1
|
Duceau B, Picard M, Pirracchio R, Wanquet A, Pène F, Merceron S, Mokart D, Moreau AS, Lengliné E, Canet E, Lemiale V, Mariotte E, Azoulay E, Zafrani L. Neutropenic Enterocolitis in Critically Ill Patients: Spectrum of the Disease and Risk of Invasive Fungal Disease. Crit Care Med 2019; 47:668-676. [PMID: 30741755 DOI: 10.1097/ccm.0000000000003687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Neutropenic enterocolitis occurs in about 5.3% of patients hospitalized for hematologic malignancies receiving chemotherapy. Data from critically ill patients with neutropenic enterocolitis are scarce. Our objectives were to describe the population of patients with neutropenic enterocolitis admitted to an ICU and to investigate the risk factors of invasive fungal disease. DESIGN A multicentric retrospective cohort study between January 2010 and August 2017. SETTING Six French ICUs members of the Groupe de Recherche Respiratoire en Onco-Hématologie research network. PATIENTS Adult neutropenic patients hospitalized in the ICU with a diagnosis of enteritis and/or colitis. Patients with differential diagnosis (Clostridium difficile colitis, viral colitis, inflammatory enterocolitis, mesenteric ischemia, radiation-induced gastrointestinal toxicity, and Graft vs Host Disease) were excluded. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS We included 134 patients (median Sequential Organ Failure Assessment 10 [8-12]), with 38.8% hospital mortality and 32.1% ICU mortality rates. The main underlying malignancies were acute leukemia (n = 65, 48.5%), lymphoma (n = 49, 36.6%), solid tumor (n = 14, 10.4%), and myeloma (n = 4, 3.0%). Patients were neutropenic during a median of 14 days (9-22 d). Infection was documented in 81 patients (60.4%), including an isolated bacterial infection in 64 patients (47.8%), an isolated fungal infection in nine patients (6.7%), and a coinfection with both pathogens in eight patients (5.0%). Radiologically assessed enteritis (odds ratio, 2.60; 95% CI, 1.32-7.56; p = 0.015) and HIV infection (odds ratio, 2.03; 95% CI, 1.21-3.31; p = 0.016) were independently associated with invasive fungal disease. CONCLUSIONS The rate of invasive fungal disease reaches 20% in patients with neutropenic enterocolitis when enteritis is considered. To avoid treatment delay, antifungal therapy might be systematically discussed in ICU patients admitted for neutropenic enterocolitis with radiologically assessed enteritis.
Collapse
Affiliation(s)
- Baptiste Duceau
- Medical Intensive Care Unit, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, France
- Paris Diderot University, Paris, France
| | - Muriel Picard
- Intensive Care Unit, CHU de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Romain Pirracchio
- Anesthesiology and Surgical Intensive Care Unit, European Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
- Department of Biostatistics and Medical Informatics, INSERM U-1153, Paris, France
| | - Anne Wanquet
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | - Frédéric Pène
- Medical Intensive Care Unit, Hospital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sybille Merceron
- Intensive Care Unit, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Djamel Mokart
- Intensive Care Unit, Paoli-Calmettes Institute, Marseille, France
| | | | - Etienne Lengliné
- Department of Hematology, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Canet
- Medical Intensive Care Unit, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, France
- Paris Diderot University, Paris, France
| | - Virginie Lemiale
- Medical Intensive Care Unit, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, France
- Paris Diderot University, Paris, France
| | - Eric Mariotte
- Medical Intensive Care Unit, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, France
- Paris Diderot University, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, France
- Paris Diderot University, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Hospital Saint Louis, Assistance Publique-Hôpitaux de Paris, France
- Paris Diderot University, Paris, France
| |
Collapse
|
2
|
Wanquet A, Courtier F, Guille A, Carbuccia N, Garnier S, Adélaide J, Gelsi-Boyer V, Mozziconacci MJ, Rey J, Vey N, Birnbaum D, Murati A. Mutation patterns in essential thrombocythemia, polycythemia vera and secondary myelofibrosis. Leuk Lymphoma 2019; 60:1289-1293. [PMID: 30601073 DOI: 10.1080/10428194.2018.1522437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Anne Wanquet
- a Laboratoire d'Oncologie Prédictive , Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille , Inserm U1068 CNRS UMR 7258 , Marseille , France.,b Aix-Marseille Université , Marseille , France.,c Département d'Hématologie , Institut Paoli-Calmettes , Marseille , France
| | - Frédéric Courtier
- a Laboratoire d'Oncologie Prédictive , Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille , Inserm U1068 CNRS UMR 7258 , Marseille , France.,b Aix-Marseille Université , Marseille , France
| | - Arnaud Guille
- a Laboratoire d'Oncologie Prédictive , Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille , Inserm U1068 CNRS UMR 7258 , Marseille , France
| | - Nadine Carbuccia
- a Laboratoire d'Oncologie Prédictive , Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille , Inserm U1068 CNRS UMR 7258 , Marseille , France
| | - Séverine Garnier
- a Laboratoire d'Oncologie Prédictive , Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille , Inserm U1068 CNRS UMR 7258 , Marseille , France
| | - José Adélaide
- a Laboratoire d'Oncologie Prédictive , Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille , Inserm U1068 CNRS UMR 7258 , Marseille , France
| | - Véronique Gelsi-Boyer
- a Laboratoire d'Oncologie Prédictive , Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille , Inserm U1068 CNRS UMR 7258 , Marseille , France.,b Aix-Marseille Université , Marseille , France.,d Département de BioPathologie , Institut Paoli-Calmettes , Marseille , France
| | | | - Jérôme Rey
- c Département d'Hématologie , Institut Paoli-Calmettes , Marseille , France
| | - Norbert Vey
- b Aix-Marseille Université , Marseille , France.,c Département d'Hématologie , Institut Paoli-Calmettes , Marseille , France
| | - Daniel Birnbaum
- a Laboratoire d'Oncologie Prédictive , Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille , Inserm U1068 CNRS UMR 7258 , Marseille , France.,b Aix-Marseille Université , Marseille , France
| | - Anne Murati
- a Laboratoire d'Oncologie Prédictive , Institut Paoli-Calmettes, Centre de Recherche en Cancérologie de Marseille , Inserm U1068 CNRS UMR 7258 , Marseille , France.,b Aix-Marseille Université , Marseille , France.,d Département de BioPathologie , Institut Paoli-Calmettes , Marseille , France
| |
Collapse
|
3
|
Wanquet A, Birsen R, Bonnet C, Boubaya M, Choquet S, Dupuis J, Lepretre S, Re D, Fahri J, Michallet AS, Ysebaert L, Lemal R, Lamy T, Delarue R, Troussard X, Cymbalista F, Levy V, Dietrich PY, Leblond V, Aurran-Schleinitz T. Management of central nervous system involvement in chronic lymphocytic leukaemia: a retrospective cohort of 30 patients. Br J Haematol 2016; 176:37-49. [PMID: 27858991 DOI: 10.1111/bjh.14387] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 07/20/2016] [Indexed: 01/01/2023]
Abstract
Central nervous system involvement (CNSi) is a rare and poorly reported complication of chronic lymphocytic leukaemia (CLL). Establishing cause and effect between the CLL and the neurological symptoms remains challenging. We have analysed a retrospective cohort of 30 CLL patients with CNSi, documented by lymphocytic infiltration either by flow cytometry of the cerebrospinal fluid (CSF; n = 29) or CNS biopsy (n = 1). Neurological symptoms were heterogeneous. At the time of CNSi, less than half of the patients had a progressive CLL and 20 had never been treated for CLL. Initial treatment with fludarabine-based immuno-chemotherapy, with or without intra-CSF therapy, led to durable response in eight out of nine untreated patients. In contrast, 50% patients receiving various prior treatments needed additional therapy within a median of 4 months (1-16). Ibrutinib led to complete response in 4/4 heavily pre-treated patients. From CNSi, 5-year overall survival was 72% and 48% for treatment-naïve and previously treated patients respectively (P = 0·06); 5-year progression-free survival (PFS) was 43% and 0% (P = 0·125). 17p deletion was significantly associated with poor PFS (P = 0·006). CNSi may be the only sign of progression of CLL and should be considered an initiation criterion of systemic treatment. Prognosis seemed to be related to CLL characteristics rather than to CNSi itself.
Collapse
Affiliation(s)
- Anne Wanquet
- Department of Haematology, Institut Paoli-Calmettes, Marseille, France
| | - Rudy Birsen
- Department of Haematology, Hôpital La Pitié-Salpêtrière, AP-HP, Paris, France
| | - Charlotte Bonnet
- Department of Neurological Surgery, CHU Bordeaux, Bordeaux, France
| | | | - Sylvain Choquet
- Department of Haematology, Hôpital La Pitié-Salpêtrière, AP-HP, Paris, France
| | - Jehan Dupuis
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, AP-HP, Créteil, France
| | | | - Daniel Re
- Department of Medicine 3, Centre Hospitalier, Antibes, France
| | | | | | | | - Richard Lemal
- Service de thérapie cellulaire et d'hématologie clinique adulte CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Richard Delarue
- Department of Haematology, Hôpital Necker, AP-HP, Paris, France
| | | | | | - Vincent Levy
- URC/CRC, Hôpital Avicenne, AP-HP, Bobigny, France
| | | | - Veronique Leblond
- Department of Haematology, Hôpital La Pitié-Salpêtrière, AP-HP, Paris, France
| | | |
Collapse
|
4
|
Wanquet A, Crocchiolo R, Furst S, Granata A, Faucher C, Devillier R, Harbi S, Lemarie C, Calmels B, Vey N, Weiller PJ, Chabannon C, Castagna L, Blaise D, El-Cheikh J. The efficacy and safety of a new reduced-toxicity conditioning with 4 days of once-daily 100 mg/m(2) intravenous busulfan associated with fludarabine and antithymocyte globulins prior to allogeneic stem cell transplantation in patients with high-risk myelodysplastic syndrome or acute leukemia. Leuk Lymphoma 2016; 57:2315-20. [PMID: 26885686 DOI: 10.3109/10428194.2016.1146948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The optimal intensity of myeloablation associated with a reduced-toxicity conditioning (RTC) regimen in order to decrease the relapse rate without increasing non-relapse mortality (NRM), is not well established yet. This retrospective analysis was done on 30 patients with hematological malignancies. The aim was to assess the safety of a RTC regimen based on the busulfan at a dose of 100 mg/m(2)/d intravenously for 4 d, fludarabine at a dose of 30 mg/m(2)/d for 5 d, and anti-thymoglobulins at a dose of 2.5 mg/kg/d for 2 d. The cumulative incidences of grade 2-4 acute graft-versus-host disease (GVHD) and all grades chronic GVHD were 37% and 42%, respectively. Median 1-year overall survival and disease-free survival were 66% and 50%, respectively. At 1 year, the cumulative incidence of relapse/disease progression was 33%. NRM was 3% and 17% at day 100 and 1 year, respectively. This RTC conditioning regimen can lead to a long-term disease control. Moreover, it appears to be safe with a low NRM rate among high-risk patients.
Collapse
Affiliation(s)
- Anne Wanquet
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France
| | - Roberto Crocchiolo
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Sabine Furst
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Angela Granata
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Catherine Faucher
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Raynier Devillier
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Samia Harbi
- c Centre de Thérapie Cellulaire , Institut Paoli-Calmettes , Marseille , France
| | - Claude Lemarie
- c Centre de Thérapie Cellulaire , Institut Paoli-Calmettes , Marseille , France
| | - Boris Calmels
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France
| | - Norbert Vey
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France
| | - Pierre Jean Weiller
- c Centre de Thérapie Cellulaire , Institut Paoli-Calmettes , Marseille , France
| | - Christian Chabannon
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Luca Castagna
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Didier Blaise
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| | - Jean El-Cheikh
- a Département d'Onco-Hématologie , Institut Paoli-Calmettes , Marseille , France ;,b Unité de Transplantation et de Thérapie Cellulaire (U2T) , Institut Paoli-Calmettes , Marseille , France
| |
Collapse
|
5
|
Wanquet A, Prebet T, Berthon C, Sebert M, Roux C, Kulasekararaj A, Micol JB, Esterni B, Itzykson R, Thepot S, Recher C, Delaunay J, Dreyfus F, Mufti G, Fenaux P, Vey N. Azacitidine treatment for patients with myelodysplastic syndrome and acute myeloid leukemia with chromosome 3q abnormalities. Am J Hematol 2015; 90:859-63. [PMID: 26113240 DOI: 10.1002/ajh.24099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/22/2015] [Indexed: 12/26/2022]
Abstract
Acute Myeloid Leukemia (AML) and myelodysplasia (MDS) with chromosome 3q abnormalities have a dismal outcome either untreated or with conventional treatments. Azacitidine (AZA) is now considered as the standard of care in high-risk MDS and oligoblastic AML patients. The objective of this study was to evaluate the impact of azacitine treatment in this cytogenetic subgroup. We report here a multicentre retrospective study of 157 patients treated with AZA for AML/MDS with chromosome 3q abnormalities and 27 patients with isolated EVI-1 overexpression. Median age was 65 years, 40 patients (25%) had inv(3)(q21q26.2) or t(3;3)(q21;q26.2), 36 patients (23%) had other balanced 3q26 rearrangements, 8 patients (5%) had balanced 3q21 rearrangements and 73 patients (46%) had other 3q abnormalities. The overall response rate was 50% (29% CR). Median overall survival was 10.6 months. By multivariate analysis, patients with lower bone marrow blast counts, higher platelet counts, non-complex cytogenetics, and absence of prior treatment with intensive chemotherapy had a better outcome. 27 patients were allo-transplanted and achieved a 21-month median OS. Balanced 3q21 translocations were associated with a better response rate and overall survival. Outcome of patients with isolated EVI-1 overexpression was comparable to that of patients with chromosome 3q lesions. Thus, AML/MDS patients with 3q abnormalities appear to be a heterogeneous group in their response to AZA, and AZA may represent a suitable option in particular as a bridge to allogeneic transplantation.
Collapse
Affiliation(s)
- Anne Wanquet
- Hematology Department; Institut Paoli-Calmettes; Marseille France
| | - Thomas Prebet
- Hematology Department; Institut Paoli-Calmettes; Marseille France
| | - Céline Berthon
- Hematology Department; Centre Hospitalo Universitaire De Lille; Lille France
| | - Marie Sebert
- Hematology Department; Assistance Publique-Hôpitaux De Paris (APHP), Hopital Saint Louis, Paris and Paris 7 University; France
| | - Clémence Roux
- Hematology Department; Centre Hospitalo Universitaire De Nice; Nice France
| | | | | | - Benjamin Esterni
- Biostatistics Department; Institut paoli-Calmettes; Marseille France
| | - Raphael Itzykson
- Hematology Department; Assistance Publique-Hôpitaux De Paris (APHP), Hopital Saint Louis, Paris and Paris 7 University; France
| | - Sylvain Thepot
- Hematology Department; Hopital Avicenne (APHP) and Paris 13 University; Bobigny France
| | - Christian Recher
- Hematology Department; Centre Hospitalo Universitaire De Toulouse; Toulouse France
| | - Jacques Delaunay
- Hematology Department; Centre Hospitalo Universitaire De Nantes; Nantes France
| | - François Dreyfus
- Hematology Department; Hopital Cochin (APHP) and Paris 5 University; Paris France
| | - Ghulam Mufti
- Hematology Department; King's College; London United Kingdom
| | - Pierre Fenaux
- Hematology Department; Assistance Publique-Hôpitaux De Paris (APHP), Hopital Saint Louis, Paris and Paris 7 University; France
| | - Norbert Vey
- Hematology Department; Institut Paoli-Calmettes; Marseille France
- Aix Marseille University; Marseille France
| |
Collapse
|
6
|
Abstract
SUMMARY Epigenetic dysregulation is one of the key mechanisms driving leukemogenesis in myelodysplastic syndromes (MDS) and acute myeloid leukemia. Over the last decade, the introduction of epigenetic targeted drugs, such as hypomethylating agents, has changed the paradigm of treatment, in particular for high-risk MDS. 5-azacitidine is one of the lead compounds of this new class of drugs and was registered for treatment of MDS in the USA in 2004 and for high-risk MDS in Europe in 2009. 5-azacitidine is able to trigger hematological responses and is the first therapy demonstrating an overall survival benefit for high-risk MDS patients as compared with conventional care regimens. In this review, we present the biological and pharmacological basis of the drug, an update on the clinical results and clinical research in MDS and acute myeloid leukemia, and discuss future developments in the field.
Collapse
Affiliation(s)
- Anne Wanquet
- Departement d’Hématologie, Institut Paoli Calmettes, 232 Boulevard Sainte Margueritte, 13009 Marseille, France
- Aix Marseille Université, Marseille, France
| | - Norbert Vey
- Departement d’Hématologie, Institut Paoli Calmettes, 232 Boulevard Sainte Margueritte, 13009 Marseille, France
- Aix Marseille Université, Marseille, France
| | - Thomas Prebet
- Departement d’Hématologie, Institut Paoli Calmettes, 232 Boulevard Sainte Margueritte, 13009 Marseille, France
| |
Collapse
|
7
|
Prebet T, Wanquet A, Sebert M, Roux C, Berthon C, Micol J, Recher C, Dreyfus F, Fenaux P, Vey N. P-273 Azacitidine treatment for patients with myelodysplastic syndrom and acute myeloid leukemia harboring chromosome 3q abnormalities. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70320-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|