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Marra JD, Galli E, Giammarco S, Chiusolo P, Metafuni E, Sora F, Laurenti L, Innocenti I, Autore F, Limongiello MA, Fresa A, Bacigalupo A, Sica S. Effect of HLA mismatch on post-transplant infections in allogeneic hematopoietic stem cell transplantation with PTCy-based GvHD prophylaxis. Bone Marrow Transplant 2023; 58:1042-1044. [PMID: 37280430 DOI: 10.1038/s41409-023-02010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 06/08/2023]
Affiliation(s)
- J D Marra
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy.
| | - E Galli
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - S Giammarco
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - P Chiusolo
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - E Metafuni
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - F Sora
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - L Laurenti
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - I Innocenti
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - F Autore
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - M A Limongiello
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - A Fresa
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - A Bacigalupo
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - S Sica
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Roma, Italy
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
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Giammarco S, Bellesi S, Metafuni E, Rossi M, Minnella G, Bacigalupo A, Sica S, Chiusolo P. Cord blood resilience in a patient with relapsing Ph + B lymphoblastic acute leukemia after hematopoietic stem cell transplantation. Ann Hematol 2022; 101:2565-2566. [PMID: 35994061 DOI: 10.1007/s00277-022-04962-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/17/2022] [Indexed: 11/01/2022]
Affiliation(s)
- S Giammarco
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - S Bellesi
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - E Metafuni
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - M Rossi
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - G Minnella
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - A Bacigalupo
- Sezione Di Ematologia, Dipartimento Di Scienze Radiologiche Ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Sica
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy. .,Sezione Di Ematologia, Dipartimento Di Scienze Radiologiche Ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - P Chiusolo
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.,Sezione Di Ematologia, Dipartimento Di Scienze Radiologiche Ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
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Chiusolo P, Marchetti C, Rossi M, Minnella G, Salutari V, Fagotti A, Di Stefano M, Giammarco S, Metafuni E, Fianchi L, Scambia G, Sica S. Topic: AS04-MDS Biology and Pathogenesis/AS04d-Somatic mutations. Leuk Res 2021. [DOI: 10.1016/j.leukres.2021.106681.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Tshomba Y, Sica S, Minelli F, Giovannini S, Murri R, De Nigris F, Codispoti FA, Sticchi D, Tinelli G. Management of mycotic aorto-iliac aneurysms: a 30-year monocentric experience. Eur Rev Med Pharmacol Sci 2021; 24:3274-3281. [PMID: 32271445 DOI: 10.26355/eurrev_202003_20695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This study aims to analyze the early and late outcomes of our 30-year experience with mycotic aneurysms of the abdominal aorta and iliac arteries. PATIENTS AND METHODS This retrospective cohort study compared the outcomes of all the patients with mycotic aneurysm, by analyzing prospectively collected data between September 1989 and October 2019 from the Unit of Vascular Surgery of Fondazione Policlinico Universitario Gemelli - IRCCS in Rome, Italy. RESULTS Twenty-three patients with mycotic aneurysm were included. Twenty-two patients underwent surgery; one patient arrived at the emergency room with unstable clinical conditions and died before being treated. Fourteen cases (60.9%) were located at the infrarenal aorta, while three cases (13.0%) were pararenal aortic aneurysms. Six cases (26.1%) had an iliac arteries localization. Seventeen patients (77.3%) underwent open surgical repair aneurysmectomy with in situ reconstruction, while three cases (13.6%) underwent extra-anatomic revascularization. Three patients (13.6%) underwent the placement of an endoprosthesis, of whom two underwent hybrid procedures, and one EVAR. The latter underwent an early conversion to open repair due to a type I endoleak. The mean length of hospital stay was 35 ± 18.7 days. Five patients (22.7%) died in the immediate postoperative period. In the follow-up of 45.5 ± 41.3 months (range 2-156), we documented six deaths (35.3%), of whom two (11.8%) were aortic-related for a 34.8% overall aortic-related mortality. Eleven patients were alive, with an overall survival of 47.8%. CONCLUSIONS Mycotic aneurysm is an extremely rare and varied pathology. Open surgical repair showed to be a safe approach because of a complete and aggressive debridement of local infected tissues, with an acceptable long-term mortality rate.
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Affiliation(s)
- Y Tshomba
- Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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Tinelli G, Ferrer C, Giudice R, Ferraresi M, Pogany G, Cao P, Tshomba Y, Montenegro C, De Nigris F, Minelli F, Sica S, Coscarella C. Long-term results of hybrid repair techniques for Kommerell's diverticulum. J Vasc Surg 2020; 72:1213-1221. [DOI: 10.1016/j.jvs.2019.11.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 11/26/2019] [Indexed: 12/17/2022]
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Piredda M, Biagioli V, Gargiulo G, Annibali O, Tirindelli M, Pignatelli A, Marchesi F, Mauroni M, Soave S, Del Giudice E, Ponticelli E, Clari M, Cavallero S, Monni P, Ottani L, Sica S, Cioce M, Cappucciati L, Alvaro R, De Marinis M. Factors influencing the level of emotional support from nurses perceived by patients undergoing haematopoietic stem cell transplantation in protective isolation. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz275.011] [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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Röth A, Nagy Z, Peffault de Latour R, Ninomya H, Panse J, Yoon S, Egyed M, Ichikawa S, Ito Y, Seok Kim J, Schrezenmeier H, Sica S, Usuki K, Sostelly A, Higginson J, Dieckmann A, Anzures-Cabreras J, Shinomiya K, Klughammer B, Jahreis A, Bucher C, Nishimura J. PF348 LONG TERM FOLLOW-UP OF PNH PATIENTS TREATED WITH THE SMART ANTI-HC5 ANTIBODY (SKY59/RO7112689) IN THE OPEN LABEL EXTENSION (OLE) OF THE COMPOSER TRIAL. Hemasphere 2019. [DOI: 10.1097/01.hs9.0000559604.06488.14] [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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Abstract
A case of acute monocytic leukemia with an apparent isolated skin relapse is reported. The cutaneous involvement was associated with a morphological bone marrow remission but a cytogenetic relapse was present. Regression of the skin lesions was obtained with a protocol including daunoblastine, aracytin and thioguanine, but the patient relapsed and died a few months later without achieving another remission. The relation between cutaneous and medullary disease is discussed.
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Affiliation(s)
- L Pagano
- Istituto di Semeiotica Medica, Università Cattolica del Sacro Cuore, Roma, Italy
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Menichella G, Pierelli L, Vittori M, Serafini R, Foddai M, Rossi P, Leone G, Sica S, Scambia G, Panici PB, Bizzi B. Five-year Experience in PBSC Collection: Results of the Catholic University of Rome. Int J Artif Organs 2018. [DOI: 10.1177/039139889301605s08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several authors have reported a faster immunological and hemopoietic post- transplant reconstitution using autologous peripheral blood stem cell (PBSC) than using autologous bone marrow stem cells. A large number of PBSC can be collected by leukapheresis during the hematological recovery after induction or salvage chemotherapy. In our experience we demonstrated that several separators, even if they have different results in mononuclear cell (MNC) yields, red blood cell and platelet contaminations, are able to collect PBSC for autotransplantation in patients with several malignant diseases and different status of disease. Eighty three patients were submitted to 590 leukapheresis procedures using 4 different blood cell separators: the results showed that all employed protocols are efficient in the collection of peripheral MNC even if after the widespread use of granulocytecolony stimulating factor (G-CSF) in the harvesting phase, the blood cell separator efficiency in terms of MNC is reduced. The use of GCSF in combination with other growth factors, during chemotherapy mobilization could simplify, in the future, this therapeutical program even if improvements in the efficiency of PBSC collection protocols are required.
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Affiliation(s)
- G. Menichella
- Research Center for the Manipulation of Blood Components, “Sacro Cuore” Catholic University, Roma - Italy
| | - L. Pierelli
- Research Center for the Manipulation of Blood Components, “Sacro Cuore” Catholic University, Roma - Italy
| | - M. Vittori
- Research Center for the Manipulation of Blood Components, “Sacro Cuore” Catholic University, Roma - Italy
| | - R. Serafini
- Research Center for the Manipulation of Blood Components, “Sacro Cuore” Catholic University, Roma - Italy
| | - M.L. Foddai
- Department of Hematology, “Sacro Cuore” Catholic University, Roma - Italy
| | - P.L. Rossi
- Research Center for the Manipulation of Blood Components, “Sacro Cuore” Catholic University, Roma - Italy
| | - G. Leone
- Department of Hematology, “Sacro Cuore” Catholic University, Roma - Italy
| | - S. Sica
- Department of Hematology, “Sacro Cuore” Catholic University, Roma - Italy
| | - G. Scambia
- Department of Ostetricia and Gynecology, “Sacro Cuore” Catholic University, Roma - Italy
| | - P.L. Benedetti Panici
- Department of Ostetricia and Gynecology, “Sacro Cuore” Catholic University, Roma - Italy
| | - B. Bizzi
- Department of Hematology, “Sacro Cuore” Catholic University, Roma - Italy
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Alberelli M, Innocenti I, Autore F, Sica S, Laurenti L, De Candia E. Clinical and laboratory characterization of platelet dysfunction caused by ibrutinib treatment in patients with chronic lymphocytic leukemia. Thromb Res 2018. [DOI: 10.1016/j.thromres.2018.02.026] [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: 11/16/2022]
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Menichella G, Lai M, Serafini R, Pierelli L, Vittori M, Ciarli M, Rumi C, Puggioni P, Scambia G, Sica S, Leone G. Large Volume Leukapheresis for Collecting Hemopoietic Progenitors: Role of CD 34+ Precount in Predicting Successful Collection. Int J Artif Organs 2018. [DOI: 10.1177/039139889902200508] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this work we evaluated the efficacy of stem cell collection with Large Volume Procedures. (LVP), and analysed the importance of the CD34+ cell precount in promoting the collection of a sufficient number of CD34+ cells for transplantation, using the Univariate Logistic Regression analysis. Eighty-nine leukapheresis were performed in 49 patients with hematological malignancies and solid tumors, mobilized with chemotherapy plus Granulocyte Colony Stimulating Factor (G-CSF). For each procedure 15.8 liters of blood were processed. The median value of Nucleated Cells (NC) and CD34+ cells precount was respectively 8.29 × 109/ml (range 1.13÷45.4) and 43.08 × 103/ml (range 1.06÷795.2). Results show the capability of LVP to collect large quantities of hemopoietic progenitors with a median CD34+ cell total yield of 215.02 × 106 (range 5.03÷2210). The yields per patients’ body weight were: CD34+ cells 3.23 × 106/kg (range 0.081÷41.58). The regression analysis between blood cell precounts and collection yields gave the following correlations: the CD34+ cell precount correlates with CD34+ yield (r = 0.78 p < 0.00) and with CD34+ cell yield/kg (r = 0.76 p < 0.00). The number of CD34+ cells processed correlated with the number of CD34+ cells collected/kg (r = 0.83 p < 0.000). To investigate the importance of CD 34+ cell precount in promoting CD34+ cell yields ≥2.5 × 106/kg we performed a Univariate Logistic Regression analysis that showed in our patients a probability of collecting ≥2.5 × 106 CD34+/kg that rose from 0.6 to 0.95 for CD 34+ precounts that oscillated from 30 to 40 × 103 CD34+ cells/ml, respectively. The Univariate Logistic Regression gave a probability of collecting ≥2.5 × 106 CD34+ cells/kg that oscillated between 0.64÷0.98 for values of CD34+ cells processed from 6 × 106/kg to 8 × 106/kg, p <0.000. Sixty-three percent of patients reached the target dose of 2.5 × 106 CD34+ cells/kg with only one LVP. Until now 12 patients have been transplanted and all have had a prompt and complete lasting recovery. These results confirm the efficacy of LVP in harvesting hemopoietic progenitors and their ability in reconstituting hemopoiesis of transplanted patients, enabling the estimation of CD34+ precounts and CD34+ cells processed values, highly predictive for the collection of ≥2.5 × 106 CD34+ cells/kg. Furthermore, the Logistic Model suggests that the best strategy to plan a successful CD34+ cell collection procedure is to identify for each patient the amount of CD34+ cells/kg to be processed rather than the fixed processing of 3÷5 blood volumes in all patients.
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Affiliation(s)
| | - M. Lai
- Hematology, Catholic University, Roma - Italy
| | - R. Serafini
- Hematology, Catholic University, Roma - Italy
| | - L. Pierelli
- Hematology, Catholic University, Roma - Italy
| | - M. Vittori
- Hematology, Catholic University, Roma - Italy
| | - M. Ciarli
- Hematology, Catholic University, Roma - Italy
| | - C. Rumi
- Hematology, Catholic University, Roma - Italy
| | - P. Puggioni
- Hematology, Catholic University, Roma - Italy
| | - G. Scambia
- Obstetrics and Gynecology Institute, Catholic University, Roma - Italy
| | - S. Sica
- Hematology, Catholic University, Roma - Italy
| | - G. Leone
- Hematology, Catholic University, Roma - Italy
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Serafini R, Menichella G, Ciarli M, Pierelli L, Lai M, Paladini U, Cicconi S, Sica S, La Barbera EO, Laurenti L, Leone G. The Application of Two Different Blood Cell Separators to Harvest CD34+ Cells in Patients Suffering from Non Hodgkin's Lymphoma. Int J Artif Organs 2018. [DOI: 10.1177/039139889902200809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
From January 1996 until now, thirty-eight PBSC procedures were carried out on 20 patients suffering from NHL, mobilized by polichemotherapy regimens plus recombinant human Granulocyte-Growth Factor (rhG-CSF). Patients were enrolled in PBSC procedures using Dideco Excel (group A) and Cobe Spectra v.4.7 (group B) blood cell separators. Twelve patients were enrolled in group A (6 males and 6 females, median age 33) and 9 patients in group B (5 males and 4 females, median age 55). The mean White Blood Cell (WBC) and Mononuclear Cells Fraction (MNC) peripheral blood counts were not statistically different in either group and neither were blood CD34+ cell peripheral counts. CD34+ cell peripheral value was predictive of the CD34+ yield while mean values of harvested CD34+ cells were not significantly different. CD34+ cell efficiences were statistically the same. The CD34+ cell purity of the apheresis harvest was statistically different between the two groups (group A = 3.0 ± 2.2%; group B = 1 ± 0.9%) p = 0.001. High CD34+ cell yields were observed in both groups which confirms that both blood cell separators are able to harvest hematopoietic progenitor cells from peripheral blood.
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Affiliation(s)
- R. Serafini
- Centro Ricerche per la Manipolazione dei Costituenti Ematici, Roma - Italy
| | - G. Menichella
- Centro Ricerche per la Manipolazione dei Costituenti Ematici, Roma - Italy
| | - M. Ciarli
- Centro Ricerche per la Manipolazione dei Costituenti Ematici, Roma - Italy
| | - L. Pierelli
- Centro Ricerche per la Manipolazione dei Costituenti Ematici, Roma - Italy
| | - M. Lai
- Centro Ricerche per la Manipolazione dei Costituenti Ematici, Roma - Italy
| | - U. Paladini
- Centro Ricerche per la Manipolazione dei Costituenti Ematici, Roma - Italy
| | - S. Cicconi
- Centro Ricerche per la Manipolazione dei Costituenti Ematici, Roma - Italy
| | - S. Sica
- Centro Ricerche per la Manipolazione dei Costituenti Ematici, Roma - Italy
| | - E. Ortu La Barbera
- Divisione di Ematologia, Cattedra di Ematologia, Università Cattolica del S. Cuore, Roma - Italy
| | - L. Laurenti
- Divisione di Ematologia, Cattedra di Ematologia, Università Cattolica del S. Cuore, Roma - Italy
| | - G. Leone
- Divisione di Ematologia, Cattedra di Ematologia, Università Cattolica del S. Cuore, Roma - Italy
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Voso MT, Leone G, Piciocchi A, Fianchi L, Santarone S, Candoni A, Criscuolo M, Masciulli A, Cerqui E, Molteni A, Finelli C, Parma M, Poloni A, Carella AM, Spina F, Cortelezzi A, Salvi F, Alessandrino EP, Rambaldi A, Sica S. Feasibility of allogeneic stem-cell transplantation after azacitidine bridge in higher-risk myelodysplastic syndromes and low blast count acute myeloid leukemia: results of the BMT-AZA prospective study. Ann Oncol 2018; 28:1547-1553. [PMID: 28368509 DOI: 10.1093/annonc/mdx154] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Indexed: 12/25/2022] Open
Abstract
Background Allogeneic stem-cell transplantation (HSCT) is the only curative treatment in myelodysplastic syndromes (MDS). Azacitidine (AZA) is increasingly used prior to HSCT, however in Europe it is only approved for patients who are not eligible for HSCT. Patients and methods We conducted a phase II multicenter study to prospectively evaluate the feasibility of HSCT after treatment with AZA in 70 patients with a myelodysplastic syndrome (MDS), 19 with acute myeloid leukemia (AML), and 8 with chronic myelomonocytic leukemia (CMML). After a median of four cycles (range 1-11): 24% of patients achieved complete remission, 14% partial remission, 8% hematologic improvement, 32% had stable and 22% progressive disease. Ten patients discontinued treatment before the planned four cycles, due to an adverse event in nine cases. Results A HSC donor was identified in 73 patients, and HSCT was performed in 54 patients (74% of patients with a donor). Main reasons for turning down HSCT were lack of a donor, an adverse event, or progressive disease (9, 12, and 16 patients, respectively). At a median follow-up of 20.5 months from enrolment, response to AZA was the only independent prognostic factor for survival. Compared to baseline assessment, AZA treatment did not affect patients' comorbidities at HSCT: the HCT-CI remained stable in 62% patients, and worsened or improved in 23% and 15% of patients, respectively. Conclusions Our study shows that HSCT is feasible in the majority of patients with HR-MDS/AML/CMML-2 after AZA treatment. As matched unrelated donor was the most frequent source of donor cells, the time between diagnosis and HSCT needed for donor search could be 'bridged' using azacitidine. These data show that AZA prior to HSCT could be a better option than intensive chemotherapy in higher-risk MDS. The trial has been registered with the EudraCT number 2010-019673-1.
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Affiliation(s)
- M T Voso
- Division of Hematology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome
| | - G Leone
- Department of Hematology, Università Cattolica del Sacro Cuore, Rome
| | - A Piciocchi
- Department of Statistical Sciences, La Sapienza University, Rome
| | - L Fianchi
- Department of Hematology, Università Cattolica del Sacro Cuore, Rome
| | - S Santarone
- Department of Hematology, Centro Trapianti Midollo Osseo, Pescara
| | - A Candoni
- Division of Hematology and BMT, Department of Experimental and Clinical Medical Sciences, Azienda Ospedaliero-Universitaria di Udine, Udine
| | - M Criscuolo
- Department of Hematology, Università Cattolica del Sacro Cuore, Rome
| | - A Masciulli
- Department of Hematology, ASST Papa Giovanni XXIII, Bergamo
| | - E Cerqui
- Department of Hematology, A.O. Spedali Civili, Brescia
| | - A Molteni
- Department of Hematology, Ospedale Niguarda, Milano
| | - C Finelli
- Department of Hematology, Ospedale Sant'Orsola Malpighi, University of Bologna, Bologna
| | - M Parma
- Department of Hematology, HSCT Adult Unit, San Gerardo Hospital, Monza
| | - A Poloni
- Department of Hematology, Azienda Ospedaliera Universitaria - Ospedali Riuniti di Ancona, Ancona
| | - A M Carella
- Department of Hematology, Ospedale Opera Padre Pio, San Giovanni Rotondo
| | - F Spina
- Department of Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - A Cortelezzi
- Department of Hematology Oncology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico and University of Milan, Milano
| | - F Salvi
- Department of Hematology, "SS Antonio e Biagio" Hospital, Alessandria
| | - E P Alessandrino
- Department of Hematology, Policlinico San Matteo and Pavia University, Pavia, Italy
| | - A Rambaldi
- Department of Hematology, ASST Papa Giovanni XXIII, Bergamo
| | - S Sica
- Department of Hematology, Università Cattolica del Sacro Cuore, Rome
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14
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Cicconi L, Divona M, Ciardi C, Ottone T, Ferrantini A, Lavorgna S, Alfonso V, Paoloni F, Piciocchi A, Avvisati G, Ferrara F, Di Bona E, Albano F, Breccia M, Cerqui E, Sborgia M, Kropp MG, Santoro A, Levis A, Sica S, Amadori S, Voso MT, Mandelli F, Lo-Coco F. PML–RARα kinetics and impact of FLT3–ITD mutations in newly diagnosed acute promyelocytic leukaemia treated with ATRA and ATO or ATRA and chemotherapy. Leukemia 2016; 30:1987-1992. [DOI: 10.1038/leu.2016.122] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/05/2016] [Accepted: 04/12/2016] [Indexed: 11/09/2022]
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15
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Tisi MC, Giustiniani MC, D'Alò F, Sica S, Hohaus S, Pagano L. A T cell lymphoblastic lymphoma with mucormycosis as unusual etiology of acute cerebral ischemia. Ann Hematol 2015; 95:517-8. [PMID: 26666534 DOI: 10.1007/s00277-015-2576-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 12/04/2015] [Indexed: 11/24/2022]
Affiliation(s)
- M C Tisi
- Institute of Hematology, Catholic University S. Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy.
| | - M C Giustiniani
- Institute of Pathological Anatomy, Catholic University S. Cuore, Rome, Italy
| | - F D'Alò
- Institute of Hematology, Catholic University S. Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - S Sica
- Institute of Hematology, Catholic University S. Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - S Hohaus
- Institute of Hematology, Catholic University S. Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - L Pagano
- Institute of Hematology, Catholic University S. Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
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16
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Martínez C, Canals C, Sarina B, Alessandrino EP, Karakasis D, Pulsoni A, Sica S, Trneny M, Snowden JA, Kanfer E, Milpied N, Bosi A, Guidi S, de Souza CA, Willemze R, Arranz R, Jebavy L, Hellmann A, Sibon D, Oneto R, Luan JJ, Dreger P, Castagna L, Sureda A. Identification of prognostic factors predicting outcome in Hodgkin's lymphoma patients relapsing after autologous stem cell transplantation. Ann Oncol 2013. [PMID: 23712545 DOI: 10.1093/annonc/mdt206.] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard of care for patients with relapsed Hodgkin's lymphoma (HL). However, there is currently little information on the predictors of outcome for patients whose disease recurs after ASCT. METHODS Five hundred and eleven adult patients with relapsed HL after ASCT from EBMT-GITMO databases were reviewed. RESULTS Treatments administered following ASCT failure included conventional chemotherapy and/or radiotherapy in 294 (64%) patients, second ASCT in 35 (8%), and alloSCT in 133 (29%). After a median follow-up of 49 months, overall survival (OS) was 32% at 5 years. Independent risk factors for OS were early relapse (<6 months) after ASCT, stage IV, bulky disease, poor performance status (PS), and age ≥50 years at relapse. For patients with no risk factors OS at 5 years was 62% compared with 37% and 12% for those having 1 and ≥2 factors, respectively. This score was also predictive for outcome in each group of rescue treatment after ASCT failure. CONCLUSION(S) Early relapse, stage IV, bulky disease, poor PS, and age ≥50 years at ASCT failure are relevant factors for outcome that may help to understand the results of different therapeutic approaches.
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Affiliation(s)
- C Martínez
- Hematology Department, Institute of Hematology and Oncology, Hospital Clinic, Barcelona, Spain.
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17
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Martínez C, Canals C, Sarina B, Alessandrino EP, Karakasis D, Pulsoni A, Sica S, Trneny M, Snowden JA, Kanfer E, Milpied N, Bosi A, Guidi S, de Souza CA, Willemze R, Arranz R, Jebavy L, Hellmann A, Sibon D, Oneto R, Luan JJ, Dreger P, Castagna L, Sureda A. Identification of prognostic factors predicting outcome in Hodgkin's lymphoma patients relapsing after autologous stem cell transplantation. Ann Oncol 2013; 24:2430-4. [PMID: 23712545 DOI: 10.1093/annonc/mdt206] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard of care for patients with relapsed Hodgkin's lymphoma (HL). However, there is currently little information on the predictors of outcome for patients whose disease recurs after ASCT. METHODS Five hundred and eleven adult patients with relapsed HL after ASCT from EBMT-GITMO databases were reviewed. RESULTS Treatments administered following ASCT failure included conventional chemotherapy and/or radiotherapy in 294 (64%) patients, second ASCT in 35 (8%), and alloSCT in 133 (29%). After a median follow-up of 49 months, overall survival (OS) was 32% at 5 years. Independent risk factors for OS were early relapse (<6 months) after ASCT, stage IV, bulky disease, poor performance status (PS), and age ≥50 years at relapse. For patients with no risk factors OS at 5 years was 62% compared with 37% and 12% for those having 1 and ≥2 factors, respectively. This score was also predictive for outcome in each group of rescue treatment after ASCT failure. CONCLUSION(S) Early relapse, stage IV, bulky disease, poor PS, and age ≥50 years at ASCT failure are relevant factors for outcome that may help to understand the results of different therapeutic approaches.
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Affiliation(s)
- C Martínez
- Hematology Department, Institute of Hematology and Oncology, Hospital Clinic, Barcelona, Spain.
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18
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Styczynski J, Gil L, Ljungman P, Donnelly J, Martino R, Theunissen K, Maertens J, Kalwak K, Hubacek P, Sica S, van der Velden W, Omar H, Nozzoli C, Fagioli F, Matthes S, Diaz M, Migliavacca M, Balduzzi A, Faraci M, Tomaszewska A, de la Camara R, Hoek J, Einsele H, Cesaro S. Epstein-Barr Virus-Related Post-Transplant Lymphoproliferative Disorder in Children Treated with Rituximab: The Impact of Viral Load and Non-Lymphoid Tissue Involvement. Biol Blood Marrow Transplant 2012. [DOI: 10.1016/j.bbmt.2011.12.255] [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: 10/14/2022]
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19
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Laurenti L, De Padua L, D'Arena G, Vannata B, Innocenti I, Tarnani M, Deaglio S, Sica S, Efremov DG, Leone G. New and old monoclonal antibodies for the treatment of chronic lymphocytic leukemia. Mini Rev Med Chem 2011; 11:508-18. [PMID: 21561405 DOI: 10.2174/138955711795843374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 03/29/2011] [Indexed: 11/22/2022]
Abstract
Over the last few years, several new agents have been under evaluation in preclinical studies and clinical trials, showing promise in treating chronic lymphocytic leukemia (CLL). Among these agents, monoclonal antibodies (mAbs) such as rituximab and alemtuzumab have changed the natural course of the disease. Nowadays there are several new promising monoclonal antibodies under investigation against the CD20, CD23, CD37 and CD40 molecules. Application of newer monoclonal antibodies represents an area of ongoing clinical research in CLL.
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Affiliation(s)
- L Laurenti
- Hematology Department, Catholic University of Sacred Hearth, Largo Agostino Gemelli, 00168 Rome, Italy.
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20
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Chiusolo P, Bellesi S, Piccirillo N, Giammarco S, Marietti S, De Ritis D, Metafuni E, Stignani M, Baricordi OR, Sica S, Leone G, Rizzo R. The role of HLA--G 14-bp polymorphism in allo-HSCT after short-term course MTX for GvHD prophylaxis. Bone Marrow Transplant 2011; 47:120-4. [PMID: 21399669 DOI: 10.1038/bmt.2011.40] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
HLA-G molecules are HLA class Ib antigens characterized by tolerogenic and immunoinhibitory functions. The HLA-G 14-bp insertion/deletion (ins/del) polymorphism controls protein expression and seems to be implicated in both MTX treatment response and SCT outcome. The aim of our study is to evaluate the role of HLA-G 14 bp polymorphism in subjects affected by hematological malignancies undergoing allo-SCT and receiving MTX therapy for GvHD prophylaxis. We performed a retrospective analysis of HLA-G 14 bp polymorphism using a specific PCR in 47 recipients and in their respective donors, and evaluated the correlation with the incidence of aGvHD, OS and disease-free survival (DFS) after allo-SCT. We did not observe any correlation between this polymorphism and the risk of aGvHD occurrence. On the contrary, we found that the recipients with a 14 bp ins/14 bp ins genotype were characterized by a lower OS and DFS in univariate and multivariate analysis (OS=OR: 3.235; DFS=OR: 3.302). These data indicate a role for recipient HLA-G 14 bp polymorphism in allo-SCT immunotolerance status and follow-up.
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Affiliation(s)
- P Chiusolo
- Hematology Department, Istituto di Ematologia, Università Cattolica del Sacro Cuore, Rome, Italy.
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21
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La Rosa G, Iaconelli M, Pourshaban M, Luca E, Valentini P, Sica S, Manzara S, Delogu G, Muscillo M. Molecular characterization of adenovirus from clinical samples through analysis of the hexon and fiber genes. J Gen Virol 2010; 92:412-20. [DOI: 10.1099/vir.0.023176-0] [Citation(s) in RCA: 12] [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] [Indexed: 11/18/2022] Open
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22
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Sabatelli M, Luigetti M, Laurenti L, Conte A, Madia F, De Matteis S, Chiusolo P, Tarnani M, Sica S. Neurologic improvement after peripheral blood stem cell transplantation in poems. Neurology 2009; 73:1165; author reply 1165-6. [PMID: 19805738 DOI: 10.1212/wnl.0b013e3181b26ff7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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23
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Gobessi S, Laurenti L, Longo PG, Carsetti L, Berno V, Sica S, Leone G, Efremov DG. Inhibition of constitutive and BCR-induced Syk activation downregulates Mcl-1 and induces apoptosis in chronic lymphocytic leukemia B cells. Leukemia 2008; 23:686-97. [DOI: 10.1038/leu.2008.346] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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24
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Sorà F, Laurenti L, Chiusolo P, De Matteis S, Leone G, Sica S. Clonal gammopathies and allogeneic stem cell transplantation. Bone Marrow Transplant 2007; 41:317. [PMID: 17982492 DOI: 10.1038/sj.bmt.1705916] [Citation(s) in RCA: 4] [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: 11/09/2022]
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25
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Voso MT, Fabiani E, D'Alo' F, Guidi F, Di Ruscio A, Sica S, Pagano L, Greco M, Hohaus S, Leone G. Increased risk of acute myeloid leukaemia due to polymorphisms in detoxification and DNA repair enzymes. Ann Oncol 2007; 18:1523-8. [PMID: 17761709 DOI: 10.1093/annonc/mdm191] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Polymorphisms in genes involved in detoxification and DNA-repair pathways may modify the individual's risk for genomic damage, and, as a consequence, the risk of developing malignant diseases. PATIENTS AND METHODS We performed a case-control study including 160 cases of acute myeloid leukaemia (AML) and 162 matched controls to test the impact of six genomic polymorphisms on the risk to develop AML and/or therapy-related AML. RESULTS We found a significantly higher prevalence of the polymorphic variants RAD51-G135C and CYP3A4-A-290G genes in AML cases, when compared with controls (P = 0.02 and P = 0.04), increasing the risk of AML 2.1-folds (95% CI: 1.1-4.0) and 3.2-fold (95% CI: 1.1-11.5), respectively. Carriers of both the RAD51-G135C and CYP3A4-A-290G variants were at highest AML risk (P = 0.003; OR:13,6; 95% CI: 2.0-585.5), suggesting a synergistic effect between these polymorphisms. CONCLUSIONS These results suggest that polymorphic variants in DNA-repair and detoxification enzymes may co-operate in modulating the individual's risk of AML.
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Affiliation(s)
- M T Voso
- Istituto di Ematologia, Universita' Cattolica del Sacro Cuore, Roma, Italy.
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26
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Cicconi S, Pittiruti M, Buononato M, Piccirillo N, Sorà F, Chiusolo P, Laurenti L, Leone G, Sica S. Non-tunneled central venous catheters in adult stem cell transplantation recipients: An effective option. J Vasc Access 2007; 2:168-74. [PMID: 17638282 DOI: 10.1177/112972980100200407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Stem cell transplantation (SCT) recipients require central venous catheter (CVC) insertion for the administration of chemotherapy, antibiotics and total parenteral nutrition. Traditionally, tunneled CVC have been considered as the golden standard although they require surgery for both insertion and removal. We prospectively evaluated the use of a non-tunneled CVC in 182 consecutive patients who had undergone allogenic or autologous SCT. The median duration of CVC was 4 weeks (range 1-24) with a significant difference between allogenic (8 weeks, range 2-24) and autologous SCT (4 weeks, range 1-24) (p<0.0001). The life expectancy of the CVC was significantly influenced by spontaneous removal, which occurred in 26 patients (13.8%). There was a significant increase of this complication in allogenic SCT (p=0.039). The overall incidence of sepsis was 24.5%, although catheter-related sepsis was microbiologically documented by positive culture of the tip only in 17 cases (9%). Non-tunneled CVC in adult SCT recipients allowed (a) bedside insertion and removal, (b) guidewire replacement for diagnostic or therapeutic purposes (dialysis or pheresis procedures) thus reducing the need for repeated venipunctures. (The Journal of Vascular Access 2001; 2: 168-174).
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Affiliation(s)
- S Cicconi
- Department of Hematology, Istituto di Semeiotica Medica, Rome - Italy
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27
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Piccirillo N, De Matteis S, De Vita S, Laurenti L, Chiusolo P, Sorà F, Reddiconto G, d'Onofrio G, Leone G, Sica S. Kinetics of peg-filgrastim after high-dose chemotherapy and autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 2007; 40:579-83. [PMID: 17637690 DOI: 10.1038/sj.bmt.1705772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/10/2022]
Abstract
Peg-filgrastim is a form of G-CSF with a sustained duration of action due to self-limited clearance. We administered 6 mg peg-filgrastim to 18 autograft recipients on day +1 after transplantation for hematologic malignancies. Plasma samples were collected at baseline and during transplantation. Hematopoietic recovery and clinical outcomes were compared to the historical data of 54 patients not receiving G-CSF. Patients receiving peg-filgrastim achieved a serum level of 115 000 pg/ml on day +2, 24 h after drug administration. Drug level maintained a plateau until day +8 and, after day +10, declined concomitantly with myeloid recovery. Patients experienced prompt neutrophil recovery: days +9 and +10 to 500 and 1000 neutrophils per microliter, and 4 days with an absolute neutrophil count <100 cells per microliter. Duration of antibiotic therapy was significantly shortened, but we did not observe significant differences in other end points. In conclusion, peg-filgrastim was well tolerated and efficacious, and hastened myeloid recovery.
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Affiliation(s)
- N Piccirillo
- 1Haematology Institute, A Gemelli Hospital, Catholic University, Rome, Italy.
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28
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Reddiconto G, Chiusolo P, Fiorini A, Farina G, Laurenti L, Martini M, Marchetti S, Fadda G, Leone G, Sica S. Assessment of cellular origin and EBV status in a PTLD after double cord blood transplantation. Leukemia 2007; 21:2552-4. [PMID: 17597809 DOI: 10.1038/sj.leu.2404818] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
MESH Headings
- Adult
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Combined Modality Therapy
- Cord Blood Stem Cell Transplantation/adverse effects
- Diagnosis, Differential
- Epstein-Barr Virus Infections/diagnosis
- Epstein-Barr Virus Infections/transmission
- Female
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 4, Human/physiology
- Humans
- Immunosuppressive Agents/adverse effects
- Infant, Newborn
- Lymphoma, Non-Hodgkin/drug therapy
- Lymphoma, Non-Hodgkin/surgery
- Lymphoproliferative Disorders/drug therapy
- Lymphoproliferative Disorders/etiology
- Lymphoproliferative Disorders/virology
- Male
- Myelodysplastic Syndromes/chemically induced
- Myelodysplastic Syndromes/surgery
- Peripheral Blood Stem Cell Transplantation
- Rituximab
- Transplantation, Autologous/adverse effects
- Transplantation, Homologous/adverse effects
- Virus Activation
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29
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Zaja F, Bacigalupo A, Patriarca F, Stanzani M, Van Lint MT, Filì C, Scimè R, Milone G, Falda M, Vener C, Laszlo D, Alessandrino PE, Narni F, Sica S, Olivieri A, Sperotto A, Bosi A, Bonifazi F, Fanin R. Treatment of refractory chronic GVHD with rituximab: a GITMO study. Bone Marrow Transplant 2007; 40:273-7. [PMID: 17549053 DOI: 10.1038/sj.bmt.1705725] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The anti-CD20 chimaeric monoclonal antibody Rituximab has recently been shown to induce significant clinical response in a proportion of patients with refractory chronic graft-versus-host disease (cGVHD). We now report 38 patients, median age 48 years (22-61), receiving Rituximab for refractory cGVHD, assessed for clinical response and survival. Median duration of cGVHD before Rituximab was 23 months (range 2-116), the median number of failed treatment lines was 3 (range 1 to > or =6) and the median follow-up after Rituximab was 11 months (1-88). Overall response rate was 65%: skin 17/20 (63%), mouth 10/21 (48%), eyes 6/14 (43%), liver 3/12 (25%), lung 3/8 (37.5%), joints 4/5, gut 3/4, thrombocytopaenia 2/3, vagina 0/2, pure red cell aplasia 0/1 and, myasthenia gravis 1/1. During the study period 8/38 died: causes of death were cGVHD progression (n=3), disease relapse (n=1), infection (n=3), sudden death (n=1). The actuarial 2 year survival is currently 76%. We confirm that Rituximab is effective in over 50% of patients with refractory cGVHD and may have a beneficial impact on survival.
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Affiliation(s)
- F Zaja
- Clinica Ematologica DIRM, Azienda Ospedaliera Universitaria, Udine, Italy.
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30
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Laurenti L, Tarnani M, Efremov DG, Chiusolo P, De Padua L, Sica S, Leone G. Efficacy and safety of low-dose alemtuzumab as treatment of autoimmune hemolytic anemia in pretreated B-cell chronic lymphocytic leukemia. Leukemia 2007; 21:1819-21; author reply 1821. [PMID: 17443222 DOI: 10.1038/sj.leu.2404703] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
MESH Headings
- Aged
- Alemtuzumab
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/etiology
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/administration & dosage
- Antibodies, Neoplasm/adverse effects
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/adverse effects
- Hemoglobins/analysis
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Male
- Middle Aged
- Treatment Outcome
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31
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De Stefano V, Fiorini A, Rossi E, Za T, Farina G, Chiusolo P, Sica S, Leone G. Incidence of the JAK2 V617F mutation among patients with splanchnic or cerebral venous thrombosis and without overt chronic myeloproliferative disorders. J Thromb Haemost 2007; 5:708-14. [PMID: 17263783 DOI: 10.1111/j.1538-7836.2007.02424.x] [Citation(s) in RCA: 160] [Impact Index Per Article: 9.4] [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: 12/15/2022]
Abstract
BACKGROUND Thrombosis of splanchnic or cerebral veins is a typical manifestation of polycythemia vera (PV) or essential thrombocythemia (ET). The recently identified Janus kinase 2 (JAK2) V617F somatic mutation is closely related to chronic myeloproliferative disorders (CMD). OBJECTIVE To assess the incidence of the JAK2 V617F mutation among patients with splanchnic or cerebral venous thrombosis with or without overt CMD. PATIENTS AND METHODS We searched for the mutation in 139 adult patients (> 18 years old) with thrombosis of hepatic veins (HVT, n = 15), or extrahepatic portal vein (PVT) and/or mesenteric vein (MVT) (n = 79), or cerebral veins (CVT, n = 45). Only 19 patients fulfilled criteria for diagnosis of PV (n = 8) or ET (n = 11) at the time of thrombosis: four had HVT, 11 PVT and/or MVT, and four CVT. RESULTS The JAK2 V617F mutation was found in 94.7% [95% CI 75.3-99.0] of the patients with overt CMD at the time of thrombosis, in 21.5% (95% CI 13.8-31.7) of the patients with abdominal venous thrombosis and without overt CMD, and in 4.8% (95% CI 1.3-16.1) of the patients with CVT and without overt CMD. Among the patients without overt CMD or thrombophilia and with unprovoked thrombosis, 29.4% (95% CI 16.8-46.1) with splanchnic venous thrombosis and 42.8% (95% CI 24.4-63.4) with PVT had the JAK2 V617F mutation. CONCLUSIONS A substantial proportion of patients with splanchnic venous thrombosis and a small, but significant, number of patients with CVT can be recognized as carriers of the JAK2 V617F mutation in the absence of overt signs of CMD. The clinical significance of such findings deserves further investigation.
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Affiliation(s)
- V De Stefano
- Institute of Hematology, Catholic University, Rome, Italy.
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32
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Fiorini A, Farina G, Reddiconto G, Palladino M, Rossi E, Za T, Laurenti L, Giammarco S, Chiusolo P, Leone G, Sica S. Reply to ‘Absence of JAK-2 (Val617Phe) point mutations in multiple myeloma’ by Dr Qin Huang et al. referred to ‘Screening of JAK2 V617F mutation in multiple myeloma’ from Fiorini A et al. published in Leukemia 2006, October 20. Leukemia 2007. [DOI: 10.1038/sj.leu.2404553] [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: 11/09/2022]
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33
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Garzia M, Sora F, Teofili L, Di Mario A, Voso MT, Rumi C, La Rocca LM, Sica S, Zini G. Blastoid Mantle Cell Lymphoma Occurring in a Patient in Complete Remission of Chronic Myelogenous Leukemia. ACTA ACUST UNITED AC 2007; 13:30-3. [PMID: 17353181 DOI: 10.1532/lh96.06030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 11/20/2022]
Abstract
The development of a de novo lymphoma in patients affected by chronic myelogenous leukemia (CML) is a rare event. The introduction of new molecular cytogenetic techniques, such as fluorescence in situ hybridization (FISH), allows a correct differential diagnosis between lymphoid blastic crisis and a blastoid variant of mantle cell lymphoma (MCL), which shows an aggressive behavior and some molecular characteristics detectable by cytogenetics and immunohistochemistry. We report a case of a blastoid variant of MCL that developed in a patient with CML who achieved complete cytogenetic and molecular response to imatinib mesylate treatment.
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Affiliation(s)
- M Garzia
- Dipartimento di Diagnostica Morfologica, Microbiologica, Molecolare e delle Malattie del Sangue, Catholic University of Sacred Heart, Rome, Italy
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Fiorini A, Reddiconto G, Farina G, Marietti S, Palladino M, Chiusolo P, Leone G, Sica S. Eradication of JAK2 V617F mutation after allogeneic transplantation in a patient with myelofibrosis with myeloid metaplasia. Leukemia 2006; 20:2198-9. [PMID: 17039230 DOI: 10.1038/sj.leu.2404430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Longo PG, Laurenti L, Gobessi S, Petlickovski A, Pelosi M, Chiusolo P, Sica S, Leone G, Efremov DG. The Akt signaling pathway determines the different proliferative capacity of chronic lymphocytic leukemia B-cells from patients with progressive and stable disease. Leukemia 2006; 21:110-20. [PMID: 17024114 DOI: 10.1038/sj.leu.2404417] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic lymphocytic leukemia (CLL) B-cells are hyporesponsive to many proliferative signals that induce activation of normal B-lymphocytes. However, a heterogeneous response has recently been observed with immunostimulatory CpG-oligodeoxynucleotides (CpG ODN). We now show that CpG ODN induce proliferation mainly in CLL B-cells from patients with progressive disease and unmutated immunoglobulin V(H) genes, whereas G(1)/S cell cycle arrest and apoptosis are induced in leukemic B-cells from stable/V(H) mutated CLL. Examination of early signaling events demonstrated that all CLL B-cells respond to CpG ODN stimulation by degradation of the NF-kappaB inhibitor IkappaB and activation of the Akt, ERK, JNK and p38 MAPK kinases, but the magnitude and duration of the signaling response was greater in the proliferating cases. Pharmacological inhibition of these pathways showed that simultaneous activation of Akt, ERK and JNK is required for cell cycle progression and proliferation. Conversely, introduction of constitutively active Akt in nonproliferating CLL B-cells resulted in induction of cyclin A following CpG ODN stimulation, indicating that increased Akt activation is sufficient to overcome the hyporesponsiveness of these cells to proliferative signals. Thus, the magnitude of Akt signaling may determine the distinct responses observed in leukemic B-cells belonging to the different prognostic subgroups.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- B-Lymphocytes/immunology
- B-Lymphocytes/metabolism
- B-Lymphocytes/pathology
- Cell Cycle
- Cell Proliferation
- Cyclins/biosynthesis
- Disease Progression
- Female
- Genes, Immunoglobulin
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- MAP Kinase Signaling System/drug effects
- Male
- Middle Aged
- Oligodeoxyribonucleotides/immunology
- Oligodeoxyribonucleotides/pharmacology
- Proto-Oncogene Proteins c-akt/metabolism
- Signal Transduction/drug effects
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Affiliation(s)
- P G Longo
- ICGEB Hematology Group, Monterotondo-Outstation, CNR Campus Adriano Buzzati-Traverso, Rome, Italy
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Fiorini A, Farina G, Reddiconto G, Palladino M, Rossi E, Za T, Laurenti L, Giammarco S, Chiusolo P, Leone G, Sica S. Screening of JAK2 V617F mutation in multiple myeloma. Leukemia 2006; 20:1912-3. [PMID: 16871278 DOI: 10.1038/sj.leu.2404332] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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37
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De Vita S, De Matteis S, Laurenti L, Chiusolo P, Sorà F, Piccirillo N, Reddiconto G, Fiorini A, Leone G, Sica S. Imatinib for secondary Ph+ acute lymphoblastic leukemia induces response in concomitant GBM. Ann Oncol 2006; 17:720-1. [PMID: 16263757 DOI: 10.1093/annonc/mdj056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Leone G, Sica S, Voso MT, Rutella S, Pagano L. Treatment of acute leukaemias with monoclonal antibodies: current status and future prospects. Cardiovasc Hematol Agents Med Chem 2006; 4:33-52. [PMID: 16529548 DOI: 10.2174/187152506775268820] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 05/07/2023]
Abstract
Monoclonal antibodies are a new class of agents targeted at specific receptors on cancer cells. In addition to direct cellular effects, antibodies can carry substances to the targeted cells, such as radioactive isotopes, toxins, and antineoplastic agents. At present monoclonal antibodies, directed against both lymphoid antigens (CD 20 and CD 52) and a myeloid antigen (CD33) are available for clinical use. In ALL, rituximab, a humanized anti CD20 antibody, has been combined to chemotherapy mainly in mature B-ALL and Burkitt's lymphoma and preliminary results are promising. Alemtuzumab is an anti-CD52 humanized antibody, which showed anti-tumour activity in CLL; clinical effects were observed in some patients with relapsed adult ALL. Monoclonal antibodies against myeloid antigens have been prevalently used in acute myeloid leukaemias (AML), where the most utilised immunological target is CD33. The CD33 molecule is expressed by approximately 90% of AMLs but not on CD34(+) bone marrow-resident hematopoietic stem cells. The humanized anti-CD33 monoclonal antibody HuM195 has only modest activity against overt AML, but it can eliminate minimal residual disease. Radioimmunotherapy with beta-particle-emitting isotopes targeting CD33 shows a major efficacy. Targeted chemotherapy with the anti-CD33-calicheamicin construct gemtuzumab ozogamicin (GO) has produced remissions as a single agent in patients with relapsed AML and appears promising when used in combination with standard chemotherapy. GO is composed of a humanized immunoglobulin G(4) (IgG(4)) monoclonal antibody (mAb), targeting the CD33 antigen and linked to a calicheamicin derivative, a cytotoxic anthracycline antibiotic. GO has been approved by FDA as second-line therapy in older patients with AML. The most common adverse effects of monoclonal antibodies are myelosuppression, infusion-related reactions, and hypersensitivity reactions. Rituximab may cause tumour lysis syndrome. Alemtuzumab causes immunosuppression, increasing the risk of infection. GO may cause hepatotoxicity.
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Affiliation(s)
- G Leone
- Istituto di Ematologia, Università Cattolica del Sacro Cuore, Largo Gemelli 8, 00168 Rome, Italy.
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Fioriti D, Degener AM, Mischitelli M, Videtta M, Arancio A, Sica S, Sora F, Pietropaolo V. BKV infection and hemorrhagic cystitis after allogeneic bone marrow transplant. Int J Immunopathol Pharmacol 2005; 18:309-16. [PMID: 15888253 DOI: 10.1177/039463200501800213] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [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: 11/16/2022] Open
Abstract
Hemorrhagic cystitis (HC) is a well-known complication after allogeneic bone marrow transplant (BMT) and can be related to adenovirus or human polyomavirus BK (BKV) infections. In this study a group of 20 patients after allogeneic BMT has been examined. BMT urine samples were analysed for the presence of Adenovirus and BKV DNAby means of polymerase chain reaction (PCR). 5/20 BMT patients developed HC after BMT. The presence of BKV DNA in urine samples was evident in 3/15 patients without HC and in 5/5 patients with HC. In 2/5 HC-patients the BKV DNA was not found after therapy with Cidofovir and Ribavirin. The search for adenovirus DNA in all samples was negative. The analysis of BKV non-coding control region (NCCR) isolated from urine samples revealed a structure very similar to the archetype in all samples. The RFLP (Restriction Fragment Length Polymorphism assay) showed the presence of BKV subtypes I and IV, with the prevalence of subtype I (4/5). This study supports the hypothesis that HC is mainly related to BKV rather than to adenovirus infection in BMT patients. Moreover, since BKV subtype I was predominant, it is reasonable to hypothesize that a specific BKV subtype could be associated with the development of HC.
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Affiliation(s)
- D Fioriti
- Department of Public Health Sciences, University La Sapienza, Rome, Italy
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De Stefano V, Sorà F, Rossi E, Chiusolo P, Laurenti L, Fianchi L, Zini G, Pagano L, Sica S, Leone G. The risk of thrombosis in patients with acute leukemia: occurrence of thrombosis at diagnosis and during treatment. J Thromb Haemost 2005; 3:1985-92. [PMID: 16102104 DOI: 10.1111/j.1538-7836.2005.01467.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.3] [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: 11/29/2022]
Abstract
BACKGROUND Thromboembolism can occur during acute leukemia, especially acute lymphoid leukemia (ALL) treated with L-asparaginase. Yet, most reports are anecdotical and scarce data are available on the risk of thrombosis in acute myeloid leukemia (AML). OBJECTIVES To evaluate the risk of thrombosis in patients with acute leukemia. PATIENTS AND METHODS Three-hundred and seventy-nine consecutive adult patients with newly diagnosed acute leukemia were recruited in an observational cohort study conducted from January 1994 to December 2003. Diagnosis was ALL in 69 patients, acute promyelocytic leukemia (APL; FAB subtype M3) in 31, and non-M3 AML in 279. All first or recurrent symptomatic thromboembolic events objectively diagnosed were recorded. RESULTS Twenty-four patients of the overall 379 (6.3%; 95% CI 4.1%-9.2%) had a first thrombosis, venous in 80% of the cases and arterial in 20%. At diagnosis, thrombosis was a presenting manifestation in 13 cases (3.4% of the whole cohort): 1.4% in ALL, 9.6% in APL, and 3.2% in non-M3 AML patients. Follow-up was carried out on 343 patients without thrombosis at diagnosis and further 11 thrombotic events (3.2%) were recorded. At 6 months from diagnosis, the cumulative incidence of thrombosis was 10.6% in ALL, 8.4% in APL, and 1.7% in non-M3 AML patients. The patients who received L-asparaginase had a 4.9-fold increased risk of thrombosis in comparison with those who did not (95% CI 1.5-16.0). The fatality rate due to thrombosis was 0.8%. CONCLUSIONS In patients with acute leukemia, the risk of thrombosis is not negligible. Thombosis can be a presenting symptom at diagnosis in a significant portion of cases with APL (9.6%) and non-M3 AML (3.2%); a similar rate of thrombosis can occur during the subsequent course of the disease. The incidence of symptomatic thrombosis at diagnosis is relatively low in ALL patients (1.4%), but is significantly increased by further treatment up to 10.6%. Strategies of antithrombotic prophylaxis should be investigated in this setting.
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Affiliation(s)
- V De Stefano
- Institute of Hematology, Catholic University, Rome, Italy.
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Sica S, Sorà F, Laurenti L, Chiusolo P, Piccirillo N, Scirpa P, Leone G. The treatment of menorrhagia in female stem cell transplant recipients. Bone Marrow Transplant 2005; 35:827. [PMID: 15750605 DOI: 10.1038/sj.bmt.1704890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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42
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Laurenti L, Piccioni P, Tarnani M, Chiusolo P, Piccirillo N, Rumi C, Sora F, Sica S, Leone G. Immune recovery after low-dose Campath therapy in a group of pretreated patients affected by B-cell chronic lymphocytic leukemia. Leukemia 2004; 19:153-4. [PMID: 15496971 DOI: 10.1038/sj.leu.2403561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
MESH Headings
- Alemtuzumab
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Antibodies, Neoplasm/therapeutic use
- Antineoplastic Agents/therapeutic use
- Humans
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Salvage Therapy
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Piccirillo N, De Matteis S, Sorà F, Laurenti L, Chiusolo P, Leone G, Sica S. Glutamine parenteral supplementation in stem cell transplant. Bone Marrow Transplant 2004; 33:455; author reply 457. [PMID: 14676779 DOI: 10.1038/sj.bmt.1704363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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44
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McCann S, Byrne JL, Rovira M, Shaw P, Ribaud P, Sica S, Volin L, Olavarria E, Mackinnon S, Trabasso P, VanLint MT, Ljungman P, Ward K, Browne P, Gratwohl A, Widmer AF, Cordonnier C. Outbreaks of infectious diseases in stem cell transplant units: a silent cause of death for patients and transplant programmes. Bone Marrow Transplant 2004; 33:519-29. [PMID: 14743201 DOI: 10.1038/sj.bmt.1704380] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [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: 11/08/2022]
Abstract
Following the closure of the National Blood and Bone Marrow Transplant Unit in Dublin, because of an outbreak of vancomycin-resistant enterococcal infection, a survey was carried out by the EBMT to investigate the occurrence of outbreaks of infection in SCT units and the impact on patient morbidity, mortality and the administration of the transplant programme over a 10-year period from 1991 to 2001. A total of 13 centres reported 23 outbreaks of infection involving 231 patients: 10 bacterial, eight viral and five fungal outbreaks were reported and 56 deaths were attributed to infection. All fungal and bacterial deaths and the majority of viral deaths occurred in allograft recipients. In all outbreaks, the infection was reported to be hospital acquired and in all the viral, and half the bacterial infections, cross-infection was a major factor. All viral, four of 10 bacterial and three of five fungal outbreaks occurred in HEPA filtered rooms. A total of 12 SCT units reported a partial or total closure. The introduction of mandatory quality management systems such as JACIE should result in a change in attitude to 'incident reporting' and together with future surveys should reduce the incidence of infectious outbreaks in SCT units.
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Affiliation(s)
- S McCann
- Department of Haematology, Durkan Leukaemia Research Laboratories, Trinity Centre, St James's Hospital, Dublin, Ireland.
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Cordonnier C, Martino R, Trabasso P, Held TK, Akan H, Ward MS, Fabian K, Ullmann AJ, Wulffraat N, Ljungman P, Alessandrino EP, Pretnar J, Gmür J, Varela R, Vitek A, Sica S, Rovira M. Mycobacterial Infection: A Difficult and Late Diagnosis in Stem Cell Transplant Recipients. Clin Infect Dis 2004; 38:1229-36. [PMID: 15127333 DOI: 10.1086/383307] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2001] [Accepted: 12/15/2003] [Indexed: 12/17/2022] Open
Abstract
The Infectious Diseases Working Party of the European Blood and Marrow Transplant Group conducted a survey to obtain information about the frequency, presentation, and treatment of mycobacterial infection (MBI) in stem cell transplant (SCT) recipients. Among 29 centers, MBI was diagnosed in 0.79% of 1513 allogeneic and 0.23% of 3012 autologous SCT recipients during 1994-1998 a median of 160 days after transplantation. The mean interval between first symptoms and diagnosis was 29 days and was still longer for patients with atypical MBI or recipients of corticosteroid therapy. The prevalence of MBI was highest among those who received matched unrelated or mismatched STCs from related donors. Of 31 patients, 20 had tuberculosis, 8 had atypical MBI, and 3 had diagnoses based on histological findings only. Five patients (16%) died, all of whom had received an allogeneic SCT. Because of the increased numbers of unmatched donors and transplantation programs in countries with a high prevalence of tuberculosis, constant vigilance is required to early detect MBI in SCT recipients.
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Affiliation(s)
- C Cordonnier
- Department of Hematology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.
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Rutella S, Pierelli L, Sica S, Serafini R, Chiusolo P, Paladini U, Leone F, Zini G, D'Onofrio G, Leone G, Piccirillo N. Efficacy of granulocyte transfusions for neutropenia-related infections: retrospective analysis of predictive factors. Cytotherapy 2003; 5:19-30. [PMID: 12745586 DOI: 10.1080/14653240310000047] [Citation(s) in RCA: 38] [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: 10/27/2022]
Abstract
BACKGROUND The transfusion of G-CSf-primed granulocytes (GTX) might represent an important treatment option for neutropenia-related infections unresponsive to conventional antimicrobial therapies and to recombinant hematopoietic growth factors. However, few studies to date have identified the factors that can predict clinical outcome and the patient populations who are likely to benefit most from GTX. The primary endpoint of the present retrospective study was to evaluate the efficacy of GTX in 22 patients with hematological malignancies who developed neutropenia-related bacterial and fungal infections that were unresponsive to appropriate antimicrobial therapies. METHODS Peripheral blood granulocytes were collected by continuous-flow leukapheresis from HLA-identical siblings after priming with G-CSF. The response to GTX was classified as 'favorable' if clinical symptoms and signs of infection resolved or 'unfavorable' if clinical symptoms and signs of infection were unchanged or worsened. Control of infection at Day 30 after the enrollment in the GTX program was considered as the outcome variable in multiple regression analysis. RESULTS Two patients died of infection before receiving the granulocyte concentrates. Bacterial infections (monomicrobial or mixed bacteremias) were documented in 11 patients, whereas fungal infections (fungemia or focal fungal infections) were diagnosed in seven patients. In two patients, no infecting agent could be isolated (clinical infection). Control of infection at Day 30 after the first GTX was achieved in 10 of 20 assemble patients. Overall, 54% of patients with bacterial infections had a favorable response, compared with 57% of patients with fungal infections. No differences in terms of survival were found when comparing patients with bacterial and those with fungal infections at a median follow-up 90 days from the first GTX. In univariate analysis, disease status before GTX, e.g., complete or partial remission, and spontaneous recovery of the neutrophil count were significantly associated with control of infection. when multivariate regression models were formed, the recovery 0.5 x 10 (9)/L PMN was the only parameter that significantly and independently correlated with a favorable response to GTX. DISCUSSION GTX can be used to successfully treat bacterial as well as fungal infections in severely neutropenic patients when administered early after the onset of febrile neutropenia in patients with remission of the underlying disease and who are likely to recover marrow function.
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Affiliation(s)
- S Rutella
- Department of Hematology Catholic University Medical School Rome, Rome, Italy
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Sica S, Avino S, Glielmi G, Cicero S. [Incidence of fever of difficult diagnosis observed from January 1990 to August 1998]. Infez Med 2003; 7:96-104. [PMID: 12759588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Design: We evalueted incidence, period and etiology of the fever of difficult diagnosis (FDD) among 169 cases of fever of unknown origin (FUO) observed from 1-90 to 8-98. Materials and methods: we used the general and orientative diagnostic criteria useful for identifying some pathologies and also for distinguishing between infectious and non infectious fevers. Only as last attempt to solve the problem did we adopt ex-adiuvantibus treatments. Results: FDD incidence was 29.58%; we identified four main categories after detailed diagnostic work up:1) Fictitious fevers and abitual hyperthermia; 2) Systemic vasculitis with atypical clinical features; 3) Rheumatic polymyalgia; 4) Steroid-responder fevers. Conclusion: FDD is not a rare event, but of complicated resolution, some remaining unsolved. Our experience suggests that we consider only a few elements at first to distinguish organic from sine materia fevers: age, history of recent surgery, general clinical picture and aspecific indexes of inflammation.
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Affiliation(s)
- S. Sica
- Dipartimento di Malattie Infettive, Universita Federico II, Napoli, Italy
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Sica S, Vargas N, Glielmi G, Avino S, Ciarallo M. [A case of sepsis caused by BCG (Bacillus Calmette Guerin) after its bladder instillation in a 71-year-old patient affected by bladder carcinoma]. Infez Med 2003; 7:257-259. [PMID: 12748448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Sometimes the Calmette-Guerin bacillus can be used with success as local immunotherapy for superficial bladder carcinoma. BCG is a living attenuated strain of Mycobacterium bovis and therefore its biadder instillation may give rise, in some particular cases, to serious systemic effects, caused either by hypersensitivity reaction or by systemic dissemination in case with low efficiency of cellular immunity. We describe a case of sepsis in a 71-year-old patient after bladder instillation of BCG with a rare complication of granulomatous hepatitis. The etiological diagnosis of granulomatous hepatitis with PCR on liver biopsy is very important for the specific therapy before the patient can undergo a steroid regime.
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Affiliation(s)
- S. Sica
- Dipartimento di Malattie Infettive e Istituto di Geriatria, Universita Federico II, Napoli, Italy
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Chiusolo P, Reddiconto G, Casorelli I, Laurenti L, Sorà F, Mele L, Annino L, Leone G, Sica S. Preponderance of methylenetetrahydrofolate reductase C677T homozygosity among leukemia patients intolerant to methotrexate. Ann Oncol 2002; 13:1915-8. [PMID: 12453860 DOI: 10.1093/annonc/mdf322] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.3] [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: 11/13/2022] Open
Abstract
BACKGROUND Methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, a common mutation of the gene encoding the enzyme that catalyzes reduction of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate, a carbon donor in the metabolism of folate, determines a striking reduction in the enzyme activity in carriers of mutation at homozygous status. PATIENTS AND METHODS We retrospectively analyzed the incidence of MTHFR C677T and the influence of genotype on methotrexate (MTX) toxicity in patients with acute leukemia undergoing maintenance chemotherapy. Seventy-eight patients were analyzed and 61 were evaluable for toxicity. MTX toxicity was assessed on bone marrow, liver and mucosae. RESULTS The incidence of the C677T mutation was as expected in the general Italian population with 23.08% of patients being TT, 38.46% of patients CT and 38.46% of patients CC. The TT genotype was significantly associated with an increase of toxicity during MTX administration. No specific pattern of toxicity was detected, although in TT patients myelosuppression and liver toxicity were more pronounced. CONCLUSIONS TT genotype may indicate a need to reduce the dose of MTX during prolonged administration. Considering the high prevalence of homozygous individuals in the Italian population, pretreatment screening may be worthwhile.
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Affiliation(s)
- P Chiusolo
- Cattedra di Ematologia, Divisione di Ematologia, Università Cattolica Sacro Cuore Roma, Italy.
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Leone G, Sica S, Chiusolo P, Teofili L, De Stefano V. Blood cells diseases and thrombosis. Haematologica 2001; 86:1236-44. [PMID: 11726314] [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: 02/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES In recent years knowledge about thrombophilia and the mechanisms underlying the pathogenesis of thrombosis has increased greatly. Nevertheless the role of leukocytes and red cells in thrombogenesis is not well established and is probably underestimated. EVIDENCE AND INFORMATION SOURCES The contribution of leukocytes and red cells to thrombogenesis has been reviewed. Moreover, the prevalence of thrombosis as a complication of hematologic diseases has been examined. The authors are involved in the investigation and management of acute and chronic hematologic diseases as well as in investigation of thrombophilia. Pub-Med was employed as a source of information. STATE OF THE ART Thrombosis is a major problem in myeloproliferative disorders such as polycythemia vera and essential thrombocythemia. A clonal involvement of megakaryocytopoiesis resulting in elevated levels of platelet-specific proteins, increased thromboxane generation, and expression of activation-dependent epitopes on the platelet surface is regarded as the main origin of thromboembolism; nevertheless, activation of leukocytes and the consequent release of elastase and alkaline phosphatase could play an important role, determining endothelial damage. Thrombosis is a relevant problem in some hemolytic anemias such as paroxysmal nocturnal hemoglobinuria and drepanocytosis. Thrombotic events in hemolytic anemias with membrane defects have been attributed, at least in part, to hypercoagulability related to the exposure of phosphatidylserine of red cell membrane activating plasma prothrombinase and supplying a procoagulant phospholipid anionic surface. A moderate but well-established risk for thrombosis occurs in acute promyelocytic leukemia and acute lymphoblastic leukemia; this risk could be increased by antiblastic drugs affecting the procoagulant activity of cells and the production of coagulation inhibitors from the liver. PERSPECTIVES Thrombotic complications during hematologic diseases other than thrombophilia due to plasma alteration could be decreased not only by anticoagulant and antiaggregating agents but also by drugs inhibiting activation of leukocytes and red cells and their interaction with platelets.
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Affiliation(s)
- G Leone
- Istituto di Ematologia, Università Cattolica, largo Gemelli 8, 00168 Rome, Italy.
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