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Article Dans Une Revue JAMA Ophthalmology Année : 2014

Autologous Hematopoietic Stem Cell Transplantation vs Intravenous Pulse Cyclophosphamide in Diffuse Cutaneous Systemic Sclerosis

Jacob van Laar
  • Fonction : Auteur
Jacob Sont
  • Fonction : Auteur
Kamran Naraghi
  • Fonction : Auteur
Annemie Schuerwegh
  • Fonction : Auteur
Erik Marijt
  • Fonction : Auteur
Madelon Vonk
  • Fonction : Auteur
Anton Schattenberg
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Marco Matucci-Cerinic
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Alexandre Voskuyl
  • Fonction : Auteur
Arjan van de Loosdrecht
  • Fonction : Auteur
Thomas Daikeler
  • Fonction : Auteur
Ina Kötter
  • Fonction : Auteur
Marc Schmalzing
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Thierry Martin
Stefan Weiner
  • Fonction : Auteur
Alexander Kreuter
  • Fonction : Auteur
Paul Emery
  • Fonction : Auteur
Klaus Machold
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Klaus Warnatz
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Daniel Adoue
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Joël Constans
Hans-Peter Tony
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Nicoletta del Papa
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Athanasios Fassas
  • Fonction : Auteur
Andrea Himsel
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David Launay
Andrea Lo Monaco
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Éric Rich
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Rene Westhovens
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Bridget Griffiths
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Riccardo Saccardi
  • Fonction : Auteur
Frank van den Hoogen
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Willem Fibbe
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Alois Gratwohl
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Alan Tyndall
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Résumé

IMPORTANCE: High-dose immunosuppressive therapy and autologous hematopoietic stem cell transplantation (HSCT) have shown efficacy in systemic sclerosis in phase 1 and small phase 2 trials. OBJECTIVE: To compare efficacy and safety of HSCT vs 12 successive monthly intravenous pulses of cyclophosphamide. DESIGN, SETTING, AND PARTICIPANTS: The Autologous Stem Cell Transplantation International Scleroderma (ASTIS) trial, a phase 3, multicenter, randomized (1:1), open-label, parallel-group, clinical trial conducted in 10 countries at 29 centers with access to a European Group for Blood and Marrow Transplantation-registered transplant facility. From March 2001 to October 2009, 156 patients with early diffuse cutaneous systemic sclerosis were recruited and followed up until October 31, 2013. INTERVENTIONS: HSCT vs intravenous pulse cyclophosphamide. MAIN OUTCOMES AND MEASURES: The primary end point was event-free survival, defined as time from randomization until the occurrence of death or persistent major organ failure. RESULTS: A total of 156 patients were randomly assigned to receive HSCT (n = 79) or cyclophosphamide (n = 77). During a median follow-up of 5.8 years, 53 events occurred: 22 in the HSCT group (19 deaths and 3 irreversible organ failures) and 31 in the control group (23 deaths and 8 irreversible organ failures). During the first year, there were more events in the HSCT group (13 events [16.5%], including 8 treatment-related deaths) than in the control group (8 events [10.4%], with no treatment-related deaths). At 2 years, 14 events (17.7%) had occurred cumulatively in the HSCT group vs 14 events (18.2%) in the control group; at 4 years, 15 events (19%) had occurred cumulatively in the HSCT group vs 20 events (26%) in the control group. Time-varying hazard ratios (modeled with treatment × time interaction) for event-free survival were 0.35 (95% CI, 0.16-0.74) at 2 years and 0.34 (95% CI, 0.16-0.74) at 4 years. CONCLUSIONS AND RELEVANCE: Among patients with early diffuse cutaneous systemic sclerosis, HSCT was associated with increased treatment-related mortality in the first year after treatment. However, HCST conferred a significant long-term event-free survival benefit. TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN54371254.

Dates et versions

hal-01945807 , version 1 (05-12-2018)

Identifiants

Citer

Jacob van Laar, Dominique Farge, Jacob Sont, Kamran Naraghi, Zora Marjanovic, et al.. Autologous Hematopoietic Stem Cell Transplantation vs Intravenous Pulse Cyclophosphamide in Diffuse Cutaneous Systemic Sclerosis. JAMA Ophthalmology, 2014, 311 (24), pp.2490-8. ⟨10.1001/jama.2014.6368⟩. ⟨hal-01945807⟩
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