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Mesguich C, Hindie E, de Senneville BD, Tlili G, Pinaquy JB, Marit G, Saut O. Improved 18-FDG PET/CT diagnosis of multiple myeloma diffuse disease by radiomics analysis. Nucl Med Commun 2021; 42:1135-1143. [PMID: 34001823 DOI: 10.1097/mnm.0000000000001437] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES In multiple myeloma, the diagnosis of diffuse bone marrow infiltration on 18-FDG PET/CT can be challenging. We aimed to develop a PET/CT radiomics-based model that could improve the diagnosis of multiple myeloma diffuse disease on 18-FDG PET/CT. METHODS We prospectively performed PET/CT and whole-body diffusion-weighted MRI in 30 newly diagnosed multiple myeloma. MRI was the reference standard for diffuse disease assessment. Twenty patients were randomly assigned to a training set and 10 to an independent test set. Visual analysis of PET/CT was performed by two nuclear medicine physicians. Spine volumes were automatically segmented, and a total of 174 Imaging Biomarker Standardisation Initiative-compliant radiomics features were extracted from PET and CT. Selection of best features was performed with random forest features importance and correlation analysis. Machine-learning algorithms were trained on the selected features with cross-validation and evaluated on the independent test set. RESULTS Out of the 30 patients, 18 had established diffuse disease on MRI. The sensitivity, specificity and accuracy of visual analysis were 67, 75 and 70%, respectively, with a moderate kappa coefficient of agreement of 0.6. Five radiomics features were selected. On the training set, random forest classifier reached a sensitivity, specificity and accuracy of 93, 86 and 91%, respectively, with an area under the curve of 0.90 (95% confidence interval, 0.89-0.91). On the independent test set, the model achieved an accuracy of 80%. CONCLUSIONS Radiomics analysis of 18-FDG PET/CT images with machine-learning overcame the limitations of visual analysis, providing a highly accurate and more reliable diagnosis of diffuse bone marrow infiltration in multiple myeloma patients.
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Affiliation(s)
- Charles Mesguich
- Nuclear Medicine Department, CHU Bordeaux.,INSERM U1035, University of Bordeaux, Bordeaux.,University of Bordeaux, IMB, UMR CNRS 5251, INRIA Project team Monc, Talence, France
| | | | | | | | | | | | - Olivier Saut
- University of Bordeaux, IMB, UMR CNRS 5251, INRIA Project team Monc, Talence, France
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Mesguich C, Latrabe V, Hulin C, Lascaux A, Bordenave L, Hindié E, Marit G. Prospective Comparison of 18-FDG PET/CT and Whole-Body MRI with Diffusion-Weighted Imaging in the Evaluation of Treatment Response of Multiple Myeloma Patients Eligible for Autologous Stem Cell Transplant. Cancers (Basel) 2021; 13:cancers13081938. [PMID: 33923781 PMCID: PMC8074107 DOI: 10.3390/cancers13081938] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022] Open
Abstract
To compare the prognostic values of 18-FDG PET/CT (FDG-PET) and Whole-Body MRI with Diffusion-Weighted Imaging (WB-DW-MRI) in the evaluation of treatment response of Multiple Myeloma (MM) patients eligible for ASCT. Thirty patients with newly diagnosed MM prospectively underwent FDG-PET and WB-DW-MRI at baseline, after induction chemotherapy and after ASCT. Response on WB-DW-MRI was evaluated with the MY-RADS criteria. FDG-PET was considered positive if residual uptake was superior to liver uptake. Imaging results were not used for treatment modification. The impact of imaging results on PFS was analyzed. After a median follow-up of 32 months, 10 patients relapsed. With WB-DW-MRI, post-induction examination was positive in 3/25 and post-ASCT examination was positive in 3/27 patients. However, neither study showed prognostic impact on PFS. FDG-PET was positive in 5/22 post-induction and 3/26 patients post-ASCT, respectively. Positivity of FDG-PET, post-induction or post-ASCT, was associated with a shorter PFS (post-induction: median PFS 19 months vs. not reached, log-rank p = 0.0089; post-ASCT: median PFS 18 months vs. not reached, log-rank p = 0.0005). Preliminary results from this small, single-center, prospective study show that, whether performed post-induction or post-ASCT, FDG-PET has a higher prognostic value than WB-DW-MRI for treatment response evaluation of newly diagnosed MM.
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Affiliation(s)
- Charles Mesguich
- Nuclear Medicine Department, CHU Bordeaux, F-33000 Bordeaux, France; (L.B.); (E.H.)
- INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France;
- Correspondence: ; Tel.: +33-5-57656335
| | - Valérie Latrabe
- Radiology Department, CHU Bordeaux, F-33000 Bordeaux, France;
| | - Cyrille Hulin
- Haematology Department, CHU Bordeaux, F-33000 Bordeaux, France; (C.H.); (A.L.)
| | - Axelle Lascaux
- Haematology Department, CHU Bordeaux, F-33000 Bordeaux, France; (C.H.); (A.L.)
| | - Laurence Bordenave
- Nuclear Medicine Department, CHU Bordeaux, F-33000 Bordeaux, France; (L.B.); (E.H.)
| | - Elif Hindié
- Nuclear Medicine Department, CHU Bordeaux, F-33000 Bordeaux, France; (L.B.); (E.H.)
| | - Gerald Marit
- INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France;
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3
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Mesguich C, Hulin C, Latrabe V, Lascaux A, Bordenave L, Hindié E, Marit G. Prospective comparison of 18-FDG PET/CT and whole-body diffusion-weighted MRI in the assessment of multiple myeloma. Ann Hematol 2020; 99:2869-2880. [PMID: 32951093 DOI: 10.1007/s00277-020-04265-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 09/07/2020] [Indexed: 12/21/2022]
Abstract
Magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18FDG 18F-FDG PET-CT) are standard procedures for staging multiple myeloma (MM). Diffusion-weighted sequences applied to whole-body MRI (WB-DWI) improve its sensitivity. We compared the number of MM bone focal lesions (FLs) detected by 18F-FDG PET-CT and WB-DWI and evaluated the diagnostic performance of 18F-FDG PET-CT for diffuse infiltration. Thirty newly diagnosed MM patients prospectively underwent 18F-FDG PET-CT and WB-DWI. The criteria for skeletal region positivity were ≥ 1 focal bone lesions (FLs) and/or diffuse disease. MRI with the MY-RADS criteria was used as a reference standard for the diagnosis of diffuse infiltration. 18F-FDG PET-CT and WB-DWI were both interpreted as positive in 28/30 patients with an agreement of 1.00 (95% CI 0.77-1.00) between the two methods. The mean numbers of FLs were 16.7 detected by 18F-FDG PET-CT and 23.9 detected by WB-DWI (P = 0.028). WB-DWI detected more FLs in the skull (P = 0.001) and spine (P = 0.006). Agreement assessed using the prevalence and bias-corrected kappa index was moderate (0.40-0.60) for the spine, sternum-ribs and upper limbs and substantial (0.60-0.80) for the pelvis and lower limbs. As regards the diagnosis of diffuse bone marrow infiltration, the sensitivity, specificity and accuracy of 18F-FDG PET-CT were 0.75, 0.79 and 0.77, respectively. Although WB-DWI detected more FLs than did 18F-FDG PET-CT, there was no difference in the detection of bone disease on a per-patient basis. 18F-FDG PET-CT showed high performance, including for evaluation of diffuse infiltration.
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Affiliation(s)
- Charles Mesguich
- Nuclear Medicine Department, CHU Bordeaux, 33000, Bordeaux, France. .,INSERM U1035, University of Bordeaux, Bordeaux, France.
| | - Cyrille Hulin
- Haematology Department, CHU Bordeaux, 33000, Bordeaux, France
| | | | - Axelle Lascaux
- Haematology Department, CHU Bordeaux, 33000, Bordeaux, France
| | | | - Elif Hindié
- Nuclear Medicine Department, CHU Bordeaux, 33000, Bordeaux, France
| | - Gerald Marit
- INSERM U1035, University of Bordeaux, Bordeaux, France
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4
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Mesguich C, Hulin C, Latrabe V, Asselineau J, Bordenave L, Perez P, Hindie E, Marit G. Prospective Comparison of 18F-Choline Positron Emission Tomography/Computed Tomography (PET/CT) and 18F-Fluorodeoxyglucose (FDG) PET/CT in the Initial Workup of Multiple Myeloma: Study Protocol of a Prospective Imaging Trial. JMIR Res Protoc 2020; 9:e17850. [PMID: 32909953 PMCID: PMC7516691 DOI: 10.2196/17850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 01/26/2023] Open
Abstract
Background The International Myeloma Working Group recommends the use of 18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for treatment response evaluation, as it is superior to magnetic resonance imaging (MRI). However, at initial staging, the sensitivity of FDG-PET remains inferior to that of MRI. Therefore, there is a need for an imaging technique that could have a sensitivity equal to that of MRI at diagnosis and could serve to evaluate therapy. 18F-choline has shown increased sensitivity when compared with 18-FDG, with about 75% more lesions detected in patients with relapsed or progressive multiple myeloma (MM). Objective Our primary objective is to prospectively compare the detection rate of bone lesions by 18F-choline PET/CT (FCH-PET) and FDG-PET in newly diagnosed MM. Our secondary objectives are to assess the accuracy of both PET modalities for the detection of bone lesions and the diagnosis of diffuse disease, to assess the detection rate of extramedullary lesions. Methods We will prospectively include 30 patients in a paired comparative accuracy study. Patients with de novo MM will undergo FCH-PET, FDG-PET, and whole-body MRI (WB-MRI) within a 3-week period. WB-MRI will be composed of conventional sequences on the spine and pelvis and of whole-body diffusion axial sequences. The following 6 skeletal areas will be defined: skull, sternum/costal grid, spine, pelvis, superior limbs, and inferior limbs. The number of focal lesions, their respective localization, and intensity of uptake will be retrieved for each skeletal area. Readings will be performed blinded from other imaging techniques. The reference standard will be WB-MRI. Focal lesions present on PET/CT but not on WB-MRI will require a decision made with a consensus of experts based on clinical and imaging data. The number of bone lesions and number of extramedullary lesions will be compared using the Wilcoxon test. The accuracy of FCH-PET and FDG-PET will be compared using the McNemar test. Results The study started in September 2019, and enrollment is ongoing. As of June 2020, 8 participants have been included. Data collection is expected to be completed in June 2021, and the results are expected to be available in December 2021. Conclusions This study will assess if FCH-PET is superior to FDG-PET for the evaluation of MM tumor burden. This will pave the way for future prospective evaluations of the prognostic value of 18-FCH for treatment response evaluation in MM patients. Additionally, this work may provide new perspectives for better assessment of the risk of smoldering MM progressing to MM. Trial Registration ClinicalTrials.gov NCT03891914; https://clinicaltrials.gov/ct2/show/NCT03891914 International Registered Report Identifier (IRRID) DERR1-10.2196/17850
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Affiliation(s)
- Charles Mesguich
- Nuclear Medicine Department, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.,INSERM U1035, Université de Bordeaux, Bordeaux, France
| | - Cyrille Hulin
- Hematology Department, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Valerie Latrabe
- Radiology Department, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Julien Asselineau
- Clinical Epidemiology Department, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Laurence Bordenave
- Nuclear Medicine Department, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Paul Perez
- Clinical Epidemiology Department, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Elif Hindie
- Nuclear Medicine Department, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Gerald Marit
- INSERM U1035, Université de Bordeaux, Bordeaux, France
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5
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Mesguich C, Hulin C, Lascaux A, Bordenave L, Marit G, Hindié E. Choline PET/CT in Multiple Myeloma. Cancers (Basel) 2020; 12:E1394. [PMID: 32481661 PMCID: PMC7352763 DOI: 10.3390/cancers12061394] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023] Open
Abstract
The field of multiple myeloma (MM) imaging has evolved. The International Myeloma Working Group recently recommended performing 18F-fluorodeoxyglucose glucose (18FDG) positron emission tomography/computed tomography (PET/CT) with the aim of staging MM patients at baseline and evaluating response to therapy. Novel oncological radiotracers such as 11C-Choline and 18F-Fluorocholine, have been studied in comparison with 18FDG, mostly in MM patients presenting with refractory disease or suspected relapse. Choline-based tracers may overcome some limitations of 18FDG, which include a lack of sensitivity in depicting skull lesions and the fact that 10% of MM patients are FDG-negative. The majority of MM lesions display a higher uptake of Choline than FDG. Also, in many situations, Choline may offer better lesion visualization, with a higher tumor to background ratio; however, various patterns of Choline and FDG uptake have been observed in MM and some limitations, notably as regards liver lesions, should be recognized. Overall, Choline may provide additional detection of up to 75% more lesions. This article aims to provide a comprehensive review of the potential role of Choline in multiple myeloma, as compared to FDG, encompassing Choline physiopathology as well as data from clinical studies.
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Affiliation(s)
- Charles Mesguich
- CHU Bordeaux, Nuclear Medicine Department, F-33000 Bordeaux, France; (L.B.); (E.H.)
- INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France;
| | - Cyrille Hulin
- CHU Bordeaux, Haematology, F-33000 Bordeaux, France; (C.H.); (A.L.)
| | - Axelle Lascaux
- CHU Bordeaux, Haematology, F-33000 Bordeaux, France; (C.H.); (A.L.)
| | - Laurence Bordenave
- CHU Bordeaux, Nuclear Medicine Department, F-33000 Bordeaux, France; (L.B.); (E.H.)
| | - Gerald Marit
- INSERM U1035, University of Bordeaux, F-33000 Bordeaux, France;
| | - Elif Hindié
- CHU Bordeaux, Nuclear Medicine Department, F-33000 Bordeaux, France; (L.B.); (E.H.)
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6
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McCarthy PL, Holstein SA, Petrucci MT, Richardson PG, Hulin C, Tosi P, Bringhen S, Musto P, Anderson KC, Caillot D, Gay F, Moreau P, Marit G, Jung SH, Yu Z, Winograd B, Knight RD, Palumbo A, Attal M. Lenalidomide Maintenance After Autologous Stem-Cell Transplantation in Newly Diagnosed Multiple Myeloma: A Meta-Analysis. J Clin Oncol 2017; 35:3279-3289. [PMID: 28742454 DOI: 10.1200/jco.2017.72.6679] [Citation(s) in RCA: 449] [Impact Index Per Article: 64.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Lenalidomide maintenance therapy after autologous stem-cell transplantation (ASCT) demonstrated prolonged progression-free survival (PFS) versus placebo or observation in several randomized controlled trials (RCTs) of patients with newly diagnosed multiple myeloma (NDMM). All studies had PFS as the primary end point, and none were powered for overall survival (OS) as a primary end point. Thus, a meta-analysis was conducted to better understand the impact of lenalidomide maintenance in this setting. Patients and Methods The meta-analysis was conducted using primary-source patient-level data and documentation from three RCTs (Cancer and Leukemia Group B 100104, Gruppo Italiano Malattie Ematologiche dell'Adulto RV-MM-PI-209, and Intergroupe Francophone du Myélome 2005-02) that met the following prespecified inclusion criteria: an RCT in patients with NDMM receiving ASCT followed by lenalidomide maintenance versus placebo or observation with patient-level data available and achieved database lock for primary efficacy analysis. Results Overall, 1,208 patients were included in the meta-analysis (605 patients in the lenalidomide maintenance group and 603 in the placebo or observation group). The median PFS was 52.8 months for the lenalidomide group and 23.5 months for the placebo or observation group (hazard ratio, 0.48; 95% CI, 0.41 to 0.55). At a median follow-up time of 79.5 months for all surviving patients, the median OS had not been reached for the lenalidomide maintenance group, whereas it was 86.0 months for the placebo or observation group (hazard ratio, 0.75; 95% CI, 0.63 to 0.90; P = .001). The cumulative incidence rate of a second primary malignancy before disease progression was higher with lenalidomide maintenance versus placebo or observation, whereas the cumulative incidence rates of progression, death, or death as a result of myeloma were all higher with placebo or observation versus lenalidomide maintenance. Conclusion This meta-analysis demonstrates a significant OS benefit and confirms the PFS benefit with lenalidomide maintenance after ASCT in patients with NDMM when compared with placebo or observation.
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Affiliation(s)
- Philip L McCarthy
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Sarah A Holstein
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Maria Teresa Petrucci
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Paul G Richardson
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Cyrille Hulin
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Patrizia Tosi
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Sara Bringhen
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Pellegrino Musto
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Kenneth C Anderson
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Denis Caillot
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Francesca Gay
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Philippe Moreau
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Gerald Marit
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Sin-Ho Jung
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Zhinuan Yu
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Benjamin Winograd
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Robert D Knight
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Antonio Palumbo
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
| | - Michel Attal
- Philip L. McCarthy, Roswell Park Cancer Institute, Buffalo, NY; Sarah A. Holstein, University of Nebraska Medical Center, Omaha, NE; Maria Teresa Petrucci, University La Sapienza; Antonio Palumbo, Takeda Italia, Rome; Patrizia Tosi, Rimini Hospital, Rimini; Sara Bringhen and Francesca Gay, University of Torino, Torino; Pellegrino Musto, Cancer Institute for Research and Care and The Referral Cancer Center of Basilicata, Rionero in Vulture, Italy; Paul G. Richardson and Kenneth C. Anderson, Dana-Farber Cancer Institute, Boston, MA; Cyrille Hulin and Gerald Marit, Bordeaux Centre Hospitalier Universitaire, Bordeaux; Denis Caillot, Dijon University Hospital Center, Dijon; Philippe Moreau, University Hospital Hôtel-Dieu, Nantes; Michel Attal, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France; Sin-Ho Jung, Duke University, Durham, NC; and Zhinuan Yu, Benjamin Winograd, and Robert D. Knight, Celgene Corporation, Summit, NJ
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Moreau P, Attal M, Caillot D, Macro M, Karlin L, Garderet L, Facon T, Benboubker L, Escoffre-Barbe M, Stoppa AM, Laribi K, Hulin C, Perrot A, Marit G, Eveillard JR, Caillon F, Bodet-Milin C, Pegourie B, Dorvaux V, Chaleteix C, Anderson K, Richardson P, Munshi NC, Avet-Loiseau H, Gaultier A, Nguyen JM, Dupas B, Frampas E, Kraeber-Bodere F. Prospective Evaluation of Magnetic Resonance Imaging and [ 18F]Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography at Diagnosis and Before Maintenance Therapy in Symptomatic Patients With Multiple Myeloma Included in the IFM/DFCI 2009 Trial: Results of the IMAJEM Study. J Clin Oncol 2017; 35:2911-2918. [PMID: 28686535 DOI: 10.1200/jco.2017.72.2975] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) are important imaging techniques in multiple myeloma (MM). We conducted a prospective trial in patients with MM aimed at comparing MRI and PET-CT with respect to the detection of bone lesions at diagnosis and the prognostic value of the techniques. Patients and Methods One hundred thirty-four patients received a combination of lenalidomide, bortezomib, and dexamethasone (RVD) with or without autologous stem-cell transplantation, followed by lenalidomide maintenance. PET-CT and MRI were performed at diagnosis, after three cycles of RVD, and before maintenance therapy. The primary end point was the detection of bone lesions at diagnosis by MRI versus PET-CT. Secondary end points included the prognostic impact of MRI and PET-CT regarding progression-free (PFS) and overall survival (OS). Results At diagnosis, MRI results were positive in 127 of 134 patients (95%), and PET-CT results were positive in 122 of 134 patients (91%; P = .33). Normalization of MRI after three cycles of RVD and before maintenance was not predictive of PFS or OS. PET-CT became normal after three cycles of RVD in 32% of the patients with a positive evaluation at baseline, and PFS was improved in this group (30-month PFS, 78.7% v 56.8%, respectively). PET-CT normalization before maintenance was described in 62% of the patients who were positive at baseline. This was associated with better PFS and OS. Extramedullary disease at diagnosis was an independent prognostic factor for PFS and OS, whereas PET-CT normalization before maintenance was an independent prognostic factor for PFS. Conclusion There is no difference in the detection of bone lesions at diagnosis when comparing PET-CT and MRI. PET-CT is a powerful tool to evaluate the prognosis of de novo myeloma.
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Affiliation(s)
- Philippe Moreau
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Michel Attal
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Denis Caillot
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Margaret Macro
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Lionel Karlin
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Laurent Garderet
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Thierry Facon
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Lotfi Benboubker
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Martine Escoffre-Barbe
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Anne-Marie Stoppa
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Kamel Laribi
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Cyrille Hulin
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Aurore Perrot
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Gerald Marit
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Jean-Richard Eveillard
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Florence Caillon
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Caroline Bodet-Milin
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Brigitte Pegourie
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Veronique Dorvaux
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Carine Chaleteix
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Kenneth Anderson
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Paul Richardson
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Nikhil C Munshi
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Herve Avet-Loiseau
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Aurelie Gaultier
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Jean-Michel Nguyen
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Benoit Dupas
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Eric Frampas
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
| | - Françoise Kraeber-Bodere
- Philippe Moreau, Florence Caillon, Caroline Bodet-Milin, Aurelie Gaultier, Jean-Michel Nguyen, Benoit Dupas, Eric Frampas, and Françoise Kraeber-Bodere, University Hospital, Nantes; Michel Attal, University Hospital, Toulouse; Denis Caillot, University Hospital, Dijon; Margaret Macro, University Hospital, Caen; Lionel Karlin, University Hospital, Lyon; Laurent Garderet, University Hospital Saint-Antoine, Paris; Thierry Facon, University Hospital, Lille; Lotfi Benboubker, University Hospital, Tours; Martine Escoffre-Barbe, University Hospital, Rennes; Anne-Marie Stoppa, Institut Paoli-Calmettes, Marseille; Kamel Laribi, University Hospital, Le Mans; Cyrille Hulin and Gerald Marit, University Hospital, Bordeaux; Aurore Perrot, University Hospital, Nancy; Jean-Richard Eveillard, University Hospital, Brest; Brigitte Pegourie, University Hospital, Grenoble; Veronique Dorvaux, University Hospital, Metz; Carine Chaleteix, University Hospital, Clermont-Ferrand; and Herve Avet-Loiseau, University Hospital, Toulouse, France; and Kenneth Anderson, Paul Richardson, and Nikhil C. Munshi, Dana-Farber Cancer Institute, Boston, MA
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Attal M, Palumbo A, Holstein SA, Lauwers-Cances V, Petrucci MT, Richardson PG, Hulin C, Tosi P, Anderson KC, Caillot D, Magarotto V, Moreau P, Marit G, Yu Z, McCarthy PL. Lenalidomide (LEN) maintenance (MNTC) after high-dose melphalan and autologous stem cell transplant (ASCT) in multiple myeloma (MM): A meta-analysis (MA) of overall survival (OS). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.8001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Antonio Palumbo
- Department of Hematology, University of Torino, Torino, Italy
| | | | | | | | | | - Cyrille Hulin
- Hematology Department, University Hospital, Nancy, France
| | - Patrizia Tosi
- Seràgnoli Institute of Hematology and Medical Oncology, Bologna University, Bologna, Italy
| | | | | | - Valeria Magarotto
- Myeloma Unit, Division of Hematology, University of Torino, AOU S. Giovanni Battista, Torino, Italy
| | | | - Gerald Marit
- Service d'Hématologie Clinique, Hôpital du Haut Leveque CHU de Bordeaux, Bordeaux, France
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9
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Fouquet G, Pegourie B, Macro M, Petillon MO, Karlin L, Caillot D, Roussel M, Arnulf B, Mathiot C, Marit G, Kolb B, Stoppa AM, Brechiniac S, Richez V, Rodon P, Banos A, Wetterwald M, Garderet L, Royer B, Hulin C, Benbouker L, Decaux O, Escoffre-Barbe M, Fermand JP, Attal M, Avet-Loiseau H, Moreau P, Facon T, Leleu X. Safe and prolonged survival with long-term exposure to pomalidomide in relapsed/refractory myeloma. Ann Oncol 2016; 27:902-7. [PMID: 26787238 DOI: 10.1093/annonc/mdw017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/07/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The IFM2009-02 trial studied pomalidomide (4 mg daily, 21/28 versus 28/28) and dexamethasone in very advanced relapsed or refractory multiple myeloma (RRMM). We observed that 40% of patients had a prolonged progression-free survival (PFS) and subsequently overall survival (OS). We sought to analyze the characteristics of these patients and study the effect of long exposure to pomalidomide. DESIGN We separated the studied population into two groups: 3 months to 1 year (<1 year) and more than 1 year (≥1 year) of treatment with pomalidomide and dexamethasone based on clinical judgment and historical control studies. We then analyzed the characteristics of patients according to duration of treatment. RESULTS The overall response rate (ORR) for the <1-year group was 43%, the median PFS 4.6 months [95% confidence interval (95% CI) 3.8-6.4] with only 6% at 12 months, and the median OS was 15 months (11.7-20.3) and 40% at 18 months. For the ≥1-year group, the response rate and survival were strikingly different, ORR at 83%, median PFS 20.7 months (14.7-35.4), median OS not reached, and 91% at 18 months. CONCLUSION Pomalidomide and dexamethasone favored prolonged and safe exposure to treatment in 40% of heavily treated and end-stage RRMM, a paradigm shift in the natural history of RRMM characterized with a succession of shorter disease-free intervals and ultimately shorter survival. Although an optimization of pomalidomide-dexamethasone regimen is warranted in advanced RRMM, we claim that pomalidomide has proven once more to change the natural history of myeloma in this series, which should be confirmed in a larger study.
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Affiliation(s)
- G Fouquet
- Department of Blood Diseases, Hôpital Huriez, CHRU Lille, Lille
| | - B Pegourie
- Department of Hematology, Hôpital A.Michallon, CHU Grenoble, Grenoble
| | - M Macro
- Department of Hematology, Hôpital Côte de Nacre, CHU Caen, Caen
| | - M O Petillon
- Department of Blood Diseases, Hôpital Huriez, CHRU Lille, Lille
| | - L Karlin
- Department of Hematology, Centre Hospitalier Lyon-Sud, Lyon
| | - D Caillot
- Department of Hematology, CHU de Dijon, Dijon
| | - M Roussel
- Department of Hematology, CHU de Toulouse, Toulouse
| | - B Arnulf
- Department of Hematology, Hôpital Saint Louis, APHP, Paris
| | - C Mathiot
- Intergroupe Francophone du Myélome (IFM)
| | - G Marit
- Department of Hematology and Cell Therapy Service, CHU de Bordeaux, Pessac, France
| | - B Kolb
- Department of Hematology, Hôpital Robert Debré, CHU Reims, Reims
| | - A M Stoppa
- Department of Hematology, Institut Paoli Calmettes, Marseille
| | - S Brechiniac
- Department of Hematology, CHU Avicennes, APHP, Paris
| | - V Richez
- Department of Hematology, CHU Nice, Nice
| | - P Rodon
- Department of Hematology, CH de Périgueux, Périgueux
| | - A Banos
- Department of Hematology, CH de la Côte Basque, Bayonne
| | - M Wetterwald
- Department of Hematology, CH de Dunkerque, Dunkerque
| | - L Garderet
- Department of Hematology, CHU St-Antoine, Paris
| | - B Royer
- Department of Hematology, Hôpital Sud, CHU Amiens, Amiens
| | - C Hulin
- Department of Hematology, Hôpital de Nancy, Nancy
| | - L Benbouker
- Department of Hematology, Hôpital de Tours, Tours
| | - O Decaux
- Department of Hematology, CHU Rennes, Rennes
| | | | - J P Fermand
- Department of Hematology, Hôpital Saint Louis, APHP, Paris
| | - M Attal
- Department of Hematology, CHU de Toulouse, Toulouse
| | | | - P Moreau
- Department of Hematology, CHU Nantes, Nantes
| | - T Facon
- Department of Blood Diseases, Hôpital Huriez, CHRU Lille, Lille
| | - X Leleu
- Department of Hematology, CHU Poitiers, Poitiers
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10
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Bahlis N, Corso A, Mügge LO, Shen ZX, Desjardins P, Stoppa A, Decaux O, de Revel T, Granell M, Marit G, Nahi H, Demuynck H, Huang SY, Basu S, Ervin-Haynes A, Leupin N, Marek J, Chen G, Facon T. Impact of Response in Patients (Pts) With Stem Cell Transplant (SCT)-Ineligible Newly Diagnosed Multiple Myeloma (NDMM) Treated With Continuous Lenalidomide + Low-Dose Dexamethasone (Rd) in the FIRST Trial. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.07.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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11
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Roussel M, Hebraud B, Caillot D, Leleu X, Macro M, Hulin C, Chaleteix C, Escoffre Barbe M, Karlin L, Marit G, Garderet L, Pegourie B, Stoppa AM, Lenain P, Royer B, Avet-Loiseau H, Attal M. Outcome at first relapse after frontline RVD regimen plus lenalidomide maintenance in transplant eligible MM patients. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Murielle Roussel
- Hematology Department, IUCT Oncopole- CHU Purpan, Toulouse, France
| | - Benjamin Hebraud
- Hematology Department, IUCT Oncopole- CHU Purpan, Toulouse, France
| | | | - Xavier Leleu
- Service des Maladies du Sang, Hôpital Claude Huriez, Lille, France
| | | | - Cyrille Hulin
- Department of Hematology and Internal Medicine, CHU Nancy-Brabois, Nancy, France
| | | | | | | | - Gerald Marit
- Service d'Hématologie Clinique, Hôpital du Haut Leveque CHU de Bordeaux, Bordeaux, France
| | | | | | - Anne-Marie Stoppa
- Department of Hematology, Institut Paoli-Calmettes, Marseille, France
| | | | - Bruno Royer
- Hematologie Clinique, CHU Amiens, Amiens, France
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12
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Moreau P, Cavo M, Sonneveld P, Rosinol L, Attal M, Pezzi A, Goldschmidt H, Lahuerta JJ, Marit G, Palumbo A, van der Holt B, Bladé J, Petrucci MT, Neben K, san Miguel J, Patriarca F, Lokhorst H, Zamagni E, Hulin C, Gutierrez N, Facon T, Caillot D, Benboubker L, Harousseau JL, Leleu X, Avet-Loiseau H, Mary JY. Combination of international scoring system 3, high lactate dehydrogenase, and t(4;14) and/or del(17p) identifies patients with multiple myeloma (MM) treated with front-line autologous stem-cell transplantation at high risk of early MM progression-related death. J Clin Oncol 2014; 32:2173-80. [PMID: 24888806 DOI: 10.1200/jco.2013.53.0329] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To construct and validate among patients with multiple myeloma (MM) who were treated with intensive therapy a prognostic index of early MM progression-related death. PATIENTS AND METHODS Patient-level data from the Intergroupe Francophone du Myélome (IFM) 2005-01 trial (N = 482) were used to construct the prognostic index. The event was MM progression-related death within 2 years from treatment initiation. The index was validated using data from three other trials: the Gruppo Italiano Malattie Ematologiche dell' Adulto (GIMEMA) 26866138-MMY-3006 trial (N = 480), the Programa para el Estudio de la Terapéutica en Hemopatía Maligna (PETHEMA)-GEMMENOS65 trial (N = 390), and the Hemato-Oncologie voor Volwassenen Nederland (HOVON) -65/German-Speaking Myeloma Multicenter Group (GMMG) -HD4 trial (N = 827). RESULTS The risk of early MM progression-related death was related to three independent prognostic variables: lactate dehydrogenase (LDH) higher than than normal, International Staging System 3 (ISS3), and adverse cytogenetics [t(4;14) and/or del(17p)]. These three variables enabled the definition of an ordinal prognostic classification composed of four scores (0 to 3). Patients with a score of 3, defined by the presence of t(4;14) and/or del(17p) in addition to ISS3 and/or high LDH, comprised 5% (20 of 387 patients) to 8% (94 of 1,139 patients) of the patients in the learning and validation samples, respectively, and they had a very poor prognosis. When applied to the population of 855 patients who had received bortezomib-based induction therapy in the four trials, the prognostic classification was also able to segregate patients into four categories, with a very poor prognosis attributed to patients with a score of 3. CONCLUSION Our model allows the simple definition of a subgroup of MM patients at high risk of early MM progression-related death despite the use of the most modern and effective strategies.
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Affiliation(s)
- Philippe Moreau
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain.
| | - Michele Cavo
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Pieter Sonneveld
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Laura Rosinol
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Michel Attal
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Annalisa Pezzi
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Hartmut Goldschmidt
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Juan Jose Lahuerta
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Gerald Marit
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Antonio Palumbo
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Bronno van der Holt
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Joan Bladé
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Maria Teresa Petrucci
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Kai Neben
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Jesus san Miguel
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Francesca Patriarca
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Henk Lokhorst
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Elena Zamagni
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Cyrille Hulin
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Norma Gutierrez
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Thierry Facon
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Denis Caillot
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Lotfi Benboubker
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Jean-Luc Harousseau
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Xavier Leleu
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Hervé Avet-Loiseau
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Jean-Yves Mary
- Philippe Moreau, University Hospital Hôtel-Dieu; Jean-Luc Harousseau, Centre Rene Gauducheau, Nantes; Michel Attal, Centre Hospitalier Universitaire (CHU) Toulouse; Hervé Avet-Loiseau, CHU Rangueil, Toulouse; Gerald Marit, University Hospital of Bordeaux, Bordeaux; Cyrille Hulin, CHU Nancy, Nancy; Thierry Facon, Hopital Claude Huriez; Xavier Leleu, University Hospital of Lille, Lille; Denis Caillot, CHU Dijon, Dijon; Lotfi Benboubker, Centre Hospitalier Régional Universitaire Tours, Tours; Jean-Yves Mary, University Hospital Paris Saint-Louis, Paris, France; Michele Cavo, Annalisa Pezzi, and Elena Zamagni, Seràgnoli Institute of Hematology, Bologna; Antonio Palumbo, University of Torino, Torino; Maria Teresa Petrucci, Sapienza University of Rome, Rome; Francesca Patriarca, University Hospital, Udine, Italy; Pieter Sonneveld, Erasmus Medical Center, Rotterdam; Bronno van der Holt, Daniel den Hoed Cancer Center at Erasmus Medical Center, Rotterdam; Henk Lokhorst, University Medical Center Utrecht, Utrecht, the Netherlands; Hartmut Goldschmidt, Universitätsklinikum Heidelberg; Kai Neben, University of Heidelberg, Heidelberg, Germany; Laura Rosinol and Joan Bladé, Hospital Clinic, Barcelona; Juan Jose Lahuerta, Hospital Universitario 12 de Octubre, Madrid; Jesus san Miguel, University of Salamanca; Norma Gutierrez, Hospital Universitario de Salamanca, Salamanca, Spain
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Tabrizi R, Marit G, Mohr C, Lascaux A, Vigouroux S, Bouabdallah K, Pigneux A, Leguay T, Dilhuydy MS, Duclos C, Dimicoli-Salazar S, Milpied NJ. Outcome of patients with multiple myeloma (MM) relapsing after front-line autologous stem cell transplantation (ASCT): Impact of reduced intensity allogeneic transplantation (RICALLO). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e19564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Chretien ML, Hebraud B, Cances-Lauwers V, Hulin C, Marit G, Leleu X, Karlin L, Roussel M, Stoppa AM, Guilhot F, Lamy T, Garderet L, Pegourie B, Dib M, Sebban C, Lenain P, Brechignac S, Royer B, Wetterwald M, Legros L, Orsini-Piocelle F, Voillat L, Delbrel X, Caillot D, Macro M, Facon T, Attal M, Moreau P, Avet-Loiseau H, Corre J. Age is a prognostic factor even among patients with multiple myeloma younger than 66 years treated with high-dose melphalan: the IFM experience on 2316 patients. Haematologica 2014; 99:1236-8. [PMID: 24727820 DOI: 10.3324/haematol.2013.098608] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Age is a strong prognostic factor in multiple myeloma. The overall survival is shorter in patients older than 66 years, and even shorter in those older than 75 years. Whether age is also a prognostic parameter in patients younger than 66 years treated homogeneously with intensive approaches is unknown. To address this issue, we retrospectively analyzed a series of 2316 patients treated homogeneously with 3-4 cycles of induction chemotherapy followed by a high-dose melphalan course, without any consolidation or maintenance. We show that patients older than 60 years have a statistically significant shorter overall survival. The analysis of prognostic parameters did not show a higher incidence of high-risk cytogenetics, but a higher incidence of International Staging System (ISS) stages 2 and 3, mainly due to higher β2-microglobulin levels. This study is the first to demonstrate the impact of age in the outcome of 'young' patients with multiple myeloma, and suggests that this parameter should be included in the stratification factors for future prospective clinical trials.
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Affiliation(s)
- Marie-Lorraine Chretien
- Unité de Génomique du Myélome, University Hospital; CRCT, INSERM U 1037; Université Paul Sabatier, Toulouse Department of Hematology, University Hospital, Dijon
| | - Benjamin Hebraud
- Unité de Génomique du Myélome, University Hospital; CRCT, INSERM U 1037; Université Paul Sabatier, Toulouse
| | | | - Cyrille Hulin
- Department of Hematology, University Hospital, Nancy
| | - Gerald Marit
- Department of Hematology, University Hospital, Bordeaux
| | - Xavier Leleu
- Department of Hematology, University Hospital, Lille
| | | | | | | | | | - Thierry Lamy
- Department of Hematology, University Hospital, Rennes
| | - Laurent Garderet
- Department of Hematology, University Hospital, St-Antoine, Paris
| | | | - Mamoun Dib
- Department of Hematology, University Hospital, Angers
| | | | | | | | - Bruno Royer
- Department of Hematology, University Hospital, Amiens
| | | | | | | | | | | | - Denis Caillot
- Department of Hematology, University Hospital, Dijon
| | | | - Thierry Facon
- Department of Hematology, University Hospital, Lille
| | - Michel Attal
- Department of Hematology, University Hospital, Toulouse
| | - Philippe Moreau
- Department of Hematology, University Hospital, Nantes, France
| | - Hervé Avet-Loiseau
- Unité de Génomique du Myélome, University Hospital; CRCT, INSERM U 1037; Université Paul Sabatier, Toulouse
| | - Jill Corre
- Unité de Génomique du Myélome, University Hospital; CRCT, INSERM U 1037; Université Paul Sabatier, Toulouse
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Hebraud B, Leleu X, Lauwers-Cances V, Roussel M, Caillot D, Marit G, Karlin L, Hulin C, Gentil C, Guilhot F, Garderet L, Lamy T, Brechignac S, Pegourie B, Jaubert J, Dib M, Stoppa AM, Sebban C, Fohrer C, Fontan J, Fruchart C, Macro M, Orsini-Piocelle F, Lepeu G, Sohn C, Corre J, Facon T, Moreau P, Attal M, Avet-Loiseau H. Erratum: Deletion of the 1p32 region is a major independent prognostic factor in young patients with myeloma: the IFM experience on 1195 patients. Leukemia 2014. [DOI: 10.1038/leu.2013.352] [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: 11/09/2022]
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Hebraud B, Leleu X, Lauwers-Cances V, Roussel M, Caillot D, Marit G, Karlin L, Hulin C, Gentil C, Guilhot F, Garderet L, Lamy T, Brechignac S, Pegourie B, Jaubert J, Dib M, Stoppa AM, Sebban C, Fohrer C, Fontan J, Fruchart C, Macro M, Orsini-Piocelle F, Lepeu G, Sohn C, Corre J, Facon T, Moreau P, Attal M, Avet-Loiseau H. Deletion of the 1p32 region is a major independent prognostic factor in young patients with myeloma: the IFM experience on 1195 patients. Leukemia 2013; 28:675-9. [PMID: 23892719 DOI: 10.1038/leu.2013.225] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/03/2013] [Accepted: 07/09/2013] [Indexed: 12/27/2022]
Abstract
Deletions of the 1p region appear as a pejorative prognostic factor in multiple myeloma patients (especially 1p22 and 1p32 deletions) but there is a lack of data on the real impact of 1p abnormalities on an important and homogeneous group of patients. To address this issue we studied by fluorescence in situ hybridization (FISH) the incidence and prognostic impact of 1p22 and 1p32 deletions in 1195 patients from the IFM (Institut Francophone du Myélome) cell collection. Chromosome 1p deletions were present in 23.3% of the patients (271): 15.1% (176) for 1p22 and 7.3% (85) for 1p32 regions. In univariate analyses, 1p22 and 1p32 appeared as negative prognostic factors for progression-free survival (PFS): 1p22: 19.8 months vs 33.6 months (P<0.001) and 1p32: 14.4 months vs 33.6 months (P<0.001); and overall survival (OS): 1p22: 44.2 months vs 96.8 months (P=0.002) and 1p32: 26.7 months vs 96.8 months (P<0.001). In multivariate analyses, 1p22 and 1p32 deletions still appear as independent negative prognostic factors for PFS and OS. In conclusion, our data show that 1p22 and 1p32 deletions are major negative prognostic factors for PFS and OS for patients with MM. We thus suggest that 1p32 deletion should be tested for all patients at diagnosis.
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Affiliation(s)
- B Hebraud
- Unité de Génomique du Myélome, University Hospital, CRCT, INSERM U 1037, Université Paul Sabatier, Toulouse, France
| | - X Leleu
- Service des Maladies du Sang, Hopital Claude Huriez, CHRU, Lille, France
| | | | - M Roussel
- Hématologie Clinique, Hôpital Purpan, Toulouse, France
| | - D Caillot
- Department of Hematology, University Hospital, Dijon, France
| | - G Marit
- Department of Hematology, University Hospital, Bordeaux, France
| | - L Karlin
- Department of Hematology, University Hospital, Lyon, France
| | - C Hulin
- Department of Hematology, University Hospital, Nancy, France
| | - C Gentil
- Service d'Epidémiologie, CHU Toulouse, Toulouse, France
| | - F Guilhot
- CIC Inserm 0802, Centre Hospitalier Universitaire, Poitiers, France
| | - L Garderet
- Department of Hematology, University Hospital, Paris, France
| | - T Lamy
- Department of Hematology, University Hospital, Rennes, France
| | - S Brechignac
- Department of Hematology, University Hospital, Bobigny, France
| | - B Pegourie
- Department of Hematology, University Hospital, Grenoble, France
| | - J Jaubert
- Department of Hematology, University Hospital, St-Etienne, France
| | - M Dib
- Department of Hematology, University Hospital, Angers, France
| | - A-M Stoppa
- Department of Hematology, Institut Paoli Calmette, Marseille, France
| | - C Sebban
- Department of Hematology, Centre Léon Bérard, Lyon, France
| | - C Fohrer
- Department of Hematology, University Hospital, Strasbourg, France
| | - J Fontan
- Department of Hematology, University Hospital, Besancon, France
| | - C Fruchart
- Department of Hematology, Centre Francois Baclesse, Caen, France
| | - M Macro
- Department of Hematology, University Hospital, Caen, France
| | | | - G Lepeu
- Department of Hematology, Departmental Hospital, Avignon, France
| | - C Sohn
- Department of Hematology, Departmental Hospital, Toulon, France
| | - J Corre
- Unité de Génomique du Myélome, University Hospital, CRCT, INSERM U 1037, Université Paul Sabatier, Toulouse, France
| | - T Facon
- Service des Maladies du Sang, Hopital Claude Huriez, CHRU, Lille, France
| | - P Moreau
- Department of Hematology, University Hospital, Nantes, France
| | - M Attal
- Hématologie Clinique, Hôpital Purpan, Toulouse, France
| | - H Avet-Loiseau
- Unité de Génomique du Myélome, University Hospital, CRCT, INSERM U 1037, Université Paul Sabatier, Toulouse, France
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Avet-Loiseau H, Hulin C, Campion L, Rodon P, Marit G, Attal M, Royer B, Dib M, Voillat L, Bouscary D, Caillot D, Wetterwald M, Pegourie B, Lepeu G, Corront B, Karlin L, Stoppa AM, Fuzibet JG, Delbrel X, Guilhot F, Kolb B, Decaux O, Lamy T, Garderet L, Allangba O, Lifermann F, Anglaret B, Moreau P, Harousseau JL, Facon T. Chromosomal abnormalities are major prognostic factors in elderly patients with multiple myeloma: the intergroupe francophone du myélome experience. J Clin Oncol 2013; 31:2806-9. [PMID: 23796999 DOI: 10.1200/jco.2012.46.2598] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Chromosomal abnormalities, especially t(4;14) and del(17p), are major prognostic factors in patients with multiple myeloma (MM). However, this has been especially demonstrated in patients age < 66 years treated with intensive approaches. The goal of this study was to address this issue in elderly patients treated with conventional-dose chemotherapy. PATIENTS AND METHODS To answer this important question, we retrospectively analyzed a series of 1,890 patients (median age, 72 years; range, 66 to 94 years), including 1,095 with updated data on treatment modalities and survival. RESULTS This large study first showed that the incidence of t(4;14) was not uniform over age, with a marked decrease in the oldest patients. Second, it showed that both t(4;14) and del(17p) retained their prognostic value in elderly patients treated with melphalan and prednisone-based chemotherapy. CONCLUSION t(4;14) and del(17p) are major prognostic factors in elderly patients with MM, both for progression-free and overall survival, indicating that these two abnormalities should be investigated at diagnosis of MM, regardless of age.
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Attal M, Lauwers-Cances V, Marit G, Caillot D, Moreau P, Facon T, Stoppa AM, Hulin C, Benboubker L, Garderet L, Decaux O, Leyvraz S, Vekemans MC, Voillat L, Michallet M, Pegourie B, Dumontet C, Roussel M, Leleu X, Mathiot C, Payen C, Avet-Loiseau H, Harousseau JL. Lenalidomide maintenance after stem-cell transplantation for multiple myeloma. N Engl J Med 2012; 366:1782-91. [PMID: 22571202 DOI: 10.1056/nejmoa1114138] [Citation(s) in RCA: 851] [Impact Index Per Article: 70.9] [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: 01/20/2023]
Abstract
BACKGROUND High-dose chemotherapy with autologous stem-cell transplantation is a standard treatment for young patients with multiple myeloma. Residual disease is almost always present after transplantation and is responsible for relapse. This phase 3, placebo-controlled trial investigated the efficacy of lenalidomide maintenance therapy after transplantation. METHODS We randomly assigned 614 patients younger than 65 years of age who had nonprogressive disease after first-line transplantation to maintenance treatment with either lenalidomide (10 mg per day for the first 3 months, increased to 15 mg if tolerated) or placebo until relapse. The primary end point was progression-free survival. RESULTS Lenalidomide maintenance therapy improved median progression-free survival (41 months, vs. 23 months with placebo; hazard ratio, 0.50; P<0.001). This benefit was observed across all patient subgroups, including those based on the β(2)-microglobulin level, cytogenetic profile, and response after transplantation. With a median follow-up period of 45 months, more than 70% of patients in both groups were alive at 4 years. The rates of grade 3 or 4 peripheral neuropathy were similar in the two groups. The incidence of second primary cancers was 3.1 per 100 patient-years in the lenalidomide group versus 1.2 per 100 patient-years in the placebo group (P=0.002). Median event-free survival (with events that included second primary cancers) was significantly improved with lenalidomide (40 months, vs. 23 months with placebo; P<0.001). CONCLUSIONS Lenalidomide maintenance after transplantation significantly prolonged progression-free and event-free survival among patients with multiple myeloma. Four years after randomization, overall survival was similar in the two study groups. (Funded by the Programme Hospitalier de Recherche Clinique and others; ClinicalTrials.gov number, NCT00430365.).
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Affiliation(s)
- Michel Attal
- Department of Hematology, Hôpital Purpan, Toulouse, France.
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Avet-Loiseau H, Attal M, Campion L, Caillot D, Hulin C, Marit G, Stoppa AM, Voillat L, Wetterwald M, Pegourie B, Voog E, Tiab M, Banos A, Jaubert J, Bouscary D, Macro M, Kolb B, Traulle C, Mathiot C, Magrangeas F, Minvielle S, Facon T, Moreau P. Long-term analysis of the IFM 99 trials for myeloma: cytogenetic abnormalities [t(4;14), del(17p), 1q gains] play a major role in defining long-term survival. J Clin Oncol 2012; 30:1949-52. [PMID: 22547600 DOI: 10.1200/jco.2011.36.5726] [Citation(s) in RCA: 166] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In multiple myeloma, many prognostic parameters have been proposed. However, all of these predict shorter survival. To identify patients with a longer life expectancy, we updated the data of patients treated in the IFM (Intergroupe Francophone du Myelome) 99-02 and 99-04 trials. PATIENTS AND METHODS A series of 520 patients was analyzed. Median follow-up was 90.5 months. To perform a comprehensive analysis of the major prognostic factors, we reanalyzed all patients for 1q gains [in addition to updating del(13), t(4;14), and del(17p) analyses]. RESULTS It was possible to identify a subgroup of patients (representing 20% of total patients) with an 8-year survival of 75%. These patients were defined by the absence of t(4;14), del(17p), and 1q gain and β(2)-microglobulin less than 5.5 mg/L. CONCLUSION We propose that all patients with newly diagnosed multiple myeloma be evaluated for these three chromosomal changes, not only to define high-risk patients but also to identify those with a longer life expectancy.
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Affiliation(s)
- Hervé Avet-Loiseau
- Laboratoire d'Hématologie, Institut de Biologie, 9 quai Moncousu, 44093 Nantes Cedex 1, France.
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Damaj G, Malard F, Hulin C, Caillot D, Garidi R, Royer B, Marit G, Stoppa A, Banos A, Morineau N, Moreau P, Fitoussi O, Tiab M, Moreau P. Efficacy of bendamustine in relapsed/refractory myeloma patients: results from the French compassionate use program. Leuk Lymphoma 2012; 53:632-4. [DOI: 10.3109/10428194.2011.622422] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Decaux O, Fuzibet J, Hulin C, Rodon P, Mathiot C, Marit G, Roussel M, Facon T, Avet-Loiseau H, Moreau P, Grosbois B, Attal M. Éfficacité d’un traitement d’entretien du myélome multiple par Lenalidomide après autogreffe de cellules souches chez les patients de moins de 65ans. Résultats du protocole IFM 05-01. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.03.036] [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: 10/28/2022]
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Orsi L, Monnereau A, Dananche B, Berthou C, Fenaux P, Marit G, Soubeyran P, Huguet F, Milpied N, Leporrier M, Hemon D, Troussard X, Clavel J. Occupational exposure to organic solvents and lymphoid neoplasms in men: results of a French case-control study. Occup Environ Med 2011; 67:664-72. [PMID: 20837648 DOI: 10.1136/oem.2009.049460] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Investigating the role of occupational exposure to solvents in the occurrence of lymphoid neoplasms (LNs) in men. METHODS The data were generated by a French hospital-based case-control study, conducted in six centres in 2000-2004. The cases were incident cases aged 18-75 years with a diagnosis of LN. During the same period, controls of the same age and gender as the cases were recruited in the same hospitals, mainly in the orthopaedic and rheumatological departments. Exposure to solvents was assessed using standardised occupational questionnaires and case-by-case expert assessment. Specific quantification of benzene exposure was attempted. The analyses included 491 male patients (244 cases of non-Hodgkin's lymphoma (NHL), 87 of Hodgkin's lymphoma, 104 of lymphoproliferative syndrome and 56 of multiple myeloma) and 456 male controls. Unconditional logistic regressions were used to estimate OR and 95% CI. RESULTS Solvent exposure, all solvents considered together, was marginally associated with NHL (OR=1.4 (1.0 to 2.0) p=0.06), but not with other LNs. No association with the main chemical series of solvents was observed. There was no trend with the average intensity or frequency of exposure. Exposure to pure benzene was not significantly related to NHL (OR=3.4 (0.8 to 15.0)). The highest maximum intensities of benzene exposure were associated with diffuse large cell lymphoma (OR=2.1 (1.0 to 4.6)). CONCLUSION The results of the present study provide estimates compatible with the hypothesis that exposures to pure benzene and high benzene intensities may play a role in some NHL. There was no evidence for a role of other organic solvents in the occurrence of LN.
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Affiliation(s)
- Laurent Orsi
- Inserm U1018, Centre for Research in Epidemiology and Population Health, 16 av. Paul Vaillant-Couturier, F-94807 Villejuif Cedex, France.
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Harousseau JL, Attal M, Avet-Loiseau H, Marit G, Caillot D, Mohty M, Lenain P, Hulin C, Facon T, Casassus P, Michallet M, Maisonneuve H, Benboubker L, Maloisel F, Petillon MO, Webb I, Mathiot C, Moreau P. Bortezomib plus dexamethasone is superior to vincristine plus doxorubicin plus dexamethasone as induction treatment prior to autologous stem-cell transplantation in newly diagnosed multiple myeloma: results of the IFM 2005-01 phase III trial. J Clin Oncol 2010; 28:4621-9. [PMID: 20823406 DOI: 10.1200/jco.2009.27.9158] [Citation(s) in RCA: 408] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To compare efficacy and safety of bortezomib plus dexamethasone and vincristine plus doxorubicin plus dexamethasone (VAD) as induction before stem-cell transplantation in previously untreated myeloma. PATIENTS AND METHODS Four hundred eighty-two patients were randomly assigned to VAD (n = 121), VAD plus dexamethasone, cyclophosphamide, etoposide, and cisplatin (DCEP) consolidation (n = 121), bortezomib plus dexamethasone (n = 121), or bortezomib plus dexamethasone plus DCEP (n = 119), followed by autologous stem-cell transplantation. Patients not achieving very good partial response (VGPR) required a second transplantation. The primary end point was postinduction complete response/near complete response (CR/nCR) rate. RESULTS Postinduction CR/nCR (14.8% v 6.4%), at least VGPR (37.7% v 15.1%), and overall response (78.5% v 62.8%) rates were significantly higher with bortezomib plus dexamethasone versus VAD; CR/nCR and at least VGPR rates were higher regardless of disease stage or adverse cytogenetic abnormalities. Response rates were similar in patients who did and did not receive DCEP. Post first transplantation, CR/nCR (35.0% v 18.4%) and at least VGPR (54.3% v 37.2%) rates remained significantly higher with bortezomib plus dexamethasone. Median progression-free survival (PFS) was 36.0 months versus 29.7 months (P = .064) with bortezomib plus dexamethasone versus VAD; respective 3-year survival rates were 81.4% and 77.4% (median follow-up, 32.2 months). The incidence of severe adverse events appeared similar between groups, but hematologic toxicity and deaths related to toxicity (zero v seven) were more frequent with VAD. Conversely, rates of grade 2 (20.5% v 10.5%) and grades 3 to 4 (9.2% v 2.5%) peripheral neuropathy during induction through first transplantation were significantly higher with bortezomib plus dexamethasone. CONCLUSION Bortezomib plus dexamethasone significantly improved postinduction and post-transplantation CR/nCR and at least VGPR rates compared with VAD and resulted in a trend for longer PFS. Bortezomib plus dexamethasone should therefore be considered a standard of care in this setting.
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Moreau P, Facon T, Attal M, Doyen C, Hulin C, Marit G, Garderet L, Tiab M, Avet-Loiseau H, Harousseau J. Comparison of reduced-dose bortezomib plus thalidomide plus dexamethasone (vTD) to bortezomib plus dexamethasone (VD) as induction treatment prior to ASCT in de novo multiple myeloma (MM): Results of IFM2007-02 study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Attal M, Cristini C, Marit G, Caillot D, Facon T, Hullin C, Moreau P, Mathiot C, Avet-Loiseau H, Harousseau JL. Lenalidomide maintenance after transplantation for myeloma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Avet-Loiseau H, Moreau P, Mathiot C, Charbonnel C, Facon T, Attal M, Hulin C, Marit G, Minvielle S, Harousseau J. Use of bortezomib to overcome the poor prognosis of t(4;14), but not del(17p), in young patients with newly diagnosed multiple myeloma. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fourrier-Réglat A, Eghbali H, Facon T, Fermand J, Fitoussi O, Marit G, Grelaud A, Bignon E, Jove J, Moore N. Effectiveness and patterns of bortezomib use in real-life practice: Results of VESUVE, a French cohort study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Harousseau JL, Avet-Loiseau H, Attal M, Charbonnel C, Garban F, Hulin C, Michallet M, Facon T, Garderet L, Marit G, Ketterer N, Lamy T, Voillat L, Guilhot F, Doyen C, Mathiot C, Moreau P. Achievement of at least very good partial response is a simple and robust prognostic factor in patients with multiple myeloma treated with high-dose therapy: long-term analysis of the IFM 99-02 and 99-04 Trials. J Clin Oncol 2009; 27:5720-6. [PMID: 19826130 DOI: 10.1200/jco.2008.21.1060] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The prognostic impact of complete response (CR) achievement in multiple myeloma (MM) has been shown mostly in the context of autologous stem-cell transplantation. Other levels of response have been defined because, even with high-dose therapy, CR is a relatively rare event. The purpose of this study was to analyze the prognostic impact of very good partial response (VGPR) in patients treated with high-dose therapy. PATIENTS AND METHODS All patients were included in the Intergroupe Francophone du Myelome 99-02 and 99-04 trials and treated with vincristine, doxorubicin, and dexamethasone (VAD) induction therapy followed by double autologous stem-cell transplantation (ASCT). Best post-ASCT response assessment was available for 802 patients. RESULTS With a median follow-up of 67 months, median event-free survival (EFS) and 5-year EFS were 42 months and 34%, respectively, for 405 patients who achieved at least VGPR after ASCT versus 32 months and 26% in 288 patients who achieved only partial remission (P = .005). Five-year overall survival (OS) was significantly superior in patients achieving at least VGPR (74% v 61% P = .0017). In multivariate analysis, achievement of less than VGPR was an independent factor predicting shorter EFS and OS. Response to VAD had no impact on EFS and OS. The impact of VGPR achievement on EFS and OS was significant in patients with International Staging System stages 2 to 3 and for patients with poor-risk cytogenetics t(4;14) or del(17p). CONCLUSION In the context of ASCT, achievement of at least VGPR is a simple prognostic factor that has importance in intermediate and high-risk MM and can be informative in more patients than CR.
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Avet-Loiseau H, Li C, Magrangeas F, Gouraud W, Charbonnel C, Harousseau JL, Attal M, Marit G, Mathiot C, Facon T, Moreau P, Anderson KC, Campion L, Munshi NC, Minvielle S. Prognostic significance of copy-number alterations in multiple myeloma. J Clin Oncol 2009; 27:4585-90. [PMID: 19687334 DOI: 10.1200/jco.2008.20.6136] [Citation(s) in RCA: 208] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Chromosomal aberrations are a hallmark of multiple myeloma but their global prognostic impact is largely unknown. PATIENTS AND METHODS We performed a genome-wide analysis of malignant plasma cells from 192 newly diagnosed patients with myeloma using high-density, single-nucleotide polymorphism (SNP) arrays to identify genetic lesions associated with prognosis. RESULTS Our analyses revealed deletions and amplifications in 98% of patients. Amplifications in 1q and deletions in 1p, 12p, 14q, 16q, and 22q were the most frequent lesions associated with adverse prognosis, whereas recurrent amplifications of chromosomes 5, 9, 11, 15, and 19 conferred a favorable prognosis. Multivariate analysis retained three independent lesions: amp(1q23.3), amp(5q31.3), and del(12p13.31). When adjusted to the established prognostic variables (ie, t(4;14), del(17p), and serum beta(2)-microglobulin [Sbeta(2)M]), del(12p13.31) remained the most powerful independent adverse marker (P < .0001; hazard ratio [HR], 3.17) followed by Sbeta(2)M (P < .0001; HR, 2.78) and the favorable marker amp(5q31.3) (P = .0005; HR, 0.37). Patients with amp(5q31.3) alone and low Sbeta(2)M had an excellent prognosis (5-year overall survival, 87%); conversely, patients with del(12p13.31) alone or amp(5q31.3) and del(12p13.31) and high Sbeta(2)M had a very poor outcome (5-year overall survival, 20%). This prognostic model was validated in an independent validation cohort of 273 patients with myeloma. CONCLUSION These findings demonstrate the power and accessibility of molecular karyotyping to predict outcome in myeloma. In addition, integration of expression of genes residing in the lesions of interest revealed putative features of the disease driving short survival.
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Affiliation(s)
- Hervé Avet-Loiseau
- L'Institut National de la Santé et de la Recherche Médicale U892, Université de Nantes, Institut de Biologie, 9 Quai Moncousu, Nantes, 44093, France
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Villeneuve S, Orsi L, Monnereau A, Berthou C, Fenaux P, Marit G, Soubeyran P, Huguet F, Milpied N, Leporrier M, Hemon D, Troussard X, Clavel J. Increased frequency of hematopoietic malignancies in relatives of patients with lymphoid neoplasms: a French case-control study. Int J Cancer 2009; 124:1188-95. [PMID: 19058175 DOI: 10.1002/ijc.24026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Lymphoid neoplasms (LNs), including non-Hodgkin's lymphoma (NHL), Hodgkin's lymphoma (HL), lymphoproliferative syndrome (LPS) and multiple myeloma (MM), are among the most frequent cancers ( approximately 17,000 new cases per year in France), after those related to smoking. LNs were investigated using the data from the ENGELA study. ENGELA is a multicenter hospital-based case-control study that was carried out in France over the period September 2000-December 2004. In all, 822 cases (397 NHL, 149 LH, 168 SLP and 108 MM) and 752 controls were included and described 5,481 and 5,188 first-degree relatives, respectively. A positive association with a familial history of hematopoietic cancer was observed for LN (OR = 1.7 [1.0-2.8]) overall and for LPS (OR = 3.2 [1.4-6.8]). The associations with HL (OR = 10.4 [2.0-53.8]) and NHL (OR = 2.4 [1.0-5.9]) were stronger for men. The associations were also stronger when the disease had been diagnosed before the relatives were aged 45 years. The results mainly support the involvement of genetic factors and suggest that at least some of those factors may be sex-linked. However, the slight overrepresentation of affected spouses among the cases might also support the responsibility of environmental factors.
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Orsi L, Delabre L, Monnereau A, Delval P, Berthou C, Fenaux P, Marit G, Soubeyran P, Huguet F, Milpied N, Leporrier M, Hemon D, Troussard X, Clavel J. Occupational exposure to pesticides and lymphoid neoplasms among men: results of a French case-control study. Occup Environ Med 2008; 66:291-8. [PMID: 19017688 DOI: 10.1136/oem.2008.040972] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Investigating the relationship between occupational exposure to pesticides and the risk of lymphoid neoplasms (LNs) in men. METHODS A hospital-based case-control study was conducted in six centres in France between 2000 and 2004. The cases were incident cases with a diagnosis of LN aged 18-75 years. During the same period, controls of the same age and sex as the cases were recruited in the same hospital, mainly in the orthopaedic and rheumatological departments. Exposures to pesticides were evaluated through specific interviews and case-by-case expert reviews. Four hundred and ninety-one cases (244 cases of non-Hodgkin's lymphoma (NHL), 87 of Hodgkin's lymphoma (HL), 104 of lymphoproliferative syndromes (LPSs) and 56 of multiple myeloma (MM) cases) and 456 controls were included in the analyses. The odds ratios (ORs) and 95% CI were estimated using unconditional logistic regressions. RESULTS Positive associations between HL and occupational exposure to triazole fungicides and urea herbicides were observed (OR = 8.4 (2.2 to 32.4), 10.8 (2.4 to 48.1), respectively). Exposure to insecticides, fungicides and herbicides were linked to a threefold increase in MM risk (OR = 2.8 (1.2 to 6.5), 3.2 (1.4 to 7.2), 2.9 (1.3 to 6.5)). For LPS subtypes, associations restricted to hairy-cell leukaemia (HCL) were evidenced for exposure to organochlorine insecticides, phenoxy herbicides and triazine herbicides (OR = 4.9 (1.1 to 21.2), 4.1 (1.1 to 15.5), 5.1 (1.4 to 19.3)), although based on small numbers. Lastly, despite the increased ORs for organochlorine and organophosphate insecticides, carbamate fungicides and triazine herbicides, no significant associations were evidenced for NHL. CONCLUSIONS The results, based on case-by-case expert review of occupation-specific questionnaires, support the hypothesis that occupational pesticide exposures may be involved in HL, MM and HCL and do not rule out a role in NHL. The analyses identified specific pesticides that deserve further investigation and the findings were consistent with those of previous studies.
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Affiliation(s)
- L Orsi
- Inserm U, Villejuif, France.
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Rossignol B, Fuzibet JG, Vieillard MH, Doyen C, Hulin C, Garderet L, Blanc M, Marit G, Grosbois B, Facon T, Moreau P. Ostéonécrose de la mâchoire sous bisphosphonates au cours du myélome multiple (le registre de l’IFM). Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.063] [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: 10/22/2022]
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Harousseau JL, Mathiot C, Attal M, Marit G, Caillot D, Hullin C, Facon T, Webb I, Avet-Loiseau H, Moreau P. Bortezomib/dexamethasone versus VAD as induction prior to autologous stem cell transplantion (ASCT) in previously untreated multiple myeloma (MM): Updated data from IFM 2005/01 trial. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8505] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Grandin L, Orsi L, Troussard X, Monnereau A, Berthou C, Fenaux P, Marit G, Soubeyran P, Huguet F, Milpied N, Leporrier M, Hemon D, Clavel J. UV radiation exposure, skin type and lymphoid malignancies: results of a French case-control study. Cancer Causes Control 2007; 19:305-15. [PMID: 18040875 DOI: 10.1007/s10552-007-9093-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Accepted: 11/07/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Investigating the relationship between skin type, UV exposure, and lymphoid malignancies (LM). METHODS We conducted a hospital-based case-control study in France, including 813 incident cases of non-Hodgkin's lymphoma (NHL), Hodgkin's lymphoma (HL), lymphoproliferative syndrome (LPS) or multiple myeloma and 748 controls. RESULTS Positive associations between HL and blond/red hair (OR = 1.8 [0.8-3.8]), very fair/fair skin (OR = 1.6 [1.0-2.5]) were observed. High propensity to burn was associated with HL (OR = 1.5 [1.0-2.2]) and LPS (OR = 1.4 [1.0-2.1]). Poor ability to tan was significantly associated with HL (OR = 1.7 [1.0-2.8]). Having light hair with high propensity to burn was associated with NHL (OR = 1.5 [0.9-2.5]) and significantly with HL (OR = 3.4 [1.4-8.4]). Having dark hair with high propensity to burn was significantly associated with LPS (OR = 1.5 [1.0-2.2]). The associations with HL and NHL were significant for men only, with significant interactions. Outdoors activities since leaving school or in the last decade were not related to LM. Only an almost negative trend was observed. Prior exposure to artificial UV was not associated with LM. CONCLUSION These results suggest a positive association between the most reactive and palest skin types and NHL or HL in men and do not rule out a slight negative relationship between UV exposure and LM.
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Affiliation(s)
- L Grandin
- INSERM U754, 16 avenue Paul Vaillant-Couturier, Villejuif, France
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Moreau P, Attal M, Garban F, Hulin C, Facon T, Marit G, Michallet M, Doyen C, Leyvraz S, Mohty M, Wetterwald M, Mathiot C, Caillot D, Berthou C, Benboubker L, Garderet L, Chaleteix C, Traullé C, Fuzibet JG, Jaubert J, Lamy T, Casassus P, Dib M, Kolb B, Dorvaux V, Grosbois B, Yakoub-Agha I, Harousseau JL, Avet-Loiseau H. Heterogeneity of t(4;14) in multiple myeloma. Long-term follow-up of 100 cases treated with tandem transplantation in IFM99 trials. Leukemia 2007; 21:2020-4. [PMID: 17625611 DOI: 10.1038/sj.leu.2404832] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
One hundred de novo multiple myeloma patients with t(4;14) treated with double intensive therapy according to IFM99 protocols were retrospectively analyzed. The median overall survival (OS) and event-free survival (EFS) were 41.4 and 21 months, respectively, as compared to 65 and 37 for patients included in the IFM99 trials without t(4;14) (P<10(-7)). We identified a subgroup of patients presenting at diagnosis with both low beta(2)-microglobulin <4 mg/l and high hemoglobin (Hb) >/=10 g/l (46% of the cases) with a median OS of 54.6 months and a median EFS of 26 months, respectively, which benefits from high-dose therapy (HDT); conversely patients with one or both adverse prognostic factor (high beta(2)-microglobulin and/or low Hb) had a poor outcome. The achievement of either complete response or very good partial response after HDT was also a powerful independent prognostic factor for both OS and EFS.
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Affiliation(s)
- P Moreau
- Hematology Department, University Hospital, Nantes, France
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Mahon F, Etienne G, Picard S, Titier K, Marit G, Begaud B, Reiffers J, Moore N, Molimard M. Trough plasma imatinib concentrations are associated with responses to standard-dose imatinib in chronic myeloid leukemia and could improve its clinical management. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7027 Background: Variable responses to imatinib in the treatment of myelogenous leukemia (CML) are incompletely understood. Previous studies focused on cellular mechanisms of resistance to imatinib. Another hypothesis for variable response lies in pharmacokinetic variability that may reduce drug exposure in patients receiving imatinib. Methods: Using high- performance liquid chromatography-tandem mass spectrometry, we assessed trough plasma imatinib concentrations at steady state (Cmin) in more than 150 CML patients. Major molecular response (MMR) was defined as a 3 logarithm reduction of BCR-ABL transcripts, quantified from peripheral blood using Q-RTPCR. In addition, suboptimal response criteria defined by the European Leukemianet were used to increase doses of imatinib. Results: i) we assessed Cmin in 85 CML patients and demonstated a correlation with imatinib doses (median values 813, 1,135, 1,709 ng/ml for respectively 300,400, 600 mg/day). ii) for 68 patients after at least one year's treatment mean Cmin were significantly higher in the group with MMR (34 patients) than in the group without (1,452.1±649.1 ng per milliliter vs. 869.3±427.5 ng per milliliter, P<0.001) whereas there was no difference in the imatinib daily dose. For Cmin and their discrimination potential for MMR, the area under receiver-operating characteristic curve was 0.775, with best sensitivity (76.5 percent) and specificity (70.6 percent) at a plasma threshold of 1,002 ng per milliliter. iii) dose escalation of imatinid, 400mg up to 600mg was proposed in 8 patients in suboptimal response (3 according to cytogenetic criteria and 5 according to molecular criteria). The median Cmin increase from 573 ng/ml [181–1,376] to 1,139 ng/ml [733–2,262] and 5 patients had a cytogenetic (n=3) or a molecular (n=2) response. Conclusions: Monitoring of imatinib plasma levels could be very useful for the management of CML patients, or should at least be checked in the case of treatment failure or suboptimal response or in patients nonadherent with imatinib or with a drug-drug interaction suspicion. No significant financial relationships to disclose.
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Affiliation(s)
- F. Mahon
- Universite Victor Segalen, Bordeaux, France; Centre Anticancéreux, Bordeaux, France; University Victor Ségalen Bordeaux 2, Bordeaux, France; CHU de Bordeaux, Bordeaux, France
| | - G. Etienne
- Universite Victor Segalen, Bordeaux, France; Centre Anticancéreux, Bordeaux, France; University Victor Ségalen Bordeaux 2, Bordeaux, France; CHU de Bordeaux, Bordeaux, France
| | - S. Picard
- Universite Victor Segalen, Bordeaux, France; Centre Anticancéreux, Bordeaux, France; University Victor Ségalen Bordeaux 2, Bordeaux, France; CHU de Bordeaux, Bordeaux, France
| | - K. Titier
- Universite Victor Segalen, Bordeaux, France; Centre Anticancéreux, Bordeaux, France; University Victor Ségalen Bordeaux 2, Bordeaux, France; CHU de Bordeaux, Bordeaux, France
| | - G. Marit
- Universite Victor Segalen, Bordeaux, France; Centre Anticancéreux, Bordeaux, France; University Victor Ségalen Bordeaux 2, Bordeaux, France; CHU de Bordeaux, Bordeaux, France
| | - B. Begaud
- Universite Victor Segalen, Bordeaux, France; Centre Anticancéreux, Bordeaux, France; University Victor Ségalen Bordeaux 2, Bordeaux, France; CHU de Bordeaux, Bordeaux, France
| | - J. Reiffers
- Universite Victor Segalen, Bordeaux, France; Centre Anticancéreux, Bordeaux, France; University Victor Ségalen Bordeaux 2, Bordeaux, France; CHU de Bordeaux, Bordeaux, France
| | - N. Moore
- Universite Victor Segalen, Bordeaux, France; Centre Anticancéreux, Bordeaux, France; University Victor Ségalen Bordeaux 2, Bordeaux, France; CHU de Bordeaux, Bordeaux, France
| | - M. Molimard
- Universite Victor Segalen, Bordeaux, France; Centre Anticancéreux, Bordeaux, France; University Victor Ségalen Bordeaux 2, Bordeaux, France; CHU de Bordeaux, Bordeaux, France
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Blaise D, Tabrizi R, Faucher C, Mohty M, Bay J, Marit G, Furst S, Charbonnier A, Chabannon C, Vey N. Allogeneic immunotherapy by hematopoietic stem cell transplantation (ASCT) after reduced intensity conditioning (RIC) following high-dose chemotherapy for patients with acute myeloblastic leukemia (AML) in first complete remission (CR1): Reduced toxicity. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7098 Background: RIC-based ASCT can be used after intensive chemotherapy in pts with CR1AML(Blaise, Cancer, 2005). Initial disease control was high and was not related to selection bias (Mohty, Leukemia, 2005).Here, we investigated if this control was maintained after a long follow-up. Methods: 37 pts (age: 51 (26–60)) with high risk clinical characteristics (70%) (Age = 50 (N=22, 59%); severe comorbidity (30%)) and/or poor risk leukemic features (65%) (Cytogenetics (35%); 2 induction courses (27%); secondary leukemia (11%), High white blood cell counts(14%) or partial remission (3%)) were treated. After CR1, pts received at least either 1 course of high dose cytarabine (24 g/m2) and anthracycline (HIDAC: N=21) or HIDAC + 1 course of. melphalan (140 mg/m2) (HDMEL) with auto-SCT Pts (HIDAC +HDM N=16). All pts were then scheduled to receive ASCT prepared with RIC (fludarabine (180 mg/m2), busulfan (8 mg/kg), Thymoglobulin (2.5 to 10 mg/kg)) followed with BMT (28%) or PBSC (72%). Results: With a Median follow-up of 3 years (16–70 mths). 15 pts experienced aGVHD (grade 2–4 aGVHD cumulative incidence (CI):22% (9–35). 10 and 14 pts presented a limited and extensive cGVHD respectively (CI cGVHD:65 % (50–80). 3 deaths were attributed to non-relapse causes (NRD) (AGVHD: 1; CGVHD: 2° (NRD CI: 8% (0–17). In all, 9 pts relapsed at 5 mths (2–19) (24% (9–35). Relapse was associated with the absence of cGVHD (cGVHD: 8 (0–19), no cGVHD 44% (12–76), p=.05). 25 pts are still alive in CR1 for overall survival and leukemia-free survival (LFS) probability estimates at 4 years of 65 % (48–79%) and 66% (49–80%) respectively. When restricting the analysis to the 33 pts evaluable for cGVHD, cGVHD remained the only independent risk factor positively influencing LFS (cGVHD: 81% (59–92); no cGVHD (56% (27–81), p=.05) Conclusions: We conclude that RIC Allo-SCT preceded by adequate prior intensive chemotherapy might offers a relatively low NRD while exerting a sustained leukemia control even in high risk pts deserving prospective evaluation against standard strategy of conventional Allo SCT. No significant financial relationships to disclose.
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Affiliation(s)
- D. Blaise
- Institut Paoli-Calmettes, Marseille, France; Hopital Haut Leveque, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France
| | - R. Tabrizi
- Institut Paoli-Calmettes, Marseille, France; Hopital Haut Leveque, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France
| | - C. Faucher
- Institut Paoli-Calmettes, Marseille, France; Hopital Haut Leveque, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France
| | - M. Mohty
- Institut Paoli-Calmettes, Marseille, France; Hopital Haut Leveque, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France
| | - J. Bay
- Institut Paoli-Calmettes, Marseille, France; Hopital Haut Leveque, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France
| | - G. Marit
- Institut Paoli-Calmettes, Marseille, France; Hopital Haut Leveque, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France
| | - S. Furst
- Institut Paoli-Calmettes, Marseille, France; Hopital Haut Leveque, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France
| | - A. Charbonnier
- Institut Paoli-Calmettes, Marseille, France; Hopital Haut Leveque, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France
| | - C. Chabannon
- Institut Paoli-Calmettes, Marseille, France; Hopital Haut Leveque, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France
| | - N. Vey
- Institut Paoli-Calmettes, Marseille, France; Hopital Haut Leveque, Bordeaux, France; Centre Jean Perrin, Clermont Ferrand, France
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Leguay T, Foucaud C, Parrens M, Fitoussi O, Bouabdallah K, Belaud-Rotureau M, Tabrizi R, Marit G, Pigneux A, Milpied N. EBV-positive lymphoproliferative disease with medullar, splenic and hepatic infiltration after imatinib mesylate therapy for chronic myeloid leukemia with two relapses and rituximab resistance. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.17536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17536 Background: Imatinib mesylate has transformed the management of the patients with chronic myeloid leukemia (CML). Initially, few undesirable effects was described. In 2003, Bekkenk presented the first EBV-positive cutaneous B-cell lymphoproliferative disease during imatinib mesylate therapy with disappearance of the cutaneous tumor after interruption of the specific inhibitor of BCR-ABL. Methods: Results: We reported a case of first EBV-positive lymphoproliferative disease with diffuse infiltration. Our patient 59 years old female was treated with imatinib mesylate for CML in chronic phase. CML was diagnosed on 2003 and imatinib mesylate therapy (400 mg/day) was initiated. A CCR was achieved after six months and a major molecular response after eighteen months. EBV-positive lymphoproliferative disease was diagnosed on 2005 and interruption of imatinib mesylate have not demonstrated efficiency. A response was initially obtained after treatment with rituximab alone, but our patient relapsed after reintroduction of imatinib at the same dose. A retreatment with rituximab have permitted a second biological complete remission and disappearance of clinical abnormalities but during only few months. At the second relapse, the disease transformed into a CD20-negative diffuse large B cell lymphoma and became resistant to rituximab therapy. Nevertheless, the lymphoproliferative disease remained responsive to conventional chemotherapy with CHOP and Interferon-alpha. Conclusions: Imatinib mesylate has modified the evolution of CML with an improvement of overall survival. In vitro studies have shown that imatinib mesylate is able to inhibit the proliferation and the activation of T-cells, and to reduce significantly the antigen-triggered expansion of CD8+ T cells in response to immunodominant EBV peptides. We speculate that such an effect might have occurred in our patient. Despite a growing number of patient receiving this tyrosine kinase inhibitor, case reports of EBV-positive lymphoproliferation disease remain rare. No significant financial relationships to disclose.
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Affiliation(s)
- T. Leguay
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - C. Foucaud
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - M. Parrens
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - O. Fitoussi
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - K. Bouabdallah
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - M. Belaud-Rotureau
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - R. Tabrizi
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - G. Marit
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - A. Pigneux
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
| | - N. Milpied
- Hôpital du Haut-Lévèque, Pessac, France; Clinique Bordeaux-Nord, Bordeaux, France
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39
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Leguay T, Foucaud C, Parrens M, Fitoussi O, Bouabdallah K, Belaud-Rotureau MA, Tabrizi R, Marit G, Pigneux A, Milpied N. EBV-positive lymphoproliferative disease with medullary, splenic and hepatic infiltration after imatinib mesylate therapy for chronic myeloid leukemia. Leukemia 2007; 21:2208-10. [PMID: 17541400 DOI: 10.1038/sj.leu.2404758] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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40
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Monnereau A, Orsi L, Troussard X, Berthou C, Fenaux P, Marit G, Soubeyran P, Huguet F, Milpied N, Leporrier M, Hemon D, Clavel J. History of infections and vaccinations and risk of lymphoid neoplasms: does influenza immunization reduce the risk? Leukemia 2007; 21:2075-9. [PMID: 17508003 DOI: 10.1038/sj.leu.2404738] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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41
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Sibaud V, Marit G, Deminière C, Campana F, Taieb A, Fricain JC. [Multiple verruciform xanthomas of the oral mucosa associated with graft versus host disease]. Ann Dermatol Venereol 2007; 133:995-9. [PMID: 17185932 DOI: 10.1016/s0151-9638(06)71086-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Verruciform xanthoma is an uncommon lesion that occurs primarily on the mucous membranes and more rarely on the skin. A few authors have reported the extremely rare occurrence of multiple lesions. Triggering or enhancing factors have been occasionally described such as an underlying immunosuppression or associated inflammatory mucous or skin diseases. We report, to the best of our knowledge, the first case report of multiple verruciform xanthomas of the oral mucosa in a patient with graft-versus-host disease with specific oral lesions. CASE REPORT A 57 year-old man presented with an 8-year history of chronic myeloid leukemia. He was considered in complete remission for leukemia after allogenic bone marrow transplantation. Nevertheless, he was still treated with immunosuppressive drugs for oral and cutaneous lesions of chronic graft-versus-host disease. In this context, the patient presented two symmetric lesions of the gingiva. These lesions had progressed over several months. The clinical presentation was similar, with a yellowish and verrucous aspect and a sessile base. Histologic and immunohistochemical analysis led to the diagnosis of multiple verruciform xanthomas. DISCUSSION The occurrence of multiple lesions of this rare tumour in our patient was probably not fortuitous. Immunosuppression associated with oral chronic inflammatory lesions are certainly involved in the pathogenesis of these two verruciform xanthomas, for example following degeneration of epithelial cells after local chronic irritation and/or reduction of Langerhans cells. Systematic research of enhancing or triggering factors seems essential in verruciform xanthoma.
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Affiliation(s)
- V Sibaud
- Service de Dermatologie, Hôpital Saint André, Bordeaux
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42
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Morschhauser F, Depil S, Jourdan E, Wetterwald M, Bouabdallah R, Marit G, Solal-Céligny P, Sebban C, Coiffier B, Chouaki N, Bauters F, Dumontet C. Phase II study of gemcitabine–dexamethasone with or without cisplatin in relapsed or refractory mantle cell lymphoma. Ann Oncol 2007; 18:370-5. [PMID: 17074972 DOI: 10.1093/annonc/mdl395] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Single-agent gemcitabine has shown encouraging results in patients with mantle cell lymphoma (MCL). This phase II study further explored the potential of a gemcitabine-based regimen in patients with relapsed or refractory MCL. Patients <70 years old received the PDG regimen: gemcitabine (1000 mg/m(2), days 1 and 8), dexamethasone (40 mg/m(2), days 1-4), and cisplatin (100 mg/m(2), day 1). Patients >/=70 years of age received dexamethasone and gemcitabine only (DG regimen). Thirty patients (12 in the DG group, 18 in the PDG group) with a median age 66.5 years (range, 47-81) received a median of six cycles in both groups. The overall response rate was 36.4% [95% confidence interval (CI), 15.2% to 64.6%] with the DG regimen and 44.4% (95% CI 24.6% to 66.3%) with the PDG regimen. The median progression-free survival was 3 months (95% CI 0.0-7.9) in the DG group and 8.5 months (95% CI 4.8-12.2) in the PDG group. With a median follow-up of 38.8 months, 13 patients (including 11 given PDG) are still alive. DG was well tolerated, and thrombocytopenia was the most prevalent toxicity in patients receiving PDG. Both regimens deserve to be further investigated as a backbone for combination chemotherapy in patients with MCL.
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Picard S, Titier K, Etienne G, Teilhet E, Ducint D, Bernard MA, Lassalle R, Marit G, Reiffers J, Begaud B, Moore N, Molimard M, Mahon FX. Trough imatinib plasma levels are associated with both cytogenetic and molecular responses to standard-dose imatinib in chronic myeloid leukemia. Blood 2006; 109:3496-9. [PMID: 17192396 DOI: 10.1182/blood-2006-07-036012] [Citation(s) in RCA: 471] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Using high-performance liquid chromatography-tandem mass spectrometry, we assessed trough imatinib plasma levels in 68 patients with chronic myeloid leukemia (CML) who responded or not to standard-dose imatinib, after at least 12 months' treatment. Mean trough imatinib plasma levels were significantly higher in the group with complete cytogenetic response (56 patients) than in the group without (12 patients; P = .03) and higher in the group with major molecular response (MMR) than in the group without (34 patients [1452 +/- 649 ng/mL] versus 34 patients [869 +/- 427 ng/mL]; P < .001). Regarding trough imatinib plasma levels and their discrimination potential for MMR, the area under receiver operating characteristic curve was 0.775, with best sensitivity (77%) and specificity (71%) at a plasma threshold of 1002 ng/mL. Therefore, monitoring of imatinib plasma levels could be very useful for the management of patients with CML or should at least be checked in the case of treatment failure or suboptimal response.
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Affiliation(s)
- Stephane Picard
- Department of Clinical Pharmacology and Toxicology, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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Rousselot P, Huguet F, Rea D, Legros L, Cayuela JM, Maarek O, Blanchet O, Marit G, Gluckman E, Reiffers J, Gardembas M, Mahon FX. Imatinib mesylate discontinuation in patients with chronic myelogenous leukemia in complete molecular remission for more than 2 years. Blood 2006; 109:58-60. [PMID: 16973963 DOI: 10.1182/blood-2006-03-011239] [Citation(s) in RCA: 400] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In the present study, we address the issue of the discontinuation of imatinib mesylate (Gleevec) in chronic myelogenous leukemia with undetectable residual disease for more than 2 years. Twelve patients were included. The median duration of real-time quantitative-polymerase chain reaction (RTQ-PCR) negativity and imatinib therapy were, respectively, 32 months (range, 24-46 months) and 45 months (range, 32-56 months) before imatinib interruption. Six patients displayed a molecular relapse with a detectable BCR-ABL transcript at 1, 1, 2, 3, 4, and 5 months. Imatinib was then reintroduced and led to a novel molecular response in most patients. Six other patients (50%) still have an undetectable level of BCR-ABL transcript after a median follow-up of 18 months (range, 9-24 months). We hypothesize that relapses observed within 6 months reflect the kinetics of undetectable dividing chronic myelogenous leukemia (CML) cells. Those cells may be eradicated or controlled in long-term nonrelapsing patients, as described in our study.
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Affiliation(s)
- Philippe Rousselot
- Fédération d'hématologie et Centre d'Investigation Clinique, Hôpital Saint-Louis, Paris, France
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Attal M, Harousseau JL, Leyvraz S, Doyen C, Hulin C, Benboubker L, Yakoub Agha I, Bourhis JH, Garderet L, Pegourie B, Dumontet C, Renaud M, Voillat L, Berthou C, Marit G, Monconduit M, Caillot D, Grobois B, Avet-Loiseau H, Moreau P, Facon T. Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. Blood 2006; 108:3289-94. [PMID: 16873668 DOI: 10.1182/blood-2006-05-022962] [Citation(s) in RCA: 544] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Newer chemotherapeutic protocols as well as high-dose chemotherapy have increased the response rate in myeloma. However, these treatments are not curative. Effective maintenance strategies are now required to prolong the duration of response. We conducted a randomized trial of maintenance treatment with thalidomide and pamidronate. Two months after high-dose therapy, 597 patients younger than age 65 years were randomly assigned to receive no maintenance (arm A), pamidronate (arm B), or pamidronate plus thalidomide (arm C). A complete or very good partial response was achieved by 55% of patients in arm A, 57% in arm B, and 67% in arm C (P = .03). The 3-year postrandomization probability of event-free survival was 36% in arm A, 37% in arm B, and 52% in arm C (P < .009). The 4-year postdiagnosis probability of survival was 77% in arm A, 74% in arm B, and 87% in arm C (P < .04). The proportion of patients who had skeletal events was 24% in arm A, 21% in arm B, and 18% in arm C (P = .4). Thalidomide is an effective maintenance therapy in patients with multiple myeloma. Maintenance treatment with pamidronate does not decrease the incidence of bone events.
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Affiliation(s)
- Michel Attal
- Service d'Hématologie, Hôpital Purpan, Place du Dr Baylac, 31059 Toulouse, France.
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Yakoub-Agha I, Doyen C, Hulin C, Marit G, Voillat L, Grosbois B, Harousseau J, Duguet C, Zerbib R, Facon T, Mary J. A multicenter prospective randomized study testing non-inferiority of thalidomide 100 mg/day as compared with 400 mg/day in patients with refractory/relapsed multiple myeloma: Results of the final analysis of the IFM 01–02 study. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.7520] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7520 Background: Thalidomide (THAL) is effective in pts with relapsed or refractory multiple myeloma (RRMM). A study by Yakoub-Agha et al of 83 patients (Hematol J, 2002) supported this effectiveness but showed a high incidence of THAL toxicity ≥ grade II, related to either THAL cumulative dose or dose-intensity. Themean daily dose of THAL in the first 90-day treatment period, however, did not influence response, overall survival (OS), or event-free survival. Given the dose-related toxicities and an unknown minimally effective THAL dose, the IFM conducted a prospective randomized study to compare the efficacy of THAL 100 mg/d with 400 mg/d in pts with RRMM after ≥2 lines of prior therapy. Methods: The study design was approved by the ethics committee at Lille University Hospital, and all pts gave written informed consent. Given the improved response seen with THAL plus dexamethasone (DEX), this combination was specified per protocol in both study arms for treatment failure (TF) defined as progression at any time or stable disease after 3 months of THAL treatment. THAL dose reduction for toxicity was permitted, but no increase over the initial dose was allowed. All pts received pamidronate routinely. The primary end point was 1-year OS. Secondary endpoints were response rate, EFS, and safety. Results: All results are based on intent-to-treat analyses. In all, 400 pts were enrolled (400 mg, n = 195; 100 mg, n = 205). The 2 groups were comparable in terms of patient characteristics, disease features including Ch13 deletion and prior therapy. Pts in the THAL 100 mg arm received DEX more frequently for TF than those in the 400 mg group, but this difference did not influence 1-year OS: 73 ± 3% vs 69 ± 3% in the 400 mg and 100 mg groups, respectively. The hypothesis of inferiority of 100 mg was rejected. Also, THAL 100 mg was better tolerated than 400 mg with less high-grade somnolence, constipation, and peripheral neuropathy (p < .001, p = .01 et p = .05, respectively). There was no difference regarding deep vein thrombosis. Conclusion: THAL 100 mg/d is comparable in terms of survival with 400 mg/d (with DEX as salvage therapy in case of TF in both arms) in pts with RRMM and better tolerated. [Table: see text]
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Affiliation(s)
- I. Yakoub-Agha
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - C. Doyen
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - C. Hulin
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - G. Marit
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - L. Voillat
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - B. Grosbois
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - J. Harousseau
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - C. Duguet
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - R. Zerbib
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - T. Facon
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
| | - J. Mary
- CHRU, Lille, France; Hematology, Mont Godienne, Belgium; CHU, Nancy, France; CHU, Bordeaux, France; CHU, Besancon, France; CHU, Rennes, France; CHU, Nantes, France; Pharmion Dvt, Paris, France; CHU, Paris, France
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Garban F, Attal M, Michallet M, Hulin C, Bourhis JH, Yakoub-Agha I, Lamy T, Marit G, Maloisel F, Berthou C, Dib M, Caillot D, Deprijck B, Ketterer N, Harousseau JL, Sotto JJ, Moreau P. Prospective comparison of autologous stem cell transplantation followed by dose-reduced allograft (IFM99-03 trial) with tandem autologous stem cell transplantation (IFM99-04 trial) in high-risk de novo multiple myeloma. Blood 2006; 107:3474-80. [PMID: 16397129 DOI: 10.1182/blood-2005-09-3869] [Citation(s) in RCA: 297] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Intergroupe Francophone du Myélome (IFM) initiated 2 trials in 1999 to study patients with high-risk (β2-microglobulin level greater than 3 mg/L and chromosome 13 deletion at diagnosis) de novo multiple myeloma. In both protocols, the induction regimen consisted of vincristine, doxorubicin, and dexamethasone (VAD) followed by first autologous stem cell transplantation (ASCT) prepared by melphalan 200 mg/m2. Patients with an HLA-identical sibling donor were subsequently treated with dose-reduced allogeneic stem cell transplantation (IFM99-03 trial), and patients without an HLA-identical sibling donor were randomly assigned to undergo second ASCT prepared by melphalan 220 mg/m2 and 160 mg dexamethasone with or without anti–IL-6 monoclonal antibody (IFM99-04 protocol). Two hundred eighty-four patients—65 in the IFM99-03 trial and 219 in the IFM99-04 trial—were prospectively treated and received at least one course of VAD. On an intent-to-treat basis, overall survival (OS) and event-free survival (EFS) did not differ significantly in the studies (medians 35 and 25 months in the IFM99-03 trial vs 41 and 30 months in the IFM99-04 trial, respectively). With a median follow-up time of 24 months, the EFS of the 166 patients randomly assigned in the tandem ASCT protocol was similar to the EFS of the 46 patients who underwent the entire IFM99-03 program (median, 35 vs 31.7 months), with a trend for a better OS in patients treated with tandem ASCT (median, 47.2 vs 35 months; P = .07). In patients with high-risk de novo MM, the combination of ASCT followed by dose-reduced allogeneic transplantation was not superior to tandem dose–intensified, melphalan-based ASCT.
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Affiliation(s)
- Frederic Garban
- Hematology Department, University Hospital Hôtel-Dieu, Place Ricordeau, 44093 Nantes cedex 01, France
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48
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Parrens M, Belaud-Rotureau MA, Fitoussi O, Carerre N, Bouabdallah K, Marit G, Dubus P, de Mascarel A, Merlio JP. Blastoid and common variants of mantle cell lymphoma exhibit distinct immunophenotypic and interphase FISH features. Histopathology 2006; 48:353-62. [PMID: 16487357 DOI: 10.1111/j.1365-2559.2005.02323.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS The recognition of blastoid variant (BV) of mantle cell lymphoma (MCL) is based on morphological criteria. Our aim was to analyse 18 MCL cases including four BV-MCL for their clinicopathological features, proliferation index, cyclin D1 and CDK4 expression and interphase fluorescence in-situ hybridization (FISH) pattern. METHODS AND RESULTS BV-MCL versus common MCL was characterized by a shorter overall duration of response after first-line therapy (11 months versus 28 months) and shorter overall survival (20 months versus 42 months). Interphase FISH showed a t(11;14) fusion pattern in all MCL tested cases. However, the four blastoid cases were characterized by extra copies of CCND1 signals. Using additional probes of chromosomes 11, 18, 21, these signals were shown to be the result of hypotetraploidy and not of a specific amplification of the normal or the translocated CCND1 allele. Moreover, the BV-MCL cases were characterized by a combined high percentage of cells expressing cyclin D1 and/or CDK4 with a proliferation (MIB-1-Ki67) index above 50%. Such features allowed the recognition of areas of large cell transformation in the case of secondary BV-MCL. CONCLUSIONS Since distinction between BV and common MCL is of clinical relevance, our data underline the need to add phenotypic and cytogenetic criteria to cytomorphology for a better recognition of BV-MCL.
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MESH Headings
- Adult
- Aged
- Antigens, CD20/analysis
- CD5 Antigens/analysis
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 14/genetics
- Cyclin D1/analysis
- Cyclin D1/genetics
- Cyclin-Dependent Kinase 4/analysis
- Female
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Interphase/genetics
- Ki-67 Antigen/analysis
- Leukosialin/analysis
- Lymphocytes/pathology
- Lymphoma, Mantle-Cell/genetics
- Lymphoma, Mantle-Cell/metabolism
- Lymphoma, Mantle-Cell/pathology
- Male
- Middle Aged
- Neoplastic Stem Cells/pathology
- Reverse Transcriptase Polymerase Chain Reaction
- Survival Analysis
- Translocation, Genetic
- Treatment Outcome
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Affiliation(s)
- M Parrens
- Department of Pathology and Tumour Biology, CHU Bordeaux and Equipe 2406, University of Bordeaux 2, Bordeaux, France.
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49
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Colombat M, Fort MP, Chollet C, Marit G, Roche C, Preudhomme C, Reiffers J, Praloran V, Mahon FX. Molecular remission in chronic myeloid leukemia patients with sustained complete cytogenetic remission after imatinib mesylate treatment. Haematologica 2006; 91:162-8. [PMID: 16461299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Imatinib mesylate induces a complete cytogenetic response (CCR) in many patients with chronic myeloid leukemia (CML). However, the ultimate goal of therapy for CML is complete elimination of Philadelphia chromosome positive cells or BCR-ABL rearrangements. We studied molecular responses in CML patients in CCR after imatinib treatment. DESIGN AND METHODS Real-time quantitative reverse transcriptase polymerase chain reaction analysis were used to monitor BCR-ABL levels in 59 CCR patients. Negative results were confirmed by two different techniques performed in two different laboratories. Patients were considered in complete molecular remission if they had four undetectable analyses from two separate samples taken three months apart. RESULTS The median follow-up was 41 months (17-53). The median BCR-ABL/ABL ratio at the time of CCR was 0.3 % (0-9.88). Patients were split into two groups: group A (n=43) comprised patients with a detectable BCR-ABL/ABL ratio throughout the follow-up and group B (n=16) included those with an undetectable level of BCR-ABL/ABL (< 10(-5)) i.e. in complete molecular remission. No relapses were observed in group B, while 13 group A patients lost their CCR. The probability of losing CCR in this group was 33.2 % >+/-18.0. By Cox regression analysis the best factor for predicting the probability of achieving molecular remission was having a CCR at 6 months (p=0.038) or at 3 months (p=0.024). INTERPRETATION AND CONCLUSIONS Molecular remission after imatinib treatment, i.e. BCR-ABL/ABL< 10-5 in peripheral blood, is not a rare event, particularly in patients achieving CCR at 6 months.
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Affiliation(s)
- Marie Colombat
- Laboratoire d'hématologie Université Victor Segalen, Bordeaux, France
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50
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Leguay T, Desplat V, Marit G, Mahon FX. D276G mutation is associated with a poor prognosis in imatinib mesylate-resistant chronic myeloid leukemia patients. Leukemia 2005; 19:2332-3; author reply 2333-4. [PMID: 16281074 DOI: 10.1038/sj.leu.2403993] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
MESH Headings
- Benzamides
- Drug Resistance, Neoplasm/genetics
- Fatal Outcome
- Humans
- Imatinib Mesylate
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Mutation, Missense
- Piperazines/pharmacology
- Piperazines/therapeutic use
- Prognosis
- Pyrimidines/pharmacology
- Pyrimidines/therapeutic use
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