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Chiarenza A, Aluisio GV, Parrinello NL, Marino S, Corsale AM, Privitera GF, Azgomi M, La Spina E, Cambria D, Curtopelle A, Isola G, Botta C, Di Raimondo F, Romano A, Santagati M. BNT162b2 mRNA vaccination affects the gut microbiome composition of patients with follicular lymphoma and chronic lymphocytic leukemia. Biomark Res 2025; 13:25. [PMID: 39930533 PMCID: PMC11812150 DOI: 10.1186/s40364-025-00734-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Accepted: 01/21/2025] [Indexed: 02/13/2025] Open
Abstract
BACKGROUND In both chronic lymphatic leukemia (CLL) and follicular lymphoma (FL) immunotherapy determines B-depletion that leads to temporary suppression of humoral immunity, which is clinically relevant especially during the COVID-19 pandemic, when most patients in the first wave received the BNT162b2 vaccine during anti-neoplastic treatment. METHODS To capture changes in the immunome and microbiome composition in CLL and FL patients upon mRNA-based vaccination, we designed a prospective, longitudinal study to profile both the humoral and the cellular response after exposure to the BNT162b2 COVID-19 vaccine. RESULTS In both CLL patients and FL patients, the second and third administrations of the BNT162b2 vaccine increased the titer of specific antibodies against SARS-CoV-2. In FL patients, vaccination induced expansion of central memory CD8 + CD57dim CD279 + T cells and reduction of the neutrophil subset myeloid 1 (CD14-CD15+CD16dimCD64+CD33-CD38+PDL1+HLA-DR-); in both cohorts, CD45RA + CD27 + CD279 + NK cells were expanded after a full cycle of vaccination. After vaccination, the genera Collinsella, Gemmiger, Lachnospiraceae, Blautia, Ruminococcus and Lactobacillus increased in both CLL patients and FL patients, whereas Faecalibacterium, Enterobacteriacae, and Enterococcus decreased. Multivariate analysis failed to identify factors associated with changes in microbiome communities among the CLL and FL cohorts, considering age, sex, exposure to anti-CD20 therapy and disease activity. Only in FL patients, alpha diversity was negatively correlated with neutrophil subsets myeloid 1 e 5 at baseline and positively correlated with neutrophil subset 6 after vaccination. PICRUSt2 analysis showed how microbiome can also affect the host health promoting chronic inflammation. The L-lysine biosynthesis pathway was more represented in CLL patients, whereas the L-valine degradation pathway and the anaerobic degradation of purine nucleobases were overrepresented in the FL cohort. CONCLUSIONS Taken together, our findings reveal the effect of the BNT162b2 vaccine in shaping the microbiome composition in CLL and FL patients, despite receiving treatment for their underlying active disease, and highlight the importance of a comprehensive analysis of the immunome and microbiome profiling to understand immune function in these cohorts of patients.
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Affiliation(s)
- Annalisa Chiarenza
- Divisione Di Ematologia, AOU Policlinico Rodolico San Marco, Catania, Italy
| | - Gaia Vertillo Aluisio
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section Microbiology University of Catania, Catania, Italy.
| | | | - Sara Marino
- Dipartimento Di Chirurgia E Specialità Medico Chirurgiche, Università Degli Studi Di Catania, Catania, Italy
| | - Anna Maria Corsale
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Grete Francesca Privitera
- Department of Clinical and Experimental Medicine, BioinformaticsUnit, University of Catania, Catania, Italy
| | - MojtabaShekarkar Azgomi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Enrico La Spina
- Dipartimento Di Chirurgia E Specialità Medico Chirurgiche, Università Degli Studi Di Catania, Catania, Italy
| | - Daniela Cambria
- Dipartimento Di Chirurgia E Specialità Medico Chirurgiche, Università Degli Studi Di Catania, Catania, Italy
| | - Angelo Curtopelle
- Divisione Di Ematologia, AOU Policlinico Rodolico San Marco, Catania, Italy
| | - Gaetano Isola
- Dipartimento Di Chirurgia E Specialità Medico Chirurgiche, Università Degli Studi Di Catania, Catania, Italy
| | - Cirino Botta
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Francesco Di Raimondo
- Divisione Di Ematologia, AOU Policlinico Rodolico San Marco, Catania, Italy
- Dipartimento Di Chirurgia E Specialità Medico Chirurgiche, Università Degli Studi Di Catania, Catania, Italy
| | - Alessandra Romano
- Divisione Di Ematologia, AOU Policlinico Rodolico San Marco, Catania, Italy.
- Dipartimento Di Chirurgia E Specialità Medico Chirurgiche, Università Degli Studi Di Catania, Catania, Italy.
| | - Maria Santagati
- Department of Biomedical and Biotechnological Sciences (BIOMETEC), Section Microbiology University of Catania, Catania, Italy.
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Duminuco A, Bulla A, Rosso R, Romeo MA, Cambria D, La Spina E, Ximenes B, Giallongo C, Tibullo D, Romano A, Raimondo FD, Palumbo GA. Immune Response and Breakthrough Infection Risk After SARS-CoV-2 Vaccines in Patients with Hemoglobinopathy: A Single Center Experience. Vaccines (Basel) 2025; 13:111. [PMID: 40006658 PMCID: PMC11860232 DOI: 10.3390/vaccines13020111] [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: 11/15/2024] [Revised: 01/06/2025] [Accepted: 01/10/2025] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND Immune system impairment is frequently reported in patients affected by hemoglobinopathies due to various mechanisms, including iron accumulation, antigenic stimulation due to numerous transfusions, chronic hemolysis, and a general hyperinflammatory state. For these reasons, the antigenic immune response after a vaccine risks being ineffective. METHODS We evaluated the anti-spike IgG production after two doses of vaccine for SARS-CoV-2 in patients affected by hemoglobinopathies. RESULTS All 114 enrolled patients (100%) developed adequate antibody production, with a median value of serum IgG of 2184.4 BAU/mL (IQR 1127.4-3502.9). The amount of antibody was unrelated to any other clinical characteristics evaluated, including transfusion dependence or non-transfusion dependence, age, gender, disease type, ferritin, blood count, spleen status, and therapy with hydroxyurea or iron chelators (in all the cases p > 0.05). Moreover, 47 (41.2%) patients developed breakthrough SARS-CoV-2 infection during the first 2 years of follow-up after vaccination, all with a mildly symptomatic course, without requiring hospitalization or experiencing a significative drop in hemoglobin values, allowing for a slight delay in their transfusion regimen. CONCLUSION Vaccination against COVID-19 is safe and effective for patients affected by hemoglobinopathies, ensuring adequate protection from severe infection.
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Affiliation(s)
- Andrea Duminuco
- Hematology Unit with BMT, A.O.U. Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy; (D.C.); (E.L.S.); (A.R.); (F.D.R.)
| | - Anna Bulla
- Thalassemia Unit, A.O.U. Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.R.); (M.A.R.); (B.X.); (G.A.P.)
| | - Rosamaria Rosso
- Thalassemia Unit, A.O.U. Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.R.); (M.A.R.); (B.X.); (G.A.P.)
| | - Maria Anna Romeo
- Thalassemia Unit, A.O.U. Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.R.); (M.A.R.); (B.X.); (G.A.P.)
| | - Daniela Cambria
- Hematology Unit with BMT, A.O.U. Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy; (D.C.); (E.L.S.); (A.R.); (F.D.R.)
| | - Enrico La Spina
- Hematology Unit with BMT, A.O.U. Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy; (D.C.); (E.L.S.); (A.R.); (F.D.R.)
| | - Benedetta Ximenes
- Thalassemia Unit, A.O.U. Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.R.); (M.A.R.); (B.X.); (G.A.P.)
| | - Cesarina Giallongo
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy;
| | - Daniele Tibullo
- Dipartimento di Scienze Biomediche e Biotecnologiche, University of Catania, 95123 Catania, Italy;
| | - Alessandra Romano
- Hematology Unit with BMT, A.O.U. Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy; (D.C.); (E.L.S.); (A.R.); (F.D.R.)
- Dipartimento di Specialità Medico-Chirurgiche, CHIRMED, Sezione di Ematologia, University of Catania, 95123 Catania, Italy
| | - Francesco Di Raimondo
- Hematology Unit with BMT, A.O.U. Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy; (D.C.); (E.L.S.); (A.R.); (F.D.R.)
- Dipartimento di Specialità Medico-Chirurgiche, CHIRMED, Sezione di Ematologia, University of Catania, 95123 Catania, Italy
| | - Giuseppe A. Palumbo
- Thalassemia Unit, A.O.U. Policlinico “G. Rodolico—San Marco”, Via S. Sofia 78, 95123 Catania, Italy; (A.B.); (R.R.); (M.A.R.); (B.X.); (G.A.P.)
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, University of Catania, 95123 Catania, Italy;
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Duminuco A, Del Fabro V, De Luca P, Leotta D, Limoli MC, Longo E, Nardo A, Santuccio G, Petronaci A, Stanzione G, Di Raimondo F, Palumbo GA. Emergencies in Hematology: Why, When and How I Treat? J Clin Med 2024; 13:7572. [PMID: 39768494 PMCID: PMC11728391 DOI: 10.3390/jcm13247572] [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: 11/08/2024] [Revised: 11/26/2024] [Accepted: 12/11/2024] [Indexed: 01/16/2025] Open
Abstract
Hematological emergencies are critical medical conditions that require immediate attention due to their rapid progression and life-threatening nature. As various examples, hypercalcemia, often associated with cancers such as multiple myeloma, can lead to severe neurological and cardiac dysfunction. Hyperleukocytosis, common in acute myeloid leukemias, increases the risk of leukostasis and multiorgan failure. Sickle cell crisis, a common complication in sickle cell disease, results from vaso-occlusion, leading to acute pain and tissue ischemia. Tumor lysis syndrome, reported in cases of rapid destruction of cancer cells, causes electrolyte imbalances and acute kidney injury. Acute transfusion reactions, fundamental in hematological conditions, can range from mild allergic responses to severe hemolysis and shock, requiring prompt management. Disseminated intravascular coagulation, involving excessive coagulation and bleeding, is commonly triggered by hematological malignancies, common in the first phases of acute promyelocytic leukemia. Recently, in the era of bispecific antibodies and chimeric antigen receptor T cells, cytokine release syndrome is a manifestation that must be recognized and promptly treated. Understanding the pathophysiology, recognizing the clinical manifestations, and ensuring adequate diagnostic strategies and management approaches for each condition are central to early intervention in improving patient outcomes and reducing mortality.
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Affiliation(s)
- Andrea Duminuco
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (P.D.L.); (D.L.); (M.C.L.); (E.L.); (A.N.); (G.S.); (A.P.); (G.S.); (F.D.R.); (G.A.P.)
| | - Vittorio Del Fabro
- Faculty of Medicine and Surgery, “Kore” University of Enna, 94100 Enna, Italy;
| | - Paola De Luca
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (P.D.L.); (D.L.); (M.C.L.); (E.L.); (A.N.); (G.S.); (A.P.); (G.S.); (F.D.R.); (G.A.P.)
| | - Dario Leotta
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (P.D.L.); (D.L.); (M.C.L.); (E.L.); (A.N.); (G.S.); (A.P.); (G.S.); (F.D.R.); (G.A.P.)
| | - Miriana Carmela Limoli
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (P.D.L.); (D.L.); (M.C.L.); (E.L.); (A.N.); (G.S.); (A.P.); (G.S.); (F.D.R.); (G.A.P.)
| | - Ermelinda Longo
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (P.D.L.); (D.L.); (M.C.L.); (E.L.); (A.N.); (G.S.); (A.P.); (G.S.); (F.D.R.); (G.A.P.)
| | - Antonella Nardo
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (P.D.L.); (D.L.); (M.C.L.); (E.L.); (A.N.); (G.S.); (A.P.); (G.S.); (F.D.R.); (G.A.P.)
| | - Gabriella Santuccio
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (P.D.L.); (D.L.); (M.C.L.); (E.L.); (A.N.); (G.S.); (A.P.); (G.S.); (F.D.R.); (G.A.P.)
| | - Alessandro Petronaci
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (P.D.L.); (D.L.); (M.C.L.); (E.L.); (A.N.); (G.S.); (A.P.); (G.S.); (F.D.R.); (G.A.P.)
| | - Gaia Stanzione
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (P.D.L.); (D.L.); (M.C.L.); (E.L.); (A.N.); (G.S.); (A.P.); (G.S.); (F.D.R.); (G.A.P.)
| | - Francesco Di Raimondo
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (P.D.L.); (D.L.); (M.C.L.); (E.L.); (A.N.); (G.S.); (A.P.); (G.S.); (F.D.R.); (G.A.P.)
| | - Giuseppe Alberto Palumbo
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (P.D.L.); (D.L.); (M.C.L.); (E.L.); (A.N.); (G.S.); (A.P.); (G.S.); (F.D.R.); (G.A.P.)
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Duminuco A, Santuccio G, Chiarenza A, Figuera A, Motta G, Caruso AL, Petronaci A, Ippolito M, Cerchione C, Di Raimondo F, Romano A. Baseline IgM Amounts Can Identify Patients with Poor Outcomes: Results from a Real-Life Single-Center Study on Classical Hodgkin Lymphoma. Cancers (Basel) 2024; 16:826. [PMID: 38398216 PMCID: PMC10886525 DOI: 10.3390/cancers16040826] [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: 01/13/2024] [Revised: 02/10/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Hodgkin Lymphoma (HL) is characterized by an inflammatory background in which the reactive myeloid cells may exert an immune-suppressive effect related to the progression of the disease. Immunoglobulin M is the first antibody isotype produced during an immune response, which also plays an immunoregulatory role. Therefore, we investigated if, as a surrogate of defective B cell function, it could have any clinical impact on prognosis. In this retrospective, observational, single-center study, we evaluated 212 newly diagnosed HL patients, including 132 advanced-stage. A 50 mg/dL level of IgM at baseline resulted in 84.1% sensitivity and 45.5% specificity for predicting a complete response in the whole cohort (area under curve (AUC) = 0.62, p = 0.013). In multivariate analysis, baseline IgM ≤ 50 mg/dL and the presence of a large nodal mass (<7 cm) were independent variables able to predict the clinical outcome, while, after two cycles of treatment, IgM ≤ 50 mg/dL at baseline and PET-2 status were independent predictors of PFS. The amount of IgM at diagnosis is a valuable prognostic factor much earlier than PET-2, and it can also provide information for PET-2-negative patients. This can help to identify different HL classes at risk of treatment failure at baseline.
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Affiliation(s)
- Andrea Duminuco
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (G.S.); (A.C.); (A.F.); (G.M.); (A.L.C.); (A.P.); (F.D.R.)
| | - Gabriella Santuccio
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (G.S.); (A.C.); (A.F.); (G.M.); (A.L.C.); (A.P.); (F.D.R.)
| | - Annalisa Chiarenza
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (G.S.); (A.C.); (A.F.); (G.M.); (A.L.C.); (A.P.); (F.D.R.)
| | - Amalia Figuera
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (G.S.); (A.C.); (A.F.); (G.M.); (A.L.C.); (A.P.); (F.D.R.)
| | - Giovanna Motta
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (G.S.); (A.C.); (A.F.); (G.M.); (A.L.C.); (A.P.); (F.D.R.)
| | - Anastasia Laura Caruso
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (G.S.); (A.C.); (A.F.); (G.M.); (A.L.C.); (A.P.); (F.D.R.)
| | - Alessandro Petronaci
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (G.S.); (A.C.); (A.F.); (G.M.); (A.L.C.); (A.P.); (F.D.R.)
| | - Massimo Ippolito
- Nuclear Medicine Center, Azienda Ospedaliera Cannizzaro, 95021 Catania, Italy;
| | - Claudio Cerchione
- Hematology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Francesco Di Raimondo
- Hematology Unit with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (G.S.); (A.C.); (A.F.); (G.M.); (A.L.C.); (A.P.); (F.D.R.)
- Department of General Surgery and Medical-Surgical Specialties, Hematology Section, University of Catania, 95123 Catania, Italy
| | - Alessandra Romano
- Department of General Surgery and Medical-Surgical Specialties, Hematology Section, University of Catania, 95123 Catania, Italy
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Ntanasis-Stathopoulos I, Filippatos C, Gavriatopoulou M, Malandrakis P, Eleutherakis-Papaiakovou E, Spiliopoulou V, Syrigou RE, Theodorakakou F, Fotiou D, Migkou M, Roussou M, Kastritis E, Dimopoulos MA, Terpos E. Tixagevimab/Cilgavimab as Pre-Exposure Prophylaxis against COVID-19 for Multiple Myeloma Patients: A Prospective Study in the Omicron Era. Diseases 2023; 11:123. [PMID: 37754319 PMCID: PMC10529256 DOI: 10.3390/diseases11030123] [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: 07/28/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Background: tixagevimab/cilgavimab, distributed under the name "Evusheld", was the first available pre-exposure prophylaxis for COVID-19 other than vaccination. It received an EUA from the FDA after sufficient trial data showed efficacy in preventing SARS-CoV-2 infections and subsequent severe disease. Its potential benefits for high-risk immunocompromised patients generated a lot of interest. Individuals with multiple myeloma fall into this category, as they are characterized by attenuated immune responses and, in some cases, vaccines have limited efficacy. Methods: this single-center, prospective study included consecutive patients with multiple myeloma. All individuals were considered high-risk for COVID-19 due to their underlying disease. Baseline demographic and clinical characteristics, as well as data regarding COVID-19 infection and antibodies, were collected. Patients were administered two intramuscular 150 mg doses of Evusheld and were monitored during the follow-up period. Results: one hundred and eleven multiple myeloma patients were included in this analysis, with a median age of 64 years (range 58-69) and fifty-three were females (47.7%). Fourteen patients (12.6%) had a prior history of COVID-19 and all patients were vaccinated with either three or four doses of mRNA-based vaccines. An increase was observed in the median neutralizing-antibody levels before and after tixagevimab/cilgavimab administration, from 92.6% to 97.3%. The high levels were sustainable, with a median neutralizing-antibody level of 95.4% at 3 months post Evusheld administration. Overall, nine patients (8.1%) were diagnosed with COVID-19 during the follow-up period, at a median of 31 days. There were no SARS-CoV-2- infection-related hospitalizations or deaths. The monoclonal antibody combination was well tolerated, with no infusion-related reactions or major adverse events, and pain at the injection site only was reported by 33 patients (30%). Conclusions: tixagevimab/cilgavimab (Evusheld) seemed beneficial for patients with multiple myeloma, who presented high neutralizing-antibody levels and a low incidence of COVID-19 during the initial Omicron wave. No new safety concerns emerged. However, novel combinations of monoclonal antibodies against the new circulating variants of SARS-CoV-2 are deemed necessary in view of the emergence of immune tolerance.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece; (I.N.-S.); (C.F.)
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Del Fabro V, Di Giorgio MA, Leotta V, Duminuco A, Bellofiore C, Markovic U, Romano A, Bulla A, Curto Pelle A, Elia F, Di Raimondo F, Conticello C. Lenalidomide plus Dexamethasone Combination as First-Line Oral Therapy of Multiple Myeloma Patients: A Unicentric Real-Life Study. Cancers (Basel) 2023; 15:4036. [PMID: 37627065 PMCID: PMC10452433 DOI: 10.3390/cancers15164036] [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: 06/05/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Based on the results obtained in clinical trials, the use of the combination of lenalidomide and dexamethasone (Len/Dex) has become a potential therapeutic choice for newly diagnosed multiple myeloma (NDMM) ineligible for autologous stem cell transplantation. This study evaluated 89 frail NDMM patients treated with first-line oral association. At the last follow-up, 34 out of 89 patients (38.2%) were alive, and 22 were still in treatment with Len/Dex. Among 73 evaluable patients who received at least two cycles, the overall response rate was 71% (N = 52). The disease control rate, defined as any level of clinical response to therapy, occurred in 71 patients (97%). We reported one or more adverse events of grade 3 or 4 (G3/4) in 65.2% (N = 58) of patients, with a prevalence of hematological toxicity (24 patients), leading to an overall discontinuation of treatment in two cases. In univariate analysis, high ISS, high serum β2-microglobulin, and creatinine clearance <30 mL/min negatively impact OS, while the depth of response positively impacts OS. Moreover, G3-4 anemia, ISS, frailty score, and ECOG negatively impacts PFS. In conclusion, elderly and more frail patients benefit from the Len/Dex combination also in the era of monoclonal antibodies, ensuring an increased PFS and OS in patients where the therapeutic choice is often limited and usually not very effective.
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Affiliation(s)
- Vittorio Del Fabro
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
| | - Mary Ann Di Giorgio
- Division of Hematology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, 95122 Catania, Italy; (M.A.D.G.); (V.L.); (C.B.)
| | - Valerio Leotta
- Division of Hematology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, 95122 Catania, Italy; (M.A.D.G.); (V.L.); (C.B.)
| | - Andrea Duminuco
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
| | - Claudia Bellofiore
- Division of Hematology, Azienda Ospedaliera di Rilievo Nazionale e di Alta Specializzazione Garibaldi, 95122 Catania, Italy; (M.A.D.G.); (V.L.); (C.B.)
- Amyloidosis Research and Treatment Center, Foundation Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, 27100 Pavia, Italy
| | - Uros Markovic
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
| | - Alessandra Romano
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
- Dipartimento di Chirurgia Generale e Specialità Medico Chirurgiche, University of Catania, 95123 Catania, Italy
| | - Anna Bulla
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
| | - Angelo Curto Pelle
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
| | - Federica Elia
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
| | - Francesco Di Raimondo
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
- Dipartimento di Chirurgia Generale e Specialità Medico Chirurgiche, University of Catania, 95123 Catania, Italy
| | - Concetta Conticello
- Division of Hematology with BMT, A.O.U. Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy; (U.M.); (A.R.); (A.B.); (A.C.P.); (F.E.); (F.D.R.); (C.C.)
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