Advertisement

Autologous haematopoietic stem cell transplantation (AHSCT) in autoimmune disease adult patients in France: analysis of the long-term outcome from the French Society for Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)

  • Perrine Guillaume-Jugnot
  • Manuela Badoglio
  • Myriam Labopin
  • Louis Terriou
  • Ibrahim Yakoub-Agha
  • Thierry Martin
  • Bruno Lioure
  • Zora Marjanovic
  • Didier Blaise
  • Stéphanie Nguyen
  • Gregory Pugnet
  • Anne Huynh
  • Christophe Deligny
  • Christophe Seinturier
  • Frédéric Garban
  • Laure Swiader
  • Jacques-Olivier Bay
  • Thorsten Braun
  • Régis Peffault de Latour
  • Marie Thérèse Rubio
  • Dominique FargeEmail author
Original Article
  • 63 Downloads

Abstract

Introduction

The use of autologous haematopoietic stem cell transplantation (AHSCT) in autoimmune disease (AD) patients has increased progressively worldwide. We retrospectively analysed the long-term outcome of AHSCT for AD reported to the French Society for Bone Marrow Transplantation and Cellular Therapy (SFGM-TC).

Method

All French AD patients (≥ 18 years at transplant) with a first AHSCT between 1997 and 2013 were included. Primary data were derived from the European Society for Blood and Marrow Transplantation (EBMT) registry, and additional data were obtained through a specific questionnaire designed for the study. Primary end-point was overall survival (OS). Secondary end points were progression-free survival (PFS) and non-relapse mortality (NRM).

Results

Ninety-four AD patients were included, of whom 71% suffered from rheumatologic diseases (n = 67, including 56 systemic sclerosis (SSc)), 16% from neurological disease (n = 15, including 14 multiple sclerosis (MS)) and 13% from various other AD (n = 12). After a median (interquartile range, IQR) follow-up of 83 months (38–130), OS at 5 and 10 years were 77% (95% CI 68.5–86.2) and 64% (95% CI 51.7–76.3), and for PFS 51% (95% CI 40.4–61.6) and 44% (95% CI 32.8–55.3), respectively. Overall, NRM was 8.7% (95% CI 4.0–15.5) at day 100, 9.8% (95% CI 4.8–16.9) at 5 years and 13.6% (95% CI 6.9–22.5) at 10 years.

Conclusions

This first SFGM-TC retrospective report shows long-term benefit of AHSCT in AD patients with acceptable toxicity.

Keywords

Adult patients Autoimmune disease Autologous Haematopoietic stem cell transplantation 

Notes

Acknowledgments

The authors would like to thank all physicians and professionals who participated in this study:

Mathieu Allez (Paris Saint Louis)

Pauline Belenotti (Marseille)

Denis Caillot (Dijon)

Frederick Christy (Marseille)

Catherine Cordonnier (Créteil)

Audrey Cras (Paris Saint Louis)

Eric Deconinck (Besancon)

Elisabeth Diot (Tours)

Guillaume Drugmanne (Brest)

Nathalie Hugon (Poitiers)

Pauline Lansiaux (Paris Saint Louis)

Thierry Le Gall (Brest)

Xavier Mariette (KB)

Mauricette Michalet (Lyon)

Marc Michel (Créteil)

Luc Mouthon (Cochin)

Vivane Queyrel (Nice)

Danielle Ragonneau (Dijon)

Myriam Renault (Lyon)

Pascal Roblot (Poitiers)

Florence Sarrot-Reynauld (Grenoble)

Compliance with ethical standards

This study was performed in accordance with the ethical guidelines of the 1975 Declaration of Helsinki. Informed consent was obtained from all patients before AHSCT.

Disclosures

None.

References

  1. 1.
    Tyndall A, Black C, Finke J, Winkler J, Mertlesmann R, Peter HH, Gratwohl A (1997) Treatment of systemic sclerosis with autologous haemopoietic stem cell transplantation. Lancet 349(9047):254CrossRefPubMedGoogle Scholar
  2. 2.
    Gratwohl A, Tyndall A (1997) Hematopoietic stem cell transplantations in treatment of autoimmune diseases. Z Rheumatol 56(4):173–177CrossRefPubMedGoogle Scholar
  3. 3.
    Farge D, Henegar C, Carmagnat M, Daneshpouy M, Marjanovic Z, Rabian C, Ilie D, Douay C, Mounier N, Clave E, Bengoufa D, Cabane J, Marolleau JP, Gluckman E, Charron D, Toubert A, for the Intensification et Autogreffe dans les Maladies Auto Immunes Résistantes (ISAMAIR) Study Group (2005) Analysis of immune reconstitution after autologous bone marrow transplantation in systemic sclerosis. Arthritis Rheum 52(5):1555–1563CrossRefPubMedGoogle Scholar
  4. 4.
    Arruda LCM, Clave E, Moins-Teisserenc H, Douay C, Farge D, Toubert A (2016) Resetting the immune response after autologous hematopoietic stem cell transplantation for autoimmune diseases. Curr Res Transl Med 64(2):107–113CrossRefPubMedGoogle Scholar
  5. 5.
    Burt RK, Shah SJ, Dill K, Grant T, Gheorghiade M, Schroeder J, Craig R, Hirano I, Marshall K, Ruderman E, Jovanovic B, Milanetti F, Jain S, Boyce K, Morgan A, Carr J, Barr W (2011) Autologous non-myeloablative haemopoietic stem-cell transplantation compared with pulse cyclophosphamide once per month for systemic sclerosis (ASSIST): an open-label, randomised phase 2 trial. Lancet 378(9790):498–506CrossRefPubMedGoogle Scholar
  6. 6.
    van Laar JM, Farge D, Sont JK, Naraghi K, Marjanovic Z, Larghero J, Schuerwegh AJ, Marijt EW, Vonk MC, Schattenberg AV, Matucci-Cerinic M, Voskuyl AE, van de Loosdrecht A, Daikeler T, Kötter I, Schmalzing M, Martin T, Lioure B, Weiner SM, Kreuter A, Deligny C, Durand JM, Emery P, Machold KP, Sarrot-Reynauld F, Warnatz K, Adoue DF, Constans J, Tony HP, del Papa N, Fassas A, Himsel A, Launay D, Lo Monaco A, Philippe P, Quéré I, Rich É, Westhovens R, Griffiths B, Saccardi R, van den Hoogen F, Fibbe WE, Socié G, Gratwohl A, Tyndall A, EBMT/EULAR Scleroderma Study Group (2014) Autologous hematopoietic stem cell transplantation vs intravenous pulse cyclophosphamide in diffuse cutaneous systemic sclerosis: a randomized clinical trial. JAMA 311(24):2490–2498CrossRefPubMedGoogle Scholar
  7. 7.
    Mancardi GL, Sormani MP, Gualandi F, Saiz A, Carreras E, Merelli E, Donelli A, Lugaresi A, di Bartolomeo P, Rottoli MR, Rambaldi A, Amato MP, Massacesi L, di Gioia M, Vuolo L, Currò D, Roccatagliata L, Filippi M, Aguglia U, Iacopino P, Farge D, Saccardi R, ASTIMS Haemato-Neurological Collaborative Group, On behalf of the Autoimmune Disease Working Party (ADWP) of the European Group for Blood and Marrow Transplantation (EBMT), ASTIMS Haemato-Neurological Collaborative Group On behalf of the Autoimmune Disease Working Party ADWP of the European Group for Blood and Marrow Transplantation EBMT (2015) Autologous hematopoietic stem cell transplantation in multiple sclerosis: a phase II trial. Neurology 84(10):981–988CrossRefPubMedGoogle Scholar
  8. 8.
    Hawkey CJ, Allez M, Clark MM, Labopin M, Lindsay JO, Ricart E, Rogler G, Rovira M, Satsangi J, Danese S, Russell N, Gribben J, Johnson P, Larghero J, Thieblemont C, Ardizzone S, Dierickx D, Ibatici A, Littlewood T, Onida F, Schanz U, Vermeire S, Colombel JF, Jouet JP, Clark E, Saccardi R, Tyndall A, Travis S, Farge D (2015) Autologous hematopoetic stem cell transplantation for refractory Crohn disease: a randomized clinical trial. JAMA 314(23):2524–2534CrossRefPubMedGoogle Scholar
  9. 9.
    Atkins HL, Bowman M, Allan D, Anstee G, Arnold DL, Bar-Or A, Bence-Bruckler I, Birch P, Bredeson C, Chen J, Fergusson D, Halpenny M, Hamelin L, Huebsch L, Hutton B, Laneuville P, Lapierre Y, Lee H, Martin L, McDiarmid S, O'Connor P, Ramsay T, Sabloff M, Walker L, Freedman MS (2016) Immunoablation and autologous haemopoietic stem-cell transplantation for aggressive multiple sclerosis: a multicentre single-group phase 2 trial. Lancet 388(10044):576–585CrossRefPubMedGoogle Scholar
  10. 10.
    Sullivan KM, Goldmuntz EA, Keyes-Elstein L, McSweeney PA, Pinckney A, Welch B et al (2018) Myeloablative autologous stem-cell transplantation for severe scleroderma. N Engl J Med 378(1):35–47CrossRefPubMedGoogle Scholar
  11. 11.
    Ljungman P, Bregni M, Brune M, Cornelissen J, de Witte T, Dini G et al (2010) Allogeneic and autologous transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe 2009. Bone Marrow Transplant 45(2):219–234CrossRefPubMedGoogle Scholar
  12. 12.
    Snowden JA, Saccardi R, Allez M, Ardizzone S, Arnold R, Cervera R, Denton C, Hawkey C, Labopin M, Mancardi G, Martin R, Moore JJ, Passweg J, Peters C, Rabusin M, Rovira M, van Laar J, Farge D, EBMT Autoimmune Disease Working Party (ADWP), Paediatric Diseases Working Party (PDWP) (2012) Haematopoietic SCT in severe autoimmune diseases: updated guidelines of the European group for blood and marrow transplantation. Bone Marrow Transplant 47(6):770–790CrossRefPubMedGoogle Scholar
  13. 13.
    Snowden JA, Badoglio M, Labopin M, Giebel S, McGrath E, Marjanovic Z et al (2017) Evolution, trends, outcomes, and economics of hematopoietic stem cell transplantation in severe autoimmune diseases. Blood Adv 1(27):2742–2755CrossRefPubMedGoogle Scholar
  14. 14.
    Pugnet G, Castilla-Llorente C, Puyade M, Terriou L, Badoglio M, Deligny C, Guillaume-Jugnot P, Labeyrie C, Benzidia I, Faivre H, Lansiaux P, Marjanovic Z, Bourhis JH, Faucher C, Furst S, Huynh A, Martin T, Vermersch P, Yakoub-Agha I, Farge D (2017) Indications and follow-up for autologous hematopoietic stem cell transplantation in autoimmune and autoinflammatory diseases: guidelines from the francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC). Bull Cancer 104(12S):S169–S180CrossRefPubMedGoogle Scholar
  15. 15.
    Farge D, Labopin M, Tyndall A, Fassas A, Mancardi GL, Van Laar J et al (2010) Autologous hematopoietic stem cell transplantation for autoimmune diseases: an observational study on 12 years’ experience from the European Group for Blood and Marrow Transplantation Working Party on autoimmune diseases. Haematologica 95(2):284–292CrossRefPubMedGoogle Scholar
  16. 16.
    Gratwohl A, Passweg J, Bocelli-Tyndall C, Fassas A, van Laar JM, Farge D et al (2005) Autologous hematopoietic stem cell transplantation for autoimmune diseases. Bone Marrow Transplant 35(9):869–879CrossRefPubMedGoogle Scholar
  17. 17.
    Nash RA, McSweeney PA, Crofford LJ, Abidi M, Chen C-S, Godwin JD et al (2007) High-dose immunosuppressive therapy and autologous hematopoietic cell transplantation for severe systemic sclerosis: long-term follow-up of the US multicenter pilot study. Blood 110(4):1388–1396CrossRefPubMedGoogle Scholar
  18. 18.
    Farge D, Marolleau JP, Zohar S, Marjanovic Z, Cabane J, Mounier N, Hachulla E, Philippe P, Sibilia J, Rabian C, Chevret S, Gluckman E, for the Intensification et Autogreffe dans les Maladies Auto Immunes Resistantes (ISAMAIR) Study Group* (2002) Autologous bone marrow transplantation in the treatment of refractory systemic sclerosis: early results from a French multicentre phase I-II study. Br J Haematol 119(3):726–739CrossRefPubMedGoogle Scholar
  19. 19.
    Alexander T, Bondanza A, Muraro PA, Greco R, Saccardi R, Daikeler T et al (2015) SCT for severe autoimmune diseases: consensus guidelines of the European Society for Blood and Marrow Transplantation for immune monitoring and biobanking. Bone Marrow Transplant 50(2):173–180CrossRefPubMedGoogle Scholar
  20. 20.
    Farge D, Burt RK, Oliveira M-C, Mousseaux E, Rovira M, Marjanovic Z, de Vries-Bouwstra J, del Papa N, Saccardi R, Shah SJ, Lee DC, Denton C, Alexander T, Kiely DG, Snowden JA (2017) Cardiopulmonary assessment of patients with systemic sclerosis for hematopoietic stem cell transplantation: recommendations from the European Society for Blood and Marrow Transplantation Autoimmune Diseases Working Party and collaborating partners. Bone Marrow Transplant 52(11):1495–1503CrossRefPubMedGoogle Scholar
  21. 21.
    Farge D, Terriou L, Badoglio M, Cras A, Desreumaux P, Hadj-Khelifa S, Marjanovic Z, Moisan A, Dulery R, Faucher C, Hij A, Martin T, Vermersch P, Yakoub-Agha I (2014) Autologous stem cell transplantation for autoimmune diseases: recommendations from the SFGM-TC. Pathol Biol 62(4):204–208CrossRefPubMedGoogle Scholar
  22. 22.
    Furst DE, Clements PJ, Steen VD, Medsger TA, Masi AT, D’Angelo WA et al (1998) The modified Rodnan skin score is an accurate reflection of skin biopsy thickness in systemic sclerosis. J Rheumatol 25(1):84–88PubMedGoogle Scholar
  23. 23.
    Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 33(11):1444–1452CrossRefPubMedGoogle Scholar
  24. 24.
    Styczynski J, van der Velden W, Fox CP, Engelhard D, de la Camara R, Cordonnier C, Ljungman P, on behalf of the Sixth European Conference on Infections in Leukemia, a joint venture of the Infectious Diseases Working Party of the European Society of Blood and Marrow Transplantation (EBMT-IDWP), the Infectious Diseases Group of the European Organizat (2016) Management of Epstein-Barr Virus infections and post-transplant lymphoproliferative disorders in patients after allogeneic hematopoietic stem cell transplantation: sixth European conference on infections in leukemia (ECIL-6) guidelines. Haematologica 101(7):803–811CrossRefPubMedGoogle Scholar
  25. 25.
    Marmont AM, van Lint MT, Gualandi F, Bacigalupo A (1997) Autologous marrow stem cell transplantation for severe systemic lupus erythematosus of long duration. Lupus 6(6):545–548CrossRefPubMedGoogle Scholar
  26. 26.
    Kreisel W, Potthoff K, Bertz H, Schmitt-Graeff A, Ruf G, Rasenack J, Finke J (2003) Complete remission of Crohn’s disease after high-dose cyclophosphamide and autologous stem cell transplantation. Bone Marrow Transplant 32(3):337–340CrossRefPubMedGoogle Scholar
  27. 27.
    Liu D, Yuan N, Yu G, Song G, Chen Y (2017) Can rheumatoid arthritis ever cease to exist: a review of various therapeutic modalities to maintain drug-free remission? Am J Transl Res 9(8):3758–3775PubMedGoogle Scholar
  28. 28.
    Arai Y, Jo T, Matsui H, Kondo T, Takaori-Kondo A (2018) Comparison of up-front treatments for newly diagnosed immune thrombocytopenia—a systematic review and network meta-analysis. Haematologica 103(1):163–171CrossRefPubMedGoogle Scholar
  29. 29.
    Kleinmann J-F, Tubach F, Le Guern V, Mathian A, Richez C, Saadoun D et al (2017) International and multidisciplinary expert recommendations for the use of biologics in systemic lupus erythematosus. Autoimmun Rev 16(6):650–657CrossRefPubMedGoogle Scholar
  30. 30.
    Gratwohl A, Sureda A, Baldomero H, Gratwohl M, Dreger P, Kröger N, Ljungman P, McGrath E, Mohty M, Nagler A, Rambaldi A, de Elvira CR, Snowden JA, Passweg J, Apperley J, Niederwieser D, Stijnen T, Brand R, Joint Accreditation Committee (JACIE) of the International Society for Cellular Therapy (ISCT) and the European Society for Blood and Marrow Transplantation (EBMT) and the European Leukemia Net (ELN) (2015) Economics and outcome after hematopoietic stem cell transplantation: a retrospective cohort study. EBioMedicine 2(12):2101–2109CrossRefPubMedGoogle Scholar
  31. 31.
    Saccardi R, Tyndall A, Coghlan G, Denton C, Edan G, Emdin M, Farge D, Fassas A, Finke J, Furst D, Lassus M, Mancardi G, Miniati I, Mini E, Pagliai F, Passweg J, Pignone A, van Laar JM, Bocelli-Tyndall C, Matucci-Cerinic M (2004) Consensus statement concerning cardiotoxicity occurring during haematopoietic stem cell transplantation in the treatment of autoimmune diseases, with special reference to systemic sclerosis and multiple sclerosis. Bone Marrow Transplant 34(10):877–881CrossRefPubMedGoogle Scholar
  32. 32.
    Burt RK, Oliveira MC, Shah SJ, Moraes DA, Simoes B, Gheorghiade M, Schroeder J, Ruderman E, Farge D, Chai ZJ, Marjanovic Z, Jain S, Morgan A, Milanetti F, Han X, Jovanovic B, Helenowski IB, Voltarelli J (2013) Cardiac involvement and treatment-related mortality after non-myeloablative haemopoietic stem-cell transplantation with unselected autologous peripheral blood for patients with systemic sclerosis: a retrospective analysis. Lancet 381(9872):1116–1124CrossRefPubMedGoogle Scholar
  33. 33.
    Elhai M, Meune C, Boubaya M, Avouac J, Hachulla E, Balbir-Gurman A, Riemekasten G, Airò P, Joven B, Vettori S, Cozzi F, Ullman S, Czirják L, Tikly M, Müller-Ladner U, Caramaschi P, Distler O, Iannone F, Ananieva LP, Hesselstrand R, Becvar R, Gabrielli A, Damjanov N, Salvador MJ, Riccieri V, Mihai C, Szücs G, Walker UA, Hunzelmann N, Martinovic D, Smith V, Müller CS, Montecucco CM, Opris D, Ingegnoli F, Vlachoyiannopoulos PG, Stamenkovic B, Rosato E, Heitmann S, Distler JHW, Zenone T, Seidel M, Vacca A, Langhe ED, Novak S, Cutolo M, Mouthon L, Henes J, Chizzolini C, Mühlen CA, Solanki K, Rednic S, Stamp L, Anic B, Santamaria VO, Santis MD, Yavuz S, Sifuentes-Giraldo WA, Chatelus E, Stork J, Laar J, Loyo E, García de la Peña Lefebvre P, Eyerich K, Cosentino V, Alegre-Sancho JJ, Kowal-Bielecka O, Rey G, Matucci-Cerinic M, Allanore Y (2017) Mapping and predicting mortality from systemic sclerosis. Ann Rheum Dis 76(11):1897–1905CrossRefPubMedGoogle Scholar
  34. 34.
    Mousseaux E, Agoston-Coldea L, Marjanovic Z, Stanciu R, Deligny C, Perdrix L, Boutouyrie P, Azarine A, Soulat G, Farge D (2018) Left ventricle replacement fibrosis detected by CMR associated with cardiovascular events in systemic sclerosis patients. J Am Coll Cardiol 71(6):703–705CrossRefPubMedGoogle Scholar
  35. 35.
    Cyclophosphamide and rATG/rituximab in patients with systemic lupus erythematosus - full text view – ClinicalTrials.gov [Internet]. [cited 2018 Jun 22]. Available from: https://clinicaltrials.gov/ct2/show/NCT00278538. Accessed 22 June 2018
  36. 36.
    Daikeler T, Labopin M, Di Gioia M, Abinun M, Alexander T, Miniati I et al (2011) Secondary autoimmune diseases occurring after HSCT for an autoimmune disease: a retrospective study of the EBMT autoimmune disease working party. Blood 118(6):1693–1698CrossRefPubMedGoogle Scholar
  37. 37.
    Sargin G, Senturk T, Cildag S (2018) Systemic sclerosis and malignancy. Int J Rheum Dis 21(5):1093–1097CrossRefPubMedGoogle Scholar
  38. 38.
    Deligny C, Clave E, Sibon D, Daikeler T, Keshmandt H, Carmagnat M, Douay C, Arfi S, Clair B, Toubert A, Farge D (2010) New onset of myasthenia gravis after treatment of systemic sclerosis by autologous hematopoietic stem cell transplantation: sustained autoimmunity or inadequate reset of tolerance? Hum Immunol 71(4):363–365CrossRefPubMedGoogle Scholar
  39. 39.
    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90CrossRefPubMedGoogle Scholar
  40. 40.
    Snowden JA, Pearce RM, Lee J, Kirkland K, Gilleece M, Veys P, Clark RE, Kazmi M, Abinun M, Jackson GH, Mackinnon S, Russell NH, Cook G, on behalf of the BSBMT Clinical Trials Committee (2012) Haematopoietic stem cell transplantation (HSCT) in severe autoimmune diseases: analysis of UK outcomes from the British Society of Blood and Marrow Transplantation (BSBMT) data registry 1997-2009. Br J Haematol 157(6):742–746CrossRefPubMedGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  • Perrine Guillaume-Jugnot
    • 1
    • 2
  • Manuela Badoglio
    • 3
    • 4
  • Myriam Labopin
    • 4
    • 5
  • Louis Terriou
    • 6
  • Ibrahim Yakoub-Agha
    • 7
  • Thierry Martin
    • 8
  • Bruno Lioure
    • 9
  • Zora Marjanovic
    • 10
  • Didier Blaise
    • 11
  • Stéphanie Nguyen
    • 2
    • 12
  • Gregory Pugnet
    • 13
  • Anne Huynh
    • 14
  • Christophe Deligny
    • 15
  • Christophe Seinturier
    • 16
  • Frédéric Garban
    • 17
  • Laure Swiader
    • 18
  • Jacques-Olivier Bay
    • 19
  • Thorsten Braun
    • 20
  • Régis Peffault de Latour
    • 21
    • 22
  • Marie Thérèse Rubio
    • 23
    • 24
  • Dominique Farge
    • 22
    • 25
    • 26
    • 27
    Email author
  1. 1.Département de Médecine Interne et Immunologie Clinique, APHPHôpital La Pitié SalpêtrièreParisFrance
  2. 2.Université Pierre et Marie CurieParisFrance
  3. 3.EBMT Paris study officeSaint Antoine HospitalParisFrance
  4. 4.Université Pierre et Marie CurieParisFrance
  5. 5.EBMT Paris study office, Department of HaematologySaint Antoine HospitalParisFrance
  6. 6.Service de Médecine Interne et Hématologie, CHRU LilleHôpital Claude HuriezLilleFrance
  7. 7.Service des Maladies du sangCHRU Lille, Hôpital Claude HuriezLilleFrance
  8. 8.Service d’Immunologie Clinique, VIH et Médecine Interne, CHRU StrasbourgNouvel Hôpital CivilStrasbourg CedexFrance
  9. 9.Service d’HématologieHôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg (HUS)StrasbourgFrance
  10. 10.Service d’Hématologie, APHPHôpital Saint AntoineParisFrance
  11. 11.Institut Paoli-Calmettes, CLCC Institut Paoli-CalmettesMarseille Cedex 9France
  12. 12.Service Hématologie Clinique, APHPHôpital La Pitié SalpêtrièreParisFrance
  13. 13.Service de Médecine Interne, CHU ToulouseHôpital PurpanToulouseFrance
  14. 14.Service d’hématologie, CHU / IUCT Oncopole de ToulouseInstitut Universitaire du Cancer de ToulouseToulouse Cedex 9France
  15. 15.Service de Rhumatologie et de Médecine Interne, CHU MartiniqueHôpital P. Zobda-QuitmanFort de FranceFrance
  16. 16.Service de Médecine Vasculaire, Pôle pluridisciplinaire de Médecine, CHU Grenoble Alpes, Site NordHôpital Couple EnfantGrenoble Cedex 9France
  17. 17.Service d’Hématologie, Pôle cancer et Maladies du SangCHU Grenoble Alpes CS10217Grenoble Cedex 9France
  18. 18.Département de Médecine Interne, APHMHôpital de la TimoneMarseille Cedex 05France
  19. 19.Service de Thérapie Cellulaire et Hématologie Clinique, CHU de Clermont FerrandHôpital d’EstaingClermont Ferrand Cedex 1France
  20. 20.Service d’Hématologie, APHPHôpital d’AvicenneBobignyFrance
  21. 21.Service d’Hématologie et Greffe de Moelle, APHPHôpital St-LouisParisFrance
  22. 22.Université Denis DiderotParisFrance
  23. 23.Service d’Hématologie, CHRU NancyHôpital BraboisVandoeuvre les NancyFrance
  24. 24.IMoPA, CNRS UMR 7365Université de LorraineVandoeuvre les NancyFrance
  25. 25.Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), Institut Universitaire d’Hématologie EA3518, APHPHôpital St-LouisParisFrance
  26. 26.Centre de Référence des Maladies auto-immunes systémiques Rares d’Ile-de-France (site constitutif)Filière FAI2R, SFGM-TCLilleFrance
  27. 27.Département de MédecineUniversité McGillMontrealCanada

Personalised recommendations