ecp cryo jk 15.11.19 [mode de compatibilité] · 1 cryo -extracorporeal photochemotherapy justyna...
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![Page 1: ECP cryo jk 15.11.19 [Mode de compatibilité] · 1 CRYO -Extracorporeal Photochemotherapy Justyna Kanold Sérvice d’hemato-oncologie pédiatrique CHU Unité CRECHE INSERM CIC1405](https://reader034.vdocuments.pub/reader034/viewer/2022050402/5f804474c9d76f257935c5d0/html5/thumbnails/1.jpg)
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CRYO - Extracorporeal Photochemotherapy
Justyna Kanold
Sérvice d’hemato-oncologie pédiatrique
CHU
Unité CRECHE INSERM CIC1405
Clermont Ferrand, France
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22J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
Collection des CMN � Photosensibilisation (psoralène)� Irradiation (UVA:2 J/cm2) �Re-injection/«transfusion»
Extracorporeal Photochemotherapy
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• Thin (damaged) veins
• Small body weight and small whole blood volume
• Relatively large extracorporeal volume of cell separators
�• Metabolic and hematologic problems
• Psychological tolerance
Needs of a sophisticated training in (paediatric) apheresis
J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
Why ECP (in paediatric practice) is difficult?
CRYO-ECP
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44J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
Why ECP (in paediatric practice) is difficult?
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55J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO_ECP
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66J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
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What will be the advantages of CRYO ECP ?
Reduced the number of apheresis while maintaining the rate of
reinjections
− Improve treatment conditions
− Expand ECP indications
− Treat patients in centers not equipped for ECP
− Standardize cell product
J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
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88J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
CRYO ECP - results
Avant 2009 : 3 enfants (Clermont)
2009 – 2015 : 20 pts (Nancy, Clermont)
2016 – 2017: ?
2018 – 2019 : 11 pts (Clermont)
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99J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
CRYO ECP - results
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1010J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
CRYO ECP - results
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1111J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
Patients Aphérèses Reinjections CRYO
Rejet pulmonaire 3 27 28
GvH 3 23 32
Sezary 3 18 18
Rejet renal 1 4 4
Lichen plan 1 4 4
TOTAL 11 (3 enfants) 76 86
CRYO ECP - results
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1212J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
CRYO ECP - results
Duré de la congélation (jours) 13 (3-119)
CD3+ congelées (107/kg)
par aphérèse 2.2 (0.1-28)
par fraction 2.3 (0.1-6.0)
Nb de fractions congelées/aphérèse 1 (1-5)
CD3+ reinjectées (107/kg) 2.1 (0.2-6.1)
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1313J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
CRYO ECP - results
Patients CRYO ECP
GvH 24* 266 NR 8/24 Merlin 2012
Pochon 2017
Pulmonary rejection 3* 28 2/3 drugs-sparing effect
Sezary 3 18 3/3 PR
Renal rejection 1 4 ?
Lichen planus 1 4 ?
Juvenile dermatopolymyositis 1* 81 CR Merlin 2012
Juvenile localized scleroderma 1* 52 CR Merlin 2012
TOTAL 34 453
�
19 enfants*
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1414J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECPCRYO ECP - results
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
Living Early Late Necrosis
Apoptosis
Non-irradiated fresh non-irradiated cryo
Irradiated fresh Irradiated cryo
*
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What are the advantages of CRYO ECP ?
Reduced the number of apheresis while maintaining the rate of
reinjections
− Improve treatment conditions YES
− Expand ECP indications YES
− Treat patients in centers not equipped for ECP NO
− Standardize cell product NO
J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
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What are the limitations of CRYO ECP ?
J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
Est ce que ça marche vraiment ?
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What are the limitations of CRYO ECP ?
J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO- ECP
Règlementaires et administratives :
•Autorisation ANSM / pathologie
•JACIE ?
Techniques et logistiques:
•Temps labo: (congélations/lavages/décongélations) x N
•Stockage des poches
•GHS aphérèse vs HDJ pour une réinjection simple et encore…….
Intellectuelles
•Indications : patient ? pathologie ?
•Combien de cellules par fraction ?
•Combien de fractions par aphérèse ?
•Quel délais de stockage max ? Réinjections de «vieux lymphocytes» ?
•Quel test ? (PHA est compliqué sur les cellules décongelées)
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1818J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
Conclusions/Perspectives:
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1919J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
CRYO-ECP
Guidelines !
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2020J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
How to set up future trials ?
CRYO-ECP
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Unité CRECHE
François Deméocq
Etienne Merlin
Victoria Grèze
Apheresis nursing staff
Valérie Hervé
Emmanuelle Lopez
Chantal Pic
Delphine Pages
J. Kanold CRECHE INSERM CIC 1405, Clermont Ferrand
Thank you !
CRYO-ECP