{"id":15570,"date":"2021-11-15T10:00:08","date_gmt":"2021-11-15T09:00:08","guid":{"rendered":"https:\/\/convergences.online\/hemato\/?p=15570"},"modified":"2024-12-11T14:05:08","modified_gmt":"2024-12-11T13:05:08","slug":"un-nouveau-traitement-de-premiere-ligne-dans-la-leucemie-a-tricholeucocytes","status":"publish","type":"post","link":"https:\/\/www.hematostat.net\/en\/un-nouveau-traitement-de-premiere-ligne-dans-la-leucemie-a-tricholeucocytes\/","title":{"rendered":"Un nouveau traitement de premi\u00e8re ligne dans la leuc\u00e9mie \u00e0 tricholeucocytes ?"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1302px;margin-left: calc(-5% \/ 2 );margin-right: calc(-5% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.375%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:2.375%;--awb-width-medium:100%;--awb-spacing-right-medium:2.375%;--awb-spacing-left-medium:2.375%;--awb-width-small:100%;--awb-spacing-right-small:2.375%;--awb-spacing-left-small:2.375%;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\"><p>R\u00e9f. : HematoStat.net ; 2 (4) : R27<\/p>\n<\/p>\n<p>Essai de phase 2 de premi\u00e8re ligne par cladribine avec rituximab concomitant ou d\u00e9cal\u00e9 chez des patients avec leuc\u00e9mie \u00e0 tricholeucocytes.<\/p>\n<p><em>Randomized Phase II Study of First-Line Cladribine With Concurrent or Delayed Rituximab in Patients With Hairy Cell Leukemia.<\/em><\/p>\n<p><a href=\"https:\/\/ascopubs.org\/doi\/full\/10.1200\/JCO.19.02250\"><em>Chiara et al. Randomized Phase II Study of First-Line Cladribine With Concurrent or Delayed Rituximab in Patients With Hairy Cell Leukemia. <\/em><em>JCO 2020. 38:14 1527-1539 DOI : https:\/\/doi.org\/10.1200\/JCO.19.02250<\/em><\/a><\/p>\n<\/p>\n<h3>R\u00e9sum\u00e9 de l\u2019\u00e9tude<\/h3>\n<p>La cladribine est le traitement de r\u00e9f\u00e9rence de premi\u00e8re ligne de la leuc\u00e9mie \u00e0 tricholeucocytes. Un essai de phase 2 r\u00e9cent a montr\u00e9 une excellente efficacit\u00e9 d\u2019une association de la cladribine au rituximab d\u00e9but\u00e9 un mois apr\u00e8s la cladribine<sup>1<\/sup>. Etant donn\u00e9 la demi-vie rapide de la cladribine, dans l\u2019hypoth\u00e8se d\u2019une synergie rituximab et cladribine, une bith\u00e9rapie concomitante est test\u00e9e dans cette \u00e9tude de phase 2 randomis\u00e9e, comparant 5 jours de cladribine (0.15 mg\/kg\/jour) avec d\u2019embl\u00e9e 8 injections hebdomadaires de rituximab 375 mg\/m\u00b2 \u00e0 une adjonction retard\u00e9e du rituximab, \u00e0 6 mois en cas de MRD d\u00e9tectable.<\/p>\n<p>Le taux de MRD ind\u00e9tectable dans le sang et dans la moelle est significativement plus \u00e9lev\u00e9 dans le groupe avec bith\u00e9rapie concomitante, o\u00f9 elles sont de 100 et 97% respectivement dans le sang et la moelle <em>vs <\/em>68 % et 32 % dans le groupe retard\u00e9 (p= 0.001 et p=0.001). Le taux de r\u00e9ponse globale et de r\u00e9mission compl\u00e8te n\u2019est pas significativement diff\u00e9rent. La tol\u00e9rance \u00e9tait bonne.<\/p>\n<h3>Dans nos pratiques<\/h3>\n<p>Malgr\u00e9 l\u2019absence de crit\u00e8re de jugement clinique, le caract\u00e8re ind\u00e9tectable de la MRD est un crit\u00e8re de jugement fiable dans diff\u00e9rentes h\u00e9mopathies \u00e0 \u00e9volution lente, y compris la leuc\u00e9mie \u00e0 tricholeucocytes. Dans le cadre d\u2019une \u00e9volution particuli\u00e8rement lente et avec peu d\u2019\u00e9v\u00e8nements, il y est difficile et tr\u00e8s long de mettre en \u00e9vidence une diff\u00e9rence significative avec les crit\u00e8res cliniques.<\/p>\n<p>Etant donn\u00e9 la bonne tol\u00e9rance de ce nouveau sch\u00e9ma de traitement, le r\u00e9sultat positif en MRD est un argument pouvant permettre de discuter l\u2019utilisation de la bith\u00e9rapie concomitante cladribine et rituximab d\u00e8s la premi\u00e8re ligne.<\/p>\n<h3>Le regard du statisticien<\/h3>\n<p>Cette publication rend des r\u00e9sultats de phase 2 tr\u00e8s int\u00e9ressants quant \u00e0 l\u2019association rituximab + cladribine. On constate en effet, d\u2019apr\u00e8s les courbes de Kaplan-Meier, une meilleure survie sans MRD pour l\u2019association en comparaison au rituximab pris \u00e0 partir de 6 mois (\u00e0 ce propos, une analyse en landmark apr\u00e8s 6 mois aurait \u00e9t\u00e9 un &#8220;plus&#8221;). Les r\u00e9sultats chiffr\u00e9s sur l\u2019efficacit\u00e9 sont bien d\u00e9taill\u00e9s \u00e0 diff\u00e9rents moments du suivi des patients. Les <em>swimmerplots <\/em>illustrant le devenir des 34 individus randomis\u00e9s de chaque bras offrent un aper\u00e7u complet sur leur suivi.<\/p><\/p>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":15571,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[36],"tags":[],"ppma_author":[442],"class_list":["post-15570","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revue-de-presse","author-marion"],"aioseo_notices":[],"authors":[{"term_id":442,"user_id":2,"is_guest":0,"slug":"marion","display_name":"HematoStat.net (M)","avatar_url":{"url":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2024\/01\/favicon-hematoStat.png","url2x":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2024\/01\/favicon-hematoStat.png"},"first_name":"HematoStat.net (M)","last_name":"","user_url":"","description":""}],"_links":{"self":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/15570","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/comments?post=15570"}],"version-history":[{"count":1,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/15570\/revisions"}],"predecessor-version":[{"id":18194,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/15570\/revisions\/18194"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/"}],"wp:attachment":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/media?parent=15570"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/categories?post=15570"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/tags?post=15570"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/ppma_author?post=15570"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}