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Ghesquières H, Cherblanc F, Belot A, Micon S, Bouabdallah KK, Esnault C, Fornecker LM, Thokagevistk K, Bonjour M, Bijou F, Haioun C, Morineau N, Ysebaert L, Damaj G, Tessoulin B, Guidez S, Morschhauser F, Thiéblemont C, Chauchet A, Gressin R, Jardin F, Fruchart C, Labouré G, Fouillet L, Lionne-Huyghe P, Bonnet A, Lebras L, Amorim S, Leyronnas C, Olivier G, Guieze R, Houot R, Launay V, Drénou B, Fitoussi O, Detourmignies L, Abraham J, Soussain C, Lachenal F, Pica GM, Fogarty P, Cony-Makhoul P, Bernier A, Le Guyader-Peyrou S, Monnereau A, Boissard F, Rossi C, Camus V. Challenges for quality and utilization of real-world data for diffuse large B-cell lymphoma in REALYSA, a LYSA cohort. Blood Adv 2024; 8:296-308. [PMID: 37874913 PMCID: PMC10824688 DOI: 10.1182/bloodadvances.2023010798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/05/2023] [Accepted: 10/01/2023] [Indexed: 10/26/2023] Open
Abstract
ABSTRACT Real-world data (RWD) are essential to complement clinical trial (CT) data, but major challenges remain, such as data quality. REal world dAta in LYmphoma and Survival in Adults (REALYSA) is a prospective noninterventional multicentric cohort started in 2018 that included patients newly diagnosed with lymphoma in France. Herein is a proof-of-concept analysis on patients with first-line diffuse large B-cell lymphoma (DLBCL) to (1) evaluate the capacity of the cohort to provide robust data through a multistep validation process; (2) assess the consistency of the results; and (3) conduct an exploratory transportability assessment of 2 recent phase 3 CTs (POLARIX and SENIOR). The analysis population comprised 645 patients with DLBCL included before 31 March 2021 who received immunochemotherapy and for whom 3589 queries were generated, resulting in high data completeness (<4% missing data). Median age was 66 years, with mostly advanced-stage disease and high international prognostic index (IPI) score. Treatments were mostly rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone (R-CHOP 75%) and reduced dose R-CHOP (13%). Estimated 1-year event-free survival (EFS) and overall survival rates were 77.9% and 90.0%, respectively (median follow-up, 9.9 months). Regarding transportability, when applying the CT's main inclusion criteria (age, performance status, and IPI), outcomes seemed comparable between patients in REALYSA and standard arms of POLARIX (1-year progression-free survival 79.8% vs 79.8%) and SENIOR (1-year EFS, 64.5% vs 60.0%). With its rigorous data validation process, REALYSA provides high-quality RWD, thus constituting a platform for numerous scientific purposes. The REALYSA study was registered at www.clinicaltrials.gov as #NCT03869619.
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Affiliation(s)
- Hervé Ghesquières
- Department of Hematology, Hopital Lyon Sud, Claude Bernard Lyon 1 University, Pierre Benite, France
| | - Fanny Cherblanc
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Aurélien Belot
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | | | - Krimo K. Bouabdallah
- Hematology and Cell Therapy Department, University Hospital of Bordeaux, Bordeaux, France
| | | | - Luc-Matthieu Fornecker
- Institut de Cancérologie Strasbourg Europe (ICANS) and University of Strasbourg, Strasbourg, France
| | | | - Maxime Bonjour
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Fontanet Bijou
- Department of Hematology, Institut Bergonie, Bordeaux, France
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Assistante Publique Hôpitaux de Paris APHP, Hopital Henri Mondor, Creteil, France
| | - Nadine Morineau
- Department of Hematology, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Loïc Ysebaert
- Institut universitaire du cancer de Toulouse Oncopole, Toulouse, France
| | - Gandhi Damaj
- Hematology Institute of Basse Normandie, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Benoit Tessoulin
- Department of Hematology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Stéphanie Guidez
- Department of Hematology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France
| | - Franck Morschhauser
- Department of Hematology, Universite de Lille, Centre Hospitalier Universitaire de Lille, Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Catherine Thiéblemont
- Université Paris Cité, Assistante Publique Hôpitaux de Paris, Hôpital Saint-Louis, Service d’Hémato-Oncologie, Paris, France
| | - Adrien Chauchet
- Department of Hematology, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Rémy Gressin
- Department of Hematology, Centre Hospitalier Universitaire de Grenoble, Institute for Advanced Biosciences, INSERM U1209/CNRS UMR 5309/Grenoble Alpes University, Grenoble, France
| | - Fabrice Jardin
- Department of Clinical Hematology, INSERM U1245 Unit, Centre Henri Becquerel, Rouen, France
| | | | - Gaëlle Labouré
- Deparment of Hematology, Centre Hospitalier de Libourne, Libourne, France
| | - Ludovic Fouillet
- Department of Hematology, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
| | | | - Antoine Bonnet
- Department of Hematology, Centre Hospitalier de Bretagne Atlantique, Vannes, France
| | - Laure Lebras
- Department of Hematology, Leon Berard Cancer Center, Lyon, France
| | - Sandy Amorim
- Department of Hematology, Hopital Saint Vincent de Paul, Lille, France
| | - Cécile Leyronnas
- Department of Hematology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Gaelle Olivier
- Department of Hematology, Centre Hospitalier de Niort, Niort, France
| | - Romain Guieze
- Department of Hematology, Centre Hospitalier Universitaire de Clermont Ferrand, Clermont Ferrand, France
| | - Roch Houot
- Department of Hematology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Vincent Launay
- Department of Hematology, Centre Hospitalier de Saint Brieuc, Saint Brieuc, France
| | - Bernard Drénou
- Department Hematology, Groupe Hospitalier Mulhouse Sud Alsace, Mulhouse, France
| | - Olivier Fitoussi
- Department of Hematology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | | | - Julie Abraham
- Department of Hematology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Carole Soussain
- Department of Hematology, Institut Curie, Saint-Cloud, France
| | - Florence Lachenal
- Department of Hematology, Centre Hospitalier Pierre Oudot, Bourgoin-Jallieu, France
| | - Gian Matteo Pica
- Department of Hematology, Centre Hospitalier Metropole Savoie, Chambery, France
| | - Patrick Fogarty
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Pascale Cony-Makhoul
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Adeline Bernier
- Lymphoma Academic Research Organisation, Hopital Lyon Sud, Pierre Benite, France
| | - Sandra Le Guyader-Peyrou
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonié, University of Bordeaux, Inserm, Team EPICENE, Bordeaux, France
| | - Alain Monnereau
- Registre des Hémopathies Malignes de la Gironde, Institut Bergonié, University of Bordeaux, Inserm, Team EPICENE, Bordeaux, France
| | | | - Cédric Rossi
- Department of Hematology, Centre Hospitalier Universitaire de Dijon Bourgogne, Dijon, France
| | - Vincent Camus
- Department of Clinical Hematology, INSERM U1245 Unit, Centre Henri Becquerel, Rouen, France
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Laloi L, Billotey NC, Dumas P, Paul F, Villate A, Simand C, Fornecker L, Puisset F, Bertoli S, Simonet MB, Laribi K, Houyou D, Santagostino A, Michel C, Guepin GR, Guerineau E, Tabrizi R, Hunault M, Giltat A, Kaphan E, Bulabois C, Cartet E, Rocher C, Lachenal F, Morisset S, Récher C, Pigneux A, Belhabri A, Michallet M, Michallet A. Retrospective, real‐life study of venetoclax plus azacitidine or low‐dose cytarabine in French patients with acute myeloid leukemia ineligible for intensive chemotherapy. Cancer Med 2022; 12:7175-7181. [PMID: 36482507 PMCID: PMC10067034 DOI: 10.1002/cam4.5459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/08/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recently, the combination of venetoclax plus a hypomethylating agent (HMA; azacitidine ordecitabine) or low-dose cytarabine (LDAC) showed promise in Phase III trials in previously untreated AML. In France at the time of this study, venetoclax was not yet approved for AML and there were therefore no formal usage recommendations. Here we report the first study in a French cohort that assessed venetoclax in combination with existing treatments for AML under real-life conditions. METHOD This retrospective, real-life study collected data on venetoclax use and management in a French cohort with acute myeloid leukemia (AML) ineligible for intensive chemotherapy. RESULT Of 118 patients, 81 were in second line/beyond (71.6% also hypomethylating agent [HMA]; 23.5% lowdose cytarabine [LDAC]) and 37 in first line. For venetoclax initiation, 57.3% underwent ramp up and 74.6% were hospitalized. Median venetoclax duration was 2.5 months (range 0.03-16.2). With all treatment lines and regimens, most common grade 3/4 adverse events were hematologic (overall 96.4% of patients) and infections (57.1%). Dosage adjustments for drug interactions and safety varied between centers. In second-line/beyond, median progression-free survival was 4.0 months (95% confidence interval [CI] 2.7-12.8) with venetoclax-HMA and 3.4 months (1.3-8.9) with venetoclax-LDAC; overall response rate was 51.9% and 41.2%, respectively. Thus, we showed that venetoclax-based treatment yields promising findings in patients with AML, but to address treatment complexity, practice harmonization is needed.
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Affiliation(s)
- Louise Laloi
- Department of Pharmacy Centre Léon Bérard Lyon France
| | | | - Pierre‐Yves Dumas
- Department of Hematology University Hospital of Bordeaux Bordeaux France
| | - Franciane Paul
- Department of Hematology University Hospital of Montpellier Montpellier France
| | - Alban Villate
- Department of Hematology University Hospital of Tours Tours France
| | - Célestine Simand
- Department of Hematology University Hospital of Strasbourg Strasbourg France
| | - Luc Fornecker
- Department of Hematology University Hospital of Strasbourg Strasbourg France
| | - Florent Puisset
- Department of Pharmacy Institut Universitaire du Cancer Oncopole Toulouse France
| | - Sarah Bertoli
- Department of Hematology Institut Universitaire du Cancer Oncopole Toulouse France
| | | | - Kamel Laribi
- Department of Hematology Hospital of Le Mans Le Mans France
| | - Dyhia Houyou
- Department of Clinical Research Hospital of Troyes Troyes France
| | | | - Claire Michel
- Department of Hematology University Hospital of Nancy Nancy France
| | | | - Elodie Guerineau
- Department of Clinical Research Hospital of Mont de Marsan Mont de Marsan France
| | - Reza Tabrizi
- Department of Hematology Hospital of Mont de Marsan Mont de Marsan France
| | - Mathilde Hunault
- Department of Hematology University Hospital of Angers Angers France
| | - Aurélien Giltat
- Department of Hematology University Hospital of Angers Angers France
| | - Eléonore Kaphan
- Department of Hematology University Hospital of Grenoble Grenoble France
| | - Claude Bulabois
- Department of Hematology University Hospital of Grenoble Grenoble France
| | - Elodie Cartet
- Department of Pharmacy Hospital of Bourgoin‐Jallieu Bourgoin‐Jallieu France
| | - Clément Rocher
- Department of Hematology Hospital of Bourgoin‐Jallieu Bourgoin‐Jallieu France
| | - Florence Lachenal
- Department of Hematology Hospital of Bourgoin‐Jallieu Bourgoin‐Jallieu France
| | | | - Christian Récher
- Department of Hematology Institut Universitaire du Cancer Oncopole Toulouse France
| | - Arnaud Pigneux
- Department of Hematology University Hospital of Bordeaux Bordeaux France
| | - Amine Belhabri
- Department of Hematology and Medical Oncology Centre Léon Bérard Lyon France
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3
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Virot E, Thuret I, Jardel S, Herbrecht R, Lachenal F, Lionnet F, Lucchini MJ, Machin J, Nimubona S, Ribeil JA, Galacteros F, Cannas G, Hot A. Pregnancy outcome in women with transfused beta-thalassemia in France. Ann Hematol 2021; 101:289-296. [PMID: 34668980 DOI: 10.1007/s00277-021-04697-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/10/2021] [Indexed: 01/19/2023]
Abstract
Because of chronic anemia, hypogonadotropic hypogonadism, and iron chelation, pregnancy in homozygous and heterozygous compound beta-thalassemia patients stays a challenge. Pregnancies of transfused beta-thalassemia women registered in the French National Registry, conducted between 1995 and 2015, are described. These pregnancies were compared with pregnancies in healthy women and to data previously published in the literature. Fifty-six pregnancies of 37 women were studied. There were 5 twin pregnancies. Assisted reproductive technologies (ART) were used in 9 pregnancies. Median term at delivery was 39 amenorrhea weeks, and median weight at birth was 2780 g. Cesarean section was performed in 53.6% of the pregnancies. There were 6 thromboembolic events, 6 serious infections, 6 pregnancy-induced hypertensions (PIH), 6 intrauterine growth retardations (IUGR), 5 severe hemorrhages, 4 gestational diabetes, 3 alloimmunizations, 2 heart diseases, and 1 pre-eclampsia. There were 5 infections and 4 osteoporosis in the first year of post-partum. ART and cesarean sections were more often used in the beta-thalassemia group, compared to control subjects. Thromboembolic events, PIH, hemorrhage at delivery, and IUGR were more frequent in the beta-thalassemia group. Time to delivery was not different, but infant weight at birth was significantly smaller in the beta-thalassemia group. In the post-partum period, global maternal complications were more frequent in the beta-thalassemia group. Pregnancy in transfused beta-thalassemia women is safe with rare obstetrical and fetal complications. Cesarean section remains often chosen, and infant weight at birth remains smaller than that in the general population, despite delivery at full term.
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Affiliation(s)
- Emilie Virot
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval 69003, Lyon, France.
| | - Isabelle Thuret
- Département d'Hématologie Pédiatrique, Centre de Référence Français Des Thalassémies, Hôpital de La Timone, Marseille, France
| | - Sabine Jardel
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval 69003, Lyon, France
| | - Raoul Herbrecht
- Département d'Onco-Hématologie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France
| | - Florence Lachenal
- Département d'Hématologie, Hôpital de Bourgoin-Jallieu, Bourgoin-Jallieu, France
| | | | - Marie-José Lucchini
- Département de Médecine Interne, Centre Hospitalier d'Ajaccio, Ajaccio, France
| | - Julie Machin
- Département d'Hématologie, Centre Hospitalier de Roubaix, Roubaix, France
| | - Stanislas Nimubona
- Dépatement d'Hématologie, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | | | - Giovanna Cannas
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval 69003, Lyon, France
| | - Arnaud Hot
- Département de Médecine Interne, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5 Place d'Arsonval 69003, Lyon, France
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4
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Park S, Kosmider O, Maloisel F, Drenou B, Chapuis N, Lefebvre T, Karim Z, Puy H, Alary AS, Ducamp S, Verdier F, Bouilloux C, Rousseau A, Jacob MC, Debliquis A, Charpentier A, Gyan E, Anglaret B, Leyronnas C, Corm S, Slama B, Cheze S, Laribi K, Amé S, Rose C, Lachenal F, Toma A, Pica GM, Carre M, Garban F, Mariette C, Cahn JY, Meunier M, Herault O, Fenaux P, Wagner-Ballon O, Bardet V, Dreyfus F, Fontenay M. Dyserythropoiesis evaluated by the RED score and hepcidin:ferritin ratio predicts response to erythropoietin in lower-risk myelodysplastic syndromes. Haematologica 2018; 104:497-504. [PMID: 30287621 PMCID: PMC6395339 DOI: 10.3324/haematol.2018.203158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 06/27/2018] [Accepted: 10/02/2018] [Indexed: 12/29/2022] Open
Abstract
Erythropoiesis-stimulating agents are generally the first line of treatment of anemia in patients with lower-risk myelodysplastic syndrome. We prospectively investigated the predictive value of somatic mutations, and biomarkers of ineffective erythropoiesis including the flow cytometry RED score, serum growth-differentiation factor-15, and hepcidin levels. Inclusion criteria were no prior treatment with erythropoiesis-stimulating agents, low- or intermediate-1-risk myelodysplastic syndrome according to the International Prognostic Scoring System, and a hemoglobin level <10 g/dL. Patients could be red blood cell transfusion-dependent or not and were given epoetin zeta 40 000 IU/week. Serum erythropoietin level, iron parameters, hepcidin, flow cytometry Ogata and RED scores, and growth-differentiation factor-15 levels were determined at baseline, and molecular analysis by next-generation sequencing was also conducted. Erythroid response (defined according to the International Working Group 2006 criteria) was assessed at week 12. Seventy patients, with a median age of 78 years, were included in the study. There were 22 patients with refractory cytopenia with multilineage dysplasia, 19 with refractory cytopenia with unilineage dysplasia, 14 with refractory anemia with ring sideroblasts, four with refractory anemia with excess blasts-1, six with chronic myelomonocytic leukemia, two with del5q-and three with unclassifiable myelodysplastic syndrome. According to the revised International Prognostic Scoring System, 13 had very low risk, 47 had low risk, nine intermediate risk and one had high-risk disease. Twenty patients were transfusion dependent. Forty-eight percent had an erythroid response and the median duration of the response was 26 months. At baseline, non-responders had significantly higher RED scores and lower hepcidin:ferritin ratios. In multivariate analysis, only a RED score >4 (P=0.05) and a hepcidin:ferritin ratio <9 (P=0.02) were statistically significantly associated with worse erythroid response. The median response duration was shorter in patients with growth-differentiation factor-15 >2000 pg/mL and a hepcidin:ferritin ratio <9 (P=0.0008 and P=0.01, respectively). In multivariate analysis, both variables were associated with shorter response duration. Erythroid response to epoetin zeta was similar to that obtained with other erythropoiesis-stimulating agents and was correlated with higher baseline hepcidin:ferritin ratio and lower RED score. ClinicalTrials.gov registration: NCT 03598582.
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Affiliation(s)
- Sophie Park
- Department of Hematology, CHU Grenoble-Alpes, Grenoble .,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | - Olivier Kosmider
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre, Institut Cochin, Université Paris Descartes
| | | | - Bernard Drenou
- Department of Hematology, Hôpital Emile Muller, CH de Mulhouse
| | - Nicolas Chapuis
- INSERM UMR1149, CNRS 8252 - Centre de Recherche sur l'Inflammation (CRI) Equipe "Hème, Fer et Pathologies Inflammatoires", Labex GREX, Centre Français des Porphyries - Hôpital Louis Mourier HUPNVS, Paris
| | - Thibaud Lefebvre
- Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris Descartes University
| | - Zoubida Karim
- INSERM UMR1149, CNRS 8252 - Centre de Recherche sur l'Inflammation (CRI) Equipe "Hème, Fer et Pathologies Inflammatoires", Labex GREX, Centre Français des Porphyries - Hôpital Louis Mourier HUPNVS, Paris
| | - Hervé Puy
- INSERM UMR1149, CNRS 8252 - Centre de Recherche sur l'Inflammation (CRI) Equipe "Hème, Fer et Pathologies Inflammatoires", Labex GREX, Centre Français des Porphyries - Hôpital Louis Mourier HUPNVS, Paris
| | - Anne Sophie Alary
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre, Institut Cochin, Université Paris Descartes
| | - Sarah Ducamp
- Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris Descartes University
| | - Frédérique Verdier
- Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris Descartes University
| | - Cécile Bouilloux
- Department of Hematology, CHU Grenoble-Alpes, Grenoble.,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | - Alice Rousseau
- Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris Descartes University
| | | | | | | | | | | | | | | | | | | | | | - Shanti Amé
- Department of Hematology, Hôpital Civil, CHU Strasbourg
| | - Christian Rose
- Department of Hematology, Hôpital Saint Vincent de Paul, Lille
| | | | - Andrea Toma
- Department of Hematology, Hôpital Universitaire Henri Mondor, AP-HP, Université Paris 12, Créteil
| | | | - Martin Carre
- Department of Hematology, CHU Grenoble-Alpes, Grenoble.,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | - Frédéric Garban
- Department of Hematology, CHU Grenoble-Alpes, Grenoble.,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | - Clara Mariette
- Department of Hematology, CHU Grenoble-Alpes, Grenoble.,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | - Jean-Yves Cahn
- Department of Hematology, CHU Grenoble-Alpes, Grenoble.,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | - Mathieu Meunier
- Department of Hematology, CHU Grenoble-Alpes, Grenoble.,Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, Grenoble
| | | | - Pierre Fenaux
- Department of Hematology, Saint Louis Hospital, AP-HP, Université Paris Diderot
| | - Orianne Wagner-Ballon
- Département d'Hématologie et Immunologie Biologiques, Hôpital Universitaire Henri Mondor, Creteil
| | - Valerie Bardet
- Service d'Hématologie Immunologie Transfusion, Hôpitaux Universitaires Paris Ile de France-Ouest, AP-HP
| | | | - Michaela Fontenay
- Assistance Publique-Hôpitaux de Paris (AP-HP), Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre, Institut Cochin, Université Paris Descartes
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5
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Mekinian A, Maisonobe L, Boukari L, Melenotte C, Terrier B, Ayrignac X, Scheinlitz N, Sène D, Hamidou M, Konaté A, Guilpain P, Abisror N, Ghrenassia E, Lachenal F, Cevallos R, Roos-Weil R, Du LTH, Lhote F, Larroche C, Bergmann JF, Humbert S, Fraison JB, Piette JC, Guillevin L, Dhote R, Amoura Z, Haroche J, Fain O. Characteristics, outcome and treatments with cranial pachymeningitis: A multicenter French retrospective study of 60 patients. Medicine (Baltimore) 2018; 97:e11413. [PMID: 30045263 PMCID: PMC6078725 DOI: 10.1097/md.0000000000011413] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to determine the characteristics, treatment, and outcome according to each etiology of pachymeningitis.We conducted a retrospective multicenter French nationwide study between 2000 and 2016 to describe the characteristics, outcome, and treatment of pachymeningitis.We included 60 patients (median age 55.5 years; interquartile range [IQR] 30-80, female/male ratio 0.43). Neurologic signs were present in 59 patients (98%) and consisted of headache in 43 (72%), cranial nerve palsy in 33 (55%), confusion in 10 (17%), seizures in 7 (12%), and focal neurologic signs in 9 (15%). Fever and weight loss were present in 8 (13%) and 13 cases (22%), respectively. Cerebral venous thrombosis was present in 8 cases (13%). Analysis of cerebrospinal fluid showed moderate hyperproteinorachia (median 0.68 g/L; IQR 0.46-3.2) with or without pleiocytosis. Diagnosis included idiopathic pachymeningitis (n = 18; 30%); granulomatosis with polyangiitis (n = 13; 17%); Erdheim-Chester disease (n = 10; 17%); IgG4-related disease and tuberculosis (n = 3; 5% each); Rosai-Dofman disease, microscopic polyangiitis, and sarcoidosis (n = 2, 3% each); cryptococcal meningitis, Lyme disease, ear-nose-throat infection, postlumbar puncture, low spinal-fluid pressure syndrome, and lymphoma (n = 1 each). We found no difference in demographics and neurologic presentation among idiopathic pachymeningitis, Erdheim-Chester disease, and granulomatosis with polyangiitis. In contrast, frequencies were lower with idiopathic pachymeningitis than Erdheim-Chester disease for general signs (6% and 40%, respectively, P = .041) and complete neurologic response (0% vs 39%, P = .045).The detection of extraneurologic signs and routine screening are needed to classify the pachymeningitis origin. Prospective studies are warranted to determine the best treatment in each case.
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Affiliation(s)
- Arsene Mekinian
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
| | - Lucas Maisonobe
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
| | | | - Cléa Melenotte
- Département de Médecine Interne, CHU de la Timone, Aix-Marseille Université, AP-HM, Marseille
| | - Benjamin Terrier
- Université Paris Descartes, Paris
- AP-HP, Hôpital Cochin, Centre de Référence des Maladies Auto-immunes et Systémiques Rares, Service de Médecine Interne, Paris
| | - Xavier Ayrignac
- Département de Neurologie, Hôpital Gui de Chauliac, CHU de Montpellier
| | - Nicolas Scheinlitz
- Département de Médecine Interne, CHU de la Timone, Aix-Marseille Université, AP-HM, Marseille
| | - Damien Sène
- Département de Médecine Interne, GH Saint-Louis Lariboisière Fernand Widal
- Université Paris Diderot, Paris
| | | | - Amadou Konaté
- Service de Médecine Interne et Vasculaire, CHU Montpellier, Montpellier
| | - Philippe Guilpain
- Service de Médecine Interne et Vasculaire, CHU Montpellier, Montpellier
| | - Noémie Abisror
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
| | - Etienne Ghrenassia
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
| | | | - Ramiro Cevallos
- Service de Médecine Interne, Clinique Sainte Anne, rue Philippe Thyss, Strasbourg
| | | | - Le Thi Huong Du
- Service de Médecine Interne, Hôpital Pitié Salpetrière, Université Paris, APHP, Paris
- Université Pierre et Marie Curie, Paris, UPMC
- Centre National de Référence des Maladies Auto-immunes et Systémiques Rares
| | - Francois Lhote
- Service de Médecine Interne, Hôpital Delafontaine, Saint Denis
| | - Claire Larroche
- Service de Médecine Interne, Université Paris, AP-HP, Avicenne, Bobigny
| | - Jean-Francois Bergmann
- Département de Médecine Interne, GH Saint-Louis Lariboisière Fernand Widal
- Université Paris Diderot, Paris
| | | | - Jean Baptiste Fraison
- Université Paris Descartes, Paris
- AP-HP, Hôpital Cochin, Centre de Référence des Maladies Auto-immunes et Systémiques Rares, Service de Médecine Interne, Paris
| | - Jean Charles Piette
- Service de Médecine Interne, Hôpital Pitié Salpetrière, Université Paris, APHP, Paris, France
| | - Loïc Guillevin
- Université Paris Descartes, Paris
- AP-HP, Hôpital Cochin, Centre de Référence des Maladies Auto-immunes et Systémiques Rares, Service de Médecine Interne, Paris
| | - Robin Dhote
- Service de Médecine Interne, Université Paris, AP-HP, Avicenne, Bobigny
| | - Zahir Amoura
- Service de Médecine Interne, Hôpital Pitié Salpetrière, Université Paris, APHP, Paris
- Université Pierre et Marie Curie, Paris, UPMC
- Centre National de Référence des Maladies Auto-immunes et Systémiques Rares
| | - Julien Haroche
- Service de Médecine Interne, Hôpital Pitié Salpetrière, Université Paris, APHP, Paris
- Université Pierre et Marie Curie, Paris, UPMC
- Centre National de Référence des Maladies Auto-immunes et Systémiques Rares
| | - Olivier Fain
- AP-HP, Hôpital Saint Antoine, Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris
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6
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Virot E, Thuret I, Galactéros F, Lachenal F, Lionnet F, Lucchini-Lecomte M, Nimubona S, Pegourie B, Ribeil J, Rose C, Steschenko D, Hot A. Devenir de la grossesse chez les patientes béta-thalassémiques transfusées : données du registre national français. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.364] [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: 11/26/2022]
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7
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Evrard J, Farnier E, Carcel C, Lachenal F, Vial T, Pont E. [Proton Pump Inhibitor and High-dose Methotrexate: Two Cases Reports]. Therapie 2015; 70:527-35. [PMID: 26242498 DOI: 10.2515/therapie/2015047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 06/12/2015] [Indexed: 11/20/2022]
Abstract
Methotrexate (MTX) is a cytotoxic agent prescribed at high dose in treatment of malignancy. Association of MTX to proton pump inhibitor (PPI) is not recommended if doses are more than 20 mg per weeks and only to take into account for smaller doses. Review relate some cases of delayed elimination of methotrexate in patients taking PPI, which increase risk of toxic event. However, currently there is no status quo on interaction between PPI and MTX according to available data. We report two clinical cases illustrating one more time a toxic event to MTX in presence of PPI. In absence of risk/benefit ratio set correctly, an assessment of appropriateness of PPI prescription before MTX therapy can limit an iatrogenic risk.
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Affiliation(s)
- Julien Evrard
- Service Pharmacie, Hôpital Pierre Oudot, CH Bourgoin-Jallieu, Bourgoin-Jallieu, France
| | - Elodie Farnier
- Service Pharmacie, Hôpital Pierre Oudot, CH Bourgoin-Jallieu, Bourgoin-Jallieu, France
| | - Corine Carcel
- Centre Régional de Pharmacovigilance de Lyon, Lyon, France
| | - Florence Lachenal
- Service Médecine Interne et Onco-Hématologie, Hôpital Pierre Oudot, CH Bourgoin-Jallieu, Bourgoin-Jallieu, France
| | - Thierry Vial
- Centre Régional de Pharmacovigilance de Lyon, Lyon, France
| | - Emmanuelle Pont
- Service Pharmacie, Hôpital Pierre Oudot, CH Bourgoin-Jallieu, Bourgoin-Jallieu, France
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8
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Affiliation(s)
- Florence Lachenal
- Department of Oncology and Hematology, Hôpital Pierre Oudot, 30 Blvd du médipôle, 38300 Bourgoin-Jallieu, France.
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9
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Lachenal F, Méeus P, Thiesse P, Pariset C. Streptococcus pneumoniae retroperitoneal and pelvic abscess. Lancet Infect Dis 2011; 11:720. [PMID: 21867957 DOI: 10.1016/s1473-3099(10)70254-1] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Florence Lachenal
- Department of Oncology and Hematology, Hôpital Pierre Oudot, Bourgoin-Jallieu, France. fl
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10
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Karkowski L, Pérard L, Mausserey C, Desmurs-Clavel H, Lachenal F, Debourdeau P, Salles G, Cathebras P, Pavic M, Ninet J, Hot A. Efficacité sur le long terme du traitement par rituximab du purpura thrombotique thrombocytopénique acquis. À propos de 12 cas. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.014] [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: 10/18/2022]
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11
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Hajek V, Pavic M, Lachenal F, Pasquet F, Karkowski L, Gerôme P. Étude rétrospective de 168 valeurs de protéine C réactive supérieure à 500mg/L : quelles étiologies et quelle gravité ? Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.447] [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: 11/28/2022]
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12
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Lachenal F, Nkana K, Nove-Josserand R, Fabien N, Durieu I. Prevalence and clinical significance of auto-antibodies in adults with cystic fibrosis. Eur Respir J 2009; 34:1079-85. [PMID: 19443536 DOI: 10.1183/09031936.00006009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to determine the prevalence of different auto-antibodies in adult, French cystic fibrosis (CF) patients and to look for a correlation between autoimmunity, patient characteristics and survival. The sera of 144 patients were screened for a wide range of antibodies. Clinical, biological and bacteriological characteristics and the cystic fibrosis transmembrane conductance regulator genotype were recorded and progression of lung disease was examined. 113 (78.5%) patients displayed one or several auto-antibodies, predominantly immunoglobulin (Ig)A anti-Saccharomyces cerevisiae antibodies (ASCA; 43.7%) and antineutrophil cytoplasmic antibodies (ANCA; 40%), of which 59% showed bactericidal/permeability-increasing protein (BPI) specificity. The presence of BPI-ANCA was associated with the number of antibiotic courses, low body mass index, Pseudomonas aeruginosa colonisation, the presence of resistant P. aeruginosa, low forced expiratory volume in 1 s, CF-related liver disease, hypergammaglobulinaemia, male sex and inflammatory syndrome. The presence of ASCA-IgA was correlated with male sex and hypergammaglobulinaemia. 41 patients presented with chronic respiratory failure and/or requested lung transplantation or died during follow-up. These events were more frequent in patients with BPI-ANCA or ASCA-IgA. These findings confirm the high frequency of auto-antibodies in CF, particularly BPI-ANCA and ASCA-IgA, and the link between BPI-ANCA, severity of lung disease and CF prognosis.
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Affiliation(s)
- F Lachenal
- Dept of Internal Medicine, Centre Hospitalier Lyon Sud, F-69495 Pierre-Bénite Cedex, France.
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13
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Abstract
Angioimmunoblastic T-cell lymphoma most often affects the elderly. Patients present with generalized lymphadenopathy and systemic symptoms; half also have hepatomegaly, splenomegaly and a rash. Polyclonal hypergammaglobulinemia, elevated lactate dehydrogenase, and anemia are the main laboratory abnormalities. Autoimmune phenomena (including autoimmune hemolytic anemia, immunologic thrombocytopenia, and autoantibodies) are common. Lymph node biopsy is needed to confirm this diagnosis. Genetic analysis that reveals a monoclonal T-cell population is also relevant. The underlying immune deficiency explains the frequency of infections. Most patients are treated with combination chemotherapy. Autologous stem cell transplantation is proposed to the youngest. Immunosuppressive drugs may be appropriate for elderly or relapsing patients. The overall 5-year survival rate is 30%.
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Affiliation(s)
- Florence Lachenal
- Service de médecine interne, Centre hospitalier Lyon Sud, Pierre-Bénite.
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15
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Lachenal F, Berger F, Ghesquières H, Biron P, Hot A, Callet-Bauchu E, Chassagne C, Coiffier B, Durieu I, Rousset H, Salles G. Angioimmunoblastic T-cell lymphoma: clinical and laboratory features at diagnosis in 77 patients. Medicine (Baltimore) 2007; 86:282-292. [PMID: 17873758 DOI: 10.1097/md.0b013e3181573059] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We retrospectively analyzed 77 patients with pathologically diagnosed angioimmunoblastic T-cell lymphoma from a single city. There were 43 men and 34 women; the median age was 64.5 years (range, 30-91 yr). Average time between first symptoms of the disease and diagnosis was 3.6 months. At diagnosis, peripheral nodes were present in all but 1 patient, and were generalized in 90% of cases. Constitutional symptoms were reported in 77% of cases and spleen enlargement in 51%. A cutaneous eruption--morbilliform, urticarial, or more polymorphic--was present in 45% of patients; in one-third of them, the eruption occurred after drug administration. Other clinical manifestations included pleuritis (22%); arthralgia or arthritis (17%); ear, nose, and throat involvement (14%); central or peripheral neurologic manifestations (10%); and ascites (5%). Most patients presented with advanced disease at diagnosis (bone marrow involvement in 60% of cases). The main laboratory abnormalities were elevated lactate dehydrogenase levels (71%), inflammatory syndrome (67%), hypergammaglobulinemia (50%), anemia (51%), and lymphopenia (52%). Auto- or disimmune manifestations were reported in one-third of patients: autoimmune hemolytic anemia was present at diagnosis in 19% of patients and thrombocytopenic purpura in 7%. Documented vasculitis was described in 12% of cases. Clonality was analyzed in lymph nodes in 47 patients: T-cell and B-cell clones were found in 45 (96%) and 20 (45%) patients, respectively. Chromosomal abnormalities were identified in 62% of cases: trisomies 3, 5, 18, 19, additional X chromosome, and deletion of chromosome 7 were the most common abnormalities. The current study underlines the diversity of presenting manifestations of angioimmunoblastic T-cell lymphoma.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers/blood
- Cytological Techniques
- Diagnostic Errors
- Disease Progression
- Female
- Follow-Up Studies
- Herpesvirus 4, Human/isolation & purification
- Humans
- Immunoblastic Lymphadenopathy/complications
- Immunoblastic Lymphadenopathy/diagnosis
- Immunoblastic Lymphadenopathy/immunology
- Immunoblastic Lymphadenopathy/pathology
- Immunoblastic Lymphadenopathy/virology
- Kaplan-Meier Estimate
- Lymphoma, T-Cell, Peripheral/complications
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/virology
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- RNA, Viral/analysis
- Retrospective Studies
- Severity of Illness Index
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Affiliation(s)
- Florence Lachenal
- From Hospices Civils de Lyon, Department of Internal Medicine (FL, ID, HR), Department of Pathology (FB), Department of Cytogenetic and Molecular Biology (ECB), and Department of Hematology (BC, GS), Centre Hospitalier Lyon Sud, Pierre-Bénite; Department of Internal Medicine (AH), Hospital Edouard Herriot, Lyon; Department of Hematology (HG, PB) and Department of Pathology (CC), Centre Léon Bérard, Lyon; and Université Claude Bernard Lyon 1 (FL, FB, AH, ECB, BC, ID, HR, GS), Lyon, France
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Le Roux K, Streichenberger N, Vial C, Petiot P, Feasson L, Bouhour F, Ninet J, Lachenal F, Broussolle C, Sève P. Granulomatous myositis: a clinical study of thirteen cases. Muscle Nerve 2007; 35:171-7. [PMID: 17068767 DOI: 10.1002/mus.20683] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [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: 11/09/2022]
Abstract
Granulomatous myositis (GM) is a rare condition that has generally been described in association with sarcoidosis. In the absence of sarcoidosis or other underlying disease, a diagnosis of isolated GM is considered. Only one study has focused on the clinical difference between isolated GM and sarcoid myopathy (SM). We report 13 cases of symptomatic GM; 8 had sarcoidosis. All patients with sarcoidosis had predominantly proximal, symmetrical lower-limb weakness, and 3 subsequently developed upper-limb or distal involvement. Three of the five patients with isolated GM had predominantly distal muscle involvement, and two had dysphagia. Corticosteroid treatment was followed by prolonged improvement in only one patient with sarcoidosis. One patient had acute sarcoid myositis and benefited from methotrexate; other immunosuppressants and etanercept proved ineffective in chronic sarcoid myopathy. Three of the five patients with isolated GM responded to corticosteroid treatment. When last examined, three patients with sarcoidosis had severe disability, whereas patients with isolated GM showed milder weakness. Thus, SM was frequently associated with severe disability and rarely improved after corticosteroid treatment, whereas most patients with isolated GM improved.
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Affiliation(s)
- Karine Le Roux
- Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
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Lachenal F, Cotton F, Desmurs-Clavel H, Haroche J, Taillia H, Magy N, Hamidou M, Salvatierra J, Piette JC, Vital-Durand D, Rousset H. Neurological manifestations and neuroradiological presentation of Erdheim-Chester disease: report of 6 cases and systematic review of the literature. J Neurol 2006; 253:1267-77. [PMID: 17063320 DOI: 10.1007/s00415-006-0160-9] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [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: 06/04/2005] [Accepted: 10/31/2005] [Indexed: 12/29/2022]
Abstract
Erdheim-Chester disease (ECD) is a rare, non-Langerhans form of histiocytosis of unknown etiology that affects multiple organs. We report 6 cases of ECD with neurological involvement and neuroradiological abnormalities on brain MRI. A literature review revealed 60 other cases of ECD with neurological involvement. We therefore analyzed 66 ECD patients with neurological involvement. Cerebellar and pyramidal syndromes were the most frequent clinical manifestations (41% and 45% of cases), but seizures, headaches, neuropsychiatric or cognitive troubles, sensory disturbances, cranial nerve paralysis or asymptomatic lesions were also reported. Neurological manifestations were always associated with other organ involvement, especially of bones (at least 86%) and diabetes insipidus (47%). Neurological involvement was responsible for severe functional handicaps in almost all patients and was responsible for the death of 6 of the 66 patients (9%). Neuroradiological findings could be separated into three patterns: the infiltrative pattern (44%), with widespread lesions, nodules or intracerebral masses, the meningeal pattern (37%), with either thickening of the dura mater or meningioma-like tumors, and the composite pattern (19%), with both infiltrative and meningeal lesions.
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Affiliation(s)
- Florence Lachenal
- Department of Internal Medicine, Centre Hospitalier Lyon Sud, 69495, Pierre-Bénite, Cedex, France.
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