1
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Durot E, Roosweil D, Chauchet A, Decroocq J, Di Blasi R, Gastinne T, Bensaber H, Cheminant M, Jacquet C, Guidez S, Gros FX, Bachy E, Coste A, Cony-Makhoul P, Treon SP, Delmer AJ, Reshef R, Le Gouill S, Castillo JJ, Houot R. High efficacy of CD19 CAR T-cells in patients with transformed Waldenström macroglobulinemia. Blood 2024:blood.2024024452. [PMID: 38669635 DOI: 10.1182/blood.2024024452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Histological transformation of Waldenström macroglobulinemia (HT-WM) carries a poor prognosis with standard treatments. Here, we report the first series of HT-WM treated with CAR T-cells showing a high efficacy and no unexpected toxicity.
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Affiliation(s)
- Eric Durot
- Hôpital Robert Debré CHU de Reims, Reims cedex, France
| | - Damien Roosweil
- Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Justine Decroocq
- Université de Paris, Institut Cochin, CNRS UMR8104, INSERM U1016, F-75014 Paris, France, Paris, France
| | | | | | - Hedi Bensaber
- University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | | | | | | | - Arthur Coste
- Hopital Robert Debre CHU de Reims, Reims cedex, France
| | | | - Steven P Treon
- Dana Farber Cancer Institute, Boston, Massachusetts, United States
| | | | - Ran Reshef
- Columbia University Medical Center, New York, New York, United States
| | | | - Jorge J Castillo
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States
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2
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Crochet G, Iacoboni G, Couturier A, Bachy E, Iraola-Truchuelo J, Gastinne T, Cartron G, Fradon T, Lesne B, Kwon M, Gounot R, Martínez-Cibrian N, Castilla-Llorente C, Abrisqueta P, Guerreiro M, Sarkozy C, Aspa-Cilleruelo JM, Camus V, Guidez S, Chauchet A, Deconinck E, Bouabdallah K, Bosch F, Barba P, Morschhauser F, Houot R. Efficacy of CAR T-Cell Therapy is Not Impaired by Previous Bispecific Antibody Treatment in Large B-Cell Lymphoma. Blood 2024:blood.2024024526. [PMID: 38657242 DOI: 10.1182/blood.2024024526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
In this retrospective study, CAR T-cells remained effective in relapsed/refractory LBCL patients after prior exposure to bispecific antibodies (BsAbs) targeting different antigens. These results are relevant to clinical practice, particularly given the increasing use of BsAbs in earlier treatment lines.
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Affiliation(s)
| | - Gloria Iacoboni
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain, Barcelona, Spain
| | | | | | - Josu Iraola-Truchuelo
- Vall d'Hebron University Hospital-Autonomous University of Barcelona, Barcelona, Spain
| | | | | | - Tom Fradon
- LYSARC, The Lymphoma Academic Research Organization, Pierre-Bénite, France
| | - Bastien Lesne
- LYSARC, The Lymphoma Academic Research Organization, Pierre-Bénite, France
| | - Mi Kwon
- Hospital G. Univ. Gregorio Marañon, Institute of Health Research Hospital Gregorio Marañon, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | - Eric Deconinck
- Centre Hospitalier Universitaire Besancon, Besancon, France
| | - Krimo Bouabdallah
- Service d'Hématologie clinique et Thérapie cellulaire, PESSAC, France
| | - Francesc Bosch
- Department of Hematology, Vall d'Hebron University Hospital, Experimental Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-1, Barcelona, Spain
| | - Pere Barba
- Hospital Vall d'Hebron, barcelona, Spain
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3
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Vic S, Thibert JB, Bachy E, Cartron G, Gastinne T, Morschhauser F, Le Bras F, Bouabdallah K, Despas F, Bay JO, Rubio MT, Mohty M, Casasnovas O, Choquet S, Castilla-Llorente C, Guidez S, Loschi M, Guffroy B, Carras S, Drieu La Rochelle L, Guillet M, Houot R. Transfusion needs after CAR T-cell therapy for large B-cell lymphoma: predictive factors and outcome (a DESCAR-T study). Blood Adv 2024; 8:1573-1585. [PMID: 38181767 PMCID: PMC10982963 DOI: 10.1182/bloodadvances.2023011727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024] Open
Abstract
ABSTRACT Chimeric antigen receptor (CAR) T-cells targeting CD19 have been approved for the treatment of relapse/refractory large B-cell lymphoma. Hematotoxicity is the most frequent CAR T-cell-related adverse event. Transfusion support is a surrogate marker of severe cytopenias. Transfusion affects patients' quality of life, presents specific toxicities, and is known to affect immunity through the so-called transfusion-related immunomodulation that may affect CAR T-cell efficacy. We analyzed data from 671 patients from the French DESCAR-T registry for whom exhaustive transfusion data were available. Overall, 401 (59.8%) and 378 (56.3%) patients received transfusion in the 6-month period before and after CAR T-cell infusion, respectively. The number of patients receiving transfusion and the mean number of transfused products increased during the 6-month period before CAR T-cell infusion, peaked during the first month after infusion (early phase), and decreased over time. Predictive factors for transfusion at the early phase were age >60 years, ECOG PS ≥2, treatment with axicabtagene ciloleucel, pre-CAR T-cell transfusions, and CAR-HEMATOTOX score ≥2. Predictive factors for late transfusion (between 1 and 6 months after infusion) were pre-CAR T-cell transfusions, CAR-HEMATOTOX score ≥2, ICANS ≥3 (for red blood cells [RBC] transfusion), and tocilizumab use (for platelets transfusion). Early transfusions and late platelets (but not RBC) transfusions were associated with a shorter progression-free survival and overall survival. Lymphoma-related mortality and nonrelapse mortality were both increased in the transfused population. Our data shed light on the mechanisms of early and late cytopenia and on the potential impact of transfusions on CAR T-cell efficacy and toxicity.
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Affiliation(s)
- Samuel Vic
- Department of Hematology, CHU de Rennes, Rennes, France
| | | | - Emmanuel Bachy
- Hematology Department, CHU Lyon Sud, Pierre Bénite, Lyon, France
| | | | | | | | - Fabien Le Bras
- Department of Hematology, Lymphoid Malignancies Unit, CHU Henri Mondor, Créteil, France
| | - Kamal Bouabdallah
- Hematology and Cellular Therapy Department, CHU Bordeaux, Bordeaux, France
| | - Fabien Despas
- Hematology and Internal Medicine Department, Institut Universitaire du Cancer-Oncopole, CHU de Toulouse, Toulouse, France
| | - Jacques-Olivier Bay
- Hematology and Cellular Therapy Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Marie-Thérèse Rubio
- Department of Hematology CHRU Nancy, biopole de l'Université de Lorraine, Nancy, France
| | - Mohamad Mohty
- Hematology Department Saint-Antoine Hospital, Sorbonne University, Paris, France
| | - Olivier Casasnovas
- Department of Hematology and INSERM 1231, CHU Dijon Bourgogne, Dijon, France
| | - Sylvain Choquet
- Hematology Department, hôpital de la Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | | | - Stéphanie Guidez
- Hematology and Cellular Therapy Department, CHU de Poitiers, Poitiers, France
| | - Michaël Loschi
- Hematology Department CHU de Nice, Université Cote d’Azur, Nice, France
| | - Blandine Guffroy
- Department of Hematology, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Sylvain Carras
- Institute for Advanced Biosciences, Hematology Department CHU Grenoble-Alpes, University Grenoble-Alpes, Grenoble, France
| | | | - Mathilde Guillet
- The Lymphoma Academic Research Organization, Statistics, Pierre-Bénite, France
| | - Roch Houot
- Department of Hematology, University Hospital of Rennes, UMR U1236 INSERM, University of Rennes, French Blood Establishment, Rennes, France
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4
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Ghesquières H, Krzisch D, Nicolas-Virelizier E, Kanoun S, Gac AC, Guidez S, Touati M, Laribi K, Morschhauser F, Bonnet C, Waultier-Rascalou A, Orsini-Piocelle F, André M, Fournier M, Morand F, Berriolo-Riedinger A, Burroni B, Damotte D, Traverse-Glehen A, Quittet P, Casasnovas O. The phase 2 LYSA study of prednisone, vinblastine, doxorubicin, and bendamustine for untreated Hodgkin lymphoma in older patients. Blood 2024; 143:983-995. [PMID: 37979133 DOI: 10.1182/blood.2023021564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/10/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023] Open
Abstract
ABSTRACT Older patients with classical Hodgkin lymphoma (cHL) require more effective and less toxic therapies than younger patients. In this multicenter, prospective, phase 2 study, we investigated a new firstline therapy regimen comprising 6 cycles of prednisone (40 mg/m2, days 1-5), vinblastine (6 mg/m2, day 1), doxorubicin (40 mg/m2, day 1), and bendamustine (120 mg/m2, day 1) (PVAB regimen) every 21 days for patients with newly diagnosed cHL aged ≥61 years with an advanced Ann Arbor stage. A Mini Nutritional Assessment score ≥17 was the cutoff value for patients aged ≥70 years. The primary end point was the complete metabolic response (CMR) rate after 6 cycles. The median age of the 89 included patients was 68 years (range, 61-88 years), with 35 patients (39%) aged ≥70 years. Seventy-eight patients (88%) completed the 6 cycles. The toxicity rate was acceptable, with a 20% rate of related serious adverse events. CMR was achieved by 69 patients (77.5%; 95% confidence interval [CI], 67-86). After a median follow-up of 42 months, 31 patients progressed or relapsed (35%), and 24 died (27%) from HL (n = 11), toxicity during treatment (n = 4), secondary cancers (n = 6), or other causes (n = 3). The 4-year progression-free survival (PFS) and overall survival rates were 50% and 69%, respectively. Multivariate analysis showed that liver involvement (P = .001), lymphopenia (P = .001), CRP (P = .0005), and comedications (P = .003) were independently associated with PFS. The PVAB regimen yielded a high CMR rate with acceptable toxicity. Over long-term follow-up, survival end points were influenced by unrelated lymphoma events. This trial was registered at www.clinicaltrials.gov as #NCT02414568 and at EudraCT as 2014-001002-17.
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Affiliation(s)
- Hervé Ghesquières
- Department of Hematology, Hopital Lyon Sud, Claude Bernard Lyon 1 University, Pierre Benite, France
| | - Daphné Krzisch
- Department of Hematology, Assistance Publique Hopitaux de Paris, Hopital Saint Louis, Paris, France
| | | | - Salim Kanoun
- Department of Hematology, Cancer Research Center of Toulouse, Team 9, INSERM Unité Mixte de Recherche 1037, Toulouse, France
| | - Anne Claire Gac
- Department of Hematology, Institut d'Hematologie de Basse Normandie, Caen, France
| | - Stéphanie Guidez
- Hematology Department, Centre Hospitalier Universitaire, Poitiers, France
| | - Mohamed Touati
- Department of Hematology, Hôpital Dupuytren, Centre Hospitalier Universitaire, Limoges, France
| | - Kamel Laribi
- Hematology Department, Centre Hospitalier, Le Mans, France
| | - Franck Morschhauser
- Department of Hematology, Centre Hospitalier Universitaire Lille, Universite de Lille, ULR 7365 Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | | | | | | | - Marc André
- Department of Hematology, Centre Hospitalier Universitaire, Université Catholique de Louvain Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Marguerite Fournier
- Department of Statistics, Lymphoma Study Association Clinical Research, Hopital Lyon Sud, Pierre Benite, France
| | - Fabienne Morand
- Department of Statistics, Lymphoma Study Association Clinical Research, Hopital Lyon Sud, Pierre Benite, France
| | | | - Barbara Burroni
- Department of Pathology, Université de Paris Cité, Centre de Recherche des Cordeliers UMRS U1138 et GH Paris Centre APHP, Paris, France
| | - Diane Damotte
- Department of Pathology, Université de Paris Cité, Centre de Recherche des Cordeliers UMRS U1138 et GH Paris Centre APHP, Paris, France
| | | | - Philippe Quittet
- Department of Hematology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Olivier Casasnovas
- Department of Hematology, University Hospital F. Mitterrand and INSERM Unité Mixte de Recherche 1231, Dijon, France
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5
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Dartigeas C, Quinquenel A, Ysebaert L, Dilhuydy MS, Anglaret B, Slama B, Le Du K, Tardy S, Tchernonog E, Orfeuvre H, Voillat L, Guidez S, Malfuson JV, Dupuis S, Deslandes M, Feugier P, Leblond V. Final results on effectiveness and safety of Ibrutinib in patients with chronic lymphocytic leukemia from the non-interventional FIRE study. Ann Hematol 2024:10.1007/s00277-024-05666-3. [PMID: 38443660 DOI: 10.1007/s00277-024-05666-3] [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: 12/26/2023] [Accepted: 02/15/2024] [Indexed: 03/07/2024]
Abstract
We conducted an observational study (FIRE) to understand the effectiveness and safety outcomes of ibrutinib in patients with chronic lymphocytic leukemia (CLL) in France, after a maximum follow-up of five years. Patients were included according to the French marketing authorization in 2016 (i.e. patients with relapsed or refractory CLL or to previously untreated CLL patients with deletion 17p and/or tumor protein p53 mutations unsuitable for chemoimmunotherapy) and could have initiated ibrutinib more than 30 days prior their enrolment in the study (i.e. retrospective patients) or between 30 days before and 14 days after their enrolment (i.e. prospective patients). The results showed that in the effectiveness population (N = 388), the median progression-free survival (PFS) was 53.1 (95% CI: 44.5-60.5) months for retrospective patients and 52.9 (95% CI: 40.3-60.6) months for prospective patients and no difference was shown between the PFS of patients who had at least one dose reduction versus the PFS of patients without dose reduction (p = 0.7971 for retrospective and p = 0.3163 for prospective patients). For both retrospective and prospective patients, the median overall survival was not reached. The most frequent treatment-emergent adverse event of interest was infections (57.6% retrospective; 71.4% prospective). A total of 14.6% of the retrospective patients and 22.4% of the prospective patients had an adverse event leading to death. Our findings on effectiveness were consistent with other studies and the fact that patients with dose reductions had similar PFS than patients without dose reduction is reassuring. No additional safety concerns than those already mentioned in previous studies could be noticed.Trial registration ClinicalTrials.gov, NCT03425591. Registered 1 February 2018 - Retrospectively registered.
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Affiliation(s)
- Caroline Dartigeas
- Hématologie et Thérapie Cellulaire, CHRU Hôpitaux de Tours, 2 Boulevard Tonnellé, 37044, Tours Cedex 9, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Véronique Leblond
- AP-HP Hôpital de La Pitié-Salpêtrière, Paris La Sorbonne, Paris, France
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6
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Camus V, Thieblemont C, Gaulard P, Cheminant M, Casasnovas RO, Ysebaert L, Damaj GL, Guidez S, Pica GM, Kim WS, Lim ST, Andre M, Gutiérrez N, Penarrubia MJ, Staber PB, Trotman J, Hüttmann A, Stefoni V, Tucci A, Fogarty P, Farhat H, Abraham J, Abarah W, Belmecheri F, Ribrag V, Delfau-Larue MH, Cottereau AS, Itti E, Li J, Delarue R, de Leval L, Morschhauser F, Bachy E. Romidepsin Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone Versus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone in Patients With Previously Untreated Peripheral T-Cell Lymphoma: Final Analysis of the Ro-CHOP Trial. J Clin Oncol 2024:JCO2301687. [PMID: 38364196 DOI: 10.1200/jco.23.01687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 02/18/2024] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.The primary analysis of the Ro-CHOP phase III randomized controlled trial (ClinicalTrials.gov identifier: NCT01796002) established that romidepsin (Ro) plus cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) did not yield an increased efficacy compared with CHOP alone as first-line treatment of peripheral T-cell lymphoma. We report the planned final analysis 5 years after the last patient enrolled. With a median follow-up of 6 years, median progression-free survival (PFS) was 12.0 months compared with 10.2 months (hazard ratio [HR], 0.79 [95% CI, 0.62 to 1.005]; P = .054), while median overall survival was 62.2 months (35.7-86.6 months) and 43.8 months (30.1-70.2 months; HR, 0.88 [95% CI, 0.68 to 1.14]; P = .324) in the Ro-CHOP and CHOP arms, respectively. In an exploratory analysis, the median PFS in the centrally reviewed follicular helper T-cell lymphoma subgroup was significantly longer in the Ro-CHOP arm (19.5 v 10.6 months, HR, 0.703 [95% CI, 0.502 to 0.985]; P = .039). Second-line treatments were given to 251 patients with a median PFS2 and OS2 after relapse or progression of 3.3 months and 11.5 months, respectively. Within the limits of highly heterogeneous second-line treatments, no specific regimen seemed to provide superior disease control. However, a potential benefit was observed with brentuximab vedotin in association with chemotherapy even after excluding anaplastic large-cell lymphoma subtype or after adjusting for histology and international prognostic index in a multivariate model (HR for PFS, 0.431 [95% CI, 0.238 to 0.779]; P = .005).
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Affiliation(s)
- Vincent Camus
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | | | - Philippe Gaulard
- Department of Pathology and InsermU955, University Hospital Henri Mondor, Créteil, France
| | - Morgane Cheminant
- Service d'Hematologie adultes, Hopital Universitaire Necker Enfants Malades, AP-HP, Paris, France
| | | | | | | | | | - Gian Matteo Pica
- Department of Hematology, Centre Hospitalier Métropole Savoie Chambéry, Chambéry, France
| | | | | | - Marc Andre
- Department of Hematology, CHU UCL Namur, Yvoir, Belgium
| | - Norma Gutiérrez
- Hospital Universitario de Salamanca, IBSAL, CIBERONC, Salamanca, Spain
| | | | - Philipp B Staber
- Division of Hematology, Department of Medicine I, Medical University Vienna, Vienna, Austria
| | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Concord, Australia
| | - Andreas Hüttmann
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | | | - Patrick Fogarty
- Biostatistics Department, LYSARC, Hôpital Lyon-Sud, Pierre-Bénite, France
| | - Hassan Farhat
- Department of Oncology-Hematology, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Julie Abraham
- Department of Hematology, Centre Hospitalo-universitaire (CHU) Dupuytren, Limoges, France
| | - Wajed Abarah
- Department of Hematology, Grand Hôpital de l'Est Francilien, Meaux, France
| | - Fatiha Belmecheri
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Vincent Ribrag
- Department of Hematology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | - Anne-Ségolène Cottereau
- Department of Nuclear Medicine, Cochin Hospital, AP-HP, Paris Cité University, Paris, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, CHU Henri Mondor, Créteil, France
| | - Ju Li
- Bristol Myers Squibb Company, Princeton, NJ
| | - Richard Delarue
- Service d'Hematologie adultes, Hopital Universitaire Necker Enfants Malades, AP-HP, Paris, France
| | - Laurence de Leval
- Institute of Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Franck Morschhauser
- Univ. Lille, CHU Lille, ULR 7365-GRITA-Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Emmanuel Bachy
- Hospices Civils De Lyon, Lyon, France
- Claude Bernard Lyon 1 University, Lyon, France
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7
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Ghesquières H, Cherblanc F, Belot A, Micon S, Bouabdallah KK, Esnault C, Fornecker LM, Thokagevistk K, Bonjour M, Bijou F, Haioun C, Morineau N, Ysebaert L, Damaj G, Tessoulin B, Guidez S, Morschhauser F, Thiéblemont C, Chauchet A, Gressin R, Jardin F, Fruchart C, Labouré G, Fouillet L, Lionne-Huyghe P, Bonnet A, Lebras L, Amorim S, Leyronnas C, Olivier G, Guieze R, Houot R, Launay V, Drénou B, Fitoussi O, Detourmignies L, Abraham J, Soussain C, Lachenal F, Pica GM, Fogarty P, Cony-Makhoul P, Bernier A, Le Guyader-Peyrou S, Monnereau A, Boissard F, Rossi C, Camus V. Challenges for quality and utilization of real-world data for diffuse large B-cell lymphoma in REALYSA, a LYSA cohort. Blood Adv 2024; 8:296-308. [PMID: 37874913 PMCID: PMC10824688 DOI: 10.1182/bloodadvances.2023010798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/05/2023] [Accepted: 10/01/2023] [Indexed: 10/26/2023] Open
Abstract
ABSTRACT Real-world data (RWD) are essential to complement clinical trial (CT) data, but major challenges remain, such as data quality. REal world dAta in LYmphoma and Survival in Adults (REALYSA) is a prospective noninterventional multicentric cohort started in 2018 that included patients newly diagnosed with lymphoma in France. Herein is a proof-of-concept analysis on patients with first-line diffuse large B-cell lymphoma (DLBCL) to (1) evaluate the capacity of the cohort to provide robust data through a multistep validation process; (2) assess the consistency of the results; and (3) conduct an exploratory transportability assessment of 2 recent phase 3 CTs (POLARIX and SENIOR). The analysis population comprised 645 patients with DLBCL included before 31 March 2021 who received immunochemotherapy and for whom 3589 queries were generated, resulting in high data completeness (<4% missing data). Median age was 66 years, with mostly advanced-stage disease and high international prognostic index (IPI) score. Treatments were mostly rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone (R-CHOP 75%) and reduced dose R-CHOP (13%). Estimated 1-year event-free survival (EFS) and overall survival rates were 77.9% and 90.0%, respectively (median follow-up, 9.9 months). Regarding transportability, when applying the CT's main inclusion criteria (age, performance status, and IPI), outcomes seemed comparable between patients in REALYSA and standard arms of POLARIX (1-year progression-free survival 79.8% vs 79.8%) and SENIOR (1-year EFS, 64.5% vs 60.0%). With its rigorous data validation process, REALYSA provides high-quality RWD, thus constituting a platform for numerous scientific purposes. The REALYSA study was registered at www.clinicaltrials.gov as #NCT03869619.
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Affiliation(s)
- Hervé Ghesquières
- Department of Hematology, Hopital Lyon Sud, Claude Bernard Lyon 1 University, Pierre Benite, France
| | - Fanny Cherblanc
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Aurélien Belot
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | | | - Krimo K. Bouabdallah
- Hematology and Cell Therapy Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Luc-Matthieu Fornecker
- Institut de Cancérologie Strasbourg Europe (ICANS) and University of Strasbourg, Strasbourg, France
| | | | - Maxime Bonjour
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Fontanet Bijou
- Department of Hematology, Institut Bergonie, Bordeaux, France
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Assistante Publique Hôpitaux de Paris APHP, Hopital Henri Mondor, Creteil, France
| | - Nadine Morineau
- Department of Hematology, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Loïc Ysebaert
- Institut universitaire du cancer de Toulouse Oncopole, Toulouse, France
| | - Gandhi Damaj
- Hematology Institute of Basse Normandie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Benoit Tessoulin
- Department of Hematology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Stéphanie Guidez
- Department of Hematology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Franck Morschhauser
- Department of Hematology, Universite de Lille, Centre Hospitalier Universitaire de Lille, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Catherine Thiéblemont
- Université Paris Cité, Assistante Publique Hôpitaux de Paris, Hôpital Saint-Louis, Service d’Hémato-Oncologie, Paris, France
| | - Adrien Chauchet
- Department of Hematology, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Rémy Gressin
- Department of Hematology, Centre Hospitalier Universitaire de Grenoble, Institute for Advanced Biosciences, INSERM U1209/CNRS UMR 5309/Grenoble Alpes University, Grenoble, France
| | - Fabrice Jardin
- Department of Clinical Hematology, INSERM U1245 Unit, Centre Henri Becquerel, Rouen, France
| | | | - Gaëlle Labouré
- Deparment of Hematology, Centre Hospitalier de Libourne, Libourne, France
| | - Ludovic Fouillet
- Department of Hematology, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
| | | | - Antoine Bonnet
- Department of Hematology, Centre Hospitalier de Bretagne Atlantique, Vannes, France
| | - Laure Lebras
- Department of Hematology, Leon Berard Cancer Center, Lyon, France
| | - Sandy Amorim
- Department of Hematology, Hopital Saint Vincent de Paul, Lille, France
| | - Cécile Leyronnas
- Department of Hematology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Gaelle Olivier
- Department of Hematology, Centre Hospitalier de Niort, Niort, France
| | - Romain Guieze
- Department of Hematology, Centre Hospitalier Universitaire de Clermont Ferrand, Clermont Ferrand, France
| | - Roch Houot
- Department of Hematology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Vincent Launay
- Department of Hematology, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Bernard Drénou
- Department Hematology, Groupe Hospitalier Mulhouse Sud Alsace, Mulhouse, France
| | - Olivier Fitoussi
- Department of Hematology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | - Julie Abraham
- Department of Hematology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Carole Soussain
- Department of Hematology, Institut Curie, Saint-Cloud, France
| | - Florence Lachenal
- Department of Hematology, Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France
| | - Gian Matteo Pica
- Department of Hematology, Centre Hospitalier Metropole Savoie, Chambery, France
| | - Patrick Fogarty
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Pascale Cony-Makhoul
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Adeline Bernier
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Sandra Le Guyader-Peyrou
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonié, University of Bordeaux, Inserm, Team EPICENE, Bordeaux, France
| | - Alain Monnereau
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonié, University of Bordeaux, Inserm, Team EPICENE, Bordeaux, France
| | | | - Cédric Rossi
- Department of Hematology, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
| | - Vincent Camus
- Department of Clinical Hematology, INSERM U1245 Unit, Centre Henri Becquerel, Rouen, France
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8
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Lemoine J, Bachy E, Cartron G, Beauvais D, Gastinne T, Di Blasi R, Rubio MT, Guidez S, Mohty M, Casasnovas RO, Joris M, Castilla-Llorente C, Haioun C, Hermine O, Loschi M, Carras S, Bories P, Fradon T, Herbaux C, Sesques P, Le Gouill S, Morschhauser F, Thieblemont C, Houot R. Nonrelapse mortality after CAR T-cell therapy for large B-cell lymphoma: a LYSA study from the DESCAR-T registry. Blood Adv 2023; 7:6589-6598. [PMID: 37672383 PMCID: PMC10641092 DOI: 10.1182/bloodadvances.2023010624] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023] Open
Abstract
CD19 chimeric antigen receptor (CAR) T cells can induce prolonged remissions and potentially cure a significant proportion of patients with relapsed/refractory large B-cell lymphomas. However, some patients may die of causes unrelated to lymphoma after CAR T-cell therapy. To date, little is known about the nonrelapse mortality (NRM) after CAR T-cell therapy. Using the French DESCAR-T registry, we analyzed the incidence and causes of NRM and identified risk factors of NRM. We report on 957 patients who received standard-of-care axicabtagene ciloleucel (n = 598) or tisagenlecleucel (n = 359) between July 2018 and April 2022, in 27 French centers. With a median follow-up of 12.4 months, overall NRM occurred in 48 patients (5.0% of all patients): early (before day 28 after infusion) in 9 patients (0.9% of all patients and 19% of overall NRM), and late (on/after day 28 after infusion) in 39 patients (4.1% of all patients and 81% of overall NRM). Causes of overall NRM were distributed as follows: 56% infections (29% with non-COVID-19 and 27% with COVID-19), 10% cytokine release syndromes, 6% stroke, 6% cerebral hemorrhage, 6% second malignancies, 4% immune effector cell associated neurotoxicities, and 10% deaths from other causes. We report risk factors of early NRM and overall NRM. In multivariate analysis, both diabetes and elevated ferritin level at lymphodepletion were associated with an increased risk of overall NRM. Our results may help physicians in patient selection and management in order to reduce the NRM after CAR T-cell therapy.
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Affiliation(s)
- Jean Lemoine
- Department of Hematology, CHU de Rennes, Rennes, France
| | - Emmanuel Bachy
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Benite, France
| | | | | | | | - Roberta Di Blasi
- Department of Hemato-Oncology, Saint Louis Hospital, Paris, France
| | | | | | - Mohamad Mohty
- Department of Hematology, Saint Antoine Hospital, Paris, France
| | | | - Magalie Joris
- Department of Hematology, CHU d’Amiens, Amiens, France
| | - Cristina Castilla-Llorente
- Department of Hematology and INSERM, UMR 1030, Université Paris-Saclay, Gustave Roussy Cancer Campus Grand Paris, Paris, France
| | - Corinne Haioun
- Lymphoid Malignancies, Henri Mondor Hospital, Créteil, France
| | | | | | - Sylvain Carras
- Department of Hematology, CHU de Grenoble, Grenoble, France
| | - Pierre Bories
- Hematology Laboratory, Onco-occitanie Network, Toulouse University Institute of Cancer-Oncopole, Toulouse, France
| | - Tom Fradon
- LYSARC, The Lymphoma Academic Research Organisation, Lyon-Sud Hospital, Pierre-Benite, France
| | - Charles Herbaux
- Department of Hematology, CHU de Montpellier, Montpellier, France
| | - Pierre Sesques
- Department of Hematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Benite, France
| | | | | | | | - Roch Houot
- Department of Hematology, CHU de Rennes, Rennes, France
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9
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Machet A, Poudou C, Tomowiak C, Gastinne T, Gardembas M, Systchenko T, Moya N, Debiais C, Levy A, Gruchet C, Sabirou F, Noel S, Bouyer S, Leleu X, Delwail V, Guidez S. Hodgkin lymphoma and female fertility: a multicenter study in women treated with doxorubicin, bleomycin, vinblastine, and dacarbazine. Blood Adv 2023; 7:3978-3983. [PMID: 36129842 PMCID: PMC10410126 DOI: 10.1182/bloodadvances.2021005557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 10/21/2021] [Accepted: 11/14/2021] [Indexed: 11/20/2022] Open
Abstract
Preservation of fertility has become a growing concern in young females with Hodgkin lymphoma (HL). However, the rate of pregnancy after the current most frequently prescribed ABVD (doxorubicin [Adriamycin], bleomycin, vinblastine, and darcarbazine) chemotherapy for HL has rarely been studied. In this study, we aim to determine the impact of ABVD on the fertility of women treated for HL. We conducted a noninterventional, multicenter study of female patients of childbearing age who were treated for HL. Two healthy apparied women nonexposed to chemotherapy (our controls) were assigned for each patient. Fertility was assessed by the number of pregnancies and births after HL treatment. Sixty-seven patients were included. The median age at diagnosis was 24.4 years (range, 16-43). HL was a localized disease for 68.7%. Of all the patients, 53.7% started at least 1 pregnancy after treatment vs 54.5% of the controls (P = .92). Of all the patients who desired children, 81% had at least 1 pregnancy. Patients treated with ABVD did not have a longer median time to pregnancy (4.8 years in the group of patients and 6.8 years for controls). Across patients, there were 58 pregnancies and 48 births (ratio, 1:2) and 136 pregnancies and 104 births (ratio, 1:3) for the control cohort. No increase in obstetric or neonatal complications has been reported in HL in our study. The number of pregnancies, births, and the time to start a pregnancy in young women treated with ABVD for HL is not different from that of controls. Therefore, females with HL treated with ABVD should be reassured regarding fertility.
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Affiliation(s)
- Antoine Machet
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Caroline Poudou
- Department of Medically Assisted Procreation, University Hospital of Poitiers, Poitiers, France
| | - Cécile Tomowiak
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Thomas Gastinne
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Martine Gardembas
- Department of Hematology, University Hospital of Angers, Angers, France
| | - Thomas Systchenko
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Niels Moya
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Celine Debiais
- Department of Anatomopathology, University Hospital of Poitiers, Poitiers, France
| | - Anthony Levy
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Cécile Gruchet
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Florence Sabirou
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Stéphanie Noel
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Sabrina Bouyer
- Department of Cytology, University Hospital of Poitiers, Poitiers, France
| | - Xavier Leleu
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Vincent Delwail
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
| | - Stéphanie Guidez
- Department of Hematology and Cell Therapy, University Hospital of Poitiers, Poitiers, France
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10
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Al Tabaa Y, Casasnovas RO, Baillet C, Bachy E, Nicolas-Virelizier E, Schiano De colella JM, Bailly C, Kanoun S, Guidez S, Gyan E, Gressin R, Morineau N, Ysebaert L, Le Gouill S, Tilly H, Houot R, Morschhauser F, Cartron G, Herbaux C. Prospective evaluation of lymphoma response to immunomodulatory therapy criteria in GATA trial from the LYSA group. Blood Adv 2023; 7:3735-3738. [PMID: 37067945 PMCID: PMC10368761 DOI: 10.1182/bloodadvances.2023009911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023] Open
Affiliation(s)
| | - Rene Oliver Casasnovas
- Hematology, Le Centre Hospitalier Universitaire (CHU) François Mitterrand, Dijon, France
| | | | | | | | | | | | - Salim Kanoun
- Team 9, Centre de Recherche Clinique de Toulouse, Toulouse, France
| | | | - Emmanuel Gyan
- Hematology and cell therapy Department, CIC INSERM U1415, CHU Tours, University of Tours, Tours, France
| | | | | | | | | | - Herve Tilly
- Hematology, Centre Henri Becquerel, Rouen, France
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11
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Bachy E, Le Gouill S, Di Blasi R, Sesques P, Manson G, Cartron G, Beauvais D, Roulin L, Gros FX, Rubio MT, Bories P, Bay JO, Llorente CC, Choquet S, Casasnovas RO, Mohty M, Guidez S, Joris M, Loschi M, Carras S, Abraham J, Chauchet A, Drieu La Rochelle L, Deau-Fischer B, Hermine O, Gastinne T, Tudesq JJ, Gat E, Broussais F, Thieblemont C, Houot R, Morschhauser F. A real-world comparison of tisagenlecleucel and axicabtagene ciloleucel CAR T cells in relapsed or refractory diffuse large B cell lymphoma. Nat Med 2022; 28:2145-2154. [PMID: 36138152 PMCID: PMC9556323 DOI: 10.1038/s41591-022-01969-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 47.0] [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: 03/29/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022]
Abstract
Axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) have both demonstrated impressive clinical activity in relapsed/refractory (R/R) diffuse large B cell lymphoma (DLBCL). In this study, we analyzed the outcome of 809 patients with R/R DLBCL after two or more previous lines of treatment who had a commercial chimeric antigen receptor (CAR) T cells order for axi-cel or tisa-cel and were registered in the retrospective French DESCAR-T registry study ( NCT04328298 ). After 1:1 propensity score matching (n = 418), the best overall response rate/complete response rate (ORR/CRR) was 80%/60% versus 66%/42% for patients treated with axi-cel compared to tisa-cel, respectively (P < 0.001 for both ORR and CRR comparisons). After a median follow-up of 11.7 months, the 1-year progression-free survival was 46.6% for axi-cel and 33.2% for tisa-cel (hazard ratio (HR) = 0.61; 95% confidence interval (CI), 0.46-0.79; P = 0.0003). Overall survival (OS) was also significantly improved after axi-cel infusion compared to after tisa-cel infusion (1-year OS 63.5% versus 48.8%; HR = 0.63; 95% CI, 0.45-0.88; P = 0.0072). Similar findings were observed using the inverse probability of treatment weighting statistical approach. Grade 1-2 cytokine release syndrome was significantly more frequent with axi-cel than with tisa-cel, but no significant difference was observed for grade ≥3. Regarding immune effector cell-associated neurotoxicity syndrome (ICANS), both grade 1-2 and grade ≥3 ICANS were significantly more frequent with axi-cel than with tisa-cel. In conclusion, our matched comparison study supports a higher efficacy and also a higher toxicity of axi-cel compared to tisa-cel in the third or more treatment line for R/R DLBCL.
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Affiliation(s)
- Emmanuel Bachy
- Hematology Department, Hospices Civils de Lyon, Pierre Bénite, Lyon, France.
- International Center for Infectiology Research (CIRI), Inserm U1111, Lyon, France.
| | | | | | - Pierre Sesques
- Hematology Department, Hospices Civils de Lyon, Pierre Bénite, Lyon, France
| | | | - Guillaume Cartron
- Hematology Department, CHU de Montpellier & UMR-CNRS, Montpellier, France
| | | | - Louise Roulin
- Hematology Department, Hôpital Henri Mondor, Créteil, France
| | | | | | - Pierre Bories
- Hematology Department, CHU de Toulouse, Toulouse, France
| | | | | | - Sylvain Choquet
- Hematology Department, Hôpital de la Pitié Salpêtrière & AP-HP Sorbonne Université, Paris, France
| | | | - Mohamad Mohty
- Hematology Department, Hôpital Saint Antoine & Sorbonne University & Inserm UMRs 938, Paris, France
| | | | | | | | - Sylvain Carras
- Hematology Department, CHU de Grenoble & University Grenoble-Alpes, Institute for Advanced Biosciences, La Tronche, France
| | - Julie Abraham
- Hematology Department, CHU de Limoges, Limoges, France
| | | | | | | | | | | | | | - Elodie Gat
- Biostatistics Department, LYSARC, Lyon, France
| | | | | | - Roch Houot
- Hematology Department, CHU de Rennes, Rennes, France
| | - Franck Morschhauser
- Hematology Department, CHU de Lille, Lille, France
- Lille University, ULR 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
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12
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Morschhauser F, Nastoupil L, Feugier P, Schiano de Colella JM, Tilly H, Palomba ML, Bachy E, Fruchart C, Libby EN, Casasnovas RO, Flinn IW, Haioun C, Maisonneuve H, Ysebaert L, Bartlett NL, Bouabdallah K, Brice P, Ribrag V, Le Gouill S, Daguindau N, Guidez S, Pica GM, García-Sancho AM, López-Guillermo A, Larouche JF, Ando K, Gomes da Silva M, André M, Kalung W, Sehn LH, Izutsu K, Cartron G, Gkasiamis A, Crowe R, Xerri L, Fowler NH, Salles G. Six-Year Results From RELEVANCE: Lenalidomide Plus Rituximab (R 2) Versus Rituximab-Chemotherapy Followed by Rituximab Maintenance in Untreated Advanced Follicular Lymphoma. J Clin Oncol 2022; 40:3239-3245. [PMID: 35947804 PMCID: PMC9553375 DOI: 10.1200/jco.22.00843] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported. The RELEVANCE trial (ClinicalTrials.gov identifier: NCT01650701) showed that lenalidomide plus rituximab (R2) provided similar efficacy to rituximab plus chemotherapy (R-chemo) in patients with advanced-stage, previously untreated follicular lymphoma (FL). We report the second interim analysis of the RELEVANCE trial after 6 years of follow-up. Patients with previously untreated grade 1-3a FL were assigned 1:1 to R2 or R-chemo, followed by rituximab maintenance. Coprimary end points were complete response (confirmed/unconfirmed) at week 120 and progression-free survival (PFS). At median follow-up of 72 months, 6-year PFS was 60% and 59% for R2 and R-chemo, respectively (hazard ratio = 1.03 [95% CI, 0.84 to 1.27]). Six-year overall survival was estimated to be 89% in both groups. Median PFS and overall survival were not reached in either group. Overall response after progression was 61% and 59%, and 5-year estimated survival rate after progression was 69% and 74% in the R2 and R-chemo groups, respectively. The transformation rate per year in the R2 and R-chemo groups was 0.68% and 0.45%, and secondary primary malignancies occurred in 11% and 13% (P = .34), respectively. No new safety signals were observed. R2 continues to demonstrate comparable, durable efficacy and safety versus R-chemo in previously untreated patients with FL and provides an acceptable chemo-free alternative.
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Affiliation(s)
| | | | | | | | | | | | - Emmanuel Bachy
- Hospices Civils de Lyon and Claude Bernard Lyon 1 Université, Lyon, France
| | | | | | | | - Ian W Flinn
- Sarah Cannon Research Institute and Tennessee Oncology, Nashville, TN
| | | | | | - Loic Ysebaert
- Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | | | | | | | | | | | | | | | | | | | | | | | - Kiyoshi Ando
- Tokai University School of Medicine, Kanagawa, Japan
| | | | | | | | - Laurie H Sehn
- BC Cancer Centre for Lymphoid Cancer, Vancouver, Canada
| | - Koji Izutsu
- National Cancer Center Hospital, Tokyo, Japan
| | | | | | | | - Luc Xerri
- Institut Paoli Calmettes, CRCM, AMU, Marseille, France
| | - Nathan H Fowler
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gilles Salles
- Memorial Sloan Kettering Cancer Center, New York, NY
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13
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Bachy E, Le Gouill S, Sesques P, Di Blasi R, Guillaume M, Cartron G, Beauvais D, Roulin L, Gros FX, Rubio MT, Bories P, Bay JO, Castilla Llorente C, Choquet S, Casasnovas RO, Mothy M, Guidez S, Joris M, Loschi M, Carras S, Abraham J, Chauchet A, Drieu La Rochelle L, Zerbit J, Hermine O, Gastinne T, Tudesq JJ, Gat E, Broussais F, Thieblemont C, Houot R, Morschhauser F. S260: A MATCHED COMPARISON OF TISAGENLECLEUCEL AND AXICABTAGENE CILOLEUCEL CAR T CELLS IN RELAPSED OR REFRACTORY DIFFUSE LARGE B-CELL LYMPHOMA: A REAL-LIFE LYSA STUDY FROM THE FRENCH DESCAR-T REGISTRY. Hemasphere 2022. [DOI: 10.1097/01.hs9.0000843932.28141.4d] [Citation(s) in RCA: 1] [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: 11/25/2022] Open
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14
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Bachy E, Camus V, Thieblemont C, Sibon D, Casasnovas RO, Ysebaert L, Damaj G, Guidez S, Pica GM, Kim WS, Lim ST, André M, García-Sancho AM, Penarrubia MJ, Staber PB, Trotman J, Hüttmann A, Stefoni V, Re A, Gaulard P, Delfau-Larue MH, de Leval L, Meignan M, Li J, Morschhauser F, Delarue R. Romidepsin Plus CHOP Versus CHOP in Patients With Previously Untreated Peripheral T-Cell Lymphoma: Results of the Ro-CHOP Phase III Study (Conducted by LYSA). J Clin Oncol 2022; 40:242-251. [PMID: 34843406 DOI: 10.1200/jco.21.01815] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/14/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Romidepsin, a histone deacetylase inhibitor, has demonstrated activity in relapsed or refractory peripheral T-cell lymphoma (PTCL) as a single agent. Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) therapy is widely used as first-line treatment of PTCL; however, it has limited efficacy. Results from a phase Ib and II study showed the feasibility of combining romidepsin with CHOP (Ro-CHOP). METHODS This study is a randomized phase III study of Ro-CHOP versus CHOP in adult patients with previously untreated PTCL. All patients received CHOP in 3-week cycles for six cycles. Romidepsin, 12 mg/m2, was administered intravenously over a 4-hour period on days 1 and 8 of each 3-week cycle for six cycles. The primary end point was progression-free survival (PFS) according to International Working Group 1999 criteria. RESULTS Between January 2013 and December 2017, 421 patients were enrolled (Ro-CHOP, n = 211; CHOP, n = 210). The median PFS for Ro-CHOP versus CHOP was 12.0 months (95% CI, 9.0 to 25.8) versus 10.2 months (95% CI, 7.4 to 13.2) with a hazard ratio of 0.81 (P = .096). In the Ro-CHOP versus CHOP arms, the median overall survival was 51.8 versus 42.9 months and the objective response rate was 63% versus 60% with complete response plus unconfirmed complete response rates of 41% versus 37% (P > .1 in all comparisons), respectively. Grade 3 or 4 treatment-emergent adverse events occurring in ≥ 30% of patients in the Ro-CHOP arm included thrombocytopenia (50% v 10% in the Ro-CHOP v CHOP arms, respectively), neutropenia (49% v 33%), anemia (47% v 17%), and leukopenia (32% v 20%). CONCLUSION The addition of romidepsin to CHOP did not improve PFS, response rates, nor overall survival and increased the frequency for grade ≥ 3 treatment-emergent adverse events. Ro-CHOP does not represent a significant advance in the standard of care for patients with previously untreated PTCL.
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Affiliation(s)
- Emmanuel Bachy
- Hospices Civils de Lyon, Lyon, France
- Claude Bernard Lyon 1 University, Lyon, France
| | - Vincent Camus
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | - Catherine Thieblemont
- APHP, Hôpital Saint-Louis, Service d'hémato-oncologie, DMU DHI, Université de Paris, Paris, France
| | - David Sibon
- Service d'Hématologie adultes, Hopital Universitaire Necker Enfants Malades, AP-HP, Paris, France
| | | | | | - Gandhi Damaj
- Hematology Institute, University Hospital, Normandy University, School of Medicine, Caen, France
| | | | - Gian Matteo Pica
- Department of Hematology, Centre Hospitalier Métropole Savoie Chambéry, Chambéry, France
| | | | | | - Marc André
- Department of Hematology, CHU UCL Namur, Yvoir, Belgium
| | | | | | - Philipp B Staber
- Division of Hematology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Judith Trotman
- Concord Repatriation General Hospital, University of Sydney, Concord, Australia
| | - Andreas Hüttmann
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center Essen, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Alessandro Re
- Hematology Division, Spedali Civili di Brescia, Brescia, Italy
| | - Philippe Gaulard
- Department of Pathology and Inserm U955, University Hospital Henri Mondor, Créteil, France
| | | | - Laurence de Leval
- Institute of Pathology, Lausanne University Hospital, Lausanne University, Lausanne, Switzerland
| | - Michel Meignan
- LYSA Imaging, APHP, Hôpital Henri Mondor, Université Paris Est, Créteil, France
| | - Ju Li
- Bristol Myers Squibb Company, Princeton, NJ
| | - Franck Morschhauser
- Univ. Lille, CHU Lille, ULR 7365 - GRITA - Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Richard Delarue
- Service d'Hématologie adultes, Hopital Universitaire Necker Enfants Malades, AP-HP, Paris, France
- Celgene, a Bristol Myers Squibb Company, Boudry, Switzerland
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15
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Bobin A, Gruchet C, Guidez S, Gardeney H, Nsiala Makunza L, Vonfeld M, Lévy A, Cailly L, Sabirou F, Systchenko T, Moya N, Leleu X. Novel Non-Immunologic Agents for Relapsed and Refractory Multiple Myeloma: A Review Article. Cancers (Basel) 2021; 13:5210. [PMID: 34680358 PMCID: PMC8534104 DOI: 10.3390/cancers13205210] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 12/28/2022] Open
Abstract
Novel treatments are needed to address the lack of options for patients with relapsed or refractory multiple myeloma. Even though immunotherapy-based treatments have revolutionized the field in recent years, offering new opportunities for patients, there is still no curative therapy. Thus, non-immunologic agents, which have proven effective for decades, are still central to the treatment of multiple myeloma, especially for advanced disease. Building on their efficacy in myeloma, the development of proteasome inhibitors and immunomodulatory drugs has been pursued, and has led to the emergence of a novel generation of agents (e.g., carfilzomib, ixazomib, pomalidomide). The use of alkylating agents is decreasing in most treatment regimens, but melflufen, a peptide-conjugated alkylator with a completely new mechanism of action, offers interesting opportunities. Moreover, with the identification of novel targets, new drug classes have entered the myeloma armamentarium, such as XPO1 inhibitors (selinexor), HDAC inhibitors (panobinostat), and anti-BCL-2 agents (venetoclax). New pathways are still being explored, especially the possibility of a mutation-driven strategy, as biomarkers and targeted treatments are increasing. Though multiple myeloma is still considered incurable, the treatment options are expanding and are progressively becoming more diverse, largely because of the continuous development of non-immunologic agents.
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Affiliation(s)
- Arthur Bobin
- Department of Hematology, CIC 1402, University Hospital, 86000 Poitiers, France; (C.G.); (S.G.); (H.G.); (L.N.M.); (M.V.); (A.L.); (L.C.); (F.S.); (T.S.); (N.M.); (X.L.)
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16
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Bobin A, Kyheng M, Guidez S, Gruchet-Merouze C, Richez V, Duhamel A, Karlin L, Kolb B, Tiab M, Araujo C, Meuleman N, Malfuson JV, Bourquard P, Lenain P, Perrot A, Roussel M, Jaccard A, Petillon MO, Belhadj-Merzoug K, Chretien ML, Fontan J, Rodon P, Schmitt A, Offner F, Voillat L, Cereja S, Kuhnowski F, Rigaudeau S, Decaux O, Humbrecht-Kraut C, Frayfer J, Fitoussi O, Roos-Weil D, Eisenmann JC, Dorvaux V, Voog EG, Moreau P, Avet-Loiseau H, Hulin C, Facon T, Leleu X. Carfilzomib maintenance in newly diagnosed non-transplant eligible multiple myeloma. Leukemia 2021; 36:881-884. [PMID: 34650225 DOI: 10.1038/s41375-021-01415-x] [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] [Received: 05/18/2021] [Revised: 08/31/2021] [Accepted: 09/06/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Arthur Bobin
- Service d'onco-hématologie, and Inserm 1402, CHU, Poitiers, France
| | - Maéva Kyheng
- Univ., ULR 2694-METRICS, CHRU, Lille, France.,Département de Biostatistiques, CHRU, Lille, France
| | - Stéphanie Guidez
- Service d'onco-hématologie, and Inserm 1402, CHU, Poitiers, France
| | | | - Valentine Richez
- Service d'Hématologie Clinique-Greffe de Moelle, CHU, Nice, France
| | - Alain Duhamel
- Univ., ULR 2694-METRICS, CHRU, Lille, France.,Département de Biostatistiques, CHRU, Lille, France
| | | | - Brigitte Kolb
- Service d'Hématologie, Hôpital Robert Debré, CHU, Reims, France
| | - Mourad Tiab
- Service d'Hématologie, CH, La Roche sur Yon, France
| | | | - Nathalie Meuleman
- Service d'Hématologie, Institut Jules Bordet, Université Libre, Bruxelles, Belgium
| | | | | | - Pascal Lenain
- Service d'Hématologie, Centre Henri Becquerel, CNLCC, Rouen, France
| | | | | | | | | | | | | | | | | | - Anna Schmitt
- Service d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Fritz Offner
- Department Clinical Hematology, University Hospital, Ghent, Belgium
| | | | | | | | | | | | | | | | | | - Damien Roos-Weil
- Service d'Hématologie, Hôpital de la Pitié Salpétrière, Paris, France
| | | | | | | | | | | | - Cyrille Hulin
- Service d'Hématologie, Hôpital Haut Leveque, CHU, Bordeaux, France
| | | | | | - Xavier Leleu
- Service d'onco-hématologie, and Inserm 1402, CHU, Poitiers, France.
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17
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Levy A, Guidez S, Debiais C, Princet I, Bouyer S, Dindinaud E, Delwail V, Systchenko T, Moya N, Gruchet C, Sabirou F, Bobin A, Gardeney H, Nsiala L, Cailly L, Olivier G, Motard C, Fleck E, Corby A, Roul C, Denis G, Dieval C, Leleu X, Tomowiak C. Waldenström macroglobulinemia and relationship to immune deficiency. Leuk Lymphoma 2021; 62:2665-2670. [PMID: 34085595 DOI: 10.1080/10428194.2021.1907379] [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] [Indexed: 10/21/2022]
Abstract
Primary or secondary immune deficiency (ID) is a risk factor, although rare, to develop Waldenström macroglobulinemia (WM). We aimed to better understand the incidence of this occurrence in the real-life and the outcome of either entity. We conducted a review of 194 WM in the Poitou-Charentes registry and identified 7 (3.6%) with a prior history of ID. Across the 7 WM with ID, 4 progressed to active WM disease and required treatment for WM with a median time between WM diagnosis and the first treatment of 1.5 years (range 0-3). The median time from ID to WM occurrence was 8 years (1-18). WM could develop from ID, although a rare event. Our first action was to systematically decrease immunosuppression with long-term control of ID. Half of indolent WM remained indolent despite ID and for remaining WM none appeared of poor risk WM.
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Affiliation(s)
- Anthony Levy
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Stéphanie Guidez
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Céline Debiais
- Laboratoire d'Anatomie Pathologie, CHU, Poitiers, France
| | | | | | | | - Vincent Delwail
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Thomas Systchenko
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Niels Moya
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Cécile Gruchet
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Florence Sabirou
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Arthur Bobin
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Hélène Gardeney
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Laly Nsiala
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Laura Cailly
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | | | | | | | - Anne Corby
- Service d'Onco-Hématologie, La Rochelle, France
| | | | | | | | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
| | - Cécile Tomowiak
- Service d'Hématologie et Thérapie Cellulaire, CHU and Inserm, Poitiers, France
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18
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Al Tabaa Y, Casasnovas O, Baillet C, Bachy E, Virelizier EN, Schiano de Colella JM, Bailly C, Kanoun S, Guidez S, Gyan E, Gressin R, Morineau N, Ysebaert L, Le Gouill S, Tilly H, Houot R, Morschhauser F, Cartron G, Herbaux C. PROSPECTIVE EVALUATION OF LYMPHOMA RESPONSE TO IMMUNOMODULATORY THERAPY CRITERIA (LYRIC) IN GATA TRIAL FROM THE LYSA GROUP. Hematol Oncol 2021. [DOI: 10.1002/hon.157_2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Y. Al Tabaa
- Scintidoc Nuclear Medicine Center Montpellier France
| | | | | | | | | | | | - C. Bailly
- CHU Nantes Nuclear Medicine Nantes France
| | - S. Kanoun
- Oncopole Toulouse Nuclear Medicine Toulouse France
| | - S. Guidez
- CHU Poitiers Hematology Poitiers France
| | - E. Gyan
- CHU Tours Hematology Tours France
| | | | - N. Morineau
- CHD Vendée Hematology La Roche sur Yon France
| | - L. Ysebaert
- Oncopole Toulouse Hematology Toulouse France
| | | | - H. Tilly
- Centre Henri Becquerel Hematology Rouen France
| | - R. Houot
- CHU Rennes Hematology Rennes France
| | | | - G. Cartron
- CHU Montpellier Hematology Montpellier France
| | - C. Herbaux
- CHU Montpellier Hematology Montpellier France
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19
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Herbaux C, Schiano de Colella JM, Thieblemont C, Guidez S, Ysebaert L, Tilly H, Gouill S, Houot R, Bachy E, Laurent C, Damaj G, Feugier P, Morineau N, Tarte K, Morschhauser F, Cartron G. ATEZOLIZUMAB + OBINUTUZUMAB + VENETOCLAX IN PATIENTS WITH RELAPSED OR REFRACTORY MARGINAL ZONE LYMPHOMA: PRIMARY ANALYSIS OF A PHASE 2 TRIAL FROM LYSA. Hematol Oncol 2021. [DOI: 10.1002/hon.57_2880] [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: 11/07/2022]
Affiliation(s)
- C. Herbaux
- CHU Montpellier, Hématologie Clinique Montpellier France
| | | | | | | | | | - H. Tilly
- CHB Unicancer, Hematology Rouen France
| | | | | | | | | | | | | | - N. Morineau
- CHD Vendée, Hematology La Roche sur Yon France
| | | | | | - G. Cartron
- CHU Montpellier, Hématologie Clinique Montpellier France
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20
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Cartron G, Bachy E, Guidez S, Gyan E, Gressin R, Morineau N, Sibon D, Casasnovas O, Le Gouill S, Tilly H, Ysebaert L, Schiano de Colella JM, Feugier P, Virelizier EN, Haioun C, Damaj G, Tarte K, Laurent C, Houot R, Thieblemont C, Morschhauser F, Herbaux C. ATEZOLIZUMAB + OBINUTUZUMAB + VENETOCLAX IN PATIENTS WITH RELAPSED OR REFRACTORY FOLLICULAR LYMPHOMA: PRIMARY ANALYSIS OF A PHASE 2 TRIAL FROM LYSA. Hematol Oncol 2021. [DOI: 10.1002/hon.22_2880] [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: 11/10/2022]
Affiliation(s)
- G. Cartron
- CHU Montpellier Hématologie Cliniqu Montpellier France
| | | | | | | | | | - N. Morineau
- CHD Vendée Hematology La Roche sur Yon France
| | | | | | | | - H. Tilly
- CHB Unicancer Hematology Rouen France
| | | | | | | | | | | | | | | | | | | | | | | | - C. Herbaux
- CHU Montpellier Hématologie Cliniqu Montpellier France
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21
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Ghesquières H, Rossi C, Cherblanc F, Le Guyader-Peyrou S, Bijou F, Sujobert P, Fabbro-Peray P, Bernier A, Belot A, Chartier L, Fornecker LM, Baldi I, Bouabdallah K, Laurent C, Oberic L, Morineau N, Le Gouill S, Morschhauser F, Haioun C, Damaj G, Guidez S, Labouré G, Fitoussi O, Lebras L, Gressin R, Salles G, Ysebaert L, Monnereau A. A French multicentric prospective prognostic cohort with epidemiological, clinical, biological and treatment information to improve knowledge on lymphoma patients: study protocol of the "REal world dAta in LYmphoma and survival in adults" (REALYSA) cohort. BMC Public Health 2021; 21:432. [PMID: 33653294 PMCID: PMC7927409 DOI: 10.1186/s12889-021-10433-4] [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] [Received: 10/06/2020] [Accepted: 02/12/2021] [Indexed: 12/24/2022] Open
Abstract
Background Age-adjusted lymphoma incidence rates continue to rise in France since the early 80’s, although rates have slowed since 2010 and vary across subtypes. Recent improvements in patient survival in major lymphoma subtypes at population level raise new questions about patient outcomes (i.e. quality of life, long-term sequelae). Epidemiological studies have investigated factors related to lymphoma risk, but few have addressed the extent to which socioeconomic status, social institutional context (i.e. healthcare system), social relationships, environmental context (exposures), individual behaviours (lifestyle) or genetic determinants influence lymphoma outcomes, especially in the general population. Moreover, the knowledge of the disease behaviour mainly obtained from clinical trials data is partly biased because of patient selection. Methods The REALYSA (“REal world dAta in LYmphoma and Survival in Adults”) study is a real-life multicentric cohort set up in French areas covered by population-based cancer registries to study the prognostic value of epidemiological, clinical and biological factors with a prospective 9-year follow-up. We aim to include 6000 patients over 4 to 5 years. Adult patients without lymphoma history and newly diagnosed with one of the following 7 lymphoma subtypes (diffuse large B-cell, follicular, marginal zone, mantle cell, Burkitt, Hodgkin, mature T-cell) are invited to participate during a medical consultation with their hematologist. Exclusion criteria are: having already received anti-lymphoma treatment (except pre-phase) and having a documented HIV infection. Patients are treated according to the standard practice in their center. Clinical data, including treatment received, are extracted from patients’ medical records. Patients’ risk factors exposures and other epidemiological data are obtained at baseline by filling out a questionnaire during an interview led by a clinical research assistant. Biological samples are collected at baseline and during treatment. A virtual tumor biobank is constituted for baseline tumor samples. Follow-up data, both clinical and epidemiological, are collected every 6 months in the first 3 years and every year thereafter. Discussion This cohort constitutes an innovative platform for clinical, biological, epidemiological and socio-economic research projects and provides an opportunity to improve knowledge on factors associated to outcome of lymphoma patients in real life. Trial registration 2018-A01332–53, ClinicalTrials.gov identifier: NCT03869619. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10433-4.
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Affiliation(s)
- Hervé Ghesquières
- Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France.
| | - Cédric Rossi
- CHU Dijon, 10 Boulevard Maréchal De Lattre De Tassigny, 21000, Dijon, France
| | - Fanny Cherblanc
- LYSARC, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | | | - Fontanet Bijou
- Bergonié Institute, 229 Cours de l'Argonne, 33076, Bordeaux, France
| | - Pierre Sujobert
- Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | | | - Adeline Bernier
- LYSARC, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Aurélien Belot
- LYSARC, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Loic Chartier
- LYSARC, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Luc-Matthieu Fornecker
- Cancerology Institute Strasbourg Europe, Avenue Molière, BP 428, 67098, Strasbourg, France
| | - Isabelle Baldi
- Inserm U1219 - EPICENE team, Université de Bordeaux, Bordeaux, France
| | | | - Camille Laurent
- Toulouse Research Center in Cancerology, 2 Avenue Hubert Curien, 31037, Toulouse, France
| | - Lucie Oberic
- IUCT Oncopole, 1 Avenue Irène Joliot Curie, 31100, Toulouse, France
| | - Nadine Morineau
- CHD Vendée, Boulevard Stéphane Moreau, 85000, La Roche-sur-Yon, France
| | | | | | - Corinne Haioun
- Henri Mondor Hospital, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Gandhi Damaj
- Hematology Institute of Basse Normandie, 6 Avenue Côte de Nacre, 14033, Caen, France
| | | | - Gaëlle Labouré
- CH Libourne, 112 Rue de la Marne, 33500, Libourne, France
| | - Olivier Fitoussi
- Polyclinique Bordeaux Nord Aquitaine, 15-35 Rue Claude Boucher, 33300, Bordeaux, France
| | - Laure Lebras
- Léon Bérard Center, 28 rue Laennec, 69008, Lyon, France
| | - Rémy Gressin
- CHU Grenoble, Bd de la Chantourne BP 217, 38043, Grenoble, France
| | - Gilles Salles
- Hospices Civils de Lyon, Lyon Sud Hospital, 165 Chemin du Grand Revoyet, 69310, Pierre-Bénite, France
| | - Loïc Ysebaert
- IUCT Oncopole, 1 Avenue Irène Joliot Curie, 31100, Toulouse, France
| | - Alain Monnereau
- Inserm U1219 - EPICENE team, Université de Bordeaux, Bordeaux, France
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Bobin A, Liuu E, Moya N, Gruchet C, Sabirou F, Lévy A, Gardeney H, Nsiala L, Cailly L, Guidez S, Tomowiak C, Systchenko T, Javaugue V, Durand G, Leleu X, Puyade M. Multiple Myeloma: An Overview of the Current and Novel Therapeutic Approaches in 2020. Cancers (Basel) 2020; 12:E2885. [PMID: 33050025 PMCID: PMC7600346 DOI: 10.3390/cancers12102885] [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] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/03/2020] [Accepted: 10/05/2020] [Indexed: 01/06/2023] Open
Abstract
The survival rate of multiple myeloma (MM) patients has drastically increased recently as a result of the wide treatment options now available. Younger patients truly benefit from these innovations as they can support more intensive treatment, such as autologous stem cell transplant or multiple drug association (triplet, quadruplet). The emergence of immunotherapy allowed new combinations principally based on monoclonal anti-CD38 antibodies for these patients. Still, the optimal induction treatment has not been found yet. While consolidation is still debated, maintenance treatment is now well acknowledged to prolong survival. Lenalidomide monotherapy is the only drug approved in that setting, but many innovations are expected. Older patients, now logically named not transplant-eligible, also took advantage of these breakthrough innovations as most of the recent drugs have a more acceptable safety profile than previous cytotoxic agents. For this heterogenous subgroup, geriatric assessment has become an essential tool to identify frail patients and provide tailored strategies. At relapse, options are now numerous, especially for patients who were not treated with lenalidomide, or not refractory at least. Concerning lenalidomide refractory patients, approved combinations are lacking, but many trials are ongoing to fill that space. Moreover, innovative therapeutics are increasingly being developed with modern immunotherapy, such as chimeric antigen receptor T-cells (CAR-T cells), bispecific antibodies, or antibody-drug conjugates. For now, these treatments are usually reserved to heavily pre-treated patients with a poor outcome. MM drug classes have tremendously extended from historical alkylating agents to current dominant associations with proteasome inhibitors, immunomodulatory agents, and monoclonal anti-CD38/anti SLAMF7 antibodies. Plus, in only a couple of years, several new classes will enter the MM armamentarium, such as cereblon E3 ligase modulators (CELMoDs), selective inhibitors of nuclear export, and peptide-drug conjugates. Among the questions that will need to be answered in the years to come is the position of these new treatments in the therapeutic strategy, as well as the role of minimal residual disease-driven strategies which will be a key issue to elucidate. Through this review, we chose to enumerate and comment on the most recent advances in MM therapeutics which have undergone major transformations over the past decade.
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Affiliation(s)
- Arthur Bobin
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Evelyne Liuu
- Department of Geriatric Medicine, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France;
| | - Niels Moya
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Cécile Gruchet
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Florence Sabirou
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Anthony Lévy
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Hélène Gardeney
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Laly Nsiala
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Laura Cailly
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Stéphanie Guidez
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Cécile Tomowiak
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Thomas Systchenko
- Department of Internal Medicine, Châtellerault Hospital Center, 1 rue du Dr Luc Montagnier, 86106 Châtellerault, France;
| | - Vincent Javaugue
- Department of Nephrology, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France;
| | - Géraldine Durand
- Department of Rhumatology, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France;
| | - Xavier Leleu
- Department of Hematology, and CIC1402 INSERM Unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France; (A.B.); (N.M.); (C.G.); (F.S.); (A.L.); (H.G.); (L.N.); (L.C.); (S.G.); (C.T.); (X.L.)
| | - Mathieu Puyade
- Department of Internal Medicine, and CIC1402 INSERM unit, Poitiers University Hospital, 2 Rue de la Milétrie, 86021 Poitiers, France
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Le Gouill S, Beldi-Ferchiou A, Alcantara M, Cacheux V, Safar V, Burroni B, Guidez S, Gastinne T, Canioni D, Thieblemont C, Maisonneuve H, Bodet-Milin C, Houot R, Oberic L, Bouabdallah K, Bescond C, Damaj G, Jaccard A, Daguindau N, Moreau A, Tilly H, Ribrag V, Delfau-Larue MH, Hermine O, Macintyre E. Molecular response after obinutuzumab plus high-dose cytarabine induction for transplant-eligible patients with untreated mantle cell lymphoma (LyMa-101): a phase 2 trial of the LYSA group. Lancet Haematol 2020; 7:e798-e807. [PMID: 32971036 DOI: 10.1016/s2352-3026(20)30291-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Obinutuzumab monotherapy has shown promising efficacy in mantle cell lymphoma. We aimed to investigate the activity of obinutuzumab plus DHAP (dexamethasone, high-dose cytarabine, and cisplatin), measured by minimal residual disease quantitative (q)PCR status in the bone marrow after four cycles. METHODS LyMa-101 was a prospective, open-label, single-arm, phase 2 trial. Participants were enrolled from 28 hospitals in France. Newly diagnosed patients with mantle cell lymphoma (aged 18 to <66 years) who were eligible for autologous stem-cell transplantation received four cycles of obinutuzumab plus DHAP (obinutuzumab 1000 mg/m2 intravenously on days 1, 8, and 15 at cycle 1 and day 1 at cycles 2, 3, and 4; dexamethasone 40 mg intravenously on days 1-4, cytarabine 2 g/m2 intravenously every 12 h on day 1, and according to local investigator, cisplatin 100 mg/m2 by continuous infusion over 24 h on day 1 or carboplatin area under the curve 5 or oxaliplatin 130 mg/m2) every 21 days before transplantation, and 3 years of obinutuzumab (1000 mg/m2 every 2 months) maintenance followed by minimal residual disease-based obinutuzumab on-demand maintenance. The primary outcome was minimal residual disease negativity in the bone marrow after four cycles of obinutuzumab plus DHAP at the end of induction, measured in the efficacy set (all minimal residual disease-informative [bone marrow or peripheral blood] patients who received at least one dose of obinutuzumab). Obinutuzumab plus DHAP was considered effective if bone marrow minimal residual disease negativity was 70% or more by intention to treat. The trial is closed to recruitment and registered with ClinicalTrials.gov, NCT02896582. FINDINGS 86 patients were enrolled between Nov 29, 2016, and May 2, 2018. 81 patients completed induction, 73 underwent autologous stem-cell transplantation, and 69 started maintenance therapy. 55 (75%) of 73 patients in the efficacy set reached minimal residual disease negativity in bone marrow at end of induction. According to the protocol definition, 18 (25%) of 73 patients in the efficacy set were minimal residual disease-positive: 12 patients who were minimal residual disease-positive in the bone marrow, plus two patients who progressed during induction, and four patients who did not have minimal residual disease assessment. The most common grade 3-4 treatment-emergent adverse events were anaemia (grade 3, 26 [31%] of 85 patients; grade 4, three [4%] of 85 patients) and neutropenia (grade 3, 13 [15%] of 85 patients; grade 4, 32 [38%] of 85 patients). 58 serious adverse events occurred during the induction phase. There were no treatment-related deaths. INTERPRETATION Obinutuzumab plus DHAP is a well tolerated regimen and has good activity for inducing minimal residual disease negativity in the bone marrow of transplant-eligible patients with mantle cell lymphoma. Obinutuzumab plus DHAP has potential activity as induction chemotherapy, with bone marrow minimal residual disease negativity potentially predicting long-term disease control. FUNDING Roche SAS.
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Affiliation(s)
- Steven Le Gouill
- Service d'hématologie clinique, CHU de Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France.
| | - Asma Beldi-Ferchiou
- Biological Haematology and Immunology Department, Groupe Hospitalier Mondor, Assistance Publique Hôpitaux de Paris, INSERM U955, Paris, France
| | - Marion Alcantara
- Onco-Haematology, Université de Paris, Hôpital and Institut Necker-Enfants Malades, Assistance-Publique-Hôpitaux de Paris, INSERM U1151, Paris, France
| | - Victoria Cacheux
- Service d'hématologie clinique du CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Violaine Safar
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | | | - Stéphanie Guidez
- Service d'hématologie clinique du CHU de Poitiers, Poitiers, France
| | - Thomas Gastinne
- Service d'hématologie clinique, CHU de Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Danielle Canioni
- Onco-Haematology, Université de Paris, Hôpital and Institut Necker-Enfants Malades, Assistance-Publique-Hôpitaux de Paris, INSERM U1151, Paris, France
| | - Catherine Thieblemont
- Service d'hémato-oncologie, L'hôpital Saint-Louis AP-HP, Université de Paris, Paris, France
| | | | - Caroline Bodet-Milin
- Service de médecine nucléaire, CHU de Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Roch Houot
- Service d'Hématologie Clinique, CHU de Rennes, Université de Rennes, INSERM U1236, Rennes, France
| | - Lucie Oberic
- Service d'hématologie, IUC Toulouse Oncopole, Toulouse, France
| | | | | | - Ghandi Damaj
- Haematology Institute, Normandy University School of Medicine, Caen, France
| | | | | | - Anne Moreau
- Service d'anatomo-pathologie, CHU de Nantes, INSERM CRCINA Nantes-Angers, NeXT Université de Nantes, Nantes, France
| | - Hervé Tilly
- Département d'Hématologie and U1245, Centre Henri Becquerel, Université de Rouen, Rouen, France
| | - Vincent Ribrag
- Département des Innovations Thérapeutiques et Essais Précoces, Université Paris-Saclay, Département d'Hématologie, Gustave Roussy, Université Paris-Saclay, Paris, France
| | - Marie-Hélène Delfau-Larue
- Biological Haematology and Immunology Department, Groupe Hospitalier Mondor, Assistance Publique Hôpitaux de Paris, INSERM U955, Paris, France
| | - Olivier Hermine
- Department of Adult Haematology, Université de Paris, Hôpital Necker-Enfants Malades, Assistance-Publique, Hôpitaux de Paris, Imagine Institute, INSERM U1153, Paris, France
| | - Elizabeth Macintyre
- Onco-Haematology, Université de Paris, Hôpital and Institut Necker-Enfants Malades, Assistance-Publique-Hôpitaux de Paris, INSERM U1151, Paris, France
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Allouchery M, Tomowiak C, Guidez S, Delwail V, Delaunay P, Lafay-Chebassier C, Salvo F, Pérault-Pochat MC. Patterns of use and safety of ibrutinib in real-life practice. Br J Clin Pharmacol 2020; 87:895-904. [PMID: 32559327 DOI: 10.1111/bcp.14440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS To provide real-life data on patterns of use and safety of ibrutinib. METHODS A cohort study including all patients initiating ibrutinib between 21 November 2014 and 21 November 2018, and followed for 1 year was conducted. Patient characteristics, ibrutinib use and adverse drug reactions (ADRs) were collected from medical records. Kaplan-Meier analysis estimated the probability of developing ibrutinib-associated serious ADRs (SADRs) with a 95% confidence interval (CI). A Cox proportional hazards model was used to investigate factors associated with SADR occurrence. RESULTS In total, 102 patients were included in the study. The median age was 70.3 years (interquartile range 64.7-75.6), the male/female gender ratio was 2.9. Almost half the patients (47.1%) were prescribed ibrutinib for chronic lymphocytic leukaemia (CLL). Forty-three patients (42.1%) permanently discontinued ibrutinib in the first year, mostly for progression (51.2%) or ADRs (32.6%). Forty-eight patients (47.1%) experienced at least one ibrutinib-associated SADR. Haematological, infectious and vascular disorders were the most frequent SADRs. The probability of developing ibrutinib-associated SADR was 35.1% (95% CI 26.3-45.7%) at 3 months, 44.8% (35.2%; 55.8%) at 6 months and 54.3% (44.0%; 65.2%) at 12 months. Age ≥80 years (hazard ratio [HR] 2.03; 95% CI 1.02-4.05) and CLL (HR 1.81; 95% CI 1.01-3.25) were significantly associated with a higher risk of SADR occurrence. CONCLUSION This study found a high cumulative incidence of ibrutinib-associated SADRs within the first year of treatment. In view of the risk of SADR, patients aged ≥80 years or treated for CLL deserve special attention.
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Affiliation(s)
- Marion Allouchery
- Pharmacologie Clinique et Vigilances, CHU de Poitiers, Poitiers, France
| | - Cécile Tomowiak
- Onco-Hématologie et Thérapie Cellulaire, CHU de Poitiers, Poitiers, France.,INSERM CIC 1402, CHU de Poitiers, Poitiers, France
| | - Stéphanie Guidez
- Onco-Hématologie et Thérapie Cellulaire, CHU de Poitiers, Poitiers, France.,INSERM CIC 1402, CHU de Poitiers, Poitiers, France
| | - Vincent Delwail
- Onco-Hématologie et Thérapie Cellulaire, CHU de Poitiers, Poitiers, France.,INSERM CIC 1402, CHU de Poitiers, Poitiers, France
| | - Paul Delaunay
- Pharmacologie Clinique et Vigilances, CHU de Poitiers, Poitiers, France
| | - Claire Lafay-Chebassier
- Pharmacologie Clinique et Vigilances, CHU de Poitiers, Poitiers, France.,Laboratoire de Neurosciences Expérimentales et Cliniques, INSERM U1084, Université de Poitiers, Poitiers, France
| | - Francesco Salvo
- Bordeaux Population Health Research Center, Pharmacoepidemiology research team, INSERM U1219, Université de Bordeaux, Bordeaux, France.,Pharmacologie Médicale, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
| | - Marie-Christine Pérault-Pochat
- Pharmacologie Clinique et Vigilances, CHU de Poitiers, Poitiers, France.,Laboratoire de Neurosciences Expérimentales et Cliniques, INSERM U1084, Université de Poitiers, Poitiers, France
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25
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Systchenko T, Defossez G, Guidez S, Laurent C, Puyade M, Debiais-Delpech C, Dreyfus B, Machet A, Leleu X, Delwail V, Ingrand P. R-CHOP appears to be the best first-line treatment for second primary diffuse large B cell lymphoma: a cancer registry study. Ann Hematol 2020; 99:1605-1613. [PMID: 32451709 DOI: 10.1007/s00277-020-04100-8] [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: 12/04/2019] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Abstract
Second primary diffuse large B cell lymphoma (spDLBCL) is defined as a metachronous tumor occurring after a first primary cancer. To date, while R-CHOP is the standard first-line treatment for de novo DLBCL, no available data show that R-CHOP is the optimal treatment for spDLBCL. This exploratory study aimed to investigate treatment of spDLBCL. From 2008 to 2015, the Poitou-Charentes general cancer registry recorded 68 cases of spDLBCL ≤ 80 years old, having received a first-line treatment with either R-CHOP (78%) or other regimens (22%). Patients without R-CHOP have worse overall survival in univariate (HR 2.89 [1.33-6.24], P = 0.007) and multivariate (HR 2.98 [1.34-6.67], P = 0.008) analyses. Patients without R-CHOP more frequently had PS > 1 (67% vs. 28%, P = 0.007) and prior chemotherapy (60% vs. 26%, P = 0.02), which suggests that both of these factors influence a clinician's decision to not use R-CHOP. Prior chemotherapy had no prognostic impact in univariate and multivariate analyses; this result could call into question the risk-benefit balance of not using R-CHOP to prevent toxicity. In our study, one DLBCL out of ten occurred after a first primary cancer, and as regards de novo DLBCL, R-CHOP appeared to be the best first-line treatment. Larger series are needed to confirm these results.
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Affiliation(s)
- T Systchenko
- Poitou-Charentes General Cancer Registry, Université de Poitiers, 6 rue de la Milétrie, 86073, Poitiers Cedex 9, France. .,INSERM CIC 1402, CHU de Poitiers, Poitiers, France. .,Haematology Department, CHU de Poitiers, Poitiers, France.
| | - G Defossez
- Poitou-Charentes General Cancer Registry, Université de Poitiers, 6 rue de la Milétrie, 86073, Poitiers Cedex 9, France.,INSERM CIC 1402, CHU de Poitiers, Poitiers, France
| | - S Guidez
- INSERM CIC 1402, CHU de Poitiers, Poitiers, France.,Haematology Department, CHU de Poitiers, Poitiers, France
| | - C Laurent
- Anatomy-pathology Department, CHU de Toulouse, Réseau Lymphopath, Toulouse, France
| | - M Puyade
- Poitou-Charentes General Cancer Registry, Université de Poitiers, 6 rue de la Milétrie, 86073, Poitiers Cedex 9, France.,INSERM CIC 1402, CHU de Poitiers, Poitiers, France
| | | | - B Dreyfus
- Haematology Department, CHU de Poitiers, Poitiers, France
| | - A Machet
- Haematology Department, CHU de Poitiers, Poitiers, France
| | - X Leleu
- INSERM CIC 1402, CHU de Poitiers, Poitiers, France.,Haematology Department, CHU de Poitiers, Poitiers, France
| | - V Delwail
- INSERM CIC 1402, CHU de Poitiers, Poitiers, France.,Haematology Department, CHU de Poitiers, Poitiers, France
| | - P Ingrand
- Poitou-Charentes General Cancer Registry, Université de Poitiers, 6 rue de la Milétrie, 86073, Poitiers Cedex 9, France.,INSERM CIC 1402, CHU de Poitiers, Poitiers, France
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Van de Wyngaert Z, Nerich V, Fouquet G, Chrétien ML, Caillot D, Azar N, Garderet L, Lenain P, Macro M, Bourhis JH, Belhocine R, Jaccard A, Karlin L, Bobin A, Moya N, Systchenko T, Gruchet C, Giraud C, Guidez S, Darras C, Princet I, Touzeau C, Moreau P, Hulin C, Deconinck E, Limat S, Leleu X. Cost and efficacy of peripheral stem cell mobilization strategies in multiple myeloma. Bone Marrow Transplant 2020; 55:2254-2260. [PMID: 32447348 DOI: 10.1038/s41409-020-0940-3] [Citation(s) in RCA: 5] [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] [Received: 12/09/2019] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/09/2022]
Abstract
Mobilization of peripheral blood stem cells (PBSC) can be performed using plerixafor, which is expensive, or high-dose cyclophosphamide (HDCy). We hypothesized that the overall cost of mobilization with plerixafor might not be greater if the cost of complication management was considered. We performed a cost analysis of these two strategies. This multicentric observational study recruited patients with myeloma who underwent a first PBSC mobilization. We considered direct medical costs, including hospitalization, mobilization agents, apheresis, and supportive treatments. We included 111 patients, 54 and 57 in the HDCy and plerixafor groups, respectively. Cost of mobilization with HDCy was 5097 ± 2982€ vs. 10958 ± 1789€ for plerixafor (p < 0.0001). Cost of agents used was 1287 ± 779€ vs. 6552 ± 509€, respectively (p = 0.0009). The mean number of days of hospitalization was 2 and 2.1 days, respectively (p = 0.035). All patients achieved the minimum PBSC collection target (p = 1.0); however, ASCT was performed with HDCy in 67% patients and with plerixafor in 86% (p = 0.02). Plerixafor mobilization incurred a greater cost, mostly due to the greater cost of the drug. Hospitalization length in the two groups was similar in our series. Interestingly, plerixafor appeared to be a very effective and safe mobilizing approach translating into a greater ASCT success.
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Affiliation(s)
- Zoé Van de Wyngaert
- CHU Lille, Service des Maladies du Sang, F-59000, Lille, France.,Hématologie et thérapie cellulaire, Hôpital Saint Antoine, APHP, Université Paris-Sorbonne, INSERM UMRs 938, Paris, France
| | - Virginie Nerich
- Department of Pharmacy, University Hospital of Besançon, Univ. Bourgogne Franche-Comté, Besançon, France.,INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | | | | | | | - Nabih Azar
- Hôpital Pitié Salpêtrière, Service d'Hématologie, F-75013, Paris, France
| | - Laurent Garderet
- Hématologie et thérapie cellulaire, Hôpital Saint Antoine, APHP, Université Paris-Sorbonne, INSERM UMRs 938, Paris, France.,Hôpital Pitié Salpêtrière, Service d'Hématologie, F-75013, Paris, France
| | | | | | | | - Ramdane Belhocine
- Hématologie et thérapie cellulaire, Hôpital Saint Antoine, APHP, Université Paris-Sorbonne, INSERM UMRs 938, Paris, France
| | - Arnaud Jaccard
- Hématologie clinique et thérapie cellulaire, CHU, Limoges, France
| | - Lionel Karlin
- Service d'Hématologie, Hospices Civils de Lyon, Lyon Sud, France
| | - Arthur Bobin
- Hematology and Inserm CIC 1402, CHU, Poitiers, France
| | - Niels Moya
- Hematology and Inserm CIC 1402, CHU, Poitiers, France
| | | | | | | | | | - Claire Darras
- Hematology and Inserm CIC 1402, CHU, Poitiers, France
| | | | - Cyrille Touzeau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | - Philippe Moreau
- Hematology Department, University Hospital Hotel-Dieu, Nantes, France
| | | | | | - Samuel Limat
- Department of Pharmacy, University Hospital of Besançon, Univ. Bourgogne Franche-Comté, Besançon, France.,INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Besançon, France
| | - Xavier Leleu
- Hematology and Inserm CIC 1402, CHU, Poitiers, France.
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Bobin A, Gardeney H, Sabirou F, Gruchet C, Lévy A, Nsiala L, Cailly L, Tomowiak C, Torregrosa J, Guidez S, Leleu X. The Role of Immunotherapy in Non-transplant Eligible Multiple Myeloma. Front Oncol 2020; 10:676. [PMID: 32435618 PMCID: PMC7218111 DOI: 10.3389/fonc.2020.00676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 04/09/2020] [Indexed: 01/21/2023] Open
Abstract
As the global population is aging and survival in multiple myeloma (MM) is increasing, treating older MM patients, redefined as non-transplant eligible (NTE), is becoming more frequent. Yet, treating these patients remains a real challenge especially because of a marked heterogeneity in the population and an increased susceptibility to treatment toxicity. Indeed, the balance between efficacy and safety must be considered at all time throughout the treatment history for these patients. Therefore, younger and older patients were historically treated in a very different way, even though the safety profile of most anti-myeloma drugs has drastically improved over the years. The emergence of immunotherapy (IT) has largely widened the therapeutic options available in MM and above all has allowed a therapy at optimal dose, and therefore optimal activity, for all patients independently of their frailty features, with no increase in safety issues. Among the novel anti-myeloma IT-based agents, anti-CD38 monoclonal antibodies (mAbs) are now becoming the new backbone of treatment for NTE patients, in association with lenalidomide and dexamethasone. Moreover, several new IT-based drugs are currently being developed and investigated either alone or in association; such as new anti-CD38 mAbs, anti-CD38 mAbs with many different combinations, but also the CAR-T cells, bispecific T-cell engager (BiTEs), or antibody drug conjugate (ADC) targeting BCMA. One would expect that immunotherapy will ultimately change and even transform the MM landscape, even for elderly patients. Immunotherapy represents a shift in treatment paradigm in MM as it provides truly efficient drugs with a very favorable safety profile.
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Affiliation(s)
- Arthur Bobin
- Service d'Hématologie et Thérapie cellulaire, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Hélène Gardeney
- Service d'Hématologie et Thérapie cellulaire, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Florence Sabirou
- Service d'Hématologie et Thérapie cellulaire, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Cécile Gruchet
- Service d'Hématologie et Thérapie cellulaire, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Anthony Lévy
- Service d'Hématologie et Thérapie cellulaire, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Laly Nsiala
- Service d'Hématologie et Thérapie cellulaire, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Laura Cailly
- Service d'Hématologie et Thérapie cellulaire, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Cécile Tomowiak
- Service d'Hématologie et Thérapie cellulaire, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,Unité Inserm CIC 1402, Poitiers, France.,Université de Médecine et Pharmacie, Poitiers, France
| | - Jose Torregrosa
- Service d'Hématologie et Thérapie cellulaire, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,Unité Inserm CIC 1402, Poitiers, France.,Université de Médecine et Pharmacie, Poitiers, France
| | - Stéphanie Guidez
- Service d'Hématologie et Thérapie cellulaire, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,Unité Inserm CIC 1402, Poitiers, France.,Université de Médecine et Pharmacie, Poitiers, France
| | - Xavier Leleu
- Service d'Hématologie et Thérapie cellulaire, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,Unité Inserm CIC 1402, Poitiers, France.,Université de Médecine et Pharmacie, Poitiers, France
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Leleu X, Fouquet G, Richez V, Guidez S, Duhamel A, Machuron F, Karlin L, Kolb B, Tiab M, Araujo C, Meuleman N, Malfuson JV, Bourquard P, Lenain P, Roussel M, Jaccard A, Pétillon MO, Belhadj-Merzoug K, Lepeu G, Chrétien ML, Fontan J, Rodon P, Schmitt A, Offner F, Voillat L, Cereja S, Kuhnowski F, Rigaudeau S, Decaux O, Humbrecht-Kraut C, Frayfer J, Fitoussi O, Roos-Weil D, Eisenmann JC, Dorvaux V, Voog EG, Attal M, Moreau P, Avet-Loiseau H, Hulin C, Facon T. Carfilzomib Weekly plus Melphalan and Prednisone in Newly Diagnosed Transplant-Ineligible Multiple Myeloma (IFM 2012-03): A Phase I Trial. Clin Cancer Res 2019; 25:4224-4230. [PMID: 31053600 DOI: 10.1158/1078-0432.ccr-18-3642] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/18/2019] [Accepted: 04/29/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Carfilzomib is a novel generation proteasome inhibitor. The Carmysap trial demonstrated that twice-weekly KMP (carfilzomib, melphalan, prednisone) might challenge the MPV (melphalan, prednisone, bortezomib) standard. We sought to study KMP weekly, allowing to increase carfilzomib's dose with maintained efficacy and improved safety profile. PATIENTS AND METHODS IFM2012-03, a phase I multicenter study of KMP weekly in elderly patients with newly diagnosed multiple myeloma (eNDMM), aimed to determine the MTD of carfilzomib. Carfilzomib was given intravenously at 36, 45, 56, and 70 mg/m2/day on days 1, 8, 15, and 22 with melphalan and prednisone, for nine 35-day induction cycles, followed by carfilzomib maintenance for 1 year. Three dose-limiting toxicities (DLT) determined MTD at the lower dose. RESULTS Thirty eNDMMs were treated, 6 per cohort at 36, 45, and 56 mg/m2 and 12 at 70 mg/m². There was one DLT at 36 mg/m2 (lymphopenia), one at 45 mg/m2 (lysis syndrome), two at 56 mg/m2 (cardiac insufficiency and febrile neutropenia), and two at 70 mg/m2 (vomiting and elevated liver enzymes). The safety profile was acceptable; however, specific attention must be paid to the risk of cardiovascular events, especially for elderly patients. The overall response rate was 93.3%, with 46.6% complete response. CONCLUSIONS The MTD dose of carfilzomib was 70 mg/m2 in this KMP weekly study in eNDMM. Response rates, and especially CR rate, were remarkable in this population, and would benefit from being assessed in a larger-scale study. The IFM2012-03 study demonstrated that the MTD of carfilzomib weekly is 70 mg/m2 in eNDMM, and 56 mg/m2 for patients older than 75 years. Carfilzomib used weekly in combination has a good efficacy and safety profile in eNDMM.
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Affiliation(s)
- Xavier Leleu
- Hematology and Inserm CIC 1402, CHU Poitiers, France.
| | - Guillemette Fouquet
- Institut Imagine, Inserm U1163 - CNRS ERL8254, Hôpital Necker, Paris, France
| | | | | | - Alain Duhamel
- Université de Lille, CHRU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
| | - François Machuron
- Université de Lille, CHRU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
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Javaugue V, Debiais-Delpech C, Nouvier M, Gand E, Chauvet S, Ecotiere L, Desport E, Goujon JM, Delwail V, Guidez S, Tomowiak C, Leleu X, Jaccard A, Rioux-Leclerc N, Vigneau C, Fermand JP, Touchard G, Thierry A, Bridoux F. Clinicopathological spectrum of renal parenchymal involvement in B-cell lymphoproliferative disorders. Kidney Int 2019; 96:94-103. [PMID: 30987838 DOI: 10.1016/j.kint.2019.01.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 11/20/2018] [Accepted: 01/04/2019] [Indexed: 01/25/2023]
Abstract
The clinicopathological characteristics of kidney infiltration in B-cell lymphoproliferative disorders remain poorly described. We retrospectively studied 52 adults with biopsy-proven malignant B-cell kidney infiltration, including Waldenström's macroglobulinemia (n=21), chronic lymphocytic leukemia (n=11), diffuse large B-cell lymphoma (DLBCL) (n=8), other lymphoma (n=11), and multiple myeloma (n=1). Kidney disease varied according to the underlying lymphoproliferative disorder. In DLBCL, malignant kidney infiltration was prominent, resulting in acute kidney injury (AKI, 75%) and kidney enlargement (88%). In the other types, associated immunoglobulin-related nephropathy (most commonly AL amyloidosis) was more common (45%), and chronic kidney disease with proteinuria was the primary presentation. All patients received chemotherapy. Over a median follow-up of 31 months, 20 patients died and 21 reached end-stage kidney disease. Renal response, achieved in 25 patients (48%), was associated with higher overall survival (97 vs. 37 months in non-renal responders). In univariate analysis, percentage of sclerotic glomeruli, kidney enlargement, and complete hematological response at 6 months were predictive of renal response. In multivariate analysis, concomitant immunoglobulin-related nephropathy was the sole independent predictor of poor renal outcome. In conclusion, clinical presentation of renal lymphomatous infiltration depends on the nature of the underlying lymphoproliferative disorder. In DLBCL, massive renal infiltration manifests with enlarged kidneys and AKI, and the diagnosis primarily relies on lymph node biopsy. In other B-cell lymphoproliferative disorders, the clinicopathological spectrum is more heterogeneous, with a high frequency of immunoglobulin-related nephropathy that may affect renal outcome; thus kidney biopsy is required for early diagnosis and prognostic assessment.
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Affiliation(s)
- Vincent Javaugue
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; CNRS UMR 7276, INSERM UMR 1262, Université de Limoges, Limoges, France; INSERM CIC 1402, Centre Hospitalier Universitaire, Poitiers, France.
| | - Céline Debiais-Delpech
- Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Mathilde Nouvier
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Elise Gand
- INSERM CIC 1402, Centre Hospitalier Universitaire, Poitiers, France
| | - Sophie Chauvet
- INSERM UMR 1138, Centre de Recherche des Cordeliers, Complement and Diseases Team, Paris, France; Assistance Publique Hôpitaux de Paris, Department of Nephrology, Hôpital Européen Georges Pompidou, Paris, France
| | - Laure Ecotiere
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Estelle Desport
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Jean-Michel Goujon
- Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Vincent Delwail
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Stéphanie Guidez
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Cécile Tomowiak
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Xavier Leleu
- Department of Hematology, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
| | - Arnaud Jaccard
- Department of Hematology, Centre Hospitalier Universitaire, Université de Limoges, Limoges, France
| | | | - Cécile Vigneau
- Department of Nephrology, Centre Hospitalier Universitaire, Rennes, France; CNRS UMR 6290, Université Rennes 1, France
| | | | - Guy Touchard
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; Department of Pathology and Ultrastructural Pathology, Centre Hospitalier Universitaire, Poitiers, France
| | - Antoine Thierry
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; INSERM UMR 1082, Centre Hospitalier Universitaire, Poitiers, France
| | - Frank Bridoux
- Department of Nephrology and Renal Transplantation, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France; CNRS UMR 7276, INSERM UMR 1262, Université de Limoges, Limoges, France; INSERM CIC 1402, Centre Hospitalier Universitaire, Poitiers, France
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30
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Chantepie SP, Garciaz S, Tchernonog E, Peyrade F, Larcher M, Diouf M, Fornecker L, Houot R, Gastinne T, Soussain C, Malak S, Lemal R, Delette C, Ibrahim A, Gac A, Reboursière E, Vilque J, Bekadja M, Casasnovas R, Gressin R, Guidez S, Coso D, Herbaux C, Yakoub‐Agha I, Bouabdallah K, Durot E, Damaj G. Bendamustine-based conditioning prior to autologous stem cell transplantation (ASCT): Results of a French multicenter study of 474 patients from LYmphoma Study Association (LYSA) centers. Am J Hematol 2018; 93:729-735. [PMID: 29473209 DOI: 10.1002/ajh.25077] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/28/2018] [Accepted: 02/21/2018] [Indexed: 11/06/2022]
Abstract
Carmustine shortage has led to an increase use of alternative conditioning regimens prior to autologous stem cell transplantation for the treatment of lymphoma, including Bendamustine-based (BeEAM). The aim of this study was to evaluate the safety of the BeEAM regimen in a large cohort of patients. A total of 474 patients with a median age of 56 years were analyzed. The majority of patients had diffuse large B-cell lymphoma (43.5%). Bendamustine was administered at a median dose of 197 mg/m2 /day (50-250) on days-7 and -6. The observed grade 1-4 toxicities included mucositis (83.5%), gastroenteritis (53%), skin toxicity (34%), colitis (29%), liver toxicity (19%), pneumonitis (5%), and cardiac rhythm disorders (4%). Nonrelapse mortality (NRM) was reported in 3.3% of patients. Acute renal failure (ARF) was reported in 132 cases (27.9%) (G ≥2; 12.3%). Organ toxicities and death were more frequent in patients with post conditioning renal failure. In a multivariate analysis, pretransplant chronic renal failure, bendamustine dose >160 mg/m2 and age were independent prognostic factors for ARF. Pretransplant chronic renal failure, hyperhydration volume, duration of hyperhydration, and etoposide dose were predictive factors of NRM. A simple, four-point scoring system can stratify patients by levels of risk for ARF and may allow for a reduction in the bendamustine dose to avoid toxicity. Drugs shortage may have dangerous consequences. Prospective, comparative studies are needed to confirm the toxicity/efficacy extents from this conditioning regimen compared to other types of high dose therapy.
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Affiliation(s)
| | | | | | | | | | - Momar Diouf
- Clinical Research DepartmentAmiens University hospitalAmiensEA4666 France
| | | | - Roch Houot
- Hematology, University hospitalRennes France
| | - Thomas Gastinne
- Department of HematologyNantes University HospitalNantes France
| | - Carole Soussain
- Department of HematologyCurie Institute, Hôpital René HugueninSaint‐Cloud France
| | - Sandra Malak
- Department of HematologyCurie Institute, Hôpital René HugueninSaint‐Cloud France
| | - Richard Lemal
- Service d'hématologie clinique adulte et de thérapie cellulaire, CHU ESTAING, EA 7453 CHELTER, Université Clermont Auvergne CIC‐501Clermont‐Ferrand France
| | | | | | | | | | - Jean‐Pierre Vilque
- Institut d'Hématologie de Basse‐Normandie, Centre François BaclesseCaen France
| | - Mohamed‐Amine Bekadja
- Hematology and Cell TherapyEtablissement Hospitalier Universitaire (EHU) 1st NovemberOran Algeria
| | | | | | - Stéphanie Guidez
- Oncologie hématologique et thérapie cellulaire, CHU PoitiersPoitiers France
| | - Diane Coso
- Department of HematologyInstitut Paoli CalmettesMarseille
| | - Charles Herbaux
- Hematology, Hôpital HURIEZ UAM allogreffe de CSH, CHRULille France
| | | | | | - Eric Durot
- Department of HematologyCentre Hospitalier UniversitaireReims Cedex FRA
| | - Gandhi Damaj
- Institut d'Hématologie de Basse‐Normandie, CHUCaen France
- Microenvironnement Cellulaire et Pathologies, Normandie Univ, UnicaenMILPAT Caen14000 France
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31
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Fouquet G, Guidez S, Richez V, Stoppa AM, Le Tourneau C, Macro M, Gruchet C, Bobin A, Moya N, Syshenko T, Sabirou F, Levy A, Franques P, Gardeney H, Karlin L, Benboubker L, Ouali M, Vedovato JC, Ferre P, Pavlyuk M, Attal M, Facon T, Leleu X. Phase I dose-escalation study of F50067, a humanized anti-CXCR4 monoclonal antibody alone and in combination with lenalidomide and low-dose dexamethasone, in relapsed or refractory multiple myeloma. Oncotarget 2018; 9:23890-23899. [PMID: 29844860 PMCID: PMC5963612 DOI: 10.18632/oncotarget.25156] [Citation(s) in RCA: 9] [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] [Received: 01/08/2018] [Accepted: 03/29/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose Multiple myeloma (MM) remains an incurable disease as tumor cells ultimately resist to all available drugs. Homing of tumor cells to the bone marrow microenvironment, involving especially the CXCR4/SDF-1 axis, allows them to survive, proliferate and resist to therapy. F50067, a humanized anti-CXCR4 IgG1 antibody, has promising preclinical activity in MM. We present a phase I multicenter escalation study in relapsed/refractory MM (RRMM) to determine the maximum tolerated dose (MTD) for F50067 alone and in combination with lenalidomide and low dose dexamethasone (Len-Dex). Experimental design 14 end-stage RRMM patients received F50067 single agent (n = 10) or in combination with Len-Dex (n = 4). Results One dose-limiting toxicity was observed, a grade 4 neutropenia lasting more than 7 days in combination arm. MTD could not be established. Thrombocytopenia was observed in 100% and neutropenia in 92.9% of patients with no cases of febrile neutropenia and no severe bleeding or hematoma. Non-hematological adverse events were of mild to moderate severity. Nine patients (6 in single arm and 3 in combination arm) were evaluable for response, with 66.7% overall response rate (≥PR) in combination arm, and 33.3% of disease control (≥SD) in single agent arm. At the time of study termination, 55.6% had progressed. Conclusion This study suggests that egression of tumor cells to the blood stream can represent a novel therapeutic strategy for MM. However, because of significant hematological toxicity, this study had to be discontinued. Further studies are needed to validate the feasibility of this approach in clinical practice.
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Affiliation(s)
- Guillemette Fouquet
- Institut Imagine, Unité Inserm U1163, Centre National de la Recherche Scientifique CNRS ERL8254, Paris, France
| | - Stéphanie Guidez
- Hôpital La Milétrie, Centre Hospitalier Universitaire, Poitiers, France.,Inserm Centre d'Investigation Clinique U1402, Centre Hospitalier Universitaire, Poitiers, France
| | - Valentine Richez
- Hôpital La Milétrie, Centre Hospitalier Universitaire, Poitiers, France
| | | | | | | | - Cécile Gruchet
- Hôpital La Milétrie, Centre Hospitalier Universitaire, Poitiers, France
| | - Arthur Bobin
- Hôpital La Milétrie, Centre Hospitalier Universitaire, Poitiers, France
| | - Niels Moya
- Hôpital La Milétrie, Centre Hospitalier Universitaire, Poitiers, France
| | - Thomas Syshenko
- Hôpital La Milétrie, Centre Hospitalier Universitaire, Poitiers, France
| | - Florence Sabirou
- Hôpital La Milétrie, Centre Hospitalier Universitaire, Poitiers, France
| | - Anthony Levy
- Hôpital La Milétrie, Centre Hospitalier Universitaire, Poitiers, France
| | - Paul Franques
- Hôpital La Milétrie, Centre Hospitalier Universitaire, Poitiers, France
| | - Hélène Gardeney
- Hôpital La Milétrie, Centre Hospitalier Universitaire, Poitiers, France
| | | | | | - Monia Ouali
- Institut de Recherche Pierre Fabre, Toulouse, France
| | | | - Pierre Ferre
- Institut de Recherche Pierre Fabre, Toulouse, France
| | | | - Michel Attal
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Thierry Facon
- Service des Maladies du Sang, Centre Hospitalier Régional Universitaire, Lille, France
| | - Xavier Leleu
- Hôpital La Milétrie, Centre Hospitalier Universitaire, Poitiers, France.,Inserm Centre d'Investigation Clinique U1402, Centre Hospitalier Universitaire, Poitiers, France
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32
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Sarkozy C, Huet S, Carlton VEH, Fabiani B, Delmer A, Jardin F, Delfau-Larue MH, Hacini M, Ribrag V, Guidez S, Faham M, Salles G. The prognostic value of clonal heterogeneity and quantitative assessment of plasma circulating clonal IG-VDJ sequences at diagnosis in patients with follicular lymphoma. Oncotarget 2018; 8:8765-8774. [PMID: 28060738 PMCID: PMC5352439 DOI: 10.18632/oncotarget.14448] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [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: 12/02/2016] [Accepted: 12/05/2016] [Indexed: 01/05/2023] Open
Abstract
Recent advances in next-generation sequencing (NGS) have enabled the quantitation of circulating tumour DNA (ctDNA) encoding the clonal rearranged V(D)J immunoglobulin locus. We aimed to evaluate the clonal heterogeneity of follicular lymphoma (FL) in the tumour and the plasma at diagnosis and to assess the prognostic value of the ctDNA level. Plasma samples at diagnosis were available for 34 patients registered in the PRIMA trial (NCT00140582). One tumour clonotype or more could be detected for 29 (85%) and 25 (74%) patients, respectively, in the tumour or plasma samples. In 18 patients, several subclones were detected in the tumour (2 to 71 subclones/cases) and/or in the plasma (2 to 20 subclones/cases). In more than half of the cases, the distribution of subclones differed between the tumour and plasma samples, reflecting high clonal heterogeneity and diversity in lymphoma subclone dissemination. In multivariate analysis, a high level of ctDNA was the only independent factor associated with patients’ progression-free survival (HR 4, IC 95 (1.1-37), p=.039). In conclusion, an NGS-based immunosequencing method reveals the marked clonal heterogeneity of follicular lymphoma in patients with FL, and quantification of ctDNA at diagnosis represents a potential powerful prognostic biomarker that needs to be investigated in larger cohorts.
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Affiliation(s)
- Clémentine Sarkozy
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service d'Hématologie, 69495 Pierre Bénite Cedex, France.,NSERM1052, CNRS 5286, Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux Lyon-1, 69495 Pierre Bénite Cedex, France
| | - Sarah Huet
- NSERM1052, CNRS 5286, Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux Lyon-1, 69495 Pierre Bénite Cedex, France.,Hospices Civils De Lyon, Laboratoire d'Hématologie, Pierre Bénite, France
| | | | - Bettina Fabiani
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Alain Delmer
- Service d'Hématologie, CHU de Reims, Reims, France
| | - Fabrice Jardin
- Centre Henri Becquerel, Service d'Hématologie, Rouen, France
| | - Marie-Helene Delfau-Larue
- Department of Biological Hematology and Immunology, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Mondor, Créteil, France
| | - Maya Hacini
- Centre Hospitalier de Chambery, Service d'Hématologie, Chambery, France
| | - Vincent Ribrag
- Institut Gustave Roussy, Service d'Hématologie, Université Paris-Sacley, Villejuif, France
| | | | - Malek Faham
- Adaptive Biotechnologies Corp., South San Francisco, CA, USA
| | - Gilles Salles
- Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Service d'Hématologie, 69495 Pierre Bénite Cedex, France.,NSERM1052, CNRS 5286, Université Claude Bernard, Faculté de Médecine Lyon-Sud Charles Mérieux Lyon-1, 69495 Pierre Bénite Cedex, France
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33
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Bertrand E, Jouy N, Manier S, Fouquet G, Guidez S, Boyle E, Noel S, Tomowiak C, Herbaux C, Schraen S, Preudhomme C, Quesnel B, Poulain S, Leleu X. Role of IRF4 in resistance to immunomodulatory (IMid) compounds ® in Waldenström's macroglobulinemia. Oncotarget 2017; 8:112917-112927. [PMID: 29348877 PMCID: PMC5762562 DOI: 10.18632/oncotarget.22872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/17/2017] [Indexed: 12/05/2022] Open
Abstract
Background Immunomodulatory drugs, IMid compounds, are active in Waldenström's macroglobulinemia (WM), although in a lesser extent than multiple myeloma, where it was initially developed. We hypothesized WM tumour cells might develop mechanisms of resistance, and sought to identify and describe these mechanisms. Material and Method MM and WM-derived cell lines, and Waldenström's CD19+ cells were treated using both lenalidomide and pomalidomide. Stable CRBN expressing cells were generated. Results WM-derived cells were resistant to IMid compounds. We demonstrated a modulation of the downstream targets of IRF4, despite low expression of cereblon, and hypothesized IRF4 was the cause for resistance to IMid compounds. We ruled out the role of various IRF4 regulatory mechanisms, and other pathways activating WM tumor cells, such as B cell activators. Conclusion This study demonstrated that mechanisms of resistance to IMid compounds could be not related to cereblon. IRF4 was identified as the potential mechanism of resistance to lenalidomide and pomalidomide in WM. It potentially explains the lesser activity observed in the clinic in WM. Interestingly, some WM patients benefited strongly to lenalidomide and pomalidomide, and future studies will have to describe the indirect mechanisms of IMid compounds in WM, possibly related to an immune-mediated process.
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Affiliation(s)
- Elisabeth Bertrand
- Univ. Lille, UMR-S 1172, Factors of Persistence of Leukemic Cells Team, JPARC - Centre de Recherche Jean-Pierre AUBERT, Neurosciences et Cancer, Lille, France.,Inserm, UMR-S 1172, Factors of Persistence of Leukemic Cells Team, Lille, France.,Institut pour la Recherche sur le Cancer de Lille, Factors of Persistence of Leukemic Cells Team, Lille, France
| | - Nathalie Jouy
- Univ. Lille, UMR-S 1172, Factors of Persistence of Leukemic Cells Team, JPARC - Centre de Recherche Jean-Pierre AUBERT, Neurosciences et Cancer, Lille, France.,Plateau de Cytométrie, BioImaging Center Lille Nord de France, BICeL Campus Hospitalo-Universitaire, Lille, France
| | - Salomon Manier
- Univ. Lille, UMR-S 1172, Factors of Persistence of Leukemic Cells Team, JPARC - Centre de Recherche Jean-Pierre AUBERT, Neurosciences et Cancer, Lille, France.,Inserm, UMR-S 1172, Factors of Persistence of Leukemic Cells Team, Lille, France.,Service des Maladies du Sang, CHU, Lille, France.,Institut pour la Recherche sur le Cancer de Lille, Factors of Persistence of Leukemic Cells Team, Lille, France
| | | | - Stéphanie Guidez
- Service d'Hématologie et Thérapie Cellulaire, Hôpital La Milétrie, et Faculté de Médecine, CHU, Poitiers, France.,CIC Inserm 1402, CHU, Poitiers, France
| | - Eileen Boyle
- Service des Maladies du Sang, CHU, Lille, France
| | | | - Cécile Tomowiak
- Service d'Hématologie et Thérapie Cellulaire, Hôpital La Milétrie, et Faculté de Médecine, CHU, Poitiers, France.,CIC Inserm 1402, CHU, Poitiers, France
| | | | - Susanna Schraen
- Laboratoire d'Hématologie, Centre de Biologie et Pathologie, CHU, Lille, France
| | - Claude Preudhomme
- Univ. Lille, UMR-S 1172, Factors of Persistence of Leukemic Cells Team, JPARC - Centre de Recherche Jean-Pierre AUBERT, Neurosciences et Cancer, Lille, France.,Inserm, UMR-S 1172, Factors of Persistence of Leukemic Cells Team, Lille, France.,Institut pour la Recherche sur le Cancer de Lille, Factors of Persistence of Leukemic Cells Team, Lille, France.,Laboratoire d'Hématologie, Centre de Biologie et Pathologie, CHU, Lille, France
| | - Bruno Quesnel
- Univ. Lille, UMR-S 1172, Factors of Persistence of Leukemic Cells Team, JPARC - Centre de Recherche Jean-Pierre AUBERT, Neurosciences et Cancer, Lille, France.,Inserm, UMR-S 1172, Factors of Persistence of Leukemic Cells Team, Lille, France.,Service des Maladies du Sang, CHU, Lille, France.,Institut pour la Recherche sur le Cancer de Lille, Factors of Persistence of Leukemic Cells Team, Lille, France
| | - Stéphanie Poulain
- Univ. Lille, UMR-S 1172, Factors of Persistence of Leukemic Cells Team, JPARC - Centre de Recherche Jean-Pierre AUBERT, Neurosciences et Cancer, Lille, France.,Inserm, UMR-S 1172, Factors of Persistence of Leukemic Cells Team, Lille, France.,Institut pour la Recherche sur le Cancer de Lille, Factors of Persistence of Leukemic Cells Team, Lille, France.,Laboratoire d'Hématologie, Centre de Biologie et Pathologie, CHU, Lille, France
| | - Xavier Leleu
- Service d'Hématologie et Thérapie Cellulaire, Hôpital La Milétrie, et Faculté de Médecine, CHU, Poitiers, France.,CIC Inserm 1402, CHU, Poitiers, France
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34
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Poulain S, Roumier C, Bertrand E, Renneville A, Caillault-Venet A, Doye E, Geffroy S, Sebda S, Nibourel O, Nudel M, Herbaux C, Renaud L, Tomowiak C, Guidez S, Tricot S, Roche-Lestienne C, Quesnel B, Preudhomme C, Leleu X. TP53 Mutation and Its Prognostic Significance in Waldenstrom's Macroglobulinemia. Clin Cancer Res 2017; 23:6325-6335. [PMID: 28754818 DOI: 10.1158/1078-0432.ccr-17-0007] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 06/03/2017] [Accepted: 07/18/2017] [Indexed: 11/16/2022]
Abstract
Purpose:TP53 is a tumor-suppressor gene that functions as a regulator influencing cellular responses to DNA damage, and TP53 alterations are associated with pejorative outcome in most B-lymphoid disorders. Little is known regarding TP53 alteration in Waldenstrom's macroglobulinemia (WM).Experimental Design: Here, we have explored the incidence of TP53 alteration using Sanger sequencing and ultradeep-targeted sequencing in 125 WM and 10 immunoglobulin M (IgM) monoclonal gammopathy of undetermined significance (MGUS), along with the clinical features and the associated genomic landscape using single-nucleotide polymorphism array and mutational landscape in an integrative study.Results: Overall, we have identified alteration of TP53 locus including mutation, deletion, and copy-neutral LOH in 11.2% of WM. TP53 mutation was acquired in 7.3% of patients with WM at diagnosis, being absent in IgM MGUS, and was highly correlated to deletion 17p. No correlation with CXCR4 mutations was observed. Patients with TP53 alteration had a greater number of genomic abnormalities. Importantly, WM with TP53 alteration had a significantly shorter overall survival, particularly in symptomatic WM, and independently of the international prognostic scoring system for Waldenstrom macroglobulinemia (IPSSWM) score. Specific treatment for WM with TP53 may have to be studied. Nutlin-3a-targeted p53 signaling induced cytotoxicity preclinically, along with new compounds such as ibrutinib, PrimaMet, or CP31398 that bypass p53 pathway in WM, paving the path for future treatment-tailored options.Conclusions: Our results highlight the clinical significance of detection of TP53 alteration in WM to determine the prognosis of WM and guide the treatment choice. Clin Cancer Res; 23(20); 6325-35. ©2017 AACR.
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Affiliation(s)
- Stéphanie Poulain
- Service d'Hématologie- Immunologie- Cytogénétique, Centre Hospitalier de Valenciennes, Valenciennes, France.,Laboratoire d'Hématologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire de Lille, Lille, France.,INSERM UMR 1172, Team 4, Cancer Research Institute of Lille, Lille, France
| | - Christophe Roumier
- Laboratoire d'Hématologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire de Lille, Lille, France.,INSERM UMR 1172, Team 4, Cancer Research Institute of Lille, Lille, France
| | - Elisabeth Bertrand
- INSERM UMR 1172, Team 4, Cancer Research Institute of Lille, Lille, France
| | - Aline Renneville
- Laboratoire d'Hématologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire de Lille, Lille, France.,INSERM UMR 1172, Team 4, Cancer Research Institute of Lille, Lille, France
| | - Aurélie Caillault-Venet
- Laboratoire d'Hématologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Emmanuelle Doye
- Laboratoire d'Hématologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Sandrine Geffroy
- INSERM UMR 1172, Team 4, Cancer Research Institute of Lille, Lille, France
| | - Sheherazade Sebda
- Laboratoire d'Hématologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Olivier Nibourel
- Laboratoire d'Hématologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire de Lille, Lille, France.,INSERM UMR 1172, Team 4, Cancer Research Institute of Lille, Lille, France
| | - Morgane Nudel
- Service des Maladies du Sang, Hôpital Huriez, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Charles Herbaux
- Service des Maladies du Sang, Hôpital Huriez, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Loic Renaud
- Laboratoire d'Hématologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Cécile Tomowiak
- Service d'Hématologie et Thérapie cellulaire, Centre d'Investigation Clinique, Hôpital de la Milétrie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,INSERM U1402, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Stéphanie Guidez
- Service d'Hématologie et Thérapie cellulaire, Centre d'Investigation Clinique, Hôpital de la Milétrie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.,INSERM U1402, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Sabine Tricot
- Service d'Hématologie- Immunologie- Cytogénétique, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Catherine Roche-Lestienne
- Laboratoire d'Hématologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire de Lille, Lille, France.,INSERM UMR 1172, Team 4, Cancer Research Institute of Lille, Lille, France
| | - Bruno Quesnel
- INSERM UMR 1172, Team 4, Cancer Research Institute of Lille, Lille, France.,Service des Maladies du Sang, Hôpital Huriez, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Claude Preudhomme
- Laboratoire d'Hématologie, Centre de Biologie Pathologie, Centre Hospitalier Régional et Universitaire de Lille, Lille, France.,INSERM UMR 1172, Team 4, Cancer Research Institute of Lille, Lille, France
| | - Xavier Leleu
- Service d'Hématologie et Thérapie cellulaire, Centre d'Investigation Clinique, Hôpital de la Milétrie, Centre Hospitalier Universitaire de Poitiers, Poitiers, France. .,INSERM U1402, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
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35
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Fouquet G, Snell KI, Guidez S, Schraen S, Boyle E, Renaud L, Desmier D, Machet A, Moya N, Systchenko T, Gruchet C, Decaux O, Arnulf B, Fohrer C, Richez V, Kolb B, Macro M, Karlin L, Royer B, Pegourie B, Hebraud B, Caillot D, Perrot A, Moreau P, Facon T, Avet-Loiseau H, Dejoie T, Hulin C, Harding S, Leleu X. Heavy + light chain analysis to assign myeloma response is analogous to the IMWG response criteria. Leuk Lymphoma 2017; 59:583-589. [PMID: 28697637 DOI: 10.1080/10428194.2017.1339876] [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: 10/19/2022]
Abstract
Automated serum heavy + light chain (HLC) immunoassays can measure the intact immunoglobulins of each light chain type separately. We though to compare HLC assays with electrophoretic techniques in determining International Myeloma Working Group (IMWG) response criteria. 114 myeloma patients from 2 trials were included. HLC measurements were made utilizing archived sera and response assessments compared with those based on electrophoretic analysis at the time of the trials. Assessments at ∼90 days and maximal response were compared as was the power of the 2 techniques for predicting later responses, overall survival, and progression. The kappa statistic indicated good agreement between the 2 methods for determining IMWG response criteria, although HLC measurements might give better predictions of subsequent responses and frequently gave an earlier indication of change. HLC measurements could represent an alternative to electrophoretic techniques in determining IMWG response. Validation with a greater range of patient responses is needed for confirmation.
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Affiliation(s)
| | | | - Stéphanie Guidez
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | | | | | | | - Déborah Desmier
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | - Antoine Machet
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | - Niels Moya
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | | | - Cécile Gruchet
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | | | | | | | - Valentine Richez
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
| | | | | | - Lionel Karlin
- j Hôpital Lyon Sud, CHU , Lyon Pierre Bénite , France
| | | | | | | | | | | | | | | | | | | | - Cyrille Hulin
- q Hôpital Haut-Leveque, CHU , Pessac Bordeaux , France
| | | | - Xavier Leleu
- c Hôpital La Milétrie and CIC Inserm 1402, CHU , Poitiers , France
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36
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Kendrick F, Evans ND, Arnulf B, Avet-Loiseau H, Decaux O, Dejoie T, Fouquet G, Guidez S, Harel S, Hebraud B, Javaugue V, Richez V, Schraen S, Touzeau C, Moreau P, Leleu X, Harding S, Chappell MJ. Analysis of a Compartmental Model of Endogenous Immunoglobulin G Metabolism with Application to Multiple Myeloma. Front Physiol 2017; 8:149. [PMID: 28367126 PMCID: PMC5355465 DOI: 10.3389/fphys.2017.00149] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/24/2017] [Indexed: 12/21/2022] Open
Abstract
Immunoglobulin G (IgG) metabolism has received much attention in the literature for two reasons: (i) IgG homeostasis is regulated by the neonatal Fc receptor (FcRn), by a pH-dependent and saturable recycling process, which presents an interesting biological system; (ii) the IgG-FcRn interaction may be exploitable as a means for extending the plasma half-life of therapeutic monoclonal antibodies, which are primarily IgG-based. A less-studied problem is the importance of endogenous IgG metabolism in IgG multiple myeloma. In multiple myeloma, quantification of serum monoclonal immunoglobulin plays an important role in diagnosis, monitoring and response assessment. In order to investigate the dynamics of IgG in this setting, a mathematical model characterizing the metabolism of endogenous IgG in humans is required. A number of authors have proposed a two-compartment nonlinear model of IgG metabolism in which saturable recycling is described using Michaelis–Menten kinetics; however it may be difficult to estimate the model parameters from the limited experimental data that are available. The purpose of this study is to analyse the model alongside the available data from experiments in humans and estimate the model parameters. In order to achieve this aim we linearize the model and use several methods of model and parameter validation: stability analysis, structural identifiability analysis, and sensitivity analysis based on traditional sensitivity functions and generalized sensitivity functions. We find that all model parameters are identifiable, structurally and taking into account parameter correlations, when several types of model output are used for parameter estimation. Based on these analyses we estimate parameter values from the limited available data and compare them with previously published parameter values. Finally we show how the model can be applied in future studies of treatment effectiveness in IgG multiple myeloma with simulations of serum monoclonal IgG responses during treatment.
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Affiliation(s)
| | - Neil D Evans
- School of Engineering, University of Warwick Coventry, UK
| | | | - Hervé Avet-Loiseau
- Unité de Génomique du Myélome, Institut Universitaire du Cancer de Toulouse Oncopole Toulouse, France
| | - Olivier Decaux
- Centre Hospitalier Universitaire de Rennes Rennes, France
| | - Thomas Dejoie
- Centre Hospitalier Universitaire de Nantes Nantes, France
| | | | | | | | | | | | | | - Susanna Schraen
- Centre Hospitalier Régional Universitaire de Lille Lille, France
| | | | | | - Xavier Leleu
- Centre Hospitalier Universitaire de Poitiers Poitiers, France
| | - Stephen Harding
- Department of Research and Development, The Binding Site Group Limited Birmingham, UK
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37
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Fouquet G, Guidez S, Petillon MO, Louni C, Ohyba B, Dib M, Poulain S, Herbaux C, Martin A, Thielemans B, Brice P, Choquet S, Bakala J, Bories C, Demarquette H, Nudel M, Tournilhac O, Arnulf B, LeGouill S, Morel P, Banos A, Karlin L, Salles G, Leblond V, Leleu X. Lenalidomide is safe and active in Waldenström macroglobulinemia. Am J Hematol 2015; 90:1055-9. [PMID: 26284823 DOI: 10.1002/ajh.24175] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 11/10/2022]
Abstract
Lenalidomide is manageable and effective in multiple myeloma, particularly in elderly patients. Surprisingly, the combination of lenalidomide with rituximab produced clinically significant anemia at 25 mg/day for 21/28 days, the highest possible dose, in Waldenström's Macroglobulinemia (WM). We aimed to determine the maximum tolerated dose (MTD) of single agent lenalidomide and determine its impact on WM. RV-WM-0426 is a multicenter dose escalation open label phase 1/2 study of lenalidomide in relapsed/refractory WM (RRWM). Lenalidomide was given orally 21/28 days per cycle for 1 year, at escalated dose of 15 to 20 mg during phase 1 to determine the MTD; the phase 2 part was conducted at the MTD. Seventeen RRWM patients were included. The MTD was established at 15 mg/day 21/28. By ITT analysis, the overall response rate was 29%. With a median follow-up of 36 months, median TTP was 16 months (95% CI 5.5-26), the 5-year OS was 91%. The most frequent adverse events ≥ grade 3 at 15 mg were 14% anemia and 43% neutropenia. The MTD of lenalidomide is 15 mg/day 21/28 days in RRWM. Lenalidomide is active in the treatment of RRWM and the safety profile appears manageable. Future studies may look into combinations of lenalidomide and continuous dosing.
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Affiliation(s)
| | | | | | - Chanaz Louni
- Département De Recherche Clinique, CHRU; Lille France
| | - Bella Ohyba
- Département De Recherche Clinique, CHRU; Lille France
| | - Malek Dib
- Département De Recherche Clinique, CHRU; Lille France
| | | | | | - Audrey Martin
- Hématologie, Hôpital Côte De Nacre, CHU Caen; France
| | | | - Pauline Brice
- Hématologie, Hôpital Pitié-Salpêtrière, APHP; Paris France
| | - Sylvain Choquet
- Institut Universitaire D'hématologie, APHP Saint Louis; Paris EA3963 France
| | | | - Claire Bories
- Maladies Du Sang, Hôpital Huriez, CHRU; Lille France
| | | | - Morgane Nudel
- Maladies Du Sang, Hôpital Huriez, CHRU; Lille France
| | | | | | | | | | | | | | | | | | - Xavier Leleu
- Maladies Du Sang, Hôpital Huriez, CHRU; Lille France
- U837 Inserm, IRCL, CHRU; Lille France
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38
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Fouquet G, Macro M, Decaux O, Fohrer C, Guidez S, Demarquette H, Le Grand C, Prodhomme C, Renaud L, Bories C, Herbaux C, Karlin L, Roussel M, Benboubker L, Hulin C, Arnulf B, Leleu X. [Pomalidomide for multiple myeloma]. Rev Med Interne 2015; 36:613-8. [PMID: 26257103 DOI: 10.1016/j.revmed.2015.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/02/2014] [Revised: 03/08/2015] [Accepted: 04/22/2015] [Indexed: 11/30/2022]
Abstract
Once characterized by a very poor outcome, multiple myeloma (MM) now has a significantly prolonged survival, with major improvements allowed by the use of "novel agents": proteasome inhibitors (first-in-class bortezomib) and immunomodulatory compounds (IMiDs; first-in-class thalidomide and lenalidomide). However, the vast majority - if not all - of patients with MM ultimately end up being refractory to all existing drugs, including these efficient novel agents. There is a clear unmet medical need in this situation, which warrants the development of the next generation of proteasome inhibitors and IMiDs, as well as new drug classes. This review focuses on pomalidomide, the next generation IMiD, recently approved by the US FDA and the EMA for patients with relapsed or refractory MM who have received at least two prior therapies, including lenalidomide and bortezomib, and have demonstrated disease progression on their last therapy.
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Affiliation(s)
- G Fouquet
- Service des maladies du sang, hôpital Huriez, CHRU de Caen, rue Michel Polonovski, 59037 Lille, France
| | - M Macro
- Hématologie, hôpital Côte-de-Nacre, CHU, 1400 Caen, France
| | - O Decaux
- Médecine interne, hôpital Sud, CHRU, 35000 Rennes, France
| | - C Fohrer
- Hématologie, hôpital Hautepierre, CHU, 67000 Strasbourg, France
| | - S Guidez
- Service des maladies du sang, hôpital Huriez, CHRU de Caen, rue Michel Polonovski, 59037 Lille, France
| | - H Demarquette
- Service des maladies du sang, hôpital Huriez, CHRU de Caen, rue Michel Polonovski, 59037 Lille, France
| | - C Le Grand
- Service des maladies du sang, hôpital Huriez, CHRU de Caen, rue Michel Polonovski, 59037 Lille, France
| | - C Prodhomme
- Service des maladies du sang, hôpital Huriez, CHRU de Caen, rue Michel Polonovski, 59037 Lille, France
| | - L Renaud
- Service des maladies du sang, hôpital Huriez, CHRU de Caen, rue Michel Polonovski, 59037 Lille, France
| | - C Bories
- Service des maladies du sang, hôpital Huriez, CHRU de Caen, rue Michel Polonovski, 59037 Lille, France
| | - C Herbaux
- Service des maladies du sang, hôpital Huriez, CHRU de Caen, rue Michel Polonovski, 59037 Lille, France
| | - L Karlin
- Service d'hématologie, hôpital Lyon-Sud, CHU, 69000 Lyon - Pierre-Bénite, France
| | - M Roussel
- Hématologie clinique, hôpital Purpan, CHU, 31000 Toulouse, France
| | - L Benboubker
- Onco-hématologie, hôpital Bretonneau, CHRU, 37000 Tours, France
| | - C Hulin
- Hématologie, hôpitaux de Brabois, CHU, 54000 Vandœuvre-lès-Nancy, France
| | - B Arnulf
- Hématologie-immunologie, hôpital Saint-Louis, AP-HP, 75010 Paris, France
| | - X Leleu
- Service des maladies du sang, hôpital Huriez, CHRU de Caen, rue Michel Polonovski, 59037 Lille, France.
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Herbaux C, Genet P, Bouabdallah K, Pignon JM, Debarri H, Guidez S, Betrian S, Leleu X, Facon T, Morschhauser F, Damaj G, Cazin B, Ysebaert L. Bendamustine is effective in T-cell prolymphocytic leukaemia. Br J Haematol 2014; 168:916-9. [PMID: 25316212 DOI: 10.1111/bjh.13175] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Charles Herbaux
- Service des Maladies du Sang, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
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Boyle EM, Fouquet G, Guidez S, Bonnet S, Demarquette H, Dulery R, Herbaux C, Noel MP, Manier S, Schraen S, Onraed B, Faucompré JL, Hennache B, Petillon MO, Mathiot C, Avet-Loiseau H, Facon T, Harding SJ, Moreau P, Leleu X. IgA kappa/IgA lambda heavy/light chain assessment in the management of patients with IgA myeloma. Cancer 2014; 120:3952-7. [PMID: 25116271 DOI: 10.1002/cncr.28946] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 06/05/2014] [Accepted: 06/18/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND Accurate quantification of immunoglobulin A (IgA) monoclonal immunoglobulins by serum protein electrophoresis (SPEP) can be difficult and can impact the assessment of response among patients with multiple myeloma (MM). Therefore, there is a need to identify new assays that better reflect disease burden and response to treatment, and correlate with patient outcome. IgA Hevylite (HLC) measures IgA kappa and IgA lambda separately and provides precise quantitative measurements of the monoclonal IgA expression and polyclonal-isotype matched suppression. In the current study, the authors assessed the usefulness of these assays in the diagnosis of IgA MM and sought to comment on the prognostic value of the assays. METHODS A study of 157 patients with IgA MM for whom diagnostic samples were available was performed. HLC measurements were performed on a nephelometer and the results were compared with those of electrophoresis. RESULTS All presentation sera (100 IgA kappa specimens and 57 IgA lambda specimens) were found to have abnormal IgA HLC ratios (IgA kappa median ratio: 336.2 [range, 8.2-7353] and IgA lambda ratio: 0.011 [range, 0.0003-0.45]). In comparison, SPEP bands were quantifiable in only 105 of 157 samples (67%) (median, 28.5 g/L [range, 2.2 g/L-98 g/L]). Of the total of 157 patients, 12 patients (8%) presented with oligosecretory myeloma (<10 g/L; including 4 patients with nonquantifiable SPEP bands). HLC uniquely allows for the measurement of isotype paired suppression, which was found to be associated with shortened overall survival in the current study. CONCLUSIONS In the current study, IgA HLC ratios were found to be abnormal in all patients and the assay was able to produce quantifiable results in more MM sera than either SPEP or total IgA, potentially representing a solution to the issue of comigration and oligosecretory MM. These preliminary data require confirmation in larger prospective trials to validate the usefulness of IgA HLC.
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Affiliation(s)
- Eileen M Boyle
- Clinical Hematology Department, Huriez Hospital, Regional University Medical Center, Lille, France
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42
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Fouquet G, Guidez S, Herbaux C, Van de Wyngaert Z, Bonnet S, Beauvais D, Demarquette H, Adib S, Hivert B, Wemeau M, Berthon C, Terriou L, Coiteux V, Macro M, Decaux O, Facon T, Huglo D, Leleu X. Impact of Initial FDG-PET/CT and Serum-Free Light Chain on Transformation of Conventionally Defined Solitary Plasmacytoma to Multiple Myeloma. Clin Cancer Res 2014; 20:3254-60. [DOI: 10.1158/1078-0432.ccr-13-2910] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Smoldering multiple myeloma (SMM) is an asymptomatic plasma cell neoplasia, characterized by monoclonal plasma cell proliferation in the absence of end-organ damage, but with a high risk of progression to multiple myeloma. It has therefore to be distinguished from monoclonal gammapathy of undetermined significance (MGUS), which has a much lower risk of progression, but also from multiple myeloma, which remains an incurable disease and requires a specific treatment. The critical question in the management of SMM is whether an early therapeutic strategy could help delaying the progression to multiple myeloma, in order to lower the risk of serious complications related to this progression, or even to cure the disease. This early treatment could not be proposed to all SMM patients, who are indeed asymptomatic, and in whom the risk of toxicity could make it difficult to justify the potential benefit obtained. The challenge is to target early at diagnosis SMM patients with a high risk of progression, using available routine tests sufficiently reliable to warrant the therapeutic sanction which relies on it. Today however, apart from randomized studies, recommendations are to maintain therapeutic abstention in SMM patients.
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Affiliation(s)
- G Fouquet
- Service des maladies du sang, hôpital Huriez, CHRU de Lille, rue M.-Polonovski, 59037 Lille, France
| | - S Guidez
- Service des maladies du sang, hôpital Huriez, CHRU de Lille, rue M.-Polonovski, 59037 Lille, France
| | - C Herbaux
- Service des maladies du sang, hôpital Huriez, CHRU de Lille, rue M.-Polonovski, 59037 Lille, France
| | - H Demarquette
- Service des maladies du sang, hôpital Huriez, CHRU de Lille, rue M.-Polonovski, 59037 Lille, France
| | - X Leleu
- Service des maladies du sang, hôpital Huriez, CHRU de Lille, rue M.-Polonovski, 59037 Lille, France.
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Fouquet G, Tardy S, Demarquette H, Bonnet S, Gay J, Debarri H, Herbaux C, Guidez S, Michel J, Perrot A, Serrier C, Miljkovic D, Avet Loiseau H, Facon T, Hulin C, Leleu X. Efficacy and safety profile of long-term exposure to lenalidomide in patients with recurrent multiple myeloma. Cancer 2013; 119:3680-6. [DOI: 10.1002/cncr.28274] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 05/15/2013] [Accepted: 05/22/2013] [Indexed: 02/02/2023]
Affiliation(s)
| | | | - Hélène Demarquette
- Hematology Department; Huriez Regional University Hospital; Lille France
| | - Sarah Bonnet
- Hematology Department; Huriez Regional University Hospital; Lille France
| | - Julie Gay
- Hematology Department; Huriez Regional University Hospital; Lille France
| | - Houria Debarri
- Hematology Department; Huriez Regional University Hospital; Lille France
| | - Charles Herbaux
- Hematology Department; Huriez Regional University Hospital; Lille France
| | - Stéphanie Guidez
- Hematology Department; Huriez Regional University Hospital; Lille France
| | | | | | | | | | | | - Thierry Facon
- Hematology Department; Huriez Regional University Hospital; Lille France
| | | | - Xavier Leleu
- Hematology Department; Huriez Regional University Hospital; Lille France
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Herbaux C, Badens C, Guidez S, Lacoste C, Maboudou P, Rose C. A NewATRXMutation in a Patient With Acquiredα-Thalassemia Myelodysplastic Syndrome. Hemoglobin 2012; 36:581-5. [DOI: 10.3109/03630269.2012.724040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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