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X Leleu,
G Fouquet,
B Hebraud,
M Roussel,
D Caillot,
M Lorraine Chrétien,
B Arnulf,
R Szalat,
L Garderet,
L Benajiba, [......],
A Caulier, A M Stoppa,
S Garciaz,
C Touzeau,
C Chaleteix,
J P Fermand,
H Avet Loiseau,
T Facon,
M Attal,
P Moreau
Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K 04/2013; · 8.30 Impact Factor
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F Magrangeas,
H Avet-Loiseau,
W Gouraud,
L Lodé,
O Decaux,
P Godmer,
L Garderet,
L Voillat,
T Facon, A M Stoppa,
G Marit,
C Hulin,
P Casassus,
M Tiab,
E Voog,
E Randriamalala,
K C Anderson,
P Moreau,
N C Munshi,
S Minvielle
[show abstract]
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ABSTRACT: Recent studies have provided direct evidence for genetic variegation in subclones for various cancer types. However, little is known about subclonal evolutionary processes according to treatment and subsequent relapse in multiple myeloma (MM). This issue was addressed in a cohort of 24 MM patients treated either with conventional chemotherapy or with the proteasome inhibitor, bortezomib. As MM is a highly heterogeneous disease associated with a large number of chromosomal abnormalities, a subset of secondary genetic events that seem to reflect progression, 1q21 gain, NF-κB-activating mutations, RB1 and TP53 deletions, was examined. By using high-resolution single-nucleotide polymorphism arrays, subclones were identified with nonlinear complex evolutionary histories. Such reordering of the spectrum of genetic lesions, identified in a third of MM patients during therapy, is likely to reflect the selection of genetically distinct subclones, not initially competitive against the dominant population but which survived chemotherapy, thrived and acquired new anomalies. In addition, the emergence of minor subclones at relapse appeared to be significantly associated with bortezomib treatment. These data support the idea that new strategies for future clinical trials in MM should combine targeted therapy and subpopulations' control to eradicate all myeloma subclones in order to obtain long-term remission.Leukemia advance online publication, 11 September 2012; doi:10.1038/leu.2012.226.
Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K 08/2012; · 8.30 Impact Factor
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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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G Damaj,
F Malard,
C Hulin,
D Caillot,
R Garidi,
B Royer,
G Marit, A M Stoppa,
A Banos,
N Morineau,
P Moreau,
O Fitoussi,
M Tiab
[show abstract]
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ABSTRACT: One hundred and ten patients with multiple myeloma were treated with bendamustine as part of a French compassionate use program. To receive bendamustine, patients had to present with relapsed or refractory disease after prior therapies that had to include alkylators, steroids, IMiDs and bortezomib. The median number of bendamustine cycles administered was 4 (1-13). The overall response rate (≥ partial response) was 30%, including 2% complete responses. The median progression-free and overall survival for the entire cohort were 9.3 and 12.4 months, respectively. In this series of patients with advanced disease, both the response rate and the duration of response are encouraging and indicate that bendamustine presents a feasible option, which should be considered for the treatment of relapsed/refractory patients.
Leukemia & lymphoma 09/2011; 53(4):632-4. · 2.40 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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L Castagna,
S Fürst,
N Marchetti,
J El Cheikh,
C Faucher,
M Mohty,
R Bouabdallah,
N Vey, A M Stoppa,
B Esterni,
D Blaise
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ABSTRACT: In this retrospective study, 63 patients >60 years with hematological malignancies and treated with allo-SCT and with reduced-intensity conditioning (RIC) were reviewed. A total of 51% of patients suffered from AML or myelodysplastic syndromes. Disease status before transplantation was CR or PR 71 with 29% transplanted with active disease. Patients were classified according to three published prognostic indexes: (1) hematopoietic cell transplantation comorbidity index (HCT-CI); (2) European BMT (EBMT) score; and (3) Pretransplantation Assessment of Mortality (PAM) score. The 100-day and 1-year treatment-related mortality (TRM) were 6 and 22%, respectively, for the entire group. The 2-year OS and PFS were 60 and 58%, respectively. The incidence of grade II-IV acute GVHD (aGVHD) and extensive chronic GVHD was 46 and 48%, respectively. In a univariate analysis, neither the HCT-CI nor the EBMT score, nor the PAM score were predictive of TRM and OS. Only the occurrence of aGVHD affected the TRM and OS. ALLO-RIC is feasible in elderly patients. Even if those prognostic scores were not adapted to elderly patients, they did not predict for TRM and OS. aGVHD is the main cause of TRM and more efforts should be made to reduce its incidence without sacrificing graft vs tumor effect.
Bone marrow transplantation 10/2010; 46(7):1000-5. · 3.00 Impact Factor
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P Moreau,
C Hulin,
G Marit,
D Caillot,
T Facon,
P Lenain,
C Berthou,
B Pégourié, A M Stoppa,
P Casassus,
M Michallet,
L Benboubker,
H Maisonneuve,
C Doyen,
S Leyvraz,
C Mathiot,
H Avet-Loiseau,
M Attal,
J L Harousseau
Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K 06/2010; 24(6):1233-5. · 8.30 Impact Factor
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P Borentain,
P Colson,
D Coso,
E Bories,
A Charbonnier, A M Stoppa,
T Auran,
A Loundou,
A Motte,
E Ressiot,
E Norguet,
C Chabannon,
R Bouabdallah,
C Tamalet,
R Gérolami
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ABSTRACT: We studied clinical outcome and clinico-virological factors associated with hepatitis B virus reactivation (HBV-R) following cancer treatment in hepatitis B virus surface antigen (HBsAg)-negative/anti-hepatitis B core antibodies (anti-HBcAb)-positive patients. Between 11/2003 and 12/2005, HBV-R occurred in 7/84 HBsAg-negative/anti-HBcAb-positive patients treated for haematological or solid cancer. Virological factors including HBV genotype, core promoter, precore, and HBsAg genotypic and amino acid (aa) patterns were studied. Patients presenting with reactivation were men, had an hepatitis B virus surface antibody (HBsAb) titre <100 IU/L and underwent >1 line of chemotherapy (CT) significantly more frequently than controls. All were treated for haematological cancer, 3/7 received haematopoietic stem cell transplantation (HSCT), and 4/7 received rituximab. Using multivariate analysis, receiving >1 line of CT was an independent risk factor for HBV-R. Fatal outcome occurred in 3/7 patients (despite lamivudine therapy in two), whereas 2/4 survivors had an HBsAg seroconversion. HBV-R involved non-A HBV genotypes and core promoter and/or precore HBV mutants in all cases. Mutations known to impair HBsAg antigenicity were detected in HBV DNA from all seven patients. HBV DNA could be retrospectively detected in two patients prior cancer treatment and despite HBsAg negativity. HBV-R is a concern in HBsAg-negative/anti-HBcAb-positive patients undergoing cancer therapy, especially in males presenting with haematological cancer, a low anti-HBsAb titre and more than one chemotherapeutic agent. HBV DNA testing is mandatory to improve diagnosis and management of HBV-R in these patients. The role of specific therapies such as rituximab or HSCT as well as of HBV aa variability deserves further studies.
Journal of Viral Hepatitis 12/2009; 17(11):807-15. · 4.09 Impact Factor
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H de Lavallade,
J El-Cheikh,
C Faucher,
S Fürst, A-M Stoppa,
D Coso,
R Bouabdallah,
C Chabannon,
J-A Gastaut,
D Blaise,
M Mohty
[show abstract]
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ABSTRACT: The aim of this retrospective analysis was to assess the benefit of reduced-intensity conditioning allo SCT (RIC allo-SCT) in a cohort of 32 relapsed multiple myeloma (MM) patients. A total of 19 patients had an HLA-identical sibling donor ('donor' group), while 13 patients had no donor ('no-donor' group). There were no significant differences between these two groups as for prognosis risk factors. Eighteen patients from the 'donor' group could actually proceed to RIC allo-SCT. With a median follow-up of 36 (range, 21-60) months, six patients died from transplant-related toxicity (cumulative incidence, 33% (95% CI, 11-55%)). Only 4 patients from the 18 transplanted patients (22%; 95% CI, 7-48%) progressed after RIC allo-SCT, as compared to 12 (86%; 95% CI, 56-98%; P=0.0003) among the nontransplanted patients. In an 'intention-to-treat' analysis, the Kaplan-Meier estimate of PFS was significantly higher in the 'donor' group as compared to the 'no-donor' group (P=0.01; 46 versus 8% at 3 years). There was no difference in terms of overall survival. However, in multivariate analysis, actual performance of RIC allo-SCT was associated with better PFS (relative risk, 0.35; 95% CI, 0.15-0.82; P=0.01). These data suggest a potential benefit for RIC allo-SCT in the management of relapsed MM warranting further prospective investigations.
Bone Marrow Transplantation 07/2008; 41(11):953-60. · 3.75 Impact Factor
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M Mohty,
H de Lavallade,
J El-Cheikh,
P Ladaique,
C Faucher,
S Fürst,
N Vey,
D Coso, A-M Stoppa,
J-A Gastaut,
C Chabannon,
D Blaise
Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K 07/2008; 23(1):194-6. · 8.30 Impact Factor
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[show abstract]
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ABSTRACT: INTRODUCTION: Chronic lymphocytic leukemia (CLL) is the most common leukaemia in the Western world. Recent advancement in the aetiology, pathophysiology and the development of new therapeutics tools have significantly modified the current management of CLL. CURRENT KNOWLEDGE AND KEY POINTS: The cellular origin of CLL is still unknown. The current main hypothesis will be first briefly described. This review will then focus on the newly defined prognostic factors and the development and use of new drugs for the treatment of CLL. To describe the modern and practical management of CLL, we will compare classical and new prognostic markers. Then, we will discuss the various therapeutic options including chemotherapy and immunotherapy (monoclonal antibodies, allogenic transplantation), and define their current respective indications. FUTURE PROSPECTS AND PROJECTS: These new diagnostic and prognostic markers will allow the characterization of new prognostic subgroups of patients. This will lead to a targeted and individualized therapeutic approach. We will present the first results of clinical trials and the on-going studies conducted in this disease.
La Revue de Médecine Interne 06/2008; 29(5):424-35. · 0.61 Impact Factor
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J El-Cheikh,
C Faucher,
S Fürst,
S Duran,
P Berger,
N Vey, A-M Stoppa,
R Bouabdallah,
J-A Gastaut,
P Viens,
D Blaise,
M Mohty
[show abstract]
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ABSTRACT: The use of high-dose corticosteroids for graft-versus-host disease (GVHD) treatment represents a major risk factor for long-term invasive fungal infections. The aim of this study was to investigate the safety and tolerance of weekly prophylactic administration of once-weekly high-dose (7.5 mg/kg) of liposomal amphotericin B (L-AmB) therapy in 21 adult patients receiving high-dose prednisone (2 mg/kg/day) for acute GVHD therapy after reduced intensity conditioning (RIC) allogeneic stem cell transplantation (allo-SCT). Patients received a median of 4 (range, 1-8) infusions of L-AmB. Seven patients (33%; 95% confidence intervals (CI), 13-53%) discontinued taking the study drug owing to study drug-related adverse events, including elevated serum creatinine (>1.5 times from baseline values; n=5), hypotension and pain (n=1), and violent chest pain and arrhythmia (n=1). The overall frequency of infusion-related reactions was 29% (n=6; 95% CI, 10-48%), but these reactions were always transient and relieved by stopping the infusion. This safety data provide support for an efficacy study of this prophylaxis strategy, because this may help further improving the outcome of RIC or nonmyeloablative allo-SCT.
Bone Marrow Transplantation 03/2007; 39(5):301-6. · 3.75 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]
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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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H de Lavallade,
C Faucher,
S Fürst,
J El-Cheikh,
N Vey,
D Coso,
R Bouabdallah, A-M Stoppa,
J-A Gastaut,
D Blaise,
M Mohty
Bone Marrow Transplantation 05/2006; 37(7):709-10. · 3.75 Impact Factor
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S de Botton,
M A Sanz,
S Chevret,
H Dombret,
G Martin,
X Thomas,
J D Mediavilla,
C Recher,
L Ades,
B Quesnel, [......],
H Wandt,
D Machover,
A Guerci,
F Maloisel, A M Stoppa,
C Rayon,
J M Ribera,
C Chomienne,
L Degos,
P Fenaux
[show abstract]
[hide abstract]
ABSTRACT: We analyzed the incidence, presenting features, risk factors of extramedullary (EM) relapse occurring in acute promyelocytic leukemia (APL) treated with all-trans retinoic acid (ATRA) and chemotherapy by using a competing-risk method. In total, 740/ 806 (92%) patients included in three multicenter trials (APL91, APL93 trials and PETHEMA 96) achieved CR, of whom 169 (23%) relapsed, including 10 EM relapses. Nine relapses involved the central nervous system (CNS) and one the skin, of which two were isolated EM relapse. In patients with EM disease, median WBC count was 26950/mm3 (7700-162000). The 3-year cumulative incidence of EM disease at first relapse was 5.0%. Univariate analysis identified age <45 years (P=0.05), bcr3 PML-RARalpha isoform (P= 0.0003) and high WBC counts (> or = 10,000/ mm3) (P<0.0001) as risk factors for EM relapse. In multivariate analysis, only high WBC count remained significant (P= 0.001). Patients with EM relapse had a poorer outcome since median survival from EM relapse was 6.7 months as compared to 26.3 months for isolated BM relapse (P=0.04). In conclusion, EM relapse in APL occurs more frequently in patients with increased WBC counts (> or = 10,000/mm3) and carries a poor prognosis. Whether CNS prophylaxis should be systematically performed in patients with WBC > or = 10,000/mm3 at diagnosis remains to be established.
Leukemia 01/2006; 20(1):35-41. · 9.56 Impact Factor
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C Callens,
S Chevret,
J-M Cayuela,
B Cassinat,
E Raffoux,
S de Botton,
X Thomas,
A Guerci,
N Fegueux,
A Pigneux, A-M Stoppa,
T Lamy,
F Rigal-Huguet,
A Vekhoff,
S Meyer-Monard,
A Ferrand,
M Sanz,
C Chomienne,
P Fenaux,
H Dombret
[show abstract]
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ABSTRACT: Internal tandem duplications (ITDs) of the FLT3 gene have been observed in about 35% of APL cases. If FLT3-ITD is associated with a worse outcome in patients with acute myeloid leukemia (AML) in general, its prognostic value in acute promyelocytic leukemia (APL) is still a matter of debate. We investigated incidence, associated clinical features, and prognostic implication of FLT3-ITD, but also FLT3-D835 point mutation and N-Ras or K-Ras mutations in 119 APL patients, all prospectively enrolled in the two consecutive APL-93 and APL-2000 trials. Mutation incidences were 38, 20, and 4%, for FLT3-ITD, FLT3-D835, and Ras, respectively. The presence of FLT3-ITD was associated with high white blood cell count, high Sanz index, M3-variant subtype, and V/S PML-RAR alpha isoforms. Complete remission (CR), induction death, and death in CR rates were not affected by FLT3 or Ras mutations, as well as cumulative incidence of relapse. However, a trend for a shorter overall survival (P=0.09) was observed in FLT3-ITD patients, because of a very poor postrelapse survival (P=0.02). This feature, which has been also reported in patients with AML in general, is suggestive of an underlying genetic instability in FLT3-ITD patients, leading to the acquisition of additional unknown bad-prognosis gene mutations at relapse.
Leukemia 08/2005; 19(7):1153-60. · 9.56 Impact Factor
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[show abstract]
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ABSTRACT: Using a genetic randomization through a 'donor' vs 'no donor' comparison, the aim of this analysis was to assess the real benefit of reduced intensity conditioning allogeneic stem cell transplantation (RIC-allo-SCT) among 95 adult high-risk acute myeloid leukemia (AML) patients. In an 'intention-to-treat' analysis, leukemia-free survival (LFS) was significantly higher in the 'donor' group as compared to the 'no donor' group (P=0.01; 54 vs 30% at 4 years). The latter held true when restricting the analysis to the 25 patients who could actually receive the RIC-allo-SCT (P=0.001). Overall transplant-related mortality in the 'transplant' group was 12%, with overall survival (OS) being significantly higher in the 'transplant' group as compared to the 'no transplant' group (P=0.01). Also, in the 'intention-to-treat' analysis, OS was significantly higher in the 'donor' group as compared to the 'no donor' group (P=0.04). In the multivariate analysis, actual performance of RIC-allo-SCT (P=0.001; RR=4.0; 95% CI, 1.7-9.6) was the strongest factor significantly predictive of an improved LFS. We conclude that if a matched related donor is identified, RIC-allo-SCT should be proposed for AML patients not eligible for standard myeloablative allo-SCT.
Leukemia 07/2005; 19(6):916-20. · 9.56 Impact Factor
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L Ades,
S Chevret,
S De Botton,
X Thomas,
H Dombret,
B Beve,
M Sanz,
A Guerci,
J S Miguel,
J Dela Serna, [......],
O Reman,
A Stamatoulas,
M Fey,
J Y Cahn,
J J Sotto,
J H Bourhis,
A Parry,
C Chomienne,
L Degos,
P Fenaux
[show abstract]
[hide abstract]
ABSTRACT: We analyzed the outcome of patients aged more than 60 included in a multicenter trial in newly diagnosed acute promyelocytic leukemia (APL93 trial), which tested the role of early addition of chemotherapy to all trans retinoic acid (ATRA) and of maintenance with ATRA and/or low-dose chemotherapy. In total, 129/533 (24.2%) patients included in this trial were older than 60. The CR rate was 86% in patients older than 60 as compared to 94.5% in younger patients (P=0.0014), due to a higher incidence of early deaths in elderly patients. The 4-year incidence of relapse was 15.6% in adults older than 60 and 23.2% in younger adults although most elderly patients received less intensive consolidation chemotherapy. However, 18.6% of the patients older than 60 years who achieved CR died in CR, mainly from sepsis during consolidation course or maintenance treatment, as compared to 5.7% of younger adults (P<0.001). Thus, overall 4-year survival of elderly patients was 57.8% as compared to 78% in younger adults (P<0.0001). APL in elderly patients appears as sensitive to ATRA-Chemotherapy based regimen as in younger adults. Less favorable outcome is mainly due to an increase of early deaths and to toxicity of consolidation treatment, strongly suggesting a beneficial role for less intensive consolidation chemotherapy and possibly introduction of arsenic derivates in the treatment of APL in the elderly.
Leukemia 03/2005; 19(2):230-3. · 9.56 Impact Factor
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S de Botton,
A Fawaz,
S Chevret,
H Dombret,
X Thomas,
M Sanz,
A Guerci,
J San Miguel,
J de la Serna, A M Stoppa,
O Reman,
A Stamatoulas,
M Fey,
J Y Cahn,
J J Sotto,
J H Bourhis,
A Parry,
C Chomienne,
L Degos,
P Fenaux
[show abstract]
[hide abstract]
ABSTRACT: To retrospectively determine the outcome of acute promyelocytic leukemia (APL) patients who underwent autologous or allogeneic stem-cell transplantation (SCT) during second complete remission.
Of 122 relapsing patients included in two successive multicenter APL trials who achieved hematological second complete remission (generally after a salvage regimen of all-trans-retinoic acid [ATRA] combined with chemotherapy), 73 (60%) received allogeneic (n = 23) or autologous (n = 50) SCT.
Seven-year relapse-free survival (RFS), event-free survival (EFS), and overall survival (OS) in the autologous SCT group were 79.4%, 60.6%, and 59.8%, respectively, with a transplant-related mortality (TRM) of 6%. Of the 28 and two patients autografted with negative and positive, respectively, reverse transcriptase-polymerase chain reaction before auto SCT, three (11%) and one relapsed, respectively. In the allogeneic SCT group, 7-year RFS, EFS, and OS were 92.3%, 52.2%, and 51.8%, respectively, with 39% TRM. OS was significantly better in the autologous SCT group than in the allogeneic SCT group (P = .04), whereas RFS and EFS did not differ significantly (P = .19 and P = .11, respectively). In patients not receiving transplantation, 7-year RFS, EFS, and OS were 38%, 30.4%, and 39.5%, respectively.
These retrospective data suggest that autologous SCT is very effective in APL relapsing after treatment with ATRA if performed in molecular remission. Allogeneic SCT yields few relapses, but it is associated with high TRM when performed after salvage with very intensive chemotherapy. Salvage with arsenic trioxyde, which has lower toxicity, should further improve the outcome of relapsing APL, especially before allogeneic SCT.
Journal of Clinical Oncology 02/2005; 23(1):120-6. · 18.37 Impact Factor
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[show abstract]
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ABSTRACT: Extramedullary (EM) localizations at diagnosis or during the course of multiple myeloma (MM) are rare. We conducted a large retrospective study to more accurately describe the clinical and laboratory features of this entity, and the outcome of these manifestations. The charts of 19 eligible patients out of 432 patients with MM were retrieved from the hematology department of the Institut Paoli-Calmettes Cancer Center. Median age was 61 (range: 39-79) with a female/male sex ratio of 8/11. Ten patients were found to have EM and extraosseous tumor at the time of MM diagnosis, and nine patients developed EM tumor during the course of the disease. Neither the stage of the disease, the LDH level, or the type of immunoglobulin (Ig) was found to be associated with the development of EM disease. Patients who developed EM tumor during the course of MM had a lower serum Ig and a higher monoclonal Bence-Jones proteinuria at the diagnosis of MM than patients who presented with EM tumor at diagnosis. Multiple sites were usually involved. Resistance to chemotherapy was frequent and response to thalidomide was poor. Eight out of the 19 patients responded to high-dose chemotherapy. The remaining 11 patients progressed while on therapy. With a median follow-up of 13 months (range: 2-65), six patients are alive, four patients are in partial remission and two patients in present progressive disease. In conclusion, EM tumors are a rare manifestation of MM, with a cumulative incidence of 4.6% of MM. Multiple sites are usually involved. The response to chemotherapy is very poor with a very low response rate to thalidomide. The prognosis is very poor, especially when the diagnosis of EM tumor is concurrent with the diagnosis of MM.
European Journal Of Haematology 01/2005; 73(6):402-6. · 2.61 Impact Factor
