD.
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Affiliation(s)
- M Randon
- Service d'ophtalmologie III, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigations cliniques Inserm-DHOS CIC 1423, centre hospitalier national d'ophtalmologie des Quinze-Vingts, DHU vision et handicaps, 28, rue de Charenton, 75012 Paris, France.
| | - H Liang
- Service d'ophtalmologie III, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigations cliniques Inserm-DHOS CIC 1423, centre hospitalier national d'ophtalmologie des Quinze-Vingts, DHU vision et handicaps, 28, rue de Charenton, 75012 Paris, France
| | - R Abbas
- Département d'épidémiologie et recherche clinique, CIC-EC 1425, hôpital Bichat, groupe hospitalier Paris Nord Val-de-Seine, AP-HP, 75018 Paris, France; UMR 1123 ECEVE, hôpital Robert-Debré, université Paris Diderot, Sorbonne Paris Cité, 48, boulevard Serurier, 75019 Paris, France
| | - S Michée
- Service d'ophtalmologie III, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin-en-Yvelines, 75012 Versailles, France
| | - A Denoyer
- Service d'ophtalmologie III, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigations cliniques Inserm-DHOS CIC 1423, centre hospitalier national d'ophtalmologie des Quinze-Vingts, DHU vision et handicaps, 28, rue de Charenton, 75012 Paris, France
| | - C Baudouin
- Service d'ophtalmologie III, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigations cliniques Inserm-DHOS CIC 1423, centre hospitalier national d'ophtalmologie des Quinze-Vingts, DHU vision et handicaps, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin-en-Yvelines, 75012 Versailles, France
| | - A Labbé
- Service d'ophtalmologie III, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France; Centre d'investigations cliniques Inserm-DHOS CIC 1423, centre hospitalier national d'ophtalmologie des Quinze-Vingts, DHU vision et handicaps, 28, rue de Charenton, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin-en-Yvelines, 75012 Versailles, France
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Fauvelle F, Kabirian F, Domingues A, Tubach F, Gault N, Abbas R. Impact d’un livret thérapeutique sur la qualité des prescriptions médicamenteuses des résidents d’EHPAD. Therapie 2015; 70:515-21. [DOI: 10.2515/therapie/2015037] [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] [Received: 02/12/2015] [Accepted: 05/15/2015] [Indexed: 11/20/2022]
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Yusuf I, Qabli SM, Magashi AM, Balarabe AI, Kabir A, Kabir MR, Olivia ES, Abbas R. Detection of colistin resistant Klebsiella pneumonia co-producing extended spectrum, AmpC beta lactamase and carbapenemase in a tertiary hospital in Nigeria. Antimicrob Resist Infect Control 2015. [PMCID: PMC4475090 DOI: 10.1186/2047-2994-4-s1-p129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abbas R, Carnet D, D'Athis P, Fiet C, Le Breton G, Romestaing M, Quantin C. [Comparison of British and French expatriate doctors' characteristics and motivations]. Rev Epidemiol Sante Publique 2015; 63:21-8. [PMID: 25614374 DOI: 10.1016/j.respe.2014.12.018] [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: 07/24/2012] [Revised: 11/07/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Migration of medical practitioners is rarely studied despite its importance in medical demography: the objective of this study was to analyze the characteristics and motivations of the French doctors settled in the United Kingdom and of the British doctors settled in France. METHODS This cross-sectional study was conducted using a self-completed questionnaire sent to all French doctors practicing in the United Kingdom (in 2005) and all British medicine doctors practicing in France (in 2009). The doctors were identified with official data from the National Medical Councils: 244 French doctors practicing in the United Kingdom and 86 British doctors practicing in France. The questionnaire was specifically developed to determine the reasons of moving to the other country, and the level of satisfaction after expatriation. RESULTS A total of 98 French doctors (out of 244) and 40 British doctors (out of 86) returned the questionnaire. Respondents were mainly general practitioners with a professional experience of 8 to 9 years. The sex ratio was near 1 for both groups with a majority of women among physicians under 50 years. The motivations were different between groups: French doctors were attracted by the conditions offered at the National Health Service, whereas British doctors were more interested in opportunities for career advancement, joining husband or wife, or favourable environmental conditions. Overall, the respondents considered expatriation as satisfactory: 84% of French doctors, compared with only 58% of British doctors, were satisfied with their new professional situation. CONCLUSION This study, the first in its kind, leads to a clearer understanding of the migration of doctors between France and the United Kingdom.
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Affiliation(s)
- R Abbas
- Service de biostatistique et informatique médicale, CHU de Dijon, BP 77908, 21079 Dijon cedex, France
| | - D Carnet
- Faculté de médecine, université de Bourgogne, 21000 Dijon, France
| | - P D'Athis
- Service de biostatistique et informatique médicale, CHU de Dijon, BP 77908, 21079 Dijon cedex, France
| | - C Fiet
- Service de biostatistique et informatique médicale, CHU de Dijon, BP 77908, 21079 Dijon cedex, France
| | - G Le Breton
- Conseil national de l'ordre des médecins, 75000 Paris, France
| | - M Romestaing
- Conseil national de l'ordre des médecins, 75000 Paris, France
| | - C Quantin
- Service de biostatistique et informatique médicale, CHU de Dijon, BP 77908, 21079 Dijon cedex, France; Inserm U 866, université de Bourgogne, 21000 Dijon, France.
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Abbas R, Binquet C, Rougier R, Le Malicot K, Lepage C. Apport des modèles multi-états dans l’étude des facteurs de reprise évolutive chez les patients atteints d’un cancer colorectal (CCR) dans les essais thérapeutiques de phase III. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2013.12.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Deshpande CS, Rakhshani A, Rakshani A, Nagarathna R, Ganpat TS, Kurpad A, Maskar R, Nagendra HR, Sudheer DC, Abbas R, Raghuram N, Anura K, Rita M, Ramarao N. Yoga for high-risk pregnancy: a randomized controlled trial. Ann Med Health Sci Res 2013; 3:341-4. [PMID: 24116310 PMCID: PMC3793436 DOI: 10.4103/2141-9248.117933] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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] [Indexed: 11/08/2022] Open
Abstract
Background: Improvements in technology have increased the chances of survival for the micro-premature infant and the very low birth-weight infant but have significantly increased the financial burden of health care organizations. This economic burden has a significant impact on third-party payers and on society in general. Aim: The study was designed to assess yoga therapy (YT) module on maternal stress level in high risk pregnancy. Subjects and Methods: In the present study, sixty-eight pregnant women (38 in the control group with standard antenatal care and 30 in the YT group) with 27.2 (5.2) years of mean age recruited from the outpatient services of medical college and hospital in Bangalore, South India, were participated. The study was a single-blind randomized controlled clinical trial. Perceived stress scale (PSS) was measured during the 12th, 20th, and 28th weeks of pregnancy. SPSS version 16.0 (Chicago, IL, USA) was used for all data analysis. When the data were found to be normally distributed, the RMANOVA were used to assess the PSS scores between the yoga and control groups. Significant values were set at P < 0.05. Results: There was a significant difference in the PSS level of the YT group with significantly reduced scores at the second follow-up (28th week of pregnancy) compared to the control group (P = 0.02). Women who took part in the YT module reported significantly fewer pregnancy discomforts decrease in PSS (P = 0.02) than the control group where the stress level was increased (RMANOVA test using SPSS-16). Conclusion: The present study suggests that the YT module can decrease the stress level during high-risk pregnancy complications. Thus, practicing YT during high-risk pregnancy is not only a cost-effective option but also a feasible and safe option. Additional well-designed studies are needed before a strong recommendation can be made.
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Affiliation(s)
- C S Deshpande
- Yoga and Life Sciences, S-VYASA University, Bangalore, India
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Chow LWC, Xu B, Gupta S, Freyman A, Zhao Y, Abbas R, Vo Van ML, Bondarenko I. Combination neratinib (HKI-272) and paclitaxel therapy in patients with HER2-positive metastatic breast cancer. Br J Cancer 2013; 108:1985-93. [PMID: 23632474 PMCID: PMC3670493 DOI: 10.1038/bjc.2013.178] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 03/12/2013] [Accepted: 04/01/2013] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Neratinib is a potent irreversible pan-ErbB tyrosine kinase inhibitor that has demonstrated antitumour activity and an acceptable safety profile in patients with human epidermal growth factor receptor (HER)-2-positive breast cancer and other solid tumours. METHODS This was a phase I/II, open-label, two-part study. Part 1 was a dose-escalation study to determine the maximum tolerated dose (MTD) of neratinib plus paclitaxel in patients with solid tumours. Part 2 evaluated the safety, efficacy, and pharmacokinetics of the combination at the MTD in patients with HER2-positive breast cancer. RESULTS Eight patients were included in the dose-escalation study; no dose-limiting toxicities were observed, and an MTD of oral neratinib 240 mg once daily plus intravenous paclitaxel 80 mg m(-2) on days 1, 8, and 15 of each 28-day cycle was determined. A total of 102 patients with HER2-positive breast cancer were enrolled in part 2. The overall median treatment duration was 47.9 weeks (range: 0.1-147.3 weeks). Common treatment-emergent adverse events (all grades/grade ≥3) included diarrhoea (92%/29%; none grade 4), peripheral sensory neuropathy (51%/3%), neutropenia (50%/20%), alopecia (46%/0%), leukopenia (41%/18%), anaemia (37%/8%), and nausea (34%/1%). Three (3%) patients discontinued treatment due to an adverse event (mouth ulceration, left ventricular ejection fraction reduction, and acute renal failure). Among the 99 evaluable patients in part 2 of the study, the overall response rate (ORR) was 73% (95% confidence interval (CI): 62.9-81.2%), including 7 (7%) patients who achieved a complete response; an additional 9 (9%) patients achieved stable disease for at least 24 weeks. ORR was 71% among patients with 0/1 prior chemotherapy regimen for metastatic disease and no prior lapatinib, and 77% among those with 2/3 prior chemotherapy regimens for metastatic disease with prior lapatinib permitted. Kaplan-Meier median progression-free survival was 57.0 weeks (95% CI: 47.7-81.6 weeks). Pharmacokinetic analyses indicated no interaction between neratinib and paclitaxel. CONCLUSION The combination of neratinib and paclitaxel was associated with higher toxicity than that of neratinib as a single agent, but was manageable with antidiarrhoeal agents and dose reductions in general. The combination therapy also demonstrated a high rate of response in patients with HER2-positive breast cancer. A phase III trial is ongoing to assess the benefit and risk of this combination in the first-line setting.
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Affiliation(s)
- L W-C Chow
- UNIMED Medical Institute, Comprehensive Centre for Breast Diseases, Hong Kong, China.
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Abstract
OBJECTIVE The aim of this study was to analyse the migration of doctors between the UK and France, in an attempt to identify the reasons for these migrations. DESIGN This was a cross-sectional study conducted using a self-completed questionnaire. SETTING The questionnaire was sent to all British doctors practising in France and to all French doctors practising in the UK. PARTICIPANTS The doctors were identified, thanks to official data of the National Medical Councils. There were 244 French doctors practising in the UK and 86 British doctors practising in France. OUTCOME MEASURES A questionnaire was specifically developed for the study to determine the reasons why doctors moved to the other country and their level of satisfaction with regard to their expatriation. RESULTS A total of 98 French doctors (of 244) and 40 British doctors (of 86) returned the questionnaire. The motivations of the two studied populations were different: French doctors were attracted by the conditions offered by the National Health Service, whereas British doctors were more interested in opportunities for career advancement, moved to join a husband or wife or to benefit from favourable environmental conditions. Overall, the doctors who responded considered the expatriation a satisfactory experience. After expatriation, 84% of French doctors were satisfied with their new professional situation compared with only 58% of British doctors. CONCLUSIONS This study, which is the first of its kind and based on representative samples, has led to a clearer understanding of the migration of doctors between France and the UK.
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Affiliation(s)
- Catherine Quantin
- Service de Biostatistique et Informatique Médicale, CHU, de Dijon, France
- INSERM U 866 Université de Bourgogne, de Dijon, France
| | - Rachid Abbas
- Service de Biostatistique et Informatique Médicale, CHU, de Dijon, France
| | - Mathieu Hagi
- Service de Biostatistique et Informatique Médicale, CHU, de Dijon, France
| | | | - M Romestaing
- INSERM U 866 Université de Bourgogne, de Dijon, France
| | - Dider Carnet
- Conseil National de l'Ordre des Médecins, Paris, France
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Abbas R, Benzenine E, Trombert B, Hagi M, Auverlot B, Bouvier AM, Goldberg M, Rodrigues JM, Quantin C. Intérêt des bases de données médico-administratives pour l’estimation de l’incidence des cancers. Rev Epidemiol Sante Publique 2011. [DOI: 10.1016/j.respe.2011.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Gandhi L, Bahleda R, Cleary JM, Hollebecque A, Kwak EL, Pandya S, Tolaney S, Abbas R, Ananthakrishnan R, Berkenblit A, Boni J, Clancy J, Turnbull KW, VoVan M, Shapiro G, Soria J. Two-dimensional phase I study of neratinib (NER) combined with temsirolimus (TEM) in patients (Pts) with solid tumors. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.3027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abbas R, Hug BA, Leister C, Burns J, Sonnichsen D. A single-dose, crossover, placebo- and moxifloxacin-controlled study to assess the effects of neratinib (HKI-272) on cardiac repolarization in healthy adult subjects. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e11070] [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: 11/20/2022] Open
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