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Di Monta G, Marone U, Avino F, Esposito E, Cepparulo V, Morra E, Saponara R, Bifulco F, Cuomo A, Cascella M, Mori S. Superomedial pedicle skin-reducing mastectomy in ptotic and large-sized breasts with two-stage reconstruction through transaxillary video-assisted technique: An effective surgical and anesthetic approach. Front Surg 2022; 9:1040602. [PMID: 36684343 PMCID: PMC9850288 DOI: 10.3389/fsurg.2022.1040602] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Skin-reducing mastectomy has been applied to several surgical techniques in which subcutaneous mastectomy is associated with various types of skin reduction, with preservation of a lower dermal flap to reinforce the inferior lateral seat of an implant. The aim of the study is to present a case series of patients with pendulous/ptotic and/or large-sized breasts treated for breast cancer at the Breast Surgery Unit of Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy, with the superomedial pedicle skin-reducing mastectomy technique, two-stage reconstruction, and transaxillary video-assisted technique, when a postoperative radiotherapy was indicated. We verified its effectiveness by discussing its results, especially in patients who are candidates for postmastectomy radiotherapy. Materials and methods A single-center retrospective study was performed between January 2020 and March 2021 on a prospectively filled database of conservative mastectomies. Of the 64 patients who underwent nipple/skin-sparing mastectomies in the mentioned period, 17 (mean age 46 years, range 30-62 years) were treated with superomedial pedicle skin-reducing mastectomy, with two-stage breast reconstruction through transaxillary video-assisted replacement expander with definitive prosthesis and contralateral symmetrization, selected for postmastectomy radiotherapy. Results We had only three minor complications. No flap necrosis, no infections, no breast seromas, and no reconstructive failures were observed. During follow-up of the patients treated with video-assisted reconstruction, there were no cases of infection, hematoma, implant rupture, or suture dehiscence in the reconstructed breast. Discussion Skin-reducing mastectomy with superomedial pedicle is a safe and reliable procedure to treat breast cancer in selected patients, i.e., those with pendulous/ptotic and or large-sized breasts. Particularly, in patients who undergo postmastectomy radiotherapy, the two-stage reconstruction with video-assisted transaxillary endoscopic approach can find its main indication, using incisions positioned far from the mammary region, offering numerous advantages.
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Affiliation(s)
- G Di Monta
- UOSD Oncoplastic Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - U Marone
- UOC Breast Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - F Avino
- UOC Breast Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - E Esposito
- UOC Breast Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - V Cepparulo
- UOSD Oncoplastic Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - E Morra
- UOSD Oncoplastic Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - R Saponara
- UOC Breast Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - F Bifulco
- UOC Division of Anesthesia, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - A Cuomo
- UOC Division of Anesthesia, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - M Cascella
- UOC Division of Anesthesia, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
| | - S Mori
- UOSD Oncoplastic Surgery, Istituto Nazionale Tumori IRCCS Fondazione "G. Pascale", Naples, Italy
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Baviera M, Barcella L, Vannini T, Colacioppo P, Marzona I, Tettamanti M, Merlino L, Fortino I, Morra E, Falanga A, Roncaglioni MC. Treatment of venous thromboembolism in Northern Italy: A population-based study from 2013 to 2018. Thromb Res 2020; 188:97-99. [DOI: 10.1016/j.thromres.2020.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 01/22/2023]
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Trojani A, Pungolino E, Dal Molin A, Lodola M, Rossi G, D’Adda M, Perego A, Elena C, Turrini M, Borin L, Bucelli C, Malato S, Carraro MC, Spina F, Latargia ML, Artale S, Spedini P, Anghilieri M, Di Camillo B, Baruzzo G, De Canal G, Iurlo A, Morra E, Cairoli R. Nilotinib interferes with cell cycle, ABC transporters and JAK-STAT signaling pathway in CD34+/lin- cells of patients with chronic phase chronic myeloid leukemia after 12 months of treatment. PLoS One 2019; 14:e0218444. [PMID: 31318870 PMCID: PMC6638825 DOI: 10.1371/journal.pone.0218444] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 06/03/2019] [Indexed: 01/05/2023] Open
Abstract
Chronic myeloid leukemia (CML) is characterized by the constitutive tyrosine kinase activity of the oncoprotein BCR-ABL1 in myeloid progenitor cells that activates multiple signal transduction pathways leading to the leukemic phenotype. The tyrosine-kinase inhibitor (TKI) nilotinib inhibits the tyrosine kinase activity of BCR-ABL1 in CML patients. Despite the success of nilotinib treatment in patients with chronic-phase (CP) CML, a population of Philadelphia-positive (Ph+) quiescent stem cells escapes the drug activity and can lead to drug resistance. The molecular mechanism by which these quiescent cells remain insensitive is poorly understood. The aim of this study was to compare the gene expression profiling (GEP) of bone marrow (BM) CD34+/lin- cells from CP-CML patients at diagnosis and after 12 months of nilotinib treatment by microarray, in order to identify gene expression changes and the dysregulation of pathways due to nilotinib action. We selected BM CD34+/lin- cells from 78 CP-CML patients at diagnosis and after 12 months of first-line nilotinib therapy and microarray analysis was performed. GEP bioinformatic analyses identified 2,959 differently expressed probes and functional clustering determined some significantly enriched pathways between diagnosis and 12 months of nilotinib treatment. Among these pathways, we observed the under expression of 26 genes encoding proteins belonging to the cell cycle after 12 months of nilotinib treatment which led to the up-regulation of chromosome replication, cell proliferation, DNA replication, and DNA damage checkpoint at diagnosis. We demonstrated the under expression of the ATP-binding cassette (ABC) transporters ABCC4, ABCC5, and ABCD3 encoding proteins which pumped drugs out of the cells after 12 months of nilotinib. Moreover, GEP data demonstrated the deregulation of genes involved in the JAK-STAT signaling pathway. The down-regulation of JAK2, IL7, STAM, PIK3CA, PTPN11, RAF1, and SOS1 key genes after 12 months of nilotinib could demonstrate the up-regulation of cell cycle, proliferation and differentiation via MAPK and PI3K-AKT signaling pathways at diagnosis.
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Affiliation(s)
- Alessandra Trojani
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
- * E-mail:
| | - Ester Pungolino
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Milena Lodola
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giuseppe Rossi
- Department of Hematology, ASST Spedali Civili, Brescia, Italy
| | - Mariella D’Adda
- Department of Hematology, ASST Spedali Civili, Brescia, Italy
| | | | - Chiara Elena
- Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mauro Turrini
- Division of Hematology, Department of Internal Medicine, Valduce Hospital, Como, Italy
| | - Lorenza Borin
- Hematology Division, San Gerardo Hospital, Monza, Italy
| | - Cristina Bucelli
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Simona Malato
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy
| | | | - Francesco Spina
- Division of Hematology–Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | - Barbara Di Camillo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giacomo Baruzzo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Gabriella De Canal
- Pathology Department, Cytogenetics, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Enrica Morra
- Executive Committee, Rete Ematologia Lombarda, Italy
| | - Roberto Cairoli
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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Perego RA, Cairoli R, Cornacchini G, Bianchi C, Corizzato M, Tresoldi E, Morra E. The Role of Quantitative Polymerase Chain Reaction in the Management of Follicular Lymphoma Patients. Tumori 2019; 91:59-66. [PMID: 15850006 DOI: 10.1177/030089160509100111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and backgroundIn order to increase the prognostic significance of polymerase chain reaction (PCR) data it has been suggested that quantitative PCR can be used to measure tumor burden. However, this option has not yet been definitely supported or refuted in patients with follicular lymphoma (FL). We decided to evaluate whether knowledge of the quantitative level of minimal residual disease and its variations can be of use in the management of FL patients.MethodsWe used qualitative and competitive PCR to study 11 patients with refractory or relapsed FL harboring the t(14;18) translocation who underwent autologous (nine patients) or allogeneic (two patients) stem cell transplantation (SCT). Competitive PCR was performed with a multiple competitor carrying specific sequences including Bcl2/lgH MBR and mcr, and the β-globin gene.ResultsAfter a median post-SCT follow-up of 44 months (range, 12-62), overall survival was 91% and disease-free survival 82%. The quantitative PCR data showed that: 1) effective chemotherapy before SCT substantially (1-2 log) reduced the tumor burden in the bone marrow (BM); 2) the increase in rearranged DNA detected in BM was associated with disease progression and relapse; 3) a PCR-negative autograft seemed to lead to lasting molecular remission even when it was performed in patients with a low level of BM infiltration before transplant; and 4) allo-SCT made and maintained the BM PCR negative even in the presence of a greater tumor burden before SCT. Six of the nine patients having CR after SCT (four auto and two allo) are in continuous molecular remission.ConclusionsIn FL patients qualitative and quantitative PCR may provide data that can be helpful for the prognostic evaluation of tumor progression and the early detection of impending relapse by highlighting biological features such as the quality of the infused material, the tumor burden at transplant, and the behavior of tumor cells after transplant.
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Affiliation(s)
- Roberto A Perego
- Department of Experimental and Environmental Medicine and Medical Biotechnologies, School of Medicine, Milano-Bicocca University, Monza, Milan, Italy.
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Rattotti S, Ferretti VV, Rusconi C, Rossi A, Fogazzi S, Baldini L, Pioltelli P, Balzarotti M, Farina L, Ferreri AJM, Laszlo D, Speziale V, Varettoni M, Sciarra R, Morello L, Tedeschi A, Frigeni M, Defrancesco I, Zerbi C, Flospergher E, Nizzoli ME, Morra E, Arcaini L. Lymphomas associated with chronic hepatitis C virus infection: A prospective multicenter cohort study from the Rete Ematologica Lombarda (REL) clinical network. Hematol Oncol 2019; 37:160-167. [PMID: 30726562 DOI: 10.1002/hon.2575] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/21/2019] [Accepted: 01/31/2019] [Indexed: 01/16/2023]
Abstract
Chronic hepatitis C virus (HCV) infection is related with an increased risk of non-Hodgkin lymphomas (NHL). In indolent subtypes, regression of NHL was reported after HCV eradication with antiviral therapy (AT). In 2008 in Lombardy, a region of Northern Italy, the "Rete Ematologica Lombarda" (REL, Hematology Network of Lombardy-Lymphoma Workgroup) started a prospective multicenter observational cohort study on NHL associated with HCV infection, named "Registro Lombardo dei Linfomi HCV-positivi" ("Lombardy Registry of HCV-associated non-Hodgkin lymphomas"). Two hundred fifty patients with a first diagnosis of NHL associated with HCV infection were enrolled; also in our cohort, diffuse large B cell lymphoma (DLBCL) and marginal zone lymphoma (MZL) are the two most frequent HCV-associated lymphomas. Two thirds of patients had HCV-positivity detection before NHL; overall, NHL was diagnosed after a median time of 11 years since HCV survey. Our data on eradication of HCV infection were collected prior the recent introduction of the direct-acting antivirals (DAAs) therapy. Sixteen patients with indolent NHL treated with interferon-based AT as first line anti-lymphoma therapy, because of the absence of criteria for an immediate conventional treatment for lymphoma, had an overall response rate of 90%. After a median follow-up of 7 years, the overall survival (OS) was significantly longer in indolent NHL treated with AT as first line (P = 0.048); this confirms a favorable outcome in this subset. Liver toxicity was an important adverse event after a conventional treatment in 20% of all patients, in particular among DLBCL, in which it is more frequent the coexistence of a more advanced liver disease. Overall, HCV infection should be consider as an important co-pathology in the treatment of lymphomas and an interdisciplinary approach should be always considered, in particular to evaluate the presence of fibrosis or necroinflammatory liver disease.
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Affiliation(s)
- Sara Rattotti
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Chiara Rusconi
- Division of Hematology, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Andrea Rossi
- Division of Hematology, Ospedali Riuniti, Bergamo, Italy
| | | | - Luca Baldini
- Division of Hematology, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | | | | | - Lucia Farina
- Division of Hematology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrés J M Ferreri
- Unit of Lymphoid Malignancies, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Laszlo
- Division of Hematology, Istituto Europeo di Oncologia, Milan, Italy
| | - Valentina Speziale
- Division of Internal Medicine, Ospedale Civile di Legnano, Legnano, Italy
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Sciarra
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lucia Morello
- Division of Hematology, Humanitas Cancer Center, Milan, Italy
| | | | - Marco Frigeni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Caterina Zerbi
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | | | - Enrica Morra
- Division of Hematology, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Luca Arcaini
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
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Robak T, Jin J, Pylypenko H, Verhoef G, Siritanaratkul N, Drach J, Raderer M, Mayer J, Pereira J, Tumyan G, Okamoto R, Nakahara S, Hu P, Appiani C, Nemat S, Cavalli F, Van Hoof A, Sheliga A, Teixeira A, Tomita A, Rocafiguera AO, Suvorov A, Kuzmin A, Khojasteh A, Mezlini A, Golenkov A, Bosly A, Belch A, Van De Velde A, Illes Á, Mukhopadhyay A, Meddeb B, De Prijck B, Garichochea B, Undar B, Gabarrón C, Cao C, Souza C, Farber C, Won Suh C, Burcoveanu CI, Cebotaru CL, Truica CL, Maruyama D, Belada D, Ben Yehuda D, Udovitsa D, Dolores, Morra E, Späth-Schwalbe E, Gonzalez-Barca E, Osmanov E, Capote FJ, Offner F, Cardenas G, Heß G, Manikhas G, Babu G, Rekhtman G, Rossi G, Marques H, Bumbea H, Wang H, Huang H, Choi I, Bulavina I, Lysenko I, Avivi I, Kryachok I, Zaucha JM, Novak J, Díaz J, Demeter J, Alexeeva J, Zhu J, Vilchevskaya K, Ishizawa K, Mauricio K, Tobinai K, Ando K, Abdulkadryrov K, Shih LY, Kuzina L, Gumus M, De Wit M, Capra M, Marques M, Golubeva M, Ojeda-Uribe M, Kyselyova M, Taniwaki M, Federico M, Crump M, Baccarani M, Ogura M, Egyed M, Udvardy M, Kurosawa M, Uike N, Khuageva N, Shpilberg O, Gladkov O, Samoilova O, Serduk O, Santi P, Zachee P, Kaplan P, Stoia R, Gressin R, Arranz R, Greil R, Grosicki S, Cancelado S, Nair S, Le Gouill S, Van Steenweghen S, Yoon SS, Chuncharune S, Scheider T, Shimoyama T, Liu T, Kinoshita T, Uchida T, Bunworasate U, Vitolo U, Pavlov V, Phooshkooru VR, Lima V, Merkulov V, Nawarawong W, Hong X, Ke X, Terui Y, Tee Goh Y, Maeda Y, Shi Y, Dunaev Y, Lorie Y, Wang Z, Shen Z, Borbenyi Z, Gasztonyi Z, Masliak Z. Frontline bortezomib, rituximab, cyclophosphamide, doxorubicin, and prednisone (VR-CAP) versus rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in transplantation-ineligible patients with newly diagnosed mantle cell lymphoma: final overall survival results of a randomised, open-label, phase 3 study. Lancet Oncol 2018; 19:1449-1458. [DOI: 10.1016/s1470-2045(18)30685-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
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Pungolino E, Rossi G, De Canal G, Trojani A, D'adda M, Perego A, Orlandi EM, Lunghi F, Turrini M, Borin L, Iurlo A, Latargia ML, Carraro MC, Spina F, Lodola M, Artale S, Anghilieri M, Spedini P, Cantoni S, Di Camillo B, Morra E, Cairoli R. Nilotinib induced bone marrow CD34+/lin-Ph+ cells early clearance in newly diagnosed CP-chronic myeloid leukemia. Am J Hematol 2018; 93:E162-E164. [PMID: 29633310 DOI: 10.1002/ajh.25106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Ester Pungolino
- Division of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milano Italy
| | - Giuseppe Rossi
- Department of Hematology; ASST Spedali Civili; Brescia Italy
| | - Gabriella De Canal
- Pathology Department; Cytogenetics, ASST Grande Ospedale Metropolitano Niguarda; Milano Italy
| | - Alessandra Trojani
- Division of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milano Italy
| | - Mariella D'adda
- Department of Hematology; ASST Spedali Civili; Brescia Italy
| | | | | | - Francesca Lunghi
- San Raffaele Hospital; Hematology and Bone Marrow Transplant Unit; Milano Italy
| | - Mauro Turrini
- Division of Hematology; Valduce Hospital; Como Italy
| | | | - Alessandra Iurlo
- Oncohematology Division, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, University of Milan; Milano Italy
| | | | | | - Francesco Spina
- Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori; Milan Italy
| | - Milena Lodola
- Division of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milano Italy
| | - Salvatore Artale
- Division of Oncology; Ospedale di Gallarate, ASST Valle Olona; Gallarate Italy
| | | | | | - Silvia Cantoni
- Division of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milano Italy
| | - Barbara Di Camillo
- Department of Information Engineering; University of Padova; Padova Italy
| | - Enrica Morra
- ASST Grande Ospedale Metropolitano Niguarda, Scientific Coordinator, Lombardy' Hematology Network; Milano Italy
| | - Roberto Cairoli
- Division of Hematology; ASST Grande Ospedale Metropolitano Niguarda; Milano Italy
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Brusamolino E, Magrini U, Canevari A, Castelli G, Morra E, Pagnucco G, Isernia P, Bernasconi C. Low-Grade Malignancy Non-Hodgkin's Lymphomas: Prognostic Relevance of their Clinicopathologic Heterogeneity. Tumori 2018; 69:331-8. [PMID: 6623656 DOI: 10.1177/030089168306900410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We reviewed 182 consecutive adult patients with low-grade malignancy, non-Hodgkin's lymphomas classified according to the Kiel classification, followed at the Division of Hematology, Policlinico S. Matteo, Pavia, from January 1975 to December 1981, to recognize, in each histopathologic type, important subgroups from the prognostic standpoint. Median follow-up was 36 months. No significant differences were observed in the response rate to conventional therapy (radiotherapy for localized disease, CVP for advanced stages) between the 4 cytologic types. The centrocytic-centroblastic lymphoma with diffuse nodal architecture showed an intermediate-grade malignancy (median survival, 50 months) and underwent cytologic progression to the high-grade malignancy centroblastic type in 10% of the cases. Large-cell centrocytic and polymorphic lymphoplasmacytoid lymphomas had a poor prognosis (median survival less than 30 months) when treated with conventional therapy for favorable histologies, and 6% of the cases transformed into the high-malignancy immunoblastic type. Patients with lymphocytic lymphoma with bulky mediastinum had a median survival of 20 months. The identification of these subgroups with a worse prognosis may have therapeutic implications.
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Affiliation(s)
- Silvia Cantoni
- Division of Hematology, Department of Oncology and Hematology, Niguarda Ca’ Granda Hospital, Milan, Italy
| | - Enrica Morra
- Division of Hematology, Department of Oncology and Hematology, Niguarda Ca’ Granda Hospital, Milan, Italy
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Abstract
The biological markers of non-Hodgkin's lymphomas (NHL) are distinguished in three categories: serological, immunophenotypic, and molecular markers. The clinical importance of biological markers in NHL is based on their support of morphologic diagnosis, their role in staging and prognostic assessment, and their contribution to monitoring minimal residual disease (MRD). The most important serological markers reflect the tumor load (beta-2 microglobulin, β2-M), proliferative activity (lactic dehydrogenase, LDH), and invasive potential of lymphomas (CA 125). LDH and β2-Mare included as important prognostic parameters in widely used staging systems. Immunophenotypic analysis identifies specific markers of lineage (B or T-cells), maturation level, cell proliferation, and clonality. Results of immunophenotyping are particularly useful in low to intermediate-grade NHLs to support the morphologic diagnosis and facilitate the detection of MRD after treatment. The molecular markers are genetic lesions involved in the pathogenesis of some categories of NHL. Their use as markers for diagnosis is justified by the selective association with specific lymphoma categories: follicular, mantle cell, diffuse large cell, and anaplastic large cell lymphomas. Molecular lesions are the most specific and sensitive markers for evaluating MRD. Today the biological markers of NHL are widely employed for diagnosis, staging, and prognostic assessment. Their systematic use may complement clinical parameters in the stratification of NHL patients, who may thus become candidates for treatments of different intensity. The detection of MRD after first-line treatment identifies patients at high risk of relapse who require additional therapy to cure their disease.
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Affiliation(s)
- E Morra
- Division of Hematology, Niguarda Ca' Granda Hospital, Milano, Italy
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Nosari A, Nichelatti M, De Gasperi A, Nador G, Anghilieri M, Mazza E, Cozzi P, Mancini V, Miqueleiz S, Bettinelli L, Lucchesini C, Baraté C, Ricci F, Ciapanna D, Ravelli E, Morra E. Incidence of Sepsis in Central Venous Catheter-Bearing Patients with Hematologic Malignancies: Preliminary Results. J Vasc Access 2018; 5:168-73. [PMID: 16596561 DOI: 10.1177/112972980400500406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Indwelling central venous catheters (CVCs) are essential devices in the management of patients with hematological disorders treated with chemotherapy. However, their nature predisposes patients to unwanted complications. Methods CVC-related complications were retrospectively analyzed in 227 hematologic patients who were consecutively admitted to our hematology department between May 2002 and April 2004. Patients’ diagnoses comprised acute myeloid leukemia (36.8%), acute lymphoid leukemia (7.3%), lymphoproliferative disorders (28.3%), multiple myeloma (19.5%), myeloproliferative syndromes (5%) and others (3.1%). The CVCs used were polyurethane three lumen 7-Fr (111 patients) for chemotherapy and 12-Fr (114 patients) for chemotherapy and peripheral blood stem cell apheresis, plus two tunneled catheters. Results The pathological events were: bacteriaemias (n=46); occlusions (n=10); exit tunnel infections (n=8); thrombosis (n=6); lung emboli (n=2). Among febrile patients the bacteriemia frequency was 20%, of which 13.6% were CVC-related (with a higher incidence in leukemia patients (p=0.027). Among the isolates, gram-positive bacteria were found in 29 cases (23 CVC-related cases), and gram-negative bacteria in 16 cases (8 CVC-related cases). Only one patient had Candida albicans sepsis. At univariate and multivariate analysis significant risk factors for infection (p<0.0001) were only the number of days/catheters and neutropenia duration. Conclusions In our hematologic patients, the CVC complications were mainly septic, with only 10.1% of CVC-related bacteriemias, despite prolonged catheterization duration. Acute leukemia patients were at major risk for sepsis, probably due to a more severe neutropenia and prolonged catheterization duration.
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Affiliation(s)
- A Nosari
- Division of Hematology, Niguarda Ca' Granda Hospital, Milan, Italy
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Trojani A, Pungolino E, Rossi G, D’Adda M, Lodola M, Camillo BD, Perego A, Turrini M, Orlandi E, Borin L, Iurlo A, Malato S, Spina F, Latargia ML, Lanza F, Artale S, Anghilieri M, Carraro MC, Canal GD, Morra E, Cairoli R. Wide-transcriptome analysis and cellularity of bone marrow CD34+/lin- cells of patients with chronic-phase chronic myeloid leukemia at diagnosis vs. 12 months of first-line nilotinib treatment. Cancer Biomark 2017; 21:41-53. [DOI: 10.3233/cbm-170209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Alessandra Trojani
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Ester Pungolino
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giuseppe Rossi
- Department of Hematology, ASST Spedali Civili, Brescia, Italy
| | - Mariella D’Adda
- Department of Hematology, ASST Spedali Civili, Brescia, Italy
| | - Milena Lodola
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Barbara Di Camillo
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Mauro Turrini
- Division of Hematology, Department of Internal Medicine, Valduce Hospital, Como, Italy
| | - Ester Orlandi
- Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenza Borin
- Hematology Division, San Gerardo Hospital, Monza, Italy
| | - Alessandra Iurlo
- Oncohematology Division, IRCCS Ca’ Granda – Maggiore Policlinico Hospital Foundation, Milano, Italy
| | - Simona Malato
- Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy
| | - Francesco Spina
- Division of Hematology – Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | | | | | | | - Gabriella De Canal
- Pathology Department, Cytogenetics, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Enrica Morra
- Executive Committee, Rete Ematologia Lombarda, Italy
| | - Roberto Cairoli
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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13
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Castillo JJ, Garcia-Sanz R, Hatjiharissi E, Kyle RA, Leleu X, McMaster M, Merlini G, Minnema MC, Morra E, Owen RG, Poulain S, Stone MJ, Tam C, Varettoni M, Dimopoulos MA, Treon SP, Kastritis E. Recommendations for the diagnosis and initial evaluation of patients with Waldenström Macroglobulinaemia: A Task Force from the 8th International Workshop on Waldenström Macroglobulinaemia. Br J Haematol 2016; 175:77-86. [PMID: 27378193 DOI: 10.1111/bjh.14196] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 03/17/2016] [Accepted: 05/04/2016] [Indexed: 12/12/2022]
Abstract
The diagnosis of Waldenström macroglobulinaemia (WM) can be challenging given the variety of signs and symptoms patients can present. Furthermore, once the diagnosis of WM is established, the initial evaluation should be thorough as well as appropriately directed. During the 8th International Workshop for WM in London, United Kingdom, a multi-institutional task force was formed to develop consensus recommendations for the diagnosis and initial evaluation of patients with WM. In this document, we present the results of the deliberations that took place to address these issues. We provide recommendations for history-taking and physical examination, laboratory studies, bone marrow aspiration and biopsy analysis and imaging studies. We also provide guidance on the initial evaluation of special situations, such as anaemia, hyperviscosity, neuropathy, Bing-Neel syndrome and amyloidosis. We hope these recommendations serve as a practical guidance to clinicians taking care of patients with a suspected or an established diagnosis of WM.
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Affiliation(s)
- Jorge J Castillo
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.
| | | | - Evdoxia Hatjiharissi
- Department of Haematology, Theageneion Hospital of Thessaloniki, Thessaloniki, Greece
| | - Robert A Kyle
- Division of Hematology, Mayo Clinic, Rochester, MN, USA
| | - Xavier Leleu
- La Miletrie Hospital, CHU Poitiers, Poitiers, France
| | - Mary McMaster
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Centre, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Monique C Minnema
- Department of Haematology, UMC Utrecht Cancer Centre, Utrecht, the Netherlands
| | - Enrica Morra
- Division of Haematology, Niguarda Ca' Granda Hospital, Milano, Italy
| | - Roger G Owen
- St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stephanie Poulain
- Service d'Hématologie-Immunologie-Cytogénétique, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Marvin J Stone
- Department of Oncology, Baylor Charles A Sammons Cancer Center, Dallas, TX, USA
| | - Constantine Tam
- Department of Haematology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - Marzia Varettoni
- Department of Haematology Oncology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Steven P Treon
- Bing Center for Waldenström Macroglobulinemia, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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14
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Xu L, Hunter ZR, Tsakmaklis N, Cao Y, Yang G, Chen J, Liu X, Kanan S, Castillo JJ, Tai YT, Zehnder JL, Brown JR, Carrasco RD, Advani R, Sabile JM, Argyropoulos K, Lia Palomba M, Morra E, Trojani A, Greco A, Tedeschi A, Varettoni M, Arcaini L, Munshi NM, Anderson KC, Treon SP. Clonal architecture of CXCR4 WHIM-like mutations in Waldenström Macroglobulinaemia. Br J Haematol 2015; 172:735-44. [PMID: 26659815 DOI: 10.1111/bjh.13897] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [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: 10/11/2015] [Accepted: 11/12/2015] [Indexed: 12/29/2022]
Abstract
CXCR4(WHIM) somatic mutations are distinctive to Waldenström Macroglobulinaemia (WM), and impact disease presentation and treatment outcome. The clonal architecture of CXCR4(WHIM) mutations remains to be delineated. We developed highly sensitive allele-specific polymerase chain reaction (AS-PCR) assays for detecting the most common CXCR4(WHIM) mutations (CXCR4(S338X C>A and C>G) ) in WM. The AS-PCR assays detected CXCR4(S338X) mutations in WM and IgM monoclonal gammopathy of unknown significance (MGUS) patients not revealed by Sanger sequencing. By combined AS-PCR and Sanger sequencing, CXCR4(WHIM) mutations were identified in 44/102 (43%), 21/62 (34%), 2/12 (17%) and 1/20 (5%) untreated WM, previously treated WM, IgM MGUS and marginal zone lymphoma patients, respectively, but no chronic lymphocytic leukaemia, multiple myeloma, non-IgM MGUS patients or healthy donors. Cancer cell fraction analysis in WM and IgM MGUS patients showed CXCR4(S338X) mutations were primarily subclonal, with highly variable clonal distribution (median 35·1%, range 1·2-97·5%). Combined AS-PCR and Sanger sequencing revealed multiple CXCR4(WHIM) mutations in many individual WM patients, including homozygous and compound heterozygous mutations validated by deep RNA sequencing. The findings show that CXCR4(WHIM) mutations are more common in WM than previously revealed, and are primarily subclonal, supporting their acquisition after MYD88(L265P) in WM oncogenesis. The presence of multiple CXCR4(WHIM) mutations within individual WM patients may be indicative of targeted CXCR4 genomic instability.
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Affiliation(s)
- Lian Xu
- Bing Center for Waldenström's Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA, USA
| | - Zachary R Hunter
- Bing Center for Waldenström's Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Nicholas Tsakmaklis
- Bing Center for Waldenström's Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA, USA
| | - Yang Cao
- Bing Center for Waldenström's Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Guang Yang
- Bing Center for Waldenström's Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Jie Chen
- Bing Center for Waldenström's Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA, USA
| | - Xia Liu
- Bing Center for Waldenström's Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Sandra Kanan
- Bing Center for Waldenström's Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA, USA
| | - Jorge J Castillo
- Bing Center for Waldenström's Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Yu-Tzu Tai
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Lipper Center for Multiple Myeloma, Dana Farber Cancer Institute, Boston, MA, USA
| | - James L Zehnder
- Department of Pathology, Stanford University Medical Center, Stanford, CA, USA
| | - Jennifer R Brown
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Ruben D Carrasco
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Ranjana Advani
- Department of Medical Oncology, Stanford University Medical Center, Stanford, CA, USA
| | - Jean M Sabile
- Department of Medical Oncology, Stanford University Medical Center, Stanford, CA, USA
| | - Kimon Argyropoulos
- Department of Medical Oncology, Memorial Sloane Kettering Cancer Center, New York, NY, USA
| | - M Lia Palomba
- Department of Medical Oncology, Memorial Sloane Kettering Cancer Center, New York, NY, USA
| | - Enrica Morra
- Haematology Unit, Niguarda Hospital, Milan, Italy
| | | | | | | | - Marzia Varettoni
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Haematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Arcaini
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Haematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nikhil M Munshi
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Lipper Center for Multiple Myeloma, Dana Farber Cancer Institute, Boston, MA, USA
| | - Kenneth C Anderson
- Department of Medicine, Harvard Medical School, Boston, MA, USA.,Lipper Center for Multiple Myeloma, Dana Farber Cancer Institute, Boston, MA, USA
| | - Steven P Treon
- Bing Center for Waldenström's Macroglobulinemia, Dana Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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15
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Roncoroni E, Pioltelli ML, Frustaci AM, Pungolino E, Morra E. Efficacy and tolerability of treatment with line II nilotinib in a patient with coronary artery disease. CMI 2015. [DOI: 10.7175/cmi.v7i1s.1142] [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
The possible cardiotoxicity of tyrosine kinase inhibitors (TKIs) is a topic of extreme interest because in the clinical practice it is frequent the management of elderly patients, in which are common comorbidities and polypharmacotherapies. Several studies have been conducted to evaluate the cardiotoxicity intrinsic to TKIs, but the results are, however, often discordant between in vitro studies and clinical practice. We present a case report about a male patient with several numerous comorbidities: COPD, diabetes mellitus and coronary artery disease. After the failure of imatinib therapy, the patient has switched in second-line to nilotinib therapy, 400 mg twice a day. The therapy was discussed and arranged with the cardiologists, with strict monitoring of cardiac and metabolic parameters. The therapy with nilotinib has allowed to obtain an optimal response according to the ELN guidelines and, from the sixth month of treatment, a major molecular response was obtained. From the standpoint of cardiologists, the patient has maintained a good compensation, despite the permanence of anginal symptoms, which required repeated therapeutic adjustments. Our case shows that nilotinib may be a well tolerated and effective therapy in a patient suffering from a major heart disease, maintaining a close clinical and cardiologic monitoring.
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Sartor C, Papayannidis C, Piciocchi A, Vitale A, Iacobucci I, Soverini S, Lollini PL, Di Raimondo F, Paolini S, Bonifacio M, Carella AM, Cazzola M, Cuneo A, Leoni P, Luppi M, Morra E, Specchia G, Elia L, Foà R, Baccarani M, Martinelli G. Abstract 5491: Sequential use of first and second generation TKIs are effective on prolonged overall survival in elderly population affected by Ph+ acute lymphoblastic leukemia: the GIMEMA experience. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-5491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: We have explored if the administration of two TKIs, Nilotinib (NIL) and Imatinib (IM) can improve the results without increasing the toxicity in the elderly Ph+ Acute Lymphoblastic Leukemia (ALL) patients. We investigate the type and number of BCR-ABL kinase domain mutations developing during and after the study.
Methods: We have designed a study (ClinicalTrials.gov. NCT01025505) in which patients more than 60 years old or unfit for intensive chemotherapy and SCT where treated with two TKIs, NIL 400 mg twice daily, and IM 300 mg twice daily, alternating for 6 weeks for a minimum of 24 weeks (study core) and indefinitely in case of response. The 6-weeks rotation schedule was respected, irrespectively of temporary discontinuations. The primary end-point was the rate of Disease Free Survival (DFS) at 24 weeks (4 courses of treatment); the secondary end points included the evaluation of CHR, CCgR and CMR rates.
Results: 39 patients have been enrolled in 15 Italian hematologic Centers (median age 66 years, range 28-84). Among these, 8 patients were unfit for standard chemotherapy or SCT (median age 50 years, range 28-59). 27 patients were p190, 5 were p210 and 7 were p190/p210. After 6 weeks of treatment, 36 patients were evaluable for response: 34 were in CHR (94%) and 2 in PHR (6%). 23 patients have already completed the study core (24 weeks), 87% were in CHR and 17 are currently continuing therapy in the protocol extension phase.
Thus, the OS at 1 year is 79%, and 64% at 2 years. Overall, 1 patient was primarily resistant and 13 patients have relapsed, with a median time to relapse of 7.6 months (range 0.8-16.1 months), for a DFS of 51.3% at 12 months.
Conclusions: In this small cohort of Ph+ ALL elderly/unfit patients, the rates of relapse and progression were not likely to be different from the rates observed with Imatinib alone.
Acknowledgements: ELN, AIL, AIRC, PRIN, FP7 NGS-PTL project.
Citation Format: Chiara Sartor, Cristina Papayannidis, Alfonso Piciocchi, Antonella Vitale, Ilaria Iacobucci, Simona Soverini, Pier Luigi Lollini, Francesco Di Raimondo, Stefania Paolini, Massimiliano Bonifacio, Angelo Michele Carella, Mario Cazzola, Antonio Cuneo, Pietro Leoni, Mario Luppi, Enrica Morra, Giorgina Specchia, Loredana Elia, Robin Foà, Michele Baccarani, Giovanni Martinelli. Sequential use of first and second generation TKIs are effective on prolonged overall survival in elderly population affected by Ph+ acute lymphoblastic leukemia: the GIMEMA experience. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5491. doi:10.1158/1538-7445.AM2015-5491
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Affiliation(s)
- Chiara Sartor
- 1Institute of Hematology “L. e A. Seràgnoli”, Bologna, Italy
| | | | | | | | | | - Simona Soverini
- 1Institute of Hematology “L. e A. Seràgnoli”, Bologna, Italy
| | | | | | | | | | | | - Mario Cazzola
- 7Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Cuneo
- 8Department of Hematology, University of Ferrara, Ferrara, Italy
| | - Pietro Leoni
- 9Division of Hematology, Nuovo Ospedale “Torrette”, Ancona, Italy
| | - Mario Luppi
- 10Department of Oncology and Hematology, University of Modena, Modena, Italy
| | - Enrica Morra
- 11Division of Hematology, “Ca Granda Niguarda Hospital”, Milan, Italy
| | | | | | - Robin Foà
- 13Division of Hematology, University “Sapienza”, Rome, Italy
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17
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Bernardi M, Zappasodi P, Fracchiolla N, Marbello L, Todisco E, Pagani C, Carrabba M, Rossi M, Guidotti F, Mancini V, Santoro A, Borlenghi E, Ciceri F, Morra E, Rossi G. Post-remission intensive treatment after induction chemotherapy is feasible in selected elderly patients with acute myeloid leukemia and age ≥75 years: a retrospective analysis of the Rete Ematologica Lombarda. Am J Hematol 2015; 90:E123-5. [PMID: 25715978 DOI: 10.1002/ajh.23990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/23/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Massimo Bernardi
- Haematology and Bone Marrow Transplant Unit; IRCCS San Raffaele Scientific Institute, via; Olgettina 60 Milan Italy
| | - Patrizia Zappasodi
- Department of Hematology Oncology; Fondazione IRCCS Policlinico San Matteo; Viale Camillo Golgi 19 Pavia Italy
| | - Nicola Fracchiolla
- Haematology Unit; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; via Francesco Sforza 35 Milan Italy
| | - Laura Marbello
- Department of Haematology; Niguarda Ca' Granda Hospital; Piazza Dell'ospedale Maggiore 3 Milan Italy
| | - Elisabetta Todisco
- Haematology Unit; Humanitas Cancer Center; via Manzoni 56 Rozzano Milan Italy
| | - Chiara Pagani
- Haematology Unit; Spedali Civili; Piazzale Spedali Civili 1 Brescia Italy
| | - Matteo Carrabba
- Haematology and Bone Marrow Transplant Unit; IRCCS San Raffaele Scientific Institute, via; Olgettina 60 Milan Italy
| | - Marianna Rossi
- Department of Hematology Oncology; Fondazione IRCCS Policlinico San Matteo; Viale Camillo Golgi 19 Pavia Italy
| | - Francesca Guidotti
- Haematology Unit; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; via Francesco Sforza 35 Milan Italy
| | - Valentina Mancini
- Department of Haematology; Niguarda Ca' Granda Hospital; Piazza Dell'ospedale Maggiore 3 Milan Italy
| | - Armando Santoro
- Haematology Unit; Humanitas Cancer Center; via Manzoni 56 Rozzano Milan Italy
| | - Erika Borlenghi
- Haematology Unit; Spedali Civili; Piazzale Spedali Civili 1 Brescia Italy
| | - Fabio Ciceri
- Haematology and Bone Marrow Transplant Unit; IRCCS San Raffaele Scientific Institute, via; Olgettina 60 Milan Italy
| | - Enrica Morra
- Department of Haematology; Niguarda Ca' Granda Hospital; Piazza Dell'ospedale Maggiore 3 Milan Italy
| | - Giuseppe Rossi
- Haematology Unit; Spedali Civili; Piazzale Spedali Civili 1 Brescia Italy
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18
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Tedeschi A, Picardi P, Ferrero S, Benevolo G, Margiotta Casaluci G, Varettoni M, Baratè C, Motta M, Gini G, Goldaniga MC, Visco C, Zaja F, Belsito Petrizi V, Ravelli E, Gentile M, Urbano MA, Franceschetti S, Ghione P, Orsucci L, Frustaci AM, Gaidano G, Vitolo U, Morra E. Bendamustine and rituximab combination is safe and effective as salvage regimen in Waldenström macroglobulinemia. Leuk Lymphoma 2015; 56:2637-42. [DOI: 10.3109/10428194.2015.1012714] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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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19
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Arcaini L, Morello L, Tucci A, Rusconi C, Ladetto M, Rattotti S, Bonfichi M, Bottelli C, Gabutti C, Bernasconi P, Varettoni M, Gotti M, Troletti D, Guerrera ML, Fiaccadori V, Sciarra R, Ferretti VV, Alessandrino EP, Rossi G, Morra E. Autologous stem cell transplantation with in vivo purged progenitor cells shows long-term efficacy in relapsed/refractory follicular lymphoma. Am J Hematol 2015; 90:230-4. [PMID: 25502635 DOI: 10.1002/ajh.23919] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/24/2014] [Accepted: 12/08/2014] [Indexed: 11/06/2022]
Abstract
High-dose chemotherapy with autologous stem cell transplantation (ASCT) has been shown effective in the control of relapsed/refractory follicular lymphoma. We evaluate the long-term outcome of patients with relapsed or refractory follicular lymphoma treated with ASCT with in vivo purged progenitors cells. We report the long-term results of a prospective multicenter phase 2 trial on 124 relapsed/refractory follicular lymphoma patients treated with a program of anthracycline-based debulking chemotherapy, immunochemotherapy, mobilization of in vivo purged PBSC followed by ASCT. Median age was 52 years; 14% of patients had grade 3A histology. Debulking chemotherapy produced CR in 16% and PR in 71%, while 13% of patients progressed. After rituximab, cyclophosphamide, vincristine, prednisone (R-COP), CR was obtained in 60% and PR in 35%; 118 patients successfully mobilized PBSC and 117 proceeded to ASCT. The harvest in all the 32 molecularly informative patients was bcl-2 negative. TRM was 0%. The 5-year PFS was 54% and the 5-year OS was 83%. After a median f-up of 6.7 years (range 1.5-13.6), 54% are still in CR. These data show that prolonged PFS is achievable in relapsed/refractory patients with high dose autologous transplantation of in vivo purged progenitor cells.
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Affiliation(s)
- Luca Arcaini
- Department of Molecular Medicine; University of Pavia; Pavia Italy
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Lucia Morello
- Department of Molecular Medicine; University of Pavia; Pavia Italy
| | | | - Chiara Rusconi
- Division of Hematology; Niguarda Ca'granda Hospital; Milano Italy
| | - Marco Ladetto
- Division of Hematology; Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo; Alessandria
| | - Sara Rattotti
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Maurizio Bonfichi
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | | | - Cristina Gabutti
- Division of Hematology; Niguarda Ca'granda Hospital; Milano Italy
| | - Paolo Bernasconi
- Department of Molecular Medicine; University of Pavia; Pavia Italy
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Marzia Varettoni
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Manuel Gotti
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Daniela Troletti
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Maria Luisa Guerrera
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | | | - Roberta Sciarra
- Department of Molecular Medicine; University of Pavia; Pavia Italy
| | - Virginia Valeria Ferretti
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | - Emilio Paolo Alessandrino
- Department of Hematology and Oncology; Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo; Pavia Italy
| | | | - Enrica Morra
- Division of Hematology; Niguarda Ca'granda Hospital; Milano Italy
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20
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Passamonti F, Vannucchi AM, Cervantes F, Harrison C, Morra E, Kantarjian H, Verstovsek S. Ruxolitinib and survival improvement in patients with myelofibrosis. Leukemia 2015; 29:739-40. [PMID: 25249013 DOI: 10.1038/leu.2014.282] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- F Passamonti
- Division of Hematology, Department of Medicine, University Hospital Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - A M Vannucchi
- Section of Hematology, Department of Critical Care, University of Florence, Florence, Italy
| | - F Cervantes
- Hematology Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - C Harrison
- Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - E Morra
- Division of Hematology, Ospedale Niguarda Cà Granda, Milano, Italy
| | - H Kantarjian
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
| | - S Verstovsek
- Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA
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Carpenedo M, Cantoni S, Coccini V, Fedele M, Morra E, Pogliani EM. Feasibility of romiplostim discontinuation in adult thrombopoietin-receptor agonist responsive patients with primary immune thrombocytopenia: an observational retrospective report in real life clinical practice. Hematol Rep 2015; 7:5673. [PMID: 25852848 PMCID: PMC4378205 DOI: 10.4081/hr.2015.5673] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 10/14/2014] [Revised: 11/18/2014] [Accepted: 12/04/2014] [Indexed: 11/28/2022] Open
Abstract
Thrombopoietin mimetics are new treatment options for patients with immune throm-bocytopenia (ITP). Because of their mechanism of action, long-term administration was envisioned in order to maintain effective thrombopoiesis. We report on 30 romiplostim treated patients: 13/27 responders (48%) achieved stable platelet counts on a mean romiplostim dose of 2.43 µg/kg and were able to stop romiplostim after a mean of 44.3 weeks (range 12-122) on therapy with sustained response maintained at a mean of 26 months (range 12-52). No bleeding events occurred during the observational period. No specific patient's features nor pattern of early response seemed to predict for sustained response. However, patients achieving safe platelet counts at lower dosages are probably worth a try of therapy tapering and discontinuation. Our observations support feasibility of romiplostim safe suspension in a relevant proportion of ITP patients.
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Affiliation(s)
- Monica Carpenedo
- Hematology and Transplant Unit, A.O. San Gerardo, University of Milan Bicocca; Milan, Italy
| | - Silvia Cantoni
- Hematology and Oncology Department, A.O. Ospedale Niguarda Cà Granda, Milan, Italy
| | - Veronica Coccini
- Hematology and Transplant Unit, A.O. San Gerardo, University of Milan Bicocca; Milan, Italy
| | - Marilena Fedele
- Hematology and Transplant Unit, A.O. San Gerardo, University of Milan Bicocca; Milan, Italy
| | - Enrica Morra
- Hematology and Oncology Department, A.O. Ospedale Niguarda Cà Granda, Milan, Italy
| | - Enrico Maria Pogliani
- Hematology and Transplant Unit, A.O. San Gerardo, University of Milan Bicocca; Milan, Italy
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Morra E, Maurelli S, Chiesa M, Van Doorslaer S. Probing the coordination environment of Ti3+ ions coordinated to nitrogen-containing Lewis bases. Phys Chem Chem Phys 2015. [DOI: 10.1039/c5cp03417e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A combined EPR and DFT study on model systems reveals fingerprint 14N hyperfine and quadrupole data to identify binding of nitrogen-containing Lewis bases to Ti(iii).
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Affiliation(s)
- E. Morra
- Dipartimento di Chimica
- University of Torino Via Giuria
- 7-10125 Torino
- Italy
- University of Antwerp
| | - S. Maurelli
- Dipartimento di Chimica
- University of Torino Via Giuria
- 7-10125 Torino
- Italy
| | - M. Chiesa
- Dipartimento di Chimica
- University of Torino Via Giuria
- 7-10125 Torino
- Italy
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Rossotti R, Travi G, Pazzi A, Baiguera C, Morra E, Puoti M. Rapid clearance of HCV-related splenic marginal zone lymphoma under an interferon-free, NS3/NS4A inhibitor-based treatment. A case report. J Hepatol 2015; 62:234-7. [PMID: 25285757 DOI: 10.1016/j.jhep.2014.09.031] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/25/2014] [Accepted: 09/28/2014] [Indexed: 02/06/2023]
Abstract
Chronic infection with hepatitis C virus (HCV) may lead to B cell activation and transformation into non-Hodgkin lymphoma (NHL). Molecular mechanisms of B cell transformation by HCV are poorly understood. One of the most common lymphoproliferative disorders in HCV-infected patients is splenic marginal zone lymphoma (SMZL). A case of a 42-years old man, affected by HCV-related SMZL, effectively treated with an IFN-free, NS3-NS4A inhibitor-based regimen, is hereby described. The patient was treated for 16 weeks with faldaprevir, deleobuvir, and ribavirin, achieving a very rapid viral eradication without relevant toxicities. A rapid haematologic response was noted as well, with a statistically significant correlation between viral decay and lymphocyte improvement (coefficient r = 0.55, p = 0.042). The viral clearance led to SMZL cure, even without the use of IFN. Thus, the causative role, played by HCV in SMZL development, is once again reinforced, whereby the antiviral, rather than the anti-proliferative activity of IFN is indirectly proven. A regimen including DAAs should be considered when treating a HCV-related extra-hepatic disease.
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Affiliation(s)
- Roberto Rossotti
- Infectious Diseases Department, "Niguarda Cà Granda" Hospital, Milan, Italy.
| | - Giovanna Travi
- Infectious Diseases Department, "Niguarda Cà Granda" Hospital, Milan, Italy
| | - Annamaria Pazzi
- Infectious Diseases Department, "Niguarda Cà Granda" Hospital, Milan, Italy
| | - Chiara Baiguera
- Infectious Diseases Department, "Niguarda Cà Granda" Hospital, Milan, Italy
| | - Enrica Morra
- Oncology/Hematology Department, Niguarda Cancer Center, "Niguarda Cà Granda" Hospital, Milan, Italy
| | - Massimo Puoti
- Infectious Diseases Department, "Niguarda Cà Granda" Hospital, Milan, Italy
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24
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Molteni A, Riva M, Cesana C, Speziale V, Nichelatti M, Scarpati B, Greco R, Ravano E, Cairoli R, Rossini S, Morra E. Prognostic relevance of the flow cytometric count of medullar blasts in myelodysplastic syndromes. Eur J Haematol 2014; 94:519-25. [PMID: 25307971 DOI: 10.1111/ejh.12465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The medullar blast count is a milestone in the prognostic assessment in myelodysplastic syndromes (MDS). The optical microscopy (OM) may sometimes be inaccurate in this disease. The aim of this work is to test the flow immunocytometric (FCM) determinations of medullar immature cells (CD45(±) ) and the expression, among them, of CD33, CD34, and CD117 markers, for their prognostic relevance. METHODS In a retrospective analysis of 98 patients affected by MDS, the IPSS was re-calculated by means of the FCM determination of blasts. Survival of patients at low or intermediate-1 IPSS risk was compared with the survival of patients at intermediate-2 or high IPSS risk. In the 64 cases with OM blast count lower than 5%, the survival of patients with the FCM count of medullar blasts ≤2% was compared with that of patients with FCM count >2%. RESULTS Each single marker had a prognostic weight comparable to the optical blast count. The FCM blast count was particularly efficient in distinguishing the risk of having up to 2% or more than 2% of blasts in patients without OM excess of blasts. CONCLUSION This method is interesting as prognostic tool, especially in patients without excess of blast.
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Affiliation(s)
- Alfredo Molteni
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Marta Riva
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Clara Cesana
- Immuno-Hematology and Transfusional Unit, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Valentina Speziale
- Department of General Medicine, AO Ospedale Civile di Legnano, Legnano, Italy
| | - Michele Nichelatti
- Service of Biostatistics Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Barbara Scarpati
- Immuno-Hematology and Transfusional Unit, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Rosa Greco
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Emanuele Ravano
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Roberto Cairoli
- Department of General Medicine, Oncology and Hematology, Ospedale Valduce, Como, Italy
| | - Silvano Rossini
- Immuno-Hematology and Transfusional Unit, AO Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Enrica Morra
- Department of Hematology, AO Ospedale Niguarda Ca' Granda, Milan, Italy
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Martinelli G, Papayannidis C, Piciocchi A, Vitale A, Iacobucci I, Soverini S, Raimondo FD, Paolini S, Bonifacio M, Carella AM, Cazzola M, Cuneo A, Leoni P, Luppi M, Morra E, Specchia G, Elia L, Foà R, Baccarani M. Abstract 5552: Extremely high rate of complete hematological response of elderly Ph+ acute lymphoblastic leukemia (ALL) patients by innovative sequential use of Nilotinib and Imatinib. A GIMEMA Protocol LAL 1408. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-5552] [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: 11/16/2022]
Abstract
Abstract
Background: We have explored if the administration of two TKIs, Nilotinib (NIL) and Imatinib (IM) can improve the results without increasing the toxicity in the elderly Ph+ Acute Lymphoblastic Leukemia (ALL) patients. We investigate the type and number of BCR-ABL kinase domain mutations developing during and after the study.
Methods: We have designed a study (ClinicalTrials.gov. NCT01025505) in which patients more than 60 years old or unfit for intensive chemotherapy and SCT where treated with two TKIs, NIL 400 mg twice daily, and IM 300 mg twice daily, alternating for 6 weeks for a minimum of 24 weeks (study core) and indefinitely in case of response. The 6-weeks rotation schedule was respected, irrespectively of temporary discontinuations. The primary end-point was the rate of Disease Free Survival (DFS) at 24 weeks (4 courses of treatment); the secondary end points included the evaluation of CHR, CCgR and CMR rates.
Results: 39 patients have been enrolled in 15 Italian hematologic Centers (median age 66 years, range 28-84). Among these, 8 patients were unfit for standard chemotherapy or SCT (median age 50 years, range 28-59). 27 patients were p190, 5 were p210 and 7 were p190/p210. After 6 weeks of treatment, 36 patients were evaluable for response: 34 were in CHR (94%) and 2 in PHR (6%). 23 patients have already completed the study core (24 weeks), 87% were in CHR and 17 are currently continuing therapy in the protocol extension phase.
Thus, the OS at 1 year is 79%, and 64% at 2 years. Overall, 1 patient was primarily resistant and 13 patients have relapsed, with a median time to relapse of 7.6 months (range 0.8-16.1 months), for a DFS of 51.3% at 12 months. Conclusions: In this small cohort of Ph+ ALL elderly/unfit patients, the rates of relapse and progression were not likely to be different from the rates observed with Imatinib alone. Acknowledgements: ELN, AIL, AIRC, PRIN, FP7 NGS-PTL project.
Citation Format: Giovanni Martinelli, Cristina Papayannidis, Alfonso Piciocchi, Antonella Vitale, Ilaria Iacobucci, Simona Soverini, Francesco Di Raimondo, Stefania Paolini, Massimiliano Bonifacio, Angelo Michele Carella, Mario Cazzola, Antonio Cuneo, Pietro Leoni, Mario Luppi, Enrica Morra, Giorgina Specchia, Loredana Elia, Robin Foà, Michele Baccarani. Extremely high rate of complete hematological response of elderly Ph+ acute lymphoblastic leukemia (ALL) patients by innovative sequential use of Nilotinib and Imatinib. A GIMEMA Protocol LAL 1408. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 5552. doi:10.1158/1538-7445.AM2014-5552
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Affiliation(s)
- Giovanni Martinelli
- 1Institute of Hematology L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | | | | | | | - Ilaria Iacobucci
- 1Institute of Hematology L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | - Simona Soverini
- 1Institute of Hematology L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | | | - Stefania Paolini
- 1Institute of Hematology L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
| | | | | | | | | | | | - Mario Luppi
- 10Direttore UO-C Ematologia, AOU Policlinico Modena, Modena, Italy
| | - Enrica Morra
- 11Direttore S.C. Ematologia, Osp. Niguarda Cà Granda, Milano, Italy
| | | | | | - Robin Foà
- 3Hematology, University “Sapienza”, Roma, Italy
| | - Michele Baccarani
- 1Institute of Hematology L. e A. Seràgnoli”, University of Bologna, Bologna, Italy
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26
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Onida F, Barosi G, Leone G, Malcovati L, Morra E, Santini V, Specchia G, Tura S. Management recommendations for chronic myelomonocytic leukemia: consensus statements from the SIE, SIES, GITMO groups. Haematologica 2014; 98:1344-52. [PMID: 24006407 DOI: 10.3324/haematol.2013.084020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
With the aim of reviewing critical concepts and producing recommendations for the management of chronic myelomonocytic leukemia, key questions were selected according to the criterion of clinical relevance. Recommendations were produced using a Delphi process and four consensus conferences involving a panel of experts appointed by the Italian Society of Hematology and affiliated societies. This report presents the final statements and recommendations, covering patient evaluation at diagnosis, diagnostic criteria, risk classification, first-line therapy, monitoring, second-line therapy and allogeneic stem cell transplantation. For the first-line therapy, the panel recommended that patients with myelodysplastic-type chronic myelomonocytic leukemia and less than 10% blasts in bone marrow should be managed with supportive therapy aimed at correcting cytopenias. In patients with myelodysplastic-type chronic myelomonocytic leukemia with a high number of blasts in bone marrow (≥ 10%), supportive therapy should be integrated with the use of 5-azacytidine. Patients with myeloproliferative-type chronic myelomonocytic leukemia with a low number of blasts (<10%) should be treated with cytoreductive therapy. Hydroxyurea is the drug of choice to control cell proliferation and to reduce organomegaly. Patients with myeloproliferative-type chronic myelomonocytic leukemia, and a high number of blasts should receive polychemotherapy. Both in myelodysplastic-type and myeloproliferative-type chronic myelomonocytic leukemia, allogeneic stem cell transplantation should be offered within clinical trials in selected patients.
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Affiliation(s)
- Francesco Onida
- Hematology - Bone Marrow Transplantation Center, Fondazione IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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27
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Montillo M, Tedeschi A, Gaidano G, Coscia M, Petrizzi VB, Orlandi E, Cascavilla N, Ghia P, Motta M, Gallamini A, Frustaci AM, Rossi D, De Paoli L, Nichelatti M, Morra E, Massaia M. Bendamustine and subcutaneous alemtuzumab combination is an effective treatment in relapsed/refractory chronic lymphocytic leukemia patients. Haematologica 2014; 99:e159-61. [PMID: 24972768 DOI: 10.3324/haematol.2014.106740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Marco Montillo
- Department of Oncology/Haematology, Niguarda Cancer Center, Niguarda Ca' Granda Hospital, Milano
| | - Alessandra Tedeschi
- Department of Oncology/Haematology, Niguarda Cancer Center, Niguarda Ca' Granda Hospital, Milano
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara
| | - Marta Coscia
- Hematology Division, University of Torino and Center for Experimental Research and Medical Studies, Torino
| | | | - Ester Orlandi
- Department of Oncology-Hematology, Hematology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Nicola Cascavilla
- Hematology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Milan
| | - Paolo Ghia
- Lymphoma Unit, Department of Onco-Hematology, San Raffaele Scientific Institute and Università Vita-Salute San Raffaele, Milan
| | | | | | - Anna Maria Frustaci
- Department of Oncology/Haematology, Niguarda Cancer Center, Niguarda Ca' Granda Hospital, Milano
| | - Davide Rossi
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara
| | - Lorenzo De Paoli
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara
| | - Michele Nichelatti
- Service of Biostatistics, Niguarda Cancer Center, Niguarda Ca' Granda Hospital, Milano, Italy
| | - Enrica Morra
- Department of Oncology/Haematology, Niguarda Cancer Center, Niguarda Ca' Granda Hospital, Milano
| | - Massimo Massaia
- Hematology Division, University of Torino and Center for Experimental Research and Medical Studies, Torino
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28
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Della Porta MG, Travaglino E, Boveri E, Ponzoni M, Malcovati L, Papaemmanuil E, Rigolin GM, Pascutto C, Croci G, Gianelli U, Milani R, Ambaglio I, Elena C, Ubezio M, Da Via’ MC, Bono E, Pietra D, Quaglia F, Bastia R, Ferretti V, Cuneo A, Morra E, Campbell PJ, Orazi A, Invernizzi R, Cazzola M. Minimal morphological criteria for defining bone marrow dysplasia: a basis for clinical implementation of WHO classification of myelodysplastic syndromes. Leukemia 2014; 29:66-75. [DOI: 10.1038/leu.2014.161] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/19/2014] [Accepted: 05/07/2014] [Indexed: 02/08/2023]
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Nosari AM, Pioltelli ML, Riva M, Marbello L, Nichelatti M, Greco A, Molteni A, Vismara E, Gabutti C, Volonterio A, Lombardi P, Morra E. Invasive fungal infections in lymphoproliferative disorders: a monocentric retrospective experience. Leuk Lymphoma 2014; 55:1844-8. [PMID: 24138328 DOI: 10.3109/10428194.2013.853299] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 11/13/2022]
Abstract
Invasive fungal infections (IFIs) seem to be a relevant cause of morbidity and mortality in patients with chronic lymphoproliferative disorders. We studied retrospectively the epidemiology, clinical manifestations and outcome of invasive fungal infections in 42 patients with lymphoproliferative diseases, treated between January 2004 and February 2012 for probable or proven IFI. In our entire population (1355 patients) of chronic lymphoproliferative malignancies, the incidence of probable/proven IFI was 3% (molds 2.3%, yeasts 0.5%, mixed infections 0.2%). Eight patients developed a yeast infection documented by blood cultures in seven cases and by the microscopic observation of Candida spp. in the vitreum after vitrectomy in one case. Among molds we diagnosed three proven infections by histologic evidence of Aspergillus spp. (n = 2) and Mucor (n = 1) in the lung and 28 probable mycoses. Three mixed infections from both molds and yeasts were also observed. Twenty-two cases showed positivity of galactomannan antigen in the serum (n = 16), in bronchoalveolar lavage (BAL) fluid (n = 4) or in both (n = 2). Cultures were positive in 11 cases. The overall rate of response to therapy was 64%. Fungal-attributable mortality rate was 17%, with a significant difference between molds and yeasts (16% vs. 25%, p = 0.03). At univariate analysis, the only risk factors related to mortality were severe and prolonged neutropenia (p = 0.003) and age (p = 0.03). Among molds, the rapid start of antifungals was probably partially responsible, together with new drugs, for the reduction of mortality, despite the severe immunosuppression of these patients.
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Molteni A, Riva M, Pellizzari A, Borin L, Freyrie A, Greco R, Ubezio M, Bernardi M, Fariciotti A, Nador G, Nichelatti M, Ravano E, Morra E. Corrigendum to ‘Hematological improvement during iron-chelation therapy in myelodysplastic syndromes: The experience of the “Rete Ematologica Lombarda”’ [Leuk Res 37 (2013) 1233–1240]. Leuk Res 2014. [DOI: 10.1016/j.leukres.2013.11.018] [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: 10/25/2022]
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Montillo M, Ricci F, Tedeschi A, Vismara E, Morra E. Bendamustine: new perspective for an old drug in lymphoproliferative disorders. Expert Rev Hematol 2014; 3:131-48. [DOI: 10.1586/ehm.10.7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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32
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Breccia M, Alimena G, Baccarani M, Bocchia M, Di Raimondo F, Gambacorti-Passerini C, Gozzini A, Morra E, Pane F, Pregno P, Rege-Cambrin G, Rosti G, Specchia G, Vigneri P, Saglio G. Current management of CML patients: Summary of the Italian Consensus Meeting held in Rome, April 11-12, 2013. Crit Rev Oncol Hematol 2013; 90:181-9. [PMID: 24405858 DOI: 10.1016/j.critrevonc.2013.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 07/24/2013] [Revised: 11/09/2013] [Accepted: 12/11/2013] [Indexed: 01/19/2023] Open
Abstract
Treatment of Chronic Myeloid Leukaemia (CML) has evolved rapidly in the last 10 years. The objectives of this national consensus meeting were to describe the optimal procedures to perform at diagnosis, the most appropriate choice of tyrosine kinase inhibitor (TKI) in the first line setting, the correct monitoring procedures, the appropriate timing for resistance identification allowing a rapid TKI switch, and the future possibility of treatment discontinuation. A panel of experts in CML management were invited for a 2-day workshop. Prior to the conference, the organizing committee selected several topics and assigned them to different physicians divided in four groups. Issues discussed were (1) role of cytogenetic and molecular response monitoring in 2013; (2) frontline treatment of CML in 2013 and therapeutic objectives; (3) how to monitor response and when to change therapy after resistance or non-optimal responses; (4) possible therapy discontinuation after achievement of deep and stable molecular responses. Different national experts reviewed the literature, analyzed levels of evidence for each topic and, after extensive discussions within smaller working groups, presented their conclusions during the meeting. Each consensus aim was then evaluated by a general vote in the plenary sessions.
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Affiliation(s)
- Massimo Breccia
- Department of Biotechnologies and Cellular Hematology, Sapienza University, Rome, Italy.
| | - Giuliana Alimena
- Department of Biotechnologies and Cellular Hematology, Sapienza University, Rome, Italy
| | | | | | - Francesco Di Raimondo
- Department of Clinical and Molecular Bio-Medicine, Section of Hematology and Oncology, University of Catania, Catania, Italy
| | | | | | - Enrica Morra
- Division of Haematology, Niguarda Hospital, Milan, Italy
| | | | - Patrizia Pregno
- Hematology 2, San Giovanni Battista Hospital and University, Turin, Italy
| | - Giovanna Rege-Cambrin
- Division of Hematology and Internal Medicine, Department of Clinical and Biological Sciences of the University of Turin, Orbassano, Italy
| | | | - Giorgina Specchia
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section University of Bari, Italy
| | - Paolo Vigneri
- Department of Clinical and Molecular Bio-Medicine, Section of Hematology and Oncology, University of Catania, Catania, Italy
| | - Giuseppe Saglio
- Division of Hematology and Internal Medicine, Department of Clinical and Biological Sciences of the University of Turin, Orbassano, Italy
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Morra E, Varettoni M, Tedeschi A, Arcaini L, Ricci F, Pascutto C, Rattotti S, Vismara E, Paris L, Cazzola M. Associated Cancers in Waldenström Macroglobulinemia: Clues for Common Genetic Predisposition. Clinical Lymphoma Myeloma and Leukemia 2013; 13:700-3. [DOI: 10.1016/j.clml.2013.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 05/07/2013] [Accepted: 05/07/2013] [Indexed: 11/30/2022]
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34
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Molteni A, Riva M, Pellizzari A, Borin L, Freyre A, Greco R, Ubezio M, Bernardi M, Fariciotti A, Nador G, Nichelatti M, Ravano E, Morra E. Hematological improvement during iron-chelation therapy in myelodysplastic syndromes: The experience of the “Rete Ematologica Lombarda”. Leuk Res 2013; 37:1233-40. [DOI: 10.1016/j.leukres.2013.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 07/01/2013] [Indexed: 12/16/2022]
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Lo-Coco F, Avvisati G, Vignetti M, Thiede C, Orlando SM, Iacobelli S, Ferrara F, Fazi P, Cicconi L, Di Bona E, Specchia G, Sica S, Divona M, Levis A, Fiedler W, Cerqui E, Breccia M, Fioritoni G, Salih HR, Cazzola M, Melillo L, Carella AM, Brandts CH, Morra E, von Lilienfeld-Toal M, Hertenstein B, Wattad M, Lübbert M, Hänel M, Schmitz N, Link H, Kropp MG, Rambaldi A, La Nasa G, Luppi M, Ciceri F, Finizio O, Venditti A, Fabbiano F, Döhner K, Sauer M, Ganser A, Amadori S, Mandelli F, Döhner H, Ehninger G, Schlenk RF, Platzbecker U. Retinoic acid and arsenic trioxide for acute promyelocytic leukemia. N Engl J Med 2013; 369:111-21. [PMID: 23841729 DOI: 10.1056/nejmoa1300874] [Citation(s) in RCA: 1051] [Impact Index Per Article: 95.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND All-trans retinoic acid (ATRA) with chemotherapy is the standard of care for acute promyelocytic leukemia (APL), resulting in cure rates exceeding 80%. Pilot studies of treatment with arsenic trioxide with or without ATRA have shown high efficacy and reduced hematologic toxicity. METHODS We conducted a phase 3, multicenter trial comparing ATRA plus chemotherapy with ATRA plus arsenic trioxide in patients with APL classified as low-to-intermediate risk (white-cell count, ≤10×10(9) per liter). Patients were randomly assigned to receive either ATRA plus arsenic trioxide for induction and consolidation therapy or standard ATRA-idarubicin induction therapy followed by three cycles of consolidation therapy with ATRA plus chemotherapy and maintenance therapy with low-dose chemotherapy and ATRA. The study was designed as a noninferiority trial to show that the difference between the rates of event-free survival at 2 years in the two groups was not greater than 5%. RESULTS Complete remission was achieved in all 77 patients in the ATRA-arsenic trioxide group who could be evaluated (100%) and in 75 of 79 patients in the ATRA-chemotherapy group (95%) (P=0.12). The median follow-up was 34.4 months. Two-year event-free survival rates were 97% in the ATRA-arsenic trioxide group and 86% in the ATRA-chemotherapy group (95% confidence interval for the difference, 2 to 22 percentage points; P<0.001 for noninferiority and P=0.02 for superiority of ATRA-arsenic trioxide). Overall survival was also better with ATRA-arsenic trioxide (P=0.02). As compared with ATRA-chemotherapy, ATRA-arsenic trioxide was associated with less hematologic toxicity and fewer infections but with more hepatic toxicity. CONCLUSIONS ATRA plus arsenic trioxide is at least not inferior and may be superior to ATRA plus chemotherapy in the treatment of patients with low-to-intermediate-risk APL. (Funded by Associazione Italiana contro le Leucemie and others; ClinicalTrials.gov number, NCT00482833.).
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Affiliation(s)
- Francesco Lo-Coco
- Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Rome, Italy.
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Cairoli R, Beghini A, Turrini M, Bertani G, Nadali G, Rodeghiero F, Castagnola C, Lazzaroni F, Nichelatti M, Ferrara F, Pizzolo G, Pogliani E, Rossi G, Martinelli G, Morra E. Old and new prognostic factors in acute myeloid leukemia with deranged core-binding factor beta. Am J Hematol 2013; 88:594-600. [PMID: 23619823 DOI: 10.1002/ajh.23461] [Citation(s) in RCA: 21] [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] [Received: 03/27/2013] [Revised: 04/04/2013] [Accepted: 04/08/2013] [Indexed: 02/06/2023]
Abstract
Acute myeloid leukemia (AML) with deranged core-binding factor beta (CBFβ) is usually associated with a favorable prognosis with 50-70% of patients cured using contemporary treatments. We analyzed the prognostic significance of clinical features on 58 patients with CBFβ-AML aged ≤60 years. Increasing age was the only predictor for survival (P <0.001), with an optimal cut-point at 43 years. White blood cells (WBCs) at diagnosis emerged as an independent risk factor for relapse incidence (P = 0.017), with 1.1% increase of hazard for each 1.0 × 10(9) /L WBC increment. KIT mutations lacked prognostic value for survival and showed only a trend for relapse incidence (P = 0.069).
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Affiliation(s)
- Roberto Cairoli
- Division of Haematology; Niguarda Hospital; Milan Italy
- Division of Haematology; Department of Internal Medicine; Valduce Hospital; Como Italy
| | - Alessandro Beghini
- Department of Medical Biotechnology and Translational Medicine; University of Milan; Milan Italy
| | - Mauro Turrini
- Division of Haematology; Niguarda Hospital; Milan Italy
| | | | - Gianpaolo Nadali
- Department of Clinical and Experimental Medicine; University of Verona; Verona Italy
| | | | - Carlo Castagnola
- Department of Haematology Oncology; University of Pavia & Fondazione IRCCS Policlinico San Matteo; Pavia Italy
| | - Francesca Lazzaroni
- Department of Medical Biotechnology and Translational Medicine; University of Milan; Milan Italy
| | | | - Felicetto Ferrara
- Division of Haematology and Stem Cell Transplantation Unit; Cardarelli General Hospital; Naples Italy
| | - Giovanni Pizzolo
- Department of Clinical and Experimental Medicine; University of Verona; Verona Italy
| | - Enrico Pogliani
- Division of Hematology and Bone Marrow Transplantation Unit; San Gerardo University Hospital; Monza Italy
| | - Giuseppe Rossi
- Department of Haematology; Spedali Civili; Brescia Italy
| | | | - Enrica Morra
- Division of Haematology; Niguarda Hospital; Milan Italy
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Ricci F, Tedeschi A, Vismara E, Colombo C, Veronese S, Nichelatti M, Cairoli R, Morra E, Montillo M. Should a positive direct antiglobulin test be considered a prognostic predictor in chronic lymphocytic leukemia? Clin Lymphoma Myeloma Leuk 2013; 13:441-6. [PMID: 23773451 DOI: 10.1016/j.clml.2013.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 12/25/2012] [Accepted: 02/01/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The clinical course of patients with B-cell CLL is often complicated by autoimmune phenomena. The DAT might be positive at some time during the course of the disease in up to 35% of cases. The aim of this retrospective study was to investigate the relationship between the occurrence of a positive DAT and biological features of CLL patients. PATIENTS AND METHODS In our institution, 146 untreated patients with CLL were studied using the DAT. RESULTS According to the statistical analysis, a high level of β2-microglobulin and unmutated IgHV emerged as factors significantly related to the presence of DAT positivity. Time to first TFS was significantly shorter in DAT-positive patients. The adverse effect of a DAT positive result was maintained in terms of TFS when patients with mutated IgHV status were excluded from statistical analysis. CONCLUSION These results suggest that the DAT might provide additional prognostic information regarding patients with IgHV unmutated status.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Coombs Test/instrumentation
- Coombs Test/methods
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Male
- Middle Aged
- Prognosis
- Retrospective Studies
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Affiliation(s)
- Francesca Ricci
- Department of Oncology/Hematology, Niguarda Ca' Granda Hospital, Milan, Italy.
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Boveri E, Croci G, Gianelli U, Gambacorta M, Isimbaldi G, Moro A, Gianatti A, Ungari M, Morra E. Histopathological and immunohistochemical evaluation of bone marrow biopsy in myelodysplastic syndromes. Int J Hematol Oncol 2013. [DOI: 10.2217/ijh.13.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY In myelodysplastic syndromes (MDS), bone marrow biopsy (BMB) is now considered part of a multidisciplinary approach to bone marrow (BM) examination that must include cytological and cytogenetic assessment, while flow-cytometry and molecular studies can provide additional useful information. Undervalued in the past, BM histology has recently grown in importance in terms of diagnosis (i.e., MDS with BM fibrosis, hypoplastic MDS) and prognostic assessment (i.e., clusters of CD34+ blasts). Thus, BM histology must be considered complementary and not overlapping with the results of the other methods of BM study. Moreover, in recent years, numerous clinico-pathological studies have evidentiated, codified and standardized a series of histopathological parameters that are now considered essential for an effective and clinically useful histomorphological evaluation of the BMB. The aim of this work is to describe the histopathological and immunohistochemical approach to BMB that the pathologists of the Lombard Hematological Network (Rete Ematologica Lombarda [REL]; Italy) are carrying out on a standardized and shared basis in MDS patients.
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Affiliation(s)
- Emanuela Boveri
- Struttura Complessa di Anatomia Patologica, Fondazione IRCCS Policlinico San Matteo, Via Forlanini 14, Pavia, Italy
| | - Giorgio Croci
- Istituto di Anatomia Patologica, Dipartimento di Medicina Molecolare, Università di Pavia, Via Forlanini 14, Pavia, Italy
| | - Umberto Gianelli
- Unità Operativa Complessa di Anatomia Patologica, Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Fondazione IRCCS Cà Granda – Ospedale Maggiore Policlinico, Milano, Italy
| | - Marcello Gambacorta
- Struttura Complessa di Anatomia Istologia Patologica e Citogenetica, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, Milano, Italy
| | - Giuseppe Isimbaldi
- Unità Operativa di Anatomia Patologica, Citologia e Genetica Medica, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy
| | - Alessia Moro
- Unità Operativa Complessa di Anatomia Patologica, Università degli Studi di Milano, Dipartimento di Scienze della Salute, Azienda Ospedaliera San Paolo, Via Antonio di Rudinì 8, Milano, Italy
| | - Andrea Gianatti
- Unità di Struttura Complessa di Anatomia Patologica, Azienda Ospedaliera Papa Giovanni XXIII, Piazza OMS 1, Bergamo, Italy
| | - Marco Ungari
- Istituto di Anatomia Patologica, Spedali Civili, Piazzale Spedali Civili 1, Brescia, Italy
| | - Enrica Morra
- Struttura di Ematologia, Ospedale Niguarda Ca’ Granda, Piazza Ospedale Maggiore 3, Milano, Italy
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Papayannidis C, Piciocchi A, Vitale A, Iacobucci I, Soverini S, Di Raimondo F, Paolini S, Pizzolo G, Carella AM, Cazzola M, Cuneo A, Leoni P, Luppi M, Morra E, Specchia G, Elia L, Foa R, Baccarani M, Martinelli G. Rate of complete hematological response of elderly Ph+ acute lymphoblastic leukemia (ALL) patients by sequential use of nilotinib and imatinib: A GIMEMA protocol LAL 1408. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.7025] [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: 11/20/2022] Open
Abstract
7025 Background: We have explored if the administration of two TKIs, Nilotinib (NIL) and Imatinib (IM) can improve the results without increasing the toxicity in the elderly Ph+ Acute Lymphoblastic Leukemia (ALL) patients. We investigate the type and number of BCR-ABL kinase domain mutations developing during and after the study. Methods: We have designed a study (ClinicalTrials.gov. NCT01025505) in which patients more than 60 years old or unfit for intensive chemotherapy and SCT where treated with two TKIs, NIL 400 mg twice daily, and IM 300 mg twice daily, alternating for 6 weeks for a minimum of 24 weeks (study core) and indefinitely in case of response. The 6-weeks rotation schedule was respected, irrespectively of temporary discontinuations. The primary end-point was the rate of Disease Free Survival (DFS) at 24 weeks (4 courses of treatment); the secondary end points included the evaluation of CHR, CCgR and CMR rates. Results: 39 patients have been enrolled in 15 Italian hematologic Centers (median age 66 years, range 28-84). Among these, 8 patients were unfit for standard chemotherapy or SCT (median age 50 years, range 28-59). 27 patients were p190, 5 were p210 and 7 were p190/p210. After 6 weeks of treatment, 36 patients were evaluable for response: 34 were in CHR (94%) and 2 in PHR (6%). 23 patients have already completed the study core (24 weeks), 87% were in CHR and 17 are currently continuing therapy in the protocol extension phase. Thus, the OS at 1 year is 79%, and 64% at 2 years. Overall, 1 patient was primarily resistant and 13 patients have relapsed, with a median time to relapse of 7.6 months (range 0.8-16.1 months), for a DFS of 51.3% at 12 months. Conclusions: In this small cohort of Ph+ ALL elderly/unfit patients, the rates of relapse and progression were not likely to be different from the rates observed with Imatinib alone. Acknowledgements: ELN, AIL, AIRC, PRIN. Clinical trial information: NCT01025505.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mario Cazzola
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Cuneo
- Università degli Studi Ferrara, Arcispedale Sant'Anna, Ferrara, Italy
| | - Pietro Leoni
- Division of Hematology, Nuovo Ospedale “Torrette”, Ancona, Italy
| | - Mario Luppi
- Department of Oncology, Haematology and Respiratory Diseases, Section of Haematology, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrica Morra
- Division of Hematology, “Ca Granda Niguarda Hospital”, Milan, Italy
| | | | | | - Robin Foa
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
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Molteni A, Riva M, Ravano E, Greco R, Cesana C, Scarpati B, Morra E. P-099 The prognostic significance of the immunocytometric blast counts in MDS patients with medullar blasts <5% at the optical evaluation. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70147-4] [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: 10/26/2022]
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Trojani A, Greco A, Tedeschi A, Lodola M, Di Camillo B, Ricci F, Turrini M, Varettoni M, Rattotti S, Morra E. Microarray demonstrates different gene expression profiling signatures between Waldenström macroglobulinemia and IgM monoclonal gammopathy of undetermined significance. Clin Lymphoma Myeloma Leuk 2013; 13:208-10. [PMID: 23477935 DOI: 10.1016/j.clml.2013.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Waldenström macroglobulinemia (WM) (symptomatic and indolent) and immunoglobulin M (IgM) monoclonal gammopathy of undetermined significance (IgMMGUS) can be identified based on the bone marrow (BM) infiltration and the existence of symptoms. The purpose of this study was to investigate the biological and genetic characteristics of both disorders comparing the molecular signature of WM versus IgMMGUS using microarray analysis. We investigated BM CD19(+) cells isolated from 21 WM patients and 10 IgMMGUS cases, and CD138(+) BM cells isolated from all of the WM patients and 4 of the IgMMGUS cases. Gene expression profiling of WM versus IgMMGUS CD19(+) cells highlighted 151 differently expressed genes and the comparison with CD138(+) cells demonstrated 43 differently expressed genes in WM versus IgMMGUS. Regulation of transcription, Janus kinase/signal transducer and activator of transcription, PI3K/Akt/mammalian target of rapamycin, mitogen-activated protein kinase signaling pathways are the relevant gene ontology biological processes occurring in CD19(+) cells, and immune response, cell activation, and signaling processes developing in CD138(+) cells mainly distinguish WM and IgMMGUS.
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Trojani A, Di Camillo B, Tedeschi A, Lodola M, Montesano S, Ricci F, Vismara E, Greco A, Veronese S, Orlacchio A, Martino S, Colombo C, Mura M, Nichelatti M, Colosimo A, Scarpati B, Montillo M, Morra E. Gene expression profiling identifies ARSD as a new marker of disease progression and the sphingolipid metabolism as a potential novel metabolism in chronic lymphocytic leukemia. Cancer Biomark 2012; 11:15-28. [PMID: 22820137 DOI: 10.3233/cbm-2012-0259] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Several studies demonstrated IGVH mutational status and ZAP70 expression as the most relevant prognostic markers in Chronic Lymphocytic Leukemia (CLL), suggesting the separation of two patient subgroups: with good mutated ZAP70 negative (MTZAP70(-) and poor unmutated ZAP70 positive (UMZAP70(+)) prognosis. DESIGN AND METHODS We determined the gene expression of B cells in 112 CLL patients divided into three classes: class 1 with MTZAP70(-), class 2 with UMZAP70(+), and class 3 included both UMZAP70(-) and MTZAP70(+). RESULTS We found LPL, AGPAT2, MBOAT1, CHPT1, AGPAT4, PLD1 genes encoding enzymes involved in lipid metabolism overexpressed in UMZAP70(+). In addition, this study identified ARSD, a gene belonging to the sphingolipid metabolism, as a new gene significantly overexpressed in UMZAP70(+) compared to MTZAP70(-). Western blots confirmed that ARSD protein levels were significantly different between the 3 classes of patients and normal controls. Statistical analysis identified a significant correlation between ARSD and IGVH; however, both ARSD protein level and IGVH were independently associated with the need for therapy of CLL patients. CONCLUSIONS ARSD is a novel prognostic factor as the time to start therapy is shorter in patients with high levels of ARSD protein and sphingolipid metabolism could represent a new biological mechanism in CLL.
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Affiliation(s)
- Alessandra Trojani
- Department of Oncology, Division of Hematology, Niguarda Hospital, Milan, Italy.
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Owen RG, Kyle RA, Stone MJ, Rawstron AC, Leblond V, Merlini G, Garcia-Sanz R, Ocio EM, Morra E, Morel P, Anderson KC, Patterson CJ, Munshi NC, Tedeschi A, Joshua DE, Kastritis E, Terpos E, Ghobrial IM, Leleu X, Gertz MA, Ansell SM, Morice WG, Kimby E, Treon SP. Response assessment in Waldenström macroglobulinaemia: update from the VIth International Workshop. Br J Haematol 2012; 160:171-6. [PMID: 23150997 DOI: 10.1111/bjh.12102] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 09/20/2012] [Indexed: 11/27/2022]
Abstract
This report represents a further update of the consensus panel criteria for the assessment of clinical response in patients with Waldenström macroglobulinaemia (WM). These criteria have been updated in light of further data demonstrating an improvement in categorical responses with new drug regimens as well as acknowledgement of the fact that such responses are predictive of overall outcome. A number of key changes are proposed but challenges do however remain and these include the variability in kinetics of immunoglobulin M (IgM) reduction with different treatment modalities and the apparent discrepancy between IgM and bone marrow/tissue response noted with some regimens. Planned sequential bone marrow assessments are encouraged in clinical trials.
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Vianelli N, Palandri F, Polverelli N, Stasi R, Joelsson J, Johansson E, Ruggeri M, Zaja F, Cantoni S, Catucci AE, Candoni A, Morra E, Björkholm M, Baccarani M, Rodeghiero F. Splenectomy as a curative treatment for immune thrombocytopenia: a retrospective analysis of 233 patients with a minimum follow up of 10 years. Haematologica 2012; 98:875-80. [PMID: 23144195 DOI: 10.3324/haematol.2012.075648] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The treatment of choice in steroid-resistant immune thrombocytopenia is still controversial due to the recent advent of new drugs (anti-CD20 antibodies and thrombopoietin mimetics) that have encouraged a generalized tendency to delay splenectomy. Consequently, it is extremely importance to define the efficacy and safety of splenectomy in the long term. We retrospectively analyzed the data of 233 patients affected by immune thrombocytopenia who underwent splenectomy between 1959 and 2001 in 6 European hematologic institutions and who have now a minimum follow up of ten years from surgery. Of the 233 patients, 180 (77%) achieved a complete response and 26 (11%) a response. Sixty-eight of 206 (33%) responsive patients relapsed, mostly (75%) within four years from first response. In 92 patients (39.5%), further treatment was required after splenectomy that was effective in 76 cases (83%). In 138 patients (59%), response was maintained free of any treatment at last contact. No significant association between baseline characteristics and likelihood of stable response was found. Overall, 73 (31%) and 58 (25%) patients experienced at least one infectious or hemorrhagic complication, which was fatal in 2 and 3 patients, respectively. A stable response to splenectomy was associated with a lower rate of infections (P=0.004) and hemorrhages (P<0.0001). Thrombosis developed in 18 patients (8%) and was fatal in 4. Splenectomy achieved a long-term stable response in approximately 60% of cases. Complications mainly affected non-responding patients and were fatal in a minority.
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Affiliation(s)
- Nicola Vianelli
- Department of Hematology and Clinical Oncology L. and A. Seràgnoli, University of Bologna, S. Orsola-Malpighi Hospital, Italy.
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Cervantes F, Dupriez B, Passamonti F, Vannucchi AM, Morra E, Reilly JT, Demory JL, Rumi E, Guglielmelli P, Roncoroni E, Tefferi A, Pereira A. Improving survival trends in primary myelofibrosis: an international study. J Clin Oncol 2012; 30:2981-7. [PMID: 22826273 DOI: 10.1200/jco.2012.42.0240] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Despite the lack of major improvements in the treatment of primary myelofibrosis (PMF), there are recent indications that the survival of patients might have increased over the years. This study was aimed at ascertaining whether survival prolongation has actually occurred in PMF. PATIENTS AND METHODS A total of 802 patients diagnosed with PMF in four European countries were compared for the presentation of features and survival according to the diagnostic periods 1980 to 1995 (n = 434) and 1996 to 2007 (n = 368); relative survival was estimated for the two groups. RESULTS Patients diagnosed between 1996 and 2007 more often had constitutional symptoms (31% v 23%) but a lower incidence of marked anemia (31% v 39%), leukocytosis greater than 25 × 10(9)/L (9% v 13%), and blood blasts (27% v 33%); risk distribution was comparable between the two groups. Median survival was 4.6 years (95% CI, 4.0 to 5.1) for patients from 1980 to 1995 and 6.5 years (95% CI, 5.5 to 7.4) for patients from 1996 to 2007 (P < .001). The latter group of patients showed improved relative survival, especially for women, patients younger than age 65 years, and patients with low or intermediate-1-risk disease. Rates of PMF-attributable mortality at 5 and 10 years were significantly lower in the second period; this reduction in disease-specific mortality occurred across all patient subgroups, except in intermediate-2-risk or high-risk patients. CONCLUSION Survival of PMF is steadily improving, except in patients in poor-risk categories. This observation must be taken into account at the time of evaluating the survival impact of newer therapies for PMF, which are currently being tested in these patient subpopulations.
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Affiliation(s)
- Francisco Cervantes
- Hospital Clínic, Institut d’Investigació Biomèdica August Pi i Sunyer, University of Barcelona, Spain.
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Cesana C, Marbello L, Scarpati B, Calzavara E, Vanzulli A, Soriani S, Nosari A, Morra E. Erythroleukemia presenting with myeloid sarcoma of the lung as detected by immunophenotypic analysis of bronchoalveolar lavage fluid. Leuk Res 2012; 36:e46-9. [DOI: 10.1016/j.leukres.2011.10.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 10/11/2011] [Accepted: 10/31/2011] [Indexed: 10/14/2022]
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Varettoni M, Tedeschi A, Arcaini L, Pascutto C, Vismara E, Orlandi E, Ricci F, Corso A, Greco A, Mangiacavalli S, Lazzarino M, Morra E. Risk of second cancers in Waldenström macroglobulinemia. Ann Oncol 2012; 23:411-5. [DOI: 10.1093/annonc/mdr119] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Oliva EN, Piccin A, Mazzucconi MG, Morra E, Recine U, Pogliani EM, Pane F, Gobbi M, Gugliotta L, Krampera M, Cascavilla N, Cacciola R, Cacciola E, Fioritoni G, Fanin R, Liberati AM, Angelucci E, Tura S. Quality of life in elderly patients with essential thrombocythaemia. An Italian multicentre study. Ann Hematol 2011; 91:527-32. [DOI: 10.1007/s00277-011-1341-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 09/12/2011] [Indexed: 11/28/2022]
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Greco A, Tedeschi A, Varettoni M, Nichelatti M, Paris L, Ricci F, Vismara E, Morra E. Factors predicting transformation of asymptomatic IgM monoclonal gammopathy. Clin Lymphoma Myeloma Leuk 2011; 11:77-9. [PMID: 21454196 DOI: 10.3816/clml.2011.n.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We evaluated the risk of transformation of asymptomatic immunoglobulin (Ig) M monoclonal gammopathy (aIgM MG) into symptomatic lymphoproliferative disease in 287 patients all analyzed for bone marrow histopathology and immunophenotyping. This series included 201 patients with IgM MG of undetermined significance (IgM MGUS) and 86 with smoldering Waldenström's macroglobulinemia (sWM). After a median of 50 months (range, 12-322 months), 32 cases of aIgM-MG (11.1%) evolved into symptomatic malignant lymphoproliferative disease, as follows: symptomatic WM (n=26), non-Hodgkin lymphoma (n=6). The cumulative transformation percentage at 5 and 10 years was 8% and 19.5%, respectively. The parameters significantly correlated with evolution were, at univariate analysis, BM lymphoplasmacytic infiltration, high erythrocyte sedimentation rate, serum MC, serum IgM size, and serum IgA size. Among patients with aIgM-MG, those at high risk of evolution were patients with sWM, a distinct entity with serum IgM monoclonal protein≥3 g/dL and/or ≥10% bone marrow lymphoplasmacytic infiltration.
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Affiliation(s)
- Antonino Greco
- Division of Hematology, Niguarda Ca' Granda Hospital, Milan, Italy
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