Aurore Perrot

Bio: Aurore Perrot is an academic researcher from French Institute of Health and Medical Research. The author has contributed to research in topics: Multiple myeloma & Minimal residual disease. The author has an hindex of 2, co-authored 5 publications receiving 21 citations.

Serum albumin or body mass index: Which prognostic factor for survival in patients with acute myeloblastic leukaemia?

Abstract: Obesity has been associated with an increased risk of developing acute myeloblastic leukaemia (AML). The outcome of AML patients could thus be dependent on their nutritional status that can be evaluated by the simple measurement of serum albumin (SA) and body mass index (BMI). These two parameters could have a value as prognostic factors to guide patients' management. We evaluated the association between SA levels, BMI, and survival, evaluated as overall survival (OS) and event-free survival. Furthermore, we investigated the association between BMI, SA, and other prognostic factors of interest in AML. This retrospective single-center study included 159 patients diagnosed with AML at Nancy Hospital between 2005 and 2013, treated with aracytine and anthracycline. Forty-four percent of patients presented with normal weight while 56% were obese/overweight. Serum albumin levels were <30 g/L for 49 patients, and ≥30 g/L for 110. Thirty-four patients with low SA levels were also obese. Favourable OS was associated with SA levels ≥30 g/L (HR = 0.467; 95% CI 0.230-0.946; P = .034) but was not impacted by the BMI. Serum albumin levels appear to be an independent prognostic factor in AML and a better parameter than BMI for evaluating the nutritional status of patients at diagnosis.

Multiple Myeloma: Heterogeneous in Every Way

Abstract: Multiple myeloma (MM) is a hematological malignancy characterized by the accumulation of tumor plasma cells (PCs) in the bone marrow (BM). Despite considerable advances in terms of treatment, patients' prognosis is still very heterogeneous. Cytogenetics and minimal residual disease both have a major impact on prognosis. However, they do not explain all the heterogeneity seen in the outcomes. Their limitations are the result of the emergence of minor subclones missed at diagnosis, detected by sensible methods such as single-cell analysis, but also the non-exploration in the routine practice of the spatial heterogeneity between different clones according to the focal lesions. Moreover, biochemical parameters and cytogenetics do not reflect the whole complexity of MM. Gene expression is influenced by a tight collaboration between cytogenetic events and epigenetic regulation. The microenvironment also has an important impact on the development and the progression of the disease. Some of these determinants have been described as independent prognostic factors and could be used to more accurately predict patient prognosis and response to treatment.

Risk and Response-Adapted Treatment in Multiple Myeloma

Abstract: Myeloma therapeutic strategies have been adapted to patients' age and comorbidities for a long time. However, although cytogenetics and clinical presentations (plasmablastic cytology; extramedullary disease) are major prognostic factors, until recently, all patients received the same treatment whatever their initial risk. No strong evidence allows us to use a personalized treatment according to one cytogenetic abnormality in newly diagnosed myeloma. Retrospective studies showed a benefit of a double autologous transplant in high-risk cytogenetics according to the International Myeloma Working Group definition (t(4;14), t(14;16) or del(17p)). Moreover, this definition has to be updated since other independent abnormalities, namely gain 1q, del(1p32), and trisomies 5 or 21, as well as TP53 mutations, are also prognostic. Another very strong predictive tool is the response to treatment assessed by the evaluation of minimal residual disease (MRD). We are convinced that the time has come to use it to adapt the strategy to a dynamic risk. Many trials are ongoing to answer many questions: when and how should we adapt the therapy, its intensity and duration. Nevertheless, we also have to take into account the clinical outcome for one patient, especially adverse events affecting his or her quality of life and his or her preferences for continuous/fixed duration treatment.

Dyscrasies plasmocytaires : formes rares et atypiques

Abstract: Resume Les dyscrasies plasmocytaires, autres que le myelome multiple, ont des presentations cliniques extremement variees. Il peut s’agir de maladies indolentes liees a de petits clones de plasmocytes a faible potentiel proliferatif mais qui synthetisent une immunoglobuline monoclonale potentiellement dangereuse pour certains organes : amylose AL, maladies de depots d’immunoglobulines monoclonales ou gammapathies dites de signification clinique. Il peut egalement s’agir de pathologies hautement agressives dans lesquelles les cellules tumorales proliferent et s’expandent hors de la moelle osseuse, constituant des formes extra-medullaires de myelome ou de veritables leucemies a plasmocytes dont le pronostic reste effroyable, meme a l’ere des nouveaux agents therapeutiques. Le spectre de prise en charge de ces formes rares et atypiques est tres large mais repose tres souvent sur l’elimination du clone plasmocytaire, utilisant par consequent la chimiotherapie classique (alkylants) mais aussi les nouveaux traitements du myelome, notamment les inhibiteurs du proteasome, les immunomodulateurs et plus recemment les anticorps monoclonaux.

The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) Score in Patients with Small Cell Lung Cancer Before First-Line Treatment with Etoposide and Progression-Free Survival.

Abstract: BACKGROUND The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a prognostic factor in patients who have some types of malignant tumors. The aim of this study was to investigate the prognostic significance of the HALP score in patients with small cell lung cancer (SCLC) before first-line treatment with etoposide. MATERIAL AND METHODS A retrospective study included 178 patients with SCLC who received first-line chemotherapy with etoposide between September 2015 and May 2019. The baseline clinical characteristics and blood parameters were recorded. Univariate and multivariate analysis and Kaplan-Meier plots were used to identify the factors associated with progression-free survival (PFS). RESULTS The optimal cut-off values of the HALP score was determined by X-tile software to be 25.8. Univariate and multivariate analysis showed that in 178 patients, the HALP score, body mass index (BMI), and serum albumin levels had no prognostic significance. In the patient age group 25.8 was an independent positive prognostic factor for outcome following first-line treatment with etoposide (HR, 0.483; 95% CI, 0.270-0.865) (P=0.014). CONCLUSIONS In patients 25.8 was an independent predictor of improved outcome, associated with increased PFS.

Anti‐CD19 and anti‐BCMA CAR T cell therapy followed by lenalidomide maintenance after autologous stem‐cell transplantation for high‐risk newly diagnosed multiple myeloma

Abstract: Few prospective studies have examined posttransplant chimeric antigen receptor (CAR) T cell infusion as candidates for front‐line consolidation therapy for high‐risk multiple myeloma (MM) patients. This single‐arm exploratory clinical trial is the first to evaluate the safety and efficacy of sequential anti‐CD19 and anti‐BCMA CAR‐T cell infusion, followed by lenalidomide maintenance after autologous stem cell transplantation (ASCT), in 10 high‐risk newly diagnosed multiple myeloma (NDMM) patients. The treatment was generally well tolerated, with hematologic toxicities being the most common grade 3 or higher adverse events. All patients had cytokine release syndrome (CRS), which was grade 1 in 5 patients (50%) and grade 2 in 5 patients (50%). No neurotoxicity was observed after CAR‐T cell infusion. The overall response rate was 100%, with the best response being 90% for a stringent complete response (sCR), and 10% for a complete response (CR). At a median follow‐up of 42 (36–49) months, seven (70%) of 10 patients showed sustained minimal residual disease (MRD) negativity for more than 2 years. The median progression‐free survival (PFS) and overall survival (OS) were not reached. Although the sample size was small and there was a lack of control in this single‐arm study, the clinical benefits observed warrant ongoing randomized controlled trials.

Current approaches to management of high-risk multiple myeloma

Abstract: The median overall survival in multiple myeloma is rapidly approaching 10 years; however, in nearly a fifth of patients the prognosis remains poor. Therefore, the modern-day management of myeloma patients should be individualized, with more intense and continuous approach in these high-risk patients. This includes first-line treatment based on multi-drug combinations employing the most effective drugs combinations, upfront autologous stem cell transplantation (in eligible patients with tandem transplantation being a consideration), and maintenance based on proteasome inhibitor-based combinations. This paper reviews the results of recent retrospective analyses and clinical trials, but also gives a glance into future by presenting the ongoing trials. This article is protected by copyright. All rights reserved.

Perspectives on the Risk-Stratified Treatment of Multiple Myeloma

Abstract: Summary: The multiple myeloma treatment landscape has changed dramatically. This change, paralleled by an increase in scientific knowledge, has resulted in significant improvement in survival. However, heterogeneity remains in clinical outcomes, with a proportion of patients not benefiting from current approaches and continuing to have a poor prognosis. A significant proportion of the variability in outcome can be predicted on the basis of clinical and biochemical parameters and tumor-acquired genetic variants, allowing for risk stratification and a more personalized approach to therapy. This article discusses the principles that can enable the rational and effective development of therapeutic approaches for high-risk multiple myeloma.