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von Arx C, Della Vittoria Scarpati G, Cannella L, Clemente O, Marretta AL, Bracigliano A, Picozzi F, Iervolino D, Granata V, Modica R, Bianco A, Mocerino C, Di Mauro A, Pizzolorusso A, Di Sarno A, Ottaiano A, Tafuto S. A new schedule of one week on/one week off temozolomide as second-line treatment of advanced neuroendocrine carcinomas (TENEC-TRIAL): a multicenter, open-label, single-arm, phase II trial. ESMO Open 2024; 9:103003. [PMID: 38615472 PMCID: PMC11033066 DOI: 10.1016/j.esmoop.2024.103003] [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: 01/31/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND There is no consensus on the second-line treatment of patients with progressive high-grade neuroendocrine neoplasms (NENs G3) and large-cell lung neuroendocrine carcinoma. These patients generally have poor performance status and low tolerance to combination therapy. In this trial, we aim to evaluate the efficacy and safety of temozolomide given every other week in patients with advanced platinum-pretreated NENs G3. PATIENTS AND METHODS This trial is an open-label, non-randomized, phase II trial. Patients with platinum-pretreated metastatic neuroendocrine carcinoma were treated with 75 mg/m2/day of temozolomide for 7 days, followed by 7 days of no treatment (regimen one week on/one week off). The primary endpoint was the overall response rate. Secondary endpoints included progression-free survival (PFS), overall survival (OS), safety and tolerability. This study is registered with ClinicalTrials.gov, NCT04122911. RESULTS From 2017 to 2020, 38 patients were enrolled. Among the patients with determined Ki67, 12 out of 36 (33.3%) had a Ki67 index <55% and the remaining 24 out of 36 (66.6%) had an index ≥55%. Overall response rate was 18% (7/38), including one complete response and six partial responses. The median PFS was 5.86 months [95% confidence interval (CI) 4.8 months-not applicable) and the median OS was 12.1 months (95% CI 5.6-20.4 months). The 1-year PFS rate was 37%. No statistically significant difference in median PFS [hazard ratio 1.3 (95% CI 0.6-2.8); P = 0.44] and median OS [hazard ratio 1.1 (95% CI 0.5-2.4); P = 0.77] was observed among patients with Ki67 <55% versus ≥55%. Only G1-G2 adverse events were registered, the most common being G1 nausea, diarrhea and abdominal pain. CONCLUSION One week on/one week off temozolomide shows promising activity in patients with poorly differentiated NEN. The good safety profile confirmed the possibility of using this scheme in patients with poor performance status.
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Affiliation(s)
- C von Arx
- Department of Breast and Thoracic Oncology, Division of Breast Medical Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples.
| | - G Della Vittoria Scarpati
- Sarcomas and Rare Tumors Unit, Istituto Nazionale Tumori - I.R.C.C.S. Fondazione "G.Pascale", Naples
| | - L Cannella
- Sarcomas and Rare Tumors Unit, Istituto Nazionale Tumori - I.R.C.C.S. Fondazione "G.Pascale", Naples
| | - O Clemente
- Sarcomas and Rare Tumors Unit, Istituto Nazionale Tumori - I.R.C.C.S. Fondazione "G.Pascale", Naples
| | - A L Marretta
- Medical Oncology Unit, Ospedale Ave Gratia Plena, San Felice a Cancello, Caserta
| | - A Bracigliano
- Nuclear Medicine, Istituto Nazionale Tumori - I.R.C.C.S. Fondazione "G. Pascale", Naples
| | - F Picozzi
- Sarcomas and Rare Tumors Unit, Istituto Nazionale Tumori - I.R.C.C.S. Fondazione "G.Pascale", Naples
| | - D Iervolino
- ISS Clinica di Domenico Iervolino, Palma Campania, Naples
| | - V Granata
- Radiology Unit, Istituto Nazionale Tumori - I.R.C.C.S. Fondazione "G. Pascale", Naples
| | - R Modica
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples
| | - A Bianco
- Medical Oncology Unit AORN Ospedale dei Colli, Naples
| | - C Mocerino
- Medical Oncology Unit AORN "A. Cardarelli", Naples
| | - A Di Mauro
- Pathology Unit, Istituto Nazionale Tumori - I.R.C.C.S. Fondazione "G. Pascale", Naples
| | - A Pizzolorusso
- Sarcomas and Rare Tumors Unit, Istituto Nazionale Tumori - I.R.C.C.S. Fondazione "G.Pascale", Naples
| | - A Di Sarno
- Endocrinology, Diabetology and Andrology Unit, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples
| | - A Ottaiano
- SSD Innovative Therapies for Abdominal Metastases, Abdominal Oncology, Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Naples, Italy
| | - S Tafuto
- Sarcomas and Rare Tumors Unit, Istituto Nazionale Tumori - I.R.C.C.S. Fondazione "G.Pascale", Naples
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2
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Baron F, Efficace F, Cannella L, Stevens-Kroef M, Amadori S, de Witte T, Lübbert M, Venditti A, Suciu S. Similar efficacy outcomes with peripheral blood stem cell versus bone marrow for autologous stem cell transplantation in acute myeloid leukemia: Long-term follow-up of the EORTC-GIMEMA randomized AML-10 trial. Am J Hematol 2024; 99:486-489. [PMID: 38174977 DOI: 10.1002/ajh.27196] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024]
Abstract
We report here the long-term follow-up of the only prospective randomized trial of autologous hematopoietic stem cell transplantation (auto-HSCT) with peripheral blood stem cells (APBSCT) versus auto-HSCT with bone marrow (ABMT) in acute myeloid leukemia (AML) patients in first remission (CR). We observed that among patients alive and still in CR 5 years after planned auto-HSCT, approximately 10% of the patients died in the following 10 years. This stresses the need for long-term close surveillance of AML patients after auto-HSCT. Further, long-term follow-up of the trial confirms that APBSCT was comparable to ABMT in term of disease-free-survival and overall survival.
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Affiliation(s)
- Frédéric Baron
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Laboratory of Hematology, University of Liège, Liège, Belgium
| | - Fabio Efficace
- Gruppo Italiano Malattie Ematologiche Dell'Adulto GIMEMA, Rome, Italy
| | - Laura Cannella
- Gruppo Italiano Malattie Ematologiche Dell'Adulto GIMEMA, Rome, Italy
| | | | - Sergio Amadori
- Gruppo Italiano Malattie Ematologiche Dell'Adulto GIMEMA, Rome, Italy
| | - Theo de Witte
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael Lübbert
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
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3
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Efficace F, Cannella L, Breccia M, Olivieri J, Platzbecker U, Vignetti M. Health-related quality of life in patients with acute promyelocytic leukemia: a systematic literature review. Expert Rev Hematol 2021; 14:645-654. [PMID: 34125642 DOI: 10.1080/17474086.2021.1943352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Remarkable advances have been made in acute promyelocytic leukemia (APL) research over the past decades and many patients can now also be cured without traditional chemotherapy. Therefore, the assessment of health-related quality of life (HRQoL) and other types of patient-reported outcomes (PROs) is highly relevant in the current APL treatment landscape.Areas covered: A systematic literature review was performed to identify APL studies assessing HRQoL that were published over the last 15 years. Eligible studies were evaluated on a predetermined data extraction form including information on the study design, PRO measure used, as well patient characteristics and summary of HRQoL findings. For descriptive purposes, selected studies were grouped and discussed based on the type of treatment: standard chemotherapy only versus those also including more recent targeted arsenic trioxide (ATO)-based strategies.Expert opinion: Inclusion of HRQoL in APL research was important to better understand the benefit-risk profile of intravenous ATO compared to traditional chemotherapy. While some information on HRQoL and symptoms in APL survivors treated with standard chemotherapy is available, the long-term effects of ATO therapy on patients' HRQoL are largely unknown. Additionally, future studies are needed to evaluate the potential advantages of oral ATO over intravenous administration.
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Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Laura Cannella
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University, Italy
| | - Jacopo Olivieri
- Clinica Ematologica, Centro Trapianti E Terapie Cellulari "C. Melzi," Azienda Sanitaria Universitaria Integrata Di Udine, Udine, Italy
| | - Uwe Platzbecker
- Medical Clinic and Polyclinic I, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
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Baron F, Efficace F, Cannella L, Muus P, Trisolini S, Halkes CJM, Fazi P, Vignetti M, Marie J, Chiusolo P, Velden W, La Sala E, Vitolo U, Thomas X, Lefrère F, Di Raimondo F, Bourhis J, Specchia G, Guimarães JE, Allione B, Vrhovac R, Ferrara F, Stevens‐Kroef M, Meert L, Witte T, Willemze R, Amadori S, Suciu S. Impact of the type of anthracycline and of stem cell transplantation in younger patients with acute myeloid leukaemia: Long-term follow up of a phase III study. Am J Hematol 2020; 95:749-758. [PMID: 32233095 DOI: 10.1002/ajh.25795] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/06/2020] [Accepted: 03/18/2020] [Indexed: 12/17/2022]
Abstract
We provide a long-term evaluation of patients enrolled in the EORTC/GIMEMA AML-10 trial which included a total of 2157 patients, 15-60 years old, randomized to receive either daunorubicin (DNR, 50 mg/m2 ), mitoxantrone (MXR, 12 mg/m2 ), or idarubicin (IDA, 10 mg/m2 ) in addition to standard-dose cytarabine and etoposide for induction chemotherapy and intermediate dose cytarabine for consolidation. Younger patients who reached complete remission with complete (CR) or incomplete (CRi) recovery were then scheduled to receive an allogeneic hematopoietic stem cell transplantation (HSCT). That was if they had a HLA-identical sibling donor; in all other cases, an autologous HSCT had to be administered. At an 11-year median follow-up, the 5-year, 10-year and 15-year overall survival (OS) rates were 33.2%, 30.1% and 28.0%, respectively. No significant difference between the three randomized groups regarding OS was observed (P = .38). In young patients, 15-45 years old, no treatment difference (P = .89) regarding OS was observed, while in patients 46-60 years old, MXR and IDA groups had a trend for a longer OS as compared to the DNR group (P = .029). Among younger patients without a favorable MRC cytogenetic risk subgroup who achieved a CR/CRi after induction chemotherapy, those with a HLA-identical sibling donor had higher 10-year and 15-year OS rates than those without. In older patients who reached CR/CRi, the long-term outcomes of those with or without a donor was similar. In conclusion, long-term outcomes of the study confirmed similar OS in the three randomized groups in the whole cohort of patients.
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Affiliation(s)
| | - Fabio Efficace
- Gruppo Italiano Malattie Ematologiche Dell'Adulto GIMEMA Rome Italy
| | - Laura Cannella
- Gruppo Italiano Malattie Ematologiche Dell'Adulto GIMEMA Rome Italy
| | - Petra Muus
- Radboud University Medical Center Nijmegen Netherlands
| | | | | | - Paola Fazi
- Gruppo Italiano Malattie Ematologiche Dell'Adulto GIMEMA Rome Italy
| | - Marco Vignetti
- Gruppo Italiano Malattie Ematologiche Dell'Adulto GIMEMA Rome Italy
| | | | | | - Walter Velden
- Radboud University Medical Center Nijmegen Netherlands
| | - Edoardo La Sala
- Gruppo Italiano Malattie Ematologiche Dell'Adulto GIMEMA Rome Italy
| | | | | | - Francois Lefrère
- Assistance Publique‐Hôpitaux de ParisNecker Children's Hospital Paris France
| | | | | | | | | | | | | | | | | | | | - Theo Witte
- Radboud University Medical Center Nijmegen Netherlands
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Baron F, Efficace F, Cannella L, Willemze R, Vignetti M, Muus P, Marie JP, Ferrero D, Fazi P, La Sala E, Bourhis JH, Fabbiano F, Bosi A, Sborgia M, Martinelli G, Wittnebel S, Trisolini S, Petti MC, Halkes CJM, van der Velden WJFM, de Witte T, Amadori S, Zittoun RA, Suciu S. Long-term follow-up of a trial comparing post-remission treatment with autologous or allogeneic bone marrow transplantation or intensive chemotherapy in younger acute myeloid leukemia patients. Haematologica 2019; 105:e13-e16. [PMID: 31097634 DOI: 10.3324/haematol.2019.221333] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Fabio Efficace
- Gruppo Italiano Malattie Ematologiche Dell'Adulto GIMEMA, Rome, Rome, Italy
| | - Laura Cannella
- Gruppo Italiano Malattie Ematologiche Dell'Adulto GIMEMA, Rome, Rome, Italy
| | - Roel Willemze
- Leiden University Medical Center, Leiden, the Netherlands
| | - Marco Vignetti
- Gruppo Italiano Malattie Ematologiche Dell'Adulto GIMEMA, Rome, Rome, Italy
| | - Petra Muus
- Radboud University Medical Center, Nijmegen, the Netherlands.,Currently: King's College Hospital, London, UK
| | | | - Dario Ferrero
- Department of Medicine and Experimental Oncology, Torino, Italy
| | - Paola Fazi
- Gruppo Italiano Malattie Ematologiche Dell'Adulto GIMEMA, Rome, Rome, Italy
| | - Edoardo La Sala
- Gruppo Italiano Malattie Ematologiche Dell'Adulto GIMEMA, Rome, Rome, Italy
| | | | | | | | | | - Giovanni Martinelli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | | | | | | | | | - Theo de Witte
- Radboud University Medical Center, Nijmegen, the Netherlands
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6
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Efficace F, Boccadoro M, Palumbo A, Petrucci MT, Cottone F, Cannella L, Zamagni E, Niscola P, Kyriakou C, Caravita T, Offidani M, Mandelli F, Cavo M. A prospective observational study to assess clinical decision-making, prognosis, quality of life and satisfaction with care in patients with relapsed/refractory multiple myeloma: the CLARITY study protocol. Health Qual Life Outcomes 2018; 16:127. [PMID: 29914509 PMCID: PMC6006751 DOI: 10.1186/s12955-018-0953-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 06/04/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Treatment decision-making in patients with relapsed/refractory multiple myeloma (RRMM) is challenging for a number of reasons including, the heterogeneity of disease at relapse and the number of possible therapeutic approaches. This study broadly aims to generate new evidence-based data to facilitate clinical decision-making in RRMM patients. The primary objective is to investigate the prognostic value of patient self-reported fatigue severity for overall survival. METHODS This multicenter prospective observational study will consecutively enroll 312 patients with multiple myeloma who have received at least 1 prior line of therapy and are considered as RRMM according to the International Myeloma Working Group (IMWG) criteria. Eligible RRMM participants will be adults (≥ 18 years old) patients and will be enrolled irrespective of comorbidities and performance status. At the time of study inclusion, data to calculate the frailty score are to be available. Patients will be followed up for 30 months and patient-reported outcome (PRO) assessment is planned at baseline and thereafter at 3, 6, 12, and 24 months. The following PRO validated questionnaires will be used: the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), the EORTC QLQ-MY20 and the EORTC QLQ-INFO25. Satisfaction with care and preference for involvement in treatment decisions will also be evaluated. Clinical, laboratory and treatment related information will be prospectively collected in conjunction with pre scheduled PRO assessments. Cox regression analyses will be used to assess the prognostic value of baseline fatigue severity (EORTC QLQ-C30) and other patient-reported health-related quality of life parameters. DISCUSSION Clinical decision-making in RRMM is a challenge and outcome prediction is also an important aspect to enhance personalized treatment planning. Given the paucity of PRO data in this population, this prospective observational study aims to provide novel information that may facilitate patients' management in routine practice. TRIAL REGISTRATION This trial is registered as identifier NCT03190525 .
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Affiliation(s)
- Fabio Efficace
- Health Outcomes Research Unit, Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA), GIMEMA Data Center and Health Outcomes Research Unit, Via Benevento, 6, 00161, Rome, Italy.
| | - Mario Boccadoro
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Antonio Palumbo
- Myeloma Unit, Division of Hematology, University of Torino, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Maria Teresa Petrucci
- Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Francesco Cottone
- Health Outcomes Research Unit, Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA), GIMEMA Data Center and Health Outcomes Research Unit, Via Benevento, 6, 00161, Rome, Italy
| | - Laura Cannella
- Health Outcomes Research Unit, Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA), GIMEMA Data Center and Health Outcomes Research Unit, Via Benevento, 6, 00161, Rome, Italy
| | - Elena Zamagni
- Seragnoli Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Pasquale Niscola
- Haematology Unit and Pathology Department, S. Eugenio Hospital Rome, Rome, Italy
| | - Charalampia Kyriakou
- Department of Haematology, London North West and University College London Hospitals, London, UK
| | - Tommaso Caravita
- Haematology Unit and Pathology Department, S. Eugenio Hospital Rome, Rome, Italy
| | - Massimo Offidani
- Clinica di Ematologia, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Franco Mandelli
- Health Outcomes Research Unit, Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA), GIMEMA Data Center and Health Outcomes Research Unit, Via Benevento, 6, 00161, Rome, Italy
| | - Michele Cavo
- Institute of Hematology Seragnoli, DIMES, University of Bologna, Bologna, Italy
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Breccia M, Baccarani M, Rosti G, Cottone F, Cannella L, Guilhot F, Vignetti M, Efficace F. Physicians' attitude towards selection of second line therapy with nilotinib and dasatinib in chronic myeloid leukemia patients. Health Qual Life Outcomes 2017; 15:204. [PMID: 29047379 PMCID: PMC5648464 DOI: 10.1186/s12955-017-0788-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/13/2017] [Indexed: 11/10/2022] Open
Abstract
We investigated factors that physicians consider of most importance in the selection of second line tyrosine kinase inhibitors treatments (TKIs) in chronic myeloid leukemia patients (CML).
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Affiliation(s)
- Massimo Breccia
- Department of Biotechnologies and Hematology, University of Rome Sapienza, Rome, Italy
| | - Michele Baccarani
- Department of Hematology-Oncology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Gianantonio Rosti
- Department of Hematology-Oncology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesco Cottone
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Laura Cannella
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | | | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy.
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Efficace F, Cannella L. The value of quality of life assessment in chronic myeloid leukemia patients receiving tyrosine kinase inhibitors. Hematology Am Soc Hematol Educ Program 2016; 2016:170-179. [PMID: 27913477 PMCID: PMC6142524 DOI: 10.1182/asheducation-2016.1.170] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The development of the oral tyrosine kinase inhibitors (TKIs) to treat chronic myeloid leukemia (CML) is one of the great triumphs of cancer research. Although the efficacy of TKIs has dramatically improved the disease-specific overall survival rate, the prevalence of CML is increasing worldwide. Currently, CML patients receive prolonged (even lifelong) treatment, and over the last decade, clinical decision making has become challenging. Therefore, consideration of the effects of TKI therapies on patients' quality of life (QoL) and symptom burden (ie, patient-reported outcomes [PROs]) is now critical to more robustly inform patient care and improve health care quality. Over the last 5 years, a number of studies have generated valuable PRO data, for example, on long-term QoL effects of imatinib therapy or symptom burden of patients switching from imatinib to second-generation TKIs. PRO findings are important, as they provide a unique patient perspective on the burden of the disease and treatments effects. We will review main evidence-based data on the use of PROs in clinical research and highlight the importance of methodological rigor of PRO assessment. Also, we will describe the potential value of using PRO assessment in routine clinical practice, for example, to facilitate timely management of side effects. Areas for future research will also be discussed.
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Affiliation(s)
- Fabio Efficace
- Data Center and Health Outcomes Research Unit, Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA), Rome, Italy
| | - Laura Cannella
- Data Center and Health Outcomes Research Unit, Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA), Rome, Italy
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Efficace F, Cannella L, Cottone F. Pushing the boundaries of care in myelodysplastic syndromes: Physical exercise to improve fatigue and health-related quality of life outcomes. Leuk Res 2016; 49:36-7. [PMID: 27526406 DOI: 10.1016/j.leukres.2016.08.003] [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: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/20/2022]
Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy.
| | - Laura Cannella
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Francesco Cottone
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
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10
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Gruszka AM, Rabascio C, Cannella L, Sammassimo S, Andreola G, Gregato G, Faretta M, Calleri A, De Molfetta R, Pruneri G, Bertolini F, Alcalay M. Molecular investigation of coexistent chronic myeloid leukaemia and peripheral T-cell lymphoma - a case report. Sci Rep 2015; 5:14829. [PMID: 26439403 PMCID: PMC4594041 DOI: 10.1038/srep14829] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 09/04/2015] [Indexed: 11/09/2022] Open
Abstract
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm underlain by the formation of BCR-ABL1 – an aberrant tyrosine kinase – in the leukaemic blasts. Long-term survival rates in CML prior to the advent of tyrosine kinase inhibitors (TKIs) were dismal, albeit the incidence of secondary malignancies was higher than that of age-matched population. Current figures confirm the safety of TKIs with conflicting data concerning the increased risk of secondary tumours. We postulate that care has to be taken when distinguishing between coexisting, secondary-to-treatment and second in sequence, but independent tumourigenic events, in order to achieve an unbiased picture of the adverse effects of novel treatments. To illustrate this point, we present a case of a patient in which CML and peripheral T-cell lymphoma (PTCL) coexisted, although the clinical presentation of the latter followed the achievement of major molecular response of CML to TKIs.
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Affiliation(s)
- Alicja M Gruszka
- Department of Experimental Oncology European Institute of Oncology, Milan, Italy
| | - Cristina Rabascio
- Laboratory of Hematology-Oncology, European Institute of Oncology, Milan, Italy
| | - Laura Cannella
- Division of Hemato-oncology European Institute of Oncology, Milan, Italy
| | - Simona Sammassimo
- Division of Hemato-oncology European Institute of Oncology, Milan, Italy
| | - Giovanna Andreola
- Division of Hemato-oncology European Institute of Oncology, Milan, Italy
| | - Giuliana Gregato
- Laboratory of Hematology-Oncology, European Institute of Oncology, Milan, Italy
| | - Mario Faretta
- Department of Experimental Oncology European Institute of Oncology, Milan, Italy
| | - Angelica Calleri
- Laboratory of Hematology-Oncology, European Institute of Oncology, Milan, Italy
| | - Rita De Molfetta
- Department of Experimental Oncology European Institute of Oncology, Milan, Italy
| | - Giancarlo Pruneri
- Division of Pathology, European Institute of Oncology, Milan, Italy.,Universita' degli Studi di Milano, Milan, Italy
| | - Francesco Bertolini
- Laboratory of Hematology-Oncology, European Institute of Oncology, Milan, Italy
| | - Myriam Alcalay
- Department of Experimental Oncology European Institute of Oncology, Milan, Italy.,Universita' degli Studi di Milano, Milan, Italy
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Cannella L, Caocci G, Jacobs M, Vignetti M, Mandelli F, Efficace F. Health-related quality of life and symptom assessment in randomized controlled trials of patients with leukemia and myelodysplastic syndromes: What have we learned? Crit Rev Oncol Hematol 2015; 96:542-54. [PMID: 26324461 DOI: 10.1016/j.critrevonc.2015.07.012] [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: 12/03/2014] [Revised: 06/10/2015] [Accepted: 07/28/2015] [Indexed: 01/26/2023] Open
Abstract
Health-related quality of life (HRQOL) and other patient-reported outcomes (PROs) are crucial for a comprehensive evaluation of treatment effectiveness. A systematic review of randomized controlled trials (RCTs) with a PRO endpoint conducted in patients with leukemia and myelodysplastic syndromes (MDS) was performed. Eligible studies were evaluated independently, according to a pre-defined coding scheme, by two reviewers. Thirteen RCTs, enrolling overall 3380 patients were identified. There were four RCTs involving acute myeloid leukemia patients (AML), one with acute lymphoid leukemia (ALL), five with chronic lymphocytic leukemia (CLL) and three with MDS. Six RCTs accurately documented PRO methodology assessment and were thus considered likely to robustly inform clinical decision-making. Of these, three RCTs dealt with AML, two with CLL, one with MDS. A growing number of RCTs in leukemia and MDS have included a PRO component in recent years. Inclusion of PROs in RCTs is feasible and can provide unique information to facilitate clinical decision-making.
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Affiliation(s)
- Laura Cannella
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Giovanni Caocci
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Marc Jacobs
- Academic Medical Center, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands
| | - Marco Vignetti
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Franco Mandelli
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy
| | - Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases (GIMEMA), Rome, Italy.
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Germano D, Tinessa V, Barletta E, Cannella L, Daniele B. Medical treatment of hepatocellular carcinoma. Minerva Med 2013; 104:545-561. [PMID: 24101112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The management of hepatocellular carcinoma (HCC) has substantially changed in the past few decades, the introduction of novel therapies (such as sorafenib) have improved patient survival. Nevertheless, HCC remains the third most common cause of cancer-related deaths worldwide. Decision-making largely relies on evidence-based criteria, as showed in the US and European clinical practice guidelines, which endorse five therapeutic recommendations: resection; transplantation; radiofrequency ablation; chemoembolization; and sorafenib. However, areas still exist in which uncertainty precludes a strong recommendation, such as the role of adjuvant therapies after resection, radioembolization with yttrium-90 or second-line therapies for advanced HCC. Many clinical trials that are currently ongoing aim to answer these questions. The first reported studies, however, failed to identify novel therapeutic alternatives (that is, sunitinib, erlotinib or brivanib). Efforts that focus on the implementation of personalized medicine approaches in HCC will probably dominate research in the next decade.
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Affiliation(s)
- D Germano
- Oncology Unit, "G. Rummo Hospital", Benevento, Italy -
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Vianello F, Cannella L, Coe D, Chai JG, Golshayan D, Marelli-Berg FM, Dazzi F. Enhanced and aberrant T cell trafficking following total body irradiation: a gateway to graft-versus-host disease? Br J Haematol 2013; 162:808-18. [PMID: 23855835 DOI: 10.1111/bjh.12472] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 06/12/2013] [Indexed: 01/01/2023]
Abstract
Pre-transplant conditioning regimens play a major role in triggering graft-versus-host disease (GVHD). This study investigated the effect of irradiation on donor T cell trafficking to lymphoid and non-lymphoid tissues by comparing the migration of carboxy-fluorescein diacetate succinimidyl ester-labelled, naïve donor T lymphocytes in vivo in irradiated and non-irradiated syngeneic mice recipients. Recruitment of adoptively transferred naïve T cells to secondary lymphoid organs was increased in irradiated mice and naïve T cells also aberrantly localized to non-lymphoid tissues. Irradiation also induced aberrant effector memory T cell migration into lymph nodes and their localization to homing-privileged non-lymphoid sites, such as the gut. The presence of a minor histocompatibility mismatch further enhanced the aberrant accumulation of T cells in both lymphoid and non-lymphoid tissue, whilst their migratory pattern was not modified as compared to fully matched irradiated recipients. These effects correlated with decreased permeability of, and the secretion of chemotactic factors by the endothelium. Our findings are consistent with the possibility that excessive, dysregulated extravasation of T cells induced by irradiation promotes the development of GVHD.
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Affiliation(s)
- Fabrizio Vianello
- Stem Cell Biology Section, Department of Haematology, Imperial College, London, UK
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14
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Cannella L, Babic A, Andreola G, Elezi R, Rabascio C, Negri M, Calabrese L, Lionetti M, Laszlo D. O-26 G-CSF AND PLERIXAFOR AS NON-TOXIC AND EFFECTIVE FIRST-LINE MOBILIZING APPROACH IN PATIENTS WITH MULTIPLE MYELOMA CANDIDATE TO ASCT. Transfus Apher Sci 2012. [DOI: 10.1016/s1473-0502(12)70027-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Pignata S, Cannella L, Leopardo D, Bruni GS, Facchini G, Pisano C. Follow-up with CA125 after primary therapy of advanced ovarian cancer: in favor of continuing to prescribe CA125 during follow-up. Ann Oncol 2012; 22 Suppl 8:viii40-viii44. [PMID: 22180398 DOI: 10.1093/annonc/mdr470] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Serum cancer antigen 125 (CA125) is widely used in ovarian cancer to monitor the effectiveness of therapy both in first line and recurrence. It is also widely used during follow-up, where it is able to identify a percentage of patients with asymptomatic recurrence. Although a recent Medical Research Council (UK)/European Organisation for Research and Treatment of Cancer trial has demonstrated that early chemotherapy in asymptomatic patients based only on CA125 increase does not prolong survival, we still believe that CA125 monitoring should be prescribed to patients during follow-up. In fact, it can help to identify patients who should undergo radiology in order to select those that can benefit from surgery or from early treatment before the onset of symptoms, which are usually related to an excessive disease burden. The delay of disease symptoms, such as those associated with the appearance of ascites or bowel occlusion, is in our view an important goal of our treatment of recurrence. Moreover, research should be done in patients with asymptomatic CA125 increase in order to identify more effective therapies that will improve survival. Finally, the reliability of CA125 as a surrogate of response under treatment with biological agents should be validated in prospective trials.
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Affiliation(s)
- S Pignata
- Division of Medical Oncology, Department of Urology and Gynecology, National Cancer Institute of Naples, Via Mariano Semmola, Naples, Italy.
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Breccia M, Loglisci G, Cannella L, Finsinger P, Mancini M, Serrao A, Santopietro M, Salaroli A, Alimena G. Application of French prognostic score to patients with International Prognostic Scoring System intermediate-2 or high risk myelodysplastic syndromes treated with 5-azacitidine is able to predict overall survival and rate of response. Leuk Lymphoma 2012; 53:985-6. [PMID: 22112007 DOI: 10.3109/10428194.2011.643408] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Breccia M, Loglisci G, Cannella L, Serrao A, Colafigli G, Salaroli A, Alimena G. Nilotinib therapy does not induce consistent modifications of cholesterol metabolism resulting in clinical consequences. Leuk Res 2011; 35:e215-6. [DOI: 10.1016/j.leukres.2011.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 07/21/2011] [Accepted: 07/25/2011] [Indexed: 10/17/2022]
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18
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Cannella L, Loglisci G, Nanni M, de Cuia MR, Colafigli G, Salaroli A, Serrao A, Alimena G, Breccia M. Trisomy 8 in Philadelphia chromosome negative cell preceding the evolution of a Philadelphia chromosome positive clone with the same additional change during imatinib treatment: revisiting the role of genetic instability in chronic myeloid leukemia. Leuk Lymphoma 2011; 53:497-8. [DOI: 10.3109/10428194.2011.615425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pignata S, Amant F, Scambia G, Sorio R, Breda E, Rasch W, Hernes K, Pisano C, Leunen K, Lorusso D, Cannella L, Vergote I. A phase I-II study of elacytarabine (CP-4055) in the treatment of patients with ovarian cancer resistant or refractory to platinum therapy. Cancer Chemother Pharmacol 2011; 68:1347-53. [DOI: 10.1007/s00280-011-1735-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 08/26/2011] [Indexed: 10/17/2022]
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20
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Volpicelli P, Latagliata R, Carmosino I, Breccia M, Vozella F, Mancini M, Cannella L, Alimena G. Familial occurrence of myelodysplastic syndrome with del(5q). Leuk Lymphoma 2011; 52:1143-5. [PMID: 21599595 DOI: 10.3109/10428194.2011.559669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Breccia M, Cannella L, Latagliata R, Loglisci G, Salaroli A, Santopietro M, Oliva EN, Alimena G. Unexpected Erythroid and Cytogenetic Responses After Discontinuation of a Short Course of Lenalidomide As a Result of Severe Skin Rash in a Patient With 5q Syndrome. J Clin Oncol 2011; 29:e402-3. [DOI: 10.1200/jco.2010.33.5083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Esther N. Oliva
- Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
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22
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Breccia M, Finsinger P, Latagliata R, Cannella L, Loglisci G, Federico V, Santopietro M, Colafigli G, Serrao A, Salaroli A, Petrucci L, Alimena G. 289 Prognostic evaluation of chronic myelomonocytic leukemia (CMML) with different prognostic models. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70291-0] [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: 10/18/2022]
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23
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Breccia M, Finsinger P, Latagliata R, Cannella L, Loglisci G, Santopietro M, Nanni M, Federico V, Serrao A, Colafigli G, Petrucci L, Salaroli A, Alimena G. 142 Myelodysplastic syndrome patients younger than 50 years: Epidemiological data and clinical features. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70144-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Breccia M, Finsinger P, Latagliata R, Cannella L, Loglisci G, Federico V, Santopietro M, Petrucci L, Salaroli A, Serrao A, Colafigli G, Alimena G. 339 Deferasirox treatment in myelodysplastic syndromes: “Real-life” efficacy and safety in a single institution patient population. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70341-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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25
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Loglisci G, Breccia M, Nanni M, Mancini M, De Cuia R, Cannella L, Salaroli A, Federico V, Serrao A, Loglisci MG, Santopietro M, Alimena G. Isodicentric duplication of Philadelphia chromosome as a mechanism of resistance to dasatinib in a patient with chronic myeloid leukemia after resistance to imatinib. Leuk Lymphoma 2011; 52:1372-5. [PMID: 21463110 DOI: 10.3109/10428194.2011.565394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Latagliata R, Breccia M, Carmosino I, Cannella L, De Cuia R, Diverio D, Frustaci A, Loglisci G, Mancini M, Santopietro M, Stefanizzi C, Volpicelli P, Vozella F, Alimena G. "Real-life" results of front-line treatment with Imatinib in older patients (≥ 65 years) with newly diagnosed chronic myelogenous leukemia. Leuk Res 2010; 34:1472-5. [PMID: 20708799 DOI: 10.1016/j.leukres.2010.07.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 07/03/2010] [Accepted: 07/04/2010] [Indexed: 10/19/2022]
Abstract
The age role was evaluated in 117 consecutive patients with newly diagnosed CML at our Institution treated with front-line Imatinib from 9/02 to 3/08. Forty patients (34.1%) aged ≥ 65 years and 77 (65.9%) <65 years. Thirty-four older patients (85%) had at least 1 comorbidity versus 39 younger patients (50.6%) (p<0.001). Complete cytogenetic response (CCyR) was achieved in 34/40 older patients (85%) as compared to 69/77 younger patients (89.6%), without statistically significant differences. Severe (grades 3-4 WHO) hematological and extra-hematological toxicities were more common in older patients (p=0.02 and p=0.017, respectively). Rates of permanent Imatinib discontinuation and dose reduction to 300 mg or less were significantly higher in older patients (p=0.009 and p=0.001, respectively). In conclusion, Imatinib in older patients with newly diagnosed CML seems to have the same efficacy as in younger patients, but tends to be more toxic, leading to higher rates of discontinuation and dose reduction. To overcome this problem, future trials concerning best dosage in this subset of patients could be useful.
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Affiliation(s)
- Roberto Latagliata
- Department of Cellular Biotechnology and Hematology, University La Sapienza of Rome, Via Benevento 6, 00161 Rome, Italy.
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Breccia M, Santopietro M, Loglisci G, Stagno F, Cannella L, Carmosino I, Alimena G. Concomitant use of imatinib and warfarin in chronic phase chronic myeloid leukemia patients does not interfere with drug efficacy. Leuk Res 2010; 34:e224-5. [DOI: 10.1016/j.leukres.2010.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 03/05/2010] [Accepted: 03/06/2010] [Indexed: 10/19/2022]
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Breccia M, Loglisci G, Salaroli A, Cannella L, Santopietro M, Alimena G. Deferasirox treatment interruption in a transfusion-requiring myelodysplastic patient led to loss of erythroid response. Acta Haematol 2010; 124:46-8. [PMID: 20616538 DOI: 10.1159/000314961] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 05/05/2010] [Indexed: 11/19/2022]
Affiliation(s)
- Massimo Breccia
- Department of Cellular Biotechnology and Hematology, Sapienza University, Rome, Italy.
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Breccia M, Federico V, Latagliata R, Mercanti C, D'Elia GM, Cannella L, Loglisci G, Salaroli A, Santopietro M, Alimena G. Evaluation of comorbidities at diagnosis predicts outcome in myelodysplastic syndrome patients. Leuk Res 2010; 35:159-62. [PMID: 20594593 DOI: 10.1016/j.leukres.2010.06.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 05/28/2010] [Accepted: 06/05/2010] [Indexed: 10/19/2022]
Abstract
Recent data suggest that proper assessment of comorbidities is useful to predict the outcome of MDS patients receiving allogeneic stem cell transplantation. However, the results obtained in this highly selected subset of patients cannot be applied to the whole MDS population. We evaluated the impact of comorbidities in 418 consecutive MDS patients diagnosed at our institute from 1992 to 2005. All patients were classified according to WHO criteria and all received only conservative and supportive treatment. One or more comorbidities were detected in 390 patients (93%) at the time of diagnosis, with a higher incidence in older patients. Cardiac diseases were the most frequent comorbidities (30%) while diabetes and correlated adverse events were the second cause of comorbidity (20%). We applied 3 comorbidity prognostic scores (CCI, HCT-CI and a MDS-CI score proposed by Della Porta et al.). According to CCI score, 253 patients had a score 0, 111 patients had a score 1 and 54 patients had a score >2. According to HCT-CI, 209 patients had a score 0, 105 patients had a score 1 and 106 patients had a score >2. With MDS-CI score, 288 patients had a score 0 and 129 patients had a score >1. We found a significant correlation between survival and stratification according to CCI and MDS-CI scores (p=0.01 and 0.02, respectively), but not according to HCT-CI score. The number of comorbidities as evaluated according to CCI was directly correlated to the development of RBC transfusion-dependency and was associated to a significantly higher risk of death not related to leukemic evolution (HR = 2.12, p ≤ 0.001). Conversely, higher risk of non-leukemic death did not correlate with higher transfusional requirement according to HCT-CI and MDS-CI scores (p = 0.3 and 0.43, respectively). As suggested by Della Porta et al., also in our experience the presence of cardiac, liver, renal, pulmonary diseases and solid tumours was found to independently affect the risk of death in a multivariable Cox regression analysis (p values from <0.01 to 0.004). In conclusion, assessment of comorbidities at diagnosis in MDS patients may improve the ability of therapeutic decisions.
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Affiliation(s)
- Massimo Breccia
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy.
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Breccia M, Cannella L, Stefanizzi C, Latagliata R, Nanni M, Diverio D, Santopietro M, Federico V, Alimena G. Cytogenetic and molecular responses in chronic phase chronic myeloid leukaemia patients receiving low dose of imatinib for intolerance to standard dose. Hematol Oncol 2010; 28:89-92. [PMID: 19728398 DOI: 10.1002/hon.920] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Imatinib mesylate is the gold standard treatment of chronic myeloid leukaemia (CML) and 400 mg/day is considered the standard dose. Although it is generally well tolerated, some patients require temporary drug discontinuation and permanent dose reduction because of haematological or non-haematological toxicities. Whether or not reduced doses are effective as the standard dose in inducing and/or maintaining complete cytogenetic and molecular response is not clear. We report the outcome of 45 CML patients in early (17) and late (28) chronic phase (CP) in whom, within a series of 250 patients treated with imatinib, reduced the dose of the drug after experiencing adverse events. Median time interval between the start of therapy and dose reduction was 58 days, whereas median administered dose was 300 mg/day. At 6 months from reduction, major cytogenetic responses (MCRs) were observed in 67% of patients, with 58% being complete cytogenetic remission (CCR), and complete molecular response (CMR) were obtained in 18% of patients. At 12 months, all patients who had obtained MCR reached CCR: this was significantly higher in low risk patients (87%) versus non-low risk patients (66 and 46%), and in early phase (82%) versus late phase (53.5%). CMR and major molecular response (MMR) were detected in 20 and 22% of patients, respectively. Low dose imatinib appears effective in patients with intolerance to standard dose, even though long-term effects remain to be established.
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Affiliation(s)
- Massimo Breccia
- Department of Cellular Biotechnologies and Hematology, University La Sapienza, Rome, Italy.
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31
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De Stefano A, Cannella L, Carlomagno C, Crispo A, Bianco R, Marciano R, Pepe S, De Placido S. Correlation between bevacizumab-related hypertension and response in mCRC patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Breccia M, Stagno F, Vigneri P, Latagliata R, Cannella L, Del Fabro V, Di Raimondo F, Alimena G. Imatinib dose escalation in 74 failure or suboptimal response chronic myeloid leukaemia patients at 3-year follow-up. Am J Hematol 2010; 85:375-7. [PMID: 20306543 DOI: 10.1002/ajh.21680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Breccia M, Muscaritoli M, Cannella L, Loglisci G, Santopietro M, Alimena G. Modifications of fasting glucose values as first sign of resistance in chronic myeloid leukemia chronic phase patients during imatinib treatment. Leuk Res 2010; 34:e122-4. [DOI: 10.1016/j.leukres.2009.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 11/18/2009] [Accepted: 11/21/2009] [Indexed: 11/30/2022]
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34
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Cannella L, Breccia M, Loglisci G, Federico V, Santopietro M, Alimena G. Safety and efficacy of nilotinib in chronic phase chronic myeloid leukemia in a patient with Wolf-Parkinson-White disease and hematological resistance after suboptimal response to imatinib at six months. Acta Oncol 2010; 49:399-400. [PMID: 20105089 DOI: 10.3109/02841860903521129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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35
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Breccia M, Bocchia M, Cannella L, Defina M, Ippoliti M, Loglisci G, Santopietro M, Lauria F, Alimena G. Reduction of imatinib dose and persistence of complete molecular response after p210 multipeptide vaccine in chronic myeloid leukaemia treated with dose escalation for acquired resistance. Br J Haematol 2010; 150:240-2. [PMID: 20346015 DOI: 10.1111/j.1365-2141.2010.08187.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Breccia M, Latagliata R, Cannella L, Carmosino I, Santopietro M, Loglisci G, Federico V, Alimena G. Refractory cytopenia with unilineage dysplasia: analysis of prognostic factors and survival in 126 patients. Leuk Lymphoma 2010; 51:783-8. [DOI: 10.3109/10428191003682759] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Breccia M, Latagliata R, Cannella L, Minotti C, Meloni G, Lo-Coco F. Early hemorrhagic death before starting therapy in acute promyelocytic leukemia: association with high WBC count, late diagnosis and delayed treatment initiation. Haematologica 2009; 95:853-4. [PMID: 20015875 DOI: 10.3324/haematol.2009.017962] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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38
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Breccia M, Frustaci AM, Cannella L, Stefanizzi C, Latagliata R, Cartoni C, Diverio D, Guarini A, Nanni M, Rago A, Cimino G, Alimena G. Comorbidities and FLT3-ITD abnormalities as independent prognostic indicators of survival in elderly acute myeloid leukaemia patients. Hematol Oncol 2009; 27:148-53. [PMID: 19274612 DOI: 10.1002/hon.889] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Elderly acute myeloid leukaemia (AML) patients have a dismal prognosis due to biological features of disease in itself and to presence of comorbidities. Aim of this study was to evaluate the prognostic impact of comorbidity prognostic score systems applied in our population of patients. as well as other clinical-biological features. We retrospectively considered the outcome of 120 patients aged >65 years diagnosed as having AML between January 2001 and December 2005. Comorbidities were evaluated by using Charlson comorbidity index (CCI), Hematopoietic cell transplantation comorbidity index (HCTCI) and a score proposed by Dombret et al. in 2007. Median patient age was 67 years. Forty-six patients were treated with intensive chemotherapy and 23 reached a complete remission. Seventy-four patients received only supportive therapies or low-dose chemotherapy. Multivariate analysis showed the effects of leukocytosis (p = 0.0013), antecedent Myelodysplastic syndrome (MDS) (p = 0.011), FLT3 abnormalities (p = 0.032), CCI (p = 0.0037) and Dombret et al. score (p = 0.045) as independent prognostic parameters for survival. Based on these variables we were able to stratify patients in low and high risk, with different median overall survival: patients were considered as low risk if they had none or only one of the above mentioned adverse factors for survival, with a median overall survival of 447 days. Patients with two or more adverse factors were categorized as high risk: this subgroup had a median overall survival of 227 days (p = 0.001). Comorbidities are independent factors that influence survival. Application of CCI and Dombret score may help to better identify patients at diagnosis who can benefit from intensive chemotherapy.
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Affiliation(s)
- Massimo Breccia
- Department of Cellular Biotechnology and Hematology, University La Sapienza, 00161 Rome, Italy.
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Cannella L, Breccia M, Stefanizzi C, Napoleone L, Santopietro M, Alimena G. Dasatinib overcomes imatinib and nilotinib failure in Philadelphia chromosome positive chronic myeloid leukemia with different mechanisms of resistance. Leuk Lymphoma 2009; 50:848-50. [PMID: 19367499 DOI: 10.1080/10428190902829425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Breccia M, Cannella L, Frustaci A, Stefanizzi C, D'Elia GM, Alimena G. Chronic myelomonocytic leukemia with antecedent refractory anemia with excess blasts: Further evidence for the arbitrary nature of current classification systems. Leuk Lymphoma 2009; 49:1292-6. [DOI: 10.1080/10428190802123499] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Breccia M, Stefanizzi C, Cannella L, Latagliata R, Frustaci AM, Carmosino I, Santopietro M, Alimena G. Differences in hematological and non-hematological toxicity during treatment with imatinib in patients with early and late chronic phase chronic myeloid leukemia. Leuk Lymphoma 2009; 49:2328-32. [DOI: 10.1080/10428190802578841] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Breccia M, Latagliata R, Cannella L, Gioiosa F, Fama A, Stefanizzi C, Vincenzo F, Mercanti C, Santopietro M, Alimena G. P017 WPSS versus Simplified Myelodysplastic Syndrome Risk Score: which is the best tool for prediction of survival in myelodysplastic patients? Leuk Res 2009. [DOI: 10.1016/s0145-2126(09)70097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Napoleone L, Latagliata R, Breccia M, Vozella F, Carmosino I, De Cuia R, Mancini M, Volpicelli P, Stefanizzi C, Cannella L, Mercanti C, Alimena G. P066 Familiar occurrence of myelodysplastic sydrome with del(5q). Leuk Res 2009. [DOI: 10.1016/s0145-2126(09)70146-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Breccia M, Cannella L, Stefanizzi C, Carotti A, Santopietro M, Alimena G. Efficacy of dasatinib in a chronic myeloid leukemia patient with disease molecular relapse and chronic GVHD after haploidentical BMT: an immunomodulatory effect? Bone Marrow Transplant 2009; 44:331-2. [DOI: 10.1038/bmt.2009.20] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Breccia M, Frustaci AM, Cannella L, Soverini S, Stefanizzi C, Federico V, Grammatico S, Santopietro M, Alimena G. Sequential development of mutant clones in an imatinib resistant chronic myeloid leukaemia patient following sequential treatment with multiple tyrosine kinase inhibitors: an emerging problem? Cancer Chemother Pharmacol 2009; 64:195-7. [DOI: 10.1007/s00280-008-0905-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
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Carlomagno C, Farella A, Bucci L, D'Armiento FP, Pesce G, Pepe S, Cannella L, Pacelli R, De Stefano A, Solla R, D'Armiento MR, De Placido S. Neo-adjuvant treatment of rectal cancer with capecitabine and oxaliplatin in combination with radiotherapy: a phase II study. Ann Oncol 2009; 20:906-12. [PMID: 19155242 DOI: 10.1093/annonc/mdn719] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Preoperative chemoradiation is now standard treatment for stages II-III rectal cancer. Capecitabine (CAP) and oxaliplatin (OX) are synergistic with radiotherapy (RT) and active in colorectal neoplasms. PATIENTS AND METHODS Two cycles of CAP 825 mg/m(2) b.i.d. (days 1-14) and OX 50 mg/m(2) (days 1 and 8) every 3 weeks were given concomitantly with pelvic conformal RT (45 Gy). Patients with a > or =T3 and/or node-positive rectal tumour were eligible. The pathologic tumour response was defined according to the tumour regression grade (TRG) scale. RESULTS Forty-six patients were enrolled. Gastrointestinal adverse events were mostly G1-G2; only two patients experienced G3 vomiting and diarrhoea and six patients had G1 peripheral neuropathy. Haematological toxicity was rare. G2 proctitis and anal pain occurred in two patients. Pathological complete response (TRG1) was observed in nine patients (20.9%; 95% CI 8.7%-33.1%); TRG2 in 19 patients (44.2%); TRG3 in 12 patients (27.9%); and TRG4 in three patients (7%). Overall, nine patients recurred: five with distant metastases, one with local recurrence, and three with both local recurrence and distant metastases. CONCLUSIONS CAP-OX-RT as preoperative treatment for rectal cancer induces a remarkable rate of complete or near-complete pathologically documented response and is well tolerated.
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Affiliation(s)
- C Carlomagno
- Departmant of Endocrinology and Molecular and Clinical Oncology, Università Federico II, Naples, Italy.
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Breccia M, D'Elia GM, Cannella L, Stefanizzi C, Fama A, Federico V, Santopietro M, Alimena G. Platelet count is an independent prognostic factor in myelodysplastic syndromes considered as low risk by French–American–British and World Health Organisation classifications. Leuk Lymphoma 2009; 50:841-3. [DOI: 10.1080/10428190902836115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Breccia M, Latagliata R, Carmosino I, Cannella L, Diverio D, Guarini A, De Propris MS, Petti MC, Avvisati G, Cimino G, Mandelli F, Lo-Coco F. Clinical and biological features of acute promyelocytic leukemia patients developing retinoic acid syndrome during induction treatment with all-trans retinoic acid and idarubicin. Haematologica 2008; 93:1918-20. [DOI: 10.3324/haematol.13510] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Breccia M, Latagliata R, Cannella L, Carmosino I, De Cuia R, Frustaci A, Stefanizzi C, Santopietro M, Alimena G. Analysis of prognostic factors in patients with refractory anemia with excess of blasts (RAEB) reclassified according to WHO proposal. Leuk Res 2008; 33:391-4. [PMID: 18676015 DOI: 10.1016/j.leukres.2008.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 06/25/2008] [Accepted: 06/27/2008] [Indexed: 11/30/2022]
Abstract
The WHO classification subdivides the FAB RAEB category into RAEB-1 (bone marrow (BM) blasts <10%, peripheral blasts <5%) and RAEB-2 (bone marrow blasts >10% and peripheral blasts >5%). We reclassified according to WHO criteria 228 RAEB patients and analysed them in terms of haematological, karyotypic and prognostic features. We used the database of 680 MDS patients referred to our Institution from 1990 to 2000. Clinical features at presentation, such as sex, age, leukocyte count, polymorphonuclear cell count (PMN), platelet count, haemoglobin level, presence of one or more lineage dysplasia were tested in univariate and multivariate analysis in the two groups of RAEB-1 and RAEB-2 reclassified patients. In multivariate analysis we identified prognostic significant factors in the two patient groups, which consisted of age >70 years and platelet count <100 x 10(9)l(-1) for RAEB-1 category, while for RAEB-2 group parameters negatively influencing survival and risk of progression were haemoglobin <10g/dl, platelet count <100 x 10(9)l(-1), bone marrow blastosis >15% and complex karyotype. We also found differences in cytogenetic data (more balanced translocations and complex karyotypes in RAEB-2 group, p=0.02), and in survival (23.3 months in RAEB-1 vs. 16.1 months in RAEB-2 group, p=0.001). WHO classification provides valuable prognostic information for RAEB patient population, and can identify those subjects with more unfavourable prognosis who should be offered alternative therapeutic strategies.
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Affiliation(s)
- M Breccia
- Department of Cellular Biotechnology and Hematology, University La Sapienza, Via Benevento 6, 00161 Rome, Italy
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Carlomagno C, D'Armiento F, Farella A, Cannella L, De Stefano A, Colantuoni M, Alfieri S, Marra M, Totaro G, Pepe S. Neoadjuvant chemoradiation therapy with capecitabine (CAP) plus oxaliplatin (OX) in rectal cancer: Final results of a phase II study. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.4090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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