M Paesmans

Institut Jules Bordet, Bruxelles, Brussels Capital, Belgium

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Publications (327)1588 Total impact

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    ABSTRACT: Background. Anti-cancer treatment and the cancer population have evolved since the last EORTC fungemia survey and there are few recent large epidemiological studies. Methods. This was a prospective cohort study including 145,030 admissions of patients with cancer from 13 EORTC centers. Incidence, clinical characteristics, and outcome of fungemia were analysed. Results. Fungemia occurred in 333 (0.23%; 95% CI, 0.21 - 0.26) patients, ranging from 0.15% in patients with solid tumors to 1.55% in hematopoietic stem cell transplantation recipients. In 297 evaluable patients age ranged from 17 - 88 years (median 56 years), 144 (48%) patients were female, 165 (56%) had solid tumors, and 140 (47%) had hematological malignancies. Fungemia including polymicrobial infection was due to: Candida spp. in 267 (90%), C. albicans in 128 (48%) and other Candida spp. in 145 (54%) patients. Favorable overall response was achieved in 113 (46.5%) patients by week 2. After 4 weeks, the survival rate was 64% (95% CI, 59% - 70%) and was not significantly different between Candida spp. Multivariable logistic regression identified baseline septic shock (OR 3.04, 95% CI 1.22 - 7.58) and tachypnoea as poor prognostic factors (OR 2.95, 95% CI 1.66 - 5.24), while antifungal prophylaxis prior to fungemia (OR 0.20, 95% CI 0.06 - 0.62) and remission of underlying cancer (OR 0.18, 95% CI 0.06 - 0.50) were protective. Conclusions. Fungemia, mostly due to Candida spp. was rare in cancer patients from EORTC centers, but was associated with substantial mortality. Antifungal prophylaxis and remission of cancer predicted better survival.
    Clinical Infectious Diseases 04/2015; DOI:10.1093/cid/civ293 · 9.42 Impact Factor
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    ABSTRACT: Regorafenib was recently approved for patients with pretreated advanced colorectal cancer (aCRC), despite a moderate improvement of the patients' outcome, and significant toxicities. Based on previous studies showing that early fluorodeoxyglucose-positron emission tomography (FDG-PET)-based metabolic response assessment (MRA) might adequately select patients unlikely to benefit from treatment, the RegARd-C trial uses early MRA to identify likely non-responders to regorafenib in a population of patients with aCRC and guide a comprehensive evaluation of genomic and epigenetic determinants of resistance to treatment. RegARd-C is a multicentric prospective study. Its primary objective is to identify non-benefitters from regorafenib given at 160 mg/day, 3 weeks out of 4 in a population of patients with pretreated aCRC. Baseline PET is repeated at day 14 of the first treatment course. MRA is blinded for the investigators. Overall survival (OS) is the primary end point and will be correlated with metabolic parameters and (epi)genetic alterations assessed from tumour and serial blood samples. A target sample size of 105 evaluable patients (70 as derivation set and 35 as validation set), is considered as sufficient to validate an expected HR for OS of metabolic responders compared to metabolic non-responders significantly <1 (with 80% power and 1-sided 5% α in case of a true HR≤0.59 and a responders rate of 47%). The study was approved by the Institut Jules Bordet's competent ethics committee and complies with the Helsinki declaration or the Belgian laws and regulations, whichever provides the greatest protection for the patient, and follows the International Conference on Harmonisation E 6 (R1) Guideline for Good Clinical Practice, reference number CPMP/ICH/135/95. The protocol and the trials results, even inconclusive, will be presented at international oncology congresses, and published in peer-reviewed journals. Genomic and epigenetic data will be made available in public open data sets. EudraCT number: 2012-005655-16; ClinicalTrials.gov number: NCT01929616. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    BMJ Open 03/2015; 5(3):e007189. DOI:10.1136/bmjopen-2014-007189 · 2.06 Impact Factor
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    Maturitas 02/2015; 81(1). DOI:10.1016/j.maturitas.2015.02.004 · 2.86 Impact Factor
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    ABSTRACT: Introduction. To compare, in the same cohort of men, the detection of clinically significant disease in standard (STD) cores versus multiparametric magnetic resonance imaging (mpMRI) targeted (TAR) cores. Material and Methods. A prospective study was conducted on 129 biopsy naïve men with clinical suspicion of prostate cancer. These patients underwent prebiopsy mpMRI with STD systematic biopsies and TAR biopsies when lesions were found. The agreement between the TAR and the STD protocols was measured using Cohen's kappa coefficient. Results. Cancer detection rate of MRI-targeted biopsy was 62.7%. TAR protocol demonstrated higher detection rate of clinically significant disease compared to STD protocol. The proportion of cores positive for clinically significant cancer in TAR cores was 28.9% versus 9.8% for STD cores (P < 0.001). The proportion of men with clinically significant cancer and the proportion of men with Gleason score 7 were higher with the TAR protocol than with the STD protocol (P = 0.003; P = 0.0008, resp.). Conclusion. mpMRI improved clinically significant prostate cancer detection rate compared to STD protocol alone with less tissue sampling and higher Gleason score. Further development in imaging as well as multicentre studies using the START recommendation is needed to elucidate the role of mpMRI targeted biopsy in the management of prostate cancer.
    BioMed Research International 01/2015; 2015:571708. DOI:10.1155/2015/571708 · 2.71 Impact Factor
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    ABSTRACT: The use of noninferiority randomised trials for patients with advanced non-small cell lung cancer has emerged during the past 10-15 years but has raised some issues related to their justification and methodology. The present systematic review aimed to assess trial characteristics and methodological aspects. All randomised clinical trials with a hypothesis of noninferiority/equivalence, published in English, were identified. Several readers extracted a priori defined methodological information. A qualitative analysis was then performed. We identified 20 randomised clinical trials (three phase II and 17 phase III), 11 of them being conducted in strong collaboration with industry. We highlighted some deficiencies in the reports like the lack of justification for both the noninferiority assumption and the definition of the noninferiority margin, as well as inconsistencies between the results and the authors' conclusions. CONSORT guidelines were better followed for general items than for specific items (p<0.001). Improvement in the reporting of the methodology of noninferiority/equivalence trials is needed to avoid misleading interpretation and to allow readers to be fully aware of the assumptions underlying the trial designs. They should be restricted to limited specific situations with a strong justification why a noninferiority hypothesis is acceptable. Copyright ©ERS 2014.
    European Respiratory Journal 12/2014; 45(2). DOI:10.1183/09031936.00092814 · 7.13 Impact Factor
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    ABSTRACT: The purposes of this study were to evaluate, in colorectal cancer patients, the cause of ICU admission and to find predictors of death during and after hospitalization. This is a retrospective study including all patients with colorectal cancer admitted in the ICU of a cancer hospital from January 1st 2003 to December 31 2012. Among 3721 ICU admissions occurring during the study period, 119 (3.2 %) admissions dealt with colorectal cancer, of whom 89 were eligible and assessable. The main reasons for admission were of metabolic (24 %), hemodynamic (19 %), cardiovascular (18 %), gastrointestinal (16 %), respiratory (13 %), or neurologic (6 %) origin. These complications were due to cancer in 43 %, to the antineoplastic treatment in 25 %, or were unrelated to the cancer or its treatment in 33 %. A quarter of the patients died during hospitalization. Independent predictors of death were the Sequential Organ Failure Assessment (SOFA) score (with risk of dying increasing by 42 % per unit of SOFA score), fever (with risk of dying multiplied by three per °C), and high values of GOT (with risk of dying multiplied by 1 % per unit increase), while cancer control (i.e., stage progression or not), compliance to the initial cancer treatment plan, and LDH ≤ median levels had prognostic significance for further longer survival after hospital discharge. This is the first study looking at specific causes for unplanned ICU admission of patients with colorectal cancer. Hospital mortality was influenced by the characteristics of the complication that entailed the ICU admission while cancer characteristics retained their prognostic influence on survival after hospital discharge.
    Supportive Care Cancer 12/2014; 23(6). DOI:10.1007/s00520-014-2524-5 · 2.50 Impact Factor
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    ABSTRACT: Introduction The first ‘Women's Health Initiative’ (WHI) randomised controlled trial assessed use of continuous combined menopausal hormone therapy (cc-MHT). It was prematurely stopped because of an increased invasive breast cancer (BC), coronary heart disease (CHD), stroke and pulmonary embolism risk. Consequently, scientific societies recommended use of MHT at the lowest effective dose for the shortest duration. As a result, a sharp decline in MHT use occurred worldwide. Aim To report in a uniform way the change in MHT use in European countries. To evaluate whether the variability of the MHT changes were related to some medical indicators. Materials and methods IMS Health provided MHT sales data for the years 2002 till 2010 for 17 countries. We tested several hypotheses to explain the heterogeneity of MHT use changes. Results and discussion In 2002, the estimated MHT rate in women 45–69 years old varied considerably between countries ranging from less than 5% to more than 25%. In all countries a profound decrease occurred between 2002 and 2010, ranging from 50% to 77%. By the end of 2010, the MHT uptake was lower than 10% in all countries except in Finland. MHT use change was not correlated to MHT use and prevailing BC incidence at baseline, nor to the number of gynaecologists per 100,000 women or to the level of information about MHT. Conclusion The global MHT use experienced a sharp decrease in all the analysed countries, although some variability exists. The decrease was unrelated to the assessed parameters.
    Maturitas 11/2014; 79(3). DOI:10.1016/j.maturitas.2014.07.002 · 2.86 Impact Factor
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    ABSTRACT: PurposeTo assess the efficacy and safety of sorafenib in patients with R/M SCCHN and to explore the predictive value of early metabolic responses.Patients and methodsSorafenib was administered orally at 400 mg BID on a continuous basis. Primary endpoint was response rate. Correlation of early 18FDG PET-CT response to time-to-event outcomes was a secondary objective.ResultsTwenty-three pts were included. Grade 3-4 toxicities included fatigue (22%), hand-foot syndrome (9%), lymphopenia (17%), hyponatremia (39%) and hypophosphatemia (48%). One pt (5%) had PR; 12 pts (55%) had SD. Early metabolic response rate was 38%. Median PFS was 2.2 months in early metabolic non responders (13/21 pts) in comparison to 7.4 months in the 8 pts with class I early metabolic response (p 0.006).Conclusions Sorafenib showed a modest antitumor activity. Data suggest a possible role of 18FDG PET metabolic response as an early predictor of a prolonged PFS. Head Neck, 2014
    Head & Neck 10/2014; DOI:10.1002/hed.23898 · 3.01 Impact Factor
  • 39th ESMO Congress (ESMO); 09/2014
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    ABSTRACT: Objectives. To assess the treatment outcomes of a single session of whole gland high intensity focused ultrasound (HIFU) for patients with localized prostate cancer (PCa). Methods. Response rates were defined using the Stuttgart and Phoenix criteria. Complications were graded according to the Clavien score. Results. At a median follow-up of 94months, 48 (44.4%) and 50 (46.3%) patients experienced biochemical recurrence for Phoenix and Stuttgart definition, respectively. The 5- and 10-year actuarial biochemical recurrence free survival rates were 57% and 40%, respectively. The 10-year overall survival rate, cancer specific survival rate, and metastasis free survival rate were 72%, 90%, and 70%, respectively. Preoperative high risk category, Gleason score, preoperative PSA, and postoperative nadir PSA were independent predictors of oncological failure. 24.5% of patients had self-resolving LUTS, 18.2% had urinary tract infection, and 18.2% had acute urinary retention. A grade 3b complication occurred in 27 patients. Pad-free continence rate was 87.9% and the erectile dysfunction rate was 30.8%. Conclusion. Single session HIFU can be alternative therapy for patients with low risk PCa. Patients with intermediate risk should be informed about the need of multiple sessions of HIFU and/or adjuvant treatments and HIFU performed very poorly in high risk patients.
    06/2014; 2014:186782. DOI:10.1155/2014/186782
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    ABSTRACT: Metastatic colorectal cancer (mCRC) may present various behaviours that define different courses of tumor evolution. There is presently no available tool designed to assess tumor aggressiveness, despite the fact that this is considered to have a major impact on patient outcome.Methods/design: CORIOLAN is a single-arm prospective interventional non-therapeutic study aiming mainly to assess the natural tumor metabolic progression index (TMPI) measured by serial FDG PET-CT without any intercurrent antitumor therapy as a prognostic factor for overall survival (OS) in patients with mCRC.Secondary objectives of the study aim to test the TMPI as a prognostic marker for progression-free survival (PFS), to assess the prognostic value of baseline tumor FDG uptake on PFS and OS, to compare TMPI to classical clinico-biological assessment of prognosis, and to test the prognostic value on OS and PFS of MRI-based apparent diffusion coefficient (ADC) and variation of vADC using voxel-based diffusion maps.Additionally, this study intends to identify genomic and epigenetic factors that correlate with progression of tumors and the OS of patients with mCRC. Consequently, this analysis will provide information about the signaling pathways that determine the natural and therapy-free course of the disease. Finally, it would be of great interest to investigate whether in a population of patients with mCRC, for which at present no known effective therapy is available, tumor aggressiveness is related to elevated levels of circulating tumor cells (CTCs) and to patient outcome.
    BMC Cancer 05/2014; 14(1):385. DOI:10.1186/1471-2407-14-385 · 3.32 Impact Factor
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    ABSTRACT: Introduction: Women affected by breast cancer (BC) will often go through menopause at an earlier age and display more frequent and severe symptoms than women who have a natural menopause. The safety of hormone replacement therapy (HRT) and vaginal estrogens for BC survivors has been debated over time and remains unclear. Non hormonal therapies such as antidepressants, gabapentine and clonidine may be useful for those patients but there are few data about their safety. Aim: This retrospective study analyses the use by BC patients of treatments known to alleviate climacteric symptoms. Material and method: Post-menopausal Estrogen Receptors positive (ER+) BC patients, aged 45-69, were identified as having bought, at least once, an aromatase inhibitor (AI) or tamoxifen between the years 2000 and 2012 through a pharmaceutical databank in Belgium. Among them, we defined users of a climacteric treatment those who bought, at least once, HRT, vaginal topical estrogens, antidepressants, clonidine and gabapentine. Results: We identified 2530 BC patients. Among them, 45% were buying a treatment known to alleviate menopausal symptoms. The majority of these treatments were non-HRT therapies. HRT and vaginal estrogens were seldom bought (respectively 1.1% and 6%), but 3% bought vaginal estrogens while buying AI. About 9.2% of tamoxifen users patients bought antidepressants implicated in tamoxifen metabolism at the same time as tamoxifen. Conclusions: Most BC patients follow current guidelines contra-indicating the use of HRT after BC, they use non hormonal therapies. In some cases they use unfortunately antidepressants that may alter the metabolism of tamoxifen.
    Maturitas 05/2014; 78(3). DOI:10.1016/j.maturitas.2014.04.020 · 2.86 Impact Factor
  • Annals of Oncology 05/2014; 25 Suppl 1:i17-i18. DOI:10.1093/annonc/mdu067.3 · 6.58 Impact Factor
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    ABSTRACT: Given recent data on genetic heterogeneity within and individual's tumor, we investigated if there were differences in the prognostic and predictive abilities of BCL2 and TP53 protein expression in primary breast cancer (TU) and corresponding axillary lymph-nodes (LN). We used patient samples from the adjuvant Belgian three-arm study which randomized between anthracycline containing regimens and traditional CMF. The endpoints analyzed were overall survival (OS), event-free survival (EFS) and interactions between chemotherapy regimens. At a median follow-up of 15.6 years, BCL2 and TP53 (in both TU and LN) were significantly associated with OS but only in the first 5 years. Likewise, BCL2 and TP53 (in both TU and LN) were associated with EFS in the first 2 years after randomization, with no association after 2 years. BCL2 and TP53 remained statistically significant after adjustment for the standard clinical-pathological characteristics in regard to OS and EFS in the respective first years after randomization, (p value < 0.001 for both markers). Furthermore, an interaction was found between high BCL2 expression in the TU (but not in LN) and benefit to CMF over anthracycline-based chemotherapy (interaction p value EFS: 0.042; OS = 0.01). No interaction was found for TP53 expression neither in TU nor in LN. We conclude that BCL2 and TP53 were predictive biomarkers for better and worse survival respectively, but only in the first two to five years after diagnosis. BCL2 expression in the TU but not in the LN was predictive of increased benefit to CMF vs anthracycline-based chemotherapy.
    Breast (Edinburgh, Scotland) 04/2014; 23(4). DOI:10.1016/j.breast.2014.03.012 · 2.58 Impact Factor
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    ABSTRACT: Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe.The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility study of prospective data collection in a pan-European setting.There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide variation in content and scope, as well as methodological quality but at the same time there was relevant duplication. The feasibility study demonstrated that it is, in principle, feasible to collect prospective demographic and clinical data on patients with lung cancer. Legal obligations vary among countries.The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe.
    European Respiratory Journal 03/2014; DOI:10.1183/09031936.00106913 · 7.13 Impact Factor
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    ABSTRACT: To explore the current clinical management of early stage breast cancer patients, identify areas of controversy, and interrogate how treating physicians implement latest advances. We conducted a 27-item survey, disseminated in 2 stages: paper distribution at selected breast cancer sessions at the ESMO 2012 Congress, and dedicated mailings to ESMO members. Descriptive statistical analysis and logistic regression analysis were applied to explore potential associations between the demographic characteristics of the participants and replies. A total of 512 physicians from 79 countries participated in the study, accounting for 465 (91%) fully completed questionnaires. The majority of the participants were ESMO members (66%), medical oncologists (86.5%), and working in multidisciplinary teams (91.6%). Heterogeneous results were captured, such as the following: 40.9% of the participants consider no genetic test useful for making adjuvant treatment decisions; 15.3% consider PET-CT a useful imaging modality for staging; 68.8% consider that postmenopausal patients with hormone receptor positive disease should always be offered an aromatase inhibitor as part of their adjuvant therapy; 78.7% prefer to administer trastuzumab concurrently with the taxane component of chemotherapy; and 27% would consider bevacizumab in the neoadjuvant setting. The logistic regression analysis did not identify any strong predictor of the probability of giving a reply fully compatible with evidence in the literature. This survey captures clinical practice and whether the latest research advances are implemented in the treatment of early stage breast cancer by an extended number of physicians. Significant individual differences were found. Areas of controversy were detected, and they deserve further exploration in order to generate 'tailored' educational tools, with the final goal being the standardization of the treatment of early stage breast cancer patients.
    Annals of Oncology 02/2014; 25(8). DOI:10.1093/annonc/mdu093 · 6.58 Impact Factor
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    ABSTRACT: In the United States, there will be a shortage of medical oncologists (MO) by 2020. However, this information is not available for Europe. The aim of this study was to assess the current number of MO in the 27 European Union (27-EU) countries and to predict their availability by 2020. Between June 2012 and January 2013, a survey was submitted to health authorities, medical oncology societies, and personal contacts in all 27-EU countries in order to gather annual data on the number of practicing MO. Data were collected by e-mail, telephone contact, or through research on official websites. Data regarding cancer incidence in 2008 and projections for 2015 and 2020 were obtained through Globocan. The mean annual increase in the number of MO was calculated for each country. The total number of MO by 2015 and 2020 was estimated, and the ratio of new cancer cases versus number of MO was calculated for 2008, 2015, and 2020. Twelve countries provided sufficient data. The average mean annual increase in the total number of MO was 5.3% (range 1.8%-8.7%), with Belgium being the lowest and UK the highest. The 2008 ratio of cancer cases versus MO was lowest in Hungary (113) and highest in UK (1067). A favorable decrease in this ratio was estimated in most countries. Our estimates, based on incidence and not on prevalence, indicate that MO availability will probably meet the projected need in most of the 12 countries analyzed, provided that: (i) these countries maintain their rate of annual increase in MO; and (ii) no unforeseen changes occur in cancer incidence. Unfortunately, minimal information is available for Eastern Europe. Our data call for the prospective surveillance of the cancer burden and MO availability to ensure adequate and equal care for cancer patients throughout Europe.
    Annals of Oncology 01/2014; 25(2). DOI:10.1093/annonc/mdt559 · 6.58 Impact Factor
  • Radiotherapy and Oncology 01/2014; 111:S23. DOI:10.1016/S0167-8140(15)30167-5 · 4.86 Impact Factor
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    ABSTRACT: Cisplatin doublets are standard 1st line treatment for advanced non-small cell lung cancer (NSCLC), without accurate predictor for response and survival, but important toxicity. Our aims were to identify predictive (for response) and prognostic (for survival) biological signatures in patients with NSCLC using messenger RNAs (mRNA) and miRNA expression. Patients with pathologically proven untreated NSCLC, receiving 1st line cisplatin-vinorelbine and with an assessable lesion were eligible. A bronchial biopsy was lysed into Tripure Isolation Reagent on ice, snap frozen, and stored at -80°C. mRNA expression was analyzed using microarrays Agilent Technologies. miRNA expression was assessed using TaqMan Low Density Arrays (756 human miR panel, Applied Biosystems). Validation was performed by RT-PCR on the selected genes. Survival was measured from the registration date and response assessed by WHO criteria. Biopsies for transcriptomic analyses were obtained from 60 consecutive patients. No statistically significant differences were observed according to the main clinical characteristics, response rate (43 vs. 41%) or survival (median 25 vs. 29 months) between derivation and validation sets. In the derivation set (n = 38 patients), two mRNA and one miRNA predictive signatures for response were obtained. One mRNA and one miRNA prognostic signatures were derived from the first set, allowing an adequate distinction of patients with good and poor overall and progression-free survivals. None of these signatures could be validated in the validation set (n = 22 patients). In this prospective study with advanced NSCLC treated with cisplatin-vinorelbine, we were able to derive with high throughput techniques predictive and prognostic signatures based on transcriptomic analyses. However, these results could not be reproduced in an independent validation set. The role of miRNA and mRNA as predictive or prognostic factors remains a research topic and the use of high throughput technology in that context questionable. The ClinicalTrials.gov study identifier is NCT00864266 (www.clinicaltrials.gov).

Publication Stats

8k Citations
1,588.00 Total Impact Points


  • 1992–2015
    • Institut Jules Bordet
      • Department of Nuclear Medicine
      Bruxelles, Brussels Capital, Belgium
  • 1990–2015
    • Université Libre de Bruxelles
      • • Bordet Institute
      • • Intensive Care Unit
      Bruxelles, Brussels Capital, Belgium
  • 1995–2014
    • University Hospital Brussels
      • Department of Neurology
      Bruxelles, Brussels Capital, Belgium
    • Centre Hospitalier Universitaire de Reims
      Rheims, Champagne-Ardenne, France
  • 1996–2012
    • Vrije Universiteit Brussel
      • Department of Obstetrics and Gynecology
      Bruxelles, Brussels Capital, Belgium
  • 2010
    • Western General Hospital
      Edinburgh, Scotland, United Kingdom
    • European Organisation for Research and Treatment of Cancer
      Bruxelles, Brussels Capital Region, Belgium
  • 2007
    • Duke University
      Durham, North Carolina, United States
  • 2005
    • Centre Hospitalier Régional Universitaire de Lille
      Lille, Nord-Pas-de-Calais, France
  • 2003
    • Fonds de la Recherche Scientifique (FNRS)
      Bruxelles, Brussels Capital Region, Belgium
  • 2001
    • Università degli Studi di Genova
      Genova, Liguria, Italy
  • 1997–2000
    • Centre Hospitalier Universitaire Saint-Pierre
      Bruxelles, Brussels Capital, Belgium
    • Great Ormond Street Hospital for Children NHS Foundation Trust
      • Department of Haematology and Oncology
      London, ENG, United Kingdom