Secukinumab retention rate is greater in patients with psoriatic arthritis presenting with axial involvement

Psoriatic arthritis (PsA) is an inflammatory disease characterized by peripheral and axial involvement. Biological disease-modifying antirheumatic drugs (bDMARDs) are the mainstream treatment for PsA and bDMARDs retention rate is a proxy for the drug's overall effectiveness. However, it is unclear whether IL-17 inhibitors can have a higher retention rate than tumor necrosis factor (TNF) inhibitors, in particular in axial or peripheral PsA. A real-life observational study was conducted on bDMARD naïve PsA patients initiating TNF inhibitors or secukinumab. Time-to-switch analysis was carried out with Kaplan-Meyer curves (log-rank test) truncated at 3 years (1095 days). Sub-analyses of Kaplan-Meyer curves between patients presenting with prevalent peripheral PsA or prevalent axial PsA were also conducted. Cox regression models were employed to describe predictors of treatment switch/swap. Data on 269 patients with PsA naïve to bDMARD starting either TNF inhibitors (n=220) or secukinumab (n=48) were retrieved. The overall treatment retention at 1 and 2 years was similar for secukinumab and TNF inhibitors (log-rank test p NS). We found a trend towards significance in the Kaplan-Meyer at 3 years in favor of secukinumab (log-rank test p 0.081). Predominant axial disease was significantly associated with a higher chance of drug survival in secukinumab users (adjusted hazard ratio 0.15, 95% confidence interval = 0.04-0.54) but not in TNF inhibitor users. In this real-life, single-center, study on bDMARD naïve PsA patients, axial involvement was associated with longer survival of secukinumab but not of TNF inhibitors. Drug retention of secukinumab and TNF inhibitors were similar in predominantly peripheral PsA.

OP0071 ASSOCIATION BETWEEN LONG-TERM EXPOSURE TO AIR POLLUTION AND IMMUNE-MEDIATED DISEASES: A POPULATION-BASED COHORT STUDY

Background

Environmental air pollution has been associated with disruption of the immune system at a molecular level.

Objectives

The primary aim of the present study is to describe the association between long-term exposure to air pollution and risk of developing immune-mediated conditions.

Methods

We conducted a retrospective observational study on a nation-wide dataset of women and men. Diagnoses of various immune-mediated diseases were retrieved. Data on the monitoring of PM10 and PM2.5 concentrations were retrieved from the Italian institute of environment protection and research (ISPRA). The long-term average PMs concentrations were the exposure of interest. Every study subject was linked to a PMs exposure value, which resulted from the average concentration of urban, rural and near-traffic stations of the subject residency from January 2013 to November 2020. Patients were linked to the nearest air quality station through ZIP code centroids. Generalized linear models were employed to determine the relationship between autoimmune diseases prevalence and PM. The fully adjusted model included age, body mass index (BMI), menopause, glucocorticoid treatment, treatment with adjuvant hormone therapy for breast or prostate cancer, specialty of the physician that entered the data and macro-area of residency (stratified as a categorical variable: northern Italy, central Italy and southern Italy.

Results

81,363 subjects were included in the study. We found a positive association between PM10 and the risk of autoimmune diseases (ρ +0.007, p 0.014). Every 10 µg/m3 increase in PM10 concentration was associated with an incremental 7% risk of having autoimmune disease. Exposure to PM10 above 30 µg/m3 and PM2.5 above 20 µg/m3 was associated with a 12% and 13% higher risk of autoimmune disease pooled together, respectively (aOR 1.12, 95% CI 1.05-1.20 and aOR 1.13, 95% CI 1.06-1.20). Exposure to PM10 was associated with an increased risk of rheumatoid arthritis (aOR 1.408, 95% CI 1.271-1.560) but no other autoimmune diseases, whereas exposure to high levels of PM2.5 were associated with an increased risk of rheumatoid arthritis (aOR 1.559, 95% CI 1.401-1.734), CTDs (aOR 1.147, 95% CI 1.024-1.286) and IBDs (1.206, 95% CI 1.028-1.415) but no other autoimmune diseases.

Conclusion

Long-term exposure to air pollution was associated with higher risk of developing autoimmune diseases, in particular rheumatoid arthritis, CTDs and IBD. Chronic exposure to levels above the threshold for human protection was associated with a 10% higher risk of developing immune-mediated diseases.

Disclosure of Interests

Giovanni Adami Shareholder of: Galapagos, Theramex, Marco Pontalti: None declared, Camilla Benini: None declared, Angelo Fassio: None declared, Eugenia Bertoldo: None declared, Davide Gatti: None declared, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb.

POS1140 SHORT-TERM EXPOSURE TO FINE PARTICULATE MATTER AND RISK OF FRAGILITY HIP FRACTURES, A CASE-CROSSOVER STUDY ON 1,042 HIP FRACTURES

Background

Fragility femoral fracture is a common, world-spread, medical condition, that has a relevant impact both clinically and economically. Chronic exposure to environmental air pollution has been linked with a higher risk of developing osteoporosis. However, little is known regarding the relationship between short-term exposure to air pollution and bone fractures.

Objectives

Our study aims to investigate the link between short-term exposure to fine particulate matters and fragility hip fractures

Methods

We retrieved data of patients suffering of hip fractures admitted to the Orthopedic Unit of the University of Verona Hospital from 2015 to 2020. We retrieved data on the monitoring of PM10 concentrations from the Italian institute of environment protection and research (ISPRA). We designed a case-crossover study to compare the exposure to particulate matters (PM10) in the 30-day period immediately before the fracture (hazard period) referent to a 30-day control period (from day -30 to -60 from the fracture). Exposure to PM10 was evaluated as mean value and AUC. Case-crossover is a peculiar study design applied to longitudinal datasets that controls for within-person time-invariant and between-patient confounders such as indoor air pollution, chronic comorbidities or concomitant medications and have been used extensively to study the effects of transient, short-term exposures on the risk of acute events (Figure 1A)

Results

1042 patients (73.7% female n=768), with a hip fracture admitted to the hospital were included in the study. Mean age of the cohort was 82.6 years (±9.55). Average exposure to PM 10 in the control period was 33,84 ug/mm3, cumulative exposure (AUC) was 952,42 ug/mm3 compared 31,72 ug/mm3 and AUC of 920,24 ug/mm3 in the hazard period (Figure 1B) The difference between levels of PM10 in the two periods was statistically significant as levels of PM10 was higher in the hazard period compared to control period, with a p-value = 0,027 (α <0,05) when comparing average concentrations in the two groups and a p-value = 0,024 (α <0,05), when comparing AUCs.

Conclusion

Our study suggests that the short-term exposure to environmental air pollution might increase the risk of femoral fragility fractures. Further studies should be taken to further investigate the biological mechanisms underlining this finding.

Disclosure of Interests

Giovanni Adami Shareholder of: Theramex, Galapagos, Marco Pontalti: None declared, Angelo Fassio: None declared, Camilla Benini: None declared, Davide Gatti: None declared, Stefano Negri: None declared, Pietro Olivi: None declared, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb.

AB1167 THE USE OF ORAL AMINO-BISPHOSPHONATES AND CORONAVIRUS DISEASE 2019 (COVID-19) OUTCOMES

Background

The determinants of the susceptibility to SARS-CoV-2 infection and severe Coronavirus Disease 19 (COVID-19) manifestations are yet not fully understood. Amino-bisphosphonates (N-BPs) have anti-inflammatory properties and have been shown to reduce the incidence of lower respiratory infections, cardiovascular events and cancer.

Objectives

We conducted a population-based retrospective observational case control study with the primary objective of determining if oral N-BPs treatment can play a role in thesusceptibility to the development of severe COVID-19.

Methods

Administrative ICD-9-CM and ATC data, representative of Italian population (9% sample of the overallpopulation), were analyzed. Oral N-BPs (mainly alendronate and risedronate) were included in the analysis. Patients treated with bisphosphonates (cases) were randomly matched (1:1 ratio) for age, sex and for other clinically relevant variables (presence of treatments other than bisphosphonates and hospitalizations) with all the health-assisted population without this treatment (controls).

Results

Incidence of Covid-19 hospitalization was 12.32 [95%CI 9.61-15.04] and 11.55 [95%CI 8.91-14.20], of ICU utilization due to COVID-19 was 1.25 [95%CI 0.38-2.11] and 1.42 [95%CI 0.49-2.36] and of all-cause death was4.06 [95%CI 2.50-5.61] and 3.96 [95%CI 2.41-5.51] for oral N-BPs users and non-users, respectively (Figure 1A). Figure 1B Incidence and 95% CI of COVID-19 related events in N-BPs treated and untreated subjects with anti-osteoporotic drugs and without corticosteroids. C. Incidence and 95% CI of COVID-19 related events in N-BPs treated and untreated without previous vertebral or hip fragility fractures. D. Incidence of COVID-19related events in bisphosphonates treated and untreated patients without previous vertebral or hip fracture without corticosteroid prescriptions.

Conclusion

In conclusion, we found that the incidence of COVID-19 hospitalization, intensive care unit (ICU) utilization and COVID-19 potentially related mortality were similar in N-BPs treated and non-treated subjects. Similar results were found in N-BPs versus other anti-osteoporotic drugs. We provided real-life data on the safety of oral N-BPs in terms of severe COVID-19 risk on a population-based cohort. Our results strongly support national and international guidelines that advocate against the discontinuation of oral bisphosphonates only for the fear of COVID-19.

Disclosure of Interests

None declared

POS1409 ASSOCIATION BETWEEN SHORT-TERM EXPOSURE TO ENVIRONMENTAL AIR POLLUTION AND PSORIASIS FLARE

Background

Psoriasis is a chronic inflammatory disease with a relapsing-remitting course. Selected environmental factors such as infections, stressful life events or drugs may trigger disease flares. Whether the air pollution could trigger psoriasis flares is still unknown.

Objectives

To investigate whether the short-term exposure to environmental air pollution is associated to psoriasis flares.

Methods

Observational study with both case-crossover and cross-sectional design was conducted. We retrospectively analyzed longitudinal data from 2013 to 2020 of patients with psoriasis attending the outpatient dermatologic clinic of the University Hospital of Verona. For the case-cross over analysis patients with at least one disease flare, defined as PASI increase ≥5 between 2 consecutive assessments in a time frame of 3-4 months, were considered. In the case-crossover analysis each patient serves as its own control; the exposure of interest is compared in two different periods in the same group of patients followed longitudinally (Figure 1). For the cross-sectional analysis, patients receiving any systemic treatment for ≥6 months, with ≥2 consecutive PASI assessment were included. We compared the mean and cumulative (area under the curve) concentrations of several air pollutants (CO, NO2, NOx, C6H6, PM10 and PM2.5) in the 60 days preceding the psoriasis flare and the control visits.

Results

A total of 957 patients with plaque psoriasis with 4,398 follow-up visits were included in the study. More than 15,000 measurements of air pollutants concentration from the official, open-source, bulletin of the Italian Institute for Environmental Protection and Research (ISPRA) were retrieved. Among the overall cohort, 369 (38.6%) patients with psoriasis flare were included in the case-crossover study. We found that concentrations of all pollutants were significantly higher in the 60 days before psoriasis flare (median PASI at the flare 12, IQR 9-18), compared to the control visit (median PASI 1, IQR 1-3, p <0.0001). In the cross-sectional analysis, exposure to mean PM10 over 20 μg/m3 and mean PM2.5 over 15 μg/m3 in the 60 days before assessment were associated with a higher risk of PASI ≥5 point worsening, aOR 1.55, 95% CI 1.21-1.99 and aOR 1.25, 95% CI 1.0-1.57, respectively (Figure 1). Sensitivity analyses that stratified for trimester of evaluation, with various lag of exposure and adjusting for type of treatment yielded similar results.

Conclusion

Air pollution may be a trigger factor for psoriasis flare.

Disclosure of Interests

Giovanni Adami Speakers bureau: Galapagos, Theramex, Francesco Bellinato: None declared, Angelo Fassio: None declared, Camilla Benini: None declared, Giampiero Girolomoni Shareholder of: AbbVie, Abiogen, Almirall, Amgen, Biogen, Bristol-Meyers Squibb, Eli-Lilly, Galderma, Genzyme, Leo Pharma, Pfizer, Regeneron, Samsung and Sanofi, Paolo Gisondi Shareholder of: Abbvie, Almirall, Amgen, Biogen, Eli Lilly, Jansenn, Novartis, Sanofi, UCB, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb

OP0242 ASSOCIATION BETWEEN EXPOSURE TO FINE PARTICULATE MATTER AND OSTEOPOROSIS: A POPULATION-BASED COHORT STUDY

Background

Environmental air pollution has been associated with disruption of bone health at a molecular level. Particulate matter (PM) exposure can simultaneously stimulate bone resorption and halt bone formation.

Objectives

The primary aim of the present study is to describe the association between long-term exposure to PM and osteoporosis in a large cohort of women at high risk of fracture.

Methods

Clinical, demographic and densitometric data were extracted from the DeFRAcalc79 dataset, which gathers data on women at risk for osteoporosis. Data on the monitoring of PM10 and PM2.5 concentrations were retrieved from the Italian institute of environment protection and research (Istituto Superiore per la Protezione e la Ricerca Ambientale, ISPRA). Every study subject was linked to a PM exposure value, which resulted from the average concentration of urban, rural and near-traffic stations of the subject residency (ZIP code centroids 25 km) from January 2013 to December 2019. Generalized linear models with robust estimators were employed to determine the relationship between BMD and PM long-term exposure. We sequentially adjusted for confounders. Model 1 included age, body mass index (BMI), presence of prevalent fragility fractures, family history of vertebral or hip fractures, and menopause. Model 2 was further adjusted for glucocorticoid treatment and comorbidities. Model 3 (main model) added to model 2 the macro-area of residency (stratified as a categorical variable: northern Italy, central Italy and southern Italy).

Results

59,950 women from 110 Italian provinces were included in the study. PM 2,5 exposure was negatively associated with T-score levels at the femoral neck (β -0.005, 95 CI -0.007 to -0.003) and lumbar spine (β -0.003, 95% CI -0.006 to -0.001). Chronic exposure to PM2.5 above 25 μg/m3 was associated with a 16% higher risk of having osteoporotic T-score at any site (aOR 1.161, 95% CI 1.105 to 1.220), exposure to PM10 above 30 μg/m3 was associated with a 15% higher risk of having osteoporotic T-score at any site (aOR 1.148, 95% CI 1.098 to 1.200).

Conclusion

Long-term exposure to air pollution was associated with higher risk of osteoporosis. Femoral neck site seemed to be more susceptible to the detrimental effect of PM exposure than lumbar spine site.

Disclosure of Interests

Giovanni Adami Shareholder of: Galapagos, Theramex, Camilla Benini: None declared, Angelo Fassio: None declared, Eugenia Bertoldo: None declared, Ombretta Viapiana: None declared, Davide Gatti: None declared, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb.

OP0239 REAL-LIFE SHORT-TERM EFFECTIVENESS OF ANTI-OSTEOPOROTIC TREATMENTS: A LONGITUDINAL COHORT STUDY

Background

Data from randomized clinical trials showed that anti-osteoporotic treatments increase bone mineral density (BMD) and reduce the risk of fragility fractures. However, data on the real-life effectiveness of such medications is still scarce.

Objectives

The primary objective of the present study is to assess the real-life effectiveness of anti-osteoporotic treatment in a representative cohort of Italian women at high risk of fracture

Methods

We conducted a cohort study on women at high risk of fracture. We retrieved clinical and densitometric data from the DeFRA database, which derives from the DeFRA tool, a web-based fracture risk assessment tool. Multivariable Cox regression survival models were employed to analyze the effectiveness of different anti-osteoporotic drugs on fracture. In sensitivity analyses we generated 1:1 matched cohorts of patients with prescription of bisphosphonates, denosumab, teriparatide or without any pharmacological prescription at baseline and 1:1 matched cohort based on the T-score variation over the time (increase in T-score vs decrease or stability in T-score values).

Results

Data from 50,862 women were available. Among these, 3,574 individuals had at least 2 consecutive visits. The crude fracture rate was 91.9/1,000 person-year for non-treated patients. The crude fracture rate in bisphosphonate users was 72.1/1,000 person-year, in denosumab users was 58.2/1,000 person-year and in teriparatide users was 19.3/1000 person-year. Overall, we found that bisphosphonates were associated with a 30% lower risk of fracture compared to no treatment (aHR 0.70, 95% CI 0.50-0.98), denosumab and teriparatide were associated with 60% and 90% lower risk of fracture, respectively (aHR 0.43, 95% CI 0.24-0.75 and aHR 0.09, 95% CI 0.01-0.70). Bisphosphonate use was associated with a lower risk of fracture only after one year of treatment. In Figure 1 are presented the Kaplan Meier curves free from fragility fracture after propensity score matching.

Conclusion

In conclusion, we found that all anti-osteoporotic medications effectively reduced the risk of fracture in the real-life. Bisphosphonate’s effect on fracture risk was apparent only after the first year of treatment. Our findings do not support the use of bisphosphonates in patients at imminent risk of fracture.

Disclosure of Interests

Giovanni Adami Shareholder of: Theramex, Galapagos, IRENE GAVIOLI: None declared, Angelo Fassio: None declared, Camilla Benini: None declared, Eugenia Bertoldo: None declared, Ombretta Viapiana: None declared, Davide Gatti: None declared, Maurizio Rossini Shareholder of: Abbvie, Amgen, Bms, Eli Lilly, Galapagos, Novartis, Pfizer, Sandoz, Theramex, Ucb.

Molecular Characterization of Pancreatic Ductal Adenocarcinoma Using a Next-Generation Sequencing Custom-Designed Multigene Panel

Despite the efforts made in the management of PDAC, the 5-year relative survival rate of pancreatic ductal adenocarcinoma (PDAC) still remains very low (10%). To date, precision oncology is far from being ready to be applied in cases of PDAC, although studies exploring the molecular and genetic alterations have been conducted, and the genomic landscape of PDAC has been characterized. This study aimed to apply a next-generation sequencing (NGS) laboratory-developed multigene panel to PDAC samples to find molecular alterations that could be associated with histopathological features and clinical outcomes. A total of 68 PDACs were characterized by using a laboratory-developed multigene NGS panel. KRAS and TP53 mutations were the more frequent alterations in 75.0% and 44.6% of cases, respectively. In the majority (58.7%) of specimens, more than one mutation was detected, mainly in KRAS and TP53 genes. KRAS mutation was significantly associated with a shorter time in tumor recurrence compared with KRAS wild-type tumors. Intriguingly, KRAS wild-type cases had a better short-term prognosis despite the lymph node status. In conclusion, our work highlights that the combination of KRAS mutation with the age of the patient and the lymph node status may help in predicting the outcome in PDAC patients.

Efficacy of mud plus bath therapy as compared to bath therapy in osteoarthritis of hands and knees: a pilot single-blinded randomized controlled trial

The primary objective of this study was to assess the efficacy of mud plus bath therapy in comparison to bath therapy alone in hand and knee osteoarthritis (HOA and KOA). We conducted a single-blinded randomized controlled trial (RCT). Patients were randomly assigned to either mud plus bath therapy (group 1) or balneotherapy (group 2). The primary outcome was a change in AUSCAN questionnaire for HOA and in WOMAC for KOA at month 12. Evaluations were performed at baseline (B), immediately after the interventions (week 2, W2) and after 3 (M3), 6 (M6), 9 (M9) and 12 (M12) months. 37 patients with KOA and 52 with HOA were randomized in the study. In HOA patients, AUSCAN pain improved more in group 1 compared to group 2 at M3, M6 and M12 (p<0.001, p=0.001 and p=0.038, respectively). AUSCAN stiffness improved more in group 1 at M3 (p=0.001). AUSCAN function improved more at M3, M6, M9 and M12 (p=0.001, p=0.001, p=0.014 and p=0.018, respectively). Regarding, KOA, WOMAC function decreased more prominently in group 1 compared to group 2 at M9 (p=0.007). The absolute values of WOMAC function at M6 and M9 were lower in group 1 compared to group 2 (p=0.029 and p=0.001, respectively). WOMAC pain absolute values were lower in group 1 at W2 (p=0.044) and at M9 (p=0.08). We conducted a RCT on the efficacy of mud plus balneotherapy over balneotherapy alone in HOA and KOA. We found that mud plus balneotherapy was more effective than balneotherapy alone on clinical outcomes of HOA. Differences in clinical outcomes of KOA were not significant, yet numerically higher.

POS1173 A SHORT DELAY IN ARTHRITIS CARE IS ASSOCIATED WITH HIGHER DISEASE ACTIVITY - LESSONS FROM THE CORONAVIRUS DISEASE 19 (COVID-19) PANDEMIC

Background:

Although disease activity is a significant outcome in rheumatology, few studies have investigated the relationship between routine care of rheumatic conditions and disease activity control.

Objectives:

To determine the association between delay in routine care of chronic inflammatory arthritides (CIAs) and disease activity during the first wave of coronavirus disease 19 pandemic in Verona, Italy.

Methods:

This study enrolled patients with an established diagnosis of rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and undifferentiated arthritis (UA). Between 01/04/2020 and 30/06/2020, participants were emailed an online questionnaire. Items comprised multiple or single-choice questions evaluating routine rheumatology care disruptions/delays and disease characteristics, treatments, comorbidities, and demographics. Compliance to anti-rheumatic medications was evaluated with I-CQR5. Disease activity was assessed with RAPID3, and active disease was defined as a RAPID3 score>1. Study period referred to the time between the last rheumatology assessment and the date of enrolment.

Results:

Of 1210 patients contacted, 450 participated, of whom 219 CIAs patients were included (RA 55.3%, PsA 35.2%, AS 15.1%, UA 3.7%). One hundred twenty-five patients (57.1%) had their routine clinical assessment delayed (median days 68.4; IQR 66.8, 85.9). Patients in this group had significantly higher MDHAQ (p=0.001) and RAPID3 (p=0.031) scores, while they did not differ for disease severity, medications or compliance. Most (87.7%) reported good compliance to therapy; only 5.9% had difficulties in supplying anti-rheumatic medications, and 13.2% discontinued medications for at least four weeks for any reason. However, several patients (37.9%) reported moderate-to-high worse disease activity perception due to routine care delay, and 31.1% self-reported a disease flare (median RAPID3 score 3.8; IQR 2.0, 5.4). One hundred one patients (46.1%) had high disease activity, while only 15.1% were in remission. In logistic regression, active disease was significantly associated with delay of scheduled routine care visit, independent of disease duration, time from last rheumatology assessment, therapy with b/tsDMARDs, and compliance (Table 1, Figure 1 below).

Table 1.PredictorActive(n=186)Remission(n=33)ORP-value95% CIInf.95% CISup.Routine care delay (yes vs no)113(60.8%)12(36.4%).0302.4591.0915.543Disease duration (years)10(4.0, 20.0)10.5(7.0, 19.8).6951.007.9721.044Time since last rheumatology assessment (days)68.4(66.8, 75.8)71.2(66.9, 74.9).8541.002.9781.027b/tsDMARDs (yes vs no)105(56.5%)15(45.5%).6531.202.5382.687I-CPR5 (likely low vs likely high adherent)36(19.4%)10(30.3%).187.563.2401.321Figure 1.

Conclusion:

In patients with established CIAs, a relatively short delay in routine assessment by a rheumatologist resulted in higher disease activity. Frequent rheumatology referrals appear to be a critical factor for disease activity control in CIAs.

Disclosure of Interests:

None declared.

Vitamin D and disease severity in coronavirus disease 19 (COVID-19)

The role of 25-OH-vitamin D in the assessment of coronavirus disease 19 (COVID-19) has not been investigated. We sought to investigate the prevalence of 25-OH-vitamin D deficiency among COVID-19 patients, and to determine the associations between 25-OH-vitamin D status and the severity of the disease. We have conducted a retrospective observational study of COVID-19 patients admitted to the University of Verona Hospital Trust. Demographic, clinical and biochemical parameters were collected at hospital admission, and serum 25-OH-vitamin D levels were measured. The following outcomes were assessed: arterial partial oxygen pressure (PaO2); C-reactive protein (CRP); length of hospitalization; requirement of oxygen therapy; non-invasive ventilation (NIV); mechanical ventilation; and death. Among 61 patients enrolled, 72.1% was 25-OH-vitamin D deficient (<20 ng/mL) and 57.4% had 25-OHvitamin D <15 ng/mL. Patients with arterial PaO2 <60 mmHg had significantly lower mean 25-OH-vitamin D levels compared to patients with PaO2 ≥60 mmHg (13.3 ng/mL vs 20.4 ng/mL respectively, p=0.03). Vitamin D deficiency was associated with 3-fold higher risk of having arterial pO2 <60 mmHg. 25-OH-vitamin D deficiency was associated with increased CRP and dyspnea. 25-OH-vitamin D deficiency was associated with more severe systemic inflammatory response and respiratory failure in COVID-19 patients.

Urgent and emergency surgery for secondary peritonitis during the COVID-19 outbreak: an unseen burden of a healthcare crisis

The COVID-19 pandemic has raised concerns about the negative impact of the fear of contagion on people’s willingness to seek medical care and the subsequent effects on patients’ prognosis. To date, not much is known about the outcomes of acute surgical diseases in this scenario. The aim of this multicenter observational study is to explore the effects of COVID-19 outbreak on the outcomes of patients who underwent surgery for peritonitis. Patients undergoing surgery for secondary peritonitis during the first COVID-19 surge in Italy (March 23–May 4, 2020—COVID period group) were compared with patients who underwent surgery during the same time interval of year 2019 (no-COVID period group). The primary endpoint was the development of postoperative complications. Logistic regression analysis was conducted to identify predictors of complications. Of the 332 patients studied, 149 were in the COVID period group and 183 were in the no-COVID period group. Patients in the COVID period group had an increased frequency of late presentations to the emergency departments (43% vs. 31.1%; P = 0.026) and a higher rate of postoperative complications (35.6% vs. 18%; P < 0.001). The same results were found in the subset analysis of patients with severe peritonitis at surgical exploration. The ASA score, severity of peritonitis, qSOFA score, diagnosis other than appendicitis, and COVID period resulted independent predictors of complications. During the COVID-19 pandemic patients with peritonitis had a higher rate of complicated postoperative courses, weighing on hospital costs and assistance efforts already pressured by the ongoing sanitary crisis.

Different fracture risk profile in patients treated with anti-osteoporotic drugs in real-life

In this retrospective study, we intended to investigate the baseline fracture risk profile in patients who started treatment with different anti-osteoporotic medications. We analyzed retrospectively the fracture risk calculated with DeFRA, a validated FRAX derived tool, in women who started an anti-osteoporotic treatment from 2010 to 2017. We analyzed baseline data of 12,024 post-menopausal women aged over 50 years. Teriparatide initiators had a baseline 10-year risk of major osteoporotic fracture of 82.1% with a Standard Deviation (SD) of 66.5%. Denosumab initiators and zoledronic acid initiators had a greater 10-year baseline risk of fracture (54.3%, SD 46.5% and 47.0%, SD 42.0 respectively) than patients initiated on alendronate (24.9%, SD 34.6%) and patients initiated on risedronate (23.9%, SD 24.1%). Using DeFRA, a FRAX™ derived tool, we showed significantly different fracture risk profiles in women who were started on various therapeutic agents for the treatment of osteoporosis in routine clinical practice.

THU0640-HPR GENDER DISPARITY IN AUTHORSHIP OF CLINICAL PRACTICE GUIDELINES IN RHEUMATOLOGY

Background:

Women are generally less represented as first author among original medical researches and clinical guidelines. Indeed, women are first authors in only 30% of clinical guidelines published in high impact medical journals. It is not known if a comparable underrepresentation occurs also in rheumatologic guidelines.

Objectives:

The aim of the present analysis is to evaluate the representation of female authors in rheumatological guidelines over a period of time between 2004 and 2019.

Methods:

We searched PubMed for guidelines published in English in the rheumatological field from 1st January 2004 to 1st January 2019. Gender of each author (man or woman) was identified by use of a minimum of two resources (i.e., author’s name and an internet search to identify the author’s photograph or gender pronoun).

Results:

We found 366 guidelines published between 2004 and 2019 (Table 1: stratified by year of publication and Table 2: stratified by disease). Overall, the proportion of female first authors was 32.0% (95% CI, 28.0% - 35%). After stratification by year of publication the percentage of female first authors was lower in past years compared to recent years. The percentage of female first author increased substantially over the time (Figure 1).

Table 1.

Percentage of female and male first author of rheumatological guidelines stratified by years

Years% FEMALE%MALE2004 (n=14)21.478.62005 (n=21)23.876.22006 (n=25)32.068.02007 (n=32)37.562.52008 (n=43)20.979.12009 (n=18)33.366.72010 (n=15)6.793.32011 (n=27)25.974.12012 (n=27)25.974.12013 (n=20)48.351.72014 (n=20)25,075,02015 (n=13)46,253,82016 (n=20)45,055,02017 (n=29)51,748,32018 (n=22)40,959,1Table 2.

Percentage of female and male first author of rheumatological guidelines stratified by disease

Disease% FEMALE% MALEOsteoarthritis (n=34)26.573.5Rheumatoid arthritis (n=96)18.881.2Fibromyalgia (n=30)2080Lupus erythematosus (n=29)34.565.5Psoriatic arthritis and Spondyloarthritis (n=73)23.376.7Sjogren syndrome (n=5)4060Gout (n=19)10.589.5Systemic sclerosis (n=18)16.783.3Polymyalgia and Giant cells’ arteritis (n=12)0100Osteoporosis (n=26)30.869.2ANCA associated vasculitides (n=14)21.478.6Polymyositis and Dermatomyositis (n=6)5050Behcet’s disease (n=4)2575Figure 1.

Temporal trend of the percentage of first author gender from 2004 to 2019 (male in blue, female in pink)

Conclusion:

We found a prevalence of male as first authors of guidelines in the rheumatological field published between January 2004 and January 2019. The EULAR Task Force on Gender Equity in Academic Rheumatology (EULAR GEAR) has been recently established, making an important first step toward gender equity in the authorship of guidelines in the rheumatological fields. Indeed, in the last 15 years we have witnessed an increase in female representativeness. Notwithstanding, efforts should be made to improve the representation of female authors nationally and internationally.

Disclosure of Interests:

Giovanni Adami: None declared, Ombretta Viapiana: None declared, Elisabetta Vantaggiato: None declared, Camilla Benini: None declared, Denise Rotta: None declared, Davide Gatti Speakers bureau: Davide Gatti reports personal fees from Abiogen, Amgen, Janssen-Cilag, Mundipharma, outside the submitted work., Maurizio Rossini Speakers bureau: AbbVie, Abiogen, Amgen, BMS, Eli-Lilly, Novartis, Pfizer, Sanofi, Sandoz and UCB

THU0479 ASSOCIATION BETWEEN CENTRAL SENSITIZATION AND CLINICAL AND ULTRASONOGRAPHIC PARAMETERS IN INFLAMMATORY ARTHRITIDES

Background:

Central sensitization (CS) is an important feature of patients with chronic pain, especially rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients. CS might interfere with the clinical evaluation of inflammation. Central Sensitization Inventory (CSI) is a validated instrument for assessing central sensitization.

Objectives:

We seek to investigate the inference of central sensitization (assessed with the CSI) on clinical (disease activity scores) and ultrasound parameters (US 7-joints score) in RA and PsA patients.

Methods:

We conducted a cross-sectional analysis on patients with an established diagnosis of RA or polyarticular PsA. Demographic, anamnestic and clinical parameters were collected. Disease activity was measured with SDAI in RA patients and with DAPSA in PsA patients. The presence and severity of synovitis was measured with the US 7-joints score. Exclusion criteria included: diagnosis of fibromyalgia, depression and patients with PsA with enthesitis predominant and/or spondylitis subtypes. Differences between variables were analysed with t-test and ANOVA for multiple comparisons. Correlation between continuous variables was analysed with Pearson correlation. CSI was analysed either as positive\negative (threshold 40 points) or divided in four categories, i.e., subclinical (≤29), mild (30-39), moderate (40-49), severe (50-59) and extreme (≥60).

Results:

We enrolled 42 patients in the study. Descriptive characteristics of the study population are presented in table 1. We found no difference in clinical parameters between diseases, sex or age. Women had a higher CSI score compared to men (mean 39.3 vs 26.7 p=0.005). We found a correlation between CSI score and DAPSA (r20.39, p =0.001), number of tender joints (r20.13, p=0.02) and HAQ (r20.47, p<0.001) (Figure 1) while we found no correlation between CSI score and SDAI or other clinical parameters. We found a significant difference in DAPSA, tender joints count and HAQ between CSI categories (ANOVA p=0.01, p=0.02 and p<0.001 respectively). US 7-joints score was associated with SDAI (r20.33, p=0.03), number of swollen joints (r20.28, p=0.002) and disease duration (r20.35, p<0.001) but not with DAPSA or tender joints.

Table 1.

Descriptive characteristics of the study population

Age (mean, SD in years)55.9 (12.3)BMI25.9 (3.9)CSI questionnaire score (mean)35 (16)CSI categories (n, %)Subclinical18 (42.9%)Mild9 (21.4%)Moderate8 (19.0%)Severe4 (9.5%)Extreme3 (7.1%)Diagnosis (n, %)PsA 52.4%9 men 13 womenRA 47.6%2 men 18 womenCSI score in PsA (mean, SD)34.4 (16.5)CSI score in RA (mean, SD)34.8 (15.5)CRP (median, IQR in mg/L)1.85 (1.0-4.6)Tender joints (mean, SD)2 (2)Swollen joints (mean, SD)1 (2)SDAI categories (n, %)Remission4 (20.0%)Low disease activity8 (40.0%)Moderate disease activity7 (35.0%)Severe disease activity1 (5.0%)DAPSA categories (n, %)Remission6 (33.3%)Low disease activity4 (22.2%)Moderate disease activity7 (38.9%)Severe disease activity1 (5.6%)US 7-joints score (mean, SD)6 (7)HAQ (mean, SD)0.6 (0.6)Prednisone equivalent (mean, SD in mg/day)1.47 (3.2)Biological DMARD (n, %)No15 (35.7%)Yes27 (64.3%)Conventional DMARD (n, %)No13 (31.0%)Yes29 (69.0%)Figure 1.

Correlation between DAPSA score and CSI score and between HAQ and CSI score

Conclusion:

We found an association between CS and sex, functional disability, tender joints count and disease activity score in PsA patients while there was no correlation between RA disease activity and central sensitization. US 7-joints score was associated with swollen joints count, disease duration and disease activity in RA patients but not in PsA patients. In PsA patients, DAPSA might be more influenced by central sensitization, especially in female individuals.

Disclosure of Interests:

Giovanni Adami: None declared, Elisabetta Gerratana: None declared, Alessandro Giollo: None declared, Camilla Benini: None declared, Elisabetta Vantaggiato: None declared, Denise Rotta: None declared, Luca Idolazzi: None declared, Davide Gatti Speakers bureau: Davide Gatti reports personal fees from Abiogen, Amgen, Janssen-Cilag, Mundipharma, outside the submitted work., Maurizio Rossini Speakers bureau: AbbVie, Abiogen, Amgen, BMS, Eli-Lilly, Novartis, Pfizer, Sanofi, Sandoz and UCB, Angelo Fassio Speakers bureau: Angelo Fassio reports personal fees from: Abiogen and Novartis, outside the submitted work.

Outcomes of enhanced one-stage ultrasound-guided hepatectomy for bilobar colorectal liver metastases compared to those of ALPPS: a multicenter case-match analysis

BACKGROUND

In case of bilobar colorectal liver metastases (CLM) associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been proposed. Enhanced one-stage ultrasound-guided hepatectomy (e-OSH) may represent a further solution for these patients. Aim of this study was to compare by case-match analyses the outcome of ALPPS and e-OSH.

METHODS

Between 2012 and 2017, patients undergoing ALPPS for bilobar CLM were matched 1:2 with patients receiving e-OSH. Patients were matched according to the Fong Score (1-3/4-5), the number of CLM (3-7/≥8), the number of CLM in the left liver (1-2/≥3) and preoperative chemotherapy. All the patients in the e-OSH group had a right -sided major vascular contact. The main endpoints of the study were perioperative outcomes, overall (OS) and disease-free survival (DFS).

RESULTS

Seventy-eight patients were selected (26 ALPPS and 52 e-OSH) based on matching process. The two treatments differed significantly in major morbidity (26.9% ALPPS vs 7.7% e-OSH, p = 0.017). Median OS (31.7 vs 32.6 months) and DFS (10.6 vs 7.8 months) were comparable between the two groups.

CONCLUSIONS

This study demonstrates that ALPPS and e-OSH for bilobar CLM achieve comparable long-term results, despite higher morbidity reported after ALPPS. These findings should drive to reposition e-OSH in managing these patients.

Changes in Dkk-1, sclerostin, and RANKL serum levels following discontinuation of long-term denosumab treatment in postmenopausal women

PURPOSE

The positive effects of denosumab (DMAb) on bone mineral density (BMD) are quickly reversible after its discontinuation. We investigated whether this rebound was associated with dysregulation of the Wnt canonical pathway and/or by the increase in the receptor-activator of nuclear factor-kappa B ligand (RANKL) serum levels.

METHODS

The study included patients (n = 15) with postmenopausal osteoporosis to whom DMAb was administered for 78 months and then discontinued. We collected BMD data at baseline/month 0 (M0), M60, M84 (6 months after last DMAb administration, coinciding when the next DMAb dose would typically be due), and after 3 and 12 months of follow-up (FU-M3 and FU-M12, respectively). Serum C-terminal telopeptide of type 1 collagen (CTX-I), Dickkopf-1 (Dkk-1), and sclerostin were measured at M0, M60, M84, FU-M3, and FU-M12. Serum N-terminal propeptide of type 1 procollagen (PINP) and RANKL were dosed at M60, M84, FU-M3, and FU-12.

RESULTS

We found a significant decrease in the T-score at all sites at FU-M12, when compared to M84 (-0.51 ± 0.91 at the lumbar spine; -0.72 ± 0.33 at the total hip; and -0.42 ± 0.27 at the femoral neck, p < 0.05). After DMAb discontinuation (M84 vs FU M12) CTX-I, PINP increased already at FU-M3 (+0.921 ± 0.482 ng/mL, +126.60 ± 30.36 ng/mL, respectively, p < 0.01), RANKL increased at FU-M12 (+0.041 ± 0.062 ng/mL, p < 0.05), while Dkk-1 and sclerostin decreased at FU-M12 (-10.90 ± 11.80 and - 13.00 ± 10.52 pmol/L, respectively, p < 0.01). No changes in BMD or any of the markers were found between M60 and M84.

CONCLUSIONS

RANKL serum levels progressively increased after discontinuation of long-term DMAb while Dkk-1 and sclerostin serum levels decreased. The increase in RANKL serum levels supports the hypothesis of a sudden loss of inhibition of the resting osteoclast line after DMAb clearance, with a hyperactivation of these cells. Our results suggest that the changes in serum Wnt inhibitors after DMAb suspension might represent a mere feedback response to the increased bone turnover.

Inhibition of tumor necrosis factor-alpha (TNF-alpha) in patients with early rheumatoid arthritis results in acute changes of bone modulators

OBJECTIVE

Dicckopf-1 (Dkk-1) is a potent inhibitor of the Wnt canonical pathway. In rheumatoid arthritis (RA), Dkk-1 is upregulated by tumor necrosis factor-α (TNF). Certolizumab pegol (CMZ) is a biologic TNF-inhibitor (TNFi) effective in RA and slows radiographic progression. Data on the immediate effects (≤1-8 weeks) of TNFi on Wnt modulators are lacking. This study investigated the acute influence of TNFi treatment on Wnt modulators (Dkk-1 and sclerostin) and bone turnover markers (BTM), including intact N-terminal propeptide of collagen type I (PINP) and C-terminal telopeptide of type I collagen (CTX-I).

METHODS

This longitudinal, uncontrolled study involved female RA patients with inadequate response to conventional methotrexate who underwent treatment with CMZ. ESR, Dkk-1, sclerostin, BTM, parathyroid hormone (PTH), and 25OH-vitamin D levels were evaluated at baseline, week 1, week 4, and week 8. Radiographs of the hands and feet were obtained at baseline and the total and erosion scores were assessed using the Simple Erosion Narrowing Score method (SENS).

RESULTS

Seventeen patients were enrolled. Dkk-1 and CTX-I significantly decreased after one week of treatment with CMZ (-49.1 ± 17.1% and -25.0 ± 20.6%, respectively, p < 0.01), whereas PINP increased (+43.2 ± 31.5%, p < 0.01). These changes persisted at week 4 and 8.

CONCLUSIONS

Our study showed that TNF-alpha inhibition with CMZ promptly results in a rapid decline of serum Dkk-1 levels, alongside decreased bone resorption and increased bone formation.

Matricellular proteins and survival in patients with pancreatic cancer: A systematic review

Extracellular matrix (ECM) plays a fundamental role in tissue architecture and homeostasis and modulates cell functions through a complex interaction between cell surface receptors, hormones, several bioeffector molecules, and structural proteins like collagen. These components are secreted into ECM and all together contribute to regulate several cellular activities including differentiation, apoptosis, proliferation, and migration. The so-called "matricellular" proteins (MPs) have recently emerged as important regulators of ECM functions. The aim of our review is to consider all different types of MPs family assessing the potential relationship between MPs and survival in patients with pancreatic ductal adenocarcinoma (PDAC). A systematic computer-based search of published articles, according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) Statement issued in 2009 was conducted through Ovid interface, and literature review was performed in May 2017. The search text words were identified by means of controlled vocabulary, such as the National Library of Medicine's MESH (Medical Subject Headings) and Keywords. Collected data showed an important role of MPs in carcinogenesis and in PDAC prognosis even though the underlying mechanisms are still largely unknown and data are not univocal. Therefore, a better understanding of MPs role in regulation of ECM homeostasis and remodeling of specific organ niches may suggest potential novel extracellular targets for the development of efficacious therapeutic strategies.

Teriparatide and denosumab combination therapy and skeletal metabolism

Several therapies are available for osteoporis. Understanding the bone turnover changes and their mutual realtionship gives an overall view and might lead to a target therapy INTRODUCTION: The aim of this study is to compare the changes in bone turnover markers in patients treated with either denosumab alone, teriparatide (TPTD) alone, or in a third therapeutic scheme, when TPTD was added to patients previously treated with denosumab.

METHODS

Fifty-nine women over 65 years old with severe postmenopausal osteoporosis (evidence of at least two moderate-severe vertebral fractures) were enrolled in the study. Serum samples were collected every 3 months. They were assayed for intact N-propeptide of type I collagen (P1NP), C-terminal telopeptide of type I collagen (CTX), intact parathyroid hormone (PTH), 25 hydroxy-vitamin D (25 OHD), Sclerostin (SOST), and Dickkopf-related protein 1 (DKK1). Bone mass density was assessed by dual-energy X-ray absorptiometry at the lumbar spine and at the total hip.

RESULTS

In the groups treated only with TPTD or with denosumab, bone turnover markers increased and decreased, respectively. In TPTD group, a later significant increase in DKK1 was observed, while in denosumab group, a progressive increase in SOST was associated with a progressive significant decrease in DKK1. In the group treated first with denosumab and in which TPTD was added 3 months later, both CTX and P1NP increased 3 months after the beginning of TPTD. The strong effect of denosumab on bone turnover seems to be reversed by TPTD treatment.

CONCLUSIONS

In this study, we showed that TPTD is able to express its biological activity even when bone turnover is fully suppressed by denosumab treatment. The combination therapy is associated with significant increases in both DKK1 and SOST.

[Risk factors for hip fracture in elderly persons]

OBJECTIVE

The aim of this observational study, promoted by the Health Authorities of the Regione Veneto (Italy), is to assess the prevalence of the most relevant environmental and individual risk factors in subjects with a recent hip fracture.

METHODS

Patients aged more than 60 years of both genders with a recent hip fracture not associated with malignancies, were administered questionnaires on dietary habits, sun exposure, and disability score. A complete family, pharmacological and pathology history was collected together with information on previous falls, details of the fracture index, and anthropometric data. In all subjects, blood was taken for the measurement of serum 25 hydroxy-vitamin D (25OHD).

RESULTS

The study included 704 patients (573 women and 131 men). Mean age was 81 ± 8 years (range 60-102). Severe pre-fracture disability was a common feature (58%) associated with multiple co-morbidities (84%), more frequently cardiovascular and neurological diseases, and specific medications. In a large proportion (86%) of the patients, environmental or individual risk factors for falling were found. Vitamin D insufficiency (serum 25OHD levels < 75 nmol/l) was quite common (70%), particularly in the regional Health Districts were strategies for preventing vitamin D deficiency were not implemented (91%). Only a small proportion (17%) of the study population had been evaluated and treated for osteoporosis.

CONCLUSIONS

In senile patients with a recent hip fracture, pre-existing disability, multiple co-morbidities, high risk of falling and inadequate intake of calcium and vitamin D is relatively common. Community and case-finding interventions aimed at selecting subjects at high risk of osteoporosis, preventing vitamin D and dietary calcium deficiency, and increasing awareness on the environmental risks of falling are highly warranted.

Stem cell factor (c-kit ligand) enhances the interleukin-9-dependent proliferation of human CD34+ and CD34+CD33-DR- cells

We have studied the effects of recombinant human interleukin-9 (IL-9), alone and combined with stem cell factor (SCF, c-kit ligand), IL-3, and granulocyte-macrophage colony-stimulating factor (GM-CSF) on the clonogenic proliferation of highly enriched human hematopoietic CD34+ and CD34+CD33-DR- progenitor cells. Colony assays were performed under serum-containing and serum-free conditions. IL-9, as a single agent, did not support colony formation. The addition of erythropoietin (Epo) to IL-9 induced the growth of erythroid progenitors (BFU-E) derived from both CD34+ and CD34+CD33-DR- cells. The IL-9-dependent growth of BFU-E derived from CD34+ cells was increased in an additive manner by SCF and, to a lesser extent, by IL-3, whereas CD34+CD33-DR- erythroid precursors were also responsive to GM-CSF in combination with IL-9. The addition of SCF to IL-9 did stimulate the development of CD34+ and CD34+CD33-DR- macroscopic, multicentered BFU-E and multilineage colonies (CFU-GEMM). When IL-9 was used in serum-free conditions, the growth of CD34+ and CD34+CD33-DR- BFU-E was observed in the presence of Epo. Moreover, a marked synergy on BFU-E colony formation was evident when IL-9 was combined with SCF, and their activity was enhanced by the addition of IL-3. IL-9 showed a negligible proliferative activity on colony-forming units-granulocyte/macrophage (CFU-GM). However, it increased the number of CD34+CD33-DR- CFU-GM responsive to IL-3 (37% of the colonies generated by phytohemagglutinin-stimulated lymphocyte conditioned medium [PHA-LCM]). The effects of IL-9 on CD34+CD33-DR- cells were also studied in a short-term suspension culture system, which evaluates the proliferation of progenitors earlier than day 14 CFU-C (Delta assay). In this system, IL-9 had a minimal activity on its own. In combination with SCF, however, it induced a nine-fold expansion of CD34+CD33-DR- cells, which generated a greater number of CFU-GM than BFU-E in secondary methylcellulose cultures. These experiments indicate that IL-9 induces the proliferation of very primitive human erythroid cells, and this effect is potentiated by SCF and other cytokines. Furthermore, IL-9 synergizes in vitro with the c-kit ligand in expanding the pool of early pluripotent hematopoietic progenitor cells.

Toxicity of high-dose busulphan and cyclophosphamide as conditioning therapy for allogeneic bone marrow transplantation in adults with haematological malignancies

The toxicity of the conditioning regimen high-dose busulfan (BU) 16 mg/kg followed by cyclophosphamide (CY) 200 mg/kg has been analysed in 60 adult patients (mean age 36 +/- 9 years) with haematological malignancies, a third of whom had advanced disease, all received the graft from fully HLA-identical siblings. Significant nausea and vomiting were rare during BU administration but occurred in 44% of the patients with CY. Severe mucositis occurred in 30% of patients. Haemorrhagic cystitis occurred in 16% of patients; interstitial pneumonia occurred in 3 patients and was fatal in one. Veno-occlusive disease of the liver occurred in 2 patients and was fatal in one: however, increase of bilirubin of at least twice the baseline value and/or isolated weight gain > 5% of pre-transplant value occurred in 28% of patients. These signs of liver toxicity disappeared in all patients after appropriate therapy. Normalisation of bilirubin levels took twice as long as normalisation of body weight: median 35 and 18 days, respectively. Hyperpigmentation of the skin, mainly involving flexural and pressure areas, occurred in 47% of patients and was manageable topically. Eight patients died of relapsed disease; 15 died of transplant complications but in six the original malignancy persisted or had recurred at the time of death. Overall transplant-related mortality was 15%. We conclude that the toxicity of this regimen has not been high, with the liver being the most seriously affected organ. A longer follow-up is necessary to assess long-term consequences.

Interleukin-11 stimulates the proliferation of human hematopoietic CD34+ and CD34+CD33-DR- cells and synergizes with stem cell factor, interleukin-3, and granulocyte-macrophage colony-stimulating factor

We have studied the effects of recombinant human interleukin-11 (rhIL-11), alone and combined with stem cell factor (SCF or c-kit ligand), IL-3, and granulocyte-macrophage colony-stimulating factor (GM-CSF) on the proliferation of highly enriched human hematopoietic CD34+ and CD34+CD33-DR- progenitor cells. CD34+ cells were purified using the avidin-biotin immunoabsorption technique and CD33+DR+ cells were subsequently removed by immuno-magnetic separation. The colony assays were performed in the presence and absence of exogenous serum. IL-11, as a single agent, induced the growth of a small number of colony-forming units-granulocyte/macrophage (CFU-GM) derived from purified CD34+ cells and failed to support the colony growth of CD34+CD33-DR- cells. The addition of erythropoietin (Epo) to IL-11 induced the growth of erythroid progenitors (BFU-E) derived from CD34+ cells but not from the same population depleted of CD33+DR+ cells. The combination of IL-11 with SCF, IL-3, or GM-CSF, in the presence of Epo, resulted in a synergistic or additive increase in the number of CFU cells (CFU-C) derived from both cell fractions. Moreover, the addition of SCF to IL-11 stimulated the development of macroscopic erythroid and multilineage colonies (CFU-GEMM) containing more than 10(4) cells. A combination of three factors (IL-11, SCF, and IL-3) resulted in the increase of the number of colonies arising from CD34+ and CD34+CD33-DR- cells (but not of their size) compared to the cultures treated with IL-11 plus SCF or IL-11 plus IL-3. The pattern of proliferative response of primitive hematopoietic progenitor cells to IL-11 in serum-free conditions was very similar to the cultures grown in serum-containing medium. It is noteworthy that IL-11 and SCF yielded colony formation that was comparable to that observed in the presence of serum. The effects of IL-11 on CD34+CD33-DR- cells were also studied in a short-term suspension culture system, which was shown to be specific for evaluating the proliferation of pluripotent hematopoietic precursors (Delta assay). In this system, IL-11 had a minimal effect on its own, whereas IL-11 plus SCF acted synergistically and their proliferative activity was improved by the addition of GM-CSF. These experiments indicate that IL-11 may be considered a "permissive" cytokine, capable of initiating the proliferation of very primitive human hematopoietic cells, which are then able to respond to late-acting CSFs.(ABSTRACT TRUNCATED AT 400 WORDS)

Donor origin of hematopoiesis after a case of allogeneic transplantation with cryopreserved marrow

In allogeneic marrow transplantation (BMT), fresh donor marrow is generally given like a simple transfusion immediately after collection. Cryopreservation, on the other hand, is extensively used in autologous marrow transplantation (ABMT). However, there could be a few instances in which donor marrow should be cryopreserved for later reinfusion mainly because of the donor's inability, for logistic or medical reasons, to undergo marrow harvesting immediately prior to transplantation. We wish to describe a case of ALL transplanted with donor harvested earlier and cryopreserved. The bone marrow was cryopreserved with 10% DMSO in a controlled rate freezer and stored for 1 month in liquid nitrogen. The VNTR (variation number tandem repeat) technique was used to demonstrate the donor origin of blood cells. Hematological reconstitution was rapidly achieved and we demonstrated the allogeneic origin of the recipient's blood cells. We confirm the possibility of using cryopreserved marrow stem cells for BMT. Cryopreservation of stem cells from other origin may also find a useful application in BMT.

GM-CSF production in human adenocarcinoma cell lines

We describe the production of human granulocyte-macrophage colony-stimulating factor (hGM-CSF), by cell lines established from patients with different stages of breast, lung and colon adenocarcinoma. GM-CSF expression has been identified by immunocytochemistry determination, quantified on conditioned medium with specific ELISA procedure and evaluated by means of proliferation and differentiation of normal human monocytic and granulocytic progenitors. The growth of cell lines after incubation with exogenous GM-CSF and antibody-antiGM-CSF was not modified. To better understand the patho-physiologic role of hGM-CSF in vivo we also estimated its serum levels at diagnosis in 75 patients with breast lung and colon adenocarcinoma and in 69 healthy person. Only two patients showed detectable GM-CSF levels. The lack of growth modulation observed in vitro with exogenous GM-CSF and antibody anti-GM-CSF suggests a non autocrine secretion by adenocarcinoma cells. The serum investigation evidences that the leukocytosis observed in adenocarcinoma patients is unrelated to a GM-CSF constitutive tumor production in vivo.