Publications by authors named "Alexandre T J Maria"
Time to use the right classification to predict the severity of checkpoint inhibitor-induced liver injury, as assessed for causality using the updated RUCAM.
Aliment Pharmacol Ther
December 2024
Article Synopsis
- - This study investigates the severity and characteristics of checkpoint inhibitor-induced hepatitis, a significant side effect of cancer immunotherapy, focusing on patients with severe liver injury (grade 3 and 4) based on the Common Terminology Criteria for Adverse Events (CTCAE).
- - A retrospective analysis of 100 patients revealed varying severity classifications and outcomes, indicating that the CTCAE may not effectively assess liver injury severity compared to hepatology-focused classification systems.
- - The findings suggest that using traditional hepatology scores could provide better insights and avoid issues like unnecessary steroid treatments and hindered re-administration of immune checkpoint inhibitors.
[Prerequisite and organisation of health-care pathways for Cell and Gene therapies, using Mesenchymal Stromal Cells (MSC) or Chimeric Antigen Receptor (CAR) T cells, in patients with autoimmune systemic diseases].
Bull Cancer
September 2024
Article Synopsis
- First-line treatments for autoimmune systemic diseases (ARD) typically involve immunosuppressive drugs, but long-term use can lead to significant health risks.
- Innovative therapies like mesenchymal stromal cells (MSCs) and Chimeric Antigen Receptor (CAR) T cell therapies are emerging as promising alternatives for severe or refractory cases of ARD.
- A workshop by the French Speaking Society of Bone Marrow and Cell Transplantation focuses on establishing healthcare pathways and safety protocols for the deployment of MSCs and CAR-T therapies in ARD treatment, emphasizing patient safety and collaboration among specialists.
Background: Recent studies indicate an association between immunosuppression for immune-related adverse events (irAEs) and impaired survival in patients who received immune checkpoint inhibitors. Whether this is related to corticosteroids or second-line immunosuppressants is unknown. In the largest cohort thus far, we assessed the association of immunosuppressant type and dose with survival in melanoma patients with irAEs.
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- * A case study of a 49-year-old patient revealed a significant 2.6-kb deletion in the NFKB1 gene, contributing to severe immune issues like respiratory infections and lymphoma, with similar findings in his brother who had milder symptoms.
- * The case highlights the importance of extensive genetic analyses, including copy number variation (CNV), to better understand and diagnose complex genetic conditions in medical genetics. *
Article Synopsis
- - The study focused on examining the relationship between primary Sjögren's syndrome (pSS) and cancer, specifically analyzing the clinical, pathological, and immunological aspects of pSS patients who also had cancer, compared to those without cancer.
- - Out of 165 pSS patients, 55 had cancers, primarily solid neoplasms, with breast and lung cancers being the most common; significantly, many cancers were diagnosed close to or shortly after the pSS diagnosis.
- - Findings suggest that there may be a connection between breast cancers and pSS, implying that the immune system's behavior in pSS patients could play a role in cancer development or control.
Article Synopsis
- - The study evaluated malnutrition prevalence in systemic sclerosis (SSc) patients at a referral center from 1985 to 2019, finding that 59.2% were malnourished and 25% had severe malnutrition.
- - Malnutrition correlated with disease features, specifically cardiac involvement and limited mouth opening (interincisal distance <35 mm), indicating potential warning signs.
- - The findings suggest that addressing malnutrition could be crucial for improving health outcomes in SSc patients, given its high prevalence and associations with serious disease symptoms.
Background: Immune checkpoint inhibitors (ICI) have transformed cancer treatment over the last decade. Alongside this therapeutic improvement, a new variety of side effects has emerged, called immune-related adverse events (irAEs), potentially affecting any organ. Among these irAEs, myocarditis is rare but life-threatening.
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- Immune checkpoint inhibitors (ICIs) can cause liver toxicity in up to 25% of patients, and this study aimed to explore patterns of ICI-induced hepatitis and their outcomes.
- The study included 117 patients, finding that 38.5% had hepatocellular, 36.8% had cholestatic, and 24.8% had mixed liver injury, with severe cases linked to hepatocellular patterns.
- Treatment varied based on the clinical pattern, with steroids used for hepatocellular cases and ursodeoxycholic acid for cholestatic ones, and about 43.6% of patients challenged again with ICIs experienced recurrence of liver injury.
Article Synopsis
- The study aimed to evaluate the safety and effectiveness of long-term home parenteral nutrition (HPN) in patients with systemic sclerosis and intestinal failure (IF), compared to control patients with IF from other causes.
- Conducted in Montpellier, France, the research tracked patients from 1985 to 2020 who were on HPN for at least 4 weeks, focusing on complications and outcomes related to the treatment.
- Results showed that while both groups experienced body mass index increases and no significant difference in infection rates, patients with systemic sclerosis had a higher incidence of HPN-related cardiac overload, highlighting the need for careful cardiac monitoring in these patients.
Article Synopsis
- - Acquired hemophagocytic lymphohistiocytosis (HLH) is a serious condition caused by an overactive immune response, often linked to infections, cancers, autoimmune diseases, and recently, immune checkpoint inhibitors (ICIs) used in cancer treatment.
- - A study analyzed 190 HLH cases related to ICI therapy, finding that most patients were older men, with HLH typically appearing about 102 days post-treatment initiation, particularly with medications like nivolumab and pembrolizumab.
- - Results showed HLH occurrences were significantly higher with ICIs compared to other drugs, leading to serious conditions in patients, with a 15.3% mortality rate, highlighting the need for clinicians to be vigilant for
[Vaccination before and after autologous hematopoietic cell transplantation for autoimmune diseases: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (MATHEC-SFGM-TC)].
Bull Cancer
February 2023
The Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC) organized the 12th workshop on hematopoietic stem cell transplantation clinical practices harmonization procedures on September 2021 in Lille, France. In the absence of specific national or international recommendation, the French working group for autologous stem Cell transplantation in Auto-immune Diseases (MATHEC) proposed guidances for vaccinations of patients undergoing autologous hematopoietic stem cell transplantation for autoimmune disease, including in the context of SARS-Cov-2 pandemic.
View Article and Find Full Text PDFCases of adult-onset Still's disease (AOSD) have been reported after COVID-19 vaccination. Here we provide a comprehensive description and analysis of all cases of AOSD reported in the literature and in pharmacovigilance databases through April 2022. Disproportionality analyses of pharmacovigilance data were performed in order to further explore the association between vaccination and AOSD.
View Article and Find Full Text PDFBackground And Purpose: In addition to combined central and peripheral demyelination, other immune diseases could involve both the central nervous system (CNS) and peripheral nervous system (PNS).
Methods: To identify immune-mediated diseases responsible for symptomatic combined central/peripheral nervous system involvement (ICCPs), we conducted a multicentric retrospective study and assessed clinical, electrophysiological, and radiological features of patients fulfilling our ICCP criteria.
Results: Thirty patients (20 males) were included and followed during a median of 79.
Ocular immunotherapy-related adverse events (IRAEs), although rare, can be sight-threatening. Our objective was to analyze ocular IRAEs diagnosed in France from the marketing of immune checkpoint inhibitors (ICPIs) until June 2021 and to review the literature. We collected the cases of 28 patients (36 ocular IRAEs), occurring after an average of 17 weeks (±19).
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- Systemic inflammatory and autoimmune diseases (SIADs) affect 10-20% of patients with myelodysplastic syndrome (MDS), with VEXAS syndrome being a newly identified condition linked to specific genetic mutations.
- This study aimed to analyze myeloid immune cell types (dendritic cells and monocytes) in MDS patients with and without SIADs, revealing significant reductions in these cells in those with SIADs, particularly in those with VEXAS syndrome.
- The findings suggest potential causes for the decreased immune cell counts, including movement to areas of inflammation, increased cell death, or issues with cell formation in the bone marrow.
Article Synopsis
- Aseptic abscess (AA) syndrome is an uncommon inflammatory disorder often linked to inflammatory bowel disease (IBD), analyzed in a study involving 71 patients from 1999 to 2020.
- The majority of abscesses were found in the spleen and lymph nodes, with many patients also presenting with other illnesses, primarily IBD, and treated with medications like corticosteroids and immunosuppressants.
- More than half of the patients experienced relapses, particularly in the same organ, but colchicine was noted to decrease the risk of relapse, while no deaths were attributed to the syndrome.
Objectives: To describe the effectiveness and safety of biologics for the treatment of relapsing and/or refractory polyarteritis nodosa (PAN).
Methods: A retrospective European collaborative study was conducted in patients with PAN who received biologics for relapsing and/or refractory disease.
Results: Forty-two patients with PAN received a total of 53 biologic courses, including TNF-α blockers in 15 cases, rituximab (RTX) in 18 cases, tocilizumab (TCZ) in 10 cases and other biologics in 10 cases.
Pulmonary hypertension reported with immune checkpoint inhibitors: a pharmacovigilance study.
Cancer Immunol Immunother
December 2022
Immune checkpoint inhibitors (ICI) restore immune response against cancer cells that can lead to immune-related adverse effects. While cardiovascular immune-related adverse effects are known to be associated with checkpoint inhibitors, recent case reports have raised concerns about the potential association with pulmonary hypertension (PH). By using the global pharmacovigilance database VigiBase, we investigated the onset of PH associated with ICI and propose a comprehensive description of the 42 cases of PH reported with ICI recorded in this database.
View Article and Find Full Text PDFSafety and preliminary efficacy of allogeneic bone marrow-derived multipotent mesenchymal stromal cells for systemic sclerosis: a single-centre, open-label, dose-escalation, proof-of-concept, phase 1/2 study.
Lancet Rheumatol
February 2022
Article Synopsis
- Systemic sclerosis is a severe autoimmune disease, and mesenchymal stromal cells (MSCs) show potential for treatment due to their immunomodulatory and antifibrotic properties, although their safety in patients has not been confirmed.
- A phase 1/2 study at Saint-Louis Hospital in Paris aimed to determine the safety and feasibility of injecting allogeneic MSCs from family donors into patients with severe diffuse systemic sclerosis.
- The study involved 20 eligible patients, assessing immediate infusion tolerance and monitoring serious adverse events over a 24-month follow-up period.
Background: Systemic sclerosis (SSc) is a severe autoimmune disease for which mesenchymal stromal cells (MSCs)-based therapy was reported to reduce SSc-related symptoms in pre-clinical studies. Recently, extracellular vesicles released by MSCs (MSC-EVs) were shown to mediate most of their therapeutic effect. Here, we aimed at improving their efficacy by increasing the MSC-EV dose or by IFNγ-priming of MSCs.
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