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Urbino I, Lengliné E, Rabian F, Cerrano M, Kim R, Chevillon F, Ferrero D, Sébert M, Dhedin N, Itzykson RA, Adès L, Raffoux E, Dombret H, Audisio E, Clappier E, Boissel N. Blinatumomab Consolidation for Adult B-Cell Acute Lymphoblastic Leukemia in First and Second Complete Remission. Blood Adv 2024:bloodadvances.2023012139. [PMID: 38507689 DOI: 10.1182/bloodadvances.2023012139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/02/2024] [Accepted: 02/15/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
| | | | | | - Marco Cerrano
- Department of Oncology, Division of Hematology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, Torino, Torino, Italy
| | - Rathana Kim
- Université Paris Cité - Hopital Saint-Louis APHP - INSERM U944, PARIS, France
| | - Florian Chevillon
- Department of Hematology, University Hospital Saint-Louis, AP-HP, Paris, France
| | | | | | | | | | - Lionel Adès
- AP-HP, Hôpital Saint Louis and University of Paris, and INSERM U944, Paris, France
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Urbino I, Lengliné E, Valade S, Cerrano M, Sebert M, Raffoux E, Rabian F, Azoulay E, Boissel N. Life-threatening complications and intensive care unit management in patients treated with blinatumomab for B-cell acute lymphoblastic leukemia. Crit Care 2024; 28:14. [PMID: 38183144 PMCID: PMC10768465 DOI: 10.1186/s13054-023-04787-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/20/2023] [Indexed: 01/07/2024] Open
Affiliation(s)
- Irene Urbino
- Hématologie Clinique, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France.
- Division of Hematology, Department of Oncology, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
| | - Etienne Lengliné
- Hématologie Clinique, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Sandrine Valade
- Medical Intensive Care Unit, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Marco Cerrano
- Hématologie Clinique, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
- Division of Hematology, Department of Oncology, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marie Sebert
- Hématologie Clinique, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Emmanuel Raffoux
- Hématologie Clinique, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Florence Rabian
- Hématologie Clinique, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France
| | - Nicolas Boissel
- Hématologie Clinique, Hôpital Saint-Louis, APHP, Université Paris Diderot, Paris, France.
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Urbino I, Secreto C, Apolito V, Olivi M, Arrigo G, Boscaro E, Catania FM, D'Ardia S, Frairia C, Giai V, Freilone R, Bruno B, Lanzarone G, Giaccone L, Busca A, Dellacasa CM, Ferrero D, Audisio E, Cerrano M. Sorafenib in combination with intensive chemotherapy for relapsed or refractory FLT3-ITD positive acute myeloid leukemia: A two centers experience. Leuk Res 2024; 136:107421. [PMID: 38042648 DOI: 10.1016/j.leukres.2023.107421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/31/2023] [Accepted: 11/14/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Irene Urbino
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Carolina Secreto
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Vincenzo Apolito
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy; Pediatric Oncohematology, Stem Cell Transplantation and Cell Therapy Division, Regina Margherita Children's Hospital, Turin, Italy
| | - Matteo Olivi
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy
| | - Giulia Arrigo
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy
| | - Eleonora Boscaro
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy
| | - Federica Maria Catania
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy; Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy
| | - Stefano D'Ardia
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Chiara Frairia
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Valentina Giai
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Roberto Freilone
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Benedetto Bruno
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy; Division of Hematology, Allogeneic Transplant and Cell Therapy Unit, AOU "Città della Salute e della Scienza di Torino" University of Turin, Italy
| | - Giuseppe Lanzarone
- Division of Hematology, Allogeneic Transplant and Cell Therapy Unit, AOU "Città della Salute e della Scienza di Torino" University of Turin, Italy
| | - Luisa Giaccone
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy; Division of Hematology, Allogeneic Transplant and Cell Therapy Unit, AOU "Città della Salute e della Scienza di Torino" University of Turin, Italy
| | - Alessandro Busca
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Chiara Maria Dellacasa
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Dario Ferrero
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Italy; Division of Hematology, Allogeneic Transplant and Cell Therapy Unit, AOU "Città della Salute e della Scienza di Torino" University of Turin, Italy
| | - Ernesta Audisio
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | - Marco Cerrano
- Department of Oncology, Division of Hematology, A.O.U. Città della Salute e della Scienza, Turin, Italy.
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4
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Boscaro E, Urbino I, Catania FM, Arrigo G, Secreto C, Olivi M, D'Ardia S, Frairia C, Giai V, Freilone R, Ferrero D, Audisio E, Cerrano M. Modern Risk Stratification of Acute Myeloid Leukemia in 2023: Integrating Established and Emerging Prognostic Factors. Cancers (Basel) 2023; 15:3512. [PMID: 37444622 DOI: 10.3390/cancers15133512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
An accurate estimation of AML prognosis is complex since it depends on patient-related factors, AML manifestations at diagnosis, and disease genetics. Furthermore, the depth of response, evaluated using the level of MRD, has been established as a strong prognostic factor in several AML subgroups. In recent years, this rapidly evolving field has made the prognostic evaluation of AML more challenging. Traditional prognostic factors, established in cohorts of patients treated with standard intensive chemotherapy, are becoming less accurate as new effective therapies are emerging. The widespread availability of next-generation sequencing platforms has improved our knowledge of AML biology and, consequently, the recent ELN 2022 recommendations significantly expanded the role of new gene mutations. However, the impact of rare co-mutational patterns remains to be fully disclosed, and large international consortia such as the HARMONY project will hopefully be instrumental to this aim. Moreover, accumulating evidence suggests that clonal architecture plays a significant prognostic role. The integration of clinical, cytogenetic, and molecular factors is essential, but hierarchical methods are reaching their limit. Thus, innovative approaches are being extensively explored, including those based on "knowledge banks". Indeed, more robust prognostic estimations can be obtained by matching each patient's genomic and clinical data with the ones derived from very large cohorts, but further improvements are needed.
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Affiliation(s)
- Eleonora Boscaro
- Division of Hematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Irene Urbino
- Division of Hematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Federica Maria Catania
- Division of Hematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Giulia Arrigo
- Division of Hematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Carolina Secreto
- Division of Hematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Matteo Olivi
- Division of Hematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Stefano D'Ardia
- Division of Hematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Chiara Frairia
- Division of Hematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Valentina Giai
- Division of Hematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Roberto Freilone
- Division of Hematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Dario Ferrero
- Division of Hematology, Department of Molecular Biotechnology and Health Sciences, University of Torino, 10126 Turin, Italy
| | - Ernesta Audisio
- Division of Hematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Marco Cerrano
- Division of Hematology, Department of Oncology, Presidio Molinette, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
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Fianchi L, Guolo F, Marchesi F, Cattaneo C, Gottardi M, Restuccia F, Candoni A, Ortu La Barbera E, Fazzi R, Pasciolla C, Finizio O, Fracchiolla N, Delia M, Lessi F, Dargenio M, Bonuomo V, Del Principe MI, Zappasodi P, Picardi M, Basilico C, Piedimonte M, Minetto P, Giordano A, Chiusolo P, Prezioso L, Buquicchio C, Melillo LMA, Zama D, Farina F, Mancini V, Terrenato I, Rondoni M, Urbino I, Tumbarello M, Busca A, Pagano L. Multicenter Observational Retrospective Study on Febrile Events in Patients with Acute Myeloid Leukemia Treated with Cpx-351 in "Real-Life": The SEIFEM Experience. Cancers (Basel) 2023; 15:3457. [PMID: 37444567 DOI: 10.3390/cancers15133457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
In the present study, we aimed to evaluate the absolute risk of infection in the real-life setting of AML patients treated with CPX-351. The study included all patients with AML from 30 Italian hematology centers of the SEIFEM group who received CPX-351 from July 2018 to June 2021. There were 200 patients included. Overall, 336 CPX-351 courses were counted: all 200 patients received the first induction cycle, 18 patients (5%) received a second CPX-351 induction, while 86 patients (26%) proceeded with the first CPX-351 consolidation cycle, and 32 patients (10%) received a second CPX-351 consolidation. A total of 249 febrile events were recorded: 193 during the first or second induction, and 56 after the first or second consolidation. After the diagnostic work-up, 92 events (37%) were classified as febrile neutropenia of unknown origin (FUO), 118 (47%) were classifiable as microbiologically documented infections, and 39 (17%) were classifiable as clinically documented infections. The overall 30-day mortality rate was 14% (28/200). The attributable mortality-infection rate was 6% (15/249). A lack of response to the CPX-351 treatment was the only factor significantly associated with mortality in the multivariate analysis [p-value: 0.004, OR 0.05, 95% CI 0.01-0.39]. Our study confirms the good safety profile of CPX-351 in a real-life setting, with an incidence of infectious complications comparable to that of the pivotal studies; despite prolonged neutropenia, the incidence of fungal infections was low, as was infection-related mortality.
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Affiliation(s)
- Luana Fianchi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Fabio Guolo
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | | | - Chiara Cattaneo
- SC Ematologia e Dipartimento di Oncologia Clinica, A.O. Spedali Civili, 25123 Brescia, Italy
| | - Michele Gottardi
- Onco Hematology, Department of Oncology, Veneto Institute of Oncology, IOV-IRCCS, 31033 Padua, Italy
| | | | - Anna Candoni
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, Università degli Studi di Modena e Reggio Emilia, 41125 Modena, Italy
| | | | - Rita Fazzi
- Hematology Unit-A.O.U.P. Ospedale Santa Chiara, 56126 Pisa, Italy
| | - Crescenza Pasciolla
- Haematology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | | | - Nicola Fracchiolla
- Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico di Milano, 20122 Milano, Italy
| | - Mario Delia
- Hematology and Transplant Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy
| | - Federica Lessi
- Ematologia e Immunologia, Clinica Azienda Ospedaliera di Padova, 35128 Padova, Italy
| | | | | | - Maria Ilaria Del Principe
- Dipartimento di Biomedicina e Prevenzione, Università degli studi di Roma "Tor Vergata", 00133 Roma, Italy
| | | | | | - Claudia Basilico
- Azienda Socio Sanitaria Territoriale dei Sette Laghi, 21100 Varese, Italy
| | | | - Paola Minetto
- Ematologia e Trapianto, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Antonio Giordano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | | | | | | | - Daniele Zama
- Policlinico Sant'Orsola Malpighi, 40138 Bologna, Italy
| | - Francesca Farina
- U.O. Ematologia e Trapianto Midollo, Dipartimento di Oncologia, Istituto Scientifico San Raffaele, 20132 Milano, Italy
| | - Valentina Mancini
- Divisione di Ematologia, Ospedale Niguarda Milano, 20162 Milano, Italy
| | - Irene Terrenato
- UOSD Clinical Trial Center e Biostatistica e Bioinformatica, IRCCS Istituto Nazionale Tumori Regina Elena, 00128 Roma, Italy
| | - Michela Rondoni
- U.O.C. di Ematologia, Azienda Unità Sanitaria Locale della Romagna, 48124 Ravenna, Italy
| | - Irene Urbino
- SC Ematologia, Ospedale AOU Città Della Salute e della Scienza, 10126 Torino, Italy
| | - Mario Tumbarello
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Alessandro Busca
- SC Ematologia, Ospedale AOU Città Della Salute e della Scienza, 10126 Torino, Italy
| | - Livio Pagano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS-Università Cattolica del Sacro Cuore, 00168 Roma, Italy
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Frairia C, Nicolino B, Secreto C, Messa E, Arrigo G, Busca A, Cerrano M, D'Ardìa S, Dellacasa C, Evangelista A, Freilone R, Giai V, Priolo G, Urbino I, Audisio E. Validation of National Early Warning Score and Quick Sequential (sepsis-related) Organ Failure Assessment in acute myeloid leukaemia patients treated with intensive chemotherapy. Eur J Haematol 2023; 110:696-705. [PMID: 36919878 DOI: 10.1111/ejh.13952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES Chemotherapy-induced neutropenia in acute myeloid leukaemia (AML) is a risk factor for life-threatening infections. Early diagnosis and prompt interventions are associated with better outcomes, but the prediction of infection severity remains an open question. Recently, National Early Warning Score (NEWS) and quick sequential organ failure assessment (qSOFA) scores were proposed as warning clinical instruments predicting in-hospital mortality, but their role in the haematological context is still unknown. METHODS We retrospectively assess the predictive role of NEWS and qSOFA in a large and homogeneous cohort of adult AML patients treated with intensive chemotherapy. In a total of 1048 neutropenic episodes recorded in 334 consecutive patients, the scores were applied to predict outcomes on the same day of fever onset, and after 24 and 48 h from score calculation. RESULTS Both NEWS and qSOFA significantly predicted death, with more accuracy on the same day (NEWS AUROC 0.984 and qSOFA AUROC 0.969) and after 24 h (NEWS AUROC 0.928 and qSOFA AUROC 0.887), while remained moderately accurate after 48 h. Furthermore, also ICU admission was accurately predicted at fever onset and after 24 h. CONCLUSIONS Both scores were useful tools in the management of post chemotherapy neutropenic febrile AML patients.
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Affiliation(s)
- Chiara Frairia
- Department of Hematology, University-Hospital Città della Salute e della Scienza, Turin, Italy
| | | | - Carolina Secreto
- Department of Hematology, University-Hospital Città della Salute e della Scienza, Turin, Italy
| | - Emanuela Messa
- Unit of Internal Medicine, ASL TO4, Chivasso, Turin, Italy
| | - Giulia Arrigo
- Department of Hematology, University-Hospital Città della Salute e della Scienza, Turin, Italy
| | - Alessandro Busca
- Department of Oncology, SSD Trapianto Allogenico, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Cerrano
- Department of Hematology, University-Hospital Città della Salute e della Scienza, Turin, Italy
| | - Stefano D'Ardìa
- Department of Hematology, University-Hospital Città della Salute e della Scienza, Turin, Italy
| | - Chiara Dellacasa
- Department of Oncology, SSD Trapianto Allogenico, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, University-Hospital Città della Salute e della Scienza, Turin, Italy
- CPO, Piemonte, Turin, Italy
| | - Roberto Freilone
- Department of Hematology, University-Hospital Città della Salute e della Scienza, Turin, Italy
| | - Valentina Giai
- Department of Hematology, University-Hospital Città della Salute e della Scienza, Turin, Italy
| | - Giorgio Priolo
- Department of Hematology, University-Hospital Città della Salute e della Scienza, Turin, Italy
| | - Irene Urbino
- Department of Hematology, University-Hospital Città della Salute e della Scienza, Turin, Italy
| | - Ernesta Audisio
- Department of Hematology, University-Hospital Città della Salute e della Scienza, Turin, Italy
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7
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Aydin S, Giai V, D'ardia S, Iovino G, Frairia C, Urbino I, Cerrano M, Beggiato E, Audisio E. ECULIZUMAB DOSE ADJUSTMENTS DURING PREGNANCIES IN PAROXYSMAL NOCTURNAL HEMOGLOBINURIA: A SINGLE CENTER EXPERIENCE. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.1258] [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: 11/07/2022] Open
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8
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Arrigo G, D'Ardìa S, Audisio E, Cerrano M, Freilone R, Giai V, Secreto C, Urbino I, Frairia C. Gilteritinib in isolated breast relapse of FLT3positive acute myeloid leukemia: a case report and review of literature. Acta Haematol 2022; 145:566-570. [PMID: 35580565 DOI: 10.1159/000524878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/01/2022] [Indexed: 11/19/2022]
Abstract
Extramedullary relapse of acute myeloid leukemia (AML) is not a rare event and FMS-like tyrosine kinase 3 (FLT3) mutation is a well-known risk factor. Gilteritinib is approved for relapsed/refractory FLT3+ AML but its efficacy in extramedullary relapse is still undefined. Here, we present the case of a 69-year-old woman with therapy-related nucleophosmin-1 (NPM1) and FLT3-internal tandem duplication (FLT3-ITD) positive acute myeloid leukemia treated with induction and consolidation with CPX-351 (liposomal daunorubicin plus cytarabine) followed by off-label azacitidine maintenance who obtained a complete remission (CR) with persistent measurable residual disease. After 19 months of CR, she experienced an isolated breast relapse of FLT3-ITD+ AML. She was started on single agent gilteritinib, resulting in a rapid and persistent complete regression of the breast nodule. Targeted therapy with gilteritinib for relapsed/refractory FLT3-ITD+ AML can be effective in isolated extramedullary relapse.
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Affiliation(s)
- Giulia Arrigo
- Division of Hematology, Department of Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Stefano D'Ardìa
- Division of Hematology, Department of Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Ernesta Audisio
- Division of Hematology, Department of Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Marco Cerrano
- Division of Hematology, Department of Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Roberto Freilone
- Division of Hematology, Department of Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Valentina Giai
- Division of Hematology, Department of Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Carolina Secreto
- Division of Hematology, Department of Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Irene Urbino
- Division of Hematology, Department of Oncology, AOU Città della Salute e della Scienza, Turin, Italy
| | - Chiara Frairia
- Division of Hematology, Department of Oncology, AOU Città della Salute e della Scienza, Turin, Italy
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9
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Martella F, Cerrano M, Di Cuonzo D, Secreto C, Olivi M, Apolito V, D'Ardia S, Frairia C, Giai V, Lanzarone G, Urbino I, Freilone R, Giaccone L, Busca A, Dellacasa CM, Audisio E, Ferrero D, Beggiato E. Frequency and risk factors for thrombosis in acute myeloid leukemia and high-risk myelodysplastic syndromes treated with intensive chemotherapy: a two centers observational study. Ann Hematol 2022; 101:855-867. [PMID: 35128571 DOI: 10.1007/s00277-022-04770-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 01/21/2022] [Indexed: 12/17/2022]
Abstract
The frequency of thrombosis in AML has been evaluated only in a few studies and no validated predictive model is currently available. Recently, DIC score was shown to identify patients at higher thrombotic risk. We aimed to evaluate the frequency of thromboembolism in AML patients treated with intensive chemotherapy and to assess the ability of genetic and clinical factors to predict the thrombotic risk. We performed a retrospective observational study including 222 newly diagnosed adult AML (210) and high-risk MDS (12), treated with intensive chemotherapy between January 2013 and February 2020. With a median follow-up of 44 months, we observed 50 thrombotic events (90% were venous, VTE). The prevalence of thrombosis was 22.1% and the 6-months cumulative incidence of thrombosis was 10%. The median time to thrombosis was 84 days and 52% of the events occurred within 100 days from AML diagnosis. Khorana and DIC score failed to stratify patients according to their thrombotic risk. Only history of a thrombotic event (p = 0.043), particularly VTE (p = 0.0053), platelet count above 100 × 109/L at diagnosis (p = 0.036) and active smoking (p = 0.025) significantly and independently increased the risk of thrombosis, the latter particularly of arterial events. AML genetic profile did not affect thrombosis occurrence. Results were confirmed considering only thromboses occurring within day 100 from diagnosis. DIC score at diagnosis, but not thrombosis, was independently associated with reduced survival (p = 0.004). Previous VTE, platelet count above 100 × 109/L and active smoking were the only factors associate with increased thrombotic risk in AML patients treated intensively, but further studies are needed to validate these results.
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Affiliation(s)
- Federica Martella
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Marco Cerrano
- Department of Oncology, Division of Hematology, AOU Città della Salute e della Scienza di Torino, Presidio Molinette, 10126, Turin, Italy.
| | - Daniela Di Cuonzo
- Unit of Clinical Epidemiology, CPO, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Carolina Secreto
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Matteo Olivi
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Vincenzo Apolito
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Stefano D'Ardia
- Department of Oncology, Division of Hematology, AOU Città della Salute e della Scienza di Torino, Presidio Molinette, 10126, Turin, Italy
| | - Chiara Frairia
- Department of Oncology, Division of Hematology, AOU Città della Salute e della Scienza di Torino, Presidio Molinette, 10126, Turin, Italy
| | - Valentina Giai
- Department of Oncology, Division of Hematology, AOU Città della Salute e della Scienza di Torino, Presidio Molinette, 10126, Turin, Italy
| | - Giuseppe Lanzarone
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Irene Urbino
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Roberto Freilone
- Department of Oncology, Division of Hematology, AOU Città della Salute e della Scienza di Torino, Presidio Molinette, 10126, Turin, Italy
| | - Luisa Giaccone
- Department of Oncology, SSD Trapianto Allogenico, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alessandro Busca
- Department of Oncology, SSD Trapianto Allogenico, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Chiara Maria Dellacasa
- Department of Oncology, SSD Trapianto Allogenico, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ernesta Audisio
- Department of Oncology, Division of Hematology, AOU Città della Salute e della Scienza di Torino, Presidio Molinette, 10126, Turin, Italy
| | - Dario Ferrero
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
| | - Eloise Beggiato
- Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Torino, Turin, Italy
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Benevolo G, Vassallo F, Urbino I, Giai V. Polycythemia Vera (PV): Update on Emerging Treatment Options. Ther Clin Risk Manag 2021; 17:209-221. [PMID: 33758507 PMCID: PMC7981161 DOI: 10.2147/tcrm.s213020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/21/2021] [Indexed: 12/13/2022] Open
Abstract
Polycythemia Vera (PV) is a chronic myeloproliferative neoplasm characterized by exuberant red cell production leading to a broad range of symptoms that compromise quality of life and productivity of patients. PV reduces survival expectation, primarily due to thrombotic events, transformation to blast phase and post-PV myelofibrosis or to development of second cancers, which are associates with poor prognosis. Current therapeutic first line recommendations based on risk adapted classification divided patients into two groups, according to age (< or >60 years) and presence of prior thrombotic events. Low-risk patients (age <60 years and no prior history of thrombosis) should be treated with aspirin (81-100 mg/d) and phlebotomy, to maintain hematocrit <45%. High-risk patients (age >60 years and/or prior history of thrombosis), in addition to aspirin and phlebotomies, should receive cytoreductive therapy in order to reduce thrombotic risk. Nowadays hydroxyurea still remains the cytoreductive agent of first choice, reserving Interferon to young patients or childbearing women. During the last years, ruxolitinib emerged as a new treatment in PV patients, as second line therapy: it appeared especially effective in patients with severe pruritus, symptomatic splenomegaly, or post-PV myelofibrosis symptoms. Currently, in PV treatment, several molecules have been tested or are under investigation. At present, the drug that has shown the most encouraging results is givinostat.
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Affiliation(s)
- Giulia Benevolo
- Division of Haematology, Città della Salute e della Scienza, Turin, Italy
| | - Francesco Vassallo
- Division of Haematology, Città della Salute e della Scienza, Turin, Italy
| | - Irene Urbino
- Division of Haematology, Città della Salute e della Scienza, Turin, Italy
| | - Valentina Giai
- Division of Haematology, Città della Salute e della Scienza, Turin, Italy
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Benevolo G, Urbino I. Myeloid Neoplasms with Eosinophilia: Rare Entities with Emerging Diagnostic and Therapeutic Challenges. Acta Haematol 2020; 146:347-348. [PMID: 33207337 DOI: 10.1159/000511327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Giulia Benevolo
- Division of Haematology, Città della Salute e della Scienza, Turin, Italy,
| | - Irene Urbino
- Division of Haematology, Città della Salute e della Scienza, Turin, Italy
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