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Winter S, Schneider M, Oelschlaegel U, Maggioni G, Riva E, Raddi MG, Bencini S, Peruzzi B, Choy D, Antunes Dos Reis R, Güse E, Lischer C, Vera J, Timms JA, Sompairac N, Sockel K, Poloni A, Tunger A, Della Porta MG, Santini V, Schmitz M, Platzbecker U, Kordasti S. Mutations in the splicing factor SF3B1 are linked to frequent emergence of HLA-DR low/neg monocytes in lower-risk myelodysplastic neoplasms. Leukemia 2024:10.1038/s41375-024-02249-z. [PMID: 38632316 DOI: 10.1038/s41375-024-02249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Susann Winter
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Marie Schneider
- Department of Hematology, Cellular Therapy, Hemostaseology and Infectious Disease, University of Leipzig Medical Center, Leipzig, Germany
| | - Uta Oelschlaegel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Giulia Maggioni
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elena Riva
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marco Gabriele Raddi
- MDS Unit, Hematology, AOU Careggi - Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sara Bencini
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Benedetta Peruzzi
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Desmond Choy
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Rita Antunes Dos Reis
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Esther Güse
- Laboratory of Systems Tumor Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie and Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Christopher Lischer
- Laboratory of Systems Tumor Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie and Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Julio Vera
- Laboratory of Systems Tumor Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg, and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie and Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Jessica A Timms
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Nicolas Sompairac
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Katja Sockel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Antonella Poloni
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Antje Tunger
- Institute of Immunology, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT); German Cancer Research Center (DKFZ); Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Matteo Giovanni Della Porta
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Valeria Santini
- MDS Unit, Hematology, AOU Careggi - Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marc Schmitz
- Institute of Immunology, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
- National Center for Tumor Diseases (NCT); German Cancer Research Center (DKFZ); Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden; Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Uwe Platzbecker
- Department of Hematology, Cellular Therapy, Hemostaseology and Infectious Disease, University of Leipzig Medical Center, Leipzig, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- German MDS Study Group (D-MDS), Leipzig, Germany
| | - Shahram Kordasti
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
- Haematology Department, Guy's Hospital, London, UK.
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2
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Mannelli F, Piccini M, Bencini S, Gianfaldoni G, Peruzzi B, Caporale R, Scappini B, Fasano L, Quinti E, Ciolli G, Pasquini A, Crupi F, Pilerci S, Pancani F, Signori L, Tarantino D, Maccari C, Paradiso V, Annunziato F, Guglielmelli P, Vannucchi AM. Effect of age and treatment on predictive value of measurable residual disease: implications for clinical management of adult patients with acute myeloid leukemia. Haematologica 2024; 109:60-71. [PMID: 37345475 PMCID: PMC10772533 DOI: 10.3324/haematol.2023.283196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023] Open
Abstract
Measurable residual disease (MRD) is a powerful predictor of outcome in acute myeloid leukemia. In the early phases of treatment, MRD refines initial disease risk stratification and is used for the allocation to allogeneic transplant. Despite its well-established role, a relatively high fraction of patients eventually relapses albeit achieving MRDneg status. The aim of this work was to assess specifically the influence of baseline features and treatment intensity on the predictive value of an MRDneg status, particularly focusing on MRD2, measured after two consecutive chemotherapy cycles. Among baseline features, younger MRD2neg patients (<55 years) had a significantly longer disease-free survival (median not reached) compared to their older counterparts (median 25.0 months, P=0.013, hazard ratio=2.08). Treatment intensity, specifically the delivery of a high dose of cytarabine in induction or first consolidation, apparently had a pejorative effect on the outcome of MRD2neg patients compared to standard dose (P=0.048, hazard ratio=1.80), a finding also confirmed by the analysis of data extracted from the literature. The combination of age and treatment intensity allowed us to identify categories of patients, among those who reached a MRD2neg status, characterized by significantly different disease-free survival rate. Our data showed that variables such as age and intensity of treatment administered can influence the predictive value of MRD in patients with acute myeloid leukemia. In addition to underscoring the need for further improvement of MRD analysis, these findings call for a reasoned application of MRD data, as currently available, to modulate consolidation therapy on adequately estimated relapse rates.
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Affiliation(s)
- Francesco Mannelli
- SOD Ematologia, Università di Firenze, AOU Careggi, Firenze, Italy; Centro Ricerca e Innovazione Malattie Mieloproliferative (CRIMM), AOU Careggi, Firenze.
| | - Matteo Piccini
- SOD Ematologia, Università di Firenze, AOU Careggi, Firenze
| | - Sara Bencini
- Centro Diagnostico di Citofluorimetria e Immunoterapia, AOU Careggi, Firenze
| | | | - Benedetta Peruzzi
- Centro Diagnostico di Citofluorimetria e Immunoterapia, AOU Careggi, Firenze
| | - Roberto Caporale
- Centro Diagnostico di Citofluorimetria e Immunoterapia, AOU Careggi, Firenze
| | | | - Laura Fasano
- SOD Ematologia, Università di Firenze, AOU Careggi, Firenze
| | - Elisa Quinti
- SOD Ematologia, Università di Firenze, AOU Careggi, Firenze
| | - Gaia Ciolli
- SOD Ematologia, Università di Firenze, AOU Careggi, Firenze
| | | | | | - Sofia Pilerci
- SOD Ematologia, Università di Firenze, AOU Careggi, Firenze
| | - Fabiana Pancani
- SOD Ematologia, Università di Firenze, AOU Careggi, Firenze, Italy; Centro Ricerca e Innovazione Malattie Mieloproliferative (CRIMM), AOU Careggi, Firenze
| | - Leonardo Signori
- SOD Ematologia, Università di Firenze, AOU Careggi, Firenze, Italy; Centro Ricerca e Innovazione Malattie Mieloproliferative (CRIMM), AOU Careggi, Firenze
| | - Danilo Tarantino
- SOD Ematologia, Università di Firenze, AOU Careggi, Firenze, Italy; Centro Ricerca e Innovazione Malattie Mieloproliferative (CRIMM), AOU Careggi, Firenze
| | - Chiara Maccari
- SOD Ematologia, Università di Firenze, AOU Careggi, Firenze, Italy; Centro Ricerca e Innovazione Malattie Mieloproliferative (CRIMM), AOU Careggi, Firenze
| | | | | | - Paola Guglielmelli
- SOD Ematologia, Università di Firenze, AOU Careggi, Firenze, Italy; Centro Ricerca e Innovazione Malattie Mieloproliferative (CRIMM), AOU Careggi, Firenze
| | - Alessandro M Vannucchi
- SOD Ematologia, Università di Firenze, AOU Careggi, Firenze, Italy; Centro Ricerca e Innovazione Malattie Mieloproliferative (CRIMM), AOU Careggi, Firenze
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3
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Capone M, Peruzzi B, Palterer B, Bencini S, Sanna A, Puccini B, Nassi L, Salvadori B, Statello M, Carraresi A, Stefanelli S, Orazzini C, Minuti B, Caporale R, Annunziato F. Corrigendum to < Rapid evaluation of T cell clonality in the diagnostic work-up of mature T cell neoplasms: TRBC1-based flow cytometric assay experience><Translational Oncology, 26C (2022) 101552]>. Transl Oncol 2023; 30:101631. [PMID: 36801075 PMCID: PMC9951112 DOI: 10.1016/j.tranon.2023.101631] [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] [Indexed: 02/12/2023] Open
Affiliation(s)
- Manuela Capone
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Benedetta Peruzzi
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Boaz Palterer
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Sara Bencini
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | | | | | - Luca Nassi
- Hematology, Unit AOU Careggi, Florence, Italy
| | | | - Marinella Statello
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Alessia Carraresi
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Stefania Stefanelli
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Chiara Orazzini
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | | | - Roberto Caporale
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Francesco Annunziato
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
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4
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Sordi B, Vanderwert F, Crupi F, Gesullo F, Zanotti R, Bonadonna P, Crosera L, Elena C, Fiorelli N, Ferrari J, Grifoni F, Sciumè M, Parente R, Triggiani M, Palterer B, Mecheri V, Almerigogna F, Santi R, Di Medio L, Brandi ML, Iorno ML, Ciardetti I, Bencini S, Annunziato F, Mannarelli C, Pieri L, Guglielmelli P, Mannelli F, Vannucchi AM. Disease correlates and clinical relevance of hereditary α-tryptasemia in patients with systemic mastocytosis. J Allergy Clin Immunol 2023; 151:485-493.e11. [PMID: 36309122 DOI: 10.1016/j.jaci.2022.09.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/05/2022] [Accepted: 09/15/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Systemic mastocytosis (SM) encompasses a heterogeneous group of clonal disorders characterized by abnormal expansion of mast cells (MCs). Beyond KIT and other genes recurrently mutated in myeloid neoplasms, several genetic variants have been described as predisposing to the development of the disease and influencing its clinical phenotype. Increased copy number variants of the TPSAB1 gene were identified as a cause of nonclonal elevated tryptasemia and defined as hereditary α-tryptasemia (HαT). Moreover, HαT is enriched in patients with SM, where it can affect the incidence of mediator-related symptoms. OBJECTIVE In a multicenter data set of 444 patients with MC disorders, we aimed to investigate the clinical correlates of germline TPSAB1 copy number gains. METHODS Droplet digital PCR was performed in all cases to ascertain the presence of HαT. Clinical history along with blood values and bone marrow examination were analyzed. RESULTS We confirmed a higher incidence of HαT+ cases (n = 59, 13.3%) in patients diagnosed with mastocytosis with respect to the general population (approximately 5%). HαT+ patients were characterized by a lower MC-associated disease burden and higher levels of tryptase. Several disease variables were coherent with this pattern, from bone marrow MC infiltration to MC-related histopathologic traits, which also accounted for a significantly higher incidence of clonal MC activation syndrome in HαT+ (10.2%) compared to HαT- (3.4%, P = .029) patients. We also confirmed that HαT+ carriers had a significantly higher frequency of anaphylaxis, without relevant differences for other clinical manifestations. CONCLUSION These findings on a large patient series support and extend previous data, and suggest that knowledge of HαT status may be useful for personalized management of patients with SM.
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Affiliation(s)
- Benedetta Sordi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Fiorenza Vanderwert
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesca Crupi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesca Gesullo
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Roberta Zanotti
- UO Ematologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Patrizia Bonadonna
- UO Allergologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Lara Crosera
- UO Ematologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Chiara Elena
- Divisione di Ematologia, IRCCS S. Matteo Hospital Foundation, Pavia, Italy
| | - Nicolas Fiorelli
- Dipartimento di Medicina Molecolare, Università di Pavia, Pavia, Italy
| | | | - Federica Grifoni
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Mariarita Sciumè
- UOC Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Roberta Parente
- Dipartimento di Medicina, Divisione di Allergologia e Immunologia Clinica, Università di Salerno, Salerno, Italy
| | - Massimo Triggiani
- Dipartimento di Medicina, Divisione di Allergologia e Immunologia Clinica, Università di Salerno, Salerno, Italy
| | - Boaz Palterer
- Centro di Diagnostica Citofluorimetrica e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Valentina Mecheri
- SOD Immunoallergologia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Florence, Italy
| | - Fabio Almerigogna
- SOD Immunoallergologia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Florence, Italy
| | - Raffaella Santi
- Sezione di Patologia, Dipartimento di Scienze della Salute, Università di Florence, Florence, Italy
| | - Lisa Di Medio
- SOD Malattie del Metabolismo Minerale e Osseo, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Maria Luisa Brandi
- SOD Malattie del Metabolismo Minerale e Osseo, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; FirmoLab, Fondazione FIRMO, Florence, Italy
| | - Maria Loredana Iorno
- Allergologia e Immunologia Clinica Azienda Toscana Centro Ospedale S. Giovanni di Dio, Florence, Italy
| | - Isabella Ciardetti
- Dipartimento di Scienze della Salute, sezione Dermatologia, Università degli Studi di Florence, Florence, Italy
| | - Sara Bencini
- Centro di Diagnostica Citofluorimetrica e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Francesco Annunziato
- Centro di Diagnostica Citofluorimetrica e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Carmela Mannarelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Lisa Pieri
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Alessandro M Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy.
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5
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Capone M, Peruzzi B, Palterer B, Bencini S, Sanna A, Puccini B, Nassi L, Salvadori B, Statello M, Carraresi A, Stefanelli S, Orazzini C, Minuti B, Caporale R, Annunziato F. Rapid evaluation of T cell clonality in the diagnostic work-up of mature T cell neoplasms: TRBC1-based flow cytometric assay experience. Transl Oncol 2022; 26:101552. [PMID: 36183675 PMCID: PMC9530610 DOI: 10.1016/j.tranon.2022.101552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/18/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022] Open
Abstract
The identification of mature T cell neoplasms by flow cytometry is often challenging, due to overlapping features with reactive T cells and limitations of currently available T cell clonality assays. The description of an antibody specific for one of two mutually exclusive T cell receptor (TCR) β-chain constant regions (TRBC1) provides an opportunity to facilitate the detection of clonal TCRαβ+ T cells based on TRBC-restriction. Here we prospectively analyzed 14 healthy controls and 63 patients with the flow cytometry protocol currently used for suspected T cell neoplasm implemented with immunostaining targeting TRBC1. Specimens were firstly classified in 3 groups based on clinical records data, laboratory findings and immunophenotypic features. T cell clonality was assessed by TCR Vβ repertoire analysis and the new rapid TRBC1 assay. Results showed that TRBC1 unimodal expression was unequivocally associated with samples presenting with immunophenotypic aberrancies. Moreover, we demonstrated that the use of TRBC1 is useful in solving uncertain cases and confirmed the high sensitivity of the method in identifying small T cell clones of uncertain significance (T-CUS). Finally, we found a high degree of concordance (97%) comparing the currently available clonality assessment methods with the proposed new method. In conclusion, our results provided real-life evidence of the utility of TRBC1 introduction in the flow cytometric clonality evaluation for the routine diagnostic work-up of T cell neoplasms.
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Affiliation(s)
- Manuela Capone
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Benedetta Peruzzi
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Boaz Palterer
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Sara Bencini
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | | | | | - Luca Nassi
- Hematology, Unit AOU Careggi, Florence, Italy
| | | | - Marinella Statello
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Alessia Carraresi
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Stefania Stefanelli
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Chiara Orazzini
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | | | - Roberto Caporale
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy
| | - Francesco Annunziato
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI), AOU Careggi, Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
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6
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Lamacchia G, Mazzoni A, Spinicci M, Vanni A, Salvati L, Peruzzi B, Bencini S, Capone M, Carnasciali A, Farahvachi P, Rocca A, Kiros ST, Graziani L, Zammarchi L, Mencarini J, Colao MG, Caporale R, Liotta F, Cosmi L, Rossolini GM, Bartoloni A, Maggi L, Annunziato F. Clinical and Immunological Features of SARS-CoV-2 Breakthrough Infections in Vaccinated Individuals Requiring Hospitalization. J Clin Immunol 2022; 42:1379-1391. [PMID: 35809212 PMCID: PMC9674730 DOI: 10.1007/s10875-022-01325-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/30/2022] [Indexed: 12/29/2022]
Abstract
Background and Purpose Waning immunity and the surge of SARS-CoV-2 variants are responsible for breakthrough infections, i.e., infections in fully vaccinated individuals. Although the majority of vaccinated infected subjects report mild or no symptoms, some others require hospitalization. The clinical and immunological features of vaccinated hospitalized COVID-19 patients are currently unknown. Methods Twenty-nine unvaccinated and 36 vaccinated hospitalized COVID-19 patients were prospectively enrolled and clinical and laboratory data were gathered. Immunophenotyping of leukocytes’ subsets, T and B cell SARS-CoV-2-specific responses were evaluated via flow cytometry. Anti-IFN-α autoantibodies were measured via ELISA. Results Despite vaccinated patients were older and with more comorbidities, unvaccinated subjects showed higher levels of pro-inflammatory markers, more severe disease, and increased mortality rate. Accordingly, they presented significant alterations in the circulating leukocyte composition, typical of severe COVID-19. Vaccinated patients displayed higher levels of anti-Spike IgGs and Spike-specific B cells. Of all participants, survivors showed higher levels of anti-Spike IgGs and Spike-specific CD4+ T cells than non-survivors. At hospital admission, 6 out of 65 patients (9.2%) displayed high serum concentrations of autoantibodies targeting IFN-α. Remarkably, 3 were unvaccinated and eventually died, while the other 3 were vaccinated and survived. Conclusion Despite more severe pre-existing clinical conditions, vaccinated patients have good outcome. A rapid activation of anti-SARS-CoV-2-specific immunity is fundamental for the resolution of the infection. Therefore, prior immunization through vaccination provides a significant contribution to prevention of disease worsening and can even overcome the presence of high-risk factors (i.e., older age, comorbidities, anti-IFN-α autoantibodies). Supplementary Information The online version contains supplementary material available at 10.1007/s10875-022-01325-2.
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Affiliation(s)
- Giulia Lamacchia
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy
| | - Alessio Mazzoni
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Anna Vanni
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy
| | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy
| | - Benedetta Peruzzi
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy
| | - Sara Bencini
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy
| | - Manuela Capone
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy
| | - Alberto Carnasciali
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy
| | - Parham Farahvachi
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy
| | - Arianna Rocca
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy
| | - Lucia Graziani
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Jessica Mencarini
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Maria Grazia Colao
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Roberto Caporale
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy
| | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy.,Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy.,Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy.,Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy.,Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Laura Maggi
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy.
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 6, 50134, Florence, Italy. .,Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy.
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7
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Mannelli F, Bencini S, Coltro G, Loscocco GG, Peruzzi B, Rotunno G, Maccari C, Gesullo F, Borella M, Paoli C, Caporale R, Mannarelli C, Annunziato F, Guglielmelli P, Vannucchi AM. Integration of multiparameter flow cytometry score improves prognostic stratification provided by standard models in primary myelofibrosis. Am J Hematol 2022; 97:846-855. [PMID: 35338671 DOI: 10.1002/ajh.26548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 12/22/2022]
Abstract
Prognostic modeling in myelofibrosis (MF) has classically pursued the integration of informative clinical and hematological parameters to separate patients' categories with different outcomes. Modern stratification includes also genetic data from karyotype and mutations. However, some poorly standardized variables, as peripheral blood (PB) blast count by morphology, are still included. In this study, we used multiparameter flow cytometry (MFC) with the aim of improving performance of existing scores. We studied 363 MF patients with available MFC files for PB CD34+ cells count determination at diagnosis. We adapted Ogata score to MF context including 2 parameters: absolute CD34+ cells count (/μL) and granulocytes to lymphocytes SSC ratio. A score of 1 was attributed to above-threshold values of each parameter. Accordingly, patients were categorized as MFClow (score = 0, 62.0%), MFCint (score = 1, 29.5%), and MFChigh (score = 2, 8.5%). MFClow had significantly longer median OS (not reached) compared to MFCint (55 months) and MFChigh (19 months). We integrated MFC into established models as a substitute of morphological PB blasts count. Patients were reclassified according to MFC-enhanced scores, and concordance (C-) indexes were compared. As regards IPSS, C-indexes were 0.67 and 0.74 for standard and MFC-enhanced model, respectively (Z score - 3.82; p = 0.0001). MFC-enhanced MIPSS70+ model in PMF patients yielded a C-index of 0.78, outperforming its standard counterpart (C-index 0.73; Z score - 2.88, p = 0.004). Our data suggest that the incorporation of MFC-derived parameters, easily attainable from standard assay used for CD34+ cells determination, might help to refine the current prognostic stratification models in myelofibrosis.
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Affiliation(s)
- Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Sara Bencini
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Giacomo Coltro
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Giuseppe G Loscocco
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
- Doctorate School GenOMec, University of Siena, Italy
| | - Benedetta Peruzzi
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Giada Rotunno
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Chiara Maccari
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesca Gesullo
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Miriam Borella
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Chiara Paoli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Roberto Caporale
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Carmela Mannarelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Francesco Annunziato
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Florence, Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
| | - Alessandro M Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence Center, Università degli Studi, Florence, Italy
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8
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Piccini M, Pilerci S, Merlini M, Grieco P, Scappini B, Bencini S, Peruzzi B, Caporale R, Signori L, Pancani F, Vannucchi AM, Gianfaldoni G. Venetoclax-Based Regimens for Relapsed/Refractory Acute Myeloid Leukemia in a Real-Life Setting: A Retrospective Single-Center Experience. J Clin Med 2021; 10:jcm10081684. [PMID: 33919958 PMCID: PMC8070927 DOI: 10.3390/jcm10081684] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 11/16/2022] Open
Abstract
Relapsed/refractory (R/R) acute myeloid leukemia (AML) is a largely unmet medical need, owing to the lack of standardized, effective treatment approaches, resulting in an overall dismal outcome. The only curative option for R/R AML patients is allogeneic hematopoietic stem cell transplantation (HSCT) which is only applicable in a fraction of patients due to the scarce efficacy and high toxicity of salvage regimens. Recently, a number of targeted agents with relatively favorable toxicity profiles have been explored in clinical trials for R/R AML patients. The Bcl-2 inhibitor venetoclax, in combination with hypomethylating agents or low dose cytarabine, has produced impressive results for newly diagnosed AML, while its role in R/R disease is not well defined yet. We retrospectively analyzed the clinical outcomes of 47 R/R AML patients treated with venetoclax-based regimens between March 2018 and December 2020 at our institution. Overall, we report a composite complete response rate of 55% with an overall acceptable toxicity profile. Outcomes were particularly favorable for NPM1 mutated patients, unlike for FLT3-ITD positive patients irrespective of NPM1 status. For patients treated with intention to transplant, the procedure could be finally performed in 54%. These findings suggest a role for venetoclax-based regimens in R/R AML patients and support the design of prospective studies.
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Affiliation(s)
- Matteo Piccini
- SOD Ematologia, Università degli Studi di Firenze e Azienda Ospedaliera Universitaria Careggi, 50139 Firenze, Italy; (M.P.); (B.S.); (A.M.V.)
| | - Sofia Pilerci
- Scuola di Specializzazione in Ematologia, Università degli Studi di Firenze, 50139 Firenze, Italy; (S.P.); (M.M.)
| | - Marta Merlini
- Scuola di Specializzazione in Ematologia, Università degli Studi di Firenze, 50139 Firenze, Italy; (S.P.); (M.M.)
| | - Pietro Grieco
- SOD Ematologia, Ospedale San Donato, Azienda Usl Toscana Sud-Est, 20121 Milano, Italy;
| | - Barbara Scappini
- SOD Ematologia, Università degli Studi di Firenze e Azienda Ospedaliera Universitaria Careggi, 50139 Firenze, Italy; (M.P.); (B.S.); (A.M.V.)
| | - Sara Bencini
- SOD Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, 50139 Firenze, Italy; (S.B.); (B.P.); (R.C.)
| | - Benedetta Peruzzi
- SOD Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, 50139 Firenze, Italy; (S.B.); (B.P.); (R.C.)
| | - Roberto Caporale
- SOD Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, 50139 Firenze, Italy; (S.B.); (B.P.); (R.C.)
| | - Leonardo Signori
- Centro di Ricerca e Innovazione per le Malattie Mieloproliferative (CRIMM), Università degli Studi e Azienda Ospedaliera Universitaria Careggi, 50139 Firenze, Italy; (L.S.); (F.P.)
| | - Fabiana Pancani
- Centro di Ricerca e Innovazione per le Malattie Mieloproliferative (CRIMM), Università degli Studi e Azienda Ospedaliera Universitaria Careggi, 50139 Firenze, Italy; (L.S.); (F.P.)
| | - Alessandro Maria Vannucchi
- SOD Ematologia, Università degli Studi di Firenze e Azienda Ospedaliera Universitaria Careggi, 50139 Firenze, Italy; (M.P.); (B.S.); (A.M.V.)
- Centro di Ricerca e Innovazione per le Malattie Mieloproliferative (CRIMM), Università degli Studi e Azienda Ospedaliera Universitaria Careggi, 50139 Firenze, Italy; (L.S.); (F.P.)
| | - Giacomo Gianfaldoni
- SOD Ematologia, Università degli Studi di Firenze e Azienda Ospedaliera Universitaria Careggi, 50139 Firenze, Italy; (M.P.); (B.S.); (A.M.V.)
- Correspondence:
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9
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Vannucchi AM, Sordi B, Morettini A, Nozzoli C, Poggesi L, Pieralli F, Bartoloni A, Atanasio A, Miselli F, Paoli C, Loscocco GG, Fanelli A, Para O, Berni A, Tassinari I, Zammarchi L, Maggi L, Mazzoni A, Scotti V, Falchetti G, Malandrino D, Luise F, Millotti G, Bencini S, Capone M, Piccinni MP, Annunziato F, Guglielmelli P. Compassionate use of JAK1/2 inhibitor ruxolitinib for severe COVID-19: a prospective observational study. Leukemia 2021; 35:1121-1133. [PMID: 32814839 PMCID: PMC7437386 DOI: 10.1038/s41375-020-01018-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/24/2020] [Accepted: 08/05/2020] [Indexed: 12/18/2022]
Abstract
Overwhelming inflammatory reactions contribute to respiratory distress in patients with COVID-19. Ruxolitinib is a JAK1/JAK2 inhibitor with potent anti-inflammatory properties. We report on a prospective, observational study in 34 patients with COVID-19 who received ruxolitinib on a compassionate-use protocol. Patients had severe pulmonary disease defined by pulmonary infiltrates on imaging and an oxygen saturation ≤ 93% in air and/or PaO2/FiO2 ratio ≤ 300 mmHg. Median age was 80.5 years, and 85.3% had ≥ 2 comorbidities. Median exposure time to ruxolitinib was 13 days, median dose intensity was 20 mg/day. Overall survival by day 28 was 94.1%. Cumulative incidence of clinical improvement of ≥2 points in the ordinal scale was 82.4% (95% confidence interval, 71-93). Clinical improvement was not affected by low-flow versus high-flow oxygen support but was less frequent in patients with PaO2/FiO2 < 200 mmHg. The most frequent adverse events were anemia, urinary tract infections, and thrombocytopenia. Improvement of inflammatory cytokine profile and activated lymphocyte subsets was observed at day 14. In this prospective cohort of aged and high-risk comorbidity patients with severe COVID-19, compassionate-use ruxolitinib was safe and was associated with improvement of pulmonary function and discharge home in 85.3%. Controlled clinical trials are necessary to establish efficacy of ruxolitinib in COVID-19.
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Affiliation(s)
- Alessandro M Vannucchi
- Center Research Innovation of Myeloproliferative Neoplasms (CRIMM), SOD Hematology, University of Florence and AOU Careggi, Florence, Italy.
| | - Benedetta Sordi
- Center Research Innovation of Myeloproliferative Neoplasms (CRIMM), SOD Hematology, University of Florence and AOU Careggi, Florence, Italy
| | | | - Carlo Nozzoli
- Internal Medicine Unit 1, AOU Careggi, Florence, Italy
| | | | | | | | - Alessandro Atanasio
- Center Research Innovation of Myeloproliferative Neoplasms (CRIMM), SOD Hematology, University of Florence and AOU Careggi, Florence, Italy
| | - Filippo Miselli
- Center Research Innovation of Myeloproliferative Neoplasms (CRIMM), SOD Hematology, University of Florence and AOU Careggi, Florence, Italy
| | - Chiara Paoli
- Center Research Innovation of Myeloproliferative Neoplasms (CRIMM), SOD Hematology, University of Florence and AOU Careggi, Florence, Italy
| | - Giuseppe G Loscocco
- Center Research Innovation of Myeloproliferative Neoplasms (CRIMM), SOD Hematology, University of Florence and AOU Careggi, Florence, Italy
| | | | - Ombretta Para
- Internal Medicine Unit 1, AOU Careggi, Florence, Italy
| | - Andrea Berni
- Internal Medicine Unit 3, AOU Careggi, Florence, Italy
| | - Irene Tassinari
- Intermediate Care Unit COVID-19, AOU Careggi, Florence, Italy
| | | | - Laura Maggi
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Alessio Mazzoni
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | | | | | | | - Fabio Luise
- Intermediate Care Unit COVID-19, AOU Careggi, Florence, Italy
| | | | - Sara Bencini
- Cytometry and Immunotherapy Diagnostic Center (CDCI), AOU Careggi, Florence, Italy
| | - Manuela Capone
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Marie Pierre Piccinni
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Francesco Annunziato
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
- Cytometry and Immunotherapy Diagnostic Center (CDCI), AOU Careggi, Florence, Italy
| | - Paola Guglielmelli
- Center Research Innovation of Myeloproliferative Neoplasms (CRIMM), SOD Hematology, University of Florence and AOU Careggi, Florence, Italy
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10
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Peruzzi B, Bencini S, Capone M, Mazzoni A, Maggi L, Salvati L, Vanni A, Orazzini C, Nozzoli C, Morettini A, Poggesi L, Pieralli F, Peris A, Bartoloni A, Vannucchi AM, Liotta F, Caporale R, Cosmi L, Annunziato F. Quantitative and qualitative alterations of circulating myeloid cells and plasmacytoid DC in SARS-CoV-2 infection. Immunology 2020; 161:345-353. [PMID: 32870529 PMCID: PMC7692244 DOI: 10.1111/imm.13254] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022] Open
Abstract
SARS-CoV-2 is responsible for a new infectious disease (COVID-19) in which individuals can either remain asymptomatic or progress from mild to severe clinical conditions including acute respiratory distress syndrome and multiple organ failure. The immune mechanisms that potentially orchestrate the pathology in SARS-CoV-2 infection are complex and only partially understood. There is still paucity of data on the features of myeloid cells involved in this viral infection. For this reason, we investigated the different activation status profiles and the subset distribution of myeloid cells and their correlation with disease progression in 40 COVID-19 patients at different stages of disease. COVID-19 patients showed a decrease in the absolute number of plasmacytoid and myeloid dendritic cells, different subset distribution of monocytes and different activation patterns of both monocytes and neutrophils, coupled to a significant reduction of HLA-DR monocyte levels. We found that some of these alterations are typical of all COVID-19 patients, while some others vary at different stages of the disease and correlate with biochemical parameters of inflammation. Collectively, these data suggest that not only the lymphoid, but also the myeloid compartment, is severely affected by SARS-CoV-2 infection.
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Affiliation(s)
- Benedetta Peruzzi
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI)AOU CareggiFlorenceItaly
| | - Sara Bencini
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI)AOU CareggiFlorenceItaly
| | - Manuela Capone
- Department of Clinical and Experimental MedicineUniversity of FlorenceFlorenceItaly
| | - Alessio Mazzoni
- Department of Clinical and Experimental MedicineUniversity of FlorenceFlorenceItaly
| | - Laura Maggi
- Department of Clinical and Experimental MedicineUniversity of FlorenceFlorenceItaly
| | - Lorenzo Salvati
- Department of Clinical and Experimental MedicineUniversity of FlorenceFlorenceItaly
| | - Anna Vanni
- Department of Clinical and Experimental MedicineUniversity of FlorenceFlorenceItaly
| | - Chiara Orazzini
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI)AOU CareggiFlorenceItaly
| | | | | | - Loredana Poggesi
- Department of Clinical and Experimental MedicineUniversity of FlorenceFlorenceItaly
- Internal Medicine Unit 3AOU CareggiFlorenceItaly
| | | | | | - Alessandro Bartoloni
- Department of Clinical and Experimental MedicineUniversity of FlorenceFlorenceItaly
- Infectious and Tropical Diseases UnitAOU CareggiFlorenceItaly
| | - Alessandro Maria Vannucchi
- Department of Clinical and Experimental MedicineUniversity of FlorenceFlorenceItaly
- Center for Research and Innovation on Myeloproliferative Neoplasms (CRIMM)SOD HematologyUniversity of Florence and AOU CareggiFlorenceItaly
| | - Francesco Liotta
- Department of Clinical and Experimental MedicineUniversity of FlorenceFlorenceItaly
- Immunology and Cell Therapy UnitAOU CareggiFlorenceItaly
| | - Roberto Caporale
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI)AOU CareggiFlorenceItaly
| | - Lorenzo Cosmi
- Department of Clinical and Experimental MedicineUniversity of FlorenceFlorenceItaly
- Immunology and Cell Therapy UnitAOU CareggiFlorenceItaly
| | - Francesco Annunziato
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI)AOU CareggiFlorenceItaly
- Department of Clinical and Experimental MedicineUniversity of FlorenceFlorenceItaly
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11
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Mannelli F, Gianfaldoni G, Bencini S, Piccini M, Cutini I, Bonetti MI, Scappini B, Pancani F, Ponziani V, Chiarini M, Borlenghi E, Bassan R, Rossi G, Bosi A. Early peripheral blast cell clearance predicts minimal residual disease status and refines disease prognosis in acute myeloid leukemia. Am J Hematol 2020; 95:1304-1313. [PMID: 32697337 DOI: 10.1002/ajh.25942] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022]
Abstract
Minimal residual disease (MRD) assessment in acute myeloid leukemia (AML) is increasingly used in risk stratification. However, several issues around this use are unresolved, including, among others, the most suitable time-point(s) for its application. Overall, late assessments appear more effective at distinguishing outcome but, in some studies, the early evaluations were already highly informative, anticipating the value of later ones. Our work integrated MRD with peripheral blast clearance (PBC), a treatment-related biomarker previously demonstrated to be a powerful predictor of response. From 2007 to 2014, we have studied 120 patients treated according to the NILG 02-06 trial and who achieved CR after induction. Patients in PBC-defined categories (separated by a 1.5-log threshold) showed significantly different probabilities of attaining MRD negativity, after either induction (MRD1) or consolidation (MRD2). Peripheral blast clearance combined with MRD1 largely anticipated MRD2-related information: when both biomarkers predicted chemosensitive disease (PBChigh /MRD1neg ), the rate of MRD2-negativity was 90%, and DFS and OS estimates were 68% and 76% at 3 years, respectively. When both markers were unfavorable (PBClow /MRD1pos ), rates of MRD2 negativity, DFS, and OS were 20%, 34%, and 24%, respectively, at 3 years. In fact, MRD2 added prognostic value only in cases with discordant PBC/MRD1 data. Our data support a reasoned timing for MRD-based therapeutic decisions, modulated on individual chemosensitivity, an approach we have implemented in a forthcoming prospective multi-center trial by Gruppo Italiano Malattie EMatologiche dell'Adulto (GIMEMA).
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Affiliation(s)
- Francesco Mannelli
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
- Centro Ricerca e Innovazione Malattie Mieloproliferative (CRIMM) AOU Careggi Florence Italy
| | | | - Sara Bencini
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
- Centro Diagnostico di Citofluorimetria e Immunoterapia AOU Careggi Florence Italy
| | - Matteo Piccini
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
| | - Ilaria Cutini
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
- SOD Terapie Cellulari e Medicina Trasfusionale AOU Careggi Florence Italy
| | - Maria Ida Bonetti
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
- Centro Diagnostico di Citofluorimetria e Immunoterapia AOU Careggi Florence Italy
| | - Barbara Scappini
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
| | - Fabiana Pancani
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
| | - Vanessa Ponziani
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
| | - Marco Chiarini
- Centro di Ricerca Emato‐Oncologica AIL (CREA) Spedali Civili Brescia Italy
- Laboratorio di Citofluorimetria; Dipartimento di Diagnostica di Laboratorio Spedali Civili Brescia Italy
| | | | - Renato Bassan
- Unità Operativa di Ematologia Ospedale dell'Angelo Mestre ‐ Venezia Italy
| | | | - Alberto Bosi
- SOD Ematologia Università di Firenze, AOU Careggi Florence Italy
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12
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Loscocco GG, Piccini M, Bencini S, Vergoni F. Bone marrow involvement in small cell lung cancer. Hematol Transfus Cell Ther 2020; 43:543-544. [PMID: 32782204 PMCID: PMC8573020 DOI: 10.1016/j.htct.2020.07.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/29/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giuseppe G Loscocco
- Azienda Ospedaliero-Universitaria Careggi (AOU Careggi), Florence, Italy; University of Florence, Florence, Italy.
| | - Matteo Piccini
- Azienda Ospedaliero-Universitaria Careggi (AOU Careggi), Florence, Italy
| | | | - Federica Vergoni
- Azienda Ospedaliero-Universitaria Careggi (AOU Careggi), Florence, Italy; University of Florence, Florence, Italy
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13
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Gianfaldoni G, Mannelli F, Intermesoli T, Bencini S, Giupponi D, Farina G, Cutini I, Bonetti MI, Masciulli A, Audisio E, Ferrero D, Pavoni C, Scattolin AM, Bosi A, Rambaldi A, Bassan R. Early peripheral clearance of leukemia-associated immunophenotypes in AML: centralized analysis of a randomized trial. Blood Adv 2020; 4:301-311. [PMID: 31978214 PMCID: PMC6988394 DOI: 10.1182/bloodadvances.2019000406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/20/2019] [Indexed: 12/15/2022] Open
Abstract
Although genetics is a relevant risk factor in acute myeloid leukemia (AML), it can be minimally informative and/or not readily available for the early identification of patients at risk for treatment failure. In a randomized trial comparing standard vs high-dose induction (ClinicalTrials.gov #NCT00495287), we studied early peripheral blast cell clearance (PBC) as a rapid predictive assay of chemotherapy response to determine whether it correlates with the achievement of complete remission (CR), as well as postremission outcome, according to induction intensity. Individual leukemia-associated immunophenotypes (LAIPs) identified pretherapy by flow cytometry were validated and quantified centrally after 3 days of treatment, expressing PBC on a logarithmic scale as the ratio of absolute LAIP+ cells on day 1 and day 4. Of 178 patients, 151 (84.8%) were evaluable. Patients in CR exhibited significantly higher median PBC (2.3 log) compared with chemoresistant patients (1.0 log; P < .0001). PBC < 1.0 predicted the worst outcome (CR, 28%). With 1.5 log established as the most accurate cutoff predicting CR, 87.5% of patients with PBC >1.5 (PBChigh, n = 96) and 43.6% of patients with PBC ≤1.5 (PBClow, n = 55) achieved CR after single-course induction (P < .0001). CR and PBChigh rates were increased in patients randomized to the high-dose induction arm (P = .04) and correlated strongly with genetic/cytogenetic risk. In multivariate analysis, PBC retained significant predictive power for CR, relapse risk, and survival. Thus, PBC analysis can provide a very early prediction of outcome, correlates with treatment intensity and disease subset, and may support studies of customized AML therapy.
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Affiliation(s)
- Giacomo Gianfaldoni
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
| | - Francesco Mannelli
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
- Centro Ricerca e Innovazione Malattie Mieloproliferative, Azienda Ospedaliero-Universitaria (AOU) Careggi, Florence, Italy
| | - Tamara Intermesoli
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Bencini
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
- Centro Diagnostico di Citofluorimetria e Immunoterapia, AOU Careggi, Florence, Italy
| | - Damiano Giupponi
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Giorgio Farina
- Unità Operativa Laboratorio Analisi-Citofluorimetria, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | - Ilaria Cutini
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
- SOD Terapie Cellulari e Medicina Trasfusionale, AOU Careggi, Florence, Italy
| | - Maria Ida Bonetti
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
| | - Arianna Masciulli
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Ernesta Audisio
- Struttura Complessa di Ematologia, Ospedale Molinette, Turin, Italy
| | - Dario Ferrero
- Divisione di Ematologia, Università di Torino, Azienda Ospedaliera S. Giovanni Battista, Turin, Italy; and
| | - Chiara Pavoni
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - Alberto Bosi
- Struttura Organizzativa Dipartimentale (SOD) Ematologia, Università di Firenze, and
| | - Alessandro Rambaldi
- Unità Strutturale Complessa di Ematologia, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Renato Bassan
- Unità Operativa di Ematologia, Ospedale dell'Angelo, Mestre-Venezia, Italy
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Mannelli F, Gesullo F, Rotunno G, Pacilli A, Bencini S, Annunziato F, Zanotti R, Scaffidi L, Giona F, Santopietro M, Grifoni F, Pieri L, Guglielmelli P, Vannucchi AM. Myelodysplasia as assessed by multiparameter flow cytometry refines prognostic stratification provided by genotypic risk in systemic mastocytosis. Am J Hematol 2019; 94:845-852. [PMID: 31056768 DOI: 10.1002/ajh.25506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Abstract
Systemic mastocytosis (SM) is characterized by extreme heterogeneity of manifestations and prognosis. Several disease-related biomarkers, including clinical, hematological and molecular variables, have been correlated with prognosis. Although relevant, the mutation profile closely reflects the WHO classification that has per se prognostic value. High-risk mutations (HRM) are largely confined to advanced forms, and thus fail in providing information regarding progression and outcome in the not-advanced variants. In this work, we studied hematopoietic cells by multi-parameter flow cytometry (MFC) in order to highlight dysplastic traits that might provide insights into outcome. A score previously validated for myelodysplastic syndromes, with high reproducibility in standard diagnostics, was used. The application of an MFC score to a cohort of 71 SM cases, concurrently genotyped for configuring a HRM category, resulted in the identification of two separate patients' categories (MFC+ and MFC-) characterized by significantly different clinical and laboratory features at presentation. The extent of dysplasia by MFC tended to parallel WHO-category and genotype-related stratification. MFC+ patients had shorter survival compared to MFC- ones, for whom the incidence of progression and/or death was virtually null. Of note, MFC score remained prognostically informative in unadvanced subsets. Furthermore, the integration of MFC and HRM was an independent predictor for outcome, also overcoming WHO-categories in multivariate analysis for EFS. Our results support the use of MFC analysis in the evaluation of patients with SM, alone and in combination with HRM, for refinement of prognosis assessment.
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Affiliation(s)
- Francesco Mannelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Francesca Gesullo
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Giada Rotunno
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Annalisa Pacilli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Sara Bencini
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e ClinicaDenothe Excellence Center Firenze Italy
| | - Francesco Annunziato
- Centro Diagnostico di Citofluorimetria e Immunoterapia, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e ClinicaDenothe Excellence Center Firenze Italy
| | - Roberta Zanotti
- Multidisplinary Outpatients Clinic for Mastocytosis (GISM)Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
- Department of Medicine, Haematology UnitAzienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Luigi Scaffidi
- Multidisplinary Outpatients Clinic for Mastocytosis (GISM)Azienda Ospedaliera Universitaria Integrata of Verona Verona Italy
- Department of Medicine, Haematology UnitAzienda Ospedaliera Universitaria Integrata of Verona Verona Italy
| | - Fiorina Giona
- EmatologiaDipartimento di Medicina Traslazionale e di Precisione, Università Sapienza Roma Italy
| | - Michelina Santopietro
- EmatologiaDipartimento di Medicina Traslazionale e di Precisione, Università Sapienza Roma Italy
| | - Federica Grifoni
- UOC EmatologiaFondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano Milano Italy
| | - Lisa Pieri
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Paola Guglielmelli
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
| | - Alessandro M. Vannucchi
- CRIMM, Centro di Ricerca e Innovazione per le Malattie Mieloproliferative, Azienda Ospedaliera Universitaria Careggi, Dipartimento di Medicina Sperimentale e Clinica, Denothe Excellence CenterUniversità degli Studi Firenze Italy
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Mannelli F, Ponziani V, Bencini S, Bonetti MI, Benelli M, Cutini I, Gianfaldoni G, Scappini B, Pancani F, Piccini M, Rondelli T, Caporale R, Gelli AMG, Peruzzi B, Chiarini M, Borlenghi E, Spinelli O, Giupponi D, Zanghì P, Bassan R, Rambaldi A, Rossi G, Bosi A. CEBPA-double-mutated acute myeloid leukemia displays a unique phenotypic profile: a reliable screening method and insight into biological features. Haematologica 2016; 102:529-540. [PMID: 28250006 PMCID: PMC5394975 DOI: 10.3324/haematol.2016.151910] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/28/2016] [Indexed: 11/09/2022] Open
Abstract
Mutations in CCAAT/enhancer binding protein α (CEBPA) occur in 5-10% of cases of acute myeloid leukemia. CEBPA-double-mutated cases usually bear biallelic N- and C-terminal mutations and are associated with a favorable clinical outcome. Identification of CEBPA mutants is challenging because of the variety of mutations, intrinsic characteristics of the gene and technical issues. Several screening methods (fragment-length analysis, gene expression array) have been proposed especially for large-scale clinical use; although efficient, they are limited by specific concerns. We investigated the phenotypic profile of blast and maturing bone marrow cell compartments at diagnosis in 251 cases of acute myeloid leukemia. In this cohort, 16 (6.4%) patients had two CEBPA mutations, whereas ten (4.0%) had a single mutation. First, we highlighted that the CEBPA-double-mutated subset displays recurrent phenotypic abnormalities in all cell compartments. By mutational analysis after cell sorting, we demonstrated that this common phenotypic signature depends on CEBPA-double-mutated multi-lineage involvement. From a multidimensional study of phenotypic data, we developed a classifier including ten core and widely available parameters. The selected markers on blasts (CD34, CD117, CD7, CD15, CD65), neutrophil (SSC, CD64), monocytic (CD14, CD64) and erythroid (CD117) compartments were able to cluster CEBPA-double-mutated cases. In a validation set of 259 AML cases from three independent centers, our classifier showed excellent performance with 100% specificity and 100% sensitivity. We have, therefore, established a reliable screening method, based upon multidimensional analysis of widely available phenotypic parameters. This method provides early results and is suitable for large-scale detection of CEBPA-double-mutated status, allowing gene sequencing to be focused in selected cases.
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Affiliation(s)
- Francesco Mannelli
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy .,Istituto Toscano Tumori, Firenze, Italy
| | - Vanessa Ponziani
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Sara Bencini
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Maria Ida Bonetti
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | | | - Ilaria Cutini
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Giacomo Gianfaldoni
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Barbara Scappini
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Fabiana Pancani
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Matteo Piccini
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
| | - Tommaso Rondelli
- SOD Laboratorio Centrale, Settore Citometria Clinica, AOU Careggi, Firenze, Italy
| | - Roberto Caporale
- SOD Laboratorio Centrale, Settore Citometria Clinica, AOU Careggi, Firenze, Italy
| | | | - Benedetta Peruzzi
- SOD Laboratorio Centrale, Settore Citometria Clinica, AOU Careggi, Firenze, Italy
| | - Marco Chiarini
- Centro di Ricerca Emato-Oncologica AIL (CREA), Spedali Civili, Brescia, Italy
| | | | - Orietta Spinelli
- Unità Strutturale Complessa di Ematologia, Ospedali Riuniti, Bergamo, Italy
| | - Damiano Giupponi
- Unità Strutturale Complessa di Ematologia, Ospedali Riuniti, Bergamo, Italy
| | - Pamela Zanghì
- Unità Strutturale Complessa di Ematologia, Ospedali Riuniti, Bergamo, Italy
| | - Renato Bassan
- Divisione di Ematologia, Ospedale dell'Angelo & Ospedale SS. Giovanni e Paolo, Mestre-Venezia, Italy
| | | | | | - Alberto Bosi
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Firenze, Italy.,Istituto Toscano Tumori, Firenze, Italy
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16
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Mannelli F, Ponziani V, Bonetti MI, Bencini S, Cutini I, Gianfaldoni G, Scappini B, Pancani F, Rondelli T, Benelli M, Caporale R, Grazia Gelli AM, Peruzzi B, Longo G, Bosi A. Multilineage dysplasia as assessed by immunophenotype has no impact on clinical-biological features and outcome of NPM1-mutated acute myeloid leukemia. Exp Hematol 2015; 43:869-879.e22. [DOI: 10.1016/j.exphem.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 06/05/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
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Angarano R, Donnini I, Guidi S, Nozzoli C, Saccardi R, Gozzini A, Mannelli F, Bonetti M, Bencini S, Bosi A. Lymphocyte collection for DLI and adoptive immunotherapy. Transfus Apher Sci 2014. [DOI: 10.1016/s1473-0502(14)50002-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: 11/26/2022]
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18
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Mannelli F, Cutini I, Gianfaldoni G, Bencini S, Scappini B, Pancani F, Ponziani V, Bonetti MI, Biagiotti C, Longo G, Bosi A. CXCR4 expression accounts for clinical phenotype and outcome in acute myeloid leukemia. Cytometry 2014; 86:340-9. [DOI: 10.1002/cyto.b.21156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 11/27/2013] [Accepted: 01/03/2014] [Indexed: 12/14/2022]
Affiliation(s)
- Francesco Mannelli
- UF di Ematologia, Dipartimento di Medicina Sperimentale e Clinica; Università degli Studi, Firenze, and Istituto Toscano Tumori; Florence Italy
| | - Ilaria Cutini
- UF di Ematologia, Dipartimento di Medicina Sperimentale e Clinica; Università degli Studi, Firenze, and Istituto Toscano Tumori; Florence Italy
| | - Giacomo Gianfaldoni
- UF di Ematologia, Dipartimento di Medicina Sperimentale e Clinica; Università degli Studi, Firenze, and Istituto Toscano Tumori; Florence Italy
| | - Sara Bencini
- UF di Ematologia, Dipartimento di Medicina Sperimentale e Clinica; Università degli Studi, Firenze, and Istituto Toscano Tumori; Florence Italy
| | - Barbara Scappini
- UF di Ematologia, Dipartimento di Medicina Sperimentale e Clinica; Università degli Studi, Firenze, and Istituto Toscano Tumori; Florence Italy
| | - Fabiana Pancani
- UF di Ematologia, Dipartimento di Medicina Sperimentale e Clinica; Università degli Studi, Firenze, and Istituto Toscano Tumori; Florence Italy
| | - Vanessa Ponziani
- UF di Ematologia, Dipartimento di Medicina Sperimentale e Clinica; Università degli Studi, Firenze, and Istituto Toscano Tumori; Florence Italy
| | - Maria Ida Bonetti
- UF di Ematologia, Dipartimento di Medicina Sperimentale e Clinica; Università degli Studi, Firenze, and Istituto Toscano Tumori; Florence Italy
| | - Caterina Biagiotti
- UF di Ematologia, Dipartimento di Medicina Sperimentale e Clinica; Università degli Studi, Firenze, and Istituto Toscano Tumori; Florence Italy
| | - Giovanni Longo
- UF di Ematologia, Dipartimento di Medicina Sperimentale e Clinica; Università degli Studi, Firenze, and Istituto Toscano Tumori; Florence Italy
| | - Alberto Bosi
- UF di Ematologia, Dipartimento di Medicina Sperimentale e Clinica; Università degli Studi, Firenze, and Istituto Toscano Tumori; Florence Italy
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Mannelli F, Cutini I, Gianfaldoni G, Bencini S, Scappini B, Pancani F, Ponziani V, Bonetti MI, Biagiotti C, Longo G, Bosi A. CXCR4 expression accounts for clinical phenotype and outcome in acute myeloid leukemia. Cytometry B Clin Cytom 2014:n/a-n/a. [PMID: 24458841 DOI: 10.1002/cytob.21156] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 11/27/2013] [Accepted: 03/01/2014] [Indexed: 11/09/2022]
Abstract
Background. In acute myeloid leukemia (AML), CXCR4 expression has been correlated with leukocytosis and prognosis. Methods. We quantified CXCR4 expression by flow cytometry on leukemic cells in 142 AML patients. Results. We confirm a correlation between high CXCR4 expression and leukemic burden. Furthermore, we documented a correlation with platelet count, dysplastic megakaryopoiesis, hepato-splenomegaly and extra-hematological disease. NPM1-mutated AML displayed a significantly higher intensity of CXCR4 compared to NPM1-wt cases: it is conceivable its clinical phenotype to be driven by high CXCR4 expression. Conclusions. CXCR4 expression resulted an independent prognostic factor. Our data support CXCR4 targeting as a potential therapeutic strategy. © 2014 Clinical Cytometry Society.
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Affiliation(s)
- Francesco Mannelli
- UF di Ematologia, Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi, Firenze; Istituto Toscano Tumori, Florence, Italy
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Fanci R, Fallani S, Cassetta M, Scappini B, Longo G, Di Gioia M, Bencini S, Bosi A, Novelli A. Therapeutic drug monitoring of posaconazole in patients with acute myeloid leukaemia: a pilot study of a monocentric experience. Drugs Cell Ther Hematol 2013. [DOI: 10.4081/dcth.2013.48] [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: 11/23/2022]
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Fanci R, Fallani S, Cassetta M, Scappini B, Longo G, Di Gioia M, Bencini S, Bosi A, Novelli A. Therapeutic drug monitoring of posaconazole in patients with acute myeloid leukaemia: a pilot study of a monocentric experience. Drugs Cell Ther Hematol 2013. [DOI: 10.4081/dcth.2013.218] [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: 11/23/2022]
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Peruzzi B, Cutini I, Gelli AMG, Rondelli T, Statello M, Bencini S, Mannelli F, Caporale R, Bosi A, Fanelli A. Diagnosis of a T-lineage acute lymphoblastic leukemia through digitalized cell analysis of the pleural effusion. Int Med Case Rep J 2013; 6:77-80. [PMID: 24204177 PMCID: PMC3818024 DOI: 10.2147/imcrj.s49278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Pleural effusion as the first clinical manifestation of acute lymphoblastic leukemia (ALL) is a relatively rare event. An early and accurate diagnosis of this clinical picture is very important for adequate patient management. Case presentation We report the atypical onset of T-lineage ALL in a 31-year-old man. The patient was admitted to the emergency room due to lung failure; at that moment, the patient’s initial blood count was normal; the chest X-ray radiography showed a massive pleural effusion and a thoracentesis was carried out. Routine investigations performed on the pleural fluid using a new technology system and digitalized cell analysis demonstrated infiltration by immature cells. Therefore, bone marrow aspirate and flow cytometry analyses were performed, leading to the diagnosis of T-lineage ALL. A cord blood transplantation procedure was performed at the first hematological remission following chemotherapy regimens. The patient died of septic shock. Conclusion The case we reported underlines the usefulness of using automated instruments to identify abnormal lymphoid cells in body fluids.
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Affiliation(s)
- Benedetta Peruzzi
- General Laboratory Unit (Microscopy and Clinical Cytometry Unit), Firenze, Italy
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Cutini I, Mannelli F, Bencini S, Gianfaldoni G, Guidi S, Bosi A. Shift of phenotypic profile in a patient with acute myeloid leukemia after allogeneic transplant: an open issue for minimal residual disease assessment. Drugs Cell Ther Hematol 2013. [DOI: 10.4081/dcth.2013.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cutini I, Mannelli F, Bencini S, Gianfaldoni G, Guidi S, Bosi A. Shift of phenotypic profile in a patient with acute myeloid leukemia after allogeneic transplant: an open issue for minimal residual disease assessment. Drugs Cell Ther Hematol 2013. [DOI: 10.4081/dcth.2013.44] [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: 11/23/2022]
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Mannelli F, Bencini S, Peruzzi B, Cutini I, Sanna A, Benelli M, Magi A, Gianfaldoni G, Rotunno G, Carrai V, Gelli AMG, Valle V, Santini V, Notaro R, Luzzatto L, Bosi A. A systematic analysis of bone marrow cells by flow cytometry defines a specific phenotypic profile beyond GPI deficiency in paroxysmal nocturnal hemoglobinuria. Cytometry B Clin Cytom 2012; 84:71-81. [PMID: 23281097 DOI: 10.1002/cyto.b.21064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 11/26/2012] [Accepted: 11/27/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Paroxysmal nocturnal hemoglobinuria (PNH) is a unique disorder caused by a PIG-A gene mutation in a stem cell clone. Its clinical picture can sometimes make challenging the distinction from other disorders, and especially from myelodysplastic syndromes (MDS), since both diseases correlate with cytopenias and morphological abnormalities of bone marrow (BM) cells. Recently, flow cytometry (FC) has been proposed to integrate the morphologic assessment of BM dysplasia, and thus to improve the diagnostics of MDS. METHODS In the present study, we have analyzed systematically FC data resulting from the study of BM cells from patients with PNH and MDS. RESULTS Our data demonstrated abnormalities in PNH beyond the deficiency of glycosylphosphatidylinositol-linked proteins and the application of a systematic approach allowed us to separate effectively MDS and PNH in a cluster analysis and to highlight disease-specific abnormalities. Indeed, the parallel evaluation of some key parameters, i.e. patterns of expression of CD45 and CD10, provided information with practical diagnostic usefulness in the distinction between PNH and MDS. Moreover, the hypo-expression of CD36 that we observed on monocytes might be related to the thrombotic tendency in PNH. CONCLUSIONS We investigated systematically the phenotypic profile of BM cells from patients with PNH; our data provide useful antigenic patterns to solve between PNH and MDS, sometimes morphologically overlapping. Moreover, some PNH-related phenotypic changes might be involved in the physiopathology of the disease and further studies addressing this issue are warranted.
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Affiliation(s)
- Francesco Mannelli
- Unità Funzionale di Ematologia, Università degli Studi, AOU Careggi, Florence, Italy.
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Gianfaldoni G, Mannelli F, Ponziani V, Longo G, Bencini S, Bosi A, Vannucchi AM. Early reduction of WT1 transcripts during induction chemotherapy predicts for longer disease free and overall survival in acute myeloid leukemia. Haematologica 2010; 95:833-6. [PMID: 20107153 DOI: 10.3324/haematol.2009.011908] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [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
We investigated the prognostic significance of early peripheral blast clearance as assessed by WT1 transcript reduction during the first days of standard induction therapy in 57 adult patients with acute myeloid leukemia (AML). Quantification of WT1 transcript by real-time quantitative PCR in peripheral blood on days 1 and 5 of treatment was performed. WT1 ratio was defined as the ratio of copy number measured on day 1 and on day 5. The median WT1 ratio was greater in patients attaining CR as compared to non-responders (11.68 vs. 2.14, respectively; P=0.0006). Furthermore, DFS and OS were significantly longer in patients displaying a WT1 ratio greater than 5.82 (i.e. the median value of whole cohort) than in patients with WT1 ratio of 5.82 or under (P=0.024 and P<0.001, respectively). These data suggest that early decrease of WT1 copy number in peripheral blood predicts for better outcome and should be considered in the management of AML patients.
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Affiliation(s)
- Giacomo Gianfaldoni
- UF di Ematologia, Dipartimento di Area Critica Medico-Chirurgica, Università degli Studi, Firenze, Italy
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Bagnoli F, De Felice C, Massafra C, Pecciarini L, Bencini S, Gioia D. Decreased parathyroid hormone serum levels in pregnant women with first-trimester vaginal bleeding. Acta Obstet Gynecol Scand 1997; 76:807-8. [PMID: 9348266 DOI: 10.3109/00016349709024355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Battaglia C, Artini PG, Bencini S, Bianchi R, D'Ambrogio G, Genazzani AR. Doppler analysis of uterine blood flow changes in spontaneous and medically induced menopause. Gynecol Endocrinol 1995; 9:143-8. [PMID: 7502691 DOI: 10.3109/09513599509160204] [Citation(s) in RCA: 9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The aim of this study was to compare the uterine blood flow variations induced by chemical castration and spontaneous menopause. Thirty infertile patients were studied in the early follicular phase (day 5-7) and then treated with gonadotropin releasing hormone agonists (GnRH-a). On day 25 from GnRH-a injection, the suppressive effect was checked. The values obtained were compared with those found in 18 postmenopausal women (menopause < 5 years). All the subjects underwent transvaginal ultrasonography, Doppler analysis of uterine arteries, hormonal assay and evaluation of hematological and biochemical parameters. In all infertile patients, the GnRH-a suppressive effect was shown at the 25th day from the injection. Endometrium thickness decreased from 0.6 +/- 0.1 mm to 0.3 +/- 0.1 mm (p < 0.05) and the pulsatility index increased from 2.52 +/- 0.31 to 3.02 +/- 0.25 (p < 0.05). The plasma estradiol level fell from 48.2 +/- 4.4 pg/ml to 13.6 +/- 7.9 pg/ml (p < 0.05). No other hormonal and biochemical parameters were significantly modified by GnRH-a. In postmenopausal women, the values of the studied parameters were similar to those found in the infertile GnRH-a-suppressed patients. These data show that GnRH-a induces vascular modifications similar to those induced by early post-menopause and that both are probably exclusively related to hypoestrogenism.
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Affiliation(s)
- C Battaglia
- Department of Obstetrics and Gynecology, School of Medicine, University of Modena, Italy
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Battaglia C, Artini PG, Ballestri M, Bonucchi D, Galli PA, Bencini S, Genazzani AP. Hemodynamic, hematological and hemorrheological evaluation of post-term pregnancy. Acta Obstet Gynecol Scand 1995; 74:336-40. [PMID: 7778423 DOI: 10.3109/00016349509024424] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 01/27/2023]
Abstract
OBJECTIVE To evaluate the hemorrheological modifications in post-term pregnant women. METHODS Pregnant women (n = 48) at > 280 days' gestation, were tested on alternate days by nonstress test; ultrasound assessment of amniotic fluid volume, placental grading, hourly measurement of fetal urine production, and maternal fetal Doppler analysis. We further recorded maternal: plasma viscosimetry, red blood cells, hemoglobin, hematocrit, platelet count, mean platelet volume, fibrinogen, antithrombin III, creatinine, uric acid, plasma calcium, hPL, and estriol. We analyzed the last values obtained within 48 hours prior to delivery. RESULTS The subjects were divided into Group I (40 wks to 40 wks+3 days; n = 16); Group II (40 wks+4 days to 41 wks; n = 16); Group III (> 41 wks; n = 16). The time-averaged maximum velocity of the fetal descending thoracic aorta was lower at Doppler analysis in Group III (29.0 +/- 3.5 cm/s) than in Group I (34.0 +/- 4.3 cm/s; p < 0.05). A decrease of the middle cerebral/umbilical pulsatility index ratio (1.75 in the Group I vs 1.52 in the Group III; p < 0.05) was shown. Furthermore, the incidence of oligohydramnios; Grannum placental grade III; plasma viscosity and coagulation parameters were significantly higher in Group III patients. The plasma viscosity resulted positively correlated with uric acid, and inversely correlated with fibrinogen, antithrombin III and platelet number values. CONCLUSIONS From the present data we conclude that post-term pregnancy may mimic a mild 'fetal growth restriction'.
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Affiliation(s)
- C Battaglia
- Department of Obstetrics and Gynecology, School of Medicine, University of Modena, Italy
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Battaglia C, Artini PG, D'Ambrogio G, Bencini S, Galli PA, Genazzani AR. Maternal hyperoxygenation in the treatment of mild intrauterine growth retardation: a pilot study. Ultrasound Obstet Gynecol 1994; 4:472-475. [PMID: 12797127 DOI: 10.1046/j.1469-0705.1994.04060472.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The aim of this study was to determine the efficacy of long-term maternal hyperoxygenation in comparison with bed rest in the management of mildly growth-retarded fetuses (5-10th centile).Thirty-eight patients with intrauterine growth retardation were studied. The patients were divided into oxygen-treated (n = 18) and untreated (n = 20) groups. Ultrasound assessment of amniotic fluid volume was performed on alternate days, and the fetal abdominal circumference was evaluated weekly. Doppler analysis of fetal/maternal circulation was performed upon the patient's arrival at hospital, after 12 h, and thereafter on alternate days until parturition. Fetal blood was sampled by cordocentesis for immediate blood gas analysis at the start of the study and on the day of delivery. Although in the treated patients there was significant improvement in Doppler flow pat tern and blood gas indices, no significant differences in type of delivery and perinatal outcome were noted between the groups. Maternal hyperoxygenation in mild intrauterine growth retardation did not improve perinatal outcome.
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Affiliation(s)
- C Battaglia
- Department of Obstetrics and Gynecology, University of Modena, Modena, Italy
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