Journal articles
Treatment of B-cell disorder improves renal outcome of patients with monoclonal gammopathy–associated C3 glomerulopathy
Sophie Chauvet
1
Veronique Fremeaux-Bacchi
2
Florent Petitprez
3
Alexandre Karras
4
Laurent Daniel
5
Stéphane Burtey
6
Gabriel Choukroun
7
Yahsou Delmas
8
Dominique Guerrot
9
Arnaud François
10
Moglie Le Quintrec
11
Vincent Javaugue
12
David Ribes
Laurence Vrigneaud
13
Bertrand Arnulf
14
Jean Michel Goujon
15, 12
Pierre Ronco
16
Guy Touchard
17, 12
Frank Bridoux
17, 12
Sophie Chauvet 1
Author Employer institution : Aix Marseille Université
Veronique Fremeaux-Bacchi 2
Author
Florent Petitprez 3
Author
Alexandre Karras 4
Author
Laurent Daniel 5
Author
Stéphane Burtey 6
Author IdHAL : stephane-burtey IdRef : https://www.idref.fr/111036372
Gabriel Choukroun 7
Author
Yahsou Delmas 8
Author
Dominique Guerrot 9
Author IdHAL : dominique-guerrot ResearcherId : http://www.researcherid.com/rid/N-7769-2019 ORCID : https://orcid.org/0000-0002-5953-5785
Arnaud François 10
Author
Moglie Le Quintrec 11
Author
Vincent Javaugue 12
Author
David Ribes
Author
Laurence Vrigneaud 13
Author
Bertrand Arnulf 14
Author
Jean Michel Goujon 15, 12
Author
1
IBDM - Institut de Biologie du Développement de Marseille (Case 907 - Parc Scientifique de Luminy 13288 Marseille Cedex 9 - France)
- AMU - Aix Marseille Université : UMR7288 (Aix-Marseille Université Jardins du Pharo 58 Boulevard Charles Livon 13284 Marseille cedex 7 - France)
- CdF (institution) - Collège de France (France)
- CNRS - Centre National de la Recherche Scientifique : UMR7288 (France)
2
Laboratoire d'Immunologie Biologique (Paris - France)
- AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) (France)
- HEGP - Hôpital Européen Georges Pompidou [APHP] (20, rue Leblanc, 75015 Paris - France)
3
CRC - Centre de Recherche des Cordeliers (15 rue de l'Ecole de Médecine - Bâtiment B - 75270 Paris Cedex 06 - France)
- UPD7 - Université Paris Diderot - Paris 7 (5 rue Thomas-Mann - 75205 Paris cedex 13 - France)
- EPHE - École pratique des hautes études (4-14 Rue Ferrus, 75014 Paris - France)
- PSL - Université Paris sciences et lettres (60 rue Mazarine 75006 Paris - France)
- UPMC - Université Pierre et Marie Curie - Paris 6 (4 place Jussieu - 75005 Paris - France)
- UPD5 - Université Paris Descartes - Paris 5 (12, rue de l'École de Médecine - 75270 Paris cedex 06 - France)
- INSERM - Institut National de la Santé et de la Recherche Médicale : U1138 (101, rue de Tolbiac, 75013 Paris - France)
4
HEGP - Hôpital Européen Georges Pompidou [APHP] (20, rue Leblanc, 75015 Paris - France)
5
LA CONCEPTION - Hôpital de la Conception [CHU - APHM] (147 Boulevard Baille 13005 Marseille - France)
6
VRCM - Vascular research center of Marseille (Faculté de Pharmacie, 27 bd Jean Moulin 13385 Marseille Cedex 5 - France)
- AMU - Aix Marseille Université : UMR S1076 (Aix-Marseille Université Jardins du Pharo 58 Boulevard Charles Livon 13284 Marseille cedex 7 - France)
- INSERM - Institut National de la Santé et de la Recherche Médicale : U1076 (101, rue de Tolbiac, 75013 Paris - France)
7
Unité de Soins Intensifs Médicaux (354 Boulevard de Beauville 80000 Amiens - France)
- CHU Amiens-Picardie (France)
- Département de Néphrologie (France)
8
Service de Néphrologie-transplantation-dialyse [Bordeaux] (pl Amélie Raba Léon
33076 BORDEAUX CEDEX - France)
- CHU Bordeaux [Bordeaux] (place Amélie Raba Léon 33076 BORDEAUX CEDEX - France)
9
Service de Néphrologie [Rouen] (1 Avenue de Germont 76031 Rouen Cedex - France)
- CHU Rouen (1, rue de Germont 76031 Rouen cedex - France)
- NU - Normandie Université (Esplanade de la Paix - CS 14032 - 14032 Caen Cedex 5 - France)
- UNIROUEN - Université de Rouen Normandie (1, rue Thomas Becket 76821 Mont-Saint-Aignan Cedex - France)
- NU - Normandie Université (Esplanade de la Paix - CS 14032 - 14032 Caen Cedex 5 - France)
10
Service d'Anatomie et Cytologie Pathologique [CHU Rouen] (1 rue de Germont 76031 Rouen cedex - France)
- CHU Rouen (1, rue de Germont 76031 Rouen cedex - France)
- NU - Normandie Université (Esplanade de la Paix - CS 14032 - 14032 Caen Cedex 5 - France)
- UNIROUEN - Université de Rouen Normandie (1, rue Thomas Becket 76821 Mont-Saint-Aignan Cedex - France)
- NU - Normandie Université (Esplanade de la Paix - CS 14032 - 14032 Caen Cedex 5 - France)
11
CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier] (191 avenue du doyen Gaston Giraud 34295 Montpellier cedex 5 - France)
12
Centre National de Référence Maladies Rares: Amylose al et Autres Maladies à Dépôts d'Immunoglobulines Monoclonales (France)
- Université de Poitiers (15, rue de l'Hôtel Dieu - 86034 Poitiers Cedex - France)
13
Service de Néphrologie [Valenciennes] (Avenue Désandrouin 59322 Valenciennes Cedex - France)
- Centre Hospitalier de Valenciennes (France)
14
Service d'hématologie biologique (75010 Paris - France)
- AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP) (France)
- Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris] (200 rue du Faubourg Saint-Denis 75475 Paris (Nord) Cedex 10 - France)
15
Service d'Anatomie et de Cytologie Pathologiques [Poitiers] (2 rue de la Milétrie BP 577, 86021 Poitiers Cedex - France)
- CHU Poitiers - Centre hospitalier universitaire de Poitiers (2 Rue de la Milétrie, 86021 Poitiers - France)
16
Remodelage et Reparation du Tissu Renal (Hopital Tenon PARIS VI 4, Rue de La Chine 75970 PARIS CEDEX 20 - France)
- UPMC - Université Pierre et Marie Curie - Paris 6 (4 place Jussieu - 75005 Paris - France)
- INSERM - Institut National de la Santé et de la Recherche Médicale : U702 (101, rue de Tolbiac, 75013 Paris - France)
17
CHU Poitiers - Centre hospitalier universitaire de Poitiers (2 Rue de la Milétrie, 86021 Poitiers - France)
Abstract : The high frequency of monoclonal gammopathy in adult patients with C3 glomerulopathy (C3G) emphasizes the role of monoclonal immunoglobulin (MIg) in the occurrence of renal disease and raises the issue of the therapeutic management. The aim of the study was to evaluate the effect of chemotherapy in a large cohort of patients with MIg-associated C3G. Fifty adult patients with MIg and biopsy-proven C3G were extracted from the French national database of C3G. We retrospectively compared renal outcomes in patients who either received or did not receive chemotherapy targeting the underlying B-cell clone. At diagnosis, renal disease was severe, with nephrotic-range proteinuria in 20/46 (43%) patients and chronic kidney disease stage 3 or above in 42/49 (86%) patients. Monoclonal gammopathy was of IgG type in 47 (94%) patients. Hematological diagnosis was monoclonal gammopathy of renal significance in 30 (60%), multiple myeloma in 17 (34%), and chronic lymphocytic leukemia in 3 (6%) patients. Complement studies showed low C3 level in 22/50 (43%) and elevated soluble C5b-9 level in 27/34 (79%) patients. Twenty-nine patients received chemotherapy (including bortezomib in 22), whereas 8 and 13 patients received various immunosuppressive drugs or symptomatic measures alone, respectively. Patients who achieved hematological response after chemotherapy had higher renal response rates (P = .0001) and median renal survival (hazard ratio, 0.22; 95% confidence interval, 0.05-0.92; P = .009) than those receiving conservative/immunosuppressive therapy. In conclusion, our results suggest that chemotherapy adapted to the B-cell clone may constitute an efficient strategy for C3G in the setting of MIg, as rapid achievement of hematological response appears to result in improved renal survival.
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Journal articles
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https://hal-amu.archives-ouvertes.fr/hal-01790090
Contributor : Françoise Dignat-George Connect in order to contact the contributor
Submitted on : Friday, May 18, 2018 - 4:55:59 PM
Last modification on : Wednesday, November 17, 2021 - 12:32:42 PM
Long-term archiving on: : Tuesday, September 25, 2018 - 3:58:26 PM
Contributor : Françoise Dignat-George Connect in order to contact the contributor
Submitted on : Friday, May 18, 2018 - 4:55:59 PM
Last modification on : Wednesday, November 17, 2021 - 12:32:42 PM
Long-term archiving on: : Tuesday, September 25, 2018 - 3:58:26 PM
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- HAL Id : hal-01790090, version 1
- DOI : 10.1182/blood-2016-08-737163
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UNIV-AMU | CNRS | UNIV-POITIERS | UPMC | EPHE | COMUE-NORMANDIE | USPC | CORDELIERS | UNIROUEN | INSERM | UNIV-PARIS5 | SORBONNE-UNIVERSITE | UNIV-PARIS7 | SU-SCIENCES | IBPS | CDF | UNIV-PARIS | UP-SANTE | PSL | ESCAPE-ROUEN | SU-TI | URCA | ESCAPE-REIMS
Citation
Sophie Chauvet, Veronique Fremeaux-Bacchi, Florent Petitprez, Alexandre Karras, Laurent Daniel, et al.. Treatment of B-cell disorder improves renal outcome of patients with monoclonal gammopathy–associated C3 glomerulopathy. Blood, American Society of Hematology, 2017, 129 (11), pp.1437-1447. ⟨10.1182/blood-2016-08-737163⟩. ⟨hal-01790090⟩
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