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Campagna A, De Benedittis D, Fianchi L, Scalzulli E, Rizzo L, Niscola P, Piccioni AL, Di Veroli A, Mancini S, Villivà N, Martini T, Mohamed S, Carmosino I, Criscuolo M, Fenu S, Aloe Spiriti MA, Buccisano F, Mancini M, Tafuri A, Breccia M, Poloni A, Latagliata R. Myelodysplastic Syndromes with Isolated 20q Deletion: A New Clinical-Biological Entity? J Clin Med 2022; 11:2596. [PMID: 35566719 PMCID: PMC9100998 DOI: 10.3390/jcm11092596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
Aims: To define the peculiar features of patients with the deletion of the chromosome 20 long arm (del20q), data from 69 patients with myelodysplastic syndromes (MDSs) and isolated del20q, followed by the Gruppo Romano-Laziale Sindromi Mielodisplastiche (GROM-L) and Ospedale Torrette of Ancona, were collected and compared with those of 502 MDS patients with normal karyotype (NK-MDS). Results: Compared to the NK-MDS group, patients with del20q at diagnosis were older (p = 0.020) and mainly male (p = 0.006). They also had a higher rate of bone marrow blast < 5% (p = 0.004), a higher proportion of low and int-1 risk according to IPSS score (p = 0.023), and lower median platelet (PLT) count (p < 0.001). To date, in the del20q cohort, 21 patients (30.4%) received no treatment, 42 (61.0%) were treated with erythropoiesis-stimulating agents (ESA), 3 (4.3%) with hypomethylating agents, and 3 (4.3%) with other treatments. Among 34 patients evaluable for response to ESA, 21 (61.7%) achieved stable erythroid response according to IWG 2006 criteria and 13 (38.2%) were resistant. Nine patients (13.0%) progressed to acute myeloid leukaemia (AML) after a median time from diagnosis of 28 months (IR 4.1−51.7). The median overall survival (OS) of the entire cohort was 60.6 months (95% CI 54.7−66.4). the 5-year cumulative OS was 55.9% (95% CI 40.6−71.2). Conclusion: According to our results, we hypothesize that MDSs with isolated del 20q may represent a distinct biological entity, with peculiar clinical and prognostic features. The physio-pathological mechanisms underlying the deletion of the chromosome 20 long arm are still unclear and warrant future molecular analysis.
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Affiliation(s)
- Alessia Campagna
- Hematology, Sant’Andrea Hospital, Sapienza University, 00185 Rome, Italy; (A.C.); (M.A.A.S.); (A.T.)
| | - Daniela De Benedittis
- Hematology, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy; (D.D.B.); (E.S.); (L.R.); (S.M.); (I.C.); (M.M.); (M.B.)
| | - Luana Fianchi
- Hematology, Policlinico Gemelli, University of Sacred Heart, 00168 Rome, Italy; (L.F.); (M.C.)
| | - Emilia Scalzulli
- Hematology, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy; (D.D.B.); (E.S.); (L.R.); (S.M.); (I.C.); (M.M.); (M.B.)
| | - Lorenzo Rizzo
- Hematology, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy; (D.D.B.); (E.S.); (L.R.); (S.M.); (I.C.); (M.M.); (M.B.)
| | | | | | | | | | | | - Tiziano Martini
- AOU Ospedali Riuniti, Università Politecnica Marche, 60126 Ancona, Italy; (T.M.); (A.P.)
| | - Sara Mohamed
- Hematology, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy; (D.D.B.); (E.S.); (L.R.); (S.M.); (I.C.); (M.M.); (M.B.)
| | - Ida Carmosino
- Hematology, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy; (D.D.B.); (E.S.); (L.R.); (S.M.); (I.C.); (M.M.); (M.B.)
| | - Marianna Criscuolo
- Hematology, Policlinico Gemelli, University of Sacred Heart, 00168 Rome, Italy; (L.F.); (M.C.)
| | - Susanna Fenu
- Hematology, San Giovanni Hospital, 00184 Rome, Italy; (A.L.P.); (S.F.)
| | | | | | - Marco Mancini
- Hematology, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy; (D.D.B.); (E.S.); (L.R.); (S.M.); (I.C.); (M.M.); (M.B.)
| | - Agostino Tafuri
- Hematology, Sant’Andrea Hospital, Sapienza University, 00185 Rome, Italy; (A.C.); (M.A.A.S.); (A.T.)
| | - Massimo Breccia
- Hematology, Policlinico Umberto I, Sapienza University, 00185 Rome, Italy; (D.D.B.); (E.S.); (L.R.); (S.M.); (I.C.); (M.M.); (M.B.)
| | - Antonella Poloni
- AOU Ospedali Riuniti, Università Politecnica Marche, 60126 Ancona, Italy; (T.M.); (A.P.)
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Mazzucconi MG, Baldacci E, Latagliata R, Breccia M, Paoloni F, Di Veroli A, Cedrone M, Anaclerico B, Villivà N, Porrini R, Montefusco E, Andriani A, Montanaro M, Scaramucci L, Spadea A, Rago A, Cimino G, Spirito F, Santoro C. Anagrelide in Essential Thrombocythemia (ET): Results from 150 patients over 25 years by the "Ph1-negative Myeloproliferative Neoplasms Latium Group". Eur J Haematol 2020; 105:335-343. [PMID: 32441419 DOI: 10.1111/ejh.13454] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Anagrelide is a drug effective in reducing platelet counts in essential thrombocythemia (ET) and Ph1-negative myeloproliferative neoplasms. The aim of this study was to evaluate the real-life use of anagrelide in patients with ET followed over 25 years at the Haematological Institutes belonging to "Ph1-negative Myeloproliferative Neoplasms Latium Group." PATIENTS AND METHODS Eligibility criteria were diagnosis of ET and treatment with anagrelide. Data were collected through an ad hoc case report form. RESULTS One hundred and fifty patients received anagrelide for a median time of 7.4 years (0.1-23.2). Anagrelide was administered as first-line therapy in 34.7% of patients, as second-line in 52% and as third-line in 13.3%: 85.4% responded to therapy. Sixty-eight/136 evaluable patients reported side effects: palpitations, peripheral vasodilation, anaemia, diarrhoea and gastric distress. Fourteen thrombotic (arterial 10, venous 4) and 51 bleeding events (minor 48, major 3) occurred. Sixteen/150 (10.6%) patients developed secondary myelofibrosis and 3/150 (2%) an acute myeloid leukaemia. CONCLUSIONS In our experience, anagrelide is an effective drug in reducing platelet levels in a high percentage of patients with ET. It is especially addressed to younger people. A careful assessment of the thrombotic risk and monitoring of cardiac function, at diagnosis and during follow-up, is mandatory.
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Affiliation(s)
| | - Ermina Baldacci
- Ematologia, Azienda Ospedaliera Universitaria Policlinico Umberto I, Roma, Italia
| | - Roberto Latagliata
- Ematologia, Azienda Ospedaliera Universitaria Policlinico Umberto I, Roma, Italia
| | - Massimo Breccia
- Ematologia, Azienda Ospedaliera Universitaria Policlinico Umberto I, Roma, Italia
| | | | | | | | | | | | | | | | | | | | | | - Antonio Spadea
- Unità di Ematologia e Trapianto di Midollo Osseo, Istituto Nazionale Tumori Regina Elena, Roma, Italia
| | | | | | | | - Cristina Santoro
- Ematologia, Azienda Ospedaliera Universitaria Policlinico Umberto I, Roma, Italia
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3
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Andriani A, Elli E, Trapè G, Villivà N, Fianchi L, Di Veroli A, Niscola P, Centra A, Anaclerico B, Montanaro G, Martini V, Aroldi A, Carmosino I, Voso MT, Breccia M, Montanaro M, Foà R, Latagliata R. Treatment of Philadelphia‐negative myeloproliferative neoplasms in accelerated/blastic phase with azacytidine. Clinical results and identification of prognostic factors. Hematol Oncol 2019; 37:291-295. [DOI: 10.1002/hon.2635] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 12/19/2022]
Affiliation(s)
| | - Elena Elli
- HematologySan Gerardo Hospital Monza Italy
| | | | | | - Luana Fianchi
- HematologySacred Hearth Catholic University of Rome Milan Italy
| | | | | | | | | | - Guido Montanaro
- Department of HematologySanto Spirito Hospital Pescara Italy
| | | | | | - Ida Carmosino
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto ISapienza University Rome Italy
| | | | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto ISapienza University Rome Italy
| | | | - Roberto Foà
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto ISapienza University Rome Italy
| | - Roberto Latagliata
- Hematology, Department of Translational and Precision Medicine, Policlinico Umberto ISapienza University Rome Italy
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4
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Latagliata R, Montanaro M, Cedrone M, Di Veroli A, Spirito F, Santoro C, Leonetti Crescenzi S, Porrini R, Di Giandomenico J, Villivà N, Spadea A, Rago A, De Gregoris C, Romano A, Anaclerico B, De Muro M, Felici S, Breccia M, Montefusco E, Bagnato A, Cimino G, Majolino I, Mazzucconi MG, Alimena G, Andriani A. High platelet count at diagnosis is a protective factor for thrombosis in patients with essential thrombocythemia. Thromb Res 2017; 156:168-171. [PMID: 28662484 DOI: 10.1016/j.thromres.2017.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 06/13/2017] [Accepted: 06/20/2017] [Indexed: 02/02/2023]
Abstract
To assess the role of platelet (PLT) count for thrombotic complications in Essential Thrombocythemia (ET), 1201 patients followed in 11 Hematological centers in the Latium region were retrospectively evaluated. At multivariate analysis, the following factors at diagnosis were predictive for a worse Thrombosis-free Survival (TFS): the occurrence of previous thrombotic events (p=0.0004), age>60years (p=0.0044), spleen enlargement (p=0.042) and a lower PLT count (p=0.03). Receiver Operating Characteristic (ROC) analyses based on thrombotic events during follow-up identified a baseline platelet count of 944×109/l as the best predictive threshold: thrombotic events were 40/384 (10.4%) in patients with PLT count >944×109/l and 109/817 (13.3%) in patients with PLT count <944×109/l, respectively (p=0.04). Patients with PLT count <944×109/l were older (median age 60.4years. vs 57.1years., p=0.016), had a lower median WBC count (8.8×109/l vs 10.6×109/l, p<0.0001), a higher median Hb level (14.1g/dl vs 13.6g/dl, p<0.0001) and a higher rate of JAK-2-V617F positivity (67.2% vs 41.6%, p<0.0001); no difference was observed as to thrombotic events before diagnosis, spleen enlargement and concomitant Cardiovascular Risk Factors. In conclusion, our results confirm the protective role for thrombosis of an high PLT count at diagnosis. The older age and the higher rate of JAK-2 V617F positivity in the group of patients with a baseline lower PLT count could in part be responsible of this counterintuitive finding.
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Affiliation(s)
- Roberto Latagliata
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy.
| | - Marco Montanaro
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Michele Cedrone
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Ambra Di Veroli
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Francesca Spirito
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Cristina Santoro
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | | | - Raffaele Porrini
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Jonny Di Giandomenico
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Nicoletta Villivà
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Antonio Spadea
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Angela Rago
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Cinzia De Gregoris
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Atelda Romano
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Barbara Anaclerico
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Marianna De Muro
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Stefano Felici
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Massimo Breccia
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Enrico Montefusco
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Antonino Bagnato
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Giuseppe Cimino
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Ignazio Majolino
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | | | - Giuliana Alimena
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
| | - Alessandro Andriani
- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
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- Department of Cellular Biotechnologies and Hematology, University "Sapienza", Rome, Italy
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5
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Santoro C, Sperduti I, Latagliata R, Baldacci E, Anaclerico B, Avvisati G, Breccia M, Buccisano F, Cedrone M, Cimino G, De Gregoris C, De Muro M, Di Veroli A, Leonetti Crescenzi S, Montanaro M, Montefusco E, Porrini R, Rago A, Spadea A, Spirito F, Villivà N, Andriani A, Alimena G, Mazzucconi MG. Role of treatment on the development of secondary malignancies in patients with essential thrombocythemia. Cancer Med 2017; 6:1233-1239. [PMID: 28544749 PMCID: PMC5463060 DOI: 10.1002/cam4.1081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 03/21/2017] [Accepted: 03/30/2017] [Indexed: 01/11/2023] Open
Abstract
Aim of this study is to explore the role of different treatments on the development of secondary malignancies (SMs) in a large cohort of essential thrombocythemia (ET) patients. We report the experience of a regional cooperative group in a real‐life cohort of 1026 patients with ET. We divided our population into five different groups: group 0, no treatment; group 1, hydroxyurea (HU); group 2, alkylating agents (ALK); group 3, ALK + HU sequentially or in combination; and group 4, anagrelide (ANA) and/or α‐interferon (IFN) only. Patients from groups 1, 2, and 3 could also have been treated either with ANA and/or IFN in their medical history, considering these drugs not to have an additional cytotoxic potential. In all, 63 of the 1026 patients (6%) developed 64 SM during the follow‐up, after a median time of 50 months (range: 2–158) from diagnosis. In univariate analysis, a statistically significant difference was found only for gender (P = 0.035) and age (P = 0.0001). In multivariate analysis, a statistically significant difference was maintained for both gender and age (gender HR1.7 [CI 95% 1.037–2.818] P = 0.035; age HR 4.190 [CI 95% 2.308–7.607] P = 0.0001). The impact of different treatments on SMs development was not statistically significant. In our series of 1026 ET patients, diagnosed and followed during a 30‐year period, the different therapies administered, comprising HU and ALK, do not appear to have impacted on the development of SM. A similar rate of SMs was observed also in untreated patients. The only two variables which showed a statistical significance were male gender and age >60 years.
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Affiliation(s)
- Cristina Santoro
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Isabella Sperduti
- Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Roberto Latagliata
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Erminia Baldacci
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | | | | | - Massimo Breccia
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | - Angela Rago
- Hematology, Polo Universitario Pontino, Latina, Italy
| | - Antonio Spadea
- Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Unit, Rome, Italy
| | | | - Nicoletta Villivà
- Hematology, Nuovo Regina Margherita Hospital ASL Roma 1, Rome, Italy
| | | | - Giuliana Alimena
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
| | - Maria Gabriella Mazzucconi
- Hematology, Department of Cellular Biotechnologies and Hematology, Sapienza University of Rome, Rome, Italy
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6
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Buckstein R, Balleari E, Wells R, Santini V, Salvetti C, Allione B, Danise P, Finelli C, Clavio M, Zhu N, Michelle G, Sabloff M, Leitch H, Leber B, Luca M, Latagliata R, Antonietta M, Villivà N, Piccioni A, Buccisano F. MDS-Can-It: A New Validated International ESA-Response Score that Further Refines the Predictive Power of the Nordic Scoring System. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30339-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Andriani A, Latagliata R, Anaclerico B, Spadea A, Rago A, Di Veroli A, Spirito F, Porrini R, De Muro M, Crescenzi Leonetti S, Villivà N, De Gregoris C, Montefusco E, Polverelli N, Santoro C, Breccia M, Cimino G, Majolino I, Mazzucconi MG, Vianelli N, Alimena G, Montanaro M, Palandri F. Spleen enlargement is a risk factor for thrombosis in essential thrombocythemia: Evaluation on 1,297 patients. Am J Hematol 2016; 91:318-21. [PMID: 26748894 DOI: 10.1002/ajh.24269] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 12/31/2022]
Abstract
Spleen enlargement, present in 10-20% of Essential Thrombocythemia (ET) patients at diagnosis, is a feature clinically easy to assess, confirmable by echography with a very low chance of misinterpretation. Nonetheless, the clinical and prognostic role of splenomegaly has been seldom evaluated. From 1979 to 2013, 1297 ET patients retrospectively collected in the database of the Lazio Cooperative Group and Bologna University Hospital were evaluable for spleen enlargement at diagnosis and included in the analysis. On the whole, spleen was enlarged in 172/1297 (13.0%) patients; in most cases (94.8%) splenomegaly was mild (≤5 cm). Patients with splenomegaly were younger, predominantly male, presented higher platelet count and JAK2V617F allele burden and had a lower incidence of concomitant cardiovascular risk factors. At least one thrombotic event during follow-up occurred in 97/1,125 (8.6%) patients without spleen enlargement compared to 27/172 (15.7%) patients with spleen enlargement (P = 0.003). Despite comparable use of cytoreductive/antiplatelet therapies in the two groups, the cumulative risk of thrombosis at 5 years was significantly higher in patients with baseline splenomegaly (9.8% versus 4.4% in patients without splenomegaly, P = 0.012). In multivariate analysis exploring risk factors for thrombosis, splenomegaly retained its negative prognostic role, together with previous thrombosis, leucocyte count and male gender. Baseline splenomegaly seems to be an independent additional risk factor for thrombosis in nonstrictly WHO-defined ET patients. This data could be useful in the real-life clinical management of these patients.
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Affiliation(s)
| | - Roberto Latagliata
- Department of Cellular Biotechnologies and Hematology, University "La Sapienza", Rome
| | | | - Antonio Spadea
- Hematology and Stem Cell Transplantation Unit, Regina Elena National Cancer Institute, Rome
| | - Angela Rago
- Division of Hematology, Polo Universitario Pontino, Latina
| | | | - Francesca Spirito
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliera San Camillo-Forlanini, Rome
| | | | | | | | | | | | | | - Nicola Polverelli
- Institute of Hematology "L. And a. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Italy
| | - Cristina Santoro
- Department of Cellular Biotechnologies and Hematology, University "La Sapienza", Rome
| | - Massimo Breccia
- Department of Cellular Biotechnologies and Hematology, University "La Sapienza", Rome
| | | | - Ignazio Majolino
- Division of Hematology and Bone Marrow Transplantation, Azienda Ospedaliera San Camillo-Forlanini, Rome
| | | | - Nicola Vianelli
- Institute of Hematology "L. And a. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Italy
| | - Giuliana Alimena
- Department of Cellular Biotechnologies and Hematology, University "La Sapienza", Rome
| | | | - Francesca Palandri
- Institute of Hematology "L. And a. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Italy
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8
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Rago A, Latagliata R, Montanaro M, Montefusco E, Andriani A, Crescenzi SL, Mecarocci S, Spirito F, Spadea A, Recine U, Cicconi L, Avvisati G, Cedrone M, Breccia M, Porrini R, Villivà N, De Gregoris C, Alimena G, D'Arcangelo E, Guglielmelli P, Lo-Coco F, Vannucchi A, Cimino G. Hemoglobin levels and circulating blasts are two easily evaluable diagnostic parameters highly predictive of leukemic transformation in primary myelofibrosis. Leuk Res 2015; 39:314-7. [PMID: 25636356 DOI: 10.1016/j.leukres.2015.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/29/2014] [Accepted: 01/02/2015] [Indexed: 01/06/2023]
Abstract
To predict leukemic transformation (LT), we evaluated easily detectable diagnostic parameters in 338 patients with primary myelofibrosis (PMF) followed in the Latium region (Italy) between 1981 and 2010. Forty patients (11.8%) progressed to leukemia, with a resulting 10-year leukemia-free survival (LFS) rates of 72%. Hb (<10g/dL), and circulating blasts (≥1%) were the only two independent prognostic for LT at the multivariate analysis. Two hundred-fifty patients with both the two parameters available were grouped as follows: low risk (none or one factor)=216 patients; high risk (both factors)=31 patients. The median LFS times were 269 and 45 months for the low and high-risk groups, respectively (P<.0001). The LT predictive power of these two parameters was confirmed in an external series of 270 PMF patients from Tuscany, in whom the median LFS was not reached and 61 months for the low and high risk groups, respectively (P<.0001). These results establish anemia and circulating blasts, two easily and universally available parameters, as strong predictors of LT in PMF and may help to improve prognostic stratification of these patients particularly in countries with low resources where more sophisticated molecular testing is unavailable.
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Affiliation(s)
- Angela Rago
- Hematology Unit (2U) ICOT/S, Maria Goretti Hospital, AUSL Latina, Italy
| | - Roberto Latagliata
- Department of Cellular Biotechnology and Hematology, University of Rome "Sapienza", Italy
| | | | | | | | | | - Sergio Mecarocci
- Hematology Unit (2U) ICOT/S, Maria Goretti Hospital, AUSL Latina, Italy
| | | | - Antonio Spadea
- Department of Hematology, Regina Elena National Cancer Institute, Rome, Italy
| | - Umberto Recine
- Department of Hematology, S. Spirito Hospital, Rome, Italy
| | - Laura Cicconi
- Department of Biomedicine and Prevention, University "Tor Vergata", Rome, Italy
| | - Giuseppe Avvisati
- Hematology, Stem Cell Transplantation, Transfusion Medicine and Cellular Therapy Unit, University "Campus Bio-Medico" of Rome, Italy
| | - Michele Cedrone
- Department of Hematology, S. Giovanni Addolorata Hospital, Rome, Italy
| | - Massimo Breccia
- Department of Cellular Biotechnology and Hematology, University of Rome "Sapienza", Italy
| | | | - Nicoletta Villivà
- Department of Hematology, "Nuovo Regina Margherita" Hospital, Rome, Italy
| | | | - Giuliana Alimena
- Department of Cellular Biotechnology and Hematology, University of Rome "Sapienza", Italy
| | - Enzo D'Arcangelo
- Department of Statistic Science, University of Rome "Sapienza", Italy
| | - Paola Guglielmelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Lo-Coco
- Department of Biomedicine and Prevention, University "Tor Vergata", Rome, Italy; Laboratory of Neuro-Oncohematology, Santa Lucia Foundation, Rome, Italy
| | - Alessandro Vannucchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Cimino
- Hematology Unit (2U) ICOT/S, Maria Goretti Hospital, AUSL Latina, Italy; Department of Cellular Biotechnology and Hematology, University of Rome "Sapienza", Italy.
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9
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Montanaro M, Latagliata R, Cedrone M, Spadea A, Rago A, Di Giandomenico J, Spirito F, Porrini R, De Muro M, Leonetti SC, Villivà N, De Gregoris C, Breccia M, Montefusco E, Santoro C, Cimino G, Majolino I, Mazzucconi MG, Alimena G, Andriani A. Thrombosis and survival in essential thrombocythemia: a regional study of 1,144 patients. Am J Hematol 2014; 89:542-6. [PMID: 24481665 DOI: 10.1002/ajh.23685] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 01/26/2014] [Accepted: 01/27/2014] [Indexed: 01/21/2023]
Abstract
To identify prognostic factors affecting thrombosis-free survival (TFS) and overall survival (OS), we report the experience of a Regional cooperative group in a real-life cohort of 1,144 patients with essential thrombocythemia (ET) diagnosed from January 1979 to December 2010. There were 107 thrombotic events (9.4%) during follow-up [60 (5.3%) arterial and 47 (4.1%) venous thromboses]. At univariate analysis, risk factors for a shorter TFS were: age >60 years (P < 0.0054, 95% CI 1.18-2.6), previous thrombosis (P < 0.0001, 95% CI 1.58-4.52) and the presence of at least one cardiovascular risk factor (P = 0.036, 95% CI 1.15-3.13). Patients with a previous thrombosis occurred ≥24 months before ET diagnosis had a shorter TFS compared to patients with a previous thrombosis occurred <24 months (P = 0.0029, 95% CI 1.5-6.1); furthermore, patients with previous thrombosis occurred <24 months did not show a shorter TFS compared with patients without previous thrombosis (P = 0.303, 95% CI 0.64-3.21). At multivariate analysis for TFS, only the occurrence of a previous thrombosis maintained its prognostic impact (P = 0.0004, 95% CI 1.48-3.79, RR 2.36). The 10-year OS was 89.9% (95% CI 87.3-92.5): at multivariate analysis for OS, age >60 years (P < 0.0001), anemia (P < 0.0001), male gender (P = 0.0019), previous thromboses (P = 0.0344), and white blood cell >15 × 10(9) /l (P = 0.0370) were independent risk factors. Previous thrombotic events in ET patients are crucial for TFS but their importance seems related not to the occurrence per se but mainly to the interval between the event and the diagnosis.
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Affiliation(s)
| | - Roberto Latagliata
- Department of Cellular Biotechnologies and Hematology; University “La Sapienza,”; Rome Italy
| | - Michele Cedrone
- Department of Hematology; San Giovanni Hospital,; Rome Italy
| | - Antonio Spadea
- Unit of Hematology; Regina Elena National Cancer Institute; Rome Italy
| | - Angela Rago
- Department of Hematology; Polo Universitario Pontino; Latina Italy
| | | | | | | | - Marianna De Muro
- Department of Hematology; University “Campus Biomedico,”; Rome Italy
| | | | - Nicoletta Villivà
- Department of Hematology; Nuovo Regina Margherita Hospital; Rome Italy
| | | | - Massimo Breccia
- Department of Cellular Biotechnologies and Hematology; University “La Sapienza,”; Rome Italy
| | | | - Cristina Santoro
- Department of Cellular Biotechnologies and Hematology; University “La Sapienza,”; Rome Italy
| | - Giuseppe Cimino
- Department of Hematology; Polo Universitario Pontino; Latina Italy
| | | | | | - Giuliana Alimena
- Department of Cellular Biotechnologies and Hematology; University “La Sapienza,”; Rome Italy
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10
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Felici S, Villivà N, Balsamo G, Andriani A. Efficacy of lenalidomide in association with cyclophosphamide and dexamethasone in multiple myeloma patient with bilateral retro-orbital localisation. Ecancermedicalscience 2013; 7:331. [PMID: 24723969 PMCID: PMC3965188 DOI: 10.3332/ecancer.2013.331] [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] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Indexed: 12/19/2022] Open
Abstract
Extramedullary localisation is an uncommon manifestation in multiple myeloma (MM). Ocular involvement is rare. Here, we describe a relapse of MM with bilateral retro-orbital localisation without any bone involvement with good and rapid response to therapy with lenalidomide, dexamethasone, and cyclophosphamide.
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Affiliation(s)
- S Felici
- Haematology Unit, Nuovo Regina Margherita, Hospital, 00153 Rome, Italy
| | - N Villivà
- Haematology Unit, Nuovo Regina Margherita, Hospital, 00153 Rome, Italy
| | - G Balsamo
- Histopathology Complex Unit, Santo Spirito Hospital, 00193 Rome, Italy
| | - A Andriani
- Haematology Unit, Nuovo Regina Margherita, Hospital, 00153 Rome, Italy
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11
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Za T, De Stefano V, Rossi E, Petrucci MT, Andriani A, Annino L, Cimino G, Caravita T, Pisani F, Ciminello A, Torelli F, Villivà N, Bongarzoni V, Rago A, Betti S, Levi A, Felici S, Gentilini F, Calabrese E, Leone G. Arterial and venous thrombosis in patients with monoclonal gammopathy of undetermined significance: incidence and risk factors in a cohort of 1491 patients. Br J Haematol 2012; 160:673-9. [PMID: 23240810 DOI: 10.1111/bjh.12168] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 11/05/2012] [Indexed: 12/21/2022]
Abstract
Monoclonal gammopathy of undetermined significance (MGUS) has been associated with an increased risk of thrombosis. We carried out a retrospective multicentre cohort study on 1491 patients with MGUS. In 49 patients (3.3%) MGUS was diagnosed after a thrombotic event. Follow-up details for a period of at least 12 months after diagnosis of MGUS were obtained in 1238 patients who had no recent history of thrombosis (<2 years) prior to diagnosis, for a total of 7334 years. During the follow-up, 33 of 1238 patients (2.7%) experienced thrombosis, with an incidence of 2.5 arterial events and 1.9 venous events per 1000 patient-years. Multivariate analysis showed increased risks of arterial thrombosis in patients with cardiovascular risk factors [hazard ratio (HR) 4.92, 95%confidence interval (CI) 1.42-17.04], and of venous thrombosis in patients with a serum monoclonal (M)-protein level >16 g/l at diagnosis (HR 3.08, 95%CI 1.01-9.36). No thrombosis was recorded in patients who developed multiple myeloma (n = 50) or other neoplastic diseases (n = 21). The incidence of arterial or venous thrombosis in patients with MGUS did not increase relative to that reported in the general population for similarly aged members. Finally, the risk of venous thrombosis did increase when the M-protein concentration exceeded >16 g/l.
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Affiliation(s)
- Tommaso Za
- Institute of Haematology, Catholic University, Rome, Italy
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12
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Andriani A, Petrucci MT, Caravita T, Montanaro M, Villivà N, Levi A, Siniscalchi A, Bongarzoni V, Pisani F, De Muro M, Coppetelli U, Avvisati G, Zullo A, Agrillo A, Gaglioti D. Evolution of bisphosphonate-related osteonecrosis of the jaw in patients with multiple myeloma and Waldenstrom's macroglobulinemia: a retrospective multicentric study. Blood Cancer J 2012; 2:e62. [PMID: 22829257 PMCID: PMC3317527 DOI: 10.1038/bcj.2012.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 09/13/2011] [Accepted: 09/28/2011] [Indexed: 02/05/2023] Open
Abstract
Bisphosphonates (BPs) are used intravenously to treat cancer-related conditions for the prevention of pathological fractures. Osteonecrosis of the jaw (BRONJ) is a rare complication reported in 4-15% of patients. We studied, retrospectively, 55 patients with multiple myeloma or Waldenstrom's macroglobulinemia followed up from different haematological departments who developed BRONJ. All patients were treated with BPs for bone lesions and/or fractures. The most common trigger for BRONJ was dental alveolar surgery. After a median observation of 26 months, no death caused by BRONJ complication was reported. In all, 51 patients were treated with antibiotic therapy, and in 6 patients, this was performed in association with surgical debridement of necrotic bone, in 16 with hyperbaric O(2) therapy/ozonotherapy and curettage and in 12 with sequestrectomy and O(2)/hyperbaric therapy. Complete response was observed in 20 cases, partial response in 21, unchanged in 9 and worsening in 3. The association of surgical treatment with antibiotic therapy seems to be more effective in eradicating the necrotic bone than antibiotic treatment alone. O(2) hyperbaric/ozonotherapy is a very effective treatment. The cumulative dosage of BPs is important for the evolution of BRONJ. Because the most common trigger for BRONJ was dental extractions, all patients, before BP treatment, must achieve an optimal periodontal health.
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Affiliation(s)
- A Andriani
- Haematology Unit, P.T.P. Nuovo Regina Margherita, Rome, Italy
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13
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Latagliata R, Spadea A, Cedrone M, Di Giandomenico J, De Muro M, Villivà N, Breccia M, Anaclerico B, Porrini R, Spirito F, Rago A, Avvisati G, Alimena G, Montanaro M, Andriani A. Symptomatic mucocutaneous toxicity of hydroxyurea in Philadelphia chromosome-negative myeloproliferative neoplasms: the Mister Hyde face of a safe drug. Cancer 2011; 118:404-9. [PMID: 21692060 DOI: 10.1002/cncr.26194] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 02/28/2011] [Accepted: 03/08/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND The current study was conducted to evaluate severe mucocutaneous toxicity during treatment with hydroxyurea (HU) in a large cohort of patients with Philadelphia chromosome-negative myeloproliferative neoplasms (MPN). METHODS Among 993 consecutive patients newly diagnosed with MPN at 4 centers in Rome between January 1980 and December 2009, 614 patients (277 men and 337 women with a median age of 64.4 years [interquartile range (IR), 54.4 years-72.7 years]) received HU. HU was administered as first-line treatment in 523 patients (85.2%) and as ≥ second-line treatment in 91 patients (14.8%). RESULTS Mucocutaneous toxicity was reported in 51 patients (8.3%) after a median period from the initiation of HU treatment of 32.1 months (IR, 10.5 months-74.6 months) and a mean HU dose of 1085 mg (± 390 mg); 30 patients (58.8%) developed a painful ulcerative skin toxicity, mainly located in the perimalleolar area; 11 patients (21.6%) had oral aphthous ulcers; and 10 patients (19.6%) developed a nonulcerative skin toxicity with erythema and skin infiltration. After the mucocutaneous toxicity occurred, HU treatment was continued at the same dose in 5 patients (9.8%), reduced in 12 patients (23.5%), and temporarily discontinued in 7 patients (13.7%); the remaining 27 patients (52.9%) required a permanent drug discontinuation. After a median period of 4.3 months (IR, 2.4 months-9.0 months) from the onset of the skin toxicity, 39 patients (76.5%) had a complete resolution and 12 patients (23.5%) had improvement without complete resolution. CONCLUSIONS Mucocutaneous toxicity during HU treatment is more common than expected and may present with different clinical features. Moreover, it often requires a permanent drug discontinuation and only a partial resolution is reported to occur in approximately 25% of patients.
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Affiliation(s)
- Roberto Latagliata
- Department of Cellular Biotechnologies and Hematology, La Sapienza University, Rome, Italy.
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14
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Zinzani PL, Pulsoni A, Gentilini P, Visani G, Perrotti A, Molinari AL, Guardigni L, Tani M, Villivà N, Stefoni V, Alinari L, Martelli M, Bonifazi F, Pileri S, Tura S, Baccarani M. Effectiveness of Fludarabine, Idarubicin and Cyclophosphamide (FLUIC) Combination Regimen for Young Patients with Untreated Non-Follicular Low-Grade Non-Hodgkin's Lymphoma. Leuk Lymphoma 2009; 45:1815-9. [PMID: 15223641 DOI: 10.1080/1042819042000219502] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the last years, fludarabine (FLU) alone or in combination with other drugs has been reported to be effective in the treatment of previously untreated low-grade non-Hodgkin's lymphomas (LG-NHL). We report on the therapeutic efficacy and toxicity of a combination of FLU, idarubicin and cyclophosphamide (FLUIC regimen) in untreated non-follicular LG-NHL. We administered a three-drug combination of FLU (25 mg/m2 i.v. on days 1 to 3), idarubicin (14 mg/m2 i.v. on day 1) and cyclophosphamide (200 mg/m2 i.v. on days 1 to 3) to treat 41 young, previously untreated patients with non-follicular LG-NHL. Chemotherapy was repeated every 4 weeks for a total of 6 cycles. Among 41 patients, 24 (59%) were diagnosed with small lymphocytic, 10 (24%) with immnocytoma, and 7 (17%) with marginal zone subtypes. Nineteen (46%) patients achieved complete response (CR) and 21 (51%) partial response, while the remaining 1 (3%) showed no benefit from the treatment. With respect to histology, we observed CR rates of 38% for the small lymphocytic subtype, 40% for the immunocytoma subtype, and 86% for the marginal zone subtype. Estimated 42-month overall survival and relapse-free survival rates were 64% and 100%, respectively. Hematologic grade 3-4 toxicity was seen in 9 (22%) patients; no opportunistic infection or death was associated with administration of the FLUIC regimen. These preliminary data suggest that FLUIC is a very active, well-tolerated regimen for young, untreated patients with advanced non-follicular LG-NHL.
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Affiliation(s)
- Pier Luigi Zinzani
- Institute of Hematology and Medical Oncology "Seràgnoli", University of Bologna, Bologna, Italy.
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15
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Pulsoni A, Villivà N, Cavalieri E, Falcucci P, La Verde G, Matera R, Petrucci MT, Tosti ME, Mandelli F. Continuous low dose of melphalan and prednisone in patients with multiple myeloma of very old age or severe associated disease. Drugs Aging 2003; 19:947-53. [PMID: 12495369 DOI: 10.2165/00002512-200219120-00005] [Citation(s) in RCA: 2] [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: 11/02/2022]
Abstract
INTRODUCTION AND OBJECTIVE The management of elderly patients with multiple myeloma is a relevant problem because it concerns a great number of patients. Patients with multiple myeloma who are very old or who have severe associated diseases have a dismal outcome. For these patients we retrospectively evaluated the effect of a mild approach with continuous low-dose melphalan and prednisone (cMP). DESIGN AND METHODS 109 patients with multiple myeloma, observed between 1985 and 2000, were treated with cMP; 67 were treated at time of diagnosis (group A; median age 78 years) and 42 as a second or subsequent line of therapy (group B; median age 72 years). The toxicity of the treatment was compared with a control group of 29 patients aged over 70 years, treated in the same institution with the conventional cyclical melphalan/prednisone regimen. RESULTS Major or minor responses were obtained in 32% of patients in group A and 13% of patients in group B. Disease was stabilised in 45% of group A and 47% of group B and progressed in 5 and 18%, respectively. Median survival was, respectively, 19 and 24 months in group A and B. Among the 42 patients who received cMP as a second-line therapy (group B), 36 (86%) had previously been treated according to the standard cyclical melphalan/prednisone schedule; of these 12 (33%) obtained a better M protein reduction after cMP compared with the previous response to first-line cyclical melphalan/prednisone. The cMP schedule was generally well tolerated, and the rate of haematological toxicity was lower than for a historical control group receiving cyclical melphalan/prednisone. CONCLUSION The cMP treatment schedule is well tolerated and results in a high proportion of patients with stable disease, with acceptable survival even in patients with advanced disease.
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Affiliation(s)
- Alessandro Pulsoni
- Department of Cellular Biotechnology and Hematology, La Sapienza University, Rome, Italy.
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16
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Pulsoni A, Anghel G, Falcucci P, Matera R, Pescarmona E, Ribersani M, Villivà N, Mandelli F. Treatment of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): report of a case and literature review. Am J Hematol 2002; 69:67-71. [PMID: 11835335 DOI: 10.1002/ajh.10008] [Citation(s) in RCA: 234] [Impact Index Per Article: 10.6] [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: 11/06/2022]
Abstract
Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare disorder of unknown etiology, usually associated with lymph node enlargement in various superficial or deep sites. It usually shows a prolonged clinical course with occasional exacerbation and remission phases. We describe the long-term follow-up of a case of SHML that showed typical clinical features and in which various therapeutic strategies were attempted. Chemotherapy and alpha-interferon (IFN) were ineffective; surgery was ultimately required with satisfactory results. From an extensive literature review we found different treatment strategies in SHML in the 80 cases published between 1969 and 2000. Spontaneous resolution of adenopathies is frequently observed: 32 out of 40 cases which did not receive chemotherapy, radiotherapy, or surgery were healthy at the time of publication. Radiotherapy alone showed conflicting results: 3 complete remissions (CR) were obtained in the 9 patients treated. Surgical debulking when required was effective--8/9 CR--while chemotherapy showed generally negative results. IFN has been previously employed in only one case. In conclusion, clinical observation without treatment is advisable when possible. In the presence of vital organ compression and/or extranodal localization with important clinical signs, surgical debulking may be necessary. Radiotherapy has shown limited efficacy, while chemotherapy is in general ineffective. More experience is needed to evaluate the role of IFN.
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Affiliation(s)
- Alessandro Pulsoni
- Department of Cellular Biotechnology and Hematology, La Sapienza University, Rome, Italy.
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