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Port-Saint-Louis-du-Rhône, France

Thepot S.,Hopital Saint Louis | Malphettes M.,Hopital Saint Louis | Gardeur A.,Hopital Saint Louis | Galicier L.,Hopital Saint Louis | And 9 more authors.
Journal of Clinical Immunology | Year: 2010

Objective: The impact of reducing immunoglobulin dosage while switching from intravenous to subcutaneous replacement therapy was evaluated. Methods: Sixty-five patients with primary hypogammaglobulinemia on stable intravenous replacement therapy were included in a monocentric longitudinal trial. IgG trough levels were measured at baseline and during 1 year following the switch to the subcutaneous route. Results: Mean IgG trough level after 12 months of subcutaneous therapy was increased by 5.4% (8.37-8.82 g/l, p=0.3), while immunoglobulin dosage had been reduced by 28.3% (151-108 mg/kg/week, p<0.0001). For the patients with the lowest serum IgG level upon intravenous infusions, serum IgG level rose by 37% (5.33-7.33 g/l, p = 0.003), while mean immunoglobulin dosage was reduced by 36% (170-109 mg/kg/week, p=0.04). Conclusion: The present study shows that sustained serum IgG levels can be achieved after switching towards subcutaneous replacement despite using reduced immunoglobulin doses. © Springer Science+Business Media, LLC 2010.

Serre J.-E.,Hospices Civils de Lyon | Michonneau D.,Service de Transplantation Renale et de Soins Intensifs | Bachy E.,French Institute of Health and Medical Research | Noel L.-H.,Laboratoire danatomopathologie | And 14 more authors.
Kidney International | Year: 2014

Post-transplant lymphoproliferative disorder (PTLD) is an uncontrolled proliferation of transformed lymphocytes fostered by immunosuppression. In addition to chemotherapy, treatment of PTLD includes a reduction of maintenance immunosuppression. Patients with PTLD have an increased risk of graft loss, suggesting that reduced immunosuppression strategy needs to be optimized with regard to graft outcome. Here we retrospectively reviewed 101 cases involving PTLD to identify the risks associated with graft loss. During a median follow-up of 70 months, 39 patients died and 21 lost their graft. Multivariate analysis found that an eGFR under 30 ml/min per 1.73 m 2 at PTLD diagnosis, a biopsy-proven acute rejection episode following reduction of immunosuppression, and the absence of calcineurin inhibition in maintenance immunosuppression are independent risk factors for allograft loss. Neither the type of PTLD nor the chemotherapy regimen was predictive of allograft failure. Histological analysis of graft biopsies showed that maintaining calcineurin inhibition after the diagnosis of PTLD reduced the risk of developing de novo anti-HLA antibodies and humoral rejection. Remarkably, calcineurin inhibitor maintenance was neither associated with higher mortality nor with worse progression-free survival. Thus, maintaining calcineurin inhibition at a reduced dose after the diagnosis of PTLD seems safe and may improve renal graft outcome, possibly through better control of the recipient's humoral immune response © 2013 International Society of Nephrology.

Salama A.,Charite - Medical University of Berlin | Janvier D.,Sanguine | Mayer B.,Charite - Medical University of Berlin | Saison C.,Sanguine | And 7 more authors.
Transfusion | Year: 2014

Background We describe a patient with a high-titer warm immunoglobulin (Ig)A autoantibody resulting in death due to hemagglutination rather than to hemolysis. Case Report A 47-year-old male patient presented with an intriguing pronounced vascular erythema of the skin. A livedo reticularis associated with cold agglutinin of high thermal amplitude was suspected. The patient's condition unexpectedly and abruptly deteriorated resulting in death 3 days after admission. Study Design and Methods Conventional serologic procedures and immunochemical methods were used. Results Serologic and immunochemical examinations revealed a warm IgA autoantibody of high titer with anti-Band 3 specificity. Although the patient presented with severe anemia, only mild signs of hemolysis were observed, with no evidence of complement activation. The autopsy revealed an enormous accumulation of agglutinated red blood cells in liver and spleen and a B-cell lymphoma and cerebral edema. Thus, the patient's death was largely caused by hypoxia related to hemagglutination rather than to hemolysis and/or anemia per se. Conclusion Strongly hemagglutinating antibodies may not only cause immune hemolysis but also hypoxia due to intravascular hemagglutination. © 2014 AABB.

Petropoulou A.D.,University Paris Diderot | Porcher R.,University Paris Diderot | De Latour R.P.,University Paris Diderot | Xhaard A.,University Paris Diderot | And 14 more authors.
Transplantation | Year: 2012

Background: Preemptive rituximab (R) treatment decreases the incidence of Epstein-Barr virus (EBV) posttransplantation lymphoproliferative disease, but the extent of immune deficiency related to R in patients who received allogeneic hematopoietic stem-cell transplantation is unclear. The aim of our study was to evaluate the incidence of late infections and immune reconstitution after preemptive R treatment of EBV infection. Methods: Seventy-eight patients receiving preemptive R between January 2005 and January 2010 were studied. Fifty-two of them could be matched with controls (not receiving R) according to administration of antithymoglobulin, stem-cell source and donor type, age and grade of acute graft-versus-host disease. Results: Among the 78 patients with EBV reactivation treated with R, the 36-month cumulative incidence of bacterial, viral, and fungal infections was 64%, 59%, and 23%, respectively. When compared with controls, bacterial infection incidence was significantly higher in R patients (55% vs. 35%), and a slower reconstitution of B cells was observed. R patients had modest but not significantly higher nonrelapse mortality (35% vs. 15%) than controls. Conclusion: R has dramatically decreased risks of posttransplantation lymphoproliferative disease but is followed by a prolonged and profound B-cell deficiency associated with an excess risk of bacterial infection and higher mortality. R should be given with caution, and immunoglobulin replacement should be provided to limit these excess risks. © 2012 Lippincott Williams & Wilkins.

Chiron A.,University Paris Diderot | Chiron A.,Laboratoire dImmunologie et dHistocompatibilite | Bouaziz J.-D.,University Paris Diderot | Carmagnat M.,University Paris Diderot | And 17 more authors.
Transplantation | Year: 2014

Background. Activating Anti-angiotensin type 1 receptor antibodies (AT1R-AA) have been described in patients with systemic scleroderma, an auto-immune disorder with clinical fibrotic features. Chronic graft-versus-host disease (cGvHD) after hematopoietic stem cell transplantation may have clinical fibrotic features, whose pathogenesis may be similar with systemic sclerosis. Objective. To evaluate the presence of AT1R-AA and their association with clinical and biological symptoms in cGvHD patients. Material and Methods. Sera from 87 patients including 45 extensive cGvHD and 42 hematopoietic stem cell transplantation patients without cGvHD were retrospectively analyzed for the presence of AT1R-AA using an enzymatic immunoassay. Results. The frequency of AT1R-AA was significantly increased (odds ratio [OR]=3.4, P=0.04) in the cGvHD group (24.4%) compared with the non-cGvHD group (7.1%). In the cGvHD group the positivity of AT1R-AA was significantly associated with: i/the presence of antinuclear antibodies (OR=5.9, P=0.04) ii/a more severe global and organspecific cGvHD scoring (P<0.05), iii/the presence of active skin or mucosal erosions (OR=19.2, P<0.01). There was no difference between the number and the types of organs involved by the cGvHD between the AT1R-AAYpositive versus AT1R-AAYnegative subgroups. Conclusion. This preliminary study suggests a potential role and prognostic value of AT1R-AA in cGvHD. © 2014 by Lippincott Williams & Wilkins.

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