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Allogeneic stem cell transplantation for peripheral T cell lymphomas: a retrospective study in 285 patients from the Societe Francophone de Greffe de Moelle et de Therapie Cellulaire (SFGM-TC).

ABSTRACT: BACKGROUND:Peripheral T cell lymphomas form a heterogeneous group with a usually dismal prognostic. The place of allogeneic stem cell transplantation to treat PTCL is debated. METHODS:We retrospectively analyzed the overall survival (OS), event-free survival (EFS), relapse, and transplant-related mortality (TRM) and associated variables in 285 adults with non-primary cutaneous PTCL (PCTL-NOS (39%), angioimmunoblastic T cell lymphomas (29%), anaplastic T cell lymphomas (15%), and other subtypes (17%)), who received alloSCT in 34 centers between 2006 and 2014. RESULTS:AlloSCT was given as part of front-line therapy (n = 138) to 93 patients in first complete response (CR) and 45 in first partial response (PR), and of salvage therapy (n = 147) to 116 patients for second or more CR/PR and 31 for progressive disease. Reduced-intensity conditioning (RIC) was given to 172 patients (62%), while 107 (38%) received myeloablative conditioning (MAC). The median follow-up was 72.4?months. The 2- and 4-year OS were 65% and 59%, respectively, and the cumulative incidence of relapse was 18% after 1?year and 19% after 2?years. TRM was 21% at 1?year, 24% after 2?years, and 28% after 4?years. In multivariate analysis, grade III-IV acute GvHD (HR = 2.57, 95% CI 1.53-4.31; p = 0.00036), low Karnofsky score < 80% (HR = 5.14, 95% CI 2.02-13.06; p = 0.00058), and progressive disease status before transplant (HR = 2.21, 95% CI 1.25-3.89; p = 0.0062) were significantly associated with a reduced OS. CONCLUSIONS:The data demonstrate in the largest retrospective cohort of non-cutaneous PTCL so far reported that alloSCT after RIC or MAC is an effective strategy, even in chemoresistant patients.

SUBMITTER: Mamez AC

PROVIDER: S-EPMC7236365 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Allogeneic stem cell transplantation for peripheral T cell lymphomas: a retrospective study in 285 patients from the Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC).

Mamez Anne-Claire AC Dupont Axelle A Blaise Didier D Chevallier Patrice P Forcade Edouard E Ceballos Patrice P Mohty Mohamad M Suarez Felipe F Beguin Yves Y Peffault De Latour Regis R Rubio Marie-Thérèse MT Tournilhac Olivier O Nguyen Stéphanie S

Journal of hematology & oncology 20200519 1

<h4>Background</h4>Peripheral T cell lymphomas form a heterogeneous group with a usually dismal prognostic. The place of allogeneic stem cell transplantation to treat PTCL is debated.<h4>Methods</h4>We retrospectively analyzed the overall survival (OS), event-free survival (EFS), relapse, and transplant-related mortality (TRM) and associated variables in 285 adults with non-primary cutaneous PTCL (PCTL-NOS (39%), angioimmunoblastic T cell lymphomas (29%), anaplastic T cell lymphomas (15%), and o ...[more]

PMID: 32429979

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Project description:BACKGROUND: How tandem autologous-allogeneic stem cell transplantation should be integrated in the treatment of multiple myeloma remains controversial. We examined the long-term outcome of patients with multiple myeloma managed with tandem autologous-allogeneic stem cell transplantation and present a prognostic factor analysis based on the experience of the Société Française de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC). DESIGN AND METHODS: This French, retrospective, registry-based study included 146 patients who had undergone tandem autologous-allogeneic transplantation for multiple myeloma at 20 SFGM-TC centers between 1998 and 2010. The patients included in the study had fully completed the two steps of a planned tandem autologous-allogeneic transplantation. No treatment had to be administered between the autologous and allogeneic parts of the tandem procedure. RESULTS: Seventy-seven patients (53%) underwent tandem autologous-allogeneic transplantation as part of upfront treatment, i.e. after a single line of treatment not including autologous transplantation. The median follow-up from the allogeneic transplant was 47.5 months (range, 1.2-132 months). At 4 years, the overall survival and event-free survival rates were 48% (95% CI 39-57 %) and 27% (95% CI 19-36), respectively. Eighteen patients (12%) experienced grade III-IV acute graft-versus-host disease and 43 patients (30%) had chronic graft-versus-host disease. The transplant-related mortality rate at 1 year was 15% (95% CI 10-22). Patients receiving tandem transplantation as upfront treatment had significantly improved event-free survival (36% versus 11%; P=0.005) and overall survival (56% versus 34%; P=0.02). Donor's age ? 50 years was associated with improved event-free survival (35% versus 16%; P=0.005) and overall survival (54% versus 41%; P=0.02). In the multivariable analysis, upfront tandem transplantation, donor's age ? 50 years and full chimerism were independent prognostic factors for better outcome. CONCLUSIONS: We confirmed the feasibility of tandem autologour-allogeneic transplantation in heavily treated patients with multiple myeloma. We identified younger donor's age and upfront tandem transplantation as two independent prognostic factors for survival which could be further explored in prospective studies.

Project description:BackgroundThere are currently few data on the outcome of acute myeloid leukemia (AML) in adolescents after allogeneic HSCT. The aim of this study is to describe the outcome and its specific risk factors for children, adolescents and young adults after a first allogeneic HSCT for AML.MethodsIn this retrospective study, we compared the outcome of AML patients receiving a first allogeneic HSCT between 2005 and 2017 according to their age at transplantation's time: children (< 15 years, n = 564), adolescent and post-adolescent (APA) patients (15-25 years, n = 647) and young adults (26-40 years; n = 1434).ResultsWith a median follow-up of 4.37 years (min-max 0.18-14.73 years), the probability of 2-year overall survival (OS) was 71.4% in children, 61.1% in APA patients and 62.9% in young adults (p = 0.0009 for intergroup difference). Both relapse and non-relapse mortality (NRM) Cumulative Incidence (CI) estimated at 2 years were different between the age groups (30.8% for children, 35.2% for APA patients and 29.4% for young adults-p = 0.0254, and 7.0% for children, 10.6% for APA patients and 14.2% for young adults, p < 0.0001; respectively). Whilst there was no difference between the three groups for grade I to IV acute GVHD CI at 3 months, the chronic GVHD CI at 2 years was higher in APA patients and young adults (31.4% and 36.4%, respectively) in comparison to the children (17.5%) (p < 0.0001). In multivariable analysis, factors associated with death were AML cytogenetics (HR1.73 [1.29-2.32] for intermediate risk 1, HR 1.50 [1.13-2.01] for intermediate risk 2, HR 2.22 [1.70-2.89] for high cytogenetics risk compared to low risk), use of TBI ≥ 8 Grays (HR 1.33 [1.09-1.61]), disease status at transplant (HR 1.40 [1.10-1.78] for second Complete Remission (CR), HR 2.26 [1.02-4.98] for third CR and HR 3.07 [2.44-3.85] for active disease, compared to first CR), graft source (HR 1.26 [1.05-1.50] for Peripheral Blood Stem Cells compared to Bone Marrow) and donor age (HR 1.01 (1-1.02] by increase of 1 year).ConclusionAge is an independent risk factor for NRM and extensive chronic GVHD. This study suggests that APA patients with AML could be beneficially treated with a chemotherapy-based MAC regimen and bone marrow as a stem cells source.

Project description:Introduction Des manifestations cutanées variées survenant lors d’infection par le SARS-CoV-2 ont été rapportées depuis mars 2020. Nous rapportons celles recueillies dans le cadre de l’étude COVID-Skin de la Société française de dermatologie (SFD). Matériel et méthodes Une enquête nationale a été lancée le 30 mars 2020 par la SFD, demandant aux médecins de signaler les cas de manifestations cutanées chez les cas suspects ou avérés de COVID-19, en utilisant un questionnaire standardisé. Nous rapportons les résultats pour les manifestations cutanées à l’exclusion des manifestations acrales décrites séparément. Les patients ont été classés COVID confirmée (RT-PCR et/ou sérologie positive), ou non confirmée (sérologie négative). Les patients n’ayant pas eu de test ou une PCR négative non confirmée par une sérologie négative n’ont pas été inclus dans l’analyse. Puis, les manifestations cutanées pour les cas avec photographies disponibles ont été classées par les auteurs sur la base de celle proposée par Galvan Casas et al (EMP, urticaire, éruptions vésiculeuses, nécrose/livedo). Résultats Nous avons recueilli 467 cas au 11 juin 2020 dont 311 cas de manifestations acrales étudiés spécifiquement. Parmi les 156 patients restants, 61 avait un diagnostic de COVID ni confirmé ni infirmé, 51 confirmé (45 RT-PCR positive et 7 avec une sérologie positive) et 44 non confirmés (sérologie négative). L’âge médian dans le groupe COVID confirmé était de 44,5 ans (IQR 30,3–63,5) vs 37,5 ans (IQR 28,5–47) chez les non confirmés, avec 61 % d’hommes (31/51) vs 67 % (29/43) respectivement. Dans le groupe COVID 49 % (25/51) des patients ont été hospitalisés, aucun dans l’autre groupe. La médiane de réalisation de la sérologie était de 28 jours (IQR 26,5–31) dans le groupe confirmé vs 22,5 jours (IQR 8,5–33,3). Une photographie était disponible chez 56 patients dont 38 dans le groupe COVID. Les principales manifestations cutanées et leur répartition entre les groupes sont résumées dans le tableau. Il n’a pas été mis en évidence de différence significative de la fréquence des différents types de manifestations entre les groupes (p = 0,127). Discussion Comparativement à l’étude de Galván Casas et al. portant sur 304 patients COVID confirmés ou probables en excluant les cas de manifestations acrales, nous trouvons une plus grande diversité de présentation clinique. Ils ont pu classer leurs patients en 4 types de manifestations : EMP 58 %, urticaire 21 %, éruptions vésiculeuses 11 % et nécrose livedo 7 %. Nous trouvons une proportion plus faible d’EMP, et d’éruptions vésiculeuse et une proportion comparable pour les 2 autres types (tableau 1). Nous avons observé divers autres types de manifestations cutanées chez 18 % dont certaines déjà rapportées. Compte tenu de l’hétérogénéité des manifestations et des diagnostics différentiels possibles, le lien formel entre l’infection et les éruptions cutanées restent à confirmer.

Project description:BACKGROUND:Beta-lactam antibiotics (βLA) are the most commonly used antibiotics in the intensive care unit (ICU). ICU patients present many pathophysiological features that cause pharmacokinetic (PK) and pharmacodynamic (PD) specificities, leading to the risk of underdosage. The French Society of Pharmacology and Therapeutics (SFPT) and the French Society of Anaesthesia and Intensive Care Medicine (SFAR) have joined forces to provide guidelines on the optimization of beta-lactam treatment in ICU patients. METHODS:A consensus committee of 18 experts from the two societies had the mission of producing these guidelines. The entire process was conducted independently of any industry funding. A list of questions formulated according to the PICO model (Population, Intervention, Comparison, and Outcomes) was drawn-up by the experts. Then, two bibliographic experts analysed the literature published since January 2000 using predefined keywords according to PRISMA recommendations. The quality of the data identified from the literature was assessed using the GRADE® methodology. Due to the lack of powerful studies having used mortality as main judgement criteria, it was decided, before drafting the recommendations, to formulate only "optional" recommendations. RESULTS:After two rounds of rating and one amendment, a strong agreement was reached by the SFPT-SFAR guideline panel for 21 optional recommendations and a recapitulative algorithm for care covering four areas: (i) pharmacokinetic variability, (ii) PK-PD relationship, (iii) administration modalities, and (iv) therapeutic drug monitoring (TDM). The most important recommendations regarding βLA administration in ICU patients concerned (i) the consideration of the many sources of PK variability in this population; (ii) the definition of free plasma concentration between four and eight times the Minimal Inhibitory Concentration (MIC) of the causative bacteria for 100% of the dosing interval as PK-PD target to maximize bacteriological and clinical responses; (iii) the use of continuous or prolonged administration of βLA in the most severe patients, in case of high MIC bacteria and in case of lower respiratory tract infection to improve clinical cure; and (iv) the use of TDM to improve PK-PD target achievement. CONCLUSIONS:The experts strongly suggest the use of personalized dosing, continuous or prolonged infusion and therapeutic drug monitoring when administering βLA in critically ill patients.

Dataset Information

Allogeneic stem cell transplantation for peripheral T cell lymphomas: a retrospective study in 285 patients from the Societe Francophone de Greffe de Moelle et de Therapie Cellulaire (SFGM-TC).

Publications

Allogeneic stem cell transplantation for peripheral T cell lymphomas: a retrospective study in 285 patients from the Société Francophone de Greffe de Moelle et de Thérapie Cellulaire (SFGM-TC).

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