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Schavgoulidze A, Corre J, Samur MK, Mazzotti C, Pavageau L, Perrot A, Cazaubiel T, Leleu X, Macro M, Belhadj K, Roussel M, Brechignac S, Montes L, Caillot D, Frenzel L, Rey P, Schiano JM, Chalopin T, Jacquet C, Richez V, Orsini Piocelle F, Fontan J, Manier S, Martinet L, Sciambi A, Mohty M, Avet-Loiseau H. RAS/RAFlandscape in monoclonal plasma cell conditions. Blood 2024:blood.2023022295. [PMID: 38643494 DOI: 10.1182/blood.2023022295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Multiple Myeloma (MM) is characterized by a huge heterogeneity at the molecular level. The RAS/RAF pathway is the most frequently mutated, in about 50% of the patients. However, these mutations are frequently subclonal, suggesting a secondary event. Since these genes are part of our routine next-generation sequencing (NGS) panel, we analyzed >10,000 patients with different plasma cell disorders in order to describe the RAS/RAF landscape. In this large cohort of patients, almost 61% of the patients presented a RAS/RAF mutation at diagnosis or relapse, but much lower frequencies in pre-symptomatic cases. Of note, the mutations were different from that observed in solid tumors (higher proportions of Q61 mutations). In 29 patients with two different mutations, we were able to perform single cell sequencing, showing that in most cases, mutations occurred in different subclones, suggesting an ongoing mutational process. These findings suggest that RAS/RAF pathway is not an attractive target, both on therapeutic and residual disease assessment points of vue.
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Affiliation(s)
| | - Jill Corre
- Institut Universitaire du Cancer de Toulouse-Oncopole, TOULOUSE, France
| | - Mehmet K Samur
- Dana-Farber Cancer Institute and Harvard School of Public Health, Boston, Massachusetts, United States
| | | | | | | | | | | | | | - Karim Belhadj
- Service d'Hematologie Clinique, Hopital Henri Mondor, Creteil, Creteil, France
| | | | | | | | | | - Laurent Frenzel
- Service d'Hématologie Adulte et unité d'hémostase clinique, Hôpital Necker, Institut IMAGINE - INSERM U 1163 / CNRS ERL 8254, Paris France, Paris, France
| | | | | | | | | | | | | | | | | | | | - Adam Sciambi
- Mission Bio, Inc., South San Francisco, California, United States
| | - Mohamad Mohty
- Hôpital Saint-Antoine, INSERM UMRs 938, and Université Sorbonne, Paris, France
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2
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Jourdes A, Cellerin E, Touzeau C, Harel S, Denis B, Escure G, Faure E, Jamard S, Danion F, Sonntag C, Ader F, Karlin L, Soueges S, Cazelles C, de La Porte des Vaux C, Frenzel L, Lanternier F, Brousse X, Cazaubiel T, Berger P, Collignon A, Blot M, Pieragostini A, Charles M, Chaleteix C, Redor A, Roland V, Cartau T, Macro M, Chalopin T, Vallet N, Perrot A, Martin-Blondel G. Characteristics and incidence of infections in patients with multiple myeloma treated by bispecific antibodies: a national retrospective study on the behalf of G2I and Intergroupe Francophone du Myélome. Clin Microbiol Infect 2024:S1198-743X(24)00098-3. [PMID: 38432433 DOI: 10.1016/j.cmi.2024.02.023] [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: 11/21/2023] [Revised: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Bispecific antibodies (BsAbs) are an effective treatment used in relapsed or refractory multiple myeloma. Despite a well-tolerated safety profile, infectious events appear to be frequent in clinical trials. Real-world data on epidemiology, characteristics, risk factors, and outcomes of infections in patients treated with BsAb are still needed. METHODS A retrospective, multicentre study in BsAb-treated patients with multiple myeloma was performed in 14 French centres from December 2020 to February 2023. The primary objective was to describe the incidence of infections that required hospitalization, specific treatment, or adaptation in BsAb administration. RESULTS Among 229 patients with multiple myeloma treated with BsAb, 153 (67%) received teclistamab, 47 (20%) received elranatamab, and 29 (13%) talquetamab. We reported a total of 234 infections, including 123 (53%) of grade of ≥3. Predominant infections affected the respiratory tract (n = 116, 50%) followed by bacteraemias (n = 36, 15%). The hospitalization rate was 56% (n = 131), and 20 (9%) infections resulted in death. Global cumulative incidence of the first infection was 70% in all patients, 73% in patients treated with B-cell maturation antigen-targeting, and 51% with GPRC5D-targeting BsAb. In univariate analyses, corticosteroids for cytokine release syndrome (CRS)/immune effector cell-associated neurotoxicity syndrome (ICANS) were associated with a higher risk of first infection (HR = 2.13; 95% CI, 1.38-3.28), whereas GPRC5D-targeting BsAb and anti-bacterial prophylaxis were associated with a lower risk (HR = 0.53; 95% CI, 0.3-0.94 and HR = 0.65; 95% CI, 0.46-0.9). Fine and Gray multivariate model found that only corticosteroids for CRS/ICANS were correlated with a higher risk of first infection (HR = 2.01; 95% CI, 1.27-3.19). DISCUSSIONS The implementation of preventive measures that aim to mitigate the risk of infection under BsAb is pivotal, notably in patients who received corticosteroids for CRS/ICANS.
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Affiliation(s)
- Aurélie Jourdes
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) de Toulouse, France
| | - Elise Cellerin
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Tours, France
| | - Cyrille Touzeau
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) Hôtel Dieu, Nantes, France
| | - Stéphanie Harel
- Service d'immuno-hématologie, Hôpital St-Louis, AP-HP, Paris, France
| | - Blandine Denis
- Service de Maladies Infectieuses et Tropicales, Hôpital St-Louis, AP-HP, Paris, France
| | - Guillaume Escure
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Lille, France
| | - Emmanuel Faure
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Lille, France; U1019-UMR 9017-Centre d'Infection et d'Immunité de Lille, INSERM, Centre National de la Recherche Scientifique, Institut Pasteur de Lille, Université de Lille, Lille, France
| | - Simon Jamard
- Service de Médecine Infectieuse et Tropicale, Centre Hospitalo-Universitaire (CHU) de Tours, France
| | - Francois Danion
- Service de Maladies Infectieuses et Tropicales, Les Hôpitaux Universitaires de Strasbourg, Strasbourg, Grand Est, France; Laboratoire d'Immuno-rhumatologie Moléculaire UMR_S 1109, INSERM, Strasbourg, Grand Est, France
| | - Cécile Sonntag
- Service d'hématologie, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg, France
| | - Florence Ader
- Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France; Centre International de Recherche en Infectiologie (CIRI), INSERM 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, Lyon, France
| | - Lionel Karlin
- Service d'hématologie, Centre Hospitalier Lyon-Sud, Lyon, France
| | - Sarah Soueges
- Département des Maladies Infectieuses et Tropicales, Hospices Civils de Lyon, Lyon, France
| | - Clarisse Cazelles
- Service d'hématologie, Hôpital Necker-Enfants Malades, AP-HP, Paris, France; Institut Cochin, Université de Paris, CNRS UMR8104, INSERM U1016, Paris, France
| | | | - Laurent Frenzel
- Service d'hématologie, Hôpital Necker-Enfants Malades, AP-HP, Paris, France; CEREMAST, Institut Imagine, INSERM U1163, AP-HP, Hôpital Necker-Enfants Malades, Université Paris Centre, Paris, France
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, AP-HP, Paris, France; Institut Pasteur, Université Paris Cité, Centre National de Référence Mycoses Invasives et Antifongiques, Groupe de Recherche Translationnelle en Mycologie, Département de Mycologie, Paris, Île-de-France, France
| | - Xavier Brousse
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) de Bordeaux, France
| | - Titouan Cazaubiel
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Bordeaux, France; Equipe Génomique et Immunologie du Myélome Multiple, Centre de Recherche en Cancérologie de Toulouse INSERM U1037, Université Paul Sabatier, Toulouse, France
| | - Pierre Berger
- Infectiologie Transversale, Institut Paoli-Calmettes, Marseille, France
| | - Aude Collignon
- Service d'hématologie, Institut Paoli-Calmettes, Marseille, France
| | - Mathieu Blot
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) de Dijon-Bourgogne, France; INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France; Equipe Lipness, INSERM LNC-UMR1231 et LabEx LipSTIC, Université de Burgundy, Dijon, France
| | - Andrea Pieragostini
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Dijon-Bourgogne, France
| | - Morgane Charles
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) d'Estaing, Clermont-Ferrand, France
| | - Carine Chaleteix
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) d'Estaing, Clermont-Ferrand, France
| | - Alexis Redor
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier de Perpignan, France
| | - Virginie Roland
- Service d'hématologie, Centre Hospitalier de Perpignan, France
| | - Tom Cartau
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) Côte de Nacre, Caen, France
| | - Margaret Macro
- Service d'hématologie, Institut bas Normand d'Hématologie, CHU Caen Normandie, Caen, France
| | - Thomas Chalopin
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Tours, France
| | - Nicolas Vallet
- Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Tours, France; Equipe INSERM U1069 N2COx, Groupe LNOx, Université de Tours, France
| | - Aurore Perrot
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) de Bordeaux, France; Service d'hématologie, Centre Hospitalo-universitaire (CHU) de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Toulouse, France
| | - Guillaume Martin-Blondel
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalo-universitaire (CHU) de Toulouse, France; Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM, Université Toulouse III, Toulouse, France.
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3
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Schavgoulidze A, Perrot A, Cazaubiel T, Leleu X, Montes L, Jacquet C, Belhadj K, Brechignac S, Frenzel L, Chalopin T, Rey P, Schiano de Collela JM, Dib M, Caillot D, Macro M, Fontan J, Buisson L, Pavageau L, Roussel M, Manier S, Mohty M, Martinet L, Avet-Loiseau H, Corre J. Prognostic impact of translocation t(14;16) in multiple myeloma according to the presence of additional genetic lesions. Blood Cancer J 2023; 13:160. [PMID: 37880285 PMCID: PMC10600097 DOI: 10.1038/s41408-023-00933-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Anaïs Schavgoulidze
- Unit for Genomics in Myeloma, University Hospital IUCT-Oncopole, Toulouse, France
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Aurore Perrot
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
- Hematology Department, IUCT-Oncopole, Toulouse, France
| | | | - Xavier Leleu
- Hematology Department, University Hospital, Poitiers, France
| | - Lydia Montes
- Hematology Department, University Hospital, Amiens, France
| | | | - Karim Belhadj
- Hematology Department, University Hospital, Créteil, France
| | | | - Laurent Frenzel
- Hematology Department, Necker University Hospital, Paris, France
| | | | - Philippe Rey
- Hematology Department, Centre Léon Bérard, Lyon, France
| | | | - Mamoun Dib
- Hematology Department, University Hospital, Angers, France
| | - Denis Caillot
- Hematology Department, Institut de Cancérologie de Bourgogne, Dijon, France
| | - Margaret Macro
- Hematology Department, University Hospital, Caen, France
| | - Jean Fontan
- Hematology Department, University Hospital, Besançon, France
| | - Laure Buisson
- Unit for Genomics in Myeloma, University Hospital IUCT-Oncopole, Toulouse, France
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Luka Pavageau
- Unit for Genomics in Myeloma, University Hospital IUCT-Oncopole, Toulouse, France
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | | | - Salomon Manier
- Hematology Department, University Hospital, Lille, France
| | - Mohamad Mohty
- Hematology Department, Saint-Antoine University Hospital, Paris, France
| | - Ludovic Martinet
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Hervé Avet-Loiseau
- Unit for Genomics in Myeloma, University Hospital IUCT-Oncopole, Toulouse, France
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France
| | - Jill Corre
- Unit for Genomics in Myeloma, University Hospital IUCT-Oncopole, Toulouse, France.
- Cancer Research Center of Toulouse (CRCT), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université Toulouse III-Paul Sabatier (UPS), Toulouse, France.
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4
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Lannes R, Samur M, Perrot A, Mazzotti C, Divoux M, Cazaubiel T, Leleu X, Schavgoulidze A, Chretien ML, Manier S, Adiko D, Orsini-Piocelle F, Lifermann F, Brechignac S, Gastaud L, Bouscary D, Macro M, Cleynen A, Mohty M, Munshi N, Corre J, Avet-Loiseau H. In Multiple Myeloma, High-Risk Secondary Genetic Events Observed at Relapse Are Present From Diagnosis in Tiny, Undetectable Subclonal Populations. J Clin Oncol 2023; 41:1695-1702. [PMID: 36343306 PMCID: PMC10043564 DOI: 10.1200/jco.21.01987] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 06/22/2022] [Accepted: 09/22/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Multiple myeloma (MM) is characterized by copy number abnormalities (CNAs), some of which influence patient outcomes and are sometimes observed only at relapse(s), suggesting their acquisition during tumor evolution. However, the presence of micro-subclones may be missed in bulk analyses. Here, we use single-cell genomics to determine how often these high-risk events are missed at diagnosis and selected at relapse. MATERIALS AND METHODS We analyzed 81 patients with plasma cell dyscrasias using single-cell CNA sequencing. Sixty-six patients were selected at diagnosis, nine at first relapse, and six in presymptomatic stages. A total of 956 newly diagnosed patients with MM and patients with first relapse MM have been identified retrospectively with required cytogenetic data to evaluate enrichment of CNA risk events and survival impact. RESULTS A total of 52,176 MM cells were analyzed. Seventy-four patients (91%) had 2-16 subclones. Among these patients, 28.7% had a subclone with high-risk features (del(17p), del(1p32), and 1q gain) at diagnosis. In a patient with a subclonal 1q gain at diagnosis, we analyzed the diagnosis, postinduction, and first relapse samples, which showed a rise of the high-risk 1q gain subclone (16%, 70%, and 92%, respectively). In our clinical database, we found that the 1q gain frequency increased from 30.2% at diagnosis to 43.6% at relapse (odds ratio, 1.78; 95% CI, 1.58 to 2.00). We subsequently performed survival analyses, which showed that the progression-free and overall survival curves were superimposable between patients who had the 1q gain from diagnosis and those who seemingly acquired it at relapse. This strongly suggests that many patients had 1q gains at diagnosis in microclones that were missed by bulk analyses. CONCLUSION These data suggest that identifying these scarce aggressive cells may necessitate more aggressive treatment as early as diagnosis to prevent them from becoming the dominant clone.
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Affiliation(s)
- Romain Lannes
- Myeloma Oncogenesis Lab, IUC-Oncopole, Toulouse, France
- CRCT, INSERM U1037, Toulouse, France
| | - Mehmet Samur
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Aurore Perrot
- CRCT, INSERM U1037, Toulouse, France
- Hematology Department, IUC-Oncopole, Toulouse, France
| | - Celine Mazzotti
- Myeloma Oncogenesis Lab, IUC-Oncopole, Toulouse, France
- CRCT, INSERM U1037, Toulouse, France
| | - Marion Divoux
- Hematology Department, University Hospital, Nancy, France
| | | | - Xavier Leleu
- Hematology Department, University Hospital, Poitiers, France
| | - Anaïs Schavgoulidze
- Myeloma Oncogenesis Lab, IUC-Oncopole, Toulouse, France
- CRCT, INSERM U1037, Toulouse, France
| | | | - Salomon Manier
- Hematology Department, University Hospital, Lille, France
| | - Didier Adiko
- Hematology Department, General Hospital, Libourne, France
| | | | | | | | | | - Didier Bouscary
- Hematology Department, Cochin University Hospital, Paris, France
| | - Margaret Macro
- Hematology Department, University Hospital, Caen, France
| | - Alice Cleynen
- Institut Montpellierain Alexander Grothendieck, CNRS, Montpellier University, Montpellier, France
| | - Mohamad Mohty
- Hematology Department, Saint-Antoine University Hospital, Paris, France
| | - Nikhil Munshi
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Jill Corre
- Myeloma Oncogenesis Lab, IUC-Oncopole, Toulouse, France
- CRCT, INSERM U1037, Toulouse, France
| | - Hervé Avet-Loiseau
- Myeloma Oncogenesis Lab, IUC-Oncopole, Toulouse, France
- CRCT, INSERM U1037, Toulouse, France
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5
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Schavgoulidze A, Talbot A, Perrot A, Cazaubiel T, Leleu X, Manier S, Buisson L, Mahéo S, Do Souto Ferreira L, Pavageau L, Hulin C, Marolleau JP, Voillat L, Belhadj K, Divoux M, Slama B, Brechignac S, Macro M, Stoppa AM, Sanhes L, Orsini-Piocelle F, Fontan J, Chretien ML, Demarquette H, Mohty M, Avet-Loiseau H, Corre J. Biallelic deletion of 1p32 defines ultra-high-risk myeloma, but monoallelic del(1p32) remains a strong prognostic factor. Blood 2023; 141:1308-1315. [PMID: 36375118 PMCID: PMC10163308 DOI: 10.1182/blood.2022017863] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
Cytogenetic abnormalities (CAs) are known to be the preponderant prognostic factor in multiple myeloma. Our team has recently developed a prognostic score based on 6 CAs, with which del(1p32) appears to be the second worst abnormality after del(17p). This study aimed to confirm the adverse effect of 1p32 deletion in patients with newly diagnosed multiple myeloma (NDMM). Among 2551 patients with newly diagnosed multiple myeloma, 11% were harboring del(1p32). Their overall survival (OS) was significantly inferior compared with patients without del(1p32) (median OS: 49 months vs 124 months). Likewise, progression-free survival was significantly shorter. More importantly, biallelic del(1p32) conferred a dramatically poorer prognosis than a monoallelic del(1p32) (median OS: 25 months vs 60 months). As expected, the OS of patients with del(1p32) significantly decreased when this abnormality was associated with other high-risk CAs [del(17p), t(4;14), or gain(1q)]. In the multivariate analysis, del(1p32) appeared as a negative prognostic factor; after adjustment for age and treatment, the risk of progression was 1.3 times higher among patients harboring del(1p32), and the risk of death was 1.9 times higher. At the dawn of risk-adapted treatment strategies, we have confirmed the adverse effect of del(1p32) in multiple myeloma and the relevance of its assessment at diagnosis.
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Affiliation(s)
- Anaïs Schavgoulidze
- Unit for Genomics in Myeloma, University Hospital IUC-Oncopole and Toulouse Cancer Research Center-Oncopole, Toulouse University, INSERM UMR1037, Toulouse, France
| | - Alexis Talbot
- Hematology Department, Saint-Louis University Hospital, University of Paris, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Aurore Perrot
- Hematology Department, University Hospital IUC-Oncopole and Toulouse Cancer Research Center-Oncopole, Toulouse, France
| | - Titouan Cazaubiel
- Hematology Department, Bordeaux University Hospital, Bordeaux, France
| | - Xavier Leleu
- Hematology Department, Poitiers University Hospital, Poitiers, France
| | - Salomon Manier
- Hematology Department, Lille University Hospital, Lille, France
| | - Laure Buisson
- Unit for Genomics in Myeloma, University Hospital IUC-Oncopole and Toulouse Cancer Research Center-Oncopole, Toulouse University, INSERM UMR1037, Toulouse, France
| | - Sabrina Mahéo
- Unit for Genomics in Myeloma, University Hospital IUC-Oncopole and Toulouse Cancer Research Center-Oncopole, Toulouse University, INSERM UMR1037, Toulouse, France
| | - Laura Do Souto Ferreira
- Unit for Genomics in Myeloma, University Hospital IUC-Oncopole and Toulouse Cancer Research Center-Oncopole, Toulouse University, INSERM UMR1037, Toulouse, France
| | - Luka Pavageau
- Unit for Genomics in Myeloma, University Hospital IUC-Oncopole and Toulouse Cancer Research Center-Oncopole, Toulouse University, INSERM UMR1037, Toulouse, France
| | - Cyrille Hulin
- Hematology Department, Bordeaux University Hospital, Bordeaux, France
| | | | - Laurent Voillat
- Hematology Department, Chalon-sur-Saône Hospital, Chalon-sur-Saône, France
| | - Karim Belhadj
- Hematology Department, Créteil University Hospital, Créteil, France
| | - Marion Divoux
- Hematology Department, Nancy University Hospital, Nancy, France
| | - Borhane Slama
- Hematology Department, Avignon Hospital, Avignon, France
| | | | - Margaret Macro
- Hematology Department, Caen University Hospital, Caen, France
| | | | - Laurence Sanhes
- Hematology Department, Perpignan Hospital, Perpignan, France
| | | | - Jean Fontan
- Hematology Department, Besançon University Hospital, Besançon, France
| | | | | | - Mohamad Mohty
- Hematology Department, Saint-Antoine University Hospital, Paris, France
| | - Hervé Avet-Loiseau
- Unit for Genomics in Myeloma, University Hospital IUC-Oncopole and Toulouse Cancer Research Center-Oncopole, Toulouse University, INSERM UMR1037, Toulouse, France
| | - Jill Corre
- Unit for Genomics in Myeloma, University Hospital IUC-Oncopole and Toulouse Cancer Research Center-Oncopole, Toulouse University, INSERM UMR1037, Toulouse, France
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6
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Schavgoulidze A, Lauwers-Cances V, Perrot A, Cazaubiel T, Chretien ML, Moreau P, Facon T, Leleu X, Karlin L, Stoppa AM, Decaux O, Belhadj K, Arnulf B, Mohty M, Ariette CM, Fohrer-Sonntag C, Lenain P, Marolleau JP, Tiab M, Araujo C, Orsini-Piocelle F, Jaccard A, Roussel M, Benboubker L, Eveillard JR, Dib M, Divoux M, Attal M, Avet-Loiseau H, Corre J. Heterogeneity in long term outcomes for R-ISS stage II in newly diagnosed multiple myeloma patients. Haematologica 2022; 108:1374-1384. [PMID: 36172814 PMCID: PMC10153521 DOI: 10.3324/haematol.2021.280566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Indexed: 11/09/2022] Open
Abstract
In the era of personalized treatment in multiple myeloma, high-risk patients must be accurately defined. The International Myeloma Working Group recommends using the Revised International Staging System (R-ISS) to identify high-risk patients. The main purpose of our work was to explore the heterogeneity of outcome among R-ISS stage II patients assessing the impact of ISS, chromosomal abnormalities (CA) and LDH level in this subgroup. Data were issued from 1,343 newly diagnosed myeloma patients up to 65 years, enrolled in 3 clinical trials implemented by the Intergroupe Francophone du Myelome. All patients were eligible to an intensive treatment. Patients R-ISS stage II but ISS stage I had 1.6 times more risk of death than patients R-ISS stage I (adjusted HR 1.6; 95% CI, 1.1 to 2.2; P = .01) and patients R-ISS stage II but ISS stage III had a better overall survival than patients R-ISS stage III (adjusted HR 0.7; 95% CI, 0.4 to 0.9, P = .02). However, among patients classified in R-ISS II, ISS stage and CA (del(17p) and t(4;14)) were still relevant prognostic factors for death. Dividing R-ISS stage II into 3 subgroups: ISS I with standard risk CA, ISS II or III with standard risk CA and, high risk CA patients, median overall survivals were respectively not reached, 112 and 71 months (P < 0.001). In conclusion, stratification of patients in the R-ISS stage II group can be improved by taking into account CA and ISS. However, this does not improve predictive performance of survival models.
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Affiliation(s)
- Anais Schavgoulidze
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse
| | | | - Aurore Perrot
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse
| | | | | | | | | | - Xavier Leleu
- Centre Hospitalier Universitaire Poitiers, Poitiers
| | | | | | | | | | - Bertrand Arnulf
- Centre Hospitalier Universitaire, Hopital Saint Louis, Paris
| | - Mohamad Mohty
- Centre Hospitalier Universitaire, Hopital Saint-Antoine, Paris
| | | | | | - Pascal Lenain
- Centre de Lutte Contre le Cancer - Centre Henri Becquerel, Rouen
| | | | - Mourad Tiab
- Centre Hospitalier Departemental Vendee, La Roche-sur-Yon
| | | | | | | | - Murielle Roussel
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse
| | | | | | - Mamoun Dib
- Centre Hospitalier Universitaire Angers, Angers
| | - Marion Divoux
- Centre Hospitalier Regional Universitaire Nancy Vandoeuvre les Nancy, Nancy
| | - Michel Attal
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse
| | - Herve Avet-Loiseau
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse
| | - Jill Corre
- Institut Universitaire du Cancer de Toulouse-Oncopole and Centre de Recherches en Cancerologie de Toulouse Institut National de la Sante et de la Recherche Medicale, Toulouse.
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Heraudet L, Galtier J, Favre S, Peyraud F, Cazaubiel T, Leroy H, Mottal N, Gros FX, Forcade E, Clément L, Dumas PY, Pigneux A, Leguay T. VANDA regimen followed by blinatumomab leads to favourable outcome in patients with Philadelphia chromosome-negative B-precursor acute lymphoblastic leukaemia in first relapse. Br J Haematol 2022; 198:523-527. [PMID: 35524489 DOI: 10.1111/bjh.18218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/28/2022]
Abstract
Adults with relapsed or refractory B-precursor acute lymphoblastic leukaemia (R/R BCP-ALL) have very poor outcome. Blinatumomab as single agent has shown activity in R/R BCP-ALL. We aimed to assess the activity of blinatumomab in concomitant association with intensive chemotherapy. Seventeen patients with R/R BCP-ALL were treated with combination of blinatumomab and VANDA (etoposide, cytarabine, mitoxantrone, dexamethasone and asparaginase) regimen. Complete remission (CR) was achieved in 14/17 patient (82%) and 11/17 (65%) were transplanted. One-year leukaemia-free survival was 58.8% for the whole cohort and 90.9% for transplanted patients. These preliminary data suggest that the VANDA-blinatumomab salvage regimen leads to a very high rate of CR and HSCT in suitable patients.
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Affiliation(s)
- Luc Heraudet
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Jean Galtier
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Simon Favre
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Florent Peyraud
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Titouan Cazaubiel
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Harmony Leroy
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Nathan Mottal
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - François-Xavier Gros
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Edouard Forcade
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Laurence Clément
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Pierre-Yves Dumas
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Arnaud Pigneux
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
| | - Thibaut Leguay
- CHU Bordeaux, Service d'Hématologie Clinique et de Thérapie Cellulaire, Bordeaux, France
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Schavgoulidze A, Cazaubiel T, Perrot A, Avet-Loiseau H, Corre J. Multiple Myeloma: Heterogeneous in Every Way. Cancers (Basel) 2021; 13:cancers13061285. [PMID: 33805803 PMCID: PMC7998947 DOI: 10.3390/cancers13061285] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 01/23/2023] Open
Abstract
Simple Summary With the development of modern therapies in multiple myeloma, prognosis stratification is becoming an indispensable tool for the choice of treatment between patients. Many factors influence the prognosis in multiple myeloma; scores, mainly based on biochemical parameters and cytogenetics, have been proposed to discriminate patients. However, these scores are not perfect and fail to predict some patients’ outcomes. In this review, we describe current evaluated factors and their limitations. In the second part, we address factors with an impact on treatment escape and prognosis, but which are not available routinely yet. Abstract Multiple myeloma (MM) is a hematological malignancy characterized by the accumulation of tumor plasma cells (PCs) in the bone marrow (BM). Despite considerable advances in terms of treatment, patients’ prognosis is still very heterogeneous. Cytogenetics and minimal residual disease both have a major impact on prognosis. However, they do not explain all the heterogeneity seen in the outcomes. Their limitations are the result of the emergence of minor subclones missed at diagnosis, detected by sensible methods such as single-cell analysis, but also the non-exploration in the routine practice of the spatial heterogeneity between different clones according to the focal lesions. Moreover, biochemical parameters and cytogenetics do not reflect the whole complexity of MM. Gene expression is influenced by a tight collaboration between cytogenetic events and epigenetic regulation. The microenvironment also has an important impact on the development and the progression of the disease. Some of these determinants have been described as independent prognostic factors and could be used to more accurately predict patient prognosis and response to treatment.
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Affiliation(s)
- Anaïs Schavgoulidze
- Centre de Recherche en Cancérologie de Toulouse, Institut National de la Santé et de la Recherche, Médicale U1037, 31059 Toulouse, France; (A.S.); (A.P.); (H.A.-L.)
| | | | - Aurore Perrot
- Centre de Recherche en Cancérologie de Toulouse, Institut National de la Santé et de la Recherche, Médicale U1037, 31059 Toulouse, France; (A.S.); (A.P.); (H.A.-L.)
- Hematology Department, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, 31059 Toulouse, France
| | - Hervé Avet-Loiseau
- Centre de Recherche en Cancérologie de Toulouse, Institut National de la Santé et de la Recherche, Médicale U1037, 31059 Toulouse, France; (A.S.); (A.P.); (H.A.-L.)
- Unit for Genomics in Myeloma, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, 31059 Toulouse, France
| | - Jill Corre
- Centre de Recherche en Cancérologie de Toulouse, Institut National de la Santé et de la Recherche, Médicale U1037, 31059 Toulouse, France; (A.S.); (A.P.); (H.A.-L.)
- Unit for Genomics in Myeloma, Institut Universitaire du Cancer de Toulouse-Oncopole, University Hospital, 31059 Toulouse, France
- Correspondence:
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Mottal N, Issa N, Dumas PY, Camou F, Sauvezie M, Gros FX, Cazaubiel T, Mourissoux G, Leroy H, Pigneux A, Guisset O, Leguay T. Reduce Mortality and Morbidity in Acute Myeloid Leukemia With Hyperleukocytosis With Early Admission in Intensive Care Unit: A Retrospective Analysis. J Hematol 2020; 9:109-115. [PMID: 33224390 PMCID: PMC7665861 DOI: 10.14740/jh691] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/04/2020] [Indexed: 01/25/2023] Open
Abstract
Background Patients presenting with acute myeloid leukemia (AML) at diagnosis are at high risk of severe complications and death, particularly with high white blood cell (WBC) count. In this retrospective study, we evaluate interest of early and systematic support in the intensive care unit (ICU) for AML with hyperleukocytosis (AML-HL) at diagnosis. Methods Patients with AML-HL, defined by WBC > 50 × 109/L, primary referred in ICU (“Early ICU”) without organ failure and before initiating chemotherapy induction were compared to patients first admitted in the Hematology Department who required a secondary transfer in ICU (“Late ICU”) or not (“No ICU”). Primary end point was mortality during the first month, and secondary end points were the use of life-sustaining therapies in ICU and risk factors for ICU transfer and mortality. Results One hundred fifty-four patients were included: 77 (50%) to the group “No ICU”, 18 (12%) to “Late ICU” and 59 (38%) to “Early ICU”. Mortality at day 30 was higher in “Late ICU” than in “Early ICU” and “No ICU”, with 27.8%; 16.9% and 2.6% respectively (P < 0.001). “Late ICU” patients had an increased use of life-sustaining therapy comparing to “Early ICU” patients (56% vs. 29%, P = 0.04). Conclusions Early referral to ICU reduces morbidity and seems an effective strategy to reduce short-term mortality in AML-HL at diagnosis.
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Affiliation(s)
- Nathan Mottal
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Nahema Issa
- CHU de Bordeaux, Hopital Saint Andre, Service de Reanimation medicale, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Pierre-Yves Dumas
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Fabrice Camou
- CHU de Bordeaux, Hopital Saint Andre, Service de Reanimation medicale, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Mathieu Sauvezie
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Francois-Xavier Gros
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Titouan Cazaubiel
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Gaelle Mourissoux
- CHU de Bordeaux, Hopital Saint Andre, Service de Reanimation medicale, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Harmony Leroy
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Arnaud Pigneux
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
| | - Olivier Guisset
- CHU de Bordeaux, Hopital Saint Andre, Service de Reanimation medicale, 1 Rue Jean Burguet, 33000 Bordeaux, France
| | - Thibaut Leguay
- CHU de Bordeaux, Hopital Haut Leveque, Service d'Hematologie Clinique et Therapie Cellulaire, 1 Avenue de Magellan, 33600 Pessac, France
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Gros FX, Cazaubiel T, Forcade E, Lechevalier N, Leguay T, Servant V, Tabrizi R, Clement L, Dumas PY, Bidet A, Pigneux A, Vigouroux S, Milpied N. Severe acute GvHD following administration of ipilimumab for early relapse of AML after haploidentical stem cell transplantation. Bone Marrow Transplant 2017; 52:1047-1048. [DOI: 10.1038/bmt.2017.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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