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Santini V, Allione B, Zini G, Gioia D, Lunghi M, Poloni A, Cilloni D, Sanna A, Masiera E, Ceccarelli M, Abdel-Wahab O, Terenzi A, Angelucci E, Finelli C, Onida F, Pelizzari A, Ferrero D, Saglio G, Figueroa M, Levis A. A phase II, multicentre trial of decitabine in higher-risk chronic myelomonocytic leukemia. Leukemia 2017; 32:413-418. [PMID: 28607470 PMCID: PMC5808077 DOI: 10.1038/leu.2017.186] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 01/31/2017] [Revised: 04/21/2017] [Accepted: 05/24/2017] [Indexed: 12/30/2022]
Abstract
Chronic myelomonocytic leukemia (CMML) is a complex clonal hematological disorder classified among myelodysplastic (MDS)/myeloproliferative neoplasms. Prognosis is poor and there is a lack of effective treatments. The hypomethylating agent decitabine has shown activity against MDS and elderly acute myeloid leukemia, but there is little data focusing specifically on its efficacy in CMML. In this prospective, phase 2 Italian study, CMML patients received intravenous decitabine 20 mg/m2 per day on Days 1–5 of a 28-day treatment cycle. Response was evaluated after four and six cycles; patients responding at the end of six cycles could continue treatment with decitabine. Forty-three patients were enrolled; >50% were high-risk according to four CMML-specific scoring systems. In the intent-to-treat population (n=42), the overall response rate after six cycles was 47.6%, with seven complete responses (16.6%), eight marrow responses (19%), one partial response (2.4%) and four hematological improvements (9.5%). After a median follow-up of 51.5 months (range: 44.4–57.2), median overall survival was 17 months, with responders having a significantly longer survival than non-responders (P=0.02). Grade 3/4 anemia, neutropenia and thrombocytopenia occurred in 28.6%, 50% and 38% of patients, respectively. Decitabine appears to be an effective and well-tolerated treatment for patients with high-risk CMML.
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Affiliation(s)
- V Santini
- Department of Hematology, AOU Careggi, University of Florence, Florence, Italy
| | - B Allione
- AOU Citta della Salute e della Scienza, Torino, Italy
| | - G Zini
- Department of Oncology and Hematology, Hematology Institute, Fondazion e Policlinico Gemelli, UCSC, Rome, Italy
| | | | - M Lunghi
- Division of Haematology, Department of Translational Medicine, UPO, Novara, Italy
| | - A Poloni
- Department of Hematology, AOU Ospedali Riuniti, Università Politecnica Marche, Ancona, Italy
| | - D Cilloni
- Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Turin, Italy
| | - A Sanna
- Università degli studi di Firenze, Dipartimento di medicina sperimentale e Clinica, Firenze, Italy
| | | | - M Ceccarelli
- AOU Città della salute e della scienza di Torino, Torino, Italy
| | - O Abdel-Wahab
- Human Oncology and Pathogenesis Program, and Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Terenzi
- BMT Centre of Perugia, Department of Hematology, Perugia, Italy
| | - E Angelucci
- Hematology and Transplant Unit, Ospedale Oncologico di Riferimento Regionale Armando Businco, Cagliari, Italy
| | - C Finelli
- Institute of Hematology, S.Orsola-Malpighi University Hospital, Bologna, Italy
| | - F Onida
- Oncohematology Unit, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico-Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - A Pelizzari
- Spedali Civili Brescia Hematology Unit, Brescia, Italy
| | - D Ferrero
- Hematology Division, Università degli Studi di Torino, Torino, Italy
| | - G Saglio
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - M Figueroa
- Department of Human Genetics and, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Rigacci L, Puccini B, Zinzani P, Kovalchuk S, Broccoli A, Evangelista A, Gioia D, Mannelli L, Castagnoli A, Santoro A, Bonfichi M, Rossi G, Anastasia A, Zaja F, Vitolo U, Pavone V, Pulsoni A, Gaidano G, Stelitano C, Salvi F, Rusconi C, Tani M, Freilone R, Borsatti E, Levis A. CLINICAL CHARACTERISTICS OF PATIENTS WITH NEGATIVE INTERIM-PET AND POSITIVE FINAL PET: DATA FROM THE PROSPECTIVE PET-ORIENTED HD0801 STUDY BY FONDAZIONE ITALIANA LINFOMI (FIL). Hematol Oncol 2017. [DOI: 10.1002/hon.2437_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - P. Zinzani
- Hematology; Ospedale Sant'Orsola Malpighi; Bologna Italy
| | | | - A. Broccoli
- Hematology; Ospedale Sant'Orsola Malpighi; Bologna Italy
| | | | - D. Gioia
- Hematology; Ospedale Alessandria; Alessandria Italy
| | | | | | - A. Santoro
- Hematology; Humanitas Cancer Center; Milan Italy
| | | | - G. Rossi
- Hematology; Ospedale Brescia; Brescia Italy
| | | | - F. Zaja
- Hematology; Ospedale Udine; Udine Italy
| | - U. Vitolo
- Hematology; AOU Città della Salute; Torino Italy
| | - V. Pavone
- Hematology; Ospedale Tricase; Tricase Italy
| | - A. Pulsoni
- Hematology; Università la Sapienza; Rome Italy
| | - G. Gaidano
- Hematology; Università Novara; Novara Italy
| | - C. Stelitano
- Hematology; Ospedale Reggio Calabria; Reggio Calabria Italy
| | - F. Salvi
- Hematology; Ospedale Alessandria; Alessandria Italy
| | - C. Rusconi
- Hematology; Ospedale Niguarda Ca' Grande; Milan Italy
| | - M. Tani
- Hematology; Ospedale Ravenna; Ravenna Italy
| | | | | | - A. Levis
- Hematology; Ospedale Alessandria; Alessandria Italy
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Cox M, Musuraca G, Arcari A, Fabbri A, Gini G, Tani M, Tucci A, Marcheselli L, Storti S, Di Landro F, Battistini R, Anticoli Borza P, Casaroli I, Zoli V, Fabbri F, Aroldi A, Naso V, Bianchi M, Borgo E, Ferranti A, Dondi A, Levis A, Tafuri A, Merli F. DEVEC: A PHASE II STUDY OF METRONOMIC CHEMOTHERAPY IN ELDERLY NON-FIT PATIENTS WITH AGGRESSIVE B-CELL LYMPHOMAS (PROMOTED BY FIL). Hematol Oncol 2017. [DOI: 10.1002/hon.2440_8] [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: 11/12/2022]
Affiliation(s)
- M.C. Cox
- Hematology Unit; AOU Sant'Andrea; Rome Italy
| | - G. Musuraca
- Hematology; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori; Meldola Italy
| | - A. Arcari
- Onco-Hematology; Guglielmo da Saliceto Hospital; Piacenza Italy
| | - A. Fabbri
- Hematology Unit; University Hospital; Siena Italy
| | - G. Gini
- Hematology Unit; Ospedali Riuniti; Ancona Italy
| | - M. Tani
- Hematology Unit; Santa Maria delle Croci Hospital; Ravenna Italy
| | - A. Tucci
- Division of Hematology; Spedali Civili di Brescia; Brescia Italy
| | - L. Marcheselli
- Diagnostic Medicine, Clinic and Pubblic Health; Università di Modena e Reggio Emilia; Modena Italy
| | - S. Storti
- Onco-Hematology; Università Cattolica Giovanni Paolo II; Campobasso Italy
| | | | | | | | - I. Casaroli
- Hematology Unit; Ospedale San Gerardo; Monza Italy
| | - V. Zoli
- Hematology Unit; Ospedale San Camillo; Rome Italy
| | - F. Fabbri
- Hematology; Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori; Meldola Italy
| | - A. Aroldi
- Hematology Unit; Ospedale San Gerardo; Monza Italy
| | - V. Naso
- Hematology Unit; AOU Sant'Andrea; Rome Italy
| | - M. Bianchi
- Hematology Unit; AOU Sant'Andrea; Rome Italy
| | - E. Borgo
- Ufficio Studi FIL; FILINF; Alessandria Italy
| | - A. Ferranti
- Ufficio Studi FIL; FILINF; Alessandria Italy
| | - A. Dondi
- Diagnostic Medicine, Clinic and Pubblic Health; Università di Modena e Reggio Emilia; Modena Italy
| | - A. Levis
- Ufficio Studi FIL; FILINF; Alessandria Italy
| | - A. Tafuri
- Hematology Unit; AOU Sant'Andrea; Rome Italy
| | - F. Merli
- Hematology Unit; Arcispedale Santa Maria Nuova; Reggio Emilia Italy
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Messa E, Gioia D, Masiera E, Castiglione A, Ceccarelli M, Salvi F, Danise P, Sanna A, Allione B, Balleari E, Poloni A, Cametti G, Ferrero D, Tassara R, Finelli C, Bonferroni M, Ciccone G, Saglio G, Levis A, Santini V. Effects of Erythropoiesis-Stimulating Agents on Overall Survival of IPSS Low/INT-1 Risk Transfusion Independent Myelodysplastic Syndrome Patients, a FISM Study. Leuk Res 2017. [DOI: 10.1016/s0145-2126(17)30206-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cicconi L, Divona M, Ciardi C, Ottone T, Ferrantini A, Lavorgna S, Alfonso V, Paoloni F, Piciocchi A, Avvisati G, Ferrara F, Di Bona E, Albano F, Breccia M, Cerqui E, Sborgia M, Kropp MG, Santoro A, Levis A, Sica S, Amadori S, Voso MT, Mandelli F, Lo-Coco F. PML–RARα kinetics and impact of FLT3–ITD mutations in newly diagnosed acute promyelocytic leukaemia treated with ATRA and ATO or ATRA and chemotherapy. Leukemia 2016; 30:1987-1992. [DOI: 10.1038/leu.2016.122] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/05/2016] [Accepted: 04/12/2016] [Indexed: 11/09/2022]
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Santi RM, Ceccarelli M, Catania G, Monagheddu C, Evangelista A, Bernocco E, Monaco F, Federico M, Vitolo U, Cortelazzo S, Cabras MG, Spina M, Baldini L, Boccomini C, Chiappella A, Bari A, Luminari S, Calabrese M, Levis A, Visco C, Contino L, Ciccone G, Ladetto M. PO-03 - Khorana score and histotype predict the incidence of early venous thromboembolism (VTE) in Non Hodgkin Lymphoma (NHL). A pooled data analysis of twelve clinical trials of Fondazione Italiana Linfomi (FIL). Thromb Res 2016; 140 Suppl 1:S177. [PMID: 27161692 DOI: 10.1016/s0049-3848(16)30136-0] [Citation(s) in RCA: 15] [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: 11/19/2022]
Abstract
BACKGROUND Recent studies show that the risk of VTE in NHL pts is similar to that observed in high risk solid tumors (i.e. pancreatic, ovarian cancer). VTE in NHL occurs in most cases within three months from diagnosis and can have substantial impact on treatment delivery and outcome as well as on quality of life. However few data are available on potential predictors. AIMS To better clarify the epidemiology of early (within six months from treatment start) VTE in NHL we conducted a pooled data analysis of 12 clinical trials from FIL. Our analysis included basic demographic features, lymphoma-related characteristics as well the Khorana score (based on histology, BMI, platelets WBC and HB counts) which is extensively used in solid tumors to predict VTE risk. PATIENTS AND METHODS From Jan. 2010 to Dec. 2014, all pts with B-cell NHL enrolled in prospective clinical trials from FIL for frontline treatment were included. For 9 studies study period included the entire trial population was included. The analyses were conducted based on CRFs as well as pharmacovigilance reports. VTE definition and grading was stated according to standard criteria of toxicity (CTCAE V4.0). Cumulative incidence of VTE from the study enrollment was estimated using the method described by Gooley et al. accounting for death from any causes as a competing risk. The Fine & Gray survival model was used to identify predictors of VTE among NHL pts. Factors predicting the grade of VTE were investigated using an ordinal logistic regression model. This pooled data analysis was approved by local IRB. RESULTS Overall, 1,717 patients belonging to 12 studies were evaluated. Eight were phase I/II or II (25% of pts) and 4 phase III (75% of pts). M/F ratio was 1.41, Median age was 57, (IQ range (IQR) 49-66). Histologies were: DLCL-B 34%, FL 41%, MCL 18%, other 6%. Median BMI was 25 (IQR 22-28). Median Hb, WBC and platelets counts were 13g/dl) (IQR 11.5-14.2), 7.1*10^(9)/l (IQR 5.6-10.3), 224*10^(9)/l (IQR 169-298), respectively. 1189 pts were evaluable Khorana score: 58% low risk, 30% intermediate risk, 12% were high risk. Human erythropoetin support was given to 9% of patients. All pts received Rituximab. Planned therapeutic programs included ASCT in 27% of pts, conventional chemotherapy in 67% a conventional chemotherapy plus lenalidomide in 6%. Overall 59 any grade VTE episodes occurred in 51 pts (2.9%), including 21 grade III-IV VTE (18 pts). None was fatal. Median time from study enrolment to VTE was 63 days (IQR: 35-110). Considering death as a competitive event the 6 months cumulative incidence of VTE was 2,2% in low risk Khorana score, 4.5% (95%IC: 2.3-6.7) in intermediate and 6.6% (95%IC: 2.4-10.8) in high risk (p=0.012) (figure 1). Khorana score was predictive also for grade III-IV events as they were 0,7% (95% CI:0.1-1.4) in low risk and 2.0% (95% CI:0.8-3.3) in intermediate-high risk (p=0.048). The results were similar also after excluding lenalidomide containing studies. The Fine and Gray multivariate analyses, adjusted for age and stage, showed that Khorana score (intermediate risk adjHR=1.96; 95%IC: 0.84-4.56 and high risk adjHR=3.81; 95%IC: 1.51-9.58) and DLCL-B histotype (adjHR=2.58; 95% CI: 1.01-6.55) were independently associated to an increased risk of VTE. Moreover an ordinal logistical regression model indicated that the increase of one point in the Khorana score resulted in an increased risk of VTE (OR=1.85; 95% CI: 1.23-2.79). CONCLUSIONS Our results suggest that DLCL-B histotype and Khorana score are predictors of VTE in NHL. The latter might become a simple and effective tool to assess the risk of VTE in NHL. Prospective validation including also patients not eligible for clinical trials is needed.
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Affiliation(s)
| | - M Ceccarelli
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Torino
| | - G Catania
- Division of Hematology, Az Osp SS Antinio e Biagio e Cesare Arrigo, Alessandria
| | - C Monagheddu
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Torino
| | - A Evangelista
- Unit of Cancer Epidemiology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino
| | - E Bernocco
- Division of Haematology - SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandrio
| | - F Monaco
- Division of Hematology, AZ Osp SS Antonio e Biagio e Cesare Arrigo, Alessandria
| | - M Federico
- Oncologia Medica, Università di Modena e Reggio Emilia, Modena
| | - U Vitolo
- Hematology II, Azienda Ospedaliera Città della Salute, Torino
| | - S Cortelazzo
- Department of Haematology and Bone Marrow Transplantation, Regional Hospital, S. Maurizio, Bolzano/Bozen
| | - M G Cabras
- Division of Hematology, Ospedale Businco, Cagliari
| | - M Spina
- Division of Hematology, IRCCS CRO Aviano
| | - L Baldini
- Division of Hematology, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano
| | - C Boccomini
- Division of Hematology II, AOU Citta della Salute e della Scienza, Torino
| | - A Chiappella
- Department of Hematology, Azienda Ospedaliera Città della Salute e della Scienza, Torino
| | - A Bari
- Program of Innovative Therapy in Oncology and Hematology, Department of Diagnostic, Clinical and Public Health Medicine University of Modena and Reggio Emilia, Modena
| | - S Luminari
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena
| | - M Calabrese
- Fondazione Italiana Linfomi Onlus, Alessandria
| | - A Levis
- Italian Lymphoma Foundation (FIL), Alessandria
| | | | | | - G Ciccone
- SCDU Epidemiologia dei Tumori-CPO Piemonte, Az Osp Citta della salute e della Scienza, Torino
| | - M Ladetto
- Division of Hematology, Az Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria; Italy
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Della Porta MG, Tuechler H, Malcovati L, Schanz J, Sanz G, Garcia-Manero G, Solé F, Bennett JM, Bowen D, Fenaux P, Dreyfus F, Kantarjian H, Kuendgen A, Levis A, Cermak J, Fonatsch C, Le Beau MM, Slovak ML, Krieger O, Luebbert M, Maciejewski J, Magalhaes SMM, Miyazaki Y, Pfeilstöcker M, Sekeres MA, Sperr WR, Stauder R, Tauro S, Valent P, Vallespi T, van de Loosdrecht AA, Germing U, Haase D, Greenberg PL, Cazzola M. Validation of WHO classification-based Prognostic Scoring System (WPSS) for myelodysplastic syndromes and comparison with the revised International Prognostic Scoring System (IPSS-R). A study of the International Working Group for Prognosis in Myelodysplasia (IWG-PM). Leukemia 2015; 29:1502-13. [PMID: 25721895 DOI: 10.1038/leu.2015.55] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 02/10/2015] [Accepted: 02/16/2015] [Indexed: 02/03/2023]
Abstract
A risk-adapted treatment strategy is mandatory for myelodysplastic syndromes (MDS). We refined the World Health Organization (WHO)-classification-based Prognostic Scoring System (WPSS) by determining the impact of the newer clinical and cytogenetic features, and we compared its prognostic power to that of the revised International Prognostic Scoring System (IPSS-R). A population of 5326 untreated MDS was considered. We analyzed single WPSS parameters and confirmed that the WHO classification and severe anemia provide important prognostic information in MDS. A strong correlation was found between the WPSS including the new cytogenetic risk stratification and WPSS adopting original criteria. We then compared WPSS with the IPSS-R prognostic system. A highly significant correlation was found between the WPSS and IPSS-R risk classifications. Discrepancies did occur among lower-risk patients in whom the number of dysplastic hematopoietic lineages as assessed by morphology did not reflect the severity of peripheral blood cytopenias and/or increased marrow blast count. Moreover, severe anemia has higher prognostic weight in the WPSS versus IPSS-R model. Overall, both systems well represent the prognostic risk of MDS patients defined by WHO morphologic criteria. This study provides relevant in formation for the implementation of risk-adapted strategies in MDS.
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Affiliation(s)
- M G Della Porta
- 1] Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy [2] Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - H Tuechler
- Hanusch Hospital, Boltzmann Institute for Leukemia Research, Vienna, Austria
| | - L Malcovati
- 1] Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy [2] Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - J Schanz
- Georg August Universität, Göttingen, Germany
| | - G Sanz
- Hospital Universitario La Fe, Valencia, Spain
| | - G Garcia-Manero
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - F Solé
- Institut de Recerca contra la Leucèmia Josep Carreras, Barcelona, Spain
| | - J M Bennett
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, USA
| | - D Bowen
- St James's University Hospital, Leeds, UK
| | - P Fenaux
- Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP)/University Paris XIII, Bobigny, France
| | - F Dreyfus
- Hôpital Cochin, AP-HP University of Paris V, Paris, France
| | - H Kantarjian
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - A Kuendgen
- Heinrich-Heine University Hospital, Düsseldorf, Germany
| | - A Levis
- Fondazione Italiana Sindromi Mielodisplastiche c/o SS Antonio e Biagio Hospital, Alessandria, Italy
| | - J Cermak
- Institute of Hematology and Blood Transfusion, Praha, Czech Republic
| | - C Fonatsch
- Medical University of Vienna, Vienna, Austria
| | - M M Le Beau
- University of Chicago Comprehensive Cancer Research Center, Chicago, IL, USA
| | - M L Slovak
- Quest Diagnostics Nichols Institute, Chantilly, VA, USA
| | - O Krieger
- Elisabethinen Hospital, Linz, Austria
| | - M Luebbert
- University of Freiburg Medical Center, Freiburg, Germany
| | | | | | - Y Miyazaki
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Pfeilstöcker
- Hanusch Hospital and L. Boltzmann Cluster Oncology, Vienna, Austria
| | | | - W R Sperr
- Medical University of Vienna, Vienna, Austria
| | - R Stauder
- Hanusch Hospital and L. Boltzmann Cluster Oncology, Vienna, Austria
| | - S Tauro
- University of Dundee, Dundee, Scotland, UK
| | - P Valent
- Medical University of Vienna, Vienna, Austria
| | - T Vallespi
- Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - U Germing
- Heinrich-Heine University Hospital, Düsseldorf, Germany
| | - D Haase
- Georg August Universität, Göttingen, Germany
| | - P L Greenberg
- Division of Hematology, Stanford University Cancer Center, Stanford, CA, USA
| | - M Cazzola
- 1] Department of Hematology Oncology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy [2] Department of Molecular Medicine, University of Pavia, Pavia, Italy
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Thombs B, Levis A, Kelley G. FRI0613-HPR Assessing Reporting Bias in Trials of Exercise Interventions for Pain Management in Rheumatic Diseases: An Application of the Test for Excess Significance. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1065] [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: 11/03/2022]
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Valencia A, Abdel-Wahab O, Buchi F, Masala E, Sanna A, Gozzini A, Figueroa M, Contini E, Torricelli F, Allione B, Lunghi M, Onida F, Polloni A, Angelucci E, Finelli F, Levis A, Gioia D, Bosi A, Santini V. 166 TARGETED SEQUENCING ANALYSIS OF COMMONLY MUTATED GENES IN CHRONIC MYELOMONOCYTIC LEUKEMIA USING NGS: IMPACT AND CLINICAL IMPLICATIONS. Leuk Res 2015. [DOI: 10.1016/s0145-2126(15)30167-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Arcaini L, Vallisa D, Rattotti S, Ferretti VV, Ferreri AJM, Bernuzzi P, Merli M, Varettoni M, Chiappella A, Ambrosetti A, Tucci A, Rusconi C, Visco C, Spina M, Cabras G, Luminari S, Tucci M, Musto P, Ladetto M, Merli F, Stelitano C, d'Arco A, Rigacci L, Levis A, Rossi D, Spedini P, Mancuso S, Marino D, Bruno R, Baldini L, Pulsoni A. Antiviral treatment in patients with indolent B-cell lymphomas associated with HCV infection: a study of the Fondazione Italiana Linfomi. Ann Oncol 2014; 25:1404-1410. [PMID: 24799461 DOI: 10.1093/annonc/mdu166] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Tumor regression after antiviral therapy (AT) is in favor of an etiological role of hepatitis C virus (HCV) in non-Hodgkin's B-cell lymphomas (NHL). PATIENTS AND METHODS We carried out a cohort study of 704 consecutive HIV-negative, HCV-positive patients with indolent NHL diagnosed and treated from 1993 to 2009 in 39 centers of the Fondazione Italiana Linfomi; 134 patients were managed with AT for lymphoma control. RESULTS For entire cohort, 5-year overall survival (OS) was 78% [95% confidence interval (CI): 74%-82%] and 5-year progression-free survival (PFS) was 48% (95% CI: 44%-53%). In multivariate analysis, the use of AT during the patients' life had positive impact on OS. Forty-four of the 100 patients treated with first-line AT achieved a complete remission (CR) and 33 a partial response (PR). HCV-RNA clearance was achieved in 80 patients and was related to lymphoma response. At a median follow-up of 3.6 years, 5-year PFS was 63% (95% CI: 50%-73%). CR + PR rate was 85% with AT as second-line treatment. CONCLUSION AT produces HCV-RNA clearance and consequent tumor regression in most patients with HCV-related indolent NHL. AT used at any time is associated with improved OS. Consequently, AT can be considered an option for patients with indolent lymphomas who do not need immediate cytoreductive treatment.
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Affiliation(s)
- L Arcaini
- Department of Molecular Medicine, University of Pavia, Pavia; Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia.
| | - D Vallisa
- Division of Hematology, Ospedale Giovanni da Saliceto, Piacenza
| | - S Rattotti
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - V V Ferretti
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - A J M Ferreri
- Unit of Lymphoid Malignancies, San Raffaele Scientific Institute, Milano
| | - P Bernuzzi
- Division of Hematology, Ospedale Giovanni da Saliceto, Piacenza
| | - M Merli
- Division of Hematology, Department of Internal Medicine, Ospedale di Circolo, Fondazione Macchi, Varese
| | - M Varettoni
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - A Chiappella
- Division of Hematology 2, AO S Giovanni Battista, Torino
| | - A Ambrosetti
- Department of Medicine, Section of Hematology, University of Verona, Verona
| | - A Tucci
- Division of Hematology, Spedali Civili, Brescia
| | - C Rusconi
- Division of Hematology, Ospedale Niguarda Ca' Granda, Milano
| | - C Visco
- Division of Hematology, Ospedale San Bortolo, Vicenza
| | - M Spina
- Division of Medical Oncology, National Cancer Center, Aviano
| | - G Cabras
- Division of Hematology, Osp A Businco, Cagliari
| | - S Luminari
- Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena
| | - M Tucci
- IMO, Department of Internal Medicine and Clinical Oncology, University of Bari, Aldo Moro, Bari
| | - P Musto
- Scientific Direction, IRCCS, Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture
| | - M Ladetto
- Division of Hematology, Department of Experimental Medicine and Oncology, University of Torino, Torino
| | - F Merli
- Hematology Unit, Department of Oncology, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia
| | - C Stelitano
- Division of Hematology, Dipartimento di Ematologia, Ospedale M. Morelli, Reggio Calabria
| | - A d'Arco
- Division of Oncohematology, Ospedale Umberto I, Nocera Inferiore
| | - L Rigacci
- Division of Hematology, Azienda Ospedaliero Universitaria Careggi, Firenze
| | - A Levis
- Division of Hematology, Azienda Ospedaliera SS Arrigo e Biagio e Cesare Arrigo, Alessandria
| | - D Rossi
- Division of Hematology, Department of Translational Medicine, Amedeo Avogadro University of Eastern Piedmont, Novara
| | - P Spedini
- Division of Haematology, Hospital of Cremona, Cremona
| | - S Mancuso
- Division of Hematology, Policlinico, Palermo
| | - D Marino
- Department of Oncology, Istituto Oncologico Veneto, IRCCS, Padova
| | - R Bruno
- Division of Infectious and Tropical Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia; Department of Clinical Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia
| | - L Baldini
- Division of Hematology, Fondazione IRCCS Cà Granda OM Policlinico, Università degli Studi, Milano
| | - A Pulsoni
- Division of Hematology, Sapienza University, Rome, Italy
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Sekeres M, Ades L, Tuechler H, Sanz G, Levis A, Malcovati L, Cazzola M, Magalhães S, Luebbert M, Haase D, Schanz J, Cermak J, Garcia-Manero G, Sole F, Benett J, Bowen D, Dreyfus F, Kantarjian H, Kuendgen A, Fonatsch C, Le Beau M, Slovak M, Krieger O, Maciejewski J, Miyazaki Y, Pfeilstoecker M, Sperr W, Stauder R, Tauro S, Valent P, Vallespi T, Van de Loosdrecht A, Germing U, Fenaux P, Greenberg P. P-113 Revised International Prognostic Scoring System (IPSS-R) for primary treated myelodysplastic syndromes (MDS) patients: A report from the IWG-PM. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70161-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Messa E, Gioia D, Masiera E, Allione B, Balleari E, Bonferroni M, Cametti G, Crisà E, Cilloni D, Danise P, Del Corso L, Ferrero D, Freilone R, Gaidano G, Lunghi M, Musto P, Pappano S, Pellizzari A, Poloni A, Santini V, Salvi F, Tassara R, Saglio G, Levis A. O-020 Erythropoietin alpha therapy in 1110 lower-risk MDS patients: A real life survey from the network of regional Italian MDS Registries. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Santini V, Allione B, Lunghi M, Levis A, Poloni A, Angelucci E, Onida F, Terenzi A, Finelli C, Ferrero D. O-018 Efficacy of decitabine in advanced chronic myelomonocytic leukemia (CMML) patients. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Figueroa M, Sotzen J, Abdel-Wahab O, Levis A, Masala E, Santini V. P-118 A DNA methylation signature at diagnosis distinguishes CMML patients who respond to decitabine. Leuk Res 2013. [DOI: 10.1016/s0145-2126(13)70166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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15
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Levis A, Grasso G, Palmisano S, Consigliere F, Gennaro V. [Not Available]. Med Lav 2012; 103:309-313. [PMID: 22880492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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16
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Stähli BE, Bonassin F, Goetti R, Küest SM, Frank M, Altwegg LA, Gebhard C, Levis A, Wischnewsky MB, Lüscher TF, Alkadhi H, Kaufmann PA, Maier W. Coronary computed tomography angiography indicates complexity of percutaneous coronary interventions. J Invasive Cardiol 2012; 24:196-201. [PMID: 22562911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) provides information regarding lesion morphology and three-dimensional coronary anatomy incremental to coronary angiography. We addressed the question whether preprocedural CCTA bears potential for guiding percutaneous coronary interventions (PCI). METHODS AND RESULTS Sixty-six coronary lesions attempted with PCI within 6 months of preprocedural CCTA were retrospectively assessed. Lesion parameters from unenhanced computed tomography (CT) for calcium scoring and CCTA were analyzed and compared with PCI complexity. Complex PCI was defined as use of buddy wire, kissing balloon, necessity of high pressure balloons, or rotablator. Complex PCIs were observed in 32 interventions (48%). Median Agatston score and Hounsfield units were higher in lesions with complex as compared to those with non-complex interventions with 130 (interquartile range, 23-276) vs 29 (0-158; P=.01), and 493 (245-631) vs 341 (68-520 Hounsfield Units; P=.04), respectively. Median local plaque volume and plaque mass were higher in complex PCI with 17 (2-39) vs 5 (0-19.5 mm³; P=.007), and 48 (15-99) vs. 16 (1.5-63 mg hydroxyapatite/mm³; P=.03), respectively. Lesions leading to complex PCI were longer [1.8 (1.2-2.8) vs 1.3 (0.8-1.7) cm; P=.03], and had a higher rate of calcified plaques (23% vs 3%; P=.03). There was a significant correlation between CCTA- and angiography-derived local SYNTAX Scores (P<.001); the CCTA-derived score seems to be predictive for failed and complex PCI (area under curve = 0.75 ± 0.13 and 0.66 ± 0.08, respectively). CONCLUSIONS Preprocedural lesion assessment by CCTA indicates complexity of PCI. In patients with suspected complex coronary anatomy, prior CCTA adds important information for planning PCI.
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Affiliation(s)
- B E Stähli
- Department of Cardiology, Cardiovascular Center, University Hospital Zürich, Switzerland
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Cattaneo C, Monte S, Algarotti A, Audisio E, Borlenghi E, Campiotti L, Cerqui E, Fanizza C, Giuliani R, Mico C, Rocconi R, Salvi A, Salvi F, Verga L, Levis A, Lambertenghi Deliliers G, Pogliani EM, Tognoni G, Rambaldi A, Rossi G. A randomized comparison of caspofungin versus antifungal prophylaxis according to investigator policy in acute leukaemia patients undergoing induction chemotherapy (PROFIL-C study). J Antimicrob Chemother 2011; 66:2140-5. [DOI: 10.1093/jac/dkr271] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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18
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Greenberg P, Tuechler H, Schanz J, Sole F, Bennett J, Garcia-Manero G, Levis A, Malcovati L, Cazzola M, Sanz G, Cermak J, Fonatsch C, LeBeau M, Slovak M, Krieger O, Luebbert M, Magalhaes S, Miyazaki Y, Pfeilstocker M, Sekeres M, Maciejewski J, Stauder R, Tauro S, van de Loosdrecht A, Germing U, Fenaux P, Haase D. 14 Revised International Prognostic Scoring System (IPSS-R), developed by the International Prognostic Working Group for Prognosis in MDS (IWG-PM). Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70016-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Voso M, Fianchi L, Criscuolo M, Levis A, Finelli C, Musto P, Maurillo L, Oliva E, Greco M, Pagano L, Leone G. 192 Response to 5-azacytidine in therapy-related malignant neoplasms (t-MN). Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70194-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Castagna L, Bramanti S, Levis A, Michieli M, Anastasia A, Mazza R, Giordano L, Sarina B, Todisco E, Gregorini A, Santoro A. Pegfilgrastim versus filgrastim after high-dose chemotherapy and autologous peripheral blood stem cell support. Ann Oncol 2010; 21:1482-1485. [DOI: 10.1093/annonc/mdp576] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Castagna L, Bramanti S, Levis A, Michieli M, Anastasia A, Mazza R, Sarina B, Todisco E, Giordano L, Santoro A. A phase II randomized study comparing pegfilgrastim (PEG) versus filgrastim (FIL) after high-dose chemotherapy (HDC) and autologous peripheral blood stem cell support (PBSC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7038 Background: The aim of this study was to demonstrate the non-inferiority of one fixed dose of PEG compared to daily FIL, in patients (pts) receiving HDC and PBSC. Methods: Criteria for elegibility were: HDC for haematological or solid tumors; at least 3 x10^6/kg CD34+ reinfused; age >18 years; normal cardiac, renal, liver and pulmonary function; signed written informed consent. Pts were randomized to receive on day+1 subcutaneously(sc) PEG (6mg) or 5 mcg/kg/d sc of FIL until ANC >1.0 x 10^9/L. Primary end points were: absolute neutrophil count (ANC) < 0.5 x 10^9/L and the number (no.) of days to achieve an ANC > 0.5 x 10^9/L from day +1. Secondary end points were: no. of days to achieve an ANC > 1.0 x 10^9/L; no. of days with fever > 38 °C; duration of antibiotic therapy; and no. of documented infections. Results: 80 pts were enrolled (40 pts for group). The duration of ANC < 0.5 x 10^9/L, the time to reach an ANC > 0.5 x 10^9/L and the time to reach an ANC > 1.0 x 10^9/L were superimposable in the two groups (mean days 6, 11, 12 respectively ). No. significant differences between FIL versus PEG group were observed in incidence of fever (24 vs 22), no. of documented infections (12 vs 10), no. of days with fever (1.7 vs 0.97 days), duration of antibiotic therapy (5.7 vs 3.5 days). No. differences in terms of extra-hematological toxicities and time to discharge between the two groups (16 vs 14). Time to reach a platelets count > 20 x 10^9/L was significantly shorter in PEG group compared to FIL group (15 vs 11 days, p value 0.05). Conclusions: This study shows that PEG was not inferior to FIL in terms of hematological reconstitution. Additionally PEG significantly shortened duration of thrombocytopenia <20 x 10^9/L. Consequently, PEG could be safely used after PBSC infusion. No significant financial relationships to disclose.
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Affiliation(s)
- L. Castagna
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale SSAntonio e Biagio, Alessandria, Italy; Medicina Oncologica Aviano, Pordenone, Italy
| | - S. Bramanti
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale SSAntonio e Biagio, Alessandria, Italy; Medicina Oncologica Aviano, Pordenone, Italy
| | - A. Levis
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale SSAntonio e Biagio, Alessandria, Italy; Medicina Oncologica Aviano, Pordenone, Italy
| | - M. Michieli
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale SSAntonio e Biagio, Alessandria, Italy; Medicina Oncologica Aviano, Pordenone, Italy
| | - A. Anastasia
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale SSAntonio e Biagio, Alessandria, Italy; Medicina Oncologica Aviano, Pordenone, Italy
| | - R. Mazza
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale SSAntonio e Biagio, Alessandria, Italy; Medicina Oncologica Aviano, Pordenone, Italy
| | - B. Sarina
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale SSAntonio e Biagio, Alessandria, Italy; Medicina Oncologica Aviano, Pordenone, Italy
| | - E. Todisco
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale SSAntonio e Biagio, Alessandria, Italy; Medicina Oncologica Aviano, Pordenone, Italy
| | - L. Giordano
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale SSAntonio e Biagio, Alessandria, Italy; Medicina Oncologica Aviano, Pordenone, Italy
| | - A. Santoro
- Istituto Clinico Humanitas, Rozzano, Italy; Ospedale SSAntonio e Biagio, Alessandria, Italy; Medicina Oncologica Aviano, Pordenone, Italy
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22
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Oliva E, Aloe Spiriti M, Poloni A, Liso V, Cilloni D, Terenzi A, Guglielmo P, Levis A, Cortelezzi A, Ghio R, Musto P, Semenzato G, Clissa C, Santini V. P077 Adaptation and changes in quality of life in patients with myelodysplastic syndrome. Leuk Res 2009. [DOI: 10.1016/s0145-2126(09)70157-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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23
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Gianni AM, Rambaldi A, Zinzani P, Levis A, Brusamolino E, Pulsoni A, Liberati M, Pogliani E, Cortelazzo S, Valagussa P. Comparable 3-year outcome following ABVD or BEACOPP first-line chemotherapy, plus pre-planned high-dose salvage, in advanced Hodgkin lymphoma (HL): A randomized trial of the Michelangelo, GITIL and IIL cooperative groups. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.8506] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Pavone V, Ricardi U, Luminari S, Gobbi P, Federico M, Baldini L, Iannitto E, Ucci G, Marcheselli L, Orsucci L, Angelucci E, Liberati M, Gavarotti P, Levis A. ABVD plus radiotherapy versus EVE plus radiotherapy in unfavorable stage IA and IIA Hodgkin's lymphoma: results from an Intergruppo Italiano Linfomi randomized study. Ann Oncol 2008; 19:763-8. [PMID: 18180244 DOI: 10.1093/annonc/mdm575] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In 1997, the Intergruppo Italiano Linfomi started a randomized trial to evaluate, in unfavorable stage IA and IIA Hodgkin's lymphoma (HL) patients, the efficacy and toxicity of the low toxic epirubicin, vinblastine and etoposide (EVE) regimen followed by involved field radiotherapy in comparison to the gold standard doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) regimen followed by the same radiotherapy program. PATIENTS AND METHODS Patients should be younger than 65 years with unfavorable stage IA and IIA HL (i.e. stage IA or IIA with bulky disease and/or subdiaphragmatic disease, erythrocyte sedimentation rate higher than 40, extranodal (E) involvement, hilar involvement and more than three involved lymph node areas). RESULTS Ninety-two patients were allocated to the ABVD arm and 89 to the EVE arm. Complete remission (CR) rates at the end of treatment program [chemotherapy (CT) + RT] were 93% and 92% for ABVD and EVE arms, respectively (P = NS). The 5-year relapse-free survival (RFS) rate was 95% for ABVD and 78% for EVE (P < 0.05). As a consequence of the different relapse rate, the 5-year failure-free survival (FFS) rate was significantly better for ABVD (90%) than for EVE (73%) arm (P < 0.05). No differences in terms of overall survival (OS) were observed for the two study arms. CONCLUSIONS In unfavorable stage IA and IIA HL patients, no differences were observed between ABVD and EVE arms in terms of CR rate and OS. EVE CT, however, was significantly worse than ABVD in terms of RFS and FFS and cannot be recommended as initial treatment for HL.
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Affiliation(s)
- V Pavone
- Division of Haematology, Ospedale G. Panico, Tricase, Lecce, Italy.
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25
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Ferrero D, Gioia D, Cilloni D, Audisio E, Cametti G, Darbesio A, Dellacasa C, Lunghi M, Gaidano G, Girotto M, Marmont F, Messa E, Perticone S, Pollio B, Salvi F, Tonso A, Saglio G, Levis A. P137 Response to erythropoietin (EPO) with or without differentiating treatment with 13-cis-retinoic-acid and dihydroxylated vitamin D3 in myelodysplastic syndromes (MDS). Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70207-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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26
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Salvi F, Gioia D, Cilloni D, Audisio E, Boccomini C, Bonferroni M, Cametti G, Ciravegna G, Darbesio A, Dellacasa C, Ferrero D, Freilone R, Lunghi M, Gallamini A, Gaidano G, Girotto M, Marmont F, Tonso A, Saglio G, Levis A. P104 Prognostic role of transfusion requirement in myelodysplastic syndromes. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Gioia D, Cilloni D, Salvi F, Audisio E, Boccomini C, Bonferroni M, Cametti G, Ciravegna G, Darbesio A, Dellacasa C, Ferrero D, Freilone R, Gatto S, Lunghi M, Gallamini A, Gaidano G, Girotto M, Marmont F, Marinone C, Messa E, Perticone S, Pollio B, Tonso A, Saglio G, Levis A. P002 Clinical and epidemiological considerations on myelodysplastic syndromes (MDS). The experience of the Piedmont MDS Register. Leuk Res 2007. [DOI: 10.1016/s0145-2126(07)70072-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Pagano L, Pulsoni A, Vignetti M, Tosti ME, Falcucci P, Fazi P, Fianchi L, Levis A, Bosi A, Angelucci E, Bregni M, Gabbas A, Peta A, Coser P, Ricciuti F, Morselli M, Caira M, Foà R, Amadori S, Mandelli F, Leone G. Secondary acute myeloid leukaemia: results of conventional treatments. Experience of GIMEMA trials. Ann Oncol 2005; 16:228-33. [PMID: 15668275 DOI: 10.1093/annonc/mdi051] [Citation(s) in RCA: 19] [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] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate the outcome of acute myeloid leukaemia (AML) in patients with a previous malignancy (sAML) treated with chemo- and/or radiotherapy, enrolled in conventional trials. PATIENTS AND METHODS In a multicentre setting, a prospective non-concurrent analysis was performed on 2513 new AML patients, aged 12-78 years, consecutively enrolled in EORTC-GIMEMA trials between 1987 and 2001. Thirty-eight patients with sAML were identified and compared with a group of 114 de novo AML patients matched according to age, French-American-British criteria, white blood cell count at diagnosis, trial and time of diagnosis of AML. Induction treatment response, disease-free survival (DFS), duration and overall survival (OS) were evaluated in the two groups. RESULTS Comparing the complete remission (CR) rate between 38 sAML patients and 114 de novo AML patients, selected according to the previously reported criteria, we observed no difference in the CR rates [25/38 (66%) versus 66/114 (58%); Pearson chi(2) 0.7393, P=0.390] as well as no differences while comparing the DFS and the OS between the two groups. CONCLUSION The results of this study suggest that sAML patients are characterised by a good performance status permitting their recruitment in conventional trials without a previous myelodysplastic phase. Similar to de novo AML patients, sAML patients show good response to treatment and the possibility of cure.
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Affiliation(s)
- L Pagano
- Cattedra di Ematologia, Università Cattolica S. Cuore, Largo Francesco Vito 1, I-00168 Rome, Italy.
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29
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Salvi F, Godio L, Campa E, Ciriello M, Ferrero D, Gallamini A, Marmont F, Paparo C, Stacchini A, Saglio G, Levis A. P-34 Different modalities of bonemarrow blast quantification can influence diagnostic and prognostic evaluation of myelodysplastic syndromes (MDS). Leuk Res 2005. [DOI: 10.1016/s0145-2126(05)80098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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Gatto S, Mengozzi G, D'Ardia S, Cametti G, Ficara F, Soave R, Gioia D, Baraldi A, Pini M, Salvi F, Levis A. P-35 Incorporation of B2M into riskassessment of patients with MDS improves the discriminatory power of the IPSS: Validation in an independent population of patients. Leuk Res 2005. [DOI: 10.1016/s0145-2126(05)80099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Federico M, Levis A, Luminari S, Chisesi T, Marcheselli L, Goldaniga M, Vitolo U, Neri S, Brugiatelli M, Gobbi PG. ABVD vs. STANFORD V (SV) vs. MOPP-EBV-CAD (MEC) in advanced Hodgkin's lymphoma. Final results of the IIL HD9601 randomized trial. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.6507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. Federico
- Università di Modena e Reggio Emilia, Modena, Italy; Ematologia, Osp SS Antonio e Biagio, Alessandria, Italy; Ematologia, Ospedale Civile, Venezia-Mestre, Italy; Dipartimento di Ematologia Ospedale Mggiore IRCCS, Milano, Italy; UOA Ematologia, Az Osp S. Giovanni Battista, Torino, Italy; Ematologia, Osp “Papardo”, Messina, Italy; Clinica Medica, Università di Pavia, Pavia, Italy
| | - A. Levis
- Università di Modena e Reggio Emilia, Modena, Italy; Ematologia, Osp SS Antonio e Biagio, Alessandria, Italy; Ematologia, Ospedale Civile, Venezia-Mestre, Italy; Dipartimento di Ematologia Ospedale Mggiore IRCCS, Milano, Italy; UOA Ematologia, Az Osp S. Giovanni Battista, Torino, Italy; Ematologia, Osp “Papardo”, Messina, Italy; Clinica Medica, Università di Pavia, Pavia, Italy
| | - S. Luminari
- Università di Modena e Reggio Emilia, Modena, Italy; Ematologia, Osp SS Antonio e Biagio, Alessandria, Italy; Ematologia, Ospedale Civile, Venezia-Mestre, Italy; Dipartimento di Ematologia Ospedale Mggiore IRCCS, Milano, Italy; UOA Ematologia, Az Osp S. Giovanni Battista, Torino, Italy; Ematologia, Osp “Papardo”, Messina, Italy; Clinica Medica, Università di Pavia, Pavia, Italy
| | - T. Chisesi
- Università di Modena e Reggio Emilia, Modena, Italy; Ematologia, Osp SS Antonio e Biagio, Alessandria, Italy; Ematologia, Ospedale Civile, Venezia-Mestre, Italy; Dipartimento di Ematologia Ospedale Mggiore IRCCS, Milano, Italy; UOA Ematologia, Az Osp S. Giovanni Battista, Torino, Italy; Ematologia, Osp “Papardo”, Messina, Italy; Clinica Medica, Università di Pavia, Pavia, Italy
| | - L. Marcheselli
- Università di Modena e Reggio Emilia, Modena, Italy; Ematologia, Osp SS Antonio e Biagio, Alessandria, Italy; Ematologia, Ospedale Civile, Venezia-Mestre, Italy; Dipartimento di Ematologia Ospedale Mggiore IRCCS, Milano, Italy; UOA Ematologia, Az Osp S. Giovanni Battista, Torino, Italy; Ematologia, Osp “Papardo”, Messina, Italy; Clinica Medica, Università di Pavia, Pavia, Italy
| | - M. Goldaniga
- Università di Modena e Reggio Emilia, Modena, Italy; Ematologia, Osp SS Antonio e Biagio, Alessandria, Italy; Ematologia, Ospedale Civile, Venezia-Mestre, Italy; Dipartimento di Ematologia Ospedale Mggiore IRCCS, Milano, Italy; UOA Ematologia, Az Osp S. Giovanni Battista, Torino, Italy; Ematologia, Osp “Papardo”, Messina, Italy; Clinica Medica, Università di Pavia, Pavia, Italy
| | - U. Vitolo
- Università di Modena e Reggio Emilia, Modena, Italy; Ematologia, Osp SS Antonio e Biagio, Alessandria, Italy; Ematologia, Ospedale Civile, Venezia-Mestre, Italy; Dipartimento di Ematologia Ospedale Mggiore IRCCS, Milano, Italy; UOA Ematologia, Az Osp S. Giovanni Battista, Torino, Italy; Ematologia, Osp “Papardo”, Messina, Italy; Clinica Medica, Università di Pavia, Pavia, Italy
| | - S. Neri
- Università di Modena e Reggio Emilia, Modena, Italy; Ematologia, Osp SS Antonio e Biagio, Alessandria, Italy; Ematologia, Ospedale Civile, Venezia-Mestre, Italy; Dipartimento di Ematologia Ospedale Mggiore IRCCS, Milano, Italy; UOA Ematologia, Az Osp S. Giovanni Battista, Torino, Italy; Ematologia, Osp “Papardo”, Messina, Italy; Clinica Medica, Università di Pavia, Pavia, Italy
| | - M. Brugiatelli
- Università di Modena e Reggio Emilia, Modena, Italy; Ematologia, Osp SS Antonio e Biagio, Alessandria, Italy; Ematologia, Ospedale Civile, Venezia-Mestre, Italy; Dipartimento di Ematologia Ospedale Mggiore IRCCS, Milano, Italy; UOA Ematologia, Az Osp S. Giovanni Battista, Torino, Italy; Ematologia, Osp “Papardo”, Messina, Italy; Clinica Medica, Università di Pavia, Pavia, Italy
| | - P. G. Gobbi
- Università di Modena e Reggio Emilia, Modena, Italy; Ematologia, Osp SS Antonio e Biagio, Alessandria, Italy; Ematologia, Ospedale Civile, Venezia-Mestre, Italy; Dipartimento di Ematologia Ospedale Mggiore IRCCS, Milano, Italy; UOA Ematologia, Az Osp S. Giovanni Battista, Torino, Italy; Ematologia, Osp “Papardo”, Messina, Italy; Clinica Medica, Università di Pavia, Pavia, Italy
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Levis A, Anselmo AP, Ambrosetti A, Adamo F, Bertini M, Cavalieri E, Gavarotti P, Genua A, Liberati M, Pavone V, Pietrasanta D, Ricetti MM, Scalabrini DR, Salvi F, Vitolo U, Angelucci E, Boccadoro M, Gallo E, Mandelli F. VEPEMB in elderly Hodgkin’s lymphoma patients. Results from an Intergruppo Italiano Linfomi (IIL) study. Ann Oncol 2004; 15:123-8. [PMID: 14679131 DOI: 10.1093/annonc/mdh012] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In advanced age the prognosis of Hodgkin's lymphoma (HL) is poor, but, as a consequence of the low incidence of HL in the elderly, prospective studies are lacking and the best treatment strategy is difficult to define. PATIENTS AND METHODS One-hundred and five HL patients over 65 years of age were treated homogeneously with an original reduced-intensity regimen designed for HL in the elderly containing vinblastine, cyclophosphamide, procarbazine, etoposide, mitoxantrone and bleomycin (VEPEMB). Forty-eight early stage (IA-IIA) patients received three courses of VEPEMB followed by involved field irradiation. Fifty-seven advanced stage (IIB-IV) patients received six courses followed by radiotherapy limited to the areas of bulky disease. RESULTS Mean age was 71 years (range 66-83). Co-morbidities were present in 39 patients (37%). A treatment plan modification for poor tolerance or toxicity was needed in 18 patients. Results were satisfactory, even if they were better in early rather than in advanced stage disease: complete response rate 98% versus 58% (P <0.01); 5-year failure-free survival 79% versus 34% (P <0.01). The results were affected by advanced stage, systemic symptoms and co-morbidity but they were not influenced by age itself. CONCLUSIONS VEPEMB is an effective and low toxic regimen for HL in the elderly. Co-morbidity is a prognostic factor more important than age itself.
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Affiliation(s)
- A Levis
- Haematology Division of the Ospedale SS Antonio e Biagio, Alessandria, Italy.
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Santi R, Demicheli M, Contino L, Fiorini T, Levis A. Homocysteine plasma levels after suspension of vitamin treatment. J Thromb Haemost 2003; 1:1330-2. [PMID: 12871346 DOI: 10.1046/j.1538-7836.2003.t01-7-00326.x] [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: 11/20/2022]
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Chisesi T, Federico M, Levis A, Deliliers GL, Gobbi PG, Santini G, Luminari S, Linfomi MB. ABVD versus stanford V versus MEC in unfavourable Hodgkin's lymphoma: results of a randomised trial. Ann Oncol 2002; 13 Suppl 1:102-6. [PMID: 12078888 DOI: 10.1093/annonc/13.s1.102] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Between January 1996 and April 2000, 355 patients with advanced Hodgkin's disease (HD) (stage II bulky disease, III and IV) were enrolled in a prospective, multicentre, randomised trial aimed at comparing the efficacy of two new promising regimens: Stanford V and MEC hybrid. ABVD was chosen as the control arm. Radiotherapy was planned at the end of induction therapy on residual masses or on sites of previous bulky lesions. One hundred and seventeen, 123 and 115 patients were treated with Stanford V, MEC and ABVD, respectively. The records of 275 enrolled patients (89 Stanford V, 88 MEC, 98 ABVD) have been reviewed and are the subject of this report. RESULTS After induction therapy a complete response (CR) was observed in 93, 89 and 74% of patients treated with MEC, ABVD and Stanford V, respectively, with a statistically significant difference (P = 0.013) between the arms. After a median follow-up of 24 months, 16 relapses have been recorded among 196 patients who achieved a CR. Relapse rates are 16, 6 and 4% for Stanford V, ABVD and MEC, respectively (P = 0.042). The 3-year survival was 93%, without any significant difference among the arms. However, a significant difference emerged in terms of failure free survival (FFS). Patients treated with Stanford V did the worst compared with those treated with ABVD or MEC (P = 0.001). Toxicity was comparable in the three treatment arms. CONCLUSION For this randomised study, both ABVD and MEC gave superior results to Stanford V in terms of response and FFS; MEC seems to be the best regimen in terms of relapse-free survival, even if a significant difference has not yet been achieved. Notwithstanding the short follow-up, these results seem to be very impressive in defining the best standard treatment for HD for this subset of patients.
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Proctor SJ, Rueffer JU, Angus B, Breuer K, Flechtner H, Jarrett R, Levis A, Taylor P, Tirelli U. Hodgkin's disease in the elderly: current status and future directions. Ann Oncol 2002; 13 Suppl 1:133-7. [PMID: 12078895 DOI: 10.1093/annonc/13.s1.133] [Citation(s) in RCA: 32] [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] [Indexed: 11/13/2022] Open
Abstract
In general, it was agreed that high rates of toxicities during treatment occur in the elderly and that there is a frequent occurrence of early relapse. It is clear that different combinations of effective therapies with lower toxicity are required. It was felt, however, that certainly in the 60-70 year age group, approaches should be vigorous to and the same diagnostic and staging procedures as in younger individuals, but with much closer monitoring of toxicity and response to treatment. It was felt that as part of the approach, liberal support with haemopoeitic growth factors (G-CSF) was necessary to reduce prolonged neutropenia. It is important to understand that age in general is not a contrary indication for aggressive treatment and that biologically younger patients under the age of 65 years, in good physical and mental condition, often should be given with stage-adapted treatment, analogous to conventional treatment protocols for the <60 years age group. It was also considered that, in patients who clearly could not accept conventional treatment, study groups could begin to define the best palliative care for patients with pre-existing organ impairment, and that in all situations of assessment, whether in trial or not, there should be a detailed prospective assessment of quality of life parameters.
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Affiliation(s)
- S J Proctor
- Department of Haematology, Royal Victoria Infirmary, School of Clinical and Laboratory Sciences, Newcastle-upon-Tyne, UK.
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Gobbi PG, Ghirardelli ML, Solcia M, Di Giulio G, Merli F, Tavecchia L, Bertè R, Davini O, Levis A, Broglia C, Maffè GC, Ilariucci F, Dore R, Ascari E. Image-aided estimate of tumor burden in Hodgkin's disease: evidence of its primary prognostic importance. J Clin Oncol 2001; 19:1388-94. [PMID: 11230483 DOI: 10.1200/jco.2001.19.5.1388] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To explore a more direct method for evaluating tumor burden (TB) in Hodgkin's disease (HD) and to verify its prognostic importance. PATIENTS AND METHODS The volume of TB at diagnosis was directly and retrospectively measured in 121 HD patients through images of the lesions recorded by computed tomographic (CT) scan of the thorax, abdomen, and pelvis for all deep sites of involvement and many superficial ones, and by ultrasonography (US) for the remaining superficial lesions. RESULTS The TB, which was obtained from the sum of the volumes of all the lesions measured on CT scans and US and normalized to body-surface area (relative TB [rTB]), showed a median value of 102.6 cm(3)/m(2) (range, 2.2 to 582.8). At multivariate analysis for prognostic value, rTB was the parameter that statistically correlated best with time to treatment failure (P = 2.2 x 10(-6)), followed by erythrocyte sedimentation rate (ESR) (P =.0003), and serum fibrinogen (P =.0112). The prognostic discrimination allowed by rTB alone proved to be clearly superior to that obtained with the score of the International Prognostic Factor Project. The rTB was found to be correlated with many clinical staging parameters (bulky disease, number of involved lymph node regions, serum lactate dehydrogenase, ESR, hemoglobin, Karnofsky index), but its predictability from these variables was low (R(2) =.668). CONCLUSION Relative TB is emerging as a strong prognostic factor in HD, more powerful than and largely independent of those hitherto known and used. Further studies are needed to confirm these results and exploit their clinical value, particularly the relationship among rTB, drug doses, and response.
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Affiliation(s)
- P G Gobbi
- Medicina Interna e Oncologia Medica, Università di Pavia, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Pavia.
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Pagano L, Pulsoni A, Mele L, Tosti ME, Cerri R, Visani G, Melillo L, Candoni A, Clavio M, Nosari A, Petti MC, Martino B, Mele A, Levis A, Allione B, Almici C, Equitani F, Leone G, Mandelli F. Acute myeloid leukemia in patients previously diagnosed with breast cancer: experience of the GIMEMA group. Ann Oncol 2001; 12:203-7. [PMID: 11300325 DOI: 10.1023/a:1008318816244] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate in a multicenter retrospective study, the clinical and laboratory characteristics and the outcome of patients with acute myeloid leukemia (sAML) previously diagnosed with breast cancer (BC) among an adult acute leukemia population. PATIENTS AND METHODS Between June 1992 and July 1996, 3934 new cases of adults with acute leukemia were recorded in GIMEMA Archive of Adult Acute Leukemia (2964 AML, 901 ALL, 69 acute leukemia expressing both myeloid and lymphoid surface markers). RESULTS Two hundred patients (5.1%) presented with a history of previous malignancy (21 of them were affected by ALL and 179 by AML). Among sAML, 37 patients (29%) had a previous breast cancer. They consisted of 36 females and 1 male, median age 56 years, range 34-87. The median latency between the 2 malignancies was 54 months (range 5-379). Twenty-seven patients received chemo- and/or radiotherapy for breast cancer (7 only chemotherapy, 6 only radiotherapy, and 14 combined treatment). All patients were surgically treated but in 10 patients surgical debridement was the sole therapy for breast cancer. The drugs most frequently employed were alkylating agents (18 patients), topoisomerase II inhibitors (9 patients), antimetabolites (20 patients) (CMF, CEF and MMM combinations). At onset of sAML the median WBC count was 7.7 x 10(9)/l (0.8-153) and the median platelet count was 33.5 x 10(9)/l (3-305). Considering morphological features, FAB subtypes were 4 M0, 5 M1, 11 M2, 5 M3, 8 M4, 3 M5, and 1 M6. Cytogenetic study was performed on 28 patients and 12 of them presented abnormalities. It is noteworthy that chromosome 5 or 7 abnormalities (typically observed in those patients treated with alkylating agents) were present only in three cases. Thirty-four patients received chemotherapy for sAML, and twenty-five of them achieved a CR (74%), with a median duration of twenty-eight weeks (5-280+). The overall survival was 8 months (1-80+). DISCUSSION The high number of sAML we observed in patients with a previous breast cancer, may be due to the fact that this malignancy is the most frequent neoplasm in women and by the high probability of cure with a consequent long disease-free survival. Our results suggest that the risk of sAML after recovery from breast cancer is increasing due to the rise in the number of patients cured from breast cancer, and in the future could be a relevant problem for haematologists.
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Affiliation(s)
- L Pagano
- epartment of Haematology, Catholic University, Roma, Italy.
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Pagana L, Pulsoni A, Tosti ME, Avvisati G, Mele L, Mele M, Martino B, Visani G, Cerri R, Di Bona E, Invernizzi R, Nosari A, Clavio M, Allione B, Coser P, Candoni A, Levis A, Camera A, Melillo L, Leone G, Mandelli F. Clinical and biological features of acute myeloid leukaemia occurring as second malignancy: GIMEMA archive of adult acute leukaemia. Br J Haematol 2001; 112:109-17. [PMID: 11225603 DOI: 10.1046/j.1365-2141.2001.02527.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Between July 1992 and June 1996, 3934 new cases of acute leukaemia were registered in the Gruppo Italiano Malattie Ematologiche Maligne dell'Adulto (GIMEMA) Archive of Adult Acute Leukaemia. Two hundred cases (5.1%) presented with a history of primary malignancy (PM), 179 of which were acute myeloid leukaemia (AML). The median age of these cases was significantly higher than that of other primitive AML (63 years vs. 57 years; P < 0.001). The number of men was significantly lower than the number of women [74/1544 (4.8%) vs. 105/1420 (7.4%); odds ratio (OR) 0.63, 95% confidence interval (CI) 0.46-0.87; P < 0.002], as was the number of patients aged <65 years [104/1963 (5.3%) vs. 75/1001 (7.5%); OR 0.69, 95% CI 0.50-0.95; P < 0.01]. An increased incidence of cancer was observed among first-degree relatives of patients with AML occurring after a PM (secondary AML; sAML) [66/179 (36.9%) sAML vs. 757/2785 (27.2%) de novo AML, age adjusted; OR 2.62, 95% CI 1.07-6.42; P < 0.005]. Prevalent types of PM were breast cancer, lymphoma and Hodgkin's disease. sAML occurred after a median latency of 52 months (range 2-379). Of the 122 patients who received chemotherapy for sAML, 67 patients (55%) achieved a complete remission (CR), three a partial remission, 15 (12%) died in induction and 37 (30%) were unresponsive. The median duration of CR was 30 weeks (range 4-250). The median overall survival was 7 months (range 1-196). Comparing acute promyelocytic leukaemia with all other French-American-British (FAB) groups, a significant increase in CR achievement was observed [14/18 (77.7%) vs. 53/101 (52.4%), P < 0.046] as well as in median CR duration (55 vs. 24 months, P < 0.02). The analysis of our data suggests that not only previous chemotherapy but also genetic predisposition could play a role in the pathogenesis of sAML.
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Affiliation(s)
- L Pagana
- Department of Haematology, Catholic University, Roma, Italia.
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Salvi F, Baraldi A, Allione B, Santi R, Inverardi D, Levis A. Unsuccessful treatment of resistant thrombotic thrombocytopenic purpura with prostacyclin. Haematologica 2000; 85:1329-30. [PMID: 11114144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Prostacyclin has been suggested as a useful agent for patients with thromobotic thrombocytopenic pupura (TTP) refractory to plasma-exchange. We report our unsuccessful experience with iloprost in a patient with TTP resistant to plasma-exghange, vincristine and high dose immunoglobulins.
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Sacchi MC, Maresca P, Tartuferi L, Bellanda M, Micheletti P, Riva S, Borzini P, Levis A, Rosti G. Platelet gel as a new routine method to improve wound healing and tissue regeneration. Transfus Med 2000. [DOI: 10.1046/j.1365-3148.2000.00261.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Pini M, Baraldi A, Pietrasanta D, Allione B, Depaoli L, Salvi F, Levis A. Low-dose of thalidomide in the treatment of refractory myeloma. Haematologica 2000; 85:1111-2. [PMID: 11025615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Aglietta M, Montemurro F, Fagioli F, Volta C, Botto B, Cantonetti M, Racanelli V, Teofili L, Ferrara R, Amadori S, Castoldi GL, Dammacco F, Levis A. Short term treatment with Escherichia coli recombinant human granulocyte-macrophage-colony stimulating factor prior to chemotherapy for Hodgkin disease. Cancer 2000; 88:454-60. [PMID: 10640980 DOI: 10.1002/(sici)1097-0142(20000115)88:2<454::aid-cncr28>3.0.co;2-q] [Citation(s) in RCA: 10] [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: 11/07/2022]
Abstract
BACKGROUND Granulocyte-macrophage-colony stimulating factor (GM-CSF) administration stimulates the proliferation of hemopoietic progenitors. Shortly (48-96 hours) after its discontinuation, feedback phenomena occur and the progenitor proliferation rate drops below baseline levels. As the quiescence of hyperplastic bone marrow suggests that hemopoietic cells may be refractory to the toxic effects of cytostatic drugs, the decision was made to test the hypothesis that GM-CSF given before chemotherapy may be myeloprotective. METHODS Fifty-six patients with newly diagnosed Stage II-IV Hodgkin disease, ages 18-77 years, were randomized to receive GM-CSF (5 microg/kg subcutaneously) or placebo from Day 7 to Day 4 before each chemotherapy administration (6 cycles of a hybrid of mechlorethamine, vincristine, procarbazine, and prednisone with doxorubicin, bleomycin, vinblastine, and dacarbazine). The treatment was considered a success if the delivery rate of chemotherapy was >90% after 3 cycles and >80% after 6 cycles. RESULTS Thirty patients received GM-CSF and 26 placebo. The dose intensity (85.2% vs. 79.6%) and the overall success in terms of delivery rate (56.7% vs. 50%) were higher in the GM-CSF group, although these differences were not statistically significant. The neutrophil nadirs were higher in the GM-CSF group during the first three cycles and subsequently similar in both groups. CONCLUSIONS No significant differences in terms of myelotoxicity or drug delivery were observed between the two treatment arms. Although the myeloprotective effect of the prechemotherapy administration of GM-CSF seems to be minimal, the data indicate a safe timing between GM-CSF discontinuation and further chemotherapy. Because cumulative myelotoxicity has been observed with other growth factors, given in the interval between the chemotherapy cycles, this may be relevant to the planning of rapid cycling.
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Affiliation(s)
- M Aglietta
- Divisione Universitaria di Oncologia ed Ematologia, Ospedale Mauriziano Umberto I-Istituto per la Ricerca e la Cura del Cancro (I. R.C.C.), Torino, Italy
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Vitolo U, Cortellazzo S, Liberati AM, Freilone R, Falda M, Bertini M, Botto B, Cinieri S, Levis A, Locatelli F, Lovisone E, Marmont F, Pizzuti M, Rossi A, Viero P, Barbui T, Grignani F, Resegotti L. Intensified and high-dose chemotherapy with granulocyte colony-stimulating factor and autologous stem-cell transplantation support as first-line therapy in high-risk diffuse large-cell lymphoma. J Clin Oncol 1997; 15:491-8. [PMID: 9053470 DOI: 10.1200/jco.1997.15.2.491] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [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: 02/03/2023] Open
Abstract
PURPOSE In our previous study with MACOPB, we identified a high-risk group of patients with a poor 3-year survival rate of 29%. These patients were defined as having at diagnosis advanced-stage disease with high tumor burden (TB) and elevated lactate dehydrogenase (LDH) level or bone marrow (BM) involvement. A novel therapeutic scheme was investigated to improve the outcome of these patients. PATIENTS AND METHODS Fifty patients with high-risk diffuse large-cell lymphoma (DLCL) were enrolled. The therapeutic scheme includes three phases: induction with 8 weeks of MACOPB; intensification with a 3-day course of mitoxantrone 8 mg/m2 plus high-dose cytarabine (HDARA-C) 2 g/m2 every 12 hours plus dexamethasone 4 mg/m2 every 12 hours (MAD protocol) and granulocyte colony-stimulating factor (G-CSF) 5 microg/kg on days 4 to 17 to harvest peripheral-blood progenitor cells (PBPC); consolidation with carmustine (BCNU), etoposide, ARA-C, and melphalan (BEAM) regimen; plus autologous stem-cell transplantation (ASCT) with PBPC, marrow, or both. RESULTS Thirty-six patients (72%) achieved a complete response (CR), 11 (22%) showed no response (NR), and three (6%) died of toxicity. Among the 22 PRs or NRs after the induction phase, 56% of patients achieved a CR with subsequent intensified therapy. With a median follow-up duration of 32 months, the overall survival and failure-free survival rates were 56% and 50%, respectively. The disease-free survival rate is 69% at 32 months. Leukapheresis after MAD and G-CSF yielded a median of 32 x 10(6)/kg CD34+ cells and 80 x 10(4)/kg granulocyte-macrophage colony-forming units (CFU-GM). Thirty-nine patients were autografted and 11 did not undergo ASCT: six because of disease progression, four due to toxicity, and one because of patient refusal. The median times to achieve engrafment were 11 days (range, 7 to 19) to a neutrophil count greater than 0.5 x 10(9)/L and 12 days (range, 8 to 60) to a platelet count greater than 50 x 10(9)/L. CONCLUSION This sequential scheme with intensified and high-dose chemotherapy with ASCT is feasible with moderate toxicity and may improve the outcome in high-risk DLCL.
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Affiliation(s)
- U Vitolo
- Divisione di Ematologia Azienda Ospedaliera S. Giovanni Battista, Torino, Italy
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Freilone R, Botto B, Vitolo U, Bertini M, Audisio E, Calvi R, Cucchi M, De Crescenzo A, Gallamini A, Ghio R, Griso L, Levis A, Massara G, Orsucci L, Ricardi U, Rota Scalabrini D, Salvi F, Secondo V, Resegotti L. Combined modality treatment with a weekly brief chemotherapy (ACOP-B) followed by locoregional radiotherapy in localized-stage intermediate- to high-grade non-Hodgkin's lymphoma. Ann Oncol 1996; 7:919-24. [PMID: 9006742 DOI: 10.1093/oxfordjournals.annonc.a010794] [Citation(s) in RCA: 10] [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: 02/03/2023] Open
Abstract
BACKGROUND A cooperative study was undertaken to evaluate the efficacy and toxicity of a very brief course of chemotherapy followed by locoregional radiotherapy in patients with localized-stage intermediate- to high-grade non-Hodgkin's lymphoma (NHL). PATIENTS AND METHOD From January 1988 to November 1994, 84 patients with localized stages IA and IIA intermediate- to high-grade NHL underwent a combined modality treatment. All patients underwent a six-week chemotherapy regimen, ACOP-B (doxorubicin 50 mg/sqm and cyclophosphamide 350 mg/sqm on weeks 1, 3, 5; vincristine 1.4 mg/sqm and bleomycin 10 mg/sqm on weeks 2, 4, 6; prednisone 50 mg p.o. daily throughout the first two weeks and thereafter every other day), followed by locoregional radiotherapy (36 Gy). RESULTS The median age was 58 years, with 35% older than 65 years; 52 patients had stage I and 32 stage II; 39 patients had extranodal +/- nodal involvement, and 4 had testicular involvement. Treatment was well tolerated, with only 38% suffering from mild mucositis and no toxic deaths. Seventy-nine patients achieved CR after ACOP-B and 83 at the end of the program. With a median follow-up of four years, relapse-free survival was 79% with 15 relapses (93% disseminated). Two patients with testis lymphoma had CNS relapses. Overall survival was 90% at four years. CONCLUSION This combined program is effective and probably curative in localized stage intermediate- to high-grade NHL, with low toxicity, also in elderly people. Patients with NHL of the testis, as primary site, require CNS prophylaxis due to the high likelihood of CNS relapse.
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Affiliation(s)
- R Freilone
- Divisione di Ematologia, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy
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45
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Levis A, Depaoli L, Bertini M, Botto B, Ciravegna G, Freilone R, Gallamini A, Gavarotti P, Ricardi U, Rota Scalabrini D, Salomone A, Salvi F, Vitolo U, Pileri A, Sannazzari GL, Resegotti L. Results of a low aggressivity chemotherapy regimen (CVP/CEB) in elderly Hodgkin's disease patients. Haematologica 1996; 81:450-6. [PMID: 8952159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hodgkin's disease (HD) after the age of 65 years is uncommon and there are no published data on chemotherapy regimens devised for elderly HD patients. PATIENTS AND METHODS From 1990 to 1993, 25 elderly HD patients were treated with the CVP/CEB regimen: chlorambucil 6 mg/sqm p.o. days 1 through 7, vinblastine 6 mg/sqm i.v. on day 1, procarbazine 100 mg/sqm p.o. days 1 through 7, prednisone 30 mg/sqm p.o. days 1 through 7, cyclophosphamide 500 mg./sqm i.v. day 15, etoposide 70 mg/sqm i.v. day 15, bleomycin 10 mg/sqm i.v. day 15. Each course was repeated every 4 weeks. Stage I and II patients were treated with 3 courses followed by involved field radiotherapy, while more advanced stage patients received 6 courses and radiotherapy was limited to bulky areas. The results of the CVP/CEB regimen are retrospectively compared to those of 74 elderly patients treated between 1982 and 1989 and subdivided into the following 2 groups: 32 patients treated according to the same therapy used at that time in younger patients, and 42 patients given alternative low aggressivity or palliative treatment. RESULTS CVP/CEB is a well-tolerated regimen, with only 1 (4%) toxic death and 2 (8%) protocol violations/interruptions. The CVP/CEB complete remission rate (73%) compares favorably with our previous groups of patients, mainly because of the lower toxic death rate. However, the CVP/CEB relapse-free survival rate is lower than that of patients treated with more aggressive conventional regimens (47% vs. 77%, p < 0.02). The CVP/CEB overall survival and event-free survival rates are 55% and 32%, respectively, and they are not statistically different from those of patients treated before 1990. CONCLUSIONS CVP/CEB is a well-tolerated low toxicity regimen with a high CR rate. The relapse rate is high and event-free survival is comparable to that of patients treated conventionally. Our results suggest the need for individualized treatment criteria for older patients with HD.
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Affiliation(s)
- A Levis
- Department of Hematology, Ospedale SS. Antonio e Biagio, Alessandria, Italy
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46
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Bertini M, Freilone R, Vitolo U, Botto B, Ciotti R, Cinieri S, Di Nota A, Di Vito F, Levis A, Orsucci L, Pini M, Rota-Scalabrini D, Todeschini G, Resegotti L. The treatment of elderly patients with aggressive non-Hodgkin's lymphomas: feasibility and efficacy of an intensive multidrug regimen. Leuk Lymphoma 1996; 22:483-93. [PMID: 8882962 DOI: 10.3109/10428199609054787] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The results of a prospective trial of an 8 week treatment for elderly patients with advanced intermediate-high grade NHL are reported. Our aim was to reduce general toxicity without losing an antilymphoma effect. For this reason the use of growth factor was studied. We also analysed the behavior of different histological groups (E + F vs G + H). From November 1991 to November 1993 100 patients older than 65 years with combination intermediate-high grade advanced stage NHL were treated with the P-VEBEC regimen, an original including epirubicin 50 mg/sqm, cyclophosphamide 300 mg/sqm and etoposide 100 mg/sqm on weeks 1, 3, 5, 7; vinblastine 5 mg/sqm and bleomycin 5 mg/sqm on weeks 2, 4, 6, 8; prednisone 50 mg/sqm/day per os in the first two weeks and thereafter every other day .46 pts received rG-CSF 5 micrograms/Kg/day throughout the treatment starting on day 2 of every week for 4 consecutive days. Twenty eight pts had B symptoms, 41 had bulky disease, 37 LDH levels above normal, 50 stage IV patients and 30 had bone marrow involvement. Sixty two percent achieved a complete remission (CR). Adverse prognostic factors for CR were E and F histology, stage IV disease, bone marrow infiltration, serum LDH levels above normal, international Prognostic Index (I.I.) intermediate-high and high risk categories and relative dose intensity (RDI) less than 0.80. Severe toxicity was rarely recorded and only one toxic death was observed. With a median follow-up of 33 months OS, DFS and EFS were 44%, 60% and 30% respectively. EFS was influenced by stage, BM involvement, level of LDH and I.I. intermediate-high and high risks. The 52 patients with DLCL (diffuse large cell lymphomas--G + H according to WF) did better with a higher CR, OS, DFS and EFS rates, than the other WF subtypes. In conclusion P-VEBEC is a feasible combination to use in elderly patients, mainly in DLCL. The use of rG-CSF improves the RDI. A RDI > 0.80 could play a role in improving the outcome, especially in patients with adverse prognostic factors. For other subgroups another schedule is probably justified.
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Affiliation(s)
- M Bertini
- Divisione di Ematologia, Ospedale S. Giovanni Battista della città di Torino, Italy
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47
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Bertini M, Freilone R, Vitolo U, Botto B, Pizzuti M, Gavarotti P, Levis A, Orlandi E, Orsucci L, Pini M. P-VEBEC: a new 8-weekly schedule with or without rG-CSF for elderly patients with aggressive non-Hodgkin's lymphoma (NHL). Ann Oncol 1994; 5:895-900. [PMID: 7535080 DOI: 10.1093/oxfordjournals.annonc.a058727] [Citation(s) in RCA: 44] [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] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Chemotherapy regimens devised for elderly patients with intermediate-high grade NHL are a matter of discussion. The aim is to reduce general toxicity without loosing an antilymphoma effect. The most important limiting factor of chemotherapy is myelotoxicity; for this reason the use of growth factor may be useful in these patients. PATIENTS AND METHODS From November '91 to November '92, 67 pts older than 65 years with intermediate-and high-grade advanced-stage NHL were treated with the P-VEBEC regimen, an original scheme with epirubicin 50 mg/m2, cyclophosphamide 350 mg/m2 and etoposide 100 mg/m2 on weeks 1, 3, 5, 7; vinblastine 5 mg/m2 and bleomycin 5 mg/m2 on weeks 2, 4, 6, 8, prednisone 50 mg/m2/day p. os in the first 2 weeks and thereafter every other day. Twenty-eight pts received r-GSF 5 micrograms/kg/day throughout the treatment starting on day 2 of every week for 4 consecutive days. Their median age was 71 years (65-80), 31 pts were male and 36 female, histology according W.F. was D 6; E 17; F 16; G 19; H 9. Twenty-five percent of pts had B symptoms, 35% had bulky disease, 41% LDH level > normal, 44% stage IV and 26% had B.M. involvement. RESULTS C.R. was achieved by 66% of pts. Adverse prognostic factors for CR were E histology, stage IV, bone marrow infiltration and LDH above normal. Severe toxicity was never recorded, no toxic death was observed. With a median follow-up of 24 months OS, DFS and EFS were 55%, 52%, and 33%, respectively. EFS was influenced by stage, BM involvement and level of LDH. The relative dose intensity (RDI) was calculated by the method of Hryniuk and Bush. Patients who received rG-CSF had a significantly higher median RDI (94% vs 79%) and lower myelotoxicity (neutrophil nadir < 500 18% vs 56%). The rate of CR was influenced by RDI > 80% (89% vs 56%). EFS was also better in pts who received a RDI higher than 80% (50% vs 18% p = 0.05). CONCLUSION P-VEBEC is a feasible cycle in elderly patients; the use of rG-CSF improves RDI. In patients with adverse prognostic factors (BM involvement, poor performance status) a RDI > 0.80 could play a role in improving the outcome.
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Affiliation(s)
- M Bertini
- Divisione di Ematologia, Ospedale Molinette, Torino, Italy
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48
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Levis A, Depaoli L, Urgesi A, Bertini M, Orsucci L, Vitolo U, Buchi G, Gallamini A, Gavarotti P, Novarino A, Rota Scalabrini D, Mazza U, Pileri A, Sannazzari GL, Resegotti L. Probability of cure in elderly Hodgkin's disease patients. Haematologica 1994; 79:46-54. [PMID: 15378948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Elderly Hodgkin's disease patients have a poor prognosis. The question arises whether these patients need aggressive treatment or a palliative strategy. So far, as a consequence of the scarcity of trials designed for them, useful information can be obtained only by retrospective analyses. METHODS We retrospectively studied clinical data from 567 patients recorded from 1982 to 1989 in the Piemonte Hodgkin's Disease Register (PHDR). The 65 patients over 65 years of age were compared to younger ones. We analyzed the role of disease independently of confounding variables, mainly inadequacy of staging and/or treatment, comorbidity and toxicity. RESULTS In the elderly comorbidity was as high as 35%. Forty elderly patients (60%) entered a suboptimal plan with a low degree of aggressivity, which was different from the usual PHDR protocol. Elderly patients also had a high proportion of subsequent protocol interruptions (25%). Chemotherapy dose intensity was negatively affected by advanced age (p < 0.01 after both 3 and 6 courses of chemotherapy). Toxic deaths were significantly higher in elderly patients than in younger ones (14% vs 1%; p < 0.05). CR rates, overall survival (OS), disease-specific survival (DSS) and event free survival (EFS) were all significantly influenced by age (p < 0.01). Relapse-free survival (RFS) in patients achieving CR did not differ according to age class (77% vs 60%; p = ns). RFS was better in elderly patients entering the PHDR protocols than in those following an alternative plan (75% vs 54%; p = 0.04); however, elderly patients treated according to PHDR guidelines showed a higher incidence of toxic deaths than those treated less aggressively (23% vs 8%). The two groups had similar EFS (36% vs 24%; p = ns). CONCLUSIONS Elderly patients who achieve CR can have good RFS and cure is possible, but the toxic cost of conventional strategies is unacceptable and selected strategies still must be found.
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Affiliation(s)
- A Levis
- Divisione di Ematologia, Ospedale Molinette, Torino, Italy
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49
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Levis A, Depaoli L, Isabella N, Resegotti L. Prognostic significance of CD34 expression and CD33/CD13 ratio in acute myeloid leukemia. Haematologica 1993; 78:420. [PMID: 8175042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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50
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Ciccone G, Mirabelli D, Levis A, Gavarotti P, Rege-Cambrin G, Davico L, Vineis P. Myeloid leukemias and myelodysplastic syndromes: chemical exposure, histologic subtype and cytogenetics in a case-control study. Cancer Genet Cytogenet 1993; 68:135-9. [PMID: 8353805 DOI: 10.1016/0165-4608(93)90010-j] [Citation(s) in RCA: 48] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We conducted a case control study of 50 acute myeloid leukemias (AML), 17 chronic myeloid leukemias (CML), 19 myelodysplastic syndromes (MDS), and 246 controls. The cases were classified according to the French-American-British (FAB) classification, and chromosome aberrations were recorded according to the International System for Human Cytogenetic Nomenclature. Exposure to suspected leukemogenic agents was assessed blindly by an industrial hygienist. Increased risks were noted for mechanics, welders, electricians, and drivers among men and among farmers and textile workers among women. Increased SMRs for leukemias in a census-based cohort study conducted in the same area (Torino) were previously reported for electricians and drivers among men and for textile workers among women. We detected nonstatistically significant increased relative risks for exposure to benzene (odds ratio, OR = 1.7), petrol refining products (1.9), polycyclic aromatic hydrocarbons (1.7), and electromagnetic fields (1.6) in men; in women, a statistically significant association with exposure to pesticides was detected [OR = 4.4; 95% confidence interval (CI) 1.7-11.5]. Although exposure to pesticides was confined to AML, MDS cases included a high proportion of subjects exposed to benzene and electromagnetic fields. No particular histologic subtype of AML was associated with chemical exposures except for that of pesticides with the M4 category. Chromosome aberrations were not associated with chemical exposures (OR = 1.0), but a nonstatistically significant excess was noted in association with electromagnetic fields (OR = 2.1).
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Affiliation(s)
- G Ciccone
- Unit of Cancer Epidemiology, Main Hospital, Torino, Italy
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