{"id":16300,"date":"2022-07-12T20:42:50","date_gmt":"2022-07-12T18:42:50","guid":{"rendered":"https:\/\/convergences.online\/hemato\/?p=16300"},"modified":"2024-12-11T15:29:24","modified_gmt":"2024-12-11T14:29:24","slug":"la-mrd-mais-pourquoi-si-tot","status":"publish","type":"post","link":"https:\/\/www.hematostat.net\/en\/la-mrd-mais-pourquoi-si-tot\/","title":{"rendered":"La MRD mais pourquoi si t\u00f4t ?"},"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 ; 3 (3) : R58<\/p>\n<p><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/34618601\/\"><i>Ibrutinib Plus Venetoclax for First-Line Treatment of Chronic Lymphocytic Leukemia: Primary Analysis Results From the Minimal Residual Disease Cohort of the Randomized Phase II CAPTIVATE Study. Wierda WG, Allan JN, Siddiqi T, Kipps TJ, Opat S, Tedeschi A, Badoux XC, Kuss BJ, Jackson S, Moreno C, Jacobs R, Pagel JM, Flinn I, Pak Y, Zhou C, Szafer- Glusman E, Ninomoto J, Dean JP, James DF, Ghia P, Tam CS. J Clin Oncol. 2021 Dec 1;39(34):3853-3865. doi: 10.1200\/JCO.21.00807. Epub 2021 Oct 7. PMID: 34618601; PMCID: PMC8713593.<\/i><\/a><\/p>\n<\/p>\n<p><strong>R\u00e9sum\u00e9 de l\u2019article<\/strong><\/p>\n<p>Cet essai de phase 2 incluait en premi\u00e8re ligne des patients de moins de 70 ans atteints de LLC. Il consistait en 3 cycles d\u2019ibrutinib suivie de 12 cycle de l\u2019association ibrutinib et v\u00e9n\u00e9toclax. Les patients ayant une MRD ind\u00e9tectable (&lt;10-4) \u00e9taient randomis\u00e9 placebo <em>versus <\/em>poursuite de l\u2019ibrutinib en double aveugle. Les autres patients \u00e9taient randomis\u00e9s de fa\u00e7on ouverte entre ibrutinib <em>versus<\/em> ibrutinib + v\u00e9n\u00e9toclax.<\/p>\n<p>Le crit\u00e8re de jugement \u00e9tait la DFS \u00e0 1 an chez les patients ayant une maladie r\u00e9siduelle ind\u00e9tectable<\/p>\n<p>Sur les 164 patients inclus dont la m\u00e9diane d\u2019\u00e2ge \u00e9tait de 58 ans, 86 patients avec une MRD ind\u00e9tectables ont \u00e9t\u00e9 randomis\u00e9s. Avec une m\u00e9diane de suivi de 31.3 mois, il n\u2019a pas \u00e9t\u00e9 observ\u00e9 de diff\u00e9rence de DFS \u00e0 1 an (95 %) entre les patients trait\u00e9s par ibrutinib <em>vs <\/em> placebo.<\/p>\n<p>Durant la p\u00e9riode de monoth\u00e9rapie, 36 des 40 patients class\u00e9s \u00e0 haut risque de syndrome de lyse sont pass\u00e9s \u00e0 un risque faible ou interm\u00e9diaire (avant la mise en route du v\u00e9n\u00e9toclax).<\/p>\n<\/p>\n<p><strong>Dans nos pratiques<\/strong><\/p>\n<p>L\u2019impact sur la pratique de cet essai est encore faible, l\u2019association des 2 m\u00e9dicaments n\u2019\u00e9tant pas encore \u00e0 l\u2019ordre du jour. Cependant, tous les groupes coop\u00e9rateurs testent actuellement sous diverses formes cette association +\/- anticorps anti-CD20 (rituximab ou obinutuzumab).<\/p>\n<\/p>\n<p><strong>Regard du biostatisticien<\/strong><\/p>\n<p>Il s\u2019agit d\u2019un essai dont le design est complexe et dont les hypoth\u00e8ses statistiques sont pour le moins critiquables. La mesure de la DFS \u00e0 1 an para\u00eet une mesure beaucoup trop pr\u00e9coce pour esp\u00e9rer montrer une diff\u00e9rence entre les diff\u00e9rents bras en premi\u00e8re ligne. Il s\u2019agit par ailleurs d\u2019un crit\u00e8re de jugement sans grande pertinence clinique.<\/p>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":9,"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":[333,92,225,160],"ppma_author":[451],"class_list":["post-16300","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revue-de-presse","tag-essais-de-phase-2","tag-ibrutinib","tag-mrd","tag-venetoclax","author-vincent-levy"],"aioseo_notices":[],"authors":[{"term_id":451,"user_id":9,"is_guest":0,"slug":"vincent-levy","display_name":"Vincent LEVY","avatar_url":{"url":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2023\/06\/Capture-decran-2021-05-07-a-13.21.23.png","url2x":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2023\/06\/Capture-decran-2021-05-07-a-13.21.23.png"},"first_name":"","last_name":"","user_url":"","description":"H\u00e9matologue, PU, PH en Pharmacie Clinique. <br>\r\nResponsable de l\u2019Unit\u00e9 de Recherche Clinique et du Centre de Recherche Clinique du GH de Seine-Saint-Denis, H\u00f4pital Avicenne. <br>\r\nMembre du CA et du CS du FILO. <br>\r\n<strong>Expertise : <\/strong>Leuc\u00e9mie lympho\u00efde chronique, essais cliniques.<br>\r\n<strong>Liens d'int\u00e9r\u00eat au 01\/01\/2023: <\/strong> Abbvie, AstraZeneca, Janssen.<br>\r\n<strong>Correspondance : <\/strong>H\u00f4pital Avicenne CRC\/URC, 125 rue de Stalingrad 96000 Bobigny."}],"_links":{"self":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16300","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\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/comments?post=16300"}],"version-history":[{"count":2,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16300\/revisions"}],"predecessor-version":[{"id":18229,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16300\/revisions\/18229"}],"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=16300"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/categories?post=16300"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/tags?post=16300"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/ppma_author?post=16300"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}