Publications by authors named "Flore Sicre De Fontbrune"

Fanconi Anemia (FA) is an inherited disorder associated with profound DNA repair defects, marked by failure to thrive, congenital malformations, progressive bone marrow failure (BMF), and an increased susceptibility to cancer. Clinical manifestations of FA vary widely, with BMF and clonal evolution predominantly affecting younger individuals, while adults are more frequently presenting with solid tumors. Individuals with FA are at a 500-fold increased risk of developing head and neck squamous cell carcinoma (HNSCC), which tends to appear at a median age of 30 years, often at advanced stages with only a 57 % two-year survival rate.

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Complement C5 inhibitor treatment with ravulizumab or eculizumab for paroxysmal nocturnal hemoglobinuria (PNH) improves outcomes and survival. Some patients remain anemic due to clinically significant extravascular hemolysis (cs-EVH; hemoglobin [Hb] ≤9.5 g/dL and absolute reticulocyte count [ARC] ≥120 × 109/L).

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Article Synopsis
  • The study examines the blood-related characteristics and overall prognosis of 127 patients with telomere biology disorders (TBD) who were diagnosed after age 15, highlighting a lack of data on this topic.
  • At diagnosis, significant haematological issues were present in nearly 76% of patients, with bone marrow failure (BMF) being the most common, affecting 46.5% of the cases, while some patients also developed additional complications over time.
  • The findings suggest that BMF patients tend to be younger and have a better survival rate compared to those with higher-risk blood cancers, indicating TBD as a complex multi-organ disease needing further research on its evolutionary nature and outcomes.
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  • Donor cell engraftment is necessary for successful stem cell transplantation, but the cellular interactions in bone marrow during this process have not been well understood.
  • Researchers used mass cytometry and CITEseq to analyze bone marrow cells three months after transplantation in patients with leukemia, finding significant changes in myeloid and B-cell progenitors, indicating a shift towards inflammation-driven hematopoiesis.
  • The study concluded that bone marrow engraftment is marked by emergency hematopoiesis and an inflammatory response, particularly in patients who experienced graft-versus-host disease (GVHD).
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  • The study examines outcomes of 67 patients (average age 20.6 years) who underwent their first allogeneic hematopoietic stem cell transplant (HSCT) due to GATA2 deficiency across 21 centers in June 2022, showing varied indications for the transplant.
  • The findings reveal significant rates of acute graft versus host disease (GvHD) and chronic GvHD; the incidence of relapses was low, with overall survival rates at 1 and 5 years being 83% and 72%, respectively.
  • The analysis highlights that monitoring bone marrow for clonal evolution is crucial to initiate HSCT before the development of excessive blasts, noting that factors like earlier years of HSCT and certain
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  • HSCT is the only curative treatment for patients with short telomere syndromes and severe bone marrow failure or myeloid malignancies, but the effectiveness is influenced by their sensitivity to the conditioning regimen.
  • In a study involving adults and adolescents treated with an alemtuzumab-based regimen, outcomes showed a low 2-year graft rejection-free survival (GRFS) rate for those with myeloid malignancies (20%) compared to other patients (57%).
  • While the overall 2-year overall survival (OS) was quite favorable at 66%, the findings suggest that alternative treatment strategies may be necessary for patients with myeloid malignancies.
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  • The genomics era has led to the identification of the ERG gene as a new autosomal dominant predisposition factor for bone marrow failure (BMF) and hematological malignancies (HM), crucial for blood cell development and function.
  • Research found several rare ERG variants associated with thrombocytopenia and various forms of HM, showing onset typically before age 40.
  • Functional studies indicated that many ERG variants disrupt its role as a transcription factor, leading to ineffective blood cell production, with implications for clinical diagnosis and treatment strategies for affected patients and families.
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  • In France, the transfusion policy for patients undergoing allogeneic hematopoietic stem cell transplantation (alloHSCT) involves giving red blood cells (RBC) matching the donor's Rh type, which poses a risk of allo-immunization to both donors and recipients.* -
  • A study spanning 8 years revealed a 7.1% incidence of Rh incompatibility in 1012 alloHSCT cases, with 10.3% of evaluable patients developing alloantibodies, but none targeted the mismatched Rh antigens.* -
  • Although no immune-mediated hemolytic anemia occurred as a result of allo-immunization, a significant association was found between anti-RBC allo-immunization and
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Systemic sclerosis (SSc) is a rare autoimmune disease (AD), characterised by early diffuse vasculopathy, activation of the immune response and progressive skin and internal organ fibrosis. In severe progressive diffuse SSc (dSSc), autologous hematopoietic stem cell transplantation (aHSCT) improves survival, despite its own risk of complications and transplant related mortality (TRM). We present herein the case of a dSSc patient undergoing aHSCT with low dose cyclophosphamide conditioning and sudden acute myopericarditis and cardiogenic shock, four weeks after a second mRNA SARS-CoV-2 vaccine (Pfizer) injection.

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  • Iptacopan, an oral factor B inhibitor, shows promise in treating paroxysmal nocturnal hemoglobinuria patients suffering from persistent hemolytic anemia, especially those not responding to anti-C5 therapy.
  • In two phase 3 trials, iptacopan significantly improved hemoglobin levels in patients with low baseline hemoglobin (under 10 g/dL), with many experiencing increases of at least 2 g/dL without needing blood transfusions.
  • The results revealed that 85% of patients in the first trial and nearly all in the second trial experienced a notable increase in hemoglobin levels, leading to reduced fatigue and dependency on transfusions.
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Article Synopsis
  • - A case study is presented about a patient who received an allogeneic stem cell transplant and contracted a SARS-CoV-2 infection in a hospital setting.
  • - The patient was treated with the neutralizing monoclonal antibody bamlanivimab just two days after the COVID-19 diagnosis.
  • - Despite the treatment, the patient developed severe pneumonia and ultimately died, with the emergence of resistance mutations to the antibody.
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Erythropoietic protoporphyria (EPP) is a rare metabolic disease of the heme biosynthetic pathway where an enzymatic dysfunction results in protoporphyrin IX (PPIX) accumulation in erythroid cells. The porphyrins are photo-reactive and are responsible for severe photosensitivity in patients, thus drastically decreasing their quality of life. The liver eliminates PPIX and as such, the main and rare complication of EPP is progressive cholestatic liver disease, which can lead to liver failure.

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  • The study evaluates the safety and effectiveness of danicopan, an oral complement factor D inhibitor, as an add-on treatment for patients with paroxysmal nocturnal haemoglobinuria (PNH) experiencing extravascular haemolysis while on C5 inhibitors (ravulizumab or eculizumab).
  • It is an ongoing, phase 3 trial called ALPHA, which randomly assigns eligible adult patients to receive danicopan or a placebo alongside their current PNH treatment for 12 weeks.
  • The primary goal of the study is to measure changes in haemoglobin concentration from baseline to week 12, with interim analysis conducted once around 75% of participants completed the trial up to that point.
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Background And Aim: Germline mutations of telomere-related genes (TRG) induce multiorgan dysfunction, and liver-specific manifestations have not been clearly outlined. We aimed to describe TRG mutations-associated liver diseases.

Approach And Results: Retrospective multicenter analysis of liver disease (transaminases > 30 IU/L and/or abnormal liver imaging) in patients with TRG mutations.

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The recent application of whole exome or whole genome sequencing unveiled a plethora of germline variants predisposing to myeloid disorders, particularly myelodysplastic neoplasms. The presence of such variants in patients with myelodysplastic syndromes has important clinical repercussions for haematopoietic stem-cell transplantation, from donor selection and conditioning regimen to graft-versus-host disease prophylaxis and genetic counselling for relatives. No international guidelines exist to harmonise management approaches to this particular clinical scenario.

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  • The study investigates the clinical and immune characteristics of human parvovirus B19 (B19V) infections in patients who have undergone allogeneic hematopoietic stem cell transplantation (alloHSCT), reporting on cases from 2010 to 2021.* -
  • A total of 35 B19V infections were identified in 33 patients, with a median time from transplant to first positive PCR test being 6.9 months, and the most common symptoms including hematological impairment, rash, and fever.* -
  • The findings highlight that B19V can lead to diverse and atypical clinical manifestations, suggesting that the virus is often under-diagnosed due to its varied presentation; targeted tissue PCR may aid in
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