{"id":16691,"date":"2023-03-29T13:29:48","date_gmt":"2023-03-29T11:29:48","guid":{"rendered":"https:\/\/convergences.online\/hemato\/?p=16691"},"modified":"2024-12-11T18:54:07","modified_gmt":"2024-12-11T17:54:07","slug":"vers-un-arret-durable-des-immunosuppresseurs-dans-le-gvh-chronique","status":"publish","type":"post","link":"https:\/\/www.hematostat.net\/en\/vers-un-arret-durable-des-immunosuppresseurs-dans-le-gvh-chronique\/","title":{"rendered":"Vers un arr\u00eat durable des immunosuppresseurs dans le GVH chronique ?"},"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 ; 4 (1) : R73<\/p>\n<p style=\"font-weight: 400;\"><a href=\"https:\/\/www.haematologica.org\/article\/view\/haematol.2021.279814\"><em>Chen GL, Onstad L, Martin PJ et al. <\/em><em>Durable discontinuation of systemic therapy in patients affected by chronic graft-versus-host disease. Haematologica <\/em><em>Vol. 108 No. 2 (2023): February, 2023<\/em><em>.<\/em><\/a><\/p>\n<p><strong>R\u00e9sum\u00e9 de l\u2019article<\/strong><\/p>\n<p>Dans cette analyse de 2 \u00e9tudes prospectives observationnelles (n=684), les auteurs rapportent une incidence cumul\u00e9e d\u2019arr\u00eats durables (&gt;12 mois) d\u2019immunosuppresseurs (IS) chez des patients trait\u00e9s par pour une GVH chronique de 32 % \u00e0 10 ans, apr\u00e8s une dur\u00e9e m\u00e9diane de traitement de 3,6 ans [1,2-10,5]. Les facteurs pr\u00e9dictifs significatifs d\u2019un succ\u00e8s d\u2019arr\u00eat incluaient les sources de greffon issus de sang de cordon (HR 2,08 <sub>95 %IC<\/sub>[1,07-4,04]) et de moelle osseuse (HR 1,80 <sub>95 %IC<\/sub>[1,00-3,24]) et une GVH digestive de s\u00e9v\u00e9rit\u00e9 l\u00e9g\u00e8re (HR 1,76 <sub>95 %IC<\/sub>[1,05-2,96]). Un score \u00e9lev\u00e9 sur l\u2019\u00e9chelle de GVH chronique de Lee r\u00e9duisait \u00e0 l\u2019inverse la probabilit\u00e9 d\u2019un arr\u00eat durable d\u2019IS (HR 0,82\/10 points <sub>95 %IC<\/sub>[0,70-0,96]).<\/p>\n<p><strong>Dans nos pratiques<\/strong><\/p>\n<p>La tr\u00e8s longue p\u00e9riode de suivi a permis de caract\u00e9riser non seulement les arr\u00eats durables (&gt; 12 mois) de traitement, mais \u00e9galement les \u00e9v\u00e8nements tardifs. Ainsi, ces arr\u00eats durables d\u2019IS n\u2019\u00e9taient pas possibles chez la majorit\u00e9 des patients atteints de GVH chronique. Par ailleurs, l\u2019\u00e9tude sugg\u00e8re \u00e9galement qu\u2019une p\u00e9riode de suivi minimale de 12 mois est requise apr\u00e8s l\u2019arr\u00eat des IS. De fa\u00e7on int\u00e9ressante, beaucoup de facteurs de risque de d\u00e9velopper une GVH chronique (<i>mismatch<\/i> HLA et de genre femme\/homme, \u00e2ge) n\u2019avaient cependant pas d\u2019impact sur la probabilit\u00e9 d\u2019un arr\u00eat durable du traitement.<\/p>\n<p><strong>Le regard du biostatisticien<\/strong><\/p>\n<p><b>L<\/b>es arr\u00eats de traitements deviennent des <em>endpoints<\/em> de plus en plus analys\u00e9s (on parle parfois de <em>treatment-free remission<\/em>) ces derni\u00e8res ann\u00e9es. La d\u00e9marche statistique utilis\u00e9e ici pour cette cohorte est la plus pragmatique : d\u2019abord on r\u00e9alise des analyses univari\u00e9es, on pr\u00e9s\u00e9lectionn\u00e9 celles qui peuvent impacter plus ou moins significativement sur la r\u00e9ponse \u00e9tudi\u00e9e (arr\u00eat durable de traitement) puis on repasse par un algorithme de s\u00e9lection (type <em>stepwise<\/em> ici) en trois phases. Ce qui interpelle en revanche, est que les auteurs ont utilis\u00e9 des r\u00e9gressions de Cox pour faire des analyses alors qu\u2019en pr\u00e9sence de risques comp\u00e9titifs, comme la rechute et le d\u00e9c\u00e8s, il aurait \u00e9t\u00e9 pr\u00e9f\u00e9rable d&#8217;utiliser du Fine &amp; Gray\u2026<\/p>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":16711,"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":[459],"class_list":["post-16691","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revue-de-presse","author-lin-pierre-zhao"],"aioseo_notices":[],"authors":[{"term_id":459,"user_id":0,"is_guest":1,"slug":"lin-pierre-zhao","display_name":"Lin-Pierre ZHAO","avatar_url":{"url":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2023\/06\/Capture-decran-2023-03-29-a-12.52.50-1.png","url2x":"https:\/\/www.hematostat.net\/wp-content\/uploads\/2023\/06\/Capture-decran-2023-03-29-a-12.52.50-1.png"},"first_name":"","last_name":"","user_url":"","description":"H\u00e9matologue. <br>\r\nChef de clinique assistant <br>\r\n<strong>Liens d'int\u00e9r\u00eats au 06\/03\/2024 : <\/strong>l'auteur d\u00e9clare ne pas avoir de liens d'int\u00e9r\u00eats. <br>\r\n<strong>Liens d'int\u00e9r\u00eats au 01\/01\/2024 : <\/strong>l'auteur d\u00e9clare ne pas avoir de liens d'int\u00e9r\u00eats. <br>\r\n<strong>Correspondance : <\/strong>Service H\u00e9matologie S\u00e9niors - Tr\u00e8fle 4 | H\u00f4pital Saint-Louis | Universit\u00e9 Paris Cit\u00e9\r\nInserm U1160 | Institut de Recherche Saint-Louis\r\n1 avenue Claude Vellefaux, 75010 Paris.<br>"}],"_links":{"self":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16691","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\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/comments?post=16691"}],"version-history":[{"count":4,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16691\/revisions"}],"predecessor-version":[{"id":18247,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/posts\/16691\/revisions\/18247"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/media\/16711"}],"wp:attachment":[{"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/media?parent=16691"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/categories?post=16691"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/tags?post=16691"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/www.hematostat.net\/en\/wp-json\/wp\/v2\/ppma_author?post=16691"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}