Adeline Lacraz

Publications (3)22.36 Total impact

• Article: The Spectrum of Type I Cryoglobulinemia Vasculitis: New Insights Based on 64 Cases.

  Benjamin Terrier, Alexandre Karras, Jean-Emmanuel Kahn, Guillaume Le Guenno, Isabelle Marie, Lucas Benarous, Adeline Lacraz, Elisabeth Diot, Olivier Hermine, Luc de Saint-Martin, Pascal Cathébras, Véronique Leblond, Philippe Modiano, Jean-Marc Léger, Xavier Mariette, Patricia Senet, Emmanuelle Plaisier, David Saadoun, Patrice Cacoub
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  ABSTRACT: Type I cryoglobulinemia vasculitis (CryoVas) is considered a life-threatening condition; however, data on the characteristics and outcome are scarce. To analyze the presentation, prognosis, and efficacy and safety of treatments of type I CryoVas, we conducted a French nationwide survey that included 64 patients with type I CryoVas between January 1995 and July 2010: 28 patients with monoclonal gammopathy of unknown significance (MGUS) and 36 with hematologic malignancy.Type I monoclonal CryoVas was characterized by severe cutaneous involvement (necrosis and ulcers) in almost half the patients and high serum cryoglobulin levels, contrasting with a lower frequency of glomerulonephritis than expected. The 1-, 3-, 5-, and 10-year survival rates were 97%, 94%, 94%, and 87%, respectively. Compared to MGUS, type I CryoVas related to hematologic malignancy tended to be associated with a poorer prognosis. Therapeutic regimens based on alkylating agents, rituximab, thalidomide or lenalinomide, and bortezomib showed similar efficacy on vasculitis manifestations, with clinical response rates from 80% to 86%.Data from the CryoVas survey show that the prognosis of type I CryoVas does not seem to be as poor as previously suggested. Besides alkylating agents, the use of regimens based on rituximab, thalidomide or lenalinomide, and bortezomib are interesting alternative options, although the exact role of each strategy remains to be defined.
  Medicine 03/2013; 92(2):61-68. · 4.35 Impact Factor
• Article: Prognostic factors of survival in patients with non-infectious mixed cryoglobulinaemia vasculitis: data from 242 cases included in the CryoVas survey.

  Benjamin Terrier, Fabrice Carrat, Evguenia Krastinova, Isabelle Marie, David Launay, Adeline Lacraz, Pauline Belenotti, Luc de Saint Martin, Thomas Quemeneur, Antoine Huart, [......], Christian Pagnoux, Estibaliz Lzaro, Frank Bridoux, Thierry Zenone, Olivier Hermine, Jean-Marc Leger, Xavier Mariette, Patricia Senet, Emmanuelle Plaisier, Patrice Cacoub
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  ABSTRACT: BACKGROUND: Data on the prognosis of non-infectious mixed cryoglobulinaemia vasculitis (CryoVas) in the era of hepatitis C virus screening are lacking.METHODS: The French multicentre and retrospective CryoVas survey included 242 patients with non-infectious mixed CryoVas. Causes of death and prognostic factors of survival were assessed and a prognostic score was determined to predict survival at 5 years.RESULTS: After a median follow-up of 35 months, 42 patients (17%) died. Causes of death were mainly serious infections (50%) and vasculitis flare (19%). One-, 2-, 5- and 10-year overall survival rates were 91%, 89%, 79% and 65%, respectively. A prognostic score, the CryoVas score (CVS), for the prediction of survival at 5 years was devised. Pulmonary and gastrointestinal involvement, glomerular filtration rate <60 ml/min and age >65 years were independently associated with death. At 5 years the death rates were 2.6%, 13.1%, 29.6% and 38.5% for a CVS of 0, 1, 2 and ≥3, respectively. At 1 year the death rates were 0%, 3.2%, 18.5% and 30.8% for a CVS of 0, 1, 2 and ≥3, respectively. The CVS was strongly correlated with the Five Factor Score (FFS) 2009, another prognostic score validated in primary necrotising vasculitis (r=0.82; p<0.0001). The area under the curve for the CVS was 0.74 compared with 0.67 for the FFS, indicating a better performance of the CVS (p=0.052).CONCLUSIONS: In patients with non-infectious mixed CryoVas, the main prognostic factors are age >65 years, pulmonary and gastrointestinal involvement and renal failure. A score including these variables is significantly associated with the prognosis.
  Annals of the rheumatic diseases 05/2012; · 8.11 Impact Factor
• Article: Management of noninfectious mixed cryoglobulinemia vasculitis: data from 242 cases included in the CryoVas survey.

  Benjamin Terrier, Evguenia Krastinova, Isabelle Marie, David Launay, Adeline Lacraz, Pauline Belenotti, Luc de Saint-Martin, Thomas Quemeneur, Antoine Huart, Fabrice Bonnet, [......], Estibaliz Lazaro, Frank Bridoux, Thierry Zénone, Fabrice Carrat, Olivier Hermine, Jean-Marc Léger, Xavier Mariette, Patricia Senet, Emmanuelle Plaisier, Patrice Cacoub
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  ABSTRACT: Data on the clinical spectrum and therapeutic management of noninfectious mixed cryoglobulinemia vasculitis (CryoVas) in the era of hepatitis C virus screening are lacking. We analyzed data from 242 patients with noninfectious mixed CryoVas included in the French multicenter CryoVas survey. Baseline manifestations were purpura (75%), peripheral neuropathy (52%), arthralgia or arthritis (44%), glomerulonephritis (35%), cutaneous ulcers (16%), and cutaneous necrosis (14%). A connective tissue disease was diagnosed in 30% and B-cell non-Hodgkin lymphoma in 22%, whereas the CryoVas was considered to be essential in 48%. With the use of Cox-marginal structural models, rituximab plus corticosteroids showed the greater therapeutic efficacy compared with corticosteroids alone and alkylating agents plus corticosteroids to achieve complete clinical, renal, and immunologic responses and a prednisone dosage < 10 mg/d at 6 months. However, this regimen was also associated with severe infections, particularly when high doses of corticosteroids were used, whereas death rates did not differ between the therapeutic regimens. The role of each of these strategies remains to be defined in well-designed randomized controlled trials.
  Blood 04/2012; 119(25):5996-6004. · 9.90 Impact Factor