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Caccese M, Desideri I, Villani V, Simonelli M, Buglione M, Chiesa S, Franceschi E, Gaviani P, Stasi I, Caserta C, Brugnara S, Lolli I, Bennicelli E, Bini P, Cuccu AS, Scoccianti S, Padovan M, Gori S, Bonetti A, Giordano P, Pellerino A, Gregucci F, Riva N, Cinieri S, Internò V, Santoni M, Pernice G, Dealis C, Stievano L, Paiar F, Magni G, De Salvo GL, Zagonel V, Lombardi G. REGOMA-OSS: a large, Italian, multicenter, prospective, observational study evaluating the efficacy and safety of regorafenib in patients with recurrent glioblastoma. ESMO Open 2024; 9:102943. [PMID: 38492275 PMCID: PMC10959650 DOI: 10.1016/j.esmoop.2024.102943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/02/2024] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND In the randomized phase II REGOMA trial, regorafenib showed promising activity in patients with recurrent glioblastoma. We conducted a large, multicenter, prospective, observational study to confirm the REGOMA data in a real-world setting. PATIENTS AND METHODS The major inclusion criteria were histologically confirmed diagnosis of glioblastoma according to the World Health Organization (WHO) 2016 classification and relapse after radiotherapy with concurrent/adjuvant temozolomide treatment, good performance status [Eastern Cooperative Oncology Group performance status (ECOG PS 0-1)] and good liver function. Regorafenib was administered at the standard dose of 160 mg/day for 3 weeks on/1 week off. Brain magnetic resonance imaging was carried out within 14 days before starting regorafenib and every 8-12 weeks. The primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS), objective response rate, disease control rate (DCR), safety and health-related quality of life. The Response Assessment in Neuro-Oncology (RANO) criteria were used for response evaluation and Common Terminology Criteria for Adverse Events (CTCAE) version 5 for assessment of adverse events (AEs). RESULTS From September 2020 to October 2022, 190 patients with recurrent glioblastoma were enrolled from 30 cancer centers in Italy: their median age was 58.5 years [interquartile range (IQR) 53-67 years], 68% were male and 85 (44.7%) were in optimal clinical condition (ECOG PS 0). The number of patients taking steroids at baseline was 113 (60%); the second surgery was carried out in 39 (20.5%). O6-methylguanine-DNA methyltransferase (MGMT) was methylated in 80 patients (50.3%) and 147 (92.4%) of the patients analyzed had isocitrate dehydrogenase (IDH) wild type. The median follow-up period was 20 months (IQR 15.6-25.5 months). The median OS was 7.9 months ([95% confidence interval (CI) 6.5-9.2 months] and the median PFS was 2.6 months (95% CI 2.3-2.9 months). Radiological response was partial response and stable disease in 13 (7.3%) and 26 (14.6%) patients, respectively, with a DCR of 21.9%. The median number of regorafenib cycles per patient was 3 (IQR 2.0-4.0). Grade 3-4 drug-related adverse events were reported in 22.6% of patients. A dose reduction due to AEs was required in 36% of patients. No deaths were considered as treatment-related AEs. CONCLUSIONS This large, real-world observational study showed similar OS with better tolerability of regorafenib in patients with relapsed glioblastoma compared with the REGOMA study.
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Affiliation(s)
- M Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua.
| | - I Desideri
- Department of Experimental and Clinical Biomedical Sciences, Radiation Oncology Unit, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence
| | - V Villani
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome
| | - M Simonelli
- Department of Biomedical Sciences, Humanitas University, Milan; Humanitas Clinical and Research Center-IRCCS, Humanitas Cancer Center, Milan
| | - M Buglione
- Radiation Oncology Unit, ASST Spedali Civili of Brescia, Brescia
| | - S Chiesa
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, U.O.C. Radioterapia Oncologica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - E Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna
| | - P Gaviani
- Neuro-Oncological Unit, Istituto Neurologico Carlo Besta, Milan
| | - I Stasi
- Division of Medical Oncology, Civil Hospital, Livorno
| | - C Caserta
- Medical Oncology Department, Santa Maria Hospital, Terni
| | - S Brugnara
- Department of Medical Oncology, Santa Chiara Hospital, Trento
| | - I Lolli
- Oncology Unit of National Institute of Gastroenterology 'S. De Bellis', Research Hospital, Castellana Grotte, Bari
| | - E Bennicelli
- Ospedale Policlinico San Martino, Oncologia Medica 2, Genoa
| | - P Bini
- Neuroncology Unit, IRCCS 'C. Mondino Foundation', University of Pavia, Pavia
| | - A S Cuccu
- Medical Oncology, Sassari Hospital, Sassari
| | - S Scoccianti
- Radioterapia Oncologica, Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence
| | - M Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
| | - S Gori
- Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella
| | - A Bonetti
- Department of Oncology, Mater Salutis Hospital, Legnago
| | - P Giordano
- Oncology Unit, Ospedale del Mare, Naples
| | - A Pellerino
- Division of Neuro-Oncology, Department of Neuroscience, City of Health and Science and University of Turin, Turin
| | - F Gregucci
- Department of Radiation Oncology, Miulli General Regional Hospital, Acquaviva delle Fonti
| | - N Riva
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) 'Dino Amadori', Meldola
| | - S Cinieri
- Oncology Unit, Ospedale Perrino, Brindisi
| | - V Internò
- Division of Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari
| | - M Santoni
- Oncology Unit, Macerata Hospital, Macerata
| | - G Pernice
- Oncology Unit, Fondazione Istituto G. Giglio, Cefalù
| | - C Dealis
- Health Directorate, Azienda Sanitaria dell'Alto Adige, Bolzano
| | - L Stievano
- Department of Oncology, Ospedale Civile, Rovigo
| | - F Paiar
- Department of Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa
| | - G Magni
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - G L De Salvo
- Clinical Research Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - V Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
| | - G Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua
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2
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Giunco S, Padovan M, Angelini C, Cavallin F, Cerretti G, Morello M, Caccese M, Rizzo B, d'Avella D, Puppa AD, Chioffi F, De Bonis P, Zagonel V, De Rossi A, Lombardi G. Prognostic role and interaction of TERT promoter status, telomere length and MGMT promoter methylation in newly diagnosed IDH wild-type glioblastoma patients. ESMO Open 2023; 8:101570. [PMID: 37230028 DOI: 10.1016/j.esmoop.2023.101570] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND The clinical relevance of promoter mutations and single nucleotide polymorphism rs2853669 of telomerase reverse transcriptase (TERT) and telomere length in patients with isocitrate dehydrogenase (IDH) wild-type glioblastoma (GBM) patients remains unclear. Moreover, some studies speculated that TERT promoter status might influence the prognostic role of O6-methylguanine DNA methyltransferase (MGMT) promoter methylation in newly diagnosed GBM. We carried out a large study to investigate their clinical impact and their interaction in newly diagnosed GBM patients. PATIENTS AND METHODS We included 273 newly diagnosed IDH wild-type GBM patients who started treatment at Veneto Institute of Oncology IOV - IRCCS (Padua, Italy) from December 2016 to January 2020. TERT promoter mutations (-124 C>T and -146 C>T) and SNP rs2853669 (-245 T>C), relative telomere length (RTL) and MGMT methylation status were retrospectively assessed in this prospective cohort of patients. RESULTS Median overall survival (OS) of 273 newly diagnosed IDH wild-type GBM patients was 15 months. TERT promoter was mutated in 80.2% of patients, and most had the rs2853669 single nucleotide polymorphism as T/T genotype (46.2%). Median RTL was 1.57 (interquartile range 1.13-2.32). MGMT promoter was methylated in 53.4% of cases. At multivariable analysis, RTL and TERT promoter mutations were not associated with OS or progression-free survival (PFS). Notably, patients C carrier of rs2853669 (C/C+C/T genotypes) showed a better PFS compared with those with the T/T genotype (hazard ratio 0.69, P = 0.007). In terms of OS and PFS, all interactions between MGMT, TERT and RTL and between TERT and rs2853669 genotype were not statistically significant. CONCLUSIONS Our findings suggest the presence of the C variant allele at the rs2853669 of the TERT promoter as an attractive independent prognostic biomarker of disease progression in IDH wild-type GBM patients. RTL and TERT promoter mutational status were not correlated to survival regardless of MGMT methylation status.
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Affiliation(s)
- S Giunco
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - M Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - C Angelini
- Neurosurgery, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - F Cavallin
- Independent Statistician, Solagna, Italy
| | - G Cerretti
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - M Morello
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - M Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - B Rizzo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - D d'Avella
- Department of Neuroscience, Neurosurgery, University of Padua, Padua, Italy
| | - A D Puppa
- Department of Neurosurgery, Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), University of Florence, Careggi University Hospital, Florence, Italy
| | - F Chioffi
- Neurosurgery, Azienda Ospedaliera- Università Padova, Padua, Italy
| | - P De Bonis
- Neurosurgery, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - V Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - A De Rossi
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Immunology and Molecular Oncology Unit, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - G Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy.
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3
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Scardina G, Ceccarelli L, Casigliani V, Mazzilli S, Padovan M, Petillo A, Tavoschi L, Foddis R, Privitera G, Baggiani A. Flu vaccination coverage in healthcare workers during a 3-year period in the context of the pandemic. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Vaccination of healthcare workers (HCWs) against seasonal influenza is considered the most effective way to protect HCWs and maintain essential healthcare services during influenza epidemics. With the present study we aimed to evaluate the efficacy of measures implemented during the three flu campaigns of 2018/19, 2019/20 and 2020/21 in a university hospital in Pisa, Italy, through the assessment of vaccination coverage (VC) in HCWs and to assess attitudes toward flu vaccination.
Methods
Flu VC was stratified according to sex, age, job and vaccination status for each season and the association between each variable and vaccination status was explored. In 2020, a survey collecting data on knowledge and attitudes on flu vaccination was distributed.
Results
Starting from the 2018/19 campaign, an increasing flu VC rate was registered: contained in 2019/20 (from 11.6% to 14.3%, Δ%=23.1) and significant (VC = 39.6%, Δ%=177.6) in 2020/21 as compared with the previous year. Physicians were the professionals most willing to get vaccinated during all seasons. Considering age the situation changed greatly over the study period, with VC rising in 2020/21 in those age groups marked by low VC in previous years (<30 and 41-50 years old, Δ%=293). Having been vaccinated in the previous year represented the most important variable to predict likelihood of accepting flu jab. However, while previously vaccinated HCWs were 13 times more likely to get the flu jab in 2019/20 compared with the others; in 2020/21 they were only 3 times. Only half of HCWS considered themselves at higher risk of contracting influenza compared to the general population, while 71% totally agreed that receiving the flu jab in 2020/21 was more important than the previous years due to COVID.
Conclusions
A significant increase in VC was observed in 2020/21, especially among those sub-groups with consistently lower uptake in previous years, due to the COVID pandemic that positively influenced vaccination uptake.
Key messages
• This study evaluates the impact of subsequent flu vaccination campaigns implemented in a large university hospital in Italy through the assessment of flu VC among HCWs.
• A significant increase in flu VC among HCWs was observed in 2020/21, especially in those categories characterized by lower VC rates in the previous years, more likely due to the COVID-19 pandemic.
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Affiliation(s)
- G Scardina
- Translational Research in Medicine, University of Pisa , Pisa, Italy
| | - L Ceccarelli
- Translational Research in Medicine, University of Pisa , Pisa, Italy
| | - V Casigliani
- Translational Research in Medicine, University of Pisa , Pisa, Italy
| | | | - M Padovan
- Occupational and Preventive Medicine, University of Pisa , Pisa, Italy
| | - A Petillo
- Occupational and Preventive Medicine, University of Pisa , Pisa, Italy
| | - L Tavoschi
- Translational Research in Medicine, University of Pisa , Pisa, Italy
| | - R Foddis
- Occupational and Preventive Medicine, University of Pisa , Pisa, Italy
| | - G Privitera
- Translational Research in Medicine, University of Pisa , Pisa, Italy
| | - A Baggiani
- Translational Research in Medicine, University of Pisa , Pisa, Italy
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4
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Cerretti G, Bosio A, Maccari M, Padovan M, Caccese M, Zagonel V, Lombardi G. P18.05.A Bevacizumab in atypical and anaplastic meningiomas: the BEMEN study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
meningiomas are the most frequent primary brain tumours. The current standard treatment for atypical and anaplastic meningioma can include surgical resection and radiotherapy. Despite the high rate of relapse no systemic treatment is indicated. Few data are available regarding the effectiveness of bevacizumab (BEV) in this setting. We performed a retrospective analysis investigating the efficacy and safety of BEV in meningioma patients relapsed after receiving surgery and radiotherapy. Gene mutations were also collected
Material and Methods
we retrospectively analyzed patients treated with off-label BEV at the Veneto Institute of Oncology from July 2019 to February 2022. Major inclusion criteria were histologically-confirmed diagnosis of grade 2-3 meningioma (according to WHO 2016 classification), previous treatment with surgery and radiotherapy, no indication to further surgical reintervention or reirradiation, absence of major contraindications to the use of BEV. Data were estrapolated from local clinical records. Bevacizumab was administered at 10 or 5mg/Kg every 2 weeks (at physician’s discretion) until progressive disease/death or unacceptable toxicity. Kaplan-Meier curves were used to estimate the survival rate; CTCAE v 5.0 was used to estimate treatment-related toxicities; RANO criteria were used for radiological assessment; NGS Foundation One panel was used to examine molecular data
Results
the median follow up was 13 months (3-30 range). 26 patients were enrolled. Median age was 68 ys (29-84); male pts were 16 (61%); 61% (16 pts) with atypical meningioma, 38.5% (10 pts) with anaplastic meningioma; 27% (7 pts) had underwent 2 or more surgeries; 58% had had 2 or more RT treatments; 96.1% (25 pts) received <2 previous lines of systemic treatment. 77% (20 pts) and 23% (6) received BEV 10 and 5mg/Kg every 2 weeks, respectively. For 61% of patients (16 pts), NGS analyses were available; 62% (10 pts) harboured NF2 mutations (1 patient had a confirmed diagnosis of neurofibromatosis type 2), 23% (6 pts) CDKN2A/2B deletion, 11% (3 pts) PTEN mutation, 8% (2 pts) FGFR mutation, 8% (2 pts) JAK alteration. Overall survival (OS) rate was 82% and 62% at 6 and 12 months respectively; 6 months PFS rate was 83%. 4 patients showed PR, 11 SD, 6 PD, no patient had CR; 5 patients were not evaluable for response. Among evaluable patients the disease control rate (stability+response) was 71% and the objective response rate was 19%. Median PFS and OS were not reached19% (5 pts) experienced CTCAE grade 1 or 2 toxicity, mainly hypertension (4 pts); 1 patient experienced grade 3 hypertension.
Conclusion
BEV showed very promising activity in recurrent grade 2-3 meningioma. The treatment was well tolerated. BEV should be considered an optimal therapeutic option in this setting of meningioma patients. The NGS results might be useful in identifying targetable mutations in case of further recurrence
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Affiliation(s)
- G Cerretti
- Veneto Institute of Oncology IOV – IRCCS, Oncology 1 , Padua , Italy
- University of Padova, Medical Oncology School of Specialization , Padua , Italy
| | - A Bosio
- Veneto Institute of Oncology IOV – IRCCS , Padua , Italy
- University of Padova, Medical Oncology School of Specialization , Padua , Italy
| | - M Maccari
- Veneto Institute of Oncology IOV – IRCCS , Padua , Italy
- University of Padova, Medical Oncology School of Specialization , Padua , Italy
| | - M Padovan
- Veneto Institute of Oncology IOV – IRCCS, Oncology 1 , Padua , Italy
| | - M Caccese
- Veneto Institute of Oncology IOV – IRCCS, Oncology 1 , Padua , Italy
| | - V Zagonel
- Veneto Institute of Oncology IOV – IRCCS, Oncology 1 , Padua , Italy
| | - G Lombardi
- Veneto Institute of Oncology IOV – IRCCS, Oncology 1 , Padua , Italy
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5
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Padovan M, Maccari M, Bosio A, Vizzaccaro S, Cestonaro I, Corrà M, Caccese M, Cerretti G, Fassan M, Zagonel V, Lombardi G. P02.02.A Next-generation sequencing (NGS) for identifying actionable molecular alterations in newly diagnosed and recurrent IDHwt-glioblastoma (GBM) patients: a large mono institutional experience. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
NGS panels allow the identification of alterations within hundreds of cancer-related genes and can guide a personalized strategy in glioma treatment.
Material and Methods
From Nov 2019 to Jan 2022 at Veneto Institute of Oncology, Padua, Italy, a large cohort of IDHwt-GBM tissues was analyzed by NGS (FoundationOne®CDx). We identified all potential actionable molecular alterations at diagnosis and/or at recurrence. High tumor mutational burden (TMB) was defined as ≥10 mutations/megabase.
Results
We analyzed 429 IDHwt-GBM samples: NGS profile was available for 419 samples (97.7%); sample failures in 10 cases (2.3%). 351 (84%) and 68 (16%) GBM samples derived from surgery at diagnosis and recurrence, respectively. All patients received radiotherapy and/or temozolomide as first line therapy. Among all the analyzed samples, the most frequent actionable molecular alterations were: CDKN2A (57%), CDKN2B (53%), EGFR amplification (39%), EGFR mutation (24%), PTEN loss (27%), RB1 (23%), NF1 (18%), PIK3CA (18%), CDK4 (15%), MDM2 (10%), PDGFRA (8%), BRCA1-2 (7%), FGFR1-3 (7%), Myc (6%), JAK (6%), ROS1 (5%), METmut (2%), METampl (2%), BRAF V600E (2%). No NTRK1/2/3 druggable alterations were observed. High TMB was found in 18 samples. The incidence of alteration of EGFR (ampl/mut), RB1, PIK3CA was statistically different between the two subgroups of samples (Fisher test). To date, 10% of patients received a personalized treatment as compassionate use, off-label use or in clinical trials (9 Dabrafenib/Trametinib, 8 Alpelisib, 3 Erdafitinib, 2 Ipatasertib, 1 Alectinib, 1 Capmatinib, 1 Palbociclib, 1 Entrectinib, 1 Pamiparib). Activity analysis is still ongoing.
Conclusion
NGS is feasible in GBM samples. Potentially, a high rate of patients could receive a personalized treatment. The activity analysis is ongoing. However, the incidence of actionable molecular alterations may differ between diagnosis and recurrent GBM samples.
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Affiliation(s)
- M Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padua , Italy
- PhD course in Clinical and Experimental Oncology and Immunology, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | - M Maccari
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padua , Italy
- School of Specialization in Medical Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | - A Bosio
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padua , Italy
- School of Specialization in Medical Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | - S Vizzaccaro
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padua , Italy
| | - I Cestonaro
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padua , Italy
| | - M Corrà
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padua , Italy
| | - M Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padua , Italy
| | - G Cerretti
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padua , Italy
- School of Specialization in Medical Oncology, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua , Italy
| | - M Fassan
- Department of Medicine (DIMED), Surgical Pathology Unit, University of Padua , Padua , Italy
| | - V Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padua , Italy
| | - G Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padua , Italy
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Caccese M, Padovan M, Cerretti G, Cavallin F, Zagonel V, Lombardi G. P11.20.A Correlation between thyroid function and regorafenib activity in recurrent IDH wild-type(IDHwt) glioblastoma(GBM) patients: a large monocentric study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Glioblastoma is the most frequent CNS malignant tumor, with high aggressiveness and poor prognosis. Regorafenib has recently demonstrated promising activity in terms of survival in recurrent glioblastoma patients. The impact of thyroid function on regorafenib activity has alreasy described in in patients with other types of tumors. This study aimed to investigate the relationship between baseline thyroid variables (TSH, fT3, fT4, fT3/fT4 ratio) and survival in IDHwt GBM patients who were treated with regorafenib.
Material and Methods
We retrospectively evaluated all consecutive recurrent IDHwt GBM patients who were treated with regorafenib at the Veneto Institute of Oncology in Padua (Italy) for which baseline thyroid function assessment was available prior to starting regorafenib. Major inclusion criteria were: histological diagnosis of IDHwt glioblastoma, regorafenib as second-line treatment, basel thyroid values available.The relationships between baseline thyroid variables (TSH, fT3, fT4, fT3/fT4 ratio) and outcomes (PFS, OS) were investigated with Cox regression models, where thyroid variables were modeled with first order polynomial or restricted cubic splines.
Results
We enrolled 108 recurrent IDHwt glioblastoma patients treated with regorafenib at our center From November 2015 to January 2022: 70% were male and median age was 50 years old. All patients received post-surgical treatment with concomitant chemotherapy and subsequent temozolomide according to Stupp protocol as first-line therapy. 32 patients (30%) underwent a second surgery upon recurrence. From starting regorafenib the median follow-up was 7.3 months (IQR 4.0-12.7). MedianPFS was 2.2 months (95% CI 2.0 to 3.4), and PFS rate was 43-13-4% at 3-6-12ms, respectively. MedianOS was 10.4 months (95% CI 7.5 to 14.5), and OS rate was 92-70-46% at 3-6-12 months, respectively. Disease Control Rate (DCR) was 42.7%. Univariate analysis suggested that the relationship between PFS and baseline fT4 may be modelled with first order polynomial (linear term p=0.06, non-linear term p=0.61) and also suggested a non-linear relationship between PFS and baseline fT3/fT4 (linear term p=0.06, non-linear term p=0.04).When adjusting for major clinical confounding factors (age, ECOG PS, second surgery, MGMT), multivariate analysis identified that baseline fT4 (as a continuous variable) is an independent risk factor for PFS (HR 1.09, 95% CI 1.02 to 1.17; p=0.02). We did not find any statistically significant associations between all baseline thyroid variables with OS and response.
Conclusion
Our study demonstrated fT4 value to be a predictive biomarker of PFS in recurrent glioblastoma patients treated with regorafenib. No correlation was showed between baseline thyroid function and survival.
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Affiliation(s)
- M Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padova , Italy
| | - M Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padova , Italy
| | - G Cerretti
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padova , Italy
| | - F Cavallin
- Independent statistician , Solagna , Italy
| | - V Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padova , Italy
| | - G Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS , Padova , Italy
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Bosio A, Caccese M, Padovan M, Cerretti G, Zagonel V, Lombardi G. P17.06.B Different dosage of bevacizumab treatment in recurrent IDHwt glioblastoma/IDHmut grade 4 astrocytoma and its impact on outcome. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Angiogenesis is one of the most distinctive hallmarks of glioblastoma (GBM). Although bevacizumab did not show to improve overall survival in phase 3 trials, it was approved by FDA and is often prescribed as off-label therapy in the recurrent clinical setting. The aim of this study is to evaluate the difference in terms of survival and safety between the 5 mg/m2 and 10 mg/m2 bevacizumab schedule in recurrent GBM.
Material and methods
All pts treated at Veneto Institute of Oncology from May 2013 to March 2022 were retrospectively reviewed. Major inclusion criteria were: histologically confirmed diagnosis of IDHwt GBM/IDHmut grade 4 astrocytoma (according to the WHO 2021 classification), relapse after first or subsequent line of therapy, treatment with bevacizumab at 5 mg/m2 or/and 10 mg/m2 every 2 weeks until progression/death or unacceptable toxicity. Bevacizumab was administered as off-label therapy. The treatment schedule was at physician’s discretion. RANO criteria and CTCAE v5.0 were used for response and toxicity assessment.
Results
81 pts were enrolled. From starting bevacizumab the median follow-up was 10.9ms [95% CI 9.8-14.0] and median age was 53ys (range 18-81). 33 (41%) pts received the 5 mg/m2 schedule. Among them, 2 (6%) were IDHmut grade 4, 8 (24%) had ≥65ys and ECOG-PS was 0-1 in 16 (48%) and ≥2 in 17 (51%), respectively. MGMT was methylated in 15 of 30 (50%) evaluable pts. Median number of prior lines of treatment was 2 (range 1-4) and 30% of pts received bevacizumab at first recurrence. 28 (84.9%) pts were evaluable for response: 7 (21%) and 5 (15%) showed PR and SD. 48 pts received the 10 mg/m2 schedule: 5 (10%) were IDHmut grade 4 astrocytoma; 29 (60%) had an ECOG-PS of 0 or 1 and 4 (8%) had ≥65ys, MGMT was methylated in 20 of 44 (45%) evaluable pts. 36 (75%) pts received bevacizumab beyond the second line of therapy. 46 (96%) pts were evaluable for response: 6 (12%) had PR, 19 (39%) SD. mOS from the start of bevacizumab was 7.3ms (95% CI 4.3-6.4), mPFS was 4.4ms [95% CI 3.7 - 6.4]. At univariate analysis, pts who received the 5 mg/m2 or the 10 mg/m2 schedule had a mOS of 5.4 and 7.7ms (p=0.08); mOS for pts with ECOG-PS < or ≥2 was 9.0 and 5.4ms (p=0.04) while mOS for pts with <2 or ≥2 lines of therapy was 4.7 and 7.7ms (p=0.056). Age and type of the tumor were not statistically significant. At multivariate analysis, MGMT methylated status was the only factor statistically associated with OS (HR=0.48, 95% CI, p=0.002) and PFS (HR=0.33, 95% CI, p=0.001), while a number of prior lines of therapy ≥2 (HR=2.07, 95% CI, p=0.02) was significantly associated only with PFS. Grade 3-4 most common adverse events were hypertension (18%) in pts treated with 5 mg/m2 and hypertension (16%) and proteinuria (2%) in pts treated with 10 mg/m2.
Conclusions
Bevacizumab treatment with a dosage of 5 mg/m2 and 10 mg/m2 seems to give comparable outcome in terms of survival in recurrent GBM pts. No difference was demonstrated for safety.
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Affiliation(s)
- A Bosio
- Department of Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS , Padua , Italy
| | - M Caccese
- Department of Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS , Padua , Italy
| | - M Padovan
- Department of Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS , Padua , Italy
| | - G Cerretti
- Department of Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS , Padua , Italy
| | - V Zagonel
- Department of Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS , Padua , Italy
| | - G Lombardi
- Department of Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS , Padua , Italy
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Bosio A, Padovan M, Caccese M, Cerretti G, Zagonel V, Lombardi G. P17.07.A Metronomic temozolomide therapy in heavily pretreated patients with recurrent glioblastoma: a large mono-institutional retrospective study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Glioblastoma (GBM) is the most common and aggressive primary brain cancer. Despite advances in surgical and first-line treatment, all pts relapse. The aim of this study is to evaluate the benefit of metronomic Temozolomide (mTMZ) for recurrent GBM.
Material and Methods
All pts treated at Veneto Institute of Oncology from September 2013 to March 2021 were retrospectively reviewed. Major inclusion criteria were: first-line therapy with Stupp protocol, relapse after first or subsequent line of therapy, treatment with mTMZ schedule (50mg/m2 continuously), hystologically confirmed diagnosis of GBM. RANO criteria and CTCAE v 5.0 were used for response and toxicity assessment.
Results
120pts were enrolled. Median follow-up was 15.6ms. Median age was 59ys (range 18-81), ECOG-PS was 0-2 in 107pts (89%) and 3 in 11 (9%). MGMT was methylated and IDH mutated in 66 of 105 (62%) and in 9 of 106 (8%) evaluable pts, respectively. Median number of prior lines of treatment was 2 (range 1-7) and 41% of pts received the therapy beyond the third line. Median time between the last standard maintenance TMZ (sTMZ) cycle and the mTMZ administration was 6ms (range 1-50) and 40% of pts started mTMZ after 3ms from sTMZ. All pts were evaluable for response: 3 (2%) and 48 (40%) showed PR and SD. mOS from the start of mTMZ was 5.4ms (95% CI 4.3-6.4), mPFS was 2.6ms (95% CI 2.3-2.8). At univariate analysis, MGMTmet and MGMTunmet pts had a mOS of 5.6 and 4.4ms (p=0.03); mOS for patients with ECOG-PS > or ≤2 was 2.3 and 6.0ms (p<0.001); number of prior lines of therapies, time between sTMZ and mTMZ and age were not significant. At multivariate analysis, MGMT methylated status (HR=2.3, 95% CI, p=0.004) and ECOG-PS (HR=0.5, 95% CI, p=0.017) remained statistically significant for PFS, while ECOG-PS (HR=0.4, 95% CI, p=0.001) was the only factor significantly associated with OS. The most common grade 3-4 hematologic toxicities were lymphopenia (10%) and thrombocytopenia (3%). Grade 3-4 nonhematologic toxicities were uncommon.
Conclusion
Rechallenge with mTMZ can be a well tolerated treatment option for recurrent GBM, even in heavily pretreated pts. Pts with MGMTmet and good ECOG-PS might report the major benefit.
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Affiliation(s)
- A Bosio
- Department of Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS , Padua , Italy
| | - M Padovan
- Department of Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS , Padua , Italy
| | - M Caccese
- Department of Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS , Padua , Italy
| | - G Cerretti
- Department of Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS , Padua , Italy
| | - V Zagonel
- Department of Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS , Padua , Italy
| | - G Lombardi
- Department of Oncology, Medical Oncology 1, Istituto Oncologico Veneto IOV-IRCCS , Padua , Italy
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Cerretti G, Bosio A, Maccari M, Padovan M, Caccese M, Zagonel V, Lombardi G. 310P Bevacizumab in meningiomas: A monocentric experience. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.443] [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: 11/01/2022] Open
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Padovan M, Maccari M, Bosio A, Vizzaccaro S, Cestonaro I, Corrà M, Caccese M, Cerretti G, M. Fassan, Zagonel V, Lombardi G. 289MO Next-generation sequencing (NGS) for identifying actionable molecular alterations in newly diagnosed and recurrent IDHwt-glioblastoma (GBM) patients: A large mono institutional experience. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.423] [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: 11/25/2022] Open
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Bosio A, Caccese M, Padovan M, Cerretti G, Zagonel V, Lombardi G. 306P Different dosage of bevacizumab treatment in recurrent IDHwt glioblastoma/IDHmut grade 4 astrocytoma and its impact on outcome. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Lini D, Nalli C, Andreoli L, Crisafulli F, Fredi M, Lazzaroni MG, Bitsadze V, Calligaro A, Canti V, Caporali R, Carubbi F, Chighizola C, Conigliaro P, Conti F, De Carolis C, Del Ross T, Favaro M, Gerosa M, Iuliano A, Khizroeva J, Makatsariya A, Meroni PL, Mosca M, Padovan M, Perricone R, Rovere-Querini P, Sebastiani GD, Tani C, Tonello M, Truglia S, Zucchi D, Franceschini F, Tincani A. POS0721 ASSOCIATION BETWEEN PRECONCEPTION COMPLEMENT LEVELS AND USE OF HYDROXYCHLOROQUINE WITH PREGNANCY OUTCOME IN PATIENTS WITH PRIMARY ANTIPHOSPHOLIPID SYNDROME AND CARRIERS OF ANTIPHOSPHOLIPID ANTIBODIES: AN INTERNATIONAL MULTICENTER STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAntiphospholipid Syndrome (APS) is a rare autoimmune disease characterized by thrombotic events and/or pregnancy morbidities in the presence of confirmed positivity for antiphospholipid antibodies (aPL). Complement was demonstrated to be involved in aPL-related pregnancy loss in animal models and several groups investigated the significance of complement levels in human disease. C3 and C4 serum levels were assessed in several cohorts of pregnant patients with APS and/or aPL positivity in order to relate complement consumption with adverse pregnancy outcome (APO).According to some authors, hydroxychloroquine (HCQ) can control the activation of the complement system, improve pregnancy outcome and reduce aPL title.ObjectivesThis study was designed to verify the effect of HCQ in addition to low dose aspirin (LDA) + low molecular weight heparin (LMWH) treatment in a multicenter cohort of primary APS (PAPS) and aPL carriers pregnant women and the possible correlation with preconception serum C3/C4 levels.MethodsMedical records of pregnant women with confirmed positivity for aPL antibodies attending twelve referral centers from January 2010 to December 2020 were retrospectively evaluated. We considered as aPL-related APO: spontaneous abortions (<10 weeks of gestation), fetal loss (≥10 weeks of gestation), neonatal death (death of a formed fetus alive at birth in the first 28 days of life), preterm delivery before 37 weeks of gestation, preeclampsia, eclampsia or HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet).ResultsWe have analyzed 164 singleton PAPS/aPL carrier pregnancies (22 aPL carriers - 13%) in 128 patients: all were treated with combination therapy (LDA+LMWH), and in 30 HCQ was added. 58 pregnancies (43%) had low levels of preconception C3/C4. A triple aPL positivity was observed in 54 pregnancies, 14 of them were treated with combination therapy + HCQ. When considering the whole cohort, the addition of HCQ had not significantly improved the gestational outcome. Further stratification was performed on the basis of complement consumption. In the group of patients with preconception low C3/C4 levels the addition of HCQ had not significantly improved pregnancy outcome. We have lastly evaluated 40 pregnancies with a high-risk profile (triple aPL positivity and complement consumption), in which we have found that HCQ significantly improved gestational outcome (p=0.018, Table 1).Table 1.Relationship between APO, therapy during pregnancy and risk profile.All pregnancies (n=164)Reduced C3/C4 (n=58)Triple aPL+ and reduced C3/C4 (n=40)LDA+LMWH (n, %)LDA+LMWH+HCQ (n, %)pLDA+LMWH (n, %)LDA+LMWH+HCQpLDA+LMWHLDA+LMWH+HCQp(n, %)(n, %)(n, %)APO62 (46%)16 (53%)ns32 (68%)4 (36%)ns23 (77%)3 (30%)0.018No APO72 (54%)14 (47%)15 (32%)7 (64%)7 (23%)7 (70%)Total1343047113010This observation could not be confirmed in patients with single or double aPL positivity.ConclusionThe study shows that administering HCQ in addition to combination therapy can improve gestational outcome in aPL/PAPS high-risk patients. This observation confirms that HCQ exerts a beneficial effect on aPL pregnancies by complement inhibition as it was shown in animal models. In addition, our results provide the clinicians a useful tool to implement conventional treatment in patients at high risk of pregnancy complication or loss.References[1]De Carolis S, et al. Is there any role for the hydroxychloroquine (HCQ) in refractory obstetrical antiphospholipid syndrome (APS) treatment? Autoimmun Rev 2015;14:760-2.[2]Mekinian A, et al. The efficacy of hydroxychloroquine for obstetrical outcome in antiphospholipid syndrome: data from a European multicenter retrospective study. Autoimmun Rev 2015;40:498-502.[3]Mekinian A et al. Obstetrical APS: is there a place for hydroxychloroquine to improve the pregnancy outcome? Autoimmun Rev 2015;14:23-9.Disclosure of InterestsNone declared
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Padovan M, Vallentgoed W, de Heer I, Lombardi G, van den Bent M, French P. P04.07 The molecular evolution of oligodendrogliomas. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Oligodendroglioma (OD) is defined by the presence of both IDH1/2 mutation and 1p/19q codeletion. Although prognosis of OD patients is relatively favorable, tumours usually relapse and often evolve to a higher malignancy grade, with some acquiring the treatment induced hypermutated phenotype. To better understand how these tumours evolve in time, we examined the molecular differences between matched primary and recurrent ODs.
MATERIAL AND METHODS
We identified 21 patients who underwent surgery at least twice [male: 11, female: 10, median age: 44 years (31–66)]. Clinical data were available for 14/21 patients: 5/14 received a treatment between resections [4 radiotherapy, 1 radiotherapy followed by PCV chemotherapy]; median time from the first to the second surgery was 71.5 months (12–158). Whole genome DNA-methylation analysis was performed using Illumina’s MethylationEPIC ‘850K’ BeadChip. Results were evaluated using the Molecularneuropathology.org platform (version 3.1.5) and in R.
RESULTS
Most samples were WHO grade 2 ODs [14, 10 and 1 tumours in first, second and third resection group, respectively]; WHO grade 3 was found in 6, 10 and 3 tumours in first, second and third resection, respectively; in 4 patients the tumour showed malignant progression from grade 2 to 3. Most ODs exhibited an IDH1 R132H mutation [17/21 patients]; in no cases was IDH1/2 mutation lost during progression. DNA methylation analysis was successfully performed in 41/45 cases [primary OD: 17, recurrent OD: 24] for a total of 18 matched pairs. 37 samples were assigned to the “IDH mutant glioma, subclass 1p/19q codeleted OD”; the remaining 4 were assigned to various other methylation classes but CNV (copy number variation) analysis confirmed the 1p19q codeletion in all samples. Recurrent tumours exhibited de novo loss of chromosome 4 in 3/24 cases (12.5%) and loss of chromosome 13 in 3/24 cases (12.5%). In unsupervised analysis of the 1000 most variable CpG sites, samples from the same patient clustered together. This indicates that the inter-tumour variability is greater than the intra-, temporal- or grading variability between tumours. There were no overt differences in DNA methylation levels between the primary and matched recurrent OD. However, lower genome wide DNA methylation levels were observed in tumours that dedifferentiated to grade 3 ODs compared to those of grade 2, indicating that DNA demethylation is associated to higher malignancy grade.
CONCLUSION
DNA methylation analysis in a cohort of primary and recurrent oligodendrogliomas highlights the genomic and epi-genetic changes that are acquired at tumour progression. We are currently expanding the cohort and collecting/integrating the clinical data to better explore the evolution of recurrent ODs.
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Affiliation(s)
- M Padovan
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - W Vallentgoed
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - I de Heer
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - G Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - M van den Bent
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - P French
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
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Caccese M, Cerretti G, Padovan M, Zagonel V, Lombardi G. P14.19 Regorafenib in recurrent glioblastoma patients: a large real-life experience. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Regorafenib (REG), an oral multikinase inhibitor of angiogenic, stromal, and oncogenic receptor tyrosine kinases showed encouraging benefit in recurrent GBM patients enrolled in the randomized, phase 2 REGOMA trial. We investigated the clinical outcome and safety of REG in a real-life population of recurrent glioblastoma patients treated at Veneto Institute of Oncology as off-label use.
MATERIAL AND METHODS
Patients receiving REG at Veneto Institute of Oncology (Padua, Italy) were entered prospectively on a clinical database. Data were retrospectively analyzed. The primary endpoints of the study were overall survival (OS) and safety. The major inclusion criteria were: histologically confirmed diagnosis of GBM, disease progression as defined by RANO criteria after surgery followed by radiochemotherapy with temozolomide, ECOG PS ≤ 2; PTS with ≥ 2 prior lines of therapy were excluded. According to original schedule, patients received REG 160 mg once daily for the first 3 weeks of each 4-week cycle until disease progression, death, unacceptable toxicity, or consent withdrawal. Kaplan-Meier method was used to estimate the survival curves, RANO criteria for radiological assessment, CTCAE v5.0 for drug related adverse events.
RESULTS
From February 2018 to September 2020, 54 consecutive patients were treated with REG and enrolled in this study: median age was 56, ECOG PS 0–1 in 91% of patients, MGMTmet in 53%, second surgery at the time of relapse were performed in 30% of enrolled patient, 41% of patients underwent steroids at baseline. At the time of analysis, median follow-up was 11.1 ms, 30 PTS (56%) had died and 50 PTS (93%) had progressed. Median OS was 10.2 ms (95%CI, 6.4–13.9), 12m-OS was 43%; median PFS was 2.3ms (95%CI, 1.3–3.3) and 6m-PFS was 18%. All patients were evaluable for response: disease control rate (DCR) was 46.3%; stable disease was reported in 38.8% and partial response in 7.4%. Age, MGMT status and corticosteroid use at baseline were not statistically significant on multivariate analysis for OS. Grade 3 drug-related adverse events (AEs) occurred in 10 patients (18%) and the most frequent were hand-foot skin reaction, asthenia and increased lipase and transaminases; 1 PT (2%) reported a grade 4 AE (rash maculo-papular). AEs led to REG dose reductions in 37% of patients and, it was permanently discontinued in 5%. No death was considered to be drug-related.
CONCLUSION
We reported a large, mono-institutional “real world” experience of REG in recurrent glioblastoma patients. Overall, results are close to those reported in REGOMA trial although, we showed a longer OS. Toxicity was moderate and manageable. Encouraging clinical benefits of REG in recurrent GBM population were confirmed.
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Affiliation(s)
- M Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - G Cerretti
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - M Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - V Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - G Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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Caccese M, Cerretti G, Padovan M, Zagonel V, Lombardi G. 359P Regorafenib in recurrent glioblastoma patients: A large real-life experience. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.023] [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] Open
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16
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Bosio A, Cerretti G, Padovan M, Caccese M, Guarneri V, Zagonel V, Lombardi G. 360P Metronomic temozolomide therapy in heavily pretreated patients with recurrent glioblastoma: A large mono-institutional retrospective study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.024] [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] Open
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Caccese M, Simonelli M, Bellu L, Villani V, Rizzato S, Ius T, Pasqualetti F, Russo M, Franchino F, Amoroso R, Bertorelle R, Cavallin F, Dipasquale A, Carosi M, Pizzolitto S, Cesselli D, Gardiman M, Padovan M, Zagonel V, Lombardi G. 361O Defining the prognostic role of MGMT methylation value by pyrosequencing assay in glioblastoma patients: A large Italian multicenter study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Padovan M, Eoli M, Pellerino A, Rizzato S, Caserta C, Simonelli M, Michiara M, Caccese M, Anghileri E, Finocchiaro G, Zagonel V, Rudà R, Lombardi G. 369MO Final results of depatuxizumab mafodotin plus temozolomide in recurrent glioblastoma patients: Real-world experience from a multicenter study of Italian Association of Neuro-Oncology (AINO). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Silvagni E, Bortoluzzi A, Borrelli M, Padovan M, Furini F, Govoni M. Conventional brain magnetic resonance imaging in the longitudinal evaluation of newly diagnosed systemic lupus erythematosus patients: a retrospective analysis from a single-centre cohort. Lupus 2020; 29:499-504. [PMID: 32138582 DOI: 10.1177/0961203320909955] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Neuropsychiatric (NP) manifestations occur mostly in the early phases of the systemic lupus erythematosus (SLE) course. Nonspecific alterations are evident in conventional brain magnetic resonance imaging (MRI), regardless of clinically overt NP symptoms. The main aims of this study were to assess the prevalence of MRI abnormalities in newly diagnosed SLE, and to evaluate the impact of MRI changes during follow-up (FU) and the clinical course of NP symptoms. MATERIALS AND METHODS Newly diagnosed SLE patients with a baseline brain MRI and with available repeated MRI during FU were retrospectively evaluated. White-matter lesions and atrophy were recorded, comparing NPSLE and non-NPSLE patients. Cox proportional hazard models were used to compare NP events during FU with MRI data. RESULTS Forty-four patients were included, 22 with NP events attributed to SLE. The baseline MRI scan was abnormal in 21 patients (47.73%). New NP events occurred in 17 patients, and worsening was found in repeated MRIs in 12 (27.27%). A worsening of MRI was associated with higher occurrence of new NP events during FU (adjusted hazard ratio 3.946 (1.175-13.253)). CONCLUSION Baseline MRI is useful in patients with an early diagnosis of SLE, allowing comparison with subsequent scans. In our study, radiological worsening of repeated brain MRI was associated with new NP events.
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Affiliation(s)
- E Silvagni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Italy
| | - A Bortoluzzi
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Italy
| | - M Borrelli
- Neuroradiology Unit, Department of Neuroscience and Rehabilitation, Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Italy
| | - M Padovan
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Italy
| | - F Furini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Italy
| | - M Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and Azienda Ospedaliero-Universitaria Sant'Anna, Cona, Italy
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Lombardi G, Del Bianco P, Brandes A, Eoli M, Rudà R, Ibrahim T, Lolli I, Pace A, Daniele B, Pasqualetti F, Rizzato S, Bergo E, Caccese M, Padovan M, Soffietti R, De Salvo G, Zagonel V. Health-related quality of life (HRQoL) evaluation in the REGOMA trial: A randomized, phase II clinical trial analyzing regorafenib activity in relapsed glioblastoma patients. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz243.004] [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: 11/13/2022] Open
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Bergo E, Caccese M, Padovan M, Bellu L, Brunello A, Zagonel V, Lombardi G. Comprehensive geriatric assessment (CGA) can categorize elderly glioblastoma (GBM) patients into three groups predicting survival: A monoinstitutional study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz243.030] [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: 11/13/2022] Open
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Caccese M, Simonelli M, Fassan M, Padovan M, Persico P, Bellu L, Dipasquale A, Gardiman M, Indraccolo S, Zagonel V, Lombardi G. Pembrolizumab (Pem) in recurrent high-grade glioma (HGG) patients with mismatch repair deficiency (MMRd): An observational study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz243.038] [Citation(s) in RCA: 1] [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: 11/14/2022] Open
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Caccese M, Simonelli M, Fassan M, Padovan M, Persico P, Bellu L, Dipasquale A, Gardiman M, Indraccolo S, Zagonel V, Lombardi G. PL2.2 Pembrolizumab (PEM) in recurrent high-grade glioma (HGG)patients with mismatch repair deficiency (dMMR): an observational study. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Pem, an immune checkpoint inhibitor, demonstrated to be activein various neoplasms with MMRd. No data exists about its efficacy in MMRdglioma patients.
MATERIAL AND METHODS
MMRd HGG relapsed after receiving RT and CT weretreated with Pem. MMR status was analyzed by immunohistochemistry,including the MLH1, MSH2, MSH6, and PMS2 markers. MMR deficiency wasdefined as presence of a weak (wMMRd) or absent (aMMRd) signal atimmunohistochemistry for at least one MMR protein. Other inclusion criteriawere: ECOG PS 0–2, histologically confirmed gliomas, dexamethasone ≤4 mg.Pem was administrated at 200 mg every 3 weeks until progression disease orunacceptable toxicity. Tumor response was evaluated by brain MRI every 10 weeksaccording to the RANO criteria. OS and PFS were evaluated by Kaplan-Meiercurves. CTCAE v4.0 was used for toxicity.
RESULTS
among 167 glioma patients, we found 22 MMRd gliomas. 12 PTS were treated with Pem: 8 wMMRd and 4 aMMRd. According to Bethesda criteria, allPTS had microsatellite stability. Tumor histologies included 5 anaplasticastrocytoma, 1 anaplastic oligodendroglioma, 6 glioblastoma (GBM). MSH2deficiency was found in 6 cases, MSH6 deficiency in 9 cases, PMS2 and MLH1deficiency in 2 cases. Median number of prior line of chemotherapy was 1 (range 1–5). Stable disease (SD) was reported in 4 PTS (33%); 8 PTS showedprogressive disease (PD). PTS with anaplastic gliomas showed a statisticallysignificant association with SD (p=0.03, OR=3); all GBM PTS reported PD; status of MMRd (weak/absent), IDH (mutated/wild-type), MSH2 and MLH6(deficient/proficient) were not associated with SD. Median follow up was 14.7 ms. OS was 5.6 ms (95% CI 0.1–13.8), PFS 2.4 ms (95% CI 1.8–2.9). OS was 2.8 ms and 5.6 ms (p=0.9), PFS was 1.8 ms and 3.1 ms (p=0.5) in PTS with wMMRd and aMMRd. PTS reporting SD and PD had PFS of 7.4 ms (95% CI 4.6–10.2) and 1.8 ms (95% CI 0.2–3.4), p=0.002; OS was “not reached” and 2.8 ms in PTS having SD vs PD (p=0.04). Grade ≥3 adverse eventswere reported in 8% of PTS.
CONCLUSION
a subgroup of recurrent MMRd HGG might benefit from Pem,especially anaplastic gliomas. There was a trend for a longer PFS and OS in PTS with aMMRd. Analyses for identifying additional molecular predictive factors is ongoing.
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Affiliation(s)
- M Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - M Simonelli
- Humanitas University, Humanitas Clinical and Research Hospital - IRCCS, Milan, Italy
| | - M Fassan
- Department of Medicine and Surgical Pathology and Cytopathology Unit, University Hospital of Padua, Padova, Italy
| | - M Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - P Persico
- Humanitas University, Humanitas Clinical and Research Hospital - IRCCS, Milan, Italy
| | - L Bellu
- Department of Oncology, Radiotherapy Unit, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - A Dipasquale
- Humanitas University, Humanitas Clinical and Research Hospital - IRCCS, Milan, Italy
| | - M Gardiman
- Department of Medicine and Surgical Pathology and Cytopathology Unit, University Hospital of Padua, Padova, Italy
| | - S Indraccolo
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV - IRCCS, Padova, Italy
| | - V Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
| | - G Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology, IOV – IRCCS, Padova, Italy
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Lombardi G, Del Bianco P, Brandes A, Eoli M, Rudà R, Ibrahim T, Lolli I, Pace A, Daniele B, Pasqualetti F, Rizzato S, Bergo E, Caccese M, Padovan M, Soffietti R, De Salvo G, Zagonel V. OS7.3 Health-related quality of life (HRQoL) evaluation in the REGOMA trial: a randomized, phase II clinical trial analyzing regorafenib activity in relapsed glioblastoma patients. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
REGOMA trial showed that regorafenib (REG) significantly improved OS and PFS in patients (pts) with relapsed GBM with respect to lomustine (LOM). REG showed a different toxicity profile compared to LOM. Here, we report final results of the HRQoL assessment, a secondary end point.
MATERIAL AND METHODS
HRQoL was measured using the European Organization for Research and Treatment of Cancer (EORTC) core questionnaire (QLQ-C30) and brain module (QLQ-BN20) administered before any MRI assessments, every 8 weeks (+/- 2 weeks) until disease progression. To evaluate treatment impact on HRQoL, questionnaires at progression were excluded. Mixed-effect linear models were fitted for each of the HRQOL domain to examine the change over progression-free time within and between arms. The models included the time of questionnaire assessment, the treatment group and their interaction, as fixed effects, and a compound symmetry covariance structure for the random effects. Differences of at least 10 points were classified as a clinically meaningful change. To correct for multiple comparisons and to avoid type I error, the level of significance was set at P=0.01 (2-sided).
RESULTS
Of 119 randomized pts, 117 partecipated in the HRQoL evaluation, and 114 had a baseline assessment (n=56 REG; n=58 LOM). No statistically significant differences were observed in any generic or cancer specific domain during treatment in the REG and LOM arms, or between the two arms, except for the appetite loss scale which was significantly worse in PTS treated with REG (Global mean 14.7 (SD=28.6) vs 7.6 (SD=16.0); p=0.0081). The rate of pts with a clinically meaningful worsening for appetite loss was not statistically different between the two arms (9 out of 24 and 0 out of 13 in the REG and LOM arm, respectively;p=0.02).
CONCLUSION
In the REGOMA trial, HRQoL did not change during regorafenib treatment. Pts treated with regorafenib and lomustine reported no significant difference in HRQoL.
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Affiliation(s)
- G Lombardi
- Department of Oncology, Oncology 1 - Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - P Del Bianco
- Clinical Research Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - A Brandes
- Medical Oncology Department, AUSL-IRCCS Scienze Neurologiche, Bologna, Italy
| | - M Eoli
- Molecolar Neuro-Oncology Unit, Besta Institute, Milano, Italy
| | - R Rudà
- Department of Neuro-Oncology, University of Turin and City of Health and Science Hospital, Torino, Italy
| | - T Ibrahim
- Medical Oncology Unit, IRST-IRCCS, Meldola, Italy
| | - I Lolli
- Medical Oncology Unit - IRCCS Saverio de Bellis, Castellana Grotte, Bari, Italy
| | - A Pace
- Neuroncology Unit, Regina Elena Cancer Institute - IRCCS, Roma, Italy
| | - B Daniele
- Medical Oncology Unit, A.O.G. Rummo, Benevento, Italy
| | - F Pasqualetti
- Radiotherapy Unit, Azienda Ospedaliera Universitaria, Pisa, Italy
| | - S Rizzato
- Department of Oncology, Azienda Sanitaria - Universitaria Integrata, Udine, Italy
| | - E Bergo
- Department of Oncology, Oncology 1 - Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - M Caccese
- Department of Oncology, Oncology 1 - Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - M Padovan
- Department of Oncology, Oncology 1 - Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - R Soffietti
- Department of Neuro-Oncology, University of Turin and City of Health and Science Hospital, Torino, Italy
| | - G De Salvo
- Clinical Research Unit, Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
| | - V Zagonel
- Department of Oncology, Oncology 1 - Veneto Institute of Oncology IOV - IRCCS, Padova, Italy
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Foschi V, Bortolotti D, Doyle AF, Stratigou V, Stephens L, Trivedi P, Rinaldi R, Padovan M, Bortoluzzi A, Lightstone L, Cairns TD, Botto M, Cook TH, Rizzo R, Govoni M, Pickering MC. Analysis of HLA-G expression in renal tissue in lupus nephritis: a pilot study. Lupus 2019; 28:1091-1100. [PMID: 31291846 DOI: 10.1177/0961203319860582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The study aimed to investigate whether HLA-G antigen is expressed in the kidneys of patients affected by lupus nephritis (LN) and whether its detection in renal biopsies could be adopted as a marker of treatment response and prognosis. METHODS Thirty renal biopsies from patients with LN were selected and analyzed through immunohistochemistry. Laboratory and clinical data were retrospectively collected at baseline, 6 and 12 months and at the latest clinical appointment. A number of patients (63.3%) were treated with rituximab (RTX) +/- methylprednisolone in the induction phase. The expression of HLA-G in glomeruli, tubules and infiltrating cells was examined and compared between lupus patients who achieved either complete or partial renal response and those who did not respond to treatment. RESULTS HLA-G staining was observed in the glomeruli of 20 of 30 samples from patients with LN. The expression of the antigen was detected in podocytes, along glomerular capillary walls, on parietal glomerular epithelial cells and within the juxtaglomerular apparatus. Seventy per cent of patients whose glomeruli expressed HLA-G achieved partial or complete response at 6 months and 75% at the latest available follow up compared with 30% and 40%, respectively, of those who did not show any expression. The pattern of staining in tubules and infiltrating cells was highly variable precluding any clinical correlation. CONCLUSION This study demonstrates that HLA-G is expressed in renal tissue in LN. Our retrospective data suggest that its expression could correlate with response to treatment.
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Affiliation(s)
- V Foschi
- 1 Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Italy.,2 Centre for Complement and Inflammation Research, Imperial College London, UK
| | - D Bortolotti
- 3 Department of Medical Sciences, Section of Microbiology and Medical Genetics, University of Ferrara, Italy
| | - A F Doyle
- 2 Centre for Complement and Inflammation Research, Imperial College London, UK
| | - V Stratigou
- 2 Centre for Complement and Inflammation Research, Imperial College London, UK
| | - L Stephens
- 2 Centre for Complement and Inflammation Research, Imperial College London, UK
| | - P Trivedi
- 4 Department of Pathology, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - R Rinaldi
- 5 Section of Pathology and Biomolecular Diagnostics, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Italy
| | - M Padovan
- 1 Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Italy
| | - A Bortoluzzi
- 1 Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Italy
| | - L Lightstone
- 6 Section of Renal and Vascular Inflammation, Department of Medicine, Imperial College London, UK.,7 Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - T D Cairns
- 7 Renal and Transplant Centre, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - M Botto
- 2 Centre for Complement and Inflammation Research, Imperial College London, UK
| | - T H Cook
- 2 Centre for Complement and Inflammation Research, Imperial College London, UK
| | - R Rizzo
- 3 Department of Medical Sciences, Section of Microbiology and Medical Genetics, University of Ferrara, Italy
| | - M Govoni
- 1 Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Italy
| | - M C Pickering
- 2 Centre for Complement and Inflammation Research, Imperial College London, UK
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Bortoluzzi A, Fanouriakis A, Costallat L, Appenzeller S, Padovan M, Murphy E, Bertsias G, Hanly J, Govoni M. FRI0316 Assessing Attribution of Neuropsychiatric Events in Systemic Lupus Erythematosus. Performance of A New Algorithm in An International Multicenter Cohort. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4307] [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: 11/04/2022]
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Palese A, Ambrosi E, Fabris F, Guarnier A, Barelli P, Zambiasi P, Allegrini E, Bazoli L, Casson P, Marin M, Padovan M, Picogna M, Taddia P, Salmaso D, Chiari P, Marognolli O, Canzan F, Saiani L. Nursing care as a predictor of phlebitis related to insertion of a peripheral venous cannula in emergency departments: findings from a prospective study. J Hosp Infect 2016; 92:280-6. [DOI: 10.1016/j.jhin.2015.10.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/19/2015] [Indexed: 11/15/2022]
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Bortoluzzi A, Padovan M, Azzini C, De Vito A, Trotta F, Govoni M. Brain unidentified bright objects (“UBO”) in systemic lupus erythematosus: sometimes they come back. A study of microembolism by cMRI and Transcranial Doppler ultrasound. Lupus 2015; 25:193-8. [DOI: 10.1177/0961203315608256] [Citation(s) in RCA: 3] [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: 04/28/2015] [Accepted: 08/26/2015] [Indexed: 11/16/2022]
Abstract
Objectives The objectives of this report are to assess the occurrence of microembolic signals (MES) detected by transcranial Doppler ultrasound (TCD) in systemic lupus erythematosus (SLE) patients with (NPSLE) and without (SLE) neuropsychiatric involvement, and to verify the correlation between MES, clinical characteristics, especially the patent foramen ovale (PFO), and the presence of punctuate T2-hyperintense white matter lesions (WMHLs) detected by conventional magnetic resonance imaging (cMRI). Methods A TCD registration to detect MES from the middle cerebral artery was carried out in SLE and NPSLE patients after exclusion of aortic and/or carotid atheromatous disease. In all patients conventional brain magnetic resonance imaging (cMRI) and transesophageal echocardiography were performed. Patients were stratified in two groups, with and without WMHLs, and compared. Results Twenty-three SLE patients (16 NPSLE and seven SLE) were enrolled in the study. Overall MES were detected in 12 patients (52.1%), WHMLs were detectable in 15 patients (13 NPSLE and two SLE) while eight patients had normal cMRI (three NPSLE and five SLE). Matching TCD ultrasound and neuroimaging data, MES were detected in 10 (nine NPSLE and one SLE) out of 15 patients with WHMLs and in only two out of eight patients (two NPSLE and six SLE) with normal cMRI, both with NP involvement. A PFO was confirmed in all cases of MES detection. Conclusion MES are frequent findings in SLE patients, especially in those with focal WMHLs detected by cMRI and correlating with PFO. These findings should be taken into account and suggest caution in the interpretation of cMRI pictures along with a careful evaluation of MES in patients with cMRI abnormalities that should be included in the workup of SLE patients.
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Affiliation(s)
- A Bortoluzzi
- Department of Medical Science, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero Universitaria Sant’Anna di Cona, Ferrara, Italy
| | - M Padovan
- Department of Medical Science, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero Universitaria Sant’Anna di Cona, Ferrara, Italy
| | - C Azzini
- Department of Neuroscience, Section of Neurology, Azienda Ospedaliero Universitaria Sant’Anna di Cona, Ferrara, Italy
| | - A De Vito
- Department of Neuroscience, Section of Neurology, Azienda Ospedaliero Universitaria Sant’Anna di Cona, Ferrara, Italy
| | - F Trotta
- Department of Medical Science, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero Universitaria Sant’Anna di Cona, Ferrara, Italy
| | - M Govoni
- Department of Medical Science, Section of Rheumatology, University of Ferrara and Azienda Ospedaliero Universitaria Sant’Anna di Cona, Ferrara, Italy
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Silvagni E, Bortoluzzi A, Padovan M, Furini F, Borrelli M, Govoni M. FRI0384 Usefulness of Brain MRI in Early Lupus: How the Morphological Imaging Changes at Onset of the Disease and After Follow-Up. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4957] [Citation(s) in RCA: 2] [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: 11/04/2022]
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Bortoluzzi A, Furini F, Campanaro F, Padovan M, Govoni M. FRI0385 UCTD and Progression to SLE. Analysis of a Wide Monocentric Cohort with a Long Follow-Up. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4913] [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: 11/03/2022]
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Giacuzzo S, Padovan M, Capucci R, Barbieri M, Govoni M. FRI0090 Pregnancy Outcome of Mothers with Rheumatic Diseases Exposed to Biological Agent during Pregnancy: A Single-Centre Study:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3342] [Citation(s) in RCA: 2] [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: 11/03/2022]
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Bortoluzzi A, Padovan M, De Stefani E, Govoni M. AB0502 All-Cause Hospitalizations in Systemic Lupus Erythematosus from A Northern Italian Referral Centre. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4904] [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: 11/04/2022]
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Bortoluzzi A, Amadelli A, Padovan M, Govoni M. THU0288 Fatigue and Quality of Life in Patients with Systemic Lupus Erythematosus: Comparison of Different Evaluation Tools and Questionnaires. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.816] [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: 11/04/2022]
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Bortoluzzi A, Bombardieri S, Casu C, Conti F, De Vita S, Doria A, Farina I, Ferraccioli G, Gremese E, Mansutti E, Mosca M, Padovan M, Piga M, Tincani A, Tomietto P, Tani C, Valesini G, Zen M, Mathieu A, Govoni M. THU0161 Neuropsychiatric involvement and SLE: Performance of a new algorithm for attribution of NP events tested on an italian multicenter cohort. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2126] [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: 11/04/2022]
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Bortoluzzi A, Padovan M, Farina I, Galuppi E, De Leonardis F, Govoni M. Therapeutic strategies in severe neuropsychiatric systemic lupus erythematosus: experience from a tertiary referral centre. Reumatismo 2012; 64:350-9. [DOI: 10.4081/reumatismo.2012.350] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 08/01/2012] [Accepted: 10/11/2012] [Indexed: 11/23/2022] Open
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Castellino G, Bortoluzzi A, Padovan M, Borrelli M, Feggi L, Govoni M. Repeated brain conventional MRI and SPECT evaluation in systemic lupus erythematosus patients with and without neuropsychiatric involvement: a follow up study. Lupus 2011; 20:1387-95. [DOI: 10.1177/0961203311415304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To assess the utility of a combined neuroimaging approach in the follow up of patients affected by systemic lupus erythematosus (SLE) with and without neuropsychiatric (NP) involvement. Methods: Patients who underwent a first combined brain conventional magnetic resonance imaging (cMRI) and single photon emission computed tomography (SPECT) and later repeated the same examinations between 2001 and 2008 were retrieved from a large database. Clinical and neuroimaging data were analysed and their relationships evaluated at baseline and at follow up. Results: Fifty SLE patients (38 with and 12 without NP involvement, mean age 36.8 yrs and mean disease duration at first instrumental evaluation 5.5 yrs) were enrolled. At baseline, the majority of them had a diffuse pattern of NP involvement. After a mean follow up period of 4 years all patients repeated neuroimaging and clinical evaluation. In 23 patients (22 with and 1 without NP manifestations at baseline) a new NP event occurred. Overall, neuroimaging remained unchanged or improved, but in some cases it worsened. No correlations were found between instrumental findings and clinical picture. Conclusions: In this study, the clinical features at baseline appeared to be a better predictor of future NP events than morphological and functional neuroimaging. Therefore the utility of repeating a combined instrumental evaluation (cMRI and SPECT) may be debatable especially for patients with diffuse NP involvement where the decision to perform serial combined neuroimaging examinations should be carefully assessed and based mainly on clinical judgement. Lupus (2011) 20, 1387–1395.
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Affiliation(s)
- G Castellino
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Italy
| | - A Bortoluzzi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Italy
| | - M Padovan
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Italy
| | | | - L Feggi
- Nuclear Medicine Services, S. Anna Hospital, Ferrara, Italy
| | - M Govoni
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Italy
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Padovan M, Govoni M, Trotta F. Semeiology of “early arthritis”. Reumatismo 2011. [DOI: 10.4081/reumatismo.2003.187] [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: 11/22/2022] Open
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Grosso D, Diamanti O, Magro C, Bryce J, Galtarossa N, Giacobbo M, Padovan M. 4192 POSTER Information Needs of Patients Receiving Chemotherapy, in or out of Clinical Trials: Who Provides the Information and How Is It Received. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71358-2] [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: 11/29/2022]
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Diamanti O, Giacobbo M, Grosso D, Galtarossa N, Zanocco M, Padovan M. 4273 POSTER The Nurse as a Source of Information in the Management of Side Effects of Chemotherapy. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)71439-3] [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: 10/17/2022]
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Abstract
When dealing with Neuropsychiatric Systemic Lupus Erythematosus (NPSLE) there are still many controversial topics. In 1999 the American College of Rheumatology gave classification criteria for 19 clinical syndromes. However major problems are still related to low specificity of some of them such as headache, cognitive impairment or mood disorders. Even though a frequency of CNS involvement from 14 to 75% has been described, depending on both the population studied and the methodology of assessment, a lower frequency ranging from 21 to 28 % derived by larger case series seems more realistic. The introduction of the concept of "borderline cases", proposed by Italian Study Group for NP-SLE, is based both on clinical and instrumental evaluation and could represent a useful tool when dealing with conditions which do not fulfil ACR classification. Also the relationship between SLE activity and NP involvement is a debated issue. Concerning pathogenesis, it seems reasonable to consider multifactorial mechanisms related to antibody-mediated damage, antiphospholipid pro-thrombotic effect, non-inflammatory vasculopathy and cytokines mediated cytotoxycity. However, direct and unequivocal evidence for the implication of any of the above-mentioned mechanisms is still lacking. Although a wide range of neuroimaging tools have been used to evaluate CNS involvement, no single technique has proven to be definitive and, when dealing with a patient with suspected NPSLE, it is important to combine different diagnostic techniques. Due to the lack of effective imaging along with limitation in knowledge of underlying pathogenetic mechanisms and paucity of histopathologic findings, therapeutic approach in NPSLE remains a difficult issue and is currently based on personal experience. Italian Study Group for NP-SLE proposes the creation of a national registry on NPSLE to validate ACR classification criteria. Furthermore, the possibility to collect large series and stratifying them for each of the included neuro-psychiatric syndromes seems a good strategy for planning multicentric controlled therapeutic trials in the near future.
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Affiliation(s)
- M Govoni
- Sezione di Reumatologia, Dip. Medicina Clinica e Sperimentale, Università di Ferrara, Azienda Ospedaliera-Universitaria S. Anna, C.so Giovecca 203 - 44100 Ferrara, Italia.
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Castellino G, Capucci R, Bernardi S, Padovan M, Giacuzzo S, Pivato E, Patella A, Trotta F, Govoni M. Pregnancy in patients with undifferentiated connective tissue disease: a prospective case-control study. Lupus 2011; 20:1305-11. [DOI: 10.1177/0961203311409610] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G Castellino
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - R Capucci
- Department of Obstetrics and Gynecology, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - S Bernardi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - M Padovan
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - S Giacuzzo
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - E Pivato
- Department of Obstetrics and Gynecology, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - A Patella
- Department of Obstetrics and Gynecology, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - F Trotta
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - M Govoni
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Ferrara and Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
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Rizzo R, Hviid TVF, Govoni M, Padovan M, Rubini M, Melchiorri L, Stignani M, Carturan S, Grappa MT, Fotinidi M, Ferretti S, Voss A, Laustrup H, Junker P, Trotta F, Baricordi OR. HLA-G genotype and HLA-G expression in systemic lupus erythematosus: HLA-G as a putative susceptibility gene in systemic lupus erythematosus. ACTA ACUST UNITED AC 2008; 71:520-9. [PMID: 18380776 DOI: 10.1111/j.1399-0039.2008.01037.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease mainly mediated by the deposit of immune complexes and defects in T lymphocytes and antigen-presenting cells along with a high production of T-helper 2 cytokines. A tolerance-inducible function of nonclassical class Ib human leukocyte antigen (HLA)-G molecule in innate and adaptive cellular responses has been reported, suggesting a role in inflammatory diseases. A 14 bp sequence insertion/deletion polymorphism (rs16375) in the 3'-untranslated region of the HLA-G gene has been associated to the stability of HLA-G messenger RNA. The insertion of the 14 bp sequence seems to be associated with lower levels of soluble HLA-G (sHLA-G). The aim of this study was to evaluate the possible association of the presence of the 14 bp sequence (+14 bp) with SLE. We have HLA-G genotyped 200 SLE patients and 451 healthy control subjects (HS; Italian) and analyzed the plasma levels of sHLA-G and interleukin-10 (IL-10) in a subset of SLE patients and healthy subjects (Italian and Danish). A significant increase of the +14 bp HLA-G allele was detected in the Italian SLE patients compared with HS [P = 0.003, OR 1.44 (95% CI 1.13-1.82)]. A significant increased frequency of HLA-G +14/+14 bp and a decreased frequency of HLA-G -14/-14 bp were observed in SLE patients. There median concentration of sHLA-G was significantly lower in the plasma of SLE patients compared with that in the plasma of healthy controls (P < 0.0001). Furthermore, the results confirmed higher concentrations of IL-10-positive plasma in SLE patients. These results support a potential role for HLA-G in the susceptibility of SLE.
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Affiliation(s)
- R Rizzo
- Department of Experimental and Diagnostic Medicine, University of Ferrara, Ferrara, Italy.
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Rubini M, Padovan M, Baricordi O, Fotinidi M, Govoni M, Trotta F. The c.1298A>C polymorphism in the methylenetetrahydrofolate reductase gene is associated with rheumatoid arthritis susceptibility in Italian patients. Clin Exp Rheumatol 2008; 26:163. [PMID: 18328173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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44
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Castellino G, Padovan M, Bortoluzzi A, Borrelli M, Feggi L, Caniatti ML, Trotta F, Govoni M. Single photon emission computed tomography and magnetic resonance imaging evaluation in SLE patients with and without neuropsychiatric involvement. Rheumatology (Oxford) 2007; 47:319-23. [DOI: 10.1093/rheumatology/kem354] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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46
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Castellino G, Govoni M, Padovan M, Colamussi P, Borrelli M, Trotta F. Proton magnetic resonance spectroscopy may predict future brain lesions in SLE patients: a functional multi-imaging approach and follow up. Ann Rheum Dis 2005; 64:1022-7. [PMID: 15640271 PMCID: PMC1755564 DOI: 10.1136/ard.2004.026773] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether single photon emission tomography (SPECT) and magnetic resonance spectroscopy (1H-MRS) can predict the appearance of new lesions in systemic lupus erythematosus (SLE), detectable by magnetic resonance imaging (MRI). METHODS (99)Tc(m)-HMPAO-SPECT, brain MRI, and (1)H-MRS were done in eight women with SLE (mean age 31.8 years; disease duration 5.5 years). NAA/Cho, NAA/Cre, and Cho/Cre ratios were assessed in hypoperfused and normoperfused areas detected by SPECT that were normal on MRI examination. Reference values were obtained in 20 normal healthy controls. In five patients, MRI was repeated four to six years after the first evaluation. RESULTS Mean NAA/Cho and Cho/Cre ratios in hypoperfused and normoperfused frontal areas were, respectively, lower and higher than control. There were no differences in NAA/Cre ratios. Mean Cho/Cre ratios were increased in hypoperfused v normoperfused brain areas (mean (SD): 1.43 (0.27) v 1.00 (0.07); p<0.023). NAA/Cre ratios were not altered (2.18 (0.30) v 1.99 (0.28); p = 0.381). Three of five patients who had a second MRI had new lesions in areas previously abnormal on MRS and SPECT but normal on first MRI. One patient with positive MRI, SPECT, and MRS showed an increase in the number of MRI lesions; one patient with negative MRI, SPECT, and MRS did not show any new lesions. CONCLUSIONS Abnormalities reflecting altered perfusion or neuronal-chemical changes can be demonstrated by functional imaging techniques even in the absence of morphological lesions detectable by MRI. The abnormal areas identified by SPECT and MRS may predict future parenchymal damage.
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Affiliation(s)
- G Castellino
- Sezione di Reumatologia, Dipartimento di Medicina clinica e sperimentale, Università degli Studi di Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy.
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47
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Padovan M, Locaputo A, Rizzo N, Govoni M, Trotta F. [The evaluation of neuropsychiatric lupus erythematosus by functional neuroimaging. Preliminary results]. Reumatismo 2004; 56:24-30. [PMID: 15105906 DOI: 10.4081/reumatismo.2004.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the performance of functional neuro-imaging for describe neurological involvement in Lupus Erithematosus Systemicus. METHODS 20 SLE patients were included into this study (18 females / 2 males). Median age was 40.5 years (range 16 -66 ys), 9 patients with a clear neurological involvement, 7 with aspecific neurological symptoms and 4 were asymptomatics, according to 1999 ACR Classification. All patients were underwent to conventional resonance imaging (RM-FLAIR), RM perfusion ( RM-PWI), RM diffusion (RM-DWI) and cerebral SPECT. The RM techniques was performed using a 1 Tesla "Signa-Horizon" Tomograph by General Electric: The data analysis was performed from two independent neuroradiologist and than trough coordinated evaluation after coregistration of acquired volumes. RESULTS In 11/20 patients (55%) lesions were demonstrated in RM-FLAIR evaluation, more frequent in cases with focal symptoms than in diffuse. RM-PWI was positive in 50% of cases. SPECT analysis was altered in 85 % of patients. In all patients RM-DWI evaluation was negative. 5 of 29 lesional areas (3 patients) showed by SPECT analysis were positive in RM-PWI. None of them was positive in RM-FLAIR study. After coordinated evaluation of RM-FLAIR, SPECT and RM-PWI, 7 findings were considered false positive. 6 Of patients with negative RM-FLAIR were positive in SPECT and 3 in RM-PWI. Only 1 patient was positive in SPECT and RM-PWI. CONCLUSIONS According to the literature, the RM-FLAIR is a very sensitive procedure to describe the lesional charge, especially in patients with focal symptoms. All lesions was considered as stable outcomes due to negativity of RM-DWI analysis. The SPECT is a sensitive technique to individuate cerebral areas of altered perfusion. The coregistration seems to be an helpful method to improve the explanation of uncertain cases. e the sections are prepared for the microscopic analysis of the various histomorphometric parameters.
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Affiliation(s)
- M Padovan
- Cattedra e Unità Operativa di Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Ferrara.
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Govoni M, Castellino G, Padovan M, Borrelli M, Trotta F. Recent advances and future perspective in neuroimaging in neuropsychiatric systemic lupus erythematosus. Lupus 2004; 13:149-58. [PMID: 15119542 DOI: 10.1191/0961203304lu1000rr] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Involvement of the central nervous system (CNS) is one of the most important complications of systemic lupus erythematosus (SLE), occurring in 14-75% of SLE patients. Neurological and psychiatric involvement is mainly manifested as cerebrovascular disease, seizures, cognitive impairment, headaches and psychosis. However, diagnosis of brain involvement in SLE (i.e., neuropsychiatric lupus: NPSLE) as well as understanding of pathogenetic mechanisms still remains a difficult challenge. Although a wide range of neurodiagnostic tools have been used in the last decade to assess CNS involvement, no single technique has proven to be definitive or reliable. Since neurometabolic impairment, neurochemistry and perfusion abnormalities in NPSLE may precede anatomic lesions, new functional techniques such as magnetic resonance spectroscopy, diffusion and perfusion weighted imaging, and magnetization transfer imaging may be useful in order to indentify pathologic changes unrevealed by conventional imaging. So these new diagnostic tools could modify diagnostic and therapeutic approaches to this major unsolved problem, also shedding some light on the physiopathology of CNS disease in SLE.
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Affiliation(s)
- M Govoni
- Cattedra e Unità Operativa di Reumatologia, Università degli Studi di Ferrara, Italy
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Padovan M, Govoni M, Trotta F. [Semeiology of "early arthritis"]. Reumatismo 2003; 55:187-94. [PMID: 14513120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
The main problems related to "early arthritis" are making an accurate diagnosis and predicting the outcome. Clinical evidence strongly suggest that structural damage occur early and that early DMARD treatment improves the long term outcome of disease. Clinical criteria would facilitate early referral of the patients to establish the risk of persistent disease. From the "early arthritis clinics" (E.A.C.) experience has been developed a set of diagnostic criteria characterized by an excellent ability to discriminate, at the first visit, between self-limiting, persistent non-erosive and persistent erosive arthritis. The proposed set consists of 7 criteria: symptom duration (6 weeks - 6 months), morning stiffness of at least 1 hour, arthritis in >/= 3 joints, bilateral compression pain in the metatarsophalangeal joints, IgM-rheumatoid factor positivity, anti-cyclic-citrullinated-peptide antibody positivity and erosions on radiographs of the hands or feet. This approach requests an easy organization to simplify the access to sanitary services and represents an hard challenge both for rheumatologist and health administration.
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Affiliation(s)
- M Padovan
- Cattedra e Unità Operativa di Reumatologia, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Ferrara, Italia.
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Rudan I, Rudan D, Campbell H, Biloglav Z, Urek R, Padovan M, Sibbett L, Janićijević B, Narancić NS, Rudan P. Inbreeding and learning disability in Croatian island isolates. Coll Antropol 2002; 26:421-8. [PMID: 12528265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The aim of this study was to investigate the prevalence of learning disability (LD) in isolate populations with different inbreeding coefficients (F). Prevalence of LD and F were determined in 10 villages from five Croatian islands: Brac, Hvar, Korcula, Lastovo and Susak. For the purpose of this study, LD was defined as the inability to attend the public school system. As the elementary schools (grade 1-8) in the place of the study are both public and compulsory, the assessment of child's inability to attend the school is performed at the age of six. This is required by all children in the country based on standard set of tests of cognitive performance defined by the Ministry of Education and Culture of the Republic of Croatia. The average inbreeding coefficients in each village population (F) were estimated in a random sample of 20-30% adults in each of the 10 villages based on 4 ancestral generations and using Wright's path method. Prevalence of LD ranged from 0.43% to 2.47%, and the inbreeding coefficients ranged from 0.8% to 4.9%. The Pearson's correlation coefficient between F and LD prevalence was 0.80 (p < 0.01). Although the relative risk per 5% inbreeding appeared very high (about 10), the absolute risk only increased from 0.18% to 1.77%. The genetic effect of inbreeding (GEI) was approximately 0.69% and the population-attributable fraction 76.6%. A review of the literature and the results of this study lead to a conclusion that a very large number of predominantly recessive genetic factors might mediate the genetic susceptibility to various forms of LD in these populations.
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Affiliation(s)
- I Rudan
- School of Public Health A. Stampar, School of Medicine, University of Zagreb, Zagreb, Croatia
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