{"id":16035,"date":"2022-03-28T20:01:24","date_gmt":"2022-03-28T18:01:24","guid":{"rendered":"https:\/\/convergences.online\/hemato\/?p=16035"},"modified":"2024-12-11T15:00:49","modified_gmt":"2024-12-11T14:00:49","slug":"allogreffe-hematopoiese-clonale-du-donneur-et-impact-sur-le-receveur","status":"publish","type":"post","link":"https:\/\/www.hematostat.net\/en\/allogreffe-hematopoiese-clonale-du-donneur-et-impact-sur-le-receveur\/","title":{"rendered":"Allogreffe : h\u00e9matopo\u00ef\u00e8se clonale du donneur et impact sur le receveur"},"content":{"rendered":"

R\u00e9f. :HematoStat.net ; 3 (1) : R46<\/p>\n

Gibson CJ, Kim HT, Zhao L, Murdock HM, Hambley B, Ogata A, et al. Donor Clonal Hematopoiesis and Recipient Outcomes After Transplantation. J Clin Oncol. 10 janv 2022;40(2):189\u2011201.<\/span><\/i><\/div>\n
<\/div>\n

R\u00e9sum\u00e9<\/h3>\n
<\/div>\n
Dans le cadre d\u2019une allogreffe, certains donneurs de cellules souches h\u00e9matopo\u00ef\u00e9tiques pr\u00e9sentent une h\u00e9matopo\u00ef\u00e8se clonale (HC). Son impact pour le receveur demeure m\u00e9connu. Un s\u00e9quen\u00e7age de 1 727 \u00e9chantillons de donneurs \u00e2g\u00e9s de plus de 40 ans a \u00e9t\u00e9 r\u00e9alis\u00e9. Une HC \u00e9tait pr\u00e9sente chez 22,5 % des donneurs et les mutations DNMT3A (14,6 %) et TET2 (5,2 %) \u00e9taient les plus repr\u00e9sent\u00e9es. La pr\u00e9sence d\u2019un clone DNMT3A avec un ratio all\u00e9lique \u2265 0,01 \u00e9tait un facteur favorable en termes de risque de rechute et de survie.<\/div>\n

Dans nos pratiques<\/h3>\n

Situation devenue fr\u00e9quente, l\u2019identification d\u2019HC du donneur lors du suivi du receveur est source d\u2019interrogation voire d\u2019inqui\u00e9tude. Dans cette \u00e9tude, la pr\u00e9sence d\u2019une mutation DNMT3A semble m\u00eame particuli\u00e8rement favorable, stimulant possiblement l\u2019effet greffe contre leuc\u00e9mie chez le receveur. Au final, le risque cumulatif de d\u00e9veloppement d\u2019une leuc\u00e9mie issue des cellules du donneur \u00e9tait de 0,7 % \u00e0 10 ans et concernaient des donneurs (7 cas sur 8) pr\u00e9sentant une mutation de DDX41, de TP53 ou de facteur d\u2019\u00e9pissage.<\/p>\n

Critique m\u00e9thodologique<\/h3>\n

Cette \u00e9tude sur une large cohorte \u00e9tudiant les principaux outcome<\/i>s li\u00e9s \u00e0 l\u2019allogreffe : OS, PFS, NRM, rechute, GvHD, utilisant les mod\u00e8les de Cox ou de Fine & Gray selon les endpoints<\/i>. En premier lieu, il a \u00e9t\u00e9 identifi\u00e9 que les cas de HC chez les donneurs \u00e9taient associ\u00e9s \u00e0 l\u2019\u00e2ge du donneur (plus de cas chez les sujets \u00e2g\u00e9s) en tenant compte de la stratification par centre (au nombre de 2). La mutation DNMT3A \u00e9tait pr\u00e9pond\u00e9rante et c\u2019est celle qui \u00e9tait associ\u00e9e \u00e0 une meilleure survie, PFS et taux de rechute d\u2019apr\u00e8s les analyses multivari\u00e9es en particulier les mut\u00e9s sans cyclophosphamide. En revanche c\u2019est la population qui pr\u00e9sentait la plus forte incidence de GvHD chronique. Une analyse plus d\u00e9taill\u00e9e des types de mutations est fournie \u00e9galement.<\/p>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":16,"featured_media":15574,"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":[456],"class_list":["post-16035","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revue-de-presse","author-alexis-genthon"],"aioseo_notices":[],"authors":[{"term_id":456,"user_id":16,"is_guest":0,"slug":"alexis-genthon","display_name":"Alexis GENTHON","avatar_url":{"url":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2023\/06\/Capture-decran-2021-05-07-a-14.25.02.png","url2x":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2023\/06\/Capture-decran-2021-05-07-a-14.25.02.png"},"first_name":"","last_name":"","user_url":"","description":"H\u00e9matologue.\r\nCorrespondance : H\u00f4pital Saint-Antoine \r\nService h\u00e9matologie clinique\r\n184 rue du Faubourg Saint-Antoine 75012 Paris."}],"_links":{"self":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16035","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\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/comments?post=16035"}],"version-history":[{"count":1,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16035\/revisions"}],"predecessor-version":[{"id":18216,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16035\/revisions\/18216"}],"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=16035"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/categories?post=16035"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/tags?post=16035"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/ppma_author?post=16035"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}