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C Protière,
P Viens,
D Genre,
D Cowen,
J Camerlo,
G Gravis,
C Alzieu,
F Bertucci,
M Resbeut, D Maraninchi,
J P Moatti
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F. Bauduer,
C. Fabères,
J. M. Boiron,
D. Blaise,
G. Marit,
A. M. Stoppa,
A. Pigneux,
C. Chabannon,
P. Cony-Makhoul,
D. Redortier, D. Maraninchi,
J. Reiffers
[show abstract]
[hide abstract]
ABSTRACT: Thirty-two patients < 55 year with AML in first complete remission underwent autologous peripheral blood stem cell transplantation
(PBSCT). Before transplant, they were treated with one or two induction courses plus one consolidation cycle including daunorubicin
and araC. Thereafter, haemopoietic stem cells (HSC) were mobilized using daunorubicin 45 mg/m2 days 1-3 plus either high-dose araC 3 g/m2 TID, 4 days (BGMT87 trial, 13 patients) or intermediate-dose araC 500 mg/m2 TID, 4 days and G-CSF from day 7 until completion of cytaphereses (BGMT91 trial, 19 patients). The median number of leukaphereses
was 6 (range 5-6). Collections were better in the BGMT91 protocol concerning median MNC (18.1 versus 9.1 108/kg, p 0.0019), median CFU-GM (36.5 versus 13.5 104/kg, p 0.017), and median CD34+ cells (12.2 versus 7.65 106/kg, p 0.24). The unpurged product was reinfused after busulfan 16 mg/kg and melphalan 140 mg/m2. All but one patients engrafted. Number of days with fever and antibiotics, and hospitalization duration were significantly
reduced in the BGMT91 protocol. No death in aplasia was encountered. The actuarial DFS at 3 years was 55%+/-18%. Sufficient
HSC can be collected in AML following intensive consolidation and autologous PBSCT represents a valuable procedure in this
setting.
Key wordsAcute myeloid leukaemia–Autologous peripheral blood stem–cell transplantation Granulocyte–colony stimulating factor
Hematology and Cell Therapy 04/2012; 42(2):135-141.
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A Gonçalves,
B Esterni,
F Bertucci,
R Sauvan,
M Cubizolles,
S Granjeaud,
C Chabannon,
G Houvenaegel,
J Jacquemier,
X-Y Meng,
ET Fung,
D Birnbaum, D Maraninchi,
P Viens,
JP Borg
Breast Cancer Research 04/2012; 7:1-1. · 5.33 Impact Factor
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C Faucher,
A G Le Corroller Soriano,
B Esterni,
N Vey,
A M Stoppa,
C Chabannon,
M Mohty,
M Michallet,
J O Bay,
D Genre, D Maraninchi,
P Viens,
J P Moatti,
D Blaise
[show abstract]
[hide abstract]
ABSTRACT: We report the first randomized study comparing early hospital discharge with standard hospital-based follow-up after high-dose chemotherapy (HDCT) and PBSCT. Patients aged 18-65 years, with an indication of PBSCT for non-leukemic malignant diseases were randomly assigned between two arms. Arm A consisted of early hospital discharge (HDCT during hospitalization, discharge at day 0, home stay with a caregiver, outpatient clinic follow-up). In arm B patients were followed up as inpatients. In total 131 patients were analyzed (66 in arm A and 65 in arm B). Patient characteristics and hematological reconstitution were comparable between the two groups. In arm A, 26 patients were actually discharged early. Patients in group A spent fewer days in hospital (11 vs 12 days, P=0.006). This strategy resulted in a 6% mean cost reduction per patient when compared with the conventional hospital-based group. The early discharge approach within the French health system, while safe and feasible, is highly dependent on social criteria (caregiver availability and home to hospital distance). It is almost always associated with conventional hospital readmission during the aplasia phase, and limits cost savings when considering the whole population of patients benefiting from HDCT in routine clinical practice.
Bone marrow transplantation 07/2011; 47(4):549-55. · 3.00 Impact Factor
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British Journal of Haematology 03/2008; 60(4):770 - 770. · 4.94 Impact Factor
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D Coso,
C Sebban,
O Boulat,
P Biron,
J Rey,
T Aurran,
C Chabannon,
L Xerri,
B Chetaille,
B Esterni,
V Ivanov,
A M Stoppa,
J M Schiano de Collela,
J A Gastaut, D Maraninchi,
R Bouabdallah
[show abstract]
[hide abstract]
ABSTRACT: The potential benefit of rituximab as adjuvant to high-dose therapy (HDT) has been investigated in patients under 60 years with poor-risk (age-adjusted international prognostic index at 2-3) CD20+ diffuse large B-cell lymphoma (DLBCL). The treatment consisted of four cycles of high-dose CEOP (cyclophosphamide, epirubicin, vincristine, prednisone), plus etoposide and cisplatin during the two last cycles. Peripheral blood stem cells were collected after cycle 1, and reinfused after cycles 3 and 4. Four weekly rituximab infusions were subsequently delivered. Among the 36 patients included, 30 could complete chemotherapy schedule, and 24/36 received rituximab. A complete response occured in 26/36 patients (72%). With a median follow-up of 30 months, the estimated 5-year overall survival (OS) and event-free survival (EFS) rates (mean +/- s.d.) were 65 +/- 16 and 63 +/- 15%, respectively. For the 24 patients who received both chemotherapy and rituximab, the estimated 5-year OS and EFS rates were 86 +/- 14 and 82 +/- 15%. These data suggest that rituximab after HDT is feasible. Both complete remission rate and survival curves compare favorably with the poor outcome usually observed in high-risk DLBCL patients managed with HDT without rituximab.
Bone Marrow Transplantation 09/2006; 38(3):217-22. · 3.75 Impact Factor
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A Gonçalves,
B Esterni,
F Bertucci,
R Sauvan,
C Chabannon,
M Cubizolles,
V J Bardou,
G Houvenaegel,
J Jacquemier,
S Granjeaud,
X-Y Meng,
E T Fung,
D Birnbaum, D Maraninchi,
P Viens,
J-P Borg
[show abstract]
[hide abstract]
ABSTRACT: A total of 30-50% of early breast cancer (EBC) patients considered as high risk using standard prognostic factors develop metastatic recurrence despite standard adjuvant systemic treatment. A means to better predict clinical outcome is needed to optimize and individualize therapeutic decisions. To identify a protein signature correlating with metastatic relapse, we performed surface-enhanced laser desorption/ionization-time of flight mass spectrometry profiling of early postoperative serum from 81 high-risk EBC patients. Denatured and fractionated serum samples were incubated with IMAC30 and CM10 ProteinChip arrays. Several protein peaks were differentially expressed according to clinical outcome. By combining partial least squares and logistic regression methods, we built a multiprotein model that correctly predicted outcome in 83% of patients. The 5-year metastasis-free survival in 'good prognosis' and 'poor prognosis' patients as defined using the multiprotein index were strikingly different (83 and 22%, respectively; P<0.0001, log-rank test). In a multivariate Cox regression including conventional pathological factors and multiprotein index, the latter retained the strongest independent prognostic significance for metastatic relapse. Major components of the multiprotein index included haptoglobin, C3a complement fraction, transferrin, apolipoprotein C1 and apolipoprotein A1. Therefore, postoperative serum protein pattern may have an important prognostic value in high-risk EBC.
Oncogene 02/2006; 25(7):981-9. · 6.37 Impact Factor
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V Ivanov,
C Faucher,
M Mohty,
K Bilger,
P Ladaique,
D Sainty,
C Arnoulet,
C Chabannon,
N Vey,
J Camerlo,
R Bouabdallah,
P Viens, D Maraninchi,
V J Bardou,
B Esterni,
D Blaise
[show abstract]
[hide abstract]
ABSTRACT: The use of recombinant human erythropoietin (rHuEPO) has been controversial after myeloablative allogeneic Stem cell transplantation (allo-SCT). Reduced intensity conditioning regimens (RIC) offer a novel approach that might translate into a different profile of erythropoietic recovery. We treated 20 consecutive patients with rHuEPO early after matched sibling RIC allo-SCT. Conditioning included fludarabine, busulfan and antithymocyte globulin. EPO treatment was analyzed in terms of toxicity, impact on the frequency of Red blood cell transfusions (RBCT) and kinetics of Hemoglobin recovery within the 60 days post-allo-SCT. Results were compared with 27 matched patients who did not receive rHuEPO. In the first 2 months after allo-SCT all patients receiving rHuEPO (100%) achieved an Hb level > 11 g/dl at a median of 30 (15-35) days post-allo-SCT, as compared to only 63% of the patients not receiving rHuEPO (P = 0.007) at a median of 35 (20-55) days (P = 0.03). A total of 70% (95% CI, 50-90) of rHuEPO patients maintained an Hb over 11 g/dl in the second month as compared to only 19% (95% CI, 4-34) in the other group (P = 0.0004). For patients receiving RBCT, the use of rHuEPO was associated with a trend towards reduced RBCT requirements. This pilot study suggests a potential benefit of early administration of rHuEPO after RIC allo-SCT on early erythropoietic recovery.
Bone Marrow Transplantation 12/2005; 36(10):901-6. · 3.75 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: PURPOSE: Breast cancer is a complex and heterogeneous disease resulting from various molecular alterations, the identification of which should have profound impact on the management of patients. CURRENT KNOWLEDGE AND KEY POINTS: The discovery of germline mutations within breast cancer susceptibility genes, such as BRCA1 and BRCA2, which are associated with a major risk of breast cancer during lifetime, has improved the assessment of the individual risk toward the disease, allowing appropriate strategies of screening and prevention. The identification of key molecular actors in the mammary oncogenesis may help to better assess the prognosis of the disease, while providing new therapeutic targets. Large-scale molecular technologies, which allow simultaneous assessment of a high number of molecular parameters in a single assay, should provide new tools to tackle complexity and heterogeneity of breast cancer. Hence, by examining transcriptional profiles of breast cancer using DNA microarrays, it was possible to reveal new prognostic tumor subgroups, previously indistinguishable. Further improvements are awaited with the recent development of high throughput and large-scale technologies investigating the tumor proteome. PROSPECTS AND PROJECTS: Precise knowledge of molecular alterations involved in each individual breast cancer will allow more effective and less toxic, tailored therapies.
La Revue de Médecine Interne 07/2005; 26(6):470-8. · 0.61 Impact Factor
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M Mohty,
J M Boiron,
G Damaj,
A S Michallet,
J O Bay,
C Faucher,
V Perreau,
K Bilger,
D Coso,
A M Stoppa,
R Tabrizi,
J A Gastaut,
M Michallet, D Maraninchi,
D Blaise
[show abstract]
[hide abstract]
ABSTRACT: In all, 41 multiple myeloma (MM) patients received an antithymocyte globulin (ATG), fludarabine, and busulfan-based reduced intensity conditioning (RIC) for allogeneic stem cell transplantation (allo-SCT) from HLA-identical siblings. In total, 29 patients (70%) were in partial remission, one patient in complete remission, and 11 (27%) with progressive disease at the time of allo-SCT. Median time between diagnosis and allo-SCT was 24 months. The cumulative incidences of grade II-IV and grade III-IV acute graft-versus-host disease (GVHD) were 36% (95% CI, 21-51%) and 7% (95% CI, 2-20%), respectively. Overall, 10 patients developed limited chronic GVHD, whereas seven developed an extensive form (cumulative incidence, 41% (95% CI, 26-56%) at 2 years). With a median follow-up of 389 days, the overall cumulative incidence of transplant-related mortality (TRM) was 17% (95% CI, 6-28%). In all, 11 patients (27%) are in continuous complete remission, and the Kaplan-Meier estimates of overall survival (OS) and progression-free survival (PFS) at 2 years were 62% (95% CI, 47-76%) and 41% (95% CI, 23-62%), respectively. PFS and OS were significantly higher in patients with chronic GVHD as compared to patients without chronic GVHD (P=0.006 for PFS and P=0.01 for OS). Collectively, these data demonstrate that RIC allo-SCT can mediate a potentially curative graft-versus-myeloma effect with an acceptable incidence of toxicity and TRM.
Bone Marrow Transplantation 08/2004; 34(1):77-84. · 3.75 Impact Factor
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F Bertucci,
C Tarpin,
E Charafe-Jauffret,
V-J Bardou,
A-C Braud,
A Tallet,
G Gravis,
F Viret,
A Gonçalves,
G Houvenaeghel,
D Blaise,
J Jacquemier, D Maraninchi,
P Viens
[show abstract]
[hide abstract]
ABSTRACT: The prognosis of inflammatory breast cancer (IBC) is poor. We evaluated clinical and biopathological characteristics that could affect survival in 74 women with nonmetastatic IBC consecutively treated in our institution between 1976 and 2000. Patients received primary anthracycline-based chemotherapy at conventional doses (n=20) or high-dose chemotherapy (HDC) with haematopoietic stem cell support (HSCS) (n=54). After chemotherapy, 84% of patients underwent mastectomy, 95% were given radiotherapy and 55% tamoxifen. Immunohistochemistry data (ER, PR, ERBB2, P53) on pre-chemotherapy specimens suggested strong differences between IBC and non-IBC. The rate of pathological complete response to chemotherapy was 26% (27% with HDC and 17% with conventional doses, not significant). No single factor was found predictive of response. With a median follow-up of 48 months after diagnosis, the 5-year projected disease-free survival (DFS) was 24% and overall survival (OS) 41%. In multivariate analysis, the strongest independent prognostic factor was the delivery of HDC. The 5-year DFS and OS of patients were respectively 28 and 50% with HDC and 15 and 18% with conventional chemotherapy. These results and comparisons with other series of patients suggest a role for HDC with HSCS as part of the therapeutic approach in IBC. Further prospective studies are required to confirm it.
Bone Marrow Transplantation 06/2004; 33(9):913-20. · 3.75 Impact Factor
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V Ivanov,
C Faucher,
M Mohty,
K Bilger,
P Ladaique,
D Sainty,
C Arnoulet,
C Chabannon,
N Vey,
J Camerlo,
R Bouabdallah, D Maraninchi,
V J Bardou,
D Blaise
[show abstract]
[hide abstract]
ABSTRACT: RBCT (RBCT) requirements of stem cell transplant (SCT) recipients are often substantial and may be related to transplant type.
An analysis was done of RBCT requirements and Hb recovery kinetic in the first 60 days after HLA-identical sibling allogeneic SCT in a series of 110 consecutive patients treated for various malignant diagnoses. Patients were prepared with either an antithymocyte globulin (ATG) and reduced intensity chemotherapy-based conditioning (RIC) (n=64) or a myeloablative conditioning regimens (MAC; n=46). Patients received marrow (n=64) or PBPCs (n=46).
Overall, intensity of conditioning regimen (RIC vs. MAC; p=0.0005) and graft source (PBPC vs. marrow; p<0.0001) independently predicted RBCT requirements. Hb recovery was accelerated after RIC when compared to MAC allo-SCT (p=0.02). In RIC patients, RBCTs were inversely correlated to Hb level before conditioning (p<0.0001) and the dose of ATG (p=0.009). Moreover, Hb level before allo-SCT significantly influenced Hb recovery kinetic after RIC but had no impact on RBCT requirements and Hb recovery after MAC.
Thus, RIC conditioning creates a different pattern of erythropoiesis recovery as compared to a MAC regimen and suggest a need for studies aimed at further reducing RBCT and accelerating Hb recovery.
Transfusion 05/2004; 44(4):501-8. · 3.22 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Lhtrognit des tumeurs est un concept aujourdhui bien tabli en oncologie mdicale. La reconnaissance de cette htrognit implique une prise en charge multidisciplinaire de la maladie, et une caractrisation aussi prcise que possible de la tumeur, associant des paramtres cliniques et biologiques, dont les plus rcemment tablis utilisent les outils danalyse molculaire haut dbit tels que puces ADN ou techniques protomiques. La mise en uvre de ces stratgies impose que laccs aux tumeurs puisse tre organis dans lintrt individuel des patients, et dans lintrt collectif des mdecins et des chercheurs intresss lucider les mcanismes de la cancrogense et laborer de nouveaux traitements. Nous dcrivons ici quelles conditions techniques et rglementaires doivent tre respectes pour atteindre ces objectifs.Tumour heterogeneity is now a well-established concept in medical oncology. Its recognition justifies a multi-disciplinary approach to tumour treatment. This includes a detailed characterisation of each cancer, that associates clinical as well as biological parameters, the latter using recently established high-throughput molecular techniques such as DNA arrays or proteomics. A key condition for successful completion of multiple analyses is an organised access to tumour tissues and this must be done while preserving the individual rights and interests of patients as well as the collective interests of the medical and scientific communities. We hereafter describe technical and regulatory conditions that need to be respected in order to reach these objectives.
Oncologie 02/2004; 6(2):93-98. · 0.17 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Les mesures de la qualit de vie sont susceptibles de modifier la pratique des cliniciens impliqus dans le domaine du cancer, car elles les aident choisir un traitement ou une procdure mdicale en prenant en compte le point de vue des patients, mieux informer leurs malades partir des expriences acquises par dautres, les faire accder au traitement qui leur est le mieux adapt (ou quils prfrent) et leur assurer un suivi de routine plus appropri. Plus gnralement, lvaluation de la qualit de vie peut modifier la pratique mdicale traditionnelle, dans le sens o elle participe un processus tendant globalement replacer le malade au centre du systme de soins. Nous illustrerons ce qui est nonc ci-dessus en prenant des exemples tirs de la littrature ou de notre propre exprience, en particulier, dans le cancer du sein.Measures to improve the quality of life of patients are likely to modify the practice of cancer clinicians, by helping them to choose a treatment or medical procedure while bearing in mind the patients point of view. These measures can enable them to better inform their patients about experiences of others, to allow them to obtain more appropriate treatment (or the treatment they prefer), and to offer them a more adopted routine follow-up. More generally, the assessment of the quality of life can modify traditional medical practice since it contributes to a process that globally tends to replace the patient in the centre of the healthcare system. We illustrate this by providing examples from the literature or from our own experience, particularly in breast cancer.
Oncologie 02/2004; 6(2):124-127. · 0.17 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: The objective of the study was to assess the long-term outcome and impact of stem cell source in patients with acute myelogenous leukemia (AML) who received ASCT in first complete remission (CR). A total of 101 patients (median age 46 years) were included in the study. Cytogenetic categories distribution was: favorable: 18%, intermediate: 42%, and unfavorable: 7%. More than one induction course was needed for CR in 21% of patients. In all, 78% of patients had received at least one course of high-dose ara-C before autologous stem cell transplantation (ASCT). Bone marrow (n=58) or peripheral blood stem cells (PBSC) (n=43) transplantation was performed at a median of 3.5 months from CR. Hematologic recovery and hospitalization duration were significantly reduced in the PBSC group. No toxic death was recorded in this group. The median follow-up of survivors is 67 months (range: 15-183). The 6-year survival, disease-free survival (DFS), and relapse probabilities are 44%, 38%, and 54%, respectively. The presence of a favorable karyotype and the use of PBSC are independently associated to better survival, and DFS by multivariate analysis. Our results confirm that long-term DFS can be achieved with high-dose chemotherapy and ASCT in patients with AML. They show that use of PBSC is associated to very low mortality rate and acceptable morbidity and contributes to an improvement of autotransplant results.
Bone Marrow Transplantation 02/2004; 33(2):177-82. · 3.75 Impact Factor
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A.-C. Braud,
G. Gravis,
J. Camerlo,
A. Goncalves,
F. Viret,
C. Tarpin,
F. Bertucci,
D. Coso,
G. Damaj,
M. Vitot,
J.-M. Schiano,
A. Madroszyk,
P. Ladaique,
P. Viens, D. Maraninchi
[show abstract]
[hide abstract]
ABSTRACT: La fatigue et lanmie sont les symptmes les plus
frquemment rapports par les patients en cours de
chimiothrapie. Les traitements curatifs sont souvent dune
efficacit retarde et insuffisante, et ont un cot non
ngligeable. Notre stratgie a t de proposer un traitement
prcoce de lanmie pour tout patient en cours de chimiothrapie
en utilisant des doses rduites et avec un schma
simplifi.Patients et
mthode:Tout patient g de plus de 18 ans trait pour une tumeur
solide ou lymphome ayant une hmoglobine infrieure ou gale
12 g/dL reoit un traitement par rythropotine (EPO). Le
traitement est de rH-EPO 20 000 UI SC une fois par semaine. Les
patients gs de plus de 70 ans recevaient de faon arbitraire
darbepotine 150 U SC une fois tous les 15 jours. Lvaluation
portait sur le nombre de patients traits, transfuss, le cot
global des prescriptions dEPO.Rsultats:Ltude porte sur 12 mois doctobre 2002 octobre 2003.
Le nombre de patients traits chaque mois est de 363 [317-415],
soit trois fois plus quen 2001. Le nombre de patients
transfuss a significativement baiss et est de 13 %, ce qui
reprsente une rduction de 30 % des transfusions sur les 6
premiers mois de lanne 2003. Le cot global des prescriptions
par EPO est rest stable malgr laugmentation du nombre de
patients traits.Conclusion:Le traitement prcocede lanmie avec des posologies
rduites et des schmas simplifis des patients traits par
chimiothrapie permet de traiter un plus grand nombre de
patients, de rduire les transfusions sans augmenter le cot
global des traitements pour la socit.Fatigue and anemia are the symptoms most frequently
reported by patients undergoing chemotherapy. The efficacy of
curative treatments is often delayed and insufficient and the
treatment cost is not insignificant. Our strategy was to propose
an early treatment of anemia for any patient undergoing
chemotherapy and using reduced doses with a simplified
regimen.Patients and
methods:Any patient over 18 years of age treated for a solid tumor
or lymphoma with an hemoglobin equal to or less than 12 g/dL
received a treatment with erythropoietin (EPO). Treatment was
rH-EPO 20,000 IU SC once a week. Patients over 70 years of age
received arbitrarily darbepoietin 150 U SC once every 15 days.
The assessment focused on the number of patients treated,
transfused and the overall cost of EPO prescriptions.Results:The study duration was 12 months from October 2002 to
October 2003. The number of patients treated each month was 363
[317-415], i. e. three times more than in 2001. The number of
patients transfused decreased significantly and was 13%, which
represents a 30% reduction in transfusions over the first 6
months of the year 2003. The overall cost of EPO prescriptions
remained stable despite the increase in the number of patients
treated.Conclusion:The early treatment of anemia with reduced dosages and
simplified regimens, and patients treated with chemotherapy,
makes it possible to treat more patients and to reduce
transfusions without increasing the overall treatment cost for
society.
Oncologie 01/2004; 6(1):49-53. · 0.17 Impact Factor
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F Viret,
C Chabannon,
D Sainty,
D Genre,
A Gonçalves,
C Arnoulet,
G Gravis,
F Bertucci,
G Houvenaeghel,
J Jacquemier,
V J Bardou,
P Ladaique,
A C Braud, D Maraninchi,
P Viens
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to evaluate the presence of micrometastatic cells in the apheresis products from patients with breast cancer, and also to determine if repeated infusion of contaminated products had any clinical impact. A total of 94 patients with high-risk breast cancer were enrolled in a prospective single center study to evaluate the use of dose-intensified chemotherapy (doxorubicine 75 mg/m(2) and cyclophosphamide 3000 or 6000 mg/m(2) for four cycles) with repeated (x 2) stem cell reinfusion. All women were monitored for the presence of metastatic cells in aphereses, collected after first course of intensive chemotherapy, and following additional mobilization with rhG-CSF. Epithelial cells were screened with monoclonal antibodies directed to cytokeratin. Eight of the 94 patients had detectable tumor cells in one or several aphereses collected after intensive chemotherapy; this was unrelated to other tumor characteristics, including size, histology, Scarff Bloom and Richardson (SBR) grading (presence or absence of hormone receptors). Hemato-poietic reconstitution was similar in the cells from these eight patients, and in the total patient population. Three of these eight patients relapsed. This study has confirmed that contamination of apheresis products remains a rare event, which does not seem to affect clinical evolution, even when reinfused into the patient.
Bone Marrow Transplantation 01/2004; 32(11):1059-64. · 3.75 Impact Factor
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M Mohty,
W Jacot,
C Faucher,
J O Bay,
C Zandotti,
L Collet,
B Choufi,
K Bilger,
O Tournilhac,
N Vey,
A M Stoppa,
D Coso,
J A Gastaut,
P Viens, D Maraninchi,
D Olive,
D Blaise
[show abstract]
[hide abstract]
ABSTRACT: In the setting of reduced-intensity conditioning (RIC) regimens for allogeneic stem cell transplantation (allo-SCT), the epidemiology of transplant-related infections is still poorly defined. In 101 high-risk patients who received an HLA-identical sibling allo-SCT after RIC, including fludarabine, busulfan and antithymocyte globulin (ATG), we report during the first 6 months a cumulative incidence of positive CMV antigenemia of 42% (95% CI 32-52%), developing at a median of 37 (range 7-116) days without evidence of CMV disease (median follow-up, 434 days). The cumulative incidence of bacteremia was 25% (95% CI 17-33%), occurring at a median of 67 (range 7-172) days, while patients had recovered a full neutrophil count. In all, 65% of the bacteremia (95% CI 49-81%) were gram negative. The cumulative incidence of fungal infections was 8% (95% CI 3-13%), with a median onset of 89 (range 7-170) days. In multivariate analysis, stem cell source (bone marrow; P=0.0002) was significantly associated with the risk of positive CMV antigenemia, while higher doses of prednisone (>2 mg/kg) represented the major risk factor for bacteremia (P=0.0001). Infectious-related mortality was 5% (95% CI 1-9%), with aspergillosis being the principal cause. Collectively, these results suggest that prospective efforts are warranted to develop optimal antimicrobial preventive strategies after RIC allo-SCT.
Leukemia 11/2003; 17(11):2168-77. · 9.56 Impact Factor
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F Viret,
M Ychou,
A Gonçalves,
V Moutardier,
V Magnin,
A C Braud,
J B Dubois,
E Bories,
G Gravis,
J Camerlo,
D Genre, D Maraninchi,
P Viens,
M Giovannini
[show abstract]
[hide abstract]
ABSTRACT: We conducted a phase 1 trial to determine the maximum tolerated dose (MTD) of weekly docetaxel delivered concurrently with radiation therapy for the treatment of locally advanced adenocarcinoma of the pancreas.
Thirteen patients with histologically proven locally non-resectable advanced adenocarcinoma of the pancreas were enrolled in this study. Patients received 4 weekly doses of docetaxel by 1-hour intravenous (IV) infusion with 40 Gy of external beam radiation therapy during 4 weeks. Patients who were stabilized or in response, received 2 additional cycles of docetaxel with a 10 Gy boost of radiotherapy. Doses were escalated at 10 mg/m2 increments in successive cohorts of 3 new patients until MTD was observed.
Four patients received docetaxel at 20 mg/m2/week, 3 at 25 mg/m2/week, 3 at 30 mg/m2/week, and 3 at 35 mg/m2/week. All patients, except 2, were given the treatment in its integrity. The most common toxicities were nausea, vomiting, asthenia, and abdominal pains. Except for 1 patient, all toxicity was reversible and did not exceed grade 3. Hematologic toxicity was mild and has not required treatment interruption. 28% of the patients had to be rehospitalized. A total of 73 cycles was administered with a mean of 4 cycles per patient (2-6).
Even the MTD was not reached, dose escalation was stopped at 35 mg/m2/week. This dose is comparable to the ones previously published using docetaxel in combination with radiotherapy in other tumors. Three patients achieved stable disease and 1 patient an objective response. This combination of weekly docetaxel and radiotherapy shows a feasible and well-tolerated regimen, with, nonetheless, a significant rate of rehospitalization, for patients with locally advanced pancreatic cancer.
Pancreas 11/2003; 27(3):214-9. · 2.39 Impact Factor
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F. Viret,
M. Ychou,
A. Gonçalves,
V. Moutardier,
V. Magnin,
A. C. Braud,
J. B. Dubois,
E. Bories,
G. Gravis,
J. Camerlo,
D. Genre, D. Maraninchi,
P. Viens,
M. Giovannini
[show abstract]
[hide abstract]
ABSTRACT: Purpose: We conducted a phase 1 trial to determine the maximum tolerated dose (MTD) of weekly docetaxel delivered concurrently with radiation therapy for the treatment of locally advanced adenocarcinoma of the pancreas.
Patients and Methods: Thirteen patients with histologically proven locally non-resectable advanced adenocarcinoma of the pancreas were enrolled in this study. Patients received 4 weekly doses of docetaxel by 1-hour intravenous (IV) infusion with 40 Gy of external beam radiation therapy during 4 weeks. Patients who were stabilized or in response, received 2 additional cycles of docetaxel with a 10 Gy boost of radiotherapy. Doses were escalated at 10 mg/m2 increments in successive cohorts of 3 new patients until MTD was observed.
Results: Four patients received docetaxel at 20 mg/m2/week, 3 at 25 mg/m2/week, 3 at 30 mg/m2/week, and 3 at 35 mg/m2/week. All patients, except 2, were given the treatment in its integrity. The most common toxicities were nausea, vomiting, asthenia, and abdominal pains. Except for 1 patient, all toxicity was reversible and did not exceed grade 3. Hematologic toxicity was mild and has not required treatment interruption. 28% of the patients had to be rehospitalized. A total of 73 cycles was administered with a mean of 4 cycles per patient (2-6).
Conclusion: Even the MTD was not reached, dose escalation was stopped at 35 mg/m2/week. This dose is comparable to the ones previously published using docetaxel in combination with radiotherapy in other tumors. Three patients achieved stable disease and 1 patient an objective response. This combination of weekly docetaxel and radiotherapy shows a feasible and well-tolerated regimen, with, nonetheless, a significant rate of rehospitalization, for patients with locally advanced pancreatic cancer.
Pancreas 09/2003; 27(3):214-219. · 2.39 Impact Factor
