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Stefoni V, Pellegrini C, Broccoli A, Baldini L, Tani M, Cencini E, Figuera A, Ansuinelli M, Bernocco E, Cantonetti M, Cox MC, Ballerini F, Rusconi C, Visco C, Arcaini L, Fama A, Marasca R, Volpetti S, Castellino A, Califano C, Cavaliere M, Gini G, Liberati AM, Musuraca G, Lucania A, Ricciuti G, Argnani L, Zinzani PL. Lenalidomide in Pretreated Mantle Cell Lymphoma Patients: An Italian Observational Multicenter Retrospective Study in Daily Clinical Practice (the Lenamant Study). Oncologist 2018; 23:1033-1038. [PMID: 29674440 DOI: 10.1634/theoncologist.2017-0597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 10/23/2017] [Accepted: 03/06/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mantle cell lymphoma (MCL) has the worst prognosis of B-cell subtypes owing to its aggressive clinical disease course and incurability with standard chemo-immunotherapy. Options for relapsed MCL are limited, although several single agents have been studied. Lenalidomide is available in Italy for patients with MCL based on a local disposition of the Italian Drug Agency. SUBJECTS, MATERIALS, AND METHODS An observational retrospective study was conducted in 24 Italian hematology centers with the aim to improve information on effectiveness and safety of lenalidomide use in real practice. RESULTS Seventy patients received lenalidomide for 21/28 days with a median of eight cycles. At the end of therapy, there were 22 complete responses (31.4%), 11 partial responses, 6 stable diseases, and 31 progressions, with an overall response rate of 47.1%. Eighteen patients (22.9%) received lenalidomide in combination with either dexamethasone (n = 13) or rituximab (n = 5). Median overall survival (OS) was reached at 33 months and median disease-free survival (DFS) at 20 months: 14/22 patients are in continuous complete response with a median of 26 months. Patients who received lenalidomide alone were compared with patients who received lenalidomide in combination: OS and DFS did not differ. Progression-free survivals are significantly different: at 56 months, 36% in the combination group versus 13% in patients who received lenalidomide alone. Toxicities were manageable, even if 17 of them led to an early drug discontinuation. CONCLUSION Lenalidomide therapy for relapsed MCL patients is effective and tolerable even in a real-life context. IMPLICATION FOR PRACTICE Several factors influence treatment choice in relapsed/refractory mantle cell lymphoma (rrMCL), and the therapeutic scenario is continuously evolving. In fact, rrMCL became the first lymphoma for which four novel agents have been approved: temsirolimus, lenalidomide, ibrutinib, and bortezomib. The rrMCL therapeutic algorithm is not so well established because data in the everyday clinical practice are still poor. Lenalidomide for rrMCL patients is effective and tolerable even in a real-life context.
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Affiliation(s)
| | | | | | - Luca Baldini
- Division of Hematology, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Monica Tani
- Unit of Hematology, Santa Maria delle Croci Hospital, Ravenna, Italy
| | | | - Amalia Figuera
- Division of Hematology, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Michela Ansuinelli
- Hematology, Department of Cellular Biotechnologies and Hematology, 'Sapienza' University, Rome, Italy
| | - Elisa Bernocco
- Division of Hematology - SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | | | | | - Chiara Rusconi
- Division of Hematology, Niguarda Cancer Center, Milan, Italy
| | - Carlo Visco
- Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Luca Arcaini
- Department of Hematology-Oncology, Fondazione IRCCS Policlinico San Matteo & Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Angelo Fama
- Hematology-Arcispedale S.Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Roberto Marasca
- Department of Medical Sciences, Section of Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | | | | | - Guido Gini
- Affiliate Clinic of Hematology Ospedali Riuniti, Ancona, Italy
| | | | - Gerardo Musuraca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS, Meldola, Italy
| | - Anna Lucania
- Hematology Unit, ASL Napoli 1 Centro, Naples, Italy
| | - Giuseppina Ricciuti
- Department of Hematology, Lymphoma Unit, Spirito Santo Hospital, Pescara, Italy
| | - Lisa Argnani
- Institute of Hematology, University of Bologna, Bologna, Italy
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Santi RM, Ceccarelli M, Bernocco E, Monagheddu C, Evangelista A, Valeri F, Monaco F, Vitolo U, Cortelazzo S, Cabras MG, Spina M, Baldini L, Boccomini C, Chiappella A, Bari A, Luminari S, Visco C, Calabrese M, Limberti G, Levis A, Contino L, Ciccone G, Ladetto M. Khorana score and histotype predicts incidence of early venous thromboembolism in non-Hodgkin lymphomas. A pooled-data analysis of 12 clinical trials of Fondazione Italiana Linfomi (FIL). Thromb Haemost 2017; 117:16-11-0895. [PMID: 28447710 DOI: 10.1160/th16-11-0895] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 11/30/2016] [Accepted: 04/10/2017] [Indexed: 12/21/2022]
Abstract
Current data suggests that the risk of venous thromboembolism (VTE) in patients with non-Hodgkin lymphoma (NHL) is comparable to that observed in patients with solid tumours, although more robust confirmatory analyses are required. With that in mind, we investigated the occurrence of VTE in a pooled analysis of 12 "Fondazione Italiana Linfomi" (FIL) prospective clinical studies. Specifically, we wished to assess the cumulative incidence of VTE in NHL patients, evaluate the predictive value of the Khorana Score (KS), and identify other potential risk factors for VTEs. Data for VTE occurrence were retrieved from study databases and pharmacovigilance reports. Our analysis includes 1717 patients from 12 prospective phase II and III trials, including newly diagnosed NHL. We observed 53 VTEs (any grade) in 46 patients, with 20 severe VTEs in 17 patients. The cumulative incidences for "all-grade" or grade ≥3 VTEs were 2.9 % (95 % CI: 2.1-3.8) and 1.1 % (95 % CI: 0.6-1.6), respectively. KS categories were positively associated with the risk of VTE of any grade, and with severe events (i. e. grade ≥3; Gray's test p-values = 0.048 and 0.012, respectively). Among NHL patients, those with diffuse large B-cell lymphoma (DLBCL) showed a greater risk of (any grade) VTE (HR: 3.42, 95 % CI: 1.32-8.84, p-value = 0.011). Our study indicates that 1) VTE is a relevant complication for NHL patients, 2) KS is predictive of VTE events and 3) DLBCL histotype is an independent risk factor for VTE incidence, for which preventative interventions could be considered.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Giulia Limberti
- Giulia Limberti, AO SS Antonio e Biagio e C. Arrigo - SC Ematolgoia, Via Venezia 16, 15121 Alessandria, Italy, Tel.: +39 0131206930, Fax: +39 0131261029, E-mail:
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3
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Ghione P, Genuardi E, Rossi D, Drandi D, Mantoan B, Barbero D, Bernocco E, Monitillo L, Cerri M, Ruggeri M, Omede P, Deambrogi C, De Paoli L, Passera R, Coscia M, Cavallo F, Massaia M, Boccadoro M, Gaidano G, Ladetto M, Ferrero S. Progressive telomere shortening is part of the natural history of chronic lymphocytic leukaemia and impacts clinical outcome: evidences from long term follow-up. Br J Haematol 2017; 181:693-695. [PMID: 28369711 DOI: 10.1111/bjh.14681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Paola Ghione
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy
| | - Elisa Genuardi
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy
| | - Davide Rossi
- Department of Haematology, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Daniela Drandi
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy
| | - Barbara Mantoan
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy
| | - Daniela Barbero
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy
| | - Elisa Bernocco
- Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Luigia Monitillo
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy
| | - Michaela Cerri
- Division of Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Marina Ruggeri
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy
| | - Paola Omede
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy
| | - Clara Deambrogi
- Division of Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Lorenzo De Paoli
- Division of Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Roberto Passera
- Nuclear Medicine, San Giovanni Battista Hospital and University of Torino, Torino, Italy
| | - Marta Coscia
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy
| | - Federica Cavallo
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy
| | - Massimo Massaia
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy
| | - Mario Boccadoro
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Marco Ladetto
- Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Simone Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy
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Santi RM, Ceccarelli M, Catania G, Monagheddu C, Evangelista A, Bernocco E, Monaco F, Federico M, Vitolo U, Cortelazzo S, Cabras MG, Spina M, Baldini L, Boccomini C, Chiappella A, Bari A, Luminari S, Calabrese M, Levis A, Visco C, Contino L, Ciccone G, Ladetto M. PO-03 - Khorana score and histotype predict the incidence of early venous thromboembolism (VTE) in Non Hodgkin Lymphoma (NHL). A pooled data analysis of twelve clinical trials of Fondazione Italiana Linfomi (FIL). Thromb Res 2016; 140 Suppl 1:S177. [PMID: 27161692 DOI: 10.1016/s0049-3848(16)30136-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent studies show that the risk of VTE in NHL pts is similar to that observed in high risk solid tumors (i.e. pancreatic, ovarian cancer). VTE in NHL occurs in most cases within three months from diagnosis and can have substantial impact on treatment delivery and outcome as well as on quality of life. However few data are available on potential predictors. AIMS To better clarify the epidemiology of early (within six months from treatment start) VTE in NHL we conducted a pooled data analysis of 12 clinical trials from FIL. Our analysis included basic demographic features, lymphoma-related characteristics as well the Khorana score (based on histology, BMI, platelets WBC and HB counts) which is extensively used in solid tumors to predict VTE risk. PATIENTS AND METHODS From Jan. 2010 to Dec. 2014, all pts with B-cell NHL enrolled in prospective clinical trials from FIL for frontline treatment were included. For 9 studies study period included the entire trial population was included. The analyses were conducted based on CRFs as well as pharmacovigilance reports. VTE definition and grading was stated according to standard criteria of toxicity (CTCAE V4.0). Cumulative incidence of VTE from the study enrollment was estimated using the method described by Gooley et al. accounting for death from any causes as a competing risk. The Fine & Gray survival model was used to identify predictors of VTE among NHL pts. Factors predicting the grade of VTE were investigated using an ordinal logistic regression model. This pooled data analysis was approved by local IRB. RESULTS Overall, 1,717 patients belonging to 12 studies were evaluated. Eight were phase I/II or II (25% of pts) and 4 phase III (75% of pts). M/F ratio was 1.41, Median age was 57, (IQ range (IQR) 49-66). Histologies were: DLCL-B 34%, FL 41%, MCL 18%, other 6%. Median BMI was 25 (IQR 22-28). Median Hb, WBC and platelets counts were 13g/dl) (IQR 11.5-14.2), 7.1*10^(9)/l (IQR 5.6-10.3), 224*10^(9)/l (IQR 169-298), respectively. 1189 pts were evaluable Khorana score: 58% low risk, 30% intermediate risk, 12% were high risk. Human erythropoetin support was given to 9% of patients. All pts received Rituximab. Planned therapeutic programs included ASCT in 27% of pts, conventional chemotherapy in 67% a conventional chemotherapy plus lenalidomide in 6%. Overall 59 any grade VTE episodes occurred in 51 pts (2.9%), including 21 grade III-IV VTE (18 pts). None was fatal. Median time from study enrolment to VTE was 63 days (IQR: 35-110). Considering death as a competitive event the 6 months cumulative incidence of VTE was 2,2% in low risk Khorana score, 4.5% (95%IC: 2.3-6.7) in intermediate and 6.6% (95%IC: 2.4-10.8) in high risk (p=0.012) (figure 1). Khorana score was predictive also for grade III-IV events as they were 0,7% (95% CI:0.1-1.4) in low risk and 2.0% (95% CI:0.8-3.3) in intermediate-high risk (p=0.048). The results were similar also after excluding lenalidomide containing studies. The Fine and Gray multivariate analyses, adjusted for age and stage, showed that Khorana score (intermediate risk adjHR=1.96; 95%IC: 0.84-4.56 and high risk adjHR=3.81; 95%IC: 1.51-9.58) and DLCL-B histotype (adjHR=2.58; 95% CI: 1.01-6.55) were independently associated to an increased risk of VTE. Moreover an ordinal logistical regression model indicated that the increase of one point in the Khorana score resulted in an increased risk of VTE (OR=1.85; 95% CI: 1.23-2.79). CONCLUSIONS Our results suggest that DLCL-B histotype and Khorana score are predictors of VTE in NHL. The latter might become a simple and effective tool to assess the risk of VTE in NHL. Prospective validation including also patients not eligible for clinical trials is needed.
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Affiliation(s)
| | - M Ceccarelli
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Torino
| | - G Catania
- Division of Hematology, Az Osp SS Antinio e Biagio e Cesare Arrigo, Alessandria
| | - C Monagheddu
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Torino
| | - A Evangelista
- Unit of Cancer Epidemiology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino
| | - E Bernocco
- Division of Haematology - SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandrio
| | - F Monaco
- Division of Hematology, AZ Osp SS Antonio e Biagio e Cesare Arrigo, Alessandria
| | - M Federico
- Oncologia Medica, Università di Modena e Reggio Emilia, Modena
| | - U Vitolo
- Hematology II, Azienda Ospedaliera Città della Salute, Torino
| | - S Cortelazzo
- Department of Haematology and Bone Marrow Transplantation, Regional Hospital, S. Maurizio, Bolzano/Bozen
| | - M G Cabras
- Division of Hematology, Ospedale Businco, Cagliari
| | - M Spina
- Division of Hematology, IRCCS CRO Aviano
| | - L Baldini
- Division of Hematology, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano
| | - C Boccomini
- Division of Hematology II, AOU Citta della Salute e della Scienza, Torino
| | - A Chiappella
- Department of Hematology, Azienda Ospedaliera Città della Salute e della Scienza, Torino
| | - A Bari
- Program of Innovative Therapy in Oncology and Hematology, Department of Diagnostic, Clinical and Public Health Medicine University of Modena and Reggio Emilia, Modena
| | - S Luminari
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena
| | - M Calabrese
- Fondazione Italiana Linfomi Onlus, Alessandria
| | - A Levis
- Italian Lymphoma Foundation (FIL), Alessandria
| | | | | | - G Ciccone
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Az Osp Citta della salute e della Scienza, Torino
| | - M Ladetto
- Division of Hematology, Az Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria; Italy
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Lobetti-Bodoni C, Mantoan B, Monitillo L, Genuardi E, Drandi D, Barbero D, Bernocco E, Boccadoro M, Ladetto M. Clinical implications and prognostic role of minimal residual disease detection in follicular lymphoma. Ther Adv Hematol 2013; 4:189-98. [PMID: 23730496 DOI: 10.1177/2040620713480522] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The identification of patients at high risk of relapse is a critical goal of modern translational research in oncohematology. Minimal residual disease (MRD) detection by polymerase chain reaction-based methods is routinely employed in the management of patients with acute lymphoblastic leukemia. Current knowledge indicates that it is also a useful prognostic tool in several mature lymphoproliferative disorders and particularly in follicular lymphoma (FL). Based on this evidence clinical trials employing MRD-based risk stratification are currently ongoing in FL. In this review the 'state of the art' of MRD evaluation in FL is discussed. A short description of technical issues and recent methodological advances is provided. Then, the bulk of the review focuses on critical take-home messages for clinicians working in the field. Finally, we discuss future perspectives of MRD detection and more generally outcome prediction in FL.
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Affiliation(s)
- Chiara Lobetti-Bodoni
- Hematology Division I, Azienda ospedaliera San Giovanni Battista, Città della Salute e della Scienza, Torino, Italy
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Lobetti-Bodoni C, Ferrero D, Genuardi E, Passera R, Bernocco E, Sia D, Grignani G, Crisà E, Monitillo L, Rocci A, Drandi D, Giai V, Zanni M, Boi M, Isaia G, Barbero D, Lunghi M, Abruzzese E, Radaelli F, Pini M, Pregno P, Carlo-Stella C, Gaidano G, Boccadoro M, Ladetto M. Telomere loss in Philadelphia-negative hematopoiesis after successful treatment of chronic myeloid leukemia: evidence for premature aging of the myeloid compartment. Mech Ageing Dev 2012; 133:479-88. [PMID: 22687638 DOI: 10.1016/j.mad.2012.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 04/11/2012] [Accepted: 05/29/2012] [Indexed: 01/08/2023]
Abstract
Telomere shortening, a well-known marker of aging and cellular stress, occurs under several conditions in the hematopoietic compartment, including aplastic anemia and following iatrogenic noxae. We decided to verify whether pathological telomere erosion also arises in restored Philadelphia-negative (Ph-negative) hematopoiesis following successful treatment of chronic myeloid leukemia (CML). Eighty-one CML patients in complete cytogenetic remission were compared to 76 age-matched healthy subjects. Myeloid cells of CML patients had shorter telomeres than controls (6521 bp vs 7233 bp, p<0.001). This difference was specific for the myeloid compartment, since it was not observed in lymphoid cells (6774 bp vs 6909 bp, p=0.620). Acquired Ph-negative cytogenetic abnormalities (p=0.010), lack of complete molecular remission (p=0.016) and age (p=0.013) were independent predictors of telomere shortening. Telomere dynamics were assessed over a median follow-up period of 22 months. We documented accelerated non-physiological ongoing telomere shortening in 17/59 CML patients (28%). Patients experiencing grade 2-4 hematological toxicity, during CML remission possessed significantly shorter telomeres compared to those lacking toxicity (p=0.005 for any toxicity, p=0.007 for anemia). CML patients suffer from significant and often ongoing telomere stress resulting in premature and selective aging of the myeloid compartment which might have long-term consequences on function and integrity of Ph-negative hematopoiesis.
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Affiliation(s)
- Chiara Lobetti-Bodoni
- Division of Hematology, University of Turin, A.O.U. San Giovanni Battista, Turin, Italy
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Abstract
The telomeric checkpoint is emerging as a critical sensor of cellular damage, playing a major role in human aging and cancer development. In the meantime, telomere biology is rapidly evolving from a basic discipline to a translational branch, capable of providing major hints for biomarker development, risk assessment and targeted treatment of cancer. These advances have a number of implications in the biology of lymphoid tumours. Moreover, there is considerable interest in the potential role of telomeric dysfunction in the wide array of immunological abnormalities, grouped under the definition of 'immunosenescence'. This review will summarize the impact of recent advances in telomere biology on the physiology and pathology of the B lymphocyte, with special interest in immunosenescence and lymphomagenesis.
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Affiliation(s)
- Chiara Lobetti-Bodoni
- Department of Experimental Oncology, Division of Hematology, University of Torino, Italy
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Rossi D, Lobetti Bodoni C, Genuardi E, Monitillo L, Drandi D, Cerri M, Deambrogi C, Ricca I, Rocci A, Ferrero S, Bernocco E, Capello D, De Paoli L, Bergui L, Boi M, Omedè P, Massaia M, Tarella C, Passera R, Boccadoro M, Gaidano G, Ladetto M. Telomere length is an independent predictor of survival, treatment requirement and Richter's syndrome transformation in chronic lymphocytic leukemia. Leukemia 2009; 23:1062-72. [PMID: 19340005 DOI: 10.1038/leu.2008.399] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Telomere length (TL) has been associated with outcome in chronic lymphocytic leukemia (CLL). The aim of this extensive analysis carried out on 401 CLL patients was to assess TL conclusively as a prognostic biomarker. Our study included two cohorts used as learning (191 patients) and blinded validation series (210 patients). A TL cutoff of 5000 bp was chosen by receiver operating characteristic (ROC) analysis and Youden's index in the learning series. In this series, TL< or =5000 bp was independently associated to a worse outcome for both overall survival (OS; 105.5 vs 281 months, P<0.001) and treatment-free survival (TFS; 24.6 vs 73 months, P<0.001). In the blinded validation series, TL< or =5000 bp was confirmed as an independent outcome predictor for OS (79.8 vs not reached, P<0.001) and TFS (15.2 vs 130.8 months, P<0.001). Moreover, TL< or =5000 bp independently predicted the risk of Richter's syndrome (5-year risk: 18.9 vs 6.4%, P=0.016). Within CLL subsets defined by biological predictors, TL consistently identified patient subgroups harboring unfavorable prognosis. These results demonstrate that TL is a powerful independent predictor of multiple outcomes in CLL, and contributes to refine the prognostic assessment of this disease when utilized in combination with other prognostic markers. We thus believe that this prognostic biomarker has the potential for a more widespread use in CLL.
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Affiliation(s)
- D Rossi
- Division of Hematology, Department of Clinical and Experimental Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
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