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D’Esposito F, Randazzo V, Vega MI, Esposito G, Maltese PE, Torregrossa S, Scibetta P, Listì F, Gagliano C, Scalia L, Pioppo A, Marino A, Piergentili M, Malvone E, Fioretti T, Vitrano A, Piccione M, Avitabile T, Salvatore F, Bertelli M, Costagliola C, Cordeiro MF, Maggio A, D’Alcamo E. RP1 Dominant p.Ser740* Pathogenic Variant in 20 Knowingly Unrelated Families Affected by Rod-Cone Dystrophy: Potential Founder Effect in Western Sicily. Medicina (Kaunas) 2024; 60:254. [PMID: 38399542 PMCID: PMC10890639 DOI: 10.3390/medicina60020254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives. Retinitis pigmentosa (RP) is the most common inherited rod-cone dystrophy (RCD), resulting in nyctalopia, progressive visual field, and visual acuity decay in the late stages. The autosomal dominant form (ADRP) accounts for about 20% of RPs. Among the over 30 genes found to date related to ADRP, RP1 pathogenic variants have been identified in 5-10% of cases. In a cohort of RCD patients from the Palermo province on the island of Sicily, we identified a prevalent nonsense variant in RP1, which was associated with ADRP. The objective of our study was to analyse the clinical and molecular data of this patient cohort and to evaluate the potential presence of a founder effect. Materials and Methods. From 2005 to January 2023, 84 probands originating from Western Sicily (Italy) with a diagnosis of RCD or RP and their relatives underwent deep phenotyping, which was performed in various Italian clinical institutions. Molecular characterisation of patients and familial segregation of pathogenic variants were carried out in different laboratories using Sanger and/or next-generation sequencing (NGS). Results. Among 84 probands with RCD/RP, we found 28 heterozygotes for the RP1 variant c.2219C>G, p.Ser740* ((NM_006269.2)*, which was therefore significantly prevalent in this patient cohort. After a careful interview process, we ascertained that some of these patients shared the same pedigree. Therefore, we were ultimately able to define 20 independent family groups with no traceable consanguinity. Lastly, analysis of clinical data showed, in our patients, that the p.Ser740* nonsense variant was often associated with a late-onset and relatively mild phenotype. Conclusions. The high prevalence of the p.Ser740* variant in ADRP patients from Western Sicily suggests the presence of a founder effect, which has useful implications for the molecular diagnosis of RCD in patients coming from this Italian region. This variant can be primarily searched for in RP-affected subjects displaying compatible modes of transmission and phenotypes, with an advantage in terms of the required costs and time for analysis. Moreover, given its high prevalence, the RP1 p.Ser740* variant could represent a potential candidate for the development of therapeutic strategies based on gene editing or translational read-through therapy for suppression of nonsense variants.
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Affiliation(s)
- Fabiana D’Esposito
- Imperial College Ophthalmic Research Group (ICORG) Unit, Imperial College, London SW7 2AZ, UK;
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80100 Naples, Italy; (E.M.); (C.C.)
- Genofta s.r.l., Sant’Agnello, 80065 Naples, Italy
| | - Viviana Randazzo
- Eye Clinic, AOOR Villa Sofia-Cervello, 90100 Palermo, Italy; (V.R.); (S.T.); (P.S.)
| | - Maria Igea Vega
- Department of Genetics, Oncohaematology and Rare Diseases, AOOR Villa Sofia-Cervello, 90100 Palermo, Italy; (M.I.V.); (F.L.); (A.V.); (M.P.); (A.M.); (E.D.)
| | - Gabriella Esposito
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80100 Naples, Italy; (G.E.); (F.S.)
- CEINGE-Advanced Biotechnologies Franco Salvatore, 80100 Naples, Italy;
| | | | | | - Paola Scibetta
- Eye Clinic, AOOR Villa Sofia-Cervello, 90100 Palermo, Italy; (V.R.); (S.T.); (P.S.)
| | - Florinda Listì
- Department of Genetics, Oncohaematology and Rare Diseases, AOOR Villa Sofia-Cervello, 90100 Palermo, Italy; (M.I.V.); (F.L.); (A.V.); (M.P.); (A.M.); (E.D.)
| | - Caterina Gagliano
- Department of Medicine and Surgery, School of Medicine, Kore University of Enna, 94100 Enna, Italy;
| | - Lucia Scalia
- Eye Clinic, Catania University, Policlinico “Rodolico”-San Marco, 95100 Catania, Italy; (L.S.); (T.A.)
| | | | - Antonio Marino
- Department of Ophthalmology, Garibaldi Hospital, 95100 Catania, Italy;
| | - Marco Piergentili
- Department of Ophthalmology, Careggi Teaching Hospital, 50100 Florence, Italy;
| | - Emanuele Malvone
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80100 Naples, Italy; (E.M.); (C.C.)
| | - Tiziana Fioretti
- CEINGE-Advanced Biotechnologies Franco Salvatore, 80100 Naples, Italy;
| | - Angela Vitrano
- Department of Genetics, Oncohaematology and Rare Diseases, AOOR Villa Sofia-Cervello, 90100 Palermo, Italy; (M.I.V.); (F.L.); (A.V.); (M.P.); (A.M.); (E.D.)
| | - Maria Piccione
- Department of Genetics, Oncohaematology and Rare Diseases, AOOR Villa Sofia-Cervello, 90100 Palermo, Italy; (M.I.V.); (F.L.); (A.V.); (M.P.); (A.M.); (E.D.)
| | - Teresio Avitabile
- Eye Clinic, Catania University, Policlinico “Rodolico”-San Marco, 95100 Catania, Italy; (L.S.); (T.A.)
| | - Francesco Salvatore
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80100 Naples, Italy; (G.E.); (F.S.)
- CEINGE-Advanced Biotechnologies Franco Salvatore, 80100 Naples, Italy;
| | | | - Ciro Costagliola
- Eye Clinic, Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, 80100 Naples, Italy; (E.M.); (C.C.)
| | | | - Aurelio Maggio
- Department of Genetics, Oncohaematology and Rare Diseases, AOOR Villa Sofia-Cervello, 90100 Palermo, Italy; (M.I.V.); (F.L.); (A.V.); (M.P.); (A.M.); (E.D.)
| | - Elena D’Alcamo
- Department of Genetics, Oncohaematology and Rare Diseases, AOOR Villa Sofia-Cervello, 90100 Palermo, Italy; (M.I.V.); (F.L.); (A.V.); (M.P.); (A.M.); (E.D.)
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2
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Vitrano A, Musallam KM, Meloni A, Karimi M, Daar S, Ricchi P, Costantini S, Vlachaki E, Di Marco V, El-Beshlawy A, Hajipour M, Ansari SH, Filosa A, Ceci A, Singer ST, Naserullah ZA, Pepe A, Cademartiri F, Pollina SA, Scondotto S, Dardanoni G, Bonifazi F, Sankaran VG, Vichinsky E, Taher AT, Maggio A. Development of a Thalassemia International Prognostic Scoring System (TIPSS). Blood Cells Mol Dis 2023; 99:102710. [PMID: 36463683 DOI: 10.1016/j.bcmd.2022.102710] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/21/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
A prognostic scoring system that can differentiate β-thalassemia patients based on mortality risk is lacking. We analysed data from 3145 β-thalassemia patients followed through a retrospective cohort design for the outcome of death. An a priori list of prognostic variables was collected. β Coefficients from a multivariate cox regression model were used from a development dataset (n = 2516) to construct a formula for a Thalassemia International Prognostic Scoring System (TIPSS) which was subsequently applied to a validation dataset (n = 629). The median duration of observation was 10.0 years. The TIPSS score formula was constructed as exp (1.4 × heart disease + 0.9 × liver disease + 0.9 × diabetes + 0.9 × sepsis + 0.6 × alanine aminotransferase ≥42 IU/L + 0.6 × hemoglobin ≤9 g/dL + 0.4 × serum ferritin ≥1850 ng/mL). TIPSS score thresholds of greatest differentiation were assigned as <2.0 (low-risk), 2.0 to <5.0 (intermediate-risk), and ≥5.0 (high-risk). The TIPSS score was a good predictor for the outcome of death in the validation dataset (AUC: 0.722, 95%CI: 0.641-0.804) and survival was significantly different between patients in the three risk categories (P < 0.001). Compared to low-risk patients, the hazard ratio for death was 2.778 (95%CI: 1.335-5.780) in patients with intermediate-risk and 6.431 (95%CI: 3.151-13.128) in patients with high-risk. This study provides a novel tool to support mortality risk categorization for patients with β-thalassemia that could help management and research decisions.
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Affiliation(s)
- Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Khaled M Musallam
- Thalassemia Center, Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Oman; Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch, South Africa
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | | | - Efthymia Vlachaki
- Thalassaemia Unit, Ippokratio University Hospital, Thessaloniki, Greece
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA), Italy
| | - Sylvia Titi Singer
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | | | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padua, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | | | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA), Italy
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Harvard Stem Cell Institute, Cambridge, MA, USA
| | - Elliott Vichinsky
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy.
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3
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Musallam KM, Vitrano A, Meloni A, Pollina SA, Karimi M, El‐Beshlawy A, Hajipour M, Di Marco V, Ansari SH, Filosa A, Ricchi P, Ceci A, Daar S, Vlachaki E, Singer ST, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Bonifazi F, Sankaran VG, Vichinsky E, Taher AT, Maggio A. Risk of mortality from anemia and iron overload in nontransfusion-dependent β-thalassemia. Am J Hematol 2022; 97:E78-E80. [PMID: 34862982 DOI: 10.1002/ajh.26428] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/17/2022]
Affiliation(s)
| | - Angela Vitrano
- Campus of Haematology Franco and Piera Cutino AOOR Villa Sofia‐V, Cervello Palermo Italy
| | - Antonella Meloni
- MRI Unit, Fondazione G. Monasterio CNR‐Regione Toscana Pisa Italy
| | | | - Mehran Karimi
- Haematology Research Center Shiraz University of Medical Sciences Shiraz Iran
| | - Amal El‐Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine Cairo University Cairo Egypt
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica University of Palermo Palermo Italy
| | | | - Aldo Filosa
- Rare Blood Cell Disease Unit "Cardarelli" Hospital Naples Italy
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit "Cardarelli" Hospital Naples Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Valenzano (BA) Italy
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman; Wallenberg Research Centre, Stellenbosch Institute for Advanced Study Stellenbosch University Stellenbosch South Africa
| | - Efthymia Vlachaki
- Thalassaemia Unit Ippokratio University Hospital Thessaloniki Greece
| | - Sylvia Titi Singer
- Division of Hematology‐Oncology, Department of Pediatrics University of California San Francisco, UCSF Benioff Children's Hospital Oakland Oakland California USA
| | | | - Alessia Pepe
- MRI Unit, Fondazione G. Monasterio CNR‐Regione Toscana Pisa Italy
| | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus Valenzano (BA) Italy
| | - Vijay G. Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana‐Farber Cancer Institute Harvard Medical School Boston Massachusetts USA
- Broad Institute of MIT and Harvard Cambridge Massachusetts USA
- Harvard Stem Cell Institute Cambridge Massachusetts USA
| | - Elliott Vichinsky
- Division of Hematology‐Oncology, Department of Pediatrics University of California San Francisco, UCSF Benioff Children's Hospital Oakland Oakland California USA
| | - Ali T. Taher
- Department of Internal Medicine American University of Beirut Medical Center Beirut Lebanon
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino AOOR Villa Sofia‐V, Cervello Palermo Italy
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4
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Musallam KM, Vitrano A, Meloni A, Addario Pollina S, Di Marco V, Hussain Ansari S, Filosa A, Ricchi P, Ceci A, Daar S, Vlachaki E, Singer ST, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Karimi M, El-Beshlawy A, Hajipour M, Bonifazi F, Vichinsky E, Taher AT, Sankaran VG, Maggio A. Primary HBB gene mutation severity and long-term outcomes in a global cohort of β-thalassaemia. Br J Haematol 2021; 196:414-423. [PMID: 34697800 DOI: 10.1111/bjh.17897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 01/19/2023]
Abstract
In β-thalassaemia, the severity of inherited β-globin gene mutations determines the severity of the clinical phenotype at presentation and subsequent transfusion requirements. However, data on associated long-term outcomes remain limited. We analysed data from 2109 β-thalassaemia patients with available genotypes in a global database. Genotype severity was grouped as β0 /β0 , β0 /β+ , β+ /β+ , β0 /β++ , β+ /β++ , and β++ /β++ . Patients were followed from birth until death or loss to follow-up. The median follow-up time was 34·1 years. Mortality and multiple morbidity outcomes were analyzed through five different stratification models of genotype severity groups. Interestingly, β0 and β+ mutations showed similar risk profiles. Upon adjustment for demographics and receipt of conventional therapy, patients with β0 /β0 , β0 /β+ , or β+ /β+ had a 2·104-increased risk of death [95% confidence interval (CI): 1·176-3·763, P = 0·011] and 2·956-increased odds of multiple morbidity (95% CI: 2·310-3·784, P < 0·001) compared to patients in lower genotype severity groups. Cumulative survival estimates by age 65 years were 36·8% for this subgroup compared with 90·2% for patients in lower genotype severity groups (P < 0·001). Our study identified mortality and morbidity risk estimates across various genotype severity groups in patients with β-thalassaemia and suggests inclusion of both β+ and β0 mutations in strata of greatest severity.
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Affiliation(s)
- Khaled M Musallam
- Thalassemia Center, Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Antonella Meloni
- MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | | | - Vito Di Marco
- Department of Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Saqib Hussain Ansari
- Department of Pediatric Haematology & Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA), Italy
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman.,Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch, South Africa
| | - Efthymia Vlachaki
- Thalassaemia Unit, Ippokratio University Hospital, Thessaloniki, Greece
| | - Sylvia T Singer
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | | | - Alessia Pepe
- MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | | | | | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA), Italy
| | - Elliott Vichinsky
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA, USA
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Harvard Stem Cell Institute, Cambridge, MA, USA
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
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Musallam KM, Vitrano A, Meloni A, Pollina SA, Karimi M, El-Beshlawy A, Hajipour M, Di Marco V, Ansari SH, Filosa A, Ricchi P, Ceci A, Daar S, Vlachaki E, Singer ST, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Bonifazi F, Sankaran VG, Vichinsky E, Taher AT, Maggio A. Survival and causes of death in 2,033 patients with non-transfusion-dependent β-thalassemia. Haematologica 2021. [PMID: 33882642 DOI: 10.3324/haematol.2021.278684.pmid:33882642;pmcid:pmc8409024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Affiliation(s)
| | - Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo
| | | | | | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz
| | - Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran
| | - Vito Di Marco
- Department of Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza (PROMISE), University of Palermo, Palermo, Italy
| | - Saqib Hussain Ansari
- Department of Pediatric Haematology and Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA)
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman; Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch
| | | | - Sylvia Titi Singer
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | | | - Alessia Pepe
- MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa
| | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA)
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Harvard Stem Cell Institute, Cambridge, MA
| | - Elliott Vichinsky
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo
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Musallam KM, Vitrano A, Meloni A, Pollina WA, Karimi M, El-Beshlawy A, Hajipour M, Di Marco V, Ansari SH, Filosa A, Ricchi P, Ceci A, Daar S, Vlachaki E, Singer ST, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Bonifazi F, Sankaran VG, Vichinsky E, Taher AT, Maggio A. Survival and causes of death in 2,033 patients with non-transfusion-dependent β-thalassemia. Haematologica 2021; 106:2489-2492. [PMID: 33882642 PMCID: PMC8409024 DOI: 10.3324/haematol.2021.278684] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo
| | | | | | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz
| | - Amal El-Beshlawy
- Department of Pediatric Haematology, Faculty of Medicine, Cairo University, Cairo
| | - Mahmoud Hajipour
- Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo
| | - Saqib Hussain Ansari
- Department of Pediatric Haematology and Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA)
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman; Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch
| | | | - Sylvia Titi Singer
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | | | - Alessia Pepe
- MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa
| | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano (BA)
| | - Vijay G Sankaran
- Division of Hematology/Oncology, Boston Children's Hospital and Department of Pediatric Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA; Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA; Harvard Stem Cell Institute, Cambridge, MA
| | - Elliott Vichinsky
- Division of Hematology-Oncology, Department of Pediatrics, University of California San Francisco, UCSF Benioff Children's Hospital Oakland, Oakland, CA
| | - Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo.
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Vitrano A, Meloni A, Addario Pollina W, Karimi M, El-Beshlawy A, Hajipour M, Di Marco V, Hussain Ansari S, Filosa A, Ricchi P, Ceci A, Daar S, Titi Singer S, Naserullah ZA, Pepe A, Scondotto S, Dardanoni G, Bonifazi F, Vichinsky E, Maggio A. A complication risk score to evaluate clinical severity of thalassaemia syndromes. Br J Haematol 2021; 192:626-633. [PMID: 33216983 DOI: 10.1111/bjh.17203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/28/2020] [Indexed: 01/16/2023]
Abstract
The thalassaemia syndromes (TS) show different phenotype severity. Developing a reliable, practical and global tool to determine disease severity and tailor treatment would be of great value. Overall, 7910 patients were analysed with the aim of constructing a complication risk score (CoRS) to evaluate the probability of developing one or more complications. Nine independent variables were included in the investigation as predictors. Logistic regression models were used for Group A [transfusion-dependent thalassaemia (TDT)], Group B [transfused non-TDT (NTDT)] and Group C (non-transfused NTDT). Statistically significant predictors included age (years), haemoglobin levels, hepatic transaminases [alanine aminotransferase (ALT) and aspartate aminotransferase] and left-ventricular ejection fraction (LVEF) for Group A; age (years), age at first chelation (months), ALT and LVEF for Group B; and age (years), mean serum ferritin (SF) levels and LVEF for Group C. The area under the receiver operating characteristic curve was 84·5%, 82·1% and 80·0% for Groups A, Group B and Group C respectively, suggesting the models had good discrimination. Finally, the CoRS for each group was categorised into four risk classes (low, intermediate, high, and very high) using the centiles of its distribution. In conclusion, we have developed a CoRS for TS that can assist physicians in prospectively tailoring patients' treatment.
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Affiliation(s)
- Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | | | | | - Mehran Karimi
- Haematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mahmoud Hajipour
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vito Di Marco
- Sezione di Gastroenterologia e Epatologia, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
| | - Saqib Hussain Ansari
- Department of Paediatric Haematology and Molecular Medicine, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan
| | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Paolo Ricchi
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano, BA, Italy
| | - Shahina Daar
- Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Sultanate of Oman
- Wallenberg Research Centre, Stellenbosch Institute for Advanced Study, Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Alessia Pepe
- U.O.C. MRI, Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | | | - Fedele Bonifazi
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano, BA, Italy
| | | | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
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Maggio A, Kattamis A, Felisi M, Reggiardo G, El-Beshlawy A, Bejaoui M, Sherief L, Christou S, Cosmi C, Della Pasqua O, Del Vecchio GC, Filosa A, Cuccia L, Hassab H, Kreka M, Origa R, Putti MC, Spino M, Telfer P, Tempesta B, Vitrano A, Tsang YC, Zaka A, Tricta F, Bonifazi D, Ceci A. Evaluation of the efficacy and safety of deferiprone compared with deferasirox in paediatric patients with transfusion-dependent haemoglobinopathies (DEEP-2): a multicentre, randomised, open-label, non-inferiority, phase 3 trial. Lancet Haematol 2020; 7:e469-e478. [PMID: 32470438 DOI: 10.1016/s2352-3026(20)30100-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transfusion-dependent haemoglobinopathies require lifelong iron chelation therapy with one of the three iron chelators (deferiprone, deferasirox, or deferoxamine). Deferasirox and deferiprone are the only two oral chelators used in adult patients with transfusion-dependent haemoglobinopathies. To our knowledge, there are no randomised clinical trials comparing deferiprone, a less expensive iron chelator, with deferasirox in paediatric patients. We aimed to show the non-inferiority of deferiprone versus deferasirox. METHODS DEEP-2 was a phase 3, multicentre, randomised trial in paediatric patients (aged 1 month to 18 years) with transfusion-dependent haemoglobinopathies. The study was done in 21 research hospitals and universities in Italy, Egypt, Greece, Albania, Cyprus, Tunisia, and the UK. Participants were receiving at least 150 mL/kg per year of red blood cells for the past 2 years at the time of enrolment, and were receiving deferoxamine (<100 mg/kg per day) or deferasirox (<40 mg/kg per day; deferasirox is not registered for use in children aged <2 years so only deferoxamine was being used in these patients). Any previous chelation treatment was permitted with a 7-day washout period. Patients were randomly assigned 1:1 to receive orally administered daily deferiprone (75-100 mg/kg per day) or daily deferasirox (20-40 mg/kg per day) administered as dispersible tablets, both with dose adjustment for 12 months, stratified by age (<10 years and ≥10 years) and balanced by country. The primary efficacy endpoint was based on predefined success criteria for changes in serum ferritin concentration (all patients) and cardiac MRI T2-star (T2*; patients aged >10 years) to show non-inferiority of deferiprone versus deferasirox in the per-protocol population, defined as all randomly assigned patients who received the study drugs and had available data for both variables at baseline and after 1 year of treatment, without major protocol violations. Non-inferiority was based on the two-sided 95% CI of the difference in the proportion of patients with treatment success between the two groups and was shown if the lower limit of the two-sided 95% CI was greater than -12·5%. Safety was assessed in all patients who received at least one dose of study drug. This study is registered with EudraCT, 2012-000353-31, and ClinicalTrials.gov, NCT01825512. FINDINGS 435 patients were enrolled between March 17, 2014, and June 16, 2016, 393 of whom were randomly assigned to a treatment group (194 to the deferiprone group; 199 to the deferasirox group). 352 (90%) of 390 patients had β-thalassaemia major, 27 (7%) had sickle cell disease, five (1%) had thalassodrepanocytosis, and six (2%) had other haemoglobinopathies. Median follow-up was 379 days (IQR 294-392) for deferiprone and 381 days (350-392) for deferasirox. Non-inferiority of deferiprone versus deferasirox was established (treatment success in 69 [55·2%] of 125 patients assigned deferiprone with primary composite efficacy endpoint data available at baseline and 1 year vs 80 [54·8%] of 146 assigned deferasirox, difference 0·4%; 95% CI -11·9 to 12·6). No significant difference between the groups was shown in the occurrence of serious and drug-related adverse events. Three (2%) cases of reversible agranulocytosis occurred in the 193 patients in the safety analysis in the deferiprone group and two (1%) cases of reversible renal and urinary disorders (one case of each) occurred in the 197 patients in the deferasirox group. Compliance was similar between treatment groups: 183 (95%) of 193 patients in the deferiprone group versus 192 (97%) of 197 patients in the deferisirox group. INTERPRETATION In paediatric patients with transfusion-dependent haemoglobinopathies, deferiprone was effective and safe in inducing control of iron overload during 12 months of treatment. Considering the need for availability of more chelation treatments in paediatric populations, deferiprone offers a valuable treatment option for this age group. FUNDING EU Seventh Framework Programme.
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Affiliation(s)
- Aurelio Maggio
- Department of Hematology and Rare Diseases, V Cervello, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy.
| | - Antonis Kattamis
- First Department of Pediatrics, National and Kapodistriam University of Athens, Athens, Greece
| | - Mariagrazia Felisi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Bari-Pavia, Italy
| | | | | | - Mohamed Bejaoui
- Pediatrics and Bone Marrow Transplantation Centre, Tunis, Tunisia
| | - Laila Sherief
- Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Carlo Cosmi
- Clinica Pediatrica, Azienda Ospedaliero Universitaria (AOU) Sassari, Sassari, Italy
| | - Oscar Della Pasqua
- Clinical Pharmacology and Therapeutics Group, University College London, London, UK
| | | | - Aldo Filosa
- UOSD Malattie rare del globulo rosso, AORN A Cardarelli, Napoli, Italy
| | - Liana Cuccia
- UOC Ematologia con Talassemia, Dipartimento di Medicina, AO Civico Di Cristina-Benfratelli, Palermo, Italy
| | - Hoda Hassab
- Department of Pediatrics and Clinical Research Center, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Manika Kreka
- Pediatrics Department, University Hospital Center Mother Teresa, Tirana, Albania
| | - Raffaella Origa
- DH Talassemia, Ospedale Pediatrico Microcitemico A CAO, AO G Brotzu, Cagliari, Italy
| | - Maria Caterina Putti
- Department of Women's and Child's Health (DSDB), University Hospital, Padova, Italy
| | | | - Paul Telfer
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
| | - Bianca Tempesta
- Consorzio per Valutazioni Biologiche e Farmacologiche, Bari-Pavia, Italy
| | - Angela Vitrano
- Department of Hematology and Rare Diseases, V Cervello, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | - Ariana Zaka
- Center of Thalassemia, Hospital Ihsan Cabej, Lushnje, Albania
| | | | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Bari-Pavia, Italy
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi Onlus, Valenzano, Italy
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Vitrano A, Ruffo GB, Pepe A, D'Ascola DG, Caruso V, Filosa A, Masera N, Pitrolo L, Rigano P, Cuccia L, Giangreco A, Di Maggio R, Maggio A. Long-term sequential deferiprone and deferasirox therapy in transfusion-dependent thalassaemia patients: a prospective clinical trial. Br J Haematol 2019; 186:e209-e211. [PMID: 31344255 DOI: 10.1111/bjh.16101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Giovan Battista Ruffo
- U.O.C. 7a Pediatria per le Emopatie Ereditarie, Centro di Prevenzione Diagnosi e Cura della Talassemia, A.O. ''G. Di Cristina'', Palermo, Italy
| | - Alessia Pepe
- U.O.C. MRI, Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | | | - Aldo Filosa
- Rare Blood Cell Disease Unit, "Cardarelli" Hospital, Naples, Italy
| | | | - Lorella Pitrolo
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Paolo Rigano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Liana Cuccia
- U.O.C. 7a Pediatria per le Emopatie Ereditarie, Centro di Prevenzione Diagnosi e Cura della Talassemia, A.O. ''G. Di Cristina'', Palermo, Italy
| | - Antonino Giangreco
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Rosario Di Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
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Vitrano A, Ruffo GB, DʼAscola DG, Caruso V, Filosa A, Masera N, Pitrolo L, Rigano P, Cuccia L, Di Maggio R, Maggio A. LONG-TERM SEQUENTIAL DEFERIPRONE AND DEFERASIROX THERAPY IN TRANSFUSION-DEPENDENT THALASSEMIA PATIENTS: A PROSPECTIVE CLINICAL TRIAL. Hemasphere 2019. [DOI: 10.1097/02014419-201906001-00403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
We studied the clinical, electrocardiographic, echocardiographic, Doppler and T2* cardiac magnetic resonance (CMR) data of all adult β-thalassemia major (β-TM) patients with heart failure (HF) consecutively observed at our referral center of the Sicilian region between 2008 and 2016. There were 16 patients enrolled in the study. Echocardiographic examination showed that only one patient had HF with systolic dysfunction of the left ventricle (HFrEF), whereas the others had HF with preserved systolic function of the left ventricle (HFpEF). Systolic dysfunction of the right ventricle (RV) was observed in 13 cases. Furthermore, 30.0% of the patients presented T2* CMR values consistent with intermediate risk of systolic dysfunction of the left ventricle (LV) due to iron overload, whereas 70.0% had normal values. Typical electrocardiographic abnormalities (wide T wave inversion and low voltages) were observed in 11 out of 16 patients. In conclusion, in the adult β-TM patients with HF recently observed at our center, the predominant form was that with diastolic dysfunction of the LV, and with systolic dysfunction of the RV. Only 30.0% had low values of T2* CMR. Typical electrocardiographic abnormalities were found in 69.0%.
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Affiliation(s)
- Luigi Mancuso
- a Franco and Piera Cutino Campus di Ematologia , Ospedali Riuniti Villa Sofia-V. Cervello , Palermo Italia
| | - Angela Vitrano
- a Franco and Piera Cutino Campus di Ematologia , Ospedali Riuniti Villa Sofia-V. Cervello , Palermo Italia
| | - Andrea Mancuso
- b Medicina Interna, Azienda di Rilievo Nazionale ad Alta Specializzazione (ARNAS) Civico , Palermo , Italia.,c Epatologia e Gastroenterologia, Ospedale Niguarda Ca' Granda , Milano , Italia
| | - Massimiliano Sacco
- a Franco and Piera Cutino Campus di Ematologia , Ospedali Riuniti Villa Sofia-V. Cervello , Palermo Italia
| | - Antonietta Ledda
- d Cardiologia, Ospedali Riuniti Villa Sofia-V. Cervello , Palermo , Italia
| | - Aurelio Maggio
- a Franco and Piera Cutino Campus di Ematologia , Ospedali Riuniti Villa Sofia-V. Cervello , Palermo Italia
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12
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Graffeo L, Vitrano A, Scondotto S, Dardanoni G, Pollina Addario WS, Giambona A, Sacco M, Di Maggio R, Renda D, Taormina F, Triveri A, Attanasio M, Gluud C, Maggio A. β-Thalassemia heterozygote state detrimentally affects health expectation. Eur J Intern Med 2018; 54:76-80. [PMID: 29934240 DOI: 10.1016/j.ejim.2018.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/10/2018] [Accepted: 06/07/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Thalassemia minor (Tm) individuals, are generally considered healthy. However, the prognosis of Tm individuals has not been extensively studied. The aim of this study was to evaluate the prognosis of Tm versus controls without β-thalassemia carrier state. METHODS A total of 26,006 individuals seeking thalassemia screening at the AOOR Villa Sofia-V. Cervello, Palermo (Italy) were retrospectively studied. Logistic penalised regression model was used to estimate risk of potential complications and survival techniques were used to study mortality. RESULTS We identified a total of 4943 Tm and 21,063 controls. Tm was associated with significantly higher risks of hospitalisation for cirrhosis (OR 1·94, 95% CI 1·30 to 2·90, p = 0·001), kidney disorders (OR 2·11, 95% CI 1·27 to 3·51, p = 0·004), cholelithiatis (OR 1·39, 95% CI 1·08 to 1·79, p = 0·010), and mood disorders (OR 2·08, 95% CI 1·15 to 3·75, p = 0·015). No statistically difference in life expectancy between thalassemia minor and control group was found (HR 1·090, 95% CI 0·777 to 1·555, p < 0·590; log-rank test p = .426). CONCLUSION This study shows that Tm affects the prognosis of Tm carriers regarding health expectation. Probably, iron overload and anaemia for several years may be at the basis of these effects.
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Affiliation(s)
- Luciano Graffeo
- Campus of Hematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Angela Vitrano
- Campus of Hematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Salvatore Scondotto
- Dipartimento Attività Sanitarie e Osservatorio Epidemiologico Assessorato Salute Regione Sicilia, Palermo, Italy
| | - Gabriella Dardanoni
- Dipartimento Attività Sanitarie e Osservatorio Epidemiologico Assessorato Salute Regione Sicilia, Palermo, Italy
| | | | - Antonino Giambona
- Campus of Hematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Massimiliano Sacco
- Campus of Hematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Rosario Di Maggio
- Campus of Hematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Disma Renda
- Campus of Hematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Federico Taormina
- Dipartimento di Scienze Economiche, Aziendali e Statistiche, Università degli Studi di Palermo, Palermo, Italy
| | - Andrea Triveri
- Dipartimento di Scienze Economiche, Aziendali e Statistiche, Università degli Studi di Palermo, Palermo, Italy
| | - Massimo Attanasio
- Dipartimento di Scienze Economiche, Aziendali e Statistiche, Università degli Studi di Palermo, Palermo, Italy
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Aurelio Maggio
- Campus of Hematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy.
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13
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Vitrano A, Sacco M, Rosso R, Quota A, Fiorino D, Oliva E, Gerardi C, Roccamo G, Spadola V, Filosa A, Tesé L, Calvaruso G, Pitrolo L, Mistretta L, Cassarà F, Di Maggio R, Maggio A. Longitudinal changes in LIC and other parameters in patients receiving different chelation regimens: Data from LICNET. Eur J Haematol 2017; 100:124-130. [PMID: 29094403 DOI: 10.1111/ejh.12989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The liver remains the primary site of iron storage, with liver iron concentration (LIC) being a strong surrogate of total body iron. MRI-R2 can accurately measure LIC. The LICNET (Liver Iron Cutino Network) was established to diagnostics of liver iron overload by MRI-R2 subjects with hemochromatosis in hematological disorders. The aims of the study were to look at variation in LIC measurements during time across different chelation regimens. METHODS This was a cross-sectional study of 130 patients attending 9 Italian centers participating in the LICNET. LIC comparisons over time (T0 and T1 ) were made using t test and/or Wilcoxon test. RESULTS LIC significantly decreased from MRI1 to MRI2 although at high variance (median change -0.8 mg Fe/g dw, range: -29.0 to 33.0; P = .011) and 7.7% of patients shifted from LIC values of high risk (>15 mg Fe/g dw) to an intermediate-risk category (7-15 mg Fe/g dw). Median change in LIC and correlation with serum ferritin levels (SF), during different chelation regimens, is reported. CONCLUSIONS These findings suggest as longitudinal variation in the LIC is possible, across all chelation regimens. It confirms as SF levels not always can be used for estimating changes in LIC.
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Affiliation(s)
- Angela Vitrano
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Massimiliano Sacco
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | | | | | | | - Esther Oliva
- A.O. "Bianchi-Melacrino- Morelli", Reggio Calabria, Italy
| | | | - Gaetano Roccamo
- Centro di Prevenzione e Cura delle Microcitemie, P.O. S'Agata Militello, Sant'Agata Militello, Italy
| | | | - Aldo Filosa
- U.O.D. Malattie Rare del Globulo Rosso, A.O.R.N. "A. Cardarelli", Napoli, Italy
| | - Lorenzo Tesé
- UOC Radiologia, AOOR Villa Sofia-Cervello, Palermo, Italy
| | - Giuseppina Calvaruso
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Lorella Pitrolo
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Laura Mistretta
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Filippo Cassarà
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Rosario Di Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
| | - Aurelio Maggio
- Campus of Haematology Franco and Piera Cutino, AOOR Villa Sofia-V. Cervello, Palermo, Italy
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Graffeo L, Vitrano A, Giambona A, Scondotto S, Dardanoni G, Gluud C, Maggio A. The heterozygote state for β-thalassemia detrimentally affects health outcomes. Am J Hematol 2017; 92:E23-E25. [PMID: 27935096 DOI: 10.1002/ajh.24619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 11/25/2016] [Accepted: 11/28/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Luciano Graffeo
- Campus of Hematology Franco e Piera Cutino, AOOR Villa Sofia‐V. CervelloPalermo Italy
| | - Angela Vitrano
- Campus of Hematology Franco e Piera Cutino, AOOR Villa Sofia‐V. CervelloPalermo Italy
| | - Antonino Giambona
- Campus of Hematology Franco e Piera Cutino, AOOR Villa Sofia‐V. CervelloPalermo Italy
| | - Salvatore Scondotto
- Dipartimento Attività Sanitarie e Osservatorio Epidemiologico Assessorato Salute Regione SiciliaPalermo Italy
| | - Gabriella Dardanoni
- Dipartimento Attività Sanitarie e Osservatorio Epidemiologico Assessorato Salute Regione SiciliaPalermo Italy
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, RigshospitaletCopenhagen University HospitalCopenhagen Denmark
| | - Aurelio Maggio
- Campus of Hematology Franco e Piera Cutino, AOOR Villa Sofia‐V. CervelloPalermo Italy
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15
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Vitrano A, Calvaruso G, Lai E, Colletta G, Quota A, Gerardi C, Concetta Rigoli L, Pitrolo L, Cuccia L, Gagliardotto F, Filosa A, Caruso V, Argento C, Campisi S, Rizzo M, Prossomariti L, Fidone C, Fustaneo M, Di Maggio R, Maggio A. The era of comparable life expectancy between thalassaemia major and intermedia: Is it time to revisit the major-intermedia dichotomy? Br J Haematol 2016; 176:124-130. [PMID: 27748513 DOI: 10.1111/bjh.14381] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/24/2016] [Accepted: 07/26/2016] [Indexed: 01/19/2023]
Abstract
In the last few decades, the life expectancy of regularly transfused β-thalassaemia major (TM) patients has dramatically improved following the introduction of safe transfusion practices, iron chelation therapy, aggressive treatment of infections and improved management of cardiac complications. How such changes, especially those attributed to the introduction of iron chelation therapy, improved the survival of TM patients to approach those with β-thalassaemia intermedia (TI) remains unknown. Three hundred and seventy-nine patients with TM (n = 284, dead 40) and TI (n = 95, dead 13) were followed retrospectively since birth until 30 June 2015 or death. Kaplan-Meir curves showed statistically significant differences in TM and TI survival (P < 0·0001) before the introduction of iron chelation in 1965, which were no longer apparent after that date (P = 0·086), reducing the Hazard Ratio of death in TM compared to TI from 6·8 [95% confidence interval (CI) 2·6-17·5] before 1965 to 2·8 (95% CI 0·8-9·2). These findings suggest that, in the era of iron chelation therapy and improved survival for TM, the major-intermedia dichotomy needs to be revisited alongside future directions in general management and prevention for both conditions.
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Affiliation(s)
- Angela Vitrano
- Campus of Haematology Franco e Piera Cutino - A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Giuseppina Calvaruso
- Campus of Haematology Franco e Piera Cutino - A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Eliana Lai
- Ospedale microcitemico, Centro Talassemici Adulti, University of Cagliari, Cagliari, Italy
| | - Grazia Colletta
- Azienda Ospedaliera Università Policlinico "Vittorio Emanuele - P.O. Ferrarotto", Catania, Italy
| | | | - Calogera Gerardi
- U.O.S. di Talassemia P.O. "Giovanni Paolo II" Sciacca, Sciacca, Italy
| | | | - Lorella Pitrolo
- Campus of Haematology Franco e Piera Cutino - A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Liana Cuccia
- U.O.C. 7a Pediatria per le Emopatie Ereditarie, Centro di Prevenzione Diagnosi e Cura della Talassemia, A.O. "G. Di Cristina", Palermo, Italy
| | - Francesco Gagliardotto
- U.O.C. 7a Pediatria per le Emopatie Ereditarie, Centro di Prevenzione Diagnosi e Cura della Talassemia, A.O. "G. Di Cristina", Palermo, Italy
| | - Aldo Filosa
- U.O.D. Malattie Rare del Globulo Rosso, A.O.R.N. "A. Cardarelli", Napoli, Italy
| | | | - Crocetta Argento
- U.O.C. Medicina Trasfusionale, A.O. "S. Giovanni di Dio", Agrigento, Italy
| | | | - Michele Rizzo
- U.O.C. Ematologia, A.O. "S. ELIA", Caltanissetta, Italy
| | | | - Carmelo Fidone
- U.O.C. Centro Trasfusionale, A.O. "M. Paternò Arezzo", Ragusa, Italy
| | - Maria Fustaneo
- Campus of Haematology Franco e Piera Cutino - A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Rosario Di Maggio
- Campus of Haematology Franco e Piera Cutino - A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Aurelio Maggio
- Campus of Haematology Franco e Piera Cutino - A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
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Vitrano A, Calvaruso G, Tesé L, Gioia F, Cassarà F, Campisi S, Butera F, Commendatore V, Rizzo M, Santoro V, Cigna V, Quota A, Bagnato S, Argento C, Fidone C, Schembari D, Gerardi C, Barbiera F, Bellisssima G, Giugno G, Polizzi G, Rosso R, Abbate G, Caruso V, Chiodi E, Gamberini MR, Giorgi B, Putti MC, Filosa A, De Ritis MR, Oliva E, Arcadi N, Fustaneo M, Mistretta L, Di Maggio R, Sacco M, Veronica DS, Giangreco A, Maggio A. Real-life experience with liver iron concentration R2 MRI measurement in patients with hemoglobinopathies: baseline data from LICNET. Eur J Haematol 2016; 97:361-70. [DOI: 10.1111/ejh.12740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Angela Vitrano
- Campus of Haematology Franco e Piera Cutino- A.O.O.R. ‘Villa Sofia-Cervello’; Palermo Italy
| | - Giuseppina Calvaruso
- Campus of Haematology Franco e Piera Cutino- A.O.O.R. ‘Villa Sofia-Cervello’; Palermo Italy
| | - Lorenzo Tesé
- Campus of Haematology Franco e Piera Cutino- A.O.O.R. ‘Villa Sofia-Cervello’; Palermo Italy
| | - Francesco Gioia
- Campus of Haematology Franco e Piera Cutino- A.O.O.R. ‘Villa Sofia-Cervello’; Palermo Italy
| | - Filippo Cassarà
- Campus of Haematology Franco e Piera Cutino- A.O.O.R. ‘Villa Sofia-Cervello’; Palermo Italy
| | | | | | | | | | | | | | | | | | - Crocetta Argento
- U.O.S. di Talassemia Ospedale San Giovanni di Dio; Agrigento Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aldo Filosa
- U.O.D. Malattie Rare del Globulo Rosso; A.O.R.N. ‘A. Cardarelli’; Napoli Italy
| | | | - Esther Oliva
- A.O. ‘Bianchi-Melacrino-Morelli’; Reggio Calabria Italy
| | - Nicola Arcadi
- A.O. ‘Bianchi-Melacrino-Morelli’; Reggio Calabria Italy
| | - Maria Fustaneo
- Campus of Haematology Franco e Piera Cutino- A.O.O.R. ‘Villa Sofia-Cervello’; Palermo Italy
| | - Laura Mistretta
- Campus of Haematology Franco e Piera Cutino- A.O.O.R. ‘Villa Sofia-Cervello’; Palermo Italy
| | - Rosario Di Maggio
- Campus of Haematology Franco e Piera Cutino- A.O.O.R. ‘Villa Sofia-Cervello’; Palermo Italy
| | - Massimiliano Sacco
- Campus of Haematology Franco e Piera Cutino- A.O.O.R. ‘Villa Sofia-Cervello’; Palermo Italy
| | - Di Salvo Veronica
- Campus of Haematology Franco e Piera Cutino- A.O.O.R. ‘Villa Sofia-Cervello’; Palermo Italy
| | - Antonino Giangreco
- Campus of Haematology Franco e Piera Cutino- A.O.O.R. ‘Villa Sofia-Cervello’; Palermo Italy
| | - Aurelio Maggio
- Campus of Haematology Franco e Piera Cutino- A.O.O.R. ‘Villa Sofia-Cervello’; Palermo Italy
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17
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Calvaruso G, Vitrano A, Di Maggio R, Lai E, Colletta G, Quota A, Gerardi C, Rigoli LC, Sacco M, Pitrolo L, Maggio A. Deferiprone versus deferoxamine in thalassemia intermedia: Results from a 5-year long-term Italian multicenter randomized clinical trial. Am J Hematol 2015; 90:634-8. [PMID: 25809173 DOI: 10.1002/ajh.24024] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/17/2015] [Accepted: 03/20/2015] [Indexed: 12/19/2022]
Abstract
In patients with thalassemia intermedia (TI), such as beta-TI, alpha-thalassemia (mainly HbH disease and mild/moderate forms of HbE/beta-thalassemia), iron overload is an important challenge in terms of diagnosis, monitoring, and treatment. Moreover, to date, the only possible chelators available are deferoxamine, deferasirox, and deferiprone. Here, we report the first 5-year long-term randomized clinical trial comparing the effectiveness of deferiprone versus deferoxamine in patients with TI. Body iron burden, which was determined by measuring serum ferritin levels in the same patient over 5 years and analyzed according to the generalized linear mixed model (GLMM), showed a linear decrease over time in the mean serum ferritin levels in both treatment groups (P-value = 0.035). The overall period of observation was 235.2 person-years for the deferiprone patients compared with 214.3 person-years for the deferoxamine patients. The results of the log-rank test suggested that the deferiprone treatment did not affect survival compared with the deferoxamine treatment (P-value = 0.360). The major adverse events observed included gastrointestinal symptoms and joint pain or arthralgia. Neutropenia and agranulocytosis were also detected, suggesting needing of strict hematological control. In conclusion, long-term iron chelation therapy with deferiprone is associated with an efficacy and safety similar to that of deferoxamine, suggesting that this drug is an alternative option in cases in which deferoxamine and deferasirox are contraindicated.
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Affiliation(s)
- Giuseppina Calvaruso
- A.O.R. “Villa Sofia - V; Cervello’’; Unità Operativa Complessa Ematologia II; Palermo Italy
| | - Angela Vitrano
- A.O.R. “Villa Sofia - V; Cervello’’; Unità Operativa Complessa Ematologia II; Palermo Italy
| | - Rosario Di Maggio
- A.O.R. “Villa Sofia - V; Cervello’’; Unità Operativa Complessa Ematologia II; Palermo Italy
| | - Eliana Lai
- Dipartimento Di Scienze Mediche; Sezione Talassemici Adulti, University of Cagliari; Italy
| | - Grazia Colletta
- Azienda Ospedaliera Univiversità Policlinico “Vittorio Emanuele -P.O Ferrarotto”; Catania Italy
| | | | | | | | - Massimiliano Sacco
- A.O.R. “Villa Sofia - V; Cervello’’; Unità Operativa Complessa Ematologia II; Palermo Italy
| | - Lorella Pitrolo
- A.O.R. “Villa Sofia - V; Cervello’’; Unità Operativa Complessa Ematologia II; Palermo Italy
| | - Aurelio Maggio
- A.O.R. “Villa Sofia - V; Cervello’’; Unità Operativa Complessa Ematologia II; Palermo Italy
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18
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Filosa A, Vitrano A, Rigano P, Calvaruso G, Barone R, Capra M, Cuccia L, Gagliardotto F, Pitrolo L, Prossomariti L, Casale M, Caruso V, Gerardi C, Campisi S, Cianciulli P, Rizzo M, D'Ascola G, Ciancio A, Maggio A. Long-term treatment with deferiprone enhances left ventricular ejection function when compared to deferoxamine in patients with thalassemia major. Blood Cells Mol Dis 2013; 51:85-8. [PMID: 23628348 DOI: 10.1016/j.bcmd.2013.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 03/10/2013] [Accepted: 03/11/2013] [Indexed: 01/19/2023]
Abstract
Transfusion and iron chelation treatment have significantly reduced morbidity and improved survival of patients with thalassemia major. However, cardiac disease continues to be the most common cause of death. We report the left-ventricular ejection fraction, determined by echocardiography, in one hundred sixty-eight patients with thalassemia major followed for at least 5years who received continuous monotherapy with deferoxamine (N=108) or deferiprone (N=60). The statistical analysis, using the generalized estimating equations model, indicated that the group treated with deferiprone had a significantly better left-ventricular ejection fraction than did those treated with deferoxamine (coefficient 0.97; 95% CI 0.37; 1.6, p=0.002). The heart may be particularly sensitive to iron-induced mitochondrial damage because of the large number of mitochondria and its low level of antioxidants. Deferiprone, because of its lower molecular weight, might cross into heart mitochondria more efficiently, improving their activity and, thereby, myocardial cell function. Our findings indicate that the long-term administration of deferiprone significantly enhances left-ventricular function over time in comparison with deferoxamine treatment. However, because of limitations related to the design of this study, these findings should be confirmed in a prospective, randomized clinical trial.
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Affiliation(s)
- Aldo Filosa
- U.O.D. Centro per le Microcitemie, A.O.R.N. A. Cardarelli, Napoli, Italy.
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19
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Maggio A, Vitrano A, Calvaruso G, Barone R, Rigano P, Mancuso L, Cuccia L, Capra M, Pitrolo L, Prossomariti L, Filosa A, Caruso V, Gerardi C, Campisi S, Cianciulli P, Elefteriou A, Angastiniotis M, Hamza H, Telfer P, Walker JM, Phrommintikul A, Chattipakorn N. Serial echocardiographic left ventricular ejection fraction measurements: a tool for detecting thalassemia major patients at risk of cardiac death. Blood Cells Mol Dis 2013; 50:241-6. [PMID: 23337255 DOI: 10.1016/j.bcmd.2012.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 12/02/2012] [Accepted: 12/03/2012] [Indexed: 01/19/2023]
Abstract
Cardiac damage remains a major cause of mortality among patients with thalassemia major. The detection of a lower cardiac magnetic resonance T2* (CMR-T2*) signal has been suggested as a powerful predictor of the subsequent development of heart failure. However, the lack of worldwide availability of CMR-T2* facilities prevents its widespread use for follow-up evaluations of cardiac function in thalassemia major patients, warranting the need to assess the utility of other possible procedures. In this setting, the determination of left ventricular ejection fraction (LVEF) offers an accurate and reproducible method for heart function evaluation. These findings suggest a reduction in LVEF≥7%, over time, determined by 2-D echocardiography, may be considered a strong predictive tool for the detection of thalassemia major patients with increased risk of cardiac death. The reduction of LVEF≥7% had higher (84.76%) predictive value. Finally, Kaplan-Meier survival curves of thalassemia major patients with LVEF≥7% showed a statistically significant decreased probability of survival for heart disease (p=0.0022). However, because of limitations related to the study design, such findings should be confirmed in a large long-term prospective clinical trial.
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Affiliation(s)
- Aurelio Maggio
- U.O.C. Ematologia II, AOR Villa Sofia-V. Cervello, Palermo, Italy.
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20
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Renda MC, Vitrano A, Attanasio M, Fecarotta E, Piazza A, Giambona A, Fiorentino G, Renda D, Rigano P, Calvaruso G, Cassarà F, Maggio A. Nonsense-Mediated Decay Mechanism Is a Possible Modifying Factor of Clinical Outcome in Nonsense cd39 Beta Thalassemia Genotype. Thalassemia Reports 2012. [DOI: 10.4081/thal.2012.e2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nonsense-mediated mRNA decay (NMD) is a surveillance system to prevent the synthesis of non-functional proteins. In β-thalassemia, NMD may have a role in clinical outcome. An example of premature translation stop codons appearing for the first time is the β-globin cd39 mutation; when homozygous, this results in a severe phenotype. The aim of this study was to determine whether the homozygous nonsense cd39 may have a milder phenotype in comparison with IVS1,nt110/cd39 genotype. Genotypes have been identified from a cohort of 568 patients affected by β-thalassemia. These genotypes were compared with those found in 577 affected fetuses detected among 2292 prenatal diagnoses. The nine most common genotypes, each with an incidence rate of 1.5% or over, and together accounting for 80% of genotype frequencies, underwent statistical analysis. Genotype prevalence was calculated within the overall group. Results are expressed as proportions with 95% confidence intervals; p ≤ 0.05 was considered statistically significant. A binomial distribution was assumed for each group; z-tests were used to compare genotype frequencies observed in the patient group with frequencies in the affected fetus group. In the absence of selecting factors, prevalence of these two genotypes was compared between a cohort of 568 β-thalassemia patients (PTS) and 577 affected fetuses (FOET) detected during the same period. IVS1,nt110/cd39 was significantly more prevalent in FOET than PTS (p < 0.0001), while there was no significant difference in prevalence of cd39/cd39 in FOET compared with PTS (p = 0.524). These results suggest a cd39 genotype NMD mechanism may be associated with improved clinical outcomes in thalassemia major.
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Maggio A, Vitrano A, Lucania G, Capra M, Cuccia L, Gagliardotto F, Pitrolo L, Prossomariti L, Filosa A, Caruso V, Gerardi C, Campisi S, Cianciulli P, Rizzo M, D'Ascola G, Ciancio A, Di Maggio R, Calvaruso G, Pantalone GR, Rigano P. Long-term use of deferiprone significantly enhances left-ventricular ejection function in thalassemia major patients. Am J Hematol 2012; 87:732-3. [PMID: 22622672 DOI: 10.1002/ajh.23219] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 03/26/2012] [Indexed: 11/07/2022]
Abstract
A multicenter randomized open-label long-term sequential deferiprone–deferoxamine (DFP-DFO) versus DFP alone trial (sequential DFP-DFO) performed in patients with thalassemia major (TM) was retrospectively reanalyzed to assess the variation in the left ventricular ejection fraction (LVEF) [1].
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Affiliation(s)
- Aurelio Maggio
- U.O.C. Ematologia II con Talassemia, Ospedali Riuniti P.O. Cervello Palermo, Palermo, Italy.
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22
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Pantalone GR, Maggio A, Vitrano A, Capra M, Cuccia L, Gagliardotto F, Filosa A, Romeo MA, Magnano C, Caruso V, Argento C, Gerardi C, Campisi S, Violi P, Malizia R, Cianciulli P, Rizzo M, D'Ascola DG, Quota A, Prossomariti L, Fidone C, Rigano P, Pepe A, D'Amico G, Morabito A, Gluud C. Sequential alternating deferiprone and deferoxamine treatment compared to deferiprone monotherapy: main findings and clinical follow-up of a large multicenter randomized clinical trial in -thalassemia major patients. Hemoglobin 2011; 35:206-16. [PMID: 21599433 DOI: 10.3109/03630269.2011.570674] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In β-thalassemia major (β-TM) patients, iron chelation therapy is mandatory to reduce iron overload secondary to transfusions. Recommended first line treatment is deferoxamine (DFO) from the age of 2 and second line treatment after the age of 6 is deferiprone (L1). A multicenter randomized open-label trial was designed to assess the effectiveness of long-term alternating sequential L1-DFO vs. L1 alone iron chelation therapy in β-TM patients. Deferiprone 75 mg/kg 4 days/week and DFO 50 mg/kg/day for 3 days/week was compared with L1 alone 75 mg/kg 7 days/week during a 5-year follow-up. A total of 213 thalassemia patients were randomized and underwent intention-to-treat analysis. Statistically, a decrease of serum ferritin level was significantly higher in alternating sequential L1-DFO patients compared with L1 alone patients (p = 0.005). Kaplan-Meier survival analysis for the two chelation treatments did not show statistically significant differences (log-rank test, p = 0.3145). Adverse events and costs were comparable between the groups. Alternating sequential L1-DFO treatment decreased serum ferritin concentration during a 5-year treatment by comparison to L1 alone, without significant differences of survival, adverse events or costs. These findings were confirmed in a further 21-month follow-up. These data suggest that alternating sequential L1-DFO treatment may be useful for some β-TM patients who may not be able to receive other forms of chelation treatment.
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Affiliation(s)
- Gaetano Restivo Pantalone
- Unità Operativa Complessa Ematologia II con Talassemia, Azienda Ospedaliera Ospedali Riuniti Villa Sofia, Vincenzo Cervello, Palermo, Italia.
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D'Alcamo E, Agrigento V, Sclafani S, Vitrano A, Cuccia L, Maggio A, Perrotta S, Capra M, Rigano P. Reliability of EMA binding test in the diagnosis of hereditary spherocytosis in Italian patients. Acta Haematol 2010; 125:136-40. [PMID: 21150181 DOI: 10.1159/000322253] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 10/24/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Elena D'Alcamo
- Azienda Ospedali Riuniti Villa Sofia - Cervello, Ospedale V. Cervello, U.O.C. Ematologia II, Laboratorio di Ricerca 'Piera Cutino', Palermo, Italia.
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25
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Restivo Pantalone G, Renda D, Valenza F, D'Amato F, Vitrano A, Cassarà F, Rigano P, Di Salvo V, Giangreco A, Bevacqua E, Maggio A. Hepatocellular carcinoma in patients with thalassaemia syndromes: clinical characteristics and outcome in a long term single centre experience. Br J Haematol 2010; 150:245-7. [PMID: 20433678 DOI: 10.1111/j.1365-2141.2010.08180.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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26
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Maggio A, Vitrano A, Capra M, Cuccia L, Gagliardotto F, Filosa A, Magnano C, Rizzo M, Caruso V, Gerardi C, Argento C, Campisi S, Cantella F, Commendatore F, D'Ascola DG, Fidone C, Ciancio A, Galati MC, Giuffrida G, Cingari R, Giugno G, Lombardo T, Prossomariti L, Malizia R, Meo A, Roccamo G, Romeo MA, Violi P, Cianciulli P, Rigano P. Improving survival with deferiprone treatment in patients with thalassemia major: A prospective multicenter randomised clinical trial under the auspices of the Italian Society for Thalassemia and Hemoglobinopathies. Blood Cells Mol Dis 2009; 42:247-51. [DOI: 10.1016/j.bcmd.2009.01.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 01/08/2009] [Accepted: 01/08/2009] [Indexed: 10/21/2022]
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27
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Maggio A, Vitrano A, Capra M, Cuccia L, Gagliardotto F, Filosa A, Romeo MA, Magnano C, Caruso V, Argento C, Gerardi C, Campisi S, Violi P, Malizia R, Cianciulli P, Rizzo M, D’Ascola DG, Quota A, Prossomariti L, Fidone C, Rigano P, Pepe A, D’Amico G, Morabito A, Gluud C. Long-term sequential deferiprone-deferoxamineversusdeferiprone alone for thalassaemia major patients: a randomized clinical trial. Br J Haematol 2009; 145:245-54. [DOI: 10.1111/j.1365-2141.2009.07609.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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