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Leccisotti L, Maccora D, Malafronte R, D'Alò F, Maiolo E, Annunziata S, Rufini V, Giordano A, Hohaus S. Predicting time to treatment in follicular lymphoma on watchful waiting using baseline metabolic tumour burden. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04138-3. [PMID: 35779106 DOI: 10.1007/s00432-022-04138-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Asymptomatic patients with follicular lymphoma (FL) and a low tumour burden can be followed without initial therapy, a strategy called watchful waiting (WW). Prediction of the time to treatment (TTT) is still a challenge. We investigated the prognostic value of baseline total metabolic tumour volume (TMTV) and whole-body total lesion glycolysis (WB-TLG) to predict TTT in patients with FL on WW. METHODS We conducted a retrospective study of 54 patients with FL (grade 1-3a) diagnosed between June 2013 and December 2019, staged with FDG PET/CT, and managed on WW. Median age was 62 years (range 34-85), stage was advanced (III-IV) in 57%, and FLIPI score was intermediate to high (≥ 2) in 52% of the patients. RESULTS The median TMTV and WB-TLG were 7.1 and 43.3, respectively. With a median follow-up of 59 months, 41% of patients started immuno-chemotherapy. The optimal cut-points to identify patients with TTT within 24 months were 14 for TMTV (AUC 0.70; 95% CI 51-88) and 64 for WB-TLG (AUC 0.71; 95% CI 52-89) (p < 0.005). The probability of not having started treatment within 24 months was 87% for TMTV < 14 and 53% for TMTV ≥ 14 (p < 0.005). TMTV was independent of the FLIPI score for TTT prediction. Patients with both FLIPI ≥ 2 and TMTV ≥ 14 had only an 18% probability of not having started treatment at 36 months, while this probability was 75% in patients with TMTV < 14. CONCLUSION Metabolic tumour volume parameters may add information to clinical scores to better predict TTT and better stratify patients for interventional studies.
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Affiliation(s)
- Lucia Leccisotti
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy. .,University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Daria Maccora
- University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rosalia Malafronte
- University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco D'Alò
- University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Rome, Italy.,Unit of Extramedullary Lymphoproliferative Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elena Maiolo
- Unit of Extramedullary Lymphoproliferative Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Salvatore Annunziata
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Vittoria Rufini
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.,University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Giordano
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.,University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefan Hohaus
- University Department of Radiological Sciences and Haematology, Università Cattolica del Sacro Cuore, Rome, Italy.,Unit of Extramedullary Lymphoproliferative Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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2
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Bellesi S, Sali M, Maiolo E, Pereyra Boza MDC, Alma E, Palucci I, Fatone F, De Maio F, Viscovo M, D'Alò F, De Stefano V, Hohaus S, Sanguinetti M. Anti CD20-based immunochemotherapy abolishes antibody response to Covid-19 mRNA vaccine in lymphoma patients vaccinated during active first line treatment. Leuk Lymphoma 2022; 63:1474-1478. [PMID: 35105258 DOI: 10.1080/10428194.2022.2032042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Silvia Bellesi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Michela Sali
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di base, Cliniche intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Maiolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Maria Del Carmen Pereyra Boza
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Alma
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Ivana Palucci
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Federica Fatone
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Flavio De Maio
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marcello Viscovo
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco D'Alò
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio De Stefano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefan Hohaus
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Sezione di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di base, Cliniche intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
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3
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Chiesa S, Beghella Bartoli F, Mazzarella C, Hohaus S, Cannatà M, Catucci F, D'Alò F, Bracci S, Nardangeli A, Martino A, Dinapoli N, Marazzi F, Manfrida S, Gambacorta M, Aristei C, Valentini V, Balducci M. OC-0929 How to manage consolidative radiotherapy after HD methotrexate in PCNSL patients: a phase II study. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02709-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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4
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Cuccaro A, Bellesi S, Galli E, Zangrilli I, Corrente F, Cupelli E, Fatone F, Maiolo E, Alma E, Viscovo M, D'Alò F, Annunziata S, Martini M, Rufini V, Giordano A, De Stefano V, Larocca LM, Hohaus S. PD‐L1 expression in peripheral blood granulocytes at diagnosis as prognostic factor in classical Hodgkin lymphoma. J Leukoc Biol 2022; 112:539-545. [PMID: 35060170 PMCID: PMC9542012 DOI: 10.1002/jlb.5ab0121-041r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 11/14/2021] [Accepted: 01/06/2022] [Indexed: 11/15/2022] Open
Abstract
Hodgkin lymphoma (HL) is a neoplastic disease in which the inflammatory microenvironment plays a pivotal role in the tumorigenesis. Neutrophilia is a typical finding in HL at diagnosis and, in particular, in association with lymphocytopenia, is a negative prognostic factor. As the immune checkpoint Programmed Death (PD)‐L1/PD‐1 has become an important therapeutic target, we were interested in the expression of PD‐L1 in peripheral blood (PB) leukocytes using flow cytometry and RT‐PCR in patients with HL and healthy controls. Granulocytes were the major PB cell fraction expressing PD‐L1. PD‐L1 expression on granulocytes was higher in patients with HL than in controls and correlated with lower T‐cell numbers in PB. We analyzed for associations between PD‐L1 expression in PB granulocytes at the time of diagnosis with patient characteristics and outcome in 126 patients with HL treated with standard chemotherapy adriamycin, bleomycin, vinblastine, and dacarbazine. Increased PD‐L1 expression in PB associated with advanced disease, systemic symptoms, positive interim positron emission tomography, and inferior progression‐free survival (PFS). PFS at 4 years was 81% (95% C.I., 71–87%) in patients with normal PD‐L1 expression and 56% (95% C.I., 35–72%) in patients with higher‐than‐normal PD‐L1 expression (p = 0.002). In conclusion, PD‐L1 expression in PB could become a potentially actionable prognostic factor in HL.
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Affiliation(s)
- Annarosa Cuccaro
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome IT
| | - Silvia Bellesi
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome IT
| | - Eugenio Galli
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome IT
- Sezione di Ematologia Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Ilaria Zangrilli
- Sezione di Ematologia Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Francesco Corrente
- Sezione di Ematologia Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Elisa Cupelli
- Sezione di Ematologia Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Federica Fatone
- Sezione di Ematologia Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Elena Maiolo
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome IT
| | - Eleonora Alma
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome IT
- Sezione di Ematologia Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Marcello Viscovo
- Sezione di Ematologia Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Francesco D'Alò
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome IT
- Sezione di Ematologia Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Salvatore Annunziata
- Sezione di Medicina Nucleare Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Maurizio Martini
- Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome IT
- Sezione di Anatomia Patologica, Dipartimento di Scienze della vita e sanità pubblica Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Vittoria Rufini
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome IT
- Sezione di Medicina Nucleare Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Alessandro Giordano
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome IT
- Sezione di Medicina Nucleare Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Valerio De Stefano
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome IT
- Sezione di Ematologia Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Luigi Maria Larocca
- Dipartimento di scienze della salute della donna, del bambino e di sanità pubblica Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome IT
- Sezione di Anatomia Patologica, Dipartimento di Scienze della vita e sanità pubblica Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
| | - Stefan Hohaus
- Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS Rome IT
- Sezione di Ematologia Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia Rome IT
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5
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D'Alò F, Zangrilli I, Cupelli E, Fianchi L, Criscuolo M, Falconi G, Fabiani E, Pagano L, Hohaus S, De Stefano V. In vitro effect of eltrombopag alone and in combination with azacitidine on megakaryopoiesis in patients with myelodysplastic syndrome. Platelets 2020; 32:378-382. [PMID: 32268817 DOI: 10.1080/09537104.2020.1742312] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Thrombocytopenia is a severe complication for patients with myelodysplastic syndrome (MDS). Eltrombopag increases platelet count in MDS patients but its combination with azacitidine elicited controversial results. We aimed to quantify the colony forming units of megakaryocytes (CFU-Mk) obtained from CD34+ bone marrow cells isolated from patients with MDS and from healthy donors that were cultured in vitro in the presence or absence of azacitidine and with or without the sequential addition of eltrombopag to the culture medium. CD34+ bone marrow cells from 6 MDS patients and 3 controls were expanded in vitro and cultured for 3 days with or without azacitidine. Subsequently, a CFU-Mk assay was performed in presence or absence of eltrombopag. The addition of eltrombopag in the CFU-Mk assay after mock treatment of CD34+ cells increased the number of CFU-Mk in both controls and patients. On the contrary, using azacitidine pretreated CD34+ cells, eltrombopag minimally increased CFU-Mk in controls and produced heterogeneous response in MDS patients with no change in two patients and CFU-Mk increase in four patients. In vitro CFU-Mk assay suggest that some MDS patients are likely to benefit from the sequential addition of eltrombopag after azacitidine treatment, in the context of a personalized medicine.
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Affiliation(s)
- Francesco D'Alò
- Dipartimento Di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Sezione Di Ematologia, Dipartimento Di Scienze Radiologiche Ed Ematologiche, Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Ilaria Zangrilli
- Dipartimento Di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Elisa Cupelli
- Dipartimento Di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Luana Fianchi
- Dipartimento Di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Marianna Criscuolo
- Dipartimento Di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giulia Falconi
- Dipartimento Di Biomedicina E Prevenzione, Università Di Roma Tor Vergata, Roma, Italy
| | - Emiliano Fabiani
- Dipartimento Di Biomedicina E Prevenzione, Università Di Roma Tor Vergata, Roma, Italy
| | - Livio Pagano
- Dipartimento Di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Sezione Di Ematologia, Dipartimento Di Scienze Radiologiche Ed Ematologiche, Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Stefan Hohaus
- Dipartimento Di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Sezione Di Ematologia, Dipartimento Di Scienze Radiologiche Ed Ematologiche, Università Cattolica Del Sacro Cuore, Roma, Italy
| | - Valerio De Stefano
- Dipartimento Di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Sezione Di Ematologia, Dipartimento Di Scienze Radiologiche Ed Ematologiche, Università Cattolica Del Sacro Cuore, Roma, Italy
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6
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Galli E, Cuccaro A, Maiolo E, Bellesi S, D'Alò F, Fusco D, Colloca G, De Stefano V, Hohaus S. Comorbidity assessment to determine prognosis in older adult patients with classical Hodgkin lymphoma. Hematol Oncol 2020; 38:153-161. [PMID: 31953864 DOI: 10.1002/hon.2715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/11/2020] [Accepted: 01/14/2020] [Indexed: 12/14/2022]
Abstract
The clinical management of older adult patients with Hodgkin lymphoma (HL) remains a major challenge. The aim of this study was to evaluate the impact of comorbidity assessment according to a standardized approach, the Cumulative Illness Rating Scale (CIRS), on prognosis in patients with classical HL aged 60 years and older. We studied 76 consecutive older adult patients with HL (median age 69 y, range 60-84) who had been treated in our institution between 1999 and 2018. Comorbidity was assessed at diagnosis according to CIRS. Anthracycline-containing chemotherapy with curative intent was administered in 59 (78%) patients. We identified 41 (54%) patients with at least one severe comorbidity rated on CIRS grade ≥ 3. Patients with severe comorbidity were more likely to have advanced-stage disease (P = .003), to have an International Prognostic Score (IPS) > 3 (P = .03), and to not receive anthracycline-containing chemotherapy (P = .008). The probability of overall survival (OS) at 3 years was 88% (95% CI, 71%-95%) in patients without severe comorbidities, while it was only 46% (95% CI, 29%-62%) in patients with a comorbidity CIRS grade ≥ 3 (P = .0001). The impact of comorbidity on prognosis was also evident when restricting the analysis to patients treated with anthracycline-containing therapy. The 3-year OS was 93% (95% CI, 76%-98%) (P = .004) in patients without severe comorbidity and 72% (95% CI, 47%-87%) in patients with severe comorbidity (P = .004). In a multivariate analysis, presence of comorbidity, but not age, was a significant factor for OS. Therefore, we conclude that a significant proportion of older adult patients with HL has severe comorbidity on the CIRS scale, which impacts more importantly than age on prognosis.
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Affiliation(s)
- Eugenio Galli
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annarosa Cuccaro
- Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Elena Maiolo
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Silvia Bellesi
- Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco D'Alò
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Domenico Fusco
- Area Invecchiamento, Ortopedia e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Giuseppe Colloca
- Istituto di Geriatria, Università Cattolica del Sacro Cuore, Rome, Italy.,Area Invecchiamento, Ortopedia e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Valerio De Stefano
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Stefan Hohaus
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.,Area di Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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7
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Annibali O, Hohaus S, Marchesi F, Cantonetti M, Di Rocco A, Tomarchio V, Di Napoli A, Pelliccia S, Battistini R, Anticoli Borza P, Abruzzese E, Cenfra N, Andriani A, Tesei C, Alma E, Palombi F, Pupo L, Petrucci L, Becilli M, Maiolo E, Bellesi S, Cuccaro A, D'Alò F, Cox MC. The neutrophil/lymphocyte ratio ≥3.5 is a prognostic marker in diffuse large B-cell lymphoma: a retrospective analysis from the database of the Italian regional network 'Rete Ematologica del Lazio per i Linfomi' (RELLI). Leuk Lymphoma 2019; 60:3386-3394. [PMID: 31259651 DOI: 10.1080/10428194.2019.1633628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In solid tumors and lymphomas, the neutrophil/lymphocyte (N/L) ratio at diagnosis has been shown to be a prognostic factor. The aim of our study was to validate the originally reported N/L ratio cut-point of 3.5 in patients with diffuse large B-cell lymphoma (DLBCL) registered in an Italian real-life database. The prognostic role of the N/L ratio at diagnosis on event-free survival (EFS) and overall survival (OS) was assessed in 505 patients with DLBCL. Patients with an N/L ratio <3.5 (n = 249) had a 4-year EFS probability of 76% and OS probability of 86%, significantly higher than the 4 year EFS rate of 48% and OS rate of 64% in patients with N/L ratio ≥3.5 (n = 256, both p<.0001). The N/L ratio was an independent prognostic factor in the multivariate analysis including the IPI score, and could separate patients with a low/intermediate risk IPI (IPI <3).
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Affiliation(s)
- Ombretta Annibali
- Ematologia, Trapianto di cellule staminali, Università Campus Bio Medico di Roma, Rome, Italy
| | - Stefan Hohaus
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Marchesi
- UO di Ematologia e Trapianto di Cellule Staminali, IRCCS Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | | | - Alice Di Rocco
- Dipartimento di Biotecnologie Cellulari e Ematologia, Università Sapienza Roma, Rome, Italy
| | - Valeria Tomarchio
- Ematologia, Trapianto di cellule staminali, Università Campus Bio Medico di Roma, Rome, Italy
| | - Arianna Di Napoli
- Anatomia Patologica, Azienza Ospedaliera Universitaria, Sant'Andrea, Rome, Italy
| | - Sabrina Pelliccia
- Ematologia, Azienza Ospedaliera Universitaria, Sant'Andrea, Rome, Italy
| | - Roberta Battistini
- U.O.C Ematologia e Trapianti CSE - A.O. San Camillo Forlanini, Rome, Italy
| | - Paola Anticoli Borza
- S.C. Ematologia e Trapianto di Cellule Staminali, Ospedale San Giovanni Addolorata, Rome, Italy
| | | | | | | | - Cristiano Tesei
- Ematologia, Azienza Ospedaliera Universitaria, Sant'Andrea, Rome, Italy
| | - Eleonora Alma
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Palombi
- UO di Ematologia e Trapianto di Cellule Staminali, IRCCS Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Livio Pupo
- UO Ematologia, Policlinico Tor Vergata Roma, Rome, Italy
| | - Luigi Petrucci
- Dipartimento di Biotecnologie Cellulari e Ematologia, Università Sapienza Roma, Rome, Italy
| | - Marco Becilli
- Ematologia, Trapianto di cellule staminali, Università Campus Bio Medico di Roma, Rome, Italy
| | - Elena Maiolo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Bellesi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annarosa Cuccaro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco D'Alò
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Broccoli A, Casadei B, Morigi A, Sottotetti F, Gotti M, Spina M, Volpetti S, Ferrero S, Spina F, Pisani F, Merli M, Visco C, Paolini R, Zilioli VR, Baldini L, Di Renzo N, Tosi P, Cascavilla N, Molica S, Ilariucci F, Rigolin GM, D'Alò F, Vanazzi A, Santambrogio E, Marasca R, Mastrullo L, Castellino C, Desabbata G, Scortechini I, Trentin L, Morello L, Argnani L, Zinzani PL. Italian real life experience with ibrutinib: results of a large observational study on 77 relapsed/refractory mantle cell lymphoma. Oncotarget 2018; 9:23443-23450. [PMID: 29805746 PMCID: PMC5955107 DOI: 10.18632/oncotarget.25215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/07/2018] [Indexed: 11/25/2022] Open
Abstract
Although sometimes presenting as an indolent lymphoma, mantle cell lymphoma (MCL) is an aggressive disease, hardly curable with standard chemo-immunotherapy. Current approaches have greatly improved patients' outcomes, nevertheless the disease is still characterized by high relapse rates. Before approval by EMA, Italian patients with relapsed/refractory MCL were granted ibrutinib early access through a Named Patient Program (NPP). An observational, retrospective, multicenter study was conducted. Seventy-seven heavily pretreated patients were enrolled. At the end of therapy there were 14 complete responses and 14 partial responses, leading to an overall response rate of 36.4%. At 40 months overall survival was 37.8% and progression free survival was 30%; disease free survival was 78.6% at 4 years: 11/14 patients are in continuous complete response with a median of 36 months of follow up. Hematological toxicities were manageable, and main extra-hematological toxicities were diarrhea (9.4%) and lung infections (9.0%). Overall, 4 (5.2%) atrial fibrillations and 3 (3.9%) hemorrhagic syndromes occurred. In conclusions, thrombocytopenia, diarrhea and lung infections are the relevant adverse events to be clinically focused on; regarding effectiveness, ibrutinib is confirmed to be a valid option for refractory/relapsed MCL also in a clinical setting mimicking the real world.
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Affiliation(s)
- Alessandro Broccoli
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Beatrice Casadei
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Alice Morigi
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | | | - Manuel Gotti
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Michele Spina
- Division of Medical Oncology A, National Cancer Institute, Aviano, Italy
| | - Stefano Volpetti
- Department of Hematology, DISM, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Simone Ferrero
- Division of Hematology, Department of Molecular Biotechnologies and Scienze for Health, University Torino, Torino, Italy
| | - Francesco Spina
- Unit of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Francesco Pisani
- Hematology and Transplantation Unit, Regina Elena National Cancer Institute, Roma, Italy
| | - Michele Merli
- Unit of Hematology, Ospedale di Circolo, Fondazione Macchi, Varese, Italy
| | - Carlo Visco
- Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | - Rossella Paolini
- Hematology Service, Medicine Department, Rovigo Hospital, Rovigo, Italy
| | | | - Luca Baldini
- OncoHematology Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milano, Italy
| | | | - Patrizia Tosi
- Hematology Unit, Infermi Hospital Rimini, Rimini, Italy
| | | | - Stefano Molica
- Unit of Oncology/Hematology, Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro, Italy
| | - Fiorella Ilariucci
- Unit of Hematology, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy
| | - Gian Matteo Rigolin
- Unit of Hematology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Francesco D'Alò
- Institute of Hematology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Anna Vanazzi
- Hemato-Oncology Division, European Institute of Oncology, Milano, Italy
| | - Elisa Santambrogio
- Unit of Hematology, University-Hospital Città della Salute e della Scienza di Torino, Torino, Italy
| | - Roberto Marasca
- Department of Medical Sciences, Hematology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Lucia Mastrullo
- Unit of Hematology, Ospedale San Gennaro di Napoli, Napoli, Italy
| | | | | | | | - Livio Trentin
- Unit of Hematology, University of Padova, Padova, Italy
| | - Lucia Morello
- Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Italy
| | - Lisa Argnani
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Pier Luigi Zinzani
- Institute of Hematology "L. e A. Seràgnoli", University of Bologna, Bologna, Italy
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Cuccaro A, Galli E, Visconti F, Zangrilli I, Corrente F, Bellesi S, Basile U, Annunziata S, Rufini V, Balducci M, D'Alò F, Hohaus S. 25(OH) vitamin D serum levels associate with patient characteristics and outcome in Hodgkin lymphoma. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - E. Galli
- Polo Oncologico; Hematology; Rome Italy
| | | | | | | | | | - U. Basile
- Laboratory Medicine, Laboratory Medicine; Rome Italy
| | | | | | | | - F. D'Alò
- Polo Oncologico; Hematology; Rome Italy
| | - S. Hohaus
- Polo Oncologico; Hematology; Rome Italy
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Tisi MC, Hohaus S, Cuccaro A, Innocenti I, De Carolis E, Za T, D'Alò F, Laurenti L, Fianchi L, Sica S, Sanguinetti M, De Stefano V, Pagano L. Invasive fungal infections in chronic lymphoproliferative disorders: a monocentric retrospective study. Haematologica 2016; 102:e108-e111. [PMID: 27856512 DOI: 10.3324/haematol.2016.151837] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Stefan Hohaus
- Institute of Hematology Catholic University S. Cuore, Rome, Italy
| | - Annarosa Cuccaro
- Institute of Hematology Catholic University S. Cuore, Rome, Italy
| | - Idanna Innocenti
- Institute of Hematology Catholic University S. Cuore, Rome, Italy
| | - Elena De Carolis
- Institute of Microbiology, Catholic University S. Cuore, Rome, Italy
| | - Tommaso Za
- Institute of Hematology Catholic University S. Cuore, Rome, Italy
| | - Francesco D'Alò
- Institute of Hematology Catholic University S. Cuore, Rome, Italy
| | - Luca Laurenti
- Institute of Hematology Catholic University S. Cuore, Rome, Italy
| | - Luana Fianchi
- Institute of Hematology Catholic University S. Cuore, Rome, Italy
| | - Simona Sica
- Institute of Hematology Catholic University S. Cuore, Rome, Italy
| | | | | | - Livio Pagano
- Institute of Hematology Catholic University S. Cuore, Rome, Italy
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11
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Cuccaro A, Annunziata S, Cupelli E, Martini M, Calcagni ML, Rufini V, Giachelia M, Bartolomei F, Galli E, D'Alò F, Voso MT, Leone G, Giordano A, Larocca LM, Hohaus S. CD68+ cell count, early evaluation with PET and plasma TARC levels predict response in Hodgkin lymphoma. Cancer Med 2016; 5:398-406. [PMID: 26758564 PMCID: PMC4799945 DOI: 10.1002/cam4.585] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/16/2015] [Accepted: 10/19/2015] [Indexed: 12/14/2022] Open
Abstract
Early response evaluation with [18F]fluordeoxyglucose (FDG) positron emission tomography after 2 cycles of chemotherapy (interim PET) has been indicated as the strongest predictor for outcome in classical Hodgkin lymphoma (HL). We studied the prognostic role of the number of tumor‐infiltrating CD68+ cells and of the plasma levels of TARC (thymus and activation‐regulated chemokine) in the context of interim PET in 102 patients with classical HL treated with Adriamycin, Bleomycin, Vinblastine, Dacarbazine (ABVD). After 2 ABVD cycles, interim PET according to Deauville criteria was negative (score 0–3) in 85 patients and positive (score 4–5) in 15 patients (2 patients technically not evaluable). TARC levels were elevated in 89% of patients at diagnosis, and decreased after 2 cycles in 82% of patients. Persistently elevated TARC levels in 18% of patients were significantly associated with a positive PET result (P = 0.007). Strong predictors for progression‐free survival (PFS) were a negative interim PET (85% vs. 28%, P < 0.0001) and CD68+ cell counts <5% (89% vs. 67%, P = 0.006), while TARC levels at diagnosis and at interim evaluation had no prognostic role. In multivariate analysis, interim PET, CD68+ cell counts and presence of B‐symptoms were independently associated with PFS. We conclude that although TARC levels are a biomarker for early response evaluation, they cannot substitute for interim PET as outcome predictor in HL. The evaluation of CD68 counts and B‐symptoms at diagnosis may help to identify low‐risk patients regardless positive interim PET.
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Affiliation(s)
- Annarosa Cuccaro
- Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy
| | - Salvatore Annunziata
- Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Elisa Cupelli
- Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maurizio Martini
- Institute of Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria L Calcagni
- Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Vittoria Rufini
- Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Manuela Giachelia
- Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Eugenio Galli
- Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco D'Alò
- Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria T Voso
- Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Leone
- Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Giordano
- Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi M Larocca
- Institute of Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Stefan Hohaus
- Institute of Hematology, Catholic University of the Sacred Heart, Rome, Italy
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12
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Tisi MC, Giustiniani MC, D'Alò F, Sica S, Hohaus S, Pagano L. A T cell lymphoblastic lymphoma with mucormycosis as unusual etiology of acute cerebral ischemia. Ann Hematol 2015; 95:517-8. [PMID: 26666534 DOI: 10.1007/s00277-015-2576-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 12/04/2015] [Indexed: 11/24/2022]
Affiliation(s)
- M C Tisi
- Institute of Hematology, Catholic University S. Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy.
| | - M C Giustiniani
- Institute of Pathological Anatomy, Catholic University S. Cuore, Rome, Italy
| | - F D'Alò
- Institute of Hematology, Catholic University S. Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - S Sica
- Institute of Hematology, Catholic University S. Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - S Hohaus
- Institute of Hematology, Catholic University S. Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - L Pagano
- Institute of Hematology, Catholic University S. Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
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13
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Tisi MC, Cupelli E, Santangelo R, Maiolo E, Alma E, Giachelia M, Martini M, Bellesi S, D'Alò F, Voso MT, Pompili M, Leone G, Larocca LM, Hohaus S. Whole blood EBV-DNA predicts outcome in diffuse large B-cell lymphoma. Leuk Lymphoma 2015; 57:628-34. [PMID: 26458141 DOI: 10.3109/10428194.2015.1072766] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
An association between Epstein-Barr Virus (EBV) infection and lymphoproliferative diseases has been reported with EBV + diffuse large B cell-lymphoma (DLBCL) of the elderly described as a distinct entity. In a cohort of 218 human immunodeficiency virus (HIV)-negative patients with diffuse large B-cell lymphomas, we detected EBV-DNA in 25% of whole blood (WB) samples at diagnosis. Presence and viral load in WB, mononuclear cells or plasma did not predict the presence of EBV in the tumor biopsy. Positive Hepatitis C virus (HCV) serology was associated with a higher frequency of EBV in WB. Patients with EBV-DNA in WB had a significantly shorter progression-free (p = 0.02) and overall survival (p = 0.05) after immunochemotherapy with R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone). We conclude that detection of EBV in WB is not a surrogate marker for EBV-association in diffuse large B-cell lymphoma, however it associates with worse outcome.
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Affiliation(s)
- Maria Chiara Tisi
- a Institutes of Hematology , Catholic University S. Cuore , Rome , Italy
| | - Elisa Cupelli
- a Institutes of Hematology , Catholic University S. Cuore , Rome , Italy
| | - Rosaria Santangelo
- b Institutes of Microbiology , Catholic University S. Cuore , Rome , Italy
| | - Elena Maiolo
- a Institutes of Hematology , Catholic University S. Cuore , Rome , Italy
| | - Eleonora Alma
- a Institutes of Hematology , Catholic University S. Cuore , Rome , Italy
| | - Manuela Giachelia
- a Institutes of Hematology , Catholic University S. Cuore , Rome , Italy
| | - Maurizio Martini
- c Institutes of Pathological Anatomy , Catholic University S. Cuore , Rome , Italy , and
| | - Silvia Bellesi
- a Institutes of Hematology , Catholic University S. Cuore , Rome , Italy
| | - Francesco D'Alò
- a Institutes of Hematology , Catholic University S. Cuore , Rome , Italy
| | - Maria Teresa Voso
- a Institutes of Hematology , Catholic University S. Cuore , Rome , Italy
| | - Maurizio Pompili
- d Department of Internal Medicine , Catholic University S. Cuore , Rome , Italy
| | - Giuseppe Leone
- a Institutes of Hematology , Catholic University S. Cuore , Rome , Italy
| | - Luigi Maria Larocca
- c Institutes of Pathological Anatomy , Catholic University S. Cuore , Rome , Italy , and
| | - Stefan Hohaus
- a Institutes of Hematology , Catholic University S. Cuore , Rome , Italy
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14
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Falconi G, Fabiani E, Fianchi L, Criscuolo M, Raffaelli CS, Voso M, Leone G, D'Alò F. 31 DEREGULATION OF PI3K/AKT SIGNALING AND WNT TARGET GENES IN BONE MARROW MESENCHYMAL STROMAL CELLS FROM PATIENTS WITH MDS. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30032-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Leli C, Cardaccia A, Ferranti M, Cesarini A, D'Alò F, Ferri C, Cenci E, Mencacci A. Procalcitonin better than C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in predicting DNAemia in patients with sepsis. ACTA ACUST UNITED AC 2014; 46:745-52. [PMID: 25195647 DOI: 10.3109/00365548.2014.936493] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Procalcitonin (PCT) levels can be used to predict bacteremia and DNAemia in patients with sepsis. In this study, the diagnostic accuracy of PCT in predicting blood culture (BC) results and DNAemia, as detected by real-time PCR (RT-PCR), was compared with that of other markers of inflammation commonly evaluated in patients with suspected sepsis, such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count. METHODS A total of 571 patients for whom BC, blood RT-PCR, PCT, CRP, ESR, and WBC count were requested for laboratory diagnosis of sepsis were included in the study. Receiver operating characteristic curve analysis was performed to compare the ability of the above biomarkers to predict BC and blood RT-PCR results. RESULTS A total of 108 pathogens were identified by BC (79 pathogens, 14.5% positive rate) and/or RT-PCR (90 pathogens, 16.5% positive rate), after exclusion of 26 contaminated samples. The PCT areas under the curve (AUCs) in predicting BC (0.843; 95% CI 0.796-0.890; p < 0.0001) and RT-PCR (0.916; 95% CI 0.888-0.945; p < 0.0001) results were significantly greater than AUCs found for CRP, ESR, and WBC count. CONCLUSIONS PCT showed a better diagnostic accuracy than CRP, ESR, and WBC count in predicting DNAemia and bacteremia in patients with suspected sepsis.
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Affiliation(s)
- Christian Leli
- From the Microbiology Section, Department of Experimental Medicine, University of Perugia, Santa Maria della Misericordia Hospital , Perugia , Italy
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Leli C, Cardaccia A, D'Alò F, Ferri C, Bistoni F, Mencacci A. A prediction model for real-time PCR results in blood samples from febrile patients with suspected sepsis. J Med Microbiol 2014; 63:649-658. [PMID: 24523157 DOI: 10.1099/jmm.0.064097-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Sepsis, a systemic, deleterious host response to infection that leads to organ dysfunction, is a potentially deadly condition needing prompt identification of the causative organisms and early appropriate antimicrobial therapy. Among non-culture-based diagnostic methods, SeptiFast (SF) can be employed to speed bacterial and fungal DNA detection, but it suffers from poor sensitivity and high cost. The aim of the present study, performed in 285 febrile patients, was to develop a prediction model to restrict the SF assay to clinical cases with a high probability of positive SF results. The prevalence of SF results positive for a pathogen was 17.2 %. Independent predictors of positive results were: blood sampling within 12 h after the onset of fever [odds ratio (OR) 20.03; 95 % confidence interval (CI) 6.87-58.38; P<0.0001]; ≥0.5 ng serum procalcitonin (PCT) ml(-1) (OR 18.52; 95 % CI 5.12-67.02; P<0.0001); body temperature ≥38 °C (OR 3.78; 95 % CI 1.39-10.25; P = 0.009); ≤3 g serum albumin dl(-1) (OR 3.40; 95 % CI 1.27-9.08; P = 0.014); and ≥13 000 white blood cells mm(-3) (OR 2.75; 95 % CI 1.09-7.69; P = 0.05). The model showed good calibration (Hosmer-Lemeshow chi-squared 1.61; P = 0.978). Area under the receiving operating characteristic curve was 0.944 (95 % CI 0.914-0.973; P<0.0001). These results suggest that a prediction model based on PCT and a few other routinely available laboratory and clinical variables could be of help in selecting patients with a high probability of SF-positive results.
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Affiliation(s)
- Christian Leli
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy
| | - Angela Cardaccia
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy
| | - Francesco D'Alò
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy
| | - Carla Ferri
- Department of Clinical Chemistry and Haematology, Santa Maria della Misericordia Hospital, Perugia, Italy
| | - Francesco Bistoni
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy
| | - Antonella Mencacci
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy
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Leli C, Meucci M, Vento S, D'Alò F, Farinelli S, Perito S, Bistoni F, Mencacci A. Microbial and vaginal determinants influencing Mycoplasma hominis and Ureaplasma urealyticum genital colonization in a population of female patients. Infez Med 2013; 21:201-206. [PMID: 24008852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Mycoplasma hominis and Ureaplasma urealyticum are associated with chorioamnionitis, preterm delivery and pelvic inflammatory disease. The aim of this study was to evaluate the possible risk factors of co-colonization by M. hominis in patients already colonized by U. urealyticum and compare demographic parameters, vaginal pH and microbiota of women colonized by U. urealyticum or M. hominis. A total of 452 patients positive for U. urealyticum or M. hominis were analysed, 421 (93.1%) of whom were positive for U. urealyticum and 31 (6.9%) for M. hominis. Patients positive for M. hominis compared to patients positive for U. urealyticum were more frequently colonized by Gardnerella vaginalis (71% vs 18.5%; p 0.0001), less frequently by lactobacilli (16.1% vs 61.5%; p 0.0001), and more frequently had a pH value higher than 4.5 (96.8% vs 57%; p 0.0001), all conditions associated to bacterial vaginosis (BV). Logistic regression analysis showed that only G. vaginalis colonization and pH higher than 4.5 were independently related to M. hominis colonization (respectively p 0.0001 and p 0.016). Thus, in women colonized by U. urealyticum, BV is an independent risk factor for M. hominis co-colonization.
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Affiliation(s)
- Christian Leli
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy
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18
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Leli C, Cenci E, Cardaccia A, Moretti A, D'Alò F, Pagliochini R, Barcaccia M, Farinelli S, Vento S, Bistoni F, Mencacci A. Rapid identification of bacterial and fungal pathogens from positive blood cultures by MALDI-TOF MS. Int J Med Microbiol 2013; 303:205-9. [PMID: 23602511 DOI: 10.1016/j.ijmm.2013.03.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 03/07/2013] [Accepted: 03/16/2013] [Indexed: 10/27/2022] Open
Abstract
Sepsis is a syndrome characterized by a systemic inflammatory response due to severe infection. Early detection of causal agents and appropriate antimicrobial treatment reduce mortality. Conventional microbiological methods often do not provide time critical results for an optimal early management. We used an in-house protocol based on Tween 80 to process 109 positive blood cultures for bacteria and yeast identification by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS), and results were compared to standard reference or automated methods. MALDI-TOF MS correctly identified 91.7% of the isolates. Correct identification was obtained for 57/62 (91.9%) aerobic/facultative anaerobic Gram-positive isolates, 53 (85.5%) at species level, and 4 (6.4%) at the genus level; 32/32 (100%) aerobic/facultative anaerobic Gram-negative isolates, 31 (96.9%) at species level, and 1 (3.1%) at the genus level; 7/7 (100%) obligate anaerobes, all at the genus level; 3/7 (42.8%) fungi, all at genus level. Overall, the median identification time of MALDI-TOF MS vs reference standard methods was significantly shorter: median (interquartile range) 7.1h (4.7-10.2) vs 48.1h (32.5-50.0), p<0.0001. MALDI-TOF MS is a valuable tool for rapid identification of pathogens in septic patients. An in-house protocol based on Tween 80 can be used to process positive blood cultures.
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Affiliation(s)
- Christian Leli
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy
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Mencacci A, Leli C, Cardaccia A, Meucci M, Moretti A, D'Alò F, Farinelli S, Pagliochini R, Barcaccia M, Bistoni F. Procalcitonin predicts real-time PCR results in blood samples from patients with suspected sepsis. PLoS One 2012; 7:e53279. [PMID: 23300907 PMCID: PMC3531374 DOI: 10.1371/journal.pone.0053279] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/27/2012] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Early diagnosis and rapid bacterial identification are of primary importance for outcome of septic patients. SeptiFast® (SF) real-time PCR assay is of potential utility in the etiological diagnosis of sepsis, but it cannot replace blood culture (BC) for routine use in clinical laboratory. Procalcitonin (PCT) is a marker of sepsis and can predict bacteremia in septic patients. The aim of the present study was to investigate whether PCT serum levels could predict SF results, and could help screening febrile patients in which a SF assay can improve the etiological diagnosis of sepsis. METHODS From 1009 febrile patients with suspected sepsis, 1009 samples for BC, SF real-time PCR, and PCT determination were obtained simultaneously, and results were compared and statistically analysed. Receiver operating characteristic (ROC) curves were generated to determine the area under the curve and to identify which cut-off of PCT value produced the best sensitivity to detect SF results. RESULTS Mean PCT values of sera drawn simultaneously with samples SF positive (35.42 ± 61.03 ng/ml) or BC positive (23.14 ± 51.56 ng/ml) for a pathogen were statistically higher than those drawn simultaneously with SF negative (0.84 ± 1.67 ng/ml) or BC negative (2.79 ± 16.64 ng/ml) samples (p<0.0001). For SF, ROC analysis showed an area under the curve of 0.927 (95% confidence interval: 0.899-0.955, p<0.0001). The PCT cut-off value of 0.37 ng/ml showed a negative predictive value of 99%, reducing the number of SF assays of 53.9%, still identifying the 96.4% of the pathogens. CONCLUSION PCT can be used in febrile patients with suspected sepsis to predict SF positive or negative results. A cut-off value of 0.37 ng/ml can be considered for optimal sensitivity, so that, in the routine laboratory activity, SF assay should not be used for diagnosis of sepsis in an unselected patient population with a PCT value <0.37 ng/ml.
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Affiliation(s)
- Antonella Mencacci
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy.
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20
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Fianchi L, Criscuolo M, Lunghi M, Gaidano G, Breccia M, Levis A, Finelli C, Santini V, Musto P, Oliva EN, Leoni P, Aloe Spiriti A, D'Alò F, Hohaus S, Pagano L, Leone G, Voso MT. Outcome of therapy-related myeloid neoplasms treated with azacitidine. J Hematol Oncol 2012; 5:44. [PMID: 22853048 PMCID: PMC3419605 DOI: 10.1186/1756-8722-5-44] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [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: 05/24/2012] [Accepted: 07/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Therapy-related myeloid neoplasms (t-MN), including myelodysplastic syndromes and acute myeloid leukemia (t-MDS and t-AML) are associated to clinical and biologic unfavorable prognostic features, including high levels of DNA methylation. METHODS We retrospectively evaluated 50 t-MN patients (34 MDS and 16 AML) selected among all patients receiving azacitidine (AZA) at 10 Italian Hematology Centers. Patients had developed a t-MN at a median of 6.5 years (range 1.7- 29) after treatment of the primary tumor (hematological neoplasm, 27 patients; solid tumor, 23 patients). RESULTS The overall response rate was 42% (complete remission: 10 patients, partial remission: 2 and hematological improvement: 8 patients) and was obtained after a median of 3 cycles (range 1-6). Median overall survival (OS) was 21 months (range 1-53.6+) from AZA start. OS was significantly better in patients with less than 20% blasts, in normal karyotype t-AML and when AZA was used as front-line treatment. This was confirmed by the multivariate analysis. CONCLUSIONS This study reports efficacy of AZA in the largest series of therapy-related MN patients treated with 5-AZA. Our data show that blasts and karyotype maintain their important prognostic role in t-MN also in the azacitidine era.
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Affiliation(s)
- Luana Fianchi
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, 00168, Roma, Italy
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21
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Leli C, Mencacci A, Bombaci JC, D'Alò F, Farinelli S, Vitali M, Montagna P, Bietolini C, Meucci M, Perito S, Bistoni F. Prevalence and antimicrobial susceptibility of Ureaplasma urealyticum and Mycoplasma hominis in a population of Italian and immigrant outpatients. Infez Med 2012; 20:82-87. [PMID: 22767305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Ureaplasma urealyticum and Mycoplasma hominis are associated with non-gonococcal urethritis, increased risk of recurrent miscarriage, infertility and pelvic inflammatory disease. Migration flows from other countries change the local epidemiological profile of infectious diseases of patients treated by general practitioners and hospital doctors. Few studies have evaluated this ever-changing issue in the Italian population. The aim of this study was to assess possible differences in prevalence and antimicrobial susceptibility of U. urealyticum and M. hominis in a population of 433 Italian and immigrant outpatients by means of the commercially available MYCOFAST(®) Screening EvolutioN 3 Kit. Prevalence of positive samples was 44.5% in Italian patients and 53.4% in immigrants. Samples positive for U. urealyticum and total isolates were more frequent in African patients: U. urealyticum, 51.5% vs 33.3%; Yates-corrected chi-square=3.98; p=0.046; total isolates, 54.5% vs 34.3%; Yates-corrected chi-square=4.45; p=0.035. Among samples positive for U. urealyticum, 66.4% were resistant to ciprofloxacin, whereas 27.6% to ofloxacin. In M. hominis isolates, 66.7% were resistant to both azythromycin and roxythromycin. Our study showed how prevalence of genital mycoplasmas and antibiotic resistance profiles change in relation to the country of origin. Therefore, surveillance is critical for the early cure and prevention of the occurrence of resistant strains.
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Affiliation(s)
- Christian Leli
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy
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22
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Basseres DS, D'Alò F, Yeap BY, Löwenberg EC, Gonzalez DA, Yasuda H, Dayaram T, Kocher ON, Godleski JJ, Richards WG, Meyerson M, Kobayashi S, Tenen DG, Halmos B, Costa DB. Frequent downregulation of the transcription factor Foxa2 in lung cancer through epigenetic silencing. Lung Cancer 2012; 77:31-7. [PMID: 22341411 DOI: 10.1016/j.lungcan.2012.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/19/2011] [Accepted: 01/20/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE We sought to determine the mechanisms of downregulation of the airway transcription factor Foxa2 in lung cancer and the expression status of Foxa2 in non-small-cell lung cancer (NSCLC). METHODS A series of 25 lung cancer cell lines were evaluated for Foxa2 protein expression, FOXA2 mRNA levels, FOXA2 mutations, FOXA2 copy number changes and for evidence of FOXA2 promoter hypermethylation. In addition, 32 NSCLCs were sequenced for FOXA2 mutations and 173 primary NSCLC tumors evaluated for Foxa2 expression using an immunohistochemical assay. RESULTS Out of the 25 cell lines, 13 (52%) had undetectable FOXA2 mRNA. The expression of FOXA2 mRNA and Foxa2 protein were congruent in 19/22 cells (p = 0.001). FOXA2 mutations were not identified in primary NSCLCs and were infrequent in cell lines. Focal or broad chromosomal deletions involving FOXA2 were not present. The promoter region of FOXA2 had evidence of hypermethylation, with an inverse correlation between FOXA2 mRNA expression and presence of CpG dinucleotide methylation (p < 0.0001). In primary NSCLC tumor specimens, there was a high frequency of either absence (42/173, 24.2%) or no/low expression (96/173, 55.4%) of Foxa2. In 130 patients with stage I NSCLC there was a trend towards decreased survival in tumors with no/low expression of Foxa2 (HR of 1.6, 95%CI 0.9-3.1; p = 0.122). CONCLUSIONS Loss of expression of Foxa2 is frequent in lung cancer cell lines and NSCLCs. The main mechanism of downregulation of Foxa2 is epigenetic silencing through promoter hypermethylation. Further elucidation of the involvement of Foxa2 and other airway transcription factors in the pathogenesis of lung cancer may identify novel therapeutic targets.
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Affiliation(s)
- Daniela S Basseres
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; University of São Paulo, São Paulo, SP, Brazil
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23
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Greco M, D'Alò F, Scardocci A, Criscuolo M, Fabiani E, Guidi F, Di Ruscio A, Migliara G, Pagano L, Fianchi L, Chiusolo P, Hohaus S, Leone G, Voso MT. Promoter methylation of DAPK1, E-cadherin and thrombospondin-1 in de novo and therapy-related myeloid neoplasms. Blood Cells Mol Dis 2010; 45:181-5. [PMID: 20655775 DOI: 10.1016/j.bcmd.2010.05.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 05/14/2010] [Indexed: 11/26/2022]
Abstract
DNA methylation is one of the major epigenetic changes in human cancers, leading to silencing of tumor suppressor genes, with a pathogenetic role in tumor development and progression in myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML). Methylation of key promoter regions, induced by cytotoxic therapy together with complex genetic changes, is important in the biology of therapy-related myeloid neoplasms (t-MN). We were interested in the characterization of the methylation pattern of AML and MDS de novo and therapy-related. We studied 385 patients (179 females, 206 males), of a median age of 66 years (range 16-98 years). There were 105 MDS, 208 de novo AML and 72 t-MN (45 MDS and 27 AML). Using a methylation-specific PCR, we studied the promoter methylation status of E-cadherin (CDH1), TSP1 and DAP-Kinase 1. These genes have been shown to be involved in the malignant transformation, interfering with angiogenesis, interaction with micro-environment, apoptosis and xenobiotic detoxification. We found no associations between promoter hypermethylation and gender or age at the time of initial diagnosis. In patients with MDS, there were no associations between hypermethylation and clinical characteristics, including IPSS score, WHO classification and cytogenetics. DAPK1 was more frequently methylated in t-MDS/AML when compared to de novo MDS and AML (39% vs 15.3% and 24.4%, p=0.0001), while methylation of CDH1 was similar in t-MDS/AML and AML (51% and 53.4%), but less frequent in de novo MDS (29%) (p=0.003). In the t-MDS/AML group, we found that the methylation pattern appeared to be related to the primary tumor, with DAPK1 more frequently methylated in patients with a previous lymphoproliferative disease (75% vs 32%, p=0.006). On the other hand, methylation of CDH1 was associated to radiotherapy for the primary malignancy (84.5% vs 38%, p=0.003). TSP1 hypermethylation was rare and not characteristic of t-MDS/AML. In 177 patients studied for concurrent methylation of several promoters, t-MN and AML de novo were significantly more frequently hypermethylated in 2 or more promoter regions than de novo MDS (20% vs 12.4%, p<0.001). Chemotherapy and individual genetic predisposition have a role in t-MDS/AML development, the identification of specific epigenetic modifications may explain complexity and genomic instability of these diseases and give the basis for targeted-therapy. The significant association with previous malignancy subtypes may underlie a likely susceptibility to methylation of specific targets and a role for constitutional epimutations as predisposing factors for the development of therapy-related myeloid neoplasm.
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Affiliation(s)
- Mariangela Greco
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy
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24
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Bozzoli V, Chiara Tisi M, D'Alò F, Massini G, Mansueto G, Vannata B, Arena V, Larocca LM, Teofili L, Leone G, Hohaus S. Intravascular large B cell lymphoma: when lymphoma is suspected but routine diagnostic work-up is negative. Leuk Lymphoma 2009; 50:1900-3. [DOI: 10.3109/10428190903234005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Hohaus S, Giachelia M, Massini G, Mansueto G, Vannata B, Bozzoli V, Criscuolo M, D'Alò F, Martini M, Larocca LM, Voso MT, Leone G. Cell-free circulating DNA in Hodgkin's and non-Hodgkin's lymphomas. Ann Oncol 2009; 20:1408-13. [PMID: 19465421 DOI: 10.1093/annonc/mdp006] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Levels of cell-free circulating DNA have been correlated to clinical characteristics and prognosis in patients with cancers of epithelial origin, while there are no data on patients with B-lymphoproliferative diseases. PATIENTS AND METHODS Cell-free DNA levels in the plasma samples of 142 patients with lymphomas [45 with Hodgkin's lymphoma (HL), 63 with diffuse large B-cell non-Hodgkin's lymphoma (DLBCL), 24 with follicular, and 10 with mantle cell non-Hodgkin's lymphoma (NHL)] at diagnosis and of 41 healthy individuals were determined using a quantitative PCR for the beta-globin gene. RESULTS Levels of circulating DNA in patients with HL, DLBCL, and mantle cell NHL were significantly higher than in controls (P < 0.01 for all). Increased levels of plasma DNA were associated with advanced stage disease, presence of B-symptoms, elevated lactate dehydrogenase levels, and age >60 years (P = 0.009; <0.0001; <0.0001; 0.04, respectively). In HL, histological signs of necrosis and grade 2 type of nodular sclerosis were associated with increased plasma DNA. Elevated plasma DNA levels were associated with an inferior failure-free survival in patients with HL (P = 0.01) and DLBCL (P = 0.03). CONCLUSION Quantification of circulating DNA by real-time PCR at diagnosis can identify patients with elevated levels that are associated with disease characteristics indicating aggressive disease and poor prognosis.
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Affiliation(s)
- S Hohaus
- Istituto di Ematologia e di Anatomia Patologica, Università Cattolica S. Cuore, Rome, Italy.
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26
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Voso MT, Hohaus S, Guidi F, Fabiani E, D'Alò F, Groner S, Späth D, Doehner K, Leone G, Doehner H, Schlenk RF. Prognostic role of glutathione S-transferase polymorphisms in acute myeloid leukemia. Leukemia 2008; 22:1685-91. [DOI: 10.1038/leu.2008.169] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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27
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Leone G, D'Alò F, Zardo G, Voso MT, Nervi C. Epigenetic treatment of myelodysplastic syndromes and acute myeloid leukemias. Curr Med Chem 2008; 15:1274-87. [PMID: 18537607 PMCID: PMC2764862 DOI: 10.2174/092986708784534947] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 04/07/2008] [Accepted: 04/08/2008] [Indexed: 12/31/2022]
Abstract
Epigenetic mechanisms affecting chromatin structure contribute to regulate gene expression and assure the inheritance of information, which are essential for the proper expression of key regulatory genes in healthy cells, tissues and organs. In the medical field, an increasing body of evidence indicates that altered gene expression or de-regulated gene function lead to disease. Cancer cells also suffer a profound change in the genomic methylation patterns and chromatin status. Aberrant DNA methylation patterns, changes in chromatin structure and in gene expression are common in all kind of tumor types. However, studies on leukemias have provided paradigmatic examples for the functional implications of the epigenetic alterations in cancer development and progression as well as their relevance for therapeutical targeting.
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Affiliation(s)
- Giuseppe Leone
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.
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28
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Koschmieder S, D'Alò F, Radomska H, Schöneich C, Chang JS, Konopleva M, Kobayashi S, Levantini E, Suh N, Di Ruscio A, Voso MT, Watt JC, Santhanam R, Sargin B, Kantarjian H, Andreeff M, Sporn MB, Perrotti D, Berdel WE, Müller-Tidow C, Serve H, Tenen DG. CDDO induces granulocytic differentiation of myeloid leukemic blasts through translational up-regulation of p42 CCAAT enhancer binding protein alpha. Blood 2007; 110:3695-705. [PMID: 17671235 PMCID: PMC2077317 DOI: 10.1182/blood-2006-11-058941] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
2-Cyano-3,12-dioxooleana-1,9-dien-28-oic acid (CDDO) induces differentiation and apoptosis of tumor cells in vitro and in vivo. Here we assessed the effects of CDDO on CCAAT enhancer-binding protein alpha (CEBPA), a transcription factor critical for granulocytic differentiation. In HL60 acute myeloid leukemia (AML) cells, CDDO (0.01 to 2 muM) induces apoptosis in a dose-dependent manner. Conversely, subapoptotic doses of CDDO promote phagocytic activity and granulocytic-monocytic differentiation of HL60 cells through increased de novo synthesis of p42 CEBPA protein. CEBPA translational up-regulation is required for CDDO-induced granulocytic differentiation and depends on the integrity of the CEBPA upstream open reading frame (uORF). Moreover, CDDO increases the ratio of transcriptionally active p42 and the inactive p30 CEBPA isoform, which, in turn, leads to transcriptional activation of CEBPA-regulated genes (eg, GSCFR) and is associated with dephosphorylation of eIF2alpha and phosphorylation of eIF4E. In concordance with these results, CDDO induces a CEBPA ratio change and differentiation of primary blasts from patients with acute myeloid leukemia (AML). Because AML is characterized by arrested differentiation, our data suggest the inclusion of CDDO in the therapy of AML characterized by dysfunctional CEBPA expression.
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Affiliation(s)
- Steffen Koschmieder
- Department of Medicine, Hematology and Oncology, University of Münster, Münster Germany.
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29
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D'Alò F, Voso MT, Guidi F, Massini G, Scardocci A, Sica S, Pagano L, Hohaus S, Leone G. Polymorphisms of CYP1A1 and glutathione S-transferase and susceptibility to adult acute myeloid leukemia. Haematologica 2004; 89:664-70. [PMID: 15194533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The origin of acute myeloid leukemia (AML) may be explained by a combination of genetic susceptibility factors and environmental exposure. We studied the polymorphisms of cytochrome P450 CYP1A1 and glutathione S-transferase (GST), enzymes involved in the metabolism of carcinogens and anti-cancer drugs, as risk factors for adult AML. DESIGN AND METHODS The prevalence of CYP1A1*2A, *2B and *4 alleles and of GSTM1 and GSTT1 homozygous deletions was examined in 193 patients with AML and 273 normal individuals using polymerase chain reaction (PCR)-based methods. RESULTS A higher prevalence of the CYP1A1*4 allele was found in AML patients than in controls (19.1% vs 9.9%, OR =2.2, 95% C.I. 1.3-3.7, p=0.006). GSTT1 homozygous deletions were also more frequent in AML patients (29% vs 19%, OR = 1.7, 95% CI 1.1-2.7, p=0.02). The combination of GSTT1 null genotype and CYP1A1 *2B and *4 alleles further increased the risk of AML (OR =10.2, 95% CI 1.2-83.9, p=0.01, and OR =7.0, 95% CI 2.0-24.8, p=0.001, respectively). INTERPRETATION AND CONCLUSIONS Polymorphic variants in xenobiotic-metabolism genes, including CYP1A1 and GSTT1, may increase the risk of adult AML, particularly when present together.
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Affiliation(s)
- Francesco D'Alò
- Istituto di Ematologia, Universita' Cattolica S. Cuore, Rome, Italy
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30
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Mencacci A, Cenci E, Mazzolla R, Farinelli S, D'Alò F, Vitali M, Bistoni F. Aeromonas veronii biovar veronii septicaemia and acute suppurative cholangitis in a patient with hepatitis B. J Med Microbiol 2003; 52:727-730. [PMID: 12867570 DOI: 10.1099/jmm.0.05214-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Gram-negative bacilli of the genus Aeromonas are widespread in aquatic environments and can be responsible for human infections. Although Aeromonas extraintestinal and systemic infections have been reported with growing frequency in recent years, Aeromonas septicaemia remains an uncommon finding, often associated with serious underlying disease and predominantly related to the species Aeromonas hydrophila, Aeromonas veronii biovar sobria and Aeromonas caviae. Here, a case of A. veronii biovar veronii septicaemia and acute suppurative cholangitis is reported in a patient with chronic hepatitis B.
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Affiliation(s)
- Antonella Mencacci
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
| | - Elio Cenci
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
| | - Rosanna Mazzolla
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
| | - Senia Farinelli
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
| | - Francesco D'Alò
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
| | - Mariolina Vitali
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
| | - Francesco Bistoni
- Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Via del Giochetto, 06122 Perugia, Italy
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31
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Voso MT, Pantel G, Rutella S, Weis M, D'Alò F, Urbano R, Leone G, Haas R, Hohaus S. Rituximab reduces the number of peripheral blood B-cells in vitro mainly by effector cell-mediated mechanisms. Haematologica 2002; 87:918-25. [PMID: 12217803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The humanized CD20 mono- clonal antibody, rituximab, has significant anti-tumor activity in patients with B-cell non-Hodgkin's lymphoma and induces depletion of B-cells in vivo. It was the objective of this study to define the contribution of the different mechanisms of action of rituximab on primary normal and malignant B-cells. DESIGN AND METHODS Primary human B-lymphocytes and effector cell fractions were isolated from peripheral blood of normal donors using an immunomagnetic separation technique. Blood samples from 20 patients with chronic lymphocytic leukemia (CLL) were studied and the B-lymphoblastoid Daudi cell line was used as a control. B-cells were cultured in the presence or absence of rituximab adding a secondary hyper-crosslinking antibody, serum as source of complement or different effector cell fractions. The cells were analyzed by immunofluorescence staining and flow cytometry. RESULTS In contrast to the B-lymphoblastoid Daudi cell line, the number of highly purified normal peripheral blood CD19+ cells was only minimally affected by rituximab in the presence of autologous serum. A significant reduction in the number of B-cells was observed when mononuclear cells from peripheral blood were added back. To identify the cell type which mediates this effect, CD3+ T-cells, CD56+ cells, and CD14+ monocytes were added to selected CD22+ B-cells. A marked B-cell decrease was only observed in the presence of CD56+ and CD14+ cells in an effector to target ratio of 10:1. The experiments with mononuclear cells from patients with CLL showed a B-cell reduction by rituximab, which was significantly enhanced following addition of granulocyte-macrophage colony-stimulating factor (GM-CSF). INTERPRETATION AND CONCLUSIONS These data support the important role of cell-mediated mechanisms in the B-cell-depleting action of rituximab and suggest that pre-treatment with GM-CSF could improve the response to rituximab in patients with CLL.
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32
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Morace G, Amato G, Bistoni F, Fadda G, Marone P, Montagna MT, Oliveri S, Polonelli L, Rigoli R, Mancuso I, La Face S, Masucci L, Romano L, Napoli C, Tatò D, Buscema MG, Belli CMC, Piccirillo MM, Conti S, Covan S, Fanti F, Cavanna C, D'Alò F, Pitzurra L. Multicenter comparative evaluation of six commercial systems and the national committee for clinical laboratory standards m27-a broth microdilution method for fluconazole susceptibility testing of Candida species. J Clin Microbiol 2002; 40:2953-8. [PMID: 12149358 PMCID: PMC120637 DOI: 10.1128/jcm.40.8.2953-2958.2002] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2002] [Revised: 04/18/2002] [Accepted: 05/27/2002] [Indexed: 11/20/2022] Open
Abstract
Fluconazole susceptibility among 800 clinical Candida isolates (60% C. albicans) and two control strains (C. krusei ATCC 6258 and C. parapsilosis ATCC 22019) was tested with the NCCLS M27-A method (gold standard) and six commercial products (Candifast, disk, Etest, Fungitest, Integral System Yeasts, and Sensititre YeastOne). Results were classified as susceptible, susceptible-dose dependent, or resistant using M27-A breakpoints or, for Fungitest, Integral System Yeasts, and Candifast, as susceptible, intermediate, or resistant, according to the manufacturers' instructions. Concordance with NCCLS M27-A results was analyzed with the chi(2) test. Intra- and interlaboratory reproducibility was also evaluated. NCCLS M27-A (90.1%), Etest (93.1%), Sensititre YeastOne (93.1%), disk (96.7%), Fungitest (92.6%), Integral System Yeasts (40.6%), and Candifast (6.0%) classified the indicated percentages of C. albicans isolates as susceptible. Among non-C. albicans strains, the percentages of susceptible isolates were as follows: NCCLS M27-A, 74.0%; Etest, 83.8%; Sensititre YeastOne, 64.1%; disk, 60.6%; Fungitest, 76.6%; Integral System Yeasts, 28.3%; and Candifast, 27.4%. All methods except Candifast and Integral System Yeasts showed good agreement with NCCLS M27-A results for both C albicans and non-C. albicans isolates. Intralaboratory reproducibility was excellent for NCCLS M27-A, Etest, Sensititre YeastOne, disk, and Fungitest (88 to 91%). Similar results emerged from the interlaboratory reproducibility evaluation. Our findings indicate that some commercial methods can be useful for fluconazole susceptibility testing of clinical Candida isolates. Those characterized by a lack of medium standardization and/or objective interpretative criteria should be avoided. Particular caution is necessary when testing is being done for clinical and epidemiological purposes.
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Affiliation(s)
- G Morace
- Istituto di Microbiologia, Università degli Studi di Milano, Italy.
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Martini M, D'Alò F, Hohaus S, Leone G, Larocca LM. Absence of structural mutations of the BAK gene in B cell lymphomas. Haematologica 2002; 87:661-2. [PMID: 12031926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
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Martini M, D'Alò F, Pierconti F, Ricci R, Capelli A, Leone G, Larocca LM. Bax mutations are an infrequent event in indolent lymphomas and in mantle cell lymphoma. Haematologica 2000; 85:1019-23. [PMID: 11025591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The Bax gene is one of the most important genes involved in apoptosis regulation. Recently, it has been proposed that inactivating mutations of this death agonist may contribute to the pathogenesis of human tumors. This study was aimed at defining the status of the Bax gene in indolent lymphomas. DESIGN AND METHODS Fifty paraffin-embedded biopsies from indolent lymphomas (10 small lymphocytic lymphomas, 5 immunocytomas, 20 follicular lymphomas and 15 marginal zone lymphomas) and 10 mantle cell lymphomas ( MCL ) were studied. All six exons of the Bax gene, together with their flanking sequences, underwent mutational analysis by PCR-SSCP followed by direct sequencing of positive cases. Moreover, Bax protein expression was investigated in all samples by immunohistochemical analysis. RESULTS All analyzed cases showed wild type Bax gene alleles and variable levels of Bax protein expression. INTERPRETATION AND CONCLUSIONS This study indicates that deregulation of apoptotic control in indolent lymphomas and MCL is not caused by Bax mutations and that other molecular mechanisms must, therefore, be involved.
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Affiliation(s)
- M Martini
- Istituto di Anatomia Patologica, Policlinico Gemelli, Università Cattolica del Sacro Cuore, L.go F. Vito 1, 00168, Rome, Italy.
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Sensini A, Marroni M, Bassotti G, Farinelli S, D'Alò F, Gentili AM, Sbaraglia G, Baldelli F. Clostridium difficile-associated reactive arthritis in an HLA-B27 negative male. J Clin Gastroenterol 1993; 16:354-5. [PMID: 8331275 DOI: 10.1097/00004836-199306000-00020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- A Sensini
- Dipartimento di Medicina Sperimentale e Scienze Biochimiche, Università degli Studi di Perugia, Assissi, Italy
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Staffolani N, Cervini M, Giannoni C, Guerra M, Pugliese M, D'Alò F, Farinelli S. [The effect of orthodontic magnets on the oral microbial flora]. Minerva Stomatol 1991; 40:483-6. [PMID: 1753928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In this study we wanted to test the in vitro effects of orthodontic magnetic brackets, developing different magnetic fields, on the oral microbial flora. We noticed that a magnetic field has its most considerable influence on Candida albicans growth; the stimulating response depends on various factors: cell inoculum, exposure time and magnetic field frequency.
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Affiliation(s)
- N Staffolani
- Cattedra di Ortognatodonzia, Università degli Studi di Perugia
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Sposini T, Bastianini L, D'Alò F, Verducci N, Sbaraglia G. Methicillin-resistant staphylococcal strains isolated from clinical samples. J Chemother 1991; 3 Suppl 1:169-71. [PMID: 12041757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Infections caused by methicillin-resistant Staphylococcus strains (MRSS) have become an increasing problem both as community-acquired and nosocomial infections. In order to eradicate colonization as well as to cure infections, optimal antibiotic treatment is required. In this study we examined the incidence of MRSS in clinical samples and compared the antibiotic susceptibility pattern of methicillin-resistant Staphylococcus aureus with that of methicillin-resistant Staphylococcus non-aureus strains. All the MRSS were resistant to penicillin. Among them there was a variation in the percentage of strains resistant to various antimicrobial agents. Within MRSS the most frequent resistances were those to erythromycin and norfloxacin. Ciprofloxacin and teicoplanin were the most effective antibiotics tested against MRSS, followed in activity by vancomycin and imipenem. The incidence of antibiotic resistance among MRSS was significantly higher than that among methicillin-susceptibility staphylococcal species.
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Affiliation(s)
- T Sposini
- Dpt. Experimental Medicine and Biochemistry Sciences, University of Perugia, Italy
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