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Allegra A, Mirabile G, Caserta S, Stagno F, Russo S, Pioggia G, Gangemi S. Oxidative Stress and Chronic Myeloid Leukemia: A Balance between ROS-Mediated Pro- and Anti-Apoptotic Effects of Tyrosine Kinase Inhibitors. Antioxidants (Basel) 2024; 13:461. [PMID: 38671909 PMCID: PMC11047441 DOI: 10.3390/antiox13040461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/31/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
The balanced reciprocal translocation t (9; 22) (q34; q11) and the BCR-ABL fusion gene, which produce p210 bcr-abl protein production with high tyrosine kinase activity, are characteristics of chronic myeloid leukemia, a myeloproliferative neoplasm. This aberrant protein affects several signaling pathways connected to both apoptosis and cell proliferation. It has been demonstrated that tyrosine kinase inhibitor treatment in chronic myeloid leukemia acts by inducing oxidative stress and, depending on its level, can activate signaling pathways responsible for either apoptosis or survival in leukemic cells. Additionally, oxidative stress and reactive oxygen species generation also mediate apoptosis through genomic activation. Furthermore, it was shown that oxidative stress has a role in both BCR-ABL-independent and BCR-ABL-dependent resistance pathways to tyrosine kinases, while patients with chronic myeloid leukemia were found to have a significantly reduced antioxidant level. The ideal environment for tyrosine kinase inhibitor therapy is produced by a favorable oxidative status. We discuss the latest studies that aim to manipulate the redox system to alter the apoptosis of cancerous cells.
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Affiliation(s)
- Alessandro Allegra
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood ‘Gaetano Barresi’, University of Messina, 98125 Messina, Italy; (G.M.); (S.C.); (F.S.); (S.R.)
| | - Giuseppe Mirabile
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood ‘Gaetano Barresi’, University of Messina, 98125 Messina, Italy; (G.M.); (S.C.); (F.S.); (S.R.)
| | - Santino Caserta
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood ‘Gaetano Barresi’, University of Messina, 98125 Messina, Italy; (G.M.); (S.C.); (F.S.); (S.R.)
| | - Fabio Stagno
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood ‘Gaetano Barresi’, University of Messina, 98125 Messina, Italy; (G.M.); (S.C.); (F.S.); (S.R.)
| | - Sabina Russo
- Division of Hematology, Department of Human Pathology in Adulthood and Childhood ‘Gaetano Barresi’, University of Messina, 98125 Messina, Italy; (G.M.); (S.C.); (F.S.); (S.R.)
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy;
| | - Sebastiano Gangemi
- Allergy and Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy;
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Roszkowska AM, Leanza R, Aragona E, Gargiulo L, Alibrandi A, Arrigo A, Bottaro A, Barone P, Stagno F, Allegra A. Retinal Vessel Analysis and Microvascular Abnormalities in Patients with Philadelphia-Negative Chronic Myeloproliferative Neoplasms. J Clin Med 2024; 13:2232. [PMID: 38673505 PMCID: PMC11051207 DOI: 10.3390/jcm13082232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/02/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Philadelphia-negative chronic myeloproliferative neoplasms are a group of clonal hematopoietic disorders including polycythemia vera, essential thrombocythemia, and primary myelofi-brosis. These neoplasms are characterized by an increased risk of thrombotic complications. Several studies have highlighted that the study of vessels of the retina offers the opportunity to visualize, in vivo, the damage to microcirculation that is common in various systemic pathologies. Methods: in our study, forty patients underwent an ophthalmological examination, using non-invasive imaging tech-niques, for analyses of their retinal vascularization. The objective was to correlate the findings ob-tained from this study of the retina with different markers of thrombotic risk, to demonstrate the usefulness of studying retinal vessels as a possible new prognostic biomarker of thrombotic risk in patients affected by Philadelphia-negative chronic myeloproliferative neoplasms. Results: retinal imaging demonstrated changes in the microcirculation, with a reduced vascular density of the deep and superficial capillary plexuses with respect to a normal group, and a correlation between retinal changes and blood parameters. Conclusions: additional research will allow us to determine whether retinal changes in individuals with chronic myeloproliferative neoplasms could be predictive of the development of thrombotic events in these subjects.
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Affiliation(s)
- Anna Maria Roszkowska
- Ophthalmology Unit, Department of Biomedical Sciences, University of Messina, 98100 Messina, Italy; (A.M.R.); (L.G.)
- Ophthalmology Department, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, 30-705 Kraków, Poland
| | - Rossana Leanza
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (R.L.); (A.B.); (P.B.); (F.S.)
| | - Emanuela Aragona
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, 20132 Milan, Italy; (E.A.); (A.A.)
| | - Ludovica Gargiulo
- Ophthalmology Unit, Department of Biomedical Sciences, University of Messina, 98100 Messina, Italy; (A.M.R.); (L.G.)
| | - Angela Alibrandi
- Unit of Statistical and Mathematical Sciences, Department of Economics, University of Messina, 98100 Messina, Italy;
| | - Alessandro Arrigo
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, 20132 Milan, Italy; (E.A.); (A.A.)
| | - Adele Bottaro
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (R.L.); (A.B.); (P.B.); (F.S.)
| | - Paola Barone
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (R.L.); (A.B.); (P.B.); (F.S.)
| | - Fabio Stagno
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (R.L.); (A.B.); (P.B.); (F.S.)
| | - Alessandro Allegra
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (R.L.); (A.B.); (P.B.); (F.S.)
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Crespiatico I, Zaghi M, Mastini C, D'Aliberti D, Mauri M, Mercado CM, Fontana D, Spinelli S, Crippa V, Inzoli E, Manghisi B, Civettini I, Ramazzotti D, Sangiorgio V, Gengotti M, Brambilla V, Aroldi A, Banfi F, Barone C, Orsenigo R, Riera L, Riminucci M, Corsi A, Breccia M, Morotti A, Cilloni D, Roccaro A, Sacco A, Stagno F, Serafini M, Mottadelli F, Cazzaniga G, Pagni F, Chiarle R, Azzoni E, Sessa A, Gambacorti-Passerini C, Elli EM, Mologni L, Piazza R. First-hit SETBP1 mutations cause a myeloproliferative disorder with bone marrow fibrosis. Blood 2024; 143:1399-1413. [PMID: 38194688 DOI: 10.1182/blood.2023021349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024] Open
Abstract
ABSTRACT SETBP1 mutations are found in various clonal myeloid disorders. However, it is unclear whether they can initiate leukemia, because SETBP1 mutations typically appear as later events during oncogenesis. To answer this question, we generated a mouse model expressing mutated SETBP1 in hematopoietic tissue: this model showed profound alterations in the differentiation program of hematopoietic progenitors and developed a myeloid neoplasm with megakaryocytic dysplasia, splenomegaly, and bone marrow fibrosis, prompting us to investigate SETBP1 mutations in a cohort of 36 triple-negative primary myelofibrosis (TN-PMF) cases. We identified 2 distinct subgroups, one carrying SETBP1 mutations and the other completely devoid of somatic variants. Clinically, a striking difference in disease aggressiveness was noted, with patients with SETBP1 mutation showing a much worse clinical course. In contrast to myelodysplastic/myeloproliferative neoplasms, in which SETBP1 mutations are mostly found as a late clonal event, single-cell clonal hierarchy reconstruction in 3 patients with TN-PMF from our cohort revealed SETBP1 to be a very early event, suggesting that the phenotype of the different SETBP1+ disorders may be shaped by the opposite hierarchy of the same clonal SETBP1 variants.
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Affiliation(s)
- Ilaria Crespiatico
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Mattia Zaghi
- Neuroepigenetics Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Mastini
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Deborah D'Aliberti
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Mario Mauri
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Carl Mirko Mercado
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Diletta Fontana
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Silvia Spinelli
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Valentina Crippa
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Elena Inzoli
- Hematology Division and Bone Marrow Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy
| | - Beatrice Manghisi
- Hematology Division and Bone Marrow Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy
| | - Ivan Civettini
- Hematology Division and Bone Marrow Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy
| | - Daniele Ramazzotti
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Valentina Sangiorgio
- Hematology Division and Bone Marrow Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy
| | - Michele Gengotti
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | | | - Andrea Aroldi
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Hematology Division and Bone Marrow Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy
| | - Federica Banfi
- Neuroepigenetics Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Cristiana Barone
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Roberto Orsenigo
- Biomedical Research in Melanoma-Animal Models and Cancer Laboratory, Vall d'Hebron Research Institute, Vall d'Hebron Hospital Barcelona UAB, Barcelona, Spain
| | - Ludovica Riera
- Department of Pathology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Mara Riminucci
- Department of Molecular Medicine, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alessandro Corsi
- Department of Molecular Medicine, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Massimo Breccia
- Department of Translational and Precision Medicine, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alessandro Morotti
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin, Italy
| | - Aldo Roccaro
- Clinical Trial Center, Translational Research and Phase I Unit, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy
| | - Antonio Sacco
- Clinical Trial Center, Translational Research and Phase I Unit, Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, Brescia, Italy
| | - Fabio Stagno
- Division of Hematology, Azienda Ospedaliero Universitaria Policlinico G. Rodolico-S. Marco, Catania, Italy
| | - Marta Serafini
- Centro Tettamanti, Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy
| | - Federica Mottadelli
- Centro Tettamanti, Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy
| | - Giovanni Cazzaniga
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Centro Tettamanti, Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy
| | - Fabio Pagni
- Department of Pathology, University of Milan-Bicocca, Monza, Italy
| | - Roberto Chiarle
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Italy
- Department of Pathology, Children's Hospital and Harvard Medical School, Boston, MA
- European Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico, Division of Haematopathology, Milan, Italy
| | - Emanuele Azzoni
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Alessandro Sessa
- Neuroepigenetics Unit, Division of Neuroscience, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Gambacorti-Passerini
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Hematology Division and Bone Marrow Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy
| | - Elena Maria Elli
- Hematology Division and Bone Marrow Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy
| | - Luca Mologni
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Rocco Piazza
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Hematology Division and Bone Marrow Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico San Gerardo dei Tintori, Monza, Italy
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Mulas O, Abruzzese E, Luciano L, Iurlo A, Attolico I, Castagnetti F, Galimberti S, Bonifacio M, Annunziata M, Gozzini A, Orlandi EM, Stagno F, Binotto G, Pregno P, Fozza C, Loi M, Trawinska MM, De Gregorio F, Cattaneo D, Albano F, Iezza M, Baratè C, Scaffidi L, Elena C, Giai V, Scalzulli E, Breccia M, La Nasa G, Caocci G. The new Systematic Coronary Risk Evaluation (SCORE2 and SCORE2-OP) estimates the risk of arterial occlusive events in chronic myeloid leukemia patients treated with nilotinib or ponatinib. Ann Hematol 2024; 103:427-436. [PMID: 38012435 PMCID: PMC10798925 DOI: 10.1007/s00277-023-05556-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/19/2023] [Indexed: 11/29/2023]
Abstract
Patients with chronic myeloid leukemia (CML) treated with nilotinib or ponatinib may experience arterial occlusive events (AOEs). It is currently recommended to thoroughly assess cardiovascular risk factors before treating CML. We identified 455 consecutive CML adult patients, 335 treated with nilotinib and 120 with ponatinib; 380 patients without previous cardiovascular diseases or diabetes were stratified according to the Systematic Coronary Risk Evaluation (SCORE2) and SCORE2-Older Persons (SCORE2-OP). This updated algorithm from the European Society of Cardiology (ESC) estimates a 10-year risk of fatal and non-fatal cardiovascular diseases. It is based on sex, age, smoking habits, systolic blood pressure, non-high-density lipoprotein cholesterol, and European geographical region of cardiovascular risk. The SCORE2/SCORE2-OP algorithm translated more patients (50.2%) to the high-very high cardiovascular risk category than the previous SCORE (25.3%). Patients with a high to very high SCORE2/SCORE2-OP risk showed a significantly higher incidence rate of AOEs (69.2% vs. 46.5%, p < 0.001). The older SCORE was less specific in estimating AOEs in patients classified as low-intermediate risk (69.8 vs. 54.2%). In multivariate analysis, no associations were found between AOEs and gender, age, and type or dose of tyrosine kinase inhibitor. Only the SCORE2/SCORE2-OP risk was confirmed as a significant predictive factor (p = 0.028; hazard ratio = 2.2; 95% confidence interval = 1.1-4.5). Patients with AOEs required, in most cases, imaging diagnostic tests, additional drugs, and sometimes invasive procedures, increasing access to visits and hospital management. This real-life study suggested that the SCORE2 and SCORE2-OP charts could help identify cardiovascular fragility in CML patients providing them with more attention and a proper TKI selection.
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MESH Headings
- Adult
- Humans
- Aged
- Aged, 80 and over
- Cardiovascular Diseases/chemically induced
- Cardiovascular Diseases/epidemiology
- Cardiovascular Diseases/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/chemically induced
- Imidazoles/adverse effects
- Pyrimidines/therapeutic use
- Protein Kinase Inhibitors/adverse effects
- Pyridazines
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Affiliation(s)
- Olga Mulas
- Department of Medical Sciences and Public Health, Hematology Unit, Businco Hospital, University of Cagliari, Cagliari, Italy
| | | | - Luigiana Luciano
- Hematology Unit "Federico II", University of Naples, Naples, Italy
| | - Alessandra Iurlo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Immacolata Attolico
- Hematology and Stem Cell Transplantation Unit, Azienda Ospedaliero-Universitaria-Consorziale (AOUC) - Policlinico, Bari, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | | | | | - Antonella Gozzini
- Hematology Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Ester Maria Orlandi
- Division of Hematology, Fondazione IRCCS Policlinico S. Matteo", Pavia, Italy
| | - Fabio Stagno
- Hematology Unit, AOU Policlinico - V. Emanuele, Rodolico Hospital, Catania, Italy
| | | | - Patrizia Pregno
- Hematology Unit, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Turin, Italy
| | - Claudio Fozza
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Maurizio Loi
- Department of Medical Sciences and Public Health, Hematology Unit, Businco Hospital, University of Cagliari, Cagliari, Italy
| | | | | | - Daniele Cattaneo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Albano
- Hematology and Stem Cell Transplantation Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro", Bari, Italy
| | - Miriam Iezza
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Chiara Elena
- Division of Hematology, Fondazione IRCCS Policlinico S. Matteo", Pavia, Italy
| | - Valentina Giai
- Hematology Unit, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Turin, Italy
| | - Emilia Scalzulli
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Giorgio La Nasa
- Department of Medical Sciences and Public Health, Hematology Unit, Businco Hospital, University of Cagliari, Cagliari, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, Hematology Unit, Businco Hospital, University of Cagliari, Cagliari, Italy.
- SC Ematologia E CTMO, Ospedale Businco, Dipartimento di Scienze Mediche e Sanità Pubblica, Università Di Cagliari, Via Jenner, Sn, 09124, Cagliari, Italy.
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Caserta S, Stagno F, Gangemi S, Allegra A. Highlights on the Effects of Non-Coding RNAs in the Osteonecrosis of the Jaw. Int J Mol Sci 2024; 25:1598. [PMID: 38338876 PMCID: PMC10855359 DOI: 10.3390/ijms25031598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Osteonecrosis of the jaw is the progressive loss and destruction of bone affecting the maxilla or mandible in patients treated with antiresorptive and antiangiogenic agents without receiving prior radiation therapy. The pathogenesis involves the inflammatory pathway of receptor activator of nuclear factor NF-kB ligand and the macrophage colony-stimulating factor, essential for osteoclast precursors survival and proliferation and acting through its receptor c-Fms. Evidence has shown the role of non-coding RNAs in the pathogenesis of osteonecrosis of the jaw and this finding might be useful in diagnosis since these small RNAs could be considered as biomarkers of apoptotic activity in bone. Interestingly, it has been proved that miR-29 and miR-31-5p, acting on specific targets such as CALCR and RhoA, promote programmed-cell death and consequently the necrosis of bone tissue. Specific long non-coding RNAs, instead, have been detected both at reduced levels in patients with multiple myeloma and osteonecrosis, and associated with suppression of osteoblast differentiation, with consequences in the progression of mandible lesions. Among non-coding genic material, circular RNAs have the capability to modify the expression of specific mRNAs responsible for the inhibition of bisphosphonates activity on osteoclastogenesis.
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Affiliation(s)
- Santino Caserta
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (S.C.); (A.A.)
| | - Fabio Stagno
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (S.C.); (A.A.)
| | - Sebastiano Gangemi
- Allergy and Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125 Messina, Italy;
| | - Alessandro Allegra
- Hematology Unit, Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, University of Messina, Via Consolare Valeria, 98125 Messina, Italy; (S.C.); (A.A.)
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6
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Malagola M, Iurlo A, Bucelli C, Abruzzese E, Bonifacio M, Stagno F, Binotto G, D'Adda M, Lunghi M, Crugnola M, Ferrari ML, Lunghi F, Castagnetti F, Rosti G, Lemoli RM, Sancetta R, Coppi MR, Corsetti MT, De Gobbi M, Romano A, Tiribelli M, Russo Rossi A, Russo S, Defina M, Farina M, Bernardi S, Butturini G, Pellizzeri S, Roccaro AM, Russo D. The Italian Multicentric Randomized OPTkIMA Trial on Fixed vs Progressive Intermittent TKI Therapy in CML Elderly Patients: 3-Years of Molecular Response and Quality of Life Monitoring After Completing the Treatment Plan. Clin Lymphoma Myeloma Leuk 2024:S2152-2650(24)00035-1. [PMID: 38369436 DOI: 10.1016/j.clml.2024.01.008] [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] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Intermittent treatment with tyrosine kinase inhibitors (TKIs) is an option for elderly chronic myeloid leukemia (CML) patients who are often candidates for life-long treatment. MATERIALS AND METHODS The Italian phase III multicentric randomized Optimize TKIs Multiple Approaches (OPTkIMA) study aimed to evaluate if a progressive de-escalation of TKIs is able to maintain the molecular remission (MR)3.0 and to improve Health-Related Quality of Life (HRQoL) in CML elderly patients. RESULTS A total of 215 patients in stable MR3.0/MR4.0 were randomized to receive an intermittent TKI schedule 1 month ON-1 month OFF for 3 years (FIXED arm; n = 111) vs. a progressive de-escalation TKI dose up to one-third of the starting dose at the 3rd year (PROGRESSIVE arm; n = 104). Two hundred three patients completed the 3rd year of OPTkIMA study. At the last follow-up, MR3.0 loss was 27% vs. 46% (P = .005) in the FIXED vs PROGRESSIVE arm, respectively. None of these patients experienced disease progression. The 3-year probability of maintaining the MR3.0 was 59% vs. 53%, respectively (P = .13). HRQoL globally improved from the baseline to the 3rd year, without any significant difference between the 2 arms. After the 3rd year, the proportion of patients who was address to TKI discontinuation in the 2 arms was 36% (FIXED) vs. 58% (PROGRESSIVE) (P = .03). CONCLUSIONS The intensification of intermittent TKI therapy is associated with a higher incidence of MR3.0 loss, but those patients who maintain the MR3.0 molecular response at the end of the study have been frequently considered eligible for TFR. The HRQoL generally improved during the de-escalation therapy in both randomization arms.
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Affiliation(s)
- Michele Malagola
- Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, Unit of Blood Disease and Stem Cell Transplantation, ASST-Spedali Civili, Brescia, Italy.
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Cristina Bucelli
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Elisabetta Abruzzese
- Division of Hematology, S. Eugenio Hospital, ASL ROMA2, Tor Vergata University, Roma, Italy
| | - Massimiliano Bonifacio
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area - University of Verona, Italy
| | - Fabio Stagno
- Hematology Unit, AOU Policlinico "G. Martino", University of Messina, Italy
| | - Gianni Binotto
- Hematology and Clinical Immunology, Department of Medicine, Padua School of Medicine, Padova, Italy
| | - Marienlla D'Adda
- Division of Hematology, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Monia Lunghi
- Division of Hematology, Department of Translation Medicine, University of Eastern Piedmont, Novara, Italy
| | - Monica Crugnola
- Hematology Unit and BMT Center University Hospital of Parma, Italy
| | - Maria Luisa Ferrari
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Lunghi
- Hematology and Bone Marrow Transplantation (BMT) Unit, San Raffaele Scientific Institute, Milano, Italy
| | - Fausto Castagnetti
- Institute of Hematology "Seràgnoli" IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences University of Bologna, Bologna, Italy
| | - Gianantonio Rosti
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola (FC), Italy
| | - Roberto Massimo Lemoli
- Chair of Hematology, Internal Medicine Dpt, University of Genova, Italy; Clinic of Hematology, IRCCS Policlinico San Martino, Genova, Italy
| | | | | | - Maria Teresa Corsetti
- Hematology Division, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marco De Gobbi
- Hematology and Internal Medicine Division, San Luigi Hospital, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy
| | - Atelda Romano
- IRCCS Regina Elena National Cancer Institute-Roma, Italy
| | - Mario Tiribelli
- Division of Hematology and BMT, Department of Medicine, University of Udine, Udine, Italy
| | | | - Sabina Russo
- Division of Hematology, Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva, Policlinico G Martino, University of Messina, Messina, Italy
| | - Marzia Defina
- Hematology Unit, Dipartimento Terapie Cellulari, Ematologia e Medicina di Laboratorio, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Mirko Farina
- Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, Unit of Blood Disease and Stem Cell Transplantation, ASST-Spedali Civili, Brescia, Italy
| | - Simona Bernardi
- Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, Unit of Blood Disease and Stem Cell Transplantation, ASST-Spedali Civili, Brescia, Italy; CREA Laboratory (Hematological-Research AIL Centre), ASST-Spedali Civili Brescia, Italy
| | - Giulia Butturini
- Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, Unit of Blood Disease and Stem Cell Transplantation, ASST-Spedali Civili, Brescia, Italy
| | - Simone Pellizzeri
- Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, Unit of Blood Disease and Stem Cell Transplantation, ASST-Spedali Civili, Brescia, Italy
| | - Aldo Maria Roccaro
- Clinical Trial Center. Translational Research and Phase I Unit, ASST Spedali Civili, Brescia, Italy
| | - Domenico Russo
- Chair of Hematology, Department of Clinical and Experimental Sciences, University of Brescia, Unit of Blood Disease and Stem Cell Transplantation, ASST-Spedali Civili, Brescia, Italy
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7
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Zambrotta GPM, Nicolini FE, Assouline S, Busque L, Pungolino E, Abruzzese E, Miggiano MC, Elena C, Alvarez-Larran A, Triguero A, Iurlo A, Bucelli C, Cerrano M, Capodanno I, Lunghi F, le Coutre P, Galimberti S, Caocci G, Maffioli M, Stagno F, Saussele S, Piazza R, Druker BJ, Fava C, Guglielmana V, Colombo F, Antolini L, Gambacorti-Passerini C. Risk of progression in chronic phase-chronic myeloid leukemia patients eligible for tyrosine kinase inhibitor discontinuation: Final analysis of the TFR-PRO study. Am J Hematol 2023; 98:1762-1771. [PMID: 37647134 DOI: 10.1002/ajh.27073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
Disease progression to accelerated/blast phase (AP/BP) in patients with chronic phase chronic myeloid leukemia (CP-CML) after treatment discontinuation (TD) has never been systematically reported in clinical trials. However, recent reports of several such cases has raised concern. To estimate the risk of AP/BP among TD-eligible patients, we conducted TFR-PRO, a cohort retro-prospective study: 870 CP-CML patients eligible for TD formed a discontinuation cohort (505 patients) and a reference one (365 patients). The primary objective was the time adjusted rate (TAR) of progression in relation to TD. Secondary endpoints included the TAR of molecular relapse, that is, loss of major molecular response (MMR). With a median follow up of 5.5 years and 5188.2 person-years available, no events occurred in the TD cohort. One event of progression was registered 55 months after the end of TD, when the patient was contributing to the reference cohort. The TAR of progression was 0.019/100 person-years (95% CI [0.003-0.138]) in the overall group; 0.0 (95% CI [0-0.163]) in the discontinuation cohort; and 0.030 (95% CI [0.004-0.215]) in the reference cohort. These differences are not statistically significant. Molecular relapses occurred in 172/505 (34.1%) patients after TD, and in 64/365 (17.5%) patients in the reference cohort, p < .0001. Similar rates were observed in TD patients in first, second or third line of treatment. CML progression in patients eligible for TD is rare and not related to TD. Fears about the risk of disease progression among patients attempting TD should be dissipated.
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Affiliation(s)
- Giovanni Paolo Maria Zambrotta
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Hematology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Franck E Nicolini
- Hématologie clinique & INSEM U1052, Centre Léon Bérard, Lyon, France
| | - Sarit Assouline
- Department of Medicine and Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Lambert Busque
- Hematology Division, Research Center, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Ester Pungolino
- Division of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | - Chiara Elena
- Department of Hematology Oncology, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Ana Triguero
- Hematology Department, Hospital Clínic, Barcelona, Spain
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Bucelli
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Cerrano
- Department of Hematology, University-Hospital Città della Salute e della Scienza, Turin, Italy
| | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Lunghi
- Department of Onco-Haematology - Haematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute and Vita-Salute Hospital, Milan, Italy
| | - Philipp le Coutre
- Department of Hematology, Oncology and Tumor Immunology, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, Azienda ospedaliera Pisana, University of Pisa, Pisa, Italy
| | - Giovanni Caocci
- Hematology Unit, Cagliari University, Businco Hospital, Cagliari, Italy
| | | | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplantation Unit, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Susanne Saussele
- Department of Hematology and Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany
| | - Rocco Piazza
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Hematology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Brian J Druker
- Division of Hematology/Medical Oncology, Knight Cancer Insitute, Oregon Health & Science University, Portland, Oregon, USA
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Veronica Guglielmana
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Hematology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Federica Colombo
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Hematology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Laura Antolini
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Carlo Gambacorti-Passerini
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Hematology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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8
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Massimino M, Stella S, Tirrò E, Pennisi MS, Stagno F, Vitale SR, Romano C, Tomarchio C, Parrinello NL, Manzella L, Di Raimondo F, Vigneri P. High BCR::ABL1 Expression Defines CD34+ Cells with Significant Alterations in Signal Transduction, Short-Proliferative Potential and Self-Renewal Ability. Onco Targets Ther 2023; 16:803-816. [PMID: 37807980 PMCID: PMC10559794 DOI: 10.2147/ott.s413825] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/12/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose Chronic Myeloid Leukemia (CML) is a clonal disorder of the hematopoietic stem cell caused by expression of the BCR::ABL1 oncoprotein. High BCR::ABL1 levels have been associated to proliferative advantage of leukemic cells, blast crisis progression and tyrosine kinase inhibitors (TKIs) inefficacy. We have previously shown that high BCR::ABL1/GUSIS transcripts measured at diagnosis are associated with inferior responses to standard dose Imatinib (IM). However, the mechanisms underlying the higher rates of disease progression and development of TKIs resistance dependent on elevated BCR::ABL1 levels remain unclear. Methods Leukemic cells were collected from CML patients showing, at diagnosis, high or low BCR::ABL1/GUSIS. BCR::ABL1 expression levels were measured using real-time PCR. Short-term culture and long-term culture-initiating cells assays were employed to investigate the role of BCR::ABL1 gene-expression levels on proliferation, clonogenicity, signal transduction, TKIs responsiveness and self-renewal ability. Cell division was performed by carboxyfluorescein-succinimidyl ester (CFSE) assay. Results We found that BCR::ABL1 oncogene expression levels correlate in both PMNs and CD34+ cells. Furthermore, high oncogene levels increased both proliferation and anti-apoptotic signaling via ERK and AKT phosphorylation. Moreover, high BCR::ABL1 expression reduced the clonogenicity of leukemic CD34+ cells and increased their sensitivity to high doses IM but not to those of dasatinib. Furthermore, we observed that high BCR::ABL1 levels are associated with a reduced self-renewal of primitive leukemic cells and, also, that these cells showed comparable TKIs responsiveness with cells expressing lower BCR::ABL1 levels. Interestingly, we found a direct correlation between high BCR::ABL1 levels and reduced number of quiescent leukemic cells caused by increasing their cycling. Conclusion Higher BCR::ABL1 levels improving the proliferation, anti-apoptotic signaling and reducing self-renewal properties cause an increased expansion of leukemic clone.
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Affiliation(s)
- Michele Massimino
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, Catania, Italy
| | - Stefania Stella
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Elena Tirrò
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Maria Stella Pennisi
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Fabio Stagno
- Division of Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, Catania, Italy
| | - Silvia Rita Vitale
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Chiara Romano
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, Catania, Italy
- Department of Medical, Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, Anatomic Pathology, University of Catania, Catania, Italy
| | - Cristina Tomarchio
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Livia Manzella
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Paolo Vigneri
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, Catania, Italy
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Humanitas Istituto Clinico Catanese, University Oncology Department, Catania, Italy
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9
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Tiribelli M, Latagliata R, Breccia M, Capodanno I, Miggiano MC, Cavazzini F, Bucelli C, Attolico I, Crescenzi SL, Russo S, Annunziata M, Sorà F, Bonifacio M, Mulas O, Loglisci G, Maggi A, Binotto G, Crisà E, Scortechini AR, Leporace AP, Sancetta R, Murgano P, Abruzzese E, Stagno F, Rapezzi D, Luzi D, Vincelli I, Bocchia M, Fava C, Malato A, Crugnola M, Pizzuti M, Lunghi F, Galimberti S, Dalmazzo M, Fanin R, Scalzulli E, Foà R, Iurlo A, Saglio G, Specchia G. Determinants of frontline tyrosine kinase inhibitor choice for patients with chronic-phase chronic myeloid leukemia: A study from the Registro Italiano LMC and Campus CML. Cancer 2023; 129:2637-2644. [PMID: 37354090 DOI: 10.1002/cncr.34923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Imatinib, dasatinib, and nilotinib are tyrosine kinase inhibitors (TKIs) approved in Italy for frontline treatment of chronic-phase chronic myeloid leukemia (CP-CML). The choice of TKI is based on a combined evaluation of the patient's and the disease characteristics. The aim of this study was to analyze the use of frontline TKI therapy in an unselected cohort of Italian patients with CP-CML to correlate the choice with the patient's features. METHODS A total of 1967 patients with CP-CML diagnosed between 2012 and 2019 at 36 centers throughout Italy were retrospectively evaluated; 1089 patients (55.4%) received imatinib and 878 patients (44.6%) received a second-generation (2G) TKI. RESULTS Second-generation TKIs were chosen for most patients aged <45 years (69.2%), whereas imatinib was used in 76.7% of patients aged >65 years (p < .001). There was a predominant use of imatinib in intermediate/high European long-term survival risk patients (60.0%/66.0% vs. 49.7% in low-risk patients) and a limited use of 2G-TKIs in patients with comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease, previous neoplasms, ischemic heart disease, or stroke and in those with >3 concomitant drugs. We observed a greater use of imatinib (61.1%) in patients diagnosed in 2018-2019 compared to 2012-2017 (53.2%; p = .002). In multivariable analysis, factors correlated with imatinib use were age > 65 years, spleen size, the presence of comorbidities, and ≥3 concomitant medications. CONCLUSIONS This observational study of almost 2000 cases of CML shows that imatinib is the frontline drug of choice in 55% of Italian patients with CP-CML, with 2G-TKIs prevalently used in younger patients and in those with no concomitant clinical conditions. Introduction of the generic formulation in 2018 seems to have fostered imatinib use.
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Affiliation(s)
- Mario Tiribelli
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medical Area, University of Udine, Udine, Italy
| | | | - Massimo Breccia
- Hematology, Department of Precision and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | | | | | - Cristina Bucelli
- Division of Hematology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Immacolata Attolico
- Hematology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Sabina Russo
- Hematology, University of Messina, Messina, Italy
| | | | - Federica Sorà
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, and Department of Radiological and Hematological Sciences, Cattolica University, Rome, Italy
| | | | - Olga Mulas
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | - Gianni Binotto
- Hematology and Clinical Immunology, Department of Medicine, University of Padua, Padua, Italy
| | - Elena Crisà
- Hematology, Ospedale Maggiore della Carità di Novara, University of Eastern Piedmont, Novara, Italy
| | | | | | | | - Pamela Murgano
- Division of Hematology, Sant'Elia Hospital, Caltanissetta, Italy
| | | | - Fabio Stagno
- Hematology Section and Bone Marrow Transplant Unit, Rodolico Hospital, Azienda Ospedaliero Universitaria Policlinico "Rodolico-San Marco", Catania, Italy
| | - Davide Rapezzi
- Hematology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | - Debora Luzi
- Onco-Hematology Department, Azienda Ospedaliera Santa Maria, Terni, Italy
| | - Iolanda Vincelli
- Hematology, Bianchi-Melacrino-Morelli Hospital, Reggio Calabria, Italy
| | - Monica Bocchia
- Hematology, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Monica Crugnola
- Hematology and Stem Cell Transplant Unit, Azienda Ospedaliero Universitaria, Parma, Italy
| | | | | | | | - Matteo Dalmazzo
- Division of Hematology and Internal Medicine, "San Luigi Gonzaga" University Hospital, Turin, Italy
| | - Renato Fanin
- Division of Hematology and Bone Marrow Transplant, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
- Department of Medical Area, University of Udine, Udine, Italy
| | - Emilia Scalzulli
- Hematology, Department of Precision and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Precision and Translational Medicine, "Sapienza" University, Rome, Italy
| | - Alessandra Iurlo
- Division of Hematology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giorgina Specchia
- Hematology Section, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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10
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Breccia M, Piciocchi A, Abruzzese E, Cilloni D, Messina M, Soddu S, Castagnetti F, Stagno F, Fazi P, Iurlo A, Caocci G, Gozzini A, Intermesoli T, D’Adda M, Pane F. Italian Physicians' Perceptions about the Role of Asciminib in Later Lines Chronic Myeloid Leukemia in Clinical Practice: A GIMEMA Survey. J Clin Med 2023; 12:5267. [PMID: 37629308 PMCID: PMC10455524 DOI: 10.3390/jcm12165267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Unmet needs remain in later lines chronic myeloid leukemia (CML): the response rate and the overall survival of resistant patients in the chronic phase who changed a second-generation TKI in the second line with another TKI with similar action are usually poor, while the off-target toxicities and the potential development of mutations increase. The recent approval of asciminib, a STAMP inhibitor, in the third line, has the potential to soon change the therapeutic algorithm for this subset of patients. Here, we report the results of a GIMEMA survey assessing the number of patients currently treated in the third line in Italy, the current approach in later lines by Italian physicians, and the future role of this drug according to the reason to switch to asciminib (resistance and/or intolerance), as well as the perceptions about the future position of this agent.
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Affiliation(s)
- Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University, 00161 Rome, Italy
| | - Alfonso Piciocchi
- GIMEMA Foundation, 00182 Rome, Italy; (A.P.); (M.M.); (S.S.); (P.F.)
| | - Elisabetta Abruzzese
- Unità Operativa Complessa U.O.C. Ematologia, Ospedale S. Eugenio, 00144 Rome, Italy;
| | - Daniela Cilloni
- Ematologia, Azienda Ospedaliera Mauriziano Umberto I, 10128 Turin, Italy;
| | - Monica Messina
- GIMEMA Foundation, 00182 Rome, Italy; (A.P.); (M.M.); (S.S.); (P.F.)
| | - Stefano Soddu
- GIMEMA Foundation, 00182 Rome, Italy; (A.P.); (M.M.); (S.S.); (P.F.)
| | - Fausto Castagnetti
- Hematology Unit, IRCCS Azienda Ospedaliero, University of Bologna, 40138 Bologna, Italy;
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Fabio Stagno
- CTC U.O di Ematologia con Trapianto di Midollo Osseo, 95123 Catania, Italy;
| | - Paola Fazi
- GIMEMA Foundation, 00182 Rome, Italy; (A.P.); (M.M.); (S.S.); (P.F.)
| | - Alessandra Iurlo
- Ematologia, Fondazione IRCCS CA’ Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy;
| | - Giovanni Caocci
- Azienda Ospedaliera Brotzu, Presidio Ospedaliero A. Businco, Struttura Complessa Ematologia E CTMO, 09124 Cagliari, Italy;
| | - Antonella Gozzini
- Struttura Ospedaliera Dipartimentale Ematologia, AOU Careggi, 50139 Firenze, Italy;
| | - Tamara Intermesoli
- Struttura Complessa Ematologia, Ospedale di Bergamo, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
| | - Mariella D’Adda
- UO Ematologia, ASST Degli Spedali Civili di Brescia, 25123 Brescia, Italy;
| | - Fabrizio Pane
- Unità Operativa Complessa Ematologia, AOU Federico II, 80131 Napoli, Italy;
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11
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Fazio M, Vetro C, Markovic U, Duminuco A, Parisi M, Maugeri C, Mauro E, Parrinello NL, Stagno F, Villari L, Triolo AM, Stella S, Palumbo GA, Di Raimondo F, Romano A, Zanotti R. A case of high-risk AML in a patient with advanced systemic mastocytosis. Clin Case Rep 2023; 11:e7134. [PMID: 37469366 PMCID: PMC10352544 DOI: 10.1002/ccr3.7134] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 07/21/2023] Open
Abstract
Aggressive SM + AML has limited therapeutic options. Even a strong combination of decitabine-venetoclax-midostaurin has a transient effect on AML and a mitigated effect on SM. Larger series are required to identify the best therapeutic strategy.
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Affiliation(s)
- Manlio Fazio
- Post Graduation School of HematologyUniversity of Catania, A.O.U. Policlinico “G.Rodolico‐San Marco”CataniaItaly
| | - Calogero Vetro
- Division of HematologyA.O.U. Policlinico “G.Rodolico‐San Marco”CataniaItaly
| | - Uroš Markovic
- Division of HematologyA.O.U. Policlinico “G.Rodolico‐San Marco”CataniaItaly
| | - Andrea Duminuco
- Post Graduation School of HematologyUniversity of Catania, A.O.U. Policlinico “G.Rodolico‐San Marco”CataniaItaly
| | - Marina Parisi
- Division of HematologyA.O.U. Policlinico “G.Rodolico‐San Marco”CataniaItaly
| | - Cinzia Maugeri
- Division of HematologyA.O.U. Policlinico “G.Rodolico‐San Marco”CataniaItaly
| | - Elisa Mauro
- Division of HematologyA.O.U. Policlinico “G.Rodolico‐San Marco”CataniaItaly
| | | | - Fabio Stagno
- Division of HematologyA.O.U. Policlinico “G.Rodolico‐San Marco”CataniaItaly
| | - Loredana Villari
- Department of PathologyA.O.U. Policlinico di CataniaCataniaItaly
| | - Anna Maria Triolo
- Division of HematologyA.O.U. Policlinico “G.Rodolico‐San Marco”CataniaItaly
| | - Stefania Stella
- Center of Experimental Oncology and HematologyA.O.U. Policlinico “G. Rodolico‐San Marco”CataniaItaly
| | - Giuseppe A. Palumbo
- Post Graduation School of HematologyUniversity of Catania, A.O.U. Policlinico “G.Rodolico‐San Marco”CataniaItaly
- Dipartimento di specialità Medico‐Chirurgiche, CHIRMED, sezione di EmatologiaUniversità degli Studi di CataniaCataniaItaly
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”University of CataniaCataniaItaly
| | - Francesco Di Raimondo
- Division of HematologyA.O.U. Policlinico “G.Rodolico‐San Marco”CataniaItaly
- Dipartimento di specialità Medico‐Chirurgiche, CHIRMED, sezione di EmatologiaUniversità degli Studi di CataniaCataniaItaly
| | - Alessandra Romano
- Dipartimento di specialità Medico‐Chirurgiche, CHIRMED, sezione di EmatologiaUniversità degli Studi di CataniaCataniaItaly
| | - Roberta Zanotti
- Department of Medicine, Hematology UnitAzienda Ospedaliera Universitaria Integrata di VeronaVeronaItaly
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12
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Mancini M, De Santis S, Monaldi C, Bruno S, Castagnetti F, Gugliotta G, Iurlo A, Cerrano M, Galimberti S, Balducci S, Stagno F, Rosti G, Cavo M, Soverini S. S152: SETD2/H3K36ME3 DEFICIENCY SUSTAINS GENOMIC INSTABILITY AND ENHANCES CLONOGENIC POTENTIAL OF CHRONIC MYELOID LEUKEMIA (CML) PROGENITORS. Hemasphere 2022. [DOI: 10.1097/01.hs9.0000843500.89390.73] [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: 11/25/2022] Open
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13
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Gugliotta G, Castagnetti F, Breccia M, Levato L, Intermesoli T, D'Adda M, Salvucci M, Stagno F, Rege-Cambrin G, Tiribelli M, Martino B, Bocchia M, Cedrone M, Trabacchi E, Cavazzini F, Porretto F, Sorà F, Simula MP, Albano F, Soverini S, Foà R, Pane F, Cavo M, Saglio G, Baccarani M, Rosti G. Treatment-free remission in chronic myeloid leukemia patients treated front-line with nilotinib: 10-year follow-up of the GIMEMA CML 0307 study. Haematologica 2022; 107:2356-2364. [PMID: 35385922 PMCID: PMC9521223 DOI: 10.3324/haematol.2021.280175] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Indexed: 11/09/2022] Open
Abstract
We report the final analysis, with a 10-year follow-up, of the phase II study GIMEMA CML 0307 (NCT00481052), which enrolled 73 adult patients (median age 51 years, range 18-83) with newly diagnosed chronic-phase (CP)-chronic myeloid leukemia (CML) to investigate the efficacy and the toxicity of front-line treatment with nilotinib (NIL). The initial dose was 400 mg twice daily; the dose was reduced to 300 mg twice daily as soon as this dose was approved and registered. The 10-year overall survival and progression-free survival were 94.5%. At the last contact, 36 (49.3%) patients were continuing NIL (22 patients at 300 mg twice daily, 14 at lower doses), 18 (24.7%) patients were in treatment-free remission (TFR), 14 (19.2%) were receiving other tyrosinekinase inhibitors and 4 (5.5%) patients have died. The rates of major (MMR) and deep (MR4) molecular responses by 10 years were 96% and 83%, respectively. The median time to MMR and MR4 were 6 and 18 months, respectively. After a median duration of NIL treatment of 88 months, 24 (32.9%) patients discontinued NIL while in stable deep molecular response. In these patients, the 2-years estimated treatment-free survival was 72.6%. The overall TFR rate, calculated on all enrolled patients, was 24.7% (18/73 patients). Seventeen patients (23.3%), at a median age of 69 years, had at least one arterial obstructive event. In conclusion, the use of NIL front-line in CP-CML can induce a stable TFR in a relevant number of patients, although cardiovascular toxicity remains of concern.
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Affiliation(s)
- Gabriele Gugliotta
- Istituto di Ematologia Seragnoli, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Fausto Castagnetti
- Istituto di Ematologia Seragnoli, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University, Rome
| | - Luciano Levato
- Unità di Ematologia, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro
| | | | | | | | - Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico Rodolico - San Marco, Catania
| | - Giovanna Rege-Cambrin
- Unità di Medicina Interna, Ospedale San Luigi Gonzaga, Università di Torino, Orbassano
| | - Mario Tiribelli
- Clinica Ematologica, Dipartimento di Area Medica, Azienda Sanitaria Universitaria Friuli Centrale, Udine
| | - Bruno Martino
- Unità di Ematologia, Grande Ospedale Metropolitano-G.O.M. Bianchi-Melacrino-Morelli, Reggio Calabria
| | - Monica Bocchia
- Hematology Unit, Azienda Ospedaliero-Universitaria Senese, Siena University, Siena
| | | | - Elena Trabacchi
- Unità di Ematologia, Ospedale Guglielmo da Saliceto, Piacenza
| | | | | | - Federica Sorà
- Unità di Ematologia, Fondazione Policlinico Universitario A Gemelli IRCSS, Università Cattolica, Roma
| | - Maria Pina Simula
- Ematologia e Centro Trapianti Midollo Osseo, Ospedale Oncologico Businco, Cagliari
| | - Francesco Albano
- Hematology and Stem Cell Transplantation Unit, Department of Emergency and Organ Transplantation (D.E.T.O.), Aldo Moro University, Bari
| | - Simona Soverini
- Istituto di Ematologia Seragnoli, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto I, Sapienza University, Rome
| | | | - Michele Cavo
- Istituto di Ematologia Seragnoli, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna
| | - Giuseppe Saglio
- Divisione Universitaria di Ematologia e Terapie Cellulari, A.O. Ordine Mauriziano, Turin
| | | | - Gianantonio Rosti
- IRCSS - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola (FC)
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14
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Romano A, Cerchione C, Conticello C, Filetti S, Bulla A, Chiarenza A, Del Fabro V, Leotta S, Markovic U, Motta G, Parisi M, Stagno F, Palumbo GA, Di Raimondo F. Reduced Absolute Count of Monocytes in Patients Carrying Hematological Neoplasms and SARS-CoV2 Infection. Cancers (Basel) 2022; 14:cancers14051173. [PMID: 35267478 PMCID: PMC8909066 DOI: 10.3390/cancers14051173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 01/31/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary In hematological neoplasms associated with COVID-19, immunological dysfunction, including reduced count of non-classical monocytes, has been suggested as a primary driver of morbidity and mortality. In this work, we investigated the contribution of absolute monocyte count to clinical outcome of COVID-19 in 120 patients affected by hematological neoplasms that tested positive to SARS-CoV-2. We found that there was no statistical difference in 30-day mortality, rate of hospitalization for intensive cure and viral clearance at 14 days between fully vaccinated and unvaccinated patients. Increased 30-day mortality was associated with presence of active/progressing disease and absolute monocyte count lower than 400 cells/uL. Reduced absolute counts of monocytes should be used as an alert of increased risk of severe/critical forms of COVID-19 in patients with hematological malignancies, even when the full vaccination cycle has been completed. Abstract Background: Clinical course of COVID-19 depends on several patient-specific risk factors, including immune function, that is largely compromised in cancer patients. Methods: We prospectively evaluated 120 adult consecutive patients (including 34 cases of COVID-19 breakthrough after two full doses of BNT162b2 vaccine) with underlying hematological malignancies and a SARS-CoV-2 infection, in terms of patient’s clinical outcome. Results: Among fully vaccinated patients the achievement of viral clearance by day 14 was more frequent than in unvaccinated patients. Increased 30-day mortality was associated with presence of active/progressing disease and absolute monocyte count lower than 400 cells/uL. Results of multivariable analysis in unvaccinated patients showed that the pre-infection absolute count of monocytes less or equal to 400 cells/mmc, active or progressive disease of the underlying hematological malignancy, the COVID-19 severity identified by hospitalization requirement and lack of viral clearance at 14 days were independent predictors of 1-year overall survival. Conclusions: Taken together, our results indicate that absolute monocyte count determined one month before any documented SARS-CoV-2 infection could identify patients affected by hematological neoplasms with increased risk of inferior overall survival.
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Affiliation(s)
- Alessandra Romano
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95124 Catania, Italy
| | - Claudio Cerchione
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori [M1] (IRST) IRCCS, 47014 Meldola (FC), Italy
- Correspondence:
| | - Concetta Conticello
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Sabina Filetti
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Anna Bulla
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Annalisa Chiarenza
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Vittorio Del Fabro
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Salvatore Leotta
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Uros Markovic
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
- Oncohematology and BMT Unit, Mediterranean Institute of Oncology, 95125 Viagrande, Italy
- Department of Biomedical, Dental, Morphological and Functional Imaging Sciences, University of Messina, 98122 Messina, Italy
| | - Giovanna Motta
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Marina Parisi
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Fabio Stagno
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
| | - Giuseppe Alberto Palumbo
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
- Ingrassia Department, University of Catania, 95100 Catania, Italy
| | - Francesco Di Raimondo
- Division of Hematology, AOU “Policlinico G. Rodolico-San Marco”, 95100 Catania, Italy; (A.R.); (C.C.); (S.F.); (A.B.); (A.C.); (V.D.F.); (S.L.); (U.M.); (G.M.); (M.P.); (F.S.); (G.A.P.); (F.D.R.)
- Postgraduate School of Hematology, University of Catania, 95124 Catania, Italy
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15
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Sicuranza A, Ferrigno I, Abruzzese E, Iurlo A, Galimberti S, Gozzini A, Luciano L, Stagno F, Russo Rossi A, Sgherza N, Cattaneo D, Zuanelli Brambilla C, Marzano C, Fava C, Mulas O, Cencini E, Santoni A, Sammartano V, Gozzetti A, Puccetti L, Bocchia M. Pro-Inflammatory and Pro-Oxidative Changes During Nilotinib Treatment in CML Patients: Results of a Prospective Multicenter Front-Line TKIs Study (KIARO Study). Front Oncol 2022; 12:835563. [PMID: 35178353 PMCID: PMC8844441 DOI: 10.3389/fonc.2022.835563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Tyrosine kinase inhibitors (TKI) may offer a normal life expectancy to Chronic Myeloid Leukemia (CML) patients. However, a higher than expected incidence of arterial occlusive events (AOEs) was observed during treatment with nilotinib. We previously showed an “inflammatory status” during nilotinib that may explain the increased incidence of AOEs. Thus, we conducted this prospective KIARO study involving 186 CML patients (89 imatinib, 59 nilotinib, 38 dasatinib). Interleukin 6 (IL6), interleukin 10 (IL10), Tumor Necrosis Factor-α (TNFα), oxLDL, and high-sensitivity C-reactive protein (hs-CRP) plasma levels were measured at diagnosis and during treatment, with the aim to investigate changes in the inflammatory status favoring AOEs of each patient. Clinical and biochemical pro-atherothrombotic profiles and the 10-year SCORE chart were also evaluated. We showed a pro-inflammatory/pro-oxidative milieu increasing along treatment with nilotinib compared with imatinib or dasatinib, as demonstrated by higher hs-CRP and oxLDL levels and increased IL6/IL10 and TNFα/IL10 ratios only in nilotinib cohort. After median follow-up of 23.3 months starting from TKI, 10/186 patients (5.4%) suffered an AOE. Approximately 5/10 (50%) AOEs occurred during nilotinib treatment despite a lower 10-year SCORE and a lower median age in this subgroup. A longer follow-up is needed to further confirm the active role of nilotinib in AOEs pathogenesis.
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Affiliation(s)
- Anna Sicuranza
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Ilaria Ferrigno
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | | | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonella Gozzini
- Department of Cellular Therapies and Transfusion Medicine, AOU Careggi, Florence, Italy
| | | | - Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico-V. Emanuele, Catania, Italy
| | | | - Nicola Sgherza
- Hematology and Transplant Center, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Cristina Marzano
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Olga Mulas
- Department of Medical Sciences and Public Health, University of Cagliari, Businco Hospital, Cagliari, Italy
| | - Emanuele Cencini
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Adele Santoni
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Vincenzo Sammartano
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Alessandro Gozzetti
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Luca Puccetti
- Hemostasis and Thrombosis Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Monica Bocchia
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
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16
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Massimino M, Vigneri P, Stella S, Tirrò E, Pennisi MS, Parrinello LN, Vetro C, Manzella L, Stagno F, Di Raimondo F. Combined Inhibition of Bcl2 and Bcr-Abl1 Exercises Anti-Leukemia Activity but Does Not Eradicate the Primitive Leukemic Cells. J Clin Med 2021; 10:jcm10235606. [PMID: 34884309 PMCID: PMC8658323 DOI: 10.3390/jcm10235606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/13/2021] [Accepted: 11/25/2021] [Indexed: 12/11/2022] Open
Abstract
Background: The management of Philadelphia Chromosome-positive (Ph+) hematological malignancies is strictly correlated to the use of BCR-ABL1 tyrosine kinase inhibitors (TKIs). However, these drugs do not induce leukemic stem cells death and their persistence may generate a disease relapse. Published reports indicated that Venetoclax, a selective BCL2 inhibitor, could be effective in Ph+ diseases, as BCL2 anti-apoptotic activity is modulated by BCR-ABL1 kinase. We, therefore, investigated if BCL2 inhibition, alone or combined with Nilotinib, a BCR-ABL1 inhibitor, affects the primitive and committed Ph+ cells survival. Methods: We used Ph+ cells isolated from leukemic patients at diagnosis. To estimate the therapeutic efficacy of BCL2 and BCR-ABL1 inhibition we employed long-term culture, proliferation and apoptosis assay. Immunoblot was used to evaluate the ability of treatment to interfere with the down-stream targets of BCR-ABL1. Results: Blocking BCL2, we observed reduced proliferation and clonogenic potential of CML CD34-positive cells and this cytotoxicity was improved by combination with BCR-ABL1 inhibitor. However, BCL2 inhibition, alone or in combination regiment with BCR-ABL1 inhibitor, did not reduce the self-renewal of primitive leukemic cells, while strongly induced cell death on primary Ph+ Acute Lymphoblastic Leukemia (ALL). Conclusion: Our results suggest that primitive CML leukemic cells are not dependent on BCL2 for their persistence and support that committed CML and Ph + ALL cells are dependent by BCL2 and BCR-ABL1 cooperation for their survival. The antileukemic activity of BCL2 and BCR-ABL1 dual targeting may be a useful therapeutic strategy for Ph+ ALL patients.
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Affiliation(s)
- Michele Massimino
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (P.V.); (S.S.); (E.T.); (M.S.P.); (L.M.)
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, 95123 Catania, Italy
- Correspondence: ; Tel.: +39-095-3781952; Fax: +39-095-3781949
| | - Paolo Vigneri
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (P.V.); (S.S.); (E.T.); (M.S.P.); (L.M.)
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, 95123 Catania, Italy
| | - Stefania Stella
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (P.V.); (S.S.); (E.T.); (M.S.P.); (L.M.)
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, 95123 Catania, Italy
| | - Elena Tirrò
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (P.V.); (S.S.); (E.T.); (M.S.P.); (L.M.)
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, 95123 Catania, Italy
| | - Maria Stella Pennisi
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (P.V.); (S.S.); (E.T.); (M.S.P.); (L.M.)
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, 95123 Catania, Italy
| | - Laura Nunziatina Parrinello
- Division of Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, 95123 Catania, Italy; (L.N.P.); (C.V.); (F.S.); (F.D.R.)
| | - Calogero Vetro
- Division of Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, 95123 Catania, Italy; (L.N.P.); (C.V.); (F.S.); (F.D.R.)
| | - Livia Manzella
- Department of Clinical and Experimental Medicine, University of Catania, 95124 Catania, Italy; (P.V.); (S.S.); (E.T.); (M.S.P.); (L.M.)
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, 95123 Catania, Italy
| | - Fabio Stagno
- Division of Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, 95123 Catania, Italy; (L.N.P.); (C.V.); (F.S.); (F.D.R.)
| | - Francesco Di Raimondo
- Division of Hematology, A.O.U. Policlinico “G. Rodolico-S. Marco”, 95123 Catania, Italy; (L.N.P.); (C.V.); (F.S.); (F.D.R.)
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17
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Stagno F, Breccia M, Annunziata M, Trawinska MM, Iurlo A, Sgherza N, Fava C, Gozzini A, Luciano L, Carmosino I, Bonifacio M, Sorà F, Leonetti Crescenzi S, Crugnola M, Gugliotta G, Galimberti S, Bucelli C, Colafigli G, Feo C, Tiribelli M, Mauro E, Russo Rossi A, Guarini A, Abruzzese E, Rosti G, Di Raimondo F, Latagliata R. Long term follow-up of frontline Dasatinib in older patients with chronic myeloid leukemia in chronic phase treated outside clinical trials: a real-life cohort observational study. Acta Oncol 2021; 60:1527-1533. [PMID: 34499575 DOI: 10.1080/0284186x.2021.1971292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND A limited amount of data has been published in chronic-phase chronic myeloid leukemia (CP-CML) patients aged >75 years treated frontline with second-generation tyrosine kinase inhibitors. AIMS To address this issue in a clinical 'real-life' setting, we retrospectively analyzed 45 CP-CML patients (pts) followed in 20 Italian Centers and treated frontline with dasatinib (DAS). PATIENTS AND METHODS Median age was 78.4 years (range 75-89.2 years). DAS starting dose was 100 mg QD in 35 pts (77.7%), 80 mg QD in 1 pts (2.2%) and 50 mg QD in 9 pts (20.1%), respectively. The median follow-up was 42.6 months (IQR 20.4 - 63.3). RESULTS Grade 3 and 4 side effects, both hematological and non-hematological, were detected in 6 (13.3%) and 12 (26.6%) pts, respectively. Pleural effusions of all grades occurred in 13 pts (28.8%) after a median period of DAS exposure of 14.7 months (IQR 3.0 - 33.1). The rates of DAS dose reduction and permanent drug discontinuation were 53.3% and 20.0%, respectively. As the best response, 42/45 patients (93.3%) achieved a complete cytogenetic response (CCyR), 35/45 (77.7%) a major molecular response (MMR) and 24/45 (53.3%) a deep molecular response (both MR 4.0 and MR 4.5). Only 1 patient (2.2%) progressed to the blast phase after 13 months of therapy; 8 deaths were observed (1 CML-related and 7 CML-unrelated). Cumulative event-free survival and overall survival at 36 months were 64.7% (95%, CI 49.4 - 80.0) and 82.3% (95%, CI 70.3-94.3), respectively. CONCLUSION These findings, although evaluated in a limited and selected cohort of patients, suggest that DAS might be effective in older patients (aged >75 years) affected by CP-CML with acceptable toxicity.
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Affiliation(s)
- Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico Rodolico-San Marco, Catania, Italy
| | - Massimo Breccia
- Department of Precision and Translational Medicine, Sapienza University, Rome, Italy
| | | | | | - Alessandra Iurlo
- Hematology Section, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Sgherza
- Hematology Unit, IRCCS “Casa Sollievo Sofferenza” Hospital, San Giovanni Rotondo, Italy
| | - Carmen Fava
- Hematology Section, Azienda Ospedaliera Mauriziano, Turin, Italy
| | | | | | - Ida Carmosino
- Department of Precision and Translational Medicine, Sapienza University, Rome, Italy
| | | | - Federica Sorà
- Hematology Section, Policlinico A. Gemelli, IRCSS Catholic University, Rome, Italy
| | | | | | - Gabriele Gugliotta
- Hematology Section “Seragnoli”, IRCCS AOU Bologna, University of Bologna, Bologna, Italy
| | | | - Cristina Bucelli
- Hematology Section, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gioia Colafigli
- Department of Precision and Translational Medicine, Sapienza University, Rome, Italy
| | - Costanzo Feo
- Immunohematology and Transfusion Unit, AORN “Gaetano Rummo”, Benevento, Italy
| | - Mario Tiribelli
- Hematology Section and BMT, University of Udine, Udine, Italy
| | - Endri Mauro
- Hematology Section, Dipartimento di Medicina Specialistica, Ca’ Foncello Hospital, Treviso, Italy
| | | | - Attilio Guarini
- Unit of Hematology and Cell Therapy, IRCCS-Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | | | | | - Francesco Di Raimondo
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico Rodolico-San Marco, Catania, Italy
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18
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Breccia M, Abruzzese E, Accurso V, Attolico I, Barulli S, Bergamaschi M, Binotto G, Bocchia M, Bonifacio M, Caocci G, Capodanno I, Castagnetti F, Cavazzini F, Crisà E, Crugnola M, Stella De Candia M, Elena C, Fava C, Galimberti S, Gozzini A, Gugliotta G, Intermesoli T, Iurlo A, La Barba G, Latagliata R, Leonetti Crescenzi S, Levato L, Loglisci G, Lucchesi A, Luciano L, Lunghi F, Luzi D, Malato A, Cristina Miggiano M, Pizzuti M, Pregno P, Rapezzi D, Rege-Cambrin G, Rosti G, Russo S, Sancetta R, Rita Scortechini A, Sorà F, Sportoletti P, Stagno F, Tafuri A, Tiribelli M, Foà R, Saglio G. COVID-19 infection in chronic myeloid leukaemia after one year of the pandemic in Italy. A Campus CML report. Br J Haematol 2021; 196:559-565. [PMID: 34636033 PMCID: PMC8652631 DOI: 10.1111/bjh.17890] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
Limited information is available on the impact of the COVID-19 pandemic on the management of chronic myeloid leukaemia (CML). The Campus CML network collected retrospective information on 8 665 CML patients followed at 46 centres throughout Italy during the pandemic between February 2020 and January 2021. Within this cohort, we recorded 217 SARS-CoV-2-positive patients (2·5%). Most patients (57%) were diagnosed as having SARS-CoV-2 infection during the second peak of the pandemic (September 2020 to January 2021). The majority (35%) was aged between 50 and 65 years with a male prevalence (73%). Fifty-six percent of patients presented concomitant comorbidities. The median time from CML diagnosis to SARS-CoV-2 infection was six years (three months to 18 years). Twenty-one patients (9·6%) required hospitalization without the need of respiratory assistance, 18 (8·2%) were hospitalized for respiratory assistance, 8 (3·6%) were admitted to an intensive care unit, while 170 (78%) were only quarantined. Twenty-three percent of patients discontinued tyrosine kinase inhibitor (TKI) therapy during the infection. Twelve patients died due to COVID-19 with a mortality rate of 5·5% in the positive cohort and of 0·13% in the whole cohort. We could also document sequelae caused by the SARS-CoV-2 infection and an impact of the pandemic on the overall management of CML patients.
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Affiliation(s)
- Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University, Roma, Italy
| | | | - Vincenzo Accurso
- UO di Ematologia con Trapianto, AU Policlinico Paolo Giaccone, Palermo, Italy
| | - Immacolata Attolico
- UO Ematologia con Trapianto, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Sara Barulli
- Divisione di Ematologia di Muraglia, CTMO Ospedale San Salvatore, Pesaro, Italy
| | | | - Gianni Binotto
- Ematologia ed Immunologia Clinica, Università degli Studi di Padova, Padova, Italy
| | - Monica Bocchia
- U.O.C. Ematologia e Trapianti, A.O. Senese - Policlinico 'Le Scotte', Siena, Italy
| | - Massimiliano Bonifacio
- Divisione di Ematologia, Istituti Ospitalieri di Verona, Policlinico G.B. Rossi, Verona, Italy
| | | | | | - Fausto Castagnetti
- Istituto di Ematologia 'Lorenzo e A. Seragnoli', Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | - Elena Crisà
- S.C.D.U. Ematologia - DIMECS e Dipartimento Oncologico, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | | | | | - Chiara Elena
- Ematologia, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Carmen Fava
- A.S.O. Ordine Mauriziano, P.O. Umberto I, Struttura Complessa a Direzione Universitaria-Ematologia e Terapie Cellulari, Torino, Italy
| | - Sara Galimberti
- Ematologia, Università di Pisa - Azienda Ospedaliera Pisana, Pisa, Italy
| | - Antonella Gozzini
- Unità di Ricerca e di Malattie del Sangue, Ematologia San Luca Vecchio, Firenze, Italy
| | - Gabriele Gugliotta
- Istituto di Ematologia 'Lorenzo e A. Seragnoli', Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | - Alessandra Iurlo
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | | | | | | | - Alessandro Lucchesi
- Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - Luigiana Luciano
- Ematologia, Azienda Ospedaliera Universitaria - Università degli Studi di Napoli 'Federico II', Napoli, Italy
| | | | - Debora Luzi
- Ematologia, A.O. Santa Maria - Terni S.C Oncoematologia, Terni, Italy
| | | | | | | | - Patrizia Pregno
- Dipartimento di Oncologia ed Ematologia S.C. Ematologia 2, A.O. Città della Salute e della Scienza di Torino S. G. Battista, Torino, Italy
| | | | - Giovanna Rege-Cambrin
- Dipartimento di Scienze Cliniche e Biologiche, Ospedale S. Luigi Gonzaga-Medicina Interna 2, Orbassano, Italy
| | - Gianantonio Rosti
- Ematologia, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola, Italy
| | - Sabina Russo
- Dipartimento di Medicina Interna, Azienda Ospedaliera Universitaria - Policlinico G. Martino, Messina, Italy
| | | | | | - Federica Sorà
- Ematologia, Policlinico Gemelli - Università Cattolica del Sacro Cuore, Roma, Italy
| | | | - Fabio Stagno
- Hematology Section and BMT Unit, AOU Policlinico 'Rodolico-San Marco', Catania, Italy
| | | | - Mario Tiribelli
- Clinica Ematologica-Centro Trapianti e Terapie cellulari, Azienda Ospedaliero-Universitaria, Udine, Italy
| | - Robin Foà
- Department of Translational and Precision Medicine, Sapienza University, Roma, Italy
| | - Giuseppe Saglio
- A.S.O. Ordine Mauriziano, Struttura Complessa a Direzione Universitaria-Ematologia e Terapie Cellulari-, P.O. Umberto I, Torino, Italy
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19
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Specchia G, Pregno P, Breccia M, Castagnetti F, Monagheddu C, Bonifacio M, Tiribelli M, Stagno F, Caocci G, Martino B, Luciano L, Pizzuti M, Gozzini A, Scortechini AR, Albano F, Bergamaschi M, Capodanno I, Patriarca A, Fava C, Rege-Cambrin G, Sorà F, Galimberti S, Bocchia M, Binotto G, Reddiconto G, DiTonno P, Maggi A, Sanpaolo G, De Candia MS, Giai V, Abruzzese E, Miggiano MC, La Barba G, Pietrantuono G, Guella A, Levato L, Mulas O, Saccona F, Rosti G, Musto P, Di Raimondo F, Pane F, Baccarani M, Saglio G, Ciccone G. Prognostic Factors for Overall Survival In Chronic Myeloid Leukemia Patients: A Multicentric Cohort Study by the Italian CML GIMEMA Network. Front Oncol 2021; 11:739171. [PMID: 34513714 PMCID: PMC8427308 DOI: 10.3389/fonc.2021.739171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
An observational prospective study was conducted by the CML Italian network to analyze the role of baseline patient characteristics and first line treatments on overall survival and CML-related mortality in 1206 newly diagnosed CML patients, 608 treated with imatinib (IMA) and 598 with 2nd generation tyrosine kinase inhibitors (2GTKI). IMA-treated patients were much older (median age 69 years, IQR 58-77) than the 2GTKI group (52, IQR 41-63) and had more comorbidities. Estimated 4-year overall survival of the entire cohort was 89% (95%CI 85.9-91.4). Overall, 73 patients (6.1%) died: 17 (2.8%) in the 2GTKI vs 56 (9.2%) in the IMA cohort (adjusted HR=0.50; 95% CI=0.26-0.94), but no differences were detected for CML-related mortality (10 (1.7%) vs 11 (1.8%) in the 2GTKIs vs IMA cohort (sHR=1.61; 0.52-4.96). The ELTS score was associated to CML mortality (high risk vs low, HR=9.67; 95%CI 2.94-31.74; p<0.001), while age (per year, HR=1.03; 95%CI 1.00-1.06; p=0.064), CCI (4-5 vs 2, HR=5.22; 95%CI 2.56-10.65; p<0.001), ELTS score (high risk vs low, HR=3.11; 95%CI 1.52-6.35, p=0.002) and 2GTKI vs IMA (HR=0.26; 95%CI 0.10-0.65, p=0.004) were associated to an increased risk of non-related CML mortality. The ELTS score showed a better discriminant ability than the Sokal score in all comparisons.
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Affiliation(s)
- Giorgina Specchia
- Former Full Professor of Hematology- University of Bari Aldo Moro" Bari GIMEMA WP CML, Bari, Italy
| | - Patrizia Pregno
- Haematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Massimo Breccia
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Roma, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Chiara Monagheddu
- Clinical Epidemiology Unit and CPO Piemonte, Città della Salute e della Scienza, Torino, Italy
| | | | - Mario Tiribelli
- Division of Hematology and BMT, Department of Medical Area, University of Udine, Udine, Italy
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, Azienda Ospedaliera-Universitaria (AOU) Policlinico-V. Emanuele, Catania, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, Businco Hospital, University of Cagliari, Cagliari, Italy
| | - Bruno Martino
- Haematology Unit, Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Luigiana Luciano
- Haematology Unit "Federico II", University of Naples, Naples, Italy
| | - Michele Pizzuti
- Department of Hematology, "San Carlo" Regional Hospital, Potenza, Italy
| | - Antonella Gozzini
- Haematology Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Anna Rita Scortechini
- Division of Hematology, Department of Molecular and Clinical Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Francesco Albano
- Department of Emergency and Transplantation, Hematology Section, University of Bari Medical School, Bari, Italy
| | | | - Isabella Capodanno
- Department of Hematology, Azienda UNITà SANITARIA LOCALE (USL)-IRCCS di Reggio Emilia, Viale Risorgimento, Reggio Emilia, Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | | | - Federica Sorà
- Institute of Hematology, Università Cattolica Sacro Cuore, Rome, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Unità Operativa (UO) Haematology, AOU Pisana, Pisa, Italy
| | - Monica Bocchia
- Haematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Giovanni Reddiconto
- Department of Ematologia, Lecce Ematologia Ospedale Vito Fazzi, Lecce, Italy
| | - Paolo DiTonno
- Haematology Unit, National Cancer Center, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Grazia Sanpaolo
- Department of Hematology and Stem Cell Transplantation Unit, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | - Valentina Giai
- Haematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Elisabetta Abruzzese
- Hemoglobinopathies Unit, Hematology Department, S. Eugenio Hospital (ASL Roma 2), Rome, Italy
| | | | - Gaetano La Barba
- Department of Hematology, "Spirito Santo" Hospital, Pescara, Italy
| | - Giuseppe Pietrantuono
- Hematology Oncology, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy
| | - Anna Guella
- Hematology Unit, Santa Chiara Hospital, Trento, Italy
| | - Luciano Levato
- Haematology Unit, A. Pugliese Hospital, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | - Olga Mulas
- Department of Medical Sciences and Public Health, Businco Hospital, University of Cagliari, Cagliari, Italy
| | - Fabio Saccona
- Clinical Epidemiology Unit and CPO Piemonte, Città della Salute e della Scienza, Torino, Italy
| | - Gianantonio Rosti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Pellegrino Musto
- Department of Emergency and Transplantation, Hematology Section, University of Bari Medical School, Bari, Italy
| | - Francesco Di Raimondo
- Division of Hematology and Bone Marrow Transplant, Azienda Ospedaliera-Universitaria (AOU) Policlinico-V. Emanuele, Catania, Italy
| | - Fabrizio Pane
- Haematology Unit "Federico II", University of Naples, Naples, Italy
| | - Michele Baccarani
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giovannino Ciccone
- Clinical Epidemiology Unit and CPO Piemonte, Città della Salute e della Scienza, Torino, Italy
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Breccia M, Pregno P, Castagnetti F, Bonifacio M, Tiribelli M, Gozzini A, Scortechini AR, Luciano L, Martino B, Stagno F, Caocci G, La Barba G, Pizzuti M, Ciccone G, Saglio G, Specchia G. Eutos long-term survival score discriminates different Sokal score categories in chronic myeloid leukemia patients, showing better survival prediction. Analysis of the GIMEMA CML observational study. Leukemia 2021; 35:1814-1816. [PMID: 34002030 DOI: 10.1038/s41375-021-01292-4] [Citation(s) in RCA: 1] [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] [Received: 12/29/2020] [Revised: 04/21/2021] [Accepted: 05/07/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Massimo Breccia
- Department of Translational and Precision Medicine, Az. Policlinico Umberto I-Sapienza University, Rome, Italy.
| | - Patrizia Pregno
- Hematology Unit, Az Ospedaliero Universitaria Città' della Salute e della Scienza, Torino, Italy
| | - Fausto Castagnetti
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, "S. Orsola-Malpighi" Hospital, Bologna, Italy
| | | | - Mario Tiribelli
- Division of Hematology and BMT, Department of Medical Area, University of Udine, Udine, Italy
| | - Antonella Gozzini
- Hematology Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Anna Rita Scortechini
- Division of Hematology, Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona, Ancona, Italy
| | - Luigiana Luciano
- Hematology Unit, Federico II University of Naples, Napoli, Italy
| | - Bruno Martino
- Hematology Unit, A.O. Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Fabio Stagno
- Hematology Section, Ferrarotto Hospital, Catania, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, Businco Hospital, Cagliari, Italy
| | - Gaetano La Barba
- Department of Hematology, "Spirito Santo" Hospital, Pescara, Italy
| | | | - Giovannino Ciccone
- Unit of Clinical Epidemiology, CPO Piemonte, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Giuseppe Saglio
- Divisione Universitaria di Ematologia e Terapie Cellulari, A.O. Ordine Mauriziano, Turin, Italy
| | - Giorgina Specchia
- Hematology Section, Department of Emergency and Transplantation - GIMEMA WP CML, University of Bari Aldo Moro, Bari, Italy
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21
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Loscocco F, Visani G, Ruzzo A, Bagaloni I, Fuligni F, Galimberti S, Di Paolo A, Stagno F, Pregno P, Annunziata M, Gozzini A, Barulli S, Gabucci E, Magnani M, Isidori A. Clinical Relevance of ABCB1, ABCG2, and ABCC2 Gene Polymorphisms in Chronic Myeloid Leukemia Patients Treated With Nilotinib. Front Oncol 2021; 11:672287. [PMID: 34055641 PMCID: PMC8155509 DOI: 10.3389/fonc.2021.672287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/21/2021] [Indexed: 12/05/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) have radically changed the outcome of chronic myeloid leukemia (CML) patients in the last 20 years. Moreover, the advent of second generation TKIs, namely nilotinib and dasatinib, have largely increased the number of CML patients achieving deep and sustained molecular responses. However, the possible mechanisms capable of influencing the maintenance of the long-term molecular response are not yet fully known and understood. In this light, polymorphisms in MDR-ABC transporters may influence the efficacy and safety of TKIs. In this study, we examined seven single nucleotide polymorphisms (SNPs) in four ABC transporter genes: ABCC1 rs212090 (5463T>A), ABCC2 rs3740066 (3972C>T), ABCC2 rs4148386 G>A, ABCC2 rs1885301 (1549G>A), ABCG2 rs2231137 (34G>A), ABCG2 rs2231142 G>C, ABCB1 rs1045642 (3435C>T), to determine their effect on the achievement and/or loss of molecular response in 90 CML patients treated with nilotinib. We found that ABCC2 rs3740066 CC and CT as well as the ABCB1 rs1045642 TT genotypes correlated with a higher probability to achieve MR3 in a shorter time (p=0.02, p=0.004, and p=0.01), whereas ABCG2 rs2231137 GG was associated with lower probability of MR3 achievement (p=0.005). Moreover, ABCC2 rs3740066 CC genotype, the ABCB1 rs1045642 CC and TT genotypes were positively correlated with MR4 achievement (p=0.02, p=0.007, and p=0.003). We then generated a predictive model incorporating the information of four genotypes, to evaluate the combined effect of the SNPs. The combination of SNPs present in the model affected the probability and the time to molecular response. This model had a high prognostic significance for both MR3 and MR4 (p=0.005 and p=0.008, respectively). Finally, we found ABCG2 rs2231142 GG genotype to be associated with a decrease risk of MR3 loss. In conclusion, MDR-transporters SNPs may significantly affect the achievement and loss of molecular response in CML patients treated with nilotinib.
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Affiliation(s)
- Federica Loscocco
- Hematology and Hematopoietic Stem Cell Transplant Center, AORMN, Pesaro, Italy
| | - Giuseppe Visani
- Hematology and Hematopoietic Stem Cell Transplant Center, AORMN, Pesaro, Italy
| | - Annamaria Ruzzo
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Fano, Italy
| | - Irene Bagaloni
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Fano, Italy
| | - Fabio Fuligni
- Genetics and Genome Biology, Paediatric Laboratory Medicine (PLM), The Hospital for Sick Children, Toronto, ON, Canada
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Stagno
- AOU Policlinico Vittorio Emanuele, Divisioni Clinicizzata di Ematologia con Trapianto di Midollo Osseo, Catania, Italy
| | - Patrizia Pregno
- AOU Città Della Scienza e Della Salute di Torino, Hematology, Torino, Italy
| | | | | | - Sara Barulli
- Hematology and Hematopoietic Stem Cell Transplant Center, AORMN, Pesaro, Italy
| | - Elisa Gabucci
- Hematology and Hematopoietic Stem Cell Transplant Center, AORMN, Pesaro, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Fano, Italy
| | - Alessandro Isidori
- Hematology and Hematopoietic Stem Cell Transplant Center, AORMN, Pesaro, Italy
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Bulla A, Markovic U, Bellofiore C, Stella S, Conticello C, DI Raimondo F, Stagno F. A Treatment-free Interval Allowed by Ponatinib as Fourth-line Therapy. Cancer Diagn Progn 2021; 1:19-22. [PMID: 35399694 PMCID: PMC8962775 DOI: 10.21873/cdp.10003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/16/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The third-generation tyrosine kinase inhibitor ponatinib has demonstrated high clinical efficacy in the setting of patients with resistant chronic phase chronic myeloid leukemia (CML), also inducing deep molecular responses. However, ponatinib-related cardiovascular toxicities make management challenging, especially of those patients with CML with previous cardiovascular comorbidities. CASE REPORT We report on the efficacy of ponatinib treatment used as fourth-line therapy in a 55-year-old woman affected by significant comorbidities (mainly cardiovascular) present before the diagnosis of CML. Ponatinib therapy induced a rapid and excellent clinical response, with the achievement of a durable deep molecular response that allowed us to propose a strategy of treatment discontinuation in order to reduce drug-related toxicities. CONCLUSION A strategy of a treatment-free interval might represent a useful clinical tool in those patients with CML who achieve a durable deep molecular response but are also affected by significant comorbidities in order to minimize the risk of ponatinib-related toxicities.
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Affiliation(s)
- Anna Bulla
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico "Rodolico - San Marco", Catania, Italy
| | - Uros Markovic
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico "Rodolico - San Marco", Catania, Italy
| | - Claudia Bellofiore
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico "Rodolico - San Marco", Catania, Italy
| | - Stefania Stella
- Center of Experimental Oncology and Hematology, Department of Clinical and Experimental Medicine,AOU Policlinico "Rodolico - San Marco", Catania, Italy
| | - Concetta Conticello
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico "Rodolico - San Marco", Catania, Italy
| | - Francesco DI Raimondo
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico "Rodolico - San Marco", Catania, Italy
| | - Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico "Rodolico - San Marco", Catania, Italy
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Malagola M, Iurlo A, Abruzzese E, Bonifacio M, Stagno F, Binotto G, D'Adda M, Lunghi M, Crugnola M, Ferrari ML, Lunghi F, Castagnetti F, Rosti G, Lemoli RM, Sancetta R, Coppi MR, Corsetti MT, Rege Cambrin G, Romano A, Tiribelli M, Russo Rossi A, Russo S, Aprile L, Bocchia M, Gandolfi L, Farina M, Bernardi S, Polverelli N, Roccaro AM, De Vivo A, Baccarani M, Russo D. Molecular response and quality of life in chronic myeloid leukemia patients treated with intermittent TKIs: First interim analysis of OPTkIMA study. Cancer Med 2021; 10:1726-1737. [PMID: 33594821 PMCID: PMC7940223 DOI: 10.1002/cam4.3778] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/15/2020] [Accepted: 01/20/2021] [Indexed: 12/12/2022] Open
Abstract
Background Intermittent treatment with TKIs is an option for the great majority (70%–80%) of CML patients who do not achieve a stable deep molecular response and are not eligible for treatment discontinuation. For these patients, the only alternative is to assume TKI continuously, lifelong. Methods The Italian phase III multicentric randomized OPTkIMA study started in 2015, with the aim to evaluate if a progressive de‐escalation of TKIs (imatinib, nilotinib, and dasatinib) is able to maintain the molecular response (MR3.0) and to improve Health Related Quality of Life (HRQoL). Results Up to December 2018, 166/185 (90%) elderly CML patients in stable MR3.0/MR4.0 completed the first year of any TKI intermittent schedule 1 month ON and 1 month OFF. The first year probability of maintaining the MR3.0 was 81% and 23.5% of the patients who lost the molecular response regained the MR3.0 after resuming TKI continuously. Patients’ HRQoL at baseline was better than that of matched peers from healthy population. Women was the only factor independently associated with worse baseline HRQoL (p > 0.0001). Overall, global HRQoL worsened at 6 (p < 0.001) but returned to the baseline value at 12 months and it was statistically significantly worse in women (p = 0.001). Conclusions De‐escalation of any TKI by 1 month ON/OFF schedule maintains the MR3.0/MR4.0 in 81% of the patients during the first 12–24 months. No patients progressed to accelerated/blastic phase, all the patients (23.5%) losing MR3.0 regained the MR3.0 and none suffered from TKI withdrawn syndrome. The study firstly report on HRQoL in elderly CML patients moving from a continuous daily therapy to a de‐escalated intermittent treatment.
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Affiliation(s)
- Michele Malagola
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca, Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Abruzzese
- Division of Hematology, S. Eugenio Hospital, ASL ROMA2, Tor Vergata University, Roma, Italy
| | | | - Fabio Stagno
- Department of Hematology, University of Catania, Catania, Italy
| | - Gianni Binotto
- Hematology and Clinical Immunology, Department of Medicine, Padua School of Medicine, Padua, Italy
| | - Mariella D'Adda
- Division of Hematology, ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Monia Lunghi
- Division of Hematology, Department of Translation Medicine, University of Eastern Piedmont, Novara, Italy
| | - Monica Crugnola
- Hematology Unit and BMT Center Azienda Ospedaliero Universitaria Parma, Parma, Italy
| | - Maria Luisa Ferrari
- Hematology and Bone Marrow Transplant Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Francesca Lunghi
- Hematology and Bone Marrow Transplantation (BMT) Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Fausto Castagnetti
- Hematology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Gianantonio Rosti
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Roberto M Lemoli
- Clinic of Hematology, University of Genoa, Ospedale Policlinico S. Martino, IRCCS, Genoa, Italy
| | | | | | - Maria Teresa Corsetti
- Hematology Division, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Atelda Romano
- IRCCS Regina Elena National Cancer Institute-Rome, Roma, Italy
| | - Mario Tiribelli
- Division of Hematology and BMT, Department of Medical and Morphological Researches, University of Udine, Udine, Italy
| | | | - Sabina Russo
- Division of Hematology, Dipartimento di Patologia Umana dell'Adulto e dell'Età Evolutiva, Policlinico G Martino, University of Messina, Messina, Italy
| | - Lara Aprile
- SC Ematologia, Ospedale S.G.Moscati, Taranto, Italy
| | - Monica Bocchia
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Lisa Gandolfi
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Mirko Farina
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Simona Bernardi
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili, Brescia, Italy.,CREA Laboratory (Hematological-Research AIL Centre), ASST-Spedali Civili Brescia, Brescia, Italy
| | - Nicola Polverelli
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Aldo M Roccaro
- Clinical Research Development and Phase I Unit, ASST-Spedali Civili Brescia, Brescia, Italy
| | - Antonio De Vivo
- Hematology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | | | - Domenico Russo
- Unit of Blood Disease and Stem Cell Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, ASST-Spedali Civili, Brescia, Italy
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24
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Manzella L, Tirrò E, Vitale SR, Puma A, Consoli ML, Tambè L, Pennisi MS, DI Gregorio S, Romano C, Tomarchio C, DI Raimondo F, Stagno F. Optimal Response in a Patient With CML Expressing BCR-ABL1 E6A2 Fusion Transcript With Nilotinib Therapy: A Case Report. In Vivo 2021; 34:1481-1486. [PMID: 32354950 DOI: 10.21873/invivo.11933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/07/2020] [Revised: 03/10/2020] [Accepted: 03/11/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIM The Philadelphia chromosome is considered the hallmark of chronic myeloid leukemia (CML). However, although most patients with CML are diagnosed with the e13a2 or e14a2 breakpoint cluster region (BCR)-Abelson 1 (ABL1) fusion transcripts, about 5% of them carry rare BCR-ABL1 fusion transcripts, such as e19a2, e8a2, e13a3, e14a3, e1a3 and e6a2. In particular, the e6a2 fusion transcript has been associated with clinically aggressive disease frequently presenting in accelerated or blast crisis phases; there is limited evidence on the efficacy of front-line second-generation tyrosine kinase inhibitors for this genotype. CASE REPORT We describe a case of atypical BCR-ABL1 e6a2 fusion transcript in a 46-year-old woman with CML. RESULTS The use of primers recognizing more distant exons from the common BCR-ABL1 breakpoint region correctly identified the atypical BCR-ABL1 e16a2 fusion transcript. Treatment with second-generation tyrosine kinase inhibitor nilotinib was effective in this patient expressing the atypical e6a2 BCR-ABL1 fusion transcript.
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Affiliation(s)
- Livia Manzella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy .,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Elena Tirrò
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Silvia Rita Vitale
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Adriana Puma
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Maria Letizia Consoli
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Loredana Tambè
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Maria Stella Pennisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Sandra DI Gregorio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Chiara Romano
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Cristina Tomarchio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Francesco DI Raimondo
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy.,Department of Surgery, Medical and Surgical Specialities, University of Catania, Catania, Italy
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
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25
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Bellofiore C, Sapienza G, Markovic U, Del Fabro V, Romano A, Stagno F, Tamburino C, Mangiafico S, Di Raimondo F, Conticello C. Myeloma Patient With Brugada Syndrome and Successful Lenalidomide Treatment. Clin Lymphoma Myeloma Leuk 2021; 21:e456-e459. [PMID: 33531286 DOI: 10.1016/j.clml.2020.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Claudia Bellofiore
- Division of Hematology, Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele Catania, Catania, Italy.
| | - Giuseppe Sapienza
- Division of Hematology, Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | - Uros Markovic
- Division of Hematology, Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | - Vittorio Del Fabro
- Division of Hematology, Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | - Alessandra Romano
- Division of Hematology, Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | - Fabio Stagno
- Division of Hematology, Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | - Sarah Mangiafico
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | - Francesco Di Raimondo
- Division of Hematology, Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | - Concetta Conticello
- Division of Hematology, Azienda Ospedaliero Universitaria Policlinico-Vittorio Emanuele Catania, Catania, Italy
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26
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Soverini S, Martelli M, Bavaro L, De Benedittis C, Papayannidis C, Sartor C, Sorà F, Albano F, Galimberti S, Abruzzese E, Annunziata M, Russo S, Stulle M, Imovilli A, Bonifacio M, Maino E, Stagno F, Maria Basilico C, Borlenghi E, Fozza C, Mignone F, Minari R, Stella S, Baccarani M, Cavo M, Martinelli G. Next-generation sequencing improves BCR-ABL1 mutation detection in Philadelphia chromosome-positive acute lymphoblastic leukaemia. Br J Haematol 2021; 193:271-279. [PMID: 33403687 DOI: 10.1111/bjh.17301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/06/2020] [Indexed: 01/30/2023]
Abstract
BCR-ABL1 kinase domain mutation testing in tyrosine kinase inhibitor (TKI)-resistant Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukaemia (ALL) patients is routinely performed by Sanger sequencing (SS). Recently, next-generation sequencing (NGS)-based approaches have been developed that afford greater sensitivity and straightforward discrimination between compound and polyclonal mutations. We performed a study to compare the results of SS and NGS in a consecutive cohort of 171 Ph+ ALL patients. At diagnosis, 0/44 and 3/44 patients were positive for mutations by SS and NGS respectively. Out of 47 patients with haematologic resistance, 45 had mutations according to both methods, but in 25 patients NGS revealed additional mutations undetectable by SS. Out of 80 patients in complete haematologic response but with BCR-ABL1 ≥0·1%, 28 (35%) and 52 (65%) were positive by SS and NGS respectively. Moreover, in 12 patients positive by SS, NGS detected additional mutations. NGS resolved clonal complexity in 34 patients with multiple mutations at the same or different codons and identified 35 compound mutations. Our study demonstrates that, in Ph+ ALL on TKI therapy, NGS enables more accurate assessment of mutation status both in patients who fail therapy and in patients with minimal residual disease above 0·1%.
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Affiliation(s)
- Simona Soverini
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Margherita Martelli
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Luana Bavaro
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Caterina De Benedittis
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Cristina Papayannidis
- Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia, Università degli Studi di Bologna, Bologna, Italia
| | - Chiara Sartor
- Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia, Università degli Studi di Bologna, Bologna, Italia
| | - Federica Sorà
- Hematology Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Albano
- Hematology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Sara Galimberti
- Hematology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | | | - Sabina Russo
- Internal Medicine Unit, AOU Policlinico di Messina, Messina, Italy
| | - Manuela Stulle
- Hematology Unit, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Annalisa Imovilli
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | | | - Elena Maino
- Hematology Unit, Ospedale Dell'Angelo, Mestre, Italy
| | - Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico V. Emanuele, Catania, Italy
| | - Claudia Maria Basilico
- ASST dei Sette Laghi, Presidio di Varese Ospedale Circolo Fondazione Macchi, Varese, Italy
| | | | - Claudio Fozza
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Flavio Mignone
- Department of Science and Innovation Technology (DISIT), University of Piemonte Orientale, Alessandria, Italy
| | | | - Stefania Stella
- Department of Clinical and Experimental Medicine and Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele Catania, Catania, Italy
| | | | - Michele Cavo
- Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia, Università degli Studi di Bologna, Bologna, Italia
| | - Giovanni Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
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27
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Caocci G, Mulas O, Capodanno I, Bonifacio M, Annunziata M, Galimberti S, Luciano L, Tiribelli M, Martino B, Castagnetti F, Binotto G, Pregno P, Stagno F, Abruzzese E, Bocchia M, Gozzini A, Albano F, Fozza C, Luzi D, Efficace F, Simula MP, Scaffidi L, Baratè C, De Gregorio F, Stella R, Gugliotta G, Pirillo F, Trawinska MM, Sicuranza A, Cattaneo D, Attolico I, Scalzulli E, Iurlo A, Foà R, Breccia M, La Nasa G. Low-density lipoprotein (LDL) levels and risk of arterial occlusive events in chronic myeloid leukemia patients treated with nilotinib. Ann Hematol 2021; 100:2005-2014. [PMID: 33388860 DOI: 10.1007/s00277-020-04392-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/21/2020] [Indexed: 12/27/2022]
Abstract
Recommendations for dyslipidemia management aimed at reducing arterial occlusive events (AOEs) have been recently published. So far, no data have been reported on the management of dyslipidemia in chronic myeloid leukemia (CML) patients treated with nilotinib. We investigated 369 CML adult patients, stratified according to the new Systematic Coronary Risk Evaluation (SCORE) scoring system. Plasma levels of cholesterol, HDL, LDL, and triglycerides were measured prior to the start of nilotinib and after 3, 6, and 12 months. The 5-year cumulative incidence of AOEs was 15.9%. Patients with cholesterol levels > 200 mg/dL and LDL > 70 mg/dL 3 months after treatment showed a significantly higher incidence of AOEs (21.9 ± 4.6% vs 6.2 ± 2.5, P = 0.003). Patients belonging to the high and very high SCORE risk group showed a significant increase of AOEs (34.4 ± 6% vs 10 ± 2.1%, P < 0.001). In multivariate analysis, both high cholesterol and LDL levels and a high and very high SCORE risk remained significantly associated with the risk of AOEs (P = 0.008; HR = 3.5; 95% CI = 1.4-8.7 and P < 0.001; HR = 4.4; 95% CI = 2-9.8, respectively). Overall, 78 patients (21.1%) presented dyslipidemia at the time of CML diagnosis and 88 (23.3%) after starting nilotinib, but only 26 of them (29.5%) were treated with statins.Low LDL and cholesterol plasma levels are associated with a significant lower risk of AOEs in CML patients treated with nilotinib in the real life.
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Affiliation(s)
- Giovanni Caocci
- Hematology Unit, Businco Hospital, ARNAS Brotzu, Cagliari, Italy. .,Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy.
| | - Olga Mulas
- Hematology Unit, Businco Hospital, ARNAS Brotzu, Cagliari, Italy.,Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
| | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale -IRCCS, Reggio Emilia, Italy
| | | | | | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Luigiana Luciano
- Hematology Unit, "Federico II" University of Naples, Naples, Italy
| | - Mario Tiribelli
- Division of Hematology and BMT, University of Udine, Udine, Italy
| | - Bruno Martino
- Hematology Unit, Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Patrizia Pregno
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Fabio Stagno
- Hematology Unit, AOU Policlinico -V. Emanuele, Rodolico Hospital, Catania, Italy
| | | | - Monica Bocchia
- Haematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Antonella Gozzini
- Hematology Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Francesco Albano
- Department of Emergency and Organ Transplantation - Hematology Section, University of Bari, Bari, Italy
| | - Claudio Fozza
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Debora Luzi
- Division of Hematology, Hematology Unit, Santa Maria Hospital, Terni, Italy
| | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | | | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | | | - Rossella Stella
- Division of Hematology and BMT, University of Udine, Udine, Italy
| | - Gabriele Gugliotta
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Francesca Pirillo
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | | | - Anna Sicuranza
- Haematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Daniele Cattaneo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Immacolata Attolico
- Department of Emergency and Organ Transplantation - Hematology Section, University of Bari, Bari, Italy
| | - Emilia Scalzulli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto 1, Rome, Italy
| | - Alessandra Iurlo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto 1, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto 1, Rome, Italy
| | - Giorgio La Nasa
- Hematology Unit, Businco Hospital, ARNAS Brotzu, Cagliari, Italy.,Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italy
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28
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Fontana D, Ramazzotti D, Aroldi A, Redaelli S, Magistroni V, Pirola A, Niro A, Massimino L, Mastini C, Brambilla V, Bombelli S, Bungaro S, Morotti A, Rea D, Stagno F, Martino B, Campiotti L, Caocci G, Usala E, Merli M, Onida F, Bregni M, Elli EM, Fumagalli M, Ciceri F, Perego RA, Pagni F, Mologni L, Piazza R, Gambacorti-Passerini C. Integrated Genomic, Functional, and Prognostic Characterization of Atypical Chronic Myeloid Leukemia. Hemasphere 2020; 4:e497. [PMID: 33196013 PMCID: PMC7655091 DOI: 10.1097/hs9.0000000000000497] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/29/2020] [Indexed: 02/06/2023] Open
Abstract
Supplemental Digital Content is available for this article. Atypical chronic myeloid leukemia (aCML) is a BCR-ABL1-negative clonal disorder, which belongs to the myelodysplastic/myeloproliferative group. This disease is characterized by recurrent somatic mutations in SETBP1, ASXL1 and ETNK1 genes, as well as high genetic heterogeneity, thus posing a great therapeutic challenge. To provide a comprehensive genomic characterization of aCML we applied a high-throughput sequencing strategy to 43 aCML samples, including both whole-exome and RNA-sequencing data. Our dataset identifies ASXL1, SETBP1, and ETNK1 as the most frequently mutated genes with a total of 43.2%, 29.7 and 16.2%, respectively. We characterized the clonal architecture of 7 aCML patients by means of colony assays and targeted resequencing. The results indicate that ETNK1 variants occur early in the clonal evolution history of aCML, while SETBP1 mutations often represent a late event. The presence of actionable mutations conferred both ex vivo and in vivo sensitivity to specific inhibitors with evidence of strong in vitro synergism in case of multiple targeting. In one patient, a clinical response was obtained. Stratification based on RNA-sequencing identified two different populations in terms of overall survival, and differential gene expression analysis identified 38 significantly overexpressed genes in the worse outcome group. Three genes correctly classified patients for overall survival.
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Affiliation(s)
- Diletta Fontana
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Daniele Ramazzotti
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Andrea Aroldi
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Hematology and Clinical Research Unit, San Gerardo Hospital, Monza, Italy
| | - Sara Redaelli
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Vera Magistroni
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | | | - Antonio Niro
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Luca Massimino
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Cristina Mastini
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Virginia Brambilla
- Department of Medicine and Surgery, Pathology, University of Milano - Bicocca, San Gerardo Hospital, Monza, Italy
| | - Silvia Bombelli
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Silvia Bungaro
- Centro Ricerca Tettamanti, Pediatria, University of Milano - Bicocca, Monza, Italy
| | - Alessandro Morotti
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - Delphine Rea
- Service d'Hématologie adulte, Hôpital Saint-Louis, Paris, France
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
| | - Bruno Martino
- Division of Hematology, Azienda Ospedaliera 'Bianchi Melacrino Morelli', Reggio Calabria, Italy
| | - Leonardo Campiotti
- Department of Medicine and Surgery, Università degli Studi dell'Insubria, Varese, Italy
| | - Giovanni Caocci
- Hematology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Emilio Usala
- Hematology Unit, Ospedale Oncologico A. Businco, Cagliari, Italy
| | - Michele Merli
- Hematology, University Hospital Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Francesco Onida
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Marco Bregni
- Oncology-Hematology Unit, ASST Valle Olona, Busto Arsizio, Italy
| | - Elena Maria Elli
- Hematology and Clinical Research Unit, San Gerardo Hospital, Monza, Italy
| | - Monica Fumagalli
- Hematology and Clinical Research Unit, San Gerardo Hospital, Monza, Italy
| | - Fabio Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto A Perego
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University of Milano - Bicocca, San Gerardo Hospital, Monza, Italy
| | - Luca Mologni
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Rocco Piazza
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Hematology and Clinical Research Unit, San Gerardo Hospital, Monza, Italy
| | - Carlo Gambacorti-Passerini
- Department of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Hematology and Clinical Research Unit, San Gerardo Hospital, Monza, Italy
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Efficace F, Iurlo A, Patriarca A, Stagno F, Bee PC, Ector G, Capodanno I, Elena C, Bonifacio M, Blijlevens NMA, Caocci G, Wan C, Abruzzese E, Breccia M, Cottone F, Okumura I, Oerlemans S, Cascavilla N, Albano F, Kota V, Sztankay M, Miggiano MC, Saussele S, Di Renzo N, Sorà F, Castagnetti F, Baccarani M, Vignetti M, Rosti G. Validation and reference values of the EORTC QLQ-CML24 questionnaire to assess health-related quality of life in patients with chronic myeloid leukemia. Leuk Lymphoma 2020; 62:669-678. [DOI: 10.1080/10428194.2020.1838509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Patriarca
- Department of Translational Medicine, Division of Hematology, University of Eastern Piedmont, Novara, Italy
| | - Fabio Stagno
- Hematology Section with BMT Unit, AOU Policlinico – V. Emanuele, Catania, Italy
| | - Ping-Chong Bee
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Geneviève Ector
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Chiara Elena
- Division of Hematology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | | | | | - Giovanni Caocci
- Dipartimento Scienze Mediche e Sanità Pubblica, Università di Cagliari, Ospedale Businco, Cagliari, Italy
| | - Chonghua Wan
- School of Humanities and Management, Research center for quality of life and applied psychology, Key Laboratory for Quality of Life and Psychological Assessment and Intervention, Guangdong Medical University, Dongguan, China
| | - Elisabetta Abruzzese
- Division of Hematology, Ospedale S. Eugenio, Tor Vergata University, ASL Roma 2, Roma, Italy
| | - Massimo Breccia
- Department of Cellular Biotechnologies and Hematology, “Sapienza” University of Rome, Rome, Italy
| | - Francesco Cottone
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Iris Okumura
- Unidade de Hematologia, Hemoterapia e Oncologia (UHHO), Serviço de Transplante de Medula Óssea (STMO), Complexo Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil
| | - Simone Oerlemans
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Nicola Cascavilla
- Department of Hematology and Stem Cell Transplant Unit, Fondazione IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Italy
| | - Francesco Albano
- Department of Emergency and Transplantation, Hematology Section, University of Bari Medical School, Bari, Italy
| | - Vamsi Kota
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Monika Sztankay
- Medical University of Innsbruck, University Hospital Innsbruck, Psychiatry II, Innsbruck, Austria
| | | | - Susanne Saussele
- III. Med. Klinik, Universitätsmedizin Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim, Germany
| | | | - Federica Sorà
- Istituto di Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Institute of Hematology “L. & A. Seràgnoli”, “Sant'Orsola-Malpighi” University Hospital, University of Bologna, Bologna, Italy
| | - Michele Baccarani
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Institute of Hematology “L. & A. Seràgnoli”, “Sant'Orsola-Malpighi” University Hospital, University of Bologna, Bologna, Italy
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Gianantonio Rosti
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Institute of Hematology “L. & A. Seràgnoli”, “Sant'Orsola-Malpighi” University Hospital, University of Bologna, Bologna, Italy
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Abstract
INTRODUCTION The treatment of chronic myeloid leukemia (CML) has been drastically changed by the approval of tyrosine kinase inhibitors (TKIs). CML is now managed as a chronic disease requiring both long-term treatment and close molecular monitoring in the majority of patients. AREAS COVERED Evidence suggests that in a substantial number of patients who have achieved a stable deep molecular response (DMR), TKI treatment can be safely discontinued without loss of response. Therefore, treatment-free remission (TFR), through the achievement of a DMR, is increasingly regarded as a feasible treatment goal in about 20% to 40% CML patients. Nevertheless, a proportion of patients with chronic-phase CML treated with TKIs remain in stable MMR and do not achieve a DMR. EXPERT OPINION We provide prospective views on how it is possible to optimize treatment for patients in stable MMR but not in DMR in order to finalize the therapeutic strategy.
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Affiliation(s)
- Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico - V. Emanuele , Catania, Italy
| | - Massimo Breccia
- Hematology, Department of Precision and Translational Medicine, Policlinico Umberto 1, Sapienza University , Rome, Italy
| | - Francesco Di Raimondo
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico - V. Emanuele , Catania, Italy
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31
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Markovic U, Bulla A, Leotta S, Stella S, Consoli ML, TambÈ L, Conticello C, DI Raimondo F, Stagno F. Second-line Dasatinib Therapy Improved Compliance and Deep Molecular Responses in Imatinib-intolerant Chronic Myeloid Leukemia Patients. Anticancer Res 2020; 40:5313-5317. [PMID: 32878823 DOI: 10.21873/anticanres.14538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Imatinib (IM) is the standard-of-care treatment for most chronic myeloid leukemia (CML) patients in chronic phase (CP). However, some patients suffer from low-grade side-effects that, in the long run, severely affect the quality of life and require treatment discontinuation due to toxicities. Fortunately, there are several therapeutic alternatives for these patients. Among them, the second-generation tyrosine kinase inhibitor dasatinib (DAS), used as second-line treatment, has shown to be a valid option in patients with CP-CML after intolerance to prior IM. PATIENTS AND METHODS Herein, we report on seven CP-CML patients who achieved a stable major molecular response (MMR) with IM-therapy, but were shifted to DAS treatment due to recurrent low-grade IM-intolerances (grades 1-2). RESULTS AND CONCLUSION All patients received conventional DAS treatment with a median daily dose of 83.3 mg. Treatment was well tolerated and side-effects were mild. In addition, after a median follow-up of 25 months (range=24-43 months) a deep molecular response (DMR) (either MR4 or MR4.5) was achieved in all patients after 24 months of treatment. This finding, although limited to a small cohort of CP-CML patients, supports the view that a therapy switch from IM to DAS induces a reduction of symptom burden, improves patient compliance and shows clinical efficacy in achieving and sustaining deep molecular responses.
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Affiliation(s)
- Uros Markovic
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico - V. Emanuele, Catania, Italy
| | - Anna Bulla
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico - V. Emanuele, Catania, Italy
| | - Salvatore Leotta
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico - V. Emanuele, Catania, Italy
| | - Stefania Stella
- Center of Experimental Oncology and Hematology, Department of Clinical and Experimental Medicine, AOU Policlinico - V. Emanuele, University of Catania, Catania, Italy
| | - Maria Letizia Consoli
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico - V. Emanuele, Catania, Italy
| | - Loredana TambÈ
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico - V. Emanuele, Catania, Italy
| | - Concetta Conticello
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico - V. Emanuele, Catania, Italy
| | - Francesco DI Raimondo
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico - V. Emanuele, Catania, Italy
| | - Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico - V. Emanuele, Catania, Italy
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32
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Breccia M, Abruzzese E, Bocchia M, Bonifacio M, Castagnetti F, Fava C, Galimberti S, Gozzini A, Gugliotta G, Iurlo A, Latagliata R, Luciano L, Pregno P, Rege-Cambrin G, Rosti G, Stagno F, Tiribelli M, Foà R, Saglio G. Chronic myeloid leukemia management at the time of the COVID-19 pandemic in Italy. A campus CML survey. Leukemia 2020; 34:2260-2261. [PMID: 32555369 PMCID: PMC7301058 DOI: 10.1038/s41375-020-0904-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/03/2022]
MESH Headings
- Betacoronavirus/isolation & purification
- COVID-19
- Coronavirus Infections/epidemiology
- Coronavirus Infections/prevention & control
- Coronavirus Infections/transmission
- Coronavirus Infections/virology
- Disease Management
- Humans
- Infection Control/methods
- Italy/epidemiology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/virology
- Pandemics/prevention & control
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/prevention & control
- Pneumonia, Viral/transmission
- Pneumonia, Viral/virology
- Practice Guidelines as Topic/standards
- Protein Kinase Inhibitors/therapeutic use
- SARS-CoV-2
- Surveys and Questionnaires
- Telemedicine
- Time-to-Treatment/statistics & numerical data
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Affiliation(s)
- Massimo Breccia
- Department of Precision and Translational Medicine, Sapienza University, Rome, Italy
| | | | | | | | - Fausto Castagnetti
- Department of Hematology/Oncology, University of Bologna, Bologna, Italy
| | - Carmen Fava
- Azienda Ospedaliera Mauriziano, Torino, Italy
| | | | | | - Gabriele Gugliotta
- Department of Hematology/Oncology, University of Bologna, Bologna, Italy
| | - Alessandra Iurlo
- Fondazione IRCSS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | - Roberto Latagliata
- Department of Precision and Translational Medicine, Sapienza University, Rome, Italy
| | | | | | | | - Gianantonio Rosti
- Department of Hematology/Oncology, University of Bologna, Bologna, Italy
| | - Fabio Stagno
- Ospedale Ferrarotto-University of Catania, Catania, Italy
| | | | - Robin Foà
- Department of Precision and Translational Medicine, Sapienza University, Rome, Italy.
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33
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Annunziata M, Bonifacio M, Breccia M, Castagnetti F, Gozzini A, Iurlo A, Pregno P, Stagno F, Specchia G. Current Strategies and Future Directions to Achieve Deep Molecular Response and Treatment-Free Remission in Chronic Myeloid Leukemia. Front Oncol 2020; 10:883. [PMID: 32582549 PMCID: PMC7280484 DOI: 10.3389/fonc.2020.00883] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 05/05/2020] [Indexed: 12/21/2022] Open
Abstract
The treatment of chronic myeloid leukemia (CML) has been radically changed by the approval of tyrosine kinase inhibitors (TKIs), which target BCR-ABL1 kinase activity. CML is now managed as a chronic disease requiring long-term treatment and close molecular monitoring. It has been shown that in a substantial number of patients who have achieved a stable deep molecular response (DMR), TKI treatment can be safely discontinued without loss of response. Therefore, treatment-free remission (TFR), through the achievement of a DMR, is increasingly regarded as a feasible treatment goal in many CML patients. However, only nilotinib has approval in this setting and a number of controversial aspects remain regarding treatment choices and timings, predictive factors, patient communication, and optimal strategies to achieve successful TFR. This narrative review aims to provide a comprehensive overview on how to optimize the path to DMR and TFR in patients with CML, and discusses recent data and future directions.
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Affiliation(s)
| | | | - Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology “L. and A. Seràgnoli”, “S. Orsola-Malpighi” Univeristy Hospital, University of Bologna, Bologna, Italy
| | - Antonella Gozzini
- Department of Cellular Therapy and Transfusional Medicine, AUO Careggi, Florence, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Patrizia Pregno
- Hematology Division, Oncology and Hematology Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, AOU Policlinico—V. Emanuele, Catania, Italy
| | - Giorgina Specchia
- Hematology Section, Department of Emergency and Organ Transplantation, University of Bari-Aldo Moro, Bari, Italy
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34
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Silvestri G, Trotta R, Stramucci L, Ellis JJ, Harb JG, Neviani P, Wang S, Eisfeld AK, Walker CJ, Zhang B, Srutova K, Gambacorti-Passerini C, Pineda G, Jamieson CHM, Stagno F, Vigneri P, Nteliopoulos G, May PC, Reid AG, Garzon R, Roy DC, Moutuou MM, Guimond M, Hokland P, Deininger MW, Fitzgerald G, Harman C, Dazzi F, Milojkovic D, Apperley JF, Marcucci G, Qi J, Polakova KM, Zou Y, Fan X, Baer MR, Calabretta B, Perrotti D. Persistence of Drug-Resistant Leukemic Stem Cells and Impaired NK Cell Immunity in CML Patients Depend on MIR300 Antiproliferative and PP2A-Activating Functions. Blood Cancer Discov 2020; 1:48-67. [PMID: 32974613 DOI: 10.1158/0008-5472.bcd-19-0039] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Persistence of drug-resistant quiescent leukemic stem cells (LSC) and impaired natural killer (NK) cell immune response account for relapse of chronic myelogenous leukemia (CML). Inactivation of protein phosphatase 2A (PP2A) is essential for CML-quiescent LSC survival and NK cell antitumor activity. Here we show that MIR300 has antiproliferative and PP2A-activating functions that are dose dependently differentially induced by CCND2/CDK6 and SET inhibition, respectively. MIR300 is upregulated in CML LSCs and NK cells by bone marrow microenvironment (BMM) signals to induce quiescence and impair immune response, respectively. Conversely, BCR-ABL1 downregulates MIR300 in CML progenitors to prevent growth arrest and PP2A-mediated apoptosis. Quiescent LSCs escape apoptosis by upregulating TUG1 long noncoding RNA that uncouples and limits MIR300 function to cytostasis. Genetic and pharmacologic MIR300 modulation and/or PP2A-activating drug treatment restore NK cell activity, inhibit BMM-induced growth arrest, and selectively trigger LSC apoptosis in vitro and in patient-derived xenografts; hence, the importance of MIR300 and PP2A activity for CML development and therapy.
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Affiliation(s)
- Giovannino Silvestri
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Rossana Trotta
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lorenzo Stramucci
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Justin J Ellis
- Department of Molecular Virology Immunology and Medical Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Jason G Harb
- Department of Molecular Virology Immunology and Medical Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Paolo Neviani
- Department of Molecular Virology Immunology and Medical Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Shuzhen Wang
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Ann-Kathrin Eisfeld
- Department of Molecular Virology Immunology and Medical Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Christopher J Walker
- Department of Molecular Virology Immunology and Medical Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Bin Zhang
- Division of Hematopoietic Stem Cell and Leukemia Research, City of Hope National Medical Center, Duarte, California
| | - Klara Srutova
- Institute of Hematology and Blood Transfusion, University of Prague, Prague, Czech Republic
| | | | - Gabriel Pineda
- Department of Medicine and Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Catriona H M Jamieson
- Department of Medicine and Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Fabio Stagno
- Division of Hematology and Unit of Medical Oncology, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Paolo Vigneri
- Division of Hematology and Unit of Medical Oncology, A.O.U. "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Georgios Nteliopoulos
- Department of Haematology, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Philippa C May
- Department of Haematology, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Alistair G Reid
- Department of Haematology, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Ramiro Garzon
- Department of Molecular Virology Immunology and Medical Genetics, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.,Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Denis-Claude Roy
- Department of Hematology and Cellular Therapy Laboratory, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Quebec, Canada
| | - Moutuaata M Moutuou
- Department of Hematology and Cellular Therapy Laboratory, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Quebec, Canada
| | - Martin Guimond
- Department of Hematology and Cellular Therapy Laboratory, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Quebec, Canada
| | - Peter Hokland
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael W Deininger
- Division of Hematology and Hematologic Malignancies and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Garrett Fitzgerald
- Center for Advanced Fetal Care University, University of Maryland School of Medicine, Baltimore, Maryland
| | - Christopher Harman
- Center for Advanced Fetal Care University, University of Maryland School of Medicine, Baltimore, Maryland
| | - Francesco Dazzi
- Division of Cancer Studies, Rayne Institute, King's College London, London, United Kingdom
| | - Dragana Milojkovic
- Department of Haematology, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Jane F Apperley
- Department of Haematology, Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - Guido Marcucci
- Division of Hematopoietic Stem Cell and Leukemia Research, City of Hope National Medical Center, Duarte, California
| | - Jianfei Qi
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Ying Zou
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Xiaoxuan Fan
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Maria R Baer
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Bruno Calabretta
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Danilo Perrotti
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.,Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Haematology, Hammersmith Hospital, Imperial College London, London, United Kingdom.,Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, Maryland
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35
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Stella S, Tirró E, Massimino M, Vitale SR, Russo S, Pennisi MS, Puma A, Romano C, DI Gregorio S, Innao V, Stagno F, DI Raimondo F, Musolino C, Manzella L. Successful Management of a Pregnant Patient With Chronic Myeloid Leukemia Receiving Standard Dose Imatinib. In Vivo 2020; 33:1593-1598. [PMID: 31471409 DOI: 10.21873/invivo.11641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND/AIM As approximately 10% of individuals developing chronic myeloid leukemia (CML) are females aged 20-44 years, a considerable number will consider a planned pregnancy if disease is well controlled by pharmacological treatment. The management of these young patients during pregnancy represents a therapeutic dilemma due to the potential teratogen effects of several tyrosine kinase inhibitors (TKIs) and is a matter of continuous debate. Indeed, despite the existence of several studies, there is currently no consensus on how to manage different pregnancy situations in subjects with CML. PATIENTS AND METHODS We describe a female patient diagnosed with Ph-positive CML one month after her first delivery who achieved excellent hematological, cytogenetic and molecular responses while on imatinib mesylate (IM) treatment. RESULTS The excellent responses allowed the patient to suspend TKI treatment in order to plan a second pregnancy. Despite IM discontinuation, stringent molecular monitoring of her BCR-ABL1/ABL1 levels allowed the safe delivery of the child and, while the patient eventually developed a molecular relapse after four years of treatment discontinuation, upon restarting IM she quickly regained a deep molecular response that is still ongoing. CONCLUSION Our case report demonstrates that, if the pregnancy is properly planned in CML patients, it can result in excellent management of the clinical therapeutic option for the benefit of both mother and child.
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Affiliation(s)
- Stefania Stella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy .,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Elena Tirró
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Michele Massimino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Silvia Rita Vitale
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Sabina Russo
- Division of Hematology, University of Messina, Messina, Italy
| | - Maria Stella Pennisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Adriana Puma
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Chiara Romano
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Sandra DI Gregorio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Vanessa Innao
- Division of Hematology, University of Messina, Messina, Italy
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Francesco DI Raimondo
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy.,Department of Surgery, Medical and Surgical Specialities, University of Catania, Catania, Italy
| | | | - Livia Manzella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
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36
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Caocci G, Mulas O, Annunziata M, Luciano L, Abruzzese E, Bonifacio M, Orlandi EM, Albano F, Galimberti S, Iurlo A, Pregno P, Sgherza N, Martino B, Binotto G, Castagnetti F, Gozzini A, Bocchia M, Fozza C, Stagno F, Simula MP, De Gregorio F, Trawinska MM, Scaffidi L, Elena C, Attolico I, Baratè C, Cattaneo D, Pirillo F, Gugliotta G, Sicuranza A, Molica M, La Nasa G, Foà R, Breccia M. Long-term mortality rate for cardiovascular disease in 656 chronic myeloid leukaemia patients treated with second- and third-generation tyrosine kinase inhibitors. Int J Cardiol 2020; 301:163-166. [DOI: 10.1016/j.ijcard.2019.10.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 09/30/2019] [Accepted: 10/21/2019] [Indexed: 11/28/2022]
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Soverini S, Abruzzese E, Bocchia M, Bonifacio M, Galimberti S, Gozzini A, Iurlo A, Luciano L, Pregno P, Rosti G, Saglio G, Stagno F, Tiribelli M, Vigneri P, Barosi G, Breccia M. Next-generation sequencing for BCR-ABL1 kinase domain mutation testing in patients with chronic myeloid leukemia: a position paper. J Hematol Oncol 2019; 12:131. [PMID: 31801582 PMCID: PMC6894351 DOI: 10.1186/s13045-019-0815-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/27/2019] [Indexed: 12/31/2022] Open
Abstract
BCR-ABL1 kinase domain (KD) mutation status is considered to be an important element of clinical decision algorithms for chronic myeloid leukemia (CML) patients who do not achieve an optimal response to tyrosine kinase inhibitors (TKIs). Conventional Sanger sequencing is the method currently recommended to test BCR-ABL1 KD mutations. However, Sanger sequencing has limited sensitivity and cannot always discriminate between polyclonal and compound mutations. The use of next-generation sequencing (NGS) is increasingly widespread in diagnostic laboratories and represents an attractive alternative. Currently available data on the clinical impact of NGS-based mutational testing in CML patients do not allow recommendations with a high grade of evidence to be prepared. This article reports the results of a group discussion among an ad hoc expert panel with the objective of producing recommendations on the appropriateness of clinical decisions about the indication for NGS, the performance characteristics of NGS platforms, and the therapeutic changes that could be applied based on the use of NGS in CML. Overall, these recommendations might be employed to inform clinicians about the practical use of NGS in CML.
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Affiliation(s)
- Simona Soverini
- Hematology/Oncology "L. e A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy.
| | | | - Monica Bocchia
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Antonella Gozzini
- Department of Cellular Therapies and Transfusion Medicine, AOU Careggi, Florence, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Patrizia Pregno
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Gianantonio Rosti
- Hematology/Oncology "L. e A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, S. Orsola-Malpighi Hospital, Via Massarenti 9, 40138, Bologna, Italy
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences of the University of Turin, Mauriziano Hospital, Turin, Italy
| | - Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico-V. Emanuele, Catania, Italy
| | - Mario Tiribelli
- Division of Hematology and Bone Marrow Transplantation, Department of Medical Area, University of Udine, Udine, Italy
| | - Paolo Vigneri
- Department of Clinical and Experimental Medicine and Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Massimo Breccia
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
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38
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Bonifacio M, Stagno F, Scaffidi L, Krampera M, Di Raimondo F. Management of Chronic Myeloid Leukemia in Advanced Phase. Front Oncol 2019; 9:1132. [PMID: 31709190 PMCID: PMC6823861 DOI: 10.3389/fonc.2019.01132] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
Management of chronic myeloid leukemia (CML) in advanced phases remains a challenge also in the era of tyrosine kinase inhibitors (TKIs) treatment. Cytogenetic clonal evolution and development of resistant mutations represent crucial events that limit the benefit of subsequent therapies in these patients. CML is diagnosed in accelerated (AP) or blast phase (BP) in <5% of patients, and the availability of effective treatments for chronic phase (CP) has dramatically reduced progressions on therapy. Due to smaller number of patients, few randomized studies are available in this setting and evidences are limited. Nevertheless, three main scenarios may be drawn: (a) patients diagnosed in AP are at higher risk of failure as compared to CP patients, but if they achieve optimal responses with frontline TKI treatment their outcome may be similarly favorable; (b) patients diagnosed in BP may be treated with TKI alone or with TKI together with conventional chemotherapy regimens, and subsequent transplant decisions should rely on kinetics of response and individual transplant risk; (c) patients in CP progressing under TKI treatment represent the most challenging population and they should be treated with alternative TKI according to the mutational profile, optional chemotherapy in BP patients, and transplant should be considered in suitable cases after return to second CP. Due to lack of validated and reliable markers to predict blast crisis and the still unsatisfactory results of treatments in this setting, prevention of progression by careful selection of frontline treatment in CP and early treatment intensification in non-optimal responders remains the main goal. Personalized evaluation of response kinetics could help in identifying patients at risk for progression.
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Affiliation(s)
| | - Fabio Stagno
- Division of Hematology With BMT, AOU Policlinico “Vittorio Emanuele”, University of Catania, Catania, Italy
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Mauro Krampera
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Francesco Di Raimondo
- Division of Hematology With BMT, AOU Policlinico “Vittorio Emanuele”, University of Catania, Catania, Italy
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39
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Efficace F, Stagno F, Iurlo A, Breccia M, Cottone F, Bonifacio M, Abruzzese E, Castagnetti F, Caocci G, Crugnola M, Capodanno I, Martino B, Tiribelli M, Patriarca A, Gozzini A, Pregno P, Saussele S, Cascavilla N, Fozza C, Bergamaschi M, Binotto G, Vignetti M, Rosti G. Health-related quality of life of newly diagnosed chronic myeloid leukemia patients treated with first-line dasatinib versus imatinib therapy. Leukemia 2019; 34:488-498. [DOI: 10.1038/s41375-019-0563-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/12/2019] [Accepted: 07/04/2019] [Indexed: 12/15/2022]
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40
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Pennisi MS, Stella S, Vitale SR, Puma A, Di Gregorio S, Romano C, Tirrò E, Massimino M, Antolino A, Siragusa S, Mannina D, Impera S, Musolino C, Mineo G, Martino B, Zammit V, Di Raimondo F, Manzella L, Stagno F, Vigneri P. BCR-ABL1 Doubling-Times and Halving-Times May Predict CML Response to Tyrosine Kinase Inhibitors. Front Oncol 2019; 9:764. [PMID: 31456947 PMCID: PMC6700306 DOI: 10.3389/fonc.2019.00764] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/29/2019] [Indexed: 12/22/2022] Open
Abstract
In Chronic Myeloid Leukemia (CML), successful treatment requires accurate molecular monitoring to evaluate disease response and provide timely interventions for patients failing to achieve the desired outcomes. We wanted to determine whether measuring BCR-ABL1 mRNA doubling-times (DTs) could distinguish inconsequential rises in the oncogene's expression from resistance to tyrosine kinase inhibitors (TKIs). Thus, we retrospectively examined BCR-ABL1 evolution in 305 chronic-phase CML patients receiving imatinib mesylate (IM) as a first line treatment. Patients were subdivided in two groups: those with a confirmed rise in BCR-ABL1 transcripts without MR3.0 loss and those failing IM. We found that the DTs of the former patients were significantly longer than those of patients developing IM resistance (57.80 vs. 41.45 days, p = 0.0114). Interestingly, the DT values of individuals failing second-generation (2G) TKIs after developing IM resistance were considerably shorter than those observed at the time of IM failure (27.20 vs. 41.45 days; p = 0.0035). We next wanted to establish if decreases in BCR-ABL1 transcripts would identify subjects likely to obtain deep molecular responses. We therefore analyzed the BCR-ABL1 halving-times (HTs) of a different cohort comprising 174 individuals receiving IM in first line and observed that, regardless of the time point selected for our analyses (6, 12, or 18 months), HTs were significantly shorter in subjects achieving superior molecular responses (p = 0.002 at 6 months; p < 0.001 at 12 months; p = 0.0099 at 18 months). Moreover, 50 patients receiving 2G TKIs as first line therapy and obtaining an MR3.0 (after 6 months; p = 0.003) or an MR4.0 (after 12 months; p = 0.019) displayed significantly shorter HTs than individuals lacking these molecular responses. Our findings suggest that BCR-ABL1 DTs and HTs are reliable tools to, respectively, identify subjects in MR3.0 that are failing their assigned TKI or to recognize patients likely to achieve deep molecular responses that should be considered for treatment discontinuation.
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Affiliation(s)
- Maria Stella Pennisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico - Vittorio Emanuele, Catania, Italy
| | - Stefania Stella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico - Vittorio Emanuele, Catania, Italy
| | - Silvia Rita Vitale
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico - Vittorio Emanuele, Catania, Italy
| | - Adriana Puma
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico - Vittorio Emanuele, Catania, Italy
| | - Sandra Di Gregorio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico - Vittorio Emanuele, Catania, Italy
| | - Chiara Romano
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico - Vittorio Emanuele, Catania, Italy
| | - Elena Tirrò
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico - Vittorio Emanuele, Catania, Italy
| | - Michele Massimino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico - Vittorio Emanuele, Catania, Italy
| | - Agostino Antolino
- Department of Transfusional Medicine, Maria Paternò-Arezzo Hospital, Ragusa, Italy
| | - Sergio Siragusa
- Division of Hematology, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | - Donato Mannina
- Division of Hematology, Papardo Hospital, Messina, Italy
| | - Stefana Impera
- Division of Oncology and Hematology, ARNAS Garibaldi-Nesima, Catania, Italy
| | - Caterina Musolino
- Division of Hematology, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico "G. Martino", University of Messina, Messina, Italy
| | - Giuseppe Mineo
- Division of Hematology, San Vincenzo Hospital, Taormina, Italy
| | - Bruno Martino
- Division of Hematology, Grande Ospedale Metropolitano, Reggio Calabria, Italy
| | - Valentina Zammit
- Division of Hematology and Bone Marrow Transplant, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico - Vittorio Emanuele, Catania, Italy
| | - Francesco Di Raimondo
- Division of Hematology and Bone Marrow Transplant, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico - Vittorio Emanuele, Catania, Italy.,Department of Surgery, Medical and Surgical Specialties, University of Catania, Catania, Italy
| | - Livia Manzella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico - Vittorio Emanuele, Catania, Italy
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico - Vittorio Emanuele, Catania, Italy
| | - Paolo Vigneri
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, Azienda Ospedaliera Universitaria (A.O.U.) Policlinico - Vittorio Emanuele, Catania, Italy
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41
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Massimino M, Stella S, Tirrò E, Consoli ML, Pennisi MS, Puma A, Vitale SR, Romano C, Zammit V, Stagno F, DI Raimondo F, Manzella L. Efficacy of Dasatinib in a Very Elderly CML Patient Expressing a Rare E13a3 Bcr-Abl1 Fusion Transcript: A Case Report. Anticancer Res 2019; 39:3949-3954. [PMID: 31262926 DOI: 10.21873/anticanres.13548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 04/11/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 11/10/2022]
Abstract
We report the case of an 89-year-old male diagnosed with chronic-phase CML and expressing a rare e13a3 BCR-ABL1 fusion transcript. His cytogenetic analysis showed the t(9;22) translocation generating the Philadelphia chromosome (Ph), with a multiplex RT-PCR detecting an atypical fragment. Using two primers complementary to exon 10 of BCR and exon 4 of ABL1, a larger PCR product was observed, where after Sanger sequencing, an e13a3 BCR-ABL1 transcript was revealed. Given the diagnosis, the patient received 100 mg of dasatinib every other day and was then monitored by measuring both hematological and cytogenetic parameters, while his BCR-ABL1 transcripts were examined by PCR and semi-nested-PCR. According to the 2013 European Leukemia Network criteria, after six months of dasatinib the patient's response was classified as warning as he displayed 20% of Philadelphia-positive metaphases. Sequencing of the ABL1 catalytic domain did not detect point mutations. A complete cytogenetic response was achieved after one year of dasatinib. However, semi-nested-PCR confirmed the presence of the e13a3 BCR-ABL1 fusion transcript that has persisted up to the latest follow-up visit.
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Affiliation(s)
- Michele Massimino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy .,Center of Experimental Oncology and Hematology, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
| | - Stefania Stella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
| | - Elena Tirrò
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
| | - Maria Letizia Consoli
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
| | - Maria Stella Pennisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
| | - Adriana Puma
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
| | - Silvia Rita Vitale
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
| | - Chiara Romano
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
| | - Valentina Zammit
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
| | - Francesco DI Raimondo
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy.,Department of Surgery, Medical and Surgical Specialties, University of Catania, Catania, Italy
| | - Livia Manzella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico - Vittorio Emanuele, Catania, Italy
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42
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Tirrò E, Massimino M, Stella S, Zammit V, Consoli ML, Pennisi MS, Vitale SR, Romano C, Pirosa MC, Martino E, DI Gregorio S, Puma A, DI Raimondo F, Manzella L, Stagno F. Efficacy of Nilotinib in a CML Patient Expressing the Three-way Complex Variant Translocation t(2;9;22). Anticancer Res 2019; 39:3893-3899. [PMID: 31262918 DOI: 10.21873/anticanres.13540] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Chronic myelogenous leukemia (CML) is characterized by the presence of the Philadelphia chromosome, resulting from the reciprocal translocation involving chromosomes 9 and 22. About 5-10% of newly diagnosed patients in chronic-phase (CP) CML show complex additional chromosomal aberrations (ACA), that may involve one or more chromosomes in addition to 9 and 22. Data concerning the prognostic significance of ACA in CP-CML subjects at diagnosis are controversial. Furthermore, there is no evidence showing that selection of imatinib (IM) or second-generation tyrosine kinase inhibitors (2G-TKI) would be of benefit for these patients. CASE REPORT We report the three-way complex variant translocation t(2;9;22) in a CP-CML patient. Conventional cytogenetic analysis was employed to identify the ACA. Multiplex reverse transcription-PCR was used to identify the BCR-ABL1 transcript and its levels were measured using quantitative real-time-PCR. This rare ACA t(2;9;22) in our young patient displayed primary resistance to IM, but was responsive to second-line treatment with nilotinib. CONCLUSION CP-CML patients exhibiting this rare aberration at diagnosis may benefit from a 2G-TKI therapy compared to IM.
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Affiliation(s)
- Elena Tirrò
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy .,Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Michele Massimino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Stefania Stella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Valentina Zammit
- Division of Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | | | - Maria Stella Pennisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Silvia Rita Vitale
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Chiara Romano
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | | | - Enrica Martino
- Division of Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Sandra DI Gregorio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Adriana Puma
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Franscesco DI Raimondo
- Division of Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy.,Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Livia Manzella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.,Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Fabio Stagno
- Division of Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
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43
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Massimino M, Stella S, Tirrò E, Consoli ML, Pennisi MS, Puma A, Vitale SR, Romano C, Zammit V, Stagno F, Di Raimondo F, Manzella L. Rapid decline of Philadelphia-positive metaphases after nilotinib treatment in a CML patient expressing a rare e14a3 BCR-ABL1 fusion transcript: A case report. Oncol Lett 2019; 18:2648-2653. [PMID: 31404304 DOI: 10.3892/ol.2019.10558] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/15/2019] [Indexed: 12/13/2022] Open
Abstract
We report a case of chronic myeloid leukemia in a 52-year-old male expressing a rare e14a3 BCR-ABL1 fusion transcript. Cytogenetic analysis showed the t(9;22) translocation and multiplex RT-PCR detected an atypical fragment of approximately 230 base pairs. Using two primers recognizing exon 10 of BCR and exon 4 of ABL1, a larger PCR product was identified, cloned, sequenced and defined as an e14a3 BCR-ABL1 rearrangement. The patient was treated with nilotinib and monitored measuring cytogenetic and hematological parameters, while BCR-ABL1 transcripts were surveyed by conventional and semi-nested PCR. The patient achieved a complete hematologic response after two months of treatment followed by a complete cytogenetic remission two months later. Furthermore, PCR and semi-nested PCR failed to detect the e14a3 BCR-ABL1 mRNA after 15 and 21 months of nilotinib, respectively.
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Affiliation(s)
- Michele Massimino
- Department of Clinical and Experimental Medicine, University of Catania, Catania I-95123, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania I-95123, Italy
| | - Stefania Stella
- Department of Clinical and Experimental Medicine, University of Catania, Catania I-95123, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania I-95123, Italy
| | - Elena Tirrò
- Department of Clinical and Experimental Medicine, University of Catania, Catania I-95123, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania I-95123, Italy
| | - Maria Letizia Consoli
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico-Vittorio Emanuele, Catania I-95123, Italy
| | - Maria Stella Pennisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania I-95123, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania I-95123, Italy
| | - Adriana Puma
- Department of Clinical and Experimental Medicine, University of Catania, Catania I-95123, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania I-95123, Italy
| | - Silvia Rita Vitale
- Department of Clinical and Experimental Medicine, University of Catania, Catania I-95123, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania I-95123, Italy
| | - Chiara Romano
- Department of Clinical and Experimental Medicine, University of Catania, Catania I-95123, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania I-95123, Italy
| | - Valentina Zammit
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico-Vittorio Emanuele, Catania I-95123, Italy
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico-Vittorio Emanuele, Catania I-95123, Italy
| | - Francesco Di Raimondo
- Division of Hematology and Bone Marrow Transplant, A.O.U. Policlinico-Vittorio Emanuele, Catania I-95123, Italy.,Department of Surgery, Medical and Surgical Specialties, University of Catania, Catania I-95123, Italy
| | - Livia Manzella
- Department of Clinical and Experimental Medicine, University of Catania, Catania I-95123, Italy.,Center of Experimental Oncology and Hematology, A.O.U. Policlinico-Vittorio Emanuele, Catania I-95123, Italy
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Stella S, Zammit V, Vitale SR, Pennisi MS, Massimino M, Tirrò E, Forte S, Spitaleri A, Antolino A, Siracusa S, Accurso V, Mannina D, Impera S, Musolino C, Russo S, Malato A, Mineo G, Musso M, Porretto F, Martino B, Di Raimondo F, Manzella L, Vigneri P, Stagno F. Clinical Implications of Discordant Early Molecular Responses in CML Patients Treated with Imatinib. Int J Mol Sci 2019; 20:ijms20092226. [PMID: 31064152 PMCID: PMC6539817 DOI: 10.3390/ijms20092226] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/16/2022] Open
Abstract
A reduction in BCR-ABL1/ABL1IS transcript levels to <10% after 3 months or <1% after 6 months of tyrosine kinase inhibitor therapy are associated with superior clinical outcomes in chronic myeloid leukemia (CML) patients. In this study, we investigated the reliability of multiple BCR-ABL1 thresholds in predicting treatment outcomes for 184 subjects diagnosed with CML and treated with standard-dose imatinib mesylate (IM). With a median follow-up of 61 months, patients with concordant BCR-ABL1/ABL1IS transcripts below the defined thresholds (10% at 3 months and 1% at 6 months) displayed significantly superior rates of event-free survival (86.1% vs. 26.6%) and deep molecular response (≥ MR4; 71.5% vs. 16.1%) compared to individuals with BCR-ABL1/ABL1IS levels above these defined thresholds. We then analyzed the outcomes of subjects displaying discordant molecular transcripts at 3- and 6-month time points. Among these patients, those with BCR-ABL1/ABL1IS values >10% at 3 months but <1% at 6 months fared significantly better than individuals with BCR-ABL1/ABL1IS <10% at 3 months but >1% at 6 months (event-free survival 68.2% vs. 32.7%; p < 0.001). Likewise, subjects with BCR-ABL1/ABL1IS at 3 months >10% but <1% at 6 months showed a higher cumulative incidence of MR4 compared to patients with BCR-ABL1/ABL1IS <10% at 3 months but >1% at 6 months (75% vs. 18.2%; p < 0.001). Finally, lower BCR-ABL1/GUSIS transcripts at diagnosis were associated with BCR-ABL1/ABL1IS values <1% at 6 months (p < 0.001). Our data suggest that when assessing early molecular responses to therapy, the 6-month BCR-ABL1/ABL1IS level displays a superior prognostic value compared to the 3-month measurement in patients with discordant oncogenic transcripts at these two pivotal time points.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents/therapeutic use
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Female
- Fusion Proteins, bcr-abl/antagonists & inhibitors
- Fusion Proteins, bcr-abl/genetics
- Fusion Proteins, bcr-abl/metabolism
- Humans
- Imatinib Mesylate/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Male
- Middle Aged
- Protein Kinase Inhibitors/therapeutic use
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Treatment Outcome
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Affiliation(s)
- Stefania Stella
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico Vittorio Emanuele, 95123 Catania, Italy.
| | - Valentina Zammit
- Division of Hematology and Bone Marrow Transplant, AOU Policlinico - V. Emanuele, 95123 Catania, Italy.
| | - Silvia Rita Vitale
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico Vittorio Emanuele, 95123 Catania, Italy.
| | - Maria Stella Pennisi
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico Vittorio Emanuele, 95123 Catania, Italy.
| | - Michele Massimino
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico Vittorio Emanuele, 95123 Catania, Italy.
| | - Elena Tirrò
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico Vittorio Emanuele, 95123 Catania, Italy.
| | - Stefano Forte
- Mediterranean Institute of Oncology, 95029 Viagrande, Italy.
| | - Antonio Spitaleri
- Division of Hematology and Bone Marrow Transplant, AOU Policlinico - V. Emanuele, 95123 Catania, Italy.
| | - Agostino Antolino
- Department of Transfusional Medicine, Maria Paternò-Arezzo Hospital, 97100 Ragusa, Italy.
| | - Sergio Siracusa
- Division of Hematology, A.O.U. Policlinico "P. Giaccone", University of Palermo, 90127 Palermo, Italy.
| | - Vincenzo Accurso
- Division of Hematology, A.O.U. Policlinico "P. Giaccone", University of Palermo, 90127 Palermo, Italy.
| | - Donato Mannina
- Division of Hematology, Papardo Hospital, 98158 Messina, Italy.
| | - Stefana Impera
- Division of Oncology and Hematology, ARNAS Garibaldi-Nesima, 95122 Catania, Italy.
| | - Caterina Musolino
- Division of Hematology, University of Messina, 98125 Messina, Italy.
| | - Sabina Russo
- Division of Hematology, University of Messina, 98125 Messina, Italy.
| | - Alessandra Malato
- Division of Hematology and Bone Marrow Transplant, Villa Sofia-Cervello Hospital, 90146 Palermo, Italy.
| | - Giuseppe Mineo
- Division of Hematology, San Vincenzo Hospital, 98039 Taormina, Italy.
| | - Maurizio Musso
- Division of Hematology, La Maddalena Hospital, 90146 Palermo, Italy.
| | | | - Bruno Martino
- Hematology Department, Grande Ospedale Metropolitano, Reggio Calabria, 89124 Reggio Calabria, Italy.
| | - Francesco Di Raimondo
- Division of Hematology and Bone Marrow Transplant, AOU Policlinico - V. Emanuele, 95123 Catania, Italy.
- Department of Surgery, Medical and Surgical Specialities, University of Catania, 95123 Catania, Italy.
| | - Livia Manzella
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico Vittorio Emanuele, 95123 Catania, Italy.
| | - Paolo Vigneri
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy.
- Center of Experimental Oncology and Hematology, A.O.U. Policlinico Vittorio Emanuele, 95123 Catania, Italy.
| | - Fabio Stagno
- Division of Hematology and Bone Marrow Transplant, AOU Policlinico - V. Emanuele, 95123 Catania, Italy.
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Abruzzese E, Bosi A, Breccia M, D’Adda M, Di Renzo N, Liberati AM, Porrini R, Orlandi EM, Pane F, Pungolino E, Sorà F, Stagno F, Sen GP, Gentilini F, De Solda F, Gambacorti-Passerini C. Treatment Patterns in Patients with Chronic-Phase Chronic Myeloid Leukaemia in Routine Clinical Practice: the SIMPLICITY Italian Population. Mediterr J Hematol Infect Dis 2019; 11:e2019025. [PMID: 31205629 PMCID: PMC6548212 DOI: 10.4084/mjhid.2019.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 03/28/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES While tyrosine kinase inhibitors (TKIs) have transformed CP-CML management, limited data exist on their use in clinical practice. METHODS SIMPLICITY (NCT01244750) is an observational study in CP-CML patients, exploring first-line (1L) TKI use and management patterns in the US and Europe. Over half of the patients recruited in Europe are from Italy (n=266). This is an analysis of the Italian cohort and a comparison with the rest of the European SIMPLICITY population. Baseline demographic, factors influencing the choice of first-line TKI, response monitoring patterns and predictors of monitoring, and treatment interruptions, discontinuations and switching by index TKIs are presented for the Italian cohort in the first year of treatment and compared with that for the overall European SIMPLICITY cohort. RESULTS Italian patients received 1L imatinib (IM; retrospective [(n=31]; prospective [n=106]), dasatinib (DAS; n=56) or nilotinib (NIL; n=73). Documented cytogenetic response monitoring by 12 months was lower than expected, but almost all patients had documented molecular response monitoring. Fewer patients discontinued first-line TKI by 12 months in Italy compared with the rest of the European SIMPLICITY population (p=0.003). Of those with ≥12 months follow-up since the start of 1L TKI, only 7.1% (n=19) of Italian patients switched to a second-line TKI, a third less than in the rest of the European SIMPLICITY population. Of interest, intolerance as opposed to resistance, was the main reason for switching. CONCLUSIONS This analysis provides valuable insights into management and treatment patterns in Italian patients with CML within routine clinical practice.
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Affiliation(s)
| | - Alberto Bosi
- U.O. di Ematologia, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Massimo Breccia
- Azienda Policlinico Umberto I-Università Sapienza, Roma, Italy
| | | | - Nicola Di Renzo
- U.O. di Ematologia e Trapianto di Cellule Staminali P.O “Vito Fazzi” - Lecce, Italy
| | | | | | | | | | | | - Federica Sorà
- UOC di Ematologia, Policlinico Universitario ‘A. Gemelli’, Roma, Italy
| | - Fabio Stagno
- Divisione Clinicizzata di Ematologia, AOU Policlinico – V. Emanuele Catania, Italy
| | - Ginny P. Sen
- ICON Clinical Research, San Diego, California, USA
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Caocci G, Mulas O, Abruzzese E, Luciano L, Iurlo A, Attolico I, Castagnetti F, Galimberti S, Sgherza N, Bonifacio M, Annunziata M, Gozzini A, Orlandi EM, Stagno F, Binotto G, Pregno P, Fozza C, Trawinska MM, De Gregorio F, Cattaneo D, Albano F, Gugliotta G, Baratè C, Scaffidi L, Elena C, Pirillo F, Scalzulli E, La Nasa G, Foà R, Breccia M. Arterial occlusive events in chronic myeloid leukemia patients treated with ponatinib in the real-life practice are predicted by the Systematic Coronary Risk Evaluation (SCORE) chart. Hematol Oncol 2019; 37:296-302. [PMID: 30892724 PMCID: PMC6766852 DOI: 10.1002/hon.2606] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/14/2019] [Indexed: 01/13/2023]
Abstract
Arterial occlusive events (AOEs) represent emerging complications in chronic myeloid leukemia (CML) patients treated with ponatinib. We identified 85 consecutive CML adult patients who were treated with ponatinib in 17 Italian centers. Patients were stratified according to the Systematic Coronary Risk Evaluation (SCORE) assessment, based on sex, age, smoking habits, systolic blood pressure, and total cholesterol levels. The 60‐month cumulative incidence rate of AOEs excluding hypertension was 25.7%. Hypertension was reported in 14.1% of patients. The median time of exposure to ponatinib was 28 months (range, 3‐69 months). Patients with a high to very high SCORE risk showed a significantly higher incidence rate of AOEs (74.3% vs 15.2%, P < 0.001). Patients aged ≥60 years showed a significantly higher incidence rate of AOEs (51.5% vs 16.9%, P = 0.008). In multivariate analysis, no association was found between AOEs and positive history of CV disease, age, dose of ponatinib, previous exposure to nilotinib, and comorbidities. Only the SCORE risk was confirmed as a significant predictive factor (P = 0.01; HR = 10.9; 95% C.I. = 1.7‐67.8). Patients aged ≥60 years who were treated with aspirin had a lower incidence rate of AOEs (33.3% vs 61.8%). Among the 14 reported AOEs, 78.6% of them showed grade 3 to 4 toxicity. This real‐life study confirmed the increased incidence of AOEs in CML patients treated with ponatinib, with high to very high SCORE risk. We suggest that patients aged ≥60 years who were treated with ponatinib should undergo prophylaxis with 100 mg/day of aspirin. Our findings emphasize personalized prevention strategies based on CV risk factors.
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Affiliation(s)
- Giovanni Caocci
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Olga Mulas
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Luigiana Luciano
- Hematology Unit "Federico II" University of Naples, Naples, Italy
| | - Alessandra Iurlo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Immacolata Attolico
- Department of Emergency and Organ Transplantation-Hematology Section, University of Bari, Bari, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Nicola Sgherza
- Hematology and Transplant Center, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Antonella Gozzini
- Hematology Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Ester Maria Orlandi
- Division of Hematology, "Fondazione IRCCS Policlinico S. Matteo", Pavia, Italy
| | - Fabio Stagno
- Hematology Unit, AOU Policlinico-V. Emanuele, Rodolico Hospital, Catania, Italy
| | | | - Patrizia Pregno
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Claudio Fozza
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | | | - Daniele Cattaneo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Albano
- Department of Emergency and Organ Transplantation-Hematology Section, University of Bari, Bari, Italy
| | - Gabriele Gugliotta
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Chiara Elena
- Division of Hematology, "Fondazione IRCCS Policlinico S. Matteo", Pavia, Italy
| | - Francesca Pirillo
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Emilia Scalzulli
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Giorgio La Nasa
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Robin Foà
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
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47
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Caocci G, Mulas O, Bonifacio M, Abruzzese E, Galimberti S, Orlandi EM, Iurlo A, Annunziata M, Luciano L, Castagnetti F, Gozzini A, Stagno F, Binotto G, Pregno P, Albano F, Martino B, Fozza C, Scaffidi L, Trawinska MM, Baratè C, Elena C, Cattaneo D, Scalzulli E, La Nasa G, Foà R, Breccia M. Recurrent arterial occlusive events in patients with chronic myeloid leukemia treated with second- and third-generation tyrosine kinase inhibitors and role of secondary prevention. Int J Cardiol 2019; 288:124-127. [PMID: 31029498 DOI: 10.1016/j.ijcard.2019.04.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/03/2019] [Accepted: 04/16/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Risk of death is particularly high in patients with a previous history of arterial occlusive events (AOEs) and the probability for a recurrent event is around 20%. Little is known about recurrent AOE and the role of secondary prevention in patients with Chronic Myeloid Leukemia (CML) with previous AOE, treated with second- and third-generation tyrosine kinase inhibitors (2ndG/3rdG TKIs), nilotinib, dasatinib, bosutinib and ponatinib. METHODS We identified a real-life cohort of 57 consecutive adult CML patients treated with 2ndG/3rdG TKI. All patients had a previous history of AOE. Ongoing use of secondary prevention of AOE (including antiplatelet agents, anticoagulant therapy, and statins) before starting a 2ndG/3rdG TKI was recorded, as well as CV risk factors. RESULTS The 60-month cumulative incidence rate of recurrent AOEs was 47.8 ± 10.9%. Despite a history of AOE, 10 patients (16%) were not receiving secondary preventative measures. Patients treated with nilotinib and ponatinib showed a higher incidence of recurrent AOEs (76.7 ± 14.3% and 64 ± 20.1%, respectively) than those treated with dasatinib and bosutinib (44 ± 24.2% and 30.5 ± 15.5%, respectively) (p = 0.01). Only treatment with a 2ndG/3rdG TKI given as second or subsequent line therapy showed a significant association with an increased incidence of recurrent AOE (p = 0.039). Overall, 17 recurrent AOEs were observed; 3 CV-related deaths were reported. CONCLUSION CML patients with a previous history of AOE treated with 2ndG/3rdG TKI represent a particular patient population with a higher probability of experiencing a recurrent AOE; individualized treatment is needed to optimize secondary prevention.
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Affiliation(s)
- Giovanni Caocci
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Olga Mulas
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | - Sara Galimberti
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Ester Maria Orlandi
- Division of Hematology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Alessandra Iurlo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Luigiana Luciano
- Hematology Unit "Federico II" University of Naples, Naples, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Antonella Gozzini
- Hematology Unit, AOU Careggi, University of Florence, Florence, Italy
| | - Fabio Stagno
- Hematology Unit, AOU Policlinico -V. Emanuele, Rodolico Hospital, Catania, Italy
| | | | - Patrizia Pregno
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Francesco Albano
- Department of Emergency and Organ Transplantation - Hematology Section, University of Bari, Bari, Italy
| | - Bruno Martino
- Hematology Unit, Azienda Ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Claudio Fozza
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | | | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Chiara Elena
- Division of Hematology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Daniele Cattaneo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Emilia Scalzulli
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Giorgio La Nasa
- Hematology Unit, Businco Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Robin Foà
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
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48
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Tirrò E, Stella S, Massimino M, Zammit V, Pennisi MS, Vitale SR, Romano C, Di Gregorio S, Puma A, Di Raimondo F, Stagno F, Manzella L. Colony-Forming Cell Assay Detecting the Co-Expression of JAK2V617F and BCR-ABL1 in the Same Clone: A Case Report. Acta Haematol 2019; 141:261-267. [PMID: 30965317 DOI: 10.1159/000496821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/11/2019] [Indexed: 01/14/2023]
Abstract
BCR-ABL1-negative myeloproliferative disorders and chronic myeloid leukaemia are haematologic malignancies characterised by single and mutually exclusive genetic alterations. Nevertheless, several patients co-expressing the JAK2V617F mutation and the BCR-ABL1 transcript have been described in the literature. We report the case of a 61-year-old male who presented with an essential thrombocythaemia phenotype and had a subsequent diagnosis of chronic phase chronic myeloid leukaemia. Colony-forming assays demonstrated the coexistence of 2 different haematopoietic clones: one was positive for the JAK2V617F mutation and the other co-expressed both JAK2V617F and the BCR-ABL1 fusion gene. No colonies displayed the BCR-ABL1 transcript alone. These findings indicate that the JAK2V617F mutation was the founding genetic alteration of the disease, followed by the acquisition of the BCR-ABL1 chimeric oncogene. Our data support the hypothesis that a heterozygous JAK2V617F clone may have favoured the bi-clonal nature of this myeloproliferative disorder, generating clones harbouring a second transforming genetic event.
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MESH Headings
- Amino Acid Substitution
- Colony-Forming Units Assay
- Fusion Proteins, bcr-abl/biosynthesis
- Fusion Proteins, bcr-abl/genetics
- Gene Expression Regulation, Enzymologic
- Gene Expression Regulation, Leukemic
- Humans
- Janus Kinase 2/biosynthesis
- Janus Kinase 2/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Male
- Middle Aged
- Mutation, Missense
- Thrombocythemia, Essential/enzymology
- Thrombocythemia, Essential/genetics
- Thrombocythemia, Essential/pathology
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Affiliation(s)
- Elena Tirrò
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy,
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy,
| | - Stefania Stella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Michele Massimino
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Valentina Zammit
- Division of Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Maria Stella Pennisi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Silvia Rita Vitale
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Chiara Romano
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Sandra Di Gregorio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Adriana Puma
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Francesco Di Raimondo
- Division of Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
- Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Fabio Stagno
- Division of Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
| | - Livia Manzella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Center of Experimental Oncology and Hematology, A.O.U. "Policlinico-Vittorio Emanuele", Catania, Italy
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49
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Bernardi S, Malagola M, Zanaglio C, Polverelli N, Dereli Eke E, D'Adda M, Farina M, Bucelli C, Scaffidi L, Toffoletti E, Deambrogi C, Stagno F, Bergamaschi M, Franceschini L, Abruzzese E, Divona MD, Gobbi M, Di Raimondo F, Gaidano G, Tiribelli M, Bonifacio M, Cattaneo C, Iurlo A, Russo D. Digital PCR improves the quantitation of DMR and the selection of CML candidates to TKIs discontinuation. Cancer Med 2019; 8:2041-2055. [PMID: 30950237 PMCID: PMC6536984 DOI: 10.1002/cam4.2087] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 12/11/2022] Open
Abstract
Treatment‐free remission (TFR) by tyrosine kinase inhibitors (TKI) discontinuation in patients with deep molecular response (DMR) is a paramount goal in the current chronic myeloid leukemia (CML) therapeutic strategy. The best DMR level by real‐time quantitative PCR (RT‐qPCR) for TKI discontinuation is still a matter of debate. To compare the accuracy of digital PCR (dPCR) and RT‐qPCR for BCR‐ABL1 transcript levels detection, 142 CML patients were monitored for a median time of 24 months. Digital PCR detected BCR‐ABL1 transcripts in the RT‐qPCR undetectable cases. The dPCR analysis of the samples, grouped by the MR classes, revealed a significant difference between MR4.0 and MR4.5 (P = 0.0104) or MR5.0 (P = 0.0032). The clinical and hematological characteristics of the patients grouped according to DMR classes (MR4.0 vs MR4.5‐5.0) were superimposable. Conversely, patients with dPCR values <0.468 BCR‐ABL1 copies/µL (as we previously described) showed a longer DMR duration (P = 0.0220) and mainly belonged to MR4.5‐5.0 (P = 0.0442) classes compared to patients with higher dPCR values. Among the 142 patients, 111 (78%) discontinued the TKI treatment; among the 111 patients, 24 (22%) lost the MR3.0 or MR4.0. RT‐qPCR was not able to discriminate patients with higher risk of MR loss after discontinuation (P = 0.8100). On the contrary, according to dPCR, 12/25 (48%) patients with BCR‐ABL1 values ≥0.468 and 12/86 (14%) patients with BCR‐ABL1 values <0.468 lost DMR in this cohort, respectively (P = 0.0003). Treatment‐free remission of patients who discontinued TKI with a dPCR <0.468 was significantly higher compared to patients with dPCR ≥ 0.468 (TFR at 2 years 83% vs 52% P = 0.0017, respectively). In conclusion, dPCR resulted in an improved recognition of stable DMR and of candidates to TKI discontinuation.
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Affiliation(s)
- Simona Bernardi
- Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy.,CREA Laboratory (Centro di Ricerca Emato-Oncologica AIL), ASST Spedali Civili di Brescia, Brescia, Italy
| | - Michele Malagola
- Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Camilla Zanaglio
- Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy.,CREA Laboratory (Centro di Ricerca Emato-Oncologica AIL), ASST Spedali Civili di Brescia, Brescia, Italy
| | - Nicola Polverelli
- Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Elif Dereli Eke
- Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy.,CREA Laboratory (Centro di Ricerca Emato-Oncologica AIL), ASST Spedali Civili di Brescia, Brescia, Italy
| | - Mariella D'Adda
- Division of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Mirko Farina
- Division of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Cristina Bucelli
- Hematology Division, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Luigi Scaffidi
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Eleonora Toffoletti
- Division of Hematology and Bone Marrow Transplantation, Department of Medical Area, University of Udine, Udine, Italy
| | - Clara Deambrogi
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, A.O.U. Policlinico - V. Emanuele, Catania, Italy
| | - Micaela Bergamaschi
- Clinical Hematology, Dipartimento Terapie Oncologiche Integrate, Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Franceschini
- Department of Biomedicine and Prevention, The University Tor Vergata, Rome, Italy
| | | | | | - Marco Gobbi
- Clinical Hematology, Dipartimento Terapie Oncologiche Integrate, Ospedale Policlinico San Martino, Genova, Italy
| | - Francesco Di Raimondo
- Hematology Section and BMT Unit, Rodolico Hospital, A.O.U. Policlinico - V. Emanuele, Catania, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Mario Tiribelli
- Division of Hematology and Bone Marrow Transplantation, Department of Medical Area, University of Udine, Udine, Italy
| | | | - Chiara Cattaneo
- Division of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Domenico Russo
- Unit of Blood Diseases and Stem Cell Transplantation, DPT of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
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50
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Fava C, Rege-Cambrin G, Dogliotti I, Cerrano M, Berchialla P, Dragani M, Rosti G, Castagnetti F, Gugliotta G, Martino B, Gambacorti-Passerini C, Abruzzese E, Elena C, Pregno P, Gozzini A, Capodanno I, Bergamaschi M, Crugnola M, Bocchia M, Galimberti S, Rapezzi D, Iurlo A, Cattaneo D, Latagliata R, Breccia M, Cedrone M, Santoro M, Annunziata M, Levato L, Stagno F, Cavazzini F, Sgherza N, Giai V, Luciano L, Russo S, Musto P, Caocci G, Sorà F, Iuliano F, Lunghi F, Specchia G, Pane F, Ferrero D, Baccarani M, Saglio G. Observational study of chronic myeloid leukemia Italian patients who discontinued tyrosine kinase inhibitors in clinical practice. Haematologica 2019; 104:1589-1596. [PMID: 30819917 PMCID: PMC6669161 DOI: 10.3324/haematol.2018.205054] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/27/2019] [Indexed: 12/22/2022] Open
Abstract
It is judged safe to discontinue treatment with tyrosine kinase inhibitors (TKI) for chronic myeloid leukemia (CML) in experimental trials on treatment-free remission (TFR). We collected a total of 293 Italian patients with chronic phase CML who discontinued TKI in deep molecular response. Seventy-two percent of patients were on treatment with imatinib, and 28% with second generation TKI at the time of discontinuation. Median duration of treatment with the last TKI was 77 months [Interquartile Range (IQR) 54;111], median duration of deep molecular response was 46 months (IQR 31;74). Duration of treatment with TKI and duration of deep molecular response were shorter with second generation TKI than with imatinib (P<0.001). Eighty-eight percent of patients discontinued as per clinical practice, and reasons for stopping treatment were: toxicity (20%), pregnancy (6%), and shared decision between treating physician and patient (62%). After a median follow up of 34 months (range, 12-161) overall estimated TFR was 62% (95%CI: 56;68). At 12 months, TFR was 68% (95%CI: 62;74) for imatinib, 73% (95%CI: 64;83) for second generation TKI. Overall median time to restart treatment was six months (IQR 4;11). No progressions occurred. Although our study has the limitation of a retrospective study, our experience within the Italian population confirms that discontinuation of imatinib and second generation TKI is feasible and safe in clinical practice.
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Affiliation(s)
- Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Orbassano
| | | | - Irene Dogliotti
- Department of Clinical and Biological Sciences, University of Turin, Orbassano
| | - Marco Cerrano
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Turin, Turin
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, Orbassano
| | - Matteo Dragani
- Department of Clinical and Biological Sciences, University of Turin, Orbassano
| | - Gianantonio Rosti
- Institute of Hematology "L. & A. Seràgnoli", St. Orsola University Hospital, Bologna
| | - Fausto Castagnetti
- Institute of Hematology "L. & A. Seràgnoli", St. Orsola University Hospital, Bologna
| | - Gabriele Gugliotta
- Institute of Hematology "L. & A. Seràgnoli", St. Orsola University Hospital, Bologna
| | - Bruno Martino
- Azienda Ospedaliera "Bianchi Melacrino Morelli", Reggio Calabria
| | | | | | - Chiara Elena
- Hematology Hunit, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | - Antonella Gozzini
- SC Terapie Cellulari e Medicina Trasfusionale, AOU Careggi, Florence
| | | | | | | | - Monica Bocchia
- Azienda Ospedaliera Universitaria, University of Siena, Siena
| | | | | | - Alessandra Iurlo
- Haematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Daniele Cattaneo
- Haematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan
| | - Roberto Latagliata
- Department of Cellular Biotechnologies and Hematology, University La Sapienza, Rome
| | - Massimo Breccia
- Department of Cellular Biotechnologies and Hematology, University La Sapienza, Rome
| | | | | | | | - Luciano Levato
- Department Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro
| | - Fabio Stagno
- Chair and Hematology Section, Ferrarotto Hospital, Catania
| | - Francesco Cavazzini
- Department of Medical Sciences -Haematology and Physiopathology of Haemostasis Section, Ferrara
| | - Nicola Sgherza
- Division of Hematology, IRCCS Ospedale Casa Sollievo Sofferenza, San Giovanni Rotondo
| | - Valentina Giai
- Division of Haematology, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria
| | - Luigia Luciano
- Division of Hematology - Departments of Clinical Medicine and Surgery, University of Naples Federico II, Naples
| | - Sabina Russo
- Department of Internal Medicine, AOU Policlinico di Messina, Messina
| | - Pellegrino Musto
- IRCCS, Centro Di Riferimento Oncologico Della Basilicata, Rionero in Vulture
| | - Giovanni Caocci
- Department of Medical Sciences, University of Cagliari, Cagliari
| | - Federica Sorà
- Hematology Department, University Cattolica del Sacro Cuore - Policlinico A. Gemelli, Rome
| | | | - Francesca Lunghi
- Division of Haematology and Bone Marrow Transplant, Ospedale San Raffaele IRCCS, Milan
| | - Giorgina Specchia
- Division of Haematology with Transplant - Outpatients, Azienda Ospedaliero-Universitaria Policlinico Consorziale di Bari, Bari, Italy
| | - Fabrizio Pane
- Division of Hematology - Departments of Clinical Medicine and Surgery, University of Naples Federico II, Naples
| | - Dario Ferrero
- Hematology Division, Department of Molecular Biotechnologies and Health Sciences, University of Turin, Turin
| | - Michele Baccarani
- Institute of Hematology "L. & A. Seràgnoli", St. Orsola University Hospital, Bologna
| | - Giuseppe Saglio
- Department of Clinical and Biological Sciences, University of Turin, Orbassano
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