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Robin C, Cordonnier C, Tridello G, Knelange N, Xhaard A, Chantepie S, Tanguy-Schmidt A, Schouten HC, Yeshurun M, Rocha V, Srour M, Kröger N, Ledoux MP, Dalgaard J, Thiebaut A, Giardino S, Calore E, Zuckerman T, Groll AH, Raida L, Avcin S, Vicent MG, Kaare A, Drozd-Sokolowska J, Turlure P, Bretagne S, Mikulska M, Camara RDL, Cesaro S, Styczynski J. Pneumocystis Pneumonia After Allogeneic Hematopoietic Cell Transplantation: A Case-Control Study on Epidemiology and Risk Factors on Behalf of the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation. Transplant Cell Ther 2024; 30:235.e1-235.e10. [PMID: 38007092 DOI: 10.1016/j.jtct.2023.11.017] [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: 09/04/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
Pneumocystis pneumonia (PCP) is a life-threatening complication after allogeneic hematopoietic cell transplantation (allo-HCT). However, allo-HCT procedures have evolved toward older patients, unrelated donors, and reduced-intensity conditioning, possibly modifying the risks. Polymerase chain reaction (PCR), widely used nowadays, is more sensitive than microscopy diagnostic methods. This study aimed to assess the factors associated with PCP in allo-HCT recipients within 2 years of HCT and managed according to current procedures. This multicenter, nested case-control study included PCP cases diagnosed by PCR, cytology, or immunofluorescence on bronchoalveolar lavage fluid between 2016 and 2018. Two controls per case were selected from the ProMISe registry and matched for the center, transplant date, and underlying disease. Fifty-two cases and 104 controls were included among the 5452 patients who underwent allo-HCT in the participating centers. PCP occurred at a median of 11.5 months after transplantation. The mortality rate was 24% on day 30 after the PCP diagnosis and 37% on day 90. The clinical presentation and mortality rates of the 24 patients diagnosed using only PCR were not different from those diagnosed with microscopy methods. Our study demonstrates a substantial incidence of, and mortality from, PCP, after allogeneic HCT despite well-established prophylactic approaches. In our experience, PCP nowadays occurs later after transplant than previously reported, justifying the prolongation of prophylaxis after six months in many cases. Allo-HCT recipients diagnosed with PCR as the only PCP marker should benefit from specific treatment as for other patients.
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Affiliation(s)
- Christine Robin
- Department of Haematology, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Créteil, France.
| | - Catherine Cordonnier
- Department of Haematology, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Créteil, France
| | - Gloria Tridello
- Department of Mother and Child, Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | | | - Alienor Xhaard
- Haematology Transplant Unit, APHP, Saint-Louis Hospital, Paris, France
| | - Sylvain Chantepie
- Basse-Normandie Haematology Institute, Caen University Hospital, Caen, France
| | - Aline Tanguy-Schmidt
- Blood Diseases Department, France Federation University Hospital "Grand Ouest against Leukemia", Angers France; CRCI2NA, Angers, France
| | | | - Moshe Yeshurun
- Institute of Hematology, Rabin Medical Center, Petach Tikva, Israel
| | - Vanderson Rocha
- Hematology Bone Marrow Transplant Unit, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Micha Srour
- Department of Haematology, Lille University Hospital, Lille, France
| | - Nicolaus Kröger
- Department of Stem cell Transplantation, University Hospital Eppendorf, Hamburg, Germany
| | - Marie-Pierre Ledoux
- Department of Haematology, Cancer Institute of Strasburg, Strasbourg, France
| | - Jakob Dalgaard
- Department of Haematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anne Thiebaut
- Department of Haematology, Grenoble Alpes University Hospital, Grenoble, France
| | - Stefano Giardino
- Haematopoietic Stem Cell Transplantation Unit IRCCS Istituto Giannina Gaslini, Pediatric Haematology and Oncology, Genova, Italy
| | - Elisabetta Calore
- Clinica di Oncoematologia Pediatrica, Azienda Ospedaliera-Università di Padova, Padova, Italy
| | - Tsila Zuckerman
- Department of Haematology and Bone Marrow Transplantation, Rambam Medical Center, Haifa, Israel
| | - Andreas H Groll
- Center for Bone Marrow Transplantation and Department of Pediatric Haematology/Oncology, University Children's Hospital, Infectious Disease Research Program, Munster, Germany
| | - Ludek Raida
- Department of Haemato-Oncology, Olomouc University Hospital, Olomouc, Czech Republic
| | | | | | - Ain Kaare
- Clinic of Haematology and Oncology, Tartu University Hospital, Tartu, Estonia
| | - Joanna Drozd-Sokolowska
- Department of Haematology, Transplantation and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Pascal Turlure
- Department of Haematology, Limoges University Hospital, Limoges, France
| | | | - Malgorzata Mikulska
- Division of Infectious Diseases, University of Genova (DISSAL), Genova, Italy; IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Rafael de la Camara
- Department of Haematology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Simone Cesaro
- Department of Mother and Child, Pediatric Haematology Oncology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Jan Styczynski
- Pediatric Haematology and Oncology, University Hospital, Collegium Medicum UMK, Bydgoszcz, Poland
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Xhaard A, Xhaard C, Rubio MT, Berceanu A, Botella-Garcia C, Coman T, Tavernier E, Labussière-Wallet H, Chevallier P, Legrand F, Thiebaut A, Menard AL, Paillard C, Chantepie S, Robin M, Nguyen S. A 16-month-long experience of COVID-19 in allogeneic haematopoietic stem cell transplantation recipients: An SFGM-TC multicentre cohort study. Br J Haematol 2023. [PMID: 36921963 DOI: 10.1111/bjh.18754] [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: 01/24/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023]
Abstract
This 16-month-long multicentre retrospective study of 225 allogeneic haematopoietic stem cell transplantation (alloHSCT) recipients with COVID-19 examines risk factors for severity and mortality, describing the successive waves of infections (from March to June 2020 and from August 2020 to June 2021). We confirm the negative role of low respiratory tract disease and immunosuppressive treatment. We highlight significantly lower percentages of severe forms and COVID-19-related mortality during the second wave. Monthly comparative evolution of cases in alloHSCT recipients and in the French population shows a higher number of cases in alloHSCT recipients during the first wave and a decrease from February 2021.
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Affiliation(s)
- Aliénor Xhaard
- Service d'hématologie-Greffe, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - Constance Xhaard
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM 1116, CHRU de Nancy, FCRIN INI-CRCT, Université de Lorraine, Nancy, France
| | - Marie-Therese Rubio
- Service d'hématologie, Hôpital Brabois, CHRU Nancy et CNRS UMR 7563, Biopôle de l'Université de Lorraine, Vandoeuvre les Nancy, France
| | - Ana Berceanu
- Service d'hématologie, CHU Jean Minjoz, Besançon, France
| | | | - Tereza Coman
- Service d'hématologie, Institut Gustave Roussy, Villejuif, France
| | - Emmanuelle Tavernier
- Département d'hématologie Clinique et de Thérapie Cellulaire, CHU Saint-Etienne, Saint-Etienne, France
| | | | | | - Faezeh Legrand
- Département d'hématologie, Institut Paoli-Calmettes, Marseille, France
| | - Anne Thiebaut
- Service d'hématologie, CHU Grenoble, Grenoble, France
| | | | | | | | - Marie Robin
- Service d'hématologie-Greffe, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Diderot, Paris, France
| | - Stephanie Nguyen
- Service d'hématologie Sorbonne Université, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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3
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Loubet P, Wittkop L, Ninove L, Chalouni M, Barrou B, Blay JY, Hourmant M, Thouvenot E, Laville M, Laviolle B, Lelievre JD, Morel J, Quoc SN, Spano JP, Terrier B, Thiebaut A, Viallard JF, Vrtovsnik F, Circosta S, Esterle L, Levier A, Vanhems P, Tartour E, Parfait B, de Lamballerie X, Launay O. One-month humoral response following two or three doses of messenger RNA coronavirus disease 2019 vaccines as primary vaccination in specific populations in France: first results from the Agence Nationale Recherche contre le Sida (ANRS)0001S COV-POPART cohort. Clin Microbiol Infect 2023; 29:388.e1-388.e8. [PMID: 36252789 PMCID: PMC9562615 DOI: 10.1016/j.cmi.2022.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES We aimed to investigate the 1-month humoral response to two or three doses of a messenger RNA coronavirus disease 2019 (COVID-19) vaccine as a primary vaccination regimen in specific populations compared with that in healthy adults. METHODS Agence Nationale Recherche contre le Sida (ANRS)0001S-COV-POPART (NCT04824651) is a French nation-wide, multi-centre, prospective, observational cohort study assessing the immune response to COVID-19 vaccines routinely administered to 11 sub-groups of patients with chronic conditions and two control groups. Patients and controls who received at least two vaccine doses and whose results 1 month after the second dose were available were included. The humoral response was assessed 1 month after the first, second and third doses (if applicable) based on the percentage of responders (positive for anti-Spike severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] IgG antibodies), geometric means of anti-Spike SARS-CoV-2 IgG antibodies (enzyme-linked immunosorbent assay) and proportion of participants with anti-SARS-CoV-2-specific neutralizing antibodies (in vitro neutralization assay for the original SARS-CoV-2 strain). All analyses were centralized. RESULTS We included 4091 participants in this analysis: 2979 participants from specific sub-populations and 1112 controls. Only 522 (17.5%) participants from the specific populations received three doses as a primary vaccination regimen. Patients living with human immunodeficiency virus, cancer and diabetes had high percentages of responders after two doses, whereas patients with solid organ transplants, allogeneic hematopoietic stem cell transplants and hypogammaglobulinaemia had the lowest percentage of responders (35.9% [95% CI, 29.2-43.0], 57.4% [95% CI, 48.1-66.3] and 77.1% [95% CI, 65.6-86.3], respectively). In those who received the third dose, the percentage of responders reached 54.2% (95% CI, 42.9-65.2) (vs. 32.3% [95% CI, 16.7-51.4] after 2 doses) among those with solid organ transplants and 73.9% (95% CI, 58.9-85.7) (vs. 56.1% [95% CI, 46.2-65.7] after 2 doses) among those with hematopoietic stem cell transplants. Similar results were found with anti-SARS-CoV-2-specific neutralizing antibodies. CONCLUSIONS A lower humoral response to COVID-19 vaccines was observed in the specific populations compared with that in the controls. The third dose of this vaccine in the primary regimen had a positive effect on the percentages of patients who developed anti-Spike IgG antibodies and specific neutralizing antibodies.
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Affiliation(s)
- Paul Loubet
- INSERM, F-CRIN, Reseau Innovative Clinical Research in Vaccinology (IREIVAC), Paris, France; Service des Maladies infectieuses et Tropicales, CHU de Nîmes, Nîmes, France; INSERM U1047 - Université de Montpellier, Nîmes, France.
| | - Linda Wittkop
- Université de Bordeaux, ISPED, INSERM, Bordeaux Population Health Research Center, U1219, CIC-EC 1401, Bordeaux, France,Inria équipe SISTM, Talence, France,CHU de Bordeaux, Service d'information médicale, INSERM, Institut Bergonié, CIC-EC 1401, Bordeaux, France
| | - Laetitia Ninove
- Unite des Virus Emergents, Aix-Marseille Université, Institut de Recherche pour le Développement 190, Inserm 1207, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Mathieu Chalouni
- Université de Bordeaux, ISPED, INSERM, Bordeaux Population Health Research Center, U1219, CIC-EC 1401, Bordeaux, France
| | - Benoit Barrou
- Service de Transplantation Rénale, Pitié Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Jean-Yves Blay
- Centre Léon-Bérard, Département de cancérologie médicale, Lyon, France,Université Claude Bernard Lyon, Unicancer, Lyon, France
| | | | | | - Martine Laville
- INSERM U1191/UMR 5203, Université de Montpellier, Montpellier, France,CHU de Lyon, Université de Lyon, Association Française d’Etudes et de Recherche de l’Obésité, INSERM, F-CRIN –French Obesity Research Centre of Excellence (FORCE) Network, Lyon, France
| | - Bruno Laviolle
- Université de Rennes, CHU Rennes, INSERM, CIC 1414, Rennes, France
| | | | - Jacques Morel
- Département de Rhumatologie, CHU et Université de Montpellier, Montpellier, France
| | - Stéphanie Nguyen Quoc
- APHP–Sorbonne Université, INSERM U1135, CNRS ERL 8255, Centre d’Immunologie et des Maladies Infectieuses–Paris, Paris, France
| | - Jean-Philippe Spano
- Sorbonne université, INSERM, institut Pierre-Louis d'épidémiologie et de santé publique (IPLESP), équipe TheraVir, AP–HP, Sorbonne université, hôpital universitaire Pitié-Salpêtrière, Oncologie médicale, CLIP2 Galilée, Paris, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, APHP, Paris, France
| | - Anne Thiebaut
- Département d’Hématologie, CHU Grenoble Alpes, Grenoble, France
| | | | - François Vrtovsnik
- Service de Néphrologie, Hôpital Bichat-Claude Bernard, APHP, Département Hospitalo-Universitaire Fire, Université de Paris, Paris, France
| | - Sophie Circosta
- INSERM, SC10-US019 Essais thérapeutiques et Maladies Infectieuses, Paris, France
| | - Laure Esterle
- Université de Bordeaux, ISPED, INSERM, Bordeaux Population Health Research Center, U1219, CIC-EC 1401, Bordeaux, France
| | | | - Philippe Vanhems
- Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, Equipe Epidémiologie et Santé Publique, Université de Lyon, Université Lyon 1, Lyon, France
| | - Eric Tartour
- Service d'Immunologie biologique, Hôpital européen Georges Pompidou/APHP, Paris, France
| | - Beatrice Parfait
- Centre de ressources Biologiques, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier de Lamballerie
- Unite des Virus Emergents, Aix-Marseille Université, Institut de Recherche pour le Développement 190, Inserm 1207, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Odile Launay
- INSERM, F-CRIN, Reseau Innovative Clinical Research in Vaccinology (IREIVAC), Paris, France,Centre d'Investigation Clinique Cochin Pasteur, Hôpital Cochin/APHP, INSERM CIC 1417, Paris, France,Université de Paris, Paris, France
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4
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Jondreville L, D’Aveni M, Labussière-Wallet H, Le Bourgeois A, Villate A, Berceanu A, Bezsera SM, Thiebaut A, Boissard-Simonet M, Legrand M, Cornillon J, Rubio MT, Chevallier P, Nguyen S. Pre-exposure prophylaxis with tixagevimab/cilgavimab (AZD7442) prevents severe SARS-CoV-2 infection in recipients of allogeneic hematopoietic stem cell transplantation during the Omicron wave: a multicentric retrospective study of SFGM-TC. J Hematol Oncol 2022; 15:169. [PMID: 36443846 PMCID: PMC9702670 DOI: 10.1186/s13045-022-01387-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
Since the emergence of the Omicron variant of SARS-CoV-2, though considered less virulent, hospitalization and death rates among immunocompromised patients remain high, especially for poor responders to vaccination. We conducted a retrospective multicentric study to evaluate pre-exposure prophylaxis with AZD7442 (tixagevimab/cilgavimab) for preventing COVID-19 in adult allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients. Among the 161 patients of our cohort, 22 (14%) contracted COVID-19 after a median follow-up of 105 days, but no severe form was observed. Only one major adverse event was reported: an acute coronary syndrome, resolved without sequelae. Pending randomized controlled trial results, our data support the use of AZD7442 as pre-exposure prophylaxis for COVID-19 during Omicron wave in allo-HSCT patients who failed to develop humoral immunity to vaccination, to prevent severe and potentially lethal forms of SARS-CoV-2 infection.
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Affiliation(s)
- Ludovic Jondreville
- grid.50550.350000 0001 2175 4109Department of Clinical Hematology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP Sorbonne Université, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
| | - Maud D’Aveni
- grid.410527.50000 0004 1765 1301Department of Clinical Hematology, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Hélène Labussière-Wallet
- grid.413852.90000 0001 2163 3825Department of Clinical Hematology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Amandine Le Bourgeois
- grid.277151.70000 0004 0472 0371Department of Clinical Hematology, Nantes University Hospital, Nantes, France
| | - Alban Villate
- grid.411167.40000 0004 1765 1600Department of Clinical Hematology, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - Ana Berceanu
- grid.411158.80000 0004 0638 9213Department of Clinical Hematology, Besançon University Hospital, Besançon, France
| | - Silvia-Maria Bezsera
- grid.488279.80000 0004 1798 7163Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Anne Thiebaut
- grid.410529.b0000 0001 0792 4829Department of Clinical Hematology, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Marion Boissard-Simonet
- grid.411158.80000 0004 0638 9213Department of Clinical Hematology, Besançon University Hospital, Besançon, France
| | - Marlène Legrand
- grid.413852.90000 0001 2163 3825Department of Clinical Hematology, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Jérôme Cornillon
- grid.488279.80000 0004 1798 7163Institut de Cancérologie Lucien Neuwirth, Saint-Priest-en-Jarez, France
| | - Marie-Thérèse Rubio
- grid.410527.50000 0004 1765 1301Department of Clinical Hematology, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Patrice Chevallier
- grid.277151.70000 0004 0472 0371Department of Clinical Hematology, Nantes University Hospital, Nantes, France
| | - Stéphanie Nguyen
- grid.50550.350000 0001 2175 4109Department of Clinical Hematology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP Sorbonne Université, 47-83 Boulevard de L’Hôpital, 75013 Paris, France
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5
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Beauvais D, Robin C, Thiebaut A, Alain S, Coiteux V, Ducastelle-Lepretre S, Marçais A, Ceballos P, Xhaard A, Redjoul R, Nguyen S, Brissot E, Joris M, Turlure P, Rubio MT, Chevallier P, Bénard N, Liautard C, Yakoub-Agha I. Effective Letermovir Prophylaxis of CMV infection post allogeneic hematopoietic cell transplantation: Results from the French temporary authorization of use compassionate program. J Clin Virol 2022; 148:105106. [PMID: 35182958 DOI: 10.1016/j.jcv.2022.105106] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/09/2022] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
Abstract
We report the results of the French Temporary Authorization of Use (ATU) compassionate program of letermovir for primary prophylaxis conducted in 21 transplant centers. Patients were CMV seropositive allogeneic hematopoietic cell transplantation recipients and at high risk for CMV infection. Primary prophylaxis was defined as initiation of letermovir between day 0 and day +28 post-transplant. Between November 2017 and January 2019, 96 patients with a median age of 56 years received letermovir and follow-up data were available for 78 patients. The median time from transplant to letermovir initiation was 4 days, and the median duration of exposure to letermovir was 78 days, with 57 patients still on treatment at the cutoff date. Letermovir was temporarily discontinued in 4 patients (5.1%) and stopped in 39 patients (50.0%), in most cases due to planned end of treatment (n = 16, 20.5%). Fifteen patients (19.2%) each presented one positive CMV PCR, in median 13 days after letermovir initiation. Clinically significant CMV infection was reported in 5 patients (6.4%). No CMV disease was reported. At least one adverse drug reaction was reported for 12 patients (15.4%). In this early access program, letermovir was effective with comparable results of the phase 3 study with a low rate of clinically significant CMV infection, including in patients who were at high-risk for CMV infection.
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Affiliation(s)
- David Beauvais
- Univ Lille, CHU Lille, Hematology Department, Inserm, Infinite U1286, Lille, France.
| | - Christine Robin
- University Paris-Est-Créteil, Hematology Department, Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France
| | - Anne Thiebaut
- Hematology Department, CHU Grenoble, Grenoble, France
| | - Sophie Alain
- INSERM, CHU Limoges, RESINFIT, U1092, National Reference Center for Herpesviruses, Limoges University, Limoges, France
| | - Valérie Coiteux
- Univ Lille, CHU Lille, Hematology Department, Inserm, Infinite U1286, Lille, France
| | | | - Ambroise Marçais
- Department of adult hematology, Assistance Publique-Hôpitaux de Paris, university hospital Necker, Paris, France
| | - Patrice Ceballos
- Hematology Department, Saint-Eloi University Hospital, Montpellier, France
| | - Alienor Xhaard
- Hematology and transplantation unit, Saint Louis Hospital, APHP, Paris, France
| | - Rabah Redjoul
- University Paris-Est-Créteil, Hematology Department, Assistance Publique-Hopitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France
| | - Stéphanie Nguyen
- Department of Hematology, AP-HP, Hôpital Pitié-Salpétrière, Sorbonne Université, Paris, France
| | - Eolia Brissot
- Service d'Hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, Sorbonne Université, INSERM UMRs 938, Paris, France
| | - Magalie Joris
- Department of Haematology, Amiens University Medical Center, Amiens, France
| | - Pascal Turlure
- CHU Limoges, Univ. Limoges, Department of Hematology, Limoges, France
| | | | | | | | | | - Ibrahim Yakoub-Agha
- Univ Lille, CHU Lille, Hematology Department, Inserm, Infinite U1286, Lille, France
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6
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Davido B, Gautier S, Riom I, Landowski S, Lawrence C, Thiebaut A, Bessis S, Perronne V, Mascitti H, Noussair L, Rancon MD, Touraine B, Rouveix E, Herrmann JL, Annane D, de Truchis P, Delarocque-Astagneau E. The first wave of COVID-19 in hospital staff members of a tertiary care hospital in the greater Paris area: A surveillance and risk factors study. Int J Infect Dis 2021; 105:172-179. [PMID: 33607301 PMCID: PMC7884916 DOI: 10.1016/j.ijid.2021.02.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/05/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction Understanding how hospital staff members (HSMs), including healthcare workers, acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first wave can guide the control measures in the current second wave in Europe. Methods From March 5 to May 10, 2020, the Raymond-Poincaré Hospital held a weekday consultation for HSMs for PCR testing. HSMs were requested to complete a questionnaire on their potential exposure to SARS-CoV-2. Results Of 200 HSMs screened, 70 tested positive for SARS-CoV-2. Ninety-nine HSMs completed the questionnaire of whom 28 tested positive for SARS-CoV-2. In the multivariable analysis, age of ≥44 years (aOR = 5.2, 95% CI [1.4–22.5]) and not systematically using a facemask when caring for a patient (aOR = 13.9, 95% CI [1.8–293.0]) were significantly associated with SARS-CoV-2 infection. Working in a COVID-19-dedicated ward (aOR = 0.7, 95% CI [0.2–3.2]) was not significantly associated with infection. Community-related exposure in and outside the hospital, hospital meetings without facemasks (aOR = 21.3, 95% CI [4.5–143.9]) and private gatherings (aOR = 10, 95% CI [1.3–91.0]) were significantly associated with infection. Conclusions Our results support the effectiveness of barrier precautions and highlight in-hospital infections not related to patient care and infections related to exposure in the community. Protecting HSMs against COVID-19 is crucial in fighting the second wave of the epidemic.
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Affiliation(s)
- Benjamin Davido
- Maladies infectieuses, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches 92380, France.
| | - Sylvain Gautier
- AP-HP, GHU Paris-Saclay University, Raymond Poincaré Hospital, Epidemiology and Public Health Department, Garches 92380, France; Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Primary Care and Prevention Team, Villejuif 94807, France
| | - Isabelle Riom
- AP-HP, GHU Paris-Saclay University, Raymond Poincaré Hospital, Epidemiology and Public Health Department, Garches 92380, France
| | - Stephanie Landowski
- Maladies infectieuses, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches 92380, France
| | - Christine Lawrence
- Laboratoire de Microbiologie et hygiène, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, AP-HP, Garches 92380, France
| | - Anne Thiebaut
- Université Paris-Saclay, Inserm U1018, CESP, High Dimensional Biostatistics Team, Villejuif 94807, France
| | - Simon Bessis
- Maladies infectieuses, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches 92380, France
| | - Veronique Perronne
- Maladies infectieuses, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches 92380, France
| | - Helene Mascitti
- Maladies infectieuses, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches 92380, France
| | - Latifa Noussair
- Laboratoire de Microbiologie et hygiène, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, AP-HP, Garches 92380, France
| | - Martine Domart Rancon
- Médecine du Travail, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, AP-HP, Garches 92380, France
| | - Beatrice Touraine
- Maladies infectieuses, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches 92380, France
| | - Elisabeth Rouveix
- Médecine Interne, Université Paris-Saclay, AP-HP Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt 92100, France; GERES, Groupe d'Etude sur les risques d'Exposition des Soignants, Paris 7518, France
| | - Jean-Louis Herrmann
- Laboratoire de Microbiologie et hygiène, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, AP-HP, Garches 92380, France
| | - Djilalli Annane
- FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), RHU RECORDS (Rapid rEcognition of CORticosteroiD resistant or sensitive Sepsis), Department of Intensive Care, Hôpital Raymond Poincaré (AP-HP), Laboratory of Infection & Inflammation - U1173, School of Medicine Simone Veil, University Versailles Saint Quentin - University Paris Saclay, INSERM, Garches 92380, France
| | - Pierre de Truchis
- Maladies infectieuses, Université Paris-Saclay, AP-HP Hôpital Raymond Poincaré, Garches 92380, France
| | - Elisabeth Delarocque-Astagneau
- AP-HP, GHU Paris-Saclay University, Raymond Poincaré Hospital, Epidemiology and Public Health Department, Garches 92380, France; Université Paris-Saclay, UVSQ, Inserm U1018, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, Villejuif 94807, France
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7
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Filser M, Aral B, Airaud F, Chauveau A, Bruce A, Polfrit Y, Thiebaut A, Gauthier M, Le Maréchal C, Lippert E, Béziau S, Garrec C, Gardie B, Girodon F. Low incidence of EPOR mutations in idiopathic erythrocytosis. Haematologica 2021; 106:299-301. [PMID: 32165487 PMCID: PMC7776331 DOI: 10.3324/haematol.2019.244160] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Bernard Aral
- Laboratoire de genetique chromosomique et moleculaire, Pôle Biologie, CHU de Dijon
| | | | | | - Aisha Bruce
- Dept of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton
| | | | | | - Martin Gauthier
- Service d'Hematologie, Toulouse-Oncopole University Cancer Institute (IUCT-O), Toulouse
| | | | - Eric Lippert
- Hematologie Biologique, CHU Brest, Université de Brest, Brest
| | - Stéphane Béziau
- Service de Genetique Medicale, CHU Nantes, Institut du Thorax, Nantes
| | - Céline Garrec
- Service de Genetique Medicale, CHU de Nantes, Nantes
| | - Betty Gardie
- Institut du Thorax, EPHE, PSL research University, Laboratory of Excellence GR-Ex, Nantes
| | - François Girodon
- Pole Biologie, Laboratory of Excellence GR-Ex, Université de Bourgogne, Dijon
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8
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Robin C, Thiebaut A, Alain S, Sicre de Fontbrune F, Berceanu A, D'Aveni M, Ceballos P, Redjoul R, Nguyen-Quoc S, Bénard N, Pahlavan-Grumel G, Cordonnier C. Letermovir for Secondary Prophylaxis of Cytomegalovirus Infection and Disease after Allogeneic Hematopoietic Cell Transplantation: Results from the French Compassionate Program. Biol Blood Marrow Transplant 2020; 26:978-984. [DOI: 10.1016/j.bbmt.2020.01.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/22/2022]
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9
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Schacherer M, Thiebaut A, Maubon D, Garnaud C, Landelle C, Cahn J. Étude observationnelle rétrospective et monocentrique des pneumocystoses pulmonaires en hématologie adulte. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Mondet J, Presti CL, Garrel C, Skaare K, Mariette C, Carras S, Park S, Carré M, Bulabois CE, Molina L, Gressin R, Thiebaut A, Courby S, Socoro-Yuste N, Faure P, Leer-Florin AM, Cahn JY, Mossuz P. Adult patients with de novo acute myeloid leukemia show a functional deregulation of redox balance at diagnosis which is correlated with molecular subtypes and overall survival. Haematologica 2019; 104:e393-e397. [PMID: 30819920 DOI: 10.3324/haematol.2018.206821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Julie Mondet
- Molecular Pathology Laboratory, Grenoble Alpes University (UGA) Hospital, Grenoble, France .,Institute for Advanced Biosciences, UGA, L'Institut National de la Santé et de la Recherche Médicale U1209, Centre National de la Recherche Scientifique (CNRS) 5309, Grenoble, France
| | - Caroline Lo Presti
- Institute for Advanced Biosciences, UGA, L'Institut National de la Santé et de la Recherche Médicale U1209, Centre National de la Recherche Scientifique (CNRS) 5309, Grenoble, France.,Laboratory of Hematology, UGA Hospital, Grenoble, France
| | | | - Kristina Skaare
- Techniques de l'Ingénierie Médicale et de la Complexité Informatique et Applications - Informatique, Mathématiques et Applications Grenoble (TIMC-IMAG), CNRS, UGA, La Tronche, France
| | - Clara Mariette
- Department of Hematology, UGA Hospital, Grenoble, France
| | - Sylvain Carras
- Department of Hematology, University Hospital, Lyon, France
| | - Sophie Park
- Institute for Advanced Biosciences, UGA, L'Institut National de la Santé et de la Recherche Médicale U1209, Centre National de la Recherche Scientifique (CNRS) 5309, Grenoble, France.,Department of Hematology, UGA Hospital, Grenoble, France
| | - Martin Carré
- Department of Hematology, UGA Hospital, Grenoble, France
| | | | - Lysiane Molina
- Department of Hematology, UGA Hospital, Grenoble, France
| | - Rémy Gressin
- Department of Hematology, UGA Hospital, Grenoble, France
| | - Anne Thiebaut
- Department of Hematology, UGA Hospital, Grenoble, France
| | | | | | - Patrice Faure
- Department of Biochemistry, UGA Hospital, Grenoble, France
| | - Anne Mc Leer-Florin
- Molecular Pathology Laboratory, Grenoble Alpes University (UGA) Hospital, Grenoble, France.,Institute for Advanced Biosciences, UGA, L'Institut National de la Santé et de la Recherche Médicale U1209, Centre National de la Recherche Scientifique (CNRS) 5309, Grenoble, France
| | - Jean-Yves Cahn
- Institute for Advanced Biosciences, UGA, L'Institut National de la Santé et de la Recherche Médicale U1209, Centre National de la Recherche Scientifique (CNRS) 5309, Grenoble, France.,Department of Hematology, UGA Hospital, Grenoble, France
| | - Pascal Mossuz
- Institute for Advanced Biosciences, UGA, L'Institut National de la Santé et de la Recherche Médicale U1209, Centre National de la Recherche Scientifique (CNRS) 5309, Grenoble, France .,Laboratory of Hematology, UGA Hospital, Grenoble, France
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11
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Perolat R, Stephanov O, Mounier A, Thiebaut A, Pirvu A, Hamidfar R, Ferretti G. Signe du halo inversé chez un patient neutropénique fébrile. Rev Mal Respir 2017; 34:778-781. [DOI: 10.1016/j.rmr.2016.08.007] [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] [Received: 06/02/2016] [Accepted: 08/29/2016] [Indexed: 10/20/2022]
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12
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Guièze R, Damaj G, Pereira B, Robin M, Chevallier P, Michallet M, Vigouroux S, Beguin Y, Blaise D, El Cheikh J, Roos-Weil D, Thiebaut A, Rohrlich PS, Huynh A, Cornillon J, Contentin N, Suarez F, Lioure B, Mohty M, Maillard N, Clement L, François S, Guillerm G, Yakoub-Agha I. Management of Myelodysplastic Syndrome Relapsing after Allogeneic Hematopoietic Stem Cell Transplantation: A Study by the French Society of Bone Marrow Transplantation and Cell Therapies. Biol Blood Marrow Transplant 2015; 22:240-247. [PMID: 26256942 DOI: 10.1016/j.bbmt.2015.07.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/30/2015] [Indexed: 11/27/2022]
Abstract
To find out prognostic factors and to investigate different therapeutic approaches, we report on 147 consecutive patients who relapsed after allogeneic hematopoietic stem cell transplantation (allo-HSCT) for myelodysplastic syndrome (MDS). Sixty-two patients underwent immunotherapy (IT group, second allo-HSCT or donor lymphocyte infusion), 39 received cytoreductive treatment alone (CRT group) and 46 were managed with palliative/supportive cares (PSC group). Two-year rates of overall survival (OS) were 32%, 6%, and 2% in the IT, CRT, and PSC groups, respectively (P < .001). In multivariate analysis, 4 factors adversely influenced 2-year rates of OS: history of acute graft-versus-host disease (hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.26 to 2.67; P = .002), relapse within 6 months (HR, 2.69; 95% CI, .82 to 3.98; P < .001), progression to acute myeloid leukemia (HR, 2.59; 95% CI, 1.75 to 3.83; P < .001), and platelet count < 50 G/L at relapse (HR, 1.68; 95% CI, 1.15 to 2.44; P = .007). A prognostic score based on those factors discriminated 2 risk groups with median OSs of 13.2 versus 2.4 months, respectively (P < .001). When propensity score, prognostic score, and treatment strategy were included in Cox model, immunotherapy was found to be an independent factor that favorably impacts OS (HR, .40; 95% CI, .26 to .63; P < .001). In conclusion, immunotherapy should be considered when possible for MDS patients relapsing after allo-HSCT.
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Affiliation(s)
- Romain Guièze
- CHU de Clermont-Ferrand, Hôpital Estaing, Service d'Hématologie Clinique Adulte, and Université Clermont 1, Clermont-Ferrand, France
| | - Gandhi Damaj
- CHU et Université Basse Normandie, Service d'Hématologie, Caen, France
| | - Bruno Pereira
- Biostatistics Unit, Direction de la Recherche Clinique, Clermont-Ferrand, France
| | - Marie Robin
- Hématologie Greffe de moelle, AP-HP, Hôpital Saint-Louis, Université Paris 7, Paris, France
| | | | | | - Stéphane Vigouroux
- Service d'Hématologie Clinique et Thérapie Cellulaire, CHU, Bordeaux, France
| | - Yves Beguin
- Hematology, CHU and University of Liège, Liège, Belgium
| | - Didier Blaise
- Unité de Transplantation et de Thérapie Cellulaire, Institut Paoli-Calmettes, Marseille, France
| | - Jean El Cheikh
- Unité de Transplantation et de Thérapie Cellulaire, Institut Paoli-Calmettes, Marseille, France
| | - Damien Roos-Weil
- Hématologie, Hôpital Pitié-Salpétrière, AP-HP, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Anne Thiebaut
- Hématologie, CHU et UMR 5525 CNRS-UJF, Grenoble, France
| | | | - Anne Huynh
- Service d'Hématologie, CHU, Toulouse, France
| | - Jérôme Cornillon
- Service d'Hématologie, Institut de Cancérologie de la Loire, Saint-Etienne, France
| | | | - Felipe Suarez
- Service d'Hématologie, APHP, Hôpital Necker Enfants-Malades, Université Paris 5, Paris, France
| | - Bruno Lioure
- Service d'Hématologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Mohamad Mohty
- Service d'Hématologie, AP-HP, Hôpital Saint-Antoine, Université Paris 6, Paris, France
| | | | | | | | | | - Ibrahim Yakoub-Agha
- Hématologie, CHRU de lille, Inserm U995, and Université Lille 2, Lille, France.
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13
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Thiebaut A, Lafuma A, Bureau I, Boyaval G, Bensoussan C, Godard C. Acute Myeloid Leukemia and Myelodisplasic Syndrome Treated With Intensive Chemotherapy In France Based On National Hospital Databases (Pmsi). Value Health 2014; 17:A524. [PMID: 27201648 DOI: 10.1016/j.jval.2014.08.1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Thiebaut
- Department of Hematology, Grenoble University Hospital, La Tronche, France
| | - A Lafuma
- Cemka-Eval, Bourg la Reine, France
| | - I Bureau
- Cemka-Eval, Bourg la Reine, France
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14
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Thiebaut A, Lafuma A, Bureau I, Boyaval G, Bensoussan C, Godard C. Allogeneic Stem Cell Transplant With Graft Versus Host Disease In France In 2012 Based On National Hospital Databases (Pmsi). Value Health 2014; 17:A524. [PMID: 27201649 DOI: 10.1016/j.jval.2014.08.1647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- A Thiebaut
- Department of Hematology, Grenoble University Hospital, La Tronche, France
| | - A Lafuma
- Cemka-Eval, Bourg la Reine, France
| | - I Bureau
- Cemka-Eval, Bourg la Reine, France
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15
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Germi R, Mariette C, Alain S, Lupo J, Thiebaut A, Brion JP, Epaulard O, Saint Raymond C, Malvezzi P, Morand P. Success and failure of artesunate treatment in five transplant recipients with disease caused by drug-resistant cytomegalovirus. Antiviral Res 2013; 101:57-61. [PMID: 24184983 DOI: 10.1016/j.antiviral.2013.10.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/16/2013] [Accepted: 10/24/2013] [Indexed: 11/16/2022]
Abstract
Cytomegalovirus (CMV) strains resistant to ganciclovir, cidofovir and/or foscarnet were genotypically and phenotypically characterised in two haematopoietic stem cell transplant recipients and three solid-organ transplant recipients with CMV disease. The anti-malaria drug artesunate led to a favourable virological and clinical response in three cases with mild CMV diseases (fever and neutropaenia) but was ineffective in two fatal CMV diseases with lung involvement in spite of a decrease in the CMV DNA load in blood and bronchoalveolar fluid.
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Affiliation(s)
- R Germi
- Department of Virology, University Hospital, Grenoble, France; Unit of Virus Host Cell Interactions UMI 3265 UJF-EMBL-CNRS, B.P. 181, 6, rue Jules Horowitz, 38042 Grenoble Cedex 9, France.
| | - C Mariette
- Department of Infectious diseases, University Hospital, Grenoble, France
| | - S Alain
- Department of Virology, French National Cytomegalovirus Reference Center, University Hospital, Limoges, France
| | - J Lupo
- Department of Virology, University Hospital, Grenoble, France; Unit of Virus Host Cell Interactions UMI 3265 UJF-EMBL-CNRS, B.P. 181, 6, rue Jules Horowitz, 38042 Grenoble Cedex 9, France
| | - A Thiebaut
- Department of Hematology, University Hospital, Grenoble, France
| | - J P Brion
- Department of Infectious diseases, University Hospital, Grenoble, France
| | - O Epaulard
- Department of Virology, University Hospital, Grenoble, France; Unit of Virus Host Cell Interactions UMI 3265 UJF-EMBL-CNRS, B.P. 181, 6, rue Jules Horowitz, 38042 Grenoble Cedex 9, France; Department of Infectious diseases, University Hospital, Grenoble, France
| | - C Saint Raymond
- Department of Pneumology, University Hospital, Grenoble, France
| | - P Malvezzi
- Department of Nephrology, University Hospital, Grenoble, France
| | - P Morand
- Department of Virology, University Hospital, Grenoble, France; Unit of Virus Host Cell Interactions UMI 3265 UJF-EMBL-CNRS, B.P. 181, 6, rue Jules Horowitz, 38042 Grenoble Cedex 9, France
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16
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Epaulard O, Villier C, Ravaud P, Chosidow O, Blanche S, Mamzer-Bruneel MF, Thiebaut A, Leccia MT, Lortholary O. A Multistep Voriconazole-Related Phototoxic Pathway May Lead to Skin Carcinoma: Results From a French Nationwide Study. Clin Infect Dis 2013; 57:e182-8. [DOI: 10.1093/cid/cit600] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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17
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Houot R, Tavernier E, Le QH, Lhéritier V, Thiebaut A, Thomas X. Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia in the Elderly: Prognostic Factors and Treatment Outcome. Hematology 2013; 9:369-76. [PMID: 15763976 DOI: 10.1080/10245330400001983] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Data on all patients diagnosed with Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL) aged 55 or older, seen in our institution over a 17-year period, were studied to determine the incidence and range of clinical and biological subtypes, and the outcome of different therapeutic approaches. Twenty-five Ph+ ALL cases (median age: 64 years) were diagnosed between 1986 and 2003 (28% of all B-lineage elderly ALL seen during this period). Karyotypic analysis was performed successfully in 22 cases, while 3 were only diagnosed by molecular biology analysis. All patients had B-cell lineage ALL. Co-expression of myeloid markers was observed in 20% of tested cases. One patient died before chemotherapy could be given. All other patients received "curative" treatment according to different protocols used during the period of study. Overall the complete remission (CR) rate was 76% (95% confidence interval, CI: 55-91%). Fifteen patients achieved CR after one course of chemotherapy and 4 patients after salvage therapy. Median disease-free survival (DFS) of the entire cohort was 5.6 months (95% CI: 4.5-8.4 months) and median overall survival was 10.1 months (95% CI: 7.9-13 months). In multivariate analysis, age>or=70 years was of poor prognostic value for achieving CR (p=0.05) and hyperleukocytosis at diagnosis was of poor prognostic value for overall survival (p=0.001). Overall survival duration was not significantly influenced by achieving CR. Ph+ ALL patients did not show a significant difference in terms of outcome as compared with Philadelphia-negative ALL patients. The very poor overall outcome in elderly patients with Ph+ ALL may be significantly improved by the introduction of imatinib mesylate into current treatment regimens.
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Affiliation(s)
- Roch Houot
- Service d'Hématologie, Hôpital Edouard Herriot, Lyon, France
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18
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Duléry R, Giraud C, Beaumont JL, Bilger K, Borel C, Dhedin N, Thiebaut A, Willems E, Alain S, Alfandari S, Dewilde A, Jouet JP, Milpied N, Yakoub-Agha I. Conduite à tenir devant une anomalie biologique découverte lors du bilan pré-don cellules souches hématopoïétiques : sérologie IgM positive pour le cytomégalovirus, le virus d’Epstein-Barr, la toxoplasmose, ou la syphilis. ACTA ACUST UNITED AC 2013; 61:155-7. [DOI: 10.1016/j.patbio.2013.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 07/19/2013] [Indexed: 11/24/2022]
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19
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Tabouret E, Barrie M, Thiebaut A, Matta M, Boucard C, Autran D, Loundou A, Chinot O. Limited impact of prognostic factors in patients with recurrent glioblastoma multiforme treated with a bevacizumab-based regimen. J Neurooncol 2013; 114:191-8. [PMID: 23756726 DOI: 10.1007/s11060-013-1170-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 05/25/2013] [Indexed: 11/29/2022]
Abstract
Bevacizumab has demonstrated activity in patients with recurrent glioblastoma. However, the impact of prognostic factors associated with recurrent glioblastoma treated with cytotoxic agents has not been determined in patients treated with bevacizumab. To analyze the prognostic factors and clinical benefits of bevacizumab and irinotecan treatment in patients with recurrent glioblastoma. This monocentric study retrospectively analyzed all patients with recurrent glioblastoma who were treated with at least one cycle of bevacizumab and irinotecan at our institution from April 2007 to May 2010. Multivariate analysis was used to analyze prognostic factors for overall survival (OS) from the initiation of bevacizumab administration. Among the 100 patients that were identified (M/F: 65/35), the median age was 57.9 years (range: 18-76). Karnofsky Performance Status (KPS) was <70 in 44 patients and ≥ 70 in 56 patients; 83 % of the patients were on steroids. The median tumor area was 2012 mm². The median progression free survival was 3.9 months (CI 95 %: 3.4-4.3). The median OS was 6.5 months (CI 95 %: 5.6-7.4). Multivariate analysis revealed that OS was affected by KPS (p = 0.024), but not by gender, age, steroid treatment, number of previous lines of treatment, tumor size, or time from initial diagnosis. KPS was improved in 30 patients, including 14/44 patients with an initial KPS <70. The median duration of maintained functional independence (KPS ≥ 70) was 3.75 months (CI 95 %: 2.9-4.6). The median OS from initial diagnosis was 18.9 months (CI 95 %: 17.5-20.3). In patients with recurrent glioblastoma treated with bevacizumab, KPS was revealed as the only factor to impact OS. The clinical benefits associated with this regimen appear valuable. A positive impact of bevacizumab administration on OS of patients with glioblastoma multiforme is suggested.
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Affiliation(s)
- E Tabouret
- Department of Neuro-Oncology, Timone Hospital, APHM, 264, rue Saint Pierre, 13005 Marseille, France.
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Herbrecht R, Caillot D, Cordonnier C, Auvrignon A, Thiebaut A, Brethon B, Michallet M, Mahlaoui N, Bertrand Y, Preziosi P, Ruiz F, Gorin NC, Gangneux JP. Indications and outcomes of antifungal therapy in French patients with haematological conditions or recipients of haematopoietic stem cell transplantation. J Antimicrob Chemother 2012; 67:2731-8. [DOI: 10.1093/jac/dks266] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Epaulard O, Leccia MT, Blanche S, Chosidow O, Mamzer-Bruneel MF, Ravaud P, Thiebaut A, Villier C, Lortholary O. Phototoxicity and photocarcinogenesis associated with voriconazole. Med Mal Infect 2011; 41:639-45. [PMID: 22055586 DOI: 10.1016/j.medmal.2011.09.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 08/03/2011] [Accepted: 09/23/2011] [Indexed: 11/15/2022]
Abstract
The antifungal voriconazole was given its marketing authorization in 2002. Several kinds of adverse effects have been reported, including acute and chronic cutaneous adverse effects, mainly due to a phototoxicity mechanism. More recently, some authors have reported that voriconazole was involved in the occurrence of multiple and often-aggressive cutaneous squamous cell carcinomas if the treatment was maintained for a long time. According to safety data in studies assessing voriconazole effectiveness, 8% of outpatients may experience phototoxic events. An overview of the different types of phototoxicity and of the concerned population was given by the 61 published case reports of photo-induced voriconazole-related skin adverse events (including 18 cases of squamous cell carcinomas). The most likely mechanisms may be phototoxicity directly related to either voriconazole or to its N-oxide main metabolite, and an interaction with retinoid metabolism; moreover, immunodeficiency may enhance the risk of skin cancer. Several issues remain to be investigated, and studies are needed concerning the phototoxicity and photocarcinogenesis of voriconazole and the prognosis of chronic non-malignant skin lesions. Voriconazole prescription must be associated with strict photoprotection; in case of a phototoxic adverse event, another azole may be recommended.
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Affiliation(s)
- O Epaulard
- Service des maladies infectieuses et de médecine tropicale, CHU de Grenoble, France.
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22
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Nicolle MC, Bénet T, Thiebaut A, Bienvenu AL, Voirin N, Duclos A, Sobh M, Cannas G, Thomas X, Nicolini FE, De Monbrison F, Piens MA, Picot S, Michallet M, Vanhems P. Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009. Haematologica 2011; 96:1685-91. [PMID: 21791468 DOI: 10.3324/haematol.2011.044636] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The study objectives were: 1) to report on invasive aspergillosis patients in a hematology department; and 2) to estimate its incidence according to the hematologic diagnosis. DESIGN AND METHODS A prospective survey of invasive aspergillosis cases was undertaken between January 2004 and December 2009 in the hematology department of a university hospital. Meetings with clinicians, mycologists and infection control practitioners were organized monthly to confirm suspected aspergillosis cases. Demographic characteristics, clinical and complementary examination results were recorded prospectively. Information on hospitalization was extracted from administrative databases. Invasive aspergillosis diagnosis followed the European Organization for Research and Treatment of Cancer criteria, and proven and probable IA cases were retained. A descriptive analysis was conducted with temporal trends of invasive aspergillosis incidence assessed by adjusted Poisson regression. RESULTS Overall, 4,073 hospitalized patients (78,360 patient-days) were included in the study. In total, 127 (3.1%) patients presented invasive aspergillosis. The overall incidence was 1.6 per 1,000 patient-days (95% confidence interval: 1.4, 1.9) with a decrease of 16% per year (-1%, -28%). The incidence was 1.9 per 1,000 patient-days (1.5, 2.3) in acute myeloid leukemia patients with a decrease of 20% per year (-6%, -36%). Serum Aspergillus antigen was detected in 89 (71%) patients; 29 (23%) had positive cultures, and 118 (93%), abnormal lung CT scans. One-month mortality was 13%; 3-month mortality was 42%. Mortality tended to decrease between 2004 and 2009. CONCLUSIONS Invasive aspergillosis incidence and mortality declined between 2004 and 2009. Knowledge of invasive aspergillosis characteristics and its clinical course should help to improve the management of these patients with severe disease.
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Affiliation(s)
- Marie-Christine Nicolle
- Service d’Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France
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23
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Kazan E, Maertens J, Herbrecht R, Weisser M, Gachot B, Vekhoff A, Caillot D, Raffoux E, Fagot T, Reman O, Isnard F, Thiebaut A, Bretagne S, Cordonnier C. A retrospective series of gut aspergillosis in haematology patients. Clin Microbiol Infect 2011; 17:588-94. [PMID: 20636423 DOI: 10.1111/j.1469-0691.2010.03310.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Gut invasive aspergillosis is an extremely rare infection in immunocompromised patients. The goal of this retrospective multicentre study is to report on cases of gut aspergillosis in haematology patients, including clinical presentation, risk factors, and outcome. Twenty-one patients from nine centres were identified. Eight had isolated gut aspergillosis, with no evidence of other infected sites, and 13 had disseminated aspergillosis. Thirteen patients had acute leukaemia. Nine were allogeneic stem cell transplant recipients. Clinical symptoms and imaging were poorly specific. The galactomannan antigenaemia test result was positive in 16/25 (64%) patients, including in four of the eight cases of isolated gut aspergillosis. Five of 21 patients had a dietary regimen rich in spices, suggesting that, in these cases, food could have been the source of gut colonization, and then of a primary gut Aspergillus lesion. The diagnosis was made post-mortem in six patients. The mortality rate in the remaining patients at 12 weeks was 7/15 (47%). Gut aspergillosis is probably misdiagnosed and underestimated in haematology patients, owing to the poor specificity of symptoms and imaging. Patients with a persistently positive galactomannan antigenaemia finding that is unexplained by respiratory lesions should be suspected of having gut aspergillosis in the presence of abdominal symptoms, and be quickly investigated. In the absence of severe abdominal complications leading to surgery and resection of the lesions, the optimal treatment is not yet defined.
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Affiliation(s)
- E Kazan
- Haematology Department, Henri Mondor Teaching Hospital, Assistance Publique-Hôpitaux de Paris and Paris 12 University, Créteil, France.
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24
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Roos-Weil D, Moreau P, Avet-Loiseau H, Golmard JL, Kuentz M, Vigouroux S, Socié G, Furst S, Soulier J, Le Gouill S, François S, Thiebaut A, Buzyn A, Maillard N, Yakoub-Agha I, Raus N, Fermand JP, Michallet M, Blaise D, Dhédin N. Impact of genetic abnormalities after allogeneic stem cell transplantation in multiple myeloma: a report of the Société Française de Greffe de Moelle et de Thérapie Cellulaire. Haematologica 2011; 96:1504-11. [PMID: 21685472 DOI: 10.3324/haematol.2011.042713] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The impact of cytogenetic abnormalities in multiple myeloma after allogeneic stem cell transplantation has not been clearly defined. This study examines whether allogeneic stem cell transplantation could be of benefit for myeloma patients with high-risk cytogenetic abnormalities. DESIGN AND METHODS This is a retrospective multicenter analysis of the registry of the Société Française de Greffe de Moelle et de Thérapie Cellulaire, including 143 myeloma patients transplanted between 1999 and 2008. RESULTS The incidences of cytogenetic abnormalities were 59% for del(13q), 25% for t(4;14), 25% for del(17p) and 4% for t(14;16). When comparing the population carrying an abnormality to that without the same abnormality, no significant difference was found in progression-free survival, overall survival or progression rate. Patients were grouped according to the presence of any of the poor prognosis cytogenetic abnormalities t(4;14), del(17p) or t(14;16) (n=53) or their absence (n=32). No difference in outcomes was observed between these two groups: the 3-year progression-free survival, overall survival and progression rates were 30% versus 17% (P=0.9), 45% versus 39% (P=0.8) and 53% versus 75% (P=0.9), respectively. CONCLUSIONS These data indicate that allogeneic stem cell transplantation could potentially be of benefit to high-risk myeloma patients.
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Affiliation(s)
- Damien Roos-Weil
- Hematology Department, University Hospital Pitié-Salpêtrière, Paris, France.
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25
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Thaon I, Thiebaut A, Jochault L, Lefebvre A, Laplante JJ, Dalphin JC. Influence of hay and animal feed exposure on respiratory status: a longitudinal study. Eur Respir J 2010; 37:767-74. [PMID: 21030452 DOI: 10.1183/09031936.00122209] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Our aim was to study respiratory symptoms and lung function decline in farmers, with particular attention to the influence of handling hay, straw and animal feed. From a cohort recruited in 1993-1994, 219 (82.6%) dairy farmers, 130 (62.5%) nondairy agricultural workers and 99 (66.4%) controls were re-evaluated in 2006. They answered medical and occupational questionnaires, underwent spirometric tests at both evaluations and pulse oximetry in 2006. Dairy and nondairy agricultural workers showed an increased risk for usual morning phlegm (adjusted OR 4.27 (95% CI 1.41-12.95) and 3.59 (95% CI 1.16-11.10), respectively). Animal feed handling was associated with increased risks of wheezing (p = 0.01) and usual morning phlegm (p = 0.04); hay or straw handling was associated with increased risk of wheezing (p = 0.008). Adjusting for smoking, age, height, sex and altitude, dairy farmers had greater declines in forced expiratory volume in 1 s (FEV(1))/forced vital capacity ratio (p = 0.01) than controls. An increased decline in FEV(1) for all agricultural workers was associated with animal feed handling, both measured as a categorical (currently versus never handling; p = 0.05) or quantitative value (years of exposure during the survey period; p = 0.03). Hay, straw or animal feed handling represents a risk factor of bronchial symptoms and, for animal feed only, of accelerated decline in expiratory flows.
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Affiliation(s)
- I Thaon
- Occupational Diseases Dept, UMR 6249 CNRS/Université de Franche-Comté, Laboratoire Chrono-environnement, France
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Thomas X, Le Q, Botton SD, Raffoux E, Chelghoum Y, Pautas C, Dreyfus F, Dhedin N, Vekhoff A, Troncy J, Pigneux A, Revel TD, Reman O, Travade P, Thiebaut A, Guerci A, Elhamri M, Fenaux P, Dombret H, Michallet M. Autologous or allogeneic stem cell transplantation as post-remission therapy in refractory or relapsed acute myeloid leukemia after highly intensive chemotherapy. Leuk Lymphoma 2009; 46:1007-16. [PMID: 16019551 DOI: 10.1080/10428190500084837] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Post-remission options were compared in a population of 262 relapsing and refractory acute myeloid leukemia patients achieving complete remission (CR) after the same re-induction according to etoposide - mitoxantrone - cytarabine (EMA) trials. The selection of post-remission therapy depended on trial recommendations, age, performance status, and availability of an HLA-identical sibling. One hundred and thirty patients received chemotherapy consolidation courses, 50 received autologous stem cell transplantation (SCT), and 43 underwent allogeneic bone marrow transplantation (BMT), while 39 did not receive any additional therapy. The preliminary analysis identified 3 favorable prognostic factors correlated with event-free survival (EFS): M3 subtype, previous CR duration > 1 year, and transplantation. Three year EFS was 68 vs. 23% with autologous SCT and allogeneic BMT in M3 patients and, respectively, 41 vs. 20% in non-M3 patients. Three year probabilities of treatment-related mortality were 11 and 47%, respectively. A statistical model was conceived with adjustment on prognostic factors and post-remission option. In the multivariate analysis, autologous SCT appeared significantly better than allogeneic BMT (P < 0.01) or chemotherapy (P = 0.001), while allogeneic BMT was not statistically different than chemotherapy. This indicates a high treatment-related toxicity with allogeneic BMT in patients re-induced by highly intensive chemotherapy, and therefore a tendency for a better outcome with autologous SCT as post-remission treatment in those patients.
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Affiliation(s)
- X Thomas
- Department of Hematology, Hôpital Edouard Herriot, Lyon, France.
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27
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Chinot OL, Boudouresque F, Bequet C, Barrie M, Thiebaut A, Matta M, Autran D, Ouafik L. Correlation of serum urokinase plasminogen activator (uPA) to progression of recurrent malignant glioma during bevacizumab treatment: A marker of invasive phenotype and a candidate to monitor therapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.2059] [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
2059 Background: Identification of circulating markers that predict tumor response or reflect progression is of crucial importance when using antiangiogenic agents. However, to date, no such parameters have been identified particularly for bevacizumab, for which, recently, increasing data have supported a role in patient with recurrent malignant glioma. Methods: Serial serum levels of VEGF, VEGFR2, FGF, SDFα, urokinase plasminogen activator (uPA), plasminogen activator inhibitor type I (PAI-1), and metalloprotesase type 9 (MMP9) were determined in a cohort of 32 patients treated with bevacizumab and irinotecan for recurrent malignant glioma. Samples were collected at the start of treatment and then at 4 weeks intervals until progression. Serum levels were measured using an enzyme-linked immunosorbent assay. Progression was defined by MacDonald's criteria, modified by integrating increase of infiltration as measured on MRI by Flair sequence. All subjects were followed for PFS and OS. Cox model analysis is used for correlation between markers and clinical outcome. Results: This preliminary analysis is restricted to pre-treatment (D0; n = 32), day 30 (D30; n = 27), and at progression time (DP; n = 15). None of the pretreatment serum level (n = 32) significantly affect PFS or OS although uPA and MMP9 tend to influence OS. Decrease of median level of all serum markers except PAI1 and VEGFR2 is observed from D0 to D30 under bevacizumab therapy, but only uPA and FGF variations tend to impact clinical outcome. From D30 to DP, increase of uPA is correlated to PFS (p = 0.028) while the observed increased of FGF and SDFα fail to reach significant correlation to PFS and OS. Conclusions: Increase of uPA serum level appear to be correlated to disease progression for patients with recurrent malignant glioma treated with bevacizumab and may reflect the invasive phenotype of glioma progression. Serum uPA may help in assessing treatment response under bevacizumab and warrant further studies. No significant financial relationships to disclose.
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Plesa C, Le QH, Chelghoum Y, Elhamri M, Tigaud I, Anglaret B, Ducastelle S, Perrin MC, Nicolini F, Belhabri A, Troncy J, Thiebaut A, Hayette S, Revesz D, Wattel E, Dumontet C, Michallet M, Thomas X. Prognostic Index for Older Adult Patients with Newly Diagnosed Acute Myeloid Leukemia: The Edouard Herriot Hospital Experience. ACTA ACUST UNITED AC 2008. [DOI: 10.3816/clk.2008.n.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Guiu S, Taillibert S, Chinot O, Taillandier L, Honnorat J, Dietrich P, Maire JP, Guillamo J, Guiu B, Catry-Thomas I, Capelle F, Thiebaut A, Cartalat-Carel S, Deville C, Fumoleau P, Desjardins A, Xuan KH, Chauffert B. Bevacizumab/Irinotecan. Un nouveau traitement actif dans les gliomes de haut grade récidivants : résultats préliminaires d’une étude multicentrique de l’Anocef. Rev Neurol (Paris) 2008; 164:588-94. [DOI: 10.1016/j.neurol.2008.04.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 04/09/2008] [Indexed: 10/22/2022]
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30
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Le Scanff J, Mohammedi I, Thiebaut A, Martin O, Argaud L, Robert D. Necrotizing gastritis due to Bacillus cereus in an immunocompromised patient. Infection 2008; 34:98-9. [PMID: 16703301 DOI: 10.1007/s15010-006-5019-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [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: 02/14/2005] [Accepted: 04/27/2005] [Indexed: 12/15/2022]
Abstract
Bacillus cereus is increasingly being acknowledged as a serious bacterial pathogen in immunocompromised patients. We present a case of acute necrotizing gastritis caused by B. cereus in a 37-year-old woman with acute myeloblastic leukemia, who recovered following total parenteral nutrition and treatment with imipenem and vancomycin. B. cereus was isolated from gastric mucosa and blood cultures. Up to now, no case of acute necrotizing gastritis due to this organism has been reported.
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Affiliation(s)
- J Le Scanff
- Medical Intensive Care, Pavilion N, Edouard Herriot Hospital, Place d'Arsonval, 69003 Lyon, France
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31
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Bénet T, Nicolle MC, Thiebaut A, Piens MA, Nicolini FE, Thomas X, Picot S, Michallet M, Vanhems P. Reduction of Invasive Aspergillosis Incidence among Immunocompromised Patients after Control of Environmental Exposure. Clin Infect Dis 2007; 45:682-6. [PMID: 17712750 DOI: 10.1086/521378] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [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: 03/05/2007] [Accepted: 06/20/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The objective of the study was to assess the impact of the relocation of an adult hematological intensive care unit on invasive aspergillosis (IA) incidence. METHODS A quasi-experimental study, including a control group and an intervention group that both underwent pretest and posttest evaluations, was conducted in the 3 adult hematological intensive care units (each composed of 14 single rooms) in a university hospital from 14 April 2005 through 1 February 2006. One of these units was relocated from the main building to an adjoining modular construction. In this unit, 4 rooms were equipped with laminar airflow before relocation; all rooms were equipped with positive pressure isolation after relocation. The 2 other units (control group), each containing 8 rooms with laminar airflow, did not undergo environmental modification. The diagnostic criteria for IA were based on the criteria of the European Organization for Research and Treatment of Cancer. RESULTS In total, 356 hospitalized patients were included. Of the 21 cases of IA, 18 were nosocomial, and 3 were of undetermined origin. In the relocated unit, the incidence of IA decreased from 13.2% (9 patients) before relocation to 1.6% (1 patient) after relocation (P=.018). Eight of the 9 patients with IA before relocation stayed in rooms without specific air treatment. The rate of IA did not change in the control group. Patient characteristics were similar in each unit before and after relocation. CONCLUSION We detected a straightforward association between environmental modification and decreased IA incidence, which emphasizes the use of an environmental strategy, including high-efficiency air filtration, in the prevention of IA.
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Affiliation(s)
- Thomas Bénet
- Department of Hygiene, Epidemiology, and Prevention, Hopital Edouard Herriot, Hospices Civils de Lyon, France
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32
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Herbrecht R, Flückiger U, Gachot B, Ribaud P, Thiebaut A, Cordonnier C. Treatment of invasive Candida and invasive Aspergillus infections in adult haematological patients. EJC Suppl 2007. [DOI: 10.1016/j.ejcsup.2007.06.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Cornely OA, Maertens J, Bresnik M, Ebrahimi R, Ullmann AJ, Bouza E, Heussel CP, Lortholary O, Rieger C, Boehme A, Aoun M, Horst HA, Thiebaut A, Ruhnke M, Reichert D, Vianelli N, Krause SW, Olavarria E, Herbrecht R. Liposomal amphotericin B as initial therapy for invasive mold infection: a randomized trial comparing a high-loading dose regimen with standard dosing (AmBiLoad trial). Clin Infect Dis 2007; 44:1289-97. [PMID: 17443465 DOI: 10.1086/514341] [Citation(s) in RCA: 484] [Impact Index Per Article: 28.5] [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: 10/07/2006] [Accepted: 01/07/2007] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Treatment of invasive mold infection in immunocompromised patients remains challenging. Voriconazole has been shown to have efficacy and survival benefits over amphotericin B deoxycholate, but its utility is limited by drug interactions. Liposomal amphotericin B achieves maximum plasma levels at a dosage of 10 mg/kg per day, but clinical efficacy data for higher doses are lacking. METHODS In a double-blind trial, patients with proven or probable invasive mold infection were randomized to receive liposomal amphotericin B at either 3 or 10 mg/kg per day for 14 days, followed by 3 mg/kg per day. The primary end point was favorable (i.e., complete or partial) response at the end of study drug treatment. Survival and safety outcomes were also evaluated. RESULTS Of 201 patients with confirmed invasive mold infection, 107 received the 3-mg/kg daily dose, and 94 received the 10-mg/kg daily dose. Invasive aspergillosis accounted for 97% of cases. Hematological malignancies were present in 93% of patients, and 73% of patients were neutropenic at baseline. A favorable response was achieved in 50% and 46% of patients in the 3- and 10-mg/kg groups, respectively (difference, 4%; 95% confidence interval, -10% to 18%; P>.05); the respective survival rates at 12 weeks were 72% and 59% (difference, 13%; 95% confidence interval, -0.2% to 26%; P>.05). Significantly higher rates of nephrotoxicity and hypokalemia were seen in the high-dose group. CONCLUSIONS In highly immunocompromised patients, the effectiveness of 3 mg/kg of liposomal amphotericin B per day as first-line therapy for invasive aspergillosis is demonstrated, with a response rate of 50% and a 12-week survival rate of 72%. The regimen of 10 mg/kg per day demonstrated no additional benefit and higher rates of nephrotoxicity.
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Michallet AS, Chelghoum Y, Thiebaut A, Le QH, Prebet T, Tavernier E, Antal D, Nicolini F, Troncy J, Elhamri M, Michallet M, Thomas X. Autologous hematopoietic stem cell transplantation for adults with acute myeloid leukemia in complete remission: the Edouard Herriot Hospital experience. Hematology 2007; 11:157-64. [PMID: 17325955 DOI: 10.1080/10245330600702794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
We retrospectively assess the long-term outcome and determined prognostic factors correlated with outcomes in adults with acute myeloid leukemia (AML) undergoing autologous hematopoietic stem cell transplantation (HSCT) in our institution over a 19-year period. A total of 78 adults who received autologous HSCT for AML in first complete remission (CR) and of 21 adults in further CR were included in the study. Bone marrow (n = 14) or peripheral blood stem cells (PBSC) (n = 85) transplantation was performed at a median of 2.9 months from CR. Hematologic recovery was significantly reduced in the PBSC group. Five-year cumulative incidences of relapse were 56 and 49%, respectively. Corresponding 5-year probabilities of event-free survival (EFS) were 33 and 35%, while those of overall survival (OS) were 38 and 49%, respectively. In multivariate analyses, cytogenetics was the main prognostic factor for outcome. Treatment-related mortality (TRM) was of 15% at 5 years, but higher in females as compared to males (p = 0.04). We confirmed that long-term EFS can be achieved after autologous HSCT in adult patients with AML. Results in adults who experience a relapse after conventional chemotherapy support the use of autologous HSCT as salvage therapy if such patients achieve a subsequent CR.
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Tjønneland A, Christensen J, Olsen A, Stripp C, Thomsen BL, Overvad K, Peeters PHM, van Gils CH, Bueno-de-Mesquita HB, Ocké MC, Thiebaut A, Fournier A, Clavel-Chapelon F, Berrino F, Palli D, Tumino R, Panico S, Vineis P, Agudo A, Ardanaz E, Martinez-Garcia C, Amiano P, Navarro C, Quirós JR, Key TJ, Reeves G, Khaw KT, Bingham S, Trichopoulou A, Trichopoulos D, Naska A, Nagel G, Chang-Claude J, Boeing H, Lahmann PH, Manjer J, Wirfält E, Hallmans G, Johansson I, Lund E, Skeie G, Hjartåker A, Ferrari P, Slimani N, Kaaks R, Riboli E. Alcohol intake and breast cancer risk: the European Prospective Investigation into Cancer and Nutrition (EPIC). Cancer Causes Control 2007; 18:361-73. [PMID: 17364225 DOI: 10.1007/s10552-006-0112-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [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: 09/05/2006] [Accepted: 12/26/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Most epidemiologic studies have suggested an increased risk of breast cancer with increasing alcohol intake. Using data from 274,688 women participating in the European Prospective Investigation into Cancer and Nutrition study (EPIC), we investigated the relation between alcohol intake and the risk of breast cancer. METHODS Incidence rate ratios (IRRs) based on Cox proportional hazard models were calculated using reported intake of alcohol, recent (at baseline) and lifetime exposure. We adjusted for known risk factors and stratified according to study center as well as potentially modifying host factors. RESULTS During 6.4 years of follow up, 4,285 invasive cases of breast cancer within the age group 35-75 years were identified. For all countries together the IRR per 10 g/day higher recent alcohol intake (continuous) was 1.03 (95% confidence interval (CI): 1.01-1.05). When adjusted, no association was seen between lifetime alcohol intake and risk of breast cancer. No difference in risk was shown between users and non-users of HRT, and there was no significant interaction between alcohol intake and BMI, HRT or dietary folate. CONCLUSION This large European study supports previous findings that recent alcohol intake increases the risk of breast cancer.
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Affiliation(s)
- Anne Tjønneland
- Institute of Cancer Epidemiology, Danish Cancer Society, Strandboulevarden 49, 2100, Copenhagen Ø, Denmark.
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Thiebaut A, Kipnis V, Chang SC, Subar A, Thompson F, Rosenberg P, Leitzmann M, Hollenbeck A, Schatzkin A. Dietary Fat intake and Breast Cancer Risk in the NIH-AARP Diet and Health Study. Am J Epidemiol 2006. [DOI: 10.1093/aje/163.suppl_11.s96-d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Maertens J, Glasmacher A, Herbrecht R, Thiebaut A, Cordonnier C, Segal BH, Killar J, Taylor A, Kartsonis N, Patterson TF, Aoun M, Caillot D, Sable C. Multicenter, noncomparative study of caspofungin in combination with other antifungals as salvage therapy in adults with invasive aspergillosis. Cancer 2006; 107:2888-97. [PMID: 17103444 DOI: 10.1002/cncr.22348] [Citation(s) in RCA: 178] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Caspofungin inhibits synthesis of beta-1,3-glucan, an essential component of the Aspergillus cell wall. This echinocandin has demonstrated efficacy (45% success) as salvage monotherapy of invasive aspergillosis (IA). Interest remains as to whether caspofungin, in combination with other antifungal classes, can improve the efficacy against IA. METHODS The study involved 53 adults with documented IA who were refractory to or intolerant of standard antifungal therapy and received caspofungin and 1 other mold-active antifungal agent (at the investigator's discretion). Efficacy was assessed by signs, symptoms, and radiographs at the end of combination therapy and Day 84 after combination therapy initiation. Favorable (complete or partial) responses required significant clinical and radiographic improvement. Diagnoses and outcomes were assessed by an independent expert. RESULTS Among the 53 patients enrolled the most common underlying diseases were acute leukemia (53%), lymphoma (11%), and chronic leukemia (6%). Pulmonary aspergillosis (81%) was the most common site, and most patients (87%) were refractory to prior therapy. Success at the end of combination therapy and Day 84 was 55% (29/53) and 49% (25/51), respectively. Fifty-seven percent of patients with neutropenia and 54% who received an allogeneic hematopoietic stem cell transplant responded favorably. Survival at Day 84 was 55%. Combination therapy, dosed on average for 31.3 days, was well tolerated. Two (4%) serious drug-related adverse events, both attributed to voriconazole, occurred. None of the patients discontinued caspofungin due to toxicity. CONCLUSIONS Caspofungin in combination with a triazole or polyene was an effective alternative as salvage therapy for patients with recalcitrant Aspergillus infections.
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Affiliation(s)
- Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium.
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Kaaks R, Berrino F, Key T, Rinaldi S, Dossus L, Biessy C, Secreto G, Amiano P, Bingham S, Boeing H, Bueno de Mesquita H, Chang-Claude J, Clavel-Chapelon F, Fournier A, van Gils C, Gonzalez C, Gurrea A, Critselis E, Khaw K, Krogh V, Lahmann P, Nagel G, Olsen A, Onland-Moret N, Overvad K, Palli D, Panico S, Peeters P, Quiros J, Roddam A, Thiebaut A, Tjonneland A, Chirlaque M, Trichopoulou A, Trichopoulos D, Tumino R, Vineis P, Norat T, Ferrari P, Slimani N, Riboli E. Serum Sex Steroids in Premenopausal Women and Breast Cancer Risk Within the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Urol 2006. [DOI: 10.1016/s0022-5347(05)00120-5] [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: 10/25/2022]
Affiliation(s)
- R. Kaaks
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - F. Berrino
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - T. Key
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - S. Rinaldi
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - L. Dossus
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - C. Biessy
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - G. Secreto
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - P. Amiano
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - S. Bingham
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - H. Boeing
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - H.B. Bueno de Mesquita
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - J. Chang-Claude
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - F. Clavel-Chapelon
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - A. Fournier
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - C.H. van Gils
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - C.A. Gonzalez
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - A.B. Gurrea
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - E. Critselis
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - K.T. Khaw
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - V. Krogh
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - P.H. Lahmann
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - G. Nagel
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - A. Olsen
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - N.C. Onland-Moret
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - K. Overvad
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - D. Palli
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - S. Panico
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - P. Peeters
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - J.R. Quiros
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - A. Roddam
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - A. Thiebaut
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - A. Tjonneland
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - M.D. Chirlaque
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - A. Trichopoulou
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - D. Trichopoulos
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - R. Tumino
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - P. Vineis
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - T. Norat
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - P. Ferrari
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - N. Slimani
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
| | - E. Riboli
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France
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Mohammedi I, Thiebaut A, Piens MA, Argaud L, Martin O, Robert D. Emergence of Candida albicans fungemia during voriconazole therapy. J Infect 2005; 51:e83-4. [PMID: 16230209 DOI: 10.1016/j.jinf.2004.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2004] [Indexed: 11/17/2022]
Affiliation(s)
- I Mohammedi
- Medical Intensive Care Unit, Pavilion N, Edouard Herriot Hospital, Place d'Arsonval 69003, Lyon, France.
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Ferrari P, Al-Delaimy WK, Slimani N, Boshuizen HC, Roddam A, Orfanos P, Skeie G, Rodríguez-Barranco M, Thiebaut A, Johansson G, Palli D, Boeing H, Overvad K, Riboli E. An approach to estimate between- and within-group correlation coefficients in multicenter studies: plasma carotenoids as biomarkers of intake of fruits and vegetables. Am J Epidemiol 2005; 162:591-8. [PMID: 16093290 DOI: 10.1093/aje/kwi242] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
In a multicenter study, the overall correlation between two variables can be broken down into a within- and a between-group correlation reflecting associations at the individual and aggregate levels, respectively. A random-effects model is used to estimate variance components of nutrition-related variables and the within- and between-group correlation coefficients. Using data from the European Prospective Investigation into Cancer and Nutrition (EPIC), the authors analyzed the association between levels of three plasma carotenoids (alpha-carotene, beta-cryptoxanthin, and lycopene) and dietary intake of three items (total fruits, carrots, and tomatoes), assessed through dietary questionnaire and single 24-hour dietary recall measurements, in a cross-sectional study involving 3,089 subjects from nine European countries. Intraclass correlation coefficients were 0.178 for alpha-carotene, 0.216 for beta-cryptoxanthin, and 0.299 for lycopene. The between-group correlation coefficients were higher than the within-group coefficients for all three carotenoids. For beta-cryptoxanthin and fruit intake, the between-group versus the within-group correlations were 0.78 and 0.26 for the dietary questionnaire and 0.85 and 0.19 for the 24-hour dietary recall. Results indicate that variability of exposure is driven mainly by the individual compared with the aggregate variation and that biomarker levels perform fairly accurately in discriminating population-level consumption of fruits and vegetables.
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Affiliation(s)
- Pietro Ferrari
- Unit of Nutrition and Cancer, International Agency for Research on Cancer, Lyon, France.
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Kaaks R, Berrino F, Key T, Rinaldi S, Dossus L, Biessy C, Secreto G, Amiano P, Bingham S, Boeing H, Bueno de Mesquita HB, Chang-Claude J, Clavel-Chapelon F, Fournier A, van Gils CH, Gonzalez CA, Gurrea AB, Critselis E, Khaw KT, Krogh V, Lahmann PH, Nagel G, Olsen A, Onland-Moret NC, Overvad K, Palli D, Panico S, Peeters P, Quirós JR, Roddam A, Thiebaut A, Tjønneland A, Chirlaque MD, Trichopoulou A, Trichopoulos D, Tumino R, Vineis P, Norat T, Ferrari P, Slimani N, Riboli E. Serum sex steroids in premenopausal women and breast cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC). J Natl Cancer Inst 2005; 97:755-65. [PMID: 15900045 DOI: 10.1093/jnci/dji132] [Citation(s) in RCA: 305] [Impact Index Per Article: 16.1] [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] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Contrasting etiologic hypotheses about the role of endogenous sex steroids in breast cancer development among premenopausal women implicate ovarian androgen excess and progesterone deficiency, estrogen excess, estrogen and progesterone excess, and both an excess or lack of adrenal androgens (dehydroepiandrosterone [DHEA] or its sulfate [DHEAS]) as risk factors. We conducted a case-control study nested within the European Prospective Investigation into Cancer and Nutrition cohort to examine associations among premenopausal serum concentrations of sex steroids and subsequent breast cancer risk. METHODS Levels of DHEAS, (Delta4-)androstenedione, testosterone, and sex hormone binding globulin (SHBG) were measured in single prediagnostic serum samples from 370 premenopausal women who subsequently developed breast cancer (case patients) and from 726 matched cancer-free control subjects. Levels of progesterone, estrone, and estradiol were also measured for the 285 case patients and 555 matched control subjects who had provided information about the day of menstrual cycle at blood donation. Conditional logistic regression models were used to estimate relative risks of breast cancer by quartiles of hormone concentrations. All statistical tests were two-sided. RESULTS Increased risks of breast cancer were associated with elevated serum concentrations of testosterone (odds ratio [OR] for highest versus lowest quartile = 1.73, 95% confidence interval [CI] = 1.16 to 2.57; P(trend) = .01), androstenedione (OR for highest versus lowest quartile = 1.56, 95% CI = 1.05 to 2.32; P(trend) = .01), and DHEAS (OR for highest versus lowest quartile = 1.48, 95% CI = 1.02 to 2.14; P(trend) = .10) but not SHBG. Elevated serum progesterone concentrations were associated with a statistically significant reduction in breast cancer risk (OR for highest versus lowest quartile = 0.61, 95% CI = 0.38 to 0.98; P(trend) = .06). The absolute risk of breast cancer for women younger than 40 followed up for 10 years was estimated at 2.6% for those in the highest quartile of serum testosterone versus 1.5% for those in the lowest quartile; for the highest and lowest quartiles of progesterone, these estimates were 1.7% and 2.6%, respectively. Breast cancer risk was not statistically significantly associated with serum levels of the other hormones. CONCLUSIONS Our results support the hypothesis that elevated blood concentrations of androgens are associated with an increased risk of breast cancer in premenopausal women.
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Affiliation(s)
- Rudolf Kaaks
- Nutrition and Hormones Group, International Agency for Research on Cancer (IARC-WHO), Lyon, France.
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Mohammedi I, Eckert A, Thiebaut A, Piens MA, Malhière S, Robert D. Pneumopathie fatale à Aspergillus nidulans. Rev Med Interne 2005; 26:249-50. [PMID: 15777589 DOI: 10.1016/j.revmed.2004.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Accepted: 09/15/2004] [Indexed: 11/28/2022]
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Ferrari P, Kaaks R, Fahey MT, Slimani N, Day NE, Pera G, Boshuizen HC, Roddam A, Boeing H, Nagel G, Thiebaut A, Orfanos P, Krogh V, Braaten T, Riboli E. Within- and between-cohort variation in measured macronutrient intakes, taking account of measurement errors, in the European Prospective Investigation into Cancer and Nutrition study. Am J Epidemiol 2004; 160:814-22. [PMID: 15466504 DOI: 10.1093/aje/kwh280] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Multicenter epidemiologic studies provide a unique opportunity to evaluate the association between exposure and disease at the individual and the aggregate levels. The two components can eventually be pooled to corroborate each other, using weights proportional to the intraclass correlation coefficient (ICC), which expresses the amount of between-cohort variability in the exposure variable compared with the total. The greater the ICC, the more the overall estimate will reflect the between-cohort component. Dietary measurements are affected by measurement errors, particularly within a cohort. In 1992-2000, the variability of macronutrient intake distribution before and after calibration for measurement error in the European Prospective Investigation into Cancer and Nutrition was evaluated. A two-level, random-effects model was used. Evaluation of macronutrient densities revealed that energy has a considerable effect on the calibration model, leading to ICC values larger than those for the absolute intakes. Given the shrinkage of the within-center variability, a sizable increase in the ICC was observed for protein in men and women (0.48 and 0.54, respectively) and carbohydrates in men (0.41). Results suggest that the effect of calibration on macronutrient intake variability is greater for the within-cohort component, thus increasing the relative importance of the between-cohort component. After calibration, the two components had a similar weight. This observation has important implications for the analysis of multicenter studies because the between-cohort component provides a large part of the overall heterogeneity.
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Morfin F, Bilger K, Boucher A, Thiebaut A, Najioullah F, Bleyzac N, Raus N, Bosshard S, Aymard M, Michallet M, Thouvenot D. HSV excretion after bone marrow transplantation: a 4-year survey. J Clin Virol 2004; 30:341-5. [PMID: 15163425 DOI: 10.1016/j.jcv.2004.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/25/2004] [Accepted: 03/01/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Herpes simplex virus (HSV) oral excretions are common after bone marrow transplantation (BMT). OBJECTIVE We report a 4-year systematic survey of HSV excretions in an adult population who underwent BMT (289 transplantations). STUDY DESIGN Patients received either intravenous ACV treatment when mucositis occurred or systematic intravenous ACV prophylaxis from initiation of the BMT conditioning until the end of aplasia. All patients were followed up for HSV excretions. RESULTS Twenty-eight patients (9.7%) excreted HSV. The occurrence of HSV excretions was similar in both allogeneic and autologous transplant patients. The incidence was significantly lower when ACV was systematically used after transplantation (2.5%) compared to when ACV was implemented for mucositis (12%). ACV-resistant HSV was detected in three patients who received allogeneic transplantation, representing 27% of allogeneic recipients excreting HSV. CONCLUSION HSV infection prophylaxis with high dose of intravenous ACV resulted in a decreased incidence of HSV excretion. Nevertheless, the risk of emergence of ACV resistance, especially among allogeneic transplant patients, appears to be identical whatever the route and dose of ACV prophylaxis.
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Affiliation(s)
- Florence Morfin
- Laboratory of Virology of the Hospices Civils de Lyon, Domaine Rockefeller, 8 avenue Rockefeller, 69373 Lyon Cedex 08, France.
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Clavel-Chapelon F, Thiebaut A, Berrino F. Alcohol consumption and breast cancer risk. Preliminary results of the EPIC cohort. IARC Sci Publ 2003; 156:155-60. [PMID: 12484153] [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] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- F Clavel-Chapelon
- E3N-EPIC Group, INSERM, Institut Gustave-Roussy, 94805, Villejuif, France
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Ferrari P, Slimani N, Ciampi A, Trichopoulou A, Naska A, Lauria C, Veglia F, Bueno-de-Mesquita HB, Ocké MC, Brustad M, Braaten T, José Tormo M, Amiano P, Mattisson I, Johansson G, Welch A, Davey G, Overvad K, Tjønneland A, Clavel-Chapelon F, Thiebaut A, Linseisen J, Boeing H, Hemon B, Riboli E. Evaluation of under- and overreporting of energy intake in the 24-hour diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr 2002; 5:1329-45. [PMID: 12639236 DOI: 10.1079/phn2002409] [Citation(s) in RCA: 200] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate under- and overreporting and their determinants in the EPIC 24-hour diet recall (24-HDR) measurements collected in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN Cross-sectional analysis. 24-HDR measurements were obtained by means of a standardised computerised interview program (EPIC-SOFT). The ratio of reported energy intake (EI) to estimated basal metabolic rate (BMR) was used to ascertain the magnitude, impact and determinants of misreporting. Goldberg's cut-off points were used to identify participants with physiologically extreme low or high energy intake. At the aggregate level the value of 1.55 for physical activity level (PAL) was chosen as reference. At the individual level we used multivariate statistical techniques to identify factors that could explain EI/BMR variability. Analyses were performed by adjusting for weight, height, age at recall, special diet, smoking status, day of recall (weekday vs. weekend day) and physical activity. SETTING Twenty-seven redefined centres in the 10 countries participating in the EPIC project. SUBJECTS In total, 35 955 men and women, aged 35-74 years, participating in the nested EPIC calibration sub-studies. RESULTS While overreporting has only a minor impact, the percentage of subjects identified as extreme underreporters was 13.8% and 10.3% in women and men, respectively. Mean EI/BMR values in men and women were 1.44 and 1.36 including all subjects, and 1.50 and 1.44 after exclusion of misreporters. After exclusion of misreporters, adjusted EI/BMR means were consistently less than 10% different from the expected value of 1.55 for PAL (except for women in Greece and in the UK), with overall differences equal to 4.0% and 7.4% for men and women, respectively. We modelled the probability of being an underreporter in association with several individual characteristics. After adjustment for age, height, special diet, smoking status, day of recall and physical activity at work, logistic regression analyses resulted in an odds ratio (OR) of being an underreporter for the highest vs. the lowest quartile of body mass index (BMI) of 3.52 (95% confidence interval (CI) 2.91-4.26) in men and 4.80 (95% CI 4.11-5.61) in women, indicating that overweight subjects are significantly more likely to underestimate energy intake than subjects in the bottom BMI category. Older people were less likely to underestimate energy intake: ORs were 0.58 (95% CI 0.45-0.77) and 0.74 (95% CI 0.63-0.88) for age (> or =65 years vs. <50 years). Special diet and day of the week showed strong effects. CONCLUSION EI tends to be underestimated in the vast majority of the EPIC centres, although to varying degrees; at the aggregate level most centres were below the expected reference value of 1.55. Underreporting seems to be more prevalent among women than men in the EPIC calibration sample. The hypothesis that BMI (or weight) and age are causally related to underreporting seems to be confirmed in the present work. This introduces further complexity in the within-group (centre or country) and between-group calibration of dietary questionnaire measurements to deattenuate the diet-disease relationship.
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Affiliation(s)
- P Ferrari
- Unit of Nutrition and Cancer, International Agency for Research on Cancer, 150 cours Albert-Thomas, 69372 Lyon Cedex 08, France.
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Persat F, Topenot R, Piens MA, Thiebaut A, Dannaoui E, Picot S. Evaluation of different commercial ELISA methods for the serodiagnosis of systemic candidosis - Bewertung kommerzieller ELISA-Methoden zur Serodiagnose der systemischen Candidose. Mycoses 2002. [DOI: 10.1046/j.1439-0507.2002.d01-120.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Different commercial enzyme-linked immunsorbent assays (ELISA) were evaluated in a preliminary study for diagnosis of systemic candidosis: Biomerica and Virotech GmbH, which allowed immunoglobulin G detection, and Platelia, which associated total antibody to antigen detection. They were tested with a home-made ELISA and compared with the routine techniques used in the hospital laboratory: indirect immunofluorescence and counter-immunoelectrophoresis. Sera were obtained from patients with probable or proven systemic candidosis (groups 3 and 4, n=8 and n=14, respectively) and from patients without systemic candidosis who were divided into controls (n=10), those hospitalized without Candida isolation (group 1, n=10) and those hospitalized with Candida isolation in a peripheral site (group 2, n=18). The immunoglobulin G ELISAs showed a higher sensitivity associated with lower specificity compared to the indirect immunofluorescence, counter-immunoelectrophoresis and total immunoglobulin ELISAs. Mannan antigen detection showed the highest specificity (78.9%). Its association with the detection of total anti-Candida immunoglobulins was more sensitive than the association of indirect immunofluorescence with counter-immunoelectrophoresis (95.4% versus 59%, respectively) with a specificity of 52.6% (versus 55.2%). Interest in the use of commercial ELISAs, more particularly the Platelia tests, has to be confirmed in a prospective study with follow-up of the patients.
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Affiliation(s)
- F Persat
- Service de Parasitologie, Mycologie Médicale et Maladies Tropicales, and Service d'Hématologie, Hôpital Edouard Herriot, Lyon, France.
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Thiebaut A, Vernant JP, Degos L, Huguet FR, Reiffers J, Sebban C, Lepage E, Thomas X, Fière D. Adult acute lymphocytic leukemia study testing chemotherapy and autologous and allogeneic transplantation. A follow-up report of the French protocol LALA 87. Hematol Oncol Clin North Am 2000; 14:1353-66, x. [PMID: 11147227 DOI: 10.1016/s0889-8588(05)70190-8] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The French protocol LALA 87 was designed to compare three different postinduction strategies in adult acute lymphocytic leukemia (ALL): chemotherapy, autologous transplantation, and allogeneic transplantation. This trial demonstrated a significant superiority of allogeneic bone marrow transplantation (BMT) in high-risk ALL patients. Similarly, there was a trend in favor of autologous BMT over chemotherapy in those same patients. Allogeneic BMT was not superior to autologous BMT or chemotherapy in less aggressive leukemia (standard-risk ALL). Further improvements are warranted in the treatment of adult ALL. The authors' current ongoing study is stratifying patients to allocate them to regimens with risk-adapted treatment intensity.
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Affiliation(s)
- A Thiebaut
- Service d'Hématologie, Hôpital Edouard Herriot, Lyon, France
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50
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Doll A, Christmann D, Kehrli P, Abu Eid M, Gillis C, Bogorin A, Thiebaut A, Dietemann JL. [Contribution of 3D CISS MRI for pre- and post-therapeutic monitoring of obstructive hydrocephalus]. J Neuroradiol 2000; 27:218-25. [PMID: 11223612] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
This report describes the use of the recent three-dimensional Fourier transform constructing imaging in the steady state (CISS) MR sequence in the management of obstructive hydrocephalus. It is a gradient-echo imaging technique with high resolution which remains sensitive to flow. It enables locating the obstruction and determining the upstream impact. It provides anatomical information about third ventricle (V3) morphology and relationships useful before ventriculostomy. Twenty patients with obstructive hydrocephalus at the level of cerebral aqueduct or posterior V3 underwent sagittal 3DFT-CISS acquisition, supplemented by frontal, axial and coronal reformations in the cerebral aqueduct axis. 9 patients were examined after ventriculostomy with the same protocol. CISS-3DFT allows good visualization of the cerebral aqueduct and diagnosis of the underlying cause of obstruction (malformation, tumor), sometimes better than classical sequences. In case of complete obstruction, the flow-related signal void is usually absent in the cerebral aqueduct or V3. The position of V3 floor and its relationship with the tip of basilar artery are well analyzed. The dilatation of the anterior V3 recesses is a better sign of activity of hydrocephalus - and then of therapeutical indication - than classical transependymal resorption signs which are not always present in chronic longstanding adult hydrocephalus. Of the 9 ventriculostomy patients seven had linear flow-related signal void through V3 floor, from anterior V3 to basal cisterns on the postoperative MR study. This flow void confirms patent ventriculostomy.
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Affiliation(s)
- A Doll
- Service de Radiologie 2, Hôpital de Hautepierre, Strasbourg, France
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