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Zinzani PL, Rambaldi A, Gaidano G, Girmenia C, Marchetti M, Pane F, Tura S, Barosi G. Infection control in patients treated for chronic lymphocytic leukemia with ibrutinib or idelalisib: recommendations from Italian society of hematology. Leuk Res 2019; 81:88-94. [PMID: 31055248 DOI: 10.1016/j.leukres.2019.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 11/19/2022]
Abstract
The introduction of new therapeutic agents in chronic lymphocytic leukemia (CLL), including the new kinase inhibitors (KIs) ibrutinib and idelalisib, has changed the therapeutic landscape of the disease. The new KIs have also changed frequency and epidemiology of infections, that represent a major cause of morbidity and mortality of the disease. Hence, the great strides in the indications and use of new KIs need parallel amelioration of prophylaxis and supportive treatment for infections. Moving from the recognition that infection control represents an unmet need, the Italian Society of Hematology (SIE) convened a panel of experts who had published and/or expressed an interest in infection complications in CLL. The goal of the project was to provide practice recommendations for the management of the infectious complications of CLL during ibrutinib or idelalisib therapy. The present publication represents the results of a series of email correspondences and meetings held during 2017 and 2018. Three domains of infectious complications during KIs therapy for CLL were explored: risk assessment, risk management and risk monitoring. We hope these recommendations will help to minimize infectious adverse events, and we believe that an optimal management of them will be rewarded by better outcomes, and better quality of life.
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Affiliation(s)
| | - Alessandro Rambaldi
- Department of Oncology-Hematology, University of Milan, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Corrado Girmenia
- Department of Hematology, Oncology and Dermatology, Azienda Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Monia Marchetti
- Hematology Unit, Oncology Department, Cardinal Massaia Hospital, Asti, Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Giovanni Barosi
- Center for the Study of Myelofibrosis. IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
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Barosi G, Passamonti F, Accorsi P, Pane F, Vannucchi AM, Velati C, Gale RP, Tura S, Barbui T. Response to "Questions arising on phlebotomy in polycythemia vera: prophylactic measures to reduce thromboembolic events require patient-focused decisions" by Heidel et al. Leukemia 2018; 32:2727-2728. [PMID: 30267006 DOI: 10.1038/s41375-018-0259-x] [Citation(s) in RCA: 1] [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: 07/20/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Giovanni Barosi
- Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
| | - Francesco Passamonti
- Department of Medicine and Surgery, University of Insubria, ASST Sette Laghi - Ospedale di Circolo, Varese, Italy
| | - Patrizia Accorsi
- Department of Hematology, Transfusion Medicine and Biotechnologies, Ospedale Civile, Pescara, Italy
| | - Fabrizio Pane
- Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Napoli, Italy
| | - Alessandro M Vannucchi
- Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, and Laboratorio Congiunto, University of Florence, Florence, Italy
| | - Claudio Velati
- Italian Society of Tranfusion Medicine and Immunohematology (SIMTI), Roma, Italy
| | - Robert Peter Gale
- Department of Medicine, Haematology Research Centre, Division of Experimental Medicine, Imperial College London, London, UK
| | | | - Tiziano Barbui
- Clinical Research Foundation (FROM), Ospedale Papa Giovanni XXIII, Bergamo, Italy
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Gugliotta L, Viganò S, D’Angelo A, Guarini A, Tura S, Mannucci PM. High Fibrinopeptide A (FPA) Levels in Acute Non-Lymphocytic Leukemia Are Reduced by Heparin Administration. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryPlasma levels of fibrinopeptide A (FPA) in 30 untreated patients with acute non-lymphocytic leukemia (ANLL) were significantly higher than in 30 healthy controls (p <0.001). Patients without laboratory signs of disseminated intravascular coagulation (DIC) had levels of FPA higher than controls (p <0.02) but markedly lower than patients with DIC (p <0.001). Five patients with M3 leukemia had a higher mean FPA level (p <0.02) and a lower peripheral blast cell count (p <0.05) than patients with other cytological subtypes of ANLL. When patients with M3 were excluded, a significant correlation was observed between the peripheral blast cell counts and the FPA levels (r = 0.66, p <0.001). FPA levels were similar with body temperature either above or below 38° C. After intravenous bolus of heparin FPA dropped to normal levels in 14 out of 17 patients who had high baseline values. These findings indicate that intravascular thrombin formation, which probably result from the expression of procoagulant activities of blast cells, is the main cause of high FPA in the majority of patients with acute non-lymphocytic leukemia.
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Affiliation(s)
- L Gugliotta
- The L. and A. Seràgnoli Institute of Hematology, University of Bologna and the Hemophilia and Thrombosis Centre, A. Bianchi Bonomi, University of Milano, Italy
| | - Silvana Viganò
- The L. and A. Seràgnoli Institute of Hematology, University of Bologna and the Hemophilia and Thrombosis Centre, A. Bianchi Bonomi, University of Milano, Italy
| | - A D’Angelo
- The L. and A. Seràgnoli Institute of Hematology, University of Bologna and the Hemophilia and Thrombosis Centre, A. Bianchi Bonomi, University of Milano, Italy
| | - Anna Guarini
- The L. and A. Seràgnoli Institute of Hematology, University of Bologna and the Hemophilia and Thrombosis Centre, A. Bianchi Bonomi, University of Milano, Italy
| | - S Tura
- The L. and A. Seràgnoli Institute of Hematology, University of Bologna and the Hemophilia and Thrombosis Centre, A. Bianchi Bonomi, University of Milano, Italy
| | - P M Mannucci
- The L. and A. Seràgnoli Institute of Hematology, University of Bologna and the Hemophilia and Thrombosis Centre, A. Bianchi Bonomi, University of Milano, Italy
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Arcioni F, Roncadori A, Di Battista V, Tura S, Covezzoli A, Cundari S, Mecucci C. Lenalidomide treatment of myelodysplastic syndromes with chromosome 5q deletion: Results from the National Registry of the Italian Drug Agency. Eur J Haematol 2018; 101:78-85. [PMID: 29569278 DOI: 10.1111/ejh.13067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The most typical cytogenetic aberration in myelodysplastic syndromes is del(5q), which, when isolated, is associated with refractory anaemia and good prognosis. Based on high rates of erythroid response and transfusion independence, Lenalidomide (LEN) became the standard treatment. This multi-centre study was designed to supplement Italian Registry data on LEN by addressing prescription, administration appropriateness, haematological and cytogenetic responses and disease evolution. METHODS MORE study was an observational, non-interventional, multi-centre, retrospective and prospective study. Cases were recruited from 45 Haematological Centres throughout Italy. Data were collected from the Italian National Registry for Lenalidomide administration and supplemented by a MORE data form. RESULTS Data from 190/213 patients were analysed. In all, 149 had been diagnosed by conventional cytogenetics (GROUP A) and 41 only by FISH (GROUP B). Overall erythroid response was obtained in 92.8% of cases. Overall cytogenetic remission was achieved in 22.6% of cases. Disease progression occurred in 15.6% of cases. Clonal cytogenetic evolution characterised progression to AML but not to higher risk MDS. CONCLUSIONS Erythroid response to Lenalidomide was similar in MDS with isolated del(5q) and with del(5q) plus one anomaly. Progression to AML or higher risk MDS showed different cytogenetic features.
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Affiliation(s)
- Francesco Arcioni
- Department of Medicine, Institute of Hematology and Center for Hemato-Oncology Research (C.R.E.O.), University of Perugia, Perugia, Italy
| | | | - Valeria Di Battista
- Department of Medicine, Institute of Hematology and Center for Hemato-Oncology Research (C.R.E.O.), University of Perugia, Perugia, Italy
| | | | | | | | - Cristina Mecucci
- Department of Medicine, Institute of Hematology and Center for Hemato-Oncology Research (C.R.E.O.), University of Perugia, Perugia, Italy
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Lauria F, Raspadori D, Foà R, Tazzari PL, Lusso P, Fierro MT, Matera L, Baccarani M, Tura S. Normal T-Lymphocyte Function in Patients with Hodgkin's Disease in Long-Lasting Remission. Tumori 2018; 72:75-80. [PMID: 2937189 DOI: 10.1177/030089168607200111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 18 patients with Hodgkin's disease (HD) in long-lasting remission (more than 5 years), the distribution of circulating T-lymphocytes was analyzed using a series of monoclonal antibodies (OKT3, T4, T8, Leu-7, Leu-11 and T10) and correlated with cell function (helper capacity in a pokeweed mitogen system and natural killer (NK) activity). A reduced proportion of OKT4 (helper/inducer)-positive cells associated with a normal absolute number was consistently accompanied by a significant increase (p < 0.005) in the proportion and absolute number of OKT8 (suppressor/cytotoxic)-positive cells. The OKT4-positive cells, despite their moderate percentage reduction, showed normal helper activity. A more extensive characterization of the lymphoid population in these patients documented a preserved cytotoxic function in a 51Cr release assay and increased proportion of cells expressing NK-associated antigens (Leu-7, Leu-11, OKT10) with a high number of cells coexpressing OKT8 and Leu-7. It is suggested that in patients with Hodgkin's disease in long-lasting remission no laboratory (or clinical) evidence of cellular immunodeficiency can be documented.
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Zinzani PL, Mazza P, Gherlinzoni F, Zanchini R, Bocchia M, Aitini E, Cavazzini G, Amurri B, Gobbi M, Tura S. Ceop Regimen in the Treatment of Advanced Low-Grade Non-Hodgkin's Lymphomas: Preliminary Report. Tumori 2018; 76:533-6. [PMID: 2284688 DOI: 10.1177/030089169007600603] [Citation(s) in RCA: 3] [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: 11/16/2022]
Abstract
Between March 1987 and December 1988, 30 previously untreated patients with low-grade non-Hodgkin's lymphomas (NHL), according to the Kiel classification, were treated by a combination of therapy including cyclophosphamide, epirubicin, vincristine, and prednisone (CEOP). Eighteen patients (60%) achieved a complete pathologic remission, and 8 patients (26.6%) had a partial response with a reduction of more than 50% of tumor-related manifestations. Four patients (13.4%) were primary resistant to CEOP. The overall survival was 96.6% with a median follow-up of 25 months from the diagnosis; none of the patients who achieved complete response relapsed at a median follow-up of 21 months from the completion of treatment. Clinical and hematologic toxicities were irrelevant. This regimen was effective in inducing a good remission rate of low-grade NHL, but a longer follow-up for definitive conclusions is warranted.
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Affiliation(s)
- P L Zinzani
- Institute of Hematology L. e A. Sergnoli, University of Bologna, Italy
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Bandini G, Ricci P, Ruggero D, Cantore M, Visani G, Tura S. Lithium and Granulocytopenia during Induction Treatment of Adult Acute Lymphoblastic Leukemia. Tumori 2018; 68:427-30. [PMID: 6960590 DOI: 10.1177/030089168206800512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Twelve adult patients with acute lymphoblastic leukemia (ALL) received lithium carbonate, 300 mg, three times a day during induction treatment. They were compared to 12 similar patients consecutively treated with the same induction regimen; patients and controls were comparable for age, degree and presence of splenomegaly, hemoglobin level, blast cell count, polymorphonuclear (PMN) cell count and platelet count at diagnosis. All patients developed a severe neutropenia. PMN count at nadir was slightly higher in the lithium group, but not at a level of statistical significance (p = 0.100). The median number of days with PMN < 1 × 109/liter was 4 in the lithium group and 14.5 in the non-lithium group (p = 0.014), while the median number of days with PMN < 0.5 × 109/liter was 0 and 2 days, respectively (p = 0.004). Duration of thrombocytopenia was similar in the 2 groups and so was the remission rate; 2 infective episodes occurred, one in the lithium group and one in the controls.
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Lauria F, Baccarani M, Barbieri E, Fiacchini M, Tura S. Combination Chemotherapy with Methotrexate, Endoxan, and Vincristine (M.E.V.) in the Treatment of non-Hodgkin's Lymphoma. Tumori 2018; 59:401-8. [PMID: 4598587 DOI: 10.1177/030089167305900602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Twelve patients with lymphocytic lymphoma (L.L.), and 9 patients with histiocytic lymphoma (H.L.), stage III and IV, were treated as outpatients with combination chemotherapy including six courses of cyclophosphamide (Endoxan), Methotrexate, and vincristine (M.E.V. regimen). Marrow depression and side-effects were moderate. In the 12 patients with L.L., there were 6 complete remissions (C.R.), 3 incomplete remission (I.R.), and 3 partial failures (P.F.). In the 9 patients with H.L., there were 7 C.R., 1 I.R. and 1 P.F. Median survival from the end of the therapy is 7 + mos. for the L.L. patients, and 10 + mos. for H.L. patients, all patients being alive but one.
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Guglielmelli P, Pietra D, Pane F, Pancrazzi A, Cazzola M, Vannucchi AM, Tura S, Barosi G. Recommendations for molecular testing in classical Ph1-neg myeloproliferative disorders-A consensus project of the Italian Society of Hematology. Leuk Res 2017; 58:63-72. [PMID: 28460339 DOI: 10.1016/j.leukres.2017.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 02/06/2017] [Revised: 03/26/2017] [Accepted: 04/20/2017] [Indexed: 12/21/2022]
Abstract
The discovery that Philadelphia-negative classical myeloproliferative neoplasms (MPNs) present with several molecular abnormalities, including the mostly represented JAK2V617F mutation, opened new horizons in the diagnosis, prognosis, and monitoring of these disorders. However, the great strides in the knowledge on molecular genetics need parallel progresses on the best approach to methods for detecting and reporting disease-associated mutations, and to shape the most effective and rationale testing pathway in the diagnosis, prognosis and monitoring of MPNs. The MPN taskforce of the Italian Society of Hematology (SIE) assessed the scientific literature and composed a framework of the best, possibly evidence-based, recommendations for optimal molecular methods as well as insights about the applicability and interpretation of those tests in the clinical practice, and clinical decision for testing MPNs patients. The issues dealt with: source of samples and nucleic acid template, the most appropriate molecular abnormalities and related detection methods required for diagnosis, prognosis, and monitoring of MPNs, how to report a diagnostic molecular test, calibration and quality control. For each of these issues, practice recommendations were provided.
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Affiliation(s)
- Paola Guglielmelli
- CRIMM-Centro Ricerca e Innovazione delle Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniela Pietra
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Alessandro Pancrazzi
- CRIMM-Centro Ricerca e Innovazione delle Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mario Cazzola
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Department of Haematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Alessandro M Vannucchi
- CRIMM-Centro Ricerca e Innovazione delle Malattie Mieloproliferative, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Giovanni Barosi
- Center for the Study of Myelofibrosis, Biotechnology Research Area, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico S. Matteo, Pavia, Italy.
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Palareti G, Finelli C, Poggi M, Tricarico M, Fiacchini M, Ricci P, Tura S, Coccheri S. Haemorheology in treated polycythaemia vera: The role of hypochromic mycrocytosis and of plasma viscosity. Clin Hemorheol Microcirc 2016. [DOI: 10.3233/ch-1986-6111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G. Palareti
- Dept. Angiology and Blood Coagulation, University Hospital S.Orsola, Bologna, Italy
| | - C. Finelli
- Inst. of Haematology “Lorenzo e Ariosto Seragnoli”, University Hospital S. Orsola, Bologna, Italy
| | - M. Poggi
- Dept. Angiology and Blood Coagulation, University Hospital S.Orsola, Bologna, Italy
| | - M.G. Tricarico
- Dept. Angiology and Blood Coagulation, University Hospital S.Orsola, Bologna, Italy
| | - M. Fiacchini
- Inst. of Haematology “Lorenzo e Ariosto Seragnoli”, University Hospital S. Orsola, Bologna, Italy
| | - P. Ricci
- Inst. of Haematology “Lorenzo e Ariosto Seragnoli”, University Hospital S. Orsola, Bologna, Italy
| | - S. Tura
- Inst. of Haematology “Lorenzo e Ariosto Seragnoli”, University Hospital S. Orsola, Bologna, Italy
| | - S. Coccheri
- Dept. Angiology and Blood Coagulation, University Hospital S.Orsola, Bologna, Italy
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Zinzani PL, Corradini P, Martelli M, Minotti G, Oliva S, Spina M, Barosi G, Tura S. Critical concepts, practice recommendations, and research perspectives of pixantrone therapy in non-Hodgkin lymphoma: a SIE, SIES, and GITMO consensus paper. Eur J Haematol 2016; 97:554-561. [PMID: 27124765 DOI: 10.1111/ejh.12768] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In this paper, we present a review of critical concepts and research perspectives and produce recommendations on the optimal use of pixantrone in non-Hodgkin lymphoma (NHL) by group discussion from an expert panel appointed by the Italian Society of Hematology and the affiliate societies, Società Italiana di Ematologia Sperimentale and Gruppo Italiano Trapianto di Midollo Osseo. METHODS Recommendations were produced using the Delphi process. Scientific evidence on pixantrone efficacy was analyzed using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology in the areas where at least one randomized trial was published. The following key issues were addressed for practical recommendations: pixantrone monotherapy in aggressive relapsed or refractory non-Hodgkin B-cell lymphomas and toxicity risk management in patients candidates to pixantrone. RESULTS AND CONCLUSIONS After a balanced and value-oriented discussion, the panel agreed that the benefit/risk profile was in favor of pixantrone in the treatment of adult patients with multiply relapsed or refractory aggressive NHL B-cell lymphomas. Pixantrone was deemed to be contraindicated in patients with uncontrolled cardiovascular disease. Despite a low rate of cardiotoxicity of pixantrone reported in clinical trials, the panel recommended that all patients receiving pixantrone should undergo periodical cardiac monitoring.
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Affiliation(s)
- Pier Luigi Zinzani
- Institute of Hematology "Seràgnoli", University of Bologna, Bologna, Italy
| | - Paolo Corradini
- Division of Hematology and Bone Marrow Transplantation, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milano, Milan, Italy
| | - Maurizio Martelli
- Dipartimento Biotecnologie Cellulari ed Ematologia, Universitá La Sapienza, Rome, Italy
| | - Giorgio Minotti
- Department of Medicine and Units of Drug Sciences and Clinical Pharmacology, University Campus Bio-Medico, Rome, Italy
| | - Stefano Oliva
- Cardiology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy
| | - Michele Spina
- Division of Medical Oncology A, National Cancer Institute, Aviano, Italy
| | - Giovanni Barosi
- Center of the Study of Myelofibrosis, Biotechnology Research Area, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
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Zinzani PL, Corradini P, Gianni AM, Federico M, Santoro A, Vitolo U, Barosi G, Tura S. Brentuximab Vedotin in CD30-Positive Lymphomas: A SIE, SIES, and GITMO Position Paper. Clinical Lymphoma Myeloma and Leukemia 2015. [DOI: 10.1016/j.clml.2015.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Tarella C, Arcaini L, Baldini L, Barosi G, Billio A, Marchetti M, Rambaldi A, Vitolo U, Zinzani PL, Tura S. Italian Society of Hematology, Italian Society of Experimental Hematology, and Italian Group for Bone Marrow Transplantation Guidelines for the Management of Indolent, Nonfollicular B-Cell Lymphoma (Marginal Zone, Lymphoplasmacytic, and Small Lymphocytic Lymphoma). Clinical Lymphoma Myeloma and Leukemia 2015; 15:75-85. [DOI: 10.1016/j.clml.2014.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 07/03/2014] [Accepted: 07/08/2014] [Indexed: 12/19/2022]
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Corradini P, Marchetti M, Barosi G, Billio A, Gallamini A, Pileri S, Pimpinelli N, Rossi G, Zinzani P, Tura S. SIE-SIES-GITMO Guidelines for the management of adult peripheral T- and NK-cell lymphomas, excluding mature T-cell leukaemias. Ann Oncol 2014; 25:2339-2350. [DOI: 10.1093/annonc/mdu152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Zinzani PL, Rigacci L, Cox MC, Devizzi L, Fabbri A, Zaccaria A, Zaja F, Di Rocco A, Rossi G, Storti S, Fattori PP, Argnani L, Tura S, Vitolo U. Lenalidomide monotherapy in heavily pretreated patients with non-Hodgkin lymphoma: an Italian observational multicenter retrospective study in daily clinical practice. Leuk Lymphoma 2014; 56:1671-6. [PMID: 25241999 DOI: 10.3109/10428194.2014.964702] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Clinical trial results indicate that lenalidomide, an immunomodulatory drug, is a promising treatment in relapsed/refractory non-Hodgkin lymphoma (NHL). This retrospective multicenter study was conducted in patients with relapsed/refractory NHL treated with lenalidomide monotherapy through a Named Patient Program in Italy. Principal endpoints were overall response rate (ORR), safety and overall survival (OS). The ORR in 64 evaluable patients was 42.2% and was similar among patients receiving 10, 15 or 25 mg/day lenalidomide. Response rates in patients with mantle cell, diffuse large B-cell and follicular lymphoma were 45.5%, 42.1% and 20%, respectively. Among patients who responded to most recent prior therapy, ORR was 50.0% versus 36.8% in patients with refractory NHL. Mean duration of response in patients receiving any lenalidomide dose was 10.5 months; 1-year progression-free survival and OS were 50.3% and 82.6%, respectively. These findings suggest that lenalidomide is effective and safe for heavily pretreated patients with NHL in the clinical setting.
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Affiliation(s)
- Pier Luigi Zinzani
- Institute of Haematology "L. e A. Seràgnoli", University of Bologna , Italy
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Cuneo A, Marchetti M, Barosi G, Billio A, Brugiatelli M, Ciolli S, Laurenti L, Mauro FR, Molica S, Montillo M, Zinzani P, Tura S. Appropriate use of bendamustine in first-line therapy of chronic lymphocytic leukemia. Recommendations from SIE, SIES, GITMO Group. Leuk Res 2014; 38:1269-77. [DOI: 10.1016/j.leukres.2014.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/08/2014] [Accepted: 06/28/2014] [Indexed: 01/09/2023]
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Onida F, Barosi G, Leone G, Malcovati L, Morra E, Santini V, Specchia G, Tura S. Management recommendations for chronic myelomonocytic leukemia: consensus statements from the SIE, SIES, GITMO groups. Haematologica 2014; 98:1344-52. [PMID: 24006407 DOI: 10.3324/haematol.2013.084020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
With the aim of reviewing critical concepts and producing recommendations for the management of chronic myelomonocytic leukemia, key questions were selected according to the criterion of clinical relevance. Recommendations were produced using a Delphi process and four consensus conferences involving a panel of experts appointed by the Italian Society of Hematology and affiliated societies. This report presents the final statements and recommendations, covering patient evaluation at diagnosis, diagnostic criteria, risk classification, first-line therapy, monitoring, second-line therapy and allogeneic stem cell transplantation. For the first-line therapy, the panel recommended that patients with myelodysplastic-type chronic myelomonocytic leukemia and less than 10% blasts in bone marrow should be managed with supportive therapy aimed at correcting cytopenias. In patients with myelodysplastic-type chronic myelomonocytic leukemia with a high number of blasts in bone marrow (≥ 10%), supportive therapy should be integrated with the use of 5-azacytidine. Patients with myeloproliferative-type chronic myelomonocytic leukemia with a low number of blasts (<10%) should be treated with cytoreductive therapy. Hydroxyurea is the drug of choice to control cell proliferation and to reduce organomegaly. Patients with myeloproliferative-type chronic myelomonocytic leukemia, and a high number of blasts should receive polychemotherapy. Both in myelodysplastic-type and myeloproliferative-type chronic myelomonocytic leukemia, allogeneic stem cell transplantation should be offered within clinical trials in selected patients.
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Affiliation(s)
- Francesco Onida
- Hematology - Bone Marrow Transplantation Center, Fondazione IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Angelucci E, Santini V, Di Tucci AA, Quaresmini G, Finelli C, Volpe A, Quarta G, Rivellini F, Sanpaolo G, Cilloni D, Salvi F, Caocci G, Molteni A, Vallisa D, Voso MT, Fenu S, Borin L, Latte G, Alimena G, Storti S, Piciocchi A, Fazi P, Vignetti M, Tura S. Deferasirox for transfusion-dependent patients with myelodysplastic syndromes: safety, efficacy, and beyond (GIMEMA MDS0306 Trial). Eur J Haematol 2014; 92:527-36. [DOI: 10.1111/ejh.12300] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Emanuele Angelucci
- Hematology and Bone Marrow Transplantation Unit; Ospedale Oncologico di Riferimento Regionale “Armando Businco”; Cagliari Italy
| | - Valeria Santini
- Division of Hematology; University of Florence; Florence Italy
| | - Anna Angela Di Tucci
- Hematology and Bone Marrow Transplantation Unit; Ospedale Oncologico di Riferimento Regionale “Armando Businco”; Cagliari Italy
| | - Giulia Quaresmini
- Hematology and Bone Marrow Transplant Unit; Azienda Ospedaliera Papa Giovanni XXIII; Bergamo Italy
| | - Carlo Finelli
- Division of Hematology; Policlinico S. Orsola-Malpighi; Bologna Italy
| | - Antonio Volpe
- Division of Hematology; San Giuseppe Moscati Hospital; Avellino Italy
| | | | - Flavia Rivellini
- UO Medicina Interna e Onco-Ematologica P.O. “Umberto I”; Nocera Inferiore Italy
| | - Grazia Sanpaolo
- Division of Hematology; IRCCS “Casa Sollievo della Sofferenza”; San Giovanni Rotondo Italy
| | - Daniela Cilloni
- Department of Clinical and Biological Sciences; University of Turin; Turin Italy
| | - Flavia Salvi
- Division of Hematology; A.O. Nazionale Santi Antonio e Biagio e C. Arrigo; Alessandria Italy
| | - Giovanni Caocci
- Bone Marrow Transplantation Center; R. Binaghi Hospital; Cagliari Italy
| | - Alfredo Molteni
- Division of Hematology; Niguarda Ca’ Granda Hospital; Milan Italy
| | - Daniele Vallisa
- Division of Medical Oncology and Hematology; Hospital of Piacenza; Piacenza Italy
| | - Maria Teresa Voso
- Division of Hematology; Università Cattolica del Sacro Cuore; Rome Italy
| | - Susanna Fenu
- Division of Hematology; San Giovanni Hospital; Rome Italy
| | | | | | - Giuliana Alimena
- Division of Hematology; “Sapienza”University of Rome; Rome Italy
| | - Sergio Storti
- Division of Hematology and Medical Oncology; Campobasso University; Campobasso Italy
| | | | - Paola Fazi
- GIMEMA Data Center; GIMEMA Foundation; Rome Italy
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Barosi G, Vannucchi AM, De Stefano V, Pane F, Passamonti F, Rambaldi A, Saglio G, Barbui T, Tura S. Identifying and addressing unmet clinical needs in Ph-neg classical myeloproliferative neoplasms: a consensus-based SIE, SIES, GITMO position paper. Leuk Res 2013; 38:155-60. [PMID: 24378116 DOI: 10.1016/j.leukres.2013.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [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: 09/09/2013] [Accepted: 09/11/2013] [Indexed: 12/31/2022]
Abstract
This article presents the results of group discussion among experts from SIE, SIES and GITMO societies aimed at highlighting unmet challenges in the management of Ph-neg myeloproliferative neoplasms (MPNs). The issues analyzed were: diagnosis of prefibrotic myelofibrosis; diagnosis of Ph-neg MPNs in the setting of splanchnic vein thrombosis (SVT); management of low-risk PV and low-risk ET patients with JAK2V617F mutation; molecular biomarkers in the prognostic evaluation of myelofibrosis (MF); ruxolitinib therapy in low-risk MF; therapy in patients with SVT-associated Ph-neg MPN; indications of splenectomy in MF. For each of these issues, proposals for advancement in clinical research were addressed.
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Affiliation(s)
- Giovanni Barosi
- Center for the Study of Myelofibrosis, Biotechnology Research Area, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
| | | | | | | | | | | | - Giuseppe Saglio
- Division of Hematology and Internal Medicine, Department of Clinical and Biological Sciences of the University of Turin, San Luigi Gonzaga University Hospital, Turin, Italy
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20
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Ferrara F, Barosi G, Venditti A, Angelucci E, Gobbi M, Pane F, Tosi P, Zinzani P, Tura S. Consensus-based definition of unfitness to intensive and non-intensive chemotherapy in acute myeloid leukemia: a project of SIE, SIES and GITMO group on a new tool for therapy decision making. Leukemia 2013; 27:997-9. [DOI: 10.1038/leu.2012.303] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [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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21
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Zinzani PL, Marchetti M, Billio A, Barosi G, Carella AM, Lazzarino M, Martelli M, Rambaldi A, Rigacci L, Tarella C, Vitolo U, Tura S. SIE, SIES, GITMO revised guidelines for the management of follicular lymphoma. Am J Hematol 2013; 88:185-92. [PMID: 23339086 DOI: 10.1002/ajh.23372] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 11/15/2012] [Accepted: 11/19/2012] [Indexed: 12/26/2022]
Abstract
By using the GRADE system, we updated the guidelines for management of follicular cell lymphoma issued in 2006 from SIE, SIES, and GITMO group. We confirmed our recommendation to frontline chemoimmunotherapy in patients with Stage III-IV disease and/or high tumor burden. Maintenance rituximab was also recommended in responding patients. In patients relapsing after an interval longer than 12 months from frontline therapy, we recommended chemoimmunotherapy with non cross-resistant regimens followed by rituximab maintenance. High dose chemotherapy followed by hematopoietic stem cell transplant was recommended for young fit patients who achieve a response after salvage chemoimmunotherapy.
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Affiliation(s)
- Pier Luigi Zinzani
- Istituto di Ematologia ed Oncologia Medica “Seragnoli,”; Università di Bologna; Bologna; Italy
| | | | - Atto Billio
- Unità di Ematologia; Ospedale Civile di Bolzano; Bolzano; Italy
| | - Giovanni Barosi
- Laboratory of Clinical Epidemiology and Center of the Study of Myelofibrosis; Fondazione IRCCS Policlinico San Matteo; Pavia; Italy
| | - Angelo Michele Carella
- Divisione di Ematologia I; IRCCS Azienda Ospedaliera Universitaria San Martino; Genova; Italy
| | - Mario Lazzarino
- Divisione di Ematologia; Fondazione IRCCS Policlinico San Matteo; Pavia; Italy
| | - Maurizio Martelli
- Dipartimento di Biotecnologie Cellulari ed Ematologia; Cattedra di Ematologia; Università La Sapienza; Roma
| | | | - Luigi Rigacci
- Unit of Hematology; AOU Careggi; University of Florence; Firenze; Italy
| | | | - Umberto Vitolo
- Divisione di Ematologia; Azienda Ospedaliera San Giovanni Battista; Torino; Italy
| | - Sante Tura
- Department of Hematology; University of Bologna; Bologna; Italy
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22
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Barosi G, Bosi A, Abbracchio MP, Danesi R, Genazzani A, Corradini P, Pane F, Tura S. Key concepts and critical issues on epoetin and filgrastim biosimilars. A position paper from the Italian Society of Hematology, Italian Society of Experimental Hematology, and Italian Group for Bone Marrow Transplantation. Haematologica 2011; 96:937-42. [PMID: 21719882 DOI: 10.3324/haematol.2011.041210] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Giovanni Barosi
- Laboratory of Clinical Epidemiology and Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
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23
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Oliva EN, Piccin A, Mazzucconi MG, Morra E, Recine U, Pogliani EM, Pane F, Gobbi M, Gugliotta L, Krampera M, Cascavilla N, Cacciola R, Cacciola E, Fioritoni G, Fanin R, Liberati AM, Angelucci E, Tura S. Quality of life in elderly patients with essential thrombocythaemia. An Italian multicentre study. Ann Hematol 2011; 91:527-32. [DOI: 10.1007/s00277-011-1341-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 09/12/2011] [Indexed: 11/28/2022]
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24
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Mauro FR, Bandini G, Barosi G, Billio A, Brugiatelli M, Cuneo A, Lauria F, Liso V, Marchetti M, Meloni G, Montillo M, Zinzani P, Tura S. SIE, SIES, GITMO updated clinical recommendations for the management of chronic lymphocytic leukemia. Leuk Res 2011; 36:459-66. [PMID: 21885123 DOI: 10.1016/j.leukres.2011.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Revised: 08/12/2011] [Accepted: 08/15/2011] [Indexed: 11/24/2022]
Abstract
By using GRADE system we updated the guidelines for management of CLL issued in 2006 from SIE, SIES and GITMO group. We recommended fludarabine, cyclophosphamide, rituximab (FCR) in younger and selected older patients with a good fitness status, no unfavourable genetics (deletion 17p and/or p53 mutations), and a less toxic treatment in nonfit and elderly patients. In patients without unfavourable genetics, relapsed after 24 months the same initial treatment including rituximab can be considered. In patients with unfavourable genetics, refractory or relapsed within 24 months from a prior fludarabine-based treatment, allogeneic SCT or experimental treatments should be given.
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Affiliation(s)
- Francesca Romana Mauro
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Università degli Studi La Sapienza, Roma, Italy
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25
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Angelucci E, Di Tucci A, Storti S, Magro D, Tosi P, Amadori S, Leoni P, Gobbi M, Brugiatelli M, Pane F, Visani G, Nobile F, Lauria F, Fanin R, Specchia G, Ditonno P, Rossi G, Forni G, Abbadessa A, Olivieri A, Porcedda S, Pilo F, Piciocchi A A, Vignetti M, Tura S. 208 Iron chelation therapy with deferasirox in transfusion dependent myelodysplastic syndrome patients. Preliminary report from the prospective MDS0306 GIMEMA trial. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70210-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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26
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Santini V, Alessandrino PE, Angelucci E, Barosi G, Billio A, Di Maio M, Finelli C, Locatelli F, Marchetti M, Morra E, Musto P, Visani G, Tura S. Clinical management of myelodysplastic syndromes: update of SIE, SIES, GITMO practice guidelines. Leuk Res 2010; 34:1576-88. [PMID: 20149927 DOI: 10.1016/j.leukres.2010.01.018] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 01/11/2010] [Accepted: 01/17/2010] [Indexed: 12/13/2022]
Affiliation(s)
- V Santini
- Functional Unit of Haematology, AOU Careggi, University of Florence, Firenze, Italy.
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27
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Vitolo U, Barosi G, Fanti S, Gianni AM, Martelli M, Petrini M, Zinzani PL, Tura S. Consensus conference on the use of 90-yttrium-ibritumomab tiuxetan therapy in clinical practice. A project of the Italian society of hematology. Am J Hematol 2010; 85:147-55. [PMID: 20095035 DOI: 10.1002/ajh.21602] [Citation(s) in RCA: 3] [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] [Indexed: 11/08/2022]
Affiliation(s)
- Umberto Vitolo
- Department of Oncology and Hematology, Hematology 2, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy.
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28
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Zinzani PL, Tani M, Gabriele A, Gherlinzoni F, De Vivo A, Ricci P, Bandini G, Lemoli RM, Motta MR, Rizzi S, Guidice V, Zompatori M, Stefoni V, Alinari L, Musuraca G, Marchi E, Bassi S, Conte R, Pileri S, Tura S, Baccarani M. High-Dose Therapy with Autologous Transplantation for Aggressive Non-Hodgkin's Lymphoma: The Bologna Experience. Leuk Lymphoma 2009; 45:321-6. [PMID: 15101718 DOI: 10.1080/10428190310001597900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Patients with aggressive non-Hodgkin's lymphoma (NHL) who relapse after initial therapy have a poor prognosis and with standard dose salvage therapy the outlook remains poor. In this work we examine the patient characteristics and outcome of patients with aggressive NHL treated with HDT and autologous transplantation at our Institute from 1982 to 1999. A retrospective analysis was performed examining patient characteristics, prior chemotherapy regimens, pretransplant disease status, HDT regimen, source of stem cells, time for hematopietic recovery, complications of transplantation, response rates, overall survival (OS) and relapse-free survival (RFS). One hundred and thirty-four patients with aggressive NHL were treated with estimated 10-year OS and RFS rates of 50% and 66%, respectively. Disease status (sensitive vs. refractory) pre-HDT was the most powerful predictive parameter for OS and RFS, at both univariate and multivariate analysis. For the entire cohort, transplant-related mortality was only 3.5% without evidence of second malignancies. Our results confirm that HDT with autologous transplantation is associated with a durable RFS in a remarkable proportion of aggressive NHL patients with very low global early and late toxicity. Improved patient selection, transplant timing, ongoing improvements in supportive care, and selected phase III trials should increase outcomes further.
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Affiliation(s)
- Pier Luigi Zinzani
- Institute of Hematology and Medical Oncology L. e A. Seràgnoli, University of Bologna, Italy.
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29
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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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30
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Visani G, Isidori A, Grafone T, Tosi P, Santini V, Malagola M, Martinelli G, Piccaluga PP, Gaziev D, Ottaviani E, Sparaventi G, Tura S. No Preferential Sensitivity of t(8;21) Acute Myeloid Leukemias to Cytosine Arabinoside in Vitro: Is Intensity of Therapy or High Dose Ara-C Crucial for Response? Leuk Lymphoma 2009; 45:1361-4. [PMID: 15359633 DOI: 10.1080/10428190310001653673] [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: 10/26/2022]
Abstract
Acute myeloid leukemia (AML) patients with core binding factor abnormalities [inv(16) or t(8;21)] have a relatively good prognosis, especially patients with inv(16) when treated with high-dose cytosine arabinoside (AraC) containing regimens, whereas in the case of t(8;21) evidences in favor of such regimen are contrasting. We previously demonstrated that blast cells from inv(16)-positive AML patients are characterized by an increased sensitivity to AraC with higher incorporation of 3H AraC into DNA and the increase of induced apoptosis in vitro. In the present study we tested the sensitivity of leukemic cells from 15 t(8;21)-positive AML patients to AraC and compared it with the results obtained from cells of 74 patients with inv(16), "intermediate" or "unfavourable" karyotype at diagnosis (for a total of 89 patients). The incorporation of 3H AraC into DNA in cells with t(8;21) was significantly lower than in cells with inv(16) (P = 0.02) or normal karyotype (P = 0.04). Interestingly, the incorporation of the drug into DNA in t(8;21) cells was similar to those with "unfavourable" karyotype. Furthermore, AraC induced apoptosis in t(8;21)-positive AML cells was not increased. These data suggest that the mechanism of response to chemotherapy for t(8;21)-positive cells is probably different then in AML cells with inv(16), underlining the possible importance for patients carrying the t(8;21) of repeated high-dose regimens and not necessarily of high-dose AraC based ones.
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MESH Headings
- Acute Disease
- Adult
- Aged
- Apoptosis/drug effects
- Chromosomes, Human, Pair 21/genetics
- Chromosomes, Human, Pair 21/ultrastructure
- Chromosomes, Human, Pair 8/genetics
- Chromosomes, Human, Pair 8/ultrastructure
- Cytarabine/administration & dosage
- Cytarabine/pharmacology
- DNA, Neoplasm/drug effects
- Drug Resistance, Neoplasm
- Female
- Humans
- Leukemia, Myeloid/drug therapy
- Leukemia, Myeloid/genetics
- Leukemia, Myeloid/pathology
- Male
- Middle Aged
- Translocation, Genetic
- Tumor Cells, Cultured/drug effects
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Santucci MA, Visani G, Russo D, Zaccaria A, Testoni N, Tosi P, Zuffa E, Fanin R, Tura S. In Vitro Activity of Alpha-Interferon on Granulocyte-Macrophage Precursors in Chronic Myeloid Leukemia (CML): Correlation with Clinical Responsiveness. Leuk Lymphoma 2009. [DOI: 10.3109/10428199209064889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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32
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Tazzari PL, Bontadini A, Gobbi M, Tassi C, Dinota A, Visani G, Michieli MG, Pileri S, Baccarani M, Tura S. Comparison of the DNA Content, Bromodeoxyuridine Incorporation and Ki-67 Antigen Expression in Human Acute Myeloid Leukemia. Leuk Lymphoma 2009; 3:45-51. [DOI: 10.3109/10428199009050974] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gahrton G, Tura S, Belanger C, Cavo M, Chapvis B, Ferrant A, Flesch M, Gore M, Gratwohl A, Gravett PJ. Allogeneic bone marrow transplantation in patients with multiple myeloma. Eur J Haematol Suppl 2009; 51:182-5. [PMID: 2697589 DOI: 10.1111/j.1600-0609.1989.tb01514.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
50 patients with a median age of 41 years (range 29-54) underwent allogenic bone marrow transplantation for multiple myeloma. 35 patients were on second-line treatment, and 15 on first-line treatment. 24 patients were considered refractory to previous treatment. 45 patients received marrow from HLA-matched sibling donors (3 of these from twin donors), and 5 from unrelated or related non-sibling donors. 21 patients entered complete remission, while 15 had persistent disease following repopulation of the marrow. 14 patients were not evaluable for remission status because of early transplantation-related death. The overall median survival from bone marrow transplantation was 27 months, with a projected long-term survival of 34%. Patients who were 40 yr of age or older had a survival that was not different from that of patients between 29 and 40 yr of age. The median disease-free survival of patients who entered complete remissions was 41 months. These patients tended to have a longer survival than patients with persistent disease following repopulation of the marrow. Allogeneic bone marrow transplantation appears to be a promising method for treatment of certain patients with multiple myeloma.
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Cavo M, Galieni P, Grimaldi M, Zuffa E, Bonelli MA, Gobbi M, Tura S. Improvement of Durie & Salmon staging for multiple myeloma by adding platelet count as a stratifying variable: a multivariate regression analysis of 163 untreated patients. Eur J Haematol Suppl 2009; 51:99-104. [PMID: 2697598 DOI: 10.1111/j.1600-0609.1989.tb01500.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The presenting clinical features of 163 previously untreated patients with multiple myeloma were correlated with survival duration using univariate and multivariate regression analyses. The univariate proportional hazard analysis ranked the parameters in the following order of importance: platelet count, haemoglobin level (Hb), tumour cell mass stage, lytic bone lesions, creatinine and age. When the individual contribution of each variable was assessed by multivariate regression analysis, platelet count was confirmed to be the dominant feature for prognosis, while clinical stage provided additional information. The introduction of platelet count could then be used to improve the discriminating power of Durie & Salmon staging, by allowing separation of the high-risk group (stages II and III) into a smaller subgroup (22%) of thrombocytopenic patients (less than 150 x 10(9) platelets/l) whose risk of death was actually very high (median survival: 9 months) and a larger subgroup (46%) of patients with normal platelet count and intermediate or standard risk (median survival: 48 months).
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Lauria F, Zinzani PL, Raspadori D, Foà R, Buzzi M, Gugliotta L, Bocchia M, Benfenati D, Tura S. Relationship between immunological phenotype and hematological response to alpha-IFN treatment in 35 patients with hairy cell leukemia. Eur J Haematol Suppl 2009; 52:3-6. [PMID: 2279543 DOI: 10.1111/j.1600-0609.1990.tb00895.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
During the past 6 years, clinical trials employing alpha-interferon (alpha-IFN) in hairy cell leukemia (HCL) have shown dramatic improvement in the management of this disease. Complete remissions (CR), however, are relatively rare (10-15%) and a minority of patients (10-25%) do not respond adequately to alpha-IFN. The possibility that the poor response to alpha-IFN treatment could be related to a peculiar immunological phenotype of the hairy cell (HC) was investigated in this study. The results demonstrated that, in the majority of patients who failed to respond to alpha-IFN, HC showed an immunological phenotype characterized by positivity with the CD5 monoclonal antibody which is usually absent on HC and characteristically expressed on B-chronic lymphocytic leukemia cells. In fact, among the 10 HCL patients who presented with this phenotype, only 5 partial remissions (PR) and 5 minor responses (MR) were achieved, as opposed to the 3 complete remissions (CR), 19 PR and 3 MR observed in the 25 CD5-negative patients. The possibility that a more extensive immunological analysis of HCL patients at diagnosis may be predictive of the response to IFN treatment is postulated.
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Affiliation(s)
- F Lauria
- Istituto di Ematologia e A. Seràgnoli, University of Bologna, Italy
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Tura S, Cavo M, Gobbi M, Rosti G, Bandini G, Miggiano C, Albertazzi L, Grimaldi M, Visani G. High-dose chemoradiotherapy and allogenic bone marrow transplantation in multiple myeloma. Eur J Haematol Suppl 2009; 51:191-5. [PMID: 2697591 DOI: 10.1111/j.1600-0609.1989.tb01516.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
17 patients with multiple myeloma (MM) received marrow transplants from their HLA-matched, MLC-negative sibling donors. 9 patients had progressive disease not responding to conventional treatments, while the other 8 patients were rated as responders. The most frequently used conditioning regimen consisted of total body irradiation and high-dose, multi-agent chemotherapy with cyclophosphamide plus either oral melphalan (5 cases) or BCNU (1 case) on both these drugs (7 cases). 12 patients were evaluable for response to BTM: 7 of them (6 responders and 1 with advanced refractory MM) entered complete remission, while 5 had a sustained decrease in tumor mass that ranged between 72% and 93%. 11 patients died of transplant-related causes, 1 of them with signs of progressive disease. The remaining 6 patients are alive and 5 of them maintain a complete remission status 4 to 67 (median 36) months after BMT. It is concluded that therapeutic benefits of transplantation in MM are still offset by the high mortality related to the procedure. A more accurate selection of patients who would most benefit from BMT and performing transplant at an earlier phase of the disease are warranted before major advances can be made in the cure of these patients.
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Mazza P, Tura S, Bocchia M, Zinzani PL, Gherlinzoni F, Mandelli F, Anselmo MP, Papa G, Antimi M, Gobbi PG. Alpha-2b recombinant interferon (Intron) in Hodgkin's lymphoma: therapeutic perspective. Eur J Haematol Suppl 2009; 52:22-4. [PMID: 2279540 DOI: 10.1111/j.1600-0609.1990.tb00900.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In an ongoing phase II study we are evaluating the role of alpha-2b recombinant interferon in Hodgkin's disease; the study design includes patients with high-risk parameters who are treated by combination chemotherapy MOPP, ABVD, MOPP + ABVD or equivalent combinations. At the end of the therapeutic program which could include also radiotherapy, patients will be randomly assigned to receive alpha-2b interferon at 3 MU/day over 3 months and then 3 MU/three times/week over 9 months or no further treatment. Up to September 1989, 107 patients were randomized; evaluable patients with a minimum follow-up of 3 months are 95, 56 in the arm of interferon and 39 in the arm of no further treatment. The results are preliminary and differences could not be disclosed between the two arms concerning either the relapse rate or the incidence of infections. Tolerance and toxicity due to alpha-2b interferon in patients with Hodgkin's disease could be defined as acceptably good considering that mild and reversible hematological toxicity was experienced in 12 (21%) patients; objective clinical toxicity was recorded in 4 (7%) patients although 7 (12%) patients refused to continue the treatment. Definite conclusions will be drawn when 100 patients per arm become evaluable.
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Affiliation(s)
- P Mazza
- Institute of Hematology L. e A. Seràgnoli, Bologna, Italy
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Brusamolino E, Bacigalupo A, Barosi G, Biti G, Gobbi PG, Levis A, Marchetti M, Santoro A, Zinzani PL, Tura S. Classical Hodgkin's lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up. Haematologica 2009; 94:550-65. [PMID: 19278966 PMCID: PMC2663619 DOI: 10.3324/haematol.2008.002451] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 12/01/2008] [Accepted: 12/19/2008] [Indexed: 11/09/2022] Open
Abstract
The Italian Society of Hematology (SIE), the Italian Society of Experimental Haematology (SIES) and the Italian Group for Bone Marrow Transplantation (GITMO) commissioned a project to develop practice guidelines for the initial work-up, therapy and follow-up of classical Hodgkin's lymphoma. Key questions to the clinical evaluation and treatment of this disease were formulated by an Advisory Committee, discussed and approved by an Expert Panel (EP) composed of senior hematologists and one radiotherapist. After a comprehensive and systematic literature review, the EP recommendations were graded according to their supporting evidence. An explicit approach to consensus methodologies was used for evidence interpretation and for producing recommendations in the absence of a strong evidence. The EP decided that the target domain of the guidelines should include only classical Hodgkin's lymphoma, as defined by the WHO classification, and exclude lymphocyte predominant histology. Distinct recommendations were produced for initial work-up, first-line therapy of early and advanced stage disease, monitoring procedures and salvage therapy, including hemopoietic stem cell transplant. Separate recommendations were formulated for elderly patients. Pre-treatment volumetric CT scan of the neck, thorax, abdomen, and pelvis is mandatory, while FDG-PET is recommended. As to the therapy of early stage disease, a combined modality approach is still recommended with ABVD followed by involved-field radiotherapy; the number of courses of ABVD will depend on the patient risk category (favorable or unfavorable). Full-term chemotherapy with ABVD is recommended in advanced stage disease; adjuvant radiotherapy in patients without initial bulk who achieved a complete remission is not recommended. In the elderly, chemotherapy regimens more intensive than ABVD are not recommended. Early evaluation of response with FDG-PET scan is suggested. Relapsed or refractory patients should receive high-dose chemotherapy and autologous hemopoietic stem cells transplant. Allogeneic transplant is recommended in patients relapsing after autologous transplant. All fertile patients should be informed of the possible effects of therapy on gonadal function and fertility preservation measures should be taken before the initiation of therapy.
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Affiliation(s)
- Ercole Brusamolino
- Clinica Ematologica, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Pavia 27100, Italy.
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Angelucci E, Barosi G, Marchetti M, Tura S. Italian Society of Hematology guidelines for thalassemia and non-invasive iron measurements: author reply. Haematologica 2009. [DOI: 10.3324/haematol.2008.001651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Morra E, Barosi G, Bosi A, Ferrara F, Locatelli F, Marchetti M, Martinelli G, Mecucci C, Vignetti M, Tura S. Clinical management of primary non-acute promyelocytic leukemia acute myeloid leukemia: Practice Guidelines by the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation. Haematologica 2008; 94:102-12. [PMID: 19001282 DOI: 10.3324/haematol.13166] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
As many options are now available to treat patients with de novo acute myeloid leukemia, the Italian Society of Hematology and two affiliated societies (SIES and GITMO) commissioned project to an Expert Panel aimed at developing clinical practice guidelines for acute myeloid leukemia treatment. After systematic comprehensive literature review, the Expert Panel formulated recommendations for the management of primary acute myeloid leukemia (with the exception of acute promyelocytic leukemia) and graded them according to the supporting evidence. When evidence was lacking, consensus-based statements have been added. First-line therapy for all newly diagnosed patients eligible for intensive treatment should include one cycle of induction with standard dose cytarabine and an anthracycline. After achieving complete remission, patients aged less than 60 years should receive consolidation therapy including high-dose cytarabine. Myeloablative allogeneic stem cell transplantation from an HLA-compatible sibling should be performed in first complete remission: 1) in children with intermediate-high risk cytogenetics or who achieved first complete remission after the second course of therapy; 2) in adults less than 40 years with an intermediate-risk; in those aged less than 55 years with either high-risk cytogenetics or who achieved first complete remission after the second course of therapy. Stem cell transplantation from an unrelated donor is recommended to be performed in first complete remission in adults 30 years old or younger, and in children with very high-risk disease lacking a sibling donor. Alternative donor stem cell transplantation is an option in high-risk patients without a matched donor who urgently need transplantation. Patients aged less than 60 years, who either are not candidate for allogeneic stem cell transplantation or lack a donor, are candidates for autologous stem cell transplantation. We describe the results of a systematic literature review and an explicit approach to consensus techniques, which resulted in recommendations for the management of primary non-APL acute myeloid leukemia.
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Affiliation(s)
- Enrica Morra
- Division of Hematology, Niguarda Ca'Granda Hospital, Milan, Italy.
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42
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Tosi P, Barosi G, Lazzaro C, Liso V, Marchetti M, Morra E, Pession A, Rosti G, Santoro A, Zinzani PL, Tura S. Consensus conference on the management of tumor lysis syndrome. Haematologica 2008; 93:1877-85. [PMID: 18838473 DOI: 10.3324/haematol.13290] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Tumor lysis syndrome is a potentially life threatening complication of massive cellular lysis in cancers. Identification of high-risk patients and early recognition of the syndrome is crucial in the institution of appropriate treatments. Drugs that act on the metabolic pathway of uric acid to allantoin, like allopurinol or rasburicase, are effective for prophylaxis and treatment of tumor lysis syndrome. Sound recommendations should regulate diagnosis and drug application in the clinical setting. The current article reports the recommendations on the management of tumor lysis syndrome that were issued during a Consensus Conference project, and which were endorsed by the Italian Society of Hematology (SIE), the Italian Association of Pediatric Oncologists (AIEOP) and the Italian Society of Medical Oncology (AIOM). Current concepts on the pathophysiology, clinical features, and therapy of tumor lysis syndrome were evaluated by a Panel of 8 experts. A consensus was then developed for statements regarding key questions on tumor lysis syndrome management selected according to the criterion of relevance by group discussion. Hydration and rasburicase should be administered to adult cancer patients who are candidates for tumor-specific therapy and who carry a high risk of tumor lysis syndrome. Cancer patients with a low-risk of tumor lysis syndrome should instead receive hydration along with oral allopurinol. Hydration and rasburicase should also be administered to patients with clinical tumor lysis syndrome and to adults and high-risk children who develop laboratory tumor lysis syndrome. In conclusion, the Panel recommended rasburicase for tumor lysis syndrome prophylaxis in selected patients based on the drug efficacy profile. Methodologically rigorous studies are needed to clarify its cost-effectiveness profile.
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Affiliation(s)
- Patrizia Tosi
- Hematology Unit, Istituto Seragnoli, Ospedale Sant'Orsola Malpighi, Bologna, Italy
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Zinzani PL, Martelli M, Poletti V, Vitolo U, Gobbi PG, Chisesi T, Barosi G, Ferreri AJ, Marchetti M, Pimpinelli N, Tura S. Practice guidelines for the management of extranodal non-Hodgkin's lymphomas of adult non-immunodeficient patients. Part I: primary lung and mediastinal lymphomas. A project of the Italian Society of Hematology, the Italian Society of Experimental Hematology and the Italian Group for Bone Marrow Transplantation. Haematologica 2008; 93:1364-71. [DOI: 10.3324/haematol.12742] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Lauria F, Foa R, Mantovani V, Fierro MT, Catovsky D, Tura S. T-cell functional abnormality in B-chronic lymphocytic leukaemia: evidence of a defect of the T-helper subset. Br J Haematol 2008. [DOI: 10.1111/j.1365-2141.1983.00277.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Angelucci E, Barosi G, Camaschella C, Cappellini MD, Cazzola M, Galanello R, Marchetti M, Piga A, Tura S. Italian Society of Hematology practice guidelines for the management of iron overload in thalassemia major and related disorders. Haematologica 2008; 93:741-52. [PMID: 18413891 DOI: 10.3324/haematol.12413] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
New measures of iron accumulation in liver and heart (superconducting quantum inference device and magnetic resonance imaging), and oral iron chelators (deferiprone and deferasirox) are available for managing iron overload in thalassemia major. To assure appropriate use of these new health technologies, the Italian Society of Hematology appointed a panel of experts to produce clinical practice-guidelines for the management of iron overload in thalassemia major and related disorders. The analytical hierarchy process, a technique for multicriteria decision analysis, was applied to relevant key questions in order to identify the alternative strategies, generate explicit criteria for their evaluation, and check how well the alternatives fulfilled the criteria. The result of a comprehensive systematic review of articles released from 1990 to 2007 was used as a source of scientific evidence to compare the decisional options pairwise, and select the final recommendation. Every step in the model was developed from questionnaires and group discussion. The resulting recommendations advise about which examination to carry out in order to plan iron chelation therapy, when to start iron chelation, which iron chelator to choose in regularly transfused patients, how to monitor iron chelation therapy, and when and how to switch standard therapy.
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Affiliation(s)
- Emanuele Angelucci
- Hematology Department and BMT Unit, Cancer Center "Armando Businco", viale Edward Jenner, 09121 Cagliari, Italy.
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46
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Tosi P, Terragna C, Testoni N, Zamagni E, Renzulli M, Tacchetti P, Montanari E, Perrone G, Ceccolini M, Brioli A, Pallotti MC, Tura S, Baccarani M, Cavo M. Evaluation of bone disease in multiple myeloma patients carrying the t(4;14) chromosomal translocation. Eur J Haematol 2007; 80:31-6. [PMID: 18036184 DOI: 10.1111/j.1600-0609.2007.00974.x] [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: 11/30/2022]
Abstract
T(4;14) chromosomal abnormality is one of the most adverse prognostic factors predicting for poor outcome in multiple myeloma (MM) patients. It has been recently suggested that bone disease, as evaluated by spinal magnetic resonance imaging (MRI), is relatively infrequent in these patients. In the present study, we aimed at further testing this hypothesis by analyzing the extent of whole bone involvement in patients showing t(4;14) chromosomal translocation as compared with negative patients. For this purpose, 53 consecutive newly diagnosed MM patients (35M, 18F, median age = 55 yr) underwent evaluation of total skeletal X-ray, whole spine MRI, and at the same time, quantification of markers of bone resorption (urinary N-terminal telopeptide, pyridinoline, deoxypyridinoline, serum crosslaps), and bone formation (bone alkaline phosphatase and osteocalcin) was performed. The presence of IgH/MMSET fusion gene as a surrogate marker for t(4;14), was detected in 11 patients (20.7%), whose clinical characteristics were similar to those observed in t(4;14) negative patients. The type of marrow involvement at spinal MRI (diffuse vs. focal vs. negative) was the same in both groups of patients, even though overt vertebral fractures were more frequently found in t(4;14) positive cases (82% vs. 43%, P = 0.05); in line with this finding, skeletal lesions were more common in t(4;14) positive patients (mean skeletal score = 8.54 +/- 1.36 SE, as compared with 3.42 +/- 0.57 SE in t(4;14) negative cases, P = 0.000). These data were confirmed by the evaluation of serum crosslaps, that were significantly increased in patients with t(4;14) abnormality as compared with negative individuals (10,400 pmol/L +/- 2160 SE vs. 5640 pmol/L +/- 859 SE P = 0.02) Our results indicate that, at variance to what has been previously reported, bone resorption is more prominent in t(4;14) positive patients.
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Affiliation(s)
- Patrizia Tosi
- Seràgnoli Institute of Hematology and Medical Oncology, Bologna University, Bologna, Italy.
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Cavo M, Tosi P, Zamagni E, Cellini C, Tacchetti P, Patriarca F, Di Raimondo F, Volpe E, Ronconi S, Cangini D, Narni F, Carubelli A, Masini L, Catalano L, Fiacchini M, de Vivo A, Gozzetti A, Lazzaro A, Tura S, Baccarani M. Prospective, randomized study of single compared with double autologous stem-cell transplantation for multiple myeloma: Bologna 96 clinical study. J Clin Oncol 2007; 25:2434-41. [PMID: 17485707 DOI: 10.1200/jco.2006.10.2509] [Citation(s) in RCA: 249] [Impact Index Per Article: 14.6] [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: 11/20/2022] Open
Abstract
PURPOSE We performed a prospective, randomized study of single (arm A) versus double (arm B) autologous stem-cell transplantation (ASCT) for younger patients with newly diagnosed multiple myeloma (MM). PATIENTS AND METHODS A total of 321 patients were enrolled onto the study and were randomly assigned to receive either a single course of high-dose melphalan at 200 mg/m2 (arm A) or melphalan at 200 mg/m2 followed, after 3 to 6 months, by melphalan at 120 mg/m2 and busulfan at 12 mg/kilogram (arm B). RESULTS As compared with assignment to the single-transplantation group (n = 163 patients), random assignment to receive double ASCT (n = 158 patients) significantly increased the probability to attain at least a near complete response (nCR; 33% v 47%, respectively; P = .008), prolonged relapse-free survival (RFS) duration of 18 months (median, 24 v 42 months, respectively; P < .001), and significantly extended event-free survival (EFS; median, 23 v 35 months, respectively; P = .001). Administration of a second transplantation and of novel agents for treating sequential relapses in up to 50% of patients randomly assigned to receive a single ASCT likely contributed to prolong the survival duration of the whole group, whose 7-year rate (46%) was similar to that of the double-transplantation group (43%; P = .90). Transplantation-related mortality was 3% in arm A and 4% in arm B (P = .70). CONCLUSION In comparison with a single ASCT as up-front therapy for newly diagnosed MM, double ASCT effected superior CR or nCR rate, RFS, and EFS, but failed to significantly prolong overall survival. Benefits offered by double ASCT were particularly evident among patients who failed at least nCR after one autotransplantation.
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Affiliation(s)
- Michele Cavo
- Istituto di Ematologia ed Oncologia Medica [Seràgnoli], Università di Bologna, Bologn, Italy.
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Tosi P, Zamagni E, Cangini D, Tacchetti P, Di Raimondo F, Catalano L, D'Arco A, Ronconi S, Cellini C, Offidani M, Perrone G, Ceccolini M, Brioli A, Tura S, Baccarani M, Cavo M. Osteonecrosis of the jaws in newly diagnosed multiple myeloma patients treated with zoledronic acid and thalidomide-dexamethasone. Blood 2007; 108:3951-2. [PMID: 17114572 DOI: 10.1182/blood-2006-07-033571] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Brugiatelli M, Bandini G, Barosi G, Lauria F, Liso V, Marchetti M, Mauro FR, Meloni G, Zinzani PL, Tura S. Management of chronic lymphocytic leukemia: practice guidelines from the Italian Society of Hematology, the Italian Society of Experimental Hematology and the Italian Group for Bone Marrow Transplantation. Haematologica 2006; 91:1662-73. [PMID: 17145603] [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: 05/12/2023] Open
Abstract
OBJECTIVES The Italian Society of Hematology (SIE) and two affiliate societies (SIES and GITMO) commissioned a project to develop clinical practice guidelines for the treatment of chronic lymphocytic leukemia (CLL). METHODS Key questions in the management of patients with CLL were formulated by an Advisory Committee and approved by an Expert Panel of eight senior hematologists. After a systematic review of the literature, recommendations for disease-specific and supportive therapies were formulated and graded according to the supporting evidence. Explicit consensus methods were used for providing recommendations for questions with incomplete or potentially biased evidence. RESULTS It is recommended that therapy is commenced in patients with CLL when at least one of the following are present: B-symptoms, progressive/obstructive lymphadenopathy or organomegaly, rapid lymphocyte doubling time, anemia or thrombocytopenia (of new onset, worsening or steroid-resistant). It is recommended that patients without co-morbidity should receive fludarabine plus cyclophosphamide, whereas elderly patients with co-morbidity should receive oral chlorambucil. Younger patients with unfavorable biological risk factors should be considered for high-dose chemotherapy and autologous or allogeneic stem cell transplantation within approved clinical trials. Patients either relapsing rapidly after, or non-responsive to, first-line chlorambucil should receive fludarabine-containing regimens. Patients either relapsing soon after or not responding to fludarabine-based chemotherapy should be considered for schedules including non-cross-reactive agents, such as alemtuzumab, possibly followed by high-dose chemotherapy and autologous transplantation in the context of a clinical trial or by allogeneic stem cell transplantation. CONCLUSIONS We describe the results of a systematic literature review and an explicit approach to consensus techniques which resulted in recommendations for the key therapeutic decisions in patients with CLL.
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Affiliation(s)
- Maura Brugiatelli
- Divisione di Ematologia, Azienda Ospedaliera Papardo, Messina, Italy
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Catani L, Fagioli ME, Tazzari PL, Ricci F, Curti A, Rovito M, Preda P, Chirumbolo G, Amabile M, Lemoli RM, Tura S, Conte R, Baccarani M, Vianelli N. Dendritic cells of immune thrombocytopenic purpura (ITP) show increased capacity to present apoptotic platelets to T lymphocytes. Exp Hematol 2006; 34:879-87. [PMID: 16797415 DOI: 10.1016/j.exphem.2006.03.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Revised: 02/23/2006] [Accepted: 03/17/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Altered self-antigen processing/presentation of apoptotic cells by DCs and/or modifications of autoantigens may lead to the development of autoantibodies. Increasing evidence indicates that platelets may undergo apoptosis. Therefore, in the present study we investigated whether platelet apoptosis and/or dendritic cells (DCs) may play a role in the stimulation of the immuno-mediated anti-platelet response in chronic immune thrombocytopenic purpura (ITP). METHODS AND RESULTS Twenty-nine patients with active ITP and 29 healthy adult volunteers were enrolled into the study. Freshly washed platelets and platelets aged in a plasma-free buffer for 72 hours at 37 degrees C were assessed by flow cytometry for phosphatidylserine exposure using annexin V-FITC, caspase activation, and platelet activation markers. CD14-derived DCs were characterized by immunophenotyping, cytokine production, and ability to present fresh and aged platelets to T lymphocytes. We demonstrated that platelets from ITP patients, either fresh or in vitro aged, show increased apoptosis (with low levels of activation) in comparison to their normal counterparts. We also found that immature DCs readily ingest apoptotic platelets. Furthermore, in ITP patients DCs, prepulsed with autologous/allogeneic fresh and aged platelets, are highly efficient in stimulating autologous T-cell proliferation as compared to DCs derived from healthy donors. This finding may be related to the upregulated expression of CD86 in DCs from ITP patients and not to higher phagocytic activity. CONCLUSION These results suggest that DC dysfunction, together with increased propensity of platelets to undergo apoptosis, may play a role in the stimulation of the immune system in ITP.
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Affiliation(s)
- Lucia Catani
- Istituto di Ematologia e Oncologia Medica L. e A. Seràgnoli, Università di Bologna, Bologna, Italy.
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