Audrey Sarry

Centre Hospitalier Universitaire de Toulouse, Tolosa de Llenguadoc, Midi-Pyrénées, France

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Publications (5)30.22 Total impact

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    ABSTRACT: We assessed the influence of obesity on the characteristics and prognosis of acute myeloid leukemia (AML). Indeed, safety of intensive chemotherapy and outcome of obese AML patients in a real-life setting are poorly described, and chemotherapy dosing remains challenging. We included 619 consecutive genetically-defined cases of AML treated with intensive chemotherapy between 2004 and 2012. In this cohort, 93 patients (15%) were classified in the obese category according to WHO classification; 59% of them received capped doses of chemotherapy because of a body surface area above 2 m(2) . Obese patients were older and presented more often with cardiovascular comorbidities. Although obese patients had more frequently de novo AML, main characteristics of AML including white blood cell count, karyotype and mutations were well-balanced between obese and non-obese patients. After induction chemotherapy, early death and complete remission rates were similar. Overall (OS), event-free (EFS) and disease-free (DFS) survival were not significantly different compared to non-obese patients. However, in the European LeukemiaNet (ELN) favorable subgroup, obese patients had lower median OS, EFS and DFS than non-obese patients (18.4, 16.8 and 17.2 vs. 43.6, 31.8 and 29.7 months, respectively) and obesity showed a significant impact on OS (OR 2.54; p=0.02) in multivariate models. Although we did not find any significant impact of obesity on outcome in the whole series, this study suggests that special efforts for chemotherapy dose optimization are needed in the ELN favorable subgroup since dose capping may be deleterious. This article is protected by copyright. All rights reserved.
    No preview · Article · Oct 2015 · American Journal of Hematology
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    ABSTRACT: We assessed in a French regional healthcare network the distribution of treatments, prognostic factors and outcome of 334 newly diagnosed acute myeloid leukemia patients aged 60 years or older over a 4-year period of time (2007-2010). Patients were selected in daily practice for intensive chemotherapy (n=115), azacitidine (n=95) or best supportive care (n=124). In these three groups, median overall survival was 18.9, 11.3 and 1.8 months, respectively. In the azacitidine group, multivariate analysis showed that overall survival was negatively impacted by higher age (p=0.010 for one unit increase), unfavorable cytogenetics (p=0.001), lymphocyte count < 0.5 G/L (p=0.015) and higher lactate dehydrogenase level (p=0.005 for one unit increase). We compared the survival of patients treated by azacitidine versus intensive chemotherapy and best supportive care using time-dependent analysis and propensity score matching. Patients treated by intensive chemotherapy had a better overall survival compared to those treated by azacitidine from 6 months after diagnosis, whereas patients treated by azacitidine had a better overall survival compared to those treated by best supportive care from 1 day after diagnosis. This study of “real life” practice shows that there is a room for low intensive therapies such as azacitidine in selected elderly acute myeloid leukemia patients.
    No preview · Article · Dec 2014 · American Journal of Hematology
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    ABSTRACT: Hemophagocytic lymphohistiocytosis is an immune dysregulation characterized by severe organ damages induced by a hyperinflammatory response and uncontrolled T-cell and macrophage activation. Secondary hemophagocytic lymphohistiocytosis typically occurs in association with severe infections or malignancies. Acute myeloid leukemia patients may be prone to develop hemophagocytic lymphohistiocytosis because of an impaired immune response and a high susceptibility to severe infections. In a series of 343 patients treated by intensive chemotherapy over a 5-year period in our centre, we identified 32 patients (9.3%) with fevers, very high ferritin levels, and marrow hemophagocytosis (hemophagocytic lymphohistiocytosis patients). Patients with hemophagocytic lymphohistiocytosis exhibited hepatomegaly, pulmonary or neurological symptoms, liver abnormalities, lower platelet count and higher levels of C-reactive protein as well as prolonged pancytopenia as compared to patients without hemophagocytic lymphohistiocytosis. A microbial etiology was documented in 24 patients: 14 bacterial infections, 9 Herpesviridae infections and 11 fungal infections. Hemophagocytic lymphohistiocytosis treatment consisted of corticosteroids and/or intravenous immunoglobulin along with adapted antimicrobial therapy. Patients with hemophagocytic lymphohistiocytosis had a median overall survival of 14.9 months, significantly lower than patients without hemophagocytic lymphohistiocytosis (22.1 months) (p=0.0016). Hemophagocytic lymphohistiocytosis was significantly associated with a higher rate of induction failures mainly due to deaths in aplasia. Hemophagocytic lymphohistiocytosis can be diagnosed in up to 10% of acute myeloid leukemia patients undergoing intensive chemotherapy and is associated with early mortality. Fever, very high ferritin levels and marrow hemophagocytosis represent the cornerstone of diagnosis. Further biological studies are needed to better characterize and recognize this syndrome in acute myeloid leukemia patients.
    Preview · Article · Oct 2013 · Haematologica
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    ABSTRACT: In acute myeloid leukemia (AML), new strategies assess the potential benefit of genetically targeted therapy at diagnosis. This implies waiting for laboratory tests and therefore a delay in initiation of chemotherapy. We studied the impact of time from diagnosis to treatment (TDT) on overall survival, early death and response rate in a retrospective series of 599 newly diagnosed AML patients treated by induction chemotherapy between the years 2000 and 2009. The effect of TDT was assessed using multivariate analysis. TDT was analyzed as a continuous variable using a specific polynomial function to model the shape and form of the relationship. The median TDT was 8 days (IQR, 4-16) and was significantly longer in patients with white blood cell count (WBC) less than 50 G/L (p<0.0001) and in older patients (p=0.0004). In multivariate analysis, TDT had no impact on overall survival (p=0.4095) as compared to age older than 60, secondary AML, WBC higher than 50 G/L, European LeukemiaNet risk groups and ECOG performance status. Furthermore, TDT was not associated with response rate and early death. Thus, waiting a short period of time for laboratory tests to characterize leukemias better and design adapted therapeutic strategies at diagnosis seems possible.
    Preview · Article · Jan 2013 · Blood
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    ABSTRACT: Mutations in DNMT3A encoding DNA methyltransferase 3A were recently described in patients with acute myeloid leukemia. To assess their prognostic significance, we determined the mutational status of DNMT3A exon 23 in 288 patients with AML excluding acute promyelocytic leukemia, aged from 18 to 65 years and treated in Toulouse University Hospital. A mutation was detected in 39 patients (13.5%). All DNMT3A exon 23+ patients had intermediate-risk cytogenetics. Mutations significantly correlated with a higher WBC count (p less than 0.001), NPM1 and FLT3-ITD mutations (p=0.027). DNMT3A mutations were conserved through xenotransplantation in immunodeficient mice. No difference in outcome between DNMT3A exon 23+ and DNMT3A exon 23- patients was found even if the results were stratified by NPM1 or FLT3-ITD status. However, DNMT3A exon 23+ patients had better median DFS (not reached vs 11.6 months, p=0.009) and OS (not reached vs 14.3 months, p=0.005) as compared to DNMT3A exon 23- patients when treated with idarubicin, whereas patients treated with daunorubicin had similar outcome regardless the DNMT3A status. This study shows that DNMT3A mutations have no impact on outcome but could be a predictive factor for response to idarubicin and thus, could have a direct influence in the way AML patients should be managed.
    Preview · Article · Nov 2011 · Oncotarget

Publication Stats

45 Citations
30.22 Total Impact Points


  • 2013-2015
    • Centre Hospitalier Universitaire de Toulouse
      • Service d'Hématologie
      Tolosa de Llenguadoc, Midi-Pyrénées, France