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Bocchia M, Carella AM, Mulè A, Rizzo L, Turrini M, Abbenante MC, Cairoli R, Calafiore V, Defina M, Gardellini A, Luzi G, Patti C, Pinazzi MB, Riva M, Rossi G, Sammartano V, Rigacci L. Therapeutic Management of Patients with FLT3 + Acute Myeloid Leukemia: Case Reports and Focus on Gilteritinib Monotherapy. Pharmgenomics Pers Med 2022; 15:393-407. [PMID: 35496349 PMCID: PMC9041600 DOI: 10.2147/pgpm.s346688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/04/2022] [Indexed: 12/26/2022] Open
Abstract
Acute myeloid leukemia is a malignant disorder of the bone marrow, characterized by differentiation, clonal expansion, and uncontrolled proliferation of malignant myeloid progenitor cells and by several molecular and genetic abnormalities. A mutation of FMS-like tyrosine kinase 3 gene can be observed in about one-third of cases of acute myeloid leukemia. Two FLT3 inhibitors are actually approved for FLT3 mutated acute myeloid leukemia: midostaurin, a multikinase first generation inhibitor with lower affinity for FLT3 binding, and gilteritinib fumarate, a potent second-generation inhibitor of both FLT3-ITD and TKD. Gilteritinib is a new effective and well-tolerated drug for patients with relapsing or refractory FLT3-positive acute myeloid leukemia. Thanks to its efficacy, low toxicity, its good manageability (oral formulation), this drug is suitable for all the patients, including elderly frail patient with concomitant therapies or pre-existing or underlying diseases, and can be used also in the outpatient setting, reducing risks and costs related to the hospitalization. We report and discuss seven cases of different patients with FLT3 positive acute myeloid leukemia successfully managed with gilteritinib in the real clinical practice.
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Affiliation(s)
- Monica Bocchia
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Angelo Michele Carella
- Division of Hematology with Hematologic Intensive Care Unit and Cellular Therapies, Department of Medical Science, Fondazione IRCCS Casa Sollievo Della Sofferenza, Foggia, Italy
- Correspondence: Angelo Michele Carella, Division of Hematology with Hematologic Intensive Care Unit and Cellular Therapies, Department of Medical Science, Fondazione IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini, San Giovanni Rotondo, Foggia, 71013, Italy, Tel +390882410054, Fax +390882410322, Email
| | - Antonino Mulè
- UOC Hematology and Oncology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Lorenzo Rizzo
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Mauro Turrini
- Division of Hematology, Valduce Hospital, Como, Italy
| | - Maria Chiara Abbenante
- Division of Hematology with Hematologic Intensive Care Unit and Cellular Therapies, Department of Medical Science, Fondazione IRCCS Casa Sollievo Della Sofferenza, Foggia, Italy
| | - Roberto Cairoli
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Valeria Calafiore
- UOC Hematology and Oncology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Marzia Defina
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Giovanni Luzi
- UOC Hematology and Stem Cell Transplant Unit, Ospedale S, Camillo, Rome, Italy
| | - Caterina Patti
- UOC Hematology and Oncology, Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | - Marta Riva
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanni Rossi
- Division of Hematology with Hematologic Intensive Care Unit and Cellular Therapies, Department of Medical Science, Fondazione IRCCS Casa Sollievo Della Sofferenza, Foggia, Italy
| | - Vincenzo Sammartano
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Luigi Rigacci
- UOC Hematology and Stem Cell Transplant Unit, Ospedale S, Camillo, Rome, Italy
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Gardellini A, Guidotti F, Zancanella M, Maino E, Steffanoni S, Turrini M. Lichen planopilaris-like eruption in chronic myeloid leukemia patient during treatment with nilotinib as second-line therapy. J Oncol Pharm Pract 2022; 28:969-971. [PMID: 35037787 DOI: 10.1177/10781552211073957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Chronic myeloid leukemia (CML) is a malignant clonal disorder of hematopoietic stem cells characterized by a translocation of genetic material between chromosomes 9 and 22 resulting in the BCR-ABL fusion oncogene expression. Nilotinib is a potent second-generation tyrosine kinase inhibitor available as first line treatment. Among side effects QTc interval prolongation, pancreatitis, metabolic disorders and skin reactions are the most commonly seen. CASE REPORT Here we describe a rare case of lichen planopilaris eruption that developed during therapy with nilotinib. MANAGEMENT & OUTCOME Nilotinib dosage was reduced together with introduction of hydroxychloroquine with progressive improvement of alopecia. DISCUSSION Collaboration with dermatologist and nilotinib dose reduction allowed to continue the drug maintaining major molecular response and patient's quality of life.
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Affiliation(s)
- Angelo Gardellini
- Division of Hematology, Department of Medicine, 9349Valduce Hospital, Como, Italy
| | - Francesca Guidotti
- Division of Hematology, Department of Medicine, 9349Valduce Hospital, Como, Italy
| | - Michelle Zancanella
- Division of Hematology, Department of Medicine, 9349Valduce Hospital, Como, Italy
| | - Elena Maino
- Division of Hematology, Department of Medicine, 9349Valduce Hospital, Como, Italy
| | - Sara Steffanoni
- Division of Hematology, Department of Medicine, 9349Valduce Hospital, Como, Italy
| | - Mauro Turrini
- Division of Hematology, Department of Medicine, 9349Valduce Hospital, Como, Italy
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Gardellini A, Guidotti F, Feltri M, Zancanella M, Maino E, Ambrosiani L, Turrini M. Eltrombopag as second line treatment in patients with primary immune thrombocytopenia: A single center real life experience. Blood Cells Mol Dis 2021; 92:102620. [PMID: 34715450 DOI: 10.1016/j.bcmd.2021.102620] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 10/20/2022]
Abstract
Glucocorticoid treatment is the standard initial therapy for patients with immune thrombocytopenia (ITP). Despite a rate of 60-80% of initial remissions, only 30 to 50% of adults have a sustained response after discontinuation. Second line options are splenectomy, thrombopoietin-receptor agonists (TPO-RAs), rituximab and intravenous immunoglobulin. Third line treatments include a mix of immunosuppressive drugs (e.g. azathioprine, ciclosporin, etc.). Recently international guidelines have proposed a treatment algorithm formalizing TPO-RAs and splenectomy as second and third line respectively, confirming splenectomy as second line choice only in emergency. Here we present a single center observational retrospective study of eltrombopag as second line treatment. We evaluated 48 adult primary chronic ITP patients since 2003. Forty-four out of 48 patients received a first line treatment with glucocorticoids. Twenty-two (61%) patients needed a second line treatment: 18 received eltrombopag, 3 a second course of steroid and one patient underwent splenectomy. Every patient before starting eltrombopag or receiving splenectomy underwent bone marrow examination. Overall response rate to eltrombopag was 94% with a CR rate of 76% and a PR of 23%; only one patient was non responder, underwent splenectomy and received subsequent treatment with rituximab, romiplostim and cyclosporin obtaining CR. One patient developed an autoimmune pancytopenia about a month after starting TPO-RA and in addition to eltrombopag received steroid and rituximab with blood count improvement. After a median follow up of 21,1 months (range 0,4-64,7 months) 16 patients (89%) are still on therapy maintaining response. As regards safety, gastrointestinal side effects were rare and low grade; only one patient discontinued eltrombopag after few weeks, because of dizziness. One patient had a relapse of deep venous thrombosis while no major bleeding complications were observed. Our real-life single center experience confirms efficacy and safety of eltrombopag as second line treatment in chronic ITP patients.
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Affiliation(s)
- Angelo Gardellini
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | - Francesca Guidotti
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy.
| | | | - Michelle Zancanella
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | - Elena Maino
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | | | - Mauro Turrini
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
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Gardellini A, Guidotti F, Maino E, Steffanoni S, Zancanella M, Turrini M. Severe immune thrombocytopenia after COVID-19 vaccination: Report of four cases and review of the literature. Blood Cells Mol Dis 2021; 92:102615. [PMID: 34653943 PMCID: PMC8494992 DOI: 10.1016/j.bcmd.2021.102615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 12/04/2022]
Affiliation(s)
- Angelo Gardellini
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | - Francesca Guidotti
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy.
| | - Elena Maino
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | - Sara Steffanoni
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | - Michelle Zancanella
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
| | - Mauro Turrini
- Division of Hematology, Department of Medicine, Valduce Hospital, Como, Italy
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Turrini M, Gardellini A, Beretta L, Buzzi L, Ferrario S, Vasile S, Clerici R, Colzani A, Liparulo L, Scognamiglio G, Imperiali G, Corrado G, Strada A, Galletti M, Castiglione N, Zanon C. Clinical Course and Risk Factors for In-Hospital Mortality of 205 Patients with SARS-CoV-2 Pneumonia in Como, Lombardy Region, Italy. Vaccines (Basel) 2021; 9:vaccines9060640. [PMID: 34208017 PMCID: PMC8230614 DOI: 10.3390/vaccines9060640] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 12/18/2022] Open
Abstract
The aim of this study is to explore risk factors for in-hospital mortality and describe the effectiveness of different treatment strategies of 205 laboratory-confirmed cases infected with SARS-CoV-2 during the Lombardy outbreak. All patients received the best supportive care and specific interventions that included the main drugs being tested for repurposing to treat COVID-19, such as hydroxychloroquine, anticoagulation and antiviral drugs, steroids, and interleukin-6 pathway inhibitors. Clinical, laboratory, and treatment characteristics were analyzed with univariate and multivariate logistic regression methods to explore their impact on in-hospital mortality. Univariate analyses showed prognostic significance for age greater than 70 years, the presence of two or more relevant comorbidities, a P/F ratio less than 200 at presentation, elevated LDH (lactate dehydrogenase) and CRP (C-reactive protein) values, intermediate- or therapeutic-dose anticoagulation, hydroxychloroquine, early antiviral therapy with lopinavir/ritonavir, short courses of steroids, and tocilizumab therapy. Multivariable regression confirmed increasing odds of in-hospital death associated with age older than 70 years (OR 3.26) and a reduction in mortality for patients treated with anticoagulant (−0.37), antiviral lopinavir/ritonavir (−1.22), or steroid (−0.59) therapy. In contrast, hydroxychloroquine and tocilizumab have not been confirmed to have a significant effect in the treatment of SARS-CoV-2 pneumonia. Results from this real-life single-center experience are in agreement and confirm actual literature data on SARS-CoV-2 pneumonia in terms of both clinical risk factors for in-hospital mortality and the effectiveness of the different therapies proposed for the management of COVID19 disease.
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Affiliation(s)
- Mauro Turrini
- Department of Medicine, Division of Hematology, Valduce Hospital, 22100 Como, Italy;
- Correspondence: ; Tel.: +39-031324419
| | - Angelo Gardellini
- Department of Medicine, Division of Hematology, Valduce Hospital, 22100 Como, Italy;
| | - Livia Beretta
- Risk Management, Valduce Hospital, 22100 Como, Italy;
| | - Lucia Buzzi
- Quality Management System, Valduce Hospital, 22100 Como, Italy;
| | - Stefano Ferrario
- Department of Medicine, Division of Pneumology, Valduce Hospital, 22100 Como, Italy; (S.F.); (A.C.)
| | - Sabrina Vasile
- Department of Mother and Child, Division of Paediatric and Neonatology, Infectious Diseases Consultant, Valduce Hospital, 22100 Como, Italy;
| | - Raffaella Clerici
- Department of Medicine, Division of Neurology, Valduce Hospital, 22100 Como, Italy;
| | - Andrea Colzani
- Department of Medicine, Division of Pneumology, Valduce Hospital, 22100 Como, Italy; (S.F.); (A.C.)
| | - Luigi Liparulo
- Department of Medicine, Division of Internal Medicine, Valduce Hospital, 22100 Como, Italy;
| | | | - Gianni Imperiali
- Department of Medicine, Division of Gastroenterology, Valduce Hospital, 22100 Como, Italy;
| | - Giovanni Corrado
- Department of Medicine, Division of Cardiology, Valduce Hospital, 22100 Como, Italy;
| | - Antonello Strada
- Department of Emergency Medicine, Valduce Hospital, 22100 Como, Italy;
| | - Marco Galletti
- Department of Intensive Care Medicine, Valduce Hospital, 22100 Como, Italy;
| | - Nunzio Castiglione
- Hospital Health Management, Valduce Hospital, 22100 Como, Italy; (N.C.); (C.Z.)
| | - Claudio Zanon
- Hospital Health Management, Valduce Hospital, 22100 Como, Italy; (N.C.); (C.Z.)
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Guidotti F, Gardellini A, Feltri M, Zancanella M, Saccà V, Ambrosiani L, Turrini M. Myeloid Sarcoma Involving Kidneys: From Diagnosis to Treatment. Case Report and Literature Review. CMI 2020. [DOI: 10.7175/cmi.v14i1.1460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Myeloid sarcomas (MS) are rare extramedullary hematological tumors which generally occur during the natural course of acute myeloid leukemia or chronic myeloid leukemia. Rarely, their onset precedes peripheral blood and bone marrow manifestations of disease. Common sites of involvement are skin, bone, soft tissue, lymph nodes, reproductive or digestive organs, and central nervous system.Herein, we report the case of a 72-year-old man affected by JAK2 V617F mutated myeloproliferative neoplasm who developed MS involving collecting system of both kidneys. MS and MS-related obstructive nephropathy were the first signs of the acute evolution of a known chronic hematological malignancy, preceding by some weeks the onset of leukocytosis.
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Congedo P, Gardellini A, Corich L, Papa A, Turrini M. The first case of Mycobacterium vaccae sepsis in a non-Hodgkin lymphoma patient: biological understandings and clinical consequencies. Access Microbiol 2020; 2:acmi000161. [PMID: 33195975 PMCID: PMC7660240 DOI: 10.1099/acmi.0.000161] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022] Open
Abstract
Mycobacterium vaccae is a rapidly growing nonpathogenic species of the Mycobacteriaceae family of bacteria that can cause pulmonary and disseminated disease in particular in immunocompromised individuals. Here we describe a first case of matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass-spectrometry (MS) identification of this pathogen in a patient with non-Hodgkin’s lymphoma during chemoimmunotherapy salvage treatment, and its impact on clinical decision making.
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Affiliation(s)
- Pierluigi Congedo
- Operative Unit of Chemical-Clinical and Microbiological Analysis, Ospedale Valduce, Como, Italy.,Clinical Pathology Laboratory Vimercate Hospital, Italy
| | - Angelo Gardellini
- Division of Hematology, Department of Medicin, Ospedale Valduce, Como, Italy
| | - Lucia Corich
- Clinical Pathology Laboratory Vimercate Hospital, Italy
| | - Angela Papa
- Operative Unit of Chemical-Clinical and Microbiological Analysis, Ospedale Valduce, Como, Italy
| | - Mauro Turrini
- Division of Hematology, Department of Medicin, Ospedale Valduce, Como, Italy
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Elli EM, Iurlo A, Aroldi A, Caramella M, Malato S, Casartelli E, Maffioli M, Gardellini A, Carraro MC, D'Adda M, Polverelli N, Rossi M, Orofino N, Carrer A, Gambacorti-Passerini C, Antolini L, Passamonti F. Deferasirox in the management of iron-overload in patients with myelofibrosis: a multicentre study from the Rete Ematologica Lombarda (IRON-M study). Br J Haematol 2019; 186:e123-e126. [PMID: 31106402 DOI: 10.1111/bjh.15964] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Elena M Elli
- Haematology Division and Bone Marrow Unit, Ospedale San Gerardo, Monza, Italy
| | - Alessandra Iurlo
- Haematology Division, IRCCS Cà Granda - Maggiore Policlinico Hospital Foundation, Milano, Italy
| | - Andrea Aroldi
- Haematology Division and Bone Marrow Unit, Ospedale San Gerardo, Monza, Italy
| | | | - Simona Malato
- Haematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy
| | | | - Margherita Maffioli
- Haematology, Department of Medicine and Surgery, University of Insubria & Ospedale di Circolo, ASST Sette Laghi, Varese, Italy
| | | | - Maria C Carraro
- Haematology and Transfusion Medicine, Sacco Hospital, Milano, Italy
| | - Mariella D'Adda
- Department of Haematology, ASST Spedali Civili, Brescia, Italy
| | - Nicola Polverelli
- Haematology, Bone Marrow Transplantation Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marianna Rossi
- Cancer Centre, Humanitas Research Hospital & Humanitas University, Milan, Italy
| | - Nicola Orofino
- Haematology Division, IRCCS Cà Granda - Maggiore Policlinico Hospital Foundation, Milano, Italy
| | - Andrea Carrer
- Haematology Division and Bone Marrow Unit, Ospedale San Gerardo, Monza, Italy
| | | | - Laura Antolini
- Centro di Biostatistica per l'epidemiologia clinica, Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Francesco Passamonti
- Haematology, Department of Medicine and Surgery, University of Insubria & Ospedale di Circolo, ASST Sette Laghi, Varese, Italy
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Abstract
Plerixafor, a hematopoietic stem cell mobilizer, is indicated in combination with G-CSF to mobilize hematopoietic stem cells to the peripheral blood for collection and subsequent autologous transplantation in patients with non-Hodgkin's lymphoma and multiple myeloma. Current evidence suggests that the addition of plerixafor with chemotherapy plus G-CSF is safe and effective in the large majority of the patients with low blood CD34(+) cell count after mobilization and/or poor yield after the first collection. Nevertheless, there are several questions strongly debated, and in this paper, we would like to identify areas of possible future use and development of the drug.
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Pruneri G, Gigli F, Rafaniello Raviele P, Gardellini A, Raimondi S, De Fiori E, Preda L, Viale G, Martinelli G, Laszlo D. Core needle biopsy as a front line diagnostic approach for lymphoma patients. Hematol Oncol 2014; 33:247-9. [DOI: 10.1002/hon.2150] [Citation(s) in RCA: 6] [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: 03/06/2014] [Revised: 05/20/2014] [Accepted: 05/22/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Giancarlo Pruneri
- European Institute of Oncology; Divisions of Pathology; Milan Italy
- University of Milan; School of Medicine; Milan Italy
| | - Federica Gigli
- European Institute of Oncology; Hemato-Oncology; Milan Italy
| | | | | | - Sara Raimondi
- European Institute of Oncology; Epidemiology and Biostatistics; Milan Italy
| | | | - Lorenzo Preda
- European Institute of Oncology; Radiology; Milan Italy
| | - Giuseppe Viale
- European Institute of Oncology; Divisions of Pathology; Milan Italy
- University of Milan; School of Medicine; Milan Italy
| | | | - Daniele Laszlo
- European Institute of Oncology; Hemato-Oncology; Milan Italy
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Montoro J, Andreola G, Gardellini A, Babic A, Negri M, Frungillo N, Martinelli G, Laszlo D. R-ESHAP plus pegfilgrastim as an effective peripheral stem cell mobilization regimen for autologous stem-cell transplantation in patients with relapsed/refractory diffuse large B-cell lymphoma. Transfus Apher Sci 2014; 50:411-4. [PMID: 24751603 DOI: 10.1016/j.transci.2014.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/05/2013] [Accepted: 03/24/2014] [Indexed: 11/30/2022]
Abstract
Stem cell (SC) mobilization is significantly influenced by the mobilization schedule in patients with lymphoma. We evaluated data from 30 patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) undergoing SC mobilization. All received R-ESHAP plus a single dose of pegfilgrastim. All patients collected ⩾ 2 × 10(6) CD34+cells/kg, 80% of them at least 5 × 10(6) CD34+cells/kg. Adverse effects of the regimen included myelosuppression and neutropenic fever. Herein, our results suggest that R-ESHAP plus pegfilgrastim is a highly effective mobilization strategy in patients affected by DLBCL associated with a low incidence of adverse events.
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Affiliation(s)
- Juan Montoro
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
| | - Giovanna Andreola
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Angelo Gardellini
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Aleksandra Babic
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Mara Negri
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Niccolò Frungillo
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Giovanni Martinelli
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Daniele Laszlo
- Haematoncology Division, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
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Gardellini A, Gigli F, Babic A, Andreola G, Radice D, Sammassimo S, Martinelli G, Laszlo D. Filgrastim XM02 (Tevagrastim®) after autologous stem cell transplantation compared to lenograstim: favourable cost-efficacy analysis. Ecancermedicalscience 2013; 7:327. [PMID: 23818939 PMCID: PMC3694838 DOI: 10.3332/ecancer.2013.327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Granulocyte colony-stimulating factors (G-CSFs), filgrastim and lenograstim, are recognised to be useful in accelerating engraftment after autologous stem cell transplantation. Several forms of biosimilar non-glycosylated G-CSF have been approved by the European Medicines Agency, with limited published data supporting the clinical equivalence in peripheral blood stem cell mobilisation and recovery after autologous stem cell transplantation. METHOD With the aim of comparing cost-effective strategies in the use of G-CSF after autologous stem cell transplantation, we retrospectively evaluated 32 patients consecutively treated with biosimilar filgrastim XM02 (Tevagrastim) and 26 with lenograstim. All patients received G-CSF (biosimilar or lenograstim) at a dosage of 5 mcg/kg/day subcutaneously from day 5 to absolute neutrophil count of 1500/mmc for three days. RESULTS The median time to absolute neutrophil count engraftment was 11 days for the filgrastim XM02 group and 12 days for the lenograstim group. As for platelets recovery, the median time was 12 days in both groups. The median number of G-CSF vials used for patients was 9.5 for Tevagrastim and 10.5 for lenograstim, reflecting a mean estimated cost of about 556.1 euros for Tevagrastim versus 932.2 euros for lenograstim (p< 0.001). The median days of febrile neutropenia were 1.5 and 1 for filgrastim XM02 and lenograstim, respectively. No adverse event related to the use of XM02 filgrastim was recorded. CONCLUSION In our experience, filgrastim XM02 and lenograstim showed comparable efficacy in shortening the period of neutropenia after cytoreduction and autologous stem cell transplantation, with a favourable cost effect for filgrastim XM02.
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Affiliation(s)
- A Gardellini
- Division of Haematoncology, European Institute of Oncology, Milan, Italy
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13
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Gigli F, Gardellini A, Babic A, Liptrott SJ, Castagna L, Martinelli G, Laszlo D. Efficacy of photopheresis extracorporeal procedure as single treatment for severe chronic GVHD: a case report. Transfus Apher Sci 2013; 49:205-7. [PMID: 23491865 DOI: 10.1016/j.transci.2013.01.013] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 10/01/2012] [Accepted: 01/10/2013] [Indexed: 11/18/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation is the only potentially curative therapeutic option for many malignant and nonmalignant hematologic disorders. Despite this, several factors unfavorably affect the outcome of this procedure and in particular chronic graft-versus-host disease (cGVHD) remains the principal cause of morbidity after allogeneic transplantation. Here we present our experience regarding a patient affected by extensive chronic GVHD (cGVHD) treated only with extracorporeal photopheresis procedure (ECP) as first line treatment. The patient, presenting an high risk myelodysplastic syndrome (MDS), underwent an allogeneic peripheral stem cells transplantation. About 2 months after transplantation she experienced a hematological and clinical relapse of MDS. After reinduction therapy with azacitidine she obtained a second complete remission. Because of the risk of relapse related to a strong immunosuppressant therapy and the previous infectious complication, we decided to start a treatment with ECP alone for cGVHD. After six procedure the patient obtained a complete resolution of all signs and symptoms of the cGVHD. This experience may support the possibility to use only an immunomodulant treatment like ECP for the cGVHD, reducing the risk of complications of prolonged immunosuppressant treatment.
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Affiliation(s)
- Federica Gigli
- European Institute of Oncology, Hematoncology Divisione, Milan, Italy; Humanitas Cancer Center, Istituto Clinico Humanitas, Istituto Di Ricovero e Cura a Carattere Scientifico, Rozzano, Milan, Italy.
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Cortelezzi A, Pasquini MC, Gardellini A, Gianelli U, Bossi A, Reda G, Sarina B, Musto P, Barcellini W, Neri A, Deliliers GL. Low-dose subcutaneous alemtuzumab in refractory chronic lymphocytic leukaemia (CLL): results of a prospective, single-arm multicentre study. Leukemia 2009; 23:2027-33. [DOI: 10.1038/leu.2009.148] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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15
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Gerli G, Vanelli C, Turri O, Erario M, Gardellini A, Pugliano M, Biondi ML. SDF1-3'A gene polymorphism is associated with chronic myeloproliferative disease and thrombotic events. Clin Chem 2006; 51:2411-4. [PMID: 16306115 DOI: 10.1373/clinchem.2005.057802] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- GianCarla Gerli
- Dipartimento di Medicina, Chirurgia, Odontoiatria-San Paolo-Università degli Studi di Milano, Italy.
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