Analyse des résultats du LTP95 du GOELAMS comparant le VIP ABVD au CHOP dans le traitement des lymphomes T périphériques en première ligne

Les lymphomes T périphériques sont des pathologies rares, hétérogènes et de mauvais pronostic. Le traitement de référence actuel est le CHOP avec des survies globales (SG) à 40% à 5 ans. Une étude rétrospective grenobloise (58 patients) entre 1989 et 1996 a évalué l'intérêt de l'association VIP-ABVD dans le traitement de ces lymphomes. Son analyse retrouve une réponse globale à 100% (RC à 89%), une SG à 70% et une survie sans évènement à 65% à 5 ans. Ces bons résultats ont motivé la réalisation d'une étude multicentrique (GOELAMS) prospective comparant le VIP-ABVD au CHOP. Ici, la réponse et la survie sont identiques aux données de la littérature avec une toxicité accrue pour le bras VIP-ABVD sans gain d'efficacité. Les raisons soulevées pour expliquer cette discordance sont une différence de présentation clinique dans les deux études (patients de meilleur pronostic pour l'étude grenobloise) et une certaine méconnaissance des facteurs pronostics dans les lymphomes T périphériques.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

High-Dose Chemotherapy for Adult-Type Ovarian Granulosa Cell Tumors A Retrospective Study of the European Society for Blood and Marrow Transplantation

OBJECTIVES: A few small retrospective series reported results with salvage chemotherapy for malignant ovarian adult-type granulosa cell tumors (GCTs), whereas no data are available on high-dose chemotherapy (HDC) with hematopoietic progenitor cell support (HSCS) in these patients. The aim of this study was to analyze the available data of HDC for adult-type GCTs. METHODS: We conducted a retrospective analysis of ovarian cancer treated with salvage HDC registered with the European Society for Blood and Marrow Transplantation. RESULTS: Of 203 adult female patients with a diagnosis of nonepithelial ovarian cancer treated with salvage HDC with HSCS and registered with the European Society for Blood and Marrow Transplantation, 4 (2%) patients were affected by GCTs. All 4 patients had ovarian adult-type GCTs that relapsed/progressed after first-line chemotherapy. The conditioning regimens included a platinum agent in all 4 patients. Bone marrow recovery was promptly achieved; neither treatment-related deaths or life-threatening toxicities occurred. At a median follow-up of 8.5 months, all patients reported a progressive disease. The patient who underwent multicycle HDC enjoyed a long-term remission of 84 months before progression and is the only one alive after 94+ months. CONCLUSIONS: We showed for the first time a case with long-lasting response to salvage multicycle HDC and HSCS in adult-type GCTs.status: publishe

Rituximab in combination with adapted-dose of ifosfamide and etoposide as salvage treatment in elderly refractory/relapsed diffuse large B-cell lymphoma patients non-candidate for high dose therapy: a retrospective study

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BeEAM (bendamustine, etoposide, cytarabine, melphalan) prior to autologous stem cell transplant for chemosensitive relapses in patients with follicular lymphoma: a prospective multicentre phase II study in Lymphoma Study Association centres

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Impact of post-brentuximab vedotin consolidation on relapsed/refractory CD30+ Hodgkin lymphomas: a large retrospective study on 240 patients enrolled in the French Named-Patient Program

International audienceBrentuximab vedotin was reported to be effective and safe against refractory/relapsed Hodgkin lymphoma in cohorts of 12 to 102 patients. Herein we report our retrospective analysis of the French experience with brentuximab vedotin used alone to treat 240 refractory/relapsed Hodgkin lymphoma patients enrolled in a named patient program between 2011 and 2013. All patients had histologically documented CD30+ Hodgkin lymphoma; 74% had refractory disease or early relapses. After a median of 3 chemotherapy lines, brentuximab vedotin was infused intravenously (1.8 mg/kg every 3 weeks). The primary endpoint was best response. Response at the end of treatment, its duration, survival data and toxicity profile were secondary endpoints. Patients received a median of 6 cycles; 68 underwent a consolidation thereafter. The best response was observed after a median of 4 cycles in 145 (60.4%) patients: 33.8% complete response/unconfirmed complete response, 26.7% partial response. Objective responses were observed decreased (39.3%) in the 28 patients \textgreater60 years. Median response duration was 8.4 months. With median follow-up at 16.1 months, median progression free-survival was 6.8 months and significantly longer for patients transplanted after brentuximab vedotin (median at 18,8 months); median overall survival was not reached. No death has been linked to brentuximab vedotin toxicity. The most common adverse events were peripheral sensory neuropathy (29.3%) and hematological toxicity. The results of this analysis support the previously reported brentuximab vedotin efficacy with manageable toxicity. Because short-term responses in most patients, high-dose therapy with stem-cell transplantation for responders should be considered rapidl

Role of up-front autologous stem cell transplantation in peripheral T-cell lymphoma for patients in response after induction: An analysis of patients from LYSA centers.

Background: Peripheral T-cell lymphoma (PTCL) remains a therapeutic challenge. Due to the rarity and the heterogeneity of PTCL, no consensus has been achieved regarding even the type of first-line treatment. The benefit of autologous stem-cell transplantation (ASCT) is, therefore, still intensely debated. Patients and methods: In the absence of randomized trials addressing the role of ASCT, we performed a large multicentric retrospective study and used both a multivariate proportional hazard model and a propensity score matching approach to correct for sample selection bias between patients allocated or not to ASCT in intention-to-treat (ITT). Results: Among 527 patients screened from 14 centers in France, Belgium and Portugal, a final cohort of 269 patients 65 years old with PTCL-not otherwise specified (NOS) (N¼78, 29%), angioimmunoblastic T-cell lymphoma (AITL) (N¼123, 46%) and anaplastic lymphoma kinase-positive anaplastic large cell lymphoma (ALK-ALCL) (N¼68, 25%) with partial (N¼52, 19%) or complete responses (N¼217, 81%) after induction was identified and information about treatment allocation was carefully collected before therapy initiation from medical records. One hundred and thirty-four patients were allocated to ASCT in ITT and 135 were not. Neither the Cox multivariate model (HR¼1.02; 95% CI: 0.69–1.50 for PFS and HR¼1.08; 95% CI: 0.68– 1.69 for OS) nor the propensity score analysis after stringent matching for potential confounding factors (logrank P¼0.90 and 0.66 for PFS and OS, respectively) found a survival advantage in favor of ASCT as a consolidation procedure for patients in response after induction. Subgroup analyses did not reveal any further difference for patients according to response status, stage disease or risk category. Conclusions: The present data do not support the use of ASCT for up-front consolidation for all patients with PTCL-NOS, AITL, or ALK-ALCL with partial or complete response after induction

BAM conditioning before autologous transplantation for lymphoma: a study on behalf of the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)

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Management of car-t cell-related encephalopathy syndrome in adult and pediatric patients: recommendations of the french society of bone marrow transplantation and cellular therapy (sfgm-tc)

International audienceCAR-T cell-related encephalopathy syndrome (CRES) reflects the potential neurotoxicity of this therapeutic approach and must be considered in the presence of any neurological symptom after the infusion of the CAR-T. This is the second most common adverse event under this therapy and its incidence varies between 12 and 55%. The median time of the onset of the first neurologic symptoms is 4days after CAR-T infusion. The duration of CRES symptoms is generally between 2 and 4days, but late CRES may occur. Monitoring and diagnosis of CERS includes clinical exam, magnetic resonance imaging and electroencephalography. In addition to symptomatic treatments, corticosteroids represent the cornerstone of the high-grade CERS treatment. Drugs targeting IL-6 should be restricted to severe forms, especially those associated with cytokine release syndrome. The purpose of this workshop is to provide practical help in dealing with this complication.L’encéphalopathie liée à l’utilisation des lymphocytes dotés de récepteur à l’antigène chimérique (CAR-T) (CAR-T cell-related encephalopathy syndrome, CRES) traduit la neurotoxicité potentielle de cette approche thérapeutique et doit être envisagée devant la survenue de tout symptôme neurologique après l’infusion des cellules CAR-T. Il s’agit du second effet indésirable le plus fréquent sous cette thérapie et son incidence varie entre 12 et 55 % selon les études. Le délai médian de survenue des premiers symptômes neurologiques est de quatre jours suivant l’infusion de cellules CAR-T. La durée des symptômes du CRES est comprise généralement entre deux et quatre jours mais des CRES tardifs peuvent survenir. La surveillance fait appel notamment au suivi clinique, à l’imagerie par résonance magnétique et à l’électroencéphalographie. La prise en charge, en dehors des mesures symptomatiques, consiste, en premier lieu, en une corticothérapie, les thérapies ciblant IL-6 étant plutôt réservées aux formes sévères. Le but de cet atelier est d’apporter une aide pratique à la prise en charge de cette complication

Clinical characteristics and outcomes of relapsed follicular lymphoma after autologous stem cell transplantation in the rituximab era

International audienceHigh-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a therapeutic option for patients with relapsed follicular lymphoma (FL). The clinical characteristics and outcomes of FL relapse after ASCT in the rituximab era have not yet been fully elucidated. We retrospectively reviewed 414 FL patients treated with ASCT between 2000 and 2014 in four hematology departments. All patients received rituximab as a first-line treatment. We specifically analyzed the clinical characteristics, treatment strategies at relapse, and outcomes of 95 patients (23%) who relapsed after ASCT. The patients (median age, 57 y) received a median of two lines of therapy (range, 2-6) prior to ASCT, with 92% in complete response (CR) or partial response (PR) before ASCT. Histological transformation at relapse after ASCT was observed in 20% of the patients. Treatment at relapse after ASCT consisted of chemotherapy with or without rituximab (n = 45/90, 50%), targeted agents (18%), rituximab monotherapy (14%), or consolidation allogeneic transplantation after induction chemotherapy (12%) and radiotherapy (6%). After relapse, the median progression-free survival (PFS) and overall survival (OS) were 1 year (95% CI, 0.541-1.579) and 5.5 years (95% CI, 1.910-9.099), respectively. In the multivariate analysis, histological transformation (HT) was associated with OS (P = .044; HR 2.439; 95% CI, 1.025-5.806), and a high FLIPI score at relapse was associated with PFS (P = .028; HR 2.469; 95% CI, 1.104-5.521). This retrospective study showed that the period of PFS of patients who relapsed after ASCT is short. A biopsy should be performed for these patients to document the HT. Our results indicate that new treatment strategies will need to be developed for these patients