P Feugier

Centre Hospitalier Universitaire de Nancy, Nancy, Lorraine, France

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Publications (69)228.88 Total impact

  • S Lepretre · C Dartigeas · P Feugier · M Marty · G Salles
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    ABSTRACT: Emergence of new agents has deeply modified treatment options and the role of chlorambucil (CLB) in B-cell malignancies. We conducted a systematic review of prospective, randomized, controlled trials (RCTs) investigating the benefits and harms of CLB used alone or in combination with other treatment in patients suffering from chronic lymphocytic leukemia (CLL), low-grade non-Hodgkin lymphoma (NHL) or Waldenström macroglobulinemia (WM). For CLL, review of the nine RCTs showed that the main advantage of CLB is its low toxicity in comparison with purine nucleoside analogs like fludarabine in either CLL or NHL. In CLL, the major disadvantage is the very low rate of complete response, except when combining an anti-CD20 antibody. For B-cell lymphoma and WM, six RCTs were summarized. Results according to the usual criteria are presented and the role of CLB, used mostly in combination with an anti-CD20 antibody, is discussed for each indication, in particular for unfit patients.
    Leukemia & lymphoma 08/2015; DOI:10.3109/10428194.2015.1085528 · 2.89 Impact Factor
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    ABSTRACT: Automated haematology analysers may inaccurately determine platelet counts in several circumstances. Spuriously elevated automated platelet counts have been reported in some acute leukaemia (AL) cases because of fragmentation of circulating blast cells (pseudoplatelets). Haemorrhagic diathesis is a common manifestation of AL, which is often caused by severe thrombocytopenia. Therefore, overestimation of the actual platelet count in patients with AL can affect its clinical management. We aimed to detect the frequency of pseudoplatelets in patients with AL. Complete blood cell counts were performed on 86 AL patients with three automated analysers (ADVIA 2120, Coulter LH 750 and Sysmex XE-2100D). Platelet counts were also performed by quantitative flow cytometry (QFC). The platelet counts of the automatic analysers were compared to the platelet counts by QFC. Blood smears were checked for the presence of pseudoplatelets. The automated analysers overestimated the platelet count due to the presence of pseudoplatelets in patients with AL. Pseudoplatelets were observed in the blood smears of 11 patients (13%). Three of these patients were near the prophylactic platelet transfusion threshold. Spurious increases in automated platelet counts by blast cell fragments are little known but frequent artefacts that should be ruled out by careful examination of peripheral blood smears. © 2015 John Wiley & Sons Ltd.
    International journal of laboratory hematology 04/2015; DOI:10.1111/ijlh.12371 · 1.87 Impact Factor
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    ABSTRACT: Chronic lymphocytic leukemia is usually diagnosed through the characteristic morphology/immunophenotype of the lymphocytes, but some CLL cases remain atypical resulting in diagnostic uncertainty. Using flow cytometry analysis, we investigated the expression of CDs160/200 on B cells from 124 patients (82 CLL, 42 other B-cell neoplasms) and nine controls. CDs160/200 measurements were determined as a ratio of the mean fluorescence intensities of leukemic cells/controls and were considered positive when the ratios were ≥2 and 20, respectively. Sixty and 83% CLL expressed CDs160/200 as compared to 5% and 10% of other B-cell neoplasms, respectively. None of the controls showed CDs160/200 expressions. Combination of both markers was observed in 55% of CLL but only in 2% of other B-cell neoplasms, and absence of both markers occurred in 12% of CLL but in 86% of other B-cell neoplasms. CDs160/200 were associated with markers of the gold standard 'Matutes score' and could be useful markers to differentiate atypical CLL from other B-cell neoplasms in the absence of available biopsies or cytogenetics and molecular studies. © 2014 John Wiley & Sons Ltd.
    International journal of laboratory hematology 12/2014; 37(4). DOI:10.1111/ijlh.12315 · 1.87 Impact Factor
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    ABSTRACT: Detection of MUM1+ cells in follicular lymphoma (FL) tissues was previously found to be associated with poor prognosis in a single report; whereas the usefulness of Ki67 immunostaining remains debated. Our goal was to establish whether these markers have predictive value for FL patients. We analyzed MUM1 and Ki67 expression using immunohistochemistry (IHC) in biopsy samples from 434 patients from the PRIMA randomized trial. The MUM1 prognostic value was then validated in a cohort of 138 patients from the FL2000 randomized trial, using the optimal cut-off value obtained from the PRIMA cohort. The surface of positive staining was quantified using computerized image analysis (CIA). In the PRIMA cohort, both high levels of MUM1 positivity (cut-off value of 0.80%) and high levels of Ki67 positivity (cut-off value of 10.25%) were significantly associated with a shorter progression free survival (PFS) (P=.004 and P=.007 for MUM1 and Ki67, respectively). In a multivariate Cox proportional hazards regression model, only MUM1 retained a statistical significance (HR=1.56, 95% CI 1.02-2.37, P=.038) after adjustment for the maintenance arm of treatment and the FLIPI score. In the FL2000 cohort, high levels of MUM1 positivity were significantly associated to a shorter PFS (P=.004) and to a trend toward a shorter overall survival (OS) (P=.043). This remained significant using a multivariate Cox regression model after adjustment for the FLIPI and the treatment arm for PFS (P=.016). These results show that MUM1 is a strong and robust predictive IHC marker in FL patients.
    Human pathology 10/2014; 45(10). DOI:10.1016/j.humpath.2014.06.019 · 2.81 Impact Factor
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    ABSTRACT: Lymphoma occurring in patients aged 90 or older is not uncommon, and its incidence is expected to increase over time. Management of these patients is difficult given their underlying fragility and the lack of information regarding this population. We retrospectively analyzed 234 patients diagnosed with lymphoma at the age of 90 years or older (90+) between 1990 and 2012 to describe their characteristics, management, outcomes and prognostic factors. The median age was 92 years; 88% were B-cell lymphomas consisting mainly in diffuse large B-cell lymphoma. The median overall survival (OS) was 7.2 months (range, 0-92 months) for the 227 patients with non-Hodgkin Lymphoma (NHL), with a significant difference between aggressive and indolent NHL (5.2 months versus 19.4 months, respectively). We further analyzed 166 NHL patients for whom detailed characteristics were available. Among these patients, 63.5% received a treatment, either local (7.5%) or systemic (56%). Lymphoma was reported as the main cause of death (40%). Treatment administration was associated with improved OS in patients with aggressive (P < 0.001) but not indolent NHL (P = 0.96). In patients with aggressive NHL, hypoalbuminemia appeared as a strong and independent negative prognostic factor. The median OS is short in 90+ patients diagnosed with lymphoma but some patients experience prolonged survival. Lymphoma represents the main cause of death in these patients. Treatment may improve survival of selected patients with aggressive but not indolent NHL. Management of these patients may be guided by prognostic factors identified in this study, notably serum albumin.
    Annals of Oncology 08/2013; 24(10). DOI:10.1093/annonc/mdt282 · 6.58 Impact Factor
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    ABSTRACT: The long-term prognosis for older patients with mantle-cell lymphoma is poor. Chemoimmunotherapy results in low rates of complete remission, and most patients have a relapse. We investigated whether a fludarabine-containing induction regimen improved the complete-remission rate and whether maintenance therapy with rituximab prolonged remission. We randomly assigned patients 60 years of age or older with mantle-cell lymphoma, stage II to IV, who were not eligible for high-dose therapy to six cycles of rituximab, fludarabine, and cyclophosphamide (R-FC) every 28 days or to eight cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) every 21 days. Patients who had a response underwent a second randomization to maintenance therapy with rituximab or interferon alfa, each given until progression. Of the 560 patients enrolled, 532 were included in the intention-to-treat analysis for response, and 485 in the primary analysis for response. The median age was 70 years. Although complete-remission rates were similar with R-FC and R-CHOP (40% and 34%, respectively; P=0.10), progressive disease was more frequent with R-FC (14%, vs. 5% with R-CHOP). Overall survival was significantly shorter with R-FC than with R-CHOP (4-year survival rate, 47% vs. 62%; P=0.005), and more patients in the R-FC group died during the first remission (10% vs. 4%). Hematologic toxic effects occurred more frequently in the R-FC group than in the R-CHOP group, but the frequency of grade 3 or 4 infections was balanced (17% and 14%, respectively). In 274 of the 316 patients who were randomly assigned to maintenance therapy, rituximab reduced the risk of progression or death by 45% (in remission after 4 years, 58%, vs. 29% with interferon alfa; hazard ratio for progression or death, 0.55; 95% confidence interval, 0.36 to 0.87; P=0.01). Among patients who had a response to R-CHOP, maintenance therapy with rituximab significantly improved overall survival (4-year survival rate, 87%, vs. 63% with interferon alfa; P=0.005). R-CHOP induction followed by maintenance therapy with rituximab is effective for older patients with mantle-cell lymphoma. (Funded by the European Commission and others; ClinicalTrials.gov number, NCT00209209.).
    New England Journal of Medicine 08/2012; 367(6):520-31. DOI:10.1056/NEJMoa1200920 · 54.42 Impact Factor
  • Leukemia: official journal of the Leukemia Society of America, Leukemia Research Fund, U.K 06/2012; 26. DOI:10.1038/leu.2012.172 · 9.38 Impact Factor
  • P. Feugier · A. Perrot
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    ABSTRACT: Los linfomas no Hodgkin (LNH) son proliferaciones tumorales de células procedentes de las series linfocíticas B o T. Pueden aparecer a cualquier edad, pero son más frecuentes en ancianos. Constituyen un grupo de hemopatías más inconexo que los linfomas Hodgkin y es típico distinguir los LNH agresivos de los LNH indolentes. La causa de los LNH es desconocida, pero se ha demostrado el papel favorecedor de la inmunodepresión, algunos patógenos (virales o bacterianos) y factores ambientales (pesticidas). Aunque la presentación clínica es variable, el diagnóstico se basa siempre en la biopsia de una adenopatía o un órgano afectado. El estudio anatomopatológico y las técnicas asociadas (inmunohistoquímica, biología molecular) permiten establecer el diagnóstico preciso del tipo de LNH (según el tipo de células B o T, la estructura difusa o folicular, la expresión de antígenos de superficie o de marcadores moleculares). Tras formular el diagnóstico, la conducta inicial consiste en un estudio de extensión, como mínimo con una tomografía computarizada (TC) cervical, torácica, abdominal y pélvica (cada vez con más frecuencia acoplada a la tomografía por emisión de positrones [PET]) y una biopsia osteomedular para precisar el estadio de la enfermedad. La evaluación en su conjunto permite definir un índice pronóstico, según recomendaciones internacionales, que orienta las elecciones terapéuticas. El tratamiento de los LNH se basa en la poliquimioterapia, la mayoría de las veces junto a una inmunoterapia (anticuerpos monoclonales) contra antígenos presentes en la superficie de las células linfomatosas. En los casos en que se ha demostrado un agente patógeno, su erradicación puede constituir la primera etapa del tratamiento. El pronóstico de los LNH ha variado en los últimos 10 años gracias a la aparición de los anticuerpos monoclonales (en especial de los anti-CD20), pero sigue siendo muy variable de un paciente a otro según la edad, el tipo de LNH y su extensión inicial.
    04/2012; 16(1):1–6. DOI:10.1016/S1636-5410(12)61139-8
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    ABSTRACT: The relevance of high-dose chemotherapy followed by auto-SCT in CLL remains to be defined. The aim of the prospective, randomized, GOELAMS LLC 98 trial was to compare two strategies in previously untreated CLL patients aged <60 years. Conventional chemotherapy (Arm A) consisted of six monthly courses of CHOP followed by six CHOP courses in every 3 months in those achieving a complete or PR. Arm A was compared with high-dose therapy with auto-SCT (Arm B), used as consolidation after three CHOP courses in case of CR or very good PR. A total of 86 patients were enrolled, of which 39 and 43 patients were evaluable in arm A and arm B, respectively. The primary endpoint was PFS. On an intent-to-treat basis and with a median follow-up time of 77.1 (range 1-135.5) months, the median PFS was 22 months in Arm A and 53 months in Arm B (P<0.0001). Median survival time was 104.7 months in arm A and 107.4 months in arm B. This trial demonstrates that frontline high-dose therapy with auto-SCT prolongs PFS but does not translate into a survival advantage in advanced CLL patients in the pre-rituximab era.
    Bone marrow transplantation 07/2011; 47(4):542-8. DOI:10.1038/bmt.2011.117 · 3.47 Impact Factor
  • Pierre Feugier · Aurore Perrot
    La Revue du praticien 01/2011; 61(1):127-35.
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    Archives of Cardiovascular Diseases 03/2009; 102. DOI:10.1016/S1875-2136(09)72437-4 · 1.66 Impact Factor
  • J Lesesve · A Palmiéri · A Brion · P Feugier · B Mahé · R Garand
    International Journal of Laboratory Hematology 07/2008; 30(3):256-8. DOI:10.1111/j.1751-553X.2007.00935.x · 1.87 Impact Factor
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    ABSTRACT: Lymphocytopenia is a prognostic factor in Hodgkin's disease. In diffuse large B-cell lymphoma (DLBCL), data are much less established, in spite of numerous reports on immune system-lymphoma interactions. This study addresses the prognostic value of blood lymphocyte subsets at diagnosis in DLBCL. Absolute values of blood lymphocyte subsets and monocytes were prospectively determined by flow cytometry in 140 patients with 2 or 3 adverse age-adjusted International Prognostic Index (aaIPI) factors included in a Groupe d'Etude des Lymphomes de l'Adulte protocol (LNH98B3). Absolute cell counts at diagnosis and aaIPI were evaluated with regard to clinical outcome. Low median cell counts of 337, 211, and 104/mul were evidenced for the CD4+, CD8+ T, and natural killer (NK) cells, respectively. In univariate analysis, only NK cell count [odds ratio (OR) = 1.81 (1.27, 2.57), P = 0.001] and aaIPI [OR = 2.29 (0.95, 5.45), P = 0.06] were associated with induction treatment response. Low NK cell count [Hazard ratio (HR) = 1.27 (1.06, 1.52), P = 0.01] and aaIPI 3 [HR = 1.95 (1.20, 3.16), P = 0.01] were also associated with a shorter event free survival (EFS). In multivariate analysis, NK cell count was associated with response [OR = 1.77 (1.24, 2.54), P = 0.002] and EFS [HR = 1.25 (1.04, 1.50) P = 0.02] independently of aaIPI. This study shows an association between circulating NK cell number and clinical outcome in DLBCL, possibly important in the context of the broadening use of rituximab, a likely NK-dependent therapy.
    Annals of Oncology 08/2007; 18(7):1209-15. DOI:10.1093/annonc/mdm110 · 6.58 Impact Factor
  • P Feugier · C Tomowiak · N Daguindau · A Perrot
    La Revue de Médecine Interne 07/2007; 28 Spec No 2:7-9. · 1.32 Impact Factor
  • P Feugier · C Tomowiak · N Daguindau · A Perrot
    La Revue de Médecine Interne 07/2007; 28 Spec No 2:2-4. · 1.32 Impact Factor
  • P Feugier · C Tomowiak · N Daguindau · A Perrot
    La Revue de Médecine Interne 07/2007; 28 Spec No 2:5-6. · 1.32 Impact Factor
  • P Feugier · C Tomowiak · N Daguindau · A Perrot
    La Revue de Médecine Interne 07/2007; 28 Spec No 2:1. · 1.32 Impact Factor
  • K. D. Andrews · P. Feugier · R. A. Black · J. A. Hunt
  • P. Feugier · C. Tomowiak · N. Daguindau · A. Perrot
    La Revue de Médecine Interne 01/2007; 28:5-6. DOI:10.1016/S0248-8663(07)80008-7 · 1.32 Impact Factor
  • P. Feugier · C. Tomowiak · N. Daguindau · A. Perrot
    La Revue de Médecine Interne 01/2007; 28:2-4. DOI:10.1016/S0248-8663(07)80007-5 · 1.32 Impact Factor