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Lambri N, Longari G, Loiacono D, Brioso RC, Crespi L, Galdieri C, Lobefalo F, Reggiori G, Rusconi R, Tomatis S, Bellu L, Bramanti S, Clerici E, De Philippis C, Dei D, Navarria P, Carlo-Stella C, Franzese C, Scorsetti M, Mancosu P. Deep learning-based optimization of field geometry for total marrow irradiation delivered with volumetric modulated arc therapy. Med Phys 2024. [PMID: 38634859 DOI: 10.1002/mp.17089] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/20/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Total marrow (lymphoid) irradiation (TMI/TMLI) is a radiotherapy treatment used to selectively target the bone marrow and lymph nodes in conditioning regimens for allogeneic hematopoietic stem cell transplantation. A complex field geometry is needed to cover the large planning target volume (PTV) of TMI/TMLI with volumetric modulated arc therapy (VMAT). Five isocenters and ten overlapping fields are needed for the upper body, while, for patients with large anatomical conformation, two specific isocenters are placed on the arms. The creation of a field geometry is clinically challenging and is performed by a medical physicist (MP) specialized in TMI/TMLI. PURPOSE To develop convolutional neural networks (CNNs) for automatically generating the field geometry of TMI/TMLI. METHODS The dataset comprised 117 patients treated with TMI/TMLI between 2011 and 2023 at our Institute. The CNN input image consisted of three channels, obtained by projecting along the sagittal plane: (1) average CT pixel intensity within the PTV; (2) PTV mask; (3) brain, lungs, liver, bowel, and bladder masks. This "averaged" frontal view combined the information analyzed by the MP when setting the field geometry in the treatment planning system (TPS). Two CNNs were trained to predict the isocenters coordinates and jaws apertures for patients with (CNN-1) and without (CNN-2) isocenters on the arms. Local optimization methods were used to refine the models output based on the anatomy of the patient. Model evaluation was performed on a test set of 15 patients in two ways: (1) by computing the root mean squared error (RMSE) between the CNN output and ground truth; (2) with a qualitative assessment of manual and generated field geometries-scale: 1 = not adequate, 4 = adequate-carried out in blind mode by three MPs with different expertise in TMI/TMLI. The Wilcoxon signed-rank test was used to evaluate the independence of the given scores between manual and generated configurations (p < 0.05 significant). RESULTS The average and standard deviation values of RMSE for CNN-1 and CNN-2 before/after local optimization were 15 ± 2/13 ± 3 mm and 16 ± 2/18 ± 4 mm, respectively. The CNNs were integrated into a planning automation software for TMI/TMLI such that the MPs could analyze in detail the proposed field geometries directly in the TPS. The selection of the CNN model to create the field geometry was based on the PTV width to approximate the decision process of an experienced MP and provide a single option of field configuration. We found no significant differences between the manual and generated field geometries for any MP, with median values of 4 versus 4 (p = 0.92), 3 versus 3 (p = 0.78), 4 versus 3 (p = 0.48), respectively. Starting from October 2023, the generated field geometry has been introduced in our clinical practice for prospective patients. CONCLUSIONS The generated field geometries were clinically acceptable and adequate, even for an MP with high level of expertise in TMI/TMLI. Incorporating the knowledge of the MPs into the development cycle was crucial for optimizing the models, especially in this scenario with limited data.
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Affiliation(s)
- Nicola Lambri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giorgio Longari
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Daniele Loiacono
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Ricardo Coimbra Brioso
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Leonardo Crespi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
- Health Data Science Centre, Human Technopole, Milan, Italy
| | - Carmela Galdieri
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesca Lobefalo
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giacomo Reggiori
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Roberto Rusconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefano Tomatis
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Luisa Bellu
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefania Bramanti
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Chiara De Philippis
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Damiano Dei
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Pietro Mancosu
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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De Philippis C, Zucchinetti C, Mannina D, Krampera M, Zinzani PL, Chiappella A, di Rocco A, Orcioulo E, Tisi MC, Pistolese F, Giordano L, Santoro A, Bramanti S. Out of specification Tisagenlecleucel is associated with outcomes comparable to standard of care product in relapsed or refractory diffuse large B-cell lymphoma. Bone Marrow Transplant 2024; 59:569-571. [PMID: 38272998 DOI: 10.1038/s41409-024-02205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/05/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024]
Affiliation(s)
- Chiara De Philippis
- IRCCS Humanitas Research Hospital, Transplantation Unit Department of Oncology and Haematology, Rozzano, Milan, Italy
| | - Cristina Zucchinetti
- IRCCS Humanitas Research Hospital, Transplantation Unit Department of Oncology and Haematology, Rozzano, Milan, Italy
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Daniele Mannina
- IRCCS Humanitas Research Hospital, Transplantation Unit Department of Oncology and Haematology, Rozzano, Milan, Italy
| | - Mauro Krampera
- Hematology and Bone Marrow Transplant Unit, Department of Engineering for Innovative Medicine, Section of Biomedicine of Innovation, University of Verona, Verona, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia "Seràgnoli", Bologna, Italy
| | - Annalisa Chiappella
- Division of Hematology and Stem Cell Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano, Milano, Italy
| | - Alice di Rocco
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Enrico Orcioulo
- Azienda Ospedaliero-Universitaria Pisana, UO Ematologia, Pisa, Italy
| | - Maria Chiara Tisi
- Hematology Unit, San Bortolo Hospital, AULSS 8 Berica, Vicenza, Italy
| | - Flavio Pistolese
- IRCCS Humanitas Research Hospital, Transplantation Unit Department of Oncology and Haematology, Rozzano, Milan, Italy
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Laura Giordano
- IRCCS Humanitas Research Hospital- Humanitas Cancer Center, Biostatistic Unit, Rozzano, Milan, Italy
| | - Armando Santoro
- IRCCS Humanitas Research Hospital, Transplantation Unit Department of Oncology and Haematology, Rozzano, Milan, Italy.
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy.
| | - Stefania Bramanti
- IRCCS Humanitas Research Hospital, Transplantation Unit Department of Oncology and Haematology, Rozzano, Milan, Italy
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3
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Dei D, Lambri N, Crespi L, Brioso RC, Loiacono D, Clerici E, Bellu L, De Philippis C, Navarria P, Bramanti S, Carlo-Stella C, Rusconi R, Reggiori G, Tomatis S, Scorsetti M, Mancosu P. Deep learning and atlas-based models to streamline the segmentation workflow of total marrow and lymphoid irradiation. Radiol Med 2024; 129:515-523. [PMID: 38308062 DOI: 10.1007/s11547-024-01760-8] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/03/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE To improve the workflow of total marrow and lymphoid irradiation (TMLI) by enhancing the delineation of organs at risk (OARs) and clinical target volume (CTV) using deep learning (DL) and atlas-based (AB) segmentation models. MATERIALS AND METHODS Ninety-five TMLI plans optimized in our institute were analyzed. Two commercial DL software were tested for segmenting 18 OARs. An AB model for lymph node CTV (CTV_LN) delineation was built using 20 TMLI patients. The AB model was evaluated on 20 independent patients, and a semiautomatic approach was tested by correcting the automatic contours. The generated OARs and CTV_LN contours were compared to manual contours in terms of topological agreement, dose statistics, and time workload. A clinical decision tree was developed to define a specific contouring strategy for each OAR. RESULTS The two DL models achieved a median [interquartile range] dice similarity coefficient (DSC) of 0.84 [0.71;0.93] and 0.85 [0.70;0.93] across the OARs. The absolute median Dmean difference between manual and the two DL models was 2.0 [0.7;6.6]% and 2.4 [0.9;7.1]%. The AB model achieved a median DSC of 0.70 [0.66;0.74] for CTV_LN delineation, increasing to 0.94 [0.94;0.95] after manual revision, with minimal Dmean differences. Since September 2022, our institution has implemented DL and AB models for all TMLI patients, reducing from 5 to 2 h the time required to complete the entire segmentation process. CONCLUSION DL models can streamline the TMLI contouring process of OARs. Manual revision is still necessary for lymph node delineation using AB models.
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Affiliation(s)
- Damiano Dei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Nicola Lambri
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Leonardo Crespi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
- Health Data Science Centre, Human Technopole, Milan, Italy
| | - Ricardo Coimbra Brioso
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Daniele Loiacono
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Elena Clerici
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Luisa Bellu
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Chiara De Philippis
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Pierina Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Stefania Bramanti
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Roberto Rusconi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giacomo Reggiori
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Stefano Tomatis
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Pietro Mancosu
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
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Di Vito C, Coianiz N, Calvi M, Terzoli S, Zaghi E, Puccio S, Frigo A, Mariotti J, De Philippis C, Mannina D, Sarina B, Mineri R, Le-Trilling VTK, Trilling M, Castagna L, Bramanti S, Santoro A, Mavilio D. Persistence of KIR neg NK cells after haploidentical hematopoietic stem cell transplantation protects from human cytomegalovirus infection/reactivation. Front Immunol 2024; 14:1266051. [PMID: 38268918 PMCID: PMC10806243 DOI: 10.3389/fimmu.2023.1266051] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/19/2023] [Indexed: 01/26/2024] Open
Abstract
Haploidentical hematopoietic stem cell transplantation (h-HSCT) is a therapeutic option to cure patients affected by hematologic malignancies. The kinetics and the quality of immune-reconstitution (IR) impact the clinical outcome of h-HSCT and limit the onset of life-threatening Human Cytomegalovirus (HCMV) infection/reactivation. Natural Killer (NK) cells are the first lymphocytes that recover after h-HSCT and they can provide rapid innate immune responses against opportunistic pathogens. By performing a longitudinal single-cell analysis of multiparametric flow-cytometry data, we show here that the persistence at high frequencies of CD158b1b2jneg/NKG2Apos/NKG2Cneg/NKp30pos/NKp46pos (KIRneg) NK cells is associated with HCMV infection/reactivation control. These KIRneg NK cells are "unlicensed", and are not terminal-differentiated lymphocytes appearing early during IR and mainly belonging to CD56bright/CD16neg and CD56bright/CD16pos subsets. KIRneg NK cells are enriched in oxidative and glucose metabolism pathways, produce interferon-γ, and are endowed with potent antiviral activity against HCMV ex vivo. Decreased frequencies of KIRneg NK cells early during IR are associated with clinically relevant HCMV replication. Taken together, our findings indicate that the prolonged persistence of KIRneg NK cells after h-HSCT could serve as a biomarker to better predict HCMV infection/reactivation. This phenomenon also paves the way to optimize anti-viral immune responses by enriching post-transplant donor lymphocyte infusions with KIRneg NK cells.
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Affiliation(s)
- Clara Di Vito
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nicolò Coianiz
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Michela Calvi
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine (BioMeTra), University of Milan, Milan, Italy
| | - Sara Terzoli
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Elisa Zaghi
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Simone Puccio
- Laboratory of Translational Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alessandro Frigo
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine (BioMeTra), University of Milan, Milan, Italy
| | - Jacopo Mariotti
- Bone Marrow Transplant Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Chiara De Philippis
- Bone Marrow Transplant Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Daniele Mannina
- Bone Marrow Transplant Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Barbara Sarina
- Bone Marrow Transplant Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Rossana Mineri
- Molecular Biology Section, Clinical Investigation Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Mirko Trilling
- Institute for Virology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Luca Castagna
- Bone Marrow Transplant Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Stefania Bramanti
- Bone Marrow Transplant Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Armando Santoro
- Bone Marrow Transplant Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Medical Biotechnologies and Translational Medicine (BioMeTra), University of Milan, Milan, Italy
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5
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Mariotti J, Ricci F, Giordano L, Taurino D, Sarina B, De Philippis C, Mannina D, Carlo-Stella C, Bramanti S, Santoro A. Outcome of High-Dose Chemotherapy Followed by Autologous Stem Cell Transplantation in Relapsed/Refractory Hodgkin Lymphoma after Different Numbers of Salvage Regimens. Cells 2024; 13:118. [PMID: 38247809 PMCID: PMC10814926 DOI: 10.3390/cells13020118] [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: 11/18/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
The introduction of novel drugs (PD-1 inhibitors and/or brentuximab vedotin) into salvage regimens has improved the response rate and the outcome of patients with relapsed/refractory Hodgkin lymphoma. However, the impact of new drugs on the outcome has not been adequately investigated so far. We retrospectively analyzed 42 consecutive patients treated at our institution with high-dose chemotherapy/autologous stem cell transplantation after either one standard chemotherapy represented by BEGEV (n = 28) or >1 salvage therapy (ST) comprising novel drugs (n = 14). With a median follow-up of 24 months, the 2-year cumulative incidence of relapse was similar between the two cohorts: 26% for 1 ST and 18% for >1 ST (p = 0.822). Consistently, overall survival and progression-free survival did not differ among the two groups: 3-year overall survival was 91% and 89% (p = 0.731), respectively, and 3-year progression-free survival was 74% and 83% (p = 0.822) for only one and more than one salvage regimens, respectively. Of note, the post-transplant side effects and engraftment rates were similar between the 1 ST and >1 ST cohorts. In conclusion, consolidation with high-dose chemotherapy/autologous stem cell transplantation is a safe and curative option, even for patients achieving disease response after more than one rescue line of therapy.
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Affiliation(s)
- Jacopo Mariotti
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (F.R.); (D.T.); (B.S.); (C.D.P.); (D.M.); (C.C.-S.); (S.B.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Milan, Italy
| | - Francesca Ricci
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (F.R.); (D.T.); (B.S.); (C.D.P.); (D.M.); (C.C.-S.); (S.B.); (A.S.)
| | - Laura Giordano
- Biostatistic Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy;
| | - Daniela Taurino
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (F.R.); (D.T.); (B.S.); (C.D.P.); (D.M.); (C.C.-S.); (S.B.); (A.S.)
| | - Barbara Sarina
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (F.R.); (D.T.); (B.S.); (C.D.P.); (D.M.); (C.C.-S.); (S.B.); (A.S.)
| | - Chiara De Philippis
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (F.R.); (D.T.); (B.S.); (C.D.P.); (D.M.); (C.C.-S.); (S.B.); (A.S.)
| | - Daniele Mannina
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (F.R.); (D.T.); (B.S.); (C.D.P.); (D.M.); (C.C.-S.); (S.B.); (A.S.)
| | - Carmelo Carlo-Stella
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (F.R.); (D.T.); (B.S.); (C.D.P.); (D.M.); (C.C.-S.); (S.B.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Milan, Italy
| | - Stefania Bramanti
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (F.R.); (D.T.); (B.S.); (C.D.P.); (D.M.); (C.C.-S.); (S.B.); (A.S.)
| | - Armando Santoro
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy; (F.R.); (D.T.); (B.S.); (C.D.P.); (D.M.); (C.C.-S.); (S.B.); (A.S.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Milan, Italy
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6
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Dodero A, Bramanti S, Di Trani M, Pennisi M, Ljevar S, Chiappella A, Massimo M, Guidetti A, Corrado F, Nierychlewska PM, Di Rocco A, Lorenzini D, Daoud R, De Philippis C, Santoro A, Carlo-Stella C, Corradini P. Outcome after chimeric antigen receptor (CAR) T-cell therapy failure in large B-cell lymphomas. Br J Haematol 2024; 204:151-159. [PMID: 37690811 DOI: 10.1111/bjh.19057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/29/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023]
Abstract
This study retrospectively evaluated the outcome of salvage therapy in 51 patients who failed axicabtagene ciloleucel or tisagenlecleucel for relapsed/refractory large B-cell lymphomas. Of these patients, 22 (43%) were enrolled in clinical trials (glofitamab or loncastuximab tesirine + ibrutinib), whereas 29 received standard therapies (lenalidomide [Len], checkpoint inhibitors [CPIs], ibrutinib [I], chemoimmunotherapy and radiotherapy) or supportive care. Overall, 26 of 39 (67%) treated patients received a treatment based on immunotherapy (glofitamab, CPI, Len) that was mainly represented by bispecific antibody (n = 18). In this subgroup, plasma samples were collected and analysed for circulating tumour DNA (ctDNA) using cancer-personalized profiling by deep sequencing (CAPP-seq). The study found that patients with high ctDNA had poor outcomes. At a median follow-up of 11.7 months, the estimated 12-month overall survival (OS) was 35%. Factors adversely affecting the prognosis in the multivariable model were the absence of response to CAR T-cell therapy (HR: 3.08; p = 0.0109) and a diagnosis other than PMBCL and t-FL (HR: 4.54; p = 0.0069). The outcome of patients failing CAR T cells is poor and requires further investigation.
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Affiliation(s)
- Anna Dodero
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefania Bramanti
- Department of Hematology, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Martina Di Trani
- Department of Hematology, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Martina Pennisi
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silva Ljevar
- Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annalisa Chiappella
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Magagnoli Massimo
- Department of Hematology, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Anna Guidetti
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- University of Milano, Milan, Italy
| | - Francesco Corrado
- Department of Biomedical Sciences, Humanitas University, Rozzano-Milan, Italy
| | | | - Alice Di Rocco
- Department of Hematology, University la Sapienza, Rome, Italy
| | - Daniele Lorenzini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rahal Daoud
- Department of Pathology, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Chiara De Philippis
- Department of Hematology, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Armando Santoro
- Department of Hematology, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano-Milan, Italy
| | - Carmelo Carlo-Stella
- Department of Hematology, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano-Milan, Italy
| | - Paolo Corradini
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- University of Milano, Milan, Italy
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7
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Lambri N, Dei D, Hernandez V, Castiglioni I, Clerici E, De Philippis C, Loiacono D, Navarria P, Reggiori G, Rusconi R, Tomatis S, Bramanti S, Scorsetti M, Mancosu P. Evaluation of plan complexity and dosimetric plan quality of total marrow and lymphoid irradiation using volumetric modulated arc therapy. J Appl Clin Med Phys 2023:e13931. [PMID: 37085997 DOI: 10.1002/acm2.13931] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/23/2022] [Accepted: 01/22/2023] [Indexed: 04/23/2023] Open
Abstract
PURPOSE To assess the impact of the planner's experience and optimization algorithm on the plan quality and complexity of total marrow and lymphoid irradiation (TMLI) delivered by means of volumetric modulated arc therapy (VMAT) over 2010-2022 at our institute. METHODS Eighty-two consecutive TMLI plans were considered. Three complexity indices were computed to characterize the plans in terms of leaf gap size, irregularity of beam apertures, and modulation complexity. Dosimetric points of the target volume (D2%) and organs at risk (OAR) (Dmean) were automatically extracted to combine them with plan complexity and obtain a global quality score (GQS). The analysis was stratified based on the different optimization algorithms used over the years, including a knowledge-based (KB) model. Patient-specific quality assurance (QA) using Portal Dosimetry was performed retrospectively, and the gamma agreement index (GAI) was investigated in conjunction with plan complexity. RESULTS Plan complexity significantly reduced over the years (r = -0.50, p < 0.01). Significant differences in plan complexity and plan dosimetric quality among the different algorithms were observed. Moreover, the KB model allowed to achieve significantly better dosimetric results to the OARs. The plan quality remained similar or even improved during the years and when moving to a newer algorithm, with GQS increasing from 0.019 ± 0.002 to 0.025 ± 0.003 (p < 0.01). The significant correlation between GQS and time (r = 0.33, p = 0.01) indicated that the planner's experience was relevant to improve the plan quality of TMLI plans. Significant correlations between the GAI and the complexity metrics (r = -0.71, p < 0.01) were also found. CONCLUSION Both the planner's experience and algorithm version are crucial to achieve an optimal plan quality in TMLI plans. Thus, the impact of the optimization algorithm should be carefully evaluated when a new algorithm is introduced and in system upgrades. Knowledge-based strategies can be useful to increase standardization and improve plan quality of TMLI treatments.
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Affiliation(s)
- Nicola Lambri
- Medical Physics Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Damiano Dei
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Victor Hernandez
- Department of Medical Physics, Hospital Universitari Sant Joan de Reus, IISPV, Tarragona, Catalonia, Spain
| | - Isabella Castiglioni
- Department of Physics "G. Occhialini", University of Milan-Bicocca, Milano, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Chiara De Philippis
- Bone Marrow Transplantation Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Daniele Loiacono
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giacomo Reggiori
- Medical Physics Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Roberto Rusconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefano Tomatis
- Medical Physics Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Stefania Bramanti
- Bone Marrow Transplantation Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Pietro Mancosu
- Medical Physics Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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8
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Lambri N, Antonetti SL, Dei D, Bellu L, Bramanti S, Brioso RC, Carlo-Stella C, Castiglioni I, Clerici E, Crespi L, De Philippis C, Galdieri C, Loiacono D, Navarria P, Reggiori G, Rusconi R, Tomatis S, Scorsetti M, Mancosu P. Impact of the Extremities Positioning on the Set-Up Reproducibility for the Total Marrow Irradiation Treatment. Curr Oncol 2023; 30:4067-4077. [PMID: 37185422 PMCID: PMC10136565 DOI: 10.3390/curroncol30040309] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/01/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023] Open
Abstract
Total marrow (lymph node) irradiation (TMI/TMLI) delivery requires more time than standard radiotherapy treatments. The patient's extremities, through the joints, can experience large movements. The reproducibility of TMI/TMLI patients' extremities was evaluated to find the best positioning and reduce unwanted movements. Eighty TMI/TMLI patients were selected (2013-2022). During treatment, a cone-beam computed tomography (CBCT) was performed for each isocenter to reposition the patient. CBCT-CT pairs were evaluated considering: (i) online vector shift (OVS) that matched the two series; (ii) residual vector shift (RVS) to reposition the patient's extremities; (iii) qualitative agreement (range 1-5). Patients were subdivided into (i) arms either leaning on the frame or above the body; (ii) with or without a personal cushion for foot positioning. The Mann-Whitney test was considered (p < 0.05 significant). Six-hundred-twenty-nine CBCTs were analyzed. The median OVS was 4.0 mm, with only 1.6% of cases ranked < 3, and 24% of RVS > 10 mm. Arms leaning on the frame had significantly smaller RVS than above the body (median: 8.0 mm/6.0 mm, p < 0.05). Using a personal cushion for the feet significantly improved the RVS than without cushions (median: 8.5 mm/1.8 mm, p < 0.01). The role and experience of the radiotherapy team are fundamental to optimizing the TMI/TMLI patient setup.
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Affiliation(s)
- Nicola Lambri
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Milan, Italy
| | - Simone Leopoldo Antonetti
- Radiation Oncology Department, SS. Antonio e Biagio e Cesare Arrigo Hospital, 15121 Alessandria, Italy
| | - Damiano Dei
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Milan, Italy
| | - Luisa Bellu
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Stefania Bramanti
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Ricardo Coimbra Brioso
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Milan, Italy
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Isabella Castiglioni
- Department of Physics "G. Occhialini", University of Milan-Bicocca, Piazza della Scienza 2, 20126 Milan, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Leonardo Crespi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
- Centre for Health Data Science, Human Technopole, 20157 Milan, Italy
| | - Chiara De Philippis
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Carmela Galdieri
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Daniele Loiacono
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Giacomo Reggiori
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Milan, Italy
| | - Roberto Rusconi
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Milan, Italy
| | - Stefano Tomatis
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Milan, Italy
| | - Pietro Mancosu
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Milan, Italy
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9
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Lambri N, Dei D, Hernandez V, Castiglioni I, Clerici E, Crespi L, De Philippis C, Loiacono D, Navarria P, Reggiori G, Rusconi R, Tomatis S, Bramanti S, Scorsetti M, Mancosu P. Automatic planning of the lower extremities for total marrow irradiation using volumetric modulated arc therapy. Strahlenther Onkol 2023; 199:412-419. [PMID: 36326856 PMCID: PMC10033624 DOI: 10.1007/s00066-022-02014-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Total marrow (and lymphoid) irradiation (TMI-TMLI) is limited by the couch travel range of modern linacs, which forces the treatment delivery to be split into two plans with opposite orientations: a head-first supine upper-body plan, and a feet-first supine lower extremities plan. A specific field junction is thus needed to obtain adequate target coverage in the overlap region of the two plans. In this study, an automatic procedure was developed for field junction creation and lower extremities plan optimization. METHODS Ten patients treated with TMI-TMLI at our institution were selected retrospectively. The planning of the lower extremities was performed automatically. Target volume parameters (CTV_J‑V98% > 98%) at the junction region and several dose statistics (D98%, Dmean, and D2%) were compared between automatic and manual plans. The modulation complexity score (MCS) was used to assess plan complexity. RESULTS The automatic procedure required 60-90 min, depending on the case. All automatic plans achieved clinically acceptable dosimetric results (CTV_J‑V98% > 98%), with significant differences found at the junction region, where Dmean and D2% increased on average by 2.4% (p < 0.03) and 3.0% (p < 0.02), respectively. Similar plan complexity was observed (median MCS = 0.12). Since March 2022, the automatic procedure has been introduced in our clinic, reducing the TMI-TMLI simulation-to-delivery schedule by 2 days. CONCLUSION The developed procedure allowed treatment planning of TMI-TMLI to be streamlined, increasing efficiency and standardization, preventing human errors, while maintaining the dosimetric plan quality and complexity of manual plans. Automated strategies can simplify the future adoption and clinical implementation of TMI-TMLI treatments in new centers.
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Affiliation(s)
- Nicola Lambri
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Damiano Dei
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Victor Hernandez
- Department of Medical Physics, Hospital Universitari Sant Joan de Reus, IISPV, Tarragona, Spain
| | - Isabella Castiglioni
- Department of Physics "G. Occhialini", University of Milan-Bicocca, piazza della Scienza 2, 20126, Milano, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Leonardo Crespi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
- Human Techopole, Centre for Health Data Science, Milan, Italy
| | - Chiara De Philippis
- Bone Marrow Transplantation Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Daniele Loiacono
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Giacomo Reggiori
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Roberto Rusconi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Stefano Tomatis
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Stefania Bramanti
- Bone Marrow Transplantation Unit, IRCCS Humanitas Research Hospital, Milan, Rozzano, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Pietro Mancosu
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy.
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10
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De Philippis C, Mannina D, Giordano L, Costantini E, Marcheselli S, Mariotti J, Sarina B, Taurino D, Santoro A, Bramanti S. Impact of Preemptive Use of Tocilizumab on Chimeric Antigen Receptor T Cell Outcomes in Non-Hodgkin Lymphoma. Transplant Cell Ther 2023:S2666-6367(23)01195-8. [PMID: 36966874 DOI: 10.1016/j.jtct.2023.03.019] [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: 01/04/2023] [Revised: 03/05/2023] [Accepted: 03/19/2023] [Indexed: 04/26/2023]
Abstract
Despite the impressive results of chimeric antigen receptor (CAR) T cell treatment for lymphomas, adverse events such as cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and infections are major issues that can lead to intensive care unit (ICU) admission and death. Current guidelines recommend tocilizumab for treating patients with CRS grade (G) ≥2; however, the optimal timing of intervention has yet to be determined. Our institution adopted the preemptive use of tocilizumab in cases of persistent G1 CRS, defined as fever (≥38 °C) for >24 hours. This preemptive tocilizumab treatment aimed to reduce evolution to severe (G≥3) CRS, ICU admission, or death. We report on 48 prospectively collected consecutive patients with non-Hodgkin lymphoma treated with autologous CD19-targeted CAR T cells. In total, 39 patients (81%) developed CRS. CRS started as G1 in 28 patients, as G2 in patients, and as G3 in 1 patient. Tocilizumab was administered in 34 patients, including 23 patients who received "preemptive" tocilizumab and 11 patients who received tocilizumab for G2 or G3 CRS from the onset of symptoms. CRS resolved without worsening severity in 19 patients out of 23 (83%) who received preemptive tocilizumab; 4 patients (17%) progressed from G1 to G2 for the development of hypotension and quickly responded to the introduction of steroids. No patients treated with a preemptive approach developed G3 or G4 CRS. Ten out of 48 patients (21%) were diagnosed with ICANS, including 5 patients with G3 or G4. Six infectious events occurred. The overall ICU admission rate was 19%. ICANS management was the most relevant reason for ICU admission (7 patients), and no patient required ICU to manage CRS. No deaths from CAR-T toxicity were observed. Our data indicate that preemptive tocilizumab use is feasible and useful in reducing severe CRS and CRS-related ICU admission, with no impact on neurotoxicity or infection rate. Therefore, early use of tocilizumab can be considered, especially for patients at high risk of CRS.
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Affiliation(s)
- Chiara De Philippis
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Milan, Italy.
| | - Daniele Mannina
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Laura Giordano
- Biostatistic Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Elena Costantini
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Simona Marcheselli
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Jacopo Mariotti
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Barbara Sarina
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Daniela Taurino
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Milan, Italy
| | - Armando Santoro
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Milan, Italy; Biostatistic Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Stefania Bramanti
- IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Milan, Italy
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11
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Mariotti J, Magri F, Giordano L, De Philippis C, Sarina B, Mannina D, Taurino D, Santoro A, Bramanti S. EASIX predicts non-relapse mortality after haploidentical transplantation with post-transplant cyclophosphamide. Bone Marrow Transplant 2023; 58:247-256. [PMID: 36414698 DOI: 10.1038/s41409-022-01874-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022]
Abstract
Endothelial Activation and Stress Index (EASIX) is a prognostic score reflecting endothelial damage. It can identify cohorts of patients at higher risk of non-relapse mortality (NRM) after allogeneic stem cell transplantation (SCT) from a matched-related or -unrelated donor. No data are available in the setting of haploidentical-SCT with post-transplant cyclophosphamide (PT-Cy). We retrospectively analyzed the role of EASIX score in a cohort of 266 patients receiving Haplo-SCT with PT-Cy at our center. By a decision-tree model, 1-year NRM was 16% vs. 29% and overall survival was 59% vs. 32%, respectively, for patients with a pre-transplant EASIX (EASIX-PRE) <0.8 vs. ≥0.8 (p < 0.001). By multivariable analysis, EASIX-PRE was an independent predictor of NRM (hazard ratio [HR] 2.43, p < 0.001) and overall survival (HR: 1.64, p = 0.011). EASIX-PRE did not predict patients at higher risk of developing acute graft-versus-host disease (GVHD) but was an independent predictor of 1-year NRM (3.2 cutoff, HR 6.61, p = 0.002; <3.2 vs. ≥3.2: 10% vs. 56%, p < 0.001) in patients developing acute GVHD. EASIX score can also represent an important tool to predict mortality in the setting of Haplo-SCT with PT-Cy. It may help to make therapeutic decisions both before the transplant and at the onset of acute GVHD.
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Affiliation(s)
- Jacopo Mariotti
- BMT and Cell Therapy Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Rozzano, Italy.
| | - Filippo Magri
- BMT and Cell Therapy Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Rozzano, Italy
| | - Laura Giordano
- Biostatistics Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Rozzano, Italy
| | - Chiara De Philippis
- BMT and Cell Therapy Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Rozzano, Italy
| | - Barbara Sarina
- BMT and Cell Therapy Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Rozzano, Italy
| | - Daniele Mannina
- BMT and Cell Therapy Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Rozzano, Italy
| | - Daniela Taurino
- BMT and Cell Therapy Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Rozzano, Italy
| | - Armando Santoro
- Biostatistics Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Rozzano, Italy
| | - Stefania Bramanti
- BMT and Cell Therapy Unit, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Rozzano, Italy
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12
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Dei D, Lambri N, Stefanini S, Vernier V, Brioso RC, Crespi L, Clerici E, Bellu L, De Philippis C, Loiacono D, Navarria P, Reggiori G, Bramanti S, Rodari M, Tomatis S, Chiti A, Carlo-Stella C, Scorsetti M, Mancosu P. Internal Guidelines for Reducing Lymph Node Contour Variability in Total Marrow and Lymph Node Irradiation. Cancers (Basel) 2023; 15:cancers15051536. [PMID: 36900326 PMCID: PMC10000500 DOI: 10.3390/cancers15051536] [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: 12/14/2022] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND The total marrow and lymph node irradiation (TMLI) target includes the bones, spleen, and lymph node chains, with the latter being the most challenging structures to contour. We evaluated the impact of introducing internal contour guidelines to reduce the inter- and intraobserver lymph node delineation variability in TMLI treatments. METHODS A total of 10 patients were randomly selected from our database of 104 TMLI patients so as to evaluate the guidelines' efficacy. The lymph node clinical target volume (CTV_LN) was recontoured according to the guidelines (CTV_LN_GL_RO1) and compared to the historical guidelines (CTV_LN_Old). Both topological (i.e., Dice similarity coefficient (DSC)) and dosimetric (i.e., V95 (the volume receiving 95% of the prescription dose) metrics were calculated for all paired contours. RESULTS The mean DSCs were 0.82 ± 0.09, 0.97 ± 0.01, and 0.98 ± 0.02, respectively, for CTV_LN_Old vs. CTV_LN_GL_RO1, and between the inter- and intraobserver contours following the guidelines. Correspondingly, the mean CTV_LN-V95 dose differences were 4.8 ± 4.7%, 0.03 ± 0.5%, and 0.1 ± 0.1%. CONCLUSIONS The guidelines reduced the CTV_LN contour variability. The high target coverage agreement revealed that historical CTV-to-planning-target-volume margins were safe, even if a relatively low DSC was observed.
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Affiliation(s)
- Damiano Dei
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Nicola Lambri
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
- Correspondence: (N.L.); (S.T.)
| | - Sara Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Veronica Vernier
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Ricardo Coimbra Brioso
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | - Leonardo Crespi
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
- Health Data Science Centre, Human Technopole, 20157 Milan, Italy
| | - Elena Clerici
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Luisa Bellu
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Chiara De Philippis
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Daniele Loiacono
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, 20133 Milan, Italy
| | - Pierina Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Giacomo Reggiori
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Stefania Bramanti
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Marcello Rodari
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Stefano Tomatis
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
- Correspondence: (N.L.); (S.T.)
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Nuclear Medicine, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Oncology and Hematology, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Pietro Mancosu
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089 Milan, Italy
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13
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Mariotti J, Legrand F, Furst S, Giordano L, Magri F, Richiardi L, Granata A, De Philippis C, Maisano V, Faraci D, Sarina B, Giaccone L, Harbi S, Mannina D, Valli V, Tordato F, Mineri R, Bramanti S, Santoro A, Bruno B, Devillier R, Blaise D, Castagna L. Risk Factors for early CMV reactivation and Impact of early CMV reactivation on Clinical Outcomes after T Cell-replete Haploidentical Transplantation with Post-transplant Cyclophosphamide. Transplant Cell Ther 2021; 28:169.e1-169.e9. [PMID: 34954296 DOI: 10.1016/j.jtct.2021.12.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Risk factors for cytomegalovirus (CMV) reactivation and the impact of CMV reactivation on patients' outcomes have been extensively investigated after matched related or unrelated donor transplants, but little is known in the setting of haploidentical stem cell transplant (Haplo-SCT) with post-transplant cyclophosphamide (PT-Cy), where recipients are supposed to be more severely immune-compromised. METHODS We retrospectively analyzed a cohort of 554 consecutive patients undergoing Haplo-SCT with PT-Cy at 3 different centers. RESULTS Early CMV reactivation, taking place within the first 120 days after transplant, occurred in 242 patients for an estimated cumulative incidence of 44%. Out of those patients, 74 (30%) had recurrent CMV and 20 (8%) CMV disease. By multivariable analysis, positive recipient CMV serostatus (Hazard ratio [HR] > 2.5, p<0.001), disease histology (lymphoid vs myeloid: HR 0.66, p=0.003) and increasing recipient age (HR 1.01, p=0.015) were independent predictors of CMV reactivation. At four months landmark analysis, CMV reactivation was associated with higher 1-year and 5-year cumulative incidence of non-relapse mortality (NRM) relative to patients without reactivation: 13% vs 5% and 22% vs 9%, respectively (p<0.001). By multivariable analysis, CMV reactivation was an independent negative predictor of non-relapse mortality (NRM) (HR 2.69, p<0.001) and was close to statistical significance for overall survival (OS) (HR: 1.38, p=0.062). CONCLUSIONS Our results suggest that CMV reactivation plays an important role at determining NRM. Because patient CMV serostatus is the main predictor of CMV reactivation, it should be considered when evaluating strategies for preventing CMV reactivation.
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Affiliation(s)
- Jacopo Mariotti
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy.
| | - Faezeh Legrand
- Department of Hematology, Transplantation Program, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Sabine Furst
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Laura Giordano
- Biostatistic Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Filippo Magri
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - Angela Granata
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Chiara De Philippis
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Valerio Maisano
- Department of Hematology, Transplantation Program, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Danilo Faraci
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy
| | - Barbara Sarina
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Luisa Giaccone
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy; Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Samia Harbi
- Department of Hematology, Transplantation Program, Institut Paoli-Calmettes, Marseille, France
| | - Daniele Mannina
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Viviana Valli
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Federica Tordato
- Infectious Disease Unit, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano 20089, Italy
| | - Rossana Mineri
- Molecular Biology Section, Clinical Investigation Laboratory, Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano 20089, Italy
| | - Stefania Bramanti
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Armando Santoro
- Department of Oncology/Hematology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Benedetto Bruno
- Department of Oncology/Hematology, A.O.U. Città della Salute e della Scienza di Torino, Presidio Molinette, Torino, Italy; Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Raynier Devillier
- Department of Hematology, Transplantation Program, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Didier Blaise
- Department of Hematology, Transplantation Program, Aix-Marseille Univ, Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Marseille, France
| | - Luca Castagna
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Italy
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14
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Arcari A, Morello L, Vallisa D, Marcheselli L, Tecchio C, Quaglia FM, Tisi MC, Zilioli VR, Di Rocco A, Perrone T, Gini G, Dogliotti I, Bianchetti N, Bozzoli V, De Philippis C, Alvarez De Celis MI, Chiappella A, Fabbri A, Pelosini M, Merli M, Molinari AL, Sciarra R, Volpetti S, Hohaus S, Nassi L, Visco C. Allogeneic stem cell transplantation in patients with mantle cell lymphoma: results from the MANTLE-FIRST study on behalf of Fondazione Italiana Linfomi. Leuk Lymphoma 2021; 62:3474-3483. [PMID: 34625013 DOI: 10.1080/10428194.2021.1961238] [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] [Indexed: 10/20/2022]
Abstract
The role of allogeneic stem cell transplantation (allo-SCT) in mantle cell lymphoma (MCL) is uncertain, even more in the era of bruton's tyrosine kinase inhibitors (BTKi) and chimeric antigen receptor T-cells. We retrospectively analyzed 55 patients who underwent allo-SCT for MCL relapsed or refractory (r/r) after rituximab and high-dose cytarabine within the MANTLE-FIRST project. With a median follow-up of 3.7 years, non-relapse mortality (NRM), progression-free survival, and overall survival were 23%, 53%, and 56%, respectively. NRM was significantly higher in the case of acute graft-versus-host disease, > 2 prior lines of therapy, age > 60 years. The outcome was similar for patients with early (≤24 months) and late progression of disease. The use of BTKi as a bridge to allo-SCT did not increase the toxicity and allowed a good control of disease. Our real-life experience confirms that allo-SCT still represents an option in MCL patients, especially if young and early-relapsed.
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Affiliation(s)
- Annalisa Arcari
- Unit of Hematology and Bone Marrow Transplantation, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Lucia Morello
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Italy
| | - Daniele Vallisa
- Unit of Hematology and Bone Marrow Transplantation, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | | | - Cristina Tecchio
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | | | | | | | - Alice Di Rocco
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Guido Gini
- Hematology, Department of Clinical and Molecular Sciences, Marche Polytechnic University, Ancona, Italy
| | - Irene Dogliotti
- Stem Cell Transplant Unit, A.O.U. "Città della Salute e della Scienza di Torino", Turin, Italy
| | | | | | - Chiara De Philippis
- Department of Medical Oncology and Hematology, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Italy
| | | | - Annalisa Chiappella
- Hematology and Bone Marrow Transplantation, IRCCS Istituto Nazionale Tumori, Milan, Italy.,Hematology, "Città della Salute e della Scienza di Torino" University Hospital, Turin, Italy
| | - Alberto Fabbri
- Hematology, Azienda Ospedaliero-Universitaria Senese and University of Siena, Siena, Italy
| | | | - Michele Merli
- Hematology, University Hospital Ospedale di Circolo e Fondazione Macchi-ASST Sette Laghi, University of Insubria, Varese, Italy
| | | | - Roberta Sciarra
- Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Volpetti
- Department of Hematology, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Stefan Hohaus
- Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Nassi
- Hematology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
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15
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Merryman RW, Castagna L, Giordano L, Ho VT, Corradini P, Guidetti A, Casadei B, Bond DA, Jaglowski S, Spinner MA, Arai S, Lowsky R, Shah GL, Perales MA, De Colella JMS, Blaise D, Herrera AF, Shouse G, Spilleboudt C, Ansell SM, Nieto Y, Badar T, Hamadani M, Feldman TA, Dahncke L, Singh AK, McGuirk JP, Nishihori T, Chavez J, Serritella AV, Kline J, Mohty M, Dulery R, Stamatoulas A, Houot R, Manson G, Moles-Moreau MP, Orvain C, Bouabdallah K, Modi D, Ramchandren R, Lekakis L, Beitinjaneh A, Frigault MJ, Chen YB, Lynch RC, Smith SD, Rao U, Byrne M, Romancik JT, Cohen JB, Nathan S, Phillips T, Joyce RM, Rahimian M, Bashey A, Ballard HJ, Svoboda J, Torri V, Sollini M, De Philippis C, Magagnoli M, Santoro A, Armand P, Zinzani PL, Carlo-Stella C. Allogeneic transplantation after PD-1 blockade for classic Hodgkin lymphoma. Leukemia 2021; 35:2672-2683. [PMID: 33658659 DOI: 10.1038/s41375-021-01193-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/19/2021] [Accepted: 02/08/2021] [Indexed: 12/17/2022]
Abstract
Anti-PD-1 monoclonal antibodies yield high response rates in patients with relapsed/refractory classic Hodgkin lymphoma (cHL), but most patients will eventually progress. Allogeneic hematopoietic cell transplantation (alloHCT) after PD-1 blockade may be associated with increased toxicity, raising challenging questions about the role, timing, and optimal method of transplantation in this setting. To address these questions, we assembled a retrospective cohort of 209 cHL patients who underwent alloHCT after PD-1 blockade. With a median follow-up among survivors of 24 months, the 2-year cumulative incidences (CIs) of non-relapse mortality and relapse were 14 and 18%, respectively; the 2-year graft-versus-host disease (GVHD) and relapse-free survival (GRFS), progression-free survival (PFS), and overall survival were 47%, 69%, and 82%, respectively. The 180-day CI of grade 3-4 acute GVHD was 15%, while the 2-year CI of chronic GVHD was 34%. In multivariable analyses, a longer interval from PD-1 to alloHCT was associated with less frequent severe acute GVHD, while additional treatment between PD-1 and alloHCT was associated with a higher risk of relapse. Notably, post-transplant cyclophosphamide (PTCy)-based GVHD prophylaxis was associated with significant improvements in PFS and GRFS. While awaiting prospective clinical trials, PTCy-based GVHD prophylaxis may be considered the optimal transplantation strategy for this patient population.
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Affiliation(s)
- Reid W Merryman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Luca Castagna
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Laura Giordano
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Vincent T Ho
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Paolo Corradini
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano, Milano, Italy
| | - Anna Guidetti
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano, Milano, Italy
| | - Beatrice Casadei
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università Degli Studi, Bologna, Italia
| | - David A Bond
- Division of Hematology, The Ohio State University, Columbus, OH, USA
| | | | - Michael A Spinner
- Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Sally Arai
- Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Robert Lowsky
- Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Gunjan L Shah
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel-Angel Perales
- Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jean Marc Schiano De Colella
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Didier Blaise
- Institut Paoli-Calmettes, Aix Marseille University, CNRS, INSERM, CRCM, Marseille, France
| | - Alex F Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | - Geoffrey Shouse
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA, USA
| | | | | | - Yago Nieto
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Talha Badar
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Mehdi Hamadani
- BMT & Cellular Therapy Program, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Tatyana A Feldman
- John Theurer Cancer Center at HMH, Hackensack Meridian Health School of Medicine, Hackensack, NJ, USA
| | - Lori Dahncke
- John Theurer Cancer Center at HMH, Hackensack Meridian Health School of Medicine, Hackensack, NJ, USA
| | - Anurag K Singh
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, USA
| | - Joseph P McGuirk
- Division of Hematologic Malignancies & Cellular Therapeutics, University of Kansas Medical Center, Westwood, KS, USA
| | - Taiga Nishihori
- Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Julio Chavez
- Department of Blood & Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, FL, USA
| | - Anthony V Serritella
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Justin Kline
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Mohamad Mohty
- Service d'Hématologie Clinique et de Thérapie Cellulaire, Hospital Saint Antoine, Sorbonne University, Paris, France
| | - Remy Dulery
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | | | - Roch Houot
- Department of Hematology, CHU Rennes, University of Rennes, Inserm U1236, Rennes, France
| | - Guillaume Manson
- Department of Hematology, CHU Rennes, University of Rennes, Inserm U1236, Rennes, France
| | | | | | | | - Dipenkumar Modi
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, MI, USA
| | | | - Lazaros Lekakis
- Division of Transplantation and Cellular Therapy, University of Miami/Sylvester Cancer Center, Miami, FL, USA
| | - Amer Beitinjaneh
- Division of Transplantation and Cellular Therapy, University of Miami/Sylvester Cancer Center, Miami, FL, USA
| | - Matthew J Frigault
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA
| | - Yi-Bin Chen
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan C Lynch
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stephen D Smith
- University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Uttam Rao
- Department of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Byrne
- Department of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Sunita Nathan
- Section of Bone Marrow Transplant and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Tycel Phillips
- Division of Hematology and Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Robin M Joyce
- Division of Hematologic Malignancy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Maryam Rahimian
- Division of Hematologic Malignancy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Asad Bashey
- Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA, USA
| | - Hatcher J Ballard
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jakub Svoboda
- Division of Hematology-Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Valter Torri
- Laboratory of Methodology of Clinical Research, Oncology Department. IRCCS Mario Negri Institute, Milano, Italy
| | - Martina Sollini
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Chiara De Philippis
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Massimo Magagnoli
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Armando Santoro
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
| | - Philippe Armand
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Pier Luigi Zinzani
- Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università Degli Studi, Bologna, Italia
- Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Carmelo Carlo-Stella
- Department of Oncology and Hematology, Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy
- Department of Biomedical Sciences, Humanitas University, Rozzano-Milan, Italy
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16
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Bramanti S, De Philippis C, Bartoli A, Giordano L, Mariotti J, Sarina B, Mannina D, Valli V, De Gregori S, Roperti M, Pieri G, Castagna L. Feasibility and Efficacy of a Pharmacokinetics-Guided Busulfan Conditioning Regimen for Allogeneic Stem Cell Transplantation with Post-Transplantation Cyclophosphamide as Graft-versus-Host Disease Prophylaxis in Adult Patients with Hematologic Malignancies. Transplant Cell Ther 2021; 27:912.e1-912.e6. [PMID: 34403790 DOI: 10.1016/j.jtct.2021.08.006] [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: 06/23/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
Busulfan (Bu) is an alkylating agent routinely used for conditioning regimens before allogeneic stem cell transplantation (allo-SCT). Bu shows wide pharmacokinetic (PK) variability among patients. Patients can have a higher systemic exposure (expressed as area under the curve [AUC]) with an increased risk of toxicity or a lower AUC with a higher probability of graft rejection and/or disease relapse. After i.v. administration, an optimal Bu therapeutic window (AUC target of 16,000 to 24,000 μM·minute) has been identified. The use of PK-guided Bu dosing leads to improved overall survival (OS) and progression-free survival (PFS) compared with fixed-dose administration in a variety of hematologic diseases. The aim of this study was to evaluate the outcomes and feasibility of a reduced-toxicity conditioning (RTC) regimen comprising thiotepa, Bu, and fludarabine (TBF) with therapeutic drug monitoring of Bu in patients with hematologic disorders. We report on 41 adult patients with myeloid or lymphoid malignancies who underwent an allo-SCT with a PK-guided Bu-based RTC regimen between January 2019 and October 2020. Patients received a total Bu dose to achieve a target AUC of 16,000 μM·minute in combination with Flu and thiotepa. The median time to absolute neutrophil count recovery and transfusion-independent platelet count recovery was 23 days (range, 15 to 42 days) and 29 days (range, 14 to 97 days), respectively. The cumulative incidence (CI) of nonrelapse mortality was 7% at 100 days and 13% at 1 year. Grade 3 liver toxicity was observed in 6 patients. One patient developed sinusoidal obstruction syndrome at day +27. Grade 3 mucositis occurred in 18 patients. Looking at grade ≥3 infections, the CI was 29% at 30 days, 34% at 60 days, 44% at 100 days, and 56% at 1 year. The 180-day CI of grade II-IV acute graft-versus-host disease (GVHD) was 15%, and the 1-year CI of overall chronic GVHD was 20%. With a median follow-up of alive patients of 14.4 months (range, 3.2 to 24 months), the CI of relapse at 1 year was 6%. The 1-year PFS was 81%, and 1-year OS was 84%. In conclusion, these data support the efficacy of PK-guided Bu dose in the context of a TBF conditioning regimen and the feasibility of therapeutic dosage monitoring of i.v. Bu for patients with hematologic diseases. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
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Affiliation(s)
- Stefania Bramanti
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | | | - Antonella Bartoli
- Fondazione IRCCS Policlinico San Matteo, Clinical and Experimental Pharmacokinetics Unit(,) Pavia, Italy
| | - Laura Giordano
- Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - Jacopo Mariotti
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | - Barbara Sarina
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | - Daniele Mannina
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | - Viviana Valli
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | - Simona De Gregori
- Fondazione IRCCS Policlinico San Matteo, Clinical and Experimental Pharmacokinetics Unit(,) Pavia, Italy
| | - Martina Roperti
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | - Gabriella Pieri
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy
| | - Luca Castagna
- IRCCS Humanitas Research Hospital-Humanitas Cancer Center, Milan, Italy.
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17
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Van Beek JJP, Puccio S, Roberto A, De Paoli F, Graziano G, Salviato E, Alvisi G, Zanon V, Scarpa A, Zaghi E, Calvi M, Di Vito C, Mineri R, Sarina B, De Philippis C, Santoro A, Mariotti J, Bramanti S, Ferrari F, Castagna L, Mavilio D, Lugli E. Single-cell profiling reveals the dynamics of cytomegalovirusspecific T-cells in haploidentical hematopoietic stem cell transplantation. Haematologica 2021; 106:2768-2773. [PMID: 34233445 PMCID: PMC8485680 DOI: 10.3324/haematol.2020.276352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/17/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Alice Scarpa
- IRCCS Humanitas Research Hospital, Rozzano, Milan
| | - Elisa Zaghi
- IRCCS Humanitas Research Hospital, Rozzano, Milan
| | | | - Clara Di Vito
- Department of Medical Biotechnologies and Translational Medicine (BioMeTra), University of Milan, Milan
| | | | | | | | - Armando Santoro
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan
| | | | | | - Francesco Ferrari
- IFOM, the FIRC Institute of Molecular Oncology, Milan, Italy; IGM-CNR, Institute of Molecular Genetics "Luigi Luca Cavalli Sforza", National Research Council, Pavia
| | | | - Domenico Mavilio
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Medical Biotechnologies and Translational Medicine (BioMeTra), University of Milan, Milan
| | - Enrico Lugli
- IRCCS Humanitas Research Hospital, Rozzano, Milan
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18
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Zaghi E, Calvi M, Puccio S, Spata G, Terzoli S, Peano C, Roberto A, De Paoli F, van Beek JJ, Mariotti J, De Philippis C, Sarina B, Mineri R, Bramanti S, Santoro A, Le-Trilling VTK, Trilling M, Marcenaro E, Castagna L, Di Vito C, Lugli E, Mavilio D. Single-cell profiling identifies impaired adaptive NK cells expanded after HCMV reactivation in haploidentical HSCT. JCI Insight 2021; 6:146973. [PMID: 34003794 PMCID: PMC8262468 DOI: 10.1172/jci.insight.146973] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/16/2020] [Accepted: 05/12/2021] [Indexed: 11/17/2022] Open
Abstract
Haploidentical hematopoietic stem cell transplantation (h-HSCT) represents an efficient curative approach for patients affected by hematologic malignancies in which the reduced intensity conditioning induces a state of immunologic tolerance between donor and recipient. However, opportunistic viral infections greatly affect h-HSCT clinical outcomes. NK cells are the first lymphocytes that recover after transplant and provide a prompt defense against human cytomegalovirus (HCMV) infection/reactivation. By undertaking a longitudinal single-cell computational profiling of multiparametric flow cytometry, we show that HCMV accelerates NK cell immune reconstitution together with the expansion of CD158b1b2jpos/NKG2Aneg/NKG2Cpos/NKp30lo NK cells. The frequency of this subset correlates with HCMV viremia, further increases in recipients experiencing multiple episodes of viral reactivations, and persists for months after the infection. The transcriptional profile of FACS-sorted CD158b1b2jpos NK cells confirmed the ability of HCMV to deregulate NKG2C, NKG2A, and NKp30 gene expression, thus inducing the expansion of NK cells with adaptive traits. These NK cells are characterized by the downmodulation of several gene pathways associated with cell migration, the cell cycle, and effector-functions, as well as by a state of metabolic/cellular exhaustion. This profile reflects the functional impairments of adaptive NK cells to produce IFN-γ, a phenomenon also due to the viral-induced expression of lymphocyte-activation gene 3 (LAG-3) and programmed cell death protein 1 (PD-1) checkpoint inhibitors.
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Affiliation(s)
- Elisa Zaghi
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Michela Calvi
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,BIOMETRA, Università degli Studi di Milano, Milan, Italy
| | | | - Gianmarco Spata
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Sara Terzoli
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Clelia Peano
- Institute of Genetic and Biomedical Research, UoS Milan, National Research Council, and Genomic Unit
| | | | | | | | | | | | | | - Rossana Mineri
- Molecular Biology Section, Clinical Investigation Laboratory, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | | | | | - Mirko Trilling
- Institute for Virology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | | | - Clara Di Vito
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,BIOMETRA, Università degli Studi di Milano, Milan, Italy
| | - Enrico Lugli
- Laboratory of Translational Immunology.,Flow Cytometry Core, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.,BIOMETRA, Università degli Studi di Milano, Milan, Italy
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19
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Sarina B, Mancosu P, Navarria P, Bramanti S, Mariotti J, De Philippis C, Clerici E, Franzese C, Mannina D, Valli V, Carlo-Stella C, Scorsetti M, Santoro A, Castagna L. Nonmyeloablative Conditioning Regimen Including Low-Dose Total Marrow/Lymphoid Irradiation Before Haploidentical Transplantation with Post-Transplantation Cyclophosphamide in Patients with Advanced Lymphoproliferative Diseases. Transplant Cell Ther 2021; 27:492.e1-492.e6. [PMID: 33857448 DOI: 10.1016/j.jtct.2021.03.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/09/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
Low-dose total body irradiation (TBI) has long been used in nonmyeloablative conditioning (NMAC) regimens before allogeneic stem cell transplantation from haploidentical donors (haplo-SCT). More recently, the use of total marrow lymphoid irradiation (TMLI) instead of TBI in conditioning is increasing. This study aimed to evaluate outcomes in a cohort of patients treated with low-dose TMLI in terms of engraftment, full donor chimerism status, graft-versus-host disease (GVHD), and extrahematologic toxicities, and to compare these outcomes with those in a cohort of patients receiving conventional TBI-containing conditioning. This retrospective single-center study included 100 patients with advanced hematologic malignancies who underwent haplo-SCT. Between 2009 and 2011, the NMAC regimen consisted of cyclophosphamide, fludarabine, and low-dose TBI (2 Gy), and after 2011, TBI was replaced with TMLI (2 Gy). Patients received post-transplantation cyclophosphamide, calcineurin inhibitor, and mycophenolate mofetil as GVHD prophylaxis. For all patients, the median time to absolute neutrophil count (ANC) recovery to >0.5 × 109/L was 21 days (range, 15 to 49 days), the 30-day incidence of ANC recovery was 97% (95% confidence interval [CI], 89% to 99%), the median time to achieve an unsupported platelet count >20 × 109/L was 26 days (range, 12 to 67 days), and the 60-day rate of platelet engraftment was 99% (95% CI, 89% to 100%). Cumulative incidence of full donor chimerism by day 100 was 88% (95% CI 79-90). Grade II-IV acute GVHD occurred in 35% of the patients (95% CI, 26% to 45%) at a median of 40 days (range, 23 to 166 days). The incidence of moderate to severe chronic GVHD was 5% (95% CI, 2% to 10%). No differences between the TBI and TMLI cohorts were seen in terms of engraftment, full donor chimerism, and GVHD. No organ toxicity was observed in the first months after transplantation in either cohort. The overall 2-year OS and PFS rates were 63%, and 54%, respectively, and were comparable in the 2 groups (P = .548). The strongest finding was that TBI can be safely replaced by TMLI in terms of engraftment, achievement of full donor chimerism status, GVHD incidence, and extrahematologic toxicities.
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Affiliation(s)
- Barbara Sarina
- BMT Unit, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy
| | - Pietro Mancosu
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy
| | - Pierina Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy
| | - Stefania Bramanti
- BMT Unit, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy
| | - Jacopo Mariotti
- BMT Unit, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy
| | - Chiara De Philippis
- BMT Unit, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy
| | - Ciro Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy
| | - Daniele Mannina
- BMT Unit, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy
| | - Viviana Valli
- BMT Unit, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy
| | - Carmelo Carlo-Stella
- BMT Unit, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Armando Santoro
- BMT Unit, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Luca Castagna
- BMT Unit, Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan, Italy.
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20
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Castagna L, Valli V, Timofeeva I, Capizzuto R, Bramanti S, Mariotti J, De Philippis C, Sarina B, Mannina D, Giordano L, De Paoli F, van Beek JJP, Zaghi E, Calvi M, Vito CD, Mavilio D, Crocchiolo R, Lugli E. Feasibility and Efficacy of CD45RA+ Depleted Donor Lymphocytes Infusion After Haploidentical Transplantation With Post-Transplantation Cyclophosphamide in Patients With Hematological Malignancies. Transplant Cell Ther 2021; 27:478.e1-478.e5. [PMID: 33819481 DOI: 10.1016/j.jtct.2021.03.010] [Citation(s) in RCA: 9] [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: 12/25/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/28/2022]
Abstract
Allogeneic stem cell transplantation from haploidentical donor using post-transplantation cyclophosphamide has been used to cure hematological diseases. Because of slow immunological reconstitution, there is an increased incidence of viral infection. The aim of our study was to prospectively evaluate the efficacy and the feasibility of a CD45RA+ depleted donor lymphocytes infusion (DLI) in terms of reduction of viral infection early after haploidentical transplantation. This a prospective single-center study. We enrolled 23 patients, of whom 19 were evaluable. Graft-versus-host disease (GVHD) prophylaxis was the same for all patients. The primary endpoint was 100-day cumulative incidence of viral infections. The primary endpoint was met, because the 100-day cumulative incidence of viral infection was 32%. The median time from transplantation to first CD45RA+ depleted DLI was 55 days (range, 46-63). 28% of patients had cytomegalovirus reactivation, no patients reactivated human herpesvirus-6; 1 patient developed BK virus related hemorrhagic cystitis. Most of the patients received the planned 3 infusions. Only 1 patient had development of grade 2 acute GVHD, and 2 patients had moderate chronic GVHD. All evaluable patients were off immunosuppressive therapy at last follow-up. The median follow-up was 12 months (range, 3-23), the 1-year overall survival and progression-free survival were 79% and 75%, respectively; the 100-day and 1-year non-relapse mortality were 5% and 12%, respectively. CD45RA+ depleted DLI are feasible in patients treated with haploidentical transplantation. The toxic profile is good with a low risk for development of both acute and chronic GVHD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Laura Giordano
- Biostatistic Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Federica De Paoli
- Laboratory of Translational Immunology, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Jasper J P van Beek
- Laboratory of Translational Immunology, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Elisa Zaghi
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Milan, Italy
| | - Michela Calvi
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Milan, Italy; Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
| | - Clara Di Vito
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Milan, Italy; Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Milan, Italy; Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
| | | | - Enrico Lugli
- Laboratory of Translational Immunology, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
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21
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Castagna L, Pagliardini T, Bramanti S, Schiano de Colella JM, Montes de Oca C, Bouabdallah R, Mariotti J, Fürst S, Granata A, De Philippis C, Harbi S, Sarina B, Legrand F, Maisano V, Weiller PJ, Chabannon C, Carlo-Stella C, Santoro A, Blaise D, Devillier R. Allogeneic stem cell transplantation in poor prognosis peripheral T-cell lymphoma: the impact of different donor type on outcome. Bone Marrow Transplant 2020; 56:883-889. [PMID: 33191403 PMCID: PMC7666822 DOI: 10.1038/s41409-020-01133-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/08/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022]
Abstract
We report the outcome of 68 patients with advanced peripheral T-cell lymphoma receiving transplantation from haploidentical or from conventional donors. The 4-year OS, PFS, 2-year cumulative incidence of relapse and 2-year GRFS was 75%, 70%, 21%, and 51%, respectively. Survival was not affected by donor type. The 2-year NRM was 9%, lower after related or haploidentical donor (21% vs 0% vs 7%; p = 0.06). Grade 2-4 aGVHD cumulative incidence was significantly different after transplantation from haploidentical vs matched sibling vs unrelated donor, and (24% vs 35% vs 58%, p = 0.024). The familial donor cohort was compared to the unrelated cohort. Familial donor induced less grade 2-4 aGVHD, with a trend to less grade 3-4 aGVHD or moderate-severe cGVHD. The OS and PFS were not different, while the relapse risk and NRM were reduced. Allo-SCT is highly effective in T-cell lymphoma, with low NRM and low relapse rate. The incidence of aGVHD was lower after haploidentical transplantation. Related donor may challenge unrelated transplant reducing the risk of relapse and NRM.
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Affiliation(s)
- Luca Castagna
- Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Thomas Pagliardini
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Stefania Bramanti
- Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | | | - Catalina Montes de Oca
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Reda Bouabdallah
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Jacopo Mariotti
- Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Sabine Fürst
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Angela Granata
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Chiara De Philippis
- Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Samia Harbi
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Barbara Sarina
- Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Faezeh Legrand
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Valerio Maisano
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Pierre Jean Weiller
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Christian Chabannon
- Centre for Clinical Investigation in Biotherapy, Institut Paoli-Calmettes, Aix-Marseille University, INSERM CBT 1409, Marseille, France
| | - Carmelo Carlo-Stella
- Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Armando Santoro
- Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Didier Blaise
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Raynier Devillier
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
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22
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Montes de Oca C, Castagna L, De Philippis C, Bramanti S, Schiano JM, Pagliardini T, Collignon A, Harbi S, Mariotti J, Granata A, Maisano V, Furst S, Legrand F, Chabannon C, Carlo-Stella C, Santoro A, Blaise D, Devillier R. Nonmyeloablative Conditioning Regimen before T Cell Replete Haploidentical Transplantation with Post-Transplant Cyclophosphamide for Advanced Hodgkin and Non-Hodgkin Lymphomas. Biol Blood Marrow Transplant 2020; 26:2299-2305. [PMID: 32822845 DOI: 10.1016/j.bbmt.2020.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/28/2020] [Revised: 07/27/2020] [Accepted: 08/09/2020] [Indexed: 12/20/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a valid option in patients with refractory lymphomas. HLA haploidentical stem cell transplantation (haplo-SCT) expanded the accessibility to allogeneic hematopoietic cell transplantation. The aims of study were to retrospectively assess the toxicity and efficacy of haplo-SCT using nonmyeloablative conditioning in patients with advanced lymphoma. In total, 147 patients with advanced lymphoma at 2 partner institutions were included. Patients received a uniform nonmyeloablative conditioning regimen and graft-versus-host disease (GVHD) prophylaxis. The primary endpoints were progression-free survival (PFS), overall survival (OS), GVHD, nonrelapse mortality, and GVHD, relapse-free survival (GRFS). Median follow-up was 39 months (range, 6 to 114 months). The median age was 46 years (range, 19 to 71 years). Sixty-five percent of patients were in complete remission (CR) at transplantation. Cumulative incidence of grade II to IV acute GVHD was 30% (95% confidence interval [Cl], 23% to 38%). Two-year cumulative incidence of all grades of chronic GVHD was 13% (95% CI, 8% to 20%). Two-year cumulative incidence of disease relapse was 19% (95% CI, 14% to 27%), with a higher incidence in patients not being in CR at allo-HCT (CR versus not CR: 12% versus 33%, P = .006). Two-year PFS, OS, and GRFS were 66% (95% CI, 59-75), 73% (95% CI, 66-81), and 56% (95% CI, 48-65), respectively. Haplo-SCT with post-transplantation cyclophosphamide may be considered a valid option for patients with aggressive lymphoma and deserves further evaluation.
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Affiliation(s)
- Catalina Montes de Oca
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Luca Castagna
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
| | | | | | - Jean Marc Schiano
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Thomas Pagliardini
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Aude Collignon
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Samia Harbi
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | | | - Angela Granata
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Valerio Maisano
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Sabine Furst
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Faezeah Legrand
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Christian Chabannon
- Centre for Clinical Investigation in Biotherapy, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France
| | - Carmelo Carlo-Stella
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Armando Santoro
- Humanitas Clinical and Research Center, IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Didier Blaise
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - Raynier Devillier
- Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
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23
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Mancosu P, Navarria P, Muren LP, Castagna L, Reggiori G, Clerici E, Sarina B, Bramanti S, De Philippis C, Tomatis S, Santoro A, Scorsetti M. Development of an Immobilization Device for Total Marrow Irradiation. Pract Radiat Oncol 2020; 11:e98-e105. [PMID: 32160952 DOI: 10.1016/j.prro.2020.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/24/2020] [Accepted: 02/15/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE A body frame dedicated to total marrow (lymph node) irradiation (TMI/TMLI) could minimize patient motion during the potentially extended beam-on time with this technique. We present the development of a dedicated immobilization system for TMI/TMLI using volumetric modulated arc therapy. METHODS AND MATERIALS Since 2010, 59 adult patients were treated with TMI/TMLI using a multi-isocenter volumetric modulated arc therapy technique. Two computed tomographies (CTs) were required (1 head-first supine and 1 feet-first supine) to cover the whole volume. For the first 10 patients, 2 standard commercial frames with personalized masks (with/without personalized vacuum cushion for the lower extremities) were used without specific interfixation (frame A). For the next 49 patients a homemade 3-frame immobilization system was adopted (frame B), where each frame was interlocked with the next one and thermoplastic masks used to fix the patient. The effectiveness of the 2 immobilization systems was assessed by offline/online matching between daily cone beam CT of each isocenter and the simulation CTs. RESULTS Mean offline shifts for frame A were 3 to 12 mm in anterior-posterior, 2 to 5 mm in cranilal-caudal, and 2 to 6 mm in left-right directions. Larger shifts were found for feet-first supine series (shifts up to 23 mm). In frame B, mean offline shifts were 1 to 4 mm in anterior-posterior, 1 to 4 mm in cranial-caudal, and 1 to 4 mm in left-right directions. Mean online adjustments were -1 ± 4 mm in anterior-posterior, 0 ± 2 mm in cranial-caudal, and 0 ± 4 mm in left-right directions. CONCLUSIONS The patient positioning shifts for TMI/TMLI irradiation were mitigated by a homemade immobilization system and the use of individualized masks.
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Affiliation(s)
- Pietro Mancosu
- Medical Physics Service, Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy.
| | - Pierina Navarria
- Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy
| | | | - Luca Castagna
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Giacomo Reggiori
- Medical Physics Service, Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy
| | - Elena Clerici
- Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy
| | - Barbara Sarina
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Stefania Bramanti
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Chiara De Philippis
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Stefano Tomatis
- Medical Physics Service, Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy
| | - Armando Santoro
- Medical Oncology Department, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy
| | - Marta Scorsetti
- Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy
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24
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Mariotti J, Taurino D, Marino F, Bramanti S, Sarina B, Morabito L, De Philippis C, Di Vito C, Mavilio D, Carlo-Stella C, Della Porta M, Santoro A, Castagna L. Pretransplant active disease status and HLA class II mismatching are associated with increased incidence and severity of cytokine release syndrome after haploidentical transplantation with posttransplant cyclophosphamide. Cancer Med 2019; 9:52-61. [PMID: 31702882 PMCID: PMC6943086 DOI: 10.1002/cam4.2607] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 05/24/2019] [Revised: 07/29/2019] [Accepted: 09/25/2019] [Indexed: 01/21/2023] Open
Abstract
Cytokine release syndrome (CRS) represents a life‐threatening side effect after haploidentical stem cell transplantation (Haplo‐SCT) with posttransplant cyclophosphamide (PT‐Cy). Factors predictive of CRS development is still a matter of debate. We retrospectively analyzed 102 consecutive patients receiving a bone marrow (BM) (n = 42) or peripheral blood stem cells (PBSC) (n = 60) Haplo‐SCT with PT‐Cy. The two cohorts were similar in main patients’ characteristics besides disease type (P = .02). Cumulative incidence of grades 1, 2, and ≥3 CRS was 80%, 52%, and 15% at a median of 2, 4, and 7 days, respectively. Moderate/High‐grade fever (39°‐41°), grade 1 and grade ≥3 CRS occurred more frequently after PBSC relative to BM grafts (68% vs 33%, P = .0005; 87% vs 71%, P = .009; 20% vs 7%, P = .07). Only patients experiencing grade ≥3 CRS had a worse outcome in terms of 1‐year overall survival (OS) and nonrelapse mortality (NRM): 39% vs 80% (P = .002) and 40% vs 8% (P = .005), respectively. By univariate analysis the only factors associated with the increased risk of ≥3 CRS were pretransplant disease status (8% for complete remission, 11% for partial remission, and 38% for active disease, P = .002), HLA‐DRB1 mismatching (57% vs 14%, P = .007), and PBSC graft (P = .07). By multivariable analysis, only pretransplant disease status (hazard ratio, HR: 6.84, P = .005) and HLA‐DRB1 mismatching (HR: 17.19, P = .003) remained independent predictors of grade ≥3 CRS. Only grade ≥3 CRS is clinically relevant for the final outcome of patients receiving Haplo‐SCT with PT‐Cy, is more frequent after a PBSC graft and is associated with pretransplant active disease and HLA‐DRB1 mismatching.
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Affiliation(s)
- Jacopo Mariotti
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center-IRCCS-via Manzoni 56, Rozzano, Italy
| | - Daniela Taurino
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center-IRCCS-via Manzoni 56, Rozzano, Italy
| | - Fabrizio Marino
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center-IRCCS-via Manzoni 56, Rozzano, Italy
| | - Stefania Bramanti
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center-IRCCS-via Manzoni 56, Rozzano, Italy
| | - Barbara Sarina
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center-IRCCS-via Manzoni 56, Rozzano, Italy
| | - Lucio Morabito
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center-IRCCS-via Manzoni 56, Rozzano, Italy
| | - Chiara De Philippis
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center-IRCCS-via Manzoni 56, Rozzano, Italy
| | - Clara Di Vito
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Carmelo Carlo-Stella
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center-IRCCS-via Manzoni 56, Rozzano, Italy.,Department of Medical Biotechnology and Translational Medicine, University of Milano, Milano, Italy
| | - Matteo Della Porta
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center-IRCCS-via Manzoni 56, Rozzano, Italy
| | - Armando Santoro
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center-IRCCS-via Manzoni 56, Rozzano, Italy.,Humanitas Clinical and Research Hospital, Humanitas University, Rozzano, Italy
| | - Luca Castagna
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center-IRCCS-via Manzoni 56, Rozzano, Italy
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Bramanti S, Calafiore V, Longhi E, Mariotti J, Crespiatico L, Sarina B, De Philippis C, Nocco A, Santoro A, Castagna L. Donor-Specific Anti-HLA Antibodies in Haploidentical Stem Cell Transplantation with Post-Transplantation Cyclophosphamide: Risk of Graft Failure, Poor Graft Function, and Impact on Outcomes. Biol Blood Marrow Transplant 2019; 25:1395-1406. [DOI: 10.1016/j.bbmt.2019.02.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 02/18/2019] [Indexed: 01/01/2023]
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Mariotti J, Devillier R, Bramanti S, Giordano L, Sarina B, Furst S, Granata A, Maisano V, Pagliardini T, De Philippis C, Kogan M, Faucher C, Harbi S, Chabannon C, Carlo-Stella C, Bouabdallah R, Santoro A, Blaise D, Castagna L. Peripheral Blood Stem Cells versus Bone Marrow for T Cell-Replete Haploidentical Transplantation with Post-Transplant Cyclophosphamide in Hodgkin Lymphoma. Biol Blood Marrow Transplant 2019; 25:1810-1817. [PMID: 31128326 DOI: 10.1016/j.bbmt.2019.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 03/14/2019] [Revised: 05/09/2019] [Accepted: 05/17/2019] [Indexed: 10/26/2022]
Abstract
Haploidentical stem cell transplantation (haplo-SCT) with post-transplant cyclophosphamide (PT-Cy) represents a potential curative strategy for patients with Hodgkin lymphoma (HL) when a matched related or unrelated donor is not available. The role of graft source, either bone marrow (BM) or peripheral blood stem cells (PBSCs), in this setting has not been fully elucidated. We performed a retrospective study on 91 patients with HL to compare the outcome after BM (n = 53) or PBSC (n = 38) transplant. Eighty-nine patients engrafted with no difference between BM and PBSCs in terms of median time for neutrophil (20 versus 20 days, P = .405) and platelet (26 versus 26.5 days, P = .994) engraftment. With a median follow-up of 40.2 months, 100-day cumulative incidences of grades II to IV acute graft-versus host disease (GVHD) and grades II to IV acute GVHD were 24% and 4%, respectively. Graft source was not associated with a different risk of acute GVHD both by univariate and multivariate analyses. Consistently, 1-year cumulative incidence of chronic GVHD was 7% with no differences between the 2 graft types (P = .761). Two-year rates of overall survival (OS), progression-free survival (PFS), nonrelapse mortality, and GVHD/relapse-free survival (GRFS) were 67%, 58%, 20%, and 52%, respectively. By univariate analysis, pretransplant disease status was the main variable affecting all outcomes. By multivariate analysis, PBSCs resulted in a protective factor for OS (hazard ratio [HR], .29; P = .006), PFS (HR, .38; P = .001), and GRFS (HR, .44; P = .020). The other independent variables affecting the final outcome were pretransplant disease status and hematopoietic cell transplant-specific comorbidity index. In conclusion, when planning a haplo-SCT with PT-Cy for patients with poor-risk HL, graft type is an important variable to take into account when selecting the best available donor.
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Affiliation(s)
- Jacopo Mariotti
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy.
| | - Raynier Devillier
- Department of Hematology, Transplantation Program, Institut Paoli Calmettes, Marseille, France
| | - Stefania Bramanti
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Laura Giordano
- Division of Biostatistics, Department of Oncology, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Barbara Sarina
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Sabine Furst
- Department of Hematology, Transplantation Program, Institut Paoli Calmettes, Marseille, France
| | - Angela Granata
- Department of Hematology, Transplantation Program, Institut Paoli Calmettes, Marseille, France
| | - Valerio Maisano
- Department of Hematology, Transplantation Program, Institut Paoli Calmettes, Marseille, France
| | - Thomas Pagliardini
- Department of Hematology, Transplantation Program, Institut Paoli Calmettes, Marseille, France
| | - Chiara De Philippis
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Maria Kogan
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Catherine Faucher
- Department of Hematology, Transplantation Program, Institut Paoli Calmettes, Marseille, France
| | - Samia Harbi
- Department of Hematology, Transplantation Program, Institut Paoli Calmettes, Marseille, France
| | - Christian Chabannon
- Cell Therapy Unit, Institut Paoli Calmettes, Marseille, France; Aix-Marseille Université, Marseille, France; Centre de Recherche en Cancérologie de Marseille, Marseille, France
| | - Carmelo Carlo-Stella
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Medical Biotechnology and Translational Medicine, University of Milano, Milano, Italy
| | - Reda Bouabdallah
- Department of Hematology, Transplantation Program, Institut Paoli Calmettes, Marseille, France
| | - Armando Santoro
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy; Humanitas University, Humanitas Clinical and Research Hospital, Rozzano, Italy
| | - Didier Blaise
- Department of Hematology, Transplantation Program, Institut Paoli Calmettes, Marseille, France; Cell Therapy Unit, Institut Paoli Calmettes, Marseille, France; Aix-Marseille Université, Marseille, France
| | - Luca Castagna
- Bone Marrow Transplant Unit, Humanitas Clinical and Research Center, Rozzano, Italy
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Mariotti J, De Philippis C, Bramanti S, Sarina B, Tordato F, Pocaterra D, Casari E, Carlo-Stella C, Santoro A, Castagna L. Caspofungin for primary antifungal prophylaxis after T-cell-replete haploidentical stem cell transplantation with post-transplant cyclophosphamide. Eur J Haematol 2019; 102:357-367. [PMID: 30672611 PMCID: PMC7163667 DOI: 10.1111/ejh.13214] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/23/2018] [Revised: 01/05/2019] [Accepted: 01/07/2019] [Indexed: 12/18/2022]
Abstract
Objectives T‐cell–replete haploidentical stem cell transplantation (Haplo‐SCT) with post‐transplant cyclophosphamide (PT‐Cy) is at high risk of invasive fungal infections (IFI), and anti‐mold–active drug is required for primary antifungal prophylaxis (PAP) according to international guidelines. No data are available on the efficacy of caspofungin as PAP in this setting. Methods Here, we report our retrospective experience with 103 consecutive patients treated with caspofungin as PAP after Haplo‐SCT. Caspofungin was administered only during the pre‐engraftment phase. Results Hundred‐day cumulative incidence of proven‐probable IFI (PP‐IFI) was 8.7% and median day of onset was 19 post‐SCT. No patient died of PP‐IFI, and overall survival (OS) and non‐relapse mortality (NRM) hazard ratio (HR) for patients experiencing IFI were 1.02 (P = 0.9) and 0.7 (P = 0.7), respectively. Three‐year overall survival (OS) and 1‐year non‐relapse mortality (NRM) were 55% and 19%, respectively. By univariate analysis, duration of neutropenic phase and partial remission pre‐transplant disease status were associated with increased incidence of IFI, but were not confirmed by multivariate analysis. Conclusion In summary, PAP with caspofungin is an effective strategy for preventing IFI in the context of Haplo‐SCT with PT‐Cy. Further efforts are required in order to identify more potent strategies able to avoid the occurrence of breakthrough infections.
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Affiliation(s)
- Jacopo Mariotti
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Chiara De Philippis
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Stefania Bramanti
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Barbara Sarina
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Federica Tordato
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Daria Pocaterra
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Erminia Casari
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Carmelo Carlo-Stella
- Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Armando Santoro
- Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Luca Castagna
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
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Sarina B, Mariotti J, Bramanti S, Morabito L, Crocchiolo R, Rimondo A, Tordato F, Pocaterra D, Casari E, De Philippis C, Carlo-Stella C, Santoro A, Castagna L. A reduced dose of fluconazole as primary antifungal prophylaxis is not associated with increased risk of invasive fungal infections after allogeneic stem cell transplantation from a HLA identical sibling. Transpl Infect Dis 2018; 20:e12906. [PMID: 29668124 DOI: 10.1111/tid.12906] [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] [Received: 07/01/2017] [Revised: 12/16/2017] [Accepted: 12/24/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Invasive fungal infections (IFI) represent a common side effect of allogeneic hematopoietic stem cell transplant (allo-SCT), resulting in increased non relapse mortality (NRM) and reduced overall survival (OS) rates. Seventy-five days of Fluconazole 400 mg/d represents the standard primary antifungal prophylaxis (PAP) after allo-SCT, especially for low-risk transplants. However, the ideal dosage of fluconazole has never been tested. METHODS Here, we report the experience of our institution on 113 consecutive patients receiving an allo-SCT from a HLA identical sibling between 1999 and 2015, where PAP consisted of fluconazole 100 mg/d only during the pre-engraftment phase. At the time of transplant, all patients were considered at low-risk for mold infection according to ECIL-5 guidelines. RESULTS Cumulative incidence of possible-probable-proven IFI was 11.7%, while proven-probable (PP-IFI) occurred in 5.5% of patients by day 100 post transplant. Of note, only 1 patient developed invasive Candidiasis due to a non-albicans strain and stool-screening tests were negative for colonization by Candida albicans species. The incidence of 1-year acute and 2-year chronic graft-versus-host-disease (GVHD) was 30% and 45%, respectively. Three-year OS and 1-year NRM were 53% and 11.3%, respectively. CONCLUSION In summary, fungal prophylaxis with fluconazole 100 mg/d results in very low incidence of PP-IFI, GVHD and NRM in low-risk allo-SCT.
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Affiliation(s)
- Barbara Sarina
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Jacopo Mariotti
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Stefania Bramanti
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Lucio Morabito
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Roberto Crocchiolo
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Andrea Rimondo
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Federica Tordato
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Daria Pocaterra
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Erminia Casari
- Infectious Diseases Unit, Hospital Health Direction, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Chiara De Philippis
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Carmelo Carlo-Stella
- Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Armando Santoro
- Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Luca Castagna
- Bone Marrow Unit, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
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Spina F, Radice T, De Philippis C, Soldarini M, Di Chio MC, Dodero A, Guidetti A, Viviani S, Corradini P. Allogeneic transplantation for relapsed and refractory Hodgkin lymphoma: long-term outcomes and graft-versus-host disease-free/relapse-free survival. Leuk Lymphoma 2018; 60:101-109. [PMID: 29716416 DOI: 10.1080/10428194.2018.1459607] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This monocentric retrospective study included 70 consecutive relapsed/refractory Hodgkin lymphoma (RR-HL) patients receiving reduced-intensity allogeneic stem cell transplantation (alloSCT). We evaluated overall and progression-free survival (OS, PFS), graft-versus host disease/relapse-free survival (GFRS), and chronic GVHD-free OS (cGVHD-free OS) defined as OS without moderate-to-severe cGVHD. Patients had a median age of 33 years (range, 18-60 years), 23% had refractory disease (SD/PD). Donors were HLA identical (39%), unrelated (30%), or haploidentical (31%). Median follow-up was 6.2 years. Five-year OS was 59% and PFS was 49%. NRM was 16% at 1 year. 44% of patients had cGVHD, and 14% moderate-to-severe cGVHD at last follow-up. GFRS and cGVHD-free OS were 26 and 48% at 5 years. In multivariate analysis, resistant disease at alloSCT impacted survival and GFRS. In conclusion, disease response before alloSCT impacts survival and GFRS. GVHD outcomes may help comparing the long-term effects of the new salvage treatments that bridge patients to alloSCT.
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Affiliation(s)
- Francesco Spina
- a Division of Hematology , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
| | - Tommaso Radice
- a Division of Hematology , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy.,b Department of Oncology and Onco-Hematology , Università degli Studi di Milano , Milan , Italy
| | - Chiara De Philippis
- a Division of Hematology , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy.,b Department of Oncology and Onco-Hematology , Università degli Studi di Milano , Milan , Italy
| | - Martina Soldarini
- a Division of Hematology , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy.,b Department of Oncology and Onco-Hematology , Università degli Studi di Milano , Milan , Italy
| | - Maria Chiara Di Chio
- a Division of Hematology , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy.,b Department of Oncology and Onco-Hematology , Università degli Studi di Milano , Milan , Italy
| | - Anna Dodero
- a Division of Hematology , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
| | - Anna Guidetti
- a Division of Hematology , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
| | - Simonetta Viviani
- a Division of Hematology , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
| | - Paolo Corradini
- a Division of Hematology , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy.,b Department of Oncology and Onco-Hematology , Università degli Studi di Milano , Milan , Italy
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30
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Mussetti A, De Philippis C, Carniti C, Bastos-Oreiro M, Gayoso J, Cieri N, Ciceri F, Greco R, Peccatori J, Patriarca F, Mariotti J, Castagna L, Corradini P. CD3+ Graft Cell Count Predicts Chronic Gvhd Incidence in Haploidentical Allogeneic Transplantation Using Post-Transplant Cyclophosphamide. Biol Blood Marrow Transplant 2018. [DOI: 10.1016/j.bbmt.2017.12.338] [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: 10/18/2022]
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Bolli N, Barcella M, Salvi E, D'Avila F, Vendramin A, De Philippis C, Munshi NC, Avet-Loiseau H, Campbell PJ, Mussetti A, Carniti C, Maura F, Barlassina C, Corradini P, Montefusco V. Next-generation sequencing of a family with a high penetrance of monoclonal gammopathies for the identification of candidate risk alleles. Cancer 2017; 123:3701-3708. [DOI: 10.1002/cncr.30777] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/04/2017] [Accepted: 04/18/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Niccolo Bolli
- Department of Oncology and Hemato-Oncology; University of Milan; Milan Italy
- Department of Hematology and Pediatric Onco-Hematology; IRCCS Foundation National Cancer Institute; Milan Italy
- The Cancer Genome Project; Wellcome Trust Sanger Institute; Cambridge United Kingdom
| | - Matteo Barcella
- Genomic and Bioinformatics Unit; Department of Health Sciences, University of Milan; Milan Italy
| | - Erika Salvi
- Genomic and Bioinformatics Unit; Department of Health Sciences, University of Milan; Milan Italy
| | - Francesca D'Avila
- Genomic and Bioinformatics Unit; Department of Health Sciences, University of Milan; Milan Italy
| | - Antonio Vendramin
- Department of Oncology and Hemato-Oncology; University of Milan; Milan Italy
- Department of Hematology and Pediatric Onco-Hematology; IRCCS Foundation National Cancer Institute; Milan Italy
| | - Chiara De Philippis
- Department of Oncology and Hemato-Oncology; University of Milan; Milan Italy
- Department of Hematology and Pediatric Onco-Hematology; IRCCS Foundation National Cancer Institute; Milan Italy
| | - Nikhil C. Munshi
- LeBow Institute for Myeloma Therapeutics; Jerome Lipper Center for Multiple Myeloma Research, Dana-Farber Cancer Institute, Harvard Medical School; Boston Massachusetts
| | - Herve Avet-Loiseau
- Laboratory for Genomics in Myeloma; University Cancer Center of Toulouse; CRCT INSERM 1037, Toulouse France
| | - Peter J. Campbell
- The Cancer Genome Project; Wellcome Trust Sanger Institute; Cambridge United Kingdom
| | - Alberto Mussetti
- Department of Hematology and Pediatric Onco-Hematology; IRCCS Foundation National Cancer Institute; Milan Italy
| | - Cristiana Carniti
- Department of Hematology and Pediatric Onco-Hematology; IRCCS Foundation National Cancer Institute; Milan Italy
| | - Francesco Maura
- Department of Oncology and Hemato-Oncology; University of Milan; Milan Italy
| | - Cristina Barlassina
- Genomic and Bioinformatics Unit; Department of Health Sciences, University of Milan; Milan Italy
| | - Paolo Corradini
- Department of Oncology and Hemato-Oncology; University of Milan; Milan Italy
- Department of Hematology and Pediatric Onco-Hematology; IRCCS Foundation National Cancer Institute; Milan Italy
| | - Vittorio Montefusco
- Department of Hematology and Pediatric Onco-Hematology; IRCCS Foundation National Cancer Institute; Milan Italy
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De Philippis C, Di Chio MC, Sabattini E, Bolli N. Bowel perforation from occult ileal involvement after diagnosis in a case of primary mediastinal large B-cell lymphoma. BMJ Case Rep 2016; 2016:bcr-2016-216317. [PMID: 27417993 DOI: 10.1136/bcr-2016-216317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary mediastinal large B-cell lymphoma (PMBCL) is confined to the mediastinum or contiguous nodal areas in most cases. Extramediastinal and abdominal involvement, especially at diagnosis, is extremely rare. Our case describes the first case of histologically proven ileal involvement of PMBCL at diagnosis that led to ileal perforation. Positron emission tomography CT could increase the sensitivity of staging by detecting unusual sites of disease localisation, and could impact clinical management.
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Affiliation(s)
- Chiara De Philippis
- Department of Oncology and Onco-Hematology, Università degli Studi di Milano, Milano, Italy
| | - Maria Chiara Di Chio
- Department of Oncology and Onco-Hematology, Università degli Studi di Milano, Milano, Italy
| | - Elena Sabattini
- Unit of Haemolymphopathology, Department of Haematology & Oncology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Niccolo Bolli
- Department of Oncology and Onco-Hematology, Università degli Studi di Milano, Milano, Italy
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Iurlo A, Radice T, De Philippis C, Zappa M, Pomati M, Cortelezzi A. Early switch to nilotinib in a case of non-optimal response to imatinib. CMI 2015. [DOI: 10.7175/cmi.v5i6s.1135] [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: 11/18/2022] Open
Abstract
We report a case of excellent response to nilotinib in a 22 years old man with chronic myeloid leukemia in suboptimal response to imatinib. After diagnosis he started cytoreductive therapy with cytarabine and hydroxyurea, then he begun therapy with imatinib 400 mg/day. After 3 months of treatment, he obtained a complete hematologic response (CHR) and a minor cytogenetic response (minor CyR). At 6 months CHR was confirmed, but bone marrow analysis showed increasing number of Ph+ cells (minimal CyR) and non significant reduction of BCR-ABL levels. According to ELN (European LeukemiaNet) guidelines, this is considered a suboptimal response. Clonal evolution, kinase domain mutations and reduced drug intake were excluded, thus we decided to early switch to nilotinib at 400 mg/BID. After 3 months of treatment we obtained a complete cytogenetic response (CCyR) and a strong reduction of BCR-ABL transcript, almost reaching a major molecular response (MMR).
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Montefusco V, Galli M, Spina F, Stefanoni P, Mussetti A, Perrone G, De Philippis C, Dalto S, Maura F, Bonini C, Rezzonico F, Pennisi M, Roncari L, Soldarini M, Dodero A, Farina L, Cocito F, Caprioli C, Corradini P. Autoimmune diseases during treatment with immunomodulatory drugs in multiple myeloma: selective occurrence after lenalidomide. Leuk Lymphoma 2014; 55:2032-7. [DOI: 10.3109/10428194.2014.914203] [Citation(s) in RCA: 21] [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: 11/13/2022]
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