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Guilbaud R, Franco Yusti AM, Leducq V, Zafilaza K, Bridier-Nahmias A, Todesco E, Soulie C, Fauchois A, Le Hingrat Q, Kramer L, Goulenok T, Salpin M, Daugas E, Dorent R, Ottaviani S, Zalcman G, Ghosn J, Choquet S, Cacoub P, Amoura Z, Barroux B, Pourcher V, Spano JP, Louet M, Marcelin AG, Calvez V, Charpentier C, Descamps D, Marot S, Ferré VM, Coppée R. Higher Levels of SARS-CoV-2 Genetic Variation in Immunocompromised Patients: A Retrospective Case-Control Study. J Infect Dis 2024; 229:1041-1049. [PMID: 37956413 DOI: 10.1093/infdis/jiad499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/30/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection lasts longer in immunocompromised hosts than in immunocompetent patients. Prolonged infection is associated with a higher probability of selection for novel SARS-CoV-2 mutations, particularly in the spike protein, a critical target for vaccines and therapeutics. METHODS From December 2020 to September 2022, respiratory samples from 444 immunocompromised patients and 234 health care workers positive for SARS-CoV-2, diagnosed at 2 hospitals in Paris, France, were analyzed using whole-genome sequencing using Nanopore technology. Custom scripts were developed to assess the SARS-CoV-2 genetic diversity between the 2 groups and within the host. RESULTS Most infections were SARS-CoV-2 Delta or Omicron lineages. Viral genetic diversity was significantly higher in infections of immunocompromised patients than those of controls. Minor mutations were identified in viruses sequenced from immunocompromised individuals, which became signature mutations for newer SARS-CoV-2 variants as the epidemic progressed. Two patients were coinfected with Delta and Omicron variants. The follow-up of immunocompromised patients revealed that the SARS-CoV-2 genome evolution differed in the upper and lower respiratory tracts. CONCLUSIONS This study found that SARS-CoV-2 infection in immunocompromised patients is associated with higher genetic diversity, which could lead to the emergence of new SARS-CoV-2 variants with possible immune evasion or different virulence characteristics.
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Affiliation(s)
- Romane Guilbaud
- Infection, Antimicrobials, Modelling, Evolution, Université Paris Cité and Sorbonne Paris Nord, Inserm, Paris, France
| | - Anna-Maria Franco Yusti
- Infection, Antimicrobials, Modelling, Evolution, Université Paris Cité and Sorbonne Paris Nord, Inserm, Paris, France
| | - Valentin Leducq
- Service de Virologie, Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Karen Zafilaza
- Service de Virologie, Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Antoine Bridier-Nahmias
- Infection, Antimicrobials, Modelling, Evolution, Université Paris Cité and Sorbonne Paris Nord, Inserm, Paris, France
| | - Eve Todesco
- Service de Virologie, Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Cathia Soulie
- Service de Virologie, Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Antoine Fauchois
- Service de Virologie, Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Quentin Le Hingrat
- Infection, Antimicrobials, Modelling, Evolution, Université Paris Cité and Sorbonne Paris Nord, Inserm, Paris, France
| | - Laura Kramer
- Service de Pharmacie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Tiphaine Goulenok
- Service de Médecine Interne, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Mathilde Salpin
- Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Eric Daugas
- Service de Néphrologie, Université Paris Cité, Inserm U1149, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Richard Dorent
- Service de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Sébastien Ottaviani
- Service de Rhumatologie, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Gérard Zalcman
- Service d'Oncologie Thoracique, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Jade Ghosn
- Infection, Antimicrobials, Modelling, Evolution, Université Paris Cité and Sorbonne Paris Nord, Inserm, Paris, France
- Service de Maladies Infectieuses, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude-Bernard, Paris, France
| | - Sylvain Choquet
- Service d'Hématologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Patrice Cacoub
- Service de Médecine Interne et Immunologie Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Zahir Amoura
- Service de Médecine Interne 2, Centre National de Référence des Histiocytoses, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Benoit Barroux
- Service d'Urologie et de Transplantation Rénale, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Valérie Pourcher
- Service de Virologie, Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Service de Maladies Infectieuses et Tropicales, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière, Paris, France
| | - Jean-Philippe Spano
- Service de Virologie, Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
- Service d'Oncologie Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Martine Louet
- Service de Santé au Travail, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Anne-Geneviève Marcelin
- Service de Virologie, Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Vincent Calvez
- Service de Virologie, Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Charlotte Charpentier
- Infection, Antimicrobials, Modelling, Evolution, Université Paris Cité and Sorbonne Paris Nord, Inserm, Paris, France
| | - Diane Descamps
- Infection, Antimicrobials, Modelling, Evolution, Université Paris Cité and Sorbonne Paris Nord, Inserm, Paris, France
| | - Stéphane Marot
- Service de Virologie, Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France
| | - Valentine Marie Ferré
- Infection, Antimicrobials, Modelling, Evolution, Université Paris Cité and Sorbonne Paris Nord, Inserm, Paris, France
| | - Romain Coppée
- Infection, Antimicrobials, Modelling, Evolution, Université Paris Cité and Sorbonne Paris Nord, Inserm, Paris, France
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2
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Choquet S, Soussain C, Azar N, Morel V, Metz C, Ursu R, Waultier-Rascalou A, di Blasi R, Houot R, Souchet L, Roos-Weil D, Uzunov M, Quoc SN, Jacque N, Boussen I, Gauthier N, Ouzegdouh M, Blonski M, Campidelli A, Ahle G, Guffroy B, Willems L, Corvilain E, Barrie M, Alcantara M, le Garff-Tavernier M, Psimaras D, Weiss N, Baron M, Bravetti C, Hoang-Xuan K, Davi F, Shor N, Alentorn A, Houillier C. CAR T-cell therapy induces a high rate of prolonged remission in relapsed primary CNS lymphoma: Real-life results of the LOC network. Am J Hematol 2024. [PMID: 38586986 DOI: 10.1002/ajh.27316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/24/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
The prognosis of relapsed primary central nervous system lymphoma (PCNSL) remains dismal. CAR T-cells are a major contributor to systemic lymphomas, but their use in PCNSL is limited. From the LOC network database, we retrospectively selected PCNSL who had leukapheresis for CAR-T cells from the third line of treatment, and, as controls, PCNSL treated with any treatment, at least in the third line and considered not eligible for ASCT. Twenty-seven patients (median age: 68, median of three previous lines, including ASCT in 14/27) had leukapheresis, of whom 25 received CAR T-cells (tisa-cel: N = 16, axi-cel: N = 9) between 2020 and 2023. All but one received a bridging therapy. The median follow-up after leukapheresis was 20.8 months. The best response after CAR-T cells was complete response in 16 patients (64%). One-year progression-free survival from leukapheresis was 43% with a plateau afterward. One-year relapse-free survival was 79% for patients in complete or partial response at CAR T-cell infusion. The median overall survival was 21.2 months. Twenty-three patients experienced a cytokine release syndrome and 17/25 patients (68%) a neurotoxicity (five grade ≥3). The efficacy endpoints were significantly better in the CAR T-cell group than in the control group (N = 247) (median PFS: 3 months; median OS: 4.7 months; p < 0.001). This series represents the largest cohort of PCNSL treated with CAR T-cells reported worldwide. CAR T-cells are effective in relapsed PCNSL, with a high rate of long-term remission and a reassuring tolerance profile. The results seem clearly superior to those usually observed in this setting.
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Affiliation(s)
- Sylvain Choquet
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Carole Soussain
- Service d'Hématologie Clinique, Institut Curie, site de Saint Cloud, France and INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - Nabih Azar
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Véronique Morel
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Carole Metz
- Unité REQPHARM, pharmacie à usage intérieur, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - Renata Ursu
- Service de Neurologie, Université de Paris Cité, APHP, Hôpital Saint Louis, Paris, France
| | | | - Roberta di Blasi
- Service d'Oncohématologie, Université de Paris Cité, APHP, Hôpital Saint Louis, Paris, France
| | - Roch Houot
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire de Rennes, UMR U1236, INSERM Université de Rennes, Etablissement Français du Sang, Rennes, France
| | - Laetitia Souchet
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Damien Roos-Weil
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Madalina Uzunov
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Stéphanie Nguyen Quoc
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Nathalie Jacque
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Inès Boussen
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Nicolas Gauthier
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Maya Ouzegdouh
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Marie Blonski
- Service de Neuro-Oncologie, Centre Hospitalier Régional Universitaire (CHRU), Université de Lorraine, Centre de Recherche en Automatique de Nancy CRAN UMR 7039, CNRS, Nancy, France
| | - Arnaud Campidelli
- Service d'Hématologie Clinique, Hôpital Brabois, Centre Hospitalier Régional Universitaire (CHRU), Nancy, CNRS UMR 7563, Biopôle de l'Université de Lorraine, Vandoeuvre les Nancy, France
| | - Guido Ahle
- Service de Neurologie, Hôpital Pasteur-Hôpitaux civils de Colmar, France
| | - Blandine Guffroy
- Service d'Hématologie Clinique, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Lise Willems
- Service d'Hématologie Clinique, Hôpital Cochin, APHP, Paris, France
| | - Emilie Corvilain
- Service d'Immunologie Clinique, Hôpital Saint Louis, APHP, Université de Paris, Paris, France
| | - Maryline Barrie
- Service de Neuro-oncologie, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Timone, Marseille, France
| | - Marion Alcantara
- Service d'Hématologie Clinique, Institut Curie, site de Saint Cloud, France and INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - Magali le Garff-Tavernier
- Service d'Hématologie Biologique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Dimitri Psimaras
- Service de Neurooncologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, INSERM, CNRS, UMR S 1127, ICM, IHU, Paris, France
| | - Nicolas Weiss
- AP-HP, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, département de neurologie, unité de Médecine Intensive Réanimation à orientation neurologique, Paris, France
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Groupe de Recherche Clinique en REanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguE (GRC-RESPIRE), Sorbonne Université, Paris, France
| | - Marine Baron
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Clotilde Bravetti
- Service d'Hématologie Biologique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Khê Hoang-Xuan
- Service de Neurooncologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, INSERM, CNRS, UMR S 1127, ICM, IHU, Paris, France
| | - Frédéric Davi
- Service d'Hématologie Biologique, Groupe Hospitalier Pitié-Salpêtrière, APHP-Sorbonne Université, Paris, France
| | - Natalia Shor
- Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Agusti Alentorn
- Service de Neurooncologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, INSERM, CNRS, UMR S 1127, ICM, IHU, Paris, France
| | - Caroline Houillier
- Service de Neurooncologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, INSERM, CNRS, UMR S 1127, ICM, IHU, Paris, France
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Boccon-Gibod C, Sourdeau E, Morel P, Chapiro E, Nguyen-Khac F, Bravetti C, Davi F, Morel V, Gauthier N, Grenier A, Boussen I, Choquet S, Leblond V, Le Garff-Tavernier M, Baron M, Roos-Weil D. Circulating tumor cells in Waldenström macroglobulinemia. Leukemia 2024; 38:903-907. [PMID: 38332185 DOI: 10.1038/s41375-024-02156-3] [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: 10/24/2023] [Revised: 01/06/2024] [Accepted: 01/11/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Clémentine Boccon-Gibod
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France.
| | - Elise Sourdeau
- Sorbonne Université, Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | | | - Elise Chapiro
- Sorbonne Université, Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
- Drug Resistance in Hematological Malignancies, Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université Paris Cité, F-75006, Paris, France
| | - Florence Nguyen-Khac
- Sorbonne Université, Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
- Drug Resistance in Hematological Malignancies, Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université Paris Cité, F-75006, Paris, France
| | - Clotilde Bravetti
- Sorbonne Université, Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
- Drug Resistance in Hematological Malignancies, Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université Paris Cité, F-75006, Paris, France
| | - Frédéric Davi
- Sorbonne Université, Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
- Drug Resistance in Hematological Malignancies, Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université Paris Cité, F-75006, Paris, France
| | - Véronique Morel
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Nicolas Gauthier
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Adrien Grenier
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Inès Boussen
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Sylvain Choquet
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Véronique Leblond
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Magali Le Garff-Tavernier
- Sorbonne Université, Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
- Drug Resistance in Hematological Malignancies, Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université Paris Cité, F-75006, Paris, France
| | - Marine Baron
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Damien Roos-Weil
- Sorbonne Université, Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, APHP, Paris, France.
- Drug Resistance in Hematological Malignancies, Centre de Recherche des Cordeliers, UMRS 1138, INSERM, Sorbonne Université, Université Paris Cité, F-75006, Paris, France.
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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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Mahadeo KM, Baiocchi R, Beitinjaneh A, Chaganti S, Choquet S, Dierickx D, Dinavahi R, Duan X, Gamelin L, Ghobadi A, Guzman-Becerra N, Joshi M, Mehta A, Navarro WH, Nikiforow S, O'Reilly RJ, Reshef R, Ruiz F, Spindler T, Prockop S. Tabelecleucel for allogeneic haematopoietic stem-cell or solid organ transplant recipients with Epstein-Barr virus-positive post-transplant lymphoproliferative disease after failure of rituximab or rituximab and chemotherapy (ALLELE): a phase 3, multicentre, open-label trial. Lancet Oncol 2024; 25:376-387. [PMID: 38309282 DOI: 10.1016/s1470-2045(23)00649-6] [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: 08/03/2023] [Revised: 11/20/2023] [Accepted: 12/14/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Survival in Epstein-Barr virus (EBV)-positive post-transplant lymphoproliferative disease following haematopoietic stem-cell transplant (HSCT) or solid organ transplant (SOT) is poor after failure of initial therapy, indicating an urgent need for therapies for this ultra-rare disease. With recent EU marketing authorisation, tabelecleucel is the first off-the-shelf, allogeneic, EBV-specific T-cell immunotherapy to receive approval for treatment of relapsed or refractory EBV-positive post-transplant lymphoproliferative disease. We aimed to determine the clinical benefit of tabelecleucel in patients with relapsed or refractory EBV-positive post-transplant lymphoproliferative disease following HSCT or SOT. METHODS In this global, multicentre, open-label, phase 3 trial, eligible patients (of any age) had biopsy-proven EBV-positive post-transplant lymphoproliferative disease, disease that was relapsed or refractory to rituximab after HSCT and rituximab with or without chemotherapy after SOT, and partially HLA-matched and appropriately HLA-restricted tabelecleucel available. Patients received tabelecleucel administered intravenously at 2 × 106 cells per kg on days 1, 8, and 15 in 35-day cycles and are assessed for up to 5 years for survival post-treatment initiation. The primary endpoint was objective response rate. All patients who received at least one dose of tabelecleucel were included in safety and efficacy analyses. This trial is registered with ClinicalTrials.gov, NCT03394365, and is ongoing. FINDINGS From June 27, 2018, to Nov 5, 2021, 63 patients were enrolled, of whom 43 (24 [56%] male and 19 [44%] female) were included, 14 had prior HSCT, 29 had SOT. Seven (50%, 95% CI 23-77) of 14 participants in the HSCT group and 15 (52%, 33-71) of 29 participants in the SOT group had an objective response, with a median follow-up of 14·1 months (IQR 5·7-23·9) and 6·0 months (1·8-18·4), respectively. The most common grade 3 or 4 treatment-emergent adverse events were disease progression (in four [29%] of 14 in HSCT and eight [28%] of 29 in SOT) and decreased neutrophil count (in four [29%] of 14 in HSCT and four [14%] of 29 in SOT). Treatment-emergent serious adverse events were reported in 23 (53%) of 43 patients and fatal treatment-emergent adverse events in five (12%); no fatal treatment-emergent adverse event was treatment-related. There were no reports of tumour flare reaction, cytokine release syndrome, immune effector cell-associated neurotoxicity syndrome, transmission of infectious diseases, marrow rejection, or infusion reactions. No events of graft-versus-host disease or SOT rejection were reported as related to tabelecleucel. INTERPRETATION Tabelecleucel provides clinical benefit in patients with relapsed or refractory EBV-positive post-transplant lymphoproliferative disease, for whom there are no other approved therapies, without evidence of safety concerns seen with other adoptive T-cell therapies. These data represent a potentially transformative and accessible treatment advance for patients with relapsed or refractory disease with few treatment options. FUNDING Atara Biotherapeutics.
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Affiliation(s)
| | - Robert Baiocchi
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami Hospital and Clinics, Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Sridhar Chaganti
- Centre for Clinical Haematology, University Hospital Birmingham, Birmingham, UK
| | - Sylvain Choquet
- Clinical Hematology Unit, Groupe Hospitalier Pitié Salpêtrière, APHP, Sorbonne Université, Paris, France
| | | | | | | | | | - Armin Ghobadi
- Division of Oncology, Washington University, St Louis, MO, USA
| | | | | | - Aditi Mehta
- Atara Biotherapeutics, Thousand Oaks, CA, USA
| | | | - Sarah Nikiforow
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Richard J O'Reilly
- Transplant Service, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ran Reshef
- Blood and Marrow Transplantation and Cell Therapy Program, Columbia University Medical Center, New York, NY, USA
| | - Fiona Ruiz
- Atara Biotherapeutics, Thousand Oaks, CA, USA
| | | | - Susan Prockop
- Department of Pediatrics, Boston Children's Hospital-Dana Farber Cancer Institute, Boston, MA, USA.
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6
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Rozenblum L, Houillier C, Baptiste A, Soussain C, Edeline V, Naggara P, Soret M, Causse-Lemercier V, Willems L, Choquet S, Ursu R, Galanaud D, Belin L, Hoang-Xuan K, Kas A. Interim FDG-PET improves treatment failure prediction in primary central nervous system Lymphoma: a LOC network prospective multicentric study. Neuro Oncol 2024:noae029. [PMID: 38366824 DOI: 10.1093/neuonc/noae029] [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: 10/30/2023] [Indexed: 02/18/2024] Open
Abstract
PURPOSE The purpose of our study was to assess the predictive and prognostic role of 2-18F-fluoro-2-deoxy-D-glucose (FDG) PET/MRI during high-dose methotrexate-based chemotherapy (HD-MBC) in de novo primary central nervous system lymphoma (PCNSL) patients aged 60 and above. METHODS This prospective multicentric ancillary study included 65 immunocompetents patients who received induction HD-MBC as part of the BLOCAGE01 phase III trial. FDG-PET/MRI were acquired at baseline, post two cycles (PET/MRI2), and post-treatment (PET/MRI3). FDG-PET response was dichotomized, with "positive" indicating persistent tumor uptake higher than the contralateral mirroring brain region. Performances of FDG-PET and International PCNSL Collaborative Group criteria in predicting induction response, progression-free survival (PFS), and overall survival (OS) were compared. RESULTS Of 48 PET2 scans performed, nine were positive and aligned with a partial response (PR) on MRI2. Among these, eight (89%) progressed by the end of the induction phase. In contrast, 35/39 (90%) of PET2-negative patients achieved complete response (CR). Among the 18 discordant responses at interim (PETCR/MRIPR), 83% ultimately achieved CR. 87% of the PET2-negative patients were disease-free at 6 months versus 11% of the PET2-positive patients (p<0.001). The MRI2 response did not significantly differentiate patients based on their PFS, regardless of whether they were in CR or PR. Both PET2 and MRI2 independently predicted OS in multivariate analysis, with PET2 showing stronger association. CONCLUSION Our study highlights the potential of interim FDG-PET for early management of PCNSL patients. Response-driven treatment based on PET2 may guide future clinical trials.
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Affiliation(s)
- Laura Rozenblum
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, F-75006, Paris, France
| | - Caroline Houillier
- Department of Neurology 2 Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Paris, France
| | - Amandine Baptiste
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Paris, France
| | - Carole Soussain
- Department of Haematology, Institut Curie, Site Saint-Cloud and INSERM U932 Institut Curie, Université PSL, 75005 Paris, France
| | | | - Philippe Naggara
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Marine Soret
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, F-75006, Paris, France
| | - Valérie Causse-Lemercier
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Lise Willems
- Department of Haematology, Cochin Hospital, APHP, Paris
| | - Sylvain Choquet
- Department of Haematology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Renata Ursu
- Department of Neurology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, APHP, France
| | - Damien Galanaud
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, F-75006, Paris, France
- Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Lisa Belin
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Paris, France
| | - Khê Hoang-Xuan
- Department of Neurology 2 Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Paris, France
| | - Aurélie Kas
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, F-75006, Paris, France
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7
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Wilson MR, Kirkwood AA, Wong Doo N, Soussain C, Choquet S, Lees C, Fox C, Preston G, Ahearne M, Strüßmann T, Clavert A, Rusconi C, Ku M, Khwaja J, Narkhede M, Lewis K, Durot E, Smith J, Renaud L, Ferreri AJM, El-Galaly T, Cwynarski K, McKay P, Eyre TA. Dosage of high-dose methotrexate as CNS prophylaxis in DLBCL: A detailed analysis of toxicity and impact on CNS relapse. Am J Hematol 2024; 99:E46-E50. [PMID: 38037530 DOI: 10.1002/ajh.27167] [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: 08/18/2023] [Revised: 10/27/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Affiliation(s)
| | - Amy A Kirkwood
- Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, UK
| | - Nicole Wong Doo
- Concord Clinical School, Concord Hospital University of Sydney, Sydney, Australia
| | | | - Sylvain Choquet
- La Pitie Salpetriere Hospital, APHP-Sorbonne Universite, Paris, France
| | - Charlotte Lees
- Oxford University Hospitals NHS Trust, Churchill Cancer Center, Oxford, UK
| | | | | | | | - Tim Strüßmann
- University Medical Center Freiburg, Freiburg, Germany
| | - Aline Clavert
- Service des Maladies du Sang, CHU Angers, Angers, France
| | - Chiara Rusconi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matthew Ku
- St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Jahanzaib Khwaja
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Katharine Lewis
- Linear Clinical Research and Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Eric Durot
- Hôpital Robert Debré CHU de Reims, Reims, France
| | - Jeffery Smith
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Loic Renaud
- Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | - Kate Cwynarski
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Pam McKay
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Toby A Eyre
- Oxford University Hospitals NHS Trust, Churchill Cancer Center, Oxford, UK
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8
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Debureaux PE, Forgeard N, Elessa D, Harel S, Frenzel L, Royer B, Talbot A, Choquet S, Davi F, Nguyen-Khac F, Cuccuini W, Cheminant M, Bravetti C, Lazarian G, Kaltenbach S, Hermine O, Roos-Weil D, Espéli M, Balabanian K, Arnulf B. Inflammation is predictive of outcome in Waldenström macroglobulinemia treated by Bruton tyrosine kinase inhibitors: a multicentric real-life study. Haematologica 2024; 109:325-330. [PMID: 37584289 PMCID: PMC10772506 DOI: 10.3324/haematol.2023.283141] [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: 03/16/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023] Open
Affiliation(s)
- Pierre-Edouard Debureaux
- INSERM U1160 EMiLy, Institut de Recherche Saint-Louis, Université Paris-Cité, Paris, France; Department of Immuno Hematology, Hospital Saint-Louis, Assistance Publique Hopitaux de Paris, Paris.
| | - Nathalie Forgeard
- Department of Immuno Hematology, Hospital Saint-Louis, Assistance Publique Hopitaux de Paris, Paris, France; Sorbonne Université, Department of Hematology, Hospital Pitie-Salpetriere, Assistance Publique Hopitaux de Paris, Paris
| | - Dikelele Elessa
- Department of Immuno Hematology, Hospital Saint-Louis, Assistance Publique Hopitaux de Paris, Paris
| | - Stéphanie Harel
- Department of Immuno Hematology, Hospital Saint-Louis, Assistance Publique Hopitaux de Paris, Paris
| | - Laurent Frenzel
- Department of Hematology, Hospital Necker, Assistance Publique Hopitaux de Paris, Paris
| | - Bruno Royer
- Department of Immuno Hematology, Hospital Saint-Louis, Assistance Publique Hopitaux de Paris, Paris
| | - Alexis Talbot
- Department of Immuno Hematology, Hospital Saint-Louis, Assistance Publique Hopitaux de Paris, Paris
| | - Sylvain Choquet
- Sorbonne Université, Department of Hematology, Hospital Pitie-Salpetriere, Assistance Publique Hopitaux de Paris, Paris
| | - Frederic Davi
- Laboratory of Hematology, Hospital Pitie-Salpetriere, Assistance Publique Hopitaux de Paris, Paris
| | - Florence Nguyen-Khac
- Laboratory of Hematology, Hospital Pitie-Salpetriere, Assistance Publique Hopitaux de Paris, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, Université Paris Cité, Inserm UMRS1138, Drug Resistance in Hematological Malignancies Team, Paris
| | - Wendy Cuccuini
- Laboratory of Cytogenetic, Hospital Saint Louis, Assistance Publique Hopitaux de Paris, Paris
| | - Morgane Cheminant
- Department of Hematology, Hospital Necker, Assistance Publique Hopitaux de Paris, Paris
| | - Clotilde Bravetti
- Laboratory of Hematology, Hospital Pitie-Salpetriere, Assistance Publique Hopitaux de Paris, Paris
| | - Gregory Lazarian
- Laboratory of Hematology, Hospital Avicenne, Assistance Publique Hopitaux de Paris, Paris
| | - Sophie Kaltenbach
- Laboratory of Hematology, Hospital Necker, Assistance Publique Hopitaux de Paris, Paris
| | - Olivier Hermine
- Department of Hematology, Hospital Necker, Assistance Publique Hopitaux de Paris, Paris
| | - Damien Roos-Weil
- Sorbonne Université, Department of Hematology, Hospital Pitie-Salpetriere, Assistance Publique Hopitaux de Paris, Paris
| | - Marion Espéli
- INSERM U1160 EMiLy, Institut de Recherche Saint-Louis, Université Paris-Cité, Paris
| | - Karl Balabanian
- INSERM U1160 EMiLy, Institut de Recherche Saint-Louis, Université Paris-Cité, Paris
| | - Bertrand Arnulf
- Department of Immuno Hematology, Hospital Saint-Louis, Assistance Publique Hopitaux de Paris, Paris, France; University of Paris Cité, Paris.
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9
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Aboubakr O, Houillier C, Choquet S, Dupont S, Hoang-Xuan K, Mathon B. Epileptic seizures in patients with primary central nervous system lymphoma: A systematic review. Rev Neurol (Paris) 2023:S0035-3787(23)01116-5. [PMID: 38042665 DOI: 10.1016/j.neurol.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) accounts for less than 5% of primary brain tumors. Epileptic seizures are a common manifestation of brain tumors; however, literature on the prevalence, characteristics, and oncological implications of seizures in patients with PCNSL is limited, and the management of antiepileptic drugs (AEDs) is unclear. This review aimed to summarize the existing knowledge on seizures in PCNSL, their potential association with surgery, oncological treatment, survival rates, and management of AEDs. METHODS A systematic review was performed according to the PRISMA recommendations and included articles published between 1953 and 2023 describing seizures in patients with PCNSL. RESULTS The search identified 282 studies, of which 21 were included. Up to 33% of patients with PCNSL developed seizures, mostly at the initial presentation. Little information was found on changes in seizure incidence through the course of the disease, and no details were found on seizure frequency, the percentage of treatment-resistant patients, or the evolution of seizures at remission. Younger age, cortical location, and immunodeficiency have been identified as potential risk factors for seizures, but evidence is very limited. The growing use of vigorous treatments including intensive chemotherapy with autologous stem cell transplantation and immunotherapy with CAR-T cells is associated with a higher incidence of seizures. The association between seizure development and patient mortality in PCNSL remains unknown. There are no data on AED prophylaxis or the use of specific AEDs in PCNSL. CONCLUSIONS Further studies are needed to investigate seizures in larger cohorts of PCNSL, to clarify their prevalence, better characterize them, identify risk factors, analyze survival rates, and make recommendations on AED management. We recommend following general practice guidelines for seizures symptomatic of brain tumors and not to prescribe AED prophylaxis in PCNSL.
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Affiliation(s)
- O Aboubakr
- Sorbonne University, Department of Neurosurgery, la Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France
| | - C Houillier
- Department of Neurology 2 Mazarin, la Pitié-Salpêtrière Hospital, IHU, ICM, AP-HP, Sorbonne University, 75013 Paris, France
| | - S Choquet
- Department of Hematology, la Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France
| | - S Dupont
- Epileptology Unit, Department of Rehabilitation, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, 75013 Paris, France
| | - K Hoang-Xuan
- Department of Neurology 2 Mazarin, la Pitié-Salpêtrière Hospital, IHU, ICM, AP-HP, Sorbonne University, 75013 Paris, France
| | - B Mathon
- Sorbonne University, Department of Neurosurgery, la Pitié-Salpêtrière Hospital, AP-HP, 75013 Paris, France; Paris Brain Institute, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne University, UMRS 1127, 75013 Paris, France; GRC 23, Brain Machine Interface, la Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France.
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10
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Khoury E, Maalouf H, Mendola A, Boutry S, Camboni A, D’Angiolella V, Choquet S, Landman-Parker J, Besson C, Poirel HA, Limaye N. CCNF (Cyclin F) as a Candidate Gene for Familial Hodgkin Lymphoma: Additional Evidence for the Importance of Mitotic Checkpoint Defects in Tumorigenesis. Hemasphere 2023; 7:e985. [PMID: 38026792 PMCID: PMC10656094 DOI: 10.1097/hs9.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Elsa Khoury
- Genetics of Autoimmune Diseases and Cancer, de Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Hiba Maalouf
- Genetics of Autoimmune Diseases and Cancer, de Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Antonella Mendola
- Human Molecular Genetics, de Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Simon Boutry
- Human Molecular Genetics, de Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Alessandra Camboni
- Pathology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Vincenzo D’Angiolella
- Department of Oncology, Medical Research Council Institute for Radiation Oncology, University of Oxford, United Kingdom
| | - Sylvain Choquet
- Service d’Hématologie, CHU La Pitié Salpétrière, Paris, France
- French Registry of Familial Lymphoid Neoplasms, Paris, France
| | - Judith Landman-Parker
- Service d’Hématologie et d’Oncologie Pédiatrique, Hôpital Armand Trousseau, Paris, France
| | - Caroline Besson
- Unité d’Hémato-Oncologie, Centre Hospitalier de Versailles, Le Chesnay, France
- Centre for Research in Epidemiology and Population Health (CESP), INSERM Unit 1018, Villejuif, France
| | | | - Nisha Limaye
- Genetics of Autoimmune Diseases and Cancer, de Duve Institute, Université catholique de Louvain, Brussels, Belgium
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11
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Desramé J, Baize N, Anota A, Laribi K, Stefani L, Hjiej S, Nabirotchkina E, Zelek L, Choquet S. Fatigue visual analogue scale score correlates with quality of life in cancer patients receiving epoetin alfa (Sandoz) for chemotherapy-induced anaemia: The CIROCO study. Cancer Treat Res Commun 2023; 37:100781. [PMID: 38039763 DOI: 10.1016/j.ctarc.2023.100781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/25/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE Available tools to measure fatigue and health-related quality of life (HRQoL) in cancer patients are often difficult to use in clinical practice. The fatigue visual analogue scale (VAS) provides a simple method to assess fatigue. This study evaluated the correlation between HRQoL and fatigue perceived by cancer patients undergoing chemotherapy. METHODS This was a non-interventional prospective study of adult cancer patients in France presenting with chemotherapy-induced anaemia (CIA) treated with epoetin alfa (Sandoz). Data were collected using an electronic case report form at study inclusion (T0), after 2-3 chemotherapy cycles (T1) and after 4-6 cycles (T2). RESULTS The study included 982 patients from September 2015 to October 2017. Overall, there was a negative correlation between fatigue VAS and HRQoL. The overall haemoglobin (Hb) change between T0 and T2 was +17.8 % (± 18.1 %). Fatigue assessed by both patients and physicians showed a clinically significant improvement during the study. Global HRQoL also increased. CONCLUSION Treatment of CIA with epoetin alfa (Sandoz) improved Hb levels, fatigue, and HRQoL, with a correlation observed between fatigue VAS score and HRQoL. Fatigue VAS could act as a simple alternative to more complex methods to measure HRQoL; however, further analyses are required to confirm this association.
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Affiliation(s)
- Jerome Desramé
- Institut Privé de Cancérologie, Hôpital Privé Jean Mermoz, 55 Av. Jean Mermoz, 69373, Lyon 69008, France.
| | - Nathalie Baize
- Centre Hospitalier Départemental Vendée, Bd Stéphane Moreau, La Roche-sur-Yon 85000, France
| | - Amélie Anota
- Methodology and Quality of Life in Oncology Unit, University Hospital of Besançon, Besançon, France; French National Platform Quality of Life and Cancer, Besançon, France; Department of Biostatistics, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, Lyon 69008, France
| | - Kamel Laribi
- Centre Hospitalier Le Mans, 194 Av. Rubillard, Le Mans 72037, France
| | - Laetitia Stefani
- Centre Hospitalier Annecy Genevois, 1 Av. De l'Hôpital, Epagny Metz-Tessy 74370, France
| | - Salim Hjiej
- Sandoz, 49 Av. Georges Pompidou, Levallois-Perret 92300, France
| | | | - Laurent Zelek
- Department of Medical Oncology, Hôpital Avicenne, Hôpitaux Universitaires Paris Seine-Saint-Denis, Assistance Publique - Hôpitaux de Paris, Université Sorbonne Paris Nord, 125, rue de Stalingrad 93000 Bobigny, Paris, France
| | - Sylvain Choquet
- Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris -Sorbonne Université, 83 Boulevard de l'Hôpital, Paris 75651, France
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12
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Caillet A, Houillier C, Sourdeau E, Gazzano M, Uzunov M, Friser V, Ribeiro M, Nicelli L, Azar N, Baron M, Phina-Ziebin X, Choquet S, Roos-Weil D. Successful treatment by CAR T-cells in multi-refractory mantle cell lymphoma with central nervous system involvement. Ann Hematol 2023; 102:3295-3297. [PMID: 37580574 DOI: 10.1007/s00277-023-05408-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Adrien Caillet
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Caroline Houillier
- IHU, ICM, Neurology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Elise Sourdeau
- Service d'Hématologie Biologique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Marianne Gazzano
- Department of Immunology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Madalina Uzunov
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Valérie Friser
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Monica Ribeiro
- IHU, ICM, Neurology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Lucia Nicelli
- Neuroradiology Unit, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Paris, France
| | - Nabih Azar
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Marine Baron
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Xavier Phina-Ziebin
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Sylvain Choquet
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France
| | - Damien Roos-Weil
- Service d'Hématologie Clinique, Hôpital Pitié-Salpêtrière, AP-HP, Sorbonne Université, 47-83 Bd de l'Hôpital 75651, Paris Cedex, France.
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13
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Walczak P, Choquet S, Dantal J, Boutboul D, Suarez F, Baron M, Morel V, Cluzeau T, Touati M, Elias M, Bachy E, Nicolas-Virelizier E, Houot R, Venton G, Jacquet C, Moles-Moreau MP, Jardin F, Durot E, Balegroune N, Ecotiere L, Guieze R, Kamar N, Ysebaert L, Couzi L, Gonzalez H, Roulin L, Ou K, Caillard S, Zimmermann H, Trappe RU, Roos-Weil D. Post-transplantation Burkitt lymphoma: a retrospective study of 55 patients. Haematologica 2023; 108:2814-2819. [PMID: 36891749 PMCID: PMC10543171 DOI: 10.3324/haematol.2022.282297] [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: 11/08/2022] [Accepted: 03/01/2023] [Indexed: 03/10/2023] Open
Affiliation(s)
- Pierre Walczak
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, APHP, Paris
| | - Sylvain Choquet
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, APHP, Paris
| | - Jacques Dantal
- Institut de Transplantation Urologie Nephrologie (ITUN), Service de Nephrologie et Immunologie clinique, CHU Nantes, Nantes
| | - David Boutboul
- Service d'Immunologie Clinique, Hopital Saint-Louis, APHP, Paris
| | - Felipe Suarez
- Service d'Hematologie Clinique, Hopital Necker, APHP, Paris
| | - Marine Baron
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, APHP, Paris
| | - Veronique Morel
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, APHP, Paris
| | | | | | - Michelle Elias
- Service de Nephrologie, Hopital Saint-Louis, APHP, Paris
| | - Emmanuel Bachy
- Service d'Hematologie Clinique, Hospices Civils de Lyon, Pierre-Benite
| | | | - Roch Houot
- Service d'hematologie, CHU Rennes, Universite de Rennes, INSERM U1236, Rennes
| | - Geoffroy Venton
- Service d'Hematologie et Therapie Cellulaire, Hopital universitaire de la Conception, Marseille
| | | | | | | | - Eric Durot
- CHU Reims, Hematologie Clinique, F-51100 Reims
| | - Noureddine Balegroune
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, APHP, Paris
| | - Laure Ecotiere
- Service de Nephrologie, Hemodialyse et Transplantation renale, Centre Hospitalier Universitaire de Poitiers, Poitiers
| | - Romain Guieze
- Service d'Hematologie Clinique et Therapie Cellulaire, CHU Clermont-Ferrand, Clermont-Ferrand France
| | - Nassim Kamar
- Service de Nephrologie et Transplantation d'Organes, CHU Rangueil, Toulouse
| | - Loic Ysebaert
- Service d'Hematologie, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse
| | - Lionel Couzi
- Service de Nephrologie, transplantation, dialyse et aphereses, CHU Bordeaux
| | - Hugo Gonzalez
- Service d'Hematologie, Centre Hospitalier Rene-Dubos, Pontoise
| | - Louise Roulin
- Service Unite Hemopathies Lymphoides, Groupe Hospitalo-universitaire Chenevier Mondor, APHP Creteil
| | - Kevin Ou
- Service de Nephrologie et Transplantation Renale, Hopital Foch, Suresnes
| | - Sophie Caillard
- Service de Nephrologie et Transplantation Renale, CHU de Strasbourg, Strasbourg
| | - Heiner Zimmermann
- Department of Internal Medicine-Oncology, Carl v. Ossietzky University of Oldenburg, Pius-Hospital, Oldenburg, Germany; Department of Haematology and Oncology, DIAKO Ev. Diakonie-Krankenhaus Bremen, Gropelinger Heerstr. 406-408, 28239, Bremen
| | - Ralf Ulrich Trappe
- Department of Haematology and Oncology, DIAKO Ev. Diakonie-Krankenhaus Bremen, Gropelinger Heerstr. 406-408, 28239, Bremen, Germany; Department of Internal Medicine II: Haematology and Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel
| | - Damien Roos-Weil
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, APHP, Paris.
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14
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Houot R, Bachy E, Cartron G, Gros FX, Morschhauser F, Oberic L, Gastinne T, Feugier P, Duléry R, Thieblemont C, Joris M, Jardin F, Choquet S, Casasnovas O, Brisou G, Cheminant M, Bay JO, Gutierrez FL, Menard C, Tarte K, Delfau MH, Portugues C, Itti E, Palard-Novello X, Blanc-Durand P, Al Tabaa Y, Bailly C, Laurent C, Lemonnier F. Publisher Correction: Axicabtagene ciloleucel as second-line therapy in large B cell lymphoma ineligible for autologous stem cell transplantation: a phase 2 trial. Nat Med 2023; 29:2665. [PMID: 37814064 PMCID: PMC10579050 DOI: 10.1038/s41591-023-02624-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Affiliation(s)
- Roch Houot
- Department of Hematology, University Hospital of Rennes, UMR U1236, INSERM, University of Rennes, French Blood Establishment, Rennes, France.
| | - Emmanuel Bachy
- Department of Hematology, Lyon Sud Hospital Center, INSERM U1111, Lyon, France
| | - Guillaume Cartron
- Department of Hematology, University Hospital of Montpellier, UMR-CNRS 5535, Montpellier, France
| | - François-Xavier Gros
- Department of Clinical Hematology and Cellular Therapy, University Hospital of Bordeaux, Bordeaux, France
| | | | - Lucie Oberic
- Department of Hematology, Cancer University Institute of Toulouse Oncopole, Toulouse, France
| | - Thomas Gastinne
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Pierre Feugier
- Department of Hematology, University Hospital of Nancy, INSERM 1256, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Rémy Duléry
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, AP-HP, INSERM UMR938, Paris, France
| | | | - Magalie Joris
- Department of Hematology, University Hospital of Amiens, Amiens, France
| | - Fabrice Jardin
- Department of Clinical Hematology, Henri Becquerel Center, INSERM U1245, Rouen, France
| | - Sylvain Choquet
- Department of Hematology, University Hospital Pitié Salpêtrière, AP-HP, Sorbonne University, Paris, France
| | - Olivier Casasnovas
- Department of Clinical Hematology, Dijon University Hospital, INSERM UMR1231, Dijon, France
| | - Gabriel Brisou
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Morgane Cheminant
- Department of Clinical Hematology, Necker-Enfants Malades University Hospital, AP-HP, INSERM UMR1163, Paris, France
| | - Jacques-Olivier Bay
- Department of Clinical Hematology and Cellular Therapy, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | | | - Cédric Menard
- French Blood Establishment and SITI Laboratory, UMR U1236, INSERM, University of Rennes, University Hospital Center of Rennes, Rennes, France
| | - Karin Tarte
- French Blood Establishment and SITI Laboratory, UMR U1236, INSERM, University of Rennes, University Hospital Center of Rennes, Rennes, France
| | | | - Cédric Portugues
- Department of Biostatistics, LYSARC, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Henri Mondor Hospital, Créteil, France
| | - Xavier Palard-Novello
- Department of Nuclear Medicine, University of Rennes, CLCC Eugène Marquis, INSERM, Rennes, France
| | - Paul Blanc-Durand
- Department of Nuclear Medicine, CHU H. Mondor, U-PEC, AP-HP, Créteil, France
| | | | - Clément Bailly
- Nantes-Angers Cancer Research Center CRCI2NA, University of Nantes, INSERM UMR1307, CNRS-ERL6075, Nantes, France
| | - Camille Laurent
- Department of Pathology, Cancer University Institute of Toulouse Oncopole, CHU Toulouse, CRCT INSERM U1037, Toulouse, France
| | - François Lemonnier
- Lymphoid Malignancies Unit, Henri Mondor Hospital, Mondor Institute for Biomedical Research, INSERM U955, University Paris-Est, Créteil, France
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15
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Houot R, Bachy E, Cartron G, Gros FX, Morschhauser F, Oberic L, Gastinne T, Feugier P, Duléry R, Thieblemont C, Joris M, Jardin F, Choquet S, Casasnovas O, Brisou G, Cheminant M, Bay JO, Gutierrez FL, Menard C, Tarte K, Delfau MH, Portugues C, Itti E, Palard-Novello X, Blanc-Durand P, Al Tabaa Y, Bailly C, Laurent C, Lemonnier F. Axicabtagene ciloleucel as second-line therapy in large B cell lymphoma ineligible for autologous stem cell transplantation: a phase 2 trial. Nat Med 2023; 29:2593-2601. [PMID: 37710005 PMCID: PMC10579056 DOI: 10.1038/s41591-023-02572-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
Axicabtagene ciloleucel (axi-cel) demonstrated superior efficacy compared to standard of care as second-line therapy in patients with high-risk relapsed/refractory (R/R) large B cell lymphoma (LBCL) considered eligible for autologous stem cell transplantation (ASCT); however, in clinical practice, roughly half of patients with R/R LBCL are deemed unsuitable candidates for ASCT. The efficacy of axi-cel remains to be ascertained in transplant-ineligible patients. ALYCANTE, an open-label, phase 2 study, evaluated axi-cel as a second-line therapy in 62 patients with R/R LBCL who were considered ineligible for ASCT. The primary end point was investigator-assessed complete metabolic response at 3 months from the axi-cel infusion. Key secondary end points included progression-free survival, overall survival and safety. The study met its primary end point with a complete metabolic response of 71.0% (95% confidence interval, 58.1-81.8%) at 3 months. With a median follow-up of 12.0 months (range, 2.1-17.9), median progression-free survival was 11.8 months (95% confidence interval, 8.4-not reached) and overall survival was not reached. There was no unexpected toxicity. Grade 3-4 cytokine release syndrome and neurologic events occurred in 8.1% and 14.5% of patients, respectively. These results support axi-cel as second-line therapy in patients with R/R LBCL ineligible for ASCT. ClinicalTrials.gov Identifier: NCT04531046 .
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Affiliation(s)
- Roch Houot
- Department of Hematology, University Hospital of Rennes, UMR U1236, INSERM, University of Rennes, French Blood Establishment, Rennes, France.
| | - Emmanuel Bachy
- Department of Hematology, Lyon Sud Hospital Center, INSERM U1111, Lyon, France
| | - Guillaume Cartron
- Department of Hematology, University Hospital of Montpellier, UMR-CNRS 5535, Montpellier, France
| | - François-Xavier Gros
- Department of Clinical Hematology and Cellular Therapy, University Hospital of Bordeaux, Bordeaux, France
| | | | - Lucie Oberic
- Department of Hematology, Cancer University Institute of Toulouse Oncopole, Toulouse, France
| | - Thomas Gastinne
- Department of Hematology, University Hospital of Nantes, Nantes, France
| | - Pierre Feugier
- Department of Hematology, University Hospital of Nancy, INSERM 1256, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Rémy Duléry
- Department of Clinical Hematology and Cellular Therapy, Sorbonne University, Saint-Antoine Hospital, AP-HP, INSERM UMR938, Paris, France
| | | | - Magalie Joris
- Department of Hematology, University Hospital of Amiens, Amiens, France
| | - Fabrice Jardin
- Department of Clinical Hematology, Henri Becquerel Center, INSERM U1245, Rouen, France
| | - Sylvain Choquet
- Department of Hematology, University Hospital Pitié Salpêtrière, AP-HP, Sorbonne University, Paris, France
| | - Olivier Casasnovas
- Department of Clinical Hematology, Dijon University Hospital, INSERM UMR1231, Dijon, France
| | - Gabriel Brisou
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | - Morgane Cheminant
- Department of Clinical Hematology, Necker-Enfants Malades University Hospital, AP-HP, INSERM UMR1163, Paris, France
| | - Jacques-Olivier Bay
- Department of Clinical Hematology and Cellular Therapy, Clermont-Ferrand University Hospital Center, Clermont-Ferrand, France
| | | | - Cédric Menard
- French Blood Establishment and SITI Laboratory, UMR U1236, INSERM, University of Rennes, University Hospital Center of Rennes, Rennes, France
| | - Karin Tarte
- French Blood Establishment and SITI Laboratory, UMR U1236, INSERM, University of Rennes, University Hospital Center of Rennes, Rennes, France
| | | | - Cédric Portugues
- Department of Biostatistics, LYSARC, Lyon-Sud Hospital, Pierre-Bénite, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Henri Mondor Hospital, Créteil, France
| | - Xavier Palard-Novello
- Department of Nuclear Medicine, University of Rennes, CLCC Eugène Marquis, INSERM, Rennes, France
| | - Paul Blanc-Durand
- Department of Nuclear Medicine, CHU H. Mondor, U-PEC, AP-HP, Créteil, France
| | | | - Clément Bailly
- Nantes-Angers Cancer Research Center CRCI2NA, University of Nantes, INSERM UMR1307, CNRS-ERL6075, Nantes, France
| | - Camille Laurent
- Department of Pathology, Cancer University Institute of Toulouse Oncopole, CHU Toulouse, CRCT INSERM U1037, Toulouse, France
| | - François Lemonnier
- Lymphoid Malignancies Unit, Henri Mondor Hospital, Mondor Institute for Biomedical Research, INSERM U955, University Paris-Est, Créteil, France
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16
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Rozenblum L, Galanaud D, Houillier C, Soussain C, Baptiste A, Belin L, Edeline V, Naggara P, Soret M, Causse-Lemercier V, Willems L, Choquet S, Ursu R, Hoang-Xuan K, Kas A. [18F]FDG PET-MRI provides survival biomarkers in primary central nervous system lymphoma in the elderly: an ancillary study from the BLOCAGE trial of the LOC network. Eur J Nucl Med Mol Imaging 2023; 50:3684-3696. [PMID: 37462774 DOI: 10.1007/s00259-023-06334-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/05/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Primary central nervous system lymphoma (PCNSL) incidence is rising among elderly patients, presenting challenges due to poor prognosis and treatment-related toxicity risks. This study explores the potential of combining [18F]fluorodeoxyglucose ([18F]FDG) PET scans and multimodal MRI for improving management in elderly patients with de novo PCNSL. METHODS Immunocompetent patients over 60 years with de novo PCNSL were prospectively enrolled in a multicentric study between January 2016 and April 2021. Patients underwent brain [18F]FDG PET-MRI before receiving high-dose methotrexate-based chemotherapy. Relationships between extracted PET (metabolic tumor volume (MTV), sum of MTV for up to five lesions (sumMTV), metabolic imaging lymphoma aggressiveness score (MILAS)) and MRI parameters (tumor contrast-enhancement size, cerebral blood volume (CBV), cerebral blood flow (CBF), apparent diffusion coefficient (ADC)) and treatment response and outcomes were analyzed. RESULTS Of 54 newly diagnosed diffuse large B-cell PCNSL patients, 52 had positive PET and MRI with highly [18F]FDG-avid and contrast-enhanced disease (SUVmax: 27.7 [22.8-36]). High [18F]FDG uptake and metabolic volume were significantly associated with low ADCmean values and high CBF at baseline. Among patients, 69% achieved an objective response at the end of induction therapy, while 17 were progressive. Higher cerebellar SUVmean and lower sumMTV at diagnosis were significant predictors of complete response: 6.4 [5.7-7.7] vs 5.4 [4.5-6.6] (p = 0.04) and 5.5 [2.1-13.3] vs 15.9 [4.2-19.5] (p = 0.01), respectively. Two-year overall survival (OS) was 71%, with a median progression-free survival (PFS) of 29.6 months and a median follow-up of 37 months. Larger tumor volumes on PET or enhanced T1-weighted MRI were significant predictors of poorer OS, while a high MILAS score at diagnosis was associated with early death (< 1 year). CONCLUSION Baseline cerebellar metabolism and sumMTV may predict response to end of chemotherapy in PCNSL. Tumor volume and MILAS at baseline are strong prognostic factors.
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Affiliation(s)
- Laura Rozenblum
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France.
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France.
| | - Damien Galanaud
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
- Department of Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Caroline Houillier
- Deparrment of Neurology 2 Mazarin, APHP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Paris, France
| | - Carole Soussain
- Department of Hematology, Institut Curie, Site Saint-Cloud and INSERM U932 Institut Curie, Université PSL, 75005, Paris, France
| | - Amandine Baptiste
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Paris, France
| | - Lisa Belin
- Department of Public Health, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Santé Publique, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Paris, France
| | | | - Philippe Naggara
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Marine Soret
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| | - Valérie Causse-Lemercier
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Lise Willems
- Department of Hematology, Cochin Hospital, APHP, Paris, France
| | - Sylvain Choquet
- Department of Hematology, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Renata Ursu
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Louis, Service de Neurologie, Paris, France
| | - Khê Hoang-Xuan
- Deparrment of Neurology 2 Mazarin, APHP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Paris, France
| | - Aurélie Kas
- Department of Nuclear Medicine, Groupe Hospitalier Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
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17
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Houot R, Bay JO, Chevallier P, Choquet S, Fornecker LM, Ianotto JC, Jaccard A, Jardin F, Legros L, Lemonnier F, Park S, Pascal L, Soussain C, Gyan E. [Creating a community of heads of department to meet hospital system challenges: First experience in haematology]. Bull Cancer 2023; 110:950-954. [PMID: 37507237 DOI: 10.1016/j.bulcan.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 07/30/2023]
Abstract
The French hospital system crises are constantly forcing the heads of departments to adapt and find solutions for maintaining optimal patient care in a context of staff shortage. Facing these challenges, we had the desire to create a community of department heads capable of helping each other, sharing their experiences, relying on collective intelligence and, ultimately, contributing to rebuilding their hospitals from the bottom up. In this respect, we arranged a two-day seminar, which brought together fourteen heads of hematology departments who share the same desire to challenge their organizations with a collaborative approach and make them evolve. The seminar was animated by an external speaker and included many fruitful sessions, both formal and informal. Following this seminar, participants are now interested in sharing this experience with other department heads throughout the organization of "collaborative seminars of heads of department." Such seminars would serve to create a real community of department heads capable of supporting each other to improve our organizations and to generate new ideas to participate in the reconstruction of our health system from the bottom. This approach is in line with the current strategy of public services to restore a prominent role to hospital departments. We hope that our initiative will also inspire heads of departments in other specialties.
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Affiliation(s)
- Roch Houot
- CHU de Rennes, service d'hématologie, Rennes, France.
| | - Jacques-Olivier Bay
- CHU de Clermont-Ferrand, service de thérapie cellulaire et d'hématologie clinique adulte, Clermont-Ferrand, France
| | | | - Sylvain Choquet
- AP-HP, hôpital de la Pitié-Salpêtrière, Sorbonne université, service d'hématologie clinique, Paris, France
| | | | - Jean-Christophe Ianotto
- CHU de Brest, institut de cancérologie et d'hématologie, service d'hématologie clinique, Brest, France
| | - Arnaud Jaccard
- CHU de Limoges, service d'hématologie clinique et de thérapie cellulaire, Limoges, France
| | - Fabrice Jardin
- Centre Henri-Becquerel, service d'hématologie, Rouen, France
| | - Laurence Legros
- AP-HP, université PARIS-Saclay, service d'hématologie clinique, Bicêtre, France
| | - François Lemonnier
- AP-HP, groupe hospitalier Henri-Mondor, unité hémopathies lymphoïdes, Créteil, France
| | - Sophie Park
- CHU de Grenoble-Alpes, clinique universitaire d'hématologie, Grenoble, France
| | - Laurent Pascal
- Hôpital Saint-Vincent de Paul, groupement des hôpitaux de l'institut catholique de Lille, service d'onco-hématologie, Lille, France
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18
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Detroit M, Collier M, Beeker N, Willems L, Decroocq J, Deau-Fischer B, Vignon M, Birsen R, Moufle F, Leclaire C, Balladur E, Deschamps P, Chauchet A, Batista R, Limat S, Treluyer JM, Ricard L, Stocker N, Hermine O, Choquet S, Morel V, Metz C, Bouscary D, Kroemer M, Zerbit J. Predictive Factors of Response to Immunotherapy in Lymphomas: A Multicentre Clinical Data Warehouse Study (PRONOSTIM). Cancers (Basel) 2023; 15:4028. [PMID: 37627056 PMCID: PMC10452259 DOI: 10.3390/cancers15164028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Immunotherapy (IT) is a major therapeutic strategy for lymphoma, significantly improving patient prognosis. IT remains ineffective for a significant number of patients, however, and exposes them to specific toxicities. The identification predictive factors around efficacy and toxicity would allow better targeting of patients with a higher ratio of benefit to risk. PRONOSTIM is a multicenter and retrospective study using the Clinical Data Warehouse (CDW) of the Greater Paris University Hospitals network. Adult patients with Hodgkin lymphoma or diffuse large-cell B lymphoma treated with immune checkpoint inhibitors or CAR T (Chimeric antigen receptor T) cells between 2017 and 2022 were included. Analysis of covariates influencing progression-free survival (PFS) or the occurrence of grade ≥3 toxicity was performed. In total, 249 patients were included. From this study, already known predictors for response or toxicity of CAR T cells such as age, elevated lactate dehydrogenase, and elevated C-Reactive Protein at the time of infusion were confirmed. In addition, male gender, low hemoglobin, and hypo- or hyperkalemia were demonstrated to be potential predictive factors for progression after CAR T cell therapy. These findings prove the attractiveness of CDW in generating real-world data, and show its essential contribution to identifying new predictors for decision support before starting IT.
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Affiliation(s)
- Marion Detroit
- Pharmacy Department, Pitié-Salpêtrière Hospital, Greater Paris University Hospitals (AP-HP), Sorbonne University, 75013 Paris, France; (M.D.); (C.M.)
| | - Mathis Collier
- Clinical Research Unit, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (M.C.); (N.B.); (J.-M.T.)
| | - Nathanaël Beeker
- Clinical Research Unit, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (M.C.); (N.B.); (J.-M.T.)
| | - Lise Willems
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Justine Decroocq
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Bénédicte Deau-Fischer
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Marguerite Vignon
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Rudy Birsen
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Frederique Moufle
- Adult Department, Hospital at Home, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (F.M.); (C.L.); (E.B.)
| | - Clément Leclaire
- Adult Department, Hospital at Home, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (F.M.); (C.L.); (E.B.)
| | - Elisabeth Balladur
- Adult Department, Hospital at Home, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (F.M.); (C.L.); (E.B.)
| | - Paul Deschamps
- Hematology Oncology Department, André Mignot Hospital, 78157 Le Chesnay, France;
| | - Adrien Chauchet
- Hematology Department, University Hospital of Besançon, 25000 Besançon, France;
| | - Rui Batista
- Pharmacy Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France;
| | - Samuel Limat
- Pharmacy Department, University Hospital of Besançon, 25000 Besançon, France; (S.L.); (M.K.)
- French National Institute of Health and Medical Research (INSERM), Etablissement Français du Sang Bourgogne Franche-Comte (EFS BFC), UMR1098, RIGHT, University of Bourgogne Franche-Comté, 25000 Besançon, France
| | - Jean-Marc Treluyer
- Clinical Research Unit, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (M.C.); (N.B.); (J.-M.T.)
- Regional Pharmacovigilance Center, Pharmacology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France
| | - Laure Ricard
- Hematology Department, Saint Antoine Hospital, AP-HP, INSERM UMRs 938, Sorbonne University, 75012 Paris, France; (L.R.); (N.S.)
| | - Nicolas Stocker
- Hematology Department, Saint Antoine Hospital, AP-HP, INSERM UMRs 938, Sorbonne University, 75012 Paris, France; (L.R.); (N.S.)
| | - Olivier Hermine
- Hematology Department, Necker Hospital, AP-HP, Centre Paris-Cité University, 75015 Paris, France;
| | - Sylvain Choquet
- Hematology Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France; (S.C.); (V.M.)
| | - Véronique Morel
- Hematology Department, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France; (S.C.); (V.M.)
| | - Carole Metz
- Pharmacy Department, Pitié-Salpêtrière Hospital, Greater Paris University Hospitals (AP-HP), Sorbonne University, 75013 Paris, France; (M.D.); (C.M.)
| | - Didier Bouscary
- Hematology Department, Cochin Hospital, AP-HP, Centre Paris-Cité University, 75014 Paris, France; (L.W.); (J.D.); (B.D.-F.); (M.V.); (R.B.); (D.B.)
| | - Marie Kroemer
- Pharmacy Department, University Hospital of Besançon, 25000 Besançon, France; (S.L.); (M.K.)
- French National Institute of Health and Medical Research (INSERM), Etablissement Français du Sang Bourgogne Franche-Comte (EFS BFC), UMR1098, RIGHT, University of Bourgogne Franche-Comté, 25000 Besançon, France
| | - Jérémie Zerbit
- Cancer Treatment Unit, Pharmacy Department, Hospital at Home, AP-HP, Centre Paris-Cité University, 75014 Paris, France
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19
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Soussain C, Malaise D, Choquet S, Ghesquières H, Houillier C. Long-lasting CRs after ibrutinib monotherapy for relapse or refractory primary CNS lymphoma (PCNSL) and primary vitreoretinal lymphoma (PVRL): Long-term results of the iLOC study by the Lymphoma Study Association (LYSA) and the French Oculo-Cerebral Lymphoma (LOC) Network (clinical trial number: NCT02542514). Eur J Cancer 2023; 189:112909. [PMID: 37301714 DOI: 10.1016/j.ejca.2023.04.025] [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: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Carole Soussain
- Hematology, Institut Curie, Site Saint-Cloud, Saint-Cloud, France.
| | - Denis Malaise
- Ophthalmology, Institut Curie, Site Paris, Université Paris V Descartes et PSL (Paris Science et Lettre), Paris, France
| | - Sylvain Choquet
- Hematology, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Hervé Ghesquières
- Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Caroline Houillier
- APHP, Sorbonne Université, IHU, ICM, Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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20
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Ghembaza A, Boleto G, Bommelaer M, Karras A, Javaugue V, Bridoux F, Alyanakian MA, Molinier Frenkel V, Ghillani-Dalbin P, Musset L, Barete S, Roosweil D, Choquet S, Le Joncour A, Mirouse A, Lipsker D, Faguer S, Vieira M, Cacoub P, Biard L, Saadoun D. Prognosis and long-term outcomes in type I cryoglobulinemia: A multicenter study of 168 patients. Am J Hematol 2023. [PMID: 37139676 DOI: 10.1002/ajh.26944] [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: 01/12/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/05/2023]
Abstract
Type I cryoglobulinemia (CG) accounts for 10%-15% of all cryoglobulinemias and are exclusively seen in clonal proliferative hematologic conditions. In this multicenter nationwide cohort study, we analyzed the prognosis and long-term outcomes of 168 patients with type I CG (93 (55.4%) IgM and 75 [44.6%] IgG). Five- and 10-year event-free survivals (EFS) were 26.5% (95% CI 18.2%-38.4%) and 20.8% (95% CI 13.1%-33.1%), respectively. In multivariable analysis, factors associated with poorer EFS were renal involvement (HR: 2.42, 95% CI 1.41-4.17, p = .001) and IgG type I CG (HR: 1.96, 95% CI 1.13-3.33, p = 0.016), regardless of underlying hematological disorders. IgG type I CG patients had higher cumulative incidence of relapse (94.6% [95% CI 57.8%-99.4%] vs. 56.6% [95% CI 36.6%-72.4%], p = .0002) and death at 10 years (35.8% [19.8%-64.6%] vs. 71.3% [54.0%-94.2%], p = .01) as compared to IgM CG, respectively. Overall, complete response of type I CG at 6 months was 38.7%, with no significant difference between Igs isotypes. In conclusion, renal involvement and IgG CG were identified as independent poor prognostic factors of type I CG.
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Affiliation(s)
- Amine Ghembaza
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de médecine interne et d'immunologie clinique, Paris, France
- AP-HP, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
- Institut national de la santé et de la recherche médicale, INSERM, UMR_S 959, Paris, France
- CNRS, FRE3632, Paris, France
| | - Gonçalo Boleto
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de médecine interne et d'immunologie clinique, Paris, France
- AP-HP, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
- Institut national de la santé et de la recherche médicale, INSERM, UMR_S 959, Paris, France
- CNRS, FRE3632, Paris, France
- Instituto Português de Reumatologia, Lisbon, Portugal
| | - Marin Bommelaer
- Service de Biostatistique et Information Médicale, AP-HP Hôpital Saint-Louis - INSERM, UMR1153, Paris, France
| | - Alexandre Karras
- Département de néphrologie, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | - Vincent Javaugue
- Service de néphrologie et Centre National de référence amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
- CNRS UMR 7276, INSERM UMR 1262, Université de Limoges, Limoges, France
| | - Frank Bridoux
- Service de néphrologie et Centre National de référence amylose AL et autres maladies à dépôts d'immunoglobulines monoclonales, Centre Hospitalier Universitaire, Université de Poitiers, Poitiers, France
- CNRS UMR 7276, INSERM UMR 1262, Université de Limoges, Limoges, France
| | - Marie-Alexandra Alyanakian
- Laboratoire d'immunologie, Hôpital Necker-Enfants Malades, AP-HP et Institut Necker-Enfants malades (INEM), Paris, France
| | | | | | - Lucile Musset
- Laboratoire d'immunochimie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Stéphane Barete
- Unité fonctionnelle de dermatologie, service de médecine interne, Hôpital Pitié-Salpêtrière, Paris, France
| | - Damien Roosweil
- Service d'hématologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sylvain Choquet
- Service d'hématologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alexandre Le Joncour
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de médecine interne et d'immunologie clinique, Paris, France
- AP-HP, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
- Institut national de la santé et de la recherche médicale, INSERM, UMR_S 959, Paris, France
- CNRS, FRE3632, Paris, France
| | - Adrien Mirouse
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de médecine interne et d'immunologie clinique, Paris, France
- AP-HP, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
- Institut national de la santé et de la recherche médicale, INSERM, UMR_S 959, Paris, France
- CNRS, FRE3632, Paris, France
| | - Dan Lipsker
- Clinique dermatologique, Université de Strasbourg, Strasbourg, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'Organes, Centre de Référence des Maladies Rénales Rares, Hôpital Rangueil, Institut National de la Santé et de la Recherche Médicale, UMR 1297, Université Paul Sabatier - Toulouse 3, Toulouse, France
| | - Matheus Vieira
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de médecine interne et d'immunologie clinique, Paris, France
- AP-HP, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
- Institut national de la santé et de la recherche médicale, INSERM, UMR_S 959, Paris, France
- CNRS, FRE3632, Paris, France
| | - Patrice Cacoub
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de médecine interne et d'immunologie clinique, Paris, France
- AP-HP, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
- Institut national de la santé et de la recherche médicale, INSERM, UMR_S 959, Paris, France
- CNRS, FRE3632, Paris, France
| | - Lucie Biard
- Service de Biostatistique et Information Médicale, AP-HP Hôpital Saint-Louis - INSERM, UMR1153, Paris, France
| | - David Saadoun
- Sorbonne Universités, Hôpital Pitié-Salpêtrière, Paris, France
- Département de médecine interne et d'immunologie clinique, Paris, France
- AP-HP, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose inflammatoire, Paris, France
- Institut national de la santé et de la recherche médicale, INSERM, UMR_S 959, Paris, France
- CNRS, FRE3632, Paris, France
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21
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Rodier C, Kanagaratnam L, Morland D, Herbin A, Durand A, Chauchet A, Choquet S, Colin P, Casasnovas RO, Deconinck E, Godard F, Delmer A, Rossi C, Durot E. Risk Factors of Progression in Low-tumor Burden Follicular Lymphoma Initially Managed by Watch and Wait in the Era of PET and Rituximab. Hemasphere 2023; 7:e861. [PMID: 37125257 PMCID: PMC10146112 DOI: 10.1097/hs9.0000000000000861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/06/2023] [Indexed: 05/02/2023] Open
Abstract
Patients (pts) with asymptomatic low-burden follicular lymphoma (FL) are usually observed at diagnosis. Time to lymphoma treatment (TLT) initiation can however be very heterogeneous and risk factors of progression are poorly studied. Our study evaluated 201 pts with grade 1-3a low-tumor burden FL diagnosed in four French centers between 2010 and 2020 and managed by a watch and wait strategy in real-life settings. After a median follow-up of 4.8 years, the median TLT was 4.2 years (95% confidence interval, 3.1-5.5). On multivariate analysis, elevated lactate dehydrogenase (hazard ratio [HR] = 2.2; P = 0.02), more than 4 nodal areas involved (HR = 1.7; P = 0.02) and more than 1 extranodal involvement (HR = 2.7; P = 0.01) were identified as independent predictors of TLT. The median TLT was 5.8 years for pts with no risk factor, 2.4 years for 1 risk factor, and 1.3 years for >1 risk factors (P < 0.01). In a subanalysis of 75 pts staged with positron emission tomography-computed tomography (PET-CT), total metabolic tumor volume (TMTV) ≥14 cm3 and standardized Dmax (reflecting tumor dissemination) >0.32 m-1 were also associated with shorter TLT (HR = 3.4; P = 0.004 and HR = 2.4; P = 0.007, respectively). In multivariate models combining PET-CT parameters and clinical variables, TMTV remained independent predictor of shorter TLT. These simple parameters could help to identify FL patients initially observed at higher risk of early progression. The role of PET-CT (extranodal sites and PET metrics) in low-burden FL appears promising and warrants further assessment in large cohorts.
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Affiliation(s)
- Cyrielle Rodier
- Department of Hematology, University Hospital of Reims, Hôpital Robert Debré, Reims, France
- UFR Médecine, Reims, France
| | - Lukshe Kanagaratnam
- Department of Research and Innovation, University Hospital of Reims, Hôpital Robert Debré, Reims, France
| | - David Morland
- Médecine Nucléaire, Institut Godinot, Laboratoire de Biophysique, UFR de Médecine, Université de Reims Champagne-Ardenne, and CReSTIC (Centre de Recherche en Sciences et Technologies de l’Information et de la Communication), EA 3804, Université de Reims Champagne-Ardenne, Reims, France
| | - Adélie Herbin
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France
| | - Amandine Durand
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France
| | - Adrien Chauchet
- Department of Hematology, University Hospital of Besançon, France
| | - Sylvain Choquet
- Department of Hematology, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Philippe Colin
- Department of Oncology, Clinique Courlancy, Reims, France
| | - René Olivier Casasnovas
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France
| | - Eric Deconinck
- Department of Hematology, University Hospital of Besançon, France
| | - François Godard
- Médecine Nucléaire, Centre Georges-François Leclerc, Dijon, France
| | - Alain Delmer
- Department of Hematology, University Hospital of Reims, Hôpital Robert Debré, Reims, France
- UFR Médecine, Reims, France
| | - Cédric Rossi
- Department of Hematology, University Hospital F. Mitterrand and Inserm UMR 1231, Dijon, France
| | - Eric Durot
- Department of Hematology, University Hospital of Reims, Hôpital Robert Debré, Reims, France
- UFR Médecine, Reims, France
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22
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Dufour J, Choquet S, Hoang-Xuan K, Schmitt A, Ahle G, Houot R, Taillandier L, Gressin R, Casasnovas O, Marolleau JP, Tamburini J, Serrier C, Perez E, Paillassa J, Gyan E, Chauchet A, Ursu R, Kas A, Soussain C, Houillier C. Systemic relapses of primary CNS lymphomas (PCNSL): a LOC network study. Ann Hematol 2023; 102:1159-1169. [PMID: 36991231 DOI: 10.1007/s00277-023-05108-6] [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: 09/22/2022] [Accepted: 01/19/2023] [Indexed: 03/31/2023]
Abstract
Primary central nervous system lymphomas (PCNSLs) classically remain confined within the CNS throughout their evolution for unknown reasons. Our objective was to analyse the rare extracerebral relapses of PCNSL in a nationwide population-based study. We retrospectively selected PCNSL patients who experienced extracerebral relapse during their follow-up from the French LOC database. Of the 1968 PCNSL included in the database from 2011, 30 (1.5%, median age 71 years, median KPS 70) presented an extracerebral relapse, either pure (n = 20) or mixed (both extracerebral and in the CNS) (n = 10), with a histological confirmation in 20 cases. The median delay between initial diagnosis and systemic relapse was 15.5 months [2-121 months]. We found visceral (n = 23, 77%), including testis in 5 (28%) men and breast in 3 (27%) women, lymph node (n = 12, 40%), and peripheral nervous system (PNS) (n = 7, 23%) involvement. Twenty-seven patients were treated with chemotherapy, either with only systemic targets (n = 7) or mixed systemic and CNS targets (n = 20), 4 were consolidated by HCT-ASCT. After systemic relapse, the median progression-free survival and overall survival (OS) were 7 and 12 months, respectively. KPS > 70 and pure systemic relapses were significantly associated with higher OS. Extracerebral PCNSL relapses are rare, mainly extranodal, and frequently involve the testis, breast, and PNS. The prognosis was worse in mixed relapses. Early relapses raise the question of misdiagnosed occult extracerebral lymphoma at diagnostic workup that should systematically include a PET-CT. Paired tumour analysis at diagnosis/relapse would provide a better understanding of the underlying molecular mechanisms.
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Affiliation(s)
- J Dufour
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - S Choquet
- Hôpital Pitié-Salpêtrière, Service d'Hématologie clinique, Paris, France
| | - K Hoang-Xuan
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - A Schmitt
- Institut de Bergonie, Service d'Hématologie, Bordeaux, France
| | - G Ahle
- Hôpitaux civils de Colmar, Service de Neurologie, Colmar, France
| | - R Houot
- Hôpital Universitaire de Rennes, Service d'Hématologie, Rennes, France
| | - L Taillandier
- Hôpital Universitaire de Nancy, Service de Neurologie, Nancy, France
| | - R Gressin
- Hôpital Universitaire de Grenoble, Service d'Hématologie, Grenoble, France
| | - O Casasnovas
- Hôpital Universitaire de Dijon, Service d'hematologie clinique, Dijon, France
| | - J P Marolleau
- Hôpital Universitaire d'Amiens, Service d'Hematologie clinique, Amiens, France
| | - J Tamburini
- Hôpital Cochin, Service d'Hématologie, Paris, France
| | - C Serrier
- Centre Hospitalier de Perpignan, Service d'Hématologie, Perpignan, France
| | - E Perez
- Hôpital Universitaire de la Réunion, Service d'oncologie-hématologie, Paris, La Réunion, France
| | - J Paillassa
- Hôpital Universitaire d'Angers, Service d'Hématologie, Angers, France
| | - E Gyan
- Hôpital Universitaire de Tours, Service d'Hématologie, Tours, France
| | - A Chauchet
- Hôpital Universitaire de Besançon, Service d'Hématologie, Besançon, France
| | - R Ursu
- Hôpital Saint-Louis, Service de Neurologie à orientation oncologique, Paris, France
| | - A Kas
- Hôpital Pitié-Salpêtrière, Service de Médecine Nucléaire, Paris, France
| | - C Soussain
- Institut Curie, Service d'Hématologie, Saint-Cloud, France and INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - C Houillier
- Hôpital Pitié-Salpêtrière, Service de Neurologie 2-Mazarin, APHP, Sorbonne Université, IHU, ICM, Paris, France.
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23
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Bravetti C, Degaud M, Armand M, Sourdeau E, Mokhtari K, Maloum K, Osman J, Verrier P, Houillier C, Roos-Weil D, Soussain C, Choquet S, Hoang-Xuan K, Le Garff-Tavernier M, Denis JA, Davi F. Combining MYD88 L265P mutation detection and clonality determination on CSF cellular and cell-free DNA improves diagnosis of primary CNS lymphoma. Br J Haematol 2023. [PMID: 36941788 DOI: 10.1111/bjh.18758] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
Diagnosis of primary central nervous system lymphoma (PCNSL) is challenging, and although brain biopsy remains the gold standard, cerebrospinal fluid (CSF) constitutes a less invasive source of lymphomatous biomarkers. In a retrospective cohort of 54 PCNSL cases tested at diagnosis or relapse, we evaluated the contribution of immunoglobulin heavy chain (IGH) gene clonality and MYD88 L265P detection on both CSF cell pellets and supernatants, in comparison with cytology, flow cytometry, interleukin (IL)-10 and IL-6 quantification. Clonality assessment included a new assay to detect partial IGH-DJ rearrangements. Clonal IGH rearrangements and/or MYD88 L265P mutation were detected in 27 (50%) cell pellets and 24 (44%) supernatant cell-free (cf) DNA. Combining analyses on both compartments, 36 (66%) cases had at least one detectable molecular marker, present only in cfDNA for 9 (16%) of them. While cytology and flow cytometry were positive in only 7 (13.0%) and 9 (17.3%) cases respectively, high IL-10 levels were observed in 36 (66.7%) cases. Overall, taking into account molecular and cytokine results, 46/54 (85%) cases had at least one lymphomatous biomarker detectable in the CSF. These results show that this combination of biomarkers evaluated on both cell pellet and supernatant CSF fractions improves significantly the biological diagnosis of PCNSL.
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Affiliation(s)
- Clotilde Bravetti
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Michaël Degaud
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Marine Armand
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Elise Sourdeau
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Karima Mokhtari
- Department of Neuropathology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Karim Maloum
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Jennifer Osman
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Patricia Verrier
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Caroline Houillier
- Department of Neurology-2, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), IHU, ICM, Sorbonne Université, Paris, France
| | - Damien Roos-Weil
- Department of Clinical Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Carole Soussain
- Division of Hematology, Institut Curie, Site Saint-Cloud, and INSERM U932, PSL Research University, Paris, France
| | - Sylvain Choquet
- Department of Clinical Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Khe Hoang-Xuan
- Department of Neurology-2, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), IHU, ICM, Sorbonne Université, Paris, France
| | - Magali Le Garff-Tavernier
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
| | - Jérôme Alexandre Denis
- Department of Endocrine and Oncological Biochemistry, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Centre de recherche Saint-Antoine (UMR_S 938), Biologie et thérapeutiques du cancer, Paris, France
| | - Frédéric Davi
- Department of Biological Hematology, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP) and Sorbonne Université, Paris, France
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Gay P, Villain C, Kottler D, Rouet A, Tomeo C, Baron M, Choquet S, Barete S, Minaud A, Barrou Z, Verny M. [Pyoderma gangrenosum and hemopathies in older patients]. Geriatr Psychol Neuropsychiatr Vieil 2023; 21:31-36. [PMID: 37115677 DOI: 10.1684/pnv.2023.1087] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Pyoderma gangrenosum (PG) belongs to neutrophilic dermatoses. PG can have different clinical presentations (ulcerated, bullous, pustular), is often painful, and preferentially affects the lower limbs. The diagnosis can be challenging, and a cutaneous biopsy is often necessary, which shows an aseptic cutaneous infiltrate of neutrophils. The association with inflammatory or hematologic conditions is frequent, especially in older patients. The hematologic diseases the most frequently associated with PG are myelodysplastic syndrome, followed by monoclonal gammopathy of undetermined significance. Because of the strong impact of its treatment, recognition of PG is crucial. The treatment is based on first-line corticosteroids and topical or systemic immunosuppressive drugs and most often leads to a favourable outcome. The management of an acute hematologic disease would further improve the prognosis of PG. The singularity of geriatric patients encourages to thoroughly balance the risks and benefits of the recommended drugs and to consider associated non-drug measures. Here, we propose a review of the scientific literature about the association between PG and hematologic diseases, with a special focus on older patients, accompanied by the report of two cases in geriatric ward.
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Affiliation(s)
- Pierre Gay
- Service de gériatrie, Centre hospitalier Pitié-Salpêtrière - Charles-Foix, Assistance publique Hôpitaux de Paris, Paris, France, Médecine, Sorbonne Université, Paris, France
| | - Cédrid Villain
- Médecine, Sorbonne Université, Paris, France, Service de gériatrie, CHU de Caen, Caen, France
| | | | - Audrey Rouet
- Service de gériatrie, Centre hospitalier Pitié-Salpêtrière - Charles-Foix, Assistance publique Hôpitaux de Paris, Paris, France, Médecine, Sorbonne Université, Paris, France
| | - Charlotte Tomeo
- Service de gériatrie, Centre hospitalier Pitié-Salpêtrière - Charles-Foix, Assistance publique Hôpitaux de Paris, Paris, France, Médecine, Sorbonne Université, Paris, France
| | - Marine Baron
- Médecine, Sorbonne Université, Paris, France, Service d'hématologie, Centre hospitalier Pitié-Salpêtrière - Charles-Foix, Assistance publique Hôpitaux de Paris, Paris, France
| | - Sylvain Choquet
- Médecine, Sorbonne Université, Paris, France, Service d'hématologie, Centre hospitalier Pitié-Salpêtrière - Charles-Foix, Assistance publique Hôpitaux de Paris, Paris, France
| | - Stéphane Barete
- Médecine, Sorbonne Université, Paris, France, Service de dermatologie, Centre hospitalier Pitié-Salpêtrière - Charles-Foix, Assistance publique Hôpitaux de Paris, Paris, France
| | - Alix Minaud
- Service de gériatrie, Centre hospitalier Pitié-Salpêtrière - Charles-Foix, Assistance publique Hôpitaux de Paris, Paris, France, Médecine, Sorbonne Université, Paris, France
| | - Zina Barrou
- Service de gériatrie, Centre hospitalier Pitié-Salpêtrière - Charles-Foix, Assistance publique Hôpitaux de Paris, Paris, France
| | - Marc Verny
- Service de gériatrie, Centre hospitalier Pitié-Salpêtrière - Charles-Foix, Assistance publique Hôpitaux de Paris, Paris, France, Médecine, Sorbonne Université, Paris, France, UMR8256 (CNRS), Team Neuronal Cell Biology & Pathology, Paris, France
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25
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Chaganti S, Barlev A, Caillard S, Choquet S, Cwynarski K, Friedetzky A, González-Barca E, Sadetsky N, Schneeberger S, Thirumalai D, Zinzani PL, Trappe RU. Expert Consensus on the Characteristics of Patients with Epstein-Barr Virus-Positive Post-Transplant Lymphoproliferative Disease (EBV + PTLD) for Whom Standard-Dose Chemotherapy May be Inappropriate: A Modified Delphi Study. Adv Ther 2023; 40:1267-1281. [PMID: 36681739 PMCID: PMC9988727 DOI: 10.1007/s12325-022-02383-z] [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: 09/01/2022] [Accepted: 11/17/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Following hematopoietic stem cell transplantation or solid organ transplantation, patients are at risk of developing Epstein-Barr virus-positive post-transplant lymphoproliferative disease (EBV+ PTLD), which is an ultra-rare and potentially lethal hematologic malignancy. Common treatments for EBV+ PTLD include rituximab alone or combined with chemotherapy. Given specific considerations for this population, including severity of the underlying condition requiring transplant, the rigors of the transplant procedure, as well as risks to the transplanted organ, there is a group of patients with EBV+ PTLD for whom chemotherapy may be inappropriate; however, there is limited information characterizing these patients. This study aimed to reach expert consensus on the key characteristics of patients for whom chemotherapy may be inappropriate in a real-world setting. METHODS A two-round modified Delphi study was conducted to reach consensus among clinicians with expertise treating EBV+ PTLD. Articles identified in a targeted literature review guided the development of round 1 and 2 topics and related statements. The consensus threshold for round 1 statements was 75.0%. If consensus was achieved in round 1, the statement was not discussed further in round 2. The consensus thresholds for round 2 were moderate (62.5-75.0%), strong (87.5%), or complete (100.0%). RESULTS The panel was composed of a total of eight clinicians (seven hematologists/hemato-oncologists) from six European countries. The panel generated a final list of 43 consensus recommendations on the following topics: terminology used to describe patients for whom chemotherapy may be inappropriate; demographic characteristics; organ transplant characteristics; comorbidities that preclude the use of chemotherapy; EBV+ PTLD characteristics; and factors related to treatment-related mortality and morbidity. CONCLUSIONS This modified Delphi panel successfully achieved consensus on key topics and statements that characterized patients with EBV+ PTLD for whom chemotherapy may be inappropriate. These recommendations will inform clinicians and aid in the treatment of EBV+ PTLD.
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Affiliation(s)
- Sridhar Chaganti
- Centre for Clinical Haematology, University Hospital Birmingham, Birmingham, UK
| | - Arie Barlev
- Atara Biotherapeutics, South San Francisco, CA, USA
| | - Sophie Caillard
- Department of Nephrology Transplantation, Strasbourg University Hospitals, Strasbourg, France
| | - Sylvain Choquet
- Department of Hematology, Hospitalier Pitié Salpétrière, Paris, France
| | - Kate Cwynarski
- Department of Haematology, University College Hospital, London, UK
| | | | - Eva González-Barca
- Department of Hematology, Institut Català d'Oncologia, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | | | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Pier L Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli", Bologna, Italy.,Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università di Bologna, Bologna, Italy
| | - Ralf U Trappe
- Department of Hematology and Oncology, DIAKO Hospital Bremen, Bremen, Germany
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Cailleteau A, Maingon P, Choquet S, Bourdais R, Antoni D, Lioure B, Hulin C, Batard S, Llagostera C, Guimas V, Touzeau C, Moreau P, Mahé MA, Supiot S. Phase 1 Study of the Combination of Escalated Total Marrow Irradiation Using Helical Tomotherapy and Fixed High-Dose Melphalan (140 mg/m²) Followed by Autologous Stem Cell Transplantation at First Relapse in Multiple Myeloma. Int J Radiat Oncol Biol Phys 2023; 115:677-685. [PMID: 36174802 DOI: 10.1016/j.ijrobp.2022.09.069] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/26/2022] [Accepted: 09/11/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE A second intensification is an option at first relapse in multiple myeloma (MM) after more than 36 months of initial remission. Many conditioning regimens have been tested, with or without total body irradiation (TBI). Recently, it was found that TBI could be replaced by total marrow irradiation (TMI) using helical tomotherapy, with promising results. METHODS AND MATERIALS This study was a prospective multicenter phase 1 trial that aimed to determine the maximum tolerated dose (MTD) of TMI administered in association with melphalan 140 mg/m², followed by autologous stem cell transplantation as consolidation at first relapse in MM. Four dose levels were explored: 8 Gy, 10 Gy, 12 Gy, and 14 Gy. The dose-limiting toxicity (DLT) was defined as grade 4 neutropenia >15 days, grade 4 thrombopenia >28 days, and all other grade 4 nonhematologic toxic effects except nausea, vomiting, alopecia, mucositis, and reaction to autologous stem cell infusion. RESULTS Thirteen patients were included; only 1 DLT at the third escalated dose level (12 Gy) was observed, whereas 1 patient was treated at 14 Gy with no adverse events. The MTD was not reached. The rate of acute toxicity was low: 38% of grade 3-4 diarrhea, mucositis, or unexplained fever. Regarding the lungs, the mean dose administered was systematically less than 8 Gy. After a median follow-up of 55 months, 70% of participants were alive. Of these 13 patients, 38.5% were in very good partial response and 30.8% were in complete response. Three of them were progression-free. Six patients were long survivors, still alive after 55 months of follow-up. CONCLUSIONS Total marrow irradiation provides good results with a good tolerance profile at first relapse in MM and makes it possible to increase the dose delivered to the planning target volume while sparing organs at risk. This technique could be discussed for all regimens before auto- or allo-stem cell rescue when TBI is required.
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Affiliation(s)
- Axel Cailleteau
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France.
| | - Philippe Maingon
- Department of Radiation Oncology, Pitié-Salpêtrière, Paris, France
| | | | - Rémi Bourdais
- Department of Radiation Oncology, Pitié-Salpêtrière, Paris, France
| | | | - Bruno Lioure
- Department of Hematology, ICANS, Strasbourg, France
| | - Cyrille Hulin
- Department of Hematology, Hôpital Haut Lévêque, University Hospital Bordeaux, Bordeaux, France
| | - Stéphanie Batard
- Department of Radiation Oncology, Institut Bergonie, Bordeaux, France
| | - Camille Llagostera
- Physics Unit, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France
| | - Valentine Guimas
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France
| | - Cyrille Touzeau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France; Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA, Nantes, France; Site de recherche intégrée sur le cancer (SIRIC), ILIAD INCA-DGOS-Inserm U12558, Nantes, France
| | - Philippe Moreau
- Department of Hematology, University Hospital Hôtel-Dieu, Nantes, France; Site de recherche intégrée sur le cancer (SIRIC), ILIAD INCA-DGOS-Inserm U12558, Nantes, France; Nantes Université, INSERM, CNRS, Université d'Angers, CRCI2NA, Nantes, France
| | - Marc-André Mahé
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, St-Herblain, France; Centre de Recherche en Cancérologie Nantes Angers, UMR 1232 Inserm - 6299 CNRS, Nantes, France
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27
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Hernández-Verdin I, Kirasic E, Wienand K, Mokhtari K, Eimer S, Loiseau H, Rousseau A, Paillassa J, Ahle G, Lerintiu F, Uro-Coste E, Oberic L, Figarella-Branger D, Chinot O, Gauchotte G, Taillandier L, Marolleau JP, Polivka M, Adam C, Ursu R, Schmitt A, Barillot N, Nichelli L, Lozano-Sánchez F, Ibañez-Juliá MJ, Peyre M, Mathon B, Abada Y, Charlotte F, Davi F, Stewart C, de Reyniès A, Choquet S, Soussain C, Houillier C, Chapuy B, Hoang-Xuan K, Alentorn A. Molecular and clinical diversity in primary central nervous system lymphoma. Ann Oncol 2023; 34:186-199. [PMID: 36402300 DOI: 10.1016/j.annonc.2022.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [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: 08/31/2022] [Accepted: 11/08/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary central nervous system lymphoma (PCNSL) is a rare and distinct entity within diffuse large B-cell lymphoma presenting with variable response rates probably to underlying molecular heterogeneity. PATIENTS AND METHODS To identify and characterize PCNSL heterogeneity and facilitate clinical translation, we carried out a comprehensive multi-omic analysis [whole-exome sequencing, RNA sequencing (RNA-seq), methylation sequencing, and clinical features] in a discovery cohort of 147 fresh-frozen (FF) immunocompetent PCNSLs and a validation cohort of formalin-fixed, paraffin-embedded (FFPE) 93 PCNSLs with RNA-seq and clinico-radiological data. RESULTS Consensus clustering of multi-omic data uncovered concordant classification of four robust, non-overlapping, prognostically significant clusters (CS). The CS1 and CS2 groups presented an immune-cold hypermethylated profile but a distinct clinical behavior. The 'immune-hot' CS4 group, enriched with mutations increasing the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) and nuclear factor-κB activity, had the most favorable clinical outcome, while the heterogeneous-immune CS3 group had the worse prognosis probably due to its association with meningeal infiltration and enriched HIST1H1E mutations. CS1 was characterized by high Polycomb repressive complex 2 activity and CDKN2A/B loss leading to higher proliferation activity. Integrated analysis on proposed targets suggests potential use of immune checkpoint inhibitors/JAK1 inhibitors for CS4, cyclin D-Cdk4,6 plus phosphoinositide 3-kinase (PI3K) inhibitors for CS1, lenalidomide/demethylating drugs for CS2, and enhancer of zeste 2 polycomb repressive complex 2 subunit (EZH2) inhibitors for CS3. We developed an algorithm to identify the PCNSL subtypes using RNA-seq data from either FFPE or FF tissue. CONCLUSIONS The integration of genome-wide data from multi-omic data revealed four molecular patterns in PCNSL with a distinctive prognostic impact that provides a basis for future clinical stratification and subtype-based targeted interventions.
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Affiliation(s)
- I Hernández-Verdin
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - E Kirasic
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - K Wienand
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany; Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany; Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - K Mokhtari
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neuropathology, Groupe Hospitalier Pitié Salpêtrière, APHP, Paris, France
| | - S Eimer
- Department of Pathology, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - H Loiseau
- Department of Neurosurgery, Bordeaux University Hospital Center, Pellegrin Hospital, Bordeaux, France; EA 7435-IMOTION, University of Bordeaux, Bordeaux, France
| | - A Rousseau
- Department of Pathology, PBH, CHU Angers, Angers, France; CRCINA, Université de Nantes-université d'Angers, Angers, France
| | - J Paillassa
- Department of Hematology, CHU Angers, Angers, France
| | - G Ahle
- Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France
| | - F Lerintiu
- Department of Neuropathology, Hôpitaux Civils de Colmar, Strasbourg, France
| | - E Uro-Coste
- Department of Pathology, CHU de Toulouse, IUC-Oncopole, Toulouse, France; INSERM U1037, Cancer Research Center of Toulouse (CRCT), Toulouse, France; Université Toulouse III Paul Sabatier, Toulouse, France
| | - L Oberic
- Department of Hematology, IUC Toulouse Oncopole, Toulouse, France
| | - D Figarella-Branger
- Neuropathology Department, University Hospital Timone, Aix Marseille University, Marseille, France; Inst Neurophysiopathol, CNRS, INP, Aix-Marseille University, Marseille, France
| | - O Chinot
- Department of Neuro-oncology, CHU Timone, APHM, Marseille, France; Institute of NeuroPhysiopathology, CNRS, INP, Aix-Marseille University, Marseille, France
| | - G Gauchotte
- Department of Biopathology, CHRU Nancy, CHRU/ICL, Bâtiment BBB, Vandoeuvre-lès-Nancy, France; Department of Legal Medicine, CHRU Nancy, Vandoeuvre-lès-Nancy, France; INSERM U1256, University of Lorraine, Vandoeuvre-lès-Nancy, France; Centre de Ressources Biologiques, BB-0033-00035, CHRU, Nancy, France
| | - L Taillandier
- Department of Neuro-oncology, CHRU-Nancy, Université de Lorraine, Nancy, France
| | - J-P Marolleau
- Department of Hematology, CHU Amiens-Picardie, Amiens, France
| | - M Polivka
- Department of Anatomopathology, Lariboisière Hospital, Assistance Publique-Hopitaux de Paris, University of Paris, Paris, France
| | - C Adam
- Pathology Department, Bicêtre University Hospital, Public Hospital Network of Paris, Le Kremlin Bicêtre, France
| | - R Ursu
- Department of Neurology, Université de Paris, AP-HP, Hôpital Saint Louis, Paris, France
| | - A Schmitt
- Department of Hematology, Institut Bergonié Hospital, Bordeaux, France
| | - N Barillot
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France
| | - L Nichelli
- Department of Neuroradiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - F Lozano-Sánchez
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | | | - M Peyre
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurosurgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - B Mathon
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurosurgery, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Y Abada
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - F Charlotte
- Department Pathology, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - F Davi
- Department Hematology, APHP, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - C Stewart
- Department Broad Institute of MIT and Harvard, Cambridge, USA
| | - A de Reyniès
- Department INSERM UMR_S1138-Centre de Recherche des Cordeliers-Université Pierre et Marie Curie et Université Paris Descartes, Paris, France
| | - S Choquet
- Department Pathology, Hôpital Pitié-Salpêtrière and Sorbonne University, Paris, France
| | - C Soussain
- Department Hematology Unit, Institut Curie, Saint-Cloud, France
| | - C Houillier
- Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - B Chapuy
- Department of Hematology and Medical Oncology, University Medical Center Göttingen, Göttingen, Germany; Department of Hematology, Oncology and Cancer Immunology, Campus Benjamin Franklin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Hoang-Xuan
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - A Alentorn
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, Sorbonne Université, CNRS, Paris, France; Department of Neurology-2, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France.
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28
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Beitinjaneh A, Baiocchi R, Chaganti S, Choquet S, Dierickx D, Dinavahi R, Gamelin L, Ghobadi A, Guzman-Becerra N, Joshi AJ, Mahadeo KM, Mehta DA, Nikiforow S, Reshef R, Ye W, Prockop S. New and Updated Results from a Multicenter, Open-Label, Global Phase 3 (P3) Study of Tabelecleucel (Tab-cel) for Epstein–Barr Virus-Positive Post-Transplant Lymphoproliferative Disease (EBV+ PTLD) Following Allogeneic Hematopoietic Cell (HCT) or Solid Organ Transplant (SOT) after Failure of Rituximab (R) or Rituximab and Chemotherapy (R+CT) (ALLELE). Transplant Cell Ther 2023. [DOI: 10.1016/s2666-6367(23)00094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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29
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Laurenge A, Ursu R, Tabouret E, Harlay V, Ahle G, Choquet S, Soussain C, Moluçon-Chabrot C, Mathon B, Mokhtari K, Pourcher V, Nichelli L, Marot S, Touat M, Hoang-Xuan K, Houillier C. SARS-CoV-2 infection in patients with primary central nervous system lymphoma in the vaccination era. Leuk Lymphoma 2023; 64:221-224. [PMID: 36318828 DOI: 10.1080/10428194.2022.2131420] [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: 11/06/2022]
Affiliation(s)
- Alice Laurenge
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Service de Neurologie 2-Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France
| | - Renata Ursu
- Service de Neurologie, AP-HP, Hôpital Saint Louis, Université de Paris, Paris, France
| | - Emeline Tabouret
- APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service de Neurooncologie, Aix-Marseille University, Marseille, France
| | - Vincent Harlay
- APHM, CNRS, INP, Inst Neurophysiopathol, CHU Timone, Service de Neurooncologie, Aix-Marseille University, Marseille, France
| | - Guido Ahle
- Service de Neurologie, Hôpitaux Civils de Colmar, Colmar, France
| | - Sylvain Choquet
- Service d'Hématologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Carole Soussain
- Service d'Hématologie, Institut Curie, site de Saint-Cloud et INSERM U932 Institut Curie, PSL Research University, Paris.,LOC Network, Paris, France
| | - Cécile Moluçon-Chabrot
- Service de Thérapie Cellulaire et Hématologie Clinique, CHU de Clermont-Ferrand - Hôpital d'Estaing, Clermont-Ferrand, France
| | - Bertrand Mathon
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Karima Mokhtari
- Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Service de Neuropathologie Laboratoire Escourolle, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France
| | - Valérie Pourcher
- INSERM 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France
| | - Lucia Nichelli
- Service de Neuroradiologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Stéphane Marot
- INSERM 1136, Institut Pierre Louis D'Epidémiologie Et de Santé Publique, Département de Virologie, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France
| | - Mehdi Touat
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Service de Neurologie 2-Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France
| | - Khê Hoang-Xuan
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Service de Neurologie 2-Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France.,LOC Network, Paris, France
| | - Caroline Houillier
- Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, Service de Neurologie 2-Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Sorbonne Université, Paris, France.,LOC Network, Paris, France
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30
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Younan N, Soussain C, Choquet S, Cassoux N, Touitou V, Schmitt A, Chinot O, Oberic L, Damaj G, Houot R, Ghesquières H, Laribi K, Ahle G, Taillandier L, Paillassa J, Gyan E, Jardin F, Delwail V, Marolleau JP, Tempescul A, Agapé P, Bourniquel M, Vacheret F, Jdid I, Le Garff-Tavernier M, Malaise D, Alentorn A, Xuan KH, Houillier C. Isolated intraocular relapses of primary cerebral lymphomas: An LOC network study. Hematol Oncol 2022; 40:976-986. [PMID: 35789106 DOI: 10.1002/hon.3044] [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: 03/08/2022] [Revised: 05/18/2022] [Accepted: 06/25/2022] [Indexed: 12/13/2022]
Abstract
Most relapses of primary central nervous system lymphoma (PCNSL) occur in the brain and are associated with a poor prognosis. Isolated intraocular relapses (IIORs) are rare and poorly described. We retrospectively selected from the French Lymphome Oculo-Cérébral database PCNSL patients who initially presented with cerebral localization and who experienced IIOR during the course of the disease. Of the 1472 patients included in the database, 55 patients presented an IIOR. Their median age was 68 years, and median Karnofsky Performance Status 80. IL-10 levels in the aqueous humor and/or in the vitreous were increased in 42/46 patients. 45/55 patients received systemic chemotherapy, and 11/55 received high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) as consolidation treatment. After a median follow-up of 69 months, 42/55 patients had relapsed, including 90% of the patients who did not receive HCT-ASCT at IIOR and 40% of the patients who received HCT-ASCT at IIOR (p < 0.001). The first relapse after the initial IIOR was exclusively in the eye in 23/42 patients, and 29/42 patients had a subsequent brain relapse during the course of the disease. The median progression-free survival, brain-free survival and overall survival from IIOR were 12.2, 48.6 and 57.1 months, respectively. Isolated intraocular relapse is not exceptional in the course of PCNSL and deserves systematic ophthalmological follow-up. Its prognosis is much better than the prognosis of brain relapse, with an evolution close to that of primary vitreoretinal lymphoma. With the exception of patients who received HCT-ASCT at IIOR, almost all patients subsequently relapsed, often with other IIORs.
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Affiliation(s)
- Nadia Younan
- Neurology, Assistance Publique - Hôpitaux de Paris (APHP), Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Carole Soussain
- Hematology, Institut Curie, Site Saint-Cloud, INSERM U932, PSL Research University, Paris, France
| | - Sylvain Choquet
- Hematology, APHP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Nathalie Cassoux
- Ophthalmology, Institut Curie, Site Paris, Université Paris V Descartes et PSL (Paris Science et Lettre), Paris, France
| | - Valérie Touitou
- Ophthalmology, APHP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | | | - Olivier Chinot
- Neuro-oncology, Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Lucie Oberic
- Hematology, Institut Universitaire du Cancer de Toulouse Oncopôle, Toulouse, France
| | - Gandhi Damaj
- Hematology, Centre Hospitalier Universitaire de Caen, Université de Caen-Normandie, Caen, France
| | - Roch Houot
- Hematology, Centre Hospitalier Universitaire de Rennes, Université de Rennes, INSERM U1236, Rennes, France
| | - Hervé Ghesquières
- Hematology, Centre Hospitalier Lyon Sud, Université Claude Bernard Lyon 1, Pierre-Bénite, France
| | - Kamel Laribi
- Hematology, Centre Hospitalier du Mans, Le Mans, France
| | - Guido Ahle
- Neurology, Hôpital Pasteur - Hôpitaux Civils de Colmar, Colmar, France
| | - Luc Taillandier
- Neurology, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Jérôme Paillassa
- Hematology, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Emmanuel Gyan
- Hematology and Cell Therapy Department, Centre Hospitalier Universitaire de Tours, Centre d'Investigations Cliniques INSERM U1517, Tours, France
| | | | - Vincent Delwail
- Hematology, CHU de Poitiers, INSERM, CIC 1402, Centre d'Investigation Clinique, Université de Poitiers, Poitiers, France
| | | | - Adrian Tempescul
- Hematology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Philippe Agapé
- Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | - Marie Bourniquel
- Ophthalmology, Hôpital d'Instruction des Armées Sainte Anne, Toulon, France
| | | | - Ibrahim Jdid
- Hematology, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Magali Le Garff-Tavernier
- Service d'hématologie biologique, APHP, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Denis Malaise
- Ophthalmology, Laboratoire d'Imagerie Translationnelle en Oncologie, Institut Curie, Paris, France.,PSL University, Inserm U1288, Orsay, France
| | - Agusti Alentorn
- Neurology, Assistance Publique - Hôpitaux de Paris (APHP), Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Khê Hoang Xuan
- Neurology, Assistance Publique - Hôpitaux de Paris (APHP), Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Caroline Houillier
- Neurology, Assistance Publique - Hôpitaux de Paris (APHP), Sorbonne Université, IHU, ICM, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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31
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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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32
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Desjardins C, Larrieu-Ciron D, Choquet S, Mokhtari K, Charlotte F, Nichelli L, Mathon B, Ahle G, Le Garff-Tavernier M, Dehais C, Hoang-Xuan K, Houillier C. P11.09.B Chemotherapy is an efficient treatment in primary CNS MALT lymphoma. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mucosae-associated lymphoid tissue (MALT) lymphomas are a rare and still poorly understood form of primary central nervous system lymphoma (PCNSL). The aim of this study was to better describe these tumors and their management, and to better appreciate their long-term prognosis after treatment.
Material and Methods
Adult immunocompetent patients with primary CNS MALT lymphoma (PCNSML) were retrospectively selected from the database on PCNSL of the Pitié-Salpêtrière Hospital. All cases had double-read for pathology.
Results
Eleven PCNSML representing 1.7% of the 662 PCNSL included in the database were selected, There were 9 women and two men, all immunocompetent. Their median age was 56 years (min 29; max 78). The median time from first symptoms to diagnosis was 13 months and the median KPS at diagnosis was 90. Location was dural in 8 cases, suggestive of meningioma in 7 cases and of subdural hematoma in 1 case, and parenchymal in 3 cases. The disease was unifocal/localized in 4 cases and multifocal/diffuse in 7 cases. In 3 cases, it was the second reading that allowed making the diagnosis. In first-line treatment, all patients received chemotherapy (CT): “systemic” CT, i.e usually used in systemic MALT lymphomas, in 7 cases (n=7) and “CNS” CT, i.e usually used in CNS lesions in 4 cases. CT was preceded by surgery in 4 cases. No patient received radiotherapy in first line. According to the IPCG (International PCNSL Collaborative Group) criteria, the overall response rate was 7/11 (64%). At latest news, 5 patients had a persistent contrast enhancement, stable without any treatment since a median of 57 months, raising the question of complete response despite persisting contrast enhancement. No patient developed neurotoxicity except for one of the 2 patients who subsequently received radiotherapy. The median follow-up was 109 months. The median progression-free survival was 78.0 months (95% CI [43.4;NA[) and the 10-year overall survival rate was 90% (95% CI [0.7;1[).
Conclusion
This series confirms the classical clinical and radiological presentation of PCNSML. Compared to the literature where the treatment was based on radiotherapy in almost two thirds of cases, the therapeutic approach presented here appears unconventional. This is the first series demonstrating that chemotherapy is an efficient treatment in PCNSML, with an excellent long-term outcome and the absence of neurotoxicity, and calling into question the relevance of the IPCG criteria for the evaluation of their therapeutic response.
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Affiliation(s)
- C Desjardins
- Neuro-oncology department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France , Paris , France
| | - D Larrieu-Ciron
- Neurology department, Hôpital Purpan, CHU de Toulouse, France , Paris , France
| | - S Choquet
- Clinical Hematology department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - K Mokhtari
- Neuropathology department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - F Charlotte
- Service d’Anatomie et Cytologie Pathologiques, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Sorbonne Université , Paris , France
| | - L Nichelli
- Neuroradiology department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - B Mathon
- Neurosurgery department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - G Ahle
- Neurology department, Hospices Civils, Colmar, France , Paris , France
| | - M Le Garff-Tavernier
- Hematobiology department, Hôpital Pitié-Salpêtrière, APHP, Paris, France , Paris , France
| | - C Dehais
- Neuro-oncology department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France , Paris , France
| | - K Hoang-Xuan
- Neuro-oncology department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France , Paris , France
| | - C Houillier
- Neuro-oncology department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France , Paris , France
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33
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Houillier C, Dureau S, Taillandier L, Houot R, Chinot O, Moluçon-Chabrot C, Schmitt A, Gressin R, Choquet S, Damaj G, Peyrade F, Abraham J, Delwail V, Gyan E, Sanhes L, Cornillon J, Garidi R, Delmer A, Al Jijakli A, Morel P, Waultier A, Paillassa J, Chauchet A, Gastinne T, Laadhari M, Plissonnier AS, Feuvret L, Cassoux N, Touitou V, Ricard D, Hoang-Xuan K, Soussain C. Radiotherapy or Autologous Stem-Cell Transplantation for Primary CNS Lymphoma in Patients Age 60 Years and Younger: Long-Term Results of the Randomized Phase II PRECIS Study. J Clin Oncol 2022; 40:3692-3698. [PMID: 35834762 DOI: 10.1200/jco.22.00491] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] 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.We previously reported the results of a randomized phase II study in patients with newly diagnosed primary CNS lymphoma (age 18-60 years). Patients were treated with high-dose methotrexate-based induction chemotherapy followed by whole-brain radiotherapy (WBRT) or high-dose chemotherapy (thiotepa-busulfan-cyclophosphamide) with autologous stem-cell transplantation (ASCT). The median follow-up was 33 months. In this report, we provide long-term data (median follow-up, 8 years) regarding the outcomes and toxicities. Fifty-three and 44 patients received induction chemotherapy followed by WBRT or ASCT, respectively. Their 8-year event-free survival from random assignment was 67% and 39% in the ASCT and WBRT arms, respectively (P = .03), with a significantly lower risk of relapse after ASCT (hazard ratio = 0.13, P < .001). One third of patients who relapsed after WBRT were alive after salvage treatment. Five and four patients died of ASCT and WBRT-related toxicities, respectively. The 8-year overall survival was 69% and 65% in the ASCT and WBRT arms, respectively (not significant). Balance (52% v 10%, P ≤ 0.001) and neurocognition (64% v 13%, P < .001) significantly deteriorated after WBRT compared with ASCT during the follow-up. This study shows that 40 Gy WBRT should be avoided in first-line treatment because of its neurotoxicity and suboptimal efficacy in reducing relapses while ASCT appears to be highly efficient in preventing relapses.
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Affiliation(s)
- Caroline Houillier
- APHP, Sorbonne Université, IHU, ICM, Service de Neurologie-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | | | - Roch Houot
- Service d'Hématologie, CHU de Rennes, Inserm U1236 Université de Rennes 1, France
| | - Olivier Chinot
- Aix-Marseille Université, CNRS, INP, AP-HM, Service de Neuro-Oncologie, CHU de la Timone, France
| | | | - Anna Schmitt
- Service d'Hématologie, Institut Bergonié, Bordeaux, France
| | - Rémy Gressin
- Onco-Haematology Department, CHU de Grenoble, France
| | - Sylvain Choquet
- Service d'Hématologie Clinique, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Gandhi Damaj
- Service d'Hématologie, CHU d'Amiens, France.,Current address: Hematology Institute, University Hospital Normandy, Caen, France
| | | | - Julie Abraham
- Service d'Hématologie et de Thérapie cellulaire, CHU de Limoges, France
| | - Vincent Delwail
- Service d'Oncologie Hématologique et de Thérapie Cellulaire, CHU de Poitiers, INSERM, CIC 1402, Poitiers, Centre d'Investigation Clinique, Université de Poitiers, Poitiers, France
| | - Emmanuel Gyan
- Service d'Hématologie et thérapie cellulaire, Centre d'Investigations Cliniques INSERM U1517, Centre hospitalier universitaire, Université de Tours, France
| | - Laurence Sanhes
- Service d'Hématologie, Centre Hospitalier de Perpignan, France
| | - Jérôme Cornillon
- Service d'Hématologie, Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France.,Current affiliation: Département d'Hématologie Clinique, CHU de ST-Etienne, France
| | - Reda Garidi
- Service d'Hématologie, Centre Hospitalier de Saint Quentin, France
| | | | | | - Pierre Morel
- Service d'Hématologie, Centre Hospitalier de Lens, France.,Current affiliation: Service d'Hématologie, CHU d'Amiens, France
| | | | | | | | | | - Mouna Laadhari
- Département d'Imagerie Médicale, Institut Curie, Site Saint-Cloud, France
| | | | - Loïc Feuvret
- Service de Radiothérapie, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Nathalie Cassoux
- Service d'Ophtalmologie, Institut Curie, site de Paris, et Université Paris V Descartes et PSL (Paris Science et Lettre), Paris, France
| | - Valérie Touitou
- Service d'Ophtalmologie, APHP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Damien Ricard
- Service de Neurologie, Hôpital d'Instruction des Armées Percy, Ecole du Val-de-Grâce, Service de Santé des Armées, Clamart, France
| | - Khê Hoang-Xuan
- APHP, Sorbonne Université, IHU, ICM, Service de Neurologie-Mazarin, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Carole Soussain
- Service d'Hématologie, Institut Curie, site de Saint-Cloud et INSERM U932 Institut Curie, PSL Research University, Paris, France
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34
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Forgeard N, Baron M, Caron J, Boccon-Gibod C, Krzisch D, Guedes N, Morel V, Jacque N, Ouzegdouh M, Choquet S, Bravetti C, Nguyen-Khac F, Chapiro E, Leblond V, Roos-Weil D. Inflammation in Waldenström macroglobulinemia is associated with 6q deletion and need for treatment initiation. Haematologica 2022; 107:2720-2724. [PMID: 35833301 DOI: 10.3324/haematol.2022.281053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Indexed: 11/09/2022] Open
Abstract
Not available.
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Affiliation(s)
- Nathalie Forgeard
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, AP-HP, Paris
| | - Marine Baron
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, AP-HP, Paris
| | - Jonathan Caron
- Sorbonne Universite, Service de Biologie moleculaire, Hopital Pitie-Salpetriere, AP-HP, Paris
| | - Clementine Boccon-Gibod
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, AP-HP, Paris
| | - Daphne Krzisch
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, AP-HP, Paris
| | - Nayara Guedes
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, AP-HP, Paris
| | - Veronique Morel
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, AP-HP, Paris
| | - Nathalie Jacque
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, AP-HP, Paris
| | - Maya Ouzegdouh
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, AP-HP, Paris
| | - Sylvain Choquet
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, AP-HP, Paris
| | - Clotilde Bravetti
- Sorbonne Universite, Service de Biologie moleculaire, Hopital Pitie-Salpetriere, AP-HP, Paris
| | - Florence Nguyen-Khac
- Sorbonne Universite, Service de Cytogenetique, Hopital Pitie-Salpetriere, AP-HP, Paris, France; Centre de Recherche des Cordeliers, INSERM, Cell Death and Drug Resistance in Lymphoproliferative Disorders Team, Sorbonne Universite, Universite Sorbonne Paris Cite, Universite Paris Descartes, Universite Paris Diderot, F-75006 Paris
| | - Elise Chapiro
- Sorbonne Universite, Service de Cytogenetique, Hopital Pitie-Salpetriere, AP-HP, Paris, France; Centre de Recherche des Cordeliers, INSERM, Cell Death and Drug Resistance in Lymphoproliferative Disorders Team, Sorbonne Universite, Universite Sorbonne Paris Cite, Universite Paris Descartes, Universite Paris Diderot, F-75006 Paris
| | - Veronique Leblond
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, AP-HP, Paris
| | - Damien Roos-Weil
- Sorbonne Universite, Service d'Hematologie Clinique, Hopital Pitie-Salpetriere, AP-HP, Paris, France; Centre de Recherche des Cordeliers, INSERM, Cell Death and Drug Resistance in Lymphoproliferative Disorders Team, Sorbonne Universite, Universite Sorbonne Paris Cite, Universite Paris Descartes, Universite Paris Diderot, F-75006 Paris.
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35
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Schuster M, Zijlstra J, Casasnovas RO, Vermaat JSP, Kalakonda N, Goy A, Choquet S, Neste EVD, Hill B, Thieblemont C, Cavallo F, De la Cruz F, Kuruvilla J, Hamad N, Jaeger U, Caimi P, Gurion R, Warzocha K, Bakhshi S, Sancho JM, Follows G, Egyed M, Offner F, Vassilakopoulos T, Samal P, Ku M, Ma X, Corona K, Chamoun K, Shah J, Shacham S, Kauffman MG, Canales M, Maerevoet M. Effect of Prior Therapy and Disease Refractoriness on the Efficacy and Safety of Oral Selinexor in Patients with Diffuse Large B-cell Lymphoma (DLBCL): A Post-hoc Analysis of the SADAL Study. Clin Lymphoma Myeloma Leuk 2022; 22:483-494. [PMID: 35078739 DOI: 10.1016/j.clml.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 12/07/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Despite a number of treatment options, patients with diffuse large B-cell lymphoma (DLBCL) whose disease has become refractory to treatment have a poor prognosis. Selinexor is a novel, oral drug that is approved to treat patients with relapsed/refractory DLBCL. In this post hoc analysis of the SADAL study, a multinational, open-label study, we evaluated subpopulations to determine if response to single agent selinexor is impacted by number of lines of prior treatment, autologous stem cell transplant (ASCT), response to first and most recent therapies, and time to progressive disease. PATIENTS Patients (n = 134) with DLBCL after 2-5 prior therapies were enrolled in SADAL and received 60mg selinexor twice weekly. RESULTS The median overall survival was 9.0 months and median progression free survival was 2.6 months. Patients who had the best overall response rate (ORR) and disease control rate were those who had prior ASCT (42.5% and 50.0%) or responded to last line of therapy (35.9% and 43.5%). Patients with primary refractory DLBCL also showed responses (ORR 21.8%). Adverse events between subgroups were similar to the overall study population, the most common being thrombocytopenia (29.1%), fatigue (7.5%), and nausea (6.0%). CONCLUSION Regardless of prior therapy and disease refractory status, selinexor treatment demonstrated results consistent with its novel mechanism of action and lack of cross-resistance. Thus, single agent oral selinexor can induce deep, durable, and tolerable responses in patients with DLBCL who have recurrent disease after several chemoimmunotherapy combination regimens.
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Affiliation(s)
| | - Josée Zijlstra
- Amsterdam UMC, Vrije Universiteit, Cancer Center, Amsterdam, Netherlands
| | | | | | | | - Andre Goy
- Hackensack University Medical Center, Hackensack, NJ, United States
| | | | | | - Brian Hill
- Cleveland Clinic, Cleveland, OH, United States
| | - Catherine Thieblemont
- APHP, Saint-Louis Hospital, Hemato-oncology, Paris, France & Diderot University, Paris, France
| | | | | | | | - Nada Hamad
- St. Vincent's Hospital Sydney, Darlinghurst, Australia
| | | | - Paolo Caimi
- UH Seidman Cancer Center, Cleveland, OH, United States
| | | | | | - Sameer Bakhshi
- Dr. B. R. A. Institute Rotary Cancer Hospital, New Delhi, India
| | | | | | | | | | | | - Priyanka Samal
- Institute of Medical Sciences & SUM Hospital, Odisha, India
| | - Matthew Ku
- St.Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Xiwen Ma
- Karyopharm Therapeutics, Newton, MA, United States
| | - Kelly Corona
- Karyopharm Therapeutics, Newton, MA, United States
| | | | - Jatin Shah
- Karyopharm Therapeutics, Newton, MA, United States
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Desjardins C, Larrieu-Ciron D, Choquet S, Mokhtari K, Charlotte F, Nichelli L, Mathon B, Ahle G, Le Garff-Tavernier M, Morales-Martinez A, Dehais C, Hoang-Xuan K, Houillier C. Chemotherapy is an efficient treatment in primary CNS MALT lymphoma. J Neurooncol 2022; 159:151-161. [PMID: 35725885 DOI: 10.1007/s11060-022-04052-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mucosae-associated lymphoid tissue (MALT) lymphomas are a rare and poorly understood form of primary central nervous system lymphoma (PCNSL). The aim of this study was to better describe these tumors, their management and their long-term prognosis. METHODS Patients with primary CNS MALT lymphoma (PCNSML) were retrospectively selected from the database on PCNSL of the Pitié-Salpêtrière Hospital. RESULTS Of 662 PCNSL, 11 (1.7%) PCNSML (9 females and 2 males, median age: 56 years) were selected. The median time from first symptoms to diagnosis was 13 months. Location was dural in 8 cases and parenchymal in 3 cases. The disease was multifocal/diffuse in 7 cases. In first line, all patients received chemotherapy (high-dose methotrexate (HD-MTX) based chemotherapy (n = 4) and non-HD-MTX-based chemotherapy (n = 7)), preceded by surgery in 4 cases. None received radiotherapy. According to the IPCG (International PCNSL Collaborative Group) criteria, the overall response rate was 7/11 (64%). At latest news, 5 patients had persistent contrast enhancement, stable with no treatment since a median of 57 months, raising the question of complete response despite persisting contrast enhancement. No patient developed neurotoxicity except for one patient who subsequently received radiotherapy. The median follow-up was 109 months. The median progression-free survival was 78.0 months and the 10-year overall survival rate was 90%. CONCLUSION This is the largest series demonstrating that chemotherapy is an efficient treatment in PCNSML, with an excellent long-term outcome and the absence of neurotoxicity, and calling into question the relevance of the IPCG criteria for the evaluation of response.
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Affiliation(s)
- Clément Desjardins
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - Delphine Larrieu-Ciron
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France.,Neurology Department, Hôpital Pierre Paul Riquet, CHU de Toulouse Purpan, Toulouse, France
| | - Sylvain Choquet
- Clinical Hematology Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Karima Mokhtari
- Neuropathology Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Frédéric Charlotte
- Service d'Anatomie et Cytologie Pathologiques, Groupe Hospitalier Pitié-Salpétrière-Charles Foix, Sorbonne Université, Paris, France
| | - Lucia Nichelli
- Neuroradiology Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Bertrand Mathon
- Neurosurgery Department, Hôpital Pitié-Salpêtrière, APHP, Paris, France
| | - Guido Ahle
- Department of Neurology, Hôpitaux Civils de Colmar, Colmar, France
| | | | - Andrea Morales-Martinez
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - Caroline Dehais
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - Khê Hoang-Xuan
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France
| | - Caroline Houillier
- Neuro-Oncology Department, Hôpital Pitié Salpêtrière, APHP, Sorbonne Université, IHU, ICM, Paris, France.
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Choquet S, Uttenthal B, Chaganti S, Comoli P, Trappe R, Friedetzky A, Xing B, Li X, Polak T, Gamelin L, Terwey JH, Dierickx D. P1457: DEMOGRAPHICS AND TREATMENT OUTCOMES IN PATIENTS WITH EBV+ PTLD TREATED WITH OFF-THE-SHELF EBV-SPECIFIC CTL (TABELECLEUCEL) UNDER AN ONGOING EXPANDED ACCESS PROGRAM IN EUROPE: FIRST ANALYSES. Hemasphere 2022. [PMCID: PMC9429700 DOI: 10.1097/01.hs9.0000848684.24968.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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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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39
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Choquet S, Chaganti S, Uttenthal B, Comoli P, Trappe RU, Friedetzky A, Xing B, Li X, Polak TB, Gamelin L, Terwey JH, Dierickx D. Demographics and treatment outcomes in patients with EBV + PTLD treated with off-the-shelf EBV-specific CTL under an ongoing expanded access program in Europe: First analyses. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.7530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7530 Background: Patients undergoing allogeneic hematopoietic cell transplant (HCT) or solid organ transplant (SOT) are at risk of developing Epstein–Barr virus driven post-transplant lymphoproliferative disorder (EBV+ PTLD), a rare hematologic malignancy, which is often aggressive and life-threatening. Patients with relapsed or refractory (r/r) EBV+ PTLD have few treatment options with poor outcomes, demonstrating a clear unmet medical need. Tabelecleucel is an investigational, off-the-shelf, allogeneic EBV-specific T-cell immunotherapy being studied in patients with serious EBV+ diseases (NCT04554914 & NCT03394365) that has demonstrated clinical benefit and favorable safety profile in the treatment of EBV+ PTLD after failure of rituximab (R) ± chemotherapy (Prockop, EBMT 2021, ATC 2021, ASH 2021). Methods: Atara Biotherapeutics supports an ongoing expanded access program (EAP) in Europe for patients with EBV+ diseases who have no other treatment options. Here we report demographics, efficacy and safety results of r/r EBV+ PTLD patients following SOT or HCT who presented between Jul 2020 and Nov 2021 and consented to research. Results: A total of 48 EAP requests from 9 countries for patients with EBV+ diseases were received. Twenty-two patients from 7 countries consented to this research: 16 EBV+ PTLD and 6 EBV+ non-PTLD. Of the 16 PTLD patients 15 received at least one dose of tabelecleucel. Overall, 9 out of 15 (60%) patients achieved a response as assessed by the treating physician, with 6 complete responses and 3 partial responses. Eight out of nine responses were seen after the first cycle. No adverse events were reported as related to tabelecleucel by the treating physician. Conclusions: The successful execution of this European EAP demonstrates the feasibility to deliver an off-the-shelf allogeneic EBV+ T-cell therapy in time-sensitive clinical situations when no other treatment options exist. These data show clinically meaningful outcomes for patients with r/r EBV+PTLD post-SOT or post-HCT treated with tabelecleucel consistent with previously reported favorable safety and efficacy profile (Prockop, ASH 2021).[Table: see text]
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Affiliation(s)
| | - Sridhar Chaganti
- University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
| | - Ben Uttenthal
- Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Bonnet A, Bossard C, Gabellier L, Rohmer J, Laghmari O, Parrens M, Sarkozy C, Dulery R, Roland V, Llamas-Gutierrez F, Oberic L, Fornecker LM, Bounaix L, Villemagne B, Szablewski V, Choquet S, Bouabdallah K, Traverse-Glehen A, Mohty M, Sanhes L, Houot R, Gastinne T, Leux C, Le Gouill S. Clinical presentation, outcome, and prognostic markers in patients with intravascular large B-cell lymphoma, a lymphoma study association (LYSA) retrospective study. Cancer Med 2022; 11:3602-3611. [PMID: 35538643 PMCID: PMC9554445 DOI: 10.1002/cam4.4742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/03/2021] [Accepted: 12/23/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Intravascular large B-cell lymphoma (lVLBCL) is a very rare type of large B-cell lymphoma. METHODS We conducted a retrospective study on IVLBCL patients treated from 2000 to 2016 in LYSA cooperative group centers. RESULTS Sixty-five patients were identified in 23 centers. Median age at diagnosis was 69 years (range 23-92). Thirty-four patients (64%) had an IPI score >3 and 40 patients (67%) had a performance status ≥2. The most frequent extra-nodal locations were bone marrow (n = 34; 52%), central nervous system (n = 25; 39%), and skin (n = 21; 33%). Nodal involvement and endocrine system were observed in 34% (n = 22) and 18% (n = 12) of all cases, respectively. Twenty-six patients (41%) had macrophage activation syndrome. Tumor cells were frequently CD5 positive (52%) with a non-germinal center origin (86%). BCL2 was expressed in 87% of all samples analyzed (n = 20) and 43% of patients had a MYC/BCL2 double expression. Fifty-six patients were treated with a regimen of chemotherapy containing rituximab, among whom 73% reached complete remission. The median progression-free survival (PFS) and median overall survival (OS) were 29.4 months and 63.8 months, respectively. History of autoimmune disorder (Hazard ratio [HR] 3.3 [1.4-7.8]; p < 0.01), nodal involvement (HR 2.6 [1.4-5.1]; p < 0.01), lack of anthracycline (HR 0.1 [0-0.4] for use; p < 0.001), or no intensification at first-line regimen (p = 0.02) were associated with worse PFS. High-dose methotrexate use was not associated with better PFS or OS. CONCLUSIONS Our study highlights the aggressive clinical picture of IVLBCL, in particular the frequency of macrophage activation syndrome, and the need for new therapies despite a response to R-CHOP-like regimen similar to non-intravascular diffuse large B-cell lymphomas.
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Affiliation(s)
| | - Céline Bossard
- Service d'anatomie et cytologie pathologique, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Ludovic Gabellier
- Service d'hématologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Julien Rohmer
- Service d'hématologie, Hôpital Pitié - Salpêtrière - APHP, Sorbonne Université, Paris, France
| | - Othman Laghmari
- Service d'anatomie et cytologie pathologique, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Marie Parrens
- Département de pathologie, Hôpital Haut-Lévêque, CHU et université de Bordeaux, Bordeaux, France
| | | | - Rémy Dulery
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, AP-HP, Université Sorbonne, INSERM, Centre de recherche Saint-Antoine, Paris, France
| | - Virginie Roland
- Centre Hospitalier de Perpignan, Service d'hématologie, Perpignan, France
| | | | - Lucie Oberic
- Service d'hématologie, Centre Hospitalier Universitaire Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Luc-Matthieu Fornecker
- Service d'hématologie, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Laura Bounaix
- Service de thérapie cellulaire et d'hématologie clinique adulte, Centre Hospitalier Universitaire Clermont-Ferrand, site Estaing, Clermont-Ferrand, France
| | - Bruno Villemagne
- Service d'onco-hématologie médecine interne, Centre Hospitalier Départemental Vendée, La Roche sur Yon, France
| | - Vanessa Szablewski
- Service d'anatomopathologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Sylvain Choquet
- Service d'hématologie, Hôpital Pitié - Salpêtrière - APHP, Sorbonne Université, Paris, France
| | - Krimo Bouabdallah
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Haut-Lévèque, CHU Bordeaux, Bordeaux, France
| | | | - Mohamad Mohty
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, AP-HP, Université Sorbonne, INSERM, Centre de recherche Saint-Antoine, Paris, France
| | - Laurence Sanhes
- Centre Hospitalier de Perpignan, Service d'hématologie, Perpignan, France
| | - Roch Houot
- Service d'hématologie, CHU Rennes, University of Rennes, INSERM U1236, Rennes, France
| | | | - Christophe Leux
- Service d'information médicale, Centre Hospitalier Universitaire Nantes, Nantes, France
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Nivet T, Baptiste A, Belin L, Ghillani-Dalbin P, Algrin C, Choquet S, Lamy T, Morel V, Musset L, Roos-Weil D, Viala K, Leblond V, Baron M. Immunochemotherapy versus rituximab in anti-myelin-associated glycoprotein neuropathy: A report of 64 patients. Br J Haematol 2022; 198:298-306. [PMID: 35420717 DOI: 10.1111/bjh.18202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 01/22/2023]
Abstract
Monoclonal immunoglobulin M (IgM) anti-myelin-associated glycoprotein (MAG) neuropathy is a rare disabling condition, most commonly treated with rituximab monotherapy (R), which leads to neurological improvement in only 30%-50% of patients. The combination of rituximab plus chemotherapy has been proven to improve the level of responses. We studied the outcomes of anti-MAG neuropathy patients treated either by R, or by immunochemotherapy (ICT) in our centre, focusing on the incidence of the first neurological response evaluated by the modified Rankin scale (mRS). From 2011 to 2018, 64 patients were studied: 34 were treated with R and 30 with ICT. According to our treatment decision-making process, the median mRS was higher in the ICT group (mRS 2) than in the R group (mRS 1). At one year, improvements of the mRS rates were 46% and 18% in the ICT and R groups of patients respectively, with median times to response of eight and 13 months (p = 0.023). Adverse effects were higher in the ICT group: 62% vs 15% (p ˂ 0.01), all grades included. One secondary acute leukaemia occurred five years after treatment with ICT. In conclusion, ICT may be used as a valid option for patients with rapidly progressive and/or severe anti-MAG neuropathy symptoms.
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Affiliation(s)
- Thomas Nivet
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France.,Department of Hematology, CHU de Rennes, Rennes, France
| | - Amandine Baptiste
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Lisa Belin
- Department of Epidemiology, Biostatistics and Clinical Research, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Pascale Ghillani-Dalbin
- Department of Immunochemistry, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Caroline Algrin
- Department of Hematology, Groupe Hospitalier mutualiste de Grenoble, Grenoble, France
| | - Sylvain Choquet
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Thierry Lamy
- Department of Hematology, CHU de Rennes, Rennes, France
| | - Véronique Morel
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Lucile Musset
- Department of Immunochemistry, AP-HP, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris, France
| | - Damien Roos-Weil
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Karine Viala
- Department of Neurophysiology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Véronique Leblond
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
| | - Marine Baron
- Department of Hematology, AP-HP, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris, France
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Denier M, Tick S, Dubois R, Dulery R, Eller AW, Suarez F, Burroni B, Maurage CA, Bories C, Konopacki J, Puech M, Bouscary D, Cantalloube A, Héron E, Marçais A, Habas C, Theillac V, Keilani C, Bonhomme GR, Gallagher DS, Boumendil J, Abarah W, Sedira N, Bertin S, Choquet S, Sahel JA, Merabet L, Brignole-Baudouin F, Putterman M, Errera MH. Hidden in the Eyes—Recurrence of Systemic Hemopathies Reportedly “In Remission”: Six Cases and Review of Literature. Medicina (B Aires) 2022; 58:medicina58030456. [PMID: 35334633 PMCID: PMC8950814 DOI: 10.3390/medicina58030456] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Secondary ocular localizations of hematological malignancies are blinding conditions with a poor prognosis, and often result in a delay in the diagnosis. Materials and Methods: We describe a series of rare cases of ocular involvement in six patients with hematological malignancies, reportedly in remission, who presented secondary ocular localizations, challenging to diagnose. Two patients had an acute lymphoblastic leukemia (ALL) and developed either a posterior scleritis or a pseudo-panuveitis with ciliary process infiltration. One patient had iris plasmacytoma and developed an anterior uveitis as a secondary presentation. Two patients had a current systemic diffuse large B-cell lymphoma (DLBCL) and were referred either for intermediate uveitis or for papilledema and vitritis with secondary retinitis. Finally, one patient with an acute myeloid leukemia (AML) presented a conjunctival localization of a myeloid sarcoma. We herein summarize the current knowledge of ophthalmologic manifestations of extramedullary hematopathies. Results: Inflammatory signs were associated with symptomatic infiltrative lesions well displayed in either the iris, the retina, the choroid, or the cavernous sinus, from the admission of the patients in the ophthalmological department. These findings suggest that patients with ALL, AML, systemic DLBCL, and myeloma can present with ophthalmic involvement, even after having been reported as in remission following an effective systemic treatment and/or allograft. Conclusions: Early detection of hidden recurrence in the eyes may permit effective treatment. Furthermore, oncologists and ophthalmologists should be aware of those rare ocular malignant locations when monitoring patient’s progression after initial treatment, and close ophthalmologic examinations should be recommended when detecting patient’s ocular symptoms after treatment.
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Affiliation(s)
- Margot Denier
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Sarah Tick
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Romain Dubois
- Institut de Pathologie, CHRU de Lille, 59000 Lille, France;
| | - Remy Dulery
- Service d’Hématologie Clinique et de Thérapie Cellulaire, Hôpital Saint Antoine, AP-HP, Sorbonne Université, INSERM UMRs938, 75012 Paris, France;
| | - Andrew W. Eller
- Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
| | - Felipe Suarez
- Department of Hematology, Hôpital Necker-Enfants Malades, INSERM UMR 1163 et CNRS ERL 8254, Institut Imagine, Sorbonne Paris Cité, Université Paris Descartes, 149 rue de Sèvres, CEDEX 15, 75743 Paris, France; (F.S.); (A.M.)
| | - Barbara Burroni
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, 75006 Paris, France;
| | - Claude-Alain Maurage
- Centre de Recherche Jean-Pierre Aubert INSERM: U837, Université du Droit et de la Santé—Lille II, Faculté de Médecine 1, Place de Verdun, CEDEX, 59045 Lille, France;
- Institut de Pathologie—CHRU de Lille, 59000 Lille, France
| | - Claire Bories
- France Department of Hematology, CHRU, 59000 Lille, France;
| | - Johanna Konopacki
- Department of Hematology, Hôpital D’instruction des Armées Percy, 92140 Clamart, France;
| | | | - Didier Bouscary
- Department of Hematology, Faculté de Médecine Sorbonne Paris Cité, Université Paris Descartes, Hôpital Cochin, AP-HP, 75014 Paris, France;
| | - Alberte Cantalloube
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Emmanuel Héron
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Ambroise Marçais
- Department of Hematology, Hôpital Necker-Enfants Malades, INSERM UMR 1163 et CNRS ERL 8254, Institut Imagine, Sorbonne Paris Cité, Université Paris Descartes, 149 rue de Sèvres, CEDEX 15, 75743 Paris, France; (F.S.); (A.M.)
| | - Christophe Habas
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Vincent Theillac
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Chafik Keilani
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Gabrielle R. Bonhomme
- Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
| | - Denise S. Gallagher
- Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
| | - Julien Boumendil
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Wajed Abarah
- Department of Hematology, Hôpital de Meaux, 77100 Meaux, France;
| | - Neila Sedira
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Stéphane Bertin
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Sylvain Choquet
- Department of Hematology, Hôpital Pitié-Salpêtrière, 75013 Paris, France;
| | - José-Alain Sahel
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
- Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
| | - Lilia Merabet
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Françoise Brignole-Baudouin
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
- Sorbonne Universités, 75006 Paris, France
| | - Marc Putterman
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
| | - Marie-Hélène Errera
- Centre Hospitalier National des Quinze-Vingts, CIC 1423, DHU Sight Restore, 28 rue de Charenton, Sorbonne-Universités, Université Pierre et Marie Curie (UPMC), 75012 Paris, France; (M.D.); (S.T.); (A.C.); (E.H.); (C.H.); (V.T.); (C.K.); (J.B.); (N.S.); (S.B.); (J.-A.S.); (L.M.); (F.B.-B.); (M.P.)
- Ophthalmology Service, University of Pittsburgh School of Medicine, Pittsburgh, PA 75012, USA; (A.W.E.); (G.R.B.); (D.S.G.)
- Correspondence:
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Baron M, Soulié C, Lavolé A, Assoumou L, Abbar B, Fouquet B, Rousseau A, Veyri M, Samri A, Makinson A, Choquet S, Mazières J, Brosseau S, Autran B, Costagliola D, Katlama C, Cadranel J, Marcelin AG, Lambotte O, Spano JP, Guihot A. Impact of Anti PD-1 Immunotherapy on HIV Reservoir and Anti-Viral Immune Responses in People Living with HIV and Cancer. Cells 2022; 11:cells11061015. [PMID: 35326466 PMCID: PMC8946896 DOI: 10.3390/cells11061015] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023] Open
Abstract
The role of immune checkpoints (ICPs) in both anti-HIV T cell exhaustion and HIV reservoir persistence, has suggested that an HIV cure therapeutic strategy could involve ICP blockade. We studied the impact of anti-PD-1 therapy on HIV reservoirs and anti-viral immune responses in people living with HIV and treated for cancer. At several timepoints, we monitored CD4 cell counts, plasma HIV-RNA, cell associated (CA) HIV-DNA, EBV, CMV, HBV, HCV, and HHV-8 viral loads, activation markers, ICP expression and virus-specific T cells. Thirty-two patients were included, with median follow-up of 5 months. The CA HIV-DNA tended to decrease before cycle 2 (p = 0.049). Six patients exhibited a ≥0.5 log10 HIV-DNA decrease at least once. Among those, HIV-DNA became undetectable for 10 months in one patient. Overall, no significant increase in HIV-specific immunity was observed. In contrast, we detected an early increase in CTLA-4 + CD4+ T cells in all patients (p = 0.004) and a greater increase in CTLA-4+ and TIM-3 + CD8+ T cells in patients without HIV-DNA reduction compared to the others (p ≤ 0.03). Our results suggest that ICP replacement compensatory mechanisms might limit the impact of anti-PD-1 monotherapy on HIV reservoirs, and pave the way for combination ICP blockade in HIV cure strategies.
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Affiliation(s)
- Marine Baron
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
- Correspondence:
| | - Cathia Soulié
- INSERM UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Virologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (C.S.); (A.-G.M.)
| | - Armelle Lavolé
- GRC #04 Theranoscan, Département de Pneumologie et Oncologie Thoracique, AP-HP, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France; (A.L.); (J.C.)
| | - Lambert Assoumou
- INSERM UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, F-75013 Paris, France; (L.A.); (D.C.)
| | - Baptiste Abbar
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
| | - Baptiste Fouquet
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
| | - Alice Rousseau
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
| | - Marianne Veyri
- Département d’Oncologie Médicale, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (M.V.); (J.-P.S.)
| | - Assia Samri
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
| | - Alain Makinson
- INSERM U1175, Département de Maladies Infectieuses, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, F-34090 Montpellier, France;
| | - Sylvain Choquet
- Département d’Hématologie Clinique, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France;
| | - Julien Mazières
- Département de Pneumologie, Centre Hospitalier Universitaire de Toulouse, F-31000 Toulouse, France;
| | - Solenn Brosseau
- Département de Pneumologie, AP-HP, Hôpital Bichat-Claude Bernard, F-75018 Paris, France;
| | - Brigitte Autran
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
| | - Dominique Costagliola
- INSERM UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Sorbonne Université, F-75013 Paris, France; (L.A.); (D.C.)
| | - Christine Katlama
- Département de Maladies Infectieuses, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France;
| | - Jacques Cadranel
- GRC #04 Theranoscan, Département de Pneumologie et Oncologie Thoracique, AP-HP, Hôpital Tenon, Sorbonne Université, F-75020 Paris, France; (A.L.); (J.C.)
| | - Anne-Geneviève Marcelin
- INSERM UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Département de Virologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (C.S.); (A.-G.M.)
| | - Olivier Lambotte
- Département d’Immunologie Clinique, AP-HP, Hôpital Bicêtre, Université Paris-Saclay, F-94270 Le Kremlin Bicêtre, France;
- INSERM, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial Diseases (IDMIT/IMVA-HB), UMR1184, Université Paris-Saclay, F-94270 Le Kremlin Bicêtre, France
| | - Jean-Philippe Spano
- Département d’Oncologie Médicale, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (M.V.); (J.-P.S.)
| | - Amélie Guihot
- INSERM U1135, CIMI, Département d’Immunologie, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, F-75013 Paris, France; (B.A.); (B.F.); (A.R.); (A.S.); (B.A.); (A.G.)
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Solignac J, Farnault L, Robert T, Fanciullino R, Choquet S, Brunet P, Venton G, Bobot M. Successful treatment with adapted high dose methotrexate in a hemodialysis patient with primary central nervous system lymphoma: 100mg/m 2 seems sufficient. Nefrologia 2022; 42:130-134. [PMID: 36153909 DOI: 10.1016/j.nefroe.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/05/2021] [Indexed: 06/16/2023] Open
Abstract
High dose methotrexate (HD-MTX) based chemoimmunotherapy is a central part of the standard approach to treatment of primary central nervous system lymphoma (PCNSL). Renal dysfunction leads to delayed MTX complete elimination and critical MTX concentration. Despite the recommendations, hemodialysis status should not exclude HD-MTX. We report the case of a 64 years old woman on chronic hemodialysis with PCNSL successfully treated with HD-MTX-based chemoimmunotherapy with an adjusted dose of 100mg/m2, instead of the usual dose of 3500mg/m2, and daily hemodialysis started 24h later. The patient had no significant toxicity and was in complete remission at 1 year after the end of the treatment. We argue that ESRD is not an absolute pitfall to the use of HD-MTX for hematological malignancies. Experts should consider the use of adjusted dose at 100mg/m2 as a viable therapeutic modality in ESRD patients.
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Affiliation(s)
- Justine Solignac
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France; C2VN, INSERM, INRAE, Aix Marseille Université, Marseille, France
| | - Laure Farnault
- Service d'Hématologie et Thérapie Cellulaire, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Thomas Robert
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Raphaelle Fanciullino
- Laboratoire de Pharmacologie, Hôpital de La Timone, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Sylvain Choquet
- Service d'Hématologie, Hôpital de la Pitié-Salpêtrière, Assistance-Publique - Hôpitaux de Paris, Paris, France
| | - Philippe Brunet
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France; C2VN, INSERM, INRAE, Aix Marseille Université, Marseille, France
| | - Geoffroy Venton
- Service d'Hématologie et Thérapie Cellulaire, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France; TAGC, INSERM UMR 1090, Aix Marseille Université, Marseille, France
| | - Mickaël Bobot
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception, Assistance Publique - Hôpitaux de Marseille, Marseille, France; C2VN, INSERM, INRAE, Aix Marseille Université, Marseille, France.
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Jary A, Marot S, Faycal A, Leon S, Sayon S, Zafilaza K, Ghidaoui E, Quoc SN, Nemlaghi S, Choquet S, Dres M, Pourcher V, Calvez V, Junot H, Marcelin AG, Soulié C. Spike Gene Evolution and Immune Escape Mutations in Patients with Mild or Moderate Forms of COVID-19 and Treated with Monoclonal Antibodies Therapies. Viruses 2022; 14:v14020226. [PMID: 35215820 PMCID: PMC8877338 DOI: 10.3390/v14020226] [Citation(s) in RCA: 18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 12/16/2022] Open
Abstract
We explored the molecular evolution of the spike gene after the administration of anti-spike monoclonal antibodies in patients with mild or moderate forms of COVID-19. Four out of the 13 patients acquired a mutation during follow-up; two mutations (G1204E and E406G) appeared as a mixture without clinical impact, while the Q493R mutation emerged in two patients (one receiving bamlanivimab and one receiving bamlanivimab/etesevimab) with fatal outcomes. Careful virological monitoring of patients treated with mAbs should be performed, especially in immunosuppressed patients.
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Affiliation(s)
- Aude Jary
- Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France; (S.M.); (S.S.); (K.Z.); (E.G.); (V.C.); (A.-G.M.); (C.S.)
- AP-HP, Pitié-Salpêtrière, Service de Virologie, Bâtiment CERVI, 47-83 Boulevard de l’Hôpital, 75013 Paris, France
- Correspondence: ; Tel.: +33-1-4217-7401
| | - Stéphane Marot
- Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France; (S.M.); (S.S.); (K.Z.); (E.G.); (V.C.); (A.-G.M.); (C.S.)
- AP-HP, Pitié-Salpêtrière, Service de Virologie, Bâtiment CERVI, 47-83 Boulevard de l’Hôpital, 75013 Paris, France
| | - Antoine Faycal
- AP-HP, Hôpital Pitié-Salpêtrière, Service de Maladie Infectieuses et Tropicales, 75013 Paris, France;
| | - Sacha Leon
- Service de Pharmacie, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France; (S.L.); (H.J.)
| | - Sophie Sayon
- Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France; (S.M.); (S.S.); (K.Z.); (E.G.); (V.C.); (A.-G.M.); (C.S.)
- AP-HP, Pitié-Salpêtrière, Service de Virologie, Bâtiment CERVI, 47-83 Boulevard de l’Hôpital, 75013 Paris, France
| | - Karen Zafilaza
- Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France; (S.M.); (S.S.); (K.Z.); (E.G.); (V.C.); (A.-G.M.); (C.S.)
- AP-HP, Pitié-Salpêtrière, Service de Virologie, Bâtiment CERVI, 47-83 Boulevard de l’Hôpital, 75013 Paris, France
| | - Emna Ghidaoui
- Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France; (S.M.); (S.S.); (K.Z.); (E.G.); (V.C.); (A.-G.M.); (C.S.)
- AP-HP, Pitié-Salpêtrière, Service de Virologie, Bâtiment CERVI, 47-83 Boulevard de l’Hôpital, 75013 Paris, France
| | - Stéphanie Nguyen Quoc
- Service d’Hématologie Clinique, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France; (S.N.Q.); (S.C.)
| | - Safaa Nemlaghi
- Service de Médecine Intensive–Réanimation (Département “R3S”), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France; (S.N.); (M.D.)
| | - Sylvain Choquet
- Service d’Hématologie Clinique, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France; (S.N.Q.); (S.C.)
| | - Martin Dres
- Service de Médecine Intensive–Réanimation (Département “R3S”), AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France; (S.N.); (M.D.)
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, 75013 Paris, France
| | - Valérie Pourcher
- Service de Maladie Infectieuses et Tropicales, Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), INSERM, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France;
| | - Vincent Calvez
- Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France; (S.M.); (S.S.); (K.Z.); (E.G.); (V.C.); (A.-G.M.); (C.S.)
- AP-HP, Pitié-Salpêtrière, Service de Virologie, Bâtiment CERVI, 47-83 Boulevard de l’Hôpital, 75013 Paris, France
| | - Helga Junot
- Service de Pharmacie, AP-HP, Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013 Paris, France; (S.L.); (H.J.)
| | - Anne-Geneviève Marcelin
- Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France; (S.M.); (S.S.); (K.Z.); (E.G.); (V.C.); (A.-G.M.); (C.S.)
- AP-HP, Pitié-Salpêtrière, Service de Virologie, Bâtiment CERVI, 47-83 Boulevard de l’Hôpital, 75013 Paris, France
| | - Cathia Soulié
- Institut Pierre Louis d’Epidémiologie et de Santé Publique (iPLESP), INSERM, Sorbonne Université, 75013 Paris, France; (S.M.); (S.S.); (K.Z.); (E.G.); (V.C.); (A.-G.M.); (C.S.)
- AP-HP, Pitié-Salpêtrière, Service de Virologie, Bâtiment CERVI, 47-83 Boulevard de l’Hôpital, 75013 Paris, France
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Azar N, Ouzegdouh M, Choquet S, Goncalves N, Leblond V. In situ off-line extracorporeal photopheresis conducted in a real-life situation at a Hemobiotherapy Department in France: A comparison of costs vs on-line procedure. J Clin Apher 2021; 37:25-30. [PMID: 34726791 DOI: 10.1002/jca.21947] [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: 02/01/2021] [Revised: 10/18/2021] [Accepted: 10/23/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The off-line extracorporeal photopheresis (ECP) procedure requires photosensitization in an external cell therapy laboratory as per the French regulatory requirement. This regulation results in higher time and costs compared with the on-line alternative performed entirely at the patient's bedside. Recently, full in situ execution of the off-line procedure has been implemented in the Pitié-Salpêtrière Hospital Hemobiotherapy Department (Paris, France). This report summarizes the center's experience regarding the organizational and costs impacts of this change compared with the on-line procedure. MATERIAL AND METHODS ECP was broken down into stages, and several procedures were monitored prospectively in real-life settings. The total costs associated with both procedures were the sum of the fixed costs and variable costs related to all stages of the procedures, nursing-time costs, property costs, and patient-related production loss costs. RESULTS Eight off-line ECP and fourteen on-line ECP procedures were monitored during five consecutive days. Procedure duration was not different (median 137.5 vs 154.0 minutes, P = .29). Times and costs associated with nursing were higher but offset by lower fixed costs of the off-line ECP. Total direct costs per procedure associated with using the off-line ECP were significantly lower than those of the on-line procedure (459.6 ± 7.1 EUR vs 953.8 ± 6.5 EUR; P = .0002). Similar results were observed when including the costs of patient production loss. CONCLUSIONS As a competitive time procedure, the in situ off-line method proved to be cost-efficient by effectively offering similar patient treatment per year compared with the on-line procedure.
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Affiliation(s)
- Nabih Azar
- Department of Hematology, Hôpital Pitié-Salpétrière, Paris, France
| | - Maya Ouzegdouh
- Department of Hematology, Hôpital Pitié-Salpétrière, Paris, France
| | - Sylvain Choquet
- Department of Hematology, Hôpital Pitié-Salpétrière, Paris, France
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47
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Bouzidi A, Labreche K, Baron M, Veyri M, Denis JA, Touat M, Sanson M, Davi F, Guillerm E, Jouannet S, Charlotte F, Bielle F, Choquet S, Boëlle PY, Cadranel J, Leblond V, Autran B, Lacorte JM, Spano JP, Coulet F. Low-Coverage Whole Genome Sequencing of Cell-Free DNA From Immunosuppressed Cancer Patients Enables Tumor Fraction Determination and Reveals Relevant Copy Number Alterations. Front Cell Dev Biol 2021; 9:661272. [PMID: 34710202 PMCID: PMC8369887 DOI: 10.3389/fcell.2021.661272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
Cell-free DNA (cfDNA) analysis is a minimally invasive method that can be used to detect genomic abnormalities by directly testing a blood sample. This method is particularly useful for immunosuppressed patients, who are at high risk of complications from tissue biopsy. The cfDNA tumor fraction (TF) varies greatly across cancer type and between patients. Thus, the detection of molecular alterations is highly dependent on the circulating TF. In our study, we aimed to calculate the TF and characterize the copy number aberration (CNA) profile of cfDNA from patients with rare malignancies occurring in immunosuppressed environments or immune-privileged sites. To accomplish this, we recruited 36 patients: 19 patients with non-Hodgkin lymphoma (NHL) who were either human immunodeficiency virus (HIV)-positive or organ transplant recipients, 5 HIV-positive lung cancer patients, and 12 patients with glioma. cfDNA was extracted from the patients' plasma and sequenced using low-coverage whole genome sequencing (LC-WGS). The cfDNA TF was then calculated using the ichorCNA bioinformatic algorithm, based on the CNA profile. In parallel, we performed whole exome sequencing of patient tumor tissue and cfDNA samples with detectable TFs. We detected a cfDNA TF in 29% of immune-suppressed patients (one patient with lung cancer and six with systemic NHL), with a TF range from 8 to 70%. In these patients, the events detected in the CNA profile of cfDNA are well-known events associated with NHL and lung cancer. Moreover, cfDNA CNA profile correlated with the CNA profile of matched tumor tissue. No tumor-derived cfDNA was detected in the glioma patients. Our study shows that tumor genetic content is detectable in cfDNA from immunosuppressed patients with advanced NHL or lung cancer. LC-WGS is a time- and cost-effective method that can help select an appropriate strategy for performing extensive molecular analysis of cfDNA. This technique also enables characterization of CNAs in cfDNA when sufficient tumor content is available. Hence, this approach can be used to collect useful molecular information that is relevant to patient care.
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Affiliation(s)
- Amira Bouzidi
- Sorbonne University, INSERM, Research Unit on Cardiovascular and Metabolic Disease UMR ICAN, Department of Endocrine Biochemistry and Oncology, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Karim Labreche
- Sorbonne University, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Marine Baron
- Sorbonne University, Center for Immunology and Infectious Diseases (CIMI-Paris), Department of Hematology, APHP, Hôpital Pitié Salpêtrière, Paris, France
| | - Marianne Veyri
- Sorbonne University, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Theravir Team, Medical Oncology, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Jérôme Alexandre Denis
- Sorbonne University, INSERM, Saint-Antoine Research Center, Cancer Biology and Therapeutics, CRSA, Department of Endocrine Biochemistry and Oncology, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Mehdi Touat
- Sorbonne University, INSERM, CNRS, Brain and Spine Institute, ICM, Department of Neurology 2-Mazarin, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Marc Sanson
- Sorbonne University, INSERM, CNRS, Brain and Spine Institute, ICM, Department of Neurology 2-Mazarin, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Frédéric Davi
- Sorbonne University, INSERM, Centre de Recherche des Cordeliers, Department of Biological Hematology, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Erell Guillerm
- Sorbonne University, INSERM, Saint-Antoine Research Center, Microsatellites Instability and Cancer, CRSA, Genetics Department, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Stéphanie Jouannet
- Sorbonne University, Neurosurgery Department, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Frédéric Charlotte
- Sorbonne University, Anatomy and Pathologic Cytology, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Franck Bielle
- Sorbonne University, Neuropathology Department, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Sylvain Choquet
- Sorbonne University, Center for Immunology and Infectious Diseases (CIMI-Paris), Department of Hematology, APHP, Hôpital Pitié Salpêtrière, Paris, France
| | - Pierre-Yves Boëlle
- Sorbonne University, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Jacques Cadranel
- Sorbonne University, Chest Department and Thoracic Oncology, GRC 04, Theranoscan, AP-HP, Hôpital Tenon, Paris, France
| | - Véronique Leblond
- Sorbonne University, Center for Immunology and Infectious Diseases (CIMI-Paris), Department of Hematology, APHP, Hôpital Pitié Salpêtrière, Paris, France
| | - Brigitte Autran
- Sorbonne University, INSERM, CNRS, Center for Immunology and Infectious Diseases (CIMI-Paris), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Marc Lacorte
- Sorbonne University, INSERM, Research Unit on Cardiovascular and Metabolic Disease UMR ICAN, Department of Endocrine Biochemistry and Oncology, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Jean-Philippe Spano
- Sorbonne University, INSERM, Research Unit on Cardiovascular and Metabolic Disease UMR ICAN, Department of Endocrine Biochemistry and Oncology, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
| | - Florence Coulet
- Sorbonne University, INSERM, Research Unit on Cardiovascular and Metabolic Disease UMR ICAN, Department of Endocrine Biochemistry and Oncology, AP-HP, Hôpital Pitié Salpêtrière, Paris, France
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48
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Dufour J, Choquet S, Schmitt A, Ahle G, Houot R, Taillandier L, Ursu R, Hoang-Xuan K, Soussain C, Houillier C. P14.48 Extracerebral relapses of primary CNS lymphoma (PCNSL): a LOC network retrospective study. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Classically PCNSL remain confined within the CNS throughout their evolution for reasons still unknown (> 80% cerebral relapses). The aim of this study was to describe the characteristics and outcomes of the rare extracerebral relapses of PCNSL.
MATERIAL AND METHODS
This is a multicenter, retrospective study. We included all immunocompetent patients newly diagnosed with diffuse large B-cell PCNSL registered in the national LOC network database since 2010 and followed prospectively, who presented an extracerebral relapse, pure (extracerebral only site) or associated with concomitant CNS relapse (mixed). All had body scan and/or TEP -CT at diagnosis work up.
RESULTS
Of the 1968 PCNSL included in the database, 29 (1.5%) patients presented a systemic relapse [median age 71 years, median KPS 70% at relapse], either pure (n=19) or mixed (n=10), with a histological confirmation in 19 cases (66%). The median delay between initial diagnosis and systemic relapse was 15 months [2–49 months], with 5 very early relapses (<8 months) and 10 late relapses (>21 months). 27 patients had symptoms, 21 related to the location of relapse and 6 with only general symptoms. The localization was thoracic (n=11), abdominal/pelvic (n=14), head/neck (n=6) and limbs (n=9). We found visceral (n=24, 83%), including testis in 5 (28%) men and breast in 3 (27%) women, lymph node (n=12, 41%) and peripheral nervous system (PNS) (n=8, 28%; 4 plexus and 4 extradural roots) involvement. 27 patients were treated with chemotherapy, either with only systemic target (n=8) (R-CHOP alone) or mixed systemic and CNS target (n=19) (R-CHOP-MTX, R-ICE, GEMOX, RDHAC) and consolidated by high-dose chemotherapy with autologous stem cell transplantation (HCT-ASCT) in 4 cases [median age 55 years, median KPS 80%], with 34% of complete response. After systemic relapse, median progression-free survival was 8 months and overall survival (OS) was 9 months, 15 months for pure systemic and 4.5 months for mixed relapses. KPS>70%, pure systemic relapses and complete response were significantly associated with higher OS in univariate analysis.
CONCLUSION
Extracerebral PCNSL relapses are very rare, mainly extranodal and involve a large spectrum of anatomical sites, the most frequent being testis, breast and PNS. Prognosis was worse in case of mixed relapse than in pure systemic relapse that was similar to non PCNSL lymphomas. Very early relapses raise the question of misdiagnosed occult extracerebral lymphoma at diagnostic work up that should include systematically a FDG PET-CT. More studies are needed to refine their treatment and to specify the role of HCT-ASCT. Paired tumor tissues at diagnosis (CNS)/relapse (extracerebral) analysis would provide a better understanding of underlying molecular mechanisms.
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Affiliation(s)
- J Dufour
- Hôpital Pitié-Salpêtriere, Paris, France
| | - S Choquet
- Hôpital Pitié-Salpêtriere, Paris, France
| | - A Schmitt
- Institut de Bergonie, Bordeaux, France
| | - G Ahle
- Centre hospitalier de Colmar, Colmar, France
| | - R Houot
- Hôpital Universitaire de Rennes, Rennes, France
| | | | - R Ursu
- Hôpital Saint-Louis, Paris, France
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49
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Valyraki N, Ahle G, Tabouret E, Houot R, Jardin F, Ghesquieres H, Choquet S, Moles M, Hoang-Xuan K, Houillier C. P14.54 Primary central nervous system lymphoma of the spinal cord: a LOC network cohort study. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Primary central nervous system lymphoma (PCNSL) mainly affects the brain (>90% of the cases), Very little data can be found in the literature on PCNSL with spinal cord localization.
MATERIAL AND METHODS
We present a retrospective study based on the French LOC network database. We selected adult immunocompetentpatients, with a histological or cytological diagnosis of PCNSL, and a spinal cord localization at initial diagnosis.
RESULTS
Of the 2043 PCNSLof the LOC database newly diagnosed since 2011, 14 patients (9 men, median age 68, median Karnofsky performance status 50%)met the selection criteria. The median diagnostic delay was 82 days (min 15-max 1080) compared to 35 days in primary cerebral lymphomas. At diagnosis, walking was impossible in 7/14 patients and 5/14 had indwelling urinary catheter. On MRI, 100% had enlargement of the spinal cord with homogeneous contrast enhancement in 13/14 cases. Spinal cord lesions were unique in 9/14 patients and multiples in 5/14 patients. CSF IL10 level was increased in 6/7 patients. Brain lesions were found in 9/14 patients, located in the posterior fossa in 5/9 cases. The diagnosis was made either on a brain biopsy (N=6), a spinal cord biopsy or surgery (N=5) or the cytologic analysis of the CSF (N=3).4/5 patients had neurological sequel after spinal cord biopsy or surgery. All the patients were treated by high-dose methotrexate-based chemotherapy, followed by spinal cord irradiation (N=1) or autograft (N=2). There was an overall response rate of 71% (complete response in 8/14). 8/14 patients relapsed, 5 in the brain, 2 in the spinal cord, and 1 both in the spinal cord and in the brain. 2-year PFS and OS were 45% and 64%, respectively. Among the long-term responders, 50% remained in wheel chair, while only 10% could walk normally.
CONCLUSION
Considering the high risk of a spinal cord biopsy,the rarity of the disease, as well as the numerous differential diagnoses, the diagnosis of spinal cord lymphoma is difficult. Searching for other lymphomatous locations or assaying CSF IL10 may be helpful in this disease where delay in diagnosis is often prolonged et can cause irreversible handicap.
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Affiliation(s)
- N Valyraki
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - G Ahle
- Hôpital Pasteur - Hôpitaux civils de Colmar, Colmar, France
| | - E Tabouret
- Hôpitaux Unoversitaires de la Timone, Marseilel, France
| | - R Houot
- Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - F Jardin
- Centre Henri Becquerel, Rouen, France
| | | | - S Choquet
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - M Moles
- Centre Hospitalier Universitaire d’Anger, Angers, France
| | - K Hoang-Xuan
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - C Houillier
- Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
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50
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Tremblay G, Daniele P, Breeze J, Li L, Shah J, Shacham S, Kauffman M, Engelhardt M, Chari A, Nooka A, Vogl D, Gavriatopoulou M, Dimopoulos MA, Richardson P, Biran N, Siegel D, Vlummens P, Doyen C, Facon T, Mohty M, Meuleman N, Levy M, Costa L, Hoffman JE, Delforge M, Kaminetzky D, Weisel K, Raab M, Dingli D, Tuchman S, Laurent F, Vij R, Schiller G, Moreau P, Richter J, Schreder M, Podar K, Parker T, Cornell RF, Lionel K, Choquet S, Sundar J. Quality of life analyses in patients with multiple myeloma: results from the Selinexor (KPT-330) Treatment of Refractory Myeloma (STORM) phase 2b study. BMC Cancer 2021; 21:993. [PMID: 34488662 PMCID: PMC8419947 DOI: 10.1186/s12885-021-08453-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/07/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Selinexor is an oral, selective nuclear export inhibitor. STORM was a phase 2b, single-arm, open-label, multicenter trial of selinexor with low dose dexamethasone in patients with penta-exposed relapsed/refractory multiple myeloma (RRMM) that met its primary endpoint, with overall response of 26% (95% confidence interval [CI], 19 to 35%). Health-related quality of life (HRQoL) was a secondary endpoint measured using the Functional Assessment of Cancer Therapy - Multiple Myeloma (FACT-MM). This study examines impact of selinexor treatment on HRQoL of patients treated in STORM and reports two approaches to calculate minimal clinically important differences for the FACT-MM. METHODS FACT-MM data were collected at baseline, on day 1 of each 4-week treatment cycle, and at end of treatment (EOT). Changes from baseline were analyzed for the FACT-MM total score, FACT-trial outcome index (TOI), FACT-General (FACT-G), and the MM-specific domain using mixed-effects regression models. Two approaches for evaluating minimal clinically important differences were explored: the first defined as 10% of the instrument range, and the second based on estimated mean baseline differences between Eastern Cooperative Oncology Group performance status (ECOG PS) scores. Post-hoc difference analysis compared change in scores from baseline to EOT for treatment responders and non-responders. RESULTS Eighty patients were included in the analysis; the mean number of prior therapies was 7.9 (standard deviation [SD] 3.1), and mean duration of myeloma was 7.6 years (SD 3.4). Each exploratory minimal clinically important difference threshold yielded consistent results whereby most patients did not experience HRQoL decline during the first six cycles of treatment (range: 53.9 to 75.7% for the first approach; range: 52.6 to 72.9% for the second). Treatment responders experienced less decline in HRQoL from baseline to EOT than non-responders, which was significant for the FACT-G, but not for other scores. CONCLUSION The majority of patients did not experience decline in HRQoL based on minimal clinically important differences during early cycles of treatment with selinexor and dexamethasone in the STORM trial. An anchor-based approach utilizing patient-level data (ECOG PS score) to define minimal clinically important differences for the FACT-MM gave consistent results with a distribution-based approach. TRIAL REGISTRATION This trial was registered on ClinicalTrials.gov under the trial-ID NCT02336815 on January 8, 2015.
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Affiliation(s)
- Gabriel Tremblay
- Purple Squirrel Economics, 1600 Notre Dame W, Suite 201, Montreal, QC, H3J 1M1, Canada.
| | - Patrick Daniele
- Purple Squirrel Economics, 1600 Notre Dame W, Suite 201, Montreal, QC, H3J 1M1, Canada
| | - Janis Breeze
- Purple Squirrel Economics, 1600 Notre Dame W, Suite 201, Montreal, QC, H3J 1M1, Canada
| | | | - Jatin Shah
- Karyopharm Therapeutics Inc., Newton, USA
| | | | | | | | - Ajaj Chari
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ajay Nooka
- Winship Cancer Institute, Emory University, Atlanta, USA
| | - Dan Vogl
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | | | | | - Noa Biran
- Hackensack Meridian Health Hackensack University Medical Center, Hackensack, USA
| | - David Siegel
- Hackensack Meridian Health Hackensack University Medical Center, Hackensack, USA
| | | | - Chantal Doyen
- Université catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | | | | | | | - Moshe Levy
- Baylor University Medical Center, Dallas, USA
| | - Luciano Costa
- University of Alabama at Birmingham, Birmingham, USA
| | | | | | | | - Katja Weisel
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Raab
- University of Heidelberg, Heidelberg, Germany
| | | | - Sascha Tuchman
- Lineberger Comprehensive Cancer Center at University of North Carolina-Chapel Hill, Chapel Hill, USA
| | | | - Ravi Vij
- Washington University School of Medicine, St. Louis, USA
| | - Gary Schiller
- David Geffen School of Medicine at University of California, Los Angeles, USA
| | | | - Joshua Richter
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | - Klaus Podar
- University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | | | | | - Karlin Lionel
- Centre Hospitalier Lyon Sud, Saint-Genis-Laval, France
| | | | - Jagannath Sundar
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
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