Sylvie Chevret

Paris Diderot University, Lutetia Parisorum, Île-de-France, France

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Publications (496)3575.12 Total impact

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    ABSTRACT: Background: In patients with hematological malignancies and acute respiratory failure (ARF), noninvasive ventilation was associated with a decreased mortality in older studies. However, mortality of intubated patients decreased in the last years. In this study, we assess outcomes in those patients according to the initial ventilation strategy. Methods: We performed a post hoc analysis of a prospective multicentre study of critically ill hematology patients, in 17 intensive care units in France and Belgium. Patients with hematological malignancies admitted for ARF in 2010 and 2011 and who were not intubated at admission were included in the study. A propensity score-based approach was used to assess the impact of NIV compared to oxygen only on hospital mortality. Results: Among 1011 patients admitted to ICU during the study period, 380 met inclusion criteria. Underlying diseases included lymphoid (n = 162, 42.6 %) or myeloid (n = 141, 37.1 %) diseases. ARF etiologies were pulmonary infections (n = 161, 43 %), malignant infiltration (n = 65, 17 %) or cardiac pulmonary edema (n = 40, 10 %). Mechanical ventilation was ultimately needed in 94 (24.7 %) patients, within 3 [2-5] days of ICU admission. Hospital mortality was 32 % (123 deaths). At ICU admission, 142 patients received first-line noninvasive ventilation (NIV), whereas 238 received oxygen only. Fifty-five patients in each group (NIV or oxygen only) were matched according the propensity score. NIV was not associated with decreased hospital mortality [OR 1.5 (0.62-3.65)]. Conclusions: In hematology patients with acute respiratory failure, initial treatment with NIV did not improve survival compared to oxygen only. Clinical trial: gov number NCT 01172132.
    Annals of Intensive Care 12/2015; 5(1). DOI:10.1186/s13613-015-0070-z · 3.31 Impact Factor
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    ABSTRACT: Importance: Noninvasive ventilation has been recommended to decrease mortality among immunocompromised patients with hypoxemic acute respiratory failure. However, its effectiveness for this indication remains unclear. Objective: To determine whether early noninvasive ventilation improved survival in immunocompromised patients with nonhypercapnic acute hypoxemic respiratory failure. Design, setting, and participants: Multicenter randomized trial conducted among 374 critically ill immunocompromised patients, of whom 317 (84.7%) were receiving treatment for hematologic malignancies or solid tumors, at 28 intensive care units (ICUs) in France and Belgium between August 12, 2013, and January 2, 2015. Interventions: Patients were randomly assigned to early noninvasive ventilation (n = 191) or oxygen therapy alone (n = 183). Main outcomes and measures: The primary outcome was day-28 mortality. Secondary outcomes were intubation, Sequential Organ Failure Assessment score on day 3, ICU-acquired infections, duration of mechanical ventilation, and ICU length of stay. Results: At randomization, median oxygen flow was 9 L/min (interquartile range, 5-15) in the noninvasive ventilation group and 9 L/min (interquartile range, 6-15) in the oxygen group. All patients in the noninvasive ventilation group received the first noninvasive ventilation session immediately after randomization. On day 28 after randomization, 46 deaths (24.1%) had occurred in the noninvasive ventilation group vs 50 (27.3%) in the oxygen group (absolute difference, -3.2 [95% CI, -12.1 to 5.6]; P = .47). Oxygenation failure occurred in 155 patients overall (41.4%), 73 (38.2%) in the noninvasive ventilation group and 82 (44.8%) in the oxygen group (absolute difference, -6.6 [95% CI, -16.6 to 3.4]; P = .20). There were no significant differences in ICU-acquired infections, duration of mechanical ventilation, or lengths of ICU or hospital stays. Conclusions and relevance: Among immunocompromised patients admitted to the ICU with hypoxemic acute respiratory failure, early noninvasive ventilation compared with oxygen therapy alone did not reduce 28-day mortality. However, study power was limited. Trial registration: Identifier:NCT01915719.
    JAMA The Journal of the American Medical Association 10/2015; DOI:10.1001/jama.2015.12402 · 35.29 Impact Factor
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    ABSTRACT: Background and aimsAnal fistula plug (AFP) is a bioabsorbable bioprosthesis used in ano-perineal fistula treatment. We aimed to assess efficacy and safety of AFP in fistulising ano-perineal Crohn's disease (FAP-CD).Methods In a multicentre, open-label, randomized controlled trial we compared seton removal alone (control group) with AFP insertion (AFP group) in 106 Crohn's disease patients with non or mildly active disease having at least one ano-perineal fistula tract drained for more than one month. Patients with abscess (collection ≥ 3 mm on MRI) or recto-vaginal fistulas were excluded. Randomization was stratified in simple or complex fistulas according to AGA classification. Primary end point was fistula closure at week 12.Results54 patients were randomized to AFP group (control group 52). Median fistula duration was 23 [10-53] months. Median Crohn's Disease Activity Index at baseline was 81 [45-135]. Fistula closure at week 12 was achieved in 31.5% patients in AFP group and in 23.1 % in control group (relative risk stratified on AGA classification, RR: 1.31; 95%CI: 0.59-4.02; p=0.19). No interaction in treatment effect with complexity stratum was found. 33.3% patients with complex fistula and 30.8% patients with simple fistula closed the tracts after AFP, as compared to 15.4% and 25.6% in controls respectively (RR of success=2.17 in complex fistula vs. RR=1.20 in simple fistula; p= 0.45). Concerning safety, at week 12, 17 patients developed at least one adverse event in AFP group vs. 8 in controls (p=0.07).ConclusionAFP is not more effective than seton removal alone to achieve FAP-CD closure.
    Journal of Crohn s and Colitis 09/2015; DOI:10.1093/ecco-jcc/jjv162 · 6.23 Impact Factor
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    ABSTRACT: Light chain myeloma cast nephropathy (MCN) is the major cause of renal failure in multiple myeloma and strongly impacts patient survival. The role of kidney biopsy in the management of MCN is unclear. Renal pathological findings were retrospectively studied in 70 patients with multiple myeloma and MCN. Patients were categorized according to the achievement or not of renal response, as defined by estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73 m(2) and/or dialysis independence at 3 months. Thirty-two patients (46%) achieved a renal response. In the whole study population, the following parameters differed significantly between patients with and without renal response, respectively: baseline median eGFR (13.3 versus 9.3 mL/min/1.73 m(2), P = 0.017), Acute Kidney Injury Network Stage 3 (68.8 versus 92.1%, P = 0.019), haematological response rate (94 versus 34%, P < 0.0001), median percentage of free light chain (FLC) reduction at Day 21 (92 versus 24%, P = 0.006) and median number of casts/10 fields (14 versus 25, P = 0.005). The extent of interstitial fibrosis and tubular atrophy was similar. In multivariate analysis, only FLC reduction at Day 21 was significantly associated with renal response. However, when considering only the subgroup of haematological responders, both median number of casts [odds ratio (OR) = 0.93, 95% confidence interval (95% CI): 0.88-0.98, P = 0.01] and extent of tubular atrophy (OR = 0.03, 95% CI: 0.00-0.52, P = 0.02) were independent predictors of renal response. In MCN, the presence of numerous casts and diffuse tubular atrophy is associated with poor renal prognosis. These data suggest that additional strategies to reduce FLC burden should be considered in patients with extensive cast formation. © The Author 2015. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
    Nephrology Dialysis Transplantation 08/2015; DOI:10.1093/ndt/gfv283 · 3.58 Impact Factor
  • Haematologica 07/2015; DOI:10.3324/haematol.2015.127001 · 5.81 Impact Factor
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    ABSTRACT: Monoclonal immunoglobulin deposition disease (MIDD) is a rare complication of plasma cell disorders, defined by linear Congo red-negative deposits of monoclonal light chain, heavy chain, or both along basement membranes. While renal involvement is prominent, treatment strategies, such as the impact of novel anti-myeloma agents, remain poorly defined. Here we retrospectively studied 49 patients with MIDD who received a median of 4.5 cycles of intravenous bortezomib plus dexamethasone. Of these, 25 received no additional treatment, 18 also received cyclophosphamide, while 6 also received thalidomide or lenalidomide. The hematological diagnoses identified 38 patients with monoclonal gammopathy of renal significance, 10 with symptomatic multiple myeloma, and 1 with Waldenstrom macroglobulinemia. The overall hematologic response rate, based on the difference between involved and uninvolved serum-free light chains (dFLCs), was 91%. After median follow-up of 54 months, 5 patients died and 10 had reached end-stage renal disease. Renal response was achieved in 26 patients, with a 35% increase in median eGFR and an 86% decrease in median 24-h proteinuria. Predictive factors were pre-treatment eGFR over 30 ml/min per 1.73 m(2) and post-treatment dFLC under 40 mg/l; the latter was the sole predictive factor of renal response by multivariable analysis. Thus, bortezomib-based therapy is a promising treatment strategy in MIDD, mainly when used early in the disease course. dFLC response is a favorable prognostic factor for renal survival.Kidney International advance online publication, 15 July 2015; doi:10.1038/ki.2015.201.
    Kidney International 07/2015; DOI:10.1038/ki.2015.201 · 8.56 Impact Factor
  • J.-E. Galimard · S. Chevret · M. Resche-Rigon
    Revue d Épidémiologie et de Santé Publique 05/2015; 63. DOI:10.1016/j.respe.2015.03.014 · 0.59 Impact Factor
  • S. Chevret
    Revue d Épidémiologie et de Santé Publique 05/2015; 63. DOI:10.1016/j.respe.2015.03.003 · 0.59 Impact Factor
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    ABSTRACT: Systemic rheumatic diseases (SRD) patients may require ICU management for SRD exacerbation, treatment-related infectious or toxicities. Observational study in 10 university-affiliated ICUs in France. Consecutive patients with SRD were included. Determinants of ICU mortality were identified through multivariable logistic analysis. 363 patients (65.3 % women, median age 59y (IQR, 42-70)) accounted for 381 admissions. Connective tissue disease (primarily Systemic Lupus Erythematosus) accounted for 66.1% of SRD and systemic vasculitides for 26.2 % (chiefly ANCA-associated vasculitides). SRD was newly diagnosed in 43 (11.3%) cases. Direct admission to ICU occurred in 143 (37.9%) cases. Reasons for ICU admissions were infection (39.9%), SRD exacerbation (34.4%), toxicity (5.8 %) or miscellaneous (19.9%). Respiratory involvement was the leading cause of admission (56.8 %), followed by shock (41.5 %) and acute kidney injury (42.2%). Median SOFA on day-1 was 5 [3-8]. Mechanical ventilation was required in 57% cases, vasopressors in 33.9% and renal replacement therapy in 28.1%. ICU mortality rate was 21.0% (80 deaths). Factors associated with ICU mortality were shock (OR: 3.77 [95%CI, 1.93 -7.36]), SOFA score at day 1 (OR: 1.19 [95%CI, 1.10-1.30]) and direct admission (OR: 0.52, [CI 0.28-0.97]. Neither comorbidities nor SRD characteristics were associated with survival. In SRD patients, critical care management is mostly needed in patients with previously known SRD; still, diagnosis can be made in the ICU in 12% of the patients. Infection and SRD exacerbation account for more than two-third of the situations, both targeting chiefly the lungs. Direct admission to the ICU might improve outcomes.
    Chest 05/2015; DOI:10.1378/chest.14-3098 · 7.48 Impact Factor
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    ABSTRACT: The propensity score (PS) is a balancing score. Following PS matching, balance checking usually relies on estimating separately the standardized absolute mean difference for each baseline characteristic. The average standardized absolute mean difference and the Mahalanobis distances have been proposed to summarize the information across the covariates. However, they might be minimized when nondesirable variables such as instrumental variables (IV) are included in the PS model. We propose a new weighted summary balance measure that takes into account, for each covariate, its strength of association with the outcome. This new measure was evaluated using a simulation study to assess whether minimization of the measure coincided with minimally biased estimates. All measures were then applied to a real data set from an observational cohort study. Contrarily to the other measures, our proposal was minimized when including the confounders, which coincided with minimal bias and mean squared error, but increased when including an IV in the PS model. Similar findings were observed in the real data set. A balance measure taking into account the strength of association between the covariates and the outcome may be helpful to identify the most parsimonious PS model. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Clinical Epidemiology 05/2015; DOI:10.1016/j.jclinepi.2015.04.009 · 3.42 Impact Factor
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    ABSTRACT: In this study, we randomly compared high doses of the tyrosine kinase inhibitor (TKI) imatinib combined with reduced-intensity chemotherapy (arm A) to standard imatinib/HyperCVAD treatment (arm B) in 268 adults (median age, 47 years) with Ph-positive acute lymphoblastic leukemia (ALL). The primary objective was the major molecular response (MMolR) rate after cycle 2, patients being then eligible for allogeneic stem cell transplantation (SCT) if they had a donor or autologous SCT if in MMolR and no donor. With less induction deaths, the CR rate was higher in arm A (98% versus 91%, P= 0.006), while MMolR rate was similar in both arms (66% versus 64%). With a median follow-up of 4.8 years, 5-year EFS and OS were estimated at 37.1% and 45.6% respectively, without difference between both arms. Allogeneic transplantation was associated with a significant benefit in RFS (HR, 0.69; P= 0.036) and OS (HR, 0.64; P= 0.02), initial WBC being the only factor significantly interacting with this SCT effect. In patients achieving MMolR, outcome was similar after autologous and allogeneic transplantation. This study validates an induction regimen combining reduced-intensity chemotherapy and imatinib in Ph-positive ALL adult patients and suggests that SCT in first CR is still a good option in Ph-positive ALL adult patients. The study is registered to as NCT00327678. Copyright © 2015 American Society of Hematology.
    Blood 04/2015; 125(24). DOI:10.1182/blood-2015-02-627935 · 10.45 Impact Factor
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    ABSTRACT: Human adenovirus (HAdV) infections are a major cause of morbidity in pediatric hematopoietic stem cell transplant (HSCT) patients. New antiviral treatments offer promising perspectives. However it remains challenging to identify patients at risk for disseminated infection and which should receive early antiviral intervention. We conducted a longitudinal study of allogeneic HSCT recipients, including a weekly HAdV monitoring, to determine the risks factors associated with HAdV infection and dissemination, and to assess whether HAdV loads in stool may be used as surrogate markers for HAdV dissemination. Between September 2010 and December 2011, out of 72 patients, the cumulative incidences at day 100 of HAdV digestive infection, systemic infection and related disease were 35.9%, 24.0% and 18.3%, respectively. In multivariate analysis, the risk factors for HAdV digestive and systemic infection were cord blood and in vitro T-cell depletion. Graft versus host disease (GvHD) grade >2 was also associated with systemic infection. In patients with HAdV digestive shedding, GvHD grade >2 and HAdV load in stool were the only risk factors of systemic infection. Median peak levels of HAdV in stool were 7.9 and 4.0 log10 copies/ml respectively in patients with HAdV systemic infection and those without. HAdV monitoring in stool of pediatric HSCT recipients receiving cord blood or in vitro T-cell depleted transplants helps to predict patients at risk for HAdV systemic infection. Our results provide a rationale to conduct randomized controlled trial to evaluate the benefit of anti-HAdV preemptive treatments based on HAdV DNA levels in stool. Copyright © 2015. Published by Elsevier Ltd.
    Clinical Microbiology and Infection 04/2015; 21(7). DOI:10.1016/j.cmi.2015.03.011 · 5.77 Impact Factor
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    ABSTRACT: Reports of patients with secondary acute promyelocytic leukemia (APL) have increased in recent years, particularly for those who received treatment with mitoxantrone, and retrospective studies have suggested that their characteristics and outcomes were similar to those of patients with de novo APL. The authors investigated patients with de novo and secondary APL who were included in the ongoing APL-2006 trial. Patients with secondary APL who were included in that trial also were compared with a previous retrospective cohort of patients with secondary APL. In the APL-2006 trial, 42 of 280 patients (15%) had secondary APL. Compared with the retrospective cohort, patients with secondary APL in the APL-2006 trial had a lower incidence of prior breast carcinoma (35.7% vs 57%; P = .03) and a higher incidence of prior prostate carcinoma (26.2% vs 4.7%; P < .001). Treatment of the primary tumor in the APL-2006 trial less frequently included combined radiochemotherapy (28.6% vs 47.2%; P = .044) and no mitoxantrone (0% vs 46.7%; P = .016) but more frequently included anthracyclines (53.3% vs 38.3%; P = .015). In the APL-2006 trial, patients who had secondary APL, compared with those who had de novo APL, were older (mean, 60.2 years vs 48.7 years, respectively; P < .0001) but had a similar complete response rate (97.6% vs 90.3%, respectively), cumulative incidence of relapse (0% vs 1.8%, respectively), and overall survival (92.3% vs 90.9%, respectively) at 18 months. Although the incidence of secondary APL appears to be stable over time, evolving strategies for the treatment of primary cancers have reduced its occurrence among breast cancer patients but have increased its incidence among patients with prostate cancer. The current results confirm prospectively that patients with secondary APL have characteristics and outcomes similar to those of patients with de novo APL. Cancer 2015. © 2015 American Cancer Society. © 2015 American Cancer Society.
    Cancer 04/2015; 121(14). DOI:10.1002/cncr.29389 · 4.89 Impact Factor
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    ABSTRACT: Rationale Systemic steroids are the standard treatment for bronchiolitis obliterans syndrome (BOS) after allogeneic hematopoietic stem cell transplantation (HSCT), despite their poor efficacy and disabling side effects. Objectives To evaluate the effectiveness and tolerance of budesonide/formoterol as an alternative treatment for BOS following HSCT. Methods In this randomized, double-blind, placebo-controlled study, we randomly assigned 32 HSCT recipients with mild/severe BOS to receive budesonide/formoterol or placebo for six months. The primary outcome was the change in the FEV1 after one month of treatment (M1) compared with the baseline value. Patients were unblinded at M1 if there was no improvement in the FEV1. Those who had initially received the placebo were switched to budesonide/formoterol. Intention-to-treat analysis was performed to assess the primary outcome. Additional analyses took scheduled treatment contamination into account. Measurements and main results At M1, the median FEV1 increased by 260 mL in the budesonide/formoterol arm compared with 5 mL in the placebo arm (p=0.012). The median increases in the FEV1 at M1 relative to the baseline value for the treated and placebo groups were 13% and 0%, respectively (p=0.019). Twenty-five patients received budesonide/formoterol during the study. The median difference in the FEV1 between the baseline and after one month of treatment for these patients was +240 mL (p=0.0001). The effect of budesonide/formoterol on the FEV1 was maintained in the 13 patients who completed six months of treatment. Conclusions Budesonide/formoterol administration led to a significant improvement in the FEV1 in patients with mild/severe BOS after allogeneic HSCT. Clinical trial registration available at, ID NCT00624754.
    American Journal of Respiratory and Critical Care Medicine 04/2015; 191(11). DOI:10.1164/rccm.201410-1818OC · 13.00 Impact Factor
  • Journal of Hepatology 04/2015; 62:S213-S214. DOI:10.1016/S0168-8278(15)30057-X · 11.34 Impact Factor
  • Journal of Hepatology 04/2015; 62:S196. DOI:10.1016/S0168-8278(15)30020-9 · 11.34 Impact Factor
  • M. Sebert · C. Aguilar · L. Ades · S. Chevret · O. Lortholary · P. Fenaux
    Leukemia Research 04/2015; 39:S63. DOI:10.1016/S0145-2126(15)30123-5 · 2.35 Impact Factor
  • Leukemia Research 04/2015; 39:S44. DOI:10.1016/S0145-2126(15)30088-6 · 2.35 Impact Factor
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    ABSTRACT: Intensive care unit (ICU) admission is associated with high mortality in allogeneic hematopoietic stem cell transplant (HSCT) recipients. Whether mortality has decreased recently is unknown. The 497 adult allogeneic HSCT recipients admitted to three ICUs between 1997 and 2011 were evaluated retrospectively. Two hundred and nine patients admitted between 1997 and 2003 were compared with the 288 patients admitted from 2004 to 2011. Factors associated with 90-day mortality were identified. The recent cohort was characterized by older age, lower conditioning intensity, and greater use of peripheral blood or unrelated-donor graft. In the recent cohort, ICU was used more often for patients in hematological remission (67% vs 44%; P<0.0001) and without GVHD (73% vs 48%; P<0.0001) or invasive fungal infection (85% vs 73%; P=0.0003) despite a stable admission rate (21.7%). These changes were associated with significantly better 90-day survival (49% vs 31%). Independent predictors of hospital mortality were GVHD, mechanical ventilation (MV) and renal replacement therapy (RRT). Among patients who required MV or RRT, survival was 29% and 18%, respectively, but dropped to 18% and 6% in those with GVHD. The use of ICU admission has changed and translated into improved survival, but advanced life support in patients with GVHD usually provides no benefits.Bone Marrow Transplantation advance online publication, 23 March 2015; doi:10.1038/bmt.2015.55.
    Bone marrow transplantation 03/2015; 50(6). DOI:10.1038/bmt.2015.55 · 3.57 Impact Factor
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    ABSTRACT: The natural history of pulmonary Langerhans cell histiocytosis (PLCH) has been unclear due to the absence of prospective studies. The rate of patients who experience an early progression of their disease is unknown. Additionally, conflicting effects of smoking cessation on the outcome of PLCH have been reported. In this prospective, multicentre study, 58 consecutive patients with newly diagnosed PLCH were comprehensively evaluated over a two-year period. Our objectives were to estimate the incidence of early progression of the disease and to evaluate the impact of smoking status on lung function outcomes. Lung function deterioration was defined as a decrease of at least 15% in FEV1 and/or FVC and/or DLCO, compared with baseline values. At each visit, smoking status was recorded based on the patients' self-reports and urinary cotinine measurements that were blinded for the patients. The cumulative incidence of lung function outcomes over time was estimated using the non-parametric Kaplan-Meier method. Multivariate Cox models with time-dependent covariates were used to calculate the hazards ratios of the lung function deterioration associated with smoking status with adjustment for potential confounders. The cumulative incidence of lung function deterioration at 24 months was 38% (22% for FEV1 and DLCO, and 9% for FVC). In the multivariate analysis, smoking status and PaO2 at inclusion were the only factors associated with the risk of lung function deterioration. The patients' smoking statuses markedly changed over time. Only 20% of the patients quit using tobacco for the entire study period. Nevertheless, being a non-smoker was associated with a decreased risk of subsequent lung function deterioration, even after adjustment for baseline predictive factors. By serial lung computed tomography, the extent of cystic lesions increased in only 11% of patients. Serial lung function evaluation on a three- to six-month basis is essential for the follow-up of patients with recently diagnosed PLCH to identify those who experience an early progression of their disease. These patients are highly addicted to tobacco, and robust efforts should be undertaken to include them in smoking cessation programs. No: NCT01225601 .
    Orphanet Journal of Rare Diseases 03/2015; 10(1):30. DOI:10.1186/s13023-015-0249-2 · 3.36 Impact Factor

Publication Stats

20k Citations
3,575.12 Total Impact Points


  • 2007–2015
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier Universitaire de Nancy
      Nancy, Lorraine, France
    • Hôpitaux Universitaires La Pitié salpêtrière - Charles Foix
      Lutetia Parisorum, Île-de-France, France
  • 1992–2015
    • Université René Descartes - Paris 5
      Lutetia Parisorum, Île-de-France, France
  • 2005–2014
    • Université de Versailles Saint-Quentin
      Versailles, Île-de-France, France
  • 2002–2014
    • Unité Inserm U1077
      Caen, Lower Normandy, France
    • Hôpital Saint-Vincent-de-Paul – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
    • Hôpital Antoine-Béclère – Hôpitaux universitaires Paris-Sud
      Clamart, Île-de-France, France
    • Fred Hutchinson Cancer Research Center
      • Division of Clinical Research
      Seattle, Washington, United States
  • 2013
    • University of Leeds
      Leeds, England, United Kingdom
  • 2008–2013
    • University of Paris-Est
      La Haye-Descartes, Centre, France
    • Institut de Cancérologie Gustave Roussy
      Villejuif, Île-de-France, France
  • 1994–2012
    • Hôpital Raymond-Poincaré – Hôpitaux universitaires Paris Ile-de-France Ouest
      Île-de-France, France
  • 2009–2011
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2004–2011
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France
    • Hôpital de Poissy Saint Germain en Laye
      Saint-Germain, Île-de-France, France
  • 2010
    • University of Limoges
      Limages, Limousin, France
    • Sunnybrook Health Sciences Centre
      • Department of Critical Care Medicine
      Toronto, Ontario, Canada
  • 2003–2007
    • Mercy Hospital St. Louis
      San Luis, Missouri, United States
    • Hôpital Bichat - Claude-Bernard (Hôpitaux Universitaires Paris Nord Val de Seine)
      • Service de Réanimation Médicale et des Maladies Infectieuses
      Lutetia Parisorum, Île-de-France, France
  • 2006
    • University of Glasgow
      Glasgow, Scotland, United Kingdom
  • 1999–2002
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      • Service d’Hépato - Gastro - Entérologie
      Lutetia Parisorum, Île-de-France, France
  • 2001
    • American Hospital of Paris
      Lutetia Parisorum, Île-de-France, France
    • Saint Louis University-Hospital of the Sacred Heart
      Baguio City, Cordillera, Philippines
  • 1996
    • Centre Hospitalier Universitaire de Caen
      Caen, Lower Normandy, France
    • Hôtel-Dieu de Paris – Hôpitaux universitaires Paris Centre
      Lutetia Parisorum, Île-de-France, France
  • 1992–1996
    • Hôpital Paris Saint Joseph
      Lutetia Parisorum, Île-de-France, France
  • 1991
    • Institut Pasteur
      Lutetia Parisorum, Île-de-France, France