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Mauro FR, Tedeschi A, Varettoni M, Zaja F, Barosi G, Zinzani PL. Identifying and addressing unmet clinical needs on the use of zanubrutinib in chronic lymphocytic leukemia: A consensus-based position paper from an ad hoc expert panel. Hematol Oncol 2024; 42:e3255. [PMID: 38362952 DOI: 10.1002/hon.3255] [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: 10/02/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
Zanubrutinib has been approved for treating patients with different lymphoproliferative disorders and now represents a significant breakthrough in treating relapsed/refractory and previously untreated patients with chronic lymphocytic leukemia (CLL). Because few systematic studies or comparative randomized clinical trials have been conducted, optimal use of zanubrutinib in approved indications may be challenging. This article presents the results of a group discussion among an ad hoc constituted panel of experts to identify and address unmet clinical needs (UCNs) in using zanubrutinib in patients with CLL. Key UCNs were selected according to the criterion of clinical relevance using the Delphi process. Panel members reviewed the results of first-line and upstream controlled trials in which the efficacy and toxicity profile of zanubrutinib and other BTK inhibitors were investigated in patients with CLL. Based on a critical discussion of data, the panel produced recommendations for using zanubrutinib and proposals for new studies to increase the evidence for the optimal treatment of patients with CLL. The recommendations given by the panel are intended for use not only by expert centers but, above all, by less experienced hematologists as well as general practitioners.
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Affiliation(s)
- Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Roma, Italy
| | - Alessandra Tedeschi
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Zaja
- Dipartimento Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
- Unità Complessa Operativa (UCO) Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia 'Seràgnoli', Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
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2
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Martino EA, Mauro FR, Reda G, Laurenti L, Visentin A, Frustaci A, Vigna E, Pepe S, Catania G, Loseto G, Murru R, Chiarenza A, Sportoletti P, Del Principe MI, Laureana R, Coscia M, Galimberti S, Ferretti E, Zucchetto A, Bomben R, Polesel J, Tedeschi A, Rossi D, Trentin L, Neri A, Morabito F, Gattei V, Gentile M. Ibrutinib as first line therapy in chronic lymphocytic leukemia patients over 80 years old: A retrospective real-life multicenter Italian cohort. Hematol Oncol 2024; 42:e3249. [PMID: 38287529 DOI: 10.1002/hon.3249] [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: 11/15/2023] [Revised: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/31/2024]
Abstract
Although chronic lymphocytic leukemia (CLL) predominantly affects the elderly, limited data exists about the outcomes of over 80-year-old patients, usually underrepresented in clinical trials. We conducted a multicenter study enrolling 79 consecutive CLL patients ≥80 years at the time of frontline therapy, all treated with ibrutinib. Nearly 48% of cases exhibited unmutated IGHV genes, 32% 17p deletion, and 39.2% TP53 mutations; 63.3% displayed a cumulative illness rating scale (CIRS) > 6. The overall response rate on ibrutinib, computed in 74/79 patients (5 patients excluded for early withdrawal), was 89.9%. After a median follow-up of 28.9 months, the median progression-free survival (PFS) and overall survival (OS) were 42.5 and 51.8 months, respectively. CIRS>6 and temporary discontinuation of ibrutinib lasting for 7-30 days were the only parameters associated with a significantly shorter PFS and were both relevant in predicting a shorter PFS compared to patients with CIRS≤6 and therapy discontinuation ≤7 days. The most common grade≥3 adverse events were infections (25.5%), neutropenia (10.1%), and anemia (2.5%). Eighteen patients (22.8%) experienced a cardiovascular event, including grade-2 atrial fibrillation (n = 9; 11%), grade-2 hypertension (n = 5; 6%), heart failure (n = 3; 3%), and acute coronary syndrome (n = 1; 1%). Mild bleeding events were observed in 27 patients (34.2%). Ibrutinib was permanently discontinued in 26 patients due to progressive disease (n = 11, including 5 Richter's syndromes), secondary malignancies (n = 6), infections (n = 3), cardiac failure (n = 3), severe bleeding (n = 2), and sudden death (n = 1). In conclusion, our analyses confirmed the overall effectiveness and favorable safety profile of the ibrutinib-single agent therapeutic approach in CLL patients ≥80 years.
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Affiliation(s)
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Gianluigi Reda
- Hematology Unit, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Laurenti
- Dipartimento Scienze Radiologiche ed Ematologiche, Divisione di Ematologia Fondazione Policlinico universitario A Gemelli, Rome, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Annamaria Frustaci
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Sara Pepe
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | | | | | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, ARNAS G. Brotzu, Cagliari, Italy
| | - Annalisa Chiarenza
- Divisione di Ematologia, A.O.U. Policlinico, PO G.Rodolico, Catania, Italy
| | - Paolo Sportoletti
- Centro di Ricerca Emato-Oncologica (CREO), Dipartimento di Medicina e Chirurgia, Università di Perugia, Perugia, Italy
| | - Maria Ilaria Del Principe
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma "Tor Vergata," Rome, Rome, Italy
| | - Roberta Laureana
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma "Tor Vergata," Rome, Rome, Italy
| | - Marta Coscia
- University Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | | | - Eleonora Ferretti
- Clinical Trials Center Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Alessandra Tedeschi
- Department of Haematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Davide Rossi
- Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Antonino Neri
- Scientific Directorate, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Massimo Gentile
- Hematology Unit, AO Cosenza, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Science, University of Calabria, Rende, Italy
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3
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Sportoletti P, Laurenti L, Chiarenza A, Gaidano G, Albi E, Mauro FR, Trentin L, Vallisa D, Pane F, Cuneo A, Albano F, Zamprogna G, Coscia M, Gozzetti A, Reda G, Caira M, Finsinger P, Gualberti G, Iannella E, Malgieri S, Molica S. Patients' preferences for chronic lymphocytic leukemia treatment: The CHOICE study. Hematol Oncol 2024; 42:e3216. [PMID: 37772620 DOI: 10.1002/hon.3216] [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: 05/26/2023] [Revised: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 09/30/2023]
Abstract
Chronic lymphocytic leukemia (CLL) therapies differ in efficacy, side effects, route, frequency, and duration of administration. We assessed patient preferences for treatment attributes and evaluated associations with disease stage, treatment line, and socio-demographic characteristics in a cross sectional, observational study conducted at 16 Italian hematology centers. Study visits occurred between February and July 2020; 401 adult patients with CLL (201 Watch and Wait (W&W), 200 treated) participated in a discrete choice experiment (DCE), composed of 8 choices between pairs of treatment profiles with different levels of 5 attributes of currently available CLL treatments (length of response, route and duration of administration, risk of side effects including diarrhea, infections, or organ damage). Health-related quality of life was assessed with the EQ-5D-5L, EORTC QLQ-C30 and QLQ CLL-16. Previously treated patients had longer disease duration (7 vs. 5 years), higher prevalence of serious comorbidities (45.5% vs. 36.2%) and high-risk molecular markers (unmutated IGHV 55.6% vs. 17.1%; TP53 mutation 15.2% vs. 4.0%). Health-related quality of life scores were similar between groups. In the DCE, W&W patients rated "possible occurrence of infections" highest (relative importance [RI] = 36.2%), followed by "treatment and relevant duration" (RI = 28.0%) and "progression-free survival (PFS)" (RI = 16.9%). Previously treated patients rated "treatment and relevant duration" highest (RI = 33.3%), followed by "possible occurrence of infections" (RI = 28.8%), "possible occurrence of organ damage" (RI = 19.4%), and "PFS" (RI = 9.8%). Concern over infection was rated highest overall; unexpectedly PFS was not among the most important criteria in either group, suggesting that the first COVID-19 pandemic wave may have influenced patient preferences and concerns about CLL therapy options.
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Affiliation(s)
- Paolo Sportoletti
- Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Luca Laurenti
- Hematology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Elisa Albi
- Strategic Research Programme in CLL, Division of Experimental Oncology, IRCCS Ospedale San Raffaele and Università Vita-Salute San Raffaele, Milan, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Livio Trentin
- Hematology Section, Department of Medicine, Azienda Ospedale Università Padova, Padova, Italy
| | - Daniele Vallisa
- Hematology Unit, Department of Oncology and Hematology, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, Azienda Ospedaliera-Universitaria, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Francesco Albano
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Hematology and Stem Cell Transplantation Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Giulia Zamprogna
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Torino and Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandro Gozzetti
- Hematology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore, University of Milan, Milan, Italy
| | | | | | | | | | | | - Stefano Molica
- Department of Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
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4
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Zinzani PL, Mauro FR, Tedeschi A, Varettoni M, Zaja F, Barosi G. Unmet clinical needs in the use of zanubrutinib in malignant lymphomas (Waldenström macroglobulinemia, marginal zone lymphoma and mantle cell lymphoma): A consensus-based position paper from an ad hoc expert panel. Hematol Oncol 2023; 41:795-808. [PMID: 37165730 DOI: 10.1002/hon.3172] [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: 02/10/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023]
Abstract
Zanubrutinib has been approved for the treatment of patients with different lymphoproliferative disorders, and now represents a major breakthrough in the treatment of patients resistant or relapsing after the recommended therapies. Because few systematic studies or comparative randomized clinical trials have been conducted, optimal use of the drug in approved indications is challenging, and questions are emerging on its use in earlier stages of the disorders. This article presents the results of group discussion among an ad hoc constituted panel of experts aimed at identifying and addressing unmet clinical needs (UCNs) in the use of zanubrutinib in the lymphomas which have received the approval of use, specifically Waldenström macroglubulinemia, marginal zone lymphoma and mantle cell lymphoma. Key UCNs were selected according to the criterion of clinical relevance using the Delphi process. The panel produced recommendations and proposals for new studies for the management of the identified UCNs. These recommendations are intended for use not only by expert centers but above all by not experienced hematologists as well as general practitioners.
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Affiliation(s)
- Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Istituto di Ematologia 'Seràgnoli', Bologna, Italy
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Roma, Italy
| | - Alessandra Tedeschi
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesco Zaja
- Dipartimento Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
- Unità Complessa Operativa (UCO) Ematologia, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Giovanni Barosi
- Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
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Moia R, Terzi di Bergamo L, Talotta D, Bomben R, Forestieri G, Spina V, Bruscaggin A, Cosentino C, Almasri M, Dondolin R, Bittolo T, Zucchetto A, Baldoni S, Del Giudice I, Mauro FR, Maffei R, Chiarenza A, Tafuri A, Laureana R, Del Principe MI, Zaja F, D'Arena G, Olivieri J, Rasi S, Mahmoud A, Al Essa W, Awikeh B, Kogila S, Bellia M, Mouhssine S, Sportoletti P, Marasca R, Scarfò L, Ghia P, Gattei V, Foà R, Rossi D, Gaidano G. XPO1 mutations identify early-stage CLL characterized by shorter time to first treatment and enhanced BCR signalling. Br J Haematol 2023; 203:416-425. [PMID: 37580908 DOI: 10.1111/bjh.19052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023]
Abstract
Here we evaluated the epigenomic and transcriptomic profile of XPO1 mutant chronic lymphocytic leukaemia (CLL) and their clinical phenotype. By ATAC-seq, chromatin regions that were more accessible in XPO1 mutated CLL were enriched of binding sites for transcription factors regulated by pathways emanating from the B-cell receptor (BCR), including NF-κB signalling, p38-JNK and RAS-RAF-MEK-ERK. XPO1 mutant CLL, consistent with the chromatin accessibility changes, were enriched with transcriptomic features associated with BCR and cytokine signalling. By combining epigenomic and transcriptomic data, MIR155HG, the host gene of miR-155, and MYB, the transcription factor that positively regulates MIR155HG, were upregulated by RNA-seq and their promoters were more accessible by ATAC-seq. To evaluate the clinical impact of XPO1 mutations, we investigated a total of 957 early-stage CLL subdivided into 3 independent cohorts (N = 276, N = 286 and N = 395). Next-generation sequencing analysis identified XPO1 mutations as a novel predictor of shorter time to first treatment (TTFT) in all cohorts. Notably, XPO1 mutations maintained their prognostic value independent of the immunoglobulin heavy chain variable status and early-stage prognostic models. These data suggest that XPO1 mutations, conceivably through increased miR-155 levels, may enhance BCR signalling leading to higher proliferation and shorter TTFT in early-stage CLL.
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Affiliation(s)
- Riccardo Moia
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Lodovico Terzi di Bergamo
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
- Bioinformatics Core Unit, Swiss Institute of Bioinformatics, Bellinzona, Switzerland
- Department of Health Science and Technology, Swiss Federal Institute of Technology (ETH Zürich), Zurich, Switzerland
| | - Donatella Talotta
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Gabriela Forestieri
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Valeria Spina
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Alessio Bruscaggin
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Chiara Cosentino
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Mohammad Almasri
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Riccardo Dondolin
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Tamara Bittolo
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Stefano Baldoni
- Institute of Hematology, Center for Hemato-Oncology Research, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Rossana Maffei
- Section of Hematology, Department of Medical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Annalisa Chiarenza
- A.O.O. Policlinico "G. Rodolico-S. Marco", U.O.C. Ematologia, Catania, Italy
| | - Agostino Tafuri
- Department of Clinical and Molecular Medicine, Hematology Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | | | | | - Francesco Zaja
- SC Ematologia, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Giovanni D'Arena
- Ematologia, P.O. San Luca, ASL Salerno, Vallo della Lucania, Italy
| | - Jacopo Olivieri
- Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), SOC Clinica Ematologica, Udine, Italy
| | - Silvia Rasi
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Abdurraouf Mahmoud
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Wael Al Essa
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Bassel Awikeh
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Sreekar Kogila
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Matteo Bellia
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Samir Mouhssine
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Paolo Sportoletti
- Institute of Hematology, Center for Hemato-Oncology Research, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Roberto Marasca
- Section of Hematology, Department of Medical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lydia Scarfò
- IRCCS Ospedale San Raffaele, Università Vita Salute San Raffaele, Milan, Italy
| | - Paolo Ghia
- IRCCS Ospedale San Raffaele, Università Vita Salute San Raffaele, Milan, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Davide Rossi
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
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6
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Laurenti L, Scarfò L, Frustaci AM, Sanna A, Iannella E, Caira M, Finsinger P, Schifano S, Neri B, Molica S, Mauro FR. Real-world evidence on venetoclax in chronic lymphocytic leukemia: The Italian experience. Hematol Oncol 2023; 41:621-630. [PMID: 36680368 DOI: 10.1002/hon.3122] [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: 10/28/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia in the western world. In Italy, venetoclax was approved for use in patients with CLL as monotherapy in 2017 and in combinations in 2019. As a result of this delayed approval, there are relatively few real-world studies from Italian clinical practice and much of the data are in heavily pretreated patients. We have collected the available studies in Italian routine practice. Three studies confirm the effectiveness and tolerability of this agent in patients with relapsed/refractory CLL and high-risk disease characteristics, many of whom had received prior B-cell receptor signaling treatment. Addition of rituximab to venetoclax produced more complete responses in patients with relapsed/refractory CLL, while higher disease burden and progression while receiving a prior Bruton's tyrosine kinase inhibitor were both associated with poorer outcomes in patients treated with venetoclax. Venetoclax was well-tolerated with low discontinuation rates. No studies of venetoclax plus obinutuzumab for the first-line treatment of patients with CLL were available due to the short time since approval in Italy. Several cohorts addressed the impact of COVID-19 on patient management and outcomes, suggesting that treated patients and those in clinical observation had similar rates of COVID-19-related hospital admission, intensive care unit admission, and mortality. Overall, the responses and tolerance to venetoclax observed in the Italian real-world setting confirm the tolerability and effectiveness of venetoclax regimens in high-risk patients.
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Affiliation(s)
- Luca Laurenti
- Diagnostic Imaging, Oncological Radiotherapy and Hematology, IRCCS Agostino Gemelli University Policlinic, Rome, Italy
| | - Lydia Scarfò
- Strategic Research Program on CLL, Division of Experimental Oncology, Università Vita Salute and IRCCS San Raffaele Hospital Milan, Milan, Italy
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7
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Visentin A, Mauro FR, Scarfò L, Gentile M, Farina L, Reda G, Ferrarini I, Proietti G, Derenzini E, Cibien F, Vitale C, Sanna A, Pietrasanta D, Marchetti M, Murru R, Rigolin GM, Sportoletti P, Trimarco V, Cavarretta CA, Angotzi F, Cellini A, Ruocco V, Zatta I, Laurenti L, Molica S, Coscia M, Ghia P, Foà R, Cuneo A, Trentin L. Continuous venetoclax in treatment-naive TP53 disrupted patients with chronic lymphocytic leukemia: A chronic lymphocytic leukemia campus study. Am J Hematol 2023; 98:E237-E240. [PMID: 37382471 DOI: 10.1002/ajh.27009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
- Veneto Institute of Molecular Medicine, Padua, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy
| | - Lydia Scarfò
- Strategic Research Program on CLL, Università Vita-salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Gentile
- Hematology Unit, Azienda Ospedaliera of Cosenza, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Lucia Farina
- Division of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore, University of Milan, Milan, Italy
| | - Isacco Ferrarini
- Department of Engineering for Innovation Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Giulia Proietti
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy
| | - Enrico Derenzini
- Divisions of Haemato-oncology, Haematology Programme, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Candida Vitale
- Department of Molecular Biotechnology and Health Sciences, University of Torino and Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Alessandro Sanna
- Hematology Unit, Department of Oncology, AOU Careggi, Florence, Italy
| | - Daniela Pietrasanta
- Division of Hematology, A.O. SS Antonio e Biagio and Cesare Arrigo, Alessandria, Italy
| | - Monia Marchetti
- Division of Hematology, A.O. SS Antonio e Biagio and Cesare Arrigo, Alessandria, Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, ARNAS G. Brotzu, Cagliari, Italy
| | - Gian Matteo Rigolin
- Hematology Section, Department of Medical Sciences, Azienda Ospedaliera-Universitaria, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Paolo Sportoletti
- Institute of Hematology and Center for Hemato-Oncology Research, University of Perugia and Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Valentina Trimarco
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Chiara Adele Cavarretta
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Francesco Angotzi
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Alessandro Cellini
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Valeria Ruocco
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Ivan Zatta
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Luca Laurenti
- Hematology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | | | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Torino and Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Paolo Ghia
- Strategic Research Program on CLL, Università Vita-salute San Raffaele and IRCCS Ospedale San Raffaele, Milan, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, Azienda Ospedaliera-Universitaria, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
- Veneto Institute of Molecular Medicine, Padua, Italy
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8
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Autore F, Fresa A, Innocenti I, Principe MID, Maglione R, Stefanizzi C, Pelliccia S, Romeo A, Cimino G, Papa E, Padua LD, Andriani A, Mengarelli A, Tafuri A, Ditto C, Mauro FR, Del Poeta G, Laurenti L. Correspondence in reference to the previously published manuscript: Reduction of cycles of bendamustine plus rituximab therapy in the cases with good response for indolent B-cell lymphomas. Hematol Oncol 2023; 41:571-573. [PMID: 35319789 DOI: 10.1002/hon.2989] [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] [Indexed: 11/06/2022]
Abstract
Takezaki et al. analyzed the outcome of 57 patients with indolent lymphomas treated with Bendamustine plus Rituximab (BR) according to the number of cycles received, showing that patients who discontinued BR after four cycles had similar outcomes compared to patients who received five or six cycles. Considering the similarities but also the differences between indolent lymphomas and chronic lymphocytic leukemia (CLL), we enriched the results obtained with a cohort of CLL patients treated with BR starting from the experience of the Lazio region group on CLL. Out of 115 patients, 97 (84%) received 4-6 cycles of BR, while 18 (16%) received 1-3 cycles. The outcome of the group of patients who received at least 4 cycles was superior in terms of response rate (ORR 96% vs. ORR 83%, p = 0.041; CR 58% vs. CR 28%, p = 0.052 respectively) and PFS [median PFS 52.6 (40.3-64.9) versus 26.2 (19.3-33.0) months, p < 0.001]. The number of patients undergoing 4 cycles of BR (4-cycles group) and 5-6 cycles (over-4-cycles group) was 9 and 88, respectively. Compared to analysis conducted by the Japanese group in indolent lymphomas, in CLL we did not observe any difference between the outcome of the 4-cycles group and the over-4-cycles group in terms of ORR (89% vs. 97%, p = 0.268) and in survival [median PFS 40.8 (13.7-67.8) versus 52.6 (38.7-66.5) months, p = 0.117]. Moreover, we observed that patients who achieved a clinical CR showed overlapping outcomes with patients who received more than 4 cycles [CR vs. non-CR median PFS not reached vs. 11.0 months; over-4-cycles group median PFS 52.6 months (40.3-64.9); p < 0.001]. Nowadays chemoimmunotherapy with BR is reserved to fit elderly CLL patients, and there are many chemo-free treatment options available; therefore, discontinuation after 4 cycles may be permissible in patients who obtained a CR in order to limit toxicity as much as possible.
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Affiliation(s)
- Francesco Autore
- Dipartimento di Diagnostica per Immagini, Hematology Unit, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alberto Fresa
- Institute of Hematology, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Idanna Innocenti
- Dipartimento di Diagnostica per Immagini, Hematology Unit, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Ilaria Del Principe
- Department of Biomedicine and Prevention, Hematology Unit, University tor Vergata of Rome, Rome, Italy
| | - Raffaele Maglione
- Department of Cellular Biotechnologies and Hematology, Hematology Unit, Sapienza University, Rome, Italy
| | | | - Sabrina Pelliccia
- Hematology Unit, Azienda Ospedaliera-Universitaria Sant'Andrea, Rome, Italy
| | - Azzurra Romeo
- Hematology Unit, Ospedale Santa Maria Goretti, Latina, Italy
| | - Giuseppe Cimino
- Hematology Unit, Ospedale Santa Maria Goretti, Latina, Italy
| | - Elena Papa
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura De Padua
- Hematology Unit, Fabrizio Spaziani Hospital, Frosinone, Italy
| | | | - Andrea Mengarelli
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Agostino Tafuri
- Hematology Unit, Azienda Ospedaliera-Universitaria Sant'Andrea, Rome, Italy
| | - Concetta Ditto
- Division of Hematology, Ospedale Belcolle, Viterbo, Italy
| | - Francesca Romana Mauro
- Department of Cellular Biotechnologies and Hematology, Hematology Unit, Sapienza University, Rome, Italy
| | - Giovanni Del Poeta
- Department of Biomedicine and Prevention, Hematology Unit, University tor Vergata of Rome, Rome, Italy
| | - Luca Laurenti
- Dipartimento di Diagnostica per Immagini, Hematology Unit, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Hematology, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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9
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Moia R, Dondolin R, De Propris MS, Talotta D, Mouhssine S, Perutelli F, Reda G, Mattiello V, Rigolin GM, Motta M, Olivieri J, Fanin R, Perbellini O, Ferrarini I, Mauro FR, Del Giudice I, Laurenti L, Tomasso A, Gentile M, Frustaci AM, Tedeschi A, Gozzetti A, Stelitano C, Visco C, Moreno C, Forconi F, Marasca R, Coscia M, Rossi D, Foà R, Gaidano G. Long-term benefit of IGHV mutated patients in a real-life multicenter cohort of FCR-treated chronic lymphocytic leukemia. Hematol Oncol 2023; 41:567-570. [PMID: 36190298 DOI: 10.1002/hon.3080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Riccardo Moia
- Division of Hematology, Department of Translational Medicine, Università Del Piemonte Orientale, Novara, Italy
| | - Riccardo Dondolin
- Division of Hematology, Department of Translational Medicine, Università Del Piemonte Orientale, Novara, Italy
| | | | - Donatella Talotta
- Division of Hematology, Department of Translational Medicine, Università Del Piemonte Orientale, Novara, Italy
| | - Samir Mouhssine
- Division of Hematology, Department of Translational Medicine, Università Del Piemonte Orientale, Novara, Italy
| | - Francesca Perutelli
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Mattiello
- Hematology Unit, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gian Matteo Rigolin
- Department of Medical Sciences, Hematology Section, AOU Arcispedale S Anna, University of Ferrara, Ferrara, Italy
| | | | - Jacopo Olivieri
- Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), SOC Clinica Ematologica, Udine, Italy
| | - Renato Fanin
- Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), SOC Clinica Ematologica, Udine, Italy
| | - Omar Perbellini
- Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Isacco Ferrarini
- Department of Medicine, Section of Haematology, University of Verona, Verona, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Luca Laurenti
- Department of Hematology, Catholic University Hospital A. Gemelli, Rome, Italy
| | - Annamaria Tomasso
- Department of Hematology, Catholic University Hospital A. Gemelli, Rome, Italy
| | | | - Anna Maria Frustaci
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Alessandra Tedeschi
- Department of Hematology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | - Caterina Stelitano
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Di Calabria, Italy
| | - Carlo Visco
- Department of Medicine, Section of Haematology, University of Verona, Verona, Italy
| | - Carol Moreno
- Hospital de La Santa Creu I Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Roberto Marasca
- Department of Medical Sciences, Section of Hematology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Davide Rossi
- Laboratory of Experimental Hematology, Institute of Oncology Research, Bellinzona, Switzerland
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Università Del Piemonte Orientale, Novara, Italy
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10
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Morabito F, Tripepi G, Mauro FR, Laurenti L, Reda G, Moia R, Condoluci A, Vincelli I, Chiarenza A, Vigna E, Martino EA, Bruzzese A, Mezzatesta S, Laureana R, Cutrona G, Di Raimondo F, Fronza G, Zucchetto A, Bomben R, Rossi FM, Olivieri J, Zaja F, Rossi D, Gaidano G, Del Principe MI, Ilariucci F, Del Poeta G, Ferrarini M, Neri A, Gattei V, Gentile M. The time to first treatment is an independent predictor of overall survival in chronic lymphocytic leukemia. Am J Hematol 2023. [PMID: 37067157 DOI: 10.1002/ajh.26927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/15/2023] [Accepted: 04/03/2023] [Indexed: 04/18/2023]
Affiliation(s)
- Fortunato Morabito
- Biotechnology Research Unit, Aprigliano, A.O./ASP of Cosenza, Cosenza, Italy
| | - Giovanni Tripepi
- Consiglio Nazionale delle Ricerche, Istituto di Fisiologia Clinica del CNR, Reggio Calabria, Italy
| | - Francesca Romana Mauro
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University, Rome, Italy
| | - Luca Laurenti
- Department of Hematology, Catholic University Hospital "A. Gemelli" Rome, Rome, Italy
| | - Gianluigi Reda
- Department of Oncology and Hemato-oncology, University of Milano and Hematology CTMO, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Moia
- Division of Haematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Adalgisa Condoluci
- Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | | | - Annalisa Chiarenza
- Divisione di Ematologia, Ospedale Ferrarotto, Università di Catania, Catania, Italy
| | - Ernesto Vigna
- Hematology Unit, Department of Onco-hematology, A.O. of Cosenza, Cosenza, Italy
| | | | - Antonella Bruzzese
- Hematology Unit, Department of Onco-hematology, A.O. of Cosenza, Cosenza, Italy
| | - Sabrina Mezzatesta
- Consiglio Nazionale delle Ricerche, Istituto di Fisiologia Clinica del CNR, Reggio Calabria, Italy
| | - Roberta Laureana
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma "Tor Vergata," Rome, Rome, Italy
| | - Giovanna Cutrona
- UO Molecular Pathology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | | | - Gilberto Fronza
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Francesca Maria Rossi
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Jacopo Olivieri
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari, Azienda Ospedaliera Universitaria S. Maria Misericordia, Udine, Italy
| | | | - Davide Rossi
- Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Maria Ilaria Del Principe
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma "Tor Vergata," Rome, Rome, Italy
| | - Fiorella Ilariucci
- Hematology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Del Poeta
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma "Tor Vergata," Rome, Rome, Italy
| | - Manlio Ferrarini
- UO Molecular Pathology, Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - Antonino Neri
- Scientific Directorate, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Massimo Gentile
- Hematology Unit, Department of Onco-hematology, A.O. of Cosenza, Cosenza, Italy
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
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11
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Levi S, Bronstein Y, Goldschmidt N, Morabito F, Ziv-Baran T, Del Poeta G, Bairey O, Del Principe MI, Fineman R, Mauro FR, Gutwein O, Reda G, Ruchlemer R, Sportoletti P, Laurenti L, Shvidel L, Coscia M, Tadmor T, Varettoni M, Aviv A, Murru R, Braester A, Chiarenza A, Visentin A, Pietrasanta D, Loseto G, Zucchetto A, Bomben R, Olivieri J, Neri A, Rossi D, Gaidano G, Trentin L, Foà R, Cuneo A, Perry C, Gattei V, Gentile M, Herishanu Y. Efficacy of front-line ibrutinib versus fludarabine, cyclophosphamide, and rituximab in patients with chronic lymphocytic leukemia: A retrospective multicenter "Real-World" study. Am J Hematol 2023; 98:E24-E27. [PMID: 36349541 DOI: 10.1002/ajh.26779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Shai Levi
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yotam Bronstein
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Neta Goldschmidt
- Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Fortunato Morabito
- Biothechnology Research Unit, AO of Cosenza, Cosenza, Italy.,Hematology and Bone Marrow Transplant Unit, Hemato-Oncology Department, Augusta Victoria Hospital, Jerusalem, Israel
| | - Tomer Ziv-Baran
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | | | - Gianluigi Reda
- Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | | | - Paolo Sportoletti
- Centro di Ricerca Emato-Oncologica (CREO), University of Perugia, Perugia, Italy
| | - Luca Laurenti
- Fondazione Universitaria Policlinico A Gemelli di Roma, Roma, Italy
| | | | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Marzia Varettoni
- Division of Haematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | | | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padova, Padova, Italy
| | - Daniela Pietrasanta
- Division of Hematology, Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Jacopo Olivieri
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari "Carlo Melzi", Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Antonio Neri
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Rossi
- Department of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padova, Padova, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Chava Perry
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Hematology, Hadassah Medical Center, Jerusalem, Israel
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Yair Herishanu
- Department of Hematology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Visentin A, Molinari MC, Pravato S, Cellini A, Angotzi F, Cavaretta CA, Ruocco V, Imbergamo S, Piazza F, Proietti G, Mauro FR, Trentin L. A Retrospective Study on the Efficacy of Subcutaneous Immunoglobulin as Compared to Intravenous Formulation in Patients with Chronic Lymphocytic Leukemia and Secondary Antibody Deficiency. Curr Oncol 2022; 30:274-283. [PMID: 36661671 PMCID: PMC9857433 DOI: 10.3390/curroncol30010022] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Secondary antibody deficiency (SAD) is a common complication in chronic lymphocytic leukemia (CLL) which favors the development of life-threatening infections. Subcutaneous immunoglobulins (IG) (SCIG) have been proven to be as effective as intravenous immunoglobulin (IVIG) in primary immunodeficiencies. Since only a few studies investigated SCIG in secondary antibody deficiency, the aim of this study was to assess the efficacy and safety of SCIG or IVIG in CLL patients with secondary antibody deficiency. One hundred and sixteen CLL patients were recruited, 63% were males, and the median age was 68 years; 44% had bronchiectasis and 76% never smoked. Forty-nine patients received IVIG and 88 SCIG, including 28 patients who shifted from IVIG to SCIG. Despite similar baseline IgG levels, patients receiving SCIG achieved higher IgG after at least +6 months (p = 0.0009). We observed that SCIG can decrease the cumulative incidence of first (HR 0.39 p < 0.0001) and second (HR 0.56 p = 0.0411) infection more than IVIG. The effect was remarkable in that patients were able to reach at least 6 g/L of IgG after 6 months of treatments (p < 0.0001). Replacement therapies were well tolerated with less adverse events and a lower discontinuation rate in patients was managed with SCIG than IVIG. In this study we describe the clinical features of a large cohort of CLL with secondary antibody deficiency receiving IG. We demonstrated that SCIG are active and well tolerated drugs that allows to reach higher IgG levels and decrease the rate of infections better than IVIG, in particular when IgG levels reach 6 g/L.
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Affiliation(s)
- Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
- Hematology Unit, Department of Medicine of Systems (DIDAS), Azienda Ospedale Università Padova, 35128 Padova, Italy
| | - Maria Chiara Molinari
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy
| | - Stefano Pravato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Alessandro Cellini
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Francesco Angotzi
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Chiara Adele Cavaretta
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Valeria Ruocco
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Silvia Imbergamo
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Francesco Piazza
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
| | - Giulia Proietti
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy
| | - Francesca Romana Mauro
- Hematology Unit, Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, 35128 Padova, Italy
- Hematology Unit, Department of Medicine of Systems (DIDAS), Azienda Ospedale Università Padova, 35128 Padova, Italy
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13
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Peragine N, De Propris MS, Intoppa S, Milani ML, Mauro FR, Cuneo A, Rigolin GM, Del Giudice I, Foà R, Guarini A. Early CD49d downmodulation in chronic lymphocytic leukemia patients treated front-line with ibrutinib plus rituximab predicts long-term response. Leuk Lymphoma 2022; 63:2982-2986. [PMID: 35913400 DOI: 10.1080/10428194.2022.2105324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Nadia Peragine
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Stefania Intoppa
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Maria Laura Milani
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Antonio Cuneo
- Hematology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Gian Matteo Rigolin
- Hematology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
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14
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Visentin A, Mauro FR, Catania G, Fresa A, Vitale C, Sanna A, Mattiello V, Cibien F, Sportoletti P, Gentile M, Rigolin GM, Quaglia FM, Murru R, Gozzetti A, Molica S, Marchetti M, Pravato S, Angotzi F, Cellini A, Scarfò L, Reda G, Coscia M, Laurenti L, Ghia P, Foà R, Cuneo A, Trentin L. Obinutuzumab plus chlorambucil versus ibrutinib in previously untreated chronic lymphocytic leukemia patients without TP53 disruptions: A real-life CLL campus study. Front Oncol 2022; 12:1033413. [PMID: 36479077 PMCID: PMC9719965 DOI: 10.3389/fonc.2022.1033413] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/20/2022] [Indexed: 08/13/2023] Open
Abstract
One of the main issues in the treatment of patients with chronic lymphocytic leukemia (CLL) deals with the choice between continuous or fixed-duration therapy. Continuous ibrutinib (IB), the first-in-class BTK inhibitor, and obinutuzumab-chlorambucil (G-CHL) are commonly used therapies for elderly and/or comorbid patients. No head-to-head comparison has been carried out. Within the Italian campus CLL network, we performed a retrospective study on CLL patients without TP53 disruption treated with IB or G-CHL as first-line therapy. Patients in the G-CHL arm had a higher CIRS score and the worst renal function. The overall response rates between the G-CHL and IB arms were similar, but more complete remissions (CRs) were achieved with G-CHL (p = 0.0029). After a median follow-up of 30 months, the progression-free survival (PFS, p = 0.0061) and time to next treatment (TTNT, p = 0.0043), but not overall survival (OS, p = 0.6642), were better with IB than with G-CHL. Similar results were found after propensity score matching and multivariate analysis. While PFS and TTNT were longer with IB than with G-CHL in IGHV unmutated patients (p = 0.0190 and 0.0137), they were superimposable for IGHV mutated patients (p = 0.1900 and 0.1380). In the G-CHL arm, the depth of response (79% vs. 68% vs. 38% for CR, PR and SD/PD; p < 0.0001) and measurable residual disease (MRD) influenced PFS (78% vs. 53% for undetectable MRD vs. detectable MRD, p = 0.0203). Hematological toxicities were common in the G-CHL arm, while IB was associated with higher costs. Although continuous IB provides better disease control in CLL, IGHV mutated patients and those achieving an undetectable MRD show a marked clinical and economic benefit from a fixed-duration obinutuzumab-based treatment.
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Affiliation(s)
- Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padova, Italy
- Veneto Institute of Molecular Medicine, Padua, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, Rome, Italy
| | - Gioachino Catania
- Division of Hematology, Hospital Saints (A. O. SS) Antonio e Biagio and Cesare Arrigo, Alessandria, Italy
| | - Alberto Fresa
- Hematology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Candida Vitale
- Department of Molecular Biotechnology and health Sciences, University of Torino and Division of Hematology, University Hospital (A.O.U.) Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Veronica Mattiello
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore, University of Milan, Milan, Italy
| | | | - Paolo Sportoletti
- Hematology and Clinical Immunology Unit, University of Perugia, Perugia, Italy
| | | | - Gian Matteo Rigolin
- Hematology Section, Department of Medical Sciences, Azienda Ospedaliera-Universitaria, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Francesca Maria Quaglia
- Department of Medicine, Section of Hematology, University of Verona and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco ARNAS “G. Brotzu”, Cagliari, Italy
| | | | - Stefano Molica
- Department Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - Monia Marchetti
- Division of Hematology, Hospital Saints (A. O. SS) Antonio e Biagio and Cesare Arrigo, Alessandria, Italy
| | - Stefano Pravato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padova, Italy
| | - Francesco Angotzi
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padova, Italy
| | - Alessandro Cellini
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padova, Italy
| | - Lydia Scarfò
- Strategic Program on CLL, University Health and Science “San Raffaele”, Milan, Italy
| | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore, University of Milan, Milan, Italy
| | - Marta Coscia
- Department of Molecular Biotechnology and health Sciences, University of Torino and Division of Hematology, University Hospital (A.O.U.) Città della Salute e della Scienza di Torino, Torino, Italy
| | - Luca Laurenti
- Hematology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Paolo Ghia
- Strategic Program on CLL, University Health and Science “San Raffaele”, Milan, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, Rome, Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, Azienda Ospedaliera-Universitaria, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padova, Italy
- Veneto Institute of Molecular Medicine, Padua, Italy
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15
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Merli M, Ferrarini I, Merli F, Busca A, Mina R, Falini B, Bruna R, Cairoli R, Marchetti M, Romano A, Cavo M, Arcaini L, Trentin L, Cattaneo C, Derenzini E, Fracchiolla NS, Marchesi F, Scattolin A, Billio A, Bocchia M, Massaia M, Gambacorti‐Passerini C, Mauro FR, Gentile M, Mohamed S, Della Porta MG, Coviello E, Cilloni D, Visani G, Federici AB, Tisi MC, Cudillo L, Galimberti S, Gherlinzoni F, Pagano L, Guidetti A, Bertù L, Corradini P, Passamonti F, Visco C. SARS-CoV-2 infection in patients with chronic lymphocytic leukemia: The Italian Hematology Alliance on COVID-19 cohort. Hematol Oncol 2022; 41:128-138. [PMID: 36265128 PMCID: PMC9874469 DOI: 10.1002/hon.3092] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 02/03/2023]
Abstract
COVID-19, the disease caused by SARS-CoV-2, is still afflicting thousands of people across the globe. Few studies on COVID-19 in chronic lymphocytic leukemia (CLL) are available. Here, we analyzed data from the CLL cohort of the Italian Hematology Alliance on COVID-19 (NCT04352556), which included 256 CLL patients enrolled between 25 February 2020 and 1 February 2021. Median age was 70 years (range 38-94) with male preponderance (60.1%). Approximately half of patients (n = 127) had received at least one line of therapy for CLL, including 108 (83.7%) who were on active treatment at the time of COVID-19 or received their last therapy within 12 months. Most patients (230/256, 89.9%) were symptomatic at COVID-19 diagnosis and the majority required hospitalization (n = 176). Overall, after a median follow-up of 42 days (IQR 24-96), case fatality rate was 30.1%, and it was 37.5% and 24.4% in the first (25 February 2020-22 June 2020) and second wave (23 June 2020-1 February 2021), respectively (p = 0.03). At multivariate analysis, male sex (HR 1.82, 95% CI 1.03-3.24, p = 0.04), age over than 70 years (HR 2.23, 95% CI 1.23-4.05, p = 0.01), any treatment for CLL given in the last 12 months (HR 1.72, 95% CI 1.04-2.84, p = 0.04) and COVID-19 severity (severe: HR 5.66, 95% CI 2.62-12.33, p < 0.0001; critical: HR 15.99, 95% CI 6.93-36.90, p < 0.0001) were independently associated with poor survival. In summary, we report a dismal COVID-related outcome in a significant fraction of CLL patients, that can be nicely predicted by clinical parameters.
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Affiliation(s)
- Michele Merli
- Division of HematologyUniversity Hospital Ospedale di Circolo e Fondazione Macchi ‐ASST Sette LaghiUniversity of InsubriaVareseItaly
| | - Isacco Ferrarini
- Department of MedicineSection of HematologyUniversity of VeronaVeronaItaly
| | - Francesco Merli
- HematologyAzienda Unità Sanitaria Locale‐Istituto di Ricovero e Cura a Carattere Scientifico Reggio EmiliaReggio EmiliaItaly
| | - Alessandro Busca
- Stem Cell Transplant CenterAzienda Ospedaliera Universitaria Citta’ della Salute e della ScienzaTurinItaly
| | - Roberto Mina
- Myeloma UnitDivision of HematologyUniversity of TurinAzienda Ospedaliera Universitaria Citta’ della Salute e della ScienzaTurinItaly
| | | | - Riccardo Bruna
- Division of HematologyDepartment of Translational MedicineUniversity of Eastern Piedmont and Ospedale Maggiore della CaritàNovaraItaly
| | - Roberto Cairoli
- HematologyAzienda Socio‐Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaMilanItaly
| | - Monia Marchetti
- HematologyAzienda Ospedaliera Santissimi Antonio e Biagio e Cesare ArrigoAlessandriaItaly
| | - Alessandra Romano
- HematologyDipartimento di Chirurgia e Specialità Medico ChirurgicheUniversità degli Studi di CataniaCataniaItaly
| | - Michele Cavo
- IRCCS Azienda Ospedaliero‐Universitaria di BolognaSeràgnoli Institute of HematologyDepartment of Experimental, Diagnostic and Specialty MedicineBologna University School of MedicineBolognaItaly
| | - Luca Arcaini
- Department of Molecular MedicineUniversity of Pavia & Division of HematologyFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - Livio Trentin
- Hematology and Clinical Immunology UnitDepartment of MedicineUniversity of PaduaPaduaItaly
| | - Chiara Cattaneo
- HematologyAzienda Socio‐Sanitaria Territoriale‐Spedali CiviliBresciaItaly
| | - Enrico Derenzini
- Onco‐Hematology DivisionIEO European Institute of Oncology IRCCS & Department of Health SciencesUniversity of MilanMilanItaly
| | | | - Francesco Marchesi
- Hematology and Stem Cell Transplant UnitIstituto di Ricovero e Cura a Carattere Scientifico Regina Elena National Cancer InstituteRomeItaly
| | | | - Atto Billio
- Division of Hematology and BMTHospital S. MaurizioBolzanoItaly
| | - Monica Bocchia
- Hematology UnitUniversity of SienaAzienda Ospedaliero Universitaria SeneseSienaItaly
| | | | | | - Francesca Romana Mauro
- HematologyDepartment of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Massimo Gentile
- Hematology UnitDepartment of Hemato‐Oncology, Ospedale AnnunziataCosenzaItaly
| | - Sara Mohamed
- UCO EmatologiaAzienda Sanitaria Universitaria Giuliano IsontinaTriesteItaly
| | - Matteo Giovanni Della Porta
- Humanitas Clinical and Research Hospital Istituto di Ricovero e Cura a Carattere Scientifico and Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Elisa Coviello
- Hematology and Bone Marrow TransplantIstituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San MartinoGenovaItaly
| | - Daniela Cilloni
- Department of Clinical and Biological SciencesUniversity of TurinSan Luigi HospitalTurinItaly
| | - Giuseppe Visani
- Dipartimento di Onco‐EmatologiaAzienda Ospedaliera Ospedali Riuniti Marche NordPesaroItaly
| | | | | | | | - Sara Galimberti
- Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | | | - Livio Pagano
- Dipartimento di Scienze Radiologiche ed EmatologicheFondazione Policlinico Universitario A Gemelli–IRCCS–Università Cattolica del Sacro CuoreRomeItaly
| | - Anna Guidetti
- Hematology and Bone Marrow TransplantationFondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei TumoriUniversity of MilanMilanItaly
| | - Lorenza Bertù
- Division of HematologyUniversity Hospital Ospedale di Circolo e Fondazione Macchi ‐ASST Sette LaghiUniversity of InsubriaVareseItaly
| | - Paolo Corradini
- Hematology and Bone Marrow TransplantationFondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei TumoriUniversity of MilanMilanItaly
| | - Francesco Passamonti
- Division of HematologyUniversity Hospital Ospedale di Circolo e Fondazione Macchi ‐ASST Sette LaghiUniversity of InsubriaVareseItaly
| | - Carlo Visco
- Department of MedicineSection of HematologyUniversity of VeronaVeronaItaly
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16
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Frustaci AM, Del Poeta G, Visentin A, Sportoletti P, Fresa A, Vitale C, Murru R, Chiarenza A, Sanna A, Mauro FR, Reda G, Gentile M, Varettoni M, Baratè C, Borella C, Greco A, Deodato M, Zamprogna G, Laureana R, Cipiciani A, Galitzia A, Curto Pelle A, Morelli F, Malvisi L, Coscia M, Laurenti L, Trentin L, Montillo M, Cairoli R, Tedeschi A. Coexisting conditions and concomitant medications do not affect venetoclax management and survival in chronic lymphocytic leukemia. Ther Adv Hematol 2022; 13:20406207221127550. [PMID: 36246422 PMCID: PMC9554118 DOI: 10.1177/20406207221127550] [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: 03/11/2022] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background The question of which parameters may be informative on venetoclax outcome in chronic lymphocytic leukemia (CLL) is still unclear. Furthermore, the choice to treat with venetoclax can be challenging in patients with baseline characteristics or comorbidities that may potentially favor some specific adverse events. Objectives This study was aimed to evaluate whether age, fitness status, patients'/disease characteristics, or concomitant medications may predict outcomes in CLL patients receiving venetoclax. Design Retrospective observational study. Methods Impact of age, presence of Cumulative Illness Rating Scale (CIRS) >6 or severe organ impairment (CIRS3+), Eastern Cooperative Oncology Group-Performance Status (ECOG-PS), renal function, and concomitant medications were retrospectively analyzed on treatment management (definitive discontinuation due to toxicity, discontinuation due to toxicity, Tox-DTD; permanent dose reduction, PDR) and survival [progression free survival (PFS), event free survival (EFS), overall survival (OS)] in unselected patients receiving venetoclax monotherapy in common practice. Results A total of 221 relapsed/refractory patients were included. Tox-DTD and PDR were reported in 5.9% and 21.7%, respectively, and were not influenced by any fitness parameter, age, number or type of concomitant medication, baseline neutropenia, or impaired renal function. None of these factors were associated with tumor lysis syndrome (TLS) development. Age and coexisting conditions had no influence on PFS and EFS. At univariate analysis, OS was significantly shorter only in patients with ECOG-PS >1 (p < 0.0001) and elderly (⩾65 years) with CIRS >6 (p = 0.014) or CIRS3+ (p = 0.031). ECOG-PS >1 retained an independent role only for EFS and OS. While Tox-DTD affected all survival outcomes, no differences in PFS were reported among patients permanently reducing dose or interrupting venetoclax for > 7 days. Conclusion Clinical outcome with venetoclax is not influenced by comorbidities, patients' clinical characteristics, or concomitant medications. Differently from other targeted therapies, this demonstrates that, except ECOG-PS, none of the parameters generally considered for treatment choice, including baseline neutropenia or impaired renal function, should rule the decision process with this agent. Anyway, if clinically needed, a correct drug management does not compromise treatment efficacy and may avoid toxicity-driven discontinuations. Plain Language Summary Chapter 1: Why was this study done? Chapter 2: Which are the main findings of the study? Chapter 3: How these findings may impact on clinical practice? Coexisting conditions and concomitant medications do not affect venetoclax management and survival in chronic lymphocytic leukemia • The question of which parameters may be informative on venetoclax outcome in chronic lymphocytic leukemia is still unclear. Furthermore, the choice to treat with venetoclax can be challenging in patients with baseline characteristics or comorbidities that may potentially favor some specific adverse events (e.g. compromised renal function or baseline neutropenia).• In our large series of patients treated outside of clinical trials, we demonstrated that neither age, fitness, comorbidities nor concomitant medications impact on venetoclax management and survival. Importantly, patients presenting with baseline neutropenia or impaired renal function did not have a higher rate of dose reductions or toxicity-driven discontinuations, thus further underlining that venetoclax may be safely administered even in those categories with no preclusions.• Differently from other targeted agents, our data demonstrate that none of the baseline factors commonly considered in treatment decision process retains a role with venetoclax. Finally, permanent dose reductions and temporary interruptions did not adversely impact PFS suggesting that, if clinically needed, a correct drug management should be adopted with no risk of compromising venetoclax efficacy.
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Affiliation(s)
| | | | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Paolo Sportoletti
- Centro di Ricerca Emato-Oncologica (CREO), Department of Medicine and Surgery, Institute of Hematology, University of Perugia, Perugia, Italy
| | - Alberto Fresa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, Università di Torino, Torino, Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A.Businco, ARNAS ‘G. Brotzu’, Cagliari, Italy
| | - Annalisa Chiarenza
- Hematology Division, A.O.U. Policlinico ‘G. Rodolico-S.Marco’, Catania, Italy
| | | | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, ‘Sapienza’ University, Roma, Italy
| | - Gianluigi Reda
- U.O.C. Ematologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | | | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Chiara Borella
- Department of Hematology, Ospedale San Gerardo, Monza, Italy
| | - Antonino Greco
- Department of Hematology, Azienda Ospedaliera Giovanni Panìco, Tricase, Italy
| | - Marina Deodato
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giulia Zamprogna
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Roberta Laureana
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Roma, Italy
| | - Alessandra Cipiciani
- Centro di Ricerca Emato-Oncologica (CREO), Department of Medicine and Surgery, Institute of Hematology, University of Perugia, Perugia, Italy
| | - Andrea Galitzia
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Angelo Curto Pelle
- Hematology Division, A.O.U. Policlinico ‘G. Rodolico-S.Marco’, University of Catania, Catania, Italy
| | | | | | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, Università di Torino, Torino, Italy
| | - Luca Laurenti
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Marco Montillo
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Roberto Cairoli
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Alessandra Tedeschi
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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17
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Deodato M, Frustaci AM, Sportoletti P, Laurenti L, Murru R, Visentin A, Reda G, Mauro FR, Quaresmini G, Vanazzi A, Vitale C, Orsucci L, Massaia M, Sanna A, Motta M, Ibatici A, Ferrarini I, Borella C, Varettoni M, Tani M, Marinoni S, Ferrario A, Zamprogna G, Montillo M, Tedeschi A. How COVID-19 pandemic changed our attitude to venetoclax-based treatment in chronic lymphocytic leukemia. Leuk Lymphoma 2022; 63:1985-1988. [DOI: 10.1080/10428194.2022.2053532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marina Deodato
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Anna Maria Frustaci
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Paolo Sportoletti
- Department of Medicine and Surgery, Institute of Hematology, Centro di Ricerca Emato-Oncologica (CREO), University of Perugia, Perugia, Italy
| | - Luca Laurenti
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, Cagliari, Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova, Padova, Italy
| | - Gianluigi Reda
- U.O.C. Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Roma, Italy
| | | | - Anna Vanazzi
- Division of Clinical Haemato-Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, Università di Torino, Torino, Italy
| | - Lorella Orsucci
- S.C. Ematologia, AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Alessandro Sanna
- Hematology, Department of Oncology, AOU Careggi, Florence, Italy
| | - Marina Motta
- Hematology Department, ASST Spedali Civili, Brescia, Italy
| | - Adalberto Ibatici
- Hematology Unit and Bone Marrow Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Isacco Ferrarini
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Chiara Borella
- Hematology Department, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Monica Tani
- U.O.C. di Ematologia Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Sara Marinoni
- UOC Ematologia, ASST Ovest milanese, Ospedale di Legnano, Legnano, Italy
| | - Andrea Ferrario
- UO Ematologia, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
| | - Giulia Zamprogna
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Marco Montillo
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Alessandra Tedeschi
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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18
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Innocenti I, Reda G, Visentin A, Coscia M, Motta M, Murru R, Moia R, Gentile M, Pennese E, Quaglia FM, Albano F, Cassin R, Deodato M, Ielo C, Frustaci AM, Piciocchi A, Rughini A, Arena V, Di Sevo D, Tomasso A, Autore F, Del Poeta G, Scarfò L, Mauro FR, Tedeschi A, Trentin L, Pompili M, Foà R, Ghia P, Cuneo A, Laurenti L. Risk of hepatitis B virus reactivation in chronic lymphocytic leukemia patients receiving ibrutinib with or without antiviral prophylaxis. A retrospective multicentric GIMEMA study. Haematologica 2022; 107:1470-1473. [PMID: 35199505 PMCID: PMC9152973 DOI: 10.3324/haematol.2021.280325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/11/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Idanna Innocenti
- Sezione di Ematologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Gianluigi Reda
- U.O.C. Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padova, Padova
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino
| | | | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, ARNAS "G.Brotzu", Cagliari
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara
| | - Massimo Gentile
- UOC Ematologia AO di Cosenza, Presidio Ospedaliero Annunziata, Cosenza
| | - Elsa Pennese
- U.O.S.D. Centro Diagnosi e Terapia dei Linfomi, Dipartimento Oncologico-Ematologico, Presidio Ospedaliero "Spirito Santo", Pescara
| | | | - Francesco Albano
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari "Aldo Moro", Bari
| | - Ramona Cassin
- U.O.C. Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
| | - Marina Deodato
- ASST Grande Ospedale Metropolitano Niguarda Hospital, Milano
| | - Claudia Ielo
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto I, Roma
| | | | | | | | | | | | - Annamaria Tomasso
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma
| | - Francesco Autore
- Sezione di Ematologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma
| | - Giovanni Del Poeta
- UOC Unit of Hematology and Stem Cell Transplantation, AOU Policlinico Tor Vergata Roma, Roma
| | - Lydia Scarfò
- Strategic Research Program on CLL, Università Vita Salute and IRCSS Ospedale San Raffaele, Milano
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto I, Roma
| | | | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padova, Padova
| | - Maurizio Pompili
- Dipartimento di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto I, Roma
| | - Paolo Ghia
- Strategic Research Program on CLL, Università Vita Salute and IRCSS Ospedale San Raffaele, Milano
| | - Antonio Cuneo
- Hematology section, Department of Medical Sciences, University of Ferrara, Ferrara
| | - Luca Laurenti
- Sezione di Ematologia, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma.
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19
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Molica S, Giannarelli D, Visentin A, Reda G, Sportoletti P, Frustaci AM, Chiarenza A, Ciolli S, Vitale C, Laurenti L, De Paoli L, Murru R, Gentile M, Moia R, Rigolin GM, Levato L, Giordano A, Del Poeta G, Stelitano C, Deodato M, Ielo C, Noto A, Guarente V, Coscia M, Tedeschi A, Gaidano G, Cuneo A, Foa' R, Trentin L, Mauro FR. Prediction of outcomes in chronic lymphocytic leukemia patients treated with ibrutinib: Validation of current prognostic models and development of a simplified three-factor model. Am J Hematol 2022; 97:E176-E180. [PMID: 35170793 DOI: 10.1002/ajh.26502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Stefano Molica
- Department of Hematology‐Oncology Azienda Ospedaliera Pugliese‐Ciaccio Catanzaro Italy
| | - Diana Giannarelli
- Biostatistic Unit Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine University of Padua Padua Italy
| | - Gianluigi Reda
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan Italy
| | - Paolo Sportoletti
- Institute of Hematology‐Centro di Ricerca Emato‐Oncologica (CREO), Department of Medicine University of Perugia Perugia Italy
| | - Anna Maria Frustaci
- Department of Hematology Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda Milano Milan Italy
| | | | | | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences University of Turin Turin Italy
| | - Luca Laurenti
- Institute of Haematology Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - Lorenzo De Paoli
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit Ospedale Oncologico A. Businco AO Brotzu Cagliari Italy
| | - Massimo Gentile
- Hematology Unit Hematology and Oncology Department Cosenza Italy
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Gian Matteo Rigolin
- Hematology, Department of Medical Sciences St. Anna University Hospital Ferrara Italy
| | - Luciano Levato
- Department of Hematology‐Oncology Azienda Ospedaliera Pugliese‐Ciaccio Catanzaro Italy
| | - Annamaria Giordano
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section University of Bari Bari Italy
| | - Giovanni Del Poeta
- Hematology, Department of Biomedicine and Prevention University Tor Vergata Rome Italy
| | - Caterina Stelitano
- Department Hematology Grande Ospedale Metropolitano Reggio Calabria Italy
| | - Marina Deodato
- Department of Hematology Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda Milano Milan Italy
| | - Claudia Ielo
- Hematology, Department of Translational and Precision Medicine 'Sapienza' University Rome Italy
| | - Alessandro Noto
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan Italy
| | - Valerio Guarente
- Institute of Hematology‐Centro di Ricerca Emato‐Oncologica (CREO), Department of Medicine University of Perugia Perugia Italy
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences University of Turin Turin Italy
| | - Alessandra Tedeschi
- Department of Hematology Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda Milano Milan Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Antonio Cuneo
- Hematology, Department of Medical Sciences St. Anna University Hospital Ferrara Italy
| | - Robin Foa'
- Hematology, Department of Translational and Precision Medicine 'Sapienza' University Rome Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine University of Padua Padua Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine 'Sapienza' University Rome Italy
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20
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Zinzani PL, Martelli M, Ferrero S, Gentile M, Laurenti L, Romana Mauro F, Sportoletti P, Tedeschi A, Varettoni M, Visco C. Use of BTK inhibitors with focus on ibrutinib in mantle cell lymphoma: an expert panel opinion statement. Hematol Oncol 2022; 40:518-527. [PMID: 35247223 DOI: 10.1002/hon.2983] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/15/2021] [Revised: 02/18/2022] [Accepted: 03/03/2022] [Indexed: 11/07/2022]
Abstract
The introduction of BTK inhibitors transformed the management of patients with mantle cell lymphoma (MCL). Ibrutinib, the first-in-class BTK inhibitor is now approved in more than 80 countries and there are over 20 new BTK inhibitors in development. In addition, novel agents show potential clinical activity (alone and in combination) and are in the approval phase and/or being studied in ongoing clinical trials. How does the practicing clinician decide on the optimal therapeutic strategy for this highly heterogenous disease? In July 2020 a group of experts from Italy, convened a meeting to address and provide clarification on a series of outstanding issues in the treatment of MCL with the view of providing clinical guidance on its management. This expert opinion statement represents the panel's collective analysis, evaluation, and recommendations and is made up of a series of questions and answers (in the form of a review of the pertinent literature) designed to replicate those posed by practicing clinicians in Italy but which are applicable to clinical settings worldwide. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università Degli Studi, Bologna, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - S Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy/AOU "Città Della Salute e Della Scienza di Torino", Torino, Italy
| | | | - Luca Laurenti
- Hematology, Università Cattolica Del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Paolo Sportoletti
- Department of Medicine, Institute of Hematology-Centro di Ricerche Emato-Oncologiche (CREO), University of Perugia, Perugia, Italy
| | - Alessandra Tedeschi
- Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
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21
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Visentin A, Mauro FR, Cibien F, Vitale C, Reda G, Fresa A, Ciolli S, Pietrasanta D, Marchetti M, Murru R, Gentile M, Rigolin GM, Quaglia FM, Scarfò L, Sportoletti P, Pravato S, Piazza F, Coscia M, Laurenti L, Molica S, Foà R, Cuneo A, Trentin L. Continuous treatment with Ibrutinib in 100 untreated patients with TP53 disrupted chronic lymphocytic leukemia: A real-life campus CLL study. Am J Hematol 2022; 97:E95-E99. [PMID: 34904743 DOI: 10.1002/ajh.26437] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine University of Padua Padova Italy
- Venetian Institute of Molecular Medicine Padua Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine "Sapienza" University Rome Italy
| | | | - Candida Vitale
- Department of Molecular Biotechnology and Health Sciences University of Torino and Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino Torino Italy
| | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore University of Milan Milan Italy
| | - Alberto Fresa
- Hematology Institute Fondazione Policlinico Universitario Agostino Gemelli IRCSS Rome Italy
| | - Stefania Ciolli
- Hematology Unit, Careggi Hospital University of Florence Florence Italy
| | - Daniela Pietrasanta
- Division of Hematology A.O. SS Antonio e Biagio and Cesare Arrigo Alessandria Italy
| | - Monia Marchetti
- Division of Hematology A.O. SS Antonio e Biagio and Cesare Arrigo Alessandria Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit Ospedale Oncologico A. Businco, ARNAS "G. Brotzu" Cagliari Italy
| | - Massimo Gentile
- Hematology Unit, Department of Hemato‐Oncology Annunziata Hospital Cosenza Italy
| | - Gian Matteo Rigolin
- Hematology Section, Department of Medical Sciences, Azienda Ospedaliera‐Universitaria, Arcispedale S. Anna University of Ferrara Ferrara Italy
| | | | - Lydia Scarfò
- Strategic Research Program on CLL Vita‐Salute University and IRCSS San Raffaele Hospital Milan Italy
| | - Paolo Sportoletti
- Hematology and Clinical Immunology Unit University of Perugia Perugia Italy
| | - Stefano Pravato
- Hematology and Clinical Immunology Unit, Department of Medicine University of Padua Padova Italy
| | - Francesco Piazza
- Hematology and Clinical Immunology Unit, Department of Medicine University of Padua Padova Italy
- Venetian Institute of Molecular Medicine Padua Italy
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences University of Torino and Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino Torino Italy
| | - Luca Laurenti
- Hematology Institute Fondazione Policlinico Universitario Agostino Gemelli IRCSS Rome Italy
| | - Stefano Molica
- Department Hematology‐Oncology Azienda Ospedaliera Pugliese‐Ciaccio Catanzaro Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine "Sapienza" University Rome Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, Azienda Ospedaliera‐Universitaria, Arcispedale S. Anna University of Ferrara Ferrara Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine University of Padua Padova Italy
- Venetian Institute of Molecular Medicine Padua Italy
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22
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Ferrero S, Gentile M, Laurenti L, Mauro FR, Martelli M, Sportoletti P, Visco C, Zinzani PL, Tedeschi A, Varettoni M. Use of BTK inhibitors with special focus on ibrutinib in Waldenström macroglobulinemia: an expert panel opinion statement. Hematol Oncol 2022; 40:332-340. [PMID: 35212014 DOI: 10.1002/hon.2982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/16/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/07/2022]
Abstract
The pivotal role that ibrutinib plays in the management of Waldenström macroglobulinemia (WM) is undisputed but there are ongoing questions regarding its positioning in the therapeutic algorithm of WM as well as in some peculiar clinical situations. A panel of experts from Italy was convened to provide real world recommendations on the use of BTK inhibitors in lymphoproliferative diseases in general, and in patients with WM in particular. This position paper represents the panel's collective analysis, evaluation, and opinions and is made up of a series of questions frequently asked by practicing clinicians and answers based on currently available evidence. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- S Ferrero
- Department of Molecular Biotechnologies and Health Sciences, Division of Haematology, University of Torino, Torino, Italy/AOU "Città della Salute e della Scienza di Torino", Torino, Italy
| | | | - Luca Laurenti
- Hematology, Università Cattolica del Sacro Cuore, Policlinico A, Gemelli, Rome, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Paolo Sportoletti
- Department of Medicine, Institute of Hematology-Centro di Ricerche Emato-Oncologiche (CREO), University of Perugia, Perugia, Italy
| | - Carlo Visco
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia "Seràgnoli", Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale Università degli Studi, Bologna, Italy
| | - Alessandra Tedeschi
- Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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23
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Mauro FR, Paoloni F, Molica S, Reda G, Trentin L, Sportoletti P, Marchetti M, Pietrasanta D, Marasca R, Gaidano G, Coscia M, Stelitano C, Mannina D, Di Renzo N, Ilariucci F, Liberati AM, Orsucci L, Re F, Tani M, Musuraca G, Gottardi D, Zinzani PL, Gozzetti A, Molinari A, Gentile M, Chiarenza A, Laurenti L, Varettoni M, Ibatici A, Murru R, Ruocco V, Del Giudice I, De Propris MS, Della Starza I, Raponi S, Nanni M, Fazi P, Neri A, Guarini A, Rigolin GM, Piciocchi A, Cuneo A, Foà R. Efficacy of Front-Line Ibrutinib and Rituximab Combination and the Impact of Treatment Discontinuation in Unfit Patients with Chronic Lymphocytic Leukemia: Results of the Gimema LLC1114 Study. Cancers (Basel) 2021; 14:cancers14010207. [PMID: 35008372 PMCID: PMC8750939 DOI: 10.3390/cancers14010207] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/28/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary This prospective, multicenter study aimed to investigate the efficacy and safety of a front-line treatment with the ibrutinib and rituximab combination in 146 unfit patients with chronic lymphocytic leukemia (CLL). We observed an OR, CR, and 48-month PFS rates of 87%, 22.6%, and 77%, respectively. Responses with undetectable MRD were observed in 6.2% of all patients and 27% of CR patients. TP53 disruption and B-symptoms revealed a significant and independent impact on PFS. The 48-month cumulative treatment discontinuation rate due to adverse events in this patient population was 29.1%. It was significantly higher in male patients, in patients aged ≥70 years, and in those managed at centers that enrolled less than five patients. In conclusion, the ibrutinib and rituximab combination was an effective front-line treatment for unfit patients with CLL. However, a high rate of treatment discontinuations due to adverse events was observed in this unfit population. Abstract The GIMEMA group investigated the efficacy, safety, and rates of discontinuations of the ibrutinib and rituximab regimen in previously untreated and unfit patients with chronic lymphocytic leukemia (CLL). Treatment consisted of ibrutinib, 420 mg daily, and until disease progression, and rituximab (375 mg/sqm, given weekly on week 1–4 of month 1 and day 1 of months 2–6). This study included 146 patients with a median age of 73 years, with IGHV unmutated in 56.9% and TP53 disrupted in 22.2%. The OR, CR, and 48-month PFS rates were 87%, 22.6%, and 77%, respectively. Responses with undetectable MRD were observed in 6.2% of all patients and 27% of CR patients. TP53 disruption (HR 2.47; p = 0.03) and B-symptoms (HR 2.91; p = 0.02) showed a significant and independent impact on PFS. The 48-month cumulative rates of treatment discontinuations due to disease progression (DP) or adverse events (AEs) were 5.6% and 29.1%, respectively. AEs leading more frequently to treatment discontinuation were atrial fibrillation in 8% of patients, infections in 8%, and non-skin cancers in 6%. Discontinuation rates due to AEs were higher in male patients (HR: 0.46; p = 0.05), patients aged ≥70 years (HR 5.43, p = 0.0017), and were managed at centers that enrolled <5 patients (HR 5.1, p = 0.04). Patients who discontinued ibrutinib due to an AE showed a 24-month next treatment-free survival rate of 63%. In conclusion, ibrutinib and rituximab combination was an effective front-line treatment with sustained disease control in more than half of unfit patients with CLL. Careful monitoring is recommended to prevent and manage AEs in this patient population.
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Affiliation(s)
- Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
- Correspondence: ; Tel.: +39-06-499741; Fax: +39-06-44241984
| | | | - Stefano Molica
- Department of Hematology, Pugliese Ciaccio Hospital, 88100 Catanzaro, Italy;
| | - Gianluigi Reda
- Hematology Department, Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy; (G.R.); (A.N.)
| | - Livio Trentin
- Hematology Division, Department of Medicine, University of Padua, 35128 Padua, Italy;
| | - Paolo Sportoletti
- Institute of Hematology-Centro di Ricerca Emato-Oncologica (CREO), Department of Medicine, University of Perugia, 06129 Perugia, Italy;
| | - Monia Marchetti
- Department of Hematology, SS. Antonio e Biagio e Cesare Arrigo Hospital and University of Eastern Piedmont, 15121 Alessandria, Italy;
| | - Daniela Pietrasanta
- Department of Hematology, Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Roberto Marasca
- Hematology Unit, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41126 Modena, Italy;
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, AOU Maggiore della Carità, 28100 Novara, Italy;
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, 10100 Torino, Italy;
| | - Caterina Stelitano
- Department of Hematology, Azienda Ospedaliera Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy;
| | - Donato Mannina
- Division of Hematology, Azienda Ospedaliera Papardo, 98158 Messina, Italy;
| | - Nicola Di Renzo
- Hematology and Stem Cell Transplant Unit, “Vito Fazzi” Hospital, 73100 Lecce, Italy;
| | - Fiorella Ilariucci
- Hematology, Azienda Ospedaliera Arcispedale Santa Maria Nuova IRCCS, 42123 Reggio Emilia, Italy;
| | - Anna Marina Liberati
- Department of Hematology, Università degli Studi di Perugia, A.O.S., 05100 Terni, Italy;
| | - Lorella Orsucci
- Department of Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, 10100 Torino, Italy;
| | - Francesca Re
- Hematology and Bone Marrow Transplant Center, Azienda Ospedaliera Universitaria di Parma, 43126 Parma, Italy;
| | - Monica Tani
- Division of Hematology, Santa Maria delle Croci Hospital, 48121 Ravenna, Italy;
| | - Gerardo Musuraca
- Istituto Scientifico Romagnoli per lo Studio e la Cura dei Tumori-IRST, 47014 Meldola, Italy;
| | - Daniela Gottardi
- A.O.U. S. Giovanni Battista A.O. Mauriziano-Umberto I, 10128 Torino, Italy;
| | - Pier Luigi Zinzani
- IRCCS Azienda Ospedaliero-Universitaria di Bologna-Istituto di Ematologia “Seràgnoli” and Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Università di Bologna, 40138 Bologna, Italy;
| | - Alessandro Gozzetti
- Hematology, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy;
| | - Annalia Molinari
- Department of Oncology and Hematology, Infermi Hospital, 47923 Rimini, Italy;
| | | | | | - Luca Laurenti
- Fondazione Policlinico Universitario A Gemelli, IRCCS, 00168 Rome, Italy;
| | - Marzia Varettoni
- Division of Hematology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy;
| | - Adalberto Ibatici
- U.O. Ematologia e Centro Trapianti di Midollo, Policlinico San Martino, 16132 Genova, Italy;
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, ARNAS “G. Brotzu”, 34121 Cagliari, Italy;
| | - Valeria Ruocco
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
| | - Maria Stefania De Propris
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
| | - Irene Della Starza
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
- GIMEMA Foundation, 00187 Rome, Italy; (F.P.); (P.F.); (A.P.)
| | - Sara Raponi
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
| | - Mauro Nanni
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
| | - Paola Fazi
- GIMEMA Foundation, 00187 Rome, Italy; (F.P.); (P.F.); (A.P.)
| | - Antonino Neri
- Hematology Department, Foundation IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, 20100 Milan, Italy; (G.R.); (A.N.)
| | - Anna Guarini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
| | - Gian Matteo Rigolin
- Hematology Section, St. Anna University Hospital, 44121 Ferrara, Italy; (G.M.R.); (A.C.)
| | | | - Antonio Cuneo
- Hematology Section, St. Anna University Hospital, 44121 Ferrara, Italy; (G.M.R.); (A.C.)
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (V.R.); (I.D.G.); (M.S.D.P.); (I.D.S.); (S.R.); (M.N.); (A.G.); (R.F.)
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24
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Tedeschi A, Frustaci AM, Mauro FR, Chiarenza A, Coscia M, Ciolli S, Reda G, Laurenti L, Varettoni M, Murru R, Baratè C, Sportoletti P, Greco A, Borella C, Rossi V, Deodato M, Biagi A, Zamprogna G, Pelle AC, Lapietra G, Vitale C, Morelli F, Cassin R, Fresa A, Cavalloni C, Postorino M, Ielo C, Cairoli R, Di Raimondo F, Montillo M, Del Poeta G. Do age, fitness, and concomitant medications influence management and outcomes of patients with CLL treated with ibrutinib? Blood Adv 2021; 5:5490-5500. [PMID: 34525181 PMCID: PMC8714729 DOI: 10.1182/bloodadvances.2021004824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/27/2021] [Indexed: 11/22/2022] Open
Abstract
Functional reserve of organs and systems is known to be relevant in predicting immunochemotherapy tolerance. Age and comorbidities, assessed by the cumulative illness rating scale (CIRS), have been used to address chemotherapy intensity. In the ibrutinib era, it is still unclear whether age, CIRS, and Eastern Cooperative Oncology Group performance status (ECOG-PS) retain their predictive role on treatment vulnerability. In this series of 712 patients with chronic lymphocytic leukemia (CLL) treated with ibrutinib outside clinical trials, baseline ECOG-PS and neutropenia resulted as the most accurate predictors of treatment feasibility and outcomes. Age did not independently influence survival and ibrutinib tolerance, indicating that not age per se, but age-related conditions, may affect drug management. We confirmed the role of CIRS > 6 as a predictor of a poorer progression- and event-free survival (PFS, EFS). The presence of a severe comorbidity was significantly associated with permanent dose reductions (PDRs), not translating into worse outcomes. As expected, del(17p) and/or TP53mut and previous therapies affected PFS, EFS, and overall survival. No study so far has analyzed the influence of concomitant medications and CYP3A inhibitors with ibrutinib. In our series, these factors had no impact, although CYP3A4 inhibitors use correlated with Cox regression analysis, with an increased risk of PDR. Despite the limitation of its retrospective nature, this large study confirmed the role of ECOG-PS as the most accurate predictor of ibrutinib feasibility and outcomes, and importantly, neutropenia emerged as a relevant tool influencing patients' vulnerability. Although CIRS > 6 retained a significant impact on PFS and EFS, its value should be confirmed by prospective studies.
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Affiliation(s)
- Alessandra Tedeschi
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Anna Maria Frustaci
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Annalisa Chiarenza
- Division of Hematology, AOU “Policlinico-Vittorio Emanuele,” University of Catania, Catania, Italy
| | - Marta Coscia
- Division of Hematology, AOU Città della Salute e della Scienza di Torino, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Stefania Ciolli
- Department of Hematology, Università degli Studi di Firenze, Firenze, Italy
| | - Gianluigi Reda
- Department of Hematology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Luca Laurenti
- Hematology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Roma, Italy
| | - Marzia Varettoni
- Division of Hematology Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, ARNAS “G. Brotzu,” Cagliari, Italy
| | - Claudia Baratè
- Department of Clinical and Experimental Medicine, Section of Hematology, University of Pisa, Pisa, Italy
| | - Paolo Sportoletti
- Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Antonino Greco
- Department of Hematology, Azienda Ospedaliera Giovanni Panìco, Tricase, Italy
| | - Chiara Borella
- Department of Hematology, Ospedale San Gerardo, Monza, Italy
| | - Valentina Rossi
- Hematology & Transfusion Medicine L. Sacco University Hospital and School of Medicine, Milano, Italy; and
| | - Marina Deodato
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Annalisa Biagi
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Giulia Zamprogna
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Angelo Curto Pelle
- Division of Hematology, AOU “Policlinico-Vittorio Emanuele,” University of Catania, Catania, Italy
| | - Gianfranco Lapietra
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Candida Vitale
- Division of Hematology, AOU Città della Salute e della Scienza di Torino, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Francesca Morelli
- Department of Hematology, Università degli Studi di Firenze, Firenze, Italy
| | - Ramona Cassin
- Department of Hematology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Alberto Fresa
- Hematology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Roma, Italy
| | - Chiara Cavalloni
- Division of Hematology Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimiliano Postorino
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Claudia Ielo
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Roberto Cairoli
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Francesco Di Raimondo
- Division of Hematology, AOU “Policlinico-Vittorio Emanuele,” University of Catania, Catania, Italy
| | - Marco Montillo
- Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Giovanni Del Poeta
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
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25
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Cafforio L, Raponi S, Cappelli LV, Ilari C, Soscia R, De Propris MS, Mariglia P, Rigolin GM, Bardi A, Peragine N, Piciocchi A, Arena V, Mauro FR, Cuneo A, Guarini A, Foa R, Del Giudice I. Treatment with ibrutinib does not induce a TP53 clonal evolution in chronic lymphocytic leukemia. Haematologica 2021; 107:334-337. [PMID: 34647439 PMCID: PMC8719070 DOI: 10.3324/haematol.2020.263715] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Indexed: 11/09/2022] Open
Abstract
Not available.
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Affiliation(s)
- Luciana Cafforio
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | - Sara Raponi
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | | | - Caterina Ilari
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | - Roberta Soscia
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | | | - Paola Mariglia
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | - Gian Matteo Rigolin
- Hematology Section, Department of Medical Science, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, University of Ferrara
| | - Antonella Bardi
- Hematology Section, Department of Medical Science, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, University of Ferrara
| | - Nadia Peragine
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | | | | | | | - Antonio Cuneo
- Hematology Section, Department of Medical Science, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, University of Ferrara
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome
| | - Robin Foa
- Hematology, Department of Translational and Precision Medicine, Sapienza University
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University.
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26
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Morabito F, Tripepi G, Moia R, Recchia AG, Boggione P, Mauro FR, Bossio S, D'Arrigo G, Martino EA, Vigna E, Storino F, Fronza G, Di Raimondo F, Rossi D, Condoluci A, Colombo M, Fais F, Fabris S, Foa R, Cutrona G, Gentile M, Montserrat E, Gaidano G, Ferrarini M, Neri A. Lymphocyte Doubling Time As A Key Prognostic Factor To Predict Time To First Treatment In Early-Stage Chronic Lymphocytic Leukemia. Front Oncol 2021; 11:684621. [PMID: 34408978 PMCID: PMC8366564 DOI: 10.3389/fonc.2021.684621] [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: 03/23/2021] [Accepted: 07/05/2021] [Indexed: 12/23/2022] Open
Abstract
The prognostic role of lymphocyte doubling time (LDT) in chronic lymphocytic leukemia (CLL) was recognized more than three decades ago when the neoplastic clone’s biology was almost unknown. LDT was defined as the time needed for the peripheral blood lymphocyte count to double the of the initial observed value. Herein, the LDT prognostic value for time to first treatment (TTFT) was explored in our prospective O-CLL cohort and validated in in two additional CLL cohorts. Specifically, newly diagnosed Binet stage A CLL patients from 40 Italian Institutions, representative of the whole country, were prospectively enrolled into the O-CLL1-GISL protocol (clinicaltrial.gov identifier: NCT00917540). Two independent cohorts of newly diagnosed CLL patients recruited respectively at the Division of Hematology in Novara, Italy, and at the Hospital Clinic in Barcelona, Spain, were utilized as validation cohorts. In the training cohort, TTFT of patients with LDT >12 months was significantly longer related to those with a shorter LDT. At Cox multivariate regression model, LDT ≤ 12 months maintained a significant independent relationship with shorter TTFT along with IGHV unmutated (IGHVunmut) status, 11q and 17p deletions, elevated β2M, Rai stage I-II, and NOTCH1 mutations. Based on these statistics, two regression models were constructed including the same prognostic factors with or without the LDT. The model with the LTD provided a significantly better data fitting (χ2 = 8.25, P=0.0041). The risk prediction developed including LDT had better prognostic accuracy than those without LDT. Moreover, the Harrell’C index for the scores including LDT were higher than those without LDT, although the accepted 0.70 threshold exceeded in both cases. These findings were also confirmed when the same analysis was carried out according to TTFT’s explained variation. When data were further analyzed based on the combination between LDT and IGHV mutational status in the training and validation cohorts, IGHVunmut and LDT>12months group showed a predominant prognostic role over IGHVmut LTD ≤ 12 months (P=0.006) in the O-CLL validation cohort. However, this predominance was of borden-line significance (P=0.06) in the Barcelona group, while the significant prognostic impact was definitely lost in the Novara group. Overall, in this study, we demonstrated that LDT could be re-utilized together with the more sophisticated prognostic factors to manage the follow-up plans for Binet stage A CLL patients.
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Affiliation(s)
- Fortunato Morabito
- Department of Onco-Hematology Azienda Ospedaliera (AO) Cosenza, Biotechnology Research Unit, Cosenza, Italy.,Department of Hematology and Bone Marrow Transplant Unit, Augusta Victoria Hospital, Jerusalem, Israel
| | - Giovanni Tripepi
- Centro Nazionale Ricerca Istituto di Fisiologia Clinica (CNR-IFC), Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Anna Grazia Recchia
- Department of Onco-Hematology Azienda Ospedaliera (AO) Cosenza, Biotechnology Research Unit, Cosenza, Italy
| | - Paola Boggione
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Sabrina Bossio
- Department of Onco-Hematology Azienda Ospedaliera (AO) Cosenza, Biotechnology Research Unit, Cosenza, Italy
| | - Graziella D'Arrigo
- Centro Nazionale Ricerca Istituto di Fisiologia Clinica (CNR-IFC), Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | | | - Ernesto Vigna
- Department of Onco-Hematology AO Cosenza, Hematology Unit AO of Cosenza, Cosenza, Italy
| | - Francesca Storino
- Department of Onco-Hematology Azienda Ospedaliera (AO) Cosenza, Biotechnology Research Unit, Cosenza, Italy
| | - Gilberto Fronza
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Di Raimondo
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Davide Rossi
- Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Adalgisa Condoluci
- Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Monica Colombo
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Franco Fais
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Sonia Fabris
- Hematology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Robin Foa
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Giovanna Cutrona
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Massimo Gentile
- Department of Onco-Hematology AO Cosenza, Hematology Unit AO of Cosenza, Cosenza, Italy
| | - Emili Montserrat
- Department of Hematology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Manlio Ferrarini
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Antonino Neri
- Hematology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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27
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Morabito F, Del Poeta G, Mauro FR, Reda G, Sportoletti P, Laurenti L, Coscia M, Herishanu Y, Bossio S, Varettoni M, Murru R, Chiarenza A, Visentin A, Condoluci A, Moia R, Pietrasanta D, Loseto G, Consoli U, Scortechini I, Recchia AG, Rossi FM, Zucchetto A, Al‐Janazreh H, Martino EA, Vigna E, Tripepi G, D'Arrigo G, Galimberti S, Rago A, Angeletti I, Biagi A, Del Giudice I, Bomben R, Neri A, Fronza G, Cutrona G, Jaksic O, Olivieri J, Rossi D, Di Raimondo F, Cuneo A, Gaidano G, Polliack A, Trentin L, Foà R, Ferrarini M, Gattei V, Gentile M. TP53 disruption as a risk factor in the era of targeted therapies: A multicenter retrospective study of 525 chronic lymphocytic leukemia cases. Am J Hematol 2021; 96:E306-E310. [PMID: 33989438 DOI: 10.1002/ajh.26235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Fortunato Morabito
- Biotechnology Research Unit AO of Cosenza Cosenza Italy
- Hematology and Bone Marrow Transplant Unit, Hemato‐Oncology Department Augusta Victoria Hospital East Jerusalem Israel
| | - Giovanni Del Poeta
- Division of Hematology S. Eugenio Hospital and University of Tor Vergata Rome Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine 'Sapienza' University Rome Italy
| | - Gianluigi Reda
- Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milan Italy
| | - Paolo Sportoletti
- Centro di Ricerca Emato‐Oncologica (CREO) University of Perugia Perugia Italy
| | - Luca Laurenti
- Fondazione Universitaria Policlinico A Gemelli di Roma Rome Italy
| | - Marta Coscia
- Division of Hematology A.O.U. Città della Salute e della Scienza di Torino Torino Italy
| | - Yair Herishanu
- Sourasky Medical Center, Institute of Hematology, and Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | | | - Marzia Varettoni
- Division of Haematology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit Ospedale A. Businco Cagliari Italy
| | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties University of Catania Catania Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch University of Padova Padova Italy
| | - Adalgisa Condoluci
- Hematology, Oncology Institute of Southern Switzerland Bellinzona Switzerland
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Daniela Pietrasanta
- Division of Hematology Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo Alessandria Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit IRCCS‐Istituto Tumori 'Giovanni Paolo II' Bari Italy
| | - Ugo Consoli
- Hematology Department G. Garibaldi Hospital Catania Italy
| | | | | | - Francesca Maria Rossi
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Hamdi Al‐Janazreh
- Hematology and Bone Marrow Transplant Unit, Hemato‐Oncology Department Augusta Victoria Hospital East Jerusalem Israel
| | | | | | | | | | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | | | - Ilaria Angeletti
- Reparto di Oncoematologia Azienda Ospedaliera Santa Maria di Terni Terni Italy
| | - Annalisa Biagi
- Division of Hematology S. Eugenio Hospital and University of Tor Vergata Rome Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine 'Sapienza' University Rome Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Antonino Neri
- Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milan Italy
| | - Gilberto Fronza
- Mutagenesis and Cancer Prevention Unit IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Giovanna Cutrona
- Molecular Pathology Unit IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Ozren Jaksic
- Department of Hematology Dubrava University Hospital Zagreb Croatia
| | | | - Davide Rossi
- Hematology, Oncology Institute of Southern Switzerland Bellinzona Switzerland
| | - Francesco Di Raimondo
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties University of Catania Catania Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences University of Ferrara Ferrara Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Aaron Polliack
- Department of Hematology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch University of Padova Padova Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine 'Sapienza' University Rome Italy
| | - Manlio Ferrarini
- Department of Experimental Medicine University of Genoa Genoa Italy
| | - Valter Gattei
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
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28
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Morabito F, Tripepi G, Del Poeta G, Mauro FR, Reda G, Sportoletti P, Laurenti L, Coscia M, Herishanu Y, Bossio S, Varettoni M, Murru R, Chiarenza A, Visentin A, Condoluci A, Moia R, Pietrasanta D, Loseto G, Consoli U, Scortechini I, Rossi FM, Zucchetto A, Al‐Janazreh H, Vigna E, Martino EA, Cassin R, D′Arrigo G, Galimberti S, Rago A, Angeletti I, Biagi A, Del Giudice I, Bomben R, Neri A, Fronza G, Monti P, Menichini P, Olivieri J, Cutrona G, Rossi D, Cuneo A, Di Raimondo F, Gaidano G, Polliack A, Trentin L, Foà R, Ferrarini M, Gattei V, Gentile M. Effectiveness of ibrutinib as first-line therapy for chronic lymphocytic leukemia patients and indirect comparison with rituximab-bendamustine: Results of study on 486 cases outside clinical trials. Am J Hematol 2021; 96:E269-E272. [PMID: 33878220 DOI: 10.1002/ajh.26201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Fortunato Morabito
- Biothecnology Research Unit, AO of Cosenza Cosenza Italy
- Hematology and Bone Marrow Transplant Unit, Hemato‐Oncology Department Augusta Victoria Hospital East Jerusalem Israel
| | | | - Giovanni Del Poeta
- Division of Hematology S. Eugenio Hospital and University of Tor Vergata Rome Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | - Gianluigi Reda
- Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milan Italy
| | - Paolo Sportoletti
- Centro di Ricerca Emato‐Oncologica (CREO) University of Perugia Perugia Italy
| | - Luca Laurenti
- Fondazione Universitaria Policlinico A Gemelli di Roma Rome Italy
| | - Marta Coscia
- Division of Hematology A.O.U. Città della Salute e della Scienza di Torino Torino Italy
| | - Yair Herishanu
- Sourasky Medical Center, Institute of Hematology, and Sackler Faculty of Medicine Tel‐Aviv University Tel Aviv Israel
| | - Sabrina Bossio
- Biothecnology Research Unit, AO of Cosenza Cosenza Italy
| | - Marzia Varettoni
- Division of Haematology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco Cagliari Italy
| | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties University of Catania Catania Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch University of Padova Padova Italy
| | - Adalgisa Condoluci
- Hematology, Oncology Institute of Southern Switzerland Bellinzona Switzerland
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Daniela Pietrasanta
- Division of Hematology Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo Alessandria Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit, IRCCS‐Istituto Tumori ‘Giovanni Paolo II’ Bari Italy
| | - Ugo Consoli
- Hematology Department G. Garibaldi Hospital Catania Italy
| | | | - Francesca Maria Rossi
- Clinical and Experimental Onco‐Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco‐Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Hamdi Al‐Janazreh
- Hematology and Bone Marrow Transplant Unit, Hemato‐Oncology Department Augusta Victoria Hospital East Jerusalem Israel
| | | | | | - Ramona Cassin
- Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milan Italy
| | | | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | | | - Ilaria Angeletti
- Reparto di Oncoematologia Azienda Ospedaliera Santa Maria di Terni Terni Italy
| | - Annalisa Biagi
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | | | - Antonino Neri
- Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milan Italy
| | - Gilberto Fronza
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Paola Monti
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Paola Menichini
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Jacopo Olivieri
- Clinica Ematologica, Centro Trapianti e Terapie Cellulari “Carlo Melzi”, Azienda Sanitaria Universitaria Integrata di Udine Udine Italy
| | - Giovanna Cutrona
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Davide Rossi
- Hematology, Oncology Institute of Southern Switzerland Bellinzona Switzerland
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences University of Ferrara Ferrara Italy
| | - Francesco Di Raimondo
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties University of Catania Catania Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Aaron Polliack
- Department of Hematology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch University of Padova Padova Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | - Manlio Ferrarini
- Department of Experimental Medicine University of Genoa Genoa Italy
| | - Valter Gattei
- Clinical and Experimental Onco‐Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
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Cuneo A, Rigolin GM, Coscia M, Quaresmini G, Scarfò L, Mauro FR, Motta M, Quaglia FM, Trentin L, Ferrario A, Laurenti L, Reda G, Ferrari A, Pietrasanta D, Sportoletti P, Re F, De Paoli L, Foglietta M, Giordano A, Marchetti M, Farina L, Del Poeta G, Varettoni M, Chiurazzi F, Marasca R, Malerba L, Ibatici A, Tisi MC, Stefoni V, Leone M, Baratè C, Olivieri J, Murru R, Gentile M, Sanna A, Gozzetti A, Gattei V, Gottardi D, Derenzini E, Levato L, Orsucci L, Penna G, Chiarenza A, Foà R. Management of chronic lymphocytic leukemia in Italy during a one year of the COVID-19 pandemic and at the start of the vaccination program. A Campus CLL report. Hematol Oncol 2021; 39:570-574. [PMID: 34258787 PMCID: PMC8426998 DOI: 10.1002/hon.2899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Antonio Cuneo
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Gian Matteo Rigolin
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marta Coscia
- Division of Hematology, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Lydia Scarfò
- Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Marina Motta
- S.C. Ematologia, ASST Spedali Civili, Brescia, Italy
| | | | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Italy
| | - Andrea Ferrario
- UOC Ematologia Azienda Socio Sanitaria Territoriale dei Sette Laghi, Ospedale di Circolo di Varese, Varese, Italy
| | - Luca Laurenti
- Hematology, Fondazione Universitaria Policlinico A. Gemelli, Rome, Italy
| | - Gianluigi Reda
- U.O.C. Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angela Ferrari
- Hematology, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Daniela Pietrasanta
- Division of Hematology, SC di Ematologia, Ospedale Civile SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paolo Sportoletti
- Department of Medicine and Surgery, Institute of Hematology and Center for Hemato-Oncological Research, Ospedale S. Maria della Misericordia, Perugia, Italy
| | - Francesca Re
- Hematology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | | | - Myriam Foglietta
- SC Ematologia Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | - Annamaria Giordano
- Hematology-Department of Emergency and Organ Transplantation, Azienda Ospedaliero Universitaria Policlinico, Bari, Italy
| | - Monia Marchetti
- Hematology-Azienda Ospedaliera Nazionale Santi Antonio e Biagio e Cesare Arrigo Alessandria, Alessandria, Italy
| | - Lucia Farina
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Marzia Varettoni
- Hematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Roberto Marasca
- Hematology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Lara Malerba
- UOC Ematologia e Centro trapianti AORMN Pesaro, Pesaro, Italy
| | - Adalberto Ibatici
- Hematology and Bone Marrow Transplant, Policlinico San Martino, Genova, Italy
| | - Maria Chiara Tisi
- Hematology, Azienda ULSS 8 Berica Dipartimento Strutturale Oncologia Clinica Vicenza, Vicenza, Italy
| | - Vittorio Stefoni
- Department of Hematology and Oncology "L. and A. Seràgnoli", Bologna, Italy
| | - Monica Leone
- Hematology, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Claudia Baratè
- Clinical and Experimental Medicine, Hematology Section, University of Pisa, Pisa, Italy
| | - Jacopo Olivieri
- Hematology Unit, Azienda Ospedaliero Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Roberta Murru
- SC Ematologia e CTMO Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
| | | | - Alessandro Sanna
- Hemtology Unit, Azienda Ospedaliero Universitaria Careggi Firenze, Firenze, Italy
| | - Alessandro Gozzetti
- Hematology Unit, University of Siena, Azienda Ospedaliera Universitaria Senese Siena, Siena, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Enrico Derenzini
- Oncohematology Division, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Luciano Levato
- SOC Ematologia, Dipartimento di Ematologia Oncologia Azienda Ospedaliera Pugliese Ciaccio Catanzaro, Catanzaro, Italy
| | - Lorella Orsucci
- SC Ematologia, AUO Città della Scienza e della Salute di Torino, Torino, Italy
| | - Giuseppa Penna
- UOC Ematologia Policlinico Universitario di Messina, Messina, Italy
| | - Annalisa Chiarenza
- Divisione di Ematologia con Trapianto di Midollo Osseo, Azienda Ospedaliera Universitaria Policlinico "G.Rodolico-S.Marco", Catania, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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Vomero M, Finucci A, Barbati C, Colasanti T, Ceccarelli F, Novelli L, Massaro L, Truglia S, Pensa C, Mauro FR, Foà R, Valesini G, Conti F, Alessandri C. Increased eryptosis in patients with primary antiphospholipid syndrome (APS): a new actor in the pathogenesis of APS. Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/8fx3u5] [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] [Indexed: 11/13/2022]
Affiliation(s)
- Marta Vomero
- Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Annacarla Finucci
- Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Cristiana Barbati
- Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Tania Colasanti
- Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Fulvia Ceccarelli
- Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Lucia Novelli
- Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Laura Massaro
- Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Simona Truglia
- Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Chiara Pensa
- Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Francesca Romana Mauro
- Department of Translational and Precision Medicine, Haematology, Sapienza University of Rome, Italy
| | - Roberto Foà
- Department of Translational and Precision Medicine, Haematology, Sapienza University of Rome, Italy
| | - Guido Valesini
- Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Fabrizio Conti
- Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Italy
| | - Cristiano Alessandri
- Department of Clinical Internal, Anesthetic and Cardiovascular Sciences, Sapienza University of Rome, Italy.
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31
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Mauro FR, Giannarelli D, Visentin A, Reda G, Sportoletti P, Frustaci AM, Chiarenza A, Ciolli S, Vitale C, Laurenti L, De Paoli L, Murru R, Gentile M, Rigolin GM, Levato L, Giordano A, Del Poeta G, Stelitano C, Ielo C, Noto A, Guarente V, Molica S, Coscia M, Tedeschi A, Gaidano G, Cuneo A, Foà R, Martelli M, Girmenia C, Gentile G, Trentin L. Prognostic Impact and Risk Factors of Infections in Patients with Chronic Lymphocytic Leukemia Treated with Ibrutinib. Cancers (Basel) 2021; 13:3240. [PMID: 34209515 PMCID: PMC8269042 DOI: 10.3390/cancers13133240] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/12/2021] [Accepted: 06/13/2021] [Indexed: 12/16/2022] Open
Abstract
Ibrutinib represents extraordinary progress in the treatment of chronic lymphocytic leukemia (CLL). However, treatment-related adverse events limit the benefit of this agent. This observational, multicenter study focused on the incidence, risk factors, and prognostic impact of infections in 494 patients with CLL treated with an ibrutinib-based treatment. Ibrutinib was given to 89 (18%) previously untreated patients (combined with rituximab, 24) and 405 (82%) relapsed/refractory patients. Pneumonia (PN), grade ≥3 non-opportunistic infections (NOI), and opportunistic infections (OI) were recorded in 32% of patients with an overall incidence rate per 100 person-year of 15.3% (PN, 10%; NOI, 3.3%; OI, 2%). Infections were the reason for the permanent discontinuation of ibrutinib in 9% of patients. Patients who experienced pneumonia or a severe infection showed a significantly inferior survival than those who were infection-free (p < 0.0001). A scoring system based on the three factors associated with a significant and independent impact on infections-PN or severe infection in the year before starting ibrutinib, chronic obstructive pulmonary disease, ≥2 prior treatments-identified patients with a two- to threefold increase in the rate of infections. In conclusion, the results of this study highlight the adverse impact of infectious events on the outcomes of CLL patients treated with ibrutinib.
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Affiliation(s)
- Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, 00161 Rome, Italy; (C.I.); (R.F.); (M.M.); (C.G.); (G.G.)
| | - Diana Giannarelli
- Biostatistic Unit, Regina Elena National Cancer Institute, IRCCS, 00144 Rome, Italy;
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy; (A.V.); (L.T.)
| | - Gianluigi Reda
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.R.); (A.N.)
| | - Paolo Sportoletti
- Institute of Hematology-Centro di Ricerca Emato-Oncologica (CREO), Department of Medicine, University of Perugia, 06129 Perugia, Italy; (P.S.); (V.G.)
| | - Anna Maria Frustaci
- Deptartment of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (A.M.F.); (A.T.)
| | | | | | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy; (C.V.); (M.C.)
| | - Luca Laurenti
- Institute of Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Lorenzo De Paoli
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (L.D.P.); (G.G.)
| | - Roberta Murru
- Haematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, AO Brotzu, 09134 Cagliari, Italy;
| | - Massimo Gentile
- Hematology Unit, Hematology and Oncology Department, 87100 Cosenza, Italy;
| | - Gian Matteo Rigolin
- Hematology, Department of Medical Sciences, St. Anna University Hospital, 44124 Ferrara, Italy; (G.M.R.); (A.C.)
| | - Luciano Levato
- Haematology Unit, A. Pugliese Hospital, Azienda Ospedaliera Pugliese Ciaccio, 88100 Catanzaro, Italy; (L.L.); (S.M.)
| | - Annamaria Giordano
- Department of Emergency and Organ Transplantation (D.E.T.O.), Hematology Section, University of Bari, 70124 Bari, Italy;
| | - Giovanni Del Poeta
- Hematology, Department of Biomedicine and Prevention, University Tor Vergata, 00133 Rome, Italy;
| | - Caterina Stelitano
- Division of Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, 89124 Reggio Calabria, Italy;
| | - Claudia Ielo
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, 00161 Rome, Italy; (C.I.); (R.F.); (M.M.); (C.G.); (G.G.)
| | - Alessandro Noto
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (G.R.); (A.N.)
| | - Valerio Guarente
- Institute of Hematology-Centro di Ricerca Emato-Oncologica (CREO), Department of Medicine, University of Perugia, 06129 Perugia, Italy; (P.S.); (V.G.)
| | - Stefano Molica
- Haematology Unit, A. Pugliese Hospital, Azienda Ospedaliera Pugliese Ciaccio, 88100 Catanzaro, Italy; (L.L.); (S.M.)
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, 10126 Turin, Italy; (C.V.); (M.C.)
| | - Alessandra Tedeschi
- Deptartment of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (A.M.F.); (A.T.)
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (L.D.P.); (G.G.)
| | - Antonio Cuneo
- Hematology, Department of Medical Sciences, St. Anna University Hospital, 44124 Ferrara, Italy; (G.M.R.); (A.C.)
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, 00161 Rome, Italy; (C.I.); (R.F.); (M.M.); (C.G.); (G.G.)
| | - Maurizio Martelli
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, 00161 Rome, Italy; (C.I.); (R.F.); (M.M.); (C.G.); (G.G.)
| | - Corrado Girmenia
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, 00161 Rome, Italy; (C.I.); (R.F.); (M.M.); (C.G.); (G.G.)
| | - Giuseppe Gentile
- Hematology, Department of Translational and Precision Medicine, “Sapienza” University, 00161 Rome, Italy; (C.I.); (R.F.); (M.M.); (C.G.); (G.G.)
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, 35121 Padua, Italy; (A.V.); (L.T.)
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32
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Visentin A, Bonaldi L, Rigolin GM, Mauro FR, Martines A, Frezzato F, Pravato S, Gargarella LR, Bardi MA, Cavallari M, Volta E, Cavazzini F, Nanni M, Facco M, Piazza F, Guarini A, Foà R, Semenzato G, Cuneo A, Trentin L. The complex karyotype landscape in chronic lymphocytic leukemia allows to refine the risk of Richter syndrome transformation. Haematologica 2021; 107:868-876. [PMID: 34092056 PMCID: PMC8968897 DOI: 10.3324/haematol.2021.278304] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 09/10/2020] [Indexed: 11/17/2022] Open
Abstract
Complex karyotype (CK) at chronic lymphocytic leukemia (CLL) diagnosis is a negative biomarker of adverse outcome. Since the impact of CK and its subtypes, namely type-2 CK (CK with major structural abnormalities) or high-CK (CK with ≥5 chromosome abnormalities), on the risk of developing Richter syndrome (RS) is unknown, we carried out a multicenter real-life retrospective study to test its prognostic impact. Among 540 CLL patients, 107 harbored a CK at CLL diagnosis, 78 were classified as CK2 and 52 as high-CK. Twenty-eight patients developed RS during a median follow-up of 6.7 years. At the time of CLL diagnosis, CK2 and high-CK were more common and predicted the highest risk of RS transformation, together with advanced Binet stage, unmutated (U)-IGHV, 11q-, and TP53 abnormalities. We integrated these variables into a hierarchical model: high-CK and/or CK2 patients showed a 10-year time to RS (TTRS) of 31%; U-IGHV/11q- /TP53 abnormalities/Binet stage B-C patients had a 10-year TTRS of 12%; mutated (M)-IGHV without CK and TP53 disruption a 10-year TTRS of 3% (P<0.0001). We herein demonstrate that CK landscape at CLL diagnosis allows the risk of RS transformation to be refined and we recapitulated clinico-biological variables into a prognostic model.
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Affiliation(s)
- Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy; Veneto Institute of Molecular Medicine, Padua
| | - Laura Bonaldi
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCSS, Padua
| | - Gian Matteo Rigolin
- Hematology section, Department of Medical Sciences, Azienda Ospedaliera- Universitaria, Arcispedale S. Anna, University of Ferrara
| | - Francesca Romana Mauro
- Hematology division, Department of Precision and Translational Medicine, "Sapienza" University, Rome
| | - Annalisa Martines
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV-IRCSS, Padua
| | - Federica Frezzato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy; Veneto Institute of Molecular Medicine, Padua
| | - Stefano Pravato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy; Veneto Institute of Molecular Medicine, Padua
| | - Leila Romano Gargarella
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy; Veneto Institute of Molecular Medicine, Padua
| | - Maria Antonella Bardi
- Hematology section, Department of Medical Sciences, Azienda Ospedaliera- Universitaria, Arcispedale S. Anna, University of Ferrara
| | - Maurizio Cavallari
- Hematology section, Department of Medical Sciences, Azienda Ospedaliera- Universitaria, Arcispedale S. Anna, University of Ferrara
| | - Eleonora Volta
- Hematology section, Department of Medical Sciences, Azienda Ospedaliera- Universitaria, Arcispedale S. Anna, University of Ferrara
| | - Francesco Cavazzini
- Hematology section, Department of Medical Sciences, Azienda Ospedaliera- Universitaria, Arcispedale S. Anna, University of Ferrara
| | - Mauro Nanni
- Hematology division, Department of Precision and Translational Medicine, "Sapienza" University, Rome
| | - Monica Facco
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy; Veneto Institute of Molecular Medicine, Padua
| | - Francesco Piazza
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy; Veneto Institute of Molecular Medicine, Padua
| | - Anna Guarini
- Hematology division, Department of Precision and Translational Medicine, "Sapienza" University, Rome
| | - Robin Foà
- Hematology division, Department of Precision and Translational Medicine, "Sapienza" University, Rome
| | - Gianpietro Semenzato
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy; Veneto Institute of Molecular Medicine, Padua
| | - Antonio Cuneo
- Hematology section, Department of Medical Sciences, Azienda Ospedaliera- Universitaria, Arcispedale S. Anna, University of Ferrara
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy; Veneto Institute of Molecular Medicine, Padua.
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33
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Morabito F, Tripepi G, Del Poeta G, Mauro FR, Reda G, Sportoletti P, Laurenti L, Coscia M, Herishanu Y, Varettoni M, Murru R, Chiarenza A, Visentin A, Condoluci A, Moia R, Pietrasanta D, Loseto G, Consoli U, Scortechini I, Rossi FM, Zucchetto A, Vigna E, Martino EA, Mendicino F, Botta C, Caracciolo D, Cassin R, D'Arrigo G, Galimberti S, Rago A, Angeletti I, Biagi A, Del Giudice I, Bomben R, Neri A, Fronza G, Cutrona G, Rossi D, Di Raimondo F, Cuneo A, Gaidano G, Polliack A, Trentin L, Foà R, Ferrarini M, Gattei V, Gentile M. Assessment of the 4-factor score: Retrospective analysis of 586 CLL patients receiving ibrutinib. A campus CLL study. Am J Hematol 2021; 96:E168-E171. [PMID: 33580969 DOI: 10.1002/ajh.26127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Fortunato Morabito
- Department of Onco‐Hematology Biotechnology Research Unit, AO of Cosenza Cosenza Italy
- Hematology and Bone Marrow Transplant Unit Hemato‐Oncology Department, Augusta Victoria Hospital East Jerusalem Israel
| | - Giovanni Tripepi
- Department of Medicine CNR‐IFC, Research Unit of Reggio Calabria Reggio Calabria Italy
| | - Giovanni Del Poeta
- Division of Hematology S. Eugenio Hospital and University of Tor Vergata Rome Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | - Gianluigi Reda
- Department of Onco‐Hematology Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milano Italy
| | - Paolo Sportoletti
- Centro di Ricerca Emato‐Oncologica (CREO) University of Perugia Perugia Italy
| | - Luca Laurenti
- Department of Onco‐Hematology Fondazione Universitaria Policlinico A Gemelli di Roma Roma Italy
| | - Marta Coscia
- Division of Hematology A.O.U. Città della Salute e della Scienza di Torino Torino Italy
| | - Yair Herishanu
- Sourasky Medical Center Institute of Hematology, and Sackler Faculty of Medicine, Tel‐Aviv University Tel‐Aviv Israel
| | - Marzia Varettoni
- Division of Haematology Fondazione IRCCS Policlinico San Matteo Pavia Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit Ospedale A. Businco Cagliari Italy
| | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties University of Catania Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch University of Padova Padova Italy
| | - Adalgisa Condoluci
- Department of Onco‐Hematology Hematology, Oncology Institute of Southern Switzerland Bellinzona Switzerland
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Daniela Pietrasanta
- Division of Hematology Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo Alessandria Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit IRCCS‐Istituto Tumori ‘Giovanni Paolo II’ Bari Italy
| | - Ugo Consoli
- Department of Onco‐Hematology Hematology Department, G. Garibaldi Hospital Catania Italy
| | - Ilaria Scortechini
- Department of Onco‐Hematology Clinica di Ematologia Ospedali Riuniti Ancona Italy
| | - Francesca Maria Rossi
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Ernesto Vigna
- Department of Onco‐Hematology Biotechnology Research Unit, AO of Cosenza Cosenza Italy
- Department of Onco‐Hematology Hematology Unit AO of Cosenza Cosenza Italy
| | | | | | - Cirino Botta
- Department of Onco‐Hematology Hematology Unit AO of Cosenza Cosenza Italy
| | - Daniele Caracciolo
- Department of Onco‐Hematology Hematology Unit AO of Cosenza Cosenza Italy
| | - Ramona Cassin
- Department of Onco‐Hematology Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milano Italy
| | - Graziella D'Arrigo
- Department of Medicine CNR‐IFC, Research Unit of Reggio Calabria Reggio Calabria Italy
| | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Angela Rago
- Department of Onco‐Hematology UOSD Ematologia ASL Roma 1 Roma Italy
| | - Ilaria Angeletti
- Department of Onco‐Hematology Reparto di Oncoematologia Azienda Ospedaliera Santa Maria di Terni Terni Italy
| | - Annalisa Biagi
- Division of Hematology S. Eugenio Hospital and University of Tor Vergata Rome Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Antonino Neri
- Department of Onco‐Hematology Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano Milano Italy
| | - Gilberto Fronza
- Mutagenesis and Cancer Prevention Unit IRCCS Ospedale Policlinico San Martino Genoa Italy
| | - Giovanna Cutrona
- Molecular Pathology Unit IRCCS Ospedale Policlinico San Martino Genova Italy
| | - Davide Rossi
- Department of Onco‐Hematology Hematology, Oncology Institute of Southern Switzerland Bellinzona Switzerland
| | - Francesco Di Raimondo
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties University of Catania Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences University of Ferrara Ferrara Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine University of Eastern Piedmont Novara Italy
| | - Aaron Polliack
- Department of Hematology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch University of Padova Padova Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine ‘Sapienza’ University Rome Italy
| | - Manlio Ferrarini
- Department of Experimental Medicine University of Genoa Genoa Italy
| | - Valter Gattei
- Clinical and Experimental Onco‐Hematology Unit Centro di Riferimento Oncologico di Aviano (CRO) IRCCS Aviano Italy
| | - Massimo Gentile
- Department of Onco‐Hematology Biotechnology Research Unit, AO of Cosenza Cosenza Italy
- Department of Onco‐Hematology Hematology Unit AO of Cosenza Cosenza Italy
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Puzzolo MC, Del Giudice I, Peragine N, Mariglia P, De Propris MS, Cappelli LV, Trentin L, Reda G, Cuneo A, Molica S, Piciocchi A, Arena V, Mauro FR, Guarini A, Foà R. TH2/TH1 Shift Under Ibrutinib Treatment in Chronic Lymphocytic Leukemia. Front Oncol 2021; 11:637186. [PMID: 33937038 PMCID: PMC8082026 DOI: 10.3389/fonc.2021.637186] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 12/02/2020] [Accepted: 03/01/2021] [Indexed: 12/16/2022] Open
Abstract
Ibrutinib may revert the T-helper (Th)2 polarization observed in chronic lymphocytic leukemia (CLL) by targeting the IL-2-inducible kinase, that shows a significant homology with the Bruton tyrosine kinase. In the front-line GIMEMA LLC1114 trial (ibrutinib+rituximab for 6 months, followed by ibrutinib maintenance), we investigated the modulation of T-cell cytokine production in 208 peripheral blood paired samples from 71 CLL patients: 71 samples prior to treatment (Day 0, D0) and at day +14 (D14; n=50), at month +8 (M8; 30), +12 (M12; 25), +18 (M18; 22) and +24 (M24; 10) of treatment. We documented a progressive decrease of CD3+CD4+IL-4+ T cells (Th2), that was significant at M8 and at M12 (p=0.019, p=0.002), a relative increase in the CD3+CD4+IFNγ+ T cells (Th1) and a decrease of CD3+CD4+IL-17+ (Th17) cells that was maintained up to M18 (M8 vs D0 p=0.003, M12 vs D0 p=0.003, M18 vs D0 p=0.004) of ibrutinib treatment. The Th2/Th1 ratio significantly decreased already after 14 days of treatment and was maintained thereafter (D14 vs D0 p=0.037, M8 vs D0 p=0.001, M12 vs D0 p=0.005, M18 vs D0 p=0.002). The Th2/Th1 modulation over time was significant only among patients with unmutated IGHV. The Th2/Th1 ratio below a cut-off of 0.088 at M8 was associated with the achievement of a complete response (CR) (p=0.016). Ibrutinib may shape the CLL T-cell profile, limiting Th2 activation and inducing a shift in the Th2/Th1 ratio. The association between the Th2/Th1 ratio decrease and the CR achievement suggests the in vivo generation of a potential host anti-tumor immune activation induced by ibrutinib.
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Affiliation(s)
- Maria Cristina Puzzolo
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Nadia Peragine
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Paola Mariglia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Luca Vincenzo Cappelli
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | | | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Science, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - Stefano Molica
- Hematology, Azienda Ospedaliera "Pugliese Ciaccio", Presidio Ospedaliero A. Pugliese - Unità Operativa di Ematologia, Catanzaro, Italy
| | | | | | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Anna Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
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35
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Morabito F, Tripepi G, Del Poeta G, Mauro FR, Reda G, Sportoletti P, Laurenti L, Coscia M, Herishanu Y, Bossio S, Varettoni M, Murru R, Chiarenza A, Visentin A, Condoluci A, Moia R, Pietrasanta D, Loseto G, Consoli U, Scortechini I, Rossi FM, Zucchetto A, Al-Janazreh H, Vigna E, Martino EA, Mendicino F, Cassin R, D'Arrigo G, Galimberti S, Rago A, Angeletti I, Biagi A, Del Giudice I, Bomben R, Neri A, Fronza G, Monti P, Menichini P, Cutrona G, Jaksic O, Rossi D, Di Raimondo F, Cuneo A, Gaidano G, Polliack A, Trentin L, Foà R, Ferrarini M, Gattei V, Gentile M. Comparison of ibrutinib and idelalisib plus rituximab in real-life relapsed/resistant chronic lymphocytic leukemia cases. Eur J Haematol 2021; 106:493-499. [PMID: 33378569 DOI: 10.1111/ejh.13573] [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: 11/17/2020] [Accepted: 12/23/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To compare the capacity of ibrutinib (IB) and idelalisib-rituximab (IDELA-R) of prolonging overall survival (OS) as in CLL patients, previously treated with chemotherapy only. METHODS A real-life cohort of 675 cases has been identified and investigated in the database of the groups participating in the study. RESULTS At an unadjusted univariate analysis, a significant death risk reduction was observed favoring IB (IDELA-R vs IB HR = 0.5, 95% CI = 0.36-0.71) although with some limitations due to the non-randomized and retrospective nature of the study and to the lower number of patients in the IDELA-R group (112 cases) related to the current prescribing practice. To overcome the potential problem of confounding by indication, we adjusted the association between the type of therapy and mortality for all variables significantly associated with OS at Cox univariate analysis. Furthermore, those variables, differently distributed between the two study groups, were introduced into the multivariate Cox model to improve the effectiveness of the analysis. By introducing all these variables into the multiple Cox regression model, we confirmed the protective effect of IB vs IDELA-R (HR = 0.67, 95% CI = 0.45-0.98, P = .04) independent of potential confounders. CONCLUSIONS Although our analysis presents some constraints, that is, the unavailability of additional potential confounders, and the retrospective nature of the study, this observation may be of help for the daily clinical practice, particularly in the absence of randomized trials comparing the two schedules.
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Affiliation(s)
- Fortunato Morabito
- Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy.,Hematology and Bone Marrow Transplant Unit, Hemato-Oncology Department, Augusta Victoria Hospital, East Jerusalem, Israel
| | - Giovanni Tripepi
- CNR-IFC, Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | - Giovanni Del Poeta
- Division of Hematology, S. Eugenio Hospital and University of Tor Vergata, Rome, Italy
| | | | - Gianluigi Reda
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Paolo Sportoletti
- Centro di Ricerca Emato-Oncologica (CREO), University of Perugia, Perugia, Italy
| | - Luca Laurenti
- Fondazione Universitaria Policlinico A Gemelli di Roma, Roma, Italy
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Yair Herishanu
- Sourasky Medical Center, Institute of Hematology and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sabrina Bossio
- Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy
| | - Marzia Varettoni
- Division of Haematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, Cagliari, Italy
| | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Andrea Visentin
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padova, Padova, Italy
| | | | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Daniela Pietrasanta
- Division of Hematology, Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Ugo Consoli
- Hematology Department, G. Garibaldi Hospital, Catania, Italy
| | | | - Francesca Maria Rossi
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Hamdi Al-Janazreh
- Hematology and Bone Marrow Transplant Unit, Hemato-Oncology Department, Augusta Victoria Hospital, East Jerusalem, Israel
| | - Ernesto Vigna
- Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy.,Hematology Unit AO of Cosenza, Cosenza, Italy
| | | | | | - Ramona Cassin
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | | | - Sara Galimberti
- Section of Hematology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Ilaria Angeletti
- Reparto di Oncoematologia Azienda Ospedaliera Santa Maria di Terni, Terni, Italy
| | - Annalisa Biagi
- Division of Hematology, S. Eugenio Hospital and University of Tor Vergata, Rome, Italy
| | - Ilaria Del Giudice
- Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Antonino Neri
- Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Gilberto Fronza
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Monti
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Menichini
- Mutagenesis and Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giovanna Cutrona
- Molecular Pathology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ozren Jaksic
- Department of Hematology, Dubrava Univerisity Hospital, Zagreb, Croatia
| | - Davide Rossi
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Francesco Di Raimondo
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, University of Ferrara, Cona, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Aaron Polliack
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch, University of Padova, Padova, Italy
| | - Robin Foà
- Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Manlio Ferrarini
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Massimo Gentile
- Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy.,Hematology Unit AO of Cosenza, Cosenza, Italy
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Cassin R, Visentin A, Giannarelli D, Noto A, Mauro FR, Baldini L, Trentin L, Reda G. Increase of immunoglobulin A during ibrutinib therapy reduces infection rate in chronic lymphocytic leukemia patients. Hematol Oncol 2020; 39:141-144. [PMID: 33034902 DOI: 10.1002/hon.2814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/22/2020] [Accepted: 09/23/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Ramona Cassin
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Padua, Italy
| | - Diana Giannarelli
- Biostatistical Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandro Noto
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
| | - Luca Baldini
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy.,Venetian Institute of Molecular Medicine, Centro di Eccellenza per la Ricerca Biomedica Avanzata, Padua, Italy
| | - Gianluigi Reda
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan, Milan, Italy
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37
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Peragine N, De Propris MS, Intoppa S, Milani ML, Mariglia P, Mauro FR, Raponi S, Soddu S, Cuneo A, Rigolin GM, Del Giudice I, Foà R, Guarini A. Modulated expression of adhesion, migration and activation molecules may predict the degree of response in chronic lymphocytic leukemia patients treated with ibrutinib plus rituximab. Haematologica 2020; 106:1500-1503. [PMID: 33054124 PMCID: PMC8094098 DOI: 10.3324/haematol.2020.262071] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Nadia Peragine
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | | | - Stefania Intoppa
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Maria Laura Milani
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Paola Mariglia
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Sara Raponi
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Stefano Soddu
- Italian Group for Adult Hematologic Diseases (GIMEMA) Foundation, Rome
| | - Antonio Cuneo
- Hematology, Department of Medical Sciences, University of Ferrara, Ferrara
| | | | - Ilaria Del Giudice
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome .
| | - Anna Guarini
- Department of Molecular Medicine, "Sapienza" University, Rome, Italy
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38
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Cuneo A, Mato AR, Rigolin GM, Piciocchi A, Gentile M, Laurenti L, Allan JN, Pagel JM, Brander DM, Hill BT, Winter A, Lamanna N, Tam CS, Jacobs R, Lansigan F, Barr PM, Shadman M, Skarbnik AP, Pu JJ, Sehgal AR, Schuster SJ, Shah NN, Ujjani CS, Roeker L, Orlandi EM, Billio A, Trentin L, Spacek M, Marchetti M, Tedeschi A, Ilariucci F, Gaidano G, Doubek M, Farina L, Molica S, Di Raimondo F, Coscia M, Mauro FR, de la Serna J, Medina Perez A, Ferrarini I, Cimino G, Cavallari M, Cucci R, Vignetti M, Foà R, Ghia P. Efficacy of bendamustine and rituximab in unfit patients with previously untreated chronic lymphocytic leukemia. Indirect comparison with ibrutinib in a real-world setting. A GIMEMA-ERIC and US study. Cancer Med 2020; 9:8468-8479. [PMID: 32969597 PMCID: PMC7666748 DOI: 10.1002/cam4.3470] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 12/29/2022] Open
Abstract
Limited information is available on the efficacy of front‐line bendamustine and rituximab (BR) in chronic lymphocytic leukemia (CLL) with reduced renal function or coexisting conditions. We therefore analyzed a cohort of real‐world patients and performed a matched adjusted indirect comparison with a cohort of patients treated with ibrutinib. One hundred and fifty‐seven patients with creatinine clearance (CrCl) <70 mL/min and/or CIRS score >6 were treated with BR. The median age was 72 years; 69% of patients had ≥2 comorbidities and the median CrCl was 59.8 mL/min. 17.6% of patients carried TP53 disruption. The median progression‐free survival (PFS) was 45 months; TP53 disruption was associated with a shorter PFS (P = 0.05). The overall survival (OS) at 12, 24, and 36 months was 96.2%, 90.1%, and 79.5%, respectively. TP53 disruption was associated with an increased risk of death (P = 0.01). Data on 162 patients ≥65 years treated with ibrutinib were analyzed and compared with 165 patients ≥65 years treated with BR. Factors predicting for a longer PFS at multivariable analysis in the total patient population treated with BR and ibrutinib were age (HR 1.06, 95% CI 1.02‐1.10, P < 0.01) and treatment with ibrutinib (HR 0.55, 95% CI 0.33‐0.93, P = 0.03). In a post hoc analysis of patients in advanced stage, a significant PFS advantage was observed in patient who had received ibrutinib (P = 0.03), who showed a trend for OS advantage (P = 0.08). We arrived at the following conclusions: (a) BR is a relatively effective first‐line regimen in a real‐world population of unfit patients without TP53 disruption, (b) ibrutinib provided longer disease control than BR in patients with advanced disease stage.
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Affiliation(s)
- Antonio Cuneo
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Anthony R Mato
- Division of Hematological Oncology, CLL Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gian Matteo Rigolin
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Alfonso Piciocchi
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Massimo Gentile
- Department of Onco-Hematology, Hematology Unit, A.O. of Cosenza, Cosenza, Italy
| | - Luca Laurenti
- Department of Radiological, Radiotherapeutic and Hematological Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - John M Pagel
- Center for Blood Disorders and Stem Cell Transplantation, Swedish Cancer Institute, Seattle, WA, USA
| | - Danielle M Brander
- Division of Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC, USA
| | - Brian T Hill
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allison Winter
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Constantine S Tam
- Peter McCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Ryan Jacobs
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA
| | | | - Paul M Barr
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - Mazyar Shadman
- Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Alan P Skarbnik
- Lymphoproliferative Disorders Program, Novant Health Cancer Institute, Charlotte, NC, USA
| | - Jeffrey J Pu
- SUNY Upstate Medical University, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - Stephen J Schuster
- Division of Hematology and Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nirav N Shah
- Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chaitra S Ujjani
- Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Lindsey Roeker
- Division of Hematological Oncology, CLL Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Atto Billio
- Hematology and Transplant Unit, San Maurizio Hospital, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology, Department of Medicine, University of Padua, Padua, Italy
| | - Martin Spacek
- Department of Medicine, Department of Hematology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | | | - Alessandra Tedeschi
- Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of eastern Piedmont, Novara, Italy
| | - Michael Doubek
- Department of Internal Medicine - Hematology and Oncology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lucia Farina
- Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Stefano Molica
- Hematology Unit, A. Pugliese Hospital, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | | | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy
| | | | | | - Isacco Ferrarini
- Hematology, Department of Cell Therapy and Hematology, University Hospital, Verona, Italy
| | - Giuseppe Cimino
- Department of Translational and Precision Medicine, University "La Sapienza", UOC di Ematologia con Trapianto, Ospedale S. Maria Goretti, Latina, Italy
| | - Maurizio Cavallari
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Rosalba Cucci
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, "Sapienza" University, Rome, Italy
| | - Paolo Ghia
- Strategic Research Program on CLL, Division of Experimental Oncology, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
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Porrazzo M, Nicolai E, Riminucci M, Vitale C, Coscia M, De Paoli L, Rago A, Buscicchio G, Maestrini G, Ligia S, Di Prima A, Corsi A, Caronna R, Gaidano G, Mauro FR. Prognostic Significance of PET/CT in Patients with Chronic Lymphocytic Leukemia (CLL) Treated with Frontline Chemoimmunotherapy. Cancers (Basel) 2020; 12:cancers12071773. [PMID: 32635175 PMCID: PMC7408608 DOI: 10.3390/cancers12071773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/05/2022] Open
Abstract
The role of positron emission tomography/computed tomography (PET/CT) in identifying Richter Syndrome (RS) is well established, while its impact on the survival of patients with chronic lymphocytic leukemia (CLL) has been less explored. The clinical characteristics and PET/CT data of 40 patients with a biopsy-proven CLL who required frontline chemoimmunotherapy, FCR (fludarabine, cyclophosphamide, rituximab) in 20 patients, BR (bendamustine, rituximab) in 20, were retrospectively analyzed. Standardized uptake volume (SUVmax) values ≥ 5 were observed more frequently in patients with deletion 11q (p = 0.006) and biopsies characterized by a rate of Ki67 positive cells ≥ 30% (p = 0.02). In the multivariate analysis, the presence of large and confluent PCs emerged as the only factor with a negative impact on progression-free survival (PFS), and overall survival (OS). Deletion 11q also revealed a significant and independent effect on PFS. SUVmax values ≥ 5 showed no statistical impact on PFS while in multivariate analysis, they revealed a significant adverse impact on OS (median survival probability not reached vs. 56 months; p = 0.002). Moreover, patients with higher SUVmax values more frequently developed Richter Syndrome (p = 0.015). Our results show that higher SUVmax values identify CLL patients with a pronounced rate of proliferating cells in the lymph-node compartment, inferior survival, and an increased risk of developing RS.
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Affiliation(s)
- Marika Porrazzo
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (M.P.); (G.M.); (S.L.); (A.D.P.)
| | - Emanuele Nicolai
- Institute of Diagnostic and Nuclear Research, IRCCS SDN, 80143 Naples, Italy;
| | - Mara Riminucci
- Department of Molecular Medicine, “Sapienza” University of Rome, 00161 Roma, Italy; (M.R.); (A.C.)
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, 10124 Torino, Italy; (C.V.); (M.C.)
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, 10124 Torino, Italy; (C.V.); (M.C.)
| | - Lorenzo De Paoli
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (L.D.P.); (G.G.)
| | - Angela Rago
- UOSD Hematology, ASL Roma 1, 00193 Rome, Italy;
| | - Giulia Buscicchio
- Department of Psychology, Catholic University of the Sacred-Heart, 20123 Milan, Italy;
| | - Giacomo Maestrini
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (M.P.); (G.M.); (S.L.); (A.D.P.)
| | - Silvio Ligia
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (M.P.); (G.M.); (S.L.); (A.D.P.)
| | - Alessio Di Prima
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (M.P.); (G.M.); (S.L.); (A.D.P.)
| | - Alessandro Corsi
- Department of Molecular Medicine, “Sapienza” University of Rome, 00161 Roma, Italy; (M.R.); (A.C.)
| | - Roberto Caronna
- Department of Surgical Sciences, Sapienza University, 00161 Rome, Italy;
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy; (L.D.P.); (G.G.)
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Via Benevento 6, 00161 Rome, Italy; (M.P.); (G.M.); (S.L.); (A.D.P.)
- Correspondence: ; Tel.: +39-06-499741; Fax: +39-06-44241984
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Autore F, Innocenti I, Corrente F, Del Principe MI, Rosati S, Falcucci P, Fresa A, Conte E, Limongiello MA, Renzi D, De Padua L, Andriani A, Pisani F, Cimino G, Tafuri A, Montanaro M, Mauro FR, Del Poeta G, Laurenti L. Front-Line Therapy for Elderly Chronic Lymphocytic Leukemia Patients: Bendamustine Plus Rituximab or Chlorambucil Plus Rituximab? Real-Life Retrospective Multicenter Study in the Lazio Region. Front Oncol 2020; 10:848. [PMID: 32587827 PMCID: PMC7298101 DOI: 10.3389/fonc.2020.00848] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/29/2020] [Indexed: 11/18/2022] Open
Abstract
Previous studies investigated the efficacy and the safety of bendamustine (B) vs. chlorambucil (Chl) associated with rituximab (R) in fludarabine-ineligible patients with treated and untreated chronic lymphocytic leukemia (CLL). We conducted a retrospective multicenter study in the Lazio region to further evaluate and compare the efficacy and the toxicity of Chl-R and B-R regimen in CLL patients over the age of 65. We enrolled 192 untreated CLL patients: 111 treated with B-R and 81 with Chl-R. The overall response rates (ORR; 93.6% in B-R and 86.5% in Chl-R) were not statistically different between the two groups, such as progression-free survival (PFS), time to retreatment (TTR), and overall survival (OS). The B-R group showed a higher hematological (p = 0.007) and extra-hematological (p = 0.008) toxicity. When comparing the toxicities according to age, we noted that the extra-hematological toxicity was higher in patients over the age of 75 who were treated with B-R than those treated with Chl-R (p = 0.03). This retrospective study confirms the feasibility of B-R and Chl-R in elderly untreated CLL patients. Currently, patients who are over 75 and unfit are usually treated with Chl-R. This scheme allows achieving the same ORR, PFS, TTR, and OS when compared with B-R because of hematological and extra-hematological toxicities due to B, in which a greater dose reduction has been shown in comparison to Chl.
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Affiliation(s)
- Francesco Autore
- Institute of Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Idanna Innocenti
- Institute of Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Corrente
- Institute of Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Ilaria Del Principe
- Hematology Unit, Department of Biomedicine and Prevention, University tor Vergata of Rome, Rome, Italy
| | - Serena Rosati
- Hematology Unit, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Paolo Falcucci
- Division of Hematology, Ospedale Belcolle, Viterbo, Italy
| | - Alberto Fresa
- Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Esmeralda Conte
- Hematology Unit, Azienda Ospedaliera-Universitaria Sant'Andrea, Rome, Italy
| | | | - Daniela Renzi
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Laura De Padua
- Hematology Unit, Fabrizio Spaziani Hospital, Frosinone, Italy
| | | | - Francesco Pisani
- Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Cimino
- Hematology Unit, Ospedale Santa Maria Goretti, Latina, Italy
| | - Agostino Tafuri
- Hematology Unit, Azienda Ospedaliera-Universitaria Sant'Andrea, Rome, Italy
| | | | - Francesca Romana Mauro
- Hematology Unit, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - Giovanni Del Poeta
- Hematology Unit, Department of Biomedicine and Prevention, University tor Vergata of Rome, Rome, Italy
| | - Luca Laurenti
- Institute of Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,Institute of Hematology, Università Cattolica del Sacro Cuore, Rome, Italy
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41
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Mauro FR, Giannarelli D, Galluzzo CM, Vitale C, Visentin A, Riemma C, Rosati S, Porrazzo M, Pepe S, Coscia M, Trentin L, Gentile M, Raponi S, Micozzi A, Gentile G, Baroncelli S. Response to the conjugate pneumococcal vaccine (PCV13) in patients with chronic lymphocytic leukemia (CLL). Leukemia 2020; 35:737-746. [PMID: 32555297 DOI: 10.1038/s41375-020-0884-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/28/2020] [Accepted: 05/21/2020] [Indexed: 11/09/2022]
Abstract
Pneumococcal (PC) vaccination is recommended for patients with chronic lymphocytic leukemia (CLL). However, response to vaccines has been investigated in a small series of CLL patients. We analyzed the antibody response and outcomes of 112 CLL patients who received the 13-valent pneumococcal conjugate vaccine (PCV13). An immune response was defined by a twofold increase in the PC-IgG levels assessed by ELISA. The median age of patients was 68 years, 23.2% showed IgG levels ≤ 400 mg/L, 6.3% progressive disease, 52% unmutated IGHV. Twenty-two (19.6%) patients were treatment-naïve and 90 (80.4%) previously treated (40.2% front-line chemoimmunotherapy; ibrutinib first/advanced-line, 9.8%/21.4%; idelalisib advanced-line, 8.9%). Nine (8%) patients developed an immune response, eight treatment-naive, and one on front-line ibrutinib. No responses were observed in patients previously treated with chemoimmunotherapy. Age ≥ 60 years (p = 0.007), IgG levels < 400 mg/L (p < 0.0001), prior treatment (p < 0.0001), and signs of disease progression (p = 0.04) were associated with a lower response rate. Pneumonia-free survival was significantly shorter in patients with clinical signs of progressive disease (HR, 8.39), prior pneumonia (HR, 7.03), and TP53 disruption (HR, 2.91). In conclusion, our results suggest that vaccination should be offered at diagnosis to CLL patients with early stage and stable disease who have better resources for an effective immune response.
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Affiliation(s)
- Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy.
| | - Diana Giannarelli
- Biostatistic Unit, Regina Elena National Cancer Institute, IRCCS, Rome, Italy
| | | | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Costantino Riemma
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Serena Rosati
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Marika Porrazzo
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Sara Pepe
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino and Department of Molecular Biotechnology and Health Sciences, University of Turin, Torino, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Massimo Gentile
- Hematology and Oncology Department, Biotechnology Research Unit, Cosenza, Italy
| | - Sara Raponi
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Alessandra Micozzi
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Giuseppe Gentile
- Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Silvia Baroncelli
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
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42
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Gentile M, Morabito F, Del Poeta G, Mauro FR, Reda G, Sportoletti P, Laurenti L, Coscia M, Herishanu Y, Recchia AG, Varettoni M, Murru R, Chiarenza A, Condoluci A, Moia R, Pietrasanta D, Loseto G, Consoli U, Scortechini I, Rossi FM, Zucchetto A, Fraticelli V, Vigna E, Botta C, Tripepi G, Arrigo GD, Rago A, Angeletti I, Biagi A, Del Giudice I, Bomben R, Rigolin GM, Rossi D, Di Raimondo F, Gaidano G, Polliack A, Cuneo A, Foà R, Gattei V. Survival risk score for real-life relapsed/refractory chronic lymphocytic leukemia patients receiving ibrutinib. A campus CLL study. Leukemia 2020; 35:235-238. [PMID: 32286543 DOI: 10.1038/s41375-020-0833-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Massimo Gentile
- Hematology Unit AO of Cosenza, Cosenza, Italy. .,Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy.
| | - Fortunato Morabito
- Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy.,Hematology Oncology Department, Augusta Victoria Hospital, East Jerusalem, Israel
| | - Giovanni Del Poeta
- Division of Hematology, S. Eugenio Hospital and University of Tor Vergata, Rome, Italy
| | - Francesca Romana Mauro
- Division of Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Gianluigi Reda
- Division of Ematologia, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico di Milano, Milano, Italy
| | - Paolo Sportoletti
- Centro di Ricerca Emato-Oncologica (CREO), University of Perugia, Perugia, Italy
| | - Luca Laurenti
- Fondazione Universitaria Policlinico A Gemelli di Roma, Roma, Italy
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Yair Herishanu
- Sourasky Medical Center, Institute of Hematology, and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Marzia Varettoni
- Division of Haematology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, Cagliari, Italy
| | - Annalisa Chiarenza
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Adalgisa Condoluci
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Riccardo Moia
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Daniela Pietrasanta
- Division of Hematology, Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Giacomo Loseto
- Hematology and Cell Therapy Unit, IRCCS-Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Ugo Consoli
- Department of Hematology, G. Garibaldi Hospital, Catania, Italy
| | | | - Francesca Maria Rossi
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, (PN), Italy
| | - Antonella Zucchetto
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, (PN), Italy
| | - Vincenzo Fraticelli
- Hematology Unit AO of Cosenza, Cosenza, Italy.,Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy
| | - Ernesto Vigna
- Hematology Unit AO of Cosenza, Cosenza, Italy.,Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy
| | - Cirino Botta
- Hematology Unit AO of Cosenza, Cosenza, Italy.,Biothecnology Research Unit, AO of Cosenza, Cosenza, Italy
| | - Giovanni Tripepi
- CNR-IFC, Research Unit of Reggio Calabria, Reggio Calabria, Italy
| | | | | | - Ilaria Angeletti
- Reparto di Oncoematologia Azienda Ospedaliera Santa Maria di Terni, Terni, Italy
| | - Annalisa Biagi
- Division of Hematology, S. Eugenio Hospital and University of Tor Vergata, Rome, Italy
| | - Ilaria Del Giudice
- Division of Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, (PN), Italy
| | - Gian Matteo Rigolin
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Davide Rossi
- Division of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Francesco Di Raimondo
- Division of Hematology, Policlinico, Department of Surgery and Medical Specialties, University of Catania, Catania, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Aaron Polliack
- Department of Hematology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Robin Foà
- Division of Hematology, Department of Translational and Precision Medicine, 'Sapienza' University, Rome, Italy
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, (PN), Italy.
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43
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Raponi S, Del Giudice I, Marinelli M, Wang J, Cafforio L, Ilari C, Piciocchi A, Messina M, Bonina S, Tavolaro S, Bordyuh M, Mariglia P, Peragine N, Mauro FR, Chiaretti S, Molica S, Gentile M, Visentin A, Trentin L, Rigolin GM, Cuneo A, Diop F, Rossi D, Gaidano G, Guarini A, Rabadan R, Foà R. Genetic landscape of ultra-stable chronic lymphocytic leukemia patients. Ann Oncol 2019; 29:966-972. [PMID: 29365086 DOI: 10.1093/annonc/mdy021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Chronic lymphocytic leukemia (CLL) has a heterogeneous clinical course. Beside patients requiring immediate treatment, others show an initial indolent phase followed by progression and others do not progress for decades. The latter two subgroups usually display mutated IGHV genes and a favorable FISH profile. Patients and methods Patients with absence of disease progression for over 10 years (10-34) from diagnosis were defined as ultra-stable CLL (US-CLL). Forty US-CLL underwent extensive characterization including whole exome sequencing (WES), ultra-deep sequencing and copy number aberration (CNA) analysis to define their unexplored genetic landscape. Microarray analysis, comparing US-CLL with non-US-CLL with similar immunogenetic features (mutated IGHV/favorable FISH), was also carried out to recognize US-CLL at diagnosis. Results WES was carried out in 20 US-CLL and 84 non-silent somatic mutations in 78 genes were found. When re-tested in a validation cohort of 20 further US-CLL, no recurrent lesion was identified. No clonal mutations of NOTCH1, BIRC3, SF3B1 and TP53 were found, including ATM and other potential progression driving mutations. CNA analysis identified 31 lesions, none with known poor prognostic impact. No novel recurrent lesion was identified: most cases showed no lesions (38%) or an isolated del(13q) (31%). The expression of 6 genes, selected from a gene expression profile analysis by microarray and quantified by droplet digital PCR on a cohort of 79 CLL (58 US-CLL and 21 non-US-CLL), allowed to build a decision-tree capable of recognizing at diagnosis US-CLL patients. Conclusions The genetic landscape of US-CLL is characterized by the absence of known unfavorable driver mutations/CNA and of novel recurrent genetic lesions. Among CLL patients with favorable immunogenetics, a decision-tree based on the expression of 6 genes may identify at diagnosis patients who are likely to maintain an indolent disease for decades.
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Affiliation(s)
- S Raponi
- Hematolog, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - I Del Giudice
- Hematolog, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - M Marinelli
- Hematolog, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - J Wang
- Division of Life Science and Department of Chemical and Biological Engineering, Hong Kong University of Science and Technology, Hong Kong
| | - L Cafforio
- Hematolog, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - C Ilari
- Hematolog, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - A Piciocchi
- GIMEMA Data Centre, GIMEMA Foundation, Rome, Italy
| | - M Messina
- Hematolog, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - S Bonina
- Hematolog, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - S Tavolaro
- Hematolog, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - M Bordyuh
- Department of Systems Biology, Columbia University, New York, USA; Department of, Biomedical Informatics, Columbia University, New York, USA
| | - P Mariglia
- Hematolog, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - N Peragine
- Hematolog, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - F R Mauro
- Hematolog, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - S Chiaretti
- Hematolog, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | - S Molica
- Department of Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - M Gentile
- Hematology Uni, Department of Hemato-Oncology, Ospedale Annunziata, Cosenza, Italy
| | - A Visentin
- Hematology Sectio, Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy
| | - L Trentin
- Hematology Sectio, Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy
| | - G M Rigolin
- Hematology Sectio, Azienda Ospedaliero Universitaria Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - A Cuneo
- Hematology Sectio, Azienda Ospedaliero Universitaria Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - F Diop
- Division of Hematolog, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - D Rossi
- Department of Hematology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Institute of Oncology Research, Bellinzona, Switzerland
| | - G Gaidano
- Division of Hematolog, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - A Guarini
- Department of Molecular Medicine, Sapienza University, Rome, Italy
| | - R Rabadan
- Department of Systems Biology, Columbia University, New York, USA; Department of, Biomedical Informatics, Columbia University, New York, USA
| | - R Foà
- Hematolog, Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
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44
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Griggio V, Vitale C, Todaro M, Riganti C, Kopecka J, Salvetti C, Bomben R, Bo MD, Magliulo D, Rossi D, Pozzato G, Bonello L, Marchetti M, Omedè P, Kodipad AA, Laurenti L, Del Poeta G, Mauro FR, Bernardi R, Zenz T, Gattei V, Gaidano G, Foà R, Massaia M, Boccadoro M, Coscia M. HIF-1α is over-expressed in leukemic cells from TP53-disrupted patients and is a promising therapeutic target in chronic lymphocytic leukemia. Haematologica 2019; 105:1042-1054. [PMID: 31289209 PMCID: PMC7109756 DOI: 10.3324/haematol.2019.217430] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022] Open
Abstract
In chronic lymphocytic leukemia (CLL), the hypoxia-inducible factor 1 (HIF-1) regulates the response of tumor cells to hypoxia and their protective interactions with the leukemic microenvironment. In this study, we demonstrate that CLL cells from TP53-disrupted (TP53dis) patients have constitutively higher expression levels of the α-subunit of HIF-1 (HIF-1α) and increased HIF-1 transcriptional activity compared to the wild-type counterpart. In the TP53dis subset, HIF-1α upregulation is due to reduced expression of the HIF-1α ubiquitin ligase von Hippel-Lindau protein (pVHL). Hypoxia and stromal cells further enhance HIF-1α accumulation, independently of TP53 status. Hypoxia acts through the downmodulation of pVHL and the activation of the PI3K/AKT and RAS/ERK1-2 pathways, whereas stromal cells induce an increased activity of the RAS/ERK1-2, RHOA/RHOA kinase and PI3K/AKT pathways, without affecting pVHL expression. Interestingly, we observed that higher levels of HIF-1A mRNA correlate with a lower susceptibility of leukemic cells to spontaneous apoptosis, and associate with the fludarabine resistance that mainly characterizes TP53dis tumor cells. The HIF-1α inhibitor BAY87-2243 exerts cytotoxic effects toward leukemic cells, regardless of the TP53 status, and has anti-tumor activity in Em-TCL1 mice. BAY87-2243 also overcomes the constitutive fludarabine resistance of TP53dis leukemic cells and elicits a strongly synergistic cytotoxic effect in combination with ibrutinib, thus providing preclinical evidence to stimulate further investigation into use as a potential new drug in CLL.
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Affiliation(s)
- Valentina Griggio
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Candida Vitale
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Maria Todaro
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Chiara Riganti
- Department of Oncology, University of Turin, Turin, Italy
| | - Joanna Kopecka
- Department of Oncology, University of Turin, Turin, Italy
| | - Chiara Salvetti
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Riccardo Bomben
- Clinical and Experimental Onco-Hematology Unit, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Michele Dal Bo
- Clinical and Experimental Onco-Hematology Unit, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Daniela Magliulo
- Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Davide Rossi
- Department of Hematology, Oncology Institute of Southern Switzerland and Institute of Oncology Research, Bellinzona, Switzerland
| | - Gabriele Pozzato
- Department of Internal Medicine and Hematology, Maggiore General Hospital, University of Trieste, Trieste, Italy
| | - Lisa Bonello
- Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Monia Marchetti
- Hematology Day Service, Oncology SOC, Hospital Cardinal Massaia, Asti, Italy
| | - Paola Omedè
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ahad Ahmed Kodipad
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Luca Laurenti
- Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Giovanni Del Poeta
- Division of Hematology, S. Eugenio Hospital and University of Tor Vergata, Rome, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Rosa Bernardi
- Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Thorsten Zenz
- Department of Medical Oncology and Hematology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Valter Gattei
- Clinical and Experimental Onco-Hematology Unit, CRO Aviano National Cancer Institute, Aviano, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Robin Foà
- Hematology, Department of Translational and Precision Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy
| | | | - Mario Boccadoro
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
| | - Marta Coscia
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy .,Department of Molecular Biotechnology and Health Sciences, University of Turin, Turin, Italy
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45
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Autore F, Strati P, Innocenti I, Corrente F, Trentin L, Cortelezzi A, Visco C, Coscia M, Cuneo A, Gozzetti A, Mauro FR, Frustaci AM, Gentile M, Morabito F, Molica S, Falcucci P, D'Arena G, Murru R, Vincelli D, Efremov DG, Ferretti A, Rigolin GM, Vitale C, Tisi MC, Reda G, Visentin A, Sica S, Foà R, Ferrajoli A, Laurenti L. Elevated Lactate Dehydrogenase Has Prognostic Relevance in Treatment-Naïve Patients Affected by Chronic Lymphocytic Leukemia with Trisomy 12. Cancers (Basel) 2019; 11:cancers11070896. [PMID: 31248056 PMCID: PMC6678692 DOI: 10.3390/cancers11070896] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/16/2019] [Accepted: 06/18/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic Lymphocytic Leukemia (CLL) patients with +12 have been reported to have specific clinical and biologic features. We performed an analysis of the association between demographic; clinical; laboratory; biologic features and outcome in CLL patients with +12 to identify parameters predictive of disease progression; time to treatment; and survival. The study included 487 treatment-naive CLL patients with +12 from 15 academic centers; diagnosed between January 2000 and July 2016; and 816 treatment-naïve patients with absence of Fluorescence In Situ Hybridization (FISH) abnormalities. A cohort of 250 patients with +12 CLL followed at a single US institution was used for external validation. In patients with +12; parameters associated with worse prognosis in the multivariate model were high Lactate DeHydrogenase (LDH) and β-2-microglobulin and unmutated immunoglobulin heavy-chain variable region gene (IGHV). CLL patients with +12 and high LDH levels showed a shorter Progression-Free-Survival (PFS) (30 months vs. 65 months; p < 0.001), Treatment-Free-Survival (TFS) (33 months vs. 69 months; p < 0.001), Overall Survival (OS) (131 months vs. 181 months; p < 0.001) and greater CLL-related mortality (29% vs. 11% at 10 years; p < 0.001) when compared with +12 CLL patients with normal LDH levels. The same differences were observed in the validation cohort. These data suggest that serum LDH levels can predict PFS; TFS; OS and CLL-specific survival in CLL patients with +12.
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Affiliation(s)
- Francesco Autore
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.
| | - Paolo Strati
- Departments of Leukemia, MD Anderson Cancer Centre, 77030 Houston, USA.
| | - Idanna Innocenti
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.
| | - Francesco Corrente
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, Università di Padova, 35122 Padova, Italy.
| | - Agostino Cortelezzi
- Hematology Unit, IRCCS Ca' Granda Policlinico-Università degli Studi, 55031 Milano, Italy.
| | - Carlo Visco
- Division of Hematology, Ospedale San Bortolo di Vicenza, 36100 Vicenza, Italy.
| | - Marta Coscia
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy.
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126 Torino, Italy.
| | - Antonio Cuneo
- Hematology section, Department of Medical Sciences, Azienda Ospedaliero Universitaria Arcispedale S. Anna, 44124 Ferrara, Italy.
| | - Alessandro Gozzetti
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy.
| | | | | | - Massimo Gentile
- Biothecnology Research Unit, Azienda Ospedaliera di Cosenza, 87100 Cosenza, Italy.
| | - Fortunato Morabito
- Biothecnology Research Unit, Azienda Ospedaliera di Cosenza, 87100 Cosenza, Italy.
| | - Stefano Molica
- Department of Hematology-Oncology, Ospedale Pugliese-Ciacco, 88100 Catanzaro, Italy.
| | - Paolo Falcucci
- Division of Hematology, Ospedale Belcolle, 01100 Viterbo, Italy.
| | - Giovanni D'Arena
- Hematology and Stem cell Transplantation Unit, IRCCS Centro di Riferimento Oncologico della Basilicata, 85028 Rionero in Vulture, Italy.
| | - Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale A. Businco, 09121 Cagliari, Italy.
| | - Donatella Vincelli
- Department of Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, 89124 Reggio Calabria, Italy.
| | - Dimitar G Efremov
- Molecular Hematology, International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy.
| | - Antonietta Ferretti
- Hematology division, Policlinico Umberto I, Università Sapienza, 00161 Roma, Italy.
| | - Gian Matteo Rigolin
- Hematology section, Department of Medical Sciences, Azienda Ospedaliero Universitaria Arcispedale S. Anna, 44124 Ferrara, Italy.
| | - Candida Vitale
- Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Torino, Italy.
- Division of Hematology, A.O.U. Città della Salute e della Scienza di Torino, 10126 Torino, Italy.
| | - Maria Chiara Tisi
- Division of Hematology, Ospedale San Bortolo di Vicenza, 36100 Vicenza, Italy.
| | - Gianluigi Reda
- Hematology Unit, IRCCS Ca' Granda Policlinico-Università degli Studi, 55031 Milano, Italy.
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, Università di Padova, 35122 Padova, Italy.
| | - Simona Sica
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.
- Institute of Hematology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
| | - Robin Foà
- Hematology division, Policlinico Umberto I, Università Sapienza, 00161 Roma, Italy.
| | | | - Luca Laurenti
- Institute of Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.
- Institute of Hematology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
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46
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Reda G, Cassin R, Gentile M, Mauro FR, Giannarelli D, Fattizzo B, Barbieri M, Silvestris I, Fabris S, Morabito F, Neri A, Barcellini W, Cortelezzi A. IgA hypogammaglobulinemia predicts outcome in chronic lymphocytic leukemia. Leukemia 2019; 33:1519-1522. [PMID: 30635629 DOI: 10.1038/s41375-018-0344-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/27/2018] [Accepted: 11/30/2018] [Indexed: 01/21/2023]
Affiliation(s)
- G Reda
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - R Cassin
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Gentile
- Hematology Unit, Department of Onco-hematology, A.O. Cosenza, Cosenza, Italy
| | - F R Mauro
- Hematology, Department of Cellular Biotechnologies and Hematology, 'Sapienza' University, Rome, Italy
| | - D Giannarelli
- Biostatistic Unit, Regina Elena National Institute for Cancer Treatment and Research, Rome, Italy
| | - B Fattizzo
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Barbieri
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - I Silvestris
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - S Fabris
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - F Morabito
- Hemato-oncology Department, Augusta Victoria Hospital, Mount of Olives, Jerusalem, Israel.,Biotechnology Research Unit, Aprigliano, Cosenza, Italy
| | - A Neri
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - W Barcellini
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Cortelezzi
- Hematology Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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47
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Morabito F, Shanafelt TD, Gentile M, Reda G, Mauro FR, Rossi D, Di Renzo N, Molica S, Angrilli F, Chiarenza A, Cutrona G, Chaffee KG, Parikh SA, Tripepi G, D'Arrigo G, Vigna E, Recchia AG, Cortelezzi A, Gaidano G, Di Raimondo F, Fais F, Foà R, Neri A, Ferrarini M. Immunoglobulin heavy chain variable region gene and prediction of time to first treatment in patients with chronic lymphocytic leukemia: Mutational load or mutational status? Analysis of 1003 cases. Am J Hematol 2018; 93:E216-E219. [PMID: 29984867 DOI: 10.1002/ajh.25206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 06/28/2018] [Indexed: 01/04/2023]
Affiliation(s)
- Fortunato Morabito
- Biotechnology Research Unit, Azienda Sanitaria Provinciale di Cosenza Aprigliano (CS) Italy
| | - Tait D Shanafelt
- Department of Medicine, Division of Hematology Stanford University California
| | - Massimo Gentile
- Hematology Unit, Department of Onco‐hematology A.O. of Cosenza Cosenza Italy
| | - Gianluigi Reda
- Hematology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan Italy
| | - Francesca Romana Mauro
- Hematology, Department of Cellular Biotechnologies and Hematology ‘Sapienza’ University Rome Italy
| | - Davide Rossi
- Oncology Institute of Southern Switzerland and Institute of Oncology Research Bellinzona Switzerland
| | | | - Stefano Molica
- Department of Oncology and Haematology Pugliese‐Ciaccio Hospital Catanzaro Italy
| | | | - Annalisa Chiarenza
- Division of Hematology AOU Policlinico‐OVE, University of Catania Catania Italy
| | - Giovanna Cutrona
- UO Molecular Pathology, IRCCS Ospedale Policlinico San Martino, Genoa Italy
| | - Kari G. Chaffee
- Division of Biomedical Statistics and Informatics Mayo Clinic Rochester Minnesota
| | - Sameer A. Parikh
- Department of Internal Medicine, Division of Hematology Mayo Clinic Rochester Minnesota
| | - Giovanni Tripepi
- Consiglio Nazionale delle Ricerche, Istituto di Biomedicina ed Immunologia Molecolare Reggio Calabria Italy
| | - Graziella D'Arrigo
- Consiglio Nazionale delle Ricerche, Istituto di Biomedicina ed Immunologia Molecolare Reggio Calabria Italy
| | - Ernesto Vigna
- Hematology Unit, Department of Onco‐hematology A.O. of Cosenza Cosenza Italy
| | - Anna Grazia Recchia
- Biotechnology Research Unit, Azienda Sanitaria Provinciale di Cosenza Aprigliano (CS) Italy
| | - Agostino Cortelezzi
- Hematology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan Italy
| | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine Università del Piemonte Orientale Novara Italy
| | | | - Franco Fais
- UO Molecular Pathology, IRCCS Ospedale Policlinico San Martino, Genoa Italy
- Department of Experimental Medicine University of Genova Genoa Italy
| | - Robin Foà
- Hematology, Department of Cellular Biotechnologies and Hematology ‘Sapienza’ University Rome Italy
| | - Antonino Neri
- Hematology Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milan Italy
| | - Manlio Ferrarini
- Department of Experimental Medicine University of Genova Genoa Italy
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48
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Gentile M, Shanafelt TD, Mauro FR, Reda G, Rossi D, Laurenti L, Del Principe MI, Cutrona G, Angeletti I, Coscia M, Herishanu Y, Chiarenza A, Molica S, Ciolli S, Goldschmidt N, Angrilli F, Giordano A, Rago A, Bairey O, Tripepi G, Chaffee KG, Sameer PA, Vigna E, Zirlik K, Shvidel L, Innocenti I, Recchia AG, Di Raimondo F, Del Poeta G, Cortelezzi A, Neri A, Ferrarini M, Gaidano G, Kay NE, Polliack A, Foà R, Morabito F. Predictive value of the CLL-IPI in CLL patients receiving chemo-immunotherapy as first-line treatment. Eur J Haematol 2018; 101:703-706. [PMID: 30039576 DOI: 10.1111/ejh.13149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Tait D Shanafelt
- Department of Medicine, Division of Hematology, Stanford University, Stanford, California
| | | | - Gianluigi Reda
- Unità di Ematologia, Fondazione Ca' Granda IRCCS, Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | - Davide Rossi
- Oncology Institute of Southern Switzerland, Institute of Oncology Research, Bellinzona, Switzerland
| | - Luca Laurenti
- Dipartimento di Ematologia, Università Cattolica "A. Gemelli" Rome, Rome, Italy
| | - Maria Ilaria Del Principe
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma "Tor Vergata," Rome, Rome, Italy
| | | | - Ilaria Angeletti
- Reparto di Oncoematologia Azienda Ospedaliera Santa Maria di Terni, Terni, Italy
| | - Marta Coscia
- Divisione di Ematologia, Università di Torino, A.O. Città della Salute e della Scienza di Torino, Torino, Italy
| | - Yair Herishanu
- Department of Hematology, Tel-Aviv Sourasky Medical and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Annalisa Chiarenza
- Divisione di Ematologia, Ospedale Ferrarotto, Università di Catania, Catania, Italy
| | - Stefano Molica
- Dipartimento di Onco-ematologia, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | | | - Neta Goldschmidt
- Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | | | - Annamaria Giordano
- Ematologia-Azienda Ospedaliero-Universitaria, Policlinico consorziale di Bari, Bari, Italy
| | - Angela Rago
- UOC Ematologia Ospedale Santa Maria Goretti, Latina, Italy
| | - Osnat Bairey
- Department of Hematology, Rabin Medical Center, Petah Tikva and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Giovanni Tripepi
- Consiglio Nazionale delle Ricerche, Istituto di Biomedicina ed Immunologia Molecolare, Reggio Calabria, Italy
| | - Kari G Chaffee
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Parikh A Sameer
- Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota
| | | | - Katja Zirlik
- Department of Haematology and Oncology, University Medical Centre Freiburg, Freiburg, Germany
| | - Lev Shvidel
- Department of Hematology Kaplan Medical Center, Rehovot and Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Idanna Innocenti
- Dipartimento di Ematologia, Università Cattolica "A. Gemelli" Rome, Rome, Italy
| | - Anna Grazia Recchia
- Unità di Ricerca Biotecnologica, Azienda Sanitaria Provinciale di Cosenza, Aprigliano (CS), Italy
| | | | - Giovanni Del Poeta
- Ematologia, Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma "Tor Vergata," Rome, Rome, Italy
| | - Agostino Cortelezzi
- Unità di Ematologia, Fondazione Ca' Granda IRCCS, Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | - Antonino Neri
- Unità di Ematologia, Fondazione Ca' Granda IRCCS, Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | | | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, UPO, Novara, Italy
| | - Neil E Kay
- Department of Medicine, Division of Hematology, Stanford University, Stanford, California
| | - Aaron Polliack
- Department of Hematology, Hadassah Medical Center, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Robin Foà
- Ematologia, Università Sapienza, Roma, Italy
| | - Fortunato Morabito
- Unità di Ricerca Biotecnologica, Azienda Sanitaria Provinciale di Cosenza, Aprigliano (CS), Italy
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49
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Cuneo A, Follows G, Rigolin GM, Piciocchi A, Tedeschi A, Trentin L, Perez AM, Coscia M, Laurenti L, Musuraca G, Farina L, Delgado AR, Orlandi EM, Galieni P, Mauro FR, Visco C, Amendola A, Billio A, Marasca R, Chiarenza A, Meneghini V, Ilariucci F, Marchetti M, Molica S, Re F, Gaidano G, Gonzalez M, Forconi F, Ciolli S, Cortelezzi A, Montillo M, Smolej L, Schuh A, Eyre TA, Kennedy B, Bowles KM, Vignetti M, de la Serna J, Moreno C, Foà R, Ghia P. Efficacy of bendamustine and rituximab as first salvage treatment in chronic lymphocytic leukemia and indirect comparison with ibrutinib: a GIMEMA, ERIC and UK CLL FORUM study. Haematologica 2018; 103:1209-1217. [PMID: 29674504 PMCID: PMC6029555 DOI: 10.3324/haematol.2018.189837] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 02/06/2018] [Accepted: 04/18/2018] [Indexed: 11/09/2022] Open
Abstract
We performed an observational study on the efficacy of ben-damustine and rituximab (BR) as first salvage regimen in chronic lymphocytic leukemia (CLL). In an intention-to-treat analysis including 237 patients, the median progression-free survival (PFS) was 25 months. The presence of del(17p), unmutated IGHV and advanced stage were associated with a shorter PFS at multivariate analysis. The median time-to-next treatment was 31.3 months. Front-line treatment with a chemoimmunotherapy regimen was the only predictive factor for a shorter time to next treatment at multivariate analysis. The median overall survival (OS) was 74.5 months. Advanced disease stage (i.e. Rai stage III-IV or Binet stage C) and resistant disease were the only parameters significantly associated with a shorter OS. Grade 3-5 infections were recorded in 6.3% of patients. A matched-adjusted indirect comparison with ibrutinib given second-line within Named Patient Programs in the United Kingdom and in Italy was carried out with OS as objective end point. When restricting the analysis to patients with intact 17p who had received chemoimmunotherapy in first line, there was no difference in OS between patients treated with ibrutinib (63% alive at 36 months) and patients treated with BR (74.4% alive at 36 months). BR is an efficacious first salvage regimen in CLL in a real-life population, including the elderly and unfit patients. BR and ibrutinib may be equally effective in terms of OS when used as first salvage treatment in patients without 17p deletion.
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Affiliation(s)
- Antonio Cuneo
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - George Follows
- UK CLL Forum, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Gian Matteo Rigolin
- Hematology, Department of Medical Sciences, St. Anna University Hospital, Ferrara, Italy
| | - Alfonso Piciocchi
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Alessandra Tedeschi
- Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology, Department of Medicine, University of Padua, Italy
| | | | - Marta Coscia
- Hematology Unit, Città della Salute e della Scienza, University of Turin, Italy
| | - Luca Laurenti
- Hematology, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, Rome, Italy
| | - Gerardo Musuraca
- Hematology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Lucia Farina
- Hematology Department, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Alfredo Rivas Delgado
- Department of Hematology, Hospital Clinic, Institut Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Piero Galieni
- Hematology and Cellular Therapy, "Ospedale C. e G. Mazzoni", Ascoli Piceno, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Biomedical Sciences and Hematology, "Sapienza" University, Rome, Italy
| | - Carlo Visco
- Hematology, San Bortolo Hospital, Vicenza, Italy
| | | | - Atto Billio
- Hematology and Transplant Unit, San Maurizio Hospital, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | | | - Annalisa Chiarenza
- Hematology Unit, Azienda Universitaria Ospedaliera Policlinico Vittorio Emanuele, Catania, Italy
| | - Vittorio Meneghini
- Hematology, Department of Cell Therapy and Hematology, University Hospital, Verona, Italy
| | | | | | - Stefano Molica
- Hematology Unit, A. Pugliese Hospital, Azienda Ospedaliera Pugliese Ciaccio, Catanzaro, Italy
| | | | - Gianluca Gaidano
- Hematology, DIMECS e Dipartimento Oncologico, Università del Piemonte Orientale Amedeo Avogadro, Novara, Italy
| | - Marcos Gonzalez
- Hematology, University Hospital-IBSAL and CIBERONC, Salamanca, Spain
| | - Francesco Forconi
- Haematology Department, University Hospital National Health Service Trust, Southampton, UK
| | | | - Agostino Cortelezzi
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Marco Montillo
- Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Lukas Smolej
- Department of Hematology, University Hospital, Hradec Kralove, Czech Republic
| | - Anna Schuh
- UK CLL Forum, Oxford University Hospitals NHS Foundation Trust, UK
| | - Toby A Eyre
- Oxford University Hospitals NHS Foundation Trust, UK
| | - Ben Kennedy
- University Hospitals of Leicester NHS Trust, UK
| | | | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | | | - Carol Moreno
- Hospital de la Santa Creu i Sant Pau, Barcellona, Spain
| | - Robin Foà
- Hematology, Department of Biomedical Sciences and Hematology, "Sapienza" University, Rome, Italy
| | - Paolo Ghia
- Division of Experimental Oncology, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
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Boriani G, Corradini P, Cuneo A, Falanga A, Foà R, Gaidano G, Ghia PP, Martelli M, Marasca R, Massaia M, Mauro FR, Minotti G, Molica S, Montillo M, Pinto A, Tedeschi A, Vitolo U, Zinzani PL. Practical management of ibrutinib in the real life: Focus on atrial fibrillation and bleeding. Hematol Oncol 2018; 36:624-632. [PMID: 29512173 DOI: 10.1002/hon.2503] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 12/15/2022]
Abstract
The Bruton tyrosine kinase inhibitor ibrutinib (IB) has attained an important role in the treatment of patients with chronic lymphocytic leukaemia, mantle cell lymphoma, and Waldenström macroglobulinemia, significantly improving clinical outcomes. However, IB therapy has been associated with an increased risk of atrial fibrillation (AF) and bleeding. We report on the expert opinion that a group of Italian haematologists, cardiologists, and pharmacologists jointly released to improve the practical management of patients at risk for AF and bleeding during treatment with IB. A proper pretreatment assessment to identify patients who are at a higher risk, careful choice of concomitant drugs, regular monitoring, and multispecialist approach were characterized as the main principles of clinical management of these patients. For patients developing AF, anticoagulant and antiarrhythmic therapy must be guided by considerations about efficacy, safety, and risk of pharmacokinetic interactions with IB. For patients experiencing bleeding or requiring procedures that increase the risk of bleeding, considerations about platelet turnover, IB-related platelet dysfunctions, and bleeding worsening by concomitant anticoagulants or antiplatelet agents provide clues to manage bleeding. Overall, AF and bleeding are manageable clinical events in patients receiving IB, not requiring drug interruption in most cases. Preexisting AF should not represent an absolute contraindication to IB therapy. For each patient candidate for IB, strategies of risk assessment and mitigation may allow to exploit the life-saving effects of in chronic lymphocytic leukaemia and mantle cell lymphoma.
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Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Paolo Corradini
- Dipartimento di Oncologia ed Emato-oncologia, Universita' degli Studi di Milano, Milan, Italy
| | - Antonio Cuneo
- Hematology Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, "Papa Giovanni XXIII" Hospital, Bergamo, Italy
| | - Robin Foà
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Paolo Prospero Ghia
- Università Vita-Salute San Raffaele and IRCCS Istituto Scientifico San Raffaele, Milano, Italy
| | - Maurizio Martelli
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Roberto Marasca
- Hematology Division, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Massaia
- Division of Hematology, Department of Molecular Biotechnologies and Health Sciences, University of Torino, Torino, Italy
| | - Francesca Romana Mauro
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Giorgio Minotti
- Department of Medicine and Center for Drug Sciences, University Campus Bio-Medico, Rome, Italy
| | - Stefano Molica
- Department of Hematology-Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | - Marco Montillo
- Department of Hematology, Niguarda Cancer Center, Niguarda Hospital, Milan, Italy
| | - Antonio Pinto
- Hematology-Oncology and Stem Cell Transplantation Unit, National Cancer Institute, Fondazione "G. Pascale" IRCCS, Naples, Italy
| | | | - Umberto Vitolo
- Città della Salute e della Scienza Hospital and University, on behalf of FIL, Turin, Italy
| | - Pier Luigi Zinzani
- Institute of Hematology and Medical Oncology "Seragnoli", University of Bologna, Bologna, Italy
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