C Faucher

Institut Paoli Calmettes, Marsiglia, Provence-Alpes-Côte d'Azur, France

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Publications (159)542.66 Total impact

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    ABSTRACT: The introduction of reduced intensity/toxicity conditioning regimens has allowed performing allogeneic hematopoietic cell transplantation in patients previously determined as to old or otherwise unfit. Although it permitted to reduce non-relapse mortality, disease control remains a major challenge. We studied the outcome of patients with acute myeloid leukemia or myelodysplastic syndrome transplanted after conditioning with fludarabine (30 mg/m2/day during three to five days), intravenous busulfan (either 260 mg/m2: reduced intensity conditioning, or 390-520 mg/m2: reduced toxicity conditioning), and rabbit anti thymoglobulin (2.5 mg/kg/day for two days). 165 patients (acute myeloid leukemia: 124, myelodysplastic syndrome: 41; median age at transplantation: 56.8 years) were included. The two-year relapse incidence was 29% (23% versus 39%, for 1st complete remission and non-1st complete remission patients, respectively, p = 0.008). The two-year progression free survival rate was 57% (95% CI: 49.9-65). It was higher in favorable or intermediate cytogenetic groups than that in unfavorable (72.7, 60.5, and 45.7%, respectively, p = 0.03). The cumulative incidence of grades 2-4 and 3-4 acute graft-versus-host disease at day 100 was 19.3% and 7.9%, respectively. The cumulative incidence of chronic graft-versus-host disease at one year was 21.6% (severe forms: 7.8%). Non-relapse mortality at one year reached 11%. The two-year overall survival rate was 61.8% (95%CI: 54.8-69.7). Unfavorable karyotype and disease status over 1st complete remission were associated with a poorer survival. This well tolerated conditioning platform can lead to long-term disease control and offers modulation possibilities according to disease stage or for further development.
    Haematologica 08/2014; · 5.94 Impact Factor
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    ABSTRACT: Autologous hematopoietic stem cell transplantation is a valid alternative to immunosuppressive treatment in certain patients with auto-immune disease; however, the role of this approach remains subject to debate. In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC) set up its fourth annual series of workshops which brought together practitioners from all of its member centers. These workshops took place in September 2013 in Lille. In this article we give an overview regarding the indications of autologous stem cell transplantation in auto-immune diseases as well as recommendations regarding post-transplant follow-up of patients.
    Pathologie Biologie 07/2014; · 1.67 Impact Factor
  • Bone Marrow Transplantation 07/2014; · 3.54 Impact Factor
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    ABSTRACT: In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC) set up its fourth annual series of workshops which brought together practitioners from all of its member centers. These workshops took place in September 2013 in Lille. Literature and intra-laboratories studies suggest that attached segment is representative of cord blood unit (CBU). Nevertheless, some discrepancies have been observed when analyzing large data registries. To address these issues, we have listed recommendations to increase the standardization of segment processing and quality control (QC), information on units of measurement and specifications and action to be taken in case of out of specifications QC results on segment.
    Pathologie Biologie 07/2014; · 1.67 Impact Factor
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    ABSTRACT: Allogeneic hematopoietic stem cell transplantation (Allo-HSCT) is recommended for patients with high-risk AML. In many situations, a matched-related (MRD) or matched-unrelated donor (MUD) is lacking, in which case unrelated cord blood units (UCB) provide an alternative. We analyzed the outcome of consecutive high-risk AML patients prepared with reduced intensity conditioning (RIC) regimens and allografted with UCB (n = 32) compared their outcome with high risk-AML patients transplanted with MRD/MUD (n = 49) in the same period of time. Grade III-IV acute graft-versus-host disease (GVHD) occurred slightly more frequently in the UCB group (25%) than in the MRD/MUD group (8%) (p = 0.069). Conversely, we found a lower incidence of extensive chronic GVHD in the UCB group (6%) than in the MRD/MUD group (20%, p = 0.085). NRM at 4 years was 16% and 22% in the UCB and MRD/MUD groups, respectively (p = 0.529). The cumulative incidence of relapse at 4 years was significantly higher in the UCB group (60%) than in the MRD/MUD group (27%, p = 0.006). Leukemia free survival (LFS) and overall survival (OS) at 4 years were 25% and 34%, respectively, in the UCB group and 50% and 56%, respectively, in the MRD/MUD group (LFS, p = 0.029; OS, p = 0.072). Multivariate analyses adjusted by cytogenetics and disease status at the time of Allo-HSCT revealed that use of UCB remained an independent predictive factor of shorter LFS (HR: 2.0 [1.1-3.6], p = 0.018), and was associated with a trend for shorter OS (HR: 1.7 [0.9-3.2], p = 0.093). While UCB provides an alternative for patients with high-risk AML lacking a MRD/MUD, the high incidence of relapse after RIC-based UCB Allo-HSCT is a concern. Attempts to improve leukemic control with UCB Allo-HSCT are warranted, as well as the evaluation of other alternative donors in this context.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 06/2014; · 3.15 Impact Factor
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    ABSTRACT: Recently, the administration of high-dose cyclophosphamide (Cy) after T cell-replete haploidentical stem cell infusion has been reported to be feasible and effective. In the original study, bone marrow (BM) was used as the source of stem cells. Here, we retrospectively analyzed the use of BM versus peripheral blood stem cells (PBSCs) in a cohort of patients receiving haploidentical T cell-replete transplantation after a non-myeloablative conditioning (NMAC) regimen with post-infusion Cy. In the PBSC vs. BM groups, the incidence of acute graft-versus-host disease (GVHD) was 33% vs. 25%, respectively, and the incidence of chronic GVHD was 13% vs. 13%, respectively. The median time to achieve a safe and unsupported absolute neutrophil or platelet count was 20 vs. 21 days and 27 vs. 29 days, respectively. The incidence of engraftment was also similar in the two cohorts. The 1-year non-relapse mortality rate was 12% vs. 22%, respectively (p=0.96). Finally, nonsignificant differences in survival were observed. In conclusion, the use of PBSCs instead of BM after T-cell replete haploidentical transplantation did not appear to be detrimental in terms of either GVHD or engraftment rate. PBSCs could be a valid alternative to BM after transplantation from a haploidentical donor using post-infusion Cy.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 02/2014; · 3.15 Impact Factor
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    ABSTRACT: In order to study the impact of human leucocyte antigen (HLA) polymorphism distribution in identifying a matched haematopoietic stem cells unrelated donor (UD), we performed a multi-centric retrospective analysis with the aim of comparing the HLA-A, HLA-B, HLA-C, HLA-DRB1 and HLA-DQB1 phenotypes of 2126 patients (772 patients for whom a donor search failed to identify a matched UD, and 1354 patients who received a 10/10 allele level matched UD). Our results showed that rare HLA-C is often responsible for difficulty in identifying a donor. This locus may add a degree of complexity to a supposed 'frequent' HLA-A HLA-B and HLA-DRB1 phenotype, turning this phenotype into a less frequent one. For example, 32.5% of the phenotypes in the non-transplanted patients could not be explained by any of the pairs of known HLA-A, HLA-B, HLA-C and HLA-DRB1 haplotypes while this percentage dropped to less than 2% if combinations of only HLA-A, HLA-B and HLA-DRB1 haplotypes were considered. Such situations can be anticipated by computing an index, based on HLA haplotype frequency, the average registry sample size (ARS). ARS is defined as the inverse of the phenotype frequency computed using all corresponding pairs of haplotype frequencies. ARS confirmed that the most significant difference between transplanted and non-transplanted patients was correlated with the introduction of the locus HLA-C in the analysis (median: 8.3e + 4 vs 3.1e + 6, P < 0.0001). The higher the ARS the lower the likelihood of finding a 10/10 match UD reflecting the rareness of the patient's HLA. The area under receiver operator characteristics (AUROC) values of the ARS computation for HLA-A, HLA-B and HLA-DRB1 was 0.82 (0.80; 0.84) at a low-resolution level (two digits). Overall, our study promotes the use of haplotype frequency-based computations to develop computer-assisted donor search.
    Tissue Antigens 01/2014; 83(1):17-26. · 2.93 Impact Factor
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    ABSTRACT: In 2005, the National Institutes of Health (NIH) proposed standard criteria for diagnosis, organ scoring and global assessment of chronic graft-versus-host disease (cGvHD) severity. We retrospectively reclassified cGvHD with NIH criteria in a monocentric cohort of 130 consecutive adult patients with hematological malignancies presenting cGvHD after receiving allo-hematopoietic stem cell transplant (HSCT) with a fludarabine–busulfan–antithymocyte globulin (ATG) conditioning regimen, among 313 consecutive HSCT recipients. We compared NIH and Seattle classifications to correlate severity and outcome. The follow up range was effectively 2–120 months. Forty-four percent developed Seattle-defined cGvHD (22% limited, 78% extensive forms). Using NIH criteria, there were 23%, 40% and 37% mild, moderate and severe forms, respectively, and 58%, 32% and 8% classic cGvHD, late acute GvHD and overlap syndrome. Five-year overall survival was 55% (49–61), and cumulative incidences of non-relapse mortality (NRM) and relapse/progression at 2 years were 19% (14–23) and 19% (14–24). NIH mild and moderate forms were associated with better survival compared to severe cGvHD (hazard ratio [HR] = 3.28, 95% confidence interval [CI]: 1.38–7.82, p = 0.007), due to higher NRM among patients with severe cGvHD (HR = 3.04, 95% CI: 1.05–8.78, p = 0.04) but comparable relapse risk (p = NS). In conclusion, the NIH classification appears to be more accurate in predicting outcome mostly by the reclassification of old-defined extensive forms into NIH-defined moderate or severe.
    Leukemia and Lymphoma 01/2014; 55(5). · 2.61 Impact Factor
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    ABSTRACT: Dans une démarche qui vise à uniformiser les procédures d’allogreffe de cellules souches hématopoïétiques (CSH), la Société française de greffe de moelle et de thérapie cellulaire (SFGM-TC) a organisé les quatrièmes ateliers d’harmonisation des pratiques en septembre 2013 à Lille. Cet atelier a été consacré au segment attaché des unités de sang placentaire dans le but d’établir des recommandations quant à la standardisation du traitement de ce segment et les mesures à prendre en cas de rupture de ce segment.
    Pathologie Biologie 01/2014; · 1.67 Impact Factor
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    ABSTRACT: Autologous hematopoietic stem cell transplantation is a valid alternative to immunosuppressive treatment in certain patients with auto-immune disease; however, the role of this approach remains subject to debate. In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC) set up its fourth annual series of workshops which brought together practitioners from all of its member centers. These workshops took place in September 2013 in Lille. In this article we give an overview regarding the indications of autologous stem cell transplantation in auto-immune diseases as well as recommendations regarding post-transplant follow-up of patients.
    Pathologie Biologie 01/2014; · 1.67 Impact Factor
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    ABSTRACT: We retrospectively analyzed outcomes of a CD34+-selected stem cell boost (SCB) without prior conditioning in 32 patients (m/22; median of 54 years; 20 - 69) with poor graft function defined as: neutrophils ≤1.5 x 109/L, and/or platelets ≤30 x 109/L, and/or hemoglobin ≤8.5 g/dL). The median interval between stem cell transplantation and SCB was 5 months (2 - 228). The median number of CD34+ and CD3+ cells were 3.4 x 106/kg (0.96 - 8.30) and 9 x 103/kg b.w. (2 - 70), respectively. Hematological improvement was observed in 81% of patients and noted after a median of 30 days (range 14 - 120) after SCB. The recipients of related grafts responded faster than those of unrelated grafts (20 vs. 30 days, p=0.04). The cumulative incidence of acute (grade II-IV) and chronic GvHD after SCB was 17% and 26%, respectively. Patients with acute GvHD received a higher median CD3+ cell dose. The 2-year probability of OS was 45%. We suggest that SCB represents an effective approach to improve poor graft function post-transplant, but optimal timing of SCB administration, anti-infective and GvHD prophylaxis needs further evaluation.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 12/2013; · 3.15 Impact Factor
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    ABSTRACT: Double cord blood transplantation extended the use of cord blood in adults for whom a single unit is not available, but it is limited due to its cost. To evaluate outcomes and cost-effectiveness of double compared to single cord blood transplantation, we analyzed 134 transplants in adults with acute leukemia in first remission. Transplants were performed in France with reduced or myeloablative conditioning regimens. Costs were estimated from donor search to 1-year after transplant. A Markov decision analysis model was used to calculate quality-adjusted-life-years and cost-effectiveness ratio within 4-years. Overall survival at 2 years was 42% versus 62% after single and double cord blood transplantation, (p=0.03); leukemia-free-survival was 33% for single and 53% for double (0.03). Relapse was 21% after double and 42% after single (p=0.006). No difference was observed for non-relapse-mortality and chronic-graft-versus-host-disease. Estimated cost within 1-year after reduced intensity conditioning, was 165.253 Euros and 191.827 Euros for single and double cord blood transplantation, respectively. After myeloablative conditioning it was 192.566 Euros for single and 213.050 Euros, for double cord blood transplantation. Compared to single, double cord blood transplantation was associated with a supplementary cost of 21.302 Euros and 32.420 Euros within 4 years, but with an improvement of quality-adjusted-life-year of 0.616 and 0.484, and an incremental cost-effectiveness ratio of 34 581 Euros and 66 983 Euros in the myeloablative and reduced intensity settings, respectively. Our results showed that for adults with acute leukemia in CR1 in France, double is more cost-effective than single cord blood transplantation, with better outcomes, including quality-adjusted-life-year.
    Haematologica 10/2013; · 5.94 Impact Factor
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    ABSTRACT: In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the third annual series of workshops which brought together practitioners from all member centers and took place in October 2012 in Lille. Here we report our results and recommendations regarding the choice of optimal unrelated cord blood unit in terms of cell dose, HLA-matching and other characteristics.
    Pathologie Biologie 09/2013; · 1.67 Impact Factor
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    ABSTRACT: Invasive fungal infections (IFIs) such as candidiasis and mold infections have caused significant morbidity and mortality among immunocompromised patients in recent years. Micafungin, a new echinocandin, inhibits fungal cell wall β-glucan synthesis, with potent activity against most species of Candida and Aspergillus. The aim of this observational study was to investigate the efficacy and safety of micafungin in prophylaxis of IFIs in 26 high-risk adult patients with various hematological diseases receiving haplo-identical Allo-SCT. Only two patients had a history of possible aspergillosis before transplant treated by voriconazole. The patients received a median of four lines (2-7) of treatment before Allo-SCT. Thirteen patients (50%) received at least one prior Auto-SCT; and eight patients (31%) received a previous Allo-SCT. Patients received a median of 29 infusions (range, 15-85) of micafungin (50 mg/day i.v. as a 1-h infusion). The treatment was initiated at the beginning of the transplant conditioning regimen until the hospital discharge. None of our patients discontinued the treatment for drug-related adverse events. Micafungin was not associated with any hepatotoxicity. Only one patient (4%) discontinued the treatment because of early disease progression. In all patients no Candida and/or Aspergillus species was documented after 3 and 6 months from transplant. None of our patients presented a positive galactomannan antigenemia >0.5. Nine patients (35%) presented a CMV reactivation. Four patients presented an acute GVHD grade II and two patients presented a chronic GVHD. The median follow-up was 11 months (3-23). At the last follow-up, there were 20 patients (77%) who were alive; four patients (12%) died because of disease progression and two patients because of graft failure. Micafungin has a good safety and tolerability profile, with an efficacy in preventing IFI in this high-risk population. Our data provide support for an efficacy study in a prophylaxis setting, but prospective and comparative clinical trials using micafungin are urgently needed to define the role of this drug in prophylaxis after haplo-identical Allo-SCT.Bone Marrow Transplantation advance online publication, 10 June 2013; doi:10.1038/bmt.2013.87.
    Bone marrow transplantation 06/2013; · 3.00 Impact Factor
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    ABSTRACT: It has been reported that chronic graft-versus-host disease (cGVHD) is associated with significant morbidity and mortality after allogeneic stem cell transplantation (allo-SCT). The risk of relapse is generally reduced when cGVHD is present, but prognosis may be affected by increased toxicity and/or risk of infection associated with immunosuppressive treatment (IST). We performed a longitudinal data analysis of cGVHD, including the evolution of cGVHD itself over time in response to IST, in a single-center cohort of 313 consecutive patients undergoing allo-SCT. We found that lack of sustained response without withdrawal of IST within 6 months of cGVHD development was associated with higher transplantation-related mortality (hazard ratio, 2.32; 95% confidence interval, 1.24-4.33) compared with cGVHD-free patients. Conversely, response conferred better overall survival (hazard ratio, 0.42; 95% confidence interval, 0.18-0.95). Our analytical approach allowed us to integrate the evolution of cGVHD in a predictive model of transplantation outcome; notably, remission associated with permanent discontinuation of IST within the first 6 months from the occurrence of cGVHD seemed to correlate most closely with final outcome. Further confirmation from larger studies is needed.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 04/2013; 19(4):576–583. · 3.15 Impact Factor
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    ABSTRACT: Cytomegalovirus (CMV) infection is a serious complication that may occur in the weeks or months following bone marrow transplantation. However, both Ganciclovir and the CMV infection itself can cause marrow toxicity, notably neutropenia, that may consequently expose these immunosuppressed patients to life-threatening bacterial and/or fungal infections. The aim of this retrospective study was to identify factors associated with the occurrence of grade III-IV neutropenia among patients receiving pre-emptive Ganciclovir therapy after allogeneic stem cell transplantation at our Institution. We identified 547 consecutive patients transplanted from January 2005 to June 2011 at our Institution. In all, 190 patients (35%) presented with CMV reactivation of whom 30 patients (5%) were excluded from the analysis because they already had neutropenia at the time of reactivation. Finally, 160 (29%) patients were analysed. According to multivariate analysis, at the time of treatment initiation, the risk factors significantly associated with a grade III-IV Ganciclovir-related neutropenia included a high viral load (hazard ratio (HR) = 2.68, 95% CI 1.25-5.737, p 0.01); an absolute neutrophil count >3000 was a protective factor (HR = 0.26, 95% CI 0.125-0.545, p <0001) whereas serum creatinine >2 mg/dL was associated with higher Ganciclovir-related neutropenia (HR = 2.4, 95% CI 1.11-5.17, p 0.002). This large analysis revealed three risk factors for Ganciclovir-related neutropenia among patients with CMV reactivation after allogeneic stem cell transplantation; prompt identification of patients at risk when antiviral therapy is started may allow clinicians to adopt adequate preventive measures, so reducing the morbidity and mortality associated with CMV reactivation.
    Clinical Microbiology and Infection 03/2013; · 4.58 Impact Factor
  • Experimental hematology 02/2013; · 3.11 Impact Factor
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    ABSTRACT: This study examines the long-term outcomes of a cohort of patients with myeloma who were treated with reduced-intensity conditioning (RIC) regimens after a minimum follow-up of 5 years at our centre. A total of 53 patients with multiple myeloma (MM) who received allogeneic hematopoietic stem-cell transplantation (Allo-SCT) between January 2000 and January 2007 were identified. The median follow-up of living patients was 84 months (51-141). The median age of the MM patients was 50 (28-70) years. Fifty-one patients (96%) received a transplant from a sibling donor. The median time between diagnosis and Allo-SCT was 34 months (6-161), and the median time between auto-SCT and Allo-SCT was 10 months (1-89). Fifty-one patients (96%) received at least one auto-SCT; 24 patients (45%) received a tandem auto-Allo-SCT. At last follow-up, 21 patients (40%) are alive > 5 years post RIC Allo-SCT. At last follow-up, 14 (26%) are in first complete remission (CR), and four patients (8%) in second CR after donor lymphocyte infusion or re-induction with one of the new anti-myeloma drugs (bortezomib or lenalidomide) after Allo-SCT. Eight patients (38%) among these long survivors received one of these new drugs as induction or relapse treatment before Allo-SCT. Disease status and occurrence of cGvHD were significantly associated with progression-free survival (PFS); hazard ratio (HR) = 0.62 (0.30-1.29, P = 0.20). Acute GvHD was correlated with higher transplant-related mortality; HR = 4.19 (1.05-16.77, P = 0.04). No variables were associated with overall survival (OS). In conclusion, we observe that long-term disease control can be expected in a subset of MM patients undergoing RIC Allo-SCT. After 10 years, the OS and PFS were 32% and 24%, respectively. The PFS curve after Allo-SCT stabilizes in time with a plateau after 6 years post Allo-SCT. Am. J. Hematol. 00:000-000, 2013. © 2013 Wiley Periodicals, Inc.
    American Journal of Hematology 02/2013; · 4.00 Impact Factor
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    ABSTRACT: In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the third annual series of workshops which brought together practitioners from all member centers and took place in October 2012 in Lille. Here we report our results and recommendations regarding the choice of optimal unrelated cord blood unit in terms of cell dose, HLA-matching and other characteristics.
    Pathologie Biologie 01/2013; 61(4):147–148. · 1.67 Impact Factor
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    ABSTRACT: Scope of the study was to investigate the impact of pre-transplant CMV serostatus of the donor and/or recipient on the outcome of patients undergoing allogeneic hematopoietic stem cell transplantation (Allo-SCT) for Multiple Myeloma (MM). To our knowledge no data are available in the literature about this issue. We retrospectively followed 99 consecutive patients who underwent reduced-intensity conditioning (RIC) Allo-SCT for MM in our cancer center at Marseille between January 2000 and January 2012. Based upon CMV serostatus, patients were classified as low risk (donor [D]-/recipient [R] -) 17 patients (17.1%), intermediate risk (D+/R) 14 patients (14.1%), or high risk - either (D-/R+) 31 patients (31.3%) or (D+/R+), 37 patients (37.3%). Cumulative incidence of CMV reactivation was 39% with a median time of 61 days (26-318). Three patients (3%) developed CMV disease. Two factors were associated with CMV reactivation: CMV serostatus group (low: 0% vs. intermediate: 29% vs. high: 50%; p=0.001) and the presence of grade II-IV acute GvHD (Hazard Ratio: HR=2.1 [1.1-3.9]). Thirty-six of the 39 patients (92%) with CMV reactivation did not present positive detection of CMV after a 21-day median duration preemptive treatment with ganciclovir. Cumulative incidence of day 100 grade II-IV acute GvHD, 1-year chronic GvHD and day 100 transplantation related mortality (TRM) were 37%, 36% and 9%, respectively. CMV reactivation and serostatus were not associated with increased GvHD and TRM or short survival. Only the presence of acute GvHD as a time dependent variable was significantly associated with increased TRM (p=0.005). Two-year overall and progression free survival were 56% and 34%, respectively. Donor and recipient CMV serostatus and acute GvHD are independent factors for increased CMV reactivation in high-risk MM patients undergoing RIC Allo-SCT. However, we did not find any influence of CMV reactivation on post transplantation outcome. CMV monitoring and pre-emptive treatment strategy could in part explain these results. Novel prophylactic measures such as immunotherapy and drug prophylaxis need to be considered in this group of patients, warranting further prospective studies.
    Mediterranean Journal of Hematology and Infectious Diseases 01/2013; 5(1):e2013026.

Publication Stats

2k Citations
542.66 Total Impact Points

Institutions

  • 1995–2014
    • Institut Paoli Calmettes
      • Cancer Research Center of Marseille (CRCM)
      Marsiglia, Provence-Alpes-Côte d'Azur, France
    • University of Washington Seattle
      Seattle, Washington, United States
  • 2013
    • Università degli Studi di Genova
      Genova, Liguria, Italy
  • 2011
    • Hôpital Ambroise Paré – Hôpitaux universitaires Paris Ile-de-France Ouest
      Billancourt, Île-de-France, France
  • 2005
    • Institut de France
      Lutetia Parisorum, Île-de-France, France
  • 2002
    • Centre d'Immunologie de Marseille-Luminy
      Marsiglia, Provence-Alpes-Côte d'Azur, France
    • Centre Jean Perrin
      Clermont, Auvergne, France
  • 2001
    • University of Auvergne
      Clermont, Auvergne, France