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Sébert M, Freiman L, Chaffaut C, Guerci A, Peterlin P, Thépot S, Beyne-Rauzy O, Park S, Cluzeau T, Chermat F, Fenaux P, Preudhomme C, Clappier E, Chevret S, Adès L, Duployez N, Duchmann M. Clinical impact of genetic alterations including germline DDX41 mutations in MDS/low-blast count AML patients treated with azacitidine-based regimens. Leukemia 2024; 38:918-922. [PMID: 38368440 DOI: 10.1038/s41375-024-02180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Marie Sébert
- Université de Paris, Unité 944/7212-GenCellDi, INSERM and Centre National de la Recherche Scientifique (CNRS), Paris, France.
- Hematology Department, Saint Louis Hospital, AP-HP, Paris, France.
- Groupe Francophone des Myelodysplasies, Paris, France.
| | - Lucie Freiman
- Hematology Department, Saint Louis Hospital, AP-HP, Paris, France
| | - Cendrine Chaffaut
- Biostatistics Department, Saint Louis Hospital, AP-HP, Paris, France
| | - Agnès Guerci
- Groupe Francophone des Myelodysplasies, Paris, France
- Hematology Department, CHU Brabois Vandoeuvre, Nancy, France
| | - Pierre Peterlin
- Groupe Francophone des Myelodysplasies, Paris, France
- Hematology Department, Nantes University Hospital, Nantes, France
| | - Sylvain Thépot
- Groupe Francophone des Myelodysplasies, Paris, France
- Hematology Department, Angers University Hospital, Angers, France
| | - Odile Beyne-Rauzy
- Groupe Francophone des Myelodysplasies, Paris, France
- Hematology Department, CHU de Toulouse, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Sophie Park
- Groupe Francophone des Myelodysplasies, Paris, France
- Hematology Department, Grenoble University Hospital, Grenoble, France
| | - Thomas Cluzeau
- Groupe Francophone des Myelodysplasies, Paris, France
- Hematology Department, Nice University Hospital, Nice, France
| | | | - Pierre Fenaux
- Université de Paris, Unité 944/7212-GenCellDi, INSERM and Centre National de la Recherche Scientifique (CNRS), Paris, France
- Hematology Department, Saint Louis Hospital, AP-HP, Paris, France
- Groupe Francophone des Myelodysplasies, Paris, France
| | - Claude Preudhomme
- Hematology Laboratory, Unité 1277-Cancer Heterogeneity Plasticity and Resistance to Therapies (CANTHER), Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Institut National de la Santé et de la Recherche Médicale (INSERM), Lille, France
| | - Emmanuelle Clappier
- Université de Paris, Unité 944/7212-GenCellDi, INSERM and Centre National de la Recherche Scientifique (CNRS), Paris, France
- Hematology Laboratory, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sylvie Chevret
- Biostatistics Department, Saint Louis Hospital, AP-HP, Paris, France
| | - Lionel Adès
- Université de Paris, Unité 944/7212-GenCellDi, INSERM and Centre National de la Recherche Scientifique (CNRS), Paris, France
- Hematology Department, Saint Louis Hospital, AP-HP, Paris, France
- Groupe Francophone des Myelodysplasies, Paris, France
| | - Nicolas Duployez
- Université de Paris, Unité 944/7212-GenCellDi, INSERM and Centre National de la Recherche Scientifique (CNRS), Paris, France
- Hematology Laboratory, Unité 1277-Cancer Heterogeneity Plasticity and Resistance to Therapies (CANTHER), Centre Hospitalier Universitaire (CHU) de Lille, University of Lille, Institut National de la Santé et de la Recherche Médicale (INSERM), Lille, France
- Hematology Laboratory, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Matthieu Duchmann
- Université de Paris, Unité 944/7212-GenCellDi, INSERM and Centre National de la Recherche Scientifique (CNRS), Paris, France.
- Hematology Laboratory, Saint Louis Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
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Sevoyan A, Mekinian A, Chermat F, Adès L, Ivanyan A, Fenaux P, Hakobyan Y. MDS/CMML from resource-limited region: Characteristics and comparison to tertiary reference European center. Eur J Haematol 2024; 112:296-300. [PMID: 37822035 DOI: 10.1111/ejh.14115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Myelodysplastic Syndromes (MDS) and Chronic Myelomonocytic Leukemia (CMML) are clonal myeloid malignancies, characterized by bone marrow failure leading to cytopenias (and possible myeloproliferation for CMML) and a high propensity to evolve to Acute Myeloid Leukemia (AML). OBJECTIVE AND METHODS The aim of our retrospective study was to evaluate the clinical and hematological features; the prevalence of MDS subtypes, R-IPSS, and the outcome of 106 Armenian MDS/CMML patients diagnosed over the 2008-2020 period in a single Armenian Hematology center and compare them to French MDS patients included in the GFM registry. RESULTS Median age in the Armenian cohort was 64 years (range 19-84) and 55% were males. The main MDS subtypes were MDS-MLD (29.2%) and MDS-SLD (27.3%), the least frequent was del 5q (0.9%). By comparison, a higher prevalence of MDS-MLD, MDS-EB2, and MDS-RS was found in the French cohort. Armenian patients' cohort generally had poor access to standard MDS treatment and 42.3% of the patients were transfusion dependent. Overall survival, however, did not significantly differ between Armenian and French cohorts. CONCLUSION Our study stresses issues regarding epidemiology, access to diagnosis, difficulties of risk stratification, and access to treatment.
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Affiliation(s)
- Anna Sevoyan
- Department of Hematology, Hôpital of Hematology, Yerevan, Armenia
| | - Arsène Mekinian
- Service de Médecine Interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Saint-Antoine, Paris, France
- French Armenian research center, Yerevan, Armenia
| | - Fatiha Chermat
- Department of Hematology, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- INSERM U944 Institut de Recherche Saint-Louis (IRSL) and Université de Paris, Paris, France
| | - Lionel Adès
- Department of Hematology, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- INSERM U944 Institut de Recherche Saint-Louis (IRSL) and Université de Paris, Paris, France
| | - A Ivanyan
- Department of Hematology, Hôpital of Hematology, Yerevan, Armenia
| | - Pierre Fenaux
- Department of Hematology, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- INSERM U944 Institut de Recherche Saint-Louis (IRSL) and Université de Paris, Paris, France
| | - Yervand Hakobyan
- Department of Hematology, Hôpital of Hematology, Yerevan, Armenia
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Kubasch AS, Peterlin P, Cluzeau T, Götze KS, Sockel K, Teipel R, Jentzsch M, Attalah H, Sebert M, Chermat F, Gloaguen S, Puttrich M, Cross M, Schneider M, Kayser S, Schipp D, Giagounidis A, Tirado-Gonzalez I, Descot A, van de Loosdrecht A, Weigert A, Metzeler KH, Fenaux P, Medyouf H, Platzbecker U, Ades L. Efficacy and safety of bemcentinib in patients with advanced myelodysplastic neoplasms or acute myeloid leukemia failing hypomethylating agents- the EMSCO phase II BERGAMO trial. Leukemia 2023; 37:2309-2313. [PMID: 37735558 PMCID: PMC10624604 DOI: 10.1038/s41375-023-02029-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/16/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023]
Affiliation(s)
- A S Kubasch
- Department of Hematology, Hemostaseology, Cellular Therapy and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
- German MDS Study Group (D-MDS), Leipzig, Germany
- The European Myelodysplastic Neoplasms Cooperative Group (EMSCO), Leipzig, Germany
| | - P Peterlin
- The European Myelodysplastic Neoplasms Cooperative Group (EMSCO), Leipzig, Germany
- Service d'hématologie Clinique, CHU de Nantes, Nantes, France
| | - T Cluzeau
- The European Myelodysplastic Neoplasms Cooperative Group (EMSCO), Leipzig, Germany
- CHU de Nice, Département d'Hématologie Clinique, Nice, France
| | - K S Götze
- German MDS Study Group (D-MDS), Leipzig, Germany
- The European Myelodysplastic Neoplasms Cooperative Group (EMSCO), Leipzig, Germany
- Department of Medicine III, Klinikum rechts der Isar, TUM, Munich, Germany
| | - K Sockel
- German MDS Study Group (D-MDS), Leipzig, Germany
- Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - R Teipel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, TU Dresden, Dresden, Germany
| | - M Jentzsch
- Department of Hematology, Hemostaseology, Cellular Therapy and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - H Attalah
- Groupe Francophone des Myélodysplasies, Paris, France
| | - M Sebert
- Groupe Francophone des Myélodysplasies, Paris, France
- Service d'Hématologie Seniors, Hopital Saint Louis, Assistance Publique-Hôpitaux de Paris and Paris Cité University, Paris, France
| | - F Chermat
- Groupe Francophone des Myélodysplasies, Paris, France
| | - S Gloaguen
- German MDS Study Group (D-MDS), Leipzig, Germany
- The European Myelodysplastic Neoplasms Cooperative Group (EMSCO), Leipzig, Germany
| | | | - M Cross
- Department of Hematology, Hemostaseology, Cellular Therapy and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - M Schneider
- Department of Hematology, Hemostaseology, Cellular Therapy and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - S Kayser
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red Cross Blood Service Baden-Württemberg-Hessen, Mannheim, Germany
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - D Schipp
- DS-Statistics, Rosenthal-Bielatal, Germany
| | - A Giagounidis
- German MDS Study Group (D-MDS), Leipzig, Germany
- The European Myelodysplastic Neoplasms Cooperative Group (EMSCO), Leipzig, Germany
- Department for Oncology, Hematology and Palliative Care, Marien Hospital Düsseldorf, Düsseldorf, Germany
| | - I Tirado-Gonzalez
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany
| | - A Descot
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany
| | - A van de Loosdrecht
- The European Myelodysplastic Neoplasms Cooperative Group (EMSCO), Leipzig, Germany
- Amsterdam UMC, VU University Medical Center, Amsterdam, Cancer Center Amsterdam, Amsterdam, Netherlands
| | - A Weigert
- Department of Hematology, Hemostaseology, Cellular Therapy and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - K H Metzeler
- Department of Hematology, Hemostaseology, Cellular Therapy and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - P Fenaux
- The European Myelodysplastic Neoplasms Cooperative Group (EMSCO), Leipzig, Germany
- Groupe Francophone des Myélodysplasies, Paris, France
- Service d'Hématologie Seniors, Hopital Saint Louis, Assistance Publique-Hôpitaux de Paris and Paris Cité University, Paris, France
| | - H Medyouf
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany
- Frankfurt Cancer Institute, Frankfurt am Main, Germany
- German Cancer Research Consortium, Frankfurt/Mainz partner site, DKFZ Heidelberg, Heidelberg, Germany
| | - U Platzbecker
- Department of Hematology, Hemostaseology, Cellular Therapy and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany.
- German MDS Study Group (D-MDS), Leipzig, Germany.
- The European Myelodysplastic Neoplasms Cooperative Group (EMSCO), Leipzig, Germany.
| | - L Ades
- The European Myelodysplastic Neoplasms Cooperative Group (EMSCO), Leipzig, Germany
- Groupe Francophone des Myélodysplasies, Paris, France
- Service d'Hématologie Seniors, Hopital Saint Louis, Assistance Publique-Hôpitaux de Paris and Paris Cité University, Paris, France
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Peterlin P, Le Bris Y, Turlure P, Chevallier P, Ménard A, Gourin MP, Dumas PY, Thepot S, Berceanu A, Park S, Hospital MA, Cluzeau T, Bouzy S, Torregrosa-Diaz JM, Drevon L, Sapena R, Chermat F, Ades L, Dimicoli-Salazar S, Chevret S, Béné MC, Fenaux P. CPX-351 in higher risk myelodysplastic syndrome and chronic myelomonocytic leukaemia: a multicentre, single-arm, phase 2 study. Lancet Haematol 2023; 10:e521-e529. [PMID: 37245522 DOI: 10.1016/s2352-3026(23)00090-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND CPX-351, an encapsulated form of cytarabine and daunorubicin, has shown greater efficacy than the classic 3 + 7 treatment administration in secondary acute myeloid leukaemia. Given that higher-risk myelodysplastic syndrome and chronic myelomonocytic leukaemia share similarities with secondary acute myeloid leukaemia, we aimed to investigate the safety and efficacy of CPX-351 in this context. METHODS This investigator-initiated two-cohort phase 2 trial was conducted by the Groupe Francophone des Myélodysplasies, with 12 participating centres in France. It comprised cohort A (reported here and completed), which included patients in first-line treatment, and cohort B, which was stopped for lack of inclusion (ie, not enough patients met the inclusion criteria), for patients with hypomethylating agent failure that is not reported here. Cohort A enrolled patients with newly diagnosed higher-risk myelodysplastic syndrome or chronic myelomonocytic leukaemia (aged 18-70 years old) with an Eastern Cooperative Oncology Group performance status of 0-1. Intravenous CPX-351 (100 mg/m2 cytarabine and 44 mg/m2 daunorubicin) was given on days 1, 3, and 5, with a second induction cycle given (same daily dose on days 1 and 3) if at least a partial response was not reached. Patients who responded could receive up to four monthly consolidation cycles (same daily dose on day 1) or allogeneic haematopoietic stem-cell transplantation (HSCT). Overall response rate after one or two induction courses according to European LeukemiaNet 2017 acute myeloid leukaemia was the primary endpoint after CPX-351 induction, whether patients received one or two induction cycles. Safety was assessed in all patients enrolled (in cohort A). This trial is registered with ClinicalTrials.gov, NCT04273802. FINDINGS Between April 29, 2020, and Feb 10, 2021, 21 (68%) male and ten (32%) female patients were enrolled. 27 (87%) of 31 patients responded (95% CI 70-96). 16 (52%) of the 31 patients received at least one consolidation cycle. 30 (97%) of the 31 patients included were initially considered eligible for allogeneic HSCT and 29 (94%) of the 31 patients had the procedure. Median follow-up was 16·1 months (IQR 8·3-18·1). The most common grade 3-4 adverse events were pulmonary (eight [26%] of 31 patients) and cardiovascular (six [19%] of 31 patients). There were 14 serious adverse events (mainly hospitalisation for infection [n=5] and only one was treatment-related) and no treatment-related death. INTERPRETATION CPX-351 appears to be active and safe in patients with higher-risk myelodysplastic syndrome and chronic myelomonocytic leukaemia, allowing bridging to allogenic HSCT in most patients. FUNDING Jazz Pharmaceuticals.
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Affiliation(s)
- Pierre Peterlin
- Clinical Hematology, Nantes University Hospital, Nantes, France.
| | - Yannick Le Bris
- Hematology Biology, Nantes University Hospital, Nantes, France
| | - Pascal Turlure
- Clinical Hematology, Limoges University Hospital, Limoges, France
| | | | - Audrey Ménard
- Hematology Biology, Nantes University Hospital, Nantes, France
| | | | - Pierre-Yves Dumas
- Clinical Hematology, Bordeaux University Hospital Haut-Lévèque, Pessac, France
| | - Sylvain Thepot
- Clinical Hematology, Angers University Hospital, Angers, France
| | - Ana Berceanu
- Clinical Hematology, Besançon University Hospital, Besançon, France
| | - Sophie Park
- Clinical Hematology, Grenoble University Hospital, Grenoble, France
| | | | - Thomas Cluzeau
- Clinical Hematology, Nice University Hospital, Nice, France
| | - Simon Bouzy
- Hematology Biology, Nantes University Hospital, Nantes, France
| | | | - Louis Drevon
- Clinical Hematology, Hôpital Saint Louis, Paris, France
| | - Rosa Sapena
- Groupe Francophone des Myelodysplasies, Paris, France
| | | | - Lionel Ades
- Clinical Hematology, Hôpital Saint Louis, Paris, France
| | | | - Sylvie Chevret
- Biostatistics Department, Hôpital Saint Louis, Paris, France
| | | | - Pierre Fenaux
- Groupe Francophone des Myelodysplasies, Paris, France
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5
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Itzykson R, Santini V, Thepot S, Ades L, Chaffaut C, Giagounidis A, Morabito M, Droin N, Lübbert M, Sapena R, Nimubona S, Goasguen J, Wattel E, Zini G, Torregrosa Diaz JM, Germing U, Pelizzari AM, Park S, Jaekel N, Metzgeroth G, Onida F, Navarro R, Patriarca A, Stamatoullas A, Götze K, Puttrich M, Mossuto S, Solary E, Gloaguen S, Chevret S, Chermat F, Platzbecker U, Fenaux P. Decitabine Versus Hydroxyurea for Advanced Proliferative Chronic Myelomonocytic Leukemia: Results of a Randomized Phase III Trial Within the EMSCO Network. J Clin Oncol 2022; 41:1888-1897. [PMID: 36455187 DOI: 10.1200/jco.22.00437] [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: 12/03/2022] Open
Abstract
PURPOSE Hydroxyurea (HY) is a reference treatment of advanced myeloproliferative neoplasms. We conducted a randomized phase III trial comparing decitabine (DAC) and HY in advanced myeloproliferative chronic myelomonocytic leukemias (CMML). PATIENTS AND METHODS Newly diagnosed myeloproliferative CMML patients with advanced disease were randomly assigned 1:1 to intravenous DAC (20 mg/m2/d days 1-5) or HY (1-4 g/d) in 28-day cycles. The primary end point was event-free survival (EFS), events being death and acute myelomonocytic leukemia (AML) transformation or progression. RESULTS One-hundred seventy patients received DAC (n = 84) or HY (n = 86). Median age was 72 and 74 years, and median WBC count 32.5 × 109/L and 31.2 × 109/L in the DAC and HY arms, respectively. Thirty-three percent of DAC and 31% of HY patients had CMML-2. Patients received a median of five DAC and six HY cycles. With a median follow-up of 17.5 months, median EFS was 12.1 months in the DAC arm and 10.3 months in the HY arm (hazard ratio [HR], 0.83; 95% CI, 0.59 to 1.16; P = .27). There was no significant interaction between treatment effect and blast or platelet count, anemia, CMML Prognostic Scoring System, Groupe Francophone des Myelodysplasies, or CMML Prognostic Scoring System–mol risk. Fifty-three (63%) DAC patients achieved a response compared with 30 (35%) HY patients ( P = .0004). Median duration of response was similar in both arms (DAC, 16.3 months; HY, 17.4 months; P = .90). Median overall survival was 18.4 months in the DAC arm and 21.9 months in the HY arm ( P = .67). Compared with HY, DAC significantly reduced the risk of CMML progression or transformation to acute myelomonocytic leukemia (cause-specific HR, 0.62; 95% CI, 0.41 to 0.94; P = .005) at the expense of death without progression or transformation (cause-specific HR, 1.55; 95% CI, 0.82 to 2.9; P = .04). CONCLUSION Compared with HY, frontline treatment with DAC did not improve EFS in patients with advanced myeloproliferative CMML (ClinicalTrials.gov identifier: NCT02214407 ).
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Affiliation(s)
- Raphael Itzykson
- Service Hématologie Adultes, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université de Paris, Génomes, biologie cellulaire et thérapeutique U944, INSERM, CNRS, Paris, France
- Groupe Francophone des Myélodysplasies, Paris, France
| | - Valeria Santini
- MDS Unit, DMSC; AOU Careggi, University of Florence, Florence, Italy
- Fondazione Italiana Sindromi Mielodisplastiche (FISiM-ets), Bologna, Italy
| | - Sylvain Thepot
- Groupe Francophone des Myélodysplasies, Paris, France
- Hematology Department CHU Angers, Université Angers, Angers, France
| | - Lionel Ades
- Service Hématologie Adultes, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
- Groupe Francophone des Myélodysplasies, Paris, France
- Service Hématologie Seniors, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Cendrine Chaffaut
- SBIM, APHP, Hôpital Saint-Louis, INSERM, UMR-1153, ECSTRA Team, Paris, France
| | - Aristoteles Giagounidis
- Marien Hospital, Klinik für Hämatologie, Onkologie und klinische Immunologie, D-Düsseldorf, Germany
- Deutsche MDS-Studiengruppe, D-04103 Leipzig, Germany
| | - Margot Morabito
- Université Paris Saclay, INSERM U1287, Gustave Roussy Cancer Center, Villejuif, France
| | - Nathalie Droin
- Université Paris Saclay, INSERM U1287, Gustave Roussy Cancer Center, Villejuif, France
| | - Michael Lübbert
- Deutsche MDS-Studiengruppe, D-04103 Leipzig, Germany
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine—University Medical Center Freiburg, Freiburg, Germany
| | - Rosa Sapena
- Groupe Francophone des Myélodysplasies, Paris, France
| | - Stanislas Nimubona
- Groupe Francophone des Myélodysplasies, Paris, France
- Service Hématologie Clinique adulte, CHU de Rennes, Rennes, France
| | | | - Eric Wattel
- Groupe Francophone des Myélodysplasies, Paris, France
- Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Gina Zini
- Hematology, Università Cattolica del S. Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Jose Miguel Torregrosa Diaz
- Groupe Francophone des Myélodysplasies, Paris, France
- Service d’Hématologie Oncologique et Thérapie Cellulaire, CIC INSERM 1402, University Hospital of Poitiers, Poitiers, France
| | - Ulrich Germing
- Deutsche MDS-Studiengruppe, D-04103 Leipzig, Germany
- Heinrich-Heine University Düsseldorf, Universitätsklinik Düsseldorf, Klinik für Hämatologie, Onkologie und Klinische Immunologie, Düsseldorf, Germany
| | - Anna Maria Pelizzari
- Fondazione Italiana Sindromi Mielodisplastiche (FISiM-ets), Bologna, Italy
- Hematology Unit, ASST Spedali Civili, Brescia, Italy
| | - Sophie Park
- Groupe Francophone des Myélodysplasies, Paris, France
- Université Grenoble Alpes, Hematology Department, CHU Grenoble Alpes, Grenoble, France
| | - Nadja Jaekel
- Deutsche MDS-Studiengruppe, D-04103 Leipzig, Germany
- University Hospital Halle, Halle, Germany
| | - Georgia Metzgeroth
- Deutsche MDS-Studiengruppe, D-04103 Leipzig, Germany
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Francesco Onida
- Fondazione Italiana Sindromi Mielodisplastiche (FISiM-ets), Bologna, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Hematology-BMT Unit, Milan, Italy
| | - Robert Navarro
- Groupe Francophone des Myélodysplasies, Paris, France
- Service d’Hématologie, CHU Montpellier, Montpellier, France
| | - Andrea Patriarca
- Fondazione Italiana Sindromi Mielodisplastiche (FISiM-ets), Bologna, Italy
- Hematology Unit, AOU «Maggiore della Carità» and University of Eastern Piedmont, I-28100, Novara, Italy
| | - Aspasia Stamatoullas
- Groupe Francophone des Myélodysplasies, Paris, France
- Centre Henri Becquerel, Rouen, France
| | - Katharina Götze
- Deutsche MDS-Studiengruppe, D-04103 Leipzig, Germany
- Technical University of Munich, Department of Medicine III, Munich, Germany
| | - Martin Puttrich
- Deutsche MDS-Studiengruppe, D-04103 Leipzig, Germany
- GWT-TUD GmbH, Dresden, Germany
| | - Sandra Mossuto
- Fondazione Italiana Sindromi Mielodisplastiche (FISiM-ets), Bologna, Italy
| | - Eric Solary
- Groupe Francophone des Myélodysplasies, Paris, France
- Université Paris Saclay, INSERM U1287, Gustave Roussy Cancer Center, Villejuif, France
- Department of Hematology, Gustave Roussy Cancer Center, Villejuif, France
| | - Silke Gloaguen
- Deutsche MDS-Studiengruppe, D-04103 Leipzig, Germany
- Clinic and Polyclinic for Hematology, Cellular Therapy and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Sylvie Chevret
- SBIM, APHP, Hôpital Saint-Louis, INSERM, UMR-1153, ECSTRA Team, Paris, France
| | | | - Uwe Platzbecker
- Deutsche MDS-Studiengruppe, D-04103 Leipzig, Germany
- Clinic and Polyclinic for Hematology, Cellular Therapy and Hemostaseology, University Hospital Leipzig, Leipzig, Germany
| | - Pierre Fenaux
- Service Hématologie Adultes, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
- Groupe Francophone des Myélodysplasies, Paris, France
- Service Hématologie Seniors, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
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Jouzier C, Cherait A, Cony-Makhoul P, Hamel JF, Veloso M, Thepot S, Cluzeau T, Stamatoullas A, Garnier A, Guerci-Bresler A, Dimicoli-Salazar S, Pica GM, Cheze S, Santana C, Chermat F, Fenaux P, Park S. Red blood cell transfusion burden in myelodysplastic syndromes (MDS) with ring Sideroblasts (RS): A retrospective multicenter study by the Groupe Francophone des Myélodysplasies (GFM). Transfusion 2022; 62:961-973. [PMID: 35452143 DOI: 10.1111/trf.16884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/27/2022] [Accepted: 02/27/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND MDS-RS patients are characterized by chronic anemia and a low risk of Acute Myeloid Leukemia (AML) progression and they generally become Red Blood Cell (RBC) transfusion dependent (TD). STUDY DESIGN AND METHODS We performed a retrospective "real-life" observational study of 6 months in 100 MDS-RS TD patients, recruited in 12 French centers, to describe transfusion characteristics, and evaluate the frequency and causes of hospitalizations, health costs, and morbidity, associated with transfusion dependency, in a French population of RBC transfusion-dependent MDS-RS patients. RESULTS 79% of the patients had high transfusion burden (HTB) and 21% low transfusion burden (LTB). HTB patients had a longer disease duration (6 vs. 3.7 years, p = 0.0078), more frequent iron chelation (82% vs. 50%, p = 0.0052) and higher serum ferritin (p = 0.03). During the 6-month study period, 22% of the patients required inpatient hospitalization, 36% of them for symptomatic anemia requiring emergency RBC transfusion. The 6-month median transfusion costs, including the cost of the day care facility, transportation to and from the hospital, iron chelation, and lab tests, was 16,188€/patient. DISCUSSION MDS-RS represents the archetypal type of chronically transfused lower-risk MDS. Most of those patients have a high transfusion burden and thus frequently need visits to the hospital's day care facility, and frequent hospitalizations, with an overall high median treatment cost. Those costs should be compared with costs of new treatments potentially able to avoid RBC transfusion dependence and to reduce the complications of chronic anemia in MDS-RS patients.
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Affiliation(s)
- Claire Jouzier
- Service d'hématologie, CHU Grenoble Alpes, Grenoble, France
| | - Amina Cherait
- Service d'hématologie seniors, Hôpital St Louis, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | | | | | - Melanie Veloso
- Service de Biostatistique, CHU Grenoble Alpes, Grenoble, France
| | - Sylvain Thepot
- Service des Maladies du sang, CHU d'Angers, Angers, France
| | | | | | - Alice Garnier
- Service d'hématologie Clinique, CHU de Nantes, France
| | | | | | - Gian Matteo Pica
- Service d'hématologie Clinique, Centre hospitalier Métropole Savoie, Chambéry, France
| | - Stéphane Cheze
- Service d'hématologie Clinique, CHU Côte de Nacre, Caen, France
| | - Clémence Santana
- Service d'hématologie, Centre Léon Bérard, Lyon et en Rhône-Alpes, France
| | - Fatiha Chermat
- Service d'hématologie séniors, Hôpital St Louis, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France
| | - Pierre Fenaux
- Service d'hématologie séniors, Hôpital St Louis, Assistance Publique des Hôpitaux de Paris (APHP), Université de Paris, France
| | - Sophie Park
- Service d'hématologie, CHU Grenoble Alpes, Université Grenoble Alpes, Institute for Advanced Biosciences, Grenoble, France
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7
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Kayser S, Schlenk RF, Lebon D, Carre M, Götze KS, Stölzel F, Berceanu A, Schäfer-Eckart K, Peterlin P, Hicheri Y, Rahme R, Raffoux E, Chermat F, Krause SW, Aulitzky WE, Rigaudeau S, Noppeney R, Berthon C, Görner M, Jost E, Carassou P, Keller U, Orvain C, Braun T, Saillard C, Arar A, Kunzmann V, Wemeau M, De Wit M, Niemann D, Bonmati C, Schwänen C, Abraham J, Aljijakli A, Haiat S, Krämer A, Reichle A, Gnadler M, Willekens C, Spiekermann K, Hiddemann W, Müller-Tidow C, Thiede C, Röllig C, Serve H, Bornhäuser M, Baldus CD, Lengfelder E, Fenaux P, Platzbecker U, Adès L. Characteristics and outcome of patients with low-/intermediate-risk acute promyelocytic leukemia treated with arsenic trioxide - an international collaborative study. Haematologica 2021; 106:3100-3106. [PMID: 34047178 PMCID: PMC8634174 DOI: 10.3324/haematol.2021.278722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to characterize a large series of 154 patients with acute promyelocytic leukemia (median age, 53 years; range, 18-90 years) and evaluate real-life outcome after up-front treatment with arsenic trioxide and all-trans retinoic acid. All patients were included in the prospective NAPOLEON registry (NCT02192619) between 2013 and 2019. The acute promyelocytic leukemia was de novo in 91% (n=140) and therapy-related in 9% (n=14); 13% (n=20) of the patients were older than 70 years. At diagnosis bleeding/hemorrhage was present in 38% and thrombosis in 3%. Complete remission was achieved in 152 patients (99%), whereas two patients (1%) experienced induction death within 18 days after starting therapy. With a median follow-up of 1.99 years (95% confidence interval: 1.61-2.30 years) 1-year and 2-year overall survival rates were 97% (95% confidence interval: 94-100%) and 95% (95% confidence interval: 91-99%), respectively. Age above 70 years was associated with a significantly shorter overall survival (P<0.001) compared to that of younger patients. So far no relapses have been observed. Six patients (4%) died in complete remission at a median of 0.95 years after diagnosis (range, 0.18-2.38 years). Our data confirm the efficiency and durability of arsenic trioxide and all-trans retinoic acid therapy in the primary management of adults with low-/intermediate-risk acute promyelocytic leukemia in the real-life setting, irrespective of age.
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Affiliation(s)
- Sabine Kayser
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany; NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg.
| | - Richard F Schlenk
- NCT Trial Center, National Center of Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg; Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg
| | | | - Martin Carre
- 5HCE Grenoble, Service d'Oncologie et Hématologie Pédiatrique, Grenoble
| | | | - Friedrich Stölzel
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, TU Dresden
| | - Ana Berceanu
- Service d'Hématologie du Pr. Cahn Hopital Jean Minjoz, Besancon
| | | | | | - Yosr Hicheri
- Département d'Hématologie Clinique du Chu Saint Eloi Montpellier
| | - Ramy Rahme
- Hôpital Saint Louis, Université Paris Diderot, Paris
| | | | | | - Stefan W Krause
- Department of Internal Medicine 5 - Hematology/Oncology, University Hospital of Erlangen
| | | | - Sophie Rigaudeau
- Service d'Hémato-Oncologie du Pr. Castaigne Hopital Andre Mignot le Chesnay
| | | | - Celine Berthon
- Service des Maladies du Sang Chru, Hopital Claude Huriez, Lille
| | - Martin Görner
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum Bielefeld Mitte
| | | | - Philippe Carassou
- Service de Médecine interne, Hématologie du Pr. Christian Chr Metz Thionville, Hopital de Marcy, Metz
| | - Ulrich Keller
- Department of Hematology, Oncology and Tumor Immunology, Charité-University Medical Center, Campus Benjamin Franklin, Berlin
| | - Corentin Orvain
- Angers University Hospital, Maladies du Sang, Angers; Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia, FHU-GOAL, France; Université d'Angers, Inserm, CRCINA, Angers
| | - Thorsten Braun
- Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Université Paris
| | | | - Ali Arar
- Service d' Oncologie Médicale Hopital de la Source, Orleans
| | | | | | | | - Dirk Niemann
- Gemeinschaftsklinikum Mittelrhein gGmbH, Koblenz
| | - Caroline Bonmati
- Division of Hematology, Hôpital de Brabois, Centre Hospitalier Universitaire de Nancy, Nancy
| | | | - Julie Abraham
- Service d' Hématologie, Thérapie Cellulaire du Pr. Bordessoule, Hopital Universitaire Dupuytren, Limoges
| | - Ahmad Aljijakli
- Service d'Hématologie du Dr. Sutton Centre Hospitalier v. Dupouy, Argenteuil
| | - Stephanie Haiat
- Service d'Hematologie Clinique, CH Sud Francilien, Corbeil Essonnes
| | - Alwin Krämer
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg; German Cancer Research Center (DKFZ) and Department of Internal Medicine V, University of Heidelberg, Heidelberg
| | - Albrecht Reichle
- Department of Medicine III - Hematology and Internal Oncology, University Hospital Regensburg, Regensburg
| | - Martina Gnadler
- St. Vincentius Kliniken, Abteilung für Hämatologie, Onkologie, Immunologie und Palliativmedizin, Karlsruhe
| | - Christophe Willekens
- Département d'Hématologie, Gustave Roussy, Université Paris-Saclay, Villejuif; INSERM Unit 1170, Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif
| | - Karsten Spiekermann
- Department of Medicine III, University Hospital, Ludwig-Maximilians University (LMU) Munich, Munich
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital, Ludwig-Maximilians University (LMU) Munich, Munich
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital of Heidelberg, Heidelberg
| | - Christian Thiede
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, TU Dresden
| | - Christoph Röllig
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, TU Dresden
| | - Hubert Serve
- Department of Internal Medicine II, University Hospital of Frankfurt Main
| | - Martin Bornhäuser
- Department of Medicine I, University Hospital Carl-Gustav-Carus, Dresden, TU Dresden
| | | | - Eva Lengfelder
- Department of Hematology and Oncology, University Hospital Mannheim, Mannheim
| | - Pierre Fenaux
- Hôpital Saint Louis, Université Paris Diderot, Paris
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig
| | - Lionel Adès
- Hôpital Saint Louis, Université Paris Diderot, Paris
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8
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Cluzeau T, Sebert M, Rahmé R, Cuzzubbo S, Lehmann-Che J, Madelaine I, Peterlin P, Bève B, Attalah H, Chermat F, Miekoutima E, Rauzy OB, Recher C, Stamatoullas A, Willems L, Raffoux E, Berthon C, Quesnel B, Loschi M, Carpentier AF, Sallman DA, Komrokji R, Walter-Petrich A, Chevret S, Ades L, Fenaux P. Eprenetapopt Plus Azacitidine in TP53-Mutated Myelodysplastic Syndromes and Acute Myeloid Leukemia: A Phase II Study by the Groupe Francophone des Myélodysplasies (GFM). J Clin Oncol 2021; 39:1575-1583. [PMID: 33600210 PMCID: PMC8099409 DOI: 10.1200/jco.20.02342] [Citation(s) in RCA: 141] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
TP53-mutated (TP53m) myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) have very poor outcome irrespective of the treatment received, including 40% responses (20% complete remission [CR]) with azacitidine (AZA) alone, short response duration, and a median overall survival (OS) of approximately 6 months. Eprenetapopt (APR-246), a novel first-in-class drug, leads to p53 protein reconformation and reactivates its proapoptotic and cell-cycle arrest functions.
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Affiliation(s)
- Thomas Cluzeau
- Cote d'Azur University, Hematology Department, Centre Hospitalier Universitaire of Nice, Nice, France.,Cote d'Azur University, Mediterranean Center of Molecular Medicine, INSERM U1065, Nice, France.,GFM
| | - Marie Sebert
- GFM.,Hematology Department, Hospital Saint Louis, Assistance Publique des Hopitaux de Paris (APHP), and Paris University, Paris, France
| | - Ramy Rahmé
- GFM.,Hematology Department, Hospital Saint Louis, Assistance Publique des Hopitaux de Paris (APHP), and Paris University, Paris, France
| | | | | | | | | | | | | | | | - Elsa Miekoutima
- Hematology Department, Hospital Saint Louis, Assistance Publique des Hopitaux de Paris (APHP), and Paris University, Paris, France
| | | | | | | | - Lise Willems
- GFM.,Hematology Department, Hospital Cochin, APHP, Paris, France
| | - Emmanuel Raffoux
- GFM.,Hematology Department, Hospital Saint Louis, Assistance Publique des Hopitaux de Paris (APHP), and Paris University, Paris, France
| | | | - Bruno Quesnel
- GFM.,Hematology Department, CHU of Lille, Lille, France
| | - Michael Loschi
- Cote d'Azur University, Hematology Department, Centre Hospitalier Universitaire of Nice, Nice, France.,Cote d'Azur University, Mediterranean Center of Molecular Medicine, INSERM U1065, Nice, France
| | | | - David A Sallman
- Hematology Unit, Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Rami Komrokji
- Hematology Unit, Moffitt Cancer Center and Research Institute, Tampa, FL
| | | | - Sylvie Chevret
- SBIM, Hospital Saint Louis, APHP, and Paris University, Paris, France
| | - Lionel Ades
- GFM.,Hematology Department, Hospital Saint Louis, Assistance Publique des Hopitaux de Paris (APHP), and Paris University, Paris, France
| | - Pierre Fenaux
- GFM.,Hematology Department, Hospital Saint Louis, Assistance Publique des Hopitaux de Paris (APHP), and Paris University, Paris, France
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9
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Kubasch AS, Schulze F, Giagounidis A, Götze KS, Krönke J, Sockel K, Middeke JM, Chermat F, Gloaguen S, Puttrich M, Weigt C, William D, Fenaux P, Schlenk RF, Thiede C, Stasik S, Mies A, Adès L, Oelschlägel U, Platzbecker U. Single agent talacotuzumab demonstrates limited efficacy but considerable toxicity in elderly high-risk MDS or AML patients failing hypomethylating agents. Leukemia 2019; 34:1182-1186. [PMID: 31796915 DOI: 10.1038/s41375-019-0645-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/17/2019] [Accepted: 11/03/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Anne Sophie Kubasch
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, Leipzig University Hospital, Leipzig, Germany.,German MDS Study Group (D-MDS), Leipzig, Germany.,The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany
| | - Freya Schulze
- German MDS Study Group (D-MDS), Leipzig, Germany.,The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Aristoteles Giagounidis
- German MDS Study Group (D-MDS), Leipzig, Germany.,The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,Department for Oncology, Hematology and Palliative Care, Marien Hospital Düsseldorf, Düsseldorf, Germany
| | - Katharina S Götze
- German MDS Study Group (D-MDS), Leipzig, Germany.,The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,Department of Medicine III, Klinikum rechts der Isar, TUM, Munich, Germany
| | - Jan Krönke
- German MDS Study Group (D-MDS), Leipzig, Germany.,The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany
| | - Katja Sockel
- German MDS Study Group (D-MDS), Leipzig, Germany.,The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Jan Moritz Middeke
- German MDS Study Group (D-MDS), Leipzig, Germany.,The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Fatiha Chermat
- The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,Groupe Francophone des Myélodysplasies, Paris, France
| | - Silke Gloaguen
- German MDS Study Group (D-MDS), Leipzig, Germany.,The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany
| | - Martin Puttrich
- The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,GWT-TUD GmbH, Dresden, Germany
| | - Carmen Weigt
- The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,GWT-TUD GmbH, Dresden, Germany
| | - Doreen William
- Institute for Clinical Genetics, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Pierre Fenaux
- The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,Groupe Francophone des Myélodysplasies, Paris, France.,Service d'Hématologie Seniors, Assistance Publique-Hôpitaux de Paris and Paris University, Paris, France
| | - Richard F Schlenk
- The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Department of Internal Medicine V, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Thiede
- The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Sebastian Stasik
- The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Anna Mies
- The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Lionel Adès
- The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,Groupe Francophone des Myélodysplasies, Paris, France.,Service d'Hématologie Seniors, Assistance Publique-Hôpitaux de Paris and Paris University, Paris, France
| | - Uta Oelschlägel
- German MDS Study Group (D-MDS), Leipzig, Germany.,The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.,Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Dresden, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, Leipzig University Hospital, Leipzig, Germany. .,German MDS Study Group (D-MDS), Leipzig, Germany. .,The European Myelodysplastic Syndromes Cooperative Group (EMSCO), Leipzig, Germany.
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10
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Sébert M, Renneville A, Bally C, Peterlin P, Beyne-Rauzy O, Legros L, Gourin MP, Sanhes L, Wattel E, Gyan E, Park S, Stamatoullas A, Banos A, Laribi K, Jueliger S, Bevan L, Chermat F, Sapena R, Nibourel O, Chaffaut C, Chevret S, Preudhomme C, Adès L, Fenaux P. A phase II study of guadecitabine in higher-risk myelodysplastic syndrome and low blast count acute myeloid leukemia after azacitidine failure. Haematologica 2019; 104:1565-1571. [PMID: 30733271 PMCID: PMC6669173 DOI: 10.3324/haematol.2018.207118] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/07/2019] [Indexed: 11/22/2022] Open
Abstract
High-risk myelodysplastic syndrome/acute myeloid leukemia patients have a very poor survival after azacitidine failure. Guadecitabine (SGI-110) is a novel subcutaneous hypomethylating agent which results in extended decitabine exposure. This multicenter phase II study evaluated the efficacy and safety of guadecitabine in high-risk myelodysplastic syndrome and low blast count acute myeloid leukemia patients refractory or relapsing after azacitidine. We included 56 patients with a median age of 75 years [Interquartile Range (IQR) 69-76]. Fifty-five patients received at least one cycle of guadecitabine (60 mg/m2/d subcutaneously days 1-5 per 28-day treatment cycles), with a median of 3 cycles (range, 0-27). Eight (14.3%) patients responded, including two complete responses; median response duration was 11.5 months. Having no or few identified somatic mutations was the only factor predicting response (P=0.035). None of the 11 patients with TP53 mutation responded. Median overall survival was 7.1 months, and 17.9 months in responders (3 of whom had overall survival >2 years). In multivariate analysis, IPSS-R (revised International Prognostic Scoring System) score other than very high (P=0.03) primary versus secondary azacitidine failure (P=0.01) and a high rate of demethylation in blood during the first cycle of treatment (P=0.03) were associated with longer survival. Thus, guadecitabine can be effective, sometimes yielding relatively prolonged survival, in a small proportion of high-risk myelodysplastic syndrome/low blast count acute myeloid leukemia patients who failed azacitidine. (Trial registered at clinicaltrials.gov identifier: 02197676)
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Affiliation(s)
- Marie Sébert
- Groupe Francophone des Myélodysplasies, Paris, France.,Hématologie Clinique, Hôpital Saint Louis, Paris, France
| | | | - Cécile Bally
- Hématologie Clinique, Hôpital Saint Louis, Paris, France
| | - Pierre Peterlin
- Groupe Francophone des Myélodysplasies, Paris, France.,CHU de Nantes, France
| | - Odile Beyne-Rauzy
- Groupe Francophone des Myélodysplasies, Paris, France.,IUCT ONCOPOLE Toulouse, France
| | - Laurence Legros
- Groupe Francophone des Myélodysplasies, Paris, France.,CHU de Nice, France
| | - Marie-Pierre Gourin
- Groupe Francophone des Myélodysplasies, Paris, France.,CHRU de Limoges, France
| | - Laurence Sanhes
- Groupe Francophone des Myélodysplasies, Paris, France.,CHU de Perpignan, France
| | - Eric Wattel
- Groupe Francophone des Myélodysplasies, Paris, France.,CHU Lyon Sud, Lyon, France
| | - Emmanuel Gyan
- Groupe Francophone des Myélodysplasies, Paris, France.,CHRU de Tours, France
| | - Sophie Park
- Groupe Francophone des Myélodysplasies, Paris, France.,CHU de Grenoble, France
| | - Aspasia Stamatoullas
- Groupe Francophone des Myélodysplasies, Paris, France.,Centre Henri Becquerel, Rouen, France
| | - Anne Banos
- Groupe Francophone des Myélodysplasies, Paris, France.,CH de la Côte Basque, France
| | - Kamel Laribi
- Groupe Francophone des Myélodysplasies, Paris, France.,CHU Côte de Nacre, Caen, France
| | | | - Luke Bevan
- Astex Pharmaceuticals Inc., Cambridge, UK
| | | | - Rosa Sapena
- Groupe Francophone des Myélodysplasies, Paris, France
| | | | - Cendrine Chaffaut
- Service de Biostatistiques, Hôpital Saint-Louis, APHP, Paris, France
| | - Sylvie Chevret
- Service de Biostatistiques, Hôpital Saint-Louis, APHP, Paris, France
| | | | - Lionel Adès
- Groupe Francophone des Myélodysplasies, Paris, France.,Hématologie Clinique, Hôpital Saint Louis, Paris, France
| | - Pierre Fenaux
- Groupe Francophone des Myélodysplasies, Paris, France .,Hématologie Clinique, Hôpital Saint Louis, Paris, France
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11
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Prebet T, Delaunay J, Wattel E, Braun T, Cony-Makhoul P, Dimicoli S, Wickenhauser S, Lejeune J, Chevret S, Chermat F, Fenaux P, Vey N. Addition of suberoylanilide hydroxamic acid (Vorinostat) to azacitidine for patients with higher risk myelodysplastic syndromes and azacitidine failure: a phase II add-on study from the Groupe Francophone des Myelodysplasies. Br J Haematol 2016; 180:735-737. [PMID: 27977052 DOI: 10.1111/bjh.14427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Thomas Prebet
- Haematology Department, Institut PAOLI-CALMETTES and Aix-Marseille Université, Marseille, France.,Section of Hematology, Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - Jacques Delaunay
- Haematology Department, Centre Hospitalo universitaire, Nantes, France
| | - Eric Wattel
- Haematology Department, Hôpital Lyon Sud, Pierre-Bénite, France
| | - Thorsten Braun
- Haematology Department, Hôpital Avicenne, Bobigny, France.,Assistance Publique Hopitaux de Paris (AP-HP), Paris, France
| | | | - Sophie Dimicoli
- Haematology Department, Centre Hospitalo Unversitaire Tripode, Pessac, France
| | | | - Julie Lejeune
- Assistance Publique Hopitaux de Paris (AP-HP), Paris, France.,Biostatistic Department, Hôpital Saint Louis, Paris, France
| | - Sylvie Chevret
- Assistance Publique Hopitaux de Paris (AP-HP), Paris, France.,Biostatistic Department, Hôpital Saint Louis, Paris, France
| | - Fatiha Chermat
- Assistance Publique Hopitaux de Paris (AP-HP), Paris, France.,Haematology Department, Hôpital Saint Louis, Paris, France
| | - Pierre Fenaux
- Assistance Publique Hopitaux de Paris (AP-HP), Paris, France.,Haematology Department, Hôpital Saint Louis, Paris, France
| | - Norbert Vey
- Haematology Department, Institut PAOLI-CALMETTES and Aix-Marseille Université, Marseille, France
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Thépot S, Ben Abdelali R, Chevret S, Renneville A, Beyne-Rauzy O, Prébet T, Park S, Stamatoullas A, Guerci-Bresler A, Cheze S, Tertian G, Choufi B, Legros L, Bastié JN, Delaunay J, Chaury MP, Sanhes L, Wattel E, Dreyfus F, Vey N, Chermat F, Preudhomme C, Fenaux P, Gardin C. A randomized phase II trial of azacitidine +/- epoetin-β in lower-risk myelodysplastic syndromes resistant to erythropoietic stimulating agents. Haematologica 2016; 101:918-25. [PMID: 27229713 DOI: 10.3324/haematol.2015.140988] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 05/26/2016] [Indexed: 11/09/2022] Open
Abstract
The efficacy of azacitidine in patients with anemia and with lower-risk myelodysplastic syndromes, if relapsing after or resistant to erythropoietic stimulating agents, and the benefit of combining these agents to azacitidine in this setting are not well known. We prospectively compared the outcomes of patients, all of them having the characteristics of this subset of lower-risk myelodysplastic syndrome, if randomly treated with azacitidine alone or azacitidine combined with epoetin-β. High-resolution cytogenetics and gene mutation analysis were performed at entry. The primary study endpoint was the achievement of red blood cell transfusion independence after six cycles. Ninety-eight patients were randomised (49 in each arm). Median age was 72 years. In an intention to treat analysis, transfusion independence was obtained after 6 cycles in 16.3% versus 14.3% of patients in the azacitidine and azacitidine plus epoetin-β arms, respectively (P=1.00). Overall erythroid response rate (minor and major responses according to IWG 2000 criteria) was 34.7% vs. 24.5% in the azacitidine and azacitidine plus epoetin-β arms, respectively (P=0.38). Mutations of the SF3B1 gene were the only ones associated with a significant erythroid response, 29/59 (49%) versus 6/27 (22%) in SF3B1 mutated and unmutated patients, respectively, P=0.02. Detection of at least one "epigenetic mutation" and of an abnormal single nucleotide polymorphism array profile were the only factors associated with significantly poorer overall survival by multivariate analysis. The transfusion independence rate observed with azacitidine in this lower-risk population, but resistant to erythropoietic stimulating agents, was lower than expected, with no observed benefit of added epoetin, (clinicaltrials.gov identifier: 01015352).
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Affiliation(s)
- Sylvain Thépot
- Service d'Hématologie Clinique, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP), and Université Paris 13, Bobigny, France
| | | | - Sylvie Chevret
- Service de biostatistique et information médicale, Hôpital Saint-Louis, AP-HP and Université Paris 7, France
| | | | - Odile Beyne-Rauzy
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire, Toulouse, France
| | - Thomas Prébet
- Département d'Hématologie, Institut Paoli-Calmettes, Marseille, France
| | - Sophie Park
- Service d'Hématologie Clinique, Hôpital Cochin, AP-HP and Université Paris 5, France
| | | | | | - Stéphane Cheze
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire, Caen, France
| | - Gérard Tertian
- Service de médecine interne, Hôpital du kremlin-Bicetre, AP-HP and Université Paris, France
| | - Bachra Choufi
- Service d'Hématologie Clinique, Hôpital de Boulogne sur mer, France
| | - Laurence Legros
- Service d'Hématologie, Centre Hospitalier Universitaire, Nice, France
| | - Jean Noel Bastié
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire, Dijon, France
| | - Jacques Delaunay
- Service d'Hématologie, Centre Hospitalier Universitaire, Nantes, France
| | - Marie Pierre Chaury
- Service d'Hématologie Clinique, Centre Hospitalier Universitaire, Limoges, France
| | - Laurence Sanhes
- Service d'Hématologie, Centre Hospitalier, Perpignan, France
| | - Eric Wattel
- Service d'Hématologie, Hôpital Universitaire Lyon Sud, Lyon, France
| | - Francois Dreyfus
- Service d'Hématologie Clinique, Hôpital Cochin, AP-HP and Université Paris 5, France
| | - Norbert Vey
- Département d'Hématologie, Institut Paoli-Calmettes, Marseille, France
| | - Fatiha Chermat
- Groupe francophone des Myélodysplasies, Hôpital Saint-Louis, AP-HP, France
| | | | - Pierre Fenaux
- Service d'Hématologie Clinique senior, Hôpital Saint-Louis, AP-HP and Université Paris 7, France
| | - Claude Gardin
- Service d'Hématologie Clinique, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP), and Université Paris 13, Bobigny, France
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Sebert M, Ades L, Stamatoullas A, Braun T, Delaunay J, de Renzis B, Jeddi R, Meddeb B, Berger MH, Samey B, Chermat F, Chaffaut C, Chevert S, Fenaux P. 123 AZACITIDINE (AZA) COMBINED WITH IDARUBICIN (IDA) IN HIGHER RISK MDS (HRMDS) – RESULTS OF A PHASE I/II STUDY BY THE GFM. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30124-7] [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: 11/16/2022]
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Ades L, De Renzis B, Jeddi R, Delaunay J, Braun T, Hunault-Berger M, Stamatoullas A, Sanhes L, Samey B, Chermat F, Meddeb B, Fenaux P. O-011 Azacitidine (AZA) + idarubicin (IDA) in untreated high-risk MDS – A GFM phase I/II study. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70033-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: 11/30/2022]
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Itzykson R, Ayari S, Vassilief D, Berger E, Slama B, Vey N, Suarez F, Beyne-Rauzy O, Guerci A, Cheze S, Thomas X, Stamatoullas A, Gardembas M, Bauduer F, Kolb A, Chaury MC, Legros L, Damaj G, Chermat F, Dreyfus F, Fenaux P, Ades L. Is there a role for all-trans retinoic acid in combination with recombinant erythropoetin in myelodysplastic syndromes? A report on 59 cases. Leukemia 2009; 23:673-8. [PMID: 19151787 DOI: 10.1038/leu.2008.362] [Citation(s) in RCA: 24] [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] [Indexed: 11/09/2022]
Abstract
Erythropoiesis-stimulating agents (ESAs) remain the first-line treatment of anemia in lower risk myelodysplastic syndromes (MDS) without 5q deletion. A preliminary report suggested that adding all-trans retinoic acid (ATRA) to ESAs may improve their erythroid response, particularly in patients with high endogenous erythropoietin (EPO) level, and may improve other cytopenias. We conducted a prospective multicenter study of EPO-beta and ATRA in anemic MDS patients with marrow blasts <10% and either previous ESA failure or relapse, endogenous EPO >500 U/l or other cytopenia(s) (absolute neutrophilic count <1.0 G/l or platelets <50 G/l). A total of 59 patients were evaluable after 12 weeks of treatment. The erythroid response rates according to IWG 2000 and 2006 criteria, respectively, were as follows: overall: 49 and 36%; patients with previous ESA failure (n=28): 43 and 32%; patients with endogenous EPO >500 U/l (n=18): 11 and 19%; patients transfused >2 red blood cells units/month (n=28) 43 and 39%. Only one neutrophil, but no platelet response, and no major side effect were observed. EPO-beta-ATRA combination appears a possible therapeutic option in anemia of MDS having failed an ESA alone, but not in patients with high endogenous EPO level, and does not improve neutropenia and thrombocytopenia.
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Affiliation(s)
- R Itzykson
- Service d'Hématologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Avicenne-Paris 13 University, Bobigny, France
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Fabre C, Sebert M, Hernandez E, Chermat F, Bordessoule D, Chaury M, Dartigeas C, de Botton S, Dreyfus F, Legros L, Mannone L, Marfaing-Koka A, Noel M, Park S, Prebet T, Stamatoullas A, Vey N, Fenaux P. P149 Treatment of high risk MDS and AML post-MDS with azacytidine (AZA): current results of the French ATU program. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70219-9] [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: 10/23/2022]
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