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Buonadonna A, Scalone S, Lombardi D, Fumagalli A, Guglielmi A, Lestuzzi C, Polesel J, Canzonieri V, Lamon S, Giovanis P, Gagno S, Corona G, Mascarin M, Belluco C, De Paoli A, Fasola G, Puglisi F, Miolo G. Prospective, Multicenter Phase II Trial of Non-Pegylated Liposomal Doxorubicin Combined with Ifosfamide in First-Line Treatment of Advanced/Metastatic Soft Tissue Sarcomas. Cancers (Basel) 2023; 15:5036. [PMID: 37894403 PMCID: PMC10605752 DOI: 10.3390/cancers15205036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Doxorubicin is a widely used anticancer agent as a first-line treatment for various tumor types, including sarcomas. Its use is hampered by adverse events, among which is the risk of dose dependence. The potential cardiotoxicity, which increases with higher doses, poses a significant challenge to its safe and effective application. To try to overcome these undesired effects, encapsulation of doxorubicin in liposomes has been proposed. Caelyx and Myocet are different formulations of pegylated (PLD) and non-pegylated liposomal doxorubicin (NPLD), respectively. Both PLD and NPLD have shown similar activity compared with free drugs but with reduced cardiotoxicity. While the hand-foot syndrome exhibits a high occurrence among patients treated with PLD, its frequency is notably reduced in those receiving NPLD. In this prospective, multicenter, one-stage, single-arm phase II trial, we assessed the combination of NPLD and ifosfamide as first-line treatment for advanced/metastatic soft tissue sarcoma (STS). Patients received six cycles of NPLD (50 mg/m2) on day 1 along with ifosfamide (3000 mg/m2 on days 1, 2, and 3 with equidose MESNA) administered every 3 weeks. The overall response rate, yielding 40% (95% CI: 0.29-0.51), resulted in statistical significance; the disease control rate stood at 81% (95% CI: 0.73-0.90), while only 16% (95% CI: 0.08-0.24) of patients experienced a progressive disease. These findings indicate that the combination of NPLD and ifosfamide yields a statistically significant response rate in advanced/metastatic STS with limited toxicity.
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Affiliation(s)
- Angela Buonadonna
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di RiferimentoOncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; (A.B.); (S.S.); (D.L.); (A.F.); or (F.P.)
| | - Simona Scalone
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di RiferimentoOncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; (A.B.); (S.S.); (D.L.); (A.F.); or (F.P.)
| | - Davide Lombardi
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di RiferimentoOncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; (A.B.); (S.S.); (D.L.); (A.F.); or (F.P.)
| | - Arianna Fumagalli
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di RiferimentoOncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; (A.B.); (S.S.); (D.L.); (A.F.); or (F.P.)
| | - Alessandra Guglielmi
- Oncology Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34100 Trieste, Italy;
| | - Chiara Lestuzzi
- Department of Cardiology, Azienda Sanitaria Friuli Occidentale (ASFO), Cardiology Unit at Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy;
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy;
| | - Vincenzo Canzonieri
- Pathology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy;
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Stefano Lamon
- Unit of Oncology, Oderzo Hospital, Azienda ULSS 2 Marca Trevigiana, 31046 Oderzo, Italy;
| | - Petros Giovanis
- Department of Oncology, Unit of Oncology, Santa Maria del Prato Hospital, Azienda ULSS 1 Dolomiti, 32032 Feltre, Italy;
| | - Sara Gagno
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy;
| | - Giuseppe Corona
- Immunopathology and Cancer Biomarkers, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy;
| | - Maurizio Mascarin
- AYA Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy;
| | - Claudio Belluco
- Department of Surgical Oncology, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy;
| | - Antonino De Paoli
- Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy;
| | - Gianpiero Fasola
- Department of Oncology, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), 33100 Udine, Italy;
| | - Fabio Puglisi
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di RiferimentoOncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; (A.B.); (S.S.); (D.L.); (A.F.); or (F.P.)
- Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Gianmaria Miolo
- Department of Medical Oncology, Unit of Medical Oncology and Cancer Prevention, Centro di RiferimentoOncologico di Aviano (CRO), IRCCS, 33081 Aviano, Italy; (A.B.); (S.S.); (D.L.); (A.F.); or (F.P.)
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Arcari A, Rigacci L, Tucci A, Puccini B, Usai SV, Cavallo F, Fabbri A, Balzarotti M, Pelliccia S, Luminari S, Pennese E, Zilioli VR, Mahmoud AM, Musuraca G, Marino D, Sartori R, Botto B, Gini G, Zanni M, Hohaus S, Tarantini G, Flenghi L, Tani M, Di Rocco A, Merli M, Vallisa D, Pagani C, Nassi L, Dessì D, Ferrero S, Cencini E, Bernuzzi P, Mammi C, Marcheselli L, Tabanelli V, Spina M, Merli F. A Fondazione Italiana Linfomi cohort study of R-COMP vs R-CHOP in older patients with diffuse large B-cell lymphoma. Blood Adv 2023; 7:4160-4169. [PMID: 37276080 PMCID: PMC10407138 DOI: 10.1182/bloodadvances.2023009839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/11/2023] [Accepted: 05/14/2023] [Indexed: 06/07/2023] Open
Abstract
Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) is the most commonly used regimen for the upfront treatment of diffuse large B-cell lymphoma (DLBCL). However, it is associated with cardiotoxicity, especially in older patients. Substituting doxorubicin with non-PEGylated liposomal doxorubicin (R-COMP) may reduce the risk of cardiac events, but its efficacy has never been demonstrated in prospective trials. We describe the characteristics and outcome of patients with DLBCL aged ≥65 years prospectively enrolled in the Elderly Project by the Fondazione Italiana Linfomi and treated with full doses of R-CHOP or R-COMP per local practice. Starting from 1163 patients, 383 (55%) were treated with R-CHOP and 308 (45%) with R-COMP. Patients treated with R-COMP were older (median age, 76 vs 71 years), less frequently fit at simplified geriatric assessment (61% vs 88%; P < .001), and had a more frequent baseline cardiac disorders (grade >1, 32% vs 8%; P < .001). Three-year progression-free survival (PFS) was similar between R-CHOP and R-COMP (70% and 64%); 3-year overall survival was 77%, and 71% respectively. R-CHOP was associated with better PFS vs R-COMP only in the Elderly Prognostic Index (EPI) low-risk group. The two groups had similar rates of treatment interruptions due to toxicities or of cardiac events (P = 1.00). We suggest R-COMP is a potentially curative treatment for older patients with intermediate- or high-risk EPI, even in the presence of a baseline cardiopathy. R-CHOP is confirmed as the standard therapy for low risk patients.
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Affiliation(s)
- Annalisa Arcari
- Hematology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Lugi Rigacci
- UOC Hematology and Stem Cell Transplantation, AO San Camillo Forlanini, Roma, Italy
| | - Alessandra Tucci
- Hematology Division, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Benedetta Puccini
- Lymphoma Unit, Hematology Department, Careggi Hospital and University of Florence, Firenze, Italy
| | - Sara Veronica Usai
- Division of Hematology, Ospedale Oncologico Armando Businco, Cagliari, Italy
| | - Federica Cavallo
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino/AOU “Città della Salute e della Scienza di Torino,” Torino, Italy
| | - Alberto Fabbri
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | - Monica Balzarotti
- Department of Medical Oncology and Hematology, Humanitas Clinical Research Hospital Istituto di Ricovero e Cura a Carattere Scientifico, Rozzano, Milan, Italy
| | - Sabrina Pelliccia
- Hematology, Department of Clinical and Molecular Medicine, University Hospital Sant’Andrea, Sapienza University of Rome, Rome, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department CHIMOMO, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Elsa Pennese
- Lymphoma Unit, Department of Hematology, Ospedale Spirito Santo, Pescara, Italy
| | | | | | - Gerardo Musuraca
- Hematology, IRCCS Istituto Scientifico Romagnolo per lo Studio dei Tumori “Dino Amadori,” Meldola, Forlì-Cesena, Italy
| | - Dario Marino
- Department of Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Roberto Sartori
- Oncohematology Unit, Veneto Institute of Oncology, Veneto Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico, Castelfranco Veneto, Treviso, Italy
| | - Barbara Botto
- Division of Hematology, Città della Salute e della Scienza Hospital and University, Torino, Italy
| | - Guido Gini
- Division of Hematology, Azienda Ospedaliera Universitaria Ospedali Riuniti, Ancona, Italy
| | - Manuela Zanni
- Hematology Unit, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Stefan Hohaus
- University Policlinico Gemelli Foundation Istituto di Ricovero e Cura a Carattere Scientifico, Catholic University of the Sacred Heart, Roma, Italy
| | - Giuseppe Tarantini
- Haematology and Bone Marrow Transplant Unit, Ospedale Monsignor R. Dimiccoli, Barletta, Italy
| | - Leonardo Flenghi
- Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Monica Tani
- Hematology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Alice Di Rocco
- Institute of Hematology, Department of Translational and Precision Medicine “Sapienza,” University of Roma, Roma, Italy
| | - Michele Merli
- Division of Hematology, Ospedale di Circolo e Fondazione Macchi ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Daniele Vallisa
- Hematology Unit, Ospedale Guglielmo da Saliceto, Piacenza, Italy
| | - Chiara Pagani
- Hematology Division, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Luca Nassi
- Lymphoma Unit, Hematology Department, Careggi Hospital and University of Florence, Firenze, Italy
| | - Daniela Dessì
- Division of Hematology, Ospedale Oncologico Armando Businco, Cagliari, Italy
| | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino/AOU “Città della Salute e della Scienza di Torino,” Torino, Italy
| | - Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese and University of Siena, Siena, Italy
| | | | - Caterina Mammi
- Gruppo Amici dell'Ematologia GRADE Onlus Foundation, Reggio Emilia, Italy
| | | | - Valentina Tabanelli
- Division of Haematopathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Michele Spina
- Division of Medical Oncology and Immune-related Tumors, Centro di Riferimento Oncologico di Aviano IRCCS, Aviano, Pordenone, Italy
| | - Francesco Merli
- Hematology Unit, Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Gao H, Xu Y, Liu Y, Mi L, Wang X, Liu W, Zhu J, Song Y. A Comparison of Clinical Prognostic Indices in Elderly Patients with Diffuse Large B-Cell Lymphoma Treated with a Pegylated Liposomal Doxorubicin Combination Regimen in China. Cancer Manag Res 2022; 14:2711-2721. [PMID: 36133738 PMCID: PMC9482890 DOI: 10.2147/cmar.s359956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background There is no consensus regarding the risk stratification scores for elderly patients with diffuse large B-cell lymphoma (DLBCL). We aimed to compare the prognostic predictive ability of the current clinical scoring indices in DLBCL elderly patients treated with the R-CODP regimen (rituximab, cyclophosphamide, pegylated liposomal doxorubicin, vincristine, and prednisone). Methods We retrospectively collected the data of elderly DLBCL patients who received the R-CODP regimen as the first-line treatment. The efficacy of the regimen was evaluated. The Akaike information criteria (AIC), concordance index (C-index), and integrated discrimination improvement (IDI) were used to assess the fitness and prognostic performance of the current clinical prognostic indices. Results In the total of 158 patients enrolled, the median follow-up time was 6.7 years (95% CI: 6.3–7.9), and the 5-year OS was 52.8% (95% CI: 45.5%–61.2%). The International Prognostic Index (IPI), National Comprehensive Cancer Network-IPI (NCCN-IPI), and Elderly International Prognostic Index (E-IPI) were all significantly associated with OS (P < 0.001 for all). However, no significance was observed in 5-year OS in the low- vs low-intermediate-risk groups for IPI (P = 0.377), NCCN-IPI (P = 0.238), and E-IPI (P = 0.080). Compared with the IPI and NCCN-IPI, the E-IPI had the lowest AIC value of 747.5 and the highest C-index of 0.692. For predicting 5-year mortality, the E-IPI showed better performance (AUC: 0.715 for E-IPI vs 0.676 for IPI, P = 0.036), with the IDI of 6.29% (95% CI: 3.71%-8.88%, P < 0.001) and 4.80% (95% CI: 1.32%-8.28%, P = 0.007) compared to the IPI and NCCN-IPI, respectively. Conclusion The E-IPI might be a better prognostic prediction model in Chinese DLBCL generics treated with R-CODP for predicting 5-year mortality. However, the IPI, NCCN-IPI, and E-IPI did not seem to be able to distinguish patients with a favorable prognosis well.
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Affiliation(s)
- Hongye Gao
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yanfeng Xu
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yanfei Liu
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Lan Mi
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Xiaopei Wang
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Weiping Liu
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jun Zhu
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yuqin Song
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
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Su X, Zhang X, Liu W, Yang X, An N, Yang F, Sun J, Xing Y, Shang H. Advances in the application of nanotechnology in reducing cardiotoxicity induced by cancer chemotherapy. Semin Cancer Biol 2021; 86:929-942. [PMID: 34375726 DOI: 10.1016/j.semcancer.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 02/08/2023]
Abstract
Advances in the development of anti-tumour drugs and related technologies have resulted in a significant increase in the number of cancer survivors. However, the incidence of chemotherapy-induced cardiotoxicity (CIC) has been rising continuously, threatening their long-term survival. The integration of nanotechnology and biomedicine has brought about an unprecedented technological revolution and has promoted the progress of anti-tumour therapy. In this review, we summarised the possible mechanisms of CIC, evaluated the role of nanoparticles (including liposomes, polymeric micelles, dendrimers, and hydrogels) as drug carriers in preventing cardiotoxicity and proposed five advantages of nanotechnology in reducing cardiotoxicity: Liposomes cannot easily penetrate the heart's endothelial barrier; optimized delivery strategies reduce distribution in important organs, such as the heart; targeting the tumour microenvironment and niche; stimulus-responsive polymer nano-drug carriers rapidly iterate; better economic benefits were obtained. Nanoparticles can effectively deliver chemotherapeutic drugs to tumour tissues, while reducing the toxicity to heart tissues, and break through the dilemma of existing chemotherapy to a certain extent. It is important to explore the interactions between the physicochemical properties of nanoparticles and optimize the highly specific tumour targeting strategy in the future.
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Affiliation(s)
- Xin Su
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoyu Zhang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wenjing Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xinyu Yang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Na An
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Fan Yang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiahao Sun
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanwei Xing
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Hongcai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China.
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Visco C, Pregnolato F, Ferrarini I, De Marco B, Bonuomo V, Sbisà E, Fraenza C, Bernardelli A, Tanasi I, Quaglia FM, Krampera M. Efficacy of R-COMP in comparison to R-CHOP in patients with DLBCL: A systematic review and single-arm metanalysis. Crit Rev Oncol Hematol 2021; 163:103377. [PMID: 34087342 DOI: 10.1016/j.critrevonc.2021.103377] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/21/2021] [Accepted: 05/29/2021] [Indexed: 11/29/2022] Open
Abstract
Doxorubicin represents the mainstay in the upfront treatment of diffuse large B-cell lymphoma (DLBCL) patients. However, its administration is sometimes hampered by the coexistence of former comorbidities/cardiac issues, especially in the elderly population. Liposome encapsulated drug delivery systems have been adopted to reduce the exposure of normal tissues to the drug, both in solid cancers and lymphomas. Despite claims for lower toxicity, the efficacy of non-pegylated liposome doxorubicin (NPLD) in DLBCL, as compared to standard doxorubicin, has never been established. We systematically reviewed relevant literature of NPLD in lymphoma treatment. Adjusting for age/comorbidities, our metanalysis revealed that the use of combinations including NPLD (R-COMP) were non-inferior in terms of response, overall and progression-free survival to the standard of care (R-CHOP) in overlapping series of DLBCL patients. R-COMP may represent a safe and active option for elderly patients with DLBCL, or for those with some extent of cardiac impairment at baseline.
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Affiliation(s)
- Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy.
| | - Francesca Pregnolato
- Experimental Laboratory of Immuno-rheumatology, Istituto Auxologico Italiano, IRCCS, Cusano Milanino, Milan, Italy
| | - Isacco Ferrarini
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Beatrice De Marco
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Valentina Bonuomo
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Eugenio Sbisà
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Costanza Fraenza
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Andrea Bernardelli
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Ilaria Tanasi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | | | - Mauro Krampera
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
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Schmittlutz K, Marks R. Current treatment options for aggressive non-Hodgkin lymphoma in elderly and frail patients: practical considerations for the hematologist. Ther Adv Hematol 2021; 12:2040620721996484. [PMID: 33747422 PMCID: PMC7940714 DOI: 10.1177/2040620721996484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/27/2021] [Indexed: 01/01/2023] Open
Abstract
Treatment decisions for aggressive non-Hodgkin lymphoma in elderly and frail patients still remain challenging. The heterogeneity of elderly patients consists of various physical and psychological states, coexisting comorbidities as well as frailty and socioeconomic status. Comprehensive geriatric assessment in elderly patients is efficient and necessary for risk stratification to identify fit patients without cardiac comorbidities who can tolerate curative treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) and those who are not suitable for a standard regimen. If anthracycline-containing therapy is not feasible, alternative treatment options have to be carefully evaluated and individual risk factors have to be considered.
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Affiliation(s)
- Katrin Schmittlutz
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Reinhard Marks
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg im Breisgau 79106, Germany
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Morrison VA, Hamilton L, Ogbonnaya A, Raju A, Hennenfent K, Galaznik A. Treatment approaches for older and oldest patients with diffuse large B-cell lymphoma - Use of non-R-CHOP alternative therapies and impact of comorbidities on treatment choices and outcome: A Humedica database retrospective cohort analysis, 2007-2015. J Geriatr Oncol 2019; 11:41-54. [PMID: 31416716 DOI: 10.1016/j.jgo.2019.07.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/27/2019] [Accepted: 07/30/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION We characterized real-world treatment patterns in older (65-74 years) and oldest (75-85 years) patients with diffuse large B-cell lymphoma (DLBCL) receiving initial therapy (R-CHOP, non-R-CHOP regimens). Impact of comorbidities on treatment choice, and overall and progression-free survival (OS, PFS) were assessed by age. PATIENTS AND METHODS Using the Humedica database, we identified 1436 newly diagnosed patients with DLBCL who received frontline therapy from 1/07-9/15. The 885 patients ≥65 years of age were further evaluated for baseline demographics, comorbidities, initial therapy, and PFS/OS. RESULTS Of 885 patients, 406 (45.9%) were age 65-74, and 479 (54.1%) age 75-85, years. First line therapy was R-CHOP (61.8%) or non-R-CHOP (38.2%). Although Charlson Comorbidity Index (CCI) scores were similar at baseline, congestive heart failure and myocardial infarction were more common in those receiving non-R-CHOP regimens. Survival outcomes were superior for those receiving initial R-CHOP, versus non-R-CHOP, therapy (median PFS 53.9 versus 27.8 months; two-year PFS 71.2% versus 51.6%, p < .0001; median OS not reached versus 45 months; two-year OS 81.3% versus 62.9%, p < .0001, respectively). Only 10.4% (R-CHOP) and 12.1% (non-R-CHOP) of patients received second line therapies. Two-year OS by age (65-74, 75-85 years) was 66.4% and 39.1%, respectively with R-CHOP (p = .0045), and 74.3% and 54.5%, respectively with non-R-CHOP (p = .004), therapy. Age ≥ 75 years and CCI of 2+ were associated with shorter OS and PFS. CONCLUSIONS This study identified real-world first line treatment patterns for older patients with DLBCL. Our findings support the feasibility of administering standard R-CHOP therapy, even to oldest patients with DLBCL.
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Affiliation(s)
- Vicki A Morrison
- Hematology/Oncology, Hennepin County Medical Center, University of Minnesota, 715 8th St, Minneapolis, MN 55404, USA.
| | - Laurie Hamilton
- Xcenda LLC, 4114 Woodlands Parkway, Suite 500, Palm Harbor, FL 34685, USA.
| | | | - Aditya Raju
- Xcenda LLC, 4114 Woodlands Parkway, Suite 500, Palm Harbor, FL 34685, USA.
| | - Kristin Hennenfent
- Xcenda LLC, 4114 Woodlands Parkway, Suite 500, Palm Harbor, FL 34685, USA.
| | - Aaron Galaznik
- Millennium Pharmaceuticals, Inc., 40 Landsdowne St, Cambridge, MA 02139, USA(1).
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Lugtenburg PJ, Lyon AR, Marks R, Luminari S. Treatment of aggressive non-Hodgkin's lymphoma in frail patients: cardiac comorbidities and advanced age. Future Oncol 2019; 15:1197-1205. [PMID: 30730219 DOI: 10.2217/fon-2019-0019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The decisive factor in selecting a treatment regimen for a frail patient with aggressive non-Hodgkin's lymphoma is identifying whether a patient is fit enough to tolerate curative-intent anthracycline-containing regimens or too frail and therefore at risk of being undertreated. As cardiac comorbidities are an important contributor to both the health status and the selection of treatment, cardiovascular profiling and baseline risk stratification prior to treatment should be considered. Comprehensive geriatric assessment is an efficient means of identifying elderly patients with non-Hodgkin's lymphoma who may benefit from a curative treatment approach. If anthracycline-based therapy is not suitable, alternative treatment options are available in frail patients with cardiac comorbidities, but these must be adjusted to the patient's health status to achieve a maximal benefit-risk ratio.
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Affiliation(s)
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton & Harefield NHS Trust, London, UK.,Imperial College London, National Heart & Lung Institute, London, UK
| | - Reinhard Marks
- Department of Hematology, Oncology & Stem Cell Transplantation, Faculty of Medicine & Medical Centre, University of Freiburg, Freiburg, Germany
| | - Stefano Luminari
- Hematology, Azienda USL IRCCS Reggio Emilia, Italy.,CHIMOMO Department University of Modena & Reggio Emilia, Reggio Emilia, Italy
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9
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Nanoparticles applied to cancer immunoregulation. Rep Pract Oncol Radiother 2018; 24:47-55. [PMID: 30425606 DOI: 10.1016/j.rpor.2018.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/08/2018] [Accepted: 10/17/2018] [Indexed: 02/06/2023] Open
Abstract
Aim In recent years, we have seen a considerable increase in the relevance of nanostructures for the safe delivery of therapeutic agents and their capacity as an immunomodulatory tool. Materials and methods Potential clinical applications related to their unique structural properties have been described in the evolving landscape of immunotherapy. Results This review briefly summarizes the evidence for the role of nanoparticles in regulating the immune response. Conclusions Their main features to highlight how to provide an innovative means of biomedical application to oncology research.
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10
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Dou XQ, Wang H, Zhang J, Wang F, Xu GL, Xu CC, Xu HH, Xiang SS, Fu J, Song HF. Aptamer-drug conjugate: targeted delivery of doxorubicin in a HER3 aptamer-functionalized liposomal delivery system reduces cardiotoxicity. Int J Nanomedicine 2018; 13:763-776. [PMID: 29440899 PMCID: PMC5804143 DOI: 10.2147/ijn.s149887] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introduction The toxic side effects of doxorubicin (DOX) have limited its use in chemotherapy. Neither liposomal DOX nor pegylated liposomal DOX are able to completely resolve this issue. This is a proof-of-concept study testing aptamer-drug conjugate (ApDC) targeted delivery systems for chemotherapeutic drugs. Methods Aptamer library targeting human epidermal growth factor receptor 3 (HER3) was screened and affinity was determined by enzyme-linked immunosorbent assay. Specificity was tested in MCF-7HER3-high, BT474HER3-high, and 293THER3-negative cells using flow cytometry and confocal microscopy. We further developed a HER3 aptamer-functionalized liposome encapsulating DOX and the efficiency of this ApDC was detected by cellular uptake analysis and cell viability assay. In MCF-7 tumor-bearing mice, tumor targeting evaluation, efficacy, toxicity and preliminary pharmocokinetic study was performed. Results The candidate #13 aptamer had highest affinity (Kd =98±9.7 nM) and specificity. ApDC effectively reduces the half maximal inhibitory concentration of DOX compared with lipsome-DOX and free DOX. In vivo imaging and preliminary distribution studies showed that actively targeted nanoparticles, such as Apt-Lip-DOX molecules, could facilitate the delivery of DOX into tumors in MCF-7-bearing mice. This targeted chemotherapy caused greater tumor suppression than other groups and alleviated side effects such as weight loss, low survival rate, and organ (heart and liver) injury demonstrated by H&E staining. Conclusion The results indicate that targeted chemotherapy using the aptamer-drug conjugate format could provide better tolerability and efficacy compared with non-targeted delivery in relatively low-dose toxic drugs.
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Affiliation(s)
- Xiao-Qian Dou
- Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Hua Wang
- Ophthalmology Department, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jing Zhang
- Bioanalysis Department, United-Power Pharma Tech Co., Ltd., Beijing, China
| | - Fang Wang
- Bioanalysis Department, United-Power Pharma Tech Co., Ltd., Beijing, China
| | - Gui-Li Xu
- Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Cheng-Cheng Xu
- Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Huan-Hua Xu
- Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Shen-Si Xiang
- Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Jie Fu
- Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, Beijing, China
| | - Hai-Feng Song
- Department of Pharmacology and Toxicology, Beijing Institute of Radiation Medicine, Beijing, China
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11
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Jurj A, Braicu C, Pop LA, Tomuleasa C, Gherman CD, Berindan-Neagoe I. The new era of nanotechnology, an alternative to change cancer treatment. Drug Des Devel Ther 2017; 11:2871-2890. [PMID: 29033548 PMCID: PMC5628667 DOI: 10.2147/dddt.s142337] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
In the last few years, nanostructures have gained considerable interest for the safe delivery of therapeutic agents. Several therapeutic approaches have been reported, such as molecular diagnosis, disease detection, nanoscale immunotherapy and anticancer drug delivery that could be integrated into clinical use. The current paper aims to highlight the background that supports the use of nanoparticles conjugated with different types of therapeutic agents, applicable in targeted therapy and cancer research, with a special emphasis on hematological malignancies. A particular key point is the functional characterization of nonviral delivery systems, such as gold nanoparticles, liposomes and dendrimers. The paper also presents relevant published data related to microRNA and RNA interference delivery using nanoparticles in cancer therapy.
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Affiliation(s)
- Ancuta Jurj
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, University of Medicine and Pharmacy “Iuliu-Hatieganu”, Cluj-Napoca, Romania
| | - Cornelia Braicu
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, University of Medicine and Pharmacy “Iuliu-Hatieganu”, Cluj-Napoca, Romania
| | - Laura-Ancuta Pop
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, University of Medicine and Pharmacy “Iuliu-Hatieganu”, Cluj-Napoca, Romania
| | - Ciprian Tomuleasa
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, University of Medicine and Pharmacy “Iuliu-Hatieganu”, Cluj-Napoca, Romania
- Department of Hematology, The Oncology Institute “Prof Dr Ion Chiricuta”, Cluj-Napoca, Romania
| | - Claudia Diana Gherman
- Practical Abilities, Department of Medical Education, University of Medicine and Pharmacy “Iuliu-Hatieganu”, Cluj-Napoca, Romania
- Department of Medical Education, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Ioana Berindan-Neagoe
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, University of Medicine and Pharmacy “Iuliu-Hatieganu”, Cluj-Napoca, Romania
- Department of Functional Genomics and Experimental Pathology, The Oncology Institute “Prof Dr Ion Chiricuta”, Cluj-Napoca, Romania
- MedFuture Research Center for Advanced Medicine, University of Medicine and Pharmacy “Iuliu-Hatieganu”, Cluj-Napoca, Romania
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12
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Wang XS, Kong DJ, Lin TY, Li XC, Izumiya Y, Ding XZ, Zhang L, Hu XC, Yang JQ, Gao SG, Lam KS, Li YP. A versatile nanoplatform for synergistic combination therapy to treat human esophageal cancer. Acta Pharmacol Sin 2017; 38:931-942. [PMID: 28552907 DOI: 10.1038/aps.2017.43] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 03/23/2017] [Indexed: 12/20/2022] Open
Abstract
One of the major goals of precision oncology is to promote combination therapy to improve efficacy and reduce side effects of anti-cancer drugs based on their molecular mechanisms. In this study, we aimed to develop and validate new nanoformulations of docetaxel (DTX) and bortezomib (BTZ) for targeted combination therapy to treat human esophageal cancer. By leveraging our versatile disulfide cross-linked micelles (DCMs) platform, we developed nanoformulations of DTX and BTZ (named DTX-DCMs and BTZ-DCMs). Their physical properties were characterized; their anti-cancer efficacies and mechanisms of action were investigated in a human esophageal cancer cell line in vitro. Furthermore, the in vitro anti-tumor activities of combination therapies (concurrent drug treatment, sequential drug treatment, and treatment using different ratios of the drugs) were examined in comparison with the single drug treatment and free drug strategies. These drug-loaded nanoparticles were spherical in shape and relatively small in size of approximately 20-22 nm. The entrapment efficiencies of DTX and BTZ into nanoparticles were 82.4% and 84.1%, respectively. The drug release rates of DTX-DCMs and BTZ-DCMs were sustained, and greatly increased in the presence of GSH. These nanodrugs were effectively internalized by KYSE30 esophageal cancer cells, and dose-dependently induced cell apoptosis. We further revealed a strong synergistic effect between DTX-DCMs and BTZ-DCMs against KYSE30 esophageal cancer cells. Sequential combination therapy with DTX-DCMs followed by BTZ-DCMs exhibited the best anti-tumor efficacy in vitro. This study demonstrates that DTX and BTZ could be successfully nanoformulated into disulfide cross-linked micelles. The nanoformulations of DTX and BTZ demonstrate an immense potential for synergistic combination therapy to treat human esophageal cancer.
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13
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Acute decompensated heart failure as a reason of premature chemotherapy discontinuation may be independent of a lifetime doxorubicin dose in lymphoma patients with cardiovascular disorders. Int J Cardiol 2017; 235:147-153. [DOI: 10.1016/j.ijcard.2017.02.073] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 02/06/2017] [Accepted: 02/20/2017] [Indexed: 12/12/2022]
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14
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Mamorska-Dyga A, Ronny FMH, Puccio C, Islam H, Liu D. A rare case of the upper extremity diffuse large B-cell lymphoma mimicking soft tissue sarcoma in an elderly patient. Stem Cell Investig 2016; 3:25. [PMID: 27486587 DOI: 10.21037/sci.2016.06.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/22/2016] [Indexed: 11/06/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma, with about 30% of new cases presenting with extranodal disease. Lesions originating from soft tissues of the upper extremities are extremely rare and may mimic other malignancies like sarcoma. We present a case of an elderly patient with right upper extremity (RUE) mass which was proven to be DLBCL instead of sarcoma. We emphasize the increasing need for investigating new therapeutic options for patients of extreme age and/or with underlying heart disease.
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Affiliation(s)
- Aleksandra Mamorska-Dyga
- 1 Department of Medicine, 2 Department of Pathology, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Faisal M H Ronny
- 1 Department of Medicine, 2 Department of Pathology, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Carmelo Puccio
- 1 Department of Medicine, 2 Department of Pathology, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Humayun Islam
- 1 Department of Medicine, 2 Department of Pathology, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Delong Liu
- 1 Department of Medicine, 2 Department of Pathology, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
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15
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Annibali O, Chiodi F, Cenfra N, Sarlo C, Mega S, Cavallari I, Rago A, Tomassini S, Mecarocci S, Cimino G, Avvisati G. 'Real Life' experience in a 'difficult to treat' patient population of non-Hodgkin lymphomas using the R-COMP regimen. Leuk Lymphoma 2016; 57:2919-2922. [PMID: 27063923 DOI: 10.3109/10428194.2016.1169410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ombretta Annibali
- a Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy Unit , University "Campus Bio-Medico" , Rome , Italy
| | - Francesca Chiodi
- a Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy Unit , University "Campus Bio-Medico" , Rome , Italy
| | - Natalia Cenfra
- b Department of Cellular Biotechnology and Hematology , University "Sapienza" of Rome , Italy
| | - Chiara Sarlo
- a Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy Unit , University "Campus Bio-Medico" , Rome , Italy
| | - Simona Mega
- c Cardiology Unit , University "Campus Bio-Medico" , Rome , Italy
| | - Ilaria Cavallari
- c Cardiology Unit , University "Campus Bio-Medico" , Rome , Italy
| | - Angela Rago
- d Hematology Unit , S. Maria Goretti Hospital, AUSL Latina , Italy
| | - Simona Tomassini
- b Department of Cellular Biotechnology and Hematology , University "Sapienza" of Rome , Italy
| | - Sergio Mecarocci
- d Hematology Unit , S. Maria Goretti Hospital, AUSL Latina , Italy
| | - Giuseppe Cimino
- b Department of Cellular Biotechnology and Hematology , University "Sapienza" of Rome , Italy.,d Hematology Unit , S. Maria Goretti Hospital, AUSL Latina , Italy
| | - Giuseppe Avvisati
- a Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy Unit , University "Campus Bio-Medico" , Rome , Italy
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