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Pizzi M, Vianello F, Binotto G, Vianelli N, Carli G, Auteri G, Nichele I, Sbaraglia M, Zoletto S, Scarmozzino F, Bresciani R, d'Amore F, Friziero A, Guzzardo V, Bertozzi I, Famengo B, d'Amore ESG, Sabattini E, Dei Tos AP. Thrombopoietin receptor agonists increase splenic regulatory T‐cell numbers in immune thrombocytopenia. Br J Haematol 2022; 198:916-922. [DOI: 10.1111/bjh.18309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/18/2022] [Accepted: 06/01/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Marco Pizzi
- Surgical Pathology and Cytopathology Unit, Department of Medicine‐DIMED University of Padua School of Medicine Padua Italy
| | - Fabrizio Vianello
- Hematology and Clinical Immunology Unit, Department of Medicine‐DIMED University of Padua School of Medicine Padua Italy
| | - Gianni Binotto
- Hematology and Clinical Immunology Unit, Department of Medicine‐DIMED University of Padua School of Medicine Padua Italy
| | - Nicola Vianelli
- IRCCS Azienda Ospedaliero‐Universitaria di Bologna Istituto di Ematologia "Seràgnoli" Bologna Italy
| | - Giuseppe Carli
- Hematology Unit Azienda ULSS 8 Berica ‐ San Bortolo Hospital Vicenza Italy
| | - Giuseppe Auteri
- IRCCS Azienda Ospedaliero‐Universitaria di Bologna Istituto di Ematologia "Seràgnoli" Bologna Italy
- Dipartimento di Medicina Specialistica Diagnostica e Sperimentale University of Bologna Bologna Italy
| | - Ilaria Nichele
- Hematology Unit Azienda ULSS 8 Berica ‐ San Bortolo Hospital Vicenza Italy
| | - Marta Sbaraglia
- Surgical Pathology and Cytopathology Unit, Department of Medicine‐DIMED University of Padua School of Medicine Padua Italy
| | - Simone Zoletto
- Hematology and Clinical Immunology Unit, Department of Medicine‐DIMED University of Padua School of Medicine Padua Italy
| | - Federico Scarmozzino
- Surgical Pathology and Cytopathology Unit, Department of Medicine‐DIMED University of Padua School of Medicine Padua Italy
| | - Rita Bresciani
- Surgical Pathology and Cytopathology Unit, Department of Medicine‐DIMED University of Padua School of Medicine Padua Italy
| | - Fabio d'Amore
- Hematology and Clinical Immunology Unit, Department of Medicine‐DIMED University of Padua School of Medicine Padua Italy
| | - Alberto Friziero
- 1st General Surgery Unit, Department of Surgery, Oncology and Gastroenterology University of Padova School of Medicine Padova Italy
| | - Vincenza Guzzardo
- Surgical Pathology and Cytopathology Unit, Department of Medicine‐DIMED University of Padua School of Medicine Padua Italy
| | - Irene Bertozzi
- 1st Medical Clinic, Department of Medicine – DIMED University of Padua School of Medicine Padua Italy
| | - Barbara Famengo
- Department of Pathological Anatomy Azienda ULSS 8 Berica ‐ San Bortolo Hospital Vicenza Italy
| | - Emanuele S. G. d'Amore
- Department of Pathological Anatomy Azienda ULSS 8 Berica ‐ San Bortolo Hospital Vicenza Italy
| | - Elena Sabattini
- Haemolymphopathology Unit IRCCS ‐ Azienda Ospedaliero‐Universitaria di Bologna Bologna Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine‐DIMED University of Padua School of Medicine Padua Italy
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2
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Carli G, Nichele I, Ruggeri M, Barra S, Tosetto A. Deep vein thrombosis (DVT) occurring shortly after the second dose of mRNA SARS-CoV-2 vaccine. Intern Emerg Med 2021; 16:803-804. [PMID: 33687691 PMCID: PMC7940863 DOI: 10.1007/s11739-021-02685-0] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Giuseppe Carli
- Hematology Department, S. Bortolo Hospital, ULSS 8 Berica, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Ilaria Nichele
- Hematology Department, S. Bortolo Hospital, ULSS 8 Berica, Viale Rodolfi 37, 36100, Vicenza, Italy
| | - Marco Ruggeri
- Hematology Department, S. Bortolo Hospital, ULSS 8 Berica, Viale Rodolfi 37, 36100, Vicenza, Italy
| | | | - Alberto Tosetto
- Hematology Department, S. Bortolo Hospital, ULSS 8 Berica, Viale Rodolfi 37, 36100, Vicenza, Italy.
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3
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Tosetto A, Testa S, Palareti G, Paoletti O, Nichele I, Catalano F, Morandini R, Di Paolo M, Tala M, Esteban P, Cora' F, Mannino S, Maroni A, Sessa M, Castaman G. The effect of management models on thromboembolic and bleeding rates in anticoagulated patients: an ecological study. Intern Emerg Med 2019; 14:1307-1315. [PMID: 31309520 DOI: 10.1007/s11739-019-02148-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/04/2019] [Indexed: 10/26/2022]
Abstract
The primary study objective is to compare the outcomes of patients taking oral anticoagulant medications in two distinct populations treated according to different management models (comprehensive vs. usual care). (Design: regional prospective cohort study; setting: hospital admission data from two regions). Eligible partecipants were patients taking oral anticoagulant drugs (vitamin K antagonist or direct oral anticoagulants), residents in the Vicenza and Cremona districts from February 1st, 2016 to June 30th, 2017. Patients were identified by accessing the administrative databases of patient drug prescriptions. The primary study outcome was admission to the Emergency Department for stroke, systemic arterial embolism, recurrence of venous thromboembolism or major bleeding. The study evaluated outcomes in 14,226 patients taking oral anticoagulants, of whom 6725 being followed in Cremona with a comprehensive management model. There were 19 and 45 thromboembolic events over 6205 and 6530 patient-years in the Cremona and Vicenza cohort, respectively (IRR 0.44, 95% CI 0.24-0.77). The reduction of events in the Cremona cohort was almost entirely explained by a decrease of events in patients taking VKA (IRR 0.41, 95% CI 0.20-0.78) but not DOACs (IRR 1.08, 95% CI 0.25-5.24). The rate of major bleeding was non-significantly higher in Cremona than in Vicenza (IRI 1.32; 95% CI 0.74-2.40). Across the two cohorts, the risk of bleeding was lower in patients being treated with DOACs rather than warfarin (10/4574 vs. 42/8161 event/person-years, respectively, IRR 0.42 95% CI 0.19-0.86). We conclude that a comprehensive management model providing centralized dose prescription and follow-up may significantly reduce the rate of thromboembolic complications, without substantially increasing the number of bleeding complications. Patients treated with direct oral anticoagulants appear to have a rate of thromboembolic complications comparable to VKA patients under the best management model, with a reduction of major bleeding.
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Affiliation(s)
- Alberto Tosetto
- Haemostasis and Thrombosis Unit, Haematology Department, San Bortolo Hospital, Via Rodolfi 37, 36100, Vicenza, Italy.
| | - Sophie Testa
- Haemostasis and Thrombosis Centre, Cremona Hospital, 26100, Cremona, Italy
| | | | - Oriana Paoletti
- Haemostasis and Thrombosis Centre, Cremona Hospital, 26100, Cremona, Italy
| | - Ilaria Nichele
- Haemostasis and Thrombosis Unit, Haematology Department, San Bortolo Hospital, Via Rodolfi 37, 36100, Vicenza, Italy
| | - Francesca Catalano
- Haemostasis and Thrombosis Centre, Cremona Hospital, 26100, Cremona, Italy
| | - Rossella Morandini
- Haemostasis and Thrombosis Centre, Cremona Hospital, 26100, Cremona, Italy
| | - Maria Di Paolo
- Haemostasis and Thrombosis Unit, Haematology Department, San Bortolo Hospital, Via Rodolfi 37, 36100, Vicenza, Italy
| | - Maurizio Tala
- Haemostasis and Thrombosis Centre, Cremona Hospital, 26100, Cremona, Italy
| | - Pilar Esteban
- Haemostasis and Thrombosis Centre, Cremona Hospital, 26100, Cremona, Italy
| | - Francesco Cora'
- Emergency Department, San Bortolo Hospital, 36100, Vicenza, Italy
| | | | - Anna Maroni
- Territorial Pharmacy Unit, San Bortolo Hospital, 36100, Vicenza, Italy
| | - Maria Sessa
- Neurology Division, Cremona Hospital, 26100, Cremona, Italy
| | - Giancarlo Castaman
- Department of Oncology, Centre for Bleeding Disorders and Coagulation, Careggi University Hospital, 50134, Florence, Italy
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4
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Bertozzi I, Ruggeri M, Nichele I, Biagetti G, Cosi E, Randi ML. Thrombotic and hemorrhagic complications in idiopathic erythrocytosis. Am J Hematol 2017; 92:E639-E641. [PMID: 28762526 DOI: 10.1002/ajh.24873] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Irene Bertozzi
- Department of Medicine; DIMED- University of Padua; Padua Italy
| | - Marco Ruggeri
- Hematology Department; San Bortolo Hospital; Vicenza Italy
| | - Ilaria Nichele
- Hematology Department; San Bortolo Hospital; Vicenza Italy
| | | | - Elisabetta Cosi
- Department of Medicine; DIMED- University of Padua; Padua Italy
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5
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Tosetto A, Testa S, Martinelli I, Poli D, Cosmi B, Lodigiani C, Ageno W, De Stefano V, Falanga A, Nichele I, Paoletti O, Bucciarelli P, Antonucci E, Legnani C, Banfi E, Dentali F, Bartolomei F, Barcella L, Palareti G. External validation of the DASH prediction rule: a retrospective cohort study. J Thromb Haemost 2017; 15:1963-1970. [PMID: 28762665 DOI: 10.1111/jth.13781] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 05/22/2017] [Indexed: 11/27/2022]
Abstract
Essentials Predicting recurrences may guide therapy after unprovoked venous thromboembolism (VTE). We evaluated the DASH score in 827 patients with unprovoked VTE to verify prediction accuracy. A DASH score ≤ 1 had a cumulative recurrence risk at 1 year of 3.6%, as predicted by the model. The DASH score performed better in younger (< 65 years old) subjects. SUMMARY Background The DASH prediction model has been proposed as a guide to identify patients at low risk of recurrence of venous thromboembolism (VTE), but has never been validated in an independent cohort. Aims To validate the calibration and discrimination of the DASH prediction model, and to evaluate the DASH score in a predefined patient subgroup aged > 65 years. Methods Patients with a proximal unprovoked deep vein thrombosis (DVT) or pulmonary embolism (PE) who received a full course of vitamin K antagonist or direct oral anticoagulant (> 3 months) and had D-dimer measured after treatment withdrawal were eligible. The DASH score was computed on the basis of the D-dimer level after therapy withdrawal and personal characteristics at the time of the event. Recurrent VTE events were symptomatic proximal or distal DVT/PE, and were analyzed with a time-dependent analysis. Observed 12-month and 24-month recurrence rates were compared with recurrence rates predicted by the DASH model. Results We analyzed a total of 827 patients, of whom 100 (12.1%) had an objectively documented recurrence. As compared with the original DASH cohort, there was a greater proportion of subjects with a 'low-risk' (≤ 1) DASH score (66.3% versus 51.6%, P < 0.001). The slope of the observed versus expected cumulative incidence at 2 years was 0.71 (95% confidence interval 0.51-1.45). The c-statistic was lower for subjects aged > 65 years (0.54) than for younger subjects (0.72). Conclusions These results confirm the validity of DASH prediction model, particularly in young subjects. The recurrence risk in elderly patients (> 65 years) was, however, > 5% even in those with the lowest DASH scores.
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Affiliation(s)
- A Tosetto
- Hematology Department, San Bortolo Hospital, Vicenza, Italy
| | - S Testa
- Hemostasis and Thrombosis Center, AO Istituti Ospitalieri di Cremona, Cremona, Italy
| | - I Martinelli
- Hemophilia and Thrombosis Center, Fondazione Angelo Bianchi Bonomi, IRCCS Ospedale Ca' Granda, Dipartimento di Medicina Interna, Università degli Studi di Milano, Milan, Italy
| | - D Poli
- Thrombosis Center, Dipartimento Oncologico AOU Careggi, Florence, Italy
| | - B Cosmi
- Department of Angiology and Blood Coagulation, S. Orsola Malpighi University Hospital, Bologna, Italy
| | - C Lodigiani
- Thrombosis and Hemorragic Diseases Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - W Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - V De Stefano
- Institute of Hematology, Catholic University, Rome, Italy
| | - A Falanga
- Thrombosis and Hemostasis Center, Department of Immunohematology and Transfusion Medicine, Bergamo, Italy
| | - I Nichele
- Hematology Department, San Bortolo Hospital, Vicenza, Italy
| | - O Paoletti
- Hemostasis and Thrombosis Center, AO Istituti Ospitalieri di Cremona, Cremona, Italy
| | - P Bucciarelli
- Hemophilia and Thrombosis Center, Fondazione Angelo Bianchi Bonomi, IRCCS Ospedale Ca' Granda, Dipartimento di Medicina Interna, Università degli Studi di Milano, Milan, Italy
| | - E Antonucci
- Fondazione Arianna Anticoagulazione, Bologna, Italy
| | - C Legnani
- Department of Angiology and Blood Coagulation, S. Orsola Malpighi University Hospital, Bologna, Italy
| | - E Banfi
- Thrombosis and Hemorragic Diseases Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - F Dentali
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - F Bartolomei
- Institute of Hematology, Catholic University, Rome, Italy
| | - L Barcella
- Thrombosis and Hemostasis Center, Department of Immunohematology and Transfusion Medicine, Bergamo, Italy
| | - G Palareti
- Fondazione Arianna Anticoagulazione, Bologna, Italy
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6
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Abstract
AbstractThe risk of recurrence after suspension of anticoagulant treatment in patients with a first episode of unprovoked venous thromboembolism (VTE) is highly variable from patient to patient. Not all patients are candidates for life-long anticoagulant therapy, essentially because there remain concerns for such an option regarding hemorrhagic complications and clinical monitoring. Thus, the “treat all” approach may be inadequate for some patients at low risk of relapse. Proper assessment of the recurrence risk may be helpful to decide the optimal therapeutic strategy in such patients. In recent years, attempts have been made to develop and validate clinical prediction rules to estimate the absolute risk of VTE recurrence in individual patients. This article highlights the advantages and disadvantages of such options, presenting three different prediction rules that have been published so far.
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Affiliation(s)
- Ilaria Nichele
- Hematology Department, S. Bortolo Hospital, Vicenza, Italy
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7
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Pieri L, Paoli C, Arena U, Marra F, Mori F, Zucchini M, Colagrande S, Castellani A, Masciulli A, Rosti V, De Stefano V, Betti S, Finazzi G, Ferrari ML, Rumi E, Ruggeri M, Nichele I, Guglielmelli P, Fjerza R, Mannarelli C, Fanelli T, Merli L, Corbizi Fattori G, Massa M, Cimino G, Rambaldi A, Barosi G, Cazzola M, Barbui T, Vannucchi AM. Safety and efficacy of ruxolitinib in splanchnic vein thrombosis associated with myeloproliferative neoplasms. Am J Hematol 2017; 92:187-195. [PMID: 27880982 DOI: 10.1002/ajh.24614] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/19/2016] [Accepted: 11/21/2016] [Indexed: 12/19/2022]
Abstract
Splanchnic vein thrombosis (SVT) is one of the vascular complications of myeloproliferative neoplasms (MPN). We designed a phase 2 clinical trial to evaluate safety and efficacy of ruxolitinib in reducing splenomegaly and improving disease-related symptoms in patients with MPN-associated SVT. Patients diagnosed with myelofibrosis (12 cases), polycythemia vera (5 cases) and essential thrombocythemia (4 cases) received ruxolitinib for 24 weeks in the core study period. Spleen volume was assessed by magnetic resonance imaging (MRI) and splanchnic vein circulation by echo-Doppler analysis. Nineteen patients carried JAK2V617F, one had MPLW515L, and one CALRL367fs*46 mutation. Eighteen patients had spleno-portal-mesenteric thrombosis, two had Budd-Chiari syndrome, and one had both sites involved; 16 patients had esophageal varices. Ruxolitinib was well tolerated with hematological toxicities consistent with those of patients without SVT and no hemorrhagic adverse events were recorded. After 24 weeks of treatment, spleen volume reduction ≥35% by MRI was achieved by 6/21 (29%) patients, and a ≥50% spleen length reduction by palpation at any time up to week 24 was obtained by 13/21 (62%) patients. At week 72, 8 of the 13 (62%) patients maintained the spleen response by palpation. No significant effect of treatment on esophageal varices or in splanchnic circulation was observed. MPN-related symptoms, evaluated by MPN-symptom assessment form (SAF) TSS questionnaire, improved significantly during the first 4 weeks and remained stable up to week 24. In conclusion, this trial shows that ruxolitinib is safe in patients with MPN-associated SVT, and effective in reducing spleen size and disease-related symptoms.
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Affiliation(s)
- Lisa Pieri
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Chiara Paoli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Umberto Arena
- Internal Medicine and Hepatology; Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Fabio Mori
- Department of Cardiology; Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Mery Zucchini
- Department of Cardiology; Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences; University of Florence - Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Alessandro Castellani
- Department of Experimental and Clinical Biomedical Sciences; University of Florence - Azienda Ospedaliera-Universitaria Careggi; Florence Italy
| | - Arianna Masciulli
- Department of Hematology; Hospital Papa Giovanni XXIII; Bergamo Italy
| | - Vittorio Rosti
- IRCCS Policlinico San Matteo Foundation; Center for the Study of Myelofibrosis, Biotechnology Research Area; Pavia Italy
| | | | - Silvia Betti
- Institute of Hematology, Catholic University; Rome Italy
| | - Guido Finazzi
- Department of Hematology; Hospital Papa Giovanni XXIII; Bergamo Italy
| | | | - Elisa Rumi
- Department of Hematology Oncology; IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Marco Ruggeri
- Department of Hematology; San Bortolo Hospital; Vicenza Italy
| | - Ilaria Nichele
- Department of Hematology; San Bortolo Hospital; Vicenza Italy
| | - Paola Guglielmelli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Rajmonda Fjerza
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Carmela Mannarelli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Tiziana Fanelli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
- University of Siena; Siena Italy
| | - Lucia Merli
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
| | - Giuditta Corbizi Fattori
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
- University of Siena; Siena Italy
| | - Margherita Massa
- IRCCS Policlinico San Matteo Foundation; Biotechnology Research Area; Pavia Italy
| | - Giuseppe Cimino
- Department of Cellular Biotechnology and Hematology; University “La Sapienza”; Rome Italy
| | | | - Giovanni Barosi
- IRCCS Policlinico San Matteo Foundation; Center for the Study of Myelofibrosis, Biotechnology Research Area; Pavia Italy
| | - Mario Cazzola
- Department of Hematology Oncology; IRCCS Policlinico San Matteo Foundation; Pavia Italy
| | - Tiziano Barbui
- Hospital Papa Giovanni XXIII and Research Foundation; Bergamo Italy
| | - Alessandro M. Vannucchi
- CRIMM-Centro Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi; Florence Italy
- DenoThe Excellence Center; Florence Italy
- Department of Experimental and Clinical Medicine; University of Florence; Florence Italy
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8
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De Stefano V, Vannucchi AM, Ruggeri M, Cervantes F, Alvarez-Larrán A, Iurlo A, Randi ML, Pieri L, Rossi E, Guglielmelli P, Betti S, Elli E, Finazzi MC, Finazzi G, Zetterberg E, Vianelli N, Gaidano G, Nichele I, Cattaneo D, Palova M, Ellis MH, Cacciola E, Tieghi A, Hernandez-Boluda JC, Pungolino E, Specchia G, Rapezzi D, Forcina A, Musolino C, Carobbio A, Griesshammer M, Barbui T. Splanchnic vein thrombosis in myeloproliferative neoplasms: risk factors for recurrences in a cohort of 181 patients. Blood Cancer J 2016; 6:e493. [PMID: 27813534 PMCID: PMC5148051 DOI: 10.1038/bcj.2016.103] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/16/2016] [Indexed: 12/13/2022] Open
Abstract
We retrospectively studied 181 patients with polycythaemia vera (n=67), essential thrombocythaemia (n=67) or primary myelofibrosis (n=47), who presented a first episode of splanchnic vein thrombosis (SVT). Budd–Chiari syndrome (BCS) and portal vein thrombosis were diagnosed in 31 (17.1%) and 109 (60.3%) patients, respectively; isolated thrombosis of the mesenteric or splenic veins was detected in 18 and 23 cases, respectively. After this index event, the patients were followed for 735 patient years (pt-years) and experienced 31 recurrences corresponding to an incidence rate of 4.2 per 100 pt-years. Factors associated with a significantly higher risk of recurrence were BCS (hazard ratio (HR): 3.03), history of previous thrombosis (HR: 3.62), splenomegaly (HR: 2.66) and leukocytosis (HR: 2.8). Vitamin K-antagonists (VKA) were prescribed in 85% of patients and the recurrence rate was 3.9 per 100 pt-years, whereas in the small fraction (15%) not receiving VKA more recurrences (7.2 per 100 pt-years) were reported. Intracranial and extracranial major bleeding was recorded mainly in patients on VKA and the corresponding rate was 2.0 per 100 pt-years. In conclusion, despite anticoagulation treatment, the recurrence rate after SVT in myeloproliferative neoplasms is high and suggests the exploration of new avenues of secondary prophylaxis with new antithrombotic drugs and JAK-2 inhibitors.
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Affiliation(s)
- V De Stefano
- Institute of Hematology, Catholic University, Roma, Italy
| | - A M Vannucchi
- Center for Research and Innovation of Myeloproliferative Neoplasms, A.O.U. Careggi, University of Florence, Florence, Italy
| | - M Ruggeri
- Ospedale San Bortolo, Vicenza, Italy
| | | | - A Alvarez-Larrán
- Department of Hematology, Hospital del Mar-IMIM, Barcelona, Spain
| | - A Iurlo
- Oncohematology Division, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - M L Randi
- Clinica Medica 1, Università di Padova, Padova, Italy
| | - L Pieri
- Center for Research and Innovation of Myeloproliferative Neoplasms, A.O.U. Careggi, University of Florence, Florence, Italy
| | - E Rossi
- Institute of Hematology, Catholic University, Roma, Italy
| | - P Guglielmelli
- Center for Research and Innovation of Myeloproliferative Neoplasms, A.O.U. Careggi, University of Florence, Florence, Italy
| | - S Betti
- Institute of Hematology, Catholic University, Roma, Italy
| | - E Elli
- Divisione di Ematologia, Ospedale San Gerardo, ASST Monza, Italy
| | - M C Finazzi
- Hematology Division, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - G Finazzi
- Hematology Division, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - N Vianelli
- Institute of Hematology and Medical Oncology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - G Gaidano
- Department of Translational Medicine, Università del Piemonte Orientale, Vercelli, Italy
| | - I Nichele
- Ospedale San Bortolo, Vicenza, Italy
| | - D Cattaneo
- Oncohematology Division, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - M Palova
- University Hospital of Olomouc, Olomouc, Czech Republic
| | - M H Ellis
- Department of Hematology, Institute Meir Medical Center, Kfar Saba, Israel
| | - E Cacciola
- Haemostasis Unit, Department of Medical, Surgical and Advanced Technologies Sciences 'G.F. Ingrassia', University of Catania, Catania, Italy
| | - A Tieghi
- Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | | | - E Pungolino
- A.O. Ospedale Niguarda Ca' Granda, Milano, Italy
| | - G Specchia
- A.O. Universitaria, Policlinico di Bari, Italy
| | - D Rapezzi
- A.O. Santa Croce e Carle, Cuneo, Italy
| | - A Forcina
- IRCCS Ospedale San Raffaele, Milano, Italy
| | | | - A Carobbio
- FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - M Griesshammer
- Johannes Wesling Medical Center Minden, University of Bochum, Minden, Germany
| | - T Barbui
- FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo, Italy
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9
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Nichele I, Ruggeri M, Rodeghiero F. Effectiveness of lenalidomide in a patient with refractory anemia with ring sideroblasts and thrombocytosis with JAK2 (V617F) mutation. Am J Hematol 2015; 90:E148-9. [PMID: 25963624 DOI: 10.1002/ajh.24049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 05/05/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Ilaria Nichele
- Department of Hematology; San Bortolo Hospital; Vicenza Italy
| | - Marco Ruggeri
- Department of Hematology; San Bortolo Hospital; Vicenza Italy
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10
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Civaschi E, Klersy C, Melazzini F, Pujol-Moix N, Santoro C, Cattaneo M, Lavenu-Bombled C, Bury L, Minuz P, Nurden P, Cid AR, Cuker A, Latger-Cannard V, Favier R, Nichele I, Noris P. Analysis of 65 pregnancies in 34 women with five different forms of inherited platelet function disorders. Br J Haematol 2015; 170:559-63. [PMID: 25899604 DOI: 10.1111/bjh.13458] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/15/2015] [Indexed: 12/01/2022]
Abstract
This study evaluated 65 pregnancies in 34 women with five different inherited platelet function disorders. Gestation was similar to that of the general population. Severe bleeds requiring blood transfusions were observed in 50% of deliveries in Glanzmann thrombasthenia (GT), but not in the patients with delta storage pool disease, Hermansky-Pudlak syndrome, P2Y12 defect or defect of thromboxane A2 receptor. Of note, severe haemorrhage also occurred in women with GT who had received prophylactic platelet transfusions, suggesting that better preventive treatments are required. Diagnosis and degree of spontaneous bleeding tendency before pregnancy were reliable parameters to predict the delivery-related bleeding risk.
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Affiliation(s)
- Elisa Civaschi
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Catherine Klersy
- Service of Biometry & Statistics, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Federica Melazzini
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Nuria Pujol-Moix
- Universitat Autònoma de Barcelona & Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain
| | - Cristina Santoro
- Ematologia, Policlinico Umberto 1, Università Sapienza, Rome, Italy
| | - Marco Cattaneo
- Dipartimento di Scienze della Salute, Medicina III, Ospedale San Paolo, Università degli Studi di Milano, Milano, Italy
| | - Cécile Lavenu-Bombled
- AP-HP, Hôpital Bicêtre, Hématologie Biologique/Centre de Référence Pathologies Plaquettaires, Le Kremlin Bicêtre, France
| | - Loredana Bury
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Pietro Minuz
- Department of Medicine, University of Verona, Verona, Italy
| | - Paquita Nurden
- Plateforme Technologique et d'Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France
| | - Ana R Cid
- Unidad de Hemostasia y Trombosis, La Fe University Hospital, Valencia, Spain
| | - Adam Cuker
- Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Véronique Latger-Cannard
- Centre de Compétence Nord-Est des Pathologies Plaquettaires from the Frame of the Reference French Centre and Service d'Hématologie Biologique, Centre Hospitalo-Universitaire, Nancy, France
| | - Remi Favier
- Haematological Laboratory, AP-HP, Armand Trousseau Children Hospital, French Reference Centre for Inherited Platelet Disorders, Paris, France.,Inserm U1170, Villejuif, France
| | - Ilaria Nichele
- Department of Cell Therapy and Haematology, San Bortolo Hospital, Vicenza, Italy
| | - Patrizia Noris
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Pavia, Italy
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11
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Noris P, Schlegel N, Klersy C, Heller PG, Civaschi E, Pujol-Moix N, Fabris F, Favier R, Gresele P, Latger-Cannard V, Cuker A, Nurden P, Greinacher A, Cattaneo M, De Candia E, Pecci A, Hurtaud-Roux MF, Glembotsky AC, Muñiz-Diaz E, Randi ML, Trillot N, Bury L, Lecompte T, Marconi C, Savoia A, Balduini CL, Bayart S, Bauters A, Benabdallah-Guedira S, Boehlen F, Borg JY, Bottega R, Bussel J, De Rocco D, de Maistre E, Faleschini M, Falcinelli E, Ferrari S, Ferster A, Fierro T, Fleury D, Fontana P, James C, Lanza F, Le Cam Duchez V, Loffredo G, Magini P, Martin-Coignard D, Menard F, Mercier S, Mezzasoma A, Minuz P, Nichele I, Notarangelo LD, Pippucci T, Podda GM, Pouymayou C, Rigouzzo A, Royer B, Sie P, Siguret V, Trichet C, Tucci A, Saposnik B, Veneri D. Analysis of 339 pregnancies in 181 women with 13 different forms of inherited thrombocytopenia. Haematologica 2014; 99:1387-94. [PMID: 24763399 DOI: 10.3324/haematol.2014.105924] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pregnancy in women with inherited thrombocytopenias is a major matter of concern as both the mothers and the newborns are potentially at risk of bleeding. However, medical management of this condition cannot be based on evidence because of the lack of consistent information in the literature. To advance knowledge on this matter, we performed a multicentric, retrospective study evaluating 339 pregnancies in 181 women with 13 different forms of inherited thrombocytopenia. Neither the degree of thrombocytopenia nor the severity of bleeding tendency worsened during pregnancy and the course of pregnancy did not differ from that of healthy subjects in terms of miscarriages, fetal bleeding and pre-term births. The degree of thrombocytopenia in the babies was similar to that in the mother. Only 7 of 156 affected newborns had delivery-related bleeding, but 2 of them died of cerebral hemorrhage. The frequency of delivery-related maternal bleeding ranged from 6.8% to 14.2% depending on the definition of abnormal blood loss, suggesting that the risk of abnormal blood loss was increased with respect to the general population. However, no mother died or had to undergo hysterectomy to arrest bleeding. The search for parameters predicting delivery-related bleeding in the mother suggested that hemorrhages requiring blood transfusion were more frequent in women with history of severe bleedings before pregnancy and with platelet count at delivery below 50 × 10(9)/L.
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Affiliation(s)
- Patrizia Noris
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy
| | - Nicole Schlegel
- National Reference Centre on Inherited Platelet Disorders and Service d'Hématologie Biologique, CHU Robert Debré and Paris 7 Denis Diderot University, Paris, France
| | - Catherine Klersy
- Service of Biometry and Statistics, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Paula G Heller
- Institute of Medical Research Alfredo Lanari, University of Buenos Aires, Argentina
| | - Elisa Civaschi
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy
| | - Nuria Pujol-Moix
- Universitat Autònoma de Barcelona, Institut de Recerca Biomèdica Sant Pau, Spain
| | - Fabrizio Fabris
- Department of Medicine-DIMED, University of Padova Medical School, Italy
| | - Remi Favier
- AP-HP, Armand Trousseau Children's Hospital, Haematological Laboratory, French Reference Center for Inherited Platelet disorders, Paris, France Inserm UMR1009, Villejuif, France
| | - Paolo Gresele
- Department of Internal Medicine, University of Perugia, Italy
| | - Véronique Latger-Cannard
- Centre de Compétence Nord-Est des Pathologies Plaquettaires from the frame of the Reference French Centre, France Service d'Hématologie Biologique, Centre Hospitalo-Universitaire, Nancy, France
| | - Adam Cuker
- Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paquita Nurden
- Plateforme Technologique et d'Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France
| | | | - Marco Cattaneo
- Medicina III, Ospedale San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Erica De Candia
- Servizio Malattie Emorragiche e Trombotiche, Istituto di Medicina Interna e Geriatria, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessandro Pecci
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy
| | - Marie-Françoise Hurtaud-Roux
- National Reference Centre on Inherited Platelet Disorders and Service d'Hématologie Biologique, CHU Robert Debré and Paris 7 Denis Diderot University, Paris, France
| | - Ana C Glembotsky
- Institute of Medical Research Alfredo Lanari, University of Buenos Aires, Argentina
| | - Eduardo Muñiz-Diaz
- Immunohematology Department, Banc de Sang i Teixits de Catalunya, Barcelona, Spain
| | - Maria Luigia Randi
- Department of Medicine-DIMED, University of Padova Medical School, Italy
| | - Nathalie Trillot
- Institut d'Hématologie-Transfusion, Pôle Biologie Pathologie Génétique, CHRU, Lille, France
| | - Loredana Bury
- Department of Internal Medicine, University of Perugia, Italy
| | - Thomas Lecompte
- Département des Spécialités de Médecine, Service d'Hématologie, Hôpitaux Universitaires de Genève, Suisse Université de Genève, Faculté de Médecine, Suisse
| | - Caterina Marconi
- Genetica Medica, Dipartimento di Scienze Mediche Chirurgiche, Policlinico Sant'Orsola-Malpighi, University of Bologna, Italy
| | - Anna Savoia
- Department of Medical Sciences, University of Trieste, Italy Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Carlo L Balduini
- Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy
| | - Sophie Bayart
- Service d'Hémostase Bio-Clinique, Centre Régional de traitement des maladies hémorragiques de Rennes-Bretagne, CHU de Rennes, Rennes, France
| | - Anne Bauters
- Institut d'Hématologie-Transfusion, Pôle Biologie Pathologie Génétique, CHRU Lille, France
| | | | - Françoise Boehlen
- Division of Angiology and Haemostasis, Department of Medical Specialisations, Faculty of Medicine and University Hospitals of Geneva, Geneva, Switzerland Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Roberta Bottega
- Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - James Bussel
- Weill Medical College of Cornell University, New York, NY, USA
| | - Daniela De Rocco
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Emmanuel de Maistre
- Service d'hématologie Biologie, Centre Hospitalo-Universitaire Dijon, France
| | | | | | - Silvia Ferrari
- Department of Medicine-DIMED; University of Padova Medical School, Padova, Italy
| | - Alina Ferster
- Unité d'Hémato-Oncologie pédiatrique, Hôpital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgique
| | - Tiziana Fierro
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | | | - Pierre Fontana
- Division of Angiology and Haemostasis, Department of Medical Specialisations, Faculty of Medicine and University Hospitals of Geneva, Geneva, Switzerland Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Chloé James
- Laboratoire d'Hématologie and National Reference Centre on Inherited Platelet Disorders, CHU Haut Lévêque, Pessac, France
| | | | | | - Giuseppe Loffredo
- Department of Oncology, Azienda Santobono-Pausilipon, Pausilipon Hospital, Napoli, Italy
| | - Pamela Magini
- Genetica Medica, Dipartimento di Scienze Mediche Chirurgiche, Policlinico Sant'Orsola-Malpighi - University of Bologna, Bologna, Italy
| | | | - Fanny Menard
- Centre Hospitalier de la côte basque, Bayonne, France
| | - Sandra Mercier
- Service de Génétique Clinique, Centre de Référence Anomalies du Développement du Grand Ouest, CHU Rennes-Hôpital Sud, Rennes, France
| | | | - Pietro Minuz
- Department of Medicine and Haematology, University Hospital of Verona, Verona, Italy
| | - Ilaria Nichele
- Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy
| | | | - Tommaso Pippucci
- Genetica Medica, Dipartimento di Scienze Mediche Chirurgiche, Policlinico Sant'Orsola-Malpighi - University of Bologna, Bologna, Italy
| | - Gian Marco Podda
- Medicina III, Ospedale San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy
| | - Catherine Pouymayou
- Laboratoire d'Hématologie and National Reference Centre on Inherited Platelet Disorders, CHU La Timone, Marseille, France
| | - Agnes Rigouzzo
- AP-HP, Armand Trousseau children Hospital, Department of Anesthesiology, Paris, France
| | - Bruno Royer
- Hématologie clinique et thérapie cellulaire, CHU Amiens, France
| | - Pierre Sie
- Laboratoire d'Hématologie and National Reference Centre of Inherited Platelet Disorders, CHU Rangueil, Toulouse, France
| | - Virginie Siguret
- Service d' Hématologie Biologique, CHU Hôpital Européen Georges Pompidou, Paris, France
| | - Catherine Trichet
- Service de Biologie Clinique Secteur Hématologie, CH Victor Dupouy, Argenteuil, France
| | - Alessandra Tucci
- Hematology Unit, Spedali Civili Hospital and University of Brescia, Brescia, Italy
| | - Béatrice Saposnik
- National Reference Centre on Inherited Platelet Disorders and Service d'Hématologie Biologique, CHU Robert Debré and Paris 7 Denis Diderot University, Paris, France
| | - Dino Veneri
- Department of Medicine and Haematology, University Hospital of Verona, Verona, Italy
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12
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Bassi G, Kamga PT, Kamdje AN, Stradoni R, Malpeli G, Amati E, Nichele I, Carusone R, Jasmina Z, Pizzolo G, Krampera M. Role of stromal cell-mediated notch signaling in hematological malignancies. Cytotherapy 2014. [DOI: 10.1016/j.jcyt.2014.01.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Zaja F, Mian M, Volpetti S, Visco C, Sissa C, Nichele I, Castelli M, Ambrosetti A, Puglisi S, Fanin R, Cortelazzo S, Pizzolo G, Trentin L, Rodeghiero F, Paolini R, Vivaldi P, Sancetta R, Isola M, Semenzato G. Bendamustine in chronic lymphocytic leukemia: outcome according to different clinical and biological prognostic factors in the everyday clinical practice. Am J Hematol 2013; 88:955-60. [PMID: 23861234 DOI: 10.1002/ajh.23546] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/04/2013] [Accepted: 07/09/2013] [Indexed: 11/10/2022]
Abstract
Bendamustine proved to be effective for the treatment of chronic lymphocytic leukemia (CLL). However, the relationship between its activity with clinico-biological prognosticators has been addressed only in few studies. We retrospectively evaluated the efficacy of bendamustine, in a real-life contest, on 142 patients, median age 70 years, median number of previous regimens 2 (0-8, 13% previously untreated). Bendamustine was administered for a median number of 4 cycles, in 84% of cases with rituximab. Overall (ORR) and complete response (CRR) rates were 68 and 16.5%, respectively. Multivariate analysis demonstrated a relationship between ORR and number of prior treatments (OR 0.25, 95% CI 0.08-0.71; P = 0.009), del(17p) (OR 0.10, 95% CI 0.03-0.32; P < 0.001) and concomitant rituximab (OR 4.37, 95% CI 1.12-17.04; P = 0.033). The estimated 1- and 2-years overall survival (OS) and progression free survival (PFS) rates were 76, 61, 51, and 26%, respectively. Previous sensitivity to fludarabine (HR 0.36, 95% CI 0.16-0.82), response to bendamustine (HR 0.21, 95% CI 0.10-0.45), and del(17p) (HR 2.18, 95% CI 1.002-4.74) had a prognostic significance in multivariate analysis for PFS, while the number of previous therapies (HR 3.48, 95% CI 1.29-9.38; P = 0.014), concomitant use of rituximab (HR 0.32, 95% CI 0.11-0.93) and response to bendamustine (HR 0.22, 95% CI 0.07-0.66) were significant for OS. Side effects included grade 3-4 neutropenia, infections, thrombocytopenia and anemia which occurred in 40, 14, 14, and 10% of patients, respectively. These results confirm the activity and safety of bendamustine and rituximab combination even in patients with unfavorable clinical and biological features excluding del(17p).
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Affiliation(s)
- Francesco Zaja
- Clinica Ematologica; DISM, Azienda Ospedaliero Universitaria S. M. Misericordia; Udine Italy
| | - Michael Mian
- Divisione di Ematologia and CTMO; Ospedale di Bolzano; Italy
- Department of Hematology and Oncology; Medical University of Innsbruck; Austria
| | - Stefano Volpetti
- Clinica Ematologica; DISM, Azienda Ospedaliero Universitaria S. M. Misericordia; Udine Italy
| | - Carlo Visco
- Dipartimento di Terapie Cellulari ed Ematologia; Ospedale S. Bortolo; Vicenza Italy
| | - Cinzia Sissa
- Clinica Ematologica, Dipartimento di Medicina, Sezione di Ematologia; Università di Verona; Italy
| | - Ilaria Nichele
- Dipartimento di Terapie Cellulari ed Ematologia; Ospedale S. Bortolo; Vicenza Italy
| | | | - Achille Ambrosetti
- Clinica Ematologica, Dipartimento di Medicina, Sezione di Ematologia; Università di Verona; Italy
| | - Simona Puglisi
- Clinica Ematologica; DISM, Azienda Ospedaliero Universitaria S. M. Misericordia; Udine Italy
| | - Renato Fanin
- Clinica Ematologica; DISM, Azienda Ospedaliero Universitaria S. M. Misericordia; Udine Italy
| | | | - Giovanni Pizzolo
- Clinica Ematologica, Dipartimento di Medicina, Sezione di Ematologia; Università di Verona; Italy
| | - Livio Trentin
- Clinica Ematologica; Dipartimento di Medicina; Padova Italy
| | - Francesco Rodeghiero
- Dipartimento di Terapie Cellulari ed Ematologia; Ospedale S. Bortolo; Vicenza Italy
| | - Rossella Paolini
- SOS Oncoematologia; Ospedale S. Maria della Misericordia; Rovigo Italy
| | | | | | - Miriam Isola
- Instituto di Statistica, Università degli Studi; Udine Italy
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14
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Falisi E, Novella E, Visco C, Guercini N, Maura F, Giaretta I, Pomponi F, Nichele I, Finotto S, Montaldi A, Neri A, Rodeghiero F. B-cell receptor configuration and mutational analysis of patients with chronic lymphocytic leukaemia and trisomy 12 reveal recurrent molecular abnormalities. Hematol Oncol 2013; 32:22-30. [PMID: 23861036 DOI: 10.1002/hon.2086] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/15/2013] [Accepted: 06/04/2013] [Indexed: 01/02/2023]
Abstract
Trisomy 12 (+12) is the third most frequent cytogenetic aberration in chronic lymphocytic leukaemia (CLL) retrievable both as the sole chromosomal abnormality or in association with additional alterations. NOTCH1 mutations are known to be more prevalent among +12 patients, whereas mutations of FBXW7, a gene involved in NOTCH1 degradation, that lead to the constitutional activation of NOTCH1 have not been investigated in this setting. We analyzed a unicentric cohort of 44 +12 patients with CLL for mutations of TP53, NOTCH1 and FBXW7 genes, and we correlated them with B-cell receptor (BCR) configurations. FBXW7, TP53 and NOTCH1 mutations were identified in 4.5%, 6.8% and 18.2% of patients, respectively. FBXW7 and NOTCH1 mutations appeared in a mutually exclusive fashion, suggesting that both aberrations might affect the same biological pathway. We found that 44.1% of +12 CLL patients had stereotyped B-cell receptors, which is significantly higher than that observed in patients with CLL and no +12 (27%, p = 0.01). Subsets #1, #8, #10, #28 and #59 were the most represented stereotyped patterns, and IGHV4-39*01 was the gene configuration most commonly used. There was a significantly higher risk for Richter's syndrome (RS) transformation in patients with NOTCH1 or FBXW7 mutations, with four of the seven (57%) patients developing RS and characterized at least by one of the two abnormalities. These observations suggest that, similarly to the aberrations of NOTCH1, FBXW7 gene mutations may also result in cell proliferation and evasion from apoptosis in patients with +12 CLL. Together with the extremely high frequency of stereotyped BCRs and RS transformation, these abnormalities appear to cluster in these CLL patients with additional chromosome 12, suggesting a connection with the prognosis of the disease.
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Affiliation(s)
- Erika Falisi
- Department of Hematology and Cell Therapy, S. Bortolo Hospital, Vicenza, Italy
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15
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Spolverini A, Pieri L, Guglielmelli P, Pancrazzi A, Fanelli T, Paoli C, Bosi A, Nichele I, Ruggeri M, Vannucchi AM. Infrequent occurrence of mutations in the PH domain of LNK in patients with JAK2 mutation-negative 'idiopathic' erythrocytosis. Haematologica 2013; 98:e101-2. [PMID: 23812944 DOI: 10.3324/haematol.2013.090175] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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16
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Visco C, Moretta F, Falisi E, Facco M, Maura F, Novella E, Nichele I, Finotto S, Giaretta I, Ave E, Perbellini O, Guercini N, Scupoli MT, Trentin L, Trimarco V, Neri A, Semenzato G, Rodeghiero F, Pizzolo G, Ambrosetti A. Double productive immunoglobulin sequence rearrangements in patients with chronic lymphocytic leukemia. Am J Hematol 2013; 88:277-82. [PMID: 23450508 DOI: 10.1002/ajh.23396] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 01/10/2013] [Accepted: 01/11/2013] [Indexed: 11/06/2022]
Abstract
The immunoglobulin heavy chain variable (IGHV) gene mutational status represents a major prognostic marker in chronic lymphocytic leukemia (CLL). Usually, the prognostic implications of IGHV gene analysis can be reliably ascertained but, occasionally, double productive rearrangements have been detected. Clinical presentation and biological features of such cases are unknown. Sixty patients with morphologically and phenotypically monoclonal CLL but double productive IGHV rearrangements were retrospectively identified by mRNA analysis from three Hematology Institutions. Clinical and biological features and survival of these 60 patients were compared with a control group of patients with CLL and single IGHV rearrangement. A prospective registry was used to assess the epidemiology of double productive IGHV among incidental patients with CLL. Using standard criteria to define IGHV-mutated (M) or unmutated (U) cases, 39 of the 60 patients (65%) with double productive IGHV rearrangement had concordant status (23 MM, 16 UU), while 21 (35%) had discordant IGHV status. As compared with M patients, the MM ones had lower CD38 expression, more favorable cytogenetics and more indolent clinical behavior. Cases with UU had similar characteristics of U patients. Discordant cases presented with adverse prognostic features and had an aggressive clinical behavior requiring early treatment, similar to U patients. The prevalence of double IGHV was 3.1%. Patients with CLL with double concordant mutational status (MM or UU) have a clinical course similar to that of the corresponding single IGHV status, while those exhibiting discordant status represent a high risk population. This may help correct stratification within clinical trials.
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Affiliation(s)
- Carlo Visco
- Department of Hematology S. Bortolo Hospital; Vicenza Italy
| | - Francesca Moretta
- Hematology Section, Department of Medicine; University of Verona; Italy
| | - Erika Falisi
- Department of Hematology S. Bortolo Hospital; Vicenza Italy
| | - Monica Facco
- Department of Medicine, Hematology and Clinical Immunology Branch; Padua University School of Medicine; Padova Italy
| | - Francesco Maura
- Department of Medical Sciences and Hematology-CTMO; University of Milano; Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano Italy
| | | | - Ilaria Nichele
- Department of Hematology S. Bortolo Hospital; Vicenza Italy
| | - Silvia Finotto
- Department of Hematology S. Bortolo Hospital; Vicenza Italy
| | | | - Elisa Ave
- Department of Medicine, Hematology and Clinical Immunology Branch; Padua University School of Medicine; Padova Italy
| | - Omar Perbellini
- Hematology Section, Department of Medicine; University of Verona; Italy
| | | | | | - Livio Trentin
- Department of Medicine, Hematology and Clinical Immunology Branch; Padua University School of Medicine; Padova Italy
| | - Valentina Trimarco
- Department of Medicine, Hematology and Clinical Immunology Branch; Padua University School of Medicine; Padova Italy
| | - Antonino Neri
- Department of Medical Sciences and Hematology-CTMO; University of Milano; Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano Italy
| | - Gianpietro Semenzato
- Department of Medicine, Hematology and Clinical Immunology Branch; Padua University School of Medicine; Padova Italy
| | | | - Giovanni Pizzolo
- Hematology Section, Department of Medicine; University of Verona; Italy
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17
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Maura F, Visco C, Falisi E, Reda G, Fabris S, Agnelli L, Tuana G, Lionetti M, Guercini N, Novella E, Nichele I, Montaldi A, Autore F, Gregorini A, Barcellini W, Callea V, Mauro FR, Laurenti L, Foà R, Neri A, Rodeghiero F, Cortelezzi A. B-cell receptor configuration and adverse cytogenetics are associated with autoimmune hemolytic anemia in chronic lymphocytic leukemia. Am J Hematol 2013; 88:32-6. [PMID: 23115077 DOI: 10.1002/ajh.23342] [Citation(s) in RCA: 27] [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: 09/07/2012] [Accepted: 09/17/2012] [Indexed: 12/25/2022]
Abstract
The development of autoimmune hemolytic anemia (AIHA) in patients with chronic lymphocytic leukemia (CLL) is associated with specific biological features. The occurrence of AIHA was hereby investigated in a retrospective series of 585 CLL patients with available immunoglobulin heavy chain variable (IGHV) gene status. AIHA occurred in 73 patients and was significantly associated with an IGHV unmutated (UM) status (P < 0.0001) and unfavorable [del(17)(p13) and del(11)(q23)] cytogenetic lesions (P < 0.0001). Stereotyped HCDR3 sequences were identified in 29.6% of cases and were similarly represented among patients developing or not AIHA; notably, subset #3 was associated with a significantly higher risk of AIHA than the other patients (P = 0.004). Multivariate analysis showed that UM IGHV, del(17)(p13) and del(11)(q23), but not stereotyped subset #3, were the strongest independent variables associated with AIHA. Based on these findings, we generated a biological risk score for AIHA development according to the presence of none (low risk), one (intermediated risk), or two (high risk) of the independent risk factors. Overall, our data indicate that UM IGHV status and/or unfavorable cytogenetic lesions are associated with the risk of developing secondary AIHA in CLL patients and suggest a possible role of specific stereotyped B-cell receptor subsets in a proportion of cases.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/genetics
- Chromosome Deletion
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 17/genetics
- Female
- Follow-Up Studies
- Humans
- Immunoglobulin Heavy Chains/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Male
- Middle Aged
- Receptors, Antigen, B-Cell/genetics
- Retrospective Studies
- Risk Factors
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Affiliation(s)
- Francesco Maura
- Department of Clinical Sciences and Community Health, University of Milan, Italy
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18
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Nichele I, Zamò A, Bertolaso A, Bifari F, Tinelli M, Franchini M, Stradoni R, Aprili F, Pizzolo G, Krampera M. VR09 cell line: an EBV-positive lymphoblastoid cell line with in vivo characteristics of diffuse large B cell lymphoma of activated B-cell type. PLoS One 2012; 7:e52811. [PMID: 23285191 PMCID: PMC3528718 DOI: 10.1371/journal.pone.0052811] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 05/17/2012] [Accepted: 11/21/2012] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND small B-cell neoplasms can show plasmacytic differentiation and may potentially progress to aggressive lymphoma (DLBCL). Epstein-Barr virus (EBV) infection may cause the transformation of malignant cells in vitro. DESIGN AND METHOD we established VR09 cell line with plasmacytic differentiation, obtained from a case of atypical, non-CLL B-cell chronic lymphoproliferative disease with plasmacytic features. We used flow cytometry, immunohistochemistry, polymerase chain reaction, cytogenetic analysis and florescence in situ hybridization in the attempt at thoroughly characterizing the cell line. We showed VR09 tumorigenic potential in vivo, leading to the development of activated DLBCL with plasmacytic features. RESULTS VR09 cells displayed plasmacytic appearance and grew as spherical tumors when inoculated subcutaneously into immunodeficient Rag2(-/-) γ-chain(-/-) mice. VR09 cell line and tumors displayed the phenotype of activated stage of B cell maturation, with secretory differentiation (CD19+ CD20+ CD79a+ CD79b+/- CD138+ cyclin D1- Ki67 80% IgM+ IgD+ MUM1+ MNDA+ CD10- CD22+ CD23+ CD43+ K+, λ- Bcl2+ Bcl6-) and they presented episomal EBV genome, chromosome 12 trisomy, lack of c-MYC rearrangement and Myd88 gene mutation, presence of somatic hypermutation in the VH region, and wild-type p53. CONCLUSION This new EBV-positive cell line may be useful to further characterize in vivo activated DLBCL with plasmacytic features.
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MESH Headings
- Aged
- Animals
- CARD Signaling Adaptor Proteins/genetics
- CD79 Antigens/genetics
- Cell Cycle
- Cell Line, Tumor
- Disease Models, Animal
- Guanylate Cyclase/genetics
- Herpesvirus 4, Human/genetics
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Variable Region/genetics
- Immunophenotyping
- In Situ Hybridization, Fluorescence
- Karyotype
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/virology
- Male
- Mice
- Mice, Knockout
- Mutation
- Myeloid Differentiation Factor 88/genetics
- Transplantation, Heterologous
- Tumor Suppressor Protein p53/genetics
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Affiliation(s)
- Ilaria Nichele
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Alberto Zamò
- Section of Pathological Anatomy, Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Anna Bertolaso
- Section of Pathological Anatomy, Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Francesco Bifari
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Martina Tinelli
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Marta Franchini
- Section of Pathological Anatomy, Department of Pathology and Diagnostics, University of Verona, Verona, Italy
| | - Roberta Stradoni
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Fiorenza Aprili
- Laboratory of Cytogenetics, Department of Pathology and Diagnostics, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanni Pizzolo
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Krampera
- Stem Cell Research Laboratory, Section of Hematology, Department of Medicine, University of Verona, Verona, Italy
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19
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Cesano A, Perbellini O, Evensen E, Chu CC, Cioffi F, Ptacek J, Damle RN, Chignola R, Cordeiro J, Yan XJ, Hawtin RE, Nichele I, Ware JR, Cavallini C, Lovato O, Zanotti R, Rai KR, Chiorazzi N, Pizzolo G, Scupoli MT. Association between B-cell receptor responsiveness and disease progression in B-cell chronic lymphocytic leukemia: results from single cell network profiling studies. Haematologica 2012; 98:626-34. [PMID: 23144194 DOI: 10.3324/haematol.2012.071910] [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] [Indexed: 01/01/2023] Open
Abstract
While many prognostic markers in B-cell chronic lymphocytic leukemia provide insight into the biology of the disease, few have been demonstrated to be useful in the daily management of patients. B-cell receptor signaling is a driving event in the progression of B-cell chronic lymphocytic leukemia and markers of B-cell receptor responsiveness have been shown to be of prognostic value. Single cell network profiling, a multiparametric flow cytometry-based assay, allows functional signaling analysis at the level of the single cell. B-cell receptor signaling proteins (i.e. p-SYK, p-NF-κB p65, p-ERK, p-p38, p-JNK) were functionally characterized by single cell network profiling in samples from patients with B-cell chronic lymphocytic leukemia in an exploratory study (n=27) after stimulation with anti-IgM. Significant associations of single cell network profiling data with clinical outcome (i.e. time to first treatment), as assessed by Cox regression models, were then confirmed in patients' samples in two other sequential independent studies, i.e. test study 1 (n=30), and test study 2 (n=37). In the exploratory study, higher responsiveness of the B-cell receptor signaling proteins to anti-IgM was associated with poor clinical outcomes. Patients' clustering based on signaling response was at least as powerful in discriminating different disease courses as traditional prognostic markers. In an unselected subgroup of patients with Binet stage A disease (n=21), increased anti-IgM-modulated p-ERK signaling was shown to be a significant, independent predictor of shorter time to first treatment. This result was independently confirmed in two test cohorts from distinct populations of patients. In conclusion, these findings support the utility of the single cell network profiling assay in elucidating signaling perturbations with the potential for the development of a clinically useful prognostic test in patients with early stage B-cell chronic lymphocytic leukemia. These data support the clinical relevance of B-cell receptor signaling in B-cell chronic lymphocytic leukemia, and suggest a key role of ERK activation in the physiopathology of this leukemia.
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20
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Tecchio C, Bonetto C, Bertani M, Cristofalo D, Lasalvia A, Nichele I, Bonani A, Andreini A, Benedetti F, Ruggeri M, Pizzolo G. Predictors of anxiety and depression in hematopoietic stem cell transplant patients during protective isolation. Psychooncology 2012; 22:1790-7. [DOI: 10.1002/pon.3215] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 09/20/2012] [Accepted: 10/01/2012] [Indexed: 01/21/2023]
Affiliation(s)
- Cristina Tecchio
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine; University of Verona; Verona Italy
| | - Chiara Bonetto
- Section of Psychiatry, Department of Public Health and Community Medicine; University of Verona; Verona Italy
| | - Mariaelena Bertani
- Section of Psychiatry, Department of Public Health and Community Medicine; University of Verona; Verona Italy
| | - Doriana Cristofalo
- Section of Psychiatry, Department of Public Health and Community Medicine; University of Verona; Verona Italy
| | - Antonio Lasalvia
- Section of Psychiatry, Department of Public Health and Community Medicine; University of Verona; Verona Italy
| | - Ilaria Nichele
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine; University of Verona; Verona Italy
| | - Anna Bonani
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine; University of Verona; Verona Italy
| | - Angelo Andreini
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine; University of Verona; Verona Italy
| | - Fabio Benedetti
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine; University of Verona; Verona Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Department of Public Health and Community Medicine; University of Verona; Verona Italy
| | - Giovanni Pizzolo
- Section of Hematology and Bone Marrow Transplant Unit, Department of Medicine; University of Verona; Verona Italy
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21
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Barbui T, Thiele J, Passamonti F, Rumi E, Boveri E, Randi ML, Bertozzi I, Marino F, Vannucchi AM, Pieri L, Rotunno G, Gisslinger H, Gisslinger B, Müllauer L, Finazzi G, Carobbio A, Gianatti A, Ruggeri M, Nichele I, D'Amore E, Rambaldi A, Tefferi A. Initial bone marrow reticulin fibrosis in polycythemia vera exerts an impact on clinical outcome. Blood 2012. [PMID: 22246040 DOI: 10.1182/blood-2011-11393819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
We examined the prevalence and prognostic relevance of bone marrow reticulin fibrosis in 526 patients with World Health Organization-defined polycythemia vera evaluated at the time of initial diagnosis. Seventy-four patients (14%) displayed mostly grade 1 reticulin fibrosis, with only 2 cases showing higher-grade fibrosis. Presenting clinical and laboratory characteristics, including JAK2V617F allele burden, between patients with and without fibrosis were similar for the most part, with the exception of a higher prevalence of palpable splenomegaly in patients with fibrosis (P < .01). Patients with fibrosis were less prone to experience thrombosis during their clinical course (1.1 vs 2.7 per 100 patient-years; P = .03) and more prone to develop post-polycythemia vera myelofibrosis (2.2 vs 0.8 per 100 patient-years; P = .01). There was no significant difference between the 2 groups in terms of overall or leukemia-free survival. The present study clarifies the incidence, degree, and prognostic relevance of bone marrow fibrosis obtained at time of initial diagnosis of polycythemia vera.
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22
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Laurenti L, Tarnani M, Nichele I, Ciolli S, Cortelezzi A, Forconi F, Rossi D, Mauro FR, D'Arena G, Del Poeta G, Montanaro M, Morabito F, Musolino C, Callea V, Falchi L, Tedeschi A, Ambrosetti A, Gaidano G, Leone G, Foà R. The coexistence of chronic lymphocytic leukemia and myeloproliperative neoplasms: a retrospective multicentric GIMEMA experience. Am J Hematol 2011; 86:1007-12. [PMID: 21953617 DOI: 10.1002/ajh.22171] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [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: 08/12/2011] [Accepted: 08/15/2011] [Indexed: 11/09/2022]
Abstract
Although the coexistence of chronic lymphocytic leukemia (CLL) and myeloproliferative neoplasms (MPN) has been sporadically reported in the literature, no systematic studies on this disease association are available. We retrospectively analyzed 46 patients affected by CLL/MPN referred by 15 Italian GIMEMA centers. The aim of this retrospective multicenter study was to define the following: clinico-biological characteristics, possible familiarity, clinical course of both diseases, and influence of MPN chemotherapy on the course of CLL. Among 46 patients, 30 patients were males, 16 patients were females; median age was 71 years. Only one case had familiar CLL. Myeloproliferative disorders consisted of essential thrombocytemia in 18 cases, polycythemia vera in 10 cases, chronic myeloid leukemia in 9 cases, primary myelofibrosis in 6 cases, and MPN/myelodysplastic syndrome in 3 cases. The lymphoproliferative disorder was diagnosed as monoclonal B-cell lymphocytosis in 8 patients and as Binet Stage A CLL in 38 patients. After a median follow-up of 49 months, 9 patients experienced progressive CLL and only 6 patients required treatment after a median of 57.5 months. The biological profile confirmed a subset of low-risk CLL. Twenty patients received chemotherapy for MPN without influence on the course of CLL: lymphocyte counts remained unchanged after 3, 6, and 12 months of treatment. This series is the largest so far reported in literature. The diagnosis of concomitant CLL/MPN is a rare event and lymphoproliferative disorders present a clinical indolent course with a low-risk biological profile. MPN therapy does not interfere with the prognosis of patients with CLL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Disease Progression
- Female
- Humans
- Incidence
- Italy/epidemiology
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/physiopathology
- Lymphocytosis/diagnosis
- Lymphocytosis/physiopathology
- Male
- Medical Records
- Middle Aged
- Myelodysplastic Syndromes/diagnosis
- Myelodysplastic Syndromes/drug therapy
- Myelodysplastic Syndromes/epidemiology
- Myelodysplastic Syndromes/physiopathology
- Myeloproliferative Disorders/diagnosis
- Myeloproliferative Disorders/drug therapy
- Myeloproliferative Disorders/epidemiology
- Myeloproliferative Disorders/physiopathology
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/epidemiology
- Neoplasms, Second Primary/physiopathology
- Oncology Service, Hospital
- Prognosis
- Retrospective Studies
- Time Factors
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Affiliation(s)
- Luca Laurenti
- Hematology Institute, Catholic University, Largo A. Gemelli 8, Rome, Italy.
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23
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Tecchio C, Nichele I, Mosna F, Zampieri F, Leso A, Al-Khaffaf A, Veneri D, Andreini A, Pizzolo G, Ambrosetti A. A proliferation-inducing ligand (APRIL) serum levels predict time to first treatment in patients affected by B-cell chronic lymphocytic leukemia. Eur J Haematol 2011; 87:228-34. [PMID: 21595749 DOI: 10.1111/j.1600-0609.2011.01650.x] [Citation(s) in RCA: 9] [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: 12/27/2022]
Abstract
PURPOSE A proliferation-inducing ligand (APRIL), a tumor necrosis factor superfamily member involved in B-lymphocytes differentiation and survival, plays a role in protecting B-Cell Chronic lymphocytic leukemia (B-CLL) cells from apoptosis. Having observed that APRIL serum (sAPRIL) levels were higher in B-CLL patients with CLL at diagnosis as compared to healthy donors (14.61±32.65 vs. 4.19±3.42 ng/mL; P<0.001), we tested the correlation existing in these patients between sAPRIL, clinical-biological parameters and disease progression. EXPERIMENTAL DESIGN sAPRIL levels were measured by ELISA in 130 patients with B-CLL at diagnosis and in 25 healthy donors. RESULTS sAPRIL levels did not correlate with gender, age, clinical stage, blood cell counts, β2-microglobulin (β2M) levels, ZAP-70 and CD38 expression. Using median sAPRIL natural logarithm (ln) as cutoff, we distinguished two groups of patients (APRIL(LOW) and APRIL(HIGH) ) who were comparable with regard to clinical-biological parameters and overall survival, but different with regard to time to the first treatment (TTFT; P=0.035). According to univariate analysis, high lymphocyte count, high β2M, Binet stage B-C, ZAP-70 expression and ln(sAPRIL) above median were associated with earlier TTFT. Advanced clinical stage, high β2M, ZAP-70 expression and ln(sAPRIL) above median remained independently predictive of shorter TTFT at multivariate analysis. Moreover, sAPRIL increased its prognostic significance when patients were stratified according to independent favorable clinical-biological characteristics (low β2M, stage A and lack of ZAP-70 expression). CONCLUSIONS sAPRIL is a novel indicator of shorter TTFT in B-CLL and a predictor of progression especially in patients otherwise considered at low risk according to validated prognostic factors.
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Affiliation(s)
- Cristina Tecchio
- Section of Hematology, Department of Medicine, University of Verona, Piazzale L A Scuro 10, Verona, Italy.
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24
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Scupoli M, Perbellini O, Cioffi F, Chignola R, Evensen E, Zanotti R, Nichele I, Lovato O, Pizzolo G. 35 BCR-signaling profiles associated with prognosis and progression in B-CLL. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70706-0] [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: 12/01/2022] Open
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25
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Tecchio C, Nichele I, Todeschini G, Pizzolo G, Ambrosetti A. Dasatinib-induced response in a rare case of chronic lymphocytic leukaemia associated with chronic myeloid leukaemia. Br J Haematol 2009; 146:222-3. [PMID: 19466973 DOI: 10.1111/j.1365-2141.2009.07731.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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26
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Veneri D, Franchini M, Randon F, Nichele I, Pizzolo G, Ambrosetti A. Thrombocytopenias: a clinical point of view. Blood Transfus 2009; 7:75-85. [PMID: 19503627 PMCID: PMC2689060 DOI: 10.2450/2008.0012-08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/12/2008] [Accepted: 09/04/2008] [Indexed: 12/31/2022]
Affiliation(s)
- Dino Veneri
- Dipartimento di Medicina Clinica e Sperimentale, Sezione di Ematologia, Università di Verona, Verona, Italy.
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